Proceedings
October 29 - 30, 2013
Omni Shoreham Hotel
2500 Calvert Street, NW
Washington, D.C. 20008
Environmental Protection
Agency
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Disclaimer
This document has been reviewed in accordance with U.S. Environmental Protection Agency (EPA) policy
and approved forpublication. Mention oftrade namesorcommercial productsdoes not constitute
endorse mentor recommendation for use.
The National Center for Environmental Research (NCER), Office of Research and Development was
responsible forthe preparation ofthis meeting report. Nica Louie served astheTaskAssignment
Manager, providingoverall direction andtechnical assistance, and isa contributingauthor/reviewer.
The proceedings were prepared bythe ScientificConsultingGroup (SCG) undercontract withthe U.S.
EPA (contract number EP-C-08-010). The document serves as a general record of presentations and
discussionsduringthe meetingand capturesthe main points while highlightingdiscussions. It is nota
complete record of all details discussed, nor does it interpret or elaborate upon matters that were
incomplete or unclear. Statements represent the individual views of the workshop participants; except
asspecifically noted, none ofthe statements representanalyses by or positions of EPA.
Reference hereintoanyspecificcommercial products, processorservice bytrade name,trademark,
manufacturer or otherwise, does not necessarily constitute or imply its endorsement, recommendation
or favoring bythe U.S. Government. The views and opinions of authors expressed herein do not
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UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
NATIONAL INSTITUTES OF HEALTH
WASHINGTON, D.C.
National Institute of
Environmental Health Sciences
OFFICE OF
RESEARCH AND DEVELOPMENT
DIVISION OF EXTRAMUARAL
RESEARCH AND TRAINING
October 28, 2013
Dear Conference Participants:
We are delighted to welcome you to the EPA/NIEHS Children's Environmental Health and Disease
Prevention Research Centers conference. We are celebrating 15 years of innovative and outstanding
accomplishments of this highly significant research program. In 1998, EPA and NIEHS established
the Children's Centers and today they continue to produce high-quality research results that are being
translated into policy and practice. As we gather during Children's Health Month, this year is very
special because we are joined by clinicians from the Pediatric Environmental Health Specialty Units to
discuss current findings and lay the groundwork for future progress.
We are excited about the opportunity to host this conference since events like this hold significant
value for both agencies. They afford us a tremendous opportunity to learn from key findings and
developments in the work of our grantees, to discuss ways to translate research into policy, to identify
how best to communicate research findings effectively to the public, and to highlight the diverse and
emerging research topics of concern affecting children in communities across the United States and
beyond. Also importantly, this conference provides a forum for innovative discussion and incubation
of ideas amongst all participants whether representing extramural or intramural scientists, clinicians,
community partners, policy makers and public health practitioners.
As you will discover, we have prepared an agenda that is fast-paced and comprehensive - featuring a
highly accomplished and multi-disciplinary group of presenters. Over the next two days, we hope to
highlight the importance of fostering collaborative and community-engaged research among basic,
clinical, and behavioral scientists and local communities. The meeting program focuses on
understanding complex interactions between the environment, genetics and epigenetics, from
preconception to young adulthood and beyond as they relate to a host of children's health outcomes.
Our Children's Centers program remains strong and timely because of you - since you share our
agencies' priorities to protect children from potentially harmful environmental exposures now and in
the future.
So once again, welcome and enjoy!
Sincerely,
Director
National Center for Environmental Research, EPA
Gwen W. Collman, Ph.D.
Director
Division of Extramural Research & Training, NIEHS
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Table of Contents
Letter ii
Agenda (speaker's name is linked to his or her biosketch) vii
Meeting Summary 1
Speaker Biosketches (listed in the same order as in the Agenda) 46
Poster Abstracts
Utilizing GIS and Mapping for More Equitable Distributions of Environmental Health Services
to Spanish-Speaking Populations 70
Damiris Agu, Program Coordinator; and Marta Jankowska
Formaldehyde Exposure Levels During Pregnancy 71
Azita Amiri, Clinical Assistant Professor; Azin Nowrouzi; Gordon McGregor; Michelle Fanucchi;
Erica Pryor; Lisa Schwiebert; Charles A. Downs; Marti Rice; and Anne Turner-Henson
Assessment of the Proinflammatory Potential of Indoor Air Particulate Matter Based
on the Cytokine Release in a Cryopreserved Human Whole Blood System 72
Patrick Breysse, Professor; Felix E. Rivera-Mariani; Kranthi Vysyaraju; Jesse P. Negherbon;
Olivia Hall; Thomas Hartung; and Nadia N. Hansel
Fast Food Intake Predicts Several Indices of Asthma Morbidity in an Urban,
Pediatric Population 73
Emily Brigham. Pulmonary Postdoctoral Fellow; Sonali Bose; Jean Curtin-Brosnan;
Elizabeth Matsui; Nadia Hansel; Charles Aloe; Greg Diette; and Meredith McCormack
Comparison of Children's Personal Exposure to and Environmental Measurements
of Airborne Pollutants With Biomarkers of Exposure 74
Seung-Hyun Cho, Research Aerosol Scientist; Jonathan Thornburg; James Raymer;
Fuyuen Yip; Tegan Boehmer; Marjorie Hinsdale-Shouse; Lisa Thalji; and Diane Wagener
Early Life Exposure to Arsenic Via Food and Water 75
Kathrvn Cottinaham. Professor; Courtney C. Carignan; Tracy Punshon; Brian P. Jackson;
Diane Gilbert-Diamond; Susan Korrick; Vicki Sayarath; Carol L. Folt; and Margaret R. Karagas
iii
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Infant Toenails as a Biomarker of In Utero Arsenic Exposure 76
Matthew Davis. Ph.D. Candidate; Z. Li; D. Gilbert-Diamond; T.A Mackenzie;
K. Cottingham; B. Jackson; J.S. Lee; E. Baker; C.J. Marsit; and M.R. Karagas
Partnerships for Environmental Public Health (PEPH) Evaluation Tools 77
Christie Drew, Chief; and Kristianna G. Pettibone
A Prospective Birth Cohort Study Involving Environmental Uranium Exposure
on Navajo Nation 78
Adrienne Ettinger, Assistant Professor; Chris Shuey; David Begay; Mae-Gilene Begay;
and Johnnye Lewis
"I did it for us, and I would do it again." Rural Latino Experiences Providing
Biospecimens for Research 79
Elaine Faustman, Professor and Director; S. Hohl; C. Gonzalez; I. Islas; E. Carosso;
and B. Thompson
Method Development and Field Application for Multiday Polycyclic Aromatic Hydrocarbon
Sampler 80
Katharine Hammond, Professor; Elizabeth M. Noth; and Fred Lurmann
Malaysian Diaper Powder as a Source of Elevated Blood Lead 81
Mateusz Karwowski, Clinical Fellow; Geoffrey S. Plumlee; Terrence Law; Mark Kellogg;
and Alan D. Woolf
Maternal Iron Metabolism Gene Variants Modify Umbilical Cord Blood Lead Levels
by Gene-Environment Interaction 82
Mateusz Karwowski, Clinical Fellow; Allan C. Just; David C. Bellinger; Rebecca Jim;
Earl L. Hatley; Adrienne S. Ettinger; Howard Hu; and Robert 0. Wright
Finding the Environmental Causes of Leukemia in Children: Center for Integrative Research
on Childhood Leukemia and the Environment at the University of California, Berkeley 83
Amy D. Kyle, Associate Professor; Catherine Metayer; Joseph Wiemels; Todd Whitehead;
Gary V. Dahl; Mark Miller; Stephen M. Rappaport; Libby Morimoto; and Patricia A. Buffler
Arsenic and Rice: Translating Research to Address Health Care Providers' Needs 84
Pui Lai. Pediatric Resident Doctor; Mark D. Miller; and Craig Steinmaus
Being Overweight Confers Susceptibility to Indoor Pollutants Among Urban Children
and Adolescents With Persistent Asthma 85
Elizabeth Matsui, Associate Professor; Kim Lu; Gregory Diette; Patrick Breysse;
Jean Curtin-Brosnan; Charles Aloe; D'Ann Williams; Roger Peng; and Meredith McCormack
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Translating Research in Environmental Health to Pediatric Practice: A Survey
of Pediatric Hematologists and Oncologists 86
Mark Miller, Director, UCSF Assistant Clinical Professor of Pediatrics; Christine Zachek;
Gary Dahl; Christopher Su; and Patricia Buffler
Kids + Chemical Safety: A Tool for Educating the Public About Chemicals 87
Patricia Nance. Science Outreach and Initiatives Leader; Michael Dourson;
and Oliver Kroner
Ambient Air Pollution and Traffic Exposures and Congenital Heart Defects
in the San Joaquin Valley of California 88
Amy Padula, Postdoctoral Fellow; LB. Tager; S.L. Carmichael; S.K Hammond;
W. Yang; F.W. Lurmann; and G.M. Shaw
Ambient Polycyclic Aromatic Hydrocarbons and Pulmonary Function
in Children 89
Amy Padula, Postdoctoral Fellow; John Balmes; Ellen Eisen; Jennifer Mann;
Elizabeth M. Noth; Frederick W. Lurmann; Boriana Pratt; Ira B. Tager; Kari Nadeau;
and S. Katharine Hammond
Home Interventions Are Effective at Decreasing Indoor Nitrogen Dioxide Concentrations 90
Laura M. Paulin, Postdoctoral Fellow; Gregory B. Diette; Meagan Scott;
Meredith C. McCormack; Elizabeth C. Matsui; Jean Curtin-Brosnan; D'Ann L. Williams;
Andrea Kidd Taylor; Madeleine Shea; Patrick N. Breysse; and Nadia N. Hansel
Optimizing the Built and Natural Environments in a Community for Children's
Health and Weil-Being 92
James Quackenboss, Research Scientist; Sally Darney; and Nicolle Tulve
Determining the Effects of Arsenic on Developmental Signaling
Pathways In Utero 93
David Robbins, Professor; Dennis Liang Fei; Devin C. Koestler; Zhigang Li;
Camilla Giambelli; Avencia Sanchez-Mejias; Julie A. Gosse; Carmen J. Marsit;
and Margaret R. Karagas
Retrospective Study of Medical Radiation Exposure in a Cohort of Children
Diagnosed With Leukemia, 2000 to 2010: A Single Institution Study 94
Robin Rohrer, Professor of Medical History
Local Trends in Particulate Matter Air Pollution and Heavy Metals at an Elementary
School in Manhattan's Chinatown With Documented High Asthma Rates 95
Anthony M. Szema; Yi Feng Chen; Laura Viens; and Jonathan C. Li
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Reproductive Environmental Health Education for OB/GYN Specialists 96
Marya Zlatnik. Professor of OB/GYN, Associate Director of MFM Fellowship;
and Mark Miller
Post-Participants List 97
vi
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r
WASHINGTON, D.C. • OCTOBER 29 - 30, 2013
AGENDA
Meeting Goals
• Share reproductive arid children's environmental health research and clinical findings and discuss implications for
improving public health, clinical practice and public policy
• Learn about cutting-edge issues from the clinic, basic research and the community
• Share findings on how research translation and community engagement can improve the lives of children and
families around issues of environmental health
• Identify key environmental health disparities and related factors that adversely affect children's health and
development
• Seek collaborations between children's environmental health researchers, health care providers and the
community
Meeting Objectives
• Expand understanding and investigate opportunities for research on various environmental topics and chemicals
affecting children's health
® Share success stories and highlight challenges, strengths and lessons learned
October 29, 2013
7:30 a.m. Registration
8:30 - 9:00 a.m. Welcome and Opening Remarks
Lek Kadeli, Principal Deputy Assistant Administrator
U.S. Environmental Protection Agency (EPA), Office of Research and Development (ORD)
Gina McCarthy, EPA Administrator
U.S. Environmental Protection Agency
Linda Birnbaum, Ph.D., Director
National Institute of Environmental Health Sciences (NIEHS)
9:00 - 10:15 a.m. Session 1: Hot Topics in Food Safety and Children's Health
Moderator: Brenda Eskenazi, Ph.D., M.A.
Children are exposed to contaminants in food that may affect their health and
development. This session focuses on some specific contaminants that are of increasing
concern to scientists, policy makers and the community. The goals of this session are to:
1) Provide an overview of what is known about the presence of arsenic and pesticides
in food, current regulatory initiatives and risk communication challenges;
2) Present the state of the science of children's health and food exposure to
pesticides, Bisphenol A (BPA) and arsenic; and
3) Stimulate audience questions and discussion with our presenters in a concluding
panel.
United States
Environmental Protection
Protecting'Children's iHealth for a Lifetime:
Environmental Health Research Meets Clinical Practice and Public Policy
vii
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BPA and Children's Health:
Updates on Food Packaging
Exposure and Health Effects
Lesliam Quiros-Alcala, Ph.D.
University of California, Berkeley
Pesticides and Children: State of
the Science of Exposure
Assessment and Health Effects
Brenda Eskenazi, Ph.D., M.A.
University of California, Berkeley
Arsenic in Food and Children's
Health: Updates on Exposure
Assessment and Health Effects
Research
Kathryn Cottingham, Ph.D.
Dartmouth College
Overview and Role of Improving
Food Safety Through Strategic
Science, Communication and
Advocacy
Michael Crupain, M.D., M.P.H.
Urvashi Rangan, Ph.D.
Food Safety and Sustainability
Center, Consumer Reports
Panel
BPA has been found in plastics and food can liners. This
presentation discusses human exposure to BPA and the
potential health effects that have been described in
children.
This presentation focuses on trends in pesticide use in
agriculture and the levels of exposures to various
pesticides in pregnant women and children. It includes a
brief review of some recent findings on health effects in
children from pesticides.
Relatively little is known about the possible effects of low-
level arsenic exposures, especially during childhood, via
food and water. This presentation summarizes exposure
estimates for the New Hampshire Birth Cohort and
describes plans to assess potential health effects in this
population.
Consuming foods contaminated with heavy metals,
pesticides and other chemicals such as BPA can increase
health risks. This presentation focuses on how scientists
can engage policy makers and the public to help reduce
exposure.
Question-and-Answer
10:15 -10:35 a.m.
Tribute—Professor Patricia Buffler
Internationally renowned researcher in childhood leukemia and environmental health
at the University of California, Berkeley's School of Public Health
10:35 - 10:55 a.m. Break
10:55 a.m. - Session 2: Air Pollution Update: Unraveling the Science, Making a Difference
12:05 p.m. Moderator: Catherine Karr, M.D., Ph.D.
Understanding the adverse impacts of air pollutants on children's health and ensuring the
translation of this evidence to clinicians and communities has matured through the
EPA/NIEHS Children's Environmental Health and Disease Prevention Research Centers (CEHC)
program and the Pediatric Environmental Health Specialty Units (PEHSU) program. This
session provides some highlights of recent epidemiological studies that are advancing our
understanding of indoor and outdoor factors, effects on the brain as well as airways, and
consideration of cumulative exposure and lifespan implications. In addition, examples of
moving forward from the etiologic science toward intervention strategies and effective
outreach and translation strategies are presented.
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Airborne Endotoxins and Asthma
Morbidity in the Inner City:
Friend or Foe?
Elizabeth Matsui, M.D., M.H.S.
The Johns Hopkins University
Early Life Traffic Pollution
Exposure and Behavior at School
Age
Nicholas Newman, D.O., M.S.
University of Cincinnati
Cincinnati Children's Hospital
The Impact of Prenatal and
Cumulative Exposure to Air
Pollutants on
Neurodevelopment
Fred erica Perera, Dr.P.H., Ph.D.
Columbia University
Air Cleaner Interventions in
Asthma—State of the Evidence
Greg Diette, M.D., M.H.S.
The Johns Hopkins University
Co-exposure to both endotoxins and certain pollutants
can modify the effects of endotoxins on markers of
airway inflammation. However, it is unknown whether
pollutant exposure modifies the effect of endotoxins on
asthma symptoms and/or morbidity, particularly in "real
world" settings. The goal of this presentation is to share
findings from an analysis of endotoxin, pollutant, and
asthma outcome data from a prospective cohort study
that looks at how endotoxin and pollutant exposure may
affect asthma among a population of urban,
predominantly black children with persistent asthma.
Findings from an ongoing birth cohort study will be
presented. This study demonstrates associations between
traffic-related air pollution exposure in the first year of
life and ADHD-related symptoms when the children
reached seven years of age. Additionally, there is
evidence of effect modification between traffic-related air
pollution exposure and maternal education.
This presentation focuses on findings from an ongoing
birth cohort study. This study has found that there are
associations between prenatal and cumulative exposure
to combustion-related air pollutants and polycyclic
aromatic hydrocarbons (PAH) with adverse
neurodevelopmental effects in children. It also includes
evidence of interactions between environmental
exposures and psychosocial stress.
Air cleaners have been touted as a potential strategy for
environmental management of asthma. Intervention
trials have varied in approach and findings. This
presentation provides an up-to-date critical review of air
cleaners and asthma research.
Translating the Link Between Air This presentation briefly describes the development and
Quality and Health Through
Community Engagement and
Partnerships
Lisa Cicutto, Ph.D., R.N.
National Jewish Health
implementation of the Denver center's website, Clean Air
Projects (www.capk-12.org). The important partnerships
and roles of the Community Advisory Board and
community organizations will be stressed and discussed.
12:05 - 1:05 p.m. Lunch/Network
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1:05 - 1:30 p.m. Keynote
Sandra Steingraber, Ph.D.
Ecologist, Author and Cancer
Survivor
An acclaimed ecologist and author, Dr. Steingraber
explores the links between human health, rights and the
environment. Her personal and scientific exploration into
these issues offers insight into how our Nation can better
protect our environment. Inspired by the 19th century
abolitionist, Elijah Lovejoy, Dr. Steingraber calls for
heroism in the face of the environmental crisis. Her
published books include Living Downstream: An
Ecologist's Personal Investigation of Cancer and the
Environment, Having Faith: An Ecologist's Journey to
Motherhood, and Raising Elijah: Protecting Children in an
Age of Environmental Crisis.
1:30 - 2:15 p.m. Children's Environmental Health Research—Past, Present and the Future
James H. Johnson, Jr., Ph.D., Director
National Center for Environmental Research
U.S. EPA/ORD
Ramona Trovato, Associate Assistant Administrator
U.S. EPA/ORD
Ken Olden, Ph.D., Sc.D., L.H.D., Former NIEHS Director
National Center for Environmental Assessment
U.S. EPA/ORD
Gwen W. Coll man, Ph.D., Director
Division of Extramural Research and Training
NIEHS
2:15 - 3:30 p.m. Session 3: Risks to Children's Health: Chemicals in Consumer Products
Moderators: Kim Harley, Ph.D., and Maida Galvez, M.D., M.P.H.
Increasing concern has been paid to children's exposure to chemicals found in common
consumer products. Household items of concern include: furniture and electronics
(containing flame retardants); cosmetics and personal care products (containing phthalates,
triclosan and other phenols); food storage containers (containing BPA); and children's toys
(containing phthalates and metals).
This session focuses on recent epidemiologic studies that are advancing our knowledge of
the health effects of these chemicals and examining trends and changes in exposure over
time. Attendees also will learn methods for communicating with patients about risks and
lowering exposure and information on current policy and regulations.
Health Effects of Chemicals in This presentation summarizes recent findings from the
Consumer Products: Flame CHAMACOS birth cohort study and other studies on the
Retardants effects of PBDE flame retardants on thyroid hormone
University of California, Berkeley retardant chemicals being used as replacements for
PBDEs.
Kim Harley, Ph.D.
function, neurodevelopment, and obesity. Additionally,
we will examine what is known about the new flame
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Chemicals in Consumer
Products: Trends in Exposure
and New Chemicals of Interest
Antonia Calafat, Ph.D.
National Center for
Environmental Health, U.S.
Centers for Disease Control
and Prevention (CDC)
Chemicals in Consumer
Products: An Overview of Clinical
Questions to the PEHSU
Maida Galvez, M.D., M.P.H.
Icahn School of Medicine
at Mount Sinai
Chemicals Management Policy:
Where Do Consumer Products
Fit?
Jerome A. Paulson, M.D.
The George Washington University
Synthetic chemicals, such as phthalates or bisphenol A
(plasticizers), parabens (preservatives), triclosan
(antimicrobial agent) and benzophenone-3 (sunscreen
agent) can be used in personal care products,
medications, paints, adhesives and in some medical
products. Because several of these chemicals have
demonstrated toxicity in experimental animals,
alternative chemicals are entering the consumers market.
Biomonitoring can be used to assess human exposure to
the replaced, as well as to the replacement, chemicals
and to evaluate exposure trends.
Families today are deluged with headlines about
environmental threats to children's health present in
consumer products, including children's toys, furnishings
and personal care products. They often turn to their
physicians for answers. However, health care providers
often lag behind their patients with respect to knowledge
about environmental chemicals. This presentation
focuses on examples and experience from the PEHSU
National Network in translating emerging science on
chemicals in consumer products to action.
This presentation looks at some of the laws and
regulations that attempt to protect the public by
managing (or not) the health threats of chemicals
contained in consumer products.
Panel
Question-and-Answer
3:30 - 3:50 p.m. Break
3:50 - 4:20 p.m. Highlight—15 Years of the CEHC Program
Brenda Eskenazi, Ph.D., M.A.
University of California, Berkeley
Fred erica Perera, Dr.P.H., Ph.D.
Columbia University
Elizabeth Matsui, M.D., M.H.S.
The Johns Hopkins University
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4:20 - 5:35 p.m. Session 4: New Findings and Tools for Understanding the Effects of Early Exposures on
Brain Function
Moderator: Elaine Faustman, Ph.D.
A tremendous increase in the availability and application of brain imaging and functioning
has opened many opportunities to better understand early brain development and how this
can be impacted by environmental influences. The purpose of this session is to understand
new techniques in brain imaging and how they relate to functional and diagnostic changes.
Human evidence across examples of developmental neurotoxicants will be presented, using
case studies. Immune system function also has proven that these pathways may contribute
to and be impacted during neurodevelopmental disorders. This session ends with a panel
discussion that identifies new opportunities for application as well as discussion on how
these novel methods will impact clinical practice.
What Can Brain Imaging Tell Us:
The Case of Organophosphate
Insecticides
Virginia Rauh, Sc.D.
Columbia University
Recent work suggests that prenatal exposure to
organophosphate insecticides is associated with deficits
in birth weight, early cognition and behavior problems in
childhood. This presentation focuses on advances in
neuroimaging that provide a window into the structural
brain disturbances that underlie these impairments.
Environmental Toxicant
Exposure and Immunological
Susceptibility: The Case of
Autism
Judy Van de Water, Ph.D.
University of California, Davis
Characterization of the relationship between the immune
and neuronal systems and their synergy with respect to
environmental exposure is key to understanding the
mechanisms through which toxicants can alter
neurodevelopment, resulting in disorders such as autism.
Emerging science concerning the role of environmental
toxicant exposure in immune dysregulation in autism
spectrum disorder (ASD) suggests that children with ASD
have a differential ex vivo response to the toxicant BDE-
49 as compared to typically developing control children.
The Impact of Early
Environmental Exposures to
Lead on Adult
Neurodevelopmental Status:
Neuroradiological and
Behavioral Assessments
Kim Dietrich, Ph.D., M.A.
University of Cincinnati
College of Medicine
Many of the most important effects of early
environmental exposures are only revealed in the fullness
of time. Adult outcomes of urban inner-city subjects
exposed to lead as infants and children are indexed using
advanced neuroradiological and behavioral assessment
tools. The current status of adult subjects enrolled in the
Cincinnati Lead Study will be presented, including
Magnetic Resonance Imaging (vMRI, fMRI, MRS, DTI) and
behavioral adjustment studies as they reach their early
30s.
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Translation and Communication
of Emerging Methods and
Opportunities to Impact Clinical
and Research Practice
Translation and communication of emerging methods and
opportunities to impact clinical and research practice.
Discussant: Elaine Faustman,
Ph.D.
Panel: Virginia Rauh, Sc.D.;
Judy Van de Water, Ph.D.;
Kim Dietrich, Ph.D., M.A.;
Kimberly Gray, Ph.D.;
Leslie Rubin, M.D.;
and Elaine Faustman, Ph.D.
5:35 - 6:00 p.m. Keynote
Could You Make Your Children's
Health Research Understandable
Even to Children?
Randy Olson, Ph.D.
The answer is, "yes," according to scientist-turned-
filmmaker Dr. Randy Olson, author of Don't Be Such a
Scientist: Talking Substance in an Age of Style. He has a new
way for you to present your research to the general public,
and even to children (provided they have Ph.D.s—no, just
kidding). It's called the WSP Model, which stands for one
Word, one Sentence and one Paragraph. But wait—there's
more! At the core of the model are two templates—the ABT
(And, But, Therefore) and the Logline. Most importantly, he
and his colleague Dorie Barton have put this model into the
CONNECTION STORYMAKER app, where you can put it to
work for your own communications needs. In this session,
they will show you how this new model provides a pathway
to telling stories that are concise, clear and compelling-
even to children (provided they have Master's degrees-
no, just kidding again).
6:00 - 7:00 p.m. Poster/Networking Session
October 30, 2013
8:00 a.m.
8:30 - 9:45 a.m.
Registration
Session 5: Next Steps for Collaboration Between the Children's Environmental Health
Centers and the Pediatric Environmental Health Specialty Units
Moderator: Pam Maxson, Ph.D.
This session will highlight how effective collaborations that capitalize on research, clinical,
NGO and governmental expertise can lead to important gains for the CEHCs, PEHSUs and
the environmental health field. The presentation will give some concrete examples of
current successful partnerships and ideas for future partnerships. The remainder of the
session will be used for group dialogue and brainstorming on potential collaborations in the
near future.
Session Overview
Pam Maxson, Ph.D.
Duke University
Introductory Remarks
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Why We Should Collaborate?
Patrice Sutton, M.P.H.
University of California, San
Francisco
Overarching Ways to Collaborate
Susan Buchanan, M.D., M.P.H.
University of Illinois
Specific Ideas and Examples for
Collaboration
This presentation highlights the importance of
collaboration and partnerships for researchers,
clinicians and the field of pediatric environmental
health.
This presentation focuses on systems-based ways for
the PEHSUs and CEHCs to collaborate.
This presentation focuses on examples of current
collaborations and ideas for future collaborations.
Sheela Sathyanarayana, M.D.,
M.P.H.
University of Washington
9:45 - 10:55 a.m. Session 6: Social Context of Environmental Exposures
Moderator: Marie Lynn Miranda, Ph.D.
This session examines the social context of environmental exposures in children's
environmental health. Animal models are used as a means to understanding combined
social and environmental stress. The session includes, discussions on the progress made in
modeling issues that children face, in assessing risk, and incorporating knowledge from the
animal models into epidemiological work.
Prenatal Stress and Neurotoxic
Metals: If One is Bad, Then Two
Must Be...?
Deborah Cory-Slechta, Ph.D.
University of Rochester Medical
School
This presentation describes cumulative central
nervous system toxicity in rodents that results from
combined exposures of prenatal stress with lead or
methylmercury, risk factors that are co-occurring in
the human environment, and that share biological
substrates and produce common adverse outcomes.
Maternal Stress and Pollution:
Rewiring Brain in Offspring
Richard L. Auten, M.D.
Duke University Medical Center
An Ecological Approach to Human
Health Studies and Health
Promotion
Mark Miller, M.D., M.P.H.
University of California, San
Francisco, PEHSU
This presentation provides research findings which
confirm that combined respiratory exposure to diesel
particles and social stress during pregnancy increase
the vulnerability of offspring to impaired postnatal
brain development.
Addressing social and cumulative impacts may be a
powerful way of building collaborative efforts among
traditionally disparate groups. Opportunities for
researchers, clinicians and policy makers include
development of studies that reflect "real world"
conditions, as well as evaluating practical
interventions that work across sectors.
Panel
Question-and-Answer
10:55-11:20 a.m. Break
11:20 - 11:30 a.m. Highlight - 15 Years of the CEHC Program
University of Washington
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11:30 a.m. - Session 7: The Clinical and Translational Implications of Epigenetics in Children's
12:30 p.m. Environmental Health
Moderator: Joe Wiemels, Ph.D.
Epigenetics is a "hot" topic in basic research, but the field's impact on public health is yet to
be determined. This session reviews the foundations of epigenetic programming in humans
during development and how perturbations in this process impact children. Epigenetics
provides researchers with a whole new set of biomarkers for identifying both exposures
and disease, and will likely lead to new tools for population and clinical research.
Ultimately, the power of manipulating epigenetic processes will be realized in the clinic,
leading to new therapeutics. Following an overview of the field, we will first learn about
how environmental chemicals (BPA and lead) directly impact epigenetic processes using an
animal model, and then discuss the use of epigenetics in understanding mechanisms of
environmental agents in disease causation in a longstanding cohort with precise and
multiple exposure metrics.
The Role of Epigenetics in the
Spectrum of Human Health: From
Basic Development Processes to
Population Research and
Therapeutics
An introduction to epigenetics research and its
potential impact on biomedical research and clinical
practices.
Joe Wiemels, Ph.D.
University of California, Berkeley
How Early BPA, Lead and
Phthalates Exposures Alter the
Epigenome and Health Outcomes
Later in Life
Dana Dolinoy, Ph.D.
University of Michigan
Mechanistic Pathways Between
Environmental Exposures and
Epigenetic Changes
Fred erica Per era, Ph.D., Dr.P.H.
Columbia University
Environmental exposures during early development
induce changes to the epigenome, resulting in
potentially harmful phenotypic effects, including
metabolic disease, cancer and neurological disorders.
Utilizing a multipronged approach with an in vivo
mouse model, human clinical samples, and an
ongoing 15-year longitudinal epidemiological study,
the overall goal of this presentation is to elucidate the
impact of perinatal BPA, phthalates and lead
exposures on metabolic homeostasis and DNA
methylation, and the interplay between the two.
This presentation focuses on applying epidemiology
to understand the mechanisms whereby
environmental exposures cause epigenetic changes
that affect human health.
Panel
Question and Answer
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12:30 - 12:55 p.m. Keynote Promoting the health and well-being of our Nation's
vulnerable children requires the social determinants
Protecting ALL Children's Health: of health (SDoH) framework. In the United States, the
Recognizing and Mitigating the SDoH framework must include a racial equity and
Effects of Chronic Exposure racial healing lens. This talk will explore programs that
to Adversity are using innovative approaches to mobilize and
support communities in their efforts to protect
Gail Christopher, D.N. children and enhance their well-being.
Kellogg Foundation
12:55 - 1:00 p.m. Closing Remarks
1:00 p.m. Adjournment
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
Omni Shoreham Hotel, 2500 Calvert Street, NW, Washington, D.C.
Tuesday, October 29 - Wednesday, October 30, 2013
MEETING SUMMARY
Reference herein to any specific commercial products, process, or service by trade name,
trademark, manufacturer, or otherwise, does not necessarily constitute or imply its
endorsement, recommendation, or favoring by the United States Government. The views and
opinions of authors expressed herein do not necessarily state or reflect those of the United
States Government, and shall not be used for advertising or product endorsement purposes.
