The Role of Healthy Schools in Children’s Environmental HealthSusan 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.

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.

Objectives

• To learn how and why children are more susceptible to environmental exposures than adults

• To become familiar with links between school facilities and student performance

• To become familiar with major CEH problems in schools, and “emerging issues”

Environmental Medicine

“ 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

• Ozone• Sulfur dioxide

Bacteria, virusesChemical contamination

LeadCarbon monoxideMold and moistureFormaldehydeCigarette smokeAsbestosRadonPesticides

AIRAIR

WATERWATER

PLACEPLACE

Children as High Risk Population

• 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

• Eating

• Drinking

• Breathing

• Touching

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

CDC, 2012CDC, 2012

CDC, 2012CDC, 2012

CDC, 2012CDC, 2012

CDC, 2012CDC, 2012

How do environmental factors exacerbate an asthma attack?

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

• Worsen airway inflammation mucous production, airway contraction

Indoor allergens – cockroaches, mold

• 36% cockroach sensitization rate in inner-city asthmatic children

• Mold - 60 species of molds are allergenic

Pesticides

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?

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

How are children exposed to unsafe levels?

– 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

• Respiratory (lungs)– Asthma

– Wheezing

– Lung infections

• Neurologic (brain and nerves)

• Dermal (skin)

Mechanism of action of OP pesticides

• Acetycholine

• Cholinesterase

• Enzyme inhibition

Nerve EndingNerve Ending

Neuromuscular JunctionNeuromuscular Junction

Symptoms of OP poisoning

• DUMBELS– diarrhea

– urination

– miosis

– bronchospasm

– emesis

– lacrimation

– salivation www.sehondrugs.nl/.../ogen_miosis.htmlwww.sehondrugs.nl/.../ogen_miosis.html

Guillette 1998: EHP 106.

Neurologic effects of pesticide exposure

• 4 year old Yaqui children

• 5 year old Yaqui children

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

• 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

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

Do School Facilities Affect Do School Facilities Affect Academic Outcome?Academic Outcome?

Hodge, 2004Hodge, 2004

Providing Adequate Outdoor Air 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

Health Gains from Improved IAQ

Proactive Maintenance in Schools withouta major maintenance backlog have higher average daily attendance, by an average of 4 to 5 students per 1,000 and a lower annual dropout rate by 10 to 13 students per 1,000.

==

Proactive Proactive MaintenanceMaintenancein Schoolsin Schools

Higher Higher AttendanceAttendance

LowerLowerDropout Dropout

RateRate

Small investmentsearn Bigger Picture pay-back in:

• Reduced healthcare costs (e.g. asthma)

• Improved test scores

• Increased high school graduation rates which boost earning potential of community

• Decreased energy costs (when energy upgrades are done correctly)

Focus on Primary Prevention

• Most hazards can be avoided through good maintenance based on common sense principles

– Ensure good ventilation

– Control moisture, reduce water damage

– Properly vent combustion appliances

– Follow basic safeguards to avoid exposure to toxic chemicals

Pediatric Environmental HealthSpecialty 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

• 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

• 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’sEnvironmental Health

Region 5 Pediatric Environmental Health Specialty Unit (PEHSU)

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

Questions?