The EPA’s Commitment to Children’s Environmental Health: History and Current Challenges

Children’s environmental health (CEH) has a 25-year history at the US Environmental Protection Agency (EPA), during which the agency has advanced CEH through research, policy, and programs that address children’s special vulnerability to environmental harm. However, the Trump administration took many actions that weakened efforts to improve CEH. The actions included downgrading or ignoring CEH concerns in decision-making, defunding research, sidelining the Children’s Health Protection Advisory Committee, and rescinding regulations that were written in part to protect children. To improve CEH, federal environmental statutes should be reviewed to ensure they are sufficiently protective. The administrator should ensure the EPA’s children’s health agenda encompasses the most important current challenges and that there is accountability for improvement. Guidance documents should be reviewed and updated to be protective of CEH and the federal lead strategy refocused on primary prevention. The Office of Children’s Health Protection’s historically low funding and staffing should be remedied. Finally, the EPA should update CEH data systems, reinvigorate the role of the Children’s Health Protection Advisory Committee, and restore funding for CEH research that is aligned with environmental justice and regulatory decision-making needs. (Am J Public Health. 2022;112(1):124–134. https://doi.org/10.2105/AJPH.2021.306537 )

Developing and implementing core competencies in children’s environmental health for students, trainees and healthcare providers: a narrative review

Knowledge of the health impacts of environmental exposures (such as pollution disasters, poor air quality, water contamination, climate change) on children’s health has dramatically increased in the past 40 years. The World Health Organization (WHO) estimated that 23% of all deaths worldwide were attributable to the environment, and 26% of deaths in children less than 5 years old could be prevented with removal of environmental risks factors. Yet, little has permeated medical education, leaving pediatric providers ill equipped to address these issues. To address this gap, members from the Pediatric Environmental Health Specialty Units, a United States nationwide network of academically affiliated experts who have created numerous environmental health educational materials and programs, have identified fifteen core environmental health (EH) competencies needed by health care providers to enable them to effectively address environmental health concerns. These competencies can serve as the foundation for the development and implementation of relevant educational programs. The core EH competencies are based upon these foundational elements: 1) Definition of “children’s environmental health” that describes how environmental exposures (positive and negative) in early life influence the health and development in childhood and across the entire human life span 2) Children are not “little adults” and so have unique vulnerabilities to environmental hazards; 3) Environmental health inequities exist, causing some children to have a disproportionate amount of unhealthy exposures and consequently a greater risk of adverse effects; 4) Climate change will translate to numerous adverse health effects that will particularly affect children worldwide. In this article, the authors describe the core environmental health competencies and provide resources, online tools, strategies, and examples targeted to all levels of training and practice to better enable leaders and educators to bring this important content to the forefront.

Maternal Dietary Patterns by Reduced Rank Regression Are Associated With Low Birth Weight Outcomes in Mothers and Children's Environmental Health Cohort

Objectives This study aims to identify the associations between maternal dietary patterns and the risks of low birth weight (≤ 10th percentile). Methods A total of 1,751 mothers and their newborns recruited for the Mothers and Children's Environmental Health cohort study between 2006 and 2010. A semiquantitative FFQ for nutrient intakes was collected and dietary patterns were derived using Reduced Rank Regression (RRR). A total of 138 food items were categorized into 40 pre-defined food groups. In this study, log transformed maternal intakes of folate, iron, and zinc were selected as the intermediate response variables based on the associations with birth weight. Associations were assessed by logistic regression with adjustment for confounding factors. Results All of energy and nutrient intakes of dietary pattern 1, characterized by high intakes of grain, green/yellow, and light-colored vegetables, legumes, fruits, red meat, poultry, eggs, fishes, seaweeds, tofu/soymilk, yogurt, and nuts significantly increased as the from quartile one to quartile four. Biochemical marker levels such as triglyceride, C-reactive protein, and malondialdehyde levels were significantly decreased from quartile one to quartile four in pattern 1. Pregnant women, who adhered to pattern 1 had a lower risk of low weight at birth in the highest quartile compared to the lowest quartile (adjusted odds ratio 0.35, 95% confidence interval 0.32–0.95). No association was observed for pattern 2(green/yellow vegetables, light-colored vegetables, kimchi, and seaweeds) and 3(grains, milk, and yogurt) with low weight at birth. Conclusions Mothers who practiced good nutrition such as various food groups were likely to have a lower risk of low weight at birth. This study was the first to use a birth cohort to investigate the association between maternal dietary pattern and low weight at birth using RRR method, which highlights the important role of whole foods or quality of nutrients during pregnancy. Funding Sources This research was supported by the BK21 FOUR (Fostering Outstanding Universities for Research) funded by the Ministry of Education(MOE, Korea) and National Research Foundation of Korea(NRF).

Applications of Systems Science to Understand and Manage Multiple Influences within Children’s Environmental Health in Least Developed Countries: A Causal Loop Diagram Approach

Least developed countries (LDCs) are home to over a billion people throughout Africa, Asia-Pacific, and the Caribbean. The people who live in LDCs represent just 13% of the global population but 40% of its growth rate. Characterised by low incomes and low education levels, high proportions of the population practising subsistence living, inadequate infrastructure, and lack of economic diversity and resilience, LDCs face serious health, environmental, social, and economic challenges. Many communities in LDCs have very limited access to adequate sanitation, safe water, and clean cooking fuel. LDCs are environmentally vulnerable; facing depletion of natural resources, the effects of unsustainable urbanization, and the impacts of climate change, leaving them unable to safeguard their children’s lifetime health and wellbeing. This paper reviews and describes the complexity of the causal relationships between children’s health and its environmental, social, and economic influences in LDCs using a causal loop diagram (CLD). The results identify some critical feedbacks between poverty, family size, population growth, children’s and adults’ health, inadequate water, sanitation and hygiene (WASH), air pollution, and education levels in LDCs and suggest leverage points for potential interventions. A CLD can also be a starting point for quantitative systems science approaches in the field, which can predict and compare the effects of interventions.

Children’s Environmental Health: A Systems Approach for Anticipating Impacts from Chemicals

Increasing numbers of chemicals are on the market and present in consumer products. Emerging evidence on the relationship between environmental contributions and prevalent diseases suggests associations between early-life exposure to manufactured chemicals and a wide range of children’s health outcomes. Using current assessment methodologies, public health and chemical management decisionmakers face challenges in evaluating and anticipating the potential impacts of exposure to chemicals on children’s health in the broader context of their physical (built and natural) and social environments. Here, we consider a systems approach to address the complexity of children’s environmental health and the role of exposure to chemicals during early life, in the context of nonchemical stressors, on health outcomes. By advancing the tools for integrating this more complex information, the scope of considerations that support chemical management decisions can be extended to include holistic impacts on children’s health.