Flashcards in Environmental Health Deck (225):
One of the primary determinants of individual and community health
Basic nursing competencies in environmental health
1. Mechanisms and pathways of exposure to environmental health hazards
2. Basic prevention and control strategies
3. Interdisciplinary nature of effective interventions
4. Role of research and advocacy
5. Diagnosis, treatment and prevention of environmentally related diseases
6. History taking
7. Exposure assessment
8. Risk communication
9. Required reporting
Environmental health comprises...
Those aspects of human health, including quality of life, that are determined by physical, chemical, biological, and social and psychologic problems in the environment
Environmental health refers to...
The theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially adversely affect the health of present and future generations
Number of chemicals that did not exist before the 1940s that have been introduced into the environment
Tens of thousands
Publicly accessible toxicity data are not available for ----- of the 3,000 high-production industrial chemicals
Of the top 20 environmental pollutants that were reported to the EPA in 1997, nearly 75% were known or suspected -------
-------- pounds of pesticide products are intentionally and legally released each year in the United States
More than 50% of Americans live in an area that exceeds current national ambient air quality standards for......
2. Nitrous oxide
3. Sulfuric oxide
Number of states that have issued one or more health advisories for mercury in their waterways
Number of states that have issued advisories for mercury for every lake and river within their borders
Number one cause of air pollution in the United States
Mobile sources (motor vehicles)
Substances found in measurable quantities in the nation's streams
2. 17-b estradiol
Number if Americans who drink water that contains contaminants which exceed one or more of the EPA safe drinking water standards
Common contaminants in drinking water
2. Other heavy metals
Body systems in laboratory animals affected by combinations of commonly used agricultural chemicals in levels typically found in groundwater
1. Immune system
2. Endocrine system
3. Neurological system
Thirty seven pesticides registered for use on food are...
Radon may be responsible for 20% of --------- among non smokers
Examples of endocrine disrupters
2. Polychlorinated biphenyls
3. Many pesticides
Endocrine disrupters appear in ----- of the population
Which diseases severity is increased by poor indoor and outdoor air quality
Host factors that determine the relationship between environment and health
3. Genetic makeup
4. Underlying diseases
5. Dose-response factors
6. Length of time exposed
Environmental health is based on what type of model?
Public health model with a emphasis on prevention
Preventive interventions in environmental health include:
1. Pollution prevention
2. Product design
3. Engineering controls
4. Purchasing choice
US environmental standards are based on health risks to...
2. 70kg (154lb)
Environmental standards may not provide sufficient protection to:
1. Pregnant women and fetuses
2. Young children
3. Frail and elderly
Synthetic chemicals can be found in...
Synthetic chemicals can be found within -------- in measurable amounts
There is limited information regarding ------------- associated with many of the synthetic chemicals in our environment
Human health effects
Neurotoxins account for more than -------- pounds released into air, water and land
In 1998 Consumer Reports tested leading-brand beef baby food and measured....
Dioxin levels the exceeded the EPA allowable quantities by 100 times
Several pesticides and herbicides have been linked to.....
Exposure to endocrine disrupters very early in life can have the potential to disrupt critical endocrine pathways with the possibility of causing adverse effects to...
1. Reproductive systems
2. Neurologic systems
3. Immunologic systems
Risks that occur in environments where people live, work, play and learn
Chemical and radiologic exposures can be.....
Occupational and environmental health nurses must assess a person's ----- exposure to environmental risks in order to understand and address potential health threats
Very specific gestational ages can be associated with....
Exquisite vulnerability to the effects of certain toxic chemicals
Opportunities for informed decision are created by...
Information via labeling and other forms of "right to know"
Potential environmental exposures and environmentally related diseases can be assessed....
2. Community wide basis
Individual environmental health assessments should take into account all potential exposures including....
National Library of Medicine's resource that provides easily accessible, peer reviewed information about the potential health hazards in our environments
ToxTown covers a broad range of information about health risks associated with...
