Gender Matters
It is well known that men and women experience different health effects. For example, women live longer than men, but they experience more incidence of disease during their lifetime. Researchers are unsure of the exact causes for these differences, but they believe many factors are involved, including genetic susceptibility and environmental factors. Some public interest groups have recently suggested that women may be disproportionately affected by environmental pollution, and researchers hypothesize that factors such as genetics and hormones may play a role.
The EPA, the NIEHS, and the Centers for Disease Control and Prevention (CDC) recently sponsored a project coordinated by the Office for Research on Women's Health (ORWH) of the National Institutes of Health to identify the state of the knowledge regarding gender differences in susceptibility to environmental factors. "Women's health and the environment is a high priority for several agencies. This project had a different slant in that it looked at susceptibility to environmental agents," says Anne Sassaman, director of the Division of Extramural Research and Training at the NIEHS and one of the conference's organizers.
The ORWH asked the Institute of Medicine (IOM) to conduct a workshop study to review the current research programs of the supporting agencies devoted to women's health, and to make recommendations about promising areas of research that may benefit from interagency coordination. The IOM formed the Committee on Gender Differences in Susceptibility to Environmental Factors, which included experts in environmental and occupational health and medicine, health sciences policy, epidemiology and public health, risk assessment, endocrinology, immunology, toxicology, and women's health. The committee held discussions with relevant agency representatives and decided to focus on the issue of women's unique susceptibility. The committee then refined its goal to identify areas in which research and policy initiatives could address women's different susceptibility to environmental factors.
A scientific workshop was held in May 1997 that focused on identifying knowledge gaps, developing strategies and priorities to address research gaps, and formulating a plan to improve the developing knowledge on gender differences in susceptibility to environmental factors. Experts on these issues made presentations at the workshop, which was divided into two panels to discuss exposure and susceptibility.
The first panel included presentations on exposures in the workplace, exposures and nutrition, and multiple exposures across the life span. Presenters discussed the importance of designing exposure histories to include information on various environmental exposures of women, pointing out that the majority of regulatory standards are based on data extrapolated from male populations or experimental animals. Another issue addressed was that of weight gain and loss. Due to dieting behavior and natural phenomena such as pregnancy, women experience more cycles of fat gain and loss than men. If toxicants stored in fat tissue are mobilized during these periods, as some researchers have suggested, then this could be a significant factor in gender differences in responding to environmental factors.
The panel on susceptibility consisted of presentations on epidemiology, gender, and environmental influences on multiple sclerosis; the implications of estrogen receptor knockout mouse studies; gender differences in metabolism and susceptibility to environmental exposures; and molecular markers of carcinogenesis. Participants discussed the importance of gaining a better understanding of basic biological mechanisms of pathways leading from exposures to health effects.
Following the workshop, the committee drafted a report entitled Gender Differences in Susceptibility to Environmental Factors: A Priority Assessment to be used as a guideline for federal agencies in setting research priorities. The report, which was released by the IOM in April 1998, makes recommendations in three main areas--research on exposures, basic biological research, and policy.
Research on Exposures
The committee made several recommendations for future research on exposures to maximize knowledge results. First, the committee recommended that researchers include a broader range of factors in the definition of "environmental exposure." Researchers should include not only chemicals, physical agents, and pathogens, but also nutritional, ergonomic (both biomechanical and physical), and behavioral factors.
The committee also felt that in order to provide more accurate information on exposure, population studies should include more complete and meaningful occupational data. Past studies do not reflect the full range of potential exposures, and the report points out that different occupations involve different types of exposures, some more hazardous than others. For example, for a field such as nursing, some workers are exposed to toxic chemotherapeutic drugs, while others are exposed to ionizing radiation, HIV, and other infectious agents. Likewise, occupational exposure studies should adequately characterize and account for the full range of multiple exposures, says the report. Many people, over the course of their lifetimes, have more than one job, each of which has its own set of exposures. In addition, these exposures should be combined with the varying exposures encountered at home.
