Neurotoxic Pollution & Neurodevelopmental Disabilities

Since poison gas was invented for combat in World War I, our industrial use of neurotoxic chemicals has increased dramatically and with it, the number of children with special needs. A 2016 study by Northwestern University found that babies conceived near toxic Superfund sites were more likely to have disabilities than their siblings born to the same mother after toxic waste was removed. An overwhelming amount of evidence from institutions like Harvard’s School of Public Health now supports the conclusion that industrial chemicals are altering human development. Yet since 2022, the US Supreme Court has decided, in cases like West Virginia v. EPA, to allow unlimited industrial pollution into our air and water. If science is correct, this will trigger unlimited special needs including ADHD and Autism spectrum disorder at a time when Congress is defunding our special education safety net.

Style Note: To address public confusion about science and to help readers educate themselves about the relative value of different scientific studies and their conclusions, Ms. McCarty has amended APA Style for citations to a simple number system in the body of this article with a complete list of experts and institutions listed in the References section below. Links are provided and readers are encouraged to read the research directly after reading this analysis.

At present, the CDC estimates that 1 in 6 students (17%) have special needs. And those are just the needs that have been identified. In urban areas, which have been dumping grounds for pollution for generations, the percentage of special needs is probably a lot higher but there is a cap on the number of people who can receive special education services in any one city. According to federal law, only the bottom 10% of students can receive special education services even if the entire population has been exposed to neurotoxic pollution. This has consequences for education but also for crime prevention. The reason we have unleaded gas in the United States, for example, is because one neurotoxin - lead - causes violent behavior. Despite knowing this, there are urban areas like Oakland, Calif., where schools still receive water from lead-lined pipes. (2017, #49) In rural areas, neurotoxic pesticides have consequences for farming communities. Pesticides are linked to the early onset of dementia. There is also a link between pesticides and autism. Harvard’s School of Public Health found that direct contact with pesticides can cause brain damage and trigger disabilities such as autism, attention-deficit/hyperactivity disorder (ADHD) and dyslexia in the children of farm workers. (2014, #12)

The rise of neurotoxic pollution & special needs

After WWI ended in 1918, the disposal of unused poison gas invented for trench warfare had a surprising benefit: abundant crops sprouted from the poison-laced soil unharmed by insects. Pleased with the results, farmers began deliberately using chemical poisons, pesticide, to increase successful food production and to make life easier. In the very next generation, during the 1940s, the first case of autism was identified in the United States. At the time, Americans didn’t search for chemical causes for this change in biological development in children. Having survived the Great Depression and the global food shortage that sparked WWII in Asia and Europe, Americans were grateful for abundant food. No one stopped to question whether putting poison intended as a chemical weapon on our food sources was a good idea or whether it might alter the long-term biological development of generations to come.

Since World War I, American industry has been playing a dangerous and deceptive game: inventing man-made chemical neurotoxins that make our lives easier in the short-term but potentially more impaired and more deadly in the long run. In Europe, new man-made chemicals must be proven safe in a lab before they can be used publicly. In the United States, however, the opposite has been true historically. Industry has been allowed to use any new man-made chemical publicly until it is proven harmful. Living and breathing human beings have become guinea pigs of industry at a time when our safety net for people with special needs is losing tax-payer support.

Chemically-altered impulse control & violence in America

To understand the connection between neurotoxins, special needs and violence, we need to understand how certain chemicals – some naturally-occurring and some man-made – can alter our biology, our abilities, and our behavior. One naturally-occurring chemical element that alters neurodevelopment is lead. The harmful effect of exposure to this heavy metal is well-documented. (2015,#1; 2009, #2; 2002, #3) One Harvard study reported that lead pipes used in the early 1900s exposed entire city populations to lead in drinking water. Lead exposure caused changes to the human central nervous system and, due to the resulting nervous system irregularity that makes it harder for people to control emotions and aggression (2002, #4), lead is now connected with the dramatic rise in homicides between 1921 and 1936. (2016, #5) While production of lead water pipes was discontinued, lead was still used in another consumer product when cars became mainstream: gasoline. Researchers at Duke University and Florida State University recently discovered that 170 million people – half of Americans – were exposed to harmful lead levels as children (2022, #6), causing lower IQ in populations exposed to leaded gasoline between the 1940s and 1980s, with the greatest drops in IQ occurring in those born between 1960 and 1970, (2020, #7; 2022, #8; 2021, #9) two decades also known for a significant uptick in violent crime across the country. At the end of the 20th century, there was a dramatic drop in violent crime nationwide as lead was phased out of gasoline. Americans didn’t fully switch to unleaded gasoline until 1996 when lead was officially banned in gasoline products intended for passenger cars. It’s important to note that industry didn’t volunteer to stop using lead. The U.S. government had to regulate industry and create laws banning lead to protect public health and safety from industrial greed that tends to seek profit at any cost.

In addition to causing lower IQ, a study supported by South Korea’s Ministry of Environment associated low-level exposure to metals like lead, cadmium, and antimony to the development of attention-deficit/hyperactivity disorder (ADHD) and impulsivity disorders in children, (2015, #1) which can impair a person’s ability to control their behavior. Lead, cadmium and antimony are known as neurotoxins – an important vocabulary word to know because there are many neurotoxins in use today associated with neurodevelopmental disorders that can impair a person’s ability to self-regulate and maintain life-long mental and physical health. The National Academy of Sciences, Engineering, and Medicine (NASEM) summarizes decades of epidemiological research on the consequences of industrial pollution: “Neurotoxicant exposures, both acute and chronic, can result in subtle and lasting mental health consequences… Children exposed to lead demonstrate greater externalizing symptoms, such as hyperactivity and antisocial behavior (Marcus et al. 2010; Needleman et al. 1996), and, in adulthood, tend to develop more disadvantageous personality profiles (Reuben et al. 2019; Schwaba et al. 2021), schizophrenia diagnoses (Opler et al. 2004), and psychiatric symptomatology across diagnostic categories (McFarlane et al. 2013; Reuben et al. 2019).” (2022, #10)

Violent crime prevention & special needs services

Every expert sees what they are trained to see and sometimes that can be a point of bias or insight. When I watched the news about the 2022 shooting of students in Uvalde, Texas and the Fourth of July shooting at a parade in Highland Park, Illinois, what jumped out at me as an education specialist was that both shooters were socially isolated to an extreme: a potential sign of autism. The Uvalde shooter had only one friend online and the Highland Park shooter lived in a basement with only an online community. In July 2024, presidential candidate Donald Trump was shot in the ear by a member of his own political party. This gunman was described in the media as socially isolated and bullied, another potential sign of autism. What former President Trump didn’t fully understand as he shouted “Fight!” is that the enemy might be a “what’ not a “who.” Trump’s three nominees to the US Supreme Court, (Justices Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett), which is now majority-conservative, recently decided to allow unlimited guns and unlimited pollution in the United States: a perfect storm of bad public policy at a time when pollution is chemically altering human beings and making them less able to control violent impulses.

The connection between social isolation, impulsivity and violence is important to note because autism cases are rising and developmental disabilities (including ADHD) in children are skyrocketing. Harvard’s School of Public Health observed, “a steep rise in the prevalence of childhood diagnosis of Autism spectrum disorder (ASD) from 6.7 per 1,000 people in the year 2000 to 16.8 per 1,000 people in 2014.” (2021, #18) According to the CDC, today about 1 in 36 children (2.8%) are currently diagnosed with autism. ADHD also has had a steep upward curve. As of 2018, the CDC reported an increase of 700% in the number of reproduction-aged women (ages 25-29) filling a prescription for an ADHD medication and an increase of 560% for women ages 30-34 filling ADHD prescriptions. As of 2012, about 1 in 10 American children had received a diagnosis of ADHD, which is associated with behavior problems. As of 2024, an estimated 7 million (11.4%) U.S. children aged 3–17 years have been diagnosed with ADHD, according to a national survey of parents using data from 2022. According to the CDC, 1 in 6 children (17%) ages 3-17 have been diagnosed with a developmental disability including ASD, ADHD as well as cerebral palsy, blindness and other disabilities. (2024, #19)

Not all autism and ADHD cases are the same. The ability to self-regulate behavior can vary dramatically from case to case. Both ASD and ADHD have mild-to-severe spectrums of behavior and individuals may have multiple impairments that can impact their ability to control their bodies like people with a “typical” human brain. While many students in special ed may have the ability to buy and use a gun like a “typical” person, they may also struggle with ADHD and Emotional Disturbance (ED), two comorbidities that often accompany a diagnosis of autism. Struggles with obsessive thoughts, obsessive behaviors and impulsivity or hyperactivity combined with their statistical likelihood of being socially bullied (2014, #20) make them both potential victims and perpetrators when it comes to gun violence. Parents fearing for their bullied child’s safety may buy a gun for their child thinking that their child can self-regulate and not use the gun as they would, and this demonstrates a lack of understanding about how the autistic and/or impulsive brain tends to function: it often can’t self-regulate. In fact before age 25, when the brain completes its development, even “typical” young people struggle to self-regulate. A young person with impairments struggles even more. The young Republican who shot Donald Trump at his rally fired eight rounds – enough to kill the former president if that was his intention. If that young gunman were still alive, I would ask him where his attention was at the moment his gun fired. Had his mind wandered, eg: to videogames, and his fingers responded impulsively to that thought before he realized what was happening? Did he fail his gun safety class because he could not control his body and reacted impulsively to his own thoughts rather than to the gun instructor’s directions?

