HHS Public Access

Author manuscript
Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
Author Manuscript

Published in final edited form as:

Int J Hyg Environ Health. 2018 June ; 221(5): 800–808. doi:10.1016/[Link].2018.04.015.

School environmental conditions and links to academic

performance and absenteeism in urban, mid-Atlantic public
schools
Jesse D Berman, PhD,
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Meredith C McCormack, MD,

Author Manuscript

Johns Hopkins School of Medicine, Baltimore, MD

Kirsten A Koehler, PhD,

Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD

Faith Connolly, PhD,

Executive Director, Baltimore Education Research Consortium, Baltimore, MD

Dorothy Clemons-Erby, BS,

Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD

Meghan F Davis, DVM, PhD,

Author Manuscript

Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of

Public Health, Baltimore, MD

Christine Gummerson, BA,

Johns Hopkins School of Medicine, Baltimore, MD

Philip J Leaf, PhD,

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Theresa D Jones, MBA MEd, and

Office of Achievement and Accountability, Baltimore City Public Schools, Baltimore, MD

Frank C Curriero, PhD

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Author Manuscript

Abstract

Corresponding Author: Jesse D Berman, Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N
Wolfe Street, Baltimore, MD 21205.
Present Address: University of Minnesota School of Public Health, Environmental Health Sciences Division, Mayo Mail Code #807,
420 Delaware Street SE, Minneapolis, MN 55455, Phone: 612-626-0923, Fax: 612-626-4837, berma186@[Link]
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
the resulting proof before it is published in its final citable form. Please note that during the production process errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
 Berman et al. Page 2

School facility conditions, environment, and perceptions of safety and learning have been
Author Manuscript

investigated for their impact on child development. However, it is important to consider how the
environment separately influences academic performance and attendance after controlling for
school and community factors. Using results from the Maryland School Assessment, we
considered outcomes of school-level proficiency in reading and math plus attendance and chronic
absences, defined as missing 20 or more days, for grades 3-5 and 6-8 at 158 urban schools.
Characteristics of the environment included school facility conditions, density of nearby roads,
and an index industrial air pollution. Perceptions of school safety, learning, and institutional
environment were acquired from a School Climate Survey. Also considered were neighborhood
factors at the community statistical area, including demographics, crime, and poverty based on
school location. Poisson regression adjusted for over-dispersion was used to model academic
achievement and multiple linear models were used for attendance. Each 10-unit change in facility
condition index, denoting worse quality buildings, was associated with a decrease in reading
Author Manuscript

(1.0% (95% CI: 0.1-1.9%) and math scores (0.21% (95% CI: 0.20-0.40), while chronic absences
increased by 0.75% (95% CI: 0.30-1.39). Each log increase the EPA’s Risk Screening
Environmental Indicator (RSEI) value for industrial hazards, resulted in a marginally significant
trend of increasing absenteeism (p<0.06), but no association was observed with academic
achievement. All results were robust to school-level measures of racial composition, free and
reduced meals eligibility, and community poverty and crime. These findings provide empirical
evidence for the importance of the community and school environment, including building
conditions and neighborhood toxic substance risk, on academic achievement and attendance.

Keywords
absenteeism; academic achievement; air pollution; chronic absence; facility condition; schools
Author Manuscript

Introduction
An estimated 35.4 million prekindergarten through 8th grade students will spend the
majority of their day attending U.S. public schools (NCES 2016). While near home
environmental conditions (Diette et al. 2007) and neighborhood characteristics (Viner et al.
2012) may impact childhood health, the conditions at schools have been shown to affect
both health and learning potential, causing long-term impacts on future opportunities
(Durán-Narucki 2008). Ambient air pollution (Gilliland et al. 2001; Mohai et al. 2011; Park
et al. 2002; Sheehan et al. 2017), building conditions (Evans et al. 2010; Mendell and Heath
2005; Simons et al. 2010), perceptions of school safety and environment (Durham et al.
2014; Wang et al. 2014; Bosworth et al. 2011; Milam et al. 2010), and community factors
(Bowen and Bowen 1999; Eamon 2005; Milam et al. 2010) have all been associated with
Author Manuscript

declines in academic performance and increases in absenteeism among children.

Consideration of school-level exposures is critical in evaluating adolescent health and the

downstream effects that health may have on school performance. As a subpopulation,
children are of particular concern; their smaller size, combined with still developing
respiratory and neurological systems makes them physiologically vulnerable to chemical
exposures (Gauderman et al. 2007; Legot et al. 2012). Near-school industrial hazards and

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 3

traffic pollutants pose substantial risk and have been connected with developmental,
Author Manuscript

reproductive, neurological, immunologic, respiratory, and hematological morbidities (Freire

et al. 2010; US EPA 2013). Many chemicals may be causally linked to multiple outcomes
making it possible for a single toxin to drive several health effects (Legot et al. 2012).
However, despite these risks, regulations regarding the siting of schools are limited. Twenty
states lack legislation for siting schools and only 10 states prohibit new schools from being
located near hazardous activities (Gaffron and Niemeier 2015).

Research investigating the effects of industrial pollutants on school children has been a topic
of growing interest. Studies in the United States and Asia have found that exposure to
industrial air pollution and Toxic Release Inventory (TRI) sites are associated with declines
in academic performance and increased absenteeism among school children (Grineski et al.
2016; Lucier et al. 2011; Makino 2000; Pastor et al. 2004; Rosofsky et al. 2014). Although
published results show consistent trends, most investigations focus on single student
Author Manuscript

populations and outcomes. It has not been effectively demonstrated how school and
community characteristics may influence academic performance and absenteeism within a
single city, and how this might vary by age groups. These factors should be important
considerations for improving academic success and planning the locations of new schools.

The objective of this research was to investigate how ambient environmental conditions and
the school physical environment simultaneously impact academic performance and
absenteeism among students. Primary factors included school building proximity to
roadways, air pollution toxicity from industrial sites, condition of school buildings, surveyed
perceptions of schools safety, teaching, and leadership, and community measures of poverty,
crime, and socio-demographic variables. This study adds to existing ecologic assessments of
school-based exposures, but by incorporating a comprehensive school inspection, multiple
Author Manuscript

community-level factors, and stratifying outcomes by age, it addresses a literature gap

concerning multi-factor relationships with both academic performance and absenteeism.

