Introduction
Asthma is a prevalent chronic condition in children, with over 12% of Americans under 18 affected, leading to annual direct healthcare costs of $11.5 billion The rising prevalence and significant financial burden of asthma have positioned it as a critical public health priority nationwide.
Historically the information available regarding asthma prevalence in
Massachusetts has relied on statewide prevalence figures for asthma, primarily gathered through the Behavioral Risk Factor Surveillance System (BRFSS), a random telephone survey conducted by state health departments in collaboration with the U.S Centers for Disease Control and Prevention (CDC) While BRFSS data effectively estimate asthma prevalence across the state, they lack community-level insights Prior to the current environmental public health tracking initiative, detailed asthma data at the community level was available only for a limited number of areas with specialized surveillance programs or research studies.
Statewide prevalence figures provide a general overview of the health of Commonwealth residents, but there is a critical need to assess asthma prevalence more precisely at state and local levels, especially among children, who have experienced the most significant increases in asthma rates Implementing a standardized pediatric asthma surveillance system that gathers community-level data on asthma prevalence enables public health officials to effectively identify and address the issue.
1 populations with asthma on the local level, evaluate at risk groups, and evaluate the impact of interventions over time more effectively than state-level data.
The Massachusetts Department of Public Health (MDPH), through its Center for Environmental Health (CEH), has proposed a systematic approach to track pediatric asthma by utilizing school health records This initiative is supported by Massachusetts law, which allows MDPH to access these records for public health investigations while ensuring strict privacy protections To effectively identify children diagnosed with pediatric asthma, CEH staff collaborated with school health nurses to review health records from participating schools.
This project is part of a broader initiative focused on monitoring health outcomes influenced by environmental factors Funded mainly by the CDC's National Environmental Public Health Tracking Program, the project seeks to assess the prevalence of pediatric asthma among Massachusetts schoolchildren, lupus in Boston, and developmental disabilities in Berkshire County Additionally, a supplemental grant enables the tracking of childhood cancer, reproductive health outcomes, and childhood lead poisoning in connection with potential environmental exposures.
This report outlines the implementation methods for the pediatric asthma tracking initiative and presents a summary of asthma prevalence data gathered during the second year, which included all public and private schools in the Commonwealth serving grades K through 8 Following the release of Year 1 results in May 2004, which were based on a limited number of schools, Year 2 marks the first comprehensive statewide collection of pediatric asthma data.
Methods A Target Population
In the 2003-2004 academic year, the Massachusetts Department of Public Health (MDPH) mandated that all public and private schools serving grades kindergarten through 8, totaling 2,128 institutions, report the number of enrolled students diagnosed with asthma.
Project Definition of Asthma
School nurses reported the number of students diagnosed with asthma by grade and gender using a standardized report form Their knowledge of a child's asthma status was derived from various sources, including emergency cards, parent resource centers, communications with parents and students, healthcare provider documentation, and direct observation of asthma attacks The survey also requested the percentage of cases with documented provider diagnoses or medication orders.
Data Collection
In March 2004, public school nurse leaders and health contacts from private schools were tasked with distributing a one-page reporting form to gather aggregate data on the number of children with asthma, categorized by grade, gender, and school building.
The reporting forms included questions about the data source and were primarily sent via email to nurse leaders or school health contacts to streamline electronic submissions In cases where email was unavailable, forms were mailed through the U.S Postal Service Follow-up calls were made to non-responding nurses by April 2004 School enrollment data was obtained from the Massachusetts Department of Education or directly from school administrative staff, with incomplete surveys from schools or those lacking 2003 data being noted.
-2004 enrollment data could not be obtained by September 2004 were considered non- responders.
Data Management
MDPH staff meticulously reviewed surveys for accuracy and completeness, addressing any missing data or inconsistencies Each school's survey was assigned a Massachusetts DOE school identifier code, and for schools not listed in the DOE database or categorized under larger institutions, MDPH created unique identifier codes following the DOE structure Only complete survey data were manually entered into the tracking project database after a thorough review, while incomplete surveys were excluded from the database.
