RESUMO
There is a growing epidemiologic interest to expand the scope of health research beyond disease and risk factors to a more comprehensive evaluation of all health states, including those on the positive end of the spectrum ("positive health"). Neighborhood quality (NQ) is a potentially modifiable factor that may influence positive health. We evaluated the association between perception of NQ in childhood and indicators of positive health among adolescents who live in low-income, urban neighborhoods of New York City. Mothers assessed NQ prospectively via questionnaire at child ages 5, 7, 9, and 11. Indicators of positive health domains including general health, physical health, and mental health were assessed and reported by mothers when their children were between the ages of 10-20 years and self-reported among a subset of children at 16-20 years. Children were grouped into "stressed" and "non-stressed" NQ groups based on the repeated prospective maternal report evaluating various aspects of their neighborhood. Overall, we found a general trend that those in the perceived "non-stressed" NQ groups had better Global Health compared to those in the "stressed" NQ group. In the subset of children who provided self-report, we observed significant associations between better overall NQ and NQ safety and better Global Health. We also observed a significant relationship between greater perceived neighborhood social cohesion and lower psychological stress. Our findings identify an important modifiable environmental factor in child and adolescent health that could serve as a focus for interventions to help break the cycle of children's environmental health disparities.
RESUMO
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.
