- Email: [email protected]
Chemicals in Daily Life: Emerging Evidence on the Impact on Child Health
DEPARTMENT
Health Policy
Chemicals in Daily Life: Emerging Evidence on the Impact on Child Health Karen G. Duderstadt, PhD, RN, CPNP
KEY WORDS BPA, chemical policy, flame retardants, toxic chemicals
Evidence is growing regarding the impact of lowdose chemical exposures on the health of children, and many families are concerned about exposure to toxic chemicals in their everyday life. A recent poll indicated that more than 80% of Americans want tighter controls on chemicals and chemical manufacturers, and they believe chemical toxicants represent a significant health hazard (Safer Chemicals Healthy Families, 2010). The issue of chemical-management policy bridges traditional partisan lines, and state policy makers are beginning to build support for legislation
Section Editor Karen G. Duderstadt, PhD, RN, CPNP University of California—San Francisco School of Nursing, Family Health Care San Francisco, California Karen G. Duderstadt, Clinical Professor, Department of Family Health Care, School of Nursing, University of California–San Francisco, San Francisco, CA. Conflicts of interest: None to report. Correspondence: Karen G. Duderstadt, PhD, RN, CPNP, Department of Family Health Care, School of Nursing, University of California-San Francisco, Room N411Y, Box 0606, San Francisco, CA 94143-0606; e-mail: [email protected]. J Pediatr Health Care. (2012) 26, 155-157. 0891-5245/$36.00 Copyright Q 2012 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.pedhc.2011.07.010
www.jpedhc.org
to improve regulatory safeguards on the distribution of high-volume chemicals. Several states have banned or have legislation pending on the ban of bisphenol A (BPA) in household products (Connecticut, Massachusetts, Illinois, New York, New Mexico, Maryland, Missouri, California, New Jersey, Pennsylvania, Vermont, and the District of Columbia). This article will briefly review eviThe issue of dence on the health efchemicalfects of three classes of management high-volume chemicals affecting children’s policy bridges health, address the retraditional partisan cent policy statement lines, and state on chemical management by the American policy makers are Academy of Pediatrics beginning to build (AAP), review the support for global ban on highvolume chemicals by legislation to the European Union improve regulatory (EU), and discuss the safeguards on the importance of advocacy by advance pracdistribution of hightice nurses and volume chemicals. pediatric health care providers in the current debate over chemical policy in the United States. EMERGING EVIDENCE BPA is a chemical produced in high volumes for use in production of polycarbonate plastics and epoxy resins. It is utilized in plastic bottles and containers, liners of metal cans, flame retardants, cosmetics, and personal care products. Chemicals are considered ‘‘high volume’’ when they are produced in quantities of more than 1 million pounds annually in the United States. Biomonitoring studies have shown that more than 90% of March/April 2012
155
persons in the United States have measurable concentrations of BPA in their urine (Braun & Hauser, 2011). Breast milk and polycarbonate feeding bottles are the primary source of BPA exposure among infants, and canned foods are the primary source of BPA exposure in children. BPA is one of the chemicals included in a growing body of evidence on toxic high-volume chemicals that may interfere with the endocrine system. The National Institute of Environmental Health Sciences (NIEHS) recently produced a report warning the public on the potential health effects of ‘‘endocrine disruptors’’ (NIEHS, 2010). Endocrine disruptors are manufactured substances or naturally occurring substances that interfere with the function of hormones in the endocrine system. They may turn on or modify signals that hormones carry and affect the normal function of tissues and organs, resulting in reduced fertility and increased incidence of some cancers, diabetes, and endometriosis (NIEHS, 2010). Phytoestrogens, which are naturally occurring substances found in soy products, also can have hormone-like activity. Di(2-ethylhexyl) phthalate is another high-volume chemical used to manufacture polyvinyl chloride medical devices, food packaging, and household products and is another endocrine-disrupting chemical. These chemicals mimic the body’s hormone signals because of their structure and activity and may disrupt control of metabolic levels and response to stress and injury. The NIEHS and the National Toxicology Program reported concern in 2008 at current low-dose exposure levels of BPA and di(2-ethylhexyl) phthalate in humans and its effect on the brain, behavior, and prostate gland in fetuses, infants, and children (NIEHS, 2010). FLAME-RETARDANT CHEMICALS The production of brominated and chlorinated forms of flame-retardant chemicals continues despite the ban of polychlorinated biphenyl in 1979. Brominated and chlorinated flame retardants are halogenated chemicals added to polyurethane foam products made for infants and children