Air Quality Education for Health Literacy

Overseen By Savannah D'Evelyn

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Disqualifiers: Junior, Senior students, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

85 Participants Needed

Trial Summary

What is the purpose of this trial?

The proposed intervention in this Youth Participatory Action Research (YPAR) proposal will improve knowledge and awareness of the health impacts of air pollution exposure, will elevate the youth voice, improve youth self-efficacy and lead to behavior changes that would reduce exposure to air pollution in a high school setting. These outcomes will be accomplished through the introduction of a new air quality curriculum into science classes, and the establishment of an after-school air quality monitoring program. All students enrolled in Food Science (Montrose High School), Intro to Agriculture (The STEAD School) and Environmental Science Academy (Grand Junction High School) will participate in the new air quality curriculum, as it will be built into the existing lesson plans. For the after-school monitoring program, the PI and participating teachers (Letters A and B) will recruit 10 to 15 students at each school to be involved in the Student Research Cohort (SRC). Information on this program and how to apply will be shared with students through their health and science classes, included in the school newsletter, and posted on billboards around the school. Students will be identified within the following inclusion criteria: 1) freshman or sophomores in high school and 2) participation in the air quality curriculum. New students will be recruited each year to keep a consistent group as students leave and/or graduate. New students will be brought up to speed by carry-over students, and each new year will represent a separate SRC dedicated to a specific goal.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the AirActions Curriculum treatment?

The American Lung Association's asthma education program showed that educating patients about asthma improved their knowledge and modestly improved their treatment behaviors and symptoms. This suggests that health education, like the AirActions Curriculum, can be effective in improving health outcomes. ^{1 2 3 4 5}

Is the Air Quality Education for Health Literacy program safe for participants?

The research articles do not provide specific safety data for the Air Quality Education for Health Literacy program or its related names. However, they focus on improving environmental health literacy through education, which generally involves learning and awareness activities rather than medical treatments, suggesting it is likely safe for participants. ^{6 7 8 9 10}

How does the AirActions Curriculum treatment differ from other treatments for air quality education?

The AirActions Curriculum is unique because it focuses on improving environmental health literacy by empowering communities to understand and reduce air pollution risks, rather than just educating individuals about personal risk behaviors. This approach aims to reach vulnerable populations and promote community-wide actions to mitigate environmental threats. ^{10 11 12 13 14}

Research Team

Savannah D'Evelyn

Principal Investigator

University of Washington

Eligibility Criteria

This trial is for freshmen and sophomores in high school who are enrolled in Honors Biology, Intro to Agriculture, or Environmental Science at Pueblo East, Montrose High School, The STEAD School, or Grand Junction High School. They must participate in the AirActions curriculum.

Inclusion Criteria

I am a freshman or sophomore at one of the specified Colorado high schools and can participate for over two years.

I am a high school teacher, administrator, or staff member willing to participate for over two years.

Exclusion Criteria

I am a junior or senior student and can't join for more than 2 years.

I am a school staff member unable to commit to a study for more than 2 years.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

AirActions Curriculum Implementation

Introduction of the AirActions curriculum to improve student knowledge on the health effects of air pollution, specifically wildfire smoke.

1 semester

Integrated into regular class schedule

YPAR Air Quality Monitoring Project

Students design and implement an air quality monitoring study using indoor, outdoor, and personal monitoring devices.

1 school year

Ongoing participation in after-school program

Follow-up

Evaluation of the impact of the curriculum and monitoring program on air-quality related behavior changes and health knowledge.

2 years

Treatment Details

Interventions

• AirActions Curriculum

Trial Overview The study tests a new air quality curriculum called AirActions within freshman science classes and an after-school air quality monitoring program. It aims to improve students' knowledge about air pollution health impacts and encourage behaviors that reduce exposure.

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

National Institute of Environmental Health Sciences (NIEHS)

Collaborator

Trials

294

Recruited

1,233,000+

Findings from Research

In a study of 499 parents of school-age children with asthma, 33% had limited health literacy, which was linked to increased parental worry and a greater perception of asthma burden, despite no differences in healthcare usage.

