Preventing Pests
for Healthier
Schools
The Health Case for Integrated
Pest Management
www.epa.gov/managing-pests-schools
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Keeping Pests Out of
Schools for Healthy
Bodies and Minds
Cockroaches, mice, rats, fleas, ticks, bed
bugs, house dust mites and other pests
found in school facilities can be hazard-
ous to the health of students and staff.
Some pests spread pathogens that are harmful
to people For example, cockroaches and rodents
spread Escherichia coli (E, coif), /./sferiaand Salmonel-
la, which cause food poisoning.
Many pests also are common sources of allergens,
which can result in serious allergic reactions and trig-
ger asthma attacks.1 In some cases, pests may con-
tribute to the onset of asthma,2 a chronic respiratory
condition that accounts for more school absenteeism
than any other childhood chronic disease.3 In an av-
erage classroom of 30 students, about three students
have asthma,4 and in total approximately 13.8 million
school days are missed each year in the United States
due to asthma.5 When students miss school days, not
only does their academic performance suffer, but their
schools stand to lose state funding as well.6
What Is Integrated Pest
Management?
Integrated pest management (IPM) is a smart,
sensible and sustainable approach to controlling
pests. IPM takes advantage of all appropriate pest
management strategies, including the judicious
use of pesticides. In contrast to conventional pest
management, which controls existing pests through
scheduled pesticide applications, IPM controls pest
populations by removing their basic survival elements,
such as food, water and shelter, and by blocking ac-
cess to facilities where these items might be readily
available.7 IPM prevents pest problems before they
begin. IPM also supports healthy school environments
by reducing the unnecessary exposure of students,
teachers and staff to pests and pesticides.
"/PM is the best way to eliminate
cockroaches which, in turn, eliminates
the allergens that they produce."
—Coby Schal, Ph.D., Professor of Urban
Entomology, North Carolina State University
Implementing IPM Within School Facilities and on School Grounds
Regular inspection and monitoring
Maintaining records and writing regular
reports on each building, detailing—
Monitoring results
Inspection findings
Recommendations
Inspection schedule
Repairs to facilities and maintenance
Weatherizing buildings and sealing pest
entryways
Traps and baits
Education and application of knowledge
of pest lifecycles
Targeted and strategic application of
pesticides
Education of school staff, teachers and
students on steps to prevent pests
All students deserve a safe and healthy school environment.
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Figure 1. Where to Look for Pests in Schools
Exterior
Conduits
Gyms and
Locker Rooms
Dumpsters
Classrooms
Landscapes
and School
Grounds
Pests are attracted to
food and water in
confined locations,
such as between
appliances and
in cabinets.
Pest populations
increase in untidy
areas, such as desks
and closets.
These areas can be
warm and poorly
ventilated, providing
breeding grounds for
pests.
All openings to the
outdoors provide
easy entry for pests.
Clutter and food can
collect quickly in
lockers throughout
the school year,
providing a safe
harbor and breeding
ground for pests.
Waste receptacles Neglected landscapes
and surrounding and1 grounds can attract
areas are vulnerable a wide variety of Pests>
to pest problems, including those that
especially when they destroy school
are located close to structures.
school buildings.
7PM is a common-sense, sustainable
approach. Rather than relying on
quick-fixes that simply suppress pests,
IPM poses the question, 'Why are these
particular pests a problem at this point
in time in this particular environment?'
This approach provides more
sustainable results."
