Urinary polycyclic aromatic hydrocarbon metabolites and attention/deficit hyperactivity disorder, learning disability, and special education in U.S. children aged 6 to 15

Childhood exposure to polycyclic aromatic hydrocarbons is associated with emotional and behavioral problems in adolescence: a longitudinal study in China

PURPOSE

The aim of this study was to investigate the relationship between childhood polycyclic aromatic hydrocarbon (PAH) exposure and emotional and behavioral problems in adolescence.

METHODS

Participants included 998 school-age children aged 7-12 years (514 girls and 484 boys). Metabolite concentrations of four PAHs (1-hydroxypyrene [1-OHPyr], 2-hydroxynaphthalene [2-OHNap], 2-hydroxyfluorine [2-OHFlu], and 9-hydroxyphenanthrene [9-OHPhe]) were measured in urine samples at baseline (Dec 2014-Dec 2015). During adolescence, we measured emotional and behavioral problems in study participants. We used logistic regression models to assess the effects of different levels of PAH metabolite concentrations on emotional and behavioral problems for boys and girls, separately.

RESULTS

Boys exposed to 1-OHPyr and 2-OHFlu had a significantly higher risk of externalizing problems (OR: 2.62, 95% CI: 1.09 ~ 6.29; OR: 2.92, 95% CI: 1.15 ~ 7.42). 2-OHNap exposure faced a higher risk of internalizing problems (OR: 3.85, 95% CI: 1.28 ~ 11.58; OR: 3.63, 95% CI: 1.13 ~ 11.63) and externalizing problems (OR: 4.27, 95% CI: 1.44 ~ 12.70; OR: 4.68, 95% CI: 1.49 ~ 14.73). Moreover, boys exposed to 9-OHPhe exhibited a significant risk of anxiety (OR: 2.84, 95% CI: 1.01 ~ 7.97; OR: 3.00, 95% CI: 1.04 ~ 8.68). Similarly, girls exposed to 9-OHPhe had a significant risk of anxiety (OR: 2.41, 95% CI: 1.25 ~ 4.64).

CONCLUSION

Childhood PAH exposures are associated with emotional and behavioral problems in adolescence, and boys seem more susceptible than girls.

Prenatal exposure to polycyclic aromatic hydrocarbons and executive functions at school age: Results from a combined cohort study

BACKGROUND

Executive functions develop rapidly in childhood, enabling problem-solving, focused attention, and planning. Exposures to environmental toxicants in pregnancy may impair healthy executive function development in children. There is increasing concern regarding polycyclic aromatic hydrocarbons (PAHs) given their ability to transfer across the placenta and the fetal blood-brain barrier, yet evidence from epidemiological studies is limited.

METHODS

We examined associations between prenatal PAH exposure and executive functions in 814 children of non-smoking mothers from two U.S. cohorts in the ECHO-PATHWAYS Consortium. Seven mono-hydroxylated PAH metabolites were measured in mid-pregnancy urine and analyzed individually and as mixtures. Three executive function domains were measured at age 8-9: cognitive flexibility, working memory, and inhibitory control. A composite score quantifying overall performance was further calculated. We fitted linear regressions adjusted for socio-demographics, maternal health behaviors, and psychological measures, and examined modification by child sex and stressful life events in pregnancy. Bayesian kernel machine regression was performed to estimate the interactive and overall effects of the PAH mixture.

RESULTS

The results from primary analysis of linear regressions were generally null, and no modification by child sex or maternal stress was indicated. Mixture analyses suggested several pairwise interactions between individual PAH metabolites in varied directions on working memory, particularly interactions between 2/3/9-FLUO and other PAH metabolites, but no overall or individual effects were evident.

CONCLUSION

We conducted a novel exploration of PAH-executive functions association in a large, combined sample from two cohorts. Although findings were predominantly null, the study carries important implications for future research and contributes to evolving science regarding developmental origins of diseases.

Prepubertal exposure to polycyclic aromatic hydrocarbons are associated with early pubertal development onset in boys: A longitudinal study

OBJECTIVE

To investigate the effects of polycyclic aromatic hydrocarbons(PAHs) on puberty in boys.

METHODS

695 subjects were selected from four primary schools in Chongqing, China. 675 urine samples from these boys were collected four PAH metabolites: 1-hydroxypyrene, 2-hydroxynaphthoic, 2-hydroxyfluorene, and 9-hydroxyphenanthrene. Pubertal development of 695 boys was assessed at follow-up visits starting in December 2015 and occurring every six months thereafter until now, data used in this article ending in June 2021. A total of 12 follow-up visits were performed. Cox proportional hazards regression models were used to analyze the relationship between PAH metabolite concentrations and indicators of pubertal timing.

RESULTS

The mean age at puberty onset of testicular volume, facial hair, pubic hair, first ejaculation, and axillary hair in boys was 11.66, 12.43, 12.51, 12.72 and 13.70 years, respectively. Cox proportional hazards regression models showed that boys with moderate level of 1-OHPyr exposure was associated with earlier testicular development (hazard ratio [HR] = 1.276, 95% confidence interval [CI]: 1.006-1.619), with moderate level of 2-OHNap were at higher risk of early testicular development (HR = 1.273, 95% CI: 1.002-1.617) and early axillary hair development (HR = 1.355, 95% CI: 1.040-1.764), with moderate level of 2-OHFlu was associated with earlier pubic hair development (HR = 1.256, 95% CI: 1.001-1.577), with high level of 9-OHPhe were at higher risk of early fisrt ejaculation (HR = 1.333, 95% CI: 1.005-1.767) and early facial hair development (HR = 1.393, 95% CI: 1.059-1.831).

CONCLUSION

Prepubertal exposure to PAHs may be associated with earlier pubertal development in boys.

