A science-based agenda for health-protective chemical assessments and decisions: overview and consensus statement.

The manufacture and production of industrial chemicals continues to increase, with hundreds of thousands of chemicals and chemical mixtures used worldwide, leading to widespread population exposures and resultant health impacts. Low-wealth communities and communities of color often bear disproportionate burdens of exposure and impact; all compounded by regulatory delays to the detriment of public health. Multiple authoritative bodies and scientific consensus groups have called for actions to prevent harmful exposures via improved policy approaches. We worked across multiple disciplines to develop consensus recommendations for health-protective, scientific approaches to reduce harmful chemical exposures, which can be applied to current US policies governing industrial chemicals and environmental pollutants. This consensus identifies five principles and scientific recommendations for improving how agencies like the US Environmental Protection Agency (EPA) approach and conduct hazard and risk assessment and risk management analyses: (1) the financial burden of data generation for any given chemical on (or to be introduced to) the market should be on the chemical producers that benefit from their production and use; (2) lack of data does not equate to lack of hazard, exposure, or risk; (3) populations at greater risk, including those that are more susceptible or more highly exposed, must be better identified and protected to account for their real-world risks; (4) hazard and risk assessments should not assume existence of a "safe" or "no-risk" level of chemical exposure in the diverse general population; and (5) hazard and risk assessments must evaluate and account for financial conflicts of interest in the body of evidence. While many of these recommendations focus specifically on the EPA, they are general principles for environmental health that could be adopted by any agency or entity engaged in exposure, hazard, and risk assessment. We also detail recommendations for four priority areas in companion papers (exposure assessment methods, human variability assessment, methods for quantifying non-cancer health outcomes, and a framework for defining chemical classes). These recommendations constitute key steps for improved evidence-based environmental health decision-making and public health protection.

Advancing the science on chemical classes.

BACKGROUND: Hazard identification, risk assessment, regulatory, and policy activity are usually conducted on a chemical-by-chemical basis. Grouping chemicals into categories or classes is an underutilized approach that could make risk assessment and management of chemicals more efficient for regulators. OBJECTIVE AND METHODS: While there are some available methods and regulatory frameworks that include the grouping of chemicals (e.g.,same molecular mechanism or similar chemical structure) there has not been a comprehensive evaluation of these different approaches nor a recommended course of action to better consider chemical classes in decision-making. This manuscript: 1) reviews current national and international approaches to grouping; 2) describes how groups could be defined based on the decision context (e.g., hazard/risk assessment, restrictions, prioritization, product development) and scientific considerations (e.g., intrinsic physical-chemical properties); 3) discusses advantages of developing a decision tree approach for grouping; 4) uses ortho-phthalates as a case study to identify and organize frameworks that could be used across agencies; and 5) discusses opportunities to advance the class concept within various regulatory decision-making scenarios. RESULTS: Structural similarity was the most common grouping approach for risk assessment among regulatory agencies (national and state level) and non-regulatory organizations, albeit with some variations in its definition. Toxicity to the same target organ or to the same biological function was also used in a few cases. The phthalates case study showed that a decision tree approach for grouping should include questions about uses regulated by other agencies to encourage more efficient, coherent, and protective chemical risk management. DISCUSSION AND CONCLUSION: Our evaluation of how classes of chemicals are defined and used identified commonalities and differences based on regulatory frameworks, risk assessments, and business strategies. We also identified that using a class-based approach could result in a more efficient process to reduce exposures to multiple hazardous chemicals and, ultimately, reduce health risks. We concluded that, in the absence of a prescribed method, a decision tree approach could facilitate the selection of chemicals belonging to a pre-defined class (e.g., chemicals with endocrine-disrupting activity; organohalogen flame retardants [OFR]) based on the decision-making context (e.g., regulatory risk management).

How Well Do Product Labels Indicate the Presence of PFAS in Consumer Items Used by Children and Adolescents?