Tuesday, October29,2013
Welcome and Opening Remarks
Lek Kadeli, Principal Deputy Assistant Administrator, Office of Research and Development
(ORD), U.S. Environmental Protection Agency (EPA)
Gina McCarthy, Administrator, EPA
Linda Birnbaum, Ph.D., D.A.B.T., A.T.S. Director, National Institute of Environmental Health
Sciences (NIEHS), National Institutes of Health (NIH)
Mr. Lek Kadeli, the Principal Deputy Assistant Administrator for EPA's Office of Research and
Development (ORD) welcomed the meeting participants to the Children's Centers annual
conference. He began his address by recognizing Children's Health Month as well as the
opportunity to celebrate the 15th anniversary of the Children's Environmental Health and
Disease Prevention Research Centers (CEHC, Children's Centers). Mr. Kadeli noted that this EPA
and NIEHS partnership has both grown in strength and helped establish the foundation for
children's environmental health research. He noted that progress made by the Children's
Centers has increased knowledge about how environmental, genetic, and epigenetic
components may be linked to conditions common in children, such as asthma and
neurodevelopmental deficits. Mr. Kadeli emphasized the need for leveraging resources,
establishing partnerships, and developing a collaborative network in order to further improve
children's health. He recognize the Pediatric Environmental Health Specialty Units (PEHSUs)
which are jointly funded by EPA and the Agency for Toxic Substances and Disease Registry
(ATSDR) and can help translate the findings of the Children's Centers and others for use by
clinicians and the general public. Mr. Kadeli reflected on the opportunity provided by this
conference to explore connections between research findings, clinical practice, and community
outreach. These connections are vital to protecting children from harmful environmental
exposures. Mr. Kadeli introduced EPA Administrator, Gina McCarthy and invited her to address
those gathered. Administrator McCarthy warmly greeted meeting participants and expressed
appreciation to everyone working on children's environmental health issues within EPA, NIEHS,
the research community and the public. The Administrator recognized those present at the
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meeting for the work that they do - whether physicians, nurses, other health care providers,
scientists, NGO's, parents and family members. She said that those present are driving the EPA
and the Federal Government to do better work to try and identify the real challenges that face
our children. While honored to be working towards this goal as the EPA Administrator, she is
also the mother of three children. EPA is essentially a public health organization with tools that
can drive protection of public healthEPA is a public health organization that relies on
partnerships with the scientific research community to obtain information that can inform
health policy. Successes such as the 92 percent drop of the median concentration of lead in
blood in 5-yearold children between 1976 and 2010 resulted from efforts to remove lead from
gasoline and paint. Other successes have been achieved in policies related to water, land
cleanup and air issues. The Clean Air Act (CAA) is among the most successful public health
statutes ever passed in the United States and has proven to save lives and money. EPA has
addressed significant air issues (e.g., particulate matter [PM], sulfur dioxide, mercury exposure),
however many challenges remain. Information on indoor air quality, asthma and other topics
are still needed and should be delivered in a way that allows families and communities to
improve their lives. Climate change poses significant challenges to health and the environment,
as increases in the ozone are expected to exacerbate asthma and result in more wildfires and
storms. EPA has invested $50 million in developing partnerships and looks to the academic
community for research and guidance in applying the knowledge gained. Administrator
McCarthy said that the heart of her message to meeting participants is that EPA is their partner
in protecting public health. She highlighted the importance of the 15 year partnership between
EPA and NIEHS with an investment of over $150 million into more than 20 Children's Centers.
This program has created leaders in the field of childrens environmental health who have
collaborated to translate their research into actions. The Administrator concluded her address
by saying that EPA and its partners need to run faster in this mission, and she thanked
participants and the research community for their willingness to be in a sprint for this
marathon, applying their practical knowledge, enthusiasm and relationships to move ahead.
EPA remains a strong ally in this endeavor.
Dr. Linda Birnbaum, NIEHS Director, reviewed key milestones in the history of NIEHS/EPA-
supported children's environmental health research, starting with the Pediatric Environmental
Research Workshop in 1993 and the establishment of the joint CEHC Program in 1998 in
response to Executive Order 13045 to protect children from environmental health risks. The
Program was expanded over the years and totals 14 Centers in 2013. NIEHS funds more than
300 other child health-related grants as well. Dr. Birnbaum expressed the Institute's
commitment to continue funding the Children's Centers program despite the constrained fiscal
environment. NIEHS support for children's health funding totaled $112 million in the 2012 fiscal
year, of which approximately $20 million supported the Centers. There is broad interest in
looking beyond easy measurements and considering functional outcomes in areas that affect
children, including at conception, in utero and during childhood/development.
The CEHC Program goals are to better understand the environmental factors affecting
children's health and turn research into treatment and interventions through establishing a
national network of multidisciplinary teams that involve communities at the outset. She noted
that innovative approaches are needed to address key research challenges, including low-level
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exposures; the vulnerability of children (i.e., higher risks); and the complex and combined
nature of exposures. Community outreach and translation activities are a key component of the
Children's Center's program addressing the need to translate science to help communities,
physicians and policymakers reach the target audiences, including nurses, health educators,
children health advocates and professional societies as well as local and state governments.
The PEHSUs play a key role in disseminating information to providers, serving as a resource for
physicians, as well as in community practice. Dr. Birnbaum cited several studies where scientific
evidence has led to policy changes. The studies showed the relationship between prenatal
exposure to organophosphate (OP) and a seven point IQ deficit in children. These studies
resulted in two landmark bills in New York City to reduce exposure to pesticides at the
household level. The translation of research into policy is needed to protect children worldwide
as borders cannot contain contamination; science underpins policy and action, and
collaborative research strengthens the knowledge base and can elevate environmental health
issues to impact global policies.
Dr. Birnbaum informed participants that earlier this year the World Health Organization (WHO)
re-established NIEHS as a partner in the Children's Environmental Health Sciences Collaborating
Centers. Joint areas of interest include: cook stoves, the fetal basis of adult diseases, climate
change and human health, e-waste, and training and education. Recent activities have included
a workshop on e-waste and child health and a consortium conference. The Fourth International
Conference on Children's Environmental Health is planned for 2015 in Bangkok and will focus
on e-waste. Goals for the next generation of Children's Centers include supporting the Centers'
network, strengthening basic science, retaining the emphasis on dissemination and translation,
continuing training opportunities and supporting existing and developing new community
partnerships. New areas and approaches include epigenetics as well as the microbiome,
"omic's" approach, exposome and pathway analysis and the development of new technologies,
biomarkers of disease and exposure, and environmental sensors.
Session 1: Hot Topics in Food Safety and Children's Health
Moderator: Brenda Eskenazi, Ph.D., University of California (UC), Berkeley
BPA and Children's Health: Updates on Food Packaging Exposure and Health Effects
Lesliam Quiros-Alcala, Ph.D., UC Berkeley
Bisphenol A (BPA) is a high-volume production chemical present in many consumer products,
with an estimated six billion pounds produced each year. Food is thought to be the dominant
source of human exposure, but other routes of exposure are also plausible. Researchers are
concerned about BPA exposures because BPA is an endocrine disruptor that can leach into food
and water. Human exposure is nearly ubiquitous; BPA is found in 93 percent of the U.S. general
population and in 96 percent of U.S. pregnant women. A 2008 National Toxicology Program
Report has also expressed concerns that BPA could affect human development.
The Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) studied
the effects of BPA exposure in a cohort of 601 pregnant women in Salinas Valley, California.
CHAMACOS also followed the children from pregnancy through age 12, with special focus at
prenatal, 5 years and 9 years of age. The women were receiving prenatal care at community
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clinics, were less than 20 weeks gestation when entering the study, were at least 18 years old
and were receiving state government assistance. The mothers primarily were born in Mexico
(85%); living within 200 percent of the poverty line (96%); had a sixth grade education or less
(44%); worked in agriculture during pregnancy (44%); and had other agricultural workers in
their household (84%). The study assessed the levels and predictors of BPA exposure and
considered the association of prenatal and/or childhood BPA exposures with thyroid hormone
levels, behavior and obesity. Higher BPA concentrations were seen in mothers who had lived
longer in the United States and had a higher soda and hamburger consumption. In addition,
higher BPA concentrations were found in children (age 9) who were obese, had higher soda
consumption, and consumed school lunches. Prenatal BPA exposure may be associated with
decreased thyroid hormone, T4, in mothers, decreased thyroid stimulating hormone (TSH) in
boys, increased internalizing behavior problems in boys and decreased body mass index (BMI)
in girls, particularly at younger ages and prepuberty. Childhood BPA exposure may be
associated with internalizing behavior problems in both boys and girls as well as attention
deficit/hyperactivity disorder (ADHD) in girls. A number of BPA substitutes have been
developed, but they have been found to be structurally similar to BPA and could pose similar
health problems.
Pesticides and Children: State of the Science of Exposure Assessment and Health Effects
Brenda Eskenazi, Ph.D., UC Berkeley
The Food Quality Protection Act of 1996 charged EPA to determine the safe levels of pesticide
residues in food. California is the leading agricultural state in the United States, and Salinas
Valley is the "salad bowl" of the Nation. CHAMACOS is a longitudinal birth cohort study that
enrolled women in 1999-2000. Pesticides studied in the cohort included OPs, pyrethroids,
methyl bromide and fungicides. OPs are acute neurotoxins that depress acetylcholine, cause
over-excitation of the central nervous system, and were widely used in homes before mid-
20005. Chlorpyrifos (CPF) was removed from home use in 2001 and diazinon in 2004. OPs
account for approximately 35 percent of all insecticides used, mostly in California. OPs degrade
quickly and are excreted in urine as dialkyl phosphate (DAP) metabolites and many measure
DAPs as a measure of exposure, although they do have limitations. DAPs fall into two classes:
dimethyl and diethyl reflecting the OPs from which they devolve.
Research found that CHAMACOS participants had OP metabolites higher than U.S. averages.
Nearby agricultural use of CPF was associated with home dust levels, and some OP pesticides
were seen in breast milk. In addition, studies showed that mothers' OP pesticide levels during
pregnancy were associated with shortened gestation, abnormal neonatal reflexes, decreased
mental development at age 2, poorer verbal abilities, autism-like behaviors and attention
problems in school-age children. Other studies also have reported an association between OP
pesticides and IQ in school-age children.
A study by the Columbia Center for Children's Environmental Health (CCCEH) found a
correlation of brain surface measures with CPF exposure levels. Additional research by CERCH
examined whether the susceptibility to OPs varies by individual and determined that the level
and efficiency of paraoxonase, an enzyme that detoxifies OPs in the body, depends on genetics
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and age. This enzyme is coded by the P0N1 gene. We have seen associations suggesting that
P0N1 may modify the relationship of DAPs and mental development.
Other types of pesticides have been found to have deleterious health associations. CHAMACOS
detected pyrethroids in dust and breast milk in both farmworker and urban homes. A general
metabolite of pyrethroids that has been related in the literature to cognitive and behavioral
development in children. Pregnant women living close to strawberry fields where the fungicide
methyl bromide is applied experienced lower birthweight. CHAMACOS also looked at maneb
and mancozeb, which are fungicides applied to lettuce and are 21 percent manganese by
weight. Manganese is an essential nutrient at low doses but a neurotoxicant at high doses.
Manganese prenatal tooth concentration can be measured via growth rings in teeth, similar to
tree growth rings. It was associated with agricultural work, soil type at the residence and
manganese dust loading.
Dr. Brenda Eskenazi highlighted areas for future work. In Costa Rica, manganese-containing
fungicides are applied by air, and much higher levels will likely be seen than those in the
CHAMACOS study, where it is applied by tractor. During the past 20 years in California, the
agricultural use of OPs has decreased, and the certified organic cropland increased. Challenges
remain, however, and the Berkeley Food Institute has been established to address food
insecurity and other complex issues faced by CHAMACOS children and their families.
Arsenic in Food and Children's Health: Updates on Exposure Assessment and Health Effects
Research
Kathryn Cottingham, Ph.D., Dartmouth College
Evidence is emerging about the impact of high levels of arsenic exposure on children's health,
including pulmonary, immunological, growth and neurodevelopmental effects. Chronic effects
of low-dose exposure have not been studied but also are of concern to researchers. Children
are exposed to arsenic in numerous ways, such as private (well) water, which is not regulated,
as well as various foods. The health effects of dietary arsenic, however, have not been well
studied. There are significant differences between organic and inorganic arsenic and rice and
other commonly available foods contain both types, posing challenges to health researchers.
Inorganic arsenic is known to be highly toxic. In 2009, the European Food Safety Authority
reported that exposure to inorganic arsenic via diet could be two to three times higher for
infants and young children than for adults.
Dr. Kathryn Cottingham described the Dartmouth Children's Center Project 2 that used a
prospective birth cohort to predict pregnant women and children's potential exposure to
arsenic via food and water and to compare to measured biomarkers of exposure. The cohort's
geographic region is an area with many private well users, and more than 1,000
mother/children pairs were recruited. During pregnancy, the researchers found that predicted
urinary arsenic concentrations were equal for eating one-half cup of cooked rice and drinking
1 liter of water at the current USEPA maximum contaminant level (10 |-ig/L). During early
infancy, predicted arsenic exposure and infant urinary arsenic concentrations are both low,
with breast-fed infants less exposed than formula-fed infants. Rice cereal is the first of many
foods high in arsenic that will increase exposure, including inorganic arsenic levels up to four
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times higher than in infant formula. In addition, "hidden" rice in packaged foods likely will be an
issue as diets increase in complexity.
Overview and Role of Improving Food Safety through Strategic Science, Communication and
Advocacy
Michael Crupain, M.D., and Urvashi Rangan, Ph.D., Food Safety and Sustainability Center,
Consumer Reports
The mission of Consumer Reports is to work for a fair, just and safe marketplace for all
consumers and to empower consumers to protect themselves. This includes food safety. The
Consumer Reports' Consumer Safety and Sustainability Group (CSSG) conduct strategic science,
that is, a systemic study of issues critical to public health. The process involves defining the
public health problem; measuring the magnitude of the problem; identifying key determinants
(e.g., political, social, biological, environmental) and stakeholders; designing and implementing
interventions (e.g., policy, advocacy, education); and developing and executing a
communication strategy. This process was used in an examination of increased exposure to
inorganic arsenic among adults and children consuming rice in the United States from 1991-
2012.
The magnitude of the problem was shown through review of biomonitoring studies (e.g.,
National Health and Nutrition Examination Survey [NHANES]), government reports, and a
Consumer Reports study that found relatively high levels of arsenic in rice and rice products.
The CSSG conducted a risk assessment, for combined risk of lung and bladder cancer, focused
on arsenic levels in rice as a basis for advice to consumers on ways to reduce health risks from
arsenic exposure. Key determinants included several environmental, cultural, agricultural and
political factors: arsenic is used as a pesticide; some cultures consume greater quantities of
rice; arsenic is traditionally fed to chickens, and chicken manure is used as fertilizer on rice
fields; and there are no limits for arsenic levels in food. Government agencies, rice consumers
and growers, schools, and restaurants are among the numerous stakeholders to consider.
Optimal interventions to protect public health include setting limits for the arsenic levels
permitted in rice, educating consumers, banning arsenic in rice production, and increasing
support for arsenic abatement research.
The CSSG's communication strategy about the findings of arsenic exposure in rice included
identifying the information needs of stakeholders and anticipating barriers as well as preparing
"talking points" to ensure that the message is clear and consistent, tailored to the specific
audience and presented in a way that does not overwhelm anyone receiving the message. In
addition, focus groups could facilitate a clear message, and the message should be kept in
context for the media to avoid misunderstanding or misrepresenting it. For example, for the
goal to educate and motivate the U.S. Food and Drug Administration (FDA) to set a limit for
arsenic in rice, the communication strategy included publishing a report about the problem of
arsenic in rice, how it happens, what the risk is, and how consumers can take action. Prior to
publication, however, press releases were prepared with special attention to the sequence of
the information and tone in quotations, specific media were contacted and an infographic was
created for social media. CSSG engaged key stakeholders by briefing lawmakers, helping to
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draft legislation, briefing medical and academic organizations to help answer questions about
arsenic exposure, and holding many meetings with FDA and other government agencies. A
concerted effort was made to communicate a consistent message throughout these activities.
Work continues in developing guidance on the benefits of varied diets as well as vulnerable
population guidance. The outcome is that the FDA is continuing to study arsenic levels in rice
and considering actions. Also FDA has removed approval for 3 out of 4 arsenic drugs approved
for use in food animal production.
Panel
Questions and Answers
Dr. Birnbaum asked about confidence in the accuracy of using spot urine tests in pregnant
women to measure BPA exposure, and she suggested that the topic of how best to measure
BPA would benefit from further discussion by the research community. Integrated exposure
might best be obtained from multiple 24-hour urine collections. She also noted that dust is a
significant source of exposure. Dr. Lesliam Quiros-Alcala acknowledged these as challenging
areas, and Dr. Eskenazi confirmed the lack of good exposure biomarkers for urine
measurements in pesticide studies. Another participant emphasized the importance of
variability and contributing factors in OP exposure, citing research that shows close correlation
to the parent compounds in blood and advocating for repeat measurements to capture episodic
data and better understand the full range of exposures.
Dr. Mateusz (Matt) Karwowski, Boston Children's Hospital and PEHSU Region 1, asked whether
Dr. Quiros-Alcala's research group had examined combined effects of prenatal and early
childhood BPA exposure. Dr. Kim Harley, UC Berkeley, replied that limited measures for
exposure were included.
Dr. Katharine Hammond, UC Berkeley, commented that better exposure methods are needed
but reminded participants that because the randomness classification of exposure presents
biases, underestimation occurs.
Dr. Ed Levin, Duke University, asked about interactions with drugs, such as ADHD therapies and
abuse of drugs. Dr. Eskenazi indicated that reported drug use, smoking and drinking are
minimal in the CHAMACOS study, but these issues will be areas for the study to watch as the
children age.
A participant considered intra/inter-individual variability and wondered whether repeated
individual measurements during pregnancy or postnatal periods have shown associations
between exposures and the consistency in the ordinal ranking of children. The response was
that brain correlations remain at a low level.
Tribute—Professor Patricia Buffler
Colleagues and friends paid tribute to Dr. Patricia Buffler, EPA/NIEHS Children's Center Director,
UC Berkley, an internationally renowned researcher in childhood leukemia and environmental
health who passed away in 2013. Dr. Buffler's contributions to children's environmental health
and biomedical research were described, including leukemia research, cancer prevention, data
sharing and research in the global environment. Dr. Gwen Collman (NIEHS), Dr. Joe Wiemels
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(UC San Francisco), Dr. Catherine Metayer (UC Berkeley), Dr. Deborah Cory-Slechta (University
of Rochester Medical Center) and Dr. Brenda Eskenazi (UC Berkeley) shared their
remembrances about Dr. Buffler's vision, enthusiasm, optimism, mentorship and mediation
abilities. Dr. Buffler loved people, celebrated life, and had a sense of both aesthetic beauty and
fun. She will be remembered and missed for her graciousness, generosity and commitment to
health science research.
Session 2: Air Pollution Update: Unraveling the Science, Making a Difference
Moderator: Catherine Carr, M.D., Ph.D., University of Washington
Airborne Endotoxins and Asthma Morbidity in the Inner-City: Friend or Foe?
Elizabeth Matsui, M.D., The Johns Hopkins University
Endotoxin is a component of Gram-negative bacteria that interacts with the human immune
system through toll-like receptor 4 (TLR4) to produce an inflammatory response. It has been
associated with adverse health outcomes in occupational settings and wheeze in US children
but has protective effects on eczema in children. In a U.K. Birth Cohort Study, higher endotoxin
exposure decreased the risk of dust mite sensitivity. The JAX Cohort Study found a bell-shaped
dose- response between mouse allergen exposure and incident mouse sensitization that was
damped with high endotoxin exposure.
Dr. Elizabeth Matsui suggested that endotoxin might interact with pollutants that affect TLRs
such as cigarette smoke, which activates TLR4, and nitrogen dioxide (NO2), which may indirectly
activate TLR2. In the Mouse Allergen and Asthma Cohort Study, Dr. Matsui and her colleagues
followed youths from Baltimore City with persistent asthma, conducting quarterly clinical
assessments and exposure assessments of indoor air quality for PM, NO2, nicotine and
endotoxin in PM10. They used a recently developed endotoxin assay, the recombinant factor C
assay, to measure endotoxin since it is specific to endotoxin, discriminating between endotoxin
and fungal glucans. The study population was predominantly male, black and impoverished,
with clinical characteristics that included high rates of sensitization to mouse allergen. There
was a smoker in approximately one-half of the homes, and indoor PM levels were high. The
only correlation of air endotoxin with allergens and pollutants was with mouse allergens. In the
setting of high nicotine exposure, higher endotoxin exposure increased the risk of asthma
morbidity, whereas in the setting of high NO2 exposure, higher endotoxin had a protective
effect against asthma morbidity. A biological mechanism for the interaction between endotoxin
and cigarette smoke is that cigarette smoke exposure enhances TLR4 expression and activity.
Dr. Matsui proposed that in contrast, since NO2 activates TLR2, and activation of TLR2 can
dampen TLR4 signaling, that this mechanism could explain NCh's attenuation of endotoxin's
effects on asthma morbidity. She concluded that among urban children with asthma, the
effects of endotoxin exposure on asthma are modified by exposure to indoor pollutants, with
nicotine having deleterious effects and NO2 enhancing the protective effects of endotoxin
against asthma. These results imply that environment-environment interactions need to be
considered in studies of the effects of the environment on asthma, and the effects of
interventions might not be as predicted.
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Questions and Answers
Dr. Nicholas Newman, University of Cincinnati, asked whether the air monitoring in Dr. Matsui's
study was exclusively indoors. She answered that it was all indoor monitoring, and that indoor
levels of PM and NO2 from past studies in Baltimore have shown that they always are much
higher than ambient levels.
Early Life Traffic Pollution Exposure and Behavior at School Age
Nicholas Newman, D.O., University of Cincinnati, Cincinnati Children's Hospital
Dr. Newman told participants that ADHD is characterized by inattentiveness and hyperactivity,
affecting approximately eight percent of U.S. children in the 4- to 15-year-old age range. It has
been associated with environmental exposures to tobacco smoke and blood lead levels. Dr.
Newman and his coworkers studied the role of another environmental exposure, traffic-related
air pollution (TRAP), in ADHD. TRAP is a complex mixture of fine and ultrafine particles, as well
as gases, that is a byproduct of internal combustion. As a surrogate for TRAP, the researchers
measured elemental carbon particles attributed to traffic, which are ultrafine, contain toxic
compounds on their surfaces and a carbon core, and have been shown to translocate to the
brain, liver, spleen and kidneys. They affect the body by causing oxidative stress at the cellular
level. Previous studies have associated black carbon, NO2 exposure, polycyclic aromatic
hydrocarbons (PAHs) and mixed particulates in decreased cognition in children; the researchers
hypothesized, therefore, that TRAP might affect behavior and in particular hyperactivity, which
is a symptom of ADHD.
Participants were recruited from the Cincinnati Childhood Allergy and Air Pollution study
(CCAAPS), and followed from birth to 7 years-of-age, with land use regression modeling used to
estimate TRAP exposure. Behavior was assessed using the Behavioral Assessment System for
Children-Parent Rating Scale, 2nd Edition (BASC-2), for which T score of greater than 60 is
interpreted as being at risk for ADHD and greater than 70 indicating clinical ADHD. The
researchers discovered that in an unstratified population, hyperactivity was not significantly
associated with TRAP exposure when adjusted for confounding factors such as cigarette
smoking. When children were divided into groups depending on whether their mothers were
educated beyond high school, TRAP was associated with hyperactivity, but only for those with
more highly educated mothers. Dr. Newman speculated that more highly educated parents
might be more likely to report ADHD, or a stronger signal correlated with maternal education
might be obscuring the effects of TRAP. The biological plausibility of TRAP exposure being
associated with ADHD is that it is associated with neuroinflammation and mucosal
inflammation of the respiratory tract, and the dopaminergic pathways associated with ADHD
might be particularly sensitive to oxidative stress. Strengths of the study include that the cohort
held together, exposure was well-characterized and BASC-2 is a well-validated instrument; the
limitations are reduced generalizability from an atopic cohort, lack of family mental health
history and lack of blood lead levels. Ongoing studies with the CCAAPS cohort involve
neuroimaging, extensive neurobehavioral assessment, additional biomarkers, collecting
information about parents, extending exposure estimates beyond the first year of life and
exploring gene-environment interactions.
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The Impact of Prenatal and Cumulative Exposure to Air Pollutants on Neurodevelopment
Frederica Perera, Dr.P.H., Ph.D., Columbia University
Dr. Frederica Perera spoke about the impact of prenatal and cumulative exposures to air
pollutants on neurodevelopment. The CCCEH is conducting parallel studies of in utero
exposures and childhood disease in New York City; Krakow, Poland; and two areas in China with
high levels of coal burning. Rates of neurodevelopmental disorders have been increasing
worldwide, with a 20 percent global prevalence of child and adolescent mental disorders and
15 percent of U.S. children affected by neurodevelopmental disorders. Lower income
communities of color experience disproportionate exposure and risk, as well as more material
hardship. The fetus and children are more susceptible because of differential exposure and
higher biological susceptibility.
Researchers are studying multiple exposures and outcomes in the CCCEH cohort, but Dr. Perera
focused her presentation on PAHs and neurodevelopment. Combustion is the main source of
ambient PAHs. Indoor sources include smoking, cooking and the burning of incense and
candles. PAHs have been linked to multiple health outcomes, being both genotoxic and
endocrine disrupting chemicals, effects that are particularly harmful in utero. The CCCEH New
York City cohort enrolled nonsmoking mothers, primarily black and Dominican, mostly low-
income, who were recruited during pregnancy and the children were followed through
adolescence. Socioeconomic status (SES) and exposure data
(e.g., personal monitoring, questionnaires on maternal hardship), biomarkers (i.e., PAH-DNA
adducts, PAH metabolites, other potentially confounding toxins, clinical data), and outcomes
(e.g., neurobehavioral development) were measured. PAH exposure was estimated by prenatal
questionnaires; area and residential monitoring with geographic information systems modeling;
personal exposure monitoring with backpack monitors; urinary metabolite measurement for
internal dose; and PAH-DNA adduct measurement for biologically effective dose. The
researchers found widespread PAH exposure, with all of the pregnant mothers exposed to
airborne PAH and having detectable PAH metabolites, all 3-year-olds having detectable
metabolites, and 40 percent of cord blood cells having PAH-DNA adducts. Behavioral and
cognitive problems in the children were measured using valid, age-appropriate tests. High PAH
prenatal exposure was associated with lower mental development and developmental delay at
age 3. At age 5, high prenatal PAH was linked to lower full-scale and verbal IQ. At ages 6 to 8,
high prenatal PAH, as well as PAH-DNA adducts in cord and maternal blood, were associated
with anxiety and depression in children. Maternal hardship, defined as lack of housing, clothes
or food, exacerbated the effects of high cord blood PAH-DNA adducts on IQ. The researchers
are assessing potential links between cumulative PAH exposure at age 9 on ADHD risk.
In the mother-and-child cohort study in Poland, a higher SES population that was
predominantly Caucasian, there were similar links between high prenatal PAH and decreased
intelligence scores. In addition, Dr. Perera stated that there was a steeper increase in maternal
demoralization because of child behavioral problems in mothers with high PAH exposure.
Currently, she is investigating mechanisms with magnetic resonance imaging (MRI), epigenetic
analyses and parallel laboratory studies with animal models. Dr. Perera stated that these results
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indicate that prenatal and cumulative PAH exposure has continuing effects on child cognitive
and neurological development through adolescence, which has implications for children's
future; there are interactions with psychosocial stressors; multifaceted interventions are
needed to reduce toxic exposures and address social stressors arising from poverty;
environmental risks need to be identified early; and benefits from interventions will continue
through childhood over a lifetime and potentially across generations.
Air Cleaner Interventions in Asthma—State of the Evidence
Gregory B. Diette, M.D., The Johns Hopkins University
Dr. Greg Diette presented evidence about whether portable air cleaners are effective in
reducing asthma morbidity. EPA recommends a multimodal approach to asthma that includes
minor, moderate and major interventions. Portable air cleaners are classified as a moderate
intervention. The recommendations of the National Heart, Lung, and Blood Institute, in
contrast, include an approach that focuses on allergen avoidance and maintain that there is
insufficient evidence to support the role of pollutant reduction in asthma. The Institute states
that air cleaners remove some allergens, but studies have failed to show that they improve
symptoms.
Dr. Diette reviewed evidence on the effectiveness of interventions on asthma. A study that
reduced indoor pollution with high-efficiency particulate absorption (HEPA) air cleaners and
exterminated cockroaches reduced asthma symptoms, indicating that air cleaners are effective
as part of a multimodal intervention. In an investigation of asthma in homes with smokers—
with control, HEPA cleaner and behavioral coach groups—the coach was ineffective, but the
cleaner reduced PM and asthma symptoms. Another study comparing a sham versus active
cleaner intervention showed some evidence of benefit from the active cleaner. Dr. Diette
emphasized that not all cleaners are HEPA cleaners, which remove PM greater than 0.3 microns
in diameter but do not remove gases. NO2 and nicotine in air both are important in asthma. In
Baltimore, unvented gas-burning stoves, which produce high indoor NO2 from incomplete
combustion, are common. Dr. Diette and his team partnered with Austin Air Systems to
produce a HEPA cleaner with activated carbon that could remove particulates and vapors. They
tested the effectiveness of this cleaner against replacement of gas-burning stoves with electric
stoves or venting gas-burning stoves and found that the air cleaner reduced NO2, but that the
stove replacement was much more effective in reducing N02; venting stoves had no effect. In
regard to adoption, the cleaner is easy to use, costs several hundreds of dollars, needs filter
replacement periodically and removes NO2 whether it is from indoor and outdoor sources. Dr.
Diette concluded that multimodal intervention is key in asthma to reduce irritants and
allergens; air cleaners could be a part of the intervention but source control is ideal. The
American Academy of Allergy, Asthma & Immunology now endorses air cleaner use for asthma
to reduce allergens and PM.
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Translating the Link between Air Quality and Health through Community Engagement and
Partnerships
Lisa Cicutto, Ph.D., R.N., National Jewish Health
Dr. Lisa Cicutto stated that Community Outreach and Translation Cores (COTCs) are included as
part of the CEHCs because of the lag between discovery and translation to interventions and
policy changes. The goal of the Clean Air Projects program is to translate, disseminate and
promote uptake of the best research on lung and environmental health to improve the lives of
Coloradoans. The COTC's activities are led by a dynamic Community Advisory Board that
identified the priority population as children and youth and advised outreach to that population
through schools. The COTC used a five-step method to develop curriculum to link air quality and
health: (1) identify existing resources, (2) review existing resources, (3) blueprint resources to
the state curriculum, (4) solicit input from teachers, and (5) implement the curriculum.
The environmental scan identified needs, preferences and best practices for environmental
education through Internet searches, literature searches, a review of an educational software
package, examination of curriculum standards and educator interviews. Resources then were
reviewed in a two-step process—an initial review followed by an in-depth review—using a
priori criteria derived from teacher interviews and Environmental Education Materials:
Guidelines for Excellence. The review criteria included fairness and accuracy, depth, emphasis
on critical thinking, action orientation, use of an inquiry-based framework, instructional
soundness, ease of use, and applicability to the topic of linking air quality and health. To be
useful, it was essential that resources were blueprinted against Colorado's curriculum
standards. Concordance was assessed by constructing a matrix of resources and standards for
each grade level and marking which standards were met for each resource. Based on the
review, resources were categorized as ready to use, needs enhancement or not useful. Ready-
to-use resources were inquiry-based, linked air quality and health and presented a complete
lesson plan; those that were not useful had problems such as an incomplete lesson plan and
inaccurate information. A majority of resources were judged not useful. Most ready-to-use
lesson plans were middle school-level, and surprisingly few were aimed at high school students.
