Category Archives: Environmental Exposures

Our Comments on Insanitary Conditions in the Preparation, Packing, and Holding of Tattoo Inks and the Risk of Microbial Contamination FDA Draft Guidance

September 11, 2023


We appreciate the opportunity to comment and support FDA’s proposed rule regarding: “Insanitary Conditions in the Preparation, Packing, and Holding of Tattoo Inks and the Risk of Microbial Contamination: Guidance for Industry Draft Guidance.”

We are a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with a particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.

Due to the growing rate of Americans getting tattoos and increased reports of infections related to contaminated tattoo ink, we agree this is an important public health issue that needs to be addressed. Microbial contamination of tattoo inks can occur in nearly 50% of inks on the market in the United States, which can include organisms that are known to cause serious infection and are highly resistant to antibiotics.1  We support the FDA’s objectives of ensuring that ink products are unadulterated and holding manufacturers accountable for contaminated products.

While the act of tattooing is primarily regulated by state, local, and tribal public health authorities, the FDA has the authority to regulate tattoo ink. In addition to microbial contamination, pigments have been found to contain potentially toxic chemicals, heavy metals, degradants, printer toner, car paint, and other substances that were not intended to be used on the human body.We agree that the FDA needs to provide guidance that will better support state, local, and tribal public health agencies to help address the growing public health burden of unsafe tattoo ink. This is especially relevant as many local tattooing regulations have recently been found to be outdated as well as inconsistent.

Accordingly, we recommend that the FDA provides explicit guidance regarding the labeling of tattoo inks. While tattoo ink manufacturers are required to include ingredient and safety risks as part of the labeling requirements under the Fair Packaging and Labeling Act, these labels are rarely seen by consumers since the ink is often purchased in bulk by tattoo studios.3 We strongly urges the FDA to require that user-friendly labels for tattoo ink be made available online to consumers prior to getting tattoos; preferably, in a consumer checklist that they must sign, so that they have the information they need to make informed decisions on the risks of tattooing.

We also recommend that the FDA include clear, understandable guidance regarding the water and dilution techniques that should be used to achieve color variation in tattoo studios. This is of particular importance as non-sterile dilution techniques were a primary cause of the nontuberculous mycobacterial skin infection outbreak that was referenced in FDA’s draft guidance. A common practice for tattoo studios is to use distilled or reverse osmosis water for dilution. However, these are non-sterile techniques, and the FDA should prohibit such techniques and instead require and explain the importance of sterile dilution techniques.

We are also concerned about the voluntary reporting system of contaminated ink products, which primarily relies on consumers. This places the burden of contamination identification and reporting on the consumer rather than the manufacturer, and also undermines the responsibility of the manufacturer to ensure that their products are unadulterated. In addition, since consumers are rarely aware of existing reporting mechanisms, the FDA should require that tattoo studios educate consumers on how to report adverse events caused by contaminated ink. We also agree with the FDA’s recommendation that tattoo ink and ink components be tested for microbial contamination and that tattoo establishments be required to discard contaminated products. Although we are concerned that the lack of proposed manufacture accountability and enforcement mechanisms, traceability, and regulatory incentives will lead to noncompliance, having such requirements will increase the risk of lawsuits for noncompliance, and that will serve as an incentive to comply with FDA requirements.

It is estimated that nearly one-third of Americans have a tattoo with reports of microbial contamination at a staggering 49%1,4 Thus, there is a great need to better regulate tattoo ink and raise awareness among the public about the risks of unsafe tattoo ink. We support the objective of the FDA in helping manufacturers to identify and discard adulterated ink to better protect public health. However, we recommend that ink labels be made readily available to consumers and sterile dilution techniques are included in the final guidance. We also strongly recommend that the FDA develop an information toolkit to increase consumer awareness regarding contamination reporting systems in tattoo studios, while working to build robust mechanisms for manufacturer reporting, traceability, and accountability.

As noted above, in addition to microbial contamination, pigments have been found to contain potentially toxic chemicals, heavy metals, degradants, printer toner, car paint, and other substances that were not intended to be used on the human body. The rate of ink contamination with unsafe substances that include but are not limited to microbial contamination has been reported as high as 67%.5 Therefore, we strongly urge the FDA to expand the regulation of all types of dangerous substances in this draft guidance or develop a similar draft guidance specifically to reduce the risks caused by these other dangerous substances.


References:

  1. Nho, SW et al. “Microbiological Survey of Commercial Tattoo and Permanent Makeup Inks Available in the United States.” Journal of Applied Microbiology, 124: 1294-1302 (2018).
  2. “NEHA Response to Request from FDA for Good Manufacturing Practices on Tattooing Inks and Pigments.” 2023.
  3. Association of Food and Drug Officials, Body Art Committee. “Tattoo Ink and Permanent Makeup Labeling Guide.” 2019.
  4. Pew Research Center. “32% of Americans have a tattoo, including 22% who have more than one.” 2023.
  5. Bonadonna, Lucia. “Survey of Studies on Contamination of Marketed Tattoo Inks.” Karger. 2015.

EPA Public Meeting on Proposed Rule to Reduce PFAS in Water

May 4, 2023


I’m Dr. Diana Zuckerman, president of the National Center for Health Research. Our nonprofit think tank focuses on the safety of medical and consumer products.  We provide research-based information to Congress, federal agencies, and the public and we do not accept funding from companies that make the products we evaluate.

My comment today relies on my research experience at Yale and Harvard and in my current position, as well as my policy expertise from working in the House, Senate, federal agencies, and the White House.

We agree that this proposed rule will improve public health, reducing cancer, heart disease, stroke, low birth weight, and other harms to adults and children.  It will save lives. But we have recommendations to improve it.

  1. We disagree that 4 ppt is the lowest level that can be reliably tested and removed. Eurofins routinely and reliably measures 2 ppt in water. And it is likely that 2 ppt will be widely usable to measure and remove PFOA and PFOS well before this rule is finalized.  Since EPA acknowledges that no level of PFOA and PFOS is safe, the limit should be 2 ppt.
  2. We understand the agency’s desire to be flexible, but flexibility to satisfy monitoring requirements will likely generate a huge loophole.  EPA needs more explicit limits to prevent a weakening of these regulations
  3. This proposed rule is an important first step, but it is long past time for the EPA to define PFAS broadly, regulate them as a class, and ban all non-essential uses.
  4. Lastly, we appreciate the law that provides funding for these efforts, but it’s time to start shifting the costs to the companies that have made these chemicals. When  companies are held financially responsible, they will be less likely to inundate us with PFAS in products. Taxpayers are already stuck with the health risks. It is not fair for municipalities and taxpayers to get stuck with the work and the cost.

NCHR Letter to Members of the Board of the Los Gatos Union School District on Artificial Turf and Playgrounds

National Center for Health Research, April 18th, 2022


Dear Superintendent Johnson and Members of the Board of the Los Gatos Union School District:

I am writing to share scientific information about artificial turf and playground surfaces, which I am confident will help you determine what is best for the children and adults in your community.

As President of the National Center for Health Research, I am writing at the request of many of your constituents to share the information we have provided to Members of Congress, state and federal agencies, state and local legislators, parents, and others who want to ensure that our children are not exposed to dangerous chemicals when they play on artificial turf or playgrounds. Our nonprofit think tank is located in Washington, D.C. Our scientists, physicians, and health experts conduct studies and scrutinize research. Our goal is to explain scientific and medical information that can be used to improve policies, programs, services, and products.

We understand that these issues are hotly debated, but some information is more accurate than others.  For example, if you look at the maintenance contract for an artificial field, you will see that it needs to be watered regularly to prevent it from becoming dangerously hard and to keep its warranty in place.  In other words, grass fields and artificial turf fields both require water, but well-designed grass fields will last much longer and be more cost-effective.

In the last few years, scientists have learned more about lead and PFAS in artificial turf, as well as the risks of some of the newer infill materials that are available to replace tire crumb. Tire crumb has well-known risks, containing chemicals that have the potential to increase obesity; contribute to early puberty; cause attention problems such as ADHD; exacerbate asthma; and eventually cause cancer. However, the plastic grass itself has dangerous levels of lead, PFAS, and other toxic chemicals as well.  PFAS are of particular concern because they enter the body and the environment as “forever chemicals,” which means that they are not metabolized and do not deteriorate, accumulating over the years. Replacing tire waste with silica, zeolite, and other materials also has substantial risks.  For example, it is well known that “particulate matter” can cause lung problems and eventually cause lung cancer.  For that reason, silica and zeolite are of great concern.

Federal agencies such as the EPA and the U.S. Consumer Product Safety Commission have been investigating the safety of these products. Despite claims to the contrary, none have concluded that artificial turf is safe. Although the Trump Administration’s EPA stated that there was no conclusive evidence that the levels of chemicals in artificial turf was harmful to children, they explained that their research was based on assumptions and that they had not conducted or reviewed studies of children exposed to artificial turf.

Lead

As you probably know, the American Academy of Pediatrics states that no level of lead exposure should be considered safe for children, because lead can cause cognitive damage even at low levels. Some children are more vulnerable than others, and that can be difficult or even impossible to predict. Since lead has been found in tire crumb as well as in new synthetic rubber, it is not surprising

that numerous artificial turf fields and playground surfaces made with either tire crumb or “virgin” rubber have been found to contain lead. However, the Centers for Disease Control and Prevention (CDC) also warns that the “plastic grass” made with nylon or some other materials also contains lead. Whether from infill, plastic grass, or rubber playground surfaces, the lead doesn’t just stay on the surface. With wear, the materials turn to dust containing lead and other chemicals that is invisible to the eye and is inhaled by children when they play.

Why are chemicals that are banned from children’s toys allowed in artificial turf and rubber playground surfaces?

Synthetic rubber and plastic are made with different types of endocrine (hormone) disrupting chemicals (also called EDCs). There is very good evidence regarding these chemicals in tire crumb, based on studies done at Yale and by the California Office of Environmental Health Hazard Assessment (OEHHA).However, rubber playground surfaces contain many of the same dangerous chemicals as tire crumb, since they are very similar materials, all made from petroleum.

A 2018 report by Yale scientists detected 92 chemicals in samples from 6 different artificial turf companies. Unfortunately, the health risks of most of these chemicals had never been studied. However, 20% of the chemicals that had been tested are classified as probable carcinogens and 40% are irritants that can cause asthma or other breathing problems, or can irritate skin or eyes.2

There are numerous studies indicating that endocrine-disrupting chemicals (also called hormone-disrupting chemicals) found in rubber and plastic cause serious health problems. Scientists at the National Institute of Environmental Health Sciences (which is part of NIH) have concluded that unlike most other chemicals, hormone-disrupting chemicals can be dangerous at very low levels, and the exposures can also be dangerous when they combine with other exposures in our environment.

