Exposing an Invisible and Silent Monster Devouring Our Children (Part 3)

This is the third is a series of three posts on the historic community response to lead poisoning in Rochester New York. You can read the first two posts here and here.

After becoming Principal of an urban, high-needs elementary school in Rochester, I set out to “level the playing field” for my school’s children and community. After raising nearly seven million dollars, replacing almost the entire school teaching staff, and creating numerous school/community partnerships, I noticed that I still had a core of children with critically serious learning and behavioral deficits. Puzzled by this, I was the first principal known to review my school children’s public health records, and what I found horrified me. What follows is the last of a three-part story of the epic battle with what I call “the invisible and silent monster that devours our children”. — Ralph Spezio

“Child Advocacy and a Community’s Heroic Response”

In Rochester, NY, our community has not only “put a face” on this silent and invisible monster through education, we have mobilized ourselves to eventually slay the terrible beast that has created carnage and devoured so many of our children in the past. In our community-wide advocacy for children, we have evolved and surpassed many other communities throughout New York State and America in regard to how we view and solve the health issues of our children.

Far too often, many communities visualize problems in what can be called silo-thinking. That is, it is the common believe in many communities that children’s health is the sole responsibility of the Health Department, and children’s safety is the sole responsibility of the Police Department, etc. and in Rochester and Monroe County, we have clearly stepped forward to say that these issues are much too complex and inter-related for us to be myopic or naively simplistic in finding solutions. In any community, I believe that we are all accountable for the health and safety of our children.

The Coalition to Prevent Lead Poisoning has many treasured partners at the government as well as grass-roots levels. The Monroe County Health Department certainly has provided courageous and visionary leadership. Our contributing partners also come from individuals, community organizations, foundations, the business community, as well as grass-roots neighborhood associations. The University of Rochester Medical Center has been a long-standing advocate and partner.

Our City and County governments have also shown courageous leadership in creating new paths forward for the advocacy of child health. The City of Rochester passed the first City Housing Ordinance in the state for primary prevention of childhood lead poisoning, and the Rochester City School District just passed the first primary prevention School Board policy in New York State and one of the most comprehensive in the nation to protect children. State legislators from the Rochester region are on the threshold of passing a major state law for primary prevention of lead poisoning and we expect that this law will become a reality in the 2008 state legislative session.

Even though Rochester/Monroe County is on the national forefront in the work to provide healthy homes for children and families to help eliminate chronic diseases such as asthma and the ravages of lead poisoning, there is much more work to be completed locally. We must celebrate and secure the accomplishments and progress that we have made as a community to date, and we must monitor this progress and evaluate its ongoing effectiveness.

Relentless child advocacy, primary prevention, and the promotion of healthy environments and healthy lifestyles need to be a central focus of everyone in our society. It is my belief that any civilized society is measured primarily by how well it takes care of its children. If the adults within that society do not mobilize to protect children, who will? Children do not have an organized voice. They can not lobby on their own behalf. They have very little control in regard to their environment. They rely almost entirely upon adults.

In Rochester/ Monroe County, I believe that we have a lot to be proud of in regard to our collective work in primary prevention of child health and safety. We still have a long way yet to go, but by “linking arms” and partnering, by sharing responsibility and accountability, and by joining together to search and find critical solutions, we will find our real success as a community. This success will be measured, not only in the excellent health of our children, but also in their undiminished potential for a happy and productive future.

NYSHealth to Fund Mental Health and Substance Use Initiatives

The New York State Health Foundation (NYSHealth), a fund created with the proceeds of the conversion of Empire BCBS to for profit status, has announced that it is adding “Integrated Mental Health/Substance Use Services” as one of its priority areas. This initiative is divided into two components: integrating services and an initiative for returning veterans.

The following is from the NYSHealth website:

Nearly 1.4 million people in New York State suffer from co-occurring mental health and substance use disorders; however, individuals with co-occurring mental health and substance use disorders rarely receive services that effectively address both of these issues. For years, the mental health and substance use systems of care have operated separately, and regulatory and financial barriers have restricted integration of these services. Not surprisingly, poor health outcomes are associated with co-occurring disorders in the absence of integrated care and individuals with co-occurring disorders are at higher risk for other serious medical problems, homelessness, violence, social isolation, and early death. NYSHealth has set as a priority area the integration of mental health and substance use services in New York State, and is dedicated to advancing potential solutions. As a component of this priority area, NYSHealth has identified returning Iraq and Afghanistan war veterans and their families as a high-need, sub-population whose broad mental health needs are not being met.

The Foundation is committing $10 million over the next 5 years for its Integrative Services initiatives and $2 million over the next two years for its Returning Veterans program.

