Advancing Health Equity in Asthma Control through EXHALE Strategies - Vermont (VT) is among the top five highest rates of adult asthma in the U.S. Approximately 60% of adults and 61% of children in VT have uncontrolled asthma leading to a lower quality of life and high healthcare costs. Vermonters with asthma are more likely to have depression, arthritis, chronic obstructive pulmonary, cardiovascular, and chronic kidney diseases than those without asthma and report only poor or fair general health. 53% of adults with asthma have work-related asthma and on average miss 10.5 days of work/year (ACBS 2021, CACBS 2019-2021). While the rate of emergency department (ED) visits for asthma has been declining since 2016, the 2021 rate, 17.1 per 10,000 Vermonters, is still high. Asthma does not affect all Vermonters equally. Black or African American adults are more likely to visit the ED for a primary cause of asthma than any other racial or ethnic group in Vermont. Those who smoke, have a disability, rent, or have a household income of less than 250% of the federal poverty level are more likely to have asthma than the general population. There is significant intersectionality among these populations and those with less than a high school education and those insured by Medicaid. VAP was created in 2000 through funding from the CDC’s National Asthma Control Program and over the next 4 years will build on its foundation of accomplishments using its evaluation learnings, organizational capacity including the Asthma Advisory Panel and AS-ME Network, and its parthers to develop a more accessible, inclusive, and guideline-based system of care for populations with high asthma burden. VAP will strategically expand EXHALE strategies and improve organizational strength to advance health equity and establish greater sustainability, contributing toward achieving CDC goals of reducing asthma-related ED visits, hospitalizations, mortality, and disparities. Priority populations include: 1) BIPOC communities; 2) children with uncontrolled asthma; and 3) Vermonters of low socioeconomic status, including Medicaid members and underinsured. Additional populations to be reached through collaboration include: 4) those exposed to secondhand smoke, including children, pregnant, new parents; 5) those who smoke; 6) renters and/or Vermonters whose homes have caused or worsened their health conditions; 7) those with a disability, 8) those at risk of work exposures; and 9) students in schools with high asthma prevalence and low asthma action plans. VAP aims to employ all six evidence-based strategies within CDC’s EXHALE framework in all four settings and use multi-component, cross-sectoral approaches to expand accessible services and collaborations with community members to address systems-level, environmental, and social drivers of health disparities to better address gaps and needs among priority populations, increase tailored health supports, address cultural and linguistic barriers to care and improve coordination of care across settings. New partnerships with community-based organizations are selected for greater reach into communities of priority populations, and will involve schools, healthcare systems, family centers, and families in the communities of focus. VAP will strengthen its infrastructure in surveillance, data-driven decision making, evaluation, culturally informed communications, upstream prevention strategies and policy efforts to improve air quality, decrease smoking and exposure, and support climate plus health and health plus home initiatives, while increasing referral linkages for those disproportionately burdened with asthma. VAP will leverage its expanded infrastructure including the Office of Health Equity Integration, the Asthma Advisory Panel, the New England States Asthma Learning Network, along with an experienced VAP team. A unified vision among diverse partners will be refined through updating Vermont’s Asthma Strategic Plan within the first 6 months of the grant.
