Poverty Exposure Research Articles

Chronic exposure of grandparents to poverty and body mass index trajectories of grandchildren: a prospective intergenerational study.

In this study, I used the growth curve model to examine the association between grandparents' (first generation (G1)) life-course exposure to chronic poverty and grandchildren's (third generation (G3)) body mass index (BMI; weight (kg)/height (m)(2)) growth trajectories. This association was estimated separately for male and female grandchildren. Analyses were based on prospective data from a US longitudinal survey, the Panel Study of Income Dynamics (1968-2011), and 2 of its supplemental studies: the Child Development Supplement (1997-2011) and the Transition into Adulthood Study (1997-2011). A prospectively enrolled nationally representative cohort of 2,613 G3 youth (1,323 male, 1,290 female) sampled in the 2 supplemental studies was linked to 1,719 grandparents from the Panel Study of Income Dynamics core sample. Chronic exposure to poverty among grandparents was prospectively ascertained annually over a 30-year period prior to the collection of data on grandchildren. Findings suggested that grandparents' chronic poverty exposure was positively associated with the slope of the BMI trajectory among granddaughters (β = 0.10, 95% confidence interval: 0.03, 0.17) but not among grandsons (β = 0.02, 95% confidence interval: -0.04, 0.08). The association between grandparents' chronic poverty exposure and granddaughters' BMI growth slope remained even after controlling for parental (second generation (G2)) socioeconomic status and BMI.

Risk factors for invasive pneumococcal disease among children less than 5 years of age in a high HIV prevalence setting, South Africa, 2010 to 2012.

Invasive pneumococcal disease (IPD) causes significant disease burden, especially in developing countries, even in the era of pneumococcal conjugate vaccine and maternal-to-child HIV transmission prevention programs. We evaluated factors that might increase IPD risk in young children in a high HIV prevalence setting. We conducted a case-control study using IPD cases identified at 24 Group for Enteric, Respiratory and Meningeal disease Surveillance-South Africa program sites (2010-2012). At least 4 controls were matched by age, HIV status and hospital to each case. Potential risk factors were evaluated using multivariable conditional logistic regression. In total, 486 age-eligible cases were enrolled. Factors associated with IPD in HIV-uninfected children (237 cases, 928 controls) included siblings <5 years [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.16-2.46], underlying medical conditions (aOR = 1.99, CI 1.22-3.22), preceding upper respiratory tract infection (aOR = 1.79, CI 1.19-2.69), day-care attendance (aOR = 1.58, CI 1.01-2.47), perinatal HIV exposure (aOR = 1.62, CI 1.10-2.37), household car ownership (aOR = 0.45, CI 0.25-0.83) and ≥2 7-valent pneumococcal conjugate vaccine doses (aOR = 0.67, CI 0.46-0.99). Among HIV-infected children (124 cases, 394 controls), IPD-associated factors included malnutrition (aOR = 2.68, CI 1.40-5.14), upper respiratory tract infection (aOR = 3.49, CI 1.73-7.03), tuberculosis in the last 3 months (aOR = 5.12, CI 1.69-15.50) and current antiretroviral treatment (aOR = 0.13, CI 0.05-0.38). Previously identified factors related to poverty, poor health and intense exposure continue to be risk factors for IPD in children. Ensuring delivery of pneumococcal conjugate vaccine and antiretroviral treatment are important for improving disease prevention.

Accumulation of childhood poverty on young adult overweight or obese status: race/ethnicity and gender disparities

BackgroundChildhood poverty is positively correlated with overweight status during childhood, adolescence and adulthood. Repeated exposure of childhood poverty could contribute to race/ethnicity and gender disparities in young adult overweight/obese (OV/OB)...

Childhood Poverty, Cumulative Risk Exposure, and Mental Health in Emerging Adults.

One out of four American children are born into poverty, but little is known about the long-term, mental health implications of early deprivation. The more time in poverty from birth-age-9, the worse mental health as emerging adults (n = 196, M = 17.30 years, 53% male). These results maintain independently of concurrent, adult income levels for self-reported externalizing symptoms and a standard learned helplessness behavioral protocol, but internalizing symptoms were unaffected by childhood poverty. We then demonstrate that part of the reason why early poverty exposure is harmful to mental health among emerging adults is because of elevated cumulative risk exposure assessed at age 13. The significant, prospective, longitudinal relations between early childhood poverty and externalizing symptoms plus learned helplessness behavior are mediated, in part, by exposure to a confluence of psychosocial (violence, family turmoil, child separation from family) and physical (noise, crowding, substandard housing) risk factors during adolescence.

