Arsenic in the U.S. Beverage Supply: A Curiosity or a Danger?

A flurry of studies originated by a broad range of people from researchers at universities to popular TV personalities like Dr. Oz have presented an often conflicting view of how much arsenic is found in what kinds of beverages at what risk to children. Arsenic, like lead, can have both development and neurological effects in young children, leading to substantial drops in IQ for consistent or chronic exposures. Arsenic can also cause multiple types of cancer, including that of the lungs and bladder, over long term exposures for both children and adults.

The purpose of this lecture is to review the past three years of experimental studies on arsenic in various beverages and to assess the health risk that arsenic in these beverages poses to various populations of American consumers, especially children. Children typically consume more fluid per body weight than adults and are particularly vulnerable to neurological damage from chronic arsenic exposure. While the EPA exposure limit for arsenic in drinking water is 10 parts per billion, no comparable exposure limit exists for juices, wines, sodas, or other beverages. In many cases, these beverages are consumed at levels approaching those of drinking water (especially by children). Families and communities lack a definitive guideline for how much of these contaminated beverages can be consumed before children run a substantial risk of chronic arsenic poisoning. Further, certain countries of origin, like China, have been implicated in contaminating the U.S. beverage supply. Is this a fair assessment, or does the problem extend well behind a particular country of origin? Given the types of beverages Americans drink on a daily basis, which groups of consumers, if any, are vulnerable to chronic arsenic poisoning?

This lecture session looks at the facts, side by side, for beverages ranging from drinking water to juices and to wines, and seeks to answer these questions, unpacking data from various studies to pull together a comprehensive conclusion and action plan to the problem of arsenic in consumer beverages.

Determination of School Site Radon Potential in Los Angeles County, California

Select communities in Los Angeles County, California that are located on uranium-rich subunits of the Miocene Monterey Formation have been found to exhibit significant indoor radon levels. Since uranium is the source of radon gas, other areas underlain by related sediments may also contain high-risk neighborhoods that may be overlooked due to a lack of data or inaccurate extrapolations. Because radon is a serious health hazard that accounts for approximately 21,000 cancer deaths each year, identification of specific radon-prone neighborhoods and school sites can help to reduce student exposure to this known carcinogen. Current methods for identifying radon-prone areas include the use of indoor radon measurements, geological subunit composition, and aerial radiometric data collected for the National Uranium Resource Evaluation (NURE) Program during the early 1970s. Unfortunately, due to air space restrictions, many densely populated areas where radiometric measurements would be the most beneficial were not surveyed by the NURE effort. The present study suggests that site-specific gamma-ray spectrometry measurements that directly measure surface uranium concentrations can be an accurate and cost-efficient method for assessing the radon potential of specific school sites on the Monterey Formation. Furthermore, comparisons with reference school districts with both classroom radon data and school site uranium measurements can be used to generate more precise risk assessments for the targeted schools.

CSI: Twin Falls, Idaho

On September 15, 2009, elemental mercury was discovered splashed around a small area within a parking lot of an apartment complex in Twin Falls, Idaho. Local and state fire and hazmat teams responded immediately, as did the Idaho Department of Environmental Quality (DEQ), the South Central Public Health District (SCPHD), and the U.S. Environmental Protection Agency (EPA). These agencies joined together in Unified Command and combined resources to assess, stabilize, and mitigate the incident while calmly dealing with the close attention from the local media. A public health concern quickly surfaced due to several factors: the source and quantity of the mercury were unknown, the timing of the incident was vague, school-aged children were involved. The concern was heightened due to the potential dangers of mercury exposure, the possible spread of contamination in homes and school, and the intense media coverage.  That concern was confirmed by data gathered by EPA and hazmat entry teams showing high levels of mercury vapors on the parking lot and inside one family’s apartment unit. Ultimately, the agencies were able to determine the mercury contamination was limited to the apartment and parking lot, and did not affect other homes, the school bus, or school. The apartment has since been remediated and family returned (after being evacuated from their residence).  Some of the “lessons learned” of the response were the importance of incident command leadership, each partner doing their jobs well and staying in their lanes, and open communication between the partners. While EPA provided equipment and technical assistance to the incident response and DEQ handled media inquiries, SCPHD worked smoothly with the school district and children to ascertain the exact number of children involved, to locate the source and amount of mercury spilled, and to provide valuable outreach to the affected families and larger community. This emergency response was a huge success as a result of close cooperation between local, state, and federal agencies. Awards were given to all partners involved by EPA in recognition of their exemplary performance and interagency cooperation during the mercury emergency response.

Lead guidelines for children’s play areas: The need for clean soil policies to protect children

Children’s empirical response to lead (Pb) in soil and revised policy needs are discussed. The median US background soil Pb is 16.5 mg/kg (range 10.3 to 30.1 ppm), and soils of urbanized areas (UAs) are often 500-1000 ppm or more. Two Pb products, Pb-based paint and additives in gasoline contaminated UAs, and 1950 through 1982 fuel sales by state accounts for ~1.4 million metric tons (MT) Pb of the US total of 4.6 million MT in the same years. Aerosol inputs into the 90 UAs from gasoline Pb additives range from 100’s to more than 100,000 MT of Pb depending on traffic flows. Soils are a sink and a source of urban Pb dust.

