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We would like to thank all those who participated and presented papers at
the Symposium, those who served as recorders in workshops and those who
peer reviewed this report. Special thanks to William Suk, PhD, MPH,
Chief, Chemical Exposures and Molecular Biology Branch, Division of
Extramural Research and Training, National Institute of Environmental
Health Sciences, whose tireless support made this project
possible.
This report was prepared by Katie A. Sokoloff, MPH, MPP, Senior Staff,
with the assistance of Peter Paviliones, Rapporteur, Rod Armstrong,
Administrative Assistant, and Nani Coloretti, Graduate Student Intern,
and under the direction of Joy E. Carlson, MPH, Director.
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We wish to gratefully acknowledge our sponsors for their generous
support:
California Department of Health Services
California Public Health Foundation
The Centers for Disease Control and Prevention
The David and Lucile Packard Foundation
Impact Assessment, Inc.
The March of Dimes Birth Defects Foundation
Medical University of South Carolina, Environmental Hazards Assessment
Program
National Institute of Environmental Health Sciences
The Teratology Society
The United States Environmental Protection Agency
University of California, Berkeley, School of Public Health Basic
Research Program
The W. Alton Jones Foundation
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In the late 19th and early 20th centuries, miners would send
canaries into untested mines to determine the safety of the air quality.
If the canaries died, the environment was known to be unsafe for
humans.
Since the 1940's, thousands of new chemicals have been produced and
integrated into every aspect of our lives. Roughly 300 new chemicals are
introduced each year. The production of synthetic materials has increased
from 1.3 billion pounds in 1940 to 320 billion pounds in 1980.1 For the
majority of compounds, the health effects on children are unknown. Less
than 10% of these chemicals have been tested for their effects on the
central nervous system, with the exception of drugs controlled by the
FDA.2 Our children have become the modern day canaries.
Children Are Exposed to Preventable Environmental Hazards.
Children today face an array of exposures to potentially toxic
environmental hazards. Hazardous substances such as lead, PCBs, solvents,
asbestos, radon, pesticides, and air pollution have found their way into
the homes, schools, and playgrounds of our children.
These exposures can have a significant impact on children's health and
well-being. All children are at risk of developing learning disabilities,
chronic and acute respiratory diseases, cancers, and illnesses caused by
damage to the nervous system from hazardous substances. The incidence of
chronic childhood diseases such as asthma and bronchitis are increasing.
Additionally, cancer rates are increasing, especially childhood cancers
such as leukemia.
Children Are Underprotected
Despite their high potential for exposure and illness from environmental
hazards, children have no special protections. No national research or
policy agenda exists to address potentially hazardous exposures to
children. Current research priorities do not include children, regardless
of their race, ethnicity, or socio-economic status. There are very few
data banks that have information on children's exposures. Regulations for
permissible exposure levels are based on data from adult animals and
humans. Risk assessments do not routinely differentiate between children
and adults.
Pediatric Environmental Health-A National Symposium
Preventing Children's Exposures to Environmental Hazards: Research and
Policy Issues was the first symposium to address the need for a
national research and policy agenda for pediatric environmental health.
The symposium brought together over 200 recognized experts on research,
policy, clinical practice, and advocacy, to share their expertise and
their vision for protecting children from exposure. The symposium was the
first step toward establishing a framework and direction for pediatric
environmental health research and policy.
The purpose of the symposium was to:
Develop a set of recommendations for federal agencies, the research
and medical community, and community-based organizations that incorporate
a multi-disciplinary and multi-cultural perspective.
Increase communication between the research, policy, clinical
practice, and advocacy arenas by building a national network of
organizations and individuals who are dedicated to issues of pediatric
environmental health.
Plenaries were held on key issues in pediatric environmental health:
children's unique vulnerabilities to environmental exposures,
environmental justice for children, the federal government's agenda for
protecting children from exposures, and successful community models for
participatory research.
Workshops were held on such topics as the role of the environment in
childhood cancer, and the possible link between childhood asthma and air
pollution. The workshops were structured to maximize group discussion,
identify the key issues, and develop recommendations for research and for
policy. Papers presented in the workshops and plenaries will be published
in Environmental Health Perspectives as a supplemental monograph.
This Symposium Summary contains highlights of all plenaries, keynotes,
and recommendations, as well as a synopsis of each workshop along with
the top five to eight recommendations that resulted. Recommendations
resulting from a spontaneous Environmental Justice Caucus that met during
the symposium are also included.
For additional copies or for more information on the Children's
Environmental Health Network, please contact:
Children's Environmental Health Network, 5900 Hollis Street, Suite E,
Emeryville, CA 94608, 510-540-3657.
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Children:
Unique and Vulnerable
Why Are Children Especially Susceptible To
Environmental Hazards?
How are Children Exposed?
What Can Be Done?
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Joan Spyker Cranmer, PhD, Professor of Pediatrics and Toxicology,
University of Arkansas
Panelists
Cynthia Bearer, MD, PhD, Assistant Professor of Pediatrics, Case Western
Reserve University
Walter Rogan, MD, Associate Director for Prevention, National Institute
of Environmental Health Sciences
Lynn Goldman, MD, MPH, Assistant Administrator, Office of Prevention,
Pesticides & Toxic Substances, US EPA
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Why Are Children Especially
Susceptible To Environmental Hazards?
Children Are Not Little Adults
Children are not just "little adults." Their biological sensitivity,
exploratory behavior, and a diet very different from that of adults make
children particularly vulnerable to environmental exposures. Not only do
children differ from adults, they differ from each other. There is more
to growth than just getting bigger. Their biological sensitivity varies
by population, ethnic group, age, and genetic make-up. However, these
variations are not usually taken into account when considering
environmental exposures to children.