Data Analysis
Participation
MDPH received asthma data from a total of 1,664 public, private, and charter schools, approximately 78% of the schools serving any of grades K-8 in the
During the school year, a total of 1,664 report forms were completed, with 1,305 submissions from public schools, accounting for 85% of the total Charter schools contributed 30 reports, representing 73%, while private schools submitted 329 forms, which is 58% The geographic distribution of these schools is illustrated in Figures 1a and 1b.
Out of the total participants, some asthma report forms were incomplete, leading to their exclusion from prevalence analyses Data from 20 schools was insufficient for estimating prevalence by grade, while 19 schools could not contribute to gender-specific prevalence estimates Nevertheless, data from nearly all reporting schools, except for two, were utilized to calculate the statewide prevalence of asthma.
Reported Asthma Prevalence
Among 638,421 students across 1,664 schools, the overall asthma prevalence was reported at 9.5% (95% CI 9.4% - 9.6%), with school-specific rates varying from 0% to 39.1% Asthma prevalence differed by school type, with charter schools at 10.0%, public schools at 9.6%, and private schools at 8.2% By grade level, statewide asthma prevalence ranged from 8.2% in kindergarten to 10.3% in fifth grade Additionally, asthma prevalence was higher in males at 10.9% compared to 8.0% in females.
Other Variables
Discussion
While there was notable variation in reported asthma prevalence between schools (range of 0 - 39.1%), caution should be used when comparing school prevalence estimates.
Differences in school health record keeping and reporting may explain the variations observed among schools To address this, the Massachusetts Department of Public Health (MDPH) plans to validate asthma data reported by school nurses by comparing it with reports from other nurses and physician medical records A funding request to the CDC for this verification process is currently pending.
A higher prevalence of asthma at one school compared to another does not necessarily indicate environmental issues within that school Pediatric respiratory symptoms can arise from various factors, including outdoor and home exposures, genetic predispositions, and lifestyle choices The MDPH pediatric asthma tracking project serves as a surveillance initiative rather than a research study, meaning its data cannot definitively determine the causes of asthma prevalence in schools However, a companion project by MDPH is monitoring indoor environmental data in several schools statewide, aiming to connect these datasets Similar efforts to link environmental data with health outcomes are also being pursued under the CDC funding.
The year two pediatric asthma prevalence data is presented by individual schools, following the year one surveillance data reported by school districts It's important to note that a town can belong to both a regional and a local school district simultaneously, resulting in some schools within the same town being assigned to different school districts This scenario also includes private and charter schools, which may further complicate the distribution of asthma data across various educational institutions.
Six schools operate independently from public school districts and were excluded from the initial surveillance efforts Consequently, providing pediatric asthma data by individual school offers more valuable insights than reporting by district.
Comparison with Year One Data
A recent survey of school nurses revealed a statewide prevalence of pediatric asthma at 9.5%, with individual schools reporting rates as high as 39% This marks a slight increase from the previous year's findings, which indicated an overall prevalence of 9.2% and a maximum of 30.8% in certain schools The second year of data collection expanded statewide surveillance, highlighting inconsistencies in reporting practices; some schools only reported children with asthma medication orders, while others included all known cases This variation likely led to an underestimation of asthma prevalence in the first year As the surveillance program progresses, improved communication with school nurses is expected to enhance the accuracy and standardization of reporting procedures.
Comparison with Other Surveillance Programs
The statewide prevalence observed in year two differs from other state and national childhood asthma surveillance efforts The 2003 BRFSS reports that 9.2% of
In Massachusetts, 11.1% of children aged 5-9 and 11.9% of those aged 10-14 are currently diagnosed with asthma, according to the BRFSS Nationally, the CDC's 2004 NHIS indicates that 7.9% of children aged 0-14 have asthma, while the 2003 National Survey of Children’s Health reveals that 8.8% of U.S children and 10.2% of Massachusetts children are affected by this condition.