ABC’s Priorities

James Norman, the president and CEO of Action for a Better Community, a Rochester-based “community action agency” and frequent collaborator with the Medical Center on a number of projects, has a piece in this week’s Democrat and Chronicle about his organization’s activities.

ABC, community partners build ladders out of poverty, ill health

During May, Community Action month, more than 1,000 grass-roots agencies nationwide celebrate the victories in the war against poverty and make a special effort to raise awareness about the challenges still facing communities.

The National Community Action Partnership in Washington, D.C., of which Action for a Better Community Inc. is a member, launched an ambitious campaign in January titled “Rooting Out Poverty.” This bold initiative draws from the experience of the national network of community action agencies. Including five action themes, the campaign is a call to action, inviting local agencies like ABC to take this national campaign to the local level. The five themes are:

• Maximize participation.
• Build an economy that works for everyone.
• Invest for the future.
• Maximize equality of opportunities.
• Ensure healthy people and places.

These themes are only the framework; the real work can only be done locally, tapping into this community’s ingenuity and collaborative spirit to find solutions for our unique challenges.

Seminar on Mental Health Program for At-Risk Children

The Summer in the City Series launches its 2008 season with presentation and discussion entitled “Fostering Recovery: Mental Health, Child Welfare and Recovery Working Together for Families.”

The topic is a new joint program involving the University’s Department of Psychiatry, the Mount Hope Family Center, the Monroe County Department of Human Services, and the Monroe County Family Court that provides children and parents in welfare and foster care programs with the mental health care they need to thrive and stay together as a family.   The program is funded by a grant from the U.S. Department of Health.

You can read a news release about the launching of the program here.

The series, which is sponsored by the Center for Community Health, will take place on Tuesday, June 3 from 12:00 to 1:00 PM in K-307 in the Medical Center.  Speakers include: Wendy Nilsen, Ph.D., the principal investigator of the project, and Cynthia Lewis, LMSW, ACSW, director of Child and Family Services with the Monroe County Department of Human Services.

A light lunch will be served.  For more information, contact centerforcommunityhealth@urmc.rochester.edu or 276-3056.

The Hazards of Pharmaceuticals in the Home and the Environment

Several stories have recently appeared in the news about the effects of pharmaceuticals in the water supply. The reported negative impacts include hormone disruption in fish, raising questions about potential impacts on human health. There are concerns about the effects of long term human consumption of these and other chemicals. Household pharmaceuticals can get into the water supply because conventional waste and drinking water treatment does not effectively eliminate most of the pharmaceutical compounds such as endocrine disruptor compounds found in oral contraceptives. Some of these chemicals enter the wastewater system when they are excreted by people who take these drugs. In other cases, chemicals may get into the wastewater when people flush old or unwanted medicine down the toilet. Flushing has been recommended in the past as a way to safely dispose of pharmaceuticals. However, because treated wastewater is released into surface water bodies, chemicals remaining in the effluent may affect wildlife or if the water eventually enters drinking water systems, humans may be affected. Below are two recent examples of how EHSC researchers and community outreach agencies are focusing on studying and eliminating pharmaceuticals in our environment.

It is important to safely dispose of unwanted pharmaceuticals to avoid accidental poisonings by children or others. Flushing them down the toilet is no longer a recommended method of disposal. People are discouraged from simply throwing unwanted medicines in the trash since children might pull them out of the trash, or once in a landfill, these chemicals may eventually seep out in drainage water. The only guidance issued to date by a federal agency regarding the disposal of medications (by consumers and other end users) is the guidance issued in February of 2007 by the White House Office of National Drug Center Policy. However several states and localities have developed their own approaches to this issue. In Washington State, a coalition of local and state governments, and non-profit organizations, developed a pilot program in which pharmacies took back unwanted medicine, (www.medicinereturn.com). Legislation that would have implemented this program on a statewide basis was introduced in 2007 but has not been passed. The New York State Legislature is also considering a bill (A. 840) that would regulate the collection and disposal of both prescription and over-the-counter drugs by manufacturers of such drugs. Until such a program is instituted, community collection days may be the safest option (See ‘What Can I Do?’).

