Unintentional Tobacco Smoke Exposure in Children.

Secondhand smoke (SHS) exposure increases the prevalence and severity of sinopulmonary diseases in children. The primary source of SHS exposure in children is through adults who live in the same house; however, the level of exposure may vary based on the adult smoking habits at home. This prospective cross-sectional study in Alberta, Canada, investigated the relationship between self-reported caregiver smoking, location, outdoor temperature and children's' urine cotinine: creatinine ratio (CCR), a marker of nicotine metabolism. Participants aged 0−9 were recruited from the Child Health Clinics at the Misericordia Community Hospital in Edmonton, Alberta, from 8 January to 24 February 2016 and 30 June to 18 August 2016. Participant CCR levels were compared to caregiver-reported smoking location and environmental factors such as temperature and season. Of the 233 participants who reported smoking status, 21% reported smoking, in keeping with local smoking rates. More participants smoked indoors during the winter than the summer; however, some families limited indoor smoking to a garage. Of the 133 parent−child dyads who provided smoking information and a child urine sample, 18 had an elevated cotinine:creatinine ratio, suggestive of significant tobacco smoke exposure, 15 of whom were from homes that reported smoking. Age < 1 year and number of cigarettes smoked in the home weekly were risks for significant exposure while season, outdoor temperature and smoking location in the home did not reach significance. Smokers should be counseled to protect children, particularly infants, from exposure by limiting the number of cigarettes smoked and isolating smoking to outside the home. Segregated areas such as a garage may provide a useful harm mitigation strategy for indoor smokers, provided the garage does not share ventilation or is not in close proximity to high-traffic areas of the home.

Need for global core competencies in Child Health and the Environment: a Canadian perspective.

Children are the planet's most valuable resource. Mortality rates and longevity in children are improving; however, morbidity related to early-life exposures is increasing and with it health spending. A focus on identifying and addressing environmental components related to not only chronic childhood illnesses but also major adult mortalities would help contain current healthcare budgets. Child Health and the Environment (CHE) is an emerging discipline dedicated to managing early-life exposures (prenatal and childhood) on health outcomes throughout life. In Canada, as well as around the world, recognition of this area is growing, but progress has been slow and training of physicians is lacking. The WHO works closely with the Children's Environmental Health Clinic in Canada as well as collaborating centres around the world to build awareness of environmental health issues and promote improved care of children. Core competencies in CHE for physicians would provide an important step forward.

Global climate change and health in Canadian children.

Climate change is a reality. Numerous expert authorities warn of the critical need to undertake and adapt environmental efforts to protect human health. Climate change is accelerating, and countries in high latitudes, such as Canada, are experiencing climate change more directly and, for some end points, more dramatically than mid- and low-latitude countries. Children are vulnerable to climate change health effects, and physicians and other health care providers need to be ready to identify, manage, and prevent climate change-related health hazards. This practice point highlights specific, climate change-related threats to the health of children and youth, and provides resources for health care providers. Climate challenges and their health impacts on children are described, based on key Canadian reports and scientifically referenced information. Enhanced awareness of the immediate and longer-term health effects of climate change on children allows physicians and other health care providers to counsel families and practice more effectively.

Interdisciplinary-driven hypotheses on spatial associations of mixtures of industrial air pollutants with adverse birth outcomes.

