Adopting a child perspective for exposome research on mental health and cognitive development - Conceptualisation and opportunities

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children's specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child's development and future health are addressed. The paper stresses that children's behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today's health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children's mental health and cognitive development leading to better outcomes.

Protective effect of restorative possibilities on cognitive function and mental health in children and adolescents: A scoping review including the role of physical activity

Background The exposome approach can be a powerful tool for understanding the intertwining of social, physical, and internal influences that shape mental health and cognitive development throughout childhood. To distil conceptual models for subsequent analyses, the EU-funded project Early Environmental quality and Life-course mental health effects (Equal-Life) has conducted literature reviews on potential mediators linking the exposome to these outcomes. We report on a scoping review and a conceptual model of the role of restorative possibilities and physical activity. Methods Peer-reviewed studies published since the year 2000 in English, on the association between the exposome and mental health/cognition in children/adolescents, and quantitatively investigating restoration/restorative quality as a mediating variable were considered. Database searches were last updated in December 2022. We used an unstructured expert-driven approach to fill in gaps in the reviewed literature. Results Five records of three distinct studies were identified, indicating a scarcity of empirical evidence in this newly developing research area. Not only were these studies few in numbers, but also cross-sectional, lending only tentative support to the idea that perceived restorative quality of adolescent's living environment might mediate the association between greenspace and mental health. Physical activity emerged as a mediator leading to better psychological outcomes in restorative environments. We provide a critical discussion of potential caveats when investigating the restoration mechanism in children and propose a hierarchical model including restoration, physical activity, and relational dynamics between children and their environment, including social context, as well as restorative environments other than nature. Conclusions It is justified to further explore the role of restoration and physical activity as mediators in the association between early-life exposome and mental health/cognitive development. It is important to consider the child perspective and specific methodological caveats. Given the evolving conceptual definitions/operationalizations, Equal-Life will attempt to fill in a critical gap in the literature.

Being a Fair Neighbor-Towards a Psychometric Inventory to Assess Fairness-Related Perceptions of Airports by Residents-Development and Validation of the Aircraft Noise-Related Fairness Inventory (fAIR-In)

Aircraft noise causes a variety of negative health consequences, and annoyance is a central factor mediating stress-related health risks. Non-acoustic factors play an important role in the experience of annoyance where the aspect of fairness is assumed to be a vital component. This paper describes the development of the Aircraft Noise-related Fairness Inventory (fAIR-In) and examines its factorial validity, construct validity and predictive validity. The development of the questionnaire included expert consultations, statements from airport residents and a large-scale online survey around three German airports (N = 1367). Its items cover distributive, procedural, informational and interpersonal fairness. Via mailshot, almost 100,000 flyers were sent out in more (>55 dB(A) L_den)- and less (≤55 dB(A) L_den)-aircraft-noise-exposed areas around Cologne-Bonn, Dusseldorf and Dortmund Airport. Thirty-two items were carefully selected considering reliability, theoretical importance and factor loading calculated via exploratory factor analysis (EFA), with all facets achieving high internal consistency (α = 0.89 to 0.92). The factorial validity, analyzed via a confirmatory factor analysis (CFA), revealed that viewing distributive, procedural, informational and interpersonal fairness as distinct factors produced a better fit to the data than other categorizations with fewer factors. The fAIR-In shows adequate results in terms of construct validity and excellent results in terms of the predictive validity of annoyance by aircraft noise (r = -0.53 to r = -0.68), acceptance of airports and air traffic (r = 0.46 to r = 0.59) and willingness to protest (r = -0.28 to r = -0.46). The fAIR-In provides airport managers with a reliable, valid and easy-to-use tool to design, monitor and evaluate efforts to improve the neighborliness between an airport and its residents.

Comparing perspectives on research needs from stakeholders vs. researchers in an exposome project

Background

Exposome research looks into how combined exposures affect human health. The EU-funded Equal-Life project focuses on physical and social exposures in a child’s environment and its effects on children’s mental health and cognitive development in the life course. Perspectives and priorities on what to study in particular might differ between practitioners and researchers. Therefore, collaboration with external stakeholders from various fields is encouraged to integrate practical experience and link it to the researchers’ aims.

