Social environment and asthma: associations with crime and No Child Left Behind programmes

Background The relationship between asthma and socio-economic status remains unclear. The authors investigated how neighbourhood, school and community social environments were associated with incident asthma in Southern California schoolchildren. Methods New-onset asthma was measured over 3 years of follow-up in the Children's Health Study cohort. Multilevel random-effects models assessed associations between social environments and asthma, adjusted for individual risk factors. At baseline, subjects resided in 274 census tracts (ie, neighbourhoods) and attended kindergarten or first grade in one of 45 schools distributed in 13 communities throughout Southern California. Neighbourhoods and communities were characterised by measures of deprivation, income inequality and racial segregation. Communities were further described by crime rates. Information on schools included whether a school received funding related to the Title 1 No Child Left Behind programme, which aims to reduce academic underachievement in disadvantaged populations. Results Increased risk for asthma was observed in subjects attending schools receiving Title I funds compared with those from schools without funding (adjusted HR 1.71, 95% CI 1.14 to 2.58), and residing in communities with higher rates of larceny crime (adjusted HR 2.02, 95% CI 1.08 to 3.02 across the range of 1827 incidents per 100 000 population). Conclusions Risk for asthma was higher in areas of low socio-economic status, possibly due to unmeasured risk factors or chronic stress.