Massachusetts School Districts Research Articles

Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings

McIntyre CL, Sheetz AH, Carroll CR, Young MC. Pediatrics. 2005;116:1134–1140 PURPOSE OF THE STUDY. To ascertain the incidence of anaphylaxis in schools, characterize the circumstances surrounding anaphylactic episodes, and evaluate practices that are used to manage students with life-threatening allergies. STUDY POPULATION AND METHODS. School districts in Massachusetts (N = 109) that completed an epinephrine-administration form whenever epinephrine was injected at school. Data were obtained from September 2001 to August of 2003. RESULTS. Forty-eight school districts noted a total of 159 administrations of epinephrine during the 2-year period of reporting. The individual was not known to have a life-threatening allergy in 24% of the cases. Thirty-one percent of the students who received epinephrine had allergy to multiple antigens, and 25% had allergy to tree nuts or peanuts only. Nineteen percent of the cases occurred outside the school building on a playground or when transporting them to or from school or on field trips. The registered school nurse in the health office administered the epinephrine in most cases. The average time from development of symptoms until epinephrine was delivered was 10 minutes. In 92% of the cases, the student involved was taken to a medical facility using the emergency medical system. CONCLUSIONS. Anaphylactic reactions in schools, although not frequent, are not uncommon events. A systematic review of anaphylactic events that required epinephrine administration identified opportunities for improvement in the treatment of students with life-threatening allergies. REVIEWER COMMENTS. The limitation of this study is that it was based on voluntary reporting. There are variations in reporting among regions in the state, but it is not possible to determine if the differences are attributable to reporting practices or actual difference in epinephrine administration. Because there were no unique identifiers for subjects in the study, there is no assurance that allergy events are not recurring repeatedly in the same student. In summary, a thorough program should be in place in the schools to evaluate, treat, and manage students with life-threatening anaphylaxis to foods.

Differences in Race, Ethnicity, and Socioeconomic Status in Schoolchildren Dispensed Injectable Epinephrine in 3 Massachusetts School Districts

Purpose of the Study. To analyze the demographic characteristics of schoolchildren dispensed injectable epinephrine in 3 school districts with widely diverse socioeconomic, racial, and ethnic populations. Study Population. Students (prekindergarten to grade 12) from 3 school districts in Massachusetts (n = 21 875) were evaluated. Two of the school districts were affluent, suburban towns outside of Boston (5855 students). The third district (16 020 students) was also a Boston suburb but with a very low per-capita income, with 23% of the school-age population living below the poverty line. The 2 suburban districts were 92% and 95% white, respectively, and the third district was 60% nonwhite. Methods. All school districts in Massachusetts are required to report the number of students using daily or as-needed prescription medications to the Department of Public Health. Data were taken from reports filed by school nurses monthly for all students from the 2003–2004 school year for these 3 school districts. Results. A total of 181 schoolchildren (0.83%) in the 3 districts were dispensed injectable epinephrine during the school year studied. Diagnoses listed for the prescription of epinephrine included peanut ree nut allergy (65%), stinging-insect allergy (19%), seafood allergy (6%), and egg or dairy allergy (3%). A miscellaneous group (7%) included diagnoses for latex, chocolate, pollen, fruit, cold air, and ibuprofen allergy. Males were more likely to be dispensed epinephrine than females (odds ratio [OR]: 1.44; P < .02). White students were nearly 5 times more likely to have been dispensed epinephrine for peanut and tree nut allergy (OR: 4.5; P < .001) and almost 9 times more likely for stinging-insect allergy (OR: 8.7; P < .001). Seventy-five percent of students dispensed epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5. Conclusions. Significant racial and socioeconomic differences for prescribing self-injectable epinephrine was seen in 3 school districts in Massachusetts. Reviewer Comments. This study describes the racial and socioeconomic demographics of children prescribed injectable epinephrine but does not address the reasons for the disparity between affluent and nonaffluent or white and nonwhite populations. This study suggests that minority, socioeconomically disadvantaged students are being either underdiagnosed or undertreated for potential anaphylactic reactions that require epinephrine. Other studies have not shown racial differences in the incidence of food allergies, suggesting that other factors are involved in the lower rate of epinephrine dispensed to disadvantaged minority students.

