Tuesday, October 19, 2010

Welcome and Introductions

Christopher Zarba, Deputy Director, National Center for Environmental Research, EPA

Peter Grevatt, Ph.D., Director, EPA Office of Children’s Health Protection and Special Advisor to EPA Administrator on Children’s Health

Session 1 – The Children’s Environmental Health Community:  Who, What, Where, and How
Moderator:  Marie Lynn Miranda, Ph.D., Director, Southern Center on Environmentally Driven Disparities on Birth Outcomes, Duke University

Session Description:  A panel representing leadership from various federal agencies and  institutions, and national programs  will present an overview of their key roles  in children’s environmental health research, clinical practice, and public health policy, including the NIEHS/EPA Children’s Environmental Health and Disease Prevention Research Centers (Children’s Centers), Pediatric Environmental Health Specialty Units (PEHSUs), the National Children’s Study (NCS), EPA, NIEHS  and Congressional leadership. This session will set the tone for fostering collaboration and will explore how the players can address children’s environmental health issues together.

Panel Speakers:
Gwen W. Collman, Ph.D., Interim Director, National Institute of Environmental Health Sciences

Jerome A. Paulson, M.D., Co-Director, Mid-Atlantic Center for Children's
Health & the Environment at Children's National Medical Center

Steven Hirschfeld, M.D., Ph.D., Acting Director, National Children's Study, Eunice Kennedy Shriver National Institute of Child Health and Human Development
                                                               
Sally Darney, Ph.D., EPA/ORD National Program Director for Human Health

Robin Appleberry, Counsel to Representative Henry A. Waxman, Chairman of the House Committee on Energy and Commerce

Session 2 – Prenatal Exposures
Moderator:  Brenda Eskenazi, Director, Children's Center for Environment Health, UC Berkeley 

Session Description: The prenatal period can be uniquely susceptible to effects from exposure to toxic substances.  Some effects may manifest early (e.g., birth defects), others later in childhood (e.g., childhood cancer), and some not until adulthood or even the next generation.  Identifying sources and exposures to chemicals during pregnancy is an important step in developing preventive intervention programs that improve health.  This session will present the science and policy approaches in two different areas:  one where the science is well-established on the impacts on development (lead) and one where the science is evolving rapidly (phthalates and other endocrine-disrupting chemicals).  In addition, speakers representing PEHSUs will present a clinical case study followed by relevant scientific findings, with an emphasis on findings to inform appropriate clinical advice.  In addition, speakers will address challenges for communicating with individual patients/parents in the clinical setting, and patients/parents and the public at large about preventing exposures.
                                                               
Speakers:
Kevin Chatham-Stephens, M.D., Pediatric Environmental Health Fellow, Mount Sinai Pediatric Environmental Health Specialty Unit

Susan Buchanan, M.D., M.P.H., Associate Director, Great Lakes Center for Children’s Environmental Health

James Quackenboss, National Exposure Research Laboratory, EPA 

Robin Whyatt, Dr.P.H., Deputy Director, Columbia Center for Children's Environmental Health

Sheela Sathyanarayana, M.D., M.P.H., Pediatric Environmental Medicine Specialist, Northwest Pediatric Environmental Health Specialty Unit at the University of Washington

Session 3 – Environmental Exposures and Neurodevelopmental Effects
Moderator:  Kimberly Gray, NIEHS

Session Description:  There is evidence to suggest that there are environmental effects on mental disorders, most notably an increased rise in many types of mental disorders in young people in the last 50 years.  The cause for the rapid rise in rates remains unknown.  However, few genetic links have been identified and replicated, and thus lend support to a substantial role of the environment in these complex diseases.  In the past ten years, the NIEHS and U.S. EPA Children's Centers have reported a link between early exposure to environmental chemicals and neurobehavioral and cognitive impairment in infants and children.  In addition, the Pediatric Environmental Health Specialty Units (PEHSU) report great interest in these health effects on the part of parents and clinicians, with more and more questioning the effects of environmental exposures and neurodevelopmentally related outcomes.
Exposure can occur early during fetal development via transplacental delivery, postnatally via breast milk, or directly through the child's environment.  We will explore the scientific data to support long-term changes in neurodevelopment associated with early exposures as well as new animal data to support potential mechanistic pathways of importance as well as new measures of sub-clinical phenotypes and potential confounding effects of current therapies.  The PEHSUs will present information on chelation practices that have not been approved by FDA and on environmental exposures and autism spectrum disorders.  This session will provide an integrated summary of studies exploring the relationship between the environment and development delays in children conducted by investigators from the Children's Environmental Health Centers and cases being confronted by PEHSUs currently.
                                                               