—Dawn Gouge, Ph.D., Associate Professor and
Associate Specialist, Urban Entomology,The
University of Arizona
Everyone in the school environment has a role to play
in identifying and reducing the conditions that harbor
pests (Figure I).9
The American Academy of Pediatrics and other
groups have joined EPA in recommending the use of
IPM in schools to reduce exposure to both pests and
pesticides. IPM has gained traction in schools across
the country, with the number of states implementing
IPM in schools increasing from five to 21 between 2008
and 2013.10
IPM is a science-based strategy that is effective, feasi-
ble and affordable. IPM not only improves the health
of students, faculty and staff, but also it can lower costs
and keep schools running efficiently. This method of
pest control has been shown to reduce pest com-
plaints in schools by 70 to 90 percent with no long-
term increase in costs.10-11
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Pest Reduction in Schools Through IPM
• Zero cockroaches were found in traps
in IPM-treated schools compared
to 82.6 cockroaches found in
conventionally treated schools every
week12
• Allergen levels in school dust samples:
14% (IPM) versus 44% (conventional)12
• IPM-treated schools administered
99.9% less active pesticide ingredient
than conventionally treated schools13
Research in Schools
Supports IPM for
Managing Pests
PM has proven to be an effective method for con-
trolling pests in homes and apartment complex-
es, inspiring research on its effectiveness in school
settings.12-13
One study, directed by North Carolina State
University, compared IPM and conventional
treatment methods in three North Carolina school
districts.12 Through visual inspection, trap setting
and dust sample collection, IPM was found to be
more effective than conventional methods involving
pest management professionals and monthly
pesticide applications. In the schools using IPM, no
cockroaches were discovered in the traps following
the implementation of IPM (e.g., sealing cracks,
addressing initial infestation levels), whereas the
traps recovered from the schools treated with
conventional methods averaged 82.6 cockroaches
per week. Forty-four percent of dust samples in the
conventionally treated schools had detectable
concentrations of cockroach allergen compared
to 14 percent from the IPM-treated schools. In the
samples with detectable allergen, the IPM-treated
schools had lower and safer levels of the allergen
(Figure 2), as well as fewer pest infestations.
Figure 2. Cockroach Allergen Levels by
School Pest Control Method
d -a
o^
O) O
1 E
< E
Conventional
Another study in North Carolina, administered in nine
schools by North Carolina State University, compared
a basic IPM program and a conventional pest man-
agement program with monthly pesticide applica-
tions. Over a 12-month period, 99.9 percent less active
pesticide ingredient was used in the application of
IPM methods compared to conventional methods.13
The study demonstrated that in school environments
with cockroach problems, even a simple IPM program
can be implemented successfully with no negative
tradeoffs and using significantly less pesticide.
The Health Case for IPM
IPM creates healthier environments for students,
faculty and staff: food preparation areas are
cleaner, bacteria are reduced, the spread of viral
pathogens is limited, and exposure to pesticides
is carefully controlled.12 Rodents, for example, can
carry bacteria and spread illness as they move from
outdoor areas to classrooms, kitchens and other
school facilities, moving easily between walls and
"We definitely can tell people that IPM
works—we wouldn't be doing it for
10 years if it didn't work."
—Ricardo Zubiate, Assistant Director, Facility
Services, Salt Lake City School District, Utah
-------
"The value of instituting an Integrated
Pest Management program in the
Metropolitan School District of Pike
Township has enabled us to utilize
all available pest management
strategies to prevent damaging pest
outbreaks while reducing risks to
human health and the environment.
The outcome has been an increase in
student attendance and academic
achievement."
—Raul Rivas, Facility/Security Director,
Metropolitan School District of Pike Township,
Indianapolis, Indiana
carrying pathogenic viruses such as Salmonella.™ An
IPM program educates staff about how to maintain a
healthy space and encourages healthy habits such
as strategic cleaning and maintenance. These efforts
emphasize eliminating conditions conducive to pests,
such as clutter and access points, and targeting
pest-vulnerable areas, such as kitchens, cafeterias
and break rooms. The cleaning and maintenance
necessary for IPM's overall success also improves the
quality of the building's indoor air.15
Asthma is the most prevalent chronic health issue
among children in the United States, affecting nearly
10 percent of children nationwide.16 Approximately
80 percent of asthma in children is allergic, meaning
caused by allergens.17 The correlation between
exposure to pests—primarily cockroaches and
rodents—and asthma has been widely documented.
Allergens found in indoor dust that have been linked
to asthma include those derived from arthropod feces
(such as from cockroaches), rodent excrement and
pet dander.18 About 43 percent of the U.S. population
is allergic to at least one common indoor allergen,
and 26 percent exhibit allergic sensitization to the
common German cockroach.12 According to the
National Cooperative Asthma Study, 37 percent of
children with asthma in the United States are allergic
to cockroach allergens.19 Children who are allergic
to these cockroach allergens also are more likely to
require medical attention for asthma-related issues.
