Proceedings
Protecting Children Where They Live, Learn, and Play
A summary of the first EPA children's environmental health border
symposium held in cooperation with the Southwest Center for
Pediatric Health at the Texas Tech University Health Science Center
in El Paso, Texas on September 24-25, 2015.
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Children's Environmental Health on the Border Proceedings
TABLE OF CONTENTS
Introduction
Audience
Symposium Format and Agenda Topics
Presentation Summaries
Photos
Symposium Agenda
Presentations
2
3
4
5
17
Attachment 1
Attachment 2
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Children's Environmental Health on the Border Proceedings
INTRODUCTION
Children's Environmental Health on the Borden Protecting Children Where They Live, Learn, and
Play was held at the Texas Tech University Health Sciences Center in El Paso, Texas, September 24-25,
2015. This was the first of two symposia to be held on the border, the first in Texas, and the second in
California.
The symposium is part of the U.S. Environmental Protection Agency's continuous work with its partners to
address binational environmental challenges and disproportionate health impacts that burden border
communities, especially as they impact children. Health impacts may include mismanagement of
pesticides, poor indoor and outdoor air quality, misuse of chemicals and other waste, poor water quality,
and binational chemical emergencies. Informing healthcare professionals, public health practitioners,
community health promoters or promotoras, and others in the community about the crucial links between
the environment and health is an essential step towards improving health outcomes in communities along
the Border.
In the fall of 2015, several groups came together to address the link between health and the environment,
specifically focusing on areas where children live, learn, and play. Contributors included the Southwest
Center for Pediatric Environmental Health at Texas Tech, US/Mexico Border Health Commission, the
US/Mexico Border 2020 Program, the U.S. Environmental Protection Agency's US/Mexico Border and
Children's Environmental Health Programs, and the Border Environment Cooperation Commission.
Symposium as Part of a Larger Children's Health Border Initiative
The two main goals of the symposium were: 1) to increase knowledge of how early childhood exposure
can affect children's health; and 2) to facilitate networking among the healthcare community, promotoras,
and the public. The first Symposium was held in El Paso, Texas on September 24-25, 2015, and a second,
in San Diego, California on January 27-28, 2016. Proceedings from the California will be available in the
spring of 2016.
In addition to symposium training which provided continuing education credits for health care providers
and public health professionals, EPA Regions 6 and 9, and the Border Health Commission, in partnership
with other local/state agencies, provided training for promotoras in several communities along the border.
These trainings began in June 2015 through October 2015 with a total of 7 training events taking place in
Texas, 1 in Arizona, and 2 in California. The curriculum for the trainings in Texas included: a) Essentials for
Healthy Homes Practitioners, course developed by the National Center for Healthy Housing; 2) Healthy
Homes and Asthma, 3) Household chemicals, 4) Carbon Monoxide and 5) "Bites and Stings", a course
focused on understanding the dangers of insects and other animals found in rural and colonia areas.
Training in Region 9 was held in Arizona and California. In Nogales, AZ and Chula Vista, CA trainings
focused on air quality and asthma, lead, pesticides, and climate change. Training in El Centro, CA
focused on air quality and asthma, pesticides, and water issues
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AUDIENCE
The audience for the Symposium was healthcare professionals (i.e., physicians, nurses, mid-level
practitioners, and respiratory therapists), public health practitioners, and promotoras. There were 119
people attending the first day, and 94 people the second day.
The audience's professional sector was distributed as follows: The largest group in attendance was made
up of promotoras with 24 percent, followed by government employees with 22 percent and academia
with 18 percent. Physicians and Nurses represented 16 and 15 percent respectively, of all attendees.
3% 2%
¦ RN
¦ Govenment
Academia
¦ MD
Promotoras
Other
Pharmacist
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SYMPOSIUM FORMAT AND AGENDA TOPICS
Day 1
The morning featured two plenary sessionsclimate change impacts on children's health, and prenatal
exposures. The afternoon focused on childhood breathinghealthy lungs and good indoor air quality.
Sessions included presentations and panel discussions on e-cigarettes, unconventional petroleum
exploration concerns, carbon monoxide, asthma, and lead. There was also a special session from
promotoras working the border area who were recently trained as part of the 2015 Border Health
Initiative.
