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Developmental toxicants, insidious in modes of action and effects, strike the very origin of our lives: the developing embryo, fetus, neonate, and child; they cause spontaneous abortions, stillbirths, malformations, early postnatal mortality, reduced birth weight, mental retardation, sensory loss as well as other functional or physical changes, including subclinical effects having far reaching social and economic impacts. The large majority of developmental defects have unknown etiologies. With this uncertainty, EPA and the scientific community world-wide give high priority to finding new approaches for assessing etiology and risks of developmental effects. The United Nations Conference on Environment and Development (UNCED) and Agenda 21 mobilized the international community to focus on risks posed by chemicals in the environment, including developmental risks. The international harmonization of test and risk assessment guidelines for developmental effects are priorities. Lead, persistent organic pollutants (POPs), endocrine disruptors, and the improvement of quantitative risk assessment methodologies, particularly for children, are priorities. EPA reinvented its research agenda to assure wide involvement of the National Science Foundation, other federal agencies, and national experts in research to address the U.S.'s public health and environmental priorities.

The California Healthy Building Study was designed to assess relations between ventilation system type and office worker symptoms in a set of U.S. buildings selected without regard to worker complaints. Twelve public office buildings in northern California meeting specific eligibility criteria were studied in the summer of 1990: three naturally ventilated, three mechanically ventilated (without air conditioning), and six air-conditioned buildings. Questionnaire data were collected from 880 workers in selected spaces within the study buildings. We adjusted effect estimates for various ventilation types for personal, job, and work place factors using logistic regression, and alternatively, using a mixed effects model (SAS/GLIMMIX) to adjust for correlated responses within study spaces. Higher adjusted prevalences of most symptom outcomes were associated with both mechanical and air-conditioned ventilation, relative to natural. With a conservative adjustment for problem building status, the highest adjusted prevalence odds ratios from logistic regression models were for dry or itchy skin [mechanical: odds ratio (OR) = 6.0, 95% confidence interval (CI) = 1.6-22; air-conditioned: OR = 6.0, 95% CI = 1.7-21] and lower respiratory symptoms (mechanical: OR = 2.9, 95% CI = 0.7-11; air-conditioned: OR = 4.0, 95% CI = 1.1-15). GLIMMIX estimates were similar, with slightly wider confidence intervals. Reporting bias was small. These findings of symptom increases within mechanically ventilated and air-conditioned U.S. buildings support previous findings available only from European buildings.

Speakers and participants in the workshop "Assessment of the Allergenic Potential of Genetically Modified Foods" met in breakout groups to discuss a number of issues including needs for future research. These groups agreed that research should progress quickly in the area of hazard identification and that a need exists for more basic research to understand the mechanisms underlying food allergy. A list of research needs was developed.

The commentary by Seal and Daum entitled “What Happened to Primum non nocere?” 1 that appeared in the May 2001 issue of Pediatrics criticized the July 1999 recommendation of the American Academy of Pediatrics (AAP) and US Public Health Service (USPHS) to delay the birth dose of hepatitis B vaccine for infants born to hepatitis B surface antigen (HBsAg)-negative women to reduce infant exposure to thimerosal.2 The commentary contains incorrect statements and oversimplifies the complex process of balancing multiple risks and benefits when formulating vaccine policy as summarized in the excellent article by Feudtner and Marcuse3 in the same issue. Some professionals had difficulty understanding the need for the July 1999 recommendations because they didn't fully understand the risks from organomercury exposure and the amounts of ethylmercury present in vaccines. Several developments in the past 2 years have reinforced the wisdom of the recommendations made in July 1999. Seal and Daum stated that methylmercury “might” be harmful to the developing fetal central nervous system. Methylmercury is neurotoxic at all ages, and the developing fetal brain is at least 10-fold more sensitive than the adult brain.4 They also incorrectly stated that “no data existed that implicated ethylmercury” as a cause of neurotoxicity. As reviewed by Ball et al,5 ethylmercury from thimerosal has caused significant neurotoxicity in infants, children, and adults. Such data were available at …

Exposure databases are useful for monitoring status and trends in environmental health. However, other supporting data are usually needed to infer human exposure or internal dose. Program planning and evaluation, environmental health surveillance, epidemiologic research, and contributions to international efforts are four major purposes for monitoring environmental exposure status and trends. Although databases play an important role in monitoring human exposure, certain methodological problems need to be overcome. The work group developed six criteria for meeting information needs for human exposure assessment. Areas that need attention are (1) specification of location, (2) specification of facility and chemical identifiers, (3) documentation of special populations at risk, (4) provision of early warning of new problems, (5) monitoring changes over time, and (6) enhancement of documentation. We tested these criteria by examining six available databases that might be used for monitoring exposure to contaminants in drinking water. Available data fell short of information needs. We drew four conclusions and offered several recommendations for each. First, available data systems lack adequate measures of human exposure. Second, data for monitoring exposures for many important population subgroups and environmental settings are inadequate. Third, an "early warning" system that monitors human exposures is needed. Fourth, designers of data-collection systems should consider the needs of users who monitor status and trends of human exposure.

