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A community-based participatory research partnership to reduce vehicle idling near public schools.

Introduction

Asthma is the most common chronic disease of childhood affecting almost 9% of children in the U.S. (Akinbami, 2006). The etiology of asthma is complex and includes a combination of genetic, demographic, social, and environmental factors. Exacerbation of existing asthma has been consistently demonstrated to be associated with traffic-related air pollution (TRAP) exposure (Delfino et al., 2004; McConnell et al., 2003; Trenga et al., 2006). Recent research suggests that exposure to TRAP is also associated with new-onset asthma (Carlsten, Dybuncio, Becker, Chan Yeung, & Brauer, 2011; Jerrett et al., 2008).

Recently, childhood exposure to air pollutants during the school day has received increased attention and community concern (Heath, 2011; Heath & Morrison, 2008). Moreover, a nationwide survey found that more than 30% of public schools in the U.S. are located within 400 m of a major roadway (Appatova, Ryan, LeMasters, & Grinshpun, 2008). Diesel-powered school buses at schools represent a significant source of TRAP, particularly ultrafine particles (UFP) with an aerodynamic diameter less than 100 nanometers. Diesel idling has also been identified as a significant factor in levels of elemental carbon near schools (Richmond-Bryant, Saganich, Bukieqicz, & Kalin, 2009). A recent case study demonstrated that school bus traffic significantly increases the total particle concentration and the concentration of diesel-associated elements, including manganese and iron, in the outdoor air near schools (Li et al., 2009).

In recognition of the potential health impact of idling buses and exposure to TRAP at schools, the U.S. Environmental Protection Agency (U.S. EPA) and many communities support efforts to reduce childhood exposure to diesel exhaust particles through anti-idling efforts, retrofitting of school buses with diesel oxidation catalysts, and the implementation of alternative fuels including low-sulfur diesel fuel (Hochstetler, Yermakov, Reponen, Ryan, & Grinshpun, 2011). The impact of these efforts on air quality and the health of asthmatic children while attending school remains unknown. In order to help quantify these effects, a Partnership in Environmental Public Health (PEPH) project between the University of Cincinnati (UC), the Cincinnati Public Schools (CPS), and the Cincinnati Health Department (CHD) was formed and the Cincinnati Anti-Idling Campaign (CAIC) was created. The goals of CAIC are to 1) determine if children are exposed to increased levels of TRAP, including UFP and diesel-related elements at schools; 2) develop and implement a community-driven anti-idling campaign to reduce exposure to TRAP at schools; and 3) evaluate the effectiveness of the research partnership and anti-idling campaign by assessing the reduction of exposure in schools and the impact on the health of children with asthma who attend these schools.

The overall CAIC involved two components: research and intervention. The research component was designed to generate air quality and health data to support the effectiveness of the intervention component. The intervention component was designed to educate the community through curriculum-based training and outreach. We have previously reported that idling buses are significantly associated with an increase in UFP concentration outside schools and result in outdoor to indoor movement of particles and elemental carbon (Hochstetler et al., 2011). The objective of this article is to describe the formation of a successful research partnership between academic environmental health researchers and community members that resulted in the development and implementation of a public health initiative to reduce TRAP exposure at schools.

Methods

Formation and Description of Partnership

The overall objective of CAIC was to develop and promote an effective anti-idling educational message aimed at decreasing children's exposure to TRAP and reduce asthma morbidity. This common goal provided the impetus for the formation of an academic-community partnership, in which environmental health researchers and community partners were able to each provide specific expertise and resources to address a specific concern. The formation of the academic-community partnership was based upon the community-based participatory research principles of active collaboration, colearning, ensuring culturally appropriate research and intervention, and the dissemination of results in a useful manner (O'Fallon & Dearry, 2002). The partnership was initiated through the exchange of research findings about sources of TRAP at schools and its likely impact on the health of asthmatic children who attend those schools. In response, key community members provided feedback on realistic strategies to reduce exposure to TRAP at schools. The initial exchange of information, ideas, and expertise laid the foundation for CAIC with UC researchers offering to provide technical expertise about air sampling, health assessments, and epidemiologic methods. In exchange, CHD and CPS community partners were tasked to lead the intervention efforts (i.e., anti-idling campaign) and disseminate study findings.

