Testimony Submitted to the
Environment and Public Works Committee
Regarding Green School Initiatives
by Daniel Swartz
Children’s Environmental Health Network
October 1, 2002
The Children’s Environmental Health Network commends this Committee for bringing attention to the issue of children’s environmental health and the important relationship between children’s health and the school environment.
We appreciate the opportunity to submit this testimony for the record. The Children’s Environmental Health Network is a non-partisan and multi-disciplinary national project whose mission is to protect the fetus and the child from environmental hazards and to promote a healthy environment. The Network’s Board of Directors and committee members include numerous experts in children’s environmental health who serve on key Federal advisory panels and scientific boards.
The last few years have seen a dramatic increase in awareness of the simple fact that children may be harmed by a wide range of environmental toxicants – often in ways quite dissimilar to adults. Yet much more needs to be done in educating the public, changing behavior, amending our policies, and gaining more information if we are to meet the challenge of providing a healthy environment and protecting our children from environmental risk.
In my testimony, I’d like to highlight a few of the basic medical and scientific concepts that form the foundation for this field and outline how our policies relating to school facilities can better recognize these concepts.
A fundamental maxim of pediatric medicine is that children are not “little adults.” What does this mean when we talk about children and environmental toxicants? Scientists have documented the many differences between adult and child behavior and exposures; often these differences lead to higher exposures for children. The medical evidence is unassailable that every child experiences particular windows of vulnerability from conception through adolescence. In brief, children can be more susceptible to harm caused by environmental agents. Exposures that for an adult may have little or no consequence can result in life-long harm for a child.
There is clear, sound science underlying these principles. There is a solid consensus in the scientific community for these concepts. As additional scientific knowledge in this field expands, it continues to reinforce this foundation. I am attaching materials on these points developed by the Network for additional background (Attachment 1).
If we take these principles and apply them to the school environment, these are the types of pediatric, scientific and public health concepts that should be shaping the policies and activities of our educational institutions:
· Children deserve a safe and healthy school environment, including protection from harmful environmental exposures.
· Every child experiences particular windows of vulnerability from conception through adolescence. Exposure at those moments of vulnerability to environmental hazards can lead to permanent and irreversible damage.
· These windows of vulnerability do not exist for adults, so standards based on effects on mature systems will not take into account children's vulnerabilities.
· Children's exposures to environmental toxicants are not the same as adult exposures; exposure estimates based on adult exposures are likely to understate children's exposures.
· Past practices which do not take children's vulnerabilities and exposures into account cannot be assumed to be protective of children's health.
· Parents and other caregivers deserve to know what their children are exposed to in school facilities and the impact of such exposures.
· Research, data collection and other components of public health infrastructure must be in place to identify and correct existing problems and to prevent potential environmental problems in school facilities and children and their caregivers should have access to these resources.
However, in most cases our educational facilities are not guided by these concepts. Children spend hours every day in and around their school. Chemical toxicants and biological agents in the classroom, on the playground, in the science lab, or in other school facilities can lead to health risks and adverse learning conditions. They can affect many different body systems and impact health, learning, productivity, and self esteem. Yet few steps have been taken to protect children from environmental toxicants in the school environment. I am also attaching to this testimony a summary of the health effects and toxicants of greatest concern in the school environment. (Attachment 2)
We join with other witnesses testifying today commending the Senate for its leadership in passing such important initiatives as the Healthy and High Performance Schools provisions in H.R. 1/P.L. 107-110, the “No Child Left Behind Act of 2001” and the “School Environment Protection Act.”
Under the Healthy and High Performance Schools program:
· The Department of Education is directed to undertake a study of “unhealthy public school buildings” and their health and learning impacts.
· A joint Department of Education-Department of Energy-Environmental Protection Agency grant program was created to award grants to State and local educational agencies to support healthy and high performance school buildings.
· The Department of Education is to biennially report to Congress on this program.
The Network was delighted at the enactment of these provisions. We strongly urge their full implementation, and expect these measures to receive the strong support of both Congress and the Administration. The Department of Education must provide funding and implementation of these provisions. The Department must also be a full participant in activities such as the Interagency Task Force on Children’s Environmental Health and Safety and the National Children's Study.
Though the Network and others were heartened by the Senate’s decision to -- twice -- adopt the “School Environment Protection Act,” we were doubly disappointed by the House’s decisions not to accept these important provisions on the education bill and the farm bill.
