Environmental Health Perspectives and children's environmental health. (Editorials).

Environmental Heath Perspectives has become the world's leading journal in children's environmental health. The annual issues devoted to children's health, published since 1998, have become the premier publication in the field. Coverage grew in 2000, and EHP now includes a special section on children's health every month. Topics addressed have included the impacts of lead, PCBs, and pesticides on neurobehavioral development (e.g., Bauer et al. 2002; Eskenazi et al. 1999; Jacobs et al. 2002); asthma and air pollution (e.g., Delfino et al. 2002; Gehan 2002); endocrine disruption and reproductive health and development (e.g., Crisp et al. 1998; Eskenazi et al. 2002); dioxins and child health (e.g., Vreugdenhil et al. 2002); chemical contamination of breast milk (e.g., Landrigan et al. 2002a); and the costs of diseases of environmental origin in children (Landrigan et al. 2002b). The number of children's health articles published each year in EHP has increased steadily from 12 in 1996 to 46 in 2001. Increasingly, too, EHP has recognized that problems in children's environmental health are international in scope, and so has carried reports from around the world.

Now, with the beginning of this new academic year, EHP plans to increase its coverage of children's environmental health yet again. EHP will publish more articles each month in the Children's Health section and will continue the publication of monographs on children's health. In addition, there will be more children's health coverage in the Environews section and on the EHP Web site. We aim to publish a quarterly EHP Children's Health edition beginning next year. We are delighted to have been named pediatric co-editors of EHP with responsibility for overseeing this increased effort. We pledge to work diligently with the entire EHP community to ensure a steadily increasing flow of manuscripts of ever improving quality.

Children's environmental health as a field has grown with extraordinary rapidity. Since 1998, 12 Children's Environmental Health Research and Disease Prevention Centers have been established in medical schools and schools of public health across the United States with the joint support of the NIEHS and the U.S. EPA [see "On a Growth Curve: Children's Environmental Health Centers," pp. A570-A572 this issue]. These centers conduct multidisciplinary basic and applied research as well as community-based prevention research. They have become powerful generators of new knowledge on the environmental causes of developmental disabilities, including learning disabilities and autism, and on the causes, triggers, and genetic determinants of pediatric asthma. These centers provided essential epidemiologic follow-up of children born in New York City after 11 September 2001. Eleven Pediatric Environmental Health Specialty Units have been formed with grants from the Agency for Toxic Substances and Disease Registry. These academic referral centers work collaboratively with practicing pediatricians and provide clinical service for children exposed to hazardous substances. The Ambulatory Pediatric Association has created a new national fellowship program in environmental pediatrics that accepted its first trainees in July of this year. And planning is under way for the National Children's Study, an ambitious prospective epidemiologic investigation that was proposed in 1998 by the President's Task Force and authorized by the Children's Health Act of 2000. This study will follow 100,000 children in all regions of the United States from early in pregnancy through adulthood to examine the impact of early environmental exposures on health and development over the life span.

Why has research in children's environmental health expanded so rapidly? We trace this growth to two events. First, in 1993, the National Academy of Sciences (NAS) published a landmark report, Pesticides in the Diets of Infants and Children (NAS 1993). This study found that children have unique patterns of exposure to environmental toxicants as well as developmentally determined vulnerabilities that have no counterpart in adult life. It found that the approaches to risk assessment and regulation then in use--which focused on average population exposures and were based principally on the adult experience--potentially failed to protect children. It called for fundamental and far-reaching revisions in research, risk assessment, and regulation. The NAS report focused on pesticides, but the implications went far beyond. Second, one year later in 1994, the Children's Environmental Health Network convened its first scientific conference on children's environmental health. This gathering reaffirmed the special susceptibility of children, examined critically the gaps in knowledge of pediatric toxicology, and recommended development of a research agenda in children's environmental health as an urgent national priority.

In 1996, those recommendations were codified into U.S. national policy with unanimous passage by both houses of Congress of the Food Quality Protection Act, which adopted all of the major recommendations of the NAS report. It requires that pesticide standards be set at levels protective of children's health. It mandates screening of chemicals for endocrine toxicity. It requires the imposition of safety factors in regulation when data on developmental toxicity are lacking. It set the stage for the establishment of the U.S. EPA's Office of Children's Health Protection in 1996, for the Presidential Executive Order of 1997 (Clinton 1997) requiring all federal agencies to reduce environmental threats to children's health, and for the current outpouring of research.

