School Physicians Research Articles

Increasing the Role of Practice Networks in Medical Research

An often-unrecognized consequence of the rise of generalist departments and divisions in US medical schools has been an improved sense of affiliation between physicians in community practice and schools of medicine. Generalists-in-training now rub shoulders with generalist researchers; continuing

Melanoma in Middle-aged and Older Men

To identify factors related to the detection of melanoma and to determine those that differ between thinner vs thicker tumors in middle-aged and older men. Survey. Three institutional melanoma clinics. Men 40 years or older who had newly diagnosed invasive melanoma. Differences in melanoma awareness, skin examination practices, discovery patterns, and social/medical care factors relative to tumor thickness. Two hundred twenty-seven men completed surveys within 3 months of melanoma diagnosis; 57 (25.1%) had thicker tumors (>2.00 mm). Thicker tumors were associated with nodular histologic features (43.9%), a lack of atypical nevi, having less than a high school education, and patient vs physician (dermatologist or nondermatologist) detection. Knowledge of melanoma (P = .007), attention to skin cancer detection information (P = .02), an interest in health topics (P = .003), and knowing the importance of physician skin examination (P = .05) were more common in those with thin tumors. Tumor thickness did not correlate with age, anatomic location, marital/cohabitation status, prior skin cancer, or sun sensitivity. Overall patient awareness of melanoma warning signs, skin self-examination practices, and Internet use were poor (<20%, <50%, and <14%, respectively). Physician discovery, the patient's higher level of education and detection-promoting awareness and attitudes, and the presence of clinically atypical nevi were related to thinner melanomas. Innovative outreach strategies and novel educational campaigns incorporating these factors, coupled with sharper messages regarding the importance of physician screening, are needed to improve early detection in middle-aged and older men.

Advantages of a two-step procedure for the screening of idiopatic scoliosis

Two different methodologies were used. In a first group(n. 5731: group A), the first clinical examination was per-formed by the school physicians. Doubtful cases werereferred by the physician to the Orthopaedic specialist. Ina second group (n. 3264: group B), the clinical examina-tion was directly performed by the orthopaedists. Eitherfor the first group or for the second, the specialist ascer-tained by X-rays the suspected scoliosis and deferred to a6 month control for the still doubtful cases. To evaluatethe lifetime attributable risk of cancer mortality, we havefollowed the ICRP 60. To calculate the social economicburde, we have assumed the present reimbursement to theHospitals by the National Health Service which is Euro 70for each examination.The statistic significance of the differences was assessed bythe z test for proportions.

Revolutions in the Machinery: Oregon Women and Citizenship in Sesquicentennial Perspective