Non‐optimal uses of video in the classroom

This paper examines some instructional practices concerning the non‐optimal uses of video, films and other mass media in the K–12 classroom. Based on a six‐year process of observing and interviewing teachers regularly in two school districts in Massachusetts, USA, this paper presents a typology of seven common patterns of non‐optimal media use, instructional practices that diminish or weaken the value of film and video viewing as a learning tool. A telephone survey was conducted with a purposive sample of 130 middle‐school and high‐school teachers to provide additional evidence concerning teacher perceptions of the frequency of their colleagues' non‐optimal use of video. Teachers in the USA report that their colleagues frequently use media for non‐educational purposes, including to fill time, to keep students quiet, as a break from learning, or as a reward for good behavior. The implications of non‐optimal media use are considered in light of renewed interest in integrating media literacy into K–12 instruction.

Identifying Teacher, School, and District Characteristics Associated with Middle and High School Teachers' Use of Technology: A Multilevel Perspective

Investment in educational technology has increased rapidly in recent years and many observers have begun to question whether, and how technology is being used as a teaching and learning tool. In order to address this issue, this research used survey data collected from 1,404 middle and high school teachers in 52 schools across 22 Massachusetts school districts to examine how technology is being used by upper grade teachers, and examines the school and district organizational characteristics that are associated with increased use of technology as a teaching and learning tool. Specifically, this research used hierarchical linear regression (HLM) techniques to model the teacher, school and district characteristics associated with five specific teacher uses of educational technology. This research found that both teacher and organizational characteristics were each found to be associated with the five technology uses, and characteristics varied in their ability to predict the five different uses.

Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings

Although the potential for life-threatening allergic reactions in children is a significant health concern for schools, there is little information about the circumstances surrounding anaphylactic events that occur in schools. The objectives of this study were to determine the incidence of anaphylaxis in schools, describe the circumstances around anaphylactic events, assess practices that are used to manage students with life-threatening allergies, and identify opportunities for improvement. A total of 109 school districts in Massachusetts completed an Epinephrine Administration Form whenever epinephrine was administered at school. Data were collected from September 2001 to August 2003. Forty-eight school districts reported a total of 115 administrations of epinephrine during the 2-year reporting period. In 24% of the cases, the individual was not known to have a life-threatening allergy. Almost one third (31%) of the students who received epinephrine had allergies to multiple substances, and one quarter (25%) had an allergy to peanuts or tree nuts only. Twenty-two (19%) cases occurred outside the school building on the playground, traveling to and from school, or on field trips. The administration of epinephrine most often occurred in the health office by a registered nurse. The average time from onset of symptoms to administration of epinephrine was 10 minutes. In 92% of the cases, the student was transported to a medical facility via the emergency medical system. Anaphylactic reactions in schools, although not frequent, are not uncommon events. A systematic review of anaphylactic events that required epinephrine administration identified opportunities for improvement in the treatment of students with life-threatening allergies.

Differences in race, ethnicity, and socioeconomic status in schoolchildren dispensed injectable epinephrine in 3 Massachusetts school districts