Poverty and Awakening Cortisol in Adolescence: The Importance of Timing in Early Life.

The deleterious effects of poverty on mental and physical health are routinely argued to operate, at least in part, via dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis, although empirical examinations connecting poverty with HPA axis functioning are rare. Research on the effects of timing of poverty is a particularly neglected aspect of this relationship. This study uses 15 years of prospective data from the Study of Early Child Care and Youth Development to assess how exposure to poverty during infancy, childhood, and adolescence is related to awakening cortisol (n = 826), a marker of HPA axis functioning. Among female participants, poverty exposure in infancy and adolescence, but not childhood, was negatively associated with awakening cortisol. Poverty exposure was unrelated to cortisol among male participants. The importance of timing and gender differences are discussed along with directions for future research.

Trauma Exposure and Posttraumatic Stress Disorder in a National Sample of Adolescents

Although exposure to potentially traumatic experiences (PTEs) is common among youths in the United States, information on posttraumatic stress disorder (PTSD) risk associated with PTEs is limited. We estimate lifetime prevalence of exposure to PTEs and PTSD, PTE-specific risk of PTSD, and associations of sociodemographics and temporally prior DSM-IV disorders with PTE exposure, PTSD given exposure, and PTSD recovery among U.S. adolescents. Data were drawn from 6,483 adolescent-parent pairs in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13 through 17 years. Lifetime exposure to interpersonal violence, accidents/injuries, network/witnessing, and other PTEs was assessed along with DSM-IV PTSD and other distress, fear, behavior, and substance disorders. A majority (61.8%) of adolescents experienced a lifetime PTE. Lifetime prevalence of DSM-IV PTSD was 4.7% and was significantly higher among females (7.3%) than among males (2.2%). Exposure to PTEs, particularly interpersonal violence, was highest among adolescents not living with both biological parents and with pre-existing behavior disorders. Conditional probability of PTSD was highest for PTEs involving interpersonal violence. Predictors of PTSD among PTE-exposed adolescents included female gender, prior PTE exposure, and pre-existing fear and distress disorders. One-third (33.0%) of adolescents with lifetime PTSD continued to meet criteria within 30 days of interview. Poverty, U.S. nativity, bipolar disorder, and PTE exposure occurring after the focal trauma predicted nonrecovery. Interventions designed to prevent PTSD in PTE-exposed youths should be targeted at victims of interpersonal violence with pre-existing fear and distress disorders, whereas interventions designed to reduce PTSD chronicity should attempt to prevent secondary PTE exposure.

Identifying inequitable exposure to toxic air pollution in racialized and low-income neighbourhoods to support pollution prevention

Numerous environmental justice studies have confirmed a relationship between population characteristics such as low-income or minority status and the location of environmental health hazards. However, studies of the health risks from exposure to harmful substances often do not consider their toxicological characteristics. We used two different methods, the unit-hazard and the distance-based approach, to evaluate demographic and socio-economic characteristics of the population residing near industrial facilities in the City of Toronto, Canada. In addition to the mass of air emissions obtained from the national pollutant release inventory (NPRI), we also considered their toxicity using toxic equivalency potential (TEP) scores. Results from the unit-hazard approach indicate no significant difference in the proportion of low-income individuals living in host versus non-host census tracts (t(107) = 0.3, P = 0.735). However, using the distance-based approach, the proportion of low-income individuals was significantly higher (+5.1%, t(522) = 6.0, P <0.001) in host tracts, while the indicator for "racialized" communities ("visible minority") was 16.1% greater (t(521) = 7.2, P <0.001) within 2 km of a NPRI facility. When the most toxic facilities by non-carcinogenic TEP score were selected, the rate of visible minorities living near the most toxic NPRI facilities was significantly higher (+12.9%, t(352) = 3.5, P = 0.001) than near all other NPRI facilities. TEP scores were also used to identify areas in Toronto that face a double burden of poverty and air toxics exposure in order to prioritise pollution prevention.

