(Published January 2010)
This chapter outlines action steps that clinicians can take and specific guidance they can recommend to help patients reduce their exposure to environmental toxicants.
Action Steps for Providers
Given the potential effects of environmental exposures on reproductive health and the importance of preventing potentially harmful exposures, it is critically important that front-line providers of women’s health care are able to identify potentially harmful environmental exposures and help mitigate or prevent them. In providing guidance, clinicians must take the realities of a patient’s daily life and the certainty of scientific evidence into consideration. If there is a simple way to avoid or mitigate a potentially harmful exposure that has a moderate or greater certainty of evidence, clinicians should maintain a low threshold for recommending it.
Providers can take several specific steps to support their patients in reducing environmental exposures, including:
- Learning about the environmental issues in their local area, to better focus their inquiry with individual patients;
- Incorporating questions about environmental exposures into every health history;
- Suggesting steps to reduce or avoid any exposures that are identified;
- Being prepared to give specific guidance to patients who are or may become pregnant;
- Helping patients assess their risk of environmental exposure at work;
- Providing information or referring patients to reputable educational Web sites; and
- Using their voice as clinicians to shape policies aimed at improving environmental conditions.
Taking an Environmental Health History
“CH2OPS,” which stands for Community, Home/Hobbies, Occupation/School, Personal, and Socioeconomic, is a helpful memory aid for reviewing the various domains of a patient’s life in which environmental exposures occur. Providers can use CH2OPS domains when taking the environmental history to assess a patient’s environmental exposures and to educate and raise awareness about potential harmful exposures. Clinicians also can help guide patients by learning about and making patients aware of resources and alternatives in their communities, homes, workplaces, and personal lives that can help them to minimize exposure to toxicants. Clinicians can consult the final chapter of this monograph, Resources for Providers and Patients, for resources for their own education and to have ready access to information for patients. Many of the following chapters also contain resources and counseling points, included in shaded boxes, specific to the topic addressed in that chapter.
|Table 1: Examples of Guidance for Patients, Based on CH2OPS Mnemonic|
|Domain||Area of Concern||Example of Guidance|
|Community||Hazardous waste sites||Have well water tested|
|Solvents||Patronize dry cleaners that avoid toxic solvents|
|Toxic chemicals||Ask beauty salons to use products without toluene, phthalates, and other toxic chemicals|
|Pesticides||Buy organic produce when possible; join community groups to advocate for restrictions on spray drifts from agricultural operations|
|Home/Hobbies||Drinking water||Be aware of the safety of private well water and community sources of drinking water|
Automotive care products
|Read labels carefully, contact manufacturers if necessary to assess contents, and avoid exposure if necessary|
|Adhesives and solvents (e.g., for art projects)||Use in well-ventilated spaces|
|Household cleaners||Use non-toxic products (e.g., vinegar and baking soda); avoid mixing ammonia and chlorine; use ammonia and chlorine bleach sparingly, with ventilation|
|Heavy metals||Be aware of fish advisories for locally caught fish (i.e., for hobby fishing); check for lead paint and pipes; follow recommendations about seafood consumption (for both species and amount)|
|Plastics||Avoid foods and beverages in plastics number 3, 6, and 7; avoid vinyl products; avoid heating food in plastic containers|
|Pesticides||Avoid using pesticides in homes, lawns, gardens, or on pets; wash fruits and vegetables; buy organic produce when possible|
|Chemicals||Become familiar with all chemicals used or encountered at work and learn about any toxic properties; wash exposed skin; change from work clothes at the workplace; wash exposed work clothes separately; use protective gear; take extra steps to avoid exposure if pregnant or planning pregnancy|
|Radiation (e.g., dental or health care workers) or biological agents (e.g., laboratory or health care workers)||Use protective gear; take extra steps to avoid exposure if pregnant or planning pregnancy|
|Pesticides||Avoid use of pesticides on school grounds and in the workplace|
|Heavy metals (e.g., arsenic)||Avoid use of pressure-treated wood in playground equipment|
|Personal||Diet, alcohol use, tobacco use, substance abuse||Review and modify personal habits to maximize overall good health|
|Medications||Review any prescription and non-prescription medications with health care provider|
|Insect repellents||Investigate ingredients of products; contact manufacturer if necessary|
|Personal care products and cosmetics||Investigate ingredients of products; contact manufacturer if necessary; check product databases (e.g., www.cosmeticsdatabase.com)|
|Know tenant and citizen rights; work with community organizations and governmental agencies to raise awareness of hazards and advocate for prevention|
The next chapter will address the links between environmental exposures and reproductive health, the concept of toxicity, and some of the mechanisms by which exposures result in negative health outcomes.