Methods

Two Delphi studies were conducted collecting and evaluating research questions to be studied in the project among a) the researchers within the project and b) among external stakeholders from various European countries. The exercise was to evaluate the research questions for group a) based on relevance and testability and for b) e.g. regarding practitioners’ work and options for policies. Involved stakeholders work in health care, and urban planning, among others. Prioritised questions are collated.

Findings

Within the researchers’ group, top-rated questions were mainly mechanism-directed in terms of how and to what extent certain factors affect children’s mental health and cognitive development, cumulative effects in different settings, among others. Stakeholders most value research questions on practical issues, e.g. effects of early experiences of discrimination, critical windows in children’s lives that are most sensitive regarding the impact of exposures on mental health and cognitive development, or impact of exposures in early stages of life.

Discussion

In comparing approaches of stakeholders and researchers, stakeholders’ input from the practical field can shape the approach of the research process. The second benefit is to derive implications for creating effective interventions and policies to prevent adverse effects of environmental exposures and to foster positive health in children and later on in life.

Key messages

• Bi-directional exchange between researchers and external stakeholders can make gaps visible.

• Engaging stakeholders into a research process can help sharpening the aim and outcome of a project.

Stakeholders’ involvement in identification of research and policy needs for children’s mental health

Background

The overarching aim of the Horizon 2020 Equal-Life project is to develop evidence-based guidance for policy-and decision-makers concerning child environment and long-term effects on mental health and cognitive development. Stakeholders at national and local level are crucial in improving the physical and social environments children grow up in. In this paper, we present preliminary results of a repeated survey on stakeholders' needs concerning environmental determinants of mental health and cognitive development of children and adolescents.

Methods

We invited potential stakeholders from relevant fields of expertise. Two of three rounds of the Delphi survey were performed by means of an on-line survey between November 2020 and February 2021.The questionnaire was aimed at identifying research questions, knowledge gaps and raised issues about data collection and analysis regarding improving mental health and cognitive development, policy needs related to environment and its role in children's mental health and the potential effectiveness of policy interventions.

Results and Conclusions

In the 1st survey round 34 stakeholders participated and in the 2nd survey round 51 stakeholders participated from 26 different countries and continents. Across both rounds of the survey most participants were from research institutes (21), public health organisations (8), civil society (6), national stakeholders (5) with only little involvement of local or regional authorities or child care organisations. Stakeholders identified several research priorities such as: instruments to improve children's mental health, preventive programs addressing mental health, integrated mental health care services, programs aimed at parenting skills and child care. Early life exposure to adverse social events and psychosocial stressors in the family and socioeconomic disadvantage were recognized as main factors for child development.

Key messages

The guidance from Equal-Life aims to include stakeholders in creation of intervention strategies and preventive measures for mental health and the cognitive development of children. Evidence-based policies and programmes can buffer the negative effects of adverse environments and create restorative ones, and by doing so improve mental health and cognitive development.

Contributors to Neighbour Noise Annoyance

Noise from neighbours has been shown to be one of the most noise annoying sources in Germany, but research on the influencing factors for the annoyance ratings is scarce. Therefore, we investigated whether different personal and contextual (social, physical) factors contribute to neighbour noise annoyance to better understand the neighbour noise annoyance situation. A population-representative survey in four areas in Germany was conducted, with each area further stratified according to their density of agglomeration (inner city, urban outskirt, rural area). Randomly selected residents from each area were invited by mail to participate in the study, either online or via a paper–pencil mode. Noise annoyance was assessed for different noise sources (e.g., neighbourhood, road, railway, aircrafts, different types of industry). In total, 1973 questionnaires were completed. We identified several factors to be predictive of neighbour noise annoyance: satisfaction with the neighbourhood, relationship with neighbours, residential satisfaction, noise sensitivity, and density of agglomeration for people living in the inner city in comparison to rural areas. Particularly, social aspects such as the relationship with neighbours and satisfaction with the neighbourhood have been shown to affect neighbour noise annoyance.

