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Margolis AE, Greenwood P, Dranovsky A, Rauh V. The Role of Environmental Chemicals in the Etiology of Learning Difficulties: A Novel Theoretical Framework. MIND, BRAIN AND EDUCATION : THE OFFICIAL JOURNAL OF THE INTERNATIONAL MIND, BRAIN, AND EDUCATION SOCIETY 2023; 17:301-311. [PMID: 38389544 PMCID: PMC10881209 DOI: 10.1111/mbe.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/09/2023] [Indexed: 02/24/2024]
Abstract
Children from economically disadvantaged communities have a disproportionate risk of exposure to chemicals, social stress, and learning difficulties. Although animal models and epidemiologic studies link exposures and neurodevelopment, little focus has been paid to academic outcomes in environmental health studies. Similarly, in the educational literature, environmental chemical exposures are overlooked as potential etiologic factors in learning difficulties. We propose a theoretical framework for the etiology of learning difficulties that focuses on these understudied exogenous factors. We discuss findings from animal models and longitudinal, prospective birth cohort studies that support this theoretical framework. Studies reviewed point to the effects of prenatal exposure to polycyclic aromatic hydrocarbons on reading comprehension and math skills via effects on inhibitory control processes. Long term, this work will help close the achievement gap in the United States by identifying behavioral and neural pathways from prenatal exposures to learning difficulties in children from economically disadvantaged families.
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Affiliation(s)
- Amy E. Margolis
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center
- New York State Psychiatric Institute
| | - Paige Greenwood
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center
| | - Alex Dranovsky
- New York State Psychiatric Institute
- Division of Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center
| | - Virginia Rauh
- Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center
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Uong SP, Zhou J, Lovinsky-Desir S, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Wilson J, Woo Baidal J, Stingone JA. The Creation of a Multidomain Neighborhood Environmental Vulnerability Index Across New York City. J Urban Health 2023; 100:1007-1023. [PMID: 37594675 PMCID: PMC10618140 DOI: 10.1007/s11524-023-00766-3] [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] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
Compared to previous studies commonly using a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to characterize the magnitude and variability of area-level factors with the potential to modify the association between environmental pollutants and health effects. Using the Toxicological Prioritization Index framework and data from the 2015-2019 U.S. Census American Community Survey and the 2020 CDC PLACES Project, we quantified census tract-level vulnerability overall and in 4 primary domains (demographic, economic, residential, and health status), 24 subdomains, and 54 distinct area-level features for New York City (NYC). Overall and domain-specific indices were calculated by summing standardized feature values within the subdomains and then aggregating and weighting based on the number of features within each subdomain within equally-weighted primary domains. In citywide comparisons, NEVI was correlated with multiple existing indices, including the Neighborhood Deprivation Index (r = 0.91) and Social Vulnerability Index (r = 0.87) but provided additional information on features contributing to vulnerability. Vulnerability varied spatially across NYC, and hierarchical cluster analysis using subdomain scores revealed six patterns of vulnerability across domains: 1) low in all, 2) primarily low except residential, 3) medium in all, 4) high demographic, economic, and residential 5) high economic, residential, and health status, and 6) high demographic, economic and health status. Created using methods that offer flexibility for theory-based construction, NEVI provided detailed vulnerability metrics across domains that can inform targeted research and public health interventions aimed at reducing the health impacts from environmental exposures across urban centers.
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Affiliation(s)
- Stephen P Uong
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Jiayi Zhou
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sandra S Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Alexander Azan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Earle C Chambers
- Department of Family and Social Medicine Bronx, Albert Einstein College of Medicine, New York, NY, USA
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Azure Thompson
- School of Public Health Brooklyn, SUNY Downstate Health Sciences University New York, New York, NY, USA
| | - Joseph Wilson
- Department of Environmental Medicine and Public Health New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Woo Baidal
- Department of Pediatrics New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA.
