U.S. Environmental Protection Agency


U.S. Environmental Protection Agency
Region 6

Children's Environmental Health

Sixth Annual Program Highlights Report

Protecting Children Where They Live, Learn, and Play

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Contents

Children's Environmental Health: Summary of Coordinated Efforts	3-6

Summary of work with Internal and External Partners

Children's Health on the Border	7-8

Symposia in Three Cities

Healthy Homes	9

Training Agents of Change to Protect Children's Health

Children's Health Month	10-11

Activities from October, 2015

Healthy Schools	12-14

Pesticide Safety and Integrated Pest Management in Schools
Indoor Environments and Asthma Triggers
Clean Diesel School Bus Program

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Children's Environmental Health: Summary of Coordinated Efforts

In 2015, EPA published the first Agency Strategy for Protecting
Children's Environmental Health: FY2015-FY2018 to help make
children's environmental health (CEH) considerations a key part of
EPA's day-to-day operations. The Strategy grew out of an Agency-wide
coordination with all national programs and regional offices. It is
ground-breaking because for the first time, a national strategy pulls
together children's health-specific objectives, measures, and indicators
under each of the five Agency goals and four cross-cutting strategies.

In addition, it allows Regions to capture work that might not otherwise
be measured under mandatory Annual Commitment System metrics,
or other program measures.

In support of the Strategy, the Environmental Justice (EJ) Program
released, EJ2020 to lay out priorities for addressing environmental issues in the most
vulnerable communities. In support of both of these strategies, the Directors of the Office of
Children's Health Protection and the Office of Environmental Justice sent a joint memo to
EPA leadership to bolster a renewed collaboration between EJ and CEH efforts. An excerpt
from the memo states:

In accordance with the cross-agency strategy"Working to Make a Visible Difference in
Communities" (MVD), the need to protect children and overburdened and vulnerable
communities has been identified as a key priority and strategic goal. Offices across EPA are
continuing to engage communities on projects and initiatives that support MVD by protecting
or enhanding human health. A crucial element of these projects and initiatives is successfully
creating opportunities to protect the most vulnerable population. This memo elucidates
resources to further engage staekholders in protecting children and overburdened and
vulnerabel communities.

The Office of Children's Health Protection and the Office of Environmental Justice are
bolstering our collaboration in an effort to expand upon current community efforts. We have
identified a number of opportunities for strengthening partnerships with communities...

Implementation of the CEH program at EPA is driven by Executive Order 13045 -
Protection of Children from Environmental Health Risks and Safety Risks. The Office of
Children's Health Protection, aims to ensure that all EPA actions and programs address the
unique vulnerabilities of children. Children may be more vulnerable to environmental exposures
than adults because their bodily systems are still developing; they eat more, drink more, and
breathe more in proportion to their body size; and their behavior can expose them more to
chemicals and organisms. CEH protection occurs within the context of voluntary programs and
regulations. In FY16, the Children's Health Coordinator accompanied Regional
Administrator, Ron Curry to six All-Hands Division meetings to introduce the CEH Strategy
to each Division and to advance coordination efforts Region-wide.

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Children's Environmental Health: Summary of Coordinated Efforts

Children's Health efforts are visible across many EPA program areas and include work by
the CEH Coordinator and many others working on children's environmental health. The
CEH Coordinator facilitates communication and participates on dozens of webinars,
working groups, and conference calls for internal and external projects and to promote EPA
programs across the Region. Strategic calls and planning meetings include monthly OCHP
staff, and Regional CEH Coordinator calls, weekly senior staff meetings, national Healthy
Homes and ad hoc calls pertaining to public engagement, the zika virus, Making a Visible
Difference in Communities, environmental justice and tribal calls, and occasional healthy
schools calls. Highlights from some of these activities are summarized below.

CEH partnered with the US/Mexico Border Program to host three symposia in FY15/16.
Beginning in September 2015, Region 6 hosted the first ever CEH Border symposium in El
Paso. It was followed by a second symposium in January in San Diego, and a third in
Brownsville in August, 2016. The coordinated efforts between the CEH and Border
programs in two regions resulted in increased awareness about CEH issues in border
communities. Details of the Symposia are on page 7.