That is why the Consumer Product Safety Commission has banned numerous endocrine-disrupting chemicals from toys and products used by children. The products involved, such as pacifiers and teething toys, are banned even though they would result in very short-term exposures compared to artificial turf or playground surfaces.

A report warning about possible harm to people who are exposed to rubber and other hormone disrupting chemicals at work explains that these chemicals “can mimic or block hormones and disrupt the body’s normal function, resulting in the potential for numerous health effects. Similar to hormones, endocrine-disrupting chemicals can function at very low doses in a tissue-specific manner and may exert non-traditional dose–response because of the complicated dynamics of hormone receptor occupancy and saturation.”3

Studies are beginning to demonstrate the contribution of skin exposure to the development of respiratory sensitization and altered pulmonary function. Not only does skin exposure have the potential to contribute to total body burden of a chemical, but also the skin is a highly biologically active organ capable of chemical metabolism and the initiation of a cascade of immunological events, potentially leading to adverse outcomes in other organ systems.

Scientific Evidence of Cancer and Other Systemic Harm

It is essential to distinguish between evidence of harm and evidence of safety. Companies that sell and install artificial turf often claim there is “no evidence children are harmed” or “no evidence that the fields cause cancer.” This is often misunderstood as meaning the products are safe or are proven to not cause harm. Neither is true.

It is true that there no clear evidence that an artificial turf field has caused specific children to develop cancer. However, the statement is misleading because it is virtually impossible to prove any chemical exposure causes one specific individual to develop cancer.

As an epidemiologist, I can also tell you that for decades there was no evidence that smoking or Agent Orange caused cancer. It took many years to develop that evidence, and the same will be true for artificial turf.

I have testified about the risks of these materials at the U.S. Consumer Product Safety Commission as well as state legislatures and city councils. I am sorry to say that I have repeatedly seen and heard scientists paid by the turf industry and other turf industry lobbyists say things that are absolutely false. They claim that these products are proven safe (not true) and that federal agencies have stated there are no health risks (also not true).

However, we know that the materials being used in artificial turf and rubber playground surfaces contain carcinogens, and when children are exposed to those carcinogens day after day, week after week, and year after year, they increase the chances of our children developing cancer, either in the next few years or later as adults. That should be adequate reason not to install them in your community. That’s why I have spoken out about the risks of artificial turf in my community and on a national level. The question must be asked: if they had all the facts, would your community choose to spend millions of dollars on fields that are less safe than well-designed natural grass fields?

Dangerously Hot and Hard Fields

When the weather is warm and/or sunny, it is usually quite pleasant to be outside – as long as you aren’t on artificial turf or an outdoor rubber surface. Even when the temperature above the grass is 80 degrees Fahrenheit, artificial turf can reach 150 degrees or higher. Obviously, a 90 degree day is likely to be even hotter than 150 degrees on turf. That can cause “heat poisoning” as well as burns.

Artificial turf fields get hard as well. Turf companies recommend annual tests at 10 locations on each turf field, using something called a Gmax score. A Gmax score over 200 is considered extremely dangerous, and it is considered by industry to pose a death risk. However, the synthetic turf industry and American Society for Testing and Materials (ASTM), suggest scores should be even lower — below 165 to ensure safety comparable to a grass field. Will your community pay to have these tests conducted annually on all your public artificial turf fields?

The hardness of natural grass fields is substantially influenced by rain and other weather; if the field gets hard, rain or watering will make it safe again. In contrast, once an artificial turf field has a Gmax score above 165, it needs to be replaced because while the scores can vary somewhat due to weather, the scores will inevitably get higher because the turf will get harder. Gmax testing involves testing 10 different areas of a playing fields, to make sure all are considered safe.  Some officials average those 10 scores to determine safety; however, experts explain that is not appropriate. If a child (or adult) falls, it can be at the hardest part of the field, which is why safety is supposed to be determined by the score of the hardest part of the field.

Environmental Issues

In addition to the health risks to school children and athletes, approximately three tons of infill materials migrate off of each synthetic turf field into the greater environment each year. About 2-5 metric tons of infill must be replaced every year for each field, meaning that tons of the infill have migrated off the field into grass, water, and our homes.4 The fields also continuously shed microplastics as the plastic blades break down.5,6 These materials may contain additives such as PAHs, flame retardants, and UV inhibitors, which can be toxic to marine and aquatic life. Microplastics are known to migrate into the oceans, the food chain, and drinking water, and they can absorb and concentrate other toxins from the environment.7,8,9

Synthetic surfaces also create heat islands.10,11 In contrast, organically managed natural grass saves energy by dissipating heat, cooling the air, and reducing energy to cool nearby buildings. Natural grass and soil protect groundwater quality; biodegrade polluting chemicals and bacteria; reduce surface water runoff; abate noise; and reduce glare.12

Alternative Infills

Envirofill artificial turf fields are advertised as “cooler” and “safer,” but our research indicates that these fields are still at least 30-50 degrees hotter than natural grass. Envirofill is composed of materials resembling plastic polymer pellets (similar in appearance to tic tacs) with silica inside. Silica is classified as a hazardous material according to OSHA regulations, and the American Academy of Pediatrics specifically recommends avoiding it on playgrounds. The manufacturers and vendors of these products claim that the silica stays inside the plastic coating. However, sunlight and the grinding force from playing on the field breaks down the plastic coating. For that reason, even the product warranty admits that only 70% of the silica will remain encapsulated. The other 30% can be very harmful as children are exposed to it in the air as particulate matter that can harm the lungs.

In addition, the Envirofill pellets and some other infill have been coated with an antibacterial called triclosan. Triclosan is registered as a pesticide with the EPA, and the FDA has banned triclosan from soaps because manufacturers were not able to prove that it is safe for long-term use. Research shows a link to liver and inhalation toxicity and hormone disruption. The manufacturer of Envirofill says that the company no longer uses triclosan, but they provide no scientific evidence that the antibacterial they are now using is any safer than triclosan. Microscopic particles of this synthetic turf infill will be inhaled by children, and visible and invisible particles come off of the field, ending up in shoes, socks, pockets, and hair.

In response to the concerns of educated parents and government officials, other new materials are now being used for infill instead of tire crumb and other very controversial materials. However, all the materials being used (such as zeolite, corn husks, and Corkonut) have raised concerns, and none are proven to be as safe or effective as well-designed grass fields.

Conclusions

There have never been any safety tests required prior to sale that prove that any artificial turf products are safe for children who play on them regularly. In many cases, the materials used are not publicly disclosed, making independent research difficult to conduct. None of these products are proven to be as safe as natural grass in well-constructed fields.

I have cited several relevant scientific articles on artificial turf in this letter, and there are numerous studies and growing evidence of the harm caused by these synthetic materials. I would be happy to provide additional information upon request (dz@center4research.org).

I am not paid to write this statement. I am one of the many parents and scientists who are very concerned about the impact of artificial fields on our children. Your decision about artificial turf and playground surfaces can save lives and improve the health of children in your community.  You owe it to your community to make sure that you know the risks of artificial turf and do all you can to protect your children from both the known risks and the suspected risks. Your decisions about artificial turf will be cited by other communities, making it even more important that your decision is based on scientific evidence, not on sales pitches by individuals with conflicts of interest.

Officials in communities all over the country have been misled by artificial turf salespeople. They were erroneously told that these products are safe. On the contrary, there is clear scientific evidence that these materials are harmful. The only question is how much exposure is likely to be harmful to which children? We should not be willing to take such a risk. Our children deserve better.

Sincerely,

Diana Zuckerman, PhD

President

References

  1. State of California-Office of Environmental Health Hazard Assessment (OEHHA), Contractor’s Report to the Board. Evaluation of Health Effects of Recycled Waste Tires in Playground and Track Products. January 2007. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C62206013.pdf
  2. Benoit G, Demars S. Evaluation of organic and inorganic compounds extractable by multiple methods from commercially available crumb rubber mulch. Water, Air, & Soil Pollution. 2018;229:64. https://doi.org/10.1007/s11270-018-3711-7
  3. Anderson SE and Meade BJ. Potential Health Effects Associated with Dermal Exposure to Occupational Chemicals. Environmental Health Insights. 2014; 8(Suppl 1):51–62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270264/
  4. York T. Greener grass awaits: Environmental & fiscal responsibility team up in synthetic turf. Recreation Management. February 2012. http://recmanagement.com/feature_print.php?fid=201202fe02
  5. Magnusson K, Eliasson K, Fråne A, et al. Swedish sources and pathways for microplastics to the marine environment, a review of existing data. Stockholm: IVL- Swedish Environmental Research Institute. 2016. https://www.naturvardsverket.se/upload/miljoarbete-i-samhallet/miljoarbete-i-sverige/regeringsuppdrag/utslapp-mikroplaster-havet/RU-mikroplaster-english-5-april-2017.pdf
  6. Kole PJ, Löhr AJ, Van Belleghem FGAJ, Ragas AMJ. Wear and tear of tyres: A stealthy source of microplastics in the environment. International Journal of Environmental Research Public Health. 2017;14(10):pii: E1265. https://www.ncbi.nlm.nih.gov/pubmed/29053641/
  7. Kosuth M, Mason SA, Wattenberg EV. Anthropogenic contamination of tap water, beer, and sea salt. PLoS One. 2018,13(4): e0194970. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895013/
  8. Oehlmann J, Schulte-Oehlmann U, Kloas W et al.  A critical analysis of the biological impacts of plasticizers on wildlife. Philosophical Transactions of the Royal Society B. 2009;364:2047–2062. http://rstb.royalsocietypublishing.org/content/364/1526/2047
  9. Thompson RC, Moore CJ, vom Saal FS, Swan SH. Plastics, the environment and human health: Current consensus and future trends. Philosophical Transactions of the Royal Society B. 2009;364:2153–2166. https://royalsocietypublishing.org/doi/full/10.1098/rstb.2009.0053
  10. Thoms AW, Brosnana JT, Zidekb JM, Sorochana JC. Models for predicting surface temperatures on synthetic turf playing surfaces. Procedia Engineering. 2014;72:895-900. http://www.sciencedirect.com/science/article/pii/S1877705814006699
  11. Penn State’s Center for Sports Surface Research. Synthetic turf heat evaluation- progress report. 012. http://plantscience.psu.edu/research/centers/ssrc/documents/heat-progress-report.pdf
  12. Stier JC, Steinke K, Ervin EH, Higginson FR, McMaugh PE. Turfgrass benefits and issues. Turfgrass: Biology, Use, and Management, Agronomy Monograph 56. American Society of Agronomy, Crop Science Society of America, Soil Science Society of America. 2013;105–145. https://dl.sciencesocieties.org/publications/books/tocs/agronomymonogra/turfgrassbiolog

 

NCHR Letter to Mayor Cohn and Members of the Rye City Council Concerning the Health Risks of Artificial Turf and Playgrounds

National Center for Health Research, November 18, 2019


Download the letter here.

