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CHILDREN'S ENVIRONMENTAL HEALTH ARTICLE
OF THE MONTH

Welcome to the Children’s Environmental Health Article of the Month! The Article of the Month is a communication tool to increase communication within and outside of the field of children’s environmental health. The Article of the Month highlights the science basis of current children’s environmental health issues for stakeholders such as families, educators, and health care professionals.

AUGUST 2010

Title
Perfluorinated Compounds, Polychlorinated Biphenyls, and Organochlorine Pesticide Contamination in Composite Food Samples from Dallas, Texas, USA

Author(s)              
Arnold Schecter
Justin Colacino
Darrah Haffner
Keyur Patel
Matthias Opel
Olaf Päpke
Linda Birnbaum

Citation
Environmental Health Perspectives 118:796–802 (2010).

Abstract
This article measured levels of some persistent organic pollutants (POPs) in U.S. food.  The chemicals measured were perfluorinated compounds (PFCs), organochlorine pesticides, and polychlorinated biphenyls (PCBs) in composite food samples. This study is part of a larger study reported in two articles, the other of which reports on levels of poly­brominated diphenyl ethers and hexabromocyclododecane brominated flame retardants in these composite foods.

POPs are a dangerous class of chemicals that include highly toxic dioxins, some pesticides, and polychlorinated biphenyls (PCBs). POPs are of concern for children because of their persistent nature and because exposure to some POPs can result in serious injuries to the developing nervous system.  Some are thought to be carcinogens and endocrine disruptors with potential effects on children.

METHODS: In this study we measured concentrations of 32 organochlorine pesticides, 7 PCBs, and 11 PFCs in composite samples of 31 different types of food (310 individual food samples) pur­chased from supermarkets in Dallas, Texas (USA), in 2009. Dietary intake of these chemicals was calculated for an average American.

DISCUSSION: Contamination varied greatly among chemical and food types. The highest level of pesti­cide contamination was from the dichlorodiphenyltrichloroethane (DDT) metabolite p,p´-dichlorodiphenyldichloroethylene. We found PCB congeners primarily in fish, with highest levels in salmon. For PFCs, we detected perfluorooctanoic acid (PFOA) in 17 of 31 samples, with the lowest concentration (0.07mg/g) found in potatoes, and the highest (1.80 ng/g) in olive oil. In terms of dietary intake, DDT and DDT metabolites, endo­sulfans, aldrin, PCBs, and PFOA were consumed at the highest levels.

CONCLUSION: Despite product bans and emission treaties, POPs are present in U.S. food, and mixtures of these chemicals are consumed by the American public at varying levels. This suggests the need to expand testing of food for chemical contaminants.

Policy Implications
This study is among many raising the importance of testing food for chemical contaminants and for eliminating hazardous chemicals from our environment, including our food supply. Despite U.S. domestic action to reduce POP emissions, levels of those pollutants are still detected in our food chain, soil, water and air.  The main source of POP exposure to humans is from contaminated food. This is of great concern, especially when considering vulnerable populations, such as children, whose systems are still developing and who are at risk from exposure to POPs.

Web link
Full article available courtesy of Environmental Health Perspectives athttp://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.0901347

Keyword(s)

Food Safety and Nutrition -- cehn/resourceguide/food.html

APRIL 2010

Title
Formaldehyde Exposure and Asthma in Children: A Systematic Review

Author(s)              
Gerald McGwin Jr.
Jeffrey Lienert
John I. Kennedy Jr.

Citation
Environmental Health Perspectives (2010) 118:313–31

Abstract
OBJECTIVE: Despite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship.

METHODS: After a comprehensive literature search, we identified seven peer-reviewed studies
providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma (e.g., self-report, physician diagnosis). Most of the studies were cross-sectional. For each study, an odds ratio (OR) and 95% confidence interval (CI) for asthma were either abstracted from published results or calculated based on the data provided. Characteristics regarding the study design and population were also abstracted.

RESULTS: This analysis found a significant association between formaldehyde exposure and childhood asthma. Further studies are needed.

Policy Implications
 
Formaldehyde, classified as a carcinogen by the International Agency for Research on Cancer, is a colorless, pungent-smelling gas, widely used to make building materials and in many household products. Because of the health outcomes associated with exposure to formaldehyde, this chemical presents a great danger to human health both indoors and outdoors. Policy makers should consider approaches to minimizing the amount of this chemical used in manufacturing and consumer products, and thus decrease the levels formaldehyde in the environment.

Web link
Full article available courtesy of Environmental Health Perspectives athttp://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.0901143

Keyword(s)

Asthma – cehn/resourceguide/asthma.html

MARCH 2010

Title
Prenatal Phthalate Exposure is Associated with Childhood Behavior and Executive Functioning

Author(s)              
Stephanie M. Engel
Amir Miodovnik
Richard L. Canfield
Chenbo Zhu
Manori J. Silva
Antonia M. Calafat
Mary S. Wolff

Citation
Environmental Health Perspectives (2010) doi:10.1289/ehp.0901470

Abstract
BACKGROUND: Some studies have reported biological consequences of phthalate exposure relevant to neurodevelopment.  (Phthalates are widely used in consumer products, such as in cosmetics and fragrances, and frequently as a compound in plastics.)

OBJECTIVE: To examine the association of prenatal phthalate exposure in children with behavior and intellectual and emotional functioning at ages 4 to 9 years.

METHODS: The Mount Sinai Children’s Environmental Health Study enrolled a multiethnic prenatal
population in New York City between 1998 and 2002 (n= 404). Third trimester maternal urines were
collected and analyzed for metabolites of phthalate. More than 175 children were assessed for
cognitive and behavioral development between the ages of 4 and 9 years.

RESULTS: Elevated levels of some phthalate metabolites in mothers were associated with poorer scores on a variety of scales:  the Aggression, Conduct Problems, Attention Problems, and Depression clinical scales; Externalizing Problems and Behavioral Symptom Index composite scales; and the Emotional Control scale.

CONCLUSION: The types of behavioral problems commonly found in children with Conduct or Attention-Deficit Hyperactivity Disorders are the same behavioral problems associated with exposure to some phthalates in utero.

Policy Implications
This study illustrates the need for policies that protect children from chemical exposures until we understand the impact of a substance’s exposure on all stages of human development  -- especially on the sensitive and irreparable steps of development.  Currently, our policies generally assume a substance is safe and require proof of harm before action will be considered  -- after the substance is already in our environment.   

Web link
Full article available courtesy of Environmental Health Perspectives at
http://ehsehplp03.niehs.nih.gov/article/info:doi%2F10.1289%2Fehp.0901470

Keyword(s)
Prenatal Exposures – cehn/resourceguide/prenatal.html

JANUARY 2010

Title
Ethical Issues in Measuring Biomarkers in Children’s Environmental Health

Author(s)              
Peter D. Sly
Brenda Eskenazi
Jenny Pronczuk
Radim Šrám
Fernando Diaz-Barriga
Diego Gonzalez Machin
David O. Carpenter
Simona Surdu
Eric M. Meslin

Citation
Environ Health Perspectives 117:1185–1190 (2009)

Abstract
BACKGROUND: Studying the impact of environmental exposures is important in children because they are more vulnerable to adverse effects on growth, development, and health. Assessing exposure in children is difficult, and measuring biomarkers is potentially useful. Research measuring bio-markers in children raises a number of ethical issues, some of which relate to children as research subjects and some of which are specific to biomarker research.

OBJECTIVE: As an international group with experience in pediatric research, biomarkers, and the ethics of research in children, we highlight the ethical issues of undertaking biomarker research in children in these environments.

DISCUSSION: Significant issues include undertaking research in vulnerable communities, specially in developing countries; managing community expectations; obtaining appropriate consent to conduct the research; the potential conflicts of obtaining permission from an ethics review board in an economically developed country to perform research in a community that may have different cultural values; returning research results to participants and communities when the researchers are uncertain of how to interpret the results; and the conflicting ethical obligations of maintaining participant confidentiality when information about harm or illegal activities mandate reporting to authorities.

CONCLUSION: None of these challenges are insurmountable and all deserve discussion. Pediatric biomarker research is necessary for advancing child health.

Policy Implications

This article illustrates the profound challenges of ethically studying the impact of environmental exposures on children and their health. Sound policies are necessary in structuring, conducting, and communicating about studies of biomarkers in children.  Conducting research involving children in disadvantaged communities and in economically-developing nations poses additional challenges.  
 
Current federal regulations and organizational standards may not be up to these emerging ethical challenges.  Supplementing the traditional institutional review board (IRB) with an environmental health and community review board (EHCRB) may be one approach.  Additional methods, such as review of a study’s ethics by an independent entity representing the public interest, may be necessary to assure that the children and communities involved in such research are adequately protected.  Additional information on this topic may be found at http://www.cehn.org/cehn/research/ethics_in_ceh_research2006.htm; this site has links to the papers resulting from the Network’s 2004 Workshop on Ethical Issues in Children’s Environmental Health Research.

