Asthma is one of the leading causes of chronic illness among children and the most commonly reported cause of childhood disability. Rates of childhood asthma in the US have been increasing over the last several decades such that the rise in asthma prevalence has been labeled as an epidemic. The causes of this increase are not well known but may be related to factors such as increased impact of environmental allergies, increased obesity rates, inadequate early immune system exposures, and increased levels of air pollutants. Research specific to rural children is limited and has resulted in conflicting findings which may reflect differences in exposures across different types of rural settings.

The current study will assess rates of lifetime and current asthma for children across the rural-urban continuum for the entire U.S. We will examine how asthma may be related to measures of air quality in rural areas adjacent or non-adjacent to larger population centers, and in areas of varying levels of agricultural and animal production, and will examine how asthma may be related to other characteristics such as parental smoking, race/ethnicity, or how asthma outcomes may be influenced by health insurance. The study design is a retrospective county-level analysis combined several national secondary data sources and will test three hypotheses:

1. Children in rural areas are at greater risk for lifetime or current asthma when they live in areas adjacent and downwind from metropolitan areas versus children in other rural areas.
2. Asthma rates will be higher for children in non-adjacent rural areas of high farm animal production compared to non-adjacent rural areas of lower animal production.
3. Rates of asthma overall will not differ between urban and rural areas, reflective of the multiple causes of asthma among children. Both spatial and statistical analyses will be undertaken. For example, multilevel logistic regression models will investigate childhood asthma prevalence as functions of air quality, parental smoking, race, health insurance, and other demographic and health services variables. Spatial models will examine childhood asthma prevalence in rural areas adjacent and downwind from urban areas versus other rural areas.

Results of the study will help to inform rural health care policy by identifying the magnitude and distribution of childhood asthma across rural settings and its relationships to risk variables.

Publications

• Childhood Asthma in Rural-Urban Areas
  Policy Brief
  West Virginia Rural Health Research Center
  Date: 06/2012
  This policy brief examines how asthma may be related to rural areas adjacent or non-adjacent to larger population centers, to variation in measures of air quality, to varying levels of agricultural and animal production, and to other characteristics such as obesity, race/ethnicity, or health insurance.
• Childhood Asthma in Rural-Urban Areas (Final Report)
  West Virginia Rural Health Research Center
  Date: 05/2012
  This report examines how asthma may be related to rural areas adjacent or non-adjacent to larger population centers, to variation in measures of air quality, to varying levels of agricultural and animal production, and to other characteristics such as obesity, race/ethnicity, or health insurance.