Dyslexia is associated with urinary polycyclic aromatic hydrocarbon metabolite concentrations of children from China: Data from the READ program

It has been found that exposure to polycyclic aromatic hydrocarbons (PAHs) is associated with the risk of certain childhood neurodevelopmental disorders. However, no research has investigated the relationship between exposure to PAHs and children's dyslexia odds. The objective of this research was to investigate whether urinary mono-hydroxylated polycyclic aromatic hydrocarbons (OH-PAHs) are associated with increased dyslexia odds in Chinese children. We recruited 1,089 children (542 dyslexic children and 547 non-dyslexic children) for this case-control study. Ten OH-PAHs were measured in the participants' urine samples, which were collected between November 2017 and March 2023. Odds ratios (ORs) of the associations between the OH-PAHs and dyslexia were calculated using logistic regression models, after adjustment for the potential confounding factors. A significant association was found between urinary concentrations of 2-hydroxynaphthalene (2-OHNap) and the elevated odds of dyslexia. The children in the highest quartile of 2-OHNap had a higher OR of dyslexia (1.87, 95% CI: 1.07-3.27) than those in the lowest quartile (P-trend = 0.02) after adjustment for the covariates. After excluding children with maternal disorders during pregnancy, logistic regression analyses showed similar results. Our results suggested a possible association between PAH exposure and the elevated odds of dyslexia.

Association between the Healthy Eating Index-2015 and Developmental Disabilities in Children: A Cross-Sectional Analysis

Few studies have examined the association between dietary quality and the risk of developmental disabilities (DDs). This study aimed to investigate the association between dietary quality and the risk of DDs in US children aged 5 to 15. We employed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Multivariable logistic regression was used to evaluate the association between HEI-2015 score, HEI component score, and the likelihood of DDs. Restricted cubic splines (RCS) were utilized to investigate nonlinear links between HEI-2015 score and the likelihood of DDs. Interaction analysis was utilized to explore differences between subgroups. HEI-2015 score was negatively linked with the risk of DDs after adjusting covariates [odds ratio (OR) = 0.99; 95% confidence interval (CI) = (0.98, 1.00)]. HEI-2015 score was separated by quartile into Q1, Q2, Q3, and Q4. Q1 represents the lowest HEI scores, while Q4 represents the highest HEI scores. Children in the fourth quartile of the HEI-2015 exhibited a decreased prevalence of DDs compared to those in the first quartile [(OR = 0.69; 95% CI = (0.53, 0.89)]. The association between HEI-2015 score and the risk of DDs was modified by race/ethnicity. The higher HEI-2015 score was associated with a lower risk of DDs, suggesting that better dietary quality may reduce the risk of DDs in children.

Prenatal exposure to polycyclic aromatic hydrocarbons and cognition in early childhood

BACKGROUND

Epidemiological evidence for gestational polycyclic aromatic hydrocarbon (PAH) exposure and adverse child cognitive outcomes is mixed; little is known about critical windows of exposure.

OBJECTIVE

We investigated associations between prenatal PAH exposure and child cognition in a large, multi-site study.

METHODS

We included mother-child dyads from two pooled prospective pregnancy cohorts (CANDLE and TIDES, N = 1,223) in the ECHO-PATHWAYS Consortium. Seven urinary mono-hydroxylated PAH metabolites were measured in mid-pregnancy in both cohorts as well as early and late pregnancy in TIDES. Child intelligence quotient (IQ) was assessed between ages 4-6. Associations between individual PAH metabolites and IQ were estimated with multivariable linear regression. Interaction terms were used to examine effect modification by child sex and maternal obesity. We explored associations of PAH metabolite mixtures with IQ using weighted quantile sum regression. In TIDES, we averaged PAH metabolites over three periods of pregnancy and by pregnancy period to investigate associations between PAH metabolites and IQ.

RESULTS

In the combined sample, PAH metabolites were not associated with IQ after full adjustment, nor did we observe associations with PAH mixtures. Tests of effect modification were null except for the association between 2-hydroxynaphthalene and IQ, which was negative in males (βmales = -0.67 [95%CI:-1.47,0.13]) and positive in females (βfemales = 0.31 [95%CI:-0.52,1.13])(pinteraction = 0.04). In analyses across pregnancy (TIDES-only), inverse associations with IQ were observed for 2-hydroxyphenanthrene averaged across pregnancy (β = -1.28 [95%CI:-2.53,-0.03]) and in early pregnancy (β = -1.14 [95%CI:-2.00,-0.28]).

SIGNIFICANCE

In this multi-cohort analysis, we observed limited evidence of adverse associations of early pregnancy PAHs with child IQ. Analyses in the pooled cohorts were null. However, results also indicated that utilizing more than one exposure measures across pregnancy could improve the ability to detect associations by identifying sensitive windows and improving the reliability of exposure measurement. More research with multiple timepoints of PAH assessment is warranted.

Children's exposure to polycyclic aromatic hydrocarbon (PAHs): a review on urinary 1-hydroxypyrene and associated health effects

This article reviewed the published studies on the environmental exposure to polycyclic aromatic hydrocarbons (PAHs) among children and assessed the urinary 1-hydroxypyrene (1-OHP) level as a biomarker of exposure to PAHs. The current knowledge of the potential health effects of increased 1-OHP in children was reviewed. Additionally, the influence of genetic polymorphism on the urinary 1-OHP level was discussed in this review. The assembled data showed that children who are attending schools or living close to industrial and polluted urban areas might have greater exposure to higher concentrations of PAHs with a higher level of urinary 1-OHP when compared to those children living in rural areas. Urinary 1-OHP may be a reliable biomarker for determining the genotoxic effects, oxidative stress and inflammation caused by exposure to PAHs. Strong research evidence indicated that the total body burden of PAHs should be evaluated by biomonitoring of 1-OHP in line with other urinary PAHs metabolites (with 2-3 rings) to evaluate recent total exposure to PAHs. Overall, the study suggests implementing a mitigation plan to combat air pollution to provide a cleaner environment for children.

