State of Connecticut Connecticut Department of Public Health Connecticut School‐based Asthma Surveillance Report 2010 School Years: Fall 2006 – Spring 2009 Connecticut School‐based Asthma Surveillance Report 2010 School Years: Fall 2006 – Spring 2009 Commissioner J. Robert Galvin, MD, MPH, MBA Connecticut Department of Public Health Prepared by: Kimberly Nguyen, MS, MPH Justin Peng, MPH Epidemiologists Health Education, Management and Surveillance Section Public Health Initiatives Branch Connecticut Department of Public Health For additional information about Connecticut School‐based Asthma Surveillance Report 2010 contact: Connecticut Department of Public Health Asthma Program 410 Capitol Avenue PO Box 340308, MS# 11HLS Hartford, CT 06134‐0308 Phone: (860) 509‐8251 http://www.ct.gov/dph/asthma Suggested citation: Nguyen, K, Peng, J, and Hargrove, S (2010). Connecticut School‐based Asthma Surveillance Report 2010, School Years: Fall 2006 – Spring 2009. Connecticut Department of Public Health, Health Education, Management and Surveillance Section, Hartford, CT. Funding provided by the Centers for Disease Control and Prevention, Grant Number 5U59EH000516‐02 Acknowledgments Connecticut Department of Public Health Lisa A. Davis, RN, BSN, MBA Branch Chief – Public Health Initiatives Branch RWJ Executive Nurse Fellow Alumni Renée D. Coleman‐Mitchell, MPH Section Chief – Health Education, Management and Surveillance Connecticut Department of Public Health Asthma Program Eileen Boulay, RN, BSN Supervisor Justin Peng, MPH Senior Epidemiologist Kimberly Nguyen, MS, MPH Epidemiologist Elizabeth Reynolds, RN, BSN, NCSN Utilization Review Nurse Salina Hargrove, AA Pre‐Professional Trainee/Health Program Assistant Table of Contents Key Findings 1 Introduction 2 Results 4 Asthma Prevalence Rates by Grade, Sex, and Race/Ethnicity 4 Asthma Prevalence Rates by District Reference Groups 4 Students with Asthma by Grade and Sex 5 Students with Asthma by Grade and Race/Ethnicity 5 Students with Asthma by Grade and Severity 5 Students with Asthma by Severity and Sex 5 Students with Asthma by Race/Ethnicity and Severity 5 Student Asthma Diagnoses Source by Race/Ethnicity 6 Asthma Information by School District 6 Figures 7 Figure 1 Asthma Prevalence Rates by Grade, Sex, and Race/Ethnicity 7 Figure 2 Asthma Prevalence Rates by District Reference Groups 8 Figure 3 Students with Asthma by Grade and Sex 9 Figure 4 Students with Asthma by Grade and Race/Ethnicity 10 Figure 5 Students with Asthma by Grade and Severity 11 Figure 6 Students with Asthma by Severity and Sex 12 Figure 7 Students with Asthma by Race/Ethnicity and Severity 13 Figure 8 Student Asthma Diagnoses Source by Race/Ethnicity 14 Appendices 15 Appendix 1 Asthma Reporting Form 15 Appendix 2 Listing of Schools Reporting 17 Appendix 3 Asthma Prevalence Rates by Grade, Sex, and Race/Ethnicity 37 Appendix 4 Asthma Prevalence Rates by District Reference Groups 38 Appendix 5 Asthma Prevalence Rates by District Reference Groups and Race/Ethnicity 39 Appendix 6 Students with Asthma by Grade and Sex 40 Appendix 7 Students with Asthma by Grade and Race/Ethnicity 42 Appendix 8 Students with Asthma by Grade and Severity 44 Appendix 9 Students with Asthma by Severity and Sex 46 Appendix 10 Students with Asthma by Race/Ethnicity and Severity 48 Appendix 11 Student Asthma Diagnoses Source by Race/Ethnicity 50 Appendix 12 Asthma Prevalence Rates by School District 51 Appendix 13 Number of Students with Asthma by Sex and School District 57 Appendix 14 Number of Students with Asthma by Race/Ethnicity and School District 75 Connecticut School-based Asthma Surveillance Report 2010 Key Findings • Asthma prevalence rates among Connecticut public school students were 13.2% for school year 2006‐2007, 13.2% for school year 2007‐2008, and 13.1% for school year 2008‐2009. • Asthma prevalence rates were higher among students in grade PK or K when compared to the students in grades 6 or 7, and grade 9, 10, or 11. This difference was less apparent for school year 2008‐2009, where the asthma rates were 14.4% among students in grade PK or K, 13.5% in grade 6 or 7, and 12.2% in grade 9, 10 or 11. • Asthma prevalence rates were higher among male students when compared to female students. For school year 2008‐2009, the asthma rates were 14.5% among male students and 11.6% among female students. • In regard to asthma prevalence rates by race/ethnicity, Hispanic students had the highest rates of asthma followed by black students, other race/ethnicity students, and white students. For school year 2008‐2009, the asthma rates were 16.9% among Hispanic students, 14.8% among black students, 12.2% among students of other race/ethnicity, and 10.6% among white students. Please note that about 8.8% of students were reported as having an unknown race/ethnicity category; therefore, asthma prevalence rates by race/ethnicity groups could potentially be underestimated. • District Reference Groups (DRG), with letters A to I, classify