Children's Environmental Health
                     i  g h t s
                  Environment, Health,
               And a Focus on Children


                         lOCUS  ON  CHILDREN?
                         Since its founding in 1970, EPA's mission
                        has been to protect human health and the
                 environment. This report, eighth in an annual series
from the Office of Children's Health Protection and Environmental
Education, highlights the Agency's  recent work on  protecting the
health of children by addressing the environments where they live,
learn and play.
In the field of environmental protection, even
experts did not always recognize that children
are different  from adults. Protective measures
were first written with the average American
adult—not children—in mind. Calculating the
environmental contribution to disease is an
evolving field, and the question of how much
disease can be prevented through healthier
environments is often asked. The World
Health Organization estimates that one-
quarter of the global disease burden is  due to
environmental factors. For children, that pro-
portion rises  to one-third. This burden is much
greater in developing countries, where infant
death from environmental causes is  12 times
higher than in developed countries. Children
encounter their environments differently than
adults. Physically, their neurological, immuno-
logical, respiratory, digestive, and other physi-
cal systems are still developing and can be
more easily harmed by exposure to environ-
mental factors. Children  eat more, drink more,
and breathe more than adults in proportion to
their body weight. Unclean food, water, and air
therefore is more threatening to their health.
Children also have unique exposure pathways,
such as through the placenta or breast milk.

Children play and learn by crawling, placing
their hands and other objects in their mouths-
exploring the world with disregard for their
own safety. These developmentally normal
behaviors may lead to unintended exposure
to environmental hazards. For example, a
small child may be exposed to lead by putting
fingers tainted with lead paint dust into her
mouth. In addition, a child has little or no con-
trol over exposure, for example, to the second-
hand smoke of a nearby adult. An older child
might play on fields treated with pesticides, or
sit day after day in a classroom contaminated
with mold allergens.

                       S  AND  SPACES
Brownfields: EPA's Brownfields Program
began in response to community concerns
about blight, disinvestment, and environmental
contamination. In the 10-plus years since the
program's inception, brownfields have been
redefined. Properties that were shunned or
eyed warily  by those with the resources to
transform them are now viewed as opportuni-
ties for environmental and economic  rebirth.
Communities with idle or abandoned  properties
have options and resources to turn them into
cornerstones of  positive change. EPA supports
brownfields  reuse rather than strictly  enforcing
for the environmental  mistakes of a property's
former owners.

Local health departments are eligible for
EPA brownfields grants and may use up
to 1 0 percent of their value to monitor the
health of populations exposed to hazardous
substances. Grantees can advocate  for con-
sideration of broader  health and environmental
issues related to site cleanup and urge
sustainable redevelopment of brownfields.
Grantees can expand parks,  community gar-
dens and exercise paths, thereby providing for

    Our Town: Involving youth is a new
    component of the Brownfields Program.
    In 2003, EPA provided funds  to Purdue
    University, in  Lafayette, Indiana, to develop
    a program to educate youth about brown-
    fields science and economics. The result
    was the Our Town program, managed
    by Purdue's Department of Engineering
    Education, which  engages public school
    youth in brownfields-related activities,
    generating grassroots momentum for
    communities to actively pursue economic
    development and improve quality of life.

In Hammond, Indiana, more than
1 80 students from seven schools,
in grades 4-1 2, helped identify
1 2 brownfields within the historically
industrial city. Three of these properties
were eventually selected for further
investigation, assessments, and
reuse planning. Students identified
likely contaminants given the sites'
histories, and confirmed the presence
of underground storage tanks. They
presented redevelopment options for the
three properties at a community meeting,
unveiling a plan to turn a former truck
transportation property into a retail garden
and landscape center. By the following
school year, Our Town had been replicated
in multiple schools in Kokomo, Lafayette,
and Indianapolis.  Our Town is now being
implemented at schools in Chicago,
Illinois; Philadelphia, Pennsylvania; Tucson,
Arizona; and Portland, Oregon. Further
expansion is expected.

From Brownfield to Children's
Museum in Colorado: The  city of
Durango became home to the  world's first
steam-powered, alternating-current power
plant in  1893. But the 8,000-square-foot
site was boarded up in the 1970s and
sat idle and dilapidated on the  banks of
the Animas River. In 2002, the Children's
Museum of Durango wanted to restore
and relocate to the site. Public health and
environmental assessments were the first
step, and the city and state worked with
EPA's Brownfields Program on assess-
ment and cleanup. Assessments found
asbestos, pigeon waste, mercury, and
uranium mining waste. Removal of asbes-
tos and  contaminated soil  and  a primary
cleanup of the facility followed. Now, at
the  new Children's Museum, kids can
experiment with the 1 9th century sci-
ences that gave rise to electrical power,
learn about locally mined energy, operate
a hydrogen-powered race car,  and explore
energy-efficient building techniques.
Smart Growth and Children's
Health: In 2004, EPA funded five commu-
nity-based projects that make the connection
between land use and children's health. Over
the last few years, these grantees-ranging
from WalkBoston to the Smart Growth for
Healthy Children program in Cocke County,
Tennessee-have begun to demonstrate
positive impacts in their communities. These
results represent a small but growing body
of data and metrics that illustrate how,
and to what extent, children can be active
participants in improving the built environ-
ments where they live. See the Journal of
Public Health Management and Practice,
Volume 1 4 Number 3 (May-June 2008) for
a summary of findings from these projects.

    Vermont: Smart Growth Vermont
    developed the Healthy Kids/Healthy
    Neighborhoods program with  assistance
    from EPA to engage youth in  community
    planning and revitalization. By evaluating
    the health and safety of their  neighbor-
    hoods and initiating service-learning proj-
    ects that address their findings, youth play
    key roles in solving  community issues and
    become excited about learning. Involving
    youth  in decision making benefits every-
    one-youth, adults, and the community.

    Massachusetts: The Concord River
    Greenway Park's goal is to restore, main-
    tain, and enhance the ecological integrity
    and social viability of the Concord River
    as it flows through the city of Lowell.
    Through planning, the Concord River was
    transformed from a boundary between
    neighborhoods into a shared natural
    resource that unites and connects them
    to broader regional  resources. Children
    were involved in the planning  process and
    their input was invaluable in determining
    the scope and extent of the project.

7 i A ^Vป ,!.'.__ . J.
Smart Growth and School Siting:
EPA and the National Trust for Historic
Preservation are looking at state policies that
influence siting and construction of public
schools. The aim is to identify and overcome
state-level policy barriers to building commu-
nity-centered schools, which allow children to
walk to school and be physically active every
school day. Community-centered schools
also reduce emissions from automobiles and
buses. As  part of the project, the trust will
work with  five states to analyze policies, con-
duct outreach and education, create a plan
for reform, and publicize the opportunities and
benefits that accompany better school siting
and construction.

Community Action for a  Renewed
Environment (CARE): This grant pro
gram helps communities address multiple
sources of toxic pollutants in their environ-
ments. EPA works with local organizations
to set priorities for risk reduction and cre-
ate  self-sustaining, community-based part-
nerships that implement local solutions to
problems posed by pollutants. Since 2005,
EPA has provided  nearly $8 million in grants
to 48 communities in 25 states. Another
1  6 communities will receive grants in 2008.
Many of these communities are focusing on
children's health, making strides to reduce
exposure to lead, mercury, and other chemi-
cals. Among  the many accomplishments: More
than 1,300 homeowners received informa-
tion and assistance on lead paint testing,
28 schools used EPA's Chemical Cleanout or
Indoor Air  Quality Tools for Schools (IAQ TfS)
programs to  eliminate chemical hazards, and
the  St. Louis, Missouri, city schools adopted
no-idling zones to  reduce exposure to vehicle
Examples of CARE Projects:

    Denver: Through Ground-Work Denver
    and assistance from AmeriCorps, more
    than 100 at-risk 1 4 to 1 7-year-olds
    designed and worked on a citywide envi-
    ronmental education program addressing
    children's health. They collaborated with
    students from the Community College
    of Denver to translate outreach materi-
    als on mercury hazards in the home into
    Spanish, and then distributed these mate-
    rials. Students also conducted home visits
    in low-income communities to encourage
    parents not to smoke around children, and
    distributed  EPA publications on children's
    environmental health.