Additional studies have shown that greater exposure to
cockroach allergens is associated with hospitalizations
of children with asthma.18
Mouse allergens also are prevalent in school settings.
A study conducted by the Boston Children's Hospital
found that mouse allergens were detectable on desk-
top surfaces in 100 percent of sampled urban pre-
schools and 95 percent of sampled urban elementary
schools.20 Children allergic to mice who are exposed
to high levels of mouse allergens were more likely to
have unscheduled doctor visits, emergency depart-
ment visits and hospitalizations.21
"Research has shown that in 24 hours
one mouse can produce up to 3,000
microdroppings of urine. In that urine
is the protein that triggers asthma.
When schools seem to indicate that
budgets are often limited for the
building repairs necessary to exclude
mice, I emphasize that implementing
a complete IPM program is actually
a cost-effective way to manage pests
and thus protect the health of school
children."
—Robert Corrigan, Ph.D., Urban Rodentologist,
RMC Pest Management Consulting
Although children may encounter pest allergens in
many settings, they spend most of their time in school
and home environments. More than 75 percent of
U.S. homes contain detectable mouse allergens,22and
there is a significant association between exposure
to mouse allergens and asthma sensitization,
particularly in inner-city, multifamily dwellings.23 These
allergens contribute directly to the exacerbation and
onset of asthma among children, and increased
exposure to allergenic proteins generated by pests
is associated with increased sensitivity to those
proteins.24 Effective reduction of pest presence
can reduce allergens and asthma triggers, and
promoting IPM in schools for the abatement of these
asthma triggers can both improve health and reduce
asthma-related absenteeism.
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IPM is a smart, sensible
and sustainable way
to reduce pests and
improve health.
Asthma, Absenteeism and
Allocated Funding: What's
IPM Got to Do With It?
In 2013 in the United States, children with asthma ages
5 to 17 years missed 13.8 million days of school, an in-
crease from 10.4 million in 2008. Nearly half (49%) re-
ported missing 1 or more school days due to asthma.5
In addition, 7 to 11 percent of children with asthma miss
more than 10 days of school each year.5 Improving in-
door air quality through IPM can help by reducing asth-
ma symptoms and minimizing missed school days.
Besides lost classroom time, school districts also often
receive—or lose—funding based on student atten-
dance.* Although attendance-based funding can
vary greatly by district, districts can lose as much as
$100 million in funding due to absenteeism alone; in
one school district, 5-year losses totaled more than
$620 million.25 To reduce absenteeism and as a result
help maintain school funding streams, school districts
should implement measures that protect their stu-
dents' health. IPM is a cost-effective approach to pest
management that can provide many benefits to the
school system: it protects student and staff health, has
the potential to increase attendance, and helps keep
school buildings in better condition.
*These states include California, Idaho, Illinois, Kentucky, Mississippi, Missouri
and Texas. (Adams, J. M. 2013."Schools Focus on Intervention, Understanding
to Stem Chronic Absenteeism." EdSource. edsource.org/2013/class-matters-
schools-increasing-focus-on-intervention-understanding-to-stem-chronic-
absenteeism-at-its-roots/37975)
Reducing the Need for
Pesticides
With an emphasis on discrete and discriminate use
of pesticides, IPM also can improve student health by
eliminating the unnecessary use of pesticides. Con-
ventional pest management entails regular (often
monthly or quarterly) pesticide applications to entire
buildings and facilities, but IPM dictates the applica-
tion of pesticides only when needed and in the specif-
ic problem area. Conventional calendar-based pest
management often does not completely eliminate a
pest population, creating a resistance among these
pests to the applied pesticides. By more effectively
reducing the number of pests in a building, IPM de-
creases reliance on pesticides.24 A study comparing
the effects of IPM in schools with the effects of con-
ventional pest management in schools showed that
buildings and structures implementing IPM used sig-
nificantly fewer pesticides and resulted in significantly
fewer pesticide residues beyond the treated area.13
It is also important to note that when pests move
readily from sewer systems, bathrooms or dumpsters
to kitchen and classroom areas, they can bring dan-
gerous microbes and pathogens with them, including
antibiotic-resistant microbes.24 By identifying potential
pest sources and emphasizing a preventative ap-
proach to eliminating pests in schools, IPM can help
to ensure a healthy learning environment.