1. Methods
1.1. Study Population and Overall Design
The study population included Baltimore City public school children in 3rd through 8th
grade. A total of 158 schools were examined using school performance data from the
2013-14 school year provided by the Maryland State Department of Education (MSDE) as
part of their accountability program. Nine of the 158 schools represent alternative programs
and settings to serve special needs students who do not participate in traditional testing and
were excluded from analysis. School environmental data, school climate surveys, and
Author Manuscript

community characteristics were also obtained as part of the analysis.

1.2. Performance Outcome Measures

Academic achievement was evaluated using the Maryland School Assessment (MSA), an
annually administered accountability assessment taken by Maryland 3rd to 8th grade school
children, during the 2013-2014 school year. The number of students taking the exam was
provided for each school, along with the count of students who scored proficient or

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 4

advanced in reading or math as determined by standards set by MSDE as part of No Child

Author Manuscript

Left Behind. It should be noted that 2013-2014 was the last year of the MSA. Transitions
were being made to the Partnership for Assessment of Readiness for College and Careers
assessment with some educators already teaching to those standards. The attendance rate is
an average of daily attendance across the academic year. The chronic absence rate identifies
students who miss more than 20 days of school if enrolled for at least 90 days. Four separate
performance measures were considered: 1) the percentage of students achieving a proficient
or advanced status in reading, 2) the percentage of students achieving a proficient or
advanced status in math, 3) the attendance rate, and 4) the chronic absence rate.

1.3. School Environmental Data

The U.S. EPA Risk-Screening Environmental Indicator (RSEI) for industrial hazards is a
model of toxic substance risk from TRI sites that considers factors of distance to industrial
Author Manuscript

point source, quantity of chemicals released, chemical toxicity, and environmental fate and
transport. Increasing numeric scores represent greater general risk (EPA 2017). Data for the
2014 year RESI were downloaded as 810×810m grids and spatially overlaid with school
locations. Each school location was assigned the value of its underlying toxicity
concentration grid cell, which represents the TRI chemical concentration multiplied by a
toxicity weight. The toxicity weight is based on human health effects from long-term
chemical exposures to the most sensitive oral or inhalation exposure pathway (EPA 2016).
The RSEI serves as an indicator for potential chronic human health impacts due to toxic
releases at nearby industrial facilities.

Physical features and school building characteristics, such as size, condition, utilization, and
educational adequacy, were assessed for all Baltimore City Public Schools in 2012
(Baltimore Board of School Commissioners 2013). Reported values included a facility
Author Manuscript

condition index (FCI) and an educational adequacy score. The FCI is an industry standard
used to evaluate building conditions, comparing the cost of repairs against building
replacement: ≤10% is good condition; 11-30% is average; 31-50% is poor; 51-74% is very
poor; ≥75% is candidate for replacement. The educational adequacy score is a metric that
captures how well the school’s physical structure, technology, and space serves academic
goals. On a 1-100 scale, it is asserted that ≥80 should be the target of a modern building
(Baltimore Board of School Commissioners 2013).

To assess the roadways around school buildings, TIGER/Line Maryland primary and
secondary roads shapefiles from 2013 were downloaded (U. S. Census Bureau 2013). We
considered roads classified in two broad categories: 1) all roads (including highways, major
roads, and city streets), and 2) highways and major roads only. Classifications for pedestrian
Author Manuscript

paths and ‘other’ roads (minor alleys, private roads, parking lot roads) were not considered.
The total length of ‘all roads’ and ‘major roads and highways’ were separately calculated at
100, 200, and 300 meter buffers around each school.

1.4. School Characteristics

A comprehensive list of available school-level variables were acquired through the MSDE
for the 2013-2014 school year ([Link] These included the

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 5

percentage of white students, the percentage of black students, the percentage of students
Author Manuscript

eligible for free and reduced meals (FARMS; used by the district as a proxy for poverty),
and the percent of students enrolled in a special education program at each school (an
indicator of additional academic needs and services which must be supplied by the school).

1.5. School Climate Survey

The Baltimore Education Research Consortium (BERC) used 2012-2013 survey
questionnaire data to align with the five broad areas of school climate as determined by the
National School Climate Center ([Link]): 1) safety - including how well
students and staff understand what is physical and verbal abuse, consistent rule enforcement,
how safe people feel from physical harm, plus safety from verbal abuse, teasing, and
exclusion; 2) teaching and learning - including support of teaching practices, opportunities
to demonstrate skills, academic rigor, support for independent thinking, and atmosphere for
Author Manuscript

dialogue; 3) interpersonal relationships - including respect for diversity and tolerance,

supportive adult relationships with students (expectations for student success, willingness to
listen, personal attention), and social support among students (peer relationships, student
academic help, new student acclimatization); 4) environment - including positive
identification with school participation in school life, the cleanliness, order, and appeal of
facilities; and 5) leadership/staff relations – including a clear administrative vision,
accessible school staff, and positive attitudes among staff to support work and learning.
While surveys were administered to faculty and staff, students, and parents, the faculty and
staff response data were used in the model. Parent surveys were not considered due to low
response rates (~25%); student surveys were not used because the district reduced the
number of survey items to compensate for a separate classroom survey leaving the collected
information much less predictive. In contrast faculty and staff responses were correlated
Author Manuscript

with independent reviews of school performance (Durham et al. 2014). For each of the five
topics, results were presented in terms of the percentage of faculty and staff within each
individual school that ‘Strongly Disagreed,’ ‘Disagreed,’ ‘Agreed,’ or ‘Strongly Agreed,’
with the ‘Agree’ and ‘Strongly Agree’ and ‘Disagree’ and ‘Strongly Disagree’ percentages
aggregated into two variables for analysis. Additional description of survey questions can be
found in Table S1 and the data are publicly available ([Link]
Page/31013).

1.6. Community Characteristics Data

Community-level characteristics were downloaded from the Baltimore Neighborhood
Indicators Alliance Vital Signs website (Baltimore Neighborhood Indicators Alliance 2014).
Vital Signs represents a long running project led by the University of Baltimore of compiled
Author Manuscript

Baltimore City data on Census Demographics, Housing and Community Development,

Children and Family Health, Crime and Safety, Workforce and Economic Development, and
Education for Baltimore City. We investigated 27 variables of potential importance. Data
were aggregated to the community statistical area (CSA), which represent neighborhoods
based on combining 2010 Census tract boundaries. Baltimore City contains 55 CSAs and
values typically represent conditions occurring within neighborhoods (Baltimore
Neighborhood Indicators Alliance 2014). Individual schools were assigned the community-
level characteristic of the CSA in which they reside.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 6

A comprehensive list of all variables considered in this analysis can be found in Table S2 for
Author Manuscript

school-level measures and Table S3 for community-level measures.