The asthma prevalence figures from the BRFSS and NHIS provide a general range for expected values in Massachusetts; however, due to differing methodologies and target populations, they are not ideal for direct comparison with MDPH surveillance data These figures are based on household samples and self-reported health information, which can impact the accuracy of the prevalence estimates Implementing a school-based surveillance approach could enhance the reliability of asthma prevalence data.
A recent report highlights the prevalence of asthma among students in Connecticut, revealing a rate of 9.7% for grades K-5 In comparison, Massachusetts K-5 students show a lower asthma prevalence of 7.9% However, there is no available data for asthma prevalence among Connecticut students in grades 6-8 for further comparison.
The Value of Asthma Surveillance
The Massachusetts approach to asthma surveillance offers significant value by utilizing school nurses and student health records as reliable health information sources This method enables the assessment of pediatric asthma prevalence at the local level for the first time, allowing for a better understanding of how indoor and outdoor environmental exposures contribute to the disease While statewide pediatric asthma prevalence aligns with findings from other surveys, community-level data reveals varying prevalence rates by school, which were previously inaccessible through broader data sources This localized asthma prevalence information is crucial for planning and executing targeted environmental health investigations and public health interventions tailored to specific community needs.
Future Efforts Aimed at Pediatric Asthma Surveillance
This report outlines the second year of the Massachusetts Department of Public Health's (MDPH) three-year Environmental Public Health Tracking Project In the initial year, the project focused on asthma surveillance in select Massachusetts schools For the second year, MDPH broadened its pediatric asthma tracking initiative to encompass all public, private, and charter schools serving grades K-8 across the state.
The Commonwealth consists of 372 school districts, with ongoing data collection for year three focusing on all schools serving grades K-8 After gathering three years of data and validating school nurse reports, an analysis will be conducted to assess changes in reported asthma prevalence in schools throughout this period.
This report highlights important progress that has been made toward the establishment of a comprehensive, statewide pediatric asthma surveillance system in the Commonwealth of Massachusetts.
References
1 U.S Centers for Disease Control and Prevention (CDC), Measuring childhood asthma prevalence before and after the 1997 redesign of the National Health Interview Survey United States MMWR Morb Mortal Wkly Rep, 2000 49(40): p.
2 Bloom, B., et al., Summary Health Statistics for U.S Children: National Health
Interview Survey, 2001 10(216), in Vital Health Stat 2003, National Center for
3 American Lung Association, Epidemiology and Statistics Unit Trends in Asthma
4 Mannino, D.M., et al., Surveillance for asthma United States, 1960-1995 MMWR
5 Massachusetts Department of Public Health, C.f.E.H., Pediatric Asthma in
6 Boezen, H.M., et al., Effects of ambient air pollution on upper and lower respiratory symptoms and peak expiratory flow in children Lancet, 1999
7 Delfino, R.J., et al., Association of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication use Environ
8 Tolbert, P.E., et al., Air quality and pediatric emergency room visits for asthma in
Atlanta, Georgia, USA Am J Epidemiol, 2000 151(8): p 798-810.
9 Sturm, J.J., K Yeatts, and D Loomis, Effects of tobacco smoke exposure on asthma prevalence and medical care use in north Carolina middle school children Am J
10 Rosenstreich, D.L., et al., The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma N Engl J
11 Smith, B.J., et al., Health effects of daily indoor nitrogen dioxide exposure in people with asthma Eur Respir J, 2000 16(5): p 879-85.
12 Lee, Y.L., et al., Indoor and outdoor environmental exposures, parental atopy, and physician-diagnosed asthma in Taiwanese schoolchildren Pediatrics, 2003 112(5): p e389.
