Children's Health Protection
Papers, Reports, and Studies
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- Workshop Connecting Social and Environmental Factors to Measure and
Track Environmental Health Disparities. In May 2005, OCHP co-sponsored a
technical workshop "Connecting Social and Environmental Factors to Measure and
Track Environmental Health Disparities" in collaboration with EPA's National
Health and Environmental Effects Research Laboratory, EPA's Office of
Environmental Justice, University of Michigan School of Public Health's
Department of Health Behavior and Health Education, and the University of
Michigan Center for Research on Ethnicity, Culture and Health. The workshop was
held in Ann Arbor, Michigan.
The purpose of this workshop was to develop a scientific foundation to explore the conceptual issues, data needs, and policy applications with regard to the social and environmental factors used to measure and track racial, ethnic, and class disparities in environmental health. The workshop convened a diverse group of environmental health scientists, epidemiologists, social scientists, and public health practitioners to initiate inter-disciplinary theoretical and methodological thinking on the question of environmental health disparities. Next steps will be to apply concepts discussed at the workshop to evaluate social disparities in children's environmental health.
All of the papers from the workshop were published in the October 2006 issue of the international journal, Environmental Research:
- Rachel Morello-Frosch and Russ Lopez (2006). The Riskscape and the Color Line: Examining the Role of Segregation in Environmental Health Disparities. (PDF) (52 pp, 599K)
- G.C. Gee and Devon Payne-Sturges (2006). National Environmental Health Measures for Minority and Low-Income Populations: Tracking Social Disparities in Environmental Health. (PDF) (18 pp, 308K)
- M. Soobader, C. Cubbin, G.C. Gee, A. Rosenbaum, and J. Laurenson (2006). Levels of Analysis for the Study of Environmental Health Disparities. (PDF) (9 pp, 201K)
- Devon Payne-Sturges, G.C. Gee, Kirstin Crowder, Bradford J. Hurley, Charles Lee, Rachel Morello-Frosch, Arlene Rosenbaum, Amy Schulz, Charles Wells, Tracey Woodruff, Hal Zenick (2006). Workshop Summary: Connecting Social and Environmental Factors to Measure and Track Environmental Health Disparities. (PDF) (8 pp, 249K)
- Devon Payne-Sturges, William Sanders, Charles Wells, Hal Zenick (2006). We Cannot Do It Alone: Building a Multi-Systems Approach for Assessing and Eliminating Environmental Health Disparities. (PDF) (5 pp, 121K)
- The Comparative Immunotoxicity of Five Selected Compounds following Developmental or Adult Exposure, Journal of Toxicology and Environmental Health, Part B, 9:1-26. Robert W. Luebke, David H. Chen, Rodney Dietert, Yung Yang, Marquea King, and Michael I. Luster. It is well established that human diseases associated with abnormal immune function, including some common infectious diseases and asthma, are considerably more prevalent at younger ages. Although not established absolutely, it is generally believed that development constitutes a period of increased immune system susceptibility to xenobiotics, since adverse effects may occur at lower doses and/or immunomodulation may be more persistent, thus increasing the relative risk of xenobiotic exposure to the immunologically immature organism. To address this issue, a brief overview of immune maturation in humans is provided to demonstrate that functional immaturity alone predisposes the young to infection. Age-dependent differences in the immunotoxic effects of five diverse compounds, diethylstilbestrol (DES), diazepam (DZP), lead (Pb), 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and tributyltin oxide (TBTO), which have undergone adult and developmental immunotoxicity testing in rodents, are then reviewed, as are human data when available. For all five chemicals, the developing immune system was found to be at greater risk than that of the adult, either because lower doses produced immunotoxicity, adverse effects were more persistent, or both. The full article is available for a charge.
- Collection and Use of Exposure Data from Human Milk Biomonitoring in the United States, Journal of Toxicology and Environmental Health, vol. 68, no. 20. Suzanne Fenton, Marian Condon, Adrienne Ettinger, Judy LaKind, Ann Mason, Melissa McDiarmid, Zhengmin Qian, Sherry Selevan. Human milk is a unique biological matrix that can be used to estimate exposures in both the mother and the breastfed infant. In addition, the presence of environmental chemicals in human milk may act as a sentinel for exposures to a broader population. Several factors play a role in determining the quantity of chemicals transferred to milk and, subsequently, to the breastfeeding infant, including maternal, infant, and chemical characteristics. Exposure to certain environmental chemicals during critical periods can disrupt normal infant development, yet few data exist to quantify the hazards posed by environmental chemicals in human milk. Chemicals measured in human milk may also provide insights to agents suspect in altering breast development and breast-related disease risk. Carefully designed exposure assessment and toxicokinetic studies are needed to elucidate mechanisms and establish relationships between human milk and other biologic matrices. Data from human milk biomonitoring studies can be used to inform and validate models that integrate information about chemical properties, human metabolism, and biomarker concentrations. Additional research is needed to determine the degree to which environmental chemicals enter, are present in, and are excreted from human milk, their impact on the host (mother), and the extent of their bioavailability to breastfeeding infants. This article describes how the collection and use of exposure data from human milk biomonitoring in the United States can be designed to inform future research and policy. The full article is available for a charge.