A Look Back at 2012: A Year of Transition

The Journal Editors would like to wish all our contributors and readers a Happy and Prosperous 2013. We are grateful to the many authors who submit their manuscripts to World Medical & Health Policy. Last year witnessed the introduction of new therapies and technologies into medical practice. Improvements in cancer detection and survival, advances in natural body orifices surgery, and handheld devices continue to enhance the practioner's toolbox. Handheld diagnostic devices based on polymerase chain reaction (PCR) technology now offers the promise for diagnostic testing in remote regions of the globe. Tied to the global information network, public health and medical consultations can be accessible to millions of individuals, helping with rapid access to medical care and services. Infectious diseases, especially those resistant to antibiotics, can be more rapidly detected, resulting in earlier appropriate therapy which improves outcomes. In 2012, many governments and private organizations focused on improving population health, access to care, delivering preventive services and containing, or eradicating, infections. Preventing the spread of HIV/AIDS, malaria and tuberculosis, poliomyelitis eradication, improving sanitation and food services will remain a 2013 priority for many international funding organizations.The recent rapid rise in global longevity, especially in developing countries, has been met with both hope and concern; hope for improved health and concern for the increase in non-communicable diseases and the inability of the current medical infrastructure to meet the demand for services. Preventive care early in life is essential to reduce the burden of chronic debilitating diseases among older individuals and ensure “healthy aging” and the wellbeing of the global community. Health care reforms and fiscal interventions to contain the rising costs of health care are not sufficient tools to address the looming health challenges. Adequate resources in the fight against contributing factors such as poverty, poor nutrition, smoking, physical inactivity, socio-economic shifts and environmental exposures, and meeting communities' needs and expectations, should be priorities for the foreseeable future (Clements, Coady, & Gupta, 2012; World Bank (2012); World Health Organization (2012)). Programs addressing health literacy and the fight against poverty and health disparities require focus and support. Adding to the burden of medical costs are natural and human made disasters. The year 2012 ranked as the second worst year for disasters costing over one billion USD per event. While the loss of life was minimized by effective preparedness, damage to critical infrastructure and medical services has been staggering. Victims of disasters require long-term care for chronic diseases. The International Federation of the Red Cross and Red Crescent Societies estimate that over 73 million individuals were displaced in 2012 due to disasters. Access to good care and preventive services for all should be a global priority. Unfortunately, a global shortage of competent and adequate health care workforce continues to be a major roadblock to the successful implementation of urgent programs targeting population's health. In many countries, even the life of medical professionals and health care workers is at risk. WHO and the World Medical Association are actively involved in promoting Physicians' political neutrality and security, together with removing the global social inequalities in public health services and health care access. In 2013, the global health community should increase its attention, and funding, to solve the problem of growing health disparities and the rising burden of non-communicable diseases. We would welcome submissions on this important issue from our readership around the globe. Last year World Medical & Heath Policy began the transition to our new publisher, Wiley-Blackwell. We look forward to the opportunites this trasition will afford in expanding the readership and reach of the journal. Future issues of our Journal will continue to explore the global medical challenges facing the world community. Arnauld Nicogosssian is Senior Editor of World Medical & Health Policy and Distinguished Research Professor and Director of the Center for the Study of International Medical Policies and Practices at George Mason University's School of Public Policy. Bonnie Stabile is Deputy Editor of World Medical & Health Policy and an Adjucnt Professor in George Mason University's School of Public Policy, and Department of Public and International Affairs. Otmar Kloiber, Editor of World Medical & Health Policy, is Secretary General of the World Medical Association. Edward Septimus, Chair of the Editorial Board of World Medical & Health Policy, is Medical Director for Infection Prevention and Epidemiology at HCA. Thomas Zimmerman, Editor of World Medical & Health Policy, is Founding Dean of Palm Beach Medical College.

Exposure to Classroom Poverty and Test Score Achievement: Contextual Effects or Selection?

It is widely believed that impoverished contexts harm children. Disentangling the effects of family background from the effects of other social contexts, however, is complex, making causal claims difficult to verify. This study examines the effect of exposure to classroom poverty on student test achievement using data on a cohort of children followed from third through eighth grade. Cross-sectional methods reveal a substantial negative association between exposure to high-poverty classrooms and test scores; this association grows with grade level, becoming especially large for middle school students. Growth models, however, produce much smaller effects of classroom poverty exposure on academic achievement. Even smaller effects emerge from student fixed-effects models that control for time-invariant unobservables and from marginal structural models that adjust for observable time-dependent confounding. These findings suggest that causal claims about the effects of classroom poverty exposure on achievement may be unwarranted.

