Category Archives: Environmental Exposures

Children and Athletes at Play on Toxic Turf and Playgrounds

 Nyedra W. Booker, PharmD, MPH and Stephanie Fox-Rawlings, PhD

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

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 Recycled Tires 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 natural rubber 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 recycled tires 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.

Due to the small number of samples and sampling sites used, the EPA stated that it is not possible to know if these findings are typical of other playgrounds or fields until additional studies are conducted.[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]

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] 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]

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.”[16]

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.[17]

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

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

Related Articles

Helping Children Recover from Stomach Flu
Can cleanliness increase the risk of allergies and asthma?
Children and cell phones: is phone radiation risky for kids?

References

  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. 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/
  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. 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.

 

Phthalates and Children’s Products

Paul Brown, Keris Krenn Hrubec, Dana Casciotti, PhD, Brandel France de Bravo, MPH, Stephanie Fox-Rawlings, PhD, Cancer Prevention & Treatment Fund

Phthalates are synthetic chemicals found in every home, in plastic toys, personal care products such as shampoos and lotions, vinyl floors, and shower curtains. They are also found in some medical products, such as saline bags, feeding tubes and catheters. They are used to make plastic flexible and to add fragrances to soap and other personal products.  Unfortunately, these chemicals don’t stay inside the products. Based on recent research on ants, scientists have concluded that the high levels of phthalates in the bodies of insects around the world are the result of phthalates in the air.[1] Because phthalates are released into the air and dust around us, they are found in human urine, blood, and breast milk.[2] Levels are highest in women and children ages 6 to 11. Young children may have higher levels of phthalates in their bodies because their hands find their way into their mouths more frequently: they touch objects made with phthalates and surfaces covered with phthalate dust, and then their hands touch their mouths.

Phthalates are called “endocrine disruptors” because they affect the body’s hormones by mimicking them or blocking them. They interfere with the body’s natural levels of estrogen, testosterone, and other hormones, which is why they are called “disruptors.” Endocrine disruptors are hard to study for several reasons: 1) we are exposed to very small quantities from many different sources every day, 2) researchers have proved that, unlike other chemicals, these appear to have more serious effects at lower levels than at higher levels.[3] Usually, we assume that the higher the dose or exposure, the greater the harm, but endocrine disruptors play by different rules. The director of the National Institute of Environmental Health Sciences, Linda Birnbaum, says that chemical manufacturers are asking “old questions” when they test for safety even though “science has moved on.”[4]

Hormones can increase the risk of some cancers, whether those hormones are natural or synthetic. Too much or too little of a hormone can be harmful. Is a child who is exposed to phthalates more likely to develop cancer as an adult?  No one knows for sure but animals exposed to phthalates are more likely to develop liver cancer, kidney cancer, and male reproductive organ damage.[5]

Phthalates are believed to also affect girls’ hormones, but the health impact is not yet known. Studies also show associations between children’s exposure to phthalates and the risk of asthma, allergies and bronchial obstruction.[6][7][8]

Researchers at Mount Sinai also found a link between obesity and phthalates.[9] They found that among overweight girls ages 6 to 8, the higher the concentration of certain phthalates (including low molecular weight phthalates) in their urine, the higher their body mass index (BMI).  BMI takes height and weight into account when determining if someone is overweight. A study among Danish children ages 4 to 9 found that the higher the concentration of phthalates (all of them), the shorter the child. This was true for girls and boys.[10] More research is needed to determine the impact of phthalates on height and BMI.

Even short-term exposure has now been linked to developmental deficits.[11] Researchers found that children in intensive care units were exposed to the phthalate DEHP through plastic tubing and catheters. The children had 18 times (!)  as much DEHP in their blood compared to children who had not spent time in the ICU. Four years later, the children who had been exposed to DEHP had more problems with attention and motor coordination. The researchers found that the DEHP caused these problems regardless of medical complications or treatments.

Prenatal Exposure to Phthalates

Childhood exposure to phthalates begins in the womb. Several studies that have tested phthalate levels in women in their third trimester of pregnancy have found health effects in the infants, toddlers, and older children of the mothers with the highest levels. There are many different types of phthalates. Most studies look at several types, and the effects tend to vary by type.  A 2011 study found that six-month-old boys whose mothers had the highest phthalate levels scored lower on brain and motor development tests.[12] The same effect was not true for female infants.

Research indicates that boys exposed to phthalates while in the womb may be more likely to develop smaller genitals and incomplete descent of the testicles.[13] Boys who are born with undescended testicles are 2-8 times more likely to develop testicular cancer later on than men born with both testicles descended[14] (their risk is lessened if they get corrective surgery before age 13.[15]). Studies by Harvard researchers have shown phthalates may alter human sperm DNA and semen quality.[16][17][18][19]

Columbia University researchers discovered that three-year olds with high prenatal exposure to two types of phthalates were more likely to have motor delays.[20] They also reported that three phthalates were linked to certain behavior problems in three-year olds, such as social withdrawal.  One phthalate in the study was linked to lower mental development in girls.

Other studies have also linked increased prenatal phthalate exposure to behavior problems. Researchers in Taiwan found an association with aggressive and disobedient behaviors in eight-year-olds of both sexes.[21][22] Similarly, researchers from Icahn School of Medicine at Mount Sinai found that higher levels of exposure to phthalates during gestation were associated with aggression, rule-breaking, and conduct problems for males only.[23]

Researchers at Mount Sinai School of Medicine studied the impact of prenatal exposure to “low molecular weight” phthalates—the kind often found in personal care products and the coatings of some medications—on the social behavior of children ages 7 to 9. Children who were exposed to higher levels of these phthalates, which include DEP and DBP, had worse scores for social learning, communication, and awareness.  This means they were less able to interpret social cues, use language to communicate, and engage in social interactions.[24]

What Is Being Done to Limit Children’s Exposure?

As of February, 2009, children’s toys and child care products sold in the U.S (such as teething rings and plastic books) cannot contain certain phthalates.  The ban on those phthalates is the result of a law passed in 2008, the Consumer Product Safety Improvement Act.  The law permanently bans certain kinds of phthalates (BBP, DBP and DEHP) from toys and child care products, and temporarily bans other phthalates (DIDP, DINP and DnOP) until a scientific board (the Chronic Hazard Advisory Panel) determines for the Consumer Product Safety Commission (CPSC) whether or not they are safe. In 2014 the Chronic Hazard Advisory Panel determined that stricter regulations were appropriate.[25] It stated that the permeant bans should remain on BBP, DBP and DEHP, and that DINP should be added to this list. Furthermore, because a large component of exposure to these chemicals comes from food and other products, it recommended increased regulation. The panel was less concerned about DIDP and DnOP, but recommended additional study. Finally, the panel recommended permanently banning DIBP, DPENP, DHEXP, and DCHP, and putting an interim ban on DIOP.