1.7. Statistical Analysis

The four performance outcomes of 1) percent of students achieving proficient or advanced
performance in reading, 2) percent of students achieving proficient or advanced performance
in math, 3) attendance rate, and 4) chronic absence rate were assessed. Models were
evaluated separately for each outcome over grades 3 to 5 and for grades 6 to 8. For academic
proficiency of reading and math performance, a negative binomial generalized linear Poisson
regression model (to accommodate statistical over-dispersion) was utilized with an offset
equivalent to the number of students tested at each school. Linear regression was used for
attendance and chronic absence rates.

We initially explored the unadjusted association between the four outcomes and each
Author Manuscript

independent variable. Covariates achieving statistical significance (p<0.05) in these

univariate models were included in the multivariate assessments for those outcomes. To
achieve parsimony, we used variance inflation factors and a forward and backward selecting
stepwise Akaike Information Criteria (AIC) to eliminate collinear variables or those with
limited statistical contribution. We tested for normality of data and outliers using Q-Q plots
and Cook’s distance metrics. One overly influential school from the grades 6 to 8 attendance
and chronic absence rates model was removed. Variables failing to achieve a p-value of 0.1
were removed from the model, followed by a final selection of variables achieving p<0.05.

We adjusted for the confounding effect of older students by classifying schools as

elementary grades only (K-5), elementary and middle school grades (K-8), middle school
grades only (6-8), and middle school plus high school grades (6-12). The RSEI distribution
Author Manuscript

displayed a strong positive skew and was addressed through a log-transformation. Statistical
computations were performed using the R Statistical software (v. 3.0) with Geographic
Information Systems (GIS) and mapping functions from ‘sp’ and ‘gstat’ packages (R Core
Team 2016).

2. Results
A summary of the school-level characteristics representing elementary and middle school
grades is presented in Table 1. A total of 126 schools were included in the elementary grades
cohort and 91 schools were included in the middle grades cohort. The majority of Baltimore
City public schools contain elementary grades only (K-5) or elementary and middle grades
(K-8). Only 23 schools serve only middle school grades or middle and high school grades.
Author Manuscript

Figure 1 shows a map of school locations by school type and proximity to major roads and
toxic release inventory (TRI) sites.

Reading proficiency averaged 63.0% (13.3% SD) in elementary school grades and 60.7%
(15.4% SD) in middle school grades, while math proficiency was 45.2% (17.4% SD) and
38.6% (18.4% SD) in those same cohorts, respectively. Mean attendance rates were similar
(around 93%) for both grade groups; however, chronic absence rates were 1.4% (4.6% SD)
higher in middle school grades, although not statistically significant. School characteristics

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 7

showed a high percentage of students in elementary grades (88.1%) and middle schools
Author Manuscript

grades (88.4%) eligible for FARMS, while schools served an average of 83% black student
populations. Middle school grades had a significantly higher percentage (21.8%; 13.1% SD)
of students enrolled in special education compared to elementary grades (13.9%; 8.1% SD)
based on a t-test comparison (p<0.05).

The school environment is represented separately through the facility condition index,
educational adequacy score, and RSEI (Figure 2). Three schools met the FCI standard of
‘good condition,’ while 22 were considered ‘average condition.’ The other 122 schools were
rated in ‘poor or worse’ condition with 40 schools scoring as candidates for replacement.
The mean educational adequacy score was around 56, ranging from 17.2 to 68.7. No schools
achieved the ≥80 educational adequacy score target for a modern building. The mapped
RSEI showed a strong trend of increasing risk toward southeast Baltimore, where TRI sites
are clustered around the Port of Baltimore (Figure 1). RSEI values were heavily right-
Author Manuscript

skewed with the Curtis Bay and Bay Brook area schools; these are located at the southern
end of the city and have scores 5-times higher than the average of all other schools.

Figure 3 shows the spatial variation of four significant community level variables, including
teen births and measures of crime and poverty. Spatial trends are apparent. The north central
portion of the city shows lower community levels of poverty and crime, while the CSAs with
the greatest poverty appear clustered around the downtown central area of the city. West
Baltimore shows higher number of homicides, while arrests are greatest in the central part of
the city.

Out of 52 initial variables examined (Tables S3–S6), we found 42 to be statistically

significant in unadjusted models. The distance of school buildings to ‘all roads’ and ‘major
Author Manuscript

roads and highways’ were not significant and excluded from further consideration in the
multivariate assessment. Results from the multivariate models are reported in Tables 2 and 3
and represent only those covariates showing statistically significant associations.

School environment and neighborhood characteristics were associated with academic

performance. Worsening school environment (facility condition index), increased perception
of unsafe schools, increased special education population, and higher teen birth rates at the
community level were associated with decreased academic performance, based on reading
and math performance at the elementary grade level (Table 2A). When schools contained
both elementary and middle school grades, as opposed to elementary grades only, math
performance decreased by 10.64% (estimated effect change −10.64%, 95% CI: −19.24,
−1.14) and reading performance decreased by 5.44% (estimated effect change −5.44%, 95%
CI: −9.95, −0.70) among the elementary grade level students. For middle school students,
Author Manuscript

higher attendance rates and better school facilities (educational adequacy scores) increased
academic performance (Table 2B). However, greater student eligibility for FARMS, higher
perception of poor teaching/learning, and greater numbers of community teen births
decreased academic performance. Similar to younger students, middle school grades in
schools with older students showed decreases in reading and math performance. In schools
that contained both middle and high school grades, we found middle school math scores to

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 8

decrease by 38.44% (estimated effect change −38.44% 95% CI: −48.37, −26.44) and reading
Author Manuscript

scores to decrease by 12.05% (estimated effect change −12.05%, 95% CI: −18.38, −5.26).

School environment and safety were associated with attendance rates and chronic absences,
which may be a surrogate for health (Table 3A and 3B). For each 10% increase in the
surveyed perception of unsafe schools, attendance rates decreased by −0.75% (95% CI:
−1.01, −0.48) and −1.69% (95% CI −2.69, −0.69) for elementary and middle school grades
respectively, while chronic absences increased by 3.61% (95% CI: 2.33, 4.90) and 8.09%
(95% CI: 4.95, 11.24). Associations with the EPA RSEI value found chronic absences to
increase by 3.40% (95% CI: −0.08, 6.76) in elementary grades for each log increase in RSEI
and 8.09% (95% CI: 4.95, 11.24) in middle school grades. These results represent strong
trends and approached statistical significance (p<0.06). Poor attendance and higher chronic
absences were associated with additional factors including worse facilities, increasing
poverty, and higher crime, notably among the elementary grade cohort. Our final model was
Author Manuscript

able to explain 46% and 29% of variability in attendance rate and 45% and 38% of
variability in chronic absence rates among elementary and middle school grades
respectively.

