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The Home & Human Health. Jerome A. Paulson, MD, FAAP Professor of Pediatrics & Public Health George Washington University Medical Director for National & Global Affairs Director, Mid-Atlantic Center for Children’s Health & the Environment Child Health Advocacy Institute - PowerPoint PPT Presentation
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The Home & Human Health
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE06-08
Jerome A. Paulson, MD, FAAPProfessor of Pediatrics & Public Health
George Washington UniversityMedical Director for National & Global Affairs
Director, Mid-Atlantic Center for Children’s Health & the Environment
Child Health Advocacy InstituteChildren’s National Medical Center
Dr Paulson has NO conflicts of interest to
declare. • This material was developed by the Mid-Atlantic
Center for Children’s health & the Environment and funded under the cooperative agreement award number 1U61TS000118-03 from the Agency for Toxic Substances and Disease Registry (ATSDR).
• Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing funds to ATSDR under Inter-Agency Agreement number DW-75-92301301-0. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications.
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
MACCHE – MACCHE – A Resource for the A Resource for the
RegionRegion• One of 10 Pediatric Environmental
Health Specialty Units (PEHSUs) in the US
• Serve DE. PA, MA, VA, WV, and DC• Source of Education• Source of Information
What Kinds of Problems does
MACCHE Deal With?• Lead poisoning• Pesticide exposures• Sick building
problems• Water pollution• Air pollution• Job related exposures
in adolescents• Volatile Organic
Compounds
• Exposure to hazardous waste sites
• Environmentally related asthma
• Agricultural pollutants
• Solvents• Carbon monoxide• Arsenic• Mercury
The Mid-Atlantic Center for Children’s Health & the Environment
MACCHE – MACCHE – Contact InformationContact Information
•www.childrensnational.org/MACCHE
• 202-471-4829
• 866-622-2341
Objectives
• Upon completion of this activity, the participant should be able to:Recognize the impact of the home
environment on the health of children.
Integrate the information into workplace wellness programs for employees.
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Fields of Study Related to Housing & Health
Geology
Neurology & development
Pulmonary disease
Immunology
Allergy
Infectious Diseases
Renovation
Architecture
Building Sciences
ManufacturingBuilding materials
Furniture Plumbing
Agriculture
Mining
Forestry
Housing & Health
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
New Building - Existing Building
• NewSiting issuesBuilding materialsRemoval of wasteDesign issues
– Lighting– Ventilation
• ExistingCleaningMaintenanceRenovation
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Housing & Human Health
• Radon• Lead• Mold• Allergens• Physical factors - injuries
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
How Radon Enters a House
http://geopanorama.rncan.gc.ca/whitehorse/radon_e.php?p=1
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Radon as Health Hazard
• Radon chemically inert and electrically uncharged
• Radioactive• Decay produces radon progeny• Inhaled into the lungs attached to dust• Emit alpha radiation• Disrupts DNA of these lung cells• Exposure to alpha radiation may lead to
development of cancerMid-Atlantic Center for Children’s Health & the Environment - MACCHE
Radon as Health Hazard
• Radon clearly associated with lung cancer in miners
• Exposed to much higher concentration of radon than in homes
• Many smokers, most males and exposed to dust and other hazards
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Radon as Health Hazard
• Committee of National Academy of Sciences estimates 15,400 or 21,800 cases of lung cancer per year in the United States can be attributed to radon among ever-smokers and never-smokers together.
• Most of the radon-related lung-cancers occur among ever-smokershttp://books.nap.edu/openbook.php?record_id=5499&page=R1
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Radon & Homes
• Issue varies in different parts of country
• How to build to limit radon incursion?
• How to monitor home over time as basement floors and walls change?
• Cost-effective amelioration methodologies?
• Request a free radon test kit [email protected] 304-356-4322
http://www.epa.gov/radon/zonemap.html#more%20about%20the%20map
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
> 4 pCi/L
2-4 pCi/L
< 2 pCi/L
What Did They Know &
When Did They Know It?