Children Are Biologically Sensitive
Children's biological sensitivity (the capacity to be easily harmed)
places them at special risk for harm from a toxic exposure. Because a
child is a growing, developing organism, she is especially vulnerable to
the effects of exposure. Her metabolic reactions-the body's way of
processing and excreting toxic substances-are not as developed as those
of an adult. According to Dr. Cynthia Bearer, Assistant Professor of
Pediatrics at Case Western Reserve University, children are especially
biologically sensitive given their differences in pathways of absorption,
tissue distribution, ability to biotransform and eliminate chemicals, and
the ways in which they respond differently to environmental chemicals and
radiation.
Children Are Developing Organisms
Children go through several stages of development. Examples of these
stages are: fetal, newborn, infant, school-age, and adolescent. Each
stage of development creates new windows of vulnerability to the effects
of an exposure and may result in long-term subtle or acute health
problems. For example, an infant's lung capacity is still increasing,
making her especially vulnerable to the effects of environmental tobacco
smoke. A child's respiratory rate is more rapid than an adult's. Hence,
she is exposed to more air and air pollutants than an adult.
Children are, in a sense, moving targets. Exposures which may go
unnoticed or be relatively harmless in an adult, can be potentially
devastating to a child. Exposures can also have consequences on future
generations of children who have not yet been conceived. In an extensive
study of PCB-contaminated food in Taiwan, children born to women up to
six years after their exposure to the chemical continued to show the same
signs of impairment to their central nervous systems-low intelligence and
motor-skills scores.
How are Children
Exposed?
Exposure Occurs at Every Developmental Stage
Fetal exposure occurs through maternal exposure to environmental
toxicants, as the fetus is dependent on the mother and many substances
can cross the placenta. Sometimes this is from a mother's self-exposure,
such as environmental tobacco smoke. However, lead in a mother's bones
which may be harmless to a mother can be transferred to her fetus,
causing exposure levels that are potentially harmful. Additionally,
maternal and paternal exposures that occur before conception can affect a
child. PCBs, for example, bioaccu-mulate in fatty fish and are stored in
the body when eaten. These are passed on to fetuses, newborns and infants
through the placenta and maternal breast milk.
Exposures also occur later in a child's development. Adolescents are
vulnerable to occupational exposures as they enter the work force through
after-school and summer jobs. In addition, some adolescents begin to
expose themselves to harmful substances such as cigarettes. According to
Dr. Cynthia Bearer, Assistant Professor of Pediatrics, Case Western
Reserve University, 50% of all new smokers are age 17 or younger. The
rapid metabolic and physiological changes that occur during puberty may
increase the impact of these harmful exposures.
Exploring, Mouthing, Playing
Children are growing, developing organisms, whose days are spent
exploring their world through touch, taste, and movement. This natural
curiosity and wonder put children at greater risk than adults for
exposure to and illness from environmental hazards. "Children," notes Dr.
Walter Rogan, "find beauty and fascination in both the glittering, such
as mercury (found in a thermometer), and the gross, like the slime found
on an intake pond." Infants and toddlers put their fingers or objects
they find in their mouths. They spend much of their time at a level lower
than that of adults, crawling on the ground where household chemicals,
pesticides, and other environmental toxins accumulate. Children probably
spend more time outdoors than do adults. This, coupled with children's
rapid respiration and high activity levels outdoors, increases their
exposure to air pollution.
Children Have a Unique Diet
Children's rapid growth during their first years of life requires
relatively higher levels of food and liquid consumption than adults.
Moreover, their bodies at this particular stage of life naturally absorb
more of what they eat and drink. Because a much greater portion of a
child's diet is composed of fruits and vegetables than his adult
counterpart, he is exposed to higher levels of pesticides and chemicals
in his food. The National Academy of Sciences report entitled Pesticides:
Diets of Infants and Children (June, 1993), found that infants and
children consume more of certain foods (such as apples) per unit of body
weight than adults, and drink more water, thus increasing their potential
exposure to toxins.3
Safe levels of pesticides and food additives, which are calculated for
the lifetime exposure of an adult, may be grossly erroneous for a child.
Children eat a great deal of certain foods, such as bananas. Pesticide
tolerances, or maximum residue limits for pesticides in food, are
calculated for adults rather than for children, and do not account for
individual variations. Such was the case with aldicarb, a pesticide
widely used on bananas. Although bananas tested as a crop had acceptable
levels of aldicarb, these levels were based on adult tolerances, and were
for the entire crop, without accounting for individual "hot" bananas. As
a result, there were unsafe levels of aldicarb for children in one bite
of the "hottest" banana.
Children Have Multiple Routes of Exposure
Because children have many routes and sources of exposures, they are at
risk not only for multiple exposures, but for exposures which may act
synergistically. And, because children have a longer "shelf life" than do
their adult counterparts, they will face more exposures throughout their
lives. However, little is known about how to add up the effects of
multiple chemical exposures-whether they are cumulative or whether they
compete with each other, and whether they interact synergistically. For
example, tolerances which are set for one chemical within a particular
class (such as chlorinated organophosphates) do not consider the effects
of exposure to another chemical within that class.
What Can Be Done?
Clinicians as Investigators and Advocates
Clinicians can play an important role in diagnosing environment-related
illness and in providing education for families and communities. For
example, clinicians have in the past traced chemical exposures causing
illness in children to pesticide spraying in homes and to mercury in
teething powders. As a result, these exposures to children were diagnosed
as environmental poisonings and the offending chemicals were subsequently
removed.
Recommendations
When developing acceptable tolerance levels, fetuses and children
must be considered-fetuses and children should be the threshold for
regulating toxic substances.
Preventive strategies regarding improving indoor and outdoor air
quality must be adopted.