Defining pathways to healthy sustainable urban development

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.

Comment on Gjestland, T. A Systematic Review of the Basis for WHO's New Recommendation for Limiting Aircraft Noise Annoyance. Int. J. Env. Res. Pub. Health 2018, 15, 2717

In his recent discussion paper in this journal, Truls Gjestland attempts a "systematic review", as he calls it, of the evidence base for aircraft noise annoyance, consolidated in a meta-analysis by Guski et al. that informed the recommended guideline value of 45 dB L_den in the recently published World Health Organization (WHO) Environmental Noise Guidelines. He questions the validity of the presented evidence, as "some of the referenced studies have not been conducted according to standardized methods, and the selection of respondents is not representative of the general airport population." Gjestland maintains that the new WHO Guidelines are based on a questionable selection of existing aircraft noise studies. Our reply comments on the arguments of Gjestland and refutes most of his critique.

The Development of a Multiple-Item Annoyance Scale (MIAS) for Transportation Noise Annoyance

In 2001, Team#6 of the International Commission on Biological Effects of Noise (ICBEN) recommended the use of two single international standardised questions and response scales. This recommendation has been widely accepted in the scientific community. Nevertheless, annoyance can be regarded as a multidimensional construct comprising the three elements: (1) experience of an often repeated noise-related disturbance and the behavioural response to cope with it, (2) an emotional/attitudinal response to the sound and its disturbing impact, and (3) the perceived control or coping capacity with regard to the noise situation. The psychometric properties of items reflecting these three elements have been explored for aircraft noise annoyance. Analyses were conducted using data of the NORAH-Study (Noise-Related Annoyance, Cognition, and Health), and a multi-item noise annoyance scale (MIAS) has been developed and tested post hoc by using a stepwise process (exploratory and confirmatory factor analyses). Preliminary results were presented to the 12th ICBEN Congress in 2017. In this study, the validation of MIAS is done for aircraft noise and extended to railway and road traffic noise. The results largely confirm the concept of MIAS as a second-order construct of annoyance for all of the investigated transportation noise sources; however, improvements can be made, in particular with regard to items addressing the perceived coping capacity.

The Combined Effects of Aircraft and Road Traffic Noise and Aircraft and Railway Noise on Noise Annoyance-An Analysis in the Context of the Joint Research Initiative NORAH

The Noise Related Annoyance Cognition and Health (NORAH) research initiative is one of the most extensive studies on the physiological and psychological long-term effects of transportation noise in Europe. It includes research on the quality of life and annoyance as well as cardiovascular effects, sleep disturbance, breast cancer, blood pressure, depression and the cognitive development of children. Within the realm of the annoyance module of the study approximately 10,000 residents of the Rhine-Main district were surveyed on the combined effects of transportation noise. This included combined noise from aircraft and road traffic noise (N = 4905), or aircraft and railway noise (N = 4777). Results show that judgment of the total noise annoyance of participants was strongly determined by the sound source which was judged as more annoying (in this case aircraft noise). To a lesser extent, the average sound pressure level of the two present sources was also of relevance.

European longitudinal study on the relationship between adolescents' alcohol marketing exposure and alcohol use

BACKGROUND AND AIMS

This is the first study to examine the effect of alcohol marketing exposure on adolescents' drinking in a cross-national context. The aim was to examine reciprocal processes between exposure to a wide range of alcohol marketing types and adolescent drinking, controlled for non-alcohol branded media exposure.

DESIGN

Prospective observational study (11-12- and 14-17-month intervals), using a three-wave autoregressive cross-lagged model.

SETTING

School-based sample in 181 state-funded schools in Germany, Italy, Netherlands, Poland.

PARTICIPANTS

A total of 9075 eligible respondents participated in the survey (mean age 14 years, 49.5% male.

MEASUREMENTS

Adolescents reported their frequency of past-month drinking and binge drinking. Alcohol marketing exposure was measured by a latent variable with 13 items measuring exposure to online alcohol marketing, televised alcohol advertising, alcohol sport sponsorship, music event/festival sponsorship, ownership alcohol-branded promotional items, reception of free samples and exposure to price offers. Confounders were age, gender, education, country, internet use, exposure to non-alcohol sponsored football championships and television programmes without alcohol commercials.