A few months before the 2008 bill passed, major retailers such as Wal-Mart, Target, and Babies “R” Us promised to remove or severely restrict children’s products containing phthalates by the end of 2008.[26] That provided added incentives for major companies making teething rings and other soft plastic products to stop using phthalates.

The ban in the U.S.followed similar bans in other countries.  In 2006, the European Union banned the use of 6 phthalates in toys that may be placed in the mouth by children younger than 3 years old.[27] The banned phthalates are DINP, DEHP, DBP, DIDP, DNOP, and BBzP.  Fourteen other countries, including Japan, Argentina, and Mexico, had also banned phthalates from children’s toys prior to the U.S.

Phthalate Exposure Continues

A 2014 study looking at data over a ten-year period (2001– 2010) found that exposures to some phthalates have declined while others have increased. Americans’ exposure to three substances permanently banned in toys and children’s products—DEHP, DBP and BBP—has declined. But exposure to other phthalates such as DiNP and DiBP, as measured in urine, has increased. The higher  levels of DiBP and other phthalates “suggest that manufacturers may be using them as substitutes for other phthalates even though the US EPA has expressed concern about their use.”[28] It is surprising that DiNP exposure has gone up since it was banned on an interim basis from children’s toys and children’s products.  Additionally, in 2013, California declared DiNP a carcinogen.[29]

Even with the ban on phthalates in children’s toys, children, and adults, too, continue to be exposed because these chemicals are in many products, including food packaging, pharmaceuticals, medical devices and tubing, soap, lotions, and shampoos.[30] Johnson & Johnson recently reformulated its baby shampoo to remove harmful chemicals,[31] and Proctor & Gamble has promised to eliminate the phthalate DEP from fragrances used in its products by the end of 2014.[32] DEP is used in personal care products  and “reductions in DEP exposures have been the most pronounced,” according to the 2014 study.[33] Ten years ago, more than a thousand companies pledged to remove “chemicals of concern from personal care products,” however, it is unclear how many have done so. The U.S. Food and Drug Administration (FDA) regulates many of these products, including baby shampoo and baby lotion.  If the FDA does not decide to ban phthalates from these products, legislation would be required to do so.

The U.S. Environmental Protection Agency (EPA) developed an “action plan” in 2010 for eight phthalates “because of their toxicity and the evidence of pervasive human and environmental exposure.” [34] The phthalates are being studied for health effects and for alternatives. The EPA developed two new rules for these chemicals. However, the rules were delayed and then withdrawn in 2013.[35] In 2014, seven of these phthalates were included in the Toxic Substances Control Act work plan, because of their potential for harm and the frequency of exposure.[36] The eighth phthalate (DnPP) was not included because it is no longer being used in new products. The chemicals on the work plan are to be assessed for additional study or regulation, but it is unclear when that assessment will occur.

While other government agencies are concerned about phthalates in specific products, the EPA’s job is to focus on the chemicals for use in any kind of product and establish safety standards for each phthalate.  A challenge for the EPA is to set safety standards that make sense given that people may be exposed to several phthalates from many different sources. Teenage girls, for instance, have been found to use up to 17 personal care products a day.[37] Setting safety standards for phthalates individually or for individual products without considering their interactions and cumulative effects could underestimate the real-world risks of phthalates to the health of children and adults.