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Payne-Sturges DC, Taiwo TK, Ellickson K, Mullen H, Tchangalova N, Anderko L, Chen A, Swanson M. Disparities in Toxic Chemical Exposures and Associated Neurodevelopmental Outcomes: A Scoping Review and Systematic Evidence Map of the Epidemiological Literature. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:96001. [PMID: 37754677 PMCID: PMC10525348 DOI: 10.1289/ehp11750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/29/2023] [Accepted: 08/10/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Children are routinely exposed to chemicals known or suspected of harming brain development. Targeting Environmental Neuro-Development Risks (Project TENDR), an alliance of > 50 leading scientists, health professionals, and advocates, is working to protect children from these toxic chemicals and pollutants, especially the disproportionate exposures experienced by children from families with low incomes and families of color. OBJECTIVE This scoping review was initiated to map existing literature on disparities in neurodevelopmental outcomes for U.S. children from population groups who have been historically economically/socially marginalized and exposed to seven exemplar neurotoxicants: combustion-related air pollution (AP), lead (Pb), mercury (Hg), organophosphate pesticides (OPs), phthalates (Phth), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs). METHODS Systematic literature searches for the seven exemplar chemicals, informed by the Population, Exposure, Comparator, Outcome (PECO) framework, were conducted through 18 November 2022, using PubMed, CINAHL Plus (EBSCO), GreenFILE (EBSCO), and Web of Science sources. We examined these studies regarding authors' conceptualization and operationalization of race, ethnicity, and other indicators of sociodemographic and socioeconomic disadvantage; whether studies presented data on exposure and outcome disparities and the patterns of those disparities; and the evidence of effect modification by or interaction with race and ethnicity. RESULTS Two hundred twelve individual studies met the search criteria and were reviewed, resulting in 218 studies or investigations being included in this review. AP and Pb were the most commonly studied exposures. The most frequently identified neurodevelopmental outcomes were cognitive and behavioral/psychological. Approximately a third (74 studies) reported investigations of interactions or effect modification with 69% (51 of 74 studies) reporting the presence of interactions or effect modification. However, less than half of the studies presented data on disparities in the outcome or the exposure, and fewer conducted formal tests of heterogeneity. Ninety-two percent of the 165 articles that examined race and ethnicity did not provide an explanation of their constructs for these variables, creating an incomplete picture. DISCUSSION As a whole, the studies we reviewed indicated a complex story about how racial and ethnic minority and low-income children may be disproportionately harmed by exposures to neurotoxicants, and this has implications for targeting interventions, policy change, and other necessary investments to eliminate these health disparities. We provide recommendations on improving environmental epidemiological studies on environmental health disparities. To achieve environmental justice and health equity, we recommend concomitant strategies to eradicate both neurotoxic chemical exposures and systems that perpetuate social inequities. https://doi.org/10.1289/EHP11750.
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Affiliation(s)
| | | | - Kristie Ellickson
- Minnesota Pollution Control Agency, St. Paul, Minnesota, USA
- Union of Concerned Scientists, Cambridge, Massachusetts, USA
| | - Haley Mullen
- Department of Geographical Sciences, University of Maryland, College Park, Maryland, USA
| | | | - Laura Anderko
- M. Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Aimin Chen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rahai R, Evans GW. Cumulative Neurotoxicological Air Pollution Exposure Is Associated with Lower Reading Improvement and Diminished Benefits of Literacy Interventions for Urban Elementary Students of Color. J Urban Health 2023; 100:493-503. [PMID: 37335466 PMCID: PMC10323057 DOI: 10.1007/s11524-023-00746-7] [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] [Accepted: 05/22/2023] [Indexed: 06/21/2023]
Abstract
The cognitive and behavioral deficits associated with air pollution exposure may have far-reaching negative effects on children's scholastic achievement. Moreover, air pollution may be conditioning the success of educational investments that support students who face greatest levels of societal adversity. This study examined the direct main effects of cumulative neurotoxicological exposure on annual reading improvement. We also tested the statistical interaction (i.e., moderation) of neurotoxicological exposure and academic intervention sessions on annual reading improvement for a large sample of ethnic minority (95%) elementary school children (n = 6080, k-6th grade) enrolled in a standard literacy enrichment program. These children were all behind grade level in reading and attended predominantly low-income schools (n = 85) in urban settings across the state of California. Multi-level modeling assessments accounted for random effects associated with school and neighborhood environments, and incorporated extensive individual, school, and community level covariates. Findings show individual elementary students of color to progress less in reading when exposed to greater accumulations of neurotoxin air pollution in their home and school environments, with the average deficit equivalent to 1.5 weeks of learning delay per year. Findings also show neurotoxicological exposure to diminish the efficacy of literacy intervention sessions received on reading improvement throughout the school year. Results suggest that pollution abatement can be a salient strategy to help bridge the child educational achievement gap. In addition to several methodological strengths, this study is one of the first to show that ambient pollution can undermine program efficacy of a literacy enrichment program.
