Perceptions of mindfulness practices as a support for individuals managing caregiving responsibilities and chronic disease: A qualitative study.

OBJECTIVES: Explore the lived experience of individuals managing and/or caregiving for someone with a chronic disease and their perceptions of developing a mindfulness program for stress reduction. METHODS: Sixteen participants with chronic disease and/or caregivers participated. Participants completed eligibility screening, demographic questionnaires, and semi-structured interviews (30-60 min each) online or by phone. Interviews (n = 16) were audio recorded, transcribed, and analyzed using thematic analysis and NVivo® 12. Survey data were analyzed using SPSS® 28. RESULTS: Four themes emerged: (a) Chronic disease management and stress-perspectives on life's stressors; (b) Stress reduction techniques/perceptions of mindfulness-knowledge and implementation of stress reduction practices and familiarity with mindfulness; (c) Mindfulness program acceptability, barriers, and facilitators-interest, barriers, and facilitators to attending; (d) Mindfulness program structure-logistics to increase access and appeal to diverse audiences. DISCUSSION: Mindfulness has the potential for addressing the complexities of stress associated with disease management. Targeting mindfulness programs for populations with chronic disease management and caregiving responsibilities should include: Consideration of group formats with participation limited to this population, structuring programs to overcome barriers (i.e., culturally appropriate location), and equipping members of the community being served as instructors to ensure culturally relevant instruction.

Systematic Review: Association of Pesticide Exposure and Child Wheeze and Asthma.

BACKGROUND: The prevalence of wheeze and asthma has risen over recent decades for all age groups, especially children. These disorders can lead to decreased quality of life, missed school, urgent care and emergency department visits, hospitalizations, and increased health care costs. Environmental exposures, including pesticide exposure, are likely a contributing factor to this increased prevalence. OBJECTIVE: To evaluate the association of pesticide exposure with childhood wheeze and asthma. METHODS: We conducted a systematic review evaluating studies of pesticide exposure (measured objectively) and child respiratory outcomes. We searched PubMed, Embase (Elsevier), CINAHL (EBSCO), Scopus (Elsevier), Cochrane Database of Systematic Reviews (Wiley), and ClinicalTrials. gov from 1988 - 2021. Main search keywords included "pesticides", "insecticides", "herbicides", "respiratory", "asthma" and "wheeze". RESULTS: Out of 5767 studies, 25 met the inclusion criteria; eight evaluated prenatal pesticide exposure (n=8407), twelve evaluated postnatal exposures (n= 50,488), and five evaluated pre-and postnatal exposures (n=20,919). Main pesticides investigated were dichlorodiphenyldichloroethylene (DDE) (14 studies) followed by organophosphates (7 studies). Primary methods of outcome assessment were questionnaire-based (84%), followed by spirometry (16%), registry data, and blood measures. Studies varied in the strength of evidence relating to study design and measures. Most studies (84%) reported a positive association of exposure with adverse child respiratory health. CONCLUSION: The studies suggest an association of pesticide exposure and childhood wheeze and asthma. The varying results and methods reinforce the need for more research and standardized approaches to these studies to confirm the suggested association of pesticide exposure and childhood wheeze and asthma.

Pediatric Primary Care Relationships and Non-Urgent Emergency Department Use in Children.

OBJECTIVE: Non-urgent emergency department (ED) use contributes to healthcare costs and disrupts continuity of care. Factors influencing patient/guardian decision-making in non-urgent situations are poorly understood. We sought to determine the association of patient/guardian - primary care provider (PCP) relationship with non-urgent ED usage and explore related factors. METHODS: In an urban practice, we recruited 218 parent-child pairs and administered a survey with the PCP relationship (PDRQ-9), caregiver knowledge of office resources, and care-seeking behavior. We performed a 12-month retrospective chart review to document non-urgent ED visits. We evaluated the association of PDRQ9 and non-urgent ED usage by regression analysis. RESULTS: Mean child age was 7.0 ± 5 years, and 32.6% of children had at least one non-urgent ED visit. Mean PDRQ9 score was 39.8 ± 7.3 and was not associated with non-urgent ED use (P = .46). Lower child age (P < .001) and shorter time coming to the PCP practice (P < .001) were both associated with increased non-urgent ED use. Only 36.4% reported usually going to their PCP when they are sick. Knowledge of office resources was limited, and when prompted with acute, non-urgent medical scenarios, in 4 of 5 scenarios, 50% or more of participants chose to go to the ED over communicating with or going to their PCP. CONCLUSIONS: We did not find an association between patient-doctor relationship strength and non-urgent ED usage. Many patients/guardians were unaware of the practice's resources and selected the ED as first choice for acute, non-urgent medical scenarios. Additional work is needed to determine interventions to reduce non-urgent ED use.