• In March 2008, 3rd year Toxicology graduate student Fanny Casado presented a talk called “Endocrine Disruptors with estrogenic activity: Promises and Challenges.” The presentation discussed the current widespread use of estrogen-based hormonal therapies that has opened opportunities to do epidemiological studies of the risks and benefits. Endocrine disruptor compounds (EDCs) are defined as chemicals, such as those found in oral contraceptives, that can alter the physiology of endocrine or hormone systems in wild-life and humans. When these chemicals were first introduced, disruptive effects were not fully appreciated. Several different lines of research have elucidated some of the mechanisms of action of these compounds, specifically the ones with estrogenic activity, giving rise to guidelines and restrictions on their use. Despite numerous investigations using in vivo models that provide information about exposure, the relationship between human diseases of the endocrine system and exposure to environmental EDCs is poorly understood.
• Action for a Better Community (ABC), an EHSC Community Advisory Board member, teamed up with the Ruth A. Lawrence Poison Control Center, the City of Rochester, Monroe County Department of Environmental Services, and the Center for Environmental Information to take part in the Environmental Protection Agency’s Great Lakes Earth Day Challenge on April 19th. This event provided opportunities for people to safely dispose of unwanted medicines as well as electronic waste. Over 55,000 doses of unwanted medicine were collected from 66 people at this event. On June 7th, there will be a free Unwanted Pharmaceuticals Collection from 8:00am-1:00pm at the City of Rochester Water Bureau, 10 Felix Street. For more information about this collection, contact Ted Murray at ABC, 325-5116.

Lead poisoning still plague in Rochester

From the Rochester Democrat and Chronicle

May 14, 2008

Lead was removed from paint in 1978, yet childhood lead poisoning is still at epidemic proportions in Rochester.This preventable plague exists because of the large number of poorly maintained older properties in our city.

While the numbers have improved in the past few years, there were still 426 Rochester children poisoned by lead in 2007 with a testing rate of less than 100 percent in Monroe County. That’s more than 400 children with elevated blood levels of a known neurotoxin, causing permanent brain damage whose effects can range from learning delays to aggression and violence. Ninety percent of those affected are in the city of Rochester and are concentrated in a handful of neighborhoods.

The question remains: After all of the research, outreach, education and funding available to repair homes, why are we still seeing an outrageous number of children poisoned annually? The Centers for Disease Control and Prevention called for the elimination of childhood lead poisoning by 2010. Here in Rochester and Monroe County, a similar goal of ending childhood lead poisoning was established. When toys from China were found to have lead, legislators at the federal and state level introduced legislation to do better inspections and to maintain high safety standards. At the same time, legislation for primary prevention was passed in the Assembly but has languished in the state Senate for more than five years.

Click here for a link to the full article.

Exercise May Protect Against Breast Cancer

In a study that provides perhaps more evidence of the benefits of adolescent exercise, researchers found that women who were active in their teens were 23 percent less likely to develop premenopausal breast cancer than their sedentary peers.

You can read an Associated Press story on the study, which appeared in the Journal of the National Cancer Institute, here.

Hookah bars: Not a safe alternative for cigarettes

Recently, a “hookah bar” has opened for business in Rochester, NY. Such establishments have been opening up in communities across the US in recent years. Tobacco control experts around the country have been reporting that young people in particular are attracted to such places that offer flavored tobacco, and the ability to use tobacco indoors – even in areas that have “clean indoor air” laws. To get around the laws, they do not serve alcohol or food so they can’t be labeled as a restaurant or a bar. Also, it is consistently reported that the attraction to hookahs is that they are “less harmful” than cigarettes, or not harmful at all because hookahs use unprocessed tobacco.

Tobacco control experts should heighten their efforts to get the word out about the dangers of hookah use however. Consider the following facts.

Recent reports from the World Health Organization (WHO) cast doubt on those claims, saying they hookah is not a harmless alternative to cigarettes. According to WHO, preliminary research reveals some serious misconceptions about the dangers of hookah smoking. Hookah smokers “may inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes.”

The WHO reports that hookah smoke still “contains high levels of toxic compounds, including carbon monoxide, heavy metals and cancer-causing chemicals.” And users still get nicotine, which causes addiction.

There is also the health risk from the by-products from the combustion of a charcoal pellet used to keep the smoking mixture burning in hookahs.

Users are at higher risk for contracting oral herpes and other communicable diseases. The evidence-base for this statement is new and hopefully growing, but consider this anecdotal report: After attending a Hookah bar in March, 2008 in Fort Collins, CO, several students developed mouth herpes, according to a local Infection Control Physician at Colorado State University’s Hartshorn Health Services.

One hour of smoking a hookah exposes users to 100 to 200 times the volume of smoke of a single cigarette, according to a report on BacchusNetwork.org. The smoke also has arsenic, lead, nickel, and 36 times the tar of a single cigarette and 15 times the CO.

Finally, the marketing of flavored tobacco like “wild berry” has been used by the tobacco industry before to lure non-smokers, especially young people, to begin a life-long addiction to their products. Hookah Bars around the country offer such flavored choices.

Tobacco control experts should plan for effective dissemination of the dangers of hookah use.

Anyone thinking about quitting any type of tobacco product can call the New York State Smoker’s Quitline for information and support at 1-866-NY-QUITS (1-866-697-8487), and visit the Smokers’ Quitsite at http://www.nysmokefree.com. Physician offices can ask the Quitline about how they can get free CME training to help their nicotine-dependent patients (or visit http://cvhpinstitute.org/tcc/.)