school districts of similar socioeconomic status (SES). In general, SES decreases with each letter from A to I, and asthma rates increased with decreasing SES. Four of the five largest cities (Bridgeport, Hartford, New Haven, and Waterbury) belonged to group I, which had the highest asthma rates. For school year 2008‐2009, the asthma rates ranged from 7.4% among students in DRG A to 19.2% among students in DRG I. • In public and private schools, the majority of asthma cases were reported as mild. In general, the percentage of students with exercise induced asthma increased as grade increased. • Males consistently showed higher percentages of mild asthma while females showed higher percentages of exercise induced asthma. • In general, the percent of students with mild asthma was highest among whites, while the percent of students with moderate asthma was highest among blacks. Exercise induced asthma was more prevalent in white students than black and Hispanic students. • About three out of every four students had an asthma diagnosis from Health Assessment Record; one out of every three students had asthma medication on file; and one out of every twenty students had an Asthma Action Plan on file. 1 Connecticut School-based Asthma Surveillance Report 2010 Introduction Pursuant to Connecticut General Statute (CGS) Section 10‐206, the State of Connecticut Department of Public Health (DPH) Asthma Program has established a statewide School‐based Asthma Surveillance System (SBASS) based on the school Health Assessment Record (HAR). The Statute also requires the Asthma Program to report the results of this surveillance to the joint standing committees of the General Assembly every three years. This report summarizes the information collected during school years 2006‐2007, 2007‐2008 and 2008‐2009. Description of the School‐based Asthma Surveillance System CGS §10‐206 requires that public schools report to the DPH, on an annual basis, information on students with asthma. A student is considered as having asthma if he/she meets any of the following conditions: 1) has a provider’s diagnosis of asthma indicated on the HAR, 2) has a provider medication order for asthma medication on file, 3) has an Asthma Action Plan (AAP) on file, 4) shows symptoms of asthma, 5) has a parental note on file indicating the child has asthma, or 6) any other indications that the child is suffering from asthma. Information on students with asthma to be reported include: grade, age, sex, race, ethnicity, asthma severity, diagnostic source, and school. This information is only reported for students with asthma in grades requiring an HAR: Pre‐Kindergarten (PK) or Kindergarten (K) for elementary schools, grade 6 or 7 for middle schools, and grade 9 or 10 or 11 for high schools (HAR requirement for high schools was changed to grade 9 or 10 from grade 10 or 11 at the beginning of the 2008‐2009 school year). In order to facilitate this process, DPH and the State Department of Education (SDE) developed reporting forms for the school nurses to use (see Appendix 1). These forms are distributed to individual school nurses through the school district nurse supervisors. School district nurse supervisors collect completed forms in their school districts and submit the forms to the DPH by September for the previous school year. All data are entered into SBASS, a Microsoft Access database, by trained DPH staff. Data quality checks are then performed to ensure the accuracy and completeness of the data entered. Methods for Asthma Rate Calculations School districts choose which grades require an HAR based on the options provided by the legislation. More specifically, it is up to the district to decide whether to require an HAR for students in grades PK or K, 6 or 7, and 9 or 10 or 11. School nurses are required to submit asthma data on the grades that require an HAR only, but some submit data on the other grades as well. Starting in school year 2006‐2007, school district nurse supervisors were asked to report specifically which grades required an HAR in their districts. Asthma rates are calculated by dividing the number of students with asthma by the total number of children enrolled in the required grades in the district. However, for some districts, 2 Connecticut School-based Asthma Surveillance Report 2010 it was still unclear what grades to include in the rates calculation because the grades specified by the school district nurse supervisors as requiring an HAR may be different from the actual grades that were reported for students with asthma. For example, a district may have indicated that grade 6 was the required grade for asthma data to be submitted, and while some nurses within the district submitted asthma data for grade 6, others may have submitted asthma data for grade 7 instead. In other instances, the district may have indicated both grades 6 and 7 were the required grades for asthma data to be submitted, but only grade 6 asthma data was submitted.