3. Discussion
Our study found that school building conditions, physical environment, and community
factors were associated with academic performance among elementary and middle school
children in the mid-Atlantic region. We observed building conditions, industrial pollutant
levels, school safety, and neighborhood crime to significantly impact student absenteeism.
We did not observe proximity to roadway types of any kind to be associated with
performance or absences. These results suggest that industrial toxins may play a more
Author Manuscript

critical role in absenteeism compared to academic achievement, while school facilities,

student safety, community crime, and poverty are important predictors of both outcomes. By
incorporating a variety of school- and community-level characteristics, this study applies a
multi-factor assessment to extend inference about how children’s environmental exposures
impact academic achievement and health.

Poor air quality has been associated with increased incidence of acute illnesses that drive
higher absenteeism among children (Grineski et al. 2016; Mohai et al. 2011; Pastor et al.
2004; Rosofsky et al. 2014). Consistent with these studies, our investigation found similar
associations between industrial pollutant exposure and absenteeism, even after controlling
for school and community-level factors. Industrial air pollution poses a particular health risk,
as it may contain particles, heavy metals, and volatile organic compounds (Kampa and
Castanas 2008). It is hypothesized that student populations will have worse health when
Author Manuscript

located in communities with higher RSEI values. However our study relied on aggregated
school data and so it could not be determined if individual absences were due to respiratory-
related morbidity or other causes. High industrial air pollution may also drive parental
avoidance behavior, even without acute health events, causing further school absences
among asthmatics and children with chronic respiratory illnesses (Currie et al. 2009; Lucier
et al. 2011).

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 9

While we observed industrial pollutants to increase absenteeism, we did not find an

Author Manuscript

association with academic performance. This is in contrast to prior research (Mohai et al.
2011; Rosofsky et al. 2014). In communities with high volume industrial pollution, the
presence of neurotoxins, developmental toxins, and heavy metals were found to lower
academic potential by limiting cognitive development (Legot et al. 2012). In El Paso, Texas
each IQR increase in hazardous air pollution resulted in a 0.40 (95% CI: 0.64, 0.17) decrease
in grade point average, with associations between TRI sites and reduced academic
performance observed in Louisiana and Texas (Lucier et al. 2011; Pastor et al. 2004). It is
possible that the schools in our study are not proximally located to industrial sites that
produce toxins specific to developmental disorders. Instead academic performance may be
driven by perceptions of school-safety, building conditions, or community crime, which are
control variables unique to our study. Another consideration is that the industrial pollution
effects are already accounted for in a model that includes absenteeism, which is strongly
Author Manuscript

correlated with student performance.

Multiple studies have identified the importance of not only industrial pollutants, but also
ambient air pollution on academic performance and absences (Chen et al. 2000; Gilliland et
al. 2001; Park et al. 2002). A constraint on our assessment was a lack of measurable
pollution data. We did not sample ambient air pollution at school sites for these years. While
two central site air pollution monitors exist in Baltimore City, these do not provide sufficient
information to evaluate variability between schools. As a surrogate we used the proximity of
roads and road density to account for traffic-related air pollution exposure (Brauer et al.
2003; Gauderman et al. 2007). It has been demonstrated that distance to roadways shows
greater risk for mortality, respiratory morbidity, and cognitive development compared to
background air pollution concentrations (Sunyer et al. 2015; Freire et al. 2010; Kim et al.
2004; Hoek et al. 2002). However, our investigation did not find roadway density to be
Author Manuscript

associated with either school absences or academic achievement. Baltimore schools

averaged a total road length of nearly 5.9km (IQR: 4.3, 7.1) within 300m of buildings. This
high near-school road density, combined with multiple industry sources, may make
roadways an inadequate measure of air pollution exposure for this region.

Another finding is that facility conditions and potentially indoor air quality (Mendell and
Heath 2005) are having a larger impact on student performance and absenteeism. We found
77% of Baltimore school facilities to be characterized as ‘poor or worse’ conditions and no
buildings were considered adequate for educational activities. The presence of poor
ventilation, mouse or cockroach allergens, and deficient classrooms were all found to reduce
attendance and impede educational performance, especially in schools from lower SES
districts and among younger students (Sheehan et al. 2017; Simons et al. 2010). Penetration
Author Manuscript

of outdoor air pollutants into the indoor school environment has been demonstrated in other
settings (Rivas et al. 2014) and is highly likely in Baltimore, where open windows often
compensate for variable heating and inadequate cooling.

Beyond environmental associations, several broad relationships were observed between

academic and absenteeism outcomes and community and school-level factors. Our study
area is an urban region with neighborhoods characterized by high crime and poverty. Prior
research has shown that both community violence and perceptions of safety can decrease

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 10

academic achievement (Bowen and Bowen 1999; Milam et al. 2010; Durham et al. 2014).
Author Manuscript

Our study found worse perceptions of school safety and community crime to be major
contributors to increased absences for all grades. Milam et al. (2010) argued that students
who fear for their safety at or while walking to school will have a compromised ability to
focus on academics and are more likely to stay at home. We further found school safety
related to decreased academic performance in elementary grades. Similar findings were
identified in a cohort of 5th grade students, where each point in declining school-level
climate and self-reported peer victimization, was related to a 1-point decrease in GPA (Wang
et al. 2014). An additional confounder for academic performance was our finding of
decreasing academic achievement in schools containing older students. This is consistent
with findings that older students are more likely to perpetuate risky behavior, including
smoking, drinking, and drug use, which lead to negative academic and developmental
outcomes (Brand et al. 2003).
Author Manuscript

There are several limitations to our study. Our analysis did not account for the potential
impacts of school turnover, which have been associated with lowered academic performance
(Alexander and Entwisle 1996). Schools with high pupil turnover will experience worse
academic scores and higher absenteeism due to these disruptive events. Alternatively,
misclassification of school and community-level confounders may occur if students take
proficiency exams in one school, but attended a different school for most of the year.
However, only 3.5% of students were not tested at their school. Of that group we have
information on the other school only for students who remained in the district, which is less
than half on average. Without information on the old and new schools attended, we are
limited in our ability to assess whether school exposures were different. A second concern is
that as an ecologic study, we cannot investigate the influence of individual-level factors on
academic performance and absenteeism, such as family education and home environment on
Author Manuscript

academic performance and absenteeism. Our assessment relies on aggregated data, at the
school or community level, which potentially misclassifies exposure. This may be
pronounced for schools located on the edge of CSA boundaries. However, the use of
aggregated data is common due to the ease of data acquisition and the importance of
maintaining personal privacy. Furthermore, Baltimore school children typically attend
schools close to their homes with this relationship being pronounced in younger students.
School-level community factors will have a likelihood of representing conditions typical at
individual homes, while our inclusion of a reduced school lunch variable can be used as a
proxy for low-income (Morrissey et al. 2014).

