Environment,
Health, and a
Focus on Children
\
United States
Environmental Protection
Agency
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Children's Environmental Health
Excellence Award
Many organizations featured in this report are Children's Environmental Health Excellence
award winners. These awards recognize ongoing and sustainable dedication to protecting
children from environmental risks. To learn more, go to www.epa.gov/children.
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Children's Environmental Health: 2007 Highlights 1
he U.S. Environmental Protection Agency (EPA) was created in 1970 to protect
human health and the environment. The year 2007 marks 10 years of concerted
Federal effort to address children's environmental health risks as mandated
by Executive Order 13045, Protection of Children from Environmental Health Risks and
Safety Risks. We have tagged asthma and lead poisoning as priorities in our work - they
pose particular dangers to children, and EPA can be especially effective in fighting them.
Strategies designed to address asthma and lead poisoning can be instructive as we tackle
emerging issues of concern to child health and development. Much of our work is done in
partnership with others and falls generally into three categories: outreach and education,
science and research, and regulatory action. Through outreach and education, we work
to train health care providers on the environmental causes or contributors to ill health in
children, and we educate parents on how to protect their children from harmful exposures.
Research in the last decade has documented many nuances about the effects of physical,
chemical, and biological exposures on children's health. We strive to write policies and
regulations that protect all children from exposure to harmful substances. This report
captures much of our work.
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Children's Environmental Health: 2007 Highlights
Why Children?
Children are different from adults, and there is clear evidence
that they may face health and development risks:
• Children's neurological, immunological, respiratory,
digestive, and other physical systems are still developing
and may be more easily harmed by exposure to any number
of factors in the environment.
• Children eat more, drink more, and breathe more than adults
in proportion to their body weight—their food, water, and
air therefore must be especially safe.
• Children play and learn by crawling and placing hands and
objects in their mouths, increasing their chances of exposure
to environmental contaminants.
• Children have unique exposure pathways, such as through
the placenta and breast milk.
• Children have limited ability to communicate and urge action
about their environment and their health; others must act on
their behalf.
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Children's Environmental Healt.
Highlights
Protecting Children
in The Great Outdoors
The Air They Breathe: In March 2007, EPA issued
a final rule to help State and tribal environmental agencies
develop and implement plans that will improve air quality for
the millions of Americans living in areas where fine particle
pollution levels do not meet the national standards EPA
established in 1997 (15.0 micrograms per cubic meter (ug/m3)
annually and 65 ug/m3 daily). Fine particle pollution, or PM2.5,
can aggravate heart and lung disease and is associated with
premature death and a variety of serious health problems (i.e.,
asthma attacks, heart attacks, chronic bronchitis, stroke, and
more). Those particularly sensitive to PM2.5 exposure include
people with heart and lung disease, older adults, and children.
All areas must meet the 1997 fine particle standards no later
than 2015. Benefits to children with asthma include at least
3,700 fewer emergency room visits per year, 140,000 fewer
days with exacerbated symptoms, and 110,000 fewer cases
of upper respiratory symptoms. Other benefits to children
include annual reductions of more than 15,000 cases of acute
bronchitis and 150,000 cases of lower respiratory symptoms. By
2020, States also must meet the more health-protective daily
PM2.5 standard (35 ug/m3) that EPA issued in 2006, which will
result in additional public health benefits to both children and
adults. By 2020, additional benefits to children with asthma
are expected to include, annually, at least 50,000 fewer days
with exacerbated symptoms, 50,000 fewer cases of lower
respiratory symptoms, 40,000 fewer cases of upper respiratory
symptoms, 7,000 fewer cases of acute bronchitis, and 1,200
fewer emergency room visits, www.epa.gov/ttn/ecas/ria.html
Under the Sun: About half of all cancers diagnosed
each year in the United States are skin cancers. Overexposure
to the sun can cause skin cancer, as well as eye damage,
cataracts, and immune system suppression. EPA's SunWise
Program works to improve knowledge, attitudes, and
behavior about sun science and protection, as sun damage
is cumulative and protection is best if started early. To date,
more than 16,000 schools in all 50 States are participating in
this program, making it the most widely used public health
education program in the country. SunWise has cultivated
many partnerships over the last 8 years; this year, a public
service announcement with Radio Disney will air on more than
40 radio stations, www.epa.gov/sunwise
Environmental Renewal for Communities:
Since 2005, EPA has provided $4.5 million in grants through
the Community Action for a Renewed Environment program
to help 29 communities adopt programs to reduce releases
of toxic pollutants. Many of these communities are focusing
on children's health among their expressed priorities, making
strides to reduce exposure to lead, mercury, and other
chemicals. EPA expects to award up to 20 more grants under
this program in 2007. www.epa.gov/care
Children First: EPA New England (Region 1) has made
children's health a priority since 2000 with the Children First
campaign. The Region's Healthy Communities Grant Program
funds up to $35,000 per community to benefit children in
low-income areas. One specific effort is to end childhood
lead poisoning in Boston, where the number of lead-poisoned
children has dropped from 1,123 cases in 2001 to 460 cases
in 2006. By working with many partners, including Tufts
University and other public, private, nonprofit, and housing
organizations under the Lead Action Collaborative, the
program increases visibility of the issue and creates strong
lead policies and regulations.