Day 2
The morning featured three plenary sessions that examined the environments where children learn and
grow and how environmental disruptions such as toxic substances and homelessness can impact children.
There was also a session on the top children's environmental health concerns and an open forum to ask
specific questions about environmental health impacts. The afternoon sessions built upon this issue and
looked at specific illnesses as well as social and environmental situations that can impact children's health
(for the symposium agenda see Attachment B, for pictures see Attachment C).
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PRESENTATION SUMMARIES
A brief summary of key points for each forum is provided below. For the complete presentations, please
see Attachment D.
Day 1 Plenary Session 1
Climate Change Impacts on Children's Health, Ruth Etzel, MD, PhD
Objectives:
How much disease could be prevented by modifying the environment?
Impacts on Children's Health
Climate Change Health Risks
Find the Win-Win Choices
Conclusions:
In Healthcare ServicesClimate change risks are already causing families to seek medical care.
Parents of children with asthma or chronic lung disease will need advice about how to protect
their health when air quality deteriorates and ozone levels increase because of heat and traffic
congestion.
In the WorkplaceIn the context of a typical medical practice, it can be approached from two
sidesfrom the point of view of purchasing and from the point of view of disposal.
In CommunitiesAs community leaders, you can get involved in the public policy arena as
potential influencers. Check the Air Quality Index (AQI) for a reporting of daily local air quality.
Day 1 Concurrent Session 1; Track A
E-Cigarettes Toxicity: The Risk to Children, Susan Smolinske, PharmD, DABAT
Objectives:
Evaluate the potential risk of exposure to vapor constituents on short and long term health of
children who are exposed to electronic cigarettes.
Understand the risks of trauma or injury to children from accidental exposure to batteries or
devices related to electronic cigarettes.
Discuss potential for child-resistant packaging to affect pediatric access to liquids.
Conclusions:
More research needed to assess risk of second and third hand exposure to excipients in e-
cigarettes.
Dripping delivery methods should be discouraged.
Use only the charging device provided by the product.
Wipe surfaces of gas appliances frequently.
Avoid use in presence of children.
Encourage adoption of child-resistant packaging for tank refills.
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Cartridge types are safer around small children.
Risk is very high of accidental ingestion for tank types.
Day 1 Concurrent Session 1; Track B
Carbon Monoxide: Odorless, Colorless, Borderless, Carl Baum, MD, FAAP, FACMT
Objectives:
Understand sources of carbon monoxide.
Describe existing treatment of carbon monoxide exposure.
Understand strategies for prevention of carbon monoxide exposure.
Day 1 Concurrent Session 2; Track A
Health Impacts of Unconventional Petroleum Exploration on Children, Stephen Borron, MD, MS, FAACT,
FACMT
Objectives:
Define unconventional petroleum exploration.
Discuss the actual and potential physical and chemical risks to children from increased drilling
activity.
Discuss the risks of negative impact on drinking water.
Describe the possible prenatal health concerns.
Identify issues related to environmental justice.
Discuss the need for application of the precautionary principle.
Conclusions:
The enormous increase in unconventional drilling activity has augmented the risk of physical
injury, toxic exposure, and water scarcity/quality issues for children, though reported injuries to
date are few.
Diesel emissions, hydrogen sulfide, and volatile organic compounds are only a few of the many
potential toxic effluents contributing to air pollution.
Exposures in children have been insufficiently studied, conclusions about causality remaining
elusive.
Efforts should be made to minimize risks through expansion of alternative fuel sources,
engineering controls to minimize exposures, and enhanced environmental regulations and
compliance efforts.
Day 1 Concurrent Session 2; Track B
E-Cigarettes: Talking Tech with the New Generation, Stormy Monks, MPH, PhD, CHES and Scott Crawford, MD.
(invited). Presented by Salvador Baeza, PharmD, DABAT
Objectives:
Describe the e-cigarette device.
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Discuss its appeal to users.
Recognize usage patterns of e-cigarettes.
Identify current e-cigarette prevention strategies.
Day 1 Concurrent Session 3; Track A
Lead: Update on an old poison, Jennifer Lowry, MD, FAAP, FACMT
Objectives:
Discuss the history of lead and understand how we ended up where we are.
Describe the sources of lead (common and new) for children, adolescents and pregnant women.
