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S. HRG. 111–1213 

PROMOTING AND IMPROVING 

CHILDREN’S HEALTH PROTECTIONS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON CHILDREN’S HEALTH 

OF THE

COMMITTEE ON 

ENVIRONMENT AND PUBLIC WORKS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 29, 2009 

Printed for the use of the Committee on Environment and Public Works 

( 

Available via the World Wide Web: http://www.gpo.gov/fdsys 
(II) 

COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

BARBARA BOXER, California, Chairman 

MAX BAUCUS, Montana 

THOMAS R. CARPER, Delaware 

FRANK R. LAUTENBERG, New Jersey 

BENJAMIN L. CARDIN, Maryland 

BERNARD SANDERS, Vermont 

AMY KLOBUCHAR, Minnesota 

SHELDON WHITEHOUSE, Rhode Island 

TOM UDALL, New Mexico 

JEFF MERKLEY, Oregon 

KIRSTEN GILLIBRAND, New York 

ARLEN SPECTER, Pennsylvania 

JAMES M. INHOFE, Oklahoma 

GEORGE V. VOINOVICH, Ohio 

DAVID VITTER, Louisiana 

JOHN BARRASSO, Wyoming 

MIKE CRAPO, Idaho 

CHRISTOPHER S. BOND, Missouri 

LAMAR ALEXANDER, Tennessee 

BETTINA POIRIER, Staff Director 

RUTH VAN MARK, Minority Staff Director 

SUBCOMMITTEE ON CHILDREN’S HEALTH

AMY KLOBUCHAR, Minnesota, Chairman 

TOM UDALL, New Mexico 

JEFF MERKLEY, Oregon 

ARLEN SPECTER, Pennsylvania 

BARBARA BOXER, California (ex officio) 

LAMAR ALEXANDER, Tennessee 

DAVID VITTER, Louisiana 

JAMES M. INHOFE, Oklahoma (ex officio) 
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C O N T E N T S 

Page 

SEPTEMBER 29, 2009 

OPENING STATEMENTS 

Klobuchar, Hon. Amy, U.S. Senator from the State of Minnesota ...................... 1 

Alexander, Hon. Lamar, U.S. Senator from the State of Tennessee ................... 4 

Merkley, Hon. Jeff, U.S. Senator from the State of Oregon ................................ 5 

Inhofe, Hon. James M., U.S. Senator from the State of Oklahoma, prepared 

statement .............................................................................................................. 98 

WITNESSES 

Grevatt, Peter, Director, Office of Children’s Health Protection and Environmental Education, U.S. Environmental Protection Agency .............................. 6 

Prepared statement .......................................................................................... 9 

Responses to additional questions from Senator Inhofe ............................... 25 

Birnbaum, Linda, Director, National Institute of Environmental Health 

Sciences and the National Toxicology Program ................................................. 29 

Prepared statement .......................................................................................... 31 

Response to an additional question from Senator Inhofe ............................. 48 

Story, Mary, Professor, Division of Epidemiology and Community Health, 

University of Minnesota ...................................................................................... 57 

Prepared statement .......................................................................................... 59 

Response to an additional question from Senator Inhofe ............................. 66 

Ewing, Reid, Professor, Department of City and Metropolitan Planning, University of Utah ...................................................................................................... 67 

Prepared statement .......................................................................................... 69 

Response to an additional question from Senator Inhofe ............................. 91 

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PROMOTING AND IMPROVING CHILDREN’S 

HEALTH PROTECTIONS 

TUESDAY, SEPTEMBER 29, 2009 

U.S. SENATE, COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS, SUBCOMMITTEE ON CHILDREN’S HEALTH, Washington, DC. 

The subcommittee met, pursuant to notice, at 9:33 a.m. in room 

406, Dirksen Senate Office Building, Hon. Amy Klobuchar (chairman of the subcommittee) presiding. 

Present: Senators Klobuchar, Alexander, and Merkley. 

OPENING STATEMENT OF HON. AMY KLOBUCHAR, 

U.S. SENATOR FROM THE STATE OF MINNESOTA 

Senator KLOBUCHAR. We will call the hearing to order for the 

Children’s Environmental Health Subcommittee. I am pleased to be 

here today with our Ranking Member, Senator Alexander from 

Tennessee. 

We have two panels with only two people each, so it won’t be too 

lengthy, I hope, and we have some really important issues to cover. 

So I am going to give an opening statement, and then I think Senator Alexander will say a few words as well, and then we will hear 

from each of you. 

I would like to extend a special welcome, first of all, to Dr. Mary 

Story, who is going to be on the second panel, who is back there, 

who is a professor at the University of Minnesota. We have worked 

together before, and she is the Director of the Robert Wood Johnson Foundation’s Healthy Eating Research Program. 

I have worked with Dr. Story many times and always appreciate 

her insight on the important issue of childhood obesity. Mary is incredibly dedicated to the health of children and truly understands 

how important it is to promote healthy lifestyles and environment 

for our kids. 

We all have a stake in making sure that our children grow up 

happy and healthy. This is important not only for the well-being 

of our children, but for the well-being of our country. We need a 

strong, healthy work force in the future to keep our economy competitive, and we also want to have these kids have great lives. And 

increasingly, we are seeing major challenges and problems for the 

health of our children. And that is why this is the first hearing, but 

I am sure we are going to have more in the future. 

I know personally that parents have an increasingly difficult job 

in today’s world. As I left this morning at 6:45 a.m., I was yelling 

up to my 14-year-old, your lunch bag is on the door. Don’t forget 
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it. The economic pressures, the time demands, the many outside influences that affect our kids, all of these and more make it an especially challenging time for America’s families. 

Today, I want to highlight some of the health issues facing our 

kids as a result of their external environments. As we consider 

landmark healthcare legislation in Congress, it is essential that we 

ensure that the health of our children is a part of any reform. 

You know, when you are a mom of a 14-year-old and you walk 

into a middle school cafeteria, you get a sense first-hand of some 

of the issues confronting kids and confronting parents. When you 

walk in there sometimes, and she’s been at a few different public 

schools, so I have seen the different scenes that they encounter, but 

on one side you will have French fries and on one side you will 

have green beans. Now, if you are a 12-year-old kid, which one do 

you think you are going to pick? 

That is why I am such a strong supporter, as a member of the 

Agriculture Committee of the updated standards that we have in 

the children’s nutrition bill for our schools that looks at the schools 

as a whole, and not just as one set of food versus the a la carte 

food versus the vending machines. 

When we talk about how to combat obesity, asthma or diabetes, 

we must consider the environment that kids are in. That means 

the environment when they walk into that cafeteria line, and it 

means the environment where they walk to school or they take the 

bus, or they can go bike riding in the afternoon, or they have no 

place to bike ride. This is a large part of the issue that we are facing. We are talking about the neighborhoods, the roads, the buildings, the food sources and the recreation facilities where people 

live, play and work. This environment influences many of the decisions that kids and families make that are really with them for a 

lifetime. 

I am interested in hearing from our experts about how we can 

proactively work to keep our children’s environment healthy and 

safe. One of the biggest challenges we face is making sure young 

people are eating right and staying active. We all know about the 

growing obesity problem with kids. According to the Center for Disease Control, one out of every three children in the U.S. between 

the ages of 2 and 19 is overweight, and nearly a quarter of all kids 

between the ages of 2 and 5 are obese or overweight. 

So in other words, a quarter of the kids come into our schools 

overweight and then when they graduate from high school, about 

a third of them are overweight. 

When I was in school, recess and physical education classes, a 

time for kids to run around and play games, it was an important 

part of our day. I remember the President’s physical fitness test. 

And while I never did that well on it, I had the second to the worst 

softball throw in 4th grade. 

Senator Alexander, Gretchen Johnson had the worst. I don’t 

want to call her out today at this public hearing. 

But the point of it is it instilled in me a respect for exercise that 

led to me taking long distance bike trips with my dad and really 

having that be a part of my life. 

Unfortunately, poor nutrition and a lack of exercise means kids 

have a greater chance of getting diseases like Type 2 diabetes, 
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heart disease and hypertension. Obesity also has an adverse impact on a child’s academic and social performances. These consequences often last a lifetime, as obese youth are statistically 

more likely to be obese as adolescents and then as adults. 

In addition to hurting our kids’ health, obesity also hurts our 

economy. According to a recent study, the hospital cost of treating 

children for obesity-related conditions rose from $35 million during 

the years 1979 to 1981 to $127 million from 1997 to 1999. And 

since obese kids are more likely to be obese adults, the costs do not 

stop at childhood. Nationally, we spend between $51 billion and 

$78 billion on healthcare related to overweight adults. That is 

nearly 9 percent of all healthcare spending in the United States. 