Many school districts around the nation have implemented integrated pest management (IPM) programs to minimize the use of pesticides and have instituted processes to provide advance notice of pesticide use in schools to parents and employees. The “School Environment Protection Act” would further encourage schools to adopt IPM programs and would provide a valuable tool for parents.
These efforts are vital, but additional efforts are needed, such as research into the relationship between environmental hazards at school and their affect on health and learning. This type of research must also involve interagency coordination and support.
Little is known about the incidence of health effects which may have a school-related environmental component, the substances to which children are exposed in school, and connections between these exposures and health effects. Little is known about exposures in the school environment, where millions of American children spend a large portion of their childhood. No research or data collection efforts exist. Schoolchildren and their families deserve access to an agency which can help answer their questions, investigate concerns and provide information on exposures.
A network for identifying, investigating, responding to, and preventing environmental health problems in schools is needed to help protect children’s health in school. Data systems that link environmental factors with health conditions need to be developed to obtain data for disease prevention and health promotion. Such a network would help to close the gap in knowledge regarding the prevalence and incidence of environmentally-related conditions and environmental exposures. The Network urges the Committee to support S. 2054, the “Nationwide Health Tracking Act of 2002.”
Schoolchildren deserve to be protected from environmental hazards in their school; however, no standards exist providing such protections.
For example, in the states with Occupational Safety and Health Administration (OSHA) coverage, school employees are covered by standards including:
· a written hazard communication standard that lists all products with toxic ingredients, access to material safety data sheets, training for employees on chemical hazards;
· protective equipment for employees to use;
· a laboratory standard covering science teachers and technicians;
· emergency evacuation procedures; and
· access to any environmental monitoring performed by the employer.
However, students are not covered by these standards.
Also, as a result of queries from school personnel, the National Institute for Occupational Safety and Health (NIOSH), has visited schools for Health Hazard Evaluation (HHE) investigations, which assess risks and exposure and health consequences for employees when there are no standards. These investigations can be requested by employers and employees.
Just as is the case with OSHA, schoolchildren are not under the jurisdiction of NIOSH, so the institute does not have the authority to undertake investigations based on concerns about student risks, exposures and health effects. The Network believes school children deserve at the very least the level of protection and research afforded working adults -- and probably even more protection.
We commend you for the leadership you have shown by holding this hearing. Again, thank you for the opportunity to testify.
Children from Environmental Toxicants
Children’s Environmental Health Network
Every day, we are exposed to dozens, perhaps hundreds, of chemicals. Such extensive exposure is relatively new. Since World War II, thousands of new, primarily synthetic, chemicals have been discovered and introduced into commerce and our environment. In 1940, the annual production of synthetic chemicals was 1.3 billion pounds; in 1980, it was 320 billion pounds.[i] In 1999, more than 7 billion pounds of toxic chemicals were released into the nation's environment.[ii] Chemicals are ubiquitous; traces of synthetic compounds are found in all humans and animals around the world.[iii]
Both synthetic and natural chemicals, such as lead, once released into the environment, can harm the health of humans and wildlife.
The diverse and growing range of chemicals to which we are exposed means that today’s children live in an environment vastly different from previous generations. Currently more than 70,000 chemicals are in use. For the majority of these chemicals, little is known about their health effects on children.[iv]
Children Are Not Just "Little Adults"
Children, from conception through adolescence, are in a dynamic state of growth as their immature nervous, respiratory, reproductive, immune and other systems develop. Because of these developing systems, growing organisms can be more vulnerable to permanent and irreversible damage from toxicants than mature organisms.
Children experience the world differently than adults, meaning that children's exposures to environmental toxicants and their levels of exposure can vary dramatically from those of adults.
The Delicate Choreography of Children's Growth
The primary task of infancy and childhood is growth and development. If growth and development are hampered, the chances of a healthy adulthood are dramatically decreased. Many different kinds of environmental insults have the potential to damage these natural processes, potentially leading to lifetime harm. It is often impossible to repair damages that occur in childhood.
Studies of the impact of exposure to environmental toxicants on development make clear that not just the degree and route of exposure but also the timing of the exposure affects the response.
Because of children’s developing systems, children can be more susceptible to harm caused by environmental agents. Exposures that for an adult may have little or no consequence can result in life-long harm for a child.