Dear Mayor Cohn and Members of the City Council:

Residents of Rye reached out to me to obtain my expertise in assessing the validity of the articles and letters provided by Stantec Design Services, regarding the health risks of installing artificial turf at what is now Nursery Field.   I am providing this information pro bono because our nonprofit research center is very concerned about the misleading information that has been presented to Rye officials regarding artificial turf.

The purpose of this letter is to focus on the research literature summarized and presented in Stantec’s review, including those in their Appendix.  It will not be focused on the logistical issues, but rather the health issues of importance to children using the field, and those who would be exposed to the chemicals in artificial turf because of its location near homes, wetlands, and a main tributary to Long Island Sound.

I will focus first on the claims that artificial turf does not cause cancer.  Dr. Archie Bleyer, quoted by Stantec, has impressive credentials, but his conclusions are based on his expertise regarding decades-old research while ignoring many of the most recent published studies.  Most important, as city officials, it is essential to distinguish between the lack of conclusive research linking artificial turf to cancer, and the often-made claim by the turf industry that artificial turf does not cause cancer.  The lack of conclusive proof of danger is not equal to proof of safety.  It is widely known that artificial turf contains chemicals that are probable and known carcinogens.   However, it takes years for cancer to develop after exposure to carcinogens.  For example, most smokers start smoking as teenagers but they don’t develop lung cancer for at least 3-4 decades. The reports of cancer clusters, such as the one among soccer players in Washington state, are the first hint that exposure to the chemicals contained in artificial turf increase the risk of cancer, but this too takes years to conclusively determine whether the cancer risk is higher due to the exposure.  That is one of the reasons why cancer clusters, such as the one reported in Washington State, can rarely determine causality.  It reminds me of cancer clusters among Vietnam veterans exposed to Agent Orange that were considered just a fluke until years later, when researchers concluded that Agent Orange caused certain types of cancer.  While we wait for this research, we cannot accurately conclude that there is no risk. Instead, we can only state that we do not know the level of risk.

Equally important, cancer is not the only health risk associated with the use of artificial turf.  The rubber pieces break down into very small pieces called particulate matter, which are kicked up into the air when the field is used where they can be inhaled.  The particulate matter can aggravate asthma, and can contain irritants and heavy metals.  The research cited by Stantec ignores that serious issue.

In addition, as the field gets hot, which can be 50-80 degrees hotter than the air or natural grass, the heat can cause heat stroke and even cause burns.  The highest temperature we have tested on a summer day in the 90’s was over 180 degrees.  In addition, heat from the fields makes it more likely that the chemicals are released into the air.  These can include polycyclic aromatic hydrocarbons (PAHs), and endocrine disruptors such as phthalates. These exposures can contribute to obesity, early puberty, ADHD, and eventually cancer.  Children are more vulnerable to these exposures than adults.

The Massachusetts HHS letter from 2015 and the letter from the State of Connecticut from 2015 both attempt to summarize information that focuses on cancer data but is broader than the cancer risk of artificial turf.  However, the studies quoted in the letter are small and so their generalizability to other fields is limited.  Importantly, it excluded several studies that raised concerns about the risks posed by artificial turf and pre-dates several more recent studies that have raised serious health concerns.

This year, testing in several communities found dangerous levels of lead in artificial turf as well as playgrounds made from synthetic rubber.  For example, testing of playgrounds and artificial turf fields in affluent and lower-income communities in Washington, D.C. resulted in more than 2 dozen that were closed due to health risks (see signs below).

Sign on artificial turf field stating that the field failed an "impact attenuation" or "hardness" test, which means that there is an increased risk of injury in the event of a fall.Sign - Warning: Do not eat infill mix in artificial turf as it may be harmful to your health

In the below left photo, children are playing on an artificial turf field near their school; tire crumb infill that had been hidden in the plastic grass came to the surface due to rain and wind.

Children playing in tire crumb infill from field

Used artificial turf with trash in the dumpster

The environmental implications of artificial turf are also important.  In the above right photo, you can see old turf has been dumped in a dumpster with trash. Much of the infill has already spread to the nearby playground, grass, and stream.

I will now focus on just a few of the studies that were not discussed in the letters submitted by Stantec, all of which demonstrate the very serious, evidence-based concerns about health risks, in chronological order:

Shalat 2011 (for the New Jersey Department of Environmental Protection) – They analyzed lead and other metals in particulate matter (dust) that is kicked up into the air by activity on the field, and thus, able to be inhaled, on 5 artificial turf fields.  The study found that there was more inhalable particulate matter in the air around a moving object (either a robot or a child soccer player) than a stationary collection system on the side of the field.  This suggests that studies using stationary collection systems underestimate exposures.  It also suggests that even low levels of activity on the field can cause inhalable particulate matter to get into the air where it can be harmful.  The study also found that the oldest field studied (8 years old) had more inhalable particulate matter than younger fields in this study (1–3 years old).  This is especially worrisome because the dust contains lead.  The authors state, “While it is not possible to draw broad conclusions from this limited sample of fields, the results suggest that there is a potential for inhalable lead to be present on turf fields that have significant amounts of lead present as detectable by surface wipes.  It also would appear likely from this sample that if the lead is present to any appreciable extent in the wipes it will likely be present in the breathing zone of players who are active on these fields, and that furthermore, these levels potentially exceed ambient EPA standards.”  Since no level of lead exposure is considered safe for children, “only a comprehensive mandated testing of fields can provide assurance that no health hazard on these fields exists from lead or other metals used in their construction and maintenance.”[1]

Llompart et al 2013 (Universidad de Santiago de Compostela) – This study examined samples from 9 playgrounds and 7 newly purchased rubber floor tiles that were made from recycled tire rubber in Spain.  It found all samples released hazardous chemicals into the air, where they can be inhaled, some of which were at high or very high levels. PAHs were found in all samples, including the carcinogenic B[a]P.  Other chemicals of concern include the phthalates DEP, DIBP, DBP, DEHP, and BHT.  The authors conclude, “The present study highlights the presence of a high number of harmful compounds, frequently at high or extremely high levels, in these recycled rubber materials.  Therefore, they should be carefully controlled, and their final use should be restricted or even prohibited in some cases.”[2]

Marsili et al 2014 (Siena University) – This study evaluated the recycled rubber infill (4 samples were not yet installed and 4 from fields that were 1-8 years old) and 1 new sample from virgin rubber in Italy. It found that levels of cadmium and zinc exceeded regulatory requirements for some or all samples, respectively. It also found very high levels of PAHs released into the air from some samples. After calculating a risk assessment for PAH inhalation from synthetic fields, the authors stated that “the quantity of toxic substances it releases when heated does not make it safe for public health.”[3]

Canepari et al 2016 (Sapienza University of Rome) – This study examined particulate matter and extractable chemicals from 1 sample of recycled tire rubber, 2 new and a single 7-year-old sample of natural rubber, and 1 sample of last-generation thermoplastic elastomer crumb (TPE).  The recycled tire rubber had a larger concentration of toxic elements, such as heavy metals.  TPE released the lowest amount of elements with high concentrations of only magnesium and calcium.  Natural rubber was more sensitive to aging and more easily broke down into small pieces that could be inhaled.  The authors concluded, “The use of natural rubber and of not-recycled thermoplastic materials, which are progressively replacing recycled tire scraps as synthetic turf fillers, does not seem to be adequately safe for human health, particularly when considering that children are the most exposed bracket of population.  Exposure risks arising from the use of these materials deserve to be further deepened.”[4]

Celeiro et al 2018 (Universidad de Santiago de Compostela) – This study evaluated the amount of chemicals released into the air from samples of recycled tire rubber infill from 15 soccer fields in Spain.  Analysis found high levels of PAHs, including the highly toxic B[a]P.  The levels of PAHs exceeded REACH Regulations for consumer products.  The study also found heavy metals such as cadmium, chromium and lead, as well as phthalates, adipates, vulcanizing agents and antioxidants could leach into runoff. “The environmental and health risks derived from the use of these surfaces have to be considered and some regulations should be adopted.”[5]

Benoit and Demars 2018 (Yale University) – This study analyzed 9 bags of recycled tire mulch from chain stores and 6 samples of recycled tire infill for athletic fields.  It focused on the chemicals which people using the fields would be expected to be exposed to, and found 92 chemical compounds.  Only about half of these compounds have been tested for effects on human health, of which 9 are carcinogens and 20 are irritants.  They concluded, “But what is known is that people routinely ingest, inhale, handle, and have abrasions which contact ground tire material.  That being so, it is prudent to assume that any chemicals in the tires or released by them can be transferred to exposed individuals.  This study shows that a large number of compounds, many of them carcinogenic or irritants, are released from shredded recycled tires through several potential routes.  Caution would argue against use of these materials where human exposure is likely, and this is especially true for playgrounds and athletic playing fields where young people may be affected.”[6]

Perkins et al 2019 (Yale University) – Based on previously published research, the researchers identified 306 chemicals found in crumb rubber. Fifty-two of these chemicals were classified as carcinogens by the U.S. EPA and/or the European ECHA. Then the researchers used the known characteristics of each chemical, such as the structure, to predict whether or not it was likely to be a carcinogen. Using this process, 197 were predicted to be carcinogens. They concluded, “Our study highlights a vacuum in our knowledge about the carcinogenic properties of many chemicals in crumb rubber infill.”  “The crumb rubber infill of artificial turf fields contains or emits chemicals that can affect human physiology.”[7]

The bottom line:  There is a growing body of evidence of the risks of the chemicals and lead in artificial turf and rubber surface playgrounds.  It would not be ethical to intentionally expose children to these play areas, and no independent researchers or government researchers have conducted long-term studies to determine if children with greater exposures are more likely to develop the health problems that are expected, such as obesity, asthma, cognitive damage, early puberty, and eventually cancer.

Please contact me with any questions at (202) 223-4000 or dz@center4research.org .

