Highlighting key accomplishments of the Children's Environmental Health Center (CEHC) at the Icahn School of Medicine at Mount Sinai.

1. Children’s
Environmental
Health Center
Annual
Review
Mount SinaiSchool of Medicine
2011

3. Mount Sinai
Children’s Environmental
Health Center
Annual Review 2011
Table of Contents
Introduction...........................................................................................................................................................................................................................2
Our History............................................................................................................................................................................................................................4
Core Programs of the Children’s Environmental Health Center.......................................................................................6
Pilot Research Projects..........................................................................................................................................................................................6
The Autism and Learning Disabilities Discovery and Prevention Project.............................................................8
The Breast Cancer and the Environment Research Program (BCERP)..................................................................8
The BCERP Puberty Study..............................................................................................................................................................................8
The Endocrine Disruptor Discovery Project....................................................................................................................................9
Fellowship in Children’s Environmental Health...........................................................................................................................9
Growing Up Healthy in East Harlem.................................................................................................................................................10
The National Children’s Study...................................................................................................................................................................10
The Mount Sinai Pediatric Environmental Health Specialty Unit (PEHSU)................................................10
The Year in Review......................................................................................................................................................................................................11
Improving Children’s Health Around the World.....................................................................................................................12
Setting the Foundation for New Discoveries:
The Autism and Learning Disabilities Discovery and Prevention Project.........................................................13
The Mount Sinai Pregnancy Biobank.................................................................................................................................................13
New Research Breakthroughs on Neurodevelopmental Impairment....................................................................13
Expanding the CEHC Team: The Recruitment of Shanna H. Swan, PhD.....................................................14
Measuring the Economic Cost of Children’s Environmental Health....................................................................14
Legislative Victory.................................................................................................................................................................................................14
Dr. Landrigan Edits the Mount Sinai Journal of Medicine...............................................................................................14
Mount Sinai Greening Our Children.................................................................................................................................................15
Looking Forward: Philanthropy at the Children’s Environmental Health Center........................................16
Appendix: Papers and Book Chapters Published by the CEHC Team in 2011..............................................17
Executive Board..............................................................................................................................................................................................................19
Contact the Children’s Environmental Health Center.............................................................................................................20

4. 2
Around the world, the rates of
childhood disease are increasing.
While the most traditional contagious diseases of childhood have been conquered, asthma, autism,
learning disabilities, allergies, obesity, and leukemia have become the most common pediatric diseases.
In the United States:
• Child asthma rates have nearly tripled over the past three decades. Asthma is now
the leading cause of emergency room visits, hospitalizations, and school absenteeism.
• One of every 110 children is affected by autism. Neurodevelopmental disorders — autism,
ADHD, dyslexia, mental retardation, and other learning disabilities — now affect 10 to 15% of the
four million babies born in the U.S. each year.
• Childhood obesity has tripled over the past 20 years, rising from 5% to 17%. Type
II diabetes, previously unknown in children, is now becoming epidemic.
• Both childhood leukemia and brain cancer have increased in incidence by about
40% since 1970. Childhood cancer has become the leading cause of death among children under
the age of 15.
• Today’s children are at greater risk for breast and testicular cancer. In young men,
incidence of testicular cancer has increased by over 50% and is being diagnosed at younger ages. In
young women, 13% of girls have reached the onset of puberty by age seven, putting them at greater
risk for lifelong breast cancer.