Addressing Health
Disparities Through IPM
Some communities experience pest-related health
effects more acutely than others. Children in un-
derserved communities, especially those in urban
settings, experience greater morbidity and hospital-
izations due to asthma.26 Studies focusing on minori-
ties have shown that non-Hispanic African American
children are about twice as likely as Caucasian
children to have asthma, and they have poorer out-
comes, including higher rates of emergency depart-
ment visits.27 According to a recent study of asthma
prevalence in Maryland, African American children in
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Baltimore have an annual asthma hospitalization rate
three times higher than that of Caucasian children.17
These urban environments are highly conducive to
large numbers of pests and pest infestations. The
combined effect of living in less sanitary areas—both
indoors and outdoors—and being unable to control
pests poses a higher risk for asthma-related emer-
gency department visits and hospitalizations.15-17-28
A study by Johns Hopkins University showed that up
to a quarter of children living in inner-city Baltimore
were exposed to pest allergens at levels equal to
those found in laboratories in which mouse studies
are conducted, levels high enough to trigger aller-
gic or asthma responses.22 With both asthma and
pest exposure disproportionally affecting under-
served and minority communities and children,29 im-
plementing IPM as a pest management strategy in
schools can improve health outcomes by reducing
pest exposure.24
From "Good Idea"
to "Great Outcomes":
Overcoming Obstacles
to IPM
Implementing IPM practices and policies in schools
can be an effective solution for reducing or
eliminating cockroaches, rodents and other pests.
Reducing such pests decreases exposure to both
pathogens and allergens, thereby reducing allergic
reactions, the onset of asthma and the exacerbation
of existing asthma. By decreasing exposure to pests
and associated allergens, IPM can be a cost-effective
way to reduce asthma symptoms, improve health
outcomes and improve school attendance—so why
aren't more schools insisting on IPM?
Barriers to IPM
Ideally, all schools would be able to find the time and
secure the funding needed to implement IPM. In reality,
schools face a number of obstacles as they try to en-
sure that IPM policies are given serious consideration
"It's not'rocket science.'It's common
sense. The challenge is to change
people's behavior when they may
have few custodial resources. Once
we overcame this challenge, change
started to happen. The building was
dirty and dingy at first, but by the end
of the year-long transition to IPM the
building was shiny and everything
was clean. It was an unbelievable
transformation. Not only were our pest
problems better addressed, we had
compliments from our parents about
the cleanliness of the school."
—Claudia Riegel, Ph.D., Director, Mosquito,Termite,
and Rodent Control Board, City of New Orleans,
Louisiana
and are observed by all school staff and contractors.
Nonetheless, all of these barriers can be overcome.
Key barriers include—
• Upfront costs. IPM reduces long-term costs for
schools, by stopping pests at the source. Labor costs
are the primary IPM expense once facilities are in
sound condition, but making repairs to facilities may
pose a financial challenge for some schools, espe-
cially if the school has a pest management contract
that does not cover these costs or does not allow for
a flexible spending allocation. Once the necessary
repairs and upgrades to keep pests out are made,
costs level out quickly, but schools must first invest
in upfront costs to eventually see the savings. Ad-
ditionally, many of the IPM strategies implemented
also can increase a building's energy efficiency and
water savings, for example, by sealing access points
or fixing leaks, leading to further cost savings.7
• Conflicting priorities. School administrators, staff
and faculty wear many different hats and juggle
multiple priorities, and each person prioritizes a dif-
ferent set of school needs. Limited resources can
lead to competing priorities, and conversations
about IPM may take a backseat to other issues that
schools face on a day-to-day basis.
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"Knowledge is a major barrier.
Many people assume that pest
control happens when they see an
individual come through and spray
the baseboards. They see a few
cockroaches with twitching legs and
think, 'That's pretty good.'Improving the
knowledge base around IPM and its
benefits is critical."
—John C. Carlson, M.D., Ph.D., Assistant Professor
of Pediatrics,Tulane University
• Lack of understanding. Resistance to IPM often
results from a lack of understanding. When school
administrators and facilities staff are not fully aware
of the benefits of IPM or the techniques and practic-
es that comprise an IPM program, they may not be
willing to make it a priority or be able to fully imple-
ment an IPM program. (See "Schools in Action: Salt
Lake City School District" featured in this brochure for
more on how school districts are using education to
strengthen their IPM program.)
