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Ding G, Gao Y, Kan H, Zeng Q, Yan C, Li F, Jiang F, Landrigan PJ, Tian Y, Zhang J. Environmental exposure and child health in China. ENVIRONMENT INTERNATIONAL 2024; 187:108722. [PMID: 38733765 DOI: 10.1016/j.envint.2024.108722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
Chinese children are exposed to broad environmental risks ranging from well-known hazards, such as pesticides and heavy metals, to emerging threats including many new man-made chemicals. Although anecdotal evidence suggests that the exposure levels in Chinese children are substantially higher than those of children in developed countries, a systematic assessment is lacking. Further, while these exposures have been linked to a variety of childhood diseases, such as respiratory, endocrine, neurological, behavioral, and malignant disorders, the magnitude of the associations is often unclear. This review provides a current epidemiologic overview of commonly reported environmental contaminants and their potential impact on children's health in China. We found that despite a large volume of studies on various topics, there is a need for more high-quality research and better-coordinated regional and national data collection. Moreover, prevention of such diseases will depend not only on training of environmental health professionals and enhanced research programs, but also on public education, legislation, and networking.
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Affiliation(s)
- Guodong Ding
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Haidong Kan
- Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China.
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Chonghuai Yan
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fei Li
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Developmental and Behavioral Pediatric & Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fan Jiang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Philip J Landrigan
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, United States; Centre Scientifique de Monaco, MC, Monaco.
| | - Ying Tian
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Maternal and Child Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Woolf AD, Jackson JE, Corcoran P, Fritz MK, Kim SS, Maslak TM, Shah M, Hansen L. An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015-19. Acad Pediatr 2024:S1876-2859(24)00108-6. [PMID: 38494060 DOI: 10.1016/j.acap.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and health care professionals. This analysis evaluated the productivity of the national PEHSU program. METHODS PEHSUs reported data on services provided to US communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented. RESULTS During this period, 6102 consultations and 4644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014 and 2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics. CONCLUSIONS PEHSUs work to decrease harmful exposures and improve children's health. They serve as expert resources for families, health care professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program.
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Affiliation(s)
- Alan D Woolf
- Division of General Pediatrics (AD Woolf), Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Mass.
| | | | - Peter Corcoran
- Department of Healthy Resilient Children, Youth & Families (P Corcoran), American Academy of Pediatrics, Itasca, Ill
| | - Meredith K Fritz
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Stephani S Kim
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Tanya M Maslak
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Manthan Shah
- US Environmental Protection Agency (M Shah), Office of Children's Health Protection, Environmental Protection Agency, Washington, DC
| | - Linda Hansen
- Office of Capacity Development and Applied Prevention Science (OCDAPS) (L Hansen), Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
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Woolf AD, Sibrizzi C, Kirkland K. Pediatric Environmental Health Specialty Units: An Analysis of Operations. Acad Pediatr 2016; 16:25-33. [PMID: 26233834 DOI: 10.1016/j.acap.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 1998 the Agency for Toxic Substances and Disease Registry (ATSDR) secured the first federal funding to develop an innovative network of public health-oriented entities: Pediatric Environmental Health Specialty Units (PEHSUs). PEHSU goals were to provide pediatric and environmental health education to health care providers and health profession students, to offer consultation to health care professionals, parents, and others regarding environmental health exposures, and to provide referrals to specialized medical resources when necessary. This report analyzes the productivity of US PEHSUs from 1999 to 2014. METHODS This was a retrospective analysis of federally mandated quarterly reports filed by each PEHSU. These reports document specific goal-related deliverables outlined under cooperative agreements awarded to the Association of Occupational and Environmental Clinics (AOEC) with funding from the Environmental Protection Agency (EPA) and ATSDR. Costs were obtained from grant budget information available from the administrator of the grants, AOEC. RESULTS Total EPA/ATSDR funding for PEHSUs paid to AOEC during 1999-2014 was $23,847,452. The average cost to the EPA/ATSDR of running each PEHSU in 2014 was $169,256. Through over 8000 consultations and educational activities, PEHSUs reached 702,506 people: 298,936 health professionals, 61,947 health professional trainees, 323,817 members of the public, and 17,806 public health officials and others. CONCLUSIONS PEHSUs have grown into an established, productive network of clinical and educational centers whose expertise and activities have benefited both the public and health care professionals alike. The federal contributions to the cost of operating these centers have been more than offset by the benefits PEHSUs have conferred on the communities they serve.
