Paroxetine hydrochloride

Paroxetine hydrochloride

Paroxetine extended-release tablets contain paroxetine hydrochloride, an SSRI. It is the hydrochloride salt of a phenylpiperidine compound identified chemically as (-)-trans-4R-(4′-fluorophenyl)-3S-[(3′,4’­ methylenedioxyphenoxy) methyl] piperidine hydrochloride hemihydrate and has the empirical formula of C19H20FNO3•HCl•1/2H2O. The molecular weight is 374.8 (329.4 as free base).

Paroxetine hydrochloride hemihydrate, USP is an odorless, off-white powder, having a melting point range of 120° to 138°C and a solubility of 5.4 mg/mL in water.

Paroxetine extended-release tablets are intended for oral administration. Each extended-release tablet contains 12.5 mg, or 25 mg paroxetine equivalent to 14.25 mg, or 28.51 mg of paroxetine hydrochloride, respectively. One layer of the tablet consists of a degradable barrier layer and the other contains the active material in a hydrophilic matrix.

Inactive ingredients consist of hypromellose, povidone, lactose monohydrate, magnesium stearate, silicon dioxide, glyceryl behenate, methacrylic acid ethyl acrylate copolymer (1:1) type A (contains copolymer substance based on methacrylic acid and ethyl acrylate, sodium lauryl sulfate and polysorbate 80), polysorbate 80, talc, triethyl citrate, titanium dioxide and polyethylene glycol. In addition, 12.5 mg tablets contain yellow ferric oxide and red ferric oxide, while 25 mg tablets contain red ferric oxide.

In addition, the tablets are printed with black ink comprising of shellac glaze (modified) in SD-45, isopropyl alcohol, black iron oxide non-irradiated, n-butyl alcohol, propylene glycol and ammonium hydroxide.

FDA approved dissolution specifications differ from the USP dissolution specifications.

FDA approved dissolution test method differs from the USP dissolution test method.


Paroxetine extended-release tablets are indicated in adults for the treatment of:

  • Major depressive disorder (MDD)
  • Panic disorder (PD)
  • Social anxiety disorder (SAD)
  • Premenstrual dysphoric disorder (PMDD)

Mechanism of Action

The mechanism of action of paroxetine in the treatment of major depressive disorder (MDD), panic disorder (PD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD) is unknown, but is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin (5-HT)


Important Administration Instructions

Administer paroxetine extended-release tablets as a single daily dose in the morning, with or without food. Swallow tablets whole and do not chew or crush.

Dosage in Patients with Major Depressive Disorder, Panic Disorder, and Social Anxiety Disorder

In patients with an inadequate response, dosage may be increased in increments of 12.5 mg per day at intervals of at least 1 week, depending on tolerability.

Dosage in Patients with Premenstrual Dysphoric Disorder

The recommended starting dosage in women with PMDD is 12.5 mg per day. Paroxetine extended-release tablets may be administered either continuously (every day throughout the menstrual cycle) or intermittently (only during the luteal phase of the menstrual cycle, i.e., starting the daily dosage 14 days prior to the anticipated onset of menstruation and continuing through the onset of menses). Intermittent dosing is repeated with each new cycle.

In patients with an inadequate response, the dosage may be increased to the maximum recommended dosage of 25 mg per day, depending on tolerability. Institute dosage adjustments at intervals of at least 1 week.

Screen for Bipolar Disorder Prior to Starting Paroxetine Extended-Release Tablets

Prior to initiating treatment with paroxetine extended-release tablets or another antidepressant, screen patients for a personal or family history of bipolar disorder, mania, or hypomania

Dosage Modifications for Elderly Patients, Patients with Severe Renal Impairment and Patients with Severe Hepatic Impairment

The recommended initial dose of paroxetine extended-release tablets is 12.5 mg per day for elderly patients, patients with severe renal impairment, and patients with severe hepatic impairment. Reduce initial dose and increase up-titration intervals if necessary. Dosage should not exceed 50 mg per day for MDD or PD and should not exceed 37.5 mg per day for SAD

Switching Patients to or from a Monoamine Oxidase Inhibitor Antidepressant

At least 14 days must elapse between discontinuation of a monoamine oxidase inhibitor (MAOI) antidepressant and initiation of paroxetine extended-release tablets. In addition, at least 14 days must elapse after stopping paroxetine extended-release tablets before starting an MAOI antidepressant

Discontinuation of Treatment with Paroxetine Extended-Release Tablets

Adverse reactions may occur upon discontinuation of paroxetine extended-release tablets. Gradually reduce the dosage rather than stopping paroxetine extended-release tablets abruptly whenever possible.


Paroxetine extended-release tablets are contraindicated in patients:

  • Taking, or within 14 days of stopping, MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome
  • Taking thioridazine because of risk of QT prolongation
  • Taking pimozide because of risk of QT prolongation
  • With known hypersensitivity (e.g., anaphylaxis, angioedema, Stevens-Johnson syndrome) to paroxetine or to any of the inactive ingredients in paroxetine extended-release tablets


Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents (e.g., SSRI, SNRI, triptans), but also when taken alone. If occurs, discontinue paroxetine extended-release tablets and initiate supportive measures.

Embryofetal and Neonatal Toxicity: Can cause fetal and neonatal harm. Increased risk of cardiovascular malformations for exposure during the first trimester. Exposure in late pregnancy may lead to an increased risk for persistent pulmonary hypertension (PPNH) of the newborn.

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk.

Activation of Mania/Hypomania: Screen patients for bipolar disorder.

Seizures: Use with caution in patients with seizure disorders.

Angle-Closure Glaucoma: Angle-closure glaucoma has occurred in patients with untreated anatomically narrow angles treated with antidepressants.

Suicidal Thoughts and Behaviors in Adolescents and Young Adults: In pooled analyses of placebo-controlled trials of antidepressant drugs (SSRIs and other antidepressant classes) that included approximately 77,000 adult patients and 4,500 pediatric patients, the incidence of suicidal thoughts and behaviors in antidepressant-treated patients age 24 years and younger was greater than in placebo-treated patients. There was considerable variation in risk of suicidal thoughts and behaviors among drugs, but there was an increased risk identified in young patients for most drugs studied. There were differences in absolute risk of suicidal thoughts and behaviors across the different indications, with the highest incidence in patients with MDD.