13 El-Sharif, N., et al., Familial and environmental determinants for wheezing and asthma in a case-control study of school children in Palestine Clin Exp Allergy,
14 Aligne, C.A., et al., Risk factors for pediatric asthma Contributions of poverty, race, and urban residence Am J Respir Crit Care Med, 2000 162(3 Pt 1): p 873-7.
15 Heinrich, J., et al., Trends in prevalence of atopic diseases and allergic sensitization in children in Eastern Germany Eur Respir J, 2002 19(6): p 1040-6.
16 Massachusetts Department of Public Health, C.f.H.I., Statistics, Research, and
Evaluation, A Profile of Health Among Massachusetts Adults, 2003 2004.
17 U.S Centers for Disease Control and Prevention, Early Release of Selected
Estimates Based on Data From the January-September 2004 National Health Interview Survey 2005.
18 Storey, E., et al., A Survey of Asthma Prevalence in Elementary School Children
2003, Environment and Human Health, Inc.: North Haven, CT.
Figure 1a Schools that Participated in the MDPH Pediatric Asthma Surveillance Activities During the 2003-2004 School Year.
Figure 1b Schools that did not participate in the MDPH Pediatric Asthma Surveillance Activities During the 2003-2004 School Year.
Figure 2 Distribution of School Nurse – Reported
Variables collected on the Pediatric Asthma Survey, 2003-2004
Male Number of male K-8 students with asthma
Female Number of female K-8 students with asthma
Grade K – Grade 8 Number of students in each grade with asthma
% Documented Percentage of students with documentation of asthma in health record
Sources Source(s) that gave nurses knowledge of children’s’ asthma status
Reported asthma prevalence by grade
Answers to questions related to school nurses records MDPH Pediatric Asthma Survey, 2003-2004
11 Number of students with documentation in the health record of a provider diagnosis of asthma range of percent of students with documented asthma 0 – 100%
1626 Mean percent of students with documented asthma 68.6%
12 How else did you (the school nurse) know these students had asthma?
(choices are not mutually exclusive)
Direct observation of an asthma attack 37.1%
Advisory Committee
Judith Auburn, Marcia Buckminster, Peg Burton, Linda Cochenour, Cindy Juckner, Karen Murphy, Carolyn O’Reilly, Sarah Poirier, Katherine Porcello, Mary Ellen Shriver, Nancy Sullivan, Karen Turmel, Mary Zamorski
MDPH Pediatric Asthma Survey, 2003-2004
{Image of Pediatric Asthma Surveillance Form Instructions}
{Image of Pediatric Asthma Surveillance Form}
Reported Asthma Prevalence by School
95% Confidence Interval Comparison with Statewide Prevalence
Abington ECC RALPH HAMLIN LANE ABINGTON 7.8 5.6 - 10.0 not statistically significantly different
Center 69 HAXTER AVE ABINGTON 5.0 2.1 - 7.9 statistically significantly lower
Frolio Jr Hs 1071 WASHINGTON ST ABINGTON 12.6 9.4 - 15.8 not statistically significantly different
North 171 ADAMS ST ABINGTON 10.5 6.3 - 14.6 not statistically significantly different
St Bridget 455 PLYMOUTH ST ABINGTON 4.9 2.2 - 7.5 statistically significantly lower
Woodsdale 128 CHESTNUT ST ABINGTON 9.7 6.7 - 12.7 not statistically significantly different
