| Children's Health and the Environment: Public Health Issues and Challenges for Risk Assessment Philip J. Landrigan,1 Carole A. Kimmel,2 Adolfo Correa,3 and Brenda Eskenazi4 1Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA; 2National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA; 3National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 4Maternal and Child Health and Epidemiology, Berkeley School of Public Health, University of California, Berkeley, California, USA Abstract
Infants and children are not little adults. They are uniquely vulnerable to environmental toxicants. To protect infants and children against toxicants, the National Research Council in 1993 called for development of an approach to risk assessment that considers children's unique patterns of exposure and their special vulnerabilities to pesticides. Many aspects of that call were codified into federal law in the Food Quality Protection Act (FQPA) of 1996. This report highlights the central elements needed for development of a child-protective approach to risk assessment: a) improved quantitative assessment of children's exposures at different life stages, from fetal life through adolescence, including acute and chronic exposures, exposures via multiple routes, and exposures to multiple agents ; b) development of new approaches to toxicity testing of chemicals that can detect unanticipated and subtle outcomes and that evaluate experimental subjects over the entire life span from early exposure to natural death to replicate the human experience ; c) development of new toxicodynamic and toxicokinetic models that account for the unique physiologic characteristics of infants and children ; d) development of new approaches to assessment of outcomes, functional, organ, cellular and molecular, over the entire life span ; these measures need to be incorporated into toxicity testing and into long-term prospective epidemiologic studies of children ; and e) application of uncertainty and safety factors in risk assessment that specifically consider children's risks. Under FQPA, children are presumed more vulnerable to pesticides than adults unless evidence exists to the contrary. Uncertainty and safety factors that are protective of children must therefore be incorporated into risk assessment when data on developmental toxicity are lacking or when there is evidence of developmental toxicity. The adequate protection of children against toxic agents in the environment will require fundamental and far-reaching revisions of current approaches to toxicity testing and risk assessment. Key words: children's environmental health, developmental toxicology, risk assessment, safety factors, toxicity testing. Environ Health Perspect 112:257-265 (2003) . doi:10.1289/ehp.6115 available via http://dx.doi.org/ [Online 25 November 2003]
This article is part of the mini-monograph "Assessing Risks in Children from Exposure to Environmental Agents." Address correspondence to P.J. Landrigan, Dept. of Community and Preventive Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1057, New York, NY 10029 USA. Telephone: (212) 241-6173. Fax: (212) 996-0407. E-mail: phil.landrigan@mssm.edu P.J.L. acknowledges support from the National Institute of Environmental Health Sciences (NIEHS) (P01ES09584 and P42ES07384) , the U.S. Environmental Protection Agency (U.S. EPA) (R827039) , The Bauman Family Foundation, The Wallace Genetic Foundation, The Rockefeller Family Fund, The Beldon Fund, The Homeland Foundation, and The Shulsky Foundation. B.E. acknowledges support from NIEHS (P01ES09605 and R01ES1135) , U.S. EPA (R86279) , and the National Institute for Occupational Safety and Health (1R01OH07400) . Additional support is provided by the Centers for Disease Control and Prevention and the University of California Toxic Substances Research and Training Program. The views in this article are those of the authors and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency or the Centers for Disease Control and Prevention. The authors declare they have no competing financial interests. Received 19 November 2002 ; accepted 29 July 2003.
The full version of this article is available for free in HTML or PDF formats. |