Sincerely,

Diana Zuckerman, Ph.D.
President

References

  1. Shalat SL. An Evaluation of Potential Exposures to Lead and Other Metals as the Result of Aerosolized Particulate Matter from Artificial Turf Playing Fields. 2011. New Jersey Department of Environmental Protection. http://www.nj.gov/dep/dsr/publications/artificial-turf-report.pdf
  2. Llompart M, Sanchez-Prado L, Pablo Lamas J, et al. Hazardous Organic Chemicals in Rubber Recycled Tire Playgrounds and Pavers. Chemosphere. 2013;90(2):423-431. https://doi.org/10.1016/j.chemosphere.2012.07.053
  3. Marsili L, Coppola D, Bianchi N, et al. Release of Polycyclic Aromatic Hydrocarbons and Heavy Metals from Rubber Crumb in Synthetic Turf Fields: Preliminary Hazard Assessment for Athletes. Journal of Environmental & Analytical Toxicology. 2014;5(2):265 http://dx.doi.org/10.4172/2161-0525.1000265
  4. Canepari S, Castellano P, Astolfi ML, et al. Release of Particles, Organic Compounds, and Metals from Crumb Rubber Used in Synthetic Turf under Chemical and Physical Stress. Environmental Science and Pollution Research International. 2018;25(2):1448-1459. https://doi.org/10.1007/s11356-017-0377-4
  5. Celeiro M, Dagnac T, Llompart M. Determination of Priority and other Hazardous Substances in Football Fields of Synthetic Turf by Gas Chromatography-Mass Spectrometry: A Health and Environmental Concern. Chemosphere. 2018;195:201-211. https://doi.org/10.1016/j.chemosphere.2017.12.063
  6. Benoit G, Demars S. Evaluation of Organic and Inorganic Compounds Extractable by Multiple Methods from Commercially Available Crumb Rubber Mulch. Water, Air, & Soil Pollution. 2018;229:64. https://doi.org/10.1007/s11270-018-3711-7
  7. Perkins AN, Inayat-Hussain SH, Deziel NC, et al. Evaluation of Potential Carcinogenicity of Organic Chemicals in Synthetic Turf Crumb Rubber. Environmental Research. 2019;169:163-172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396308/

NCHR Letter to Mayor Cohn and Members of the Rye City Council Concerning Artificial Turf and Playgrounds

National Center for Health Research, October 16th, 2019


Dear Mayor Cohn and Members of the Rye City Council:

I am writing on behalf of the National Center for Health Research.  Our nonprofit think tank is located in Washington, D.C. Our scientists, physicians, and health experts conduct studies and scrutinize research. Our goal is to explain scientific and medical information that can be used to improve policies, programs, services, and products.   We have been contacted by families in Rye who are concerned about the risks of artificial turf and playgrounds. We are impressed with their knowledge and agree with them that converting grass fields to artificial turf poses unnecessary dangers to children in your community.

As a scientist who has worked on health policy issues for more than 30 years, I don’t shock easily.  However, it is shocking and disturbing that artificial turf athletic fields and playgrounds are exposing children on a daily basis to chemicals and materials that are known to have the potential to increase obesity; contribute to early puberty; cause attention problems such as ADHD; harbor deadly bacteria; exacerbate asthma; and eventually cause cancer.

Federal agencies such as the EPA and the U.S. Consumer Product Safety Commission have been investigating the safety of these products. A recently released EPA report found toxic chemicals in artificial turf, but did not evaluate whether or not the level of exposure would harm children.  Despite claims to the contrary, no federal agency has concluded that artificial turf is safe.

Scientific Evidence of Cancer and Other Systemic Harm

First, it is important to distinguish between evidence of harm and evidence of safety.  Companies that sell and install artificial turf often claim there is “no evidence that children are harmed” or “no evidence that the fields cause cancer.”  This is often misunderstood as meaning the products are safe or are proven to not cause harm. Neither is true.

The artificial turf industry will tell you there is no clear evidence that their fields caused any child to develop cancer.  That is true, but the statement is misleading because it is virtually impossible to prove any chemical exposure causes one specific individual to develop cancer.

As an epidemiologist, I can also tell you that for decades there was no evidence that smoking or Agent Orange caused cancer. It took many years to develop that evidence, and the same will be true for artificial turf.

I have testified about the risks of these materials at the U.S. Consumer Product Safety Commission as well as state legislatures and city councils. I am sorry to say that I have repeatedly seen and heard scientists paid by the turf industry and other turf industry lobbyists say things that are absolutely false. They claim that these products are proven safe (not true) and that federal agencies have stated there are no health risks (also not true).

Most research has focused on the risks of infill made from recycled tire waste. However, recent research has indicated the presence of dangerous levels of chemicals in the plastic blades of grass as well as in the tire waste. So, even if the infill is replaced with a safer materials, the plastic grass carpet itself is dangerous.

We know that the materials being used contain carcinogens, and when children are exposed to those carcinogens day after day, week after week, and year after year, they increase the chances of our children developing cancer, either in the next few years or later as adults. That should be adequate reason not to install them in your community. That’s why I have spoken out about the risks of artificial turf in my community and on a national level. The question must be asked: if they had all the facts, would Rye or any other community choose to spend millions of dollars on fields that are less safe than well-designed natural grass fields?

Synthetic rubber and plastic are made with different types of endocrine (hormone) disrupting chemicals as well as carcinogens.  There is very good evidence regarding these chemicals in tire crumb, based on studies done at Yale and by the California Office of Environmental Health Hazard Assessment (OEHHA). [1]

A 2015 report by Yale scientists detected 96 chemicals in samples from 5 different artificial turf companies, including unused bags of tire crumb. Unfortunately, the health risks of most of these chemicals had never been studied.  However, 20% of the chemicals that had been tested are classified as probable carcinogens and 40% are irritants that can cause asthma or other breathing problems, or can irritate skin or eyes. [2]

There are numerous studies on the impact of hormone-disrupting chemicals (also called endocrine disrupting chemicals or EDCs), and the evidence is clear that these chemicals found in rubber and plastic cause serious health problems.  Scientists at the National Institute of Environmental Health Sciences (which is part of NIH) have concluded that unlike most other chemicals, hormone-disrupting chemicals can be dangerous at very low levels, and the exposures can also be dangerous when they combine with other exposures in our environment.

That is why the Consumer Product Safety Commission has banned numerous endocrine-disrupting chemicals from toys and products used by children. The products involved, such as pacifiers and teething toys, have been banned for more than a decade, even though they would result in very short-term exposures compared to artificial turf.

A report warning about possible harm to people who are exposed to rubber and other hormone disrupting chemicals at work explains that these chemicals “can mimic or block hormones and disrupt the body’s normal function, resulting in the potential for numerous health effects.  Similar to hormones, EDC can function at very low doses in a tissue-specific manner and may exert non-traditional dose–response because of the complicated dynamics of hormone receptor occupancy and saturation.”[3]

Studies are beginning to demonstrate the contribution of skin exposure to the development of respiratory sensitization and altered pulmonary function. Not only does skin exposure have the potential to contribute to total body burden of a chemical, but also the skin is a highly biologically active organ capable of chemical metabolism and the initiation of a cascade of immunological events, potentially leading to adverse outcomes in other organ systems.

Envirofill and Alternative Infills

Artificial turf fields are often 50-70 degrees hotter (or more) compared to grass fields, and this can be dangerous for children on a warm day.  Envirofill artificial turf fields is advertised as “cooler” and safer than tire crumb, but our research indicates that these fields are still at least 30-50 degrees hotter than natural grass.  Envirofill is composed of materials resembling plastic polymer pellets (similar in appearance to tic tacs) with silica inside.  Silica is classified as a hazardous material according to OSHA regulations, and the American Academy of Pediatrics specifically recommends avoiding it on playgrounds. The manufacturers and vendors of these products claim that the silica stays inside the plastic coating.  However, sunlight and the grinding force from playing on the field breaks down the plastic coating.   For that reason, even the product warranty admits that only 70% of the silica will remain encapsulated.  The other 30% can be very harmful as children are exposed to it in the air.

In addition, the Envirofill pellets have been coated with an antibacterial called triclosan.  Triclosan is registered as a pesticide with the EPA and the FDA has banned triclosan from soaps because manufacturers were not able to prove that it is safe for long-term use.  Research shows a link to liver and inhalation toxicity and hormone disruption.  The manufacturer of Envirofill says that the company no longer uses triclosan, but they provide no scientific evidence that the antibacterial they are now using is any safer than triclosan.  Microscopic particles of this synthetic turf infill will be inhaled by children, and visible and invisible particles come off of the field, ending up in shoes, socks, pockets, and hair.

In response to the concerns of educated parents and government officials, other new materials are now being used instead of tire crumb and other very controversial materials.  However, all the materials being used (such as volcanic rock, corn husks, and Corkonut) have raised concerns and none are proven to be as safe or effective as well-designed grass fields.  And as noted above, the plastic grass itself is made from dangerous chemicals.

Dangerously Hard Fields, Turf Burns, and Hot Fields

I want to briefly mention safety issues pertaining to Gmax scores.  A Gmax score measures how hard a field is, specifically regarding brain injuries.  A score over 200 is considered extremely dangerous and is considered by the synthetic turf industry to pose a death risk.  However, the synthetic turf industry and ASTM (American Society for Testing and Materials), suggest scores should be even lower — below 165 to ensure safety comparable to a grass field.

The hardness of natural grass fields is substantially influenced by rain and other weather; if the field gets hard, rain or watering will make it safe again.  In contrast, once an artificial turf field has a Gmax score above 165, it needs to be replaced because while the scores can vary somewhat due to weather, the scores will inevitably get higher because the turf will get harder.  Gmax testing involves testing 10 different areas of a playing fields, and some officials average those 10 scores to determine safety.  However, experts explain that is not appropriate.  If a child (or adult) falls, it can be at the hardest part of the field, which is why that is the way safety is determined.

In addition to hard fields, artificial turf is more likely to cause “turf burns” which can be very painful and can get infected.  There is a good reason why almost all professional baseball parks use grass rather than artificial turf, and why professional football and soccer teams also prefer natural grass.