The report also recommends that research examine gender differences to environmental factors over the life span, including critical exposure periods such as fetal development. Research indicates that susceptibility and the severity of the impact of exposures varies over the life span, and further understanding is needed in this area. In order to study the effects of exposures at different stages of life, the report encourages the development of more accurate animal models.
In studying the difference in susceptibility between genders, the report says the key is to recognize that the real differences occur in the types of exposures experienced by each gender. The report recommends that further research be conducted into the factors that account for different exposures, and investigations should be conducted on whether men and women respond differently to the same exposures.
Basic Biological Research
In order to understand gender differences in susceptibility to environmental factors, there is a need for further understanding of the basic biological differences, including genetic and physiologic differences, between men and women, says the report. The report suggests that research should focus on the contribution of environmental factors to the gender-determined risk of disease from a given exposure. The report recommends that priority should be given to studies of human diseases that are manifested differently in men and women, or in which gender modulates susceptibility to environmental factors.
Metabolic, neuroendocrine, immune, and hormonal differences between men and women also require further study. Although differences between genders have been recognized in these processes, researchers are unsure what role these differences play in susceptibility to environmental factors. The report also encourages further study into the identification of genetic markers of susceptibility, which could produce benefits for prevention and diagnosis. According to the report, a major step recently taken in this area is the NIEHS's initiative to collect susceptibility genes for large-scale studies on how these genes vary among people. Results from this project will contribute greatly toward knowledge of the role of genetics in susceptibility to environmental factors.
The report also calls for translational research to bridge the gaps among cellular, animal, and human systems. For example, when epidemiologists identify a relationship between risk factors and disease that suggests gender-specific differential susceptibility, researchers then need to examine the basis of that relationship at the molecular and cellular level. Researchers should continually look for the broader implications of mechanistic research conducted at the molecular, cellular, and animal levels, says the report.
Policy
The report suggests several strategies for how federal agencies can work to implement the recommended research priorities. The importance of agency collaboration is stressed continually throughout the report. Studying gender susceptibility to environmental factors encompasses three major areas of research--worker health and safety, women's health research, and environmental health--which are each funded separately through different agencies. In order to coordinate and prioritize research, as well as discuss progress, the report suggests that the agencies jointly sponsor annual workshops.
In addition, according to the report, agencies should work together to expand the scope of interagency cooperation and collaboration, which has been historically limited to project review. Sponsoring agencies should also urge other federal agencies that have programs that support women's health to become involved in the quest for more research into the role of gender in susceptibility to environmental factors.
In order to carry out the recommended research priorities, the report suggests that federal agencies not only rank gender and environment issues higher in their budgets, but also look for innovative opportunities to match funding with other types of research support, such as collaborations with nongovernmental organizations including nonprofit organizations, foundations, universities, labor unions, and industry, especially pharmaceutical companies. Partnering with such groups could produce data and information that may have both long-term biomedical significance and short-term value for product development and marketing, the report says.
The report recommends opening up existing national health surveys and their databases to a broader scientific community. Databases such as the CDC's National Center for Health Statistics, National Health and Nutrition Examination Survey, National Health Interview Survey, and National Disability Study contain potentially valuable information for this research. In addition, the report says, it would be valuable to increase access to research resources that have been collected for health surveys, such as DNA, serum, and tissue samples. The report suggests that federal agencies work to identify, protect, and utilize such resources, while taking into account ethical standards and laws governing confidentiality, informed consent, and privacy.
Implementing the Results
Representatives of the sponsoring agencies are pleased with the results of the workshop and the report, citing this effort as a positive example of interagency collaboration. "We enjoyed working together," says Margaret Chu, an EPA toxicologist who helped organize the conference. "I am always an optimist regarding interagency collaboration. Although it does require an extraordinary amount of effort, in the long run it is beneficial."
