From: Subject: CEHN: An Introduction to Children's Environmental Health Date: Sun, 19 Sep 2004 17:39:15 -0400 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C49E6F.9521DF40"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C49E6F.9521DF40 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.cehn.org/cehn/WhatisPEH.html CEHN: An Introduction to Children's Environmental = Health
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An Introduction to
Children's = Environmental=20 Health

This piece provides a brief overview = of why=20 children's environmental health is a growing cause for concern. = Although=20 by no means a comprehensive review of this complex subject, this = piece=20 includes a discussion of why children are more vulnerable than = adults to=20 environmental exposures, what types of exposures affect children, = and=20 which children are at particular risk.

Children today live in an environment that is vastly different = from=20 that of previous generations. Explosions in technology, = information,=20 population and material goods mark the end of the 20th century. = One of the=20 key contributions to the current technological age has been the = discovery=20 and use of thousands of new chemicals. During the last 50 years = hundreds=20 of thousands of chemicals have been developed and the production = of=20 synthetic chemicals has increased from 1.3 billion lbs. in 1940 to = 320=20 billion lbs. in 1980.1=20 Chemicals are ubiquitous in our environment worldwide, and traces = of=20 man-made chemical compounds (toxicants) are found in all humans = and=20 animals.2

Currently, use of more than 70,000 chemicals is allowed in the = United=20 States. Little is known about the health effects of the majority = of these=20 chemicals on children.3 In = the=20 last several decades, health effects due to chemical exposures = have been=20 noted in wildlife.4=20 Exposures to environmental toxins, such as lead, are now known = to=20 cause permanent damage to a child's nervous system.5=20 Other toxicants are being implicated in causing adverse health = effects=20 in children.6,7 = While=20 exposures to some environmental hazards have decreased because of = new=20 regulations and standards, children continue to be exposed to = toxicants in=20 the air, water and food.8

The elegance and delicacy of the development of a human being = from=20 conception through adolescence affords particular windows of = vulnerability=20 to environmental hazards. Exposure at those moments of = vulnerability can=20 lead to permanent and irreversible damage. In order to protect = children=20 more effectively and proactively, we must consider why children = are more=20 vulnerable than adults, what types of exposures affect children = and which=20 children are at particular risk.

Why = are=20 Children Not Just "Little Adults" When It Comes to Environmental=20 Exposures?

As Ken Olden, Director of the National Institute of = Environmental=20 Health Sciences (part of the National Institutes of Health) has = stated, "A=20 little kid goes from a single cell to a laughing, sociable, = intelligent,=20 friendly human being over a course of two years that's dramatic = growth and=20 development."9

Children, beginning at the fetal stage and continuing through=20 adolescence, are physiologically very different from adults. They = are in a=20 dynamic state of growth, with cells multiplying and organ systems=20 developing at a rapid rate. At birth their nervous, respiratory,=20 reproductive and immune systems are not yet fully developed. In = the first=20 four months of life an infant more than doubles its weight. Young = children=20 breathe more rapidly and take in more air in proportion to their = body=20 weight than do adults. They also have higher metabolic rates and a = higher=20 proportionate intake of food and liquid than do adults.10 =

The rate at which children absorb nutrients from the = gastrointestinal=20 tract is likewise different than the rate for adults, a fact that = can=20 impact their exposure to toxicants. For example, children have a = greater=20 need for calcium for bone development than do adults and will = absorb more=20 of this element when it is present in the gastrointestinal tract. = When=20 lead has been ingested into the gut, however, the body will absorb = it in=20 place of calcium. Consequently, an adult will absorb 10% of = ingested lead,=20 while a toddler will absorb 50% of ingested lead.11 =

Because metabolic systems are still developing in the fetus and = child,=20 their ability to detoxify and excrete toxins differs from that of = adults.=20 This difference is sometimes to the child's advantage, but more = frequently=20 they are not able to excrete toxins as well as adults, and thus = are more=20 vulnerable to them.12=20 ALIGN=3D"JUSTIFY">Not only does a child's physiology differ = from an=20 adult's, so does its environment. In its first environment, its = mother's=20 womb, the fetus may be permanently damaged by exposure to a wide = variety=20 of chemicals that can cross into its bloodstream through the = placenta.=20 These chemicals include lead,13=20 polychlorinated biphenyls,14 = methylmercury,15=20 ethanol and nicotine from environmental tobacco smoke.11=20 Researchers are also looking at possible connections between = health=20 abnormalities and a group of chemicals called endocrine = disruptors, which=20 mimic the body's hormones and have been shown to disrupt = reproductive and=20 hormone systems in wildlife.

