America’s Children 

and the Environment:

A First View of Available Measures
ii America’s Children and the Environment: A First View of Available Measures

Table of Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Summary List of Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

About This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Part I: Environmental Contaminants . . . . . . . . . . . . . . . . . . . . . . . . 11

Outdoor Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Indoor Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Drinking Water Contaminants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Pesticide Residues in Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Land Contaminants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Part II: Biomonitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Concentrations of Lead in Blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Part III: Childhood Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Respiratory Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Childhood Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Appendix A: Data Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Appendix B: Data Source Descriptions . . . . . . . . . . . . . . . . . . . . . 75

Appendix C: Environmental Health 

Objectives in Healthy People 2010 . . . . . . . . . . . . . . . . . . . . . . . . . 85
Acknowledgments 1

Acknowledgments

any individuals and agencies assisted with the preparation of 

this report.

The report’s principal authors and project managers were Tracey J. Woodruff and Daniel

A. Axelrad, of the U.S. Environmental Protection Agency’s (EPA) National Center for

Environmental Economics, and Amy D. Kyle, of the University of California at Berkeley,

School of Public Health. This report was edited by Brad Hurley of ICF Consulting. This

report would not be possible with out the support and leadership of Ramona Trovato,

Director of the Office of Children’s Health Protection and Al McGartland, Director of

the National Center for Environmental Economics. 

Representatives from various EPA offices provided assistance with obtaining data,

selecting measures to be included in this initial report, and internal peer review. They

included the following:

■ Office of Air and Radiation: Barry Gilbert, Brian Gregory, David Guinnup, 

Wendy Kammer, David McKee, David Mintz

■ Office of Children’s Health Protection: Michael Firestone

■ Office of Enforcement and Compliance Assurance: Sue Pohedra

■ Office of Environmental Information: Rebecca Madison

■ Office of Prevention, Pesticides, and Toxics Substances: Doreen Cantor, 

Elizabeth Doyle, Tim Kiely, Joseph Merenda, Andy Privee, Martha Shimkin,

William Smith, David Widawsky, Pamela Wilkes 

■ Office of Research and Development: Jane Caldwell

■ Office of Solid Waste and Emergency Response: Paul Balserak, David Bennett,

Rafael Gonzalez

■ Office of Water: Rebecca Allen, Lee Kyle, Abraham Siegel, Elizabeth Southerland,

James Taft, Sherri Umansky

■ Region 6: Evelyn Daniels

Other federal agencies that provided assistance with data and analysis included the following:

■ National Center for Health Statistics, Centers for Disease Control and Prevention:

Lara Akinbami, Larry Edmonds, Clifford Johnson, Sherline Lee, Deborah Levey,

Sue Partridge, Diane Shinberg, Paula Yoon

■ U.S. Census Bureau: Larry Sink

Abt Associates compiled much of the data analyzed for the report, under contract 

with EPA. Abt’s contributors to this report included Amy Benson, Jennifer Brady,

Kathleen Cunningham, Kenneth Davidson, Brad Firlie, Paul First, Rosaline Juan,

Emily King, Laura Kirk, Don McCubbin, Daniel McMartin, Suzanne Persyn, 

Ellen Post, David Pulaski, and Andrew Stoeckle.

The following individuals served as external peer reviewers for the report: David Brown,

Northeast States for Coordinated Air Use Management; Patricia A. Buffler, University

of California, Berkeley; Gwen Collman, National Institute of Environmental Health

Sciences; Fernando Guerra, San Antonio Metropolitan Health District; Polly Hoppin,

U.S. Department of Health and Human Services; Phil Lee, University of California,

San Francisco; Maria Morandi, University of Texas, Houston; Swati Prakash and 

Peggy Shepard, West Harlem Environmental Action; Kristin Ryan, Alaska Department

of Environmental Conservation; Ken Schoendorf and Diane Wagener, National Center

for Health Statistics, Centers for Disease Control and Prevention; Nadia Shalauta Juzych,

Michigan Public Health Institute; Daniel Swartz, Children’s Environmental Health

Network; John Wargo, Yale School of Forestry and Environmental Studies; and

Cynthia Warrick, Howard University.

M
2 America’s Children and the Environment: A First View of Available Measures

Summary List of Measures

Name Description of Measure Year(s)

Environmental Contaminants

Outdoor Air Pollution

Common Air Pollutants Percentage of children living in areas in which air quality 1990 to 1998

standards were exceeded

Percentage of children’s days with good, moderate, or 1990 to 1998

unhealthy air quality

Hazardous Air Pollutants Percentage of children living in counties where at least 1990

one hazardous air pollutant concentration was greater

than a health benchmark in 1990

Indoor Air Pollution

Environmental Percentage of homes with children under 7 where 1994 to 1999

Tobacco Smoke someone smokes regularly

Drinking Water Contaminants

Drinking Water Percentage of children living in areas served by public 1993 to 1998

Standards water systems that exceeded a drinking water standard 

or violated treatment requirements

Nitrates and Nitrites Percentage of children living in areas served by public 1993 to 1998

water systems in which the nitrate/nitrite drinking 

water standard was exceeded

Monitoring and Reporting Percentage of children living in areas with major 1993 to 1998

violations of drinking water monitoring and reporting

requirements

Pesticide Residues in Foods Percentage of fruits, vegetables, grains, dairy, and 1994 to 1998

processed foods with detectable pesticide residues

Land Contaminants

Hazardous Waste Sites Percentage of children living in counties with 1990 to 2000

Superfund sites

Percentage of children living in counties that had 1990 to 2000

Superfund sites in 1990

Biomonitoring

Concentrations of Lead in Blood Average concentrations of lead in blood for 1976 to 1994

children 5 and under

Percentage of children aged 1-5 with concentrations of 1992 to 1994

lead in blood greater than 10 μg/dl
Summary List of Measures 3

Summary List of Measures

Name Description of Measure Year(s)

Childhood Diseases

Respiratory Diseases Percentage of children under 18 with asthma 1990 to 1996

and chronic bronchitis

Percentage of children under 18 with asthma, 1997-98 1997 to 1998

Asthma hospitalization rate for children 0-14 1987 to 1998

Childhood Cancer Cancer incidence and mortality for children under 20 1975 to 1995

Cancer incidence for children under 20 by type 1973 to 1996
4 America’s Children and the Environment: A First View of Available Measures

About This Report

merica’s Children and the Environment: A First View of Available Measures is the

U.S. Environmental Protection Agency’s (EPA) first report on trends in measures

reflecting environmental factors that may affect the health and well-being of children in

the United States. This report represents an initial step in the identification, development, and compilation of a set of measures that fully reflect environmental factors

important for children.

Developed by EPA’s Office of Children’s Health Protection in collaboration with EPA’s

National Center for Environmental Economics in the Office of Policy, Economics and

Innovation, America’s Children and the Environment presents measures that reflect

trends in levels of environmental contaminants in air, water, food, and soil; concentrations of lead measured in children’s bodies; and childhood diseases that may be influenced by environmental factors.

As part of EPA’s commitment to children’s health, the Office of Children’s Health

Protection and the National Center for Environmental Economics will continue to

work to obtain data needed for measures that more fully reflect how environmental

contaminants affect children’s health. 

What are the purposes of this report?

This report has two principal objectives. First, America’s Children and the Environment

presents concrete, quantifiable measures for key factors relevant to the environment and

children in the United States. This initial work offers a basis for a better understanding

of time trends for some of these factors and for further investigation of others. The

authors and sponsors hope it will contribute to the effort to integrate the environmental health needs of children into the nation’s policy agenda.

The second purpose of this report is to provide a starting point for discussions among

policymakers and the public about how to improve federal data on children and the

environment.

The long-term purpose of America’s Children and the Environment is to identify or

develop measures that could be used by policymakers and the public to track and

understand the environmental health experience of children and, ultimately, to identify

and evaluate ways to improve it. The work involved in developing the measures for

children and the environment will contribute to this long-term goal.

How is the report structured?

The report first presents a series of measures and then discusses the direction of future work.

The first section of the report presents measures reflecting trends in levels of environmental contaminants that are likely to affect children’s health. These measures are

intended to show the percentage of children exposed to critical concentrations of contaminants in air, water, food, and soil. When data on actual environmental concentrations of contaminants are not available, the report presents surrogate measures.

The second section presents measures that reflect trends in concentrations of key contaminants measured in children’s bodies. Such data provide direct evidence of children’s

exposures and can be tracked to determine whether childhood exposures are changing

over time.

A
About This Report 5

About This Report

The third section presents measures that reflect trends in certain childhood diseases, the

frequency or severity of which may be related to environmental factors. Information is presented about changes in the frequency of occurrence of these diseases over time.

The sections presenting measures are followed by a discussion of future directions,

including ways in which the existing measures could be improved, alternative data

sources, and measures that might be included in future versions.

Appendix A provides tables that summarize the data on which the measures were based,

and Appendix B describes the sources of the data used in this report and the construction

of the measures. Appendix C has a list of health goals relevant to the topics in this

report, developed by Healthy People 2010, a collaborative effort coordinated by the

U.S. Department of Health and Human Services to establish national health objectives.

Why did EPA focus on measures for children?

Children may be affected by environmental contaminants quite differently than adults

are, both because children may be more highly exposed to contaminants and because they

may be more vulnerable to the toxic effects of contaminants.

Children generally eat more food, drink more water, and breathe more air relative to

their size than adults do, and consequently may be exposed to relatively higher amounts

of contaminants in these media. Children’s normal activities, such as putting their hands

in their mouths or playing on the ground, create opportunities for exposures to contaminants that adults do not face. In addition, environmental contaminants may affect children disproportionately because their immune defenses are not fully developed or their

growing organs are more easily harmed.

To fully integrate the needs of children into the work of EPA and other agencies, it will

be helpful to define targets for research and for interventions to reduce contaminant

exposures and improve health. 

In preparing this report, we have begun to assess the completeness of existing information for each of the three major types of measures: levels of contaminants in the environment, concentrations of contaminants in children’s bodies, and frequency of key

childhood diseases. We also have assessed how well the data sources reflected the particular experience of children. 

As would be expected in any first such endeavor, the analysis identified a number of

areas in which better or more appropriate data are needed. The assessment of priorities

for obtaining additional information is a continuing process that will be furthered by

review and reaction to the initial presentation in this report.

How were the measures in this report selected?

Three principal criteria were used to select measures for the report: importance to the

health of children, availability of data for much or all of the United States, and sufficient quality of data to generate a reliable measure.

For environmental contaminants, we first identified five important media for children’s

exposure: outdoor air, indoor air, drinking water, food, and soil. For each of these, we

reviewed the data sources available from federal environmental and health agencies and

selected the most informative sources that provided national coverage (or close to it) and

a reasonable assurance of reliability. If data about concentrations of key contaminants
could be identified and were of adequate quality, we used that source. If not, we selected the best available surrogate. 

For concentrations of contaminants in children’s bodies, we selected lead, a pollutant

long recognized as having major impacts on children’s health, and obtained the best

available information about lead concentrations in the blood of children.

For childhood diseases associated with environmental factors, we initially selected the two

diseases identified as priorities by the Interagency Task Force on Environmental Health

Risks and Safety to Children, organized by EPA and the U.S. Department of Health and

Human Services: asthma and childhood cancer. We added an additional respiratory disease, chronic bronchitis, because it is associated with air pollution. We then identified the

best available data to assess time trends for the frequency of these diseases in children. 

For each data source and topic, we structured the measures primarily to portray changes

over time. In future versions of this report, measures also may be designed to reflect

regional differences and ethnic and racial differences in effects or exposures. 

What are the sources for the data in this report?

For most measures, federal agencies provided the data.

The data on environmental contaminants are from data systems maintained by EPA

and by state environmental agencies. The data on lead in blood and on respiratory diseases are from the National Center for Health Statistics in the Centers for Disease

Control and Prevention. The data on cancer are from the National Cancer Institute.

County-level population data from the Census Bureau are used to calculate how many

children potentially were affected by environmental contaminants. Detailed descriptions of the data sources may be found in Appendix B.

What groups of children are included in this report?

Most of the measures include all children in the United States under the age of 18.

Exceptions are noted in the descriptions of the measures.

What years are included in this report?

The report includes data for the 10 years from 1990 through 1999 whenever possible. In

many cases, data were available for only some of these years. In other cases, data available

before 1990 were included to provide an expanded depiction of trends.

What is the Office of Children’s Health Protection at EPA?

The Office of Children’s Health Protection (OCHP) supports and facilitates EPA’s efforts to

protect children from environmental threats. OCHP’s mission is to make the protection

of children’s health a fundamental goal of public health and environmental protection in

the United States. OCHP reviews EPA proposals for their impact on children and funds

work designed to improve the protection of children from environmental hazards. 

6 America’s Children and the Environment: A First View of Available Measures

About This Report
About This Report 7

About This Report

What are the Office of Policy, Economics and Innovation and

the National Center for Environmental Economics at EPA?

The Office of Policy, Economics and Innovation develops new approaches and provides

analysis to enable EPA to better address emerging environmental challenges. The office

addresses cross-cutting environmental management strategies, identifies emerging

issues, and acts as a catalyst for testing and institutionalizing integrative approaches to

environmental protection. Within the Office of Policy, Economics, and Innovation,

EPA’s National Center for Environmental Economics (NCEE) provides economic and

health analysis of important environmental issues for the regulatory and policy process.

NCEE also conducts research that will improve our current understanding of the

impacts of environmental contaminants on public health. NCEE’s staff includes specialists in air, water, solid waste, cross-media economics, and children’s health risks. The

center’s health scientists emphasize new methods for assessing previously unidentified

risks, assessing relationships between exposures and disease, and developing tools to

communicate this information to the public. 
Outdoor Air Pollution

■ Between 1990 and 1998, the percentage of children living in counties where one or

more of the six criteria air pollutants (ground-level ozone, particulate matter, carbon

monoxide, lead, sulfur dioxide, and nitrogen dioxide) exceeded national air quality

standards decreased from 28 percent to 24 percent, although it fluctuated from a

high of 32 percent to a low of 17 percent.

■ The percentage of children’s days with unhealthy air quality decreased between

1990 and 1998, dropping from 4 percent in 1990 to less than 2 percent in 1998. 

■ In 1990, 100 percent of America’s children lived in counties in which a 1-in-100,000

benchmark for cancer risk was exceeded by at least one hazardous air pollutant. In

the same year, 6 percent of children lived in counties in which a 1-in-10,000 cancer

risk benchmark was exceeded by at least one hazardous air pollutant. Also in the

same year, nearly 95 percent of children lived in counties in which a benchmark for

non-cancer health effects was exceeded by at least one hazardous air pollutant. 

Indoor Air Pollution

■ The percentage of homes with children under 7 in which someone regularly smokes

declined from 29 percent in 1994 to 19 percent in 1999. 

Drinking Water Contaminants

■ Between 1993 and 1998, the percentage of children living in areas served by

public water systems in which a drinking water standard for chemicals, radiation,

or microbial contaminants was exceeded, or treatment rules were violated, decreased

from 19 to 8 percent. 

■ Between 1993 and 1998, the number of children served by a public water system in

which the nitrate or nitrite drinking water standard was exceeded decreased by close

to 20 percent.

■ The percentage of children living in areas served by public water systems with at

least one major monitoring or reporting violation dropped from 21 percent in 1993

to 10 percent in 1998. 

Pesticide Residues in Foods

■ Of the fruits, vegetables, grains, dairy, and processed foods tested by the U.S.

Department of Agriculture’s Pesticide Data Program, 62 percent showed detectable

pesticide residues in 1994. This number decreased to 55 percent in 1998 but

fluctuated in the interim years.

Concentrations of Lead in Blood

■ Average concentrations of lead in the blood of children aged 5 and under dropped

78 percent from 16.5 micrograms per deciliter in 1976-80 to 3.6 in 1992-94. The

decrease is largely attributed to the elimination of leaded gasoline between 1973

and 1995. 

■ Between 1992 and 1994, approximately 1.5 million children aged 17 and younger

had elevated blood lead levels (higher than 10 micrograms per deciliter).

8 America’s Children and the Environment: A First View of Available Measures

Key Findings

Part I:

Environmental

Contaminants

Part II:

Biomonitoring
Key Findings 9

Key Findings

■ Race and poverty affect a child’s likelihood of having elevated concentrations of lead

in his or her blood. Children living in families with incomes below the poverty line

are more likely to have elevated blood lead levels. Black children are more likely to

have elevated levels than white non-Hispanic and Hispanic children. 

Respiratory Diseases

■ The prevalence of asthma among children in the United States increased 75 percent

between 1980 and 1994. In 1990, 5.8 percent of children had asthma, increasing to

7.5 percent in 1995. 