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

6. 4
Our History
The Children’s Environmental Health Center (CEHC) builds upon three decades of work by Dr. Philip
J. Landrigan, who has devoted his career to protecting children against environmental threats to health.
As a pediatrician, Dr. Landrigan has seen first hand the threats that untested, synthetic chemicals can
pose to children’s health. In response, he established the country’s first academic research and policy
center to examine the links between toxic exposures and childhood illness in 1998, formerly called
the Center for Children’s Health and the Environment (CCHE). CCHE evolved into the Children’s
Environmental Health Center (CEHC), officially established in 2007.
Dr. Landrigan and his team at CEHC are deeply experienced in translating research into successful
strategies for improving children’s health. Our Center understands how to use research findings to
advocate for evidence-based policies that protect children against toxic exposures in the environment.
We have done it before.
Dr. Landrigan’s work in disease prevention began in the 1970s at the Centers for Disease Control and
Prevention (CDC), where he led efforts to control measles and rubella epidemics across the United
States. During this time, he also worked in the Global Campaign for the Eradication of Smallpox —
one of the great medical triumphs of the twentieth century. Each year, smallpox killed thousands of
people around the world; now it has been virtually eliminated.
In the early 1970s, Dr. Landrigan began a series of landmark
studies that investigated the effects of lead on American children.
Using careful epidemiologic investigations conducted among
children who lived near a lead smelter in El Paso, Texas, he
found that lead causes brain damage to children — even when
exposures are too low to cause obvious signs and symptoms. This
breakthrough discovery led to a fundamental new understanding
of how lead and other toxic chemicals can damage the developing
brains of infants and children. Ultimately, this discovery convinced
the U.S. government to mandate removal of lead from gasoline and
paint — actions that have produced a 95% decline in childhood
lead poisoning, increased the average IQ score by six points, and
saved the U.S. government $200 billion each year.
In 1993, Dr. Landrigan led the creation of a groundbreaking report
at the National Academy Sciences (NAS), which found children to
be uniquely susceptible to the effects of pesticides. This NAS report
argued that “children are not little adults” and compiled evidence
showing that children are more vulnerable to pesticides and other
toxic chemicals. It also called for stricter regulations on pesticide
use to protect children’s health. Dr. Landrigan’s efforts profoundly
changed public policy on pesticides and other toxic substances,
serving as the blueprint for the Food Quality Protection Act of
1996 — the only federal environmental law that contains explicit
provisions for the protection of children.
This NAS report also created the intellectual foundation for the
1997 Presidential Executive Order on Children’s Health and
the Environment, which recognized that children are uniquely
susceptible to environmental hazards. During this time, Dr.
Landrigan served as the Senior Advisor on Children’s Health to the
Environmental Protection Agency (EPA), where he played a leading
role in establishing a new Office of Children’s Health Protection
and set the groundwork for the National Children’s Study.
Our Center’s Director, Philip J. Landrigan, MD, MSc

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

8. 6
Core Programs of the Children’s
Environmental Health Center
At the Children’s Environmental Health Center (CEHC), our primary goal is to conduct new research
that protects our children against environmental threats to health. We accomplish this by guiding,
supporting, and building the programs of the Department of Preventive Medicine at Mount Sinai
School of Medicine.
Core initiatives include:
Pilot Research Projects are the signature research initiative of the CEHC. Using a “venture capital”
approach to fund research, our Center supports new studies that investigate the environmental
causes of childhood diseases, including asthma, autism, learning disabilities, obesity, and diabetes.
All projects are selected through a competitive peer-reviewed process, and each project is specifically
evaluated for its ability to generate major funding from the National Institutes of Health (NIH),
CDC, and other private foundations. Only the best and the brightest are chosen for funding. In just
three years, our initial investment of $310,000 has generated a return on investment of almost $7.29
million from the NIH and other major foundations.
Number of Projects Funded: 35
Number of Papers in Peer Reviewed Journals Generated from Pilot Projects: Over 10
Average Cost of a Pilot Project: $16,500
Total Grant Dollars Generated from Pilot Projects: $7.29 million
0
$500,000
$1,000,000
$1,500,000
20152014201320122011201020092008
$1,604,862
$1,399,862
$1,494,862
$1,269,875 $1,269,875
$250,000
$100,000 $100,000 $110,000
$273,000
NIH & OTHER GRANTS RECEIVED (Annual Direct Dollars)
PILOT GRANTS AWARDED
AnnualDirectDollars
Investing in Knowledge: NIH Grants Generated by CEHC Pilot Projects