• Knowledge of lead hazards goes back to ancient times
• 1904. Publication of paper linking exposure to lead-based paint exposure & childhood lead poisoning. J. Lockhart Gibson, Australiannoted dangers of painted walls and verandas
• 1905. Gibson “[T]he use of lead paint within the reach of children should be prohibited by law.“
• US restriction on indoor lead paint 1978
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Scope of the Problem
• Not an issue with new housing• An issue with pre-1978 housing• Have the potential to eradicate childhood
lead poisoning“…an estimated 25% of the nation's housing
(equivalent to 24 million housing units) had significant lead-based paint hazards in the form of deteriorated paint, dust lead, or bare soil lead.” (Jacobs, et al. 2002. Environ Health Perspect 110:A599-A606) (http://www.ehponline.org/members/2002/110pA599-A606jacobs/jacobs-full.html
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Younger Children at Greater Risk
• 1-2 year olds
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Impact of Lead on the Body
• Function ofAge of child
– GI absorption
Amount ingestedLength of time of exposurePeak BLL vs. cumulative
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Impact of Lead on the Body
• Blood lead levels in children < 10 μg/dLLearning disabilitiesHyperactivityAggression and other behavior
problemsDecreased IQDecreased linear growth
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Impact of Lead on the Body
• Blood lead levels in children20 μg/dL – decreased nerve conduction
velocity40 μg/dL – decreased hemoglobin
synthesis80 μg/dL – encephalopathy: seizures,
coma> 100 μg/dL – death
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Normal IQ Distribution
160140120100806040
70 130I.Q.
6.0 million "gifted"
6.0 million “persons withintellectual disability"
mean 100
Effects of a 5 Point Decrease in Mean IQ
160140120100806040
mean 95
70 130
2.4 million "gifted"9.4 million “persons with
intellectual disability"
57% INCREASE IN
“Persons with Intellectual disabilities”
I.Q.
Lead & Homes
• Primary Prevention the Only Appropriate SolutionScreening of children (secondary
prevention) may have been appropriate in the past
Making housing lead-safe is appropriate now and in the future
Immoral & unethical to use children to identify substandard housing
What legal mechanisms do we need to screen homes and make dangerous homes lead-safe?Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Damp Indoor Spaces and Health
Institute of MedicineNational Academy of
Scienceshttp://books.nap.edu/catalog.php?record_id=11011
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
What happens in damp buildings?
• May get increased growth of mold – fungus – mildew Different terms meaning the same thing All indoor space has some mold Mold and products of mold
• May get increased bacterial growth Bacteria and products of bacteria All indoor space has some bacteria
• May get increased dust mites All indoor space, except the most dry or very cold, have
some dust mites
• May get release of degradation products from break down of building materials
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Environmental Mold Exposure
WallWall
DoorDoor
http://www.cdc.gov/nceh/publications/books/housing/Graphics/chapter_05/Figure5.01.jpg
Ceiling Ceiling heavily heavily contaminated contaminated with moldwith mold
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Indoor factors supporting mold
growth• Nutrition - building materials • Moisture - leaking roofs or pipes,
condensation on or water intrusion through, walls or basements
• Inadequate and/or poorly maintained ventilation systems that May not provide enough air for dilution and/or
dehumidificationMay contain sources of mold and/or disperse
mold spores into the occupants’ breathing zone
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Four ways that fungi can cause disease in
humans (and animals)
• May be building relatedAllergic or hypersensitivity reactionsIrritant reactionsToxic reactions
• Not likely to be building relatedInfections
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Allergic reactions most common
• About 10% of the population has allergic antibodies to fungal antigens, and 5% have clinical illnessAllergic rhinitis (“hay fever”) or asthma
• Outdoor molds more abundant and important in airway allergic disease
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Allergic Symptoms
• NasalClear nasal
dischargeNasal congestionSneezingPost-nasal drip with
sore throatCoughingHoarsenessNasal obstruction
• PulmonaryAsthma attacks in
sensitized individuals
New onset of asthma
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Molds & Volatile Organic Compounds
• Molds growth can → volatile organic compounds (VOCs) - alcohols, esters, aldehydes, and aromatic compounds
• VOC production varies with growth conditions
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
In higher concentrations, VOCs
can be highly irritating• Eye irritation and conjunctivitis• Skin rashes• Runny nose• Laryngitis and hoarseness• Cough• Chest tightness• Headache and fatigue
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Mycotoxins
• Produced by some, not all molds• Toxigenic species do not always
produce mycotoxin-depends on various conditions
• Mycotoxins - large moleculesNot significantly volatile; i.e., don’t “off
gas”Don’t migrate through walls or floors
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Exposure to Mycotoxins
• For inhalation must get fungal fragments or spores into air
• May cause skin irritation if contact fungi
• Can be toxic when ingested
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Mold & Homes
• Issue varies in different parts of country
• How to build appropriately to control moisture?