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Affiliation(s)
- Rouzbeh Rahai
- Department of Human Centered Design, College of Human Ecology, Cornell University, T57, Human Ecology Building, 37 Forest Home Dr., NY 14853 Ithaca, USA
| | - Gary William Evans
- Department of Human Centered Design, Department of Psychology, College of Human Ecology, Cornell University, T57, Human Ecology Building, 37 Forest Home Dr., NY 14853 Ithaca, USA
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Dickerson AS, Dickerson AS. Prenatal socioenvironmental exposures and autism spectrum disorder: A web of confusion. CHILD DEVELOPMENT PERSPECTIVES 2023; 17:32-38. [PMID: 37334167 PMCID: PMC10275509 DOI: 10.1111/cdep.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although evidence of heritability for autism spectrum disorder (ASD) is strong, studies of twin pairs suggest that at least some portion of the etiology is attributable to environmental factors, either directly or through interaction with genes. Given the multitude of environmental and psychosocial exposures that have been reported to increase atypical neurodevelopment in offspring, in this article, we summarize what prenatal air pollutant, chemical, and occupational exposures and psychosocial stressors have been reportedly associated with ASD and co-occurring neurodevelopmental disorders. We highlight consistencies in reported associations and recommend areas for research to close gaps in our understanding of environmental risk for ASD. Because this issue is of particular importance in historically marginalized communities and low- and middle-income countries, we also discuss the importance of environmental justice issues and exposure disparities in research, and we advocate for prioritizing policies to reduce disparities and improve service provision in vulnerable populations.
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Affiliation(s)
- Aisha S. Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dou Y, Li M, Shi H, Duan X, Tan C, Zhao C, Wang X, Zhang J. The relationship between home environment and early childhood development of left-behind children under 3 years in rural China. Infant Behav Dev 2023; 71:101829. [PMID: 36842295 DOI: 10.1016/j.infbeh.2023.101829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China. METHODS Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition. RESULTS Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates. CONCLUSIONS Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.
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Affiliation(s)
- Yan Dou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China; Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Mengshi Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China
| | - Huifeng Shi
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China; Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, PR China
| | - Xiaoqian Duan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China
| | - Chang Tan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China
| | - Chunxia Zhao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China
| | - Xiaoli Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China; Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China
| | - Jingxu Zhang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, PR China; Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 100191, PR China.
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Relationships between maternal body mass index and child cognitive outcomes at 3 years of age are buffered by specific early environments in a prospective Canadian birth cohort. J Dev Orig Health Dis 2023; 14:42-52. [PMID: 35481433 DOI: 10.1017/s2040174422000228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Fetal and child development are shaped by early life exposures, including maternal health states, nutrition and educational and home environments. We aimed to determine if suboptimal pre-pregnancy maternal body mass index (BMI; underweight, overweight, obese) would associate with poorer cognitive outcomes in children, and whether early life nutritional, educational and home environments modify these relationships. Self-reported data were obtained from mother-infant dyads from the pan-Canadian prospective Maternal-Infant Research on Environmental Chemicals cohort. Relationships between potential risk factors (pre-pregnancy maternal BMI, breastfeeding practices and Home Observation Measurement of the Environment [HOME] score) and child cognitive development at age three (Weschler's Preschool and Primary Scale of Intelligence, Third Edition scale and its subcategories) were each evaluated using analysis of variance, multivariable regression models and moderating analyses. Amongst the 528 mother-child dyads, increasing maternal pre-pregnancy BMI was negatively associated with scores for child full-scale IQ (β [95% CI]; -2.01 [-3.43, -0.59], p = 0.006), verbal composite (-1.93 [-3.33, -0.53], p = 0.007), and information scale (-0.41 [-0.70, -0.14], p = 0.003) scores. Higher maternal education level or HOME score attenuated the negative association between maternal pre-pregnancy BMI and child cognitive outcome by 30%-41% and 7%-22%, respectively, and accounted for approximately 5%-10% greater variation in male children's cognitive scores compared to females. Maternal education and higher quality home environment buffer the negative effect of elevated maternal pre-pregnancy BMI on child cognitive outcomes. Findings suggest that relationships between maternal, social and environmental factors must be considered to reveal pathways that shape risk for, and resiliency against, suboptimal cognitive outcomes in early life.
