Dunn’s mother, Maria Cotto, has long had severe asthma. Dunn inherited the condition, though she has mostly grown out of it as an adult. Now, Dunn’s 12-year-old son also has severe asthma.

“People kind of shrug it off as not that big of a deal,” said Dunn, who lives with her family in East Harford. “But I see what it’s done to my mother, and I see what it’s doing to my son, and what it has done to me.”

In Connecticut, 10.6% of children and 10.5% of adults have asthma, according to state data from 2019.  According to DataHaven’s 2021 Community Wellbeing survey, 12% of adults have asthma.

Asthma does not impact all people equally.

“In the state of Connecticut, similarly to other states in the country, this condition disproportionately affects minority populations, including African Americans and Hispanics,” said Dr. Mario Perez, an assistant professor of medicine at UConn Health who studies asthma disparities and who Cotto sees for her asthma.

DataHaven’s survey found that 11% of white, 13% of Black, and 21% of Latino adults have asthma.

Economics also seems to play a role. Only 6% of adults in wealthy towns have asthma, while 16% of adults in cities like New Haven, Waterbury, Hartford and Bridgeport have the condition. In addition, 19% of adults earning less than $30,000 per year have asthma, compared to only 9% of those earning $100,000 per year.

“Residents in city centers are typically three to four times more likely to visit the emergency room with an asthma diagnosis than residents of outer suburban areas,” said Mark Abraham, executive director, DataHaven.

Air Quality And Geography

Connecticut has long been known as the “tailpipe of the nation” due to pollution that drifts in from other states. The 2022 State of the Air report from the American Lung Association gave every Connecticut county a poor grade for ozone levels. Fairfield, Middlesex, New Haven and New London all received a grade of F, while Tolland and Windham counties received D grades, and Hartford and Litchfield were each given a C.

“We know that environmental factors, particularly factors such as air pollution, can be associated and contribute to the disease and to disease flare,” Perez said.

A 2009 study of New Haven County children recruited from the Yale Asthma Care Center found an increased risk of symptoms and inhaler use in children with asthma who had exposure to traffic-related fine particles.

Additionally, some research has suggested a link between crime and asthma rates, which highlights the need for healthier communities overall. “Having the sense that your neighborhood is more secure actually decreases the rate of asthma and asthma exacerbations,” Perez says.

City Risk Factors And Glimmers Of Hope

Melanie Stengel Photo.

Robert Carmon shows off his basketball skills on the court off Glade Street near his West Haven home. His asthma has improved since he was diagnosed as an infant.

Robert Carmon, 11, who recently moved from New Haven to West Haven, developed asthma as an infant and was rushed to the hospital by his parents on a near-weekly basis during the early years of his life. Robert has improved since C-HIT first reported on him in 2018, but the condition still impacts his life. He’d like to play on the basketball team at school but can’t because he worries his asthma will flare up. “I can play pickup games as long as I don’t play too hard,” he said.

The frequency of his trips to the emergency room has decreased, but he still goes to the hospital about once every month or so, said Robert’s father, Chaz Carmon.

Stories such as Robert’s are common in Connecticut cities. In recent years they have ranked high in the Asthma and Allergy Foundation of America’s annual Asthma Capitals Report, but this year saw marked improvement. Hartford moved from 17th worst to 69th on the list, Bridgeport dropped to 85^th, from 29th in 2021, while New Haven dropped from 5th to 90th.

“New Haven saw the biggest positive jump in rank of all the 100 metropolitan statistical areas that we analyze,” said Hannah Jaffee, a research analyst with the Asthma and Allergy Foundation.

However, people shouldn’t read too much into the improved rankings because this year’s list was created based on different data sources than previous years. For example, insurance claims were examined instead of the self-reported surveys used previously. In addition, more localized data was utilized rather than the county-level data used for the report in previous years.

Even still, Jaffee said, the three most populous counties have seen some improvement.

“When we do look at the county-level data that we previously used asthma prevalence rates for Fairfield, Hartford and New Haven county, they’ve all declined over the past five years,” she said. The death rate has also generally declined in those three counties over the past 20 years, Jaffee added.

Improving Asthma Rates

Proven strategies for reducing asthma incidence and severity include working to ensure all residents have access to culturally competent health care and improving indoor and outdoor air quality for those in cities.

“Asthma triggers can be mitigated through housing quality improvements like better air conditioning filters and education for families about what the triggers might be. If you’re running a gas stove for cooking, and you don’t have good ventilation, it’s producing a lot of air pollution inside.”

— Mark Abraham, executive director, DataHaven

The Connecticut Asthma Program is a state-run initiative attempting to decrease asthma disparities through partnerships with health care providers while providing education about the condition and expanding access to Connecticut’s asthma home visiting program. The state has also promoted the Centers for Disease Control and Prevention’s (CDC) EXHALE framework for asthma management.