Impact of polycyclic aromatic hydrocarbon exposure on cognitive function and neurodegeneration in humans: A systematic review and meta-analysis

Introduction

This article documents an emerging body of evidence concerning the neurological effect of polycyclic aromatic hydrocarbon (PAH) exposure with regard to cognitive function and increased risk of neurodegeneration.

Methods

Two electronic databases, PubMed and Web of Science, were systematically searched.

Results

The 37/428 studies selected included outcomes measuring cognitive function, neurobehavioral symptoms of impaired cognition, and pathologies associated with neurodegeneration from pre-natal (21/37 studies), childhood (14/37 studies), and adult (8/37 studies) PAH exposure. Sufficient evidence was found surrounding pre-natal exposure negatively impacting child intelligence, mental development, average overall development, verbal IQ, and memory; externalizing, internalizing, anxious, and depressed behaviors; and behavioral development and child attentiveness. Evidence concerning exposure during childhood and as an adult was scarce and highly heterogeneous; however, the presence of neurodegenerative biomarkers and increased concentrations of cryptic "self" antigens in serum and cerebrospinal fluid samples suggest a higher risk of neurodegenerative disease. Associations with lowered cognitive ability and impaired attentiveness were found in children and memory disturbances, specifically auditory memory, verbal learning, and general memory in adults.

Discussion

Although evidence is not yet conclusive and further research is needed, the studies included supported the hypothesis that PAH exposure negatively impacts cognitive function and increases the risk of neurodegeneration in humans, and recommends considering the introduction of a variable "rural vs. urban" as covariate for adjusting analyses, where the neurological functions affected (as result of our review) are outcome variables.

Prenatal exposure to polycyclic aromatic hydrocarbons is not associated with behavior problems in preschool and early school-aged children: A prospective multi-cohort study

BACKGROUND

Epidemiological study findings are inconsistent regarding associations between prenatal polycyclic aromatic hydrocarbon (PAH) exposures and childhood behavior. This study examined associations of prenatal PAH exposure with behavior at age 4-6 years in a large, diverse, multi-region prospective cohort. Secondary aims included examination of PAH mixtures and effect modification by child sex, breastfeeding, and child neighborhood opportunity.

METHODS

The ECHO PATHWAYS Consortium pooled 1118 mother-child dyads from three prospective pregnancy cohorts in six U.S. cities. Seven PAH metabolites were measured in prenatal urine. Child behavior was assessed at age 4-6 using the Total Problems score from the Child Behavior Checklist (CBCL). Neighborhood opportunity was assessed using the socioeconomic and educational scales of the Child Opportunity Index. Multivariable linear regression was used to estimate associations per 2-fold increase in each PAH metabolite, adjusted for demographic, prenatal, and maternal factors and using interaction terms for effect modifiers. Associations with PAH mixtures were estimated using Weighted Quantile Sum Regression (WQSR).

RESULTS

The sample was racially and sociodemographically diverse (38% Black, 49% White, 7% Other; household-adjusted income range $2651-$221,102). In fully adjusted models, each 2-fold increase in 2-hydroxynaphthalene was associated with a lower Total Problems score, contrary to hypotheses (b = -0.80, 95% CI = -1.51, -0.08). Associations were notable in boys (b = -1.10, 95% CI = -2.11, -0.08) and among children breastfed 6+ months (b = -1.31, 95% CI = -2.25, -0.37), although there was no statistically significant evidence for interaction by child sex, breastfeeding, or neighborhood child opportunity. Associations were null for other PAH metabolites; there was no evidence of associations with PAH mixtures from WQSR.

CONCLUSION

In this large, well-characterized, prospective study of mother-child pairs, prenatal PAH exposure was not associated with child behavior problems. Future studies characterizing the magnitude of prenatal PAH exposure and studies in older childhood are needed.

Fetal Exposure to Air Pollution in Late Pregnancy Significantly Increases ADHD-Risk Behavior in Early Childhood

BACKGROUND

Air pollution nowadays has seriously threatened the health of the Chinese population, especially in the vulnerable groups of fetuses, infants and toddlers. In particular, the effects of air pollution on children's neurobehavioral development have attracted widespread attention. Moreover, the early detection of a sensitive period is very important for the precise intervention of the disease. However, such studies focusing on hyperactive behaviors and susceptible window identification are currently lacking in China.

OBJECTIVES

The study aims to explore the correlation between air pollution exposure and hyperactive behaviors during the early life stage and attempt to identify whether a susceptible exposure window exists that is crucial for further precise intervention.

METHODS

Based on the Longhua Child Cohort Study, we collected the basic information and hyperactivity index of 26,052 children using a questionnaire conducted from 2015 to 2017, and the Conners' Parent Rating Scale-revised (CPRS-48) was used to assess hyperactive behaviors. Moreover, the data of air pollution concentration (PM₁₀, PM_2.5, NO₂, CO, O₃ and SO₂) were collected from the monitoring station between 2011 to 2017, and a land-use random forest model was used to evaluate the exposure level of each subject. Furthermore, Distributed lag non-linear models (DLNMs) were applied for statistic analysis.

RESULTS

The risk of child hyperactivity was found to be positively associated with early life exposure to PM₁₀, PM_2.5 and NO₂. In particular, for an increase of per 10 µg/m³ in PM₁₀, PM_2.5 and NO₂ exposure concentration during early life, the risk of child hyperactivity increased significantly during the seventh month of pregnancy to the fourth month after birth, with the strongest association in the ninth month of pregnancy (PM₁₀: OR = 1.043, 95% CI: 1.016-1.071; PM_2.5: OR = 1.062, 95% CI: 1.024-1.102; NO₂: OR = 1.043, 95% CI: 1.016-1.071). However, no significant associations among early life exposure to CO, O₃ and SO₂ and child hyperactive behaviors were observed.