Does fetal leptin and adiponectin influence children's lung function and risk of wheeze?

Adipocytokines, which are secreted during fetal development by both mothers and fetuses, may influence fetal lung development, but little human data are available. We used data from the HOME Study to investigate the associations of cord blood adipocytokine concentrations with children's lung forced expiratory volume (FEV1; N = 160) and their risk of wheeze (N = 281). We measured umbilical cord serum adipocytokine concentrations using enzyme-linked immunosorbent assays and FEV1 using a portable spirometer at ages 4 and 5 to calculate the percent predicted FEV1 (%FEV1). Parents completed standardized questionnaires of their child's wheeze symptoms every 6 months from birth to age 5, then again at ages 6 and 8. We used multivariable linear mixed models and modified Poisson regression with generalized estimating equations to estimate associations of adipocytokine concentrations (log2-transformed) with children's %FEV1 and the risk of wheeze, respectively, adjusting for sociodemographic, perinatal, and child factors. Cord serum leptin was not associated with children's %FEV1. Higher cord serum adiponectin concentrations were associated with higher %FEV1 in girls (ß = 3.1, 95% confidence interval [CI]: 0.6, 5.6), but not in boys (ß = -1.3, 95% CI: -5.9, 3.3) (sex × adiponectin p-value = 0.05). Higher leptin was associated with lower risk of wheeze in girls (RR = 0.74, 95% CI: 0.66, 0.84), but not boys (RR = 0.87, 95% CI: 0.69, 1.11) (sex × leptin p-value = 0.01). In contrast, higher adiponectin concentrations were associated with lower risk of wheeze (RR = 0.84, 95% CI: 0.73, 0.96) in both boys and girls. These data suggest that fetal adipocytokines may impact lung development and function in early childhood. Future studies are needed to confirm these findings and explore the mechanisms underlying these associations.

Predictors of Behavioral Changes After Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Adenotonsillectomy (AT) is associated with improved behavior in children with obstructive sleep apnea (OSA). However, it is unknown whether polysomnographic parameters are superior to the parent-reported severity of sleep-disordered breathing (SDB) in predicting behavioral changes after AT. Objective: To ascertain whether polysomnographic parameters vs parent-reported severity of SDB are better predictors of treatment-related behavioral changes in children with OSA. Design, Setting, and Participants: This ad hoc secondary analysis of the Childhood Adenotonsillectomy Trial (CHAT) downloaded and analyzed data from January 1 to January 31, 2020. Children aged 5 to 9 years with a polysomnographic diagnosis of OSA were enrolled in the CHAT and subsequently randomized to undergo either early AT or watchful waiting with supportive care. All outcome measures were obtained at baseline and at follow-up (7 months after randomization). Interventions: Early AT vs watchful waiting with supportive care. Main Outcomes and Measures: Postrandomization changes between the baseline and follow-up periods were derived from (1) T scores in 4 validated behavioral assessments (Conners Global Index parent and teacher versions, Behavior Rating Inventory of Executive Function metacognition index, and Child Behavior Checklist of total, internalizing, and externalizing behavior subscales); (2) 8 aggregated polysomnographic parameters representing the severity of obstruction, hypoxemia, sleep quality, and structure; and (3) the parent-reported severity of SDB measured by the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) scale. The treatment-related changes in each of the behavioral outcomes attributable to changes in SDB severity (represented by the subjective PSQ-SRBD score and objective polysomnographic parameters) were measured and compared using mediation analysis. Results: A total of 453 children were assessed at baseline, of whom 234 were girls (52%) and the mean (SD) age was 6.6 (1.4) years. The postrandomization changes in 7 of 8 behavioral outcome measures between the baseline and follow-up periods were partially mediated by the changes in PSQ-SRBD scores (range of nonzero causally mediated effects, 2.4-3.5), without contribution from any of the polysomnographic parameters. Conclusions and Relevance: This secondary analysis of a national randomized clinical trial found that most treatment-related behavioral changes in children with OSA were mediated by the changes in parent-reported SDB severity alone. These findings suggest that polysomnographic parameters provide clinicians with limited means to predict the improvement in neurobehavioral morbidity in OSA. Trial Registration: ClinicalTrials.gov Identifier: NCT00560859.