Monitor all antidepressant-treated patients for any indication for clinical worsening and emergence of suicidal thoughts and behaviors, especially during the initial few months of drug therapy, and at times of dosage changes. Counsel family members or caregivers of patients to monitor for changes in behavior and to alert the healthcare provider. Consider changing the therapeutic regimen, including possibly discontinuing paroxetine extended-release tablets, in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

Drug Interactions Leading to QT Prolongation: The CYP2D6 inhibitory properties of paroxetine can elevate plasma levels of thioridazine and pimozide. Since thioridazine and pimozide given alone produce prolongation of the QTc interval and increase the risk of serious ventricular arrhythmias, the use of paroxetine extended-release tablets is contraindicated in combination with thioridazine and pimozide

Discontinuation Syndrome: Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible

Hyponatremia: Hyponatremia may occur as a result of treatment with SNRIs and SSRIs, including paroxetine extended-release tablets. Cases with serum sodium lower than 110 mmol/L have been reported. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. Signs and symptoms associated with more severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Reduction of Efficacy of Tamoxifen: Some studies have shown that the efficacy of tamoxifen, as measured by the risk of breast cancer relapse/mortality, may be reduced with concomitant use of paroxetine as a result of paroxetine’s irreversible inhibition of CYP2D6 and lower blood levels of tamoxifen

Bone Fracture: Epidemiological studies on bone fracture risk during exposure to some antidepressants, including SSRIs, have reported an association between antidepressant treatment and fractures. There are multiple possible causes for this observation and it is unknown to what extent fracture risk is directly attributable to SSRI treatment.


Most common adverse reactions (≥5% and at least twice placebo) in placebo-controlled MDD, PD, SAD, and PMDD clinical trials: abnormal ejaculation, abnormal vision, asthenia, constipation, decreased appetite, diarrhea, dizziness, dry mouth, female genital disorder, impotence, insomnia, libido decreased, nausea, somnolence, sweating, tremor.

To report SUSPECTED ADVERSE REACTIONS, contact Sinotherapeutics Inc. at 1-877-382-6787 and/or at or FDA at 1-800-FDA-1088 or


Pregnancy Category D: Epidemiological studies have shown that infants exposed to paroxetine in the first trimester of pregnancy have an increased risk of congenital malformations, particularly cardiovascular malformations. If paroxetine is used during pregnancy, or if the patient becomes pregnant while taking paroxetine, advise the patient of the potential hazard to the fetus.

Treatment of Pregnant Women During Their Third Trimester: Neonates exposed to SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), including paroxetine extended-release tablets, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These features are consistent with either a direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation syndrome. It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome.

Nursing Mothers: Like many other drugs, paroxetine is secreted in human milk. Because of the potential for serious adverse reactions in nursing infants from paroxetine extended-release tablets, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use: The safety and effectiveness of paroxetine extended-release tablets in pediatric patients have not been established

Geriatric Use: SSRIs and SNRIs, including paroxetine extended-release tablets, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse reaction

Renal and/or Hepatic Impairment: Increased plasma concentrations of paroxetine occur in patients with renal and hepatic impairment. The initial dosage should be reduced in patients with severe renal impairment and patients with severe hepatic impairment


Since the introduction of immediate-release paroxetine hydrochloride in the United States, spontaneous cases of deliberate or accidental overdosage during paroxetine treatment have been reported worldwide. These include overdoses with paroxetine alone and in combination with other substances. There are reports of fatalities that appear to involve paroxetine alone.

Commonly reported adverse reactions associated with paroxetine overdosage include somnolence, coma, nausea, tremor, tachycardia, confusion, vomiting, and dizziness. Other notable signs and symptoms observed with overdoses involving paroxetine (alone or with other substances) include mydriasis, convulsions (including status epilepticus), ventricular dysrhythmias (including torsade de pointes), hypertension, aggressive reactions, syncope, hypotension, stupor, bradycardia, dystonia, rhabdomyolysis, symptoms of hepatic dysfunction (including hepatic failure, hepatic necrosis, jaundice, hepatitis, and hepatic steatosis), serotonin syndrome, manic reactions, myoclonus, acute renal failure, and urinary retention.

Overdose Management

No specific antidotes for paroxetine are known. If over-exposure occurs, all your poison control center at 1-800-222-1222 for latest recommendations.

Types of Weight-loss Surgery

The type of surgery that may be best to help a person lose weight depends on a number of factors. You should discuss with your doctor what kind of surgery might be best for you.

What are the surgical options?

In the United States, surgeons most often perform three types of operations

  • gastric sleeve
  • gastric bypass
  • adjustable gastric band

Surgeons less commonly use a fourth operation, biliopancreatic diversion with duodenal switch.

Gastric sleeve

In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. The surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect hormones or bacteria in the gastrointestinal system that affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.

Gastric bypass

Gastric bypass surgery, also called Roux-en-Y gastric bypass, is done in three steps. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less because you feel full sooner.

Next, the surgeon divides your small intestine into two parts and attaches the lower part directly to the small stomach pouch. Food will bypass most of your stomach and the upper part of your small intestine, so your body absorbs fewer calories.

The surgeon then reconnects the upper part of the small intestine to a new location farther down on the lower part of the small intestine. This allows digestive juices in the stomach to flow from the bypassed part of the small intestine to the lower part of the small intestine, so that food can be fully digested. The bypass changes hormones, bacteria, and other substances in the gastrointestinal tract that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.

Adjustable gastric band

In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. Like gastric sleeve and gastric bypass surgery, the gastric band makes you feel full after eating a small amount of food. The inner band has a circular balloon inside that is filled with saline solution. The surgeon can adjust the inner band to resize the opening from the pouch to the rest of your stomach by injecting or removing the saline solution through a small device, called a port, that is placed under your skin.

After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it.

Today, adjustable gastric band surgery is less commonly performed in the United States, compared with the gastric sleeve or gastric bypass, because it is associated with more complications, predominantly the need for band removal due to intolerance. Gastric band surgery also typically results in significantly less weight loss and is associated with more complications, predominately the need for band removal due to intolerance.