Web link
Full article available courtesy of Environmental Health Perspectives at
http://ehp.niehs.nih.gov/members/2009/0800480/0800480.html

Keyword(s)

Children’s Exposures – cehn/resourceguide/exposurevulnerabilities.html

DECEMBER 2009

Title
Global Climate Change and Children's Health 

Author(s)              
Katherine M. Shea and the Committee on Environmental Health 

Citation
American Academy of Pediatrics Volume 120, Number 5, November 2007

Context
Children's health and climate change

Abstract

There is a broad scientific consensus that the global climate is warming, the process is accelerating, and that human activities are very likely (90% probability) the main cause. This warming will have effects on ecosystems and human health, many of them adverse. Children will experience both the direct and indirect effects of climate change. Actions taken by individuals, communities, businesses, and governments will affect the magnitude and rate of global climate change and resultant health impacts. This technical report reviews the nature of the global problem and anticipated health effects on children and supports the recommendations in the accompanying policy statement on climate change and children’s health. 

Although little research thus far has concentrated on the pediatric age group, it is likely that children will suffer disproportionately from climate change. Furthermore, the state of the world of future children is uncertain and depends on actions taken to mitigate and adapt to climate change and other global scale trends. Pediatric health care professionals are in an ideal position to advocate for action, not only to address climate change but also, more broadly, to ensure sustainability. Specific recommendations for pediatricians and governments are enumerated in the American Academy of Pediatrics policy statement on climate change and children’s health, which accompanies this technical report.

Climate change is happening and makes us vulnerable to environmental dangers such as increase in volatilization of persistent organic pollutants (POPs) and pesticides to the atmosphere in regions subject to decrease in rainfall, or increase in surface deposition of POPs, or run-off of pesticides in regions subject to increase in rainfall (Noyes et al., 2009).

Policy Implications

This study is among the few raising the importance of addressing climate change and children’s health. This research joins others in indicating that children will be the population that is both first and worst harmed by climate change.  Children need to be protected from climate change impacts.  Thus, our policies must specifically consider children if we are to protect them.  Children’s unique vulnerabilities, susceptibilities and environments must be included in research, planning, assessments, and strategies.  However, this does not appear to be occurring.

Web link
Full Article from the journal Pediatrics available at http://pediatrics.aappublications.org/cgi/content/abstract/120/5/e1359

Keyword(s)

Persistent Organic Pollutants, Global Warming, Health Effects cehn/resourceguide/keywordindex.html

Additional Reference:

Noyes PD, et al, The toxicology of climate change: Environmental contaminants in a warming world, Environ Int (2009), doi:10.1016/j.envint.2009.02.006

NOVEMBER 2009

Title
Confirmed Moisture Damage at Home, Respiratory Symptoms and Atopy in Early Life: A Birth-Cohort Study

Conclusion
Moisture and mold have been shown to affect the respiratory system, and trigger asthma like symptoms. This birth cohort study shows that moisture and mold in the kitchen in living area increases the risk for wheezing in early childhood.

Author(s)              
Anne M. Karnoven
Anne Hyvärinen
Marjut Roponen
Matthias Hoffmann
Matti Korppi
Sami Remes
Erika von Mutius
Aino Nevalainen
Juha Pekkanen

Citation
Pediatrics 2009;124:e329–e338

Context
Wheezing in early childhood and exposure to moisture and mold.

Abstract
Objective: Most previous studies on the association between moisture or mold problems in the home and respiratory symptoms in children were cross-sectional and based on self-reported exposure. The aim of this study was to evaluate the impact of objectively observed moisture damage and visible mold in the homes on early-life respiratory morbidity and atopic sensitization in a birth cohort.

Methods: Building inspection was performed by building engineers in the homes of 396 children, and the children were followed up with questionnaires from birth to the age of 18 months. Specific immunoglobulin E levels were measured at the age of 1 year.

Results: Doctor-diagnosed wheezing was associated with the severity of moisture damage in the kitchen and with visible mold in the main living area and especially in the bedroom of the child. The risk for parent-reported wheezing apart from cold increased with the severity of moisture damage in the kitchen. Moisture damage in the bathrooms or other interior spaces had no significant association with wheezing. No significant associations were observed for other end points, such as cough, or respiratory infections. There was a suggestion for an increased risk for sensitization to cat dander linked with moisture and mold exposure.

Conclusion: This birth-cohort study supports previous observations that moisture mold problems in the kitchen and in the main living area increase the risk for wheezing in early childhood. The results
underline the importance of assessing separately the health effects of moisture and mold problems in different areas of the home.

Web link
Article courtesy of the American Academy of Pediatrics, and available at:
http://www.ncbi.nlm.nih.gov/pubmed/19651571

Keyword(s)

Respiratory Diseases, Air Pollutant, cehn/resourceguide/respiratorydiseases.html

OCTOBER 2009

Title
Are We Really Addressing the Core of Children’s Environmental Health?

Author(s)              
Nsedu Obot Witherspoon

Citation
Environmental Health Perspectives Volume 117, Number 10, October 2009

Abstract
More than 3 million children < 5 years of age die each year from environment-related conditions, making the environment one of the most critical contributors to the > 10 million child deaths annually throughout the world [World Health Organization (WHO) 2005]. Some factors of susceptibility, including race, ethnicity, and socioeconomic status, are generally not well understood in the context of risk assessment. For children’s environmental health the focus is almost exclusively on age-related differences and exposure hazards, without much discussion of the myriad additional factors including nutritional status, preexisting health status, multiple exposures, and gender differences that can affect the life course of a child.

There must be a conscious effort to move beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities among our children (Schultz and Northridge 2004). It is essential for decision makers at international and national levels to continue working together with researchers, nongovernmental organizations, communities, and families to identify the linkages between key environmental hazards and the variety of social determinants plaguing children worldwide.

Web link
 Full Article courtesy of the Environmental Health Perspectives, and available athttp://www.ehponline.org/docs/2009/117-10/editorial.html

Keyword(s)

Exposures to children, cehn.org/cehn/resourceguide/exposurevulnerabilities.html

Reference:

CEHN (Children’s Environmental Health Network). 2009. Climate Disruption and Children’s Health. Available: http://www.cehn.org/climate.htm [accessed 8 September 2009].

Food Quality Protection Act of 1996. 1996. Public Law 104-170.

Gasparini L, Cruces G, Tornarolli L. 2009. Recent Trends in Income Inequality in Latin America. Working Paper 132. Mallorca, Spain:ECINEQ. Available: http://www.ecineq.org/milano/WP/ECINEQ2009-132.pdf [accessed 11 September 2009].

Horn I, Beal AC. 2004. Child health disparities: framing a research agenda. Ambul Pediatr 4(4):269–275.

Landrigan P. 2009. What’s getting into our children? NY Times. 4 August 2009. Available: http://www.mountsinai.org/img/vgn_lnk/Regular%20Content/File/Advertorials/MS_OpEd%20Ad_080309_Revised.pdf [accessed 8 September 2009].

For complete list of references go to http://www.ehponline.org/docs/2009/117-10/editorial.html

SEPTEMBER 2009

Topic
Organohalogens influence on school performance

Title
Prenatal Exposure to Organohalogens, including Brominated Flame Retardants, influences Motor, Cognitive, and Behavioral Performance at School Age

Conclusion
Organohalogen compounds  (OHCs) are a class of organic compounds that contain at least one halogen bonded to carbon. OHCs are widely used in pesticides, flame retardants, and other industrial applications. OHCs are neurotoxic and bioaccumulate in human tissue. This study investigated on influence of prenatal exposure to OHCs and suggests association between transpacental transfer of polybrominated flame retardant, a form of OHC, and school performance.

Author(s)              
Elise Roze
Lisethe Meijer
Attie Bakker
Koenraad N.J.A. Van Braekel
Pieter J.J. Sauer
Arend F. Bos

Citation
EHP (31 August 2009).

Context
Prenatal exposure to OHCs and school performance

Abstract
Objective: Organohalogen compounds (OHCs) are known to have neurotoxic effects on the developing brain. Our objective was to investigate the influence of prenatal exposure to such compounds, including brominated flame retardants, on motor, cognitive, and behavioral outcome in healthy children at school age.

Methods: This study was part of the prospective Groningen-infant-COMPARE study. It included 62 children in whose mothers various organohalogens had been determined in the 35th week of pregnancy. Thyroid hormones were determined in umbilical cord blood. When the children were five to six years old we assessed their neuropsychological functioning. This included motor performance (coordination, fine motor skills), cognition (intelligence, visual perception, visuomotor integration, inhibitory control, verbal memory, and attention), and behavior.

Results: Brominated flame retardants correlated with worse fine manipulative abilities, worse attention, better coordination, better visual perception, and better behavior. The chlorinated OHCs correlated with less choreiform dyskinesia (involuntary jerking movements). The hydroxylated polychlorinated biphenyls correlated with worse fine manipulative abilities, better attention, and better visual perception. The wood protective agent PCP correlated with worse coordination, less sensory integrity, worse attention, and worse visuomotor integration.

Conclusion: Our results demonstrated for the first time that transplacental transfer of polybrominated flame retardants is associated with the development of children at school age. Due to the widespread use of these compounds, especially in the USA where concentrations in the environment are four times higher than in Europe, these results cause serious concern.

