||-k Jfe United States
^hLlf| Environments
I I	Agency
Children's Environmental Health Disparities:
Black and African American Children and Asthma
This fact sheet focuses on relationship between environment and asthma among Black and African American
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 Black and African Ameri-
can children's environmental health
risks related to asthma. It also tells
you how you can take actions to
protect all children.
The burdens of asthma fall more
heavily on Black children. In 2001-
2005, Black children, regardless of
family income, reported higher rates
of asthma. Thirteen percent of Black
children had asthma. This compares
to 8% of White, 8% of Hispanic, and
12% of American Indians and Alas-
kan Natives children. (See Figure 1;
Since 1980, the difference in asthma
rates between Black and White
children has become larger,16 Black
children are twice as likely to be
hospitalized for asthma and are four
times as likely to die from asthma as
White children.1617
What is Asthma?
Asthma is caused by the narrow-
ing or blocking of the lung airways.
People with asthma often have trou-
ble breathing. They may experience
wheezing and shortness of breath.
They may feel pain or tightness 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.86 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%.86
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
symptoms (e.g. shortness of breath,
cough, wheezing and chest tightness
in someone who already has devel-
oped 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)
can make asthma worse and/or
provoke asthma attacks.19'20 88
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Figure 1: Percentage of Children Under 18 with Asthma, 2000-2005
Non-Hispanic Black
Non-Hispanic White
** Asian
Near Poor
Near Poor
Watch for the Air Quality Index
during your local weather report. The
index uses colors to show how much
pollution is in the air. Green and yel-
low mean air pollution levels are low.
Orange, red, or purple mean pollution
is at levels that may make asthma
worse. (See Figure 2.)
Black children have nearly
two times the rates of current
asthma as White children.
Near Poor
** American Indian/
Alaska Native
i	1	r
0	5	10
SOURCE: National Center for Health Statistics http://www.cdc.gov/nchs/health data for all ages.htm
* Unreliable data
** Includes Hispanics
 Outdoor Triggers: High levels
of air pollution (ozone, nitrogen
oxides, acidic aerosols, and
fine particles) in the air are also
associated 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 usu-
ally highest in summer. Particle
pollution can be high any time
of year and is higher near busy
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
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.
Figure 2: US EPA's Air Quality Index color codes.
Air Quality Index
(AQI) Values
Levels of Health Concern
When the A Q!
is in this range:
...air quality conditions are:
...as symbolized
by this color:
0 to 50
51 to 100
101 to 150
Unhealthy for Sensitive Groups

151 to 200
201 to 300
Very Unhealthy
301 to 500
SOURCE: US EPA's AirNow website http://airnow.gov/index.cfm7action = static.aqi
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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
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).
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.
EPA's Indoor Air Quality Tools for
Schools Program helps schools iden-
tify and prevent environmental asthma
triggers. It also promotes healthy
school environments. For more infor-
mation visit http://epa.gov/iaq/schools.
Black children are two times
as likely to be hospitalized for
asthma and are four times
as likely to die from asthma
as White children.
EPA's Asthma Home Environ-
ment Checklist gives explains how to
conduct home environmental as-
sessments. This checklist can help
identify asthma triggers in the home.
For a copy of the checklist visit httpill
www.epa .gov/asthma/pdf s/homeenvi-
ronment _checklist.pdf.
The Community Asthma Educa-
tion Prevention Program (CAPP)
of Philadelphia provides asthma
education classes to patients and
their families, child care providers,
and school personnel. CAPP also
provides in home environmental as-
sessments to eligible patients. For
more information please email CAPP
at cap@email.chop.edu or call (215)
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.htmi 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
617-451-0049 x504.

Visit http://yosemite.epa.gov/ochp/ochpweb.nsf/content/homepage.htm or call (202) 564-2188.

For more information on children's environmental health, visit the
EPA's Office of Children's Health Protection and Environmental Edu-
cation at http://yosemite.epa.gov/ochp/ochpweb.nsf/content/homep-
age.htm. You can also call the office at (202) 564-2188.
	America's Children and the Environment data/indicators, http://www.
	Office of Minority Health, Centers for Disease Control and Preven-
tion, http://www.cdc.gov/omh/
	Pediatric Environmental Health Specialty Units, www.aoec.org/
PEHSU.htm or call toll free 1-888-347-2632
	Environmental Management of Pediatric Asthma: Guidelines for
Health Care Providers, http://www.neefusa.org/heaith/asthma/
	National Center on Minority Health and Health
Disparities, National Institutes of Health,
	African American Health Care and Medical Information, http://
	African American Health Netwoift, National Medical Association,
	Kaiser Family Foundation Health Disparities Report:
A Weekly Look at Race, Ethnicity and Health/ http://
	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
	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.