6. Drinking water
7. Recreational water
10. Hazardous waste sites
13. EMFs (electric and magnetic fields)
Within ToxTown there is a database of likely chemical exposures associated with....
An extensive list of specific job categories
Household product information found on www.household.nlm.nih.gov
1. Auto products
3. Home maintenance
4. Pet care
5. Arts and crafts
6. Personal care
7. Cleaning products
---------- provides high quality information regarding children's exposures; their e-house website specifically provides information about home related environmental health risks
The Children's Health and Environment Coalition
The EPA website provides...
A range of environmental exposure information
EPA website that provides geographically related information
EPA website provides air, water and hazardous waste site information by location/region
The Children's Environmental Health Network
Website that has developed a health assessment tool for children
- University of Maryland's website
- Has a home assessment survey that includes information about the health implications of environmental exposures
Agency of Toxic Substances and Disease Registry
- agency within the CDC
- created ToxFacts
Provides excellent toxicological information on chemicals that are commonly associated with environmental health risks
Community environmental health assessments identify potential exposures in
1. Water (including drinking water)
2. Air (including indoor air)
3. Dust (including lead based paint particles)
4. Soil (including exposures from current and previous land use)
5. Radiation (ionizing and nonionizing)
Environmental assessments may depend on extrapolating from...
Aggregate national, statewide, county or metropolitan exposure data
Geographic information system (GIS)
-A method for assessing community risks to environmental exposures and potential health problems
-consists of computerized mapping of graphically related data
-environmental and exposure data can be entered and evaluated for geographic relationships
-data can be presented in map form
Sources of more information on GIS
2. Agency for Toxic Substances and Disease Registry
3. Geography departments in universities
Essential competences for environmental health assessments
1. Federal, state and local health and environmental statues and regulations
2. Practices regarding what data are collected and how they are accessed
Principle sciences used to determine the relationship between environmental exposures and health outcomes
Epidemiology and toxicology
Uses epidemiologic techniques to examine environmental exposures
Study design of choice in environmental health
Analytical studies (cohort and case control)
Type of study rarely done in environmental health
Because it is unethical to intentionally expose individuals or communities to environmental hazards
Cluster investigations are often used to...
Respond to community concerns about an excess of cancer or birth defects
Common results of cluster investigations
Negative or equivocal results
Cluster investigations are most convincing when....
The disease in question is rare and very specific for the putative etiologic exposure
Example of a disease that a cluster investigation would be useful
Asbestos causing mesothelioma
Limitations of environmental epidemiology
1. Exposures often poorly defined and measured
2. A very limited understanding of mixed exposures
3. Relatively small number of individuals constitute the study populations
4. Lack of understanding about variability in the susceptibility of segments of the populations
5. Long latency between many environmental exposures and the evidence of chronic disease
Most common type of environmental exposure
Why is small study population a limitation of environmental epidemiology
Small study populations yield limited statistical power to detect an association between exposures of concern and health effects
Segments of population that could have variable susceptibility rates
1. The poor
Why is lack of understanding about variability of susceptibility in a population a limitation of environmental epidemiology
It limits the ability to compare findings across studies
The science that examines the toxic effects of agents in the environment
The science that investigates the adverse affects of chemicals on health
Toxicology is similar to...
The effects of hazardous chemicals can be...
1. Immediate (acute)
2. Long term
3. Present after a latency period
Effect of hazardous chemicals often associated with presentation after a latency period
Host factors that must be considered when looking at hazardous chemicals
5. Drugs that a person may be taking
6. Pregnancy status
Host factors may affect....
The therapeutic or toxic effect of a drug or chemical
Hazardous chemical exposures are often....
