Hazardous chemicals in outdoor and indoor surfaces: artificial turf and laminate flooring.

BACKGROUND: Synthetic materials, increasingly used for indoor and outdoor surfaces including homes and playgrounds, may contain toxic chemicals. Infants have a higher potential of exposure to chemicals in these materials, which may pose a risk to their health. OBJECTIVE: To understand potential risks related to outdoor surface coverings, based on a review of the literature and regulations, and to assess levels of hazardous chemicals in surface coverings in Israel. METHODS: We reviewed the literature and regulations on artificial turf. We tested 46 samples of surfaces for trace metals in synthetic playground surfaces; trace metals, phthalates, and di(2-ethylhexyl) terephthalate (DEHT) in synthetic grass, and phthalates, DEHT and formaldehyde in laminate flooring. RESULTS: Twelve studies reporting high levels of polycyclic aromatic hydrocarbons (PAH), and varying levels of trace metals in synthetic playground surfaces were identified, as well as five international regulations on lead with maximum acceptable concentrations in the range 40-500 mg/kg. Surface tests showed that 20 out of 30 samples of synthetic playground surfaces exceeded relevant standards for trace metals, of which five had cadmium levels ≥30 mg/kg and four had chromium levels ≥510 mg/kg. In synthetic grass, three out of eight samples exceeded relevant standards, with lead levels ≥1200 mg/kg. In Laminate flooring (n = 8) formaldehyde levels were in the range of 0.7-1.2 mg/m2 formaldehyde, and five samples contained ~5% DEHT. SIGNIFICANCE: The literature on chemicals in surfaces is limited, but indicates some exceedance of regulatory limits. Trace metals in synthetic playground surfaces and synthetic grass, not regulated in Israel, exceeded relevant international standards in 72% of samples. Laminate flooring, regulated for formaldehyde, did not exceed the 3.5 mg/m2 standard, but contained DEHT, a replacement for ortho-substituted phthalates. The results of this preliminary study show that flooring surfaces may be a source of children's exposure to toxic chemicals. IMPACT STATEMENT: Synthetic surfaces are increasingly being used in, for example, children's playgrounds and sports fields. Exceedances of regulatory limits from other jurisdictions, of heavy metal levels in most outdoor surfaces sampled in Israel indicates the potential for children's exposure. Domestic regulations should be implemented to reduce the risk to children from exposure to these surfaces.

Factors associated with performance of influenza immunization among the elderly.

BACKGROUND: Influenza is a major cause of morbidity and mortality in the elderly. While immunization has been shown to reduce these complications, many of the elderly are not immunized. OBJECTIVE: To identify correlates for under-utilization of influenza immunization among the elderly. METHODS: A telephone survey was conducted among a random sample of patients aged 65 and over registered at a Jerusalem primary care community clinic. The 626 questionnaires were analyzed for associations of immunization receipt for the latest influenza season. Multivariate logistic regression was performed to identify independent correlates. Respondents were also asked what factors had influenced their decision about immunization. RESULTS: The most frequently reported influence on getting immunized was a physician's recommendation. Immunization was independently associated with the identity of the primary care physician (P < 0.0001) and with having visited the physician during the previous 3 months (P = 0.0006). Immunization was more likely among persons who believed that it provides complete protection from influenza (P < 0.0001) and less likely among those who believed immunization can cause influenza (P < 0.0001). Higher immunization rates were also associated with being married (P = 0.0031). CONCLUSION: Through their influence on patient knowledge and the effect of their recommendation, primary care physicians play a pivotal role in determining immunization rates. Physicians should routinely discuss the effects of immunization and recommend it to the elderly.