Influence of a Poverty Simulation on Nursing Student Attitudes Toward Poverty

This study aimed to determine a poverty simulation's influence on nursing students' attitudes toward poverty. Five cohorts of baccalaureate nursing students participated in the study; two cohorts (experimental group, n = 103) participated in the simulation and three did not (control group, n = 75). The Attitudes Towards Poverty Short Form was administered before the simulation and 6 weeks later; higher scores indicated more positive attitudes toward poverty. Experimental group pretest scores were higher. Higher pretest global scores were negatively correlated with religious affiliation (Spearman's rho = -0.294, p = 0.000) and positively correlated with prior poverty exposure (Spearman's rho = 0.284, p = 0.000) and liberal political views (Spearman's rho = 0.444, p = 0.000). Controlling for pretest differences, posttest mean scores for the experimental group (78.73) were significantly higher (p = 0.007). The poverty simulation is an engaging learning experience providing an opportunity for students to gain sensitivity in working with this population.

Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes

BackgroundAlthough the links between poverty and health have often been studied , the dynamics of poverty and physical health in early childhood remain under-investigated. In particular, it is not known whether the health of young children is affected differently from that of adults by patterns of poverty unique to them.MethodsWe examined patterns of health from 5 to 41 months of age as a function of concurrent, lagged, and chronic exposure to insufficient income. Using data from the first four rounds of the Quebec Longitudinal Study of Child Development, we performed multilevel logistic and multilevel Poisson regressions and latent growth curve analyses to explore associations between exposure to poverty and mother-reported asthma-like attacks, and maternal perception of health status controlling for neonatal, maternal, and environmental characteristics.ResultsThe mean number of mother-reported asthma-like attacks significantly decreased as children aged. The likelihood of being perceived in a poorer health status also decreased across time. Concurrent poverty was associated with more mother-reported asthma-like attacks and with a higher risk of being perceived in poorer health status. One-period-lagged poverty was associated with more mother-reported asthma-like attacks and this remained significant after controlling for concurrent poverty. The number of mother-reported asthma-like attacks was significantly higher among children in the chronic poverty class compared to those in the never-poor class, particularly at 17 and 29 months. Perceived health status at 5-months was significantly poorer among chronically poor children compared to never-poor children.ConclusionExposure to poverty negatively affects two major health indicators in early childhood – maternal perception of child health and mother-reported asthma-like attacks. Patterns of the effects vary according to timing and duration of poverty exposure. Further longitudinal research is warranted to disentangle time-specific from cumulative effects of poverty on child health.

Tracking exposure to child poverty during the first 10 years of life in a Quebec birth cohort.

Early childhood poverty is associated with adult chronic diseases. The objectives of this study were to examine patterns of exposure to poverty during the first 10 years of life in the Quebec Longitudinal Study of Child Development (QLSCD) cohort according to three measures of poverty and to explore family characteristics associated with different poverty exposures. Data from 1,334 participants from the QLSCD were collected annually at home from ages 5 months through 10 years. Household income (previous 12 months) and sources of income were recorded at each data round. Poverty status was operationalized as 1) living below the low income cut-off of Statistics Canada, 2) receiving social welfare and 3) being in the lowest quintile of socio-economic status. We plotted trends in the prevalence of child poverty over time. We used latent class growth modelling to identify subgroups with similar poverty trajectories. Duration of poverty according to each measure was computed separately for early childhood, middle childhood, and the entire 10 years of life. Four trajectories of poverty were identified: stable poor, decreasing likelihood, increasing likelihood, and never poor. The three measures of poverty do not cover the same population, yet the characteristics of those identified as poor are similar. Children of non-European, immigrant mothers were most likely to be poor, and there was a higher likelihood of children from single-parent families to live in chronic poverty during the first 10 years. A large proportion of children are exposed to poverty before 10 years of age. More effective public policies could reduce child poverty.

"We're still in a struggle": Diné resilience, survival, historical trauma, and healing.

