{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T15:03:30Z","timestamp":1793113410397,"version":"4.5.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Ozone (O3<\/jats:sub>) is the most frequently exceeded air pollutant standard in the US. While short-term exposure is associated with acute respiratory health, the epidemiologic evidence linking postnatal O3<\/jats:sub> exposure to childhood asthma and wheeze is inconsistent and rarely evaluated as a mixture with other air pollutants.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To determine associations between ambient O3<\/jats:sub> and subsequent asthma and wheeze outcomes both independently and in mixture with fine particulate matter and nitrogen dioxide in regions with low annual O3<\/jats:sub> concentrations.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study consisted of a pooled, multisite analysis across 6 US cities using data from the prospective ECHO-PATHWAYS consortium (2007-2023). Included children had complete airway surveys, complete address histories from age 0 to 2 years, and a full term birth (\u226537 weeks). Logistic regression and bayesian kernel machine regression (BKMR) mixture analyses were adjusted for child anthropomorphic, socioeconomic, and neighborhood factors.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Exposure to ambient O3<\/jats:sub> in the first 2 years of life derived from a validated point-based spatiotemporal model using residential address histories.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was asthma and wheeze at ages 4 to 6 years; the secondary outcome was asthma and wheeze at ages 8 to 9 years. Outcomes were based on caregiver reports derived from a validated survey.<\/jats:p><\/jats:sec>Results<\/jats:title>The analytic sample of 1188 participants had a mean (SD) age of 4.5 (0.6) years at the age 4 to 6 years visit and consisted of 614 female participants (51.7%) and 663 mothers who had a bachelor\u2019s degree or higher (55.8%). The mean (SD) O3<\/jats:sub> concentration was 26.1 (2.9) parts per billion (ppb). At age 4 to 6 years, 148 children had current asthma (12.3%) and 190 had current wheeze (15.8%). The odds ratio per 2 ppb higher O3<\/jats:sub> concentration was 1.31 (95% CI, 1.02-1.68) for current asthma and 1.30 (95% CI, 1.05-1.64) for current wheeze at age 4 to 6 years; null associations were observed for outcomes at age 8 to 9 years, and for sensitivity covariate adjustment. BKMR suggested that higher exposure to O3<\/jats:sub> in mixture was associated with current asthma and wheeze in early childhood.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study with relatively low ambient O3<\/jats:sub> exposure, early-life O3<\/jats:sub> was associated with asthma and wheeze outcomes at age 4 to 6 years and in mixture with other air pollutants but not at age 8 to 9 years. Regulating and reducing exposure to ambient O3<\/jats:sub> may help reduce the significant public health burden of asthma among US children.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.4121","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T16:59:08Z","timestamp":1743785948000},"page":"e254121","source":"Crossref","is-referenced-by-count":12,"title":["Early-Life Ozone Exposure and Asthma and Wheeze in Children"],"prefix":"10.1001","volume":"8","author":[{"given":"Logan C.","family":"Dearborn","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marnie F.","family":"Hazlehurst","sequence":"additional","affiliation":[{"name":"Center for Child Health, Behavior, and Development, Seattle Children\u2019s Research Institute, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison R.","family":"Sherris","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam A.","family":"Szpiro","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew B.","family":"Day","sequence":"additional","affiliation":[{"name":"Center for Child Health, Behavior, and Development, Seattle Children\u2019s Research Institute, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine T.","family":"Loftus","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magali N.","family":"Blanco","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret A.","family":"Adgent","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen R.","family":"Andrade-Torres","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Ni","sequence":"additional","affiliation":[{"name":"School of Public Health, College of Health and Human Services, San Diego State University, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Crocker","sequence":"additional","affiliation":[{"name":"Center for Respiratory Biology and Therapeutics, Seattle Children\u2019s Research Institute, Seattle, Washington"},{"name":"Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhao","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel D.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle"},{"name":"Department of Epidemiology, University of Washington, Seattle"},{"name":"Department of Medicine, School of Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruby H. 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