Asthma is the most common pediatric chronic disease. Asthma has high morbidity in low income and minority children and is known to be a leading cause of school absence. Despite knowledge of effective asthma management interventions, gaps continue to exist in the implementation of asthma programs at the community level. Implementation science, which can promote the uptake of proven interventions into routine practice, can be a helpful tool for improving the implementation of asthma interventions with community partners such as schools. The Environmental Protection Agency (EPA) has created Indoor Air Quality best practice recommendations known as Tools for Schools to help improve the indoor school environment, which can influence pediatric asthma. This proposal plans to use an implementation science model known as the Consolidated Framework for Implementation Research (CFIR) to evaluate use of Tools for Schools recommendations within Baltimore City Schools, with the aim of ultimately implementing a comprehensive school based asthma management program. This study will leverage the ongoing EPA funded Baltimore City Healthy Schools study (STAR83563901), which is investigating the impact of indoor and outdoor air quality on student health and achievement, and has collected detailed environmental sampling in over 30 public schools in multiple seasons as well as chronic school absence data. We plan to assess how school functions recommended by Tools for Schools (specifically building maintenance, ventilation, integrated pest management, and renovations and repairs) impact chronic school absences using linear regression modeling. Through partnerships formed by the Healthy Schools study, we will survey at least one school administrator within each school to understand asthma management practices currently occurring within schools. We will then assess how endorsement of asthma practices in line with Tools for Schools recommendations impacts chronic school absences through linear regression modeling. We suspect that schools with higher endorsement of Tools for Schools recommended school functions and asthma practices will have lower chronic school absences. The final component of our proposed study involves interviewing school stakeholders about priorities and barriers to asthma management within their respective schools through semi-structured phone interviews. We plan to use lessons learned from our data regarding school functions, asthma practices, and current priorities and barriers to asthma management to implement a future comprehensive school based asthma intervention.

Despite having effective interventions for pediatric asthma, the disease continues to be a significant cause of morbidity and gaps exist in the implementation of asthma management programs at the community level. Implementation science can be used to more effectively implement asthma management programs with community partners such as schools. This proposal uses an implementation science framework and combines analysis of existing data with collection of new data via surveys and qualitative interviews to investigate best practice behaviors occurring in schools as recommended by the Environmental Protection Agency with the ultimate goal of informing the development of a comprehensive school based asthma management program.