Resources were disseminated to Colorado educators by creating a website, sending electronic
and postal notices to teachers, and conducting professional development seminars.
The project was promoted by EPA Region 8 and the created website was designed to be easy to
use. Lesson plans were searchable by topic, grade and learning objective. The website
highlighted activities in the community. There have been approximately 4,000 page views,
resources are available through the Partnerships for Environmental Public Health Resource
Center, and the website continues to be updated with new lesson plans and professional
development opportunities. The program received an EPA Environmental Education Grant,
which allowed it to fund activities that have included air quality monitoring, anti-idling
campaigns and theatrical presentations. This website can be found at www.capk-12.org.
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Panel
Question and Answer
A participant asked Drs. Perera and Newman whether, given the effects of PAHs in early
childhood, there would be beneficial health effects if EPA prioritized regulating hydrocarbons
from gasoline combustion. Dr. Perera answered that likely there would be health benefits, but
EPA already regulates PAHs as hazardous air pollutants, although the Agency has not set
National Ambient Air Quality Standards (NAAQS) for PAHs. Dr. Newman added that he had not
studied PAHs in particular, but evidence is growing for the need to regulate ultrafine particles
separately from other PM because the very high surface-to-volume ratio results in more
interactions with biological membranes.
Dr. Susan Buchanan, University of Illinois at Chicago, asked Dr. Cicutto about the input that
education specialists had provided in curriculum development. Dr. Cicutto replied that to
ensure that the resources were used by educators, the researchers had interviewed science and
other curriculum specialists from the school district to develop review criteria and rate the
collected resources. These educators received a small gift card in compensation.
A participant observed that for targeted and genome-wide association studies, issues of
biological plausibility and sample size need to be considered in designing cohort studies, but in
a broader context of exploring interactions, he asked about the existence of guidelines for
sample size and study design. Dr. Perera agreed that her sample sizes were small, but the
conclusions drawn from them are strengthened by replication in different cohorts, over
gradients of exposure and in different ethnic groups; in addition, animal experiments indicate
similar interactions. Dr. Matsui added that strategies to maximize statistical power when
studying the effects of mixtures include dimension-reducing statistical approaches such as
principal components analysis, applied either in an unbiased way or to identify clusters of
pollutants that are most relevant to a particular health outcome. Another strategy to reduce
dimensionality is to use biomarkers of the effects of mixtures of multiple environmental
exposures, which could be developed using cellular assays. She acknowledged that sample size
becomes problematic when exploring smaller effects.
Dr. Amy Kyle, UC Berkeley, asked Dr. Perera, based on her results on interactions, whether
metrics for psychosocial factors and deprivation should be included in most studies of
environmental stressors, and if so, the implications of such inclusion for policy change. Dr.
Perera responded that goal of all of the meeting participants is to protect the most vulnerable
populations, which among children are those with additional types of stress such as poverty
that amplify the toxic effects of pollutants. Achieving this goal will require multifaceted
interventions that combine addressing the root causes of poverty with reducing environmental
exposures.
Keynote
Sandra Steingraber, Ph.D., Ecologist, Author and Cancer Survivor
Dr. Sandra Steingraber began by thanking the scientists working on pediatric environmental
health whose research and findings has made her work, as a researcher and writer, possible.
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She explained that her research in pediatric environmental health began with her own
pregnancy and she became interested in epigenetics and pediatric toxicology. This led her to
write two books, Having Faith, which focuses on the period of development between
conception and breast feeding and Raising Elijah which focuses on the effects of endocrine
disruptors on children and the timing and tempo of puberty.
Dr. Steingraber stated that her diagnosis with bladder cancer at the age of 20 led her to pursue
a career in environmental health. She explained that as a postdoctoral fellow at Harvard in
1993, she had been studying the health effects of perchloroethylene, a known carcinogen,
when she received data documenting the presence of the solvent in the drinking water wells
where she grew up. She decided to take a leave of absence from research to write and build
support based on existing data with the goal of reducing exposures and creating a healthier
environment for all children.
Dr. Steingraber addressed the impact of both toxic chemicals and climate change on children's
health. She attributed various diseases including asthma, pediatric cancers, early puberty and
learning disabilities to the accumulation of toxic chemical pollutants in our bodies. Regarding
climate change, she explained how environmental factors such as drought, floods, dying coral
reefs and extinction could result in conditions such as asthma, pediatric cancers, early puberty,
and learning disabilities. She also addressed the by-products that result from the combustion of
fossil fuels and fugitive emissions in the form of methane, which are potent greenhouse gases
that cause global warming. Dr. Steingraber expressed concern regarding the use of fossil fuels
for making plastics and pesticides since the by-products are known to cause disease. She was
also concerned about unconventional means of fossil fuel extraction until it has been
sufficiently investigated and there is a better understanding of the public health impact. She
stressed the need for renewable energy to protect children from the toxic by-products of fossil
fuel combustion and from the consequences of climate change.
Dr. Steingraber closed by stating that it is impossible to make thoughtful policy decisions
without adequate data. She exhorted the meeting participants to join her in turning the future
of our Nation toward green engineering and green chemistry to help solve the public health
problems for which so many scientists in the audience have worked hard to document and
provide an intervention.
Children's Environmental Health—Past, Present and the Future
James H. Johnson, Jr., Ph.D., Director, National Center for Environmental Research, ORD, EPA
Ken Olden, Ph.D., Sc.D., L.H.D., Former NIEHS Director, National Center for Environmental
Assessment (NCEA), ORD, EPA
Ramona Trovato, Associate Assistant Administrator, ORD, EPA
Gwen W. Collman, Ph.D., Director, Division of Extramural Research and Training, NIEHS
Dr. James Johnson introduced the speakers for the session celebrating 15 years of the
Children's Centers Program, mentioning that the session offers a retrospective look at this
Program's origins and how the panel members used their expertise and authority to bring
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children's environmental health to the forefront and establish such a distinguished legacy. Dr.
Johnson thanked the Children's Centers researchers saying that we could not be more grateful
to them for their work.
Ms. Ramona Trovato began by describing how the Office of Children's Health Protection (OCHP)
was established in 1997 under the guidance of Administrator Carol Browner. She attributed the
establishment of OCHP to the incredible work conducted by a coalition of non-profit
stakeholders such as the Healthy Schools Network (HSN) and the Children's Environmental
Health Network (CEHN) who brought important issues on children's environmental health to
the attention of Administrator Browner and many other policy makers.
Ms. Trovato explained that one of the initial challenges had been to identify how the Federal
Agencies could best collaborate on children's environmental health. In 1998, NIEHS and EPA
formed a partnership to establish the Children's Centers Program, starting with eight Children's
Centers. This program benefitted from NIEHS' experience in funding centers with a strong
community component. Ms. Trovato stated that the Children's Centers have been critical to
environmental health research and she thanked the researchers for their amazing research and
work which has translated into better lives for children. She also mentioned the importance of
disseminating findings to parents, schools and communities so that they can make good
decisions, which is a key component of the Center program. Ms. Trovato also spoke to the
tremendous work conducted by the PEHSU program which was conceived by Dr. Robert Amler
at ATSDR as well as the Federal Steering Committee. She acknowledged the work of the
practitioners in the PEHSU program in helping to improve the health of children, families, and
communities.
Ms. Trovato reiterated the EPA mission of protecting the environment and human health -
saying that while children comprise 30 percent of the population, they are 100 percent of the
future. She closed by stressing the critical role of research in informing public policy and further
emphasizing the importance of research translation to action. She thanked the Children's
Centers researchers and the PEHSUs for their contributions and ended by saying that she is
proud of the way the agencies came together to make a difference for children in the United
States and around the world.
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Dr. Ken Olden began by thanking NIEHS staff members who encouraged him to work with the
EPA. He also thanked the EPA for collaborating with NIEHS to establish the Children's Centers
program. Dr. Olden explained that the Children's Centers program was created to address
issues of public concern, and the work of the Centers can inform public policy decisions as it
relates to human health and the environment.
Dr. Olden recalled his objectives as the new NIEHS Director in 1991 which included making the
Institute responsive to the needs of the American people and to reframe the Institute as a
public health agency. He continued by saying that as a person who had spent most of his career
at NIH, he had a clear vision of the strengths and weaknesses of the Institute. He felt that NIEHS
was an outstanding research organization but also believed that the Institute did not focus on
public health - which is more about translating the science into practice. Except for clinical
work, the investments at NIH cannot impact areas such as prevention which is what
environmental health is about.
At the beginning of his tenure, Dr. Olden arranged regional town meetings to talk with
professional organizations and the public about how NIEHS could better serve communities. He
asked attendees of these town hall meetings about concerns regarding their health as related
to the environment. Following an enlightened conversation with Congressman William Natcher
regarding his vision for NIEHS, Dr. Olden recognized that the work of the Institute needed to be
rebranded, as the significance of the work was not clear to people.
When Dr. Olden became the Director of NIEHS in 1991, he felt that there was a need to
abandon the chemical by chemical approach that was being used in years prior - and ask the
big questions. The new goal was to identify the big issues that needed to be addressed as a
nation in order to improve environmental health decision making. In addition, improving
environmental health decisions should be grounded on differences in exposure based on age
and stage of development.
Dr. Olden remarked that at that the start of his tenure they did not have good science on
environmental health issues. While meeting with people around the country, Dr. Olden realized
the importance of representing children's interests - since they cannot lobby or make
investments for their own health. He reiterated that his primary motivation for the work of the
Children's Centers was to address scientific issues that made sense in the larger context and
identify the big issues.
A keystone of the Children's Centers program was to have the first set of Centers announced by
Vice President Al Gore at the White House, along with support from then-First Lady Hilary
Clinton who was very interested in children's health. Dr. Olden expressed appreciation for the
Program's growth from eight Centers in 1998 to 14 Centers in 2013. He continues to follow the
Centers' work and said that while living in New York, he was aware of the great work at the
Children's Center at Columbia University.
Dr. Olden closed by saying that he could have never imagined all the amazing work done by the
Children's Centers and the success and impact of the program 15 years later. He continues to
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support the program's development because it provides strong science in an area that needs to
be addressed from a global perspective.
Dr. Collman has been part of the Children's Centers Program since the start and acknowledged
the many colleagues who have been instrumental in numerous roles. She reflected that
watching this Program grow during the past 15 years has been similar to being a parent
watching a child grow into adolescence. Parents hope their teenagers start to consider the
future and wonder when maturity will come; sometimes there are teenagers who are above
average. The Children's Centers Program is like one of those super achieving adolescents—so
much has been done in a small amount of time. The Program has built a critical mass of experts
and scientists, trained many researchers, worked with communities, and added new cohorts. It
has not been a static program. Community partners are mature, and the process has been
rewarding.
Dr. Collman highlighted CEHC accomplishments. The Program has produced more than 1,000
publications, created new tools and new technologies, incorporated other areas of science
(e.g., epidemiology and exposure assessment), helped develop a deeper understanding of
environmental causes of children's health outcomes, and provided evidence for regulatory
action. In addition, the Centers' science has contributed to many debates at an international
level. Important studies have shown the dangers of high levels of lead, BPA, and pesticides (e.g.,
DDT), and recent work is demonstrating the link between the onset of obesity and the impact
of early life exposures on weight control and eating habits. Multidisciplinary and laboratory
research have also elucidated the mechanisms of exposures for childhood cancers. The Centers
are committed to working with community groups and helping explain the scientific process
and translate information to concerned communities and parents.
The NIEHS uses the finding produced by the Centers in many ways. One way is to review the
weight of evidence in order to support National Toxicology Program recommendations. The
National Toxicology Program has developed new guidelines to weigh evidence from animal and
human studies. Assessments underway or completed include: obesity, diabetes and the role of
environmental exposures; air pollution and children's respiratory outcomes; and the
translational effect of the chemicals that have been studied. In addition, there is heightened
awareness for professional organizations' activity such as through discussion of preventive
measures or direct action. The American Academy of Pediatrics, American College of Obstetrics
and Gynecologists, and American Heart Association have provided guidelines to their respective
constituencies that focus on exposures to chemicals and other agents during pregnancy, early
childhood and adulthood.. Three advisory reports prepared by the President's Cancer Panel,
Institute of Medicine and Interagency Breast Cancer and Environmental Research Coordinating
Committee all call for a life-stage approach of environment exposure to wide range of cancers,
encourage the translation of research into the community as soon as possible, and advocate
the development and adoption of new tools.
With a strong work base of scientists in the United States, opportunities exist to impact global
health. NIEHS has recently become a WHO Collaborating Center and will work as one of eight
Collaborating Centers. These centers provide assistance to WHO on a variety of health and
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environment topics many of which are rooted in poverty and social inequities, such as exposure
to rare minerals and metals and air pollution effects. The Institute welcomes the assistance of
U.S. scientists especially from the CEHC program interested in working on environmental and
public health issues in communities around the world. Dr. Collman invited participants to the
January 2014 meeting in Bangkok, Thailand, to discuss these issues. In addition, a new
International Society for Children's Health and the Environment has been established to
promote and discuss children environmental health needs and encouraged the active
involvement of our grantees in this scientific society. Dr. Collman noted the great strength in
Children's Centers Program on its 15th anniversary and invited participants to share ideas on
how to move the Program forward even further.
Dr. Johnson thanked the panelists for sharing their insights. He acknowledged their contribute
ons in helping forge the strong partnership between EPA and NIEHS and encouraged the
Centers to continue the race, stating that they make a difference.
Session 3: Risks to Children's Health: Chemicals in Consumer Products
Moderators: Kim Harley, Ph.D., and Maida Galvez, M.D.
Session 3 focused on chemicals in consumer products and how they affect children's health. A
consumer product, defined by the Consumer Product Safety Commission, is "Any article or
component part thereof, produced or distributed for sale to a consumer for use or for the
personal use, consumption or enjoyment of a consumer in or around a permanent or
temporary household or residence, a school, in recreation, or otherwise." In short, a consumer
product refers to everyday items that people have in their homes. These items, including
processed foods, food packaging and personal care products, contain contaminants such as
BPA, phthalates and nanoparticles. Doctors, in general, are not well informed about the
contaminants that exist in consumer products.
Certain segments of the population are better educated and have the financial capacity to
purchase products marketed as safer alternatives, but many are not, which leads to
environmental disparities and in part contributes to health disparities. The general public
receives health messages from the media, some of which can be sensationalized, misleading or
lack context. This session covered topics including emerging science, chemical exposure,
messaging and policy related to health effects in children.
Health Effects of Chemicals in Consumer Products: Flame Retardants
Kim Harley, Ph.D., UC Berkeley
Dr. Harley explained that flame retardants are products added to consumer products (e.g.,
polyurethane foam furniture, textiles and electronics) to reduce flammability. One of the main
routes of exposure occurs when chemicals leach out of the foam and into the environment as
part of dust, which is then inhaled or ingested. Young children also are exposed to flame
retardants through breastfeeding.
Examples of flame retardants include polybrominated diphenyl ethers (PBDEs), Firemaster 550
and chlorinated tris. At UC Berkeley, most of the research focuses on PBDEs, which have a half-
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life of 2 to 12 years. Of the 209 PBDE congeners, 12 are used commercially in penta, octa or
deca mixtures. Penta was used in foam, and although it was phased out beginning in 2004, it is
still present persists in furniture, and exposures continue.
Elevated PBDE levels are of concern because they have been shown to be endocrine disruptors
with a particular effect on thyroid hormone. Additionally, animal studies have demonstrated
the neurotoxicity of the chemicals. Notably, 97 percent of the U.S. population has detectable
levels of PBDEs, which are higher than in the rest of the world. The highest levels of PBDEs in
house dust have been found in Salinas, California, which is home to the CHAMACOS cohort. The
higher levels in California can be explained by a law requiring that furniture must be flame
retardant for 12 seconds. The people at greatest risk of exposure to PBDEs are young children
who crawl on the floor and put objects in their mouth.
The CHAMACOS study has investigated the health effects of PBDEs in a farm-working
community. Research has focused on the levels and determinants of exposure as well as
association of penta PBDEs with fertility, thyroid function, fetal growth, neurobehavior, obesity
and age at puberty. The study also intends to characterize new exposures experienced by
children.
Serum levels of penta PBDE are lower in CHAMACOS mothers compared to the national cohort
from NHANES. This might be explained by the immigrant status of CHAMACOS mothers. As the
length of U.S. residency increases, PBDE levels rise. CHAMACOS children have higher levels of
PBDEs than mothers and the national cohort. An analysis of reproductive outcomes indicated
that women with higher serum PBDEs experience difficulty becoming pregnant and deliver
children with decreased birth weight and lower levels of thyroid stimulating hormone. Maternal
PBDE levels were correlated with increased ADHD behavior and lower IQ in their children,
indicating effects on neurobehavioral development. Child PBDE levels also were associated with
negative changes in IQ. Additional studies have corroborated the demonstrated effects of
PBDEs on neurodevelopment.
Preliminary evaluation of the association of PBDEs with obesity or puberty indicated that
although child PBDEs are associated with lower BMI at age 7, maternal PBDEs are associated
with a trend of larger waist circumference in boys and smaller in girls. Experimental artifacts
related to the lipophilic nature of PBDEs (especially congener BDE-153) might explain the
surprising findings; future research will explore further the association of PBDEs with weight
and puberty.
Importantly, the endpoints in the CHAMACOS study might not be independent, as thyroid
hormone changes might explain the effect of PBDEs on fertility, birth weight, BMI and
neurobehavioral development. Although PBDE levels are declining across the United States,
substitute flame retardant products will need to be evaluated for safety and toxicity.
Chlorinated tris, for example, is a carcinogenic chemical that was banned from sleepwear in
1977 but is now appearing in furniture foam and provides a common exposure. Current
research is examining the sources of exposure and health effects of chlorinated tris and other
organophosphate flame retardants. The UC Berkeley Center also is interested in evaluating
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personal care products through the Health and Environmental Research on Make-Up of Salinas
Adolescents (HERMOSA) and CHAMACOS studies.
Chemicals in Consumer Products: Trends in Exposure and New Chemicals of Interest
Antonia Calafat, Ph.D., National Center for Environmental Health, Centers for Disease Control
and Prevention (CDC)
Dr. Antonia Calafat noted the importance of lifestyle choices in choosing personal care
products. Consumer and personal care products contain a mixture of active and inactive
chemicals. Although active chemicals (e.g., triclosan, parabens) contribute to the product
effects, inactive chemicals
(e.g., phthalates, BPA) do not contribute to the product function and thus are not labeled on
the packaging. Increased scrutiny of chemicals in personal care products has stimulated the
development of alternative chemicals such as plasticizers and other compounds. BPA, for
example, is being replaced by other bisphenols.
The CDC assesses chemical exposures through biomonitoring, which can be a very powerful
tool when properly applied. An example of successful biomonitoring revealed a link between
SES and triclosan exposures. Triclosan is an antibacterial agent present in products such as
soaps. NHANES data showed that although no differences by race/ethnicity or gender were
found, triclosan levels (measured in urine) increase with household income, perhaps because
people with higher SES are more concerned about microbes. Another example is the gender
gap in methyl parabens exposure between men and women; females use more personal care
products that contain this preservative. Non-Hispanic blacks also tend to have higher exposures
to methyl parabens than non-Hispanic whites or Mexican Americans, reflecting differences in
products use across race/ethnicity as well as gender. Diethyl phthalate (DEP) can be used in
products with a scent, and non-Hispanic blacks also have higher exposure to DEP. One
explanation for these trends is that non-Hispanic blacks tend to use more hair products.
Because of increased public scrutiny and legislative action, phthalates are being replaced with
other chemicals in products. NHANES data tracking the concentration of phthalates in 2,500
representative participants showed that the levels of substitute phthalates increase as the
levels of original phthalates decrease. Hexamolf DINCH® is a phthalates replacement plasticizer
that also is increasingly being detected in urine samples after the chemical was introduced in
2002. BPA is another plasticizer used in epoxy resins, plastics and food can linings. Increased
scrutiny of BPA is shifting use to alternatives such as bisphenol S and bisphenol F.
Data from NHANES show that concentrations of certain flame retardants, specifically PBDEs,
might be decreasing. The levels of another flame retardant, chlorinated tris, in dust are several
orders of magnitude higher than the levels of its metabolite in urine. This result emphasizes
that the ubiquitous nature of chemicals in the environment relative to their trace levels in
humans might be of concern if contamination prior to analysis (e.g., through the collection
procedure) occurs, and quality control procedures always should be implemented during
sample collection. Dr. Calafat emphasized that even if many analytes can be accurately
measured, not all analytes are good exposure biomarkers. Future NHANES work and studies on
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targeted populations will attempt to track exposures to legacy chemicals and their alternatives,
evaluate mixtures, and better interpret biomonitoring data. The trend toward the development
and use of nonpersistent chemicals will introduce more variability in concentrations of the
chemicals in biological samples that may increase the potential for exposure misclassification.
This concern could be addressed by collecting multiple samples from an individual and pooling
them prior to analysis.
Chemicals in Consumer Products: An Overview of Clinical Questions to the PEHSU
Maida Galvez, M.D., MPH Icahn School of Medicine at Mount Sinai
Dr. Maida Galvez discussed challenges in health messaging to the general public. People have
anxiety about the health effects of chemicals in the environment and how their personal
choices might have negatively affected their or their children's health. When starting any health
talk, Dr. Galvez recognizes that the general audience is prepared to be scared, and she
emphasizes that people should not focus on past exposures but rather how they can reduce
future exposures moving forward. Many parenting efforts have a positive impact on children,
such as reading to them, giving nutritious food, and providing a loving and supportive
environment.
The PEHSUsform a respected national network of expert pediatricians who learn and practice
risk communication related to the realm of children's environmental health. They are a
resource for filtering what parents need to know, but ultimately it is difficult for them to
answer whether a specific product is safe for a child. An analysis of calls to the Region 2 PEHSU
(New York, New Jersey, Puerto Rico and the U.S. Virgin Islands) from 2007 to 2012 indicated
that 60 percent of inquiries were from the general public and 25 percent were from health care
professionals. There was an even split between queries about classic environmental exposures
(e.g., lead, mercury, mold, pesticides, asbestos) and current/emerging chemicals of concern
(e.g., phthalates, BPA, PBDEs).
The PEHSUs help to communicate what can be done to reduce exposures to environmental
chemicals. Dr. Galvez noted that parents do the best they can with the information that they
have at the time of a decision. The PEHSUs encourage parents to gather evidence-based
information to make the best decisions but in the absence of scientific uncertainty to err on the
side of caution and choose what are known to be safer alternatives. Simple messages shared
with families to encourage a precautionary approach is to eat fresh fruits and vegetables to
reduce exposure to phthalates found in processed foods, avoid the use of #3 and #7 plastics in
the microwave and dishwasher, mop and dust regularly, encourage frequent hand washing,
minimize handling of receipts to reduce exposure to BPA, and use fewer products less
frequently. For example, people who used shampoo, lotion and fragrance three times or less
have lower levels of exposure. Existing databases, such as http://www.cosmeticsdatabase.org,
can help to identify safer products. Accomplishing all of these actions can be challenging.
The PEHSU organizes its messages according to key topics: What is the exposure? What are the
health effects and vulnerabilities in children? What are the action items that parents can pursue
to reduce those exposures? Dr. Galvez expressed caution for the need to recognize the role of
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health professionals in shifting the burden to consumers when action items are suggested.
Parents are stressed, and presenting a list of tasks for parents to accomplish to reduce their
children's exposure can be daunting. Legislative policies can be very effective. A National
Research Defense Council factsheet, for example, indicates that Congress must ensure that
important information about chemical use (e.g., phthalates) is not hidden from people. The
Toxic Substances Control Act (TSCA) should be reformed to ensure protection of people and the
environment from toxic chemicals.
Educating the public is helpful because grassroots advocacy carries a big impact. It makes a
difference when parents complain to legislative bodies that they did not know that BPA was in a
product, for example. One grassroots effort led to a ban of BPA in Suffolk County, New York.
Dr. Galvez presented several lessons learned. PEHSUs and the American Academy of Pediatrics
should be involved early when developing health messages for the public to ensure consistent
messaging. PEHSUs provide an important training foundation for clinicians, who need to be
trained to communicate to families. In addition to the fellowship program for physician
scientists, a training program is needed for clinicians who want to focus on health policy. The
general public is ahead of doctors on environmental issues, so messaging to both audiences
often is similar. The evidence base for unintended consequences of action items need to be
carefully considered. For example, frequent hand washing using products with triclosan might
not be a beneficial practice because exposure to one chemical of concern will be increased
even though exposure to other chemicals might be decreased. The national or international
context of major concerns (e.g., tobacco smoke, clean water and air) also is important.
Exposures related to consumer products are widely prevalent and documented, and it is
important to assess the potential for harm prior to releasing new chemicals into the
environment.
Chemicals Management Policy: Where Do Consumer Products Fit?
Jerome A. Paulson, M.D., The George Washington University
Many consumers assume that products for sale on store shelves are safe to use and will not
cause harm. The reality is that there is not a functional chemical management policy in the
United States. The infrastructure does not exist to deal with the 6,200 chemicals actively being
used or the 83,000 chemicals that have been on the market in the past 50 years. The primary
law in the United States that is supposed to form the foundation of chemical management
policy is the Toxic Substances Control Act (TSCA) administrated by EPA. Despite valiant efforts
since 1976 when the law was passed, EPA does not control toxic substances in part because of
the way the law was written and because of the way it was interpreted by the Supreme Court.
Five separate acts of Congress were required to prohibit the few chemicals that have ever been
banned under TSCA.
TSCA does not regulate pharmaceuticals, cosmetics or pesticides, which are regulated under
separate laws (Federal Food, Drug and Cosmetics Act [FFDCA]; Federal Insecticide, Fungicide
and Rodenticide Act [FIFRA]; and Consumer Products Safety Act [CPSA]). The FFDCA, which
regulates consumer products, was amended by the Food Quality Protection Act (FQPA) in 1996.
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Food and pesticide testing through FFDCA and FIFRA requires premarket testing, postmarket
follow-up, and testing specific to pregnant women and children, but cosmetics and other
products do not. Labels on pesticides and cosmetics require declaration of active ingredients
only, and there is no information about the inactive ingredients (often comprising the vast
majority of the product) being applied to the lawn, house or human body. The CPSA has been
amended several times and requires that products intended for use by children meet certain
standards, including lead content, size of parts, and some phthalates and flame retardants. For
the vast majority of consumer products, however, there is no requirement for premarket
testing, postmarket follow-up or other monitoring. A statutory or regulatory definition of the
term "personal care product" is lacking. The personal care product industry includes a wide
range of products dedicated to health and beauty, including perfume, sunscreen, hair and skin
care products, cosmetics, and toothpaste, as well as some soaps and cleaning compounds.
In addition to the TSCA, FFDCA, FIFRA and CPSA, chemical management policy is influenced by
legislation such as the Clean Air Act (CAA), Clean Water Act, Occupational Safety and Health
Act, and others. Pharmaceutical and pesticide management is an active process in which
companies are required to perform testing and share the results with regulatory agencies that
make a decision about the safety of the product before it is marketed. EPA assesses cumulative
and aggregate toxicity for pesticides; this standard should be applied to all chemical
management policy. Additionally, a great deal of information about pesticides and
pharmaceuticals becomes publically available, but a tremendous barrier related to confidential
business information exists for almost all other types of consumer products. It is important that
information be made available so that consumers are better informed about what they are
buying and using. The current system could be classified as "evidence-avoidance-based"
because if companies have information about anything related to TSCA, it must be disclosed,
but they can remain in compliance of the law by not gathering the information.
Recommendations based in part on the American Academy of Pediatrics' policy statement
suggest that the chemical management system be evidence-based with a foundation of
chemical testing (e.g., neurotoxicity, endocrine disruption) as well as aggregate and cumulative
risk. Harmonization across different laws will ensure that all products are tested in a similar
manner regardless of the end purpose. All regulatory agencies, but particularly EPA under TSCA,
need a method of requiring that companies provide additional testing if there is a concern
about potential health risks. All chemical products must meet a standard of a reasonable
certainty of no harm as for pharmaceutical and pesticide products. Postmarket surveillance is
important to monitor the effects of a chemical on the environment and human health over
time, and agencies need the ability to remove a chemical if surveillance indicates that it no
longer meets safety standards. Finally, corporations who market these products need to fund
these efforts as well as develop mechanisms for biomonitoring so that the federal government
is relieved from determining how to monitor exposures to all of the complex substances.
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Panel
Questions and Answers
In response to a question about the contribution of other agents to the CHAMACOS outcomes,
Dr. Harley explained that a benefit of the CHAMACOS study is that the levels of many chemicals
were measured and some, like lead, were found to be low. Additional compounds, such as OPs,
were analyzed to exclude confounding associations. She acknowledged the importance of
performing sensitivity analyses to ascertain whether toxicants that might coexist with PBDEs
might be contributing to health issues. BPA and PBDE levels are not correlated. PBDEs and OPs,
however, showed similar associations with attention and IQ, so they had to be analyzed
carefully to confirm that the effects were independent.
A participant noted that industry is quick to replace toxic chemicals with substitutes as soon as
concerns are raised. He asked for recommendations of practical efforts that members of the
audience could engage in to encourage comprehensive TSCA reform. Dr. Paulson expressed
doubt about the possibility of TSCA reform in near future. Both of the recent EPA
Administrators have used the tools available to improve the situation, and it is important for
the community to support those efforts. He also suggested that people talk to Congressional
representatives to support TSCA reform.
Dr. Paulson described the industry response to the growing body of research surrounding
chemical products. He encouraged the audience to read David Michaels' book Doubt Is Their
Product, which explains how tobacco companies recognized that they only had to create doubt,
not refute scientific information. This lack of certainty creates a barrier for legislation related to
crafting public health or environmental health policy.
A participant expressed appreciation for the diversity of topics discussed during the meeting,
including how the Centers are beginning to consider more than one chemical and disease
outcome concurrently. These efforts to better understand the integration of pathways of
toxicity might provide more information about the relationships between different human
diseases. She encouraged the audience members to consider holistic system approaches. She
also expressed surprise that an exposure that increases risk for ADHD might also be associated
with a higher BMI. Dr. Harley agreed and explained that the pathways affected by a complex
mixture of exposures need further investigation.
Highlight—15 Years of the CEHC Program
Elizabeth Matsui, M.D., The Johns Hopkins University
Brenda Eskenazi, Ph.D., UC Berkeley
Frederica Perera, Dr.P.H., Ph.D., Columbia University
The Johns Hopkins University
Dr. Matsui presented the three main findings from The Johns Hopkins University Center, which
focuses on inner city asthma and the indoor environment. The first major finding of the Center
is that mouse allergen exposure is strongly associated with asthma morbidity. Children who
were mouse-sensitized had a 50 percent probability of an acute asthma event. Other allergens
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do not have such a strong association with pulmonary inflammation specifically associated with
mouse allergen exposure, which suggests that public health efforts should focus on mouse
allergens. Integrated pest management can reduce mouse allergens by 75 percent. The Center
currently is conducting a clinical trial to determine whether integrated pest management
reduces the incidence of asthma.
