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Environmental Factor, January 2015

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HP2020 progress report webinar features Birnbaum

By Eddy Ball

Headshot of Birnbaum

As she discussed the effects of environmental exposures on children’s development, Birnbaum emphasized the role of primary prevention. “A good start lasts a lifetime,” she told the audience. (Photo courtesy of Steve McCaw)

NIEHS and National Toxicology Program Director Linda Birnbaum, Ph.D., was one of two scientific experts featured during a Dec. 5 Healthy People 2020 (HP2020) webinar focused on environmental health and tobacco use. She presented an overview of NIEHS programs and new environmental health research findings related to leading health indicators.

Birnbaum was joined by Tim McAfee, M.D., director of the Centers for Disease Control and Prevention (CDC) Office on Smoking and Health. The community highlight section of the program featured Kara Skahen, director of the Live Smoke Free program at the Association for Nonsmokers-Minnesota, where translation of research has led to a 30-fold increase in the number of smoke-free public housing units from 2007 to 2014

“We spend about 30 percent of our budget on prevention,” Birnbaum proudly said of the role of NIEHS research support on improving public health. “In many ways, we are the public health institute at NIH.”

For his part, McAfee pointed to effective measures to reduce tobacco consumption and related adverse health effects. Use of tobacco products is now less than half the rate in 1965. “We know what works,” he said.

A bumpy road to HP2020 targets

While there is reason for optimism, Birnbaum and other experts on the program emphasized that much remains to be done before HP2020 can meet all of its leading health indicator targets. As an introductory overview by Karen DeSalvo, M.D., acting assistant secretary for health at the U.S. Department of Health and Human Services, made it clear that cigarettes are still the leading cause of preventable death in the U.S, and millions of deaths each year continue to be attributable to preventable environmental causes.

Following DeSalvo was Irma Arispe, Ph.D., associate director of the CDC National Center for Health Statistics. Out of 64 HP2020 measurable environmental health objectives, only 18 have been met or are improving, she said. In terms of the 66 HP2020 measurable tobacco use objectives, 28 have been met or are improving, while 27 show little or no detectable change.

On the environmental front, research of the kind Birnbaum described is uncovering the adverse health effects of much lower levels of exposure to arsenic, manganese, lead, and mercury, as well as endocrine-disrupting chemicals found in plastics and fire retardants. New research on the developmental origins of health and disease, and growing awareness of health disparities, have complicated the environmental picture, by adding concerns that, in some cases, go beyond the HP2020 agenda.

In many ways, the path to meeting tobacco use targets is clearer, although the barriers are significant. McAfee pointed to the 18-fold funding advantage enjoyed by tobacco marketers and important gaps in regulation. Only a small part of tobacco tax and lawsuit settlement resources are actually being spent on the cessation campaign, and there is a troubling rise in the use of unregulated e-cigarettes, deceptive advertising continues, and some populations continue to have high rates of use.

The final 30 minutes of the webinar featured a roundtable discussion, with presenters and representatives of partner agencies answering questions from viewers.


  • Flame Retardands - NIEHS funded researchers at the University of Cincinnati found that prenatal exposure to Polybrominated Diphenyl Ether (PBDE) was associated with lower IQ and higher hyperactivity scores in children.
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    Exposure to fire retardant chemicals, as illustrated in this slide from Birnbaum’s presentation, is still nearly 50 percent greater than targeted by EH 20.18. (Photo courtesy of Linda Birnbaum and HP2020)

  • A graph showing tons of toxic pollutants released into the environment over time. The trend is overall downward with two upward bumps around 2011 and 2013.
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    This slide from Arispe’s presentation illustrates bumps on the road to reducing the amount of toxic pollutants released each year. Newly introduced chemicals, and better understanding of the effects of exposures at low levels and during windows of susceptibility, are almost constantly complicating environmental health metrics. (Photo courtesy of Irma Arispe and HP2020)

  • 50 Years Ago - An assortment of images depicting smoking in mainstream media.
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    McAfee showed this slide as a reminder of how much the smoking picture has improved over the past 50 years. In the 1950s and 1960s, smoking was allowed nearly everywhere, as celebrities and even cartoon figures glamorized the habit, and physicians went on record as recommending brands. (Photo courtesy of Tim McAfee and HP2020)

  • What makes for a good policy? Written in a lease or house rules. Defines
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    Skahen described resources available from the Live Smoke Free program. They include clear guidelines, educational resources, signage, a how-to module, a statewide smoke-free housing directory, training and technical assistance, and an online webinar series. (Photo courtesy of Kara Skahen and HP2020)

NIEHS and the interagency collaboration

A federal interagency workgroup leads the HP2020 effort. It includes representatives from U.S. Department of Health and Human Services agencies and offices, as well as 8 other agencies and departments with primary concerns ranging from justice and education to housing and transportation.

NIEHS takes part in the HP 2020 initiative as the co-lead agency on the environmental health topic area, and is one of three National Institutes of Health agencies leading the respiratory diseases topic area. The NIEHS HP2020 representative is program analyst Bill Jirles of the Office of Policy, Planning, and Evaluation.

Presentations and additional information related to the more than 35 webinars in the 2010-2014 HP2020 series are available online. The series continues in February 2015 with a progress review of objectives in the areas of social determinants of health, and lesbian, gay, bisexual, and transgender health.



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