BMJ Open (Jun 2025)

Residing in a low-income-low-food-access neighbourhood and asthma in early and middle childhood in the Environmental influences on Child Health Outcomes (ECHO) program: a multisite cohort study

  • ,
  • Yeyi Zhu,
  • Emily A Knapp,
  • Li Luo,
  • Carlos A Camargo,
  • Maria Gloria Dominguez-Bello,
  • Holly B Schuh,
  • Kohei Hasegawa,
  • Qi Zhao,
  • T Michael O’Shea,
  • Irva Hertz-Picciotto,
  • Aruna Chandran,
  • Margaret R Karagas,
  • Diane R Gold,
  • Ronald Gangnon,
  • Wei Perng,
  • John Ainsworth,
  • Zhaozhong Zhu,
  • David Cella,
  • Jo Wilson,
  • Courtney K. Blackwell,
  • Annemarie Stroustrup,
  • Andrea Aguiar,
  • Antonella Zanobetti,
  • Judy Aschner,
  • Heike Luttmann-Gibson,
  • Dana Dabelea,
  • Jennifer Check,
  • Brenda Poindexter,
  • Sara B. DeMauro,
  • Codruta Chiuzan,
  • Manuel Jiménez,
  • Michelle Hernandez,
  • Richard Gershon,
  • Young Shin Kim,
  • Emily Oken,
  • Carmen J Marsit,
  • Leonardo Trasande,
  • Priya Duggal,
  • Izzuddin M Aris,
  • Tebeb Gebretsadik,
  • Monica Mcgrath,
  • Ganesa Wegienka,
  • Emily Ho,
  • Aaron Hamvas,
  • Andrea Cassidy-Bushrow,
  • Kun Lu,
  • Soma Datta,
  • Sheryl Magzamen,
  • Robert A. Wood,
  • Elaine Symanski,
  • Sheela Sathyanarayana,
  • Rachel L Miller,
  • Carrie Breton,
  • Karen Young,
  • Nigel Paneth,
  • John A. McLean,
  • Assiamira Ferrara,
  • Scott T. Weiss,
  • Augusto A. Litonjua,
  • Linda Adair,
  • L Kristin Newby,
  • Amanda Thompson,
  • Frank Gilliland,
  • Barry M Lester,
  • Michelle L. Macy,
  • Catherine J Karr,
  • Carole Ober,
  • Jean M Kerver,
  • Kristen Lyall,
  • Nathalie L. Maitre,
  • Tamarra James-Todd,
  • Todd Rosen,
  • Hector Mendez-Figueroa,
  • Sarah Osmundson,
  • Veronica A Wang,
  • Rima Habre,
  • Patrick H Ryan,
  • Jeff Blossom,
  • Amii M Kress,
  • Shohreh F Farzan,
  • Donghai Liang,
  • Leslie D Leve,
  • Deborah H Bennett,
  • Flory L Nkoy,
  • Cindy T McEvoy,
  • P Brian Smith,
  • Lisa P. Jacobson,
  • Diane Catellier,
  • Christian Douglas,
  • Emily Knapp,
  • Amii Kress,
  • Maxwell A. Mansolf,
  • Jin-Shei Lai,
  • Suman R. Das,
  • Jane E. Freedman,
  • Simon A. Mallal,
  • Ravi V. Shah,
  • Meghan H. Shilts,
  • Akram N. Alshawabkeh,
  • Jose F. Cordero,
  • John Meeker,
  • Carlos A. Camargo Jr.,
  • Ashley F. Sullivan,
  • Traci A. Bekelman,
  • Greta Wilkening,
  • Brianna F. Moore,
  • Anne P. Starling,
  • Deborah J. Rinehart,
  • Daphne Koinis-Mitchell,
  • Viren D'Sa,
  • Sean C.L. Deoni,
  • Hans-Georg Mueller,
  • Cristiane S. Duarte,
  • Catherine Monk,
  • Glorisa Canino,
  • Jonathan Posner,
  • Tenneill Murray,
  • Claudia Lugo-Candelas,
  • Anne L. Dunlop,
  • Patricia A. Brennan,
  • Christine Hockett,
  • Amy Elliott,
  • Lisa A. Croen,
  • Monique M. Hedderson,
  • Leonard B. Bacharier,
  • Casper G. Bendixsen,
  • James E. Gern,
  • Diane R. Gold,
  • Tina V. Hartert,
  • Daniel J. Jackson,
  • Christine C. Johnson,
  • Christine L.M. Joseph,
  • Meyer Kattan,
  • Gurjit K. Khurana Hershey,
  • Robert F. Lemanske Jr.,
  • Susan V. Lynch,
  • Rachel L. Miller,
  • George T. O’Connor,
  • Dennis Ownby,
  • Katherine Rivera-Spoljaric,
  • Patrick H. Ryan,
  • Christine M. Seroogy,
  • Anne Marie Singh,
  • Edward M. Zoratti,
  • Shohreh Farzan,
  • Frank D. Gilliland,
  • Deborah H. Bennett,
  • Julie B. Schweitzer,
  • Rebecca J. Schmidt,