So what can we do to get our kids to exercise and eat healthy 

foods? Well, first we need to focus on prevention and ensure that 

kids have access to safe places to play and healthy foods. And that 

starts in our neighborhoods and our schools, and it starts in our 

homes. Studies have shown people living in more walkable communities have a reduced risk of obesity, and children with easy access 

to recreational facilities and playgrounds are more active than 

those with limited access. 

Programs like EPA’s Smart Growth America are working to build 

more pedestrian friendly communities and combat the prevalence 

of obesity. We are also working in the Agriculture Committee to increase, as I mentioned, nutrition standards for all food sold in 

schools. 

Another issue where we have more work to do is asthma. Nearly 

9 million children in the United States have asthma, and it is the 

leading serious chronic illness among our children. Outdoor air pollution worsens existing asthma. Outdoor pollutants known to trigger asthma attacks include ozone, particulate matter, nitrogen dioxide and sulfur dioxide. Children are already at greater risk from 

outdoor air pollution than healthy adults, since kids have smaller 

airways than adults, which are blocked easier, causing kids to 

breathe more rapidly. 

Since children are less likely to acknowledge breathing difficulties that result from pollution and limit their exposure, asthma and 

the influence of environment are especially significant for kids. 

When I entered the Senate, I fought to make our kids safer and 

healthier. I worked to get toxic toys off our shelves. We had a 

major consumer products bill which I think the Wall Street Journal 

called the most sweeping consumer legislation in 16 years. Senator 

Pryor and I and others on the Commerce Committee worked very 

hard to get the legislation passed. 

The other and last topic I wanted to mention was the issue of 

formaldehyde. As you know, formaldehyde is used in many products as an adhesive or bonding agent for composite wood products. 

At room temperature, formaldehyde releases an invisible gas into 

the air. 

Now, we know that formaldehyde in small concentrations is a 

normal part of our environment. It is in wood furniture that you 

probably have at home. However, the problem is exposure to formaldehyde gas in higher concentrations, especially over a prolonged 

period, if inhaled can cause nausea, asthma and other serious 
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health problems. We know because kids are smaller and have 

fewer pounds, this is exacerbated when it comes to children. 

Most seriously, formaldehyde is listed as a probable human carcinogen by the U.S. Environmental Protection Agency. Estimates 

by the State of California suggest that daily prolonged exposure to 

formaldehyde may contribute to tens of thousands of cancer cases 

in the U.S. each year. 

In recent years, there has been a growing concern about formaldehyde in composite wood products imported from other countries. In the U.S., our timber industry has come up with voluntary 

standards that they are meeting. This is a problem with foreign 

wood that is coming in, composite wood and others that is coming 

into our country. That is why Senator Crapo and I have introduced 

bipartisan legislation that would establish national standards for 

formaldehyde emissions in new composite wood products, and I am 

interested in the effect this chemical and others have on our kids. 

We are excited about this legislation. We have the support of environmental groups, consumer groups, as well as the timber industry. 

I look forward to hearing from our panelists about these issues 

and other environmental health issues that are affecting our kids. 

They are the most vulnerable among us, and it is our responsibility 

to protect them and help them to grow up healthy. 

With that, I would like to turn it over to Senator Alexander, cochair of this committee. 

OPENING STATEMENT OF HON. LAMAR ALEXANDER, 

U.S. SENATOR FROM THE STATE OF TENNESSEE 

Senator ALEXANDER. Thank you, Amy. 

I want to congratulate Senator Klobuchar for conceiving of this 

hearing and hosting it, and I look forward to hearing what the witnesses have to say. 

I have another hearing at 10:30 a.m., but I will be here for the 

next hour. 

One of the most remarkable statements that I have heard in the 

last few years is the statement by distinguished journals such as 

the New England Journal of Medicine or the Institute of Medicine, 

the Trust for America’s Health, others, who say today’s children 

are likely to be the first generation to live shorter, less healthy 

lives than their parents. That is enough to cause you to stand up 

and stop and say, this is a country that is always getting better 

and better; that doesn’t sound like the United States of America. 

And one reason for that, of course, is the growing number of 

adult diseases that we see in children. Pediatricians tell me, I had 

a hearing at Maharry University last October and they talked 

about how many of these adult diseases, especially Type 2 diabetes, 

sometimes heart disease, other chronic illnesses the pediatricians 

are seeing in young children and the terrible consequences of a lifetime of those diseases is for them. And much of that comes from 

obesity, which is a function of diet and exercise. 

So we know the problem, and we see the specific results, and we 

know what causes it. So I think part of our job here is to listen 

to the experts who can tell us not what comprehensive thing can 

we do, because we don’t do comprehensive very well here. Our 
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country is too big and too complicated, and we like our freedom too 

much, but there are bound to be some important steps we can take 

in the right direction to deal with that part of the health problem. 

And the other one that Senator Klobuchar mentioned has to do 

with clean air. One of the first pieces of legislation I introduced 

here when I became a Senator, and I did it with Senator Carper 

6 years ago, was tough standards for sulfur, nitrogen and mercury. 

And that has been complicated some by the court decision that has 

knocked out the rule for sulfur and nitrogen, but I am looking forward to hearing testimony about what standards for sulfur and nitrogen and mercury we need. 

We talk a lot about carbon around here, and I believe carbon is 

a problem, and we need to deal with it, but we know what to do 

about sulfur, nitrogen and mercury. We have the technology to get 

it out of the smokestacks, and my view is we ought to go ahead 

and do it. 

I know that in Tennessee, the estimates are we have a million 

children, which is most of our children, who are at risk for asthma. 

According to the American Lung Association, there are a half-million people who have asthma. Chattanooga, Memphis and Knoxville have specific air pollution problems. And that not only affects 

our health, but it affects our ability to attract the Volkswagens of 

the world and their suppliers because they can’t come if we don’t 

meet our air quality standards. 

So I am interested in both those issues that the Chairman has 

mentioned, one being practical steps toward obesity; and two being 

practical steps to go ahead and clean up the air of sulfur, nitrogen 

and mercury so that we have healthier children. 

I look forward to the testimony. Thank you. 

Senator KLOBUCHAR. Thank you very much, Senator Alexander, 

and thanks for your leadership in this area. 

Senator Merkley. 

OPENING STATEMENT OF HON. JEFF MERKLEY, 

U.S. SENATOR FROM THE STATE OF OREGON 

Senator MERKLEY. Thank you, Madam Chair. 

I simply associate myself with the comments of the distinguished 

Chair and the Republican leader and hope that we can get right 

to the testimony. 

Senator KLOBUCHAR. OK. You see, people can work together in 

Washington. 

Right, Lamar? 

Senator ALEXANDER. Right. 

Senator KLOBUCHAR. Exactly. 

Here we go. I am going to introduce this panel first and then 

have each speak for 5 minutes. 

The first, Dr. Peter Grevatt. Dr. Grevatt is both the Director for 

the EPA’s Office of Children’s Health Protection and Environmental Education and the Senior Adviser on Children’s Environmental Health for EPA Administrator Lisa Jackson. Dr. Grevatt 

assists the EPA with his experience in risk assessment for critical 

public health issues. He has worked with members from local, 

State and national government and formerly in the EPA’s Office of 
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Solid Waste as its Senior Science Adviser and Director of its Economics Methods and Risk Analysis Division. 

Linda Birnbaum is the Director of the National Institute of Environmental Health Sciences and the National Toxicology Program. 

Having spent the previous 16 years—Dr. Birnbaum served as the 

EPA’s Senior Adviser on Experimental Toxicology. She has been a 

Federal scientist for almost 29 years and has received many 

awards for her work as a toxicologist and her leadership in the 

field. She has authored over 600 peer reviewed publications and reports and is an Adjunct Professor of her field at both UNC Chapel 

Hill and Duke University. 

Thank you very much. We look forward to hearing from both of 

you. 

Dr. Grevatt. 

STATEMENT OF PETER GREVATT, DIRECTOR, OFFICE OF 

CHILDREN’S HEALTH PROTECTION AND ENVIRONMENTAL 

EDUCATION, U.S. ENVIRONMENTAL PROTECTION AGENCY 

Mr. GREVATT. Good morning, Madam Chair, and thank you and 

members of the subcommittee. 

My name is Peter Grevatt, and I am the Director of the Office 

of Children’s Health Protection and Environmental Education at 

the Environmental Protection Agency. And thank you for the opportunity to appear before the subcommittee to discuss EPA’s efforts to promote and improve children’s health. 

As a parent of two school age children myself, I share with everyone here a vital interest in protecting our children in every way 

possible. 

This hearing is a very important event for EPA. Ensuring that 

our children live, learn and grow in a safe environment is central 

to the Agency’s work. Administrator Jackson has established three 

broad principles to guide EPA’s work. The first is that science must 

be the determining factor in EPA decisionmaking. The second is 

adherence to the rule of law. And the third is that we must operate 

in transparency. 

