A systematic review and meta-analysis examining the interrelationships between chemical and non-chemical stressors and inherent characteristics in children with ADHD.

Children may be more vulnerable to the combined interactions of chemical and non-chemical stressors from their built, natural, and social environments when compared to adults. Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed childhood neurodevelopmental disorder and is considered a major public health issue, as 75% of childhood cases persist into adulthood. ADHD is characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattention, with the neurotransmitter serotonin regulating these symptoms. Monoamine oxidase A (MAOA) aids in serotonin uptake and is often implicated in behavioral and emotional disorders, including ADHD. When children are exposed to cigarette smoke, bisphenol A (BPA), or organophosphate pesticides, MAOA activity is inhibited. Non-chemical stressors, such as traumatic childhood experiences, and lifestyle factors, complicate the relationship between genotype and exposures to chemical stressors. But the co-occurrence among outcomes between exposures to chemical stressors, non-chemical stressors, and the low activity MAOA genotype suggest that mental illness in children may be influenced by multiple interacting factors. In this systematic review, we examine the existing literature that combines exposures to chemical and non-chemical stressors (specifically childhood trauma), MAOA characteristics, and ADHD diagnosis to investigate the interrelationships present. We observe that chemical (lead [Pb], phthalates/plasticizers, persistent organic pollutants, and cigarette smoke) exposure is significantly related to ADHD in children. We also observed that existing literature examining the interaction between MAOA, exposures to chemical stressors, and traumatic experiences and their effect on ADHD outcomes is sparse. We recommend that future studies investigating childhood ADHD include chemical and non-chemical stressors and inherent characteristics to gain a holistic understanding of childhood mental health outcomes.

Serum concentrations of perfluorinated compounds (PFC) among selected populations of children and adults in California.

Perfluorinated compounds (PFCs) have been widely used in industrial applications and consumer products. Their persistent nature and potential health impacts are of concern. Given the high cost of collecting serum samples, this study is to understand whether we can quantify PFC serum concentrations using factors extracted from questionnaire responses and indirect measurements, and whether a single serum measurement can be used to classify an individual's exposure over a one-year period. The study population included three demographic groups: young children (2-8 years old) (N=67), parents of young children (<55 years old) (N=90), and older adults (>55 years old) (N=59). PFC serum concentrations, house dust concentrations, and questionnaires were collected. The geometric mean of perfluorooctane sulfonic acid (PFOS) was highest for the older adults. In contrast, the geometric mean of perfluorooctanoic acid (PFOA) was highest for children. Serum concentrations of the parent and the child from the same family were moderately correlated (Spearman correlation (r)=0.26-0.79, p<0.05), indicating common sources within a family. For adults, age, having occupational exposure or having used fire extinguisher, frequencies of consuming butter/margarine, pork, canned meat entrées, tuna and white fish, freshwater fish, and whether they ate microwave popcorn were significantly positively associated with serum concentrations of individual PFCs. For children, residential dust concentrations, frequency of wearing waterproof clothes, frequency of having canned fish, hotdogs, chicken nuggets, French fries, and chips, and whether they ate microwave popcorn were significant positive predictors of individual PFC serum concentrations. In addition, the serum concentrations collected in a subset of young children (N=20) and the parents (N=42) one year later were strongly correlated (r=0.68-0.98, p<0.001) with the levels measured at the first visits, but showed a decreasing trend. Children had moderate correlation (r=0.43) between serum and dust concentrations of PFOS, indicating indoor sources contribute to exposure. In conclusion, besides food intake, occupational exposure, consumer product use, and exposure to residential dust contribute to PFC exposure. The downward temporal trend of serum concentrations reflects the reduction of PFCs use in recent years while the year-to-year correlation indicates that a single serum measurement could be an estimate of exposure relative to the population for a one-year period in epidemiology studies.

Polybrominated diphenyl ether serum concentrations in a Californian population of children, their parents, and older adults: an exposure assessment study.

BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in many household items. Given concerns over their potential adverse health effects, we identified predictors and evaluated temporal changes of PBDE serum concentrations. METHODS: PBDE serum concentrations were measured in young children (2-8 years old; N = 67), parents of young children (<55 years old; N = 90), and older adults (≥55 years old; N = 59) in California, with concurrent floor wipe samples collected in participants' homes in 2008-2009. We also measured serum concentrations one year later in a subset of children (N = 19) and parents (N = 42). RESULTS: PBDE serum concentrations in children were significantly higher than in adults. Floor wipe concentration is a significant predictor of serum BDE-47, 99, 100 and 154. Positive associations were observed between the intake frequency of canned meat and serum concentrations of BDE-47, 99 and 154, between canned meat entrees and BDE-154 and 209, as well as between tuna and white fish and BDE-153. The model with the floor wipe concentration and food intake frequencies explained up to 40% of the mean square prediction error of some congeners. Lower home values and renting (vs. owning) a home were associated with higher serum concentrations of BDE-47, 99 and 100. Serum concentrations measured one year apart were strongly correlated as expected (r = 0.70-0.97) with a slight decreasing trend. CONCLUSIONS: Floor wipe concentration, food intake frequency, and housing characteristics can explain 12-40% of the prediction error of PBDE serum concentrations. Decreasing temporal trends should be considered when characterizing long-term exposure.

Urinary pyrethroid and chlorpyrifos metabolite concentrations in Northern California families and their relationship to indoor residential insecticide levels, part of the Study of Use of Products and Exposure Related Behavior (SUPERB).

Since the 2001 U.S. federally mandated phase-out of residential uses of organophosphates (OPs), use of and potential for human exposure to pyrethroids in the indoor residential environment has increased. We report concentrations of common pyrethroids, pyrethroid metabolites, and chlorpyrifos in floor wipes, and urinary concentrations of pyrethroid metabolites and 3,5,6-trichloro-2-pyridinol (TCPy) in samples collected in 2007-2009 from 90 northern California families as part of the Study of Use of Products and Exposure Related Behavior (SUPERB). Correlation and regression analyses examined associations between floor wipe and urine sample concentrations. The most frequently detected urinary metabolites were TCPy (64.7%, median concentration of 1.47 ng/mL) and 3-phenoxybenzoic acid (3PBA) (62.4%, 0.79 ng/mL). Compared to the National Health and Nutrition Examination Survey (NHANES) 2001-2002 general U.S. population, this population had substantially higher pyrethroid metabolite and lower TCPy urinary concentrations. This may be related to the increased residential use of pyrethroids after the phase-out of OPs. Chlorpyrifos (98.7%), cis- and trans-permethrin (97.5%), bifenthrin (59.3%), and 3PBA (98.7%) were frequently detected in the floor wipes. Floor wipe concentrations for pyrethroid insecticides were found to be significant predictors of child creatinine-adjusted urinary metabolite concentrations (log-log regression coefficients ranging from 0.26 to 0.29; p < 0.05) suggesting that indoor residential exposure to pyrethroid insecticides is an important exposure route for children.

Indoor residence times of semivolatile organic compounds: model estimation and field evaluation.

Indoor residence times of semivolatile organic compounds (SVOCs) are a major and mostly unavailable input for residential exposure assessment. We calculated residence times for a suite of SVOCs using a fugacity model applied to residential environments. Residence times depend on both the mass distribution of the compound between the "mobile phase" (air and dust particles settled on the carpet) and the "non-mobile phase" (carpet fibers and pad) and the removal rates resulting from air exchange and cleaning. We estimated dust removal rates from cleaning processes using an indoor-particle mass-balance model. Chemical properties determine both the mass distribution and relative importance of the two removal pathways, resulting in different residence times among compounds. We conducted a field study after chlorpyrifos was phased out for indoor use in the United States in 2001 to determine the decreases in chlorpyrifos air concentrations over a one-year period. A measured average decrease of 18% in chlorpyrifos air concentrations indicates the residence time of chlorpyrifos is expected to be 6.9 years and compares well with model predictions. The estimates from this study provide the opportunity to make more reliable estimates of SVOCs exposure in the indoor residential environment.