Behaviors characteristic of early childhood also affect a = child's=20 exposure to toxicants. In the first year of life the young child = spends=20 hours close to the ground where he or she may be exposed to = toxicants in=20 dust, soil and carpets as well as to pesticide vapors in low-lying = layers=20 of air.

Normal development in early childhood includes a great deal of=20 hand-to-mouth behavior, providing another avenue for exposure to = such=20 toxicants as lead in paint dust or chips and to pesticide = residues.

Children also spend more time outdoors than do most adults, = often=20 engaged in vigorous play. Because children breathe more air per = pound of=20 body weight than adults and because their respiratory systems are = still=20 developing, they are prone to greater exposure to and potential = adverse=20 effects from air particulates, ozone and other chemicals that = pollute=20 outdoor air.16,17 =

Finally, a child's diet differs in important ways from that of = an=20 adult. Because children eat more fruits and vegetables and drink = more=20 liquids in proportion to their body weight, their potential = exposure to=20 ingested toxicants such as lead, pesticides, and nitrates is = greater. For=20 example, the average infant's daily consumption of six ounces of = formula=20 or breast milk per kilogram of body weight is equivalent to an = adult male=20 drinking 50 eight-ounce glasses of milk a day.11=20 Likewise, proportionate to its body weight, the average = one-year-old eats=20 two to seven times more grapes, bananas, pears, carrots and = broccoli than=20 an adult.18 =

Two other concerns bear addressing. Because they are exposed to = toxicants at an earlier age than adults, children have more time = to=20 develop environmentally-triggered diseases with long latency = periods, such=20 as cancer and possibly Parkinson's disease.19 = The=20 effects of multiple and/or cumulative exposures to toxicants and = their=20 potential synergistic effects are also not known and demand = further=20 research.

Which Children Are Most=20 Affected?

All children are affected by environmental hazards. Pollution = and=20 environmental degradation know no county, state, regional, or = national=20 border. Contaminants are transported through many media including = air,=20 water, soil and food throughout the world. However, children = living in=20 poverty and children in racial or ethnic communities are at=20 disproportionate risk for exposure to environmental hazards.

According to 1994 Census data, 21%, or more than 14 million = children in=20 the US live in poverty.20=20 Poverty can compound the adverse effects of exposure to toxicants = because=20 it is so often associated with inadequate housing, poor nutrition, = and=20 limited access to health care. A primary source of exposure to = lead, for=20 example, is from flaking lead-based paint, a condition that is = more common=20 in poorly-maintained older housing often found in low-income=20 neighborhoods.

Higher rates of poverty are one of the factors that place = children of=20 ethnic and minority communities at disproportionate risk for = environmental=20 exposures. While 16% of white, non-Hispanic children live in = poverty, the=20 rates in the African-American and Hispanic communities are 415 and = 41%,=20 respectively.20 =

Race has also been shown to be a factor in increased rates of = exposure=20 to certain environmental hazards. An estimated 2.75 million to = 3.85=20 million children (one out of four) live within one mile of a = National=20 Priorities List hazardous waste site. African-American, = Hispanic-American=20 and Native-American children are over-represented in these = communities. A=20 1987 study conducted by the United Church of Christ showed that = the racial=20 composition of neighborhoods was a major factor in the placement = of=20 hazardous waste facilities in the US .21 A = 1993=20 study conducted on race and toxic waste sites confirmed racial = disparities=20 in the placement of facilities.22 In = California, all three of the Class I toxic waste dumps are in or = near=20 Hispanic communities.23 = Sixty=20 percent of Hispanics versus 315 of non-Hispanic whites live in = counties of=20 the US in which levels of at least two or more pollutants exceed = EPA air=20 quality standards.24 =