■ In 1997-98, 8.3 percent of non-Hispanic Black children living in families with

incomes below the poverty level had asthma, the highest for all racial groups and

income levels.

■ The frequency of asthma hospitalizations for children aged 0 to 14 fluctuated

between 1987 and 1998. In 1987, the frequency was 284 hospitalizations per year

per 100,000 children. The frequency increased to 369 per 100,000 in 1995 and

then dropped to 277 per 100,000 in 1998.

Childhood Cancer

■ The frequency of cancer in childhood increased from 130 cases per million children

in 1975 to 150 cases per million in 1995, though this increase appears to have

leveled off since 1990.

■ While the frequency of childhood cancer has increased, the number of deaths from

cancer in children has declined significantly since 1972. The decline in deaths is

largely due to significant improvements in treatment for many forms of cancer in

children.

■ Between 1973 and 1996, leukemia was the cancer most commonly diagnosed among

children and represented 25 percent of cases. The frequency of acute lymphoblastic

leukemia increased moderately from 23 cases per million in 1973-1978 to

approximately 27 cases per million in 1991-1996. The frequency of acute myeloid

leukemia has remained stable.

Part III: Childhood

Diseases

PART I

Environmental 

Contaminants
12 America’s Children and the Environment: A First View of Available Measures

his section of the report presents measures reflecting levels of contaminants of

concern for children and how these levels have changed over time. Many different substances can affect the health of children. Children may come into contact with

harmful pollutants in air, water, food, and soil. Tracking the levels of these pollutants is

an important step toward ensuring that environmental policies protect children.

This section includes measures for contaminants in outdoor air, indoor air, drinking water,

food, and soil. Most of the measures show the percentages of children who may be at risk

from exposure to critical concentrations of pollutants.

Ideally, the report would include measures that reflect trends in concentrations of all

important pollutants in all relevant exposure media. However, data of this type are not

available for the most part, and the measures in this section are based largely on surrogates for such data.

The measures in this section do not account for some forms of environmental contaminants that also are important for children but are less amenable to measurement and

data collection at a national scale. These include contaminants in dusts and soils in and

near homes. Also, the measures do not include exposures through breast-feeding or

exposures that occur prenatally. 

The Future Directions section (see page 57) describes additional information that would

be important to assess potential environmental threats to children fully, as well as ways

in which existing data systems might be improved to provide better information for

assessments.

Within Part I, the data used to develop measures of pollutants in outdoor air are the

most complete. Information about the six most common outdoor air pollutants (often

called the criteria pollutants) is available for nine of the 10 target years for this report.

The data used are close surrogates for measured concentrations of pollutants, as they

indicate whether air quality standards for pollutants were exceeded. Data for some pollutants are available for the vast majority of counties, though data for all six pollutants

are available for relatively few counties due to limitations in monitoring networks. The

criteria air pollutant measures thus represent all six of the relevant pollutants, provide

very good coverage of the target time period, and offer fairly good but not complete

coverage of the counties of the United States.

For hazardous outdoor air pollutants, the analysis includes data for one year, 1990. The

data used to generate the measure are estimates of ambient concentrations of 148 pollutants—most of the pollutants identified as hazardous air pollutants under the Clean

Air Act—for all counties in the contiguous United States.

For indoor air, this initial report includes one pollutant: environmental tobacco smoke.

Many other important pollutants, including combustion products and volatile organic

compounds, would be relevant to include if data could be identified. The measure used in

this report is a surrogate for measured concentrations of environmental tobacco smoke in

the home, as it is based on a survey that collected nationally representative data in 1994,

1996, and 1999 about the number of homes with young children in which people smoke.

Part I:

Environmental

Contaminants

T
For drinking water, the report uses surrogate measures for concentrations of contaminants

in drinking water, relying on reported violations of drinking water standards for a wide

variety of chemicals, physical agents such as radiation, and microbes such as bacteria and

viruses. The measures also show trends for violations of rules for treatment of drinking

water. The coverage of the measures in this section is fairly complete in terms of geographic areas, years of available data, and chemicals included. However, the reports of violations of standards are incomplete due to monitoring and reporting limitations.

For food, this report presents a measure of the frequency with which detectable levels

of pesticides were found in fruits, vegetables, and other foods from 1994-1998. This

measure is a surrogate for concentrations of pesticides in foods. The measure has fairly

complete national coverage and is available for several years within the target range.

However, it does not distinguish among different pesticides or among different foods

with pesticide residues. Some pesticides may pose greater risks to children than others

do, and residues on some foods may pose greater risks than residues on other foods.

Moreover, the measure does not include many contaminants in food that are relevant

to children, such as mercury. 

For soil, little or no information about contaminants is available at a national scale. The

report includes a surrogate measure based on the location of Superfund hazardous waste

sites. This measure provides good coverage in that data are available for all counties for

1990-2000, but the measure is recognized to have significant limitations.

Part I: Environmental Contaminants 13
14 America’s Children and the Environment: A First View of Available Measures

Outdoor Air Pollution

Air pollution contributes to a wide variety of health effects, though most of the evidence

for health impacts is from studies on adults. The most common air pollutants—groundlevel ozone, particulate matter, carbon monoxide, lead, sulfur dioxide, and nitrogen

dioxide—are regulated by EPA and the individual states. These pollutants often are

called criteria pollutants. 

Several of these pollutants, including ozone and particulate matter, have been associated

with increases in respiratory-related diseases in children, including reduction of lung

function, increases in respiratory symptoms, and increased severity or frequency of

asthma attacks.1-9 Lead damages the central nervous system in children. Higher concentrations of particulate matter increase mortality in the general population.10-11

EPA sets National Ambient Air Quality Standards for each of these pollutants to protect people from adverse health effects. The standards specify how much of each pollutant is allowed in the air. Some of the standards are designed to protect the public from

adverse health effects that can occur after being exposed for a short time, such as one

hour or one day. Other standards are designed to protect people from health effects

that can occur after being exposed for a much longer time, such as a year. For example,

current standards for carbon monoxide are for periods of one hour and eight hours,

while the current standard for nitrogen dioxide is for one year. The standards and the

varying time periods for which they apply are shown in Appendix B as Table 1. 

State agencies that monitor air quality report their results to EPA, which then reports

instances in which the measured concentration of a pollutant exceeds the standard for

that pollutant. A description of the methods used to determine whether an exceedance

has occurred is available in Appendix B.

For this measure, we used EPA’s results showing when air quality standards were exceeded

in counties in the United States. We calculated the percentage of children living in areas

with reported exceedances for the six criteria pollutants. This measure shows the percentage of children that may be exposed to poor air quality at some point during a year.

This measure does not differentiate between areas in which standards are exceeded

frequently or by a large margin and areas in which standards are exceeded only rarely

or by a small margin. Also, because the nature of health effects varies significantly and

the averaging times associated with different standards vary widely, exceedances for different standards are not comparable. For example, the ozone standard considers measured levels of ozone within a one-hour period and health effects such as lung function

decrements, respiratory symptoms, and hospital admissions. In contrast, the averaging

time for the lead standard is three months and is based on health effects such as IQ

decrements and hypertension.

Healthy People 2010: Objective 8-01 of the Healthy People 2010 initiative aims to reduce the

number of people exposed to air that fails to meet EPA’s health-based

standards for criteria air pollutants. See Appendix C for more information.

Common Air

Pollutants

Air Quality

Exceedances 

During a Year
Part I: Environmental Contaminants 15

Outdoor Air Pollution

■ From 1990 through 1998, approximately 25 percent of children lived in a county

in which at least one air quality standard was exceeded during the year.

■ The highest number of exceedances was for ozone. In 1990, approximately 23 percent

of children lived in counties in which the ozone standard was exceeded on at least one

day. In 1998, approximately 21 percent of children lived in such counties. 

■ In 1990, approximately 10 percent of children lived in counties in which the

carbon monoxide standard was exceeded. In 1998, approximately 4 percent of

children lived in such counties. 

■ From 1990 to 1998, the percentage of children living in counties that exceeded the

daily standard for particulate matter fluctuated, but was as high as 10 percent in

1992 and 1995.

■ On average, 2 percent of children lived in counties that exceeded the standard for

lead. The main sources of ambient concentrations of lead are metals processors,

such as smelters, and battery manufacturers.12

■ No exceedances of the nitrogen dioxide standard have occurred since 1991.

However, the nitrogen dioxide standard is based on measurements over a full year

and therefore is not comparable to the other standards included here. Also, few

exceedances of the sulfur dioxide standard have occurred since 1993. Consequently,

these two pollutants are not included on the graph.

Measure E1 Percentage of children living in counties in which air quality

standards were exceeded

SOURCE: U.S. Environmental Protection Agency, Office of Air and Radiation, Aerometric Information Retrieval System.

0%

5%

10%

15%

20%

25%

30%

35%

Any Standard

Ozone

Particulate

Matter

Carbon Monoxide

Lead

1990 1991 1992 1993 1994 1995 1996 1997 1998
16 America’s Children and the Environment: A First View of Available Measures

Outdoor Air Pollution

EPA provides an Air Quality Index (AQI) that offers useful information about air quality. The purpose of the AQI is to help individuals understand what local air quality

means to their health. The AQI is like a yardstick: the higher the AQI value, the greater

the level of air pollution and the greater the danger to health. 

The AQI is based on measurements of up to five of the six air quality criteria pollutants

(carbon monoxide, ozone, nitrogen dioxide, sulfur dioxide, and particulate matter). The

AQI is a measure of air quality for each day. An AQI value of 100 for a given criteria

pollutant generally corresponds to the national ambient air quality standard (NAAQS)

for that pollutant and the level EPA has set to protect public health for that pollutant

on a single day.

EPA has divided the AQI scale into categories. Air quality is considered “good” if the

AQI is between 0 and 50. At this level, air quality is satisfactory and air pollution poses

little or no risk over the short term. Air quality is considered “moderate” if the AQI is

between 51 and 100. Air quality at this level is acceptable, but some pollutants may

present a moderate health concern for a very small number of individuals. Moreover,

such a level may pose health risks if maintained over many days. Air quality is considered “unhealthy for sensitive groups” if the AQI is between 101 and 150. Members of

sensitive groups such as children may experience health effects, but the general public is

not likely to be affected. Air quality is considered “unhealthy” if the AQI is between

151 and 200. The general population may begin to experience health effects, and

members of sensitive groups may experience more serious health effects.

Measure E2 on the following page uses the reported AQI for the counties of the United

States. This measure was developed by reviewing the air quality designation for each

day for each county. The daily designations were weighted by the number of children

living in each county. The resulting measure may be considered to be reported in

“child-days,” where the designation for each day for each child in a county is counted

toward the total. This measure reflects the number of days that children live in a county with air quality in each category.

The advantage of this approach, compared with that used in measure E1 on the previous

page, is that it provides a sense of the intensity of pollution over the course of a year.

This method provides data on the air quality category for each day, rather than simply

reporting whether a county ever exceeds standards for these pollutants. 

The limitation of this method is that the AQI is based on the single pollutant with the

highest value for each day; it does not reflect any combined effect of multiple pollutants. It reflects short-term, daily pollution burdens and is not well suited for reporting

concentrations of lead and nitrogen dioxide because these pollutants do not have oneday standards. This approach is influenced by the frequency of measurements. Because

the AQI is reported daily, pollutants that are measured daily—such as ozone—will

appear to have more effect than those that are measured less frequently, such as particulate matter.

Daily Air Quality 
Part I: Environmental Contaminants 17

Outdoor Air Pollution

■ The percentage of children’s days that were designated as having “unhealthy” air

quality decreased between 1990 and 1998, dropping from 4 percent in 1990 to less

than 2 percent in 1998. The percentage of children’s days that were designated as

having “moderate” air quality remained about the same between 1990 and 1998, at

about 27 percent.

■ The coverage of monitoring for this measure was largely unchanged between 1990

and 1998. Approximately 10 percent of children’s days of exposure to air pollutants

were not monitored at all. Even on days that were monitored, in many cases only one

or a few pollutants were monitored. Areas that do not have monitors may be expected

to have good air quality, but we do not have monitoring data to verify this.

Measure E2 Percentage of children’s days with good, moderate, or

unhealthy air quality

0%

10%

20%

30%

40%

50%

60%

70%

No Monitoring Data

Good

Moderate

1990 1991 1992 1993 1994 1995 1996 1997 1998

SOURCE: U.S. Environmental Protection Agency, Office of Air and Radiation,Aerometric Information Retrieval System.

Unhealthy
18 America’s Children and the Environment: A First View of Available Measures

Outdoor Air Pollution

Hazardous air pollutants, also known as air toxics, have been associated with a number

of adverse human health effects, including cancers, asthma and other respiratory ailments, and neurological problems such as learning disabilities and hyperactivity.13-17

Examples of the 188 hazardous air pollutants listed in the Clean Air Act include benzene, trichloroethylene, mercury, chromium, and dioxins. Ambient concentrations

result from emissions by local or regional sources such as chemical manufacturing

plants, refineries, waste incinerators, electricity generating plants, dry cleaners, cars,

trucks, and buses. For some hazardous air pollutants, ambient concentrations also

result from emissions that occurred in past years or from natural sources. 

Unlike the criteria air pollutants, there are no national air quality standards for hazardous

air pollutants that can be used to construct a health-based measure. Instead, we have

compared ambient concentrations of hazardous air pollutants with health benchmark

concentrations derived from scientific assessments conducted by EPA and other environmental agencies.13; 18-20

For this analysis we used four different health benchmark concentrations. Three benchmarks reflect potential cancer risks, at levels of one-in-a-million risk, 1-in-100,000 risk,

and 1-in-10,000 risk. If a particular hazardous air pollutant is present in ambient air at

a one-in-a-million benchmark concentration, for example, one additional case of cancer

would be expected in a population of one million people exposed for a lifetime. The

fourth benchmark concentration corresponds to the level at which a hazardous air pollutant may be associated with human health effects other than cancer.

The four benchmarks generally reflect expected effects in adults, rather than potential

risks to children or risks in adulthood stemming from childhood exposure. Benchmarks

are not available to reflect these concerns.

The estimates of ambient concentrations of air toxics for the year 1990 were computergenerated. The computer model provided estimates for every county in the continental

United States. The computer estimates are consistent with the limited set of actual measurements of ambient air toxics concentrations available for 1990. 

This measure only considers exposures to air toxics that occur by inhalation. An important additional pathway of exposure to many air toxics is through deposition of those

pollutants to land and water, and subsequent accumulation in the food chain. For hazardous air pollutants that are persistent in the environment, exposures through food

consumption typically are greater than inhalation exposures. Hazardous air pollutants

for which these food chain exposures are important include mercury and other hazardous air pollutants that can damage a child’s nervous system.21-23

Healthy People 2010: Objective 8-04 of the Healthy People 2010 initiative focuses on reducing

emissions of hazardous air pollutants. See Appendix C for more information.

Hazardous Air

Pollutants and 

Health Benchmarks

Hazardous Air

Pollutants
Part I: Environmental Contaminants 19

Outdoor Air Pollution

■ In 1990, all children lived in counties in which the one-in-a million and 1-in100,000 cancer risk benchmarks were exceeded by at least one hazardous air

pollutant. Six percent of children lived in counties in which at least one hazardous

air pollutant exceeded the 1-in-10,000 benchmark. 

■ Approximately 95 percent of children lived in counties in which the benchmark for

health effects other than cancer was exceeded by at least one hazardous air pollutant. 

■ Actual exposures may differ from ambient concentrations. Indoor concentrations of

hazardous air pollutants from outdoor sources may be slightly lower than ambient

concentrations, though they can be significantly higher if any indoor sources are

present. Levels of some hazardous air pollutants may be substantially higher inside

cars and school buses, and those higher levels would increase the risks. 

■ In the upcoming year, as part of its National Air Toxics Assessment (NATA)

activities, EPA will finalize a national-scale assessment of hazardous air pollutant

risks for the year 1996 (see ww.epa.gov/ttn/uatw/nata for a complete description).

In the future, measures of hazardous air pollutant risks to children will be developed

using information from NATA, which will be updated every three years.

Measure E3 Percentage of children living in counties where at least one

hazardous air pollutant concentration was greater than a

health benchmark in 1990

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cancer Benchmark:

One-in-a-Million

Cancer Benchmark:

1-in-100,000

Cancer Benchmark:

1-in-10,000

Benchmark for

other health effects

SOURCE: U.S. Environmental Protection Agency, Cumulative Exposure Project.
20 America’s Children and the Environment: A First View of Available Measures

Indoor Air Pollution

Children can be exposed to a number of air pollutants inside homes, schools, and other

buildings. Some of these pollutants come from indoor sources, including emissions

from combustion sources such as gas stoves, fireplaces, and secondhand tobacco smoke;

off-gassing from building materials such as treated wood and paints, furnishings, carpet,

and fabrics; and consumer products such as sprays, window cleaners, and laundry soap.