Biliopancreatic diversion with duodenal switch

A surgical procedure called biliopancreatic diversion with duodenal switch, or “mixed surgery,” involves two separate procedures. The first procedure is similar to gastric sleeve surgery. A second surgical procedure divides the small intestine into two tracts. Food moves through one tract, bypassing most of the small intestine. This reduces the number of calories and amount of nutrients absorbed. Digestive juices flow from the stomach through the other intestinal tract and mix with food as it enters the colon.

This type of surgery allows you to lose more weight compared with the other three operations described above. However, it is also the most likely to cause surgery-related problems and a shortage of vitamins, minerals, and proteins in your body. For these reasons, surgeons do not perform this particular procedure often.

However, some surgeons may recommend it for patients who have severe obesity plus other health conditions.

Most Common Weight-loss Surgeries

Gastric Sleeve

A surgeon removes about 80 percent of stomach, creating a long, banana-shaped pouch.


  • Greater weight loss than gastric band
  • No changes to intestines
  • No foreign objects placed in body
  • Short hospital stay


  • Cannot be reversed
  • Risk of vitamin and iron deficiency (shortage)
  • Higher chance of surgery-related problems than gastric band
  • Risk of acid reflux and hiatal hernia (caused by the stomach pushing up against the diaphragm)

Gastric Bypass

A surgeon staples top part of the stomach, creating a small pouch, and attaches it to the middle part of the small intestine.


  • Greater weight loss than gastric band
  • No foreign objects placed in body


  • Difficult to reverse
  • Higher chance of vitamin and iron shortage than gastric band or gastric sleeve
  • Higher chance of surgery-related problems than gastric band
  • May increase risk of alcohol use disorder

Adjustable Gastric Band

A surgeon places an inflatable band around top part of the stomach, creating a small pouch with an adjustable opening.


  • Can be adjusted and reversed
  • Short hospital stay and low risk of initial surgery-related problems
  • No changes to intestines
  • Lowest risk of vitamin shortage


  • Less weight loss than other types of weight-loss surgery
  • Frequent follow-up visits to adjust band; some people may not adapt to band
  • Possible future surgery to remove or replace all or part of the band system.

How is the surgery performed?

Weight-loss surgery is mostly done laparoscopically, which requires only small cuts, under general anesthesia. Through these incisions, the surgeon can insert thin tools and a small scope attached to a camera that projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring. Recovery may also be faster with laparoscopic surgery.

Open surgery, which involves a single, large cut in the abdomen, may be a better option than laparoscopic surgery for certain people. You may need open surgery if you have a high level of obesity, had stomach surgery before, or have other complex medical problems.

What should I expect before surgery?

Before surgery, you will meet with several health care professionals, such as an internist, a dietitian, a psychiatrist or psychologist, and a bariatric surgeon.

  • The internist will ask about your medical history, perform a thorough physical exam, and order blood tests. If you smoke, you may benefit from stopping smoking  at least 6 weeks before your surgery.
  • The dietitian will explain what and how much you will be able to eat and drink after surgery and help you prepare for how your life will change after surgery.
  • The psychiatrist or psychologist may assess you to see if you are ready to manage the challenges of weight-loss surgery.
  • The surgeon will tell you more about the surgery, including how to prepare for it and what type of follow-up you will need.

These health care professionals also will advise you to become more active and adopt a healthy eating plan before and after surgery. Losing weight and bringing your blood glucose—also known as blood sugar—levels closer to normal before surgery may lower your chances of having surgery-related problems.

Some weight-loss surgery programs have groups you can attend before and after surgery to help answer questions about the surgery and offer support.

What should I expect after surgery?

After surgery, you will need to rest and recover. Walking and moving around the house may help you recover more quickly. Start slowly and follow your health care professional’s advice about the type of physical activity you can do safely. As you feel more comfortable, add more physical activity.

After surgery, you will probably be started on a liquid diet. Over several weeks, you will move to a soft diet that includes such foods as cottage cheese, yogurt, or soup. Eventually you will begin consuming solid foods again. Your health care professional will tell you which foods and beverages you may have and which ones you should avoid. You will need to eat small meals and chew your food well. You will need to take dietary supplements  that your health care professional prescribes to make sure you are getting enough vitamins and minerals.

How much weight can I expect to lose?

The number of pounds people lose after weight-loss surgery depends on the individual and on the type of surgery. One study found that after 1 year, people undergoing adjustable gastric banding, gastric sleeve, and gastric bypass lost between 38 and 87 pounds. Of the three most common procedures, gastric bypass produced greater weight loss, on average, but had more complications in the month after surgery. Most people regained some weight over time, but

that amount was usually small compared with their initial weight loss.

Your weight loss could be different. Remember, reaching your goal depends not only on the surgery but also on sticking with healthy lifestyle habits.

Weight-loss devices

The U.S. Food and Drug Administration has approved several weight-loss devices  that do not permanently change your stomach or small intestine. These devices cause less weight loss than weight-loss surgery, and some are only used temporarily with the intention that patients learn to change their eating habits and physical activity levels. Researchers haven’t studied any of them over a long period of time and don’t know the long-term risks and benefits.

Two devices use one or more inflatable balloons that are inserted endoscopically, or

through the mouth and esophagus. Your health care professional will give you a sedative before the procedure. Once the balloons are in your stomach, they are inflated with saline solution to take up space in your stomach and help you feel fuller. They are intended for use while you make changes to your eating plan and physical activity level. You will need to have the balloons removed after 6 months to a year.

A newer balloon device places a bulb in the stomach that is connected to a smaller bulb placed at the far end of the stomach, where the stomach connects to the small intestine. This device slows food down as it leaves the stomach and enters the small intestine. This device is intended to be used temporarily, for up to 12 months, while you participate in a diet and exercise program. The device is then removed.

Another option is a gastric emptying device. This device involves a tube that connects from the inside of your stomach to a port on the outside of your abdomen. About 20 to 30 minutes after eating, you attach tubing from the port to a pump and open the port’s valve. The pump drains your stomach contents through a tube into the toilet, so that your body doesn’t absorb about 30 percent of the calories you ate. The device can be removed in the office at any time, but it may require surgery to close the opening if it does not seal over time.

