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Utah’s Recess Guidance: Based on Air Quality 801-536-4036 Steve Packham, PhD, D.A.B.T National Association of Clean Air Agencies: 2011.

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Presentation on theme: "Utah’s Recess Guidance: Based on Air Quality 801-536-4036 Steve Packham, PhD, D.A.B.T National Association of Clean Air Agencies: 2011."— Presentation transcript:

1 Utah’s Recess Guidance: Based on Air Quality 801-536-4036 Steve Packham, PhD, D.A.B.T National Association of Clean Air Agencies: 2011 National Air Quality Conferences. March 7, 2011

2 On most days Utah experiences good air quality

3 But on other days the valleys look like this:

4 These days are caused by temperature inversions Occurs during winter months when normal conditions (cool air above, warm air below) are inverted Pollutants become trapped in cold air near valley floor Primary winter pollutant is particulate matter (PM)

5 Should schools cancel outdoor recess?

6 Utah’s Approach 1. Partnerships: Find and form them. Stakeholders Policy makers EducatorsCommunicators Scientists, etc. 2. Facts: Know them and share them with the partners. TechnicalRegulatoryPoliticalLimitations 3. Move forward: Do what you can given current limitations. Learn to communicate with partners. Identify and address limitations. ( partnership effort ) Increase knowledge (literature, gather data) Expand partnerships if necessary 4. Move forward again: Repeat steps 1-3. 2004 initial Guidelines 2008 updated Guidelines

7 Partners Bear River Health Department Edward Redd, MD Intermountain Health Care Pediatrician, Nicole Frie, MD Greenville Elementary School, Logan, Cache County, Utah Principal, Joel Allred Utah Department of Environmental Quality Utah Division of Air Quality (Steve Packham, PhD) Utah Department of Health Asthma Task Force Rebecca Giles, Utah Asthma Program Director Sam LeFevre, Environmental Epidemiologist Utah State University (Interns: spirometry testing) University of Utah Medical School Department of Family and Preventative Medicine, Division of Public Health (Stephen Alder, PhD) Division of General Pediatrics (Karen F. Buchi, MD) Primary Children’s Foundation

8 Stakeholders Including but not limited to American Lung Association of Utah Cache County Clean Air Task Force Local Health Departments Local School Districts Parent Teachers Association School Superintendents/Principals School Nurses Teachers

9 2004: The First Guidelines AQI 101-150 – –Accommodate “sensitive students” AQI 150-200 – –Move all students insideLimitations –Indoor/outdoor PM2.5? –Health benefit?

10 Addressing the 2004 Limitations Addressing the 2004 Limitations The Hawthorne Elementary School Pilot Study (SLAM Station) We learned there was an exposure benefit from staying indoors. We still did not know if there was a health benefit from indoor recess. But, at Hawthorne we learned how to get data on health effects 1.Is there a significant difference between indoor and outdoor PM2.5? 2.Is there a health benefit from indoor recess on bad air days?

11 The Partners Did A Study Study designed to answer… Is lung function adversely impacted by poor air quality? Do children with asthma have greater negative lung function responses due to outdoor recess on poor air quality days? Is there a point at which outdoor air quality justifies replacing outdoor activities with indoor alternatives?

12 Partners Got Buy-in From political leaders From the school From the parents From the students From the teachers

13 Process Played Out in the Public Domain (2004-2008)

14 The School Greenville Elementary School. North Logan, Utah 168 3 rd 199 4 th 183 5 th 96% white, mostly non- smoking homes

15 Pulmonary Function Testing 20 min mid-day recess (pre- to post-recess testing)

16 Dr. Redd: On site during study

17 PM2.5 Monitoring Utah Division of Air Quality (SLAM Station 2-3 miles away) Outdoor Station Indoor Station

18 Greenville PM2.5

19 Greenville Asthma/Recess Study (2007) Demographics (n=101) –Age Mean 9.18 S.D.0.95 –Female56 (55.4%) –White, non-Hispanic92 (91%) –With asthma54 (53.5%) –# of Observations Mean29.9 Range(7, 37)

20 Greenville Outcomes Pre-recess –FVC –FEV1 –FEV1/FVC –PEFR Pre- to Post-recess –FVC –FEV1 –FEV1/FVC –PEFR

21 General Pre- to Post-recess Observations No statistically significant decrease in FEV1/FVC or PEFR as a function of asthma, PM2.5 (highest 60 ug/m3), or activity associated with outdoor recess. No significant interactions. Significant Increase in pre-recess FVC over the course of the study Decrease in FVC in students presenting with URI symptoms These significant observations provided evidence of the spirometry methods’ capability of detecting effects if there were any.

22 Updated Recess Guidelines 2008 Guidelines updated based on Greenville results. We abandoned AQI We pegged guidelines to hourly PM2.5

23 What I Learned AQI; inadequate Today’s-recess decision based on the AQI is like using yesterday’s weather for a rain-free-picnic decision today. Solutions; may pose new risks The solution 1 for an adverse health effect 2 associated with an environmental risk factor 3 can itself become a risk factor for other health effects. 4 Averages Studies using 24-h air quality averages are insufficient to accurately predict health effects associated with short term exposure doses. People Are intrigued with air quality and health, but skeptical. Are willing to become involved. Respond to open, honest disclosure of facts and motives. –It’s important to talk straight, give them the facts –Be open and honest about your motives. Communication Make public health about personal health. outdoor air quality. obesity, diminished attention span, teacher fatigue, etc.). 1. Outdoor recess. 2. asthma 3. outdoor air quality. 4. obesity, diminished attention span, teacher fatigue, etc.).

24 Percentage Average Utah PM2.5 Concentration = 9.24 ug/m3 “Say you were standing with one foot in the oven and one foot in an ice bucket. According to the percentage people, you would be perfectly comfortable.” Bobby Bragan 10/30/1917 - 1/21/2010 Bobby Bragan: Longtime baseball man who managed Braves Hall of Famers Hank Aaron, Eddie Mathews and Warren Spahn.

25 Milestone of Human Development One year olds think that if they like Goldfish Crackers, then Mommy and Daddy like Goldfish Crackers, too. Sooner or later children come to understand that Mommy and Daddy don’t necessarily like Goldfish. That moment is one of the great milestones of human development. I reached that milestone some time between 2004 and 2008. Malcolm Gladwell. What the Dog Saw. Back Bay Books. New York Boston London 2009

26 We Speak Two Languages Public-health Speak - Numbers Averages Risk ratios Statistics New study finds….. –Everything seems to kill us or make us sick. –We are fostering “conditioned helplessness” Personal-health Speak - Symptoms The air burns my eyes and lungs I wheeze I cough and have phlegm. I experience shortness of breath I have to use my inhaler

27 We See Air Quality Differently A person sees air quality like this. We see air quality like this

28 There Are No Lines in Nature

29 The AQI Divides a Continuum into Health Advisories

30 Recess Based on Current Conditions Utah Air Quality Web Page (previous hour) 1.County tabs 2.Concentration graphic 3.Numerical concentration 4.Visual web cam 1 2 3 4

31 The Conceptual Thermometer ug/m 3 v AQI

32 Recess Guidelines Our Goal: Teach Utahans to “read” the air; make on- the-ground decisions in real-time based on a personal record of their symptoms.

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