As part of a community/university collaborative effort to promote the mental health and well-being of Diné (Navajo) youth, we explored the relevance of addressing historical trauma and current structural stressors, and of building on individual and community strengths through healing and social transformation at multiple levels. Qualitative analyses of 74 ethnographic interviews with 37 Diné youth, parents, and grandparents suggested that a focus on historical trauma as a conceptual frame for behavioral health inequities, understood within the context of resilience and survival, is appropriate. Our findings also highlight the salience of current stressors such as poverty and violence exposure. We explore the fit of an historical trauma healing framework and present implications for intervention and transformation through revitalization of traditional knowledge, culturally based healing practices, intergenerational education, and social change strategies designed to eliminate social inequities.

Transactional Sex Amongst AIDS-Orphaned and AIDS-Affected Adolescents Predicted by Abuse and Extreme Poverty

Little is known about impacts of familial AIDS on abuse and sexual health outcomes amongst adolescents. Objectives were to determine whether familial AIDS is: (1) associated with severe physical, emotional, and sexual abuse; (2) associated with transactional sexual exploitation; and (3) explore whether relationships between familial AIDS and transactional sex are mediated by extreme poverty and abuse. Adolescent self-report study in deprived South African communities. A 2009 follow-up of a 2005 study achieved 71% retention (n = 723). The 2009 sample included AIDS-orphaned (n = 236), other-orphaned (n = 231), and non-orphaned (n = 220) adolescents, whose primary caregivers were AIDS sick (n = 109), other sick (n = 147), and healthy (n = 220). Abuse and transactional sex were measured using widely used and validated self-report measures. AIDS orphanhood and parental AIDS sickness predicted emotional and physical abuse and transactional sexual exploitation. Orphanhood or parental sickness by non-AIDS causes, and having healthy caregivers, did not predict any abuse outcomes. Adolescents "dually" affected by AIDS orphanhood and sickness showed a 3-fold likelihood of severe emotional and physical abuse and, amongst girls, a 6-fold likelihood of transactional sexual exploitation, compared with those in healthy families. Heightened risk of transactional sex amongst adolescents in AIDS-affected families was mediated by extreme poverty and abuse exposure. In combination, the effects of familial AIDS, food insecurity, and exposure to abuse raised prevalence of transactional sex amongst girls from 1% to 57%. Adolescents from AIDS-affected families are highly vulnerable to severe physical and emotional abuse and transactional sex. This has implications for policy and programming in child protection and HIV prevention services.

The relation of violence exposure and ethnicity to intelligence and verbal-performance discrepancies in incarcerated male adolescents.

Incarcerated populations have an estimated incidence of intellectual disabilities (IDs) far higher than national norms, ranging as high as 10%. In the present study, the relation between ID and violence exposure in 115 incarcerated adolescents was examined. Interpersonal violence exposure (IPV-E) predicted an average decrease in full scale IQ of 4.5 points, explaining approximately 5% of the difference in IQ. Child maltreatment increased the odds of having a verbal disability by three folds and explained 17% of the variance in verbal disability. Hierarchical regression was used to examine the relative contribution of ethnicity, poverty, and violence exposure to intellectual functioning. The literature on racial bias in incarceration and the implications for the present study are discussed.

Labor market flexibility and poverty dynamics

The past two decades have witnessed a rapid growth in flexible work arrangements that, in some instances, could expose workers to a higher poverty risk via limited job stability, few advancement opportunities, and low wages. Nowhere in the world has this increase in flexible work arrangements being more evident than in Spain, where about a third of the wage and salary workforce holds fixed-term contracts. Using Spanish panel data and maximum-likelihood binary models that account for state dependence and unobserved heterogeneity, we examine the poverty implications of past and present temporary employment. Our findings suggest that fixed-term contracts are linked to a greater poverty exposure among women and older men relative to open-ended contracts. Furthermore, this greater poverty exposure can last several years due to feedback effects operating via job instability or via the transition to work statuses characterized by higher poverty hazards. Finally, the adverse impact of temporary employment is linked to the short duration of some contracts, thus signaling the importance of work attachment.