The response of children to urban soil Pb contamination in New Orleans serves as a case example. The maximum of ~1811 MT lead (Pb) in exterior paint on 86,000 New Orleans houses, compares with ~12,000 MT from vehicle exhaust yielding ~ 9100 MT Pb; ~4850 MT were particles >10 µm and ~4200 MT were <0.25 µm. Brick public properties in the inner city had significantly more Pb contamination and higher prevalence of elevated children’s blood Pb than same-aged brick public properties in the outlying urban areas. The median Pb dust in the inner-city soil was 438 mg/kg or 3.7 times larger than median soil Pb of 117 mg/kg (p-value <0.0001). The prevalence of children’s blood Pb ≥ 10µg/dL was 22.9% within the inner-city and 9.1% in the outlying areas of New Orleans (p-value <0.0001). Lead dust from gasoline additives explains the discrepancy of soil Pb and children’s blood Pb in the traffic congested inner-city core compared with the lower traffic outer areas of New Orleans. Similar patterns of environmental Pb dust contamination and childhood Pb exposure are expected in all US cities. To meet the goal of primary childhood Pb prevention, the findings underscore the need for revised soil policies that act to eliminate the impact on children of Pb dust that has accumulated in urban soils.

Sanitation in Classroom and Food Preparation Areas in Child Care Facilities in North Carolina and South Carolina [POSTER]

Introduction:  Approximately 60% of U.S. children age 5 and younger spend time in child care settings.  Such environments increase risk of enteric disease, including foodborne illness.

 

Purpose: To describe adherence to sanitation standards in classrooms and food preparation areas in child care facilities in the southeastern United States.  

Methods:  Site visits were conducted at 35 licensed child care facilities: 27 centers (77%) and 8 homes (23%). Data were collected in two classrooms at 16 facilities; thus, the sample size for classroom-level data was 51 (43 rooms for centers and 8 homes). Data collection methods included questionnaires, audits, observations, and environmental samples. Audits in up to two classrooms (an infant, toddler, and/or combined infant/toddler classroom) at each facility and the food preparation area were performed using a form similar to a regulatory inspection form. Audit data were used to calculate indices to describe adherence to sanitation standards based on the 2009 FDA Food Code and guidance from food safety experts.

Results:  The mean classroom sanitation index (0-8) was 7.7 (SD=0.7) and the mean food preparation area sanitation index (0-10) was 7.2 (SD=1.4). Items with low compliance included availability of a sanitizer test kit and use of hair restraints by food handlers. For classrooms with a refrigerator used to store food and beverages for children, 40% of centers and 75% of homes had refrigerators with ambient temperatures > 39°F. For facilities with a separate food preparation area, 48% of centers and 63% of homes had refrigerators with ambient temperatures > 39°F. 

Significance: Most facilities participating in this study adhered to sanitation standards within the classroom; however, improvements with regard to sanitation in food preparation areas and refrigerator operating temperature are needed.  These results, in conjunction with observational data and microbiological analysis of environmental samples, provide insight into risk factors for enteric disease transmission in child care facilities. 

Pediatrician's Perceptions on Child Lead Poisoning

Despite national reductions in reported cases of child lead poisoning, the illness still disproportionately affects many socially disadvantaged communities. No previous research has identified the extent to which pediatricians consider and utilize environmental interventions within treatment protocols.  Quantitative and qualitative methods were used to analyze pediatricians' perceptions on environmental contributors and interventions related to the issue of child lead poisoning. Within an assessment study, more than 100 pediatricians revealed their perceptions about environmental causes and interventions for child lead poisoning. Logistic regression and split data anaylsis were used to quantify pediatrician perceptions. The study revealed that pediatricians with more than half of their patients receiving Medicaid assistance were  approximately twice as likely to emphasize the importance of environmental issues in matters relating to child lead poisoning (OR 2.62, 95%CI 1.15-5.96).

Identification and Evaluation of Pediatric Environmental Exposures

Health care providers and public health officials are increasingly asked to evaluate a child's health risk from long or short-term exposures to environmental agents. As children (and fetus) develop and grow, they pass through critical windows of susceptibility and are more vulnerable than adults to environmental toxicants.  PEHSUs (Pediatric Environmental Health Specialty Units) are a network of academically based pediatricians, toxicologists, exposure scientists, and others capable of responding to requests for information and offering advice on prevention, diagnosis, management, and treatment of environmentally-related health effects in children. PEHSUs also provide training on pediatric environmental health, including translation of research findings into practice or policy for health care professionals, public health officials, community groups, and others. 

