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UTMB-CET: Community Outreach and Engagement Core

Division II: Asthma & Children's Environmental Health

Sharon Croisant, MS, PhD
Director, Asthma & Children's Environmental Health
Director, COEC

Asthma is a serious, life-threatening respiratory disease that affects millions of Americans, accounting for nearly 2 million emergency department visits each year. In response to the growing asthma problem, the Asthma Division provides education and outreach programs to share information about indoor and outdoor environmental factors that trigger asthma. Although there is no cure, asthma can be controlled through medical treatment and management of environmental asthma triggers.

Current Programs & Projects

Port Arthur Indoor Air Quality Outreach and Education. During 2009-10, the COEC initiated an indoor air quality outreach project funded by the EPA in Port Arthur, TX designated by Region 6 as one of ten EJ Showcase Communities in the country. West Port Arthur is a primarily minority, medically underserved population, encompassed on all sides by industrial development, with expressed community concerns related to the high proportion of children and adults with asthma and/or respiratory disease.

kids walking in park, refineries very nearby

This project entails visits to 200 homes to complete assessments for environmental health and respiratory risks, followed by targeted education and suggestions for intervention to improve indoor air quality. This joint project includes the COEC and a local not-for-profit environmental group, the Community In-power Development Association, Inc. With the UTMB Center to Eliminate Health Disparities (CEHD), the COEC is now working to develop an environmental justice and cumulative risk framework to be implemented in Port Arthur to better consider the true health impact of multiple risks, especially on vulnerable populations.

Environmental Health Prevention & Research Project. Through a project of the UTMB Emergency Department that seeks to identify topics for prevention outreach efforts in the community, COEC agreed to help identify and prioritize environmental health intervention and education activities utilizing the UTMB's Trauma Registry. Initial areas of exploration, among others, include childhood injury, motor vehicle accidents including both motorcycle and vehicular/bicycle involvement, among others. Patterns of injury will be explored to identify seasonal variation and geographic distribution. In conjunction with the Institute for Translational Sciences (ITS) - the intuitional home for UTMB's Clinical & Translational Science Award (CTSA) - this information will be used to inform public policy for planning and prevention of injury. It will also be used to develop new environmental health education and intervention efforts based upon findings. Initial interventions implemented in conjunction with the Department of Preventive Medicine & Community Health and Trauma Services include "Hard Hats for Little Heads" helmet education and outreach in May 2011 at several community events.

smiling girl in bike helmet, holding certificate

Camp RAD (Reactive Airway Disease) was designed to teach asthma self-management skills directly to children. This camp has been the recipient of the Archon Award, (Sigma Theta Tau International Honor Society of Nursing) in recognition of its exemplary modeling of community-based, multidisciplinary programming. Camp RAD consists of an annual day camp operated over a Monday through Friday in late spring or early summer for 50 children from the Houston Independent School District. It includes a two-day training workshop for counselors, two parent-camper orientations, and a post camp process evaluation as well as a one-year outcome evaluation. Previous camp participants have experienced a 60% reduction in ER visits and a 74% reduction in missed school days, demonstrating that a professionally designed camp that teaches, applies, and practices asthma control methods can alter behavior, perception, and improve outcomes.

New Developments

Healthy Historic Homes: COEC is currently exploring a new partnership with the Galveston Historical Foundation, one of the largest historic preservation organizations in the country, by combining environmental health and preservation education to contractors and preservation professionals as well as owners of historic properties. COEC also served as part of the planning team for the GHF "Green Revival: Healthy & Practical Historic Homes" project which began with a historic home at risk of demolition and rehabilitated the property to become a model for sustainable technology and lifestyle as well as healthy living within a historic home. Galveston Island is home to one of the largest collections of Victorian architecture in the nation and three-fourths of its housing is considered historic, meaning it is fifty years or older.

Past Initiatives

Breathe Easy: Air Quality Index Notification System (BEAQINS): The BEAQINS program entails use of a multi-color flag system consistent with the EPA's Air Quality Index and its prescribed behaviors appropriate to vulnerable populations. The flags, colored green, yellow, orange and red, correspond to the colors of the Air Quality Index and advise parents, students and school staff of the air quality forecast for the day, and influence outdoor activity decisions. This program is directed towards schools in the Galveston and Houston school districts who 1) receive flags and appropriate educational sessions and materials for teachers/ administration, students, and their parents; 2) receive assistance for each participating school in enacting policies with specific considerations to reducing outdoor exposures during adverse conditions; 3) receive assistance for each participating school in developing an indoor air quality management plan through the use of a template indoor air quality management plan based on EPA's Tools for Schools; 4) Evaluate the efficacy of educational sessions and the flag program with schools, students, and parents.

LEAST. The COEC developed a series of safety training sessions for the more than 2,000 college students that volunteered their spring break to help clean up Galveston Island after hurricane Ike. With support from Houston Mayor Bill White's office as well as companies, GB Biosciences and Dooley Tackaberry on behalf of Syngenta and the Texas Chemical Council, COEC personnel reviewed safety procedures for working in a post-hurricane landscape with them and provided essential equipment such as masks and gloves. COEC also worked with Houston partner, TEJAS, to provide educational outreach to non-English speaking populations in Galveston. In addition, the LEAST Lead Project laid the foundation for exploring new partnerships and broad-based community outreach. LEAST stands for: Laboratory analysis of blood lead level samples, Education for parents to make home environments lead-safe, Administer treatment for children with elevated lead levels, Studies based on empirical evidence, Tracking of health system functioning.

Response to community concerns on environmental health Sediment Testing & Outreach in the Aftermath of Hurricane Ike. In the aftermath of Hurricane Ike, the director of St. Vincent's House, a local community-based organization, brought to the attention of the NIEHS Center, COEC and CEHD concerns about the safety of the sediment that washed through homes, businesses, and streets due to Hurricane Ike. This led to a component addition to the LEAST Lead Project where CET scientists tested the storm sediment for various toxins. The sediment remained distinctly visible on both public and private property several months after the hurricane. In response, a team worked with local donors and the city government to quickly test the sediment for toxins, including lead, arsenic, chromium, cadmium, PCB's, dioxins, asbestos, sulfur compounds, diesel range organics, and semi-volatile organics. COEC coordinated risk information dissemination and communicated results for quick dissemination to City of Galveston, Texas and county officials, public health officials, redevelopment and City planners, community organizations and hands-on recovery workers. Since the initial education and outreach efforts, the information has been framed as a coastal community resiliency message for sustained use in ongoing preparations for future storms.


GC-SURF. During the summers of 2003-2005, Center investigators initiated the Gulf Coast Study of Urban Air Quality and Respiratory Function (GC SURF) to study pulmonary function in a cohort of lifeguards in Galveston. The data gathered helped the investigators determine particular times of day when changes in air quality could affect breathing health. Now, whenever the Texas Commission on Environmental Quality deems that air quality conditions exist that might affect vulnerable populations, the city's 26 lifeguard towers and 7 free-standing beach stations deploy an orange flag and display information on posters and in brochures describing the particular environmental issues and guidelines for protecting health.

COEC believes this program to be the first in the nation to enlist lifeguard participation in an environmental health public warning system. The group has now also developed a partnership with the Galveston County Health District to display the environmental flags at each tower when water quality is less than optimal.

lifeguard tower with red flag

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