Other key community partners included, but were not limited to, a school-specific campaign coordinator and school principal, First Student (the school bus service company), Hamilton County Department of Environmental Services, Growing Well Cincinnati (a local child health organization), WCET (a local public television station), and Alliance for Leadership and Interconnection (a nonprofit organization to develop and manage the production of a project-specific anti-idling training video).

CAIC Development and Implementation

The approach taken for CAIC focused on maximizing the use of existing resources and building upon them to produce a highly effective campaign. CAIC also aimed to empower the community with knowledge to support and promote the health initiatives while generating a sustainable campaign for future use. Activities for the public health intervention were divided into four components: 1) campaign research and development (August 2009-July 2010); 2) campaign implementation and completion (August 2010-July 2011); 3) online training video development (August 2010-July 2011); and 4) U.S. EPA's Tools for Schools review and implementation (August 2009-July 2011).

Campaign Research and Development Four CPS schools were selected to participate in CAIC. These four schools were selected because of the prevalence of reported asthma among the student population and potential exposure to TRAP from nearby major roads and idling school buses (Hochstetler et al., 2011). The long-term goal of CAIC was to establish anti-idling campaign methods effective at the four selected schools. This in turn would serve as a model and utilize the information gathered to further spur implementation of the intervention strategies throughout the CPS district.

Initial steps included developing key contacts with each participating school and with community partners. This group then strategized to develop campaign goals, activities, and desired outcomes, and existing resources available for use were identified. Augmentation of existing resources was done based on need along with the development of other project materials (campaign templates, curriculum revisions, administrative programs, communications, and training video, etc.).

One key component to the anti-idling campaign was an educational program that was presented to all CPS school bus drivers. In the summer prior to the campaign implementation (June 2010), footage of school bus exhaust was filmed and edited. From this material, CHD and First Student Group jointly developed an anti-idling video for the bus drivers' in-service training program. In addition, a presentation was created detailing the rationale behind the anti-idling campaign, which emphasized the increase in particulate exposure due to idling that may result in negative health effects on both children and adults. A scenario designed to simulate school buses arriving and idling in a "caravan" was created for air sampling by using a P-Trak particle counter. In the simulated scenarios two school buses were lined up and sampling was conducted near the driver's seat to capture potential exposure for the driver. The bus engines were turned off until the air particulate levels in the area of the bus driver's seat reached background concentrations. Once the background levels were reached in the area of the bus driver's seat, the engines were started and remained running in idle (Ohio Revised Code 3717.42) for six minutes. The concentration of ambient particles was measured near the driver's seat on the second bus at one-minute intervals during those six minutes. After six minutes the particulate level was measured again (outside the buses) to simulate a student walking through the exhaust towards the school.

Campaign Implementation

The campaign implementation took the form of school bus service educational presentations, schoolwide educational assemblies kicking off parental pledge drives, staff educational challenge (online video and survey), and a variety of community engagements.

A presentation for use during the school bus driver annual training was developed by CHD. This presentation reemphasized the information presented in the video and highlighted the impact of diesel particulates upon the driver's health. Drivers were asked to sign a pledge card to reduce idling. Knowledge gained by the drivers during the driver education program, video, and PowerPoint presentation was assessed by comparing knowledge based on a pre- and posteducation test. A paired t-test using SPSS software was used to analyze all pre- and posttest data.

Teachers at the participating schools were briefed on the program through an informational letter that clearly outlined the process and the goals of the program. The three classrooms at each school with the highest percentage of pledge cards completed by parents and returned to school earned a classroom incentive. Participating teachers in the classroom pledge drive received a gift, and those in the winning classrooms received a special thank you note. In addition to outreach efforts to students and parents, idling reduction signs were placed at the participating schools.