  • Janine M. LaSalle,
  • Alison E. Hipwell,
  • Kate E. Keenan,
  • Catherine J. Karr,
  • Nicole R. Bush,
  • Kaja Z. LeWinn,
  • Frances Tylavsky,
  • Kecia N. Carroll,
  • Christine T. Loftus,
  • Leslie D. Leve,
  • Jody M. Ganiban,
  • Jenae M. Neiderhiser,
  • Cindy T. McEvoy,
  • Eliot R. Spindel,
  • Robert S. Tepper,
  • Craig J. Newschaffer,
  • Heather E. Volk,
  • Rebecca Landa,
  • Sally Ozonoff,
  • Joseph Piven,
  • Heather Hazlett,
  • Juhi Pandey,
  • Robert Schultz,
  • Steven Dager,
  • Kelly Botteron,
  • Daniel Messinger,
  • Wendy Stone,
  • Jennifer Ames,
  • Thomas G. O'Connor,
  • Richard K. Miller,
  • Michele R. Hacker,
  • T. Michael O'Shea Jr.,
  • Rebecca C. Fry,
  • Jean A. Frazier,
  • Rachana Singh,
  • Caitlin Rollins,
  • Angela Montgomery,
  • Ruben Vaidya,
  • Robert M. Joseph,
  • Lisa K. Washburn,
  • Semsa Gogcu,
  • Kelly Bear,
  • Julie V. Rollins,
  • Stephen R. Hooper,
  • Genevieve Taylor,
  • Wesley Jackson,
  • Julie Daniels,
  • Michael Msall,
  • Madeleine Lenski,
  • Rawad Obeid,
  • Steven L. Pastyrnak,
  • Elizabeth Jensen,
  • Christina Sakai,
  • Hudson Santos,
  • Jean M. Kerver,
  • Charles J. Barone,
  • Michael R. Elliott,
  • Douglas M. Ruden,
  • Chris Fussman,
  • Julie B. Herbstman,
  • Amy Margolis,
  • Susan L. Schantz,
  • Sarah Dee Geiger,
  • Karen Tabb,
  • Rita Strakovsky,
  • Tracey Woodruff,
  • Rachel Morello-Frosch,
  • Amy Padula,
  • Joseph B. Stanford,
  • Christina A. Porucznik,
  • Angelo P. Giardino,
  • Rosalind J. Wright,
  • Robert O. Wright,
  • Brent Collett,
  • Nicole Baumann-Blackmore,
  • Chris G. McKennan,
  • Matt Altman,
  • Judy L. Aschner,
  • Stephanie L. Merhar,
  • Paul E. Moore,
  • Gloria S. Pryhuber,
  • Mark Hudak,
  • Ann Marie Reynolds Lyndaker,
  • Andrea L. Lampland,
  • Burton Rochelson,
  • Sophia Jan,
  • Matthew J. Blitz,
  • Michelle W. Katzow,
  • Zenobia Brown,
  • Timothy Rafael,
  • Dawnette Lewis,
  • Natalie Meirowitz,
  • Jennifer K. Straughen,
  • Amy Eapen,
  • Alex Sitarik,
  • Kim Woodcroft,
  • Audrey Urquhart,
  • Albert Levin,
  • Tisa Johnson-Hooper,
  • Brent Davidson,
  • Tengfei Ma,
  • Emily S. Barrett,
  • Martin J. Blaser,
  • Daniel B. Horton,
  • Kristy Palomares,
  • Lyndsay A. Avalos,
  • Kelly J . Hunt,
  • Roger B. Newman,
  • Michael S. Bloom,
  • Mallory H. Alkis,
  • James R. Roberts,
  • Sunni L. Mumford,
  • Heather H. Burris,
  • Lynn M. Yee,
  • Antonia F. Olidipo,
  • Andrew S. Haddad,
  • Lisa R. Eiland,
  • Nicole T. Spillane,
  • Kirin N. Suri,
  • Stephanie A. Fisher,
  • Jeffrey A. Goldstein,
  • Leena B. Mithal,
  • Raye-Ann O. DeRegnier,
  • Ruby H.N. Nguyen,
  • Meghan M. JaKa,
  • Abbey C. Sidebottom,
  • Michael J. Paidas,
  • JoNell E. Potter,
  • Natale Ruby,
  • Lunthita Duthely,
  • Arumugam Jayakumar,
  • Isabel Maldonado,
  • Meghan Miller,
  • Jonathan L. Slaughter,
  • Sarah A. Keim,
  • Courtney D. Lynch,
  • Kartik K. Venkatesh,
  • Kristina W Whitworth,
  • Thomas F. Northrup,
  • Ricardo A. Mosquera,
  • Margaret R. Karagas,
  • Juliette C. Madan,
  • Debra M. MacKenzie,
  • Johnnye L. Lewis,
  • Brandon J. Rennie,
  • Bennett L. Leventhal,
  • Somer Bishop,
  • Sara S. Nozadi,
  • Todd Everson,
  • Cynthia M. Loncar,
  • Elisabeth C. McGowan,
  • Stephen J. Sheinkopf,
  • Brian S. Carter,
  • Jennifer B. Helderman,
  • Charles R. Neal,
  • Lynne M. Smith

