Extant literature shows evidence of non-chemical stressors impacting children's health. Some impacts are adverse, and some are positive. A gap in research exists with studies that consider the health impact from interaction of non-chemical and chemical stressors.

1. U.S. Environmental Protection Agency
Office of Research and Development
EPA
Background Objective
Methods
hibbert.kathleen@epa.gov
Non-Chemical Stressors in a Child’s Social Environment
Kathleen Hibbert, Ph.D. and Nicolle S. Tulve, Ph.D.
U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC
Non-chemical stressors exist in the built, natural and social environments
including physical factors (e.g., noise, temperature and humidity) and
psychosocial factors (e.g., poor diet, smoking, illicit drug use)[1]. Scientists
study how non-chemical stressors (e.g., social support, stress, exposure to
violence) from the social environment (e.g., places where children live, learn,
play) affect the biological response to chemical exposures; impacting
children’s health[2-5].
Initial search strings included the term ”non-chemical stressor” accompanied
with “child” and “health”. Secondary search strings included specific non-
chemical stressors (i.e., violence, acculturation, social support) in
conjunction with the words “child” and “health”.
Preliminary Observations
The objective of this work is to synthesize the published extant research on
non-chemical stressors from a child’s social environment.
Published after 2000
Observational, experimental or review
Examined relationships between non-
chemical & chemical stressors
Written in English
Found in the social environment
Does not appear in original search,
but appears in an included article
1. Tulve, N.S.R., Jazmin DC; Lichtveld, Kim; Darney, Sally P; Quackenboss, James J, Development of a conceptual framework depicting a child’s total (built, natural, social) environment in order
to optimize health and well-being. Journal of Environment and Health Science, 2016. 2(2): p. 1 - 8
2. Chen, E.S., H. M.; Strunk, R. C.; Brauer, M., Chronic traffic-related air pollution and stress interact to predict biologic and clinical outcomes in asthma. Environ Health Perspect, 2008. 116(7):
p. 970-5.
3. Clougherty, J.E.L., Jonathan I; Kubzansky, Laura D; Ryan, P Barry; Suglia, Shakira Franco; Canner, Marina Jacobson; Wright, Rosalind J, Synergistic effects of traffic-related air pollution and
exposure to violence on urban asthma etiology. Environmental health perspectives, 2007: p. 1140-1146.
4. Rider, C.V.D., M. L.; Hertzberg, R. C.; Mumtaz, M. M.; Price, P. S.; Simmons, J. E., Incorporating nonchemical stressors into cumulative risk assessments. Toxicol Sci, 2012. 127(1): p. 10-7.
5. Sexton, K.R., A. D., Using exposure biomarkers in children to compare between-child and within-child variance and calculate correlations among siblings for multiple environmental
chemicals. J Expo Sci Environ Epidemiol, 2012. 22(1): p. 16-23.
References
Future Research Directions
Inclusion Criteria
Conduct meta-analysis to identify priority non-chemical stressors from a child’s
social environment
Complete community-level spatial analysis of non-chemical stressors
Incorporate priority non-chemical stressors into exposure modeling
Economic Violence Food
Household Income Neighborhood violence Food insecurity
Socioeconomic Status(SES) Intrafamilial violence Food Habits
Country GDP Victim of violence Food & culture
Poverty (physical, sexual, social) Available food options
Neighborhood SES Witness to violence School lunches
Being "bullied" Market size
Tulve et al., 2016
Figure 1. Flowchart showing the extant literature search.
Figure 2. General topic areas identifying the non-chemical stressors in a child’s social
environment. (Circle size represents number of articles in that topic area.)
Table 1. List of specific non-chemical stressors found in selected general topics shown in
Figure 2. (Column colors match the general topic areas.)
372 articles were included in the review
Multiple non-chemical stressors were identified in several manuscripts, resulting in a
total of 678 non-chemical stressors associated with a child’s social environment
More articles included Food (n=129), Economic (n=96), Acculturation (n=73) and
Violence (n=68) than other non-chemical stressors
Sparse literature on many other stressors from social environment (e.g., public safety,
education)
Complexity of indicator variation among constructed non-chemical stressors
(violence, SES)
Term “non-chemical stressor” is often a surrogate for ‘other’ stressors
Inconsistent reporting on the use of non-chemical stressors in the scientific literature
Despite the challenge of reviewing this topic, it is highly important for
understanding children’s health and well-being as described in our conceptual
framework (Figure 3) (red arrow denotes area of research)
Figure 3. Conceptual framework
depicting children’s health/well-being.
Adverse Childhood
Experiences
Greenspace
Significant Impact
on Child Health
Yes - All health
outcomes
Yes = 71%,
No = 29%
Health Outcomes
Risk Behavior,
Dental Health,
Neurological
Response
Stress, Obesity,
Emotional Well-
being, Aggression
Beneficial to Health None Yes = 100%
Chemical Exposure
Considered None None
Age Range 0 - 17 years 5 to 18 years
Additional Non-
Chemical Stressors
Studied
Sexual Violence,
Physical Violence,
Stress, Birth Order
Social Support,
Coastal Proximity,
Urbanization,
Neighborhood
Quality
Review Papers? None Yes = 20%
Animal vs. Human Human = 100% Human = 100%
Table 2. Preliminary observations by non-chemical
stressor for selected general topic areas.