The 2nd Amendment exists to allow American citizens to protect themselves from tyranny, a right we may need to exercise soon given the global rise of aggressive dictatorships. Statistically, however, the person you are most likely to kill with a gun is yourself. (2023, #46) followed by a loved one. In 2022, “48,117 people died by firearms in the United States — an average of one death every 11 minutes. Over 26,993 people died by firearm suicide, 19,592 died by firearm homicide, 472 died by unintentional gun injury, and an estimated 649 were fatally shot by law enforcement. In addition, an average of more than 200 Americans visit the emergency department for nonfatal firearm injuries each day.” (2021, #47) In the United States, bullets rarely hit the true source of human suffering. Too often, they miss their mark and harm the innocent. The 20-year-old Republican man who shot Donald Trump may have been exposed to neurotoxic chemicals as a fetus and child because for decades, Congress has written laws to protect industrial profits instead of human health. In addition to neurotoxin exposure, this young man probably didn’t receive all the special ed services he needed because Congress has refused to fully fund special education. A 2021 special education funding bill is still sitting in Congress, without enough bipartisan votes to pass it into law.

Medication is available for ADHD and can increase the ability to self-regulate if a student remembers to take it. Unfortunately, students often hate the side effects of these medications and stop taking them. There is no current medication that treats autism. This is because any combination of more than 100 genes can cause autism and, while we don’t know every cause that activates every gene, there is rising evidence in the global scientific community that pollution is triggering autism genes as well as ADHD. Stopping pollution from entering the environment and cleaning it up before it leaches into groundwater and the womb is critical for healthy human development everywhere. There is now scientific evidence that Superfund clean-ups can reduce the risk of chemically-altered fetal development.

Superfund sites & fetal development

Since WWII, industries have dumped millions of tons of toxic wastes – heavy metals and organic solvents - into our natural environment at more than 15,000 uncontrolled sites across the country. (1999, #11) Most of these toxic dumping sites – legal or illegal – are near poor communities of color. Since WWII, the number of human diseases has dropped in the United States but there has been a dramatic increase in cancers in children as well as neurodevelopmental impairments such as Autism spectrum disorder, ADHD and Lower IQ (1999, #11) that scientific experts now associate with exposure to neurotoxic pollution including pesticides (2014, #12).

Industrial toxic dump sites

What happens when heavy metals and organic solvents such as lead, trichlorethylene, chromium, benzene, and arsenic (1999, #11) are dumped at waste sites where they mix and interact with each other? In 2016, one in four Americans – 80 million people - lived within 3 miles of a Superfund toxic waste site (2016, #13) typically an abandoned industrial, military or nuclear site in the United States (2019, #11). Many more illegal dump sites are found in low-income communities, who have suffered the greatest exposure, but toxins dumped in one neighborhood don’t stay there. They move via water and air. People move too. During gentrification, new owners of an old home may not realize they purchased a piece of environmental injustice that may alter their family health.

Too often, humans are exposed and harmed before a toxic clean-up happens in the USA. At a former naval military base converted into low-income and subsidized housing on San Francisco’s Treasure Island, children were playing in radioactive dirt, which contained the radioactive element radium as well as chemicals like dioxin and petroleum byproducts. In a Reuters’ investigation (2019, #14), it’s notable that government clean-up of the island was a rapid response. Superfund clean-ups are often delayed for decades as the EPA struggles to find proof of specific harm, a requirement for clean-up required by law. The radioactive dirt was a clear cause of harm. Radioactive materials cause one health problem: cancer. Finding a singular cause for a single health problem is almost impossible at sites where many chemicals are dumped together and that may cause multiple health problems without a clear scientific marker of which exact chemical caused what exact health problem. For decades, federal law has required U.S. Environmental Protection Agency (EPA) scientists to prove that an isolated toxin causes one specific health problem to activate a clean-up, so most Superfund clean-ups are delayed or never happen while the data remains “inconclusive” among American scientists. With the new Supreme Court cuts to EPA oversight of pollution, unlimited toxic waste can now be dumped into our environment regardless of impacts to a fetus or child development. In the past, there has been bipartisan support among liberal and conservative politicians to provide at least some protection of clean air and clean water to protect human health. Since 2010, however, the polarized political climate in Congress has often crippled teamwork between political parties and kept laws at a standstill.

A 1999 report, Chemical Wastes, Children's Health, and the Superfund Basic Research Program explains why neurotoxins do more damage at a younger age of exposure:

“Children undergo rapid growth and development, and their developmental processes are easily disrupted. Many organ systems in infants and children undergo very rapid change prenatally, as well as in the first months and years after birth. These developing systems are very delicate and are not well able to repair damage that may be caused by environmental toxicants. Thus, if cells in an infant's brain are destroyed by chemicals such as lead, mercury, or solvents, or if false signals are sent to the developing reproductive organs by endocrine disruptors, there is high risk that the resulting dysfunction will be permanent and irreversible. Because children have more future years of life than most adults, they have more time to develop chronic diseases triggered by early exposures. Many diseases that are caused by toxicants in the environment require decades to develop. Many of those diseases, including cancer and neurodegenerative diseases, are now thought to arise through a series of stages that require years or even decades to evolve from earliest initiation to actual manifestation of disease. Carcinogenic and toxic exposures sustained early in life, including prenatal exposures, appear more likely to lead to disease than similar exposures encountered later (in life).” (1999, #11)

In 1999, this same report (co-produced by the Mount Sinai School of Medicine in New York, the National Institute of Environmental Health Sciences in North Carolina and the Agency for Toxic Substances and Disease Registry in Atlanta, Georgia) explained how neurotoxin-induced neurodevelopmental impairments impact society at large: “Neurodevelopmental impairments produce lifelong needs for special education; they lead to increased risk of hospitalization, institutionalization, and incarceration; they diminish lifetime productivity and earning capacity; they create enormous personal, familial, and economic burdens; and they engender family and societal disruption.” (1999, #11)

Twenty-five years ago, when that report was written, only 3% of American children were diagnosed with any category of developmental disorders which included learning disabilities, dyslexia, intellectual retardation, attention deficit/hyperactivity disorder, autism and pervasive developmental disorder. That percentage has jumped to 17% in a couple of decades. We now have decades of research that confirm and further clarify these 1999 observations about how Superfund toxic waste affects children’s behavior, academics, and development. The 2016 report, Inequality Before Birth: The Developmental Consequences of Environmental Toxins, reviewed Superfund and pediatric health data collected by the state of Florida from families who lived near toxic sites. The same 4,500 families with more than one child were monitored over the course of nine years between 1994 and 2002. A review of this data by scientists at Northwestern University and the University of Florida found changes in development in the children born to the same household near a Superfund toxic waste site before and after it was cleaned up. Their findings: “Children who were conceived near a Superfund site before it was cleaned up are more likely to have a cognitive disability, to be suspended from school, to score lower on state tests, and to repeat a grade than children born to the same mothers in the same location after the hazardous waste had been cleaned…. Those conceived within a mile of a Superfund site before cleanup were 10 percentage points more likely to be diagnosed with a cognitive disability such as a specific learning disability, autism, or speech and language impairment than children who weren’t as exposed.” (2016, #13)

Man-made chemicals: Safe until proven harmful in the USA

Any newly-invented, man-made chemical is considered safe for public use until the U.S. Environmental Protection Agency (EPA) proves that it directly causes one specific disease or neurodevelopmental disorder. This makes keeping up with the rate of chemical invention a challenge for American scientists who often needed years of studies to develop proof of harm. In contrast, Europe has protected human health instead of industrial profits. Any newly-invented chemical is always considered harmful until chemical companies invest in their own research to prove it is safe (2007, #15). Then as a follow-up, European government scientists verify the validity of those industrial scientific results with their own studies before permitting public use. This has created a very high safety standard for man-made chemicals that has protected human biological development in Europe.

In contrast, in the US, any industrial scientist claiming “a lack of conclusive evidence” about a new chemical allows that chemical to remain in public use. In the United States, pro-industry scientists, like the ones who told us for decades that cigarettes were safe and did not cause cancer, can produce scientific results that challenge the validity of any research that points to evidence of harm. This has created a roundabout of “inconclusive” proof of harm that has allowed industries to continue using a chemical, exposing all Americans including pregnant women and children to hazards without having to provide any warning labels. If by chance a chemical is proven unsafe and finally removed from public use, chemical companies can simply create a slightly different version of that same chemical, which they can then immediately dump right back into the environment without restriction, until the scientific research catches up.

US Supreme Court allows unlimited guns, pollution

Is someone in special education with a developmental disability the guilty party if society gives him unlimited, easy access to rapid-fire weapons? The danger of the Supreme Court’s 2022 ruling allowing unlimited open-carry guns (New York State Rifle & Pistol Association Inc. v. Bruen) is further compounded by other overly-simple rulings by the Court on pollution. Corporations can now pollute as much as they want, even with harmful, man-made chemicals that do not exist in nature. These national rulings fail to acknowledge the connection between neurotoxic pollution, the rise in neurodevelopmental disorders and the growing human impulsivity caused by altered biological development. The current US Supreme Court’s failure to connect the dots means it is ill-equipped to protect public health and safety on multiple levels.

The US Supreme Court is reversing laws that limit industrial pollution and stripping away the U.S. Environmental Protection Agency’s oversight of industry. In March 2024, the Union of Concerned Scientists raised alarms about two recent US Supreme Court decisions that reverse protections for clean air and clean water: the 2022 West Virginia v. EPA decision which allows unlimited air pollution and the 2023 Sackett v. EPA that allows unlimited pollution in waterways like wetlands and streams. “The court… limited the EPA’s ability to cut carbon emissions from power plants, effectively ending efforts launched by the Obama administration to save up to 3,600 lives a year, avoid 90,000 asthma attacks, 1,700 heart attacks and 300,000 missed school and workdays… (the Court also) ignored decades of hydrology showing how wetlands have invisible underground connections to larger bodies of water … (and) how clean water is its own economic engine, contributing mightily to the national outdoor recreation economy. The Bureau of Economic Analysis last year estimated that recreation economy was worth $564 billion in 2022.” (2024, #48) The Union of Concerned Scientists also notes that in 2022, Justice Neil Gorsuch expressed his opinion that a previous decision Chevron v. National Resources Defense Council should be overturned and that agencies like the Environmental Protection Agency and its scientists should have even less power to limit industrial profits in the future, an intention with global implications. (2024, #48)

American-manufactured chemicals do not stay in the USA but impact the world’s biosphere endangering the health of people in other countries. As a result, the European Food Safety Authority (EFSA) has begun conducting its own research on chemicals and exposure in the United States and sounding warnings to the global public. In March 2021, a national team of scientists in Denmark concluded that American mothers are being exposed to a dangerous chemical found in products like water bottles called BPA, or Bisphenol A, that has endocrine-disrupting abilities which cause developmental malformations and nervous system disfunction (2024, #42). They concluded that mothers exposed to BPA may have greater odds of having children with autism and that autism may not develop until after 5 years of age so continual testing of children for BPA exposure and monitoring for symptoms of autism was recommended.  (2021, #31). In December 2021, Europe alerted the American Food & Drug Administration (FDA) about the dangerous levels of BPA chemical used in the production of plastic for consumers in the USA. (2022, #16). Later that same year, the US Supreme Court began hearing cases against the U.S. Environmental Protection Agency, reversing environmental laws passed by Congress and, ironically, endangering the fetal development of babies it has protected from abortion.

Pro-industry “reviews” of current scientific research often involve a few scientists from a single lesser-known institution who cast doubt about research done by much larger groups of scientists, undermining research results by calling them “inconclusive.” One such 2019 review by three scientists at the Medical University of South Carolina concluded that “controlled pesticide dosing experiments in animals… support a mechanistic relationship in the development of ADHD and/or ASD” and that “The available evidence supports the hypothesis that pesticide exposure at levels that do not cause acute toxicity may be among the multifactorial causes of ADHD and ASD, though further study is needed, especially for some of the newer pesticides.” (2019, #17) In other words, keep those new pesticides in circulation despite possible harm to human development. “Multifactorial (which means multiple) causes” and “Further study is needed” is code for “inconclusive” and therefore not eligible for removal from the public marketplace. Because our conservative-controlled legal system now protects industrial profits over human health, a few pro-industry scientists can undermine research done by countless numbers of researchers at multiple national institutions. When confronted with the connection between pesticides and ADHD and other health disorders, industry representatives defend the immediate public use of new man-made chemicals with the arguably unethical USA standard that one specific “conclusive” chemical must be linked to one specific health condition in order to remove a chemical from public use. The “inconclusive” argument has allowed decades of public poisoning despite the now overwhelming evidence that these chemicals are impairing entire generations of Americans with no slowing down in sight. Harvard scientists launched a national challenge to the American Chemistry Council a decade ago:

"We need to do something to protect the next generation's brains," said Philippe Grandjean of the Harvard School of Public Health (watch video) regarding the behavioral and brain effects of chemical exposures during pregnancy and early childhood. (2014, #27) He recommended in 2014 changing the standard for chemical safety to the European standard of lab testing first to prove safety before releasing man-made chemicals on the public, an idea obstructed by a lack of bipartisan support in Congress. For now, while awaiting effective regulation of toxic chemicals, Harvard recommends buying organic fruits and vegetables to minimize pesticide exposure because, at this point in time, “the health benefits of eating American fruits and vegetables outweigh the risk of developing ADHD or ASD.” There is a far greater risk to migrant farm workers who often have direct pesticide-skin exposure (1999, #12), and this video misses an opportunity to recommend OSHA protections for these workers who, because they have no worker visas, are not protected by worker safety laws in the United States. To add insult to injury, when the children of migrant farm workers show up to school with an inability to self-regulate like their more privileged peers, community members tend to blame bad parenting or bad teaching rather than the pervasive use of neurotoxic pesticides in farming.

Protecting the fetus & children from toxin exposure

The challenge of protecting children from toxins already in the environment is outlined in a joint community-based research project by Columbia University’s School of Public Health and West Harlem Environmental Action, Inc., which recommends engaging politicians to solve this problem (2002, #3) at the level of the law. Unfortunately, new Congressional laws governing neurotoxins will now require the support of 2/3 of the representatives in Congress to override a U.S. Supreme Court decision. Since the liberal-party Democrats cannot muster 51% support at this time, there is not a lot of hope for 66% support among politicians unless we see a greater commitment to voting among the 41 million young Americans now eligible to vote as of 2024. Many of these young potential voters witnessed the rise in gun violence and special education needs during their time as students in the education system and they might be more inclined to support liberal-leaning laws regarding human health and the environment, particularly when air pollution also contributes to climate change. Disaffection among voters most impacted by pollution, however, has been an ongoing problem for decades. Disaffection is a vicious cycle of hopelessness that ironically empowers the most pro-industry politicians, which creates even more overwhelming injustice and a belief that social change is impossible. Until disaffected voters participate in the election of new representatives to Congress, and vote consistently in every election, we are stuck with the current freeze on bipartisan cooperation and a U.S. Supreme Court empowered to reverse decades of progress regarding environmental law. Countries without environmental laws, like China, reveal how much more toxic our world can become but also provide insight into how much the U.S. EPA has protected so far in America.

Evidence of harm:  A multidisciplinary approach

To fortify the evidence of a connection between environmental toxins and behavioral, mental and physical health outcomes, the National Academies of Sciences, Engineering, and Medicine (NASEM) hosted a national workshop in 2021. Experts in the fields of epidemiology (environmental, psychiatric, genetic, social, and behavioral), toxicology and neuro-and-developmental psychology met with each other to compare their research findings. NASEM covered three main categories of toxins – pesticides, solvents, and metals – and their impact on human health and development. Multidisciplinary insights revealed that exposure to each of these neurotoxin categories is associated with higher levels of neurodevelopmental disabilities (2022, #10) that are on the rise, an observation mirrored by national CDC data. NASEM’s event included institutions such as Harvard Medical School, Columbia University, Duke University, George Washington University, UCSF and Lundbeck, LLC, a biopharmaceutical company studying brain diseases in Illinois. 

Pesticides & ASD, ADHD and mental health disorders

The root word “cide” means “to kill.” We find it in words like homicide or infanticide. While pesticide is designed to kill “pests,” a term for insects, an argument can be made that pesticide is now altering fetal and human development in ways that significantly impair a human being’s ability to take care of themselves. As of 2019, 90% of Americans had detectable levels of pesticides in their bodies, with migrant farm workers being the most heavily exposed (2018, #21). By 2022, one in three Americans had been exposed to toxic herbicide. (2022, #22) The Harvard School of Public Health found a connection between organophosphates and ADHD (2010, #23) confirmed by researchers at Cincinnati Children's Hospital Medical Center who “found an association between exposure to commonly-used household pyrethroid pesticides and ADHD symptoms such as hyperactivity and impulsivity.” (2015, #32) NASEM 2021 scientists also found mental health impacts: “Exposure to pesticides, particularly acetylcholinesterase-inhibiting organophosphates, has been linked to increases in depressive symptomatology, anxiety and depression diagnoses (Suarez-Lopez et al. 2021), suicides (Khan et al. 2019), and general neuropsychiatric symptomatology (Rauh and Margolis 2016).” Chemicals in pesticides are now used for agriculture, manufacturing processes, parks, golf courses, rights of way, and for home-and-garden use. NASEM’s multidisciplinary event discussed how pesticides can cause depressive and anxiety behaviors in mice. In humans, pesticides can cause an accumulation of acetylcholine and disrupted neurotransmission in the parasympathetic nervous system.  (2022, #10)  

NASEM’s discovery of a mental health connection to pesticides is particularly interesting in light of the spike in mental health problems during the pandemic when an unprecedented number of Americans were using Chlorox wipes, a household pesticide (2021, #25) on their bare hands. During the COVID-19 pandemic, The Clorox Company’s share price skyrocketed nearly 50% between March and August 2020 as schools dramatically increased their use of Chlorox wipes in classrooms. Students can be directly exposed to pesticide by touching wipes, their desktops cleaned with such wipes or by breathing in air-borne particles if a room does not have adequate ventilation, which many older school buildings lack. Since the pandemic, many schools have reported a regression in student achievement without considering the possible connection between chemicals and cognitive deficits.

Bleach-free Chlorox wipes contain “quats,” a class of chemicals also used in paints, pesticides, hand sanitizers, and personal care products. Quats can cause infertility, birth defects and other health problems (2023, #24) including neurological conditions and brain damage (2009, #2) that the Harvard School of Public Health has connected to autism, ADHD, dyslexia and lower IQ.  (2014, #27) The full scientific name for “quats” is Quaternary Ammonium Compounds. The drop in test scores since the pandemic may be a direct result of classroom use of Chlorox wipes, which contain “quats” that can lower IQ. An interesting experiment might be to remove Chlorox wipes from all classrooms, switch back to organic soap (the safest way to effectively kill viruses when hands are washed for 26 seconds in hot water) and see if student test scores bounce back. A women’s magazine recommends several ways to Quit the Quats at home.

Solvents & ASD, ADHD, dyslexia and lower IQ

Stronger than quats, solvents such as liquid bleach, acetone, methyl ethyl ketone, toluene, nPB, and trichloroethylene (TCE) have more serious potential health impacts. The chemical industry claims that solvent-induced brain impairments tend to be temporary and go away when a cleaning solvent is removed from a room. However, experts in the field of neurology believe the duration of exposure is a factor. If a human being is exposed for many years, some of those damages may become permanent. Scientists found that a lifetime of high exposure to chlorinated solvents, petroleum solvents, and benzene by people in the cleaning industry was significantly associated with poor cognition. (2014, #28) Experts in the field of neuropsychiatry found that extensive exposure in adults can cause solvent-induced encephalopathy and related cognitive, behavioral, and emotional deficits. (2015, #30)

A descendant of the Chlorine gas used during WWI, chlorine bleach inhalation can cause discomfort and coughing in the short-term and over the long-term, chronic chemical pneumonitis, a stiffness of the lungs which if untreated can result in respiratory failure. The cleaning industry is not the only industry at risk for solvent exposure. A North American labor organization in Washington, DC, recommends always wearing gloves, long sleeves and a respirator when using chemical solvents to reduce exposure.  “Millions of workers are exposed to solvents every year in the construction industry,” said LIUNA General President Terry O’Sullivan. “Solvents and the vapors they emit pose both short and long-term hazards for laborers. With new research showing that continued solvent exposure causes permanent effects on the brain, protecting workers from these hazards is more important than ever.” (2024, #29)

In 2021, NASEM collaborators agreed that chemical solvents impact human development: “Solvent exposure has been linked to changes in personality, motivation, and impulsivity (Condray et al. 2000; van Valen et al. 2012) and to higher rates of mood, anxiety, bipolar, and psychotic disorders (Aschengrau et al. 2012; Visser et al. 2011).” (2022 #10) NASEM’s multidisciplinary experts found that solvent chemicals used in cleaning products, degreasing products, pesticides, paints, adhesives, cosmetics, coatings, and ink can cause depression and despair in mice.  In humans, solvents can cause dysregulation of glial cells, demyelination of nerve fibers, ischemic damage, and necrosis in the brain’s white matter. (2022 #10)

Heavy Metals & learning deficits, ADHD, ASD

Metals like lead are easier to prove harmful perhaps because these neurotoxins have been used by industry for the longest amount of time so there is extensive documentation of the direct harm to human health.  Heavy metals also cause similar biological harm to lab mice as they do to humans. Even with proof of harm, legal restrictions on the public use of heavy metals are difficult to achieve because so many industries depend on them. NASEM experts found that metal neurotoxic chemicals found in mining, smelting, battery manufacturing and recycling, construction, automotive, and electronics can cause learning deficits and hyperactivity in mice. In humans, exposure to neurotoxic metals like lead can cause permanent damage to the central nervous system. (2022 #10) A 2021 study funded by the Research Council of Norway that involved scientists from Columbia University, the University of North Carolina at Chapel Hill and the Norwegian Institute of Public Health found that exposure to heavy metals like cadmium, lead, mercury, and arsenic while in-utero can change fetal biological development and increase the likelihood of both ADHD and Autism spectrum disorder in children. (2021, #33) A 2022 study of domestic air pollution at public housing projects in the U.S. found that children diagnosed with ADHD and hyperactivity had the highest levels of heavy metals – including lead, mercury, antimony, and bismuth – in their urine samples but scientists concluded that this “cross-sectional study could not determine the causality of lead and ADHD.” (2022, #34) In other words, even though the very presence of that much heavy metal in a child’s urine should be a public safety concern, the legal standard for proof of harm remains too high.

The reluctance of conservative politicians to reduce profits at all by reducing public exposure to neurotoxic pollution in air, water and soil raises concerns that a conservative-controlled US government will allow long-banned neurotoxins like lead to be used in products like gasoline.  Despite decades of scientific documentation about lead, the conservative Brookings Institute in 2017 made a case that it is not possible to know if lead is the true cause of developmental harm. This pro-industry circular logic – with the starting and ending point being industrial chemicals, if profitable, are inherently safe – may find its way into more laws moving forward if Congress acquires a majority of conservative seats in the future. Brookings’ expert, notably an associate professor of economics at Texas A&M University – not a doctor or scientist – Jennifer Doleac wrote: “It’s an intriguing idea — particularly since we don’t have a better explanation for the big changes in crime rates during this period. Several studies have found correlations between lead exposure and crime, at varying levels of geography (from neighborhoods to nations). But correlation, as we all know by now, does not imply causation.” (2017, #35) As an economic expert, Doleac ultimately recommends government funding of CDC-recommended interventions for young people exposed to lead as a public safety investment but only after she creates doubt about scientific conclusions regarding public health, a domain in which she is not an expert.

Air Pollution & ADHD, ASD, asthma, lung disease

Neurotoxic chemicals cause great harm in air pollution. NASEM experts found that  “…individual and mixtures of pollutants with neurotoxic properties such as perfluoro- and polyfluoroalkyl substances and outdoor air pollutants e.g., nitrogen oxides and particulate matter (de Prado-Bert et al. 2018), have been linked to risk of autism (Long et al. 2019), ADHD (Jorcano et al. 2019; Liew et al. 2015), depression, anxiety (Braithwaite et al. 2019), and schizophrenia (Newbury et al. 2019), and to elevations in risk of mental illness across diagnostic categories (Brokamp et al. 2019; Reuben et al. 2021).” (2022, #10)

Americans can gain insights about unlimited air pollution and human health by studying China, which has no environmental protection laws and is “currently facing severe air pollution from industrialization and urbanization. Less than 1% of the 500 largest cities in China meet air quality guidelines recommended by the World Health Organization. Seven cities in China have been ranked among the ten most polluted cities in the world.” (2016, #36) A 2016 study at the Department of Respiratory Medicine at Soochow University in China found that pollution in the form of fine particulate matter that is 2.5 microns or less in diameter can penetrate deeply into the lungs, irritate and corrode the alveolar wall, and consequently impair lung function (2016, #36) and lead to lung disease. In the United States, even with laws limiting air pollution, particulate matter is responsible for 63% of deaths from environmental causes, according to Harvard’s School of Public Health. (2022, #37) Unprecedented and dramatic fire seasons in the American West since 2017 have incinerated entire neighborhoods including cars and household appliances containing heavy metals and have given citizens across the socioeconomic spectrum a taste of PM2.5 exposure. These historic forest fires combined with the production of fossil fuels has made California the worse state in the nation for air quality according to the American Lung Association. A recent meta-analysis by Harvard’s School of Public Health found that air pollution is now also linked to a rise in autism if exposure occurs during pregnancy or early childhood. (2021, #18) The 2021 study found that “the risk of autism increased by 64% with exposure to 10 micrograms of PM 2.5 per cubic meter of air (mcg/m3) during early childhood and by 31% during prenatal periods. During the prenatal period, the greatest risk was found during the third trimester. The results also suggested that PM2.5 exposure could affect vulnerable populations even at low levels, below current regulations.” (2021, #18)

The American Lung Association (AMA) in its State of the Air report concluded that one in four Americans breathe polluted air, with communities of color being hardest hit by airborne neurotoxins. (2021, #38) The AMA’s report focuses on “two industrial air pollutants — both emitted by the burning of fossil fuels — that are dangerous to human health: fine particulate matter (or PM2.5, also known as soot) and ozone (also known as smog) … which can cause asthma, heart attacks, strokes, and lung cancer.” A 2020 national study in Denmark in collaboration with the University of Wisconsin-Milwaukee concluded that “residential air pollution exposure, specifically nitrogen dioxide, during early childhood is associated with the development of ADHD, even when adjusted for parental level of income and education.” (2020, #40) A 2022 study, funded by the Canadian Institutes of Health Research and conducted in collaboration with the Universities of California at Berkeley and Los Angeles, found that children in the Vancouver metro area living with high air pollution due to PM 2.5 particles and very low levels of green space had 62 percent increased risk of developing ADHD… Children living in greener, less polluted areas had 50 percent less risk of ADHD. (2022, #39).

In what is now considered a model of university-community collaboration, Columbia University’s Mailman School of Public Health worked with 10 community-based health and advocacy organizations in 2002 to track the rates of developmental and respiratory diseases in underserved, minority populations living in New York City's Washington Heights, Harlem, and the South Bronx. Columbia University’s analysis of personal air samples from 250 pregnant women from these low-income communities showed universally-detectable levels of one or more carcinogenic PAHs in air pollution, which can cause neurodevelopmental impairments, cancer and asthma. (2002, #41) A joint report by Columbia University and West Harlem Environmental Action, Inc., The Challenge of Preventing Environmentally Related Disease in Young Children, states the complexity of the problem when multiple toxins are present at the same time: “Blacks and Latinos in these neighborhoods represent high-risk groups for asthma, adverse birth outcomes, impaired development, and some types of cancer. The Columbia Center for Children's Environmental Health in Washington Heights uses molecular epidemiologic methods to study the health effects of urban indoor and outdoor air pollutants on children, prenatally and postnatally, in a cohort of over 500 African-American and Dominican (from the Dominican Republic) mothers and newborns. Extensive data are collected to determine exposures to particulate matter <2.5 micron in aerodynamic diameter (PM<2.5 microns), polycyclic aromatic hydrocarbons (PAHs), diesel exhaust paniculate (DEP), nitrogen oxide, nonpersistent pesticides, home allergens (dust mite, mouse, cockroach), environmental tobacco smoke (ETS), and lead and other metals. Biomarkers, air sampling, and clinical assessments are used to study the effects of these exposures on children's increased risk for allergic sensitization, asthma and other respiratory disorders, impairment of neurocognitive and behavioral development, and potential cancer risk.” (2002, #41) Inability to connect one specific toxin (cause) to one specific health problem (result) has put government clean-ups out of reach for these communities, an injustice suffered by the poor across the country for decades. However, we are now seeing a level of toxin exposure, and a historic rise in special needs, that is affecting even the wealthiest of American families.

 The impact on schools and prison populations

Our education system is not the only sector overwhelmed by this change in human development. Our prisons are now full of inmates with mental health and special education needs. An analysis of 42 studies of ADHD in incarcerated populations (youth and adult) published by Psychological Medicine found “a fivefold increase in prevalence of ADHD in youth prison populations (30.1%) and a 10-fold increase in adult prison populations (26.2%).” (2015, #45) That was a decade ago. A 2021 study of 1,708 incarcerated minors in Washington State found that “39.6% of the youth had diagnoses eligible for special education; over 42% of these youth had two or more qualifying diagnoses.” This study of minors was published by the Journal of Orthopsychiatry, a branch of psychiatry concerned with prevention of mental or behavioral disorders, with emphasis on child development and family life. Controlling for demographics, mental health, and self-regulation skills, this study concluded that “probation youth with special education needs, compared to the rest of the probation youth, were more likely to recidivate (return to prison multiple times).” (2021, #43) In the 2016 Survey of Prison Inmates, a national survey of adults incarcerated in U.S. state and federal prisons, 57.3% of inmates reported a psychiatric or learning disorder. A review of this data by the journal Psychiatric Services recommended the need for policies that increase participation in mental health and education services in the prison setting. (2024, #44)

Services for people who already have special needs is critical, but it can also be argued that regulating neurotoxic chemicals that increase the likelihood of human disabilities and impulsivity-related violence is also of utmost importance. Donald Trump found that out the hard way. It could be argued that the hand that fired a bullet at his ear was his own. Perhaps now, he and his ultra-conservative colleagues will listen to scientific evidence that warns against mixing unlimited guns with unlimited pollution.

Copyright © 2024 by Ellen McCarty. All rights reserved.

For this article, Ms. McCarty analyzed research and data from the following institutions (find numbered list of specific studies in References section below) in the USA: Harvard University, Columbia University, Princeton University, Icahn School of Medicine at Mount Sinai, Duke University, Northwestern University, Johns Hopkins University, Indiana University, Pennsylvania State University, University of Minnesota, Michigan State University, University of Wisconsin-Milwaukee, George Washington University, University of North Carolina at Chapel Hill, Wake Forest School of Medicine, Medical University of South Carolina, East Carolina University, Edward Via College of Osteopathic Medicine, University of Florida, Baylor College of Medicine, University of Texas at El Paso, Texas A&M University, University of Utah, University of Nevada, Arizona State University, University of Washington, University of Denver, University of California San Francisco, UCLA, UC Berkeley, UC Davis, Case Western Reserve University, Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Rutgers Robert Wood Johnson Medical School, University of Rochester School of Medicine and Dentistry, Brown University, University of Southern California, Children’s Hospital Los Angeles, State University of New York, Loyola Law School, Center for Disease Control (CDC), National Institutes of Health, National Institute of Environmental Health Sciences, Agency for Toxic Substances and Disease Registry, National Center for Environmental Health, Centers for Disease Control and Prevention, Union of Concerned Scientists, W.G. Hefner Veterans Affairs Medical Center, Economic Policy Institute, National Academies of Sciences, Engineering, and Medicine (NASEM), United States Government Accountability Office, Lundbeck, LLC, National Center for Biotechnology Information (NCBI), Heartland Health Research Alliance, Ltd., US Public Health Service, California Department of Toxic Substances Control, California Office of Environmental Health Hazard Assessment, Environmental and Occupational Health Sciences Institute, Center for Human Experimental Therapeutics, Brookings Institute, Environmental Systems Research Institute, The American Lung Association, National Association of Clean Air Agencies, Association of Air Pollution Control Agencies, United States Environmental Protection Agency (EPA), Vertex Pharmaceuticals, AMF Consulting, Inc., and Pacific Institute for Research and Evaluation; and in Europe: European Food Safety Authority (EFSA), Imperial College London (UK), Oxford (UK), King's College London (UK), Université Montpellier (France), University of Bordeaux (France), Université Versailles Saint-Quentin (France), University of Southern Denmark, Mental Health Services in the Region of Southern Denmark, Copenhagen University Hospital (Denmark), University of Copenhagen (Denmark), Odense University Hospital (Denmark), The Lundbeck Foundation Initiative for Integrative Psychiatric Research (Denmark), Aarhus University (Denmark), University of Oslo (Norway), Norwegian Institute of Public Health (Norway), Barcelona Biomedical Research Park (Spain); and in Canada: Université de Poitiers, University of British Columbia, Laboratoire de Physiologie Humaine, University of Montreal, Simon Fraser University, British Columbia Children’s Hospital; and in South Korea: Seoul National University College of Medicine, Inje University College of Medicine, Gachon University of Medicine and Science, Eulji University, Seoul National University College of Medicine and Institute of Environmental Medicine; and in China: Southern University of Science and Technology and Second Affiliated Hospital of Soochow University.

References

Citations Style note: To reduce public confusion about scientific studies, Ms. McCarty has amended APA Style for citations to include the complete list of experts and institutions involved in each scientific study. While more efficient, APA Style’s use of “et al.” and omission of the names of research institutions and all their experts in citations unfortunately makes a few rogue scientists at lesser-known institutions appear just as legitimate as larger groups of researchers collaborating across major universities and nationally-recognized institutions. Ms. McCarty’s decision to use unabridged reference listings is an effort to correct this public confusion about science. If the general public doesn’t understand scientific research and its conclusions, then science will have that much less impact on public policy and social change. If you’d like to share additional research with Ms. McCarty, please email her at mindfulyouth@comcast.net

#1  Experts: Soon-Beom Hong, Mee-Hyang Im, Jae-Won Kim, Eun-Jin Park, Min-Sup Shin, Boong-Nyun Kim, Hee‑Jeong Yoo, In-Hee Cho, Soo-Young Bhang, Yun-Chul Hong, and Soo-Churl Cho; Institutions: Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea; Department of Psychiatry, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Republic of Korea; Department of Psychiatry, Gangnam Eulji Hospital, Eulji University, Seoul, Republic of Korea; Department of Preventive Medicine, Seoul National University College of Medicine and Institute of Environmental Medicine, Seoul, Republic of Korea; March 2015; Environmental Lead Exposure and Attention Deficit/Hyperactivity Disorder Symptom Domains in a Community Sample of South Korean School-Age Children; Environmental Health Perspectives, volume 123 number 3. Available at http://dx.doi.org/10.1289/ehp.1307420

#2  Expert: Elise Gould, Institution: Economic Policy Institute, Washington, DC, USA; July 2009; Childhood Lead Poisoning: Conservative Estimates of the Social and Economic Benefits of Lead Hazard Control; Environmental Health Perspectives, volume 117 number 7. Available via http://dx.doi.org/

#3  Experts: Frederica P. Perera, Susan M. Illman, Patrick L. Kinney, Robin M. Whyatt, Eiizabeth A. Keivin, Peggy Shepard, David Evans, Mindy FuiiHove, Jean Ford, Ractiel L Miiier, Ilan H. Meyer, Virginia A. Rauh; Institutions: Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA; West Harlem Environmental Action, Inc., New York, New York, USA; February 2002; The Challenge of Preventing Environmentally Related Disease in Young Children: Community-Based Research in New York City; Environmental Health Perspectives, volume 110, number 2. Available at http://ehpnetI.niehs.nih.gOv/docs/2002/l 10pl97'204perera/abstract.html

#4  Journalist: Alex Cukan Source: UPI; Feb. 15, 2002; Domestic abuse and the nervous system; Albany, NY, USA. Available at https://www.upi.com/Science_News/2002/02/15/Domestic-abuse-and-the-nervous-system/68891013821928/

#5  Experts: James J. Feigenbaumy and Christopher Mullerz; Institutions: NSF-IGERT Multidisciplinary Program in Inequality & Social Policy at Harvard University (Grant No. 0333403) and the Robert Wood Johnson Foundation Health & Society Scholars program; March 22, 2016; Lead Exposure and Violent Crime in the Early Twentieth Century, Boston, Massachusetts, USA.