CEH also coordinated with the EJ Program, RCRA, and others to address children's health
issues in Pineville/Alexandria, Louisiana as part of the Making a Visible Difference in
Communities initiative. CEH and EJ staff also supported stakeholder work to advance
awareness about harmful chemicals in children's products that are targeted to low income
communities. Meetings were held in Dallas and in Washington, DC to assist stakeholders
with connecting to the right audiences and to help deliver their message to Federal
agencies to address children's health disparities. CEH supported the Tribal Program,
presenting on Children's Health at the 19th Annual Tribal Environmental Summit in Dallas
and presenting key points on CEH to a monthly regional Tribal call.

CEH further worked with the Office of External Affairs coordinating on social marketing
to promote positive messages about the work Region 6 is doing to protect children across
the region; messages were published via Facebook and Twitter during Children's Health
Month, Public Health Week, and for special events. The Environmental Education
Program provided funding to purchase 48 flag sets flags for the AQI School Flag program
which was then promoted during the Regional Sustainability Day, and a school nurse
conference in New Mexico. EPA Region 6 staff is also working with staff from EPA's Office
of Air Quality Planning Standards staff and the Louisiana Department of Environmental
Quality to deliver a webinar. The webinar scheduled to be conducted during Children's
Health Month, 2016 will raise awareness about air quality and how it impacts student
health. CEH also coordinated with Environmental Education to provide materials to Baton
Rouge schools after devastating floods.

The Lead Based Paint Program funded a grant to support Healthy Homes training and also
continued to fund the Circuit Rider initiative, an outreach effort that has reached thousands of
people across Texas, New Mexico, Louisiana, and Arkansas in the past few years. This year

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Children's Environmental Health: Summary of Coordinated Efforts

The circuit rider visited 193 communities including 168 city/county health offices, 71 health care
professional/facilities and attended 23 health/wellness and back-to-school community events.

Coordinating with EPA's Office of Solid Waste and Emergency Response, and the EPA

lab in Houston occurs periodically in response to public inquiries that pertain to children's
health environmental exposures. The CEH program frequently responds to requests for
publications for health fairs, fall festivals, Earth Day, and other family events by providing
materials and staffing booths. The Coordinator also responds to requests from the public.

IN FY16, the CEH Coordinator worked on a multi-region work group to analyze the Healthy
Homes initiative and make recommendations to the Office of Children's Health
Protection on continuing this important tool to bring training to communities across the
county. Efforts resulted in finding a new vehicle that Regions can tap into for training. The
Coordinator also volunteered to review applications for the Children's Health Award, a
national competition that recognizes three individuals during Children's Health Month at
an award ceremony in DC. One of the selectees, Dr. Genny Carrillo is a professor at Texas
A&M School of Public Health in McAllen, Texas and has worked on childhood asthma and
promotora training for years. She is a former EPA grantee and also presented her program
at the Brownsville CEH symposium.

The South West Center for Pediatric Environmental Health at Texas Tech in El Paso became
the new Region 6 PEHSU in FY15 and as such, has contributed a significant amount of time
and resources to protecting children's environmental health in Region 6. The CEH
Coordinator works with the PEHSU on planning events, consulting on inquiries pertaining
to children's exposures to chemicals and toxins, and coordinating on work that supports
EPA's mission. In FY 16 the EPA Administrator visited the PEHSU to speak with public
health students and visit colonias in Texas and New Mexico. Details of her visit to the
Border are on page 8.

The CEH Coordinator continued to support the Health and Wellness Alliance for
Children in FY16 by attending periodic meetings; the CEH Coordinator participated in the
kick off meeting of the 1000 Communities Campaign on February 25th southern Dallas. The
NCHH launched the Campaign to reduce substandard housing in 1,000 communities by
2025, while maintaining and potentially expanding the supply of affordable housing. As one
of the efforts to support the campaign, the Alliance is working with the City of Dallas on
housing code revisions that would address minimum housing standards to keep families
(especially children) from being exposed to asthma triggers at home. Dallas City Council
members Erik Wilson (District 8) and Carol King Arnold (District 4) attended the event
sponsored by Wells Fargo, Habitat for Humanity, and the National Center for Healthy
Housing. EPA also participated in the annual Health and Wellness Alliance for Children
Symposium at the Communities Foundation of Texas on April 19th, and then on July 22nd,
organized and attended the Healthy Homes Leaders workshop at the Paul Lawrence

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Children's Environmental Health: Summary of Coordinated Efforts

Dunbar Library in Southern Dallas. On November 24th, EPA recognized the Alliance for
their work to protect children in a ceremony at City Hall. A description of the event appears
on page 11.

