摘要：Objectives. The Community Action to Fight Asthma Initiative, a network of coalitions and technical assistance providers in California, employed an environmental justice approach to reduce risk factors for asthma in school-aged children. Policy advocacy focused on housing, schools, and outdoor air quality. Technical assistance partners from environmental science, policy advocacy, asthma prevention, and media assisted in advocacy. An evaluation team assessed progress and outcomes. Methods. A theory of change and corresponding logic model were used to document coalition development and successes. Site visits, surveys, policymaker interviews, and participation in meetings documented the processes and outcomes. Quantitative and qualitative data were analyzed to assess strategies, successes, and challenges. Results. Coalitions, working with community residents and technical assistance experts, successfully advocated for policies to reduce children's exposures to environmental triggers, particularly in low-income communities and communities of color. Policies were implemented at various levels. Conclusions. Environmental justice approaches to policy advocacy could be an effective strategy to address inequities across communities. Strong technical assistance, close community involvement, and multilevel strategies were all essential to effective policies to reduce environmental inequities. Incorporating environmental justice into strategies to reduce health disparities involved identifying the root causes of social inequalities, building upon community democratic decision-making processes, and identifying environmental health hazards—and connecting all of these to public health outcomes. 1 , 2 By addressing interconnections among environmental exposures, socioeconomic and structural factors, and biological processes, an environmental justice framework was a powerful tool for addressing health inequities. Through increased understanding of the political and economic forces that contributed to environmental inequalities, and by working closely with residents and local organizations, researchers, advocates, and policymakers, coalitions reduced environmental health inequities. Childhood asthma provided a particularly dramatic example of the interrelationships between environmental risk factors, socioeconomic vulnerability, and poor health. Known environmental risk factors, or “triggers,” of asthma included outdoor air pollution from freeways, railways, and pesticides; other mobile and stationary sources of pollution; indoor air pollution resulting from mold, mildew, and poor ventilation in substandard housing or school facilities; allergens (e.g., dust mites, cockroaches and rodent dander); and cleaning products and other chemicals.3–7 Low-income children and children of color were more likely than others to have asthma; they were also more likely to live in substandard housing and be exposed to environmental toxins in their homes, schools, and communities. 8 – 12 In California, for example, it was common to see asthma prevalence rates that varied 2- to 3-fold, depending upon geography, racial/ethnic composition, and economic status of the communities being compared. 13 – 15 Despite the traditional societal focus on individual level factors in determining risk for asthma and other chronic conditions, emerging research suggested that neighborhood settings and other community level factors played a substantial role in shaping health status. 16 – 22 Historically, community initiatives to reduce asthma disparities among children often failed to address the environmental justice component of eliminating asthma triggers, or to create policy change aimed at the environmental root causes. The complexity of the roots of asthma disparities demanded a multifactorial, multilevel, and interdisciplinary approach. 23 – 25 To effectively identify and address problems, develop appropriate strategies, and ensure lasting change, interventions to ameliorate asthma disparities required community involvement at each stage. 3 , 26 – 28 This article describes the strategies implemented, outcomes achieved, and lessons learned from a statewide community-based environmental justice and policy advocacy initiative developed to reduce environmental asthma triggers for California children.