A third limitation is that environmental data is incomplete. Baltimore City has limited air
monitoring stations and measures such as the EPA’s RSEI have fairly large spatial
Author Manuscript

resolution, so exposure assessments may fail to capture small-scale differences at nearby

schools. Our investigation may also overlook environmental exposures important to
childhood health. Heavy metals, particularly lead, have been associated with deficiencies in
intellectual and academic performance(Bellinger et al. 1992; Mielke et al. 2005). However,
in the absence of biomarker data, their impact on the Baltimore City cohort could not be
assessed.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 11

Conclusions
Author Manuscript

Numerous factors influence the academic performance and absenteeism of school children,
including the environment, building conditions, safety, teaching, and the surrounding
community. Our findings suggest that the condition of school buildings and perceptions of
safety strongly influenced both academic performance and absenteeism. Industrial toxins
were associated with an increase in absences, but were not linked with reduced academic
performance. Healthy school environments more supportive for learning and development
can be promoted through investment in building infrastructure and safety measures. Siting
new schools in areas less impacted by industrial sources of pollution and by modifying
existing schools to better meet academic needs will foster improved environmental health
with long-term developmental benefits for adolescents.

Supplementary Material
Author Manuscript

Refer to Web version on PubMed Central for supplementary material.

Acknowledgements
We would like to thank Tonya Webb, Emily Sherman, the Office of Achievement and Accountability, the Office of
21st Century Buildings, and the rest of Baltimore City Schools for their continued support throughout this project.
We also thank contributing study personnel, including Hannah Braun and Kristoffer Spicer.

This publication was developed under Assistance Agreement No. 83563901 awarded by the U.S. Environmental
Protection Agency to MC McCormack. It has not been formally reviewed by EPA. The views expressed in this
document are solely those of the authors and do not necessarily reflect those of the EPA. The EPA does not endorse
any products or commercial services mentioned in this publication. Additional funding was provided by NIH ORIP
1K01OD019918 (MFD).
Author Manuscript

Abbreviations
BERC Baltimore Education Research Consortium

CSA Community Statistical Area

EPA Environmental Protection Agency

FARMS Free and reduced meals

FCI Facility Condition Index

MSA Maryland School Assessment

MSDE Maryland State Department of Education

Author Manuscript

RSEI Risk-Screening Environmental Indicators

TRI Toxic Release Inventory

References
Alexander KL, Entwisle DR. 1996 Children in motion: School transfers and elementary school
performance. J Educ Res 90: 3.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 12

Baltimore Board of School Commissioners. 2013 21-st Century Buildings for Our Kids: Baltimore
City Public Schools 10-Year Plan.
Author Manuscript

Baltimore Neighborhood Indicators Alliance. 2014 Vital Signs 15. Available: [Link]
vital_signs/ [accessed 13 April 2017].
Bellinger DC, Stiles KM, Needleman HL. 1992 Low-Level Lead Exposure, Intelligence and Academic
Achievement: A Long-term Follow-up Study. Pediatrics 90: 855–861. [PubMed: 1437425]
Bosworth K, Ford L, Hernandaz D. 2011 School Climate Factors Contributing to Student and Faculty
Perceptions of Safety in Select Arizona Schools*. J Sch Health 81:194–201; doi:10.1111/
j.l746-1561.2010.00579.x. [PubMed: 21392011]
Bowen NK, Bowen GL. 1999 Effects of Crime and Violence in Neighborhoods and Schools on the
School Behavior and Performance of Adolescents. J Adolesc Res 14:319–342; doi:
10.1177/0743558499143003.
Brand S, Felner R, Shim M, Seitsinger A, Dumas T. 2003 Middle school improvement and reform:
Development and validation of a school-level assessment of climate, cultural pluralism, and school
safety. J Educ Psychol 95:570–588; doi:10.1037/0022-0663.95.3.570.
Brauer M, Hoek G, van Vliet P, Meliefste K, Fischer P, Gehring U, et al. 2003 Estimating Long-Term
Author Manuscript

Average Particulate Air Pollution Concentrations: Application of Traffic Indicators and Geographic
Information Systems. Epidemiology 14: 228–239. [PubMed: 12606891]
Chen L, Jennison BL, Yang W, Omaye ST. 2000 Elementary school absenteeism and air pollution.
Inhal Toxicol 12:997–1016; doi:10.1080/08958370050164626. [PubMed: 11015140]
Currie J, Hanushek EA, Kahn EM, Neidell M, Rivkin SG. 2009 Does Pollution Increase School
Absences? Rev Econ Stat 91:682–694; doi:10.1162/rest.91.4.682.
Diette GB, Hansel NN, Buckley TJ, Curtin-Brosnan J, Eggleston PA, Matsui EC, et al. 2007 Home
Indoor Pollutant Exposures among Inner-City Children With and Without Asthma. Environ Health
Perspect 115:1665–1669; doi:10.1289/ehp.10088. [PubMed: 18008001]
Durán-Narucki V 2008 School building condition, school attendance, and academic achievement in
New York City public schools: A mediation model. J Environ Psychol 28:278–286; doi:10.1016/
[Link].2008.02.008.
Durham R, Bettencourt A, Connolly F. 2014 Measuring School Climate: Using existing data tools on
climate and effectiveness to inform school organizational health. 38.
Author Manuscript