    Pennsylvania: Pennsylvania State
    University is partnering with local child-
    care centers and  schools in Philadelphia
    to educate students, teachers, and
    maintenance staff about the  benefits
    of Integrated Pest Management (IPM),
    reaching more than 1,000 people, garner-
    ing more than 225 pledges to use safer
    pest-control practices, and providing infor-
    mation in both English and Spanish.

    Montana: Rocky Mountain College
    is working with partners to improve
    the health of American Indian children
    through chemical removal and disposal
    in schools and Boys and Girls Clubs, and
    by conducting outreach to K-1 2 schools
    on lead exposure, asthma triggers, and
    other environmental health issues. Visit to learn
    more about the successes of CARE in
    Indian Country.

                 I MATE  CHANGE  AND
                       HILDREN'S  HEALTH
                          U.S. Climate
                    Science Program
multi-agency effort focused on improving our
understanding of the science of climate change
and its potential impacts. Climate change,
interacting with changes  in land use and demo-
graphics, has the capacity to affect important
human dimensions, especially human health,
human settlements, and human  welfare. A report
by EPA, coordinated with CCSP, Synthesis
and Assessment Product 4.6: Analyses of the
Effects of Global Change on Human Health
and Welfare and Human Systems, was released

Climate change's projected effects  include:

  • greater frequency of heat  waves
  • increased variability of precipitation
  • changes in minimum and maximum
  • sea-level rise
  • increased intensity of tropical storms
  • more droughts

  • more coastal and riverine flooding

Direct and indirect impacts to health and well-
being can include morbidity and mortality asso-
ciated with heat  waves and extreme weather
events, changes  in the range and incidence of
vector- and water-borne diseases, exacerbation
of air pollution and aeroallergens, contaminated
food and water, and impacts on mental health.

Children are more vulnerable to the  health
impacts of climate change, mainly due to
physiological differences between children and
adults. Children have a smaller body mass to
surface area ratio than adults,  making them
more vulnerable to heat-related morbidity and
mortality. They are more vulnerable  to air pol-
lution's health effects due to their increased
breathing rates relative to body size. They
spend time outside, often in active recreation,
and their developing immune systems can
make them more susceptible to water- and
food-borne diseases. There is also some evi-
dence that children are susceptible to psycho-
logical impacts, such as post-traumatic stress
disorder, associated with extreme weather
such as  floods. See more information about
children's health and climate change at

North Carolina Kids Fight Climate
Change:  EPA Region 4 (Alabama, Florida,
Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, and Tennessee) presented
a program to Durham Middle School on cli-
mate and energy. The school gathered more
than 2,000 pledges to install 6,000 compact
fluorescent lamps. The school's commit-
ments are responsible for eliminating nearly
2.5 million pounds of carbon dioxide. The
school has become an active environmental
advocate and has formed an environment club.

New Jersey Earth Day: EPA Region
3 (Delaware, District of Columbia, Maryland,
Pennsylvania, Virginia, and West Virginia)
worked with third to  sixth graders to explore
how daily activities affect the environment. In
the fifth-grade class of Hillside Intermediate in
Bridgewater, New Jersey, 22 students decided
to reduce the carbon footprint of their school
by recycling and eliminating use of single-use
plastic water bottles. The students developed
a design for a reusable school water bottle.
Proceeds from the bottle sales were used
to buy recycling  bins for the playgrounds.
The class reduced the amount of single-use
plastic water bottles students were using by
80 percent, resulting in savings of 26 gallons
of gasoline, and  one barrel of oil. The students
plan to continue their efforts in the  upcom-
ing school year, with the goal of 100 percent
use of the school water bottle,
regSesd 1 /childhealth/projects.htm.

               TECTING  CHILDREN
                "    ERE THEY  LEARN

Air Quality in Schools: According to
a survey by the Centers for Disease Control
and Prevention, more than half of the nation's
schools are now implementing  indoor air qual-
ity management programs. The study also
determined that 86 percent of those schools
based their efforts on  EPA's IAQ TfS program,
which is designed to reduce asthma attacks,
bronchitis, and other respiratory ailments, as
well as increase performance and productiv-
ity of students and staff. Key components
of IAQ TfS include outreach and educa-
tion, training, and recognition opportunities.

EPA has worked with the Connecticut
Department of Public Health for the past five
years to address indoor air quality by imple-
menting and  sustaining IAQ TfS in public
schools. Partners have  provided training to
more than 500 schools, with a  special focus
on Hartford, New Haven, and Stamford. The
project supports training workshops for custo-
dians and provides Web-based tools for stu-
dents, families, and staff. Nearly 90 percent of
all public schools in Connecticut are participat-
ing, and reduced absenteeism and improved
health in schools are well documented. In
Vermont and New Hampshire, exemplary
school districts are chosen as mentors to
other school districts to implement TfS.

HealthySEAT: In  2007, EPA offered
an enhanced version of its free, fully cus-
tomizable Healthy School Environments
Assessment Tool (HealthySEAT) to help
school districts establish voluntary self-
assessment and prevention programs  cover-
ing every facet of school health and safety.

The Ohio School Environmental Health and
Safety Inspection Rules, also known as
"Jarod's  Law," went into effect in September

2007. The law, named for a six-year-old killed
in a school accident, is designed to protect
and improve the environmental health and
safety of Ohio's primary and secondary school
students and staff. Jarod's Law requires
experts from local health departments to
annually inspect the school buildings and
associated grounds within their jurisdictions to
identify health and safety concerns. Recently,
HealthySEAT was customized to include all
Jarod's Law requirements,

Clean  School Bus USA: Every
school day, 450,000 school buses trans-
port 25  million students to and from school,
sporting events, and other functions. Each
year, those school buses emit tons of diesel
exhaust that causes soot and smog and trig-
gers asthmatic episodes. Since its launch in
2003, EPA's Clean School Bus USA program
has worked to reduce children's exposure to
diesel exhaust by reducing the pollution cre-
ated by school buses. As a result, more than
2 million  students are riding cleaner buses. An
estimated 40,000 buses are using emission
reduction technologies and cleaner fuels, and
school districts across the United States are
implementing idle-reduction programs, reduc-
ing air pollution and  saving  money on fuel.

    Learning About Diesel: The Clean
    School Bus USA program  partnered with
    Scholastic Inc. to publish a new book  in
    the  popular Magic School Bus children's
    series. In The Magic School Bus Gets
    Cleaned Up, the children and Ms. Frizzle
    explore the pollution emitted from their
    own  school bus and learn how to reduce
    the emissions as they travel through a
    diesel engine. The children learn about
    idle reduction and ways the community
    can help reduce health risks from die-
    sel exhaust. At the end of the book, the
    magic bus gets  its own pollution control
    device, a particulate-matter filter.
    No Idle Zones: Idle-reduction pro-
    grams have started statewide in Florida,
    North Carolina, and South Carolina.
    EPA Region 4 has supported more than
    135 bus retrofit programs impacting more
    than 11,300 school buses, and supports
    wider use of biodiesel, hybrid, or electric
    school buses.

    Better Buses: Students in Baltimore
    City Public Schools in Maryland will soon
    breathe cleaner air. An EPA grant will help
    the school system reduce diesel pollution
    by retrofitting  19 diesel-powered school
    buses with pollution control technologies.
    A second grant will support develop-
    ment of an indoor air quality program in
    190 school buildings. Personnel at various
    levels will be trained to identify, recognize,
    and develop solutions to  reduce exposure
    of building occupants to indoor pollutants.