Association Between Changes in Timing of Spring Onset and Asthma Hospitalization in Maryland.

Importance: Ongoing climate change is affecting the health of communities across the globe. While direct consequences, including morbidity and mortality tied to increases in the frequency of extreme weather events, have received significant attention, indirect health effects, particularly those associated with climate change-driven disruptions in ecosystems, are less understood. Objective: To investigate how ongoing changes in the timing of spring onset related to climate change are associated with rates of asthma hospitalization in Maryland. Design, Setting, and Participants: This cross-sectional study of 29 257 patients with asthma used general additive (quasi Poisson) and mixed-effect (negative binomial) models to investigate the association between changes in the timing of spring onset, detected using satellite observations, and the risk of asthma hospitalization in Maryland from 2001 to 2012. Data analysis was conducted from January 2016 to March 2019. Exposures: Phenology data, derived from the National Aeronautics and Space Administration's Moderate Resolution Imaging Spectroradiometer, were used to calculate location-specific median dates for start of season from 2001 to 2012. How the start of season for a given year and location deviated from the long-term average was calculated and categorized as very early, early, normal, or late. Main Outcomes and Measures: Daily asthma hospitalization in Maryland during the spring season (ie, March to May). Results: There were 108 358 total asthma hospitalizations during the study period, of which 29 257 (27.0%; 14 379 [49.1%] non-Hispanic black patients; 17 877 [61.1%] women) took place during springtime. In the unadjusted model, very early (incident rate ratio [IRR], 1.17; 95% CI, 1.07-1.28) and late (IRR, 1.07; 95% CI, 1.00-1.15) onset of spring were associated with increased risk of asthma hospitalization. When the analysis was adjusted for extreme heat events and concentrations of particulate matter with an aerodynamic diameter less than 2.5 µm, the risk remained significant for very early spring onset (IRR, 1.10; 95% CI, 1.02-1.20) but not for late spring onset (IRR, 1.03; 95% CI, 0.97-1.11). Conclusions and Relevance: These results suggest that ongoing changes in the timing of spring onset, which are related to climate variability and change, are associated with asthma hospitalization. Given the high burden of allergic diseases and the number of individuals sensitized to tree pollen, these findings serve as a wake-up call to public health and medical communities regarding the need to anticipate and adapt to the ongoing changes in the timing and severity of the spring allergy season.

PFAS (per- and polyfluoroalkyl substances) and asthma in young children: NHANES 2013-2014.

Per- and polyfluoroalkyl substances (PFAS) are a class of persistent chemicals used as industrial surfactants, fire-fighting foams, and textile treatments. Early childhood exposure to perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) may affect the immune system to increase the risk of allergic and respiratory diseases. However, there are substantial gaps in our knowledge about the relationship between PFAS and immune-mediated outcomes such as asthma in children. Thus, we examined the cross-sectional associations of serum PFOA, PFOS, PFNA, and PFHxS concentrations with childhood asthma. We used data from children aged 3-11 years who participated in the National Health and Nutrition Examination Survey (2013-2014). Serum PFAS concentrations were measured in serum using analytical chemistry methods. Asthma was assessed by parent-reported, doctor-diagnosed, asthma using a standardized questionnaire. Controlling for covariates, we estimated odds ratios for asthma per standard deviation increase in ln-transformed serum PFAS concentrations (n = 607). We also examined effect measure modification by child age, sex, and race/ethnicity. PFOA (1.1; 95% CI: 0.8, 1.4), PFOS (1.2; 95% CI: 0.8, 1.7), PFNA (1.1; 95% CI: 0.8, 1.6), and PFHxS (1.1; 95% CI: 0.9, 1.6) were weakly associated with an increased odds of asthma. Age modified associations between serum PFOS, but not other serum PFAS concentrations, and odds of asthma (age x PFOS interaction term p-value = 0.03). Sex and race/ethnicity did not modify these associations. We observed some evidence that serum PFAS concentrations are weakly associated with increased asthma prevalence in US children.