CONCLUSIONS

Early life exposure to PM₁₀, PM_2.5 and NO₂ is associated with an increased risk of child ADHD-like behaviors at the age around 3 years, and the late-prenatal and early postnatal periods might be the susceptible exposure windows.

Prenatal urinary metabolites of polycyclic aromatic hydrocarbons and toddler cognition, language, and behavior

BACKGROUND

Animal and epidemiological studies suggest that prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) may negatively impact toddler neurodevelopment.

METHODS

We investigated this association in 835 mother-child pairs from CANDLE, a diverse pregnancy cohort in the mid-South region of the U.S. PAH metabolite concentrations were measured in mid-pregnancy maternal urine. Cognitive and Language composite scores at ages 2 and 3 years were derived from the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3). Behavior Problem and Competence scores at age 2 were derived from the Brief Infant and Toddler Social Emotional Assessment (BITSEA). We used multivariate linear or Poisson regression to estimate associations with continuous scores and relative risks (RR) of neurodevelopment delay or behavior problems per 2-fold increase in PAH, adjusted for maternal health, nutrition, and socioeconomic status. Secondary analyses investigated associations with PAH mixture using Weighted Quantile Sum Regression (WQS) with a permutation test extension.

RESULTS

1- hydroxypyrene was associated with elevated relative risk for Neurodevelopmental Delay at age 2 (RR = 1.20, 95% CI: 1.03,1.39). Contrary to hypotheses, 1-hydroxynaphthalene was associated with lower risk for Behavior Problems at age 2 (RR = 0.90, 95% CI: 0.83,0.98), and combined 1- and 9-hydroxyphenanthrene was associated with 0.52-point higher (95% CI: 0.11,0.93) Cognitive score at age 3. For PAH mixtures, a quintile increase in hydroxy-PAH mixture was associated with lower Language score at age 2 (βwqs = -1.59; 95% CI: -2.84, -0.34; p_permutation = 0.07) and higher Cognitive score at age 3 (βwqs = 0.96; 95% CI: 0.11, 1.82; p_permutation = 0.05). All other estimates were consistent with null associations.

CONCLUSION

In this large southern U.S. population we observed some support for adverse associations between PAHs and neurodevelopment.

Association between exposure to air pollutants and attention-deficit hyperactivity disorder (ADHD) in children: a systematic review and meta-analysis

Recent studies have reached mixed conclusions regarding the association between exposure to air pollutants and attention-deficit hyperactivity disorder (ADHD). We performed systematic review and meta-analysis to determine whether air pollutants were risk factors for the development of ADHD in children. We systematically searched databases for all relevant studies up to 2 July 2019. Together, the studies indicated that exposure to PAHs (risk ratio (RR): 0.98, 95% confidence interval (CI): 0.82-1.17), NOx (RR: 1.04, 95% CI: 0.94-1.15), and PM (RR: 1.11, 95% CI: 0.93-1.33) did not have any material relationship with an increased risk of ADHD. Heterogeneity of study data was low (I²: 2.7%, P = 0.409) for studies examining PAHs, but was substantial for NOx and PM (I²: 68.4%, P = 0.007 and I²: 60.1%, P = 0.014, respectively). However, these results should be interpreted with caution since the number of epidemiological studies investigating this issue were limited.

Trends in urinary metabolites of polycyclic aromatic hydrocarbons (PAHs) in the non-smoking U.S. population, NHANES 2001-2014

BACKGROUND

Recent studies indicate airborne PAH levels have decreased in the U.S., but it is unclear if this has resulted in PAH exposure changes in the U.S.

POPULATION

OBJECTIVE

Examine temporal trends in urinary metabolites of Naphthalene, Fluorene, Phenanthrene, and Pyrene in U.S. non-smokers, 6+ years old.

METHODS

We used biomonitoring data from the National Health and Nutrition Examination Survey (NHANES) program, 2001-2014, (N = 11,053) using survey weighted linear regression. Models were adjusted for age, sex, race/ethnicity, creatinine, BMI, income, diet, and seasonality. Stratified models evaluated the effect of age, sex, and race/ethnicity on trends.

RESULTS

Between 2001 and 2014, Naphthalene exposure increased 36% (p < 0.01); Pyrene exposure increased 106% (p < 0.01); Fluorene and Phenanthrene exposure decreased 55% (p < 0.01), and 37% (p < 0.01), respectively. Naphthalene was the most abundant urinary PAH, 20-fold higher than Fluorene and Phenanthrene, and over 50-fold higher than Pyrene compared to reference groups, effect modification was observed by age (Naphthalene, Pyrene), sex (Fluorene, Pyrene), and race/ethnicity (Naphthalene, Fluorene, Phenanthrene, Pyrene).

SIGNIFICANCE

This study shows exposure to Naphthalene and Pyrene increased, while exposure to Fluorene and Phenanthrene decreased among the non-smoking U.S. general population between 2001 and 2014, suggesting environmental sources of PAHs have changed over the time period.

Proximity to traffic and exposure to polycyclic aromatic hydrocarbons in relation to Attention Deficit Hyperactivity Disorder and conduct disorder in U.S. children

BACKGROUND

Traffic related air pollution (TRAP) and its component polycyclic aromatic hydrocarbons (PAHs) may be neurotoxic in children. There is limited research on postnatal exposure to TRAP and PAHs and child neurodevelopment.