Eamon MK. 2005 Social-Demographic, School, Neighborhood, and Parenting Influences on the
Academic Achievement of Latino Young Adolescents. J Youth Adolesc 34:163–174; doi:10.1007/
s10964-005-3214-x.
EPA. 2016 RSEI Toxicity Weights. US EPA. Available: [Link]
[accessed 23 March 2018].
EPA O. 2017 Risk-Screening Environmental Indicators (RSEI) Model. Available: https://
[Link]/rsei [accessed 17 April 2017].
Evans GW, Yoo MJ, Sipple J. 2010 The ecological context of student achievement: School building
quality effects are exacerbated by high levels of student mobility. J Environ Psychol 30:239–244;
doi:10.1016/[Link].2010.01.001.
Freire C, Ramos R, Puertas R, Lopez-Espinosa M-J, Julvez J, Aguilera I, et al. 2010 Association of
traffic-related air pollution with cognitive development in children. J Epidemiol Community
Health 64:223–228; doi:10.1136/jech.2008.084574. [PubMed: 19679705]
Gaffron P, Niemeier D. 2015 School Locations and Traffic Emissions — Environmental (In)Justice
Findings Using a New Screening Method. Int J Environ Res Public Health 12:2009–2025; doi:
Author Manuscript

10.3390/ijerph120202009. [PubMed: 25679341]

Gauderman WJ, Vora H, McConnell R, Berhane K, Gilliland F, Thomas D, et al. 2007 Effect of
exposure to traffic on lung development from 10 to 18 years of age: a cohort study. The Lancet
369:571–577; doi:10.1016/S0140-6736(07)60037-3.
Gilliland FD, Berhane K, Rappaport EB, Thomas DC, Avol E, Gauderman WJ, et al. 2001 The effects
of ambient air pollution on school absenteeism due to respiratory illnesses. Epidemiol Camb Mass
12: 43–54.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 13

Grineski SE, Clark-Reyna SE, Collins TW. 2016 School-based exposure to hazardous air pollutants
and grade point average: A multi-level study. Environ Res 147:164–171; doi:10.1016/[Link].
Author Manuscript

2016.02.004. [PubMed: 26875067]

Hoek G, Brunekreef B, Goldbohm S, Fischer P, van den Brandt PA. 2002 Association between
mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet
360: 1203. [PubMed: 12401246]
Kampa M, Castanas E. 2008 Human health effects of air pollution. Environ Pollut 151:362–367; doi:
10.1016/[Link].2007.06.012. [PubMed: 17646040]
Kim JJ, Smorodinsky S, Lipsett M, Singer BC, Hodgson AT, Ostro B. 2004 Traffic-related Air
Pollution near Busy Roads: The East Bay Children’s Respiratory Health Study. Am J Respir Crit
Care Med 170:520–526; doi:10.1164/rccm.200403-281OC. [PubMed: 15184208]
Legot C, London B, Rosofsky A, Shandra J 2012 Proximity to industrial toxins and childhood
respiratory, developmental, and neurological diseases: environmental ascription in East Baton
Rouge Parish, Louisiana. 333–346; doi:10.1007/s11111-011-0147-z.
Lucier C, Rosofsky A, London B, Scharber H, Shandra JM. 2011 Toxic Pollution and School
Performance Scores: Environmental Ascription in East Baton Rouge Parish, Louisiana. Organ
Author Manuscript

Environ 24:423–443; doi:10.1177/1086026611430853.

Makino K 2000 Association of School Absence with Air Pollution in Areas around Arterial Roads. J
Epidemiol 10:292–299; doi:10.2188/jea.10.292. [PubMed: 11059510]
Mendell MJ, Heath GA. 2005 Do indoor pollutants and thermal conditions in schools influence student
performance? A critical review of the literature. Indoor Air 15:27–52; doi:10.1111/j.
1600-0668.2004.00320.x.
Mielke HW, Berry KJ, Mielke PW, Powell ET, Gonzales CR. 2005 Multiple metal accumulation as a
factor in learning achievement within various New Orleans elementary school communities.
Environ Res 97:67–75; doi:10.1016/[Link].2004.01.011. [PubMed: 15476735]
Milam AJ, Furr-Holden CDM, Leaf PJ. 2010 Perceived School and Neighborhood Safety,
Neighborhood Violence and Academic Achievement in Urban School Children. Urban Rev
42:458–467; doi:10.1007/s11256-010-0165-7. [PubMed: 21197388]
Mohai P, Kweon B-S, Lee S, Ard K. 2011 Air Pollution Around Schools Is Linked To Poorer Student
Health And Academic Performance. Health Aff (Millwood) 30:852–862; doi:10.1377/hlthaff.
2011.0077. [PubMed: 21543420]
Author Manuscript

Morrissey TW, Hutchison L, Winsler A. 2014 Family income, school attendance, and academic
achievement in elementary school. Dev Psychol 50:741–753; doi:10.1037/a0033848. [PubMed:
23914750]
NCES. 2016 National Center for Education Statistics. NCES Fast Facts. Available: [Link]
fastfacts/[Link]?id=372 [accessed 13 June 2017].
Park H, Lee B, Ha E-H, Lee J-T, Kim H, Hong Y-C. 2002 Association of Air Pollution With School
Absenteeism Due to Illness. Arch Pediatr Adolesc Med 156:1235–1239; doi:10.1001/archpedi.
156.12.1235. [PubMed: 12444836]
Pastor M, Sadd JL, Morello-Frosch R. 2004 Reading, Writing, and Toxics: Children’s Health,
Academic Performance, and Environmental Justice in Los Angeles. Environ Plan C Gov Policy
22:271–290; doi:10.1068/c009r.
R Core Team. 2016 R: A Language and Environment For Statistical Computing. R Foundation for
Statistical Computing:Vienna, Austria.
Rivas I, Viana M, Moreno T, Pandolfi M, Amato F, Reche C, et al. 2014 Child exposure to indoor and
Author Manuscript

outdoor air pollutants in schools in Barcelona, Spain. Environ Int 69:200–212; doi:10.1016/
[Link].2014.04.009. [PubMed: 24875803]
Rosofsky A, Lucier CA, London B, Scharber H, Borges-Mendez R, Shandra J. 2014 Environmental
ascription in Worcester County, MA: toxic pollution and education outcomes. Local Environ
19:283–299; doi:10.1080/13549839.2013.788485.
Sheehan WJ, Permaul P, Petty CR, Coull BA, Baxi SN, Gaffin JM, et al. 2017 Association Between
Allergen Exposure in Inner-City Schools and Asthma Morbidity Among Students. JAMA Pediatr
171:31–38; doi:10.1001/jamapediatrics.2016.2543. [PubMed: 27893060]

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 14

Simons E, Hwang S-A, Fitzgerald EF, Kielb C, Lin S. 2010 The Impact of School Building Conditions
on Student Absenteeism in Upstate New York. Am J Public Health 100:1679–1686; doi:10.2105/
Author Manuscript