EPA’s children’s health activities are guided by these principles, 

as reflected in several recent actions, including the release for public comment of the reanalysis of data on perchlorate for regulatory 

determination, EPA’s commitment to reconsidering the 2008 national ozone standard, and a recent unprecedented air toxics monitoring effort near schools. 

Children’s rapid development makes them vulnerable to toxicants during pregnancy and childhood. Children have a greater exposure to chemicals through behaviors such as crawling, putting 

objects in their mouths, and eating non-food items, and early life 

exposures can have serious consequences throughout a child’s life. 

Our work at EPA extends beyond protecting the natural environment. Our focus is not just on how human activities affect the environment. It is also about how the environment that we’ve created 

in our communities can affect our health and well-being. 

Children’s health issues touch almost every aspect of EPA’s 

work, and we have recently established a five-part strategy to ensure protection of children’s environmental health. First, EPA will 

work to ensure that our regulations provide for protection of chil-
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dren. Already we have decided to reconsider the 2008 national 

smog standards to ensure that they are scientifically sound and 

protective of human health. Smog, which is known as ground level 

ozone, has been linked to asthma and other respiratory illnesses in 

children. 

In addition, EPA will work to address the continuing disparity in 

exposures and health effects for some of America’s children. For example, almost three times as many African American children have 

elevated blood lead levels compared to Caucasian children. Between 2004 and 2007, African American and Puerto Rican children, 

regardless of family income, reported higher levels of asthma. 

EPA will work to improve the environment in public health for 

all of America’s children. 

Second, we will work to ensure safe chemicals management. 

TSCA, this country’s chemical management legislation, was originally enacted in 1976 and is the only major environmental statute 

that has not been reauthorized. The TSCA inventory currently contains over 80,000 existing chemicals, few of which have been studied for their risks to children. It has proven difficult in some cases 

to take action to limit or ban chemicals found to cause unreasonable risks to human health or the environment, and there is a 

growing willingness in the U.S., including among industry, to work 

on efforts to reform TSCA. 

And it is clear that the time has come to bring TSCA into the 

21st century, and we are very hopeful that Congress will act to update TSCA so that we are better able to take action on chemicals 

that pose a concern, particularly chemicals that pose a concern for 

children. 

Third, we will work with Federal, State, tribal and local public 

health agencies to design and implement community-based children’s health programs. The Administrator and I understand the 

importance of interagency collaboration on children’s environmental health issues, and we will reestablish a pivotal and influential role for EPA with other Federal departments and agencies addressing children’s environmental health. 

For example, we are currently working with a variety of Federal 

agencies and a diverse group of stakeholders to provide communities with the information and support they need to address children’s environmental health issues in homes and schools and other 

environments where children spend much of their time. 

Fourth, we will support research to better understand children’s 

environmental health issues. The Children’s Environmental Health 

Research Centers established in 1998 by NIEHS and EPA examine 

the interactions between key environmental exposures and a range 

of children’s health outcomes, including growth and development, 

asthma, and neurodevelopmental disorders such as autism. Research results from the Children’s Centers have led to novel findings associated with disease in children. 

EPA is also a national collaborator in the National Children’s 

Study, the largest ever study of children’s health in the U.S., which 

will contribute to a better understanding of the role of environmental factors in health and disease. 

Fifth, EPA will measure the effectiveness of our actions. Currently, EPA is developing appropriate indicators of its efforts in 
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protecting children’s health. As an agency, we will enhance our 

ability to report on progress in protecting children’s environmental 

health going forward. 

I would like to thank you, Chairman Klobuchar and members of 

the subcommittee for the opportunity to talk to you today. Administrator Jackson and I share your commitment to children’s environmental health, and we appreciate your ongoing interest in our efforts, and I look forward to answering any questions that you may 

have. 

[The prepared statement of Mr. Grevatt follows:] 
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Senator KLOBUCHAR. Thank you very much. 

Dr. Birnbaum. 

STATEMENT OF LINDA BIRNBAUM, DIRECTOR, NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES AND THE 

NATIONAL TOXICOLOGY PROGRAM 

Ms. BIRNBAUM. Madam Chairwoman, distinguished subcommittee members, I am pleased to be here to present testimony 

on research supported by the Department of Health and Human 

Services. My name is Linda Birnbaum, and I am the Director of 

the National Institute of Environmental Health Sciences and Director of the National Toxicology Program within the Department. 

As a public servant, scientist, mother and grandmother, I am 

convinced that a healthy environment is vitally important to a 

child’s development and a child’s health for his or her entire life. 

NIEHS has long recognized the critically important need for research on children’s environmental health. We have spent more 

than $106 million on children’s environmental health research this 

year. I would like to share with you some of our recent findings. 

A scientist with the University of Southern California, supported 

by NIEHS, found that maternal smoking during pregnancy leads to 

permanent changes in the way a child’s genes work without changing the genes themselves. We now understand that prenatal exposure to tobacco smoke is associated with a number of health problems later in life including childhood obesity, respiratory disease, 

and cancer. 

USC researchers also found that new cases of asthma increased 

among children who exercise outdoors in communities where ozone 

levels are high, but not in areas where ozone is low. 

Cognitive development of children is especially vulnerable to environmental effects. Recently, Columbia University scientists reported that a mother’s exposure to an urban air pollutant known 

as polycyclic aromatic hydrocarbons, or PAHs, adversely affects the 

child’s IQ. Children exposed to high levels of PAHs had IQ scores 

that were 4 points lower than those of less exposed children. Such 

a significant decrease impacts success in school. 

Other Columbia researchers, working with children in Bangladesh, found that arsenic levels in drinking water were associated with decreases in IQ. These levels of arsenic are found in well 

water in some areas of the United States. 

With regard to lead poisoning, NIEHS scientists studied the effect of chelation as a treatment of mild to moderate lead poisoning. 

Our research found that once lead is elevated in a child’s blood, 

subsequent chelation treatment cannot restore lost IQ. This result 

supports the need for prevention. 

The Superfund legislation directed NIEHS to fund research on 

the health effects of chemicals at Superfund sites and on technologies to clean them up. Building schools on former industrial 

properties is a common practice nationwide that can expose children to toxicants assumed to be contained below ground. Researchers in Brown University’s Superfund Research Program are developing models that assess the fate and transport of these hazardous 

substances to the surface. They are working with communities to 
30 

improve school placement, thus empowering regulators and community groups with tools to prevent exposure among children. 

With funding from the NIEHS Superfund Program, Harvard 

University is working in Tar Creek, Oklahoma, with the local 

health center, community groups and the county health department in establishing a birth cohort and asking questions that are 

directly relevant to this community. For example, how does metal 

waste change in the environment, making exposure more or less 

likely? And are exposed children affected by these metals? 

The scientists are helping those responsible for clean up and educating residents in ways to reduce exposures. 

Dr. Grevatt mentioned the NIEHS-EPA Children’s Centers, 

which not only support multidisciplinary research grants, but are 

adding formative centers to foster new research. The Children’s 

Centers are expanding their initial focus on asthma, pesticides, and 

neurobehavioral disorders into birth defects, childhood cancer, diabetes, pubertal development and the relationship of fetal exposure 

and adult disease. 

Our Breast Cancer and Environment Research Centers investigate the impact of prenatal and childhood exposures on breast development and the altered risk of adult breast cancer. A primary 

focus of this study is on endocrine disruptors and personal care or 

household products. 

The National Toxicology Program is supporting animal studies to 

investigate the effects of some of these compounds. Studies have 

been completed and are underway on estrogenic compounds, including genistine found in soy products and bisphenol A. A wide variety 

of herbal supplements, chemicals used in everyday products, and 

even radiation from cell phones are being investigated in multiple 

generations of animals. These studies are critical in linking environmental exposures during pregnancy and childhood with a variety of health effects not only on growth and development, but also 

on late life diseases such as Parkinson’s and cancer. 

The National Children’s Study is another major project of importance to children’s health. NIEHS and EPA are the two lead agencies, and our scientists have been integral in its planning. The 

CDC provides essential support through its analyses of blood, 

breast milk and urine for more than 100 chemicals. Enrollment efforts are now underway at seven locations. 

The National Children’s Study is an unprecedented opportunity 

to answer difficult questions about many of the diseases and exposures I have mentioned. 

These are only a few examples of the critically important research being funded by the NIEHS and the NTP and a short description of the impact this research will have on the health of our 

children. 

And I am happy to answer any questions. 

[The prepared statement of Ms. Birnbaum follows:] 
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Senator KLOBUCHAR. Thank you very much. 

We will start with Senator Alexander. 

Senator ALEXANDER. Thanks, Madam Chairman. 

Thank you for the testimony. 

Dr. Grevatt, you talked about environmental triggers. Can you 

expand on what you mean by environmental triggers? 

Mr. GREVATT. Environmental triggers of disease. I mean, it is 

well understood that many of the diseases that we are concerned 

about in kids have multiple factors that contribute to them, both 

genetic factors and lifestyle factors, but certainly we know in the 

case of asthma that there are a number of triggers, indoor air pollutants and outdoor air pollutants, as well as other factors within 

homes that contribute to asthma attacks. And so those are the triggers that I am talking about. 