Pesticide legislation should be reviewed to determine how well it is
protecting the most vulnerable populations, and reformed when it is not
adequate.
EPA should be required to set a course of action that will begin
considering the multiple, synergistic, and cumulative effects of
exposures to children.
There should be a concentrated effort to get data that will fill the
gaps on harmful exposures to children, especially dietary
exposure.
Finally, clinicians can help by considering environmental exposures
when diagnosing illness.
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Environmental Justice and Children
What is Environmental Justice?
Do Toxic Hazards Disproportionately Affect
Certain Communities?
Are Children in Poverty and Children from
Racial or Ethnic Communities More at Risk for Diseases Caused by
Environmental Hazards?
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Deeohn Ferris, JD, Former Program Director, Environmental Justice
Program, Lawyer's Committee for Civil Rights Under the Law
Panelists
Sylvia Herrera, Southwest Network for Environmental and Economic
Justice
Raphael Metzger, Director of Special Initiatives, National Coalition of
Hispanic Health and Human Services Organizations
Lawrie Mott, MS, Senior Scientist, Natural Resources Defense
Council
Raymond "Rico" Gonzalez, Eco Rap
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Communities
in Action:
Initiatives and Success Stories
Akwesasne Mothers Milk Project
Brownsville Community Health
Center
Brownsville Community Health Center Makes a
Difference
Recommendations for Change
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Robert Bullard, PhD, Professor, Center for Afro-American Studies,
UCLA
Panelists
Katsi Cook, Former Director, Akwesasne Mother's Milk Project, Albany,
NY
Paula Gomez, Executive Director, Brownsville Community Health Center,
Brownsville, TX
Patricia Jackson, People for Community Recovery, Chicago, Il
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The Federal
Government's Role in Children's Environmental Health
What are the Following Federal Agencies
Doing
to Address Children's Environmental Health?
What is Missing in the Government's Overall
Approach
to Addressing Environmental Health Hazards?
Recommendations from the Discussants
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Birt Harvey, MD, Professor and Associate Chair, Dept. of Pediatrics,
Stanford University
School of Medicine
Federal Panel
Lynn Goldman, MD, MPH, Assistant Administrator, Office of Prevention,
Pesticides and Toxic Substances, US EPA
William Harlan, MD, Associate Director for Disease Prevention, National
Institutes of Health
Devra Lee Davis, PhD, Senior Advisor, Public Health Service, Dept. of
Health and Human Services
Barry Johnson, PhD, Assistant Administrator and Assistant Surgeon
General, Agency for Toxic Substances and Disease Registry
Stephen B. Thacker, MD, MSC, Acting Director, National Center for
Environmental Health, Centers for Disease Control and Prevention
Discussants
Ellen Widess, JD, Director of Health and Safety Policy, Child Advocacy
Institute
Shelley Hearne, Dr. PH, American Public Health Association
Adolph Falcon, MPP, Vice President, Policy and Research, COSSMHO
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Dr. Joycelyn Elders
U.S. Surgeon General
"Children cannot 'just say no' to pollution," stated U.S. Surgeon
General, Dr. Joycelyn Elders. Dr. Elders discussed two major threats to
children's health today: environmental tobacco smoke and lead poisoning.
The Surgeon General noted that public action to reduce environmental
tobacco smoke (ETS) is growing: and pointed out the increased amount of
public research from the Environmental Protection Agency and CDC. The
Surgeon General described recent testimony on a bill to eliminate ETS
from all public places, suggesting that legislation would be one way to
reduce ETS. Dr. Elders further urged the audience to join her in
educating the American public: "We must tell the public that when we
smoke, our children are smoking." She also encouraged continued efforts
to eliminate second-hand smoke from the environment.
The second environmental health hazard Dr. Elders described as
particularly dangerous to children was lead poisoning. Although lead
poisoning is an area "where we have achieved some success,...we still
have a lot of work to do," stated Dr. Elders. Dr. Elders emphasized that
mainly lower income minority children in urban areas still report
elevated blood-levels. She outlined a four-pronged approach: identify
more lead hazards, collect appropriate data, educate the public about
lead poisoning, and continue screening blood lead levels.
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Congressman Henry Waxman (D-CA)
Chair, House Subcommittee on Health and the Environment
Congressman Waxman (D-CA), Chair of the House Subcommittee on Health and
the Environment of the Committee on Energy and the Environment,
emphasized three environmental hazards that particularly affect children:
lead poisoning, environmental tobacco smoke, and pesticides. Waxman
stressed that, "People have to understand that when we talk about
environmental protection-when we look at it only in terms of adults-we
are neglecting the special impact that some of these environmental
hazards have on children...very often they are the most affected [but
are] neglected."
The impact on children is not only an important health concern, but is
also politically strategic. Waxman further explained this idea using
recent lead poisoning regulations as an example of Congress's ability to
pass protective environmental health laws in an unfavorable political
climate. There are two factors that contributed to Congress's
accomplishment: first, a clear, sound scientific case about the hazards
that lead poses to children; and second, the ability to capitalize on the
strong emotional appeal of protecting children from these hazards. Waxman
noted that these two factors would help pass current environmental health
proposals for children through Congress.
Waxman presented this years' bills that focus on environmental health.
The Pesticide Food and Safety Act will change the way pesticides are
regulated. He criticized current pesticide policy: "Our federal pesticide
program does not give American consumers, and especially our children,
the assurance that our food supply is safe, as incredible as that may
seem." A second bill on environmental tobacco smoke (ETS) bans smoking in
public places, and is supported by every Surgeon General from the past 25
years.