BACKGROUND: Adverse birth outcomes (ABO) such as prematurity and small for gestational age confer a high risk of mortality and morbidity. ABO have been linked to air pollution; however, relationships with mixtures of industrial emissions are poorly understood. The exploration of relationships between ABO and mixtures is complex when hundreds of chemicals are analyzed simultaneously, requiring the use of novel approaches. OBJECTIVE: We aimed to generate robust hypotheses spatially linking mixtures and the occurrence of ABO using a spatial data mining algorithm and subsequent geographical and statistical analysis. The spatial data mining approach aimed to reduce data dimensionality and efficiently identify spatial associations between multiple chemicals and ABO. METHODS: We discovered co-location patterns of mixtures and ABO in Alberta, Canada (2006-2012). An ad-hoc spatial data mining algorithm allowed the extraction of primary co-location patterns of 136 chemicals released into the air by 6279 industrial facilities (National Pollutant Release Inventory), wind-patterns from 182 stations, and 333,247 singleton live births at the maternal postal code at delivery (Alberta Perinatal Health Program), from which we identified cases of preterm birth, small for gestational age, and low birth weight at term. We selected secondary patterns using a lift ratio metric from ABO and non-ABO impacted by the same mixture. The relevance of the secondary patterns was estimated using logistic models (adjusted by socioeconomic status and ABO-related maternal factors) and a geographic-based assignment of maternal exposure to the mixtures as calculated by kernel density. RESULTS: From 136 chemicals and three ABO, spatial data mining identified 1700 primary patterns from which five secondary patterns of three-chemical mixtures, including particulate matter, methyl-ethyl-ketone, xylene, carbon monoxide, 2-butoxyethanol, and n-butyl alcohol, were subsequently analyzed. The significance of the associations (odds ratio > 1) between the five mixtures and ABO provided statistical support for a new set of hypotheses. CONCLUSION: This study demonstrated that, in complex research settings, spatial data mining followed by pattern selection and geographic and statistical analyses can catalyze future research on associations between air pollutant mixtures and adverse birth outcomes.

Lead toxicity with a new focus: Addressing low-level lead exposure in Canadian children.

Although acute and subacute lead toxicity requiring active treatment is rare in Canada, paediatricians need to be aware of new evidence linking lower lead levels to neurodevelopmental deficits. Health Canada has identified potential exposures occurring prenatally, in infancy and during early childhood from food and water, household dust, soil, and mouthing products that contain lead. Children with neurodevelopmental problems who live in older housing and newcomers to Canada may be at greater risk. Symptoms may be latent, subtle, and chronic. Blood assay, widely available clinically, does not confirm diagnosis unless lead exposure has been recent. Human biomonitoring data are available in the Canadian Health Measures Survey, and Health Canada has suggested that clinicians use these new reference ranges. Early detection and prevention of lead exposure are key public health objectives because effects of lead toxicity are chronic and treatment is complex.

Environmental pediatrics: an introduction and evaluation of online resources.

INTRODUCTION: The World Health Organization (WHO) estimates that three million children under the age of 5 die annually from environmentally related disease. In the United States, the cost of environmentally related public health concerns is estimated as greater than $55 billion. Environmental exposure is among parents' top health concerns for children. Yet, the study of the effects of environmental exposure on health outcomes is a developing field, and clinicians feel inadequately prepared to address these concerns. The Children's Environmental Health Clinic (ChEHC) is the first clinic of its kind in Canada. Their website includes a list of online resources on major topics related to child health and the environment. There has not yet been an objective evaluation of the comprehensiveness of the topics or scientific quality of the information on the website. This study seeks to offer an accessible introduction to the field of environmental pediatrics, including an online resource for evidence-based information on key topics in the field. These resources assist in disease prevention, health promotion, education, and the increasing need to balance environmental health risks. METHODS: A scoping review of scientific and gray literature in the field of environmental pediatrics was performed to inform a written introduction to the field and to identify gaps in the content of the ChEHC website. The content of the ChEHC website was then objectively evaluated using the National Network of Libraries of Medicine checklist for health websites. RESULTS: Ten categories within the field of environmental pediatrics emerged from the literature review. A small number of gaps were identified on the website and in the literature. The content of the ChEHC website was found to be of high quality. FUTURE DIRECTIONS: The website will be updated using the results of the study as a guide, to make it as relevant, complete, and evidence-based as possible. CONCLUSIONS: Environmental pediatrics is an important, emerging topic. There is a need for accessible, evidence-based pediatric environmental health resources for clinicians and the general public. The products of this study (a publication and website) respond to that need and thus assist in disease prevention and health promotion.

E-Waste and Harm to Vulnerable Populations: A Growing Global Problem.