Policy Implications

This study illustrates that today’s children have chemical compounds in their environments, and their bodies, that are known to be, or are likely to be, harmful to human health and development.  This is legal under our current statutes and regulations.  Thus, our policies, laws and regulations are not adequately protecting our children and must be improved.

Web link
 Full Article courtesy of the Environmental Health Perspectives, and available at

Keyword(s)

Bioaccumulants, Neurotoxins, Pesticides cehn/resourceguide/neurotoxins.html

AUGUST 2009

Topic
Airborne Polycyclic Aromatic Hydrocarbon and Child IQ

Title
Prenatal Airborne Polycyclic Aromatic Hydrocarbon Exposure and Child IQ at Age 5 Years

Conclusion
Polycyclic aromatic hydrocarbons (PAHs) are released into the air from incomplete combustion and/or pyrolysis, the chemical decomposition of a condensed substance by heat. This study of children in New York City investigates the relationship between prenatal exposure to PAHs and child IQ. The results suggest that prenatal exposure to PAHs could be associated with lowered children’s IQ.

Author(s)                               
Frederica P. Perera
Zhigang Li
Robin Whyatt
Lori Hoepner
Shuang Wang
David Camann
Virginia Rauh

Citation
Pediatrics. 124:e195-e202 (2009)

Context
Prenatal exposure to environmental PAHs may adversely affect children’s IQ.

Abstract
Objective: This study evaluated the relationship between prenatal exposure to airborne polycyclic aromatic hydrocarbons (PAHs) and child intelligence.

Methods: Children of nonsmoking black or Dominican-American women residing in New York City were monitored from in utero to 5 years of age, with determination of prenatal PAH exposure through personal air monitoring for the mothers during pregnancy. At 5 years of age, intelligence was assessed for 249 children by using the Wechsler Preschool and Primary Scale of Intelligence-Revised. Multivariate linear regression models were used to estimate and to test the associations between prenatal PAH exposure and IQ.

Results: After adjustment for maternal intelligence, quality of the home caretaking environment, environmental tobacco smoke exposure, and other potentially confounding factors, high PAH levels (above the median of 2.26 ng/m3) were inversely associated with full-scale IQ (P= .007) and verbal IQ (P= .003) scores. Children in the high exposure group had full-scale and verbal IQ scores that were 4.31 and 4.67 points lower, respectively, than those of less-exposed children (<2.26 ng/m3). The associations between logarithmically transformed, continuous, PAH levels and these IQ measures also were significant (full-scale IQ: b= -3.00; P= .009; verbal IQ: b= -3.53; P= .002).

Conclusion: These results provide evidence that environmental PAHs at levels encountered in New York City air can affect children’s IQ adversely.

Policy Implications

This study illustrates how children have unique vulnerabilities and susceptibilities to environmental hazards compared to adults.  Exposures that may cause little or no harm to adults may cause life-long damage to children.  Thus, our policies should not treat children as “little adults,” such as by extrapolating from what is safe for adults when determining what exposures (to pollutants, to chemicals in products, to pesticides) are safe for children. 

Web link
Article available courtesy of Pediatrics athttp://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-3506v1

Keyword(s)

Neurotoxins cehn/resourceguide/neurotoxins.html

JULY 2009

Topic
Bisphenol A (BPA) and other phenols in Premature Infants

Title
Exposure to Bisphenol A and Other Phenols in Neonatal Intensive Care Unit Premature Infants

Conclusion
BPA, primarily used in a category of plastics, has been known to leach from plastic linings of canned foods and baby bottles. This study investigated premature infants’ exposure to di(2-ethylhexyl) phthalate (DEHP), a plasticizer found in polyvinyl chloride (PVC) medical devices, and its metabolites. Infants under more frequent use of these medical devices had higher urine concentration of BPA.

Author(s)                               
Antonia M. Calafat
Jennifer Weuve
Xiaoyun Ye
Lily T. Jia
Howard Hu
Steven Ringer
Ken Huttner
Russ Hauser

Citation
Environmental Health Perspectives 117:639–644 (2009)

Context
BPA and other phenols concentration detected in premature infants in intensive care units

Abstract
Objective: We previously demonstrated that exposure to polyvinyl chloride plastic medical devices containing di(2-ethylhexyl) phthalate (DEHP) was associated with higher urinary concentrations of several DEHP metabolites in 54 premature infants in two neonatal intensive care units than in the general population. For 42 of these infants, we evaluated urinary concentrations of several phenols, including bisphenol A (BPA), in association with the use of the same medical devices.

Methods: We measured the urinary concentrations of free and total (free plus conjugated) species of BPA, triclosan, benzophenone-3, methyl paraben, and propyl paraben.

Results: Intensity of use of products containing DEHP was strongly associated with BPA total concentrations but not with any other phenol. Adjusting for institution and sex, BPA total concentrations among infants in the group of high use of DEHP-containing products were 8.75 times as high as among infants in the low use group (p < 0.0001). Similarly, after adjusting for sex and DEHP-containing product use category, BPA total concentrations among infants in Institution A were 16.6 times as high as those among infants in Institution B (p < 0.0001).

Conclusion: BPA geometric mean urinary concentration (30.3 μg/L) among premature infants undergoing intensive therapeutic medical interventions was one order of magnitude higher than that among the general population. Conjugated species were the primary urinary metabolites of BPA, suggesting that premature infants have some capacity to metabolize BPA. The differences in exposure to BPA by intensity of use of DEHP-containing medical products highlight the need for further studies to determine the specific source(s) of exposure to BPA.

Policy Implications

BPA was detected in urine samples of 93% of children and adults who participated in a study conducted by the CDC in 2003-2004. The Food and Drug Administration has deemed BPA  as safe, despite some animal studies showing a wide range of health effects, including an increased risk of obesity, increasing breast cancer and prostate cancer cell growth, links to damage in developing brain tissue, changing gene behavior, provoking insulin resistance, and harming the ability of embryos to attach to the uterus.  A human study also linked BPA exposure to cardiovascular disease and diabetes.

The findings from Calafat and colleagues’ study suggest health concerns within this vulnerable population, thus the need to reconsider safer levels of exposure to BPA, the quality of medical devices used in this population, and halting infants’ and children’s exposure to BPA. 

Canada and some U.S. states are moving to ban plastic with BPA in baby bottles.  Congressional leaders have urged FDA to reconsider its assessment that BPA is safe.  Legislation has been introduced in Congress to ban BPA in food and drink packaging.

Web link
Full article available courtesy of Environmental Health Perspectives at Environ Health Perspect at http://www.ehponline.org/docs/2008/0800265/abstract.html

Keyword(s)

Endocrine Disruptors  cehn/resourceguide/endocrinesiruptors.html

JUNE 2009

Topic
The effect of arsenic in drinking water on pregnancy outcomes.

Title
Arsenic in drinking water and pregnancy outcomes.

Conclusion
Several studies on arsenic have investigated sources of the compound and variations in concentration levels in arsenic-contaminated water. This study investigates health outcomes including pregnancy complications among women of reproductive age chronically exposed to arsenic-contaminated water in Bangladesh.  Adverse pregnancy outcomes  -- in terms of spontaneous abortion, stillbirth, and preterm birth rates -- were significantly higher in the exposed group than those in the non-exposed group.

Author(s)                               
Akhtar Ahmad
Salim Ullah Sayed
Shampa Barua
Manzurul Haque Khan
M. H. Faruquee
Abdul Jalil
Abdul Hadi
Humayun Kabir Talukder

Citation
Environmental Health Perspectives 109:629-631(2001)

Context
The toxic effects of arsenic on human health are different for acute and chronic exposures.

Abstract
Objective: We studied a group of women of reproductive age (15-49 years) who were chronically exposed to arsenic through drinking water to identify the pregnancy outcomes in terms of live birth, stillbirth, spontaneous abortion, and preterm birth.

Methods: We compared pregnancy outcomes of exposed respondents with pregnancy outcomes of women of reproductive age (15-49 years) who were not exposed to arsenic-contaminated water. In a cross-sectional study, we matched the women in both exposed and non-exposed groups for age, socioeconomic status, education, and age at marriage.

Results: The total sample size was 192, with 96 women in each group (i.e., exposed and non-exposed). Of the respondents in the exposed group, 98% had been drinking water containing [Greater and equal to] 0.10 mg/L arsenic and 43.8% had been drinking arsenic-contaminated water for 5-10 years. Adverse pregnancy outcomes in terms of spontaneous abortion, stillbirth, and preterm birth rates were significantly higher in the exposed group than those in the non-exposed group (p = 0.008, p = 0.046, and p = 0.018, respectively).

Conclusion: Adverse pregnancy outcomes were more common among women who were exposed to arsenic-contaminated water over a long period of time. Exposure to arsenic-contaminated water suggests a serious threat to healthy and safe pregnancy outcomes.