Provide education to patients regarding management of elevated blood lead.
Conclusions:
Lead exposure is still a major concern for children.
No known threshold for lead exposure and no safe lead level.
Current reference value is >5 mcg/dL (mean 1.3 mcg/dL).
Neurocognitive effects cannot be reversed even with chelation.
Primary prevention is key.
Most children are asymptomatic.
Screening and parental education are important.
Chelation should be considered for blood lead level >44 mcg/dL in coordination with a
toxicologist.
Health effects of lead exposure can persist into adulthood.
Day 1 Concurrent Session 3; Track B
Asthma and Lead Home Interventions, Marc Hanfling, MD, FAAP
Objectives:
Identify who would benefit from environmental home visits.
Describe basic elements of an environmental home visit for different clients.
Explain how learners can participate and learn from an environmental investigation.
Day 1 Concurrent Session 4; Track A
Lead and Asthma - Panel Discussion, facilitated by Marc Hanfling, MD, FAAP
Addressing Childhood Asthma, Karin Hopkins, MPH, Cristina M. Baker, MPH, Jennifer Karnik, MPH,
(invited)
Objectives:
Understanding Asthma
Asthma along the Border
Childhood Asthma in Texas
Home Interventions
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Treatment & Control
Conclusions:
Physical & emotional pain for the childtrauma of not being able to breathe, & missing out on
normal peer activities.
Permanent lung damage can occur, blocking air passages & reducing lung capacity as an adult.
Leading cause of school absenteeism, lowering academic performance & affecting future wage
earning potential.
Economic burden for families resulting from lost work days for parents caring for children with
asthma symptoms & paying for ER visits.
Adults with asthma are at higher risk for other chronic health conditions such as obesity; COPD,
emphysema, or chronic bronchitis; depression, diabetes, and hypertension. May be moderated by
learning to control the disease as a child & improving health behaviors.
Day 1 Concurrent Session 4; Track B
Promotoras on Asthma and other CEH issues - Panel Discussion, facilitated by Patricia Juarez, MPH, PHD
Healthy eating and active living in the Paso del Norte Region, Leah Whigham, PhD, FTOS,
Objectives:
Paso del Norte Region
Healthy Eating/Active Living Initiative Goals
Collective Impact Model
Development of Strategic Plan
Conclusions:
Healthy Eating/Active Living Initiative Goals
o GOAL 1: Increase fruit & vegetable consumption and improve portion control
o GOAL 2: Increase physical activity and decrease sedentary behavior
o GOAL 3: Create an environment that promotes healthy eating and active living without
bias against obesity
o GOAL 4: Achieve long term sustainability of PdNIHL & HEAL initiative
Factors affecting participation in community intervention projects, Celina Alvarado Gamino.
Objectives:
Need of participation in community intervention projects
Identify the factors that influence the decision to participate
Actual levels of participation
Elements not considered in implementations
Enable greater participation and better performance of projects
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Conclusions:
The reaction of the recipient when learning of the mechanisms of the support programs
(appearance of homes, testimony of mothers, and proximity to leaders) is to sell donated
products; avoid the arrangement of buildings, hide appliances, lie or omit information.
Welfare projects, unclear information on criteria for selection of beneficiaries, causes uncertainty,
conflict and division between people.
Participants of religious groups are also identified: support to their relatives, not promoting incorp
oration of new members, they do not share knowledge.
Implementing institutions dynamics have not been the most suitable. Passivity, speculation,
deception, political control with its clientele and paternalistic practice has developed a permanent
co-dependent relationship.
There is not only available, but deep desire to participate, be taken into account, considered in
their way of thinking and feeling.
Day 2 Plenary Session 3
Mercury: Common - Caustic - Costly... and Scary..., Kurt Kleinschmidt, MD, FACEP, FACMT
Objectives:
Describe the typical presentation of mercury toxicity
List the potential participants in a mercury event
State the most important contributing factor that can help an event "to go well"
Discuss factor that can make mercury costly to manage
Conclusions:
Inhalational mercury often presents like a viral syndrome with fever and rash
The Risk Communication piece can be vast and there is a need to ensure that all the players are at
the table
Everybody talking, sharing their expertise, and all agreeing on the plan.
Mercury clean ups can be very expensive.
