Preventing Pests
   for Healthier
   The Health Case for Integrated
   Pest Management

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
                    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
Inspection schedule
        Repairs to facilities and maintenance

        Weatherizing buildings and sealing pest
Traps and baits

Education and application of knowledge
of pest lifecycles

Targeted and strategic application of

Education of school staff, teachers and
students on steps to prevent pests
  All students deserve a safe and healthy school environment.

           Figure 1. Where to Look for Pests in Schools
          Gyms and
          Locker Rooms

                                and School
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

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

  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
  • 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

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
1 E
< E
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

  —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

  —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.

  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.
Reducing the Need for


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

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,
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.

  "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

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.
  School Integrated Pest Management for Teachers. U.S. Cooperative Extension System, 2015.
  IPM Cost Calculator. Southwest Technical Resource Center for School IPM, 2015.
  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.
                                                                            It Today!

     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
    • 85% reduction in pests since 2010

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3  USEPA. 2015. "Asthma Facts." EPA-402-F-04-019. Office of Air and Radiation, EPA.

4  USEPA. 2015. "What Is Asthma?"

5  CDC (U.S. Centers for Disease Control and Prevention), NCEH (National Center for Environmental Health), EHHE
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11 Chambers, K., et al. 2011. The Business Case for Integrated Pest Management in Schools: Cutting Costs and
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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
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13 Williams, G. M., H. M. Linker, M. G. Waldvogel, R. B. Leidy, and C. Schal. 2005."Comparison of Conventional and
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14 Corrigan, R. Ph.D., Urban Rodentologist, RMC Pest Management Consulting. Phone interview.
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15 Wang, C., and G. W. Bennett. 2009. "Cost and Effectiveness of Community-Wide Integrated Pest Management for
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16 Bloom, B., L.I.Jones, and G. Freeman. 2013. "Summary Health Statistics for U.S. Children: National Health Interview
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19 Gore, J. C., and C. Schal. 2007. "Cockroach Allergen Biology and Mitigation in the Indoor Environment." Annual
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20 Kanchongkittiphon,W.,et al. 2014. "Allergens on Desktop Surfaces in Preschools and Elementary Schools of
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22 Matsui, E.G., E.Simons, C. Rand, A. Butz, I J. Buckley, R Breysse, and PA. Eggleston. 2005. "Airborne Mouse Allergen
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23 Phipatanakul.W., RA. Eggleston, E. C.Wright, R. A. Wood, and the National Cooperative Inner-City Asthma Study.
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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.

26 USEPA. 2015. "EPA: Learning Triggers Key to Preventing Asthma Attacks."

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
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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.
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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.

30 Zubiate, R. Assistant Director, Facility Services, Salt  Lake City School District. Phone interview. October 1,2015.
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