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8 Νοε 2013 (πριν από 4 χρόνια και 2 μέρες)

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Maryann Suero, Ph.D.

Jacqueline Wuellner, RN, MPH

April 6, 2002

Spotlight on Children’s

Environmental Health

Healthy Schools, Healthy You Conference

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

What does “environment”

mean?

Environmental Exposures


Sunshine



Fresh Air



Water

Environmental Exposures




Air pollutants


Pesticides


Lead


Arsenic


Mercury


Asbestos


Radon


Routes of exposures


Inhalation

















Ingestion




Absorption through the skin

Children Are Not Little Adults

Different adverse health effects in

Children vs Adults

Physically
different, many
organ systems
are not fully
developed

Behaviorally
they are different

Windows of
Vulnerability
throughout
development

Children Are Not Little Adults

They are physically

different, many organ
systems are not fully
developed


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 ratio

relative to adults





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????



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

Infant

Adult

Children Are Not Little Adults


They behave differently
than adults

Difference in Behavior



Explore the world
through their senses



Touch & Taste



More time outdoors



Differences in Behaviors




Diet and eating habits differ


Newborns
-

breast milk or
formula


Infants / Toddlers



“Fussy Eaters” abound


“Grazing” is common


School aged children

Average child eats 6.9 times more
apples than an adult, not
accounting for child’s smaller size.

Adults

Non
-
nursing Infants

Major Problems in CEH


Lead poisoning



Asthma



School environments


“Emerging” Issues

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


Lead Poisoning in the US

All Incomes
At or Above Poverty Level
Below Poverty Level
0
3
6
9
12
15
18
All
Black
Hispanic
White
Percent of Chi ldren (1 - 5 y/o) wi th Elevated Blood Lead (1994)
Children with EBL (> 20ug/dl) in
Selected Cities (1998)

0
500
1000
1500
2000
2500
3000
3500
Number
Chicago
New York
Philadelphia
Milwaukee
Detroit
Baltimore
Los Angeles
Boston
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


Asthma in the US

1980
1985
1990
1995
2000
Year
20
30
40
50
60
70
80
90
100
Asthma Prevalence, per 1000 children
Overall
White
Black
Hispanic
Components of Asthma Management



I. Medical Management



Diagnosis



Trigger Identification



Treatment



Education





Common Asthma Triggers


Allergic



Dust mites


Molds


Pollen


Animal dander


Pests


Non
-
Allergic



Tobacco smoke


Pesticides


Wood or coal
smoke


Ozone


Particulate
matter



II.
Environmental Management



Trigger Identification


Education


Avoidance/remediation


Education


Components of Asthma Management

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


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

School Environmental Health



Lack funds for remediation



High population density in schools



Schools may have many hazardous
chemicals


Potential Environmental Hazards in
Schools


Poor indoor air quality


Exposure to


Asbestos


Mercury


Pesticides


Other hazardous
chemicals


Schools often don’t recognize
the problems

When it comes to

fetuses, infants, children, adolescents,

we know
VERY LITTLE

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


Region 5 Center for Children’s
Environmental Health

1
-
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

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
)


Resources for Schools


Indoor Air Quality Tools for Schools

www.epa.gov/iaq/schools


Integrated Pest Management

www.epa.gov/pesticides/ipm


Mercury

www.mercury
-
k12.org/


Environmental Management Systems
approach to school environmental health


Regional Resources for Schools
(copies
available)




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)

Children Are Different


Exposures



Doses



Susceptibility



Latency


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

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


A Healthy Environment Means
Healthier Kids