Web link
Full article available courtesy of Environmental Health Perspectives at Environ Health Perspect at
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1240346

Keyword(s)

Carcinogen  cehn/resourceguide/carcinogen.html

MAY 2009

Topic
The importance in incorporating pediatric environmental health curriculum models into pediatric health care  

Title
Children’s Environmental Health Faculty Champions Initiative: A Successful Model for Integrating Environmental Health into Pediatric Health Care

Conclusion
The Children’s Environmental Health Faculty Champion Initiative was successful in building capacity among health care providers in PEH resulting in: 1) increased PEH knowledge among faculty champions, 2) the education of a significant number of health care providers in PEH, and 3) sustained changes in knowledge, practice, curricula, and institutional policies. Faculty champions faced numerous barriers to information integration: time limitations in practice settings, competing time constraints in a busy academic career, a perceived or actual lack of influence in their institutional and practice settings, and inability to change institutional and practice settings. Future programs could include training on instituting policy changes and involvement of at least two representatives from each institution for increased faculty champion support. Researchers concluded that future research should consider whether program content should vary among practitioner types (i.e., nurse, nurse practitioner, physician, physician assistant), and which teaching and outreach strategies work best.

Author(s)                               
Bonnie Rogers
Leyla Erk McCurdy
Katie Slavin
Kimberly Grubb
James R. Roberts

Citation
Environmental Health Perspectives 117:855 (2009)

Context
Several studies of health care professionals have identified the need for increased environmental health education. Few studies have evaluated the effectiveness of programs that incorporate PEH into curricula and practice. The purpose of this study is to evaluate the National Environmental Education Foundation’s (NEEF) Children’s Environmental Health Faculty Champions Initiative, which was designed to build health professional capacity to address children’s environmental health issues. We anticipate that the program will enhance the development of effective strategies to produce health care professionals competent in PEH.

Abstract
Background: Pediatric medical and nursing education lack the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat environmental exposure–related diseases. The need for improvements in health care professionals’ environmental health knowledge has been expressed by leading institutions. However, few studies have evaluated the effectiveness of programs that incorporate pediatric environmental health (PEH) into curricula and practice.

Objective: We evaluated the effectiveness of the National Environmental Education Foundation’s (NEEF) Children’s Environmental Health Faculty Champions Initiative, which is designed to build environmental health capacity among pediatric health care professionals.

Methods: Twenty-eight pediatric health care professionals participated in a train-the-trainer workshop, in which they were educated to train other health care professionals in PEH and integrate identified PEH competencies into medical and nursing practice and curricula. We evaluated the program using a workshop evaluation tool, action plan, pre- and posttests, baseline and progress assessments, and telephone interviews.

Results: During the 12 months following the workshop, the faculty champions’ average pretest score of 52% was significantly elevated (p < 0.0001) to 65.5% on the first posttest and to 71.5% on the second posttest, showing an increase and retention of environmental health knowledge. Faculty champions trained 1,559 health care professionals in PEH, exceeding the goal of 280 health care professionals trained. Ninety percent of faculty champions reported that PEH had been integrated into the curricula at their institution.

Conclusion: The initiative was highly effective in achieving its goal of building environmental health capacity among health care professionals. The faculty champions model is a successful method and can be replicated in other arenas.

Web link
Full article available courtesy of Environmental Health Perspectives at Environ Health Perspect 117:850–855 (2009)
http://www.ehponline.org/members/2008/11813/11813.html

Keyword(s)
children, education, environmental health, medicine, medical schools, nursing, nursing schools, pediatrics

APRIL 2009

Topic
How air pollution impacts respiratory symptoms. 

Title
Acute Effects of Air Pollution on Pulmonary Function, Airway Inflammation, and Oxidative Stress in Asthmatic Children

Conclusion
Various methods have been used to investigate the relationship between exposure to air pollutants and airway inflammation. Research in this study demonstrated a decrease in small airway function associated with ambient levels of sulfur dioxide, nitrogen dioxide, ozone, and particulate matter. An increase in oxidative stress was also illustrated in children with an increase in relative levels of sulfur dioxide, nitrogen dioxide, ozone, and particulate matter. Observing levels of thiobarbituric acid relative substances is an effective means for examining air pollution-related oxidative stress among asthmatic children.

Author(s)                               
Ling Liu
Raymond Poon
Li Chen
Anna-Maria Frescura
Paolo Montuschi
Giovanni Ciabattoni
Amanda Wheeler
Robert Dales

Citation
Environmental Health Perspectives 117(4):668-674

Context
A number of studies have shown a correlation with asthma and air pollution. Asthma impacts children in various ways and compromises quality of life by increasing number of hospitalizations and causing pulmonary distress, airway inflammation and other symptoms. This study seeks to understand the impact of relative amounts of air pollutants including sulfur oxide, particulate matter, ozone and nitrogen dioxide on compromising respiratory function in children.

Abstract
Background: Air pollution is associated with respiratory symptoms, lung function decrements, and hospitalizations. However, there is little information about the influence of air pollution on lung injury.

Objective: In this study we investigated acute effects of air pollution on pulmonary function and airway oxidative stress and inflammation in asthmatic children.

Methods: We studied 182 children with asthma, 9–14 years of age, for 4 weeks. Daily ambient concentrations of sulfur dioxide, nitrogen dioxide, ozone, and particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) were monitored from two stations. Once a week we measured spirometry and fractional exhaled nitric oxide (FeNO) , and determined thiobarbituric acid reactive substances (TBARS) and 8-isoprostane—two oxidative stress markers—and interleukin-6 (IL-6) in breath condensate. We tested associations using mixed-effects regression models, adjusting for confounding variables.

Results: Interquartile-range increases in 3-day average SO2 (5.4 ppb) , NO2 (6.8 ppb) , and PM2.5 (5.4 µg/m3) were associated with decreases in forced expiratory flow between 25% and 75% of forced vital capacity, with changes being –3.1% [95% confidence interval (CI) , –5.8 to –0.3], –2.8% (95% CI, –4.8 to –0.8) , and –3.0% (95% CI, –4.7 to –1.2) , respectively. SO2, NO2, and PM2.5 were associated with increases in TBARS, with changes being 36.2% (95% CI, 15.7 to 57.2) , 21.8% (95% CI, 8.2 to 36.0) , and 24.8% (95% CI, 10.8 to 39.4) , respectively. Risk estimates appear to be larger in children not taking corticosteroids than in children taking corticosteroids. O3 (5.3 ppb) was not associated with health end points. FeNO, 8-isoprostane, and IL-6 were not associated with air pollutants.

Conclusion: Air pollution may increase airway oxidative stress and decrease small airway function of asthmatic children. Inhaled corticosteroids may reduce oxidative stress and improve airway function.

Policy implications
As scientific methods improve and as researchers expand our knowledge about the impact of environmental exposures on children’s health, scientists are consistently finding impacts on children’s health from pollutants and other toxicants at lower and lower levels of exposure.  This study reinforces this conclusion and illustrates the need for policies that specifically take into account children’s unique vulnerabilities, susceptibilities and exposures and, in the absence of certainty, provide additional safety margins to protect them.

Web link
Full article available courtesy of Environmental Health at:
http://www.ehponline.org/members/2008/11813/11813.html

Keyword(s)
Asthma, Air Pollution, Exaled Breath Condensate, Pulmonary Function, Oxidative Stress

MARCH 2009

Topic
How environmental public health tracking of childhood asthma illustrates the connection of high pollution concentration and childhood asthma outcomes.

Title
Environmental Public Health Tracking of Childhood Asthma Using California Air Interview Survey, Traffic, and Outdoor Air Pollution Data

Conclusion
The California Health Interview Survey (CHIS) is a useful tool in assessing linkages in child asthma occurrences and air quality in relation to the Environmental Public Health Tracking (EPHT) tool.  Direct connections were illustrated in the case study of California for exposure to elevated air pollution and childhood asthma. The major advantages of using the CHIS tool included relatively large sample size and a diverse representation of the population and a spatially refined assessment. Disadvantages of the reporting methods included: reliance accuracy of parental reports of diagnoses and symptoms, lack of information some potential cofounders and lack of residential and school histories.

Author(s)                               
Michelle Wilhelm
Ying-Ying Meng
Rudolph P. Rull
Paul English
John Balmes
Beate Ritz

Citation
Environmental Health Perspectives 116(8):1254-1260

Context
Asthma is a disease that affects many children in the United States.  Although there is data illustrating the connection of long-term exposure to O3, PM10 and NO2 to chronic respiratory impairments, little data exists on the influence of these pollutants on asthma. There are a number of tools currently in use for the assessment of air pollutants in relationship to childhood asthma morbidity. This article examines the California Health Interview Survey and its efficacy in evaluating the associations and linkages of asthma to various levels of air pollutants.

Abstract
Background: Despite extensive evidence that air pollution affects childhood asthma, state-level and national-level tracking of asthma outcomes in relation to air pollution is limited.

Objectives: Our goals were to evaluate the feasibility of linking the 2001 California Health Interview Survey (CHIS), air monitoring, and traffic data; estimate associations between traffic density (TD) or outdoor air pollutant concentrations and childhood asthma morbidity; and evaluate the usefulness of such databases, linkages, and analyses to Environmental Public Health Tracking (EPHT).

Methods: We estimated TD within 500 feet of residential cross-streets of respondents and annual average pollutant concentrations based on monitoring station measurements. We used logistic regression to examine associations with reported asthma symptoms and emergency department (ED) visits/hospitalizations.