Douglas 21 ELM ST ACTON 10.7 8.0 - 13.5 not statistically significantly different
Gates 75 SPRUCE ST ACTON 11.3 8.5 - 14.1 not statistically significantly different
Luther Conant 80 TAYLOR RD ACTON 9.1 6.6 - 11.7 not statistically significantly different
McCarthy-Towne 11 CHATER RD ACTON 6.7 4.5 - 8.9 statistically significantly lower
Merriam 11 CHARTER RD ACTON 8.1 5.7 - 10.4 not statistically significantly different
Raymond J Grey JH 16 CHARTER RD ACTON 11.4 9.4 - 13.4 not statistically significantly different
Acushnet Elementary School 800 MIDDLE ROAD ACUSHNET 8.8 6.4 - 11.1 not statistically significantly different
St Francis Xavier 223 MAIN ST ACUSHNET 3.0 0.6 - 5.3 statistically significantly lower
Adams Middle 30 COLUMBIA ST ADAMS 5.3 3.2 - 7.4 statistically significantly lower
Plunkett Elementary 14 COMMERCIAL ST ADAMS 17.8 14.7 - 20.9 statistically significantly higher
St Stanislaus Kostka 108 SUMMER STREET ADAMS 6.6 2.4 - 10.8 not statistically significantly different
Agawam Junior High 1305 SPRINGFIELD ST AGAWAM 14.5 12.0 - 17.1 statistically significantly higher
James Clark School 65 OXFORD ST AGAWAM 10.2 7.2 - 13.2 not statistically significantly different
ELC - North Zone 40 ARMINGTON ST ALLSTON 18.6 7.0 - 30.2 not statistically significantly different
Horace Mann 40 ARLINGTON ST ALLSTON 9.5 3.9 - 15.1 not statistically significantly different
Jackson Mann 40 ARMINGTON ST ALLSTON 5.0 3.2 - 6.8 statistically significantly lower
St Anthony 57 HALTON ST ALLSTON 10.6 5.9 - 15.4 not statistically significantly different
Thomas Gardner 30 ATHOL ST ALLSTON 3.2 1.3 - 5.0 statistically significantly lower
9 WATER ST AMESBURY - DATA NOT SHOWN*
Amesbury Elementary 20 S HAMPTON RD AMESBURY 5.2 3.1 - 7.3 statistically significantly lower
Amesbury Middle 220 MAIN ST AMESBURY 6.3 4.7 - 8.0 statistically significantly lower
193 LION'S MOUTH RD AMESBURY 7.8 5.5 - 10.2 not statistically significantly different
AMESBURY 26.7 4.3 - 49.0 not statistically significantly different
Amherst Montessori School 27 POMEROY LANE AMHERST 0.0 0.0 - 0.0 statistically significantly lower
Amherst Regional MS 170 CHESTNUT STREET AMHERST 12.8 10.3 - 15.4 statistically significantly higher
Crocker Farm Elementary 280 WEST STREET AMHERST 8.2 5.1 - 11.3 not statistically significantly different
Fort River Elementary 70 SO EAST STREET AMHERST 13.3 10.3 - 16.3 statistically significantly higher
Marks Meadow Laboratory NO PLEASANT STREET AMHERST 10.6 6.3 - 14.8 not statistically significantly different
Wildwood Elementary 71 STRONG STREET AMHERST 14.9 11.5 - 18.2 statistically significantly higher
Andover West Middle 70 SHAWSHEEN RD ANDOVER 7.5 5.1 - 9.8 not statistically significantly different
Bancroft Elementary 15 BANCROFT RD ANDOVER 11.5 8.4 - 14.6 not statistically significantly different
Doherty Middle 50 BARTLET STREET ANDOVER 11.0 8.4 - 13.6 not statistically significantly different
Henry C Sanborn Elementary 90 LOVEJOY RD ANDOVER 7.0 4.4 - 9.6 statistically significantly lower
