State School Rankings ... for Allergies?

Most state school rankings tout the schools that offer the best education or college sports or low cost. But one health group advocate thinks that asthma and allergies should get a state ranking list too.

After years of taking calls from concerned parents or school administrators, the Asthma and Allergy Foundation of America or AAFA noticed that "some states are just better than others when it comes to protecting their child's safety," said Mike Tringale, director of external affairs at the Asthma and Allergy Foundation of America.

By safety, Tringale means the care for allergies and asthma. Other things like gun safety may seem more important to adults than irritating conditions like allergies or asthma. But the U.S. Centers for Disease Control and Prevention reports that childhood asthma rates doubled since 1980 and that asthma is the third-ranking reason for a kid to go to the hospital.

"Asthma is the number-one chronic reason why children miss school in the U.S.," said Tringale.

With that in mind, the Asthma and Allergy Foundation of America set out to recognize the best states for asthma and allergy policies. Some did fantastic, others did not.

The following states made the organization's Honor Roll, or honorable mention.

New Jersey

Yes, it's true. New Jersey might be known more for oil refineries than for its invigorating air quality. But when it comes to making health policy for kids, the Garden State tied with two other top states for best rules in place.

To rank states like New Jersey, the group used 18 criteria policies. Rules ranged from notifying parents of pesticide use to the right of a child to carry their own allergy medication.

New Jersey hit all of them on the nose, except for the nurse-to-student ratio. To manage students' asthma or allergies well, the AAFA panel recommended at least one nurse for every 750 students.

A ratio of 750 kids to one nurse sounds high, but school principles have had to work with much worse.

"I had one nurse for 2,200 students. Under this guideline I'd have three nurses," said Mel Riddile, the principal for the T.C. Williams High School in Alexandria, Va., and the associate director of High School Services at National Association of Secondary School Principals.

"In many jurisdictions, they just have a nurse's assistant, not even a real nurse in the area," said Riddile.


Only four states in the country could meet the 750 kids-to-one-nurse policy. Vermont was one of them, tying with New Jersey on the Honor Roll list.

This small state, which is ranked second to last in population, managed to lead the pack with asthma and allergy care.

Not only did Vermont score well with its students-to-nurse ratio, the state also required emergency protocols set in place for an asthma attack.

While Vermont could likely beat New Jersey in outdoor air quality, the one point where the state fell short was the indoor air quality rules. Unlike New Jersey, Vermont did not mandate that all schools follow an indoor air quality policy.

However, some individual schools have indoor air quality management policies requiring proper carpet care, management of HEPA filters and careful pesticide use.


"When it comes to health care, New England states seem to be ahead of the pack," said Tringale. Indeed, Connecticut tied with Vermont and New Jersey for the top of the asthma and allergy Honor Roll.

Connecticut also hit all but one mark on the gold standard list of 18 essential policies, falling short on the issue of requiring incident records for allergic reactions or asthma attacks.

But to listen to veteran principal Riddile, school officials don't tend to forget asthma attacks.

"When kids have asthma attacks in school, it's really very upsetting," said Riddile.

According to Riddile and the AAFA, indoor air quality can have a lot to do with the rate of asthma attacks. When Riddile's high school moved from an old building to a brand new "green" environmentally friendly building with sophisticated venting, the number of asthma attacks dropped.

"When we were in the old building, we would see it [asthma attacks] almost two or three times a week," said Riddile. After the move, he remembered being struck by the lack of attacks.

"I turned around and said, 'You know, I can't remember the last time I even heard on the school radio a call for that."

Rhode Island

Falling shortly behind Connecticut is yet another New England state: Rhode Island.

Rhode Island hit all but two of the 18 gold standard policies. The state sets policies for emergency response to asthma attacks, policies for indoor air quality and tobacco policies.

"Here's our gold standard: Are kids exposed to tobacco in schools?" said Charlotte Collins, who headed the Honor Roll effort and serves as director of public policy and advocacy for the AAFA.

Collins, who is also a lawyer, has seen many changes in terms of tobacco use and schools.

"I've seen high schools in my past in which tobacco was not only not banned, but there was a smoking area in the cafeteria for the kids," said Collins, who also remembered teens who used to bring in chairs and ashtrays to the parking lot and smoke.