Partnerships with non-profit organizations such as the Alliance, an organization within
Children's Health Hospital, and others are vital to expanding EPA's reach to protect
children. The CEH Coordinator participated in senior level meetings with the Campaign for
Healthier Solutions to support their efforts to address harmful chemicals in consumer products,
and also participated in several calls with Champion Impact Capital to explore the possibility of
social impact bonds for childhood asthma prevention.

Equally as important is the ongoing coordination between Federal Agencies such as the
Administration for Children and Families (ACF). The ACF Federal Workgroup meets
quarterly at HHS Headquarters in their Region 6 Dallas office. Coordination with the
Regional Department of Housing and Urban Development, the Agency for Toxic Substances
and Disease Registry, and others occurs informally as situations arise.

Overall, the goal of the CEH program is to ensure that children are protected from
environmental risks and that they are considered in all agency actions. In the following
pages, this CEH Annual Report provides details on several key highlights and measures
from Region 6 efforts that occurred from October 1, 2015 to September 30, 2016.

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Children's Health on the Border

EPA is working along the US/Mexico Border to address binational environmental
challenges and disproportionate health impacts that burden border communities. Health
impacts such as poor water quality and improper solid waste disposal, poor indoor and
outdoor air quality, mismanagement of pesticides, misuse of chemicals and other issues,
affect children more than adults due to children's unique vulnerabilities.

The US/Mexico border area covers over
1500 linear miles with San Diego being
on the far western end and Brownsville
on the far eastern end. El Paso is
roughly halfway between the two cities
and so it was chosen as the site of the
first symposium. In 2015 the Children's
Health and Border Programs in Region
6 and 9 began working collaboratively
to bring CEH educational symposia to
those working in border communities.

Three Symposia in One Year

•	The first symposium took place over two days
on September 24-25, 2015 in El Paso, Texas on
the campus of Texas Tech in El Paso. It was
hosted by the Southwest Center for Pediatric
Environmental Health. Continuing education
credits were provided to participants. Over
one hundred doctors, nurses, promotoras, and
public health professionals attended the two-
day event in which thirty experts presented on
issues such as asthma, lead and mercury
exposure, climate change impacts on
children's health and a dozen other topics.

Simultaneous English/Spanish translation was provided for all the presentations.

•	The second symposium was held fourth months later in San Diego on January 27,
2016 and included a roundtable discussion on next steps.

•	A third symposium, was held in Brownsville, Texas on August 25, 2106. This was the
first symposium to be broadcast over a live web feed so participants from other
cities could view plenary sessions. In addition to the symposium, a Healthy Homes
course was offered in conjunction with the event to offer training on the
relationship between housing and public health.



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Children's Health on the Border

Results

Second, the symposium in El Paso received attention from the
local press. Dr. Ruth Etzel, the Director of EPA's Office of
Children's Health Protection and Dr. Stephen Borron, Director
of the Southwest Center for Pediatric Environmental Health
were interviewed on camera and the interview was broadcast
on local news raising awareness about children's
environmental health to the general public.

The outcomes from these combined events produced several results. First, the number of
people trained during the three symposia totaled more than 390 people over four days of
training. Subsequently, these "change agents" will take the training they received back to
their communities and share with parents, teachers, patients, and other who care for
children, ultimately reaching thousands of border residents and improving the
environmental health of kids who live in border communities.