Exposure to environmental tobacco smoke has been recognized as an important health

risk for children and is included in this report. Information on the toxic effects of other

important indoor pollutants indicates that they could pose health risks to children.24

We will continue to explore data sources for other indoor air pollutants to include in

future reports. 

Children who are exposed to environmental tobacco smoke, also known as secondhand

smoke, are at increased risk for a number of adverse health effects, including lower respiratory tract infections, bronchitis, pneumonia, fluid in the middle ear, asthma symptoms, and sudden infant death syndrome (SIDS).25-28 Exposure to environmental tobacco smoke also may be a risk factor contributing to new cases of asthma.25; 29-30 Young

children appear to be more susceptible to the effects of environmental tobacco smoke

than older children are.25

Environmental tobacco smoke in the home is an important source of exposure because

children spend most of their time at home and indoors. This report’s measure for environmental tobacco smoke is the percentage of homes with children under 7 in which

someone smokes regularly. This measure is a surrogate for the exposure of children to

tobacco smoke, and the data are based on a national survey. Data are available for three

of the 10 target years. The measure reflects the percentage of homes, rather than children, although it is expected that the two would track closely.

Healthy People 2010: Objective 27-09 of the Healthy People 2010 initiative seeks to reduce

the percentage of children regularly exposed to secondhand smoke.

See Appendix C for more information.

Smoking in the Home

Environmental

Tobacco Smoke
Part I: Environmental Contaminants 21

Indoor Air Pollution

■ The percentage of homes with children under 7 in which someone smokes on a regular

basis decreased from 29 percent in 1994 to 19 percent in 1999.

■ The percentage of homes with children under 7 in which someone is a smoker is greater

than the percentage in which someone is allowed to smoke in the home.

■ Most often the smoker in the home is one of the parents.

■ The decline in the percentage of children exposed to environmental tobacco smoke

in the home is similar to the decline in the percentage of adults who smoke.

Measure E4 Percentage of homes with children under 7 where someone

smokes regularly

0%

5%

10%

15%

20%

25%

30%

35%

1994 1996 1999

SOURCE: U.S. Environmental Protection Agency, Office of Air and Radiation, Indoor Environments Division, Surveys on

Radon Awareness and Environmental Tobacco Issues.
22 America’s Children and the Environment: A First View of Available Measures

Drinking Water Contaminants

The contaminants in drinking water are quite varied and can cause a range of diseases

in children, including cancer, developmental effects such as learning disorders, and

acute diseases such as gastrointestinal illness. Children are particularly sensitive to

microbial contaminants because their immune systems may be less well developed than

those of most adults. Children are sensitive to lead, which affects brain development,

and to nitrates, which can cause methemoglobinemia (blue baby syndrome).

EPA sets drinking water standards for public water systems, referred to as Maximum

Contaminant Levels (MCLs). These standards are designed to protect against adverse

health effects from contaminants in drinking water while taking into account technical

feasibility of meeting the standard. MCLs have been adopted for more than 80 microbial

contaminants, chemicals, and radionuclides. EPA also adopts standards for the protection

of drinking water sources and for the treatment of drinking water to increase its safety.

An important treatment-related standard, the Surface Water Treatment Rule, requires

treatment of surface water by filtration to remove contaminants.

In 1998, EPA established more stringent filter performance requirements to further

strengthen microbial protection. In the same year, EPA also established new drinking

water standards for disinfection byproducts, exposure to which has been associated with

long-term bladder cancer and possible reproductive effects. Most recently, EPA finalized

standards protecting against radionuclides in drinking water. Because these standards

have been promulgated only recently, this report does not reflect the increased public

health protection achieved through their implementation.

One way to measure children’s risk of exposure to contaminated drinking water is to

identify public water systems that contain contaminants at levels greater than those

allowed by the drinking water standards. Ideally, we would look at data on concentrations of all of the chemical and microbial contaminants in all public drinking water

systems and identify any areas of risk for children. This is not currently possible, for

two reasons. First, the national data systems for drinking water do not track concentrations of contaminants in drinking water, but rather the frequency with which standards

are exceeded. Second, the information on violations is incomplete because not all public water systems fully monitor contaminants or report their monitoring results. (We

do, however, have some data that identify the public water systems that do not monitor

or report their results.) 

We can use information about violations as a surrogate for exposure to unacceptably

high levels of drinking water contaminants. We also need to consider information

about water systems that do not monitor or report results, because we do not know

with certainty whether populations served by these systems are at risk. 

Data are available only for public water systems. Approximately 42 million people are

served by private drinking water systems, which are not required to monitor and report

the quality of drinking water. We do not have information to indicate whether these

people are at risk.

Healthy People 2010: Objective 8-05 of the Healthy People 2010 initiative seeks to increase the

number of people served by community water systems that meet the

regulations of the Safe Drinking Water Act. See Appendix C for more

information.

Exceedances of

Drinking Water

Standards
Part I: Environmental Contaminants 23

Drinking Water Contaminants

■ The percentage of children served by public water systems that exceeded a Maximum

Contaminant Level or violated a treatment standard decreased from 19 percent in

1993 to 8 percent in 1998. 

■ Every category of violation decreased between 1993 and 1998. The largest decline

was for violations of the microbial contaminants standards.

■ A violation of “treatment and filtration” is defined as any failure in the treatment

process, or in operation and maintenance activities, or both, that may affect water

quality. EPA has a rule that specifies the type of treatment and maintenance activities

that systems must use to prevent microbial contamination of drinking water. 

■ Data on violations reported to the federal government are of generally high quality.

However, many public water systems fail to report all violations. A recent review of

the data concluded that 68 percent of the microbial contaminant violations are

reported, 19 percent of the violations for other contaminants are reported, and

11 percent of the treatment and filtration violations are reported.31

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

1993 1994 1995 1996 1997 1998

All Health-based Violations

Lead and Copper

Microbial Contaminants

All Other Contaminants

Treatment and Filtration

Measure E5 Percentage of children living in areas served by public water

systems that exceeded a drinking water standard or violated

treatment requirements

SOURCE: U.S. Environmental Protection Agency, Office of Water, Safe Drinking Water Information System.
24 America’s Children and the Environment: A First View of Available Measures

Drinking Water Contaminants

High levels of nitrites or nitrates in the water supply can interfere with infants’ ability

to absorb oxygen and can lead to “blue-baby” syndrome (methemoglobinemia), which

can result in death. EPA has set drinking water standards for nitrates and nitrites. 

The percentage of children living in areas served by public water systems that violate

these standards can be used as a measure of risk of exposure to nitrates and nitrites.

However, some families are served by water supplies, such as wells, that are not included in this measure because they are not part of public water systems and are not subject

to monitoring. Many people served by private water supplies live in rural and agricultural areas, and may be at particular risk. Fertilizer and livestock manures are significant

contributors of nitrates and nitrites in groundwater supplies of drinking water. 

Nitrates and Nitrites
Part I: Environmental Contaminants 25

Drinking Water Contaminants

■ In 1993, approximately 147,000 children were served by public water systems that

violated the nitrate or nitrite standard. In 1998, 117,000 children were served by

systems that violated the nitrate or nitrite standard. 

■ The primary sources of nitrates include livestock manure (especially from feedlots),

fertilizers, and human sewage.

Measure E6

0.0%

0.1%

0.2%

0.3%

0.4%

1993 1994 1995 1996 1997 1998

Percentage of children living in areas served by public water

systems in which the nitrate/nitrite standard was exceeded

SOURCE: U.S. Environmental Protection Agency, Office of Water, Safe Drinking Water Information System.
26 America’s Children and the Environment: A First View of Available Measures

Drinking Water Contaminants

Public water systems are required to monitor for contaminants and report violations of

drinking water standards to EPA. However, not all public water systems conduct all

required monitoring and report violations. Such water systems violate monitoring and

reporting requirements. 

Some monitoring and reporting violations, such as late reporting, are minor. But some

water systems have major violations, such as failing to collect any water samples during a

specified monitoring period. Children that live in areas that are not adequately monitoring

for water contaminants may be at risk, but the extent of the risk is unknown.

Monitoring and

Reporting 
Part I: Environmental Contaminants 27

Drinking Water Contaminants

■ In 1993, approximately 21 percent of children lived in an area served by a public

water system that had at least one major monitoring and reporting violation. This

figure decreased to about 10 percent in 1998.

■ The largest number of monitoring and reporting violations occurred for the lead and

copper standards. Approximately 11 percent of children in 1993 were served by

public water systems with monitoring and reporting violations for lead and copper,

decreasing to about 5 percent in 1995. The number has remained constant since then.

■ The percentage of children who live in areas with a major chemical and radiation

monitoring violation declined from approximately 9 percent in 1993 to about 2

percent in 1998.

Measure E7 Percentage of children living in areas with major violations of

drinking water monitoring and reporting requirements

SOURCE: U.S. Environmental Protection Agency, Office of Water, Safe Drinking Water Information System.

0%

5%

10%

15%

20%

25%

1993 1994 1995 1996 1997 1998

Lead and Copper

Any Major Violation

Chemical and

Radiation

Microbial Contaminants

Treatment and Filtration
28 America’s Children and the Environment: A First View of Available Measures

Pesticide Residues in Foods

Most of the food produced for human consumption is grown using pesticides.

Chemical control of weeds, insects, fungi, and rodents has enabled agricultural productivity and intensity to increase. However, these economic benefits are not without their

risks to human and environmental health. Small amounts of some pesticides may

remain as residues on fruits, vegetables, grains, and other foods. If exposures are great

enough, many pesticides may cause harmful health effects, including delayed or altered

development, cancer, acute and chronic injury to the nervous systems, lung damage,

reproductive dysfunction, and possibly dysfunction of the endocrine (hormone) and

immune systems.32-33

Children’s exposures to pesticide residues may be relatively higher than those of most

adults. Pound for pound, children generally eat more than adults, and they may be

exposed more heavily to certain pesticides because they consume a diet different from

that of adults.34 For instance, children typically consume larger quantities of applesauce, milk, and orange juice per pound of body weight. 

Protecting the food supply from harmful levels of pesticide residues requires the ongoing attention of government agencies, pesticide producers, and pesticide users. The

U.S. Department of Agriculture (USDA) collects annual data on pesticide residues in

food. Among the foods sampled by the USDA’s Pesticide Data Program in recent years

are several that are important parts of children’s diets, including apples, apple juice,

bananas, carrots, green beans, orange juice, peaches, pears, potatoes, and tomatoes. EPA

evaluates the safety of all new and existing pesticides and restricts pesticide use to those

applications that do not pose unacceptable human health or ecological risks.

Pesticides are not the only contaminants in food that may affect children’s health adversely.

Industrial contaminants (such as dioxins, PCBs, and mercury), microbial contaminants

(such as E. coli), and natural contaminants (such as aflatoxin) also can be found in foods.

The Pesticide Data Program does not analyze foods for the presence of these types of contaminants, although other government programs monitor for some of them.

The chart on the following page displays the percentage of foods with detectable pesticide residues reported by the PDP from 1994 to 1998.35-36 This measure is a surrogate

for children’s exposure to pesticides in foods: If the frequency of detectable levels of pesticides in foods decreases, it is likely that exposures will decrease. However, this measure

does not account for many additional factors that affect the risk to children. For example, some pesticides may pose greater risks to children than others do; residues on some

foods may pose greater risks than residues on other foods due to differences in amounts

consumed. For some pesticides, residues at levels below detection limits may pose

important risks, while for other pesticides detectable levels of residues may not pose a

significant health concern. In addition, year-to-year changes in the percentage of samples

with detectable pesticide residues may be affected by changes in the selection of foods

that are sampled each year.
Part I: Environmental Contaminants 29

Pesticide Residues in Foods

■ In 1994, 62 percent of all food samples tested by the U.S. Department of

Agriculture’s Pesticide Data Program (PDP) had detectable levels of at least one

pesticide. The proportion of samples with detections increased to 68 percent in

1996, then declined to 55 percent in 1998.

■ In 1998, 29 percent of samples had detectable levels of multiple pesticides,

compared with 36 percent in 1994. During the same period, the proportion of

samples with detectable levels of a single pesticide remained relatively constant.

■ PDP data from 1994-96 were further evaluated for the presence of pesticides in 19

foods frequently eaten by children. This analysis focused on detections of

carcinogenic and neurotoxic pesticides. Twenty-five percent of the samples had

detectable levels of carcinogenic pesticides, and 34 percent had detectable levels of

neurotoxic pesticides (not shown).

■ Each year, less than 0.2 percent of all sampled foods had residues that violated

established tolerances. A tolerance is the amount of pesticide residue legally allowed

to remain on a food commodity.

Measure E8

SOURCE: U.S. Department of Agriculture,Agricultural Marketing Service, Pesticide Data Program Annual Summary

(Calendar Years 1993-1998).

80%

70%

60%

50%

40%

30%

20%

10%

0%

1994 1995 1996 1997 1998

Food Samples with

a Single Pesticide

Detected

Food Samples with

Residues of Multiple

Pesticides Detected

All Food Samples

with Pesticide

Residues Detected

Percentage of fruits, vegetables, grains, dairy, and processed

foods with detectable pesticide residues
30 America’s Children and the Environment: A First View of Available Measures

Land Contaminants

Abandoned and uncontrolled hazardous waste sites may pose risks to children who play

in or near them, and the sites also may cause pollution of drinking water, ambient air,

and foods. Superfund is the federal government’s program to clean up these sites. EPA’s

principal mechanism for placing sites on Superfund’s National Priorities List (NPL) is a

scoring system that uses information from initial, limited investigations to assess the

relative potential of sites to pose a threat to human health or the environment. 

Sites with scores indicating a high risk potential are proposed for addition to the NPL.

EPA then accepts public comments on the sites, responds to the comments, and finalizes the listing for those sites that continue to meet the requirements for addition to the

list. Sites on the NPL are studied in detail and cleaned up as necessary. Sites are deleted

from the list when EPA determines that no further response is required to protect

human health or the environment. 

Sites at which substantial cleanup work has been completed may be designated as having reached “Construction Completion.” This means that any physical construction

necessary to reduce potential exposures has been completed, and other controls are in

place to prevent exposure while final cleanup levels are being achieved. Construction

Completion represents a level of site remediation at which potential exposures have

been significantly reduced, although additional cleanup work remains. 

Residence in a county where a Superfund site is located is a surrogate measure for potential exposure to contaminants found at these sites. This measure has complete national

coverage and includes data for multiple years. The limitations of this measure are that

some children living in counties with Superfund sites may live many miles away from

those sites, in which case the potential for exposure could be low. Also, the hazards

posed to children may vary significantly across the different Superfund sites. 

Healthy People 2010: Objective 8-12 of the Healthy People 2010 initiative addresses the mitigation of hazardous waste sites on the National Priority List. See Appendix C

for more information.

Hazardous 

Waste Sites
Part I: Environmental Contaminants 31

Land Contaminants

■ About 58 percent of children lived in counties with Superfund sites as of August

2000. This figure represents an increase from approximately 55 percent in 1990.

The increase is due to the addition of sites to the list through the 1990s as initial

evaluations were completed. The soil at these newly listed sites probably has been

contaminated for many years, so the increase in the percentage of children living in

counties with Superfund sites does not necessarily reflect an increase in hazards to

children in recent years. 

■ Sites that have reached “Construction Completion” are expected to pose a

substantially reduced hazard. When only the Superfund sites that have not reached

this milestone are considered, the percentage of children living in counties with

hazardous waste sites has declined from 55 percent in 1990 to 50 percent in 2000. 

■ More than 750 out of the 1,500 sites on Superfund’s National Priorities List (NPL)

have reached Construction Completion. Of these, cleanup has been completed at

more than 200 sites and they have been removed from the NPL. 

Measure E9 Percentage of children living in counties with Superfund sites

SOURCE: Environmental Protection Agency, Superfund NPL Assessment Program (SNAP) Database.

0%

10%

20%

30%

40%

50%

60%

70%

1990 1992 1994 1996 1998 2000

All Superfund Sites

All Superfund Sites That Have Not Yet

Reached "Construction Completion"
32 America’s Children and the Environment: A First View of Available Measures

Land Contaminants

Another way to look at trends in children potentially affected by Superfund sites is to

focus only on changes in those sites that were on Superfund’s National Priorities List

(NPL) at the end of fiscal year 1990. As noted above, the analysis based on the entire

NPL may be misleading, because the addition of sites to the NPL in recent years does

not necessarily mean that risks have increased. Most of the newly listed sites have been

contaminated for many years, and their addition to the NPL in the 1990s means only

that EPA has recognized the contamination and that the administrative processes

required for listing have been completed.