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Age-Specific
Carcinogenesis:
Radiation and Genetics
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Margaret Tucker, MD, Chief, Genetic Epidemiology Branch, National Cancer
Institute
Panelists
George Lambert, MD, Associate Professor, Pediatrics, Robert Wood Johnson
Medical School,
New Jersey
David Malkin, MD, Division of Hematology/Oncology, Univ. of
Toronto
Robert Miller, MD, Chief, Clinical Epidemiology Branch, National Cancer
Institute (Retired)
Richard Thomas, PhD, Director, Toxicology and Risk Assessment, National
Academy of Sciences
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This workshop focused on cancer as a genetic disease, stemming
from either a mutant gene (e.g. retinoblastoma) or a mutant
susceptibility gene requiring an additional mutation (from exposure to an
environmental carcinogen, for example). Epidemiological studies were
reviewed demonstrating a high correlation between age at time of exposure
and the risk of developing cancer.
Findings of the recent National Academy of Sciences/National Research
Council reports on pesticides in children's diets and on risk assessment
were summarized, highlighting recommendations for achieving better
exposure models and more reliable exposure estimates for
children.
Recommendations:
Broaden research on age-specific phenomena such as exposure,
behavior, enzyme activity. Such research should include children from
racial/ethnic communities, who run a higher risk of exposure to
carcinogens, and whose genetic make-up puts them at a disadvantage for
metabolizing such carcinogens.
Devote more research to exposure assessment, including
epidemiological tools and biomarkers.
Promote banking of biological specimens (e.g. serum, fibroblasts and
other tissues, including blood and other cells), both for children and
members of high-risk groups.
Continue support of long-term follow-up on cohorts that have special
exposures (those exposed to high levels of radiation through A-bomb
blasts and other groups exposed to radiation), chemical exposures, and
cancer survivors.
Focus research on genetic differences between adults and children,
and on outcome assessment (in both children and adults).
Develop and evaluate prevention strategies in: health education,
including diet; legislation (e.g. smoking bans); correlates of
risk-taking behavior (e.g. smoking, sun exposure); the Canadian
cigarette-labelling plan.
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Asthma Among
Children-
Does Air Pollution Play a Role?
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Henry Falk, MD, MPH, Director, Division of Environmental Hazards and
Health Effects, Centers for Disease Control and Prevention (CDC)
Panelists
David Bates, MD, Professor Emeritus, Univ. of British Columbia, Dept. of
Health Care and Epidemiology
Ruth Etzel, MD, PhD, Chief, Air Pollution and Respiratory Health Branch,
CDC
Floyd Malveaux, MD, PhD, Associate Professor and Chair, Dept. of
Microbiology, Howard University School of Medicine
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Panelists in this workshop delivered presentations on the rising
prevalence of childhood asthma and on proven methods for its prevention,
including ways to reduce exposure to tobacco smoke and indoor allergens.
Panelists discussed the possible role of pesticides in causing asthma.
Panelists also discussed the socio-economic conditions that lead to
higher incidences of asthma and respiratory disease in general.
Participants learned of the higher rates of asthma among children from
racial/ethnic communities, particularly African-American children. The
greater prevalence of asthma and respiratory diseases among these
children can be attributed not only to higher exposures to air pollution,
but lack of both access to health care and effective asthma management
programs.
The workshop's participants identified five chief issues:
The overall lack of nationwide data on asthma among children from
racial/ethnic communities.
The need to direct more research in the area of indoor sources of air
pollution, and to recommend effective steps toward prevention.
The need to promote a holistic approach to childhood asthma's
prevention.
The need to reduce the increasing levels of environmental
emissions.
The need to recognize socio-economic factors that contribute to a
higher prevalence of asthma among children.
Recommendations: were not developed. due to time constraints. Workshop
participants developed these points for further debate.
To compensate for the lack of national data on air pollution and its
effects on respiratory problems among different ethnic groups and
low-income communities, relevant agencies should incorporate the
guidelines of Office of Management and Budget Directive 15 into their
data-collection efforts.
More research should be devoted to the threat of increasing outdoor
and indoor (e.g. tobacco smoke) air pollution.
To encourage a more holistic approach to prevention, Congress should
examine health care proposals to see if they address environmental
factors.
More efforts should be devoted to controlling environmental sources
of emissions (e.g. ozone and PM10).
Socio-economic conditions should be improved to mitigate exposures to
outdoor and indoor sources of air pollution.
Health-care administrators and policy makers should work to provide
both more access for continuous primary care and funding for patient
education.
Health care providers should consider cultural attitudes and
practices when assessing and treating respiratory problems among people
of color.
Relevant officials should increase their efforts to make schools
smoke-free. School nurses should provide more education on smoking health
hazards among youth and facilitate smoke-free wellness centers in
schools.
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Building Healthy
Environments for Children:
Visions for the Future
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Maureen Corry, MPH, Director, Education and Health Promotion, March of
Dimes Birth
Defects Foundation
Panelists
Sabrina Alimahomed, President, Tree Musketeers
Paul Bierman-Lytle, Masters Corporation, Former Chair, Environmental
Health Committee, American Institute of Architecture
Henry Holmes, Associate Director, Urban Habitat Program, Earth Island
Institute
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This workshop addressed the role of sustainable development as it applies
to homes and cities of the future. Panelists discussed examples of
sustainable buildings and environmentally sound architecture, and how
their incorporation in home construction reduces not only emissions of
indoor toxicants (i.e. "sick-building" syndrome) but the continued
reliance on non-renewable resources for construction materials. The
workshop also addressed the broader concerns of environmentally sound
urban planning, which attempts to design cities taking into account the
myriad of inter-relationships among land use, transportation policy, and
cities' cultural and ethnic diversity.
Participants in the workshop also heard from a young environmental
activist, who suggested that the next generation of policy makers will
already have an abiding concern for environmental protection. The
consciousness of this generation is already informed by years of
witnessing environmental pollution's tragic outcomes, and their future
participation in the policy-making process will undoubtedly reflect this
concern. Even in their adolescence, millions of children are ready to be
pressed into service in protecting their generation's and future
generations' environmental safety.
