Our Health and PVC – What’s the Connection?

For much of the time when children’s bodies and intellect are developing, they are spending their time inside a school. Healthy schools free from toxins that damage development are therefore critical to children’s health and well-being. However, our nation's schools are in trouble, and many are actually a threat to our children's health and ability to learn. An emerging toxic plastic of concern, polyvinyl chloride (PVC or vinyl), is used widespread in schools across the nation.
Children More At Risk From Toxic Chemicals
Children are not "little adults" - their developing brains and bodies, their metabolism and behaviors make them uniquely vulnerable to harm from toxic chemicals.
- Exposure begins in the womb through the mother's exposures to toxic chemicals. Infants ingest chemicals through breast milk, formula and contact with their environment.
- Rapid brain development in the fetus, infants and young children make them more susceptible to harm from chemicals that may impair brain function and development.
- For their weight, children eat, drink and breathe more than adults - so pound for pound they take in a greater quantity of toxic contaminants. A small exposure translates into a big dose.
- Children put things in their mouths and spend a lot of time on the floor and ground, so they may ingest chemicals from toys, containers, dirt and dust on a regular basis< sup=""><>.
Health Problems Suffered by Children On the Rise
Increasingly, children are being found to be hyperactive, slow to learn, and disruptive in school. The number of children in special education programs classified with learning disabilities increased 191% from 1977 to 1994ii. Asthma is a leading reason for school absenteeism and the number one chronic childhood illnessiii. One in a hundred American children has an autism spectrum disorder (ASD)iv. 8,000 American children are diagnosed each year with cancerv , and the incidence of cancer in children jumped 26% between 1975 and 1998vi. The incidence of testicular cancer in young men has increased by 60% and the incidence of hypospadias (abnormal positioning of the opening of the urethra on the penis) in newborn boys doubled from 1968 to 1993vii. These rising trends in toxic-related childhood illnesses indicate the urgent need to eliminate children's exposure to toxins in all areas where children learn, play and live.
Chemicals released by the polyvinyl chloride (PVC or vinyl) plastic lifecycle such as Dioxins and phthalates have been linked with many of these diseases. viiiEven worse, PVC building products, school and office supplies are widespread in our nation’s schools.
PVC and Toxic Chemicals in Our Babies and Bodies
In recent years, a growing body of scientific evidence has found that toxic chemicals released by the PVC lifecycle are trespassing into our bodies.
- Today babies are being born pre-polluted with potentially harmful levels of phthalatesix and Dioxinsx that may possibly cause lifelong health problems.
- Phthalates have been found in indoor air and dust, and in human urine, blood and breast milkxi.
- An extensive study of 2,500 individuals found metabolites of at least one phthalate in 97 percent of those testedxii.
- Phthalates are highest in children ages 6 to 11, and in womenxiii. In a more recent study, certain phthalates were found to be present in 100% of girls age 6 to 9xiv.
- Dioxins build up in our bodies over our lifetime and can remain there for many years. The levels of dioxins in our bodies are at or near the levels known to cause harmxv.
- The half-life of dioxin (the amount of time it takes for half of a given amount of dioxin to break down) in people ranges from seven to eleven yearsxvi.
- Infants can be exposed to both phthalatesxvii and Dioxinsxviii in breast milk. However despite these exposures, breast milk is still best for babyxix.
PVC and Asthma – Are Schoolchildren, Teachers, and Custodians at Risk?
Asthma is a serious, sometimes life-threatening respiratory disease that affects 7 million American children and 16 million adultsxx . An average of one out of every 13 school-age children has asthma. In fact, asthma is a leading cause of school absenteeism: 14.7 million school days are missed each year due to asthmaxxi. In recent years, a number of studies have found a correlation between phthalates emitted from PVC building products and asthma:
- A study published in 2009 found a statistically significant link between PVC flooring and asthmaxxii.
- A 2008 study found an association between concentrations of phthalates in indoor dust and wheezing among preschool children. The presence of PVC flooring in the child’s bedroom was the strongest predictor of respiratory ailmentsxxiii.
- A study of 10,851 children found the presence of floor moisture and PVC significantly increased the risk of asthmaxxiv.
- A study among personnel in four geriatric hospitals found asthma symptoms were more common in the two buildings with signs of phthalate degradation in PVC flooringxxv.