Reclaiming Space for Children: The Small
Business Liability Relief and Brownfield Revitalization Act
describes a brownfield as "real property, the expansion,
redevelopment, or reuse of which may be complicated by the
presence or potential presence of a hazardous substance,
pollutant, or contaminant." But to communities nationwide,
brownfields are vacant lots, abandoned gas stations, industrial
or mine sites, methamphetamine labs, or blighted lands and
buildings where contamination may linger, posing unknown
risks to children, neighbors and the environment. EPA is
working with the C Agency for Toxic Substances and
Disease Registry (ATSDR), Environmental Law Institute,
National Association of City and County Health Officials,
and American Planning Association to pursue redevelopment
design that improves children's health. Walking and biking
trails; parks; access to schools, health care, community
gardens, and healthy food; and improving safety and
security—all focus on reducing or eliminating children's
exposures to hazardous and toxic materials while increasing
child-friendly community design, www.epa.gov/brownfields
Children's Environmental Health Excellence award winner.
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Children's Environmental Health: 2007 Highlights
Protecting Children Indoors
At Home: Getting the Lead
Out—Among Other Things
Lead Safe Babies: EPA and the C National Nursing
Centers Consortium started the first Lead Safe Babies
grant in Philadelphia in 1999. Lead Safe Babies is a primary
prevention program to educate families about effective
techniques for reducing lead exposure. Trained outreach
workers from nurse-managed health centers provide home
visits to low-income caregivers in at-risk areas. Families who
have participated in the program experience a statistically
significant increase in their level of knowledge about lead
poisoning and prevention techniques, and report lower blood
lead levels than those in the same geographic areas who
have not participated in the program. In Philadelphia, this
program has reached over 8,000 mothers and babies. Lead
Safe Babies has been implemented in Pennsylvania, Maryland,
Connecticut, and the District of Columbia, www.nncc.us/
programs/programs_Lead_Safe_Babies.htm
Reducing Lead Poisoning: Research suggests that
the primary sources of lead exposure for most U.S. children
are deteriorating lead-based paint and lead-contaminated dust
and soil. Under the 1992 Residential Lead-Based Paint Hazard
Reduction Act, EPA has established training and certification
rules and standards for lead in paint, dust, and soil. Recent
efforts to eliminate childhood lead poisoning by 2010 include
proposing a regulation to ensure lead-safe work practices
during renovation, repair, and painting in homes; targeting
assistance to low-income families whose children are known
to be at highest risk; working with the Consumer Product
Safety Commission to address lead in child-oriented products;
and continued education and outreach. EPAs new community-
based grants fund local efforts, such as outreach, training, and
local ordinance development projects, to reduce childhood lead
poisoning. In 2007, EPA is awarding $8.3 million to 70 grantees
across the country to fund efforts in areas with high incidence
of elevated blood lead levels in children, www.epa.gov/lead
Secondhand Smoke: The 2005 National Health
Interview Survey found that approximately 8 percent
of children age 6 and under were regularly exposed to
environmental tobacco smoke (secondhand smoke), compared
to 20 percent in 1998. Secondhand smoke is harmful to
everyone, especially infants and young children. This exposure
Children's Environmental Health Excellence award winner.
can cause middle ear infections, bronchitis, pneumonia, and
Sudden Infant Death Syndrome, and it can help cause or
worsen asthma, particularly for children under 6. A Surgeon
General's report in July 2006 found there is no safe level of
exposure, yet millions of young children are exposed in their
homes. EPAs Smoke-Free Homes and Cars program continues
its effort to reduce such exposures. The program has received
more than 127,000 pledges since its launch in 2001, with more
than 10,000 submitted in 2007. This year EPA and the U.S.
Department of Health and Human Services are working with
nearly 1 million children in Head Start to reduce their health
risks related to secondhand smoke and other environmental
triggers of asthma, www.epa.gov/smokefree
Pesticides in Low-Income Housing: EPA
continues to support the C National Center for Healthy
Housing in promoting integrated pest management (IPM) in
low-income housing to protect children from overexposure
to pesticides. IPM can reduce exposure to both pests and
pesticides. Cockroaches are one of the most frequent and
potent allergens provoking asthma in children. The center has
provided IPM training to more than 75 small and medium-size
public housing authorities, more than 600 health and housing
professionals, and developed the IPM in Multi-Family Housing
course, www.healthyhomestraining.org
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Children's Environmental Health: 2007 Highlights 5
At School:
A Whole New Class of Tools
HealthySEAT: EPA's approach to environmental quality
at the 120,000 public and private K-12 schools in the
United States continues to evolve. Previously EPA offered
a disparate collection of unrelated environmental programs
that challenged resource-strapped school districts. EPA now
has www.epa.gov/schools, which provides one-stop shopping
for the most current information on all school environmental
health issues. In 2006, EPA launched the Healthy School
Environments Assessment Tool (HealthySEAT), a first-of-its-
kind, free, and fully customizable software to help school
districts set up assessment programs covering every facet of
school health and safety. HealthySEAT is a much-needed tool
to track school conditions and improvements across a wide
range of issues, from cleanliness to emergency preparedness,
from playground safety to asbestos management. The State of
New Hampshire has customized HealthySEAT and is training
its school districts to use the program. Ohio and California are
working on versions that will allow school districts to meet
new requirements for facility assessments, and many districts
are already using HealthySEAT as part of their school facility
management systems. EPA will release an enhanced version of
the program in fall 2007.