Recommendations (developed by three sub-groups):
The Youth Role in Creating a Healthy Future
The federal government should include children under the age of 18 in
its definition of diversity, thereby encompassing the diversity
requirement for granting research funding and including more participants
at federally funded conferences.
Health and Sustainability for Children
Congress should consider a tax on non-renewable resources.
The federal government should create interagency (e.g. among HHS,
HUD, EPA, etc.) pilot projects to demonstrate effective environmental
architecture and construction in communities and evaluate health-based
outcomes.
Disseminate more information on health and sustainable community
development to the public (including these recommendations).
Devote more efforts to identifying market incentives that encourage
manufacturers to produce more environmentally responsible
products.
Establish standard-setting practices that involve more relevant
groups.
Hold more interdisciplinary conferences on the link between
children's health and sustainable community development.
Healthy Communities
Devote more efforts to better education about the issues and
challenges facing communities. Such education should address the
community's distinct cultural needs and experiences.
Develop mechanisms to increase community participation that can
provide effective influence in the policy-making process.
Coordinate policy making at the regional level.
While better models need to be developed, governmental action on
addressing lead pollution should be used as an example of an
interagency/interdisciplinary approach to public health issues.
Link public health issues together to show their interrelationships
and real-life impacts.
Develop community impact statements as an integral part of community
partnerships.
Include prevention and environmental health issues in education
curriculums and in practice.
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Neurotoxicology-The Role of the Environment in
Injuries
to the Developing Nervous System
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Gary E. Goldstein, MD, President, Kennedy Krieger Institute
Panelists
Herbert Needleman, MD, Professor of Pediatrics, Univ. of Pittsburgh
School of Medicine
Patricia Rodier, PhD, Senior Scientist, Dept. of OB/GYN, Univ. of
Rochester Medical Center
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Pesticides-How Research Has
Succeeded and Failed in
Informing Policy
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Barbara Boardman, MD, Instructor, Pediatrics, Harvard Medical
School
Panelists
Carolyn Brickey, Project Director, National Campaign for Pesticide Policy
Reform
Theo Colborn, PhD, Senior Scientist, World Wildlife Fund
Richard Wiles, Director, Agricultural Pollution Prevention Program,
Environmental Working Group
Mary Wolff, PhD, Associate Professor, Mt. Sinai School of
Medicine
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Though scientists have amassed reams of data on environmental hazards to
children's health, they have not been effective in conveying these
hazards to policy makers.
Participants in this workshop heard presentations on this problem from
several perspectives. Can scientists themselves be more effective in
communicating their research findings to the public? Should public
advocates take a more active role in "packaging" scientists' messages for
the media and for the public at large? How can research mobilize public
opinion and inform public policy on complex issues, such as the link
between pesticide exposures and their adverse effects on public health?
Are there institutional barriers in scientific research itself that makes
it harder to arrive at definitive answers?
Panelists in this workshop addressed these questions in their discussions
on the successes and failures in translating scientific research into
public policy, including DDE and the link with breast cancer, and
endocrinologic and reproductive effects on wildlife.
Recommendations were not developed, however workshop participants
developed these points for further debate:
Research
Recognize the need to reduce the necessity of continued pesticide
use, possibly through alternative agricultural methods such as
bio-control (i.e. integrated pest management).
Encourage federal attention on forming an institute of eco-toxicology
research (including the on-going research at the National Institute for
Environmental Health Sciences, the Environmental Protection Agency, the
Agency for Toxic Substances and Disease Registry, and the National
Institutes of Health).
Recognize the need for individual review process.
Recognize the need for protocols in monitoring analytical methods;
these should be available from companies.
Recognize the need for short-term screening.
Thoroughly test new pesticide products and their metabolites.
Encourage the development of more cancer (including
hormonally-related) and reproductive studies on the adverse effects of
pesticides.
Design better methods for assessing exposures and evaluating
statistical data on subtle effects of pesticide exposures.
Risk assessment
Recognize the need to develop models that assess the impact of
additional doses on cancer and non-cancer illnesses.
Develop new models that differentiate the effects of exposures to
multiple toxic chemicals with similar adverse effects (e.g. lead
poisoning and neuro-toxic pesticides).
Assessment should be geared toward the total health risk from a given
compound; tolerance levels should be less than a health-based
standard.
Apply toxic equivalency factors to other classes of compounds (i.e.
neurotoxins).
Encourage better communication between the research and policy
communities.
Encourage better scientific communication with the media and with the
public at large. Regarding the former, scientists could hold a workshop
just for journalists to communicate new findings.
Apply truth-in-advertising requirements to claims based on scientific
data.
Convene "think tank" panels to answer questions from the
media.
Policy
Target research to identify highly toxic chemicals and to restrict
"bad actors" with specific timeline.
Develop incentives to reduce the use of products that use pesticides
or to encourage the development of alternative technologies that don't
include pesticides.
Maintain interaction with farmers and growers when developing
policies to reduce overall use of pesticides.
USDA should support and help implement alternative methods to
pesticide use, and should develop policies that encourage research into
less toxic methods.
With concern for the consumer's right to know, investigate the
feasibility of full-disclosure laws that could apply to products treated
with pesticides.
Investigate the possibility of establishing a system of nationwide
reporting on pesticide use.
Grant access to proprietary health data used in pesticide
registration.