In addition to the health risks to school children and athletes, approximately three tons of infill materials migrate off of each synthetic turf field into the greater environment each year.  About 2-5 metric tons of infill must be replaced every year for each field, meaning that tons of the infill have migrated off the field into grass, water, and our homes.[4] The fields also continuously shed microplastics as the plastic blades break down.[5,6] These materials may contain additives such as PAHs, flame retardants, UV inhibitors, etc., which can be toxic to marine and aquatic life; and microplastics are known to migrate into the oceans, food chain, and drinking water and can absorb and concentrate other toxins from the environment. [7,8,9]

As noted above, artificial turf gets much hotter than grass, and so does the air above it.  Synthetic surfaces create heat islands. [10,11] In contrast, organically managed natural grass saves energy by dissipating heat, cooling the air, and reducing energy to cool nearby buildings.  Natural grass and soil protect groundwater quality, biodegrade polluting chemicals and bacteria, reduce surface water runoff, and abate noise and reduce glare. [12]

Conclusions

There are currently no safety tests required prior to sale that prove that any artificial turf products are safe.  In many cases, the materials used are not made public, making independent research difficult to conduct. None of these products are proven to be as safe as natural grass in well-constructed fields.

I have cited several relevant scientific articles on artificial turf in this letter, and I can attest to the fact there are numerous studies and growing evidence of the harm caused by these synthetic materials. I would be happy to provide additional information upon request (dz@center4research.org or 202 223-4000).

I am not paid to write this statement. I am one of the many parents and scientists who are very concerned about the impact of artificial fields on our children.  Your decision about artificial turf can save lives and improve the health of children in Rye and will serve as a model to other communities.

Officials in communities all over the country have been misled by artificial turf salespeople. They were erroneously told that these products are safe.  But on the contrary, there is clear scientific evidence that these materials are potentially harmful. The only question is how harmful and how much exposure is likely to be harmful?  We should not be willing to take such a risk. Our children deserve better.

Sincerely,

Diana Zuckerman, PhD
President

 

References

  1. State of California-Office of Environmental Health Hazard Assessment (OEHHA), Contractor’s Report to the Board. Evaluation of Health Effects of Recycled Waste Tires in Playground and Track Products. January 2007. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C62206013.pdf
  2. Yale Study Reveals Carcinogens and Skin Irritants in Synthetic Turf. http://wtnh.com/2015/09/03/new-yale-study-reveals-carcinogens-and-skin-irritants-in-synthetic-turf/
  3. Anderson SE and Meade BJ, Potential Health Effects Associated with Dermal Exposure to Occupational Chemicals, Environ Health Insights. 2014; 8(Suppl 1): pgs 51–62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270264/
  4. York T. Greener grass awaits: Environmental & fiscal responsibility team up in synthetic turf. Recreation Management. February 2012. http://recmanagement.com/feature_print.php?fid=201202fe02.
  5. Magnusson K, Eliasson K, Fråne A, et al. Swedish sources and pathways for microplastics to the marine environment, a review of existing data. Stockholm: IVL- Swedish Environmental Research Institute. 2016. https://www.naturvardsverket.se/upload/miljoarbete-i-samhallet/miljoarbete-i-sverige/regeringsuppdrag/utslapp-mikroplaster-havet/RU-mikroplaster-english-5-april-2017.pdf
  6. Kole PJ, Löhr AJ, Van Belleghem FGAJ, Ragas AMJ. Wear and tear of tyres: A stealthy source of microplastics in the environment. Int J Environ Res Public Health. 2017 14(10). pii: E1265. https://www.ncbi.nlm.nih.gov/pubmed/29053641/
  7. Kosuth M, Mason SA, Wattenberg EV. Anthropogenic contamination of tap water, beer, and sea salt. PLoS One. 2018. 13(4): e0194970. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895013/
  8. Oehlmann J, Schulte-Oehlmann U, Kloas W et al.  A critical analysis of the biological impacts of plasticizers on wildlife. Phil Trans R Soc B. 2009. 364: 2047–2062. http://rstb.royalsocietypublishing.org/content/364/1526/2047
  9. Thompson RC, Moore CJ, vom Saal FS, Swan SH. Plastics, the environment and human health: Current consensus and future trends. Philos Trans R Soc Lond B. 2009. 364: 2153–2166.
  10. Thoms AW, Brosnana JT, Zidekb JM, Sorochana JC. Models for predicting surface temperatures on synthetic turf playing surfaces. Procedia Engineering. 2014. 72: 895-900. http://www.sciencedirect.com/science/article/pii/S1877705814006699
  11. Penn State’s Center for Sports Surface Research. Synthetic turf heat evaluation- progress report. 012. http://plantscience.psu.edu/research/centers/ssrc/documents/heat-progress-report.pdf
  12. Stier JC, Steinke K, Ervin EH, Higginson FR, McMaugh PE. Turfgrass benefits and issues. Turfgrass: Biology, Use, and Management, Agronomy Monograph 56. American Society of Agronomy, Crop Science Society of America, Soil Science Society of America. 2013. 105-145 https://dl.sciencesocieties.org/publications/books/tocs/agronomymonogra/turfgrassbiolog

Buy a Sleep Mask! It’s an Investment in Your Health

Jessica Becker, Cancer Prevention and Treatment Fund

A study published in 2023 found that wearing an eye mask to block light while sleeping overnight in the home improves memory and alertness the next day.  That should help with driving, learning, and other important activities5.

The new research did not evaluate why the eye mask was so beneficial, but previous research shows that sleeping in total darkness allows your body to produce as much of the hormone melatonin as possible. This is good because when your production of melatonin drops, you are at greater risk of breast and/or colorectal cancer and other health risks.

What is Melatonin?

Melatonin is a hormone that is naturally produced in your body. It is secreted by the pineal gland, which is buried deep in the brain. Melatonin is only produced at night and only when it is dark, which means that melatonin production peaks between 3:00 a.m. and 5:00 a.m. for most people. This hormone helps to regulate your circadian rhythm, which is like your body’s natural clock. When melatonin and several other chemicals are released, you feel drowsy and your body temperature lowers. In addition to this sleep-cycle function, melatonin also works as an antioxidant. This means that it can help prevent damage to your DNA that can result from aging, exposure to cancer-causing chemicals, or harmful rays from the sun. Preventing damage to DNA is important because DNA damage can cause cancer.

Doesn’t My Body Produce Enough Melatonin?

There have been major advancements in technology over the last two centuries, one being the light bulb. Because of the light bulb (and electricity, in general), we are able to stay awake and active much later, so the night is not as dark as it used to be. Think of New York City: the city that never sleeps. Cities are so lit up at night that it can be hard to see the stars. This is referred to as “light pollution.”  And, of course, even in the middle of nowhere, you can keep your lights on all night in your house.

Our ability to turn night into day has allowed for more night shift work, often called “the graveyard shift.” Even if you don’t work on the late shift, you may be working at home late at night or staying up late watching TV or using the internet.  Unfortunately, this kind of schedule has many effects on your body, including reducing the amount of melatonin produced. But it is not just night owls or shift workers who suffer from a decreased production of melatonin. Sleep studies show that almost everyone wakes up at some point during the night, even if we do not remember it. Unless you have blackout shades on your windows, there is a good chance that some light is coming into your bedroom and that your eyes are registering this light during those wakeful periods.[2]

New technology is compounding the effects of light pollution. Early incandescent light bulbs that were dim and yellow and did not affect melatonin production very much. Now, artificial light emits more blue wavelengths. For example “Cool White” fluorescent bulbs are a very popular choice of light bulb because they are bright, moderately energy efficient, and relatively inexpensive. They also produce a lot of blue light which is why they have a “cool” effect. Maybe you have noticed while driving that certain people’s headlights appear to be very bright and have a blue tint to them. These new headlights produce blue wavelengths of light. Unfortunately, research shows that blue wavelengths of light are especially effective at reducing melatonin production in humans.[3] All types of computer monitors and television screens also emit blue light.

Why Is Having Less Melatonin A Bad Thing?

Believe it or not, the International Agency for Research on Cancer (IRAC) classified shift work as a probable human carcinogen in 2007. There have been numerous studies showing a link between night shift work and an increased incidence of breast cancer. For instance, a 2003 study done in the Netherlands found that by working half a year at night, a person’s risk of breast cancer increased 150%.[3] This major study found that nurses who worked night shifts at least 3 times a month for 15 years or more had a 35% increased risk of colorectal cancer.[3] If you’re still unconvinced, a 2009 study conducted in 147 communities in Israel found that women who lived in neighborhoods where it was bright enough to read a book outside at midnight had a 73% higher risk of developing breast cancer than women living in areas without outdoor lighting.[2]

What Can I Do To Limit My Chances Of Getting Cancer Because of Light At Night?

The good news is that there are easy and inexpensive ways to limit the amount of light you are exposed to at night. For starters, if you have electronic appliances in your bedroom that produce light (like a clock radio or cable box), pick those that have red lights as opposed to green or blue lights. Walmart, Target, Best Buy, and many other stores all carry alarm clocks and radios that display the time in red numbers. These brands are not more expensive than their blue numbered counter-parts. Studies show that red lights don’t cause as much of a decrease in the amount of melatonin produced by your body.[4] Also, if you have a television or computer in your bedroom, turn it off before you go to sleep.

It is also a good idea to limit the amount of time you spend in front of a screen at night. If you spend a few hours a night in front of your computer, whether or not you’re not in your bedroom, you are decreasing the amount of melatonin that is being produced in your brain. Most screens today offer a “night mode” which reduces the amount of blue light used and creates an orange tint. This is a recommended setting to use before bed.

Also, since melatonin production is highest between the hours of 3:00 am and 5:00 am, make sure you’re in bed and asleep by 3:00 a.m., and if at all possible, sleep until at least 5:00 am. While you probably will not be able to petition your community to get the street light in front of your house turned off, you can buy blackout shades to block the light. Most department stores sell blackout shades, and they are relatively inexpensive. If you don’t want to invest a penny more in “window treatments,” consider using a sleep mask. Airlines sometimes give them away in travel kits, but you can also buy them online or in a department store. Besides lowering the risk of getting certain cancers, sleep masks can also help you fall asleep faster, have a better night’s sleep, and feel much better the next day. Those are great benefits for such a simple, no-risk strategy.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff. 

  1. Navara J, Nelson R. The Dark Side Of Light At Night: Physiological, Epidemiological, and ecological consequences. Journal of Pineal Research. 2007, (43)
  2. Chepesiuk R. Missing the Dark: Health Effects of Light Pollution. Environmental Health Perspectives. 2009, (117)
  3. Pauley S. Lighting For The Human Circadian Clock: Recent Research Indicated That Lighting Has Become A Public Health Issue. Medical Hypotheses. 2003
  4. Reiter R. Circadian Disruption and Cancer: Making the Connection. The New York Academy of Sciences. 2009
  5. Greco, V., Bergamo, D., Cuoccio, P., Konkoly, K. R., Muñoz Lombardo, K., & Lewis, P. A. (2023). Wearing an eye mask during overnight sleep improves episodic learning and alertness. Sleep, 46(3), zsac305. https://doi.org/10.1093/sleep/zsac305

What are Artificial Turf and Playgrounds Made Of? Can They Cause Cancer? Obesity? Asthma?

