Examining the relative contributions of neighborhood disadvantage and collective efficacy on childhood asthma in Los Angeles: A multilevel analysis

Background: According to the 2000 U.S. Census, 15 million children were living in high poverty neighborhoods; this estimate is expected to increase with the 2010 Census. Although there is empirical support of the association between neighborhood disadvantage and many health outcomes, asthma remains relatively unstudied and displays mixed results. As such, the association between neighborhood social factors and asthma warrants further investigation. The specific hypotheses that were tested were whether (1) neighborhood disadvantage and (2) collective efficacy are associated with asthma prevalence controlling for individual and household factors, in addition to potential interactions with demographic factors. Methods: 3114 children (less than 18 years of age) from Wave 1 of the Los Angeles Family and Neighborhood Survey (LA FANS) were included in the analyses; three level multilevel logistic regression models were fitted to examine the relationship between individual, family and neighborhood factors on the probability of having an asthma diagnosis and the probability of having an asthma attack. Results: The prevalence of asthma in the sample is 11 percent. We anticipate neighborhood disadvantage to be positively associated with both asthma diagnosis and asthma morbidity and collective efficacy to be negatively associated, consistent with current literature. Conclusions: If supported, this study provides several contributions to the study of neighborhood effects on children‘s health outcomes by: (1) providing a more comprehensive view of the cumulative effects of neighborhood disadvantage on health, (2) contributing to studies having examined collective efficacy and asthma, (3) applying multilevel modeling techniques to examine heterogeneity in asthma outcomes.