State Honor Roll 2019


The 2019 State Honor Roll of Asthma and Allergy Policies for Schools download pdf ranks the states with the best public policies for people with asthma, food allergies, anaphylaxis and related allergic diseases in U.S. elementary, middle and high schools. Use our interactive map to see your state's report.


Which States Made AAFA’s 2019 State Honor Roll?

Fifteen states are included in AAFA’s Honor Roll this year!
  • Connecticut
  • Delaware
  • District of Columbia*
  • Illinois
  • Indiana
  • Massachusetts
  • Mississippi
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • Rhode Island
  • Vermont
  • Washington
  • West Virginia

Check your state's report


*The District of Columbia joins Connecticut in meeting all 23 core policies. This distinguished achievement shows the commitment our nation’s capital has made to protect students with asthma and allergies. It is an excellent example for states to follow when considering asthma and allergy friendly policies.

How the State Honor Roll Report Works

The report checks to see how every state compares against 23 key measures that affect people with asthma and allergies in schools. States make the honor roll when they hit 18 of 23 core policies. State Honor Roll MethodologyDownload PDF

AAFA’s Core Policies for Protecting Students’ Asthma and Allergy Health

Medication and Treatment

  1. State requires physician’s written instructions to be on file to dispense prescription medication to students.
  2. State policy ensures students’ right to self-carry and self-administer prescribed asthma medication.
  3. State policy ensures students’ right to self-carry and self-administer prescribed anaphylaxis medication.
  4. State policies or procedures shield school personnel from liability for unintended injuries.
  5. State requires local school districts to create asthma and anaphylaxis medication policy and provide resources, guidelines and parameters.
  6. State policy mandates schools to identify and maintain records for students with chronic conditions including asthma and anaphylaxis.
  7. State requires a procedure updating health records periodically.
  8. State requires that schools maintain asthma/allergy incident reports for reactions, attacks and medications administered.
  9. State requires a student health history form that includes asthma/allergy information to be maintained for each student.
  10. State requires schools to have emergency protocols for asthma.
  11. State requires schools to have emergency protocols for anaphylaxis.
  12. Nurse-to-student ratio is 1:750 or better.

Extra credit:

  1. State requires anaphylaxis medicine – epinephrine – stocking and authority to administer in schools.
  2. State allows and/or requires asthma quick-relief medicine – albuterol – stocking and authority to administer in schools.
  3. State has or is preparing an explicit asthma program with policies, procedures and resources for schools to manage students with asthma.
  4. State has or is preparing an explicit anaphylaxis program with policies, procedures and resources for schools to manage students with allergies.
  5. State has adopted policy that each school will have one full-time nurse.
  6. State has adopted policy stating that school districts provide case management for students with chronic health conditions such as asthma.


  1. State recognizes problem of asthma in schools and has begun to address it.
  2. State recognizes problem of allergy in schools and has begun to address it.

Extra credit:

  1. State sponsors or provides funding for staff training in asthma awareness covering school asthma program/policy and procedures.
  2. State sponsors or provides funding for staff training in food allergies.

School Environment

  1. State has mandated that all schools must have indoor air quality (IAQ) management policies.
  2. State has adopted a policy requiring that districts and schools conduct periodic inspections of heating, ventilation and air conditioning (HVAC) system and other items important in asthma/allergy management.
  3. State has IAQ policies that include specific components important in asthma/allergy management – HVAC, HEPA (high efficiency particulate air) filters, carpeting, and pesticide use.
  4. State recommends/requires that districts or schools use Integrated Pest Management (IPM) techniques OR ban use of pesticides inside school.
  5. State requires schools to notify parents of upcoming pesticide applications.
  6. State limits school bus idling time and establishes proximity restrictions.
  7. All smoking is prohibited in school buildings and on school grounds.
  8. All smoking is prohibited on school buses and at school-related functions.
  9. Tobacco-use prevention is required in health education curriculum.

Extra credit:

  1. State makes funding or resources available for technical IAQ assistance to schools.
  2. State recommends standards and programs to promote environmentally preferable materials for school construction, maintenance and cleaning.
  3. State requires school facility design standards that include low emission construction materials, pollutant source controls, durable and easy to clean surfaces and floors, moisture/mold controls.
  4. State has implemented or actively promotes diesel school bus engine retrofitting program.
  5. State requires districts or schools to provide tobacco-use-cessation services to students.

2019 Spotlight Articles:

Our Work Isn’t Done: AAFA’s Recommendations for Policymakers, Advocates and Parents

  1. Continue efforts to require stocking of quick-relief asthma medicine in schools. Make sure schools are equipped to obtain the medicine and know how to use it.
  2. Remove barriers to putting these laws into practice, whether that means more funding, awareness or training.
  3. Refresh or develop programs to improve air quality, both for indoor air pollution and outdoor air pollution in the school environment.
  4. Encourage innovation and partnerships between government and private companies (public-private partnerships).


AAFA’s 2019 State Honor Roll Report of Asthma and Allergy Policies for Schools was supported in part by a grant from Genentech.

2019 Report Authors and Advisors

Asthma and Allergy Foundation of America

Matthew Berner

Web Developer

Tanya Bumgardner
Content Editor and Manager

Melanie Carver
Vice President, Community and Health Services

Sanaz Eftekhari
Vice President, Corporate Relations and Research

Nicole Gaghan
Art Director

Kimberly Rafferty
Sr. Marketing and Communications Project Manager

Jenna Riemenschneider
Director of Advocacy and Special Projects

George Washington University

Darla Bishop, MPH
Research Assistant

Claire Heyison
Research Assistant

Katie Horton, RN, MPH, JD
Research Professor

Aaron Karacuschansky, MPH
Research Associate

Shomar Searchwell
Research Assistant

Naomi Seiler, JD
Associate Research Professor 

Anya Vanacek, MPH
Senior Research Associate