Table 4.

Suggestions for positive change promoting awareness and increased respiratory health for children residing in region with chronic poor air quality

Key stakeholders	Suggestions for improvement
Policy development	Development of local, state and federal level policies to address exposure to children from community based railyard industries
	Encourage air quality monitoring around schools near major railyard sources
School districts and boards	Consider development of vegetation borders for schools near major pollution source; strategic planning, urban vegetation has been shown to reduce atmospheric pollutants
	Encourage planting of allergen friendly plants for landscaping. Contact local Masters Gardner Programs or American Horticulture Society (www.ahs.org)
	Contact a local Breathmobiles® mobile clinic in your area and have the school as a designated site, or work with local medical institutions to provide follow-up care for those in need. Mobile clinics are effective in reaching underserved communities and providing cost-effective preventive health services
	Promote “allergy and asthma friendly” school campuses through best practices to eliminate asthma triggers. The U.S. Department of Health and Human Services has more information: (http://www.nhlbi.nih.gov/health/prof/lung/asthma/asth_sch.pdf)
	Implement higher efficiency filtration for use within schools, to help reduce pollutants from exposing children inside the building
Principals	Work with local American Lung Association (ALA), county health departments, medical and academic institutions to increase educational opportunities for students, parents and school personnel
	Routine monitoring of daily air quality measurements (www.airnow.gov). Use air quality levels to determine outdoor activities and if needed modify such as encouraging a walking recesses (i.e. no basketballs distributed or equipment that encourages running) or indoor recess
Teachers	Encourage allergen free environments in the classroom, to reduce likelihood of encountering asthmatic triggering agents.
School health care providers	Offer routine, annual respiratory screening for all children, through validated screening survey
	Offer referrals for children in need of additional medical support
	Encourage linking of families in need to educational and resource support for managing respiratory conditions
Local community physicians	Physicians, especially pediatricians and family practice providers, potentially offer more routine screening for children in areas with chronic poor air quality. Alarmingly, studies have identified that as many as 15 % of children in urban settings may experience undiagnosed asthma
	Work with school districts on referrals for children identified through the annual school health screening as potentially having a respiratory condition
	Provide trainings for school personnel to keep current on best practices for respiratory health in their school
	Provide local health fairs to increase awareness, respiratory screening and resource linkage for those in need
Academic/research institutions	Conduct larger scale follow-up studies to assess for potential health impacts (i.e. respiratory, cognitive function, behavioral health, obesity)
	Develop and implement creative strategies to promote health and wellness for the community; providing a major resource for promoting a resilient community