Children's environmenal health: the school environment.

03Original abstract

Since the government action on the removal of lead from gasoline in the 1970s, children's environmental health research and policy measures have expanded greatly. Education and outreach campaigns urge parents to ensure their homes are lead free and to check for the presence of radon, mold, and other potential environmental hazards. However, children also spend a good portion of their days in school environments, with the conditions of many schools being so poor that Lloyd Kolbe, founding and former director of the U.S. Centers for Disease Control and Prevention's (CDC) Division of Adolescent and School Health, has referred to them as “America's largest unaddressed children's health crisis” (Healthy Schools Network, 2005, p. ii.).According to 2008 National Center for Education Statistics (NCES) data, there are approximately 132,000 public and private schools in the United States, employing over 7 million adults and enrolling 56 million children (NCES, 2008). Twenty percent of the U.S. population attends elementary and secondary schools, many of which are very densely occupied (U.S. Environmental Protection Agency [EPA], 2002).In 2006, a national collaborative report entitled Lessons Learned (Healthy Schools Network, 2006) estimated that 32 million U.S. children were at risk due solely to school conditions. These conditions include the presence of old and peeling paint, asbestos, mold, poor indoor air quality, and pesticides, as well as possible preexisting on-site or off-site contamination. According to the EPA (2002), one half of U.S. schools have indoor environmental quality problems. Indoor concentrations of pollutants are commonly three to five times higher than outdoor concentrations due to chemicals found in some conventional cleaning products, improper cleaning procedures, defective or ineffective climate control (HVAC) systems, interior finishes, exterior pollutants, personal care products, and renovation projects (EPA, 2002). Contamination is portable as well and can be brought inside from outdoor exposures.Childhood exposures to environmental toxins have been associated with various cognitive and behavioral impairments, immune dysfunction, adverse reproductive and developmental effects, cardio-respiratory illnesses, and cancer (Greater Boston Physicians for Social Responsibility [GBPSR], 2000; Landrigan, Needleman, & Landrigan, 2002; Rudant et al., 2007; Salam, Li, Langholz, & Gilliland, 2004). One out of every 10 school-aged children, or over 6.7 million children under 18 years of age, has asthma, and between 1977 and 1994 the number of children in special education increased 191% (Akinbami, 2006; American Lung Assocation, 2009; GBPSR, 2000). The prevalence of diagnosed learning disabilities, autism spectrum disorders, and attention deficit hyperactivity disorder in children has increased dramatically nationwide (GBPSR, 2000). Environmental contaminants, especially those that affect indoor air quality, have also been linked to increased allergies and sensitivities, rashes, headaches, and other symptoms, often referred to as sick building syndrome (EPA, 2008).Environmental toxic exposures have also been linked with decreased IQ. One study reported that, on average, a 1-µg/dL increase in blood lead results in a decrease of 0.46 IQ points (Canfield et al., 2003). This rate of decline in intellectual functioning appears even greater (1.37 IQ points lost per 1-µg/dL increase in blood lead) among children with blood lead levels below, rather than above, the CDC recommended level of 10 µg/dL (Canfield et al., 2003). Taking into account this increased effect at lower body burdens, more children may be at greater risk of harm from lead exposure than previously believed.Lead has been relatively well researched with regard to its adverse effect on IQ. Yet, other toxicants and combinations of chemicals have also been associated with lowered cognitive functioning. For example, a 2009 Columbia University study found that exposure to polycyclic aromatic hydrocarbons, chemicals released into the air from burning of coal, diesel, oil, gas, and other substances, such as tobacco, can also inversely impact IQ in the developing brain. Schools that have idling buses or are close to major highways may have higher levels of polycyclic aromatic hydrocarbons in the indoor air (Perera et al., 2009).Researchers have found that lowered IQ, even by just a few points, negatively impacts an individual's future earnings (Schwartz, 1994). Other hidden expenses of unaddressed children's environmental health concerns include parents' lost wages due to medical and therapeutic expenses and missed work and the costs to school districts and taxpayers of postconstruction remediation efforts, which often far exceed the costs of precautionary or proactive measures (Center for Health Environment and Justice [CHEJ], 2005). Additonal expenses may arise from lawsuits brought against school districts by affected families. Indeed, the adverse effects of childhood environmental exposures, such as lead poisoning–induced aggression and violence, affect society as a whole. It is estimated that anywhere from $4.6 to $18.4 billion in costs of neurobehavioral disorders alone in the U.S. are attributable to