Disparities in Postacute Stroke Rehabilitation Disposition to Acute Inpatient Rehabilitation vs. Home

We evaluated the factors associated with discharge disposition to either inpatient rehabilitation or home after acute stroke hospitalization. We analyzed data from three concurrent years of State Hospital Discharge Data (years 2002-2004) of patients admitted with a primary International Classification of Diseases-9 code diagnosis of 430-434.9 and 436 (n = 7810). Logistic regression models tested whether discharge to inpatient rehabilitation vs. home was associated with socio-demographic factors. We controlled for covariates, including medical factors, such as number of intensive care unit days, Charlson Comorbidity Index, therapy charges, and available resources in their county. We found that older age, a greater number of intensive care unit days, higher total therapy charges, and lower poverty in their county of residence were associated with discharge to acute inpatient rehabilitation. Factors associated with discharge to home included younger age, fewer intensive care unit days, lower therapy charges, and higher poverty in their county of residence. Enabling factors, such as county poverty status and exposure to therapy may be important factors related to postacute stroke disposition.

Indicators of 21st century socioclimatic exposure

Policies that attempt to curb greenhouse gas emissions, allocate emissions rights, or distribute compensation to those most damaged by climate change must explicitly incorporate the international heterogeneity of the climate change threat. To capture the distinct susceptibilities associated with lack of infrastructure, potential property loss, and gross human exposure, we develop an integration of climate change projections and poverty, wealth, and population metrics. Our analysis shows that most nations of the world are threatened by the interaction of regional climatic changes with one or more relevant socioeconomic factors. Nations that have the highest levels of poverty, wealth, and population face greater relative exposure in those dimensions. However, for each of those socioeconomic indicators, spatial heterogeneity in projected climate change determines the overall international pattern of socioclimatic exposure. Our synthesis provides a critical missing piece to the climate change debate and should facilitate the formulation of climate policies that account for international variations in the threat of climate change across a range of socioeconomic dimensions.

Childhood Poverty and Health

A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms underlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by multiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent poverty (i.e., during adolescence) did not affect these physiological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumulative risk exposure accompanying childhood poverty.

Hogging the Air: CAFO Emissions Reach into Schools

Confined animal feeding operations (CAFOs) can pollute the surrounding air with malodorous compounds, bacteria, fungi, and endotoxin. CAFO-related health impacts have been investigated primarily in adults, but children may be at greater risk because of their size and developmental stage. Since children spend considerable time at school, researchers at the University of North Carolina at Chapel Hill conducted an investigation of schools’ proximity to swine CAFOs to determine the extent to which students may be exposed to airborne CAFO emissions [EHP 114:591–596; Mirabelli et al.]. They determined that some students may encounter CAFO-associated exposures at school and also found that students of color and of low socioeconomic status were the most likely to be affected. Compared to people living farther away, residents living near CAFOs report a higher prevalence of headaches and respiratory symptoms such as coughing. One study found that CAFO neighbors experience lower secretion and concentration of an immune system protein during odor episodes; another reported livestock odor as having a negative impact on adult levels of tension, depression, and anger. For children, the closer they live to a CAFO, the greater their risk of asthma symptoms. CAFOs are disproportionately sited in communities of color and areas of poverty. These populations may be more susceptible to the ill effects of airborne exposures owing to existing health challenges such as higher-than-average disease rates and inadequate health care access. The study findings are based in part on the geographic locations of swine CAFOs and 339 public schools in North Carolina, a state with significant hog, cattle, and poultry industries. Additionally, personnel from 267 schools completed a 21-item survey that included questions about the frequency and intensity of livestock odors in the schools’ indoor and outdoor environments. Publicly available records detailed schools’ racial and ethnic composition and the proportion of students participating in the National School Lunch Program, which provides free or reduced-price meals to students from low-income families. Participation in the program served as an indicator of students’ socioeconomic status. Of the 226 schools included in the final analysis, distances between a school and the closest swine CAFO ranged from 0.2 to 42.0 miles. Of these, 29% were within 3 miles of one or more swine CAFOs, 21% reported livestock odors outdoors, and 8% reported noticeable livestock odors indoors. The overall average rating of odor intensity was 2.2 on a scale of 1 to 5; the average rating inside buildings was 2.8. Schools with noticeable odors were more likely attended by students of lower socioeconomic status, regardless of race. Schools with more white students or students of higher socioeconomic status tended to be farther from a swine CAFO. Although the researchers did not characterize the composition of swine CAFO–associated air pollution or identify specific health-related effects, they conclude that livestock-related odors in and around schools may indicate the presence of hazardous airborne contaminants from nearby CAFOs. Their results confirm and expand previous research describing racial and economic disparities in exposure to CAFO emissions.