1. 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

2. 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 1U61TS 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
Neither EPA nor ATSDR endorse the purchase of any
Commercial products or services mentioned in PEHSU publications. 2

3. 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

4. AIR WATER PLACE Particulate Matter Ozone Sulfur dioxide Lead
Carbon monoxide
Mold and moisture
Formaldehyde
Cigarette smoke
Asbestos
Radon
Pesticides
Bacteria, viruses
Chemical contamination 4

5. 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

6. A Child’s Environment Is All Around Her
Eating
Drinking
Breathing
Touching

7. Oral Behaviors Children have frequent touching and mouthing behaviors
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

8. 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. 8

9. Asthma

10. CDC, 2012

11. CDC, 2012

12. CDC, 2012

13. CDC, 2012

14. 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

15. Indoor allergens – cockroaches, mold
36% cockroach sensitization rate in inner-city asthmatic children
Mold - 60 species of molds are allergenic 15

16. Common Lead Sources-Children
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)
Plenary A - Susan Cummins, MD, MPH

17. Geometric Mean Blood Lead, g/dL
Geometric Mean Blood Lead Levels in Children 1 to 5 years National Health & Nutrition Surveys 16
88% 10 g/dL 14
14.9 12 10
Geometric Mean Blood Lead, g/dL 8 6
1.6% 10 g/dL 4
3.6 2
2.7
1.9
NHANES II
NHANES III
NHANES III
NHANES IV
Source: CDC
Plenary A - Susan Cummins, MD, MPH

18. Neurobehavioral Effects
No “safe” blood lead level for neurobehavioral effects
Loss of IQ
Behavioral problems
Poor school performance

19. Summary: Blood Lead & IQ
Verbal IQ
Cumulative Frequency Distribution
Blood lead 1 to 10 ug/dL lowers IQ by ~4-6 points
Effects not reversible

20. 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.”

21. 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 United
States: reference range concentrations. Environ Res 71: (1995)

22. 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
household sprays, mispackaged pesticides (look like drinks), concentrates, pica & household contamination, groundwater contamination, container re-use, grain storehouses & bait (looting), locally grown food. 22

23. Health effects of exposure to pesticides at unsafe levels
Respiratory (lungs)
Asthma
Wheezing
Lung infections
Neurologic (brain and nerves)
Dermal (skin)

24. Mechanism of action of OP pesticides
Acetycholine
Cholinesterase
Enzyme inhibition
Nerve Ending
Neuromuscular Junction

25. Symptoms of OP poisoning
DUMBELS
diarrhea
urination
miosis
bronchospasm
emesis
lacrimation
salivation

26. Neurologic effects of pesticide exposure
4 year old Yaqui children
5 year old Yaqui children
Yaquii children in Mexico: high levels of multiple pesticides in cord blood and breast milk. Cases and controls with similar social background, only difference was exposure. Found decreases in stamina, gross and fine eye-hand coordination, 30-minute memory, and the ability to draw a person. Guillette 1998: EHP 106.
Guillette 1998: EHP 106.

27. Prenatal Exposure to Organophosphate Pesticides and IQ in 7-Year-Old Children. Bouchard et al. (2011). Environ Health Perspect, 119(8),
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
This chart does not show statistical significance. The red box is used only to show which results the quote is referring to. Table 3 in this article shows that for DAP a 10-fold increase in level resulted in stati sig decrease in all tests.
“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”

28. 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

29. Pediatric Environmental Health 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
Plenary A - Susan Cummins, MD, MPH 29 29

30. 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 30 30

31. Region 5 PEHSU UIC School of Public Health Great Lakes Center
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) 31

32. Great Lakes Center for Children’s Environmental Health
Region 5 Pediatric Environmental Health Specialty Unit (PEHSU)
(312) or (866) 32 32

34. Questions?