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Yan Z, Ren J, Lin W, Wu J. Parents' Perceived Social Support and Children's Approaches to Learning in Rural China: A Moderated Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14533. [PMID: 36361411 PMCID: PMC9654344 DOI: 10.3390/ijerph192114533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to investigate the relationship between parents' perceived social support (PSS) and young children's approaches to learning (ATLs) in rural China, as well as the mediating effect of the home learning environment (HLE) and the moderating effect of parental negative emotions (PNE). Using the cluster random sampling method, 2714 kindergarteners (Mage = 52.99 months, SD = 10.28; 52.00% boys; 27.43% only child) were recruited from rural areas of eight provinces in China. With questionnaires, parents reported their PSS and PNE, HLE, and the children's ATLs. The results indicated that: (1) parents' PSS positively predicted children's ATLs; (2) the HLE partially mediated the relationship between parents' PSS and children's ATLs; and (3) PNE moderated the relationship between parents' PSS and children's ATLs. Thus, the results supported a moderated mediation model on the relationship between parents' PSS and young children's ATLs, with the HLE as a mediator and the parents' PSS as a moderator. These findings offer new avenues for intervening and supporting the development of young children's ATLs.
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Affiliation(s)
- Zhonglian Yan
- Faculty of Education, Northeast Normal University, Changchun 130024, China
| | - Jing Ren
- Faculty of Education, Northeast Normal University, Changchun 130024, China
| | - Wenqi Lin
- Faculty of Education, Northeast Normal University, Changchun 130024, China
| | - Jianfen Wu
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou 311121, China
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Chandra M, Rai CB, Kumari N, Sandhu VK, Chandra K, Krishna M, Kota SH, Anand KS, Oudin A. Air Pollution and Cognitive Impairment across the Life Course in Humans: A Systematic Review with Specific Focus on Income Level of Study Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031405. [PMID: 35162428 PMCID: PMC8835599 DOI: 10.3390/ijerph19031405] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
Cognitive function is a crucial determinant of human capital. The Lancet Commission (2020) has recognized air pollution as a risk factor for dementia. However, the scientific evidence on the impact of air pollution on cognitive outcomes across the life course and across different income settings, with varying levels of air pollution, needs further exploration. A systematic review was conducted, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Guidelines to assess the association between air pollution and cognitive outcomes across the life course with a plan to analyze findings as per the income status of the study population. The PubMed search included keywords related to cognition and to pollution (in their titles) to identify studies on human participants published in English until 10 July 2020. The search yielded 84 relevant studies that described associations between exposure to air pollutants and an increased risk of lower cognitive function among children and adolescents, cognitive impairment and decline among adults, and dementia among older adults with supportive evidence of neuroimaging and inflammatory biomarkers. No study from low- and middle-income countries (LMICs)was identified despite high levels of air pollutants and high rates of dementia. To conclude, air pollution may impair cognitive function across the life-course, but a paucity of studies from reLMICs is a major lacuna in research.
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Affiliation(s)
- Mina Chandra
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
- Correspondence: ; Tel.: +91-98-1183-1902
| | - Chandra Bhushan Rai
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
| | - Neelam Kumari
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
| | - Vipindeep Kaur Sandhu
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India; (C.B.R.); (N.K.); (V.K.S.)