9. 7
Core Programs
2008
• A Pilot Exposure Assessment Using Newly Identified Biomarkers — Atrazine, Perchlorate, and Perfluorooctanoic Acid / Stephanie
Engel, PhD, MPH and Cheryl Stein, PhD
• A Pilot Study of the Association between Endocrine Disruptors and Obesity Related Health Conditions / Maida Galvez, MD, MPH
and Barbara Brenner, DrPH
• Impact of LEED-Certified Green Housing on Asthma in Urban NYC / Elizabeth Garland, MD
• Patenting a New Tool for Sampling of Human Placenta to Study Gene-Environment Interactions in Maternal-Child Health / Luca
Lambertini, PhD
• Profiling the Imprinted Epigenome in Human Placenta / Luca Lambertini, PhD
• Effects of Maternal Bisphenol-A Exposure on Fetal GAD1 Epigenetics / Michele La Merrill, PhD, MPH
• Climate Change and Health Impact Survey and Focus Groups for New York Pediatricians / Perry Sheffield, MD, MPH
• Collection of Biological and Environmental Specimens in Anticipation of a Cohort Examining Prenatal Methylmercury Exposure in a
Subsistence Fishing Population in Lake Chapala, Mexico / Leonardo Trasande, MD, MPP
2009
• Maternal Genetic Variation in Relation to Preterm Delivery, Pregnancy Induced Hypertension and Gestational Diabetes in a Multi-
Racial Birth Cohort / Stephanie Engel, PhD, MPH
• Impact of LEED-Certified Green Housing on Asthma in Urban NYC / Anita Geevarughese, MD
• Profiling the Imprinted Epigenome in Human Placenta / Luca Lambertini, PhD
• Effects of Chronic Exposure to Polyhalogenated Pollutants on Metabolic Syndrome and Cardiovascular Risk Factors / Michele La
Merrill, PhD, MPH
• Preparation for a Report on Children’s Environmental Health in New York State / Philip J. Landrigan, MD, MSc
• Evaluation of the Pollen Count Variability within and around New York City Neighborhoods / Perry Sheffield, MD, MPH
• Mercury in Lake Chapala, Mexico / Leonardo Trasande, MD, MPP
2010
• Fetal and Childhood Exposures to Phthalates and Childhood Growth / Stephanie Engel, PhD, MPH
• Impact of LEED-Certified Housing on Asthma in Urban NYC / Anita Geevarughese, MD
• Effects of Maternal Exposure to Persistent Organic Pollutants on Obesity and Diabetes in Adult Offspring / Michele La Merrill, PhD, MPH
• Indoor Air Pollution in Punjab, India / Mana Mann, MD, MPH
• Gene-Environment Interaction Effects on Obesity Among Hispanic and African American Children / Saskia Sanderson, PhD
• Polybrominated Diphenylether Exposure and Risk of Infant Adiposity / Leonardo Trasande, MD, MPP
2011
• Bed Bug Infestation: Implications for the Health of East Harlem Children / Barbara Brenner, DrPH
• A Role of PCBs in Insulin Resistance / Christoph Buettner, MD, PhD
• The Open Space Index: Growing Up Healthy in East Harlem / Kevin Chatham-Stephens, MD and Maida Galvez, MD, MPH
• Evaluation of Children’s Dietary Intakes and Eating Behaviors in East Harlem / Andrea Deierlein, PhD
• Examination of the Effects of in utero Phthalate Exposure on Brain Development in a Rat Model / Sarah Felice Evans, PhD
• Inhalation, Dietary and non-Dietary Exposures to PBDEs and Blood Levels in the Older Adults Living in Brooklyn, NY — A Pilot
Study / Tina Fan, PhD and Kimberly Morland, PhD
• A Pilot Study of the Association between Endocrine Disruptors, Thyroid Function and Childhood Obesity / Maida Galvez, MD, MPH,
Barbara Brenner DrPH, and Nancy Mervish, PhD
• Patenting a New Tool for Sampling of Human Placenta to Study Gene-Environment Interactions in Maternal-Child Health / Luca
Lambertini, PhD
• Developing the Mount Sinai Pregnancy Biobank — Placenta Sampling Method / Luca Lambertini, PhD
• Maternal Exposure to Environmental DDT and Risk of Metabolic Syndrome / Michele La Merrill, PhD, MPH
• Childhood Perchlorate Exposure and Changes in Bodyweight among NYC Inner City Youth / Nancy Mervish, PhD
• A Pilot Study of the Association between Environmental Toxins Distribution and Spanish Speaking Populations in New York, New
Jersey, Puerto Rico, U.S. Virgin Islands / Damiris Perez, MPA
• Hospital-Based Phthalate Exposure in Very Low Birth Weight Neonates / Annemarie Stroustrup, MD, MPH
• Early Life Exposure to Indoor Pollution and Adulthood Lung Cancer / Menghua Tao, MD, PhD and Jia Chen, ScD
CEHC Pilot Projects, 2008-2011