Third, In addition to the numbers reached through raising awareness and direct training,
EPA Administrator Gina McCarthy, made a trip to El Paso. During her visit, she met with
pediatricians from the Southwest Center for Pediatric Environmental Health, staff at the
West Texas Regional Poison Center, and students enrolled in public health at UT and Texas

Tech universities. She also toured communities in New
Mexico and west Texas for her first glimpse at the colonias,
or unincorporated
communities that exist

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along the border. These
communities usually
consist of sub- standard
housing, unpaved roads,
and are host to illegal
dumping standing water,
and minimal infrastructure
to support basic services
such as electricity and clean water.

Finally, these combined events resulted in coordination between the Regional CEH and
Border offices, the Office of Children's Health Protection, and the Office of International and
Tribal Affairs to request additional resources be devoted to this area with the hope of
increasing the scope and reach of children's health work along the border in years to come.

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Healthy Homes

Training on the Border and across Texas

In recent years, EPA's Office of Children's Health Protection funded training courses that
were conducted by the National Center for Healthy Housing. Using the train-the-trainer
model, courses were targeted to train those who are responsible for the health and safety
of families—especially children. However, the contract with the National Center for Healthy
Housing expired in 2015 and that aspect of the program was no longer available to Regions.

In an effort to keep the training going, Region 6 participated on a national workgroup to
develop an alternative plan to bring Healthy Homes training back to communities, the
rationale being that one way to prevent childhood exposures is to target the areas where
children live. By educating caregivers and housing experts about the link between housing
and health-critical for prenatal care and for early childhood development. Representatives
from several regions participated on the workgroup and presented alternatives to OCHP
national leadership to propose continuing the program. As of September 2015 a proposal is
under development to present to a potential new partner to continue this important work.

Results

In the meantime, the Region 6 Lead Based Paint and the Children's Health Programs joined
forces to bring Healthy Homes training to the Region, filling the gap until a new permanent
training solution could be implemented. The Lead Program provided 20K in funding to the
University of Texas School of Health Science Center in Houston to conduct training. They
were able to train 195 people in seven communities across Texas including three along
the US/Mexico Border. The Texas Department of State Health Services was consulted to
help select communities and training was conducted in Houston, El Paso, Dallas, Tyler, Fort
Worth, Harlingen and McAllen. The Harlingen training was performed in conjunction with
the Children's Health Symposium in Brownsville.

In addition, the staff of the Region 6 PEHSU, located at the Southwest Center for Pediatric
Environmental Health at Texas Tech became certified to teach Healthy Homes in 2016.
Having access to this new partner will allow EPA to continue providing training around the
Region at no cost to local communities. Training is already being planned in the new fiscal
year for Pineville/Alexandria in Louisiana and Corpus Christi in Texas. In addition to
certifying trainers and educating about environmental asthma triggers, lead based paint,
household chemicals and pesticides, training also serves as an incentive for communities to
partner with EPA to develop sustained relationships on children's environmental health
protection.

More than 1,295 people have taken Healthy Homes certification courses in Region 6
since 2011! This train-the-trainer model aims to expand the reach of Healthy Homes
practices to thousands of residents in Region 6.

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Children's Health Month

EPA recognizes October as Children's Health Month. Throughout the month, the Region
places special emphasis on children's environmental health activities which usually began
in late September. Outreach was conducted in Texas, New Mexico, Louisiana, Oklahoma,
and Arkansas.

This year, activities kicked off in September at the end of FY15 with the Children's Health
Symposium in El Paso, Texas. Protecting Children Where They Live, Learn, and Play, set

the stage for a key focus along the US/Mexico border. More than 130 health care providers
were trained and received continuing education credits. Region 6 participated in planning
with Region 9 for their symposium in San Diego, and held then held a third in Brownsville.

An All Employee Memo was sent out internally to Regional staff announcing monthly
events, announcing the National Strategy to Protect Children's Health FY15-18, and

reinforcing the importance supporting and engaging in children's health protection in all
Regional programs.

CEH partnered with the Regional Science Council to invite Dr. Kurt C. Kleinschmidt,
Professor of Emergency Medicine at the University of Texas Southwestern Medical Center
to present to Regional staff on a local mercury event that impacted children in Dallas a few
years ago. Dr. Kleinschmidt's presentation highlighted clinical aspects of mercury toxicity
and the complex issues related to such an event. About 50 people attended the
presentation.