Breathing Lessons: Better indoor air quality
management in schools has reduced exposure to pollutants
and improved the health of approximately 18 million
students, faculty, and staff. The Indoor Air Quality Tools
for Schools (IAQ TfS) program began in the mid 1990's to
help schools address indoor air issues. By 2002,22 percent
of schools had indoor air quality management programs
consistent with IAQ TfS, and EPA is recruiting 1,100 schools
in 2007. The goal is to have 35 percent of America's
schools adopt such practices by 2012. Key elements of
the program include outreach and education, training, tool
development, and awards, www.epa.gov/iaq/schools
Less Lead, More Water: Exposure to lead is a
significant health concern, especially for young children and
infants, and drinking water is one possible source. EPA's
objective is to raise awareness about the implications of
lead in drinking water. In January 2006, EPA released the 3Ts
for Reducing Lead in Drinking Water at Schools and Child
Care Facilities Toolkit, which contains materials to adopt a
3Ts—fraining, festing, and felling—strategy. In 2007, EPA
released a DVD on lead testing and a document that identifies
funding sources for water quality improvements, www.epa.
gov/safewater/schools
Working Together in Michigan: In EPA Region
5, the Greater Grand Rapids Children's Environmental
Health Initiative is a collaboration of community groups and
government agencies to promote healthier homes, child
care facilities, school environments, and communities. Local
program champions include the Asthma Network of West
Michigan, Healthy Homes Coalition of West Michigan, and
West Michigan Environmental Action Council. The initiative
came together in June 2006 and so far includes participation
and support from community and advocacy groups, public
health and environmental agencies, and local business and
industry. Working with the coalition, Region 5 has trained
more than 800 school and child care facility managers, science
teachers, school nurses and other health care providers,
transportation managers, and property owners and managers
on children's environmental health topics. Region 5 also helped
remove 5,500 pounds of outdated chemicals from 41 schools.
Chemical Safety in Tennessee: The School
Chemical Cleanout Program was formally announced in 2004
by EPA Region 4 at Red Bank Middle School in Chattanooga. A
$51,000 grant was awarded to the Tennessee Department of
Environment and Conservation to properly identify and dispose
of potentially dangerous chemicals from secondary schools.
Since then, 33,000 pounds of hazardous waste, including
flammable solids, liquids, oxidizing liquids, corrosive acids,
alkalis, mercury compounds, and degraded containers, have
been removed from more than 140 schools in Tennessee.
Preventive programs such as chemical management training
for lab instructors and "green chemistry" were also provided.
www.epa.gov/sc3/
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Mercury, Fish, and Children's Diets: Mercury
occurs naturally in the environment and is released into the
air through industrial pollution. When airborne mercury falls
into water, bacteria there transform it into methylmercury,
which fish absorb as they feed. Eating fish with high levels of
methylmercury can be harmful to developing nervous systems.
The brochure What You Need to Know About Mercury in
Fish and Shellfish (available in eight languages) provides
comprehensive advice to women of childbearing age and
children about how to reduce mercury exposure while still
getting nutritional benefits from eating fish. Recently, EPA
released quick-reference versions of this advice as an eye-
catching poster (One Fish, Two Fish, Don't Fish, Do Fish) and
a handy key chain tag (Choose Fish Wisely], www.epa.gov/
fishadvisories
The 1996 Food Quality Protection Act(FQPA)
remains the most comprehensive overhaul of the Nation's
pesticide and food safety laws in decades. EPA has completed
over 99 percent of the required tolerance reassessments for
all pesticides used on food, as required by FQPA. This Act
changed the safety standards that EPA uses in evaluating
potential pesticide risks, taking into consideration that children
may be more sensitive to pesticides than adults. Under FQPA,
the Agency may require up to an extra 10-fold children's
safety factor in dietary risk assessments. EPA has banned
use of organophosphate pesticides that pose unacceptable
risks to children, including indoor and outdoor residential uses
of chlorpyrifos and diazinon and many food uses of methyl
parathion and azinphos methyl.
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Children's Environmental Healt.
Highlights
Developing and Using Data to
Protect Children
Environmental Health Indicators: Since 2000,
EPA's groundbreaking America's Children and the Environment
reports and Web site have led the way in systematically
presenting data on environmental contaminants that can affect
children's health, on body burden, and on childhood illnesses
that can be influenced by exposure. Parents, teachers, doctors,
nurses, researchers, government officials, and the public can
visit the site to get current information and trend data on
important topics in children's environmental health, such as:
• Percentage of U.S. children living in counties where air
pollution exceeds national standards
• Blood lead levels in children under 6 years of age
• Percentage of U.S. children with asthma
Most measures presented in America's Children and the
Environment ate based on databases maintained by EPA,
the Centers for Disease Control and Prevention, and other
Federal agencies. Along with graphical presentations of the
data, the report provides concise summaries of the scientific
information on how environmental contaminants can affect
children's health. The Web site and reports have been an
important influence on other efforts to provide data concerning
the health and welfare of children, both nationally and
internationally. The Interagency Forum on Child and Family
Statistics was established though Executive Order 13045
and publishes an annual report on conditions and trends for
children and families. The 10th anniversary edition of the
Forum's America's Children: Key National Indicators of Weil-
Being, 2007now includes more data on physical environment
and safety. EPA spearheaded the international Children's
Environmental Health Indicators initiative launched at the
World Summit on Sustainable Development in 2002. Now
under the leadership of the World Health Organization, this
effort will enable many countries to develop their own national
indicators of children's environmental health. Regular reporting
of critical data is crucial to understanding the potential
impacts of environmental contaminants on children's health,
and ultimately helps to identify and evaluate ways to improve
their environments and health, www.epa.gov/envirohealth/
children www.who.int/ceh
Better Testing: Toxicity Testing in the Twenty-First
Century: A Vision and a Strategy, released with EPA support
by the National Academy of Sciences in June 2007, presents
a plan to improve testing and human health assessments
for environmental contaminants. There are still many
knowledge gaps surrounding toxicity testing, including a
lack of comprehensive understanding about early life-stage
susceptibility, the impact of genetic diversity, mechanisms
of toxic action, cumulative risk, health effects, and more.
