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Lawson JA, Kim M, Jandaghi P, Goodridge D, Balbuena L, Cockcroft D, Adamko D, Khanam U. Risk and protective factors of asthma and mental health condition multimorbidity in a national sample of Canadian children. Pediatr Allergy Immunol 2024; 35:e14199. [PMID: 39092605 DOI: 10.1111/pai.14199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The coexistence of childhood asthma and mental health (MH) conditions can impact management and health outcomes but we need to better understand the etiology of multimorbidity. We investigated the association between childhood asthma and MH conditions as well as the determinants of their coexistence. METHODS We used data from the Canadian Health Survey of Children and Youth 2019 (3-17 years; n = 47,871), a cross-sectional, nationally representative Statistics Canada dataset. Our primary outcome was condition status (no asthma or MH condition; asthma only; MH condition only; both asthma, and a MH condition (AMHM)). Predictors of condition status were assessed using multiple multinomial logistic regression. Sensitivity analyses considered individual MH conditions. RESULTS MH condition prevalence was almost two-fold higher among those with asthma than those without asthma (21.1% vs. 11.6%, respectively). There were increased risks of each condition category associated with having allergies, other chronic conditions, and family members smoking in the home while there were protective associations with each condition status category for being female and born outside of Canada. Four additional variables were associated with AMHM and MH condition presence with one additional variable associated with both AMHM and asthma. In sensitivity analyses, the associations tended to be similar for most characteristics, although there was some variability. CONCLUSION There are common risk factors of asthma and MH conditions along with their multimorbidity with a tendency for MH risk factors to be associated with multimorbidity. MH condition presence is common and important to assess among children with asthma.
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Affiliation(s)
- Joshua A Lawson
- Department of Medicine and the Canadian Centre for Rural and Agricultural Health, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Minyoung Kim
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Parisa Jandaghi
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Don Cockcroft
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Darryl Adamko
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Ulfat Khanam
- Health Sciences Program, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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van der Eijk Y, Woh J. Is secondhand smoke associated with mental health issues? A narrative review of the evidence and policy implications. Health Policy 2023; 136:104900. [PMID: 37651970 DOI: 10.1016/j.healthpol.2023.104900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Secondhand smoke (SHS) is a well-established cause of lung cancer, respiratory disease, heart disease and developmental issues in children, with an overwhelming evidence base spanning over four decades. In this narrative review, we describe studies which have also linked self-reported or cotinine-assessed SHS exposure in the home, workplace and other settings to mental health disorders including depression, suicide, anxiety, and psychological distress in children and adults, sleeping disorders, Attention Deficit Hyperactivity Disorder and behavioural issues in children, and dementia in older adults. In general, evidence indicates that SHS exposure is associated with these disorders in a dose-response manner, with higher odds reported in people who are exposed to SHS at high levels, frequently, and in the home environment. Most studies so far are cross-sectional albeit in large, nationally representative samples from various countries with a smaller number of longitudinal studies. More research is needed in this area to determine whether SHS is a direct cause of adverse mental health outcomes, and whether creating smokefree environments leads to improved mental wellbeing. In particular, more research is needed on the impact of smokefree home environments, an area which has received relatively little focus in smokefree interventions which generally target public places.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, MD1 Tahir Foundation Building, National University of Singapore, 12 Science Drive 2 #09-01C, 117549, Singapore.