Making IPM a Reality in
Every School
Through their own experiences, school IPM experts
have identified key motivators in developing and im-
plementing strategies that can improve health, de-
crease absenteeism and save money for schools:
• "Educate, educate, educate." A school or school
district won't be able to fully implement IPM if its staff
does not know what IPM entails or what benefits it
offers. According to Dr. Claudia Riegel, schools need
to be educated about IPM and to understand the
broader benefits of the program. Communicating
with staff (both internal and external), parents and
students about procedures, expectations and out-
comes of IPM ensures that everyone is working to-
gether toward the same goal of eliminating pests
and improving school health.
Prioritize resources. Although IPM can be a cost-
effective solution in the long-term—reducing the
overall presence of pests and decreasing the
amount of pesticides needed—initial implemen-
tation requires both time and money. School ad-
ministrators, by ensuring that IPM is a permanent
allocation in the budget and acting as champions
for smart, sensible and sustainable pest control, can
ensure that this vital operational aspect of school
health isn't overlooked as more immediate school
concerns and issues arise.
Focus on health. There are a number of reasons why
IPM is a smart choice for schools, and focusing on
the health case can encourage schools and school
districts to commit to an IPM program. Student, teach-
er and staff health is a unifying issue that everyone
can agree on, and making this a central message is
critical when crafting a campaign for IPM.
"Children are the most vulnerable
members of society when it comes to
the effects of poor pest management.
One hundred percent of our future is in
their hands. We really should invest in
creating the healthiest, most effective
learning environment for our students."
—Dawn Gouge, Ph.D., Associate Professor and
Associate Specialist,The University of Arizona
IPM offers schools the opportunity to go beyond con-
ventional pest control and implement a more effective
pest management strategy, ultimately decreasing the
presence of pests and eliminating the unnecessary
use of pesticides in schools. Pesticide use is not mutu-
ally exclusive with an IPM program, but "pesticides in
the absence of an IPM program are unacceptable."24
IPM seeks to prevent pest infestations before they be-
gin, in addition to addressing them when they occur.
Research has shown that IPM is a science-based,
effective approach to pest management that de-
livers the healthy environment students, faculty and
8
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staff deserve. School pests, particularly cockroaches
and rodents, can negatively affect health by caus-
ing or exacerbating asthma and spreading illness,
thereby contributing to absenteeism and potentially
negatively affecting school funding. In addition, IPM
does not increase long-term costs when compared
to conventional pest management efforts. IPM—a
science-based strategy for reducing pests that im-
proves health and saves money—is a proven solution
that schools should adopt as their new "smart, sensi-
ble and sustainable" pest management practice.
Suggested Resources
"The Basics of School Integrated Pest Management" webinar. U.S. EPA, 2014.
www.epa.gov/managing-pests-schools/previous-webinars-about-integrated-pest-management-
schools#Oct2014.
School Integrated Pest Management for Teachers. U.S. Cooperative Extension System, 2015.
articles.extension.org/pages/21012/school-integrated-pest-management-for-teachers#.Vk95WU2FMdU.
IPM Cost Calculator. Southwest Technical Resource Center for School IPM, 2015. www.ipmcalculator.com.
There's an App for That! ^ -*
EPAs School IAQ Assessment Mobile App is your
"one-stop shop for implementing IAQ management
guidance, including about IPM, from the IAQ Tools
for Schools Action Kit.Through actionable steps and
checklists, the app assists schools and school dis
tricts in assessing facilities to protect the health of children and school staff.
sustainable manner.
Download
It Today!
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Schools in Action: Salt Lake City School District
PM is a smart, sensible and sustainable way to minimize ex
sure to pests and their associated allergens and asthma t
gers. With IPM, negative health outcomes and absenteeism are
reduced and funding levels for schools are less likely to be lost.
IPM can both eradicate pests and maintain healthy environments,
and schools across the country are taking notice.
