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School‟s Out… Forever Laura Smith-Creaser, RN State University of New York Institute of Technology

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Abstract School buildings have historically served a variety of purposes including that of radioactive fallout shelter, public / community gathering place, polling / election voting sites, as well as educational institutions. The common thread being the building is a place where people gather in mass quantity. While these gatherings are usually uneventful, there are occasions where the gathering of people in mass is not a good or healthy thing – when health hazards (usually unseen) are present and have the opportunity to spread rapidly due to the mass gatherings. As recently as within the last 40 years, school building construction required the use of materials that the dangers of which were not known or understood until much more recently. As these buildings age and decay, the then unknown health hazards begin to expose themselves in the form of people getting sick in the immediate and areas surrounding the decaying building. Policy in response to these identified hazards is usually issued in retrospect. Medical professionals often are able to identify the cause of the illness, but the source is sometimes a mystery – until one tours the victim‟s neighborhood.

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Healthy People 2020 (2010) continues, from decades before, to recognize that “the environment directly effects health status and plays a major role in quality of life, years of healthy life lived, and health disparities.” Environmental Health is defined as preventing or controlling disease, injury and disability related to the interactions between people and their environments.” Healthy People 2020 (2010) states, under “Environmental Health”, that “Maintaining a healthy environment is central to increasing quality of life and years of healthy life. Globally, nearly 25 percent of all deaths and total disease burden can be attributed to environmental factors.” Health-related policies tend to be authored after some health damage is has already been done which is laudable for a prevention focus for the future, but too little, too late for those whose health has already been impacted. Among the many goals contained within Healthy People 2020 (2010) remains “Environmental Health.” The HP 2020 goal is clear and concise, “Promote health for all through a healthy environment.” There are six targeted objective areas attached to this goal which will be expanded upon later in this paper: 1. Outdoor Air Quality 2. Surface and ground water quality 3. Toxic substances and hazardous wastes 4. Homes and communities 5. Infrastructure and surveillance 6. Global environmental health

In my home community and many similar rural communities, many of the buildings are older – most built pre-1960. Of particular concern for the purposes of this discussion, my focus is

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on old, abandoned school buildings that are scattered throughout many rural areas. While these buildings are no longer used as schools, the still can have great impact in the community. The buildings, though standing, are steadily decaying and decomposing producing a variety of potential health hazards related to such materials as asbestos, lead, and molds in the local area. Some suggest that tearing the buildings down creates greater hazards and risk than just leaving them, but exactly what are these hazards and risks? While not used as much in modern construction the New Jersey Public Employees Occupational Safety and Health Program [PEOSHP] wrote in their 2004 publication Renovation & Construction in Schools – Controlling Health and Safety Hazards, “asbestos is present in many schools in building materials such as pipe and boiler insulation, sprayed-on or troweled-on fire resistant surface materials, roofing products and siding, acoustical products, and floor and ceiling tiles. Asbestos-containing materials (ACM) are considered relatively safe if the fibers within the building material are firmly bonded or compacted. When asbestos becomes loose or crumbles (called „friable‟), microscopic fibers can be released into the air and cause a health risk when breathed in or swallowed. Potential health problems, which take years to develop, include scarring of the lung (asbestosis), pleural plaques (scarring of the inner lining of the rib cage) and cancers such as mesothelioma and lung cancer. Exposures to asbestos are most likely to occur during removal of ACM or disturbing ACM during renovation activities.” Another building material frequently used in past constructions of school buildings is lead. Whether it be pipes or paint, the New Jersey PEOSHP (2004) stated that “lead exposures occur when lead-containing coatings or paint are disturbed or removed from surfaces during building renovation and demolition. As with asbestos, lead-based paint that is in good repair and is not flaking poses minimal risk. The paint becomes a threat when it is damaged due to abrasion

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(e.g., sanding), poor maintenance, water damage, or during renovation and construction. Lead can be absorbed into the body by inhalation or ingestion.” The typical abandoned school building, like those in my community and scattered around the region, often has such lead-based paint flaking off the walls, decaying lead pipes that might still be connected to the community water supply, and water (as well as other) damage from a variety of causes. While the elements of asbestos and lead are concerning enough, when you add in molds, it becomes an obvious triple threat to the health and well-being of persons in the vicinities of these structures. According to the New Jersey PEOSHP (2004) publication states “There is potential for exposure to mold spores and other biological materials from existing contaminated building materials during renovation and construction activities. This can happen when workers have to repair or remove water-damaged building materials such as sheet rock, ceiling tiles and carpeting that have become contaminated, Mold spores (such as Stachybotrys chartarum) become airborne when work is being done on heating, ventilation and air conditioning systems that have areas of microbial growth (e.g., contaminated insulation inside the ductwork). Some mold spores, when breathed in, can cause asthma, rhinitis, sinus infections, pneumonia, and other respiratory infections.” The Center for Disease Control (2009) publishes a fact sheet entitled “Facts about Stachybotrys chartarum and Other Molds” (Attachment 1) that provides a highly educational examination of molds and the health dangers associated with them. The number of residents impacted can vary depending on their location, the weather (particularly wind direction), and proximity to the site. In some situations, water resources can become contaminated from ground seepage as well. Most people do not enter these buildings and are highly unaware of the conditions and risks that exist sometimes right next door.