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Technology
Exchange:
The Molecular/Clinical Interface
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
William Suk, PhD, MPH, Chief, Chemical Exposures and Molecular Biology
Branch, Division of Extramural Research and Training, National Institute
of Environmental Health Sciences (NIEHS)
Panelists
Bert Lubin, MD, Director of Medical Research, Children's Hospital,
Oakland Research Institute
Frederica Perera, PhD, Associate Professor, Columbia University School of
Public Health
Leslie Robison, MD, Associate Professor, Pediatrics, Univ. of
Minnesota
John Durant,PhD, Post Doctoral Student, MIT Center for Environmental
Health Sciences
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Endocrine
Effects of Prenatal Exposure to PCBs, Dioxin, and Other
Xenobiotics
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Moderator
Theo Colborn, PhD, Senior Scientist, World Wildlife Fund
Panelists
Linda Birnbaum, PhD, Director, Environmental Toxicology Division, Health
Effects Research Lab, US EPA
Leon Guo, MD, Dept. of Industrial Health, National Cheng Kung Univ.
Medical College, Taiwan
John McLachlan, PhD, Director, Division of Intramural Research,
NIEHS
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Polychlorinated biphenyls (PCBs) and other chlorinated compounds-DDT and
other chemically-related pesticides still in use-have been linked to
disruptions of the endocrine system, responsible for the production of
sex hormones. Evidence from studies of wildlife affected by industrial
emissions and spills of these chemicals into the surrounding ecosystem
shows serious population declines and impaired reproduction in these
species. Human equivalents appear as lowered sperm counts and increasing
rates of testicular cancer in men, undescended testicles in adolescent
males, and endometriosis in young women. Breast cancer and immune system
disorders have also been linked to exposure to these chemicals.
This workshop was devoted to reviewing the effects of these specific
compounds on the developing endocrine system. Panelists explored the
mechanisms of the effects on the endocrine system and transgenerational
effects of in-utero exposures as well as implications for future research
policy.
Recommendations were not developed, however workshop participants
developed these points for further debate:
For laboratory researchers
Assess the full range of hormone systems and develop screenings for
such a range. Apply these screenings to chemical interactions (including
multiple-chemical interactions). Assess effects of interactions on
different organ systems. Develop non-invasive sampling methods and
exposure markers. Integrate molecular and organ system data.
For epidemiologists
Investigate effects of high exposure to toxic substances in humans
and wildlife through "natural experiments". Bank samples of tissues
collected from highly exposed sub-groups. Improve surveillance of
hormone-related cancer outcomes.
For policy makers
Identify sources of contamination in food supply and other exposure
pathways to assess economic and policy implications of curtailing the use
of chemicals that disrupt endocrine system function (per analysis by the
National Academy of Sciences).
When setting tolerance levels in food and threshold levels for
intervention for toxic substances, establish a priority list for the
application and incorporation of other toxicological data, including
substances that disrupt hormones.
Incorporate results of research on how chemicals disrupt endocrine
system function into national policy-making arenas.
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From
Science to Soundbite:
Understanding and Improving Communication
Between Science and the Media
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Ned Groth, PhD, Director, Technical Policy & Public Service, Consumer's
Union
Panelists
Elinor Blake, MSW, Health Program Specialist, Environmental Health
Investigations Branch,
California Dept. of Health Services
David Carpenter, MD, Dean, School of Public Health, Univ. at Albany,
SUNY; Host, National Public Radio
Janet Raloff, Senior Editor for Environment/Policy, Science News
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Neurotoxicology-
Learning and Behavioral Consequences of
Prenatal Environmental Exposures
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Martin Philbert, PhD, Assistant Professor, Dept. of Neurotoxicology,
Rutgers Univ.
Panelists
Steven Gilbert, PhD, Research Associate Professor, Dept. of Environmental
Health, Univ. of Washington
J. Routt Reigart, MD, Professor of Pediatrics, Medical Univ. of South
Carolina
Hugh Tilson, PhD, US EPA, Director, Neurotoxicology Division, Health
Effects Research Lab, US EPA
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Panelists focused on fetal exposure to methylmercury and its effects on
physiological and cognitive development in the fetus and at different
stages of the child's life. Those attending the workshop learned about
methylmercury, high concentrations of which are found in areas with
coal-fired power plants and incinerators. Native Americans who subsist on
locally caught fish, and low-income neighborhoods near incinerators, are
particularly vulnerable to methylmercury exposure.
High levels of exposure to this metal, which passes through the placenta
and concentrates in the fetus, have been found to result in severe
neurodevelopmental problems in children, including behavioral disorders,
learning impairment, delayed motor development, and sensory
defects.
Panelists discussed the problem of determining "safe" levels of exposure
to methylmercury and developed a series of recommendations addressing
policy and research issues.
Recommendations
Encourage legislation that regulates chemicals in the environment.
Such legislation should include consideration of neuro-developmental
effects and should aim at protecting the most sensitive groups (i.e.
pregnant women, fetuses, newborns, and children). Such legislation should
also include funding methods to pay for research and regulatory processes
(e.g. the "polluter pays" principle).
Develop pro-active outreach to child advocacy groups in order to
develop policy and legislation.
Improve risk communication to populations at risk by forging links
between universities and local health departments, between health
departments and affected communities, and between universities and
communities.
Develop systemic and new approaches for the screening of
environmental exposures, developmental disabilities in clinical settings,
and for potential neuro-developmental toxicants.
Promote accessibility of child-based data that includes information
on neuro-developmental outcomes and toxicants.
Policy should follow science rather than the public's perception of
risk.
Science should not be a barrier to timely policy.
Fetuses and newborns should be considered vulnerable hosts. Policy
should be goal-directed and consistent, and should ensure the safety of
all populations, including the most sensitive groups.
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Pesticides-The National Academy of Sciences Report:
How
Can the Recommendations Be Implemented?
