wEPA
United StalB
Environmental Protectio
Agency
    Children's Environmental Health Disparities:  Hispanic
            and  .atino  American  Children and  Asthma
        This fact sheet focuses on relationship between environment and asthma among Hispanic children.
             This fact sheet also provides important actions that can be taken to protect all children.
  Pollution in the environment may
harm children more than adults. This
is because children's bodies are still
growing. Also, they eat more, drink
more, and breathe more in propor-
tion to their body size than adults.
And children's normal behavior can
expose them more to pollution. This
means that exposure to a given
amount of pollution results in a larger
quantity of the pollutant in children's
bodies compared to adults.
  Children of racial and ethnic
minorities and poor children may be
exposed to more pollution.93 Thus,
they may face the biggest health
risks from pollution. This fact sheet
describes Hispanic children's environ-
mental health risks related to asthma.
It also tells you how you can take
actions to protect all children.
  The burdens of asthma fall heav-
ily on Black and Hispanic children.
Overall, 8% of Hispanic children have
asthma. But there are big differences
among ethnic groups. Puerto Rican
children have the highest rates of
asthma at 20%, compared with 7%
for Mexican-American children. There
are also differences in hospitalizations
                   due to asthma. Hispanic children are
                   almost twice as likely to be hospital-
                   ized for asthma as White children.15

                   What is Asthma?
                     Asthma is caused by the narrow-
                   ing or blocking of the lung airways.
                   People with asthma often have
                   trouble breathing.  They may experi-
                   ence wheezing and shortness of
                   breath. They may  feel pain or tight-
                   ness in the chest and cough at night
                   or early morning.13 However, children
                   can have symptoms at anytime.84
                     Asthma is a leading chronic dis-
                   ease affecting children. About 6.5
                   million children in the United States
                   have asthma.103 It  is a major reason
                   for children going to the hospital or
                   being absent from  school.
                     Asthma rates have increased
                   worldwide.85 The US rate increased
                   75% from 1980 to 1994. The  larg-
                   est increase was among children up
                   to 4 years old (160%). Rates among
                   children 5 to 14 years old increased
                   by 74%.8S
                     Increases in asthma rates among
                   poor minorities have been even
larger than the averages. They have
also had larger increases in deaths
from asthma.87
  Asthma is a complex disease with
a number of causes. Some children
may inherit a tendency to develop
asthma. Racial and ethnic differences
in the burden of asthma may be
related to social and economic status,
access to health care, and exposure
to environmental triggers.13

Asthma Triggers
  Asthma cannot be cured. How-
ever, people with asthma can man-
age the disease by avoiding triggers,
both indoors and outdoors and using
medications.18 Triggers are objects or
pollutants that cause asthma symp-
toms (e.g. shortness of breath, cough,
wheezing and chest tightness in
someone who already has developed
asthma) or make them worse.18

 Indoor Triggers: Secondhand
   smoke, dust mites, cockroach-
   es, pets with fur or feath-
   ers, household pests, mold,
   household sprays, and nitrogen
   dioxide (from gas appliances)
                                          Asthma

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                 Figure 1: Percentage of Children Under 18 with Asthma, 2000-2005
    Non-Hispanic Black


   Non-Hispanic White


>_        All Hispanic

o
z
K      Mexican origin
L1J
o
cc
    Puerto Rican origin


          * * Asian
  ** American Indian/
       Alaska Native
                                                  15
                                                             20
                                                                        25
                 0          5          10
                                        INCOME
SOURCE: National Center for Health Statistics http://www.cdc.gov/nchs/health data for all ages.htm
* Unreliable data
** Includes Hispanics
   can make asthma worse and/or
   provoke asthma attacks.19'20'88

 Outdoor Triggers: High levels
   of air pollution (ozone, nitrogen
   oxides,  acidic aerosols, and fine
   particles) in the air are also as-
   sociated with making asthma
   symptoms worse.21'22/ 89  These
   pollutants come from smoke,
   dust, and emissions from cars,
   factories, and power plants.
   Exposure to high levels of ozone
   may trigger asthma attacks or
   cause children to develop asth-
   ma. The risk is greatest when
   children exercise or play sports
   outdoors when ozone levels are
   high.23 Ozone levels are usually
   highest  in summer. Particle pollu-
   tion can be high any time of year
   and is higher near busy roads.

What Can You Do?
   If your child has asthma or you
suspect he or she has asthma, visit
a doctor. Ask the doctor to help
you learn which triggers affect your
child's asthma, and ways to help
your child avoid these triggers at
home, school, and play. Work with
your child's doctor to develop an
asthma management plan. Be sure
to share a copy of the plan with your
child's teacher and school nurse. For
more information on indoor asthma
triggers and developing an asthma
management plan, visit http://www.
epa .gov/iaq/asthma/triggers .html.

   Watch for the Air Quality Index
during your local weather report.
The index uses colors to show how

Figure 2: US EPA's Air Quality Index color codes.
               much pollution is in the air. Green
               and yellow mean air pollution levels
               are low. Orange, red, or purple mean
               pollution is at levels that may make
               asthma worse. (See Figure 2.)
                 State agencies use TV and radio
               to warn the public of ozone alerts.
               On Ozone Action Days, people with
               asthma should spend less time being
               active outdoors. Early mornings or
               late evenings are better times for
               outdoor activities when ozone is
               expected to be  high.
                 Many communities have programs
               and resources to help families. Find
               a community asthma program near
               you by visiting the Communities
               in Action for Asthma-Friendly
               Environments Network at http://
               www.asthmacommunitynetwork.org. If
               you work with a community asthma
               program, join the Network to have
               access to information, tools, and
               proven strategies for improving the
               health of people with asthma.
                 Get involved with groups that
               promote policies to improve air qual-
               ity. For example, some groups work
               to prohibit smoking  in public places.
               Others work with local governments
               to help improve air quality.
                 An example of a successful com-
               munity organization is Detroiters
               Working for  Environmental Justice
               (DWEJ). They convinced the city
  Air Quality Index
  (AQI) Values
  When the A
  is in this range:
  Oto50

  51 to 100
  151 to 200
  201 to 300
  301 to 500
Levels of Health Concern
  ir quality conditions are:
...as symboliz,
by this color:
Good

Moderate
                       Unhealthy for Sensitive Groups
Unhealthy
Very Unhealthy
SOURCE: US EPA's AirNow website http://airnow.gov/index.ofm?action = static.aqi
       Visit http://yosemite.epa.gov/ochp/ochpweb.nsf/content/homepage.htm or call (202) 564-2188.