Children are different from adults in other ways. Because biochemical systems are still developing in the fetus and the child, their ability to detoxify and excrete toxins differ from adults. This difference is sometimes to their advantage, but more frequently children are not as able to excrete toxins and thus are more vulnerable to them.[v]
What we don’t know about the effects and potential effects of environmental toxicants is far more than what we do know, not just for the nervous system (see box) but also for our reproductive, immune and other critical systems, as well as our state of knowledge for carcinogenic, endocrine and other health effects.
Children Experience The World Differently
Children's exposures to environmental toxicants, and their levels of exposure, can vary dramatically from those of adults.
Pound for pound, children eat more food, drink more water, and breathe more air than adults do. Young children have higher metabolic rates than do adults.[vi] A school-age child, on average, drinks twice as much water per pound of body weight and eats two to three times as much fruit per pound of body weight as an adult.[vii] Because of these differences, potential exposure to toxins that might be in the water or the air such as lead, pesticides, and nitrates is potentially greater for children.
Exposure differences are also a result of locations where children spend time, the activities in which children indulge, and children’s level of personal hygiene. Thus, in identifying how children may be exposed to a chemical and the level of exposure, it is inadequate to simply extrapolate from adult exposure.
Behavioral differences, because of age and developmental stages, means that opportunities for exposure to environmental chemicals such as pesticides also differ. These differences exist both between adults and children as well as between children of different ages.
Some examples of children's behavior and activities that lead to exposure differences include:
jYoung children spend hours close to the ground where there may be more exposure to toxins in dust, soil, and carpets as well as to low lying vapors such as radon or pesticides.
j Toddlers and primary school children may spend many hours sitting or lying on the floor while watching TV or playing games (2-3 hours/day). They place their fingers in their mouth frequently (9-10 times/hour); they are constantly touching their clothes (65 times/hour), objects (118 times/hour) and surfaces (97 times/hour). When they put their fingers in their mouth, whatever they have touched, they swallow.
j Children often eat snacks while sitting on the floor, thus whatever environmental chemicals are on the floor can adhere to both their hands and food and will be ingested through hand to mouth activities and through contamination of the food with dirty hands.
j Primary school children are likely to spend more time outdoors than toddlers or infants, typically in contact with dirt or grass and are also more likely to be outside barefoot than either older or younger children. They roll on the grass, tumble, and play games. They typically do not wash their hands after coming indoors and before eating. Whatever is on the grass may be absorbed through the skin on the body and feet or ingested when they put their hands in their mouth.
j Older children also spend a lot of time outdoors, typically playing organized games such as soccer or football, or hanging out. Their activities may include dermal contact with soil or grass.[viii]
This type of behavior/exposure data do not exist for children older than 12. In addition to sources of exposure through play that may be similar to younger children, older children may have exposures similar to adults. For example, adolescents may work on farms or can be exposed to workplace toxins in shop class, vocational-education settings, and in work settings.
The data that do exist show that children are more heavily exposed than adults to toxicants such as pesticides. For example, studies that looked at biomarker levels for a commonly used organophosphate pesticide, chlorpyrifos, in children and adults found that the levels of the pesticide in children were substantially higher than in the adult population.
In brief, a child's metabolism, physiology, diet, exposure patterns, and behavior are different than those of an adult.
A child is exposed to multiple toxicants in the course of her/his life, sometimes simultaneously, sometimes sequentially. Children have a longer life span than adults so they have more time to develop diseases with long latency periods that may be triggered by earlier environmental exposures, such as cancer or Parkinson's disease.[ix] The effects of multiple and/or cumulative exposures and their potential synergistic effects are not known.
Experience with a variety of chemicals, from alcohol to environmental toxicants like lead and mercury, has shown us that what is safe for the adult is not necessarily safe for the fetus, infant or child. Exposure levels that for an adult would have no impact or a transitory impact can have life-long negative consequences for a child.
For More Information:
Contact the Children’s Environmental Health Network at 202-543-4033 or visit the Network's Web site <www.cehn.org> which includes the Resource Guide on Pediatric Environmental Health.
The Network is a non-partisan and multi-disciplinary national project whose mission is to protect the fetus and the child from environmental hazards and to promote a healthy environment. The Network’s three areas of concentration are education, research and policy.
