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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.

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Healthy Schools Spell Success

By Lynn Ringenberg, MD

School environments play an important role in the health and academic success of children. Children spend 90% of their time indoors. Much of that time is spent in school, which translates into more than 2,300 days during the 13 years between kindergarten and 12th grade. Twelve million preschoolers are in daycare centers, many of which fail to meet state licensing requirements. These centers can be private homes or buildings specifically designed or remodeled to care for infants and toddlers. There are millions of school-aged children in after-school and summer programs, including numerous sports activities. All these children are at risk for exposure to environmental hazards.

Unhealthy school environments can affect children’s health, attendance, concentration, and performance, as well as lead to expensive clean up and remediation, which many schools simply can’t afford. To foster children’s health and academic achievement, healthy school environments should be addressed and integrated within the educational system to ensure children have a healthy environment in which to learn and play.

Many of our nation's schools were built before 1984 and have not undergone major renovation or environmental inspections for toxic substances in many years. Because of this, these schools are likely to contain materials such as asbestos, lead or toxic PCBs (polychlorinated biphenyls). PCBs were recently found in light fixtures   in some 750 New York City schools.  Through pressure from parents, students and school staff, these fixtures will be removed by 2016. Lighting ballasts and caulking installed between 1950 and 1978 contain PCBs, which bio-accumulate in children at high levels after prolonged exposure and have been linked to cancer, respiratory, endocrine, reproductive and immune disorders. The U.S. banned PCB production in 1979.

Poor air quality inside schools places children at risk of short-term health problems, like eyes, throat and nose irritation and long-term health problems, like asthma. Pollen, soot, fiberglass fibers, chalk dust, lead, and other airborne particulates can cause respiratory and other health problems. Formaldehyde may cause irritation of the mouth, throat, nose, and eyes; worsen asthma symptoms; and cause headaches and nausea. Portable classrooms containing composite wood products, like plywood or particleboard are particularly dangerous. Paints, adhesives, carpets, cleaning products and building materials may contain volatile organic compounds (VOCs), which are associated with upper and lower respiratory problems and other health concerns. This off-gassing of VOCs is of particular concern in portable classrooms in the first few years of use. Biological air pollutants are found to some degree in every school -- such things as molds, hair and animal dander, dust mite allergens and cockroach allergens. They may cause toxic or allergic reactions, especially with excessive exposure. Caution should be used in applying pesticides outside or inside the school since toxic residue that can be ingested, inhaled or absorbed through the skin can have adverse health affects. Materials related to integrated pest management in schools are available from the US Environmental Protection Agency (EPA).

Air quality outside the schools depends on factors such as traffic patterns, nearby industrial complexes, proximity to waste sites, coal-fired power plants, coal ash disposal sites, local herbicide and pesticide use, atmospheric condition (heat and humidity) and geography. Outdoor air pollution is linked to respiratory problems in children, including decreased lung function, coughing, wheezing, more frequent respiratory illness, and asthma exacerbation. Most of this exposure happens while traveling to or from school and when playing outside. Twenty five million students ride a school bus every day, with the buses traveling about four billion miles each year. Diesel exhaust is comprised of very fine particles of carbon and a mixture of toxic gases, to include benzene, a known carcinogen. School administrative personnel can reduce traffic-related emissions by discouraging vehicles idling and improving the school traffic flow. The EPA has a free toolkit on Clean School Bus USA program and information about ozone levels and smog alerts are available at the EPA’s Air Now Web site.

Ensuring safe drinking water in schools is important because that’s where kids spend most of their day and drinking water is the best choice of fluids for good health. Schools should meet or exceed federal and state laws for lead and other water quality measures. Lead is a serious toxic metal that should not be found in the human body. Lead is toxic to the central nervous system of children and the reproductive system; it also damages kidneys, leading to possible hypertension as adults. No safe blood level in children has been determined. Lead levels below 10 ug/dl are associated with reduced IQ and attention span, learning disabilities, poor classroom performance, hyperactivity, behavioral problems, impaired growth, and hearing loss. Very high lead levels can cause coma, convulsions, and even death. The degree of harm from lead exposure in the air, dust, food, soil and water depends on the total exposure in a child’s environment, and lead in drinking water may be a significant contributor. The CDC now recommends public health actions be initiated for blood lead levels above 5 micrograms of lead per deciliter of blood.

Another toxic metal, arsenic, is abundantly present in the earth’s crust and can leach into water, especially unprocessed well water. Arsenic affects every organ in the body with primary target organs of the gastrointestinal tract and skin. The National Toxicology Program and the International Agency for Research on Cancer (IARC) classify arsenic as a known carcinogen, with an increased risk of bladder, lung and skin cancers. According to the National Toxicology Program’s 10th Report on Carcinogenics in 2011, exposure to arsenic in drinking water during early childhood or in utero greatly increases subsequent mortality in young adults from lung cancer. Schools with private wells should have water tested for bacterial and chemical contamination at regular intervals. Information about water quality is available from the EPA Safewater program.

And finally, children, including those with disabilities, must have a safe outdoor environment in which to play, participate in sports and explore the natural world around them. With this outdoor playground come potential risks related to air pollution, ultraviolet (UV) radiation, contaminated soil, groundwater, play surfaces and equipment, as well as contact with birds, animals, and reptiles and traumatic injuries. Children can be exposed to arsenic in the form of wood decks and other playground structures treated with chromated copper arsenate (CCA). Although this type of pesticide wood-treatment was banned for residential uses in 2003, pressure treated chromated copper arsenate wood still may be available for sale. Also, artificial turf may contain toxicants (VOCs, PAHs, and heavy metals such as zinc, iron, manganese and lead) and increase certain types of injuries, like knee and concussions. Information is available from the National Playground Safety Handbook developed by the Consumer Product Safety Commission (CPSC) (http://www.cpsc.gov)

Keeping our children safe and healthy should be a top priority. There are many tools available to help schools get and stay healthy. The Healthy School Environments Assessment Tool developed by the EPA, is a free downloadable program that can be used to systematically track and manage information about school environmental conditions as well as school compliance with government regulations and voluntary school requirements. Additional specific guidance is available in the Health, Mental Health and Safety Guidelines for Schools.

  1. AAP.org, Pediatric Environmental Health, 3rd Edition, 2012
  2. EPA.org
  3. CDC.gov
  4. Is Artificial Grass Toxic?
  5. We Can Do Better -- State Child Care Center Licensing

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