FINDINGS

The analyses showed one-directional long-term effects of alcohol marketing exposure on drinking (exposure T1 on drinking T2: β = 0.420 (0.058), P < 0.001, 95% confidence interval (CI) = 0.324-0.515; exposure T2 on drinking T3: β = 0.200 (0.044), P < 0.001, 95% CI = 0.127-0.272; drinking T1 and drinking T2 on exposure: P > 0.05). Similar results were found in the binge drinking model (exposure T1 on binge T2: β = 0.409 (0.054), P < 0.001, 95% CI = 0.320-0.499; exposure T2 on binge T3: β = 0.168 (0.050), P = 0.001, 95% CI = 0.086-0.250; binge T1 and binge T2 on exposure: P > 0.05).

CONCLUSIONS

There appears to be a one-way effect of alcohol marketing exposure on adolescents' alcohol use over time, which cannot be explained by either previous drinking or exposure to non-alcohol-branded marketing.

Exposure to Online Alcohol Marketing and Adolescents' Drinking: A Cross-sectional Study in Four European Countries

AIMS

The Internet is the leading medium among European adolescents in contemporary times; even more time is spent on the Internet than watching television. This study investigates associations between online alcohol marketing exposure and onset of drinking and binge drinking among adolescents in four European countries.

METHOD

A total of 9038 students with a mean age of 14.05 (SD 0.82) participated in a school-based survey in Germany, Italy, the Netherlands and Poland. Logistic regression analyses of cross-sectional cross-country survey data were undertaken. Exposure to online alcohol marketing, televised alcohol advertising and ownership of alcohol-branded items was estimated to be controlled for relevant confounders. Onset of drinking and binge drinking in the past 30 days were included in the study as outcome variables.

RESULTS

Adjusted for relevant confounders, higher exposure to (online) alcohol marketing exposure was found to be related to the odds of starting to drink (p < 0.001) and the odds of binge drinking in the past 30 days (p < 0.001). This effect was found to be consistent in all four countries. Active engagement with online alcohol marketing was found to interact more strongly with drinking outcomes than passive exposure to online alcohol marketing.

CONCLUSIONS

Youngsters in the four European countries report frequent exposure to online alcohol marketing. The association between this exposure and adolescents' drinking was robust and seems consistent across national contexts.

A measurement model for general noise reaction in response to aircraft noise

In this paper a measurement model for general noise reaction (GNR) in response to aircraft noise is developed to assess the performance of aircraft noise annoyance and a direct measure of general reaction as indicators of this concept. For this purpose GNR is conceptualized as a superordinate latent construct underlying particular manifestations. This conceptualization is empirically tested through estimation of a second-order factor model. Data from a community survey at Frankfurt Airport are used for this purpose (N=2206). The data fit the hypothesized factor structure well and support the conceptualization of GNR as a superordinate construct. It is concluded that noise annoyance and a direct measure of general reaction to noise capture a large part of the negative feelings and emotions in response to aircraft noise but are unable to capture all relevant variance. The paper concludes with recommendations for the valid measurement of community reaction and several directions for further research.

Night-time Noise Annoyance: State of the Art

The annoyance-reaction is one of the central variables in noise research. After an introduction to different concepts and definitions of noise annoyance different scales of how noise annoyance can be measured are shown. The question is discussed whether disturbance effects of noise at different times of day are given. To clarify this problem, the results of a series of actual German noise studies are reported. In these studies differences between day- and night-time annoyance are found depending on the sound sources. For the case of road traffic noise no differences between day and night-time annoyance were found. In contrast, annoyance reactions are related to the time of day for railway and air traffic noise. Especially for aircraft noise, above a Leq of 50 dB(A) night-time annoyance rises faster than day-time annoyance. The effects are discussed in the frame of a cognitive model of noise annoyance. It is argued that annoyance judgements are based on an internal representation of the noise situation. Part of this representation are the event characteristics of the sound sources and their estimated impacts for disturbances at different times of day.