Parents of children at the participating schools received idling reduction packets that included a letter describing the program, a fact sheet, and pledge forms. The materials were sent home with the students at the same time that "air-quality assemblies" were offered at their schools. Parents were asked to read the idling reduction message and sign and return the pledge forms. Signed pledge forms by parents were considered essential by CAIC to assist with anti-idling activities within a five-day time period. Both the student and the parent were awarded incentive items in recognition of having turned in the signed pledge form.

Monitoring of vehicle idling duration during school drop off or pick up times was conducted for five days at one of the four participating schools, in order to establish idling practices pre- and post-anti-idling campaign activities.

Online Training Video Development

A nonprofit organization was contracted to develop and manage the production of a project-specific anti-idling training video. Additionally, a public service announcement and a storybook were developed with narration from district students and other key individuals. This video is currently used across the CPS district as a promotional tool and is available online at www. cps-k12.org/.

U.S. EPA Tools for Schools

An indoor environmental quality (IEQ) management program was developed based upon the U.S. EPA's Indoor Air Quality Tools for Schools kit with several key objectives: 1) reduce the levels of indoor air pollutants through preventive measures such as routine maintenance activities, periodic building evaluations and inspections, and IEQ-specific procedures; 2) provide and maintain adequate air exchanges by repairing and maintaining ventilation equipment, which will promote a comfortable and healthy learning and working environment; 3) provide response to IEQ-related concerns in a thorough and time-sensitive manner, and effectively communicate the progress of investigations and their resolution to all interested parties; and 4) provide information and training for staff and the community on environmental health and safety issues.

Results

The school bus idling demonstration utilized two school buses provided by First Student. The first bus was a new 2010 model and the second bus was an older model that was less than five years old. The sampling was conducted midmorning in July and it was 83[degrees]F and sunny with no wind. The background concentration for airborne particulate matter (without bus engines running) in the area was found to be 7,700 particles/cc. Measurements were then taken inside the bus at the driver seat location. One minute after the buses were started and allowed to idle, the particle count increased to 16,500 particles/ cc with subsequent elevation in particle concentration ranging from 10,600 particles/ cc to 27,200 particles/cc over a six minute period of time (Figure 1). These values varied with specific activities performed by the driver during the sampling period including opening the side window and turning on the driver fan to increase ventilation.

Ambient particulate readings were also measured outside the buses after the buses idled for six minutes along a path the students would follow when exiting the bus and walking toward the school entrance to simulate students' exposure to diesel particulates. At the front door of the first bus the particulate level was 9,500 particles/cc, and midway past the first bus the particulate level was 14,700 particles/cc. The particulate level at the back of the first bus and front of the second bus was 26,500 particles/cc, the level at the midpoint of the second bus was 17,100 particles/ cc, and the level at the rear of the second bus was >50,000 particles/cc (Figure 2).

In total, 397 bus drivers signed pledges to reduce idling. Pre- and posteducation assessments were completed by bus drivers with the posteducation assessment done at the conclusion of the education program. A total of 324 drivers completed both tests and demonstrated a significant increase in idling knowledge (7.3/10 to 8.5/10 correct answers, p < .05). Three of the four schools actively participated in parent pledge drives, kicked off by schoolwide "air quality" assemblies that focused on idling reduction education. The percentage of pledge cards signed by parents was 42% at school #1 (n = 496), 21% at school #2 (n = 698), and 41% at school #3 (n = 370).

Study personnel from CHD and CPS attended open houses and other community and school assemblies to educate parents, teachers, and students on the importance of reducing vehicle idle time. A total of 53 pre- and posteducation tests were given in the three open houses. The mean of the pre- and posttest was 2.5/4 correct answers, which significantly increased to 3.6/4 after an educational intervention during open houses (p < .05). In addition, an online survey was completed over two and a half weeks by administrators and staff at CPS. Two hundred ninety people provided responses to all seven questions on the pretest. After a brief training video, 214 people completed the posttest. The questions and results of the posttest are presented in Table 1. Additionally, the final question (question 7) asked, "You feel you will, based on the information provided, try to idle as little as possible." The respondents chose to reduce idling 40% more than before the training, with n = 210 indicating their intention to reduce idling.

