Environmental Health Risks in Community Based Residential Settings

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Environmental Health Risks in Community Based
Residential Settings

• Allison Del Bene Davis PhD, RN
• April 10, 2007

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Objectives

• To discuss the vulnerability of people with
  intellectual, cognitive and developmental
  disabilities to environmental health risks
• To identify common environmental health hazards
  that can be present in group homes and ALU
  settings
• To present solutions to decrease risks for people
  with developmental disabilities and their staff.

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Body Burden
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Home Environmental Exposures

• It has been estimated that Americans spend over
  90 of their time indoors
• ( ALA, 2006, EPA 2006)
• Human exposure to pollutants is influenced by
  both outdoor and indoor air
• (Janssen et al, 2005)
• Pollution indoors is created from both outdoor
  air coming inside and from products and
  behavioral practices inside the home

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DD Population Vulnerabilities

• Formally defined by AHRQ in 2003 as a priority
  population with recognized healthcare
  disparities.
• Economically disadvantaged
• Higher rates of DD among blacks 24.3 / 1000
  versus 13.6 / 1000 for whites.

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Characteristics of People with DD that Increase
Risk of Toxic Exposures

• Communication skills
• Motor skills
• Nutrition issues
• Behaviors persisting past a developmentally
  appropriate age
• Health problems related to DD
• Pharmaceuticals

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Other Characteristics that Increase Risk from
Environmental Contaminants

• Parental / caregiver choices and behaviors
• Household practices
• Socioeconomic status
• Non-updated regulations of residential and
  segregated work settings

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Neurological Fragility and Neurotoxicant Exposure
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Sources of Indoor Environmental Health Risks

• HOME
• SCHOOL /
• DAY PROGRAM/
• WORK

• Lead paint from older, deteriorating housing
• Contaminated drinking water
• Pesticide exposure from foods and home spraying
• Mercury
• Contaminated indoor air from ETS radon, carbon
  monoxide, household products
• Hazardous chemicals in schools, mold, cleaning
  supplies, products used in employment settings.

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Community-Based Residential Settings
Source D. Braddock, R. Hemp, S. Parish, and M.C.
Rizzolo, The State of the States in Developmental
Disabilities (final report), Chicago University
of Illinois at Chicago, Department of Disability
and Human Development, (in press).
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Home Environmental Health Risks

• Lead
• Mercury
• Carbon Monoxide
• Radon
• Pesticides/ Household Products
• Environmental Tobacco Smoke

• Home age, windows, pipes
• Metallic, fish consumption
• Potential exposure, protective devices
• Abatement, testing
• Use patterns, routine contracts, specific
  products
• Use inside home

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Common Household Exposures

• Lead
• Mercury
• Radon
• Carbon Monoxide
• Pesticides

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Lead

• Household Exposures
• Older homes
• Chipped, peeling, and flaking paint
• Home renovation products like sanding
• Old windows, porch,

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Lead

• 74 of homes built before 1980 contain lead based
  paint (CDC, 1991)
• In adults, low dose cumulative lead exposure is
  inversely associated with scores on cognitive
  function tests ( Weisskopf et al, 2004, Shih et
  al, 2006)
• In non-occupationally exposed adults, blood and
  bone lead levels are associated with increased
  systolic blood pressure
• (Bener, 2001, Cheng et al 2001, Glenn et al
  2003, Martin et al 2006)

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Results - Lead
9 Homes built before 1978 not tested
Del Bene Davis, 2006
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Mercury

• Household Exposures
• Medical thermometers, BP cuffs, thermostats,
  fluorescent lights.
• Dietary sources - Fish

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Mercury

• Exposure to methylmercury in adults has been
  associated with neurobehavioral abnormalities in
  adults ( Yokoo et al, 2003, Carta et al, 2003)
• Methylmercury exposure in adults has also been
  associated with increased cardiovascular risks
  such as acute MI (Salonen et al, 1995, Guallar,
  2002)

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Results - Mercury
Del Bene Davis, 2006
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Carbon Monoxide Exposure
Source EPA, 2005
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Carbon Monoxide

• Low dose CO exposure is associated with
  impairment of higher cognitive function such as
  memory, new learning, attention and concentration
  (Amitai et al, 1998)
• CO exposure is associated with myocardial injury,
  hypo-perfusion of cardiac tissue, EKG changes and
  cardiac arrest (Raub, 2000, Satran et al, 2005)

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Results Carbon Monoxide
No CO detectors in 21 out of 28 homes where
there was at least one CO source
Del Bene Davis, 2005
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Radon
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Radon

• Radon is ranked as the second leading cause of
  lung cancer (ACS, 2006)
• Radon levels above the EPA action level of 4
  pCi/L are common in Anne Arundel County other
  Maryland counties (EPA, 2006)

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Results - Radon
Del Bene Davis, 2006
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Pesticides

• Household pesticides are designed to kill by
  being toxic to the nervous or reproductive
  systems
• Many commonly available household pesticides can
  be rapidly absorbed through the lungs and skin

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Pesticides Sources

• Pesticides are used in
• Homes,
• Schools
• On food crops,
• In commercial buildings,
• Gardens, lawns
• Exposure occurs primarily from ingestion of food
  products and from residential or commercial use
  (CDC, 2001)

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Results - Pesticides
21 out of 49 houses with pesticide spraying every
three months or more frequently
Del Bene Davis, 2006
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Volatile Organic Compounds

• General short term acute health effects of
  exposure to these compounds cause respiratory,
  eye and throat irritation, loss of coordination
  and dizziness, and exacerbation of asthma and
  respiratory conditions (EPA, 2006)
• Long term health effects of some of these VOCs
  are cancer, liver, kidney and CNS damage (EPA,
  2006)
• In a study of children, home formaldehyde
  exposure was associated with increased risk of
  allergic sensitization to other common allergens
  ( Garrett et al, 1999)

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Results - VOCs
Del Bene Davis, 2006
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Environmental Health Risks in Residential
Settings - Summary

• 9 out of 27 homes built before 1978 were not
  tested for lead
• 9 out of 57 homes contained mercury thermometers
• 56 out of 57 homes were not tested for radon

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Continued

• 21 out of 28 homes with at least 1 one combustion
  source had no CO detector
• 86 of homes had a professional pesticide
  spraying contract
• 95 of homes reported using air fresheners
• 70 of homes had six or more cleaning supplies

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Steps to Minimize Risks

• Lead safe housing
• Reduce environmental mercury and mercury intake
• Carbon monoxide detectors and vented appliances
• Integrated pest management
• Green cleaning / safer household product
  alternatives

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Resources

• National Library of Medicine Household Product
  Database (http//householdproducts.nlm.nih.gov/)
• National Library of Medicine Tox Town
  (http//toxtown.nlm.nih.gov/)
• Coalition to End Lead Poisoning
  (http//www.leadsafe.org/)
• EPA Carbon Monoxide (http//www.epa.gov/iaq/co.htm
  l )
• Environmental Working Group (http//www.ewg.org )
• Citizens Guide to Radon (http//www.epa.gov/radon
  /pubs/citguide.html )
• Beyond Pesticides (http//www.beyondpesticides.org
  )

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• Questions