to enhance the flame retardancy of these products. However, in studies of building contents, those treated with halogenated flame retardants resisted igniting by only a few additional seconds compared with those without flame retardants (Shaw et al., 2010). When chlorinated and brominated flame retardants burn, the smoke produces toxic chemicals, including dioxins, which have been associated with cancer, including soft tissue sarcoma, non-Hodgkin’s lymphoma, adult-onset leukemia, multiple myeloma, breast cancer, bladder cancer, and stomach cancer. These chemicals also are associated with thyroid dysfunction and immune suppression. More than 155 scientists who have studied the impact of chemicals nationally and globally convened in 2010 and signed the San Antonio Statement on Brominated 156
Volume 26 Number 2
and Chlorinated Flame Retardants, which urged the reform of chemical policy in the United States. The San Antonio Statement addresses the issue of persistent use of brominated and chlorinated flame-retardant chemicals that bioaccumulate in humans and the environment and the limited degradation of chemicals over time in our environment (Birnbaum & Bergman, 2010; DiGangi et al., 2010). Although limited toxicity studies on the impact of flame-retardant chemicals are available, current evidence indicates that the brominated and chlorinated flame retardant chemicals are reproductive and developmental toxicants and disrupt endocrine and neurological function. Despite known effects on humans and wildlife, these chemicals to date have not been regulated in the United States. AAP AND CHEMICAL-MANAGEMENT POLICY The AAP Committee on Environmental Health recently published a statement on chemical-management policy and recommended substantial changes to current U.S. chemical-management policy to protect the health of children and pregnant women (AAP, 2010). Currently the U.S. chemical industry is regulated by the Toxic Substances Chemical Act (TSCA) (Public Law No. 94-469 [1976]), which was passed in 1976 and has never undergone revision. TSCA is not protective of children or pregnant women, and the legislation required the Environmental Protection Agency (EPA) to carry the ‘‘burden of proof’’ in order to restrict chemical production. Chemical manufacturers are not required to perform any safety testing on chemicals before notifying the EPA of their intent to market a new chemical product. In addition, certain chemical substances were exempt from the regulations when the law was enacted, including chemicals utilized in the production of cosmetics, foods, drugs, and pesticides. The EPA does not routinely monitor many chemical ingredients to assess the risk to children and families (Duderstadt, 2009). As a result, evidence on chemical hazards, such as BPA in infant feeding bottles, is being released to the public through media campaigns, increasing anxiety and confusion among consumers. The AAP policy statement on chemical management urges regulation of chemicals based on evidence when it is available or on a ‘‘reasonable level of concern’’ when considering release of chemicals on the market. This approach is consistent with the precautionary principle, which advocates have strongly promoted as the basis for revising TSCA. The precautionary principle states that where there are threats of serious or irreversible damage to human health or environment, scientific certainty is not required to impose restrictions on potentially harmful chemical toxicants. The AAP policy statement further urges policy makers to enact legislation that mandates that products be tested for toxicity on children and pregnant women, including neurodevelopmental and reproductive toxicity, prior to release. Journal of Pediatric Health Care
The policy statement can be accessed at www. pediatrics.org/cgi/doi/10.1542/peds.2011-0523. EU AND CHEMICAL-MANAGEMENT POLICY In 2007, the EU enacted the Registration, Evaluation & Authorization of Chemicals to regulate the chemical inventory and enhance innovation and competitiveness of the EU chemical industry. Twelve chemiGiving the EPA cals were banned with more authority to the regulation (for a list of the banned perobtain data from sistent organic pollutthe chemical ants, see Duderstadt, manufacturers 2009). In 2011, the EU further banned the remains the best sale or use of additional approach to reduce high-volume chemithe risk of harmful cals. This phase-out affects three plastic chemical softening chemicals— exposures to child phthalates—that were health. targeted because of their reproductive toxicity. The E.U. regulation also bans a brominated, flame-retardant chemical because of persistent bioaccumulation and toxicity, and a chemical-musk xylene, which is used in epoxy resins and adhesives and should be regarded as carcinogenic to humans. Use of these banned chemicals continues in the United States and in developing countries. ADVOCACY FOR CHEMICAL-MANAGEMENT POLICY Currently, two bills are being considered in Congress to amend the TSCA legislation. Sen. Frank Lautenberg (D-N.J.) introduced legislation (S.847—Safe Chemical Act of 2011) to revamp TSCA and increase the regulatory authority of the EPA to target chemicals of concern and to regulate new and existing chemicals. The legislation is intended to align the regulations for the U.S. Chemical Industry with EU regulations. In addition,