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

References

  1. Rudel RA, Brody JG, Spengler JD, Vallarino J, Geno PW, Sun G, Yau A (2001). Identification of selected hormonally active agents and animal mammary carcinogens in commercial and residential air and dust samples. Journal of Air and Waste Management Association 51(4):499-513.
  2. Kato K, Silva MJ, Reidy JA, Hurtz D, Malek NA, Needham LL, Nakazawa H, Barr DB, Calafat AM (2003). Mono(2-ethyl-5-hydroxyhexyl) phthalate and mono-(2-ethyl-5-oxhexyl) phthalate as biomarkers for human exposure assessment to di-(2-ethylhexyl) phthalate. Environmental Health Perspectives 112: 327-330.
  3. Vandenberg et al. (2012). Hormones and Endocrine Disrupting Chemicals: Low-dose Effects and Nonmonotonic Dose Responses. Endocrine Reviews.  First published ahead of print March 14, 2012 as doi:10.1210/er.2011-1050.
  4. Cone, Marla and Environmental Health News. Low Doses of Hormone-Like Chemicals May Have Big Effects. Scientific American.march 15, 2012. http://www.scientificamerican.com/article.cfm?id=low-doses-hormone-like-chemicals-may-have-big-effects.
  5. Vastag, B., (2001). CDC Unveils First Report on Toxins in People, JAMA 285(14): 1827-1828.
  6. Jaakkola JJ, Knight TL (2008 July). The Role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: a systematic review and meta-analysis. Environ Health Perspect, 116(7): 845-53.
  7. Kanazawa A, Kishi R (2009 May). Potential risk of indoor semivolatile organic compounds indoors to human health. Nippon Eiseigaku Zasshi, 64(3): 672-82.
  8. Hsu NY, Lee CC, Wang JY, et al. (2012). Predicted risk of childhood allergy, asthma, and reported symptoms using measured phthalate exposure in dust and urine. Indoor Air. 22(3): 189-99.
  9. Teitelbaum SL, Mervish N, L Moshier E, Vangeepuram N, Galvez MP, Calafat AM, Silva MJ, L Brenner B, Wolff MS. (2012, January).Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environmental Research 112:186-193.
  10. Boas M, Frederiksen H, Feldt-Rasmussen U, Skakkebaek NE, Hegedus L, Hilsted L, et al. (2010). Childhood exposure to phthalates: associations with thyroid function, insulin-like growth factor I, and growth. Environmental Health Perspectives 118:1458-1464.
  11. Verstraete S, Vanhorebeek I, Covaci A, Güiza F, Malarvannan G, Jorens PG, Van den Berghe G. (2016). Circulating phthalates during critical illness in children are associated with long-term attention deficit: a study of a development and a validation cohort. Intensive Care Med 42(3):379-92.
  12. Yeni Kim Y, Eun-Hee Ha, Eui-Jung Kim, et al. (2011). Prenatal Exposure to Phthalates and Infant Development at Six Months: Prospective Mothers and Children’s Environmental Health (MOCEH) Study, Environmental Health Perspectives. 119(10): 1495-500.
  13. Main KM, Skakkebaek NE, Virtanen HE, Toppari J (2010). Genital anomalies in boys and the environment. Best Pract Res Clin Endocrinol Metab.Apr;24(2):279-89.
  14. Toppari J, Kaleva M. Maldescendus testis. Horm Res 1999;51:261-9.
  15. Pettersson A et al. (2007) Age at surgery for undescended testis and risk of testicular cancer. New England Journal of Medicine 356:1835-41.
  16. Duty, S. M., M. J. Silva, et al., (2003). Phthalate exposure and human semen parameters. Epidemiology 14(3): 269-77.
  17. Duty, S. M., N. P. Singh, et al., (2003). The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay. Environ Health Perspect 111(9): 1164-9.
  18. Duty, S. M., A. M. Calafat, et al., (2004). The relationship between environmental exposure to phthalates and computer-aided sperm analysis motion parameters. J Androl 25(2): 293-302.
  19. Duty, S. M., A. M. Calafat, et al., (2005). Phthalate exposure and reproductive hormones in adult men. Hum Reprod 20(3): 604-10.
  20. Whyatt RM, Liu X, Rauh, VA, Calafat AM, Just AC, Hoepner L, Diaz D, et al. (2012). Maternal prenatal urinary phthalate metabolite concentrations and child mental, psychomotor and behavioral development at age three years.  Environmental Health Perspectives 120(2):290-5.
  21. Lien YJ, Ku HY, Su PH, Chen SJ, Chen HY, Liao PC, Chen WJ, & Want SL (2015). Prenatal Exposure to Phthalate Esters and Behavioral Syndromes in Children at 8 Years of Age: Taiwan Maternal and Infant Cohort Study. Environ Health Perspect 123(1): 95–100.
  22. Prenatal Phthalate Exposures and Neurobehavioral Development Scores in Boys and Girls at 6–10 Years of Age. Environ Health Perspect 122(5): 521–528.
  23. Kobrosly RW, Evans S, Miodovnik A, Barrett ES, Thurston SW, Calafat AM, & Swan SH (2014).
  24. Miodovnik A, Engel SM, Zhu C, et al. (2011). Endocrine disruptors and childhood social impairment.  Neurotoxicology Mar;32(2):261-7.
  25. CPSC. Chronic Hazard Advisory Panel on Phthalates and Phthalate Alternatives. 2014. http://www.cpsc.gov/PageFiles/169902/CHAP-REPORT-With-Appendices.pdf
  26. Pereira, J. and Stecklow, S. (2008, May). Wal-Mart Raises Bar on Toy-Safety Standards, The Wall Street Journal.
  27. Sathyanarayana S, Swan SH et al., (2008, February). Baby Care Products: Possible Sources of Infant Phthalate Exposure, Pediatrics, Vol. 121, No. 2.
  28. Zota AR, Calafat AM, & Woodruff TJ (Advance on-line publication January 15, 2014) Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001-2010.
  29. Lee SM, (January 15, 2014). Banned chemicals replaced by worrisome ones, UCSF study shows. SFgate.com (San Francisco Chronicle).
  30. U.S. Food and Drug Administration (2008). Phthalates and Cosmetic Products. Retrieved November 4, 2009 at http://www.fda.gov/Cosmetics/ProductandIngredientSafety/SelectedCosmeticIngredients/ucm128250.htm
  31. Thomas K (January 17, 2014). The ‘No More Tears’ Shampoo, Now With No Formaldehyde. The New York Times. http://www.nytimes.com/2014/01/18/business/johnson-johnson-takes-first-step-in-removal-of-questionable-chemicals-from-products.html.
  32. Prcoter & Gamble Web site: What are Phthalates?  Accessed January 22, 2014. http://www.pg.com/en_US/sustainability/safety/ingredients/phthalates.shtml.
  33. Zota AR, Calafat AM, & Woodruff TJ (Advance on-line publication January 15, 2014) Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001-2010.
  34. EPA. Phthalates Action Plan Summary. http://www.epa.gov/assessing-and-managing-chemicals-under-tsca/phthalates.
  35. Sheppard Kate (September 6, 2013). EPA Quietly Withdraws Two Proposed Chemical Safety Rules. Huffington Post. http://www.huffingtonpost.com/2013/09/06/epa-chemical-safety_n_3882262.html.
  36. EPA. TSCA Work Plan for Chemical Assessments: 2014 Update. https://www.epa.gov/sites/production/files/2015-01/documents/tsca_work_plan_chemicals_2014_update-final.pdf
  37. Environmental Working Group. 2008. Sutton R. Adolescent exposures to cosmetic chemicals of concern. http://www.ewg.org/research/teen-girls-body-burden-hormone-altering-cosmetics-chemicals.

Are E-Cigarettes Safer Than Regular Cigarettes?

Brandel France De Bravo, MPH, Sarah Miller, Jessica Becker, and Laura Gottschalk, PhD, Cancer Prevention & Treatment Fund

Electronic cigarettes, or e-cigarettes, are being marketed as the “safe” new alternative to conventional cigarettes. But are e-cigarettes safe?  What does the FDA think about them?  Are e-cigarettes going to reverse the decline in smoking—giving new life to an old habit—or can they help people quit smoking? Here is what you need to know before picking up an e-cigarette.

What Are E-Cigarettes?

E-cigarettes are battery-operated devices shaped like cigarettes that provide a way to get nicotine. Nicotine is an addictive drug (it stimulates and relaxes) that is naturally found in tobacco. The most popular way for people to take in nicotine is to inhale it by smoking cigarettes. E-cigarettes also allow nicotine to be inhaled, but they work by heating a liquid cartridge containing nicotine, flavors, and other chemicals into a vapor. Because e-cigarettes heat a liquid instead of tobacco, what is released is considered smokeless.[1]

Are E-Cigarettes Safer Than Traditional Cigarettes?

