from polluted water and pesticides drew attention to the toxicity of a variety of chemicals and raised questions about the chronic effects of these chemicals. When they were used over long periods of time, we began to see strains of antibiotic-resistant diseases, such as gonorrhea and tuberculosis. Agricultural pests and lice also developed resistance to the insecticides used to control them.

A Note About Terminology:

Three words are commonly used to describe harmful substances, which can be either naturally occurring or man-made: toxic, toxin, and toxicant.

In this training guide, we use these terms interchangeably. 

B. Assessing Risk

The sheer volume of potentially toxic products that surround us seems almost overwhelming. It is easy to see why many people decide to either (1) ignore the problem and hope it will go away or (2) become frantic in trying to eliminate all risks from their lives.

However, what we all really need to do is to learn to assess environmental risk, and take steps individually and collectively to minimize those risks. This module discusses protection from individual risk, then Module 3: Building Communities Which Consider the Seventh Generation explores the collective action that can have larger impact.

What is a risk? A risk is a chance that something harmful or unwanted will occur-depending on what a person does or is exposed to.

Some environmental risks are clear-cut. We know that breathing air contaminated with cigarette smoke is hazardous; several illnesses result from the exposure. We also know that certain levels of lead in the bloodstream can have damaging effects. The risk assessment, however, becomes much more complex when we consider The long-term effects of low-dose exposure to toxins.

An extra challenge in assessing risk from an environmental toxin is that no one is exposed to only one risk. Regulations and manufacturers' guidelines set limits on the exposure a person can receive without harm from a given substance, but they do not consider that people might be exposed to several different substances. These substances generally do not act independently, and can work together to multiply the toxic effect.

For someone to decide whether to avoid a certain environmental risk, he first needs information. With the information, a person can make a judgment about which risk is acceptable and which-for a variety of reasons-is unacceptable.

Scientists ask questions'when faced with the possibility that a substance is harmful. Then they evaluate the information in the answers.

Did the toxicant cause these? Well, maybe yes for the women; probably not for the men. Why? Human biology. A toxicant that affected a group of women who were twenty, years old might very well affect the children they conceive ten years later because women's egg cells are present in their bodies from their infancy. However, since men 's sperm cells are not present from infancy, the men's exposure to the same toxicant at age twenty would be less likely to affect children they help to conceive later.

Once the information is in, it is time to make a choice. Do I change what I do, where I live, what I eat-so that I reduce my risk of a harmful effect from some substance? As with other health topics, the facts are only part of educating people about risks to their well-being. People might be more or less concerned with environmental risks depending on several factors.

In communicating about environmental risks, we must pay as much attention to people's concerns and perceptions of risk as we do to "the facts." Their concern, and our response to that concern, will be as important to their ultimate decision about what to do about a certain risk as will be the information we provide.

Head Start staff, because of their trusted position in their communities, can be valuable sources of information for families. People can easily be misled by sensational information and overreact to a sensationalized risk. Staff can assure that scientific information is clear and that bureaucrats and decision-makers respond to concerns. By considering the questions in
this section, staff can take a critical look at a supposed risk, interpret information for families, and help them decide what to do.

C. Risks and Routes of Toxic Exposure

Thousands of substances can cause harm to human beings. To help staff to plan strategies to protect children, families, and themselves from these hazards, we have organized the substances into routes of exposure.

It is important to recognize that the following overview of risks only lists some broadly distributed toxins. Risk varies by region throughout the United States. For example, people working with pesticides or living near farms will be more exposed to those substances; those in the Northeast have more exposure to radon; those who live near heavy traffic will be more exposed to ozone and nitrogen dioxide.

With thousands of chemicals circulating in our environment, pinning exact cause and effect is tough. It took many years, many studies, and much argument to document that cigarette smoking does cause lung cancer. The effects of the toxins in the following tables are not unquestionably proven. The effects have been demonstrated in animal studies, or studies of humans, or both.

One thing to note: Scientists can measure many things, but are much less able to pinpoint the exact effect of a certain substance on health. For example, they may know that a nursing mother's milk contains a certain chemical, but they are unsure about that chemical's effect on her baby.

For the toxicants listed in the following tables, the intensity or severity of the response to the exposure will vary. Just as some people smoke cigarettes and do not get lung cancer, some people are exposed to environmental toxics and do not seem to be affected. Most of the following substances, however, are deadly if the exposure is great enough.