The Center has investigated and established a relationship between indoor PM exposure and
asthma symptoms. In a follow-up study, households received an air purifier that decreased the
amount of indoor PM and increased children's number of symptom-free days. The study also
found an association between indoor NO2 concentration and asthma symptoms. Air purifiers
resulted in a marked reduction in NO2. The third finding was that greater BMI potentiated the
effects of PM exposure.
The clinical implication of these findings is that the Center recommends air purifiers for patients
with asthma. There is no mechanism for insurers to pay for or subsidize the air purifiers,
however. Another recommendation is to assess sources of exposure to NO2 (e.g., gas
appliances) and replace them with alternatives. Dr. Matsui suggested that environmental
regulations could be tailored to individual susceptibility.
UC Berkeley
Dr. Eskenazi acknowledged the EPA/NIEHS project officers who have led the CEHC consortium
for the last 15 years. She introduced a video about the CHAMACOS study at the Center for
Environmental Research and Children's Health at UC Berkeley. The CHAMACOS study is located
in the Salinas Valley in Monterey, California, home to thousands of farmworkers, mostly from
Mexico. There is a long history of tension between farm owners and agricultural workers in that
region. In 1996, the FQPA was passed, which reflected the need to consider the health effects
of pesticides and changed the way that pesticides were regulated.
The CHAMACOS study focuses on the effects of pesticides on pregnant women and children in
agricultural communities. The effects on children occur via exposure to contaminated food, and
also from proximity to agricultural fields and interaction with farmworkers. The Center has
since expanded its work to investigate the exposures outside of agriculture. In 1999, the Center
built a field office at the county hospital in Salinas, California. More than 600 pregnant women
were recruited, and their children have been followed from birth into adolescence. Biological
and environmental samples and interviews have been used to assess children's growth and
development.
The CHAMACOS study has resulted in more than 100 publications in top journals and has
received local, national and international media attention. The study has developed
interventions to reduce exposures to farmworkers in the field and in their homes. The ultimate
goal is to reduce environmental exposures to all families. CHAMACOS also has trained hundreds
of students and staff in the community.
Columbia University
Dr. Perera introduced the focus of the research at the CCCEH, which is to investigate the
synergistic effects of multiple exposures. These effects are mediated by epigenetic mechanisms
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and changes in neural development. Some of the major findings of the Center are that in utero
PAH exposure disrupts global DNA methylation, and these patterns persist through age 3.
Further, prenatal PAH exposure is associated with hypermethylation of a particular gene,
interferon gamma, in cord blood samples. The gene has a critical role in brain development and
could mediate the observed effects of PAH exposure on working memory at age 7. In utero PAH
exposure has been associated with obesity and with cockroach sensitization as well. The
Center's research shows that in addition to airway inflammation, phthalates are associated with
eczema and childhood behavioral and developmental impairment. Exposure to BPA similarly
has effects on asthma and behavioral outcomes.
Parallel experimental studies have demonstrated sex-specific, nonmonotonic effects of BPA
exposure on estrogen receptor alpha in the offspring hypothalamus. Those changes in gene
expression were associated with changes in methylation and gene expression and could
mediate the observed alterations in social and anxiety-like behavior.
A key finding of the Center is that social stressors and toxic pollutants interact. This has led to
community outreach efforts to ensure that the local community is informed about how to make
their homes and children healthier. The Center's work also has influenced policy, including laws
to phase out dirty fuel sources and implement integrated pest management in public housing.
The work has brought attention to the need for coordinated social and environmental
interventions. It has shown that continuing exposure to environmental pollutants affects
children's health and their ability to lead healthy productive lives. The benefits of prevention in
childhood will accrue throughout the life course, and there is a need for more research and
prevention in children's environmental health.
Session 4: New Findings and Tools for Understanding the Effects of Early Exposures on Brain
Function
Moderator: Elaine Faustman, Ph.D., University of Washington
What Can Brain Imaging Tell Us: The Case of Organophosphate Insecticides
Virginia Rauh, Sc.D., Columbia University
Dr. Virginia Rauh introduced the neuroimaging tools used at the CCCEH. The tools are used for
structural imaging, distinct from functional MRI imaging. Traditionally, neuroimaging was used
for three purposes, to: (1) understand the relationship between specific areas of the brain and
functions they serve, (2) locate areas of the brain that are affected by particular disorders and
diseases, and (3) develop strategies to treat various brain disorders and diseases.
In the context of neurotoxicological research, researchers wonder whether clinical symptoms
and signature syndromes are associated with chemical exposures. It is not known whether
windows of vulnerability exist during which the insult is the greatest or likely to be permanent.
Finally, it is necessary to investigate how chemical insults affect the structure and function of
the brain in developing and mature organisms. This last question can be addressed using
neuroimaging tools.
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Nevertheless, there are many challenges because identical environmental exposures can map
to many clinical and behavioral symptoms (nonspecific effects); rarely do exposure-related
symptoms compose a single behavioral phenotype. Therefore, valid clinical endpoints are
difficult to define. Even if there is a clear neural or behavioral signature of exposure, the
mapping of brain regions to behavior is quite inexact.
CPF is a chemical that inhibits acetylcholinesterase. It may affect the brain via other
mechanisms as well and have long-term neurobehavioral effects for which acetylcholinesterase
inhibition is not the appropriate biomarker. The CCCEH has found that in utero CPF exposure
affects health, behavior and cognition of children at age 7.
Dr. Rauh presented several findings that involve imaging from a pilot study. The first result was
that the brains of children who were exposed to CPF had volumetric deformations and
differences in specific regions, and a dose-response relationship is observed, with a significant
positive relationship between exposure and brain deformation. The implicated brain areas
involve attention, language, social cognition, reward, emotion, inhibitory control and executive
function. The second major effect was that the brain deformation was associated with lower IQ.
Thus, prenatal exposure was associated with structural and functional changes in the
developing brain that persist through middle childhood.
The Effects of Environmental Toxicant BDE-49 on Immune Function in Children with Autism
Judy Van de Water, Ph.D.
Dr. Judy Van de Water described the goal of the UC Davis Center, which is to understand the
mechanism by which exposures affect cells at a molecular level, and how these changes lead to
altered behavioral outcomes. The specific goal is to examine the environmental factors, genes
and immune system as they relate to autism susceptibility. Brominated diphenyl ethers (BDEs)
are known to affect the nervous system, but their effects on the immune system have been less
studied. It is increasingly apparent that the immune system and nervous system co-develop,
sharing many signaling molecules, and a perturbation that affects one system may also affect
the other.
Autism is a complex disorder for which there are few (if any) biological markers. The
heterogeneity of this disorder makes it difficult to study. Researchers hypothesized that
exposure to BDEs might cause a disregulated immune profile, which in turn would increase the
likelihood of autism. A 2009 study showed that BDE-47 increased inflammatory cytokines and
the frequency of autism. In a more recent study, cells exposed to BDE-49 produced more
interleukin 4 (IL-4). In vivo, children with increased IL-4 levels following ex vivo BDE exposure
also exhibited worse cognitive function. BDE affected other immune cells, such as T helper 2
cells, and cytokines, such as IL-13. Future work will focus on the mechanism by which these
cytokines lead to behavioral outcomes (autism) and will explore why some children respond
differently to the same exposure.
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The Impact of Early Environmental Exposures to Lead on Adult Neurodevelopment Status:
Neuroradiological and Behavioral Assessments
Kim Dietrich, Ph.D., University of Cincinnati College of Medicine
Dr. Kim Dietrich described a study on the effects of lead exposure in the Cincinnati Lead Study
cohort that has been going on for 34 years at the University of Cincinnati College of Medicine.
This prospective longitudinal study recruited over 400 women in the first trimester of
pregnancy and their children at delivery and continues to follow these subjects into their late
20s and early 30s. The mothers and children lived in areas that historically have had a high
incidence of clinical childhood lead poisoning since the 1950s. The exposure levels in this cohort
were high by contemporary standards; for example, at least 33 percent of the children had at
least one blood lead concentration above 25 ug/dL over the first five years of life, the CDC level
of concern in 1985. Although there is an established relationship between lead exposure and
IQ, the effects observed in this study were not limited to IQ alone.
When subjects were in their mid-adolescence, researchers found that parental and average
postnatal blood lead levels were associated with self-reported delinquent behavior. When
followed into early adulthood, childhood blood lead concentrations continued to be associated
with officially documented criminal arrests. For example, even when controlling for variables
such as other exposures or poor home environment, there remained a significant association
between lead exposure and violent offenses (e.g., murder, rape, assault and robbery) such that
every 5 micrograms of lead per deciliter of blood averaged over five years resulted in a 30
percent increase in arrests. Upon further follow-up, Cincinnati researchers found that the
number of lifetime arrests of participants in this study from ages 18 to 31 years could be
predicted by maternal prenatal blood lead concentration and average childhood blood lead
concentration. Further work on this cohort used advanced neuroimaging tools to determine
how lead exposure affects brain structure, function, physiology and thus behavior. When they
were in early adulthood, dose-dependent reductions in brain activation, cortical gray matter in
the frontal lobe, injury to myelin and axonal structures were found in subjects exposed to
higher levels of lead in childhood. The main lesson for researchers from this study is that the
most important effects of early exposures to lead may only be observable after many years.
That is, the full spectrum of effects of exposure to central nervous system toxicants, such as
lead, may only be observable in the fullness of time in longer term prospective studies.
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Translation and Communication of Emerging Methods and Opportunities to Impact Clinical
and Research Practice
Discussant: Elaine Faustman, Ph.D.
Panel:
Virginia Rauh, Sc.D.
Judy Van de Water, Ph.D.
Kim Dietrich, Ph.D., M.A.
Kimberley Gray, Ph.D.
Leslie Rubin, M.D.
Elaine Faustman, Ph.D.
Dr. Gray noted that this year is the "year of the brain." The NIH has developed the "neural
blueprint" and "neural toolbox" to make quick assessments of the five domains of neural
health. These tools exist in multiple languages and could be useful for the Children's Centers.
A participant mentioned that there is a relationship between autoimmune diseases in the
mother and autism in her children. The participant described a family in which the first-born
son developed autism, whereas the younger sister did not. Autism is a symptom complex, and
some individuals might share symptoms, but the causes might be completely different. The
autoimmune status of the mother, as well as genetic predisposition and epigenetic markers, all
influence the manifestation of autism.
A clinician in the audience noted the importance of windows of susceptibility. Any insult (e.g.,
pesticides, lead, other chemicals) that occurs soon after conception will affect developmental
processes and outcomes. The specific insult may not have a specific outcome; the outcome may
be the result of a perturbation during a specific window in development. A participant
responded that researchers have not gone far enough in delineating the specific profiles
associated with particular exposures. Dr. Eskenazi noted that the timing of exposure often is
unknown, especially when no biological samples are available. She also commented that there
has not been a discussion of resiliency. Not every child responds the same way to an exposure;
for example, not every child becomes autistic if exposed to paradichlorobenzene. Further
research is needed to understand the interaction between exposure and other factors that may
enhance or ameliorate the effects of exposure. Dr. Rubin noted that the interaction between
exposure and other stressors has been examined. The effects are greater when other stressors
are involved. A participant noted that the brain is able to repair itself. There are many
protective factors, including a healthy diet. All of these must be taken into consideration.
A participant emphasized that it is important not to focus only on what is not known. There is
clear evidence that lead exposure produces effects, and this should not be lost underneath the
variability of responses to lead. She gave the example that only 11 percent of smokers develop
lung cancer, and this led to resistance against policies to regulate tobacco. Similarly, children's
responses to exposures can be variable, but it should be emphasized that exposures do have
demonstrable effects on health and behavior.
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A participant urged caution in how the research findings are communicated to the public. There
is a difference between a personalized risk assessment for individuals versus a population-
based environmental risk assessment.
Keynote: Could You Make Your Children's Health Research Understandable Even to Children?
Randy Olson, Ph.D., Harvard University
Dr. Randy Olson, a marine biologist, presented a narrative training approach to help scientists
better communicate with their audiences. Dr. Olson is a past-professor at the University of New
Hampshire and an alumnus of the University of Southern California Film School. He has co-
written several books about broad communication and produced the film documentary, Flock
of Dodos, and he currently gives workshops to science organizations. His first book, Don't Be
Such a Scientist, described the problem with communicating science to the public, and his
second book, Connection: Hollywood Storytelling and Critical Thinking, provides communication
solutions through narrative training, which is the instilling an instinct of what the narrative is
and how information is compiled into a narrative structure. Structure and simplicity are key
features that differentiate narrative training from other types of training.
The goal of narrative training is to fully engage one's audience in the message being imparted.
A neurocinematics study (Hassan, 2008) used MRI to look at the brain activity of people
watching film clips. The researchers saw an index of 70 percent in similar brain activity patterns
(i.e., engaged audience) among those watching a video with a tight narrative in contrast to a 10
to 20 percent similarity pattern among those watching a video segment with no storyline.
Dr. Olson shared an example of how narrative principles can help structure information. He
worked with scientists planning a convention on sea level rise to modify the online description
of the meeting that delineated eight topics of discussion. The original heading "Responding to
Sea Level Rise" became "Sea Level Rise: New, Certain and Everywhere," along with changes to
font sizes and capitalization. In addition, the original two-paragraph text was recast into three
paragraphs that each focused on one of the three words, "new, certain and everywhere." The
revisions were based on the WSP model of one Word (theme), one Sentence (ABT), and one
Paragraph (logline) and brought the theme down from eight topics to three words.
Dr. Olson focused on the narrative template ABT, which stands for "replacing Ands with Buts
and Therefores" and has been used successfully by Trey Parker, co-creator of the television
show, South Park. ABT is most easily described in terms of a three-act play: Act I provides an
exposition ("And"), with a question ("But") segueing into Act II, culminating with an answer and
synthesis ("Therefore") in Act III. The ABT template actually has been applied throughout the
centuries, by Socrates and the German philosopher Josef Hegel, as well as current
neurophysiologists and literature professors.
Dr. Olson applied this technique to study descriptions found on several CEHC university
websites: (1) Endocrine disruptors are known to enter the womb and can be damaging, but
whether they have long-term effects is not known; therefore, Columbia University researchers
are following a group of New York City children since birth to explore this. (2) Exposure to toxin
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in utero can lead to diseases later in life, but biomarkers can identify these risks; therefore,
researchers at Brown University are using mouse models to identify biomarkers. He also
demonstrated the technique applied to several paintings and as a downloadable app
("Connection Storymaker"). The narrative training workshop allows participants to assess their
messages quantitatively (e.g., how many words were used), and the app serves as a tool to help
shape one's health research story and develop better narrative instincts.
Wednesday, October30,2013
Session 5: Next Steps for Collaboration Between the Children's Environmental Health Centers and
the Pediatric Environmental Health Specialty Units
Session Overview and Introductory Remarks
Pam Maxson, Ph.D., Duke University
The session began with an overview of the CEHCs and PEHSUs, followed by several
presentations about collaboration. Participants then broke into four breakout groups based on
geographic regions to discuss opportunities for CEHC and PEHSU collaboration. Topics and
specific proposed collaborations from these discussions were provided to the full group.
The mission of the CEHCs is to better understand environmental factors affecting children's
health. This is completed by promoting research translation; enhancing communication,
innovation and research; and promoting multidisciplinary research. The basic CEHC structure
includes three individual research or translational projects and an outreach and translation
core.
The PEHSUs aim to improve the environmental health of children by enhancing education and
consultative services to clinicians, health professionals and the community and by providing
evidence-based information from a network of experts in environmental health. A typical
PEHSU staff includes a project director, a coordinator, an occupational environmental medicine
physician, a pediatrician and other specialists. PEHSUs are involved in consultation,
education/outreach and referral.
Why We Should Collaborate
Patrice Sutton, UC San Francisco
The CEHCs and PEHSUs have a shared goal to translate the environmental health regarding
environmental health effects that span the lifetime. Collaboration would be useful for a variety
of reasons. (1) Collaboration could advance the uptake of environmental health science in the
medical field. Approximately 78 percent of 2,500 American Congress of Obstetricians and
Gynecologists (ACOG) obstetricians who replied to UCSF's survey felt that they are interested in
promoting prevent harmful environmental exposures, but fewer than 25 percent reported
taking their patients' environmental health history. The PEHSUs can serve as an invaluable
referral mechanism to support action by obstetricians and gynecologists in the field of
environmental health. Recognition of the role of the CEHCs and the PEHSUs in uptake of the
science by practicing physicians was recognized in the September 2013 groundbreaking Joint
Opinion issued by ACOG and the American Society for Reproductive Medicine which, notably,
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was based in part on CEHC research and states that the PEHSUs are a resource for obstetricians
and gynecologists.(2) Collaboration can improve public policy, such as working together to
advance local, state and national medical societies' positions on environmental health policy.
(3) PEHSUs have "an ear to the ground" and are essential to informing the science conducted at
the CEHCs. (4) In addition, the PEHSUs serve an important science education and outreach role;
for example, they have been effective in getting environmental health science into the local
medical societies' news and in conducting outreach to practicing physicians. (5) Collaboration
has had proven success. In 2012, the Reproductive and Children's Environmental Health
Working Group brought together policymakers, federal agencies (EPA, Agency for Toxic
Substances and Disease Registry [ATSDR]), leaders of professional societies and others to begin
building an infrastructure for reproductive environmental health.
Overarching Ways to Collaborate
Susan Buchanan, M.D., University of Illinois at Urbana-Champaign
To increase collaboration between the CEHCs and PEHSUs, various activities could be
undertaken. The CEHCs could invite the PEHSUs to attend CEHC monthly webinars. Likewise,
the PEHSUs could invite CEHCs to attend PEHSU monthly National Conversations. In addition,
the PEHSUs/CEHCs could build a long-term infrastructure to bring regional centers together at
the institutional, center and individual levels.
There are a number of activities that could be implemented to increase capacity of the CEHCs
and PEHSUs. These include co-sponsorship of trainee rotation experience, the PEHSUs helping
in the access to clinical populations for research, and the CEHCs consulting with the PEHSUs
regarding clinical issues. The CEHCs could inform the PEHSUs of important research findings to
enhance clinical translation, risk communication and messaging. The PEHSUs could inform the
CEHCs about common exposures resulting in calls/visits to the PEHSUs.
Specific Ideas and Examples for Collaboration
Sheela Sathyanarayana, M.D., University of Washington
There are a number of ways that the PEHSUs and CEHCs can collaborate through a coordinated
response and translation of research findings. The importance of timely coordination is seen in
the example of arsenic and foods. Seven PEHSUs received 68 concerned calls from parents
and/or health care providers and eventually created a factsheet on arsenic as a resource. The
factsheet, however, was published about 1 year later. A CEHC with important research results
that will be published in the near future could work with the PEHSU network regarding how
findings might be shared with the public for more immediate impact, such as through press
releases or factsheets for clinicians and families.
The Centers and/or PEHSUs may identify highly exposed children or children with adverse
health outcomes with suspected environmental etiologies. These cases represent important
opportunities for hypothesis generation to inform CEH research. Developing case reports for
publication can move the CEH field forward and highlight research gaps. One example of a
sentinel event/case report involves BPA and neurodevelopment, in which the Cincinnati Center
identified a pregnant woman with high exposure to BPA and contacted the Region 10 PEHSU to
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discuss how to counsel the mother; the infant had abnormal neurobehavioral outcomes. In
another case, the UC San Francisco Center found a high level of mercury in a pregnant woman
and informed the Region 9 PEHSU and the local department of health about this finding; a
discussion led to the finding that the woman used a face cream contaminated with mercury.
Collaboration between the PEHSUs and CEHCs also can occur via combined symposia or
conferences. The Symposium on Cumulative Impacts and Children's Environmental Health
(January 2013), which included six CEHCs and the Region 9 PEHSU, began a dialogue on
cumulative impacts analyses between Centers. A Symposium on Children's Environmental
Health Research Matters with the Region 10 PEHSU highlighted community engagement in
University of Washington Center's child cohorts, PEHSU factsheets on wildfire/wood-smoke
exposures, and regional research on the children's safe products rule. The Region 4 PEHSU and
Southeast CEHC combined their expertise in the Break the Cycle of Environmental Health
Disparities symposia to focus on environmental impacts in the context of health disparities and
both groups and their student trainees made presentations and shared publications.
Collaborative policy efforts include the Program on Reproductive Health and the Environment's
Meet the Decision Makers training fellowship; CCCEH's successful efforts in CPF legislation,
which has led to further research; and Region 10 PEHSU's testimony on phthalates in children
for the Washington State's Children's Health Safe Products Act.
Breakout Group Reports
Attendees were asked to separate into four breakout groups, discuss collaborative activities
and share their thoughts to the full group. To facilitate collaboration beyond this meeting, the
groups were composed of CEHCs and PEHSUs that were close in geographic area. The breakout
groups considered the following questions:
• What collaboration(s) can you commit to or complete in the next 1 to 2 years?
• How can nongovernmental organizations (NGOs), foundations and government partners
contribute to or benefit from participation?
• How will you accomplish your collaboration?
• What will you need to make it happen?
Group 1: Dartmouth Center/Region 1 PEHSU and Columbia Center/Region 2 PEHSU
Carmen Marsit, Geisel School of Medicine at Dartmouth University, said that despite the
geographic distance among some of these CEHCs and PEHSUs, collaborative opportunities
include joint meetings and attendance at each organization's presentations or events as well as
work with local clinicians to increase their awareness of PEHSU resources. The CEHCs will
include the PEHSUs on their news lists and press releases to keep the PEHSUs informed about
forthcoming study findings and publications. Another area for collaboration is to involve NGOs;
it would be helpful to compile and share information about potential NGO stakeholders with
the CEHCs and PEHSUs.
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Group 2: University of Washington Center/Region 10 PEHSU and University of Illinois at Urbana-
Champaign Centers/Region 5 PEHSU
Nick Newman, Region 5 PEHSU, reported that Group 2 focused its discussion on pesticides.
Information could be deployed by creating a Web-based module or update an existing online
database. An alternate approach is to connect with clinician resources (e.g., UpToDate18,
MedScape, Epocrates", WebMD) to disseminate a more in-depth knowledge about pesticides
and other environmental health topics to the public. The PEHSUs could contribute to the
CEHCs' endocrine disruption research and outreach activities by providing contacts with local
networks.
Group 3: The Johns Hopkins University Center/Region 3 PEHSU, Duke Center/Region 4 PEHSU
and Region 6
Ed Levin, Duke University, summarized Group 3's discussion on enhancing communication,
particularly through electronic media such as via joint webinars and videos. In addition, to
accommodate busy schedules, asynchronous types of communication are useful. Blogs, chat
rooms and online drop boxes could be used to post recent articles. Other collaborative
opportunities include facilitating the dissemination of focused CEHC research and interactions
between the organizations.
Group 4: UC Berkeley and Davis/Region 9 PEHSU, Region 7 PEHSU and National Jewish Health
Center/Region 8 PEHSU
Robert Gould, UC San Francisco, stated that Group 4 encompassed a diverse background of
participants and covered a wide geographic range. Collaborative ideas include developing ways
to work across these distances. For those without a Center nearby, can one be identified to
work with, even if it is outside the region? Challenges include the lack of funding for the PEHSUs
as well as funding for sustainable, collaborative work among the organizations. In addition, a
long-term method to track the various resources (e.g., programs, presentations, community
partners) and expedite collaborations with the PEHSUs and CEHCs is needed; an EPA staff
member from Region 9 has volunteered to facilitate the compilation of this information.
Researchers in these CEHCs and PEHSUs have many other partners (e.g., contacts within
professional, medical and public health associations) who might assist with the development of
policy as well as greater collaboration with hospital-based institutions to incorporate the
PEHSU/CEHC expertise.
Questions and Answers
Dr. Sheela Sathyanarayana thanked participants and organizers for their discussion. She invited
funders (e.g., EPA, NIEHS, CDC) to share their thoughts on how to incentivize the collaborations.
Are there opportunities for short- and long-term collaborations?
One participant noted that the ATSDR built collaboration into its funding announcements,
particularly with schools of nursing and medical schools, for the translation and uptake in the
medical school curriculum, and he encouraged incorporating collaboration early in the training
of medical professionals.
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Another participant responded that this is included in the Children's Centers Program. Each
Center is required to have a health specialist; the description of the health specialist could be
made clearer. Each Center receives $1 million for three projects and two cores. Rather than be
prescriptive, the Program is structured to allow the Centers to self-assemble, meaning that
CEHC Directors determine their partners (e.g., PEHSUs). For peer-review purposes, however,
clinical partners must be local.
Mr. Rich Callan, EPA, said that further discussions will continue, and he encouraged
collaboration among the Centers and PEHSUs. He suggested that attendees might follow-up
with each other immediately after this meeting (e.g., complete sign-up sheets to exchange
emails, plan monthly calls). EPA would like to see this discussion grow and looks forward to
hearing about future partners.
One area to work on now concerns opportunities for PEHSUs and CEHCs to work together to
respond to time-sensitive environmental issues. NIH has an R21 grants program that accepts
applications on an ongoing basis for time-sensitive issues, and NIEHS staff are available to
answer questions about this.
Ms. Khesha Reed, EPA Office of Children's Health Protection, commented that EPA's Children
Health Coordinators in the regions are available as a resource. Many coordinators currently
work with PEHSUs, and they also would welcome the opportunity to work with the Centers.
Dr. Sathyanarayana encouraged participants to report on their collaborations at next year's
meeting.
Session 6: Social Context of Environmental Exposures
Moderator: Marie Lynn Miranda, Ph.D., University of Michigan
Exposure to environmental toxicants is modulated by social and environmental stress; air
pollution has a different effect on child development in the context of a community in which
there is a great deal of social stress and no housing stability, employment stability, crime or
places for children to play. The interaction between chemical and psychosocial stress has
synergistic and nonlinear effects on growth, neural development and immune function.
Prenatal Stress and Neurotoxic Metals: If One Is Bad, Then Two Must Be...?
Deborah Cory-Slechta, Ph.D., University of Rochester Medical School
The reason to study risk factors in combination is that most diseases and disorders are complex;
they arise from the interaction of multiple risk factors. In many places, neurotoxic exposures
and social or environmental stress co-occur. Most importantly, chemical, social and
environmental stressors share biological substrates and produce common adverse effects. The
effects of psychosocial stress and toxic metals are mediated by the hypothalamic-pituitary-
adrenal (HPA) axis. These stressors also share common adverse outcomes, particularly deficits
in cognitive ability, memory and attention.
In an experiment in which rats were exposed continuously to lead, a subset of those also was
exposed to prenatal stress. Mice exposed to the combination of stressors were less able to
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learn prototypical responding to a fixed interval schedule of food reinforcement, a behavioral
paradigm considered a surrogate for impulsivity. The stressors affected male and female rats
differently. The stressors had molecular as well as behavioral effects; the researchers found
increased hippocampal nuclear glucocorticoid receptors in male rats and effects on frontal
cortex serotonin in females. A similar study on the combined effects of methylmercury and
stress found that this combination produces synergistic effects, impairing learning and memory
in female offspring. The combined stressors led to changes in brain chemistry. The
neurochemical effects of methylmercury were sexually dimorphic and nonmonotonic,
sometimes peaking at intermediate methylmercury concentrations.
In a subsequent experiment, mice were exposed to lead and prenatal stress and then given a
history of positive reward or subjected to forced swimming (negative experience). The
consequences of lead and prenatal stress were influenced by behavioral experience in the
consequent trajectory of lead and stress-related neurochemical changes. Dr. Cory-Slechta
noted that although this finding is not surprising, it often is ignored in neurodevelopmental
toxicology studies.
Many studies have led to the conclusion that the study of chemical risk factors in isolation from
other predisposing risk factors underestimates human health risks. They are studied in the
absence of context. There is a need to move beyond experimental models focused on single risk
factors because they are not consistent with the reality of human diseases and disorders, most
of which are complex and multifactorial. The attributable risks of chemicals will differ
depending on the psychosocial context.
Maternal Stress and Pollution: Rewiring Brain in Offspring
Richard L Auten, M.D., Duke University Medical Center
Dr. Richard Auten described his work on the interaction of genetic, environmental and social
factors influencing the health of a developing human. Stressors affecting the human HPA axis
modify its susceptibility to pollutants, and this susceptibility can be transduced from mother to
fetus, thus affecting the child's response to later adverse life events, including exposure to poor
diet. The challenge in research is to balance the precision of single-agent toxicological
approaches with the reality of multifactorial "real world" exposures. Multiple complex
exposures are difficult to analyze. Animal models allow a greater complexity of experimental
design while allowing the control to understand precisely how interactions affect outcomes.
This study's focus on diesel and stress was motivated by earlier work examining maternal diesel
inhalation during pregnancy before birth and effects on offspring susceptibility to high-fat diet
and obesity. In the experiment, the combined maternal exposure to diesel and offspring
exposure to a high-fat diet led to offspring obesity as well as to effects on behavior and on
immune function. The combined exposure increased anxiety and decreased learning in
offspring. Male offspring were affected more adversely than females.
It has been challenging to simulate stressors similar to those experienced by humans in the
animal models. Mothers exposed to social isolation and bright lights produce offspring with
increased Cortisol levels, impaired learning, and increased anxiety and depression. In this study,
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researchers used a milder form of stress by reducing the bedding of the mice. The mothers
increased their activity to search for bedding and did not attend to the pups. The pups in turn
had higher Cortisol responses and decreased learning. If the nest restriction happened only
during pregnancy and was then restored after the pups were born, the pups still exhibited
adverse health effects, indicating that maternal stress is transmitted prenatally to the
developing fetus. The combination of diesel exposure and nest deprivation affected neural and
immune function in the offspring, and the pups' response was sexually dimorphic, with stronger
effects seen in the males. The combined stressors had effects on microglia, which are critical for
fate specification in neurons. This could be a mechanism by which stress affects brain chemistry
and development.
An Ecological Approach to Human Health Studies and Health Promotion
Mark Miller, M.D., UC San Francisco PEHSU
Dr. Mark Miller emphasized the importance of feedback between animal models and human
studies in increasing the understanding of the impacts of exposure on children's health.
Although science traditionally has been reductionistic and effective at isolating factors, this
forum has demonstrated how important it is to examine the synergistic effects brought by the
interactions of different exposures. In the world of alternative or complementary medicine,
people are reconnecting mind and body; science also is beginning to demonstrate the
importance of the interactions between genetic, environmental and psychosocial exposures.
Exposures and effects occur at a variety of scales, from the molecular level to individual
relationships and even the larger-scale social structures. To move toward evidence-based,
science-based policy, it is necessary to think in an integrated manner about the environmental
and social factors that affect health.
Rodents placed in an enriched environment have improved health outcomes; some of the
molecular basis for this effect already is known. This presents an opportunity to consider the
role of the environment in mitigating the effects of exposures to toxicants. Interventional
studies examining the effects of lead exposure in an enriched environment are needed to
determine whether there are methods to design the environment so as to ameliorate the
effects of environmental toxicants.
Panel
Questions and Answers
Dr. Eskenazi noted that, as an epidemiologist, she struggles with how to unite animal models
with human studies. Animal studies typically have limited sample sizes and also do not take into
account the innate variation in reactivity that is observed in humans. Dr. Marie Lynn Miranda
suggested that animal and epidemiological studies must meet in the middle; there is a constant
feedback loop in which epidemiological and clinical observations inform the design of animal
model experiments, and experiments might point to new social and environmental factors that
should be examined in epidemiological studies. This feedback is what makes the work at the
CEHC Centers so important.
Dr. Cory-Slechta acknowledged that there always will be a sample size issue in animal studies.