Results: Assignment of TD and air pollution exposures for cross-streets was successful for 82% of children with asthma in Los Angeles and San Diego, California, Counties. Children with asthma living in high ozone areas and areas with high concentrations of particulate matter < 10 µm in aerodynamic diameter experienced symptoms more frequently, and those living close to heavy traffic reported more ED visits/hospitalizations. The advantages of the CHIS for asthma EPHT include a large and representative sample, biennial data collection, and ascertainment of important socio-demographic and residential address information. Disadvantages are its cross-sectional design, reliance on parental reports of diagnoses and symptoms, and lack of information on some potential confounders.

Conclusions: Despite limitations, the CHIS provides a useful framework for examining air pollution and childhood asthma morbidity in support of EPHT, especially because later surveys address some noted gaps. We plan to employ CHIS 2003 and 2005 data and novel exposure assessment methods to re-examine the questions raised here.

Policy implications
This evaluation illustrates the value of environmental public health tracking as well as the dearth of information currently available regarding children’s exposures to environmental toxicants.  The absence of both exposure information and incidence of chronic diseases (such as asthma) make the task of protecting children from environmental toxicants difficult if not impossible.  Creating effective policies and programs to assure that all children grow up in a healthy environment requires adequate environmental public health tracking programs.

Web link
Full article available courtesy of Environmental Health at:
http://www.ehponline.org/members/2008/10945/10945.html

Keyword(s)
Asthma, Air Pollutants, Environmental Health Tracking

FEBRUARY 2009

Topic
How to decrease children’s exposure to lead by 2010. 

Title
Lead Exposures in U.S. Children, 2008: Implications for Prevention

Conclusion
Although current policies and prevention measures are in place, there is still much work to be done to decrease incidences of child lead exposure.  It is recommended that federal agencies support local and state efforts by 1) Monitoring lead in air, drinking water, food, consumer products and children’s toys. 2) Enforcing laws that control lead contamination, 3) Educating specific populations about lead and controlling exposures, 4) Improving exposure modeling techniques accounting for all sources of exposure and 5) Conducting research and ongoing evaluation of lead poisoning prevention activities. Finally, it is important to ensure that there are systems in place that monitor and evaluate all children’s potential lead exposures.

Author(s)
Ronnie Levin                                   
Mary Jean Brown
Michael E. Kashtock
David E. Jacobs
Elizabeth A. Whelan
Joanne Rodman
Michael R. Schock
Alma Padilla
Thomas Sinks

Citation
Environmental Health Perspectives 116(10):1285-1293

Context
The adverse health effects of lead are widely known and range from death, insanity, and sterility to nervous system damage.  Children are exposed to lead through different substances, especially paint, dust, soil and more recently toys and children’s jewelry. Exposure in children has been shown to affect intellectual development, lifetime achievement and in extreme cases, cause death. Federal, state and local policies have helped decrease incidences of exposure in children and ultimately decreased the Blood Lead Levels (BLLs) of children in the U.S. This study examines new-found sources of lead exposure (specifically related to elevated blood lead levels) and prevention measures (policy and public health) needed to eliminate elevated blood lead levels in children by 2010.

Abstract
Objectives: We reviewed the sources of lead in the environments of U.S. children, contributions to children’s blood lead levels, source elimination and control efforts, and existing federal authorities. Our context is the U.S. public health goal to eliminate pediatric elevated blood lead levels (EBLs) by 2010.

Data Sources: National, state, and local exposure assessments over the past half century have identified risk factors for EBLs among U.S. children, including age, race, income, age and location of housing, parental occupation, and season.

Data Extraction and Synthesis: Recent national policies have greatly reduced lead exposure among U.S. children, but even very low exposure levels compromise children’s later intellectual development and lifetime achievement. No safe level of lead exposure has been found. Although lead paint and dust may still account for up to 70% of EBLs in U.S. children, the U.S. Centers for Disease Control and Prevention estimates that ≥ 30% of current EBLs do not have an immediate lead paint source, and numerous studies indicate that lead exposures result from multiple sources. EBLs and even deaths have been associated with inadequately controlled sources including ethnic remedies and goods, consumer products, and food-related items such as ceramics. Lead in public drinking water and in older urban centers remain exposure sources in many areas.

Conclusions: Achieving the 2010 goal requires maintaining current efforts, especially programs addressing lead paint, while developing interventions that prevent exposure before children are poisoned.  It also requires active collaboration across all levels of government to identify and control all potential sources of lead exposure, as well as primary prevention.

Web link
Full article available courtesy of Environmental Health at:
http://www.ehponline.org/members/2008/11241/11241.html

Keyword(s)
Lead poisoning, Primary prevention

JANUARY 2009

Topic
How a common plastic ingredient may affect obesity and related diseases.  

Title
Bisphenol A at Environmentally Relevant Doses Inhibits Adiponectin Release from Human Adipose Tissue Explants and Adipocytes

Conclusion
Bisphenol A (BPA), a widely used ingredient in plastics, is shown in this study to affect human tissues at doses similar to typical exposure in our day-to-day lifestyles. The study links typical BPA exposure to metabolic syndrome, a cluster of associated conditions that include obesity, hypertension and an increased risk of diabetes and cardiovascular disease, by monitoring levels of adiponectin, a hormone in our bodies that protect against metabolic syndrome. Recognizing the widespread presence of BPA in our environment, the authors note more research needs to be undertaken in order to further understand the effects of BPA on the endocrine (hormonal) system.

Author(s)
Eric R. Hugo
Terry D. Brandebourg
Jessica G. Woo
Jean Loftus
J. Wesley Alexander
Nira Ben-Jonathan

Citation
Environmental Health Perspectives 116(12):1642-1647

Context
The number of overweight and obese children has increased over the last few decades to epidemic levels, having a profound impact on our children’s futures; overweight and obese children have an increased risk of many serious diseases. Traditionally, diet and exercise have been the focus of solutions to this epidemic, but increasing evidence, including this study, points toward an additional factor that also needs to be taken into consideration – environmental factors, especially exposure to commonly used chemicals.

Abstract
Background: The incidence of obesity has risen dramatically over the last few decades. This epidemic may be affected by exposure to xenobiotic chemicals. Bisphenol A (BPA), an endocrine disruptor, is detectable at nanomolar levels in human serum worldwide. Adiponectin is an adipocyte-specific hormone that increases insulin sensitivity and reduces tissue inflammation. Thus, any factor that suppresses adiponectin release could lead to insulin resistance and increased susceptibility to obesity-associated diseases.

Objectives: In this study we aimed to compare a) the effects of low doses of BPA and estradiol (E2) on adiponectin secretion from human breast, subcutaneous, and visceral adipose explants and mature adipocytes, and b) expression of putative estrogen and estrogen-related receptors (ERRs) in these tissues.

Methods: We determined adiponectin levels in conditioned media from adipose explants or adipocytes by enzyme-linked immunosorbant assay. We determined expression of estrogen receptors (ERs) a and b, G-protein–coupled receptor 30 (GPR30) , and ERRs a, b, and g by quantitative real-time polymerase chain reaction.

Results: BPA at 0.1 and 1 nM doses suppressed adiponectin release from all adipose depots examined. Despite substantial variability among patients, BPA was as effective, and often more effective, than equimolar concentrations of E2. Adipose tissue expresses similar mRNA levels of ERa, ERb, and ERRg, and 20- to 30-fold lower levels of GPR30, ERRa, and ERRb.

Conclusions: BPA at environmentally relevant doses inhibits the release of a key adipokine that protects humans from metabolic syndrome. The mechanism by which BPA suppresses adiponectin and the receptors involved remains to be determined.

Policy implications
Due to concerns about potential health impacts of Bisphenol A exposure, a variety of legislative bodies are already debating Bisphenol A prohibitions, especially in children’s products. This includes the U.S. Congress and more than a dozen states, and Canada has announced plans to limit the use of the chemical.

Web link
Full article available at: http://www.ehponline.org/members/2008/11537/11537.html
Further discussion of this article is available at: http://www.ehponline.org/docs/2008/116-12/ss.html#bisp

Keyword(s)
Bisphenol A, Endocrine Disruptors, Overweight & Obesity, Plastics

DECEMBER 2008

Topic
The need for effective asthma management for all children. 

Title
Disparities in allergy testing and health outcomes among urban children with asthma

Conclusion
The researchers have found that many children, especially minorities, in urban areas are not receiving treatment for allergies and education on avoidance of household allergens as part of their comprehensive asthma management plans. To be effective, the information on specific allergic reactions in asthmatic children needs to be followed with taking precautions to avoid exposure to those allergens that are found to trigger asthma symptoms.

Author(s)
Jeanette A. Stingone
Luz Claudio

Citation
The Journal of Allergy and Clinical Immunology 122(4):748-753

Context
Asthma has become a widespread disease affecting a significant portion of our children. An effective asthma management plan for each affected child is essential for protecting the child’s health and improving their quality of life. This study shows that many urban children with asthma are not receiving diagnoses or care for allergies that could improve their asthma symptoms.  