The SunWise Program, a K-8 public health and environmental education program was
scheduled to sun set in 2015 and was subsequently passed on to the National
Environmental Education Foundation to manage. Region 6 took the remaining inventory of
SunWise materials including a dozen hand-held meters that measure the UV Index and
mailed health education information to several organizations including:

• Louisiana Children's Discovery Center

• Northeast Texas Children's Museum

• Louisiana Children's Museum

• Children's Museum of Houston

• The Woodlands Children's Museum

• The Myriad Botanical Gardens in Oklahoma City

The organization will promote SunWise in an effort to educate hundreds of families in
three states about skin cancer prevention and stratospheric ozone protection.

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Children's Health Month

Social media focused promoted children's health protection during October and included:

•	Internal BLOG on the Region 6 Community of Leaders page

•	Tweets and Face Book posts throughout the month on ways to protect children's
health

•	An article was published in the Region's Local Emergency Planning Committees
Bulletin

•	The Annual Children's Environmental Health Regional Highlights Report was
published for 2015

General outreach focused throughout the month included participation in asthma and
family event days such as Greenfest, a local even where EPA partners annually with the
City of Dallas. This year it was held at the Farmer's Market, near downtown. Greenfest is a
family event day that provides citizens with information on health and ways to protect the
environment; CEH Month Posters were distributed to the Departments of Health in New
Mexico and Texas; promoted Children's Health at the West Dallas Coalition Meeting; and
Lead Planners were distributed to organizations during Lead Poisoning Prevention Week
the last week in October to raise awareness about childhood lead poisoning.

Health and Wellness Alliance for Children and
the City of Dallas Recognized by EPA

Although the recognition happened after Children's
Health Month, on November 24, 2015, EPA
Regional Administrator Ron Curry was pleased to
honor the City of Dallas and the Health and
Wellness Alliance for Children for their work on
asthma and other CEH issues in Dallas County. He
presented plaques to both organizations in a brief
ceremony at City Hall.

Staff from the City of Dallas and Health and
Wellness Alliance for Children pose during the
award ceremony

EPA Regional Administrator, Ron
Curry talks with Dallas City
Manager, A.C. Gonzales

Work with the HWAC
continues as they advocate for the city to revise housing
codes to address asthma triggers found in homes. In
addition to providing technical assistance to HWAC, the
Children's Health Program sponsored a Healthy Homes
workshop in South Dallas during the summer to develop
leadership on the Healthy Homes initiative for targeted
communities in Dallas where older housing stock and
children's environmental health issues are a key focus.

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Healthy Schools: Pesticide Safety and Integrated Pest Management

In October 2015, EPA released its Strategic Plan for School Integrated Pest Management, FY
2016-2017. This document, the FY2014-2018 EPA Strategic Plan, and the US EPA Region 6
Pesticides Program FY 2016 School IPM Work Plan were are the foundation for all Region 6
pesticide safety and integrated pest management (IPM) in schools activities.

Stakeholder and Regional Collaboration

The Region 6 Pesticides program continued to focus its pesticide safety and IPM in schools
efforts to promote a "wholesale" approach to establishing sustainable and verifiable
programs that mitigate pests and reduce reliance on pesticides. This included serving on
the Southern IPM Center's Advisory Council, and collaborating and consulting the Southern
IPM Center's IPM in Schools working group which represents State Lead Agency, Extension
Services, and industry in the southern States, to include Arkansas, Louisiana, Oklahoma,
and Texas. Region 6 also expanded its regional stakeholder outreach to include state-level
and local regional representatives and groups with influence within the school community
(administrators, business officials, facility managers, nurses, teachers, and parents. Efforts
and communications were based on the Principles of Agreement s igned by their national
level representative organizations at the EPA's 2016 National School IPM Roundtable.