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Better methods to analyze interactions are needed. In addition, animals should be separated
based on their innate reactivity and personality; each child has a unique profile of predisposing
factors. This will require the development of new statistical methods for analysis. Dr. Miranda
noted that there has been a great deal of investment in technologies to generate data but little
investment in the development of methods to analyze the data. Methods development will be
critical for further progress.
Dr. Miller grappled with how to incentivize collaborations between the PEHSUs and CEHC. How
to incentivize collaborations is an issue that should be addressed at the federal level.
Dr. Devon Payne-Sturges, EPA, indicated that Dr. Madeleine Scammel, an EPA Science To
Achieve Results (STAR) grantee who works on cumulative risk assessment at Boston University,
is borrowing methods in mathematics (Gaulois lattice method) to examine the effects of
combined factors, and other STAR grantees are developing statistical methods. Every grantee is
required to produce annual reports. It would be useful to complete a review of cumulative risk
assessments with EPA and combine these issues with Children's Centers.
Dr. Sally Darney, EPA, and Dr. Miranda noted that there is interest in investigating how enriched
environments can enhance or mitigate stresses.
A participant asked whether anybody has investigated the combined effects of lead and
mercury. Dr. Cory-Slechta indicated that these would be next steps. She is more interested in
the synergistic effects of exposures affecting the same biological substrate. The case must be
made that lead, mercury and stress share the same biological substrates.
Dr. Auten indicated that the difficulty is to investigate unknown biological pathways that deal
with resiliency. For example, adaptive immunity can influence how things play out with
subsequent exposures later in life. Dr. Neumann noted that human exposure typically occurs
with a long half-life so it is essentially a lifetime exposure at some level, whereas animal models
usually are exposed for a well-defined period. What is the best way to interpret the results from
animal models in terms of observational epidemiology? Dr. Cory-Slechta explained that the
merit of exposing animals for a specific window is to determine the maternal contribution to
the effects on offspring. Nevertheless, it is important to study the effects of both short windows
and chronic exposures to separate the cause and effects. Dr. Miranda noted that some
exposures tend to be chronically episodic exposures. In both animal studies presented today,
there is long-term chronic exposure during the prenatal or postnatal period. Dr. Auten
explained that the nature of the exposure (e.g., chronic, episodic) has implications for
resiliency. Homeostatic mechanisms resist these insults but may be able to resist them only to a
point. If periodicity or magnitude is excessive, homeostatic mechanisms may not be able to
mitigate the negative effects of exposures. Dr. Cory-Slechta commented that the focus on the
maternal exposure is with an eye toward intervention. If maternal exposure leads to lifetime
changes, and most screening programs occur in children, then the screening and intervention
are happening too late in life. It is critical to understand the maternal contribution, because
early intervention is an important window of opportunity.
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Highlight—15 Years of the CEHC Program
Elaine Faustman, Ph.D., University of Washington
The University of Washington Center focuses on translating results of the study to participants
who reside primarily in the agricultural community, in which there is tension surrounding the
issues of pesticide use and best practices. The Center takes a multipronged approach, in the
field and in the laboratory, investigating the interactions between genes and environment
across time. Methodologies include animal studies, cell culture studies and extrapolations to
observations in the field.
The Center has been using community-based participatory research for 15 years to investigate
mechanisms of environmental exposure. The Community Advisory Board was founded in 1999.
A hallmark of the CEHC program is the investigation of episodic, practice-driven exposures:
chronic and repeated high dose exposures. Repeated environmental and biospecimen sampling
occurs over time. Studies investigate the effects of chemical and nonchemical stressors on
respiratory health by pairing migrant farmworkers with non-farmworkers for comparison.
Questionnaires and biomarkers are used to assess stress.
At heart of this Center is community intervention, activities of which have touched more than
15,000 people. The identification of critical pathways of exposure has been very important for
understanding how pesticides affect farmworkers and their families and for determining
appropriate interventions. In spite of the time and inconvenience, participants have cooperated
with the researchers to find solutions together. The Center has organized bimonthly journal
clubs, toolkits, webinars and other outreach activities to ensure that the community receives
the benefits of this research.
Session 7: The Clinical and Translational Implications of Epigenetics in Children's Environmental
Health
Moderator: Joe Wiemels, Ph.D., UC Berkeley
The Role of Epigenetics in the Spectrum of Human Health: From Basic Development Processes
to Population Research and Therapeutics
Joe Wiemels, Ph.D., UC Berkeley
Dr. Wiemels introduced the discussion about epigenetics with the statement, "Your DNA is not
your destiny." DNA is the same in all body cells but is packaged and marked differently based
on cell types, which allows them to have distinct cell functions. The science of epigenetics
focuses on how DNA is packaged, the differences in packaging between different cell types, and
how this packaging affects gene function. DNA is wrapped on histones and commonly
acetylated or methylated; these modifications alter gene expression. Although epigenetic
marks are heritable from one cell to its daughter cells, epigenetic features are modifiable as
cells differentiate into different functions. For example, as stem cells develop into functional
blood cells, their DNA is demethylated at genes important for blood cell function.
Most epigenetic variation is established early in development. After fertilization, somatic cells
are first demethylated, and then heavily methylated. Early fetal development is a time in life
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during which methylation patterns rapidly change. By birth, most of these patterns are fixed
for life, and certain features of epigenetic patterns can affect childhood and lifetime disease
risk. Some epigenetic changes are adaptations to our growth environment: adaptation to
nutrition, behavior and chemical environments affects the epigenetic markers in cells. Many
diseases (cancer and others) are linked to epigenetic modifications. Many drugs have epigenetic
mechanisms of action.
How Early BPA, Lead and Phthalates Exposures Alter the Epigenome and Health Outcomes
Later in Life
Dana Dolinoy, Ph.D., University of Michigan
Dr. Dana Dolinoy introduced her work about how exposures to BPA, lead and phthalates can
affect the risk for metabolic syndrome later in life. There are many mechanisms by which these
toxicants affect disease risk, one of which is epigenetics. The epigenome is modifiable using
nutrition and pharmaceuticals to counteract the effects of environmental exposures and thus
represents an opportunity for intervention.
To investigate environmental effects on the epigenome and the potential for intervention, Dr.
Dolinoy described the viable yellow agouti mouse model. Yellow mice are not methylated at the
agouti locus and have an increased risk of metabolic syndrome and obesity, whereas brown
mice are methylated at this locus, so the agouti gene is not expressed, and the mice remain
lean. Maternal nutrition as well as exposures to chemicals such as BPA affects the distribution
of coat colors in the offspring, indicating that environmental exposures affect DNA methylation
at the agouti locus and perhaps elsewhere. Nutritional supplementation with methyl donors
such as folate can reverse the BPA-induced shift in coat colors and DNA methylation.
The explosion of technology surrounding epigenetics will allow researchers to move from single
candidate gene studies to investigating the full epigenome; collaborations with
bioinformaticians will be necessary to analyze the resulting data. In studying the epigenome, it
will be important to link epigenetic changes to phenotypes. Some epigenetic effects could be
bystander effects and might not have an effect on gene expression or affect health.
The University of Michigan Center focuses on how chemicals alter the epigenome, particularly
early in life, because the epigenome is programmed early in development. In this study, mice
were exposed to different diets before being mated, and the pups were followed through
lactation. Diet affected the coat color distribution of the pups in a nonmonotonic fashion, with
high maternal exposure shifting the coat color distribution toward the yellow range but lower
exposure levels resulting in the opposite. Other genes also respond nonmonotonically upon
exposure. Pathway analysis of differentially methylated genes showed that methylation
changes disproportionately affected metabolic pathways and immune response pathways.
Dr. Dolinoy described another experiment in which body weight, body composition and activity
were measured in response to maternal BPA exposure. The animals were fed a normal-fat diet.
Although BPA is typically believed to be an obesogen, in this mouse model, BPA causes
hyperactivity, lower body mass, lower food intake and a better hormone profile in female
offspring. Researchers plan to further investigate by challenging these mice with a high-fat diet
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and also by analyzing how BPA might mediate its effects on hyperactivity by affecting gene
expression in the brain.
In another exposure study, mice were exposed to lead perinatally. Lead is a well-characterized
neurotoxin, but its effects as an obesogen are less known. Pregnant mice were exposed to lead
via their water at three doses, and there was a detectable shift in the distribution of coat colors
of the offspring. Higher doses of lead caused an increase in the number of yellow offspring.
There was a sexually dimorphic effect; male offspring had increased body weight, but the
female offspring did not. Lead was shown to cause locus- and sex-specific methylation effects at
weaning, persistent increased food intake and body fat in males. Future studies will investigate
how methylation patterns shift over time, whether these patterns are gene or tissue specific,
and how they are affected by lead exposure.
Mechanistic Pathways between Environmental Exposures and Epigenetic Changes
Frederica Perera, Ph.D., Dr.P.H., Columbia University
Dr. Perera introduced the mission of the CCCEH, which is to prevent childhood
neurodevelopmental impairment, asthma, obesity and cancer through early identification of
environmental risk factors and translation to intervention. Prenatal exposures to PAH and BPA
can have consequences throughout life and even transgenerational effects. The mechanisms by
which in utero exposures affect fetal development include genotoxicity (DNA damage and
mutations), oxidative stress, epigenetic alterations and interference with normal hormonal
pathways. The Center focuses on exposures during the prenatal window because epigenetic
programming occurs during this time.
The goal of the study was to determine whether exposure to PAH and BPA is associated with
changes in DNA methylation, especially at loci that are critical in fetal brain development. In the
Center's cohort study that enrolled 720 mother-child pairs, prenatal or postnatal exposure to
PAH and BPA was associated with adverse reproductive and neurobehavioral outcomes.
Prenatal PAH exposure was associated with changes in brain morphology as assessed by MRI at
ages 7 through 9 and lower levels of global DNA methylation. Patterns of methylation in cord
blood (at birth) were correlated with methylation patterns at 3 years of age, indicating that
modifications in utero can persist in childhood.
The study has also focused on specific candidate genes, chosen because of their known
importance in early brain development and roles in endocrine function, immune function and
inflammatory pathways. The first example, interferon gamma, is a pro-inflammatory cytokine
involved in neurogenesis. It is known to mediate the effects of maternal inflammation on the
fetus. In cord blood samples from the Center's cohort, prenatal PAH was associated with
increased promoter methylation of interferon gamma in regions 1 and 2 of the gene.
Brain-derived neurotrophic factor (BDNF), another candidate gene, is involved in the survival
and differentiation of neuronal cells. It is expressed in the hippocampus and other regions of
the brain. In the Center's studies conducted in New York City as well as in China, exposure to
PAH was associated with lower BDNF protein in cord blood.
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ERa (Estrogen receptor alpha) is another candidate, involved in fetal neurodevelopment, and
previously associated with BPA exposure.
In collaboration with the University of Cincinnati. Center researchers analyzed cord bloods from
the cohort using the lllumina 450k microarray. More than 2,000 of these sites showed
differential methylation patterns in response to prenatal exposure to PAH. The researchers
currently are conducting a pathway analysis using gene ontology to determine which cellular
functions are affected by the changes in DNA methylation. Thus far, they have identified a
number of pathways relevant to neurodevelopment.
In parallel laboratory experiments, gestational exposure to BPA resulted in sex-specific changes
in ERaexpression in the offspring hypothalamus that were associated with changes in DNA
methylation also in the offspring hypothalamus, and with alteration in social and anxiety-like
behavior in the offspring.
Center investigators are able to utilize these datasets to explore the role of epigenetic
mechanisms in mediating other exposure-outcome associations observed in the cohort, for
example with exposure to phthalates and pyrethroids.
The focus on environmental epigenetics is important because it provides a mechanism that can
theoretically be targeted for intervention and prevention.
Translation of research is key to prevention, and the Center's research already has had impact
on policy, including laws to reduce emissions from diesel busses and trucks and other
combustion sources in New York City as well as other measures to reduce exposures.
Preventive policies are needed to protect children at this vulnerable lifestage.
Questions and Answers
Dr. Jennifer Lowry, Children's Mercy Hospital, expressed concern that, although translation and
prevention are necessary directions, clinical practitioners often misinterpret the information
they receive from researchers. There is a need to conduct translation and outreach so that
research findings are interpreted accurately. Dr. Newman agreed, commenting that findings
should not be disseminated prematurely to prevent misinterpretation by clinicians and
community members.
Dr. Kari Nadeau, Stanford University, mentioned that he has observed "connectivity," or a
ripple effect, in methylation at specific alleles. In other words, methylation at one site may
increase the likelihood of methylation at nearby sites (and vice versa for demethylation). Thus,
there is potential for amplification of environmental exposures, as the methylation patterns
spread spatially through the genome. Dr. Dolinoy agreed that methylation is correlated spatially
in the genome and noted that it is important to use the right statistical methods to analyze and
report methylation patterns.
Another participant noted that some of the clinical trials at The Johns Hopkins University Center
might accelerate the tests of multifactorial interventions and noted that the research
community should consider how to build community-based efficacy trials. Dr. Dean Baker, UC
Irvine, elaborated that Centers have normal avenues for community outreach and translation,
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but a formal mechanism (e.g., talks and focus groups) is needed to obtain feedback from the
community. In addition, Centers should share lessons learned about methods for translating
research findings to the community in their region.
EPA/NIEHS Children's Centers Program Office Remarks
Nica Louie, M.S., EPA
Ms. Louie thanked meeting participants on behalf of the EPA and NIEHS Children's Centers
program staff and expressed gratitude for the ability to host the annual Children's Centers
meeting - despite the Federal government shutdown. She said that in order to leave the
meeting with the words and wisdom of Dr. Christopher, she would offer brief closing remarks
and then end the meeting with the keynote address.
She began by stating that a meeting on children's environmental health transcends every
individual, every affiliation, organization and personal goal. Stressing that such a meeting is
about moving a really vital field forward. She expressed appreciation to the exceptional
presenters, keynote speakers and expert panelists that made the conference a success and
acknowledged the tremendous efforts of the Steering Committee members (listed
alphabetically):
Martha Berger (EPA/OCHP), Pat Buffler (UC Berkeley), Rich Callan (EPA/NCER), Jenny Collins
(NIEHS), Sally Darney (EPA/ORD), Ken Elstein (EPA), Elaine Faustman (University of
Washington), Kim Gray (NIEHS), Jennifer Lowry (Region 7 PEHSU), Jennifer Mall (EPA/NCER),
Marie Lynn Miranda (University of Michigan), Devon Payne Sturges (EPA/NCER), Sheela
Sathyanarayana (Region 10 PEHSU), and Virginia Rauh (Columbia University).
Ms. Louie expressed gratitude that the PEHSUs were able to join the annual Children's Centers
meeting and thanked her fellow program staff Rich Callan, Kim Gray and Cindy Lawler, as well
as EPA Communications Director, Kelly Widener and The Scientific Consulting Group, Inc.
(contractor) whose personal sacrifices made the meeting possible.
She closed by thanking EPA and NIEHS senior management, Jim Johnson, Linda Birnbaum and
Gwen Collman for their support and expressed hope that the participants leave the meeting
empowered, with new collaborative opportunities and experience tremendous success. She
recalled EPA Administrator McCarthy's urging to renew the commitment to children's health
and encouragement to sprint through the marathon.
Keynote: Protecting ALL Children's Health: Recognizing and Mitigating the Effects of Chronic
Exposure to Adversity
Gail Christopher, D.N., Kellogg Foundation
Dr. Gail Christopher, who serves as Vice President for Program Strategy at her foundation,
expressed her deep respect for the pioneering and cutting-edge work of the Children's Centers.
In establishing the Kellogg Foundation, W.K. Kellogg stipulated only one condition: that it be
used to help children. The foundation's mission statement is, "We envision a Nation that
marshals its resources to ensure that all children thrive." Most children born today in the
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United States are of color, and they bear a disproportionate burden of adversity, including
adversity from exposure to environmental toxins.
Dr. Christopher discussed the interface between social determinants of health and
environmental justice. Social determinants of health are defined broadly as the circumstances
in which people are born, grow up, play, live and work. If society addressed the social
determinants of health, which are shaped by the distribution of power, there would be no need
to address environmental justice. In the United States, the distribution of power arises from a
historical legacy of determining a person's value based on their physical characteristics.
Uprooting this belief often is ignored in addressing disparities and inequities. The Kellogg
Foundation recognizes the need for leaders to deal with the unfinished business of structural
inequalities. Dr. Christopher enjoined the participants as leaders to understand that uprooting
structural inequalities is central to translating their work to policies and actions.
Children experience double jeopardy when they live in both poor families and poor
neighborhoods. A disproportionate number of black and Hispanic children live in poor families
and poor neighborhoods compared with white children. Schools today are more segregated
than when the U.S. Supreme Court decided the case of Brown v. Board of Education. Past
inequalities persist at great cost to society. The gap in earning between people of color and
non-Hispanic whites continues and is worse in times of recession. If current inequities are not
addressed, they will produce more harm to the Nation's children in the future, a population
that is projected to be "majority minority" by 2018. There are continued disparities in birth
outcomes for African-American and white women that also depend on the mother's
employment opportunities and educational levels. In addition to blacks, disparities affect all
groups perceived as different, including Alaska Native peoples, Native Americans, Hispanicsand
Appalachian whites. The term "racial equity" describes actions to address existing race-based
disparities, which include economics, housing, education, exposure to disease, burden of
disease and access to quality health care. To achieve racial equity, everyone must participate; it
cannot be a "we-they" conversation. Dr. Christopher shared a personal story that is part of her
motivation to work toward achieving racial equity. Her 6-week-old baby had a congenital heart
defect, but her doctor failed to inform her of an operation that could have saved her child's life.
Dr. Christopher's baby died 1 month after being diagnosed. Dr. Christopher stated that her
personal loss pales in comparison to the widespread denial of opportunities to people based on
racism.
The effects of inequities and disparities are particularly evident in the cumulative impacts of
stress. As the Children's Centers have shown, stress dramatically accelerates health risks. The
CDC has developed 59 data-based indicators to determine the factors that need to be changed
and the way to change them to address disparities in stress. Exposure to environmental toxins
is missing, however, from these indicators. Of the 59,13 were selected as actionable, including
adverse childhood experiences, experience of racial discrimination by pregnant women and
children, segregation in communities, smoking in the home, child or adult obesity, food
insecurity, depression in youth, and incarceration rates. Dr. Christopher provided an example of
a community response to a stressor: the strong local food movement that has formed in
Detroit, Michigan, in response to food insecurity.
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Dr. Christopher outlined personal actions that can be taken to address the legacy of
determining a person's value based on his or her physical characteristics. These actions address
unconscious biases and microaggression. She urged everyone to take the test developed by
Harvard University to assess implicit social biases. Although progress has been made in some
social institutions, implicit biases have not been addressed sufficiently in the health care
system. Microaggression result from the ways in which actions are interpreted and
misinterpreted on a daily basis, leading to a stress response. Organizations can make concrete
changes to change the work environment and reduce this source of stress. There is a need to
create dynamics in communities to minimize individuals' exposure to unconscious bias and
microaggression. The Kellogg Foundation has invested $100 million in communities and seen
amazing transformations. She urged scientists to bring the lens of the legacy of disparities to
their work and commit to finding holistic and context-based answers. There is a need to provide
the social supports that will protect children from harm from disparities. Dr. Christopher
thanked the participants for inviting her and expressed her pleasure from learning about a
community that is willing to work together to transcend the legacy of disparities.
Adjournment
The meeting organizers thanked the speakers and participants and adjourned the meeting at
1:15 p.m.
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Speaker Biosketches
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Gina McCarthy
U.S. Environmental Protection Agency (EPA)
Gina McCarthy is the Administrator of the U.S. Environmental Protection Agency.
Appointed by President Obama in 2009 as Assistant Administrator for EPA's Office of Air and
Radiation, Gina McCarthy has been a leading advocate for common-sense strategies to protect
public health and the environment.
Previously, Ms. McCarthy served as the Commissioner of the
Connecticut Department of Environmental Protection. During her
career, which spans more than 30 years, she has worked at both the
state and local levels on critical environmental issues and helped
coordinate policies on economic growth, energy, transportation and the
environment.
Ms. McCarthy received a B.A. in Social Anthropology from the University of Massachusetts at
Boston and a joint M.S. in Environmental Health Engineering and Planning and Policy from Tufts
University.
When she is not in Washington, DC, Ms. McCarthy lives in the Greater Boston area with her
husband and two dogs, just a short bike ride away from their three children, Daniel, Maggie and
Julie.
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Linda S. Birnbaum, Ph.D.
National Institute of Environmental Health Sciences (NIEHS), National
Institutes of Health (NIH)
Dr. Birnbaum is the Director of the NIEHS of the NIH arid the National
Toxicology Program (NTP). As NIEHS and NTP Director, Dr. Birnbaum
oversees a budget of $730 million that funds biomedical research to
discover how the environment influences human health and disease. The
Institute also supports training, education, technology transfer and
community outreach. NIEHS currently funds more than 1,000 research
grants.
A board certified toxicologist, Dr. Birnbaum has served as a federal scientist for nearly 34 years.
Prior to her appointment as NIEHS and NTP Director in 2009, she spent 19 years at the U.S.
Environmental Protection Agency (EPA), where she directed the largest division focusing on
environmental health research. Dr. Birnbaum started her federal career with 10 years at the
NIEHS, first as a senior staff fellow in the NTP, then as a principal investigator and research
microbiologist, and finally as a group leader for the Institute's Chemical Disposition Group.
Dr. Birnbaum has received many awards and recognitions. In October 2010, she was elected to
the Institute of Medicine of the National Academies, one of the highest honors in the fields of
medicine and health. She was elected to the Collegium Ramazzini, and received an honorary
Doctor of Science from the University of Rochester and a Distinguished Alumna Award from the
University of Illinois. Other awards include the 2011 NIH Director's Award, Women in
Toxicology Elsevier Mentoring Award, Society of Toxicology Public Communications Award,
EPA's Health Science Achievement Award and Diversity Leadership Award, National Center for
Women's 2012 Health Policy Hero Award, Breast Cancer Fund Heroes Award, 2013 American
Fublic Health Association Homer N. Calver Award, 2013 Children's Environmental Health
Network Child Health Advocate Award, and 14 Scientific and Technological Achievement
Awards, which reflect the recommendations of EPA's external Science Advisory Board, for
specific publications.
She is the author of more than 600 peer-reviewed publications, book chapters and reports. Dr.
Birnbaum's own research focuses on the pharmacokinetic behavior of environmental
chemicals; mechanisms of action of toxicants, including endocrine disruption; and linking of
real-world exposures to health effects. She is also an adjunct professor in the Gillings School of
Global Public Health, the Curriculum in Toxicology, and the Department of Environmental
Sciences and Engineering at the University of North Carolina at Chapel Hill, as well as in the
Integrated Toxicology and Environmental Health Program at Duke University.
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Lek Kadeli, M.A.
U.S. Environmental Protection Agency (EPA), Office of Research
and Development (ORD)
Mr, Kadeli is the Acting Assistant Administrator in EPA's ORD. He has
more than 29 years of management experience in both government and
the private sector, with broad experience in leading organizational
change and improvement, policy development, resource management,
information management, and technology.
Mr. Kadeli began his EPA career in 1990 as an analyst in the Office of the Comptroller, and also
served as the Senior Budget Officer in EPA's Office of International Activities. He moved to ORD
in 1993 to serve as Chief of Resource Planning and Program Coordination, and in 1998 served as
the Acting Deputy Director of ORD's National Exposure Research Laboratory in Research
Triangle Park, North Carolina. He was the director of ORD's Office of Resources Management
and Administration from 2001 to 2005 before becoming the Deputy Assistant Administrator for
Management. He previously served as the Acting Assistant Administrator for ORD from January
through December of 2009.
Mr. Kadeli received two of the Agency's highest awards for exemplary service: a Gold Medal for
Distinguished Service and the Lee Thomas Award for Excellence in Management.
Mr. Kadeli graduated from George Mason University in 1983 with a B.A. in International
Relations. In 1986, he earned an M.A. in National Security Studies from Georgetown University.
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Gail C. Christopher, D.N.
W.K. Kellogg Foundation
Dr, Christopher is Vice President for Program Strategy at the W.K.
Kellogg Foundation. In this role, she leads the Food, Health and Well-
Being, Racial Equity, Community and Civic Engagement and Leadership
programming.
Dr. Christopher is a nationally recognized leader in health policy, with
particular expertise and experience in the issues related to social determinants of health, health
disparities and public policy issues of concern to our Nation's future. She has more than 20
years of experience in designing and managing national initiatives and nonprofit organizations.
She brings extensive knowledge and experience in creating a comprehensive approach to well-
being and is nationally recognized for her pioneering work to infuse holistic health and diversity
concepts into public sector programs and policy discourse. Her distinguished career and
contributions to public service were honored in 1996 when she was elected as a Fellow of the
National Academy of Public Administration. A prolific writer and presenter, Dr. Christopher is
the author or co-author of three books, a monthly column in the Federal Times, and more than
250 articles, presentations and publications.
Dr. Christopher holds a Doctorate of Naprapathy degree from the Chicago National College of
Naprapathy in Illinois and completed advanced study in the interdisciplinary Ph.D. program in
holistic health and clinical nutrition at the Union for Experimenting Colleges and Universities at
Union Graduate School of Cincinnati, Ohio. She is President of the Board of Directors of the
Trust for America's Health.
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Sandra Steingraber, Ph.D.
Ecologist, author and cancer survivor, Sandra Steingraber, Ph.D., is an
internationally recognized authority on the environmental links to
cancer and human health. Dr. Steingraber's highly acclaimed
book, Living Downstream: An Ecologist's Personal Investigation of
Cancer and the Environment, presents cancer as a human rights issue.
Originally published in 1997, it was the first study to bring together
data on toxic releases with data from U.S. cancer registries and won
praise from international media.
Dr. Steingraber's second book, Having Faith: An Ecologist's Journey to Motherhood, explores
the intimate ecology of motherhood. Both a memoir of her own pregnancy and an investigation
of fetal toxicology, Having Faith reveals the extent to which environmental hazards now
threaten each stage of infant development and was featured in a PBS documentary by Bill
Moyers. Called "a poet with a knife" by Sojourner magazine, Dr. Steingraber is the recipient of
many prestigious awards, and the Sierra Club has heralded her as "the new Rachel Carson." An
enthusiastic and sought-after public speaker, Dr. Steingraber also has keynoted at conferences
on human health and the environment throughout the United States and Canada, including at
Harvard, Yale, Cornell, Columbia and the Woods Hole Research Center. Interviews with Dr.
Steingraber have appeared in The Chicago Tribune>, USA Today, The Cleveland Plain Dealer, and
on National Public Radio, "The Today Show" and "Good Morning America."
Randy Olson, Ph.D.
Wrigley Institute for Environmental Studies at the University
of Southern California (USC)
Dr. Olson is the writer/director of the feature films Flock of Dodos: The
Evolution-Intelligent Design Circus, (Tribeca '06, Showtime '07), Sizzle:
A Global Warming Comedy (Outfest '08), and author of Don't Be Such
a Scientist: Talking Substance in an Age of Style (Island Press '09).
Dr. Olson's work focuses on the challenges involved in communicating
science to the general public and on the current attacks on mainstream science in fields such as
evolution and climate science. He is a former marine biologist (Ph.D., Harvard University) who
achieved tenure at the University of New Hampshire before changing careers to filmmaking by
obtaining an M.F.A. in Cinema from the University of Southern California (USC). He is an adjunct
faculty member with the Wrigley Institute for Environmental Studies at USC. His production
company, Prairie Starfish Productions, is based at Raleigh Studios in Los Angeles.
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Ramona Trovato
U.S. Environmental Protection Agency (EPA)
Ms. Trovato is the Associate Assistant Administrator for the U.S.
Environmental Protection Agency's Office of Research and Development.
During her career at the EPA, Ms. Trovato has had the opportunity to
work in 7 major organizations in headquarters: Office of Research and
Development, Office of the Administrator, Office of Water, Office of
Enforcement and Compliance Assurance, Office of Air and Radiation, Office of Environmental
Information and Office of Solid Waste and Emergency Response. She also worked in Region 3.
Ms. Trovato has received several awards that are particularly noteworthy. During her
government service she was recognized with the Distinguished Career Award in recognition of
extraordinary leadership and exceptional dedication in serving the American people; the
President's Meritorious Executive Rank Award for leadership, for achieving results in
environmental and public health protection, and for building strong coalitions and partnerships
to achieve environmental and public health goals; the EPA's Silver Medal for developing the
National Environmental Laboratory Accreditation Conference; and the President's Award of the
Association of Public Health Laboratories for meritorious service to public health
laboratories. In 2005, she received EPA's Children's Environmental Health Champion Award.
During this time, Ms. Trovato worked on many complex environmental issues with many
thoughtful, professional, and hard-working people to find solutions that were protective of the
environment and public health, and cost effective. She is most proud of her work in protecting
and promoting children's health; finding a safe solution for disposal of low-level, transuranic
waste; consolidating 8 different Clean Water Act penalty policies; developing and implementing
the comprehensive State ground water protection program; working with the private sector
and states to make the best and highest use of properties cleaned up under the Superfund
program; enhancing the IT department's commitment to service through improved
understanding of program needs; nurturing, developing and implementing the National
Environmental Laboratory Accreditation Program; and working to assure that the country has
the environmental laboratory capability and capacity to respond to emergencies related to
homeland security.
Ms. Trovato received a B.S. Degree in Zoology from the University of Maryland at College Park
in 1974. She undertook additional studies in chemistry, facilitation, negotiation, information
technology management, management and leadership throughout her career.
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James H. Johnson, Jr., Ph.D.
U.S. Environmental Protection Agency (EPA), Office of Research
and Development (ORD)
Dr. Johnson is the Director of the National Center for Environmental
Research (NCER) at EPA's ORD. In this role, Dr. Johnson continues a life-
long career dedicated to sustaining and advancing scientific research
and education initiatives supporting environmental protection, quality
of life programs and policies, and environmental workforce
development. Dr. Johnson has served on numerous committees and
boards for the National Academies, EPA and academic institutions. He is a member of the Anne
Arundel Community College (MD) Board of Trustees, and is Professor Emeritus of Civil
Engineering and Dean Emeritus of the College of Engineering, Architecture and Computer
Sciences at Howard University.
Dr. Johnson earned his B.S. in Civil Engineering from Howard University, M.S. from the
University of Illinois, and Ph.D. in Applied Sciences from the University of Delaware. He is the
2005 recipient of the National Society of Black Engineers' Lifetime Achievement Award in
Academia and the 2008 Water Environment Federation Gordon Maskew Fair Award. His
research interests include the treatment and disposal of hazardous substances, the use of
nanomaterials for environmental restoration, the evaluation of environmental policy issues in
relation to minorities, and the development of environmental curricula and strategies to
increase the pool of underrepresented groups in the science, technology, engineering and math
(STEM) disciplines.
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Kenneth Olden, Sc.D., L.H.D.
U.S. Environmental Protection Agency (EPA), National Center
for Environmental Assessment (NCEA)
Dr. Olden joined NCEA in July 2012 with a strong legacy of promoting
scientific excellence in environmental health. From 1991 to 2005, he
served as the Director of the National Institute of Environmental Health
Sciences (NIEHS) and the National Toxicology Program (NTP) in the U.S.
Department of Health and Human Services. He made history in this role
as the first African-American to direct one of the National Institutes of
Health. In 2005, he returned to his research position as chief of the Metastasis Group in the
Laboratory of Molecular Carcinogenesis at the NIEHS, and for academic year 2006-2007, held
the position of Yerby Visiting Professor at the Harvard School of Public Health.
