Asthma is the most prevalent chronic illness among children and adolescents, reported in 1 in 10 children. 1 With an estimated 10.5 million missed days of school attributable to asthma in , asthma is a cause of concern for economic, academic, and health reasons. Children with asthma missed more school days than their counterparts; however, literature on patterns of absences is extremely limited. A recent systematic review reported poor air quality, including allergen exposures, has been shown to be related with asthma exacerbations. 5 Effects of Asthma and Air Quality on Missed School Days: Findings from the Asthma 411 School Initiative Opeyemi Jegede 2, Leslie Allsopp, MSN, MPH 1, Omobola Mudasiru 1, David A Sterling, PhD, CIH 1 ; University of North Texas Health Science Center School of Public Health; 1 Environmental and Occupational Health Sciences, 2 Biostatistics & Epidemiology Background Demographic and school absences data were collected from elementary and middle school students in FWISD for the 2013/2014 academic year, as part of an ongoing school- based asthma control initiative. Outcome: Sets of consecutive missed days were defined as the count of the number of times each student missed 2 or more days in a row during the academic year, not treating Friday and Monday as consecutive days 3. Main predictor and Covariates: Asthma status is the main predictor, Table 1 shows the covariates considered. Daily maximum AQI values were obtained from two TCEQ air monitoring sites for daily O 3, NO 2, CO, and PM 2.5 values. Negative binomial regression was used to model the relationship between counts of sets of consecutive missed school days and asthma, without accounting for weekends. 3 Spearman’s correlation was computed to understand the relationship between AQI measure and number of missed school days, under 3 models (Figure 2), stratified by Table 1: There were significant differences in the average of sets of missed school days, age, gender, and grade by asthma status. Table 2: Adjusted incidence rate ratios from the regression model, indicates that children with asthma missed more sets of consecutive school days 44% more than non-asthmatic children. Males and middle school students also missed more set of consecutive school days compared to their respective counterparts at rates of 61% and ~82% respectively. An interaction between sex and lunch type was observed; males who received subsidized lunches had a reduced rate (~62%) of sets of missed days. Of all lag periods assessed, there was a statistically significant relationship in only very few of the points. However, there is an evident differential relationship for students with asthma. 1 Centers for Disease Control and Prevention (CDC) Adolescent and School Health – Asthma and Schools. Accessed at on 04/09/ on 04/09/ Centers for Disease Control and Prevention (CDC) Asthma’s Impact on the Nation – Data from CDC National Asthma Control Program. Accessed at on 04/09/ Samina S. Mizan, Derek G. Shendell, and George G. Rhoads. (2011). Absence, Extended Absence, and Repeat Tardiness Related to Asthma Status among Elementary School Children. Journal of Asthma, 48:228–234, Szyszkowicz M, Kousha T. (2014). Emergency department visits for asthma in relation to the Air Quality Health Index: a case-crossover study in Windsor, Canada. Can J Public Health Jul 31;105(5):e Dick S, Doust E, Cowie H, Ayres JG, Turner S. (2014). Associations between environmental exposures and asthma control and exacerbations in young children: a systematic review. BMJ Open Feb 12;4(2). 6 Trupin L, Katz PP, Balmes JR, Chen H, Yelin EH, Omachi T, Blanc PD. (2013). Mediators of the socioeconomic gradient in outcomes of adult asthma and rhinitis. Am J Public Health Feb;103(2) Compared to females, males had a significantly increased rate of sets of missed school days 6. Similar relationship was observed for individuals receiving lunch support, although not statistically significant. We observed an interaction between sex and lunch status whereby males who were receiving lunch support had a lower incidence rate of consecutive missed school days. Our analysis showed negative and positive relationships between absences and AQI, depending on days of lag. 5 This may result from AQI measures not being representative of actual exposure and the small sample size. However, future investigation should be directed to the evident difference between asthmatics and non-asthmatic students. In conclusion, our study increases the knowledge base about the patterns by which asthmatics miss school compared with their non-asthmatic counterparts. Children with asthma missed more multiple sets of school days than children without asthma, and showed a statistically significant increase with more sets of consecutive absences. Table 1: Characteristics of Study Participants by Asthma Status 1.Compare incidence rate of sets of consecutive missed school days between children with and without asthma. 2.Determine the relationship between exposure to poor air, as measured by the EPA’s Air Quality Index (AQI), and missed school days. Characteristics Asthma Status (N = 1443) Yes (159)No (1284) Average Missed Days*** Sets of Missed Days***2.2±2.81.5±2.4 Age*11.6± ±3.2 Sex** Male Female 101 (63.5) 58 (36.5) 671 (52.3) 613 (47.7) Grade** Pre-K Elementary Sch. Middle Sch. 24 (15.1) 32 (20.1) 103 (64.8) 146 (11.4) 424 (33.0) 714 (55.6) Lunch Type Free/Reduced Full-priced 136 (85.5) 23 (14.5) 1066 (83.0) 218 (17.0) Figure 1: Line plot of proportion of sets of missed days by asthma status VariableRate Ratio (95% CI) p Asthma (Yes vs. No)1.44 (1.12, 1.86).005 Sex (Male vs Female)1.61 (1.06, 2.43).025 Age.98 (.91, 1.06).629 Lunch Type (Free/Red. Vs. Full)1.34 (.94, 1.89).103 Grade (ref = Middle) Pre-K Elementary.64 (.33, 1.26).55 (.37,.83) Sex*Lunch Type.62 (.39,.97).037 asthma status and lag days applied for up to 7 days 4. Statistical analysis was conducted and charts created using SAS 9.3 and R. Table 2: Adjusted Rates Ratios of Consecutive Missed Days p-value ***<.001 **<.01 *≤.05 Methods Objectives Methods (continued) Results Discussion & Conclusion References Figure 2: Correlation Coefficient Chart of AQI and Missed School Days