The ORWH plans to incorporate the report's recommendations into its women's health agenda, currently being updated, which Sassaman calls a "road map" for research for all the national institutes. Sassaman says the NIEHS will use the report in prioritizing research. "Lots of the items in the recommendations are in our research portfolio, and we'd like to see them expanded," she says. For example, the NIEHS already emphasizes research on special populations, a focus that could incorporate several of the report's recommendations.
Other agencies will also work to include priorities regarding gender differences in susceptibility to environmental factors in their future research portfolios. In addition to using the recommendations to set research priorities, Chu says the EPA will look at the report from a regulatory perspective. "In assessing risk to the human population, historically we've used a one-size-fits-all approach," says Chu. She says the EPA will work to identify unique susceptibility "so that when we do set environmental standards, we can be sure that we protect everyone."
Brandy E. Fisher
It's not unusual to find kids who believe that science and fun belong at opposite ends of the spectrum. Why has it traditionally been so hard to get children interested in science? Perhaps it is a simple matter of proving that science can be fun--at least, that's the approach the NIEHS is taking with its Kids' Page, located at http://www.niehs.nih.gov/ kids/kids.htm.
Currently, the Kids' Page logs approximately 1,000 visitors each month, and attendance is growing. Marcia Soward, management systems and policies coordinator in the NIEHS's Office of Management, created and maintains the site. The Kids' Page was developed shortly before a presidential memorandum entitled Expanding Access to Internet-based Educational Resources for Children, Teachers, and Parents was issued on 19 April 1997, asking all government Web sites to incorporate or increase children's educational materials on their sites by October 1997.
Source: Brooke Atkinson, Lassiter High School, Marietta, Georgia |
The Kids' Page has something for all age groups of children, and pulls in resources from all over the Internet, as well as taking advantage of institute staffers' ability to mix fun and science. The Read All about It link takes readers to articles on intriguing environmental health topics such as cloning and the mysterious rash of frog deformities that were first discovered by Minnesota schoolchildren in 1995. The NIEHS . . . What's up with That link tells kids about the institute and what kind of work is done there. This link also leads to the on-line version of the institute's recently published Environmental Diseases from A to Z pamphlet. The Getting Your Own Lab Coat link, authored in part by Dick Sloane, a researcher at the institute, describes what different kinds of scientists do, and tells youngsters what's involved in someday becoming a scientist. This page also includes links to NIEHS-related research sites such as a page describing the institute's use of alternative methods for toxicology testing. Finally, Links to More Fun leads to other fun science-related sites, including pages on colors, comets, and microscopy.
The Games & Surprises, Brainteasers, Science Word Scrambles, Science Spelling Bee, and What's Wrong with These Pictures links lead to a mixed bag of games, from charting your own biorhythms, to watching virtual fireworks, to manipulating three-dimensional images of chemical models. There are also lots of word puzzles and brainteasers designed to help kids learn to think more creatively. After all, as the page says, "NIEHS scientists always need to think creatively in order to discover new ways to identify and treat environmentally caused health problems." There's even a video game in which the object is to keep a hapless river rafter from crashing into barrels of toxic waste.
Say, can you imagine a world with no hypothetical situations? Hmmm . . . The Laugh It Up link contains science-related jokes, riddles, and "funny thoughts," many of which were contributed by NIEHS employees or their own kids. The Let's Go to a Party link guesses how various historical scientists and inventors might respond to a party invitation (Samuel Morse's reply: "I'll be there on the dot. Can't stop now--must dash!") and offers links that let kids investigate these scientific celebrities and their famous discoveries. The Color Our World Bright & Beautiful link lets kids "color" on-line, while the Environmental Art Gallery showcases drawings by talented young artists.
Kids aren't the only visitors to the NIEHS Kids' Page. The site has won a number of Internet awards, including Design World Internet Service's Voyager Bronze Award, the Artistic Reality Web Productions' Cool Reality Award, and the Bonus Network's Bonus.com Award.
Susan M. Booker
Last Updated: June 3, 1998