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Affiliation(s)
- Alan D Woolf
- Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital, Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU), and Harvard Medical School, Boston, Mass.
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Landrigan PJ. Children's Environmental Health: A Brief History. Acad Pediatr 2016; 16:1-9. [PMID: 26498257 DOI: 10.1016/j.acap.2015.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/14/2015] [Accepted: 10/16/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Children's environmental health (CEH), the branch of pediatrics that studies the influence of the environment on children's health, has grown substantially in the past 3 decades and become an increasingly visible and important component of pediatric medicine. GOALS To trace the historical origins of CEH; to identify factors responsible for its recent growth. FINDINGS CEH has historical roots in toxicology, epidemiology, and occupational medicine. It arose in the second half of the 20th century through a melding of insights from pediatric toxicology, nutritional epidemiology, and social science research. Convergent research in these 3 fields has documented children's unique sensitivities to chemical, nutritional, and psychosocial hazards during windows of vulnerability in early development and has shown that early-life exposures can produce disease and disability in childhood and across the life span. Key events in the development of CEH were: 1) formation by the American Academy of Pediatrics in 1957 of a committee on environmental health that has nurtured the growth of the field for 5 decades and evolved into the Council on Environmental Health; 2) observations made in the 1980s that nutritional deficiency in utero increased risk for adult-onset obesity, diabetes, and cardiovascular disease-work that led to the hypothesis of the developmental origins of health and disease; 3) social science research showing that early exposure to psychosocial stress and trauma increases risk for chronic illness; and 4) publication in 1993 by the National Academy of Sciences of a report, Pesticides in the Diets of Infants and Children, which elevated awareness among national policy makers of children's vulnerability to toxic hazards, moved US environmental policy toward protection of children's health, and catalyzed research investment in CEH in the United States and globally. CONCLUSIONS CEH has made substantial progress but faces emerging challenges, including new chemicals and pesticides; increasing movement of polluting industries to poor countries where environmental and public health protections are few; and global climate change. In the future, CEH will require continued investment in research and education and will need to adopt an increasingly global perspective.
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Affiliation(s)
- Philip J Landrigan
- Department of Preventive Medicine and Pediatrics, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY.
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Zachek CM, Miller MD, Hsu C, Schiffman JD, Sallan S, Metayer C, Dahl GV. Children's Cancer and Environmental Exposures: Professional Attitudes and Practices. J Pediatr Hematol Oncol 2015; 37:491-7. [PMID: 26334434 PMCID: PMC4571458 DOI: 10.1097/mph.0000000000000416] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 07/23/2015] [Indexed: 12/03/2022]
Abstract
BACKGROUND Epidemiologic studies worldwide have provided substantial evidence of the contributions of environmental exposures to the development of childhood cancer, yet this knowledge has not been integrated into the routine practice of clinicians who care for children with this disease. To identify the basis of this deficit, we sought to assess the environmental history-taking behavior and perceptions of environmental health among pediatric hematologists and oncologists. PROCEDURE A web-based survey was sent from June to October 2012 to 427 pediatric oncologists, fellows, and nurse practitioners from 20 US institutions, with an overall response rate of 45%. RESULTS Survey responses indicated that environmental exposures are of concern to clinicians. The vast majority of respondents (88%) reported receiving questions from families about the relationship between certain environmental exposures and the cancers they regularly treat. However, a lack of comfort with these topics seems to have limited their discussions with families about the role of environmental exposures in childhood cancer pathogenesis. Although 77% of respondents suspected that some of the cases they saw had an environmental origin, their methods of taking environmental histories varied widely. Over 90% of respondents believed that more knowledge of the associations between environmental exposures and childhood cancer would be helpful in addressing these issues with patients. CONCLUSIONS Although limited in size and representativeness of participating institutions, the results of this survey indicate a need for increased training for hematology/oncology clinicians about environmental health exposures related to cancer and prompt translation of emerging research findings in biomedical journals that clinicians read.