PFAS are persistent and toxic chemicals used in many commercial and industrial applications that are often added to consumer products, including those used by children and adolescents, to impart water and stain resistance. Since product labels rarely list chemical additives, including PFAS, we evaluated whether other information on product labels can be used by consumers to select products without PFAS. We selected 93 items marketed to or often used by children and adolescents across three product types (furnishings, apparel, bedding) and five labeling groups representing different combinations of water and/or stain resistance and "green" (including "nontoxic") assurances. We screened all products for total fluorine (F) and analyzed solvent extracts from a subset (n = 61) for 36 targeted PFAS and from a smaller subset (n = 30) for perfluoroalkyl acids (PFAAs) generated by precursor oxidation using the total oxidizable precursor (TOP) assay. Products advertised as water- and/or stain-resistant had more frequent detections and higher concentrations of total F than those without such claims, and targeted PFAS were detected only in products labeled as water- and/or stain-resistant. Concentrations of PFAAs generated by precursor oxidation using the TOP assay often exceeded pre-oxidation concentrations, suggesting that PFAA precursors contribute to solvent-extractable PFAS from products. Among products advertised as water- and/or stain-resistant, detection frequencies and concentrations of targeted PFAS were similar regardless of green assurances. This study illustrates many nonessential uses of PFAS in products used by children and adolescents and suggests that while water- and stain-resistant assurances can identify products likely to contain PFAS, current green assurances do not consistently indicate the absence of PFAS.

Per-and polyfluoroalkyl substances (PFAS) and persistent chemical mixtures in dust from U.S. colleges.

Indoor spaces contain several classes of persistent organic chemicals, including per- and polyfluoroalkyl substances (PFAS), polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), and organochlorine pesticides (OCPs). However, concentrations of PFAS and persistent chemical mixtures and their associations with building characteristics on college campuses are understudied. We collected dust from 43 nonresidential spaces on four U.S. college campuses in 2016 and evaluated associations of room characteristics (carpeting, upholstered furniture, and years since last furnished) with dust concentrations of PFAS, PBDEs, PCBs, and OCPs. Nine PFAS, twelve PBDEs, two PCBs, and four OCPs were each detected in at least 75% of the spaces, including several chemicals (e.g., DDT) that have been banned for decades. Concentrations were correlated within and, in some cases, between chemical classes. Wall-to-wall carpeting (compared to rooms without wall-to-wall carpeting) was associated with higher concentrations of six individual PFAS and a mixture of PFAS, and the number of pieces of upholstered furniture was associated with increased concentrations of a mixture of PBDEs. These findings indicate that carpeting and furniture are current sources of PFAS and PBDEs, respectively. Building and finish materials should be carefully selected to avoid exposure to persistent chemicals.

Do flame retardant concentrations change in dust after older upholstered furniture is replaced?

Upholstered furniture has been a major source of chemical flame retardant (FR) exposures in US homes since the 1970s. FRs are a large group of chemicals, many of which are associated with adverse health effects, including cancer, reproductive toxicity, and neurotoxicity. California homes have some of the highest dust concentrations of FRs, due to Technical Bulletin 117 (TB117), California's outdated flammability standard for furniture foam that was generally followed across the US and Canada. In 2014, this standard was updated to a smolder standard for furniture fabric called TB117-2013, and it is no longer reliant on FRs. This update provided an opportunity to measure differences in FR dust levels in California homes before and after residents replaced older upholstered furniture, or its foam, with products that met the new standard and were expected to be FR-free. We collected dust from homes of participants who had plans to replace older upholstered furniture, or furniture foam, with FR-free options. We returned for follow-up dust collection six, 12, and 18 months following replacement. Concentrations of three polybrominated diphenyl ethers (PBDEs) (BDE-47, BDE-99, BDE-100), three chlorinated organophosphate ester FRs (tris(2-chloroethyl) phosphate (TCEP), tris(2-chloroisopropyl) phosphate (TCIPP), and tris(1,3-dichloroisopropyl) phosphate (TDCIPP)), and one aryl organophosphate ester FR triphenyl phosphate (TPHP), were widely detected in participant homes. All measured FRs decreased in nearly all homes after the older upholstered furniture was replaced. The decreases in FRs were significant in both homes that replaced entire pieces of furniture and those that replaced only the furniture foam. This study demonstrates that replacing older upholstered furniture or foam significantly reduces concentrations of a range of FRs in the home. Foam replacement offers a potentially more economic alternative that produces a lower volume of waste.