For this alternative analysis, we disregard sites added to the NPL since 1990 and consider only those sites that were listed by September 30, 1990. We then track the sites

that remain on the NPL in subsequent years—i.e., the sites at which remediation was

not complete as of 1992, 1994, etc. Both final remediation and cleanup (which results

in deletion from the NPL) and “Construction Completion” (which indicates significant

reductions in potential exposures) are considered. 

This analysis provides an indication of progress in remediation at those sites that were

included on the NPL in 1990. The limitation of this measure is similar to that of the

previous Superfund measure in that both measures only present the number of children

living in counties with Superfund sites. The hazards posed by any Superfund site may be

localized and therefore may not affect many residents of the county in which it is located.

Hazardous Waste

Sites Listed 

as of 1990
Part I: Environmental Contaminants 33

Land Contaminants

■ In 1990, 55 percent of children lived in counties that had Superfund sites. By 2000,

many of those counties no longer had sites on Superfund’s National Priorities List

(NPL), because final remediation and cleanup of their sites had been achieved. Fifty

percent of children live in counties that had Superfund sites in 1990 and still have

Superfund sites in 2000. 

■ Many of the sites that were on the NPL in 1990 and remain on the list today have

been substantially remediated and are described as having reached “Construction

Completion.” Forty percent of children currently live in counties that had

Superfund sites in 1990 and still have Superfund sites that have not reached

Construction Completion, a reduction from 55 percent in 1990.

Measure E10 Percentage of children living in counties that had Superfund

sites in 1990

SOURCE: Environmental Protection Agency, Superfund NPL Assessment Program (SNAP) Database.

0%

10%

20%

30%

40%

50%

60%

70%

1990 1992 1994 1996 1998 2000

All Superfund Sites

All Superfund Sites That Have Not Yet Reached

"Construction Completion”

PART II

Biomonitoring

Part II: Biomonitoring 37

his section of the report presents measures reflecting levels of contaminants in

children.

Data on the levels of pollutants in children’s bodies provide direct information about

exposures to environmental contaminants that may harm children. These measurements

most often are taken from blood samples, but also can come from sources such as urine

or hair. The disadvantage of these measurements is that it is difficult to determine the

source of the exposures. For example, lead may occur in children’s blood when they

inhale airborne lead, eat contaminated food, or when they play in contaminated soil or

dust and then put their hands in their mouths. 

Also, it is invasive to obtain samples and can be expensive to obtain enough samples to

estimate the distribution of contaminants in children for the nation or for groups that

may have higher exposures such as the poor. 

The measures in this report for biomonitoring present data on concentrations of lead in

blood. Blood lead is an important measure because it is directly related to neurological

and developmental effects in children, and national data are available for a number of

years. Many other pollutants for which biomonitoring data are not currently available

on a national level are important to children’s health. However, the federal government

currently is collecting and analyzing biomonitoring data for a number of other compounds

important to children, including pesticides, heavy metals such as mercury and cadmium,

and compounds that indicate exposure to environmental tobacco smoke. This work will

be incorporated into future editions of this report.

Part II:

Biomonitoring

T
38 America’s Children and the Environment: A First View of Available Measures

Concentrations of Lead in Blood 

Lead is a major environmental health hazard for young children. Research shows that

blood lead levels of 10 micrograms per deciliter of blood (μg/dL) in young children can

result in lowered intelligence, reading and learning disabilities, impaired hearing,

reduced attention span, hyperactivity, and antisocial behavior.37 However, there currently is no demonstrated safe concentration of lead in blood, and adverse health effects

can occur at lower concentrations.

Today, high blood lead levels are due mostly to deteriorated lead paint in older homes

and contaminated dust and soil.37 Soil that is contaminated with lead is an important

source of lead exposure because children play outside and very small children frequently

put their hands in their mouths. Research shows that pulverized leaded paint and past

emissions of lead in gasoline that subsequently were deposited in the soil contribute to

lead-contaminated soil and house dust.38

Children also may be exposed to lead through drinking water contaminated by pipes

and fixtures containing lead. In the past, ambient concentrations of lead from leaded

gasoline were a major contributor to childhood blood lead levels. 

Healthy People 2010: Objective 8-11 of the Healthy People 2010 initiative aims to totally

eliminate elevated blood levels in children. See Appendix C for more

information.

Lead in the Blood 

of Young Children
Part II: Biomonitoring 39

Concentrations of Lead in Blood 

■ Average blood lead levels in children 5 years old and under dropped from 16.5

micrograms per deciliter (μg/dL) between 1976 and 1980 to 3.6 μg/dL between

1992 and 1994, a decline of 78 percent.

■ The decline in average blood lead levels is due largely to the phasing out of lead in

gasoline between 1973 and 1995.12 Some decline also was due to legislation

banning lead from paint and plumbing supplies.

■ In 1976-1980 the average child, regardless of family income, had an elevated blood

lead level (i.e. concentrations greater than 10 μg/dL). However, children living in

families with incomes below the poverty line had higher average blood lead

concentrations than those living in families with incomes at or above the poverty

line. This disparity continued through the 1990s.

■ Although the concentration of lead in blood is an important indicator for risk, it

reflects only current exposures. Lead also accumulates in bone. Recent research suggests

that concentrations of lead in bone may be more related to adverse health outcomes in

children than concentrations in blood are.39 This suggests that concentrations in bone

may better reflect the net burden of exposure. However, methods for measuring lead in

bone are more time-consuming and expensive than those for measuring lead in blood.

■ Concentrations of lead in air remain greater than the National Ambient Air Quality

Standards in some areas in the United States. The main sources of ambient

concentrations of lead are metals processors such as smelters and battery manufacturers.

Measure B1

1976-1980 1988-1991 1992-1994

0

5

10

15

20

25

Blood Lead Concentrations (μg/dL)

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and

Nutrition Examination Survey.

Average concentrations of lead in blood for children 5 and

under

All Family Incomes Above

Poverty Level

Family Incomes Below

Poverty Level
40 America’s Children and the Environment: A First View of Available Measures

Concentrations of Lead in Blood 

Many children still have elevated blood lead levels (levels above 10 μg/dL). Race and

poverty affect the likelihood that a child has an elevated blood lead level. Blood lead

levels are highest for younger children, because their exposure per pound of body

weight is greater due to their smaller body weight. 

The youngest age group for which data are available, ages 1-5, are presented here.

Measures of blood lead by race and income can help identify the groups that are at

greatest risk. 

Blood Lead by 

Race and Income
Part II: Biomonitoring 41

Concentrations of Lead in Blood 

■ In 1992-1994, approximately 1.5 million children (2.3 percent) 17 and younger

had elevated blood lead levels (concentrations greater than 10 μg/dL). Four percent

of children between the ages of 1 and 5 (890,000) had elevated blood lead levels.

■ Children who lived in families with incomes below the poverty line had a greater

risk of elevated blood lead levels than those who lived in families with incomes at or

above the poverty line.

■ For all income levels, non-Hispanic Black children had a greater risk of elevated

blood lead levels than white children. However, the disparity is greater for Black

children who live in families with incomes below the poverty line.

■ Approximately 73,000 children had blood lead levels greater than 20 μg/dL

between 1992 and 1994. This is twice the level considered to be elevated.

■ Currently, there is no demonstrated safe concentration of lead in blood. Recent

research on a national sample of children measured effects down to the lowest

detectable concentrations of lead in blood, and the results suggest that health effects

can occur at blood lead levels as low as 2.5 μg/dL.40 Approximately 11 million

children between the ages of 1 and 5, about 54 percent of that age group, had blood

lead levels of 2.5 μg/dL or greater between 1992 and 1994.

Measure B2 Percentage of children ages 1-5 with concentrations of lead in

blood greater than 10 micrograms per deciliter, 1992-1994

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

All Black non-Hispanic Hispanic White non-Hispanic

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and

Nutrition Examination Survey.

All At or Above Poverty Level Below Poverty Level

PART III

Childhood 

Diseases

Part III: Childhood Diseases 45

his section of the report presents measures of adverse health effects in children

that may be influenced by exposures to environmental contaminants.

There are many important diseases that affect children, some in which environmental

contaminants are known to play a role and others for which the role is unclear. This

report focuses on important childhood diseases for which we have nationally representative and readily available data, and for which some evidence exists to indicate or suggest

that the disease is partially influenced by environmental contaminants. The diseases

selected for this report are asthma, chronic bronchitis, and childhood cancer. The

Interagency Task Force on Environmental Health Risks and Safety to Children, organized by EPA and the Department of Health and Human Services, has identified asthma

and childhood cancer as priorities. 

Additional diseases that may be partially influenced by environmental contaminants

include other respiratory diseases, waterborne diseases, methemoglobinemia, birth

defects, developmental defects, and learning disorders. Diseases that may result from

childhood exposures to environmental contaminants, but that do not manifest themselves until adulthood, are not addressed in this report.

Part III:

Childhood

Diseases

T
46 America’s Children and the Environment: A First View of Available Measures

Respiratory Diseases

Asthma is the most common chronic disease among children and is a costly disease in

both human and monetary terms.41 Children with asthma may need to limit daily activities to control or prevent asthma attacks and often require long-term use of medications.

Extreme exacerbation of asthma can lead to emergency room visits, hospitalizations,

and sometimes death. The tendency to develop asthma can be inherited, but not all

children with asthma have a family history of the disease. Exposures to indoor and outdoor sources of biological and chemical environmental contaminants have been shown

to cause asthma or exacerbate existing asthma. Exposures to outdoor air pollutants,

such as particulate matter, have been shown to exacerbate asthma. Chronic bronchitis

also is a condition in children that has been associated with exposure to air pollutants,

including particulate matter and ozone.42-43

Respiratory Outcomes

in Children: 

Asthma and 

Chronic Bronchitis
Part III: Childhood Diseases 47

Respiratory Diseases

■ Between 1990 and 1995, the number of children with asthma increased by about

30 percent, from 5.8 percent in 1990 to 7.5 percent in 1995. The number of

children with asthma in the United States increased by 75 percent from 1980 to

1994. A slight decrease in asthma rates occurred between 1995 and 1996.

■ The number of children with chronic bronchitis increased slightly from 5.4 percent

in 1990 to 5.7 percent in 1996.

■ Some environmental factors may cause children to develop asthma, but the causes

of asthma are not completely understood. In a recent report, the Institute of

Medicine identified house dust mites as an agent known to cause asthma, and

cockroaches and tobacco smoke as other indoor sources suspected to cause

asthma.41

■ Other environmental factors may increase the severity or frequency of asthma in

children who have the disease. Children with asthma are particularly sensitive to

outdoor air pollution such as ozone, particulate matter, and sulfur dioxide. These

pollutants can exacerbate asthma, possibly leading to an increased use of

medication, visits to doctors’ offices, and trips to emergency rooms. In severe cases

asthma can lead to hospital admissions and even death.

8%

7%

6%

5%

4%

3%

2%

1%

0%

Measure D1

1990 1991 1992 1993 1994 1995 1996

Asthma

Chronic Bronchitis

Percentage of children under 18 with asthma and chronic

bronchitis

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview

Survey.
48 America’s Children and the Environment: A First View of Available Measures

Respiratory Diseases

Children of lower-income families and children of color are more likely to have asthma.

These children often have less access to medical care, which can increase the severity

and impact of their illness. Data for 1997-1998 show that the percentage of children

with asthma differs by racial and ethnic groups, and by poverty level.

In 1997, the method for measuring asthma among children was changed. Estimates for

the percentage of children with asthma are lower in 1997-1998 than in 1996, but it is

not clear whether this is due to an actual decrease in the percentage of children with

asthma or the change in how asthma is measured. 

Prevalence of Asthma

by Race and Income
Part III: Childhood Diseases 49

Respiratory Diseases

■ In 1997-98, 5.4 percent of all children had asthma. 

■ Non-Hispanic Black children living in families with incomes below the poverty

level have the highest rates of asthma of any group: 8.3 percent of children. 

■ Approximately 5 percent of both White non-Hispanic children and Hispanic

children have asthma.

■ Children living in families with incomes below the poverty level had higher rates of

asthma, 6.2 percent, than those children living in families at or above the poverty

level, 5.3 percent.

Measure D2 Percentage of children under 18 with asthma,1997-98

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview

Survey.

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

All At or Above Poverty Level Below Poverty Level

All Black non-Hispanic Hispanic White non-Hispanic
50 America’s Children and the Environment: A First View of Available Measures

Respiratory Diseases

The rate of children hospitalized for asthma is another important measure because it

represents the most severe cases—those in which asthma could not be controlled on an

outpatient or emergency department basis. 

Only a fraction of children with asthma are admitted to the hospital. Hospitalization for

asthma can be related to a number of factors, including air pollution and lack of access

to primary health care. Studies conducted in the northeastern United States indicate

that air pollution during the summer was associated with approximately 6-24 percent

of all hospital admissions for asthma.44

Healthy People 2010: Objective 24-02a of the Healthy People 2010 initiative seeks to reduce 

asthma-related hospitalizations of children under 5. See Appendix C for

more information.

Asthma

Hospitalizations
Part III: Childhood Diseases 51

Respiratory Diseases

■ The asthma hospitalization rate for children aged 0-14 increased from 284 per

100,000 in 1987 to 369 per 100,000 in 1995, and then dropped to 277 per

100,000 in 1998.

■ Children aged 0-14 represent 38 percent of asthma hospitalizations for all ages

(children and adults) during 1998.45

■ Asthma hospitalizations accounted for 7 percent of all hospitalizations for children

aged 0-14 in 1998, and asthma was the fourth leading cause of non-injury-related

hospital admissions.45

■ Outdoor air pollutants such as particulate matter and ozone are associated with

increased emergency room visits and hospital admissions.42-43

■ Exposure to two other important air pollutants, nitrogen dioxide and sulfur

dioxide, has been shown to decrease lung function in asthmatics.46

Measure D3 Asthma hospitalization rate for children 0-14

0

100

200

300

400

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

Rate per 100,000

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview

Survey.
52 America’s Children and the Environment: A First View of Available Measures

Childhood Cancer

Cancer in childhood is quite rare compared with cancer in adults, but it still causes the

most deaths, other than injuries and accidents, among children 0-19 years of age.47

Childhood cancer is not a single disease, as it includes a variety of malignancies. The

forms of childhood cancer that are most common vary at different ages.

The incidence of childhood cancer increased from 1975 until about 1990. The frequency

of the disease appears to have become fairly stable overall since 1990. Mortality has

declined substantially during the last 25 years, due largely to improvements in treatment.

The causes of cancer in children are poorly understood, though in general it is thought

that different forms of cancer have different causes. Established risk factors for the

development of childhood cancer include family history, genetic defects, radiation, and

certain pharmaceutical agents used in chemotherapy.47 Evidence from epidemiological

studies suggests that environmental contaminants such as pesticides and certain chemicals, in addition to radiation, may contribute to an increased frequency of some childhood cancers.32 Some studies have found that children born to parents who work with

or use such chemicals are more likely to have cancer in childhood.48 It may be that the

chemicals cause mutations in parents’ germ cells that may increase the risk of their children developing certain cancers, or perhaps the parental exposure is passed on to the

child while in utero, affecting the child directly. Children’s direct exposures to such

chemicals also may contribute to cancer. 

Cancer Incidence 

and Mortality
Part III: Childhood Diseases 53

Childhood Cancer

■ Age-adjusted annual incidence of cancer in children increased from 130 to 150 cases

per million children between 1975 and 1995. The incidence appears to have leveled

off after 1990. Mortality decreased from 50 to 30 deaths per million children during

the same period.

■ Rates of cancer incidence vary by age. Rates are highest among infants, decline until

age 9, and then rise again with increasing age. Between 1986 and 1995, children

under 5 and those aged 15-19 experienced the highest incidence rates of cancer at

approximately 200 cases per million. Children aged 5-9 and 10-14 had lower

incidence rates at approximately 110 and 120 cases per million respectively.

■ Between 1992 and 1996, incidence rates of cancer were highest among whites at

160 per million. Hispanics were next highest at 150 per million. Asians and Pacific

Islanders had an incidence rate of 140 per million, Black children had a rate of

120 per million, and Native Americans and Alaska Natives had the lowest at 80 per

million. Data on the incidence of childhood cancer by race and ethnicity are shown in

the data tables in Appendix A.

Measure D4 Cancer incidence and mortality for children under 20

SOURCE: Incidence data are from the National Cancer Institute, Surveillance, Epidemiology and End Results Program.