- A study of workers in an office building found they were diagnosed with adult-onset asthma at a rate of about 9 times higher than expected. The researchers identified PVC flooring as the source of chemicals, such as 2-ethyl-l-hexanol, l-butanol, in the airxxvi.
- A study of adults working in rooms with plastic wall covering materials were more than twice as likely to develop asthma. These researchers pointed to other recent epidemiologic studies in children conducted in Norway, Finland, Sweden, and Russia that also found links between PVC, phthalates, and respiratory problemsxxvii.
Learning and Developmental Disabilities and PVC
According to recent studies, the incidence of learning and developmental disabilities appears to be rising, affecting about one in six children in the U.S. under the age of 18xxviii. Many factors – heredity, gene expression, social environment, nutrition and chemical contaminants – contribute to brain development in complex ways. Chemical contaminants, however, have historically been the least researched and are the most preventable. Recent research also shows that the developing fetus and children are particularly vulnerable to environmental exposures. Given this, protecting children from exposures to neurotoxicants starting as early as fetal development is an essential public health measure if we are to help prevent further increases in LDDsxxix. Additionally according to the American Association on Intellectual and Developmental Disabilities, “students with disabilities are a special “at risk” population for the harmful effects of exposures to environmental hazards at schoolxxx.” A number of chemicals released by the PVC lifecycle have been linked with or have been shown to cause learning and developmental disabilities. These include Dioxins xxxi, xxxii, Leadxxxiii , and Mercuryxxxiv . Preliminary research suggests phthalates may also be linked to learning and developmental disabilitiesxxxv. A study published in 2009 found a statistically significant link between PVC flooring and autism spectrum disorder. The study found that children who live in homes with vinyl floors, which can emit phthalates, are twice as likely to have autismxxxvi.
Is PVC Plastic Making us Fat?
Obesity is a serious health concern for children and adolescents, making children at risk for health problems during their youth and as adults. The prevalence of obesity has increased dramatically in recent years. For children aged 6-11, prevalence increased from 6.5% to 17.0%xxxvii. While exposure to toxic chemicals is not the primary cause of obesity, the latest scientific studies suggest that certain chemicals may contribute to obesityxxxviii. PVC chemicals that have been linked to obesity include hormone-disrupting phthalatesxxxix and organotinsxl. One new study examining organotins found that, “developmental or chronic lifetime exposure to organotins may therefore act as a chemical stressor for obesity and related disordersxli.” Another study found that exposure to phthalates may be linked with childhood obesityxlii. Additionally, exposure to Dioxins have been linked to Diabetes xliii,xliv.
Breast Cancer and PVC – What’s the Connection?
Not counting skin cancer, breast cancer is the most common cancer in women, and is on the rise. Incidence rates in the United States increased by more than 40 percent between 1973 and 1998. A woman's lifetime risk of breast cancer is now one in eightxlv. According to the Breast Cancer Fund, “no more than 10 percent of breast cancers are genetic, and science points to toxic chemicals and radiation as factors in the sharp rise of breast cancer incidencexlvi.” A number of the cornerstone chemicals used and released by the PVC lifecycle into our environment have been found to cause or may be linked with breast cancer. These include vinyl chloridexlvii , Dioxinsxlviii , and phthalatesxlix . For example:
- Vinyl chloride is classified as a known human carcinogen by the EPA, National Toxicology Program, and IARC. It’s been linked to increased mortality from breast cancer among workers involved in the manufacture of PVC. Additionally, animals exposed long-term to low levels of airborne vinyl chloride show an increased risk of mammary tumorsl.
- Certain phthalates, including DEHP, have been found to significantly increase cell proliferation in MCF-7 breast cancer cells. In addition, this same phthalate inhibited the anti-tumor action of tamoxifen in MCF-7 breast cancer cellsli.
- Dioxins are known human carcinogens and endocrine disruptors. A recent study on women exposed to dioxins during a chemical plant explosion found a tenfold increase in TCDD levels were associated with more than twice the risk of breast cancer. Additionally, several studies have shown that administration of dioxin (especially TCDD) to pregnant rats leads to structural abnormalities in the development of their pups’ mammary tissues and higher incidence of tumors when the pups grow to adulthoodlii.
- Early puberty is a known risk factor for breast cancer, and studies have suggested exposure to phthalates and Dioxins may be possible causes of early pubertyliii.