Release of silver from nanotechnology-based consumer products for children.

We assessed the potential for children's exposure to bioavailable silver during the realistic use of selected nanotechnology-based consumer products (plush toy, fabric products, breast milk storage bags, sippy cups, cleaning products, humidifiers, and humidifier accessory). We measured the release of ionic and particulate silver from products into water, orange juice, milk formula, synthetic saliva, sweat, and urine (1:50 product to liquid mass ratio); into air; and onto dermal wipes. Of the liquid media, sweat and urine yielded the highest amount of silver release, up to 38% of the silver mass in products; tap water yielded the lowest amount, ≤1.5%. Leaching from a blanket into sweat plateaued within 5 min, with less silver released after washing. Between 0.3 and 23 µg m(-2) of silver transferred from products to wipes. Aerosol concentrations were not significantly elevated during product use. Fabrics, a plush toy, and cleaning products were most likely to release silver. Silver leached mainly via dissolution and was facilitated in media with high salt concentrations. Levels of silver to which children may potentially be exposed during the normal use of these consumer products is predicted to be low, and bioavailable silver is expected to be in ionic rather than particulate form.

Pesticide, allergen, PCB, and lead measurements in childcare centers located on tribal lands in the Pacific Northwest, United States.

BACKGROUND: Children's potential exposures to chemical and biological agents in tribal childcare centers are not well characterized. OBJECTIVES: (1) The environmental health of childcare centers in Portland Area Indian Country was characterized by measuring selected pesticides, polychlorinated biphenyls (PCBs), allergens, and lead (Pb) in outdoor soil and indoor dust. (2) We compared our results to other studies of childcare centers in both the United States and globally. METHODS: At 31 tribal childcare centers in Washington, Oregon, and Idaho, we collected indoor dust and outdoor soil samples from at least one classroom, multipurpose room, and outdoor play area. Number of rooms sampled depended on facility size. Surface wipes were collected from the floor, play/work surface, and windowsill and analyzed for selected pesticides and PCBs. Vacuum samples were collected from the floor and analyzed for selected allergens. Lead was measured in surface wipes and outdoor soil collected at 11 centers. A questionnaire collected information on demographics, cleaning habits, and pesticide usage. RESULTS: At least one pesticide was measured at all childcare centers. cis-Permethrin (surface wipes: 0.003-180 ng/cm2), trans-permethrin (surface wipes: 0.002-200 ng/cm2) and piperonyl butoxide (surface wipes: 0.001-120 ng/cm2) were measured in all centers. Lead was measured in most surface wipes (<0.25-14 ng/cm2) and all outdoor soil samples (8.4-50 mg/kg). Aroclors 1242 and 1254 were detected on indoor surfaces in three centers at very low loadings. Allergen residues were measured at very low concentrations in vacuum dust samples (Der p 1: <0.012-0.12 µg/g; Der f 1: <0.012-0.09 µg/g; Mus m 1: <0.002-10.055 µg/g). In general, we observed lower levels of chemical and biological agents than what has been reported previously. SIGNIFICANCE: By understanding the environmental health of childcare centers, we can better understand the role of child-specific environments in promoting children's health and well-being. IMPACT STATEMENT: To our knowledge, this is the first study to characterize the environmental health of tribal childcare centers in the Pacific Northwest. Combined with the information we have on childcare centers from around the world, this study expands our knowledge on young children's potential exposures to chemical and biological agents in locations where they spend significant amounts of time.

Pyrethroid exposure among children residing in green versus non-green multi-family, low-income housing.

