Effects of prenatal community violence and ambient air pollution on childhood wheeze in an urban population - 04/11/13

Doi : 10.1016/j.jaci.2013.09.023

Yueh-Hsiu Mathilda Chiu, ScD ^a,^b, Brent A. Coull, PhD ^c,^d, Michelle J. Sternthal, PhD ^d, Itai Kloog, PhD ^d,^h, Joel Schwartz, PhD ^d,^e, Sheldon Cohen, PhD ^f, Rosalind J. Wright, MD, MPH ^a,^b,^g,^⁎
^a Kravis Children's Hospital
^f Department of Pediatrics
^g Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
^c Department of Biostatistics
^d Department of Environmental Health
^e Department of Epidemiology, Harvard School of Public Health, Boston, Mass
^f Department of Psychology, Carnegie Mellon University, Pittsburgh, Pa
^h Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel

^∗Corresponding author: Rosalind J. Wright, MD, MPH, One Gustave L. Levy Place, Box 1198, New York, NY 10029.

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Abstract

Background

Prenatal exposures to stress and physical toxins influence children’s respiratory health, although few studies consider these factors together.

Objectives

We sought to concurrently examine the effects of prenatal community-level psychosocial (exposure to community violence [ECV]) and physical (air pollution) stressors on repeated wheeze in 708 urban children followed to age 2 years.

Methods

Multi-item ECV reported by mothers in pregnancy was summarized into a continuous score by using Rasch modeling. Prenatal black carbon exposure was estimated by using land-use regression (LUR) modeling; particulate matter with a diameter of less than 2.5 μm (PM_2.5) was estimated by using LUR modeling incorporating satellite data. Mothers reported child’s wheeze every 3 months. The effects of ECV and air pollutants on repeated wheeze (≥2 episodes) were examined by using logistic regression. Interactions between ECV and pollutants were examined.

Results

Mothers were primarily black (29%) and Hispanic (55%), with lower education (62% with ≤12 years); 87 (12%) children wheezed repeatedly. In models examining concurrent exposures, ECV (odds ratio [OR], 1.95; 95% CI, 1.13-3.36; highest vs lowest tertile) and black carbon (OR, 1.84; 95% CI, 1.08-3.12; median or greater vs less than median) were independently associated with wheeze adjusting for sex, birth season, maternal atopy, education, race, and cockroach antigen. Associations were similar for PM_2.5 (adjusted OR, 2.02; 95% CI, 1.20-3.40). An interaction between ECV with air pollution levels was suggested.

Conclusions

These findings suggest that both prenatal community violence and air pollution can contribute to respiratory health in these urban children. Moreover, place-based psychosocial stressors might affect host resistance such that physical pollutants can have adverse effects, even at relatively lower levels.

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Key words : Community violence, prenatal stress, traffic air pollution, particulate matter, repeated wheeze, prenatal exposure

Abbreviations used : AOD, BC, BMI, ECV, GAM, HPA, LUR, NO₂, OR, PM_2.5, RERI, SES

Plan

Methods

ECV

Air pollution levels

Children’s repeated wheeze

Covariates

Analysis

Results

ECV, air pollution, and wheeze

Stratified analyses

Discussion

	The Asthma Coalition on Community, Environment, and Social Stress (ACCESS) project has been funded by grants R01 ES010932, U01 HL072494, and R01 HL080674 (R.J.W.), and biostatistical support (B.A.C.) was funded by ES000002.
	Disclosure of potential conflict of interest: B. A. Coull, J. Schwartz, and R. J. Wright have received grants from the National Institutes of Health. The rest of the authors declare that they have no relevant conflicts of interest.