Massachusetts Facility
Administrators Association (MFAA):
Over the past few  years, MFAA, through  a
cooperative agreement with EPA's Region 1
(Connecticut, Maine, Massachusetts, New
Hampshire, Rhode Island, and Vermont),  has
been developing and delivering an environ-
mental health and  safety training program
for school facility managers across the state.
Massachusetts is one of the first states to
offer an accredited training program for school
facility managers. The program received  rec-
ognition during EPA's Environmental Merit
Award ceremony on  Earth Day 2008.

Healthier Illinois Schools: A new
state law requires  elementary and secondary
schools, both public and private, to purchase
and use only environmentally  sensitive clean-
ing supplies. Only  products that meet specific
standards, such as those of EPA's Design for
the  Environment Program, may be used.  This
makes Illinois the second state (after New
York) to require purchase and  use of environ-
mentally sensitive  cleaning supplies in schools.
EPA Region 5 (Illinois, Indiana, Michigan,

Minnesota, Ohio, and Wisconsin) helped plant
some of the seeds of green cleaning in Illinois
by funding a pilot project with the Healthy
Schools Campaign, working with Chicago
Public Schools, and supporting a sustainable
schools project,

Chemical  Cleanout Campaign: The
Schools Chemical Cleanout Campaign  inven-
tories and removes outdated and potentially
harmful chemicals from schools; conducts
educational workshops for teachers on safe
chemical  management, lab safety regulations,
and chemical waste disposal; and promotes
green chemistry,

In  New Hampshire, Plymouth State University
is conducting a  Supplemental Environmental
Project (an environmentally beneficial effort
that a violator performs in lieu of payment of
a portion  of a penalty) to assist  K-12 schools
with chemical management practices, includ-
ing staff training and waste removal.

Tribal Schools: EPA is reducing the health
risks from exposure to hazardous waste, labo-
ratory chemicals, pesticides, and asbestos
by improving compliance at schools in Indian
Country, where approximately 460,000 chil-
dren and  staff spend their days. These  schools
are often challenged by a need  for ongoing
and consistent environmental  management
and maintenance programs. EPA developed
comprehensive,  Indian Country-specific mate-
rial and widely distributed the  Tribal Schools
Compliance Assistance Notebook. From
2005 to 2007, EPA conducted compliance
monitoring inspections at 1 28 schools. A sum-
mary of EPA's efforts is available at www.epa.
tribal.html, and the notebook is available at
Program s/Tribal+Schools.
Children's Health Initiative in
Region 2: Through this four-year effort,
EPA Region 2 (New Jersey, New York, Puerto
Rico, and U.S. Virgin Islands) has protected
286,700 children from hazardous materials
by helping schools identify and address envi-
ronmental concerns. Through  integration of
the drinking water, asbestos, pesticides, and
hazardous waste programs, EPA is focusing
on K-1 2 school systems in  specific communi-
ties to ascertain the status  of testing drink-
ing water for lead in schools and to review
compliance with hazardous waste regula-
tions. In Trenton, New Jersey,  EPA collected
568 drinking water samples from 10 elemen-
tary schools. Test results, then remediation,
are the next steps,

Asthma is a complex chronic disease affecting millions of people in the United
States, including 6.5 million children. The burden of asthma is great: Emergency
room and  hospital visits, missed school days, and missed work days, all contribute
to an estimated annual national cost of $19 billion.
Communities Addressing Asthma:
290 community-based asthma programs
have joined the EPA Communities in Action
for Asthma Friendly Environments Network.
Participants pursue strategies to achieve
positive health outcomes, including cultivating
program leaders, establishing sound com-
munity relationships, maximizing cooperative
opportunities, providing integrated health care
services, and  implementing tailored environ-
mental interventions. The network is supported
by an  interactive Web site that  provides edu-
cation, communication, and resource sharing.
The network and supporting  organizations
meet annually at the EPA-sponsored National
Asthma Forum, which provides events
throughout the year for community leaders
to accelerate adoption of best practices for
asthma care. This year, a pre-forum workshop
focused on building a business case for com-
prehensive asthma management that includes
patient education and environmental  manage-

Heartland Tackles Asthma: EPA
Region 7 (Iowa, Kansas, Missouri, and
Nebraska), in partnership with the American
Lung Association of the Central States, hosted

the first-ever Heartland Region Asthma
Forum, in Omaha, Nebraska. A comprehensive
agenda covered the new National Guidelines
for the Diagnosis and Management of Asthma,
EPA Communities in Action for Asthma
Friendly Environments initiative, and work-
shops on indoor environmental assessments
and outdoor air quality.

Southwest Asthma Advances:
Through grants, organizations throughout EPA
Region 6 (Arkansas, Louisiana, New Mexico,
Oklahoma, and Texas) are training children
and their families to reduce environmental
asthma triggers. In Oklahoma, 186 children
were trained on how to reduce environmental
asthma triggers through the Pawnee Health
Clinic. Along the Texas/Mexico border, more
than  75 health Promotoras were trained. In
Arkansas, New Mexico, and Texas, 1 7 school
nurses, 72 families, 44 health care profes-
sionals, and 211 child care providers have
been trained this year.  In rural East Texas,
30 children were treated by the Region 6
Pediatric Environmental Health Specialty Unit
(PEHSU)-the Southwest Center for Pediatric
Health—in the Breath of Life, a mobile asthma
education and treatment van.

Arresting Asthma Triggers: Make the
Road by Walking is a community organiza-
tion in Brooklyn, New York, that is raising
awareness about children's asthma triggers.
EPA provided  a cooperative agreement to
benefit the Bushwick neighborhood, where
children suffer from the old housing stock
and lack of information on how to avoid
exposure to asthma triggers.  Many of the
residents are renters and require landlords to
make repairs and maintain units. The project
reduced exposure to asthma triggers by edu-
cating more than 1,200 residents, providing
extended hours for asthma treatment services,
expanding local  partnerships, and convening
a new coalition of 1 0 community groups to
influence policy,
Innovative Asthma Programs: in
2008, EPA selected three organizations
for the National Environmental Leadership
Award in Asthma Management. The award
recognizes health plans and health care pro-
viders who have demonstrated leadership in
managing environmental triggers as part of a
comprehensive asthma management program,
and who are improving the health of children
they serve. Award winners serve as mentors
and models for best practices in asthma care.

    2008 Winners are:

    Monroe Plan of Rochester,
    New York: The Monroe Plan covers
    5,633 children with asthma in Monroe
    County and  1 2 neighboring rural counties.
    In partnership with ViaHealth, a health
    care delivery system, the plan launched
    a program to shift asthma care away
    from emergency services and inpatient
    care and toward improved patient self-
    management. The program now covers all
    plan members with moderate to severe
    pediatric asthma and includes assistance
    to health care providers. Asthma action
    plans, education, and home assessments
    helped reduce emergency room visits
    from 1.1 per person to 0.95 visits per
    person over the first three years of the
    program. Inpatient admissions decreased
    from 98.3 per 1,000 to 84.1 5 per 1,000
    in the first three years.

    University of Michigan Health
    System, Ann Arbor, Michigan:
    This health system is a nonprofit health
    care provider serving 1 2,21 4  adults and
    children with asthma in four counties
    in southeastern Michigan. The program
    includes in-home asthma education
    through the Michigan Visiting Nurses
    Asthma Home Environmental Assessment
    Program. This award  winner achieved a
    50 percent decrease in asthma-related

    hospitalizations from July 2005 to June
    2007. Between June 2006 and June
    2007, the program had a 60 percent
    decline in emergency room visits and
    85 percent fewer hospitalizations.

