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Future issues of toxicological profiles will have five new sections. Each
profile will have a section on child health in Chapter 1 (Public Health
Statement), which is designed for the lay public. ATSDR also distributes
these Public Health Statements separately as a compendium. A section on
children's susceptibility will be added to Chapter 2 and a section on children's
exposure will be added to Chapter 5. Data gaps found in analyzing the literature
for these child health sections will be explicitly discussed in a new Data
Needs section that will be a blueprint for future research to protect child
health. Priority data needs documents, developed from the data needs section
in the toxicological profiles, will have a child health section as well.
The profiles will address, at a minimum, the following issues.
ATSDR's widely distributed Fact Sheets are an even more condensed summary for the lay public and also have discussions of child health issues derived from the public health statements. Priority Data Needs documents, developed from the Data Needs section in the Toxicological Profiles, are adding child health sections as well.
ATSDR is working to further improve the manner in which health assessors evaluate issues relating to children. For example, ATSDR's training course on basic public health assessment had an increased focus on evaluating the impact of hazardous substances in the environment on children. Topics discussed in the course, which is taken by agency and state health assessors, include children's behaviors that influence exposure frequency, physiologic and biochemical factors that might lead to greater sensitivity to hazardous substances, the role of exposure investigations, and the influences of culture, diet, and nutritional status. The course emphasizes that caution must be exercised in trying to extrapolate information from adults to children, because children are not simply small adults. ATSDR plans to modify its Public Health Assessment Guidance Manual to reflect the increased emphasis on evaluating children's health issues and methods for making those evaluations.
ATSDR also recognizes the need to expand its HazDat database to include data on children's issues at hazardous waste sites, so we can learn more about the characteristics of children that influence exposure and the potential development of adverse health effects. There is also an increased emphasis on the use of exposure investigations to confirm present exposures.
In addition, at sites where biologic or environmental data are limited and unlikely to be obtained, modeling and relational geographic information systems are used to obtain more accurate estimates of past exposure. These tools will increasingly be used at sites and will assist in conducting epidemiological studies of people who may have been exposed as children. ATSDR has used geographic information systems to estimate the number of children living near National Priority List (NPL) sites. On the basis of data from 1,255 sites, there were 1,127,563 children under 6 years of age living within 1-mile borders of the sites, or about 11% of the potentially affected population. Women of child-bearing age account for about 24% of the population near waste sites. The average site population at these sites was 8,073 people, and the average number of children under 6 years of age was 898.
ATSDR is seeking new databases to evaluate adverse health effects in children. National registries of childhood illnesses, especially cancers, are under consideration. ATSDR plans to develop environmental assessment procedures for a national children's environmental cancer registry, in cooperation with other federal agencies. ATSDR also continues to evaluate its existing data collection systems for their ability to address children's health issues, for example, the National Exposure Registry. Currently, registrant cohorts exposed to trichloroethylene (TCE), trichloroethane (TCA), benzene, and dioxin are followed. This registry is identifying databases that provide the necessary comparative rates for generating testable hypotheses for a broader range of health end points that are directed at the health of children. The registry also is giving additional emphasis to including adequate numbers of children in the sub-registries. ATSDR also is continuing several key health studies (see following list) to identify information needs and initiate research, and improve program activities to focus more specifically on children's health. ATSDR is improving the review of health studies and extramural awards by including more pediatricians in the peer review process and by promoting children's health issues when announcing requests for proposals. Additional health outcomes specific to children are being identified to make health studies more sensitive to illnesses experienced by children, and ATSDR seeks to identify health outcome databases that record these outcomes.
Birth Defects and Reproductive Disorders
Hanford Infant Mortality and Fetal Death Analysis, Washington
Case Control Study of Neural Tube Defects, New Jersey
Cardiovascular Malformations and Maternal Exposure, New York
Birth Defects in Children of Color, California
Drinking Water Contamination and Birth Outcomes, NJ
Volatile Organic Compounds in Drinking Water and Adverse Pregnancy Outcomes, Camp Lejeune, North Carolina
Public Drinking Water Contamination and Birth Outcomes, Iowa
Lung and Respiratory Diseases
Residential Exposure to Urban Air Toxicants and Childhood Asthma
Determining Immunotoxicity of Lead Exposure in Children in the Tri-State Mining District, Illinois, Kansas, Missouri
Reference Ranges for Immune Function Test Battery Results in Children
Impact of TCE Exposure on Oral and Motor Function and Speech and Hearing in Children
Exposure and Biomedical Testing
Coeur D'Alene River Basin Environmental Health Exposure Assessment, Idaho
Lead Screen Study, Silver Valley (Bunker Hill), Idaho
Biomedical Test Batteries Emphasizing Children
Health Promotion and Education Activities
Although there are many other on-going DHEP child health-related activities, including the pediatric Case Study in Environmental Medicine and the children's risk perception study, the rest of this section will focus on the Pediatric Environmental Health Specialty Unit (PEHSU) Program.
The PEHSU Program
From this modest beginning, in FY 01 the Program had grown to include:
• national network of 11 operating units
• inclusion of EPA as a partner in all of these units
• increasing international interest in establishing similar units
• continuing and increasing interest and demand for these services from governmental agencies at all levels and from the public
• opportunities to collaborate with additional partners, such as NIEHS/EPA/CDC Centers of Childrens Environmental Health and Disease Prevention Research
• impact on field of pediatric environmental health
• development of a body of published articles, curricula, and educational materials
There is at least one PEHSU in each of the 10 EPA/ATSDR regions. Most of the PEHSU have websites. Links are provided here: Region 1 ; Region 2 ; Region 3 ; Region 4 ; Region 5 ; Region 6 ; Region 7 ; Region 8 and Region 9 ; Region 10. These units facilitate linkages between environmental medicine and pediatric specialists to build regional and national referral networks, thus improving environmental health services for children exposed to hazardous substances.
For additional information on the PEHSU Program, call Katherine Kirkland, MPH, Executive Director, AOEC (202-347-4976) or Christine Rosheim, DDS, MPH, Project Officer, ATSDR (404-498-0323).Top
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