It should also be noted That illnesses or injuries caused by toxins-unless they are high-dose, acute exposures-can creep up on a person over time. Signs and symptoms might suggest another common illness but not respond to treatment. It is important to consider environmental damage as a possible cause for any illness.
Some Toxicants in Air
 
What It Is
Source
Effects
Tobacco smoke cigarette smokers, includes a variety of pollutants irritates lung passages; impairs oxygen transport; leads to respiratory illness, lung cancer
Carbon monoxide from incomplete combustion of fuel; stoves and autos blocks the red blodd cells' ability to carry oxygen
Ozone formed from a combustion of nitrogen and hydrocarbons (auto exhaust & industry) and sunlight damages the respiratory tract; causes difficulty in breathing; asthma
Particulates tiny particles of dust, soot, auto exhaust impaired lung function; asthma; increased repiratury illness
Radon a breakdown product of naturally occuring uranuim; seeps into homes and schools lung cancer
Electric and magnetic fields (EMF) electric charges from any power  line or electric appliance biological changes in cells; possible association with cancer
Ionizing radiation nuclear power plants, atomic weapons testing/use, nuclear waste storage sites various cancers
Unltraviolet radiation the sun damages and wrinkles skin; causes skin cancer
Head Start has taken an important step in protecting children, staff, and families from air pollutants by banning smoking on the premisis. The chart above highlights other pollutants.

The various types of radiation are included in "air" catagory because they are all around us.

Some toxins in Water
 
 
What it is
Source
Effects
Peticides appear in water supply as runoff of agricultural or landscaping use
  • acute: nervouse system damage, skin irritation, gastrointestinal distress
  • chronic: damage to nervous, immune, or reproductive system; cancer
Lead plumbing solder damage to nervouse and circulatoory systems; learning disabilities and anemia
Microorganisms (parasites, bacteria) sometimes found in well water, occasionally in public water systems with inadequate treatment a variety of gastrointestinal illness
Dioxin industrial processes; breakdown product of chlorinated compounds various cancers
PCB's (Ploychlorinated biphenyls) electronic compounds skin rash; liver cancer; central nervous system damage
 
Some Toxicants in Food
What it is 
Source
Effects
Pesticides  residues on food products, mostly fruits and vegetables  · acute: nervous system damage, skin initation, gastrointestinal distress 
chronic: damage to the immune, reproductive, or nervous systems, cancer 
Microorganisms (parasites, bacteria)  improper food handling and storage gastrointestinal ilinessess (e.g., diarrhea and vomiting)
PCBs (Polychlorinated biphenyls)  electronic components: 
concentrated in the fatty tissues of fish		  skin rash; behavioral disorders; liver cancer
One of Head Start's important goals is to provide nourishing food for children. Another is to build healthy eating habits among all program participants. We consider levels of sugar, salt, and fat in the food. Nutritionists advise us to eat several servings of fruits and vegetables each day.

Food safety is important to any food program. There are two general ways that food could be contaminated and unhealthy. Microorganisms can contaminate food at the farm or factory, or through unsafe food preparation practices at the Head Start center or home. With fresh fruits and vegetables, there might be residues of pesticides or other chemicals. In August 1996, the growing concern about contamination of fresh produce resulted in the passage of a new law, the Food Quality and Protection Act of 1996. This law changes some of the ways that pesticides have been regulated. For the first time, specific information about the effects of pesticides on infants and children is considered.

There is great regional variation in food growing practices and in eating practices. Some people eat more apples, others more meat. The greatest risk of PCB ingestion is faced by those whose diets are high in fish caught from lakes and bays that have been polluted by PCBs.
 
Some Toxins in Building Materials/Home Products 
What it is
Source
Effects
Formaldehyde  pressed wood (much is used in mobile home construction), particle board, and carpets  irritates skin and respiratory system; headache; gastrointestinal distress 
Lead  palnt on walls, sills, etc.; pottery; cosmetics  nervous system damage; learning disabilities; anemia 
Asbestos  building insulation  skin irritation; lung cancer 
Home cleaning/pesticide products  cleaners; bug sprays; chemicals for landscaping  skin irritation; childhood cancer; nervous system effects
Organic solvents  products used to dissolve grease and paint  cancer skin irritation 
Many products used in the home are very toxic.

In 1786, Benjamin Franldin wrote to a colleague and described the signs of lead poisoning he had observed among workmen in different countries. Two hundred years later, the problem of lead poisoning is still with us, mainly affecting children. Lead is a widespread substance, and exposure to this toxin can occur through many routes. Since the 1970s, lead exposure through air has dropped with the elimination of leaded gasoline and lead exposure through food has been reduced by removing lead from the canning process. Children still encounter lead through paint in older buildings or in the soil around those buildings. Because small children put everything in their mouths, they can easily ingest lead from toys, dirt, paint chips, or window sills.

