Children's  Environmental

Health:  2OO6  Report
Environment, Health, and a
Focus on Children

The mission of the United States
Environmental Protection Agency (EPA) is to
protect human health and the environment.
Recently, the World Health Organization
estimated that as much as 24 percent of
global disease is caused by avoidable
environmental exposures, and that the
environment significantly affects more than
80 percent of major diseases. More than
33 percent of disease in children under
the age of five is caused by environmental
exposures (WHO, 2006). EPA is taking action in
response to the clear evidence that children
face unique risks for these reasons:
• The neurological, immunological, respiratory,
  digestive and other body systems in children
  are still developing and are more easily
  harmed by environmental exposures;
• Children eat more food, drink more fluids, and
  breathe more air than adults in proportion
  to their body mass—their food, water, and
  air must therefore  be especially safe;
• Children play and learn by crawling and placing
  hands and objects in their mouths—increasing
  their potential exposure to environmental
  contaminants. They do not understand risk
  until they get older and are more mature,
  again enhancing exposure potential;
• There are unique exposure pathways such as
  through the placenta and through breast milk;
• Children have a long life expectancy
  during which the consequences of
  exposures might become evident; and
• Children are limited in their capacity to
  communicate and urge action about their
  environmental health risks, so others
  must speak and act on their behalf.
         United States
         Environmental Protection
                                   Children's Environmental Health: 2OO6 Report

           This annual publication

           highlights a variety of efforts

           across EPA undertaken

explicitly to improve the environments

where children live, learn and play.

We discuss recent projects to improve

schoolenvironments.addressindoor and

outdoor air quality, and reduce exposures

to chemicals and pesticides. We also

highlight research, regulatory, and data

development work, as well as efforts to

protect children from overexposure to

the sun, to train healthcare providers and

to provide international leadership.
Protecting Children
in Schools
In orderto learn, children must have safe

and healthy schools and they must be able

to concentrate, free from environmentally-

related conditions that may precede illness.
Asthma, lead poisoning, inadequate ventilation,

moisture and mold problems, improper use

of pesticides, and inadequate chemical

management are all environmental issues

in schools. EPA is taking an integrated

and coordinated approach to improve the

health, productivity and performance of 53

million children and 6 million staff in the

nation's 120,000 public and private schools

while saving energy, resources and money.

HealthySEAT: Efforts to help school administrators
ensure that students and staff have safe and healthy
environments in which to learn and work were
accelerated in 2006 with the release of the Healthy
School Environments Assessment Tool (HealthySEAT).
The new HealthySEAT software developed by
EPA allows school systems to establish and
manage voluntary, comprehensive, environmental
management systems for all of their school
facility environmental health and safety issues.
HealthySEAT is a  free software tool that comes
pre-loaded with approximately 400 assessment
actions covering the major elements of all of EPA's
regulatory and voluntary programs for schools,
and many from other Federal agencies as well.

HealthySEAT is designed to be customized to reflect
the school district's own issues and  priorities,
and to track the status of facility conditions and
improvements school by school. Based on a
model created by the Los Angeles Unified School
District and developed in collaboration with
several states and school districts across the
country, HealthySEAT provides a truly integrated
approach to protecting children's health in
schools. For more infor dmation and to download
HealthySEAT, visit
Z   Children's Environmental Health: 2OO6 Report

Indoor Air Quality: In 2006, EPA is recruiting
1,200 schools to implement indoor air quality
management practices, bringing the total over
ten years to 35,000 schools.  These  practices
have reduced  exposure to indoor pollutants and
improved the indoor environment and health of
approximately 18 million  students, faculty, and
staff.  EPA's Indoor Air Quality Tools for Schools
Program (IAQ  TfS) has been supporting schools for
over a decade with the goal  to reduce exposures to
indoor environmental contaminants in 35 percent of
America's schools by 2012 through the promotion of
voluntary adoption of IAQ management practices.
Key elements  of the program include outreach and
education, training, technical tool development,
and awards.

Chemical Cleanout and Prevention Program:
EPA continues to encourage  safe chemical
management and to help state, local, and tribal
programs remove dangerous chemicals from schools.
EPA encourages school districts and communities
to promote a safer learning environment through
use of its informational material and Web site with
valuable resources for teachers, administrators, and
community partners.

Chemical and Waste Management—
the Lansing,  Michigan Pilot: Throughout the
United States, school districts struggle to find
cost-effective  and comprehensive solutions to their
chemical  and waste management challenges. EPA
recently supported a revolutionary pilot to improve
chemical  and waste management in schools.
Rather than placing additional  burden on teachers
and other school personnel, the school district's
supply chain was transformed from product sellers
to product service providers, using their expertise
to comprehensively improve  chemical and waste
management without additional cost to the school
district. General Motors,  Chemical Strategies
Partnership, Michigan Department of Environmental
Quality, and EPA partnered to make this pilot a
success. A step-by-step workbook based on the
Lansing Public School District Pilot  is being created
to assist interested organizations. See www.epa.
Reducing Lead in Drinking Water: EPA
developed a suite of new tools and guidance
documents to encourage schools and child care
facilities to implement the 3T's (Training, Testing,
Telling)—a voluntary lead in drinking water
reduction program. Exposure to lead is a significant
health concern, especially for young children and
infants, whose growing  bodies tend to absorb more
lead than the  average adult. EPA's  objective is to
provide school officials and child care providers
with the tools they need to understand and
address lead in drinking water in their facilities.