• How to monitor home over time as the building envelope changes?
• How to repair home once moisture incursion has occurred?
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Indoor air pollutants & asthma
• AllergensDust mites (cause/exacerbate)Animal allergens – cats, dogs, rats or mice
(exacerbate)Molds (cause/exacerbate)
• OthersEnvironmental tobacco smoke (exacerbate)Chemicals in the air: wood smoke, paint,
perfume, cosmetics, pesticides, cleaning agents
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Asthma & Housing
• Estimated that 40% of doctor diagnosed asthma in children due to residential exposure
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Cockroaches
• Need warmth• Need water• Need source of
foodKitchenWhere food is
consumed– Kitchen– TV viewing area
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Asthma Morbidity Associated with
Cockroach Antigen• -/- no allergy/low
exposure• -/+ no allergy/high
exposure• +/- allergy/low
exposure• +/+ allergy/high
exposure 0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
-/- -/+ +/- +/+
ER visits/yrHsptl/yr
Rosenstreich, et al. NEJM. 336(19):1356-63, 1997 May 8
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
House dust mites
• Need warmth• Need high
humidity• Need source of
food – dead skin from humans
• Live in mattresses, upholstered furniture and carpet http://creatures.ifas.ufl.edu/urban/house_dust_mite_fig1.jpg
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Asthma Morbidity Associated with House Dust Mite Sensitivity
0
10
20
30
40
50
60
0-2 mm 3-4 mm 5-6 mm >/= 7 mm
Freq wheezeRecent medsReg morbidityUrgent visit
Peat et al. Aust NZ J Med 1994;24:270-6
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Indoor Allergens & Homes
• Maintenance• Humidity control – not too much, not
too little
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Housing Structure & Injuries
• Issues are a function of age of residentsKidsElderly
• Issues are a function of the clinical status of the residentsVision impairedMobility impaired
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Housing Structure & Injuries
• New ConstructionWhat is standard
vs. what is “extra”?How protective are
the local codes?
• Existing HousingWhat can be
retrofit?How protective are
the local codes?
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Magnitude of Problem
• 13.5 million nonfatal injuries occur in and around the home4 million ER visits and 2800 deaths per
year from home injuries in children
• 2900 people die in house fires,
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
Housing Structure & Injuries
• Recognized Effective InterventionsInstallation of working smoke alarmsIsolation 4-sided pool fencingPre-set safe temperature hot water
heatersAir condition during heat waves Window guards
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE
SUMMARY
• Housing influences health• Somewhat different issues for new vs.
existing housing• Housing professionals & health care
professionals have many areas where they can work together to improve individual and public health
• Need a holistic approach when dealing with housing issues in older homes
Mid-Atlantic Center for Children’s Health & the Environment - MACCHE