    The Asthma Network of West
    Michigan, in Grand Rapids, is a
    community coalition that provides
    comprehensive home-based case
    management to 94,500 children and
    adults with asthma in western Michigan.
    Results include improved health out-
    comes and cost savings. This success
    has led to a partnership with Priority
    Health (a winner of the 2007 National
    Environmental Leadership Award in
    Asthma Management), which agreed  to
    reimburse the network for its home visit
    program. The partnership is the nation's
    first between a grassroots coalition and
    managed care plan. The network has
    contracts with five local health plans,
    and its asthma management program
    provides asthma education, coordination
    with health care providers, development
    of asthma action plans, home environ-
    mental assessments, and social service
    support. This comprehensive care has
    led to a 64 percent decrease in hospi-
    talizations and 60 percent decrease in
    emergency room visits. These improved
    health outcomes resulted in approximately
    $800 in net health care cost savings per
    child per year.

Goldfish  Media Campaign: The
National Childhood Asthma Public Service
Media Campaign, a collaboration between
EPA and the Ad Council, uses the imagery
of a goldfish out of water to convey the mes-
sage of urgency and provides tips for parents
to help manage asthma triggers, such as
making their homes smoke-free and  control-
ling mold and dust mites. The Ad Council
recently conducted a study to determine the
ads' effectiveness. The campaign outscored
commercial advertising on measures of con-
sumer likability; engaging and empowering
families, especially African-American and
Hispanic families; promoting asthma manage-
ment behaviors; calls to the hotline; and visits
to the Web site for asthma education informa-
tion. The Chris Draft Foundation joined the
goldfish campaign in 2008, and Draft himself,
a professional football player, is featured in
radio announcements,

Asthma  Health Outcomes Project:
The project is a landmark study sponsored
by EPA to  understand asthma disparities and
determine  how communities can best improve
health outcomes of people with asthma. EPA
and the  Centers for Disease Control and
Prevention's National Center for Environmental
Health (NCEH) coordinated a successful  half-
day workshop at Meharry Medical College
in Tennessee and a seminar at Morehouse
School of Medicine in Georgia, where more
than 185 faculty, students,  and  health care
professionals were educated  about  asthma.

                             THE  SUN
•ป . ,.
SunWise Communities: With more than
 1 million people diagnosed with skin cancer
each year, teaching children to be safe in the
sun  is an important step toward decreasing
the incidence of this preventable disease.
Since sun damage is cumulative and protec-
tion  is best if started early, EPA's SunWise
Program works to improve children's sun
safety knowledge, attitudes, and behavior. A
recent study published in Pediatrics (vol. 121
no. 5) found that SunWise efforts between
 1999 and 201 5 should prevent more than
50 premature deaths and 11,000 cases of
skin cancer in the United States, resulting in
a $2-$4 savings in public health costs  for
every federal dollar invested. In addition to
the more than 21,000 schools and informal
education organizations now signed up  with
SunWise, three more areas became SunWise
Communities this year,
• The city of Boston has pledged to plant
  100,000 trees by 2020, increasing its
  canopy cover by 60 percent.

• Recent statistics on skin cancer  indi-
  cate that Cobb County, Georgia,  has a
  51 percent higher incidence of melanoma
  than the national average. In response, the
  county has distributed SunWise kits to all
  its schools and provided education about
  overexposure to ultraviolet rays.

• Washington State built on previous
  SunWise efforts in King and Pierce
  Counties to become the third state to push
  for sun safety in its schools. Washington
  has the fifth highest melanoma incidence
  rate and seventh highest death rate in the
  country.  Melanoma occurs almost as fre-
  quently in the cloudy and rainy part of the
  state as the sunny and dry eastern part.

                  E  AIR  THEY  BREATHE
                        Standard: On
                    March 12, 2008, EPA
              announced a new eight-hour
standard for ozone. The new primary eight-hour
standard, which sets limits to protect public
health, including the health of sensitive popula-
tions such as asthmatics, children, and older
adults, was changed from 0.080 parts per
million to 0.075 parts per million. Benefits for
children's health include preventing some cases
of bronchitis and aggravated asthma,  decreas-
ing hospital and emergency room visits, and
reducing school absenteeism due to respiratory

Smoke-Free Homes for Head Start
Children: Exposure to secondhand smoke
can cause middle ear infections, bronchitis,
pneumonia, decreased lung function, sud-
den infant death syndrome, and can worsen
asthma. A 2007 Surgeon General's report,
reaffirmed that there is no safe level of sec-
ondhand smoke. Millions of young children
continue to  be exposed to it in  their homes.

EPA and the U.S. Department of Health and
Human Services (DHHS) are improving the
quality of life for nearly 1 million  Head  Start chil-
dren through secondhand smoke and asthma
outreach efforts. Head Start teachers, staff, and
parents will create smoke-free, asthma-friendly
homes using tools and resources from the agen-

Residential Wood Smoke: EPA'S Great
American Woodstove Changeout campaign is
facilitating replacement of older, dirtier wood-
stoves and fireplaces with new, cleaner burn-
ing appliances such as masonry heaters and
gas-fueled, pellet-fueled, and EPA-certified
stoves. Particle pollution, such as the particles
in wood smoke, can be harmful to children.
Since 2005, the program has replaced more
than 7,500 woodstoves and fireplaces, avoid-
ing nearly 200 tons of particle  pollution and
realizing an  estimated $50 million per year  in
health benefits,
Outdoor Wood  Heaters: EPA has also
developed a voluntary program that is help-
ing to bring cleaner outdoor wood heaters to
market. These heaters, also known as outdoor
wood boilers, look like a small shed with a
smokestack, typically located on the outside
of the building to be heated. They burn wood
to heat water that is piped underground to
provide heat and hot water to homes, barns
and greenhouses. The heaters are mostly
used in rural, cold climates where wood is
readily available; however, they can be found
throughout the United States. EPA encour-
ages manufacturers to produce cleaner mod-
els, encourages users to buy the  cleanest
models available, and educates users on the
health effects of woodsmoke. New heaters
that qualify for EPA's program are at least
70 to 90 percent cleaner than existing units.

Reducing Children's Exposure to
Household Smoke: More than half the
world's population relies on solid  fuels (e.g.,
wood, dung, crop residues, and coal) for
everyday cooking and heating needs,  filling
homes with harmful particulate matter, carbon
monoxide, and toxic smoke. Among children
younger than five, breathing unsafe levels
of this smoke more than doubles the  risk of
acute lower respiratory infections. Worldwide,
such infections continue to be the biggest
killer of young children, causing more than
2 million deaths annually and  accounting for
19 percent of deaths in children under five.
The Partnership for Clean  Indoor Air, launched
by EPA in 2002, is tackling this issue by intro-
ducing safer, cleaner burning, fuel-efficient
cooking and heating technology. Today, more
than  1 70 public and private sector part-
ners  are working in  67 countries  to improve
health by reducing household air  pollution.
This effort has helped more than  1.4 million
households adopt clean and efficient  cook-
ing and heating practices.  Partners aim to
reach another 6 million households by 2010.

               TECTING  CHILDREN  FROM
Public Health and Urban Pests: The
spread of mosquito- and tick-borne diseases
in Europe and North America and the asthma
epidemic in industrialized nations have sig-
naled the need to carefully assess the threat
of urban pests to public health. According to
the World Health Organization (WHO), asthma
attacks are triggered by an allergic response
in 50 percent of adults and in 80 percent of
children with asthma. In urban areas,  sensitiza-
tion to pests,  including  rodents, cockroaches,
and dust mites, is common among asthmat-
ics. EPA supported  a WHO project in which
international experts in pest-related fields
provided evidence for policies to address this
public health problem. These experts  identi-
fied the public health risks posed by various
pests and measures to prevent and control
them, and in 2008 WHO published the book
Public Health Significance of Urban Pests
Integrated Pest Management (IPM)
Promotes Healthier Schools: EPA
recommends that schools use IPM to reduce
pesticide exposure  to children. IPM is a safer
and usually less costly option than conven-
tional pest management. IPM programs use
common sense strategies to reduce sources
of food, water,  and  shelter for pests in and
around buildings, and encourage careful use
of pesticides. More than 20 percent of schools
use IPM. EPA's goal is to have all schools on
board by 2015.