Day 2 Plenary Session 5
Pediatric Environmental Health Specialty Units, Panel on Top Ten Environmental Health Concerns,
Facilitated by Stephen Borron, MD, MS, FAACT, FACMT, Marc Hanfling, MD, FAAP, Jennifer Lowry.MD,
FAAP Larry Lowry, PhD, Mark Miller, MD, MPH
Objectives:
Describe the roles and activities of the Pediatric Environmental Health Specialty Units
List 10 environmental exposures of significant concern to children
Present a few illustrative examples
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Conclusions:
Heavy metals - lead, mercury, and arsenic
Air pollution and its effects on asthma
Threats to clean, safe, inexpensive drinking water
Endocrine disruptors
Environmental carcinogens
Pesticides
Global climate change
Mold
Carbon monoxide
Social determinants of health / healthy homes
Day 2 Open Forum: "Promotoras working in the Community" with Ruth Etzel, MD, PhD
Panelists: Sue Forster-Cox, PhD, MPH, MCHES, Angie Sanchez Corral, Olivia Figueroa
Environmental Health / Home Safety Education Project: A recipe for success, Sue Forster-Cox, PhD, MPH,
MCHES,
Objectives:
Ingredients for a successful environmental health program:
o Key players
o Promotoras preparation
o Spreading community awareness
o Home Safety Assessment
o Incentives
Conclusions:
Clients had increased knowledge and awareness of:
o Fire safety
o Food safety
o Pesticide safety
Environmental Health / Home Safety Education Project
o Replicable
o Flexible
o Attractive to funders
Day 2 Concurrent Session 5; Track A
Social and Environmental Factors in Pediatric Obesity, Jesus Peinado, MD, FAAP
Objectives:
Identify the social and environmental influences as a causative factor for obesity
Discuss the epidemiological evidence for obesogens actions
Discuss the effects of obesity in the pediatric population
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Conclusions:
Air pollution is now recognized as a novel risk factor for the development of obesity
Several xenobiotic chemicals can disrupt the normal development and homeostatic controls over
adipogenesis and energy balance
Exposure to obesogens has been identified to induce obesity.
Obese individuals are also more vulnerable to the harmful effects of air pollutants
Despite the emerging evidence for the role of air pollutants in obesity, this topic is still in its
infancy More knowledge needs to be generated by means of dose-response studies on air
pollutants and obesity to conclusively establish the link
5 to Go!!! Message
5: Eat FIVE fruits and veggies a day
4: Give and get FOUR compliments a day
3: Consume THREE dairy a day
2: No more than TWO media hours a day
1: At least ONE hour of exercise a day
0: No sugar-sweetened drinks, ever
Day 2 Concurrent Session 5; Track B
Childhood Leukemia: a preventable Disease? Mark Miller, MD, MPH
Objectives:
Why did this patient get this disease at this time?
Or, why does this population have a higher incidence?
Conclusions:
Underlying issue and difficulties have some parallel with leukemia in children
Rare / difficult to study prospectively
Serious outcome
There is no consensus about mechanisms of causation
Individual studies showing association
There are a number of meta-analyses mostly identifying consistent patterns of risk
Intervention impact can only really be studied with widespread population adoption of prevention
activity and then evaluate incidence rates.
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Day 2 Concurrent Session 5; Track C
Changing community culture to decrease obesity and diabetes, Joseph McCormick, MD
Objectives:
The Story of Brownsville, TX: Model for an Emerging Healthy Community
Conclusions:
Diabetes and Obesity in our population are higher than most other areas of the US.
Half of those with diabetes are undiagnosed primarily because of lack of health insurance
therefore no access to health services.
Only half of those who report having diabetes are under treatment
Underlying heart disease and liver disease, and other manifestations of diabetes are extremely
prevalent but undiagnosed.
Diabetes underlies over 60% of hospital admissions for congestive heart failure, over 90% for
renal disease, and nearly 100% for amputations.
High costs of diabetes found in our population because of high prevalence, advanced disease
because of lack of access.
The Approach Can be Replicated!
Day 2 Concurrent Session 6; Track A
Outdoor Air Pollution, How does it affect our Children's health, Carl a Campbell, MD, MS
Objectives:
Overview of children's environmental health (CEH) & how air pollution affects our children
Determinants and Characteristics of Air Pollution
Symptoms/Problems Caused by Air Pollution
Why do we worry about children's susceptibility to air pollution?