The health status of children belonging to low-income and = racial and=20 ethnic communities reflects their increased risk of exposure to=20 environmental hazards. Eight percent of low-income children are=20 lead-poisoned compared to 1.9% of middle- and 1.0% of high-income=20 children. African-American and Mexican-American children have = higher rates=20 of lead poisoning than white non-Hispanic children (11.2% and 4.0% = respectively, compared to 2.15).25 = Rates=20 for asthma-related deaths and hospitalizations are routinely = higher for=20 African-American children than for Caucasian children. Coupling = the risk=20 factors of poverty with environmental exposures places children in = racial=20 and ethnic communities at multifactorial risk for illness. =

Selected Known Hazards for Children

Children face myriad environmental hazards radiation, solvents, = asbestos, mercury, arsenic, sulfur dioxide and ozone, to name but = a few.=20 They fall into categories such as neurotoxins, endocrine = disruptors,=20 carcinogens, and respiratory irritants and inflammatants. = Discussed below=20 are three selected environmental hazards known to seriously impact = children's health.

Lead

  • Phase 2 of the Third National Health and Nutrition = Examination=20 Survey (conducted from October 1991 to September 1994) indicated = that=20 930,000 preschool children in the US had blood lead levels above = the=20 Centers for Disease Control and Prevention (CDC) intervention = level of=20 10 mg/dL;25=20 nearly 275,000 had blood lead levels greater than 15 mg/dL and = nearly=20 85,000 had greater than twice the CDC intervention level (20 = mg/dL).26=20 Exposure to lead has been associated with an array of = neurodevelopmental=20 effects, including attention deficits, decreased IQ scores,=20 hyperactivity and juvenile delinquency.27,28 = Research has also shown an association between slightly = elevated=20 blood lead levels in children at the age of 24 months and lower = general=20 cognitive function at 5 years of age.29=20

    The elimination of lead from gasoline in the 1970s, one of = the great=20 public health success stories of that decade, resulted in = significant=20 decreases in blood lead levels.30 = Although lead has been removed from most paint products now = on the=20 market, lead-based paint in older homes is still the most common = source=20 of high-dose lead exposure for preschool-aged children. = Nationwide,=20 approximately 3 million tons of lead remain in an estimated 57 = million=20 occupied private housing units built before 1980, a figure that=20 represents 74% of the nation's housing stock.31=20 Childhood lead exposures can occur through ingestion of paint = chips or=20 dust from deteriorating surfaces, from chewing on painted cribs, = or=20 through inhalation of lead paint dust produced by sanding during = renovation.30 = Lead=20 is also found in drinking water as a result of leaching from=20 lead-soldered plumbing and in soil containing lead residues from = automobile exhaust.6=20

Air Pollution

  • Air pollution affects children more than adults because of = their=20 narrow airways, more rapid rate of respiration, and the fact = that they=20 inhale more pollutants per pound of body weight.32 = Common indoor air pollutants include carbon monoxide, radon, = environmental tobacco smoke, asbestos, formaldehyde and mercury. = Common=20 outdoor air pollutants include ozone and particulate matter.=20

    Health effects associated with both indoor and outdoor air = pollution=20 include increased perinatal mortality, increased acute = respiratory=20 illnesses (e.g., bronchitis and pneumonia), aggravation of = asthma,=20 increased frequency of physician visits for chronic cough and = ear=20 infections, and decreases in lung function.17 = Researchers are seeking to identify indoor and outdoor air=20 pollutants that serve to exacerbate asthma. Among persons under = the age=20 of 20, the prevalence of asthma increased by 42% between 1980 = and 1987.=20 A recent study of neonatal mortality found an association = between=20 elevated concentrations of fine particulates and neonatal = deaths,=20 including sudden infant death syndrome (SIDS).34=20 There is little doubt that high levels of air pollution are = responsible=20 for increased morbidity, and in some cases mortality, in = children.17 =

    Ironically, increases in indoor air pollution can be = attributed to=20 what are generally considered to be improvements in our quality = of life.=20 These include energy saving measures such as better insulation = and=20 decreased ventilation rates in houses, increased furnishings, = increased=20 mean indoor temperature and increased indoor humidity.35 In = addition, the number of "airtight" buildings has increased since = the=20 1970s, as has the use of synthetic building materials and = unvented=20 combustion appliances.36 = These factors coupled with an increase in the amount of time = we=20 spend indoors, have increased the concentration of indoor = environmental=20 pollutants and our exposure to them.