    In Indiana,  the Monroe County Community
    School Corporation's IPM program was
    developed  in the mid-1990s and has
    been replicated in 10 states. This program
    boasts a 90 percent reduction in pesticide
    use, pest problems, and pest-control costs.

    In Utah, the Salt Lake City School District
    became the nation's 28th school dis-
    trict to earn the IPM Institute of North

    America's IPM STARฎ certification fol-
    lowing a rigorous, 37-point inspection.
    Both pesticide applications and pest
    occurrences have dropped by more than
    90 percent since the district's program
    began. EPA Region 8 (Colorado, Montana,
    North Dakota, South Dakota, Utah, and
    Wyoming) provided funding for the effort.

Integrated Pest Management (IPM)
In Section 8 Housing: A partnership
between  EPA and the Department  of Housing
and Urban Development is bringing IPM to
families living in Section 8 housing  (a federal
program that provides housing assistance to
eligible low-income renters and homeowners)
through a pilot program called the MarkeHo-
Market Green Incentives Initiative. This pro-
gram provides financial incentives for property
owners to green their rehabilitation and main-
tenance practices, including  a requirement for
switching from conventional, chemical-focused
pest management to prevention-oriented IPM
strategies. The program is expected to reach
about 2,400 Section 8 developments over the
next five years, involving about half a million
low-income residents. The potential health
benefits of reducing exposure to pests and
pesticides are significant-50 percent of resi-
dents report  at least occasional cockroaches
or rodents and 10 percent report always hav-
ing cockroaches or rodents.  Research into
allergic asthma shows a strong correlation
between  allergies to cockroaches and asth-
matic  response. Most allergic asthma sufferers
are children in low-income urban areas.

Reducing  Pesticide Exposure in
Child Care Centers: This year, EPA and
DHHS' Office of Head Start launched a national
pesticide awareness campaign called Play It
Safe. The campaign features a suite  of outreach
materials, available in English  and Spanish, tar-
geting Head Start parents and staff. Training
for 250 child-care employees serving more
than 1,500 children was provided in 2008 by
the Pennsylvania Integrated Pest Management
Program (PA IPM). PA IPM is training staff of
Philadelphia's Latino child care facilities.
Recognizing IPM  Leaders: EPA sup
ports the IPM Institute's IPM STAR certifi-
cation program, which  provides incentives
to reduce pests and pesticide  risks to chil-
dren's health. Certification clearly establishes
competence in a way that is recognized by
others. Applicants undergo careful on-site
evaluations of their IPM programs. To date,
practitioners in more than 35 school dis-
tricts and child-care centers are certified and
more are waiting to go through the process.

Safer Rodent Control: in May
EPA announced new safety measures for
10 rodent-control  products. Rodent-control
pesticides, or rodenticides, are an important
tool for public health pest control, including
controlling mice and rats around  the home.
However, these products have been associ-
ated with accidental exposures to thousands
of children each year. Rodenticides marketed
to consumers must be enclosed  in bait sta-
tions, making them inaccessible to children.
Loose bait, such as pellets, is prohibited for
use in homes. Data indicate that  children  in
low-income families are disproportionately
exposed to rodenticides.

Latino Outreach to Prevent
Pesticide Poisoning: An  outreach cam
paign during National Poison Prevention Week
targeted  Latino families and reached 32 mil-
lion people in the United States and Latin
America with the message "Children act fast,
and poisons do, too!" American Association of
Poison Control Centers (AAPCC) data show
that more than 50 percent of the 2 million
incidents of exposure to chemicals and other
materials each year involve children younger
than six, with 90 percent of calls concerning
home exposures. EPA's Pesticides Hispanic
Outreach Initiative reduces exposure risk by
showing how to minimize exposure, defining
the symptoms of pesticide poisoning, and  pro-
viding information  on where to get help.

                  ING  CHILDREN

Reducing Lead Poisoning: Children
are exposed to lead most often through
unintentional ingestion of lead-containing
particles, such as paint dust or contaminated
soil. Under the 1992 Residential  Lead-Based
Paint Hazard Reduction Act,  EPA estab-
lished training and certification rules and
standards for lead in paint, dust, and soil. In
April 2008, EPA issued a new rule aimed at
protecting  children from lead paint hazards.
The Lead Renovation, Repair, and Painting
Program rule (40 CFR Part 745) requires
contractors and construction professionals to
be certified and to use lead-safe work prac-
tices during renovation, repair, and painting
in pre-1978 housing and child-care centers,
pre-schools, and kindergartens. The rule
also requires contractors to provide a new
lead hazard information brochure to property
owners, tenants, and owners and operators
of buildings that have child-occupied facili-
ties, as well as to the parents and guardians
of children under age six using the facilities.
The rule will be fully effective in April 201 0.

Lead Grants:

• In 2007, EPA provided more than $3 million
  through the National Community-Based
  Lead Grant Program to educate those
  at risk, provide lead awareness training,
  and develop local ordinances aimed at
  lead abatement in communities with older
  housing. Grant recipients include city health
  departments, colleges and universities,
  community organizations, religious groups,
  and other nonprofit organizations.

• The Targeted Lead Grant Program funds
  projects in areas with high numbers of
  children with elevated blood lead levels.  In
  2007,  EPA awarded $5.2 million in grants to
  address immediate needs of communities
  and highlight model lead-poisoning
  prevention strategies.

• EPA awarded nearly $1 million in
  grants to 15 tribes to reduce the
  incidence of childhood lead poisoning
  and support educational outreach and
  baseline assessments of exposure.

Less  Lead, More Water: Drinking
water is also a source of lead exposure in
children. EPA is addressing lead in drink-
ing water in school and child-care facilities
by developing tools and guidance. These
materials encourage voluntary lead  reduc-
tion programs and help school officials and
child-care providers minimize lead in drinking
water. To date, more than 1,300 toolkits, 730
school guides, 3,900 child-care facility guides,
and 1,300 DVDs have been distributed.

Getting the Lead Out of Pacoima:
The community of Pacoima, California, used a
$100,000 grant from EPA  to reduce exposure
to lead paint and increase blood lead testing
for children at risk. Many of the 22,035 homes
in this high-density low-income, mostly Latino
community are more than 30 years old and
still contain lead paint. Pacoima Beautiful, a
community organization, partnered with local
organizations and  trained them to work with
residents to raise awareness of the risks of
lead paint, the importance of lead testing in
children, and the need for home testing and
abatement. The program tested 675 children
for blood lead levels, provided  information
to 2,500 residents on safe  cleaning prac-
tices and other simple measures  to reduce
lead levels, and  tested 300 homes for  con-
tamination. Of those homes, 31.4 percent
exceeded the lead dust criteria for floors and
windows. Of those that exceeded the criteria,
27 percent have been renovated  or referred to
free services or low-interest loans to remove
the lead hazards,
Boston, Massachusetts, Lead
Campaign: EPA Region 1  (Connecticut,
Maine, Massachusetts, New Hampshire,
Rhode Island, and Vermont) seeks to end
childhood lead  poisoning in Boston by 2010.
The Lead Action Collaborative includes Tufts
University and other public, private, nonprofit
and housing organizations and increases vis-
ibility of the issue, creates strong lead policies
and regulations, and targets enforcement
and outreach to reduce risk to children. This
coordinated effort has produced impressive
results: The number of lead-poisoned children
in Boston dropped from 1,123 in 2001 to
362 in 2007.

