English

The child care environment is vitally important to the healthy development of millions of young children who receive care outside their homes.  Along with creating a safe, nurturing, and stimulating child care program, protecting children from exposure to indoor environmental contaminants is critical to advancing the core goals of early care and education.  Children are not simply “little adults” when it comes to environmental exposures – they may be more highly exposed to pollutants and more vulnerable to their effects.

This report, prepared by the Environmental Law Institute and the Children’s Environmental Health Network, provides an overview of how state policy addresses indoor environmental exposures in the child care setting.  While there has been considerable progress in establishing policies to address key indoor contaminants, there is ample room for strengthening state laws, regulations, and non-regulatory initiatives.  The report describes the state of state policy today and highlights notable examples to assist policymakers, agency officials, non-governmental organizations and associations, and others who work to advance quality child care and promote children’s health.

The report includes the following chapters:

• Introduction
• Environmental Tobacco Smoke
• Radon
• Carbon Monoxide Alarms
• Mold and Dampness
• Building Ventilation and Temperature
• Pesticides
• Lead-Based Paint
• Asbestos
• Other Chemical Exposures: Cleaning, Renovation, and Consumer Products
• Facility Site/Location
• State Non-Regulatory Initiatives: Education, Assistance, and Incentives
• Conclusion
• Appendix: Where to Find State Statutes and Regulations Online

To learn more and download the full report visit: http://www.eli.org/buildings/reducing-environmental-exposures-child-care-facilities

Background: Although it is thought that inner-city areas have a high burden of asthma, the prevalence of asthma in inner cities across the United States is not known.

Objective: We sought to estimate the prevalence of current asthma in US children living in inner-city and non–inner-city areas and to examine whether urban residence, poverty, or race/ethnicity are the main drivers of asthma disparities. Methods: The National Health Interview Survey 2009-2011 was linked by census tract to data from the US Census and the National Center for Health Statistics. Multivariate logistic regression models adjusted for sex; age; race/ethnicity; residence in an urban, suburban, medium metro, or small metro/rural area; poverty; and birth outside the United States, with current asthma and asthma morbidity as outcome variables. Inner-city areas were defined as urban areas with 20% or more of households at below the poverty line. Results: We included 23,065 children living in 5,853 census tracts. The prevalence of current asthma was 12.9% in inner-city and 10.6% in non–inner-city areas, but this difference was not significant after adjusting for race/ethnicity, region, age, and sex. In fully adjusted models black race, Puerto Rican ethnicity, and lower household income but not residence in poor or urban areas were independent risk factors for current asthma. Household poverty increased the risk of asthma among non-Hispanics and Puerto Ricans but not among other Hispanics. Associations with asthma morbidity were very similar to those with prevalent asthma. Conclusions: Although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood.

Sponsoring Programs:

Healthy Homes, U.S. Department of Housing and Urban Development

State Tobacco Education and Prevention Partnership, Colorado Department of Public Health and Environment

This document provides codes used to bill Medicaid within states for asthma care services, including descriptions of services covered. The information can be used to advocate for expanded Medicaid and private payer reimbursement in your state.

With more states exploring reimbursement for asthma interventions – for home-based asthma education, home assessments, and/or products that support environmental management of asthma triggers – this document will be updated frequently to reflect new policy changes.