Results

Region 6 conducted 15 outreach and training events at 9 separate venues. A total of 964
district administrators, school nurses, facilities management, stakeholder state/tribal/
federal agency staff, IPM coordinators, pest management professional, federal/state/
county/local environmental health professionals, and associated professional organization
members from across the region were trained and consulted at these events including:

•	2016 Children's Environmental Health Symposium: Children's Environmental
Health on the Boarder, Brownsville, Texas

•	National Environmental Health Association's 2016 AEC & HUD Healthy Homes
Conference, San Antonio, Texas

•	19th Annual Tribal Environmental Summit, Dallas, Texas

•	20th Head to Toe School Nurse Conference, Albuquerque, NM

•	Mt. Auburn Elementary School Health and Career Fair, Dallas, Texas

•	2015 Texas School Nurse Organization Annual Conference, Dallas, Texas

•	2015 Annual Statewide School IPM Coordinator Conference & Meeting of TIPMAPS
Members, Waco, Texas

•	EPA Center of Expertise National Webinar Writing an IPM Policy for your School
District

•	31st Annual New Mexico School Facilities Managers Workshop, Albuquerque, NM

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Healthy Schools: Addressing Childhood Asthma

An estimated 23 million people, including six million children have asthma. To address this
epidemic, EPA's Indoor Environments Program develops and maintains partnerships,
publishes publications and public service announcements, hosts a recognition program,
and provides funding opportunities to address environmental triggers that cause asthma.
Region 6 conducts multiple outreach activities that promote the adoption of asthma
education and safety practices in homes, schools, and childcare centers, in Environmental
Justice communities, Indian Sovereign Nations and Border Communities. This year EPA
conducted 9 outreach events and managed 3 asthma related grants with a focus on Asthma
and Healthy Buildings. A summary of key initiatives to address asthma in FY16 include:

Asthma Boot Camp

EPA funded a grant with the University of Texas, San Antonio to provide children with a fun
filled day while learning how to manage their asthma. Participants learned about asthma
medications, asthma triggers and the environment, how to monitor their asthma, and much
more while having a fun day at the DoSeum, San Antonio's museum for kids.

Results

Three camps were held reaching a total of 50 children and 250 family members and 12

respiratory therapists were trained. Each child who attended also received a peak flow
meter, medication holding chamber, and asthma booklet.

Region 6 Indoor Environments Programs continues to support the Asthma Community
Network an online resource, and this year added another 50 members to the community.

Cleaner School Buses Address Outdoor Air Pollution

Region 6 supports clean air programs that will ultimately help improve children's health. In
January 2011, President Obama signed the Diesel Emissions Reduction Act (DERA) of 2010
reauthorizing DERA through fiscal year 2016 and allowing EPA to offer rebates in addition
to grants. EPA decided to offer the rebates to eligible entities for the replacement of school
buses.

EPA designed the School Bus Rebate program to encourage school bus fleet turnover so
more children can ride buses with the cleanest emissions standards or buses that have
been retrofitted to reduce emissions. The 2015 School Bus Replacement and Retrofit
Funding Opportunity provided financial assistance to public and private fleet owners for
the replacement or retrofit of school buses powered by model year 2006 or older engines
with new buses powered by a certified 2015 or newer model year engine, or operate solely

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Healthy Schools: Addressing Childhood Asthma

on electricity. Eligible replacement school buses can operate on ultra-low sulfur diesel fuel
(ULSD), battery or hybrid drive trains, or alternative fuels.

Results

EPA received over $7 million in funding for the 2015 rebate program and over 530 school
bus fleets applied to the program, requesting over $50 million in funding.

Four school districts in Region 6 received rebates to replace 14 school buses from the
national funding. Region 6 had additional funding outside of the national allocation because
money was returned from grantees that did not use all of their grant funds, and also funds
from the 2015 DERA National competition were not utilized. All of the funds ($915,000)
were re-allocated to support school bus rebates for the replacement of 45 school buses
in Region 6. Rebates were given to Calcasieu Parish School Board, Houston Independent
School District, Lincoln Parish Schools, Mounds Public School, Rapides Parish School Board,
Rockwall Independent School District and Turkey Ford School.

Special Recognition

EPA Administrator, Gina McCarthy awarded the Agency's National Honor Award, to
the team of Regional Indoor Air Quality Coordinators in recognition of collective,
outstanding public health efforts to improve the lives of people with asthma.

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