BACKGROUND: Electronic waste (e-waste) is produced in staggering quantities, estimated globally to be 41.8 million tonnes in 2014. Informal e-waste recycling is a source of much-needed income in many low- to middle-income countries. However, its handling and disposal in underdeveloped countries is often unsafe and leads to contaminated environments. Rudimentary and uncontrolled processing methods often result in substantial harmful chemical exposures among vulnerable populations, including women and children. E-waste hazards have not yet received the attention they deserve in research and public health agendas. OBJECTIVES: We provide an overview of the scale and health risks. We review international efforts concerned with environmental hazards, especially affecting children, as a preface to presenting next steps in addressing health issues stemming from the global e-waste problem. DISCUSSION: The e-waste problem has been building for decades. Increased observation of adverse health effects from e-waste sites calls for protecting human health and the environment from e-waste contamination. Even if e-waste exposure intervention and prevention efforts are implemented, legacy contamination will remain, necessitating increased awareness of e-waste as a major environmental health threat. CONCLUSION: Global, national, and local levels efforts must aim to create safe recycling operations that consider broad security issues for people who rely on e-waste processing for survival. Paramount to these efforts is reducing pregnant women and children's e-waste exposures to mitigate harmful health effects. With human environmental health in mind, novel dismantling methods and remediation technologies and intervention practices are needed to protect communities. CITATION: Heacock M, Kelly CB, Asante KA, Birnbaum LS, Bergman AL, Bruné MN, Buka I, Carpenter DO, Chen A, Huo X, Kamel M, Landrigan PJ, Magalini F, Diaz-Barriga F, Neira M, Omar M, Pascale A, Ruchirawat M, Sly L, Sly PD, Van den Berg M, Suk WA. 2016. E-waste and harm to vulnerable populations: a growing global problem. Environ Health Perspect 124:550-555; http://dx.doi.org/10.1289/ehp.1509699.

Children's health in Latin America: the influence of environmental exposures.

BACKGROUND: Chronic diseases are increasing among children in Latin America. OBJECTIVE AND METHODS: To examine environmental risk factors for chronic disease in Latin American children and to develop a strategic initiative for control of these exposures, the World Health Organization (WHO) including the Pan American Health Organization (PAHO), the Collegium Ramazzini, and Latin American scientists reviewed regional and relevant global data. RESULTS: Industrial development and urbanization are proceeding rapidly in Latin America, and environmental pollution has become widespread. Environmental threats to children's health include traditional hazards such as indoor air pollution and drinking-water contamination; the newer hazards of urban air pollution; toxic chemicals such as lead, asbestos, mercury, arsenic, and pesticides; hazardous and electronic waste; and climate change. The mix of traditional and modern hazards varies greatly across and within countries reflecting industrialization, urbanization, and socioeconomic forces. CONCLUSIONS: To control environmental threats to children's health in Latin America, WHO, including PAHO, will focus on the most highly prevalent and serious hazards-indoor and outdoor air pollution, water pollution, and toxic chemicals. Strategies for controlling these hazards include developing tracking data on regional trends in children's environmental health (CEH), building a network of Collaborating Centres, promoting biomedical research in CEH, building regional capacity, supporting development of evidence-based prevention policies, studying the economic costs of chronic diseases in children, and developing platforms for dialogue with relevant stakeholders.

Fish consumption by children in Canada: Review of evidence, challenges and future goals.

Fish consumption is of great importance to children's health and is essential for neurodevelopment, which begins in pregnancy and continues throughout early childhood and into adolescence. However, fish consumption presents conflicting health outcomes associated with its nutritional benefits and its adverse contaminant risks, because both avoiding fish as well as the consumption of contaminated fish can potentially harm children. This may be challenging to communicate. The present review was performed to assess the current knowledge and recommendations around 'smart' fish-consumption decisions. Health Canada advises, as well as other advisories and guides, that fish should be consumed for its health benefits, while also informing consumers, especially women and children, to limit certain fish consumption. The current literature must attempt to handle the challenges inherent in communicating the dilemmas of children's fish consumption. Incorporation of new knowledge translation strategies are proposed as a means to raise the level of knowledge about optimal fish consumption practices.