The results of vehicle idle time monitoring conducted by staff and students at one participating school before and after the education intervention are presented in Figure 3. Ten buses were monitored preintervention at pickup and drop off; nine buses were monitored postintervention at pickup and drop off. The buses idled an average of 289 seconds during arrival preintervention, which was reduced to 116 seconds following the anti-idling intervention. The mean number of vehicles preintervention at drop off was 61 and at pickup was 35; postintervention, the number of vehicles was 41 at drop off and 28 at pickup. The average amount of time that private vehicles idled during arrival preintervention was 29 seconds, compared to the postintervention average of 24 seconds. For departures, the buses idled an average of 397 seconds preintervention and 78 seconds postintervention. Vehicles picking up children idled for 244 seconds preintervention and idled for 79 seconds post intervention.

Discussion

We sought to develop a bidirectional community-academic partnership and establish the CAIC by collaborating with community partners and stakeholders to integrate health education and healthy habits into the learning environment. The objective of the research team was to impart education to the community on ways to minimize air pollution by decreasing vehicle idling not only around the school environment, but throughout the community. The research partnership developed, implemented, and communicated an anti-idling campaign while simultaneously conducting air sampling and health assessments to determine its effectiveness. The rate of pledge cards returned, the increase in bus driver and community knowledge, and observed decrease in vehicle idling time demonstrate the effectiveness of the campaign and partnership.

We identified bus drivers as key stakeholders in our campaign and sought to involve them and their employer from the onset of the project. Working cooperatively with the bus drivers and company allowed us to provide education about the health effects of diesel exhaust. Our collaboration with the bus operators also provided us the opportunity to simulate a bus idling scenario and demonstrate, with supportive data, the impact of bus idling on particle concentrations and potential exposure to students and drivers (Figures 1 and 2). The rate of pledge cards returned by the bus drivers suggests bus drivers are willing participants in an anti-idling campaign, particularly when informed of the impact that idling has on ambient air quality.

The bus driver education was reinforced by vehicle idling monitoring by students and staff at one school. During morning drop off and afternoon pickup, students and staff reminded bus drivers of the importance of reducing vehicle idling by handing him or her a water bottle, and a postcard signed by the school staff thanking them for not idling along with a key chain and a fact sheet reminding them of school and company policy. For arrivals, a 60% reduction in bus idling time and a 15% reduction in private car idling time occurred. For departures, an 80% reduction in bus idling time and a 68% reduction in private car idling time occurred.

Parents, students, administrators, and teachers at the participating schools were also involved in the successful implementation of the campaign. The return rate of the parent pledge cards to reduce idling demonstrated family participation and engagement in the campaign. A lack of time and not owning a vehicle, rather than lack of relevance, were the most frequently cited reasons for not participating in the parent pledge drive. The significant increase from the pre- to posttest scores indicated that the parents, teachers, and students understood the health effects of idling of vehicles. The online survey strongly supported the need to consistently educate school personnel on policies that impact students' health. After viewing the video on the impacts of idling and comparing those with the CPS anti-idling policies, CPS administrators and staff responses to the survey improved. Feedback on the survey was positive with improved awareness of a policy that had already been in existence.

Limitations to our study include the limited period of follow-up, the voluntary nature of participating in the assessments, and the limited observational data of idling at some schools. In addition, individual interpretation of pre- and posteducation assessments may result in biased results of the impact of the campaign. Objective data, however, support the successful implementation of the campaign including the observed reduction in vehicle idling time. In addition, as part of CAIC, air quality data will be collected to assess the impact of the campaign on reducing air pollutant exposure at schools.

In order to maintain the success of CAIC, anti-idling signs were placed near the schools to serve as a messaging tool and reminder for parents and guardians to turn off their vehicle engines while dropping off and picking up students. An IEQ management program was also initiated to assist schools and individuals in getting involved at a local, school-based level in efforts to improve air quality. This IEQ team will be knowledgeable in using the information and training methods provided by the U.S. EPA Tools for Schools program that has been successfully utilized by other school districts.