Mortality data are from Centers for Disease Control and Prevention, National Center for Health Statistics.

0

50

100

150

200

Incidence

Mortality

1975 1980 1985 1990 1995

Rate per million
54 America’s Children and the Environment: A First View of Available Measures

Childhood Cancer

Trends in the total incidence of childhood cancer are useful indicators for assessing the

overall burden of cancer among children. However, broad trends mask changes in frequency of individual cancers. Individual cancers often have patterns that diverge from

the overall trend. Moreover, environmental factors may be more likely to contribute to

some childhood cancers than to others.

Ionizing radiation, such as from x-rays, is a known cause of leukemia and brain

tumors.49-50 There is suggestive–but not conclusive–evidence that parental exposures to

certain chemicals may be a cause of leukemia, brain cancer, non-Hodgkin’s lymphoma,

and Wilms’ tumor in children.51

A number of studies have evaluated the relationship between pesticide exposure and

certain types of childhood cancer, and while the evidence is suggestive of a link, it is

still not conclusive.47 Most studies of the relationship between pesticide exposure and

leukemia and brain cancer show increased risks for children whose parents used pesticides at home or work, and for children who may be exposed to pesticides in the

home.52-53 Evidence is limited but suggestive that non-Hodgkin’s lymphoma in children

may be linked to parental pesticide exposure and exposure to pesticides in the home.52

There is some evidence linking pesticide use to Wilms’ tumor and Ewing’s sarcoma.52

Childhood Cancer 

by Type
Part III: Childhood Diseases 55

Childhood Cancer

■ Leukemia was the most common cancer diagnosis for children from 1973-1996,

representing 25 percent of the total cancer cases. Incidence of acute lymphoblastic

leukemia has increased moderately from 23 cases per million between 1973-1978 to

approximately 27 cases per million between 1991-1996. Rates of acute myeloid

leukemia have remained stable. 

■ Central nervous system tumors represented 17 percent of childhood cancers. The

incidence of central nervous system tumors increased from approximately 23 per

million in 1973-1978 to 29 per million in 1991-1996.

■ Lymphomas, which include Hodgkin’s disease and non-Hodgkin’s lymphoma,

represent approximately 16 percent of childhood cancers. Hodgkin’s disease

declined slightly from roughly 14 per million in 1973-1978 to approximately 13

per million in 1991-1996. Non-Hodgkin’s lymphomas increased from 8.9 per

million in 1973-1978 to approximately 11 per million in 1991-1996.

Acute

lymphoblastic

Acute

myeloid

Central

nervous

system tumors

Hodgkin's

Lymphoma

Non-Hodgkin's

Lymphoma

Thyroid

carcinoma

Malignant

melanoma

Leukemias Lymphomas Carcinomas and other

epithelial neoplasms

Measure D5a Cancer incidence for children under 20 by type

0

5

10

15

20

25

30

1973-1978 1979-1984

1985-1990 1991-1996

SOURCE: Surveillance, Epidemiology, and End Results Program 1973-1996, Division of Cancer Control and Population

Sciences, National Cancer Institute.

Rate per million
■ Different types of cancer affect children at different ages. Neuroblastomas, Wilms’

tumor (tumors of the kidney), and retinoblastoma (tumors in the eye) usually are

found only in very young children. Leukemias and nervous system cancers are most

common through age 14; lymphomas, carcinomas, and germ cell and other gonadal

tumors are more common in those 15-19 years old.47 

Measure D5b Cancer incidence for children under 20 by type

0

5

10

15

20

25

30

Germ cell

tumors

Soft

tissue

sarcomas

Osteosarcoma

Ewing's

sarcoma

NeuroblastomaWilms'

tumor

RetinoblastomaHepatoblastoma

Malignant Bone Tumors

1973-1978 1979-1984 1985-1990 1991-1996

SOURCE: Surveillance, Epidemiology, and End Results Program 1973-1996, Division of Cancer Control and Population

Sciences, National Cancer Institute.

Rate per million

56 America’s Children and the Environment: A First View of Available Measures

Childhood Cancer
Future Directions 57

n the process of developing this report, we identified a number of limitations to

the most readily available data and the methods used to collect and present them.

This section discusses recommended improvements to the measures in the report and

improvements to the data sources used to calculate the measures. We also include a

discussion of tracking systems for childhood diseases. 

There are many important measures that we would like to include in future reports;

our discussion here is focused on those of greatest importance, which were identified

through discussion with experts in the field. 

Ideally, measures would be available to reflect all important factors in each of the three

parts of this report. 

For environmental contaminants, ideal measures would reflect concentrations in the

environment of all of the chemical and biological agents that are important for children.

The measures would reflect the potential for children to be exposed to these pollutants.

For concentrations of contaminants measured in children, ideal measures would reflect

concentrations of the key pollutants that tend to accumulate in children and that pose

high risks of health effects.

For childhood diseases, ideal measures would reflect all the important childhood diseases that may be caused by or exacerbated in part by environmental factors.

Ideally, for measures in all three parts of the report, data sources would provide information for all of the nation’s children. Data also would be available for 10 years or

more to provide information about changes over time. Information would be available

on differences among geographic areas, differences among racial-ethnic groups, and differences by various social and economic status factors.

In the sections below, we outline potential improvements to the existing measures and

describe other data that we would like to include in future reports. As future editions of

this report are developed, we will continue to review and assess data sources that are

available. This review and assessment will be an ongoing process as new sources of data

are identified and, we hope, existing sources of data are improved.

Our goal is to have nationally representative measurements of concentrations of environmental contaminants that could affect children’s health in air, water, food, and soil. 

Common Air Pollutants

The measures used for criteria air pollutants are based on two kinds of data: exceedances

of national standards and the reports of daily air quality generated through the Air

Quality Index. 

To further develop measures in this area, the first priority is to obtain data on measured

concentrations of air pollutants in all counties. These data would allow for a more

detailed assessment of the severity of pollution, both in terms of the numbers of days in

Future Directions

I

Characteristics of

Ideal Measures

Data for Existing and

New Measures

Environmental

Contaminants
58 America’s Children and the Environment: A First View of Available Measures

which standards are exceeded and the actual concentrations of pollutants. The data also

would allow better assessment of the measure’s completeness. 

As noted in Part I of the report, the information about exceedances of standards shows

only whether air quality, at any point during a year, exceeds a standard. It does not

allow any analysis of how often such exceedances occur. On the other hand, it does

provide disaggregation of the data separately for each pollutant.

Measures based on actual concentrations may better capture the potential health risks to

children. Such measures could portray the combined pollution burden from multiple pollutants on any single day as well as the full duration of concentrations at various levels.

Hazardous Air Pollutants

The measures in this report for hazardous air pollutants (air toxics) are based on data

from the year 1990 only. Work is underway to produce measures that will reflect trends

over time in ambient concentrations of hazardous air pollutants. Estimates of ambient

concentrations in 1996 are expected to be completed within the coming year and will be

incorporated into next year’s report. Estimates will be updated every three years thereafter. 

Data from air toxics monitoring programs also could be considered for inclusion in future

editions of this report. Currently, national data on air toxics monitoring are limited and

much of the monitoring and data collection are performed at the state level. 

The air toxics measures presented in this report do not distinguish between situations

in which many hazardous air pollutants exceed health benchmarks and those in which

only one exceeds the benchmarks. Measures accounting for the number of hazardous

air pollutants exceeding health benchmarks may provide a fuller picture of the potential

risks to children. To develop these measures further, the authors will consider monitoring information and updated modeling data. 

The hazardous air pollutants measures in this report are further limited because they

represents only the presence of these pollutants in ambient air. For certain hazardous air

pollutants that are persistent in the environment, greater exposures occur in food.

These pollutants settle out of the air onto land and into bodies of water, and then are

taken up in the food chain. Future work on measures of food contaminants will consider this pathway of exposure (see the section on food contaminants below).

Indoor Air Pollutants

Indoor air contaminants are represented by a surrogate measure reflecting the percentage of homes where people smoke. The most important improvement to this measure

would be to add data for other sources of indoor air pollutants, such as consumer products, gas stoves, and furnishings, for both homes and schools. We have not identified

any nationally representative data on air contaminants for homes, schools, and other

indoor environments in which children may spend large amounts of time, but we will

continue to explore possible measures in this area. 

Future Directions
Future Directions 59

Drinking Water Contaminants

The measures for contaminants in drinking water reflect violations of national standards. These measures share the limitations of the criteria air pollutant measures, as

described above, in that they do not distinguish among the impacts of various concentrations of contaminants. The data on drinking water contaminants are less complete

than those used for the air measures because less reporting of water contaminants

occurs at the national level. In addition, the drinking water contaminant measures in

this report rely on the Maximum Contaminant Level (MCL) standards, which are

based partly on health considerations but also take into account technical feasibility.

Each MCL also has a corresponding Maximum Contaminant Level Goal (MCLG),

which is based only on health considerations. The MCLG could be considered for

measures in future reports.

Actual measured contaminant concentrations would provide the most relevant measures of potential risks to children. The most complete data are collected at the state

level; information from the states would need to be compiled nationally to improve the

measures for drinking water. Another problem with the data on drinking water is that

many water systems do not adequately monitor for contaminants, so we have no information about potential risks to children in those areas. Future reports will consider data

collected at the state level.

Since 1999, EPA has required water suppliers to send annual reports on drinking water

quality to their customers. These reports contain information on the drinking water

source and the level, or range of levels, of contaminants found in local drinking water.

These data also will be considered along with state data in future reports. 

Information on sources of contamination to ground water and surface water sources

that supply water to public water systems is important for identifying the key contributors to drinking water contamination. EPA now requires states to assess all the ground

water and surface water sources that supply water to public water systems. These assessments will identify the major potential sources of contamination to drinking water supplies, and will help officials determine the water systems’ susceptibility to contamination. Information from state assessments will be considered for future reports.

Surface Water Contaminants

In future reports we hope to characterize the risks to children posed by the consumption of fish contaminated with mercury, PCBs, and other toxicants that affect neurological development. Many states target their warnings on the consumption of fish

from contaminated water to pregnant women and children. We also would like to characterize the risks posed to children by swimming in waters with bacterial contamination. Children are at greater risk of illness while swimming than adults are because of

their longer exposure times and more frequent accidental ingestion of water. 

On October 10, 2000 the Beaches Environmental Assessment and Coastal Health Act

was signed into law. This new amendment to the Clean Water Act requires nationally

consistent bacterial standards for recreational waters in all coastal and Great Lakes

beaches, and provides grants for states and tribes to conduct beach monitoring and

notification programs. Data generated under this provision, when available, may be

useful for constructing measures for future reports.

Future Directions
60 America’s Children and the Environment: A First View of Available Measures

Pesticide Residues and Other Food Contaminants

Contaminants in food are represented in this report by a measure of the frequency with

which pesticides are detected in tested samples of produce. This measure does not distinguish among differing levels of contamination. Furthermore, the detection limits do

not provide a health-based point of comparison, as they are not equivalent to levels of

concern for children’s health.

For future reports we will consider improved measures for pesticides that incorporate

the actual measured levels of pesticide residues, along with children’s food consumption

rates that are available from surveys conducted by the U.S. Department of Agriculture. 

The Food Quality Protection Act (FQPA) of 1996 established a single, health-based

safety standard for new and existing pesticides and their residues in raw and processed

food. EPA now routinely considers the combined effects of pesticide exposure from

food, drinking water, and other non-work related uses, as well as the effects of pesticides that act in the same way in the body. We will consider new data, standards and

analytical techniques developed in the implementation of FQPA in developing measures for future versions of this report.

We also will examine the available data on the presence of other types of contaminants

in foods. As noted above, some hazardous air pollutants find their way into the food

chain after being deposited from the atmosphere, and their presence in food can pose

more of a risk to children than their presence in the air. In addition, children are

exposed in utero and nursing infants may be exposed to persistent contaminants in

breast milk. We will explore the feasibility of preparing measures of these other food

contaminants for future reports.

Finally, some children may be exposed to particularly elevated levels of contaminants in

food, including children in homes where much of the diet comes from subsistence fishing or subsistence farming. We will explore the availability of suitable data regarding

such differential exposures for future reports.

Land Contaminants

For contaminants in soil, this report includes a measure of the percentage of children

living in counties that have a Superfund site. This measure will be refined for future

reports by considering whether children live in close proximity to one of these sites

(e.g., within one mile), rather than whether they live anywhere in the same county. A

measure of children living in proximity to brownfield sites also will be considered for

future reports. We are not aware of nationally representative databases of contaminants

in soil. Measures for soil contaminants will focus on proximity to sites found to have

high levels of contamination or other surrogates.

Other Contaminated Media

Key additional data needs focus on exposure pathways and environments that are particularly important for children. A number of contaminants may gather on household

surfaces, including those found in indoor air, contaminants in soil that are tracked into

the home, and those from the workplace that inadvertently are brought into the home

on the parents’ clothes or body. Young children may be frequently exposed to environmental contaminants that gather on floors and other surfaces in the home through

hand-to-mouth and object-to-mouth contact. Data available for these exposure scenarios are limited.

Future Directions
Future Directions 61

Currently, nationally representative biomonitoring data are available for concentrations of

lead in blood. Data are needed on concentrations of other contaminants in children’s bodies.

The Centers for Disease Control and Prevention (CDC) currently are collecting additional biomonitoring data for an annual National Exposure Report Card. The report

card is intended to provide concentrations of toxic substances present in the U.S. population, from measurements in samples of blood and urine. CDC’s sampling process will

provide some measurements for children. The 25 substances to be included in the first

report card will include heavy metals, cotinine, nonpersistent pesticides, and phthalates.

We will develop new biomonitoring measures for future versions of this report as the

CDC data become available. 

The childhood diseases in this report were selected using several criteria: The data had

to be nationally representative and readily available; some proportion of the observed

effects should be caused, or suspected to be caused, by environmental contaminants;

and the diseases must be important to children. The current report includes measures

for respiratory related diseases, with an emphasis on asthma, and measures for childhood cancer. Other measures of severity for respiratory effects will be considered for

future reports, including emergency room visits and deaths. Several additional respiratory conditions, such as lung function, are influenced by environmental factors but are

not included in this report. Future work will focus on identifying appropriate data

sources for these measures.

A number of additional types of childhood diseases, such as birth defects and waterborne diseases, may be environmentally mediated, but we do not have consistent

nationally representative data for them. For other important effects, such as learning

and neurological disorders, identifying appropriate data sources may be difficult. Future

work will focus on identifying important childhood diseases for which existing data

sources may be used for tracking. 

Tracking systems are important for following trends in diseases that may be important in

children. These systems can help researchers and health officials identify progress toward

reducing diseases and areas that require research and interventions. Some childhood diseases are tracked at the state level. Examples of tracking systems include cancer registries

in some states, which collect data on all the reported cancers in those states. Measures of

the extent to which we track these important diseases could be added to future editions

of this report. For example, the percentage of states that have tracking systems for certain types of important childhood diseases could be included as a measure in next year’s

report. Suggested topics include birth defects, asthma, and learning disorders.

Future Directions

Childhood Diseases

and Tracking

Biomonitoring
62 America’s Children and the Environment: A First View of Available Measures

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8 Schwartz, J., D. W. Dockery, L. M. Neas, D. Wypij, J. H. Ware, J. D. Spengler, P. Koutrakis, F. E. Speizer, and B. G.

Ferris, Jr. 1994. Acute effects of summer air pollution on respiratory symptom reporting in children. American Journal of

Respiratory and Critical Care Medicine 150 (5 Pt 1):1234-42.

9 Studnicka, M., E. Hackl, J. Pischinger, C. Fangmeyer, N. Haschke, J. Kuhr, R. Urbanek, M. Neumann, and T. Frischer.

1997. Traffic-related NO2 and the prevalence of asthma and respiratory symptoms in seven year olds. European

Respiratory Journal 10 (10):2275-8.

10 Dockery, D. W., C. A. Pope 3d, X. Xu, J. D. Spengler, J. H. Ware, M. E. Fay, B. G. Ferris Jr., and F. E. Speizer. 1993.

An association between air pollution and mortality in six U.S. cities. New England Journal of Medicine 329 (24):1753-9.

11 Pope 3rd, C. A., M. J. Thun, M. M. Namboodiri, D. W. Dockery, J. S. Evans, F. E. Speizer, and C. W. Heath Jr. 1995.

Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. American Journal of Respiratory

and Critical Care Medicine 151 (3 Pt 1):669-74.

12 U.S. Environmental Protection Agency. 2000. National Air Quality and Emissions Trends Report, 1998. Research

Triangle Park, North Carolina: Office of Air Quality Planning and Standards.

