| |
For an index
of NYCOSH in the News, click here.
Health
Education Awards
DOH News
April 9, 1997
http://www.health.state.ny.us/nysdoh/press97/phwrel.htm
The State Health Department today presented awards to eight public
health programs as part of New York State's 17th annual Health
Education Awards ceremony. The ceremony, part of Public Health
Week in New York, celebrated the contributions of schools, community
partnerships and health care providers in providing high-quality
preventive health services to New Yorkers.
"Effective
public health programs utilize the broad partnerships available
in our communities," said State Health Commissioner Barbara
A. DeBuono, M.D. "Schools, civic groups, businesses, labor
and the media all have a role to play in improving the quality
of our lives. Each one of these programs exemplifies this type
of community collaboration."
Programs receiving
awards were:
For Excellence
in Health Education Programming:
The Cornell Cooperative
Extension of Nassau County for its "Healthy Heart Snack
Choices Initiative." Since July 1994, the program has involved
children and parents in food-related learning activities and
has reached more than 4,000 children in 41 child care programs
in Nassau County.
The Edmund W.
Miles Middle School of Amityville, Long Island for its AIDS Education
Program. The school has taught adolescents about HIV and AIDS
and has involved students in activities to help them understand
and support people with AIDS. Students have volunteered their
services to local HIV/AIDS community organizations and have adopted
local families affected by the disease.
For Outstanding
Health Education Programming:
The Asthma Education
program of the Lutheran Medical Center's Sunset Park Family Health
Center Network of Brooklyn. To meet an increase in the incidence
of asthma in the community, the network established a task force
of nurse case managers and health educators who focus on the
needs of asthma patients and their families.
The New
York Committee for Occupational Safety and Health. The Committee,
a non-profit coalition of more than 200 local unions and 400
physicians, lawyers, public health professionals, has provided
training and education programs in response to a wide variety
occupational health hazards.
For Meritorious
Health Education Programming:
The Dutchess
County Department of Health for its Youth Violence Prevention
Coalition. The Coalition, utilizing the skills and experience
of educators, medical professionals, criminal justice experts,
church leaders, youth and concerned citizens, has implemented
alternative activities for youth and advocated prevention measures
that teach youth to resolve conflict in non-violent ways.
The Samaritans
of the Capital District for a volunteer-staffed suicide education
initiative for students. The initiative includes a training program,
on-site education programs in local schools, publications, and
a confidential helpline youth can contact in times of crisis.
The Ramapo Central
School District (Rockland County) for its health education program.
The program has been a driving force behind the expansion and
integration of health education into many facets of student lives.
The Rochester
General Hospital for its diabetes heath outreach and education
program among Hispanics living in the Rochester area. The program
features culturally sensitive education programs and support
groups for Hispanics with diabetes, enhanced accessibility to
health care through outreach programs, and blood glucose screenings
for local residents.
Sick Days at
Work
By Kathryn S.
Brown
Environmental Health Perspectives
October 1996
http://ehp.niehs.nih.gov/docs/1996/104-10/focus.html
Early in her medical career, Rebecca Bascom became puzzled by
a stream of patients complaining of respiratory problems. Bascom,
a pulmonary specialist, ran standard lung tests on these patients,
whose lungs, surprisingly, seemed to function normally. "With
everybody I had seen before . . . I knew the tests to order,
the way to treat them," recalls Bascom, now director of
the University of Maryland School of Medicine's Environmental
Research Facility. "With this group, there just wasn't any
[test] that seemed to work." It turns out Bascom's patients
were being made ill by substances in the air in their offices.
These patients were among the first wave of office workers to
complain of a set of symptoms that is now referred to as sick
building syndrome (SBS).
According to the World Health Organization, up to 30% of new
and remodeled buildings worldwide contain enough pollutants to
make workers ill. Asbestos, radon, and environmental tobacco
smoke can cause lung cancer or chronic pulmonary disease. And
pollutants like volatile organic compounds (VOCs) and bioaerosols--airborne
particles emitted by fungi and bacteria--may be causing equally
hazardous, though less well-understood, illnesses. Scientists
have identified more than 1,500 indoor air pollutants from sources
such as carpets, photocopiers, and ventilation ducts.
