Mount Sinai. Annual Review. Children s Environmental Health Center. School of Medicine

Transcription

1 Mount Sinai School of Medicine Children s Environmental Health Center Annual Review 2011

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3 Mount Sinai Children s Environmental Health Center Annual Review 2011 Table of Contents Introduction...2 Our History...4 Core Programs of the Children s Environmental Health Center...6 Pilot Research Projects...6 The Autism and Learning Disabilities Discovery and Prevention Project...8 The Breast Cancer and the Environment Research Program (BCERP)...8 The BCERP Puberty Study...8 The Endocrine Disruptor Discovery Project...9 Fellowship in Children s Environmental Health...9 Growing Up Healthy in East Harlem...10 The National Children s Study...10 The Mount Sinai Pediatric Environmental Health Specialty Unit (PEHSU)...10 The Year in Review...11 Improving Children s Health Around the World...12 Setting the Foundation for New Discoveries: The Autism and Learning Disabilities Discovery and Prevention Project...13 The Mount Sinai Pregnancy Biobank...13 New Research Breakthroughs on Neurodevelopmental Impairment...13 Expanding the CEHC Team: The Recruitment of Shanna H. Swan, PhD...14 Measuring the Economic Cost of Children s Environmental Health...14 Legislative Victory...14 Dr. Landrigan Edits the Mount Sinai Journal of Medicine...14 Mount Sinai Greening Our Children...15 Looking Forward: Philanthropy at the Children s Environmental Health Center...16 Appendix: Papers and Book Chapters Published by the CEHC Team in Executive Board...19 Contact the Children s Environmental Health Center...20

4 2 Around the world, the rates of childhood disease are increasing. While the most traditional contagious diseases of childhood have been conquered, asthma, autism, learning disabilities, allergies, obesity, and leukemia have become the most common pediatric diseases. In the United States: Child asthma rates have nearly tripled over the past three decades. Asthma is now the leading cause of emergency room visits, hospitalizations, and school absenteeism. One of every 110 children is affected by autism. Neurodevelopmental disorders autism, ADHD, dyslexia, mental retardation, and other learning disabilities now affect 10 to 15% of the four million babies born in the U.S. each year. Childhood obesity has tripled over the past 20 years, rising from 5% to 17%. Type II diabetes, previously unknown in children, is now becoming epidemic. Both childhood leukemia and brain cancer have increased in incidence by about 40% since Childhood cancer has become the leading cause of death among children under the age of 15. Today s children are at greater risk for breast and testicular cancer. In young men, incidence of testicular cancer has increased by over 50% and is being diagnosed at younger ages. In young women, 13% of girls have reached the onset of puberty by age seven, putting them at greater risk for lifelong breast cancer.

5 Introduction There is a strong and growing body of evidence that links environmental exposures to increasing rates of these diseases. Children are uniquely vulnerable to the effects of toxic chemicals. Their developmental processes are easily disrupted, and their ability to excrete toxic chemicals is significantly lower than adults. Their bodies are smaller and absorb more chemicals. During unique windows of early vulnerability that occur during the nine months of pregnancy and early childhood exposures to even low levels of toxic chemicals can produce harmful effects. In 2008, our country spent $76.6 billion on children s diseases induced by the environment 3.5% of annual healthcare costs. We know that these diseases are preventable; yet, less than 2% of our annual medical dollars are spent to prevent and understand their causes. According to the Centers for Disease Control and Prevention (CDC), almost half of Americans are suffering from at least one chronic disease. As a result, we spend more per capita than any other nation on healthcare, including $1.5 trillion on chronic diseases that are known to be preventable. Numerous studies have shown that disease prevention is one of the most cost-effective, long term strategies to improve our country s health. Yet, the U.S. spends more on direct medical care and health insurance than it does on preventive action. Estimates consistently show that less than 2% of our annual medical dollars are spent on disease prevention. Now, more than ever, we need to focus on the causes of chronic diseases not merely deal with the consequences. 3 The Children s Environmental Health Center is dedicated to discovering the preventable environmental causes of childhood diseases. America s children are at risk of becoming the first generation in over a century to live shorter, less healthy lives than their parents. While public health initiatives have made great strides in reducing the rates of preventable diseases like heart disease, lung cancer, and diabetes, it is time to focus on the diseases that affect our children. At CEHC, we are at the forefront of this emerging field. Under the leadership of Philip J. Landrigan, MD, MSc, renowned pediatrician and epidemiologist, we are conducting groundbreaking research to identify the preventable causes of childhood disease.

6 Our History The Children s Environmental Health Center (CEHC) builds upon three decades of work by Dr. Philip J. Landrigan, who has devoted his career to protecting children against environmental threats to health. As a pediatrician, Dr. Landrigan has seen first hand the threats that untested, synthetic chemicals can pose to children s health. In response, he established the country s first academic research and policy center to examine the links between toxic exposures and childhood illness in 1998, formerly called the Center for Children s Health and the Environment (CCHE). CCHE evolved into the Children s Environmental Health Center (CEHC), officially established in Dr. Landrigan and his team at CEHC are deeply experienced in translating research into successful strategies for improving children s health. Our Center understands how to use research findings to advocate for evidence-based policies that protect children against toxic exposures in the environment. We have done it before. Dr. Landrigan s work in disease prevention began in the 1970s at the Centers for Disease Control and Prevention (CDC), where he led efforts to control measles and rubella epidemics across the United States. During this time, he also worked in the Global Campaign for the Eradication of Smallpox one of the great medical triumphs of the twentieth century. Each year, smallpox killed thousands of people around the world; now it has been virtually eliminated. In the early 1970s, Dr. Landrigan began a series of landmark studies that investigated the effects of lead on American children. Using careful epidemiologic investigations conducted among children who lived near a lead smelter in El Paso, Texas, he found that lead causes brain damage to children even when exposures are too low to cause obvious signs and symptoms. This breakthrough discovery led to a fundamental new understanding of how lead and other toxic chemicals can damage the developing brains of infants and children. Ultimately, this discovery convinced the U.S. government to mandate removal of lead from gasoline and paint actions that have produced a 95% decline in childhood lead poisoning, increased the average IQ score by six points, and saved the U.S. government $200 billion each year. In 1993, Dr. Landrigan led the creation of a groundbreaking report at the National Academy Sciences (NAS), which found children to be uniquely susceptible to the effects of pesticides. This NAS report argued that children are not little adults and compiled evidence showing that children are more vulnerable to pesticides and other toxic chemicals. It also called for stricter regulations on pesticide use to protect children s health. Dr. Landrigan s efforts profoundly changed public policy on pesticides and other toxic substances, serving as the blueprint for the Food Quality Protection Act of 1996 the only federal environmental law that contains explicit provisions for the protection of children. Our Center s Director, Philip J. Landrigan, MD, MSc This NAS report also created the intellectual foundation for the 1997 Presidential Executive Order on Children s Health and the Environment, which recognized that children are uniquely susceptible to environmental hazards. During this time, Dr. Landrigan served as the Senior Advisor on Children s Health to the Environmental Protection Agency (EPA), where he played a leading role in establishing a new Office of Children s Health Protection and set the groundwork for the National Children s Study.

7 History We will do it again. The research conducted at the Children s Environmental Health Center (CEHC) employs the same evidence-based, epidemiologic framework that has guided Dr. Landrigan s past successes. We recruit the best and the brightest young pediatricians and researchers to work with us in the growing field of environmental pediatrics, and we provide the educational resources to train this next generation of leaders. We give our trainees the tools to conduct sophisticated research that builds the foundation for evidence-based policies. Our researchers have published important research papers in the most highly cited scientific journals and leading textbooks. This year alone, our team has published over 35 papers in peer-reviewed journals. (See appendix.) Research topics have included: Environmental origins of childhood cancer, including a recent textbook chapter on occupational carcinogens and cancer in children. Environmental origins of autism, including a comprehensive review by Dr. Landrigan in Current Opinions in Pediatrics. Industrial chemicals and neurodevelopmental disorders, including a Lancet paper that identifies 200 chemicals known to be neurotoxic to human development. Prenatal exposure to pesticides and impairments in neurodevelopment, including a groundbreaking study that found that children exposed prenatally to organophosphate pesticides were likely to have lower IQs. Prenatal exposure to phthalates and delays in learning, including a recent study that shows children exposed to phthalates in the womb are more likely to display autisticlike behaviors. The contribution of the urban built environment to childhood obesity, including over ten peer-reviewed papers. 5 CEHC in the Press Our Center s research is frequently quoted in major publications as a source of credible information on children s environmental health. We have written editorials for the New York Times; we have testified before President s Cancer Panel and U.S. Congress; we have presented to the EPA and the World Health Organization. Our team has appeared in many prestigious news publications, including: ABC CBS CNN Fox The Huffington Post NBC The New York Times Time Magazine

8 6 Core Programs of the Children s Environmental Health Center At the Children s Environmental Health Center (CEHC), our primary goal is to conduct new research that protects our children against environmental threats to health. We accomplish this by guiding, supporting, and building the programs of the Department of Preventive Medicine at Mount Sinai School of Medicine. Core initiatives include: Pilot Research Projects are the signature research initiative of the CEHC. Using a venture capital approach to fund research, our Center supports new studies that investigate the environmental causes of childhood diseases, including asthma, autism, learning disabilities, obesity, and diabetes. All projects are selected through a competitive peer-reviewed process, and each project is specifically evaluated for its ability to generate major funding from the National Institutes of Health (NIH), CDC, and other private foundations. Only the best and the brightest are chosen for funding. In just three years, our initial investment of $310,000 has generated a return on investment of almost $7.29 million from the NIH and other major foundations. Investing in Knowledge: NIH Grants Generated by CEHC Pilot Projects $1,604,862 $1,500,000 $1,399,862 $1,494,862 $1,269,875 $1,269,875 $1,000,000 Annual Direct Dollars $500,000 0 $100,000 $100,000 $110, $273, $250, PILOT GRANTS AWARDED NIH & OTHER GRANTS RECEIVED (Annual Direct Dollars) Number of Projects Funded: 35 Number of Papers in Peer Reviewed Journals Generated from Pilot Projects: Over 10 Average Cost of a Pilot Project: $16,500 Total Grant Dollars Generated from Pilot Projects: $7.29 million

9 Core Programs CEHC Pilot Projects, A Pilot Exposure Assessment Using Newly Identified Biomarkers Atrazine, Perchlorate, and Perfluorooctanoic Acid / Stephanie Engel, PhD, MPH and Cheryl Stein, PhD A Pilot Study of the Association between Endocrine Disruptors and Obesity Related Health Conditions / Maida Galvez, MD, MPH and Barbara Brenner, DrPH Impact of LEED-Certified Green Housing on Asthma in Urban NYC / Elizabeth Garland, MD Patenting a New Tool for Sampling of Human Placenta to Study Gene-Environment Interactions in Maternal-Child Health / Luca Lambertini, PhD Profiling the Imprinted Epigenome in Human Placenta / Luca Lambertini, PhD Effects of Maternal Bisphenol-A Exposure on Fetal GAD1 Epigenetics / Michele La Merrill, PhD, MPH Climate Change and Health Impact Survey and Focus Groups for New York Pediatricians / Perry Sheffield, MD, MPH Collection of Biological and Environmental Specimens in Anticipation of a Cohort Examining Prenatal Methylmercury Exposure in a Subsistence Fishing Population in Lake Chapala, Mexico / Leonardo Trasande, MD, MPP 2009 Maternal Genetic Variation in Relation to Preterm Delivery, Pregnancy Induced Hypertension and Gestational Diabetes in a Multi- Racial Birth Cohort / Stephanie Engel, PhD, MPH Impact of LEED-Certified Green Housing on Asthma in Urban NYC / Anita Geevarughese, MD Profiling the Imprinted Epigenome in Human Placenta / Luca Lambertini, PhD Effects of Chronic Exposure to Polyhalogenated Pollutants on Metabolic Syndrome and Cardiovascular Risk Factors / Michele La Merrill, PhD, MPH Preparation for a Report on Children s Environmental Health in New York State / Philip J. Landrigan, MD, MSc Evaluation of the Pollen Count Variability within and around New York City Neighborhoods / Perry Sheffield, MD, MPH Mercury in Lake Chapala, Mexico / Leonardo Trasande, MD, MPP 2010 Fetal and Childhood Exposures to Phthalates and Childhood Growth / Stephanie Engel, PhD, MPH Impact of LEED-Certified Housing on Asthma in Urban NYC / Anita Geevarughese, MD Effects of Maternal Exposure to Persistent Organic Pollutants on Obesity and Diabetes in Adult Offspring / Michele La Merrill, PhD, MPH Indoor Air Pollution in Punjab, India / Mana Mann, MD, MPH Gene-Environment Interaction Effects on Obesity Among Hispanic and African American Children / Saskia Sanderson, PhD Polybrominated Diphenylether Exposure and Risk of Infant Adiposity / Leonardo Trasande, MD, MPP 2011 Bed Bug Infestation: Implications for the Health of East Harlem Children / Barbara Brenner, DrPH A Role of PCBs in Insulin Resistance / Christoph Buettner, MD, PhD The Open Space Index: Growing Up Healthy in East Harlem / Kevin Chatham-Stephens, MD and Maida Galvez, MD, MPH Evaluation of Children s Dietary Intakes and Eating Behaviors in East Harlem / Andrea Deierlein, PhD Examination of the Effects of in utero Phthalate Exposure on Brain Development in a Rat Model / Sarah Felice Evans, PhD Inhalation, Dietary and non-dietary Exposures to PBDEs and Blood Levels in the Older Adults Living in Brooklyn, NY A Pilot Study / Tina Fan, PhD and Kimberly Morland, PhD A Pilot Study of the Association between Endocrine Disruptors, Thyroid Function and Childhood Obesity / Maida Galvez, MD, MPH, Barbara Brenner DrPH, and Nancy Mervish, PhD Patenting a New Tool for Sampling of Human Placenta to Study Gene-Environment Interactions in Maternal-Child Health / Luca Lambertini, PhD Developing the Mount Sinai Pregnancy Biobank Placenta Sampling Method / Luca Lambertini, PhD Maternal Exposure to Environmental DDT and Risk of Metabolic Syndrome / Michele La Merrill, PhD, MPH Childhood Perchlorate Exposure and Changes in Bodyweight among NYC Inner City Youth / Nancy Mervish, PhD A Pilot Study of the Association between Environmental Toxins Distribution and Spanish Speaking Populations in New York, New Jersey, Puerto Rico, U.S. Virgin Islands / Damiris Perez, MPA Hospital-Based Phthalate Exposure in Very Low Birth Weight Neonates / Annemarie Stroustrup, MD, MPH Early Life Exposure to Indoor Pollution and Adulthood Lung Cancer / Menghua Tao, MD, PhD and Jia Chen, ScD 7

10 8 The Autism and Learning Disabilities Discovery and Prevention Project is a coordinated, multidisciplinary effort to discover the environmental causes of autism and learning disabilities. Currently, one in six American children is afflicted with a developmental disability. In most cases these disorders affect the brain and nervous system; the most common include autism, attention deficit hyperactivity disorder (ADHD), dyslexia, sensory deficits, cerebral palsy, and other learning disabilities. While sophisticated research has linked genetic factors to autism spectrum disorder (ASD), we are learning that genetics alone accounts for only about one third of cases. We now believe that toxic exposures in the environment play important roles in contributing to these neurodevelopmental disabilities. As rates of diagnosis continue to rise 9% of American children have autism; 14% have ADHD there is pressing need for more research on the undiscovered environmental causes of autism and learning disabilities. Launched in May 2010, this project guides and supports these research endeavors, ultimately developing a plan for prevention. Early Research Progress An early result of this project is a series of scientific articles on the environmental causes of autism that will appear in Environmental Health Perspectives, the high impact peer-reviewed journal of the National Institute for Environmental Health Sciences (NIEHS). These papers originated at an international conference sponsored by our Center. Publication underscores the national policy impact on CEHC s research. Papers in this series: Introduction: A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities Philip Landrigan, MD, MSc, Luca Lambertini, PhD, and Linda Birnbaum, PhD Mount Sinai School of Medicine and the NIEHS Tipping the Balance of Autism Risk: Pesticide Exposures that Influence Neuroexcitability, Oxidative Stress, and Immune Functions Janie Shelton, MPH, Irva Hertz-Picciotto, PhD, and Isaac N. Pessah, PhD University of California, Davis The Disappearing Seasonality of Autism Conceptions in California Soumya Mazumdar, PhD, Ka-Yuet Liu, D.Phil, Ezra Susser, MD, DrPH, and Peter Bearman, PhD Columbia University Maternal Smoking during Pregnancy and the Prevalence of Autism Spectrum Disorders Using Data from the Autism and Developmental Disabilities Monitoring Network Amy E. Kalkbrenner, PhD, et al. University of North Carolina, Chapel Hill, among other research institutions Autism Spectrum Disorders: Neuropathology and Animal Models Neha Uppal, PhD, Patrick R. Hof, MD, et al Mount Sinai School of Medicine The Breast Cancer and the Environment Research Program (BCERP) is a multidisciplinary network of scientists, doctors, and community partners who examine environmental exposures that may contribute to breast cancer. Funded by the NIEHS and the National Cancer Institute (NCI), research in the BCERP focuses on exposures during the stages of life when women may be most vulnerable the onset of puberty and other windows of susceptibility. The BCERP Puberty Study is a multi-year study that investigates and identifies predictors of early onset of puberty in young girls. Early sexual maturation increases the risk for breast cancer by 30%, representing a critical period for long-term risk. Led by Mary S. Wolff, PhD, our Center is one of

11 Core Programs three sites across the U.S. involved in this collaborative study. Already, we have found that phenols, phthalates, and phytoestrogens environmental chemicals found in cosmetics, perfumes, lotions, and shampoos accelerate the timing of puberty and put girls at greater risk for breast cancer later in life. The Endocrine Disruptor Discovery Project is a comprehensive research plan that encompasses the BCERP studies, in addition to other projects that examine the effects of exposures to bisphenol-a (BPA), phthalates, pesticides, and perchlorate on children s health. Endocrine disruptors are man-made chemicals, many of them widely dispersed in the environment, that interfere with hormone signaling. These messages exert powerful control over brain development, body growth, reproductive development, and the timing of puberty. When messages are blocked or disrupted, the consequences can be serious and long-lasting. Our NIH-funded Fellowship in Children s Environmental Health is a highly competitive, three-year training program for the future leaders of environmental pediatrics. Each year, we select two or three of the most highly accomplished pediatricians and postdoctoral students from across the U.S. for mentored training in epidemiological research. Our graduates often stay at Mount Sinai, becoming leaders at our Center, in the training program, and throughout the field of public health. For example: Joel Forman, MD, our first fellow, is now an Associate Professor and Vice-Chair for Education in the Department of Pediatrics and Director of the Residency Program in Pediatrics. Maida P. Galvez, MD, MPH is now Associate Professor in the Departments of Preventive Medicine and Pediatrics, as well as Director of the Pediatric Environmental Health Specialty Unit (PEHSU). Nathan Graber, MD, MPH now serves as the Director of Environmental and Occupational Disease Epidemiology at the New York City Department of Public Health and Mental Hygiene. Perry Sheffield, MD, MPH is now lead investigator for the Queens and Nassau County sites of the National Children s Study and Deputy Director of the PEHSU. The Breast Cancer and the Environment Puberty Study Location of Study: East Harlem, New York City Number of Girls Enrolled: Over 1,500 Overall, 13% of 7-year old girls have reached the onset of puberty. The age of puberty varies by race and ethnicity: 23.4% Black 14.9% Hispanic 10.4% White The proportion of girls who exhibit breast development at ages 7 and 8 years particularly among white girls is greater than that of girls who were born 10 to 30 years earlier. For each year that menarche is delayed, risk for breast cancer decreases by 9% in premenopausal woman and 4% in postmenopausal women. Spotlight on New Research in Endocrine Disruptors Michele La Merrill, PhD, MPH In 2011, Michele La Merrill, PhD, MPH received a competitive, five-year grant from the NIH to support her work on early life exposures to the pesticide DDT and its contribution to metabolic syndrome. Metabolic syndrome is a condition of abnormal metabolism with symptoms including obesity, diabetes, high cholesterol, and high blood pressure and it affects over 47 million people in the U.S. Michele La Merrill, PhD, post-doctoral fellow in children s environmental health Number of Fellows Recruited: 15 Number of Fellows Graduated: 8 Numbers of Articles Published in Peer-Reviewed Journals: Over 30 Number of Conference Presentations: Over 15 9

12 Growing Up Healthy in East Harlem is a five-year study that examines how the environment influences diet, physical activity level, and subsequent risk for childhood obesity. Targeting our home community at Mount Sinai, this project found obesity to be epidemic in children living in East Harlem, with 24% identified as obese and 15% at risk for obesity by the ages of 6 to 8 years old. 10 East Harlem children have easy access to unhealthy foods. 55% live on a block with a convenience store. 41% live on a block with fast food stores. The presence of convenience stores on the same block as a child s home was associated with a higher BMI-percentile. Children living on a block with one or more convenience stores were more likely to have a higher BMI-percentile than children who had no convenience stores on their block. Inequities in food store availability exist by race/ethnicity in East Harlem. 100% of African American Census blocks had neither supermarkets nor grocery stores. The National Children s Study (NCS) is the largest study of children s health and the environment ever launched in the country. By following 100,000 children across the country, from conception to age 21, it aims to discover the preventable causes of childhood and adult disease. Dr. Landrigan and our team hold a leadership role in this NIH-funded study, managing research locations in Queens, Nassau, and Monroe Counties. The Mount Sinai Pediatric Environmental Health Specialty Unit (PEHSU) is the clinical component of our Center, part of a national network of PEHSUs supported by the CDC. To date, our pediatricians have provided care to the families of over 5,000 children who have experienced toxic environmental exposures or have suffered from diseases of environmental origin. Spotlight on Community Outreach at the Queens Vanguard Center At the end of 2010, the Queens Vanguard Center of the NCS launched a series of workshops to educate the Queens community. The NCS team now sends health educators, pediatricians, and other experts to lead workshops in English, Spanish, Arabic, and Hebrew on how to reduce environmental exposures. Workshop topics include Safer Alternatives to Plastics: Cracking the Code on Plastic Labels, Asthma Triggers in the Home, Pesticide Exposure in our Everyday Life, and Healthy Living and the Built Environment. The PEHSU in Action In early 2011, toxic polychlorinated biphenyls (PCBs) were found in the lighting ballasts of New York City public schools. Responding to this public health crisis, PEHSU Director Dr. Galvez and industrial hygienist Alice Freund, MS participated in the New York City Council s Joint Hearing on PCBs in Schools. Dr. Landrigan and Dr. Galvez also participated in an interview with the New York Times. PEHSU Director Maida P. Galvez, MD, MPH In 2006, the PEHSU was called in to a New Jersey daycare center, called the Kiddie Kollege, in response to mercury contamination. Our team soon discovered that the center was built on the former site of a mercury thermometer factory, exposing children to elemental mercury a toxic chemical that can impair their mental, physical, and emotional development. This discovery led to passing of the Kiddie Kollege legislation, which mandates the state to test all schools and daycare centers for industrial pollutants.

13 11 Members of the CEHC team: Joel Forman, MD; Perry Sheffield, MD, MPH; Maida P. Galvez, MD, MPH; Anita Geehavarughese, MD; Michele La Merrill, PhD, MPH; Damiris Perez, MPA; and Amir Miodovnik, MD, MPH The Year in Review Formally established in 2007, the Children s Environmental Health Center (CEHC) spent its early years developing research programs, initiating new projects, and building the foundation for a new, highly innovative type of research center. Unlike other institutions, which specialize in research on one disease or condition, our Center utilizes a comprehensive research model one that examines individual toxic exposures in the environment and their subsequent effects on children s health. After three years of cultivating strategies and initiating pilot research, our Center is now elevating our research programs, generating more breakthrough discoveries, and advocating for policies that protect our children against environmental threats to health. This past year, our accomplishments include: Establishing our presence worldwide and building international partnerships. For example, we were designated a Collaborating Centre in Children s Environmental Health by the World Health Organization (WHO). Creating the research infrastructure to shape our discoveries on the environmental causes of autism and learning disabilities. Making important discoveries about the impact of toxic chemicals on neurodevelopmental impairment. Securing the necessary faculty and funding to build our Endocrine Disruptor Discovery Project. Bringing new visibility to the economic costs of children s environmental health.

14 12 Improving Children s Health Around the World Throughout his career, Dr. Landrigan has consulted extensively with the WHO, working to build global capacity in children s environmental health. Due to this extensive collaboration, the CEHC was designated a World Health Organization (WHO) Collaborating Centre in Children s Environmental Health in October As a Collaborating Centre, CEHC joins a network of over 800 institutions in 90 countries that work with the WHO to conduct research, train health professionals, and host international conferences. Specifically, CEHC is one of four international Collaborating Centres in Children s Environmental Health one of the two Centres of its type in the United States. A New International Partnership In July 2010, Mount Sinai School of Medicine developed a new partnership with the Chulabhorn Research Institute (CRI) of Thailand. The CRI was established in 1987 by Dr. HRH Princess Chulabhorn Mahidol of Thailand, who has a postdoctoral degree in chemistry. To initiate this partnership, Princess Maidhol travelled to Mount Sinai to sign a Memorandum of Understanding, establishing a collaborative framework between the two institutions. This five-year affiliation will facilitate the exchange of information to improve children s environmental health, especially in the areas of research and education. Spotlight on International Collaboration Jia Chen, ScD In 2010, team member Jia Chen, ScD travelled to Lyon, France to work with international collaborators at the WHO s cancer agency, the International Agency for Research in Cancer (IARC). As a visiting scholar, Dr. Chen spent the following year working with the world s leading cancer researchers to study how diet influences both breast and lung cancer. Luz Claudio, PhD Born in Puerto Rico, Luz Claudio, PhD has devoted her career to addressing environmental health issues of minority populations and disadvantaged populations abroad. In over 15 years, she has mentored 70 minority students, supported the career development of 52 fellows from Mexico, Brazil, and Chile, and trained 16 health care providers from Uruguay, Costa Rica, and Colombia. She also serves on the Advisory Board of the NIH s Fogarty International Center, which promotes international collaboration and supports research initiatives in the developing world. Luz Claudio, PhD In 2011, Our Team Has Visited Ahmedabad, India Asturias, Spain Bangkok, Thailand Barcelona, Spain Bologna, Italy Brussels, Belgium Buenos Aires, Argentina Geneva, Switzerland Hangzhou, China Lyon, France Montreal, Canada Quebec, Canada Tel Aviv, Israel Tokyo, Japan Philip J. Landrigan, MD, MSc and Eileen Solomon, Director of Special Events at the Mount Sinai Medical Center, greet HRH Princess Chulabhorn Maidhol of Thailand

15 The Year in Review Setting the Foundation for New Discoveries: The Autism and Learning Disabilities Discovery and Prevention Project After launching this project, our first goal was to convene at an international symposium to review current research, identify data gaps, and create a research plan for discovery. In December 2010, our Center hosted a day-long symposium, titled Exploring the Environmental Causes of Autism and Learning Disabilities, in partnership with Autism Speaks. Thirteen international leaders came together to address growing questions and to share preliminary results with over 300 health professionals and community members. Our List of Suspect Chemicals: As a direct result, our team developed a list of the top ten chemicals that we believe are most likely to cause autism and learning disabilities. These priority chemicals are widely distributed in the environment and have been detected in the bodies of pregnant women. A Scholarly Series on Autism and the Environment: By focusing on these culprit chemicals, we are creating the foundation for a strong research strategy into the environmental causes of autism and learning disabilities. This list will be published in Environmental Health Perspectives the highest ranked journal in environmental health along with a series of five scholarly papers in early The Mount Sinai Pregnancy Biobank A crucial platform for discovery, the Mount Sinai Pregnancy Biobank is a unique, shared resource that provides researchers with access to umbilical cord blood and placental tissue samples from pregnancies delivered at Mount Sinai Hospital. Currently, there are no other resources with this capacity. Our team has been instrumental in establishing and launching the Pregnancy Biobank, and this new tool will provide the basic elements needed to unearth many of the most common pregnancy outcomes. In September 2011, the Pregnancy Biobank received initial funding from the William Randolph Hearst Foundation. This preliminary funding gives us the equipment needed to begin sample collection, processing, and storage, and it allows our team to begin implementing collection procedures. New Research Breakthroughs on Neurodevelopmental Impairment The Mount Sinai Pregnancy Biobank has the potential to support investigations in: Pregnancy Outcomes: Preterm birth, preeclampsia, and intrauterine growth restriction. Neurodevelopmental Disorders: Autism spectrum disorder (ASD), attention deficit/hyperactivity disorder (ADHD), and schizophrenia. Developmental Antecedents: Infant temperament, parent-child interactions, and attachment behaviors. Other Common Childhood Conditions: Including asthma, obesity, diabetes, and hypertension. Furthering the development of the Autism and Learning Disabilities Discovery and Prevention Project, our Center published two important studies this year. Both linked toxic exposures in the environment to neurodevelopmental impairment. 13 Prenatal Phthalate Exposure Linked to Autistic-Like Symptoms In March 2011, our team found that children who had been exposed to high levels of phthalates in the womb were more likely to exhibit social impairment. Led by Amir Miodovnik, MD, MPH, the study used the Social Responsiveness Scale a quantitative scale for measuring the severity of social impairment related to Autistic Spectrum Disorders (ASD) to measure these behavioral traits. Ultimately, they found that prenatal phthalate exposure was associated with greater social deficits, poorer social cognition, less social awareness, and poorer social communication in children ages 7 to 9. Exposure to Organophosphate Pesticides Linked to Lower Intelligence In April 2011, three independent studies revealed important links between prenatal pesticide exposure and diminished IQ in children. At our Center, a team of researchers, led by Stephanie M. Engel, PhD, MPH, revealed that prenatal exposure to organophosphate pesticides has a negative impact on the cognitive development of school-aged children, particularly their perceptual reasoning skills. While other studies have linked exposures to neurodevelopmental outcomes in newborns, ours is the first to suggest that neurodevelopmental effects extend throughout early childhood.

16 14 Expanding the CEHC Team: The Recruitment of Shanna H. Swan, PhD In April 2011, the country s top reproductive epidemiologist, Shanna H. Swan, PhD, joined our team, bringing over 30 years of research experience to our Center. Dr. Swan s research focuses on how endocrine disruptors impact our children s development, particularly when a mother is exposed during pregnancy. Most notably, Dr. Swan led a study that revealed that phthalates, a chemical commonly used in plastics, alter the development of young boys. This landmark research led to the banning of phthalates from children s toys. As an expert in the effects of phthalate exposure, Dr. Swan will be instrumental in guiding the research our Endocrine Disruptor Exploratory Project. Measuring the Economic Cost of Children s Environmental Health: Our Center Publishes Three Important Papers in Health Affairs Each year, our country spends an estimated $76.6 billion 3.5% of all health care costs on childhood diseases induced by the environment, revealed a recent study by Leonardo Trasande, MD, MPP. This paper was published along with two other papers by the CEHC team, all highlighting the staggering economic impact of toxic chemicals. Legislative Victory: BPA Banned from Cash Receipts in Connecticut A recent ban in Connecticut highlights the effectiveness of evidence-based testimony. In spring of 2011, our Center testified in support of a bill to ban bisphenol-a (BPA) from thermal receipt paper in the state of Connecticut. When used on cash receipts, BPA is unbound to the paper, meaning that it can rub off, stick to the skin of those who touch it, and expose both shoppers and cashiers to higher levels of the chemical. In June 2011, the bill was unanimously passed by the State Senate making Connecticut the first state to ban BPA from thermal receipt paper. Bringing New Visibility to Children s Environmental Health: Dr. Landrigan Edits Mount Sinai Journal of Medicine Spotlight on Shanna H. Swan, PhD Number of Peer-Review Papers Published: Over 150 National Grant Dollars: Over $14 million Consulted for: the FDA, the EPA, the NIH, among other government agencies Notable Findings: Baby boys are more likely to experience changes in their genitals if their mothers were exposed to phthalates during pregnancy (Environmental Health Perspectives paper of the year, 2005). Phthalate exposure affects the play behavior of young boys (International Journal of Andrology, 2009) Research in Action: Dr. Swan s research helped persuade the U.S. government to pass the Consumer Product Safety Improvement Act in 2008, which banned phthalates from children s toys. Childhood Disease of Environmental Origin is Very Expensive Condition Induced by the Environment Lead Poisoning Autism Intellectual Disability Exposure to Mercury Pollution ADHD Asthma Childhood Cancer Total Yearly Cost The January/February 2011 issue of the Mount Sinai Journal of Medicine brought together thought leaders in children s environmental health including many of our Center s researchers and collaborators to examine new research in environmental pediatrics and bring visibility to this emerging field. Dr. Landrigan and Dr. Miodovnik edited this issue of the peerreviewed journal. Shanna H. Swan, PhD Yearly Cost Estimate $50.9 billion $7.9 billion $5.4 billion $5.1 billion $5 billion $2.2 billion $95 million $76.6 billion Source: Trasande L and Liu Y (2011). Reducing the Staggering Costs of Environmental Disease in Children, Estimated at $76.6 Billion in Health Affairs 30(5):863-70

17 The Year in Review Over $700,000 Raised at Mount Sinai Greening Our Children Each year, our Center hosts an annual benefit luncheon, Mount Sinai Greening Our Children. Over the past four years, we have raised over $1.85 million to support new research into the environmental causes of children s disease. In May 2011, CEHC held its fourth annual luncheon at the Hyatt Regency in Greenwich, Connecticut. Seven hundred attended and helped raise over $700,000 for our Center making this year the most successful to date. This year s event also taught guests how to live a greener and healthier life, featuring a new Green Expo and a meet-and-greet poster session with the CEHC team. The event concluded with a panel discussion, moderated by actress and environmental activist Jessica Capshaw. Panel speakers included Dr. Landrigan, Dr. Swan, and Christopher Gavigan, Executive Board member and national children s health advocate. 15 Members of the CEHC Executive Board (left to right) Alex Bergstein; Seth Bergstein; Anne Robertson; Tanya Murphy; David Wasserman; Jonathan Piel; Philip J. Landrigan, MD, MSc; Wendy Mindel Rubinstein; Rhonda Sherwood; Toby Cone; Christopher Gavigan; and Karen Miller. Left photo: Tanya Murphy; Toby Cone; and Rhonda Sherwood. Middle photo: Luncheon co-chair Eunice Burnett; Rhonda Sherwood; Christopher Gavigan; and luncheon co-chair Elisabeth Wolfe. Right photo: Maida Galvez, MD, MPH; Mary Wolff, PhD; and Seth Bergstein. Left: Jessica Capshaw and Christopher Gavigan. Middle: The ballroom at the Greenwich Hyatt. Right: Jill Brack; Luz Claudio, PhD; Toby Cone; and Joel Forman, MD.

18 Looking Forward: Philanthropy at the Children s Environmental Health Center 16 Children are not simply little adults. They are uniquely vulnerable to toxic exposures in the environment. We need to find definitive answers about the relationship between toxic chemicals and health so we can protect our children now and in the future. Philip J. Landrigan, MD, MSc Director, Children s Environmental Health Center To find these answers, there is a critical need for research. Now more than ever we need to support intelligent action that examines these relationships, transmits our findings to public officials, and protects our children from these looming diseases. Philanthropy is crucial for continuing and advancing the Center s work. In addition to general, unrestricted support, contributions can be targeted for specific research projects and program areas. Charitable gifts enable us to support an additional number of researchers who are investigating the links between environmental exposures and disease in children. A gift to CEHC catalyzes groundbreaking research. All donations to CEHC directly support research with over 90% of gifts allocated to research projects including our pilot projects, our studies on autism and learning disabilities, and our work on endocrine disruptors, breast cancer, and early puberty. A gift to CEHC continues to give. At CEHC, your gift serves as venture capital for new research into the environmental causes of childhood disease. Using this initial funding, our team is able to generate the necessary data required for grant support from the NIH and other private foundations. By allocating just $310,000 in three years, our research has generated a return on investment of almost $7.29 million in major grants. A gift to CEHC is an investment in the future of our children. As parents, grandparents, and concerned community members, we all want to ensure safer lives for our children. Toxic exposures are abundant in our environment. Without this critical research, our children are put at risk for further exposures. Even the smallest discovery is an investment in the future of our children. Funding Opportunities at the Children s Environmental Health Center Endow the Children s Environmental Health Center $5 million Endow a Professor in Children s Environmental Health $2 million Endow the Mount Sinai Biobank $1.1 million Endow the Fellowship in Children s Environmental Health $1 million Support a Three-Year Fellowship $150,000 Create a Research Fund $50,000 + Fund a Pilot Project $10,000 $25,000

19 17 Appendix Papers and Book Chapters Published by the CEHC Team in Community Engagement in Children s Environmental Health Research Barbara L. Brenner, DrPH, LMSW and Melissa P. Manice, MPH Mount Sinai Journal of Medicine 2. Children s Environmental Health in Schools Kevin Chatham-Stephens, MD, Mana Mann, MD, Andrea Wershof Schwartz, MD, and Philip J. Landrigan, MD Submitted to American Educator 3. Asthma Mortality in Puerto Rico: Luz Claudio, PhD, and others Journal of Asthma 4. Environmental Justice: An International Perspective Luz Claudio, PhD, and others Encyclopedia of Environmental Health 5. Phthalate Exposure Associated with Self-Reported Diabetes among Mexican Women Luz Claudio, PhD, and others Environmental Research 6. Prenatal Exposure of a Girl with Autism Spectrum Disorder to Horsetail (Equisetum Arvense) Herbal Remedy and Alcohol: A Case Report Luz Claudio, PhD, and others Journal of Medical Case Reports 7. The Association between Maternal Glucose Concentration and Child BMI at Age 3 Years Andrea Deierlein, PhD, and others Diabetes Care 8. Childhood Hair Product Use and Earlier Age at Menarche in a Racially Diverse Study Population: A Pilot Study Andrea Deierlein, PhD, and others Annals of Epidemiology 9. Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Infant Anthropometric Outcomes Andrea Deierlein, PhD, and others Journal of Pediatrics 10. Implementation of the New Institute of Medicine Gestational Weight Gain Guidelines Andrea Deierlein, PhD, and others Journal of Midwifery and Women s Health 11. Prenatal Exposure to Organophosphates Paraoxonase 1 and Cognitive Development in Childhood Stephanie M. Engel, PhD, Jia Chen, ScD, Mary S. Wolf, PhD, and others Environmental Health Perspectives 12. Differential Methylation of Imprinted Genes in Growth- Restricted Placentas Luca Lambertini, PhD, Jia Chen, ScD, et al. Reproductive Science 13. The Association between First Trimester Micronutrient Intake, MTHFR Genotypes, and Global DNA Methylation in Pregnant Women Michele La Merrill, PhD, and others Journal of Maternal-Fetal and Neonatal Medicine 14. Childhood Obesity and Environmental Chemicals Michele La Merrill, PhD, MPH, and Linda S. Birnbaum, PhD, DABT Mount Sinai Journal of Medicine 15. Pre-Pregnancy Body Mass Index, Smoking During Pregnancy, and Infant Birth Weight Michele La Merrill, PhD, Cheryl Stein, PhD, Philip J. Landrigan, MD, Stephanie M. Engel, PhD, et al. Annals of Epidemiology

20 Children s Health and the Environment: An Overview Philip J. Landrigan, MD, MSc and Amir Miodovnik, MD, MPH Mount Sinai Journal of Medicine 17. Children s Vulnerability to Toxic Chemicals: A Challenge and Opportunity to Strengthen Health and Environmental Policy Philip J. Landrigan, MD, et al. Health Affairs 18. Environment and Heart Disease Philip J. Landrigan, MD, Michele La Merrill, PhD, and others Hurst s The Heart (13th edition) 19. New Academic Partnerships in Global Health: Innovations at Mount Sinai School of Medicine Philip J. Landrigan, MD, Luz Claudio, PhD, and others Mount Sinai Journal of Medicine 20. Lead Poisoning of a Child Associated with Use of a Cambodian Amulet New York City, 2009 Mana Mann, MD, et al. Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention 21. Occupational Carcinogens and Cancer in Children Mana Mann, MD and Philip J. Landrigan, MD Submitted to Occupational Cancer 22. Temporal Variability in Urinary Concentrations of Perchlorate, Nitrate, Thiocyanate and Iodide among Children Nancy Mervish, PhD, Barbara Brenner, DrPH, Maida P. Galvez, MD, Mary S. Wolff, PhD, Susan L. Teitelbaum, PhD, and others Journal of Exposure Science and Environmental Epidemiology 23. Endocrine Disruptors and Childhood Social Impairment Amir Miodovnik, MD, Stephanie M. Engel, PhD, Mary S. Wolff, PhD, and others NeuroToxicology 24. Environmental Neurotoxicants and the Developing Brain Amir Miodovnik, MD, MPH Mount Sinai Journal of Medicine 25. The Association of Tree Pollen Concentration Peaks and Allergy Medication Sales in New York City: Perry Sheffield, MD, et al. ISRN Allergy 26. Climate Change, Aeroallergens, Pediatric Allergic Disease Perry Sheffield, MD, MPH, Kate R. Weinberger, MA, and Patrick L. Kinney, ScD Mount Sinai Journal of Medicine 27. The Effects of Outdoor Air Pollutants on the Costs of Pediatric Asthma Hospitalizations in the United States, Perry Sheffield, MD, Leonardo Trasande, MD, and others Medical Care 28. Fine Particulate Matter Pollution Linked to Respiratory Illness in Infants and Increased Hospital Costs Perry Sheffield, MD, Leonardo Trasande, MD, and others Health Affairs 29. Modeling of Regional Climate Change Effects on Ground-level Ozone and Childhood Asthma Perry Sheffield, MD, et al. American Journal of Preventive Medicine 30. A Tale of Two Countries: Rethinking Sexual Risk for HIV among Young People in South Africa and the United States Cheryl Stein, PhD, and others Journal of Adolescent Health 31. The Epidemiology of Hospitalized Postpartum Depression in New York State, Cheryl Stein, PhD, and others Annals of Epidemiology 32. Gestational Weight Gain and Birth Outcome in Relation to Pre-Pregnancy Body Mass Index and Ethnicity Cheryl Stein, PhD, and others Annals of Epidemiology 33. Maternal Ethnicity and Preeclampsia in New York City, Cheryl Stein, PhD, Stephanie M. Engel, PhD, and others Paediatric and Perinatal Epidemiology 34. Serum Perfluorinated Compound Concentration and Attention Deficit/Hyperactivity Disorder in Children Aged 5 to 18 Years Cheryl Stein, PhD, et al. Environmental Health Perspectives 35. Economics of Children s Environmental Health Leonardo Trasande, MD, MPP Mount Sinai Journal of Medicine 36. Reducing the Staggering Costs of Environmental Disease in Children, Estimated at $76.6 Billion in 2008 Leonardo Trasande, MD, MPP, et al. Health Affairs 37. Measures of Obesity Associated with Asthma Diagnosis in Ethnic Minority Children Nita Vangeepuram, MD, Susan L. Teitelbaum, PhD, Maida P. Galvez, MD, Barbara Brenner, DrPH, Mary S. Wolff, PhD, and others Journal of Obesity

21 Children s Environmental Health Center Executive Board David Wasserman Chairman Rhonda Sherwood Vice Chairman 19 Alexandra Bergstein Seth Bergstein Christopher Daggett Benjamin Edmands Christopher Gavigan Richard Fuller Michael McCally, MD, PhD Karen Miller David Murphy Tanya Murphy Jonathan Piel Anne Robertson Maria Rodale Wendy Mindel Rubinstein Hattie Ruttenberg Philip J. Landrigan, MD, MSc Director Shanna H. Swan, PhD Vice Chair for Research

22 20 Contact the Children s Environmental Health Center Children s Environmental Health Center / One Gustave L. Levy Place, Box 1057 New York, New York T: F: World Health Organization Collaborating Centre in Children s Environmental Health Written by Katherine Southwick / Designed by Anne Garland / printed on recycled paper

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