The Academy's report describes the field of toxicity testing
as approaching a "scientific pivot point.. .poised to take
advantage of revolutions in biology and biotechnology."
http://books.nap.edu/openbook.php?record_id=11970&page=R1
Assessing Exposures: EPA has released the draft
Child-Specific Exposure Factors Handbook tot peer review
and public comment. The handbook provides a summary of
statistical data on various factors used in assessing exposures
to children, including drinking water consumption; soil
ingestion and mouthing behavior; inhalation rates; dermal
factors, such as skin surface area and soil adherence factors;
consumption of retail and homegrown foods; breast milk
intake; body weight; and activity pattern data. http://cfpub.
epa.gov/ncea/cfm/recordisplay.cfm?deid=56747
Pesticides Exposure: EPA conducted observational
studies over the past 10 years to improve understanding
of children's exposures to chemicals. Results are described
in a 2007 report, Important Exposure Factors for Children:
An Analysis of Laboratory and Observational Field Data
Characterizing Cumulative Exposure to Pesticides, which
summarizes real-world measurement data, critical for
improving exposure assessments. Data are presented for a
number of different pesticides in air, dust, soil, and food. The
findings ensure that scientists, modelers, and risk assessors
have the most up-to-date information available to develop
more accurate risk assessments and risk reduction measures.
www.epa.gov/nerl/research/data/
Helping Rule Writers: The Guide to Considering
Children's Health When Developing EPA Actions: Implementing
Executive Order 13045 and EPA's Policy on Evaluating Health
Risks to Children helps EPA staff determine whether the
Executive order or policy apply to an EPA action. Since the
1998 issuance of the Rule Writer's Guide to Executive Order
13045, EPA has published several guidance documents related
to risk assessment, regulatory policy, and action development.
This revision of the guide reflects these new developments
and more clearly integrates EPA's child health policy with the
action development process, www.epa.gov/children
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Children's Environmental Health: 2007 Highlights
Discovering, Understanding,
and Documenting Effects of
Environmental Exposures
The National Children's Study is the largest
and longest study of children's health and development
ever planned in the United States. It will look at how the
environment influences the health and development of
100,000 children in 105 locations from before birth—and
in some cases before conception—to age 21. Participating
children will represent the ethnic and economic diversity of
the Nation. Authorized by Congress in 2000, the study is one
of the most ambitious child health research efforts to date and
the first of its kind to explore important health issues—from
birth defects to a number of major diseases, such as asthma
and diabetes. The study is led by the National Institutes of
Health in collaboration with EPA and the Centers for Disease
Control and Prevention. In February 2007, the study received
an appropriation from Congress for expansion into additional
communities across the country. With this step, the Nation's
leaders made a commitment to promote optimum health and
save lives and dollars for generations to come.
The research plan is being reviewed by the National Research
Council and the Institute of Medicine of the National
Academies, the lead Federal agencies, and the public in
2007. The plan includes discussion of the study hypotheses,
sample design, rationale for outcome and exposure measures,
statistical analysis plan, data use and confidentiality
protections, human subject protections, the information
management system, and adverse event reporting.
Since 2005, the first seven study centers ("vanguard centers")
have been preparing to implement the study in their respective
locations. Fifteen to 20 new contracts for additional centers
around the country will be awarded in fall 2007 as a result of
the new funding. The vanguard centers will begin enrolling at
least 250 newborns each year for 5 years beginning in 2008.
The new study centers will begin recruitment in 2009. Initial
results are expected in 2010. www.nationalchildrensstudy.gov
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Children's Environmental Health: 2007 Highlights 9
Translating 10 Years of Research Results
Into Public Health Actions: Executive Order
13045 stimulated a wide array of EPA-supported children's
environmental health research, particularly through the
Science to Achieve Results (STAR) grants program. In 1998,
the STAR program, which supports human health, ecology,
economics, and engineering sciences through grants and
fellowships, initiated a diverse portfolio focused specifically on
children's health research. The goals are to better understand
children's genetic, life stage, or behavioral susceptibilities;
better characterize child-specific harmful chemical exposures;
and demonstrate cost-effective, protective interventions,
particularly at the household and community levels. Since
1998, EPA, in partnership with the National Institute of
Environmental Health Sciences, has funded 21 Centers for
Children's Environmental Health and Disease Prevention
Research (11 are currently active; the C Columbia Center
for Children's Environmental Health is a Children's
Environmental Health award winner), 19 grants on vulnerability
to toxic substances in the environment, 8 grants to study
biomarkers for children's risks, 7 studies of economic valuation
of children's health outcomes, 5 grants on early indicators of
environmentally-related disease, and 3 grants for aggregate
assessments of pesticide exposure. Ten years ago, society
didn't know:
• How environmental exposures change across life stages,
from newborn to school-age children through adulthood
• Which genetic factors contribute to children's vulnerability
• How to assess aggregate and cumulative exposures
• What biological markers in children's urine or blood tell
us about exposure or effects
• Where to intervene to prevent harmful exposures
• Which interventions are effective and sustainable in
clinical settings
Through the work of the Centers for Children's Environmental
Health and Disease Prevention Research, much has been
learned, including:
• People metabolize pesticides differently based on their
genotype; some metabolize faster, others slower. This is
a particular concern during pregnancy, as many babies
do not develop the ability to metabolize some pesticides
during the first 2 years of life.
• Children living close to major roadways in southern
California have a higher risk of asthma.
• EPA's ban on two household pesticides, diazinon and
chlorpyrifos, resulted in a rapid decrease in exposures
in New York City. Children born after the ban were also
healthier in general.
• IPM can be effectively implemented in urban areas to
reduce both pesticide and allergen triggers.
• There are novel, non-invasive ways of measuring
children's exposure to environmental chemicals.
• Community partners play critical roles in informing,
implementing, and translating children's environmental
health research.
STAR funded human health research has added substantially
to knowledge about children's environmental health. STAR
work has been cited in numerous policy and decision-making
documents, including those issued by the U.S. Environmental
Protection Agency, the World Health Organization, the Agency
for Toxic Substances and Disease Registry, Health Canada,
and others.
