Utility of Geospatial Visualization and Social Vulnerability Index to Inform the Dissemination of School-Based Asthma Initiative

Purpose: The contributors to pediatric asthma disparities are multifactorial; low-income and minority students face higher risks of school absences, hospitalization, and mortality. The CDC has recognized the Asthma 411 Model as an evidence-based program to improve asthma outcomes. In 2017, a Consortium was formed to enable Tarrant County school districts (ISDs) to adopt and implement Asthma 411. This study's objective is to determine whether ISD adoption of Asthma 411 reaches students at great risk for adverse outcomes. Methods: The independent variable is a three-level, categorical indicator of Asthma 411 adoption by ISDs: primary adopters (initiated 2017), secondary adopters (initiated 2018-2020), non-adopters. ArcGIS, a Geographic Information System (GIS) platform, was used to map the independent variable. A data layer was added with CDC's 2018 Social Vulnerability Index (SVI). The SVI includes American Community Survey census tract data organized around four distinct themes associated with disparities: Socioeconomic status, Household Composition & Disability, Minority Status and Language, and Housing Type & Transportation. Results: Visually, primary adopters appear to include communities with higher risk as defined by SVIs. Non-adopters appear to include less socially vulnerable communities but do include pockets of students at risk. Conclusion: The Asthma 411 Consortium appears to reach the majority of communities at risk but targeted expansion may be beneficial. GIS may assist public health planning by visualizing access to services. Application of spatial statistics and further investigation of the SVI as a measure of risk will strengthen the analysis and better inform dissemination.