# Neighborhood socioeconomic disadvantage and school stock inhaler utilization in a statewide program

## TL;DR

Schools in disadvantaged neighborhoods have higher use of stock inhalers for asthma, suggesting greater need for accessible medication.

## Contribution

This study identifies a link between socioeconomic disadvantage and increased use of school stock inhalers for asthma management.

## Key findings

- Schools in high disadvantage areas had significantly higher stock inhaler event rates than those in low disadvantage areas.
- Adjusted models showed that non-elementary schools had lower stock inhaler event rates compared to elementary schools.
- The association between socioeconomic disadvantage and inhaler use remained significant after adjusting for school and student characteristics.

## Abstract

The burden of asthma is disproportionately experienced by children from marginalized populations, including those from socioeconomically disadvantaged neighborhoods. Children can benefit from support beyond the home to counter negative asthma outcomes. Schools can stock quick-acting inhalers to ensure access to medication for any individual experiencing respiratory distress.

This study evaluated the relationship between stock inhaler use within schools and socioeconomic neighborhood disadvantage of schools.

An observational study examined stock inhaler events at schools utilizing data from the Illinois Schools Undesignated Albuterol Program in the 2023–2024 school year. Schools were assigned Area Deprivation Index (ADI) rankings based on the average ADIs of the school's census block groups and categorized into quartiles. Simple and adjusted zero-inflated mixed-effects beta regressions were conducted to assess the relationship between school ADI quartile and stock inhaler use. Covariates included school type, rurality, and proportion of non-Hispanic White students.

Of 2,171 enrolled schools, 279 reported a total of 675 stock inhaler events. Most events involved students (n = 656). Individuals who used stock inhalers were 47% female, 38% Black, and 29% White. Schools in high disadvantage areas (ADI Q4) had higher stock inhaler event rates than schools in very low disadvantage areas (Q1) (OR = 1.49, 95% CI = 1.16, 1.90, p = 0.002). This relationship remained significant after adjusting for school and student characteristics and also was significant for moderate disadvantage (Q3) schools (Q3: OR = 1.30, 95% CI = 1.03, 1.66, p = 0.03; Q4: OR = 1.53, 95% CI = 1.20, 1.96, p < 0.001). In adjusted models, non-elementary schools had a lower stock inhaler event rate than elementary schools (OR = 0.67, 95% CI = 0.55, 0.81, p < 0.001), while the proportion of White students and rural location were not associated with event rates.

We found that school neighborhood socioeconomic disadvantage was associated with stock inhaler utilization in Illinois schools. Future research is needed to investigate the driving factors, as stock inhaler programs can help address disparities in access to asthma care among children.