Clean School Bus  USA: EPA launched its Clean
School  Bus USA program in 2003 to reduce children's
exposure to diesel exhaust from school  buses.
When inhaled, pollutants in diesel exhaust may
aggravate asthma and allergies or cause other
serious health problems for children. At least 80
communities in 40 states have lowered pollution
from their local school buses as a  direct result of
almost  $18 million in Clean School Bus grants. As
a result, over 2 million children are riding cleaner
school buses. Over 20,000 school buses have been
involved in Clean School Bus projects and nearly
1000 tons of soot will be reduced at their conclusion.
The benefits to children  and communities are less
exposure to particulate matter in diesel exhaust
and fewer asthma episodes and emergency room
visits Visit

Energy Efficiency and Children's Health:
EPA's ENERGY STAR  program  helps improve the
school environment for our children by providing
better lighting, reducing indoor and outdoor air
contaminants, and regulating  temperature and
humidity to prevent mold and dust mites. School
districts spend more  than $5 billion annually on
energy. Typically, 30  percent of the energy used in
a school is wasted. Energy efficiency reduces costs
and provides a cleaner living environment. Of the
9,000 school buildings tested, more than 470 have
earned  the ENERGY STAR logo. Buildings that have
earned  the logo use about 40 percent less energy
than average buildings. See
                                           Children's Environmental Health: 2OO6 Report

SunWise Program: Ultraviolet (UV) rays from the
sun are classified as a human carcinogen. Serious
health effects, including skin cancer, eye damage,
cataracts, and immune system suppression can
be caused by overexposure to the sun. SunWise
teaches children and their caregivers how to protect
themselves from overexposure to the sun, and has
been shown to be effective at increasing sun safety
knowledge and awareness in children ages 5 to 12.
More than 14,000 schools and informal learning
centers are signed up for the SunWise Program
(up from 12,000 in 2005), making SunWise the
most widely used public health education program
in the country. Visit

Integrated Pest Management (IPM): An IPM
program employs common sense strategies to reduce
sources of food, water and shelter for pests. IPM
programs take advantage of all pest management
strategies, including careful use of pesticides when
necessary. Integrated pest management provides an
opportunity to create a safer learning environment—
to  reduce children's exposure to pesticides as well as
eliminate pests. EPA is encouraging school officials
to  adopt IPM practices to reduce children's exposure
to  pesticides. The IPM Institute of North America's
IPM STAR school certification program ensures IPM
is practiced in schools. The Monroe Model, from
Monroe County, Indiana, is known for its ability to
engage staff at all levels in pest management and
has been widely adopted.  Both of the models are
being demonstrated throughout  many parts of the
United States. These two models have positively
affected more than 3 million  students and staff in
our nation's schools. The measure of their success
is the exposure reduction achieved. On average,
schools show a 71 percent reduction in pesticide
applications and a 78 percent reduction in pest
complaints See
Children  and  the Air

Tneu 5reathe

Air pollution, whether indoors or

out, affects the health  of children

in countries all over the world.

While playing or at rest, children

breathe more rapidly and inhale

more pollutants per pound of

body weight than adults. The

airway passages in children are

narrower than those in adults, and

irritation caused by air pollution can result in

proportionately greater airway obstruction

(American Academy of Pediatrics Committee

on Environmental Health, 2003). In addition

to associations between air pollution and

respiratory symptoms, asthma exacerbations,

and asthma hospitalizations, recent studies

also find links between air pollution and

preterm birth, infant mortality, deficits in

lung growth, and possibly, development

of asthma (PEDIATRICS Vol. 114 No. 6).

Asthma: While health effects of exposure to
polluted air vary by type of pollutants inhaled and
the exposure level, a look at recent asthma research
findings and statistics  illustrates the importance of
clean air for children. Research has shown that:

•  Exposure to dust mites, molds,
   cockroaches, pet dander, and secondhand
   smoke trigger asthma attacks;

•  Exposure to secondhand smoke can cause
   asthma in pre-school  aged children;

"T   Children's Environmental Health: 2OO6 Report

   Exposure to dust mites can cause asthma;
•  Ozone and particle pollution can
   cause asthma attacks;

•  Exposure to particulate matter
   can reduce lung function;

•  When ozone levels are high, more
   people with asthma have attacks that
   require a doctor's attention; and

•  Ozone makes people more sensitive
   to asthma triggers such as pet dander,
   pollen, dust mites, and mold.

In the United States, 20 million people, including
6.1 million children, have asthma, which accounts
for more than 14 million outpatient clinic visits and
nearly 2 million emergency department visits each
year. African Americans continue to have higher
rates of asthma emergency department visits
(380  percent higher), hospitalizations (225 percent
higher), and deaths (200 percent higher) than
Caucasians. Approximately 2 million Hispanics in
the United States have asthma and Puerto Ricans
are disproportionately affected. Asthma is the
most common serious chronic disease of  childhood,
costing society annual expenditures for health and
lost productivity estimated at $16 billion. More
information is available
Controlling Asthma: EPA launched a new effort
to support communities in delivering quality asthma
care. The Communities in Action for Asthma
Friendly Environments Network links community-
based asthma programs committed to improving
health outcomes and sharing knowledge, resources
and tools. Network participants pursue strategies
to achieve positive  health outcomes, including
cultivating strong program leaders, establishing
sound community relationships, maximizing
cooperative opportunities, providing integrated
healthcare services, and implementing tailored
environmental interventions. The  network is
supported through an interactive Web site which
provides the platform for real-time education,
communication, resource sharing, and recognition.

Innovative Asthma Programs: EPA's National
Environmental Leadership Award  in Asthma
Management recognizes health plans and
healthcare providers who have demonstrated
leadership in managing environmental triggers
as part of a comprehensive  asthma management
program. Award winners serve as mentors and
models for best practices in asthma care. This
year EPA recognized two organizations:

    IMPACT DC: With comprehensive asthma
    management for children, IMPACT DC, a
    program of the Children's Research Institute
    at Children's  National Medical Center in
    Washington, D.C.,  reduces emergency room
    visits and decreases asthma severity. The
    program's unique approach uses the  emergency
    department to  identify and educate asthma
    patients, link them to primary care physicians
    or Medicaid managed care organizations, and
    follow them to ensure they receive effective
    long-term care. IMPACT DCs educational
    activities resulted in increased behaviors to
    reduce exposure to environmental triggers.  The
    proportion  of families using a mattress pad or
    pillow cover on a child's bed after receiving the
    program's asthma counseling was 75 percent
    compared with 23  percent in the control group.
                                           Children's Environmental Health: 2OO6 Report

    Blue Cross of California, SSB: This managed
    care system demonstrates leading-edge
    approaches to asthma care by providing multi-
    lingual pharmacist consultations, home visits
    to assess environmental risks for high risk
    members, and incentives for physicians who
    follow the program's guidelines. As a result
    of its asthma education program, Blue Cross
    of California, SSB decreased hospitalizations
    by 60 percent and emergency room visits by
    46 percent for continually-enrolled members.
    In addition, Blue Cross of California, SSB
    contributes to education and research efforts
    addressing  air quality and its effect on asthma
    through a community-wide coalition it founded.

