Home, School, and Work Settings

The quality of their housing influences children’s health. Housing conditions can contribute to the incidence of asthma, injuries, and lead poisoning (Manuel, 1999). As children age, they spend more time in physical locations outside the home, such as child care, school, and workplace settings that expose them to new physical environments. Thus, parents’ choice of child care facility may affect both indoor and outdoor (e.g., playgrounds, backyards) exposures. For example, child care exposure to cigarette smoke may differ from exposure in children’s own homes (Wright et al., 1989).

School-age children spend 35 to 50 hours per week in and around school buildings. In some communities, schools have been built on relatively undesirable land, such as landfill sites like Love Canal. Schools are often located on old industrial sites or near highways, resulting in exposure to auto emissions and air pollution (Frumkin, 2003). Many school buildings are old and poorly maintained, leading to exposures to air pollutants, radon, asbestos, pesticides, and lead (Etzel and Balk, 1999). The U.S. General Accounting Office reported that 20 percent of primary and secondary schools had indoor air quality problems; more than half had environmental pollutant or building ventilation problems that could affect air quality (U.S. General Accounting Office, 1995). Radon above the EPA’s action level was found in 2.7 percent of schools surveyed during the 1990–1991 school year (U.S. Environmental Protection Agency, 1992). Asbestos, used extensively in schools until the 1970s, was still present in more than 8,500 schools in 1980, potentially exposing over 3 million students (U.S. Environmental Protection Agency, 1987).

Many adolescents have jobs that may expose them to occupational hazards (Pollack et al., 1990). Every year, at least 70 children die from work-related incidents (Centers for Disease Control and Prevention, 1996) and more than 65,000 are injured severely enough to seek care in emergency departments (Brooks et al., 1993). Under the Fair Labor Standards Act of 1938, which regulates work hours and safety, children younger than 18 are prohibited from working with hazardous chemicals in nonagricultural jobs. Prohibitions on chemical work in agriculture extend only to age 16, and work by children and adolescents on their own family farms is unregulated at the national level. During 1992–1995, 155 deaths were reported among agricultural workers age 19 and younger; 64 (41 percent) of these youths were working in their family’s business (Derstine, 1996). For each death, many more experience nonfatal injury (Rivara and Barber, 1985), usually from farm machinery or exposure to toxins.

Child Injury and the Provision of Safe Environments

Injuries are the leading cause of death among children between ages 1 and 19, accounting for more deaths than homicide, suicide, congenital anomalies, cancer, heart disease, respiratory illness, and HIV combined (Centers for Disease Con-

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