DOI
https://doi.org/10.1136/bmjopen-2024-094317
Journal volume & issue
Vol. 15, no. 6

Abstract

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Importance Access to healthy and affordable foods may play a role in reducing inflammation and in healthy pulmonary immune system development.Objective To investigate the association between residing in a low-income and low-food-access (LILA) neighbourhood and risk of childhood asthma. A positive association was hypothesised.Design, setting and participants This prospective cohort study consists of 16 012 children from 35 longitudinal studies in the Environmental influences on Child Health Outcomes programme (children born 1998–2021) from across the contiguous USA. We conducted survival analyses adjusted for child sex, race/ethnicity, maternal education, gestational smoking, and parental history of asthma.Exposure(s) Several commonly used geospatial food access metrics were linked to residential locations including: LILA census tracts where the nearest supermarket is >1 mile in urban and >10 miles in rural areas (LILA1 and 10), >1 mile in urban and >20 miles in rural areas (LILA1 and 20), >0.5 mile in urban and >10 miles in rural areas (LILA0.5 and 10), and >0.5 mile without a vehicle or >20 miles (LILAvehicle). Each metric was linked to lifetime residential history timelines then dichotomised according to whether the child had spent at least 75% of their life living in a LILA area separately for birth through age 5 years (cumulative early childhood) and birth through age 11 years (cumulative middle childhood).Main outcomes(s) and measure(s) Asthma incidence in cumulative early and middle childhood.Results Residing in a LILA0.5 and 10 and LILAvehicleneighbourhood was associated with a higher asthma incidence in cumulative early and middle childhood. The LILA0.5 and 10 and LILAvehicle associations were stronger for asthma during cumulative early childhood, where we observed hazard ratios of 1.13 (95% CI 1.02 to 1.24) and 1.13 (95% CI 1.01 to 1.27), respectively. The associations were higher among children who were Hispanic, were female and had lower maternal education.Conclusion and relevance Limited residential food access was associated with higher childhood asthma incidence, especially among female and Hispanic children and those with lower maternal education. Our findings support multipronged efforts to increase access to healthy and affordable food options and lower food insecurity in LILA neighbourhoods.