KIMBERLY JENSEN Revolutions in the Machinery OregonWomen and Citizenship inSesquicentennial Perspective HISTORIANS ENGAGE in a dynamic process of research, writing, and analysis that often leads us from one subject of study to new questions and freshfields of inquiry.As we commemorate the sesquicentennial ofOregon statehood in 2009,1 find myself in just such a transition as a historian of women. My previous research concerned U.S. women and the FirstWorld War, inparticular how groups ofwomen ? physicians, nurses, and women at-arms ? claimed a more complete female citizenship at a time when the final years of the national woman suffragemovement intersected with questions of service to the state during wartime and broader civic roles for women beyond voting.1 In the course ofmy research, I encountered Oregon physician and activist Esther Pohl Lovejoy. Her medical work in France in 1917and 1918and thehistories shewrote ofwomen physicians in the conflict became a vital part ofmy larger analysis. As I learned more about Lovejoy's rich history as an early Oregon medical school graduate and physician, a public health activist, a suffragist,a congressional candidate, and a key figure in international medical relief, I decided towrite her biography as the next step on my historian s journey. As part of this process, ithas been crucial forme to study Oregon women shistory as a context for Lovejoy's life and activism. Because Lovejoy was involved in claiming amore complete citi zenship in her work forwoman suffrage, through her service in appointed office as Portland City Health Officer from 1907 to 1909, and in her quest for elected office in 1920, questions ofwomen's citizenship are also central tomy current project. While seeking to understand Esther Lovejoy as an OHQ vol. no, no. 3 ? 2009 Oregon Historical Society Before theachievement ofwoman suffrageinOregon in 1912,a fewwomen held appointed office,includingEstherPohl, Portland CityHealth Officer (at right),and Sara A. Evans, PortlandMarket Inspector, pictured hereat CityHall in 1907 (detail of larger photograph). Oregon woman and activist, Ihave tried to uncover and analyze thebroader history ofOregon women as citizens. Citizenship maybe defined as the set of rights and obligations thatmem bers of a community or state possess by law.The rules about citizenship are setby federal, state, and for some, tribal authorities. In theUnited States, as in other nations, citizenship has been gendered in theory and practice. As his torian Linda Kerber demonstrates, "from thebeginning American women's relationship to the state has been different in substantial and important respects from that ofmen." Citizenship has been embodied as male, from voting, office holding, and jury service to bearing arms to defend home and nation. In the early American Republic, white married women's legal Jensen, Revolutions in the Machinery 337 loyaltywas to their husbands, not to the state.As Kerber notes, the idea that women are connected to the state and to citizenship indirectly through their husbands and male relatives and not directly as individuals was a powerful one that continued aswomen began to claim and win individual citizenship rights in thenineteenth century and beyond, and it"lurks behind what many people take tobe the common sense of thematter inour own time."2Not all men were accorded the rights of citizenship. Early property qualifications forvoting meant economic statusmattered. Whiteness and manhood were also necessary for citizenship and naturalization into the twentieth century. Because citizenship may also be defined as "the broader political, legal, and social meanings that attach to one's place within the polity," gender, race, ethnicity, and gender identity all have been categories that actively privi lege some and deny others civic power and authority.3 Alice Kessler-Harris emphasizes another gendered aspect of civic identitywith what she terms "economic citizenship." In the United States, the "public commitment to themale-breadwinner family" produced a different set of rights and obli gations forwomen as economic citizens in theworkplace and civic realm.4 Women have been at the nexus of struggles to secure full citizenship. Many have fought to end what Gretchen Ritter termswomen's "border status" of civic identity, to claim complete civic rights and full adult membership and human rights in their communities, the state, and the nation.5 What follows are some reflections about Oregon women...

Lexicon creation to promote faculty development in medical communication

Objective Most medical educators have little or no training in teaching and assessing medical communication, and they are not consistent in what they teach. The authors set out to reach consensus in our educational community on a lexicon of communication terms for use in teaching physician–patient communication skills to second-year medical students. Methods An interdisciplinary medical school physician–patient communication committee assembled 23 important terms and agreed on definitions for each term. Thirty core preclinical faculty representing nine medical specialties reviewed the lexicon. Faculty were surveyed about lexicon definitions, barriers to use, and methods of using during educational encounters. Results All preclinical faculty members agreed on 19 out of 23 definitions and most respondents agreed on the definitions of the remaining four terms. Sixty-nine percent of respondents said they used the terms during their teaching encounters. Conclusion Implementing a process to create a shared language around physician–patient communication may help unify and enhance faculty educational efforts. We were able to establish that medical educators can agree on the content of a medical communication lexicon for use with students. The use of defined and consistently used terms in multiple venues may reduce ambiguity, standardize teaching, enhance recognition of communication skills, and promote effective reinforcement and remediation by faculty. Practice implications Evidence suggests that most medical educators have little or no training in teaching and assessing medical communication and that they are not consistent in what they teach. Asking a community of faculty to share responsibility for creating a communication lexicon may be an efficient and effective way to educate faculty and unify their educational effort.

Medical Emergencies Occurring at School

Children and adults might experience medical emergency situations because of injuries, complications of chronic health conditions, or unexpected major illnesses that occur in schools. In February 2001, the American Academy of Pediatrics issued a policy statement titled "Guidelines for Emergency Medical Care in Schools" (available at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/2/435). Since the release of that statement, the spectrum of potential individual student emergencies has changed significantly. The increase in the number of children with special health care needs and chronic medical conditions attending schools and the challenges associated with ensuring that schools have access to on-site licensed health care professionals on an ongoing basis have added to increasing the risks of medical emergencies in schools. The goal of this statement is to increase pediatricians' awareness of schools' roles in preparing for individual student emergencies and to provide recommendations for primary care and school physicians on how to assist and support school personnel.