Emission  Standards: In March, EPA announced
proposed new emission standards to reduce toxic
fumes and associated health risks from gasoline,
vehicles, and gas containers. By 2030, these
proposed Mobile Source Air Toxic regulations and
fuel and vehicle standards should reduce toxic
emissions from  passenger vehicles to 80 percent
below 1999 emissions. The proposed  standards
would take effect in 2011 for fuel requirements,
2010 for passenger vehicles, and 2009 for fuel
containers.  The  proposal, supporting documentation,
and information about submitting comments are
online at

Air Toxics and Dry Cleaners: On July 13th,
EPA announced  a new rule to reduce emissions
of perchloroethylene (perc) from all dry cleaners,
including a  phase-out of the chemical in existing
dry cleaners located in residential buildings. The
rule prohibits the use  of perc in any new co-
residential dry cleaner. About 28,000 dry cleaners
across the country, many in major cities such
as New  York and Washington D.C., use perc in
the wash cycle to clean clothes. Of the total,
1,300 operate in residential buildings. Because
apartments in these buildings are located very
close  to  dry cleaners,  residents' exposures and
their estimated cancer risks can be much higher
than for typical area source dry cleaners. Perc has
been shown in animal studies to cause cancer. In
addition, recent studies on residential exposures to
perchloroethylene have found neurological effects
in residents living near dry cleaning facilities. Perc
can cross the placenta and effects on developing
nervous systems could pose  a special concern for
fetuses and young children. For more information,

Children and Secondhand Smoke: Exposure to
secondhand smoke increases the risks of asthma
episodes, middle ear, and lower respiratory tract
infections, such as pneumonia  and  bronchitis. A
recent EPA survey showed that approximately 20
percent of children with asthma are exposed to
secondhand smoke in their homes.  Asthma and
secondhand smoke exposure rates are higher in
low-income and low education households, with
parents accounting for a  majority of the exposure.
By 2005, more than 120,000  parents and caregivers
committed to keep smoke-free homes and cars for
children by taking EPA's Smoke-free Home and Car
Pledge. To take the Pledge and to find out more
about how to protect children from  secondhand
smoke, visit

Teaching Students about Air Pollution:
Air Pollution: What's the Solution? is  an online
educational curriculum that uses real-time data to
help students in grades 6 through 12  discover the
science behind the causes and effects of outdoor
air pollution. Students use scientific data and
animated maps to monitor the  presence of pollution
and gain a better understanding of  air pollution
and the associated health effects. Visit www.

EPA and the Weather Channel  sponsored a twenty
minute program to show how air quality can affect
people and their health and to  explain actions to
reduce air pollution. The  segment offers valuable
information about the dangers  of air pollution and
stresses the  effects it has on the environment
and human health. The video is available free
online at
html in the section titled "Forecast Earth."
6>   Children's Environmental Health: 2OO6 Report

Protecting Children from

Cnemical  Exposures

There are up to 80,000 chemicals registered

for manufacture in the United States, and only

a fraction of these have been tested for their

effects on human health. Children are exposed

to chemicals every day, as they are ubiquitous:

in schools, child care centers, farms, fields,

grocery stores, homes, lawns, and dry cleaners.

Chemicals are also found in thousands of

consumer products, including children's toys.

Toxicity and Exposure Assessment for
Children's Health (TEACH): TEACH consolidates
children's health and related developmental
toxicology information from the scientific literature
and improves access to that information through an
interactive Web site. TEACH complements existing
informational tools on health risks to children from
exposure to chemicals in the environment. The
TEACH Web site includes two main components:
a searchable database and chemical summaries.
The TEACH Database contains summaries of
research articles from peer-reviewed journals
that pertain to early life and childhood exposure
and health effects for the TEACH chemicals of
concern. The TEACH Chemical Summaries highlight
information from the TEACH Database and other
federal resources in a standardized format for each
TEACH chemical of concern. The site includes a
database of research articles from peer-reviewed
journals that pertain to early life and childhood
exposure and health effects for  each chemical.
Eighteen chemicals or chemical  groups are currently
in TEACH, chosen because  of their potential
effects on children's health. They are: arsenic,
benzo(a)pyrene, benzene, formaldehyde, manganese,
alkyl mercury, elemental  mercury, inorganic mercury,
nitrates/nitrites, phthalates, polychlorinated
biphenyls (PCBs), trichloroethylene (TCE), vinyl
chloride, and five pesticides: atrazine, 2,4-
dichlorophenoxyacetic acid (2,4-D), diethyltoluamide
(DEET), dichlorvos, and pyrethroids (permethrin
and resmethrin). Visit

2010/15 PFOA Stewardship: In January of  2006,
EPA invited the eight fluoropolymer and telomer
manufacturers to participate in a global stewardship
program on PFOA and related chemicals.  PFOA,
also known as C8 or Ammonium Perfluorooctanoate
(APFO), is used in the manufacturing process of
fluoropolymers which impart desirable properties,
including fire resistance and oil, stain, grease, and
water repellency. They are  used to provide non-stick
surfaces on cookware and waterproof, breathable
membranes for clothing.  PFOA is persistent in
the environment. It has been detected in  low
levels in wildlife and humans, and animal studies
have indicated developmental and other effects
of concern. Companies were asked to commit
to reducing PFOA from emissions and product
content by 95 percent no later than 2010, and to
work toward eliminating  PFOA from emissions
and product content no later than 2015. Eight
companies made commitments to participate in
this program: Arkema, Asahi, Ciba, Clariant,  Daikin,
DuPont, 3M/Dyneon, and Solvay Solexis. For more
information, see
                                         Children's Environmental Health: 2OO6 Report   /