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Staying Active at Any Size

Physical activity may seem hard if you’re overweight. You may get short of breath or tired quickly. Finding or affording the right clothes and equipment may be frustrating. Or, perhaps you may not feel comfortable working out in front of others.

The good news is you can overcome these challenges. Not only can you be active at any size, you can have fun and feel good at the same time.

Can anyone be active?

Research strongly shows that physical activity is safe for almost everyone. The health benefits of physical activity far outweigh the risks.

The activities discussed here are safe for most people. If you have problems moving or staying steady on your feet, or if you get out of breath easily, talk with a health care professional before you start. You also should talk with a health care professional if you are unsure of your health, have any concerns that physical activity may be unsafe for you, or have

  • a chronic disease such as diabetes, high blood pressure, or heart disease a
  • bone or joint problem—for example, in your back, knee, or hip—that could get worse if you change your physical activity level

Why should I be active?

Being active may help you live longer and protect you from developing serious health problems, such as type 2 diabetes, heart disease, stroke, and certain types of cancer. Regular physical activity is linked to many health benefits, such as lower blood pressure and blood glucose, or blood sugar

  • healthy bones, muscles, and joints
  • a strong heart and lungs
  • better sleep at night and improved mood

The Physical Activity Guidelines for Americans, 2nd edition, define regular physical activity as at least 150 minutes a week of moderate-intensity aerobic activity, such as brisk walking. Brisk walking is a pace of 3 miles per hour or faster. A moderate-intensity activity makes you breathe harder but does not overwork or overheat you. You should also do muscle-strengthening activities at least 2 days a week.

You may reach this goal by starting with 5 minutes of physical activity several times a day, 5 to 6 days a week. You could then gradually work up to 10 minutes per session, 3 times a day. If you do even more activity, you may gain even more health benefits

When combined with healthy eating, regular physical activity may also help you control your weight. However, research shows that even if you can’t lose weight or maintain your weight loss, you still can enjoy important health benefits from regular physical activity.

Physical activity also can be a lot of fun if you do activities you enjoy and are active with other people. Being active with others may give you a chance to meet new people or spend more time with family and friends. You also may inspire and motivate one another to get and stay active.

What do I need to know about becoming active?

Choosing physical activities that match your fitness level and health goals can help you stay motivated and keep you from getting hurt. You may feel some minor discomfort or muscle soreness when you first become active. These feelings should go away as you get used to your activity. However, if you feel sick to your stomach or have pain, you may have done too much. Go easier and then slowly build up your activity level. Some activities, such as walking or water workouts, are less likely to cause injuries.

If you have been inactive, start slowly and see how you feel. Gradually increase how long and how often you are active. If you need guidance, check with a health care or certified fitness professional.

Here are some tips for staying safe during physical activity:

  • Wear the proper safety gear, such as a bike helmet if you are bicycling.
  • Make sure any sports equipment you use works and fits properly.
  • Look for safe places to be active. For instance, walk in well-lit areas where other people are around. Be active with a friend or group.
  • Stay hydrated to replace the body fluids you lose through sweating and to prevent you from getting overheated.
  • If you are active outdoors, protect yourself from the sun with sunscreen and a hat or protective visor and clothing.
  • Wear enough clothing to keep warm in cold or windy weather. Layers are best.

If you don’t feel right, stop your activity. If you have any of the following warning signs, stop and seek help right away:

  • pain, tightness, or pressure in your chest or neck, shoulder, or arm
  • extreme shortness of breath
  • dizziness or sickness

Check with a health care professional about what to do if you have any of these warning signs.

If your activity is causing pain in your joints, feet, ankles, or legs, you also should consult a health care professional to see if you may need to change the type or amount of activity you are doing.

What kinds of activities can I do?

You don’t need to be an athlete or have special skills or equipment to make physical activity part of your life. Many types of activities you do every day, such as walking your dog or going up and down steps at home or at work, may help improve your health.

Try different activities you enjoy. If you like an activity, you’re more likely to stick with it. Anything that gets you moving around, even for a few minutes at a time, is a healthy start to getting fit.


Walking is free and easy to do—and you can do it almost anywhere. Walking will help you

  • burn calories
  • improve your fitness
  • lift your mood
  • strengthen your bones and muscles

If you are concerned about safety, try walking in a shopping mall or park where it is well lit and other people are around. Many malls and parks have benches where you can take a quick break. Walking with a friend or family member is safer than walking alone and may provide the social support you need to meet your activity goals.

If you don’t have time for a long walk, take several short walks instead. For example, instead of a 30-minute walk, add three 10-minute walks to your day. Shorter spurts of activity are easier to fit into a busy schedule.

Walking tips

  • Wear comfortable, well-fitting walking shoes with a lot of support, and socks that absorb sweat.
  • Dress for the weather if you are walking outdoors. In cold weather, wear layers of clothing you can remove if you start getting too warm. In hot weather, protect yourself against the sun and heat.
  • Warm up by walking more slowly for the first few minutes. Cool down by slowing your pace.


Dancing can be a lot of fun while it tones your muscles, strengthens your heart and lungs, and boosts your mood. You can dance at a health club, dance studio, or even at home. Just turn on some lively music and start moving. You also can dance to a video on your TV or computer.

If you have trouble standing on your feet for a long time, try dancing while sitting down. Chair dancing lets you move your arms and legs to music while taking the weight off your feet.


Riding a bicycle spreads your weight among your arms, back, and hips. For outdoor biking, you may want to try a mountain bike. Mountain bikes have wider tires and are sturdier than bikes with thinner tires. You can buy a larger seat to make biking more comfortable.

For indoor biking, you may want to try a recumbent bike. On this type of bike, you sit lower to the ground with your legs reaching forward to the pedals. Your body is in more of a reclining position, which may feel better than sitting straight up. The seat on a recumbent bike is also wider than the seat on a regular bike.

If you decide to buy a bike, check how much weight it can support to make sure it is safe for you.

Workout clothing tips

  • Clothes made of fabrics that absorb sweat are best for working out.
  • Comfortable, lightweight clothes allow you to move more easily.
  • Tights or spandex shorts are the best bottoms to wear to prevent inner-thigh chafing.
  • Women should wear a bra that provides extra support during physical activity.