13 U.S. Environmental Protection Agency. Integrated Risk Information System. Available from

http://www.epa.gov/iris/index.html.

14 Schettler, T., J. Stein, F. Reich, M. Valenti, and D. Wallinga. 2000. In Harm’s Way: Toxic Threats to Child

Development. Boston, MA: Greater Boston Physicians for Social Responsibility.

15 May, M. 2000. Disturbing behavior: Neurotoxic effects in children. Environmental Health Perspectives 108 (6):A262-A267.

16 Woodruff, T.J., J. Caldwell, V.J. Cogliano, and D.A. Axelrad. 2000. Estimating cancer risk from outdoor concentrations

of hazardous air pollutants in 1990. Environmental Research 82:194-206.
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References

17 Ware, J.H., J.D. Spengler, L.M. Neas, J.M. Samet, G.R. Wagner, D. Coultas, H. Ozkaynak, and M. Schwab. 1993.

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18 California Environmental Protection Agency. 1999. Hot Spots Unit Risk and Cancer Potency Values. California

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19 California Environmental Protection Agency. 2000. All Chronic Reference Exposure Levels Adopted by OEHHA as of

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20 Caldwell, J. C., T. J. Woodruff, R. Morello-Frosch, and D. A. Axelrad. 1998. Application of health information to hazardous air pollutants modeled in EPA’s cumulative exposure project. Toxicology and Industrial Health 14 (3):429-454.

21 U.S. Environmental Protection Agency. 2000. Deposition of Air Pollutants to the Great Waters: Third Report to

Congress. Washington, DC.

22 U.S. Environmental Protection Agency. 1996. Mercury Study Report to Congress, Volumes I to VII. Washington DC:

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23 National Research Council. 2000. Toxicological Effects of Methylmercury. Washington DC: National Academy Press. 

24 Diez, U., T. Kroessner, M. Rehwagen, M. Richter, H. Wetzig, R. Schulz, M. Borte, G. Metzner, P. Krumbiegel, and O.

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25 U.S. Environmental Protection Agency. 1992. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other

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26 Benninger, M.S. 1999. The impact of cigarette smoking and environmental tobacco smoke on nasal and sinus disease: a

review of the literature. American Journal of Rhinology 13:435-8. 

27 Dybing E. and T. Sanner. 1999. Passive smoking, sudden infant death syndrome (SIDS) and childhood infections.

Human and Experimental Toxicology 18:202-5. 

28 Cook D.G. and D.P. Strachan. 1999. Health effects of passive smoking: Summary of effects of parental smoking on the

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29 Wahlgren D.R., M.F. Hovell, E.O. Meltzer, and S.B. Meltzer. 2000. Involuntary smoking and asthma. Current Opinion

in Pulmonary Medicine 6:31-6. 

30 Lindfors A., M. van Hage-Hamsten, H. Rietz, M. Wickman, and S.L. Nordvall. 1999. Influence of interaction of environmental risk factors and sensitization in young asthmatic children. Journal of Allergy and Clinical Immunology 104:755-62.

31 U.S. Environmental Protection Agency. 2000. Data Reliability Analysis of the EPA Safe Drinking Water Information

System/Federal Version (SDWIS/FED). Washington DC: EPA Office of Water.

32 Zahm, S.H., and S.S. Devesa. 1995. Childhood cancer: overview of incidence trends and environmental carcinogens.

Environmental Health Perspectives 103 (Suppl. 6):177-184.

33 Goldman, L.R. 1995. Children—unique and vulnerable: Environmental risks facing children and recommendations for

response. Environmental Health Perspectives 103 (Suppl. 6):13-18.

34 National Research Council. 1993. Pesticides in the Diets of Infants and Children. Washington, DC: National Academy Press.
64 America’s Children and the Environment: A First View of Available Measures

References

35 Agricultural Marketing Service. 1993-1998. Pesticide Data Program: Annual Summary (Calendar Years 1993-1998):

U.S. Department of Agriculture.

36 Adapted from a draft indicator proposed by Florida State University under a cooperative agreement with U.S. EPA. See

http://www.fcpm.fsu.edu/caprm/.

37 Centers for Disease Control and Prevention. 1997. Screening Young Children for Lead Poisoning: Guidance for State

and Local Public Health Officials. Atlanta.

38 Mielke, H.W., and P.L. Reagan. 1998. Soil is an important pathway of human lead exposure. Environmental Health

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39 Hu, H. 1998. Bone lead as a new biologic marker of lead dose: Recent findings and implications for public health.

Environmental Health Perspectives 106 (Suppl. 4):961-7.

40 Lanphear, B.P., K.D. Dietrich, P. Auinger, and C. Cox. 2000. Subclinical lead toxicity in U.S. children and adolescents.

Public Health Reports (in press).

41 Institute of Medicine. 2000. Clearing the Air: Asthma and Indoor Air Exposures. Washington, DC: National Academy Press.

42 U.S. Environmental Protection Agency. 1996. Air Quality Criteria for Ozone and Related Photochemical Oxidants.

Research Triangle Park, NC.

43 U.S. Environmental Protection Agency. 1996. Air Quality Criteria for Particulate Matter. Research Triangle Park, NC.

44 Thurston, G. D., K. Ito, P. L. Kinney, and M. Lippmann. 1992. A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers. Journal of Exposure

Analysis and Environmental Epidemiology 2 (4):429-50.

45 Hall, M.J., and J.R. Popovic. 2000. 1998 Summary: National Hospital Discharge Survey. Advance data from vital and

health statistics. Hyattsville, Maryland: National Center for Health Statistics.

46 American Thoracic Society. 1996. Health effects of air pollution. American Journal of Respiratory and Critical Care

Medicine 153:3-50.

47 Reis, L.A.G., M.A. Smith, J.G. Gurney, M. Linet, T. Tamra, J.L. Young, and G.R. Bunin. 1999. Cancer Incidence and

Survival among Children and Adolescents: United States SEER Program 1975-1995. Bethesda, MD: National Cancer

Institute, SEER Program.

48 Colt, J.S., and A. Blair. 1998. Parental occupational exposures and risk of childhood cancer. Environmental Health

Perspectives 106 (Suppl 3):909-925.

49 Boice, Jr., J.D., and R.W. Miller. 1999. Childhood and adult cancer after intrauterine exposure to ionizing radiation.

Teratology 59 (227-233).

50 Doll, R., and R. Wakeford. 1997. Risk of childhood cancer from fetal irradiation. British Journal of Radiology 70:130-139.

51 Zahm, S.H. 1999. Childhood leukemia and pesticides. Epidemiology 10:473-475.

52 Zahm, S.H., and M.H. Ward. 1998. Pesticides and childhood cancer. Environmental Health Perspectives 106 

(Suppl. 3):893-908.

53 Buckley, J.D., L.L. Robison, R. Swotinsky, D.H. Garabrant, M. LeBeau, P. Manchester, M.E. Nesbit, L. Odom, J.M.

Peters, and W.G. Woods. 1989. Occupational exposures of parents of children with acute nonlymphocytic leukemia: A

report from the Children’s Cancer Study Group. Cancer Research 49 (4030-4037).
Glossary of Terms 65

Glossary of Terms

Air Toxics:

Synonym for "hazardous air pollutants." (See below). 

Ambient Air: 

Any unconfined portion of the atmosphere: open 

air, surrounding air. 

Benzene:

A colorless, volatile, flammable, toxic liquid aromatic 

hydrocarbon (C6H6) used in organic synthesis, as a 

solvent, and as a component of motor fuel.

Biomonitoring: 

Analysis of blood, urine, tissues, etc., to measure chemical

exposure in humans. 

Carcinoma: 

Cancer that begins in the tissues lining or covering 

an organ.

Carbon Monoxide (CO): 

A colorless, odorless, poisonous gas produced by 

incomplete fossil fuel combustion. 

Chromium: 

A heavy metal that is an important hazardous air pollutant.

(See “heavy metals.”) 

Contaminant: 

Any physical, chemical, biological, or radiological substance

or matter in air, water, or soil that can have adverse health

effects. 

Criteria Pollutants: 

The 1970 amendments to the Clean Air Act required EPA

to set National Ambient Air Quality Standards for certain

pollutants known to be hazardous to human health. EPA

has set standards to protect human health and welfare for

six pollutants: ozone, carbon monoxide, total suspended

particulates, sulfur dioxide, lead, and nitrogen oxides. The

term "criteria pollutants" derives from the requirement that

EPA must describe the criteria—characteristics and potential health and welfare effects of these pollutants—for setting or revising standards. 

Deciliter: 

One-tenth of a liter (0.1 liter).

Exposure: 

Human contact with environmental contaminants or concentrations of contaminants in media. 

Media: 

Specific environments–air, water, soil–that are the subject of

regulatory concern and activities because of potential for

human exposure.

Environmental Tobacco Smoke: 

Mixture of smoke exhaled by a smoker and the smoke from

the burning end of the smoker’s cigarette, pipe, or cigar. 

Germ Cell Tumor: 

A type of tumor found in the ovaries or testicles.

Gonadal Tumor:

Tumor specific to the gonads.

Hazardous Air Pollutants: 

Air pollutants that are not covered by ambient air quality

standards but which, as defined in the Clean Air Act, may

reasonably be expected to cause or contribute to irreversible

illness or death. Such pollutants include asbestos, beryllium, mercury, benzene, coke oven emissions, radionuclides,

and vinyl chloride. A total of 188 hazardous air pollutants

are listed in section 112(b) of the Clean Air Act, as amended in 1990.

Heavy Metals: 

Metallic elements with high atomic weights, e.g., mercury,

chromium, cadmium, arsenic, and lead; can damage living

things at low concentrations. 

Immunodeficiency:

Inability to produce a normal complement of antibodies 

or immunologically sensitized T cells, especially in response

to specific antigens.

Ionizing Radiation: 

Radiation that can strip electrons from atoms, i.e., alpha,

beta, and gamma radiation. 

Lymphoma: 

Lymphomas are tumors in the lymph system, which is

responsible for fighting diseases in the body and is part 

of the immune system. Lymphomas are the third most

common form of cancer in children.
66 America’s Children and the Environment: A First View of Available Measures

Glossary of Terms

Mercury: 

A heavy metal that can bioaccumulate in the environment

and is highly toxic if breathed or swallowed.

Methemoglobinemia:

The presence of excess methemoglobin in the blood, which

replaces hemoglobin and results in loss of the ability to

transport oxygen in the blood. A small amount of methemoglobin is present in the blood normally, but injury or

toxic agents, such as nitrites, convert a larger proportion of

hemoglobin into methemoglobin. 

Microgram (μg): 

One-millionth of a gram. 

Microorganisms: 

Tiny living organisms that can be seen only with the aid 

of a microscope. Some microorganisms can cause acute

health problems when consumed in drinking water. 

Also known as microbes. 

Mortality: 

Death rate.

National Ambient Air Quality Standards

(NAAQS): 

Standards established by EPA to protect human health and

the environment from criteria pollutants, which apply for

outside air throughout the nation.

Nitrogen Dioxide (NO2): 

A chemical that results from nitric oxide combining 

with oxygen in the atmosphere; a major component 

of photochemical smog. 

Ozone:

A gas that results from complex chemical reactions between

nitrogen dioxide and volatile organic compounds; the

major component of smog. 

Particulate Matter:

Particles in the air, such as dust, dirt, soot, smoke, and liquid droplets; may have significant effects on human health.

Polychlorinated Biphenyls (PCBs): 

A group of toxic, persistent chemicals used in electrical

transformers and capacitors for insulating purposes, and 

in gas pipeline systems as a lubricant. The sale and new use

of PCBs were banned by law in 1979. 

Prenatal:

Occurring, existing, or performed before birth. 

Radionuclides:

Radioactive isotopes or unstable forms of elements.

Retinoblastomas:

Tumors of the eye.

Sulfur Dioxide (SO2): 

A pungent, colorless, gaseous pollutant formed primarily by

the combustion of fossil fuels. 

Superfund: 

The program operated under the legislative authority 

of the Comprehensive Environmental Response,

Compensation and Liability Act of 1980 (CERCLA) 

that funds and carries out EPA solid waste emergency 

and long-term removal and remedial activities. These activities include establishing the National Priorities List, investigating sites for inclusion on the list, determining their priority, and conducting and/or supervising cleanup and other

remedial actions. 

Trichloroethylene (TCE): 

A stable, low boiling-point colorless liquid, toxic 

if inhaled. Used as a solvent or metal decreasing agent, 

and in other industrial applications.
APPENDIX A

Data Tables
68 America’s Children and the Environment: A First View of Available Measures

Data Tables

1990-1995

1990 1991 1992 1993 1994 1995

Ozone 22.6% 25.1% 16.9% 21.0% 19.0% 27.7%

Particulate matter 8.0% 6.3% 9.6% 2.7% 2.3% 10.0%

Carbon monoxide 9.5% 8.5% 6.2% 5.1% 6.6% 5.0%

Lead 2.2% 6.0% 1.8% 2.1% 1.7% 1.8%

Sulfur dioxide 0.5% 2.1% 0.1% 0.5% 0.1% 0.1%

Nitrogen dioxide 3.7% 3.7% 0.0% 0.0% 0.0% 0.0%

Any Standard 28.0% 31.9% 20.9% 24.3% 23.6% 30.9%

1996-1998

1996 1997 1998

Ozone 16.4% 18.5% 20.7%

Particulate matter 1.5% 2.4% 2.0%

Carbon monoxide 5.7% 3.8% 4.3%

Lead 1.6% 1.4% 1.6%

Sulfur dioxide 0.1% 0.1% 0.1%

Nitrogen dioxide 0.0% 0.0% 0.0%

Any Standard 19.9% 21.9% 23.2%

SOURCE: U.S. Environmental Protection Agency, Office of Air and Radiation, Aerometric Information Retrieval System.

Table E1 Percentage of children living in counties in which air quality

standards were exceeded

Table E2 Percentage of children’s days with good, moderate, or 

unhealthy air quality

1990-1994

Pollution Level 1990 1991 1992 1993 1994

Good 58.8% 58.9% 62.6% 61.9% 60.1%

Moderate 27.7% 27.7% 24.1% 25.3% 26.9%

Unhealthy 4.0% 3.9% 3.5% 3.0% 3.0%

No Monitoring Data 9.5% 9.4% 9.8% 9.8% 10.0%

1995-1998

Pollution Level 1995 1996 1997 1998

Good 61.3% 63.3% 63.3% 61.9%

Moderate 25.5% 24.6% 24.5% 27.1%

Unhealthy 2.8% 2.2% 1.6% 1.6%

No Monitoring Data 10.3% 10.0% 10.6% 9.4%

SOURCE: U.S. Environmental Protection Agency, Office of Air and Radiation, Aerometric Information Retrieval System.
69

Data Tables

Appendix A: Data Tables

Table E3 Percentage of children living in counties where at least one

hazardous air pollutant concentration was greater than a health

benchmark in 1990

Cancer, Cancer, Cancer, Other 

Benchmark one-in-a-Million 1-in-100,000 1-in-10,000 Health Effects

Percentage of Children 100.0% 100.0% 6.0% 95.0%

SOURCE: U.S. Environmental Protection Agency, Cumulative Exposure Project.

Table E4 Percentage of homes with children under 7 where someone

smokes regularly

1994 1996 1999

Percentage of Homes 28.7% 27.6% 19.0%

SOURCE: U.S. Environmental Protection Agency, Office of Air and Radiation, Indoor Environments Division, Survey on Radon Awareness and

Environmental Tobacco Issues.

Table E5 Percentage of children living in areas served by public water

systems that exceeded a drinking water standard or violated

treatment requirements

Type of standard violated 1993 1994 1995 1996 1997 1998

Lead and copper 9.6% 7.0% 5.9% 5.2% 5.0% 4.8%

Microbial contaminants 8.2% 7.6% 4.4% 4.2% 3.6% 2.7%

All other contaminants 2.3% 2.2% 2.2% 2.0% 1.5% 0.9%

Treatment and filtration 2.1% 1.1% 1.2% 1.3% 0.4% 0.2%

All health-based violations 18.6% 13.8% 12.9% 11.6% 10.2% 8.3%

SOURCE: U.S. Environmental Protection Agency, Office of Water, Safe Drinking Water Information System..

