Running head: PREVENTION OF EXPOSURE TO ENVIRONMENTAL CHEMICALS
Prevention of Exposure to Environmental Chemicals in Children
Nadzeya Lazarev, RN
NUR 4114: Comprehensive Client Care for Urban Health Issues
Professor Kevin McGirr
December 14, 2012
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Prevention of Exposure to Environmental Chemicals in Children
Introduction
While public health initiatives have made great strides in reducing the rates of preventable
diseases -- such as smallpox, polio, and measles -- today’s children are at risk of 21st century
epidemics, like asthma, cancer, attention deficit hyperactivity disorder (ADHD), diabetes, and
obesity, which are on the rise in our society. One of every 88 U.S. children is affected by autism.
Both childhood asthma and childhood obesity have tripled over the past three decades. Rates of
childhood leukemia, brain cancer and other childhood cancers have increased by more than 20%
since 1975 (Safer Chemicals, Healthy Families Coalition, 2012). Researchers have demonstrated that
incidence of these diseases in children is directly linked to exposure to environmental chemicals,
such as lead, asbestos, radon, solvents, polychlorinated biphenyls (PCBs), pesticides, etc.
Over 80,000 new chemicals have been invented over the past 50 years and are found in our
everyday products (Landrigan, 2009). Since 1999, the Centers for Disease Control and Prevention
(CDC) have been assessing the levels of synthetic chemicals in the blood and urine of the U.S.
population. The findings have demonstrated that nearly all Americans, including newborns, are
contaminated with more than 200 household and industrial chemicals and pesticides, which can
accumulate in our bodies (“Contaminated without Consent”, 2007). Recent research in pediatrics and
developmental toxicology has developed the notion of “windows of vulnerability” that are critical
periods in early development when exposures to even minute doses of toxic chemicals -- levels that
would have no adverse effect on adults -- can disturb organ development and cause permanent
functional impairments in children (Landrigan & Goldman, 2011). Therefore, eliminating exposure
to environmental chemicals in children remains a goal of greatest importance to public health.
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The impact of environmental chemicals on children
Children are uniquely vulnerable to toxic chemicals in the environment. In comparison with
adults, children have greater exposures to toxic chemicals for their body weight. Since children drink
more water per pound, take in three to four times more calories per pound and have more air intake
per pound than adults, they are disproportionately exposed to toxic chemicals in air, food, and water.
Children’s hand-to-mouth behavior and play on the ground further amplify their exposures.
Moreover, due to immature metabolic pathways, children are not able to effectively metabolize and
eliminate toxic chemicals (Landrigan & Goldman, 2011).
The development of children’s brain and nervous system progresses over a long period -from the first trimester in pregnancy through adolescence. The brain consists of billions of highly
integrated sets of neural circuits that are interacting under the influences of genetics, environment,
and experience. While genes determine when neural circuits are formed, children’s environment and
experiences shape how that formation reveals. Thus, being a part of the environment, toxic
chemicals are guiding and disrupting early developmental processes of the brain and nervous system.
Unfortunately, most of environmental chemicals have not undergone even minimal
assessment for potential toxicity, but those chemicals which have been screened for toxic effects
disrupt early human development and cause diseases in children. For instance, if cells in an infant’s
brain are exposed to lead or a pesticide, the child can suffer the consequences of developmental
disabilities in childhood and neurological degeneration, such as Parkinson’s disease, in late
adulthood. If developing reproductive organs of a child receive inappropriate hormonal signals sent
by a synthetic chemical endocrine disruptor -- such as certain chemicals commonly found in
household products, plastics, and cosmetics (phthalates), and on clothing (flame retardants) -- the
child may experience a lifelong reproductive impairment (Landrigan & Goldman, 2011).
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Challenges
The absence of sufficient research-based evidence about the possible risks associated with
children’s exposure to untested synthetic chemicals makes government officials overlook this
worrisome public health issue. While the majority of chemicals are still not tested, dysfunctions may
go unacknowledged for many years as happened with childhood lead poisoning that had been a
silent epidemic for many decades before sufficient evidence about toxic effects on brain
development was collected to mandate the removal of lead from gasoline, most kinds of paint, and
other products.
Failure to assess chemicals for possible toxicity mirrors the failure of the Toxic Substances
Control Act of 1976 that has not carried out its intentions in requiring testing already on commerce
and new chemicals. Making a flagrant mistake, Congress supposed that 62,000 already on commerce
chemicals were safe and allowed to remain in commerce without any toxicity testing requirement,
unless the Environmental Protection Agency (EPA) gave evidence that those chemicals posed an
“unreasonable risk” (Goldman, 2002). The standard of the “unreasonable risk” has placed a
considerable barrier for the EPA to regulate industrial and consumer chemicals making the removal
of toxic chemicals from the market almost impossible. As a result, only five chemicals, namely,
PCBs, chlorofluorocarbons, dioxin, asbestos, and hexavalent chromium, have been controlled under
the act in 35 years since its passage and only PCBs and asbestos were completely banned.
Advocates from environmental and children's health groups indicate that there is limited
public access to federal agencies which may address the issue of environmental hazards to children's
health. Members of affected communities cannot express their concerns about exposure to toxic
chemicals to federal officials via an established and centralized mechanism. While developing
policies for children, federal officials do not consider children’s unique environments and numerous
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routes of exposure to toxic chemicals; rather they see children as little adults. In addition, federal
officials fail to distinguish the unfavorable health effects of exposure to toxic chemicals between
children in wealthy and low-income communities, and also fail to distinguish the dissimilar cultural
factors among diverse ethnic groups (Widess, Herne, & Falcon, 2010).
Review of literature
Over the past three decades, scientists and medical experts have become more and more
worried about the negative effects of environmental chemicals on children both before and after
birth. The pioneering study by the Environmental Working Group in collaboration with
Commonweal was conducted to screen ten newborn babies, randomly selected by the Red Cross
from U.S. hospitals, for 413 industrial chemicals, pollutants and pesticides (Houlihan, Kropp, Wiles,
Gray, & Campbell, 2005). The researches stated that all those ten infants were born contaminated
since 287 chemicals, pesticides, and pollutants were discovered in the blood samples of their
umbilical cords. The researchers have broken the past belief of scientists that the placenta protected a
developing baby from most environmental chemicals and pollutants by bringing up the evidence that
the umbilical cord carries chemicals which are toxic to the brain and nervous system and cause
cancer in humans or animals and birth defects in animal tests. The researchers also noted that
exposure to such a complex mixture of chemicals have never been tested for its dangers on
children’s development.
Recently, some researchers have deviated from the standard testing of a single chemical and
studied the adverse effects of a combination of a few chemicals on children, trying to reflect some
kind of reality in terms of exposure to multiple chemicals. Henn et al. (2012) decided to examine
interactive effects of manganese and lead which are both known for their neurotoxic effects on
children. The researchers enrolled 455 children at birth and followed them until 36 months of age.
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The researchers found out that joint exposure to manganese and lead in early childhood was
associated with more severe mental and psychomotor development deficiencies than expected based
on effects of exposure to each metal alone. Henn et al. provided evidence that synergism between
lead and manganese exists, and increased lead toxicity among children is associated with high
manganese co-exposure. The researchers highlighted “the importance of understanding health effects
of mixed exposures, particularly during potentially sensitive developmental stages such as early
childhood” (Henn et al., 2012, p. 131).
Researchers have raised their concerns about the neurodevelopment effects of even low-level
exposure to environmental chemicals in children. While researchers are gradually increasing their
studies to evaluate exposure levels of many other chemicals that were previously considered to be
without adverse effects in small doses, lead has received the most attention. Recent studies showed
that there is no safe level of lead exposure since low-level long-term exposure to lead is associated
with deficits in the neurobehavioral-cognitive performance manifested from childhood through
adolescence (Olympio, Gonqalves, Gfinther, & Bechara, 2009).
Philip J. Landrigan, MD, MSc, who is known for over four decades of research in children’s
environmental health, discusses the costs associated with exposure of children to toxic chemicals
(Landrigan, 2012). While direct costs consist of medical expenses for persons made ill by toxic
exposures, indirect costs include time lost from school or work, costs of rehabilitation and costs of
special education as well as decreased economic productivity in persons whose brains, lungs or other
organ systems are permanently damaged by toxic exposures. Economic costs of pediatric diseases,
such as lead poisoning, prenatal methyl mercury exposure, childhood cancer, asthma, intellectual
disability, autism, and attention deficit hyperactivity disorder, caused by harmful exposures in the
environment were estimated to be $76.6 billion in 2011. “The single largest component of these
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costs was the diminished lifelong economic productivity that resulted from permanent reduction in
cognitive capability (IQ score) in children exposed to neurotoxic chemicals, such as lead, in early
life” (Landrigan, 2012, p. 286). The information on the costs of children’s disease caused by
environmental contamination is significantly important and worth developing since it can direct to
major policy changes, prevent loss of billions of dollars and enhance the lives of generations.
