The Influence of the Social and Physical Environment on Child Behavior

P-395 Abstract: Previous studies linking violence exposure to adverse child behavior have not accounted for other environmental neurotoxicants such as lead and tobacco smoke, which are also known to affect behavior and cognitive development and are associated with violence exposure. We assess the influence of witnessing violence on child behavior in a cohort of women and children followed from 20 weeks gestation. When the children were approximately 7 years of age, maternal-report of their child’s lifetime community violence exposure was assessed using the My Exposure to Violence (ETV) scale; children who were 8 years or older also completed the survey. Maternal-report on inter-parental conflict was obtained using the Conflict Tactics Scale (CTS). At the time of the ETV assessment mothers completed the Checklist of Child Distress Symptoms (CCDS), approximately 3 years later they completed the Behavior Assessment System for Children (BASC). Using a non-linear mixed model, Rasch models were used to obtain a continuous measure of violence using both parent and child responses to the ETV survey; scores were categorized into tertiles. Linear regression was used to assess the influence of violence on behavioral problems adjusting for blood lead, in-utero tobacco smoke and other confounders. In the sample of 161 children, 53% were boys and 56% of households spoke primarily Spanish. The mean ± SD peak blood lead level was 8.5 μg/dl ± 6.1. Relative to the lowest, the highest tertile of the ETV scale predicted an increase of 4.3 SE 2.1 in the attention problems score; and 0.33 SE .12 in the arousal scale (both p <.05). Perceived threat of neighborhood violence predicted an increase of 5.3 SE 2.4 in attention problems; 9.0. SE 2.8 in internalizing behaviors; 0.42 SE .11 in the hopelessness scale; 0.71 SE .12 in the intrusiveness scale and 0.66 SE .15 in the avoidance scale (all p<.05). The highest CTS home verbal aggression tertile predicted an increase of 5.1 SE 2.2 in the attention scale and a 6.2 SE 2.6 in internalizing behaviors (both p<.05). Peak blood lead levels predicted an increase of 3.7 SE 1.7 in the externalizing scale; 3.7 SE 1.4, in the internalizing behaviors scale of the BASC and 0.12 SE .06 in the hopelessness scale of the CCDS (all p<.05). Violence, both at home and in the community, predicts increased attention problems, internalizing behaviors and child distress symptoms even after adjusting for lead and tobacco smoke exposure.