| | - Kalpana Chandra
- Delhi Jal Board, Government of National Capital Territory of Delhi, New Delhi 110094, India;
| | - Murali Krishna
- JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India;
| | - Sri Harsha Kota
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India;
| | - Kuljeet Singh Anand
- Department of Neurology, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India;
| | - Anna Oudin
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umea, Sweden;
- Department of Laboratory Medicine, Lund University, 901 87 Umea, Sweden
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Margolis AE, Ramphal B, Pagliaccio D, Banker S, Selmanovic E, Thomas LV, Factor-Litvak P, Perera F, Peterson BS, Rundle A, Herbstman JB, Goldsmith J, Rauh V. Prenatal exposure to air pollution is associated with childhood inhibitory control and adolescent academic achievement. ENVIRONMENTAL RESEARCH 2021; 202:111570. [PMID: 34181922 PMCID: PMC8578437 DOI: 10.1016/j.envres.2021.111570] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/15/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Prenatal air pollution exposure is associated with reductions in self-regulation and academic achievement. Self-regulation has been separately linked with academic achievement. Understudied, however, are the contributions of pollution exposure to inhibitory control, a facet of self-regulation, and whether pollution-related inhibitory control deficits are associated with impairment in academic achievement. METHODS Participants were recruited from a prospective birth cohort. Measures of prenatal airborne polycyclic aromatic hydrocarbons (PAH) during the third trimester of pregnancy, inhibitory control (NEPSY Inhibition) at mean age = 10.4 years, and Woodcock-Johnson Tests of Achievement-III at mean age = 13.7 were available for N = 200 participants. Multiple linear regression examined sex-dependent and sex independent associations among prenatal PAH, childhood inhibitory control, and academic achievement during adolescence, and whether childhood inhibitory control mediated associations between prenatal PAH and academic achievement during adolescence, controlling for ethnicity, maternal country of birth, language of prenatal interview, maternal marital status, maternal years of education, material hardship, quality of home caregiving environment, and early life stress. RESULTS Across all participants, higher prenatal PAH was significantly associated with worse spelling skills (WJ-III Spelling, β = -0.16, 95%Confidence Interval [CI]: 0.30, -0.02, p = .02). Trend level associations between higher prenatal PAH and worse reading comprehension (WJ-III Passage Comprehension, β = -0.13, 95%CI: 0.28, 0.01, p = .07) and math skills (WJ-III Broad Math, β = -0.11, 95%CI: 0.25, 0.03, p = .11) were detected. Across all participants, higher PAH was significantly associated with worse inhibitory control (β = -0.15, 95%CI: 0.29,-0.01 p = .03). Better inhibitory control was significantly associated with better reading comprehension (WJ-III Passage Comprehension, β = 0.22, 95%CI: 0.09, 0.36, p < .002) and math skills (WJ-III Broad Math Index, β = 0.32, 95%CI: 0.19, 0.45, p < .001), and trend level associations with better spelling skills (WJ-III Spelling, β = 0.12, 95%CI: 0.02, 0.26, p = .10). Inhibitory control significantly mediated PAH-related achievement effects for Passage Comprehension (β = -0.61, 95%CI: 1.49, -0.01) and Broad Math Index (β = -1.09, 95%CI: 2.36, -0.03). CONCLUSIONS Higher prenatal PAH exposure and lower childhood inhibitory control were associated with worse spelling, passage comprehension, and math in adolescence. Notably, childhood inhibitory control mediated PAH exposure-related effects on achievement in adolescents. Identifying these potential exposure-related phenotypes of learning problems may promote interventions that target inhibitory control deficits rather than content specific deficits.
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Affiliation(s)
- Amy E Margolis
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
| | - Bruce Ramphal
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Sarah Banker
- Mt. Sinai Icahn School of Medicine, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Ena Selmanovic
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Lauren V Thomas
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Frederica Perera
- Department of Environmental Health Sciences and Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Bradley S Peterson
- Department of Psychiatry, Keck School of Medicine University of Southern California, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences and Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Virginia Rauh
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
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Araya F, Stingone JA, Claudio L. Inequalities in Exposure to Ambient Air Neurotoxicants and Disparities in Markers of Neurodevelopment in Children by Maternal Nativity Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147512. [PMID: 34299963 PMCID: PMC8304619 DOI: 10.3390/ijerph18147512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
Exposure levels to environmental pollutants vary significantly among different populations. These inequities in exposure to hazardous air pollutants (HAP) among different populations can contribute to disparities in neurodevelopmental outcomes. The aim of this study was to determine if exposure to HAP varies by maternal nativity status, a demographic marker often overlooked in the study of health disparities. We also assessed if those inequalities in exposure levels are associated with neurodevelopmental measures in young children. To do this, we obtained data from the Early Childhood Longitudinal Study-Birth cohort (ECLS-B), a nationally representative sample of children born in the U.S. in the year 2001 (n = 4750). Bayley’s Short Form-Research Edition (BSF-R) was used to measure cognitive development at 2 years of age. Using residential location at nine months of age, participants were assigned exposures to ten HAPs identified as potentially neurotoxic. Linear regression models were used to assess the joint effect of maternal nativity status and HAP exposure on neurodevelopment. Results showed inequities in exposure levels to ten different HAPs among the populations, as approximately 32% of children of foreign-born mothers were exposed to high levels of HAPs, compared to 21% of children born to U.S.-born mothers. Adjusting for socioeconomic factors, both isophorone exposure (a marker of industrial pollution) (−0.04, 95% CI, −0.12, 0.04) and maternal nativity status (−0.17, 95% CI, −0.27, −0.06) were independently associated with lower standardized BSF-R mental scores in children. Interaction between nativity status and isophorone was not statistically significant, but the change in mental scores associated with isophorone exposure was greater in children of foreign-born mothers compared to children of U.S.-born mothers (−0.12, vs. −0.03, p = 0.2). In conclusion, exposure to HAPs within the highest quartile was more commonly found among children of foreign-born mothers as compared to children of US-born mothers, indicating inequities in pollutant exposure by nativity status within urban populations. Exposures associated with nativity status may negatively contribute to children’s neurodevelopment.
