Children's Environmental Health Indicators in Context of the Sustainable Development Goals for Small Island Developing States.

The unique environmental vulnerability of small island developing states (SIDS) is likely to impact negatively on children's health. Children's environmental health indicators (CEHI) are standardized measures that can be used to assess the environmental exposures and their resulting health outcomes in children. This study sought to utilize the United Nations (UN) global Sustainable Development Goals (SDGs), with their associated targets and indicators, as a framework for a CEHI proposal for SIDS. Exposure-side indicators were taken from key themes from the 2012 Rio+20 UN Conference on Sustainable Development, and health-side indicators were selected based on the most significant contributors to the burden of disease in children. The multiple-exposures⁻multiple-effect (MEME) framework was then used to show the relationships between environmental exposures and children's health outcomes. The framework was populated with available data from the World Bank's DataBank. Whilst there was some data available at a population level, major gaps in both exposure-side and health-side indicators were revealed. In order to progress children's environmental health in SIDS, a further piece of work is required to propose a fully prioritized set of exposure-side and health-side CEHIs; based on, but not exclusively linked to, the SDGs.

Children's Environmental Health Indicators for Low- and Middle-Income Countries in Asia.

BACKGROUND: Given that low- and middle-income countries (LMICs) in Asia still have high child mortality rates, improved monitoring using children's environmental health indicators (CEHI) may help reduce preventable deaths by creating healthy environments. OBJECTIVES: Thus, the aim of this study is to build a set of targeted CEHI that can be applied in LMICs in Asia through the CEHI initiative using a common conceptual framework. METHODS: A systematic review was conducted to identify the most frequently used framework for developing CEHI. Due to the limited number of eligible records, a hand search of the reference lists and an extended search of Google Scholar were also performed. Based on our findings, we designed a set of targeted CEHI to address the children's environmental health situation in LMICs in Asia. The Delphi method was then adopted to assess the relevance, appropriateness, and feasibility of the targeted CEHI. FINDINGS: The systematic review indicated that the Driving-Pressure-State-Exposure-Effect-Action framework and the Multiple-Exposures-Multiple-Effects model were the most common conceptual frameworks for developing CEHI. The Multiple-Exposures-Multiple-Effects model was adopted, given that its population of interest is children and its emphasis on the many-to-many relationship. Our review also showed that most of the previous studies covered upper-middle- or high-income countries. The Delphi results validated the targeted CEHI. The targeted CEHI were further specified by age group, gender, and place of residence (urban/rural) to enhance measurability. CONCLUSIONS: Improved monitoring systems of children's environmental health using the targeted CEHI may mitigate the data gap and enhance the quality of data in LMICs in Asia. Furthermore, critical information on the complex interaction between the environment and children's health using the CEHI will help establish a regional environmental children's health action plan, named "The Children's Environment and Health Action Plan for Asia."

Association between maternal intake of n-6 to n-3 fatty acid ratio during pregnancy and infant neurodevelopment at 6 months of age: results of the MOCEH cohort study.

BACKGROUND & AIMS: Long-chain polyunsaturated fatty acids (LC-PUFAs) are essential for infant neurodevelopment. The nutritional adequacy of dietary LC-PUFAs depends not only on the LC-PUFAs intake but also on the n-6 to n-3 fatty acid ratio (n-6/n-3 PUFAs). This study aimed to identify the association between the maternal dietary n-6/n-3 PUFAs and motor and cognitive development of infants at 6 months of age. METHODS: We used data from 960 participants in the Mothers and Children's Environmental Health (MOCEH) study, which is a multi-center prospective cohort study. Dietary intake of pregnant women was assessed by a one-day 24-h recall method. Food consumption of infants was estimated based on the volume of breast milk and weaning foods. The duration of each feed was used to estimate the likely volume of milk consumed. Dietary intake of infants at 6 months was also assessed by a 24-h recall method. Cognitive and motor development of infants at 6 months of age was assessed by the Korean Bayley scales of infant development edition II (BSID-II) including the mental developmental index (MDI) and the psychomotor developmental index (PDI). RESULTS: Maternal intakes of n-6/n-3 PUFAs and linoleic acid (LA)-to-α-linolenic acid (ALA) ratio (LA/ALA) were 9.7 ± 6.3 and 11.12 ± 6.9, respectively. Multiple regression analysis, after adjusting for covariates, showed that n-6/n-3 PUFAs was negatively associated with both the MDI (ß = -0.1674, P = 0.0291) and PDI (ß = -0.1947, P = 0.0380) at 6 months of age. These inverse associations were also observed between LA/ALA and both the MDI and PDI (MDI; ß = -0.1567; P = 0.0310, PDI; ß = -0.1855; P = 0.0367). Multiple logistic regression analysis, with the covariates, showed that infants whose mother's LA/ALA were ranked in the 2nd, 3rd, and 4th quartile were at approximately twice the risk with more than twice the risk of delayed performance on the PDI compared to the lowest quartile (1st vs. 2nd; OR = 2.965; 95% CI = 1.376 - 6.390, 1st vs. 3rd; OR = 3.047; 95% CI = 1.374 - 6.756 and 1st vs. 4th; OR = 2.551; 95% CI = 1.160 - 5.607). CONCLUSIONS: Both the maternal dietary n-6/n-3 PUFAs and LA/ALA intake were significantly associated with the mental and psychomotor development of infants at 6 months of age. Thus, maintaining low n-6/n-3 PUFAs and LA/ALA is encouraged for women during pregnancy.