Water workouts

Swimming and water workouts put less stress on your joints than walking, dancing, or biking. If your feet, back, or joints hurt when you stand, water activities may be best for you. If you feel self-conscious about wearing a bathing suit, you can wear shorts and a T-shirt while you swim.

Exercising in water

  • lets you be more flexible. You can move your body in water in ways you may not be able to on land.
  • reduces your risk of hurting yourself. Water provides a natural cushion, which keeps you from pounding or jarring your joints.
  • helps prevent sore muscles.
  • keeps you cool, even when you are working hard.

You don’t need to know how to swim to work out in water. You can do shallow- or deep-water exercises at either end of the pool without swimming. For instance, you can do laps while holding onto a kickboard and kicking your feet. You also can walk or jog across the width of the pool while moving your arms.

For shallow-water workouts, the water level should be between your waist and chest. During deep-water workouts, most of your body is underwater. For safety and comfort, wear a foam belt or life jacket.

Tips for protecting your hair

If you’re worried that pool water will damage or mess up your hair, try these tips:

  • Use a swim cap to help protect your hair from pool chemicals and getting wet.
  • Wear a natural hairstyle, short braids, locs, or twists, which may be easier to style after a water workout.
  • Buy a shampoo to remove chlorine buildup, available at most drug stores, if your hair feels dry or damaged after a pool workout.

Strength training

Strength training involves using free weights, weightlifting machines, resistance bands, or your own body weight to make your muscles stronger. Lower-body strength training will improve your balance and prevent falls.

Strength training may help you

  • build and maintain strong muscles as you get older
  • continue to perform activities of daily living, such as carrying groceries or moving furniture
  • keep your bones strong, which may help prevent osteoporosis and fractures

If you are just starting out, using a weightlifting machine may be safer than dumbbells. As you get fit, you may want to add free-weight exercises with dumbbells.

You do not need a weight bench or large dumbbells to do strength training at home. You can use a pair of hand weights to do bicep curls. You can also use your own body weight: for example, get up and down from a chair.

Proper form is very important when lifting weights. You may hurt yourself if you don’t lift weights properly. You may want to schedule a session with a certified fitness professional to learn which exercises to do and how to do them safely. Check with your health insurer about whether your health plan covers these services.

If you decide to buy a home gym, check how much weight it can support to make sure it is safe for you.

Strength-training tips

  • Aim for at least 2 days per week of strengthen-training activities.
  • Try to perform each exercise 8 to 12 times. If that’s too hard, the weight you are lifting is too heavy. If it’s too easy, your weight is too light.
  • Try to exercise all the major muscle groups. These groups include the muscles of the legs, hips, chest, back, abdomen, shoulders, and arms.
  • Don’t work the same muscles 2 days in a row. Your muscles need time to recover.

Mind and body exercise

Your local hospital or fitness, recreation, or community center may offer classes such as yoga, tai chi, or Pilates. You also may find some of these workouts online and can download them to a computer, smart phone, or other device. These types of activities may help you

  • become stronger and more flexible
  • feel more relaxed
  • improve balance and posture

These classes also can be a lot of fun and add variety to your workout routine. If some movements are hard to do or you have injuries you are concerned about, talk with the instructor about how to adapt the exercises and poses to meet your needs—or start with a beginner’s class.

Daily life activities

Daily life activities, such as cleaning out the attic or washing the car, are great ways to get moving. Small changes can add more physical activity to your day and improve your health. Try these:

  • Take 2- to 3-minute walking breaks at work several times a day, if possible.
  • Stand, walk, or stretch in place during TV commercials.
  • Take the stairs instead of the elevator or escalator whenever you can.
  • Park farther from where you are going and walk the rest of the way.

Even a shopping trip can be exercise because it provides a chance to walk and carry your bags. Chores such as mowing the lawn, raking leaves, and gardening also count.

Where can I be active?

You can find many fun places to be active. Having more than one place may keep you from getting bored. Here are some options:

  • Join or take a class at a local fitness, recreation, or community center.
  • Enjoy the outdoors by taking a hike or going for a walk in a safe local park, neighborhood, or mall.
  • Work out in the comfort of your own home with a workout video or by finding a fitness channel on your TV, tablet, or other mobile device.

Tips for choosing a fitness center

  • Make sure the center has exercise equipment for people who weigh more and staff to show you how to use it.
  • Ask if the center has any special classes for people just starting out, older adults, or people with mobility or health issues.
  • See if you can try out the center or take a class before you join.
  • Try to find a center close to work or home. The quicker and easier the center is to get to, the better your chances of using it often.
  • Make sure you understand the rules for joining and ending your membership, what your membership fee covers, any related costs, and the days and hours of operation.


Hexavalent Chromium

Hexavalent chromium is a form of the metallic element chromium. Chromium is a naturally occurring element found in rocks, animals, plants, soil, and volcanic dust and gases. It comes in several different forms, including trivalent chromium and hexavalent chromium. Trivalent chromium is often referred to as chromium (III) and is proposed to be an essential nutrient for the body. Hexavalent chromium, or chromium (VI), is generally produced by industrial processes.

How is hexavalent chromium used?

Chromium compounds, such as hexavalent chromium, are widely used in electroplating, stainless steel production, leather tanning, textile manufacturing, and wood preservation. The U.S. is one of the world’s leading producers of chromium compounds.

How are people exposed to hexavalent chromium?

Hexavalent chromium exposure occurs through breathing it in, ingesting it in food or water, or direct contact with the skin.

What are the known health effects of inhaling hexavalent chromium?

Hexavalent chromium compounds have been shown to cause lung cancer in humans when inhaled. The Report on Carcinogens lists hexavalent chromium compounds as known human carcinogens. Studies have consistently shown increased lung cancer rates in workers who were exposed to high levels of chromium in workroom air.

People who work in industries that process or use chromium or chromium compounds can be exposed to higher than normal levels of chromium. Occupational exposures occur mainly among workers who handle chromate-containing pigments, spray paints, or coatings; operate chrome plating baths; or weld or cut metals that contain chromium, such as stainless steel. Some of the adverse health effects from hexavalent chromium exposures include nasal and sinus cancers, kidney and liver damage, nasal and skin irritation and ulceration, and eye irritation and damage.