Rhode Island -- and Massachusetts, the next ranking state -- ban smoking in school buildings, on school grounds and on all school buses and school-related functions.


Massachusetts and Rhode Island have statewide policies requiring tobacco prevention education. Only four states -- Alaska, Florida, Ohio and Wyoming -- had none of those tobacco measures. Twenty-five other states fell short.

Beyond the irritating exposure of smoke, the AAFA was worried about the long-term health effects of miming smokers.

"We look for states that have blanket bans," said Collins, who noted that, "with school kids, the primary role models are not really their parents -- it's their teachers, and primarily their friends."

"If you can create an environment where they aren't exposed [to tobacco] at all, then it's very, very useful," said Collins.


Thousands of miles away from the New England and Northeast leaders, the Pacific state of Washington chimed in on the Honor Roll tying the score with Massachusetts.

Like Rhode Island, Washington fell a bit short in terms of student-nurse ratio and it lacked some blanket indoor air quality policies or allergy awareness policies.

But on the whole, Washington kept hitting the mark. The state met every standard in regards to letting children carry their allergy and asthma medicines.

"A child who has to bring an epinephrine pen, which has a sharp point of a syringe, can run into problems," said Tringale. The adrenaline in an epinephrine pen can save a child suffering from an allergic anaphylaxis shock.

Although the pens open airways, which can keep the allergic child breathing, that sharp point on the syringe can cause safety concerns.

"Some schools would not allow that in the gym, or for the children to carry it in the classroom," said Tringale. "Some schools would require asthma inhalers and [an] epinephrine syringe to be locked in the nurse's office and the nurse only comes in three days a week."

But Washington has statewide policies to ensure those students can carry their asthma inhalers or get to their epinephrine when they need it.

New Mexico

With most of the state's population living in thin air at 6,000 feet above sea level, it's no wonder the government paid attention to breathing.

New Mexico fell just below the AAFA's Honor Roll, but the Land of Enchantment deserves an honorable mention. It made 14 of the 18 gold standard requirements.

"Most of what we saw, we were pleased with [in all states]," said Collins, who took extra care to draft the requirements for the Honor Roll. Collins helped put together a panel of active parents, school administrators, asthma educators, school nurses, doctors and social workers to come up with the criteria.

"It's important to have policy to have uniform standards based on not just the loudest mother, but best practice," said Tringale.

"We tried to not just make it a bunch of clinicians and medical types," said Collins, but people who were on the ground working in the schools.

Only three other states met 14 of the 18 gold standard requirements.

New York

New York, neighbor to most of the Honor Roll states, fell just slightly below the Honor Roll rankings. But it came close, with 14 points on the 18-point scale.

Children in New York have all the tobacco bans, the indoor air quality standards and the rights to carry their medications. But New York administrators might have less paperwork to file.

New York didn't meet the AAFA standards in reporting asthma incidents or mandated asthma awareness programs. Still, the Empire State made a good showing for policies in place, and Tringale thinks that's essential.

"Definitely, there must be a policy," said Tringale, who added parents would not want their child's education standard to change from school to school, or district to district. "We think the same thing about health," he said.


Two hundred miles south of New York lies Maryland, yet another leader in setting the standard for allergy care.

Maryland scored the same as New York -- 14 points out of 18 -- but missed out in different areas. Maryland was more likely to lag on policies for tobacco bans at school functions and indoor air quality control.

That's no moot point for Principal Riddile. "Air quality in schools should be a definite priority, and it is among the school systems I know," he said.

The move from an old building into a new one changed more than the air quality for his school.

"Our attendance went up, we had fewer sick days," said Riddile. "I noticed a difference with [my] allergies."

While Maryland lacked on indoor air quality control policies, West Virginia, which tied Maryland for an honorable mention, did gangbusters.

West Virginia

Though the state is close to Tobacco Country, West Virginia led the way in terms of banning tobacco on school grounds. The state was also strong in terms of letting children have access to their medicine, and indoor air quality.

According to Tringale, states like West Virginia could hopefully inspire other states to change their ways.

"When you shine a spotlight on some areas, there's clearly a lack of light on others and we'd like some states to pick up the pace," said Tringale.