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12
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Langkamp DL, Barnes AJ, Zuckerman KE. Secondary Analysis of Existing Data Sets for Developmental Behavioral Pediatrics. J Dev Behav Pediatr 2021; 42:322-330. [PMID: 33560045 DOI: 10.1097/dbp.0000000000000915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Secondary analysis of existing large, national data sets is a powerful method to address many of the complex, key research questions in developmental behavioral pediatrics (DBP). Major advantages include decreasing the time needed to complete a study and reducing expenses associated with research by eliminating the need to collect primary data. It can also increase the generalizability of research and, with some data sets, provide national estimates that may form the basis for developing policy. However, few resources are available to direct researchers who seek to develop expertise in this area. This study aims to guide investigators with limited experience in this area who wish to improve their skills in performing secondary analysis of existing large data sets. This study provides direction on the steps to perform secondary analysis of existing data sets. It describes where and how data sets can be identified to answer questions of interest to DBP. Finally, it offers an overview of a number of data sets relevant to DBP.
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Affiliation(s)
- Diane L Langkamp
- Division of Developmental Behavioral Pediatrics, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH
| | - Andrew J Barnes
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Katharine E Zuckerman
- Division of General Pediatrics, Oregon Health & Science University, Oregon Health & Science University-Portland State University School of Public Health, Portland, OR
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13
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Bangma JT, Hartwell H, Santos HP, O'Shea TM, Fry RC. Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm. Pediatr Res 2021; 89:326-335. [PMID: 33184498 PMCID: PMC7658618 DOI: 10.1038/s41390-020-01236-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 01/30/2023]
Abstract
Individuals born extremely preterm are at significant risk for impaired neurodevelopment. After discharge from the neonatal intensive care, associations between the child's well-being and factors in the home and social environment become increasingly apparent. Mothers' prenatal health and socioeconomic status are associated with neurodevelopmental outcomes, and emotional and behavioral problems. Research on early life risk factors and on mechanisms underlying inter-individual differences in neurodevelopment later in life can inform the design of personalized approaches to prevention. Here, we review early life predictors of inter-individual differences in later life neurodevelopment among those born extremely preterm. Among biological mechanisms that mediate relationships between early life predictors and later neurodevelopmental outcomes, we highlight evidence for disrupted placental processes and regulated at least in part via epigenetic mechanisms, as well as perinatal inflammation. In relation to these mechanisms, we focus on four prenatal antecedents of impaired neurodevelopment, namely, (1) fetal growth restriction, (2) maternal obesity, (3) placental microorganisms, and (4) socioeconomic adversity. In the future, this knowledge may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm. IMPACT: This review highlights early life risk factors and mechanisms underlying inter-individual differences in neurodevelopment later in life. The review emphasizes research on early life risk factors (fetal growth restriction, maternal obesity, placental microorganisms, and socioeconomic adversity) and on mechanisms (disrupted placental processes and perinatal inflammation) underlying inter-individual differences in neurodevelopment later in life. The findings highlighted here may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm.
