Asthma discriminates against Black people in Fort Worth. The reasons how are complicated
Quiniece Robinson has done her best to help her son JoSaun navigate life with asthma.
When he was 10, she noticed he was wheezing. She took him to a hospital and learned he had asthma, a chronic condition that inflames and narrows the airways in the lungs. He was prescribed home treatments such as inhalers and steroids.
JoSuan is now 14. He doesn’t play basketball or participate in outside activities like he used to. The things that trigger an asthma attack are unpredictable; sometimes he has attacks even while sitting down. An attack may result in hospital stays of up to three days.
His condition has caused him to miss more than 20 days of school this year, which has hurt his academic progress.
In August, Cook Children’s Medical Center contacted Robinson to provide information and resources related to asthma, including information on the Healthy Homes Asthma Program, which helps identify triggers and creates a healthier home environment.
“Had I been looking for the signs before, I probably would have found it out before he turned age 10,” Robinson said. “And who knows what could have happened before age 10 for him?”
JoSaun is among an estimated 10.8% of children age 17 and younger in Tarrant County who have asthma, according to Cook Children’s 2021 Community Health Needs Assessment survey. The survey shows Asthma does not strike equally across demographic groups, with 15.4 % of Black children and 9.7% of Hispanic children in Tarrant County suffering from asthma compared to 8.7% of white children.
In Fort Worth, 19.3% of non-Hispanic Black adults have asthma, compared to 7.4% of Hispanic adults and 12.2% of non-Hispanic white adults, according to Tarrant County Public Health’s 2024 Behavioral Risk Factor Surveillance System Survey. In Fort Worth, 16.7% of adults with an annual income of less than $25,000 have asthma, compared to 10.3% of adults with an annual income of more than $75,000, according to the survey.
There are many factors that link the increased prevalence of asthma among certain groups of people and neighborhoods, but there is not a direct answer as to why certain populations are hit harder than others, experts say. Conditions related to asthma include inadequate ventilation and exposure to such things as pollution, mold and cockroaches, factors that are often related to substandard housing and associated with segregation and racism, experts say.
What is known is that asthma has wide-ranging negative effects on those with the disease, causing school and work absences, and sleep disturbances, along with the financial impact of missed work or the expense of treatment.
In Fort Worth, residents of neighborhoods such as Como, Las Vegas Trail, Historic Southside, Seminary, the Stop 6 area, and Diamond Hill, have a higher incidence of asthma, based on data from CDC Places. These are majority Black and Hispanic neighborhoods with poverty rates as high as 33% and with median incomes from as low as $26,328 in Como to as high as $51,972 in Diamond Hill, well under Fort Worth’s median income of $77,082, according to the Census.
Schools and asthma
Robinson says her son JoSuan has a hard time keeping up at school due to his frequent absences and that teachers aren’t always helpful with the situation.
Robinson is also afraid that JoSuan will have an asthma attack at school, where he is not allowed to carry his inhaler. He has to go to the nurse’s office to use his inhaler if an attack strikes.
“I’m always checking on him every couple of hours to see if he is breathing OK or how he is feeling because I’m a little paranoid,” Robinson said.
Though Robinson is anxious about JoSuan when he is at school, that situation is better for many people since the introduction of the Asthma 411 program, which allows nurses to keep albuterol at school to treat children having an asthma attack. This allows quick relief medication to almost any child experiencing respiratory distress, even if the child didn’t have a prescription or didn’t have their prescription filled.
The program was first introduced at Eastern Hills Elementary School in 2014 and has since spread to eight school districts in Tarrant County.
There were 1,476 reported treatments in the 2023-2024 school year provided through the Asthma 411 program among the 353 campuses in 10 school districts in the Greater Tarrant Area Asthma 411 Consortium. About three-quarters of those students were able to return to class and complete their school day, and fewer than 2% required emergency service, according to Leslie Allsopp, an assistant professor at the Texas College of Osteopathic Medicine and the manager of the Asthma 411 program.
She says the program should just be a piece of a larger support network for children with asthma. People with asthma should seek comprehensive asthma control instead of relying on quick relief medication, as it can bring more problems, Allsopp said. The overuse of asthma medication like albuterol can result in a higher frequency, severity and impact of symptoms, according to a study from the National Library of Medicine.