Multiple assessment methods of prenatal exposure to radio frequency radiation from telecommunication in the Mothers and Children's Environmental Health (MOCEH) study.

OBJECTIVES: To evaluate prenatal exposure to radiofrequency radiation (RFR) from telecommunication using a mobile phone questionnaire, operator data logs of mobile phone use and a personal exposure meter (PEM). MATERIAL AND METHODS: The study included 1228 mother-infants pairs from the Mothers and Children's Environmental Health (MOCEH) study - a multicenter prospective cohort study ongoing since 2006, in which participants were enrolled at ≤ 20 weeks of pregnancy, with a follow-up of a child birth and growth to assess the association between prenatal environmental exposure and children's health. The questionnaire included the average calling frequency per day and the average calling time per day. An EME Spy 100 PEM was used to measure RFR among 269 pregnant women from November 2007 to August 2010. The operators' log data were obtained from 21 participants. The Spearman's correlation test was performed to evaluate correlation coefficient and 95% confidence intervals between the mobile phone use information from the questionnaire, operators' log data, and data recorded by the PEM. RESULTS: The operators' log data and information from the self-reported questionnaire showed significantly high correlations in the average calling frequency per day (ρ = 0.6, p = 0.004) and average calling time per day (ρ = 0.5, p = 0.02). The correlation between information on the mobile phone use in the self-reported questionnaire and exposure index recorded by the PEM was poor. But correlation between the information of the operators' log data and exposure index for transmission of mobile communication was significantly high: correlation coefficient (p-value) was 0.44 (0.07) for calling frequency per day, and it was 0.49 (0.04) for calling time per day. CONCLUSIONS: The questionnaire information on the mobile phone use showed moderate to high quality. Using multiple methods for exposure assessment might be better than using only one method. Int J Occup Med Environ Health 2016;29(6):959-972.

Environmental Pollution: An Under-recognized Threat to Children's Health, Especially in Low- and Middle-Income Countries.

Exposures to environmental pollutants during windows of developmental vulnerability in early life can cause disease and death in infancy and childhood as well as chronic, non-communicable diseases that may manifest at any point across the life span. Patterns of pollution and pollution-related disease change as countries move through economic development. Environmental pollution is now recognized as a major cause of morbidity and mortality in low- and middle-income countries (LMICs). According to the World Health Organization, pollution is responsible for 8.9 million deaths around the world each year; of these, 94% (8.4 million) are in LMICs. Toxic chemical pollution is growing into a major threat to children's health in LMICs. The disease and disability caused by environmental pollution have great economic costs, and these costs can undercut trajectories of national development. To combat pollution, improved programs of public health and environmental protection are needed in countries at every level of development. Pollution control strategies and technologies that have been developed in high-income countries must now be transferred to LMICs to assist these emerging economies to avoid the mistakes of the past. A new international clearinghouse is needed to define and track the health effects of pollution, quantify the economic costs of these effects, and direct much needed attention to environmental pollution as a risk factor for disease.

Maternal iron intake at mid-pregnancy is associated with reduced fetal growth: results from Mothers and Children's Environmental Health (MOCEH) study.

BACKGROUND: Iron supplementation is a common recommendation for pregnant women to prevent iron deficiency during pregnancy. There is an increasing concern about excessive iron consumption as a general iron prophylaxis by pregnant women without any due consideration about their dietary iron intake or iron status. Our present study investigated the association between total iron intake from diet and supplements and fetal growth in 337 pregnant women at mid-pregnancy in South Korea. METHODS: Iron intake from diet and supplements was examined by a 24-hour recall method. Subjects were divided into three groups based on tertiles of total iron intake levels. Fetal biometry was assessed by ultrasonography at mid-pregnancy. RESULTS: About 99% of the non-supplement users had iron intake below the recommended nutrient intake (RNI) for pregnant women (24 mg), whereas 64.9% of supplement users had iron intake above the upper level (UL) (45 mg). In the babies of mothers in the third tertile of iron intake (>17.04 mg), biparietal diameter, abdominal circumference, and femur length were lower by 0.41 cm (P =0.019), 0.41 cm (P = 0.027), and 0.07 cm (P = 0.051), respectively, than the babies of mothers in the second tertile of iron intake (11.49 ~ 17.04 mg). CONCLUSION: These results suggest that excessive maternal iron intake at mid-pregnancy is associated with reduced fetal growth. Iron supplementation for pregnant women should be individualized according to their iron status. Appropriate diet education is needed for pregnant women so that they can consume adequate amounts of iron from food and supplements.

