Breathing easier: schools find indoor air quality can be addressed with common sense and without great expense.

Adina Neale's first lesson on school indoor air quality was a pop quiz on crisis control.

The crisis began in February 1999 when an ailing student in the Saugus Union School District in Santa Clarita, Calif., visited a local doctor. The doctor said blood tests revealed exposure to arsenic, formaldehyde, phenol and mold toxins that could have originated in a portable classroom. As parents panicked, the doctor quickly concluded that several hundred children had been exposed to dangerous chemicals.

A principal enlisted Neale, then a 2nd-grade teacher, to throw together an indoor air quality program. The school quickly began environmental testing and enlisted help from the U.S. Environmental Protection Agency and the state health department. But community hysteria outpaced school action. Many parents accused the school of poisoning their children and covering up a horrible secret. They organized a class-action lawsuit against the northern Los Angeles County district and the portable building manufacturer.

The mass outcry continued unabated for more than a year. But by May 2000, the state health department had confirmed the school's findings that no serious health threats existed and had criticized the doctor's methodologies as erroneous and invalid. The lawsuit against the school district unraveled, and the district appeased some of the most irate parents by inviting them to join its new indoor air quality oversight committee. The committee initiated policies that eliminated all pets, plants and strong perfumes and required air filter changes five times a year.

"If we had had the program in place when all this started, I can almost guarantee that this never would have happened," says Neale, now the district's indoor air quality coordinator and a 5th-grade teacher. "It would never have gotten to the crisis point that it had. We would never have had to spend $600,000 to crawl out from this cloud that was following us. This totally took over the district office operations because everyone was fielding air quality calls. The media was there all the time; they were calling us all the time."

Spreading Interest

While the Saugus school crisis may be extreme, efforts to confront school environmental issues are becoming more commonplace. Eager to improve student health and performance and leery of potential litigation, administrators at school systems across the nation increasingly are tackling potential indoor air quality problems ranging from inadequate ventilation to mold and pests.

A 1995 study by the U.S. General Accounting Office showed that half the nation's schools have at least one environmental problem. While research on the relationship between school environment and student health is still in its infancy, scientists have established that some environmental conditions, such as secondhand smoke and dust mites, can trigger asthma episodes and allergic reactions. Many school officials, fearful that unseen allergens and irritants may be hampering learning, are heeding federal government recommendations to clean up their schools.

"Definitely we're seeing more schools taking an initiative on this," says Elissa Feldman, associate director for the EPA's indoor environments division. "A number of factors have combined to make the latter half of the 20th century probably worse in indoor environmental problems than the first half of the 20th century."

The flurry of school activity can be traced back to several factors. The average public school in the United States is 42 years old. Most were built as cheaply as possible and gradually were starved for maintenance money. Cash-strapped district officials tended to cut upkeep dollars in order to save money for teachers and classroom instruction. But inattention to maintenance over several decades exacerbated problems with leaky roofs, dirty carpets and malfunctioning ventilation systems.

Meanwhile, school officials have witnessed a rise in children's health problems, particularly asthma. Asthma is now the most common chronic childhood illness, accounting for more than 14 million missed school days each year, according to the Centers for Disease Control and Prevention.

In the mid-1990s, as staff and parents lodged more complaints about the air quality in school buildings, the EPA launched its Tools for Schools program. EPA provides schools with a free tool kit that can help eliminate five common indoor asthma triggers: secondhand smoke, dust mites, pet dander, mold and pets.

EPA's kit provides a detailed checklist so that school administrators, teachers and maintenance staff can identify problems systematically and address them. Some indoor air quality problems can be fixed for little or no cost, including making sure that air vents are not blocked, sealing food and water to discourage cockroaches, prohibiting pets in classrooms and cleaning regularly. Other fixes may require a more costly overhaul, such as cleaning or replacing an ailing heating and ventilation system or removing old carpets that often provide a haven for dust mites.

"We've got about 10,000 schools implementing the kit, and many, many more are very interested," Feldman says. "We're now looking at getting whole school districts to adopt the kit, and it seems to be a strategy that has increasing promise."

The New York City Public Schools have agreed to implement the tool kit in all schools, serving more than 1 million children, by school year 2005-2006. Cleveland, Ohio, Jefferson County, Ky., and schools in West Virginia are among those committed to use the tool kit, EPA officials said.

