Health effects of wildfire smoke in children and public health tools: a narrative review

WSPEHSU staff (Stephanie Holm, MD, MPH; Mark Miller, MD, MPH; and John Balmes, MD) explore current knowledge and knowledge gaps regarding the health effects of wildfire smoke in children, as well as tools for public health responses aimed at children, including consideration of low-cost sensor data, respirators, and exposures in school environments. Wildfire smoke is an environmental health threat to which children are particularly vulnerable. Scientists from the WSPEHSU at UCSF describe evidence to help clinical and public health authorities provide accurate information to families regarding harms caused from wildfire smoke. WSPEHSU’s Co-Director, Dr. Miller, says with children having to live with harmful air quality for weeks and even months annually, we need clear evidence based strategies to protect them.

Head Lice Management: Integrated Pest Management for Homes, Structures, Gardens and Landscapes

July 2020. WSPEHSU’s Child Care Health Consultant, Victoria Leonard, is an author of this piece on head lice from the University of California Agriculture and Natural Resources, Statewide Integrated Pest Management Program (UC IPM Program). 

The International Society for Children’s Health and the Environment Commits to Reduce Its Carbon Footprint to Safeguard Children’s Health 

7 January 2020. WSPEHSU’s ObGyn core consultant, Marya Zlatnik, was an author of this statement from the International Society for Children’s Health and the Environment that appeared in Environmental Health Perspectives. The Lancet Countdown and the 2018 Intergovernmental Panel on Climate Change declared that the worst impacts of climate change are and will continue to be felt disproportionately by children. Children are uniquely vulnerable to the consequences of climate change, including heat stress, food scarcity, increases in pollution and vector-borne diseases, lost family income, displacement, and the trauma of living through a climate-related disaster. These stressors can result in long-lasting physical and mental health sequelae. Based upon these concerns associated with climate change, the International Society for Children’s Health and the Environment developed a statement about ways in which the Society could take action to reduce its contribution of greenhouse gas emissions. 

Healthy Air, Healthy Brains: Advancing Air Pollution Policy to Protect Children’s Health

April 2019, Vol 109, No. 4. Healthy air leads to healthy brains: This American Journal of Public Health Paper cites mounting evidence of links between air pollution and neurodevelopmental problems and makes recommendations for reducing children’s exposure to unhealthy air.

Health Professionals’ Environmental Health Literacy

This chapter, by Phil Brown, Stephanie Clark, Emily Zimmerman, Maria Valenti, and Mark D. Miller, is in Environmental Health Literacy, 2019, edited by Symma Finn and Liam R. O’Fallon.  This book explores various and distinct aspects of environmental health literacy (EHL) from the perspective of investigators working in this emerging field and their community partners in research. Chapters aim to distinguish EHL from health literacy and environmental health education in order to classify it as a unique field with its own purposes and outcomes. Contributions in this book represent the key aspects of communication, dissemination and implementation, and social scientific research related to environmental health sciences and the range of expertise and interest in EHL.

Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes

August 29, 2018. Children in childcare settings are vulnerable to environmental health risks, particularly those posed by products used to disinfect and sanitize. This article examines the efficacy, ease of use and toxicities of disinfectants used in child care. It argues that evidence-based guidelines are needed regarding surface disinfection in child care. Currently recommended disinfectants do not disinfect against all child care–relevant organisms and many pose significant health risks to children and staff in child care settings.  The article finds that peroxide products have less potential for respiratory toxicity than bleach or quats.

Childhood Leukemia and Primary Prevention

Current Problems in Pediatric and Adolescent Health Care,  46(10):317-352, 2016. Leukemia is the most common pediatric cancer, affecting 3800 children per year in the United States. Its annual incidence has increased over the last decades, especially among Latinos. To protect children’s health, it is prudent to initiate programs designed to alter exposure to well-established leukemia risk factors rather than to suspend judgment until no uncertainty remains. Primary prevention programs for childhood leukemia would also result in the significant co-benefits of reductions in other adverse health outcomes that are common in children, such as detriments to neurocognitive development.

Arsenic and Rice: Translating Research to Address Health Care Providers’ Needs

Journal of Pediatrics, 2015. This article provides clinical guidance to pediatric clinicians looking for answers to patient and family questions about arsenic exposure from rice.

