title: Asthma prevalence and morbidity among rural Iowa schoolchildren.
abstract: BACKGROUND
  There are conflicting findings about the prevalence of asthma among farm and nonfarm children.
  
  
  OBJECTIVE
  We sought to estimate asthma prevalence and morbidity and determine differences between farm and nonfarm children.
  
  
  METHODS
  The study population consisted of all children aged 6 to 14 years enrolled in 10 school districts in 2 noncontiguous rural Iowa counties from 2000 through 2002. The mailed parental screening questionnaire included the International Study of Asthma and Allergies in Childhood core questionnaire, items from the Functional Severity Index, and items on physician diagnosis and medication and urgent care use.
  
  
  RESULTS
  The response rate was 86.6%. The 12-month prevalence of wheeze was 19.1%. Self-reported physician diagnosis of asthma was reported by 13.4%. On multivariable analysis controlling for age, sex, and county, children who lived on farms were less likely than those who lived in town to have ever wheezed (odds ratio, 0.71; 95% CI, 0.58-0.87) or to have wheezed during the past year (odds ratio, 0.77; 95% CI, 0.60-0.98). However, this protective association with farming was only observed in one of the study counties. Among those who wheezed, farm and nonfarm children were equally likely to have been given a diagnosis of asthma and had comparable morbidity.
  
  
  CONCLUSIONS
  By using a standardized questionnaire with a high response rate in this large, rural, population-based study, asthma prevalence rivaled that in large Midwestern cities. Unmeasured risk factors might account for the apparent protective effect in Keokuk County. These findings cast doubt on a protective effect of rural life for the development of childhood asthma.
authors.affiliation: Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chrischilles
authors.forename: Richard
authors.initials: R
authors.lastname: Ahrens
authors.forename: Angela
authors.initials: A
authors.lastname: Kuehl
authors.forename: Kevin
authors.initials: K
authors.lastname: Kelly
authors.forename: Peter
authors.initials: P
authors.lastname: Thorne
authors.forename: Leon
authors.initials: L
authors.lastname: Burmeister
authors.forename: James
authors.initials: J
authors.lastname: Merchant
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D005260:Female; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires