Environmental Injustice: Focus on Pediatric Neurodevelopmental Disorders

1
Environmental InjusticeFocus on Pediatric
Neurodevelopmental Disorders
AAIDD Toxic Exposures and Developmental
Disabilities Environmental Health Lecture
Series March 11, 2008

• Lawrence D. Rosen, MD
• Chair, Integrative Pediatrics Council
• lrosen_at_integrativepeds.org

2
The State of Childrens Health

• Cancer
• Prematurity
• Asthma/allergies
• Obesity/Diabetes
• Neurodevelopmental and Mental Health Disorders

3
Epidemiology

• 1/150 in US with ASD
• 1/100 in NJ with ASD
• 1/60 boys in NJ with ASD
• 1/12 in US with ADHD
• 1/6 with neurodevelopmental disorder
• Sharp increases also seen for depression, bipolar
  disorder, anxiety

4
Children as a priority

• The health of our children is one of the most
  important investments we can make and should be
  among our top priorities.
• -The Childrens Environmental Health Network
• The true measure of a nations standing is how
  well it attends to its children their health
  and safety, their material security, their
  education and socialization, and their sense of
  being loved, valued, and included in the families
  and societies into which they are born.
• - UNICEF, Child poverty in perspective An
  overview of child well-being in rich countries,
  Innocenti Report Card 7, 2007

5
How are we doing?
6
Environmental Injustice

• Environmental Justice is the fair treatment and
  meaningful involvement of all people regardless
  of race, color, national origin, or income with
  respect to the development, implementation, and
  enforcement of environmental laws, regulations,
  and policies. (U.S. EPA)
• Injustice is done when there exist health
  disparities based on these same factors.

7
Why Children?

• Children are not little adults - CHE LDDI
  statement, November 2007
• Neuroendocrine/immune development
• Differences in exposure to environmental toxins
• Doubly exposed (pre- and postnatal)
• Differences in excretion
• No political voice

8
The most vulnerable of the vulnerable

• Many of the children who are most heavily
  exposed in our society to environmental toxins
  are the same children who are poor, the same
  children who have either no access or inadequate
  access to medical care.
• - Dr. Philip Landrigan

9
CHE LDDI Scientific Consensus Statement
10
Environmental Triggers

• Genetic/Epigenetic Interaction
• Timing (prenatal and postnatal)
• Mixtures/multiple exposures
• List of potential stressors
• Malnutrition
• Stress
• Infections, ant-infectives, vaccines
• Toxins (air, land, water)

11
Host Factors
12
The Iceberg Model
PHENOMICS
METABOLOMICS
PROTEOMICS
GENOMICS
13
Specific Examples

• Lead
• Polychlorinated biphenyls (PCBs)
• Polycyclic aromatic hydrocarbons (PAHs)
• Nutrition
• Stress

14
Lead

• Even very low levels a/w ND differences
• BLLs gt5 mcg/dL among 1- to 5-year-old children
  was 25.6
• BLLs gt5 mcg/dL
• 46.8 of non-Hispanic black children
• 27.9 of Mexican American children
• 18.7 of non-Hispanic white children
• Older housing and poverty is greater risk
• Compared with non-Hispanic white children,
  non-Hispanic black children were 3 times more
  likely to have a BLL 5-10 mcg/dl, 7 times more
  likely to have a BLL of 10-20 mcg/dL, and 13.5
  times more likely to have a BLL gt20 mcg/dL

Bernard SM, McGeehin MA Pediatrics 2003. Review
of Third National Health and Nutrition
Examination Survey, 1988-1994.
15
PCBs

• PCB exposure affects development (multiple
  sources in LDDI statement)
• Native American children at high risk
  multigenerational exposure
• The most notable finding was the significant
  negative relationship between PCB levels and two
  separate measures of long term memory. There was
  also a negative relationship with a measure of
  comprehension and knowledge.
• - Newman et al PCBs and cognitive functioning
  of Mohawk adolescents. Neurotoxicol Teratol. 2006

16
PAHs

• Long known as carcinogens, more recently
  recognized as neurotoxic
• Children gt risk due to inhalation
• Inner city gt exposure
• Prenatal exposure affects neurodevelopment
  (Perera NYC studies)
• High prenatal exposure to PAHs was associated
  with lower mental development index at age 3
• The odds of cognitive developmental delay were
  also significantly greater for children with high
  prenatal exposure

17
Malnutrition

• Iron
• Zinc/Copper
• Vitamin D
• Essential fatty acids (omega 3s)

18
Stress of Poverty

• Multiple stressors (financial, social)
• Increased rates of maternal depression
• Alters neurohormones
• Dr. Martha Farah (Center for Cognitive
  Neuroscience, U-Penn) Stress is Neurotoxic

19
Conclusions

• Focus on childrens health
• Paradigm shift
• Focus on wellness and prevention
• Precautionary principle
• Interdisciplinary dialogue

20
References/Resources

• Rosen LD, Imus D Environmental injustice
  children's health disparities and the role of the
  environment. Explore (NY). 2007
  Sep-Oct3(5)524-8.
• CHEs LDDI Scientific Consensus Statement on
  Environmental Agents Associated with
  Neurodevelopmental Disorders www.healthandenviron
  ment.org
• Integrative Pediatrics Council
  www.integrativepeds.org, see for more web
  resources

21
Environmental InjusticeFocus on Pediatric
Neurodevelopmental Disorders
AAIDD Toxic Exposures and Developmental
Disabilities Environmental Health Lecture
Series March 11, 2008

• Lawrence D. Rosen, MD
• Chair, Integrative Pediatrics Council
• lrosen_at_integrativepeds.org