- Human Milk Biomonitoring Data: Interpretation and Risk Assessment Issues, Journal of Toxicology and Environmental Health, vol. 68, no. 20. Judy LaKind, Robert Brent, Michael Dourson, Sam Kacew, Gideon Koren, Babasaheb Sonawane, Anita Tarzian, Kathleen Uhl. Biomonitoring data can, under certain conditions, be used to describe potential risks to human health (for example, blood lead levels used to determine children’s neurodevelopmental risk). At present, there are very few chemical exposures at low levels for which sufficient data exist to state with confidence the link between levels of environmental chemicals in a person’s body and his or her risk of adverse health effects. Human milk biomonitoring presents additional complications. Human milk can be used to obtain information on both the levels of environmental chemicals in the mother and her infant’s exposure to an environmental chemical. However, in terms of the health of the mother, there are little to no extant data that can be used to link levels of most environmental chemicals in human milk to a particular health outcome in the mother. This is because, traditionally, risks are estimated based on dose, rather than on levels of environmental chemicals in the body, and the relationship between dose and human tissue levels is complex. On the other hand, for the infant, some information on dose is available because the infant is exposed to environmental chemicals in milk as a “dose” from which risk estimates can be derived. However, the traditional risk assessment approach is not designed to consider the benefits to the infant associated with breastfeeding and is complicated by the relatively short-term exposures to the infant from breastfeeding. A further complexity derives from the addition of in utero exposures, which complicates interpretation of epidemiological research on health outcomes of breastfeeding infants. Thus, the concept of “risk assessment” as it applies to human milk biomonitoring is not straightforward, and methodologies for undertaking this type of assessment have not yet been fully developed. This article describes the deliberations of the panel convened for the Technical Workshop on Human Milk Surveillance and Biomonitoring for Environmental Chemicals in the United States, held at the Hershey Medical Center, Pennsylvania State College of Medicine, on several issues related to risk assessment and human milk biomonitoring. Discussion of these topics and the thoughts and conclusions of the panel are described in this article. The full article is available for a charge.
- Human Milk Research for Answering Questions about Human Health, Journal of Toxicology and Environmental Health, vol. 68, no. 20. Richard Wang, Michael Bates, Daniel Goldstein, Suzanne Haynes, Karen Hench, Ruth Lawrence, Ian Paul, Zhengmin Qian. Concerns regarding human milk in our society are diverse, ranging from the presence of environmental chemicals to the health of breastfed infants and the economic value of breastfeeding to society. The panel convened for the Technical Workshop on Human Milk Surveillance and Biomonitoring for Environmental Chemicals in the United States, held at the Hershey Medical Center, Pennsylvania State College of Medicine, on 24–26 September 2004, considered how human milk research may contribute to environmental health initiatives to benefit society. The panel concluded that infant, maternal, and community health can benefit from studies using human milk biomonitoring. Unlike other biological specimens, human milk provides information regarding exposure of the mother and breastfed infant to environmental chemicals. Some of the health topics relevant to this field of research include disorders of growth and development in infants, cancer origins in women, and characterization of the trend of exposure to environmental chemicals in the community. The research focus will determine the design of the study and the need for the collection of alternative biological specimens and the long-term storage of these specimens. In order to strengthen the ability to interpret study results, it is important to identify reference ranges for the chemicals measured and to control for populations with high environmental chemical exposure, because the amount of data on environmental chemical levels in human milk that is available for comparison is extremely limited. In addition, it will be necessary to validate models used to assess infant exposure from breastfeeding because of the variable nature of current models. Information on differences between individual and population risk estimates for toxicity needs to be effectively communicated to the participant. Human milk research designed to answer questions regarding health will require additional resources to meet these objectives. The full article is available for a charge.
- Methodologic Considerations for Improving and Facilitating Human Milk Research, Journal of Toxicology and Environmental Health, vol. 68, no. 20. Cheston Berlin, Betty Crase, Peter Fürst, Judy LaKind, Gerry Moy, Larry Needham, Linda Pugh, Mary Rose Tully. Over the past several decades, interest in using human milk as a biomonitoring matrix has increased. However, it is not always an easy matter for a new mother to provide a milk sample. In this article, guidance on facilitating collection of human milk is provided. This includes addressing the mother’s ease in expressing a milk sample, and engaging with many audiences to reduce the likelihood of negatively impacting the already low breastfeeding rates in the United States. In addition, this article covers concepts regarding long-term storage and integrity of human milk samples to maximize the utility of those samples, and proposed methods for improving public access to the full spectrum of human milk biomonitoring data, with context to understand the information presented. The environmental chemicals and chemical classes for which robust analytical methods exist are enumerated, and a process for prioritizing the development of analytical methods for additional environmental chemicals is described. The full article is available for a charge.