Recommendations
[Previous Chapter]
[Next Chapter] [Table of Contents]
Moderator
Jim Aidala, Associate Assistant Administrator, Office of Prevention,
Pesticides, and Toxic Substances, US Environmental Protection Agency
(EPA)
Panelists
Jay Feldman, Executive Director, National Coalition Against the Misuse of
Pesticides
Marcia vanGemert, PhD, Toxicology Program, US EPA
Richard Jackson, MD, MPH, Chief, Division of Communicable Disease
Control, California Dept. of Health Services
John McCarthy, PhD, Vice President of Global Scientific and Regulatory
Affairs, National Agricultural Chemical Association
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How have recommendations from the National Research Council's June 1993
report on Pesticides and the Diets of Infants and Children been
implemented? Those attending this workshop heard presentations from
panelists representing government, industry, and advocacy, who discussed
progress toward meeting the report's recommendations and future
actions.
In the presentation from the advocacy perspective, participants were
alerted to the rising cancer rates in children and their possible link to
continued exposure to pesticide residues on foods. The presentation from
the Environmental Protection Agency highlighted the various ways the
agency is addressing the NAS report, especially in the areas of
toxicology, risk assessment, food and water consumption, and residue
chemistry. The industry presentation focused on NACA's response to the
NAS report-which recommendations they agreed with and which they found
questionable.
Participants also learned about the difficulty the NAS report's
contributors encountered with data. Among the issues arising in this
presentation were: the lack of monitoring cases of illness among workers
and consumers exposed to pesticides, possibly changing the default
ten-fold safety factor for risk assessments, and the possible expansion
of toxicity computer modeling in the future.
Recommendations
Require industry to quantify risks to children and make information
available to the public. Disseminate the Environmental Protection
Agency's information to the public. Encourage "Right to Know" for
pesticides. Find threshold for phase-outs of chemicals; where uncertain,
support non-exposure.
Develop a national strategy to: follow up on incomplete studies (e.g.
hazard assessment on children), and promote monitoring and surveillance
of human populations. Focus on human and animal studies.
Encourage international approaches to pediatric environmental health.
Adopt the most stringent standard.
Fit benchmark dose to endpoints (clarify model for data set used).
Clearly state assumptions of model; use conservative assumptions when
there is uncertainty.
Target farmworkers' children when regulating phase-out of
chemicals.
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The Role of the
Environment in Birth Defects and Developmental Delay
Recommendations
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Moderator
Jim Hanson, MD, President, Teratology Society
Panelists
John Harris, MD, Chief, California Birth Defects Monitoring
Program
Godfrey P. Oakley, Jr., MD, MPH, Director, Division of Birth Defects and
Developmental Disabilities Branch, CDC
Lowell Sever, PhD, Senior Scientist, Battelle Pacific Northwest
Labs
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Are birth defects and developmental delay attributable to environmental
causes? Previous scientific studies have suggested that neural tube
defects in newborns are attributable to fetal exposures to environmental
agents, such as organic solvents, pesticides, heavy metals, and ionizing
radiation.
This workshop discussed these particular birth defects, such as folic
acid preventable spina-bifida and anencephaly, as well as
poverty-associated mental retardation. The role of epidemiologic research
in finding environmentally caused birth defects among specific population
groups was also discussed.
Participants developed recommendations aimed at increasing research
efforts in identifying environmental factors attributed to these
particular birth defects. Recommendations also urged support for the
Birth Defect Prevention Act of 1994 and suggested ways to improve
folic-acid supplementation to lessen the likelihood of such neural tube
birth defects in population groups especially susceptible to associated
environmental hazards.
Recommendations
Support the Birth Defect Prevention Act of 1994.
Organize a national interagency workgroup to coordinate laboratory
science and human clinical and epidemiological (population-based)
research with strong public participation.
Develop an aggressive national program to eradicate preventable
neural tube defects stemming from folic acid deficiencies (with strong
media component, federal agency support, and funding).
Remove barriers to folic acid supplementation. In particular,
vitamins should be removed from the list of proscribed items in food
stamps.
Develop appropriate population-based methods for assessing adverse
developmental outcomes, ranging from spontaneous abortion to functional
deficits (not limited to structural defects).
Develop prevention and intervention programs for fetal alcohol
syndrome and fetal alcohol effects.
Address transborder regulation, liability, and health issues, such as
those addressed in the debate over the North American Free Trade
Agreement. Address, in particular, the occupational and environmental
hazards posed by the expansion of the maquiladora (foreign-owned border
factory) industry.
Educate professionals and professional groups (e.g. AAP, ACOG) about
causes and prevention of adverse developmental outcomes.
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The Role of the
Environment in Childhood Cancer
Recommendations
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Moderator
Rick Kreutzer, MD, Public Health Medical Officer, Environmental Health
Investigations Branch, California Dept. of Health Services
Panelists
David Rall, MD, PhD, Assistant Surgeon General (retired)
Sheila Zahm, ScD, Epidemiologist, Environmental Epidemiology Branch,
National Cancer Institute
Lauren Zeise, PhD, Chief, Reproductive & Cancer Hazard Assessment
Section, California EPA
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Each year in the U.S., an estimated 8,000 children-from newborns up to
age 14-are diagnosed with cancer. Panelists in this workshop discussed
the few well-established environmental causes of childhood cancer, such
as radiation, chemotherapeutic agents, and diethylstilbestrol (DES).
Workshop participants heard presentations on other agents suspected in
playing a role in the development of childhood cancer, such as
electromagnetic fields, pesticides, and environmental tobacco
smoke.
As the participants also learned, the evidence isolating these agents as
proven carcinogens is still inconclusive; moreover, some of these agents
contribute to cancers that develop many years after exposure during
childhood. Panelists also discussed the special vulnerability of children
to possible environmental carcinogens. Participants in this workshop also
learned of the difficulty in using animal studies to predict cancer in
children exposed to carcinogens.