METHODS

We linked data from the U.S. NHANES 2001-2004 with the National Highway Planning Network 2005 to examine the proximity to major roads (highway or urban/rural principal arterials), urinary PAH metabolites, and diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) based on Diagnostic Interview Schedule for Children (C-DISC) in 1253 children aged 8-15 years. We calculated odds ratios (ORs) and 95% Confidence Intervals (CIs) for ADHD and CD by traffic proximity and PAH exposures using logistic regression adjusted for confounders.

RESULTS

Higher ADHD prevalence was observed among children living <500 m (9.86%) compared to those ≥500 m (3.84%) from a major road. Prevalence of children with CD was comparable (<500 m: 2.51% and ≥500 m: 2.43%). We found little difference in urinary PAH metabolite levels between children living near major roads and those who did not. Children living <500 m from a major road had a non-significant OR of 2.06 (95% CI 0.85-5.03) for ADHD diagnosis. Children living on ≥2 major roads within 500 m of a highway had a non-significant OR of 2.27 (95% CI 0.71-7.26) for ADHD diagnosis. There was no association between proximity to major roads and CD diagnosis.

CONCLUSION

We found living close to a major road was not associated with increased PAH levels. We did not find statistically significant relation between proximity to a major road or urinary PAH metabolite levels and ADHD or CD diagnosis in this cross-sectional analysis. Prospective studies are needed for the investigation of postnatal TRAP exposure and ADHD and CD diagnosis.

A framework for assessing the impact of chemical exposures on neurodevelopment in ECHO: Opportunities and challenges

The Environmental influences on Child Health Outcomes (ECHO) Program is a research initiative funded by the National Institutes of Health that capitalizes on existing cohort studies to investigate the impact of early life environmental factors on child health and development from infancy through adolescence. In the initial stage of the program, extant data from 70 existing cohort studies are being uploaded to a database that will be publicly available to researchers. This new database will represent an unprecedented opportunity for researchers to combine data across existing cohorts to address associations between prenatal chemical exposures and child neurodevelopment. Data elements collected by ECHO cohorts were determined via a series of surveys administered by the ECHO Data Analysis Center. The most common chemical classes quantified in multiple cohorts include organophosphate pesticides, polychlorinated biphenyls, polybrominated diphenyl ethers, environmental phenols (including bisphenol A), phthalates, and metals. For each of these chemicals, at least four ECHO cohorts also collected behavioral data during infancy/early childhood using the Child Behavior Checklist. For these chemicals and this neurodevelopmental assessment (as an example), existing data from multiple ECHO cohorts could be pooled to address research questions requiring larger sample sizes than previously available. In addition to summarizing the data that will be available, the article also describes some of the challenges inherent in combining existing data across cohorts, as well as the gaps that could be filled by the additional data collection in the ECHO Program going forward.

Association between exposure to polycyclic aromatic hydrocarbons and attention deficit hyperactivity disorder in children: a systematic review and meta-analysis

Some studies have shown that exposure to polycyclic aromatic hydrocarbons (PAHs) is a dangerous factor for attention deficit hyperactivity disorder (ADHD). This systematic review and meta-analysis aimed to clarify this relationship, and to collect and analyze all the relevant evidences in published reports of epidemiologic studies. PubMed, Science Direct, Web of Science, Scopus, and Google Scholar databases were searched through September 31, 2018. The study quality was evaluated using the Newcastle-Ottawa Scale. Moreover, fixed- and random-effect models were used. The data in this meta-analysis were presented as adjusted odds ratio (AOR). From 959 articles, six articles were included in the systematic review, and for meta-analysis, one study (that was not AOR) was excluded. The participants included in the studies were 2799 with the age range of 5-15 years old, and 93.6% were living in America. Four of the studies were placed in one group, due to having a common author (Perera). Moreover, a significant association was found between PAH exposure and ADHD in these studies (odds ratio = 2.57, 95% CI = 1.75-3.78); however, in all studies, there was no significant association between PAH exposure and ADHD for children (overall odds ratio = 1.99, 95% CI = 0.96-4.11) with low heterogeneity (I² = 28.73%; P value < 0.001). This study provided a systematic review and meta-analytic evidence for the association between PAH exposure and ADHD by a small number of studies. Further research study can be conducted in various countries. Graphical Abstract.

Exposure to air pollution in early childhood and the association with Attention-Deficit Hyperactivity Disorder

BACKGROUND

Exposure to air pollution in early life has been linked to cognitive deficits and adverse neurodevelopmental effects. However, studies examining associations between air pollutants and Attention-Deficit/Hyperactivity Disorder (ADHD) have had conflicting findings.

METHODS

Individuals born in Denmark 1992-2007 (n = 809,654) were followed for the development of ADHD from 1997 to 2013. Data on daily concentrations of nitrogen dioxide (NO₂) and fine particulate matter (PM_2.5) from air-modeling data at a 1 km × 1 km resolution at residences within the first five years of life, was linked with population-based data from the Danish national registers, including data on clinical diagnoses of ADHD. We estimated incidence rate ratios (IRRs) with 95% confidence intervals (CI) for ADHD, according to increases in exposures, adjusting for age, year, sex, and parental education and income.

RESULTS

Exposure to NO₂ and PM_2.5 during early life was associated with a significantly increased risk of ADHD: IRR of 1.38 (Cl: 1.35 to 1.42) per 10 μg/m³ increase in NO₂ and an IRR of 1.51 (Cl: 1.41 to 1.62) per 5 μg/m³ increase in PM_2.5. In two-pollutant models, the association between NO₂ and ADHD did not change (IRR 1.35; 95% CI: 1.31 to 1.39), while the association with PM_2.5 was substantially attenuated (IRR 1.07; 95% CI: 0.98 to 1.16), although in stratified models an elevated association with PM_2.5 was found in the lowest quintile of NO₂ exposure.

CONCLUSIONS

In this large nationwide prospective cohort study, residential air pollution exposure, specifically NO₂, during early childhood was associated with the development of ADHD, even when adjusted for parental level of income and education.

