Project background and goals
The Asthma in Schools: Data-to-Action Pilot Project sought to connect schools having high student asthma prevalence with Massachusetts Department of Public Health (DPH) resources on indoor air quality and asthma prevention during the 2023-2024 school year in alignment with DPH’s 2024-2028 Strategic Plan to Advance Racial Equity. The 2024-2028 Strategic Plan to Advance Racial Equity acknowledges that, to advance health equity, DPH must use an intersectional, equity-centered lens to focus on addressing the persistent racial inequities impacting the health access, treatment, outcomes, and overall well-being of people across the Commonwealth, specifically those who identify as Black, Indigenous, Hispanic/Latino, and/or Asian/Pacific Islander. The Asthma in Schools: Data-to-Action pilot project brought existing DPH resources to the highest-need communities and schools that often face complex barriers and experience disparities in health outcomes (i.e. asthma prevalence) due to structural racism and systems of oppression. To address long-standing inequitable distribution of resources among these highest-need communities and schools, DPH conducted proactive outreach with the aim of bringing available services, such as indoor air quality assessments, technical assistance, and educational materials and resources to the communities and schools that need them most.
DPH’s Indoor Air Quality Unit (IAQ), Division of Environmental Epidemiology (DEE), Asthma Prevention and Control Program (APCP), and School Health Services (SHS) collaborated to design and implement this pilot project. Schools were invited to participate based on pediatric asthma prevalence1 and community characteristics, such as Vulnerable Health Environmental Justice (VHEJ) classification.
The DPH partners laid out a series of project goals prior to approaching the schools. These goals were to:
- Collaborate among existing DPH programs and increase their reach to create asthma-friendly schools.
- Develop a standard methodology for identifying communities and schools most in need of asthma control support.
- Develop recommendations, tools, and resources for maintaining and improving school conditions and expanding asthma education.
- Develop effective strategies for sharing and communicating educational materials and school-specific recommendations to relevant stakeholders, including school administration, nurses, teachers, and facilities directors.
- Develop a road map for extending this project beyond its pilot phase sustainably into the future.
Participating schools
One school participated in each of the following four districts: Chicopee, Gardner, Holyoke, and Lowell. School recruitment started in May of 2023. In the late winter of 2024, IAQ representatives performed walkthroughs at each school. The walkthroughs, which were attended by each school’s facilities director, examined school buildings for issues related to indoor air quality. Unlike typical IAQ assessments, the walkthroughs did not include testing of indoor air quality metrics such as carbon dioxide and fine particulate matter (PM2.5).
After each visit, IAQ findings were summarized and delivered to the schools in a detailed walkthrough report. The walkthrough reports, publicly available on the IAQ website, are tailored to each school and include a complete list of findings and recommendations. Recommendations range from low-cost behavioral changes, such as turning on air purifiers, to long-term capital improvement projects, such as installing new heating, ventilation, and air conditioning (HVAC) systems. The indoor air quality issues identified varied across the four schools that participated. Some of the more common findings included clutter observed in classrooms and not using air filtration devices or unit ventilators (i.e., univents, or ventilation and heating units which provide fresh air to a room). At some schools, IAQ observed water damage in ceiling tiles and other indoor locations, and at all schools, HVAC systems were noted to likely be beyond their service lifespan. The recommendations provided to each school serve as best practices relating to indoor air quality that apply to most public-school buildings across the Commonwealth and are advised to be shared amongst other schools in the district.
Project evaluation
To assess the impact of the project and to better meet the needs of schools, DPH surveyed and interviewed staff and administration from each school. Teachers, nurses, facilities directors, and administrators were asked about multiple topics, including their knowledge of indoor air quality and asthma, barriers to improving indoor air quality in their schools, and changes they made after the walkthroughs.
Overall, administrators were complimentary of the walkthrough process and welcomed the insight into how to improve indoor air quality in their schools. When interviewed several weeks after their walkthroughs, administrators at three of the four schools visited noted that some concrete actions had already been taken or planned to improve their schools’ indoor air quality. However, administrators also noted that they would appreciate additional follow-up from DPH to review the walkthrough report for more explanation of the technical details. Nurses and facilities directors also welcomed the walkthroughs; all nurses had accessed resources on either indoor air quality or indoor air quality and asthma before the walkthrough, and facilities directors were able to identify at least one barrier to improving indoor air quality in their schools. Many of the teachers surveyed expressed interest in the connections between asthma and indoor air quality, but many were also unaware of resources on the subject before and after the walkthrough. Most teachers were not aware of or had not read the walkthrough report. Administrators, facilities directors, nurses, and teachers all identified budgets and old buildings as barriers to achieving better indoor air quality in their schools.
Project outcomes
There were many successful aspects of this project. As soon as a month after the walkthrough, schools had started to implement low barrier recommended changes (e.g., turning on univents) to improve indoor air quality, and administrators at one school noted that they were planning to use the walkthrough report to justify an initiative to de-clutter and “beautify” their school. At another school, the facilities director noted that the recommendations could be applied to other schools in their district, suggesting that just one walkthrough can have benefits beyond the school visited. In some cases, the project resulted in collaboration between facilities directors and school nurses. All schools planned to consider or make additional changes to improve indoor air quality over the next year. Overall, the walkthroughs resulted in increased awareness of indoor air quality and asthma in schools among administrators, facilities directors, and nurses.
Next steps
DPH will use the lessons learned from the pilot project to refine and improve its walkthroughs and educational resources to deliver greater benefits to schools in the future. Suggestions for increasing the impact and reach of the project include:
- DPH will consider planning post-walkthrough meetings with administrators, facilities directors, nurse leaders, and teachers from each school to review the walkthrough report findings.
- DPH will more directly incorporate the role of teachers by:
- Providing schools with indoor air quality resources tailored to teachers,
- Helping to ensure that the resources get into the hands of teachers, and
- Including teachers in the planning and execution stages of the project.
- DPH will leverage the Green and Healthy Schools Report, which includes best practices and resources for schools, to assist school administrators in improving indoor air quality and to inform future outreach materials.