JACKSON — Jessica Wells spends a lot of her time mopping and vacuuming, dusting the baseboards and wrapping her daughters’ bedding with special protective pillowcases and sheets. But Wells isn’t a neat freak — she’s a mom to twin 10-year-olds with asthma.

After a decade of monthly trips to her daughters’ pediatrician for asthma attacks and a stint in the emergency room, Wells made her first big change of many-to-come. She moved her three daughters out of their mold-infested apartment and into a new home. What seemed unthinkable a few years prior for the single mother-of-three, she saved up and made it work. The girls love their three-bedroom house with a big yard on a quiet street. For Wells, it’s more square-footage to keep up with and a hefty rent bill, but worth it for the peace-of-mind knowing the walls aren’t making her daughters sick.

The 20 most challenging places to live with asthma, according to AAFA’s 2019 Asthma Capitals report.

“You just have to be real cautious what you have your children around because I’m not trying to be in the hospital with my child,” Wells said. Constantly cleaning, avoiding smokers, and monitoring her kids’ outdoor time are just some of the measures she takes to evade their asthma triggers.

Her biggest fear, like any parent’s, is that her twins, Madison and Makayla, would suffer a bad asthma attack and not have enough time to get to a hospital.

Her concerns are warranted: Jackson is one of the deadliest cities in the U.S. for people with asthma. In 2016, Mississippi saw the most deaths from asthma per capita, and has long fluctuated among the top states. Jackson also outranks many other Southern cities on the “2019 Allergy and Asthma Capitals” list. While other neighboring cities have similar allergens, environmental triggers and even higher asthma prevalence rates, Mississippi consistently has one of the highest death rates due to asthma — driven by Jackson’s.

Jackson residents don’t suffer disproportionately from the disease, but experts say health officials have not emphasized prevention and patient education — two of the most important lines of defense against asthma.

Nobody should die from asthma — it’s a matter of controlling it, says Sanaz Eftekhari, a vice president with the Asthma and Allergy Foundation of America, which published the “Asthma Capitals” report. “What’s happening is, if you’re not diagnosed and you’re not giving your daily medication that helps you manage it properly, that’s where those deaths are happening.”

That’s where Jackson’s Green and Healthy Homes Initiative comes in. The group runs a “Healthy Homes for Kids” program that helps families reduce their homes’ asthma triggers, by equipping families with everything from wet mops, allergen-catching vacuums, and allergy-friendly cleaning supplies that are safer for people with allergies and asthma. A big part of the program, too, is health literacy, says Jarkisha Spann, a community education specialist for the group.

“A lot of people don’t know that bleach triggers your asthma, and air freshener and incense and candles (too),” said Spann. “We love things that smell good.”

Since beginning work with the organization as a volunteer in 2015 and joining full-time, Spann has learned to better control her own son’s asthma. She echoes Wells about the constant fear that looms when you have a child with asthma.

“Most people’s homes that I go to, they’re surprised because no one ever told them (about the triggers),” said Spann. “Even a pediatrician or physician — they don’t even explain those things to them, and I know firsthand because my kids have asthma and nobody ever explained those things to me. They gave us meds and sent us home.”

Jessica Wells uses the cleaning supplies provided by Green and Healthy Homes Initiative to help mitigate allergens and asthma triggers at home. Prevention is key, according to the asthma experts. Credit: Eric J. Shelton/Mississippi Today, Report For America

Many families don’t know before enrolling in the healthy homes program that allergies and asthma often occur in tandem. Household and environmental allergens, such as pollen, dust, mold and pet dander, can also trigger and often exacerbate asthma. Further, parents who don’t have the condition themselves often don’t realize how household conditions affect their child’s ability to breathe — often they just see the wheezing and coughing once it’s snowballed out of control.

Describing a training session she had with the American Lung Association, Spann said one of the exercises involved asthma educators breathing through a coffee straw with their nose plugged — that’s what it’s like for someone during an asthma attack.

Spann, as well as program coordinator Catherine Lee, reiterate a mantra over and over again: asthma safety is about prevention and education, and requires a team-based approach.

The nonprofit partners with Central Mississippi Health Services, a Jackson-based health clinic. Dr. Janice Bacon, a pediatrician at the clinic, has helped her patients, including Wells’ children, better understand the disease. Bacon explains that patients need to be vigilant in both taking medication and guarding themselves from triggers.

“You can maximize the controlling medicine, but if you are still being exposed to your number one, number two triggers every day, especially if you’re talking about indoors when you’re asleep or in your room, then it’s a vicious cycle,” Bacon said.

