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Combined association of BTEX and material hardship on ADHD-suggestive behaviours among a nationally representative sample of US children.

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.

SUBMITTER: Dellefratte K

PROVIDER: S-EPMC7092642 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Project description:IMPORTANCE:Polycyclic aromatic hydrocarbons (PAH) are carcinogenic and neurotoxic combustion by-products commonly found in urban air. Exposure to PAH is disproportionately high in low income communities of color who also experience chronic economic stress. OBJECTIVE:In a prospective cohort study in New York City (NYC) we previously found a significant association between prenatal PAH exposure and Attention Deficit Hyperactivity Disorder (ADHD) behavior problems at age 9. Here, we have evaluated the joint effects of prenatal exposure to PAH and prenatal/childhood material hardship on ADHD behavior problems. MATERIALS AND METHODS:We enrolled nonsmoking African-American and Dominican pregnant women in New York City between 1998 and 2006 and followed their children through 9 years of age. As a biomarker of prenatal PAH exposure, PAH-DNA adducts were measured in maternal blood at delivery and were dichotomized at the limit of detection (to indicate high vs. low exposure). Maternal material hardship (lack of adequate food, housing, utilities, and clothing) was self-reported prenatally and at multiple time points through child age 9. Latent variable analysis identified four distinct patterns of hardship. ADHD behavior problems were assessed using the Conners Parent Rating Scale- Revised. Analyses adjusted for relevant covariates. RESULTS:Among 351 children in our sample, across all hardship groups, children with high prenatal PAH exposure (high adducts) generally had more symptoms of ADHD (higher scores) compared to those with low PAH exposure. The greatest difference was seen among the children with hardship persisting from pregnancy through childhood. Although the interactions between high PAH exposure and hardship experienced at either period ("persistent" hardship or "any" hardship) were not significant, we observed significant differences in the number of ADHD symptoms between children with high prenatal PAH exposure and either persistent hardship or any hardship compared to the others. These differences were most significant for combined high PAH and persistent hardship: ADHD Index (p < 0.008), DSM-IV Inattentive (p = 0.006), DSM-IV Hyperactive Impulsive problems (p = 0.033), and DSM-IV Index Total (p = 0.009). CONCLUSION:The present findings add to existing evidence that co-exposure to socioeconomic disadvantage and air pollution in early life significantly increases the risk of adverse neurodevelopmental outcomes. They suggest the need for multifaceted interventions to protect pregnant mothers and their children.

Project description:ImportancePolycyclic aromatic hydrocarbons are common carcinogenic and neurotoxic urban air pollutants. Toxic exposures, including air pollution, are disproportionately high in communities of color and frequently co-occur with chronic economic deprivation.ObjectivesWe examined whether the association between child IQ and prenatal exposure to polycyclic aromatic hydrocarbons differed between groups of children whose mothers reported high vs. low material hardship during their pregnancy and through child age 5. We tested statistical interactions between hardships and polycyclic aromatic hydrocarbons, as measured by DNA adducts in cord blood, to determine whether material hardship exacerbated the association between adducts and IQ scores.DesignProspective cohort. Participants were recruited from 1998 to 2006 and followed from gestation through age 7 years.SettingUrban community (New York City)ParticipantsA community-based sample of 276 minority urban youth EXPOSURE MEASURE: Polycyclic aromatic hydrocarbon-DNA adducts in cord blood as an individual biomarker of prenatal polycyclic aromatic hydrocarbon exposure. Maternal material hardship self-reported prenatally and at multiple timepoints through early childhood.Main outcome measureChild IQ at 7 years assessed using the Wechsler Intelligence Scale for Children.ResultsSignificant inverse effects of high cord PAH-DNA adducts on full scale IQ, perceptual reasoning and working memory scores were observed in the groups whose mothers reported a high level of material hardship during pregnancy or recurring high hardship into the child's early years, and not in those without reported high hardship. Significant interactions were observed between high cord adducts and prenatal hardship on working memory scores (β = -8.07, 95% CI (-14.48, -1.66)) and between high cord adducts and recurrent material hardship (β = -9.82, 95% CI (-16.22, -3.42)).ConclusionThe findings add to other evidence that socioeconomic disadvantage can increase the adverse effects of toxic physical "stressors" like air pollutants. Observed associations between high cord adducts and reduced IQ were significant only among the group of children whose mothers reported high material hardship. These results indicate the need for a multifaceted approach to prevention.

Project description:OBJECTIVES:We aimed to analyse the healthcare seeking behaviours (HSB) of populations with different migration status and examine the relationship between migration status and HSB. DESIGN:A secondary analysis of cross-sectional data of China Labor-force Dynamics Survey wave 2016, which was conducted by the Sun Yat-sen University every 2 years since 2010. SETTING:29 provinces/cities/autonomous regions in mainland China, excluding Tibet and Hainan province. PARTICIPANTS:3522 respondents in a condition in the previous 2 weeks or during the last 12 months were analysed. MAIN OUTCOME MEASURES:The migration status included internal migrants (IMs), returned population, rural residents and urban residents. The HSB including health services utilisation and choice of health facilities for their health services. Multivariable logistic regressions were used to examine the association between migration status and HSB. RESULTS:2193 and 1898 of 3522 respondents were in need of outpatient services (having a condition in the previous 2 weeks) or inpatient services (being asked to use the inpatient services during the last 12 months). Compared with urban residents, the returned population (OR=0.66, 95% CIs 0.49 to 0.89) and rural residents (OR=0.65, 95% CIs 0.51 to 0.82) were less likely to have an unmet need for outpatient services. The latter tended to choose lower-level hospitals, while the IMs preferred the lowest-level healthcare facilities for health services. After controlling for confounding factors, the results above did not reach any statistical significance. CONCLUSION:Association between migration status and HSB might be through enabling resource and needs. Returned population, IMs and rural residents tended to choose low-level hospitals for their health service needs, but this association was mainly associated with their poorer social and economic resources. Improving their social and economic resources would be helpful for reducing the barriers of HSB.

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Combined association of BTEX and material hardship on ADHD-suggestive behaviours among a nationally representative sample of US children.

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