Consumer behavior and exposure to parabens, bisphenols, triclosan, dichlorophenols, and benzophenone-3: Results from a crowdsourced biomonitoring study.

Nearly all Americans have detectable concentrations of endocrine disrupting chemicals from consumer products in their bodies, and expert panels recommend reducing exposures. To inform exposure reduction, we investigated whether consumers who are trying to avoid certain chemicals in consumer products have lower exposures than those who are not. We also aimed to make exposure biomonitoring more widely available. We enrolled 726 participants in a crowdsourced biomonitoring study. We targeted phenolic compounds-specifically parabens, bisphenol A (BPA) and analogs bisphenol F (BPF) and bisphenol S (BPS), the UV filter benzophenone-3, the anti-microbial triclosan, 2,4-dichlorophenol, and 2,5-dichlorophenol-and collected survey data on consumer products, cleaning habits, and efforts to avoid related chemicals. We investigated associations between 68 self-reported exposure behaviors and urine concentrations of ten chemicals, and evaluated whether associations were modified by intention to avoid exposures. A large majority (87%) of participants reported taking steps to limit exposure to specific chemicals, and, overall, participants achieved lower concentrations than the general U.S. population for parabens, BPA, triclosan, and benzophenone-3 but not BPF and BPS. Participants who reported avoiding all four ingredient groups-parabens, triclosan, bisphenols, and fragrances-were twice as likely as others to be in the lowest quartile of cumulative exposure. Avoiding certain products and reading ingredient labels to avoid chemicals was most effective for parabens, triclosan, and benzophenone-3. Avoiding BPA was not effective for reducing bisphenol exposures. Avoiding certain chemicals in products was generally associated with reduced exposure for chemicals listed on labels. Greater ingredient transparency will help consumers who read labels to reduce their exposure to a wider range of potentially harmful chemicals. In order to more equitably address public health, labeling policies should be complemented by regulations that exclude harmful chemicals from consumer products.

Pruning chemicals from the green building landscape.

Green building design has substantially minimized environmental impacts by reducing energy consumption compared with traditional buildings. Yet, it is not uncommon for a green building to meet the highest criteria for energy efficiency and be built with materials that contain chemicals hazardous to occupant health. Because of this discrepancy in achieving holistic sustainability, the architecture/engineering/construction (AEC) industry has never been more interested in occupant health and well-being than it is today. At the same time, numerous scientific studies have documented exposures to and associated health effects of chemicals used in building materials. Opportunities to translate environmental health research so that it is useful to the AEC community exist across the landscape of healthier buildings. For example, research can be conducted to prioritize building material and chemical combinations to demonstrate how green building certification systems, government building codes, and the building products marketplace can increase energy performance while also addressing the greatest chemical exposures and health impacts. In order for scientific research to be used to create and support healthier environments, researchers should design and translate their research with this landscape in mind and should consider experts in the AEC industry as ambassadors for change. We provide key examples of how scientists have promoted healthy building practices and highlight additional research opportunities.

Dietary Habits Related to Food Packaging and Population Exposure to PFASs.