The key difference between traditional cigarettes and e-cigarettes is that e-cigarettes don’t contain tobacco.  But, it isn’t just the tobacco in cigarettes that causes cancer. Traditional cigarettes contain a laundry list of chemicals that are proven harmful, and e-cigarettes have some of these same chemicals.

Since 2009, FDA has pointed out that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could be exposed.”[2] For example, in e-cigarette cartridges marketed as “tobacco-free,” the FDA detected a toxic compound found in antifreeze, tobacco-specific compounds that have been shown to cause cancer in humans, and other toxic tobacco-specific impurities.[3] Another study looked at 42 of these liquid cartridges and determined that they contained formaldehyde,  a chemical known to cause cancer in humans.[4] Formaldehyde was found in several of the cartridges at levels much higher than the maximum EPA recommends for humans.

The body’s reaction to many of the chemicals in traditional cigarette smoke causes long-lasting inflammation, which in turn leads to chronic diseases like bronchitis, emphysema, and heart disease.[5f] Since e-cigarettes also contain many of the same toxic chemicals, there is no reason to believe that they will significantly reduce the risks for these diseases.

There are no long-term studies to back up claims that the vapor from e-cigarettes is less harmful than conventional smoke. Cancer takes years to develop, and e-cigarettes were only very recently introduced to the United States. It is almost impossible to determine if a product increases a person’s risk of cancer or not until the product has been around for at least 15-20 years. Despite positive reviews from e-cigarette users who enjoy being able to smoke them where regular cigarettes are prohibited, very little is known about their safety and long-term health effects.

Can E-Cigarettes Be Used to Cut down or Quit Smoking Regular Cigarettes?

If a company makes a claim that its product can be used to treat a disease or addiction, like nicotine addiction, it must provide studies to the FDA showing that its product is safe and effective for that use. On the basis of those studies, the FDA approves or doesn’t approve the product. So far, there are no large, high-quality studies looking at whether e-cigarettes can be used to cut down or quit smoking long-term. Most of the studies have been either very short term (6 months or less) or the participants were not randomly assigned to different methods to quit smoking, including e-cigarettes. Many of the studies are based on self-reported use of e-cigarettes. For example, a study done in four countries found that e-cigarette users were no more likely to quit than regular smokers even though 85% of them said they were using them to quit.[6] Another year-long study, this one in the U.S., had similar findings.[7] People may believe they are smoking e-cigarettes to help them quit,  but 6-12 months after being first interviewed, nearly all of them are still smoking regular cigarettes.

Until there are results from well-conducted studies, the FDA has not approved e-cigarettes for use in quitting smoking.[8]

Teenagers, Children, and E-Cigarettes

The percentage of teenagers who have tried e-cigarettes has almost quadrupled in just four years, from 5% in 2011 to 19% in 2015.  Three million U.S. students in middle school and high school tried e-cigarettes in 2015, according to the National Youth Tobacco Survey.  And, 1 in 5 middle schoolers who said they had tried e-cigarettes also said they had never smoked conventional cigarettes.[9]

E-cigarette use by young people is worrisome for a number of reasons:

1) The younger people are when they begin smoking, the more likely it is they will develop the habit: nearly 9 out of 10 smokers started before they were 18.[10]

2) Nicotine and other chemicals found in e-cigarettes might harm brain development in younger people.[11]

3) E-cigarettes may introduce many more young people to smoking who might otherwise never have tried it, and once they are addicted to nicotine, some may decide to get their “fix” from regular cigarettes. Whether e-cigarettes end up being a “gateway” to regular cigarettes or not, young people who use them risk becoming addicted to nicotine and exposing their lungs to harmful chemicals.

The sharp rise in young e-cigarette users highlights the need to stop manufacturers from targeting teenagers with candy-like flavors and advertising campaigns.

Even children who are too young to smoke have been harmed by e-cigarettes. The liquid used in e-cigarettes is highly concentrated, so absorbing it through the skin or swallowing it is far more likely to require an emergency room visit than eating or swallowing regular cigarettes. In 2012, less than 50 kids under the age of six were reported to poison control hotlines per month because of e-cigarettes. In 2015, that number had skyrocketed to about 200 children a month, almost half of which were under the age of two![12]

How Are E-Cigarettes Regulated?

The FDA was given the power to regulate the manufacturing, labeling, distribution and marketing of all tobacco products in 2009 when President Obama signed into law the Family Smoking Prevention and Tobacco Control Act and in 2010 a court ruled that the FDA could regulate e-cigarettes as tobacco products.[13]

It wasn’t until 2016 that the FDA finally announced a rule to regulate e-cigarettes.[14] Under the final rule, the FDA plans to ban the sale of e-cigarettes to anyone under the age of 18.  The rule also requires all makers of e-cigarettes sold after February 15, 2007 to go through a “premarket review.” This is the process that the FDA uses to determine whether potentially risky products are safe. However, companies are allowed to have anywhere from 18 months to two years to prepare their applications. And it will take another year for the FDA to actually approve these applications. So don’t expect e-cigarettes currently on the market to be officially allowed to be sold by the FDA for another couple of years.

In the meantime, individual states have always had the power to pass laws restricting the sale and use of e-cigarettes. For example, in May 2013, the California state senate proposed a law making all e-cigarettes subject to the same regulations and restrictions as traditional cigarettes and tobacco products.  However, that did not become law.

The Bottom Line

E-cigarettes have not been around long enough to determine if they are harmful to users in the long run.  Unfortunately, many people, including teenagers, are under the impression that e-cigarettes are safe or that they are effective in helping people quit smoking regular cigarettes.  Neither of these assumptions has yet been proven. Studies by the FDA show that e-cigarettes contain some of the same toxic chemicals as regular cigarettes, even though they don’t have tobacco.  The big three tobacco companies—Lorillard, Reynolds American, and Altria Group—all have their own e-cigarette brands, so it’s not surprising that e-cigarettes are being marketed and advertised much the way regular cigarettes used to be.  Here are the 7 Ways E-Cigarette Companies Are Copying Big Tobacco’s Playbook.

Unless you want to be a guinea pig, hold off on e-cigarettes until more safety information is available.  And if you need help quitting or reducing the number of cigarettes you are smoking, check out the smokefree.gov website.

