Childhood asthma rates are on the rise across the country. In Rhode Island, it’s about 12 percent, according to the state health department - one of the highest rates in New England. Hiding in that statistic: in some inner city schools, almost half the kids have asthma. Now, a new program aims to help some of the most vulnerable kids manage their asthma better in school, with a little help from their peers.
An athlete with asthma
If you’ve never had an asthma attack, here’s what it’s like:
“Chest tightens. Can’t really breathe. You know, stuffy. And sweat a lot and just get nervous. Think you’re going to die.”
This is Andy Darius. He’s 17, about to be a senior at Shea High School in Pawtucket…though he looks a little younger. When he smiles his cheeks plump out and reveal a little dimple. He’s also a serious football player. That’s despite having asthma severe enough to land him in the emergency room every once in a while. He’s standing at the head of the table in his family’s dining room, holding up a couple of prized possessions: team sweaters.
“This sweater was from my sophomore year playing football at Shea. And this one was from last year, my junior year in football.”
Tough for tweens: managing asthma in school
Before he can even step on the football field, Darius has to make sure his asthma is under control. He takes two pumps from his inhaler before every game because strenuous exercise can trigger asthma. He’s learned to avoid other triggers, like dust or heat. Those skills, plus the fact that Darius’ family is originally from the Caribbean, make him the perfect recruit for a new study underway in Rhode Island. It’s called ASMAS.
“And that stands for asthma management in schools, was developed to address the high prevalence of asthma in the middle school setting and, more specifically, to develop a more culturally tailored intervention for Latinos in urban providence.”
Daphne Koinis-Mitchell is a staff psychologist at the Bradley Hasbro Children’s Research Center, and director of the Community Asthma Program at Hasbro Children’s Hospital, as well as a professor at Brown University's medical school. She’s testing a theory that high schoolers might be able to help younger kids – like middle schoolers—manage their asthma better in school. Especially if they come from the same ethnic group, and even from the same neighborhood. As for why she’s focusing on middle schoolers? She says kids this age are becoming more independent, and not as likely to want a lot of hand holding from the school nurse. Plus there hasn’t been a whole lot of attention focused on them.
“Many of the interventions that are out there are focused on elementary aged children or high school children. And there are even fewer that are for urban families that are tailored for specific minority groups.”
Latino kids, especially those of Caribbean descent, she says, have much higher rates of asthma than other groups. It’s worse in poor urban neighborhoods. Koinis-Mitchell says asthma rates in some inner city Rhode Island schools are pushing 50 percent. That means too many kids are missing school, ending up in the emergency room, and suffering more than they have to. Asthma is a chronic condition, but it can be managed.
So she’s recruited teens like Andy Darius to show younger kids how to get their asthma under control. The hope is that the middle schoolers will see Darius and the others as peers, people they can relate to, and want to emulate. The peers are training now for the coming school year.
Training peers and educators
“And then we’re going to go over three main topics: what’s your role as a high school peer, so what are you going to be doing, what’s your role..."
Darius and a few other teens have gathered around a table in a stuffy conference room at Pawtucket High school. PowerPoint slides flash on the white school walls. This is orientation. Koinis-Mitchell and her ASMAS colleagues are going over what the peers need to know. Most importantly, they have to know all about asthma. But they’ll also need some strategies for facing a room full of tweens.
“What are you going to do if they start acting up, how can you teach them and have them pay attention to you and keep things running smoothly?"
But what middle school students might appreciate the most is hearing how the teens themselves have coped with asthma.
“As we’re doing the training, we’re actually going to have you come up with some personal experiences and examples of your own asthma and how you’ve kind of managed it and controlled it so you can share that with them.”
Reaching kids at school helps families
So why try to reach kids in school? Why not leave it to their families? ASMAS researcher Daphne Koinis-Mitchell says families play a key role, but poor urban families often already have a lot on their plates.
“When you’re facing additional stressors that make it difficult to put food on the table, it’s not that many caregivers don’t want to tend to the asthma, they just have other competing demands that make it difficult.”
Add to that, says Koinis-Mitchell, the challenge of managing asthma in school, where kids are expected to be learning and paying attention.
"And sometimes the asthma is not at the forefront, even though they may detect they’re experiencing symptoms, sometimes they don’t want to draw attention to themselves, so they’ll ignore the symptoms, and the symptoms interfere with their learning.”
So this is where schools can play a role, and already do - especially the school nurse.
Linda Mendonca is the nurse at the high school for the arts in Pawtucket. She’s been working with kids with asthma for years. She also helps run a statewide pilot project helping school administrators reduce asthma triggers in old school buildings.
“It’s very important for the school nurse to know whether the student has asthma or not, to try to get an asthma action plan, which is not always easy, and ensuring they have their inhaler at school.”
An asthma action plan is a worksheet doctors fill out with kids who have asthma. It maps out a child’s particular triggers, what medications he or she takes, and whether he or she has an inhaler for attacks. School nurses are supposed to get a copy, but don’t always. If a family doesn’t have a regular doctor or the parents’ English is limited, it can be even tougher, says Mendonca. So she tries to fill in the gaps.
“Whether it’s with the parent, helping to make sure they’re taking their maintenance medication, they have their inhalers, that they’re following whatever the plan their doctor has set for them, that can be a problem at times.”
So could a program like ASMAS – training high schoolers to teach middle schoolers with asthma – help? Mendonca thinks so.
“Any time you can use peers to educate and teach and motivate is a good thing.”
Ready for fall
Back at his house in Pawtucket, 17-year-old Andy Darius is getting ready to start his senior year and to face a classroom full of middle schoolers for the first time. Each of his younger siblings has asthma, so Darius has some experiences he can use. He says he likes kids, and they like him usually. Plus, he says, he really wants to help.
“’Cause they’re little kids and growing up I was a little kid too, and I don’t want bad things to happen to them too. I’d rather let them learn now at an early age so when they get older they’ll really have a responsibility at a young age.”