Community Setting

Studies indicate that when those three evidence-based public health interventions are packaged and provided to children, they have the potential to yield a positive return on investment. Health Investments that Pay Off: Strategies for Addressing Asthma in Children examines the interventions, which have been found to reduce emergency department visits and hospitalizations, improve asthma control, decrease the frequency of symptoms, decrease work and school absenteeism and improve quality of life.

“Asthma cannot presently be prevented or cured, but people who have asthma can live a symptom-free, fully active life with proper treatment and services, beginning at an early age,” said NGA Executive Director Dan Crippen. “To improve health outcomes among children and reduce medical expenses, governors can incorporate interventions into their overall agenda for state health care transformation.”

Governors can take the following actions to implement and finance asthma-based interventions:

·Use a broad range of qualified providers to support effective and efficient delivery of asthma services;

·Encourage collaboration and resource sharing across public and private programs and sectors;

·Use health insurers to improve clinical management and payment for services; and

·Build efficiency and sustainability for the interventions through evaluations.

 To learn more about the NGA Center for Best Practices Health Division, please visit www.nga.org/cms/center/health 

METHODS

As part of the Children’s Health Study, we measured lung function annually in 2120 children from three separate cohorts corresponding to three separate calendar periods: 1994–1998, 1997–2001, and 2007–2011. Mean ages of the children within each cohort were 11 years at the beginning of the period and 15 years at the end. Linear-regression models were used to examine the relationship between declining pollution levels over time and lung-function development from 11 to 15 years of age, measured as the increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) during that period (referred to as 4-year growth in FEV1 and FVC).

RESULTS

Over the 13 years spanned by the three cohorts, improvements in 4-year growth of both FEV1 and FVC were associated with declining levels of nitrogen dioxide (P<0.001 for FEV1 and FVC) and of particulate matter with an aerodynamic diameter of less than 2.5 μm (P= 0.008 for FEV1 and P<0.001 for FVC) and less than 10 μm (P<0.001 for FEV1 and FVC). These associations persisted after adjustment for several potential confounders. Significant improvements in lung-function development were observed in both boys and girls and in children with asthma and children without asthma. The proportions of children with clinically low FEV1 (defined as <80% of the predicted value) at 15 years of age declined significantly, from 7.9% to 6.3% to 3.6% across the three periods, as the air quality improved (P=0.001).

CONCLUSIONS

We found that long-term improvements in air quality were associated with statistically and clinically significant positive effects on lung-function growth in children. (Funded by the Health Effects Institute and others.)