Perez says that the most effective interventions will take place before a patient ever arrives in front of him. “I think we as a society have to address everything from the environmental pollution and climate that we’re creating as humans to improving education and access to health care, but also improving the socio-economic status of the population in general.”

In the meantime, some say more can be done individually to help those with asthma. For instance, while Robert’s current school allows him to keep his asthma pump on hand, he wasn’t allowed to do that in the past. “They always said you have to keep your bag in your locker,” he said. That could cause asthma attacks to get out of control before he could get to his pump.

His father adds that each school should have a nebulizer in the nurse’s office with staff trained to administer asthma medication. That way, a student “can be on the nebulizer at least until the parents get there,” Carmon says, and if the nebulizer helps enough, the student might be able to return to class.

Cotto says it’s important for medical staff to remember that each patient is different. Cotto horrifyingly learned this when she was given epinephrine during an emergency asthma flare. While the medication can be helpful to some patients, it nearly killed her.

“I’m allergic to it. When they administered it to me, my heart stopped,” she said. When this happened in 2013, she ended up in a coma for 22 days.

After Cotto’s coma, her asthma worsened, and she could not leave the house without oxygen for many years. In 2014 she began seeing Perez, who took the time to figure out her specific triggers and a treatment plan that worked for her. Though she struggles at times, her asthma is more under control than it has been in years.

“He tried a whole bunch of different medications and finally found one that works for me,” Cotto says. “I’m actually able to leave the house without oxygen.”  That’s something she hasn’t done for nearly a decade.

You can find out more about asthma in Connecticut and asthma management in general by visiting the following sites:

• The Connecticut Asthma Program
• Connecticut’s asthma home visiting program
• The CDC’s EXHALE framework for asthma management
• The Asthma and Allergy Foundation of America’s annual Asthma Capitals Report

Both counties include a growing number of families relying on federally funded free and reduced-price school meals to feed their children during tough economic times.

Hunger among school-age children in Connecticut is on the rise and experts do not expect the trend to change soon given the state’s 9 percent unemployment rate and sluggish economy.

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“Children in Connecticut are hungry,” said Susan Maffe, president of the School Nutrition Association of Connecticut (SNACT) and director of Food Service for the Meriden public school system. “We know of children who come to school on Monday whose last meal was probably the lunch they ate at school on Friday.”

“Childhood hunger is impacting school districts across the board in urban, rural, even wealthy communities,” said Therese Dandeneau, an education consultant with the Connecticut Department of Education’s school nutrition programs.

Among the evidence of childhood hunger in Connecticut:

• Thirty-four percent of all students in Connecticut’s public school districts were eligible for free or reduced-price lunch during the 2010-11 school year, up from 26.4 percent during the 2004-05 school year, according to Connecticut Department of Education statistics.
• Urban areas account for a large proportion of those in need. In Bridgeport, for example, 98.8 percent of the student body is eligible for free and reduced-priced meals. But rural and suburban communities are impacted, too. The number of eligible students from affluent towns such as Glastonbury (498) and Westport (173), for instance, has more than doubled. Other towns, such as Avon (190), have seen a threefold increase, the state numbers show.
• Thirty-five new schools served breakfast to an additional 22,000 students in 2011, according to End Hunger Connecticut!, a non-profit agency in Hartford. Despite the increase, Connecticut ranks last nationwide (51st including the District of Columbia) when it comes to taking part in a federally funded breakfast program. Schools also are missing out on millions in federal funds – about $2.1 million in Hartford and $1.7 million in Waterbury, for example – by not fully participating in the breakfast program.
• The number of towns participating in a federally funded pilot program to supplement summer meals almost tripled to 48 in 2012, up from 17 in 2011, according to the state education department. Although more children are eating at summer feeding sites, only a quarter of the students who eat free or reduced-price lunch at school participate in summer food programs, reports End Hunger Connecticut!

“People are beginning to see nutrition as a piece of the education puzzle,” said Lucy Nolan, executive director of End Hunger Connecticut!, which last year launched the “Connecticut No Kid Hungry” campaign with Gov. Dannel Malloy’s office and Share Our Strength, a national organization fighting childhood hunger.

Nolan and others point to research showing the link between eating breakfast and improved standardized testing scores. Connecticut schools that provide meals report improved academic success, classroom participation and daily attendance along with decreased tardiness and bad behavior.

Long-term health improves, too, with studies showing that “girls who participate in at least one federal nutrition program have better weight outcomes than girls who don’t,” she said.

Among those lacking good nutrition are children who have access to food but remain malnourished. “This is a group of students we tend to forget about,” said Susan Fiore, nutrition education coordinator with the state education department. “We want students to successfully navigate the school system and achieve their full potential. But children who are hungry or malnourished can not function at their peak capacity.”