Researchers suggest that symptoms of SBS result from a complex,
hard-to-study blend of pollutants that affects individuals differently.
In response, scientists are wielding a range of research tools--from
epidemiology studies to air chamber studies--to solve the indoor
air pollution problem.
A Growing Concern
The problem of indoor pollution has generated concern among the
scientific community around the world. This past July, indoor
air researchers met in Japan at the Seventh International Conference
on Indoor Air Quality and Climate to discuss the latest research
on the topic. Next year, the National Institutes of Health will
host the International Society of Indoor Air Quality and Climate's
Fifth Conference on Healthy Buildings, which brings together
physicians, epidemiologists, microbiologists, and engineers who
specialize in indoor air quality.
In the United States, up to 21 million employees are exposed
to poor indoor air quality, according to the Occupational Safety
and Health Administration. Several major office buildings have
recently made headlines by being diagnosed as "sick."
At a New York office used by Memorial Sloan-Kettering Cancer
Center, environmental investigators found high levels of carbon
monoxide that forced more than 700 workers into temporary quarters.
At Boston's Suffolk County Courthouse, a fume-emitting waterproofing
compound caused over 800 employees to move to makeshift offices
elsewhere. And in Washington, D.C., health investigators discovered
toxic fungi and poor ventilation in the Department of Transportation's
headquarters. Again, workers had to evacuate.
Jim Young, a spokesperson for the New York Committee for Occupational
Safety and Health (NYCOSH), a nonprofit advocacy group for workers,
says he receives about 300 telephone calls a month from workers
worried about their health. The majority of these calls, he says,
involve indoor pollutants. "Indoor air quality is probably
the most prevalent occupational health problem that we hear about,"
Young says. "There have just been more and more calls over
time."
Researchers trace a rise in indoor air pollution to the 1970s
when the energy crisis dictated a cut in air-handling costs.
In 1973, the American Society of Heating, Refrigerating, and
Air-Conditioning Engineers (ASHRAE) reduced the professional
standard for the minimum amount of outdoor air brought into buildings
by 70%. In the past, office employees had received 20-30 cubic
feet of outdoor air per minute per person (cfm/p). The 1973 recommendation
called for heating, ventilation, and air-conditioning (HVAC)
systems to provide a minimum of just 5 cfm/p of outdoor air.
This outdoor air cutback accompanied a gradual rise in the use
of photocopiers, laser printers, personal computers, and other
equipment that may release chemical fumes. What's more, architectural
designs changed and sealed windows, wall-to-wall carpeting, and
fiberglass or particle board materials that may also contribute
to the problem were increasingly used in buildings.
Researchers say that lower ventilation rates combined with increased
exposure to indoor pollutants might explain the rash of SBS-type
illnesses.
According to the EPA, most Americans spend up to 90% of their
time indoors, whether at the office or home. The EPA also suggests
many indoor pollutants are concentrated at levels 2-5 times higher
than outdoor levels. Other researchers suggest that psychological
factors associated with the work environment including monotonization,
loss of privacy, electronic monitoring of productivity, a faster
work pace, and bad management practices may also play a role
by increasing worker stress and compounding awareness of symptoms.
Too Little Data
Still, despite the statistics and plausible explanations, studies
of hazardous buildings suffer from a lack of data as well as
disagreements over sampling techniques, exposure assessments,
and nomenclature.
"Think of it this way," says John Spengler, a professor
of environmental science and physiology at Harvard University,
"when you're doing classic epidemiology, you may have to
control a lot of variables, but you're still just making observations
about individuals or groups of individuals. When you talk about
buildings, you expand the inherent variability. You have to consider
stress, job dissatisfaction, vibration, noise, lighting. There
are so many factors that it's much more difficult to study. So
there has yet to be a 1,000-building study."