- Integrated Assessment of Environment and Health: America’s
the Environment. - In Press. AD Kyle, TJ Woodruff, and
The significance of the environment for health is increasingly
There is a need for systematic approaches to assessment of
factors most relevant to health, health outcomes most influenced by
environment, and the relationships between them, as well as for
representing the results of such assessments in policy deliberations.
As a step
in the development of such methods, we used findings and data from
environmental protection and public health sectors to develop a set
representing topics relevant to children’s environmental health. We
definition of the environment that emphasized contaminants and a
involved both analytic and deliberative elements. The steps in this
were to: (1) develop a conceptual framework to depict relationships
environment and health with relevant types of data and information;
topic areas of significance for children; (3) identify best available
sources and devise measures; (4) assess possible surrogate data
measures when needed; (5) design and implement metrics for
measures using specified data elements; (6) select graphical
measures; (7) identify related measures; and (8) identify data
Representatives of policy and stakeholder audiences participated in this process. The measures are presented in three groups, reflecting contaminants in the environment, contaminants in human tissues, and diseases and disorders. They present scientifically based representations of data understandable to stakeholders and policy makers that integrate key information from the health and environment sectors in a consistent format. View the full paper.
- Review and Analysis of Inhalation Dosimetry Methods for Application to Children’s Risk Assessment, Journal of Toxicology and Environmental Health. Gary L. Ginsberg, Brenda Perkovich Foos, and Michael P. Firestone. Young children have a greater ventilation rate per body weight or pulmonary surface area as compared to adults. The implications of this difference for inhalation dosimetry and children’s risk assessment were evaluated in runs of the USEPA, 1994 Reference Concentration (RfC) methodology and the ICRP, 1994 inhalation dosimetry model. Dosimetry estimates were made for 3 month old children and adults for particles and Category 1 and 2 reactive gases in the following respiratory tract regions: extrathoracic (ET), tracheobronchial (BB), bronchioles (bb) and pulmonary (PU). Systemic dosimetry estimates were made for non-reactive (Category 3) gases. Results suggest similar ET dosimetry for children and adults for all types of inhaled materials. BB dosimetry was also similar across age groups except that the dosimetry of ultra-fine particles in this region was two fold greater in 3 month old children than adults. In contrast, the bb region generally showed higher dosimetry of particles and gases in adults than children. Particle dose in the PU region was 2-4 fold higher in 3 month old children, with the greatest child/adult difference occurring for submicron size particles. Particulate dosimetry estimates with the default RfC methodology were below those found with the ICRP model for both adults and children for sub-micron sized particles. There were no cases in which reactive gas dosimetry was substantially greater in the respiratory regions of 3 month old children than in adults, especially for liver dose of metabolite for rapidly metabolized gases. These analyses support the approach of assuming 2 fold greater inhalation dose in children than adults, although there are cases in which this differential can be greater and others where it can be less. The full article is available for a charge .
- Trends in Environmentally Related Childhood Illnesses, PEDIATRICS, vol. 113 no. 4, April 2004. Tracey Woodruff, Daniel Axelrad, Amy Kyle, Onyemaechi Nweke, Gregory Miller, Bradford Hurley. Tracking incidence or prevalence of diseases and using that information to target interventions is a well-established strategy for improving public health. The need to track environmentally mediated chronic diseases is increasingly recognized. Trends in childhood illnesses are 1 element of a framework for children’s environmental health indicators, which also includes trends in contaminants in the environment and in concentrations of contaminants in bodies of children and their mothers. This article presents data on 3 groups of important childhood diseases or disorders that seem to be caused or exacerbated, at least in part, by exposure to environmental agents and for which nationally representative data are available. They are asthma, childhood cancers, and neurodevelopmental disorders. Data were used from the National Health Interview Survey for asthma and neurodevelopmental disorders; the Surveillance, Epidemiology, and End Results Program for childhood cancer incidence; and the National Vital Statistics System for childhood cancer mortality. The prevalence of children with asthma doubled between 1980 and 1995, from 3.6% in 1980 to 7.5% in 1995. The annual incidence of childhood cancer increased from 1975 until approximately 1990 and seems to have become fairly stable since. Childhood cancer mortality has declined substantially during the past 25 years. Incidence of certain types of cancers has increased since 1974, including acute lymphoblastic leukemia, central nervous system tumors, and non-Hodgkin’ s lymphoma. Approximately 6.7% of children aged 5 to 17 were reported to have attention-deficit/hyperactivity disorder in 1997–2000, and approximately 6 of every 1000 children were reported to have received a diagnosis of mental retardation during the same period.The full article is available online free of charge .