Exposure to ambient air pollution and early childhood behavior: A longitudinal cohort study

BACKGROUND

Prenatal and early life air pollution exposure may impair healthy neurodevelopment, increasing risk of childhood behavioral disorders, but epidemiological evidence is inconsistent. Little is known about factors that determine susceptibility.

METHODS

Participants were mother-child dyads from the CANDLE study, an ECHO PATHWAYS Consortium birth cohort set in the mid-South United States, who completed a preschool visit. We estimated prenatal and childhood exposures to nitrogen dioxide (NO₂) and particulate matter less than 10 μm (PM₁₀) at participants' residences using a national annual average universal kriging model (land-use regression with spatial smoothing). Distance to nearest major roadway was used as a proxy for traffic-related pollution. Primary outcomes were children's internalizing and externalizing behavior problems. Regression models were adjusted for individual- and neighborhood-level socioeconomic measures, maternal IQ, and multiple other potential confounders. We tested for effect modification by select maternal and child characteristics.

RESULTS

The analytic sample (N = 975 of 1503 enrolled) was 64% African American and 53% had a household annual income below $35,000; child mean age was 4.3 years (SD: 0.4). Mean prenatal NO₂ and PM₁₀ exposures were 12.0 ppb (SD: 2.4) and 20.8 μg/m3 (SD: 2.0); postnatal exposures were lower. In fully adjusted models, 2 ppb higher prenatal NO₂ was positively associated with externalizing behavior (6%; 95% CI: 1, 11%). Associations with postnatal exposure were stronger (8% per 2 ppb NO₂; 95%CI: 0, 16%). Prenatal NO₂ exposure was also associated with an increased odds of clinically significant internalizing and externalizing behaviors. We found suggestive evidence that socioeconomic adversity and African American race increases susceptibility. PM₁₀ and road proximity were not associated with outcomes.

CONCLUSIONS

Findings showed that air pollution exposure is positively associated with child behavior problems and that African American and low SES children may be more susceptible. Importantly, associations were observed at exposures below current air quality standards.

Urinary biomarkers of polycyclic aromatic hydrocarbons and the association with hearing threshold shifts in the United States adults

Polycyclic aromatic hydrocarbons (PAHs) are regarded as environmental pollutants that contribute to several adverse health outcomes. There is no research evidence to support a connection between PAH exposure and hearing loss. Our study aimed to determine the association between PAH exposure and hearing threshold shifts using the National Health and Nutrition Examination Survey (NHANES) dataset. A cross-sectional study was conducted among 1,071 US adults participating in the NHANES from 2001 to 2004. The association between PAH metabolites and the log-transformed hearing threshold was investigated using multivariate regression models, which included log-transformed, low-frequency and high-frequency thresholds. After additional pertinent adjustments, a positive correlation between PAH metabolite concentration and log-transformed hearing thresholds was observed. Individuals in the fourth quartile of PAH metabolite concentration had higher hearing thresholds compared with those in the first quartile of PAH metabolite concentration. Exposure to PAHs is related to hearing threshold shift at both low and high frequencies in the US adult population.

Association between ambient gaseous and particulate air pollutants and attention deficit hyperactivity disorder (ADHD) in children; a systematic review

ADHD is a common neurodevelopmental disorder highly attributed to genetics, but the combination of other social and environmental determinants, as well as potential gene-environment interactions, can also be responsible. This paper aims to review relevant literature published up to April 2018 for determining whether air pollution caused by ambient gaseous (NO₂, SO₂, PCDD/Fs, Benzene) and particulate matters (PM₁₀, PM_2.5, PM₇, PAH, BC/EC) as an environmental risk factor is associated with increased risk of ADHD in children. Relevant literature was identified through electronic searches of PubMed, Embase, Web of Science, Scopus database and gray literature. A total of 872 articles were initially identified 28 of which meeting the defined inclusion criteria were included. The methodological quality of the included articles was evaluated using the modified Critical Appraisal Skills Programs (CASP) and confounding variables, exposure and outcome measurement were assessed. The results of this systematic review revealed that there is more evidence on the detrimental effects of EC, BC, and PM on ADHD compared to PAH. Among gaseous air pollutants, association was found between SO₂ and urinary level of t,t-MA (trans, trans-muconic acid) as a proxy-biomarker of NO₂ exposure, not merely benzene. However few studies related to NO₂ (0.46%) found detrimental effects. Overall, the number of studies reporting an association between air pollution and increased risk of ADHD is relatively higher compared to the number of studies reporting no association. However, the findings of the studies provided limited evidence to support the idea that exposure to air pollution may be linked to increased risk of ADHD. Well-designed and harmonized studies considering standard methods for individual exposure assessment, critical windows of susceptibility, and appropriate tools for outcome measurement, can improve the quality of epidemiological studies and strengthen the evidence. Since ADHD with its long-term consequences can impose large costs to communities and impact the children performance, determination of the risk factors in children and particularly the role of the environment as priorities for research should be considered.

Exposure to environmental toxicants and young children's cognitive and social development

Background Understanding the role of environmental toxicant exposure on children's development is an important area of inquiry in order to better understand contextual factors that shape development and ultimately school readiness among young children. There is evidence suggesting negative links between exposure to environmental toxicants and negative physical health outcomes (i.e. asthma, allergies) in children. However, research on children's exposure to environmental toxicants and other developmental outcomes (cognitive, socioemotional) is limited. Objectives The goal of the current review was to assess the existing literature on the links between environmental toxicants (excluding heavy metals) and children's cognitive, socioemotional, and behavioral development among young children. Methods This literature review highlights research on environmental toxicants (i.e. pesticide exposure, bisphenol A, polycyclic aromatic hydrocarbons, tobacco smoke, polychlorinated biphenyls, flame retardants, phthalates and gas pollutions) and children's development across multiple domains. Results The results highlight the potential risk of exposure to multiple environmental toxicants for young children's cognitive and socioemotional development. Discussion Discussion will focus on the role of environmental toxicants in the cognitive and socioemotional development of young children, while highlighting gaps in the existing literature.

