Ashley A. Lowe

Climate change has intensified wildfire frequency and severity across North America, creating air quality challenges for urban areas both near and far from fire sources. While health effects of wildfire smoke are well-documented, its association with educational outcomes remains poorly understood. This study investigates associations between wildfire smoke and student attendance patterns across sociodemographic subgroups in New York City (NYC) public schools. We conducted a population-based time-stratified case-crossover study analyzing 2.11 million school-days from 1,443 NYC K-12 public schools between the 2011-2012 and 2018-2019 academic years. At the school level, we linked daily student attendance data with wildfire-specific fine particulate matter (PM2.5) concentration estimates, meteorological conditions, and school-level sociodemographic characteristics. Using a case-crossover design with date-clustered inference, we examined associations between daily wildfire smoke exposures and school-level absence rates. We conducted stratified analyses by school level and performed effect modification analyses across racial/ethnic composition, economic need and free/reduced lunch, English language learner status, special education enrollment, and tree canopy cover. Economic impacts were estimated using the US Environmental Protection Agency Benefits Mapping and Analysis Program framework. Wildfire smoke was associated with higher absence rates on the same day of exposure (rate ratio [RR] = 1.13; date-clustered 95% CI: 1.02-1.26), with significant effects in elementary schools (RR=1.11, 95% CI: 1.01-1.21) and middle schools (RR=1.15, 95% CI: 1.06-1.25), but not high schools (RR=1.10, 95% CI: 0.97-1.23). We did not find any effect modification by school-level demographic factors or tree cover. Economic analysis estimated annual losses of $69.7 million (95% CI from RR uncertainty: $37.2-$110.8 million). These findings reveal disparities in educational settings where environmental stressors compound existing inequities. Targeted interventions – including improved school air filtration and enhanced air quality monitoring – may help protect student health and educational equity.

To reduce chronic school absenteeism and morbidity and mortality among school-aged children, the prompt administration of albuterol sulfate in schools remains vital. School-based stock inhaler programs are a practical approach to ensure equitable access to life-saving rescue medication for students. School and community partnerships can potentially strengthen program implementation and fidelity by integrating evidence-based practices into routine care. We report the findings of a novel practice facilitation model developed by the Maricopa County Department of Public Health to facilitate the implementation of the Stock Inhaler for Schools Program in K-12 Schools. Three-hundred twenty-four schools participated in the program, with 153 schools reporting a stock inhaler event for a total of 1,310 events across four school years. Most events (78%) were compliant with the protocol for administering the stock inhaler to a student. These findings suggest that implementing a practice facilitation model is feasible and important for enhancing fidelity to program requirements.

Background: Asthma affects approximately 8.2% of United States school-aged children, with a significantly higher prevalence among socioeconomically disadvantaged minority children. Among Diné (Navajo) children living on the Navajo Nation, asthma rates exceed 20%. The community asthma program (CAP) was developed in partnership with the Navajo Nation following a year-long community engagement process. CAP is a 7-year, multicomponent, evidence-based intervention designed to improve asthma management within Indian Health Service facilities and Diné K-12 schools. Purpose: This study evaluates CAP’s implementation processes and outcomes using document analysis, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR) frameworks. We describe our data sources, coding methods, and their contributions to understanding implementation, as well as discuss strengths, limitations, and implications for process evaluation. Methods: CAP research documents were collected from the 2017 community engagement period through the intervention’s conclusion in 2023. When COVID-19 limited access to implementation settings, additional data sources, including email correspondence and meeting minutes, were analyzed using document analysis to examine activities, experiences, and attitudes related to CAP implementation. Results: Multiple data sources, including RE-AIM forms, staff interviews, and research team documents, identified key process indicators and explanatory factors. While these sources provided valuable context, system- and provider-level fidelity indicators are needed to fully assess intervention reach and quality. Conclusions: Findings underscore the importance of collecting process data throughout implementation and leveraging diverse data sources to capture the local implementation context comprehensively. Clinical Trial Information: The Clinical Trials Registration # NCT03377647.