Diana Zuckerman, PhD, National Center for Health Research


Is your child playing on rubber and plastic instead of grass?  Grass has been replaced with artificial materials at schools and parks all over the country and especially in Washington D.C., Maryland, and Virginia. but there is growing evidence they can be harmful to children and adults.

Regardless of what they look like, all artificial fields and playgrounds are made with materials that can be dangerous to people of all ages.

Many athletes don’t like artificial turf, and only 2 professional ballparks now use it.  In addition to plastic “grass,” rubber, silica, and other materials are used to keep the “grass” in place and provide more cushioning.  Unfortunately, artificial turf increases “turf burn” abrasions from sliding, puts additional stress on joints, and can become dangerously hot in the sun.  It may also cause cancer and other serious long-term health problems.

 Recycling Tires from Playgrounds

More than 20 million recycled rubber tires are processed every year for playground surface cover and sports surfaces. Using tire scraps seemed like a great idea at first – keeping them out of landfills and providing a potentially softer landing on the playground. It was known that burning old tires released harmful, smelly chemicals into the air and ground water, but parents didn’t realize that recycled tires and new rubber used on fields and playgrounds (such as pictured below) can also be dangerous. You may think of rubber as a natural product from rubber trees – but rubber is a mix of latex from rubber trees mixed with petroleum products.  That means it can include lead, phthalates, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and other chemicals known or suspected to harm human health. For example, phthalates are chemicals that affect hormones and many have been banned from children’s toys because they can increase the risks of obesity, early puberty, attention problems, and cancer. The EPA warns that breathing air contaminated with PAHs may increase the chance of developing cancer, and the U.S. Agency for Toxic Substances and Disease Registry warns that PAHs may increase the risk of cancer and birth defects.

 Why Aren’t They Proven Safe?

There is no government agency that requires synthetic playground surfaces to be tested before they can be sold. In fact, the materials used are often not made public — justified as “trade secrets.”  However, some researchers independently have examined the safety of these playground surfaces, resulting in signs like the local one below.

It would not be ethical to conduct a study exposing children to tire shreds, knowing they could be unsafe, so the California Office of Environmental Health Hazard Assessment conducted three studies that mimicked children’s exposures instead.  Results showed that a single incident of eating or touching tire shreds would probably not harm a child’s health, but repeated or long-term exposure might. Five chemicals, including four PAHs, would get on children’s skin if they played on these surfaces. One of the PAHs, “chrysene,” was higher than the level considered safe, and could increase the chances of a child developing cancer.

In addition, only 10 of the 32 playgrounds studied met California’s safety standard for falls, which meant that falling on these hard surfaces could cause a brain injury of other serious harm. In contrast, all five surfaces made of wood chips met the safety standard.

In Washington, D.C., 37 of their 51 artificial turf fields failed 2017 safety tests, due to hardness scores above 165 (see the sign above). In 2019, Washington, D.C. admitted that 17 of their playgrounds have dangerously high levels of lead.  Also in 2019, the nonprofit Ecology Center tested the crumb rubber that was found on the broken rubber surfaces of several playgrounds in Washington, D.C.  They found that some of the pieces had dangerously high levels of lead.

A 2015 report by Yale scientists analyzed 14 different samples used for school athletic fields and playgrounds.  They detected 96 chemicals, most of which have never been carefully studied, so their health risks are unknown.  However, 20% of the chemicals that had been tested are considered to probably cause cancer.  In addition, 40% are irritants that can cause breathing problems such as asthma, and can irritate skin or eyes.

What About your Schools or Parks?

These are a few of the many materials to be concerned about:

  • Loose tire shred (rubber mulch) or “crumb” on a surface that can be raked, including artificial “grass” fields.
  • Tire shreds that are combined with a binder and then poured onto a permanent surface.
  • Tiles made from tire shreds and binder that have been factory-molded, then glued to a playground surface.
  • Colorful rubber that is “poured in place” (PIP), which is not necessarily made from tires but can contain many of the same dangerous materials.

How to Protect your Children

Children are much more likely to be harmed by exposure to chemicals in their environment than adults because they are smaller (so the exposure is greater) and because their bodies are still developing. Pregnant women should be even more careful to avoid these exposures.

Parents in many communities are persuading local officials to conduct safety tests on artificial turf fields every year, and to  install grass or wood chips because they are safer in terms of chemical exposure, heat, and if their children fall.

 

 

 

 

 

 

Meanwhile, here are some tips for parents from the Consumer Product Safety Commission: 

  1. Children should avoid mouth contact with playground surfacing materials. Some of these materials are small and look like seeds, mulch, or small candies. They may pose a choking hazard as well as a dangerous chemical exposure.
  2. Avoid eating food or drinking beverages while directly on playground surfaces, and wash hands before handling food.
  3. Limit the time at a playground on hot days. Children tell us they can often see the heat waves rising off the fields on warm, sunny days.
  4. Clean hands and other exposed skin after visiting the playground, and consider changing clothes if marks or dust from the rubber is visible on fabrics.
  5. Clean any toys that were used on a playground after the visit.

These safeguards will help reduce your child’s exposure, but if they are playing on one of these fields or playgrounds for hours every week, there is still reason for concern.

That’s why our Center has testified before the Washington, D.C. City Council and the Maryland Senate and House of Delegates and why we are working with parents across the country who seek our help in convincing their communities to choose grass and avoid artificial turf.

If you would like to download and print a PDF version, click here.

References:

  1. Llompart M, Sanchez-Prado L, Lamas JP, Garcia-Jares C, et al. Hazardous organic chemicals in rubber recycled tire playgrounds and pavers. Chemosphere. 2013;90(2):423-431. http://www.sciencedirect.com/science/article/pii/S0045653512009848
  2. US Environmental Protection Agency (EPA). Polycyclic Aromatic Hydrocarbons (PAHs)-Fact Sheet. November 2009. https://www.epa.gov/north-birmingham-project/polycyclic-aromatic-hydrocarbons-pahs-fact-sheet Accessed May 2016.
  3. Agency for Toxic Substances and Disease Registry (ATSDR). Polycyclic Aromatic Hydrocarbons. September 1996. http://www.atsdr.cdc.gov/toxfaqs/tfacts69.pdf Accessed May 2016.
  4. State of California-Office of Environmental Health Hazard Assessment (OEHHA), Contractor’s Report to the Board. Evaluation of Health Effects of Recycled Waste Tires in Playground and Track Products. January 2007. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C62206013.pdf Accessed May 2016.
  5. Yale Study Reveals Carcinogens and Skin Irritants in Synthetic Turf. http://wtnh.com/2015/09/03/new-yale-study-reveals-carcinogens-and-skin-irritants-in-synthetic-turf/

 

Children and Athletes at Play on Toxic Turf and Playgrounds

Nyedra W. Booker PharmD MPH and Stephanie Fox-Rawlings PhD, National Center for Health Research.


Is your child playing on rubber instead of grass at the playground? The use of human-made surfaces on playgrounds has increased dramatically over the years. First developed during the 1960s primarily for athletic fields, these artificial surfaces were also part of a strategy to provide children with more opportunities for outdoor physical activity, particularly in the inner city where outdoor playgrounds were scarce.[1] The first artificial turf (marketed as “Chemgrass”) was made of plastic, yet looked a lot like natural grass.  Since then, these artificial surfaces have expanded and many look like colorful rubber surfaces.  But regardless of what they look like, all are made with materials that can be dangerous to children and adults.

As its use for various sports activities increased significantly over the years, so did the concerns. Athletes began to complain that the surface was much harder than natural grass, as some studies also began to show that the use of artificial turf could increase the risk for football and other sports-related injuries. This prompted a ban on the use of artificial turf by the English Football Association in 1988, while many ballparks and professional sports stadiums in the United States began converting back to using natural grass during the 1990s. Over time, material such as rubber was added to keep the blades of “grass” in place and provide more cushioning.[1] Artificial turf containing rubber and other cushioning materials was also assumed to reduce sports-related injuries, but study results have not always supported that assumption.[2] Even with modern fields, many professional athletes dislike playing on artificial turf. It increases the severity of abrasions due to sliding, puts additional stress on joints, and heats up much more than grass does in the sun – and can become dangerously hot.[3][4] Following their failure to force soccer’s international governing body (FIFA) to use sod instead of artificial turf for the 2015 Women’s World Cup, an international group of women players are suing the FIFA.[5]

Some of the benefits of artificial turf are that it’s a long-lasting “all-weather” material that does not require a lot of maintenance in the short-term or potentially dangerous pesticides. Artificial turf is currently used on more than 12,000 athletic fields in the U.S.[6]    Unfortunately, these surfaces often don’t last as long as expected.

From the Tire Swings to Play Surfaces made from Tires or New Rubber

Do you remember when children used to play on tire swings in the backyard or at the park? Those same tires are now being put to a new and possibly hazardous use! Recycled rubber tires have become one of the top choice materials for surfacing children’s playgrounds. [7] In 2013, approximately 233 million scrap tires were generated, of which 8% (approximately 17.5 million tires) was processed for playground surface cover and 4% (almost 10 million tires) for sports surfaces. [8] Logically, tire scraps seemed like a surface that would be less likely to harm children if they fell. Recycling tires for use in playgrounds also keeps them out of landfills where they take up space, harbor rodents and other animals, and trap standing water that serve as breeding grounds for mosquitoes and other disease-bearing insects. But just as tires that have been thrown away can catch fire and release many different harmful chemicals into the air and ground water, tire materials and other synthetic rubber can release chemicals into the air we breathe.[9]    Those chemicals can also get on our skin and even in our mouths.  This is an example where what seemed like helpful recycling can instead be harmful.

The tire material and other rubber used on playgrounds can include the following:

  •    Loose tire shred (rubber mulch) or “crumb” on a surface that can be raked.
  •    Tire shreds that are combined with a binder and then poured onto a permanent surface
  •    Tiles made from tire shreds and binder that have been factory-molded, then glued to a playground surface.[7]
  •    Colorful rubber that is “poured in place” (PIP) that is not necessarily made from tires but contains many of the same dangerous materials.

Are Playground Surfaces Made With Rubber or Tire Crumb Safe?