The STAR program is working closely with Federal, State,
and community partners to disseminate these and many
other findings to create healthier environments and nurture
healthier kids. STAR managers also anticipate continuing, even
broadening, Federal partnerships for future research efforts.
www.epa.gov/ncer and www.epa.gov/cehc
Children's Environmental Health Excellence award winner.
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10 Children's Environmental Health: 2007 Highlights
Environmental Expertise
and Health Care Providers
C Pediatric Environmental Health Specialty
Units: EPA and ATSDR fund 10 Pediatric Environmental
Health Specialty Units (PEHSUs)—one in each EPA Federal
region. Other units in Mexico and Canada joined to create
a North American network of more than 100 physicians
and other health professionals with expertise in pediatrics,
toxicology, occupational health, epidemiology, and other
disciplines. Each PEHSU provides education and consultation
to health care providers, parents, and public health officials
about suspected exposures and the possible health effects. In
the 10-year life of the program, 100,000 health professionals
have been trained on children's environmental health issues.
The PEHSU network is managed by the C Association of
Occupational and Environmental Clinics. Two examples of
PEHSU work are:
In Region 3, theO Mid-Atlantic Center for
Children's Health and the Environment
has been conducting annual children's environmental health
conferences since 2002 in partnership with EPA, ATSDR,
and State environmental and health departments. These
conferences address clinically important issues in children's
environmental health, such as lead, indoor and outdoor
air pollution, emerging chemicals, and pesticide exposure
in homes and schools. The PEHSU teaches participants to
recognize the clinical impact of environmental toxicants on
the health of children, describes a variety of approaches
to management and interventions for environmental health
problems in children, and identifies resources to investigate
and manage environmental health problems. The unit has also
been instrumental in addressing children's health issues across
the region. Staff testified before the Washington, DC City
Council on lead in drinking water; worked with the Center for
Risk Science at George Washington University to organize a
summit and develop a strategic plan on asthma in the District;
provided training to migrant clinicians on Virginia's Eastern
Shore as part of EPA Region 3's outreach effort; and are active
members on the District's lead screening advisory committee
and lead task force, and the Maryland children's environmental
health advisory committee. The PEHSU recently gave a lecture
at the U.S. Senate child care center on mold in response to
exposure concerns. It provides education and consultation
through grand rounds, workshops, and health fairs all over the
Mid-Atlantic region, www.health-e-kids.org
In Region 6, the C Southwest Center for
Pediatric Environmental Health at the
University of Texas Health Science Center in Tyler has
been active in the professional community, sponsoring or
presenting environmental health education to health care
providers since 2000. From October 2005 to March 2007,
the PEHSU reached 1,800 health care professionals, offering
51 continuing education credits in children's environmental
health to physicians, nurses, and respiratory therapists in
Louisiana, New Mexico, and Texas. Outreach activities include
presentations at health fairs, including the unique Poison
Jungle Safari held at the El Paso Zoo in Texas. The PEHSU has
been working closely with the North East Texas Public Health
District, using health educators to reach the community on
issues such as lead poisoning, sun exposure, smoking risks,
and hand washing. Health educators targeted disadvantaged
groups such as residents of low-income ZIP codes and patients
in public health clinics. Related activities include asthma
summits for health care professionals and camps for asthmatic
children in the Rio Grande Valley, intergenerational training
using seniors to train students in after school programs, and
a study of the efficacy of the smoke-free home pledge. The
PEHSU assisted EPA and others in preparing health advisory
documents after Hurricane Katrina and presented displays
on children's environmental health at State medical society
meetings in Arkansas, Louisiana, and New Mexico in 2005.
It has also presented to pediatric residents in Oklahoma and
worked with the Oklahoma Poison Center, www.swcpeh.org
The University of Massachusetts Lowell
has an EPA grant to work with health professionals who
serve low-income, immigrant, refugee, and minority
children in small urban and rural areas in New England.
This population is generally underserved by children's
Children's Environmental Health Excellence award winner.
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Children's Environmental Health: 2007 Highlights 11
environmental health capacity-building efforts even though
it suffers disproportionately from exposure to environmental
contaminants. In collaboration with State health departments,
professional development workshops for nurses and other
public health professionals have been conducted in all six New
England States using a curriculum based on the professional
competencies identified in the Institute of Medicine's 1995
report Nursing, Health, and the Environment: Strengthening
the Relationship to Improve the Public's Health. As of June
2007,378 nurses and public health professionals representing
more than 150 organizations have completed the capacity-
building development programs, which offer a range of new
clinical skills for prevention. Educational sessions were
also provided for more than 450 student nurses and 30
faculty members. Participants were encouraged to address
environmental health issues in their practices and engage
patients and their families in prevention efforts. More than 90
percent of participants said they were currently incorporating
principles of children's environmental health into their care,
benefiting the health of more than 20,000 children, www.uml.
edu/childrenshealth
TheC National Environmental Education
Foundation (formerly the National Environmental
Education and Training Foundation), with funding from EPA,
has developed 28 children's environmental health faculty
champions in medical and nursing schools throughout
the Nation. These champions are integrating children's
environmental health into their institutions by teaching,
revising curricula, and serving as models for integrating
environmental health into health professional education.
Within 8 months of the faculty champion workshop, the
28 champions trained more than 1,500 additional health
professionals, including physicians, nurses, nurse practitioners,
physician assistants, medical residents, and students.