Three outbreaks of food poisoning involving watermelons or cucumbers and caused by the carbamate pesticide aldicarb occurred in California between 1985 and 1988. For each outbreak, and for an outbreak of aldicarb poisoning associated with English cucumbers previously reported in the literature, dosages of aldicarb sulfoxide that caused the illnesses were estimated. Estimated dosages ranged between 0.0023 [corrected] and 0.06 mg/kg body weight, and most were well below the 0.025 mg/kg Lowest Observed Effect Level (LOEL) for subclinical blood cholinesterase depression previously reported for humans. These findings are consistent with aldicarb sulfoxide (ASO) illnesses that have occurred in other states. Aldicarb appears to be more toxic than previously suspected. Scientific and regulatory implications are discussed.

Is it time for congress to reduce its commitment to research related to the U.S. Department of Homeland Security (DHS)? Your article “Congress dials back research on understanding terrorism” (Y. Bhattacharjee, News Focus, 4 Aug., p. [610][1]) states, “senators would prohibit DHS from funding

To the Editor.— Dr Edgar J. Schoen does not like lead screening.1 In a letter to Pediatrics, "Lead Toxicity in the 21st Century: Will We Still Be Treating It?" he refers to a study my colleagues at the California Department of Health Services and I conducted in Oakland, California as "a vivid example of how poor methodology and biased selection of subjects can lead to greatly exaggerated prevalence rates," accusing me of having a "serious omission" in a submission to Morbidity and Mortality Weekly Report.

There are numerous pesticides and toxic chemicals in the environment that have yet to be evaluated for potential to cause developmental neurotoxicity. Recent legislation and testing initiatives provide an impetus to generating more information about potential hazards to children. In the United States, the 1996 Food Quality Protection Act (FQPA) required the U.S. Environmental Protection Agency (U.S. EPA) to make a finding that a pesticide food use is safe for children. In addition, the law requires U.S. EPA to incorporate an additional 10-fold factor in risk assessments for pesticide residue tolerances to take into account the special sensitivities of infants and children as well as incomplete data with respect to toxicity and exposures. The potential of chemicals in food and drinking water to cause endocrine disruption will also be examined via the Endocrine Disruptor Screening and Testing Program required by the FQPA and the 1996 Safe Drinking Water Act. In addition, a new voluntary chemical information program will provide screening-level information for the some 2,800 high-volume chemicals in commerce in the United States. These initiatives will need to be accompanied by research focused on developmental toxicity for children, including developmental disabilities. Developmental disabilities exact a large toll on children's health in the United States. Three major developmental disabilities--autism, cerebral palsy, and severe mental retardation--each affect substantial numbers of children. We know very little about the etiology of these conditions. A number of priority areas for research are suggested, including a large environmental prospective study of developmental neurotoxicity.

Children may be more susceptible to exposures to environmental toxins than adults and may be more vulnerable to their effects. Because of this, the health care community and those responsible for children need to be alert to possible environmental factors in identifying and responding to the health problems of children. Their focus should be on the causes of the health problem, emphasizing environmental sources, and not on simply treating the symptoms.

In Reply. —Dr Cunningham agrees that there is a need for a more targeted approach to lead screening. Certainly a tenet of public health is that our preventive efforts are most effective when we focus on those who are most at risk. However, how can we target in the absence of supportive data? In 1991, the CDC concluded that it would not be possible to predict which communities are at low enough risk of childhood lead exposure that screening would not be required. 1 The NHANES III data 2 would indicate that surveillance of lead exposure and reassessment of the CDC guidelines may well result in screening being more targeted in the future. In the meanwhile, unless there are data and methods available to determine which areas are of low risk, it is sound public policy for legislatures to follow the CDC guidelines. Dr Schoen is certainly entitled to his

Doing a better job of protecting children from environmental hazards requires having more and better information about both children’s susceptibility and their exposure to toxic substances. There are many critical gaps in knowledge of this issue. This article presents several examples specifically related to children’s exposure to pesticides which illustrate environmental risks for children. The cases examined include the risk posed to children by the use of the insecticide aldicarb on bananas, and reported illnesses in children caused by the use of the insecticide diazinon in the home and by the use of interior house paint containing mercury. The cases presented illustrate how regulatory agencies, parents, health care providers, and others who come into contact with children on a regular basis all have roles to play in filling in the information gaps regarding children’s exposure to environmental hazards and the deleterious effects of these exposures.