Improving communication and understanding between healthcare providers and parents could help reduce the perceived burden of asthma on families and enhance the quality of life for parents managing their child's condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of parent health literacy among urban children with persistent asthma. Shone, LP., Conn, KM., Sanders, L., et al.[2022]

The Lung Center program 'Overcoming Your Asthma' significantly improved participants' knowledge about asthma and led to modest improvements in treatment behaviors and asthma symptoms, such as reduced wheezing and breathing difficulties, after one month.

While the program showed benefits shortly after participation, these improvements were not consistently maintained at the six-month follow-up, indicating a need for ongoing education and support for asthma management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of American Lung Association-Indiana Lung Centers asthma program. Summers, KH., Zillich, AJ., Nyhuis, AW., et al.[2019]

A health literacy-informed written asthma action plan (WAAP) significantly improved the quality of asthma counseling among providers, with 96.7% using specific times of day for medication instructions compared to only 51.7% with the standard plan.

Providers using the low-literacy WAAP were more effective in recommending spacer use (83.6% vs 43.1%) and addressing the need for daily medications even when sick (93.4% vs 34.5%), without increasing counseling time, indicating that the plan enhances communication without added complexity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. Yin, HS., Gupta, RS., Tomopoulos, S., et al.[2016]

In a study of 433 older adults with moderate to severe asthma, low health literacy (HL) was linked to worse lung function (FEV1 <70% predicted) and increased hospitalizations and emergency department visits for asthma.

Improving health literacy could be a key strategy to enhance asthma management and outcomes in elderly patients, as it is a modifiable factor that influences their health status.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Asthma outcomes are poor among older adults with low health literacy. Federman, AD., Wolf, MS., Sofianou, A., et al.[2021]

The Asthma Action Plan (AAP) developed for families with low health literacy was validated by caregivers and achieved a readability level suitable for a 4th grader, making it accessible for its intended audience.

The AAP received high scores for understandability and actionability (100%), and was endorsed by the Allergy & Asthma Network, indicating it is a promising tool to improve asthma management and ensure guideline-concordant care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and assessment of a low literacy, pictographic asthma action plan with clinical automation to enhance guideline-concordant care for children with asthma. Reeves, PT., Kenny, TM., Mulreany, LT., et al.[2023]

The study involved 53 participants from four Arizona communities and showed that tailored Environmental Health Literacy (EHL) trainings significantly increased knowledge and self-efficacy regarding environmental health risks, particularly in rainwater harvesting and water contamination.

The interdisciplinary approach not only enhanced participants' skills but also fostered trust and collaboration between scientists and community members, highlighting the importance of contextual EHL education in addressing local environmental health issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing Environmental Health Literacy through Contextual Learning in Communities at Risk. Davis, LF., Ramirez-Andreotta, MD., McLain, JET., et al.[2023]

A study involving 24 interviews and a survey of 275 Environmental Health professionals identified 37 skills and 69 knowledge items essential for Environmental Health Literacy (EHL), highlighting the importance of these competencies in public health.

The survey revealed that over 70% of EH professionals agreed on six key knowledge items as essential for EHL, paving the way for future research to enhance public understanding and improve health outcomes related to environmental factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defining Environmental Health Literacy. Lindsey, M., Chen, SR., Ben, R., et al.[2021]

Community-engaged exposure assessment studies, like the University of Arizona's Metals Exposure Study, are effectively enhancing environmental health literacy by reporting biomonitoring data back to participants.

These report back activities not only stimulate informal science learning but also empower individuals to use their research experiences to address personal and community health goals, particularly in mining communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reporting back environmental exposure data and free choice learning. Ramirez-Andreotta, MD., Brody, JG., Lothrop, N., et al.[2019]

Many workers have low literacy and limited English skills, which makes it difficult for them to understand current health and safety training programs, as one-fifth read below an eighth-grade level.

Health and safety educators are developing innovative training strategies that focus on participatory education to better meet the needs of these workers and empower them in their learning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health and safety education for workers with low-literacy or limited-English skills. Wallerstein, N.[2022]

Current communication strategies about air pollution are unclear and often fail to specify who is responsible for providing accurate information, which can lead to confusion among the public.