Polybrominated Diphenyl Ethers (PBDEs):
EPA released a PBDE project plan to summarize
relevant information on this group of brominated
flame retardant chemicals. EPA is working with all
parties to ensure that fire safety, environmental
concerns, and public health are all considered
for these chemicals, which are widely used in
a variety of manufactured products.  Concerns
about liver toxicity, thyroid toxicity, developmental
toxicity and developmental neurotoxicity are
particularly important for children. The plan outlines
EPA's overall approach to activities for these
chemicals, which includes pentabromodiphenyl
ether (pentaBDE), octabromodiphenyl ether
(octaBDE), and decabromodiphenyl ether
(decaBDE) Visit
Integrated Pest Management in Public
Housing: Over 2.5 million people live in public
housing, and many are families with young children.
Controlling common  pests like cockroaches and
rodents is an enduring challenge for low-income
families. Research has shown that cockroaches and
rodents are common asthma triggers for children
living in urban environments. In collaboration
with the National Centers for Disease Control
and Prevention, the Department of Housing and
Urban Development, and the National Center for
Healthy Housing, EPA is providing integrated pest
management training for public health and housing
officials as well as for  residents of subsidized
housing to control pests and minimize exposure
to pesticides. EPA is also sponsoring two projects
with the Providence  Housing Authority and the
Housing Authority of the District of Columbia in
an effort to transform pest management practices
and evaluate health  outcomes for residents.

Hispanic Outreach and Pesticide Safety: EPA
reached out to over 3 million Latinos through national
and local TV, radio, and print to promote pesticide
safety for Spanish-speaking farmworker families
during National Poison Prevention Week. During
the campaign, the Agency made special efforts to
convey the need to protect children of farmworkers
from exposure to pesticide residues where they live
and play. An estimated 84 percent of the farmworker
labor force is Spanish-speaking and many rely on
Spanish language media for their  health information.

Lead-Based Paint: EPA proposed new
requirements for contractors and construction
professionals when working in homes that contain
lead-based paint. The goal of these requirements
is to reduce lead exposure to children. EPA is
proposing that contractors be trained in the use
of lead-safe work practices, renovators and firms
be certified,  providers of renovation training be
accredited, and renovators follow protective work
practice standards. For more information visit

Children and Toxics: A report by the Commission
for Environmental Cooperation (CEC) profiles
children's health and the relative risk of industrial
chemicals. Using pollution data from  Canada
and the United States, the report highlights
our need to better understand exposures to
industrial chemicals  as well as chemicals  used
in residential and school settings, and the
association of these  chemicals with potential
health effects in children. This report is available
on the CEC Web site
3   Children's Environmental Health: 2OO6 Report

Indicators of Children's

Environmental  Health

To guide and improve environmental, health,

and development policy in the United

States and throughout the world, EPA has

spearheaded efforts to fill information  and

data gaps on environmental conditions

and health outcomes in children.

America's Children and the Environment:
This series of reports on measures helps
track and understand the potential impacts of
environmental contaminants on children's health
and, ultimately help to identify and evaluate
ways to minimize environmental impacts on
children. The reports bring together quantitative
information from a variety of sources to show
trends in levels of environmental contaminants
in air, water, food, and soil;  concentrations of
contaminants measured in the bodies of children
and women; and highlight childhood illnesses that
may be influenced by exposure to environmental
contaminants. In 2006, new data are available
Global Indicators: EPA launched a partnership
to develop global indicators for children's
environmental health at the World Summit on
Sustainable Development in 2002. The partnership
is working to increase understanding and improve
the quality of information about the linkages
between environmental conditions and human
health outcomes and will enable us to measure
progress toward improving environments for
children. The partnership includes governments,
non-governmental organizations, and international
organizations and  is managed by the World Health
Organization. Progress on indicator development
is being made in Europe, Africa, the Middle East,
and in North America. Visit

North American  Indicators: Thirteen children's
environmental health indicators for Mexico, the
United States, and Canada were developed under
the auspices of the Commission for  Environmental
Cooperation in partnership with the  International
Joint Commission, the  Pan-American Health
Organization, the World Health Organization,  and the
governments of the three countries. Indicators cover
asthma and respiratory disease, exposure to lead and
other toxic substances, and waterborne diseases.
See results and data at
                                         Children's Environmental Health: 2OO6 Report

Promoting Pediatric


Health  Expertise

Environmental health is currently an

insignificant part of health professional

education. Yet the public relies on doctors and

nurses for their health information, including

that related to environmental exposures.

Healthcare providers receive little or no

training about the health problems related to

the environment, yet they are recognized by

the public as the most authoritative source

of health information. In response, EPA has

undertaken a variety of efforts to provide

recognized centers of children's environmental

health expertise, promote learning about

the environmental causes of diseases in the

healthcare community, and to create training

materials for healthcare providers. EPA is

better able to safeguard human health when

healthcare providers  are able to address

pediatric environmental health concerns.

Pediatric  Environmental Health Specialty
Units (PEHSU): EPA and the Agency for Toxic
Substances and Disease Registry support a program
that enables experts to educate other  healthcare
providers, consult on diagnosis and treatment of
environmentally-related illness, and educate the
public about children's environmental health. The
program has been recognized by other countries
and international organizations as effective and
worth emulating. See
Katrina Response: Recent hurricanes along
the Gulf Coast and flooding in New Orleans
presented environmental and health problems
for the entire population, and EPA worked with
the PEHSUs to address the unique needs and
vulnerabilities of children. For example:

•  children get dehydrated more quickly than adults;

•  children suffer the effects of unclean
   drinking water before adults; and

•  children with asthma may be affected  by
   pollutants in flooded homes and outdoor air.

for information addressing:

•  how to provide clean water to children
   in disaster-affected areas;

•  how to clean up after a flood  in  a manner
   that is protective of children;

•  what to do with toys that were in flood waters;

•  how to protect children from
   exposure to mold; and

•  whether to allow older children
   to help in clean up work.

PEHSU Research: The investigators of the
MidAmerica Pediatric Environmental Health
Specialty Unit are doing a pilot study to assess the
effect of exposure to diesel bus emissions in the
schoolyard on pediatric respiratory health. This is
an observational risk assessment study to test two
hypotheses: 1) There is a direct relationship between
concentration of particulate matter  and severity
of respiratory symptoms experienced by students
exposed to school bus emissions; and 2) The
amount of particulate matter that children breathe
at school is partially determined by the combined
action of three variables: a) the number of buses
that service the school; b) whether the  buses leave
their motors running while parked at the school;
and c) whether the students stand in the vicinity
of the buses during drop-off and pick-up times.
1O   Children's Environmental Health: 2OO6 Report

Capacity building for

Health Professionals

EPA awarded seven grants (totaling $1,042,152)

to help increase the number of physicians,

nurses and public health workers able to

address the broad spectrum of children's

environmental health issues, whether in their

private practices, in the institutions where they

work,  in academia, or in their communities.