Reproductive Health Problems and PVC
Across the country, reproductive health problems are on the rise. Fertility problems, miscarriages, preterm births, early puberty, and birth defects are all up. Women under 25 and women between 25 and 34 have reported an increasing number of fertility problems over the last several decades. Reproductive health problems aren’t limited to women. Average sperm count appears to be steadily declining, and there are rising rates of male genital birth defects such as hypospadias, a condition in which the urethra does not develop properlyliv. At the same time, scientific researchers are finding that exposure to toxic chemicals may cause many of these disorders. Toxic chemicals released by the PVC cycle associated with these disorders include the endocrine disrupting phthalateslv and Dioxins. These chemicals interfere with the body’s natural hormones and can scramble messages that natural hormones transfer between cells. Exposure to these chemicals before birth may possibly increase the chance of reproductive health problems. There may be no other plastic than PVC that releases as many reproductive toxicants during its lifecycle.
- Exposure to phthalates have been linked to reproductive problems including shorter pregnancy durationlvi , premature breast development in femaleslvii , early onset of pubertylviii , sperm damagelix , and impaired reproductive development in boyslx .
- Research in male animals has shown that exposure to various phthalates causes birth defects of the genitals – such as hypospadias (an abnormal location for the opening of the urethra on the underside of the penis) and undescended or small testicles – resulting in low sperm counts and infertilitylxi.
- Exposure to dioxin can cause or has been associated with birth defectslxii , decreased fertilitylxiii , inability to carry pregnancies to termlxiv , endometriosislxv , lowered testosterone levelslxvi , decreased sperm countslxvii , and decreased testis sizelxviii .
- Studies in workers have found lowered testosterone levelslxix , decreased testis sizelxx , and birth defects in offspring of Vietnam veterans exposed to Agent Orangelxxi .
What Can I Do? Take Action for Healthy PVC-Free Schools
There’s some good news! Safer and cost-effective alternatives are already available for virtually every PVC product on the market. Here’s how you can help today:
- Encourage your school to renovate or build their school with PVC-free building materials such as PVC-free linoleum flooring and TPO roofing.
- Encourage your school district, county or state to adopt a healthy PVC-free policy to avoid the use of PVC building materials and office supplies in favor of safer cost-effective alternatives.
- Educate parents, teachers and students! Organize a screening of Blue Vinyl and Sam Suds for your PTA, teacher’s union, or concerned students.
- Encourage organizations, such as teacher’s unions and parenting groups, to endorse the campaign.
- Back to school – go PVC-free! When buying your back-to-school supplies, shop for PVC-free products.
- Get involved today! If you’re interested in getting involved, contact CHEJ at mike@chej.org or 212-964-3680.
References
i Landrigan, P. et al. Children's health and the environment: a new agenda for preventive research. Environmental Health Perspectives June 1998.
ii Muir, T. and Zegarac, M. 2001. Societal costs of exposure to toxic substances: economic and health costs of four case studies that are candidates for environmental causation. Environmental Health Perspectives Supplements Volume 109, Number S6, December.
iii American Lung Association. 2008. “Childhood asthma overview.” April. Online: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22782 (22 October 2009).
iv Wallis, C. 2009. “New studies see a higher rate of autism: is the jump real?” Time Magazine, October 5. Online: http://www.time.com/time/health/article/0,8599,1927824,00.html (22 October 2009).
v Landrigan, P. 2004. Environmental health threats to children: a look at the facts. INFORM. Online: http://www.informinc.org/enchil.pdf (22 October 2009).
vi US EPA. 2003. America's children and the environment: measures of contaminants, body burdens, and illnesses, 2003, U.S. EPA. Online: http://www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/1b/46/e5.pdf (22 October 2009).
vii Landrigan, P. 2004. Environmental health threats to children: a look at the facts. INFORM. Online: http://www.informinc.org/enchil.pdf (22 October 2009).
viii Thornton, J. 2002. Environmental impacts of polyvinyl chloride building materials – A Healthy Building Network report. Washington, DC: Healthy Building Network. Online: http://www.healthybuilding.net/pvc/Thornton_Enviro_Impacts_of_PVC.pdf (22 October 2009).
ix Latini, G. et al. 2003. In-Utero exposure to Di-(2-ethylhexyl)-phthalate and human pregnancy duration. Environmental Health Perspectives 111:1783-1785.