Scientific study of the origin, nature, chemistry, effects and use of drugs
Science that investigates the adverse effects of chemicals on health
Definition of dose in pharmacology
Refers to the amount of a drug absorbed from an administration
Definition of dose in toxicology
Refers to the amount of a chemical absorbed into the body from a chemical exposure
Definition of administration in pharmacology
A drug can be administered:
1. One time
2. Short term
3. Long term
Definition of exposure in toxicology
The actual contact that a person has with a chemical
1. One time
2. Short term
3. Long term
Dose-response curve in pharmacology
Graphically represents the relationship between the dose of a drug and the response elicited
Dose-response curve in toxicology
Describes the relationship of the body's response to different amounts of an agent such as a drug or toxin
Routes of administration in pharmacology
Routes of entry in toxicology
3. Dermal absorption
In pharmacology with drugs there are ------- (desirable effects) and ----- (undesirable effects)
In toxicology only ----- effects are of concern
The ability of a chemical to damage an organ system, disrupt a biochemical process or disturb an enzyme system
In pharmacology beyond the therapeutic dose a drug.....
May become toxic
Potency in pharmacology
Refers to the relative amount of a drug required to produce the desired response
Potency in toxicology
Refers to the relative amount of a toxic chemical it takes to elicit a toxic effect compared with other chemicals
In pharmacology examples of biologic monitoring and the drugs it is done for
1. Anticoagulants (warfarin) and clotting time
2. Digoxin and actual drug levels
In toxicology examples of biologic monitoring and the toxic exposures it is done for
1. Lead and Blood lead levels
2. Environmental tobacco smoke and metabolites of chemicals such as cotinines
US regulatory process for drugs includes....
Several stages of animal and human testing
US regulatory process for hazardous chemicals that are not food or drugs....
Requires virtually no original testing
How many chemicals in widespread use today-including those regularly found in human tissue, including umbilical cord blood and amniotic fluid- have been submitted to any testing to determine possible neurologic, reproductive or developmental impacts?
European Union chemical policy
EU comprehensive chemical policy that requires more pre-market testing and disclosure than in the US
E: evaluation and
A: authorization of
Examples of unique risks that children have related to environmental exposures
1. Different metabolic and physiologic processes from adults
2. Normal exploratory behavior
3. Spend 90% of day in a variety of indoor environments
4. Children born today will cumulatively have more exposures to toxic chemicals than children born previously
5. Exposure to toxins can cause permanent damage
6. Exposure to toxins in diet is significant
Children have higher rates of absorption of toxic materials than adults via the following routes
What types of normal exploratory cause children to have increased opportunities to ingest toxins?
1. Hand to mouth activity
Main indoor environments where children spend 90% of their time on developed countries
2. Day care centers
4. Motor vehicles
Chemicals and pollutants often present in indoor environments
1. Tobacco smoke
2. Building materials
3. Consumer products
5. Insects and other pests
7. Inadequately ventilated cooking and heating devices
8. Influx of outdoor air pollutants
The concentration of indoor pollutants can be ------- than outdoor pollutants
4 to 10 times more
Exposure to environmental toxins can disrupt and cause permanent damage to the following developing systems:
Main source of child's exposure to toxic chemicals through their diet
1. Pesticide residues on apples and other fruits/vegetables
2. Lead in drinking water
3. Polychlorinated biphenyls and dioxins in breast milk
----- have not been routinely included in environmental risk assessment
Most environmental health regulations are based on studies on ----------
------------ can create varying degrees of vulnerability to toxic chemicals, even in healthy humans
Humans developmental stages
Reproductive disorders that may result from exposure to toxic substances
1. Male and female infertility
2. Menstrual irregularities
3. Spontaneous abortion or fetal loss
4. Major and minor birth defects
5. Developmental abnormalities
------ US children live within four miles of a toxic waste dump
Living close to a toxic waste dump creates increased potential for hazardous chemical exposures via....
2. Drinking water
3. Direct contact
------ children in the US exceed currently acceptable levels of lead in their blood
Acceptable blood lead level for child
10 microliters/dl or less
Lead exposure is associated with...
