Effects of prenatal community violence and ambient air pollution on childhood wheeze in an urban population

Background Prenatal exposures to stress and physical toxins influence children's respiratory health, although few studies consider these factors together. Objectives We sought to concurrently examine the effects of prenatal community-level psychosocial (exposure to community violence [ECV]) and physical (air pollution) stressors on repeated wheeze in 708 urban children followed to age 2 years. Methods Multi-item ECV reported by mothers in pregnancy was summarized into a continuous score by using Rasch modeling. Prenatal black carbon exposure was estimated by using land-use regression (LUR) modeling; particulate matter with a diameter of less than 2.5 μm (PM_2.5) was estimated by using LUR modeling incorporating satellite data. Mothers reported child's wheeze every 3 months. The effects of ECV and air pollutants on repeated wheeze (≥2 episodes) were examined by using logistic regression. Interactions between ECV and pollutants were examined. Results Mothers were primarily black (29%) and Hispanic (55%), with lower education (62% with ≤12 years); 87 (12%) children wheezed repeatedly. In models examining concurrent exposures, ECV (odds ratio [OR], 1.95; 95% CI, 1.13-3.36; highest vs lowest tertile) and black carbon (OR, 1.84; 95% CI, 1.08-3.12; median or greater vs less than median) were independently associated with wheeze adjusting for sex, birth season, maternal atopy, education, race, and cockroach antigen. Associations were similar for PM_2.5 (adjusted OR, 2.02; 95% CI, 1.20-3.40). An interaction between ECV with air pollution levels was suggested. Conclusions These findings suggest that both prenatal community violence and air pollution can contribute to respiratory health in these urban children. Moreover, place-based psychosocial stressors might affect host resistance such that physical pollutants can have adverse effects, even at relatively lower levels.