As a young doctor at Seattle Children’s Hospital, Mary Crocker, M.D., faced a clinical challenge from an unanticipated source: wildfire smoke. Her patients were presenting with exacerbated asthma symptoms from exposure to smoke, and when parents asked how to best protect their children, Crocker was not always sure what to tell them.

“It was frustrating that I didn’t have great advice to share with them because I didn’t learn about wildfire smoke in medical school,” she said. “That’s when I decided I needed to do more.”

As she read about wildfire smoke and children’s health, Crocker realized there were few evidence-based interventions to protect children at risk of exposure. She was inspired to develop these interventions, but she needed more time for research. 

Crocker then joined the University of Washington Pediatric and Reproductive Environmental Health Scholars (PREHS) program. The NIEHS-funded program provides pediatricians with protected time to develop their research capacity, conduct community-engaged research, and translate research findings into clinical interventions.

Perks of PREHS

Before PREHS, Crocker had some research training through a fellowship with the National Institutes of Health Fogarty International Center. Through a Peru-based project, she examined the health effects of indoor air pollution from burning wood for fuel.

“One of the outcomes we studied was pneumonia in children,” said Crocker. “That was my first opportunity to conduct environmental health research, and it coincided with my interests in lung health."

She credits her Fogarty fellowship and a career development award from Seattle Children’s Hospital as steppingstones to PREHS. According to Crocker, PREHS classes in environmental epidemiology, qualitative research methods, and data analysis significantly improved her research skills.

“PREHS course work has strengthened my ability to design rigorous studies, understand data analysis, and interpret results,” she explained.

Crocker added that the biggest perk of PREHS is mentorship. Her primary mentor, Catherine Karr, M.D., Ph.D., helped Crocker tap into resources she did not know existed, like funding opportunities through NIEHS or research support through different academic departments.

“I think PREHS will benefit me for a long time,” said Crocker. “I’m able to take what I learn from my research and use it in clinical practice. I can share my findings with patients and say, ‘This is what I found, and here are some things that are helpful.’”

Wildfire smoke and children’s respiratory health

Through PREHS, she has become confident giving advice to families on how to reduce their exposure to wildfire smoke — informed by her work summarizing how wildfire smoke influences respiratory health — for the estimated 7.4 million children exposed annually, 700,000 of whom have asthma.

“The number one thing I tell families is to know your air quality,” Crocker said. “I show them how to check the air quality index on apps and websites and tell them what actions need to be taken at different thresholds.”

Protective measures Crocker recommends include staying inside if possible, wearing an N95 mask if going outside, ensuring smoke cannot enter the home, and installing a home air filter to remove smoke pollution.

“For some children, wildfire smoke exposure may trigger mild respiratory symptoms, like nasal secretions or coughing,” Crocker explained. “But for others, it can be more severe, like wheezing, coughing, and shortness of breath that can lead to hospitalization and be life-threatening.”

However, to effectively prevent wildfire smoke exposure, physicians need to know when to step in and what to tell their patients. For Crocker, this was a challenge when she first started at Seattle Children’s Hospital, and she was curious if other doctors had a similar experience. To find out, she conducted a survey of pediatric pulmonary providers in Washington state.

“We asked about different components of wildfire smoke and how to manage it in a clinical setting, and we identified many opportunities for improvement,” said Crocker. “For example, most providers knew what the air quality index was, but not all were familiar with how it is calculated. Also, not all providers felt confident helping families prevent exposure.”

To bridge this gap, Crocker has taken a more active role in pediatric resident training, developing lesson plans for how physicians can address wildfire smoke. She also supports the use of interactive lectures, case studies, and perhaps most importantly, pediatric board exam questions focused on wildfire smoke.

Centering community

Before PREHS, Crocker collaborated with the Public Health Seattle and King County Asthma Program, which pairs environmental home inspections with education to support families of children with asthma.

As a PREHS scholar, Crocker has continued working with her local public health department to make the services available to more families. She developed a protocol for virtual home visits, taking into consideration concerns identified by families of children with asthma. According to Crocker, interventions like this new protocol would not be effective unless informed through community-engaged research.

“Engaging communities in research is essential,” explained Crocker. “We can do research about communities very easily, but if you want to make a difference and improve health, you need to listen to the individual voices within that community.”