Exposure to environmental tobacco smoke among South Korean adults: a cross-sectional study of the 2005 Korea National Health and Nutrition Examination Survey.

BACKGROUND: Studies have identified that environmental tobacco smoke exposure is associated with sociodemographic factors such as age, sex, and socioeconomic status, but few studies have been conducted in South Korea. In this study, the authors investigated the extent of environmental tobacco smoke exposure and factors related in a nationally representative sample of Korean adults. METHODS: The data of 7,801 adults aged 19 years and over collected during the 2005 Korea National Health and Nutrition Examination Survey were analyzed. Information on smoking habits and exposure to environmental tobacco smoke was obtained by self-reports using a standardized questionnaire. Risks of environmental tobacco smoke exposure conferred by sociodemographic variables and behavioral risk factors were evaluated using logistic regression methods. RESULTS: Overall, 36.1% of nonsmokers (defined as those not currently smoking) and 50.1% of current smokers were found to be exposed to environmental tobacco smoke either at work or at home. Among the nonsmokers, women were more likely to be exposed to environmental tobacco smoke at home (OR = 5.22, 95%CI, 4.08-6.67). Furthermore, an inverse relationship was found between education level and the risk of environmental tobacco smoke exposure at home (OR = 1.73, 95%CI, 1.38-2.17 for those with a high school education; OR = 2.30, 95%CI, 1.68-3.16 for those with a middle school education; and OR = 2.58, 95%CI, 1.85-3.59 for those with less than an elementary school education vs. those with a college education or more). In addition, those with office, sales service, or manual labor jobs were found to be at significantly higher risk of environmental tobacco smoke exposure at work than those with professional, administrative, or managerial jobs. Also, the risk of environmental tobacco smoke exposure in the workplace was significantly higher for alcohol drinkers than non-drinkers (OR = 1.23, 95%CI, 1.07-1.47). After adjusting for age, sex and education, it was found that those exposed to environmental tobacco smoke at home were more likely to have been admitted to hospital during the previous year (OR 1.29, 95%CI, 1.002-1.66). CONCLUSIONS: In this study of Korean adults, exposure to environmental tobacco smoke at home or work was found to be affected by sex, age, marital status, educational level, and type of occupation. Accordingly, these factors should be given appropriate consideration by those developing policies or interventions designed to control exposure to environmental tobacco smoke.

Parental socioeconomic status and unintentional injury deaths in early childhood: consideration of injury mechanisms, age at death, and gender.

The aim of this study was to determine whether the socioeconomic status (SES) of parents influences early childhood unintentional injury deaths for different injury mechanisms and the gender and age at death of the child. Study design is a population-based retrospective study. Death certificate data from 1995 to 2004 were linked to birth certificate data from 1995 to 1996 for each child who died when aged < or = 8 years. Parental age, birth order, marital status, residence area, educational level, and occupation were used as indices for SES. Cox proportional-hazards analysis was employed. Our results indicate that nonmetropolitan residence, low parental education level, and a father working in a nonadministrative job or as a farmer were associated with a higher risk of death from injury for both boys and girls. A mother aged younger than 20 years and parents working in manual jobs were associated with a higher risk in boys only. The risks of some socioeconomic factors (low parental education and a father working in a manual job or as a farmer) were evident for children aged 1-4 years. The risks of rural residency tended to increase in older children, and the risk of injury from having a mother aged younger than 20 years increased for younger children. The risks of childhood injury deaths from traffic accidents, falls, and fire/burns were associated with the SES of the parents. Younger parents were associated with higher risks of injury deaths from traffic accidents (hazard ratio [HR]: father, 7.9; mother, 1.9) and falls (HR: father, 2.0; mother, 2.5). A father working as a farmer was associated with a higher risk of childhood injury death from fire/burns (HR = 4.0). In conclusion, the parental SES risk profiles of childhood injury deaths varied with the age and gender of the child, and with the injury mechanism. Therefore, reducing excess injury deaths during early childhood requires preventive efforts targeted at high-risk parents, and based on injury mechanism and on the gender and age of the child.

The Mothers and Children's Environmental Health (MOCEH) study.