Flakes Play in North Carolina:
The Durham Affordable Housing Coalition
conducted a public education project, Lead
Safe...For Our Children's Sake, to reduce
childhood lead  poisoning. Targeting African-
American and Latino families living in high-risk
homes, this effort resulted in "Flakes Play,"
a musical production about lead-poisoning
prevention produced by the Walltown
Children's Theater. The play has heightened
public awareness of the dangers of lead  and
how to prevent lead poisoning in children,
especially in vulnerable, low-income families. htm#4

                   Toxicity and
              Assessment for
        Children's Health (TEACH):
TEACH is EPA Region 5's (Illinois, Indiana,
Michigan, Minnesota, and Wisconsin) 10-year
effort to consolidate and summarize current
peer-reviewed scientific literature published
since 1972. TEACH focuses on a subset
of chemicals relevant to children's environ-
mental  exposure and toxicity. The project is
Web-based and has two major components: a
searchable database and chemical summaries.
The database is used to search summaries of
literature on children's exposure and toxicity.
The chemical summaries  highlight information
from the database and other sources, such
as EPA's 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

Children's Exposures to Chemicals
In Their Everyday Environments:
Researchers in EPA's National Exposure
Research Laboratory continue to work to
develop, refine, and validate analytical meth-
ods for different classes of chemicals found
in children's everyday environments, including
brominated flame retardants, perfluorinated
chemicals, and current-use pesticides. A num-
ber of manuscripts have been published in
peer-reviewed literature, including articles on
methods for measuring pesticides in house
dust, lead in paint, and  perfluorinated chemi-
cals in  house dust, soil, water, and fish. Data
analysis has been performed and published in
the scientific literature for a number of recent
studies. Recently published manuscripts
have reported on  sources and pathways of
exposure, important exposure factors, and
relationships of environmental measurements
to biomonitoring results. EPA  researchers are
collaborating with academics and other federal
agencies to collect and analyze data on chil-
dren's exposures. These efforts allow EPA sci-
entists to understand what chemicals children
are exposed to in their everyday environments,
what the sources of those chemicals are, what
the most important exposure factors are,  and
how exposures and risks can be reduced.

Mercury, PCBs, and Fish in New
York and New Jersey: An estimated
16 percent of women of reproductive age in
the United States eat fish at least once per day.
While a good source of protein, studies show
some fish and shellfish contain mercury, PCBs,
pesticides, and other harmful contaminants at
levels that can result in pre- or postnatal impair-
ments. New York City's Health and Nutrition
Examination Survey biomonitoring study
revealed that New Yorkers have more than
three times the national average of mercury in
their blood. One-quarter of the 1,81 1  New York
residents tested had blood mercury concentra-
tions at or above the 5 ug/L New York State
reportable level. The study also found that for-
eign-born Chinese residents had blood mercury
concentrations more than two and a half times
that of the general population in the city.
Although the fish species commonly associ-
ated with the highest levels of mercury are not
seen frequently in Chinese kitchens, the study
found that Chinese-Americans eat fish three
times more often than others in the city. www.

In response to the findings, EPA funded two
public health projects. The first project will
develop  a geographic information system
(GIS) tool to identify areas in New York and
New Jersey where women of child-bearing
age are  at highest risk of eating contaminated
fish. The second project will determine mer-
cury and PCB levels in fish species most com-
monly sold in the New York City area. This will

provide an effective way to reach vulnerable
populations. The second project involves fish
testing from the largest wholesale market in
the United States. An exciting and innovative
aspect of the testing is using DMA coding for
accurate species identification. Both studies
are anticipated to improve targeting of future
outreach efforts.

Reducing and Eliminating  Mercury
Use and Exposure: Mercury is contained
in some products, such as thermostats, ther-
mometers, and barometers, that are commonly
found in homes, health care facilities, and
schools. If these products break, toxic mercury
vapors can be inhaled. EPA is taking action to
reduce and eliminate mercury in products  by
developing information on safer alternatives,
working with states to reduce use of mercury
in products and promote  mercury-containing
product collection and recycling, developing
regulations to reduce re-introduction of dis-
continued products, and working with other
federal agencies on short- and long-term
management of surplus elemental mercury
supplies. EPA is also working with other coun-
tries and the United Nations Environment
Program to address risks associated with
mercury uses, releases, and  exposure interna-
tionally. EPA is working with Argentina, China,
Costa Rica, and Mexico to reduce mercury
in hospitals; and with Burkina Faso, Chile,
Ecuador, Mexico,  Panama, and  South Africa
to conduct mercury product  inventories, mar-
ket studies, and risk management projects.

Fish Consumption Information:
EPA's National Fish Advisory Program
recently released a new Fish Kids Web site
( that
teaches kids about contaminants in fish and
fish consumption advisories  using fun, inter-
active stories and games. The Web site is
designed for kids ages 8-12 and is best used
with an adult. Whether they buy fish or catch
their own, kids and their families can use this
site to learn how to choose fish wisely.
Understanding Chemical
Exposures: EPA's Voluntary Children's
Chemical Evaluation Program (VCCEP) is
designed to evaluate hazards, exposures, and
risks of chemicals to children, and to develop
information needed to assess these risks.
Companies that manufactured or imported
20 of 23 chemicals to which children  have a
high  likelihood of exposure have committed
to provide EPA with information on health
effects, exposure,  risk, and data needs. The
information provided to date on  15 chemi-
cals,  their subsequent reviews, and related
Agency decisions  are provided on the Web
site ( After con-
ducting an interim evaluation of the program,
EPA  is considering using a modified VCCEP
approach to follow up on chemicals of inter-
est in its  new Chemical Assessment and
Management Program, which assesses and
initiates action on  more than 6,750 indus-
trial chemicals manufactured in  quantities of
25,000 pounds or more,

         VI RON MENTAL
                      LTH  INDICATORS
                 Children and The
              Environment is a lead-
        ing source of information on envi-
ronmental factors related to the health  and
well-being of children in the United States.
The Web site and reports present data  on
levels of contaminants in the environment
that can affect children's health, and on
childhood illnesses that can be influenced
by exposure to contaminants. Data are
updated annually, most recently in July  2008.

Some examples:

• Approximately 53 percent of U.S. chil-
  dren lived in counties where ozone levels
  exceeded National Ambient Air Quality
  Standards at least one day in  2006. (see
  chart below)

• About 10 percent of children were served
  by community water systems that exceeded
  a Maximum Contaminant Level or violated  a
  treatment standard in  2006.

• The median concentration of lead in the
  blood of children five years old and younger
  dropped from 15 micrograms per deciliter
  (ug/dL) in 1976-1980 to 1.6 ug/dL in
  2003-2004, a decline of 89 percent.

• In 2006, 9.3 percent (6.8 million) of all
  children had asthma.

International Children's
Environmental Health Indicators:
EPA has  been working with WHO and other
organizations to promote development of
children's environmental health indicators
internationally, an effort initiated at the World
Summit on Sustainable Development in 2002.
The pilot  phase of this work culminated in
an international workshop in Tunisia in April
2008. Participants reviewed and assessed
the progress made on developing the health
indicators based on reports prepared for
North America, Europe, Argentina, Cameroon,
Kenya,  Oman, Tunisia, and Zimbabwe. Key
conclusions from the workshop focused on
next steps for improving and expanding chil-
dren's environmental health indicators, and
reflected  a strong commitment by all partici-
pants to continue this work. The consensus
of the workshop was that a small "core set"
of indicators, representing common interests
and concerns across regions and nations,
should  be further developed by all countries.
Percentage of children living in counties where air quality standards were exceeded
        Any standard
       !    i   !    t    i    i   I    5    5    I   T
    1993 1994 1995 1996  1997 1998 1999 2000  2001  2002 2003 2004 2005  2006
                                                             PM-10: Particles less than 10 micrometers
                                                             in diameter
                                                             PM-2.5: Particles less than 2.5 micrometers
                                                             in diameter
             SOURCE: U.S. EPA, America's
             Children and the Environment

             DATA: U.S. EPA, Office of Air and Radiation,
             Aerometric Information Retrieval System

