Reducing Environmental and Occupational Cancer Risks Toolkit

4. Advance Risk Reduction Strategies within Institutions

Institutions, including schools, daycares, public housing, and businesses are important targets for cancer risk exposure reduction strategies. These strategies may reflect the full suite of interventions in the framework above and include for example: 

  • Intervention Strategy Types: Eliminate; Substitute;  Redesign

Municipalities and schools are routinely faced with requests to “upgrade” their athletic grass fields to artificial or synthetic turf. However, synthetic turf fields are not an upgrade for the health of those using, spectating, or living near the fields. Tire crumb fields, which is the most common type of synthetic turf, contain a variety of hazardous chemicals, including carcinogens such as polycyclic aromatic hydrocarbons (PAHs) and others, such as per-and polyfluoroalkyl substances (PFAS) with suspected links to cancer clusters. The European Union has recently restricted synthetic turf fields containing PAHs because of increased cancer risks. In the U.S., we have no ability to know the levels of chemicals in synthetic turf because suppliers are not required to test and disclose the levels of chemicals in their products. Several municipalities in California, Connecticut, and Massachusetts have issued their own restrictions on turf fields, some of which are focused on the presence of other chemicals in turf fields such as PFAS. A review of synthetic turf policies can be found here. 

  • Example Objective: Reduce exposure to carcinogenic and other toxic chemicals in artificial turf athletic fields. 
  • Example Intervention Strategies: (A) Develop partnerships to provide education and outreach to inform boards of health, parks commissions, school boards, and other decision-making authorities regarding the health impacts of synthetic turf and the need to invest in the maintenance of existing grass athletic playing fields using organic practices as a safer alternative. (B) Develop partnerships to explore opportunities to affect policy change, including replicating restriction policies prohibiting the use of artificial turf that have been effective models elsewhere in the US and internationally. Policies should encourage the substitution with safer alternatives, such as organically managed natural grass. 

Comprehensive resources to support interventions on the topic of artificial turf fields can be found through the Lowell Center for Sustainable Production.

Intervention Strategy Types: Educate; Redesign

Firefighters work in very dangerous conditions. They may be exposed to a variety of carcinogenic compounds produced by the combustion of materials involved in the fire response. Firefighters may also be exposed to flame retardants and PFAS that are also released from products burned in fires as well as diesel exhaust emissions from firefighting vehicles. When protective clothing, known as turnout gear, is not adequately cleaned or stored after a fire response or training event, chemicals on the gear or equipment can contaminate vehicles and the fire station; reusing such gear can increase exposure to carcinogenic and other toxic compounds. Moreover, comprehensive studies conducted by NIOSH investigators demonstrate that these conditions contribute to a higher risk of several types of cancers among firefighters than among the general public (Daniels et al. 2015); (Tsai et al. 2015)

  • Example Objective: Reduce exposure to carcinogenic agents among firefighters. 
  • Example Intervention Strategies: Develop partnerships to provide education and outreach as well as technical assistance to firefighters regarding the adoption of evidence-informed exposure reduction strategies such as those outlined by Horn et al. 2022, including use of administrative controls (e.g., routine cleaning of fire houses, changing practices of doffing turnout gear to minimize transfer of contaminants to skin); engineering controls (e.g., use of diesel exhaust capture systems; changing designs of fire stations to minimize exposure to contaminants); and substitution options (e.g., using simulated smoke and fire versus live fires to achieve training objectives).

Intervention strategy type: Substitute

Dry cleaning is a misnomer. It is not “dry,” but instead uses liquid chemical solvents to remove stains and clean delicate fabrics. Perchloroethylene (also called tetrachloroethylene) has been the chemical of choice in dry cleaning for decades. The World Health Organization’s International Agency for Research on Cancer (IARC) has classified perc as “probably carcinogenic to humans” (Group 2A). Concern about the health effects of perchloroethylene and pending regulations have motivated the dry cleaning industry to seek substitutes. However, not all substitutes are equal with regard to human health effects. Some dry cleaners have adopted the use of other solvents, which also have toxicity concerns. Other dry cleaners have decided to transition away from the use of chemical solvents, including perchloroethylene as well as other hazardous chemicals based on health concerns, market opportunity, and the financial and technical feasibility of a known safer alternative: Professional Wet Cleaning (Onasch et al. 2017).  Professional Wet Cleaning is a water-based process that cleans delicate “dry clean only” textiles (wool, silk, rayon, natural and human-made fibers) using computer-controlled washers and dryers, along with biodegradable detergents and specialized finishing equipment to prevent fabric shrinkage and damage. 

This dry cleaning alternative has been incentivized in programs across the country, including in Massachusetts, Pennsylvania, and California, among others, because of its safety profile. Based on this experience, the Massachusetts Toxics Use Reduction Institute has developed a range of technical materials to enable organizations in other jurisdictions to support small-business dry cleaners in making the switch to Professional Wet Cleaning.

  • Example Objective: Increase adoption of wet cleaning technologies to reduce exposure to carcinogenic chemicals used in dry cleaning.  
  • Example Intervention Strategies: (A) Develop partnerships that can provide support to dry cleaners to transition to wet cleaning technologies. Support opportunities based on best practices conducted in other states, including the use of: technical support, peer demonstrations, and grants to facilitate dry cleaners to transition to wet cleaning technologies. (B) Develop partnerships to explore adopting policies that incentivize the use of professional wet cleaning. Model policies to consider include those in New York City, which require public disclosure of cleaning chemicals used by a facility and banning specific dry cleaning chemicals, such policies adopted by the city of Philadelphia and the state of California

Intervention strategy type: Substitute

Carcinogenic chemicals are still being used throughout facilities in the U.S. despite there being rigorous restrictions and bans in other countries such as those in the European Union. Beginning in the 1990s, there was significant support and attention to pollution prevention – preventing pollution at its source rather than regulating releases/emissions.  Since then, tremendous knowledge has been gained about the availability of safer alternatives to carcinogenic and hazardous substances used by facilities for a range of functions, and applications. These substitution options include, for example, alternatives to: 

  • hexavalent chromium in plating operations and other coatings; 
  • halogenated solvents used for metal cleaning or surface cleaning applications; and 
  • perchloroethylene-based brake cleaners in autobody shops.
  • Example Objective: Reduce the industry’s use of carcinogenic chemicals. 
  • Example Intervention Strategies: (A) Develop partnerships to gather information on the use of carcinogenic substances by industrial users statewide. (B) Provide technical support to educate industrial users about safer alternatives and to support substitution activities.

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