environmental toxicants (Landrigan, Schechter, Lipton, Fahs, & Schwartz, 2002).Between 1976 and 1994, the average blood lead levels of U.S. children plunged from 16 µg/dL to 3.2 µg/dL, primarily as a result of the removal of lead from products such as gasoline and paint in the 1970s (Gilbert & Weiss, 2006). Grosse, Matte, Schwartz, and Jackson (2002) estimated that U.S. preschool-aged children in the late 1990s had IQs that were, on average, 2.2–4.7 points higher than they would have been had their blood lead distribution matched that observed among U.S. preschool-aged children in the late 1970s. Each 1-point increase in an individual's IQ has been associated with a 1.76% to 2.37% increase in future earning potential, and the researchers estimated that the economic benefit for each year's cohort of 3.8 million 2-year-old children ranged from $110 billion to $319 billion (in 2000 dollars; Gross et al., 2002). This represents a truly significant public health triumph in the United States, yet the problems of lead exposure continue to persist for many children. The CDC estimates that there remain approximately 310,000 children aged 1–5 years with BLLs greater than 10 µg/dL, the upper limit of what is considered an acceptable level, which is arguably too high (CDC, 2005; Gilbert & Weiss, 2006).Although adults also work in school environments, the deleterious health impacts of environmental hazards may be greater for children. The unique physical and behavioral characteristics of children as well as the paucity of research, policy, and regulation with regard to school environments and children's health underscore the need to recognize and address school children as a particularly vulnerable population.Children are not “little adults,” and, therefore, assessments of their exposures to, and outcomes resulting from, environmental toxicants using adult-based toxicological models are insufficient. Children breathe more, eat more, and drink more per pound of body weight than adults, increasing their risk of exposures. Their behaviors also expose them to more possible contaminants (e.g., hand-to-mouth behaviors, more time spent on the ground), and they cannot always identify and protect themselves against hazards (Guzelian, 1992; National Research Council, 1993).Not only are children generally exposed to toxins at higher levels than adults, they may also absorb the toxins more readily than adults, placing them at even greater risk of harm. The efficiency of detoxification and elimination of toxins from the body may differ in children and adults. For example, young children may lack sufficient amounts of a key enzyme needed to metabolize and excrete a particular contaminant quickly, resulting in longer residency time of the contaminant in the body, leading potentially to greater toxicity and harm.Children's organ systems continue developing through early childhood and are, thus, more vulnerable to adverse effect. Longer exposures to some toxins, such as those experienced since early childhood, leads to greater body burdens, with potentially more detrimental health outcomes. Those with existing disabilities may be more vulnerable, both with regard to exposure and absorption, and, thus, at even greater risk.Public sector employees (including teachers and others working within the public school system) in 25 states are protected from environmental and occupational hazards through state-adopted, Occupational Safety and Health Administration (OSHA)–approved standards. All but 4 of these states also provide protection to private sector employees, such as private school staff and administrators (Healthy Schools Network, 2005). Injured workers may also be eligible for, and receive, worker's compensation, sick leave, union support, and access to U.S. Department of Health and Human Services–funded occupational health clinics; they may also be able to switch their job locations. Thus, there exists protection for some of the adults employed in schools in the United States.However, OSHA standards do not exist for any of the children attending these schools who are exposed to the same environmental hazards and are more vulnerable to their effects. In addition, chemical regulations under the Toxic Substances Control Act (TSCA) of 1976 in the U.S. do not guarantee adequate protection to children because they are based upon risk assessment models derived from adult populations and other inherently limited assumptions (Environmental Working Group [EWG], 2005).Whereas the health effects of some contaminants, such as lead, tobacco, and asbestos, have been well studied, barely any of the approximately 80,000 chemicals inventoried by the TSCA have been fully tested for their impacts on human health (U.S. General Accounting Office, 2005). In fact, only 7% of the 2,863 most commonly used chemicals have undergone complete toxicological testing, and few of these have been studied for neurodevelopmental effects (EPA, 1998).Research of children's environmental health issues at school is either minimal or nonexistent. In fact a seemingly noncontagious outbreak of rashes in 2001–2002, which affected approximately 1,000 children in 27 states, could not be meaningfully investigated due to the lack of baseline data of children's environmental health measures at schools (Healthy Schools