#6  Experts: Michael J. McFarland, Matt E. Hauer and Aaron Reuben; Institution: Office of Population Research, Princeton University, Princeton, NJ; March 2022; Half of US population exposed to adverse lead levels in early childhood, PNAS, National Academy of Science. Available at https://www.pnas.org/doi/full/10.1073/pnas.2118631119

#7  Experts: Marc Mesnil, Norah Defamie, Christian Naus and Denis Sarrouilhe; Institutions: Laboratoire STIM, ERL7003 CNRS-Université de Poitiers, Poitiers, France; Faculty of Medicine, Department of Cellular & Physiological Sciences, Life Sciences Institute, University of British Columbia, Vancouver, Canada; Laboratoire de Physiologie Humaine, Faculté de Médecine et Pharmacie, Poitiers, France; December 2020; Brain Disorders and Chemical Pollutants: A Gap Junction Link?; Biomolecules 2021, 11, 51. Available at https://doi.org/10.3390/biom11010051 and  https://www.mdpi.com/journal/biomolecules

#8  Journalist: Adrianna Rodriguez; Source: USA Today; March 2022; Americans born before 1996 may have a lower IQ from exposure to leaded gasoline, study finds. Here’s why. Available at https://www.usatoday.com/story/news/health/2022/03/07/lead-us-gas-cars-may-have-lowered-americans-iq-study-finds/9373062002/

#9  Journalist: Alex Knapp; Source: Forbes; December 2021; How Lead Caused America's Violent Crime Epidemic. Available at https://www.forbes.com/sites/alexknapp/2013/01/03/how-lead-caused-americas-violent-crime-epidemic/?sh=6f325d5712c4

#10  Experts: Aaron Reuben, Erika M. Manczak, Laura Y. Cabrera, Margarita Alegria, Meghan L. Bucher, Emily C. Freeman, Gary W. Miller, Gina M. Solomon and Melissa J. Perry; Institutions: Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA, Department of Psychology, University of Denver, Denver, Colorado, USA, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, USA, Departments of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA, Lundbeck, LLC, Deerfield, Illinois, USA, Department of Medicine, University of California San Francisco, San Francisco, CA, Public Health Institute, Oakland, CA, Department of Environmental and Occupational Health, George Washington University, Washington, District of Colombia, USA; February 2022; The Interplay of Environmental Exposures and Mental Health: Setting an Agenda; Environmental Health Perspectives, 130(2).  Available at https://doi.org/10.1289/EHP9889

#11  Experts: Philip J. Landrigan, William A. Suk and Robert W. Amier; Institutions: Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA, Division of Environmental Research and Training, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA; Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA; June 1999; Chemical Wastes, Children's Health, and the Superfund Basic Research Program; Environmental Health Perspectives, Volume 107, Number 6. 

#12  Writer: Karen Feldscher, HSPH Communications; Institutions: Harvard School of Public Health, National Institute of Health, National Institute for Environmental Health Sciences; February 2014; Toxic chemicals linked to brain disorders in children: Harvard study finds six newly recognized chemicals to add to list, The Harvard Gazette, Cambridge, Massachusetts, USA. Available at https://news.harvard.edu/gazette/story/2014/02/toxic-chemicals-linked-to-brain-disorders-in-children/

#13 Writer: Jaclyn Zubrzycki; Source: Education Week; Institutions: Northwestern University and the University of Florida; June 2016; Toxic Waste Takes a Toll on Children’s Behavior, Academics, Development. Available at https://www.edweek.org/leadership/toxic-waste-takes-a-toll-on-childrens-behavior-academics-development/2016/06

#14  Journalists: Robin Respaut and Reade Levinson; Source: Reuters Investigates; January 2019; A California Naval Base shutters and contamination lingers decades later. Available at https://www.reuters.com/investigates/special-report/usa-military-legacy/

#15  Writer: Paul Anderson, Public Affairs; Institution: United States Government Accountability Office; August 2007, Chemical Regulation: Comparison of U.S. and Recently Enacted European Union Approaches to Protect against the Risks of Toxic Chemicals, GAO Highlights of Report to Congressional Requestors. Available at https://www.gao.gov/assets/gao-07-825.pdf

#16  Journalist: Tom Perkins on EFSA Media Office Relations Office published opinion; Institution: European Food Safety Authority (EFSA); December 2021; Opinion on Bisphenol A: EFSA proposes lowering the tolerable daily intake. Available at https://www.efsa.europa.eu/en/news/bisphenol-efsa-draft-opinion-proposes-lowering-tolerable-daily-intake   News coverage, Feb 2022: Americans exposed to toxic BPA at levels far above what EU considers safe –  Petition urges FDA to strongly limit use of BPA, which is linked to cancer and other health problems; The Guardian. Available at https://www.theguardian.com/us-news/2022/feb/06/americans-exposed-toxic-bpa-fda-study

#17  Experts: James R Roberts, Erin Dawley, J Routt Reigart; Institution: Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA for the National Center for Biotechnology Information (NCBI); January 2019; Children's low-level pesticide exposure and associations with autism and ADHD: a review. Available at https://pubmed.ncbi.nlm.nih.gov/30337670/

#18  Experts: Cheng-Kuan Lin, Yuan-Ting Chang, Fu-Shiuan Lee, Szu-Ta Chen and David Christiani; Institutions: Harvard T.H. Chan School of Public Health; April/May 2021; Air pollution linked with increased risk of autism in children & Association between exposure to ambient particulate matters and risks of autism spectrum disorder in children: a systematic review and exposure-response meta-analysis; Environmental Research Letters, Boston, Mass. Overview and full study available at https://www.hsph.harvard.edu/news/hsph-in-the-news/air-pollution-linked-with-increased-risk-of-autism-in-children/#:~:text=Exposure and https://iopscience.iop.org/article/10.1088/1748-9326/abfcf7

#19  Institution: Center for Disease Control (CDC). Current year (2024); National ADHD statistics available at https://www.cdc.gov/adhd/data/ and archived CDC data  is available at https://archive.cdc.gov/#/results?q=adhd%20trends&start=0&rows=10 Women and ADHD statistics available at https://archive.cdc.gov/#/details?q=adhd%20trends&start=0&rows=10&url=https://www.cdc.gov/media/releases/2018/p0118-ADHD-prescriptions-increasing.html  National ASD statistics via CDC available at https://www.cdc.gov/autism/data-research/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/autism/data.html

#20  Expert: Elizabeth A. Laugeson; Institution: UCLA Semel Institute for Neuroscience and Human Behavior; 2014, The PEERS Curriculum for School-based Professionals: Social Skills Training for Adolescents with Autism spectrum disorders; Los Angeles, Calif.

