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Original research
Longitudinal relationships between early-life homelessness and school-aged asthma and wheezing
  1. Ryan Keen1,2,
  2. Hannah Hayoung Kim1,
  3. Jarvis T Chen1,
  4. Henning Tiemeier1,
  5. Megan T Sandel3,
  6. Christy Denckla4,
  7. Natalie Slopen1
  1. 1 Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Boston Medical Center, Boston, Massachusetts, USA
  4. 4 Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Ryan Keen, Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA; ryankeen{at}g.harvard.edu

Abstract

Background Homelessness is a disruptive life event with profound impacts on children’s health. It remains unclear, however, whether homelessness in early life has an enduring association with asthma and wheezing among school-aged children.

Objective To test whether early-life homelessness is prospectively associated with asthma and wheezing during school-aged years.

Methods We draw on data from 9242 children from the Avon Longitudinal Study of Parents and Children. Children were categorised as ‘ever’ or ‘never’ homeless based on maternal reports from the prenatal period through age 5 years. Children were assigned a binary indicator of asthma/wheezing based on maternal reports of asthma and wheezing at ages 6.8, 7.6 and 8.6 years. We used multilevel logistic regression models to test the association of interest in both bivariate analyses and models adjusted for a broad set of potential confounders. We conducted sensitivity analyses using generalised estimating equations and considering asthma and wheezing separately to test the robustness of the results.

Results Between 12.1% and 14.3% of children had asthma or wheezing at ages 6.8, 7.6 and 8.6 years, and these conditions were more common among ever homeless participants. Ever-homeless children displayed higher odds of asthma or wheezing than never-homeless children (OR: 1.59, 95% CI 1.02 to 2.48) after adjustment for child, maternal and household risk factors. Sensitivity analyses yielded similar results.

Conclusion Early-life homelessness is prospectively associated with asthma and wheezing among school-aged children and should be prioritised by interventions promoting healthy child development.

  • ASTHMA
  • HOMELESS PERSONS
  • CHILD HEALTH
  • LONGITUDINAL STUDIES
  • HOUSING

Data availability statement

Data may be obtained from a third party and are not publicly available. Access to Avon Longitudinal Study of Parents and Children data is through a system of managed open access (http://www.bristol.ac.uk/alspac/researchers/access/).

https://doi.org/10.1136/jech-2024-222028

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Access to Avon Longitudinal Study of Parents and Children data is through a system of managed open access (http://www.bristol.ac.uk/alspac/researchers/access/).

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    Footnotes

    • Contributors RK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: RK, HHK, JTC, MTS, HT, NS. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: RK, HHK, NS. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: RK, HHK, JTC. Obtained funding: RK, HHK, NS, CD. Supervision: JTC, MTS, HT, NS.

    • Funding The primary funding source for this study is provided by the UK Medical Research Council and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol. This publication is the work of the authors and will serve as guarantors for the contents of this paper. A comprehensive list of grant funding is available on the ALSPAC website. Partial funding for this specific research was provided by the Initiative on Health and Homelessness at the Harvard T.H. Chan School of Public Health (no grant/award number) and by the Center on the Developing Child at Harvard University (no grant/award number).

    • Competing interests HT reported receiving funding from the NICHD, the National Institute of Environmental Health Sciences and the Dutch Medical Research Council outside the submitted work. MTS reported receiving non-financial support from and serving as an unpaid board member of Enterprise Community Partners and the National Low Income Housing Coalition. RK reported serving as an unpaid board member of the Stanford Housing Equity Project. No other disclosures were reported.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.