    In the outdoor environment, there has been an effort to = reduce=20 exposure to ozone and particulates. Ozone, the most pervasive = air=20 pollutant in the United States, is produced when hydrocarbons = and=20 nitrogen oxides emitted from motor vehicles and other sources = react in=20 the presence of sunlight.37 = Exposure to ozone has been associated with increased asthma = rates in=20 children38 as = well as a reduction in lung function, and also causes = exercise-related=20 wheezing, coughing and chest tightness.37=20 During 1991-93, ozone levels exceeded the National Ambient Air = Quality=20 Standard on four or more occasions in 104 cities or counties, an = area=20 that encompasses 24% of the US population under the age of = 13.=20 African-American, Asian/Pacific Islander and Hispanic = children are=20 disproportionately represented in areas that exceed acceptable = ozone=20 levels.37 = Most=20 recently the US Environmental Protection Agency has issued = regulations=20 to decrease the levels of ozone and air particulates in outdoor = air.=20

Pesticides

  • Children are often exposed to toxicants through the = agricultural and=20 home use of pesticides or the ingestion of pesticide residues on = food or=20 in water. Pesticides used today generally fit into five main = categories:=20 insecticides, herbicides, fungicides, nematocides and = rodenticides.39 = Increased awareness of acute pesticide poisoning has led to = an=20 apparent decrease in acute episodes of toxicity, and public = health=20 concern has thus shifted to evaluating the effects of low level = chronic=20 pesticide exposures.39=20 Again, children may be more vulnerable than adults to = experiencing=20 latent or delayed effects over the long course of their = lifetime.=20 Researchers have become concerned about the potential = associations=20 between chronic pesticide exposures and chemical carcinogenesis, = environmental estrogen disruption and developmental = neurotoxicity.39 = A 1993 National Academy of Sciences report stated that some=20 pesticides may interfere with physiological processes of the = child,=20 including the immune, respiratory and neurological systems.10=20

Childhood Diseases

The US has seen a worrisome increase in certain childhood = diseases, and=20 researchers are working hard to determine whether this increase is = linked=20 to environmental exposures. As noted, childhood asthma has = increased by=20 more than 40% since 1980, affecting more than 4.2 million children = under=20 the age of 18 nationwide. The incidence of two types of childhood = cancers=20 has risen significantly over the past 15 years: acute lymphocytic = leukemia=20 is up 10% and brain tumors are up more than 30%.40=20 Although there are no registries for learning disabilities and = attention=20 deficit disorders among children, there has been growing attention = in=20 recent years to an apparent increase in both.

Policy Implications

The key to protection is prevention. Recently, there has been a = dramatic shift in the recognition of children's environmental = health=20 issues in Congress and federal agencies. In November 1996, the US=20 Environmental Protection Agency (EPA) released a report, = Environmental=20 Health Threats to Children and announced that for the first time = children=20 would be considered in all EPA risk-assessment and = standard-setting=20 procedures. Congress passed the Food Quality Protection Act in = September=20 1996, which specifically focuses on setting standards to protect = children=20 from pesticide residues and other hazards in foods. This = legislation is=20 based on recommendations from a ground-breaking research report = published=20 in 1993 by the National Research Council entitled Pesticides in = the Diets=20 of Infants and Children. In April 1997, President Clinton signed = an=20 Executive Order on Children's Environmental Health and Safety = (#13045)=20 requiring federal agencies to include children and their unique=20 susceptibilities in standard-setting procedures and establishing = an=20 interagency task force to ensure coordination of regulations and = research.=20 These actions provide an important framework for protecting = children.=20 Whether they prove to be effective will depend on how diligently = they are=20 implemented.