La consommation de poisson est essentielle pour la santé des enfants et pour le développement neurologique, qui commence pendant la grossesse et se poursuit pendant la petite enfance et l'adolescence. Cependant, les issues de santé liées à ses bienfaits nutritionnels et aux risques néfastes des contaminants qu'il contient sont conflictuels, parce que le fait d'éviter le poisson peut nuire à l'enfant tout autant que la consommation de poisson contaminé. Il peut être difficile de transmettre ce message. Les auteurs ont effectué la présente analyse pour évaluer les connaissances et les recommandations actuelles au sujet des décisions relatives à la consommation « intelligente ¼ de poisson. Les conseils de Santé Canada, de même que d'autres avis et lignes directrices, indiquent qu'il faut consommer du poisson en raison de ses bienfaits pour la santé, mais ils préconisent également aux consommateurs, notamment les femmes et les enfants, de limiter la consommation de certains poissons. Les publications actuelles doivent viser à relever les défis inhérents à la communication des dilemmes liés à la consommation de poisson par les enfants. On propose d'intégrer de nouvelles stratégies de transfert du savoir pour accroître le niveau de connaissances sur les pratiques optimales de consommation de poisson.

Food additives, essential nutrients and neurodevelopmental behavioural disorders in children: A brief review.

In recent decades, changing lifestyles in Canadian homes has led to demand for foods with long shelf lives that are cosmetically appealing, palatable, easy to prepare and to consume. Food additives, especially preservatives and artificial colours as well as suboptimal intake of essential nutrients, have been linked to hyperactive behaviours and poor attention in a subgroup of children. Although other risk factors (ie, genetic, etc) for these conditions have received more attention in the scientific literature, the authors believe that there is enough evidence to consider dietary influences as a modifiable risk factor. This would involve raising awareness among clinicians and, subsequently, reviewing food regulatory processes to better protect children in Canada - similar to the regulations recently undertaken by the British Food Standards Agency. Conflicts of interest due to food and medication industry support for organizations advocating for children would need to be resolved by open communication between government regulatory agencies, academia and industry. Canadian parents and children need to be advised to limit unnecessary food additives and consume a diet rich in essential nutrients while more complete relationships are being explored further.

Is lead a concern in Canadian autistic children?

BACKGROUND: The Centers for Disease Control and Prevention (CDC) threshold for intervention for blood lead level (BLL) is greater than 0.48 µmol/L, but new research suggests that there are adverse effects at any level of exposure. Children with autism are at increased risk for lead exposure and intoxication, and have later and more prolonged exposures because of exploratory oral behaviours and pica. OBJECTIVE: To estimate the mean BLL and prevalence of high BLL in a convenience sample of autistic children living in northern Alberta, based on the CDC threshold for intervention. METHODS: Children with autism were recruited from the clinics at the Glenrose Rehabilitation Hospital in Edmonton, Alberta. A complete blood count and differential, serum ferritin and BLL were requested after consent was obtained. Summary statistics were reported. For dichotomous outcomes, proportions were presented. Continuous outcomes for the two groups with a BLL of 0.1 µmol/L or greater, or less than 0.1 µmol/L were compared. RESULTS: None of the children tested had a BLL exceeding 0.48 µmol/L. Nine children (19%) had BLLs of 0.1 µmol/L or greater but less than 0.48 µmol/L, and 39 (81%) had BLLs of less than 0.1 µmol/L. Those with a BLL of 0.1 µmol/L or greater had significantly more pica or oral exploratory behaviours. CONCLUSION: Children with autism in northern Alberta may not be at risk for elevated BLLs that exceed the CDC threshold for intervention. They should be screened for lead exposure risk factors and tested if there are risks, especially behaviours relating to pica and oral exploration of objects. Clinicians may need to further explore the reasons for low-level exposures to lead in the autistic population.

Development of the pediatric environmental health specialty unit network in North America.