Outdoor air pollution at the US-Mexico border
Conclusions:
Measures to reduce or prevent exposures to outdoor chemical air pollutants (reduce GHGs).
o Advocate for public policies that promote sustainable (less-polluting) energy sources, less
reliance on fossil fuel burning, and reduced energy use in general,
o Decrease pollution by walking, biking, taking mass transit for transportation choices,
o Monitor the daily Air Quality Index (ozone and particle pollution; 0-300 scale) if family
members have asthma or other conditions made worse by poor quality outdoor air.
o Parents, teachers, coaches can limit outdoor exercise/practice on days with high AIQ
index and avoid student exposure to idling buses,
o Close windows; use air conditioning on high AQI Index days
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Day 2 Concurrent Session 6; Track B
Coccidioidomycosis ("Valley Fever"): An Environmental Health Risk Endemic to the U.S.-Mexico Binational
Border Region, Paul Dulin, MA
Objectives:
Coccidioidomycosis Epidemiology
Transmission
Risk Factors for Valley Fever
Diagnosis
Guidelines for Treating Cocci
What about Cocci in Mexico?
Conclusions:
Expand knowledge in the clinical and public health community concerning the burden of cocci
disease, with emphasis on New Mexico, Texas, and Mexican Border states, and how to diagnose
and treat it.
Continue implementing pilot surveillance for Coccidioidomycosis in Mexico Border States of
Sonora and Chihuahua, to serve as model for all of Mexico.
Establish/maintain state laboratory capacity and epi surveillance in all Mexican Border States.
Provide sustained financing in the U.S. and Mexico to support the efforts listed above and
eventuallyto develop a cocci vaccine to be administered to those at risk in endemic areas in the
binational border region.
Day 2 Concurrent Session 6; Track C
Mosquito Borne Illness Dengue, Beatriz Tapia, MD, MPH
Objectives:
Dengue Virus
Transmission of Dengue Virus
2009 New Dengue Classification
Top Ten Dengue Points Texas Promotoras Should Know
Conclusions:
Dengue is spread through the bite of a mosquito.
South Texas has had dengue outbreaks and is at high risk for more outbreaks given its proximity
to Mexico (which has lots of dengue), the presence of the right mosquito and large cross border
movement.
Communities need to be educated how to reduce mosquitos in their yards and homes -
REMEMBER:
o Clean
o Cover
o Empty and clean every week
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Avoid mosquito bites to avoid dengue
o Use mosquito repellent
o Wear long pants and sleeves
o Keep windows closed and use screens if open
Dengue is an acute febrile illness which passes through 3 phases (febrile, critical and recovery)
People with dengue infection should rest, drink plenty of water and avoid aspirin and non-
steroidal anti-inflammatory agents (NSAIDs)
Persons with dengue should take care not to be bitten by a mosquito and potentially infect others
in the home
Most persons with dengue make a complete recovery but some will get very sick AFTER their
fever goes away
There are warning signs for severe dengue:
o Abdominal pain
o Persistent vomiting
o Bleedinq from qums or elsewhere
o Excessive sleepiness
People with warning signs should be seen by a doctor.
