Home Environmental Health Hazards: Assessment

and Risk Reduction

January 13, 2009

Indoor Environments and Health

Nurses and Home Environmental Health Risks

Perez, National Library of Medicine

Common Household Exposures

Lead Mercury Radon Carbon Monoxide Pesticides

Lead

Household Exposures• Older homes• Chipped, peeling, and

flaking paint• Home renovation

products like sanding• Old windows, porch,

Lead – Effects on Children

Affects children’s immune, nervous, and renal systems

Linked to developmental disabilities Linked to growth retardation in children,

children have short stature and increased BMI (Kim et al., 1995)

Lead

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)

Mercury

Household Exposures

• Medical thermometers, BP cuffs, thermostats, fluorescent lights.

• Dietary sources - Fish

Mercury – Effects on Children

Attention deficits, hearing impairments, vision impairments

Linked to damage to the brain, kidneys, and developing fetus

Developmental disabilities

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)

Carbon Monoxide Exposure

Source: EPA, 2005

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)

Long Term Effects

Cognitive impairment Dementia, Parkinson’s Memory, attention and

concentration problems Neuropsychiatric

problems: depression, anxiety, irritability personality changes

Frequent job loss Loss of IQ

Radon

Radon – Health Effects

• Radon is the second leading cause of lung cancer after smoking

• There is no established “safe” level of radon

• Smokers who are exposed to the average household level of radon 1.3pCi/L have a 20 in 1000 chance of dying of lung cancer versus 2 in 1000 for the non-smoker.

Source: A Citizen's Guide to Radon  The guide to protecting yourself and your family from radon, http://www.epa.gov/radon/pubs/citguide.html

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

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)

Pesticides – Effects on Children

Household exposure doses can result in: Headache Weakness, Dizziness, restlessness, Anxiety, confusion, Skin and respiratory irritation Central nervous system depression, and lowering of

the seizure threshold.

Amount of Pesticides Used in the U.S.

By Pesticide Group, 2000 and 2001 Estimates ( EPA)

1. See Table 3.4 (conventional pesticides) for additional details and

Pesticide GroupTotal (Mil lbs)

2000 2001

Conventional Pesticides (1) 926 888

Other Pesticides (2) 308 315

Specialty Biocides (3) 353 363

Chlorine/Hypochlorites (4) 2,532 2,609

Wood Preservatives (5) 809 797

Total 4,928 4,972

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)

Household Products

National Library of Medicine Household Product Database

Home Environmental Health and Safety Assessment Tool

Assessment Yes No N/A Standard of Practice

Home built before 1978 O O O

Home tested for lead O O O

Living space in basement O O O

Attached garage O O O

Home radon test O O O

Home radon ventilation system O O O

Living space in basement O O O

Test homes built before 1978 for lead.

Maintain home to prevent chipping or peeling paint

Remove shoes indoors Test first three floors of

all homes for radon Do not idle care in

garage

Combustion heating source O O O

Gas, kerosene or propane space heater O O O

Wood stove O O O

Fireplace O O O

Ensure proper venting of all combustion heating sources.

Annual assessment to ensure proper function.

Do not use grills, or generators indoors

Gas dryer O O O Vented O O O Gas hot water heater O O O Vented O O O

Gas stove O O O

Gas dryers, hot water heaters and stove need to vent outdoors

Well water O O O Lead pipes O O O Water tested for contaminants O O O

Known contaminants: O O O

Routine well testing and maintenance of private wells.

Review consumer confidence reports for public water supply

Smoke detector O O O Carbon monoxide detector O O O Fire extinguisher O O O Fire evacuation route O O O Emergency phone numbers O O O Disaster plan O O O

Shelter –in-place supplies O O O

Smoke detector on all floors and in bedrooms

Carbon monoxide detector on all levels in homes with combustion source or garage

Assessment Yes No N/A Standard of Practice

Insects in home O O O

Rodents in home O O O

If yes what: ________________________________

Pesticide spraying in home O O O

If yes what / how often:______________________

Pesticide contract O O O

Frequency:_________________________________

Use of integrated pest management techniques for controlling pests.

Use least hazardous methods of pest control

Air freshener used in home O O O Candles O O O

Plug-ins O O O

Incense O O O

How many times per day: O O O

Use of strong smelling cleaners O O O

Minimize use of air fresheners. Use less hazardous and irritating alternatives to control odors.

Use of low VOC household cleaners and green cleaning techniques.

Tuna fish served in home O O O

If yes, how often per week:__________________

Fresh fruit/vegetables used O O O

Local/ organic products used O O O

See federal and state recommended fish consumption advisories

Wash all fruits and vegetables before eating

Consider organic or locally grown products

Mercury thermometer in house O O O Other mercury devices O O O

Needle boxes for needles O O O

Use of traditional or cultural remedies containing mercury O O O

Use non-mercury containing medical devices

Dispose of all mercury devices and batteries per local hazard waste collection procedures

Smoking allowed in home O O O House smells like smoke O O O

Cigarette products present O O O

Institute no smoking indoors policy

Other Assessment Tools

http://www.neetf.org/

Resources for NursesEnvironmental Health and Nursing Practice ( 2003)Springer Publishing Company

ATSDR Environmental Health Nursing Initiativehttp://www.atsdr.cdc.gov/EHN/

Pediatric Environmental Health ( 2nd Ed) available at www.aap.org/bookstore

The National Environmental Education and Training Foundation http://www.neetf.org/Health/index.htm

Physicians for Social Responsibility http://www.psr.org/home.cfm?id=environment

National Library of Medicine – Environmental Health and Toxicology, Specialized Information Services http://sis.nlm.nih.gov/enviro.html

Questions