Potential interventions
The program designed to protect farm workers’ children of the lower Yakima Valley was a
successful approach to reduce children’s exposure to environmental contaminants, such as
pesticides. The program utilized effective community-based education activities that had been
identified in a five-year randomized controlled trial conducted in the Yakima Valley Children by the
University of Washington’s Center for Child Environmental Health Risks Research. Trained staff of
the program provided education materials for farm workers and their family members, including
children, with simple, culturally-appropriate messages, and also involved the residents in simulation
activities in order to teach them how to protect themselves from pesticide exposure and break the
take-home pathway.
To reach as many residents as possible, the staff provided an array of education activities in
various settings. Educational information was given at health fairs, community festivals, and block
parties, and presentations were arranged at church events and worksites, including orchards and
farms. A pesticide puppet show, developed by the University of Washington, was presented at block
parties and festivals. At elementary schools, discussions with parents and school personnel were held
regularly to encourage activities that protect pesticide exposure. The discussions included such
messages and recommendations as:
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Wash hands frequently with soap and water; wash children’s hands and toys frequently;
drink 6-8 glasses of water a day; always wash fruits and vegetables before eating; clean
home, car, and pets regularly; wear appropriate protective work clothes; do not enter recently
sprayed fields; remove boots and hats before entering home; shower and put on clean clothes
immediately after returning home from work; wash work clothes after one wearing and
separately from other family laundry; when picking up children from daycare directly after
work, use a clean blanket or towel to carry them; do not let children play in fields or swim in
irrigation ditches; use and store pesticides safely; use pesticide alternatives in the home and
garden; and protect against sprays drifting into the yard. (Thompson, 2006, p. 7)
The same and similar messages about protecting against pesticide exposure were also
integrated in the courses of English as a Second Language, citizenship classes, and preschools
classes. In addition, health educators gave 30-45 minute discussions about a specific pesticide topic
in home health parties where friends and relatives gathered together. The health educators also
talked about the significance of protecting one’s family -- especially children due to their
vulnerability -- from pesticide exposure. Finally, staff of the program reached the farm workers in a
door-to-door way as well as spoke with them at grocery stores and other places where the farm
workers crowded together (Thompson, 2006).
Beti Thompson, Ph.D., one of the program leaders, stated that the messages and
recommendations of the program were well-comprehended by over 2,000 farm workers and their
family members. The farm workers have begun consistently to implement pesticide safety health
behaviors that were presented during the interventions. Therefore, carrying out this comprehensive
program in farming communities may reduce pesticide exposure in children.
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Stakeholders
Even though the current laws do not protect children’s health from toxic exposure, all
federal, state, and local government officials should be primary stakeholders since prevention of
exposure of children to environmental chemicals carries economic benefits for the U.S. government.
While preventing the exposure, the nation’s health will improve, economic productivity over
children’s lifetime will increase, and the direct and indirect costs of healthcare will decrease.
Moreover, when politicians and policy makers accept their jobs, they take on the responsibility to
design and implement effective laws and regulations to protect children.
Government organizations and agencies work together to address the issue of toxic exposure
and to protect children from chemical hazards. Having the authority through the Act of 1976, the
EPA evaluates new and existing chemicals and their risks, and finds ways to prevent or reduce
pollution before it gets into the environment. For instance, the U.S. Department of Health and
Human Services, the Centers for Disease Control and Prevention, the National Center for
Environmental Health, the Centers of Medicare and Medicaid Services, the Food and Drug
Administration, the National Institute for Environmental Health Sciences, the U.S. Consumer
Product Safety Commission, and U.S. Department of Housing and Urban Development collaborate
with one another to communicate information pertinent to children’s chemical exposure. Many of
these organizations provide grants for scientists or health professionals to conduct research which
will present evidence to inform policy decisions.
Another stakeholder is the public which is composed of parents, caregivers, siblings,
children, concerned citizens, health care providers, teachers, professors, child care professionals,
peer groups, community groups, etc. Parents, as direct protectors, are concerned to raise healthy
children in healthy environments. Health care providers have responsibilities in promoting healthy
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development of children and preventing harm from chemicals; they create or join in professional
organizations (e.g., American Academy of Pediatricians, Alliance of Nurses for Healthy
Environments) to vigorously express concerns about environmental chemicals, encourage the federal
government to reform the chemical policy and protect future generations from severe harm. Teachers
and professors of education institutions (K-12, colleges, and universities) are also responsible for the
welfare of children and at the same time interested in school ratings based on students’ scholar
achievements.
The chemical industry is another interested stakeholder. More than 9,000 companies are
located all over the United States and have become valuable contributors to American economy,
bringing in revenue of $555 million per year through the production of huge amounts of never tested
chemicals (EPA, 2011). When TSCA reform takes place, the chemical sector will be the one who
will be concerned to protect its businesses from losing profits.