Long-Term Savings

AASA and other educational organizations have held conferences and training sessions to educate superintendents about indoor air quality and Tools for Schools. The association also provides information and resources, pays travel costs for school officials to attend EPA's annual indoor air quality conference and provides a network for urban superintendents to talk to one another about additional challenges they might confront with low-income students.

Feldman would not estimate the costs associated with Tools for Schools because schools' indoor air quality problems vary widely. But she says attention to potential air quality problems generally saves schools money over the long term. One District of Columbia school spent $1.6 million on indoor air quality repairs, including an overhaul of the heating and ventilation system. A comprehensive indoor air quality program probably would have cost the school only about $365 annually for regular maintenance, Feldman figures.

Michael Forer, environmental health safety supervisor for the St. Cloud, Minn., Area School District 742, believes schools that ignore potential indoor air quality problems are being "penny-wise and pound-foolish."

Forer started an indoor air quality program at his district in 1995 after watching an Oprah Winfrey show that featured EPA's Tools for Schools. After he ordered the kit, he learned that the nurse coordinator had noticed an increase in student absenteeism as well as diagnoses of asthma and allergies. Teachers had complained about stuffy classrooms and discomfort during the school day.

He used the Tools for Schools kit to analyze building problems and formed a committee consisting of himself, the school nurse coordinator, the business manager, several principals and a school board member. He also hired a consulting firm to train district engineers.

The engineers tested carbon dioxide and humidity levels in all classrooms. They cleaned and upgraded ailing heating, ventilation and air conditioning systems. After discovering mold in carpets, Forer began a gradual carpet removal program. Animals in classrooms now are prohibited; students who bring cats, rabbits or hamsters for show-and-tell must display them in a media center or gymnasium, where custodians can immediately clean up fur or feathers.

In 2001, the EPA honored the St. Cloud district for excellence in its indoor air quality plan. Each of the district's 19 school buildings and three administrative buildings received some work over the last seven years. Forer estimates costs have totaled between $1.5 million and $2 million, mostly for duct cleaning.

Anecdotally, school officials have noticed an apparent drop in sick days. Forer hopes to measure absenteeism and other health indicators to determine the program's efficacy. Already, the indoor air quality program has helped change attitudes. Before the program began, administrators occasionally told frustrated teachers and staff that the problems existed only inside their heads. Now Forer encourages teachers to voice their concerns. "If they call me and say we're having a problem, then we need to listen to that," he says.

Limited Research

But even as schools rush to relieve student and faculty discomfort, many questions about the impact of indoor air quality on health remain unanswered.

Published scientific literature indicates that schools contain high levels of allergens that can exacerbate asthma symptoms in children. But scientists have not resolved whether allergens in schools actually cause the development of asthma or whether controlling them will curtail sick days among asthma sufferers.

"There is not literature documenting that in individual children those allergens are causing asthma attacks," says Lani Wheeler, a medical officer with the Centers for Disease Control and Prevention's Division on Adolescent and School Health.

Wheeler, a public health pediatrician working on the CDC's asthma initiative, says published research has yet to address whether improving the air quality in schools will limit students' asthma episodes, although the National Institutes of Health is financing several studies that could provide answers.

Scientific studies haven't yet established a clear link between asthma and impaired school performance, although the evidence does indicate that asthma sufferers miss school more frequently than their peers.

"This is a real struggle and balance for schools to sort out," Wheeler says. "Certainly what most everyone is encouraging is to do as many of the low-cost things as possible, starting with keeping everything neat and clean, not having classrooms cluttered and collecting a lot of dust."

Exemplary Efforts

School administrators and health officials have taken increasingly active roles in trying to control students' asthma, partly because high rates of absenteeism can negatively affect a school's showing on state report cards and other assessments. But new asthma guidelines issued by the National Institutes of Health in 1997 also spurred schools' involvement, says Howard Taras, chairman of the American Academy of Pediatrics' committee on school health.

The guidelines stated that students with asthma should not need to miss school and that physicians should send asthma action plans for students to schools. These plans might require that school officials administer medicines or monitor symptoms.