BACKGROUND: Per- and polyfluoroalkyl substances (PFASs) are common industrial and consumer product chemicals with widespread human exposures that have been linked to adverse health effects. PFASs are commonly detected in foods and food-contact materials (FCMs), including fast food packaging and microwave popcorn bags. OBJECTIVES: Our goal was to investigate associations between serum PFASs and consumption of restaurant food and popcorn in a representative sample of Americans. METHODS: We analyzed 2003-2014 serum PFAS and dietary recall data from the National Health and Nutrition Examination Survey (NHANES). We used multivariable linear regressions to investigate relationships between consumption of fast food, restaurant food, food eaten at home, and microwave popcorn and serum levels of perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorohexanesulfonic acid (PFHxS), and perfluorooctanesulfonic acid (PFOS). RESULTS: Calories of food eaten at home in the past 24 h had significant inverse associations with serum levels of all five PFASs; these associations were stronger in women. Consumption of meals from fast food/pizza restaurants and other restaurants was generally associated with higher serum PFAS concentrations, based on 24-h and 7-d recall, with limited statistical significance. Consumption of popcorn was associated with significantly higher serum levels of PFOA, PFNA, PFDA, and PFOS, based on 24-h and 12-month recall, up to a 63% (95% CI: 34, 99) increase in PFDA among those who ate popcorn daily over the last 12 months. CONCLUSIONS: Associations between serum PFAS and popcorn consumption may be a consequence of PFAS migration from microwave popcorn bags. Inverse associations between serum PFAS and food eaten at home-primarily from grocery stores-is consistent with less contact between home-prepared food and FCMs, some of which contain PFASs. The potential for FCMs to contribute to PFAS exposure, coupled with concerns about toxicity and persistence, support the use of alternatives to PFASs in FCMs. https://doi.org/10.1289/EHP4092.

Health Toll From Open Flame and Cigarette-Started Fires on Flame-Retardant Furniture in Massachusetts, 2003-2016.

Objectives. To evaluate the risk of death and injury in residential fires started on upholstered furniture, with a focus on open flame and cigarette-related heat sources.Methods. We used civilian death and injury data from 34 081 residential fires in the Massachusetts Fire Incident Reporting System from 2003 to 2016. We compared outcomes associated with fires that started on upholstered furniture ignited by smoking materials versus open flames.Results. Although fires starting on upholstered furniture were not common (2.2% of total fires), odds of death and injury were significantly higher in these fires than in fires started on other substrates. Among furniture fires, odds of death were 3 times greater when those fires were ignited by smoking materials than when ignited by open flames (odds ratio = 3.4; 95% confidence interval = 1.3, 10.9).Conclusions. Furniture fires started by smoking materials were associated with more deaths than were furniture fires started by open flames.Public Health Implications. Historically, furniture flammability regulations have focused on open flame heat sources, resulting in the addition of toxic flame retardants to furniture. Interventions to reduce deaths should instead focus on smoking materials.

Environmental chemicals and breast cancer: An updated review of epidemiological literature informed by biological mechanisms.

BACKGROUND: Many common environmental chemicals are mammary gland carcinogens in animal studies, activate relevant hormonal pathways, or enhance mammary gland susceptibility to carcinogenesis. Breast cancer's long latency and multifactorial etiology make evaluation of these chemicals in humans challenging. OBJECTIVE: For chemicals previously identified as mammary gland toxicants, we evaluated epidemiologic studies published since our 2007 review. We assessed whether study designs captured relevant exposures and disease features suggested by toxicological and biological evidence of genotoxicity, endocrine disruption, tumor promotion, or disruption of mammary gland development. METHODS: We systematically searched the PubMed database for articles with breast cancer outcomes published in 2006-2016 using terms for 134 environmental chemicals, sources, or biomarkers of exposure. We critically reviewed the articles. RESULTS: We identified 158 articles. Consistent with experimental evidence, a few key studies suggested higher risk for exposures during breast development to dichlorodiphenyltrichloroethane (DDT), dioxins, perfluorooctane-sulfonamide (PFOSA), and air pollution (risk estimates ranged from 2.14 to 5.0), and for occupational exposure to solvents and other mammary carcinogens, such as gasoline components (risk estimates ranged from 1.42 to 3.31). Notably, one 50-year cohort study captured exposure to DDT during several critical windows for breast development (in utero, adolescence, pregnancy) and when this chemical was still in use. Most other studies did not assess exposure during a biologically relevant window or specify the timing of exposure. Few studies considered genetic variation, but the Long Island Breast Cancer Study Project reported higher breast cancer risk for polycyclic aromatic hydrocarbons (PAHs) in women with certain genetic variations, especially in DNA repair genes. CONCLUSIONS: New studies that targeted toxicologically relevant chemicals and captured biological hypotheses about genetic variants or windows of breast susceptibility added to evidence of links between environmental chemicals and breast cancer. However, many biologically relevant chemicals, including current-use consumer product chemicals, have not been adequately studied in humans. Studies are challenged to reconstruct exposures that occurred decades before diagnosis or access biological samples stored that long. Other problems include measuring rapidly metabolized chemicals and evaluating exposure to mixtures.

