The role of the physical environment in school readiness in England: Evidence from the Millennium Cohort Study

The early years, the period from birth until compulsory school age, is a critical time for outcomes later in life. School readiness measured towards the end of that period is a comprehensive indicator of children's developmental milestones reached in the early years. Characteristics of the physical environment, including greenspace and air quality, have long been linked to young children's cognitive, emotional, and behavioural outcomes, but not their school readiness directly, and no study has assessed the role of the physical environment in both the home and the neighbourhood in school readiness. We filled this gap by investigating associations between both neighbourhood and home physical environments and school readiness in England using data from 6127 children of the Millennium Cohort Study. Exposures included neighbourhood greenspace and air pollution, as well as parent-reported garden access, and damp/condensation and secondhand smoke in the home. School readiness was measured using the teacher-reported Foundation Stage Profile total score (range 0-117) at around age 5. We ran linear regression models adjusted for child, family, and neighbourhood characteristics, including the child's age at assessment and cognitive ability, family socioeconomic status, and urbanicity. Exposure to secondhand smoke in the home was associated with lower school readiness scores (coefficient: -2.04; 95% CI: -3.25, -0.84). The effect was robust to mutually adjusting for all exposures as well. We did not find evidence of associations between school readiness and neighbourhood greenspace, air pollution, garden access, or damp/condensation. If causal, our findings suggest that smoking indoors when children are present could negatively affect children's readiness for school. Study limitations, such as exposure misclassification due to relatively crude measures of exposures, and the potential for unmeasured confounding, should be considered in the interpretation of our findings.