Health In Schools
Children’s Environmental Health Network
Chemical toxicants and biological agents in the classroom, on the playground, in the science lab, or in other school facilities can lead to health risks and adverse learning conditions. They can affect many different body systems and impact health, learning, productivity, and self esteem.[x]
Children spend hours every day in and around their school facilities. However, few steps have been taken to protect children from environmental toxicants in the school environment.
Other than lead[xi], asbestos,[xii] and radon,[xiii] the Federal government has not instituted requirements or guidelines that would protect children from the same chemical exposures that require employee notification and other worker protections. Although students may indirectly benefit from the Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH) activities that cover school employees, OSHA and NIOSH have no jurisdiction for investigating the health impact of exposure to students. Additionally, only 26 states have OSHA coverage for their public employees.[xiv]
Specific health effects and toxicants of concern in the school environment include:
Children are especially susceptible to air pollutants. The airways of young children are smaller than those of adults. Inhalation of air pollutants that would produce only a slight response in an adult can result in a significant obstruction in the airways of a young child. Children have increased oxygen needs compared to adults, they breathe more rapidly and, therefore, inhale more pollutants per pound of body weight than adults. They often spend more time engaged in vigorous outdoor activities than adults.
· Asthma is the leading serious chronic illness among children.[xv] The number of children with asthma in the United States is rapidly growing, increasing by 75 percent between 1980 and 1994.[xvi] Asthma is the number one cause of hospitalization among children under the age of 15.[xvii]
· Asthma is the leading cause of school absenteeism due to a chronic illness.[xviii] The U.S. Environmental Protection Agency estimated that American children lost 17 million school days in 1997 due to the disease, and that parents lost 5 million work days in order to care for their children with asthma-related illness.[xix] Nearly 1 in 13 school-age children has asthma.[xx]
· The impact of asthma falls disproportionately on African-American and certain Hispanic populations and appears to be particularly severe in urban inner cities.[xxi] These differences include both the incidence of asthma as well as mortality rates. In 1997, non-Hispanic Black children living in families with incomes below the poverty level were found to have the highest rates of asthma.[xxii] Between 1980 and 1993, death rates for asthma were consistently highest among blacks aged 15-24 years.[xxiii]
· Major indoor triggers of asthma attacks include irritants such as commercial products (paints, cleaning agents, pesticides, perfumes), building components (sealants, plastics, adhesives, insulation materials), animal and insect allergens, environmental tobacco smoke, and molds.[xxiv] Many of these triggers can be found in schools.[xxv]
· Although the causes of asthma are not yet known, one recent 10-year study found that ozone was linked to causing asthma, especially among physically active school age children living in high ozone communities.[xxviii]
· Nitrogen dioxide and sulfur dioxide decrease lung function in asthmatics.[xxix] Long-term exposure to air pollution (such as nitrogen dioxide and particulate matter) slows children's lung development over time. While these are generally thought of as outdoor air pollutants, these agents will be found in schools that keep windows open much of the year. In addition, children will encounter these pollutants during school hours while on the playground or sports field during recess, physical education and sporting events.
· Poor indoor air quality can reduce a person's ability to perform specific mental tasks requiring concentration, calculation, or memory.[xxx]
· Air quality problems inside school buildings can arise from a variety of sources, such as mold growth from excessive moisture, chemical emissions, insufficient fresh air supply, pollutants, and high radon levels.[xxxi]
· 27% of schools in a U.S. General Accounting Office survey reported unsatisfactory ventilation. 22% reported unsatisfactory indoor air quality generally.[xxxii]
· An EPA investigation of 29 schools across the country found inadequate ventilation in most of the schools.[xxxiii]
Seventeen percent of children under 18 have been diagnosed with one or more developmental disabilities. These disabilities include Attention Deficit-Hyperactivity Disorder (ADHD) and autism and are the result of complex interactions among genetic, environmental and societal factors that impact children during vulnerable periods of development.[xxxiv]
· A recent Centers for Disease Control and Prevention (CDC) report indicated that approximately 1.6 million elementary school-aged children (7 percent of children 6-11 years of age) have been diagnosed with ADHD, which is also known as Attention Deficit Disorder (ADD).[xxxv]
· A recent National Institute of Environmental Health Sciences (NIEHS) study indicated that the incidence of ADHD may be greatly underestimated by school and public health officials. In the study, parents reported more than 15 percent of boys in grades one through five had been diagnosed with ADHD. Overall, more than nine percent of all fourth and fifth grade children studied were taking medication to treat ADHD.[xxxvi]
· Known or suspected causes of brain and nervous system disorders are exposure to lead, methylmercury, and some pesticides, therapeutic drugs and food additives.[xxxvii] Other chemical classes suspected of developmental neurotoxicity include cancer chemotherapy medications, polyhalogenated hydrocarbons, psychoactive drugs, and solvents.