The training resources are available online and are being
widely disseminated through publications and professional
conferences, reaching tens of thousands of pediatric health
professionals, www.neefusa.org
Pediatric Training: Greater Boston Physicians for
Social Responsibility (GBPSR) coordinated the Pediatric
Environmental Health Toolkit Training Program with local
partners, including Physicians for Social Responsibility (PSR)
chapters, in five States over 2 years. EPA supported this
training program. The toolkit, endorsed by the American
Academy of Pediatrics, was developed by GBPSR; the San
Francisco Bay Area chapter of PSR; the C Region 9 PEHSU
at the University of California, San Francisco; and a team
of pediatricians from around the country. It identifies critical
developmental stages and opportunities for age-appropriate
interventions to promote health and wellness. The training
sessions were well received at all 5 sites and included more
than 180 health care professionals, including physicians
and nurses, health educators, and public health specialists,
with expected secondary trainings to reach 1,000 more. The
programs provided overviews of toolkit concepts in a series
of case studies and background information on environmental
health, as well as introductions to local pollution issues and
local resources on environmental health, including the 10
PEHSUs. http://psr.igc.org/ped-toolkit-project.htm
TheO National Center for Healthy Housing,
with funding from EPA, is delivering training to public
health nurses on residential environmental health hazards.
Substandard housing is a key determinant of health and
has been linked to childhood lead poisoning, asthma and
respiratory disease, and unintentional injuries. The center
reached 400 nurses through its modified flagship course,
Essentials for Healthy Homes Practitioners, which explains
the relationships between housing and health and identifies
ways to improve housing-related health outcomes. As part
of this effort, the center launched a new online Pediatric
Environmental Home Assessment course specifically targeting
nurses. www.healthyhomestraining.org/Nurse/index.htm
,
Children's Environmental Health Excellence award winner.
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.mental Health: 2007 Highlights
Protecting Children Worldwide
Educating Professionals in Central and
Eastern Europe: Medical and public health schools in
Iowa, Kansas, and Ohio are providing, with EPA support, a 2-
year pediatric environmental health education program to child
health professionals in Bosnia-Herzegovina, Croatia, Hungary,
Poland, Romania, and Slovakia. Last year more than 40
participants completed the series of interactive lectures and
attended a 3-day workshop in Slovakia. This year more than 60
participants registered for the program. First-year participants
are enthusiastic about their experiences:
• One has joined an environmental research project jointly
sponsored by her country and the European Union.
• Another has begun a series of lectures on children's
environmental health for senior medical students.
• A third participant reports: "I can recognize environment-
related risk factors and contributors more often, and
discuss it with parents and children more convincingly.
I am often able to convince parents and children of the
importance of these factors, and help them to avoid
hazardous environmental risk."
• A fourth graduate has initiated a 40-hour course to train
Hungarian nurses about children's environmental health.
• A Romanian colleague reports that "I try to identify
environmental factors early in the disease evolution as
a risk factor, especially in respiratory tract diseases."
Involvement with the collaboration "is a big opportunity
for us to build relationships with other colleagues.. .In
my country a very useful collaboration between the
participants is growing up," she says.
After the project wraps up this year, organizers hope to provide
opportunities for graduates to meet regularly and remain
connected through the Fogarty Network-sponsored Summer
Institute for Rural and Environmental Health held annually in
Eastern Europe.
Teaching the Hemisphere's Health Pros:
The Canadian Institute of Child Health is working with the
Asociacion Argentina de Medicos por el Medio Ambiante;
Canadian Association of Paediatric Health Centres;
International Society of Doctors for the Environment; Societies
of Paediatrics in Argentina, Chile, Paraguay, and Uruguay;
and the World Health Organization (WHO) to educate and
train health care professionals about children's environmental
health issues. With funding from EPA, eight workshops
were held with the WHO Training Modules on Children's
Environmental Health, translated and adapted to reflect local
issues, reaching 2,000 professionals.
The International Pediatric Association (IPA),
with support from EPA, launched a virtual International
Pediatric Environmental Health Leadership Institute, which
could eventually reach up to 500,000 pediatricians about
children's environmental health. IPA, WHO, and the United
Nations Environment Program held workshops in Nairobi,
New Delhi, and Port-au-Prince that attracted 67 medical
professionals from 21 African countries, 44 professionals from
India, and 70 professionals from Haiti. The workshops used the
WHO Training Modules on Children's Environmental Health,
which were developed with EPA support. The leadership
institute will evaluate its training by administering a pediatric
environmental health examination to those who attended
the workshops. Pediatricians will become diplomats of the
institute and will help teach workshops, serve as resources
for information requests, provide clinical consultation upon
request, and advise policymakers. Ultimately, the institute will
improve participants' expertise and leadership in recognizing,
diagnosing, preventing, and managing pediatric diseases
linked to environmental factors, and will enable them to be
champions of healthy environments for children.
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Children's Environmental Health: 2007 Highlights 13
Quicksilver Response: In February 2006, St. Andrew's
School in Paranaque, Philippines, had a mercury spill in a
classroom during a chemistry experiment. Few measures were
taken to clean up the mercury, which appeared to be tracked
throughout the school, and some of the children reportedly
played with the mercury beads. Clinical evaluation determined
that 18 children had high mercury levels and 3 later underwent
chelation therapy. A multi-agency task force of national and
local government agencies was formed to assess and direct
cleanup of the school; however, they soon realized they had
neither the equipment nor expertise to adequately assess
conditions. The Philippine government made a formal request
of the U.S. Embassy for technical assistance from EPA. The
EPA Region 9 Environmental Response Team traveled to
Manila to assess the severity of the spill and help craft a
response plan. The Philippines/EPA team supervised the
complete remediation of the mercury hazard, using local
contractors, and certified that mercury vapor levels were
recognized as safe before reopening the school.
Curbing Cooking Smoke: More than half the
world's population and about three-quarters of households in
developing countries rely on solid fuels (e.g., wood, dung, crop
residues, and coal) for everyday cooking and heating needs,
filling homes with harmful smoke and paniculate matter.