www.jpedhc.org
legislation has been introduced in the House of Representatives (H.R. 2359—Safe Cosmetics Act of 2011) that focuses solely on regulating chemicals in personal care products. Advocacy by advance practice nurses and pediatric health care providers is critical to mount the necessary support in Congress to pass the legislation in 2012. Pediatric health care providers should urge Congress to enact revisions compatible with the EU restrictions, which require industry to test new chemicals for the burden of exposure before bringing chemicals to market or importation. Giving the EPA more authority to obtain data from the chemical manufacturers remains the best approach to reduce the risk of harmful chemical exposures to child health. It is critical for pediatric health care providers to support this legislative effort to lead us into a new era of safer chemicals for healthier children and families. REFERENCES American Academy of Pediatrics Committee on Environmental Health. (2010). Policy statement: Chemical-management policy: Prioritizing children’s health. Pediatrics, 127(5), 983-990. Birnbaum, L. S., & Bergman, A. (2010). Brominated and chlorinated flame retardants: The San Antonio Statement. Environmental Health Perspectives, 118(12), A514-A515. Braun, J., & Hauser, R. (2011). Bisphenol A and children’s health. Current Opinion in Pediatrics, 23(2), 233-239. DiGangi, J., Blum, A., Bergman, A., de Wit, C. A., Lucas, D., Mortimer, D., . Webster, T. F. (2010). San Antonio Statement on Brominated and Chlorinated Flame Retardants. Environmental Health Perspectives, 118(12), A516-A518. Duderstadt, K. G. (2009). Chemical policy and the impact on child health. Journal of Pediatric Health Care, 23(6), 421-424. National Institute of Environmental Health Sciences. (2010). Endocrine disruptors. Retrieved from http://www.niehs.nih.gov/ health/topics/agents/endocrine/index.cfm Safer Chemicals Healthy Families. (2010). New polling data indicates overwhelming public support for chemicals regulation. Retrieved from http://www.saferchemicals.org/2010/09/ new-polling-data-indicates-overwhelming-public-support-forchemicals-regulation.html Shaw, S. D., Blum, A., Weber, R., Kannan, K., Rich, D., & Lucas, D. (2010). Halogenated flame retardants: Do the fire safety benefits justify the risks? Reviews on Environmental Health, 25(4), 261-305.
March/April 2012
157
Health Policy
Chemicals in Daily Life: Emerging Evidence on the Impact on Child Health Karen G. Duderstadt, PhD, RN, CPNP
KEY WORDS BPA, chemical policy, flame retardants, toxic chemicals
Evidence is growing regarding the impact of lowdose chemical exposures on the health of children, and many families are concerned about exposure to toxic chemicals in their everyday life. A recent poll indicated that more than 80% of Americans want tighter controls on chemicals and chemical manufacturers, and they believe chemical toxicants represent a significant health hazard (Safer Chemicals Healthy Families, 2010). The issue of chemical-management policy bridges traditional partisan lines, and state policy makers are beginning to build support for legislation
Section Editor Karen G. Duderstadt, PhD, RN, CPNP University of California—San Francisco School of Nursing, Family Health Care San Francisco, California Karen G. Duderstadt, Clinical Professor, Department of Family Health Care, School of Nursing, University of California–San Francisco, San Francisco, CA. Conflicts of interest: None to report. Correspondence: Karen G. Duderstadt, PhD, RN, CPNP, Department of Family Health Care, School of Nursing, University of California-San Francisco, Room N411Y, Box 0606, San Francisco, CA 94143-0606; e-mail: [email protected]. J Pediatr Health Care. (2012) 26, 155-157. 0891-5245/$36.00 Copyright Q 2012 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.pedhc.2011.07.010
www.jpedhc.org
to improve regulatory safeguards on the distribution of high-volume chemicals. Several states have banned or have legislation pending on the ban of bisphenol A (BPA) in household products (Connecticut, Massachusetts, Illinois, New York, New Mexico, Maryland, Missouri, California, New Jersey, Pennsylvania, Vermont, and the District of Columbia). This article will briefly review eviThe issue of dence on the health efchemicalfects of three classes of management high-volume chemicals affecting children’s policy bridges health, address the retraditional partisan cent policy statement lines, and state on chemical management by the American policy makers are Academy of Pediatrics beginning to build (AAP), review the support for global ban on highvolume chemicals by legislation to the European Union improve regulatory (EU), and discuss the safeguards on the importance of advocacy by advance pracdistribution of hightice nurses and volume chemicals. pediatric health care providers in the current debate over chemical policy in the United States. EMERGING EVIDENCE BPA is a chemical produced in high volumes for use in production of polycarbonate plastics and epoxy resins. It is utilized in plastic bottles and containers, liners of metal cans, flame retardants, cosmetics, and personal care products. Chemicals are considered ‘‘high volume’’ when they are produced in quantities of more than 1 million pounds annually in the United States. Biomonitoring studies have shown that more than 90% of March/April 2012