There has been increasing evidence that raises concerns about the safety of tire waste as well as new rubber and other synthetic materials used on playground surfaces. While rubber includes some natural rubber (called latex) from rubber trees, it also contains phthalates (chemicals that affect hormones, see Phthalates and Children’s Products), polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) and other chemicals known or suspected to cause adverse health effects.[10] PAHs, for example, are natural or human-made chemicals that are made when oil, gas, coal or garbage is burned.[11] According to the EPA, breathing air contaminated with PAHs may increase a person’s chance of developing cancer, and the Agency for Toxic Substances and Disease Registry (ATSDR) states that PAHs may increase the risk for cancer and also increase the chances of birth defects.[11] [12]

What the Scientific Studies Say

The California Office of Environmental Health Hazard Assessment (OEHHA) conducted three laboratory studies in 2007 to investigate the potential health risks to children from playground surfaces made from tire waste. One study evaluated the level of chemicals released that could cause harm to children after they have had contact with loose tire shreds, either by eating them or by touching them and then touching their mouth. The other two studies looked at the risk of injury from falls on playground surfaces made from tire waste compared to wood chips, and whether tire shreds could contaminate air or water.[7]

It would not be ethical to ask children to eat tire shreds, so the researchers created chemical solution that mimicked the conditions of a child’s stomach and placed 10 grams of tire shreds in it for 21 hours at a temperature of 37°C. Researchers then measured the level of released chemicals in the solution and compared them to levels EPA considered risky. The study also mimicked a child touching the tire shreds and then touching her mouth by wiping recycled tire playground surfaces and measuring chemical levels on the wipes. To evaluate skin contact alone, the researchers tested guinea pigs to see if rubber tire playground samples caused any health problems. This study assumed that children would be using the playground from the ages of 1 through 12. Results of the OEHHA studies showed that a single incident of eating or touching tire shreds would probably not harm a child’s health, but repeated or long-term exposure might. Five chemicals, including four PAHs, were found on wipe samples. One of the PAHs, “chrysene,” was higher than the risk level established by the OEHHA, and therefore, could possibly increase the chances of a child developing cancer.[7]

Out of the 32 playgrounds surfaced in recycled tires that the researchers in California looked at, only 10 met that state’s 2007 standard for “head impact safety” to reduce brain injury and other serious harm in children who fall while playing. In contrast, all five surfaces made of wood chips met the safety standard.[7]

A 2012 study analyzing rubber mulch taken from children’s playgrounds in Spain found harmful chemicals in all, often at high levels.[10] Twenty-one samples were collected from 9 playgrounds in urban locations. The results showed that all samples contained at least one hazardous chemical, and most contained high concentrations of several PAHs. Several of the identified PAHs can be released into the air by heat, and when that happens children are likely to inhale them. While the heat needed to do this was very high in some cases (140 degrees Fahrenheit/ 60 ºC), many of the chemicals also became airborne at a much lower temperature of 77 ºF (25 ºC). The authors concluded that the use of rubber tire waste on playgrounds “should be restricted or even prohibited in some cases.”[10]

A 2015 report by Yale scientists analyzed the chemicals found in 5 samples of tire crumbs from 5 different companies that install school athletic fields, and 9 different samples taken from 9 different unopened bags of playground rubber mulch. The researchers detected 96 chemicals in the samples. A little under a half have never been studied for their health effects, so their risks are unknown, and the other chemicals have been tested for health effects, but those tests were not thorough. Based on the studies that were done, 20% of the chemicals that had been tested are considered to probably can cause cancer, and 40% are irritants that can cause breathing problems such as asthma, and/or can irritate skin or eyes. [13]

What The EPA has Done

The EPA created a working group that collected and analyzed data from playgrounds and artificial turf fields that used tire material. Samples were collected at six turf fields and two playgrounds in four study sites (Maryland, North Carolina, Georgia and Ohio). In a report released in 2009, the agency concluded that the level of chemicals monitored in the study and detected in the samples were “below levels of concern.” There were limitations to this study, however. The study did not measure the concentration of organic chemicals that are known to vaporize during summer heat (called SVOCs). SVOCs include PAH.

A meeting was then convened by the EPA in 2010, bringing together various state and federal agencies to discuss safe levels of chemical exposure on playgrounds made from tire rubber, and opportunities for additional research. [14] When announcing the results of the study, EPA joined other organizations in recommending that as a precaution, young children wash their hands frequently after playing outside.[14]

In the case of PAHs, the EPA has concluded that while there are currently no human studies available to determine their effects at various levels, based on laboratory findings, “breathing PAHs and skin contact seem to be associated with cancer in humans.” [11]

In February 2016, the U.S. government announced a new action plan to better understand the likely health risks of tire crumb and similar artificial surfaces. This initiative involves 4 U.S. government agencies: the EPA, Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR) and Consumer Product and Safety Commission (CPSC). In December 2016, they released a status report. [15]

What is the Impact on Our Environment?

Although this article focuses on the impact of artificial turf on health, it is worth noting that artificial turf also has a negative impact on the environment.  Sarah-Jeanne Royer, PhD, a postdoctoral fellow at the University of Hawaii who has published research on the impact of degrading plastic on greenhouse gasses, explained to National Center for Health Research staff that artificial turf fields are made of polyethylene and sometimes nylon so they produce greenhouse gasses.[16] The “outgassing” from the plastic is higher during the day but continues at lower levels at night.  Because the artificial turf fields have millions of fragments, they have a very high surface area that produces much more greenhouse gas than a flat carpet would.

How to Protect your Children

So how can you protect your child at the playground? Remember that children are much more likely to be harmed by exposure to chemicals in their environment than adults because they are smaller (so the exposure is greater) and because their bodies are still developing. This is why it’s important to significantly reduce (or try to eliminate) any contact your child may have with substances that are known or suspected to be harmful. If you have more than one playground in your area, choose the one that doesn’t have a recycled rubber play surface or other types of rubber or synthetic surface.

Parents can actively persuade local officials that playgrounds should use wood chips rather than rubber or other substances that are less safe when children fall, and more dangerous in terms of chemicals that they breathe or get on their hands.

The CDC, Consumer Product Safety Commission (CPSC) and EPA all recommend that you teach your child the importance of frequent hand washing, especially after playing outside and before eating.[14] The President’s Cancer Panel  advised to “minimize children’s exposure to toxics” and “both mothers and fathers should avoid exposure to endocrine-disrupting chemicals and known or suspected carcinogens prior to a child’s conception and throughout pregnancy and early life, when risk of damage is greatest.”[17]

The Consumer Product Safety Commission recommends the following precautions:

  1. Avoid mouth contact with playground surfacing materials, including mouthing, chewing, or swallowing playground rubber. This may pose a choking hazard, regardless of chemical exposure.
  2. Avoid eating food or drinking beverages while directly on playground surfaces, and wash hands before handling food.
  3. Limit the time at a playground on extremely hot days.
  4. Clean hands and other areas of exposed skin after visiting the playground, and consider changing clothes if evidence of tire materials (e.g., black marks or dust) is visible on fabrics.
  5. Clean any toys that were used on a playground after the visit. [18]

To learn more about artificial turf and concerns about cancer risks for kids and young adults, watch this ESPN news video here.

Related Articles

NCHR Letter to the DC City Council on Artificial Turf
Risks of Head Injuries on Artificial Turf Fields in Washington, DC
Nearly a Dozen Artificial Turf Fields in DC Failed Last Round of Safety Tests

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

  1. Claudio L. Synthetic Turf-Health Debate Takes Root. Environmental Health Perspectives, 2008; 116(3):A117-22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265067/.
  2.  New York State Department of Health. Fact Sheet: Crumb-Rubber Infilled Synthetic Turf Athletic Fields. August 2012 (last revised). http://www.health.ny.gov/environmental/outdoors/synthetic_turf/crumb-rubber_infilled/fact_sheet.htm Accessed May 2016.
  3. Dubois L. Artificial Turf Controversy a Constant in Backdrop of Women’s World Cup. Sports Illustrated. June 24, 2015. http://www.si.com/planet-futbol/2015/06/23/womens-world-cup-artificial-turf-canada.
  4. Goff S. Women’s World Cup will be played on lush, green artificial turf. Washington Post. June 5, 2015. https://www.washingtonpost.com/sports/womens-world-cup-will-be-played-on-lush-green-artificial-turf/2015/06/05/a786a0ac-0b8d-11e5-951e-8e15090d64ae_story.html Accessed May 2016.
  5. Dockterman E U.S. Women’s Soccer Team Refuses to Play on Turf. Time. Dec 8, 2015. http://time.com/4140786/womens-soccer-team-turf/ Accessed May 2016.
  6. Synthetic Turf Council. About Synthetic Turf. https://syntheticturfcouncil.site-ym.com/page/Public. Accessed May 2016.
  7. State of California-Office of Environmental Health Hazard Assessment (OEHHA), Contractor’s Report to the Board. Evaluation of Health Effects of Recycled Waste Tires in Playground and Track Products. January 2007. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C62206013.pdf Accessed May 2016.
  8. Rubber Manufacturers Association. US Scrap Tire Markets 2013. Nov 2014. https://rma.org/sites/default/files/US_STMarket2013.pdf Accessed May 2016.
  9. US Environmental Protection Agency (EPA). Wastes-Resource Conversation-Common Wastes & Materials – Scrap Tires (Frequent Questions). http://www.homepages.ed.ac.uk/shs/Hurricanes/Frequent%20Questions%20%20%20Scrap%20Tires%20%20%20US%20EPA.html Accessed May 2016.
  10. Llompart M, Sanchez-Prado L, Lamas JP, Garcia-Jares C, et al. Hazardous Organic Chemicals in Rubber Recycled Tire Playgrounds and Pavers. Chemosphere. 2013;90(2):423-431. http://www.sciencedirect.com/science/article/pii/S0045653512009848
  11. US Environmental Protection Agency (EPA). Polycyclic Aromatic Hydrocarbons (PAHs)-Fact Sheet. November 2009. https://www.epa.gov/north-birmingham-project/polycyclic-aromatic-hydrocarbons-pahs-fact-sheet Accessed May 2016.
  12. Agency for Toxic Substances and Disease Registry (ATSDR). Polycyclic Aromatic Hydrocarbons. September 1996. http://www.atsdr.cdc.gov/toxfaqs/tfacts69.pdf Accessed May 2016.
  13. Benoit G, Demars S. Evaluation of Organic and Inorganic Compounds Extractable by Multiple Methods From Commercially Available Crumb Rubber Mulch. Water Air Soil Pollut 2018. 229(3): 64. https://doi.org/10.1007/s11270-018-3711-7
  14. US Environmental Protection Agency (EPA). Fact Sheet – The Use of Recycled Tire Materials on Playgrounds & Artificial Turf Fields. http://www.emcmolding.com/uploads/files/file130102132640.pdf
  15. EPA. Federal Research on Recycled Tire Crumbs Used on Playing Fields. December, 2016. https://www.epa.gov/sites/production/files/2016-12/documents/federal_research_action_plan_on_recycled_tire_crumb_used_on_playing_fields_and_playgrounds_status_report.pdf. Accessed August, 2017.
  16. Astroturf. https://www.astroturf.com/synthetic-turf-products/sports-grass-infill/
  17. Reuben, S. (2010). Reducing Environmental Cancer Risk What We Can Do Now. Annual Report President’s Cancer Panel. U.S. Department of Health and Human Services. https://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf. Accessed 6 Jun. 2018.
  18. CPSC. Crumb Rubber Information Center. https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/Crumb-Rubber-Safety-Information-Center

Third-hand smoke

Noy Birger and Celeste Chen, Cancer Prevention & Treatment Fund

You know that smoking and being exposed to other people’s cigarette smoke (second-hand smoke) is dangerous, but did you know that residue from cigarette smoke, which remains on just about every surface exposed to that smoke, is also harmful? This is called third-hand smoke.