Senator ALEXANDER. Do you have established research about 

whether sulfur dioxide or nitrogen oxides are environmental triggers for children? 

Mr. GREVATT. I believe that both sulfur dioxide and nitrogen oxides can contribute to the onset of asthma attacks, but less is understood about what causes the disease of asthma in the first place, 

but the triggers that I am referring to is what causes the onset of 

the asthma attacks. 

Senator ALEXANDER. I see. And would you suppose that limiting 

the discharges from power plants of sulfur and nitrogen oxide 

would be beneficial to the health of children with asthma? 

Mr. GREVATT. I think it is important to look at all the opportunities that we have to protect kids from various environmental pollutants, those that you mention and others, from a number of 

sources, yes. 

Senator ALEXANDER. Dr. Birnbaum, Senator Carper and I have 

prepared legislation that would provide strict national limits on 

sulfur, nitrogen and mercury emissions from power plants. And we 

have submitted that to the EPA for its analysis and comment and 

technical advice. Has your office had a chance to look at that bill 

yet? 

Ms. BIRNBAUM. I am not sure whether we have or not, but we 

have a great deal of research that we are conducting on the health 

effects of all the pollutants you mentioned. And we know that all 

of those pollutants have long lasting effects on children’s asthma, 

respiratory health, and intelligence as well. 

Senator ALEXANDER. Since this is a piece of legislation that we 

would like to move pretty quickly, could I ask your office to take 

a look at that, and if EPA is still in its analysis of the bill or even 

if it is not, to give us your thoughts about how your research connects with the standards that we suggest in the bill? 

Ms. BIRNBAUM. We will be happy to do that. 

Senator ALEXANDER. What have you found out about mercury? 

You know, sulfur and nitrogen, we have been regulating for a 

while, and it blows around the world coming out of power plants. 

But there is some evidence that mercury comes out of coal-fired 

power plants and doesn’t blow very far, and so it affects adults and 

children near the power plants. 

Have you done any research on mercury and its effect on children, and especially whether it comes from power plants? 
51 

Ms. BIRNBAUM. We have done a great deal of work looking at effects of mercury, and we know that both inorganic mercury, which 

is what comes out of the stack, and the methylmercury, which is 

produced when the mercury lands on, you know, on lakes and gets 

into fish, have severe impacts on neurodevelopment and behavior 

in children. So that is a great concern that we have had for many 

years. 

Senator ALEXANDER. But do you have an opinion, or has your research shown whether the mercury that causes the problem comes 

from a nearby source like a power plant within 20 miles? Or 

whether it comes, like sulfur dioxide might, comes from a power 

plant that is hundreds of miles away? 

Ms. BIRNBAUM. We have not conducted research on the fate and 

transport of mercury. I believe EPA has done quite a bit of that. 

Senator ALEXANDER. Those are all my questions at the moment, 

Madam Chairman. 

Senator KLOBUCHAR. Thank you very much, Senator. 

I talked at the beginning of my statement about obesity and exercise, and I think I will have more questions for the second panel 

about that. I think we know what the causes of obesity are, for the 

most part, and we know what we need to do to solve it. But I would 

like to focus with both of you on some of the issues with some of 

these diseases that we are hearing a lot about with kids, outside 

of the obesity issue. 

The first that I hear a lot about, besides this obesity exercise 

issue, when it comes to kids is autism. And I just wondered, and 

again people are searching for a cause. They are trying to figure 

if it is environmental or what the issues are. And I know it is a 

very hotly charged issue because so many parents understandably 

are upset about it. 

Could you just talk sort of concretely about what, and I am sure 

NIH is investigating it, but what EPA is doing right now in terms 

of looking at potential environmental causes? 

I am going to start with Dr. Grevatt. 

Mr. GREVATT. Yes, thank you. 

A number of things we are doing to look at environmental causes 

related to autism and other neurodevelopmental disorders, including the support that I mentioned that we jointly provide for the 

National Children’s Research Centers, which are looking at these 

sorts of key issues, trying to understand the role of environmental 

factors in autism. 

We can be certain that autism is not just a disease that is driven 

completely by environmental factors, but to the extent that there 

are environmental factors that we can control, we think it is critical. 

Senator KLOBUCHAR. What are the factors you are looking at exactly? 

Mr. GREVATT. Different neurodevelopmental toxicants such as 

mercury, lead, other heavy metals. I think at this point there is 

really a high level of uncertainty about what the specific environmental contributors to autism, other neurodevelopmental disorders 

are. ADHD is another issue that many are concerned about, as well 

as the broad set of autism spectrum disorders. 

Senator KLOBUCHAR. Dr. Birnbaum. 
52 

Ms. BIRNBAUM. We have a great deal of research, and as you 

know, the Interagency Autism Act of 2006 established a cross-agency effort to coordinate some of the autism research, and we participate in that actively. We fund not only some of the basic research, 

which is trying to develop animal models which will enhance our 

ability to test individual pollutants, but also we are doing a number of epidemiology studies. We have two large ones, one called 

CHARGE being conducted at the University of California at Davis, 

and the other called EARLI, which is a multi-center study. And 

both of these are looking at the multiple environmental impacts 

that could be associated with autism. 

We know that almost all complex diseases have both an environmental and a genetic component. So one of the exciting things 

about the EARLI study that just started, and this has recruited 

1,200 women who already have one child with autism. So we know 

that there is a genetic predisposition for those women that a second 

child might also have autism. And we are following that up to understand how the environment can impact what happens with subsequent births. 

I did want to mention very briefly that in addition, there are 

many different environmental triggers of obesity that are beginning 

to be understood. So for example, air pollution is associated. There 

is growing information that in areas of high air pollution, there is 

more obesity in children there, a clear association. 

Senator KLOBUCHAR. And again, thank you for this answer. If I 

could just finish autism, and then we will move to this. 

Ms. BIRNBAUM. Sure. 

Senator KLOBUCHAR. I just want to say there is just growing 

frustration that so many parents, including parents I know. And I 

know there is some discussion, well maybe they are just identifying 

it when they didn’t identify it before. And I really don’t think that 

is true. I think we are starting to see increasing numbers, and that 

makes me think that it is perhaps something outside of genetics or 

something has happened. 

Ms. BIRNBAUM. We know it is something complicated. We know 

it is not simple. We know that the exposures are occurring either 

in the womb or in the first year or so of life. Children are frequently diagnosed with autism between 18 and 24 months, so it is 

some very, very early impact on their neurodevelopment. 

Senator KLOBUCHAR. Right. I appreciate your looking into this, 

and I am sure we are going to focus on this more going forward. 

But to the obesity issue, and I didn’t mean to say there weren’t 

environmental factors. That is what this hearing is about. I just 

meant that it seems easier to see some of the root causes. But 

could you elaborate on why you think the air pollution connection? 

Ms. BIRNBAUM. Well, it is not only air pollution. We are seeing 

that a number of early pesticide exposures and then exposures to 

some of the old persistent organic pollutants that are out there, 

that children who are exposed in utero to these kinds of pesticides 

go on later in life, not so late in life actually, to begin to be heavy 

and that this persists. 

There are a series of studies that have been conducted now starting after World War II where populations have been followed. And 

what they found is that where there were some kind of early life 
53 

restriction on nutrition, and I am not talking about actual malnutrition, but a deficit of certain foods, for example, after World 

War II in Europe. They followed those patients or those subjects 

now for 50 or 60 years, and what they find is that those who had 

some kind of early life stressful event such as under-nutrition in 

fact go on to have a higher incidence not only of obesity, but cardiovascular disease, diabetes and cancer. 

And in fact, we can now model those kinds of exposures in our 

different animal studies, which provide support for the reality of 

these findings. And the human epidemiology studies looking at 

some of these individual pollutants are beginning to support these 

findings. 

Senator KLOBUCHAR. So you are talking about having some 

under-nourishment in the womb or when a baby is born? 

Ms. BIRNBAUM. What is very interesting is that when children 

are born, these children are not what you would call growth-retarded. They are not so small that previously would just have 

thought, oh, that is a little bit of a little baby. But in fact, we are 

finding that even a 5 percent detriment in newborn weight as compared to what they should have been is associated with, as they 

grow, obesity and a plethora of other adverse outcomes. 

Senator KLOBUCHAR. Right, and I don’t think people always 

think about this. They think, well, if you have a littler baby, then, 

you know, they are going to be little. And in fact, this 

malnourishment and not getting the right nutrients can later lead 

to a higher—— 

Ms. BIRNBAUM. Right, but it is not only malnourishment. I think 

it is very important, you know, we are quick to blame obesity on 

people’s lifestyle, eating too much, eating the wrong foods, not exercising enough. But this new understanding that there may be early 

developmental insults that can in fact predispose you to these 

things is a very important understanding. 

