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Social environment and asthma: associations with crime and No Child Left Behind programmes
  1. Ketan Shankardass1,2,
  2. Michael Jerrett3,
  3. Joel Milam2,
  4. Jean Richardson2,
  5. Kiros Berhane2,
  6. Rob McConnell2
  1. 1Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
  2. 2Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  3. 3School of Public Health, Division of Environmental Health Science, University of California, Berkeley, California, USA
  1. Correspondence to Dr Rob McConnell, 1540 Alcazar Street, Suite 236 CHP 236, 9013 Los Angeles, CA 90089-9013; rmcconne{at}


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.

  • Asthma
  • multilevel models
  • socio-economic
  • air pollution

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  • Funding This work was supported by the National Institute of Environmental Health Sciences (grant numbers 5R03ES014046-02, 1R01 ES016535, 5P01ES009581, 5P01ES011627, and 5P30ES007048); the US Environmental Protection Agency (grant numbers R831845, RD831861 and R826708); the National Cancer Institute (grant number 1U54CA116848-01); the Hastings Foundation; and the Canadian Institutes of Health Research.

  • Competing interests None.

  • Patient consent Obtained from the parents.

  • Ethics approval Ethics approval was provided by the University of Southern California IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.