155
persons in the United States have measurable concentrations of BPA in their urine (Braun & Hauser, 2011). Breast milk and polycarbonate feeding bottles are the primary source of BPA exposure among infants, and canned foods are the primary source of BPA exposure in children. BPA is one of the chemicals included in a growing body of evidence on toxic high-volume chemicals that may interfere with the endocrine system. The National Institute of Environmental Health Sciences (NIEHS) recently produced a report warning the public on the potential health effects of ‘‘endocrine disruptors’’ (NIEHS, 2010). Endocrine disruptors are manufactured substances or naturally occurring substances that interfere with the function of hormones in the endocrine system. They may turn on or modify signals that hormones carry and affect the normal function of tissues and organs, resulting in reduced fertility and increased incidence of some cancers, diabetes, and endometriosis (NIEHS, 2010). Phytoestrogens, which are naturally occurring substances found in soy products, also can have hormone-like activity. Di(2-ethylhexyl) phthalate is another high-volume chemical used to manufacture polyvinyl chloride medical devices, food packaging, and household products and is another endocrine-disrupting chemical. These chemicals mimic the body’s hormone signals because of their structure and activity and may disrupt control of metabolic levels and response to stress and injury. The NIEHS and the National Toxicology Program reported concern in 2008 at current low-dose exposure levels of BPA and di(2-ethylhexyl) phthalate in humans and its effect on the brain, behavior, and prostate gland in fetuses, infants, and children (NIEHS, 2010). FLAME-RETARDANT CHEMICALS The production of brominated and chlorinated forms of flame-retardant chemicals continues despite the ban of polychlorinated biphenyl in 1979. Brominated and chlorinated flame retardants are halogenated chemicals added to polyurethane foam products made for infants and children to enhance the flame retardancy of these products. However, in studies of building contents, those treated with halogenated flame retardants resisted igniting by only a few additional seconds compared with those without flame retardants (Shaw et al., 2010). When chlorinated and brominated flame retardants burn, the smoke produces toxic chemicals, including dioxins, which have been associated with cancer, including soft tissue sarcoma, non-Hodgkin’s lymphoma, adult-onset leukemia, multiple myeloma, breast cancer, bladder cancer, and stomach cancer. These chemicals also are associated with thyroid dysfunction and immune suppression. More than 155 scientists who have studied the impact of chemicals nationally and globally convened in 2010 and signed the San Antonio Statement on Brominated 156
Volume 26 Number 2
and Chlorinated Flame Retardants, which urged the reform of chemical policy in the United States. The San Antonio Statement addresses the issue of persistent use of brominated and chlorinated flame-retardant chemicals that bioaccumulate in humans and the environment and the limited degradation of chemicals over time in our environment (Birnbaum & Bergman, 2010; DiGangi et al., 2010). Although limited toxicity studies on the impact of flame-retardant chemicals are available, current evidence indicates that the brominated and chlorinated flame retardant chemicals are reproductive and developmental toxicants and disrupt endocrine and neurological function. Despite known effects on humans and wildlife, these chemicals to date have not been regulated in the United States. AAP AND CHEMICAL-MANAGEMENT POLICY The AAP Committee on Environmental Health recently published a statement on chemical-management policy and recommended substantial changes to current U.S. chemical-management policy to protect the health of children and pregnant women (AAP, 2010). Currently the U.S. chemical industry is regulated by the Toxic Substances Chemical Act (TSCA) (Public Law No. 94-469 [1976]), which was passed in 1976 and has never undergone revision. TSCA is not protective of children or pregnant women, and the legislation required the Environmental Protection Agency (EPA) to carry the ‘‘burden of proof’’ in order to restrict chemical production. Chemical manufacturers are not required to perform any safety testing on chemicals before notifying the EPA of their intent to market a new chemical product. In addition, certain chemical substances were exempt from the regulations when the law was enacted, including chemicals utilized in the production of cosmetics, foods, drugs, and pesticides. The EPA does not