High Plain Elementary 333 HIGH PLAIN RD ANDOVER 8.3 6.0 - 10.6 not statistically significantly different
Saint Augustine 26 CENTRAL STREET ANDOVER 3.5 1.7 - 5.2 statistically significantly lower
Shawsheen School 18 MAGNOLIA AVENUE ANDOVER 11.8 7.3 - 16.2 not statistically significantly different
South Elementary 55 WOBURN ST ANDOVER 9.2 6.8 - 11.6 not statistically significantly different
95% Confidence Interval Comparison with Statewide Prevalence
West Elementary*K-8 enrollment < 15, data not shown to protect student confidentiality58 BEACON ST ANDOVER 11.2 8.7 - 13.8 not statistically significantly different
Wood Hill Middle School 11 CROSS STREET ANDOVER 8.1 5.5 - 10.8 not statistically significantly different
Brackett EASTERN AVE ARLINGTON 6.2 3.7 - 8.7 statistically significantly lower
Cyrus E Dallin 185 FLORENCE AVE ARLINGTON 4.0 2.0 - 6.0 statistically significantly lower
Ecole Bilingue 17 IRVING ST ARLINGTON 1.6 -1.5 - 4.8 statistically significantly lower
Hardy LAKE ST ARLINGTON 8.2 5.0 - 11.3 not statistically significantly different
John A Bishop 25 COLUMBIA RD ARLINGTON 4.0 2.1 - 5.9 statistically significantly lower
Lesley Ellis 41 FOSTER ST ARLINGTON 11.1 2.7 - 19.5 not statistically significantly different
M Norcross Stratton ARLINGTON 6.1 3.3 - 8.8 statistically significantly lower
May Institute 10 ACTON STREET ARLINGTON 10.4 1.8 - 19.1 not statistically significantly different
Ottoson Middle ACTON ST ARLINGTON 9.5 7.7 - 11.4 not statistically significantly different
Pierce 41 PARK AVE ARLINGTON 2.2 0.3 - 4.1 statistically significantly lower
St Agnes Elementary 39 MEDFORD ST ARLINGTON 6.2 3.8 - 8.6 statistically significantly lower
Thompson 15 NORTH UNION ST ARLINGTON 2.2 0.6 - 3.9 statistically significantly lower
Briggs Elementary 96 WILLIAMS RD ASHBURNHAM 9.3 6.7 - 11.9 not statistically significantly different
Overlook Middle School 10 OAKMONT AVENUE ASHBURNHAM 5.1 3.4 - 6.9 statistically significantly lower
Ashby Elementary 911 MAIN ST ASHBY 8.9 5.5 - 12.3 not statistically significantly different
Sanderson Academy 808 CAPE ST ASHFIELD 13.0 8.0 - 17.9 not statistically significantly different
STREET ASHLAND 6.8 4.3 - 9.3 statistically significantly lower
David Mindess 90 CONCORD ST ASHLAND 6.9 4.9 - 9.0 statistically significantly lower
Henry E Warren Elementary 73 FRUIT STREET ASHLAND 4.4 2.8 - 6.0 statistically significantly lower
William Pittaway Elementary 75 CENTRAL STREET ASHLAND 5.0 2.1 - 8.0 statistically significantly lower
School 1062 PLEASANT ST ATHOL 17.6 14.3 - 20.9 statistically significantly higher
Ellen Bigelow 129 ALLEN ST ATHOL 4.2 -1.5 - 9.8 not statistically significantly different
Pleasant St 1060 PLEASANT ST ATHOL 14.9 10.7 - 19.0 statistically significantly higher
Riverbend RIVERBEND ST ATHOL 15.9 11.8 - 20.1 statistically significantly higher
Sanders Street 314 SANDERS ST ATHOL 14.4 9.2 - 19.6 not statistically significantly different
Silver Lake 245 SILVER LAKE ST ATHOL 13.6 7.0 - 20.2 not statistically significantly different
A Irvin Studley Elementary 299 RATHBUN WILLARD
ATTLEBORO 7.9 5.4 - 10.4 not statistically significantly different