Non-governmental organizations are dedicated to raise national awareness and understanding
about the harm of toxic chemicals in consumer products, organize campaigns and press for reforms
to policies and laws related to the control of dangerous environmental chemicals, as well as the
replacement of unnecessary toxic chemicals with safer greener alternatives, and protect pregnant
women, unborn children and infants from chemical exposure. For instance, the Collaborative on
Health and the Environment, Mt. Sinai School of Medicine’s Children’s Environmental Health
Center, Columbia University’s Center for Children’s Environmental Health, Health Care without
Harm, and Physicians for Social Responsibility have provided the latest environmental scientific
basis on chemical exposure and impacts on developing children (EPA, 2012).
The media, as another interested stakeholder, facilitates exchange of information about the
exposure of environmental chemicals in children among stakeholders through a variety of channels,
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such as newspapers, magazines, videos, educational films, television or radio public announcements,
mass media advertising, television entertainment shows, and the Internet.
Policy recommendations
The 1976 Toxic Substances Control Act (TSCA) does not regulate environmental chemicals
effectively. The Act has not undergone any improvements for more than 30 years and does not
protect children and pregnant women from exposure to toxic chemicals. Therefore, the chemical
policy should be reformed. First, to be effective, TSCA reform should promptly require removing
the most dangerous bioaccumulative chemicals out of commerce and reducing the use of other
chemicals. Green chemistry research should continue to evolve, and safer chemicals should be used
instead of those with known health hazards. Secondly, TSCA reform should require manufacturers
of chemicals to disclose information about toxic effects of their products and provide clear content
and warning labels that will disseminate accurate scientific information to the public, businesses, and
workers. Chemical manufacturers should not hide information about chemicals’ safety; rather they
should become responsible for their products. For instance, when full information of toxic effects of
organophosphates is given on the packaging of insecticides, consumers, including pregnant women
and caregivers of children, are able to take more informed choices about using these products.
Thirdly, TSCA reform should be based on thorough studies that determine safe levels of exposure to
chemicals with regards to age and vulnerability. The new chemical policy should consider that the
brain development of young children can be negatively influenced by exposure to chemicals (e.g.,
lead or mercury) at levels that would not significantly affect the brains of adults. Furthermore,
“levels of exposure that are relatively safe for a young infant can be harmful to a fetus, and what is
relatively less dangerous for a fetus can have serious and permanent consequences for the brain of an
embryo at the beginning of pregnancy” (Center on the Developing Child at Harvard University,
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2007, p. 27). Accounting for these recommendations, the chemical policy reform will present a good
chance to radically enhance public health.
Summary
Incidence of ever-increasing chronic childhood diseases, such as cancers, asthma, and
learning disabilities, is directly linked to exposure to toxic environmental chemicals. Eliminating
exposure to environmental chemicals in children remains a goal of substantial importance to public
health. At critical days during children’s rapid and complex early development, environmental
chemicals can enduringly alter the structure and function of the developing brain and nervous
system, creating a weak foundation for all future learning, behavior, and health. Nonetheless, the
prevention of children’s exposure to chemicals is faced with many challenges since lack of sufficient
evidence about the possible risks makes government officials fail to take proper actions. Failure of
never changing the Toxic Substances Control Act of 1976 further worsens the situation by not
providing enough authority to the EPA over the regulation of chemicals.
Scientists and expert health professionals have become progressively concerned about the
adverse effects of a complex mixture of chemicals on children both before and after birth and the
neurodevelopment effects of even low-level chemical exposures. Infants are born contaminated with
more than 200 chemicals in their umbilical cord blood. Studies continue to supply research-based
evidence about synergistic effects of mixed exposures on early mental and psychomotor
development.
No single intervention has been demonstrated to be an effective way in the prevention of
childhood chemical exposure, rather a multifaceted comprehensive approach should be utilized to
reduce or prevent the exposure. As an example, the Yakima Valley program designed to protect farm
workers’ children from pesticides’ exposures implemented a variety of effective community-based
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education activities that facilitated changes in pesticide safety health behaviors among farm workers
and their families.
Exposure of children to toxic chemicals creates a huge burden on the nation and carries
enormous direct and indirect costs. The U.S. government and other interested stakeholders should
take on the responsibility to take actions to reform the chemical policy, control childhood chemical
exposures, eliminate dangerous sources of exposure, protect the lives of future generations from
environmental harm, preserve our nation’s health care and educational resources, and enhance public
health.
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References
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