A comprehensive asthma control plan for individuals would include a variety of steps from self education and management, regular assessment and monitoring, and identifying and avoiding environmental triggers. The CDC has developed the EXHALE strategies as a resource to inform and improve asthma control and reduce health care costs. These strategies include eliminating smoke and exposure to second hand smoke, home visits to identify and reduce triggers, asthma self management education, and environmental practices to reduce asthma triggers indoors, outdoors, and where people work and learn.
Allsopp says teachers and administrators are on the front lines of helping children stay healthy and be successful in school. Whether it is training to deal with respiratory distress or to stop bleeding, schools should have the best resources to keep students in school and achieve academic success, she said.
“The biggest barrier is competing priorities, because needs are so large and the demands that are being placed on schools are so great, and arguably there is a need for more support for both schools and school health to meet the needs of our children and show their success,” Allsopp said.
Housing affects asthma
Racial disparities in housing practices from redlining, displacement due to rising house costs, exclusionary zoning and policies preventing people from moving to specific neighborhoods have resulted in inequities in housing conditions, which has also fostered asthma disparities, according to a study from the National Library of Medicine.
Dr. Shade Afolabi is a pediatric pulmonologist and assistant professor at UT Southwestern Medical Center. She says there is evidence that poor ventilation in homes causes people to be more sensitized to dust, mold and cockroaches, whose droppings, saliva, and decomposing bodies are triggers for asthma. Pollution in homes and schools with little green space around them and close to highways exacerbates asthma, Afolabi said. Even though there is no evidence that these conditions cause asthma, they are triggers for it, she says.
“Imagine someone who doesn’t live in that condition has asthma,” Afolabi said. “They’re going to have fewer problems with it. They’re going to be much better controlled, and you likely aren’t going to see them have to talk about their asthma nearly as much, or having nearly as many issues or exacerbations with their asthma and showing you that in school if they’re not living in an environment that’s constantly triggering them.”
Dr. Hector Grajeda, a pediatrician at Cook Children’s Neighborhood Health Center in the Northside neighborhood, says asthma symptoms may become milder as patients age, but they don’t completely go away. Thus, education and awareness can help families get the right treatment and care early in life to prevent future risks.
According to the Asthma and Allergy Foundation of America, adults are more likely than children to die from asthma. In 2022, 3,235 people died from asthma in the U.S., with Black people being two times more likely to die from asthma than white people.
“It is important for parents to understand that asthma can be very serious and actually it can kill,” Grajeda said.
Robinson and her son live in Southwest Fort Worth near the Chisholm Trail Parkway and I-20, an area where there is a higher prevalence of asthma, according to CDC Places. When Cook Children’s contacted Robinson for an opportunity to take part in the Healthy Homes program, she said yes.
The Healthy Homes Asthma Program is a free and involves community health workers who work alongside families to provide environmental assessments in the family’s home, help them address asthma triggers, provide asthma education, and help navigate healthcare services. The program conducts 125 home visits across the community every year.
Healthcare workers provide cleaning supplies and make sure families have access and understanding of medications and receive follow-up calls every month to check the progress with the child’s symptoms. Cook Children’s has seen a decrease in the number of emergency department visits involving families who have completed the program.
“Families just have a lot on their plate, so if their child’s not in immediate respiratory distress or having breathing problems at the moment they’re going to focus on the next pressing issue, like making sure they have dinner on the table,” Courtney Barnard, director of child wellness at Cook Children’s Center for Community Health, said.
Healthcare workers provided Robinson with a high efficiency particulate air filter, a new bed to reduce the presence of dust mites, and information about asthma and its triggers. The efforts helped alleviate JoSuan’s triggers, and Robinson saw a difference in her son’s breathing and how he sleeps.
Robinson also has asthma but did not get the same education on it growing up and did not know anyone else who had it. The Healthy Homes Asthma Program and a new asthma prescription provided what she and JoSuan needed.
“I’m hoping for that to improve his situation in life,” Robinson said.
This story was originally published March 21, 2025 at 5:00 AM.