| | - Joanne Woh
- Saw Swee Hock School of Public Health, MD1 Tahir Foundation Building, National University of Singapore, 12 Science Drive 2 #09-01C, 117549, Singapore
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Merianos AL, Nabors LA, Odar Stough CC, Olaniyan AC, Smith ML, Mahabee-Gittens EM. Associations of household tobacco smoking status with childhood temperament among U.S. preschool-aged children. J Affect Disord 2023; 329:113-123. [PMID: 36841302 PMCID: PMC10042486 DOI: 10.1016/j.jad.2023.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/28/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND This study investigated the association between household tobacco smoking status and temperament among U.S. 3-5-year-olds. METHODS A secondary analysis of 2019-2020 National Survey of Children's Health data (N = 11,100) was conducted. Temperament dimensions of effortful control (characterized by attention focusing), negative affectivity (characterized by anger and soothability), and surgency (characterized by activity level and shyness) were assessed. Weighted ordinal regression models were conducted while adjusting for child and family covariates. RESULTS Approximately 13 % of children lived with smokers. Compared to children who did not live with smokers, children living with smokers displayed behaviors of poorer effortful control and were more likely to be easily distracted (AOR = 1.59, 95%CI = 1.24-2.04) and less likely to keep working on tasks until finished (AOR = 0.56, 95%CI = 0.44-0.71). Children living with smokers displayed behaviors of greater negative affectivity and were at increased odds of being angry or anxious when transitioning between activities (AOR = 1.50, 95%CI = 1.13-1.98) and losing their temper when things did not go their way (AOR = 1.53, 95%CI = 1.20-1.96), and were at decreased odds of calming down quickly when excited (AOR = 0.54, 95%CI = 0.42-0.70). Children living with smokers displayed behaviors of poorer surgency and were less likely to play well with others (AOR = 0.58, 95%CI = 0.45-0.76) and sit still compared to same-aged children (AOR = 0.56, 95%CI = 0.44-0.71). LIMITATIONS The NSCH uses a cross-sectional survey design; longitudinal associations and objective measures could not be assessed. However, the NSCH is nationally representative and results are generalizable to U.S. 3-5-year-olds. CONCLUSIONS Findings suggest household tobacco smoking influences temperament in early childhood. Results signify the need to promote household tobacco cessation.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - Laura A Nabors
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Merianos AL, Jacobs W, Olaniyan AC, Smith ML, Mahabee‐Gittens EM. Tobacco Smoke Exposure, School Engagement, School Success, and Afterschool Activity Participation Among US Children. THE JOURNAL OF SCHOOL HEALTH 2022; 92:1202-1213. [PMID: 35989183 PMCID: PMC9669117 DOI: 10.1111/josh.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Tobacco smoke exposure (TSE), defined as secondhand smoke (SHS) and thirdhand smoke (THS), is associated with negative health consequences. This study's objective was to assess the associations between home TSE status and school engagement, school success, and afterschool activity participation among school-aged children. METHODS We conducted a secondary analysis of 2018-2019 National Survey of Children's Health cross-sectional data. Children ages 6-11 years (N = 17,466) were categorized into home TSE groups: no home TSE; THS exposure only; and SHS and THS exposure. Weighted logistic and Poisson regression models were built. RESULTS Compared to children with no home TSE, children with home THS exposure only and SHS and THS exposure were at decreased odds of being engaged in school (AOR = 0.69, 95%CI = 0.57, 0.83; AOR = 0.63, 95%CI = 0.41, 0.97, respectively), and at increased odds of having ≥1 school-to-home contact about child problems in school (AOR = 1.83, 95%CI = 1.50, 2.23; AOR = 1.58, 95%CI = 1.05, 2.37, respectively). Children with THS exposure only were at increased odds of missing ≥1 school day (AOR = 1.43, 95%CI = 1.13, 1.81). Children with THS exposure only (ARR = 0.90, 95%CI = 0.83, 0.96) and SHS and THS exposure (ARR = 0.74, 95%CI = 0.61, 0.89) were at reduced likelihood of participating in a higher number of afterschool activities. CONCLUSIONS Children exposed to home tobacco smoke are at unique risk for poorer school engagement and success.
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Affiliation(s)
- Ashley L. Merianos
- University of Cincinnati, School of Human ServicesPO Box 210068CincinnatiOH45221‐0068
| | - Wura Jacobs
- Department of KinesiologyCalifornia State University Stanislaus, One University CircleTurlockCA95382
| | - Afolakemi C. Olaniyan
- University of Cincinnati, School of Human ServicesPO Box 210068CincinnatiOH45221‐0068
| | - Matthew Lee Smith
- School of Public Health, Texas A&M University212 Adriance Lab RoadCollege StationTX77843
| | - E. Melinda Mahabee‐Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency MedicineCollege of Medicine, University of Cincinnati3333 Burnet Avenue, MLC 2008, 3333 Burnet AvenueCincinnatiOH45229
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Gao Y, Wang T, Duan Z, Pu Y, Zhang J. The association between neurodevelopmental and behavioral problems and tobacco smoke exposure among 3-17 years old children. Front Public Health 2022; 10:881299. [PMID: 36033778 PMCID: PMC9399492 DOI: 10.3389/fpubh.2022.881299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/11/2022] [Indexed: 01/21/2023] Open
Abstract
Children being exposed to tobacco smoke can lead to poor developmental and behavioral problems. We aimed to explore the correlation between neurodevelopmental and behavioral problems (NBPs) and tobacco smoke exposure (TSE) among children aged 3-17 years. In this study, data were obtained from the 2018-2019 U.S. National Survey of Children's Health (NSCH). Children in the range of 3-17 years old were taken as the research subjects, and their parents were surveyed through questionnaires. TSE status was defined as one of three groups: no tobacco smoke exposure (no TSE), someone smoking but not inside the house (no home TSE), and someone smoking inside the house (home TSE). NBPs mainly included behavioral or conduct problems, intellectual disability, learning disability, speech or other language disorders, and developmental delay. We used the sampling weights provided by the NSCH to weight the data in order to obtain an unbiased population estimate. One-way ANOVA and Chi-square tests were performed to examine the difference of each variable. Logistic regression analysis and stratified analysis were carried out to investigate the association between NBPs and TSE. A total of 48,783 children were included in this study, with an average age of 10.1 years. In total 17.9% of all the participants were preschool children, 35.1% were school-age children, and 47.0% were school-age adolescents. More than 85.0% of children lived with no TSE. Over 90.0% of children were healthy in each NBP. Children living with home TSE and no home TSE showed significant adjusted odds ratios (aORs) compared with no TSE in four NBPs besides intellectual disability. The stratified analysis found aORs were higher for NBPs in preschool children compared to the school-age children and school-age adolescents. Male children living with home TSE showed higher aORs in moderate/severe NBP conditions. Our study indicated it is necessary to protect the health of young children from TSE by intervention measures.