Among children younger than 5, breathing dangerous levels of
this smoke increases susceptibility to acute lower respiratory
infections. Worldwide, such infections continue to be the
biggest killer of young children, causing more than 2 million
deaths annually—19 percent of deaths in children younger
than 5. The Partnership for Clean Indoor Air, launched by EPA
in 2002, is tackling this issue by introducing safer and cleaner
burning fuels and cooking technology that result in healthier
homes. More than 130 public and private organizations in 67
countries are working together on the initiative. Since 2003,
they have convinced 1.3 million households to adopt clean
and efficient cooking. In March 2007, at the Third Biennial
Partnership Forum, 35 organizations made commitments to get
clean, efficient cook stoves to 1.4 million households in the
next year and more than 6.6 million households within 3 years.
www.pciaonline.org
Mining Gold: EPA continues to achieve reductions in
mercury use and emissions through global partnerships. In
Senegal, for example, EPA is working with local organizations
and mining communities to reduce exposure to mercury
used in artisanal gold mining. In many artisanal mining
communities, there is little public awareness of mercury's
dangers or how to minimize risk. Nursing mothers and children
are often involved directly in the amalgamation and refining
processes that release significant amounts of mercury vapor.
By introducing best practices and appropriate technologies,
the project will improve the health and developmental
outcomes of children in these communities. In the Brazilian
Amazon, EPA has developed a mercury vapor control system
for small-scale shops that refine the amalgamated gold.
Presently mercury is emitted directly into streets in Amazonian
towns. The low-cost, locally manufactured system will reduce
mercury emissions by more than 80 percent, www.chem.unep.
ch/mercury/partnerships/
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4 Children's Environmental Health: 2007 Highlights
Asthma and the Environment
Asthma continues to be a major environmental public health
challenge worldwide. Its prevalence has continued to increase
over the last 10 years. In the United States, more than 20
million people, including 6.5 million children in 2005, have
asthma, which accounts for more than 14 million outpatient
clinic visits and nearly 2 million emergency room visits every
year. Asthma is the most common serious chronic disease of
childhood, and reducing exposures to environmental asthma
triggers is an essential component of national asthma care
guidelines.
Addressing Disparities: African Americans continue
to have higher rates of asthma-related emergency room visits
(350 percent higher), hospitalizations (240 percent higher), and
deaths (200 percent higher) than Caucasians. Approximately
2 million Hispanic Americans have asthma; Puerto Ricans are
disproportionately affected. Further, costs to society in annual
expenditures for health and lost productivity continue to
increase and are currently estimated at $16 billion. To address
disparities, EPA funded the Asthma Health Outcomes Project
to understand what is working at the community level. The
results of this landmark study indicate that successful asthma
programs have common characteristics: strong community
ties, connections to health care systems, partnerships with a
variety of other organizations, and ability to provide asthma
interventions tailored to individual needs.
www.asthma.umich.edu
EPA launched the Communities in Action for
Asthma-Friendly Environments network in
2006. This initiative is aimed at accelerating adoption of best
practices at the community level, linking community resources
to a sustainable infrastructure, and accelerating national
progress toward reducing asthma and asthma disparities.
Nearly 200 community programs are pursuing strategies to
improve health outcomes. The network is supported through
an interactive Web site that allows education, communication,
resource sharing, and recognition. With a goal of 1,000
communities participating by 2010, EPA expects national
indicators of asthma morbidity and mortality to decline.
www.asthmacommunitynetwork.org
Research: EPA scientists developed the Asthma Research
Strategy in 2002 to advance scientific understanding
of exposure, health effects, risk assessment, and risk
management of indoor and outdoor environmental pollutants
linked to asthma. EPA supports research studies to address
three high-priority areas:
• Role of air pollutants in onset and exacerbation of asthma
• Susceptibility, or factors that increase risk for subgroups,
such as socioeconomic status, residence history, genetics,
lifestyle, and health
• Interventions for reducing risks from environmental factors
Education and Outreach Activities: With the
Ad Council, EPA launched the National Childhood Asthma
Public Service Campaign in 2000 to educate parents about
preventing serious asthma attacks. Public awareness
efforts over the last 10 years have resulted in much greater
awareness among caregivers of the environmental triggers of
asthma. Educating families is essential to improving asthma
outcomes. Working with national nonprofit organizations,
EPA has supported educational efforts to help families reduce
exposures to the things in their homes that make asthma
worse. Nationally, awareness and response have improved;
now, 30 percent of caregivers of children with asthma take
actions to reduce exposure. EPA has also worked to educate
more than 2,000 health care providers about environmental
triggers. With encouragement from EPA, health plans in
the United States have also made measurable progress in
integrating environmental concerns into asthma management.
Medicaid plans increased coverage for environmental asthma
management from 5 percent in 2004 to 27 percent in 2006.
Private plans increased coverage from 19 percent to 27 percent.
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Children's Environmental Health: 2007 Highlights 15
Awards and Recognition: EPA's National
Environmental Leadership Award in Asthma Management
recognizes health plans and health care providers who best
manage the environmental triggers of asthma. Recognized
in 2007:
Maine Health: Serving more than 90,000 patients
with asthma, including 27,000 children, the AH! [Asthma
Health] Program run by MaineHealth combines standards-
based clinical care with strong environmental asthma
management. The program has a strong presence outside
its clinical settings, having built relationships with
community organizations, schools and child care centers,
public health departments, and others. It has reduced
emergency room use, hospitalizations, and missed school
days, and improved physician compliance with national
guidelines for asthma care.