Early childhood wheezers: identifying asthma in later life.

Wheeze in young children is common, and asthma is the most common noncommunicable disease in children. Prevalence studies of recurrent asthma-like symptoms in children under the age of 5 years have reported that one third of children in the US and Europe are affected, and rates and severity appear to be higher in developing countries. Over the last few decades, significant research efforts have focused on identification of risk factors and predictors of wheeze and on tools to identify which children who wheeze will progress to develop asthma. We reviewed the phenotypes of childhood wheezing, genetic risk factors, environmental factors, testing/predictive indices, and primary prevention. While it is generally agreed that a complex interaction of environmental exposure and genetic susceptibility contributes to the development of asthma, limitations in predictive tools and tests restrict our ability to provide families with guidance as to whether their child with wheeze will ultimately develop asthma. Additional research is needed to clarify childhood wheeze phenotypes, to develop tools to determine which children will develop asthma, and to determine how and when to intervene. If these areas can be addressed, it would help reduce this large burden on children, families, and society.

Family hardships and serum cotinine in children with asthma.

BACKGROUND AND OBJECTIVE: A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS: We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS: We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported ≥ 1 hardship, and 41% reported ≥ 4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with ≥ 4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine. CONCLUSIONS: Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.

Bisphenol a exposure and the development of wheeze and lung function in children through age 5 years.

IMPORTANCE: Bisphenol A (BPA), a prevalent endocrine-disrupting chemical, has been associated with wheezing in children, but few studies have examined its effect on lung function or wheeze in older children. OBJECTIVES: To test whether BPA exposure is associated with lung function, with wheeze, and with pattern of wheeze in children during their first 5 years. DESIGN, SETTING, AND PARTICIPANTS: A birth cohort study, enrolled during early pregnancy in the greater Cincinnati, Ohio, area among 398 mother-infant dyads. We collected maternal urine samples during pregnancy (at 16 and 26 weeks) and child urine samples annually to assess gestational and child BPA exposure. MAIN OUTCOMES AND MEASURES: We assessed parent-reported wheeze every 6 months for 5 years and measured child forced expiratory volume in the first second of expiration (FEV1) at age 4 and 5 years. We evaluated associations of BPA exposure with respiratory outcomes, including FEV1, child wheeze, and wheeze phenotype. RESULTS: Urinary BPA concentrations and FEV1 data were available for 208 children and urinary BPA concentrations and parent-reported wheeze data were available for 360 children. The mean maternal urinary BPA concentration ranged from 0.53 to 293.55 µg/g of creatinine. In multivariable analysis, every 10-fold increase in the mean maternal urinary BPA concentration was associated with a 14.2% (95% CI, -24.5% to -3.9%) decrease in the percentage predicted FEV1 at 4 years, but no association was found at 5 years. In multivariable analysis, every 10-fold increase in the mean maternal urinary BPA concentration was marginally associated with a 54.8% increase in the odds of wheezing (adjusted odds ratio, 1.55; 95% CI, 0.91-2.63). While the mean maternal urinary BPA concentration was not associated with wheeze phenotype, a 10-fold increase in the 16-week maternal urinary BPA concentration was associated with a 4.27-fold increase in the odds of persistent wheeze (adjusted odds ratio, 4.27; 95% CI, 1.37-13.30). Child urinary BPA concentrations were not associated with FEV1 or wheeze. CONCLUSIONS AND RELEVANCE: These results provide evidence suggesting that prenatal but not postnatal exposure to BPA is associated with diminished lung function and the development of persistent wheeze in children.

