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Pesticide exposure and asthma morbidity in children residing in urban, multi-family housing



Children are potentially more susceptible to the adverse effects of pesticides due to more sensitive organ systems and lower capacity to metabolize and eliminate chemicals compared to adults. The health risks are particularly concerning children with asthma, living in low-income neighborhoods in multi-family housing because of their impaired respiratory health, and factors associated with low-income, multi-family environments.


To assess the association between pesticide exposure and asthma morbidity among children 7–12 years residing in low-income, multi-family housing.


The concentrations of seven urinary pesticide biomarkers: 3,5,6-trichloro-2-pyridinol (TCPy), 2-isopropyl-4-methyl-6-hydroxypyrimidine, para-nitrophenol (PNP), 3-phenoxybenzoic acid (3-PBA), 4-fluoro-3-phenoxybenzoic acid, trans-3-(2,2-dichlorovinyl)-2,2-dimethyl-cyclopropane-1-carboxylic acid, and 2,4-dichlorophenoxyacetic acid (2,4-D) were measured. Children (n = 162) were followed for one year with three measures of pesticides biomarkers. Associations between individual biomarkers and asthma attack, asthma related health care utilization, and fraction of exhaled nitric oxide (FeNO), adjusting for demographic and household factors were examined with Generalized Estimating Equations (GEE). Weighted Quantile Sum (WQS) regression was used to examine the effect of pesticide mixture on asthma attacks and asthma-related health care utilization (HCU).


In adjusted GEE models, positive non-significant associations were found between PNP and HCU (adjusted Odds Ratio(aOR):2.05 95% CI:0.76–5.52) and null associations for 3-PBA and HCU (aOR:1.07 95% CI: 0.88–1.29). Higher concentrations of PNP and 2,4-D were associated with significantly lower FeNO levels (PNP: −17.4%; 2,4-D:−19.74%). The mixture was positively associated with HCU in unadjusted (OR: 1.56 97.5% CI: 1.08–2.27) but not significant in adjusted models (aOR: 1.40 97.5% CI: .86–2.29). The non-specific pyrethroid biomarker 3-PBA at baseline contributed the greatest weight to the index (45%).


There were non-significant associations between pesticide biomarkers and respiratory outcomes in children with asthma. There was a suggestive association between urinary pesticide biomarkers and HCU. Further studies with larger sample sizes could help to confirm these findings.

Impact statement

  • Pesticide exposure among children in the urban environment is ubiquitous and there is a dearth of information on the impact of low-level chronic exposure in vulnerable populations. This study suggested that pesticide exposure at concentrations below the national average may not affect asthma morbidity in children. However, different biomarkers of pesticides showed different effects, but the mixture suggested increasing pesticide exposure results in asthma related HCU. The results may show that children with asthma may be at risk for negative health outcomes due to pesticides and the need to further examine this relationship.

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Fig. 1: Mean, median, interquartile range, 10th and 90th percentiles of pesticide biomarker concentrations (µg/g creatinine) by visit.
Fig. 2: Spearman correlations between pesticide biomarkers at each time point.

Data availability

Individuals who would like to access data can contact Dr. Werthmann ( with a specific request for data access.


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The authors would like to thank the children and their parents for their participation and our community partners for their assistance throughout the study. We also thank Mark Davis and William Roman for the measurement of the pesticide biomarkers and Connie Sosnoff for the measurement of cotinine.


This study was funded by the Centers for Disease Control and Prevention (CDC) grant #5UO1EH000990 with supplemental funding from the U.S. Environmental Protection Agency (EPA) interagency agreement #DW-75–9584500 and the U.S. Department of Housing and Urban Development (HUD) interagency agreement # I-PHI-01062.

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Authors and Affiliations



DW had full access to the data and takes responsibility for the integrity of the data and accuracy of analysis; DW, FR, GC, AC, MO were involved in the design and conduct of the analysis; DW, FR, GA, TR, AC, MO, GC contributed to the drafting of the manuscript; DW, FR, GA, TR, AC, MO, GC were involved in the editing of the manuscript. All authors approved the manuscript for submission.

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Correspondence to Derek W. Werthmann.

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Werthmann, D.W., Rabito, F.A., Adamkiewicz, G. et al. Pesticide exposure and asthma morbidity in children residing in urban, multi-family housing. J Expo Sci Environ Epidemiol (2023).

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  • Pesticides
  • Asthma
  • Pyrethroids
  • Organophosphorous
  • 2
  • 4-D


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