Priority Health: The private, nonprofit health
plan serves 8,000 patients with asthma, including
5,600 children, in 43 Michigan counties. In the late
1990s, Priority Health recognized the need for home-
based asthma care that includes environmental trigger
management. To deliver effective care, Priority Health
formed a first-of-its-kind partnership with the Asthma
Network of West Michigan. The partnership uses
the network's case managers and social workers to
provide home-based education, home environmental
assessments, and resources to reduce exposure to
asthma triggers. The results of this effort include
improved medication use and significant reduction in
emergency room visits and hospitalizations.
Read more about asthma and the environment at www.epa.
gov/asthma
The Asthma Regional Council, created in 2001 with
help from EPA New England (Region 1), is a coalition of public
agencies, private organizations, and researchers working to
address the environmental contributors to asthma. The council
has documented and tracked asthma rates in children and
adults, trained hundreds of professionals on healthy housing,
adopted IPM, and instituted healthy building and maintenance
standards at 67,450 existing and new housing units to
benefit children and families across New England, www.
asthmaregionalcouncil.org/
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16 Children's Environmental Health: 2007 Highlights
: j.
Increasing Environmental
Health Literacy
Born to Be Healthy: The Prenatal Partnership on
Environmental Health works to ensure that children in
the United States are born in the best health possible by
eliminating or cutting environmental health risks to pregnant
women. The coalition of health professional organizations,
academia, Federal agencies, PEHSUs, and other service
providers has these goals:
• Promote community behaviors and social changes that
reduce exposure of pregnant women and children to
environmental health risks.
• Promote clinician behaviors that (1) reduce exposure of
pregnant women and children to environmental health
risks, (2) educate families about risks, and (3) support
community and social changes that reduce risks to
pregnant women and children.
• Promote individual behaviors that reduce risks to
pregnant women and children.
• Promote understanding of environmental health risks
before, during, and after pregnancy,
PEHSU Tribal Summit: The 2007 Tribal Nations
Children's Environmental Health Summit was organized by
EPA and the PEHSUs from Region 6, Region 8, and Region
10 in partnership with ATSDR and the Indian Health Service.
Tribal children can have different exposures to environmental
contaminants than the general population because of their
unique cultures, lifestyles, and religions. As a result, they can
face a disproportionate burden of environmental health hazards.
Toxicity and Exposure Assessment for
Children's Health (TEACH): Begun in 1998 to
improve access to children's environmental health risk
information, this Region 5 project consolidates scientific
literature for a subset of chemicals and provides access through
a Web site. The site has two major components: a searchable
database and chemical summaries. It includes all peer-reviewed
scientific literature on children's environmental exposure and
toxicity related to the subset of chemicals.published since 1972.
The chemical summaries highlight information from TEACH
and other government resources such as the Integrated Risk
Information System. TEACH currently provides information for
18 chemicals or chemical groups, including arsenic, benzene,
formaldehyde, three forms of mercury, and polychlorinated
biphenyls (PCBs). www.epa.gov/teach
Outreach to Prevent Pesticide Poisonings:
Spanish-speaking households are often not reached by
traditional English-language media, but rates of asthma and
the potential for pesticide exposure in this population are
among the highest in the Nation. Therefore, EPA started an
education campaign in Spanish about the dangers of pesticide
exposure, especially among children. During this year's
National Poison Prevention Week, EPA reached over 28 million
Hispanics through national and local TV, radio, and print media
outlets, centered on the theme "Children Act Fast and So Do
Poisons." Nearly half of all U.S. households with children under
age 5 had at least one pesticide stored in an unlocked cabinet
and within reach of children. Other outreach messages address
IPM techniques for pest control and pesticide risk reduction,
migrant family worker safety, children's health and pesticides,
green landscaping practices, and pregnancy and pesticides.
Scouting and Environmental Health: EPA
began work with the Girl Scouts of America on environmental
health issues in 2001. An Environmental Health Badge
was created and an Environmental Awareness Badge Day
was started in collaboration with the Northwest Georgia
Girl Scout Council in EPA Region 4. For each of the last 5
years, more than 50 volunteers from EPA, Hughes Spalding
Children's Hospital, Keep Georgia Beautiful, Lowe's home
improvement stores, and other organizations have shared their
environmental health expertise with scouts. Scouts progress
through a series of creative stations that educate them on a
range of environmental topics, such as water and air pollution
testing, pollution prevention, recycling, asthma screening,
lead awareness, and sun safety. The council presented Region
4 with the local Girl Scout Daisy Award and National Trefoil
Award, the highest award an outside organization can receive
from the Girl Scouts.
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PA recognizes that environmental challenges to children's health remain. Some
are daunting in their scope, such as the effects of global climate change on
the health of the world's children. Some problems seem to mock us with their
persistent recurrence, such as the disproportionate effects of exposure on minority
and poor children. Some challenges are inevitable—such as natural disasters and
their environmental health consequences—and must be addressed with the best
judgment, resources, and professionalism we can muster. All these concerns,
together with the longstanding challenges to clear our air, filter our water,
restore the land, safely grow food, remove waste, and treat sewage,
require our continued leadership and collaboration with many
diverse partners.
While we have made significant progress since Executive
Order 13045 was issued 10 years ago, much more can
be accomplished. EPA is committed to protecting
children and is steadfast in its efforts to develop
sound science, issue protective regulations,
and raise awareness to create a healthy
environment so that current and future
generations of children continue
to thrive.
Child Aging Health Protection
Division (1107A)
EPA-100-K-07-002
www.epa.gov
September 2007
Recycled/Recyclable—Printing with Vegetable Oil Based Inks on 100% Postconsumer, Process Chlorine Free Recycled Paper
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&ERA
United States
Environmental Protection
Agency
Child Aging Health Protection Division (1107A)
1200 Pennsylvania Avenue, NW
Washington, DC 20460
Official Business
Penalty for Private Use $300
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