The environmental history is an important tool to identify potentially significant environmental exposures. The environmental exposure history is enhanced by environmental measurements to characterize the intensity of environmental exposures. Following an introduction to pediatric environmental health, case examples from the University of Washington PEHSU will highlight the utility of exposure measurements in the determination of pediatric environmental health risks. Cases include exposure to petrochemicals in contaminated drinking water and soil, an indoor air quality problem in a public school and pesticides exposure due to spray drift.   The environmental exposure history is critical to the identification of pediatric exposures of concern, and exposure evaluation enhances the risk assessment and risk communication.  Funded by the CDC and EPA through an agreement with the Association of Occupational and Environmental Clinics, the PEHSU network is a useful pediatric environmental health resource.

Effectiveness of Local Lead Poisoning Prevention Laws

While federal law provides an overall public policy framework to prevent childhood lead poisoning in the US, primary prevention remains a task that must occur at the local level.  This presentation discusses the proposition that local jurisdictions are most effective at preventing childhood lead poisoning when three key elements are in place: (1) local law that is strong enough to achieve primary prevention; (2) the political will to enforce such law; and (3) a legal structure realistically compatible with local (private and public) financial resources. 

Three local jurisdictions provide the setting for a closer look at the above proposition.  Representatives from the City of San Diego (CA), from Rochester (NY), and from the District of Columbia (Washington DC) will provide highlights from their respective local lead laws, a history of enforcement efforts to date, and a brief discussion about the apparent effectiveness of their respective local efforts at primary prevention, including insights about lessons learned along the way.

This presentation will provide attendees with valuable information about what makes for effective lead poisoning prevention legislation and how to establish a viable enforcement system.  All three speakers were intimately involved in the crafting of their respective local laws.  All three are prepared to discuss the outcomes to date of local enforcement efforts and are eager to address any questions attendees may have about recommendations for other jurisdictions.

Children's EH Power Point Program [POSTER]

Promote the Dow Grant/NEHA endorsed Children's PP Program to attendees via poster and brochures.

Children & Environmental Chemicals: Are they more vulnerable?

Children are obviously our most beloved resource. Therefore protecting them from harm via public health policies should be of utmost importance to all health practitioners. Health policies should be based, however, on sound, peer reviewed science regardless whether they are for adults or children. However over the past decade or so, there seems to be a movement to use hypothetical risk to children for the formation of new policies, when the real risks to children seem to go unattended. Hypothetical risk would include trace levels of environmental chemicals such as pesticides, food additives, and environmental contaminants such as dioxin and PCBs. The basic tenet behind eliminating even trace elements of such chemicals is based on idea that children are more suseptable to trace levels than adults, so regulations must be more stringent. However, does science really support this principal? Are children more vulnerable to trace levels of environmental chemicals?

Extreme Green Cleaning: Cleaning without chemicals

Studies by the U.S. Department of Environmental Protection have shown that using less toxic and chemical-free cleaning products and processes have effectively reduced the absenteeism rates in schools; resulting in lowering reported asthma and other respiratory ailments associated with poor air quality created by traditional cleaning products.

Chemical Free Cleaning implies that the act of cleaning must leave no chemical residual in the air or on any surface. There must be no toxic result to the user or building occupants including allergic reactions, and there must be no insult to the environment as a result of the cleaning technology used. Chemical Free Cleaning is therefore based on the empowerment of water. Several new and emerging technologies show considerable promise in cleaning and biocidal effectiveness.

Food Safety Risk, Response, and Resources: A School Food Service Action Guide

The goal of Food Safety Risk, Response, and Resources: A School Food Service Action Guide is to provide easy-to-use resources, communication sheets, and fact sheets to assist in reducing the risks of foodborne illness. The key to successfully addressing foodborne illness is communication with members of the school community who are involved with food safety including food and nutrition directors, local health departments, school nurses, district school board members, and parents.

Students and staff consume billions of meals and numerous snacks each year in U.S. schools. The Centers for Disease Control and Prevention (CDC) estimates that 48 million people have a foodborne illness each year. An estimated 3,000 individuals die each year as a result of contracting a foodborne illness.

Between 1998 and 2006, 298 outbreaks have been reported where food was prepared on the school premises. However, the percentage of outbreaks from schools is less than 4% of the total outbreaks nationwide. The reporting data supplied by the states does not distinguish between outbreaks involving school meal programs and those involving food items from other sources such as food bought from home to be used as part of a classroom instruction activity or a social event.

However, over a ten year period, there were 40 outbreaks that were directly attributed to school meal programs (GAO, 2003). The cost in medical expenses, lost income and lawsuits is billions of dollars (Scallan E. and others, 2011). USDA estimates that medical costs and productivity losses due to foodborne illnesses range between $6.5 billion and $34.9 billion annually. Foodborne illnesses affect the health of students and staff, causing symptoms that range from mild discomfort to chronic illness and death. If students or staff became ill with a foodborne illness, they are likely to miss school and students’ full learning potential may not be fulfilled. Preventing foodborne illness and preparing a food-safe school environment for the millions of young people that attend school and consume millions of meals each day is a critical matter of school safety and preparedness.