Asthma and factors that aggravate asthma in the rural setting are key health priorities identified in an ongoing community-academic partnership, Proyecto Bienestar (PB). This longstanding partnership is a collaboration between the Northwest Community Education Center (NCEC)/KDNA Radio, the Yakima Valley Farm Workers Clinic (YVFWC), Heritage University and the University of Washington (UW). Preventing exacerbations is the most important challenge in asthma treatment and national guidelines recognize the role of indoor environmental factors and traffic-related pollutants. This project addresses an important data gap regarding the role of ambient environmental factors that affect a rural Hispanic population, where asthma morbidity is disproportionately high. In the first phase of the project we will geo- temporally locate episodes of asthma aggravation among a cohort of clinically confirmed asthmatics and utilize geographic information software to map the distribution of agricultural processes that may be responsible for triggering these episodes. The most common suspected ambient triggers will be prioritized. Guided by the timing of the suspected agricultural processes and the reported episodes, sampling with an innovative multi channel sampler will be done with a grid of community-based monitors which will sample air for the suspected aggravators. The asthmatic cohort will continue to be followed into year three. Analysis will focus on concentrations of the suspected triggers which will be compared to reports of new asthma exacerbations by subjects. An educational outreach program based on confirmed and/or strongly suspected aggravators will be developed for delivery through Radio KDNA, the YVFWC and the University of Washington. A clinician training curricula based on management of rural asthmatics will be developed and delivered to the YVFWC clinical providers and their Asthma Outreach Program community health workers. Evaluation will include process evaluation of PB, outcome evaluation of enhanced data collection and asthma management and product quantification including papers, presentations and student participants and impact evaluation of changes community response.

Public Health Relevance

This community based project characterizes ambient triggers of asthma in the rural setting by following 50 asthmatic community subjects, geo-temporally plotting their exacerbations and comparing these with known agricultural exposures. Subsequently, ambient sampling with an innovative and adaptable sampler will confirm the nature of the exposures and an informational campaign will share the findings with the public, clinicians and the scientific community. A multifaceted evaluation will assess the process, outcomes and impact of the program on the partnership, the participants, the clinical providers and the community.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZES1-SET-V (01))
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Dilworth, Caroline H
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University of Washington
Public Health & Prev Medicine
Schools of Public Health
United States
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Loftus, Christine; Yost, Michael; Sampson, Paul et al. (2015) Regional PM2.5 and asthma morbidity in an agricultural community: a panel study. Environ Res 136:505-12
Loftus, Christine; Yost, Michael; Sampson, Paul et al. (2015) Ambient Ammonia Exposures in an Agricultural Community and Pediatric Asthma Morbidity. Epidemiology 26:794-801
Armstrong, Jenna L; Fitzpatrick, Cole F; Loftus, Christine T et al. (2013) Development of a unique multi-contaminant air sampling device for a childhood asthma cohort in an agricultural environment. Environ Sci Process Impacts 15:1760-7
Hofmann, Jonathan N; Crowe, Jennifer; Postma, Julie et al. (2009) Perceptions of environmental and occupational health hazards among agricultural workers in Washington State. AAOHN J 57:359-71