Training in environmental health in general, and pediatric environmental health in particular, is inadequate. The Agency for Toxic Substances and Disease Registry began to develop pediatric environmental health specialty units (PEHSUs) after noting the dearth of practitioners who could evaluate and manage children with exposures to environmental health hazards. The Environmental Protection Agency subsequently joined in providing support for what has developed into a network of 13 PEHSUs in North America. PEHSUs provide services to families, act as consultants to clinicians and public agencies, develop educational materials, and respond to natural disasters, including hurricanes and wildfires. PEHSUs are relatively easy to organize and should be replicable internationally.

Medical laboratory investigation of children's environmental health.

Medical laboratory testing is vital for investigating and managing children who have environmentally related disorders and children with environmental chemical exposures. Few of these compounds can be measured in a routine clinical service laboratory. An understanding of the exposure circumstances and toxicology of the agent is required for the ordering and interpretation of tests. Test interpretation requires understanding of the capabilities and limitations of these tests. Adequate investigation, management, and follow-up of exposed children are mandatory.

Trends in childhood cancer incidence: review of environmental linkages.

Cancer in children is rare and accounts for about 1% of all malignancies. In the developed world, however, it is the commonest cause of disease-related deaths in childhood, carrying with it a great economic and emotional cost. Cancers are assumed to be multivariate, multifactorial diseases that occur when a complex and prolonged process involving genetic and environmental factors interact in a multistage sequence. This article explores the available evidence for this process, primarily from the environmental linkages perspective but including some evidence of the genetic factors.

Ambient air pollution and children's health: A systematic review of Canadian epidemiological studies.

BACKGROUND: There is growing concern about the health effects of ambient air pollution (AP) in children. The present article summarizes and compares local information regarding the adverse effects of AP on the health of Canadian children with reports from elsewhere. METHODS: PUBMED, MEDLINE and EMBASE databases were searched for epidemiological studies, published between January 1989 and December 2004, on the adverse health effects of criteria air pollutants among Canadian children. RESULTS: Eleven studies investigated the association between AP and various respiratory health outcomes, while one study assessed the effect of AP on sudden infant death syndrome. Another study examined the effects of AP on pregnancy outcomes. Most of the available information was from Ontario and British Columbia. Despite inconsistencies among study results and data from elsewhere, evidence from Canadian studies suggest that AP may cause adverse respiratory health effects in children and adverse pregnancy outcomes, and may contribute to infant mortality in Canada. INTERPRETATION: AP has detrimental health effects among Canadian children. Paediatricians and other health care workers with an interest in child health should encourage parents and children to adhere to smog (AP) advisories. Existing regulatory practices should be reviewed to reduce current levels of ambient air pollutants in Canada.

An urban survey of paediatric environmental health concerns: Perceptions of parents, guardians and health care professionals.

OBJECTIVES: To conduct a survey in Edmonton, Alberta, to gather information regarding concerns about the influence of environmental factors on children's health and to use the information to set an agenda for the resources of the Paediatric Environmental Health Specialty Unit at Misericordia Hospital (Edmonton, Alberta). METHODS: Two questionnaires with 28 closed-ended questions were developed to examine parents', guardians' and health care professionals' concerns. They comprised items about six environmental factors (air, water and food quality; household supplies; radiation; and waste disposal). Health care professionals were also asked four questions about their knowledge of and their needs in Paediatric Environmental Health. Parents and guardians attending the public health centres and nurses working therein received questionnaires. Physicians were surveyed by e-mail. RESULTS: After verification, the questionnaire data from 400 parents or guardians and 152 health care professionals were used for analyses. Results from contingency table, Hotelling's T² and effect size analyses revealed similarities in the levels of concern in both groups, and the results were combined. The greatest concern of both groups was with environmental tobacco smoke, followed by pesticides in water. Concerns about six additional environmental elements were also expressed. The health care professionals showed a high level of concern about the need for resources, specific training and public education regarding paediatric environmental health. CONCLUSION: A significant level of concern was consistently found between the two groups studied, regardless of professional training. The highest level of concern was with a well-documented topic (ie, environmental tobacco smoke). Less concern associated with decreased documentation calls for increasing the knowledge of society, including health care professionals, to address the adverse effects of environmental factors on children.