#21  Experts: Yu-Han Chiu, Paige L. Williams, Lidia Mínguez-Alarcón, Matthew Gillman, Qi Sun, Maria Ospina, Antonia M. Calafat, Russ Hauser, Jorge E. Chavarro; Institutions: Departments of Nutrition, Epidemiology, Biostatistics and Environmental Health at Harvard T.H. Chan School of Public Health and Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Environmental Influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health, Rockville, Maryland; National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia and Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; January 2018; Comparison of questionnaire-based estimation of pesticide residue intake from fruits and vegetables with urinary concentrations of pesticide biomarkers, Journal of Exposure Science and Environmental Epidemiology. Available at http://www.nature.com/jes News coverage: https://www.thenation.com/article/archive/pesticides-farmworkers-agriculture/

#22  Experts: Marlaina S. Freisthler, C. Rebecca Robbins, Charles M. Benbrook, Heather A. Young, David M. Haas, Paul D. Winchester and Melissa J. Perry; Institutions: Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC; Heartland Health Research Alliance, Ltd., Brookfield, WI; Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN; Neonatology, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN; February 2022; Association between increasing agricultural use of 2,4-D and population biomarkers of exposure: findings from the National Health and Nutrition Examination Survey, 2001–2014; Environmental Health. Available at https://doi.org/10.1186/s12940-021-00815-x News coverage: https://www.theguardian.com/environment/2022/feb/09/toxic-herbicide-exposure-study-2-4-d

#23  Experts: Maryse F. Bouchard, David C. Bellinger, Robert O. Wright and Marc Weisskopf;   Institutions: Harvard School of Public Health, Boston, MA; Department of Environmental and Occupational Health, University of Montreal; Montreal, Canada; June 2010; Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides; Pediatrics 125 (6): e1270–e1277. Available at www.pediatrics.org/cgi/doi/10.1542/peds.2009-3058 and https://doi.org/10.1542/peds.2009-3058 News Coverage: https://www.reuters.com/article/us-adhd-pesticides/pesticides-tied-to-adhd-in-children-in-u-s-study-idUSTRE64G41R20100517

#24  Experts: William A. Arnold, Arlene Blum, Jennifer Branyan, Thomas A. Bruton, Courtney C. Carignan, Gino Cortopassi, Sandipan Datta, Jamie DeWitt, Anne Cooper-Doherty, Rolf U. Halden, Homero Harari, Erica M. Hartmann, Terry C. Hrubec, Shoba Iyer, Carol F. Kwiatkowski, Jonas LaPier, Dingsheng Li, Li Li, Jorge G. Muñiz Ortiz, Amina Salamova, Ted Schettler, Ryan P. Seguin, Anna Soehl, Rebecca Sutton, Libin Xu, Guomao Zheng; Institutions: Northwestern University, Evanston, Illinois; University of Minnesota, Minneapolis, Minnesota; Michigan State University, East Lansing, Michigan; ; Indiana University, Bloomington, Indiana; University of Nevada, Reno, Nevada; US Public Health Service, Rockville, Maryland; East Carolina University, Greenville, North Carolina; Edward Via College of Osteopathic Medicine, Blacksburg, Virginia; Arizona State University, Tempe, Arizona; University of Washington, Seattle, Washington; University of California, Davis, California; Minnesota; Green Science Policy Institute, University of California, Berkeley, California; California Department of Toxic Substances Control, Sacramento, California; Icahn School of Medicine at Mount Sinai, New York, New York; California Office of Environmental Health Hazard Assessment, Oakland, California; Science and Environmental Health Network, Bolinas, California; San Francisco Estuary Institute, Richmond, California; Southern University of Science and Technology, Shenzhen, Guangdong 518055, China; May 2023, Quaternary Ammonium Compounds: A Chemical Class of Emerging Concern; Environmental Science & Technology 2023, 57, 20, 7645–7665. Available at https://pubs.acs.org/doi/10.1021/acs.est.2c08244  News Coverage:  Common disinfectant wipes expose people to dangerous chemicals, research reveals https://www.theguardian.com/us-news/2023/may/11/concern-over-increase-in-disinfectant-wipes-linked-to-health-problems

#25  Source: The Chlorox Company 2021 Annual Report, available here: https://s21.q4cdn.com/507168367/files/doc_financials/2021/ar/Clorox-2021-Integrated-Annual-Report.pdf

#26  Experts: Erin F. Cohn, Benjamin, L. L. Clayton, Mayur Madhavan, Kristin A. Lee, Sara Yacoub, Yuriy Fedorov, Marissa A. Scavuzzo, Katie Paul Friedman, Timothy J. Shafer & Paul J. Tesar Institution: Case Western Reserve University, Cleveland, Ohio; May 2024; Pervasive environmental chemicals impair oligodendrocyte development; Nature Neuroscience 27, 836–845. Available at https://doi.org/10.1038/s41593-024-01599-2  News coverage: Common household chemicals pose new threat to brain health, study finds https://www.sciencedaily.com/releases/2024/03/240325135708.htm

#27  Experts: Philippe Grandjean, Philip J Landrigan; Institution: Harvard School of Public Health in Boston, Massachusetts; Icahn School of Medicine at Mount Sinai in New York City; March 2014; Neurobehavioural effects of developmental toxicity; The Lancet Neurology Volume 13, Issue 3, p. 330-338. Available at  https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70278-3/fulltext & https://doi.org/10.1016/S1474-4422(13)70278-3  News coverage: Researchers warn of chemical impacts on children https://www.usatoday.com/story/news/nation/2014/02/14/chemicals-adhd-autism/5494649/

#28  Experts: Erika L. Sabbath, ScD, Laure-Anne Gutierrez, Cassandra A. Okechukwu, Archana Singh-Manoux, Hélène Amieva, Marcel Goldberg, Marie Zins, and Claudine Berr Institutions: Harvard Center for Population and Development Studies, Cambridge, Massachusetts; Neuropsychiatrie: recherche épidemiologique et clinique, Université Montpellier I, Hôpital La Colombière, France; Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts; Centre for Research in Epidemiology and Population Health and Department of Psychology, University of Bordeaux, Bordeaux, France; Population-based Cohort Platform, Epidemiology and Public Health Research Center, Université Versailles Saint-Quentin, Montpellier, France; May 2014; Time may not fully attenuate solvent-associated cognitive deficits in highly exposed workers; Neurology 82 (19) 1716-1723. Available here: https://doi.org/10.1212/WNL.0000000000000413 &  https://www.neurology.org/doi/abs/10.1212/wnl.0000000000000413?sid=3124a737-55dd-4e52-b5fb-a05fc9024488

#29  Expert: Laborers’ Health and Safety Fund of North America, Washington, DC; Institution: National Institute of Environmental Health Sciences; current year (2024); Solvents Pose Long-Term Cognitive Hazards; Washington, DC. Available at https://lhsfna.org/solvents-pose-long-term-cognitive-hazards/

#30  Experts: Robin A. Hurley, Katherine H. Taber; Institutions: Veterans Affairs Mid Atlantic Mental Illness Research, Education and Clinical Center, and the Research and Education Service Line at the W.G. Hefner Veterans Affairs Medical Center, Salisbury, North Carolina; Depts. of Psychiatry and Radiology at Wake Forest School of Medicine, Winston-Salem, North Carolina; Menninger Dept. of Psychiatry and Behavioral Sciences and the Dept. of Physical Medicine and Rehabilitation at Baylor College of Medicine, Houston, Texas; Division of Biomedical Sciences at the Edward Via College of Osteopathic Medicine, Blacksburg, Virginia; January 2015; Occupational Exposure to Solvents: Neuropsychiatric and Imaging Features; The Journal of Neuropsychiatry and Clinical Neurosciences Volume 27, Number 1. Available at https://doi.org/10.1176/appi.neuropsych.270101

#31  Experts: Julie Bang Hansen, Niels Bilenberg, Clara Amalie Gade Timmermann, Richard Christian Jensen, Hanne Frederiksen, Anna-Maria Andersson, Henriette Boye Kyhl and Tina Kold Jensen;  Institutions: Department of Clinical Research and Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark; Department of Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark; Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark; OPEN Patient data Explorative Network (OPEN), Odense, Denmark; March 2021; Prenatal exposure to bisphenol A [BPA] and autistic- and ADHD-related symptoms in children aged 2 and 5 years from the Odense Child Cohort; Environmental Health 20:24. Available at https://doi.org/10.1186/s12940-021-00709-y

#32 Experts: Melissa Wagner-Schuman, Jeffery N. Epstein, Kimberly Yolton, Tanya E. Froehlich, Jason R. Richardson, Peggy Auinger, Joseph M. Braun, Bruce P. Lanphear, Jason R. Richardson, Bruce P. Lanphear, Kimberly Yolton, Tanya E. Froehlich, Jeffery N. Epstein; Institutions: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Rutgers Robert Wood Johnson Medical School and Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey; University of Rochester School of Medicine and Dentistry, Rochester, New York; Brown University School of Public Health, Providence, Rhode Island; Simon Fraser University, Vancouver, British Columbia, Canada; Department of Environmental and Occupational Medicine, Piscataway, New Jersey; Department of Neurology, Center for Human Experimental Therapeutics, Rochester, NY; Child & Family Research Institute, BC Children’s Hospital, Vancouver, British Columbia, Canada; Division of General and Community Pediatrics, Cincinnati, Ohio; Division of Developmental and Behavioral Pediatrics, Cincinnati, Ohio; Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio; May 2015; Association of pyrethroid pesticide exposure with attention-deficit/hyperactivity disorder in a nationally representative sample of U.S. children; Environmental Health 14, 44. Available at https://doi.org/10.1186/s12940-015-0030-y and https://ehjournal.biomedcentral.com/articles/10.1186/s12940-015-0030-y  News coverage: https://www.sciencedaily.com/releases/2015/06/150601122535.htm

#33  Experts: Thea S. Skogheim, Kjell Vegard F. Weyde, Stephanie M. Engel, Heidi Aase, Pål Surén, Merete G. Øie, Guido Biele, Ted Reichborn-Kjennerud, Ida H. Caspersen, Mady Hornig, Line S. Haug, Gro D. Villanger; Institutions: Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Psychology, University of Oslo, Oslo, Norway; Division of Mental and Physical Health and Centre for Fertility and Health and Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; July 2021; Metal and essential element concentrations during pregnancy and associations with autism spectrum disorder and attention-deficit/hyperactivity disorder in children; Environment International Volume 152. Available at https://doi.org/10.1016/j.envint.2021.106468  News coverage: ADHD and Autism Associated With In-Utero Heavy Metals and Essential Minerals https://neurosciencenews.com/asd-adhd-heavy-metals-18207/