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to buy new vehicles for its fleet
that run on "clean" fuels instead of
diesel. The new vehicles improve
air quality. DWEJ accomplished
this through a number of activities.
They presented local air quality
data at city council meetings. They
held community meetings around
Detroit and invited state and city
officials.  They helped citizens write
comments to the Metropolitan Plan-
ning Organization. And they helped
citizens get appointed  to the Detroit
Department of Transportation com-
munity board.  For more information
on DWEJ visit http://www.dwej.org/
or call 313-833-DWEJ (3935).
   Join the Health and  Environment
Action Network (MEAN). MEAN is a
national pollution monitoring program
created by the National Alliance for
Hispanic Health and  Environmental
Countdown. HEAN  provides people
with equipment to track local
sources of pollution.  The equipment
includes pollution sensors, GPS
devices and video cameras. For
more information visit http://hean.
environmentalcountdown .com.

What's Being Done?
   Here are some examples of efforts
by Federal governmental agencies,
local and national organizations to
childhood asthma.
   EPA's Asthma Initiative supports
research, education,  and public out-
reach  to help people  with asthma.
Learn  more at www.epa.gov/asthma.
Para mas la informacion acerca del
programa del asma de  EPA visita
www.epa.gov/espanol/saludhispana/
asma .htm.
   EPA's Indoor Air Quality Tools
for Schools Program  helps schools
identify and prevent  environmental
asthma triggers. It also promotes
healthy school environments. For
more information visit http://epa.gov/
iaq/schools.
  EPA's Asthma Home Environ-
ment Checklist gives explains how
to conduct home environmental
assessments. This checklist can help
identify asthma triggers in the home.
For a copy of the checklist visit
http://www.epa.gov/asthma/pdfs/home
environment checklist.pdf. Para mas la
informacion visita http://www.epa.gov/
asthma/pdfs/asthma trifold span.pdf
  The Children's RESPIRA Educa-
tion Program provides bilingual
medical services, asthma education,
and home environmental assess-
ments for Latino families in the
Newark area. For more information
about RESPIRA visit http://www.
programsforparents.com/respira/index.
html or call (973) 972-8801.
  The Community Asthma Education
Prevention Program (CAPP) of Phila-
delphia provides asthma education
classes to patients and their families,
child care providers, and school per-
sonnel. CAPP also provides in home
environmental assessments to eligible
  Studies show that childhood
    asthma is more common
 among Puerto Ricans than any
     other Hispanic group.


patients. For more information please
email CAPP at cap@email.chop.edu
or call (215)590-5621.
  Allies Against Asthma (AAA) helps
community groups concerned about
asthma in children. AAA also provides
lists of asthma education programs
across the US. For more information
about asthma programs in your area
visit: http ://www .asthma .umich .edu/in-
dex.html or call 734-615-3312.
  The  New England Asthma Region-
al Council promotes healthy housing,
healthy schools, and home assess-
ments to identify and reduce asthma
triggers. In addition, the Council is
building an asthma tracking system
across  New England which links
health data with environment data.
For more information visit: http://
www.asthmaregionalcouncil.org or call
617-451-0049x504.
                                            Asthma

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                                                                                                                                                                  EPA100F08031
RESOURCES:

For more information on children's environmental health, visit the
EPA's Office of Children's Health Protection and Environmental
Education at http://yosemite.epa.gov/ochp/ochpweb.nsf/content/
homepage.htm. You can also call the office at (202) 564-2188.
 America's Children and the Environment data/indicators,
  http://www.epa.gov/envirohealth/children/index.htm
 Office of Minority Health, Centers for Disease Control and
  Prevention, http://www.cdc.gov/omh/
 Pediatric Environmental Health Specialty Units, www.aoec.org/
  PEHSUhtm or call toll free 1-888-347-2632
I Environmental Management of Pediatric Asthma: Guidelines for
 Health Care Providers http://www.neefusa.org/health/asthma/
 asthmaguidelines.htm
I National Center on Minority Health and Health
 Disparities, National Institutes of Health, http://ncmhd.nih.gov/
I National Alliance for Hispanic Health, http://www.hispanichealth.org/
I National Council of La Raza, http://www.nclr.org/
I Kaiser Family Foundation Health Disparities Report:
 A Weekly Look at Race, Ethnicity and Health/ http://
 kaisemetwork.org/daily_reports/rep_disparities.cfm.
I DiversityData, Harvard School of Public Health website on
 indicators of how people of different racial/ethnic backgrounds live
 includes comparative data about housing, neighborhood conditions,
 residential integration, and education, www.DiversityData.org
I Unnatural Causes, a TV documentary series and public outreach
 campaign on the causes of socioeconomic racial/ethnic inequities s
 in health, http://www.unnaturalcauses.org/
           Visit http://yosemite.epa.gov/ochp/ochpweb.nsf/content/homepage.htm or call  (202) 564-2188.

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