Montana Asthma Advisory Group

1
Montana Asthma Advisory
Group

• March 6th, 2009

2
Announcements

• Demo kits and educational materials Pick up
  yours today!
• Becoming an Asthma Educator and Care Manager
  Course April 24th in Bozeman
• EPA Region 8 Greening Our Schools and
  Communities Childrens Health Summit
  August 11th-13th in Missoula
• Breathe Well, Live Well Facilitator Training
  March 24th in Casper, WY 9 am to
  430 pm, funding available for travel and hotel

3
Montana State Asthma Plan

• Thank you for your input and involvement in
  creating this document!
• Printed in mid-February
• Dissemination plan
• Mailing
• Press release
• Professional newsletters?
• Utilizing this document in your agency

4
Montana State Asthma Plan Logic Model
Input
Activities
Outcomes
Impacts

• Surveillance Establish and maintain a
  comprehensive state asthma surveillance system
• Partnerships Establish and maintain effective
  partnerships with stakeholders across the state
  to increase the reach and impact of asthma
  control efforts
• Healthcare Improve systems and quality of asthma
  care
• Environment Reduce exposure to
  environmental irritants and allergens that cause
  and/or exacerbate asthma
• Schools/Child care Increase the capacity of
  Montana schools and childcare
  facilities to manage asthma

• Montana Asthma
• Workgroup
• Partners
• Montana Asthma Control
  Program Staff
• Resources and time from stakeholders statewide
• Coordinated planning and implementation of state
  asthma plan

• Increase public awareness about asthma
• Promote policy and environmental changes to
  create systems with increased capacity to manage
  asthma over the long term
• Empower persons with asthma to manage their own
  disease
• Reduce activity limitations and school/work days
  missed due to asthma

• Improve the quality of life for all
  Montanans with asthma
• Reduce geographic, racial
  and
  socioeconomic disparities in asthma
  morbidity and mortality
• Reduce ED visits for asthma
• Reduce hospitalizations
  for asthma
• Reduce direct and indirect asthma costs
• Reduce asthma deaths

Surveillance and Evaluation Increase knowledge
of asthma in Montana through ongoing, systematic
data collection and program evaluation.
Underlying Themes
Disparities,
Communication, Sustainability and Evaluation
Montana State Asthma Plan Logic Model
Montana State Asthma Plan Logic Model
Activities
Impacts
Input
Outcomes
Activities
Impacts
Input
Outcomes

• Reduce activity limitations and school/work days
  missed due to asthma
• Reduce direct and indirect asthma costs
• Promote policy and environmental changes to
  create systems with increased capacity to
  manage asthma over the long term
• Increase public awareness about asthma

• Surveillance Establish and maintain a
  comprehensive state asthma surveillance system
• Partnerships Establish and maintain effective
  partnerships with stakeholders across the state
• Healthcare Improve systems and quality of asthma
  care in Montana
• Environment Reduce exposure to
  environmental irritants and allergens that cause
  and/or exacerbate asthma
• Schools/Daycares Increase the capacity of
  Montana schools and childcare
  facilities to manage asthma

• Improve the quality of life for all
  Montanans with asthma
• Reduce geographic, racial
  and
  socioeconomic disparities in asthma morbidity
  and mortality
• Reduce asthma deaths
• Reduce hospitalizations
  for asthma
• Reduce ED visits for asthma

• Reduce activity limitations and school/work days
  missed due to asthma
• Reduce direct and indirect asthma costs
• Promote policy and environmental changes to
  create systems with increased capacity to
  manage asthma over the long term
• Increase public awareness about asthma

• Surveillance Establish and maintain a
  comprehensive state asthma surveillance system
• Partnerships Establish and maintain effective
  partnerships with stakeholders across the state
• Healthcare Improve systems and quality of asthma
  care in Montana
• Environment Reduce exposure to
  environmental irritants and allergens that cause
  and/or exacerbate asthma
• Schools/Daycares Increase the capacity of
  Montana schools and childcare
  facilities to manage asthma

• Improve the quality of life for all
  Montanans with asthma
• Reduce geographic, racial
  and
  socioeconomic disparities in asthma morbidity
  and mortality
• Reduce asthma deaths
• Reduce hospitalizations
  for asthma
• Reduce ED visits for asthma

Surveillance and Evaluation Increase knowledge
of asthma in Montana through ongoing, systematic
data collection and program evaluation.
Surveillance and Evaluation Increase knowledge
of asthma in Montana through ongoing, systematic
data collection and program evaluation.
Underlying Themes
Disparities,
Communication, Sustainability and Evaluation
Underlying Themes
Disparities,
Communication, Sustainability and Evaluation
5
Montana State Asthma Plan

• Three main sections of the plan
• Surveillance
• Evaluation
• Interventions
• Healthcare Interventions
• Environmental Interventions
• School Childcare Interventions

August 2009
November 2009
6
Montana State Asthma Plan

• Scope Bigger than just the Montana Asthma
  Control Program
• Structured to encompass much of what you all are
  doing in your own organizations
• Our program will be applying for federal funding
  to implement specific strategies in the state
  plan

7
Update CDC Grant

• Funding opportunity announcement (FOA) due out
  any day
• Open to all states-currently funding 37 states, 9
  cities and Puerto Rico
• 5 years of funding
• Approximate award 375,000 per year