- The Price Premium for Organic Babyfood. April 2004 Journal of Agricultural and Resource Economics. Maguire, Kelly B., Nicole Owens, and Nathalie B. Simon. Abstract: The price premium associated with organic babyfood is estimated by applying a hedonic model to price and characteristic data for babyfood products collected in two cities: Raleigh, North Carolina and San Jose, California. The price per ounce of babyfood is modeled as a function of a number of babyfood and store characteristics. The resulting organic price premium is equal to approximately 3 to 4 cents per ounce. To the extent this premium reflects consumer willingness-to-pay to reduce pesticide exposures, it could be used to infer values for reduced dietary exposures to pesticide residues for young children.
- Children's Environmental Health - An International Perspective, Int J Hyg Environ Health. M.P. Firestone and R.W. Amler. Parents in all countries want and deserve safe and healthy environments for their children. Children in all countries need, as part of normal growth and development, regular and frequent opportunities to interact with their environments as they learn to crawl, run, climb, swim, and explore. Environmental scientists and regulators recognize that environmental hazards are not contained by international borders. This is of special concern for children, because they are intrinsically at greater risk, compared to adults. They have different opportunities for exposure, greater response to certain toxicants, and less empowerment to alter their environments. There is a growing awareness that adverse health effects in children can adversely affect a country's future productivity and well-being. Multiple government agencies, NGOs, and advocates are mobilizing to address these concerns. A sustained concerted effort will be needed to afford equitable and effective environmental health protection to the world's children, present and future. The full article is available for a charge.
- Valuation of Childhood Risk Reduction: The Importance of Age, Risk Preferences, and Perspective, Risk Analysis, vol. 22, no. 2. Dockins C., R.R. Jenkins, N. Owens, N. B. Simon and L. Bembenek Wiggins. This article explores two problems analysts face in determining how to estimate values for children's health and safety risk reductions. The first addresses the question: Do willingness-to-pay estimates for health risk changes differ across children and adults and, if so, how? To answer this question, the article first examines the potential effects of age and risk preferences on willingness to pay. A summary of the literature reporting empirical evidence of differences between willingness to pay for adult health and safety risk reductions and willingness to pay for health and safety risk reductions in children is also provided. The second dimension of the problem is a more fundamental issue: Whose perspective is relevant when valuing children's health effects - society's, children's, adults-as-children, or parents'? Each perspective is considered, followed ultimately by the conclusion that adopting a parental perspective through an intrahousehold allocation model seems closest to meeting the needs of the estimation problem at hand. A policy example in which the choice of perspective affects the outcome of a regulatory benefit-cost analysis rounds out the article and emphasizes the importance of perspective.
- Willingness to Pay for Reduced Accident Risk for Children: Inferences from the Demand for Bicycle Safety Helmets (November 2003, PDF) (14 pp, 405K). Jenkins, Robin R., Nicole Owens, and Lanelle Bembenek Wiggins. Paper presented at the Valuing Environmental Health Risk Reductions to Children Workshop, October 20-21, 2003, Washington, DC. Abstract: This paper develops a household production model in which parents produce bicycling safety for their children. Using data from the National Survey on Recreation and the Environment, via a random utility model, we estimate conditional indirect utility as a function of bike safety and infer WTP for reduced risk of fatal and non-fatal head injury. We obtain estimates of parental values for children that include a VSL of $9.5 million and a VSI of $7.0 million.
- Air Pollution and Asthma: The Effects of Ambient Exposure on Asthma Medication Use (PDF) (2 pp, 94K)
- NCEE Working Paper Series
- Willingness to Pay to Reduce a Child's Pesticide Exposures: Evidence from the Baby Food Market (May 2002)
- Data Requirements for Valuation of Children's Health Effects and Alternatives to Valuation (September 2002)
- Existing Literature and Recommended Strategies for Valuation of Children's Health Effects (September 2002)
- On Techniques to Value the Impact of Environmental Hazards on Children's Health (September 2002)
- Valuing Indirect Effects From Environmental Hazards on Children's Life Chances (September 2002)
- Benefits Transfer of Children's Health Values (September 2002)
- Evaluation of the Child Health Champion Pilot Program: Final Report (September 2002, PDF) (126 pp, 352K). Learn more about this program.
- Evaluation of the Children's Health Valuation Handbook (September 2001, PDF) (29 pp, 577K). Learn more about the Children's Health Valuation Handbook.
- Cost of Illness Studies
- National Costs of Asthma for 1997 (August 2000, PDF) (31 pp, 134K)
- Cost-Effectiveness of Asthma Management Programs
- Cost of Illness Estimates for Incident Cases of Select Childhood Cancers