Air Pollution Exposure During Pregnancy and Symptoms of Attention Deficit and Hyperactivity Disorder in Children in Europe

BACKGROUND

Exposure to air pollution during pregnancy may increase attention-deficit/hyperactivity disorder (ADHD) symptoms in children, but findings have been inconsistent. We aimed to study this association in a collaborative study of eight European population-based birth/child cohorts, including 29,127 mother-child pairs.

METHODS

Air pollution concentrations (nitrogen dioxide [NO2] and particulate matter [PM]) were estimated at the birth address by land-use regression models based on monitoring campaigns performed between 2008 and 2011. We extrapolated concentrations back in time to exact pregnancy periods. Teachers or parents assessed ADHD symptoms at 3-10 years of age. We classified children as having ADHD symptoms within the borderline/clinical range and within the clinical range using validated cutoffs. We combined all adjusted area-specific effect estimates using random-effects meta-analysis and multiple imputations and applied inverse probability-weighting methods to correct for loss to follow-up.

RESULTS

We classified a total of 2,801 children as having ADHD symptoms within the borderline/clinical range, and 1,590 within the clinical range. Exposure to air pollution during pregnancy was not associated with a higher odds of ADHD symptoms within the borderline/clinical range (e.g., adjusted odds ratio [OR] for ADHD symptoms of 0.95, 95% confidence interval [CI] = 0.89, 1.01 per 10 µg/m increase in NO2 and 0.98, 95% CI = 0.80, 1.19 per 5 µg/m increase in PM2.5). We observed similar associations for ADHD within the clinical range.

CONCLUSIONS

There was no evidence for an increase in risk of ADHD symptoms with increasing prenatal air pollution levels in children aged 3-10 years. See video abstract at, http://links.lww.com/EDE/B379.

The association between exposure to environmental factors and the occurrence of attention-deficit/hyperactivity disorder (ADHD). A population-based retrospective cohort study

BACKGROUND

A number of factors contribute to attention deficit hyperactivity disorder (ADHD) and although they are not fully known, the occurrence of ADHD seems to be a consequence of an interaction between multiple genetic and environmental factors. However, apart from pesticides, the evidence is inadequate and inconsistent as it differs not only in the population and time period analysed, but also in the type of study, the control of the confounding variables and the statistical methods used. In the latter case, the studies also differ in the adjustment of spatial and temporal variability. Our objective here, is to provide evidence on an association between environmental factors and ADHD.

METHODS

In our study, we used a population-based retrospective cohort in which we matched cases and controls (children free of the disease) by sex and year of birth (n = 5193, 78.9% boys). The cases were children born between 1998 and 2012 and diagnosed with ADHD (n = 116). To evaluate whether there was a geographical pattern in the incidence of ADHD, we first represented the smoothed standardized incidence rates on a map of the region being studied. We then estimated the probability of being a case by using a generalized liner mixed model with a binomial link. As explanatory variables of interest, we included the following environmental variables: distance to agricultural areas, distance to roads (stratified into three categories according to traffic density and intensity), distance to petrol stations, distance to industrial estates, and land use. We control for both observed (individual and family specific variables and deprivation index) and unobserved confounders (in particular, individual and familial heterogeneity). In addition, we adjusted for spatial extra variability.

RESULTS

We found a north-south pattern containing two clusters (one in the centre of the study region and another in the south) in relation to the risk of developing ADHD. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables. Specifically, living within 100 m from an agricultural area or a residential street and/or living fewer than 300 m from a motorway, dual carriageway or one of the industrial estates analysed was associated (statistically significant) with an increased risk of ADHD.

CONCLUSION

Our results indicate that some environmental factors could be associated with ADHD occurring, particularly those associated with exposure to pesticides, organochlorine compounds and air pollutants because of traffic.

Early life exposure to air pollution particulate matter (PM) as risk factor for attention deficit/hyperactivity disorder (ADHD): Need for novel strategies for mechanisms and causalities

Epidemiological studies have demonstrated that air pollution particulate matter (PM) and adsorbed toxicants (organic compounds and trace metals) may affect child development already in utero. Recent studies have also indicated that PM may be a risk factor for neurodevelopmental disorders (NDDs). A pattern of increasing prevalence of attention deficit/hyperactivity disorder (ADHD) has been suggested to partly be linked to environmental pollutants exposure, including PM. Epidemiological studies suggest associations between pre- or postnatal exposure to air pollution components and ADHD symptoms. However, many studies are cross-sectional without possibility to reveal causality. Cohort studies are often small with poor exposure characterization, and confounded by traffic noise and socioeconomic factors, possibly overestimating the study associations. Furthermore, the mechanistic knowledge how exposure to PM during early brain development may contribute to increased risk of ADHD symptoms or cognitive deficits is limited. The closure of this knowledge gap requires the combined use of well-designed longitudinal cohort studies, supported by mechanistic in vitro studies. As ADHD has profound consequences for the children affected and their families, the identification of preventable risk factors such as air pollution exposure should be of high priority.

Prenatal and postnatal exposure to NO2 and child attentional function at 4-5years of age

BACKGROUND

Prenatal and postnatal exposure to air pollution has been linked to cognitive impairment in children, but very few studies have assessed its association with attentional function.

OBJECTIVES

To evaluate the association between prenatal and postnatal exposure to nitrogen dioxide (NO₂) and attentional function in children at 4-5years of age.