Canadian Institute of Child Health (Institut
Canadien de la sante infantile) is training
as many as 37,000 healthcare professionals in
Canada, Argentina, Uruguay,  Paraguay, and Chile to
recognize,  assess and  initiate protocols to prevent
environmentally-related diseases in  children.
Master Trainers have been identified in four South
American countries and Canada for the August
2006 workshops in Buenos Aires and Canada.

University of Massachusetts Lowell focuses
on health professionals who serve low-income,
immigrant/refugee, and minority children in
small cities and rural areas in New England. This
population is generally underserved by children's
environmental health capacity building efforts
although it suffers disproportionately from the
impacts of environmental contaminants. Workshops
for nurses and other public health professionals are
being conducted in all six New England states.

National Center for Healthy Housing is
delivering training to public health nurses in
residential environmental health and  safety hazards.
Substandard  housing is a key determinant of  health
and has been linked to childhood  lead poisoning,
asthma and respiratory disease, and unintentional
injuries. Training is being offered through NCHH's
National Healthy Homes Training  Center and
Network, a national training program funded  by
the CDC, HUD, and EPA. The training  is delivered
through a network of five university partners.

Greater Boston Physicians for Social
Responsibility (GBPSR) is coordinating the
Pediatric Environmental Health Toolkit Training
Program in five states (Massachusetts, California,
Minnesota, Oregon, and Washington) adapting
their new clinical  tool, the Pediatric Environmental
Health Toolkit as the core curriculum. The program
is directly training 250 health professionals who
care for children and an additional 1250 providers
through peer training. Training programs are
conducted  in collaboration with PSR chapters,
local American Academy of Pediatric  chapters,
and medical schools with whom  GBPSR previously
conducted their In Harm's Way Continuing Medical
Education courses. The Toolkit was developed by
GBPSR and the San Francisco Bay Area  chapters of
Physicians for Social Responsibility in partnership
with the Pediatric Environmental Health Specialty
Unit at the University of California, San  Francisco,
and a team of pediatricians from around the country.
Recently, the American Academy of Pediatrics
endorsed the Toolkit. See
                                          Children's Environmental Health: 2OO6 Report    II

Northeastern Ohio Universities - College of
Medicine (NEOUCOM) is offering post-graduate
training in pediatric environmental health to
pediatricians in five countries in Central and Eastern
Europe (Romania, Hungary, Poland, Slovakia,
and Croatia). Lectures and didactic exercises
are delivered via the internet using two-way
synchronous audio with graphics to be followed
by a final workshop in Bratislava, Slovakia.

International Pediatric Association is launching
a virtual International Pediatric  Environmental
Health Leadership Institute that could train up to
500,000 pediatricians about children's environmental
health and improve their capacities for leadership
in the recognition, diagnosis, prevention, and
management of pediatric diseases linked to
the environment.  Eighty-eight participants from
African countries  attended the first workshop in
Nairobi, Kenya including 60 medical professionals
from 21 African countries. An outcome of the
Nairobi workshop was a statement on children's
environmental health. The second workshop will
be in Cochin, India. IPA will evaluate the training
by certifying pediatricians in environmental
health through written and oral exams.

National Environmental  Education and Training
Foundation is creating children's environmental
health faculty champions at medical and nursing
schools throughout the country. Twenty-eight
faculty champions selected from academic centers
will take a leadership role in integrating children's
environmental health into their  institutions in a
sustainable fashion, lend expertise and support in
their institutions and surrounding communities, teach
courses, integrate competencies into curriculum, and
serve as a model  for how to integrate environmental
health into health professional education. The
faculty champions will train an  additional 300 plus
health professionals at academic  institutions who
can incorporate children's environmental health
into their teachings and clinical practices. The
training tools will also be disseminated through
these cosponsors: American Academy of Pediatrics,
Ambulatory Pediatric Association, American
Association of Colleges of Nursing, Association
of Academic Health Centers, and the National
Association of Pediatric Nurse Practitioners.
Studuine; Environmental
        j   o         .
Exposures and
Children's Health
Scientists, environmental and health

managers, healthcare professionals, and

policy makers need to know more about

environmental factors and whether they are

harmful, harmless or helpful to children's

health and development. Studies conducted

with adults often have unknown application

for characterizing risk to children. Recent

research has contributed greatly to our

understanding of how environmental

exposures early in life may lead to childhood

diseases or diseases later in  life.

Research Findings: EPA and the National Institute
for Environmental Health Sciences support eleven
Centers for Children's Environmental Health
and Disease Prevention Research. The Centers
use community-based participatory research to
understand and prevent children's exposure to
environmental hazards. The research centers are
developing innovative ways to investigate the role
of environmental stressors in important childhood
disorders such as asthma, autism, and learning
disabilities and finding effective strategies to reduce
the risks from these exposures. Highlights include:

   Air Pollution Exposure and Respiratory Health
   •  Disadvantaged asthmatic children in urban
     areas appear to be at an increased risk for
     higher residential allergen and elevated
     air pollution exposure. This combination
     of asthma triggers in the home appears to
     contribute to a disparity in asthma burden
     between inner city and non-inner city children.
     (Breysse et al., 2005.  Indoor exposure to air
1Z    Children's Environmental Health: 2OO6 Report

  pollutants and allergens in the homes of
  asthmatic children in inner-city Baltimore.
  Environmental Research 98:167-176)

• Children two years or younger living
  adjacent to major roadways have an
  increased  risk of developing asthma.  This
  is particularly the case for children without
  family history of asthma. This "roadside
  effect" was more pronounced in girls.
  (McConnell et al., 2006. Traffic, Susceptibility,
  and Childhood Asthma. Environmental
  Health Perspectives. 114:766-772)

