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News/Marist poll, notes that only health response should contem- Jonathan P. Caulkins, PhD marijuana. The Oregonian. May 4, 2015.
Available at: http://www.oregonlive.
16% of marijuana users cite “to plate advertising restrictions, but com/marijuana/index.ssf/2015/05/
have fun” as their reason for using; fear that much more will be REFERENCES meet_the_people_who_will_advis.html.
more (19%) cite pain relief.6 1. National Academies of Sciences, Accessed September 25, 2017.
needed if legalization involves Engineering, and Medicine. The health
Profitable industries carry con- a for-profit industry. There are effects of cannabis and cannabinoids: the 6. Ingraham C. 11 charts that show
siderable clout in state capitols; current state of evidence and recom- marijuana has truly gone mainstream.
many other, safer ways to legalize Washington Post. April 19, 2017. Available
profitable industries with a rabid mendations for research. Washington,
marijuana, such as restricting DC: National Academies Press; 2017. at: https://www.washingtonpost.com/
fan base, all the more so. supply to a government monopoly news/wonk/wp/2017/04/19/11-charts-
2. Richter KP, Levy S. Big marijuana— that-show-marijuana-has-truly-gone-
or to nonprofit organizations lessons from big tobacco. N Engl J Med. mainstream/?utm_term=.ef47abaa0575.
whose charters reserve a majority 2014;371(5):399–401. Accessed November 8, 2017.
of seats on their governing boards 3. Pacula RL, Kilmer B, Wagenaar AC, 7. Caulkins JP, Kilmer B, Kleiman MAR,
Chaloupka FJ, Caulkins JP. Developing
LEGALIZING AN for public health and child welfare public health regulations for marijuana:
et al. Considering marijuana legalization:
insights for Vermont and other jurisdic-
INDUSTRY advocates and that define their lessons from alcohol and tobacco. Am J tions. Santa Monica, CA: RAND; 2015.
mission as meeting existing de- Public Health. 2014;104(6):1021–1028.
Legalizing an industry has many
consequences. Fiala et al. give us mand (to undercut the black 4. Kleiman MAR. Against Excess: Drug
Policy for Results. New York, NY: Basic-
a baseline regarding one, namely market) without undertaking Books; 1992.
aggressive marketing efforts. I marketing efforts designed to 5. Crombie N. Fifteen Oregonians tapped
agree that a comprehensive public increase consumption.7 to help shape rules for regulating
has been focus, standardization, SUPPORTIVE trigger abatement through home Delaney Gracy, MD, MPH
creation of best practices, and im- INTERVENTIONS visits. In this study, the authors
provement in the clinical man- And so we must think outside show that all programs assessed
ACKNOWLEDGMENTS
agement of asthma in children. of the box—or more literally, improved patient Asthma Con-
I thank John Carlson, MD, PhD, assistant
outside of the clinic—for sup- trol Test scores and decreased professor, Department of Pediatrics, Sec-
portive interventions. Several emergency room utilization. tions of Allergy & Immunology and
Community Pediatrics and Global Health,
home-visiting programs focusing They also show that the de-
Tulane University School of Medicine,
MANAGEMENT on trigger identification, abate- mographics of the population for his asthma expertise in preparing this
And yet, families are clearly ment, and management have served will likely affect the editorial. I also thank Dennis Walto, CEO
of Children’s Health Fund, for his insight
still struggling, and costs related shown promising evidence of baseline, and possibly the degree
and support.
to poor asthma control are the impact—on asthma control for of change. Of particular value, as
drivers of the massive asthma- patients, on quality of life for part of this project, the authors REFERENCES
related expense burden to the patients and their families, and on implemented and demonstrate 1. Akinbami LJ, Simon AE, Rossen LM.
health care system. Asthma financial return on investment for the effectiveness of a tool designed Changing trends in asthma prevalence
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asthma-related costs to the health
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system.7 A home-visiting, envi-
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et al. Addressing the childhood
ogy. They also must manage is a major shift for health care in enough to apply to a somewhat
asthma crisis in Harlem: the Harlem
inhaled medications (often mul- the United States. We face the heterogeneous group of programs. Children’s Zone Asthma Initiative.
tiple) that require good tech- questions we must always con- This type of tool has the potential Am J Public Health. 2005;95(2):
nique for optimal effect, learn to sider when making treatment or to be very important in creating 245–249.
predict and respond to seasonal service delivery changes based on needed cross-program compari- 3. Clark NM, Shah S, Dodge JA, Thomas
patterns and other illnesses that external data or a pilot program’s sons, setting benchmarks of suc- LJ, Andridge RR, Little RJA. An evalu-
can perpetually change asthma cess, accumulating impact data ation of asthma interventions for preteen
success. How do we know if
medication needs, and often deal to support intervention re- students. J Sch Health. 2010;80(2):80–87.
a pilot program will have gen-
with fear, stigma, and errone- imbursement, and facilitating the 4. Asthma Disparities Working Group. The
eralizable results? How do we Coordinated Federal Action Plan to Reduce
ously low expectations for disease know when, where, and under impact assessment of individual
Racial and Ethnic Asthma Disparities. US
management potential. Addi- what conditions it will or won’t programs.
Environmental Protection Agency. 2012.
tionally, parents and caregivers work? And if I am the one im- Available at: https://www.epa.gov/asthma/
must coordinate with, provide plementing, how do I know how coordinated-federal-action-plan-reduce-
medication for, and inform I am doing? Will this service or racial-and-ethnic-asthma-disparities.
schools and anyone else who program be billable and sustain- DRIVE CHANGE Accessed November 8, 2017.
cares for the child about their able, and if not, what data do we In a time when our health 5. Gracy D, Fabian A, Roncaglione V,
child’s specific needs and triggers. need to advocate for change? In system is increasingly focused on Savage K, Redlener I. Health Barriers to
Behavior change for disease quality measures, value-based Learning: The Prevalence and Educational
an evidence-based and value-based
Consequences in Disadvantaged Children.
management is always difficult. care era, individually and collec- care incentive models, and
New York, NY: Children’s Health Fund;
But for a child to achieve good tively, we have to decide how we quantitative impact assessment,
2017.
asthma control, not only the will invest our time and resources. well-designed tools, methods,
6. Guidelines for the Diagnosis and Manage-
patient likely needs to change and comparative values are keys
ment of Asthma: Expert Panel Report 3 (EPR
behavior, but also the caregiver, to meaningful data and the as- 3). Bethesda, MD: National Institutes of
and other people in the house- similation of information that can Health, National Heart, Lung, and Blood
hold as well. If the child is drive change. This kind of change Institute; 2007.
persistently exposed to their HOME VISITS is urgently needed by millions 7. CDC’s National Asthma Control Program:
triggers—such as cigarette The article by Dong et al. in of children across the country An Investment in America’s Health. Atlanta,
smoke, perfume, cockroaches, this issue of AJPH (p. 103) offers who struggle with uncontrolled GA: Centers for Disease Control and
or even pets—good control and a comparative analysis of several asthma, and for whom educa- Prevention; 2013.
good outcomes may be very different pediatric asthma man- tional success, and even eco-
difficult to achieve. agement programs that target nomic success, are at risk.