Day 2 Concurrent Session 7; Track A
Children and Waterborne Disease: What Are the Risks? Kristina Mena, MSPH, PhD and
Objectives:
Risk Assessment
Hazard vs. Risk
Hazard Identification
Conclusions:
Risk factors for waterborne disease among children
o Immature immune defense mechanisms
o Higher water ingestion rate
o Potentially greater exposure to waterborne hazards
Future approaches addressing children and waterborne disease
o Database development
o Epidemiological studies
o Clinical studies
o Informed risk assessments
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Water Matters: Drinking Water-Borne Illness in Children Living in Colonias on the Border, William
Hargrove, MS, PhD
Objectives:
We conducted a Health Impact Assessment (HIA) focused on water and sanitation in Vinton, TX
o Assess quality of water sources in the community and health of residents
o Identify potential health impacts of improved water and sanitation infrastructure
o Inform decisions by community, local government, and donors regarding proposed
infrastructure improvements
Conclusions:
Existing Conditions and their Impacts
Existing Condition
Impacts
Poor water quality: As, TDS, Coliform Bacteria
High As blood levels in children
Gastrointestinal ailments
Skin problems
Reliance on bottled water for drinking
High cost of drinking water
Poor septic tank management
Risk of overflows leading to:
Exposure/gastrointestinal ailments
~dors
Contamination of groundwater
Inadequate fire hydrants
High cost of fire insurance
Inability to fight fires
Lack of local health clinics
Lack of local access to health care, especially
preventative care
Lack of water availability at local parks
Lack of drinking water fountains and shade lead to less use
Prolonged drought
Unreliability of water supply; periods of no service
Lack of retail businesses
Lack of economic vitality
Poor job opportunities locally
Day 2 Concurrent Session 7; Track B
Pesticides in children, Janett Santos, MD
Objectives:
Show data related to pesticide exposures in Mexico
Point out common pesticides involved in children's exposure and poisoning at our Poison Center
Focus on preventive measures that can be easily spread among public and patients
Conclusions:
Preventive measures should be reinforced
Less exposure everywhere
Fight the cause instead of the problem
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Reduce pests at home
Reduce exposure
Reduce potential accidents
Product label for identification
SINTOX antidote kit content: Toxogonin (Obidoxime), Atropine, Vitamin Kl, Loratadine, Sodium
Sulfate. Activated charcoal, Bentonite, Nitrile gloves, guidelines.
Day 2 Concurrent Session 7; Track C
Designing Multi-cultural Health Posters for Children and their Parents, Margaret Short, DMin, MA, MDiv,
PDiv, BCC and Dr. Cynthia Kratzke, PhD, CHES
Objectives:
Identify methods to develop health posters reaching children and adults.
Discuss pre-testing multi-cultural health promotion posters.
Conclusions:
Our changing roles to teach and reach pediatric patients and parents: 1) Developers: posters,
brochure; 2) Reviewers: new apps, sites; 3) Evaluators: accuracy.
Poster health information also used with mobile technology
Health educators and clinical staff may collaborate for using or developing health posters.
Cost is incurred to use print materials or mobile technology - which works and can we use both?
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Attachment "C"
Symposium Photos
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icveis in CA Prej'n.int Won
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Attachment 1
Symposium Agenda
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Children's Environmental Health on the Border Proceedings
Children's Environmental Health on the Border:
Protecting Children Where They Live, Learn, and Play
September 24-25,2015
Texas Tech University Health Sciences Center - El Paso
El Paso,Texas
Background
The U.S. Environmental Protection Agency continues to work with its partners to address binational
environmental challenges and disproportionate health impacts that burden Border communities,
especially as they impact children. Health impacts include mismanagement of pesticides, poor indoor
and outdoor air quality, misuse of chemicals and other waste, poor water quality, and binational
chemical emergencies. Informing healthcare professionals, public health practitioners, promotoras,
and others in the community about the crucial links between the environment and health is an
essential step towards improving health outcomes in communities along the Border.
This fall, several groups have come together to address the link between health and the environment,
especially where children live, leam, and play. Contributors to this effort include the Southwest Center
for Pediatric Environmental Health at Texas Tech, US/Mexico Border Health Commission, the
US/Mexico Border 2020 Program, the U.S. Environmental Protection Agency's US/Mexico Border
and Children's Environmental Health Programs, and the Border Environmental Cooperation
Commission.
Symposium as Part of a Larger Border CEH Initiative
The two main purposes of the symposium are: 1) to increase knowledge of how early childhood
exposures can affect children's health; and 2) to facilitate networking among the healthcare
community, promotoras, and the public. Two symposia are being planned. The first Symposium will
be held in El Paso, Texas in September, and a second one will be held in San Diego, California on
January 27-28, 2016. In addition, the Border Health Commission will train promotoras in several
communities along the border, and they will be featured during the symposium in El Paso. Housing
officials, promotoras, and others will also be trained in the Essentials of Healthy Homes training in
Hidalgo and Cameron Counties in Texas to further support healthy environments for children.
Audience
Healthcare professionals (i.e., physicians, nurses, mid-level practitioners, and respiratory therapists),
public health practitioners, promotoras, and the public are encouraged to attend.
