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."
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.