Review of Organic Wastewater Compound Concentrations and Removal in Onsite Wastewater Treatment Systems.

Onsite wastewater treatment systems, such as septic systems, serve 20% of U.S. households and are common in areas not served by wastewater treatment plants (WWTPs) globally. They can be sources of nutrients and pathogen pollution and have been linked to health effects in communities where they contaminate drinking water. However, few studies have evaluated their ability to remove organic wastewater compounds (OWCs) such as pharmaceuticals, hormones, and detergents. We synthesized results from 20 studies of 45 OWCs in conventional drainfield-based and alternative onsite wastewater treatment systems to characterize concentrations and removal. For comparison, we synthesized 31 studies of these same OWCs in activated sludge WWTPs. OWC concentrations and removal in drainfields varied widely and depended on wastewater sources and compound-specific removal processes, primarily sorption and biotransformation. Compared to drainfields, alternative systems had similar median and higher maximum concentrations, reflecting a wider range of system designs and redox conditions. OWC concentrations and removal in drainfields were generally similar to those in conventional WWTPs. Persistent OWCs in groundwater and surface water can indicate the overall extent of septic system impact, while the presence of well-removed OWCs, such as caffeine and acetaminophen, may indicate discharges of poorly treated wastewater from failing or outdated septic systems.

Flame Retardant Chemicals in College Dormitories: Flammability Standards Influence Dust Concentrations.

Furniture flammability standards are typically met with chemical flame retardants (FRs). FRs can migrate out of products into dust and are linked to cancer, neurological impairment, and endocrine disruption. We collected 95 dust samples from dormitory common areas and student rooms on two U.S. college campuses adhering to two different furniture flammability standards: Technical Bulletin 117 (TB117) and Technical Bulletin 133 (TB133). Because TB133 requires furniture to withstand a much-more-demanding test flame than TB117, we hypothesized that spaces with TB133 furniture would have higher levels of FRs in dust. We found all 47 targeted FRs, including 12 polybrominated diphenyl ether (PBDE) congeners, 19 other brominated FRs, 11 phosphorus FRs (PFRs), 2 Dechlorane-Plus (DP) isomers, and 3 hexabromocyclododecane (HBCDD) isomers in the 95 dust samples. We measured the highest reported U.S. concentrations for a number of FRs, including BDE 209 (up to 990 000 ng/g), which may be used to meet the TB133 standard. We prioritized 16 FRs and analyzed levels in relation to flammability standard as well as presence and age of furniture and electronics. Adherence to TB133 was associated with higher concentrations of BDE 209, decabromodiphenylethane (DBDPE), DPs, and HBCDD compared to adherence to TB117 in univariate models (p < 0.05). Student dormitory rooms tended to have higher levels of some FRs compared to common rooms, likely a result of the density of furniture and electronics. As flammability standards are updated, it is critical to understand their impact on exposure and health risks.

Firefighters and flame retardant activism.

In the past decade, exposure to flame retardant chemicals has become a pressing health concern and widely discussed topic of public safety for firefighters in the United States. Working through local, state, and national unions and independent health and advocacy organizations, firefighters have made important contributions to efforts to restrict the use of certain flame retardants. Firefighters are key members in advocacy coalitions dedicated to developing new environmental health regulations and reforming flammability standards to reflect the best available fire science. Their involvement has been motivated by substantiated health concerns and critiques of deceptive lobbying practices by the chemical industry. Drawing on observations and interviews with firefighters, fire safety experts, and other involved stakeholders, this article describes why firefighters are increasingly concerned about their exposure to flame retardant chemicals in consumer products, and analyzes their involvement in state and national environmental health coalitions.