Most recently, Dr. Olden served as the Founding Dean of the School of Public Health at Hunter
College, City University of New York. He has published extensively in peer-reviewed literature,
chaired or co-chaired numerous national and international meetings, and has been an invited
speaker, often as keynote, at more than 200 symposia. He has won a long list of honors and
awards, including the Presidential Distinguished Executive Rank Award, the Presidential
Meritorious Executive Rank Award for sustained extraordinary accomplishments, the
Toxicology Forum's Distinguished Fellow Award, the HHS Secretary's Distinguished Service
Award, the American College of Toxicology's First Distinguished Service Award and the National
Minority Health Leadership Award.
Alone among Institute directors, he was awarded three of the most prestigious awards in public
health: the Calver Award (2002), the Sedgwick Medal (2004) and the Julius B. Richmond Award
(2005). Most recently, he received the Cato T. Laurencin M.D., Ph.D. Lifetime Research Award
from the National Medical Association Institute, the largest and oldest national organization
representing African-American physicians and their patients in the United States. He was
elected to membership in the Institute of Medicine at the National Academy of Sciences in 1994
and appointed member of the Visiting Committee for the Harvard University Board of
Overseers from 2007 to 2010.
Dr. Olden holds the following degrees:
• Temple University, Philadelphia, Ph.D., Cell Biology and Biochemistry, 1970.
• University of Michigan, Ann Arbor, M.S., Genetics.
• Knoxville College, B.S., Biology.
Additionally, Dr. Olden has numerous honorary degrees from several prestigious colleges
and universities.
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Richard Auten, M.D.
Duke University Medical Center
Dr. Auten received his Bachelor of Arts and medical degrees at the
University of North Carolina at Chapel Hili. After training in pediatrics at
the University of Rochester, he practiced as a pediatrician for 3 years
and returned to the University of Rochester for a neonatal medicine
fellowship. He joined the faculty of the Department of Pediatrics in 1990
and is now a Professor of Pediatrics. His research interests have focused
on the mechanisms of neonatal lung injury, as well as the interaction
between fetal inflammatory exposures and abnormal postnatal development. His research has
been supported by the American Lung Association, the Children's Miracle Network, the U.S.
Environmental Protection Agency, the National Institutes of Health and the March of Dimes, as
well as industry contracts. He is the author of more than 60 peer-reviewed scientific
publications and serves on the editorial boards of the American Journal of Physiology and the
American Journal of Perinatology.
Susan Buchanan, M.D M P H,
University of Illinois Department of Environmental and Occupational Health
Sciences
Dr. Buchanan is the Director of the Great Lakes Center for Children's
Environmental Health, which is the federally funded Pediatric
Environmental Health Specialty Unit for the U.S. Environmental Protection
Agency's Region 5. She also is a Clinical Assistant Professor at the
University of Illinois Department of Environmental and Occupational Health
Sciences.
Dr. Buchanan graduated from the Ohio State University College of Medicine and completed a
Family Medicine residency at the Medical Center Hospital of Vermont. After 9 years of clinical
Family Medicine practice, she sought additional training and board certification in Occupational
and Environmental Medicine. She is Associate Professor of Environmental and Occupational
Health Sciences at the University of Illinois at Chicago (UIC) School of Public Health, where she
teaches and conducts research on prenatal exposure to environmental pollutants. She is
Director of the UIC residency program in Occupational and Environmental Medicine.
f ?
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Antonia Calafat, Ph.D.
U.S. Centers for Disease Control and Prevention (CDC)
Dr. Calafat is the Chief of the Organic Analytical Toxicology Branch at the Division of Laboratory
Sciences, National Center for Environmental Health of the CDC. She earned her Bachelor's,
Master's and Doctoral degrees in Chemistry from the University of the Balearic Islands (Spain).
Prior to her career at CDC, she was a Fulbright Scholar and a Research Associate at Emory
University. She currently leads CDC's biomonitoring programs for assessing human exposure to
pesticides, polycyclic aromatic hydrocarbons and persistent organic pollutants such as
polyfluoroalkyl compounds. She also leads CDC's biomonitoring programs for polybrominated
diphenyl ethers, polychlorinated dibenzo-p-dioxins, furans, biphenyls and chemicals added to
consumer and personal care products, such as phthalates and phenols (e.g., bisphenol A,
triclosan and parabens). She has developed and maintained extensive collaborative research
with leading scientists in the fields of exposure science, epidemiology, toxicology and health
assessment. Her research has made relevant contributions to CDC's biomonitoring program,
including the CDC's National Reports on Human Exposure to Environmental Chemicals.
Lisa Cicutto, Ph.D., R.N.
National Jewish Health and University of Colorado Denver Children's
Environmental Health Center
Dr. Cicutto directs the Clinical Science Program at the University of
Colorado Denver and is currently the Director of Community Outreach
and Research at National Jewish Health and Co-Director of the
Community Outreach and Translation Core of the Denver Children's
Environmental Health Center funded by the National Institute of
Environmental Health Sciences and the U.S. Environmental Protection
Agency. In her role, she is dedicated to reducing the lung health burden of communities
through the translation and uptake of the best available research and evidence. She has more
than 20 years of experience working in community settings—primarily schools, child-care
settings and homes—to develop, implement and evaluate programs that are responsive to
community needs while being evidence-based and supportive of the partnerships that often are
needed with health care providers. One of the school-based asthma education programs of
which she led the development, implementation and evaluation is now a mandated program in
Ontario Public Health.
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Gwen W. Collmari, Ph.D.
Division of Extramural Research and Training, National Institute
of Environmental Health Sciences (NIEHS)
Dr. Coliman is Director of the NiEHS Division of Extramural Research and
Training where she leads approximately 60 professional staff in areas of
scientific program administration, peer review, and the management and
administration of about 1,500 active grants each year. She directs
scientific activities across the field of environmental health sciences,
including basic sciences (i.e., DNA repair, epigenetics, environmental genomics), organ-specific
toxicology (i.e., reproductive, neurotoxicology, respiratory), public health-related programs
(i.e., environmental epidemiology, environmental public health), and training and career
development. She also oversees the implementation of the Superfund Research Program and
the Worker Education and Training Program. Dr. Coliman served in program development and
management, beginning in 1992 as a member, then as Chief, of the Susceptibility and
Population Health Branch. She directed research on the role of genetic and environmental
factors on the development of human disease, from animal models of genetic susceptibility to
population studies focusing on etiology and intervention. She was responsible for building the
NIEHS grant portfolio in environmental and molecular epidemiology, and developed several
complex multidisciplmary research programs. These include the NIEHS Breast Cancer and the
Environment Research Centers Program; the NIEHS/U.S. EPA Centers for Children's
Environmental Health and Disease Prevention; and the Genes, Environment and Health
Initiative. Also under her guidance, a team created a vision for the Partnerships for
Environmental Public Health programs for the next decade.
Deborah A. Cory-Slechta, Ph.D.
University of Rochester School of Medicine and Dentistry
Dr. Cory-Slechta is currently a Professor of Environmental Medicine
and Pediatrics; former Dean for Research, Chair of the Department of
Environmental Medicine and Director of the National Institute
of Environmental Health Sciences (NIEHS) Environmental Health Sciences
Center at the University of Rochester Medical School; and former Director of
the Environmental and Occupational Health Sciences Institute (EOHSI) of Rutgers/Robert Wood
Johnson Medical School. Dr. Cory-Slechta has served on the editorial boards of
Neurotoxicology, Toxicology, Toxicological Sciences, Fundamental and Applied Toxicology,
Neurotoxicology and Teratology, and the American Journal of Mental Retardation. She also has
served in elected positions as President of the Neurotoxicology Specialty Section of the Society
of Toxicology, and President of the Behavioral Toxicology Society, and been named a Fellow of
the American Psychological Association. Her research on the role of environmental
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neurotoxicants in developmental disabilities and neurodegenerative diseases has resulted in
more than 150 papers and book chapters to date.
Kathryn Cottingham, Ph.D.
Dartmouth College
Dr. Cottingham is an ecologist and biostatistician who began working on
children's exposure to arsenic as part of Dartmouth's formative Center
for Children's Environmental Health and Disease Prevention Research.
She led the 3-year pilot project investigating how infants born to the
women in the prospective New Hampshire Birth Cohort (NHBC) are
exposed to arsenic via both food and water and currently co-leads an
ongoing exposure assessment that will be used to quantify effects of
arsenic on growth and neurodevelopment through age 5. Dr. Cottingham and colleagues have
conducted market-basket surveys of arsenic concentrations in infant formulas and weaning
foods, evaluated associations between rice consumption and short-and long-term biomarkers
of arsenic exposure, and quantified the relative exposure of infants in the NHBC to arsenic via
breast milk versus formula. Their ongoing work includes assessing infant exposure to arsenic via
rice cereal and other high-arsenic foods during weaning.
Michael Crupain, M.D., M.P.H.
Consumer Reports Foods Safety and Sustainability Center
Dr. Crupain is an Associate Director of the Consumer Reports Safety
and Sustainability group and directs food safety testing for the
Consumer Reports Foods Safety and Sustainability Center. He is
interested in the intersection of food, agriculture and health policy,
and is board-certified in Preventive Medicine. He completed his
medical training at New York Medical College and residency at The
Johns Hopkins Bloomberg School of Public Health, where he also teaches.
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Kim Dietrich, Ph.D., M.A,
University of Cincinnati College of Medicine, Department of
Environmental Health
Dr. Dietrich is a lifespan developmental neuropsychologist and
Professor of Environmental Health, Director of the Division of
Epidemiology and Biostatistics, and Associate Director of the
Molecular Epidemiology in Children's Environmental Health training
program at the University of Cincinnati College of Medicine, Dr,
Dietrich has served as a consultant to numerous national and international organizations
concerned with the impact of environmental chemical exposures on the health and
development of young children, He is the author of the Cincinnati Lead Study, the longest
running longitudinal prospective investigation of lead and child neuropsychological and
behavioral development. Over the course of his nearly 40-year-long career in pediatric
neuroepidemiology, he has examined the impact of a wide variety of early environmental
chemical and social influences on infant, child, adolescent and adult development.
Gregory Diette, M.D., M.H.S.
The Johns Hopkins University
Dr. Diette is Professor of Medicine, Epidemiology and Environmental
Health Sciences. He is a pulmonologist with a practice devoted to the
care of patients with obstructive lung diseases, including asthma and
chronic obstructive pulmonary disease (COPD). He has an extensive
portfolio of patient-based research in asthma and COPD, supported by
the National Institutes of Health and other sponsors. Dr. Diette's current research focuses on
identifying factors that cause or provoke asthma with special interest in air pollutants
(particulate matter, NO2, secondhand smoke) and allergens (including mouse) that are
especially problematic in inner-city homes. His research includes the effects of these pollutants
and allergens on inflammation and oxidative stress. More recently, his research has been
examining how dietary patterns, especially a Western-style diet, may increase susceptibility to
inhalable pollutants and allergens.
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October 29-30 2013
f
Dana Dolinoy, Ph.D.
University of Michigan School of Public Health
Dr. Dolinoy serves as the John G. Searle Assistant Professor of
Environmental Health Sciences at the University of Michigan (UM) School
of Public Health and leads the Environmental Epigenetics and Nutrition
Laboratory, which investigates how nutritional and environmental factors
interact with epigenetic gene regulation to shape health and disease. Dr.
Dolinoy is as an investigator in the U.S. Environmental Protection
Agency/National Institute of Environmental Health Sciences-funded UM
Children's Environmental Health and Disease Prevention Research Center, investigating early
exposure to bisphenol A (BPA), lead and phthalates; epigenetics; and later-in-life body weight
and hormone outcomes. In 2011, Dr. Dolinoy received the Norman Kretchmer Memorial Award
from the American Society for Nutrition and the Classic Paper of the Year Award from
Environmental Health Perspectives.
Brenda Eskenazi, Ph.D., M.A.
University of California, Berkeley
Dr. Eskenazi is the Jennifer and Brian Maxwell Professor of Maternal and
Child Health and Epidemiology at the University of California, Berkeley.
She is a neuropsychologist and epidemiologist whose long-standing
research interest has been the effects of toxicants, including lead,
solvents, environmental tobacco smoke, dioxin and pesticides, on
human reproduction (both male and female) and child development.
She is the Principal Investigator (PI) and Director of an National
Institutes of Health/U.S. Environmental Protection Agency Center for Excellence in Children's
Environmental Health Research and its keystone project, CHAMACOS, which investigates the
exposure pathways and health effects of pesticide exposure in farmworkers and their children
and develops interventions to prevent future exposure. She is currently investigating
associations between pubertal development and endocrine-disrupting chemicals, including
flame retardants and pesticides, in children of the CHAMACOS cohort. Dr. Eskenazi was also the
PI on a grant aimed at understanding the effects of U.S.-Mexico migration on childhood obesity;
she conducted research on food insecurity, obesity and maternal perception of child weight.
She also is the PI on other National institute of Environmental Health Sciences-funded projects
on endocrine disruption; one based in Seveso, Italy, investigating the reproductive health of a
cohort of women exposed to high levels of dioxin by studying the age of onset of menarche
among other endpoints; and another examining the effects of persistent and nonpersistent
endocrine disrupters on neurodevelopment. Dr. Eskenazi recently has been awarded the
LiKaShing Award and the John R. Goldsmith Award for lifetime achievement in environmental
epidemiology.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Maida Galvez, M.D., M.P.H.
Icahn School of Medicine at Mount Sinai
Dr. Galvez is an Associate Professor of Preventive Medicine and
Pediatrics at the Icahn School of Medicine at Mount Sinai in New
York City, She directs the Region 2 Pediatric Environmental
Health Specialty Unit at Mount Sinai. She was Co-Principal
Investigator and designated New Investigator of the National
Institute of Environmental Health Sciences/U.S. Environmental Protection Agency (EPA)-funded
Children's Environmental Health and Disease Prevention Research Center community-based
project, Growing Up Healthy in East Harlem. She is a co-investigator, responsible for pubertal
staging methodology, in the national consortium of Breast Cancer Environment Research
Centers and lead pediatrician in the Centers for Disease Control and Prevention-funded IMPACT
Diabetes project. Dr. Galvez currently serves on the EPA federal advisory board for the Office of
Children's Health Protection, on the EPA Scientific Advisory Board Human Health Committee
and as President of District 2 Chapter 3 of the American Academy of Pediatrics.
Kim Harley, Ph.D.
Center for Environmental Research and Children's Health (CERCH),
University of California, Berkeley (UCB)
Dr. Harley is an Associate Adjunct Professor of Public Health at UCB.
She is a reproductive and perinatal epidemiologist whose research
focuses on the association between endocrine-disrupting chemicals
and child development, including neurodevelopment, obesity and
the onset of puberty. Dr. Harley also is Associate Director for Health
Effects of UCB's Center for Environmental Research and Children's
Health (CERCH) and coordinates the CHAMACOS Study of immigrant farmworker women and
their children living in the Salinas Valley. Her research focuses on the effects of environmental
chemical exposures to mothers and children living in a migrant farm worker community. Her
work has focused on the reproductive and developmental effects of bisphenol A (BPA), PBDEs,
DDT and organophosphate pesticides.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Elizabeth Matsui, M.D., M.H.S.
Children's Environmental Health Center (CEHC), The Johns
Hopkins University
Dr. Matsui's research program focuses on the clinical
investigation of allergen and pollutant exposure and allergic
airways disease. She also is a practicing pediatric
allergist/immunologist. She holds a Master's Degree in
Epidemiology and has directed The Johns Hopkins Children's
Center's Data Management and Analysis Core for the past 7
years. She serves as the Project Leader for the Hopkins Children's Center, directing studies
focused on the effect of dietary interventions on asthma. In addition to her roles in the Hopkins
Children's Center, she is a Co-Investigator in the Inner-City Asthma Consortium, a Co-
Investigator on an ROl-funded prospective cohort study of mouse workers at The Jackson
Laboratory and the Principal Investigator of a UOl-funded, multicenter clinical trial of home
mouse allergen abatement in mouse-allergic children with asthma.
Pam Maxson, Ph.D.
Southern Center on Environmentally Driven Disparities in Birth
Outcomes, Duke University
Dr. Maxson is the Research Director of the Children's Environmental
Health Initiative at the School of Natural Resources and Environment at
the University of Michigan. She is the Project Manager for the Southern
Center on Environmentally Driven Disparities in Birth Outcomes
(SCEDDBO), as well as the Director of its Community Outreach and
Translational Core. Dr. Maxson's research interests lie in the influence of
chemical and nonchemical stressors on pregnancy and childhood outcomes. She has extensive
experience collaborating with physicians, research scientists and the community on the
interface of research and practice in health and the environment.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Dr. Mark Miller, M.D., M.P.H.
University of California, San Francisco (UCSF)
Dr. Miller is an Assistant Clinical Professor in the Department of Pediatrics
at the UCSF and the Director of the UCSF Pediatric Environmental Health
Specialty Unit (PEHSU). He is a Public Health Medical Officer and the
Director of the Children's Environmental Health Program for the California
Environmental Protection Agency Office of Environmental Health Hazard
Assessment. He also works with the Center for Integrative Research on
Childhood Leukemia and the Environment at the University of California,
Berkeley (UCB). He completed his M.D. degree and pediatric residency from Michigan State
University College of Human Medicine, an M.P.H. in Environmental Health Sciences from UCB,
and a residency in Preventive Medicine with the California Department of Health Services. Dr.
Miller spent 13 years as a pediatrician in private practice in Chico, California. He is a founding
member and on the Board of Councilors of the International Society for Children's Health and
the Environment. His articles on pediatric environmental health issues have appeared in such
publications as Pediatrics, Environmental Health Perspectives and the Handbook of Pediatric
Environmental Health (American Academy of Pediatrics).
Nicholas Newman, D.O., M.S.
Cincinnati Children's Hospital/University of Cincinnati Pediatric
Environmental Health Specialty Unit (PEHSU)
Dr. Newman is a board-certified pediatrician and occupational/
environmental medicine physician and the Site Director of the Region
5 PEHSU Satellite at Cincinnati Children's Hospital Medical Center.
Dr. Newman is interested in understanding the effects of common
environmental toxicants on children and in translating this
information into actions that will improve children's health.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
¦rW
M
Jerome A. Paulson, M.D.
The George Washington University School of Medicine and Health
Sciences
Dr. Paulson is a Professor of Pediatrics at The George Washington
University School of Medicine and Health Sciences and Professor of
Environmental and Occupational Health at The George Washington
School of Public Health and Health Services.
Dr. Paulson is the Medical Director for National and Global Affairs
of the Child Health Advocacy Institute at the Children's National Medical Center. He is the
Director of the Mid-Atlantic Center for Children's Health and the Environment and of the
Environmental Health Track at The George Washington University School of Medicine and
Health Sciences.
Dr. Paulson is the chairperson of the executive committee of the Council on Environmental
Health of the American Academy of Pediatrics. He also serves on the Children's Health
Protection Advisory Committee for the U.S. Environmental Protection Agency. He was a
recipient of a Soros Advocacy Fellowship for Physicians from the Open Society Institute; worked
with the Children's Environmental Health Network; and has served as a Special Assistant to the
Director of the National Center on Environmental Health of the Centers for Disease Control and
Prevention, working on children's environmental health issues. He has developed several new
courses for The George Washington School of Public Health about children's health and the
environment. He is the editor of the October 2001 and the February and April 2007 editions of
Pediatric Clinics of North America on children's environmental health.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Frederica Perera, Dr.P.H., Ph.D.
Columbia University Children's Environmental Health Center (CEHC)
Dr. Perera is a Professor at Columbia University's Mailman School of Public
Health, where she serves as Director of the Columbia Center for Children's
Environmental Health, Dr. Perera is internationally recognized for
pioneering the field of molecular epidemiology, utilizing biomarkers to
understand links between environmental exposures and disease.
Currently, she and her colleagues are applying advanced molecular and imaging techniques
within longitudinal cohort studies of pregnant women and their children, with the goal of
identifying preventable risk factors for developmental disorders, asthma, obesity and cancer in
childhood. Her areas of specialization include prevention of environmental risks to children,
molecular epidemiology, disease prevention, environment-susceptibility interactions, and risk
assessment. She is the author of more than 300 publications, including 260 peer reviewed
articles, and has received numerous honors, including First Irving J. Selikoff Cancer Research
Award, The Ramazzini Institute (1995); The Century Club Award Newsweek (1997); First
Children's Environmental Health Award, The Pew Center for Children's Health and the
Environment (1999); Distinguished Lecturer, Occupational and Environmental Cancer, National
Cancer Institute (2002); Doctoris Honoris Causa, Jagiellonian University, Krakow, Poland (2004);
Children's Environmental Health Excellence Award, U.S. Environmental Protection Agency
(2005); and the Children's Environmental Health Network (CEHN) Award (2008).
Lesliam Quiros-Alcala, Ph.D.
University of California, Berkeley
Dr. Quiros-Alcala is a Postdoctoral Fellow at the Center for
Environmental Research and Children's Health at the University of
California, Berkeley. Her research explores the effects of
environmental contaminants on women's and children's health and
evaluates factors related to exposures in susceptible populations.
Her current research focuses on bisphenol A exposure in Latino
mothers and children, and studying the effects of current-use
pesticides on brain and nervous system development in children.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Urvashi Rangan, Ph.D.
Consumer Reports' Consumer Safety and Sustainability Group
Dr. Rangan is an environmental health scientist and toxicologist.
She leads Consumer Reports' Consumer Safety and Sustainability
Group and serves as the Executive Director of its Food Safety and
Sustainability Center. Dr. Rangan oversees all of Consumer
Reports' safety testing projects and risk assessments. She serves
as the lead spokesperson on these issues, translating complex
scientific concepts into actionable consumer advice and policy
recommendations. She has expertise in food safety issues, food labeling, risk assessment and
sustainable production practices. In addition to appearing frequently in major news outlets, she
testifies to government bodies, has given lectures at various universities and conferences, and
has directly challenged critics of a sustainable food system.
Virginia Rauh, Sc.D.
Columbia Center for Children's Environmental Health, Columbia
University Mailman School of Public Health
Dr. Rauh is Professor of Population and Family Health at the Mailman
School of Public Health, Columbia University, and Deputy Director of the
Columbia Center for Children's Environmental Health. She is a perinatal
epidemiologist with a focus on the adverse impact of exposure to air
pollutants, including secondhand smoke and pesticides, on pregnancy
and child health. She has been the Principal Investigator on numerous
major research projects, including the impact of organophosphorus insecticides and
secondhand smoke on child neurodevelopment and structural brain abnormalities (MRI); a
randomized intervention trial for low-birth weight infants; a multisite study of lifestyles in
pregnancy; a study of developmental outcomes of children born to inner-city adolescent
mothers; a multilevel analysis of the impact of Head Start on New York City school children; and
a study of links between race, stressors and preterm birth. She serves on numerous national
committees, including advisory groups at the National Institute of Environmental Health
Sciences, The Eunice Kennedy Shriver National Institute of Child Health and Human
Development and the Scientific Advisory Board for the U.S. Environmental Protection Agency.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Sheela Sathyanarayana, M.D., M.P.H.
Department of Pediatrics, University of Washington
Dr. Sathyanarayana is an Assistant Professor of Pediatrics and Adjunct
Assistant Professor in the Department of Environmental and Occupational
Health Sciences at the University of Washington. Dr. Sathyanarayana
serves as the Co-Director of the Pediatric Environmental Health Specialty
Unit (PEHSU) in Region 10, where she performs environmental health
consults for health care professionals, government entities and individual
families related to environmental exposures and children's health. Her
research interests focus on exposures to endocrine-disrupting chemicals, including phthalates
and bisphenol A, and their impact on reproductive development. Currently, Dr. Sathyanarayana
is the Center Director and Clinical Director for The Infant Development and Environment Study,
which is a multicenter cohort study of phthalate exposures in pregnancy and health outcomes
in children. She recently was named Outstanding New Investigator within the University of
Washington Center for Ecogenetics and Environmental Health (CEEH). She currently serves as
the Co-Chair for the U.S. Environmental Protection Agency's Children's Health Protection
Advisory Committee.
Patrice Sutton, M.P.H.
Children's Environmental Health Research Center, University of California,
San Francisco
Ms. Sutton is a Research Scientist at the University of California, San
Francisco, Program on Reproductive Health and the Environment (PRHE).
She is the Director of PRHE's Community Outreach and Translation Core,
spearheading collaborative efforts to advance reproductive environmental
health in clinical and policy arenas. Ms. Sutton has more than 25 years of
experience in occupational and environmental health research, industrial
hygiene, public health practice, policy development, and community-based advocacy. As a
contractor to California's State Health Department from 1987 to 2006, she was responsible for
conducting all aspects of research investigations that spanned a disparate range of issues,
including lead poisoning, tuberculosis, asthma and pesticide-related illness. She has extensive
experience in collaborating with directly impacted workplace and community-based
populations, labor, and governmental and nongovernmental organizations in the development
of research strategies and policy recommendations to protect public health.
¦ j
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30 2013
Judy Van de Water, Ph.D.
National Institute of Environmental Health Sciences (NIEHS) Center for
Children's Environmental Health, University of California, Davis (UC
Davis)
Dr. Van de Water joined the faculty in the Department of internal
Medicine at the University of California, Davis, in 1999. In 2000, she
also joined the faculty of the newly formed UC Davis M.I.N.D. Institute
when she began her research on the immunobiology of autism.
Dr. Van de Water's laboratory pursues research programs pertaining to autoimmune and
clinical immune-based disorders, including the biological aspects of autism spectrum disorders.
The application of Dr. Van de Water's immunopathology background has been instrumental in
the dissection of the immune anomalies noted in some individuals with autism, and in the
differentiation of various autism behavioral phenotypes at a biological level. Dr. Van de Water
is currently the Director of the NIEHS-funded Center for Children's Environmental Health at UC
Davis, investigating potential environmental risk factors contributing to the incidence and
severity of childhood autism.
Joseph L. Wiemels, Ph.D.
University of California, Berkeley (UCB)/University of California,
San Francisco (UCSF)
Dr. Wiemels is a Professor of Epidemiology at University of California,
San Francisco. He did a postdoctoral fellowship studying the etiology of
childhood leukemia in the United Kingdom, Returning to California in
2000, Dr. Wiemels has been a faculty member at UCSF and working with
UCB colleagues on the California Childhood Leukemia Study, as well as
spearheading other efforts at UCSF aimed at understanding the causes of
brain cancer, meningioma, and skin and pancreatic cancers. He works to build connections
between epidemiology and molecular genetics, and define the stepwise progression of cancer
and the body's own attempts to react against tumors.
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Poster Abstracts
Page 69
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Utilizing GIS and Mapping for More Equitable Distributions of Environmental Health Services
to Spanish-Speaking Populations
Damiris Agu, Program Coordinator; grid Mgrtg Jgnkowskg
Pedigtric Environmental Health Specialty Unit (PEHSU), Mount Sinai Hospital, New York, NY
Background: The Region II PEHSU, which covers New York, New Jersey, Puerto Rico and the U.S.
Virgin Islands, was created to ensure that communities have access to specialized medical
knowledge for children faced with environmental hazards. According to the Natural Resource
Defense Council, a disproportionate amount of the Region II Spanish-speaking population live in
poor housing with existing patterns of environmental injustice.
Aim: Knowledge of the geographic distributions of potential toxic environmental exposures, as
well as key demographic indicators, is essential to target outreach to vulnerable populations
and to address environmental health disparities.
Methods: We used Geographic Information System (GIS) data on childhood disease,
environmental exposures and demographic indicators for Region II Spanish-speaking
communities at the county level. Environmental justice organizations, as well as PEHSU
historical calls and outreach events from the database, were integrated into the GIS to assess
future outreach steps and high-priority sites.
Results: To address our objective of improving PEHSU programs by focusing on vulnerable
communities, a series of maps were constructed. These maps determine the density of children
under 18 years old; families with children living in poverty; Spanish-speaking families with
children; core chemical releases; and prevalence of childhood asthma, lead poisoning, low birth
weight and obesity in federal Region II.
Conclusion: The study analysis will provide information to advance the development of new
tools, such as a map atlas to assist communities with environmental risk assessments and
hazardous prioritization, and to create a model of service expansion for other PEHSU sites, both
nationally and internationally.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Formaldehyde Exposure Levels During Pregnancy
Azita Amiri1'2, Clinical Assistant Professor; Azin Nowrouzi3;
Gordon McGregor4; Michelle Fanucchi5; Erica Pryor2; Lisa Schwiebert6; Charles A. Downs8;
Marti Rice6; and Anne Turner-Henson 7
1College of Nursing, University of Alabama in Huntsville, Huntsville, AL
2School of Nursing, University of Alabama at Birmingham, Birmingham, AL
3Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Iran
4College of Science, University of Alabama in Huntsville, Huntsville, AL
5School of Public Health, University of Alabama at Birmingham, Birmingham, AL
6School of Medicine, University of Alabama at Birmingham, Birmingham, AL
7Nell Hodgson Woodruff School of Nursing, Emory University; City, ST
Introduction: Chronic exposure to formaldehyde during pregnancy has been linked to adverse
pregnancy outcomes such as abortion, congenital malformation, fetal growth restriction, and
premature birth, although few studies have examined formaldehyde exposure during
pregnancy.
Purpose: To determine personal exposure to formaldehyde during pregnancy and to identify
residential sources of formaldehyde.
Method: Formaldehyde exposure (vapor badge, urine formic acid) was examined in 140 women
in their second trimester of pregnancy during the winter and spring of 2013. One time urine
samples were collected during a routine prenatal visit, and women wore the vapor badges for
24 hours. Urine cotinine and self-reporting of potential residential sources of formaldehyde
were measured.
Results: The mean level of formaldehyde exposure using the vapor monitor badges was 0.04
parts per million (ppm) (SD = 0.06); 36.4 percent of participants exceeded Minimum Risk Levels
(MRLs) of 0.03 ppm, the Agency for Toxic Substances and Disease Registry (ATSDR) standard for
personal exposure for 14-364 days. Formaldehyde levels by vapor monitor badge (< 0.03 and >
0.03 ppm) were correlated with season of data collection (p < 0.008), indoor temperature of
dwellings (p < 0.014), and house remodeling (p < 0.037). No significant relationship was found
between formaldehyde detected by vapor monitor badge, formic acid and cotinine.
Conclusion: Home and lifestyle behaviors can lead to air pollutant risks due to formaldehyde.