The MOCEH study is a prospective hospital- and community-based cohort study designed to collect information related to environmental exposures (chemical, biological, nutritional, physical, and psychosocial) during pregnancy and childhood and to examine how exposure to environmental pollutants affects growth, development, and disease. The MOCEH network includes one coordinating center, four local centers responsible for recruiting pregnant women, and four evaluation centers (a nutrition center, bio-repository center, neurocognitive development center, and environment assessment center). At the local centers, trained nurses interview the participants to gather information regarding their demographic and socioeconomic characteristics, complications related to the current gestation period, health behaviors and environmental factors. These centers also collect samples of blood, placenta, urine, and breast milk. Environmental hygienists measure each participant's level of exposure to indoor and outdoor pollutants during the pre- and postnatal periods. The participants are followed up through delivery and until the child is 5 years of age. The MOCEH study plans to recruit 1,500 pregnant women between 2006 and 2010 and to perform follow-up studies on their children. We expect this study to provide evidence to support the hypothesis that the gestational environment has an effect on the development of diseases during adulthood. We also expect the study results to enable evaluation of latency and age-specific susceptibility to exposure to hazardous environmental pollutants, evaluation of growth retardation focused on environmental and genetic risk factors, selection of target environmental diseases in children, development of an environmental health index, and establishment of a national policy for improving the health of pregnant women and their children.

[Environmental health surveillance of low birth weight in Seoul using air monitoring and birth data].

OBJECTIVES: The principal objective of this study was to determine the relationship between maternal exposure to air pollution and low birth weight and to propose a possible environmental health surveillance system for low birth weight. METHODS: We acquired air monitoring data for Seoul from the Ministry of Environment, the meteorological data from the Korean Meteorological Administration, the exposure assessments from the National Institute of Environmental Research, and the birth data from the Korean National Statistical Office between January 1, 2002 and December 31, 2003. The final birth data were limited to singletons within 37-44 weeks of gestational age. We defined the Low Birth Weight (LBW) group as infants with birth weights of less than 2500g and calculated the annual LBW rate by district. The air monitoring data were measured for CO, SO(2), NO(2), and PM(10) concentrations at 27 monitoring stations in Seoul. We utilized two models to evaluate the effects of air pollution on low birth weight: the first was the relationship between the annual concentration of air pollution and low birth weight (LBW) by individual and district, and the second involved a GIS exposure model constructed by Arc View 3.1. RESULTS: LBW risk (by Gu, or district) was significantly increased to 1.113(95% CI=1.111-1.116) for CO, 1.004 (95% CI=1.003-1.005) for NO(2), 1.202(95% CI=1.199-1.206) for SO(2), and 1.077(95% CI=1.075-1.078) for PM(10) with each interquartile range change. Personal LBW risk was significantly increased to 1.081(95% CI=1.002-1.166) for CO, 1.145(95% CI=1.036-1.267) for SO(2), and 1.053(95% CI=1.002-1.108) for PM(10) with each interquartile range change. Personal LBW risk was increased to 1.003(95% CI=0.954-1.055) for NO(2), but this was not statistically significant. The air pollution concentrations predicted by GIS positively correlated with the numbers of low birth weights, particularly in highly polluted regions. CONCLUSIONS: Environmental health surveillance is a systemic, ongoing collection effort including the analysis of data correlated with environmentally-associated diseases and exposures. In addition, environmental health surveillance allows for a timely dissemination of information to those who require that information in order to take effective action. GIS modeling is crucially important for this purpose, and thus we attempted to develop a GIS-based environmental surveillance system for low birth weight.

[Public perceptions of the risk of Asian dust storms in Seoul and its metropolitan area].

OBJECTIVES: In spite of the recent increased concern for Asian dust storms, there are few studies concerning how dangerous the general public recognizes these dust storms to be. This study examined the public's perceptions of the risk of the Asian dust storms and also the source of the information concerning the risk. METHODS: A telephone interview survey using a standardized questionnaire was done for the adults living in Seoul and its metropolitan area from May 15th, 2003 to May 16th, 2003. The contents of the questionnaire were the sociodemographic characteristics, the perceptions of risk to the Asian dust storms, and the coping strategy of the study participants. RESULTS: The study participants get their information on Asian dust storms mainly from TV newscasts and they have a good knowledge of them. They regard it as one of the most dangerous health risks, along with dioxin. They think that it is associated with allergic rhinitis, conjunctivitis and bronchial asthma, etc. Of the 500 study participants, 201(40.2%) persons suffered bodily discomforts during the Asian dust storm period. CONCLUSIONS: Although there are uncertainties about the health risks of Asian dust storms, the public thinks these dust storms are very dangerous to health in many ways. This negative perception will not disappear easily. To fill the gap of the public's perceptions of the risk and the objective evidence of its health effects, more studies about its health effects and the methods to reduce exposure are required.