Abstract
Background: Previous research has found that treating allergies and reducing exposure to allergens can reduce asthma morbidity.

Objective: We sought to examine whether urban asthmatic children were receiving care for allergies as part of a comprehensive asthma management plan.

Methods: A cross-sectional study, consisting of a parent-reported questionnaire, was conducted in 26 randomly selected New York City public elementary schools during the 2002-2003 school year.

Results: In a sample of 5250 children aged 5 to 12 years, 13.0% were found to have current asthma. The prevalence of allergy diagnosis was 21.0%. Less than half (47.3%) of the subjects with current asthma reported a physician’s diagnosis of allergies.

The frequency of a reported allergy diagnosis varied with race/ethnicity, ranging from 14.4% in Mexican American children to 67.9% in white children. Only 54.9% of asthmatic children with an allergy diagnosis reported allergy testing. Children from lower-/middle-income households and children with public forms of health insurance were the least likely to report testing (adjusted odds ratios, 0.18 and 0.46). Higher frequencies of reported allergy testing were associated with education on allergen avoidance, use of allergy medications, lower exposure to household allergens, and lower prevalence of wheezing.

Conclusions: Many children do not receive comprehensive asthma treatment that includes management of allergies and education on avoidance of household allergens. Lower reported allergy testing might indicate lower access to medical care among middle-income families who are ineligible for public programs but who do not have the income to access higher quality care. Interventions aimed at improving medical care and adherence to treatment guidelines are necessary to decrease asthma morbidity.

Clinical Implications: Successful asthma management includes proper diagnosis of allergies and allergy testing. Allergy testing can be used to tailor allergen avoidance instruction and treatment and to guide patients to reduce exposure to allergens that can trigger asthma exacerbations.

Web link
Abstract available at: http://www.jacionline.org/article/S0091-6749(08)01456-5/abstract

Keyword(s)
Asthma

NOVEMBER 2008

Topic
Summarizes how aluminum and lead can affect the brain.

Title
Aluminium and lead: molecular mechanisms of brain toxicity

Conclusion
Although the toxic nature of aluminum and lead are still not thoroughly understood, there are several common mechanisms through which these metals harm brain function. Both metals harm the nervous system by impairing cell signaling, neurotransmission, other essential cell functions, and causing oxidative stress, effects which may be interconnected and combine to produce negative health outcomes.

Author(s)
Sandra V. Verstraeten
Lucila Aimo
Patricia I. Oteiza

Citation
Archives of Toxicology 2008 Jul 31. [Epub ahead of print]

Context
Aluminum and lead have both emerged as health concerns for children. Aluminum exposure can occur through soil contamination and various industrial processes and products; it is also used in some vaccines as an additional ingredient that is supposed to enhance the vaccine’s effectiveness. It has been proposed that aluminum is associated with Alzheimer’s dementia and Parkinson’s disease.

Lead has been established as a major health concern for children. Lead exposure can occur through lead paint, toys, plastics in which lead is used as an additive, and other sources. Lead poisoning can result in decreased IQ, learning disabilities, behavioral problems, and mental retardation. This study highlights the common mechanisms through which both metals can negatively affect the brain.    

Abstract
The fact that aluminium (Al) and lead (Pb) are both toxic metals to living organisms, including human beings, was discovered a long time ago. Even when Al and Pb can reach and accumulate in almost every organ in the human body, the central nervous system is a particular target of the deleterious effects of both metals. Select human population can be at risk of Al neurotoxicity, and Al is proposed to be involved in the etiology of neurodegenerative diseases. Pb is a widespread environmental hazard, and the neurotoxic effects of Pb are a major public health concern. In spite of the numerous efforts and the accumulating evidence in this area of research, the mechanisms of Al and Pb neurotoxicity are still not completely elucidated. This review will particularly address the involvement of oxidative stress, membrane biophysics alterations, deregulation of cell signaling, and the impairment of neurotransmission as key aspects involved Al and Pb neurotoxicity.

Policy implications
Although we do not currently have any clear explanations for the neurotoxicity of aluminum and lead, there are several common denominators in aluminum and lead toxicities. Efforts to understand and prevent lead exposure and poisoning have received many more resources than similar efforts with aluminum. A greater investment is called for to understand aluminum exposure and method of toxicity so that we can have a better understanding of potential harm from aluminum exposure, if prevention efforts are called for, and if so, what are effective prevention efforts.

Web link
Full article available at: http://www.springerlink.com/content/n2577l6701144654/

Keywords
Heavy Metals, Lead, Lead Poisoning, Neurotoxicants, Toxicology

OCTOBER 2008

Topic
How high traffic areas influence air quality and health.

Title
Residential Traffic and Children's Respiratory Health

Conclusion
Living near a high traffic area, such as a major thorough thru like a highway, is associated with increased asthma in children. This study illustrates that pollution from a high traffic area can impact children’s health, even in a region considered to have overall good air quality.

Author(s)
Janice J. Kim
Karen Huen
Sara Adams
Svetlana Smorodinsky
Abby Hoats
Brian Malig
Michael Lipsett
Bart Ostro

Citation
Environmental Health Perspectives 116(9):1274-1279

Context
High traffic areas and the resulting exhaust emitted from cars is a significant source of air pollution. Living, working or going to school near a high traffic area has been associated with several health issues, including premature birth, asthma and cardiovascular diseases. This study looks at the influence nearby traffic areas have on children’s respiratory health in a region with good overall air quality.  

Abstract
Background: Living near traffic has been associated with asthma and other respiratory symptoms. Most studies, however, have been conducted in areas with high background levels of ambient air pollution, making it challenging to isolate an independent effect of traffic. Additionally, most investigations have used surrogates of exposure, and few have measured traffic pollutants directly as part of the study.

Objective: We conducted a cross-sectional study of current asthma and other respiratory symptoms in children (n = 1,080) living at varying distances from high-traffic roads in the San Francisco Bay Area, California, a highly urbanized region characterized by good regional air quality due to coastal breezes.

Methods: We obtained health information and home environmental factors by parental questionnaire. We assessed exposure with several measures of residential proximity to traffic calculated using geographic information systems, including traffic within a given radius and distance to major roads. We also measured traffic-related pollutants (nitrogen oxides and nitrogen dioxide) for a subset of households to determine how well traffic metrics correlated with measured traffic pollutants.

Results: Using multivariate logistic regression analyses, we found associations between current asthma and residential proximity to traffic. For several traffic metrics, children whose residences were in the highest quintile of exposure had approximately twice the adjusted odds of current asthma (i.e., asthma episode in the preceeding 12 months) compared with children whose residences were within the lowest quintile. The highest risks were among those living within 75 m of a freeway/highway. Most traffic metrics correlated moderately well with actual pollutant measurements.

Conclusion: Our findings provide evidence that even in an area with good regional air quality, proximity to traffic is associated with adverse respiratory health effects in children.

Web link
Full article available at: http://www.ehponline.org/members/2008/10735/10735.html

Keywords
Air Pollutants, Outdoor Air Quality

SEPTEMBER 2008

Topic
How lead exposure and genes play a role in lead poisoning.

Title
Variants in Iron Metabolism Genes Predict Higher Blood Lead Levels in Young Children

Conclusion
Genes that influence how the body handles (metabolizes) iron can also influence how the body processes lead. This study shows certain genetic variations affecting iron metabolism are also associated with increased blood lead levels in children, suggesting there is an increased risk of lead poisoning for some individuals.

Author(s)
Marianne R. Hopkins
Adrienne S. Ettinger
Mauricio Hernández-Avila
Joel Schwartz
Martha María Téllez-Rojo
Héctor Lamadrid-Figueroa
David Bellinger
Howard Hu
Robert O. Wright

Citation
Environmental Health Perspectives 116(9):1261-1266

Context
Elevated lead levels in children is an issue of concern because it can cause decreased IQ, learning disabilities, delayed development, and seizures, among other health ailments. Sources of lead in the environment have decreased with the removal of lead-based paint and leaded gasoline from many markets. However, children are still exposed to lead through a variety of sources, including dust and chips from lead-based paint in older homes and other buildings, lead water pipes, and toys. This study explores how genetics combine with environmental exposures to influence lead levels in the body.

Abstract
Background: Given the association between iron deficiency and lead absorption, we hypothesized that variants in iron metabolism genes would predict higher blood lead levels in young children.

Objective: We examined the association between common missense [[genetic]] variants in the hemochromatosis (HFE) and transferrin (TF) genes and blood lead levels in 422 Mexican children.

Methods: Archived umbilical cord blood samples were genotyped for HFE (H63D and C282Y) and TF (P570S) variants. Blood lead was measured at 24, 30, 36, 42, and 48 months of age. A total of 341 subjects had at least one follow-up blood lead level available and data available on covariates of interest for inclusion in the longitudinal analyses. We used random-effects models to examine the associations between genotype (HFE, TF, and combined HFE + TF) and repeated measures of blood lead, adjusting for maternal blood lead at delivery and child's concurrent anemia status.