Published surveys depicting the increase in the incidence of food allergy, especially peanut or tree nut allergy, in children have not reported any differences in race, ethnicity, or socioeconomic status. To analyze the demographics of schoolchildren with diverse racial, ethnic, and socioeconomic characteristics dispensed injectable epinephrine. School nurses in 44 schools enrolling 21,875 students recorded the characteristics of students dispensed injectable epinephrine in the 2003-2004 school year. Surveyed school districts included 2 affluent suburban districts enrolling 5,855 students (> 92% white) and 1 urban district enrolling 16,020 students (60% nonwhite). A total of 181 students in all 3 districts were dispensed injectable epinephrine; 118 of these children had peanut or tree nut allergy. Males were more likely to be dispensed injectable epinephrine than females (odds ratio [OR], 1.44; P < .02). Whites were more likely to have been dispensed injectable epinephrine than nonwhites (OR, 4.76; P < .001). Whites were nearly 5 times more likely to be dispensed injectable epinephrine for peanut or tree nut allergy than nonwhites (OR, 4.5; P < .001). Most students (75%) dispensed injectable epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5 (P < .001). Whites were more likely than nonwhites to be dispensed injectable epinephrine for stinging insect allergy (OR, 8.7; P < .001). This study found significant racial, ethnic, and socioeconomic differences in the prevalence of childhood allergic disorders, especially peanut or tree nut allergy, requiring prescribed injectable epinephrine in a school setting. Additional studies are needed to determine whether minority children are being underdiagnosed or undertreated for allergic disorders requiring injectable epinephrine or whether they truly have a lower incidence of such allergic disorders.

The Fate of New Funding: Evidence from Massachusetts’ Education Finance Reforms

In 1993, the state of Massachusetts implemented comprehensive reforms that included increased state aid to local school districts. This study presents empirical evidence on whether these reforms actually increased educational spending and, if so, in what functional areas. These evaluations are based on relatively detailed annual financial data from the unified school districts in Massachusetts and two neighboring states over the 1990–1996 period. The results indicate that the reforms did increase state aid to and spending by those districts that spent the least prior to the reforms. Furthermore, most of the new spending in these low-spending districts was directed toward student instruction and capital investments.

Local school district adoption of state-recommended policies on HIV prevention education

Background. This study evaluated the extent to which school districts in Massachusetts adopted HIV education policies consistent with state education agency recommendations, and whether adoption of state-recommended policy language was associated with other core components of school-based HIV prevention programs such as staff development, curriculum, and implementation characteristics. Methods. A census of health coordinators ( n = 251) and high school HIV teachers ( n = 174) in randomly selected schools in Massachusetts were surveyed. Chi-squares and analysis of variance (ANOVAs) were used to analyze data. Results. Most districts' policies fully incorporated state-recommended language for training HIV teachers (62%), providing HIV education within comprehensive sexuality education (62%), and providing skills-based instruction (57%). Districts adopting state-recommended policies were significantly more likely to have trained more HIV teachers (82% vs. 59% of teachers trained; P < 0.001), provided HIV education to a greater percentage of students (90% vs. 50% of students educated; P < 0.001), and adopted research-based curricula (44% vs. 27%; P < 0.01). High school teachers who received training and those using research-based curricula covered more HIV prevention topics and used more skills-based instructional methods than those who did not receive training or did not use research-based curricula ( P < 0.01). Conclusions. Results suggest that strong, state-level HIV prevention education policy recommendations can help shape local school health policy and, when adopted locally, can positively influence the reach and quality of HIV education.

Assessing Public School Programs for Visually Handicapped Students

Stresses that programs developed for the education of visually handicapped children in public schools must be evaluated in order to better serve the children and to justify continued support for the programs. Describes the Program Assessment of Special Education Services to Children with Special Needs with Regard to Vision that has been field tested in several Massachusetts school districts.

DEMAND‐RESPONSE AND SCHOOL BOARD MEMBER INCUMBENT DEFEAT

This study is based on the earlier work of Iannaccone and Lutz, Kirkendall and Le Doux and Burlingame and uses socio‐economic data obtained from 77 school districts in Massachusetts through the period 1963–1972. The study examines a series of hypotheses related to the “gap” that may develop between community demand and school board response. Some of the findings are (i) the Iannaccone‐Lutz model of school board member incumbent defeat is valid and the “gap” between community demands and the school board's response is an important factor in the operational model; (ii) the school board's response to community's demands (tax rate) is an important variable in determining the “gap” resulting in incumbent defeat and in predicting the variance in this political phenomenon in school districts; (iii) socio‐economic‐political indicators of school district change selected by Kirkendall are related to school board member incumbent defeat.