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Those most at risk include children, the elderly, and those with compounding health conditions that increase their risks, but when we are talking about airborne contaminants, there is risk to any and all that might be exposed. With this school building located in the primary residential area of the village (with homes being as close as 500 feet) the risks are real. Of the forty-two goals developed as a part of the Healthy People 2020 (2010) initiative, environmental health continues to remain an active goal as it has for the last three decades. The Environmental Health goal is broken into the six parts: 1. Outdoor Air Quality 2. Water Quality 3. Toxics and Waste 4. Health Homes and Healthy Communities 5. Infrastructure and Surveillance 6. Global Environmental Health, The objectives with relevant focus for this paper include areas such as: 1. Airborne Toxins 2. Safe Drinking Water 3. Blood Lead Levels particularly in children 4. Risks Posed by Hazardous Sites 5. Toxic Pollutants 6. Indoor Allergen Levels 7. School Policies to promote healthy and safe environments 8. Homes with Lead-based Paint 9. Exposure to Environmental Chemicals

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10. Monitoring Diseases caused by exposure to environmental hazards.

The New York State Prevention Agenda (2012) for 2013-2017, which was revised as recently as March 2012, contains the State‟s “vision and proposed public health priorities” and included among these priorities is a significant and seemingly intentional correlation to the Environmental Health section of the Healthy People 2020 initiative, The Prevention Agenda / State Health Improvement Plan (2012) identifies “four core areas that impact health. These are: the quality of the water we drink, the air we breathe, and the built environments where we live, work, learn and play, and injuries and occupational health.” The proposed priority (goal) relevant to environmental health is labeled “Advance a Health Environment” and identifies “example strategies [such as]: anti-idling ordinances; lead remediation in housing; healthy community design; education to prevent food-borne disease; school-based violence prevention; and healthy homes.” The agenda proposes to measure relevant factors such as “asthma hospitalization rates, outdoor air quality, and lead poisoning [statistics].” The Prevention Agenda states that “Lead is among the most common environmental toxins affecting young children in New York State. Lead poisoning is associated with serious and lifelong adverse health, developmental and cognitive outcomes that are completely preventable. In 2008, the incidence of lead poisoning was 5.6 per 1,000 children (less than six years of age) tested.” What other statistics of significance that help explain why this is a NYS health priority? “Current asthma prevalence has increased in NYS over the past six years. In 2009, the current asthma prevalence was 9.8% (compared to 8.4% for the U.S.).” New York State “policies” pertaining to environmental health issues – specifically asbestos removal, lead abatement and mold remediation – tend to have their foundations in State

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laws (many of which have their foundations in Federal laws). For example, NYS Public Health laws (n.d.)such as Nuisance and Sanitation (Article 13) have sections specifically dedicated to environmental health. Title 10, §1370 – 1376 specifically address “Control of Lead Poisoning” and have sub-sections with titles like “Lead Poisoning Prevention Program” (§1370) and “Abatement of Lead Poisoning Conditions” (§1373). The foundations for these regulations can be traced back to the Federal Toxic Substances Control Act (TSCA) and 40 CFR Part 745 “LeadBased Paint Poisoning Prevention in Certain Residential Structures.” The Lead Abatement Program: Training and Certification Program for Lead-Based Paint Activities (TSCA §402/404); and Residential Hazard Standards for Lead in Paint, Dust and Soil (TSCA §403). “Lead in water is regulated under both the Clean Water Act and Safe Drinking Water Act.” “Lead in air is regulated two ways under the Clean Air Act – as one of six common pollutants for which the EPA has issued national ambient air quality standards (NAAQS) and as a toxic air pollutant (also called a hazardous air pollutant) for which industrial facility emissions are regulated.” The coalition undersigning the New York State Prevention Agenda (2012) includes “a diverse group of environmental, occupational health, and violence and injury prevention experts from local, State, and Federal government agencies; business; labor; community-based organizations; academic and research organizations.” I believe that it would be practical to add additional members representing the construction; heating, ventilation and air conditioning [HVAC]; and refurbishment/demolition fields as these individuals are the subjects of much of the mandated education that is a part of regulations and policies pertaining to environmental health compliance. These representatives could be assistive in finding creative ways to either stabilize, refurbish or demolish the hazardous vacated school buildings keeping in mind the safety, health and well being of the surrounding community. Hundreds of other entities become a