Provocative Questions in Parochial Sex Education Classes: Higher Incidence in Younger Students

Study Objective Recent data show US adolescents are engaging in sexual activity at earlier ages; however, little is known about young teens' sexual attitudes and behaviors. Examining teens' questions in sex education classes may provide insight into these attitudes and behaviors. Design Quasi cohort study Setting Parochial middle school sex education classes Participants 5 th through 8 th graders Interventions Students' anonymous written questions submitted at the outset of sex education classes between 2003 and 2005. Main Outcome Measures Questions were classified into topic categories. Three additional variables were then coded for each question. Ethics/guidance questions included requests for advice or value judgments. Prohibited questions included the topics homosexuality, abortion, masturbation, and contraception. “Red flag” questions were those that suggested consideration of or engagement in sexual behavior. Results Among 473 questions submitted by 410 students, the most popular topics for 5 th/6 th graders were pregnancy and puberty, and for 7 th/8 th graders puberty and menstruation. 41 questions (8.6%) were prohibited. 29 questions (6.2%) asked about ethics/guidance. 18 questions (3.81%) were coded as red flag questions. A chi-square analysis showed that 5 th/6 th graders asked more questions in the ethics/guidance (8.3% versus 3.64%) and red flag question categories (5.53% versus 1.82%) ( P < 0.05) than 7 th/8 th graders. Conclusions Although provocative questions represent a minority of these middle students' queries, these requests suggest the urgency of providing appropriate guidance to young teens, given the risks of early sexual activity. The role of school education programs, physicians and parents in addressing questions of this sort should be considered.

The history of the rise and fall in importance of the clinicopathologic conference in American medicine

This article is a review of the history of the clinicopathologic conference, a teaching method used for and by physicians in medical schools and hospitals throughout the United States since the beginning of the 20th century.

Students With Chronic Diseases: Nature of School Physician Support

To educate children with chronic diseases in the least restrictive environment, schools must prevent, recognize, and react appropriately to symptom exacerbations. Schools are often pushed to their limits of knowledge, resources, and comfort level. This study determined the health conditions of students for whom districts seek school physician consultation and the nature of school physician consultants' involvement. A retrospective record review was performed on 250 of the most recent records of school-elicited referrals from an academic center that provides physician consultation to school districts. Referrals were sent from 8 school districts in southern California (July 1996 to October 2006). Data collected were nature of student's special health need, the school physician consultant's intervention required to satisfy schools' needs, student grade level, enrollment in special education, and health-related excessive absenteeism. No single chronic condition, symptom, or special health care need predominated. Six types of school physician consultant activities were used to overcome hurdles schools faced when accommodating students with special health care needs. The 3 most common were direct communication with students' own physicians (70% of students), recommending an appropriate level of school health services when this was a matter of controversy (42%), and formulating portions of students' individualized school health plans (38%). A portion of students with special health care needs benefited from district referral to a school physician consultant. Whether some of these referrals can be avoided if school personnel and students' own physicians are supported and trained to communicate more effectively with one another needs to be explored.

The Measure of Merit: Talents, Intelligence, and Inequality in the French and American Republics, 1750–1940 (review)