#34  Experts: Jayajit Chakraborty, Timothy W. Collins, Sara E. Grineski & Jacob J. Aun Institutions: Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, Texas; Department of Geography and Department of Sociology, University of Utah, Salt Lake City, Utah; June 2022; Air pollution exposure disparities in US public housing developments; Scientific Reports 12, 9887. Available at https://doi.org/10.1038/s41598-022-13942-3 and https://www.nature.com/articles/s41598-022-13942-3

#35  Expert: Jennifer Doleac; Institution: Associate Professor of Economics at Texas A&M University, College Station, Texas; Brookings Institute, Washington, DC; June 2017; New evidence that lead exposure increases crime; Washington, DC. Available at https://www.brookings.edu/articles/new-evidence-that-lead-exposure-increases-crime/

#36  Experts: Yu-Fei Xing, Yue-Hua Xu, Min-Hua Shi, Yi-Xin Lian; Institution: Department of Respiratory Medicine, Second Affiliated Hospital of Soochow University, Suzhou, China; January 2016; The impact of PM2.5 on the human respiratory system; Journal of Thoracic Disease 8(1):E69-E74. Available at https://jtd.amegroups.org/article/view/6353/6196

#37  Experts: Abdulrahman Jbaily , Xiaodan Zhou, Jie Liu, Ting-Hwan Lee, Leila Kamareddine, Stéphane Verguet & Francesca Dominici; Institutions: Departments of Global Health and Population and Biostatistics and Global Health and Population at Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Harvard Data Science Initiative, Cambridge, Massachusetts; Environmental Systems Research Institute, Redlands, California; January 2022;  Air pollution exposure disparities across US population and income groups; Nature 601, pages 228–233. Available at https://www.nature.com/articles/s41586-021-04190-y

#38  Experts: Allen S Lefohn and John Balmes; Institutions: The American Lung Association; National Association of Clean Air Agencies, Association of Air Pollution Control Agencies; State of the Air 2021. Available at https://www.lung.org/getmedia/17c6cb6c-8a38-42a7-a3b0-6744011da370/sota-2021.pdf News coverage: 4 in 10 Americans breathe polluted air, with people of color hit hardest https://grist.org/health/air-pollution-communities-of-color-american-lung-association/

#39  Experts: Weiran Yuchi , Michael Brauer, Agatha Czekajlo, Hugh W. Davies, Zoë Davis, Martin Guhn, Ingrid Jarvis, Michael Jerrett, Lorien Nesbitt, Tim F. Oberlander, Hind Sbihi, Jason Su, Matilda van den Bosch; Institutions: School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Forest Resource Management and Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, Vancouver, Canada; Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California; School of Public Health, University of California at Berkeley, Berkeley, California; ISGlobal, Barcelona Institute for Global Health - Campus MAR Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; March 2022; Neighborhood environmental exposures and incidence of attention deficit/hyperactivity: A population-based cohort study; Environment International Volume 161 107120. Available at https://doi.org/10.1016/j.envint.2022.107120

#40  Experts: Malene Thygesen, Gitte Juel Holst, Birgitte Hansen, Camilla Geels, Amy Kalkbrenner, Diana Schendel, Jørgen Brandt, Carsten Bøcker Pedersen, Søren Dalsgaard; Institutions: Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus and Copenhagen, Denmark; Department of Public Health, Environment, Occupation and Health and Department of Public Health and Epidemiology, and Department of Environmental Science and Big Data Centre for Environment and Health, BERTHA and Centre for Integrated Register Based Research, CIRRAU, Aarhus University, Aarhus, Denmark; Geological Survey of Denmark and Greenland, GEUS, Denmark; April 2020; Exposure to air pollution in early childhood and the association with Attention-Deficit Hyperactivity Disorder; Environmental Research Volume 183, 108930. Available at https://www.sciencedirect.com/science/article/abs/pii/S0013935119307273?via%3Dihub

#41  Experts: Frederica P. Perera, Susan M. iilman, Patrick L. Kinney, Robin M. Whyatt, Eiizabeth A. Keivin,Peggy Shepard, David Evans, Mindy FuiiHove, Jean Ford, Ractiel L Miiier/ ilan H. Meyer, and Virginia A. Rauh; Institutions: Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York; West Harlem Environmental Action, Inc., New York, New York; Funded in part by the National institute of Environmental Health Sciences, Research Triangle Park, North Carolina and other grants;  February 2002; The Challenge of Preventing Environmentally Related Disease in Young Children: Community-Based Research in New York City; Environmental Health Perspectives Children’s Health Review Volume 110 Number 2. Available at https://ehp.niehs.nih.gov/doi/10.1289/ehp.02110197

#42 Source: United States Environmental Protection Agency; current year (2024); Overview of Endocrine Disruption. Available at https://www.epa.gov/endocrine-disruption/overview-endocrine-disruption#:~:text=Effects%20of%20Endocrine%20Disruption,-In%20the%20last&text=developmental%20malformations%3B,immune%20and%20nervous%20system%20function

#43  Experts: Bo-Kyung Elizabeth Kim, Jennifer Johnson, Laura Rhinehart, Patricia Logan-Greene, Jeanette Lomeli and Paula S. Nurius; Institutions: USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California; Department of Pediatrics, Children’s Hospital Los Angeles; Department of Education, University of California, Los Angeles; School of Social Work, State University of New York at Buffalo, New York; Center for Juvenile Law and Policy, Loyola Law School, Los Angeles, California; School of Social Work, University of Washington, Seattle, Washington; 2021; The school-to-prison pipeline for probation youth with special education needs; American Journal of Orthopsychiatry, 91(3), 375–385. Available at:  https://doi.org/10.1037/ort0000538

#44  Experts: Brandy F. Henry and Joy Gray; Institutions: Department of Educational Psychology, Counseling, and Special Education, College of Education, and Consortium on Substance Use and Addiction, Social Science Research Institute, Pennsylvania State University, University Park, Pennsylvania; May 2024; Access to Psychiatric and Education Services During Incarceration in the United States; Psychiatric Services. Available at https://doi.org/10.1176/appi.ps.20230335 and https://psychiatryonline.org/doi/10.1176/appi.ps.20230335 Bureau of Justice Statistics: https://bjs.ojp.gov/library/publications/disabilities-reported-prisoners-survey-prison-inmates-2016

#45  Experts: S. Young, D. Moss, O. Sedgwick, M. Fridman and P. Hodgkins Institutions: Global HEOR, Vertex Pharmaceuticals, Boston, Massachusetts; AMF Consulting, Inc., Los Angeles, California; Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Broadmoor Hospital, West London Mental Health Trust, London, UK; Caudex Medical, Oxford, UK; Department of Psychology, Institute of Psychiatry, King's College London, UK; January 2015; A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations; Psychological Medicine, Volume 45, Issue 2. Available at https://doi.org/10.1017/S0033291714000762 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301200/

#46  Source: Center for Gun Violence Solutions, Bloomberg School of Public Health, Johns Hopkins University and Center for Disease Control (CDC data from 2022); 2023; Firearm Violence in the United States; Available at https://publichealth.jhu.edu/center-for-gun-violence-solutions/research-reports/firearm-violence-in-the-united-states

#47 Experts:  Kathryn Schnippel, Sarah Burd-Sharps, Ted R Miller, Bruce A Lawrence, David L Swedler; Institutions: Everytown for Gun Safety Support Fund, New York, New York; Pacific Institute for Research and Evaluation, Calverton, Maryland; May 2021; Nonfatal firearm injuries by intent in the United States: 2016-2018 Hospital Discharge Records from the Healthcare Cost and Utilization Project; Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. (3):462-470. Available at https://pubmed.ncbi.nlm.nih.gov/34125015/ and 10.5811/westjem.2021.3.51925  

#48  Expert: Derrick Z. Jackson, Fellow; Institution: Union of Concerned Scientists; March 2024; The US Supreme Court is Operating Like a Rogue EPA; https://blog.ucsusa.org/derrick-jackson/the-us-supreme-court-is-operating-like-a-rogue-epa/  News coverage: https://www.nytimes.com/2024/06/29/climate/supreme-court-epa.html

#49  Journalist: Jill Tucker; Source: SF Gate; October 2017; Lead contamination found in water at 7 Oakland schools. Available at https://www.sfgate.com/bayarea/article/Lead-contamination-found-in-water-at-7-Oakland-12310183.php Government responses: https://www.ousd.org/community/health-concerns-in-our-communities/water-quality-in-ousd#:~:text=Overview,buildings%20is%2057%20years%20old

As of 2023, President Biden has authorized national funds for the removal of all lead pipes carrying drinking water to cities. https://www.whitehouse.gov/briefing-room/statements-releases/2023/11/30/fact-sheet-biden-harris-administration-announces-new-action-to-protect-communities-from-lead-exposure/