8
What is the funding for?

• Provide impetus to further develop program
  capacity to address asthma from a public health
  perspective
• Three main funding areas
• Surveillance
• Partnerships
• Interventions
• Funding only for non-research activities

9
Montana grant application

• Funding for expanded staffing and
• Specific state plan strategies
• Surveillance Maintain expand
• Partnerships Maintain expand
• Healthcare ACMS, Hospital/ED discharge program,
  asthma educators
• Environmental Training, advertising, small
  grants
• School Childcare Mini-grants for school
  nurses, continue trainings

10
How you can help!

• Need to demonstrate strong, statewide
  partnerships
• Must include letters of support from partners in
  the appendices of our application
• Strong letters of support will go a long way in
  helping us secure this funding
• See handout
• 5 minute exercise Skim state plan and look for
  specific objectives you your organization
  support

11
Environmental Interventions

• Page 18-19 of the plan
• Overarching goal Reduce exposure to
  environmental irritants and allergens
• Objectives
• Reduce exposure to ETS smoking in general
• Provide education and training
• Increase public awareness
• Support ongoing data collection
• Support initiatives that focus on at-risk groups

12
Grant application env. objectives

• Reduce exposure to ETS and reduce number of
  people with asthma who are current smokers
• Train professionals across the state to reduce
  exposure to asthma triggers, targeting healthcare
  providers, school maintenance staff and county
  sanitarians
• Support ongoing community based programs in low
  income, rural or Tribal communities through small
  grants

13
Environmental proposals for grant

• Tobacco smoke strategies (Year 1)
• Mobilize MAAG members to support full
  implementation of the CIAA
• Promote the Montana Quitline at asthma related
  events and conferences
• Partner with MTUPP to a create a targeted
  advertising campaign that details the link
  between smoking and asthma

14
Environmental proposals for grant

• Training strategies (Year 1)
• Ensure that the assessment and abatement of
  asthma triggers is an integral part of the AE-C
  review course curriculum
• Include IAQ information in asthma training of at
  least 100 school and/or child care providers
• Present IAQ and asthma information at the August
  2009 Greening Our Schools and Communities
  conference
• Present data on asthma triggers at the annual
  county sanitarian conference

15
Environmental proposals for grant

• Community based grant strategies (Year 1)
• Write and disseminate a proposal to provide
  supplemental funding to two community based IAQ
  programs in at-risk communities in Montana
• Through a review process, fund two programs that
  provide either IAQ assessment at homes or
  schools for persons with asthma or community
  based education on asthma triggers
• Track progress of grantees throughout the year

16
Questions for today

• What key asthma triggers should we be focusing on
  in Montana?
• Common
• Affect health
• Can be mitigated
• What population groups are most at risk for
  exposure to asthma triggers?

17
Data on triggers in Montana

• Smoking and Environmental Tobacco Smoke
• 22.5 of adults with asthma in MT are smokers
  including 39.8 of American Indian adults with
  asthma (2007 BRFSS)
• 13.3 of adults with asthma report that someone
  has smoked inside their home in the past week
  (2006 BRFSS Asthma Call-Back)
• 20.0 of Montana adults live with other adults
  who smokes 33.1 of children live with at least
  one smoker (2008 Adult Tobacco Survey)

18
Wildfires
In 2007, Montana ranked 14th out of the 50 states
for total number of wildfires and 5th for number
of acres burned. Source National Interagency
Fire Council
19
Pets and Pests
20
Ventilation and heating
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Trigger abatement
22
The great Dust Mite debate

• Are they an issue in Montana?
• Not much definitive, empirical data on the
  presence of dust mites in Montana
• Dust mites do not survive for prolonged periods
  in relative humidity below 45 or at altitude
  about 3000 ft
• Can survive in areas of human habitation where
  relative humidity is higher (mattresses, pillow
  cases)
• Recent debate about effectiveness of abatement
  (mattress covers etc)

23
The great Dust Mite debate

• Ian Foley MT State Entomologist
• Dust mites, family Pyroglyphidae, certainly
  do occur in the state, but like many plant and
  animal pests, the Montana climate is not
  hospitable to them. Dust mites do not survive
  very well in areas of low humidity, but dust
  mites probably would be able to survive in areas
  of human habitation that have increased relative
  humidity such as a damp basement or slightly
  warmer/wetter portion of the state like the
  Flathead and Bitterroot Valley's. While I think
  that dust mites certainly are present in the
  state I do not know if they are common or occur
  at high enough population levels to cause
  problems.

24
Other triggers

• Diesel and other motor vehicle exhaust
• Outdoor air pollution and particulate matter
  (particularly in areas with inversions)
• Cold weather, exercise, colds and other
  respiratory infections, household sprays and
  other VOCs
• Outdoor allergens like pollen

25
Now you get to vote!

• What key asthma triggers should we be focusing on
  in Montana?
• Common
• Affect health
• Can be mitigated
• Greenkey, important trigger
• Yellownominal trigger or one for which more data
  needs to be collected
• Redunimportant trigger, should not be focused on
  in MT
• What population groups are most at risk for
  exposure to asthma triggers?

26
Announcements

• Demo kits and educational materials Pick up
  yours today!
• Becoming an Asthma Educator and Care Manager
  Course April 24th in Bozeman
• EPA Region 8 Greening Our Schools and
  Communities Childrens Health Summit
  August 11th-13th in Missoula
• Breathe Well, Live Well Facilitator Training
  March 24th in Casper, WY 9 am to
  430 pm, funding available for travel and hotel