Senator KLOBUCHAR. And may help us to solve some of it. 

OK. Very good. 

Senator Merkley. 

Senator MERKLEY. Thank you, Madam Chair. 

Thank you for your testimony. 

Dr. Grevatt, in your testimony, you have a reference to the Toxic 

Substances Control Act being the only major environmental statute 

that has not been reauthorized, and that it has ‘‘proven difficult in 

some cases to take action to limit or ban chemicals found to cause 

unreasonable risks to human health.’’ 

Can you give us some examples of those types of situations 

where chemicals have been found to cause unreasonable risk, but 

it has been difficult to take action? 

Mr. GREVATT. Yes, thank you. I think probably the best known 

challenge in terms of TSCA was with the attempted ban on asbestos, which ultimately was proved unsuccessful under TSCA. And 

there has been quite a bit that has been accomplished under TSCA, 

so the message here is not so much that we haven’t been able to 

accomplish anything in TSCA. There has been quite a bit. 

But our belief and the Administrator’s belief is that going forward in order to safely manage chemicals, we need some stronger 

tools than we have available to us in TSCA today. 
54 

Senator MERKLEY. Then does that example pretty much stand by 

itself, or are there dozens of examples of that nature, or a few more 

that are significant that you want to mention? 

Mr. GREVATT. I think there are a number of other examples. I 

would be happy to provide you with specifics later, but there are 

a number of other examples where the provisions in TSCA make 

it difficult for EPA to obtain some of the information that we need 

in order to support whatever approach that we think is appropriate. 

Senator MERKLEY. That would be helpful. I will ask you to follow 

up and provide that information. That would be great. 

Mr. GREVATT. Be glad to. 

Senator MERKLEY. And I wanted to turn, Dr. Birnbaum, to lead. 

And in your testimony, you note that we got it out of gasoline, and 

we removed it from paint, but that it still remains a significant 

issue. Is that primarily due to drinking water? And what else can 

be done? 

Ms. BIRNBAUM. Well, much lead is coming from older homes and 

older facilities where lead was present, for example, in the paint 

and in other places. So that exposure to lead via dust is a major 

route of childhood exposure. In certain areas, there has been lead 

found in drinking water, and that has been due to lead soldering 

that was used in pipes, and when some of the procedures were 

changed for disinfection of water, it changed the pH and more lead 

leached out of the pipes. But I think that the major exposure to 

childhood lead is largely through dust in older buildings and older 

facilities. 

Senator MERKLEY. Thank you. 

I want to turn in the time I have to this issue of endocrine systems and endocrine disrupters. If one tracks the change in the age 

at which puberty occurs over a significant length of time, I don’t 

know if that is decades or 100 years or what kind of data we have, 

has there been a significant shift? 

Ms. BIRNBAUM. Yes, there has been a dramatic decrease in the 

age of puberty, and a lot of that is probably due to better nutrition. 

Some of it is due to increased obesity, but you cannot explain all 

of the change in puberty from those two factors. 

Senator MERKLEY. Which brings us to the endocrine disrupters? 

Ms. BIRNBAUM. Yes, it would. Many, many chemicals have the 

ability to alter our hormone system. I think it is important to understand that the purpose of our hormones is to maintain our normal physiology and maintain us on an even keel. And that even a 

slight alteration of some of our hormonal balance, especially at a 

key window which occurs during development, can have long lasting consequences. 

Senator MERKLEY. So in your testimony, there are many, many 

items that are mentioned ranging from a compound found in Teflon 

to epoxy resin, coatings of canned foods, polycarbonate tableware, 

food storage containers, water bottles, baby bottles. This list, apart 

from the Teflon, I think is the role of, is it BPA? Can you talk a 

little bit about this compound, and I guess it is softener in plastics, 

and what kind of evidence is mounting that it is a significant 

issue? 
55 

Ms. BIRNBAUM. OK, well, I can talk both about the compound 

that is present in Teflon is not BPA. 

Senator MERKLEY. Right. 

Ms. BIRNBAUM. That’s perfluorooctanoic acid or other 

perfluorinated compounds. But the compound you mentioned in the 

other places you mentioned is BPA. And BPA used to be called a 

weak estrogen, but now we understand that in fact in certain circumstances, it can be a very strong estrogen. It is present in over 

93 percent of the American population based on the CDC monitoring of our population. And we find that the way it is handled 

in the body is different in infants than it is in adults. And infants 

have more difficulty eliminating the BPA than adults do, for example. 

There have been over 900 peer reviewed studies published on the 

health effects of BPA, and we know that development is a critical 

time for susceptibility to BPA. We know that it is associated with 

long-term changes in the reproductive organs and in reproductive 

behavior, and there are effects on the brain development as well 

that are persistent. And there is growing evidence that there are 

effects on the heart as well. 

And in fact, some of the effects on the cardiovascular system, 

there have been associations reported in adults with elevated BPA 

within the background population, but people within the background population who have higher BPA than others appear to 

have an increased risk of heart disease as well. So there are many, 

many different effects that are being reported. 

We are currently conducting research on BPA so that this past year we have actually had a $31 million program specifically trying 

to look and definitely understand the potential health consequences 

of BPA exposure. 

Senator MERKLEY. Can I give one question to follow up on that? 

Then have you all put out recommendations in terms of should 

parents not use plastic baby bottles, pacifiers? Or is there a series 

of recommendations? Or do you also plan any sort of regulatory action? 

Ms. BIRNBAUM. We are not a regulatory agency. We are a research agency, but we have published two large documents. One 

was a consensus statement developed by many of our NIEHS-funded researchers that reviewed all of the literature on BPA health effects. And 2 years later, the NTP has evaluated all the literature 

related to developmental and reproductive exposures to BPA, and 

the conclusion of that was that there was definitely some concern 

for exposure to BPA for a number of different health effects. 

We have been working very closely with our colleagues at FDA 

as they look to make the regulatory decisions about BPA. 

Senator MERKLEY. Thank you. 

Senator KLOBUCHAR. All right. I just had one last question before 

we go on to our next panel, something I raised in my opening statement. 

Dr. Birnbaum, I understand that your institute’s National Toxicology Program’s report on carcinogens will reconsider the classification of formaldehyde from its current status of ‘‘reasonably anticipated to be a human carcinogen’’ and are considering naming it 

a carcinogen. As I mentioned, Senator Crapo and I just introduced 
56 

a bill that will phase in new national standards for formaldehyde 

in composite wood products, understanding that there are trace levels in products, but setting a .01 parts per million standard. 

Can you tell us about some of the benefits of limiting formaldehyde exposure for kids? 

Ms. BIRNBAUM. Well, we know that formaldehyde is extremely irritating. We know that it can actually stimulate an asthmatic response. And then there is growing evidence that in fact, from a 

number of studies, especially some recent ones that were just released from the National Cancer Institute, that formaldehyde appears to be associated with an increase in cancer in people as well. 

We expect to have an external peer review of all the information 

that we will use to make a listing decision of whether it is a known 

or reasonably anticipated to be carcinogen. That peer panel will be 

held in November. 

Senator KLOBUCHAR. OK. Thank you very much. So it is OK for 

dissecting frogs a few times a year, but possibly harmful in prolonged exposure. 

Ms. BIRNBAUM. Most people who are now doing dissections with 

formaldehyde are doing it under a hood so that the fumes are wafted away, and they are not inhaling them. 

Senator KLOBUCHAR. OK. I didn’t know that. I was just thinking 

back to my elementary school days. 

[Laughter.] 

Senator KLOBUCHAR. All right. I want to thank both of you. 

Any follow ups? 

Senator ALEXANDER. Well, does that mean we can’t take kids to 

the Natural History Museum, because President Teddy Roosevelt 

skinned all the animals and used formaldehyde and put them 

there? 

Ms. BIRNBAUM. Well, most of the formaldehyde has ether, they 

are either enclosed in glass, or if they are not, that the formaldehyde at least that Teddy Roosevelt did has long since evaporated 

from the material. 

Senator KLOBUCHAR. I think what we are talking about here are 

some of the trailers in Katrina and some of the other concerns from 

in wood products in homes and this long-term exposure. 

Ms. BIRNBAUM. And I think that is a valid concern. 

Senator KLOBUCHAR. OK. Thank you very much. Thank you, 

both of you. It was very enlightening. We look forward to having 

you back again. 

We will bring up our second panel. 

OK, very good. Welcome to our second panel. I already mentioned Dr. Mary Story from the University of Minnesota. She is a 

Professor with the School of Public Health and an Adjunct Professor at the U of M’s Department of Pediatrics. She is also Director of the Robert Wood Johnson Foundation’s Healthy Eating Research Program. Her expertise lies in studying childhood obesity 

and eating habits. 

Dr. Story is widely published on the topic of childhood nutrition 

and obesity and is on the editorial board for the Journal of the 

American Dietetic Association. 