Questions Needing = Further=20 Exploration

Informed and effective policy is reliant upon knowledge and=20 understanding of the effects of environmental hazards on = children's=20 health. Research that identifies patterns of environmental = diseases in=20 children, assesses children's exposures to environmental = toxicants,=20 determines developmental periods of vulnerability, and quantifies=20 dose-response relationships will bring us closer to preventive=20 interventions. Larger research issues must be addressed to improve = our=20 understanding of the relationship between environmental exposures = and=20 health outcomes in children. These include an understanding of: =

the developmental process, including the critical periods of=20 vulnerability during which environmental exposures can cause = adverse=20 health effects

the environmental exposures that occur early in life and their=20 relationship to the development of adult disease and to = transgenerational=20 effects (health effects that occur in the child or subsequent = offspring of=20 the person who is exposed to an environmental toxin)

the health effects of low level exposures to environmental = toxicants=20 such as dioxins, endocrine disruptors and lead

the health effects of cumulative and multiple exposures to=20 environmental hazards

the behavioral outcomes that result from environmental damage = to the=20 nervous system

the effects on the immune and reproductive systems and the = resultant=20 disease outcomes

References

1 Diagnosing and Treating = Environmental Health=20 Problems. Interview with Robert R. Orford, Minnesota Medicine=20 1991;74:7-10.

2 Colborn T, Dumanoski D and Myers = JP. Our=20 Stolen Future. New York, NY: Dutton, 1996.

3 Schaefer M. Children and Toxic = Substances:=20 Confronting a Major Public Health Challenge. Environmental Health=20 Perspectives 1994;102(Supp 2):155-156.

4 Colborn T. Chemically Induced = Alterations on=20 Sexual and Functional Development: The Wildlife/Human Connection.=20 Princeton, NJ: Princeton Scientific Publishing, 1992.

5 Goldstein GW. Neurologic Concepts = of Lead=20 Poisoning in Children. Pediatric Annals June 1992;21:384-388.

6 Meadows R. Growing Pains. = Environmental=20 Health Perspectives February 1996;104(2):146-149.

7 Goldman L. Case Studies of = Environmental=20 Risks to Children. Future of Children Summer/Fall 1995;5(2):27-33. =

8 Pirkle JL, Brody DJ and Gunter EW. = The=20 Decline in Blood Lead Levels in the United States: The National = Health and=20 Nutrition Examination Surveys (NHANES). Journal of American = Medical=20 Association 1994;272:284-291.

9 Environmental Health Summit = Conference, June=20 1995.

10 National Research Council. = Pesticides in=20 the Diets of Infants and Children. Washington, DC: National = Academy Press,=20 1993.

11 Bearer CF. "Environmental Health = Hazards:=20 How Children Are Different From Adults." Future of Children = Summer/Fall=20 1995;5(2):11-26.

12 Echobichon DJ and Stevens DD. = "Perinatal=20 Development of Human Blood Esterases." Clinical Pharmacology and=20 Therapeutics 1973;14:41-47.

13 Rabinowitz MB and Needleman HL. = "Temporal=20 Changes in the Lead Concentrations of Umbilical Cord Blood." = Science=20 1982;216:1429-1431.

14 Guo YL, Lambert G, and Hsu C. = "Endocrine=20 Effects of Prenatal Exposures to PCBs, Dioxins, and Other = Xenobiotics."=20 Environmental Health Perspectives September 1995;103(6):117-121. =

15 Gilbert SG and Grant Webster KS. = "Neurobehavioral Effects of Developmental Methylmercury Exposure." = Environmental Health Perspectives September 1995;103(6):135-142. =

16 Bates DV. "The Effects of Air = Pollution on=20 Children." Environmental Health Perspectives September = 1995;103(6):49-53.=20

17 White M, Etzel R, Wallace W and = Lloyd C.=20 "Exacerbations of Childhood Asthma and Ozone Pollution in = Atlanta."=20 Environmental Research 1994;65:56-68.

