Online for Asthma

The landscape may be rural and the views pristine, but three western Warren County towns seem to have unusually high rates of childhood asthma and other respiratory complaints. Parents and town officials believe that environmental problems are the cause, and they want answers: Are the kids living in White, Belvidere and Harmony townships at greater risk for breathing problems, and if so, why?

The towns have turned to two UMDNJ researchers with expertise in studying the links between asthma and outdoor air pollutants. A $3.1 million fine against Roche Vitamins Inc.–which two years ago admitted to releasing excessive toxic chemicals into the air from its manufacturing plant in Belvidere–will be applied to various community projects. One undertaking will provide epidemiologist Stanley H. Weiss, MD, a UMDNJ-New Jersey Medical School associate professor of preventive medicine and community health, and Clifford P. Weisel, PhD, professor of environmental and community medicine at UMDNJ-Robert Wood Johnson Medical School, with $180,000 to design surveys and analyze data relating to asthma prevalence among the towns’ children. Both investigators hold faculty appointments at UMDNJ’s School of Public Health. Weiss is also chair of the epidemiology section of the New Jersey Public Health Association.

Also under scrutiny are emissions from a major power generating plant in eastern Pennsylvania, near this area. Sulfur dioxide in the air has already been found to exceed nationally mandated levels. New environmental monitoring stations are being constructed in Belvidere to measure sulfur dioxide and other pollutants around-the-clock.

In household surveys conducted by community groups in White Township and Belvidere, asthma rates reported by residents were high, exceeding 20 percent in the 10 - to 20-year age group. According to Weiss, these surveys validated the need for further study of asthma in the region. The new UMDNJ studies will use a standardized approach to data gathering and analysis to determine if, in fact, the asthma prevalence is higher than normal. The epidemiologist designed a survey which was distributed to students in grades kindergarten through 12 in all of the towns’ public schools. Weiss expects more than 1,000 returns by late fall.

The survey’s first eight questions are those used on the standardized ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire, so that responses can be compared to national and international data. Additional questions ask about environmental smoke exposure, whether asthma was diagnosed by a physician and at what age, and whether the child has a computer with Internet access at home. Only children with asthma diagnosed by a doctor will be in the follow-up study. If the child has symptoms of asthma, the researchers will suggest follow-up by a physician. That child can then enter the study if a positive diagnosis is made.

All of these steps will most likely lead to the identification of 100 to 200 students in grades 5 through 12 with physician-diagnosed asthma to participate in the project. After a pilot group tests the forms, Weiss and Weisel will kick off what looks to be a first-of-its-kind clinical research study where all data collection will be done via the Web.

The participants will first answer a more detailed baseline questionnaire, including the names as well as dosages of all drugs used. Then each child will be asked to log onto the Web every day for approximately two months–either at home or at school to fill out a short form, recording any breathing problems, what medications and dosages they are using that day, and general health status. They will also self-measure their respiratory peak flow rate daily using a hand-held device, an approach in-creasingly being urged as part of asthma management action plans.

The investigators know that kids often need incentives to complete daily chores. They will pay the children for each day they submit the form; and each week, every child who completes the form every day is entered into a lottery for prizes.

By the end of December, the researchers hope to have enough data for an initial analysis. They will identify the correlation, if any, between hourly sulfur dioxide levels and worsening asthma symptoms and determine whether to continue the approach in the spring.

The investigators have been funded by the CDC to continue their studies in the region for three years to compare local industrial emissions to school absenteeism due to asthma.