Salt Lake City School District (SLCSD) in Utah has demonstrated
its commitment to school health, launching a successful IPM pro
gram that has reduced both costs and pesticide use across the
district.30 Although both SLCSD and its pest management con
tractor were committed to establishing an IPM program, SLCSD's
facility director noticed that the pest management technicians
were not utilizing proper techniques and continued to spray pes
ticides indiscriminately. Inspired by a presentation at a children's
Services, Salt Lake Cit\
health conference in 2004 and troubled by the lack of IPM prac
tices at SLCSD, the facility director developed an IPM pilot program in 2005 for three of the district's schools.
SLCSD terminated its pest management contract and brought the pest management program in-house,
training the custodial staff in IPM and licensing them to apply pesticides.
Over the past 10 years, SLCSD has reduced its total pest management costs and pesticide use. IPM ser
vices now cost only $2,000 to $3,000 annually, and pesticides have been applied fewer than 45 times over
the past decade, a significant reduction from its prior monthly scheduled sprayings.The key to this success,
says Ricardo Zubiate, Assistant Director of Facilities, has been having a champion to advocate for IPM pol
icies, ensure their implementation, and educate all school stakeholders throughout the process.The entire
school, from the kitchen staff to the teachers, needs to be informed about IPM and the signs of infestation
)blems to custodial staff as quickly as possible.
• 24,723 students
• 53 schools
• $25,000 saved annually on pest
management
• 85% reduction in pests since 2010
10
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Endnotes
1 Apter.A. J.,and RA. Eggleston. 2005. "Controlling the Environment of Asthmatic Children: Benefits and
Limitations." In Childhood Asthma, edited by Stanley J.Szefler and Soren Pedersen, 187-210.N.p.: CRC Press.
2 Institute of Medicine. 2000. "Executive Summary." Clearing the Air: Asthma and Indoor Air Exposures. Washington,
D.C.:The National Academies Press. 2000:1-18. www.nap.edu/read/9610/chapter/2tt6.
3 USEPA. 2015. "Asthma Facts." EPA-402-F-04-019. Office of Air and Radiation, EPA.
www.epa.gov/asthma/2015-asthma-fact-sheet.
4 USEPA. 2015. "What Is Asthma?" www.epa.gov/asthma/what-asthma.
5 CDC (U.S. Centers for Disease Control and Prevention), NCEH (National Center for Environmental Health), EHHE
(Division of Environmental Hazards and Health Effects). 2015. "Asthma-Related Missed School Days Among
Children Aged 5-17 Years." Last modified October 5. www.cdc.gov/asthma/asthma_stats/default.htm.
6 Adams, J. M. 2013. "Schools Focus on Intervention, Understanding to Stem Chronic Absenteeism." EdSource.
edsource.org/2013/class-matters-schools-increasing-focus-on-intervention-understanding-to-stem-chronic-
absenteeism-at-its-roots/37975.
7 Brenner, B. L, et al. 2003. "Integrated Pest Management in an Urban Community: A Successful Partnership for
Prevention." Environmental Health Perspectives 111(13):! 649-53.
8 USEPA. 2015. "Introduction to Integrated Pest Management." Last modified September 10.
www.epa.gov/managing-pests-schools/introduction-integrated-pest-management.
9 USEPA. 2015. "Managing Pests in Schools: Information on Pests in Schools and Their Control." Last modified April
28.www.epa.gov/managing-pests-schools/information-pests-schools-and-their-control.
10 Gouge, D. H., M. L. Lame, and J. L. Snyder. 2006. "Use of an Implementation Model and Diffusion Process for
Establishing Integrated Pest Management in Arizona Schools." American Entomologist 2006:190-6.
11 Chambers, K., et al. 2011. The Business Case for Integrated Pest Management in Schools: Cutting Costs and
Increasing Benefits, The IPM Institute of North America, Inc. 8 pp.
www.ipminstitute.org/school_ipm_2020/ipm_business_case.pdf.
12 Nalyanya, G., J. C. Gore, H.M. Linker, and C.Schal. 2004. "German Cockroach Allergen Levels in North Carolina
Schools: Comparison of Integrated Pest Management and Conventional Cockroach Control." Journal of
Medical Entomology46(3): 420-7.
