title: Disparity in the availability of injectable epinephrine in a large, diverse US school district.
abstract: BACKGROUND
  Food allergies affect 2.5% of the US population. Results of studies show that minorities have the highest prevalence of food allergies. The Houston Independent School District (HISD) has an urban, socioeconomically diverse population and the role of ethnicity and socioeconomic status (SES) with availability of epinephrine has not been explored in this population.
  
  
  OBJECTIVE
  This study sought to understand the association of SES and the presence of epinephrine in urban schools.
  
  
  METHODS
  A 6-item questionnaire about food allergy characteristics was sent by e-mail to one nurse per elementary school in the HISD to identify the number, characteristics and treatment of food allergic reactions, and the presence of epinephrine injectors. The reactions and presence of injectors were assessed for the previous school year. Schools were categorized by socioeconomic variables as "low" or "non-low" based on National School Lunch Program student participation. Poisson, logistic, and linear regression analyses were used for group comparisons.
  
  
  RESULTS
  One or more children with food allergies were reported in 97% of responding schools, but only 43% of schools reported having epinephrine injectors. A larger number of injectors in schools were associated with students of higher SES (r(2) = 0.701; P < .001). There were 6 times more injectors in non-low SES schools than in low SES schools (P < .03). Low SES and limited English proficiency were associated with decreased epinephrine injectors in schools.
  
  
  CONCLUSIONS
  In the HISD, epinephrine injectors were more likely to be found in non-low SES schools versus low SES schools. Because minority students are disproportionately highly represented in low SES schools, there appears to be a disparity in the availability of injectable epinephrine for minority students in HISD schools.
authors.affiliation: Department of Pediatrics, Allergy and Immunology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
authors.forename: Sweta S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Department of Epidemiology, Baylor College of Medicine, Houston, Tex.
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
authors.forename: E
authors.initials: E
authors.lastname: O'Brian Smith
authors.affiliation: Department of Pediatrics, Allergy and Immunology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex. Electronic address: cmdavis@texaschildrenshospital.org.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Davis
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D002648:Child; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007267:Injections; D008297:Male; D012572:School Health Services / Q000706:statistics & numerical data*; D012573:School Nursing / Q000379:methods* / Q000706:statistics & numerical data; D012574:Schools; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013781:Texas; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000316:Adrenergic alpha-Agonists; D004837:Epinephrine
keywords: Epinephrine; Food allergy; School; Socioeconomic status