Also with us, Dr. Reid Ewing is a prolific writer and researcher 

on the topic of urban planning and development. At the moment, 
57 

he is also the Associate Editor of the Journal of the American Planning Association and a columnist for Planning Magazine. 

The doctor has been directly involved in politics as well, having 

served two terms in the Arizona State Legislature and working in 

the Congressional Budget Office on urban policy. He received his 

master’s degree and Ph.D. in city urban planning from Harvard 

University and MIT respectively. Right now, he is a Professor with 

the University of Utah’s Department of City and Metropolitan 

Planning. 

Thank you both. We look forward to hearing from you for 5 minutes each, and then we will have questions. 

Dr. Story. 

STATEMENT OF MARY STORY, PROFESSOR, DIVISION OF EPIDEMIOLOGY AND COMMUNITY HEALTH, UNIVERSITY OF 

MINNESOTA 

Ms. STORY. Madam Chair, members of the subcommittee, thank 

you for the nice introduction and for inviting me to testify, and asking me to address one of the most important health threats facing 

our children today, obesity. 

You mentioned that nearly one in three children and adolescents 

in this country are overweight or obese. That is more than 23 million children and teenagers. We must intentionally reverse the epidemic of childhood obesity or our families, communities, our States 

and our Nation will face a future of deteriorating health, lower 

worker productivity, and increasing need for social services and 

healthcare support. 

How did we get to this point? There is no easy answer. There is 

no single answer. We know that the current food environment is 

not conducive to healthy eating. Few children eat the recommended 

amount of fruits and vegetables, and children today eat too much 

fat, sugar and calories. We also know that children are not as physically active either in school or outside of school. 

To address the obesity epidemic, we must change the environment for our children. We need to remove the barriers to make 

sure that the healthy choice is the easy choice. This can only be 

done with the engagement of parents, schools, communities, industry, government and the media. We know that it is an individual’s 

decision what and how much to eat and how much physical activity 

they get. But individual behavior change can only occur in a supportive environment with accessible and affordable healthy food 

choices and opportunities for regular physical activity. 

I wanted to briefly highlight three areas in the environment that 

play a critical role for children: communities, schools and childcare. 

First, the community environment. Many of our communities do 

not provide access to healthy, affordable food or have parks or safe 

places for children to play. Too often, people have to rely on convenience or corner stores that offer few healthy foods and at higher 

prices because they don’t have access to full service grocery stores. 

Research shows that greater access to supermarkets may be related to a reduced risk for obesity. There is now a movement across 

many States and communities to offer incentives to attract full 

service supermarkets back into lower income urban and rural communities. This initiative was recently backed by the Institute of 
58 

Medicine. Whatever Congress can do to further these efforts is 

worth pursuing. 

The second area is the school environment. Recent research, and 

we have plenty of it, shows that our school environments are not 

as healthy as they could or should be. In fact, kids have wide access to junk food and soda throughout the school day in cafeterias, 

vending machines and school stores, and less than 5 percent of elementary schools are providing students with daily physical activity. 

Senator Klobuchar, you have been such a great leader in the 

area of improving the school environment, from supporting efforts 

to get rid of junk food in schools, to helping strengthen local school 

district wellness policies. These efforts are critical to changing the 

school environment to make the healthy choice the easy choice, in 

fact, the default choice, and to promote the short and long term 

health of our children. 

It is a similar situation in childcare facilities. You mentioned the 

staggering statistic that one in four preschool children today is already obese or overweight. USDA’s Child and Adult Care Food Program serves more than 3 million children in childcare centers and 

childcare homes. Congress can improve the nutritional quality of 

meals and snacks in the program by having stronger nutrition 

standards in line with the dietary guidelines for Americans, such 

as serving low fat milk, restricting fried foods and sugared beverages, and providing a healthier food environment. 

We know you have a particular interest in this area, and we appreciate your leadership in making sure that children get a healthy 

start in life. 

In closing, I would like to say that we need health in all policies 

approach, transportation policies, climate change legislation, child 

nutrition programs, the stimulus package, and of course health reform. All of these need to be viewed through the lens of health, especially children’s health. 

Thank you for the opportunity to address the subcommittee on 

this important issue. 

[The prepared statement of Ms. Story follows:] 
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Senator KLOBUCHAR. Thank you very much. 

Dr. Ewing. 

STATEMENT OF REID EWING, PROFESSOR, DEPARTMENT OF 

CITY AND METROPOLITAN PLANNING, UNIVERSITY OF UTAH 

Mr. EWING. Thank you, Madam Chairman. 

I am going to deviate from my written testimony pretty substantially. 

Senator KLOBUCHAR. We always like surprises here. 

[Laughter.] 

Mr. EWING. OK. Well, I don’t know how surprising it will be, but 

rather than talking about evidence-based research, which was the 

centerpiece of my written testimony, I am going to briefly mention 

that and then go on to things Congress can do to solve the problem. 

Senator KLOBUCHAR. That is good. 

Mr. EWING. So the evidence linking the built environment, the 

design of communities, to public health is pretty compelling. One 

of the most heavily researched subjects in my field, urban planning, is the effect of the D variables, density and diversity of land 

uses and design of streets, the effect of that on people’s travel 

choices. And that literature is pretty hard to criticize. It is strong. 

There is some literature as well, although less, that says that 

these compact walkable communities increase people’s overall levels of physical activity, including walking and other forms of physical activity. And there is even some literature, and this is the 

weakest of the three, that says that people living in these walkable 

communities tend to weigh less than comparable individuals living 

in suburban sprawl. That is literature that only goes back about 

5 or 6 years, but studies have been pretty consistent in finding 

that. 

So we now know with some certainty that there is a link between 

the way we design our urban areas and the health of adults. There 

is a little less literature on children, but one can extrapolate, I 

think, with some assurance. 

So my own work, I have looked at children’s decision to walk to 

school and found that it is very much related to the distance. It argues for neighborhood schools, as opposed to large schools drawing 

from much larger areas. I have also found that sidewalks on the 

major roads leading to school will increase the likelihood of children actually walking, rather than being driven. 

I guess I did the first study linking obesity to urban sprawl, obesity in children, and found that children living in compact walkable 

areas are less likely to be obese than those living in, again, a 

sprawling suburb. So that is the evidence. 

Now, what to do about the problem? You have a number of bills 

already introduced. One would continue funding of the Safe Routes 

to School Program. It is S. 1156. It was introduced by Senators 

Harkin, Burr, Sanders, Merkley and Collins, I believe. And it 

would continue a program that began in 2005 to provide moneys 

for sidewalk improvements, for bikeways, for traffic calming along 

access roads to school. So that is before you and certainly worth 

considering. 

A second piece of legislation, Senate Bill 584, is called the Complete Streets Act of 2009. All federally funded roads, were this to 
68 

pass, would be required to accommodate all users, not just motor 

vehicles, but pedestrians and transit users and bicyclists as well. 

Oregon has been doing this since 1971, and it is one of the reasons 

why they have such great bike facilities and such great pedestrian 

facilities. 

The third bill is probably the most sweeping. It is related to climate, and your committee will have partial jurisdiction over it. It 

was introduced by Senators Carper and Specter, and it is called the 

Clean Low Emissions Affordable Transportation Act of 2009. Ten 

percent of the funds from the auctioning of carbon emissions allowances would go into a pot, and that pot would fund low emission 

transportation improvements like bikeways and sidewalks. 

In addition, States and large metropolitan areas would be required for the first time to develop transportation greenhouse gas 

reduction plans as part of their long range transportation planning. 

And smaller metropolitan planning organizations could qualify for 

those funds if they chose to prepare plans. 

So these three pieces of legislation would all lead to the kinds of 

infrastructure improvements that might make our society more active and children in particular. 

Thank you very much. 

[The prepared statement of Mr. Ewing follows:] 
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Senator KLOBUCHAR. Thank you very much, Dr. Ewing. 

I think we will turn to Senator Merkley. I now know why he is 

such a bike rider, given Oregon’s emphasis. I have seen him bike 

ride. We have gone bike riding together, but I will say that Senator 

Mark Warner put us to shame. His bike didn’t have a basket on 

it, remember? 

[Laughter.] 

Senator KLOBUCHAR. But I will say that I have been out in Oregon myself. I know that they have amazing bike opportunities out 

there. 

So, Senator Merkley. 

Senator MERKLEY. I think it is Oregon in competition with Minnesota and the lake system. 

Thank you very much for your testimony. 

Dr. Story, you talked about several different factors. And I wanted to know if when changes have been made in the school setting 

whether follow up studies have shown any significant results? I believe that some schools have significantly changed the structure of 

their lunch offerings from high corn syrup frozen food to much 

healthier lunches. Others have removed junk food from vending 

machines. Others have eliminated specific choices such as soda 

drinks or candy bars. 

Do we have any kind of follow up studies that show whether 

these changes at the school level make an impact? 