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

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

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

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

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

15. 13
Setting the Foundation for New Discoveries:
The Autism and Learning Disabilities Discovery and Prevention Project
After launching this project, our first goal was to convene at an international symposium to review
current research, identify data gaps, and create a research plan for discovery. In December 2010, our
Center hosted a day-long symposium, titled Exploring the Environmental Causes of Autism and Learning
Disabilities, in partnership with Autism Speaks. Thirteen international leaders came together to address
growing questions and to share preliminary results with over 300 health professionals and community
members.
Our List of Suspect Chemicals: As a direct result, our team developed a list of the top ten chemicals
that we believe are most likely to cause autism and learning disabilities. These priority chemicals are
widely distributed in the environment and have been detected in the bodies of pregnant women.
A Scholarly Series on Autism and the Environment: By focusing on these culprit chemicals, we are
creating the foundation for a strong research strategy into the environmental causes of autism and
learning disabilities. This list will be published in Environmental Health Perspectives — the highest ranked
journal in environmental health — along with a series of five scholarly papers in early 2012.
The Mount Sinai Pregnancy Biobank
A crucial platform for discovery, the Mount Sinai Pregnancy
Biobank is a unique, shared resource that provides researchers
with access to umbilical cord blood and placental tissue samples
from pregnancies delivered at Mount Sinai Hospital. Currently,
there are no other resources with this capacity. Our team has
been instrumental in establishing and launching the Pregnancy
Biobank, and this new tool will provide the basic elements needed
to unearth many of the most common pregnancy outcomes.
In September 2011, the Pregnancy Biobank received initial
funding from the William Randolph Hearst Foundation. This
preliminary funding gives us the equipment needed to begin
sample collection, processing, and storage, and it allows our
team to begin implementing collection procedures.
New Research Breakthroughs on
Neurodevelopmental Impairment
Furthering the development of the Autism and Learning Disabilities Discovery and Prevention Project,
our Center published two important studies this year. Both linked toxic exposures in the environment
to neurodevelopmental impairment.
Prenatal Phthalate Exposure Linked to Autistic-Like Symptoms
In March 2011, our team found that children who had been exposed to high levels of phthalates in
the womb were more likely to exhibit social impairment. Led by Amir Miodovnik, MD, MPH, the
study used the Social Responsiveness Scale — a quantitative scale for measuring the severity of social
impairment related to Autistic Spectrum Disorders (ASD) — to measure these behavioral traits.
Ultimately, they found that prenatal phthalate exposure was associated with greater social deficits,
poorer social cognition, less social awareness, and poorer social communication in children ages 7 to 9.
Exposure to Organophosphate Pesticides Linked to Lower Intelligence
In April 2011, three independent studies revealed important links between prenatal pesticide exposure
and diminished IQ in children. At our Center, a team of researchers, led by Stephanie M. Engel, PhD,
MPH, revealed that prenatal exposure to organophosphate pesticides has a negative impact on the
cognitive development of school-aged children, particularly their perceptual reasoning skills. While
other studies have linked exposures to neurodevelopmental outcomes in newborns, ours is the first to
suggest that neurodevelopmental effects extend throughout early childhood.
The Year in Review
The Mount Sinai Pregnancy Biobank has
the potential to support investigations in:
• Pregnancy Outcomes: Preterm birth,
preeclampsia, and intrauterine growth
restriction.
• Neurodevelopmental Disorders:
Autism spectrum disorder (ASD),
attention deficit/hyperactivity disorder
(ADHD), and schizophrenia.
• Developmental Antecedents:
Infant temperament, parent-child
interactions, and attachment
behaviors.
• Other Common Childhood Conditions:
Including asthma, obesity, diabetes,
and hypertension.

