Impact of housing instability on child behavior at age 7.

Housing instability is a thought to be a major influence on children's healthy growth and development. However, little is known about the factors that influence housing instability, limiting the identification of effective interventions. The goals of this study were to 1) explore factors, including material hardship, satisfaction with living conditions and housing disrepair, that predict housing instability (total number of moves that a child experienced in the first seven years); and 2) examine the relationship between housing instability and child behavior at age 7, measured by the Child Behavior Checklist. We analyzed these associations among children enrolled in the Columbia Center for Children's Environmental Health (CCCEH) Mothers and Newborns study. In our analysis, we found that housing disrepair predicted residential change after 3 years of age, but not before. Persistent material hardship over the seven-year time period from pregnancy through age 7 was associated with increased number of moves. Children who experienced more than three moves in the first 7 years had significantly more thought- and attention-related problems compared to children who experienced less than 3 moves over the same time period. Children who experienced more than 3 moves also had higher total and internalizing problem behavior scores, although these differences were not statistically significant. We conclude that housing instability is significantly associated with problem behavior in early childhood and that interventions to reduce socioeconomic strain may have the greatest impact in breaking the cycle of children's environmental health disparities related to housing instability.

Automated assessment of the quality of diffusion tensor imaging data using color cast of color-encoded fractional anisotropy images.

Diffusion tensor imaging (DTI) data often suffer from artifacts caused by motion. These artifacts are especially severe in DTI data from infants, and implementing tight quality controls is therefore imperative for DTI studies of infants. Currently, routine procedures for quality assurance of DTI data involve the slice-wise visual inspection of color-encoded, fractional anisotropy (CFA) images. Such procedures often yield inconsistent results across different data sets, across different operators who are examining those data sets, and sometimes even across time when the same operator inspects the same data set on two different occasions. We propose a more consistent, reliable, and effective method to evaluate the quality of CFA images automatically using their color cast, which is calculated on the distribution statistics of the 2D histogram in the color space as defined by the International Commission on Illumination (CIE) on lightness and a and b (LAB) for the color-opponent dimensions (also known as the CIELAB color space) of the images. Experimental results using DTI data acquired from neonates verified that this proposed method is rapid and accurate. The method thus provides a new tool for real-time quality assurance for DTI data.

Academic achievement varies with gestational age among children born at term.

OBJECTIVE: The goal of this study was to examine the degree to which children born within the "normal term" range of 37 to 41 weeks' gestation vary in terms of school achievement. METHODS: This study analyzed data from 128050 singleton births born between 37 and 41 weeks' gestation in a large US city. Data were extracted from city birth records to assess a number of obstetric, social, and economic variables, at both the individual and community levels. Birth data were then matched with public school records of standardized city-wide third-grade reading and math tests. Specifically, we assessed (1) whether children born within the normal term range of 37 to 41 weeks' gestation show differences in reading and/or math ability 8 years later as a function of gestational age, and (2) the degree to which a wide range of individual- and community-level social and biological factors mediate this effect. RESULTS: Analyses revealed that gestational age within the normal term range was significantly and positively related to reading and math scores in third grade, with achievement scores for children born at 37 and 38 weeks significantly lower than those for children born at 39, 40, or 41 weeks. This effect was independent of birth weight, as well as a number of other obstetric, social, and economic factors. CONCLUSIONS: Earlier normal term birth may be a characteristic considered by researchers, clinicians, and parents to help identify children who may be at risk for poorer school performance.

Environmental justice and the health of children.

Environmental injustice is the inequitable and disproportionately heavy exposure of poor, minority, and disenfranchised populations to toxic chemicals and other environmental hazards. Environmental injustice contributes to disparities in health status across populations of differing ethnicity, race, and socioeconomic status. Infants and children, because of their unique biological vulnerabilities and age-related patterns of exposure, are especially vulnerable to the health impacts of environmental injustice. These impacts are illustrated by sharp disparities across children of different racial and ethnic backgrounds in the prevalence of 3 common diseases caused in part by environmental factors: asthma, lead poisoning, and obesity. Documentation of linkages between health disparities and environmental injustice is an important step toward achieving environmental justice.

Housing and health: intersection of poverty and environmental exposures.

