Health issues and healthcare utilization among adults who reported exposure to tear gas during 2020 Portland (OR) protests: a cross-sectional survey

Abstract

Background Repeated use of chemical irritants for crowd-control by local and federal law enforcement during sustained racial justice protests in the U.S. has raised concerns about potential adverse health effects. The objective of this study was to describe the health consequences of exposure to tear gas agents and associated healthcare utilization among adults reporting recent exposure to tear gas. Methods A cross-sectional, self-administered web-based survey of a convenience sample of 2257 adults reporting recent exposure to tear gas in Portland, Oregon (U.S.), administered between July 30, 2020-August 20, 2020. Descriptive analyses were conducted on socioeconomic characteristics, reported health issues, utilization of healthcare services, and frequency of reported exposure to tear gas. Associations between reported mental health issues, healthcare utilization and race and/or ethnic categories were assessed using a chi-square test. For tests of association, racial and/or ethnic categories were divided into White/Non-Hispanic only and all other racial/ethnic categories due to a small number of Black, American Indian or Alaska Native, Asian/Pacific Islander, Hispanic participants and participants with multiple race and/or ethnic background. Effect sizes for the differences were expressed as Cramer’s V, a metric that measures associations between nominal responses. The Cochran-Armitage trend test was used to assess the relationship between health issues and the number of reported days of exposure to tear gas (i.e., a proxy dose of exposure) grouped into 1 day, 2–4 days, and ≥ 5 days. Missing data (item non-response) were omitted from the analysis. Results Almost all respondents (2116; 93.8%) reported physical (2114; 93.7%) or psychological (1635; 72.4%) health issues experienced immediately after (2105; 93.3%) or days following (1944; 86.1%) the exposure. A slightly higher proportion experienced delayed head or gastrointestinal tract issues compared with immediate complaints. The majority (1233; 54.6%) reported receiving or planning to seek medical or mental care. We observed a positive exposure-response trend for all except mouth-related delayed issues (p < 0.01). Conclusion Persons who reported exposer to tear gas agents also reported physical and psychological health issues over a multiple-day period. Health issues reported increased with the frequency of reported exposure, indicating a potential dose-response; these health effects often led to healthcare utilization. This study provides evidence of potential unexpected harms of tear gas in civilians.

More than tears: associations between exposure to chemical agents used by law enforcement and adverse reproductive health outcomes

“…Number of days of exposure had a significant positive associations with experiencing an adverse reproductive health outcome as participants who reported adverse reproductive health outcomes. This finding confirmed our hypothesis and, while the magnitude of each adverse reproductive health outcome was not quantified in this analysis, the significant association and increased days of exposure may indicate a crude dose-response pattern which has been observed for other health outcomes previously in tear gas exposure studies ( 10 ).…”

“…More recently, evidence of a dose-response relationship between to self-reported tear gas exposure and menstrual irregularities was established in Portland, Oregon utilizing cross-sectional data from summer 2020 exposures ( 10 ). Toxicology studies establishing CS and CN Immediately Dangerous to Life or Health Concentrations (IDLH) were last conducted in military settings in the 1960s and did not include surveillance for reproductive health effects ( 11 ).…”

State violence against protesters

“…Protests occurred over many weeks and federal agents repeatedly deployed massive quantities of chemical irritants and smoke including via thermal foggers, as shown in Figure 1.5 -hand-held devices producing large volumes of tear smoke from water or oil-based solutions, as well as from 'smoke pots' -open pots of burning incandescent substance (believed to be HC -Hexachloroethane) that produced dense clouds of grey/ white smoke. Protesters reported a wide range of respiratory and/or reproductive health impacts after attending protests and being exposed to the chemical irritants, including unusual effects on menstrual cycles (see Torgrimson-Ojerio et al, 2021).…”

“…One peer-reviewed study based on a web-based survey of 2257 adults reporting recent exposure to tear gas in Portland, Oregon (U.S.), found that 54.5% of 1650 respondents who potentially menstruate reported menstrual changes. The most reported issues were increased menstrual cramping, unusual spotting, increased bleeding, and more days of bleeding (Torgrimson-Ojerio et al, 2021).…”

Pharmacologic Inhibition of Transient Receptor Potential Ion Channel Ankyrin 1 Counteracts 2-Chlorobenzalmalononitrile Tear Gas Agent–Induced Cutaneous Injuries

“…Deployment of the tear gas agent 2-chlorobenzalmalononitrile (CS; C 10 H 5 ClN 2 , CAS: 2698-41-1) for riot control has significantly increased in recent years ( Olajos and Salem, 2001 ; Blain, 2003 ; Bessac et al, 2009 ; Bessac and Jordt, 2010 ; Schep et al, 2015 ; Rothenberg et al, 2016 ; Torgrimson-Ojerio et al, 2021 ). CS tear gas has been commonly used by police forces as a riot control agent (RCA) to disperse crowds and subdue individuals.…”