Results: Of 422 children genotyped, 17.7, 3.3, and 18.9% carried the HFEH63D, HFEC282Y, and TFP570S [[genetic]] variants, respectively. One percent of children carried both the HFE C282Y and TF P570S variants, and 3% of children carried both the HFE H63D and TF P570S variants. On average, carriers of either the HFE (β = 0.11, p = 0.04) or TF (β = 0.10, p = 0.08) variant had blood lead levels that were 11% and 10% higher, respectively, than wild-type subjects. In models examining the dose effect, subjects carrying both variants (β = 0.41, p = 0.006) had blood lead 50% higher than wild-type subjects and a significantly higher odds of having a blood lead level > 10 µg/dL (odds ratio = 18.3; 95% confidence interval, 1.9–177.1).

Conclusions: Iron metabolism gene variants modify lead metabolism such that HFE variants are associated with increased blood lead levels in young children. The joint presence of variant alleles in the HFE and TF genes showed the greatest effect, suggesting a gene-by-gene-by-environment interaction.

Web link
Full article available at: http://www.ehponline.org/members/2008/11233/11233.html   
Further discussion of this article is available at: http://www.ehponline.org/docs/2008/116-9/ss.html#meta

Keywords
Lead, Lead Poisoning

AUGUST 2008

Topic
How cell phones may impact the behavior of young children.

Title
Prenatal and Postnatal Exposure to Cell Phone Use and Behavioral Problems in Children

Conclusion
Cell phone exposure, especially prenatal exposure, is associated with behavioral problems in school-aged children. The associated behavioral difficulties include emotional, conduct, hyperactivity and peer problems. These associations highlight the potential affects radiofrequency fields may have on public health.

Author(s)
Hozefa A. Divan
Leeka Kheifets
Carsten Obel
Jorn Olsen

Citation
Epidemiology 19(4):523-529

Context
Cell phone technology and use has quickly become widespread. However, despite the commonplace use of cell phones, little is known about the impacts this technology may have on those that are the most vulnerable, children. This study illustrates the need for precaution and further research on radiofrequency fields emitted by cell phones and similar devices.

Abstract
Background: The World Health Organization has emphasized the need for research into the possible effects of radiofrequency fields in children. We examined the association between prenatal and postnatal exposure to cell phones and behavioral problems in young children.

Methods: Mothers were recruited to the Danish National Birth Cohort early in pregnancy. When the children of those pregnancies reached 7 years of age in 2005 and 2006, mothers were asked to complete a questionnaire regarding the current health and behavioral status of children, as well as past exposure to cell phone use. Mothers evaluated the child’s behavior problems using the Strength and Difficulties Questionnaire.

Results: Mothers of 13,159 children completed the follow-up questionnaire reporting their use of cell phones during pregnancy as well as current cell phone use by the child. Greater odds ratios for behavioral problems were observed for children who had possible prenatal or postnatal exposure to cell phone use. After adjustment for potential confounders, the odds ratio for a higher overall behavioral problems score was 1.80 (95% confidence interval = 1.45–2.23) in children with both prenatal and postnatal exposure to cell phones.

Conclusions: Exposure to cell phones prenatally - and, to a lesser degree, postnatally - was associated with behavioral difficulties such as emotional and hyperactivity problems around the age of school entry. These associations may be noncausal and may be due to unmeasured confounding. If real, they would be of public health concern given the widespread use of this technology.

Policy implications
This preliminary research raises the question of what government policies are or should be in place to assure that children are appropriately and adequately protected from unknown or unstudied hazards of new technologies.

Web link
Abstract available at: http://www.epidem.com/pt/re/epidemiology/abstract.00001648-200807000-00001.htm

Keywords
Electric and Magnetic Fields (EMFs), Prenatal Exposures

JULY 2008

Topic
How common household materials can affect indoor air quality and children’s health.

Title
Indoor Residential Chemical Emissions as Risk Factors for Respiratory and Allergic Effects in Children: A Review

Conclusion
Evidence shows many residential materials, such as particleboard and plastics, may be decreasing indoor air quality and impacting respiratory health and allergies in children. These common but less recognized risk factors need to be further researched and addressed to aid in the implementation of preventive actions.

Author(s)
M.J. Mendell

Citation
Indoor Air 17:259-277

Context
Many infants and children spend the majority of their time indoors. It has been documented that it is not unusual for indoor air to be of poorer quality than outdoor air. Poor air quality and chemical exposures can impact children’s health by causing and/or triggering asthma, respiratory illnesses and allergies. While some sources of poor indoor air quality, such as mold, have been well studied, other elements of our built environment have been given less attention. This study calls for a wider consideration of indoor air quality risk factors and identifies a need for further research.

Abstract
Most research into effects of residential exposures on respiratory health has focused on allergens, moisture/mold, endotoxin, or combustion products. A growing body of research from outside the US; however, has associated chemical emissions from common indoor materials with risk of asthma, allergies, and pulmonary infections. This review summarizes 21 studies in the epidemiologic literature on associations between indoor residential chemical emissions, or emission-related materials or activities, and respiratory health or allergy in infants or children. Associations, some strong, were reported between many risk factors and respiratory or allergic effects. Risk factors identified most frequently included formaldehyde or particleboard, phthalates or plastic materials, and recent painting. Findings for other risk factors, such as aromatic and aliphatic chemical compounds [[e.g. chemicals found in adhesives, PVC flooring and carpeting]], were limited but suggestive. Elevated risks were also reported for renovation and cleaning activities, new furniture, and carpets or textile wallpaper. Reviewed studies were entirely observational, limited in size, and variable in quality, and specific risk factors identified may only be indicators for correlated, truly causal exposures. Nevertheless, overall evidence suggests a new class of residential risk factors for adverse respiratory effects, ubiquitous in modern residences, and distinct from those currently recognized. It is important to confirm and quantify any risks, to motivate and guide necessary preventive actions.

Practical Implications: Composite wood materials that emit formaldehyde, flexible plastics that emit plasticizers, and new paint have all been associated with increased risks of respiratory and allergic health effects in children. Although causal links have not been documented, and other correlated indoor-related exposures may ultimately be implicated, these findings nevertheless point to a new class of little recognized indoor risk factors for allergic and respiratory disease, distinct from the current set of indoor risk factors. The available evidence thus raises initial questions about many common residential practices: for instance, using pressed wood furnishings in children's bedrooms, repainting infant nurseries, and encasing mattresses and pillows with vinyl for asthmatic children. The findings summarized here suggest a need for substantially increased research to replicate these findings, identify causal factors, and validate preventive strategies.

Policy implications
This review article reinforces the need for a legal framework, standards and enforcement mechanism for indoor air/environmental quality and for commercial/consumer/ construction products commonly used in indoor environments. Parents and other caregivers do not know what constitutes healthy indoor air, nor do they have a right to know in advance of hazards at school or child care, nor do they have recourse or interventions to protecting their children when they suspect or have proof that poor indoor air quality is harming their child.

Federal standards exist for many outdoor air pollutants. But no indoor air/environmental quality standard exists for children at home, at school/child care, or in other indoor environments. Addressing indoor air quality is challenging. The U.S. Environmental Protection Agency has an active and successful indoor environments program, focused on voluntary efforts and market-based approaches. Congress needs to give the agency the legislative authority to set standards and enforce them, as well as promote better product stewardship and more disclosure about products used indoors.

Web link
Full article available courtesy of the publisher at: http://www3.interscience.wiley.com/cgi-bin/fulltext/118513148/HTMLSTART 

Keywords
Air Pollutants, Asthma, Indoor Air Quality, Respiratory Diseases

JUNE 2008

Topic
How air quality during pregnancy can influence the health of children.

Title
Prenatal Exposure to Wood Fuel Smoke and Low Birth Weight

Conclusion
Cooking with wood fuel during pregnancy, a potentially modifiable exposure, was associated with low birth weight and marginally lower mean birth weight compared with using natural gas as a fuel.

Author(s)
Amna R. Siddiqui
Ellen B. Gold
Xiaowei Yang
Kiyoung Lee
Kenneth H. Brown
Zulfiqar A. Bhutta

Citation
Environmental Health Perspectives 116(4):543-549

Context
A child’s first environment, the womb, is influenced by the mother’s surroundings. One factor during pregnancy that can impact a baby’s health is air quality. One cause of poor air quality, tobacco smoke, has been a leading cause of low birth weight for infants. Low birth weight is tied to a range of ailments impacting a child’s development, including high mortality rates, impaired growth and chronic disease. There are many potential sources of poor air quality beyond tobacco smoke. Wood is used as a primary fuel source in many parts of the world, often for cooking, releasing wood smoke into the surrounding environment. This study further strengthens evidence that an expectant mother’s exposure to wood smoke is associated with low birth weight.

Abstract
Background: Maternal exposure to wood fuel smoke may lead to impaired fetal growth due to hypoxia and or oxidative stress from smoke constituents such as carbon monoxide and particulate matter.

Objectives: We studied the risk of low birth weight (LBW) and reduced mean birth weight in relation to reported use of wood for cooking during the prenatal period, compared with natural gas (NG).

