The role of healthy indoor environments in children s health susan buchanan md mph
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The Role of Healthy Indoor Environments in Children’s Health Susan Buchanan, MD, MPH. Great Lakes Center for Children’s Environmental Health University of Illinois at Chicago. Disclosures/Acknowledgements. I have no commercial, financial, or other conflicts of interest to disclose.

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The role of healthy indoor environments in children s health susan buchanan md mph

The Role of Healthy Indoor Environments in Children’s HealthSusan Buchanan, MD, MPH

Great Lakes Center for Children’s Environmental Health

University of Illinois at Chicago


Disclosures acknowledgements
Disclosures/Acknowledgements Health

I have no commercial, financial, or other conflicts of interest to

disclose.

This material was developed by the Great Lakes Center for

Children’s Environmental Health and funded under the

cooperative agreement award number 1U61TS000118-05 from

the Agency for Toxic Substances and Disease Registry (ATSDR).

Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the

PEHSU by providing funds to ATSDR under Inter-Agency Agreement number DW

75-92301301-0. Neither EPA nor ATSDR endorse the purchase of any

Commercial products or services mentioned in PEHSU publications.


Environmental medicine
Environmental Medicine Health

“ If you want to learn about the health of a population, look at the air they breathe, the water they drink, and the place that they live.”

Hippocrates

Air, Water, Places


Particulate Matter Health

Ozone

Sulfur dioxide

AIR

WATER

PLACE

Lead

Carbon monoxide

Mold and moisture

Formaldehyde

Cigarette smoke

Asbestos

Radon

Pesticides

Bacteria, viruses

Chemical contamination


Children as high risk population
Children as High Risk Population Health

  • Developing brain

  • Different physiology

  • Different diets

  • Longer life span

  • High risk behaviors

  • Don’t make their own risk management decisions

  • Children are not little adults


A child s environment is all around her
A Child’s Environment HealthIs All Around Her

  • Eating

  • Drinking

  • Breathing

  • Touching


Oral Behaviors Health

Child Video Study

  • Children have frequent touching and mouthing behaviors

    • median [range]

  • touches to surfaces 83/hr [11-405]

  • hand to mouth area 35/hr [16-129]

  • hand/object in mouth 21/hr [4-126]

  • Ko et al, J Expo Sci Environ Epid 2007


    Indoor pollutants may be more important than outdoor pollutants
    Indoor pollutants may be more important than outdoor pollutants!

    *Americans spend more than 90% of their time indoors (home, work, school, daycare)

    Allergens

    Dust mites

    Cockroaches

    Pets

    Mold

    Irritant chemicals (cleaners, formaldehyde)

    Pesticides

    Inhaling irritants or allergens can cause coughing, wheezing, and

    asthma attacks.


    Asthma
    Asthma pollutants!


    CDC, 2012 pollutants!


    CDC, 2012 pollutants!


    CDC, 2012 pollutants!


    CDC, 2012 pollutants!


    How do environmental factors exacerbate an asthma attack
    How do environmental factors exacerbate an asthma attack? pollutants!

    Act as a trigger to incite an attack in individual with hyperresponsiveness (susceptibility)

    Worsen airway inflammation  mucous production, airway contraction


    Indoor allergens cockroaches mold
    Indoor allergens – cockroaches, mold pollutants!

    36% cockroach sensitization rate in inner-city asthmatic children

    Mold - 60 species of molds are allergenic


    Common lead sources children
    Common Lead Sources-Children pollutants!

    • Deteriorated leaded paint, dust

    • Lead contaminated soil

    • Occupational sources (take-home)

    • Folk remedies

    • Food & food containers (including lead-glazed ceramics)

    • Lead-contaminated drinking water

    • Imported cosmetics (Kohl, Surma)

    • Other (fishing sinkers, lead shot)


    Geometric mean blood lead levels in children 1 to 5 years national health nutrition surveys
    Geometric Mean Blood Lead Levels in Children 1 to 5 years pollutants!National Health & Nutrition Surveys

    16

    88% 10 g/dL

    14.9

    14

    12

    10

    8

    Geometric Mean Blood Lead, g/dL

    6

    1.6% 10 g/dL

    4

    3.6

    2

    2.7

    1.9

    0

    1976-1980

    1988-1991

    1991-1994

    1999-2002

    NHANES II

    NHANES III

    NHANES III

    NHANES IV

    Source: CDC


    Neurobehavioral effects
    Neurobehavioral Effects pollutants!

    • No “safe” blood lead level for neurobehavioral effects

    • Loss of IQ

    • Behavioral problems

    • Poor school performance


    Summary blood lead iq
    Summary: Blood Lead & IQ pollutants!

    Blood lead 1 to 10 ug/dL lowers IQ by ~4-6 points

    Effects not reversible

    Cumulative Frequency Distribution

    Verbal IQ


    Pesticides
    Pesticides pollutants!