Schools are places where children and elemental mercury may come together via thermometers and barometers, in laboratory courses or “show-and-tell.” Mercury can also be released through broken fluorescent light tubes or thermostats. Elemental mercury is a liquid at room temperature but readily volatizes to a colorless and odorless vapor.
· Mercury is a potent neurotoxicant and children are particularly susceptible to mercury’s dangers. Mercury interferes with brain development and more easily passes into the brains of fetuses and young children than into the brains of adults.
· Both short- and long-term exposure to mercury vapor can lead to brain disorders. These include a wide variety of cognitive, personality, sensory and motor disturbances.[xxxviii]
· Mercury poisoning is linked to kidney and liver damage and reproductive disorders.
· Exposure to high levels of mercury vapor, such as heating elemental mercury in inadequately ventilated areas, have resulted in fatalities.[xxxix]
· Mercury-containing products or spills must be properly handled. Even small mercury spills require specialists. Improper clean-up of a mercury release, such as vacuuming up the mercury from a broken thermometer, will spread the mercury into the air.[xl]
· In July 2000, the National Academy of Sciences concluded that every effort should be made to reduce the release of mercury into the environment.
· Pesticide exposure may result in symptoms ranging from relatively mild headaches and skin rashes to paralysis and death. Some long-term illnesses linked to pesticide exposure may be subtle -- such as neurological disorders or reduced cognitive skills.[xli] Long-term illnesses and those with delayed onsets, such as cancer, which may appear years after exposure, can also occur. Most exposures to pesticides cause no symptoms. Even when exposures are symptomatic, they are often misdiagnosed. This may mask the true extent of the illnesses caused by pesticides.[xlii]
· Scientific reviews of the U.S. pesticide regulatory system identified important gaps in knowledge about the health effects of pesticides on children’s developing systems as well as children’s actual exposures to pesticides.[xliii] According to the American Academy of Pediatrics, “because the health effects of pesticide exposure on children are not well studied, an approach that reduces their exposure to these chemicals is desirable.” [xliv]
· Pesticide use in schools can be widespread. It can include “routine spraying,” ostensibly to prevent the development of problems, in classrooms, hallways, the cafeteria, and other areas. This type of use may result in children being exposed to high levels of pesticides.[xlv] Additionally, pesticides can be used in the building when an infestation is noted and pesticides may also be used outside on lawns and playing fields.
· Information about on the amount of pesticides used in the nation’s 110,000 public schools is not available. The Federal government does not collect such data, and, as of 1999, only two states collected data on pesticide use in a manner that allows for identifying use in school facilities.[xlvi]
· From 1993 through 1996, about 2,300 pesticide-related exposures involving individuals at schools were reported, according to the American Association of Poison Control Centers (although these data are not believed to be complete).[xlvii]
· Lead is a potent neurotoxin. Exposure to lead can cause a variety of health effects, including delays in normal physical and mental development in children, slight deficits in attention span, hearing, and learning disabilities of children. Long-term effects can include stroke, kidney disease, and cancer.[xlviii]
· Children of day-care-age who are in lead-contaminated buildings will be at highest risk of adverse outcomes from the exposure, but older children may be effected as well.
· A common source of lead exposure for children today is lead paint and the contaminated dust and soil it generates.[xlix] According to a report on the condition of the nation’s school facilities by the U. S. General Accounting Office, schools built before 1980 were painted with lead paint.[l]
· Children may also be exposed to lead through drinking water that has elevated concentrations from lead plumbing materials. Lead contamination in drinking water occurs from corrosion of lead pipes and it cannot be directly detected or removed by the water system.[li] According to the EPA, the longer water remains in contact with leaded-plumbing, the more the opportunity exists for lead to leach into water. As a result, facilities with on again/off again water use patterns, such as schools, may have elevated lead concentrations.[lii]
· Some support was provided to schools through the Lead Contamination Control Act of 1988 to identify and correct lead-in-drinking-water problems at schools, especially water coolers with lead-lined tanks.[liii]
SCHOOL BUSES and DIESEL EXHAUST
· According to the EPA, diesel engine emissions contribute to serious public health problems including: premature mortality, aggravation of existing asthma, acute respiratory symptoms, chronic bronchitis, and decreased lung function. They have also been linked to increased incidences of various cancers in adults in more than 30 health studies.