Asbestos was used widely for many years in insulation. Workers have suffered from lung cancer as a result of their contact with this substance. Now, if asbestos is in place and intact, it does not pose a risk for users of the rooms where it is found. If it is disturbed-through flaking, peeling, or construction/renovation activities-it can be very harmful and must be removed by specially trained and experienced workers.

D. Who is at risk?

Environmental contaminants present a risk for everyone. Effects on adults range from acute episodes of poisoning to chronic exposures. Workers with toxic substances are the usual victims of acute exposures, from spills of pesticides or contact with cleaning supplies, for instance. An example of a chronic exposure is the experience of asbestos workers who developed lung cancer many years after their work with the substance. Another example is damage to reproductive systems in men and women who work over time with toxic chemicals. There is also some concern about reproductive damage from general exposure to chemicals in the day-to-day environment.

From conception through adolescence, children are physiologically different from and behave differently than adults. In general, the younger the child, the more potentially damaging is an effect from a toxic exposure.

Children's immature organ systems are especially sensitive to environmental hazards. Exposures might disrupt and cause permanent damage to developing nervous, immune, and respiratory systems of young children. Children's metabolic processes are quite different from adults': they absorb toxic materials more easily than adults through their skin and through their respiratory and gastrointestinal systems. They are also less able to detoxify, metabolize, and excrete certain toxins and so are more vulnerable to adverse health effects.

Children's behavior is also very different from adults'. Older children are outside more and engage in more active play. Infants and toddlers spend a great deal of time on the ground, lying or crawling, and putting all that they can reach into their mouths. They eat more fruits and vegetables than do adults and drink more water. Children are closer to ground level, and are exposed to toxins in the soil and in the air that is closer to the ground.

Children with disabilities are due special attention. A visually impaired child, for example, is more likely to work close to an art or craft project and breathe toxic fumes. Children with mental or emotional disabilities might not be able to follow safety precautions.

Tolerances for exposure to many toxic substances are established by manufacturers and government regulators. There are several reasons to be skeptical of tolerance limits and health protection. Health may not be protected, even when tolerance levels are not exceeded, because the limits:

Therefore, many child health experts are warning that children are not adequately protected by tolerances set for toxins in air, water, food, or building materials.

The experience with lead poisoning is an example of greater knowledge leading to establishing much lower tolerances, or action levels. Early in this century, people were not aware that low levels of lead in the bloodstream could cause damage to children; only acute lead poisoning with dramatic and damaging effects was known. As researchers documented effects on children at lower levels, the tolerance was changed. The Centers for Disease Control and Prevention (CDC) now considers a blood lead level above 10 mcg/dl unacceptable.

E. Head Start Facilities

Head Start programs are required to choose facilities that are conducive to learning, reflect the stages of development of each child, and are safe and healthy places for staff and family members.

Some important issues to consider in selecting facilities are:

Consideration should be taken of the facility itself, the surrounding area, and the area through which children, families, and staff travel in the normal course of their Head Start day's activities.

Construction or renovation of facilities entails another set of questions that must be addressed, as construction could disturb or uncover toxins that otherwise would not be a problem. Examples are the need for specially trained workers to abate the problems raised by lead, asbestos, or serious soil contamination.


Note to Trainer/Coach:

This training guide takes an ecological approach to toxins, exploring those that cause damage to humans and others in the ecosystem. There are many other substances that are not inherently toxic, but can be dangerous if misused. There is also the issue of safe structures-design and shape-in the Head Start environment.

The latter two issues are explored in the Health guide Safety First: Prevention and Management of Childhood Injuries. You will also find information and activities related to the environment and communicable diseases in Preventing and Managing Communicable Diseases. 


Questions for Discussion/Reflection References for Background Information

Activity 1: Children's Developmental Stages

Purpose: Participants will consider the developmental tasks and behavioral characteristics of children up to age five, and determine how to minimize risks during their Head Start experience.

For this activity you will need:

· Handout G: Children's Developmental Stages & Environmental Risks

Step 1: Meet with the participant(s) and discuss the children in your program. Do you have infants, toddlers, and/or preschoolers? Talk a while about the major characteristics of children in each of the groups you serve:


Coach's Note:
You may wish to use the Education guide, Enhancing Children's Growth and Development, to expand your discussion of children's developmental stages. For another activity that expands on this concept, see Module 1: Understanding Injuries in Safety First: Preventing & Managing Childhood Injuries from the Health series. 