Related Content:

Quitting smoking: women and men may do it differently
Third-hand smoke
Smoking cessation products

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

References

  1. Richard J. O’Connor Non-cigarette tobacco products: What have we learned and where are we headed? Tob Control. Author manuscript; available in PMC 2013 July 19. Published in final edited form as: Tob Control. 2012 March; 21(2): 181–190. doi: 10.1136/tobaccocontrol-2011-050281.
  2. “Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA.” FDA News & Events. FDA, 22 July 2009. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm.
  3. “Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA.” FDA News & Events. FDA, 22 July 2009. Web. 09 Aug. 2013. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm.
  4. Varlet et al. (2015) Toxicity of refill liquids for electronic cigarettes. International Journal for Environmental Research and Public Health. 12:4796-4815.
  5. Stoller, JK & Juvelekian, G; Chronic Obstructive Pulmonary Disease; 2010 Cleveland Clinic Center for Continuing Education. https://my.clevelandclinic.org/departments/respiratory/depts/chronic-obstructive-pulmonary-disease.
  6. Adkison SE, O’Connor RJ, Bansal-Travers M, et al. Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med. 2013;44(3):207-215.
  7. Grana RA, Popova L, Ling PM. A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation. JAMA Internal Medicine, published online March 24, 2014
  8. “Electronic Cigarettes” FDA News & Events. FDA, 25 July 2013. http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm
  9. Singh T, Arrazola RA, Corey CG, et al. Tobacco Use Among Middle and High School Students – United States, 2011-2015. CDC Morbidity and Mortality Weekly Report. April 15, 2016. 65(14);361-367.
  10. Centers for Disease Control and Prevention. Fact sheets: Youth and tobacco use.  http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/.
  11. US Department of Health and Human Services. Preventing tobacco use among youth and young adults. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm.
  12. Kamboj A, Spiller HA, Casavant MJ, et al. Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States. Pediatrics. May 2016. In Press.
  13. “Regulation of E-Cigarettes and Other Tobacco Products.” FDA News & Events. FDA, April 25, 2011. http://www.fda.gov/newsevents/publichealthfocus/ucm252360.htm.
  14. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. 21 CFR Parts 1100, 1140, and 1143 (2016).

Phthalates Q&A

By Paul Brown & Stephanie Fox-Rawlings, PhD
Updated 2016

Phthalates are synthetic chemicals found in everyday plastic products, including toys, children’s care products, medical tubes and saline or blood bags, and food packaging. They are used to make plastic flexible.  They are also used in many personal care products that smell good, such as shampoo and creams, as well as air fresheners. The use of some phthalates is being restricted in some products; however, they are still very common. Phthalates can leach out of the plastic to cause health problems, especially for young children.

Q: Animals exposed to phthalates are more likely to develop serious diseases and health problems, such as liver cancer, kidney cancer, and male reproductive organ damage1, but have any studies shown that phthalates cause health problems in humans?

A: Yes, studies by Harvard researchers have shown that phthalates may damage human sperm DNA, reduce sperm numbers, and reduce its mobility2, and another study from several major medical centers has found that phthalates may cause genital changes for boys.3 Mount Sinai researchers found that girls exposed to more phthalates were more likely to be overweight.[end Wolff MS. (2012, January).Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environmental Research 112:186-193] Other studies have shown that being exposed to phthalates increases the chance of developing asthma, allergies and bronchial obstruction.4

Q: Can phthalate exposure affect a child’s behavior?

A: Yes, prenatal exposure to phthalates and/or as a young child increases the chances of cognitive and behavior problems.5 Higher levels of phthalates have been associated with attention and memory problems, increased aggression and law-breaking behaviors, as well as poor social skills.

Q: Have scientists representing the European Union concluded that phthalates are safe?

A: No, in 2006, the European Union banned the use of 6 phthalates in toys that may be placed in the mouth by children younger than 3.6 The banned phthalates are DINP, DEHP, DBP, DIDP, DNOP, and BBzP. More recently the European Union banned the use of DEHP, BBP, DBP and BiBP in electronic equipment starting in 2019. The chemicals cause environmental and health hazards during recycling or disposal.7

Q: How are phthalates regulated in the US?

A: As of February 2009, U.S. law bans children’s toys and child care products related to sleep or feeding that contain the phthalates BBP, DBP, or DEHP. Toys or items that can be placed in a child’s mouth cannot contain DIDP, DINP, or DnOP.8 In 2014, the Chronic Hazard Advisory Panel recommended banning DIBP, DPENP, DHEXP, DCHP, and DIOP.9 The Consumer Protection and Safety Commission (CPSC) followed with a proposed a rule to ban DIBP, DPENP, DHEXP, and DCHP in children’s toys and care products.10 However a final rule (and thus the ban) has not been published. The Environmental Protection Agency (EPA) has planned to assess seven phthalates under the Toxic Substances Control Act, which could limit their use in all kinds of products.11 These are DBP, DIBP, BBP, DEHP, DnOP, DINP, and DIDP. However, it is unclear when assessment will occur.

Q: If phthalates are banned, will the toy industry start using unsafe alternatives?

A:  No, federal legislation requires that alternatives to the banned phthalates are not hazardous under the Federal Hazardous Substance Act.8 Manufactures are also required to sufficiently test their product to insure it will not cause injury through normal use or predictable misuse.

Q: Should the Consumer Product Safety Commission (CPSC) establish federal regulations for phthalates that preempt state laws?

A: That would be a bad idea because some States have better laws than the federal government. The CPSC is a small agency that has a hard time keeping up with reports of unsafe products that are sold in the U.S. In 2015, CPSC recalled more than 600 distinct products, including 52 for children and babies.11 The states of California and Washington have passed strong laws to protect adults and children from unsafe products, and it would be inappropriate for federal laws to interfere. California has listed six phthalates (DBP, DEHP, BBP, DINP, DIDP, and DNHP) on their Prop 65 lists of chemicals known to cause cancer, birth defects or reproductive harm.12 In Washington state, the definition of “children’s product” is broader that that used by the CPSC. Therefore, there are some children’s products that cannot be sold in the state of Washington but are not banned by the CPSC. Examples include children’s cosmetics or clothing that are not packaged as toys.13

For more information, contact Dr. Diana Zuckerman or Paul Brown at (202) 223-4000 or by e-mail at dz@center4research.org and pb@center4research.org

Home sweet home? Flame retardants in your home can harm you

By Abigail Fredenburg, PhD, Caitlin Kennedy, PhD, Anna Mazzucco, PhD
Updated 2016

Could your couch increase your chances of getting cancer? Possibly. Studies show that every day we are exposed to chemicals that were intended to protect us from household fires but are hazardous to our health.14 15 Toxic flame retardants are used in upholstered furniture such as couches, chairs, and mattresses, as well as in drapery and carpets. They are even in our televisions and plastic-cased electronics. Flame retardants have also been found in foam in baby products such as baby carriers, high chairs, strollers, and nursing pillows.16

Who invited cancer-causing chemicals into our homes?