x Environmental Working Group. 2005. BodyBurden – the pollution in newborns. Washington, DC. July 14. Online: http://www.ewg.org/reports/bodyburden2/execsumm.php (21 October 2009).
xi Chase, B. and Curtis, K. 2008. Is it in us? Chemical contamination in our bodies. A report from the Body Burden work group & Commonweal Biomonitoring Resource Center. Online: http://isitinus.org/documents/Is%20It%20In%20Us%20Report.pdf (21 October 2009).
xii Centers for Disease Control and Prevention. 2005. Third national report on human exposure to environmental chemicals. Atlanta, GA: CDC.
xiii Centers for Disease Control and Prevention. 2005. Third national report on human exposure to environmental chemicals. Atlanta, GA: CDC.
xiv Wolff MS, Teitelbaum SL, Windham G, Pinney SM, Britton JA, Chelimo C, et al. 2007. Pilot study of urinary biomarkers of phytoestrogens, phthalates, and phenols in girls. Environmental Health Perspectives 115(1):116-121.
xv USEPA. 2003. Exposure and human health assessment for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) and related compounds, part III: integrated summary and risk characterization for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) and Related Compounds. USEPA, Office of Research and Development, NAS Review Draft, December.
xvi Gibbs, L. 1995. Dying from Dioxin. Boston, MA: South End Press.
xvii Main et al. 2006. Human breast milk contamination with phthalates and alterations of endogenous reproductive hormones in infants three months of age. Environmental Health Perspectives Volume 114, Number 2, February.
xviii Gibbs, L. 1995. Dying from Dioxin. Boston, MA: South End Press.
xix Environmental Working Group. 2003. “Mother’s milk: breast milk is still best.” Online: http://www.ewg.org/node/8415 (21 October 2009).
xx Center for Disease Control and Prevention. 2009. “FastStats – Asthma.” Online: http://www.cdc.gov/nchs/fastats/asthma.htm (20 October 2009).
xxi U.S. Environmental Protection Agency. 2009. “Managing asthma in schools.” Online: http://www.epa.gov/iaq/schools/asthma.html (20 October 2009).
xxii Larsson, M. et al. 2008. Associations between indoor environmental factors and parental- reported autistic spectrum disorders in children 6-8 years of age. Neurotoxicology doi:10.1016/j.neuro.2009.01.011
xxiii Kolarik, B. et al. 2008. The association between phthalates in dust and allergicdiseases among Bulgarian children. Environmental Health Perspectives 116(1): 98-103.
xxiv Bornehag et al. 2002. Dampness in buildings and health. Dampness at home as a risk factor for symptoms among 10,851 Swedish children. (DBH-STEP 1). SP Swedish National Testing and Research Institute and the International Centre for Indoor Environment and Energy, Technical University of Denmark Karlstad University, Sweden.
xxv Norbäck D. et al. 2000. Asthma symptoms in relation to measured building dampness in upper concrete floor construction, and 2-ethyl-1-hexanol in indoor air. The International Journal of Tuberculosis and Lung Disease Volume 4, Number 11, pp. 1016-1025(10), International Union Against Tuberculosis and Lung Disease.
xxvi Tuomainen, A., Seuri, M., and A. Sieppi. 2004. Indoor air quality and health problems associated with damp floor coverings in an office building. International Archives of Occupational and Environmental Health 77(3): 222-226.
xxvii Jaakkola, J.J.K., Ieromnimon, A. and M.S. Jaakkola. 2006. Interior surface materials and asthma in adults: a population-based incident case-control study. American Journal of Epidemiology 164(8): 742–749.
xxviii Boyle CA, Decoufle P, Yeargin-Allsopp M. 1994. Prevalence and health impact of developmental disabilities in US children. Pediatrics March 93(3):399- 403.
xxix Learning and Developmental Disabilities Initiative. Online: http://www.iceh.org/LDDI.html (22 October 2009).
xxx AAIDD. 2007. Students with disabilities in schools. Online: http://www.aamr.org/ehi/media/Health_Schools_Fact_Sheet_2003_202007.pdf (22 October 2009).
xxxi Schantz, S.L. and Bowman, R.E. 1989. Learning in monkeys exposed perinatally to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Neurotoxicology and Teratology 11: 13-19.