AJPH.2009.165324. [PubMed: 20634471]

Sunyer J, Esnaola M, Alvarez-Pedrerol M, Forns J, Rivas I, López-Vicente M, et al. 2015 Association
between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School
Children: A Prospective Cohort Study. PLOS Med 12:e1001792; doi:10.1371/[Link].
1001792. [PubMed: 25734425]
U. S. Census Bureau. 2013 TIGER/Line Shapefile. Md Roads. Available: [Link]
dataset/tiger-line-shapefile-2013-state-maryland-primary-and-secondary-roads-state-based-
shapefile [accessed 17 April 2017].
US EPA O. 2013 TRI-Listed Chemicals. US EPA. Available: [Link]
inventory-tri-program/tri-listed-chemicals [accessed 5 July 2017].
Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. 2012 Adolescence and the
social determinants of health. The Lancet 379:1641–1652; doi:10.1016/S0140-6736(12)60149-4.
Wang W, Vaillancourt T, Brittain HL, McDougall P, Krygsman A, Smith D, et al. 2014 School climate,
peer victimization, and academic achievement: Results from a multi-informant study. Sch Psychol
Author Manuscript

Q 29:360–377; doi:10.1037/spq0000084. [PubMed: 25198617]

Author Manuscript
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 15

Highlights
Author Manuscript

• The impact of environment and community on school performance was

assessed

• Exposure to industrial hazards increases absenteeism among school-aged

children

• Building facilities and perceptions of safety impact performance and

absenteeism

• Consideration of school and community factors is important for adolescent

success
Author Manuscript
Author Manuscript
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 16
Author Manuscript
Author Manuscript
Author Manuscript

Figure 1.
Author Manuscript

Distribution of Baltimore City schools (N=158) representing grades 3 through 8. Mapped

background includes community statistical area (CSA) boundaries, major roads and
highways, toxic release inventory (TRI) sites.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 17
Author Manuscript
Author Manuscript

Figure 2.
Mapped Baltimore City Schools (N=158) stratified by facility condition index† (FCI),
educational adequacy scores,‡ and the Risk Screening Environmental Indicator# (RSEI)
value.
† The FCI is an industry standard percentage of building conditions: ≤10% is good

condition; 11-30% is average; 31-50% is poor; 51-74% is very poor; ≥75% is candidate for
replacement.
‡ The educational adequacy score measures how well a school’s physical structure,

technology, and space serves academic goals. On a 1 to 100 scale, lower scores indicate
inadequate buildings and ≥80 is a modern building target. No schools achieved a score
Author Manuscript

higher than 69.

#The EPA Risk Screening Environmental Indicator models risk from industrial toxic release

inventory sites. It considers factors including distance to point source, quantity of chemicals
released, toxicity, and fate and transport. Increasing scores represent greater general risk.
Numeric categories are roughly equivalent to distribution quantiles.
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 18
Author Manuscript
Author Manuscript
Author Manuscript

Figure 3.
Mapped community statistical area (CSA) characteristics in Baltimore City for: number of
Author Manuscript

teen births per 1,000 female teens; percent of households at or below the poverty line; the
number of homicides per 1,000 people; number of adult arrests per 1,000 people.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 19

Table 1.

School-level summary statistics of Baltimore City schools academic performance, school-environment,

Author Manuscript

characteristics, surveyed performance, and community characteristics (2013-2014 academic year)

School Statistics School Variable Grades 3-5 Grades 6-8

Mean (SD) Mean (SD)

Performance Measures † 63.0% (13.3) 60.7% (15.4)
Reading Proficiency (%)

† 45.2% (17.4) 38.6% (18.4)

Math Proficiency (%)

Attendance Rate 93.0% (1.7) 92.6% (3.4)

†† 16.6% (8.1) 18.0% (12.7)

Chronic Absence Rate

School Environment ‡ 61.5 (26.1) 55.5 (25.8)

Facility Condition Index (FCI)

‡ 56.0 (7.8) 55.4% (9.0)

Educational Adequacy Score
Author Manuscript

# 3,547 (2,099) 3,716 (2,363)

Risk Screening Environmental Indicator (RSEI)
Length of All Roads (m) within 100m of School 671.5 (243.0) 620.8 (227.2)

Length of Highways or Major Roads (m) within 100m of School 82.2 (214.0) 50.9 (171.2)

School Characteristics Free/Reduced Meals Eligible 88.1% (14.5) 88.4% (10.9)

% of Students Enrolled in Special Education 13.9% (8.1) 21.8% (13.1)

% Black Students 84.3% (23.1) 82.8% (23.7)

‡‡ School Safety - Disagree 21.2% (9.8) 22.3% (10.0)

School Climate Survey

Teaching and Learning - Disagree 14.8% (7.0) 15.5% (7.1)

Leadership and Staff Relations - Disagree 18.1% (9.4) 19.4% (9.7)

School Type (Count, % total) Elementary Grades Only 52 (41.3%) -

Elementary + Middle Grades 74 (58.7%) 68 (74.7%)

Author Manuscript

Middle Grades Only - 8 (8.8%)

Middle Grades + High School - 15 (16.5%)

§ CSA Teen Birth Rate (per 1,000 female teens) 38.8 (21.7) 37.7 (21.8)
Community Characteristics

CSA % Adults on Probation/Parole 6.3% (3.2) 5.8% (3.1)

CSA % Family Households below the Poverty Line 21.6% (11.2) 20.9% (12.1)

CSA Gun Homicides Rate (per 1,000 residents) 0.3 (0.2) 0.3 (0.2)

CSA Adult Arrests Rate (per 1,000 adults) 58.6 (43.0) 51.8 (38.2)

CSA Juvenile Drug Arrest Rate (per 1,000 juveniles) 34.2 (32.1) 28.3 (28.5)

§§ 33.9 (22.8) 37.5 (23.1)

CSA Racial Diversity Index

CSA % Female Headed Households 56.0% (15.6) 54.2% (17.0)

CSA % Vacant/Abandoned Houses 9.9% (11.1) 7.6% (9.5)

Author Manuscript

†
Denotes the percentage of students performing at a proficient or advanced level based on standardized reading and mathematics testing
‡
FCI is a percentage representing building conditions with lower scores representing better conditions and higher scores representing greater need
for building replacement. Educational adequacy scores represent how well a facility meets academic needs with lower scores representing
inadequate buildings.