"Because of those 1997 guidelines, more attention has been paid to, 'Hey, we know a lot about this. Now let's change things,'" says Taras, a San Diego pediatrician who has advised the San Diego City Schools on indoor air quality. "Schools can have a role in asthma management that has been recognized."

One school district that has attempted to reduce asthma episodes by improving air quality is Montgomery County, Md. The genesis for the district's air quality program came in 1995 when district administrators received some complaints about foul odors and mold. In addition, some members of the well-educated community wanted the district to adopt a formal process for addressing indoor air quality. In response, the district formed a team to develop recommendations for handling indoor air quality.

Four years later, the district's new Environmental Safety Indoor Air Quality Unit launched a systematic, proactive program that centered on identifying potential problems in each school. Environmental safety experts identified priority schools based on past complaints. They also used county health data to pinpoint schools in zip codes where children had experienced high instances of hospital visits due to asthma attacks.

"Does that mean that our schools are causing (asthma)?" asks Dave Beatty, one of the district's environmental safety coordinators. "No." Adds colleague, Barry Hemler: "We just wanted to make sure we did what we could so asthma is not triggered during the day."

Hemler and Beatty focused on the ventilation systems, installing new equipment, upgrading systems and cleaning air filters. They examined auto body shops, science classrooms and carpentry shops to make sure exhaust systems were extracting unpleasant odors. They evaluated cleaning supplies and checked that all supplies were stored in appropriate containers. They educated teachers and staff about keeping buildings clean. And they spent about $100,000 on carpet removal each year.

Over the past three years, the capital improvement costs totaled between $4.5 million and $5 million, a sum supported by senior management, the county council and the community. In 2001, the EPA honored the district's efforts by designating Montgomery County an indoor air quality excellence award winner.

A Cautious Campaign

Although large, relatively affluent districts such as Montgomery County have spent millions on indoor air quality improvements, some small, rural districts have tackled the problem with much smaller budgets.

Don Kussmaul, superintendent of East Dubuque Unit School District 119 in northwestern Illinois, learned about Tools for Schools at an AASA conference in 1998. He thought that improving the school environment made a lot of sense so he picked up a tool kit.

"I sat down with the maintenance director, and he and I looked at that thing, scared, for a while, wondering what can of worms we might open up," recalls Kussmaul, whose district along the cornfields of the Mississippi River enrolls 628 students.

To avoid scaring parents or faculty, Kussmaul and his maintenance director moved cautiously, expanding their air quality team over several years and gradually addressing minor hazards. In a building constructed in 1969, they discovered and removed asbestos wrapped around a ventilation system.

Total spending since 1999 has reached $14,000, not counting the hours of time and labor. Tests to check air quality cost about $1,400 in the district's elementary school building and $2,100 in the high school. But many solutions required no money. Before the air quality program, delivery drivers pulled their trucks in front of the cafeteria, left their engines running and propped the school doors open as they delivered produce.

"I have two cooks with asthma, and we were bringing those fumes right into the workplace," Kussmaul says. "Now, if you want to sell to us, you turn your engine off' before delivering the product. The district also requires school bus drivers to turn off the engines as they drop off and pick up students. In the afternoon, buses pick up children in a large open area,

Kussmaul's efforts received national recognition in 2002 when the EPA honored East Dubuque Unit School District for its commitment to a healthy school environment,

Common Sense

But even schools committed to a healthy environment can suffer missteps that waste time and money. Several administrators suggested pursuing large projects such as carpet removal when students are on vacation and limiting work during the school year to late afternoons and evenings to minimize classroom disruptions. Schools also should avoid going overboard in ordering expensive tests and hiring costly consultants.

"If your carpet is nine or 10 years old and you're getting complaints about itchy eyes, a good assumption is that you've got mold in your carpet, says Forer of Minnesota's St. Cloud district.

Because each carpet test costs about $120, he recommends districts tethered by tight budgets approve a minimal amount of testing. "If all the carpeting is the same age and you find mold, s a pretty good bet you have it elsewhere."

Although Forer used consultants to train staff and offer initial advice, he also advises schools to use restraint in hiring outside experts, an opinion that East Dubuque's Kussmaul shares. Air quality teams that discover major structural or architectural hazards will need to bring in outside experts, but district officials should not assume they need assistance in identifying and fixing smaller problems.