BACKGROUND: There is growing concern about children's chronic low-level pesticide exposure and its impact on health. Green building practices (e.g., reducing leakage of the thermal and pressure barrier that surrounds the structure, integrated pest management, improved ventilation) have the potential to reduce pesticide exposure. However, the potential impact of living in green housing on children's pesticide exposure is unknown. OBJECTIVE: To address this question, a longitudinal study of pyrethroid metabolites (3-phenoxybenzoic acid [3-PBA], 4-fluoro-3-phenoxybenzoic acid [4-F-3-PBA], trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid [trans-DCCA]) in first morning void urine, collected from 68 children from New Orleans, Louisiana residing in green and non-green housing was conducted. METHODS: Children were followed for 1 year with three repeated measures of pesticide exposure. Generalized estimating equations examined associations between housing type (green vs. non-green) and urinary pyrethroid metabolite concentrations adjusting for demographic and household factors over the year. RESULTS: Ninety-five percent of samples had detectable concentrations of 3-PBA (limit of detection [LOD]: 0.1 µg/L); 8% of 4-F-3-PBA (LOD: 0.1 µg/L), and 12% of trans-DCCA (LOD: 0.6 µg/L). In adjusted models, green housing was not associated with statistically significant differences in children's 3-PBA urinary concentrations compared to non-green housing.

A quest to identify suitable organic tracers for estimating children's dust ingestion rates.

Chemical exposure via dust ingestion is of great interest to researchers and regulators because children are exposed to dust through their daily activities, and as a result, to the many chemicals contained within dust. Our goal was to develop a workflow to identify and rank organic chemicals that could be used as tracers to calculate children's dust ingestion rates. We proposed a set of criteria for a chemical to be considered a promising tracer. The best tracers must be (1) ubiquitous in dust, (2) unique to dust, (3) detectable as biomarkers in accessible biological samples, and (4) have available or obtainable ADME information for biomarker-based exposure reconstruction. To identify compounds meeting these four criteria, we developed a workflow that encompasses non-targeted analysis approaches, literature and database searching, and multimedia modeling. We then implemented an ad hoc grading system and ranked candidate chemicals based on fulfillment of our criteria (using one small, publicly available dataset to show proof of concept). Initially, five chemicals (1,3-diphenylguanidine, leucine, piperine, 6:2/8:2 fluorotelomer phosphate diester, 6:2 fluorotelomer phosphate diester) appeared to satisfy many of our criteria. However, a rigorous manual investigation raised many questions about the applicability of these chemicals as tracers. Based on the results of this initial pilot study, no individual compounds can be unequivocally considered suitable tracers for calculating dust ingestion rates. Future work must therefore consider larger datasets, generated from broader measurement studies and literature searches, as well as refinements to selection criteria, to identify robust and defensible tracer compounds.

A Meta-Analysis of Stressors from the Total Environment Associated with Children's General Cognitive Ability.

General cognitive ability, often referred to as 'general intelligence', comprises a variety of correlated abilities. Childhood general cognitive ability is a well-studied area of research and can be used to predict social outcomes and perceived success. Early life stage (e.g., prenatal, postnatal, toddler) exposures to stressors (i.e., chemical and non-chemical stressors from the total (built, natural, social) environment) can impact the development of childhood cognitive ability. Building from our systematic scoping review (Ruiz et al., 2016), we conducted a meta-analysis to evaluate more than 100 stressors related to cognitive development. Our meta-analysis identified 23 stressors with a significant increase in their likelihood to influence childhood cognitive ability by 10% or more, and 80 stressors were observed to have a statistically significant effect on cognitive ability. Stressors most impactful to cognition during the prenatal period were related to maternal health and the mother's ability to access information relevant to a healthy pregnancy (e.g., diet, lifestyle). Stressors most impactful to cognition during the early childhood period were dietary nutrients (infancy), quality of social interaction (toddler), and exposure to toxic substances (throughout early childhood). In conducting this analysis, we examined the relative impact of real-world exposures on cognitive development to attempt to understand the inter-relationships between exposures to both chemical and non-chemical stressors and early developmental life stages. Our findings suggest that the stressors observed to be the most influential to childhood cognitive ability are not permanent and can be broadly categorized as activities/behaviors which can be modified to improve childhood cognition. This meta-analysis supports the idea that there are complex relationships between a child's total environment and early cognitive development.