Children’s Cancer and Environmental Exposures: Professional Attitudes and Practices

Journal of Pediatric Hematology Oncology, 37(7), 491-497, 2015. Epidemiologic studies worldwide have provided substantial evidence of the contributions of environmental exposures to the development of childhood cancer, yet this knowledge has not been integrated into the routine practice of clinicians who care for children with this disease. To identify the basis of this deficit, we sought to assess the environmental history-taking behavior and perceptions of environmental health among pediatric hematologists and oncologists.  Survey responses indicated that environmental exposures are of concern to clinicians. The vast majority of respondents (88%) reported receiving questions from families about the relationship between certain environmental exposures and the cancers they regularly treat. However, a lack of comfort with these topics seems to have limited their discussions with families about the role of environmental exposures in childhood cancer pathogenesis.  Although limited in size and representativeness of participating institutions, the results of this survey indicate a need for increased training for hematology/oncology clinicians about environmental health exposures related to cancer and prompt translation of emerging research findings in biomedical journals that clinicians read.

A Network of Pediatric Environmnetal Health Speciality Units (PEHSUs): Filling a Critical Gap in the Health Care System (pdf)
This paper was published in Medycyna Środowiskowa.
Environmental Medicine 2012 15 (3), a journal of the Institute of Occupational Medicine and Environmental Health in Sosnowiec, Poland and the Polish Society of Environmental Medicine ( It is posted here with the permission of the journal and it’s editor Z. Rudkowski.

Practical Guidelines for Evaluating Lead Exposure in Children with Mental Health Conditions: Molecular Effects and Clinical Implications (pdf)
by UCSF PEHSU staff Drs. Burke and Miller
Postgraduate Medicine, Volume 123, Issue 1, January 2011 (with permission of the publishers) In this article, we review some of the clinical and scientific challenges that relate to the assessment and treatment of children presenting for mental health care who may have potential lead exposure.

Impact of Environmental Chemicals on Lung Development
by UCSF PEHSU’s Dr. Mark D. Miller and Melanie A. Marty, MA
Environmental Health Perspectives 118:1155-1164 (2010). This paper reviews evidence on the impact of environmental chemicals on lung development and key signaling events in lung morphogenesis, and the relevance of potential outcomes to public health and regulatory science. Using peer-reviewed literature on developmental lung biology and toxicology, mechanistic studies, and supporting epidemiology the authors evaluated potential mechanisms for xenobiotics to affect lung development and potentially result in altered function as an adult.

Thyroid-Disrupting Chemicals: Interpreting Upstream Biomarkers of Adverse Outcomes (pdf)
Miller MD, Crofton KM, Rice DC, Zoeller RT Environmental Health Perspectives 117:1033*1041 (2009).
Background: There is increasing evidence in humans and in experimental animals for a relationship between exposure to specific environmental chemicals and perturbations in levels of critically important thyroid hormones (THs). Identification and proper interpretation of these relationships are required for accurate assessment of risk to public health.
We review the role of TH in nervous system development and specific outcomes in adults, the impact of xenobiotics on thyroid signaling, the relationship between adverse outcomes of thyroid disruption and upstream causal biomarkers, and the societal implications of perturbations in thyroid signaling by xenobiotic chemicals. Data sources: We drew on an extensive body of epidemiologic, toxicologic, and mechanistic studies.

Outcomes of the California Ban on Pharmaceutical Lindane: Clinical and Ecologic Impacts (pdf)
By UCSF PEHSU staff and collaborators Humphreys EH, Janssen S, Heil A, Hiatt P, Solomon G, Miller MD. in Environmental Health Perspectives, 2008 Mar;116(3):297-302.
Conclusions: The California experience suggests that elimination of pharmaceutical lindane produced environmental benefits, was associated with a reduction in reported unintentional exposures, and did not adversely affect head lice and scabies treatment. This ban serves as a model for governing bodies considering limits on the use of lindane or other pharmaceuticals.

Environmental Risk Communication for the Clinician (pdf)
By UCSF PEHSU staff Drs. Miller and Solomon in Pediatrics Vol. 112 No. 1 July 2003;112:211*217
Although they are accustomed to discussing risks in the medical arena through the process of informed consent, primary care clinicians may have difficulty communicating with their patients and communities about environmental health risks. Clinicians are generally trusted and can play important roles as educators, alert practitioners, or even advocates talking about environmental health risks with individuals and groups. Communication of risk requires an understanding of how scientists and clinicians assess risk the process of quantitative or qualitative risk assessment. Risk is never a purely scientific issue; risk is perceived differently depending on some well-understood characteristics of the hazard, the individual perceiving the risk, and the social context. Many low-income communities of color have faced and continue to face disproportionate environmental exposures and disease burdens. The issue of environmental justice can significantly affect the context of a discussion about a specific environmental risk. The essence of risk communication has been well described and requires careful evaluation of the science and the social context, honesty, listening to and partnering with the community, and a clear, compassionate team approach.