At one time, It made sense to require flame retardants that would prevent or slow the spread of fire, but we now know those same chemicals can cause cancer. They also can affect children’s growth and brain development.

Dr. Linda Birnbaum, the director of the National Institute of Environmental Health Services, explains that new research used 3-D imaging to demonstrate how synthetic flame retardants “interfere with the body’s natural hormones.”17 When chemicals affect adult hormone levels, they can be very harmful, such as reducing fertility or harming a developing fetus.

Other research shows how this can affect children’s learning. University of Cincinnati’s Dr. Aimin Chen and colleagues studied pregnant women and their children to determine the effect of prenatal exposure on learning and behavior. The researchers measured the amount of common flame retardants in 301 pregnant women at 16 weeks of pregnancy and tested their children during their first 5 years of life. Pregnant women with higher levels of flame retardants had children who tended to have more learning problems at ages 2, 3, 4, and 5 years, and the children also were more likely to be hyperactive.18

Another important way that young children are exposed to flame retardant chemicals is through their crib mattresses. The volatile organic compounds (VOCs) in crib mattresses come from the foam stuffing, usually made of polyurethane or polyester. Studies from the last ten years suggest that exposure to these chemicals increases the risk of asthma and lung infections in young children.19 20 A study from 2014 revealed that infants may be at greater risk from the chemicals in crib mattresses than adults for several reasons: their small size means there is less distance between a baby’s body and the mattress, and babies generate more body heat while sleeping which causes more chemicals to be released into the air that they breathe. Also, babies sleep more hours a day than adults do, lengthening the time they are exposed to the mattress chemicals.21

These findings have important implications for children’s health and are why previous flame retardants, such as brominated “Tris,”were banned from use in children’s pajamas in the late 1970s and chemicals called PentaBDE and OctaBDE were phased out of commercial products, beginning in 2004.22 23 Despite these laws, we are still exposed to these and even more harmful chemicals. Why? Because banned chemicals are replaced by new chemicals that we don’t yet know much about. As shown in recent studies, these new chemicals can also be dangerous, and in some cases may be more dangerous. Researchers found higher-than-expected levels of one such chemical, organophosphate esters, in the outdoor air in 5 sites around the U.S. Great Lakes. This new chemical was found in amounts 100 to 1,000 times higher than older PBDE’s.24

Even after flame retardants are phased out, we keep getting exposed when we use old furniture passed on to family members, or sold at garage sales. Because there is no standard process to safely dispose of furniture containing flame retardants, these chemicals remain in our environment via discarded furniture, dust, and air.2 Flame retardant chemicals can even be measured in tree bark. Research shows the highest levels are in densely populated areas, such as Toronto, Canada, but high levels are also found in remote regions of Indonesia and Nepal.25

Researchers at Duke University led a national study to identify flame retardant chemicals in the polyurethane foam used in couches. TDCPP was the most commonly detected flame retardant, often used to replace PentaBDE and OctaBDE in couches manufactured after their 2004 phase out. TDCPPcan cause cancer and is very similar to the Tris that was banned decades ago. Of the 102 couches tested, researchers detected toxic flame retardants in 85% of them.26

In a second study conducted by the Silent Spring Institute, dust samples were collected from 16 homes in California. House dust is the primary way Americans are exposed to toxic flame retardants, by inhaling and ingesting them.1 Researchers found Tris in 75% of the homes despite its ban from children’s pajamas more than 30 years ago and its listing in California as a chemical known to cause cancer.

California has a higher furniture flammability standard than other states, known as Technical Bulletin 117 (TB117). Because of its large size, it is often easier for companies to follow California’s standards for all their products, not just those sold in California. Manufacturers also make their products comply with TB117 to protect themselves against law suits.27 But, as a result, they are risking consumers’ health by exposing Americans to higher levels of flame retardants in their homes than they would otherwise be.28

In general, California’s stricter standards (on organic foods and on air quality, for instance) have paved the way for protections across the country, but in the case of flame retardants, their standards have been harmful.

We all depend on government regulators to keep us as safe as possible, by making our homes, cars, airplanes, foods, and medicines as safe as possible. Unfortunately, current standards for flame retardant furniture are not based on solid research.29 Fortunately, California has responded to criticisms of their standards by adopting new guidelines in November 2013 based on the latest research. The new guidelines require upholstery and fabric covers to be smolder proof, a new test that simulates fires from a lit cigarette. The changes are meant to more accurately reflect the situations that usually lead to fires in homes, and make it possible for manufacturers to use lower amounts of less toxic chemicals. As a consequence, manufacturers will use different, and presumably safer, flame retardants for products sold in California and across the country. The changes went into effect in January 2015.30 31

Since many of us can’t buy all new furniture to help reduce exposure to these toxic chemicals, we need to try to keep our homes as dust free as possible. Remember, as these flame retardants are released or shed from upholstered furniture and other household products, they accumulate in house dust. Vacuum regularly, use a wet-mop, and wash your hands frequently. Have young children who spend a lot of time on the floor wash their hands regularly, too.

If you are thinking of buying a new mattress or furniture, the Green Science Policy Institute provides a reference guide for furniture made without added flame retardants.32 There are now also many “green” furniture companies that use all natural and non-toxic materials like wool and organic cotton that are not only better for you and your family, but also for the environment. In 2015, Ikea, Wal-Mart Stores Inc., Ashley Furniture industries Inc. and Macy’s Inc. stated they would ban flame retardants from all their furniture, although it is not clear when the bans would be in place.33 34 Keep in mind that not all furniture comes with a tag outlining what it is made from. You may want to check online to find out more before you buy furniture that could expose yourself and your loved one to chemicals for years to come.

The bottom line is that reducing dust in your home, maintaining or replacing old furniture and making careful decisions about new purchases are important steps for keeping a healthy home!

Children and Cell Phones: Is Phone Radiation Risky for Kids?