Immunogenicity studies suggest that recombinant influenza vaccine (RIV) may provide better protection against influenza than standard-dose inactivated influenza vaccines (SD IIV). This randomized trial evaluated the relative vaccine effectiveness (VE) and immunogenicity of RIV versus SD IIV in frontline workers and students aged 18–64 years. Participants were randomized to receive RIV or SD IIV and followed for reverse-transcription polymerase chain reaction (RT-PCR)–confirmed influenza during the 2022–2023 influenza season. Sera were collected from a subset of participants before and at 1 and 6 months postvaccination and tested by hemagglutination inhibition for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria and against cell-grown vaccine reference viruses for A/H1N1 and A/H3N2. Overall, 3988 participants were enrolled and vaccinated (25% of the trial sample size goal); RT-PCR–confirmed influenza occurred in 20 of 1963 RIV recipients and 28 of 1964 SD IIV recipients. Relative VE was 29% (95% confidence interval [CI], −26% to 60%). In the immunogenicity substudy (n = 118), the geometric mean titer ratio (GMTR) comparing RIV to SD IIV at 1 month was 2.3 (95% CI, 1.4–3.7) for cell-grown A/H1N1, 2.1 (95% CI, 1.3–3.4) for cell-grown A/H3N2, 1.1 (95% CI, .7–1.6) for B/Victoria, and 1.4 (95% CI, .9–2.0) for B/Yamagata. At 6 months, GMTRs were >1 against A/H1N1, A/H3N2, and B/Yamagata. Relative VE of RIV compared to SD IIV did not reach statistical significance, but RIV elicited more robust humoral immune responses to 2 of 4 vaccine viruses at 1 month and 3 of 4 viruses at 6 months after vaccination, suggesting possible improved and sustained immune protection from RIV. Clinical Trials Registration. NCT05514002.

Tobacco farm laborers are primarily women and children working for very low wages. The aim of this study was to explore occupational and reproductive health challenges faced by women tobacco farm laborers in Mysore District, India. We conducted interviews and six focus group discussions among 41 women tobacco farm laborers. Codes and themes were generated based on deductive and inductive approaches using the socioecological model. Participants reported symptoms of green tobacco sickness including headaches, back pain, gastric problems, weakness, and allergies during menstruation, pre-natal, and post-natal periods. Participants had poor awareness about the health effects of tobacco farming, and there were gender inequalities in wages and the use of personal protective equipment. Participants received support from family and community health workers during their pregnancy and post-natal period. Women reported wanting maternity benefits from the tobacco board, as well as monetary support and nutritional supplements. There is a need for health education about the environmental dangers of tobacco among farm laborers, and more supportive policies for women farmworkers during pregnancy and post-natal periods.

Indian tobacco farm laborers are primarily women and children working for very low wages. The aim of this study was to explore occupational and reproductive health challenges faced by women tobacco farm labors in Mysore District, India. We conducted interview and six focus group discussions among 41 women tobacco farm laborers. Codes and themes were generated based on deductive and inductive approaches using the socio-ecological model. Participants reported symptoms of green tobacco sickness including headaches, back pain, gastric problems, weakness, and allergies during menstruation, pre-natal, and post-natal periods. Participants had poor awareness about the health effects of tobacco farming and there were gender inequalities in wages and use of personal protective equipment. Participants received support from family and commu-nity health workers during their pregnancy and post-natal period. Women reported wanting ma-ternity benefits from the tobacco board, monetary support, and nutritional supplements. There is a need for health education about the environmental dangers of tobacco among farm laborers, and more supportive policies for women farmworkers during pregnancy and post-natal periods.

A stock inhaler program provided access to rescue medication (albuterol sulfate) for school children. School staff were provided with a standardized protocol for medication administration. We hypothesized licensed nurses were more likely to report compliant events compared to unlicensed school staff. Stock inhaler events were defined as either compliant or non-compliant. A school protocol compliance score was calculated using the total number of compliant events divided by the total number of all events. The protocol for administration indicated 4 puffs for mild respiratory distress and 8 puffs for severe respiratory distress; therefore, events were defined as compliant if the dose of medication was divisible by 4. A Cragg Poisson hurdle regression was used to examine the association between compliance score and school staff experience. One-hundred fifty-two schools reported 999 stock inhaler events. Of these events, 28% were compliant and 72% of events were non-compliant. After controlling for school organizational type, grades served, and school size, school staff experience was not predictive of protocol compliance. Future efforts should focus on improving protocol compliance among licensed nurses and unlicensed school staff.