Children's Environmental Health: Proceedings of a Workshop (2023)

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CHILDREN’S ENVIRONMENTAL HEALTH: PROCEEDINGS OF A WORKSHOP Elizabeth Boyle and Alexandra McKay, Rapporteurs Board on Population Health and Public Health Practice Health and Medicine Division Board on Environmental Studies and Toxicology Division on Earth and Life Studies Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education THE NATIONAL ACADEMIES PRESS Washington, DC THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 PREPUBLICATION COPY: UNCORRECTED PROOFS 

This activity was supported by a contract between the National Academy of Sciences and the Environmental Protection Agency. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26848 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Children’s environmental health: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26848. PREPUBLICATION COPY: UNCORRECTED PROOFS 

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS 

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PLANNING COMMITTEE ON CHILDREN’S ENVIRONMENTAL HEALTH: A WORKSHOP ON FUTURE PRIORITIES FOR ENVIRONMENTAL HEALTH SCIENCES 1 Committee Members GERMAINE M. BUCK LOUIS (Chair), George Mason University MONA HANNA-ATTISHA, Michigan State University DARRYL B. HOOD, The Ohio State University HEATHER B. PATISAUL, North Carolina State University NSEDU O. WITHERSPOON, Children’s Environmental Health Network Staff HEALTH AND MEDICINE DIVISION STAFF ELIZABETH BARKSDALE BOYLE, Project Director, Senior Program Officer GILLIAN BUCKLEY, Senior Program Officer ALEXANDRA MCKAY, Senior Program Assistant ROSE MARIE MARTINEZ, Senior Board Director DIVISION ON EARTH AND LIFE STUDIES STAFF KALEY BEINS, Program Officer (until 2022) KATE GUYTON, Senior Program Officer CLIFFORD DUKE, Board Director DIVISION OF BEHAVIORAL AND SOCIAL SCIENCES AND EDUCATION STAFF ERIN FOX, Program Officer (until 2022) NATACHA BLAIN, Board Director 1 The National Academies of Sciences, Engineering, and Medicine's planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS 

Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: SHOJI F. NAKAYAMA, National Institute for Environmental Studies, Japan ARAMANDLA RAMESH, Meharry Medical College TRACEY J. WOODRUFF, University of California, San Francisco Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Howard Frumkin. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. PREPUBLICATION COPY: UNCORRECTED PROOFS 

Contents BOX AND FIGURES 1 Introduction 1 OPENING REMARKS 3 CHILDREN’S ENVIRONMENTAL HEALTH AT THE EPA 3 CRITICAL DATA GAPS AND THE PROMISE OF NEW METHODS 4 2 Informing Decision Making: State of the Science and Critical Gaps 11 WHY ADDRESSING ENVIRONMENTAL THREATS TO CHILDREN’S ENVIRONMENTAL HEALTH STILL MATTERS 12 CHILDREN’S ENVIRONMENTAL HEALTH, RESEARCH AND CIVIC ENGAGEMENT 14 HEAT AND CHILDREN’S HEALTH 17 PANEL DISCUSSION: CRITICAL GAPS THAT HOLD BACK PROGRESS IN ENVIRONMENTAL HEALTH POLICY 20 3 Environmental Influences on Children’s Health Across the Life-Span and Generations 24 THE EXPOSOME AND HEALTH EQUITY 25 BIOMARKERS OF PRENATAL EXPOSURE TO AIR POLLUTION AND CHILDREN’S HEALTH AND DEVELOPMENT 27 TESTICULAR CANCER AS A LATE SYMPTOM OF TESTICULAR DYSGENESIS SYNDROME 33 DISENTANGLING HETEROGENEOUS OUTCOMES TO BETTER UNDERSTAND ENVIRONMENTAL IMPACTS ON PREGNANCY AND CHILD HEALTH 37 PRENATAL EXPOSURES AND BIOMARKERS AS MARKERS FOR AUTISM RISK 39 PANEL DISCUSSION: RETHINKING EXPOSURES TO INFORM DECISION MAKING 41 4 Harnessing Data for Decision Making 42 STRATEGIES FOR USING DATA DELIVERING PUBLIC HEALTH 43 BREAKOUT SESSIONS 45 ALTERNATIVE ANIMAL MODELS 46 CUMULATIVE RISK ASSESSMENT 47 BIOMARKERS 49 5 Balancing Prevention and Uncertainty 51 CASE EXAMPLES OF SCIENCE INFORMING POLICY 52 MINNESOTA DEPARTMENT OF HEALTH CASE EXAMPLES 52 NEW YORK STATE CHILDREN’S ENVIRONMENTAL HEALTH CENTERS (NYSCHECK) 55 STRATEGIES TO IMPROVE CHILDREN’S ENVIRONMENTAL HEALTH IN KING COUNTY, WA 57 PREPUBLICATION COPY: UNCORRECTED PROOFS 

PANEL DISCUSSION: STRATEGIES FOR TAKING ACTION DESPITE UNCERTAINTY 59 CLOSING REMARKS 61 LITTLE MISS FLINT VIDEO 61 6 References 63 Appendix A Workshop Agenda 71 Appendix B Biosketches for Workshop Planning Committee Members, Speakers, and Discussants 74 PREPUBLICATION COPY: UNCORRECTED PROOFS 

FRONT MATTER xi Box and Figures BOX 1-1 Statement of Task, 2 FIGURES 1-1 Global chemical production and capacity index over time, 7 1-2 Cumulative plastic production since 1960 (calculated as the sum of annual global polymer resin, synthetic fiber, and plastic additive production), 7 3-1 Timing of maturational events in human brain development, 29 3-2 Simplified scheme of molecular epidemiology and biomarkers, 30 3-3 Current model for the pathogenesis of germ cell tumors, 34 3-4 Hypothesized pathway for development of testicular germ cell cancer from testicular dysgenesis syndrome via dysfunction of fetal Sertoli and Leydig cells, 35 3-5 Global trends in testicular cancer diagnosis, 36 PREPUBLICATION COPY: UNCORRECTED PROOFS