Secondhand tobacco exposure is associated with nonalcoholic fatty liver disease in children.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in children in the United States, and prevalence rates are rising. Smoking is associated with NAFLD, but the association of secondhand smoke exposure with NAFLD is unknown. AIMS: To investigate the association of secondhand tobacco exposure with NAFLD in children. METHODS: We surveyed parents/guardians of 304 children aged 3-12 years who had received an abdominal ultrasound at Penn State Hershey Medical Center. The survey addressed demographics, medical history, secondhand tobacco exposure, activity level, screen viewing time and other environmental exposures. A pediatric radiologist and sonographer reviewed the ultrasounds to grade the presence of bight liver compatible with NAFLD. We conducted logistic regression analysis to assess the association of secondhand tobacco exposure and NAFLD. RESULTS: 54% of eligible potential participants responded to the survey. Fatty liver was present in 3% of the children. Increasing child age was associated with increased odds of NAFLD (OR 1.63 95% CI 1.1, 2.4). Reported child obesity was associated with increased odds of NAFLD (OR 44.5 95% CI 5.3, 371.7). The rate of NAFLD was higher in the smoke exposed group (6.7% vs. 1.7%). For every extra pack per day smoked at home, the odds of a child having NAFLD increased 1.8 times (AOR 1.8, 95% CI 1.2, 2.8), and any exposure increased a child's odds of NAFLD four-fold (AOR 4.0, 95% CI 1.02, 15.8). CONCLUSION: We found an association of secondhand smoke exposure and NAFLD in children. This may represent an area for future prevention efforts.

Bisphenol A exposure is associated with decreased lung function.

OBJECTIVE: To examine the associations of bisphenol A (BPA) exposure with lung function measures and exhaled nitric oxide (FeNO) in children. STUDY DESIGN: We performed a cross-sectional analysis of a subsample of US children age 6-19 years who participated in the 2007-2010 National Health and Nutrition Examination Survey. We assessed univariate and multivariable associations of urinary BPA concentration with the predicted pulmonary function measures for age, sex, race/ethnicity and height (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], forced expiratory flow 25%-75%, and FEV1 divided by FVC) and with FeNO. RESULTS: Exposure and outcome data were available for 661 children. Median BPA was 2.4 ng/mL (IQR: 1.3, 4.1). In multivariable analysis, a larger urinary BPA concentration was associated with significantly decreased percent predicted forced expiratory flow 25%-75% (%FEF2575) (3.7%, 95% CI 1.0, 6.5) and percent predicted FEV1 divided by FVC (%FEV1/FVC) (0.8%, 95% CI 0.1, 1.7) but not percent predicted FEV1, percent predicted FVC, or FeNO. A child in the top quartile of BPA compared with the bottom quartile had a 10% decrease in %FEF2575 (95% CI -1, -19) and 3% decrease in %FEV1/FVC (95% CI -1, -5). CONCLUSIONS: BPA exposure was associated with a modest decrease in %FEF2575 (small airway function) and %FEV1/FVC (pulmonary obstruction) but not FEV1, FVC, or FeNO. Explanations of the association cannot rule out the possibility of reverse causality.

Cotinine in children admitted for asthma and readmission.

OBJECTIVE: To explore the relationship between tobacco smoke exposure (reported versus biomarker) and rates of readmission for children hospitalized for asthma. METHODS: We enrolled a prospective cohort of 774 children aged 1 to 16 years admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was at least 1 asthma- or wheeze-related readmission within 1 year. Caregivers reported any tobacco exposure at home, in a secondary residence, or in the car. We measured serum and saliva cotinine levels with mass spectrometry. We used logistic regression to evaluate associations between tobacco exposure and readmissions. RESULTS: A total of 619 children had complete tobacco exposure data; 57% were African American and 76% had Medicaid. Seventeen percent of children were readmitted within 1 year. Tobacco exposure rates were 35.1%, 56.1%, and 79.6% by report, serum, and saliva measures, respectively. Caregiver report of any tobacco exposure was not associated with readmission (adjusted odds ratio: 1.18; 95% confidence interval: 0.79-1.89), but having detectable serum or salivary cotinine was associated with increased odds of readmission (adjusted odds ratio [95% confidence interval]: 1.59 [1.02-2.48] and 2.35 [1.22-4.55], respectively). Among children whose caregivers reported no tobacco exposure, 39.1% had detectable serum cotinine and 69.9% had detectable salivary cotinine. Of the children with reported exposure, 87.6% had detectable serum cotinine and 97.7% had detectable salivary cotinine. CONCLUSIONS: Detectable serum and salivary cotinine levels were common among children admitted for asthma and were associated with readmission, whereas caregiver report of tobacco exposure was not.