Speakers:
Susan Schantz, Director, FRIENDS Children’s Environmental Health Center, University of Illinois

Leslie Rubin, M.D., Co-Director, The Southeast Pediatric Environmental Health Specialty Unit at Morehouse School of Medicine

Alan Woolf, M.D., M.P.H., New England Pediatric Environmental Health Specialty Unit at The Children’s Hospital, Boston 

Lunch on your own

Session 4 – Role of Children's Environmental Health Science to Inform Chemicals Management
Moderator:  John M. Balbus, M.D., M.P.H., Senior Advisor for Public Health, National Institute of Environmental Health Sciences

Session Description:  Chemical production has dramatically increased since World War II, with more than 80,000 chemical substances registered for use in the United States, and about 2,800 of these are used or imported in more than 1 million pounds.  Only a fraction of these substances have been adequately tested for potential human health effects due to inadequacies in the current regulatory structure in the United States.  This has been recognized by the U.S. EPA, nongovernmental organizations, and industry. 

Session 5 – Children’s Environmental Health in a Global Context
Moderator:  Leslie Rubin, M.D., PEHSU Co-Director, The Southeast Pediatric Environmental Health Specialty Unit at Morehouse School of Medicine

Session Description:  Ninety-one percent of the world’s 1.8 billion children ages 0-14 years live in developing countries.  Urbanization, unregulated industrialization, population growth and displacement, and increased pressure on limited natural resources underlie the environmental hazards in poorer nations.  The World Health Organization (WHO) estimates that approximately one third of the disease burden in developing countries is attributable to environmental factors, two to three times higher than the attributable portion in the most developed countries. This unequal disease burden on the poorer nations may be further aggravated by differences in access to health care.  The disparate burden of disease for children in developing countries due to air, water, soil, and food contamination is less well characterized compared with children in the more developed nations.  Mitigation measures are often unaddressed in the quest for economic  development.  Obstacles to protecting children’s environmental health in developing countries include inadequate medical and public health infrastructure and financial resources, shortage of laboratory equipment and trained technical personnel, and distrust between the public and governmental agencies.

This session will explore the existing and potential infrastructure for establishing and maintaining global partnerships to improve children’s environmental health in a global context.  Specifically, lessons learned and future directions for research collaboratives, training initiatives, and establishment of a network of global children’s environmental health centers will be discussed.
                                               
Speakers:
Catherine Karr, M.D., Ph.D., M.S., Director, Northwest Pediatric Environmental Health Specialty Unit at the University of Washington 

Tom Robins, University of Michigan Fogarty Center 

Frederica P. Perera, Dr.P.H., Director, Columbia Center for Children’s Environmental Health

Session 6 – Social and Community Context for Understanding Children’s Environmental Health Outcomes
Moderator:  Marie Lynn Miranda, Ph.D., Director, Southern Center on Environmentally Driven Disparities on Birth Outcomes, Duke University

Session Description:  Although it is widely agreed that maternal and fetal health and well-being are determined by multiple forces, surprisingly little is known about the interactions of those forces.  For example, elevated environmental exposures often occur in communities facing multiple social stressors like deteriorating housing, inadequate access to health care, poor schools, high unemployment, high crime, and high poverty — all of which may compound the effects of environmental exposures.  This phenomenon is especially severe for low income and minority pregnant mothers, with significant health implications for the fetuses they carry.  This session will focus on the social context within which environmental exposures occur as well as the differential response to environmental exposures that may be induced by underlying social stress.

Speakers:
Rosalind J. Wright, M.D., Channing Laboratory, School of Medicine, Harvard University

Richard Auten, M.D., Department of Pediatrics, School of Medicine, Duke University

Scott Crain, Medical-Legal Partnership of Seattle

Wednesday, October 20, 2010

Session 7 – Federal Partnerships to Protect Children’s Environmental Health
                                                               
Speakers:
Kevin Teichman, Ph.D., Deputy Administrator of Science, Office of Research and Development, EPA

Lisa P. Jackson, M.S., EPA Administrator

Gwen Collman, Ph.D., National Institute for Environmental Health Sciences

Howard K. Koh, M.D., M.P.H., Assistant Secretary for Health, U.S. Department of Health and Human Services

Session 8 – Recap of the Previous Day

Session 10 – Opportunities for Collaboration – Reporting Out From Breakouts
Moderator:  Peter Grevatt, Ph.D., Director, EPA Office of Children’s Health Protection and Special Advisor to EPA Administrator on Children’s Health

Session 11 – The Big Talk – Next Steps for Children’s Environmental Health
                                                               
Speaker:
Annie Murphy Paul, journalist and author of “Origins:  How the Nine Months Before Birth Shape the Rest of our Lives”