Reviewed by: The Measure of Merit: Talents, Intelligence, and Inequality in the French and American Republics, 1750–1940 Martin S. Staum John Carson . The Measure of Merit: Talents, Intelligence, and Inequality in the French and American Republics, 1750–1940. Princeton: Princeton University Press, 2007. xvii + 401 pp. $39.50, £26.95 (ISBN-10: 0-691-01715-8, ISBN-13: 978-0-691-01715-0). In an extensively researched book encompassing wide domains of American and French intellectual history, Carson discusses the reconciliation of democratic ideology with the existence of unequal talent and intelligence. Both the French and the Americans developed measures of merit to justify unequal outcomes. In France, state-sponsored competitive examinations and expert judgment selected successful leaders. There was minimal interest in quantifying intelligence. In the United States, however, belief in a single, measurable, unilinear variable of "intelligence" triumphed among psychologists. Part of the explanation relates to the increased sensitivity in American culture to alleged group or "racial" differences. In the late Enlightenment and early nineteenth century, many authors postulated "virtues and talents," whether derived from heredity or education, as the only justification for social distinctions. "Talents" were ambiguous enough a designation to allow conservatives to use them as vehicles for exclusion, while progressive thinkers heralded a counterweight to privilege. A particularly effective chapter on anthropology outlines how brain size or a similar physical index became a significant variable for assumed differences in "intelligence" among racial groups. Yet in the end, all such correlations failed. The relative homogeneity of the French nation decreased the cultural resonance of anthropologists' arguments about racial hierarchy inside France. While acknowledging the importance of the colonial project, the author, however, does not highlight the importance of French colonial ambitions paralleling the emergence of polygenist racial theory. Nor does he allow for the differential application of neo-Lamarckian anthropology that allowed the French to judge Europeans as perfectible while non-Europeans were often doomed to a slow climb up the evolutionary ladder. Carson deftly illustrates the physiological imperative and pathological studies that dominated the new French "scientific" psychology. He also shows that Alfred Binet, developer of the metric scale of intelligence, at first imitated an anthropological approach including correlations between head volume and intelligence. Binet's eventual revision of the metric scale apparently shifted intelligence from a multivalent complex of traits to a single numerical entity representing mental level. Paradoxically, in France the Binet scale languished. School physicians were unwilling to cede power to psychologists in diagnosing abnormality. In the United States, Lewis Terman, among others, revised the Binet scale to promote the IQ test as an assessment of intelligence. While critics of the IQ test never disappeared, its cultural impact was far greater in the United States than in France. During the First World War, American psychologists tested 1.75 million soldiers. French psychologists felt no such need for mechanical methods to replace expert judgment. For them, clinical psychological studies and a more complex view of intelligence prevented undue enthusiasm for the IQ results. Some American psychologists [End Page 456] later used the army tests to question the viability of democracy or to make invidious ethnic distinctions for the benefit of northern Europeans. By the 1930s and 1940s, more environmentalist explanations of IQ predominated. The author concludes that the measure of merit is always ambiguous and will differ by culture and time period. Despite the admitted abuses of the IQ scale for racial exclusion, he somewhat surprisingly asserts that debates on hereditary versus environmental origins of intelligence will never be resolved either in popular or scientific discourse. Measures of merit are just too convenient a tool for a democracy that always needs to justify inequality. The entire debate shows "how scientific knowledge and social order not only interact and continually reconstitute each other, but also shape the lives of the individuals living in their midst" (p. 280). This richly rewarding study should especially appeal to historians of anthropology and psychology. The publishers, however, have not served readers well by omitting a bibliography. Martin S. Staum University of Calgary Copyright © 2008 The Johns Hopkins University Press

Outstanding internists who rendered great service to school hygiene

During the period of Independent Poland (1918-1939), the role of school hygiene was appreciated. At that time in the city of Lódź, a circle of outstanding Lódź physicians worked as school physicians. The circle included among others: Włodzimierz Dylewski, Stanisław Gutentag, Rachela Kalecka, Zygmunt Lugowski, Bolesław Mikłaszewski, Maria Rotenberg and Leonia Zeligsonówna. This article commemorates their names and retained pieces of their biographical entries for future generations. Some of those persons were Poles of Jewish origins, which was characteristic of the multiethnic city of Lódź before 1939.

A School-Based Approach to Early Identification and Management of Students with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most challenging chronic conditions for children, families, schools, and physicians. Because symptoms of ADHD can be mistaken for other health conditions and misdiagnosis can occur, accurate diagnosis and treatment require comprehensive evaluation. This article introduces a school-based framework- ADHD Identification and Management in Schools (AIMS)-developed by a multidisciplinary team composed of a pediatrician, school nurses, and school psychologists that sought to improve communication between school personnel and physicians, standardize practice, and improve the quality of care for children with ADHD. The framework provides school nurses with an evidence-based, systematic method for early identification and management of children with ADHD.