· Diesel exhaust is known to be a major source of fine particles that can lodge deep in children's lungs, increasing the likelihood of asthma, chronic bronchitis, heart disease and even premature death.[liv]
· In the United States, nearly 600,000 school buses transport 24 million students to school daily. Collectively, U.S. children spend 3 billion hours on school buses each year.[lv]
· Children who ride diesel school buses are exposed to an excessive amount of toxic diesel exhaust. The excess levels on the buses are 23 to 46 times higher than levels considered to be significant cancer risks according to the U.S. Environmental Protection Agency and federal guidelines. The diesel exhaust exposures are likely to result in an additional 23 to 46 cancer cases per million children exposed.[lvi]
· Mold grows on virtually any substance when moisture and oxygen are present, including ceiling tiles, carpets, wood and paper. Some molds, such as black molds or Stachybotrys, are known to produce potent toxins which can cause impaired breathing and cause allergies.[lvii]
· Children can be exposed to mold in schools if the building has indoor air that is very damp or if there have been water leaks. Mold may grow within 48 hours if the building materials or furnishings are damp.[lviii]
· The common symptoms of mold toxin exposure include headache, fatigue, diarrhea, nausea and respiratory irritation.[lix]
[i] Diagnosing and Treating Environmental Health Problems. Interview with Robert R. Orford, Minnesota Medicine 1991;74:7-10.
[ii] Based on data from the U.S. EPA’s Toxic Release Inventory for 1999, posted on http://www.scorecard.org/env-releases/us-map.tc.
[iii] Colborn T, Dumanoski D and Myers JP. Our Stolen Future. New York, NY:Dutton, 1996.
[iv] Schaefer M. Children and Toxic Substances: Confronting a Major Public Health Challenge. Environmental Health Perspectives 1994;102(Supp 2):155-156.
[v] Echobichon DJ and Stevens DD. Perinatal Development of Human Blood Esterases. Clinical Pharmacology and Therapeutics 1973;14:41-47.
[vi] National Research Council. Pesticides in the Diets of Infants and Children. Washington, DC: National Academy Press, 1993.
[vii] Guzelian PS, Henry CJ, Olin SS, eds. Similarities and Differences Between Children and Adults: Implications for Risk Assessment 1992. ILSI Press.
[viii] Busser HJ, Ott J, van Lummel RC, Uiterwaal M and Blank R. Ambulatory monitoring of children's activity. Medical Engineering and Physics 1997 19: 440-5.
Connolly RD and Elliot JM. Evolution and ontogeny of hand function in N. Blurton-Jones (ed). Ethological Studies of Child Behavior Cambridge UP, London, 1972.
Eaton WO and Yu AP. Are sex differences in child motor activity level a function of sex differences in maturational status? Child Development 1989 60:1005-11.
Engstrom L-M. Physical activity of children and youth. Acta Paediatric Scand 1980 Suppl 282:101-5.
Fenske RA, Black KG, Elkner KP, Lee C, Methner M and Soto R. Potential exposure and health risks of infants following indoor residential pesticide application. Am J. Public Health 1990 80:689-93.
Freedson PS. Field monitoring of physical activity in children. Pediatric Exercise Sci 1989 8-18.
Freeman NCG, Ettinger A, Barry M and Rhoads G. Hygiene and food related behaviors associated with blood lead levels of young children from lead contaminated homes. J Exp Assess and Environ Epi 1997 7:103-18.
Freeman NCG, Lioy PJ, Pellizzari E, Zelon H, Thomas K, Clayton A and Quackenboss J. Responses to the Region 5 NHEXAS Time/activity diary. J Exp Assess and Environ Epi 1999 in press.
Gallahue DL Understanding Motor development: infants, children, adolescents (2nd ed) Benchmark Press, Indianapolis 1989.
Quackenboss J, Pellizzari ED, Clayton A, Lioy PJ, Shubat P and Sexton K. Measurement and analysis of children's exposures to pesticides and PAHs. The 7th annual meeting of the International Society of Exposure Analysis, Nov. 2-5, Research Triangle Park, NC 1997.
