    [Senate Hearing 111-1213]
    [From the U.S. Government Publishing Office]

                                                           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

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                   COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS

                         ONE HUNDRED ELEVENTH CONGRESS
                                 FIRST SESSION

                      BARBARA BOXER, California, Chairman
    MAX BAUCUS, Montana                  JAMES M. INHOFE, Oklahoma
    THOMAS R. CARPER, Delaware           GEORGE V. VOINOVICH, Ohio
    FRANK R. LAUTENBERG, New Jersey      DAVID VITTER, Louisiana
    BENJAMIN L. CARDIN, Maryland         JOHN BARRASSO, Wyoming
    BERNARD SANDERS, Vermont             MIKE CRAPO, Idaho
    AMY KLOBUCHAR, Minnesota             CHRISTOPHER S. BOND, Missouri
    SHELDON WHITEHOUSE, Rhode Island     LAMAR ALEXANDER, Tennessee
    TOM UDALL, New Mexico
    JEFF MERKLEY, Oregon
    KIRSTEN GILLIBRAND, New York
    ARLEN SPECTER, Pennsylvania

                        Bettina Poirier, Staff Director
                     Ruth Van Mark, Minority Staff Director
                                  ----------

                       Subcommittee on Children's Health

                       AMY KLOBUCHAR, Minnesota, Chairman
    TOM UDALL, New Mexico                LAMAR ALEXANDER, Tennessee
    JEFF MERKLEY, Oregon                 DAVID VITTER, Louisiana
    ARLEN SPECTER, Pennsylvania          JAMES M. INHOFE, Oklahoma (ex
    BARBARA BOXER, California (ex            officio)
        officio)

                                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

             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 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, 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 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, co-chair 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 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 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 children. 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 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:]

       [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        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 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:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        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?
        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.
        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 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.
        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?
        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 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, 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 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:]

       [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        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 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:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        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 activity 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.
        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 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 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 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 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
    recently 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.

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