• Early life exposures to traffic-related  pollutants
  in urban environments appear to affect
  the immune system by increasing allergic
  responses, leading to respiratory symptoms in
  children as young as two years old. (Al-alem et
  al., 2006. Association of mouse,  cockroach and
  dust mite  IgE  levels at age 2 with traffic-related
  exposure and respiratory symptoms in an inner-
  city birth cohort. Journal of Allergy Clinical
  Immunology 117(2): Supplement 1, S178)
• Genetic variations in immune response to
  air pollutants may offer protection or confer
  susceptibility to the incidence of asthma.
  Some of these genetic differences appear
  to vary significantly between ethnic groups,
  potentially contributing to health disparities.
  (Yu-Fen et al., 2006. Association of Tumor
  Necrosis  Factor G-308A with Childhood
  Asthma and Wheezing. American Journal of
  Respiratory and Critical Care Medicine 173:
  970-976  and Donohue et al., 2006. Ethnic
  Differences in Frequencies of Single Nucleotide
  Polymorphisms from Glutathione S-Transferase
  (GST) and IL13. Journal of Allergy Clinical
  Immunology 117(2): Supplement 1, S162)

Pesticide Exposure and Genetic
Susceptibility to Effects
• Newborns in farmworker communities exposed
  to several organophosphate pesticides (OPs)
  display broad variability in  sensitivity to OPs
  due to variations in a particular gene called
  PON1. This  gene produces  enzymes which
  metabolize  many OPs but these enzymes
  vary in both serum levels and detoxification
  efficiencies depending on the version of
  the  gene. This is far greater variability
  than previously predicted. (Furlong et al.,
  2005. Role of Paraoxonase (PON1) Status in
  Pesticide Sensitivity: Genetic and Temporal
  Determinants. Neurotoxicology  26: 651-
  659 and Furlong et al., 2006. PON1 status
  of farmworker mothers and children as a
  predictor of organophosphate sensitivity.
  Pharmacogenetics & Genomics. 16(3):183-190)

• Toddlers in  farmworking communities gather
  twice the amount of multiple pesticide residues
  on their clothing  compared to crawlers. This
  disparity  in  pesticide loading was consistent
  with urine samples collected from the children
  in the study. (Bradman et al., 2006. Pesticides
  and their metabolites in the homes and urine
  of farmworker children living in the Salinas
  Valley, CA. Journal of Exposure  Sciences
  and Environmental Epidemiology (In press}}

• Prenatal exposures to pesticides were
  ubiquitous in one urban cohort of pregnant
  women whose exposure to chlorpyrifos
                                        Children's Environmental Health: 2OO6 Report

     and diazinon was associated with adverse
     birth outcomes, however, researchers found
     that the recent EPA ban on these two
     residential pesticides reduced exposure
     within their study population and improved
     public health by significantly increasing
     healthy births within a  year of the regulation.
     (Whyatt et al., 2004. Prenatal insecticide
     exposures, birth weight and length among
     an urban minority cohort. Environmental
     Health Perspectives 112:1125-32)

   Complex Chemical Exposure and
   Neurodevelopment Outcomes
   • Prenatal exposure to environmental tobacco
     smoke and postpartum social stresses
     experienced by mothers act separately and
     synergistically on cognitive development at
     age two. (Rauh et al., 2004. Developmental
     effects of exposure to environmental tobacco
     smoke and material hardship among inner-city
     children. Neurotoxicology and Teratology
     26: 373-85)

   • High prenatal exposure to air pollutants is
     associated with three times greater risk of
     cognitive development  delay at age three.
     (Perera et al., 2006. Effect of prenatal
     exposure to airborne polycyclic aromatic
     hydrocarbons on neurodevelopment in the first
     three years of life among inner-city children.
     Environmental Health Perspectives (In press}}

Each of the Centers supports a Community Outreach
and Translation Core to take basic research findings
into intervention and prevention methods, enhancing
awareness among communities, healthcare
professionals, and policy makers.. For example,
the University of Washington has developed a
partnership with their Pediatric Environmental Health
Specialty Unit to conduct continuing education
courses for healthcare professionals who work
with children and parents. The Columbia Center
applied its research findings to an integrated pest
management intervention in New York City low-
income public housing, convincing city officials
to replace traditional extermination methods in
public housing with less toxic techniques.
           Environmental Health
The EPA/NIEHS Children's Environmental Health
Centers were featured in the October, 2005 issue
of Environmental Health Perspectives. The issue
contains a mini-monograph of seven collaborative
"lessons learned" papers from the Centers. See

National Children's Study: The National Children's
Study, mandated by Congress in 2000, plans to
follow 100,000 children from before birth to age 21.
By working with pregnant women and couples, the
Study will gather data about how environmental
factors alone, or interacting with genetic factors,
affect childhood health. Examining a wide  range
of environmental factors—from air, water, and
dust to what children eat and how often they see
a doctor—will help scientists develop prevention
strategies and cures for a wide range of childhood
diseases. By collecting data nationwide—before
diseases arise—this study can  test unproven
theories and generate hypotheses that would
inform spin-off studies for years to come.

This interagency effort, led by the National
Institute of Child Health and Human
Development in collaboration with EPA, the
Centers for Disease Control and Prevention,
and the National Institute of Health Sciences,
announced the first Vanguard Centers to
launch  and carry out the study in late 2005.
      Children's Environmental Health: 2OO6 Report

National  Children's
Studu Locations
Vanguard locations labeled
                                         Lincoln, Pipestone, and Yellow Medicine Counties, Minnesota
                                         and Blockings County, South Dakota
                                                                              New York City (Queens)
                                                                              New York*
                                                                                Duplin County
                                                                                North Carolina
The Vanguard Centers are:

•  University of California, Irvine with
   Children's Hospital of Orange County
   for Orange County, California

•  Mt. Sinai School of Medicine with Columbia
   University Mailman School of Public Health,
   New York City Dept. of Health and Mental
   Hygiene, University of Medicine and Dentistry
   of New Jersey, and Columbia  University
   Dept. of Obstetrics and Gynecology for
   New York City (Queens), New York

•  University of North Carolina-Chapel Hill
   with Battelle Memorial Institute, and Duke
   University for Duplin County, North  Carolina

•  Children's Hospital of Philadelphia and
   Drexel University School of Public Health
   with University of Pennsylvania for
   Montgomery County, Pennsylvania

