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HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2025 33 222 Sylvie Avallone et al., “School Meals Case Study: France,” School Meals Coalition (2023), https://www.schoolmealscoalition.org/sites/default/files/2024-05/Avallone_ etal_2023_School_Meals_Case_Study_France_.pdf. 223 International Confederation of Dietetic Associations. (n.d.). National School Lunch Program (Japan). Sustainability Case Studies. Retrieved May 5, 2025, from https:// icdasustainability.org/case-study/national-school-lunch-program/. 224 Food and Agriculture Organization of the United Nations. (n.d.). Sweden: School food. Retrieved May 5, 2025, from https://www.fao.org/platforms/school-food/ around-the-world/europe-and-central-asia/sweden/en. 225 Food and Agriculture Organization of the United Nations. (n.d.). Finland: School food. Retrieved May 5, 2025, from https://www.fao.org/platforms/school-food/ around-the-world/europe-and-central-asia/finland/en. 226 U.S. Department of Agriculture, Food and Nutrition Service. 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ACE environments and contaminants https://www.epa.gov/americaschildrenenvironment/ace-environments-and- findings that showminimal, if any, risk, this still demonstrates the need for continued studies from the public and private sectors, especially the NIH, to better understand the cumulative load of multiple exposures and how it may impact children’s health, including exposures from: • PFAS: a large group of more than 12,000 distinct synthetic chemicals widely used for water-, oil-, and stain-resistance in products, such as nonstick cookware, food packaging, textiles, cosmetics, and firefighting foam. 275 According to a recent review by the National Academies of Sciences, Engineering andMedicine , 276 high levels of certain types of PFAS exposure has been associated with a variety of health effects, including immune suppression and, changes in cholesterol in children. Announced in May 2025, EPA will implement national enforceable drinking water standards for two PFAS compounds in drinking water and consider regulatory determinations for another four PFAS compounds, in line with a new agency-wide strategy. • Microplastics: plastic fragments less than 5 millimeters in size used frequently in products such as clothing, medicine, and shower gels. 277 One single-site study in 2025 showed that the concentration found inAmericans’ brain tissue increased by 50% between 2016 and 2024. 278 Some studies have additionally found that microplastics often carry endocrine-disrupting chemicals that interfere with hormonal development and potentially trigger early puberty— especially in girls—and heighten the risks of obesity, infertility, and hormone-related cancers. 279 280 281 • Fluoride: an inorganic salt first added to water in 1945 to combat cavities. 282 By 2022, over 60% of Americans—more than 70% of those on CommunityWater Systems—were consuming fluoridated water. 283 A2025 systematic review published in JAMAPediatrics , analyz- ing 74 high- quality studies, found a statistically significant association between exposure to fluoride above recommended levels and reduced IQ levels in children. 284 EPA is currently conducting a review of additional research that will inform any potential revisions to the federal drinking water standard. 285 • Electromagnetic Radiation (EMR): an exposure due to the proliferation of cell phones, 286 Wi- Fi routers, cell towers, and wearables). 287 Some studies have linked EMR exposure to reduced sperm counts and motility but not quality. 288 The NIH’s National Toxicology Pro- gram identified “clear evidence” of DNA damage and increased cancer risk in rats. 289 However, a recent systematic review of over 50 studies found low to inadequate evidence on impact in children and called for more high-quality research. 290 • Phthalates: used primarily to make plastics more flexible, durable, and long-lasting, are found in vinyl flooring, food packaging, dust, personal care products, medical devices, and synthetic fabrics. Research shows continuous exposure to certain phthalates can trig- ger hormone dysregulation and reproductive and developmental problems for babies in-utero and infants. 291 The FDAhas restricted the use of several phthalates in food packaging and industry has discontinued use over time. 292 • Bisphenols: a group of industrial chemicals primarily used to manufacture polycarbonate plastics and epoxy resins are found in con- sumer goods such as food and beverage containers. 293 Some studies have shown bisphenols to be endocrine-disrupting 294 by mimick- ing estrogen and interfering with hormone signaling and the reproductive system in animals and humans. 295296 Public concern about safety has resulted in a use ban for some products. 297 298 • Crop Protection Tools: including pesticides, herbicides, and insecticides. Some studies have raised concerns about possible links between some of these products and adverse health outcomes, especially in children, but human studies are limited. 299 300 301 For example, a selection of research studies on a herbicide (glyphosate) have noted a range of possible health effects, ranging from reproductive and developmental disorders as well as cancers, liver inflammation and metabolic disturbances. 302 303 304 305 In experimental animal and wildlife studies, exposure to another herbicide (atrazine) can cause endocrine disruption and birth defects. 306 Common expo- sures include lawn care, farming, and pesticide residues; however, a large-scale FDA study of pesticide residues (2009-2017) found