Ms. STORY. Yes, we do. And we, through our Healthy Eating Research Program from the Robert Wood Johnson Foundation, we 

funded several of the studies that have really tried looking at evaluating district and States that have actually removed the junk 

foods from the schools. And they have shown that when you reduce 

the soft drinks in schools, kids don’t make up. They don’t just drink 

more away from school; that it really does reduce their caloric intake, and the same with other, you know, of the other unhealthier 

food. So removing those, changing the school environment really 

does help improve the overall caloric intake. 

Some of the concerns that I have been hearing about lately is 

with the school wellness policies or schools that have policies to 

take out the foods from the vending machines and school stores. 

Some schools now are still having fundraisers, so that they are selling soft drinks and these really unhealthy foods during the school 

day at school events. So we really need to have much stronger policies in the schools. 

And the school wellness policies, which was a mandate in the 

last Child Nutrition Reauthorization that said that every school 

district had to have a school wellness policy, those are not being 

implemented as planned. So we really have to strengthen the local 

school wellness policies to really be able to implement stronger nutrition standards. 

Senator MERKLEY. I saw an article somewhere this past year 

that was related to activity in schools, and it had two features. One 

was that the increased activity was related to being a better fit 

with grade school children and their need to move around. And so 

they were actually replacing some sit-down desks with stand-up 

desks, and then providing more often kind of break times, maybe 

5 minutes an hour where everybody stretches or has a little activ-
93 

ity around the room. They were finding better academic results 

concentration, but also kids were burning more calories. 

Is there research on that? This was an interesting article, but is 

there research yet on that type of changes in elementary schools 

as it might impact obesity or also impact academic performance? 

Ms. STORY. There is much more research now. I don’t know with 

taking the desks out of school, but just having—— 

Senator MERKLEY. Not the desk, but the chairs. 

Ms. STORY. The chairs. But there is research from the University 

of Kansas that showed that just increasing the amount of recess 

that children get and physical activity is related to higher performance on, you know, academic performance and learning. And it 

makes sense. I mean, if you are sitting all day, kids can’t learn. So 

there really is research now that really shows that link with physical activity. 

And recess in many schools now has really been engineered out 

of the school day, or else we were just talking before this where it 

might be at the very end of the school day, a 20-minute recess 

which really makes no sense, but we have seen schools that have 

not had any recess. 

Senator MERKLEY. Thank you. 

And Dr. Ewing, thank you for your research on the community 

impact. This is something that Portland and other cities in Oregon 

have been paying a lot of attention to and trying to increase the 

likelihood that kids will walk to school, have safe routes so parents 

feel comfortable allowing them to do so, and certainly to ride bikes 

more. 

Are there any kind of really new developments in this research? 

Mr. EWING. Developments? Well, there is a lot of research. I 

guess the best development was the decision by the Robert Wood 

Johnson Foundation to start funding this kind of research, and it 

has led to a plethora of studies. There were no studies of the effect 

of community design, density of population and diversity of land 

use mixes prior to 2003, and now there are something like 20, 

many funded by the Foundation. So that is a big development. 

Also, I could make available to your committee three literature 

reviews. I didn’t write them, but became aware of them. And it is 

possible that your staff wouldn’t be aware of them. They are good. 

They basically make the points we have been making up here. 

Now, the side of the energy equation I am interested in is physical activity, and you (Ms. Story) are on the other side of that equation with diet and caloric intake. And we could probably both provide you with some very good literature reviews. 

Senator MERKLEY. Thank you. I appreciate your testimony. 

Mr. EWING. You are welcome. 

Senator KLOBUCHAR. Thank you very much. 

I think, Dr. Story, the thing I was most struck by in your testimony when you said 5 percent of elementary schools have physical 

education. Do you want to talk about that? Do you mean that they 

don’t have recess, or they don’t have gym time? Or are you bulking 

them together? 

Ms. STORY. That is 5 percent, it is actually 3.8 percent of elementary schools that have daily physical education. 
94 

Senator KLOBUCHAR. So it is daily. Exactly. And I my daughter 

was at one school that was 90 percent free and reduced lunch, 

where the teachers did an incredible job trying to work hard and 

get these kids up to speed, but they didn’t really have any place 

to go. And so I saw first-hand the difference when she went to a 

bigger school, a middle school where they had gym every single 

day. 

And when they had health, which was about a third of the year, 

and that is when they stopped doing gym, they actually had them 

wear pedometers every day. And at the end of the day, she would 

be running in place in our little apartment in Virginia to try to get 

her steps in. And that is a vast difference in what I have seen at 

some schools everywhere in this country, where they say, well, you 

just have gym for a third of the year or a fourth of the year. And 

that is a real problem because then they are not getting that daily 

physical education that you are talking about. 

So one thing that I wanted to ask about as well is that you were 

talking about the changing world here where families aren’t getting 

nutritious food. And I know that because of economics, because of 

just time constraints, many of them, as you point out, are going to 

convenience stores or going to fast food places. 

Could you talk about how this changing environment has influenced the health of our children? 

Ms. STORY. Research has shown that, like in low income communities and in rural communities, there is less grocery stores. And 

even, as an example, in our home State, North Minneapolis, which 

is one of the poorest neighborhoods in Minneapolis, there are 

68,000 residents and two grocery stores. One was just recently, 

they have an ALDI’s and a Cub. Many other places, there is a grocery store in many suburbs, one for every 10,000 residents. 

So in the last 10 years, grocery stores, large supermarkets have 

moved out of low income areas. And the research really has shown 

the last 2 years that if you are relying mainly on convenience 

stores, that you are more likely to be overweight, and bringing in 

a new grocery store or bringing a kind of full service grocery stores 

may be related to this reduction in obesity. 

So many communities now are starting to look at ways to bring 

in healthy foods such as fruits and vegetables, which often are nonexistent in convenience and grocery stores. And we have seen families who have to get their food out of a gas station or drug store, 

where it is really expensive. 

So that is where I think the environment is so critical. You can’t 

tell people to eat healthy when they don’t have access to healthy 

foods in their neighborhood. 

Senator KLOBUCHAR. I would agree that there is a low income aspect of this that is very difficult. But also, I think that time constraints for all families with kids, because I can tell you I have 

bought a few meals in gas stations. 

So my question is, one of the things we are looking at in the 

healthcare bill is putting at least calories, having them more accessible at restaurants and at fast food places. So at least you know, 

because as you know, a number of them offer some low calorie options. They are, and it is great, but people, you can’t really tell how 

many calories are in each thing sometimes, and sometimes when 
95 

you ask, they give you this huge book and it is really embarrassing. 

Like you go, oh, could I see your calories? And I am sure you need 

that for background if you are looking for certain nutrients and 

things. 

But what we are trying to work on is that there is some way to 

do it, just for at least the calories, to make it easier, and they do 

that at some chain restaurants already. But could you comment on 

that? 

Ms. STORY. Right now, 50 percent of the food dollar, 50 percent 

of the food dollar is spent eating out in the United States. And 

much of it now, too, is the fast food restaurants. And for families 

that are really stretched for time, you know, the dollar menus, you 

know, it is just really appealing. 

And so to have the calories labeled in the restaurants, and right 

now there are several, well, in Oregon or at least in Multnomah 

County, and Seattle, King County, Philadelphia, New York City, 

California, all have passed labeling laws for labeling calories. 

In the healthcare reform, we are hoping that there will be the 

passage so that all chain restaurants, and this is restaurants with 

more than probably 15 restaurants, would be able to have the calories labeled. And it has been, we have really funded some research 

that really has shown that it really, people do choose less calories. 

People have no idea how much calories are in food. Even studies 

that they have done with registered dietitians and asking them to 

estimate the amount of calories in food, it is really hard to estimate. 

It has only been since 1993 that we have had nutrition facts on 

the back of packages, and now it is really hard to imagine the time 

when you couldn’t look on the back of a food package and really 

see the calories that were in that serving. And I think because 50 

percent of the food dollar is spent eating out, we need to have the 

same kind of disclosure, the same information for consumers to 

make wise choices. 

Senator KLOBUCHAR. OK, thank you very much. Just one last 

question for you. In your testimony, you talked about several agencies, HHS, EPA, Department of Agriculture, that currently are 

working to combat the child obesity issue. Do you think there is 

enough communication across these agencies? 

Ms. STORY. No, I don’t, and I think that a recommendation would 

be that the agencies really form an Obesity Task Force and really 

work together. 

Senator KLOBUCHAR. Thank you. Now, I know you have a plane 

to catch, Dr. Story, and if you want to leave a little earlier, I am 

just going to have a few questions of Dr. Ewing. So I know you 

have to get back to Minnesota, which I know everyone would like 

to do right now. So thank you very much. 

Ms. STORY. Thank you. 