What do NTP studies say about hexavalent chromium in drinking water?

The NTP studies show that sodium dichromate dihydrate, a compound containing hexavalent chromium, causes cancer in laboratory animals following oral ingestion. Researchers found significant increases in tumors at sites where tumors are rarely seen in laboratory animals. Male and female rats had malignant tumors in the oral cavity. The studies conducted in mice found increases in the number of benign and malignant tumors in the small intestine, which increased with dose in both males and females.

Are there safety levels for exposure to chromium in drinking water?

The U.S. Environmental Protection Agency has set a maximum contaminant level of 100 parts per billion for total chromium in drinking water. Numerous states have established limits of 50 parts per billion of total chromium in drinking water.

What can I do to prevent exposure of my family to hexavalent chromium?

Work with your public health officials to determine if hexavalent chromium is present in your environment, such as water, air, and soil, and at what levels, particularly if you live near a site where chromium compounds are disposed of or manufactured. Children should avoid playing in soils near uncontrolled hazardous waste sites where chromium may have been discarded.

Limit occupational exposure to hexavalent chromium compounds. The Occupational Safety and Health Administration established a hexavalent chromium standard that protects employees from chromium exposure risks, such as lung cancer, skin ulcers, and dermatitis.

Bed Bugs control: Do-it-yourself Bed Bug Control

Bed Bug Control

The common bed bug (Cimex lectularius) has long been a pest – feeding on blood, causing itchy bites and generally irritating their human hosts. The Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture (USDA) all consider bed bugs a public health pest. However, unlike most public health pests, bed bugs are not known to transmit or spread disease.

They can, however, cause other public health issues, so it’s important to pay close attention to preventing and controlling bed bugs.

Experts believe the recent increase in bed bugs in the United States may be due to more travel, lack of knowledge about preventing infestations, increased resistance of bed bugs to pesticides, and ineffective pest control practices.

The good news is that there are ways to control bed bugs. Getting good, solid information is the first step in both prevention and control. While there is no chemical quick fix, there are effective strategies to control bed bugs involving both non-chemical and chemical methods.

Bed bugs can be hard to find and identify, given their small size and their habit of staying hidden. It helps to know what they look like, since the various life stages have different forms.

Getting Rid of Bed Bugs

When a bed bug infestation is discovered there are multiple methods for controlling it. Be aware that it will take time and patience; there is no quick fix for eradication. There are both chemical and non-chemical approaches are available. While using one or the other works, an approach that uses a combination of both can be the most effective. Using this combination of approaches is often referred to as integrated pest management.

Preparing for control is very important whether you are considering hiring a professional or planning to do it yourself.

Controlling bed bugs using integrated pest management means using a variety of methods, including both chemical and non-chemical techniques.

If you would like to use a do-it-yourself approach, be sure to come up with a plan to execute to ensure eradication and safety. All do-it-yourself products, especially foggers, should be researched and employed properly. In addition, you should be careful to only use legal control methods, as others may cause serious harm.

Hiring a pest management professional is a good option in many cases, but you need to be careful in how you select a company.

Do-it-yourself Bed Bug Control

Treating bed bugs is complex and can take weeks to months, depending on the extent of the infestation. Your likelihood of success depends on many factors, including how many bed bugs you have, how much clutter is available for hiding places, whether your neighbors have bed bugs, and whether all residents of a house of building will Participate.

To be successful, everyone in the home will need to cooperate and do their part

The following steps will help you begin:

1. Identify the problem

2. Develop a plan

3. Keep the infestation from expanding

4. Prepare for treatment

5. Kill the bed bugs

6. Evaluate and prevent

You may have to follow these steps more than once to kill all the bugs and their eggs.

Identify the Problem

Identify the pest:Collect a sample of the pest to show an extension agent. Extension agents can identify the pest at no cost to you. They are trained in pest control and know your local area.

If an extension agent or other expert says the pest is a bed bug, notify your landlord if you live in an apartment. The units near yours should be inspected.

Inspect all areas that may have bed bugs, plus surrounding living spaces, to find out the extent of infestation.

Develop a Plan

  • Make a schedule for completing the steps below. Be sure to include any personal plans, such as vacations.
  • Keep records through the whole process. Note the dates and exact locations where pests are found. This will help you track progress and better know where to target your work.
  • Keep checking for at least a year after you’re done to make sure all the bed bugs are gone.

Keep the Infestation from Spreading

  • Seal any small hiding areas. Use silicon caulk to seal cracks and crevices. This eliminates hiding places and gets the bugs out into the open.
  • Remove infested items. Place them in a sealed plastic bag and treat them.
  • Items that cannot be treated should be placed in a sealed plastic bag or storage
  • container and left there for up to a year to ensure any active bugs are dead.
  • Purchase protective covers that seal mattresses and box springs. With covers that seal, the bed bugs will get trapped inside and die.
  • Vacuum after each use. Seal the bag as tightly as possible and immediately throw it out in an outdoor trash container.
  • Discard furniture responsibly if you can’t safely eliminate the bed bugs. Destroy it so someone else won’t be tempted to bring it into their home.
  • Have infested items picked up as soon as possible by the trash collection agency.
  • Don’t discard furniture if you can safely eliminate the bed bugs from it.

Prepare for Treatment

Preparing for treatment is very important; it will make it easier to monitor for bed bugs that haven’t been eliminated. This preparation should be completed whether you are doing the treatment yourself or hiring a professional.

Kill the Bed Bugs

  • Make sure the methods you select are safe, effective and legal.
  • Avoid treatments that don’t work. Rubbing alcohol, kerosene and gasoline could harm you and your family and can easily ignite with a spark or cigarette. Sticky traps are not for bed bugs, but they may be effective at catching spiders, cockroaches, and other insects.
  • Consider non-chemical methods of killing bed bugs. Some will be more useful than others depending on your situation. These and other methods can be helpful, but they might not get rid of the infestation entirely:

Heat treatment: You can use a clothes dryer on high heat. You can also use black plastic bags in a hot, closed car in the sun, but success depends on your climate and other factors. Do-it-yourself heat treatments might not work.