State-of-the-Science Review of Non-Chemical Stressors Found in a Child's Social Environment.

Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children's health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child's social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000-2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child's social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children's health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child's social environment when addressing children's environmental health considerations.

Urinary phthalate metabolites and metabolic syndrome in U.S. adolescents: Cross-sectional results from the National Health and Nutrition Examination Survey (2003-2014) data.

OBJECTIVE: There is limited research on the association between phthalates and metabolic syndrome (MetS). Among adolescents, phthalate exposure, which can occur from multiple sources, has been linked to several risk factors for MetS. The objective was to investigate the association between urinary phthalate metabolite concentrations (i.e., mono-ethyl phthalate (MEP), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), mono-benzyl phthalate (MBzP), mono-(3-carboxylpropyl) phthalate (MCPP), and di(2-ethylhexyl phthalate (DEHP)) and MetS in adolescents aged 12-19 years using the National Health and Nutrition Examination Survey (NHANES) data (2003-2014). A secondary aim was to assess if observed associations varied by a measure of socioeconomic status, economic adversity, which was defined using parental income and educational attainment as well as household food security. METHODS: We used NHANES data which included physical examination, laboratory urinalysis and fasting blood profiles, and self-reported health characteristics and demographics. Physical examination and laboratory data were used to obtain values of MetS components and urinary phthalate metabolites. We created age-, sex-, and survey year-specific tertiles of creatinine-corrected urinary phthalate metabolites. Analysis was performed using appropriate weighting procedures that accounted for NHANES' complex sampling design. After univariate and bivariate analyses, we performed adjusted logistic regressions to test for associations between individual phthalate metabolites and MetS as well as MetS components and number of MetS components, separately, using the lowest tertile as the reference category. A cross-product term (phthalate metabolite*economic adversity) was subsequently added to adjusted models. RESULTS: Among 918 participants (mean age 16 years, 45% female, 18% with economic adversity), the prevalence of MetS was 5.3%. Prior to adjustment, adolescents with MetS had marginally higher concentrations of phthalate metabolites than adolescents without MetS. There was a suggestive positive association between intermediate concentrations of MnBP and odds of MetS after adjustment (T2: Odds Ratio (OR) = 2.66 (95% confidence interval: 0.98-7.24); T3: OR = 2.11 (0.71-6.27)). Males with higher MnBP concentrations had higher odds of dyslipidemia; however, associations were mostly non-significant for females. Relationships between MiBP concentrations and odds of MetS varied by sex. Males with higher concentrations of MnBP and MiBP had greater odds of having a higher number of MetS components. Relationships between phthalate metabolites and MetS did not vary by economic adversity. CONCLUSION: There was a suggestive positive association between MnBP and MetS among adolescents. Associations between phthalate metabolites and MetS as well as MetS components may vary by sex, but may not vary by economic adversity. Further research of the relationships between phthalate exposures, MetS, and potential interactions with socioeconomic factors is warranted.

Abdominal obesity, metabolic dysfunction, and metabolic syndrome in U.S. adolescents: National Health and Nutrition Examination Survey 2011-2016.