Table E6 Percentage of children living in areas served by public water

systems in which the nitrate/nitrite standard was exceeded

1993 1994 1995 1996 1997 1998

Percentage of children 0.2% 0.1% 0.3% 0.2% 0.4% 0.2%

SOURCE: U.S. Environmental Protection Agency, Office of Water, Safe Drinking Water Information System.
70 America’s Children and the Environment: A First View of Available Measures

Data Tables

Table E7 Percentage of children living in areas with major violations of

drinking water monitoring and reporting requirements

1993 1994 1995 1996 1997 1998

Lead and copper 10.8% 6.6% 5.5% 5.3% 5.8% 5.2%

Microbial contaminants 2.9% 2.5% 2.0% 1.6% 2.0% 1.7%

Chemical and radiation 9.4% 6.4% 4.8% 4.4% 2.3% 2.5%

Treatment and filtration 1.2% 0.4% 0.3% 0.4% 0.2% 0.3%

Any major violation 21.4% 14.5% 11.6% 10.7% 10.0% 9.6%

SOURCE: U.S. Environmental Protection Agency, Office of Water, Safe Drinking Water Information System.

Table E8 Percentage of fruits, vegetables, grains, dairy, and processed

foods with detectable pesticide residues

1994 1995 1996 1997 1998

Food samples with a single pesticide detected 25.2% 24.7% 23.0% 26.9% 26.3%

Food samples with multiple pesticides detected 36.3% 40.3% 44.6% 28.6% 28.8%

All food samples with pesticide residues detected 61.5% 65.0% 67.6% 55.5% 55.1%

SOURCE: U.S. Department of Agriculture, Agricultural Marketing Service. Pesticide Data Program: Annual Summary (Calendar Years 1993-1998).

Table E9 Percentage of children living in counties with Superfund sites

1990 1992 1994 1996 1998 2000

All Superfund sites 55% 56% 58% 57% 57% 58%

All Superfund sites that have not 

reached Construction Completion 55% 54% 53% 53% 51% 50%

SOURCE: U.S. Environmental Protection Agency, Superfund NPL Assessment Program (SNAP) Database.

Table E10 Percentage of children living in counties that had 

Superfund sites in 1990

1990 1992 1994 1996 1998 2000

All Superfund sites 55% 55% 55% 52% 51% 50%

All Superfund sites that have not 

reached Construction Completion 55% 53% 49% 46% 42% 40%

SOURCE: U.S. Environmental Protection Agency, Superfund NPL Assessment Program (SNAP) Database.
71

Data Tables

Appendix A: Data Tables

Table B2 Percentage of children ages 1-5 with concentrations of lead in

blood greater than 10 micrograms per deciliter, 1992-1994

All Black Non-Hispanic Hispanic White Non-Hispanic

All 4.4% 11.2% 5.2% 2.3%

Above poverty level 2.1% 5.6% 4.7% 1.1%

Below poverty level 8.9% 16.2% 4.7% 6.4%

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.

Table D1 Percentage of children under 18 with asthma and chronic

bronchitis

1990 1991 1992 1993 1994 1995 1996

Percentage of children 

with asthma 5.8% 6.2% 6.3% 7.2% 6.9% 7.5% 6.2%

Percentage of children 

with chronic bronchitis 5.3% 5.3% 5.4% 5.9% 5.5% 5.4% 5.7%

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Table B1 Average concentration of lead in blood for children 5 and under

Blood lead levels in micrograms per deciliter

1976-1980 1988-1991 1992-1994

All 16.5 4.7 3.6

Above poverty level 15.5 4.0 2.9

Below poverty level 20.2 6.3 5.0

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.
72 America’s Children and the Environment: A First View of Available Measures

Data Tables

Table D2 Percentage of children under 18 with asthma, 1997-98

All Black Non-Hispanic Hispanic White Non-Hispanic

All 5.4% 6.8% 4.9% 5.2%

Above poverty level 5.3% 6.5% 4.7% 5.2%

Below poverty level 6.2% 8.3% 5.2% 5.3%

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Table D3 Asthma hospitalization rate for children 0-14 (rate per 100,000)

1987-1994 1987 1988 1989 1990 1991 1992 1993 1994

Asthma hospitalizations 

per 100,000 284 310 312 308 339 344 280 295

1995-1998 1995 1996 1997 1998

Asthma hospitalizations 

per 100,000 369 338 358 277

SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey.

Addendum to D1 Estimated average percentage of children under 18 with asthma

during the previous 12 months, by selected years

Characteristic

Race/Ethnicity 1980-81 1985-86 1990-91 1995-1996

White, non-Hispanic 3.6% 5.1% 6.0% 6.5%

Black, non-Hispanic 4.2% 6.0% 7.3% 8.2%

Hispanic NA 3.2% 5.1% 7.6%

Age (years)

0-4 2.9% 3.2% 4.3% 5.0%

5-10 4.9% 5.5% 6.3% 7.4%

11-17 3.2% 5.8% 7.1% 7.7%

Overall prevalence 3.7% 4.9% 6.0% 6.9%

NOTE: There are insufficient samples for each year by demographic group to include annual prevalence by age and race and ethnicity. We have provided

prevalence estimates by two-year groupings for each of the age, race, and ethnicity categories covered in the National Health Interview Survey.

SOURCE: National Health Interview Survey, 1980-1986, presented in Morbidity and Mortality Weekly Report, Oct. 13, 2000. 49(40): 908-911.
73

Data Tables

Appendix A: Data Tables

Table D5 Cancer incidence for children under 20 by type (rate per million)

1973-78 1979-84 1985-90 1991-96

Acute lymphoblastic leukemia 23.1 25.6 28.2 26.8

Acute myeloid leukemia 5.4 4.7 4.1 5.4

Hodgkin’s disease 14 14.4 14.1 12.8

Non-Hodgkin’s lymphoma 8.9 9.7 10.2 10.7

CNS tumors 22.6 22.5 28.9 29

Neuroblastoma 7.4 7.5 7.4 7.9

Retinoblastoma 2.4 2.8 2.9 3

Wilms’ tumor 5.4 6.3 6 6.2

Hepatoblastoma 0.7 0.9 1 1.2

Osteosarcoma 3.9 4.7 5.2 4.9

Ewing’s sarcoma 2.5 3.6 3 3.1

Soft tissue sarcomas 10 10.6 11.6 11

Germ cell tumors 8.3 9.7 10.1 12.4

Thyroid carcinoma 4.8 4.7 5.3 5.2

Malignant melanoma 3.6 4 5.3 5.2

SOURCE: Surveillance, Epidemiology, and End Results Program 1973-1996. Division of Cancer Control and Population Sciences, National Cancer Institute.

Table D4 Age-adjusted cancer incidence and mortality rates for children

under 20 (rate per million)

1975-1980 1975 1976 1977 1978 1979 1980

Incidence 128 141 141 144 145 142

Mortality 51 51 50 45 46 46

1981-1985 1981 1982 1983 1984 1985

Incidence 138 144 144 154 157

Mortality 44 45 43 39 38

1986-1990 1986 1987 1988 1989 1990

Incidence 157 152 150 165 154

Mortality 38 36 35 35 34

1991-1995 1991 1992 1993 1994 1995

Incidence 162 160 160 156 154

Mortality 34 33 33 32 30

SOURCE: Incidence data from National Cancer Institute, Surveillance, Epidemiology and End Results Program. Mortality data from Centers for Disease

Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
74 America’s Children and the Environment: A First View of Available Measures

Data Tables

Addendum to D5 Childhood cancer incidence by age, 1991-1995 (rate per million)

0-4 5-9 10-14 15-19

Lymphocytic leukemia 59.0 30.9 18.9 15.1

Acute non-lymphocytic leukemia 9.6 4.5 6.5 8.5

Hodgkin's disease 0.6 3.6 12.4 33.0

Non-Hodgkin's lymphoma 3.9 5.8 7.4 12.1

Central nervous system 34.8 30.3 26.0 19.5

Neuroblastoma 27.0 2.8 0.8 0.6

Retinoblastoma 12.4 0.5 0.0 0.0

Wilms’ tumor 18.1 5.1 0.8 0.4

Hepatic tumors 4.7 0.6 0.4 1.3

Osteosarcoma 0.4 2.9 7.6 9.4

Ewing's sarcoma 0.7 2.0 4.6 4.1

Soft tissue sarcomas 10.7 7.9 10.4 14.8

Germ cell, trophoblastic, other 

gonadal neoplasms 6.7 2.2 7.6 29.1

Epithelial and unspecified 3.8 3.3 11.8 39.0

SOURCE: Cancer in North America, 1991-1995. North American Association of Central Cancer Registries. American Cancer Society, Surveillance

Research.

Addendum to D5 Cancer incidence for children under 20 by race/ethnicity and

gender, 1992-1996 (rate per million)

Male Female

All Races 163.0 148.0

White 170.0 152.0

Black 129.0 122.0

American Indian/Alaska Native 80.0 70.0

Asian/Pacific Islander 150.0 137.0

Hispanic 155.0 136.0

SOURCE: SEER Stat Software, Surveillance, Epidemiology, and End Results Program 1973-1996. Division of Cancer Control Population Sciences,

National Cancer Institute. American Cancer Society, Surveillance Research.
APPENDIX B

Data Source

Descriptions
76 America’s Children and the Environment: A First View of Available Measures

Air Quality Exceedances

EPA’s Office of Air Quality Planning and Standards has set health-based National

Ambient Air Quality Standards (NAAQS) for six common pollutants, often referred to

as criteria pollutants. These standards are shown in Table 1 below. 

State and local environmental agencies conduct air monitoring programs to measure

concentrations of these pollutants. The individual measurements are submitted to EPA

for inclusion in a national database called the Aerometric Information Retrieval System. 

EPA, as part of its data management system, identifies instances in which levels of air pollutants measured in the air are greater than the air quality standards. Each of these events

is called an “exceedance.” An exceedance occurs when a measured concentration exceeds a

target value that is actually higher than the air quality standard. Concentrations measured

in the air must be averaged over a time period set in accordance with the standard for

that pollutant. The target values used to identify exceedances are shown in Table 1 below. 

To use these data in measure E1, for carbon monoxide and ozone, we identified counties in which air quality exceeded the one-hour standards at any time during the year.

For particulate matter and sulfur dioxide we identified counties in which the one-day

standards were exceeded at any time during the year. For nitrogen dioxide, we identified counties in which air quality exceeded the standard for the year, and for lead we

identified counties in which air quality exceeded the lead standard for a three-month

period.

Agency Contact:

David Mintz (mintz.david@epa.gov)

U.S. EPA, Office of Air Quality 

Planning and Standards (OAQPS)

Tel: (919) 541-5224

Data Source Descriptions

Common Air

Pollutants

Table 1 National Ambient Air Quality Standards (NAAQS) and the 

Values Used to Define Exceedances by EPA

Target value to 

Pollutant Duration of Standard Standard define exceedance

Carbon monoxide Eight-hour average 9 ppm 9.5 ppm

One-hour average 35 ppm Not applicable

Nitrogen dioxide One year average 0.053 ppm 0.0535 ppm

Ozone One-hour averagea 0.12 ppm 0.125 ppm

Eight-hour average 0.08 Not applicable

Lead Three-month average 1.5 μg/m3 1.55 μg/m3

Particulate matter under 10 microns One-day (24 hour) average 150 μg/m3 155

One year average 50 μg/m3 Not applicable

Sulfur dioxide One-day (24 hour) average 0.14 ppm 0.145 ppm

One year average 0.03 ppm Not applicable

a The ozone 1-hour standard applies only to areas that were designated non-attainment when the ozone 8-hour standard was adopted in July 1997.
77

Air Quality Index

EPA uses the Air Quality Index (AQI) to evaluate daily air quality for five major pollutants for which it has established NAAQS under the Clean Air Act. The AQI is an

update of the Pollutant Standards Index (PSI). Both indices convert the measured pollutant concentration in a community’s air to a number on a scale of 0 to 500. The

most important number on this scale is 100, which corresponds to the NAAQS for

each pollutant established under the Clean Air Act. A PSI or AQI level in excess of 100

means that a pollutant is in the unhealthy range on a given day; a PSI or AQI level at

or below 100 means that a pollutant reading is in the satisfactory range. Once these

levels are measured, the PSI or AQI figures are reported in all metropolitan areas of the

United States with populations exceeding 200,000. Data on the PSI are used in this

report, since we have historical data for the PSI. New data for the AQI will be incorporated as the data become available. Information on the AQI can be found at

http://www.epa.gov/airnow/aqibroch/. 

Detailed information on the PSI data is presented in the following:

■ The Pollutant Standards Index. EPA 451/K-94-001. February 1994, U.S.

Environmental Protection Agency, Office of Air Quality Planning and Standards,

Research Triangle Park, NC 27711. (Portions of this document are available on the

web at http://www.epa.gov/airprogm/oar/oaqps/psihold.html).

Agency Contact:

AIRS Hotline

U.S. EPA, Office of Air Quality 

Planning and Standards (OAQPS)

Tel: (800) 334-2405

Hazardous Air Pollutants

The Cumulative Exposure Project, conducted by EPA’s Office of Policy, Economics and

Innovation, estimated outdoor concentrations of 148 hazardous air pollutants for 1990.

EPA used a computer dispersion model, the Assessment System for Population

Exposure Nationwide (ASPEN), to estimate concentrations. ASPEN was developed as

part of the Cumulative Exposure Project and expands on standard EPA models by

including the capability to model a large number of pollutants across the entire continental United States. EPA combined ASPEN with an inventory of estimated 1990 hazardous air pollutant emissions, from both mobile and stationary sources, to produce the

1990 ambient concentration estimates. The model’s estimates were generally consistent

with the limited monitoring data available for hazardous air pollutants from 1990.

More information is available at http://www.epa.gov/CumulativeExposure. 

To create the measures in this report, we started by calculating an average ambient concentration for each hazardous air pollutant in each county in 1990. This county-level

value was calculated by averaging together the ASPEN estimates for each of the census

tracts within each county. Then we compared the ambient concentration of each pollutant in each county with health benchmark values. Benchmark values are drawn from

the toxicological literature and represent varying levels of potential concern for public

health. We then identified counties in which the estimated 1990 ambient concentration of any hazardous air pollutant was greater than the health benchmarks, and calculated the total number of children living in those counties.

Appendix B: Data Source Descriptions

Data Source Descriptions

Hazardous Air

Pollutants
78 America’s Children and the Environment: A First View of Available Measures

Agency Contact:

Daniel Axelrad (axelrad.daniel@epa.gov)

U.S. EPA, Office of Policy, Economics and Innovation

Tel: (202) 260-9363

Surveys on Radon Awareness and Environmental Tobacco Smoke Issues

In 1994 and 1996, EPA’s Indoor Environments Division commissioned a commercial

contractor, Survey Communications, Inc., to conduct surveys on radon awareness and

environmental tobacco smoke issues. Approximately 31,000 households in the 50 states

were contacted in 1994 and 1996. All interviews were conducted by telephone using a

random digit dialing sampling methodology. Both the 1994 and the 1996 surveys

asked whether the household included any children under the age of 6. In addition,

they asked the following:

■ Does anyone in your household smoke cigarettes, cigars, or a pipe?

■ Do you allow anyone to smoke in your home on a regular basis?

In the 1994 survey, 6,411 households had children under the age of 6. In the 1996 survey, 6,851 households had children under the age of 6. The percentages of homes with

children under the age of six in which someone smokes, or in which someone smokes

regularly, were obtained by crossing the question on children with the appropriate

question on smoking in the household.

In 1999, EPA commissioned the Center for Survey Research and Analysis at the University

of Connecticut to conduct a similar but much smaller survey. The results of this survey

were based on 1,005 telephone interviews with respondents located in the contiguous

48 states, using a random digit dialing sampling methodology. The survey questions

regarding smoking in the home were similar to the questions in the 1994 and 1996 surveys. In the 1999 there were 225 households with children 6 years of age or younger survey.

Although the 1999 survey was substantially smaller than the 1994 and 1996 surveys, all

three surveys were designed to produce nationally representative samples.

Agency Contact:

Brian Gregory (gregory.brian@epa.gov)

U.S. EPA, Office of Air and Radiation

Tel: (202) 564-9024 

Safe Drinking Water Information System (SDWIS)

The Safe Drinking Water Information System (SDWIS) is the national regulatory compliance database for EPA’s drinking water program. SDWIS includes information on

the nation’s 170,000 public water systems and data submitted by states and EPA

regions in conformance with reporting requirements established by statute, regulation,

and guidance. 

EPA sets national standards for drinking water. These requirements take three forms:

maximum contaminant levels (MCLs, the maximum level of a specific contaminant that

can occur in drinking water), treatment techniques (specific methods that facilities must

follow to remove certain contaminants), and monitoring and reporting requirements

Data Source Descriptions

Drinking Water

Contaminants

Indoor Air Pollution
79

(schedules that utilities must follow to report testing results). States report any violations of these three types of standards to EPA. 