The importance of adequate housing for the maintenance of health and well-being has long been a topic of scientific and public health policy discussion, but the links remain elusive. Here we explore the role of the residential environment in the etiology of illness (specifically asthma) and the persistence of socioeconomic health disparities. Housing conditions, shaped by social forces, affect exposure to physical and chemical "toxicants," thereby translating social adversities into individual illness and population health disparities. We discuss the mediating role of housing in determining health outcomes at multiple levels (social-structural, neighborhood, and individual family). To date, little attention has been paid by most environmental health scientists to the social-structural conditions underlying gross inequities in the distribution of toxic exposures, with even less attention to the processes whereby these social conditions may directly affect susceptibility to the toxic exposures themselves. This chapter goes beyond traditional medical and environmental science models to incorporate a range of social and physical determinants of environmental pollutions, illustrating how these conditions result in health and illness. We focus here on childhood asthma as an example of a serious public health problem that has been associated with low income, minority status, and characteristics of the home environment. We end the chapter with a discussion of the environmental justice movement and the role of housing as a potential agent of change and focus of interventions aimed to reduce the harmful effects of environmental pollutants.

The economic impact of early life environmental tobacco smoke exposure: early intervention for developmental delay.

BACKGROUND AND OBJECTIVES: Early-life exposure to environmental tobacco smoke (ETS) can result in developmental delay as well as childhood asthma and increased risk of cancer. The high cost of childhood asthma related to ETS exposure has been widely recognized; however, the economic impact of ETS-related developmental delay has been less well understood. METHODS AND RESULTS: The Columbia Center for Children's Environmental Health (CCCEH) has reported adverse effects of prenatal ETS exposure on child development in a cohort of minority women and children in New York City (odds ratio of developmental delay = 2.36; 95% confidence interval 1.22-4.58). Using the environmentally attributable fraction (EAF) approach, we estimated the annual cost of one aspect of ETS-related developmental delay: Early Intervention Services. The estimated cost of these services per year due to ETS exposure is > Dollars 50 million per year for New York City Medicaid births and Dollars 99 million per year for all New York City births. CONCLUSION: The high annual cost of just one aspect of developmental delay due to prenatal exposure to ETS provides further impetus for increased prevention efforts such as educational programs to promote smoke-free homes, additional cigarette taxes, and subsidizing of smoking cessation programs.

Stress, bacterial vaginosis, and the role of immune processes.

Bacterial vaginosis (BV), the most common lower genital tract infection in women of reproductive age, is associated with adverse gynecologic and reproductive health outcomes. Women at highest risk for BV are young, unmarried, low income, undereducated, and African American. Behaviors such as vaginal douching, numerous sexual partners, frequent sexual intercourse, receptive oral sex, and substance use may contribute to risk, but they account for only a modest proportion of the observed race/ethnicity variance in BV. These subpopulations are also exposed to more social disadvantages or "stressors" such as poverty, poor housing, crime-infested neighborhoods, and discrimination than other groups. Growing physiologic evidence links psychosocial stress to the development of disease. Evidence supports a statistically significant, independent effect of stress on the risk and observed racial/ethnic disparity in the rate of BV. This paper reviews such evidence.

Principles and practices of neurodevelopmental assessment in children: lessons learned from the Centers for Children's Environmental Health and Disease Prevention Research.

Principles and practices of pediatric neurotoxicology are reviewed here with the purpose of guiding the design and execution of the planned National Children's Study. The developing human central nervous system is the target organ most vulnerable to environmental chemicals. An investigation of the effects of environmental exposures on child development is a complex endeavor that requires consideration of numerous critical factors pertinent to a study's concept, design, and execution. These include the timing of neurodevelopmental assessment, matters of biologic plausibility, site, child and population factors, data quality assurance and control, the selection of appropriate domains and measures of neurobehavior, and data safety and monitoring. Here we summarize instruments for the assessment of the neonate, infant, and child that are being employed in the Centers for Children's Environmental Health and Disease Prevention Research, sponsored by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency, discuss neural and neurobiologic measures of development, and consider the promises of gene-environment studies. The vulnerability of the human central nervous system to environmental chemicals has been well established, but the contribution these exposures may make to problems such as attention deficit disorder, conduct problems, pervasive developmental disorder, or autism spectrum disorder remain uncertain. Large-scale studies such as the National Children's Study may provide some important clues. The human neurodevelopmental phenotype will be most clearly represented in models that include environmental chemical exposures, the social milieu, and complex human genetic characteristics that we are just beginning to understand.