"This is an issue that must be handled first by school people rather than outside consultants," says Kussmaul, an AASA Executive Committee member. "Many times we run to outside sources for help, and it becomes extremely expensive when we have the tools in front of us to solve those problems."

Taras, the San Diego pediatrician, recommends schools confront indoor air quality issues with a dose of common sense.

"Sometimes I've seen schools that are just not thinking properly," he says. "They'll keep chicken coops outside or don't vacuum really often. There's a whole number of issues that sometimes schools just forget. But I also have seen it go the other way, where one person thinks they've got an air problem in a classroom or school and it becomes sort of a hysterical reaction instead of scientifically examining symptoms and measuring. It's very important for schools to have measured, scientific responses."

Adina Neale of California's Saugus Union School District knows the value of a measured response. But she also understands the difficulty of remaining calm and methodical in the midst of a crisis.

"It was insane. We kept trying to do everything right, and things kept going wrong," she recalls. While the school district uncovered no major environmental hazards, Neale believes the upgrades and new policies will help ensure against a future crisis.

"We could not afford a $100 million lawsuit," she says. "That would bankrupt the district. But more importantly, we have to find out what's going on in the classrooms. The result of it is a healthier environment for everybody."

RELATED ARTICLE: Penny-Pinching Ways To Improve Indoor Air

As school administrators grapple with budget deficits, fluctuating enrollments and expanding testing requirements, ridding a school of dust mites and stale air may seem like an agenda item of secondary importance unlikely to receive funding.

But environmental experts and school administrators suggest improving a building's environment is feasible even if a district's resources are limited and money is scarce.

"These are voluntary programs," says Julio Rovi, a senior associate at The Cadmus Group, a federal contractor for the U.S. Environmental Protection Agency that works with schools on energy and indoor air quality initiatives.

Among the recommendations he and others offer for starting an indoor air quality program with current staffing and existing resources are these:

* Form an indoor air quality team. Designate an indoor air quality coordinator and involve all relevant departments and staff.

The EPA recommends that an indoor air quality team consist of a principal, a nurse, a teacher, the facilities chief, a parent and possibly a school business official. Successful school environmental programs have support from school administrators and school board members.

"The No. 1 thing we've never seen work is to pretend it doesn't happen or to pretend it's only a problem for one individual office in the district," Rovi says. "The fragmented approach usually does not work."

* Use the Tools for Schools kit. Use the EPA's free resource kit, available from AASA, to identify and evaluate problems before hiring costly consultants or paying for expensive tests.

Tackle the easy fixes first. Seal food properly to discourage cockroaches and other pests. Clean schools thoroughly to minimize dust. Vacuum carpets frequently to control dust and curtail mold.

* Don't attempt a stand-alone project. When addressing indoor air improvement, you can save money by looking for ways to incorporate air quality initiatives into existing budgets. Tie indoor air quality corrections to school renovations and other improvement projects.

Rovi recommends schools link air quality improvements with energy-efficiency projects. He estimates that schools could save 10 to 30 percent of the cost in their utility bills by replacing outdated cooling, heating and ventilation systems with more modern, energy-efficient systems.

Adina Neale, the indoor air quality coordinator at Saugus Union School District in Los Angeles County, suggests folding indoor air quality activities into the maintenance budget.

"It can be dovetailed into the existing maintenance program quite easily, and it's easier to do when you're not in a crisis mode," she says. "You can make the transition within half a year." Also, going districtwide allows administrators to standardize equipment and staff training and eliminate liability loopholes.

When neglected problems burgeon into crises, such as floods resulting from leaky roofs and basements, school officials may be forced to dip into emergency funds and spend 10 to 20 times the sum that smaller, preventive repairs would have cost, Rovi says.

* Educate staff. Teachers and custodial staff need to know what constitutes an effective indoor air quality program, and they will need some training.

Instruct teachers to make sure air vents remain unblocked. Keep classrooms free of clutter to help custodians clean efficiently and effectively. Erase chalkboards at the end of each day to control chalk dust. Ask teachers to inform the air quality team if they or their students experience physical discomfort such as persistent headaches, itchy eyes or respiratory distress.

"You can do all this great maintenance work and it won't matter unless you have trained staff," Neale says.