routinely monitor many chemical ingredients to assess the risk to children and families (Duderstadt, 2009). As a result, evidence on chemical hazards, such as BPA in infant feeding bottles, is being released to the public through media campaigns, increasing anxiety and confusion among consumers. The AAP policy statement on chemical management urges regulation of chemicals based on evidence when it is available or on a ‘‘reasonable level of concern’’ when considering release of chemicals on the market. This approach is consistent with the precautionary principle, which advocates have strongly promoted as the basis for revising TSCA. The precautionary principle states that where there are threats of serious or irreversible damage to human health or environment, scientific certainty is not required to impose restrictions on potentially harmful chemical toxicants. The AAP policy statement further urges policy makers to enact legislation that mandates that products be tested for toxicity on children and pregnant women, including neurodevelopmental and reproductive toxicity, prior to release. Journal of Pediatric Health Care
The policy statement can be accessed at www. pediatrics.org/cgi/doi/10.1542/peds.2011-0523. EU AND CHEMICAL-MANAGEMENT POLICY In 2007, the EU enacted the Registration, Evaluation & Authorization of Chemicals to regulate the chemical inventory and enhance innovation and competitiveness of the EU chemical industry. Twelve chemiGiving the EPA cals were banned with more authority to the regulation (for a list of the banned perobtain data from sistent organic pollutthe chemical ants, see Duderstadt, manufacturers 2009). In 2011, the EU further banned the remains the best sale or use of additional approach to reduce high-volume chemithe risk of harmful cals. This phase-out affects three plastic chemical softening chemicals— exposures to child phthalates—that were health. targeted because of their reproductive toxicity. The E.U. regulation also bans a brominated, flame-retardant chemical because of persistent bioaccumulation and toxicity, and a chemical-musk xylene, which is used in epoxy resins and adhesives and should be regarded as carcinogenic to humans. Use of these banned chemicals continues in the United States and in developing countries. ADVOCACY FOR CHEMICAL-MANAGEMENT POLICY Currently, two bills are being considered in Congress to amend the TSCA legislation. Sen. Frank Lautenberg (D-N.J.) introduced legislation (S.847—Safe Chemical Act of 2011) to revamp TSCA and increase the regulatory authority of the EPA to target chemicals of concern and to regulate new and existing chemicals. The legislation is intended to align the regulations for the U.S. Chemical Industry with EU regulations. In addition,
www.jpedhc.org
legislation has been introduced in the House of Representatives (H.R. 2359—Safe Cosmetics Act of 2011) that focuses solely on regulating chemicals in personal care products. Advocacy by advance practice nurses and pediatric health care providers is critical to mount the necessary support in Congress to pass the legislation in 2012. Pediatric health care providers should urge Congress to enact revisions compatible with the EU restrictions, which require industry to test new chemicals for the burden of exposure before bringing chemicals to market or importation. Giving the EPA more authority to obtain data from the chemical manufacturers remains the best approach to reduce the risk of harmful chemical exposures to child health. It is critical for pediatric health care providers to support this legislative effort to lead us into a new era of safer chemicals for healthier children and families. REFERENCES American Academy of Pediatrics Committee on Environmental Health. (2010). Policy statement: Chemical-management policy: Prioritizing children’s health. Pediatrics, 127(5), 983-990. Birnbaum, L. S., & Bergman, A. (2010). Brominated and chlorinated flame retardants: The San Antonio Statement. Environmental Health Perspectives, 118(12), A514-A515. Braun, J., & Hauser, R. (2011). Bisphenol A and children’s health. Current Opinion in Pediatrics, 23(2), 233-239. DiGangi, J., Blum, A., Bergman, A., de Wit, C. A., Lucas, D., Mortimer, D., . Webster, T. F. (2010). San Antonio Statement on Brominated and Chlorinated Flame Retardants. Environmental Health Perspectives, 118(12), A516-A518. Duderstadt, K. G. (2009). Chemical policy and the impact on child health. Journal of Pediatric Health Care, 23(6), 421-424. National Institute of Environmental Health Sciences. (2010). Endocrine disruptors. Retrieved from http://www.niehs.nih.gov/ health/topics/agents/endocrine/index.cfm Safer Chemicals Healthy Families. (2010). New polling data indicates overwhelming public support for chemicals regulation. Retrieved from http://www.saferchemicals.org/2010/09/ new-polling-data-indicates-overwhelming-public-support-forchemicals-regulation.html Shaw, S. D., Blum, A., Weber, R., Kannan, K., Rich, D., & Lucas, D. (2010). Halogenated flame retardants: Do the fire safety benefits justify the risks? Reviews on Environmental Health, 25(4), 261-305.
March/April 2012
157