Senator KLOBUCHAR. Dr. Ewing, I was thinking of what you said 

about the accessibility of paths and walking paths, bike paths. For 

a while, when we moved out here, we were in an apartment in a 

very heavy density area, it will go unnamed, where literally you 

couldn’t take a walk because there were so many lights and it 

wasn’t timed in any way. And I couldn’t believe the difference that 

made for our family taking walks, versus now we are renting a 
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house in a neighborhood, and it is easier to do. And there are sidewalks, and it is just easier to take walks or to go on a bike ride 

or something like that. 

And so you talked about these ideas for legislation. Do you want 

to just talk about the history of this? Have there been improvements in this country? You know, you mentioned certain States 

that have done a better job of it. And are there links that we see 

between healthier families, lower obesity rates, and this kind of accessibility to paths for walking and bicycling? 

Mr. EWING. I don’t know of any work at that geography. Colorado 

has the fewest overweight adults, as it turns out, and they have 

for ever so long. And Mississippi, as I recall, has the most as a percentage of their adult population, the problem is there are so many 

confounding factors that would cause Colorado to have low rates of 

obesity in adults and Mississippi have high rates. 

So most of the research we do at this point is at the scale of the 

individual. You will find a large number of individuals using a national data base, and we have weight and height information for 

them from which we can determine whether they are obese or not 

or what their body mass index is. And then we look at the area 

they live in, a small area, a quarter-mile around their house, or 

maybe the county they live in. And it is at that level that most of 

the research has been done simply because you can then say with 

greater certainty that one thing is causing another, that it is bike 

paths and sidewalks that are causing kids to walk to school, as my 

research showed. 

So there are leading States. Oregon is incredible in all the things 

they have done. I mentioned them earlier in my testimony. I guess 

I am most impressed with the State of Oregon and the requirements that have been handed down to regional entities and metropolitan planning organizations there in Portland Metro. 

They have not only pushed for bike paths and sidewalks, but 

they have also tried to keep blocks short, and short blocks are a 

very important determinant of walking. And they have tried to increase densities, and they have shops within walking distance of 

homes. And they have drawn an urban growth boundary around all 

of Portland, which has made all this happen. 

So the model, and it is really very much in the climate bill I 

mentioned before, is California to a degree. Some of the planning 

they are doing now for climate change, and Oregon and Washington State is another leader. 

Senator KLOBUCHAR. You know, one of the things I notice is that 

when kids have to walk, say, miles, in a mile zone, that makes a 

big difference. And if they are all walking, to me as a parent, it 

feels safer because you have a bunch of kids walking at the same 

time, but obviously that safety concern is always there. 

I saw an article a few months ago about, it might have been in 

Europe, where they were basically doing a walking bus with elementary kids, which I think is actually cheaper to have someone 

who would have been the bus driver, who would have been driving 

the bus, who is maybe walking like 2 miles with these kids, and 

goes to the corner and they have to be there, and then they are 

walking this whole group, and suddenly you have 25 kids walking 
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together with someone in charge. Is that going on anywhere in the 

United States? 

Mr. EWING. I believe it is. I have seen photos of walking school 

buses, of all the little kids tagging along. I can’t tell you where it 

is done. My area of expertise is urban planning, but from the reading I have done in this particular literature, I think that there are 

places that have been promoting walking school buses, and walk 

your kid to school days have been pretty common. 

And perhaps you can help with that, too. 

Ms. STORY. Yes, we could. Jim Seles directs the active living research, which is the counterpart to the RWJF Healthy Eating Research, and I can contact him and get information for you on the 

walking school buses and the studies that have really been done 

around that. 

Senator KLOBUCHAR. Thank you. 

Most of my questions of you, Dr. Ewing, were about Federal policy, and you really answered most of those in your opening statement, which I appreciate, having some of your ideas on how we can 

advance this on the Federal level, in addition to the local level. 

So I wanted to thank both of you here. I think we have a big job 

in front of us. I think we have an Administration that is very focused on this issue, from the First Lady planting the healthy garden on down to all of their weight lifting and various healthy activities, and strong arms and things like that. We really haven’t 

had that kind of focus. I think that is good. 

But I also think that we need to do things in terms of actually 

putting incentives into law. And for me, we start with this school 

nutrition bill, which will send a clear message when you look at 

kids getting 30 to 50 percent of their calories in school, so they 

really aren’t given a choice. They aren’t given a bad choice, just 

don’t give it to them, and that’s just how it is. 

I think the second piece of this is recess and exercise, and whether or not that is more encouraged on the local or State level is 

something that we have to look at as we look at the reauthorization of No Child Left Behind, or as they call it in my State, Leave 

the Money Behind. But you know, the hope is to try to make some 

changes here on the State and Federal level and get out that message about exercise in the schools that has got to be a key piece 

of this. 

The third would be as we look at environmental policies and 

urban planning policies, and tying resources to making sure you 

have those exercise options available. And the fourth, and probably 

the most pertinent for what we are doing right now, is the 

healthcare reform debate. We know that Safeway reduced the expenses for their healthcare by 13 percent by aggressive wellness 

policies with families and tying premiums to exercising and things 

like that. So, what can we do in terms of making sure we put those 

incentives in place with health care so that we have them? 

And I would say the last thing is what we started with here with 

our first panel is just looking at these environmentally related diseases outside of obesity and outside of some of the things we just 

talked about with our panel, and that is autism and asthma and 

some of the things that we have been seeing on the rise with kids. 

And we are making sure we are pushing with the agencies to come 
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up with the causes, and then hopefully the solution as we see more 

and more parents struggle with it. 

And I am sure there is overlap between some of these, you would 

argue, with obesity and some of these other diseases. We just don’t 

want this to be the step-child of all this, but it is getting overlooked 

as we look at healthcare reform, because I just see it as something 

we have not been paying enough attention to. 

I still remember when Paul Wellstone ran for office, and he had 

a T.V. commercial that ran in Minnesota where he had kids in 

highchairs trying to write checks. And basically the theme was 

these kids don’t have a lobbying arm. They don’t have the kind of 

access to Washington that other groups do. And that is what we 

have to remember as we go forward with the healthcare and environmental policy. 

So I want to thank you all for taking the time to testify. As I 

mentioned, this will be the first of many hearings and other legislation that we do in this area, and I am looking forward to working 

with all of you. Thank you. 

Ms. STORY. Thank you. 

Senator KLOBUCHAR. We will keep the record open for 2 weeks 

for the submission of material. 

The hearing is adjourned. 

[Whereupon, at 10:58 a.m. the subcommittee was adjourned.] 

[An additional statement submitted for the record follows:] 

STATEMENT OF HON. JAMES M. INHOFE, 

U.S. SENATOR FROM THE STATE OF OKLAHOMA

As a father and grandfather, protecting the health of children—born and unborn—is a personal priority. I believe the best way to protect children’s health is 

to use the best available science to properly assess risk. Moreover, in addition to 

valuing and protecting pregnant women the science should specifically value and 

protect the well-being of unborn children. 

Current science reflects that in some cases children can be more susceptible, in 

other cases less susceptible, and in some cases equally susceptible to environmental 

exposures when compared to adults. On a body weight basis children can have 

greater exposure than adults. EPA takes this susceptibility to exposure differential 

into account when EPA assesses potential risks to children. 

Despite what some allege, children are not always at greater risk from carcinogenic compounds than adults. In some instances children can have a greater susceptibility, but in other instances they are much more resistant. EPA’s current risk assessment methods are highly protective and are designed to protect all individuals, 

including children and other subpopulations, over their entire lifespan. 

As we hear from the witnesses today it is also important to understand that the 

major threats to children are not based on environmental exposures. Rather, most 

threats to children are a function of behavior and lifestyle and are largely preventable: 

• Statistics from the Centers for Disease Control show that unintentional injuries—nearly half of which are motor vehicle accidents—continue to be the leading 

cause of death for children aged 1–14. Nearly all of these accidents are preventable. 

• CDC statistics show that for children under 1 year of age, the number of deaths 

has decreased by nearly 40 percent since 1980. The leading cause of death in children under 1 year continues to be congenital abnormalities, and the proportion of 

deaths attributable to such conditions has remained constant at about 20 percent 

despite changes in environmental exposures. Other major factors in mortality of 

children under 1 year of age include disorders related to short gestation and low 

birth weight, sudden infant death syndrome, and maternal factors such as smoking, 

alcohol consumption, and injury. 

• In 2004, the National Institute of Medicine’s Board on Children, Youth, and 

Families noted that issues related to metabolic syndromes are increasing rapidly. 

For example, the Federal Interagency Forum on Child and Family Statistics re-
99 

cently noted that the proportion of children ages 6–17 who were overweight or obese 

tripled from 1976 to 2004. 

I look forward to hearing perspectives on how the Federal Government can 

strengthen protections for children from environmental exposures. I also hope to 

hear from EPA and the researchers on what efforts are being made to specifically 

value and protect the health and well-being of unborn children. 

Æ