Things That Go Bump in the Public Health Night

Halloween in Philly for Yudell 10.31.11 IMG_4299
These kids' costumes are not the real scares on Halloween.

Tonight kids will don various costumes to masquerade door to door, stuffing their jack-o-lanterns with sugary delights, chocolate bars, and small change from the occasional guy who forgot to stock up on Halloween treats. There are important public health messages we hear every Halloween — to wear reflective clothing and carry a flashlight, make sure not to eat too much candy, make sure you know where that candy came from, and, of course, brush your teeth extra well after eating 17 chocolate bars.

Halloween has its share of fun scares but, like in Twilight Zone: The Movie when Dan Aykroyd asks “Do you want to see something really scary,” there are much scarier things in the world for kids and their families. These are the things that keep public health scientists awake at night. Like, why do autism rates continue to rise, what are we doing about still-too-high youth smoking rates, and what are the long-term effects on children’s health of chemical exposures that are so pervasive in our environment?


According to the most recent data from the Centers for Disease Control and Prevention, Autism Spectrum Disorders now affect approximately 1 in 110 children in the United States. In 2000, rates were estimated at 1 in 2000.

Despite all hopes otherwise, we still know frustratingly little about autism, and we have an incomplete understanding about why prevalence continues to rise.

But did you know that from the 1940s until at least the 1970s many scientists believed that autism was caused by bad parenting, most oftentimes bad mothering? The “Refrigerator Mother” hypothesis claimed that cold and emotionally distant mothers drove their children into an emotionally frozen state, and only through intense and often abusive forms of psychotherapy and other treatments could autistic children be cured of their disorder. This awful approach had dreadful implications for treatment, and for the parents of children with autism. The legacy of anger and distrust fuelled by the refrigerator hypothesis continues to shape, to some degree, current popular and scientific understandings of the disorder. Debunked beliefs regarding the connection between autism and vaccines may be understood as the way in which a group of parents and researchers have inverted what had once been mother and parent blame, to blame science and scientists for the disorder.

Today, work in genetics has identified genes involved in the disorder, and we also know, despite vocal sentiment to the contrary, that vaccination does not cause autism. In fact, in one case, the opposite is true — exposure of unvaccinated pregnant women to rubella, a vaccine-preventable disease, increases risk for autism. Recent studies point to other possible triggers — one of the largest twin studies of autism to date suggests that non-genetic factors account for over 60 percent of autism risk, while another study shows a slightly elevated risk for autism for children of women who took a specific class of anti-depressants. Twenty-five percent of the increased prevalence in California between 1992 and 2005 can even be attributed to a shift in diagnosis from mental retardation to autism. We still have so much to learn, and there is so much at stake.

Kids and Smoking

Did you know that Philadelphia has the highest youth smoking-rate among comparable big cities in the country? Philadelphia has approximately 4,398 tobacco retailers, 40% of which are within a block of a school, 80% within two blocks — that’s 27 for every 1,000 kids ages 10-17 in the city. White kids are most at risk in Philadelphia, having more that five times the smoking rates of Hispanics, and 14 times that of African American youth.

Overall, teen smoking rates have been dropping since 1997 (that’s good news!), when more than 1 in 3 high school seniors were smokers; the most recent data, for 2009, show that 1 in 5 high school students are still smokers when they leave high school and that 90% of adult smokers became addicted as kids. But youth smokers still have the hardest time quitting their addiction, and 30% of youth smokers will stay smokers and die prematurely from it -- and they are also more likely to use alcohol and illegal drugs, as well as have panic attacks, anxiety disorders, and suffer depression. And the decline seems to have plateaued -- youth smoking rates have stabilized in recent years. More work in prevention is needed, as is continued attention to regulating tobacco marketing and its impact on kids.

Chemical Exposures

If your children are out and about trick-or-treating tonight it is likely that their costume is flame-resistant. The Federal Flammable Fabrics Act requires costumes sold by retailers to be flame resistant, and experts encourage the use of flame-resistant costume fabrics like polyester and nylon in home-made costumes.

Flame resistance is very important, but on a daily basis we all interact with another class of products that have been treated to make them flame retardant. Chemical flame-retardants are everywhere  —on your upholstery, in your car, in your furniture’s foam padding, and in your computers and appliances. Because flame retardants save lives — they slow the rate of ignition and fire growth, giving people more time to escape fires — they are an important technology. But some flame retardants have also been shown to accumulate in human tissue and in the environment. One particular class of them, polybrominated diphenylethers, or PBDEs, are currently being investigated by the Environmental Protection Agency and other scientists to understand their health risks. Though they are still used here, PBDEs are no longer manufactured in the United States.

It is known to environmental health scientists and others that children are more sensitive to chemical exposures than adults. From pesticides, lead, and Bisphenol A, childhood exposure has both known and unknown short- and long-term impacts on the public’s health. But according to leading public health scientists Philip Landrigan and Lynn Goldman, current law, in the form of the Toxic Substances Control Act, has created a “substantial barrier to the regulation of industrial and consumer chemicals.” They assert that this “standard has been so burdensome that the Environmental Protection Agency has not been able to remove chemicals from the market except when there is overwhelming evidence of potential harm.” In place of the Toxic Substances Control Act, Landrigan and Goldman recommend a health-based chemical policy that would systematically examine all chemicals on the market for toxicity, and the strict assessment of new chemicals before they are marketed. In the current political climate, such an approach seems unlikely to succeed. But for every chemical that is marketed with its potential health effects not fully understood, we may be harming ourselves and our children.

Now that is really scary.

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