Lead poisoning is one of the worst environmental threats to children in the United States and is also entirely preventable. 1 An increased understanding of the adverse effects of lead poisoning—neurological, endocrinological, hematological, reproductive, and growth—resulted in the Centers for Disease Control and Prevention lowering the acceptable blood lead level three times in the last 20 years. 2 The article by Pirkle et al 3 documents the dramatic decrease in blood lead levels from 0.62 to 0.14 μmol/L (12.8 to 2.8 μg/dL) between 1976 to 1980 and 1988 to 1991. Most significantly, the percentage of US children aged 1 to 5 years with blood lead levels 0.48 μmol/L (10 μg/dL) or greater decreased from 88.2% to 8.9%. Decreases in blood lead levels occurred for all age and income groups. This is surely one of the most remarkable public health achievements of the decade and is undoubtedly the result of government

Objective: To determine if the severity of subacute symptoms in eosinophilia-myalgia syndrome (EMS) was affected by medical history or use of nutritional supplements other than tryptophan before illness. Design and Study Population: A case-control study was conducted of EMS cases systematically sampled from all those reported to a statewide surveillance system in California in 1989. Excluding two previous EMS-related deaths, interviews were completed in 73% (57/78) of the eligible case patients sampled. Main Outcome Measures: The severity of any myalgia(s), dyspnea, or walking impairment during each of the first 3 months of EMS was quantified by means of self-reported integer scores ranging from 0 (asymptomatic) to 10 (severe symptoms). Case patients in the top tercile of combined, unweighted monthly scores were defined as having severe symptoms. Results: All interviewees (57 of 57) had consumed supplemental tryptophan before illness; 89% (51/57) were female. The odds of severe symptoms were not significantly associated with gender, age, previous antidepressant use, or cumulative amounts of supplemental tryptophan consumed before or after EMS onset ( P >.1). Previous consumption of any multivitamin(s), however, was associated with significantly lower odds of severe symptoms (adjusted odds ratio, 0.05; 95% confidence limits, 0.007, 0.4; P =.006). Conclusions: The consumption of multivitamincontaining supplements before EMS appears to have modified the severity of subacute symptoms in this sample of cases from California. (Arch Intern Med. 1993;153:2368-2373)

This cross-sectional study, conducted in 1988, examines the association between hemoglobin level and behavior problems in 236 Hispanic children, ages 2 to 5 years, residing in low-income census tracts in the Los Angeles area. Venous blood samples were analyzed for hemoglobin, mean corpuscular volume, free erythrocyte protoporphyrin, and lead. Family and child data were obtained through a home interview with the child's mother or guardian. Behavior problems were assessed using questionnaires modeled after Child Behavior Checklists for children ages 2 to 3 and 4 to 5 years. A significant correlation between decreasing hemoglobin values and increasing total behavior problems scores was found for girls, 2 to 3 and 4 to 5 years old. These associations remained significant in both age groups after adjusting for maternal education and marital status. Statistically significant inverse correlations also were found between hemoglobin and social withdrawal, sleep problems, and depression (internalizing subscale behaviors) in 2− to 3-year-old girls, and between hemoglobin and aggression and hyperactivity (externalizing subscale behaviors) in 4− to 5-year-old girls. The potentially negative consequences of these anemia-related behavior problems on children's development, learning ability, and parent-child relationships warrant further investigation. J Dev Behav Pediatr 13:209–214, 1992. Index terms: hemoglobin, anemia, behavior, children, Hispanic.

To assess the effect of interim clean-up measures on the current health of a community, we conducted a follow-up survey of 193 residents living near the McColl waste disposal site and a comparison area located approximately 5 miles from the site. Results from this survey were compared with results from a similar survey conducted 7 years earlier. Odors were detected at least once per week by 32.7% of "high-exposed" respondents in 1988 compared with 68.5% in 1981, but prevalence odds ratios (PORs) comparing symptom reporting between "high-exposed" and comparison-area respondents were greater than that of the 1981 survey for 89% of symptoms. PORs comparing symptom reporting between these two areas were greater than 2.0 for 64% of symptoms assessed in the current survey. Symptoms reported in excess did not represent a single organ system or suggest a mechanism of response. PORs comparing respondents who were very worried about the environment and those reporting no worry were greater than 2.0 for 86% of symptoms. These finding, along with environmental data from the area, suggest that living near the waste disposal site and being very worried about the environment, rather than a toxicologic effect of chemical from the site, explain excess symptom reporting found in this follow-up study.

In order to assess the potential health impact of a hazardous waste disposal site, the parents of Love Canal and control children were interviewed about their children's health. The study population consisted of 523 Love Canal and 440 control children. The Love Canal population was composed of two groups. The homeowner group was primarily white and middle class. The renter group was primarily black and lived in low income housing. The two Love Canal groups were matched with two control groups from the same city for income, race, and education. The mean age of Love Canal children was 117.6 ± SE 2.2 months compared to 98.0 ± 2.4 months for control children. Interviewers questioned parents concerning children's health problems which were diagnosed by a physician. Seven health problems were more prevalent in Love Canal children after controlling for age, race, sex, household size, income and education. Adjusted odds ratios were: seizures, 2.45; learning problems, 1.51; hyperactivity (homeowners only)...