Network, 2005).The National Institute for Occupational Safety and Health (NIOSH) performed a workplace evaluation of a school near “ground zero” in New York City and found evidence of new-onset diseases among school staff. However, no agency offered a similar service for students, including children with special needs, in the dust-contaminated school (Bartlett & Petrarca, 2002). Furthermore, had any investigations been conducted, meaningful assessment would have been difficult due to the lack of any baseline data on students' health.A NIOSH Healthy Hazard Evaluation (HHE) evaluates worker health and safety on site based on previous and current individual medical conditions. The same type of evaluation could have been done for school children but was not, thus depriving children (who outnumber adults in schools), their families, schools, IEO sciences, and NIOSH of important information. Children are the work product, or “output,” of schools, so not having any assessment of them erodes the educational mission.Some environmental concerns, such as the prevention of urban sprawl, the creation of walkable and bikable communities, the need for safe routes to school, and the selection of a locale conducive to high-performing schools, are often considered when choosing a school site; however, the presence of on- or off-site sources of pollution are usually not considered. This is mainly due to considerations of land cost and availability (CHEJ, 2005). School districts seek out inexpensive land due to declining school budgets and rising, unfunded mandates, such as the No Child Left Behind Act (legislation enacted in 2002 that ties federal funding for schools to states' performances in standards-based assessments). Contaminated land is inexpensive because it is unsuitable for housing and most types of businesses.Availability of land is another factor in site selection. School districts in rural areas look to site schools on inexpensive, unused agricultural land, which is often contaminated with pesticides, whereas urban school districts, limited in their siting choices due to the shortage of undeveloped land, often turn to sites on or near abandoned landfills or abandoned industrial sites, such as brownfields, or near heavily polluting industries (CHEJ, 2005). Furthermore, urban school districts, motivated to save money or to devote greater percentages of their budgets to hiring highly qualified teachers and improving schools' technology and curriculum, may be unwilling to invest in proper clean up of contaminated sites. There are 1,100 public schools, and over 600,000 students attending public schools, within half a mile of contaminated sites (CHEJ, 2005). This issue directly affects children's health, especially low-income and non-White children, who may have less access to health care and who have higher rates of asthma and lead poisoning (CHEJ, 2005).According to a 50-state siting laws survey detailed in a 2005 report entitled Building Safe Schools: Invisible Threats, Visible Actions, only 10 states have laws that prohibit the siting of a school on or near sources of pollution or other environmental hazards (CHEJ, 2005). These hazards include sites affected by air, motor vehicle, and rail traffic; sites near utility transmission lines; sites impacted by air and noise pollution; sites where hazardous or solid waste was disposed; and sites especially vulnerable to natural hazards, such as flooding or earthquakes.The report indicated that only 6 states require environmental investigation of potential school sites, such as the preparation of Phase I or Phase II environmental assessments or environmental impact statements for school projects. A Phase I environmental assessment is a cursory evaluation of the site, in which surveyors check for obvious of hazards, such as those that can be or Phase II assessments would be based on the of a Phase I assessment and would of site (e.g., Environmental impact statements or the and environmental effects of a such as the building of a school, and states require public or public school sites, and states require or the creation of school siting report also that states have no laws that either prohibit or the siting of a school on or near or environmental hazards and that states do not require school districts to potential school sites for the presence of pollutants or other environmental hazards or to environmental impacts associated with potential school toxicants at contaminated sites include such as lead, and such as and from and gasoline and from at which often at sites where has been in and many more (CHEJ, of the most lead and are and IQ (U.S. Agency for Toxic Substances and Disease IQ leads to cognitive and attention and is linked to behaviors, and and also affect the are also both associated with adverse reproductive effects, and in is associated with are also of cognitive functioning in children, more on its health effects are needed is a need for school siting laws that would siting on or near sources of environmental hazards and require investigation and assessment of hazards on potential school sites or impacts to future of proper clean and of contaminated and public in siting of a siting is in public education is also to a siting The of laws and federal on school siting is not In addition, chemical are