                 HEALTH  DISPARITIES
                        Eliminating health disparities, the gap in morbidity and
                       mortality between social groups (e.g. racial/ethnic  minorities
                  and low-income populations), is of great importance to promoting
child health. Current research suggests that characteristics  of social, physical,
and built environments contribute to these disparities. For example, children  in
socioeconomically disadvantaged communities are disproportionately diagnosed
with asthma. In fact, black children in America are twice as likely to be hospitalized
for asthma and four times as likely to die from asthma as white children. Eight
percent of Hispanic children  have asthma, but there are big differences among
ethnic groups. Puerto Rican children have the highest rates of asthma at 20 percent,
compared with 7 percent for Mexican-American children.
Southeast Pediatric Environmental
Health Specialty Unit (PEHSU):The
PEHSU conducted a research symposium on
environmental health disparities in children.
Break The Cycle is a collaborative, interdis-
ciplinary research and training program with
faculty from southeastern universities mentor-
ing students to develop projects that reduce
or prevent environment-related illnesses. The
program addresses issues such as obesity,
health effects of agricultural pesticides on
children of migrant farmers, childhood asthma,
disparities in girls'  pubertal development, and
environmental justice awareness. Students in
diverse areas of study explore problems and
solutions related to environmental health dis-
parities. One case  study on PCB contamina-
tion in Anniston, Alabama, included a biology
seminar with 1 50 students at Spelman, a his-
torically black women's  college in Atlanta. The
research was presented at a workshop in May
at Emory University's Rollins School of Public
Fact Sheets: Tools are needed to identify
children who are most at risk and to under-
stand the cumulative impact of social and
physical environments on children's health.
Feedback from users of EPA's America's
Children and the Environment shows that
information targeted for specific audiences
is more effective than information aimed at
general audiences. EPA's new fact sheets
reflect this by addressing disparities in sec-
ondhand smoke exposure and asthma among
African-American and Hispanic-American
children. Each fact sheet includes information
on actions that parents can take to protect
their children, and positive actions EPA and
other organizations are taking to address each
environmental health issue. The intended audi-
ences for these outreach materials are par-
ents and community organizations working on
environmental health issues for specific minor-
ity populations. These new fact sheets can
be found at

                      NS  LEARNED  AND THE
              'CONTINUED NEED FOR  R
       A Decade of Research: in March
       2008, the National Center for Environmental
       Research (NCER) in ERA's Office of
       Research and Development released the
report A Decade of Children's Environmental
Health Research: Highlights from EPA's
Science to Achieve Results (STAR) Program.
The report summarizes research from the
program over the past 10 years, highlighting
scientific findings in epidemiology, exposure
science, genetics, community-based partici-
patory research, interventions, statistics, and
methods. This body of work has influenced
policy and scientific research on children's
health in the United States and abroad. The
report is available at

Translating Research  Into Practice:
ERA, the National Institute for Environmental
Health Sciences, the PEHSUs, and the
Children's Environmental Health Centers
organized a workshop for a  group of clini-
cians, researchers, and health advocates from
academia, government, and  nonprofit organi-
zations to discuss ongoing research in chil-
dren's environmental health, issues in clinical

practice, and opportunities for translating sci-
entific findings. Topics included:

• Research on biomarkers for children's expo-
  sure to pesticides;

• Pesticide exposures and neurodevelopment
  in children from farmworker families;

• IPM in urban housing;

• Evidence concerning children's exposure to
  phthalates (chemicals in many plastics) as
  potential endocrine disrupters;

• Environmental  management for asthma care
  and prevention;

• Outcomes of early life exposures to metals
  and neurotoxins;

• Transportation, the built environment, and
  children's health;

• The National Children's Study (NCS);

• Tools for recovery and communicating risks
  to children in the aftermath of disasters
  such as Hurricane Katrina; and

• The National Forum on  Children and Nature,
  which is sponsoring demonstration projects
  addressing the issue of children's isolation
  from nature.

Conference Summary, Agenda, Presentations
and Proceedings Report:
10_10_07/10_1 0_07_workshop.html

Environmental Factors and Puberty:
Five articles  based on the findings of the
workshop entitled "The Role of Environmental
Factors on the Onset and Progression of
Puberty" were  published as a supplement to
Pediatrics on Feb. 1, 2008. This workshop,
sponsored by EPA, NIEHS, and Serono
International, was the first effort to evalu-
ate the data and  come to consensus across
disciplines, perspectives, and biases on the
evidence for a secular trend in puberty tim-
ing (i.e., change in the age of puberty over
time) and the role of environmental factors
in  puberty timing in children. The articles
review the expert panel conclusions and the
state of the science on the role of body fat,
endocrine disrupters,  and other environmental
chemicals in puberty onset and progression
from both the animal  and epidemiological
literature. Several EPA scientists are authors.
vol 1 21 /Supplement_3/

Food Allergies: Approximately
6-8 percent of children suffer from a food
allergy during their first three years of life.
Many of these children go on to develop a
tolerance, and  so the prevalence of food aller-
gies in adults is approximately 3 percent. The
reasons why some children outgrow the dis-
ease and others do not are unclear. As with
other types of  allergic diseases, the incidence
of food allergy appears to be increasing and
allergic individuals can experience life-threat-
ening reactions. EPA  has developed two com-
plementary mouse  models for food allergy that
suggest thresholds exist for induction of these
allergic responses.  These models provide a
means to explore underlying mechanisms for
allergies and to understand the basis for sus-

Children's  Inhalation Dosimetry
and Health Effects for Risk
Assessment: Understanding children's
risks due to exposure via the inhalation path-
way is  a special challenge. Children are differ-
ent from adults and could experience different
exposures due to differences in dosimetry (i.e.,
child-adult differences in respiratory/systemic
dose resulting  from exposure to the same air-
borne concentrations), child-specific behavior,
and different health effects based on their
growth and development. A special issue of
the Journal of Toxicology and Environmental
Health (vol. 71, no. 3, 2008) includes sum-
mary manuscripts from the children's

inhalation workshop that EPA hosted in 2006,
as well as independent research articles on
related topics contributed by workshop partici-
pants. This effort is the first to bring together
the existing and emerging information on chil-
dren's inhalation dosimetry, health effects, and
risk assessment, and to explore and discuss
new approaches for children's inhalation risk
assessment practice.

Toxicity Testing: This past year, the
National Academy of Sciences (MAS) released
Toxicity Testing in the 21st Century: A Vision
and a Strategy, funded in part by EPA. The
report discusses how toxicity testing  is poised
to take advantage of advances in toxicog-
enomics, bioinformatics, systems biology,
epigenetics, and computational toxicology to
transform toxicity testing. The MAS report pro-
vides a blueprint for this  paradigm shift.

National Children's Study (NCS):
Patterns of illness in children have  changed
substantially in the  last 100 years.  Infectious
disease and sanitation used to be major risks
to children's health. Today it is not uncommon
to know a child with a chronic condition such
as asthma, autism, or obesity. The extent to
which environmental factors can influence the
incidence of these diseases is not well under-
stood. The NCS will answer important ques-
tions related to the environment  and  health,
and will provide the foundation for  government
policy, medical practice, and individual deci-
sions that will improve  the overall health of
children. The NCS will  look at how  the envi-
ronment interacts with genetics and other fac-
tors to influence the health and development
of 100,000 children in 105  locations across
the United States. Children included in the
study will proportionately represent the geo-
graphic, ethnic, and economic diversity of the
nation's children.

The NCS is a result of collaboration by four
lead federal agencies: the Eunice Kennedy
Shriver National Institute of  Child Health and
Human Development (the study's home at the
National Institutes of Health), EPA, CDC, and
NIEHS. This interagency coordination ensures
alignment with the Children's Health Act of
2000, which authorized the study.

Much progress has been made in the
past eight years. Twenty-two new Study
Centers were announced to support the
NCS in 26 communities in 2007; more
will be announced in fall 2008. The first
Study Centers are planning to enroll partici-
pants in 2009. Recent reviews of the NCS
Research Plan by NAS  and scientists in
the lead agencies concurred that the study
goals and design are responsive to the
Children's Health Act. These reviews  pro-
vide a number of recommendations, some
of which are being implemented and  oth-
ers that can  be considered in the future.

