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.
&EPA
United States
Environmental Protection
Agency
Children's Environmental Health: 2OO6 Report
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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 www.epa.gov/schools/.
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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. Visitwww.epa.gov/iaq/schools/.
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. Visitwww.epa.gov/sc3/.
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.
gov/epaoswer/hazwaste/minimize/cms.htm.
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.
Visitwww.epa.gov/safewater/schools.
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 www.epa.gov/cleanschoolbus/
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 www.energystar.gov/.
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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 www.epa.gov/sunwise.
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 www.epa.gov/pesticides/ipm/
Children and the Air
Tneu 5reathe
\^s
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;
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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 atwww.epa.gov/asthma.
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.
See www.asthmacommunitynetwork.org.
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.
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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 www.epa.gov/otaq/toxics.htmttmobile
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,
visitwww.epa.gov/air/drycleaningrule
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 www.epa.gov/smokefree
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.
k12science.org/curriculum/airproj/index.html
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 www.epa.gov/apti/broadcast.
html in the section titled "Forecast Earth."
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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 www.epa.gov/teach/.
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 www.epa.gov/oppVpfoa/
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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 www.epa.gov/oppt/pbde/
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
www.epa.gov/lead/pubs/renovation.htm.
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 www.cec.org/pubs_.
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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
atwww.epa.gov/envirohealth/children.
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 www.who.int/ceh/.
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 www.cec.org/pubs.
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Promoting Pediatric
Environmental
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 www.aoec.org/pehsu.
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.
See www.epa.gov/katrina/faqs.htmtt13
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.
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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.
Visit www.cich.ca/projects/epa/lndex.htm
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.
Visitwww.centerforhealthyhousing.org
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 www.igc.org/psr.
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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
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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
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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
www.ehponline.org/docs/2005/113-10/toc
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
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National Children's
Studu Locations
^J
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
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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.
Visitwww.nationalchildrensstudy.gov
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
www.nationalchildrensstudy.gov/abouV
organization/program_office/iig/index.cfm.
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
atwww.nationalchildrensstudy.gov/about/
organization/program_office/iig/index.cfm.
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.
gov/ncea/cfm/recordisplay.cfm?deid=146583
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.
epa.gov/ncea/cfm/recordisplay.cfm?deid=55145
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
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that may occur during childhood or later in life as
a result of such exposures. Visit http://cfpub.epa.
gov/ncea/cfm/recordisplay.cfm?deid=150263
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
www.who.int/ipcs/features/ehc/en/index.html
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 http://cfpub.epa.gov/si/osp_
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 www.epa.gov/fedrgstr/EPA-
GENERAL/2006/February/Day-06/g1045.htm
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/
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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 www.unep.org/pcfv.
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 www.cehca-2005.org/.
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
www.chem.unep.ch/mercury/partnerships/
\8> Children's Environmental Health: 2OO6 Report
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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 www.epa.gov/children
Children's Environmental Health: 2OO6 Report
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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:
www.epa.gpv/cnilaren
<~>
United States
Environmental Protection
Agency
Child and Aging
Health Protection Division
October 2006
EPA100-F-06-011
Recycled/Recyclable
Printed with Vegetable Oil-Based Inks on
Recycled Paper (Minimum 50 percent Postconsumer)
Process Chlorine Free
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