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

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

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

19. 17
1. Community Engagement in Children’s Environmental
Health Research
Barbara L. Brenner, DrPH, LMSW and Melissa P. Manice, MPH
Mount Sinai Journal of Medicine
2. Children’s Environmental Health in Schools
Kevin Chatham-Stephens, MD, Mana Mann, MD, Andrea
Wershof Schwartz, MD, and Philip J. Landrigan, MD
Submitted to American Educator
3. Asthma Mortality in Puerto Rico: 1980 – 2007
Luz Claudio, PhD, and others
Journal of Asthma
4. Environmental Justice: An International Perspective
Luz Claudio, PhD, and others
Encyclopedia of Environmental Health
5. Phthalate Exposure Associated with Self-Reported
Diabetes among Mexican Women
Luz Claudio, PhD, and others
Environmental Research
6. Prenatal Exposure of a Girl with Autism Spectrum Disorder
to “Horsetail” (Equisetum Arvense) Herbal Remedy and
Alcohol: A Case Report
Luz Claudio, PhD, and others
Journal of Medical Case Reports
7. The Association between Maternal Glucose Concentration
and Child BMI at Age 3 Years
Andrea Deierlein, PhD, and others
Diabetes Care
8. Childhood Hair Product Use and Earlier Age at Menarche
in a Racially Diverse Study Population: A Pilot Study
Andrea Deierlein, PhD, and others
Annals of Epidemiology
9. Effects of Pre-Pregnancy Body Mass Index and Gestational
Weight Gain on Infant Anthropometric Outcomes
Andrea Deierlein, PhD, and others
Journal of Pediatrics
10. Implementation of the New Institute of Medicine
Gestational Weight Gain Guidelines
Andrea Deierlein, PhD, and others
Journal of Midwifery and Women’s Health
11. Prenatal Exposure to Organophosphates Paraoxonase 1
and Cognitive Development in Childhood
Stephanie M. Engel, PhD, Jia Chen, ScD, Mary S. Wolf, PhD,
and others
Environmental Health Perspectives
12. Differential Methylation of Imprinted Genes in Growth-
Restricted Placentas
Luca Lambertini, PhD, Jia Chen, ScD, et al.
Reproductive Science
13. The Association between First Trimester Micronutrient
Intake, MTHFR Genotypes, and Global DNA Methylation
in Pregnant Women
Michele La Merrill, PhD, and others
Journal of Maternal-Fetal and Neonatal Medicine
14. Childhood Obesity and Environmental Chemicals
Michele La Merrill, PhD, MPH, and Linda S. Birnbaum,
PhD, DABT
Mount Sinai Journal of Medicine
15. Pre-Pregnancy Body Mass Index, Smoking During
Pregnancy, and Infant Birth Weight
Michele La Merrill, PhD, Cheryl Stein, PhD, Philip J.
Landrigan, MD, Stephanie M. Engel, PhD, et al.
Annals of Epidemiology
Appendix — Papers and Book Chapters Published by the CEHC Team in 2011