Water systems must monitor for contaminant levels on fixed schedules and report to

EPA when a maximum contaminant level has been exceeded. States also must report

when systems fail to meet specified treatment techniques. More information about the

maximum contaminant levels can be found online at

http://www.epa.gov/OGWDW/mcl.html. 

EPA sets minimum monitoring schedules that drinking water systems must follow.

These minimum reporting schedules (systems may monitor more frequently) vary by

the size of the water system as well as by contaminant. Some contaminants are monitored daily, others need to be checked far less frequently (every nine years is the longest

monitoring cycle). For example, at a minimum, drinking water systems will monitor

continuously for turbidity, monthly for bacteria, and once every four years for radionuclides. A monitoring and reporting violation occurs when the system did not perform

the required testing, take adequate samples, or report a violation as required. Only

major monitoring and reporting violations are used in this report. 

SDWIS includes the total population served by each public water system and the state

in which the public water system resides. However, SDWIS does not include the number of children served. The numbers of children served by the public water systems

were estimated by determining the ratio of children in the state in which the public

water system resides and multiplying the ratio by the number of people served by that

public water system.

For additional information see the EPA’s SDWIS website at 

http://www.epa.gov/safewater/sdwisfed/sdwis.htm.

Agency Contact:

Abraham Siegel (siegel.abraham@epa.gov)

U.S. EPA Office of Ground Water and Drinking Water

Tel: (202) 260-2804

Pesticide Data Program

In 1991, the U.S. Department of Agriculture (USDA) was charged with implementing a

program to collect data on pesticide residues in food. The Pesticide Data Program (PDP)

has been in operation since 1991 and has published its findings for calendar years 1991

through 1998. PDP continues to focus on the National Academy of Sciences’ 1993 recommendation that pesticide residue monitoring programs target foods that are highly

consumed by children, and that the analytical testing methods used in these monitoring

efforts should be standardized, validated, and subject to strict quality control and quality

assurance programs. Consequently, since 1994 PDP has modified its commodity testing

profile to include not only fresh fruits and vegetables, but also canned and frozen fruits

and vegetables, fruit juices, whole milk, wheat, soybeans, oats, corn syrup, peanut butter, and poultry. In 1998, PDP collected and analyzed a total of 8,500 food samples,

including approximately 7,000 samples of fruits and vegetables. More information is

available at http://www.ams.usda.gov:80/science/pdp/index.htm

Each sample of food tested in the PDP is analyzed to determine whether the residues of

a variety of different pesticides are present. For the pesticide measure in this report, we

Appendix B: Data Source Descriptions

Data Source Descriptions

Pesticide Residues 

in Foods
80 America’s Children and the Environment: A First View of Available Measures

assigned each sample to one of three groups: (1) no pesticides present at detectable levels;

(2) one pesticide present at detectable levels; and (3) two or more pesticides present at

detectable levels. The numbers of samples with one pesticide and the numbers with

multiple pesticides were totaled for each year 1994-98 and calculated as a percentage of

the total number of samples in each year. 

Agency Contact:

Martha Lamont (Martha.Lamont@usda.gov)

USDA, Agricultural Marketing Service 

Tel: (703) 330-2300

Superfund NPL Assessment Program Database

The Superfund NPL Assessment Program (SNAP) is a relational database system containing data for proposed, final, and deleted National Priorities List (NPL) sites. The

majority of the information contained in SNAP is the data that support the NPL listing of sites; e.g., Hazard Ranking System (HRS) scoring factors, site narratives, site

characteristics, contaminants, locational information, proposed and final Federal

Register dates and citations, etc. For the most part, the data contained in SNAP are a

snapshot at the time of NPL proposal and listing, although SNAP also contains a minimal amount of data (date and status) on Construction Completions, partial deletions,

and deletions. This information allows SNAP to give an accurate overall picture of the

status of the NPL on a real-time basis. All of the data contained in SNAP are publicly

available information.

The measures presented in this report made use of SNAP’s information on each county

in which an NPL site is found and on the status of the NPL site—i.e., date proposed

for the NPL, date of final listing, date of Construction Completion, and date of deletion. We then assembled data snapshots of the sites that were on the NPL on

September 30 of 1990, 1992, 1994, 1996, and 1998. In addition, a snapshot for

August 2000 (when information was obtained from SNAP for the purpose of assembling these measures) was assembled. We developed two measures for each of these

dates. The first measure was based on all sites with either proposed or final listing on

the NPL as of the target date, but excluding those sites deleted from the NPL on or

before the target date. The second measure differed from the first in that sites that had

reached Construction Completion (but were not yet deleted from the NPL) also were

excluded. The counties with Superfund sites then were identified using the site location

information in SNAP.

Agency Contact:

Terry Jeng (jeng.terry@epa.gov)

U.S. EPA Office of Emergency and Remedial Response

Tel: (703) 603-8852

Data Source Descriptions

Land Contaminants
Appendix B: Data Source Descriptions 81

Data Source Descriptions

National Health and Nutrition Examination Survey

Data on children’s blood lead levels were obtained from the National Health and

Nutrition Examination Surveys (NHANES) II and III, conducted by the National

Center for Health Statistics. The survey is designed to assess the health and nutritional

status of the non-institutionalized civilian population of the United States, aged 2

months and older. NHANES collects data through both direct physical examinations

and interviews, using a complex multi-stage, stratified, clustered sampling design.

Interviewers obtain information on personal and demographic characteristics, including

age, household income, and race and ethnicity by self-reporting or as reported by an

informant. The first survey, NHANES I, was conducted during the periods 1971-1974

and 1974-1975; NHANES II covered the period 1976-1980; and NHANES III covered the period 1988-1994. Only NHANES II and III, however, contain data on blood

lead levels. Descriptions of the survey design, the methods used in estimation, and the

general qualifications of the data are presented in the following:

■ Plan and Operation of the Second National Health and Nutrition Examination

Survey, 1976-80: Programs and Collection Procedures, Series 1, No. 15. Vital and

Health Statistics, Hyattsville, MD: National Center for Health Statistics.

■ Plan and Operation of the Third National Health and Nutrition Examination

Survey, 1988-94: Series 1: Programs and Collection Procedures, No. 32. Vital and

Health Statistics, Hyattsville, MD: National Center for Health Statistics.

The percentage of children with blood lead levels greater than 10μg/dL is influenced by

the proportion of nonresponses within each category. Families with incomes below the

poverty level had a lower response rate than families with incomes at or above the poverty

level. The percentages are thus the best estimates available, but contain some error.

NHANES Website: www.cdc.gov/nchs/nhanes.htm

Agency Contact:

Clifford Johnson (clj1@cdc.gov)

National Center for Health Statistics

Tel: (301) 45-4292

National Health Interview Survey

Data on the prevalence of asthma and bronchitis are from the National Health

Interview Survey (NHIS), a continuing nationwide sample survey of the civilian noninstitutionalized population in which data are collected by personal household interviews. Interviewers obtain information on personal and demographic characteristics,

including race and ethnicity, by self-reporting or as reported by an informant.

Investigators also collect data about illnesses, injuries, impairments, chronic conditions,

activity limitation caused by chronic conditions, utilization of health services, and other

health topics. For most health topics, the survey collects data over an entire year.

The NHIS sample includes an over-sample of Black and Hispanic persons and is

designed to allow the development of national estimates of health conditions, health

service utilization, and health problems of the U.S. civilian non-institutionalized population. Over the years, the response rate for the ongoing part of the survey has run

between 94 and 98 percent. In 1997, interviewers collected information on 36,116

persons, including 14,290 children. 

Concentrations of

Lead in Blood 

Asthma and Chronic

Bronchitis
82 America’s Children and the Environment: A First View of Available Measures

Descriptions of the survey design, the methods used in estimation, and the general

qualifications of the data are presented in the following: 

■ Massey, J.T., T.F. Moore, V.L. Parsons, and W. Tadros 1989. Design and estimation

for the National Health Interview Survey, 1985-1994. Vital and Health Statistics 2

(110). Hyattsville, MD: National Center for Health Statistics. 

■ Benson, V. and M. Marano (1998 ). Current estimates from the National Health

Interview Survey, 1995. Vital and Health Statistics 10 (199). Hyattsville, MD:

National Center for Health Statistics. 

NHIS Website: http://www.cdc.gov/nchs/nhis.htm

Agency Contact:

For information on activity limitations and general health status:

Laura Montgomery (lem3@cdc.gov)

National Center for Health Statistics

Tel: (301) 436-3650 

National Hospital Discharge Survey

Data on asthma hospitalizations were obtained from the National Hospital Discharge

Survey (NHDS). The NHDS is a national probability survey designed to meet the

need for information on characteristics of in-patients discharged from non-federal

short-stay hospitals in the United States. The NHDS collects data from a sample of

approximately 270,000 in-patient records acquired from a national sample of approximately 500 hospitals. Only hospitals with an average length of stay of fewer than 30

days for all patients, general hospitals, or children’s general hospitals are included in the

survey. Federal, military, and Department of Veterans Affairs hospitals, as well as hospital units of institutions (such as prison hospitals), and hospitals with fewer than six

beds staffed for patient use, are excluded. Data from the NHDS are available annually.

NHDS Website: http://www.cdc.gov/nchs/about/major/hdasd/nhdsdes.htm

Agency contact:

Hospital Care Statistics Branch

National Center for Health Statistics

Tel: (301) 458-4321

Surveillance, Epidemiology and End Results Program

The population-based data used for incidence of cancer are from the Surveillance,

Epidemiology and End Results (SEER) Program of the National Cancer Institute (NCI).

Information from five states (Connecticut, Hawaii, Iowa, New Mexico, and Utah) and

five metropolitan areas (Atlanta, Georgia; Detroit, Michigan; Los Angeles, California;

San Francisco-Oakland, California; and Seattle-Puget Sound, Washington) accounting

for approximately 14 percent of the United States’ population are included. The participating regions were selected primarily for their ability to operate and maintain a population-based cancer reporting system and for their epidemiologically significant population

subgroups. With respect to selected demographic and epidemiologic factors, they are,

when combined, a reasonably representative subset of the U.S. population. 

Data Source Descriptions

Childhood Cancer 
83

The mortality data for all cancer deaths among children in the United States are from

data based on underlying cause of death from the National Vital Statistics System,

administered by the National Center for Health Statistics. Mortality data are obtained

by NCI and provided for all causes of cancer. 

All rates are age-adjusted to the 1970 U.S. standard population.

SEER Website: http://seer.cancer.gov

Agency Contact:

Surveillance, Epidemiology, and End Results Program

National Cancer Institute

U.S. Census County-Level Data

County population estimates are created by the U.S. Census Bureau starting with the

most recent decennial census figure (April 1, 1990) and updating that figure with

information on births, deaths, domestic migration (in/out flows with other counties in

the United States), and international migration (in/out flows with other countries) that

have occurred between the census date and the date of the population estimate. 

The U.S. Census Bureau Population by Race and Age data are estimates of the resident

population of the counties in the United States, by age (ages 0 to 84, 85 and over), sex

(male, female), race (White; Black; American Indian, Eskimo and Aleut; Asian and

Pacific Islander) for July 1 of each year from 1990 to 1998. A complete description of

the population estimation methodology can be found on the Census Bureau’s

Methodology for Estimates of State and County Total Population website at

http://www.census.gov/population/methods/stco99.txt and on the Census Bureau’s

Methodology for Estimating County Population by Age and Race website at

http://www.census.gov/population/estimates/county/casrh_doc.txt.

Agency Contact:

U.S. Census Bureau

Population Estimates Branch

Tel: (301) 457-2385

http://www.census.gov/population/www/estimates/countypop.html

Appendix B: Data Source Descriptions

Data Source Descriptions

Child Population Data

APPENDIX C

Environmental

Health Objectives

in Healthy 

People 2010
86 America’s Children and the Environment: A First View of Available Measures

ealthy People 2010, an initiative coordinated by the U.S. Department of Health

and Human Services, Office of Disease Prevention and Health Promotion, establishes national health objectives for the first decade of the new millennium. Launched

in January 2000, Healthy People 2010 seeks to increase the quality and number of

years of healthy life and to eliminate health disparities among Americans.

Healthy People 2010 includes a number of goals and objectives that relate to the children’s

environmental health risks considered in America’s Children and the Environment.

Objective 8-1 of Healthy People 2010 aims to reduce the proportion of persons

exposed to air that fails to meet EPA’s health-based standards for criteria air pollutants.

The goal is to reduce the number of exceedances of the standards for carbon monoxide,

nitrogen dioxide, sulfur dioxide, and lead from their present levels to zero by 2010.

Exceedances for ozone would be reduced to zero by 2012, and particulate matter

(10mm or less in diameter) by 2018.

Objective 8-4 focuses on reducing emissions of hazardous air pollutants. Healthy

People 2010’s goal is a 75 reduction in hazardous air pollutant releases by 2010, from

8.1 million tons nationally in 1993 to 2 million tons in 2010. 

Objective 8-5 aims to increase the proportion of persons served by community water

systems with drinking water that meets the regulations of the Safe Drinking Water Act

to 95 percent by 2010, compared with 85 percent in 1995. 

Objective 8-11 aims to eliminate elevated blood lead levels in children by 2010. Lead

poisoning remains a preventable environmental problem in the United States.

Objective 8-12 addresses health risks associated with exposure to hazardous waste sites.

This objective seeks to remediate 98 percent of the hazardous waste sites listed as

National Priority List (Superfund) sites, Resource Conservation and Recovery Act facilities, leaking underground storage facilities, and brownfield properties.

Objective 24-2a seeks to reduce asthma-related hospitalizations of children under 5

from 45.6 hospitalizations per 10,000 children in 1998 to 25 per 10,000 in 2010.

Objective 27-9 aims to reduce the percentage of children regularly exposed to secondhand smoke from the 27 percent reported in 1994 to 10 percent by 2010.

Healthy People 2010 is available at www.health.gov/healthypeople or by calling 

1(800)367-4725.

Environmental Health Objectives in Healthy People 2010

H
Help children breathe easier

■ Don’t smoke or let others smoke in your home or car. 

■ Keep your home as clean as possible. Dust, mold,

certain household pests, secondhand smoke, and pet

dander can trigger asthma attacks and allergies. 

■ Limit outdoor activity when air pollution is bad, such

as on ozone alert days.

Protect children from lead poisoning

■ Wash children’s hands before they eat, and wash

bottles, pacifiers, and toys often. 

■ Wash floors and window sills to protect kids from

dust and peeling paint contaminated with lead—

especially in older homes. 

■ Run the cold water for 30 seconds to flush lead from

pipes before drawing water to drink. 

■ Get kids tested for lead—check with your doctor.

■ Test your home for lead paint hazards if it was built

before 1978. 

Protect children from carbon monoxide

(CO) poisoning

■ Have fuel-burning appliances, furnace flues, and

chimneys checked once a year. 

■ Never use gas ovens or burners for heat and never use

barbeques/grills indoors or in the garage. 

■ Never sleep in rooms with unvented gas or kerosene

space heaters.

■ Don’t run cars or lawnmowers in the garage. 

■ Install a UL approved CO detector in sleeping areas. 

Keep pesticides and other toxic

chemicals away from children

■ Put food and trash away in closed containers to keep

pests from coming into your home. 

■ Don’t use pesticides if you don’t have to—look for

alternatives. 

■ Read product labels and follow directions. 

■ Use bait and traps instead of bug sprays when you can,

and place the bait and traps where kids can’t get them. 

■ Store chemicals where kids can’t reach them and never

put them in other containers that kids can mistake for

food or drink. 

■ Keep children, toys, and pets away when using

pesticides and don’t let kids play in fields, orchards

and gardens after pesticides have been used.

■ Wash fruits and vegetables under running water before

eating—peel them when possible. 

Protect children from too much sun

■ Have them wear hats, sunglasses, and protective clothing.

■ Use sunscreen on kids older than 6 months and keep

infants out of the sun. 

■ Keep children out of the mid-day sun—the sun is

most intense between 10 and 2. 

Safeguard them from high levels of radon

■ Test your home for radon with a home test kit. 

■ Fix your home if your radon level is 4 pCi/L or

higher. If you need help, call your state radon office 

or 1-800-644-6999. 

Protect children from contaminated fish

and polluted water

■ Call the local or state health department to learn

about any beach closings or local advisories limiting

the amount of fish to be eaten. 

■ Take used motor oil to a recycling center and properly

dispose of toxic household chemicals. 

■ Find out what’s in your local drinking water—call

your local water system for your annual drinking

water quality report, or if you have a private home

drinking water well, test it every year. 

For more information call:

1 877 590 KIDS

www.epa.gov/children

EPA Office of Children’s Health Protection

Tips to Protect Children from Environmental Hazards