This work is an exploration of critical remaining questions in the field of pediatricair pollution epidemiology. Because children are uniquely susceptible and vulnerable to
environmental exposures, a thorough understanding of the relationships between air
pollution exposure and child health is needed. In this dissertation, I weigh in on three
extant questions in pediatric air pollution epidemiology: (1) what are the different ways
children might be affected by air pollution, (2) what are the long-term effects of
children’s exposure, and (3) are there periods during which children are especially
vulnerable?
Chapter 2 is a systematic review summarizing new epidemiologic research
associating ozone exposures with lung function, published during 2013-2020. Ozone
effects on lung function are particularly important to understand in the context of the air
pollution-health outcomes literature given the complex relationships between ozone and
other air pollutants with known lung function effects. On March 18, 2018 and Sept 8,
2020 PubMed was searched using the terms “health AND ozone”, filtering to articles in
English, about humans, from 2013 or later. Articles were selected for this review if they
reported a specific relationship between a lung function outcome and ozone exposure.
Of 3271 articles screened, 55 ultimately met criteria for inclusion. A systematic review
with assessment of potential for bias was conducted, but a meta-analysis was not done
because of differences in exposure duration and outcome quantification. There is
consistent evidence of small decreases in children’s lung function, even associated with
very low levels of short-term ozone exposure. The effects on adult lung function from
exposure to low-level, short-term ozone are less clear, though there may be ozoneassociated
decrements in the elderly. Finally, long-term ozone exposure decreases both
lung function and lung function growth in children, though there are few new studies of
2
long-term ozone and lung function in adults. Much of this literature involves
concentrations below the current US Environmental Protection Agency’s National
Ambient Air Quality Standard of 70 ppb over an 8-hour averaging time, suggesting that
this current standard may not adequately protect children from ozone-related
decrements in lung function.
Chapter 3 is a study of prenatal PM2.5 exposure and childhood IQ. Because PM2.5
is a ubiquitous environmental exposure, the potential for small changes in cognition
associated with PM2.5 exposure could have great societal costs. Prior studies have
demonstrated a relationship between in-utero PM2.5 exposure and cognitive
development, but it is not known whether these effects are similar in rural populations
and if they persist into late childhood/early adolescence. In this study I used IQ testing
of the Center for the Health Assessment of Mothers and Children of Salinas
(CHAMACOS) cohort at age 10.5 years, to test for an association between prenatal
PM2.5 exposure and both full and subscale measures of IQ. A 3 μg/m3 increase in
average PM2.5 over pregnancy was associated with a 1.79-point decrease in full-scale
IQ (95% CI -2.96, -0.61), and subscale measures (Working Memory IQ (WMIQ) -1.65,
95% CI -2.98, -0.41; Processing Speed IQ (PSIQ) -1.34, 95% CI -2.66, -0.02). Flexible
modeling over the course of pregnancy illustrated mid-to-late pregnancy (months 5-7)
as particularly susceptible times, but with sex differences regarding which subscales
were most affected (Verbal Comprehension IQ (VCIQ) and WMIQ in males, and PSIQ
in females) and in the timing of susceptible windows (generally these occurred mid
gestation in males and later gestation in females).
Chapter 4 is a study of the association of multiple air pollutants and changing
metabolic function in childhood. Previous studies have shown that air pollution exposure
may contribute to metabolic dysfunction in childhood. However, little work is available
on how air pollution relates to changes in metabolic parameters during childhood. In this
study we assess growth in BMI percentile, waist-height ratio, systolic and diastolic blood
pressure, hemoglobin A1c and high-density lipoprotein cholesterol between two
assessments during childhood (approximately ages 8 and 10 years), in a cohort living in
Fresno, CA. No relationship between changes in metabolic dysfunction and air pollution
was found, despite high quality exposure data and power to detect clinically meaningful
changes. Smaller changes in metabolic function may still be present and could be
important for public health.
Air pollutant exposure continues to adversely affect the health of children and
ongoing efforts are needed both to further understand these effects and better protect
children’s health.