A data-driven approach to stock inhaler programming implementation in Chicago Public Schools

Asthma rates are high in Chicago, but rescue inhaler access is more limited among Black and low-income populations, which impacts school attendance and academic achievement. Stock inhalers are undesignated asthma inhalers for respiratory distress at school, which may alleviate these needs. We assessed the pre-intervention asthma environment of pilot, ramp-up, and non-pilot Chicago Public Schools to retroactively ensure an equitable scale-up of a stock inhaler intervention across a large urban district. We also examined support plans for asthma by school and student characteristics. We used chi-squared tests, Kruskal Wallis tests, and generalized estimating equation models to analyze the association of asthma status with school and student characteristics within district-run schools. 517 district-run schools and over 266,000 students were included. High schools had a higher median asthma prevalence (6.39%) than elementary schools (4.49%). Students who identify as Non-Hispanic Black had higher odds of asthma than Hispanic students (OR:1.20[1.11, 1.30], p < 0.001), but these students subsequently had lower odds of a 504 plan (OR:0.7[0.6, 0.7], p < 0.001) and higher odds of an IEP (OR: 1.2[1.1, 1.3], p < 0.001) compared to Hispanic students with asthma. Low-income (OR:1.53[1.45, 1.57], p < 0.001) and unhoused students (OR:1.43[1.30, 1.57], p < 0.001) had higher odds of asthma than those without these characteristics. While the scale-up itself was equitable, the analysis revealed gaps in asthma prevalence and support plans in Chicago Public Schools. Data-driven approaches like stock inhalers in schools are one solution to reducing disparities in access to asthma documentation and medication.