20. 18
16. Children’s Health and the Environment: An Overview
Philip J. Landrigan, MD, MSc and Amir Miodovnik, MD, MPH
Mount Sinai Journal of Medicine
17. Children’s Vulnerability to Toxic Chemicals: A Challenge and
Opportunity to Strengthen Health and Environmental Policy
Philip J. Landrigan, MD, et al.
Health Affairs
18. Environment and Heart Disease
Philip J. Landrigan, MD, Michele La Merrill, PhD, and others
Hurst’s The Heart (13th edition)
19. New Academic Partnerships in Global Health: Innovations
at Mount Sinai School of Medicine
Philip J. Landrigan, MD, Luz Claudio, PhD, and others
Mount Sinai Journal of Medicine
20. Lead Poisoning of a Child Associated with Use of a
Cambodian Amulet — New York City, 2009
Mana Mann, MD, et al.
Morbidity and Mortality Weekly Report, Centers for Disease Control
and Prevention
21. Occupational Carcinogens and Cancer in Children
Mana Mann, MD and Philip J. Landrigan, MD
Submitted to Occupational Cancer
22. Temporal Variability in Urinary Concentrations of
Perchlorate, Nitrate, Thiocyanate and Iodide among Children
Nancy Mervish, PhD, Barbara Brenner, DrPH, Maida P. Galvez,
MD, Mary S. Wolff, PhD, Susan L. Teitelbaum, PhD, and others
Journal of Exposure Science and Environmental Epidemiology
23. Endocrine Disruptors and Childhood Social Impairment
Amir Miodovnik, MD, Stephanie M. Engel, PhD, Mary S.
Wolff, PhD, and others
NeuroToxicology
24. Environmental Neurotoxicants and the Developing Brain
Amir Miodovnik, MD, MPH
Mount Sinai Journal of Medicine
25. The Association of Tree Pollen Concentration Peaks and
Allergy Medication Sales in New York City: 2003 – 2008
Perry Sheffield, MD, et al.
ISRN Allergy
26. Climate Change, Aeroallergens, Pediatric Allergic Disease
Perry Sheffield, MD, MPH, Kate R. Weinberger, MA, and
Patrick L. Kinney, ScD
Mount Sinai Journal of Medicine
27. The Effects of Outdoor Air Pollutants on the Costs of
Pediatric Asthma Hospitalizations in the United States,
1999 – 2007
Perry Sheffield, MD, Leonardo Trasande, MD, and others
Medical Care
28. Fine Particulate Matter Pollution Linked to Respiratory
Illness in Infants and Increased Hospital Costs
Perry Sheffield, MD, Leonardo Trasande, MD, and others
Health Affairs
29. Modeling of Regional Climate Change Effects on
Ground-level Ozone and Childhood Asthma
Perry Sheffield, MD, et al.
American Journal of Preventive Medicine
30. A Tale of Two Countries: Rethinking Sexual Risk for HIV
among Young People in South Africa and the United States
Cheryl Stein, PhD, and others
Journal of Adolescent Health
31. The Epidemiology of Hospitalized Postpartum Depression
in New York State, 1995 – 2004
Cheryl Stein, PhD, and others
Annals of Epidemiology
32. Gestational Weight Gain and Birth Outcome in Relation
to Pre-Pregnancy Body Mass Index and Ethnicity
Cheryl Stein, PhD, and others
Annals of Epidemiology
33. Maternal Ethnicity and Preeclampsia in New York City,
1995 – 2003
Cheryl Stein, PhD, Stephanie M. Engel, PhD, and others
Paediatric and Perinatal Epidemiology
34. Serum Perfluorinated Compound Concentration and
Attention Deficit/Hyperactivity Disorder in Children Aged 5
to 18 Years
Cheryl Stein, PhD, et al.
Environmental Health Perspectives
35. Economics of Children’s Environmental Health
Leonardo Trasande, MD, MPP
Mount Sinai Journal of Medicine
36. Reducing the Staggering Costs of Environmental Disease
in Children, Estimated at $76.6 Billion in 2008
Leonardo Trasande, MD, MPP, et al.
Health Affairs
37. Measures of Obesity Associated with Asthma Diagnosis
in Ethnic Minority Children
Nita Vangeepuram, MD, Susan L. Teitelbaum, PhD, Maida P.
Galvez, MD, Barbara Brenner, DrPH, Mary S. Wolff, PhD,
and others
Journal of Obesity

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

22. Contact the Children’s
Environmental Health
Center
Children’s Environmental Health Center
www.cehcenter.org / www.mountsinaiGOCluncheon.org
One Gustave L. Levy Place, Box 1057
New York, New York 10029
T: 212-824-7125
F: 212-966-0407
World Health Organization
Collaborating Centre in
Children’s Environmental Health
Written by Katherine Southwick / Designed by Anne Garland / printed on recycled paper
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