    As defined by the US Federal Insecticide, Fungicide, and

    Rodenticide Act (FIFRA) of 1970:

    “any substance intended for preventing, destroying,

    repelling, or mitigating any insects, rodents, nematodes,

    fungi, weeds, or any other forms of life declared to be

    pests.”


    Who is exposed to pesticides
    Who is exposed to pesticides? pollutants!

    In early 1990s, nationwide survey found urinary metabolites of chlorpyrifos and parathion in 82% and 41% of those tested.

    An average of 12 different pesticides per home were measured in carpet dust and average of 11 pesticides in indoor air (non-agricultural households)

    Hill RH, Head SL Jr, Baker S. Pesticide residues in urine of adults living in the United

    States: reference range concentrations. Environ Res 71:99-108 (1995)


    How are children exposed to unsafe levels
    How are children exposed to unsafe levels? pollutants!

    Accidental or deliberate ingestion

    Mispackaged or container re-use

    Pica (eating dirt, sand, clay)

    Dust ingestion

    Inadequate ventilation in recently treated areas


    Health effects of exposure to pesticides at unsafe levels
    Health effects of exposure to pesticides at unsafe levels pollutants!

    • Respiratory (lungs)

      • Asthma

      • Wheezing

      • Lung infections

    • Neurologic (brain and nerves)

    • Dermal (skin)


    Mechanism of action of op pesticides
    Mechanism of action of pollutants!OP pesticides

    • Acetycholine

    • Cholinesterase

    • Enzyme inhibition

    Nerve Ending

    Neuromuscular Junction


    Symptoms of op poisoning
    Symptoms of OP poisoning pollutants!

    • DUMBELS

      • diarrhea

      • urination

      • miosis

      • bronchospasm

      • emesis

      • lacrimation

      • salivation

    www.sehondrugs.nl/.../ogen_miosis.html


    Neurologic effects of pesticide exposure

    4 year old Yaqui children pollutants!

    5 year old Yaqui children

    Neurologic effects of pesticide exposure

    Guillette 1998: EHP 106.


    Prenatal Exposure to Organophosphate pollutants!Pesticides and IQ in 7-Year-Old Children.Bouchard et al. (2011). Environ Health Perspect, 119(8), 1189-1195.

    “Children in the highest quintile of maternal DAP concentrations had an average deficit of 7.0 IQ points compared with those in the lowest quintile”

    • Birth cohort study of Latino farmworker families

    • DAP metabolites from children at 6 months and 1, 2, 3.5, and 5 yo

    • WISC-4 to 329 children at 7 yrs, adjusted for maternal education and intelligence, HOME score


    Providing adequate outdoor air ventilation can improve student health and performance
    Providing Adequate Outdoor Air pollutants!Ventilation Can Improve Student Health and Performance

    • In most schools, ventilation rates are below recommended levels

    • Growing evidence suggests that increasing outdoor air intake can

      • improve student and teacher performance

      • increase test scores

      • reduce airborne transmission of infection


    Pediatric environmental health specialty units pehsu
    Pediatric Environmental Health pollutants!Specialty Units (PEHSU)

    Funded by federal ATSDR, EPA

    Staffed by:

    Occupational/Environ-mental Med physician

    Peds or Family Med physician

    Medical toxicologist

    Pediatric health nurse

    Industrial hygienist


    Pehsu services
    PEHSU Services pollutants!

    Provide clinical consultation

    Telephone consults to health care providers and families

    Clinic visits at UIC, Stroger Hospital, Cincinnati Children’s Hospital, Lurie Children’s Memorial

    Consult to public health and environmental agencies

    Train physicians, nurses, and other health professionals in children’s environmental health


    Region 5 pehsu
    Region 5 PEHSU pollutants!

    • University of Illinois at Chicago (Drs. Susan Buchanan, Dan Hryhorczuk, Peter Orris)

      • UIC School of Public Health Great Lakes Center

      • University Health Service (Occupational Medicine Clinic)

      • Residency in Occupational and Environmental Medicine

    • John H. Stroger, Jr. Hospital of Cook County (Drs. Mark Mycyk, Steve Aks, Ann Naughton, RN)

      • Division of Toxicology, Department of Emergency Medicine

      • Toxikon Consortium (Dr. Jerrold Leiken)

    • Cincinnati Children’s Hospital

      • Center for Children’s Environmental Health (Dr. Nicholas Newman)

    • Lurie Children’s Memorial Hospital

      • Lead Clinic (Dr. Helen Binns)


    Great lakes center for children s environmental health
    Great Lakes Center for Children’s pollutants!Environmental Health

    Region 5 Pediatric Environmental Health Specialty Unit (PEHSU)

    (312) 636-0081 or (866) 967-7337


    Questions? pollutants!


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