Top 10 Selections: April 2013

For our third quarterly Top 10 list, we again selected from several dozen candidate news articles, journal articles, policy decisions and reports that have had a significant impact or are likely to have a significant impact on thinking and action in the field of environmental health. We consider these selections to be the biggest contributors toward new insights, toward changing the conversation or expanding the scope of the conversation on a topic to a new audience or awareness, or toward defining a new trend. Comments are welcome.

The selections, in no particular order:

  1. Report: Late Lessons from Early Warnings: Science, Precaution, Innovation from the European Environment Agency.
    As stated in the promotional text for this report: “The case studies across both volumes of Late Lessons from Early Warnings cover a diverse range of chemical and technological innovations, and highlight a number of systemic problems. The ‘Late Lessons Project’ illustrates how damaging and costly the misuse or neglect of the precautionary principle can be, using case studies and a synthesis of the lessons to be learned and applied to maximizing innovations whilst minimizing harms.” This report explores weaknesses in regulatory science and expands on histories of past environmental and public health mistakes. It includes new substances with potential for harm and several false positives. All is drawn together to provide a framework in which precaution guides policy.
    See more information about the partnership call CHE hosted on this report: Late Lessons from Early Warnings: A Retrospective Look at Learning about Precaution.
  2. The need to look at mixtures in assessing safety.
    Two items this quarter address the need to look at interactions among exposures when determining risk of exposures. First is Research Brief 217: Majority of Women Exposed to Multiple Pollutants, from the National Institute of Environmental Health Sciences (NIEHS). According to a new analysis of thousands of US women of child-bearing age, almost 83% of women aged 16 to 49 meet or exceed median blood levels of one or more of three environmental pollutants—lead, mercury, and polychlorinated biphenyls (PCBs)—that are known to harm brain development of fetuses and babies. Most women exceeded the median blood level for two or more of these pollutants, even though “scientists do not yet know whether co-exposure to all three chemicals is more harmful than each chemical alone.” With exposures this pervasive, it is imperative that risks be assessed and policies adopted to protect fetuses and children. The second item is a statement from NIEHS on this topic:  Unraveling the health effects of environmental mixtures: an NIEHS priority. NIEHS recognizes that it “is imperative to develop methods to assess the health effects associated with complex exposures in order to minimize their impact on the development of disease.” NIEHS draws from its background in both supporting and conducting combined exposure research to state that this topic will continue to be a priority at the Institute.
  3. America’s real criminal element: lead  and Correlation between exposure to lead and violence is being taken seriously across scientific world.
    “New research finds that lead is the hidden villain behind violent crime, lower IQs, and even the ADHD epidemic. And fixing the problem is a lot cheaper than doing nothing.” This line of investigation has deep repercussions socially. With substantial costs not only to individuals and their families, but to our entire society, from crime, lowered educational attainment and attendant problems. There is new impetus to prevent or to find and remediate lead in housing, in soil, and in consumer goods. Beyond the social significance, though, this story is a great case study in epidemiology and criminology.
  4. New report: U.S. Health in International Perspective: Shorter Lives, Poorer Health.
    This report from the National Research Council and the Institute of Medicine investigates potential reasons for the US health disadvantage and assesses its larger implications. No single factor can fully explain the US disadvantage:  It likely has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions. This report packages the ecological model of health which CHE encourages our partners to consider when investigating environmental effects on health.
  5. Further impacts from smoking tobacco.
    Three studies provide new thinking around an old problem, in case anyone still needed a reason to reduce tobacco use.