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Affiliation(s)
- Jacqueline T Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hadley Hartwell
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hudson P Santos
- Biobehavioral Laboratory, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Biobehavioral Laboratory, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Curriculum in Toxicology and Environmental Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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14
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The Relationship Between Air Pollution and Cognitive Functions in Children and Adolescents: A Systematic Review. Cogn Behav Neurol 2020; 33:157-178. [PMID: 32889949 DOI: 10.1097/wnn.0000000000000235] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Air pollution has a negative impact on one's health and on the central nervous system. We decided to assess studies that evaluated the relationship between air pollution and cognitive functions in children and adolescents by reviewing studies that had been published between January 2009 and May 2019. We searched three major databases for original works (26 studies) and for studies using brain imaging methods based on MRI (six studies). Adverse effects of air pollutants on selected cognitive or psychomotor functions were found in all of the studies. Exposure to nitrogen dioxide, for example, was linked to impaired working memory, general cognitive functions, and psychomotor functions; particulate matter 2.5 was linked to difficulties in working memory, short-term memory, attention, processing speed, and fine motor function; black carbon was linked to poor verbal intelligence, nonverbal intelligence, and working memory; airborne copper was linked to impaired attentiveness and fine motor skills; isophorone was linked to lower mathematical skills; and polycyclic aromatic hydrocarbons in fetal life were linked to lower intelligence scores. The studies using MRI showed that high concentrations of air pollutants were linked to changes in the brain's white matter or lower functional integration and segregation in children's brain networks. In view of the global increase in air pollution, there is a need for further research to elucidate the relationship between air pollution and cognitive and motor development in children. According to some studies, neuroinflammation, the e4 allele of the apolipoprotein E gene, and gutathione-S-transferase gene polymorphism processes may play a role.
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15
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Widen EM, Nichols AR, Kahn LG, Factor-Litvak P, Insel BJ, Hoepner L, Dube SM, Rauh V, Perera F, Rundle A. Prepregnancy obesity is associated with cognitive outcomes in boys in a low-income, multiethnic birth cohort. BMC Pediatr 2019; 19:507. [PMID: 31862007 PMCID: PMC6924019 DOI: 10.1186/s12887-019-1853-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background Maternal obesity and high gestational weight gain (GWG) disproportionally affect low-income populations and may be associated with child neurodevelopment in a sex-specific manner. We examined sex-specific associations between prepregnancy BMI, GWG, and child neurodevelopment at age 7. Methods Data are from a prospective low-income cohort of African American and Dominican women (n = 368; 44.8% male offspring) enrolled during the second half of pregnancy from 1998 to 2006. Neurodevelopment was measured using the Wechsler Intelligence Scale for Children (WISC-IV) at approximately child age 7. Linear regression estimated associations between prepregnancy BMI, GWG, and child outcomes, adjusting for race/ethnicity, marital status, gestational age at delivery, maternal education, maternal IQ and child age. Results Overweight affected 23.9% of mothers and obesity affected 22.6%. At age 7, full-scale IQ was higher among girls (99.7 ± 11.6) compared to boys (96.9 ± 13.3). Among boys, but not girls, prepregnancy overweight and obesity were associated with lower full-scale IQ scores [overweight β: − 7.1, 95% CI: (− 12.1, − 2.0); obesity β: − 5.7, 95% CI: (− 10.7, − 0.7)]. GWG was not associated with full-scale IQ in either sex. Conclusions Prepregnancy overweight and obesity were associated with lower IQ among boys, but not girls, at 7 years. These findings are important considering overweight and obesity prevalence and the long-term implications of early cognitive development.
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Affiliation(s)
- Elizabeth M Widen
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, 103 W 24TH ST A2703, Austin, TX, 78712, USA. .,Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, 12th Floor, New York, NY, 10032, USA.
