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ASPPH Fellow Spotlight: ASPPH/EPA Environmental Health Fellow Evaluates Infant Exposure via Breast Milk and Infant Formula for Upcoming High-Priority Toxic Substances Control Act (TSCA) Chemicals

Czarina Cooper, MPH graduate of Emory University Rollins School of Public Health, recently completed a year-long ASPPH Fellowship at the U.S. Environmental Protection Agency (EPA), hosted by the Office of Children’s Health Protection (OCHP) in Washington, DC. While at Rollins, Cooper worked as a graduate research assistant for the Household Air Pollution Intervention Network (HAPIN) Trial, a multicounty randomized controlled trial assessing the impact of liquified petroleum gas (LPG) cooking stove and fuel intervention on maternal and child health. Her capstone project evaluated the association between household air pollution (PM2.5) and neurodevelopment and stunting of infants from rural communities of Guatemala. These experiences led her to the ASPPH fellowship at EPA where she could continue her work in protecting children’s environmental health.

The EPA OCHP goal is to ensure that all EPA actions and programs address the unique vulnerabilities of children. As a fellow, Cooper worked on reviewing and addressing children’s environmental health issues, including potential exposures and health effects, on Toxic Substances Control Act (TSCA) chemical risk evaluations. Under TSCA, “EPA evaluates potential risk from new and existing chemicals and acts to address any unreasonable risks chemicals may have on human health and the environment”. The Frank R. Lautenberg Chemical Safety for the 21st Century Act that amended TSCA in 2016 required EPA to consider subpopulations including infants, children, and pregnant women. An important route of exposure to consider when constructing exposure scenarios in risk evaluations is the ingestion of breast milk and infant formula. According to EPA’s Exposure Factors Handbook, there are chemicals that may be transferred to breast-fed infants via human milk and there are also chemicals found in infant formula and in the drinking water used to prepare it. Children are more vulnerable to these exposures than adults because they eat and drink more in proportion to their body size. They also have a significantly less varied diet and may only be consuming breast milk or formula for sustenance.

Cooper’s main project was a literature review and assessment of available human breast milk biomonitoring studies and infant formula analysis for 22 high-priority TSCA chemicals. PubMed was used to conduct the literature review and specific search strings were used to identify studies that measured the specific chemical or in some cases the metabolite, in breast milk or infant formula. She manually screened titles and abstracts and then thoroughly extracted data from articles that met the criteria. A formal study quality evaluation of each study was not performed. However, some issues relevant to study quality were considered during the inclusion/exclusion process.

Results from the literature review demonstrated that several of the next 22 high-priority chemicals under TSCA have been detected in breast milk and a few have been detected in infant formula. Among those were various phthalates and flame retardants. Cooper gave a virtual presentation to EPA’s Office of Pollution Prevention and Toxics (OPPT), summarizing these findings, which included tables of the chemical concentrations detected in breast milk or formula. The chemical-specific information was also provided to OPPT for use in their upcoming risk evaluations. Next, Cooper is preparing a manuscript for submission to a peer-reviewed journal.

ASPPH is currently accepting applications to the ASPPH/EPA Environmental Health Fellowship Program. To learn more, please visit the ASPPH website or view the Program Announcement.