METHODS

We used data from four regions of the Spanish INMA-Environment and Childhood-Project, a population-based birth cohort. Using land-use regression models (LUR), we estimated prenatal and postnatal NO₂ levels in all of these regions at the participants' residential addresses. We assessed attentional function using the Kiddie-Conners Continuous Performance Test (K-CPT). We combined the region-specific adjusted effect estimates using random-effects meta-analysis.

RESULTS

We included 1298 children with complete data. Prenatal exposure to NO₂ was associated with an impaired standard error of the hit reaction time (HRT(SE)) (increase of 1.12ms [95% CI; 0.22 a 2.02] per 10μg/m³ increase in prenatal NO₂) and increased omission errors (6% [95% CI; 1.01 to 1.11] per 10μg/m³ increase in prenatal NO₂). Postnatal exposure to NO₂ resulted in a similar but borderline significant increase of omission errors (5% [95% CI; =0.99 to 1.11] per 10μg/m³ increase in postnatal NO₂). These associations did not vary markedly between regions, and were mainly observed in girls. Commission errors and lower detectability were associated with prenatal and postnatal exposure to NO₂ only in some regions.

CONCLUSIONS

This study indicates that higher exposure to ambient NO₂, mainly during pregnancy and to a lesser extent postnatally, is associated with impaired attentional function in children at 4-5years of age.

Toxicity of inhaled particulate matter on the central nervous system: neuroinflammation, neuropsychological effects and neurodegenerative disease

Particulate matter (PM) combined with meteorological factors cause the haze, which brings inconvenience to people's daily life and deeply endanger people's health. Accumulating literature, to date, reported that PM are closely related to cardiopulmonary disease. Outpatient visits and admissions as a result of asthma and heart attacks gradually increase with an elevated concentration of PM. Owing to its special physicochemical property, the brain could be a potential target beyond the cardiopulmonary system. Possible routes of PM to the brain via a direct route or stimulation of pro-inflammatory cytokines have been reported in several documents concerning toxicity of engineered nanoparticles in rodents. Recent studies have demonstrated that PM have implications in oxidative stress, inflammation, dysfunction of cellular organelles, as well as the disturbance of protein homeostasis, promoting neuron loss and exaggerating the burden of central nervous system (CNS). Moreover, the smallest particles (nano-sized particles), which were involved in inflammation, reactive oxygen species (ROS), microglial activation and neuron loss, may accelerate the process of the neurodevelopmental disorder and neurodegenerative disease. Potential or other undiscovered mechanisms are not mutually exclusive but complementary aspects of each other. Epidemiology studies have shown that exposure to PM could bring about neurotoxicity and play a significant role in the etiology of CNS disease, which has been gradually corroborated by in vivo and in vitro studies. This review highlights research advances on the health effects of PM with an emphasis on neurotoxicity. With the hope of enhancing awareness in the public and calling for prevention and protective measures, it is a critical topic that requires proceeding exploration. Copyright © 2017 John Wiley & Sons, Ltd.

Prenatal exposure to outdoor air pollution and child behavioral problems at school age in Japan

INTRODUCTION

Recent studies suggest positive associations between prenatal exposure to ambient air pollution and neurodevelopment of children, but evidence on the adverse effects of exposure to air pollution on child neurobehavioral development remains limited. We thus examined associations between prenatal exposure to outdoor air pollution and child behavioral problems at school age, using data from a nationwide population-based longitudinal survey in Japan, where participants were recruited in 2001 and are continuously followed.

METHODS

Suspended particulate matter (SPM), nitrogen dioxide, and sulfur dioxide concentrations during the 9months before birth were obtained at municipality level and assigned to those participants born in the corresponding municipality. We analyzed data from singleton births with linked pollution data available (e.g., n=33,911 for SPM). We used responses to survey questions about behavioral problems at age 8years. We conducted multilevel logistic regression analysis, adjusting for individual and municipality-level variables.

RESULTS

Air pollution exposure during gestation was positively associated with risk for behavioral problems related to attention and delinquent or aggressive behavior. In the fully adjusted models, odds ratios following a one-interquartile-range increase in SPM were 1.06 (95% confidence interval: 1.01, 1.11) for interrupting others, 1.09 (1.03, 1.15) for failure to pay attention when crossing a street, 1.06 (1.01, 1.11) for lying, and 1.07 (1.02, 1.13) for causing public disturbance.

CONCLUSIONS

Prenatal exposure to outdoor air pollution was associated with behavioral problems related to attention and delinquent or aggressive behavior at age 8years in a nationally representative sample in Japan.

Air Pollution and Neuropsychological Development: A Review of the Latest Evidence

For the last decade, literature on the detrimental impacts of air pollution on brain, cognition and behavior has exponentially increased. Our aim is to review the latest epidemiologic literature on the association between outdoor air pollution and neuropsychological developmental in children. Two independent researchers searched for published studies between January 1, 2012 and June 12, 2015 in MEDLINE, Web of Science, and Science direct using defined keywords on outdoor air pollution and neuropsychological development. Selection of articles was based on study eligibility criteria. We encountered sufficient evidence of detrimental effects of pre- or postnatal exposure to polycyclic aromatic hydrocarbons on global intelligence quotient. The evidence was also sufficient for the association between pre- or postnatal exposure to fine particulate matter (PM2.5) and autism spectrum disorder, and limited evidence was encountered between nitrogen oxides and autism spectrum disorder. For other exposure-outcome associations reviewed, the evidence was inadequate or insufficient. Although evidence is not yet conclusive and further research is needed, the latest epidemiological studies support the hypothesis that pre- or postnatal exposure to ambient pollution, particularly polycyclic aromatic hydrocarbons, PM2.5, and nitrogen oxides has a negative impact on the neuropsychological development of children. The public health impact of air pollutants cannot be ignored and the precautionary principle should be applied to protect children.