Reed KJ, Jimenez M, Lioy PJ and Freeman NCG. Quantification of Children's Hand and Mouthing Activities. J Exp Assess and Environ Epi 1999 in press.
Tsang AM and Klepeis NE. Descriptive Statistics Tables from a detailed analysis of the National Human Activity Pattern Survey (NHAPS) Data 1996 US EPA/600/R-96/074.
Wiley JA. Study of Children's Activity Patterns California Air Resources Board, Sacramento, 1991.
[ix] Landrigan PJ and Carlson JE. Environmental Policy and Children's Health. Future of Children Summer/Fall 1995;5(2):34-52.
[x] California Department of Health Services. California Interagency Working Group on Indoor Air Quality in Schools, "Indoor Environmental Quality in California Schools: An Assessment of Needs and Opportunities". August 1999.
[xi] Lead Contamination Control Act, P.L. 100-572.
[xii] The Asbestos Hazard Emergency Response Act (AHERA) requires all schools to inspect and assess the condition of asbestos-containing material. (EPA regulations, Title 15, Chapter 53, Subchapter II).
[xiii] In 1989, EPA recommended that schools nationwide be tested for the presence of radon. U.S. EPA, Radon in Schools: Air and Radiation. Second Edition.
[xiv] OSHA Coverage of State and Local Government Workers
[xv] American Lung Association, 2002
[xvi] U.S. Environmental Protection Agency, America’s Children and the Environment, December 2000.
[xvii] ALA, 2002
[xviii] U.S. Environmental Protection Agency. Indoor Air-Asthma Facts. Available at www.epa.gov/iaq/asthma/introduction.html
[xix] U.S. Environmental Protection Agency, National Costs of Asthma for 1997.
[xxi] U.S. Environmental Protection Agency. Indoor Air-Asthma Facts. Available at www.epa.gov/iaq/asthma/introduction.html
[xxii] U.S. Environmental Protection Agency, America’s Children and the Environment, December 2000, p. 49.
[xxiii] Centers for Disease Control and Prevention, “Asthma Mortality and Hospitalization among Children and Young Adults—United States, 1980-1993,” Morbidity & Mortality Weekly Report, May 3, 1996.
[xxiv] American Academy of Pediatrics, Handbook of Pediatric Environmental Health, 1999, p. 45.
[xxv] Environmental Law Institute, Research Report. Healthier Schools: A Review of State Policies for Improving Indoor Air Quality. January 2002.
[xxvi] U.S. Environmental Protection Agency, 1996 Air Quality Criteria for Particulate Matter, Research Triangle Park, NC.
[xxvii] U.S. Environmental Protection Agency, 1996 Air Quality Criteria for Ozone and Related Photochemical Oxidants, Research Triangle Park, NC.
[xxviii] Rob McConnell, Kiros Berhane, Frank D. Gilliland, Stephanie J. London, Talat Islam, W. James Gauderman, Edward Avol, Helene G. Margolis and John M. Peters. "Asthma in Exercising Children Exposed to Ozone," The Lancet, Vol. 359, No. 9304, Feb. 2, 2002
[xxix] American Thoracic Society, “Health Effects of Air Pollution,” Am Journal of Respiratory and Critical Care Medicine, 153:3-50, 1996.
[xxx] U.S. Environmental Protection Agency. "Indoor Air Quality and Student Performance" Indoor Environments Division. Office of Radiation and Indoor Air. August 2000.
[xxxi] Environmental Law Institute, Research Report. Healthier Schools: A Review of State Policies for Improving Indoor Air Quality. January 2002.
[xxxiii] U.S. Environmental Protection Agency. Indoor Air-Schools. Frequently Asked Questions.
[xxxiv] In Harm's Way. Toxic Threats to Child Development Project. Executive Summary. 1998. Greater Boston Physicians for Social Responsibility.
[xxxv] “Prevalence of Attention Deficit Disorder and Learning Disability,” CDC's National Center for Health
Statistics, May 2002. Available at http://www.cdc.gov/nchs/data/series/sr_10/sr10_206.pdf.
[xxxvi] Prevalence of Medication Treatment for Attention Deficit-Hyperactivity Disorder Among Elementary School Children in Johnston County, North Carolina. Andrew S. Rowland, UNM Department of Family and Community Medicine. Available at http://www.apha.org/news/press/2002_journal/feb02.htm.