More than one third of participants in this study had formaldehyde exposure levels for a 24-
hour period exceeding ATSDR recommended levels for 14-364 days. Promoting home and
lifestyle behaviors to reduce formaldehyde exposures as well as other indoor air pollutants
should be included as part of prenatal care.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Assessment of the Proinflammatory Potential of Indoor Air Particulate Matter Based on the
Cytokine Release in a Cryopreserved Human Whole Blood System
Patrick Breysse1, Professor; Felix E. Rivera-Mariani1; Kranthi Vysyaraju1; Jesse P. Negherbon1;
Olivia Hall1; Thomas Hartung1; and Nadia N. Hansel2
1The Johns Hopkins University Bloomberg School of Public Health, 2The Johns Hopkins School
of Medicine, Baltimore, MD
There is a growing recognition that indoor particulate matter (PM) can impact respiratory
health. The composition of indoor air PM differs from outdoor, with indoor PM generally
containing more biologically derived components. Assessment of human health based on
biologically derived components (e.g., endotoxin from Gram-negative bacteria) limits our
understanding of the human health effects to indoor PM. In this study, we evaluated an
innovative human in vitro assay, the human whole-blood pyrogen assay, to study the pro-
inflammatory potential of indoor PM collected in urban homes in Baltimore, MD. PM mass and
endotoxin concentrations were determined by gravimetric analysis and testing filter extracts
with the Limulus Amoebocyte Lysate assay, respectively. The pro-inflammatory potency of the
whole extracts and endotoxin-depleted extracts, based on the release of cytokines by blood
immune cells, was evaluated with the whole-blood pyrogen assay. PM mass and endotoxin
concentration did not explain the inflammatory potency of the PM. Depletion of endotoxin in
the extracts abolished the TNF-a response but only reduced IL-l|3 and IL-6 by 40 percent and 50
percent, respectively. Taken together, our results suggest that the pro-inflammatory potential
of indoor PM from homes of an urban setting is not limited to endotoxin, and that gravimetric
and endotoxin measurements of PM do not fully reflect its pro-inflammatory potency. This
study demonstrates the limitation of using endotoxin alone to assess pro-inflammatory
potential of PM and that the human whole-blood pyrogen assay provides a more
comprehensive assessment of the pro-inflammatory potency of indoor air PM in an urban
environment.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Fast Food Intake Predicts Several Indices of Asthma Morbidity
in an Urban, Pediatric Population
Emily Brigham1, Pulmonary Postdoctoral Fellow; Sonali Bose1; Jean Curtin-Brosnan2;
Elizabeth Matsui3; Nadia Hansel1; Charles Aloe3; Greg Diette1; and Meredith McCormack1
1Department of Pulmonary Medicine, 2Department of Pediatrics, 3Department of Pediatric
Allergy gnd Immunology, The Johns Hopkins University School of Medicine, Baltimore, MD
Rationale: Asthma is a common pulmonary diagnosis in the pediatric population and continues
to increase in prevalence. Asthma disproportionately affects inner-city minority children.
Identifying modifiable risk factors for poor asthma control is a research priority. In adult
populations, one well-recognized risk factor for asthma is obesity, although studies aiming to
identify a link in children have yielded mixed results. A potential mediating factor is diet, which
has been linked to both the development of childhood obesity and asthma. We investigated the
association between fast food intake (representing a high-fat, high-salt, high-calorie diet) and
asthma morbidity in an urban, minority pediatric population.
Methods: DISCOVER is an ongoing, NIH-funded project studying indoor air pollution and
asthma, longitudinally evaluating 180 children (ages 5-12) in Baltimore City. Each child enrolled
has an initial clinic visit during which they complete a detailed questionnaire with their primary
caregiver and completed pulmonary function tests (PFTs). We compared responses to a fast
food intake frequency question in cross-section to PFTs, body mass index (BMI), reported
medication and urgent care use, and selected questions regarding asthma symptoms in the last
12 months. Asthma symptom responses were compared in each category of fast food intake
(low: < 1 time per week, moderate: 2-3 times per week, and high: 4-6 times per week).
Responses were compared by chi-squared analysis, nonparametric test of trend and logistic
regression.
Results: Preliminary results on 150 children demonstrated 102 (68%) with low, 36 (24%) with
moderate and 12 (8%) with high intake. BMI was evaluated as a discrete, categorical variable
(normal weight, overweight, and obese) and was not significantly associated with fast food
intake. Fast food was associated with symptoms of nighttime wheeze and cough, and this
relationship was not significantly modified by BMI. Symptoms remained associated after logistic
regression with control for age, race and sex. Fast food intake was not associated with urgent
care use, medication use or other evaluated symptoms.
Conclusion: In a cohort of urban, predominantly African-American children, high fast food
intake is associated with at least two symptoms of asthma morbidity: dry cough and nighttime
wheeze. Diet may be an important, modifiable risk factor to improve asthma outcomes for
inner-city children, a highly affected group.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Comparison of Children's Personal Exposure to and Environmental Measurements
of Airborne Pollutants With Biomarkers of Exposure
Seung-Hyun Cho1, Research Aerosol Scientist; Jonathan Thornburg1; James Raymer1;
Fuyuen Yip2; Tegan Boehmer2; Marjorie Hinsdale-Shouse3; Lisa Thalji3; and Diane Wagener3
1RTI International, Research Triangle Park, NC
2Centers for Disease Control and Prevention, Atlanta, GA
3RTI International, Research Triangle Park, NC
A sub-study of the Children's Health After the Storm (CHATS), an environmental health study of
children in Louisiana and Mississippi, has the purpose of assessing ways to minimize exposure
misclassification bias and identifying an exposure metric with a strong association to
biomarkers of exposure.
For each child, we conducted 1-week measurements of personal exposure, and indoor and
outdoor concentrations of particulate matter (PM10), second-hand smoke (SHS), and gaseous
pollutants; and assessments of corresponding urinary biomarkers of exposure.
Data show that personal exposures to PM10 and SHS (mean 38 |-ig/m3 and 20 |-ig/m3) exceed the
indoor and outdoor concentrations. The personal exposure and indoor levels are highly
correlated, but neither are correlated with outdoor measurements. The level of personal PM
exposure is significantly influenced by the personal SHS and indoor PM concentrations, and the
compliance to protocol for wearing the personal monitor at a lesser degree. The ranked
personal and indoor SHS concentrations are moderately but significantly correlated to the
urinary marker.
Strong personal indoor correlations indicate that a significant portion of personal exposure
occurs inside the residence. A similar level of associations of personal and indoor SHS measures
with urinary marker indicates that SHS exposures mainly occur in the home. However, the
deviation of personal exposure measurements from the corresponding indoor concentrations
can be up to 50 percent for the group with higher personal monitor-wearing compliance. This
demonstrates the need for personal exposure monitoring with the adherence to the sampling
protocol to capture the level that children are exposed to accurately.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Early Life Exposure to Arsenic Via Food and Water
Kathryn Cottingham 1, Professor; Courtney C. Carignan2; Trncy Punshon2; Brign P. Jgckson2;
igne Gilbert-Digmond2; Susgn Korrick3; Vicki Sgygrgth2; Cgrol L Folt; 2'4
grid Mgrggret R. Kgrgggs2
1Centerfor Children's Environmentgl Heglth gnd Disegse Prevention gt Dgrtmouth, Hgnover, NH
2Dgrtmouth College, Hgnover, NH
3Hgrvgrd Medicgl School, Cgmbridge, MA
4University of North Cgroling, Chgpel Hill, NC
Background: Although childhood exposure to high concentrations of arsenic (As) in drinking
water has been associated with adverse health effects, less is known about the effects of lower
levels of exposure from water or food, the likely exposure route for most infants.
Aims: We estimated the potential exposure to arsenic via water and food in a population of
U.S. infants who are potentially exposed to arsenic via well water, and compared these
estimates to measured urinary arsenic.
Methods: We used telephone surveys of infant feeding patterns at 4, 8, and 12 months and
measurements of arsenic in water, formula powder, breast milk, and rice cereal to estimate an
infant's arsenic ingestion (n ~ 300). We further collected a 3-day food diary and tested infant
urine samples at 6 weeks of age to determine the correlation between estimated arsenic
ingestion and biomarker concentrations (n = 71).
Results and Conclusions: Exclusively breast-fed infants had lower estimated arsenic exposure
and urinary arsenic concentrations at 6 weeks of age than exclusively formula-fed infants (P <
0.0001). More than 10 percent of infants were estimated to be consuming formula made with
water that was above the current World Health Organization maximum contaminant level (10
l-ig/L). During weaning, 90 percent of families fed their infants rice cereal, most starting
between 4 and 6 months of age. Estimated arsenic exposure due to rice cereal was 1.5-7.4 |ag
As per day, higher than for breast milk or formula except when the formula was made with
high-arsenic water. Both water and food appear to be exposure routes for arsenic for infants in
our population.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Infant Toenails as a Biomarker of In Utero Arsenic Exposure
Matthew Davis1, Ph.D. Candidate; Z. Li1; D. Gilbert-Diamond 1;T.A Mackenzie.1;
K. Cottingham2; B. Jackson2; J. S. Lee3; E. Baker4; C.J. Mars it1; and M.R. Karagas1
1Geisel School of Medicine at Dartmouth, Hanover, NH
2Dartmouth College, Hanover, NH
3Women and Infants Hospital, Providence, Rl
4Dartmouth-Hitchcock Medical Center, Hanover, NH
Background: A growing body of evidence suggests that in utero and early life exposure to
arsenic may have detrimental effects on children, even at low-to-moderate levels, which are
common in the United States and elsewhere. However, studies to date have used a wide variety
of different biomarkers, such as urine, blood, hair and nails to estimate gestational exposure
that have not been extensively tested for their reliability. We evaluated infant toenails as a
biomarker of arsenic exposure in birth cohorts from New Hampshire and Rhode Island.
Methods: We tested 170 mother-infant toenail samples from the New Hampshire Birth Cohort
Study using inductively coupled plasma mass spectrometry. We further compared infant toenail
arsenic concentration to maternal urinary arsenic at 24-28 weeks of gestation (excluding
arsenobetaine and arsenocholine), as well as maternal arsenic consumption from water and
rice. We used multiple linear regression models to examine relationships between arsenic
biomarkers and used structural equation modeling to combine maternal arsenic biomarker
measures into a latent class variable of maternal arsenic exposure. For validation, we examined
the correlation between maternal-infant toenail concentrations in an independent birth cohort
of 130 mother-infant pairs from Rhode Island.
Results: In both the New Hampshire and Rhode Island mother-infant cohorts, infant toenail
arsenic concentration correlated most strongly with maternal postpartum toenail
concentrations (Spearman correlation coefficient 0.34 and 0.29, respectively). In adjusted linear
regression models of the New Hampshire cohort, a doubling of maternal toenail arsenic
concentration was associated with a 53.8 percent (95% CI: 33.9, 76.7) increase in infant toenail
arsenic concentration. An increase of one standard deviation of a latent variable of maternal
arsenic exposure in a structural equation model was associated with nearly a 50 percent
increase in infant toenail arsenic concentration [1.45 (95% CI: 1.23, 1.72)].
Conclusion: In this study population of U.S. women exposed to low levels of arsenic, infant
toenails appear to be a reliable biomarker for estimating arsenic exposure during gestation that
is relatively easy to collect.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Partnerships for Environmental Public Health (PEPH) Evaluation Tools
Christie Drew, Chief; and Kristianna G. Pettibone
Program Analysis Branch, National Institute of Environmental Health Sciences,
National Institutes of Health, Bethesda, MD
This poster provides an overview of the PEPH Evaluation Metrics manual. The poster addresses
why the manual was developed and for whom. It provides information on the five core PEPH
activities that are addressed in the manual: partnering, leveraging, products and dissemination,
capacity building, and education and training. It showcases examples of the components
included in each chapter, including example metrics and Metrics in Action. Finally, the poster
highlights the Web-based training that accompanies the manual. The manual and training are
available at http://www.niehs.nih.gov/pephmetrics.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
A Prospective Birth Cohort Study Involving Environmental Uranium Exposure
on Navajo Nation
Adrienne Ettinger, Assistant Professor; Chris Shuey2;David Begay3; Mae-Gilene Beggy4;
grid Johnnye Lewis5
tygle School of Public Heglth, New Hgven, CT
2Southwest Resegrch grid Informgtion Center, Albuguergue, NM
3University of New Mexico gnd Dine College, Albuguergue, NM
4Ngvgjo Division of Heglth, Window Rock, AZ
5University of New Mexico, Albuguergue, NM
Background: In October, 2007, the U.S. House Committee on Oversight and Government
Reform held hearings and subsequently appropriated funds to study the environmental effects
of uranium mining on the Navajo Nation. The Navajo Nation was heavily mined for uranium to
support development of the atomic bomb and subsequent cold-war weapons production from
1942 through the late 1960s. The last mines closed in the mid-1980s, leaving 1,100 mine waste
sites associated with 520 discrete mines, most of which have never been fully remediated. No
comprehensive health studies have been conducted to assess the impact to the Navajo people
from exposures to these wastes. The Agency for Toxic Substances and Disease Registry (ATSDR)
staff held meetings with community members and stakeholders and determined that
investigating the effects of environmental exposures to uranium wastes on Navajo pregnancies
and birth outcomes would appropriately respond to both the community concerns and to the
congressional mandate.
Objective: In August 2010, the Centers for Disease Control and Prevention (CDC) awarded a
cooperative agreement to the University of New Mexico (UNM) Community Environmental
Health Program (CEHP) to work with CDC/Agency for Toxic Substances and Disease Registry
(ATSDR), Navajo Area Indian Health Service (NAIHS) and the Navajo Nation to design and
conduct a prospective study to determine whether uranium exposures affect pregnancy, birth
outcomes and child development on the Navajo Nation. The project also should provide broad
public health benefits for Navajo communities through education on environmental prenatal
risks, early assessment, and referral for identified developmental delays.
Implementation: A research plan was developed by the UNM Team, in consultation with
Navajo Nation agencies, community members and NAIHS staff, and has been approved by UNM
and Navajo Nation human research review boards and the federal OMB. This research involves
recruiting and following 1,500 pregnant women living on the Navajo Nation during their
pregnancy, at delivery and following the infants through their first year. Environmental
monitoring, biological sample analysis, surveys and developmental screenings will be
performed. Information gathered and analyzed will be provided to the Navajo Nation and
NAIHS to improve future pregnancy and birth outcomes and services and to inform policy on
the cleanup of environmental hazards.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
"I did it for us, and I would do it again."
Rural Latino Experiences Providing Biospecimensfor Research
Elaine Faustman1, Professor and Director; S. Hohl2; C. Gonzalez2,3; I. Islas2,4; E. Carosso2;
and B. Thompson2
1University of Washington School of Public Health, 2Fred Hutchinson Cancer Research Center,
3University of Washington Interdisciplinary Graduate Program in Molecular
and Cellular Biology, Seattle, WA; 4Centerfor Community Health Promotion, Sunnyside, WA
Racial and ethnical minorities historically have been underrepresented in biomedical research.
Latinos exhibit lower rates of participation and higher rates of attrition in biomedical research
than non-Hispanic whites and other ethnic groups, and rural Latinos are even less likely to
participate in biomedical research. Participation of such groups in biomedical research is critical
to advancing global knowledge and reducing health disparities. Several studies have explored
the barriers and facilitators of participation for these vulnerable populations. However, few, if
any, have described the experiences of a minority population that has provided biospecimens
for research.
Page 79
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Method Development and Field Application for Multiday Polycyclic Aromatic
Hydrocarbon Sampler
Katharine Hammond1, Professor; Elizabeth M. Noth1; and Fred Lurmann2
1University of California, Berkeley, CA; 2Sonoma Technology, Inc., Petaluma, CA
A 96-hour integrated filter-based sampler for collection of airborne polycyclic aromatic
hydrocarbons (PAHs) with 4, 5 and 6 rings was developed for use in environmental monitoring
and applied in Bakersfield, California. We developed and evaluated a filter-based, 96-hour PAH
sampler against 24-hour, filter-based samplers in a bus garage with PAH concentrations
comparable to outdoor environmental conditions. The method was found to be precise
(average coefficient of variation was 6%). For the 10 PAHs analyzed, the mean of the 96-hour
integrated samples collected in triplicate was within 30 percent of the mean sum of the four
sequential 24-hour samples. The field experiment was conducted in Bakersfield, California, at
14 locations, mostly public schools. We collected 96-hour integrated samples for four time
intervals from November 2010 to January 2011. At one site, we also collected continuous
particle-bound PAHs of 3-rings or greater using the PAS2000 monitor (EcoChem Analytics,
League City, TX). Duplicates were collected at two sites. There were 54 96-hour PM2.5 samples
collected over four intervals at a total of 14 locations, including duplicate samples collected at 2
locations. Concentrations of PAHs during the sampling periods were low, with only 13 percent
of individual PAH concentrations measured greater than 1 ng/m3. For £10PAH, the Pearson
correlation coefficient between all pairs of duplicates is 0.93, and the CV for the set of
duplicates is 3 percent. The Pearson correlation coefficient between the £10PAH
concentrations and the PAS2000 mean 96-hour concentrations was 0.95. The mean
concentration of the filter-based £10PAH concentrations were consistently lower than the
PAS2000. Because of the low concentrations in the field experiment and the relatively low
number of sites, we did not perform formal tests of spatial autocorrelation. However, we
observed that higher PAH concentrations were closer to railyards and locations of high traffic
intensity. In conclusion, we have presented the development and application of a precise and
sensitive field method for collecting 96-hour PAH concentrations at environmental levels.
Page 80
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Malaysian Diaper Powder as a Source of Elevated Blood Lead
Mateusz Karwowski1, Clinical Fellow; Geoffrey S. Plumlee2; Terrence Law3; Mark Kellogg3;
and Alan D. Woolf1
1Department of Medicine and the Pediatric Environmental Health Center, Boston Children's
Hospital; and the Department of Pediatrics, Harvard Medical School, Boston, MA;
2U.S. Geological Survey, Reston, VA; and 3Department of Laboratory Medicine,
Boston Children's Hospital, Boston, MA
Introduction: Although the majority of childhood lead exposure in the United States results
from ingestion of lead-based paint dust, nonpaint sources are increasingly implicated. We
present a case of elevated blood lead (EBL) in a 9-month-old infant due to a Malaysian folk
remedy.
Case Report: An infant girl born in the United States to a Malaysian father and Taiwanese
mother had an elevated screening capillary blood lead level (BLL) of 18 mcg/dL (CDC reference
< 5 mcg/dL) at her 9-month health supervision visit. A venous specimen drawn 4 days later was
13 mcg/dL. Her zinc protoporphyrin levels, complete blood count (CBC) and iron studies were
normal. She was asymptomatic with normal past medical and developmental histories; she was
not yet independently mobile. Environmental history was negative for residential lead hazards
as the family's home was built in the year 2000. Further history revealed that parents were
applying an imported diaper powder solely to her vaginal area once or twice weekly. The
powder was sold at a Malaysian corner store/pharmacy and sent by a relative. Quantitative
analysis indicated the pale yellow powder contained 62 percent lead. Mineralogical analysis
confirmed that the powder was predominately lead monoxide (litharge), and also contained
magnesium carbonate and the magnesium silicate mineral talc. Scanning electron microscopy
showed all particles measured less than 250 |am, the maximum value for hand-mouth transfer,
and many were of respirable sizes (<2-5 |am). Four weeks after discontinuing its use, the
infant's venous BLL fell to 8 mcg/dL.
Discussion: Although inorganic lead can be absorbed transdermal^ and via mucosal tissues, our
patient was likely exposed through additional routes, including hand-mouth transfer, inhalation
of airborne powder, swallowing of lead particles cleared from the respiratory tract,
contamination of foodstuffs and contact with contaminated surfaces. To our knowledge, this is
the first case of EBL due to infant diaper powder reported in the United States.
Conclusion: Folk remedies, including skin care products, are a potential explanation for EBL in
childhood, particularly in children for whom no residential source of lead is discovered. Health
care providers should query families of young children regarding their cultural practices and
maintain a low threshold for lead screening.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Maternal Iron Metabolism Gene Variants Modify Umbilical Cord Blood Lead Levels
by Gene-Environment Interaction
Mateusz Karwowski1, Clinical Fellow; Allan C. Just2; David C. Bellinger3; Rebecca Jim4;
Earl L Hatley4; Adrienne S. Ettinger5; Howard Hu6; and Robert 0. Wright7
1Boston Children's Hospital; 2Department of Environmental Health, Harvard School of Public
Health; 3Department of Neurology, Boston Children's Hospital, Boston, MA; 4Local
Environmental Action Demanded Agency, Inc., Vinita, OK; 5Center for Perinatal, Pediatric, and
Environmental Epidemiology; Department of Chronic Disease Epidemiology, Yale School of
Public Health, New Haven, CT; 6Divisions of Clinical Public Health, Epidemiology, Global Health,
and Occupational and Environmental Health, Dalla Lana School of Public Health, University of
Toronto, Canada; and 7Departments of Preventive Medicine and Pediatrics, Icahn School of
Medicine at Mount Sinai, New York, NY
Background: Given the relationship between iron metabolism and lead toxicokinetics, we
hypothesized that polymorphisms in iron metabolism genes might modify maternal-fetal lead
transfer.
Objective: To determine whether maternal and/or infant transferrin (TF) and hemochromatosis
(HFE) gene missense variants modify the association between maternal blood lead (MBL) and
umbilical cord blood lead (UCBL).
Methods: We studied 476 mother-infant pairs whose archived blood specimens were
genotyped for TF P570S, HFE H63D and HFE C282Y. MBL and UCBL were collected within 12
hours of delivery. Linear regression models were used to examine the association between log-
transformed MBL and UCBL, and to explore gene-environment interactions.
Results: The geometric mean MBL was 0.61 |ag/dL (range 0.03, 3.2) and UCBL 0.42 (< 0.02, 3.9).
Gene variants were common, with carrier frequencies ranging from 12 to 31 percent; all were
in Hardy-Weinberg equilibrium. In the full regression model, log MBL was associated with log
UCBL (3 = 0.92, 95% CI: 0.82, 1.03) such that a 1 percent increase in MBL was associated with a
0.92 percent increase in UCBL. Maternal hematocrit at 28 weeks (3 Interaction = -0.02, 95%
CI: -0.05, 0.003) and at delivery (3 Interaction = -0.02, 95% CI: -0.04, 0.001) were inversely
associated with UCBL. Infants born to C282Y variants had 38 percent lower UCBL (p < 0.05) than
those born to wild-type mothers (3 Interaction = -0.27, 95% CI: -0.52, -0.01).
Conclusion: Maternal HFE C282Y gene variant status is associated with reduced placental
transfer of lead. If incorporated into preventive strategies, maternal genotype information has
the potential to reduce in utero lead exposure.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Finding the Environmental Causes of Leukemia in Children: Center for Integrative Research on
Childhood Leukemia and the Environment
at the University of California, Berkeley
Amy D. Kyle1, Associate Professor; Catherine Metayer2; Joseph Wiemels3; Todd Whitehead2;
Gary V. Dahl4; Mark Miller5; Stephen M. Rappaport2; Libby Morimoto2;
and Patricia A. Buffler2
1Centerfor Integrative Research on Childhood Leukemia and the Environment, University of
California, Berkeley, CA; 2University of California, Berkeley, CA; 3University of California San
Francisco (UCSF), San Francisco, CA; 4Stanford University, Palo Alto, CA; 50ffice of Environmental
Health Hazard Assessment and UCSF Pediatric Environmental Health Specialty Unit, San
Francisco, CA
Introduction: Leukemia is the most common cancer in children. Genetic factors and
environmental factors are both thought to contribute to childhood leukemia, and prenatal and
early-life exposures appear to be important. Fortunately, mortality from childhood leukemia
has decreased greatly with better treatments. However, the causes are mostly not yet known.
Our Goal: Our fundamental goal is to develop and implement methods that can determine
preventable or modifiable environmental factors that contribute to leukemia in children and
the mechanisms by which the disease develops.
Approaches: We draw on the long-standing California Childhood Leukemia Study to conduct
epidemiological studies of factors that may contribute to the development of leukemia.
We build collaborations with investigators and studies around the world to pool data and
knowledge to increase the power of studies, leading the development of a Childhood Leukemia
International Consortium, training new investigators and initiating new projects.
We improve methods to measure environmental factors, with a focus on homes, including
measurements using house dust, to better assess prenatal and early-life exposures.
We create ways to detect markers of exposure in small quantities of biospecimens (such as
blood).
We look at how environmental factors cause both genetic and epigenetic changes that may
contribute to leukemia and develop new methods to measure this. We connect with
organizations and individuals interested in improving children's environmental health and
explain our results using traditional and new media, including video.
Results: Our poster provides links to key results through abstracts, links to Web resources,
including video, and readable bar codes for mobile devices.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Arsenic and Rice: Translating Research to Address Healthcare Providers' Needs
Pui Lai1, Pediatric Resident Doctor; Mark D. Miller2,3'4, and Craig Steinmaus2,5
1Children's Hospital Oakland and Research Institute, Oakland, CA
2Children/s Environmental Health Program at California Environmental Protection
Agency (Cat EPA)
3University of California, San Francisco, Pediatric Environmental Health Specialty Units
4CIRCLE at University of California, Berkeley, CA
5University of California, Berkeley School of Public Health, Berkeley, CA
Background: Recent publications show elevated inorganic arsenic in rice grain and rice
products. Minimal information has been provided to health care providers, yet clinicians are
faced with providing guidance on rice consumption regularly.
Aim: Identify key information for clinicians faced with providing guidance on rice consumption
for the pediatric population.
Methods: Review and analyze peer-reviewed articles and government populations.
Key Information for Health Care Providers: Arsenic, a known human carcinogen, is associated
with neuro-developmental and other adverse health effects. Cancer risk has been
demonstrated to be greater with early life exposure to arsenic. The U.S. Environmental
Protection Agency standard of 10 |ag As/L of water is associated with estimated lifetime excess
cancer risk of 1 in 300 (NRC). There is no standard for food. More than 85 percent of rice grain
and rice products contain inorganic arsenic, with 23 percent containing concentrations that
pose a potential cancer risk > 1 in 300. Eating 0.56 cups of cooked rice/day is comparable to
drinking lL/d of 10 |ag As/L drinking water. The top 1 percent of rice-eating children consumes
at least 1.75 cups of cooked rice/day, associated with an excess cancer risk far above 1 in 300.
The top 1 percent of childhood rice consumers has a median urinary arsenic level double that of
non-rice consuming children. Arsenic in rice poses increased health risk in children and heavy
rice-eating populations, including Asian Americans, individuals with celiac disease or severe
food allergies, and others.
Conclusion: Researchers should keep clinicians updated via publications they read with more
detailed information translating current findings of relevance. Clinicians can identify and
counsel heavy-rice consuming patients and consider providing practical rice intake reduction
measures in a culturally sensitive way.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Being Overweight Confers Susceptibility to Indoor Pollutants Among Urban Children
and Adolescents With Persistent Asthma
Elizabeth Matsui, Associate Professor; Kim Lu; Gregory Diette; Patrick Breysse;
Jean Curtin-Brosnan; Charles Aloe; D'Ann Williams; Roger Peng; and Meredith McCormack
The Johns Hopkins University, Baltimore, MD
Background: Both obesity and exposure to indoor pollutants, which have been associated with
asthma morbidity, are common in urban minority populations. Whether obesity is a risk factor
for the effects of indoor pollutant exposure on asthma is unknown.
Aims: To examine the effect of weight on the relationship between indoor pollutants and
asthma in urban minority children.
Methods: One hundred and forty-eight 5- to 17-year-old children with asthma were followed
for 1 year. Asthma symptoms, acute care visits, lung function, pulmonary inflammation and
indoor pollutants were assessed every 3 months. Weight category was based on body mass
index percentile.
Results: Participants were predominantly black (91%) and had public health insurance (85%).
Four percent were underweight, 53 percent were normal weight, 15 percent were overweight,
and 28 percent were obese. Overweight and obese participants had more symptoms associated
with fine particulate matter (PM2.5) exposure than normal weight participants across a range of
asthma symptoms. Overweight and obese participants also had more asthma symptoms
associated with NO2 exposure than normal weight participants, although this was not observed
across all asthma symptom outcomes. Weight did not affect the relationship between coarse
particulate matter (PM2.5-10) and asthma. Relationships between indoor pollutant exposure and
acute care visits, lung function, and pulmonary inflammation did not differ by weight.
Conclusions: Being overweight may increase susceptibility to indoor PM2.5 and NO2 in urban
children with asthma. Interventions aimed at weight loss may reduce PM2.5- and NO2-
associated asthma morbidity; interventions aimed at reducing indoor pollutant levels may be
particularly beneficial in overweight children.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Translating Research in Environmental Health to Pediatric Practice: A Survey of Pediatric
Hematologists and Oncologists
Mark Miller1,2'3. Director, UCSF Assistant Clinical Professor of Pediatrics; Christine Zachek1; Gary
Dahl4; Christopher Su4; and Patricia Buffler2
1University of San Francisco, California (UCSF) Pediatric Environmental Health Specialty Units
(PEHSU), San Francisco, CA
2Center for Integrative Research on Childhood Leukemia (CIRCLE), University of California,
Berkeley, Berkeley, CA
3California Environmental Protection Agency Office of Environmental Health Hazard
Assessment, Sacramento, CA
4Department of Pediatric Hematology and Oncology, Stanford University, Palo Alto, CA
Background: Clinical practice plays an important role in advancing children's environmental
health and preventing harmful exposures. Although scientific studies have highlighted evidence
of environmental contributions to childhood cancer incidence, we hypothesize that there have
not been corresponding advances to incorporate this evidence into routine clinical practice.
Aims: To assess environmental history-taking behavior and perceptions of environmental
health among pediatric hematologists and oncologists.
Methods: A Web-based survey was conducted among 427 members of professional clinical
networks across the country. Abstracts from the 2011-2012 American Society of Pediatric
Hematology/Oncology (ASPHO) meetings also were reviewed to identify current clinical studies
that investigate environmental risk factors.
Results: There were 191 respondents who completed the survey (45 percent). Environmental
exposures are of concern to clinicians, but a lack of familiarity or comfort in discussing these
issues with patient's families presents a significant barrier. Although 76 percent of practitioners
suspected some cases to have environmental etiologies, few asked about environmental
exposures. Greater than 90 percent of clinicians responding stated they would find it helpful to
have more information regarding the association between childhood cancers and
environmental exposures. Of the ASPHO abstracts reviewed, less than 1 percent investigated
environmental factors.
Conclusions: This research implies a need for increased training and awareness of
environmental health among pediatric practitioners, as well as a need for interventions related
to history-taking such as identifying behavior change strategies or incorporating self-
administered intake questionnaires into patient care. By publishing research findings in journals
that clinicians read, environmental epidemiologists can help bridge this knowledge gap and
increase physician comfort in communicating research findings to patients.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Kids + Chemical Safety: A Tool for Educating the Public About Chemicals
Patricia Nance. Science Outreach and Initiatives Leader; Michael Dourson; and Oliver Kroner
Toxicology Excellence for Risk Assessment (TERA), Cincinnati, OH
With an increasingly "plugged-in", connected, and informed public, there is an evolving need
for rapid availability and global dissemination of accurate information. Important decisions
about personal health, and public health and safety are made daily by the scientific and medical
community, legislators, the public and the media often based on inaccurate, incomplete or
biased information on the Internet. The exposure of children to chemicals in their environment
and the possible effects on childhood growth and development is a paramount social concern.
