Utahs Recess Guidance Based on Air Quality Steve

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

On most days Utah experiences good air quality

But on other days the valleys look like this:

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)

Should schools cancel outdoor recess?

Utah’s Approach 1. Partnerships: Find and form them. Stakeholders Policy makers Educators Communicators Scientists, etc. 2. Facts: Know them and share them with the partners. Technical Regulatory Political Limitations 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

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, Ph. D) Utah Department of Health Asthma Task Force Rebecca Giles, Utah Asthma Program Director Sam Le. Fevre, 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, Ph. D) Division of General Pediatrics (Karen F. Buchi, MD) Primary Children’s Foundation

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

2004: The First Guidelines AQI 101 -150 – Accommodate “sensitive students” AQI 150 -200 – Move all students inside Limitations – Indoor/outdoor PM 2. 5? – Health benefit?

Addressing the 2004 Limitations The Hawthorne Elementary School Pilot Study (SLAM Station) 1. Is there a significant difference between indoor and outdoor PM 2. 5? 2. Is there a health benefit from indoor recess on bad air days? 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

The Partners Did A 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?

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

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

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

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

Dr. Redd: On site during study

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

Greenville PM 2. 5

Greenville Asthma/Recess Study (2007) Demographics (n=101) – Age Mean S. D. – Female – White, non-Hispanic – With asthma – # of Observations Mean Range 9. 18 0. 95 56 (55. 4%) 92 (91%) 54 (53. 5%) 29. 9 (7, 37)

Greenville Outcomes Pre-recess – – FVC FEV 1/FVC PEFR Pre- to Post-recess – – FVC FEV 1/FVC PEFR

General Pre- to Post-recess Observations No statistically significant decrease in FEV 1/FVC or PEFR as a function of asthma, PM 2. 5 (highest 60 ug/m 3), 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.

Updated Recess Guidelines 2008 Guidelines updated based on Greenville results. We abandoned AQI We pegged guidelines to hourly PM 2. 5

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. 1. Outdoor recess. 2. asthma 3. outdoor air quality. 4. obesity, diminished attention span, teacher fatigue, etc. ).

Percentage Average Utah PM 2. 5 Concentration = 9. 24 ug/m 3 “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.

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

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

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

There Are No Lines in Nature

The AQI Divides a Continuum into Health Advisories

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

The Conceptual Thermometer ug/m 3 v AQI

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