[xxxvii] Congressional Office of Technology Assessment report on neurotoxicity, 1990.
[xxxviii] ATSDR. Toxicological Profile, Mercury, http://www.atsdr.cdc.gov/toxprofiles/tp46.html. For specific information on memory loss, see the section on Health Effects, Section 184.108.40.206, Neurological Effects of Metallic Mercury http://www.atsdr.cdc.gov/toxprofiles/tp46-c2.pdf.
[xxxix] American Academy of Pediatrics, Handbook of Pediatric Environmental Health, 1999, p. 147.
[xl] American Academy of Pediatrics, Handbook of Pediatric Environmental Health, 1999, p. 152
[xli] U.S. General Accounting Office, PESTICIDES: Use, Effects, and Alternatives to Pesticides in Schools (RCED-00-17), November 1999, p. 3.
[xlii] U.S. General Accounting Office, PESTICIDES: Use, Effects, and Alternatives to Pesticides in Schools (RCED-00-17), November 1999, p. 3.
[xliii] National Research Council. Pesticides in the Diets of Infants and Children. Washington, DC: National Academy Press, 1993.
[xliv] American Academy of Pediatrics, Handbook of Pediatric Environmental Health, 1999, p. 314.
[xlv] American Academy of Pediatrics, Handbook of Pediatric Environmental Health, 1999, p. 314.
[xlvi] U.S. General Accounting Office, PESTICIDES: Use, Effects, and Alternatives to Pesticides in Schools (RCED-00-17), November 1999, p. 2.
[xlvii] U.S. General Accounting Office, PESTICIDES: Use, Effects, and Alternatives to Pesticides in Schools (RCED-00-17), November 1999, p. 2.
xviCalifornia Interagency Working Group on Indoor Air Quality, Committee on Indoor Environmental Quality in Schools, "Indoor Environmental Quality in California Schools: An Assessment of Needs and Opportunities, August 1999.
xvii Myrhrvold, A.N., Olsen, E., and O.Laundsen. "Indoor Environment in Schools-Pupils health and performance in regard to CO2 concentrations".
xv111 Natural Resources Defense Council and Coalition for Clean Air, No Breathing in the Aisles: Diesel Exhaust Inside School Buses, 2001
xixU.S. Newswire via Comtex, February 7, 2002. Berkeley, California.
xx Environment and Human Health, Inc., Children's Exposure to Diesel Exhaust on School Buses, February 7, 2002. Available at www.ehhi.org.
[xlviii] U.S. Environmental Protection Agency. Office of Water. National Primary Drinking Water Regulations. Consumer Factsheet on Lead.
[xlix] U.S. EPA Office of Children’s Health Protection, at http://www.epa.gov/children/toxics.htm.
[l] U. S. General Accounting Office, Report to Congressional Requesters. 1995 School Facilities: Condition of America's Schools, GAO/HEHS-95-61., p. 27.
[li] U.S. Environmental Protection Agency. Office of Water. National Primary Drinking Water Regulations. Consumer Factsheet on Lead.
[lii] U.S. EPA, “Lead in drinking water in schools and non-residential buildings,” EPA 812-B-94-002, April 1994, available at http://www.epa.gov/safewater/consumer/leadinschools.html.
[liii] U.S. EPA, “Lead in drinking water in schools and non-residential buildings,” EPA 812-B-94-002, Section 1 - Background Information (p. 3-11), April 1994, available at http://www.epa.gov/safewater/consumer/leadinschools.html.
[liv] U.S. Newswire via Comtex, February 7, 2002. Berkeley, California.
[lv] Environment and Human Health, inc., Children's Exposure to Diesel Exhaust on School Buses, February 7, 2002. Available at www.ehhi.org.
[lvi] Natural Resources Defense Council and Coalition for Clean Air, No Breathing in the Aisles: Diesel Exhaust Inside School Buses, 2001
[lvii] Stricherz, Mark. "Moldy Buildings: Troubling Trend For Many Districts". Education Week. September 26, 2001.
[lviii] "Mold in My School: What Do I Do". The California Department of Health Services. National Clearinghouse for Educational Facilities. March 2002.
[lix] "Mold in My School: What Do I Do". The California Department of Health Services. National Clearinghouse for Educational Facilities. March 2002