The associations of triclosan and paraben exposure with allergen sensitization and wheeze in children.

Triclosan and parabens are chemicals used in personal care and medical products as microbicides and preservatives. Triclosan and paraben exposure may be associated with allergy (atopy), but these associations have not been evaluated with respect to other atopic states such as eczema (atopic dermatitis). This study examines the associations of urinary triclosan and paraben concentrations with allergic sensitization and asthma in children according to eczema history. We performed a cross-sectional analysis of U.S. children aged 6-18 years who participated in the National Health and Nutrition Examination Survey (2005-2006). Triclosan and paraben concentrations were measured in urine. We assessed associations of triclosan and parabens with allergic sensitization and asthma using multivariable logistic regression in 837 children with complete data and stratified our results by eczema status. After covariate adjustment, triclosan and methyl and propyl paraben concentrations were positively associated with the odds of aeroallergen sensitization. Eczema did not significantly modify the association between triclosan or paraben levels and aeroallergen sensitization, asthma, or wheeze. The odds of parent-reported atopic asthma increased 34% (95% CI, 0, 81) across triclosan concentration quartiles. Increasing triclosan concentrations (quartiles) were associated with 2.3 times the odds of food sensitization (95% CI, 1.14, 4.44) among children with eczema, but not among children without eczema (OR, 1.25; 95% CI 0.93, 1.68; effect measure modification, p = 0.04). Triclosan and paraben exposures may increase the risk of atopic asthma and aeroallergen sensitization. Prospective studies are necessary to confirm these findings and determine if these chemicals pose a risk to children's health.

Urinary phthalates and increased insulin resistance in adolescents.

BACKGROUND: Di-2-ethylhexylphthalate (DEHP) is an environmental chemical commonly found in processed foods. Phthalate exposures, in particular to DEHP, have been associated with insulin resistance in adults, but have not been studied in adolescents. METHODS: Using cross-sectional data from 766 fasting 12- to 19-year-olds in the 2003-2008 NHANES, we examined associations of phthalate metabolites with continuous and categorical measures of homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: Controlling for demographic and behavioral factors, diet, continuous age, BMI category, and urinary creatinine, for each log (roughly threefold) increase in DEHP metabolites, a 0.27 increase (95% confidence interval 0.14-0.40; P < .001) in HOMA-IR was identified. Compared with the first tertile of DEHP metabolite in the study population (14.5% insulin resistant), the third tertile had 21.6% prevalence (95% confidence interval 17.2%-26.0%; P = .02). Associations persisted despite controlling for bisphenol A, another endocrine-disrupting chemical commonly found in foods, and HOMA-IR and insulin resistance were not significantly associated with metabolites of lower molecular weight phthalates commonly found in cosmetics and other personal care products. CONCLUSIONS: Urinary DEHP concentrations were associated with increased insulin resistance in this cross-sectional study of adolescents. This study cannot rule out the possibility that insulin-resistant children ingest food with higher phthalate content, or that insulin-resistant children excrete more DEHP.

The contribution of housing renovation to children's blood lead levels: a cohort study.