| | - Amy R Nichols
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, 103 W 24TH ST A2703, Austin, TX, 78712, USA.,Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, 12th Floor, New York, NY, 10032, USA
| | - Linda G Kahn
- Department of Pediatrics, New York University School of Medicine, 403 East 34th St, New York, NY, 10016, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street Room 1614, New York, NY, 10032, USA
| | - Beverly J Insel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street Room 1614, New York, NY, 10032, USA.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lori Hoepner
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, 12th Floor, New York, NY, 10032, USA.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Environmental and Occupational Health Sciences, SUNY Downstate Medical Center, School of Public Health, 450 Clarkson Avenue, MSC 43, Brooklyn, NY, 11203, USA
| | - Sara M Dube
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, 103 W 24TH ST A2703, Austin, TX, 78712, USA.,Department of Nutritional Sciences, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Virginia Rauh
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B-2, Room 213, New York, NY, 10032, USA
| | - Frederica Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, 12th Floor, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street Room 1614, New York, NY, 10032, USA
| | - Andrew Rundle
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, 12th Floor, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street Room 1614, New York, NY, 10032, USA
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16
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Phansikar M, Ashrafi SA, Khan NA, Massey WV, Mullen SP. Active Commute in Relation to Cognition and Academic Achievement in Children and Adolescents: A Systematic Review and Future Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245103. [PMID: 31847267 PMCID: PMC6950697 DOI: 10.3390/ijerph16245103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022]
Abstract
Active commuting to school (ACS) is an important source of physical activity among children. Recent research has focused on ACS and its benefits on cognition and academic achievement (AA), factors important for success in school. This review aims to synthesize literature on the relationship between ACS and cognition or AA among children and adolescents. Peer-reviewed articles in PubMed, Web of Science, PsycINFO and Cochrane Library assessing ACS with cognition and/or AA among children, until February 2019, were selected. Twelve studies across nine countries (age range 4–18.5 years) were included. One study used accelerometers, whereas all others used self-report measures of ACS. A wide range of objective assessments of cognitive functioning and AA domains were used. Five among eight studies, and four among six found a positive relationship between ACS and cognitive or AA measure, respectively. Four studies found dose–response relationships, and some studies found sex differences. The quantitative analysis found that ACS was not significantly associated with mathematics score (odds ratio = 1.18; CI = 0.40, 3.48). Findings are discussed in terms of methodological issues, potential confounders, and the strength of the evidence. Future studies should conduct longitudinal studies and use objective measures of ACS to understand this relationship further.
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Affiliation(s)
- Madhura Phansikar
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (M.P.); (S.A.A.); (N.A.K.)
| | - Sadia Anjum Ashrafi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (M.P.); (S.A.A.); (N.A.K.)
| | - Naiman A. Khan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (M.P.); (S.A.A.); (N.A.K.)
| | - William V. Massey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA;
| | - Sean P. Mullen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (M.P.); (S.A.A.); (N.A.K.)
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
- Correspondence: ; Tel.: +1-217-244-4502
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Dellefratte K, Stingone JA, Claudio L. Combined association of BTEX and material hardship on ADHD-suggestive behaviours among a nationally representative sample of US children. Paediatr Perinat Epidemiol 2019; 33:482-489. [PMID: 31657027 PMCID: PMC7092642 DOI: 10.1111/ppe.12594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/16/2019] [Accepted: 08/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous research shows that environmental and social factors contribute to the development of attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE To determine the relationship between early-life exposure to common ambient air pollutants (benzene, toluene, ethylbenzene, and xylene, also known as BTEX), household material hardship (a measure of socio-economic status), and ADHD-suggestive behaviours in kindergarten-age children. METHODS Pollutant exposure estimated from the 2002 National Air Toxics Assessment at each child's residential ZIP code at enrolment was linked to the Early Childhood Longitudinal Study Birth Cohort (n = 4650). Material hardship was assigned as a composite score of access to food, health care, and housing. Kindergarten teachers rated children's behaviours and activity in the classroom using a five-point Likert scale. Children with summary scores in the bottom decile were classified as displaying ADHD-suggestive behaviours. Logistic regression models were constructed to estimate the association between both BTEX exposure and material hardship on ADHD-suggestive behaviours. RESULTS The odds of displaying ADHD-suggestive behaviours were greater in children with combined high-level exposure to BTEX and in those experiencing material hardship (odds ratio 1.54, 95% confidence interval [CI] 1.12, 2.11, and OR 2.12, 95% CI 1.25, 3.59, respectively), adjusting for covariates. These associations were stronger when restricting the study population to urban areas. There was no evidence of interaction between early life BTEX exposure and material hardship, although the effects of BTEX exposure were slightly greater in magnitude among those with higher material hardship scores. CONCLUSIONS Children exposed to air toxics, material hardship, or both early in life are more likely to display signs of ADHD-suggestive behaviours as assessed by their kindergarten teachers. The associations between exposures to air pollution and to socio-economic hardship were observed in all children but were particularly strong in those living in urban areas.
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Affiliation(s)
- Kayla Dellefratte
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luz Claudio
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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