Hannah Kalvin

Children use cell phones to watch TV, play games, make phone calls, and send text
messages.  Many older kids and teens have their own cell phones, which they are attached to kid texting24/7. But are there risks to such frequent use by children, and if so is that different than the risks for adults?

Cell phones emit a type of radiation that is known as Radio Frequency-Electromagnetic Radiation (RF-EMR), also referred to as microwave radiation. There have been concerns from the scientific community about whether or not cell phones are safe. Cancer is a particular concern, but since cancers take 10-20 years to develop and children’s frequent cell phone use is a relatively recent development, there are more questions than answers.  To read more about whether we should be worried about cell phone radiation in general, read our article here.

There are several studies of the impact of cell phone radiation on children. Here are some of the conclusions so far:

  • A 2010 study of cell phone radiation noted that, “in general and on average, children suffer a higher exposure of their brain regions than adults.”  This is because children have proportionally smaller heads and brains, yet receive the same levels of cell phone radiation as adults.35 The American Academy of Pediatrics agrees, saying that “when used by children, the average RF energy deposition is two times higher in the brain and 10 times higher in the bone marrow of the skull, compared with mobile phone use by adults.”36
  • Another study found that people who begin using cell phones (and cordless landline phones) before the age of 20 are at an even higher risk of developing brain tumors than people who begin using these wireless phones as adults.37,38 This is because of the closer proximity of the source of radiation to the brain of kids (they have thinner tissues and bones than adults).
  • Research also suggests that cell phone exposure could affect children’s behavior.39 The children in the study who were hyperactive or had emotional or behavioral problems, including trouble getting along with other kids, were much more likely to have mothers who used cell phones during pregnancy. After accounting for other factors that could affect behavior, the children of these mothers were 80% more likely to have behavioral problems than children whose mothers rarely or didn’t use cell phones. However, this is difficult to study because mothers who use cell phones frequently during pregnancy or after the baby is born, may pay less attention to their children, resulting in the children’s bad behavior. More research is needed to understand the link between mother’s cell phone use and children’s behavior.
  • Children that used cell phones more were more likely to have ADHD. Although the link to ADHD was only for children who also had high levels of lead in their blood, when researchers adjusted for blood lead level, they still found that ADHD was more likely for children who made more phone calls and spent a longer amount of time on the phone.40 This study was conducted in Korea, so it would be important to do similar research on children living in other countries.
  • A 2014 article reviewing studies on children and their cell phone use found that the younger the child, the greater the risk of brain cancer and brain tumors. The same article also points to studies concluding that cell phones are associated with an increased risk of breast cancer (due to adolescents putting cell phones in their bras), parotid (salivary) gland tumors, and sperm damage for adolescents and adults.41

Reactions To Research About Cell Phone Radiation

In 2012, the American Academy of Pediatrics wrote a letter to the Federal Communications Commission, which sets the standards for cell phone radiation in the United States, and recommended that they reevaluate these standards since this had not been done since 1996. Their reasoning is that “children, however, are not little adults and are disproportionately impacted by all environmental exposures, including cell phone radiation.”2 But, as of 2015, the FCC still says that there is no evidence between wireless device use and health problems and continues to uphold the regulations from 1996.42 Other countries have taken a different approach. As of 2014, Turkey, Belgium, Australia, and France have warned about the dangers of children’s cell phone usage.7

 

Conclusions

Scientists disagree on whether cell phone radiation can cause cancer or other health problems.  Since so many children and adults use cell phones so frequently, that makes it difficult to do a study comparing high and low cell phone usage.  And since brain tumors and other cancers usually do not develop until several decades after the initial exposure, it could be years before we know how risky cell phones are and under what circumstances.7

By the time we find out, many people will have been harmed if cell phones are found to be dangerous. Here are some precautionary tips on how to protect your children from the health issues that could be connected to cell phone radiation.43

  1. Turn airplane mode on when giving a child a technology device or when a cell phone is near a pregnant abdomen, to prevent exposure to radiation.
  2. Turn off wireless networks and devices to decrease your family’s radiation exposure whenever you aren’t actively using them. As an easy first step, turn your Wi-Fi router off at bedtime.
  3. Decrease use of phones or wifi where wireless coverage is difficult, in order to avoid an increase in radiation exposure.
    The warning about RF exposure found on an iPhone 5s.
    The warning about RF exposure found on an iPhone 5s.
  4. Use the speaker phone or a plug in earpiece when you use a cell phone. To protect children from radiation, they should not use cell phones except in emergency and should use the speaker phone.
  5. Increase the distance between you and your cell phone whenever it is on, to reduce your exposure to radiation emitted. For example, do not use a cell phone while a child is on your lap, and do not carry your cell phone in your baby carrier, crib, or pockets. When the phone is on, tell your kids to put it in a backpack as far from their body as possible (such as an outside pocket) or on the desk or other furniture at home, instead of holding it or carrying it in a pocket.
  6. Read the fine print: All device manufacturers advise that cell phones should be at least 5 millimeters, or about ¼ of an inch away from your body or brain. With the iPhone 6 and the iPhone 6s, the company advises users to keep the cell phone at least 10 millimeters, or about half an inch, away from your body or brain. See the safe distance for your phone. For iPhone 5 and iPhone 6, this is located under: Settings -> General -> About -> Legal -> RF Exposure.
  7. Share this info with your friends, family, and schools so that they can make these simple changes as well.

 

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

Agent Orange and Serious Diseases including Multiple Myeloma

Nicholas J. Jury, PhD and Diana Zuckerman, PhD
2015

It has taken many years to determine how Agent Orange exposure during the Vietnam War has harmed the health of those who were exposed. One of the reasons is that it can take decades for cancer to develop after a dangerous exposure.  Agent Orange was used extensively by the United States military during the Vietnam War to clear vegetation to make it easier to see enemy soldiers. Agent Orange was contaminated with dioxin, making it more dangerous to humans. Nearly 1.5 million veterans were exposed to Agent Orange during the war 44  when approximately, 20 million gallons of Agent Orange were sprayed over Vietnam during Operation Ranch Hand. 45,46

Although more research is still needed to learn more about the risks of Agent Orange, by 2012, the Institute of Medicine had concluded that individuals exposed to Agent Orange are more likely to develop these types of cancers and serious diseases 47:

Cancers:

  • Chronic B-cell leukemia
  • Chronic lymphocytic leukemia
  • Hodgkin disease
  • Non-Hodgkin lymphoma
  • Prostate cancer
  • Respiratory cancers (bronchus, larynx, lung, and trachea)
  • Soft tissue sarcoma

Serious diseases:

  • Early-onset peripheral neuropathy
  • High blood pressure
  • Ischemic heart disease
  • Parkinson disease
  • Stroke
  • Type 2 diabetes

The report also stated that some of the children being born to those exposed had spinal cord birth defects. 48

New research indicates Agent Orange also increases the chances of developing a type of cancer of the bone marrow called multiple myeloma.

