Evidence map›Paper›PMID 42380643›Full record

ReviewJournal of exposure science & environmental epidemiology2026

The combined impact of chemical and non-chemical stressors on adverse health outcomes: an overview of reviews from the epidemiological literature and experimental animal studies.

Jessica Trowbridge, Emily Lasher, Xing Gao, Nicholas Chartres, Rashmi Joglekar, Rachel Morello-Frosch, Mary A Fox, Devon Payne-Sturges, Jessie P Buckley, Tracey J Woodruff

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of exposure science & environmental epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jessica TrowbridgeProgram on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA. Jessica.Trowbridge@ucsf.edu.
Emily LasherProgram on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Xing GaoProgram on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Nicholas ChartresSchool of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Rashmi JoglekarProgram on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Rachel Morello-FroschDepartment of Environmental Science and Policy Management and School of Public Health, University of California, Berkeley. Dr. Morello-Frosch stepped off the project as of May 1, Berkeley, CA, USA.
Mary A FoxRisk Sciences and Public Policy Institute, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Devon Payne-SturgesDepartment of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Jessie P BuckleyGillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Tracey J WoodruffProgram on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA. traceyw@stanford.edu.

Funding

UNC-CH CENTER FOR ENVIRONMENTAL HEALTH &SUSCEPTIBILITYP30ES010126 · NIEHS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Hazel B Nichols · 2001 to 2026
$36.3M
UCSF Environmental Research and Translation for Health Center (EaRTH Center)P30ES030284 · NIEHS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Rashmi Joglekar · 2020 to 2026
$11.2M
NIEHS NIH HHS P30 ES010126NIEHS NIH HHS P30 ES030284
6 · The paper itself

Abstract

backgroundAssessing environmental chemical health risks requires accounting for a range of factors that influence risk, including exposure to multiple chemicals, biological factors, and non-chemical stressors, such as socioeconomic status, access to health care, and discrimination. Exposure to non-chemical stressors can interact with or modify the effects of chemical exposures on adverse health outcomes, making them a critical component of cumulative risk assessment. However, incorporating this research into evidence-based decision-making, including cumulative risk assessment approaches, requires a comprehensive evaluation of the literature to understand the magnitude of non-chemical stressors' impact on the exposure-outcome relationship.

objectiveTo conduct an overview of reviews to identify, evaluate, and summarize the body of evidence on this topic in published systematic and scoping reviews.

methodsWe pre-published our study protocol, conducted a systematic literature search, and we reviewed and extracted data from eligible studies, using the Navigation Guide Methodology for Systematic Review. We adapted and used the AMSTAR 2.0 tool to evaluate and rate the quality of environmental health studies.

resultsWe identified 13 systematic and five scoping reviews that met our pre-defined eligibility criteria. All reviews evaluated human epidemiologic evidence, and one evaluated human and animal evidence. Three reviews were of moderate quality, four reviews were of low quality, and 11 reviews were critically low. We summarized the findings from reviews rated as low or moderate quality (n = 7). The most common exposure was air pollution. Studies described a broad range of outcomes and used varied definitions and conceptualizations of non-chemical stressors, including using race ethnicity as an indicator of social stress or socioeconomic status (SES) or using direct and indirect measures of SES, such as health insurance status and median household income. Two reviews with certainty assessments found an increased association with adverse health outcomes when environmental chemical and non-chemical stressors were considered together versus individually. IMPACT: Current risk assessment methods fail to account for the combined effect of chemical and non-chemical stressors. Consolidating systematic reviews on the influence of extrinsic non-chemical stressors can facilitate the development of risk assessment methods that account for their impact.

Indexed as

Environmental ExposureEnvironmental PollutantsAnimalsHumansRisk AssessmentEnvironmental Pollutantscumulative risknon-chemical stressorsoverview of reviewssystematic review

Identifiers

PMID42380643
PMCPMC13538057

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.