Ozone Concentration, Physical Activity, and Emotional and Behavioral Problems in Children and Adolescents

Yushan Zhang; Wen-Wen Bao; Weidong Ji; Yu Zhao; Nan Jiang; Jiaqi Chen; Yinhuan Guo; Gongbo Chen; Yuming Guo; Guanghui Dong; Yajun Chen

doi:10.1016/j.envres.2024.120697

Ozone Concentration, Physical Activity, and Emotional and Behavioral Problems in Children and Adolescents

Environ Res. 2024 Dec 26:120697. doi: 10.1016/j.envres.2024.120697. Online ahead of print.

Authors

Yushan Zhang¹, Wen-Wen Bao², Weidong Ji³, Yu Zhao⁴, Nan Jiang⁵, Jiaqi Chen¹, Yinhuan Guo¹, Gongbo Chen⁶, Yuming Guo⁶, Guanghui Dong⁷, Yajun Chen⁸

Affiliations

¹ School of public health, Sun Yat-sen University, Guangzhou, Guangdong, China.
² School of public health, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China.
⁴ School of public health, Sun Yat-sen University, Guangzhou, Guangdong, China; Institute for Global Health, ISGlobal, Barcelona, Spain; Pompeu Fabra (UPF), Barcelona, Spain.
⁵ School of public health, Sun Yat-sen University, Guangzhou, Guangdong, China; Women's hospital school of medicine Zhejiang University, Hangzhou, Zhejiang, China.
⁶ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁷ Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
⁸ School of public health, Sun Yat-sen University, Guangzhou, Guangdong, China. Electronic address: chenyj68@mail.sysu.edu.cn.

PMID: 39732417
DOI: 10.1016/j.envres.2024.120697

Abstract

Background: No prior study has examined the mutual association of long-term outdoor ozone (O₃) concentration and physical activity (PA) with emotional and behavioral problems (EBPs) in children and adolescents. This study aims to investigate the association between long-term outdoor O₃ concentration and the risk of EBPs in children and adolescents and further explore whether increased PA levels modify this association.

Methods: Data were obtained from the 2020 wave follow-up examination of an ongoing prospective cohort study (COHERENCE project) in Guangzhou, China. A total of 419,033 children aged 6-17-year-old were included. Annual average outdoor O₃ concentrations were obtained from the China High Air Pollutants (CHAP) dataset based on participants' residential addresses. PA levels were identified using the International Physical Activity Questionnaire Short Form (IPAQ). EBPs were assessed by the Chinese Parent-Report Strengths and Difficulties Questionnaire (SDQ-P).

Results: Each interquartile range (IQR) increase in outdoor O₃ concentration was associated with an increased odds ratio (OR) for abnormal emotional problems (OR: 1.024, 95% CI: 1.010-1.038), conduct problems (OR: 1.015, 95% CI: 1.002-1.029), peer relationship problems (OR: 1.029, 95% CI: 1.006-1.052), prosocial behavior (OR: 1.023, 95% CI: 1.012-1.034), total difficulties (OR: 1.024, 95% CI: 1.010-1.038), and internalizing behavior (OR: 1.039, 95% CI: 1.026-1.053), in fully adjusted models. The highest OR for abnormal EBPs was observed in children with low PA levels, in combination with high O₃ concentration.

Conclusion: This study identified that long-term outdoor O₃ concentration is associated with an increased risk of EBPs in children and adolescents, with higher PA levels attenuating these risks.

Keywords: children and adolescents; emotional and behavioral problems; ozone; physical activity.