Assessment of Health Issues and Concerns of Israeli Seventh Graders During School Physician Examinations: A Pilot Study

The AMA Guidelines for Adolescent Preventive Services (GAPS) recommends annual medical evaluations during adolescence, emphasizing screening and counseling regarding psychosocial issues. In Israel, seventh graders undergo medical examinations within the school health services, focusing on the detection of physical conditions. We addressed the psychosocial issues of these students by introducing an expanded school physician evaluation. Twelve school physicians performed structured expanded health evaluations for seventh graders in 11 schools. Each student completed a questionnaire (checklist) with 22 health topics "about which s/he may want to receive information." The physician then carried out a biomedical and psychosocial evaluation, physical examination, and offered counseling to the student. Two hundred and seventy-eight students were examined. The questionnaire required 1-2 minutes, and the physician's evaluation 20-25 minutes. Health behaviors revealed included: currently dieting (28%), no physical activity after school (35%), ever smoked cigarettes (3%), ever smoked a water pipe (9%), used alcoholic beverages (6%), and does not always use front (22%) or rear (55%) seat belt. Nine percent rated their mood as being less than 7 (on a scale from 1 to 10). The leading topics about which the students requested information were height (50%), acne (42%), weight (38%), nutrition/diet (37%), physical activity (35%), and menstrual period (29% of the girls). The physicians counseled the students on an average of 3.6 topics per visit. An expanded school physician examination identifies students with psychosocial problems otherwise undetected during standard physical examinations, and provides the opportunity to address their personal concerns.

How does a Belgian health care provider deal with a request for emergency contraception?

Objective To evaluate how Belgian health care providers deal with a request for emergency contraception.Method In 2002–2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay.Results All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents.Conclusion The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.

A School-Based Approach to Early Identification and Management of Students With ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most challenging chronic conditions for children, families, schools, and physicians. Because symptoms of ADHD can be mistaken for other health conditions and misdiagnosis can occur, accurate diagnosis and treatment require comprehensive evaluation. This article introduces a school-based framework—ADHD Identification and Management in Schools (AIMS)—developed by a multidisciplinary team composed of a pediatrician, school nurses, and school psychologists that sought to improve communication between school personnel and physicians, standardize practice, and improve the quality of care for children with ADHD. The framework provides school nurses with an evidence-based, systematic method for early identification and management of children with ADHD.

Present Status and Problems of Schools for Physically Disabled Children from the Viewpoint of a School Physician

Present Status and Problems of Schools for Physically Disabled Children from the Viewpoint of a School Physician

Child Guidance and Mental Health in the Netherlands

In the Netherlands, as in the United States, the introduction of the concept of ‘mental health’ in education is closely related to the development of a network of child guidance clinics. The first of these was established in Amsterdam in 1928. However, a substantial movement to actively promote mental health did not come into existence until after the Second World War. Unlike in the USA, at the time in the Netherlands the school was considered of only little importance in the crusade for the prevention of mental illness. Teachers and school physicians alike were at the same time recognized as helping forces in the promotion of mental strength and conceived of as inadequately equipped to diagnose problem children. The tradition of labelling the school as a sick‐making institution appears to have been an important asset for the child guidance clinics’ lobby to successfully discredit the institution. Parents’ educational competence was likewise undermined by the infiltration of child‐psychiatric theory, concepts and categories of discourse. The mental health movement promoted an attitude towards the family that was even more disturbingly ambiguous. On the one hand the family was considered a most powerful medicine against what was consistently diagnosed as the moral crisis of society. On the other hand contemporary child‐psychiatric theory pointed at parenting as the prime seedbed of neurosis. Inspired by Sol Cohen’s new cultural history of education the author traces the origins and the initial success of the child guidance approach as part of a larger process of ‘medicalization’, accompanied by ‘neurotization’ as an effect of the growing influence of psychoanalysis. She argues that these processes created the conditions for the Dutch child guidance clinics to monopolize the care, treatment and knowledge of problem children. After discussing the growing ambiguity as to parents’ and the school’s competence in preventing mental illness, the establishment and early development of the Dutch child guidance clinics are described. Finally, an analysis is given of the clinics’ diagnoses and treatment of ‘difficult’ children at the height of the mental health movement’s success, immediately after the war. The child guidance clinics’ work was presented as a blessing for individuals, for society and for the public purse. The self‐image of the institution emphasized its role in the prevention of adult crime and psychiatric treatment. Moreover, the clinics were supposed to prevent much more expensive hospitalization of children in reformatories and children’s homes. In reality, however, they selected for treatment primarily those cases that fitted their approach. In doing so, they could further promote the belief in the mental health movement’s central idea of mental illness as a widespread disease. The child guidance clinics’ lobby succeeded in providing itself with a key role in the theatre of children’s mental health, the expert answer to what was conceived of as a serious crisis in society. Moreover, the lobby claimed to be the solution to the existing ambiguities as to the family and the school as child‐rearing milieux. Therefore, the way the child guidance clinics succeeded in promoting their own approach at the expense of the status and competence of other educational professions and institutions was both enabled by medicalization and neurotization and was itself another step in these processes.