The districtwide anti-idling policy was also reviewed in collaboration with partners and stakeholders. The research team reviewed the current Ohio law regarding school bus idle times in school loading zones (Ohio Administrative Code 3301-83-20) and compared these to legal idle restrictions effective in other states, the bus company's areawide effort to minimize idling in school loading zones, and the district's current "bus idle protocol." Revised policies and the protocols were incorporated into CPS board policy in fall 2010 and included limiting bus idling times to no more than five minutes in school loading and unloading zones (in accordance with Ohio law).

A grant Web site was also developed to house grant-related resources in addition to information about the project status, to promote sustainability. This site (www.cps-k12. org/) was intended to help facilitate ongoing efforts of any public entity to initiate an antiidling campaign by providing ease of access to resources including training materials, videos, campaign promotional templates, and links to other easy-to-use materials.

Conclusion

Our goal was to implement an effective public health initiative aimed at reducing traffic-related air pollution exposure within the school community. Based on our assessments, we have demonstrated that a community driven public health initiative can be effective in both 1) enhancing community awareness about the benefits of reducing idling vehicles; and 2) increasing active participation in idling reduction. Our partnership has continued to grow toward a sustainable process and other school communities are taking advantage of resources developed. Additional partner connections have developed whereby the curriculum and materials are being integrated into after-school and community mentoring and educational programs. Future research is planned to assess the impact of the anti-idling campaign on air quality at schools and on the health of asthmatic children who attend these schools.

Acknowledgements: The study was part of a large research grant funded through the National Institute of Environmental Health Sciences (# R21ES017957). We are thankful to the Alliance for Leadership and Interconnectivity, to Cincinnati local television station WCET, and the CHD for assistance in the production and editing of the videos that will be part of the video library. We are also grateful to Hamilton County Department of Environmental Services for providing the anti-idling signs and assisting in the school-wide air quality assemblies for this project through their anti-idling support program.

Corresponding Author: Patrick H. Ryan, Assistant Professor of Pediatrics and Environmental Health, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5041, Cincinnati, OH 45229. E-mail: Patrick. Ryan@cchmc.org.

References

Akinbami, L. (2006). The state of childhood asthma, United States, 1980-2005. Advance Data, 381, 1-24.

Appatova, A.S., Ryan, P.H., Lemasters, G.K., & Grinshpun, S.A. (2008). Proximal exposure of public schools and students to major roadways: A nationwide U.S. survey. Journal of Environmental Planning and Management, 51(5), 631-646.

Carlsten, C., Dybuncio, A., Becker, A., Chan-Yeung, M., & Brauer, M. (2011). Traffic-related air pollution and incident asthma in a high-risk birth cohort. Occupational and Environmental Medicine, 68(4), 291-295.

Delfino, R.J., Quintana, P.J., Floro, J., Gastanaga, V.M., Samimi, B.S., Kleinman, M.T., Liu, L.J., Bufalino, C., Wu, C.F., & McLaren, C. (2004). Association of FEV1 in asthmatic children with personal and microenvironmental exposure to airborne particulate matter. Environmental Health Perspectives, 112(8), 932-941.

Heath, B. (2011, June 13). EPA's tests of air outside schools find problems. USA Today. Retrieved from http://www.usatoday.com/ news/nation/environment/2011-06-09-air-pollution-schools_n. htm http://www.usatoday.com/news/nation/environment/201106-09-air-pollution-schools_n.htm

Heath, B., & Morrison, B. (2008, December 9). Air tests reveal elevated levels of toxics around schools. USA Today. Retrieved from http://www.usatoday.com/news/nation/environment/school-airmonitoring1.htm

Hochstetler, H.A., Yermakov, M., Reponen, T., Ryan, P.H., & Grinshpun, S.A. (2011). Aerosol particles generated by diesel-powered school buses at urban schools as a source of children's exposure. Atmospheric Environment, 45(7), 1444-1453.