Step 2: Give each participant a copy of Handout G: Children's Developmental Stages & Environmental Risks. Select one age group of children for the participant to focus on.

Based on your discussion in Step 1, fill in the top section of Handout G. Note behavioral characteristics of children in this age group. Review the information on routes of exposure from toxins and children's special risks from the Background Information.

Step 3: Make notes in each of the sections on "air," "water," "food," and "building/home."

Step 4: Give the participants some time to observe children of this age in the program. Take a few days with your chart, and consider what these children do and how they might be exposed to toxicants. Continue to make notes.

Step 5: After noting your observations, think about what you can do in your program to make things safer for children of this age.

Step 6: Meet with the participant(s) to discuss how you can make the changes necessary to protect children at their specific developmental stages.

Points to Consider

Activity 2: Is Something in the Air?

Purpose: Participants consider a variety of situations to improve their alertness to the possibility of environmental illness or injury. They identify the steps to take when faced with such situations, and who in the community can help.

For this activity you will need:

· Handouts H-1 through H-4: Stories

· Writing materials for participants

Step 1: Briefly review for your participants the Background Information section on routes of exposure for toxins. Emphasize that many illnesses can be caused by environmental exposures, though they seem just like illnesses caused by other factors. Many health care providers are not trained to look for environmental causes, and are not alert to the possibility of exposure.

Head Start staff do not diagnose illnesses, but they do have two important roles:

Step 2: Divide the participants into four groups. Ask each group to assign a recorder/reporter. Give the participants in each group a copy of Part I of the stories from Handouts H-l, H-2, H-3, or H-4. Each group should have a different story.

Step 3: Allow the groups 10 minutes to review Part I of their story and to discuss it. Post on the flip chart the following questions for them to discuss and report on:

Step 4: After 10 minutes, ask the participants if they have some ideas of what could be causing the problem. Ask whether they need more information. They will likely say yes. Tell them that a good way to get more information is from a family member or friend who can give background on the affected person's activities, and home.

Step 5: Ask for one person in each group to volunteer to be the family member or friend. Give this individual Part II of the story for that group. Ask the person to share that information with his group.

Step 6: Give the groups another five minutes to discuss the story in light of additional information. Add a fourth question to the flip chart:

Step 7: When the groups are ready to report back, ask the first one to summarize its story and respond to the questions on the flip chart. When the report is finished, encourage the other groups to offer additions and suggestions.

Step 8: In their responses to the questions, each group should have noted that they want to consult someone from the community who has expertise in environmental illness.

Step 9: Now ask for another volunteer from each group. This person will be the community expert. Give this person Part III from Handouts H- 1, H-2, H-3, or H-4 for that group and ask him to describe the toxin responsible for the illness. Affirm that collecting information and making contacts are important roles for Head Start staff.

Discuss how staff members can develop relationships with
experts in environmental health in their local community.

Trainer's Note:

Be sure to note that a community practitioner would respect the individual's confidentiality and not give out information on diagnosis. This is a training situation only! 

Points to Consider

Activity 3: An Apple a Day ... or Not?

Purpose: Staff members will develop skills in risk assessment and communication. They will create a framework for this type of evaluation by working through questions related to three fresh foods.

For this activity you will need:

· A large blackboard or paper to draw a chart
· Markers
· Key to Activity 3: Fruits & Pesticides Fact Sheets-For Trainer Only

Step 1: Begin the discussion with a review of the importance of nutrition to Head Start's services. We are all committed to providing the safest, healthiest food for children and promoting healthy eating habits. We want to give families information so that they can maintain good nutritional habits or improve their diet. But what about pesticides? Is there a risk to children? Are some fruits or vegetables better to serve than others?

Step 2: Review the concepts in the Background Information on "Assessing Risk." During this activity apply the framework outlined there to the question of pesticide risk' from fresh fruits. Assure the group they won't be asked to engage in the highly technical and scientific process of risk assessment, but only to do a lay person's assessment.

Step 3: For this activity, ask the group members to imagine that they are a committee that is choosing foods for use in their center's meals and snacks. Tell them that three suppliers have offered to deliver fresh fruit every week: one offers apples, the other strawberries, and the third bananas. Imagine that, up until now, your program has had to rely on mostly canned or frozen fruits and vegetables because of your location and the foods' costs. You can only make arrangements with one fruit supplier. The parents want this because enough fruit will be delivered for the families to purchase some for home at a very low price. However, several staff members and parents are concerned about the pesticide residues on produce and want the committee to find out if any or all of these fruits are safe for the children to eat.

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