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ElHassan NO, Hall RW, Thomas BR, Palmer TW, Kaiser JR, Li C. Anxiety, Depression, and Behavioral and/or Conduct Disorder in Adolescence Among Former Preterm and Term Infants of Different Race and Ethnicities. J Racial Ethn Health Disparities 2022; 10:1379-1391. [PMID: 35578153 DOI: 10.1007/s40615-022-01323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare parental reports of recent diagnoses of anxiety, depression, and/or behavioral/conduct disorder among former preterm (PT) and term adolescents by race/ethnicity and evaluate receipt of mental healthcare within the past year among those adolescents with any of these conditions. STUDY DESIGN A total of 20,871 Non-Hispanic white (NHW), Non-Hispanic black (NHB), and Hispanic adolescents were evaluated using data from the 2017/2018 National Survey of Children's Health. PT birth and race/ethnicity disparity in the diagnosis of these emotional/behavioral problems and receipt of mental healthcare among adolescents with any of these diagnoses were analyzed using logistic regression. RESULTS The unadjusted prevalence (95% CI) of these diagnoses was significantly higher among former PT (0.19 [0.17-0.22]) compared to term (0.15 [0.14-0.16]) adolescents. Despite having higher rates of adverse socioeconomic measures, former PT and term NHBs and Hispanics had lower unadjusted prevalence of these diagnoses in comparison to NHWs. After adjusting for differences in demographic, clinical, and socioeconomic characteristics, NHBs (0.47 [0.36-0.64]) and Hispanics (0.40 [0.30-0.54]) remain at lower odds of the composite measure of the emotional and/or behavioral problems compared to NHWs, while PT birth did not have a significant impact on this outcome measure. Only 53% of adolescents with these diagnoses received recent mental healthcare. No significant differences in the adjusted odds of receipt of mental healthcare were noted across the groups based on PT birth or race/ethnicity. CONCLUSIONS In contrast to PT birth, race/ethnicity had a significant impact on the adjusted odds of emotional/behavioral disorders during adolescence. Among adolescents with these diagnoses, PT birth and race/ethnicity did not significantly influence the adjusted odds of receipt of mental healthcare.
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Affiliation(s)
- Nahed O ElHassan
- Department of Pediatrics (Neonatal-Perinatal Medicine), Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-5, Little Rock, AR, 72202, USA.
| | - Richard W Hall
- Department of Pediatrics (Neonatal-Perinatal Medicine), Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-5, Little Rock, AR, 72202, USA
| | - Billy R Thomas
- Department of Pediatrics (Neonatal-Perinatal Medicine), Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-5, Little Rock, AR, 72202, USA
| | - Timothy W Palmer
- Department of Pediatrics (Neonatal-Perinatal Medicine), Penn State Health Children's Hospital, Hershey, PA, USA
| | - Jeffrey R Kaiser
- Department of Pediatrics (Neonatal-Perinatal Medicine), Penn State Health Children's Hospital, Hershey, PA, USA
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chenghui Li
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Jackson DB, Testa A. Environmental Tobacco Smoke and Early Language Difficulties among U.S. Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6489. [PMID: 34208503 PMCID: PMC8296409 DOI: 10.3390/ijerph18126489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022]
Abstract
Objective: Environmental Tobacco Smoke (ETS) is a serious public health concern with the potential to interfere with various components of healthy child development. Even so, there has been limited nationally representative research investigating these connections. The current study examines the relationship between ETS and language difficulties among toddlers and preschool-aged children in the United States. Method: Data are derived from the 2018 National Survey of Children's Health and facilitate strategic comparisons between different forms of ETS-namely, children who live with family members who smoke vs. children whose family members smoke inside the housing unit. Results: The findings reveal a robust association between family members smoking inside the housing unit and both receptive and expressive language difficulties, but only among male children. After adjusting for covariates, smoking inside the housing unit is associated with a 182% increase in the rate of early composite language difficulties among male children. These associations persist even when compared to male children who live with smoking family members who do not smoke inside the housing unit. Conclusions: The findings suggest a need for interventions designed to reduce ETS in households with young children and increase targeted language skill training for vulnerable children in an effort to enhance child development and well-being. To maximize this effort, we advocate for interdisciplinary teams, including medical and public health practitioners, educators, and researchers, to work together to develop and implement evidence-based strategies to limit ETS in homes and facilitate healthy language development among young children.