•  University of Utah for Salt Lake County, Utah

•  University of Wisconsin-Madison and  Medical
   College of Wisconsin with National Opinion
   Research Center, Marquette University, UW-
   Milwaukee Center for Urban Initiatives Research,
   UW Marine and Freshwater Biomedical
   Sciences Center/Institute for Environmental
                                                   Health, and Children's Service Center of
                                                   Wisconsin for Waukesha County, Wisconsin

                                                •  South Dakota State University with Children's
                                                   Medical Center of Cincinnati and the
                                                   University of Cincinnati for Brookings County,
                                                   South Dakota and Lincoln, Pipestone, and
                                                   Yellow Medicine Counties, Minnesota

                                          Children's Environmental Health: 2OO6 Report

The National Children's Study is developing the
Study Protocol, a roadmap to guide researchers'
sampling, recruitment, and data collection activities.
EPA is planning a pilot study to test the feasibility
of household-based recruitment in North Carolina.

International Research Activities: To encourage
a wider exchange of information on children's
environmental research in other countries,
an International Interest Group has attracted
investigators worldwide who are currently working
on or  are interested in establishing longitudinal
cohort studies. The International Interest Group
complements the National Children's Study and
seeks to facilitate communication and sharing
of ideas. More information is available at

International Cancer Research: Around the
world, several large infant/child prospective studies
have been launched to examine environmental
and biological determinants of common diseases.
A workshop in September, 2005 established an
International Childhood Cancer Cohort Consortium—
a global alliance of longitudinal studies of children
to enable investigations of the role of various
environmental exposures in the etiology of childhood
cancer. Because of its longitudinal design and large
sample size, it will be easier to  see associations
considered statistically meaningful. Initially, this
effort may provide valuable insights about the causes
of childhood leukemia, and later may be helpful for
studying other types of cancer as well as other rare
childhood diseases. More information is available

Age Groups for Children's Exposure
Assessment: Guidance on Selecting Age
Groups for Monitoring and Assessing Childhood
Exposures to Environmental Contaminants
helps researchers assess childhood exposure to
environmental contaminants and the  resultant
potential dose. A consistent set of childhood age
groups, supported by an underlying scientific
understanding of differences in behavior and
physiology that may affect exposures and internal
dose in children,  improves EPA's exposure and risk
assessments for children and assists  the Agency
in implementing various regulatory initiatives.
These age groups will guide future analyses of
exposure factors  data and new research and
data collection efforts. Documents and additional
information are available at http://cfpub.epa.

Exposure Factors for Children: The 2002
interim final report on the Child-Specific Exposure
Factors Handbook is being updated. The document
provides a summary of the available and up-to-date
statistical data on factors to use when assessing
childhood exposures. These include: drinking water
consumption; soil ingestion; inhalation rates; dermal
factors such as skin area and soil  adherence factors;
consumption of fruits and vegetables, fish, meats,
dairy products, homegrown foods, and breast milk;
activity patterns;  body weight; use of consumer
products; and life expectancy. Documents and
additional information are available at http://cfpub.

Children's Health Risk Assessment: The
draft Framework  for Assessing Health Risks of
Environmental Exposure to Children outlines the EPA
risk assessment process with a focus on childhood
exposures, identifies sources for  more detailed
information on life stage-specific considerations,
and includes web links to on-line publications. The
document emphasizes the need to take into account
the  potential exposures to environmental agents
during preconception and all stages of development
and focuses on the relevant adverse health outcomes
16    Children's Environmental Health: 2OO6 Report

that may occur during childhood or later in life as
a result of such exposures. Visit http://cfpub.epa.

A complementary document by the World Health
Organization's International Programme on Chemical
Safety, Principles for Evaluating Health Risks in
Children Associated with Exposure to Chemicals,
was supported by EPA and other organizations. See

Life Stage Pharmacokinetics: Age-related
physiological changes in the body  may cause
differences in the way the body handles chemical
exposures. Models can  be used to predict internal
doses by taking into account the rate of absorption,
distribution among target organs and tissues,
metabolism, and elimination from  the body. A
draft report of Approaches for the Application
of Physiologically Based Pharmacokinetic (PBPK)
Models and Supporting Data in Risk Assessment
addresses the application  and evaluation of these
PBPK models for risk assessment applications.
The draft  document and additional information
are available at
sciencedisplay.cfm?dirEntrylD=135427. A
final report is expected  in  November, 2006.

Research Protections for Children: A rule
announced in January banned all third-party
intentional dosing research on pesticides involving
children and  pregnant women intended for
submission to EPA. EPA will  neither conduct nor
support any intentional  dosing studies that involve
pregnant women or children for all substances EPA
regulates. Visit

Children's Inhalation Dosimetry and Health
Effects for Risk Assessment Workshop: EPA
hosted this workshop to review existing and
emerging information on children's inhalation
dosimetry, health effects, and risk assessment,
and to explore and discuss new approaches for
children's inhalation risk assessment practice.
Physiological and behavioral factors distinguish
children from adults in  many ways that affect
inhalation dosimetry and assessment of health
effects upon exposure to environmental agents.
Epidemiology studies suggest that children may be
more sensitive than adults to a variety of criteria
air pollutants and air toxics, yet this information
has been incorporated in risk assessment to only
a limited extent. The workshop explored key areas
of children's inhalation dosimetry, as well as the
use of biomarkers of exposure and mode-of-action
information to address children's health outcomes
in risk assessment. The summary of the workshop is
planned for publication in a peer-reviewed journal.