    1. Passive smoking can dramatically increase the risk of developing severe dementia Breathing in someone else’s cigarette fumes increases your risk of severe dementia, according to researchers. The study is the first to find a significant link between passive smoking and the neurological disease.
      See the study: Association between environmental tobacco smoke exposure and dementia syndromes
      Between the widespread exposure to environmental tobacco smoke and the substantial costs to society of dementia, this is a huge public health issue. If reducing exposures to tobacco smoke can decrease the incidence or severity of dementia, the benefits to society could be enormous, in addition to the improvement in quality of life for individuals and their families.
    2. Cigarette smoke may increase microbial virulence
      A new study expands the potential health effects to a new front, showing that acute in vitro exposure of Staphylococcus aureus to cigarette smoke promoted biofilm formation and adhesion to human cells.
      See the study: Cigarette smoke increases staphylococcus aureus biofilm formation via oxidative stress.
    3. Cutting smoking saves more in health bills than lost tax: EU
      The cost and health benefits of getting people not to smoke—and better still, not to start—more than outweigh the taxes the tobacco industry pays to governments, the European Commission said Monday.
  6. Pollution crisis in China.
    A long series of news reports on air and water pollution, the resulting unrest in the population, and the government’s response describes a society’s struggle with chemical contamination in China.

    1. Chinese struggle through ‘airpocalypse’ smog
    2. Beijing air pollution soars to hazard level
    3. Beijing orders official cars off roads to curb pollution
    4. Chinese take fight against water pollution to social media
    5. Chinese Internet users scream for clean air act
    6. Eye-stinging Beijing air risks lifelong harm to babies
    7. Water pollution: a Bay of Pigs moment in China
    8. China’s toxic harvest: a “cancer village” rises in protest
    9. China steps up toxics controls
    10. Waiting to exhale in China
    11. A new environment for fight against pollution
    12. In China, breathing becomes a childhood risk
  7. Global data and meta-analayses of prenatal exposures and birth outcomes.
    Two large studies showcase the effects of environmental exposures on pregnancy outcomes.

    1. Environmental risk factors of pregnancy outcomes: a summary of recent meta-analyses of epidemiological studies
      The meta-analyses found statistically significant negative associations between environmental tobacco smoke and stillbirth, birth weight, and any congenital anomalies; PM2.5 and preterm birth; outdoor air pollution and some congenital anomalies; indoor air pollution from solid fuel use and stillbirth and birth weight; polychlorinated biphenyls (PCB) exposure and birth weight; disinfection by-products in water and stillbirth, small for gestational age, and some congenital anomalies; occupational exposure to pesticides and solvents and some congenital anomalies; and agent orange and some congenital anomalies.
    2. Maternal exposure to particulate air pollution and term birth weight: A multi-country evaluation of effect and heterogeneity
      A growing body of evidence has associated maternal exposure to air pollution with adverse effects on fetal growth; however, the existing literature is inconsistent. The objectives of this study were to quantify the association between maternal exposure to particulate air pollution and term birth weight and low birth weight (LBW) across fourteen centers from nine countries and to explore the influence of site characteristics and exposure assessment methods on between-center heterogeneity in this association. Maternal exposure to particulate pollution was associated with low birth weight at term across study populations. This study helps clarify previous disparate findings on air pollution and birth weight. Taking into account differences in location and methodology, these findings support the association between maternal particulate matter exposure and low birth weight.
  8. US report urges deeper look into breast cancer’s environmental links.
    A new federal advisory panel report makes a forceful case for more research into environmental causes of breast cancer, which was diagnosed in 227,000 women, killed 40,000 and cost more than $17 billion to treat in the United States last year. For years, the focus in breast cancer has been on early detection and treatment, and this move toward prevention shifts the focus upstream.
    See the report: Breast Cancer and the Environment: Prioritizing Prevention and information about CHE’s partnership call on the report.
  9. UN, WHO panel calls hormone-disrupting chemicals a ‘global threat.’
    An international team of experts reported today that evidence linking hormone-mimicking chemicals to human health problems has grown stronger over the past decade, becoming a “global threat” that should be addressed. There’s still much research needed, but this moves the conversation about health effects of endocrine disrupting chemicals onto a bigger stage.
    See the report: State of the Science of Endocrine Disrupting Chemicals and other coverage: European Parliament vote on EDCs conveys urgency of protecting health.
  10. Transgenerational effects of prenatal exposure to environmental obesogens in rodents.
    Three studies were published this quarter:

    1. Transgenerational inheritance of increased fat depot size, stem cell reprogramming, and hepatic steatosis elicited by prenatal obesogen tributyltin in mice
    2. plastics derived endocrine disruptors (bpa, dehp and dbp) induce epigenetic transgenerational inheritance of obesity, reproductive disease and sperm epimutations
    3. Hydrocarbons (jet fuel JP-8) induce epigenetic transgenerational inheritance of obesity, reproductive disease and sperm epimutations

    This is a new finding in both obesity research and in transgenerational research. These studies all show the ability of environmental chemicals (not only endocrine disruptors, but also jet fuel) to promote obesity in three generations of rodents.
    See information about CHE’s working group call on these studies: Transgenerational Effects of Prenatal Exposure to Environmental Obesogens in Rodents.

The Toxic Chemical Experiment on Our Reproductive Systems

Cassidy Randall
Director of Outreach and Engagement, Women’s Voices for the Earth

This piece is posted in full on the WVE blog. It’s excerpted here with permission of the author.

People often ask me, “Why a women’s environmental organization?”

I always take a breath before answering, because there are so many reasons, and because each one contributes to my passion to get toxic chemicals out of our world:

Women’s health problems linked to toxic chemicals are on the rise. Rising rates of breast cancer, early puberty, contaminated breast milk, infertility, birth defects – the list, unfortunately, goes on.

Women are greater users of consumer products that contain toxic chemicals, like personal care products, fragrance, and cleaning products.

Women of color are at greater risk. Many products marketed to women of color, such as skin lighteners, hair relaxers, and dyes, contain some of the most toxic chemicals on the market; flame retardant chemicals have increased by 40% in the breast milk of Inuit women in the Arctic; according to the CDC, African American women are 34% more likely to die of breast cancer than white women.

Continue reading on the WVE site.

Massachusetts Pursues the Primary Prevention of Asthma

Polly Hoppin
Co-coordinator of CHE’s Asthma Working Group

Massachusetts communities have high asthma rates, resulting in a substantial societal burden of human suffering, lost capacity and productivity, and direct fiscal costs. In 2010, 10.4% of adults in Massachusetts had asthma—one of the highest prevalence estimates in the nation. Current asthma prevalence among adults increased by 22.4% between 2000 and 2010. In 2009, 9.3% of Massachusetts children had current asthma [1]. And Massachusetts is not alone: asthma rates are increasing in states across the US.

As with other chronic diseases, far more resources focus on managing asthma in people who have it than on preventing the disease. Better compliance with medications, behavior modifications resulting from asthma education, and environmental interventions that reduce a person’s exposure to allergens and irritants are essential secondary prevention strategies that can reduce asthma attacks and keep people out of the doctor’s office, emergency room or hospital, often cost-effectively. Yet, there remains an urgent need to better understand the root causes of asthma and to develop strategies for reducing the rate of new cases.

A growing body of research documents associations between asthma onset and a range of risk factors, many of which are modifiable, such as exposure to contaminants and allergens in indoor air [2]; lack of breast feeding [3]; maternal health (including stress associated with poverty and racism, as well as obesity, and other factors [4]; and outdoor air pollution [5]. Evidence is also emerging that both adults and children living in close proximity to air pollution sources—for example traffic on busy roadways—are at higher risk than those living at greater distance [6]. Even higher rates of asthma onset are observed among children exposed to traffic who also experience significant stress in their lives [7]. Hundreds of specific chemicals have been associated with the onset of asthma in workers [8], and recent studies suggest that many of these same chemicals are found in household settings and may be associated with the onset of asthma in both children and adults [9]. A small but growing body of research has examined the impacts on asthma onset of specific interventions to reduce modifiable risk factors such as exposure to dust mites and other indoor allergens [10] as well as vitamin D deficits [11]. Several studies have demonstrated reduced rates of new onset asthma among recipients of an intervention to address multiple risk factors as compared to a control group [12]. A review of these studies suggests that a more systemic, multifactorial approach may be effective [13].