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Children's Environmental Health on the Border Proceedings
CojiliBBiiig EdncatloD Crests
Medical and nursing school education programs provide life curriculum time defeated to
environmental health. This synposiiim wil provide education regarding some of the major concerns
and environmental health impacts upon children.
This activity has been planned and implemented in accordance with the accreditation requirements
and polities of the Accreditation Council tor Continuing Medical Education fAGCME) through the phi
prawdership of Texas Tech Uriwereif Health Sciences Center El Paso, Paul L Foster School of
Medicine, US-MX Border 2020 Program, West Texas Regional Poison Certs', University Medial
Center of EI Paso and Border Environment Cooperation Commission. Funding provided by the U.S.
Environmental Protection Agency.
Texas Tech University Health Sciences Center EI Paso, Paul L Foster School of Medicine is
accredited by the ACCME to provide continuing medical education for physicians.
Texas Tech University Health Sciences Center El Paso, Paul L. Faster School of Medicine
designates this live ad'wity for a maximum of 11 75 AMft PRA Category 1 Credits. Physicians
should claim only tie credit commensurate with the extent of tier participation h the activity
University Medical Center of EI Paso is an approved provider of continuing nursina education by the
Texas Nurses Association, an accredited approver by fie American Nurses Credentialing Center's
Commission on Accrediation.
This course has been approved tor up to 11.75 cenfinuirg nursing education contact hours
Sponsored by Texas Tech Uriwersity Health Sciences Center El Paso - Southwest Cents' for
Pediatric Environmental Health, a designated provider of continuing education contact hours (CECH)
in health educator! by the National Commission for Health Education Credentialing, inc. This
program is desgnataJ far Certified Heath Education Specialists (CHES) and/or Master Certified
Health Education Specialists {MGHES} to receive up to 11 total Categoiy 1 continuing education
contact hours. Maximum advanced4evel CECH hours available are 2
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Children's Environmental Health on the Border Proceedings
Symposium Format and Agenda Topics:
Day 1
The morning will feature two plenary sessionsclimate charge impacts on children's health, and prenatal exposures. The
afternoon will focus on childhood breathinghealthy lungs and good indoor air quality. Sessions will include presentations
and panel discussions on e-cigarettes, hydraulic fracturing concerns, carbon monoxide, asthma, and lead. There will also
be a special session from promotoras working the border area who were recently trained as part of Ihe 2D 15 Border
Health Initiative.
Day 2
The morning will feature three plenary sessions that examine the environments where children learn and grow and how
environmental disruptions such as toxic substances and homelessness can impact children. There will also be sessions
on the top children's environmental health concerns and an open forum to ask specific questions about environmental
health impacts. The afternoon sessions will build upon this theme and look at specific illnesses and social and
environmental situations that can impact children's health.
PLEASE NOTE: The two concurrent tracks will focus on medical and public health issues. Asterisks ['"] after a session
title indicates a public health track.
Day 1 Thursday, September 24,2015
8:00 - 9:00
Registration
6:00 - 0:30
Opening Remarks
Samuel Coleman, P.E, Deputy Regional Administrator, U.S. EPA, Region 9
Ron Curry, Regional Administrator, U.S. EPA, Region 6
Jane Nishida, JD Director, U.S. EPA, Office of International and Tribal Affairs
JM de la Rosa, MD, FAAP, U.S.-MX Border Heallh Commission Member - Texas