Methods: We studied a historical cohort of women who had a singleton live birth in the years 2000–2002, from a semirural area of Pakistan. Infant's birth weight was obtained from records, and prenatal records had data for maternal body mass index and parity [[the number of times a woman has given birth]]. Cooking habits, daytime sleep habits, and type of fuel used during the pregnancies in 2000–2002 were ascertained by a survey done in 2004–2005. We performed multiple linear and logistic regression modeling using propensity scores to adjust for confounding variables.

Results: Unadjusted mean (± SD) birth weight was 2.78 ± 0.45 kg [[kilograms]] in wood users, and 2.84 ± 0.43 kg (p < 0.06) in NG users. Infants born to wood users averaged 82 g [[grams]] lighter than infants born to NG users when weight was adjusted for confounders (p < 0.07). The rate of LBW (< 2,500 g) was 22.7% among wood users compared with 15.0% in NG users (p < 0.01), for an adjusted relative risk of 1.64 (95% confidence interval, 1.10–2.34). The population attributable risk for LBW explained by wood use was estimated to be 24%.

Conclusion: Cooking with wood fuel during pregnancy, a potentially modifiable exposure, was associated with LBW and marginally lower mean birth weight compared with using NG.

Web link
Full article available at http://www.ehponline.org/members/2008/10782/10782.html 

Keywords
Air Pollutants, Low Birth Weight, Prenatal Exposures

MAY 2008

Topic
How diet can impact the amount of pesticides children take into their bodies.

Title
Dietary Intake and Its Contribution to Longitudinal Organophosphorus Pesticide Exposure in Urban/Suburban Children

Author(s)
Chensheng Lu
Dana B. Barr
Melanie A. Pearson
Lance A. Waller

Citation
Environmental Health Perspectives 116(4):537-542

Context
Modern agriculture often relies on pesticides to control unwanted insects, competing plants, and other organisms that can reduce the yield of a crop. The use of pesticides on crops leaves pesticide residues on food, which children and adults take into their bodies when they eat. However, organic crops are grown using little or no chemicals. This study shows that children’s exposure to a particular class of pesticides, organophosphates, can be greatly reduced by changing their diet to organic fruits and vegetables.

Abstract
Background: The widespread use of organophosphorus (OP) pesticides has led to frequent exposure in adults and children. Because such exposure may cause adverse health effects, particularly in children, the sources and patterns of exposure need to be studied further.

Objectives: We assessed young urban/suburban children's longitudinal exposure to OP pesticides in the Children's Pesticide Exposure Study (CPES) conducted in the greater Seattle, Washington, area, and used a novel study design that allowed us to determine the contribution of dietary intake to the overall OP pesticide exposure.

Methods: Twenty-three children 3–11 years of age who consumed only conventional diets were recruited for this 1-year study conducted in 2003–2004. Children switched to organic diets for 5 consecutive days in the summer and fall sampling seasons. We measured specific urinary metabolites for malathion, chlorpyrifos, and other OP pesticides in urine samples collected twice daily for a period of 7, 12, or 15 consecutive days during each of the four seasons.

Results: By substituting organic fresh fruits and vegetables for corresponding conventional food items, the median urinary metabolite concentrations were reduced to nondetected or close to nondetected levels for malathion and chlorpyrifos at the end of the 5-day organic diet intervention period in both summer and fall seasons. We also observed a seasonal effect on the OP urinary metabolite concentrations, and this seasonality corresponds to the consumption of fresh produce throughout the year.

Conclusions: The findings from this study demonstrate that dietary intake of OP pesticides represents the major source of exposure in young children.

Policy implications
This study reinforces the need for child-focused pesticide regulatory policies.  It illustrates that caregivers with the resources, interest and ability to provide organic foods for their children can measurably decrease their child's exposure to potentially harmful pesticides.  But all children deserve this additional measure of protection.  Our pesticide regulations are capable of doing so (such as by further lowering acceptable pesticide residue levels on foods, eliminating neurotoxic pesticides from food use, etc.).  Specifically, the article underscores the importance of maintaining and expanding the Food Quality Protection Act  -- legislation adopted in 1996 which began the process of assuring that children and other vulnerable populations are adequately considered and protected in pesticide regulation.

The study also raises the question of exposures through foods provided in institutional settings (schools, hospitals, etc.) and through programs such as the Federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

An additional question raised by this study's authors is that the level of children's exposure to pesticides in their diet may be associated with the foods country of origin  -- are imported foods adequately checked to assure that they meet U.S. standards?

Web link
Full article available at http://www.ehponline.org/members/2008/10912/10912.html  

Keywords
Food Safety & Nutrition, Pesticides

APRIL 2008

Topic
The link between infant lead exposure and the development of Alzheimer’s disease later in life.

Title
Alzheimer’s Disease (AD)-Like Pathology in Aged Monkeys after Infantile Exposure to Environmental Metal Lead (Pb): Evidence for a Developmental Origin and Environmental Link for AD

Author(s)
Jinfang Wu
Md. Riyaz Basha
Brian Brock
David P. Cox
Fernando Cardozo-Pelaez
Christopher A. McPherson
Jean Harry
Deborah C. Rice
Bryan Maloney
Demao Chen
Debomoy K. Lahiri
Nasser H. Zawia

Citation
Journal of Neuroscience 28(1):3-9

Context
Alzheimer’s disease commonly occurs in older adults causing deterioration of the brain leading to dementia and death. Building on evidence that exposure to particular substances early in life can influence the adult onset of disease, the authors explore the long-term impacts of lead exposure in infants in relation to Alzheimer’s disease. Using animal models to follow subjects from exposure through maturity, the researchers find early lead exposure increases the expression of Alzheimer’s disease-related genes later in life, illustrating the role environmental and genetic factors may both play together in the disease.

Abstract
The sporadic nature of Alzheimer's disease (AD) argues for an environmental link that may drive AD pathogenesis; however, the triggering factors and the period of their action are unknown. Recent studies in rodents have shown that exposure to lead (Pb) during brain development predetermined the expression and regulation of the amyloid precursor protein (APP) and its amyloidogenic β-amyloid (Aβ) product in old age. Here, we report that the expression of AD-related genes [APP, BACE1 (β-site APP cleaving enzyme 1)] as well as their transcriptional regulator (Sp1) were elevated in aged (23-year-old) monkeys exposed to Pb as infants. Furthermore, developmental exposure to Pb altered the levels, characteristics, and intracellular distribution of Aβ staining and amyloid plaques in the frontal association cortex. These latent effects were accompanied by a decrease in DNA methyltransferase activity and higher levels of oxidative damage to DNA, indicating that epigenetic imprinting in early life influenced the expression of AD-related genes and promoted DNA damage and pathogenesis. These data suggest that AD pathogenesis is influenced by early life exposures and argue for both an environmental trigger and a developmental origin of AD.

Web link
Full article available courtesy of the Journal of Neuroscience at http://www.jneurosci.org/cgi/content/full/28/1/3

Keywords
Disease Susceptibility, Lead

MARCH 2008

Topic
New environmental health approaches focusing on how substances in the environment, such as pollutants, can interact with genes to influence health and disease.

Title
Environmental Exposures and Gene Regulation in Disease Etiology

Author(s)
Thea M. Edwards
John Peterson Myers

Citation
Environmental Health Perspectives 115(9): 1264-1270

Context
Environmental factors, especially contaminants, have been increasingly shown to influence human health. Endocrine (hormone) disruption is an example of how chemicals in the environment can affect the body, influencing development, growth, maturation, and reproduction by mimicking hormones or interacting with hormone receptors. The ability of environmental factors to alter gene expression and regulation is explored in this article.

Abstract
Objective: Health or disease is shaped for all individuals by interactions between their genes and environment. Exactly how the environment changes gene expression and how this can lead to disease are being explored in a fruitful new approach to environmental health research, representative studies of which are reviewed here.

Data sources: We searched Web of Science and references of relevant publications to understand the diversity of gene regulatory mechanisms affected by environmental exposures with disease implications.

Data synthesis: Pharmaceuticals, pesticides, air pollutants, industrial chemicals, heavy metals, hormones, nutrition, and behavior can change gene expression through a broad array of gene regulatory mechanisms. Mechanisms include regulation of gene translocation, histone modifications, DNA methylation, DNA repair, transcription, RNA stability, alternative RNA splicing, protein degradation, gene copy number, and transposon activation. Furthermore, chemically induced changes in gene regulation are associated with serious and complex human diseases, including cancer, diabetes and obesity, infertility, respiratory diseases, allergies, and neurodegenerative disorders such as Parkinson and Alzheimer diseases. One of the best-studied areas of gene regulation is epigenetics, especially DNA methylation. Our examples of environmentally induced changes in DNA methylation are presented in the context of early development, when methylation patterns are initially laid down. This approach highlights the potential role for altered DNA methylation in fetal origins of adult disease and inheritance of acquired genetic change.

Conclusions: The reviewed studies indicate that genetic predisposition for disease is best predicted in the context of environmental exposures. Second, the genetic mechanisms investigated in these studies offer new avenues for risk assessment research. Finally, we are likely to witness dramatic improvements in human health, and reductions in medical costs, if environmental pollution is decreased.

Web link
Full article available at http://www.ehponline.org/members/2007/9951/9951.html

Keywords
Chemicals, Disease Susceptibility, Fetal origins of disease

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