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In California, child care facilities must comply with California Child Care Licensing (CCL) regulations for sanitizing and disinfecting in order to maintain infection control. Bleach, a cost-effective multipurpose product, is widely used to meet CCL requirements. However, bleach is known to exacerbate asthma, and according to the State's Work-Related Asthma Program, exposure to bleach has been associated with new asthma cases. Therefore, starting in 2008, the San Francisco Asthma Task Force conducted a grant-funded* pilot project to identify methods for infection control practices that eliminate or reduce child care operator exposure to bleach. 

Based on the findings of the project, the Task Force has established recommendations for bleach-free sanitizers and disinfectants that are safer for asthma; and recommendations regarding safer practices for using bleach. The goal of these recommendations and suggestions--which include specific training needs for management, staff and parents--is to encourage the sustainability of best practices while protecting the health of child care workers and the children served. 

*Funding was provided by San Francisco Foundation, Regional Asthma Management & Prevention, a private donor, and the San Francisco Public Health Foundation.

This review identifies economic values of home-based, multi-trigger, multi-component interventions with an environmental focus and presents ranges for the main economic outcomes (e.g., program costs, benefit-cost ratios and incremental cost-effectiveness ratios). A previous review concluded that these interventions were effective in reducing asthma morbidity among children and adolescents. Of the 1,551 studies identified for inclusion in the review, 13 were selected. Each of these had program costs ranging from $231-$14,858 per participant per year.  This range was affected by completeness of their program cost data, level of intensity of the environmental remediation, the type of educational component included, the professional status of the home visitor and the frequency of visits by the home visitor. The study ultimately found that the benefits from these kinds of interventions can "match or even exceed their program costs" and that "these programs provide a good value for dollars spent on the interventions."

The School Flag Program helps children, parents, school personnel and the community be aware of daily air quality conditions using brightly colored flags. Each day, a flag is raised in front of participating schools that signals the level of air pollution for that day. By comparing the colored flags to the Air Quality Index (AQI), members of the school and the surrounding community can tell what the daily air quality is, and adjust their activities to reduce their exposure to air pollution. Green indicates good air quality, yellow is moderate, orange means unhealthy for sensitive groups (like children and those with asthma), and red signals unhealthy air for everyone. A purple flag means the air quality is very unhealthy and sensitive groups should avoid all outdoor exertion and everyone else should limit outdoor exertion.