State study links asthma to economic circumstances

Children who live in wealthy communities north of Boston are not as likely to have asthma as those in congested cities because they often learn in newer schools and live in better-maintained houses where their parents are less likely to smoke, specialists said.

About 89 percent of the 187 local schools surveyed by the state had asthma rates statistically equivalent to, or lower than, the state average, according to a recent report.

The state average asthma rate was 9.5 percent, with rates as high as 39 percent.

The rate was higher than the state average in 20 of the 187 schools, most of which were in the region's cities: Peabody, Salem, Lynn, Chelsea, Revere, Melrose, and Haverhill.

Dr. Sean Palfrey, a professor of pediatrics and public health at Boston University and the immediate past president of the Massachusetts chapter of the American Academy of Pediatrics, said one major cause of asthma is exposure to dust, smog, and cigarette smoke.

Children in middle- or upper-class families tend to be exposed to these less than children in poor families.

''Largely there is a connection, because the wealthy are able to keep their homes cleaner," Palfrey said. ''They can afford better vacuum cleaners. Their houses are not peeling or chipping. The homes aren't as close to each other, so when the next-door neighbor renovates, you don't get the air pollution. The incidence of smoking is lower, and schools tend to be in better shape."

The Department of Public Health examined the prevalence of asthma among students in kindergarten through eighth grade in all state schools. About 1,664 schools, or 78 percent, responded to the survey.

Locally, neither Groveland nor Merrimac reported results.

In this area, the rates ranged from a high of 31.6 percent at the Lakeside School, a small private school in Peabody, to a low of 0 percent at the Moody School in Haverhill and the Early Learning Center in Malden, both of which are preschool-kindergarten programs.

Georgie Marks, the director of nursing for the city of Chelsea, said students in her schools are more likely to be exposed to asthma triggers than students in suburbs.

''I don't think it's the schools, but it's where they're living," she said. ''We have a lot of people living in small spaces. The home environment is something we're constantly evaluating with the families."

Marks said a key to managing asthma is making sure that children and parents are educated about the symptoms and potential triggers. Through the Chelsea Community School Program, Marks is holding two forums in October for parents and children to learn more about managing asthma.

''This isn't going to go away," she said. ''Asthma is a chronic disease, and it needs to be treated and assessed."

The Clark Avenue School in Chelsea had one of the highest reported asthma rates in the region at 17.5 percent. One other school of six public schools in Chelsea had an asthma rate above the state average.

Robert Knorr, director of the state's environmental epidemiology program, said parents shouldn't read too much into the statistics for the individual schools.

While a high rate may indicate a problem with air quality at a school, he said there are many other factors that cause asthma, such as genetics and environmental factors in the student's home.

Knorr said data collection was done on a school-by-school basis because it's the most comprehensive way to obtain information from all students.

In past years, state officials have collected asthma rates statewide through a random telephone survey conducted by state health departments, in conjunction with the US Centers for Disease Control and Prevention.

To get a better grasp of the problem, state officials felt it would be helpful to collect information at the community level through school health records.

Last year, the state collected data for 2002-2003 from a small number of schools, but this year information was collected for 2003-2004 from schools across the state.

''With this data, we'll have this picture of how the rates vary and we'll be able to evaluate patterns and identify causes. Eventually, we might have a clear idea of what's going on with asthma because right now, we don't really know," Knorr said.

Asthma is a common chronic disease among children that appears to have increased in prevalence in the past decade, according to the state Department of Public Health. It affects more than 12 percent of Americans under 18 and costs $11.5 billion in direct healthcare costs annually.

Asthma, which affects the lungs, is one of the most common long-term diseases of children, causing repeated episodes of wheezing, breathlessness, chest tightness, and coughing.

School health officials said they welcome any state effort that will help identify and prevent asthma.

''Part of the problem is we don't know exactly what causes asthma," said Mary Doherty, the school nurse at the Greenwood School in Wakefield, which had an asthma rate of 18.6 percent. ''It's not just a building issue or home issue."

But she does know the number of students with asthma is rising and she is encouraged that the state and physicians are doing more to prevent, not just manage, asthma.

Three schools in Haverhill reported asthma rates higher than the state average, but the city had one -- the Moody School -- with the lowest rate.

School nurse supervisor Eileen Parry didn't have an explanation for the Moody School's results, but said one possibility could be that it's a preschool-kindergarten program with younger children who may not have been diagnosed yet.

The state has just completed collecting more data from schools for the last school year, Knorr said. When all three years of data have been collected, an analysis of the changes over the three-year period can be performed, he said.