xxxii Seo, B-W., Sparks, A.J., Medora, K., Amin, S., and Schantz, S.L. 1999. Learning and memory in rats gestationally and lactationally exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Neurotoxicology and Teratology 21: 231-239.
xxxiii Learning and Developmental Disabilities Initiative. 2007. Practice prevention – lead. December. Online: http://www.iceh.org/pdfs/LDDI/PracPrevention/lead.pdf (22 October 2009).
xxxiv Learning and Developmental Disabilities Initiative. 2008. Practice prevention – mercury. December. Online: http://www.iceh.org/pdfs/LDDI/PracPrevention/mercury.pdf (22 October 2009).
xxxv Learning and Developmental Disabilities Initiative. 2007. Practice prevention – plastics. September. Online: http://www.healthandenvironment.org/working_groups/childrens_health/columns_facts (22 October 2009).
xxxvi Larsson, M. et al. 2008. Associations between indoor environmental factors and parental- reported autistic spectrum disorders in children 6-8 years of age. Neurotoxicology. doi:10.1016/j.neuro.2009.01.011
xxxvii Center for Disease Control and Prevention. 2009. Childhood overweight and obesity. Online: http://www.cdc.gov/obesity/childhood/index.html (22 October 2009).
xxxviii Grossman, E.. 2007. “Chemicals may play role in rise of obesity.” The Washington Post. March 12. Online: http://www.washingtonpost.com/wp-dyn/content/article/2007/03/11/AR2007031100918.html (22 October 2009).
xxxix Lee, J. 2009. “Child obesity is linked to chemicals in plastics.” New York Times, April 17, City Room. Online: http://cityroom.blogs.nytimes.com/2009/04/17/child-obesity-is-linked-to-chemicals-in-plastics/?pagemode=print (20 October 2009).
xl Grün, F. and Blumberg, B. 2006. Environmental obesogens: organotins and endocrine disruption via nuclear receptor signaling. Endocrinology Vol. 147, No. 6 s50-s55 Online: http://endo.endojournals.org/cgi/content/abstract/147/6/s50 (22 October 2009).
xli Grun, F. et al. 2006. Endocrine-disrupting organotin compounds are potent inducers of adipogenesis in vertebrates Molecular Endocrinology 20 (9): 2141-2155
xlii Lee, J. 2009. Child obesity is linked to chemicals in plastics. New York Times, April 17, City Room. Online: http://cityroom.blogs.nytimes.com/2009/04/17/child-obesity-is-linked-to-chemicals-in-plastics/?pagemode=print (20 October 2009).
xliii Pazderova-Vejlupkova, J. et al. 1981. The development and prognosis of chronic intoxication by tetrachlorodibenzo-p-dioxin in men. Archives of Environmental Health 36 (1): 5-11.
xliv Henriksen, G.L. et al. 1997. Serum dioxin and diabetes mellitis in veterans of operation ranch hand. Epidemiology 8 (3): 252-258.
xlv The Breast Cancer Fund. 2008. “Breast cancer facts.” 2008. Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.84426/k.1906/Facts_about_Breast_Cancer_and_Prevention.htm (22 October 2009).
xlvi The Breast Cancer Fund. Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.44850/k.189A/Prevention_What_We_Do.htm (22 October 2009).
xlvii The Breast Cancer Fund. “Vinyl chloride.” Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.3956611/k.2202/Chemical_Fact_Sheet_Vinyl_Chloride.htm (22 October 2009).
xlviii The Breast Cancer Fund. “Dioxins.” Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.84505/k.76B7/Chemical_Fact_Sheet_Dioxin.htm (22 October 2009).
xlix The Breast Cancer Fund. “Phthalates.” Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.84570/k.E2A4/Chemical_Fact_Sheet_Phthalates.htm (22 October 2009).
l The Breast Cancer Fund. “Vinyl chloride.” Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.3956611/k.2202/Chemical_Fact_Sheet_Vinyl_Chloride.htm (22 October 2009).
li The Breast Cancer Fund. “Phthalates.” Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.84570/k.E2A4/Chemical_Fact_Sheet_Phthalates.htm (22 October 2009).
lii The Breast Cancer Fund. “Dioxins.” Online: http://www.breastcancerfund.org/site/c.kwKXLdPaE/b.84505/k.76B7/Chemical_Fact_Sheet_Dioxin.htm(22 October 2009).