Cyril K Brennan Middle 320 RATHBUN WILLARD
ATTLEBORO 10.5 8.2 - 12.7 not statistically significantly different
Dayspring Christian 1052 NEWPORT AVE ATTLEBORO 8.7 5.5 - 11.8 not statistically significantly different
Hill-Roberts Elementary 80 ROU AVENUE ATTLEBORO 10.9 8.1 - 13.6 not statistically significantly different
Hyman Fine Elementary 790 OAKHILL AVE ATTLEBORO 1.2 0.3 - 2.2 statistically significantly lower
Peter Thatcher Elementary 7 JAMES ST ATTLEBORO 10.1 7.5 - 12.6 not statistically significantly different
Robert J Coelho Middle 99 BROWN ST ATTLEBORO 10.1 7.6 - 12.5 not statistically significantly different
St John The Evangelist 13 HODGES ST ATTLEBORO 3.3 1.2 - 5.5 statistically significantly lower
Thomas E Willett School 32 WATSON AVE ATTLEBORO 10.4 7.5 - 13.3 not statistically significantly different
Wamsutta Middle School 300 LOCUST ST ATTLEBORO 10.0 7.9 - 12.2 not statistically significantly different
Auburn Middle 10 SWANSON RD AUBURN 11.5 8.9 - 14.1 not statistically significantly different
Bryn Mawr 35 SWANSON AVE AUBURN 8.4 5.0 - 11.8 not statistically significantly different
Mary D Stone 10 CHURCH ST AUBURN 6.2 3.1 - 9.2 statistically significantly lower
Pakachoag 110 POKACHOAG ST AUBURN 13.4 9.5 - 17.2 not statistically significantly different
Avon Middle High School 1 PATRICK CLARK
DRIVE AVON 11.1 5.6 - 16.6 not statistically significantly different
AVON 10.8 7.5 - 14.0 not statistically significantly different
95% Confidence Interval Comparison with Statewide Prevalence
AYER 9.3 6.3 - 12.3 not statistically significantly different
Francis W Parker Charter 49 ANTIETAM ST AYER 19.1 12.4 - 25.8 statistically significantly higher
Page-Hilltop 117 WASHINGTON ST AYER 8.4 6.1 - 10.7 not statistically significantly different
Academy of Early Learning 465 FALMOUTH RD BARNSTABLE 0.0 0.0 - 0.0 statistically significantly lower
BARNSTABLE RD BARNSTABLE 5.8 4.3 - 7.3 statistically significantly lower
Cape Cod Academy 50 OSTERVILLE-WEST
BARNSTABLE 8.0 4.4 - 11.5 not statistically significantly different
Trinity Christian Academy 979 MARY DUNN RD BARNSTABLE 1.2 -1.2 - 3.6 statistically significantly lower
Quabbin Regional Mid/HS 800 SOUTH ST BARRE 13.3 10.5 - 16.1 statistically significantly higher
Ruggles Lane 105 RUGGLES LANE BARRE 6.3 4.2 - 8.3 statistically significantly lower
Becket Washington School 12 MAPLE ST BECKET 10.0 4.4 - 15.6 not statistically significantly different
John Glenn Middle 19 MCMAHON RD BEDFORD 5.9 3.9 - 8.0 statistically significantly lower
Lt Elezer Davis DAVIS RD BEDFORD 9.4 6.8 - 12.0 not statistically significantly different
Lt Job Lane School 66 SWEETWATER AVE BEDFORD 9.5 7.0 - 12.0 not statistically significantly different
Chestnut Hill Community 59 STATE STREET BELCHERTOWN 9.1 6.8 - 11.4 not statistically significantly different
Cold Spring 57 SOUTH MAIN ST BELCHERTOWN 6.0 3.4 - 8.6 statistically significantly lower
Swift River Elementary 57 STATE BELCHERTOWN 13.1 10.4 - 15.8 statistically significantly higher
Tadgell Hall 7 BERKSHIRE AVE BELCHERTOWN 11.9 7.1 - 16.7 not statistically significantly different
