The role of school safety perceptions in childhood asthma diagnosis disparities.

Abstract

Objective: Childhood racial and ethnic asthma disparities in the United States are the consequence of structural inequities such as those in socioeconomic status (SES) and exposure to violence, but little research has explored the role of the school environment in perpetuating racial and ethnic disparities. This study examines associations between perceptions of unsafe school environments (USEs) and subsequent asthma diagnosis for elementary-aged children and the extent to which USE mediates relations from SES and race/ethnicity to asthma diagnosis for Black, Latinx, and non-Latinx White children. Method: We conducted a secondary analysis of data from the Early Childhood Longitudinal Study. Structural equation modeling was used to evaluate the association between USE and subsequent asthma diagnosis, controlling for child sex, and indirect effects of SES and race/ethnicity on asthma diagnosis via USE. Results: For 6,532 children, USE in second grade positively predicted new asthma diagnoses in third grade and mediated the association between SES and new asthma diagnosis. SES and USE serially mediated the relationship between race/ethnicity and asthma diagnosis. Identifying as non-Latinx White was associated with a lower likelihood of subsequent asthma diagnosis via higher SES and lower USE while identifying as Black or Latinx was associated with a higher likelihood of subsequent asthma diagnosis via lower SES and higher USE. Conclusion: USE was associated with pediatric asthma diagnosis and mediated the relationship between SES and asthma diagnosis as well as race/ethnicity and asthma diagnosis. Findings highlight the need to consider USE as a social determinant of health for pediatric asthma. Public Significance StatementFindings from this study suggest that disparities in unsafe schooling environments contribute to disparities in asthma diagnosis for Black and Latinx students. These findings validate the impact of social determinants of health for children in the United States and suggest a need for resources that support safe and supportive school environments.