Understanding and fixing indoor air pollution problems hasn't
been as easy as researchers hoped. "Ten years ago, as epidemiologists
we anticipated that we would figure out the causes [of SBS] by
studying the atmosphere in buildings and diagnosing the probability
[of illness] by knowing what's in the air," remarks Michael
Hodgson, an associate professor of occupational and environmental
medicine at the University of Connecticut. "But that has
not worked because of limitations in our study designs, sampling
frames, and exposure assessment strategies." Simply increasing
ventilation rates, for example, hasn't solved the problem in
every instance, although studies show that symptoms do improve
when rates are increased from the current professional design
standard of 25 cfm/p of outdoor air to 50cfm/p. In 1990, ASHRAE
modified its ventilation guidelines, recommending that building
owners return outdoor air flow rates to around 20 cfm/p. Still,
indoor air pollution complaints continue.
Ongoing uncertainty leaves builders and engineers without any
indoor air regulatory standards to follow, notes Hillel Koren,
director of the human studies division at the EPA's National
Health and Environmental Effects Research Laboratory. "It
would be very difficult, at this point, to create [regulatory
standards]," Koren says. "In outdoor pollutants, like
ozone, there are ambient national quality standards and a scientific
database. In indoor air, we are at an early stage of establishing,
characterizing, and developing good biomarkers and endpoints.
Here, we are just getting started." Still, Hodgson argues
that regulatory standards have always lagged behind good professional
standards and that adoption of the ASHRAE standard would solve
a lot of the health complaints.
A Volatile Situation
At first, Mary Ann Mazzella, an administrative aide at New York
University, began suffering from headaches. Then she began to
have sinus problems. Soon she noticed she was feeling lethargic.
Eventually, on hot days, she got so nauseous at the office that
she'd call it quits and head home early. "I never got to
the point where I was seriously ill," says Mazzella, "but
I felt terrible."
With help from her local union, Mazzella got her office building's
blueprints and surmised the source of her misery: industrial
fumes and poor ventilation. "I work in a renovated factory
building," Mazzella says. "We're supposed to have fresh
air ducts every few feet. We don't. We have no windows. And the
air conditioning shuts down for days at a time."
In fact, the photocopying room in Mazzella's building lacked
a filtering system to flush out air rich in VOCs, including formaldehyde
and ozone, which are emitted by photocopiers. This is a common
oversight, according to indoor air researchers. Reporting in
the July 1995 issue of the ASHRAE Journal, Hodgson and colleagues
noted that, "In our experience, complaints around photocopiers
abound, presumably because of ventilation inadequate for the
needs imposed by this particular source."
In addition to
photocopiers, a variety of building equipment and materials including
paint, cleaning compounds, glues, silicone caulking material,
insecticides, laser printers, personal computers, photographic
equipment, fiberglass, and carpeting can give off irritating
chemicals. Like Mazzella, employees affected by this chemical
soup report a number of allergy-like symptoms.
Researchers often classify VOC sources based on how fast their
emissions decline. For example, solid, dry materials like carpet
or particle board are "slow decay" sources, meaning
they strike the air with an initial blast of chemicals, then
emissions slowly fall. Wet products like paints, adhesives, or
waxes are "fast decay" sources that release most of
their chemicals within minutes to days, though VOCs may be emitted
for months or even years.
One wet product to gain attention in recent years is the adhesive
glue used to install some carpets. Such glue can infuse the air
with VOCs such as formaldehyde. Because of these chemicals, manufacturers
recommend that new carpet owners temporarily turn up their ventilation
systems.
Some workers may be more susceptible to VOC emissions than others.
A myriad of factors ranging from noise to harsh lighting can
aggravate symptoms of illness, making employees more aware of
their physiological reactions. Awareness of an unusual odor,
such as one emanating from carpeting, for example, can even make
employees suspicious of air quality that is actually acceptable.