13 Williams, G. M., H. M. Linker, M. G. Waldvogel, R. B. Leidy, and C. Schal. 2005."Comparison of Conventional and
Integrated Pest Management Programs in Public Schools." Journal of Economic Entomology 98(4): 1275-83.
14 Corrigan, R. Ph.D., Urban Rodentologist, RMC Pest Management Consulting. Phone interview.
Octobers, 2015.
15 Wang, C., and G. W. Bennett. 2009. "Cost and Effectiveness of Community-Wide Integrated Pest Management for
German Cockroach, Cockroach Allergen, and Insecticide Use Reduction in Low-Income Housing." Journal of
Economic Entomology 102(4): 1614-23.
16 Bloom, B., L.I.Jones, and G. Freeman. 2013. "Summary Health Statistics for U.S. Children: National Health Interview
Survey, 2012." National Center for Health Statistics. Vital Health Statistics 10(258): 1 -81.
www.cdc.gov/nchs/data/series/sMO/srl 0_258.pdf.
11
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17 Breysse, R N., et al. 2005. "Indoor Exposures to Air Pollutants and Allergens in the Homes of Asthmatic Children in
Inner-City Baltimore." Environmental Research 98(2): 167-76.
18 Rabito, F. A., J.Carlson, E.W. Holt, S.lqbal, and M.A.James. 2011. "Cockroach Exposure Independent of
Sensitization Status and Association with Hospitalizations for Asthma in Inner-City Children." Annals of Allergy,
Asthma and Immunology 106(20): 103-9.
19 Gore, J. C., and C. Schal. 2007. "Cockroach Allergen Biology and Mitigation in the Indoor Environment." Annual
Review of Entomology 52:439-63.
20 Kanchongkittiphon,W.,et al. 2014. "Allergens on Desktop Surfaces in Preschools and Elementary Schools of
Urban Children with Asthma. Allergy: European Journal of Allergy and Clinical Immunology 69(7): 960-3.
21 Sheehan,W.J.,et al. 2010. "Pest and Allergen Exposure and Abatement in Inner-City Asthma: A WorkGroup
Report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee."
Journal of Allergy and Clinical Immunology 125(3): 575-81.
22 Matsui, E.G., E.Simons, C. Rand, A. Butz, I J. Buckley, R Breysse, and PA. Eggleston. 2005. "Airborne Mouse Allergen
in the Homes of Inner-City Children with Asthma." Journal of Allergy and Clinical Immunology 115(2): 358-63.
23 Phipatanakul.W., RA. Eggleston, E. C.Wright, R. A. Wood, and the National Cooperative Inner-City Asthma Study.
2000. "Mouse Allergen. II.The Relationship of Mouse Allergen Exposure to Mouse Sensitization and Asthma
Morbidity in Inner-City Children with Asthma." Journal of Allergy and Clinical Immunology 106(6): 1075-80.
24 Schal, C. Ph.D., Professor of Urban Entomology, North Carolina State University. Phone interview. October 27,2015.
25 Faryon, J. 2011 ."Empty Seats Costs San Diego School District Millions." inewsource.
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26 USEPA. 2015. "EPA: Learning Triggers Key to Preventing Asthma Attacks." yosemite.epa.gov/opa/admpress.nsf/
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27 CDC (U.S. Centers for Disease Control and Prevention), NCEH (National Center for Environmental Health), EHHE
(Division of Environmental Hazards and Health Effects). 2012."Asthma's Impact on the Nation: Data from the
CDC National Asthma Control Program." www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf.
28 Chew,G. L, M.S. Perzanowski, R. L. Miller, J. C.Correa, L.A. Hoepner, C. M. Jusino, M. G. Becker,and R L. Kinney.
2003. "Distribution and Determinants of Mouse Allergen Exposure in Low-Income New York City Apartments."
Environmental Health Perspectives 111(10):! 348-51.
29 Akinbami, L. J., et al. 2012.Trends in Asthma Prevalence, Health Care Use, and Mortality in the United States,
2001 -2010. NCHS Data Brief, No. 94. Hyattsville, MD: National Center for Health Statistics.
www.cdc.gov/nchs/data/databriefs/db94.htm.
30 Zubiate, R. Assistant Director, Facility Services, Salt Lake City School District. Phone interview. October 1,2015.
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