title: A Systematic Review of the Interplay Between Social Determinants and Environmental Exposures for Early-Life Outcomes.
abstract: Early-life social and environmental exposures have independent effects on many child health outcomes. Increasingly, investigators have suggested that these exposures, which commonly co-occur, may have synergistic effects and have thus begun to evaluate if environmental and social factors jointly contribute to child health. This systematic review summarizes findings and methodological approaches across studies examining the interplay between environmental and social exposures in relation to commonly assessed childhood health outcomes: asthma, cognition and behavior, perinatal outcomes, and obesity.
  
  
  
  Forty-one studies met the search criteria and were reviewed. Of these, 37, 34, and 29 % of studies focused on asthma, cognition/behavior, and perinatal outcomes, respectively. No study focused on obesity. Across all studies reviewed, 72 % observed significant synergistic associations between social and environmental exposures. Air pollution was the most frequently studied environmental exposure, and socioeconomic status was the most commonly studied social factor. The emerging evidence suggests that social and environmental risks may jointly affect child health. Recommendations for future research are discussed, including enhancing characterization of the social environment and broadening the types of environmental risks assessed.
authors.affiliation: Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Place, Rensselaer, NY, 12144, USA. aappleton@albany.edu.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Appleton
authors.affiliation: Department of Anthropology, University at Albany College of Arts and Sciences, 1400 Washington Avenue, Albany, NY, 12222, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Holdsworth
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
mesh_terms: D000397:Air Pollution / Q000009:adverse effects; D001249:Asthma; D002648:Child; D002652:Child Behavior; D000067576:Child Health; D003071:Cognition; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D018743:Perinatal Care; D012307:Risk Factors; D012923:Social Class
keywords: Child health; Environmental exposures; Social determinants