What could a state concerned about asthma prevalence do to reverse rates over time? For which risk factors is the weight of the evidence strong, indicating a known association between exposure and asthma onset? Where there remain uncertainties about the strength of the science, what other considerations might justify action to modify one or more risk factors? What kinds of interventions would align best with an understanding of asthma development as a complex, multifactorial process?

A two-day symposium on April 23-24, 2013, at the Massachusetts Medical Society will pursue these questions and feed recommendations into the next statewide strategic plan for asthma, which is in the early planning stages. Polly Hoppin and Molly Jacobs of the Lowell Center for Sustainable Production at the University of Massachusetts, Lowell, are convening the symposium, pursuing a goal they and others helped install in the current state strategic plan: “to develop….[with input from] a diverse group of professionals and individuals… a roadmap for better understanding the causes of asthma and the role of primary prevention in Massachusetts” [14]. The Symposium planning committee includes representatives of the Massachusetts Asthma Advocacy Partnership, a statewide asthma coalition; the regional offices of the American Lung Association; the US Department of Health and Human Services and EPA; the state Department of Public Health; the Asthma Regional Council of New England; the Boston Public Health Commission; hospitals and universities. CHE Science Director Ted Schettler has been instrumental in helping shape the agenda and is giving the opening presentation.

Ten years ago, research on the cost-effectiveness of home-based programs in reducing asthma symptoms was just emerging. New England organizations were leaders in synthesizing the research and convening public and private payers to discuss how to provide people with severe asthma home-based environmental interventions and asthma education to help bring their asthma under control. These activities played an important role in generating federal support for the delivery and financing of home visits for asthma. Organizers of the primary prevention symposium intend the April meeting to break comparably new ground in both the meeting processes used and its outcomes. A decade from now, we hope to be able to point to this gathering as an important first step in advancing understanding of the primary causes of asthma and action to address them.

[1] Massachusetts Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health, and US Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention, multiple years.

[2] e.g., Mendell MJ. Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: a review.  Indoor Air. 2007; 17(4):259-77; Jaakkola JJ, Knight TL. The role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: A Systematic Review and Meta-analysis. Environ Health Perspect 116(7):845-853; Chen YC, Tsai CH, Lee YL, et al. Early-life indoor environmental exposures increase the risk of childhood asthma. International Journal of Hygiene and Environmental Health. 2011;215:19-25.

[3] Kull I, Wickman M, Lilja G, et al. Breast feeding and allergic diseases in infants—a prospective birth cohort study. Archives of Disease in Childhood. 2002;87:478-481; Oddy WH, Hold PG, Sly PD, et al. Associations between breast feeding and asthma in 6 year old children: Findings of a prospective birth cohort study.  British Medical Journal. 1999;319:815-819.

[4] Wright RJ, Cohen S, Carey V, Weiss ST, Gold DR. Parental stress as a predictor of wheezing in infancy: A prospective birth-cohort study. American Journal of Respiratory & Critical Care Medicine. 2002;165:358–365; Mrazek DA, Klinnert M, Mrazek PJ, Brower A, McCormick D, Rubin B, Ikle D, Kastner W, Larsen G, Harbeck R, et al. Prediction of early-onset asthma in genetically at-risk children. Pediatric Pulmonology. 1999;27:85–94; Sternthal MJ, Coull BA, Chiu YH, et al. Associations among maternal childhood socioeconomic status, cord blood IgE levels, and repeated wheeze in urban children. Journal of Allergy and Clinical Immunology. 2011;128(2):337-345; Scholtens S, Wija AH, Brunekreef B, et al. Maternal overweight before pregnancy and asthma in offspring followed for 8 years. International Journal of Obesity. 2009 Sep 29. [Epub ahead of print]