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part of fulfilling this agenda including governmental agencies like OSHA, the EPA, colleges and universities (like Cornell University), and various independent training entities such as the entity reflected in Attachment 2 – Environmental Education Associates who offer certified training programs for Asbestos removal, handling and management; lead renovation and remediation; and mold assessment and remediation. They are an accredited EPA training provider. Dunn, Burns & Sattler, (2003), in their article Environmental Health of Children, published in the Journal of Pediatric Health Care, 2003, Vol. 17, identify that “Pediatric primary health care providers are increasingly expected to assess the effect of the environment on children‟s health, manage environmentally related health problems, and educate families to prevent exposure… the term „environmental health‟ generally refers to toxins in the environment, not accidents, violence, dysfunctional families, etc.” Dunn, Burns & Sattler (2003) further state that “the provider should focus on three factors: the nature of the contaminant, the type of exposure, and the vulnerability or susceptibility of the child exposed. Specifically, when the contaminant is toxic, when exposure is high, repeated, or long-term, and when the child is vulnerable, there is greater risk for an environmental health problem.” The potential environmental problems associated with schools aren‟t restricted to old, abandoned school buildings specifically as Dunn, Burns and Sattler (2003) discuss: “During the school-aged years, children are exposed to toxins in their school and home environments – asbestos, PCBs, paints, and chemicals in art and science projects, air pollutants, pesticides, and wood preservatives in playground equipment, play areas, lawns and school yards… schools sometimes are built on land that had been previously contaminated by

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chemical toxins or near know environmental hazards or, because of construction and maintenance have become „poisoned schools‟.”

What are the health impacts a provider needs to be aware of? Since many environmental toxins affect similar body systems, it is essential that providers learn how to differentiate symptoms and sources, understand the health effects, and become familiar with prevention strategies to educate patients and families. Attachment #2, from Dunn, Burns, & Sattler‟s Table 2, provides an excellent overview of common pediatric toxicants and their relationship to disease. In another article entitled “Infusing Environmental Health Concepts in an Existing Nursing Course”, featured in Nurse Educator, Vol. 37, No. 6, Sattler (2012) teams with Anita Savell, DNP, RN, APHN-BC, to further emphasize the importance of providing environmental health education to health providers (particularly nurses): “Environmental health is a vast subject area including air, water, food, products, toxic chemicals, sustainability, climate change, and other broad topics. The World Health Organization states that „environmental health addresses all the physical, chemical, and biological factors external to a person and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health… nurses need to know how to assess and address many environmental exposures found in homes, workplaces, and schools… the informed nurse can promote health and prevent

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illness by communicating the health risks present in our most familiar environments to individuals and families.”

In discussing the strategies to accomplish this educational objective, Savell & Sattler share their recognition that “As teachers of a community health theory course, we are compelled to impress on our students that community health nursing entails community-based or population-focused nursing care directed to the overall health of communities. There are many environmental forces that influence human health. To increase environmental health content, we developed an assignment that allowed individual students to explore a wide range of environmental health issues… given the need for the integration of environmental health into nursing curriculum and the fact that must nursing faculty do not feel that they have adequate expertise in a wide range of environmental topics, the combined use of Web-enhanced materials, a guest lecture and student presentations on selected topics if a good option.” In conclusion, it is important to be cognizant of the potential health hazards that may exist in our environments. Health care professionals need to be aware of and take into consideration the very real potential hazards that come from environmental causes. Environmental considerations need to be a part of the initial assessment, diagnostic processes and patient education. Knowing what hazards are potentially out there should be mandatory education for today‟s health care professionals. Policy makers need to consider some potential concerns proactively – before harm to health has occurred.

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REFERENCES Dunn, A.M., Burns, C., and Sattler, B. (2003). Environmental Health of Children. Journal of Pediatric Health Care 17(5), 223-231. doi:10.1067/mph.2003.33

Savell, A.D. and Sattler, B. (2012). Infusing Environmental Health Concepts into an Existing Nursing Course. Nurse Educator 37(6), 268-272 doi:10.1097/NNE.obo13e31826f27a7

Renovation & Construction in Schools: Controlling Health and Safety Hazards (March 2004). Retrieved 3/2/13 from www.state.nj.us/health/eoh/peoshweb/schoolsren.pdf

Center for Disease Control (2009). Facts About Stachybotrys chartarum and Other Molds. (n.d.). Retrieved 3/2/13 from http://www.cdc.gov/mold/stachy.htm

Environmental Education Associates Essentials for Healthy Homes Practitioner (2013). Retrieved 3/8/13 from http://www.environmentaleducation.com

Healthy People 2020 (2013). Retrieved 3/2/13 from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=12

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Healthy People 2020 – Environmental Quality (2013). Retrieved 3/2/13 from http://www.healthypeople.gov/2020.LH1/environmentalQuality.aspx Health Problems Associated with Exposure to Asbestos (2010). Retrieved 3/8/13 from http://www.publichealth.va.gov/exposures/asbestos/index.asp Environmental Protection Agency. (2013). Lead Regulations (n.d) Retrieved 3/8/13 from http://www.epa.gov/lead/regulations.html

Environmental Protection Agency (2012). Learn About Lead (n.d.) Retrieved 3/8/13 from http://www.epa.gov/learn_about_lead.html

Public Health Law (n.d.) Retrieved 3/8/13 from http://public.leginfo.state.ny.us/LAWSSEAF.cgi?QUERYTYPE=Laws+&QUERYDATA.