and often not well by the Thus, parents and school may often be of on-site the need for a educational as of the safety data by a cleaning do not always provide complete on the health hazards of the and are not at for products & cleaning products may and that affect the the such as and and & Landrigan, 2006; et al., 2006; 2002; & et al., U.S. National 2000). commonly found in such as and have been linked with as have some found in such as and including of Occupational and Environmental 2000; et al., 2000; & 1994). and found in cleaning products also are associated with 2000; & chemicals are commonly found in cleaning products and can be to the human body in very The and many of the of other body systems the of chemical to on into the and also can either from to their proper or and with the either important are and adverse health outcomes may The are in cleaning and found in care products and and found in and 2000; et al., 2006; et al., 2005). conventional cleaning chemicals and some less toxic 2005 the public schools a cleaning policy (Environmental Institute New York an the of cleaning products and the New York for public and private schools similar in and a in New to of states had cleaning In addition, many school districts have to or have cleaning even in the of and cleaning not only on the of toxic chemical but for the of more and the of proper for the cleaning staff. cleaning both for and for cleaning (e.g., and are A and human and environmental health its to In a cleaning the of cleaning can be with just one the number of chemicals in and and are also to their conventional in such as care and and indoor air cleaning include on proper and the of the cleaning products, as well as on and chemical these would be in a where the of is another important of cleaning The of and may be of & can be with and be to clean to and to in areas such as those areas by regulations and those where body may be and can most and may be for points, rather than to a cleaning need only their to a free of cleaning products on to staff and a by products and to based on the unique of the For schools that to the of a cleaning an evaluation of the current products, and used on site be conducted, and baseline such as the number of to the be Schools may also to an environmental health and safety to staff other than and to and schools would policy that would staff and However, it is most important that schools it is to a cleaning school an for a number of various and are and within school and and areas may also and among and other educational within schools (Healthy Schools Network, 2006). associated with include the of diseases from and allergies and asthma by and and to some or (EPA, from and may also physical hazards to (EPA, However, conventional control may hazards of their is often the of prevention and control in U.S. schools, and are used on school to control and are to and and and are often to enzyme or (EPA, are potentially toxic to children, and adults. Indeed, with the EPA are not to be safe for human health (Landrigan, Needleman, & Landrigan, 2002). of the enzyme in pesticides, in and in against remain in children through at 7 et al., Thus, this of to school-aged children as well as the of in a to regulation rather than a more precautionary have not been tested by standards and are commonly the complete of each at 10 years University Furthermore, most in have not been tested for their health effects on children (Landrigan, Needleman, & Landrigan, toxicological found that many harm the developing and as resulting in and and many are or (Landrigan, Needleman, & Landrigan, 2002). human health problems associated with exposure include and upper and even and in et al., 2005; for exposure to some has also been associated with health such as childhood such as and developmental and behavioral and disorders & & Rudant et al., 2007; Salam, Li, Langholz, & Gilliland, Weiss, & no federal regulations exist for in schools, the EPA that schools to the risk of exposure to children. is a and usually less for within schools, it not of A school of including the and of when However, a on measures and toxic such as to sources of and for within school and school include the and are at from and in and are either or and are and at a and are by the of each and are is and of at a are times the rather than one the or is to and rather than of are used when are needed (EPA, can and have been found as far as from the of for 2003). Thus, of particularly for schools near agricultural is also and be school schools to their school and and and provide when are used in the United are densely and often and by or budgets are often the to be when budgets In to poor availability of school sites and the lack of research and policy these unaddressed health hazards to the need to for school sites, and schools need to the and of the schools an environmental health to report on conditions and to provide to and the of school projects and the public to protect to from and air out areas to to such as to cleaning and to and clean out such as the National and primarily by the National Institute of Child Health and Human exposures in and Health by the a to these exposures. that and federal a for children's health at by the

Intellectual and developmental disabilities, 2010 · doi:10.1352/1934-9556-48.2.135