BACKGROUND: Routine renovation of older housing is a risk factor for childhood lead poisoning, but the contribution to children's blood lead levels is poorly defined for children with lower exposure levels. METHODS: We examined a prospective cohort of 276 children followed from 6 to 24 months of age. We conducted surveys of renovation activities and residential lead hazards and obtained blood lead level (B-Pb) every six months. We analyzed B-Pb in a repeated measures design using a mixed effects linear model. RESULTS: Parent reported interior renovation ranged from 11 to 25% of housing units at the four, 6-month periods. In multivariable analysis, children whose housing underwent interior renovation had a 12% higher mean B-Pb by two years of age compared with children whose housing units were not renovated (p < 0.01). The time between renovation and the child blood lead sample was associated with higher B-Pb (p-value for trend <0.01); compared to children in non-renovated housing, children whose housing units underwent renovation in the prior month had a 17% higher mean B-Pb at two years of age, whereas children whose housing renovation occurred in the prior 2-6 months had an 8% higher mean B-Pb. We also found an association between higher paint lead loading, measured using an X-ray fluorescence (XRF) based paint lead index, and child B-Pb (p = 0.02); for every 10 mg/cm2 increase in paint lead loading index there was a 7.5% higher mean childhood B-Pb. CONCLUSIONS: In an analysis of data collected before the recent changes to Environmental Protection Agency's Lead, Renovation, Repair and Painting Rule, routine interior housing renovation was associated with a modest increase in children's B-Pb. These results are important for the provision of clinical advice, for housing and public health professionals, and for policymakers.

Urinary phthalates are associated with higher blood pressure in childhood.

OBJECTIVE: To examine associations of urinary phthalate levels with blood pressure (BP) and serum triglyceride and lipoprotein levels in children. STUDY DESIGN: We performed a cross-sectional analysis of a subsample of US children aged 6-19 years who participated in the National Health and Nutrition Examination Survey between 2003 and 2008. We quantified exposure to 3 families of phthalates--low molecular weight, high molecular weight and di-2-ethylhexylphthalate (DEHP)--based on molar concentration of urinary metabolites. We assessed descriptive, bivariate, and multivariate associations with BP and lipid levels. RESULTS: Controlling for an array of sociodemographic and behavioral factors, as well as diet and body mass index, levels of metabolites of DEHP, a phthalate commonly found in processed foods, were associated with higher age-, sex-, and height-standardized BP. For each log unit (roughly 3-fold) increase in DEHP metabolites, a 0.041 SD unit increase in systolic BP z-score was identified (P = .047). Metabolites of low molecular weight phthalates commonly found in cosmetics and personal care products were not associated with BP. Phthalate metabolites were not associated with triglyceride levels, high-density lipoprotein level, or prehypertension. CONCLUSIONS: Dietary phthalate exposure is associated with higher systolic BP in children and adolescents. Further work is needed to confirm these associations, as well as to evaluate opportunities for intervention.

Race/ethnicity-specific associations of urinary phthalates with childhood body mass in a nationally representative sample.

BACKGROUND: Phthalates have antiandrogenic effects and may disrupt lipid and carbohydrate metabolism. Racial/ethnic subpopulations have been documented to have varying urinary phthalate concentrations and prevalences of childhood obesity. OBJECTIVE: We examined associations between urinary phthalate metabolites and body mass outcomes in a nationally representative sample of U.S. children and adolescents. METHODS: We performed stratified and whole-sample cross-sectional analyses of 2,884 children 6-19 years of age who participated in the 2003-2008 National Health and Nutrition Examination Survey. Multivariable linear and logistic analyses of body mass index z-score, overweight, and obesity were performed against molar concentrations of low-molecular-weight (LMW), high-molecular-weight (HMW), and di-2-ethylhexylphthalate (DEHP) metabolites, controlling for sex, television watching, caregiver education, caloric intake, poverty-income ratio, race/ethnicity, serum cotinine, and age group. We used sensitivity analysis to examine robustness of results to removing sample weighting, normalizing phthalate concentrations for molecular weight, and examining different dietary intake covariates. RESULTS: In stratified, multivariable models, each log unit (roughly 3-fold) increase in LMW metabolites was associated with 21% and 22% increases in odds (95% CI: 1.05-1.39 and 1.07-1.39, respectively) of overweight and obesity, and a 0.090-SD unit increase in BMI z-score (95% CI: 0.003-0.18), among non-Hispanic blacks. Significant associations were not identified in any other racial/ethnic subgroup or in the study sample as a whole after controlling for potential confounders, associations were not significant for HMW or DEHP metabolites, and results did not change substantially with sensitivity analysis. CONCLUSIONS: We identified a race/ethnicity-specific association of phthalates with childhood obesity in a nationally representative sample. Further study is needed to corroborate the association and evaluate genetic/epigenomic predisposition and/or increased phthalate exposure as possible explanations for differences among racial/ethnic subgroups.