"Smell plays a role because people smell things they don't
expect to and [believe] there must be something wrong,"
explains William Cain, a professor of surgery and head of the
Chemosensory Perception Laboratory at the University of California
at San Diego. "They think that if something smells bad,
it may be bad for you. That really isn't a good toxicological
rule."
Cain is conducting experiments to separate the psychological
effects of odor from measurable nasal inflammation and eye irritation,
which more accurately pinpoint building-induced health problems.
In a recent study to be published in Perception and Psychophysics,
Cain and colleagues administered mixtures of VOCs to two sets
of people: those with a normal sense of smell, and anosmics,
or those without a sense of smell. In both groups of people,
the researchers established threshold levels of physiological
irritation for mixtures of chemicals like ethyl acetate, butanol,
and benzene. "Every organic compound has an odor threshold
and an irritation threshold," says Cain. "At some point
above these thresholds, people can sense irritation. Our work
entails measuring the difference. We use people without a sense
of smell to measure the point where things truly become irritating."
So far, Cain and colleagues have found that the more chemical
compounds that are combined, the more likely they are to cause
physiological reactions. "If you want to be rash, you might
say we get increasing additivity [more reactions between chemicals]
with increasing complexity. You may have nine components in a
study, and the real environment has 100 components. By the time
you get to 100, you really have a tremendously more potent stimulus
than you would predict by just knowing the individual components
involved."
The additivity of VOCs may have foiled many attempts to discern
toxic levels of chemicals in a building. Traditionally, environmental
investigators simply measured the levels of individual airborne
chemicals. But this approach overlooks the interaction between
those chemicals. "The whole theory since the 1930s has operated
on a flawed philosophy that maximum allowable concentrations
were the best way [to measure indoor pollutants]," says
Hodgson. "That helps explain why people have symptoms even
while [equipment] perceives low levels."
Unfortunately, Cain says, research into VOC interaction is technical
and expensive. "The problem is that we've got hundreds of
chemicals. If we're going to talk about health effects that we're
interested in, we've got to begin building the database one chemical
at a time. Looking at the task, it seems almost insurmountable.
But it's the tried-and-true path."
Koren is one researcher willing to travel that path. He and his
colleagues are conducting a number of chamber studies in which
they expose subjects to controlled amounts of VOCs. Using nasal
wash to measure a subject's reactions and ocular examinations,
the scientists can look for objective biological changes that
indicate inflammation. "Our procedures allow us to measure
changes that would lead to irritation and congestion, which are
some of the most prominent complaints of SBS," Koren says.
Rather than build a database one chemical at a time, Koren hopes
to find a model or prototype of VOCs to represent whole families
of compounds with similar structures. "Ideally, once we
find some clinical endpoints, I'd like to work with epidemiologists
who can identify sick buildings, engineers to monitor exposure,
. . . biologists of various disciplines that can analyze whatever
we find," Koren says. "It's got to be the kind of research
that can integrate studies."
Invisible Zoo
Abundant as they may be, VOCs are not the only hazards to inhabit
office air. Fungi, bacteria, viruses, algae, and other microbes
lurk inside air ducts, grow around ceiling tiles, and thrive
on almost any warm, damp surface.
Microbes need only four basic ingredients to survive: organic
nutrients on which to feed, moisture (whether from humid air
or standing water), a surface on which to grow, and darkness.
Fungi usually travel from outdoors into a building, so high concentrations
of mold or fungi occur in buildings surrounded by trees or shrubs.
Once the microbes get inside, they capitalize on the nourishing
environment of indoor humidity, dust, and dirt.
While their living requirements are minimal, microbes' health
effects are quite substantial. Bacteria and fungi can produce
airborne particles called bioaerosols, such as spores or mycotoxins.
These bioaerosols can leave employees with symptoms such as coughing,
headaches, and other allergic reactions. Buildings left vacant
or recently renovated are particularly susceptible to microbe
invasions. Researchers suggest that renovating a building may
increase the concentration of indoor air contaminants 1,000-fold.