[5] Künzli N, Bridevaux P-O, Liu L-J S, et al. Traffic-related air pollution correlates with adult-onset asthma among never-smokers. Thorax. 2009;64:664-670; Jerrett M, Shankardass K, Berhane K, et al. Traffic-Related Air Pollution and Asthma Onset in Children: A Prospective Cohort Study with Individual Exposure Measurement. Environmental Health Perspectives. 2008;116:1433-1438; McConnell R, Islam T, Shankardass K, et al. Childhood incident asthma and traffic-related air pollution at home and school. Environmental Health Perspectives. 2010 Jul;118(7):1021-6; Clark NA, Demers PA, Karr CJ, et al. Effect of early life exposure to air pollution on development  of childhood asthma. Environmental Health Perspectives. 2009;118(2):284-290; Shankardass K, McConnell R, Jerrett M, et al.  Parental stress increases the effect of traffic-related air pollution on childhood asthma incidence. Proceedings of the National Academies of Science USA. 2009;106:12406-11.

[6] McConnell R, Islam T, Shankardass K, et al. Childhood incident asthma and traffic-related air pollution at home and school. Environmental Health Perspectives. 2010 Jul;118(7):1021-6.

[7] Shankardass K, McConnell R, Jerrett M, et al. Parental stress increases the effect of traffic-related air pollution on childhood asthma incidence. Proceedings of the National Academies of Science USA. 2009;106:12406-11.

[8] Malo J-L, Chan-Yeung M. Appendix: Agents Causing Occupational Asthma with Key References. In: Bernstein LI, Chan-Yeung M, Malo J-L, Bernstein DI (eds). Asthma in the Workplace. 3rd Ed. New York: Taylor & Francis, 2006.

[9] Mendell MJ. Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: a review. Indoor Air. 2007; 17(4):259-77.

[10] Maas T, Kaper J, Sheikh A, et al. Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma. Cochrane Database of Systematic Reviews. 2009; Jul 8;(3):CD006480.

[11] Litonjua AA. Vitamin D deficiency as a risk factor for childhood allergic disease and asthma.
Current Opinions in Allergy and Clinical Immunology. 2012 Jan 19. [Epub ahead of print]

[12] see Chan-Yeung M, Ferguson A, Watson W, et al.  The Canadian Childhood Asthma Primary Prevention Study: Outcomes at 7 Years of Age. Journal of Allergy and  Clinical Immunology. 2005 Jul;116(1):49-55.

[13] Maas T, Kaper J, Sheikh A, et al. Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma. Cochrane Database of Systematic Reviews. 2009; Jul 8;(3):CD006480.

[14] Strategic Plan for Asthma in Massachusetts, 2009-2014. Department of Public Health, Commonwealth of Massachusetts, 2009.

The Environment and Social Media

Karin Gunther Russ, MS, RN
National Coordinator of the Fertility and Reproductive Health Working Group

CHE’s mission includes sharing emerging scientific research on various environmental factors that can contribute to disease and disability. The best research data in the world cannot make an impact if it is not widely accessible and read. In today’s world, this means making wise use of social media tools such as Facebook, Twitter and web-based blogs. Many of you may be quite experienced in social media, but for those who aren’t or who aren’t aware of the social media tools CHE uses, below is a brief overview of various types of social media and strategies that have been shown to work well to communicate environmental health messages.

Social media is an increasingly effective method of reaching a broad audience. The Pew Internet Project reports 67% of adults who go online use social networking sites. Social media use ranges from 83% of 18-29 year olds to 35% of those age 65 years and older (1). Environmental organizations are one of the most active groups using social media. Craig Newman, founder of, conducted a review in 2011 and found that environmental groups are second only to animal advocates in the average number of Facebook posts and tweets per week (2).

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