AEC
Auditorium
6:30- 10:30
Plenary Session 1
Climate Change Impacts on Children's Health, Ruth Etzel, MD, PhD
AEC
Auditorium
10:30-10:45
Break
10:45 -11:30
Plenary Session 2
Environmental Contam inants and Reproductive Health: What Should We Tell Our
Patients? Marya Zlatnik, MD, FACOG
AEC
Auditorium
11:30 -1:00
Lunch and Video: 77re Last Ride, Larry Lowry, PhD
AEC
Auditorium
1:00-1:45
Concurrent Session 1
Track A - E-CigareSes Toxicity: The Risk to Children, Susan Smolinske, PharmD,
DABAT
Track B - Carbon Monoxide: Odorless, Colorless, Borderless, Carl Baum, MD,
FAAP, FACMT
MEB 1100
MEB 1200
2:00 - 2:45
Concurrent Session 2
Track A - Health Impacts of Unconventional Petroleum Exploration on Children
Stephen Borron, MD, MS, FAACT, FACMT
Track B -E-Cigarettes: Talking Tech with the New Generation, Stormy Monks,MPH,
PhD, CHES and Scott Crawford, MD
MEB 1100
MEB 1200
3:00 - 3:45
Concurrent Session 3
Track A - Lead poisoning, Jennifer Lowry, MD, FAAP, FACMT
Track B -Asthma and Lead Home Interventions, Marcus Hanfling, MD, FAAP
MEB 1100
MEB 1200
4:00-5:00
Concurrent Session 4
Track A - Lead and Asthma Panel Discussion, Karin Hopkins, MPH, Cnstina M. Baker,
MPH, Jennifer Kamik, MPH, facilitated by Marc Hanfling, MD, FAAP
Track B -Promotoras on Asthma and other CEH issues Panel Discussion, Leah
Whigham, PhD, FTOS, Celina Alvarado Gamino and Emilia Saenz, B.S. facilitated by
Patricia M. Juarez-Carrillo, MPH, PHD
MEB 1100
MEB 12D0
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Children's Environmental Health on the Border Proceedings
Day 2 Friday, September 25, 2015
8:00-8:30
Registration
8:30-9:00
Opening Remarks
Susan Forster-Cox, Ph.D., U.S.-Mexico Bonder Health Commission Member
- Mew Mexico
Jose L. Velasco, Executive Director, U.S.-Mexico Border Health Commission -
U.S. Section
Bradley P. Fuhrman, MD - Dept. Chair Of TTUHSC Dept. of Pediatrics, Physician-in-
chief El Paso Children's Hospital
AEC
Auditorium
6:00 - 0:45
Plenary Session 3
Mercury Exposure in the School Environment, Kurt Kleinschmidt, MD, FACEP,
FACMT
AEC
Auditorium
0:45- 10:45
Plenary Session 4
Childhood Homelessness and Insecurity and Their Effects on Health
Dr. Gilbert Handal, MD, FAAP
AEC
Auditorium
10:45-11:00
Break
11:00 - 12:00
Plenary Session 5
Pediatric Environmental Health Specialty Units, Panel on Top Ten Environmental
Health Concerns Facilitated by Stephen Borron, MD, MS, FAACT, FACMT - Marcus
Hanfling, MD, FAAP, Jennifer Lowry, MD, FAAP, Larry Lowry, PhD, Mads Miller, MD,
MPH
AEC
Auditorium
12:0D- 1:00
Lunch
AEC
Auditorium
12:15-1:00
Open Forum "Promotoras working in 1he Community" with Ruth Etzel, MD, PhD
Panelists: Sue Forster-Cox, PhD, MPH, MCHES, Arigie Sanchez Corral, Olivia
Figueroa
AEC
Auditorium
1:00-1:45.
Concurrent Session 5
Track A - Social and Environmental Factors in Pediatric Obesity. Jesus Peinado, MD,
FAAP
Track B - Childhood Leukemia and the Environment, Mark Miller, MD, MPH
Track C - "" Changing Community Culture to Decrease Diabetes, Joseph
McCormick, MD
MEB 112D
MEB 114D
MEB 1150
2:00 - 2:45
Concurrent Session 6
Track A - Outdoor Air Pollution, Carta Campbell, MD, MS
Track B - Valley Fever, Paul Dulin, MA
Track C - "" Mosquito Borne Illness, BeaSriz Tapia, MD, MPH
MEB 112D
MEB 1140
MEB 115D
3:00-4:00
Concurrent Session 7
Track A - Drinking Waler-Borne Illness in Children, Kristina Mena, MSPH, PhD and
William Hargrove, MS, PhD
Track B - Pesticide Exposure, Janett Santos, MD
Track C - Designir>g Multi-cultural Health Posters for Children and their Parents,
Margaret Short DMin, MA MBh/, PDiv, BCC and Dr. Cynthia Kratzke, PhD, CHES
MEB 112D
MEB 114D
MEB 1150
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Children's Environmental Health on the Border Proceedings
Attachment 2
Symposium Presentations
Can be found on www2.epa.gov/border2020
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