Veterans who have been exposed to Agent Orange or other herbicides during military service are eligible to receive Veterans Administration health care benefits and compensation for respiratory cancers without having to prove the connection between their disease and exposure.  49

Does Agent Orange cause Multiple Myeloma?

Bone marrow is crucial for making new blood cells. Multiple myeloma causes blood cells to accumulate in the bone marrow and interfere with the process of making new blood cells. 50  Patients who develop multiple myeloma are usually diagnosed first with a condition called monoclonal gammopathy of undetermined significance (MGUS). 51, 52  Patients who have MGUS tend to develop multiple myeloma, and this risk increases over time. 53  More than 26,000 people are expected to be diagnosed with multiple myeloma this year, and less than half are predicted to survive. 54

In its 2012 report, the Institute of Medicine stated that there was insufficient evidence to conclude that exposure to Agent Orange can cause multiple myeloma. 55  However, a study published in a cancer journal in 2015 reported that veterans who were exposed to Agent Orange were 2.4 times more likely to develop MGUS than the veterans who were not exposed to it. 56  The study was based on 958 veterans who served in the United States Air Force during Operation Ranch Hand. This study provides compelling evidence that Agent Orange exposure can increase the risk of multiple myeloma.

Tanning beds: safe alternative to sun?

By Heidi Mallis, B.A and Diana Zuckerman, PhD
Updated 2015

For many years, tanning beds were advertised as a safe alternative to a natural suntan, but in fact, there was no evidence that was true.  No U.S. government agency evaluated sun lamps, tanning beds, or tanning booths to make sure they were safe.  As a result, nearly 30 million people in the U.S. were using tanning beds each year57, 2.3 million of whom were adolescents.58

Research evidence was growing about the risks of tanning beds.  According to the American Academy of Dermatology and the World Health Organization, indoor tanning increases a person’s chances of developing melanoma by 59 percent, and the risk goes up with each use.59

Finally, in 2014 the U.S. Food and Drug Administration (FDA) announced that all sun lamps and UV lamps intended for use in sun lamp products must come with warnings include the following:

  • This product is contraindicated for persons under the age of 18 years;
  • This product must not be used if skin lesions or open wounds are present;
  • This product should not be used on people who have had skin cancer or a family history of skin cancer
  • People repeatedly exposed to UV radiation should be regularly evaluated for skin cancer3

As evidence grew of the link between tanning beds and skin cancer, especially for men and women in their 20s, more than 60% of states passed some kind of legislation restricting the use of tanning salons by children under 18 and two states, California and Vermont, have passed complete bans of indoor tanning for minors.60

What does this mean for you?

Tanning beds expose the user to a lot of artificial UV radiation in a short period of time. Just one 8-20 minute session exposes a person to more UV radiation than an entire afternoon spent in natural sunlight. In fact, doses of UV radiation emitted by high pressure sunlamp products may be up to 10 to 15 times higher than that of the midday sun, which is more intense than UV radiation found in nature.

A study conducted by Dr. S. Elizabeth Whitmore and Dr. Warwick Morison of Johns Hopkins University School of Medicine found that ten tanning sessions in two weeks produced evidence of a suppressed immune system among participants. This means that the body is less capable of fighting off infectious agents.61 Tanning bed use is also associated with faster skin aging because the UV radiation destroys skin fibers and damages elasticity. Characteristics of skin aging include wrinkles, dark spots, and a leathery texture.62

The International Agency for Research on Cancer lists tanning beds in its highest cancer risk category, “carcinogenic to humans.” This means that there is enough evidence to conclude that tanning beds can cause cancer in humans. Prior to 2009, the agency, which is part of the World Health Organization (WHO), previously classified tanning beds as “probably carcinogenic.” The change came after an analysis of more than 20 epidemiological studies indicating that people who begin using tanning devices before age 30 are 75% more likely to develop cutaneous melanoma, the most serious type of skin cancer63

Skin cancer is the most common form of cancer, with more than one million cases diagnosed each year in the U.S. There are three types of skin cancer: squamous cell, basal cell, and melanoma. Squamous cell carcinomas typically occur on surfaces exposed to the most sunlight, such as the ears or face. This type of skin cancer can spread quickly to other organs in the body. Basal cell carcinomas account for 8 out of 10 skin cancers. They grow very slowly and rarely spread to other parts of the body (as a result, they are highly treatable). Melanomas are the third and most dangerous type of skin cancer. They are less common than basal and squamous cell carcinomas but much more serious.64 Melanomas usually present as a change to an existing mole or an entirely new mole that is black or has a blue-black area. Their diameter is typically larger than that of a pencil eraser. If caught early, melanomas are often completely curable. However, they are much more likely to spread to other parts of the body if not found early.65

Risk factors for all three types of skin cancer include:

  • Lifetime exposure to UV radiation (from natural or artificial sources)
  • Family history of skin cancer
  • Geographic location (people who live close to the equator as well as in the mountains are exposed to higher levels of UV radiation)
  • Fair skin that freckles or burns easily
  • Severe sunburns as a child
  • Radiation therapy

Here are a few ways to lower your risk and avoid wrinkles and other skin damage:

  • Avoid direct sun exposure during midday hours (from 10 am-4 pm),
  • Use sunscreen with a sun protection factor (SPF) of at least 15
  • Regularly check your skin for any new moles, sores, or scaly patches (and visit a dermatologist if you notice the lesion changing form or color), and
  • Avoid using a tanning bed or booth (especially if you are a child, teenager, or young adult).66

Keeping track of moles and other changes to your skin are an easy way to improve your skin health. However, the U.S. Preventive Services Task Force suggests that if you are not at an increased risk of developing skin cancer, there is no need for yearly skin checks by a dermatologist.67

Continue to monitor any existing or new moles and contact your doctor if you detect any significant changes in size, shape, or color.