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Affiliation(s)
- Christine M. Zachek
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco
| | - Mark D. Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
| | | | - Joshua D. Schiffman
- Department of Pediatrics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Catherine Metayer
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
| | - Gary V. Dahl
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
- Stanford University School of Medicine, Stanford, CA
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Landrigan PJ, Goldman LR. Children’s Vulnerability To Toxic Chemicals: A Challenge And Opportunity To Strengthen Health And Environmental Policy. Health Aff (Millwood) 2011; 30:842-50. [DOI: 10.1377/hlthaff.2011.0151] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Philip J. Landrigan
- Philip J. Landrigan ( ) is the dean for global health and a professor of both preventive medicine and pediatrics at the Mount Sinai School of Medicine, in New York City
| | - Lynn R. Goldman
- Lynn R. Goldman is the dean of the School of Public Health and a professor of environmental and occupational health at the George Washington University, in Washington, D.C
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Landrigan PJ, Goldman LR. Protecting children from pesticides and other toxic chemicals. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2011; 21:119-120. [PMID: 21224896 DOI: 10.1038/jes.2011.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Philip J Landrigan
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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Rubin LI, Geller RJ, Nodvin J, Marcus M, Howett M, Merrick J. Break the cycle of environmental health disparities in vulnerable children. REVIEWS ON ENVIRONMENTAL HEALTH 2011; 26:135-137. [PMID: 22206188 DOI: 10.1515/reveh.2011.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Paulson JA, Karr CJ, Seltzer JM, Cherry DC, Sheffield PE, Cifuentes E, Buka I, Amler RW. Development of the pediatric environmental health specialty unit network in North America. Am J Public Health 2009; 99 Suppl 3:S511-6. [PMID: 19890150 DOI: 10.2105/ajph.2008.154641] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Training in environmental health in general, and pediatric environmental health in particular, is inadequate. The Agency for Toxic Substances and Disease Registry began to develop pediatric environmental health specialty units (PEHSUs) after noting the dearth of practitioners who could evaluate and manage children with exposures to environmental health hazards. The Environmental Protection Agency subsequently joined in providing support for what has developed into a network of 13 PEHSUs in North America. PEHSUs provide services to families, act as consultants to clinicians and public agencies, develop educational materials, and respond to natural disasters, including hurricanes and wildfires. PEHSUs are relatively easy to organize and should be replicable internationally.
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Affiliation(s)
- Jerome A Paulson
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
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Polivka BJ, Chaudry RV, Sharrock T. Using mixed methods to evaluate the Pediatric Lead Assessment Network Education Training Program (PLANET). Eval Health Prof 2009; 32:23-37. [PMID: 19131376 DOI: 10.1177/0163278708328741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Pediatric Lead Assessment Network Education Training Program (PLANET) is a peer-to-peer in-person 1-hr lead poisoning prevention educational program for health professionals. This evaluation was designed to determine the impact of the PLANET program. Evaluation methods included analyzing data from PLANET sign-in sheets, evaluation forms, pre/postknowledge tests, claims data, and focus groups (FGs) and interviews (IVs) with PLANET attendees and nonattendees. Claims data were used to compare blood lead testing rates for physicians attending and those not attending a PLANET program. Over 2,000 health professionals attended the 192 PLANET presentations delivered between June 2001 and December 2006; most were registered nurses or physicians. Written evaluations were overwhelmingly positive. Posttests indicated increased provider knowledge about childhood lead poisoning prevention, and assessment of blood lead testing rates showed higher testing rates for PLANET attendees. FG and IV participants suggesting improvements including using alternative delivery modes.
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