International Childhood Cancer
Cohort Consortium (I4C): Childhood
cancer is a devastating  disease. Fortunately,
the number of children with the disease is so
small that a very large sample size is  required
to study it. Around the world, several  large
infant and child prospective studies have been
launched to examine environmental and bio-
logical determinants of  common diseases. The
I4C was established in 2005 as a global alli-
ance of longitudinal studies to enable investi-
gations of the role of 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 could provide insights about the
causes of childhood leukemia, and later could
be helpful for studying other types of can-
cer as well as other rare childhood diseases.
Protocols have been developed to examine
the feasibility of combining data from studies
from around  the world. EPA supported two
workshops, in 2005 and 2007. See more at

                 HEALTH  SPECIALTY  UNITS
           Pediatric Environmental
           Health Specialty Units
A unique partnership between EPA and
the Agency for Toxic Substances and
Disease Registry (ATSDR) has completed its
10th year. Both agencies support the PEHSU
program, which provides education and con-
sultation to health care providers, officials,
and the community through their network of
more than  1 00 physicians, nurses, toxicolo-
gists, and social workers in the United States,
Canada, and Mexico. PEHSUs are a source
of information and advice on environmental
conditions that influence children's health.
PEHSUs are academically based, typi-
cally at university medical centers, and work
together as a network capable of responding
to requests regarding prevention, diagnosis,
management, and treatment of childhood
conditions related to environmental factors.
The need for pediatric environmental health
expertise exists worldwide, and the PEHSU
model is being adopted by other countries.
Highlights from the PEHSUs include creation
of fact sheets on wildfires and bisphenol A;
participating in a Spanish webcast on lead
poisoning; a successful effort to limit exposure
to secondhand smoke in Tyler, Texas; working
with colleagues in Chile to assist in creat-
ing a PEHSU in Santiago; addressing issues
in child-care centers by working with the
Children's Environmental Health Network; and
creating a satellite PEHSU in Cincinnati, Ohio.

               RONMENTAL  HEALTH  FOR
               EALTH  CARE  PROVIDERS
Many children's health problems resulting from environmental exposures can be
prevented, and need to be diagnosed, managed, and treated. While the public
looks to health professionals for this, most are not educated on environmental
precipitants of disease. The Institute of Medicine published two studies in the 1990s
recommending that a greater effort be made to incorporate environmental health
concepts  into the training of health professionals.
Prenatal Environmental Health: EPA
recently awarded grants to address envi-
ronmental health issues during the prenatal
period. Grantees will educate pregnant women
about environmental health risks, demonstrate
the effectiveness of information dissemination
and behavior change, and increase the num-
ber of health professionals fluent in prenatal
environmental health issues.
• The Inter-Tribal Council of Michigan, Inc.
  will address tobacco smoke, mercury, lead,
  and drinking water contaminants to Native
  American women  of child-bearing age.

• The Oregon Department of Human Services
  aims to increase knowledge and promote
  behavior change among pregnant women
  who are exposed to mercury, lead, second-
  hand smoke, chemicals, pesticides, con-
  taminated drinking water, and work- and
  hobby-related environmental hazards.

• In Pennsylvania, the Philadelphia
  Department of Health will develop training
  and education programs for health care
  providers and pregnant women on environ-
  mental health risks of prenatal exposure to
  secondhand smoke and lead poisoning.

• The Ohio Department of Health  will develop
  and implement an easy-to-use environ-
  mental risk profile focusing on second-
  hand smoke, lead, mercury, radon, carbon
  monoxide, indoor pesticides, and other
  environmental toxics that can adversely
  affect birth outcomes.

• The Duval County [Florida] Health
  Department will develop training programs
  for physicians, prenatal care providers, and
  Healthy Start staff on  environmental health
  risks of prenatal exposure to methylmercury,
  lead, secondhand  smoke, and drinking water

Health Care Provider Grants: More
than 9,000 health professionals were trained
to address environmental health concerns
as a result of projects funded by EPA. The
University of Massachusetts Lowell educated
health professionals with a combined cli-
ent base of 60,000  children in the six New
England states. Positive  changes occurred in
individual professional practice and organiza-
tional  policy in these states, including nurse-
led efforts to enact anti-idling legislation and
incorporation of environmental health into
public health  nurse education. Another effort,
by the National Center for Healthy Housing,
brought together housing and health officials.
Other grantees include:

• Canadian Institute of Child Health in
  partnership with the Asociacion Argentina
  Medicos por el Medio Ambiente and
  Argentine Society of Doctors for the

• National Environmental Education

• Greater Boston Physicians for Social

• International Pediatric Association

• KSOHIA  Collaboration of medical and pub-
  lic health universities in Kansas, Ohio, Iowa,
  and six Eastern European countries.

These grants support education and train-
ing of health professionals on environmental
health issues. As a result of the train-the-
trainer approach and the online tools devel-
oped, incorporating environmental  health into
health care provider education and practice
will continue to expand beyond the life of
these grants.

                               Children's Environmental Health
                               2007 Champion
Dr. Ruth Etzel, an internationally known epidemiologist, pediatrician, and
environmental health specialist, was the 2007 Children's Environmental Health
Champion. Dr. Etzel was recognized for 20 years of work and for driving the effort
to emphasize the critical importance of children's environmental health for health
professionals. She founded and served as editor of the first and second editions
of the American Academy of Pediatrics' Pediatric Environmental Health. Working
with the Ambulatory Pediatric Association, Dr. Etzel helped launch the first Pediatric
Environmental Health Fellowships in the United States in 2001. Most recently she
worked with the International Pediatric Association to launch a virtual International
Pediatric Environmental Health Leadership Institute.
2007 Excellence Award winners:

• The Asociacion Argentina Medicos por
  el Medio Ambiente , on behalf of the
  International Society of Doctors for
  the Environment, Building Children's
  Environmental Health Capacity Among
  Health Care Professionals in the Southern
  Cone, Buenos Aires, Argentina

• Association of Occupational and
  Environmental Clinics, PEHSU program,
  Washington, DC

• Asthma Regional Council of New England,
  a program of the Medical Foundation of
  Boston, Environmental Investments Project,
  Dorchester, MA

• Children's Hospital of Pittsburgh Pediatric
  Residency Program, Pediatric Environmental
  Health Curriculum, Pittsburgh, PA

• Los Angeles Unified School District,
  Office of Environmental  Health and Safety,
  Safe School Inspection Program, Los
  Angeles, CA
• Magee-Women's Hospital of the
  University of Pittsburgh Medical Center,
  Magee Environmental Health Initiatives,
  Pittsburgh, PA

• National Center for Healthy Housing,
  Pediatric Environmental Home Assessment
  Online Training, Columbia, MD

• Northwest Pediatric Environmental Health
  Specialty Unit, University of Washington,
  Seattle, WA

• Procter & Gamble Company, P&G Live,
  Learn and Thrive/Children's Safe  Drinking
  Water, Cincinnati, OH

• EPA, National Exposure Research
  Laboratory, Research Triangle Park, NC

The environment clearly affects the health of children. Some environmental health
issues are daunting in their scope, such as the effects of global climate change on
the health of the world's children. Some problems mock us with their persistence,
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. These concerns, together with the longstanding mission to clear our air,
filter our water, restore the land, safely grow our food, remove waste, and treat sewage,
require our continued commitment and collaboration with many diverse partners.
EPA will continue to safeguard the health  of children through its efforts to develop
sound science, issue protective regulations, and raise awareness to create a healthy   .
environment so that current and future generations continue to thrive.              /
Office of Children's Health Protection and Environmental Education

United States
Environmental Protection

Office of Children's Health Protection and Environmental Education
Child and Aging Health Protection Division (11 07A)
1 200 Pennsylvania Avenue, NW
Washington, DC 20460
Official Business
Penalty for Private Use $300