Bellingham Memorial Middle 130 BLACKSTONE ST BELLINGHAM 7.9 6.0 - 9.7 not statistically significantly different
Clara Macy Elementary 60 MONIQUE DR BELLINGHAM 6.8 3.7 - 9.8 not statistically significantly different
Primavera Jr/Sr H S 80 HARPIN STREET BELLINGHAM - DATA NOT SHOWN*
South Elementary HARPIN ST BELLINGHAM 6.4 4.1 - 8.8 statistically significantly lower
Stall Brook 342 HARTFORD AVE BELLINGHAM 8.5 5.5 - 11.5 not statistically significantly different
Arlington 115 MILL STREET BELMONT - DATA NOT SHOWN*
Belmont Day 55 DAY SCHOOL LANE BELMONT 12.0 7.9 - 16.1 not statistically significantly different
Daniel Butler WHITE ST BELMONT 7.1 3.9 - 10.4 not statistically significantly different
Mary Lee Burbank 266 SCHOOL ST BELMONT 7.0 4.1 - 9.8 not statistically significantly different
Roger E Wellington ORCHARD ST BELMONT 5.9 3.6 - 8.1 statistically significantly lower
Winn Brook WATERHOUSE ST BELMONT 8.2 5.5 - 11.0 not statistically significantly different
Winthrop L Chenery Middle 95 WASHINGTON ST BELMONT 6.0 4.7 - 7.4 statistically significantly lower
Berkley Community School 59 S MAIN ST BERKLEY 6.4 4.2 - 8.5 statistically significantly lower
Berlin Memorial 34 SOUTH ST BERLIN 10.5 6.6 - 14.4 not statistically significantly different
Bernardston Elementary 37 SCHOOL ROAD BERNARDSTON 6.8 2.7 - 10.9 not statistically significantly different
Ayers/Ryal Side School 40 WOODLAND AVE BEVERLY 8.2 5.6 - 10.8 not statistically significantly different
Centerville Elementary 17 HULL ST BEVERLY 10.0 6.7 - 13.2 not statistically significantly different
Cove Elementary 20 EISON HOWER AVE BEVERLY 9.2 6.4 - 11.9 not statistically significantly different
Covenant Christian School 35 CONANT ST BEVERLY 2.8 -0.3 - 5.9 statistically significantly lower
Hannah Elementary R 41 BRIMBAL AVE BEVERLY 5.5 2.9 - 8.0 statistically significantly lower
McKeown Elementary 70 BALCH ST BEVERLY 12.1 8.0 - 16.2 not statistically significantly different
North Beverly Elementary 48 PUTNAM ST BEVERLY 7.5 4.8 - 10.3 not statistically significantly different
St John the Evangelist 111 NEW BALCH ST BEVERLY 2.0 0.3 - 3.7 statistically significantly lower
Eugene C Vining 121 LEXINGTON ROAD BILLERICA 7.9 5.0 - 10.7 not statistically significantly different
Frederick J Dutile 35 RIVER ST BILLERICA 0.8 0.0 - 1.5 statistically significantly lower
Hajjar Elementary 59 ROGER STREET BILLERICA 6.8 4.8 - 8.8 statistically significantly lower
John F Kennedy KIMBROUGH RD BILLERICA 4.6 2.9 - 6.4 statistically significantly lower
(%) 95% Confidence Interval Comparison with Statewide Prevalence
Locke Middle 110 ALLEN RD BILLERICA 8.9 6.8 - 11.1 not statistically significantly different
Marshall Middle School 15 FLOYD STREET BILLERICA 6.7 5.1 - 8.4 statistically significantly lower
Parker 52 RIVER ST BILLERICA 7.0 4.5 - 9.5 statistically significantly lower
Thomas Ditson 39 COOK STREET BILLERICA 8.7 6.7 - 10.7 not statistically significantly different
Frederick W Hartnett Middle 35 FEDERAL ST BLACKSTONE 12.4 9.8 - 15.0 statistically significantly higher
*K-8 enrollment