A total of 191,116 students were eligible for free or reduced-priced lunch during 2010-11. Free or reduced-price meals are served to students whose family income is at or below 130 percent (free meals) or at or below 185 percent (reduced-price meals). The U.S. Department of Agriculture through the Connecticut education department partially reimburses local school districts for free, reduced-price and paid meals. But some school districts have trouble getting qualifying families to register for free and reduced meals so schools can be reimbursed.

Sluggish Economy Fuels Hunger

Connecticut educators and school nutrition experts cite a depressed economy as the driving force behind the rise in childhood hunger, although 2009 criteria changes that automatically certify recipients of the Supplemental Nutrition Assistance Program (SNAP or “food stamps”) for free and reduced-priced school lunch account for some of the increase.

“One of the first things to go is the food budget,” said Donna Grant, executive director of the Thompson Ecumenical Empowerment Group (TEEG) that operates a food bank and provides summer meals and breakfast to thousands of children each year. TEEG serves communities in Windham County, considered the state’s least “food secure” county in 2011 by the Connecticut Food Bank because residents do not have consistent access to enough food.

“Two adults working full-time at $11 an hour still cannot meet the basic needs of a family of four,” said Grant. “Entry-level jobs in this area have dried up. People who are unemployed remain out of work and those with entry-level positions see little opportunity to change their status.”

Grant suspects the number of children receiving free or reduced-price school meals represents only a fraction of those in need because pride keeps some families from seeking help. “Many people in rural communities are vulnerable because they are land-rich and cash-poor,” she said. “They would never want to expose themselves as not being able to care for themselves.”

Even towns in Connecticut’s affluent counties – such as Fairfield and Litchfield – are dealing with increased childhood hunger due to the economic downturn, experts said. For example, 13.2 percent of students enrolled Greenwich public schools are eligible for free and reduced-priced meals, up from 7.5 percent since 2004. In Norwalk, 43.2 percent of all students are eligible, up from 23.1 percent. In Litchfield County, school districts serving Goshen, Warren, Washington, Roxbury and Bridgewater have seen their numbers increase.

“We’ve seen instances in wealthier school districts where both parents have lost their jobs and have no income to maintain expensive homes and high mortgages,” said Dandeneau. “They’re asking for help” to fill out forms for free and reduced-price school meals.

Programs For Those In Need

Child advocates hope initiatives underway will help reduce childhood hunger in Connecticut. In September, 85 schools in 16 school districts began participating in a program that offers students free fresh fruits and vegetables throughout the day to reinforce healthy snacks.

A variety of summer programs – from open feeding sites where youngsters can get meals to issuing families additional SNAP funds to supplement their food budget – decrease the risk of “food insecurity” among families when school is out of session, said Dandeneau.

A federal pilot program helping families in Litchfield and Windham counties as well as Waterbury and surrounding communities supplement their summer meals has proven successful. “People think of the cities as having the most need,” said Nolan. “But there’s a lot of rural hunger and eastern Connecticut has significant needs.”

Reaching rural residents poses unique difficulties because some areas lack the population density to qualify for federally funded summer feeding sites, explained Dawn Crayco, deputy director of End Hunger Connecticut!. Lack of public transportation can also hinder participation. “It’s difficult for rural towns to have a sustainable site,” she said.

Local participation in the federal breakfast program remains a challenge even though the number of schools offering breakfast increased by 14 percent from last year, said Crayco. Only 61.5 percent of Connecticut schools that offer free and reduced-price lunch also offer breakfast, according to End Hunger Connecticut! School districts are also missing out on millions of dollars from the federal government that would be available if they served breakfast.

“Breakfast is a tool, just like textbooks, to help students learn,” said Crayco.

“It’s ironic that we tell students to eat breakfast and get plenty of sleep when there’s a big test,” noted Nolan. “But what about all the other days? Offering students breakfast can make a difference each and every day.”

A top aim of the “Connecticut No Kid Hungry” campaign is expanding the federal school breakfast program by adding 84 schools and 2,025 students this school year. State funds are available to assist schools that want to offer breakfast. “So far, we’ve added 45 schools and have exceeded our goal of reaching an additional 2,025 students,” said Crayco.

Some schools hesitate to offer breakfast because of “perceived obstacles” concerning operational costs, student supervision and interference with the school day, said Dandeneau.

For Maffe, the benefits of implementing a breakfast program outweigh the challenges.  “School districts that offer breakfast report decreased absenteeism and fewer trips by students to the nurse’s office. Students are more attentive,” said Maffe, director of Food Service for Meriden, where 66.6 percent of the student body is eligible for free or reduced-price meals. This year, the district began serving free breakfast to all students at the Casimir Pulaski Elementary School, with plans to expand the program to other schools soon, she said.

Despite these gains, ending childhood hunger in Connecticut remains elusive, said Maffe.

“I don’t see a fix any time soon.”

To listen to WNPR’s Where We Live segment on this story click here.