2009 Articles of the Month - Children's Environmental Health Network

2009 Articles of the Month

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/Advertorial... [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

http://www.ehponline.org/docs/2009/0901015/abstract.html

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)
L ead 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