She added that both sides of prevention can be difficult for patients in higher poverty areas like Jackson: On one side, the costs between inhalers, a nebulizer machine, and the medicine itself can be “astronomical,” she said. On the other end, it can be difficult to convince landlords to address indoor triggers like mold or mildew. Bacon gave the Wellses a nebulizer machine — for one of the twins to wear at night to help regulate her breathing — at no charge, and connected the family to the Healthy Homes program for more home-based risk assessment.

“How much can you get the owner to do, and not get you in trouble with your living situation?” Bacon said. Ultimately, at the program’s urging, the Wells family left their moldy apartment after the landlord failed to fix moldy infrastructure. Mississippi’s landlord-tenant laws allow a tenant to leave a lease penalty free, as long as all previous rent is paid, if the conditions are unhealthy.

In the three years of the “Healthy Homes for Kids Program,” the group has worked with over 100 clients, 90 percent of whom have household incomes under $25,000. The biggest asthma triggers in those households were bleach, air fresheners and mold. In 2018, after the three-month program ended, the number of clients who said their child’s asthma was well controlled jumped from 35 percent to 90 percent. Learning their child’s triggers, how to mitigate them, and swapping out cleaning supplies were the most helpful changes, families found. Other improvements included a decline in emergency room visits, fewer missed school days, and less reliance on rescue medications.

The last round of individualized three-month programming just wrapped up, but Lee says she is looking for more revenue streams to dedicate to the program for next year. She always welcomes calls from families who need help controlling asthma and allergy triggers at home. She also points to programs like that of Memphis-based La Bonheaur Children’s Hospital, which has enrolled nearly 600 children to prevent asthma triggers that hamper control at home, as a model for Mississippi health policy. The program reduced hospitalizations by 70 percent and cut each child’s care costs by half.

According to the most recent data the Green and Healthy Homes Initiative collected, the state pays almost $63 million per year for asthma-related emergency department visits. Hinds County alone saw more than 3,500 asthma-related emergency department visits in 2016. The sharp changes in Mississippi’s weather can also leave asthma patients vulnerable, Bacon said, and emergency visits tend to spike this time of year.

“For example, it’s rainy today, and by next Tuesday the high is going to be 37,” she said in a November interview. “What happens is that child may be dressed a certain way (in the morning), but then when they get home from school it’s going to be a different temperature. So it’s an issue of trying to dress them appropriately.”  

The Wells family has been doing much better since moving into a new home and applying home prevention strategies. Other than one recent asthma flare-up, triggered by a respiratory infection, the girls are happy and healthy. They’re excited to have a big yard to play in and quiet street to bike down, although their grass allergy makes out-door time come with a caveat.

Jessica Wells lines up her daughter’s medications. After her last asthma attack, her daily doses increased to help control symptoms. Credit: Eric J. Shelton/Mississippi Today, Report For America

“They’re allergic to everything, grass, pollen, dirt,” Wells said. “I do give them some outdoor time though. We ride bikes, we just don’t stay outdoors (for) a long time. We’ll ride down the street and come right back.”

While seasonal and unexpected weather changes can wreak havoc on most immune systems, any respiratory complications are all the scarier for families who are also trying to control asthma. “It just makes everything worse,” Wells said of her daughter’s cold that led to an asthma attack this fall.

In addition to the health tips, Wells is also grateful for the extra support. “I haven’t heard them sneezing, they haven’t been sick, they’ve been doing good,” Wells said of her kids, who see Bacon once a month. “It has helped me a lot and lowered my stress. It does (help) and being a single parent too. It’s always great to have that support.”

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Alex Rozier, from New York City, is Mississippi Today’s data and environment reporter. His work has appeared in the Boston Globe, Open Secrets, and on NBC.com. In 2019, Alex was a grantee through the Pulitzer Center’s Connected Coastlines program, which supported his coverage around the impact of climate change on Mississippi fisheries.

Erica Hensley, a native of Atlanta, has been working as an investigative reporter focusing on public health for Mississippi Today since May 2018. She is a Knight Foundation fellow for our newsroom’s collaboration with local TV station WLBT and curates The Inform[H]er, our monthly women and girls’ newsletter. She is the 2019 recipient of the Doris O'Donnell Innovations in Investigative Journalism Fellowship. Erica received a bachelor’s in print journalism and political science from the University of Southern California Annenberg School for Communication and Journalism and a master’s in health and medical journalism from the University of Georgia Grady College for Journalism and Mass Communication.