Professionals have access to more intensive and proven methods that can even treat whole houses with heat. Do not try to kill bed bugs by increasing your indoor temperature with a thermostat, propane space heater, or fireplace – this does not work and is dangerous.

Cold treatment may work, but can only be successful in the home environment if the freezer is set to 0°F. Many home refrigerator freezers are not cold enough to kill bed bugs. You must leave the items in a sealed bag in the freezer at 0° for three days. Always use a thermometer to check the temperature, since home freezers are not always set to 0°.

Steam cleaners (wet or dry) can get into cracks and fabrics to treat carpets, baseboards, bed frames, and other furniture. The steam temperature must be at least 130°F but should not have a forceful airflow, or it may cause bed bugs to scatter. Use a diffuser to prevent scattering.

If needed, hire a pest management professional or use pesticides carefully according to the label directions:

  • Look for EPA-registered pesticides that have bed bugs listed on the label.
  • Use foggers (bug bombs) only with extreme care and only if bed bugs are listed on the label. Improper use can harm your health or cause a fire or explosion. Foggers should not be your only method of bed bug control. The spray will not reach the cracks and crevices where bed bugs hide.

Carefully look for any evidence of bed bugs every few days after you complete your initial cleanup and control processes. If you see bed bugs, either the initial cleanup missed some bugs or eggs have hatched. Retreatment may be needed.; Consider using different types of pesticides if repeated treatments are needed.

  • Desiccants (chemicals that dry things out) can be particularly effective in some situations since they work by drying out the bug (which means the bed bugs can’t develop resistance). However, t hey may take several months to work. If using desiccants, be sure to use only products registered by EPA as a Pesticide
  • Pool or food grade diatomaceous earth should not be used. This type of diatomaceous earth (made from t he fossilized remains of tiny aquatic organisms called diatoms) can harm you when you breathe it in. The pesticide version uses a different size of diatoms, which reduces the hazard.

Bed bug interceptor traps can be placed under the legs of furniture to catch bed bugs and keep them from climbing the legs. Both commercial and do-it-yourself interceptors are options. Follow the directions below to create your interceptor traps.

Bed bug interceptors (place under furniture legs to catch bed bugs).

Gather supplies you need to make your own interceptor traps:

  • Two clean plastic containers with sturdy, tall side over 1 inch container fits inside the larger one). Cleaned and re-purposed deli or take out food containers are a great option.
  • Masking or painter’s tape with a rough texture.
  • Talcum powder.

Follow these directions to make an interceptor trap:

  • Ensure that the small container is large enough to set a bed or couch leg inside
  • Place masking tape around the outside of the larger container so the bed bugs can easily climb up into the container.
  • Glue or tape the two containers together, the small one sitting in the larger one.
  • Sprinkle a little talcum powder into the bottom of both containers. Talcum is slippery and will keep the bed bugs inside the container.
  • Make enough interceptor traps to be placed under each leg of the infested furniture such as beds, couch, or chairs.
  • If needed, move y our furniture a few inches from any walls and ensure no lines are touching the floor, only the furniture legs ensure no linens are touching the floor, only the furniture legs.
  • Check and clean the interceptors every week. Reapply talcum powder.
  • Dispose of captured bed bugs into a plastic zip-type or sealable bag.

Evaluate and Prevent

  • Continue to inspect for bed bugs (including monitoring interceptor traps if applicable) at least every 7 days in case any eggs remain.


Bed Bugs appearance, characteristics and behavior

The common bed bug (Cimex lectularius) has long been a pest – feeding on blood, causing itchy bites and generally irritating their human hosts. The Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture (USDA) all consider bed bugs a public health pest. However, unlike most public health pests, bed bugs are not known to transmit or spread disease.

They can, however, cause other public health issues, so it’s important to pay close attention to preventing and controlling bed bugs.

Experts believe the recent increase in bed bugs in the United States may be due to more travel, lack of knowledge about preventing infestations, increased resistance of bed bugs to pesticides, and ineffective pest control practices.

The good news is that there are ways to control bed bugs. Getting good, solid information is the first step in both prevention and control. While there is no chemical quick fix, there are effective strategies to control bed bugs involving both non-chemical and chemical methods.

Bed bugs can be hard to find and identify, given their small size and their habit of staying hidden. It helps to know what they look like, since the various life stages have different forms.

Bed Bugs Appearance and Life Cycle

Knowing what to look for is the first step in identifying and controlling bed bugs. There are many bugs that look like bed bugs, so an accurate identification is a critical first step to avoid costly treatment for the wrong bug.

Adult bed bugs, in general, are:

  • about the size of an apple seed (5-7 mm or 3/16 – 1/4 inch long);
  • long and brown, with a flat, oval-shaped body (if not fed recently);
  • balloon-like, reddish-brown, and more elongated (if fed recently);
  • a “true bug” (characteristics of true bugs include a beak with three segments;
  • antenna that have four parts; wings that are not used for flying; and short, golden-colored hairs); and smelly, with a “musty-sweetish” odor produced through glands on the lower side of the body.

Young bed bugs (also called nymphs), in general, are: smaller, translucent or whitish-yellow in color; and if not recently fed, can be nearly invisible to the naked eye because of coloring and size.

Bed bug eggs, in general, are:

  • tiny, the size of a pinhead;
  • pearl-white in color; and
  • marked by an eye spot if more than five days old.

The life cycle of a bed bug is shown in the photograph below. During its lifetime, a bed bug will go through the following stages (Starting from the top left, moving counterclockwise):

  • Eggs (1mm).
  • 1 st stage nymph (1.5 mm).
  • 2 nd stage nymph (2 mm).
  • 3 rd stage nymph (2.5 mm).
  • 4 th stage nymph (3 mm).
  • 5th stage nymph (4.5 mm).
  • Unfed adult female.
  • Unfed adult male.

How to Find Bed Bugs

If you have a bed bug infestation, it is best to find it early, before the infestation becomes established or spreads. Treating a minor infestation, while an inconvenience, is far less costly and easier than treating the same infestation after it becomes more widespread.

However, low-level infestations are also much more challenging to find and correctly identify. Other insects, such as carpet beetles, can be easily mistaken for bed bugs. If you misidentify a bed bug infestation, it gives the bugs more time to spread to other areas of the house or hitchhike a ride to someone’s house to start a new infestation.