Recommendations again underscored the need for prevention programs to
mitigate children's exposure to known and suspected carcinogens.
Recommendations
Create and fund comprehensive pediatric environmental health centers,
whose elements would include basic and applied science, epidemiology,
medicine, policy, community participation, law, urban planning, and
education.
Recognize the need to develop prevention programs for knowable
hazards (i.e. UV light and tobacco, especially second-hand smoke). For
example, babies should have warning labels saying "Do not expose to UV
light or second-hand smoke."
Industry and regulatory agencies should recognize the need for
disclosure in household products and pesticide ingredients.
Shift the burden of proof to industry in demonstrating the safety of
their products, including the disclosure of identified carcinogens in
these products and the assessment of their risk.
Develop an Environmental Bill of Rights for Children; make current
laws more protective for children.
In the absence of information, legislators and regulatory officials
should take a public health approach in drafting relevant laws and
policies. Such an approach would assume that vulnerable populations need
more protection, especially regarding children's exposures.
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The Role of
Nutrition in Mitigating Environmental Insults
Recommendations
[Previous Chapter] [Next Chapter] [Table of Contents]
Moderator
Harvey Karp, MD, Assistant Professor, UCLA School of Medicine
Panelists
Howard Hu, MD, MPH, DS, Associate Professor, Harvard School of Public
Health
Kathryn Mahaffey, PhD, Acting Chief, Chemical Mixtures Assessment Branch,
Environmental Criteria Assessment Office, EPA
Babasaheb Sonawane, PhD, Chief, Reproductive and Developmental Toxicology
Branch, US EPA
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Can nutritional supplements and anti-oxidants mitigate the adverse health
effects of exposures to toxic substances in the environment? This was the
central question addressed in this workshop, which explored the role of
nutrition in mitigating environmental insults to children and its
associated policy implications.
Panelists provided an overview of toxic contaminants in human milk,
including halogenated organic compounds and metals. Participants agreed
that more research should be devoted to identifying breast milk
contaminants and to developing better, more appropriate risk-assessment
methods for infants that account for their food consumption, nutritional
patterns, etc.
Panelists also discussed nutrition as a public health strategy to reduce
adverse effects of high blood lead levels, focusing on nutritional
components that reduce the body's absorption of lead (e.g. adequate
levels of calcium and iron). Participants developed recommendations
around the strategies of nutritional supplements and optimal diet
recommendations, in addition to prevention efforts by state and local
health
departments.
Ethical issues concerning the role of nutrition in mitigating health
consequences of toxic exposures were also discussed. Participants agreed
that efforts at preventing environmental hazards should be the primary
method in reducing such hazards, and that nutritional approaches should
supplement these efforts at prevention.
Recommendations
Support optimal nutrition for whole population (survey, identify, and
replicate successful programs).
Develop database of various social groups' food consumption (i.e.
SES).
Study how consumers decide what foods to buy.
Support nutritional education in medical, public health, primary, and
secondary schools.
Study the protective effects of anti-oxidants among populations at
risk from environmental stressors (i.e. ozone).
Encourage farmers and USDA to promote low or no pesticide
use.
Support FDA in the scrutiny of health department claims.
Review Recommended Daily Allowances (RDAs) to see if these are
optimal for various new environmental stressors.
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Environmental
Justice Caucus Recommendations
[Previous Chapter] [Table of Contents]
The following environmental justice representatives met during the
symposium to discuss research and policy issues, and to develop
recommendations:
Robert Bullard, PhD, Professor, Center for Afro-American Studies,
UCLA
Luke Cole, JD, Staff Attorney, Center on Race, Poverty & the Environment,
California Rural
Legal Assistance
Raymond "Rico" Gonzales, Eco Rap
Running-Grass, Executive Director, Three Circles Center for Multicultural
Environmental Education
Henry Holmes, Associate Director, Urban Habitat Program
Janet A. Phoenix, MD, Manager of Public Health Programs, National Safety
Council
Beverly H. Wright, PhD, Associate Director, Xavier Univ., Deep South
Center for
Environmental Justice
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Recommendations:
Policy
In setting minimum standards for environmental health research,
policy and practice, standards should be protective of the most
vulnerable subsets of sensitive populations.
There needs to be legislative strategies which address the state and
federal levels.
The potential for conflict in resource allocation must be
addressed.
Research
There should be a focus on developing new paradigms and models of
research. There need to be changes not only on the focus of research, but
on how the research is conducted.
There needs to be explicit implementation/action plans for completed
research.
There is a need to redefine "interdisciplinary" to represent
something other than many different types of scientists (e.g. community
people, agency officials and scientists, environmentalists, and other
public advocates must be involved).
Community Interactions
Researchers from outside of the community should explain limitations
in the research up front, and not create false expectations.
The community should be involved in designing the research and
protocol.
Research must be culturally, linguistically, and educationally
appropriate-post-college language is not appropriate.
There is a need to transfer information and expertise from academics
and government to communities. There needs to be a focus on early
education.
There is a need to institutionalize this expertise and education on
the community level.
Research should be more action-oriented and less academic.
Leadership
Use historically Black colleges and universities and minority
institutions which are often in the very communities which are most
heavily affected.
Address a lack of people of color in the administration of minority
institutions.
Involve students, professors, and professionals of color in
identifying, defining, and addressing the problems.
Conference Organization
Planning committee and conference implementation needs to be more
inclusive-participation needs to be expanded. Participation should be
open, equitable, and diverse.
Work groups should include grassroots voices in more than token
capacity.
To influence dialogue about fundamental issues, the conference should
be structured to facilitate discussion at the beginning, not at the end
of the conference.
The recommendations from this symposium should be tied to those from
the NIEHS conference which preceded it. Their outcomes need to be
coordinated.
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