liii Steingraber, S. 2007. The falling age of puberty in U.S. girls: what we know, what we need to know. The Breast Cancer Fund. Online: http://www.breastcancerfund.org/atf/cf/%7BDE68F7B2-5F6A-4B57-9794-AFE5D27A3CFF%7D/The%20Falling%20Age%20of%20Puberty%20report.pdf (22 October 2009).
liv Rushing, R. 2009. Reproductive roulette - declining reproductive health, dangerous chemicals, and a new way forward. Center for American Progress. July 21. Online: http://www.americanprogress.org/issues/2009/07/reproductive_roulette.html (22 October 2009).
lv Rushing, R. 2009. Reproductive roulette - declining reproductive health, dangerous chemicals, and a new way forward. Center for American Progress. July 21. Online: http://www.americanprogress.org/issues/2009/07/reproductive_roulette.html (22 October 2009).
lvi Latini, G. et al. 2003. In-Utero exposure to Di-(2-ethylhexyl)-phthalate and human pregnancy duration. Environmental Health Perspectives 111:1783-1785.
lvii Colón, I. Et al. 2000. Identification of phthalate esters in the serum of young Puerto Rican girls with premature breast development. Environmental Health Perspectives 108: 895-900.
lviii Steingraber, S. 2007. The falling age of puberty in U.S. girls: what we know, what we need to know The Breast Cancer Fund. Online: http://www.breastcancerfund.org/atf/cf/%7BDE68F7B2-5F6A-4B57-9794-AFE5D27A3CFF%7D/The%20Falling%20Age%20of%20Puberty%20report.pdf (22 October 2009).
lix Duty, SM et al. 2003. The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay. Environmental Health Perspectives 111:1164-1169.
lx Swan, S. et al. 2005. Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environmental Health Perspectives 113: 1056-1061.
lxi Rushing, R. 2009. Reproductive roulette - declining reproductive health, dangerous chemicals, and a new way forward. Center for American Progress. July 21. Online: http://www.americanprogress.org/issues/2009/07/reproductive_roulette.html (22 October 2009).
lxii Gray, L.E., Jr., Wolf, C., and Ostby, J.S. 1997. In utero exposure to low doses of 2,3,7,8-tetrachlorodibenzo-p-dioxin alters reproductive development of female Long Evans hooded rat offspring. Toxicology and Applied Pharmacology 146: 235-237.
lxiii Murray, F.J. et al. 1979. "Three- generation reproduction study of rats given 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in the diet. Toxicology and Applied Pharmacology 50: 241-252.
lxiv Allen, J.R. et al. 1979. Reproductive effects of halogenated aromatic hydrocarbons on nonhuman primates. Annals of the New York Academy of Sciences 320: 419-425.
lxv Rier, S.E. et al. 1993. Endometriosis in rhesus monkeys (Macaca mulatta) following exposure to 2,3,7,8-tetrachloro- dibenzo-p-dioxin (TCDD). Fundamentals of Applied Toxicology 21: 433-441.
lxvi Moore, R.W. et al. 1985. Androgenic deficiency in male rats treated with 2,3,7,8-tetrachlorodibenzo-p-dioxin. Toxicology and Applied Pharmacology 79: 99-111.
lxvii Gray, L.E., Jr., Ostby, J.S., and Kelce, W.R. 1997. A dose response analysis of reproductive effects of a single gestational dose of of 2,3,7,8-tetrachlorodibenzo-p-dioxin in male Long Evans hooded rat offspring. Toxicology and Applied Pharmacology 146: 11-20.
lxviii Roegner, R.H. et al. 1991. Air Force Health Study: An Epidemiological Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Serum Dioxin Analysis of 1987 Examination Results. NTIS# AD A-237-516 through AD A-237-524.
lxix Egeland, G.M. et al. 1994. Total serum testosterone and gonadotropins in workers exposed to dioxin. American Journal of Epidemiology 13: 272-281.
lxx Roegner, R.H. et al. 1991. Air Force Health Study: An Epidemiological Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides. Serum Dioxin Analysis of 1987 Examination Results. NTIS# AD A-237-516 through AD A-237-524.
lxxi Erickson, J.D. et al. 1984. Vietnam veterans risks for fathering babies with birth defects. Journal of the American Medical Association 252: 903-912.