There has occurred a similar, more recent burst of activity in children's environmental health internationally. The World Health Organization has created a Task Force in children's environmental health in response to growing concerns by member nations about the contributions made by environmental threats to the global burden of pediatric disease (Brundtland 2002). Its mission is to prevent disease and disability caused in children by chemical, physical, and biological threats. In the past three years, the task force has organized major international meetings in Manila, Washington, and Bangkok to raise consciousness and to disseminate knowledge about children's health worldwide [see "World's Children Threatened." EHP 110:A290 (2002)]. At the Bangkok meeting, scientists and policy makers issued a statement committing themselves to work together to protect the health of all children (WHO 2002). The theme of World Health Day 2003 will be "Healthy Environments for Children."

We anticipate that in the years ahead publication of research in children's environmental health from nations around the world will continue to increase. A sound infrastructure has been established, and newly trained scientists of many disciplines are coming into the field. Extraordinary interdisciplinary synergy has been seen in the United States in the Children's Environmental Health Centers, and these will continue to be uniquely important foci of scientific excellence. We expect that new knowledge will be gained of children's environmental exposures, that gene-environment interactions will be elucidated, that breakthroughs in understanding the environmental causes of disease in children will be made, and that community-based intervention research will provide a sound basis for prevention. It will be our responsibility to continue EHP's proud tradition of publishing outstanding research in children's health.

REFERENCES

Bauer R, Colborn T, Palanza P, Parmigiani S, vom Saal F, eds. 2002. Impact of Endocrine Disruption on Brain Development and Behavior. Environ Health Perspect 110(suppl 3):328-449.

Brundtland GH. 2002. Health: a pathway to sustainable development. JAMA 288:156.

Clinton WJ. 1997. Executive Order 13045. The Protection of Children to Environmental Risks and Safety Risks. Fed Reg 62:19885-19888.

Crisp TM, Clegg ED, Cooper RL, Wood WP, Anderson DG, Baetcke KP, et al. 1998. Environmental endocrine disruption: an effects assessment and analysis. Environ Health Perspect 106(suppl 1):11-56.

Delfino RJ, Zeiger RS, Seltzer JM, Street DH, McLaren CE. 2002. Association of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication use. Environ Health Perspect 110:A607-A617.

Eskenazi B, Brandman A, Castorina R. 1999. Exposures of children to organophosphate pesticides and their potential adverse health effects. Environ Health Perspect 107(suppl 3):409-419.

Eskenazi B, Mocarelli P, Warner M, Samuels S, Vercellini P, Olive D, et al. 2002. Serum dioxin concentrations and endometriosis: a cohort study in Seveso, Italy. Environ Health Perspect 110:629-634.

Gehan B, ed. 2002. Air Toxics and Asthma. Environ Health Perspect 110(suppl 4):499-589.

Jacobs DE, Clickner RP, Zhou JY, Viet SM, Marker DA, Rogers JW, et al. 2002. The prevalence of lead-based paint hazards in U.S. housing. Environ Health Perspect 110:A599-A606.

Landrigan PJ, Sonowane B, Mattison D, McCally M, Garg A, eds. 2002a. Chemical Contaminants in Breast Milk. Environ Health Perspect 110:A313-A351.

Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. 2002b. Environmental pollutants and disease among American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environ Health Perspect 110:721-728.

NAS. 1993. Pesticides in the Diets of Infants and Children. Washington, DC:National Academy Press.

Vreugdenhil HJI, Slijper FME, Mulder PGH, Weisglas-Kuperus N. 2002. Effects of perinatal exposure to PCBs and dioxins on play behavior in Dutch children at school age. Environ Health Perspect 110:A593-A598.

WHO. 2002. The Bangkok Statement. International Conference on Environmental Threats to the Health of Children: Hazards and Vulnerability, 3-7 March 2002. Bangkok, Thailand.

Brenda Eskenazi
University of California, Berkeley
Berkeley, California
[e-mail]

Philip J. Landrigan
Mount Sinai Medical Center
New York, New York
[e-mail]