Scott McIntosh, PhD

Exposing an Invisible and Silent Monster Devouring Our Children (Part 2)

This is the second in a series of three posts on the historic community response to lead poisoning in Rochester New York. You can read the first post here.

After becoming Principal of an urban, high-needs elementary school in Rochester, I set out to “level the playing field” for my school’s children and community. After raising nearly seven million dollars, replacing almost the entire school teaching staff, and creating numerous school/community partnerships, I noticed that I still had a core of children with critically serious learning and behavioral deficits. Puzzled by this, I was the first principal known to review my school children’s public health records, and what I found horrified me. What follows is the second of a three-part story of the epic battle with what I call “the invisible and silent monster that devours our children”. — Ralph Spezio

“Lifting the Rock and Exposing the Monster”

At this point, I received permission to view the Monroe County Health records of the children that attended my school, and what I found as I studied each folder stunned and horrified me. There emerged a common denominator for all of the children who were having severe difficulties with learning and/or behavior:

• Of the 3, 4, and 5 year old children who lived in the neighborhood and were coming to school for the first time, 41% of them had medical histories of blood-lead levels that were over 10 mg/dl (micrograms per deciliter). The Center for Disease Control states that this blood-lead level and levels that are even lower can cause permanent brain damage and loss of IQ.
• It is important to note that many of the children in this cohort were not included in this 41% (even though they had many of the same symptoms) because they had no medical histories of a blood lead screening as required by NYS law.
• It is also important to note that, when I looked in their medical records, 100% of my special education children also had histories of high blood-lead levels.

I called childhood lead poisoning the “invisible and silent monster that was devouring our children right before our very eyes”. It reduces their IQ, and in doing so, it steals their future. The houses surrounding my urban elementary school were mostly rented out and owned by landlords that did not live within that community. Most were built at the end of the 1800’s and were in serious disrepair. These houses, the houses where children ate, slept, played, and lived were toxic. Nearly one-half of my children, coming to school from these houses, had medical blood-lead readings that were alarmingly high, causing physical problems, brain damage, and permanent loss of IQ.

The Rochester community was completely outraged, especially when they were educated regarding the devastation that lead poisoning can do to a developing child. Children can be severely lead poisoned, not only from deteriorated housing, but also from a remodeling job that does not employ lead-safe work practices. Urban, suburban, and rural communities are all affected by this silent monster.

The neuropsychological problems associated with lead poisoning are insidious and severe. This potent neurotoxic element creates serious cognitive and behavioral problems for children. These problems include:

• Delayed language or motor milestone in infants and toddlers
• Poor speech articulation
• Poor language understanding or usage
• Problems maintaining attention in school or home
• High activity level (hyperactivity)
• Problems with learning and remembering new information
• Rigid, inflexible problem-solving abilities
• Delayed general intellectual abilities
• Learning problems in school (reading, language, math, and writing)
• Problems controlling behavior (e.g., aggressive, impulsive)
• Problems with fine or gross motor coordination

The physical symptoms include headaches, irritability, abdominal pain, vomiting, anemia, blood pressure problems, kidney disease, skeletal problems and a list too numerous to continue. There is no safe level or threshold for lead in a developing child’s body.

Nearly one half of our children at School No.17 were coming to school for the first time from the surrounding homes with permanent damage from lead poisoning. The lead poisoning monster knows how to hide and disguise itself so that it remains invisible. An invisible enemy can take bites and chucks out of a population at will. The only way to fight an invisible enemy is to put a face on that enemy, and we put a face on the monster of lead poisoning through education and policy change. That is what the Rochester/Monroe County community has done and continues to do.

Next: “Child Advocacy and a Community’s Heroic Response”

Regional Cancer and Environment Forum

On Thursday, May 29, 2008 from 10am-3 pm, the Breast Cancer Coalition of Rochester will host a forum that will feature:

Prevention of Weight Gain as a Strategy to Decrease Breast Cancer Risk, Dr. Barbour Warren, Research Associate, BCERF

The Estrogen Connection: Estrogenic Chemicals in Plastics, Personal Care Products and Electronics, Dr. Suzanne Snedeker, Associate Director for Translational Research, BCERF

Phthalates, Obesity and Insulin Resistance: First Looks, Dr. Richard Stahlhut, Environmental Health Post-doctoral Fellow, University of Rochester

The Rochester Healthy Home: A Model for Integrated Toxics Education, Dr. Katrina Korfmacher, Assistant Professor of Environmental Medicine, University of Rochester

RSVP to Carmi Orenstein at 607-255-1185 or cso1@cornell.edu