Existing information on air quality lacks essential details about risk mitigation and long-term health effects, and it often does not effectively reach vulnerable populations, highlighting a critical need for improved communication strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Public Awareness of Air Pollution and Health Threats: Challenges and Opportunities for Communication Strategies To Improve Environmental Health Literacy. Ramírez, AS., Ramondt, S., Van Bogart, K., et al.[2020]

The Asthma-Friendly Outdoor Air Quality Flag Program effectively educates communities in Central California about outdoor air pollution and its health effects, aiming to reduce exposure to asthma triggers like ozone and particles.

The program demonstrates that simple, visual, and low-cost educational interventions can successfully improve air quality awareness and lead to policy changes in schools, benefiting diverse communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The outdoor air quality flag program in central California: a school-based educational intervention to potentially help reduce children's exposure to environmental asthma triggers. Shendell, DG., Rawling, MM., Foster, C., et al.[2016]

A new health literacy instrument for understanding ambient air pollution was developed and validated through a study involving 1,297 participants, demonstrating strong content validity and internal consistency (Cronbach's alpha = 0.93).

The instrument is designed to help stakeholders create effective interventions to empower the public in managing exposure to air pollution, ultimately improving community health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychometric properties of novel instrument for evaluating ambient air pollution health literacy in adults. Chen, IC., Li, CY., Lu, CY., et al.[2023]

The initiative by the National Environmental Education Foundation (NEEF) significantly improved pediatric health care providers' knowledge about environmental triggers of asthma, with attendees reporting increased intention to manage these triggers after training.

The program has reached over 12,000 health care professionals nationwide, indicating its broad impact, although challenges and barriers to full integration into practice were also identified.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Integrating Environmental Management of Asthma into Pediatric Health Care: What Worked and What Still Needs Improvement? Roberts, JR., Newman, N., McCurdy, LE., et al.[2023]

Only 3.2% of parents of asthmatic children were familiar with the Pollution Standard Index (PSI), indicating a significant gap in knowledge about daily air quality monitoring.

While 65.6% of parents recognized the effects of air pollution on their asthmatic children, their overall practice scores suggested they lacked effective strategies to protect their children from air pollution, leaving them at risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Knowledge and Practice of Asthmatic Children's Parents About Daily Air Quality. Yazdanparast, T., Seyedmehdi, SM., Khalilzadeh, S., et al.[2021]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

The role of parent health literacy among urban children with persistent asthma. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Outcomes of American Lung Association-Indiana Lung Centers asthma program. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. [2016]

4. England pubmed.ncbi.nlm.nih.gov

Asthma outcomes are poor among older adults with low health literacy. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Development and assessment of a low literacy, pictographic asthma action plan with clinical automation to enhance guideline-concordant care for children with asthma. [2023]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Increasing Environmental Health Literacy through Contextual Learning in Communities at Risk. [2023]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Defining Environmental Health Literacy. [2021]

8. England pubmed.ncbi.nlm.nih.gov

Reporting back environmental exposure data and free choice learning. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Health and safety education for workers with low-literacy or limited-English skills. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Public Awareness of Air Pollution and Health Threats: Challenges and Opportunities for Communication Strategies To Improve Environmental Health Literacy. [2020]

11. United States pubmed.ncbi.nlm.nih.gov

The outdoor air quality flag program in central California: a school-based educational intervention to potentially help reduce children's exposure to environmental asthma triggers. [2016]

12. United States pubmed.ncbi.nlm.nih.gov

Psychometric properties of novel instrument for evaluating ambient air pollution health literacy in adults. [2023]

13. United States pubmed.ncbi.nlm.nih.gov

Integrating Environmental Management of Asthma into Pediatric Health Care: What Worked and What Still Needs Improvement? [2023]

14. Iran pubmed.ncbi.nlm.nih.gov

Knowledge and Practice of Asthmatic Children's Parents About Daily Air Quality. [2021]