Third-hand smoke or smoke residue clings to hair and fabrics, including clothing, carpets, drapes, and furniture upholstery.[1]  The residue reacts with other chemicals and materials in the air, combining to form substances that cause cancer.[2] This toxic mix is then breathed in or absorbed through the skin.

One particular chemical found in third-hand smoke, NNA, has been scrutinized because it can directly interact with and damage DNA, possibly paving the way for cancer to grow. Researchers believe that NNA behaves similarly to a byproduct of nicotine called NNK, which has long been known to cause cancer.

In a 2014 study, researchers confirmed that NNA not only breaks up DNA just like NNK does, but also attaches itself to DNA. By breaking up and attaching to DNA, NNA is able to produce cells that grow when they shouldn’t, creating tumors and causing damaging genetic mutations.[3]

Third-Hand Smoke Is Sneaky

Many public buildings ban indoor smoking, and the majority of people who smoke are aware of the health risks–to them and everyone around them–and therefore confine their smoking to outdoors, away from children and non-smokers. But even after the cigarette has been put out, you can carry dangerous nicotine residue back inside on your hair and clothes, and consequently put others at risk of developing cancer.[1]

Children are particularly vulnerable. Like adults, they can absorb the tar and nicotine leftovers through their skin. The effect on children is greater because they are smaller and still developing. Also, children are more likely to put their residue-covered hands on their nose or in their mouth.[4] Chemicals such as NNA that are produced when smoke residue mixes with chemicals in the air can cause developmental delays in children.[1] Parents should know that if they smoke in the car, their children can absorb the cancer-causing chemicals from the car upholstery, even if the children weren’t inside the car when the parent was smoking

Third-hand smoke is a new health concern.  While we know that the residue combines with the air and other pollutants, like car exhaust fumes, to make a cancer-causing substance, we don’t yet know for certain that it causes cancer in humans and if so, how much exposure is dangerous.[5] Figuring out the answer will be challenging, because most people exposed to third-hand smoke are also exposed to second-hand smoke. We know that non-smokers develop lung cancer, for example, but we usually don’t know if a non-smoker developed cancer because he or she was exposed to third-hand smoke, or for other reasons unrelated to smoking.

Bottom Line

Smokers with children or who live with non-smokers should never smoke inside the home or in their car, and clothing worn while smoking should be washed as soon as possible. If you smell cigarette smoke in a place or on someone, it means you are being exposed to third-hand smoke. An expert on helping people quit smoking recommends that after quitting, people should thoroughly clean their homes, wash or dry clean clothing, and vacuum their cars to remove the dangerous smoke leftovers.[2] Ideally, it would be best to replace furnishings that may have absorbed the chemicals from third-hand smoke, such as sofas, and re-carpet floors, re-seal and re-paint walls, and replace contaminated wallboard. Even if a smoker hasn’t quit yet, it’s a good idea to vacuum and wash clothes, curtains and bedding regularly to reduce their and their loved ones’ exposure to the dangerous chemicals that form when smoke residue mixes with the air.[3]

All articles on our website are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. “The dangers of thirdhand smoke.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 July 2017. http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
  2. Sleiman M, Gundel LA, Pankow JF, Peyton J, Singer BC, Destaillats H. Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. Proceedings of the National Academy of Sciences. January 6, 2010 www.pnas.org/cgi/doi/10.1073/pnas.0912820107.
  3. American Chemical Society (ACS). “Major ‘third-hand smoke’ compound causes DNA damage and potentially cancer.” ScienceDaily. ScienceDaily, 16 March 2014. www.sciencedaily.com/releases/2014/03/140316203156.htm.
  4. Winickoff JP, Friebely J, Tanski SE, Sherrod C, Matt GE, Hovell MF, et. al. Beliefs About the Health Effects of “Thirdhand” Smoke and Home Smoking Bans. Pediatrics. (123.1)74-79.
  5. Ballantyne C, What is third-hand smoke? Is it hazardous? Scientific American. January 6, 2009. http://www.scientificamerican.com/article.cfm?id=what-is-third-hand-smoke.

The last 50 years of smoking: cigarettes and what we know about them has changed

Anna E. Mazzucco, Ph.D.

The U.S. Surgeon General just released an annual report on the negative health effects of smoking.  But this one marks the 50th anniversary of the very first report on smoking in 1964.  We’ve learned a lot about smoking in 50 years, and unfortunately most of the news is bad.

Many health problems in addition to Lung Cancer

While many people know that smoking comes with serious health risks, such as lung cancer and chronic obstructive pulmonary disease (COPD), the 50th anniversary report warns about less widely known risks. For example, smoking increases the risk of:

  • ectopic pregnancy (this type of pregnancy kills the fetus and the mother can also die or become infertile as a result)
  • birth defects
  • diabetes
  • heart disease
  • stroke
  • rheumatoid arthritis
  • difficulty getting or maintaining an erection (erectile dysfunction or ED).

Smoking also increases your chances of developing cancers. A United Kingdom study involving over 100, 000 women found a significant link between smoking and breast cancer. Over a 7-year period, about 2% of women who ever smoked developed cancer compared to about 1.6% of women who never smoked. This means that smoking causes about 4 in 1000 breast cancers. Even though that number seems small (less than half a percent), it is statistically significant. Starting smoking at a younger age, smoking 15 or more daily cigarettes, and smoking for at least 10 years increase the chances of developing breast cancer. If you smoke, you should talk to your doctor about ways to quit. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits. To read more, click here.

Whether you’re a cancer patient, cancer survivor, or have no known health conditions, smoking puts you at greater risk of dying. Exposure to tobacco smoke while in the womb and smoking in the teenage years have both been shown to cause long-term problems regarding brain development.

 20 Million people have died from smoking since 1964

Although smoking has decreased over the 50 years—from 52% to 25% of adult men, and from 35% to 19% of adult women—the decline has slowed over the last two decades. However, among adults who never completed high school or who have a GED diploma, almost 1 in 2 are smokers.[end Centers for Disease Control and PreventionCurrent Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report. 2012; 61(44):889–94 [accessed 2014 Feb 10]  The report estimates that half a million Americans die from smoking every year, and this number has not changed in a decade. Smoking costs the U.S. economy about $100 billion per year, including direct medical costs and the indirect cost of lost productivity from employee sick time due to smoking-related illness.

The Surgeon General cautions that current efforts to reduce smoking are not getting as much support as they need.  While many states have received substantial funds from settlements with tobacco companies which were intended for tobacco control programs, this funding is frequently been spent elsewhere.  In 2013, Alaska was the only state to fund their tobacco control programs at the level recommended by the Centers for Disease Control and Prevention (CDC).

 What more should be done to reduce smoking?

In 2009, the FDA was given much more authority to regulate tobacco products, and in 2010, it made it illegal to sell tobacco products to anyone under 18, banned free samples of cigarettes, and prohibited cigarette brands from sponsoring music and other cultural events. While making public spaces smoke-free and increasing the price of cigarettes and other tobacco products has helped, we need to do more.  Most experts agree that effective tobacco control programs require a combination approach: public health campaigns supplemented by laws that limit where you can smoke, make cigarettes harder to buy, and ensure that programs to help people quit smoking are covered by all health plans.  Under the Affordable Care Act, Medicare, Medicaid and employer-sponsored insurance plans are required to cover medications to help with quitting.  Unfortunately, it is still unclear exactly what will be covered through the state insurance exchanges, even though they are subsidized through the federal government.

Of course, the ideal strategy is to prevent a person from starting to smoke, since tobacco is very addictive.  The Surgeon General’s report says more advertising campaigns targeting young people with anti-smoking messages are needed, since 87% of adult smokers had their first cigarette by age 18.  A study published in 2014 revealed that the nicotine dose from cigarettes increased 15% between 1999 and 2011, making them more addictive without any warning to consumers.[end Land T et al.  Recent Increases in Efficiency in Cigarette Nicotine Delivery: Implications for Tobacco Control.  Nicotine and Tobacco Research. 2014.]  That is only one example of a long history of misleading information from tobacco companies, which is why anti-tobacco ads are so important.  For example, the Surgeon General’s report details how “low-tar” cigarettes, advertised by tobacco companies as safer, were later found to be just as harmful.   In addition, other changes in cigarette design and content have also had unexpected health effects, such as increasing rates of one of the two most common types of smoking-related lung cancer, adenocarcinoma.

Once a person starts to smoke, all doctors and health experts agree: quitting smoking is one of the best things you can do for your health and the health of your loved ones, no matter how long you’ve been smoking.  Studies show that the health benefits of quitting kick in soon after you stop.   Twenty minutes after your last cigarette your high blood pressure will drop; within 3 months your lung function will improve; one year later your risk of heart disease will fall to half of what it was when you were smoking; and five years after your last cigarette your risk of several cancers will drop by half as well.[end S. A. Kenfield, M. J. Stampfer, B. A. Rosner, G. A. Colditz. Smoking and Smoking Cessation in Relation to Mortality in Women. JAMA: The Journal of the American Medical Association, 2008; 299 (17): 2037-2047.],[end Centers for Disease Control and Prevention. 2010 Surgeon General’s Report—How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. 2010.]  For information on how to quit, see this article.  If you are considering taking medication to help with quitting, check out this article.  And if you are thinking of using e-cigarettes to cut back on regular cigarettes, you should know that there are many unanswered questions about the risks of e-cigarettes and almost no research to support their use in smoking cessation. For more on e-cigarettes, read here.  Many e-cigarette brands are owned by tobacco companies which have been caught lying to the American public about the risks of their products repeatedly.