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 20

#
The RSEI is an EPA modeled value of chemical risk from industrial toxic release inventory (TRI) sites. Higher scores indicate greater risks.
††
The percent of students missing 20 or more days during a school year
‡‡
Surveyed data from the Baltimore Education Research Consortium showing the percent of faculty that disagree with school safety, teaching and
Author Manuscript

learning, or leadership and staff relations.

§
Represents Neighborhood Indicators Alliance Vital Signs data for community statistical area characteristics at each schools location.
§§
Racial diversity index ranges from 0 to 100, where 0 represents no diversity and 100 represents total diversity.
Author Manuscript
Author Manuscript
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 21

Table 2A.

Estimated percent change among students in elementary grades (3-5) achieving proficiency or advanced
Author Manuscript

mathematics or reading scores for each 1-unit change in school and community level variables.

Mathematics Reading

School and Community Variables Estimate (95% CI) p-value Estimate (95% CI) p-value

Facility Condition Index −0.21% (−0.40, −0.02) <0.05 −0.10% (−0.19, −0.01) <0.05

% of students in special education −1.89% (−2.98, −0.91) <0.001 −0.95% (−1.54, −0.38) <0.001

% Eligible for free/reduced meals - NS −0.27% (−0.44, −0.09) <0.05

% perception of unsafe schools −2.27% (−2.76, −1.77) <0.001 −1.09% (−1.33, −0.84) <0.001

School-Type
Author Manuscript

† Ref - Ref -
Elementary Grades only
Elementary and Middle Grades −10.64% (−19.24, −1.14) <0.05 −5.44% (−9.95, −0.70) <0.05

CSA Teen Birth Rate −0.33% (−0.55, −0.12) <0.05 −0.23% (−0.33, −0.12) <0.001

‡ −3.02% (−4.28, −1.47) <0.001 - NS

CSA Gun related homicide rate

CSA Racial Diversity Index - NS 0.17% (0.08, 0.27) <0.001

NS denotes non-significance and exclusion from the final model for that outcome
†
Represents the reference group (Ref) for school-type categories (elementary and junior high grades)
‡
Based on a 0.1 change in the number of gun related homicides per 1,000 people at the CSA level
Author Manuscript
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 22

Table 2B.

Estimated percent change in middle school grades (6-8) achieving proficiency or advanced mathematics or
Author Manuscript

reading scores for each 1-unit change in school and community level variables.

Mathematics Reading

School and Community Variables Estimate (95% CI) p-value Estimate (95% CI) p-value

Attendance Rate 4.53% (1.56, 7.66) <0.05 2.16% (0.96, 3.40) <0.001

Facility Condition Index - NS −0.10% (−0.20, 0.01) 0.07*

Educational adequacy score 0.85% (0.07, 1.61) <0.05 0.40% (0.10, 0.70) <0.05

% Eligible for free/reduced meals −0.86% (−1.67, −0.07) <0.05 −0.47% (−0.77, −0.17) <0.05

% Black Students - NS −0.12% (−0.22, −0.01) <0.05

Author Manuscript

% perception of poor teaching and learning −2.60% (−3.53, −1.64) <0.001 −1.22% (−1.62, −0.81) <0.001

School-Type
† Ref - Ref -
Elementary and Middle Grades
Middle Grades Only −24.08% (−39.72, −3.53) <0.05 −11.85% (−20.19, −2.69) <0.05
Middle Grades and HS −38.44% (−48.37, −26.44) <0.001 −12.05% (−18.38, −5.26) <0.001

CSA Teen Birth Rate −0.32% (−0.67, 0.03) <0.10* −0.22% (−0.36, −0.09) <0.001

‡ −3.70 (−5.34, −1.47) <0.05 - NS

CSA Number of Gun Homicides

CSA Number of Juvenile Drug Arrests - NS 0.28% (0.11, 0.45) <0.001

Author Manuscript

CSA % Vacant Housing - NS −1.16% (−1.67, 0.64) <0.001

NS denotes non-significance and exclusion from the final model for that outcome
*
Marginal statistical significance
†
Represents the reference group (Ref) for school-type categories
‡
Based on a 0.1 change in the number of gun related homicides per 1,000 people at the CSA level
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 23

Table 3A.

The estimated change in attendance rate and chronic absence rate (e.g. missing 20 or more days per year)
Author Manuscript

among elementary school students for each 10-unit increase in school and community level variables.

Attendance Rate Chronic Absence Rate

School and Community Variables Estimate (95% CI) p-value Estimate (95% CI) p-value
Facility Condition Index −0.16% (−0.25, −0.07) <0.001 0.75% (0.30, 1.19) <0.001

† - NS 3.40% (−0.08, 6.76)* <0.06

RSEI Value

% perception of unsafe schools −0.75% (−1.01, −0.48) <0.001 3.61% (2.33, 4.90) <0.001

CSA % Households Below the Poverty Line −0.37% (−0.59, −0.14) <0.001 1.95% (0.47, 3.43) <0.05

CSA Arrest Rate - NS −0.57% (−1.01, −0.13) <0.05

‡ - NS 0.83% (0.22, 1.43) <0.05

CSA Number Gun Related Homicides

NS denotes non-significance and exclusion from the final model for that outcome
Author Manuscript

*
Marginal statistical significance
†
Based on a log increase in RSEI value at school locations
‡
Based on a 0.1 change in the number of gun related homicides per 1,000 people at the CSA level
Author Manuscript
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.
 Berman et al. Page 24

Table 3B.

The estimated change in attendance rate and chronic absence rate (e.g. missing 20 or more days per year)
Author Manuscript

among middle school students for each 10-unit increase in school and community level variables.

Attendance Rate Chronic Absence Rate

School and Community Variables Estimate (95% CI) p-value Estimate (95% CI) p-value
† −1.15% (−1.98, −0.31) <0.05 3.57% (−0.21, 7.27)* <0.06
RSEI Value

% perception of unsafe schools −1.69% (−2.69, −0.69) <0.001 8.09% (4.95, 11.24) <0.001

% perception of negative school environment 1.11% (−0.06, 2.28)* <0.07 - NS

% perception of poor leadership and staff relations - NS −3.90% (−7.16, −0.64) <0.05

NS denotes non-significance and exclusion from the final model for that outcome
*
Marginal statistical significance
†
Author Manuscript

Based on a log increase in RSEI value at school locations

Author Manuscript
Author Manuscript

Int J Hyg Environ Health. Author manuscript; available in PMC 2019 June 01.