PURPOSE: The objectives were to use National Health and Nutrition Examination Survey data to (1) estimate the prevalence of metabolic syndrome (MetS) risk factors (elevated blood pressure, triglycerides, blood glucose, and low HDL cholesterol); (2) estimate the prevalence of MetS using three common definitions; and (3) compare the odds of MetS risk factors/MetS when using different measures of abdominal obesity (sagittal abdominal diameter [SAD] versus waist circumference [WC]) among U.S. adolescents. METHODS: Analyses were performed on data collected from adolescents aged 12-19 years (n = 1214) participating in the 2011-2016 National Health and Nutrition Examination Survey. Prevalence of MetS risk factors and MetS were estimated. Unadjusted and adjusted binomial/multinomial logistic regressions were performed to test associations between WC and SAD z-scores and MetS risk factors/MetS. Analyses were performed for all participants and were stratified by sex as well as race/ethnicity. RESULTS: Males were more likely to have MetS risk factors. Depending on sex and the definition applied, the prevalence of MetS ranged from 2% to 11% and was lowest among females. Adjusted logistic regressions showed that one z-score increase in SAD and WC resulted in similar increased odds of MetS risk factors/MetS, but associations between abdominal obesity and MetS varied by the definition applied and race/ethnicity. CONCLUSIONS: Metabolic dysfunction and MetS are prevalent among U.S. adolescents, and it is important to consider how MetS components and MetS are measured in population inference.

Chemical and non-chemical stressors affecting childhood obesity: a systematic scoping review.

Childhood obesity in the United States has doubled over the last three decades and currently affects 17% of children and adolescents. While much research has focused on individual behaviors impacting obesity, little research has emphasized the complex interactions of numerous chemical and non-chemical stressors found in a child's environment and how these interactions affect a child's health and well-being. The objectives of this systematic scoping review were to (1) identify potential chemical stressors in the context of non-chemical stressors that impact childhood obesity; and, (2) summarize our observations for chemical and non-chemical stressors in regards to child-specific environments within a community setting. A review was conducted to identify chemical and non-chemical stressors related to childhood obesity for the childhood life stages ranging from prenatal to adolescence. Stressors were identified and grouped into domains: individual behaviors, family/household behaviors, community stressors, and chemical exposures. Stressors were related to the child and the child's everyday environments and used to characterize child health and well-being. This review suggests that the interactions of chemical and non-chemical stressors are important for understanding a child's overall health and well-being. By considering these relationships, the exposure science research community can better design and implement strategies to reduce childhood obesity.

Outdoor Air Emissions, Land Use, and Land Cover around Schools on Tribal Lands.

Children from tribes are more burdened with adverse respiratory well-being outcomes versus other U.S. children. The objectives of this study were to identify stressors from the built and natural environments for tribal school-aged children. Outdoor air concentrations around U.S. tribal schools were linked to National Emission Inventories; ecoregions and National Land Cover Database; and American Community Survey and school map layers. Nine school sites (seven tribes, five U.S. states) were in three ecoregions: North American Deserts, Northern Forests, and Mediterranean California. Closest emission sources were oil, gas, airport, and manufacturing facilities. Maximum annual outdoor air concentrations were measured for toluene at two schools (29 ppb and 15 ppb, 2011), located four miles from a solid waste landfill and eight miles from paperboard/saw mills. Maximum annual concentrations of metals in particulate matter 10 micrometers and smaller were highest for manganese (68 ng/m³, 2011). Schools were in mainly arid and heavily forested lands. Closest emission sources were predominantly off tribal lands. Measurements were limited (<30/year). Compared to schools off tribal lands, schools on tribal lands were further away from roadway sources. Future research may examine outdoor air quality around schools with more developed land and indoor air for tribal children's total exposure.

Review of built and natural environment stressors impacting American-Indian/Alaska-Native children.