Like VOCs, microbial contamination can be difficult to assess
and treat. Current microbiological techniques are very limited,
says Mark Mendell, an epidemiologist with the Cincinnati office
of the National Institute for Occupational Safety and Health.
"For one thing," he says, "conventional measurements
typically only measure organisms that will actually grow on culture,
but it is not only the living organisms that can cause problems.
Nonliving spores, or pieces of organisms, or substances released
from organisms can all have health effects, either allergic or
toxic. For example, there are substances called mycotoxins (released
from fungi) and endotoxins (contained in gram-negative bacteria)
that are known to have serious adverse health effects at high
levels in agricultural environments. A variety of evidence now
suggests that both of these may be causing health effects at
high levels in some indoor environments as well, but these substances
are not usually measured indoors."
Koren and others are trying to identify what makes a person susceptible
to irritation from biological contaminants. Koren's microbe research
includes buildings and homes, both of which can host high levels
of fungi and other microbes. Koren is studying interactions between
outdoor and indoor pollutants. "Our question is, does exposure
to outdoor pollutants like ozone increase a person's sensitivity
to [indoor pollutants] like dust mites," Koren says. "We
hope to help other agencies come up with prevention policies
that take into account how the indoor environment fits with the
outdoor environment."
In one experiment, Koren and colleagues exposed asthmatic study
participants sensitive to dust mites to ozone and later to allergens
carried by dust mites found in homes. Results appear to show
that the combined contaminants spur a much stronger asthmatic
reaction than either does alone.
Filling in the Gaps
Because little data exists on VOCs, microbes, and other indoor
pollutants, researchers are furiously working to fill in the
gaps. For example, the EPA's Indoor Air Division is about halfway
through a study of 100 randomly-chosen office buildings across
the United States with the goal of creating basic pollution data
on typical buildings.
"There isn't a lot of information about the quality of air
in office buildings now," explains Susan Womble, an EPA
environmental scientist and manager of the project, called Baseline
Information on Indoor Air Quality in Large Buildings, or BASE.
"So when people investigate sick building syndrome, for
example, they don't have anything to compare their measurements
to."
With the help of 40 experts, the EPA developed a standardized
protocol--including characterization of a building, environmental
monitoring, and questionnaires on health symptoms--with which
to inspect buildings. Scientists have now studied 41 buildings.
Information on the first 13 became available to researchers this
fall. "We expect to use the data for trends and to help
us spot indicators that we should be following up on," Womble
says. "We're hoping that this will also give us some insight
into other studies that we need to target."
Meanwhile, James Woods, an environmental design professor and
director of the Center for Building Health, Safety, and Productivity
at Virginia Polytechnic Institute and State University, is working
on a different approach: communication between practitioners.
Because indoor air pollution spans many fields, epidemiology,
microbiology, occupational medicine, and engineering specialists
often find themselves working at cross purposes. Woods explains,
"A clinician is going to approach the problem from the patient's
perspective. A public health person is going to look at preventive
measures. Engineers look at specific buildings. Policy makers
look at sets of buildings. We want to try to get that all together
and be able to address problems."
To bring indoor air specialists together, Woods and colleagues
are planning a 1997 meeting, Healthy Buildings: Global Issues
and Regional Solutions. The conference will be hosted by the
NIH in conjunction with ASHRAE's annual conference. Eventually,
Woods hopes to establish standardized methods of defining, tracking,
and treating buildings that, over time, experience varying rates
of pollution.
"I think awareness [of building pollution] is changing,"
Woods says. "So the social trend is greater demand for improved
performance of buildings. That includes thermal conditions, lighting,
acoustic, and ergonomic factors." Woods notes that such
factors affect employee stress, which in turn aggravates most
health symptoms. "If you address just one of these factors,
the level of stress is not affected well enough. You've got to
address all of them."
While these researchers attempt to refine existing approaches,
others are examining often overlooked pollutants. At Cornell
University, Alan Hedge, a professor of design and environmental
analysis, blames some indoor health complaints on manmade mineral
fibers dropped into the air by ceiling tiles, insulation, and
ventilation systems. In a recent study, Hedge and colleagues
discovered high rates of employee health complaints correlated
with high numbers of manmade mineral fibers in settled dust.