Jerrett, M., Shankardass, K., Berhane, K., Gauderman, W.J., Kunzli, N., Avol, E., Gilliland, F., Lurmann, F, Molitor, J.N., Molitor, J.T., Thomas, D.C., Peters, J., & McConnell, R. (2008). Traffic-related air pollution and asthma onset in children: A prospective cohort study with individual exposure measurement. Environmental Health Perspectives, 116(10),1433-1438.

Li, C., Nguyen, Q., Ryan, P.H., LeMasters, G.K., Spitz, H., Lobaugh, M., Glover, S., & Grinshpun, S.A. (2009). School bus pollution and changes in the air quality at schools: A case study. Journal of Environmental Monitoring, 11(5), 1037-1042.

McConnell, R., Berhane, K., Gilliland, F., Molitor, J., Thomas, D., Lurmann, F., Avol, E., Gauderman, W.J., & Peters, J.M. (2003). Prospective study of air pollution and bronchitic symptoms in children with asthma. American Journal of Respiratory Critical Care Medicine, 168(7), 790-797.

O'Fallon, L.R., & Dearry, A. (2002). Community-based participatory research as a tool to advance environmental health sciences. Environmental Health Perspectives, 110(Suppl. 2), 155-159.

Richmond-Bryant, J., Saganich, C., Bukiewicz, L., & Kalin, R. (2009). Associations of PM and black carbon concentrations 2.5 with traffic, idling, background pollution, and meteorology during school dismissals. Science of the Total Environment, 407(10), 3357-3364.

Trenga, C.A., Sullivan, J.H., Schildcrout, J.S., & Shepherd, K.P., Shapiro, G.G., Liu, L.J., Kaufman, J.D., & Koenig, J.Q. (2006). Effect of particulate air pollution on lung function in adult and pediatric subjects in a Seattle panel study. Chest, 129(6), 1614-1622.

Cynthia Eghbalnia, MPH, CIH

Cincinnati Public Schools

Ken Sharkey, MPH, RS

Cincinnati Health Department

Denisha Garland-Porter, MPH, RS

Division of Biostatistics and Epidemiology,

Cincinnati Children's

Hospital Medical Center

Mohammad Alam, Phd

Marilyn Crumpton, MPH, MD

Camille Jones, MPH, MD

Cincinnati Health Department

Patrick H. Ryan, PhD

Division of Biostatistics and Epidemiology,

Cincinnati Children's

Hospital Medical Center

Department of Environmental Health,

University of Cincinnati

Table 1

Results of Pre and Post Online Training Questions and Responses
Completed by Cincinnati Public Schools (CPS) Staff and Administrators

Question                                    Correct   Pretest
                                            Answer    Correct

1. Does CPS have an anti-idling policy?      True       35%
2. Does the yellow bus service provider      True       35%
  for CPS have an anti-idling policy?
3. It is important to warm up the engine     False      74%
  with an idling period of 5 minutes or
  more, especially in cold weather.
4. It is better for an engine to run at      False      78%
  low speed (idling) than to run at
  regular (i.e., 30 mph) speed
5. Children and adults are equally           False      90%
  sensitive to air pollution.
6. It is better to leave the engine          False      54%
  idling because a "cold start" produces
  more pollution.

Question                                    Posttest   Improvement
                                            Correct

1. Does CPS have an anti-idling policy?       97%         177%
2. Does the yellow bus service provider       94%         169%
  for CPS have an anti-idling policy?
3. It is important to warm up the engine      97%          31%
  with an idling period of 5 minutes or
  more, especially in cold weather.
4. It is better for an engine to run at       93%          19%
  low speed (idling) than to run at
  regular (i.e., 30 mph) speed
5. Children and adults are equally            97%          8%
  sensitive to air pollution.
6. It is better to leave the engine           69%          28%
  idling because a "cold start" produces
  more pollution.
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Title Annotation:ACVANCEMENT OF THE SCIENCE
Author:Eghbalnia, Cynthia; Sharkey, Ken; Garland-Porter, Denisha; Alam, Mohammad; Crumpton, Marilyn; Jones,
Publication:Journal of Environmental Health
Geographic Code:1U3OH
Date:May 1, 2013
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