Breathless in Harlem: no one knows excatly what causes asthma, but many are convinced the primary culprit is air pollution, especially particles from burning diesel fuel. (World Reports).

Something is taking kids' breath away in a pocket-sized neighborhood in New York City, and the primary culprit is air pollution. Asthma rates among children within a 24-block area in central Harlem are five times higher than the national average, according to the Asthma Initiative, a program administered by the Harlem Hospital Center, the Harlem Children's Zone, and Columbia University's Mailman School of Public Health.

You would never think it meeting 10-year-old Taylor, who lives in the heart of the neighborhood. Her smile lights up her central Harlem street of peeling brownstones and apartment complexes. She plays with her friends on the dusty steps, running, climbing on the railings, and occasionally tickling her infant cousin, who also has asthma.

But her mother easily remembers how bad it was the first time Taylor was coughing and suddenly could not breathe. She rushed Taylor to the hospital and watched the doctors put her on a nebulizer--a machine that turns medication to a fine mist to better penetrate a patient's constricted airways. She was hospitalized for nearly four months, missing Thanksgiving, Christmas, and her birthday.

Robin Judd, Taylor's mother, has short-cropped hair shaded with silver. She speaks with the knowledge of someone who has done the research. She regularly battles her landlord and the city over issues like pest infestation and idling buses, knowing they trigger asthma attacks. Such factors are called triggers because they set an attack in motion--lungs inflame, airways constrict--as if a switch was flicked or a trigger was pulled.

The Asthma Initiative's goal is to screen every child in Taylor's neighborhood under 13 years old--all 2,400 of them--for asthma, and provide comprehensive services to those who have the illness. But midway through the screening, data showing that 25 percent of the children in the area have the illness shocked researchers.

Asthma kills about 5,000 people per year in the US but is not usually life-threatening if managed properly. But asthma costs. It's the number one cause of school absenteeism nationwide. Children with the illness who do make it to class are often too tired to pay attention or participate, since they have been kept awake struggling to breathe, or by their medications.

Children with asthma also make frequent and expensive trips to hospital emergency rooms. Annual treatment of asthma totals about $3.2 billion in the US, according to the American Lung Association. "Our main goal of the initiative is to end emergency room visits and missed school days," says Kellye Jackson of the Harlem Hospital Center.

No one knows exactly what causes asthma but many are convinced air pollution is a big factor, especially small particles emitted by burning diesel fuel, and smog from heavy traffic. "Although there may be a genetic predisposition to asthma, its growth in places like Harlem is almost certainly due to environmental hazards. Young people in a densely populated area like Harlem breathe more pollutants than suburban youth," said education writer Richard Rothstein in a New York Times op-ed.

Activists say asthma in Harlem, where 47 percent of families earn less than $10,000 per year, is a clear case of environmental injustice--poor people of color shouldering a disproportionate number of environmental insults. They cite specifics like the four out of five New York City Metropolitan Transit Authority bus depots located in poor neighborhoods.

The Natural Resources Defense Council says asthma attacks are often caused by the combustion of fossil fuels and the release of airborne particles, sulfur dioxide, and ground-level ozone.

A nurse on the central Harlem Asthma Initiative team who has personally visited about 50 families, Sandy Klihr-Beall, says "the environmental stuff really does make a difference." She ought to know. Sandy has had asthma for years, and keeps it under control through medicine and cleanliness. One child with asthma in central Harlem slept in a basement apartment five feet from a city bus stop. Judd says school buses often park on her street with their engines running.

The hundreds of other substances that lead to attacks include cigarette smoke, aerosols, paint fumes, dust, cold air, feathers, and molds.

The Asthma Initiative team is a squad of 12 professionals whose roster reads like a modern assault force on public health issues: doctors, statisticians, assistants, a manager, a social worker, and a community representative who doubles as a translator.

The asthma team battles the illness on four fronts--medical, educational, environmental, and social. Aside from screening every child, members conduct extensive education campaigns teaching parents how to administer the medicine and how to keep their homes as clean as possible. "Nine out of ten times it's educating the parents," says Jackson.

This can be challenging in central Harlem, where many of the families are new arrivals from developing countries. Verbal instructions as well as medication labels must be translated into many different languages. Delicate issues need to be addressed--such as explaining to one family, for example, that the family heirloom, an old dusty rug brought over from their country of origin, is likely not helping their child's asthma. If the parents smoke, they must be reminded their children are more likely to have asthma.

The team supplies vacuum cleaners, mattress covers, pest control services, and other services to help control triggers. In one rat-infested apartment where kids were sleeping on a mattress on the floor, says Doris Prester, a community social worker on the team, bunk beds were provided to get the kids farther away from potential allergens.

The team will also bring in a cleaning service and an exterminator if necessary. Once the big battles are solved, like beds off the floor, the team continues to provide advice, and health care when needed. "We want to empower families to take control of the asthma and not let the asthma take control of them," says Prester.