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Affiliation(s)
- Dylan B. Jackson
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX 78249, USA;
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Lin LZ, Xu SL, Wu QZ, Zhou Y, Ma HM, Chen DH, Chen GB, Yu HY, Yang BY, Zeng XW, Hu LW, Dong GH. Association of Prenatal, Early Postnatal, or Current Exposure to Secondhand Smoke With Attention-Deficit/Hyperactivity Disorder Symptoms in Children. JAMA Netw Open 2021; 4:e2110931. [PMID: 34014325 PMCID: PMC8138689 DOI: 10.1001/jamanetworkopen.2021.10931] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Few studies have investigated the association between the exposure window (prenatal, early postnatal, and current period) of secondhand smoke (SHS) and attention-deficit/hyperactivity disorder (ADHD) symptoms and subtypes in children. OBJECTIVE To evaluate the associations of prenatal, early postnatal, or current SHS exposure with ADHD symptoms and subtypes among school-aged children. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, 48 612 children aged 6 to 18 years from elementary and middle schools in Liaoning province, China, between April 2012 and January 2013 were eligible for participation. Data on SHS exposure and ADHD symptoms and subtypes for each child were collected via questionnaires administered to parents or guardians by school teachers. Data were analyzed from September 14 to December 2, 2020. MAIN OUTCOMES AND MEASURES The ADHD symptoms and subtypes (inattention, hyperactivity-impulsivity, and combined) were measured based on a validated tool developed from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Generalized linear mixed models were evaluated to estimate the association of SHS exposure with ADHD symptoms and subtypes. RESULTS A total of 45 562 participants completed the questionnaires and were included in this study (22 905 girls [50.3%]; mean [SD] age, 11.0 [2.6] years; 2170 [4.8%] with ADHD symptoms). Compared with their unexposed counterparts, children who were ever exposed (odds ratio [OR], 1.50; 95% CI, 1.36-1.66) or always exposed to SHS (OR, 2.88; 95% CI, 2.55-3.25) from pregnancy to childhood had higher odds of having ADHD symptoms and subtypes (ORs ranged from 1.46 [95% CI, 1.31-1.62] to 2.94 [95% CI, 2.09-4.13]). Compared with their unexposed counterparts, children with SHS exposure had higher odds of having ADHD symptoms when exposed in the prenatal period (OR, 2.28; 95% CI, 2.07-2.51), early postnatal period (OR, 1.47; 95% CI, 1.29-1.68), or current period (OR, 1.20; 95% CI, 1.09-1.31). Compared with their unexposed counterparts, children whose fathers smoked 10 or more cigarettes/d on both weekdays and weekends had higher odds of having ADHD symptoms and subtypes (ORs ranged from 1.48 [95% CI, 1.28-1.70] to 2.25 [95% CI, 1.29-3.93]). CONCLUSIONS AND RELEVANCE Being exposed to SHS from pregnancy to childhood was associated with higher odds of having ADHD symptoms and subtypes among school-aged children, and the associations were somewhat stronger for SHS exposure during prenatal and early postnatal periods. Our findings highlight the important public health implications of reducing SHS exposure, which may decrease the health and economic burdens of individuals with ADHD.
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Affiliation(s)
- Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shu-Li Xu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qi-Zhen Wu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yang Zhou
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, China
| | - Hui-Min Ma
- State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Protection and Resources Utilization, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou, China
| | - Duo-Hong Chen
- Department of Air Quality Forecasting and Early Warning, Guangdong Environmental Monitoring Center, State Environmental Protection Key Laboratory of Regional Air Quality Monitoring, Guangdong Environmental Protection Key Laboratory of Atmospheric Secondary Pollution, Guangzhou, China
| | - Gong-Bo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hong-Yao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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