Maryann Suero, Ph.D. Jacqueline Wuellner, RN, MPH April 6, 2002

1. Healthy Schools, Healthy You Conference Maryann Suero, Ph.D.Jacqueline Wuellner, RN, MPHApril 6, 2002 Spotlight on Children’s Environmental Health

2. Objective: • Identify how and why children are more susceptible to some environmental exposures than adults • Discuss some of the leading childhood illnesses that have strong environmental components • Provide resources for participants

3. What does “environment”mean?

4. Sunshine Fresh Air Water Environmental Exposures

5. Environmental Exposures • Air pollutants • Pesticides • Lead • Arsenic • Mercury • Asbestos • Radon

6. Routes of exposures Inhalation Ingestion Absorption through the skin

7. Windows of Vulnerability throughout development Children Are Not Little Adults Physically different, many organ systems are not fully developed Behaviorally they are different Different adverse health effects in Children vs Adults

8. Children Are Not Little Adults They are physically different, many organ systems are not fully developed

9. Pound for pound, kids • breathe more air than adults • drink more water than adults • eat more food than adults • have increased surface area to body mass ratiorelative to adults

10. Pop quiz:The average baby drinks 5 ounces of fluid per kilogram of body weight per day.How much pop would an average man have to drink using the above formula????

11. Answer: 30 twelve ounce drinks/day is the amount of liquid an adult must drink to equal proportionately what an infant drinks every day. Adult Infant

12. They behave differently than adults Children Are Not Little Adults

13. Difference in Behavior • Explore the world through their senses Touch & Taste • More time outdoors

14. Differences in Behaviors Diet and eating habits differ • Newborns - breast milk or formula • Infants / Toddlers – “Fussy Eaters” abound “Grazing” is common • School aged children

15. Average child eats 6.9 times more apples than an adult, not accounting for child’s smaller size. Adults Non-nursing Infants

16. Major Problems in CEH • Lead poisoning • Asthma • School environments “Emerging” Issues

17. Childhood Lead Poisoning • While average childhood blood lead concentrations have declined • Still large numbers of lead poisoned children, mostly in large urban areas • Screening rates very low (perception that problem has gone away) • Mostly caused by exposure to lead paint dust • Disparities by race and income

18. Lead Poisoning in the US

19. Children with EBL (> 20ug/dl) in Selected Cities (1998)

20. Toward Solving the Lead Poisoning Problem • Raise the level of awareness • More screening of children at risk • Coordination of efforts (Federal, State, Local, Community Partners) • Housing • Family Services / Nutrition • Environment • Education • Health

21. Asthma in the US

22. Components of Asthma Management I. Medical Management Diagnosis Trigger Identification Treatment Education

23. Allergic Dust mites Molds Pollen Animal dander Pests Non-Allergic Tobacco smoke Pesticides Wood or coal smoke Ozone Particulate matter Common Asthma Triggers

24. Components of Asthma Management II. Environmental Management Trigger Identification Education Avoidance/remediation Education

25. Toward Solving the Asthma Epidemic • More and better quality data needed • No one organization has all the resources, technology or authority to solve the problem • Requires coordination of efforts (Federal, State, Local, Community Partners) • Health • Housing • Family Services • Environment • Education • Agriculture

26. School Environmental Health • One of every 5 (includes children and adults) in US spends their days in schools • GAO reports more than half of all schools report at least one environmental condition is unsatisfactory, especially poor IAQ

27. School Environmental Health • Lack funds for remediation • High population density in schools • Schools may have many hazardous chemicals

28. Potential Environmental Hazards in Schools • Poor indoor air quality • Exposure to • Asbestos • Mercury • Pesticides • Other hazardous chemicals • Schools often don’t recognize the problems

29. TOXICITY When it comes to fetuses, infants, children, adolescents, we know VERY LITTLE

30. Cumulative Exposure: We’re Still Trying! • Consider one chemical with different routes of exposure • Consider multiple chemicals with same mechanism of toxicity through one exposure pathway • Consider multiple chemicals with same mechanism of toxicity through multiple routes of exposure • Consider multiple health endpoints simultaneously

31. Region 5 Center for Children’s Environmental Health1-800-672-3113 • Co-funded by EPA and ATSDR • Serves as a Regional resource to: • evaluate, treat and prevent environmental illness in children • train pediatricians and others in environmental health issues • promote children’s environmental health in communities • expand knowledge of children’s environmental health through research

32. EPA Resources on CEH • www.epa.gov/children • Tips to Protect Children from Environmental Threats (www.epa.gov/children/whatwe/tips.htm) • Engage Youth in Children's Environmental Health Protection (www.epa.gov/children/whatwe/engage.pdf)

33. Resources for Schools • Indoor Air Quality Tools for Schoolswww.epa.gov/iaq/schools • Integrated Pest Managementwww.epa.gov/pesticides/ipm • Mercury www.mercury-k12.org/ • Environmental Management Systems approach to school environmental health • Regional Resources for Schools (copies available)

34. Where Do We Go From Here? • We have much to learn (we don’t even know what we don’t know yet) • We have to be creative, innovative, flexible(single media, single discipline approaches are not likely to work) • We have to be proactive and cautious(we don’t want quick fixes to create more problems down the road)

35. Children Are Different • Exposures • Doses • Susceptibility • Latency

36. Resource for families, teachers, and communities Maryann Suero Regional Team Manager, Children’s Health US Environmental Protection Agency Region 5 77 W. Jackson Blvd, T-13J Chicago, IL 60604 (312) 886-9077 suero.maryann@epa.gov

37. Resource for families and health care providers Jackee Wuellner, RN Coordinator Great Lakes Center for Children’s Environmental Health 1900 West Polk Street Chicago, IL 60612 312-633-5310 jwuell1@uic.edu

38. A Healthy Environment Means Healthier Kids