Background
Childhood pneumonia is a major global health burden influenced by environmental and psychosocial factors, yet their potential interaction during critical developmental windows remains poorly understood.
Objective
To investigate the effects of parental socioeconomic and psychological stress, and interaction with indoor and outdoor environments to affect childhood pneumonia.
Methods
We conducted a combined retrospective cohort and cross-sectional study of 8689 preschool children in Changsha, China. Information on each child's health status, parental stress, and household environment exposure from one year before pregnancy to postnatal period were collected using a survey. Ambient air pollution and temperature data were obtained from local monitoring stations. Individual pollutant exposure at home during different time windows was estimated using the inverse distance weighted (IDW) method. Multivariate logistic regression was applied to assess the independent and interactive effects of parental stress with indoor and outdoor environments on childhood pneumonia.
Results
We found that childhood pneumonia was related with parental education level, fatigue, headache, and inattention. High parental social stress increased pneumonia risk of parental smoking and mould/damp clothing or bedding, while low parental social stress reduced pneumonia risk from indoor exposure to flowering plants. Children with high parental socioeconomic stress had a stronger association between air pollution and pneumonia. High parental psychological stress increased childhood pneumonia as a result of air pollution exposure, notably for particulate matter in early life.
Conclusions
Parental stress independently and interactively increases childhood pneumonia risk in relation to indoor (new furniture, mould/dampness) and outdoor (NO2, SO2) exposures during early life.
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