1. Behavioral effects (violent behavior)
2. Cognitive effects
Environmental tobacco smoke is responsible for ------ lost school days by children
Epidemiologic studies suggest a relationship between nitrates in drinking water and -------
------ of the children in Arkansas who live near an herbicide manufacturing plant had herbicide residues in their urine
-------- is the number one reason that children miss school and are hospitalized in the US
Over -------- children under the age of 18 are affected by asthma in the US
Indoor triggers for asthma include:
1. Second hand smoke
2. Dust mites
3. Cockroach feces and exoskeleton dust
Outdoor triggers for asthma include:
2. Nitrogen oxides
3. Diesel exhaust
Children can be exposed directly by contact to -------- in play structures, decks and other items
Arsenic treated (chromated copper arsenate) wood (ie treated wood or pressure treated wood)
Arsenic from treated wood can leach.....
Into groundwater that may be a source of drinking water
--------- are more sensitive to the effects of ozone
Pollutants in some fish can cause.....
Toxic chemicals that are know. To affect the brain and can play a role in brain disorders
5. Tobacco smoke and nicotine
6. Bisphenol A
Lead exposures during infancy and childhood can cause:
1. Attention problems
3. Impulsive behavior
4. Reduced IQ
5. Poor school performance
7. Delinquent behavior
Mercury crosses the placenta
Mercury exposure in pregnant women can impair.... of unborn child
2. Language development
3. Visual-spatial skills
The "safe" level of mercury continues to ----- the more mercury is studied
High levels of manganese in hair is associated with.....
Laboratory experiments with animals link manganese with......
2. Parkinson's disease
PCBs, especially in fatty tissue can....
1. Impair reflexes and IQ
2. Delay mental development and development of motor skills
3. Associated with hyperactivity
One of the best studied agents for its effects on the developing brain
Tobacco smoke and nicotine
Children born to women who smoke during pregnancy are at risk for....
1. IQ deficits
2. Learning disorders
3. Attention deficits
Bisphenol A effects on brain
Alters the expression of genes that are important for long term memory formation and for early brain development
A rocket fuel that now contaminate drinking water in many communities in the western United States
Effects of perchlorate
Interferes with thyroid hormone control of brain development in mice
Solvent that causes learning, speech and motor skill problems in children
Refers to the fair treatment for people of all races, cultures, incomes, regarding the development of environmental, laws, regulations and policies
The environmental health status that poor communities experience is compounded by effects of:
1. Poor housing
2. Poor nutrition
3. Poor access to healthcare
6. Employment in the most hazardous jobs
Environmental risk burden is generally greater for...
Minorities and those who are economically disadvantaged
Why is the environmental risk burden get ally greater for minorities and those who are economically disadvantaged?
They are exposed to a greater number and intensity of environmental pollutants in food, air, water, homes and workplaces
The National Health and Nutrition Exam Study results indicate....
Minority women have higher levels of toxic chemicals in their bodies than do white women
Information sharing may be less effective in economically disadvantaged communities as a function of....
Language and literacy issues including the challenge of understanding technical language in warning signs and other right to know material
Indicators of increased environmental risk burden include:
1. Proximity to hazardous waste sites, polluting industries and incinerators
2. Substandard housing
What substandard housing conditions place people at increased environmental risk?