In another study, after installing filter systems that collected
the fibers, Hedge says, the number of complaints plummeted.
Hedge stumbled across the mineral fiber phenomenon while investigating
a building for VOC contamination. "We were inside the building
when one employee said to me 'I'm sure there's something in this
building. I've got an air filter on my desk. Would you take a
look at it?'" Hedge recalls. "I shook the filter out
and looked at some samples on [microscope] slides. I was absolutely
astonished to find samples full of what looked like glass fibers."
Intrigued, Hedge began reading up on mineral fibers. He learned
that in the 1960s--when homes were built using fiberglass in
the linings of ductwork--residents complained of health problems
similar to today's SBS. He also discovered a number of building
practices introduced in the 1970s that might be implicated in
illnesses, such as the use of fiberglass in broad ceiling spaces
or insulation placed inside the ventilation system where mineral
fibers can shred and rain down on employees. "Inhaling [fibers]
is like swallowing a . . . javelin," Hedge says. "If
you swallow them end-ways, they can get quite far. The fiber
pieces are three to eight microns in diameter and up to 30 microns
long. They can cause fiber damage to epithelial cells of your
eyes, nose, and throat." Hedge also believes fibers cause
skin irritation and other symptoms.
Hedge says many researchers, steeped in the study of microbes
or VOCs, have yet to seriously pursue the mineral fiber-illness
relationship. However, researchers in England are working on
similar studies, and Hedge is planning further studies on fibers.
Regulation Unlikely
At least for the time being, enforced regulations on workplace
air quality appear unlikely. The closest policy makers have come
is a 1994 proposal by OSHA that addressed a wide range of pollutants,
including tobacco smoke. The proposed legislation called for
employers to implement and maintain controls for many known pollutants.
The proposal also asked employers to develop indoor air quality
compliance plans and do inspections to make sure those plans
work. While many indoor air researchers and activists supported
the OSHA proposal, even more building owners, managers, and employers
opposed it. "In our period of public comment we received
over 115,000 comments," says Debra Janes, a health scientist
and project manager at OSHA. "It's hard to find anyone who
wants to take responsibility [for indoor air pollution]. And
nobody wants to be cited over something they have no control
over. Say there's a wet photocopier with solvents that are leaking.
The building manager will say, 'That's not related to the building
design. Why should we be responsible?'" Given the blast
of negative responses, Janes says, it will take OSHA "a
while" to review the responses received during the comment
period.
The EPA continues to emphasize voluntary building standards to
prevent indoor air pollutants. "We think there are incentives
for doing it voluntarily," says Elissa Feldman, deputy director
of the EPA's indoor air division. "Some real estate markets
have rentable office space that's overflowing. [Quality indoor
air] is a niche that some building owners could use to their
advantage. It's also true that indoor air costs increasingly
are associated with liability. In a big lawsuit, [the victim]
can go after everybody from the architect to the general contractor
and everybody along the way. Plus, getting a reputation as a
sick building is really death to a marketable property."
The only way to tighten indoor air regulation and improve patients'
diagnoses is to amass a broad collection of studies on poorly
understood pollutants, researchers say. However, says Koren,
"We are experiencing dwinding funding for this important
health issue. There is a great deal of research that has only
begun and that needs to be pursued vigorously to improve our
understanding of the risks associated with the indoor air environment.
And that is our number one goal."
Triangle Shirtwaist
Factory Fire Site is National Historic Landmark
By Debra E.Bernhardt
Cultural Resources Management
August 1994
http://crm.cr.nps.gov/archive/17-1/17-1-12.pdf
Click on any of
the boxes in the left margin to learn more about NYCOSH.
Click here to send
an e-mail message to NYCOSH with comments or suggestions for
additions to this site.
This page was last
updated on January 27, 2002
|
|