Children's exposures to chemical and non-chemical stressors from their everyday environment affects their overall health and well-being. American-Indian/Alaska-Native (AI/AN) children may have a disproportionate burden of stressors from their built and natural environments when compared to children from other races/ethnicities. Our objectives were to identify chemical and non-chemical stressors from AI/AN children's built and natural environments and evaluate their linkages with health and well-being outcomes from the peer reviewed literature. Library databases (e.g. PubMed) were searched to identify studies focused on these stressors. References were excluded if they: did not discuss AI/AN children or they were not the primary cohort; discussed tribes outside the United States (U.S.); were reviews or intervention studies; or did not discuss stressors from the built/natural environments. Out of 2539 references, 35 remained. Sample populations were predominantly (70%) in New York (NY) and Alaska (AK); 14 studies reported on the same cohort. Studies with matching stressors and outcomes were few, ruling out a quantitative review. Respiratory and developmental outcomes were the main outcomes evaluated. Primary non-chemical stressors were residential proximity to polluted landscapes, lack of indoor plumbing, and indoor use of wood for heating or cooking. The main chemical stressors were volatile organic compounds (VOCs), particulate matter (PM2.5), polychlorinated biphenyls (PCBs), p,p'-DDE, hexachlorobenzene (HCB), lead, and mercury. Our qualitative review was suggestive of a potential increase in respiratory illness from indoor wood use or no plumbing, which can be used as a guide to promote healthy environments for AI/AN children. We identified limited studies (<40), demonstrating this population as understudied. Future studies need to consider: sample populations from other tribes in the U.S., stressors outside the household, other elements of the natural environment, and an evaluation of stressors from AI/AN children's total environment (built, natural, and social).

Contributions of a Child's Built, Natural, and Social Environments to Their General Cognitive Ability: A Systematic Scoping Review.

The etiology of a child's cognitive ability is complex, with research suggesting that it is not attributed to a single determinant or even a defined period of exposure. Rather, cognitive development is the product of cumulative interactions with the environment, both negative and positive, over the life course. The aim of this systematic scoping review was to collate evidence associated with children's cognitive health, including inherent factors as well as chemical and non-chemical stressors from the built, natural, and social environments. Three databases were used to identify recent epidemiological studies (2003-2013) that examined exposure factors associated with general cognitive ability in children. Over 100 factors were evaluated from 258 eligible studies. We found that recent literature mainly assessed the hypothesized negative effects of either inherent factors or chemical exposures present in the physical environment. Prenatal growth, sleep health, lead and water pollutants showed consistent negative effects. Of the few studies that examined social stressors, results consistently showed cognitive development to be influenced by both positive and negative social interactions at home, in school or the community. Among behavioral factors related to diet and lifestyle choices of the mother, breastfeeding was the most studied, showing consistent positive associations with cognitive ability. There were mostly inconsistent results for both chemical and non-chemical stressors. The majority of studies utilized traditional exposure assessments, evaluating chemical and non-chemical stressors separately. Collective evidence from a limited number of studies revealed that cumulative exposure assessment that incorporates multiple chemical and non-chemical stressors over the life course may unravel the variability in effect on cognitive development and help explain the inconsistencies across studies. Future research examining the interactions of multiple stressors within a child's total environment, depicting a more real-world exposure, will aid in understanding the cumulative effects associated with a child's ability to learn.

Characterization of silver nanoparticles in selected consumer products and its relevance for predicting children's potential exposures.

Due to their antifungal, antibacterial, antiviral, and antimicrobial properties, silver nanoparticles (AgNPs) are used in consumer products intended for use by children or in the home. Children may be especially affected by the normal use of consumer products because of their physiological functions, developmental stage, and activities and behaviors. Despite much research to date, children's potential exposures to AgNPs are not well characterized. Our objectives were to characterize selected consumer products containing AgNPs and to use the data to estimate a child's potential non-dietary ingestion exposure. We identified and cataloged 165 consumer products claiming to contain AgNPs that may be used by or near children or found in the home. Nineteen products (textile, liquid, plastic) were selected for further analysis. We developed a tiered analytical approach to determine silver content, form (particulate or ionic), size, morphology, agglomeration state, and composition. Silver was detected in all products except one sippy cup body. Among products in a given category, silver mass contributions were highly variable and not always uniformly distributed within products, highlighting the need to sample multiple areas of a product. Electron microscopy confirmed the presence of AgNPs. Using this data, a child's potential non-dietary ingestion exposure to AgNPs when drinking milk formula from a sippy cup is 1.53 µg Ag/kg. Additional research is needed to understand the number and types of consumer products containing silver and the concentrations of silver in these products in order to more accurately predict children's potential aggregate and cumulative exposures to AgNPs.