We studied dioxin levels in residents of two California households where dioxin contaminated homegrown eggs and beef were found, in order to determine the level of exposure to dioxins. Risk assessments for carcinogenicity and reproductive toxicity showed that theoretical risks exceeded proscribed regulatory levels. Advisory guidelines were issued about consumption of eggs, chicken and beef. Serum samples from exposed and matched rural comparison subjects were analyzed and preliminary dioxin data show statistically significant elevations of 2,3,7,8-penta and hexa dioxin isomers for both homes. Comparison subjects from rural California had lower serum dioxin levels than those previously reported for Missouri and Sweden. Adipose tissue from a resident of one of the homes was tested for dioxins. The resident died six months later and a post mortem retesting of adipose and testing of liver and lung tissues for dioxins was done. No unusual dioxin levels were found; levels of dioxin in adipose remained stable despite six months of not eating contaminated produce. Dioxins were not a contributing cause of death. In this study, dioxin contaminated eggs and beef have elevated 2,3,7,8-tetra, penta and hexa dioxin levels in serum. The ongoing investigation will seek to delineate the source and extent of contamination, and to determine the extent of the exposed population and potential health impacts.

Birth weight, prematurity, gestational age, and birth defects were assessed in 239 children exposed during gestational life to the Love Canal neighborhood and in 707 control children. The population living in Love Canal was composed of two groups; those referred to as homeowners who lived in single family homes and were predominantly white, and those referred to as renters who lived in a low income apartment complex and were predominantly black. These two groups were matched with comparable groups in the same city and a questionnaire was administered by trained interviewers at a neighborhood site or in the home. Mothers of exposed and control children were similar in socioeconomic status, smoking, alcohol consumption and medication use during pregnancy. There was no significant difference in prematurity, but the prevalence of low birth weight babies (

Studies carried out in California, following a fire which involved a pentachlorophenol wood treatment plant have indicated that low concentrations of dioxins and furans in soil can lead to bioaccumulation in chickens and cattle which are in contact with the soil. These compounds were found to distribute into various tissues of the animals and into the eggs of the chickens. A significant change in congener profile and isomer pattern was seen when comparing soils to tissues. Source tests of local incinerators showed quite different congener profile than was seen in soils. Concentrations found in animal products used as food suggest the possibility of excessive human exposure based on modest consumption assumptions.

(1988). Study, Endpoints, Goals, and Prioritization for a Program in Hazardous Chemical Epidemiology. Archives of Environmental Health: An International Journal: Vol. 43, No. 2, pp. 94-99.

Initial studies of children living near the hazardous waste site, Love Canal, showed that several health problems and low birthweight were more prevalent compared to control children. To determine whether growth was affected by exposure to environmental toxins, stature for age and weight for age percentiles (SAPR and WAPR) were determined for 493 Love Canal and 428 control children. For prepubertal children, a dose-response effect was seen with longer exposure associated with greater decreases in SAPR and WAPR. Those born and spending at least 75% of their lives in the Love Canal area were most affected: SAPR was 46.6 ± SE 2.2 for exposed compared to 53.0 ± 1.0 for controls (p=0.004) and WAPR was 50.1 ± SE 2.2 for exposed compared to 54.0 ± 1.0 for controls (p=0.05). Multiple linear regression analysis showed that white and black males and black females were most affected. The difference in stature could not be accounted for by differences in mid-parent stature, socioeconomic class, nutrition, birthweight, or chronic illness leaving exposure to the Love Canal area as the most likely cause. Differences seen in prepubertal children were not seen in pubertal children nor in parents who grew up in the Love Canal area suggesting a possible cohort effect. We conclude that anthropometric measures are valid and sensitive tools in assessing health impact of hazardous waste sites on children.

In Reply.— Drs Witt and Wagner express concern that our report suggests that aldicarb-related illness could result from food residues below the level of laboratory detection. Their arguments are based on a small study of corporate executives and on experimental data. A further description of the illnesses would be useful in clarifying our assertions in the earlier article. Report of a Case.— On the morning of July 4,1985, one of the index cases in this outbreak, a 62-year-old woman receiving digoxin therapy, was seen with lacrimation, salivation, diaphoresis, vomiting, diarrhea, and muscle twitching. She was in shock, with a heart rate of 31 beats per minute and atrial fibrillation. Two other family members who had shared a watermelon with her were also severely ill. Before there had been any publicity about contaminated melons, the physician diagnosed cholinesterase-inhibitor poisoning. Treatment with atropine resulted in resolution of the symptoms. Based on the