18 National Research Council. = Pesticides in=20 the Diets of Infants and Children. Washington, DC: National = Academy Press,=20 1993.

19 Landrigan PJ and Carlson JE.=20 "Environmental Policy and Children's Health." Future of Children=20 Summer/Fall 1995;5(2):34-52.

20 US Bureau of the Census. 1994: = Current=20 Population Reports P60-189. Washington, DC: US Government Printing = Office,=20 1994.

21 Commission for Racial Justice = United=20 Church of Christ. Toxic Wastes and Race in the US: A National = Report on=20 the Racial and Socioeconomic Characteristics of Communities with = Hazardous=20 Waste Sites. New York, NY: Public Data Access, 1987.

22 Goldman BA and Fitton L. Toxic = Wastes and=20 Race Revisited: An Update of the 1987 Report on the Racial and=20 Socioeconomic Characteristics of Communities with Hazardous Waste = Sites.=20 Washington, DC: The Center for Policy Alternatives, 1994.

23 Cole SW. Empowerment as the Key = to=20 Environmental Protection: The Need for Environmental Poverty Law. = Ecology=20 Law Quarterly 1992;19:620-657.

24 Wernette DR and Nieves LA. = Breathing=20 Polluted Air: Minorities Are Disproportionately Exposed. EPA = Journal=20 1992;18:16-17.

25 CDC. "Update: Blood Lead Levels = United=20 States, 1991=821994" MMWR, February, 1997.

26 Pirkle JL, Brody DJ and Gunter = EW. "The=20 Decline in Blood Lead Levels in the United States: The National = Health and=20 Nutrition Examination Surveys (NHANES)." Journal of American = Medical=20 Association 1994;272:284-291.

27 Needleman HL and Gastonis CA. = "Low-Level=20 Lead Exposure and the IQ of Children A Meta-Analysis of Modern = Studies."=20 Journal of the American Medical Association February 2, 1990;=20 263(5):673-78.

28 Needleman HL, Riess JA, Tobin = MJ,=20 Biesecker GE and Greenhouse JB. "Bone Lead Levels and Delinquent=20 Behavior." Journal of the American Medical Association. February = 7,=20 1996;275(5):363-369.

29 Bellinger D, et al. "Low-Level = Exposure=20 and Children's Cognitive Function During the Preschool Years." = Pediatrics=20 1991;87(2):219-227.

30 Needleman HL and Landrigan PJ. = Raising=20 Children Toxic Free - How To Keep Your Child Safe from Lead, = Asbestos,=20 Pesticides, and Other Environmental Hazards. New York, NY: Farrar, = Straus=20 and Giroux, 1994.

31 U.S. Bureau of the Census. = Statistical=20 Abstract, 1992.

32 American Academy of Pediatrics = (AAP).=20 "Ambient Air Pollution: Respiratory Hazards to Children." American = Association of Pediatrics News. 1993.

33 American Lung Association. = Danger Zones:=20 Ozone Air Pollution and Our Children. 1995.

34 Woodruff T, Grillo J, Schoendorf = K. "The=20 Relationship Between Selected Causes of Postneonatal Infant = Mortality and=20 Particulate Air Pollution in the United States." Environmental = Health=20 Perspectives June 1997; 105(6).

35 Halken S. "Environmental Causes = of Asthma=20 in Children." Pediatric Allergy Immunol. 1994;5 (Supp 1):57-60. =

36 Samet JM, Marbury MC and = Spengler JD.=20 "Health Effects and Sources of Indoor Air Pollution. Part I." Am = Rev=20 Respir Dis 1987;136:1486-1508.

37 CDC. "Children at Risk from = Ozone Air=20 Pollution United States, 1991." MMWR 1995;44:309-312.

38 CDC. "Populations at Risk from = Air=20 Pollution United States, 1991." MMWR. 1993;42:301-4.

39 Reigart JR. "Pesticides and = Children."=20 Pediatric Annals December 1995;24(12):663-668.

40 Bleyer AW. "What Can Be Learned = About=20 Childhood Cancer from 'Cancer Statistics Review 1973-1988'". = Cancer May=20 1993;71(Supp 10):3229-3236.



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