Many websites dedicated to children and chemical exposures are available. However, these
websites can be generally characterized as either government sites that are technically dense,
not interactive with users, and primarily targeted to the scientific community; or sites
developed by special interest groups that lack technical depth, may or may not accurately
represent the toxicology of the subject chemicals, or may or may not be interactive with users,
but that are nevertheless written at a level understandable to a broad public audience. A
challenge for protection of children's health to chemical exposures is to develop a website that
can rapidly communicate independent, scientifically accurate information needed to make
important decisions in a way that a broad user audience can understand and apply. Kids +
Chemical Safety is a scientifically accurate website, staffed by experts in toxicology, public
health protection and scientific communication that evenly represents perspectives, provides
current information, and is interactive and understandable to serve a broad audience, inclusive
of scientists, parents and the media.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Ambient Air Pollution and Traffic Exposures and Congenital Heart Defects
in the San Joaquin Valley of California
Amy Padula1, Postdoctoral Fellow; LB. Tager2; S.L. Carmichael1; S.K. Hammond2; W. Yang1;
F.W. Lurmann3; and G.M. Shaw1
Stanford University School of Medicine, Stanford, CA; 2University of California, Berkeley, CA;
3Sonoma Technology, Inc., Petaluma, CA
Congenital anomalies are a leading cause of infant mortality and an important contributor to
childhood and adult morbidity. Major structural congenital anomalies are diagnosed in 2-4
percent of births, and the heart is the most common organ affected. Environmental
contaminants have been suggested as risk factors for some anomaly groups, including heart
defects. We used maternal interview data from the California Center of the National Birth
Defects Prevention Study (n = 813 cases and n = 828 controls).
Air pollutant and traffic exposure data were calculated at the geocoded maternal residence
during the first 2 months of pregnancy. We estimated the odds of congenital heart defects
using logistic regression, comparing the highest to lowest quartile of each exposure and
adjusting for maternal race/ethnicity, education and vitamin use. The majority of mothers were
Hispanic and had at least a high school education. A quarter of the population was exposed to
active or passive smoke. Mothers of cases were less likely to take multivitamins in early
pregnancy and more likely to be multiparous. The correlations of CO with NO (r = 0.81), NO2 (r =
0.73) and PM2.5 (r = 0.84) were high, which reflects the common source of motor vehicles.
Ozone was negatively correlated with the traffic-related pollutants.
Overall, there was no clear association between traffic-related air pollution and congenital
heart defects. Exposure to PM10 and traffic density during early pregnancy may contribute to
the occurrence of ventricular septal defects in this population. Results were mixed for other
pollutants and showed little consistency with previous studies
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Ambient Polycyclic Aromatic Hydrocarbons and Pulmonary Function in Children
Amy Padula1, Postdoctoral Fellow; John Balmes2'3; Ellen Eisen2; Jennifer Mann2 Elizabeth M.
Noth2; Frederick W. Lurmann4; Boriana Pratt2; Ira B. Tager2; Kari Nadeau1; and
S. Katharine Hammond2
Stanford University School of Medicine, Stanford, CA; 2University of California, Berkeley, CA;
3University of California, San Francisco, CA; 4Sonoma Technology, Inc., Petaluma, CA
Background: Polycyclic aromatic hydrocarbons (PAHs) are formed by incomplete combustion of
carbon-containing fuels, and exposure to PAHs has been associated with increased risk of
wheezing and impaired T regulatory cell function in a cohort of asthmatic children living in
Fresno, CA.
Objective: To assess whether exposure to PAHs is associated with lower lung function in
children, with and without asthma.
Methods: Children ages 9 to 18 living in Fresno were recruited (n = 297; 135 with asthma, 162
without asthma) for respiratory health evaluation, including medical history, current symptoms,
and pre- and post-bronchodilator spirometry. Exposure to PAHs based on a previously
published land-use regression model was estimated for each child. Linear regression was used
to evaluate the association between annual mean PAH exposure in the year prior to testing and
maximum post-bronchodilator FEV1.
Results: Mean PAH exposure was 2.99 ng/m3. In a model adjusted forage, sex, race, height and
socioeconomic status, a 1 ng/m3 increase in PAH was associated with a 0.11 L (-0.21, -0.02)
decrease in FEV1 among non-asthmatic children and a 0.01 L (-0.12, 0.09) decrease among
asthmatic children.
Conclusion: This is the first study to assess the effect of individual PAH exposure estimates on
lung function in children or adults. Surprisingly, we found a significant effect in non-asthmatic
children but not in asthmatic children. The primary source of PAH exposures in these children is
likely traffic emissions. If the results of this preliminary analysis are confirmed, greater efforts
to control PAH exposure from traffic and other sources would be warranted.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Home Interventions Are Effective at Decreasing Indoor Nitrogen
Dioxide Concentrations
Laura M. Paulin1, Postdoctoral Fellow; Gregory B. Diette1,2; Meagan Scott1; Meredith C.
McCormack1'2; Elizabeth C. Matsui3; Jean Curtin-Bros nan3; D'Ann L. Williams2;
Andrea Kidd Taylor4; Madeleine Shea5; Patrick N. Breysse2; and Nadia N. Hansel1'2
1Department of Medicine, School of Medicine, Pulmonary/Critical Care, 2Department of
Environmental Health Sciences, The Johns Hopkins Bloomberg School of Public Health,
3Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD;
4Department of Health Policy and Management, School of Community and Health Policy,
Morgan State University, Baltimore, MD; 5Delmarva Foundation, Columbia, MD
Rationale: Nitrogen dioxide (NO2) is a byproduct of combustion that is produced by indoor gas
appliances, including cooking stoves. Exposure to indoor NO2 is associated with worse
respiratory symptoms in those with obstructive airways disease. We conducted a randomized
trial in Baltimore City homes to evaluate the effectiveness of home-based interventions aimed
at reducing indoor NO2 concentrations in homes with unvented gas stoves.
Methods: Homes were recruited in partnership with the Baltimore City Health Department's
Healthy Homes Inspections and Health Services Program between June 2009 and March 2011.
Homes in Baltimore City with unvented gas stoves were eligible for randomization into one of
three groups: (1) replacement of existing gas stove with an electric stove; (2) installation of
ventilation hood over an existing gas stove; and (3) placement of portable air cleaners with
High-Efficiency Particulate Air (HEPA) and carbon filters in the home. All participants had home
inspections and 7 days of continuous air quality assessment, including NO2 monitoring using
passive badges at baseline, 1 week, and 3 months postintervention.
Results: One hundred homes were randomized to receive either replacement with electric
stove (n = 24), ventilation hood installation (n = 24) or air cleaner placement (n = 52). When
compared to baseline (19.7 ppb), replacement of gas stoves with electric stoves resulted in a
decrease of indoor NO2 concentrations at 1 week (10.9 ppb) and at 3 months (9.7 ppb, a
decrease of 51%, p-value = 0.01); 88 percent of homes had decreased NO2 concentrations at 3
months. Compared to baseline NO2 concentrations (19.2 ppb), homes receiving air cleaners had
a decrease in median indoor NO2 concentrations at 1 week (14.1 ppb) and 3 months (15.5 ppb,
a decrease of 19%, p-value = 0.05); 66 percent of homes had decreased concentrations at 3
months. Ventilation hood installation did not result in a significant change in median NO2
concentrations at 1 week or 3 months when compared to baseline.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Conclusions: Our results show that replacing gas stoves with electric stoves or placement of air
cleaners with HEPA and carbon filters can decrease indoor NO2 concentrations in urban homes
with unvented gas stoves. Additional studies now are needed to assess the health impact of
NO2 reduction on people with obstructive lung disease.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Optimizing the Built and Natural Environments in a Community for Children's Health
and Weil-Being
James Quackenboss1, Research Scientist; Sally Darney2; and Nicolle Tulve3
1National Exposure Research Laboratory, Human Exposure and Atmospheric Sciences Division,
Exposure Measurements and Analysis Branch, U.S. Environmental Protection Agency (U.S. EPA),
Las Vegas, NV
2National Health and Environmental Effects Laboratory, Toxicity Assessment Division, U.S. EPA,
Research Triangle Park, NC
3National Exposure Research Laboratory, Human Exposure and Atmospheric Sciences Division,
Exposure Measurements and Analysis Branch, U.S. EPA, Research Triangle Park, NC
An emerging concept in the field of children's environmental health is the need for a systems
approach to characterize and optimize the built and natural environments where children live,
learn and play. A holistic, systems model should enable decision makers in community sectors,
such as land use planning, buildings and infrastructure, and transportation, to adequately
consider children's lifestage-specific needs in community design and remediation efforts.
Research to understand the linkages between cumulative environmental exposures (chemical
and non-chemical) that occur in community settings and childhood health outcomes is central
to this systems approach and informs decisions that prevent or diminish potentially harmful
exposures and associated health risks. Equally important is research about how characteristics
of the built and natural environments, such as natural lighting in schools and affordable access
to green space and nature, can interact to actively promote children's health and well-being.
This poster highlights research under way in EPA's Office of Research and Development's
Sustainable and Healthy Communities Research Program to provide state and local
governments and community planners with the knowledge and tools they need to support
decisions and health impact assessments specific to children's environments. Examples include
an eco-health browser used to document the benefits of natural environments for children's
health; community assessment tools to help identify problems; geospatial tools that integrate
ecosystem goods and services with demographics and features of the built environment at
national to local scales; and an Environmental Quality Index that incorporates public health
data pertinent to birth outcomes and childhood diseases at the county scale.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Determining the Effects of Arsenic on Developmental Signaling Pathways In Utero
David Robbins1, Professor; Dennis Liang Fei1,2; Devin C. Koestler3; Zhigang Li3; Camilla
Giambelli1; Avencia Sanchez-Mejias1; Julie A. Gosse4; Carmen J. Marsit3;
and Margaret R. Karagas3
1Department of Surgery, Molecular Oncology Program, Miller School of Medicine,
University of Miami, Miami, FL
2Program in Experimental and Molecular Medicine, Department of Pharmacology and
Toxicology, Geisel School of Medicine at Dartmouth College, Hanover, NH
3Department of Community and Family Medicine, Geisel School of Medicine
at Dartmouth College, Hanover, NH
4Department of Molecular and Biomedical Sciences, University of Maine, Orono, ME
5Department of Biochemistry and Molecular Biology, Miller School of Medicine,
University of Miami, Miami, FL
f Current address: National Institutes of Health, National Human Genome Research Institute,
Bethesda, MD
Emerging evidence now suggests that in utero arsenic exposure poses health risks to the
developing fetus. This evidence consists of both epidemiological studies and data from a
number of animal models, and shows an association between prenatal arsenic exposure and
adverse developmental outcomes. However, the majority of these studies utilized levels of
arsenic exposure not commonly found in the United States. Thus, the relevance of these
findings to the lower levels of arsenic commonly found in the United States remain unknown,
as do the mechanisms underlying such effects on early child development. Using a cohort of
pregnant women exposed to arsenic at low levels, we have begun to increase our
understanding of the impact of low-dose arsenic exposure on fetal health by: (1) identifying
arsenic-associated fetal tissue biomarkers, (2) examining biomarkers of pivotal developmental
signaling pathways, (3) elucidating the mechanism by which arsenic modulates these
developmental signaling pathways, and (4) determining the association between expression of
these biomarkers and specific developmental endpoints. Here, we will present our rationale,
methodology and results to date, focusing on recent work identifying the expression of the
arsenic transporter AQP9 as a robust fetal biomarker for arsenic exposure. Further, we have
identified a positive association between the placental expression of phospholipase ENPP2 and
infant birth weight. These findings suggest one path by which arsenic may affect birth outcome.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Retrospective Study of Medical Radiation Exposure in a Cohort of Children Diagnosed
With Leukemia, 2000 to 2010: A Single Institution Study
Robin Rohrer, Professor of Medical History
Seton Hill University, Greensburg, PA, and University of Pittsburgh, Pittsburgh, PA
Background: Prenatal or early childhood exposure to medical radiation used in diagnosis or
treatment is an identified risk for childhood cancers but can be difficult to document. The
author developed a family questionnaire/interview form to identify possible exposures at the
Children's Hospital of Pittsburgh (CHP).
Aims: This retrospective study examines prenatal and early childhood medical radiation
exposure in a cohort of children diagnosed with either acute lymphoblastic leukemia (ALL) or
acute myeloid leukemia (AML) from 2000 to 2010. The hospital is a tristate regional referral
center that treats 150 to 180 new cases of cancer in children per year. About 30 percent of
these diagnosed children have AML or ALL.
Methods: Each consented family so far (approximately 50% of the cohort) has been
interviewed in person or by phone call. Medical staff and psycho-social staff referred patient
families for an interview with the author.
Results: To date, the author has been able to interview for exposures in about 50 percent of the
cohort over the last 10 years. Among the interviewed families, about 70 percent had a
documented medical radiation exposure among the following: preconception sinus or chest X-
ray or CT of either parent, sinus X-ray in mother, or diagnostic radiation in child.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Local Trends in Particulate Matter Air Pollution and Heavy Metals at an Elementary School
in Manhattan's Chinatown With Documented High Asthma Rates
Anthony M. Szema1; Yi Feng Chen2; Laura Viens1; and Jonathan C. Li1
1Stony Brook University School of Medicine, Stony Brook, NY; and 2St. Luke's Roosevelt Hospital,
New York, NY
Supported by the New York State Department of Environmental Conservation and the New York
City Department of Education, Office of Mayor Michael Bloomberg;
and Three Village Allergy & Asthma, PLLC, South Setauket, NY
Objective: To explore recent trends in the air pollution exposures of children attending school
in Manhattan's Chinatown in the context of high asthma prevalence.
Methods: We reviewed ambient air monitoring data reported by the New York Department of
Environmental Conservation for the Division Street Monitoring Site in New York City. We
evaluated the trends over time in particulate matter pollution, as well as the direction and
magnitude of changes in chemical composition of this pollution. We compared this data with
guidelines established by the U.S. Environmental Protection Agency, the World Health
Organization and the Texas Commission on Environmental Quality.
Results: Overall levels of daily and annual particulate matter air pollution averages (PM2.5 and
PM 10) have decreased at this site between 2007 and 2011. Opposing this trend was a rapid rise
in certain PM2.schemical constituent concentrations, including cerium and arsenic.
Conclusions: Relative increases in the concentration of certain chemical components of
particulate matter air pollution may explain the high rates of asthma in a setting of declining
overall particulate matter pollution. Efforts to decrease the level of particulate matter air
pollution are necessary but not sufficient to protect pediatric respiratory health. We must
conduct further research into the effects of chronic metal exposure, continue the observed
reductions in overall particulate matter levels and initiate reductions in specific metal
concentrations.
Keywords: Particulate Matter, Air Pollution, Manhattan, Chinatown, Asthma, Asian-American,
Arsenic, Cerium, Diesel Exhaust, PM2.5 and PM10.
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Reproductive Environmental Health Education for OB/GYN Specialists
Marya Zlatnik1, Professor of OB/GYN, Associate Director of MFM Fellowship;
and Mark Miller2; Director of University of San Francisco, California (UCSF) Pediatric
Environmental Health Specialty Units (PEHSU) and the Director of the Children's Environmental
Health Program at California Environmental Protection Agency
1UCSF and Division of Occupational and Environmental Health, Department of Pediatrics,
San Francisco, CA
2Department of OB/GYN and Reproductive Sciences, UCSF, San Francisco, CA
Background: Because environmental health affects reproduction, and current OB/GYN
residency curricula do not address the subject, we aimed to design an elective rotation in
Reproductive Environmental Health & Justice (REHJ), in conjunction with UCSF PEHSU.
Objective: The purpose of this elective is to provide OB/GYN Residents/Fellows with experience
in all aspects of reproductive environmental health. During the rotation at the UCSF PEHSU, the
Fellow will learn to bring scientific analysis and medical knowledge to reproductive
environmental health issues, and to communicate about these issues in a culturally appropriate
way to a broader audience, including the general public, the media, and the broader health care
community. An additional objective is to develop competencies for the specialty of
Reproductive Environmental Health and appropriate measures (performance indicators) for the
achievement of these competencies.
Methods: The proposed rotation was modeled on the extant pediatric Resident/Fellow rotation
at the UCSF Pediatric Environmental Health Specialty Unit, using the current PEHSU faculty and
clinic resources, in collaboration with UCSF OB/GYN faculty, for proposed REHJ rotation.
Proposed competencies for Fellows in Reproductive Environmental Health were drafted with
input from competencies proposed by the Institution of Medicine, Ambulatory Pediatric
Association and the American College of Occupational and Environmental Health.
Results: An elective rotation, devised as a month-long block in the context of a 3-year
fellowship in Maternal Fetal Medicine or a 4-year residency in Obstetrics and Gynecology, is
proposed. Twenty-seven Reproductive Environmental Health competencies are proposed. The
competencies are presented from three separate perspectives: academic, individual patient
care and community advocacy.
Conclusion: The proposed REHJ elective for OBGYN residents and MFM Fellows is intended to
promote the dissemination of important concepts in the OB/GYN community. These
competencies are intended to assist in structuring the training experience, achieving consensus
with respect to expectations of Fellows and faculty, providing opportunities for Fellows to
assess their own needs or gaps in training, and identifying the expertise of fellowship graduates
to potential employers.
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I
o ¦ J -¦ •' '''
Post-Participants List
Barbara Abbott
U.S. Environmental Protection Agency
National Health and Environmental Effects
Research Laboratory
Azita Amiri
University of Alabama, Huntsville
College of Nursing
Elyssa Arnold
U.S. Environmental Protection Agency
Office of Pesticide Programs
Richard Auten
Duke University
Pediatrics Department
Daniel Axelrad
U.S. Environmental Protection Agency
Office of Policy
Tina Bahadori
U.S. Environmental Protection Agency
Chemical Safety for Sustainability
Research Program
Caroline Baier-Anderson
U.S. Environmental Protection Agency
Design for the Environment
Dean Baker
University of California, Irvine
Center for Occupational and Environmental
Health
Joe Balintfy
National Institutes of Health
National Institute of Environmental Health
Sciences
Claire Barnett
Healthy Schools Network
Paola Barzelatto
Dint, Doblajes Internacionales
Nancy Beaudet
University of Washington
Pediatric Environmental Health Specialty
Units
Martha Berger
U.S. Environmental Protection Agency
William Jefferson Clinton Federal Building
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Melanie Biggs
Margot Brown
Consumer Product Safety Commission
U.S. Environmental Protection Agency
Office of Children's Health Protection
Linda Birnbaum
National Institute of Environmental Health
Maria Brown
Sciences
The Johns Hopkins University School of
National Toxicology Program
Medicine
Adrienne Black
Whitney Brown
Grocery Manufacturers Association
Academy of Nutrition and Dietetics
Science and Regulatory Affairs
Ashley Bubna
Janice Bolden
U.S. Environmental Protection Agency
U.S. Environmental Protection Agency
Office of Research and Development
Mid-Atlantic Region
Susan Buchanan
Joe Braun
Region 5
Brown University
Great Lakes Center for Children's
Department of Epidemiology
Environmental
Health
Maggie Breville
U.S. Environmental Protection Agency
Erica Burt
Office of Research and Development
Region 5
Great Lakes Center for Children's
Patrick Breysse
Environmental Health
Environmental Health Sciences
The Johns Hopkins Bloomberg School of
Antonia Calafot
Public Health
Centers for Disease Control and Prevention
Jeremy Brooks
Rich Callan
U.S. Environmental Protection Agency
U.S. Environmental Protection Agency
Lauren Brown
Courtney Carignan
Abt Associates
Dartmouth College
Seung-Hyun Cho
RTI International
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Krista Christensen
U.S. Environmental Protection Agency
Carol Christensen
U.S. Environmental Protection Agency
Gail Christopher
W.K. Kellogg Foundation
Josephine Chu
U.S. Environmental Protection Agency
Climate Change Division
Lisa Cicutto
National Jewish Health
Gwen Collman
National Institutes of Health
National Institute of Environmental Health
Sciences
Deborah Cory-Slechta
University of Rochester Medical School
Department of Environmental Medicine
Kathryn Cottingham
Dartmouth College
Department of Biological Sciences
Krysten Crews
National Jewish Health
Michael Crupain
Consumer Reports
Alva Daniels
U.S. Environmental Protection Agency
Office of Research and Development
Sally Darney
U.S. Environmental Protection Agency
Matthew Davis
Geisel School of Medicine at Dartmouth
Lena Diaw
National Institutes of Health
National Heart, Lung, and Blood Institute
David Diaz-Sanchez
U.S. Environmental Protection Agency
Kim Dietrich
University of Cincinnati College of Medicine
Environmental Health Department
Greg Diette
The Johns Hopkins University
Dana Dolinoy
University of Michigan School of Public
Health
Department of Environmental Health
Sciences
Christie Drew
National Institutes of Health
National Institute of Environmental Health
Sciences
Page 99
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Doug Durante
National Institutes of Health
Clean Fuels Development Coalition (CFDC)
Rebecca Dzubow
U.S. Environmental Protection Agency
Office of Children's Health Protection
Jennifer Eden
Public Participant
Brian Erkkila
U.S. Food and Drug Administration
Center for Tobacco Products
Brenda Eskenazi
University of California, Berkeley
School of Public Health
Adrienne Ettinger
Yale University School of Public Health
Sandy Evalenko
U.S. Environmental Protection Agency
Office of Water
Elaine Faustman
University of Washington
Nigel Fields
U.S. Department of Interior
National Park Service
Barbara Fiese
University of Illinois at Urbana-Champaign
Family Resiliency Center
Michael Firestone
U.S. Environmental Protection Agency
Office of Children's Health Protection
Brenda Foos
U.S. Environmental Protection Agency
Office of Children's Health Protection
Leslie Friedlander
U.S. Environmental Protection Agency
Office of Pollution Prevention and Toxics
Bernard Fuemmeler
Duke University Medical Center
Department of Community and Family
Medicine
Sarah Gallagher
U.S. Environmental Protection Agency
Maida Galvez
Icahn School of Medicine at Mount Sinai
Preventive Medicine
Wanda Gamble
Battelle Memorial Institute
Health and Analytics Department
Mary Gant
National Institutes of Health
National Institute of Environmental Health
Sciences
Wayne Garfinkel
U.S. Environmental Protection Agency
Region 4
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Robert Geller
Emory University School of Medicine
Department of Pediatrics
Nicole Giffen
U.S. Environmental Protection Agency
Rose Goldman
Harvard Medical School
Harvard School of Public Health
Ali Goldstone
George Washington School of Public Health
and Health Services
Environmental and Occupational Health
Robert Gould
University of California, San Francisco
Program on Reproductive Health and
the Environment
Kimberly Gray
National Institutes of Health
National Institute of Environmental Health
Sciences
Peter Griffith
National Aeronautics and Space
Administration
Adam Gustafson
Boyden Gray and Associates
Maureen Gwinn
U.S. Environmental Protection Agency
Katharine Hammond
University of California, Berkeley
School of Public Health
Kim Harley
University of California, Berkeley
Center for Environmental Research and
Children's Health
Michael Hatcher
Department of Health and Human Services
Agency for Toxic Substances and Disease
Registry
Jacquelyn Hayes
U.S. Environmental Protection Agency
Region 9
Bill Holmberg
American Council on Renewable Energy
Maeve Howett
Emory University
Southeast Pediatric Environmental Health
Specialty Unit
Sharon Huff
University of Texas Health Northeast
Southwest Center for Pediatric
Environmental Health
Patrick Hunt
Weber Shandwick
Brian Jackson
Dartmouth College
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
James Johnson
Donna King
U.S. Environmental Protection Agency
BIOASYS
National Center for Environmental Research
Katherine Kirkland
Reginald Johnson
Association of Occupational and
Examiner
Environmental Clinics
Pediatric Environmental Health Specialty
Seema Jolly
Units
University of Michigan School of Public
Health
Emily Kobernik
Fred Jorgensen
Centers for Disease Control and Prevention
Aquilent
Office of Analysis and Epidemiology
Lek Kadeli
Brenda Koester
U.S. Environmental Protection Agency
University of Illinois at Urbana-Champaign
Office of Research and Development
Family Resiliency Center
Sheila Kaplan
Susan Korrick
Harvard University
Channing Division of Network Medicine
Edmond J. Safra Center for Ethics
Brigham and Women's Hospital
Margaret Karagas
Erica Koustas
Geisel Medical School at Dartmouth College
U.S. Environmental Protection Agency
Section of Biostatistics and Epidemiology
National Center for Environmental Research
Alison Karp
Amy Kyle
U.S. Environmental Protection Agency
University of California, Berkeley
National Center for Environmental Research
Pui Lai
Catherine Karr
Children's Hospital Oakland
University of Washington
Pediatrics Department
Benjamin Lang
ACORE
Matt Karwowski
Boston Children's Hospital
Greg Lank
U.S. Environmental Protection Agency
National Center for Environmental Research
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Christopher Lau
U.S. Environmental Protection Agency
National Health and Environmental Effects
Research Laboratory
Cindy Lawler
National Institutes of Health
National Institute of Environmental Health
Sciences
Nick Le
U.S. Food and Drug Administration
Toxicology Department
Edward Levin
Duke University Medical Center
Department of Psychiatry
Sylvana Li
U.S. Environmental Protection Agency
National Center for Environmental Research
Nica Louie
U.S. Environmental Protection Agency
National Center for Environmental Research
Jennifer Lowry
Children's Mercy Hospital
Mary Manibussan
U.S. Environmental Protection Agency
National Center for Environmental Research
Jennifer Mann
University of California, Berkeley
School of Public Health
Carmen Marsit
Dartmouth College
Geisel School of Medicine
Elizabeth Matsui
The Johns Hopkins University
Pam Maxson
Duke University
Kathleen McCann
Social and Scientific Systems, Inc.
Gina McCarthy
U.S. Environmental Protection Agency
Rob McConnell
University of Southern California
Lindsay McCormick
U.S. Environmental Protection Agency
Association of Schools of Public Health
Scott McCullers
Sullivan Higdon & Sink
Leyla McCurdy
National Environmental Education
Foundation
Kimla McDonald
George Washington University Medical
Faculty Associates
Michael McKnight
Green and Healthy Homes Initiative
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Cynthia McOliver
U.S. Environmental Protection Agency
Suril Mehta
U.S. Environmental Protection Agency
Office of Children's Health Protection
Cynthia Merse
U.S. Environmental Protection Agency
Catherine Metayer
University of California, Berkeley
School of Public Health
Aubrey Miller
National Institutes of Health
National Institute of Environmental Health
Sciences
Greg Miller
U.S. Environmental Protection Agency
Office of Children's Health Protection
Mark Miller
University of California, San Francisco
Marie Lynn Miranda
Children's Environmental Health Initiative
Rachel Morello-Frosch
University of California, Berkeley
School of Public Health
Rebecca Morley
National Center for Healthy Housing
Jacqueline Mosby
U.S. Environmental Protection Agency
Office of Children's Health Protection
Jacqueline Moya
U.S. Environmental Protection Agency
National Center for Environmental
Assessment
Carolyn Murray
Dartmouth College
Children's Environmental Health and
Disease Prevention Center
Kari Nadeau
Stanford University
Department of Pediatrics
Patricia Nance
Toxicology Excellence for Risk Assessment
Nicholas Newman
Cincinnati Children's Hospital Medical
Center
Cynthia Nolt-Helms
U.S. Environmental Protection Agency
National Center for Environmental Research
Bridget O'Brien
U.S. Environmental Protection Agency
Office of Solid Waste and Emergency
Response
Kenneth Olden
U.S. Environmental Protection Agency
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Lisa Oiler
University of Kansas Hospital Poison Control
Center
Randy Olson
Kim Osborn
ICF International
Ada Otter
Region 10
Northwest Pediatric Environmental
Health Specialty Unit
Vasantha Padmanabhan
University of Michigan
Department of Pediatrics
Zenobia Palmer
Food and Drug Administration
Center for Devices and Radiological Health
Priyanka Pathak
U.S. Environmental Protection Agency
Office of Children's Health Protection
Jerome Paulson
Mid-Atlantic Center for Children's Health
and the Environment
Children's National Medical Center
Devon Payne-Sturges
U.S. Environmental Protection Agency
Ashleigh Peoples
Social and Scientific Systems, Inc.
Frederica Perera
Columbia Center for Children's
Environmental Health
Karen Peterson
University of Michigan School of Public
Health
Zoe Petropoulos
Georgetown University
Anna Pollack
George Mason University
James Quackenboss
U.S. Environmental Protection Agency
National Exposure Research Laboratory
Lesliam Quiros-Alcala
University of California, Berkeley
School of Public Health
Abbey Race
Stanton Communications
Santhini Ramasamy
U.S. Environmental Protection Agency
Urvashi Rangan
Consumer Reports
Virginia Rauh
Columbia University Mailman School of
Public Health
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Khesha Reed
Sheela Sathyanarayana
U.S. Environmental Protection Agency
Seattle Children's Research Institute
Office of Children's Health Protection
Susan Schantz
Rebecca Rehr
University of Illinois
U.S. Environmental Protection Agency
Comparative Biosciences
Association of Schools of Public Health
Sarah Scheinfeld
David Reynolds
George Washington University
Inside U.S. Environmental Protection
Public Health and Health Services
Agency Newsletter
Steven Scofield
Irelene Ricks
U.S. Environmental Protection Agency
American Association of State Colleges and
Region 4
Universities
Paula Selzer
Pat Rizzuto
U.S. Environmental Protection Agency
Bloomberg BNA, Inc.
Region 6
John Rogers
Rachel Shaffer
U.S. Environmental Protection Agency
Environmental Defense Fund
Toxicity Assessment Division
Deborah Shprentz
Megan Romano
American Lung Association
Brown University
Center for Environmental Health and
Christopher Sibrizzi
Technology
Association of Occupational and
Environmental Clinics
Melissa Rose
Pediatric Environmental Health Specialty
University of California, Davis
Units
Leslie Rubin
Barry Steffen
Southeast Pediatric Environmental Health
U.S. Department of Housing and Urban
Specialty Unit
Development
Office of Policy Development and Research
Karin Russ
Collaborative on Health and Environment
Sandra Steingraber
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Carol Stroebel
Children's Environmental Health Network
Patrice Sutton
University of California, San Francisco
Program on Reproductive Health and the
Environment
Stanley Szefler
National Jewish Health
Claudia Thompson
National Institutes of Health
National Institute of Environmental Health
Sciences
Veronica Tinney
Children's National Medical Center
Mid-Atlantic Center for Children's Health
and the Environment
Ramona Travato
U.S. Environmental Protection Agency
Office of Research and Development
Kristie Trousdale
Children's Environmental Health Network
Judy Van de Water
University of California, Davis
Department of Internal Medicine
Steve Vander Griend
Urban Air Initiative
Laura Viens
Stony Brook University School of Medicine
Preventive Medicine Department
Evan Von Leer
Weber Shandwick
Isabel Walls
U.S. Department of Agriculture
Prentiss Ward
U.S. Environmental Protection Agency
Fan Way-Cahill
U.S. Department of Agriculture
Animal and Plant Health Inspection Service
Anita Weinberg
Loyola University, Chicago
Child Law Policy Institute
Joe Wiemels
University of California, San Francisco
Ryann Williams
U.S. Environmental Protection Agency
National Center for Environmental Research
Nsedu Obot Witherspoon
Children's Environmental Health Network
Tracey Woodruff
University of California, San Francisco
Department of Obstetrics, Gynecology
and Reproductive Sciences
Alan Woolf
Children's Hospital Boston
Harvard Medical School
Page 107
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Protecting Children's Health for a Lifetime: Environmental Health Research
Meets Clinical Practice and Public Policy
October 29-30, 2013
Jerry Yen
Congressional Research Service
Margo Young
U.S. Environmental Protection Agency
Region 10
Tina Yuen
National Association of County and City
Health
Officials
Lauren Zajac
Mount Sinai School of Medicine
Preventive Medicine Department
Marya Zlatnik
University of California, San Francisco
Department of Obstetrics and Gynecology
Contractor Support
Mary Allen
The Scientific Consulting Group, Inc.
Denise Hoffman
The Scientific Consulting Group, Inc.
Darlene Summers
The Scientific Consulting Group, Inc.
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