1. Friable asbestos
2. Deteriorating lead paint
3. Yards with contaminated soil
Federal mandates to address environmental justice include:
1. Environmental Justice Act (1993)
2. Executive Order 12898 (1994): Federal Actions to Address Environmental Justice in Minority Populations
The passage of federal legislation to address environmental justice resulted in:
The development of policies to more comprehensively reduce the incidence of environmental inequality by mandating that every federal agency act in a manner to address and prevent environmental illnesses and injuries
National Environmental Justice Advisory Council
-created in 1994
- created as a federal advisory committee to the EPA to convene community, governmental and business constituents to assess environmental justice issues and make recommendations to the Administrator of the EPA
------ and -------- are interrelated concepts of critical importance to the field of environmental health and to occupational and environmental health nurses
Refers to the process of advocating for individual clients and families to solve problems and secure needed services
Is aimed at changing policy, institutional systems, and norms, laws or patterns of resource allocation to improve the health of the group or community
Collaborative approaches in class advocacy
Are characterized as citizens and authorities working collaboratively to reach an agreed-upon goal
Example of collaborative approaches
Membership on planning and advisory committees
Campaigning approaches in class advocacy
Require that citizens or professionals work singly or collectively to persuade authorities (lawmakers and regulators) that new problem definitions and solutions are needed
Examples if campaigning approaches
Contest strategies in class advocacy
Involve citizens organizing to force attention to community problems that they feel are being ignored or mishandled by authorities
Examples of contest strategies
Examples of legal remedies in class advocacy
Class action lawsuits
Types of class advocacy
1. Collaborative approaches
2. Campaigning approaches
3. Contest strategies
4. Legal remedies
------ are often primary health care providers in poor and disenfranchised communities
The probability of undesirable effects (or unhealthy outcomes) arising from exposure to hazard
Strategies for dealing with environmental risks:
1. Risk assessment
2. Risk management
3. Risk communication
Refers to the use of available information to evaluate and eliminate exposure to a substance and the resulting adverse health effects
Formal risk assessment is used by almost all....
Federal regulatory agencies
Formal risk assessment should be distinguished from ---------- to identify health risks
Risk assessment is.....
Risk assessment virtually always depends on estimates for each of the following steps:
1. Hazard identification
2. Dose-response evaluation
3. Exposure assessment
4. Risk characterization
Relies on toxicologic and epidemiologic studies of the potential of a substance to cause harm
Measures whether the harm increases with increasing doses of the substances
Involves measuring the amount of the chemical or other harmful substance to which a population is exposed with a goal of estimating the dose
Involves eliminating the public or environmental impact or problem
Estimations of risk can be widely diverse, depending on.....
Who is doing the risk assessment
The context in which a risk assessment is typically used is in.....
Policy and regulatory development
During the time when a risk assessment is used in policy and regulatory development ---------------- are likely to be equally important variables influencing the final policy or standard
Political and economic interests
The process of evaluating alternative strategies for reducing risk and prioritizing or selecting among them
Risk management strategies often involve....
Types of risk management strategies
Levels targeted by risk management strategies
1. Company-institutional level
2. Local government
3. State government
4. National government
Example of international level risk management strategy
The Kyoto Agreement
- aka Kyoto Protocols
- framework laid down by 38 countries to prevent global warming
Kyoto Agreement main proposal
In 1997, the nations joining in the treaty agreed to reduce their emission of greenhouse gases by 2012
Why are greenhouse gases related to global warming?
Greenhouse gases trap heat within our planet's atmosphere and cause an increase in global temperatures
Average emission cuts by the Kyoto Agreement are calculated to be about....
Under the United Nations Convention on Climate Change, governments...
1. Gather and share information on greenhouse gas emissions, national policies and best practices
2. Launch national strategies for addressing greenhouse emissions and adapting to expected impacts, including the provision of financial and technological support to developing countries
3. Cooperate in preparing for adapting to the impacts of climate change
The reduction of emissions is grouped into two classes of greenhouse gases:
1. Relates to carbon dioxide, nitrous oxide and methane
2. Relates to hydroflurocarbon gases, perfluorocarbons and sulphur hexafluoride
Reductions made to carbon dioxide, nitrous oxide and methane are compared to emission levels from what year?
Reductions made to hydroflurocarbon gases, perfluorocarbons, and sulphur hexafluoride are compared to emissions from what year?
True or false: The United States is among the signatories of the Kyoto Agreement
----------- can be a critical took in risk management
Engineering strategies to control exposure to environmental hazards are similar to......
Industrial hygiene hierarchy of controls
Environmental strategies to control exposure to environmental hazards include.....