Bites on the skin are a poor indicator of a bed bug infestation. Bed bug bites can look like bites from other insects (such as mosquitoes or chiggers), rashes (such as eczema or fungal infections), or even hives. Some people do not react to bed bug bites at all.

Looking for Signs of Bed Bugs

A more accurate way to identify a possible infestation is to look for physical signs of bed bugs. When cleaning, changing bedding, or staying away from home, look for:

  • Rusty or reddish stains on bed sheets or mattresses caused by bed bugs being crushed.
  • Dark spots (about this size: •), which are bed bug excrement and may bleed on the fabric like a marker would.
  • Eggs and eggshells, which are tiny (about 1mm) and pale yellow skins that nymphs shed as they grow larger.
  • Live bed bugs.

Where Bed Bugs Hide

When not feeding, bed bugs hide in a variety of places. Around the bed, they can be found near the piping, seams and tags of the mattress and box spring, and in cracks on the bed frame and headboard.

If the room is heavily infested, you may find bed bugs:

  • In the seams of chairs and couches, between cushions, in the folds of curtains.
  • In drawer joints.
  • In electrical receptacles and appliances.
  • Under loose wall paper and wall hangings.
  • At the junction where the wall and the ceiling meet.
  • Even in the head of a screw.

Since bed bugs are only about the width of a credit card, they can squeeze into really small hiding spots. If a crack will hold a credit card, it could hide a bed bug.

Bed Bug Behavior and Habit

Understanding the behavior of bed bugs (how they eat, live, and reproduce) will help you to find an infestation before it becomes established and to monitor for the presence of bed bugs after your home has been treated.


  • Appear to prefer to feed on humans, but will feed on other mammals and birds as well.
  • Will readily travel 5-20 feet from established hiding places (called harborage) to feed on a host.
  • Even though they are primarily active at night, if hungry they will seek hosts in full daylight.
  • Feeding can take 3-12 minutes.
  • The rusty or tarry spots found on bed sheets or in bug hiding places are because 20% of the time adults and large nymphs will void remains of earlier blood meals while still feeding.

Life stages/mating:

Bed bugs need at least one blood meal before the individual bug can develop to the next of the six life stages.

  • They can feed more than once.
  • Each stage also requires the molting of skin.

To continue to mate and produce eggs, both males and females must feed at least once every 14 days.

Each female may lay 1 to 3 eggs per day and 200-500 eggs per her lifetime (6-12 months but could be longer).

Egg-to-egg life cycle may take four to five weeks under favorable conditions.

Living conditions:

Bed bugs can survive and remain active at temperatures as low as 7°C (46°F), but they die when their body temperatures reaches 45°C (113°F).

Tropical bed bugs (Cimex hemipterus) require a higher average temperature than the common bed bug and are found in tropical and subtropical areas.

Hydraulic Fracturing & Health

Hydraulic fracturing, or fracking, is a method used to extract natural gas and oil from deep rock formations known as shale. Using this method, drilling operators force water, sand, and a mix of chemicals into horizontally drilled wells, causing the shale to crack and release natural gas or oil.

Hydraulic fracturing is one part of a broader process known as unconventional natural gas development, which refers to all operations associated with fracked wells, from well construction to the transport of gas and oil off the site.

Does hydraulic fracturing pose health risks to the people living near drilling sites?

Although research is underway, few studies to date have provided conclusive evidence about how unconventional natural gas development affects the health of nearby communities. Residents, environmental advocates, and some researchers have expressed concerns about potential health effects and environmental impacts on water and air in their communities.

More than two decades since the rapid expansion of unconventional natural gas extraction, researchers are now beginning to grasp the scope and extent of associated health effects and related costs. Mounting evidence related to environmental effects shows a need to analyze and quantify health and socioeconomic impacts using a common metric

Water quality

In some cases, it may be possible for natural gas and hydraulic fracturing-associated chemicals to travel through cracks in the rock into an underground drinking water source. Water contamination could also occur if a well is improperly installed, if chemicals are spilled from trucks or tanks, or if flowback is not effectively contained. Flowback is when water used in the hydraulic fracturing process flows out of the well. The extent of water contamination from these sources is currently unknown.

Air quality

Drilling sites can potentially affect local air quality in several ways. First, any process involving combustion can release toxic chemicals into the air. For example, the burning off, or flaring, of excess natural gas; the operation of heavy equipment at the well site; and the use of diesel trucks to transport materials to and from a site may all contribute to air pollution. In addition, the chemicals and sand used in the hydraulic fracturing process, as well as other chemicals that surface with the natural gas, may potentially become airborne and affect air quality.

Since operators are not always required to divulge the specific chemicals used, the extent of air pollution and the potential dangers to local communities are not well understood.

Community impacts

The changes associated with building and having a drilling site can have numerous impacts on community well-being. Some of these impacts may be positive. For example, a drilling operation can increase local employment rates, and result in greater access to health care. Drilling-associated activities, and a sudden influx of a large transient workforce, can also have negative impacts on a community. These may include increased noise, light, and traffic; heavier burdens on local infrastructure and resources, such as roads and hospitals; higher rates of crime and substance abuse; and changes to community character.

Are there health risks to the people who work at drilling sites?

Most of what is known about the health risks from unconventional natural gas development comes from studies of workers at these sites. While studies of worker exposures and health are limited, ongoing efforts continue to gather important insights. Currently, three hydraulic fracturing-specific health risks have been identified, in addition to risks, such as accidents, that are often associated with industrial occupations involving the use of heavy equipment.

1. Silica sand inhalation: Without proper protection, workers may inhale fine particles of silica sand, the type of sand used in the hydraulic fracturing process. Inhaling these particles can cause lung diseases.

2. Exposure to chemical spills: Accidental chemical spills may expose workers to compounds used in the hydraulic fracturing process, presenting a variety of health risks.

3. Exposure from flowback operations: Initial field studies suggest that workers performing certain operations may be exposed to high levels of volatile hydrocarbons, which can be acutely toxic. Exposures have resulted in the deaths of at least four workers involved in flowback operations, since 2010.

For health. For knowledge

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