* Explain your actions. Unless you're confronting a crisis, take your time and gradually develop and expand your new indoor air quality program. Let parents and staff know what you are doing and why.

"We were scared to death as to how we were going to do this without putting people in a panic," says Don Kussmaul, superintendent of the East Dubuque, Ill., Unit School District 119. "You have to keep calm. Go about it slowly and openly."

AASA Promotes Healthy Air

AASA is helping the Environmental Protection Agency to spread clean air through the nation's school corridors and classrooms.

In a cooperative agreement between AASA and the EPA's Indoor Environments Division, the association has agreed to raise awareness on the importance of monitoring and improving indoor air quality by encouraging school leaders to create indoor air quality teams and implement an action plan to clear the air in schools.

AASA received a three-year grant of $525,642.

To avoid a federal mandate on this issue, AASA has been urging superintendents to take a proactive stance and voluntarily address the indoor air quality in their district's buildings. As a resource, AASA provides training and information to school leaders across the nation. These efforts include a new initiative working with urban districts to raise awareness of indoor air quality.

AASA also has been a major provider of the IAQ Tools for Schools Action Kit developed by EPA. School districts can obtain this complimentary kit by contacting AASA's EPA project manager Ericka Plater, who can provide additional assistance on indoor air quality. She can be reached at 703-875-0731 or [e-mail].

AASA Partners With Districts on Asthma Initiatives

Eleven schools around the nation are trying to reduce asthma-related absences with a little help from AASA.

The association has launched a five-year effort to reduce the burden of asthma among children. During 20022003, AASA provided small grants to assist rural, urban and suburban schools in improving asthma management, curtailing sick days and boosting academic results.

"The whole premise is to look at best practices for keeping children in school and learning," says Susan Chaides, coordinator of health and nursing services for the Alhambra School District in Los Angeles County, one of the grant recipients. "Ultimately our goal is that our kids are in school and able to learn and concentrate and that asthma is not impacting their learning."

Financed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health, the mini-grants are part of a $1 million, 5-year cooperative agreement between AASA and CDC.

To receive the money, school officials had to present a plan outlining their approach to asthma management and education and agree to test two practices developed by a national panel convened by AASA.

School initiatives include efforts to enhance parental knowledge, improve communication with physicians and local health departments, increase asthma clinic referrals and develop specialized asthma plans for individual students. Some school officials are developing systemwide health forms to standardize records or asking nurses to write quarterly reports to the doctors of children with asthma.

Fighting Misconceptions 

A major goal among all participating schools is to dissolve misconceptions that students, parents and faculty might have about asthma, which now ranks as the most common chronic childhood disease.

School officials said many families lack sufficient education about the illness. Sometimes children use inhalers too often or they're not taking optimal medications. Sometimes parents wrongly believe that a child with asthma cannot participate in physical education.

"We've run into some situations at schools where we've found that they don't really understand the health needs," says Beverly Smith, coordinator of student services in the Talladega County, Ala., schools, a grant recipient.

Smith recalls a situation in which a 7th-grader with asthma missed school frequently. School officials learned the student's mother was afraid he might die if she sent him to school.

Smith invited the mother to school and gathered his teachers, principal, physical education teacher, school counselors and school system nurse Laurie Thornton as well as medical personnel from the local hospital. They helped the mother to understand that her son would be safe at school and explained the importance of disclosing previous medications when her son switched doctors.

Talladega school officials are planning parent conferences and health fairs that will address asthma management. Smith said she also hoped to purchase a video about asthma that could educate teachers, bus drivers and custodians. Thornton will visit some homes to help parents create healthier environments outside school. Dust and pets in the home, for example, could exacerbate a student's asthma episodes.

"We also are preparing programs for our parents because we feel the education of parents about asthma is very important," says Don Kussmaul, superintendent in East Dubuque, Ill., a grant recipient. "We can change conditions in our schools, but they have to also realize that they need to make changes at home as well."

This project keeps students with asthma in school and learning through the use of a set of strategies, or powerful practices, designed and tested by local school districts, To receive a draft of these practices or other information on this project, contact Tennille Brown at 703-875-0759 or [e-mail].

Rachel Smolkin is a free-lance writer based in Arlington, Va., specializing in health and education. E-mail: [e-mail]