Elimination of the exposure through substitution of products or processes
Examples of environmental strategies to control exposure to environmental hazards
1. Reduction of pollution at its source
2. Waste minimization
3. Reuse, recycling
4. Emissions control
5. Waste cleanup
Risk management strategies should always include involvement of....
All stakeholders regarding the nature of risk and the costs and benefits of proposed risk-management options
------- and ------- are vehicles to successful risk management
---------- may be used to manage risk in combination with other strategies
------------ should always "be at the table" regarding decisions to are being made about their risks
Assumes that where there are possible threats of serious or irreversible damage, lack of scientific certainty shall not be used as a reason for postponing measures to prevent risks
In 2003, the ANA adopted the ------------, based in the ------------, as the primary tenet on which they will base their environmental health policy/ advocacy work
Precautionary Principle is based on the following statement:
When an activity raises threats of harm to the environment or human health, precautionary measures should be take. Even if dorm cause and effect relationships are not fully established scientifically
All statements of the Precautionary Principle contain a version of this formula:
When the health of humans and the environment is at stake, it may not be necessary to wait for scientific certainty to take protective action
The Precautionary Principle is based on the common sense idea behind many adages:
1. Be careful
2. Better safe than sorry
3. Look before you leap
4. First do no harm
"Precautionary Principle" is a translation of:
The German Vorsorgeprinzip
Vorsorge literally means forecaring
The ethical assumption behind the Precautionary Principle is.....
Humans are responsible to protect, preserve and restore the global ecosystems on which all life, including our own, depends
Any action that contributes to preventing hr, to humans and the environment, learning more about the consequences of actions, and acting appropriately is...
Precaution is best linked to the following methods:
1. Exploring alternatives to possibly harmful actions, especially clean technologies that eliminate waste and toxic substances
2. Placing the burden of proof on proponents of an activity rather than on victims or potential victims of the activity
3. Setting and working towards goals that protect personal health and the environment
4. Bringing democracy and transparency to decisions affecting health and the environment
In 2003 the ANA adopted the "Precautionary Approach" as a guiding tenet for....
Their environmental health policy and advocacy work
The ANA's Precautionary Approach is based on....
The Wingspread definition of the Precautionary Principle
In the context of environmental health, is the art of communicating about the potential health risks associated with environmental exposures
Four elements to consider in risk communication
1. The message
2. The messenger
3. The audience
4. The context
Considerations related to message include:
1. Environmental health risks are often hard to define
2. Exposures may be difficult to characterize
3. The exposed population can be very diverse in age and many other important variables
4. Exposures will always include multiple chemicals, whereas most scientific investigation is primarily about individual chemicals and rarely chemical mixtures
5. Sometimes scientific evidence is inconclusive or nonexistent
Characteristics of the successful messenger include:
1. The messenger must be perceived as trusted and credible.
2. The messenger must be prepared to communicate with empathy and care when the message evokes hostile emotions
Characteristics of the audience include:
1. Audiences bring individual biases to any forum in which environmental health risks must be discussed
2. Audience's distrust of the messenger may be based on their feelings about whom the messenger represents (eg government, industry, an environmental organization)
3. An audience may trust or distrust a messenger based on his or her age, race, sex
Considerations related to context are as follows:
1. Risk communication does not occur in a vacuum; it often occurs when there has been a perceived environmental health threat such as a potentially contaminated water supply, an accidental release of hazardous chemicals,or a newly identified hazardous waste site adjacent to a daycare center
2. The conditions and context will influence the audience's ability to listen and trust
3. The media can play an important part in a community's understanding and biases regarding environmental risk
Risk communication is affected by...
Factors that affect perceptions of risk as less risky
4. Controlled by self
5. Not memorable
6. Not dread
8. Diffuse in time and space
9. Not fatal
12. Individual mitigation possible
Factors that affect perceptions of risk as more risky
4. Controlled by others
8. Focused in time and space
12. Individual mitigation impossible