Protecting All the

Children  of the World

Each year, more than three million  children

under agefive die due to environmentally-

related causes, often from the effects of a basic

lack of clean air to breathe and clean water to

drink. Morbidity from chronic overexposure to

harmful chemicals and pesticides compromises

the normal growth and development and ability

to learn for millions more children  each year.
                                         Children's Environmental Health: 2OO6 Report   I/

Lead Phase-out in Africa: The Partnership for
Clean Fuels and Vehicles was launched by EPA, the
United Nations Environment Programme, and dozens
of other partners more than three years ago at the
World Summit on Sustainable Development. In 2002,
leaded gasoline was used in all but one country in
Sub-Saharan Africa. By January of 2006, with the
assistance of the Partnership and the World Bank,
all 49 Sub-Saharan African countries had  stopped
refining and importing leaded gasoline. When the
remaining supply is exhausted, Sub-Saharan Africa
will have eliminated the use of  leaded gasoline.
This action to reduce exposure to lead affects
millions of people and is particularly important
to Africa's children, who represent 44  percent
of the population. The partnership aims to realize
a global phase-out of leaded gas by the end of
2008. Learn more at
Central Asia and Children's Environmental
Health: In April of 2005 and June, 2006, scientists
and policy makers attended the Children's
Environmental Health Conference for Central
Asia, held outside of Almaty,  Kazakhstan with
support from EPA. The focus of the conference
was on children's environmental health issues in
Central Asia, with participants from Kazakhstan,
Kyrgyzstan, Uzbekistan, Tajikistan, Armenia,
Azerbaijan, Russia, Turkey, Palestine, Pakistan,
Jordan, the United States, Canada, Italy and
Japan. As a result, participants formed a nonprofit
organization to discuss and find solutions to their
common children's environmental health problems.
Their Web site is

Global Protections from Mercury: EPA is
leading the implementation of four partnerships
to reduce global mercury use  and emissions in
artisanal and small-scale gold mining, chlor-alkali
manufacturing, coal combustion, and in consumer
products containing mercury.  Mercury released in
these sectors affects children disproportionately,
as mercury is a powerful neurotoxin. Many children
work with their families to mine and refine gold,
and are directly exposed to mercury and mercury
vapors. In addition, artisanal gold mining may
release up to 1000 tons per year of mercury
globally. A large portion of these releases are
atmospheric, affecting children through deposition
in areas far from the release  site. EPA is working
with other countries to reduce mercury exposures
in artisanal gold mining, and  is developing public
information materials for global distribution. Visit
\8>    Children's Environmental Health: 2OO6 Report

Children's Environmental

Health Awards

Developing a new generation of pediatricians

with environmental health expertise;

studying the effect of on-road emissions

in asthmatic children to prevent the health

impacts of air pollution; and starting a

"green cleaning" program to reduce

exposures to environmental hazards in

schools. These programs are 3 of 14 that

were recognized by the EPA at the second

Children's Environmental Health Excellence

Awards ceremony in April 2006.

Children's Environmental  Health Champion:
The 2006 Children's Environmental Health
Champion Award was presented to Dr.  Philip
J. Landrigan—a pioneer and leader in the
field of children's environmental health who
is recognized for his many accomplishments,
including his work with the Center for Children's
Health and the Environment, and the Pediatric
Environmental Health Specialty Unit at Mt. Sinai.

The 2006 Excellence Award Winners are:

•  Ambulatory Pediatric Association
   (APA), Fellowship  Program in Pediatric
   Environmental Health, Bronx, NY

•  The Ashkin Group, LLC, Bloomington, IN

•  Coalition for a Smoke-Free Valley (The
   Coalition is part of the Community
   Health Department of Lehigh Valley
   Hospital and  Health Network), Keep Us
   Healthy Collaborative, Allentown, PA

•  Community Asthma Prevention Program
   (CAPP), Community Asthma Prevention
   Program of Philadelphia,  Philadelphia, PA
•  Department of Development, Cuyahoga
   County, Cuyahoga Lead Hazard
   Reduction Program, Cleveland, OH

•  Emory University School of Medicine, EVA
   (Emisiones Vehiculares y Asthma) or Vehicular
   Emissions and Asthma, Atlanta, GA

•  Get the Lead Out! Collaborative, Grand Rapids, Ml

•  Loyola University Chicago Civitas  Child Law
   Center, Lead Safe Chicago, Chicago, IL

•  National Center for Healthy Housing (NCHH)
   Enterprise Community Partners, The Home-Based
   Child Care  Lead Safety Program, Columbia, MD

•  National Environmental Education &
   Training Foundation (NEETF), Integrating
   Environmental Health into Pediatric
   Healthcare, Washington, D.C.

•  Oregon Environmental Council,
   Providing Caregivers Tools to Protect
   Children's Health, Portland, OR

•  The University of Georgia College of
   Family and Consumer Sciences, Georgia
   Radon Education Program, Athens, GA

•  University of Medicine and Dentistry of New
   Jersey (UMDNJ) - School of Public Health,  Center
   for School and Community Health Education,
   ToxRAP™ Education Program (Toxicology,  Risk
   Assessment, and Pollution), Piscataway,  NJ

•  West Virginia Division of Tobacco
   Prevention, West Virginia Clean Indoor
   Air Program, Charleston, WV

The Children's Environmental Health Awards are
designed to recognize ongoing and sustainable
dedication to, and notable leadership in, protecting
children from environmental health risks at the local,
regional, national and international level. Twenty-
nine additional organizations received Recognition
Awards for their demonstrated commitment to
protecting  children from environmental health  risks.
To view a list of the Excellence and Recognition
Award recipients and learn more about their
programs, go to
                                        Children's Environmental Health: 2OO6 Report

EPAs  Mission  to  Protect Cnilaren

                                     In 1995, EPA made it a priority to explicitly
                                     and consistently take into account
                                     environmental health risks to infants and
                                     children in all studies and public health
                                     standards set for the United States.

                                     The President's Executive Order on
                                     Environmental Health Risks and Safety Risks
                                     to Children requires all federal agencies to
                                     address health and safety risks to children,
                                     coordinate research priorities on children's
                                     health, and ensure that their standards take
                                     into account special risks to children.

                                     EPA established the Office of Children's Health
                                     Protection to catalyze, support, and facilitate
                                     Agency efforts to protect children's health
                                     from environmental risks. The mission of the
                                     Office is to make the protection of children's
                                     health a fundamental goal of public health and
                                     environmental protection. Protecting children
                                     where they live, learn, and play is essential
                                     to ensuring that our environment is safe and
                                     healthy, now and for future generations.
                                     In 2006, the Office of Children's Health
                                     Protection was reorganized and became the
                                     Child and Aging Health Protection Division.
Tor more information^ visit fiPAs Cniid and
Aging Health Protection Division at:
          United States
          Environmental Protection

          Child and Aging
          Health Protection Division

          October 2006
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