Prevalence and Characteristics of Body Piercing and Tattooing Among High School Students

Although body piercing and tattooing seem to be gaining popularity among a diversity of social and age groups, studies of these practices in general adolescent populations are scarce. This study establishes the prevalence of body modification (tattooing and body piercing) among high school students in grades 7-11 (aged 12 to 18).Data come from a 2002 in-school survey conducted among a representative sample of 2,180 students (81% response rate) enrolled in the 23 high schools of the Outaouais region in Quebec. Systematic sampling was performed. Specific data on tattooing and body piercing are available for 2,145 students (1% non-response rate).A prevalence of 27% for body piercing and 8% for tattooing is observed among high school students. Differences between girls and boys are observed in many ways: i.e., frequency and number of tattoos or piercings; aftercare practices. While most teens say that a "professional" in a studio performed their body modification and that they received aftercare instruction, a high percentage of students report health complications following the procedure.Results show that tattooing and body piercing are common among adolescents and may involve health risks. Consequently, appropriate preventive measures should be adopted by professionals such as school counsellors, nurses, physicians and others who are in contact with teenagers to help them make informed choices.

Prevalence and characteristics of body piercing and tattooing among high school students.

Although body piercing and tattooing seem to be gaining popularity among a diversity of social and age groups, studies of these practices in general adolescent populations are scarce. This study establishes the prevalence of body modification (tattooing and body piercing) among high school students in grades 7-11 (aged 12 to 18). Data come from a 2002 in-school survey conducted among a representative sample of 2,180 students (81% response rate) enrolled in the 23 high schools of the Outaouais region in Quebec. Systematic sampling was performed. Specific data on tattooing and body piercing are available for 2,145 students (1% non-response rate). A prevalence of 27% for body piercing and 8% for tattooing is observed among high school students. Differences between girls and boys are observed in many ways: i.e., frequency and number of tattoos or piercings; aftercare practices. While most teens say that a "professional" in a studio performed their body modification and that they received aftercare instruction, a high percentage of students report health complications following the procedure. Results show that tattooing and body piercing are common among adolescents and may involve health risks. Consequently, appropriate preventive measures should be adopted by professionals such as school counsellors, nurses, physicians and others who are in contact with teenagers to help them make informed choices.

Communication and Education About Asthma in Rural and Urban Schools

To assess the quality of communication and education about asthma in Pennsylvania public schools. Survey of a stratified random sample of school nurses in rural and urban Pennsylvania public schools (n = 996) concerning communication with school nurses about asthma by physicians and parents, nurses' perceived obstacles to asthma management at school, and utilization of and need for education about asthma. A total of 757 surveys were received (response rate 76%). Thirty-nine percent of school nurses rated their communication with physicians about asthma as either poor or very poor. Urban nurses were significantly more likely to report poor/very poor physician communication (P = .09). Fifty-two percent of the nurses overall (43% rural, 56% urban) also cited lack of communication with parents as an important obstacle to asthma management. Forty-nine percent of school nurses (43% rural, 52% urban) reported attending an asthma education program during the previous year, and 75% (83% rural, 71% urban) expressed interest in additional education. Education about asthma was provided for classroom teachers in 54% of schools (56% rural, 54% urban) and provided for students in 58% of schools (54% rural, 60% urban). These findings document need for improvement in communication about children's asthma between school nurses and physicians. Although communication appears better in rural relative to urban schools, it is a salient issue in both settings. Study findings also indicate the need for expanded professional education opportunities for school nurses and improved access to appropriate curricular materials for school staff, parents, and students.