I 
112TH CONGRESS 
1ST SESSION H. R. 2332 
To amend the Public Health Service Act to establish a program of research 
regarding the risks posed by the presence of dioxin, synthetic fibers, 
and other additives in feminine hygiene products, and to establish a 
program for the collection and analysis of data on toxic shock syndrome. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 23, 2011 
Mrs. MALONEY (for herself, Mr. FARR, and Mr. CONYERS) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to establish a pro-
gram of research regarding the risks posed by the pres-
ence of dioxin, synthetic fibers, and other additives in 
feminine hygiene products, and to establish a program 
for the collection and analysis of data on toxic shock 
syndrome. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Robin Danielson Act’’. 
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TITLE I—RESEARCH REGARDING 
RISKS POSED BY DIOXIN, SYN-
THETIC FIBERS, AND OTHER 
ADDITIVES IN FEMININE HY-
GIENE PRODUCTS 
SEC. 101. FINDINGS. 
The Congress finds as follows: 
(1) Tampons are used by approximately 
73,000,000 women in the United States today, and 
the average woman may use as many as 16,800 
tampons in her lifetime. A woman on estrogen re-
placement therapy may use as many as 24,360 tam-
pons in her lifetime. 
(2) The Environmental Protection Agency and 
the International Agency for Research on Cancer, an 
arm of the World Health Organization, have con-
cluded that dioxins are a probable human carcinogen 
(cancer causing agent). 
(3) According to the Food and Drug Adminis-
tration, dioxins are formed as a result of combustion 
processes such as commercial and municipal waste 
incineration and from burning fuels (like wood, coal, 
or oil). Dioxins are a byproduct of chlorine bleaching 
of pulp and paper. 
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(4) Tampons currently sold in the United 
States are composed of cotton, rayon, or of a com-
bination of cotton and rayon. Rayon is produced 
from cellulose fibers derived from bleached wood 
pulp. 
(5) While bleaching processes that do not 
produce dioxin in any amount are available, most 
wood pulp manufacturers currently use elemental- 
chlorine free bleaching processes. This process uses 
chlorine dioxide as a bleaching agent and still pro-
duces dioxins. 
(6) The Food and Drug Administration has not 
explicitly forbidden the use of chlorine in tampon 
manufacturing. 
(7) Trace amounts of dioxins can also be found 
in tampons that use a chlorine-free bleaching proc-
ess as well as 100 percent cotton tampons as the 
Environmental Protection Agency states that due to 
decades of pollution, dioxin can be found in the air, 
water, and ground and thus can be found in both 
cotton and wood pulp raw materials used in tampon 
production. 
(8) The effects of dioxin from various sources 
are cumulative. Women may be exposed to dioxin in 
tampons and other menstrual products for as long 
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as 60 years over the course of their reproductive 
lives. 
(9) The Food and Drug Administration has his-
torically relied on data provided by manufacturers of 
feminine hygiene products in determining product 
safety. 
(10) Although the Food and Drug Administra-
tion currently requires tampon manufacturers to 
monitor dioxin levels in their finished products, they 
do not generally collect this information and it is not 
readily available to the public. 
(11) Recent studies have produced conflicting 
information about the link between dioxin exposure 
and increased risks for endometriosis. 
(12) The Environmental Protection Agency has 
concluded that people with high levels of exposure to 
dioxins may be at risk for other noncancer effects 
that could suppress the immune system, increase the 
risk of pelvic inflammatory disease, reduce fertility, 
and interfere with fetal and childhood development. 
(13) Toxic Shock Syndrome (TSS) has been 
linked to tampon use especially those tampons con-
taining synthetic fibers and the absorbency of the 
tampon. TSS is a rare bacterial illness that occurs 
mostly in menstruating women. During 1979 and 
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1980, the syndrome was responsible for at least 55 
deaths and 1,066 nonfatal cases. 
(14) In response to a 1988 lawsuit, the Food 
and Drug Administration has required tampons to 
be labeled with reference to an absorbency standard 
(e.g., super tampons must absorb between 9 and 12 
grams of liquid). 
(15) As a result of independent research that 
showed that synthetic fiber additives in tampons am-
plify toxin production, which is associated with toxic 
shock syndrome, manufacturers have ceased to in-
clude three of the four synthetic ingredients once 
often used to increase tampon absorbency. Highly 
absorbent viscose rayon is still used in tampon pro-
duction. According to some TSS researchers inci-
dence of menstrually related TSS is creeping up and 
strains of Staphylococcus aureus causing it are be-
coming more antibiotic resistant and more virulent. 
SEC. 102. NATIONAL INSTITUTES OF HEALTH; RESEARCH 
ON DIOXIN PURSUANT TO OFFICE OF RE-
SEARCH ON WOMEN’S HEALTH. 
Part F of title IV of the Public Health Service Act 
(42 U.S.C. 287d et seq.) is amended by adding at the end 
the following section: 
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‘‘SEC. 486C. CERTAIN PROJECTS REGARDING WOMEN’S 
HEALTH. 
‘‘(a) DIOXIN IN FEMININE HYGIENE PRODUCTS.— 
‘‘(1) IN GENERAL.—The Director of NIH, in 
collaboration with the Director of the Office, shall 
provide for the conduct or support of research to de-
termine the extent to which the presence of dioxin, 
synthetic fibers, and other additives in tampons and 
other feminine hygiene products— 
‘‘(A) poses any risks to the health of 
women who use the products, including risks re-
lating to cervical cancer, endometriosis, infer-
tility, ovarian cancer, breast cancer, immune 
system deficiencies, pelvic inflammatory disease, 
and toxic shock syndrome; and 
‘‘(B) poses any risks to the health of chil-
dren of women who used such products during 
or before the pregnancies involved, including 
risks relating to fetal and childhood develop-
ment. 
‘‘(2) REQUIREMENT
REGARDING
DATA
FROM 
MANUFACTURERS.—Research under paragraph (1) 
shall include research to confirm the data on tam-
pons and other feminine hygiene products submitted 
to the Commissioner of Food and Drugs by manu-
facturers of such products. 
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‘‘(3) DEFINITION.—For purposes of paragraph 
(1), the term ‘feminine hygiene products’ means 
tampons, pads, liners, and similar products used by 
women with respect to menstruation or other gen-
ital-tract secretions. 
‘‘(b) REPORTS.—Reports on the results of research 
under subsection (a) shall be periodically submitted to the 
Congress, the Commissioner of Food and Drugs, the Ad-
ministrator of the Environmental Protection Agency, and 
the Chairman of the Consumer Product Safety Commis-
sion. Such reports shall be made available to the public 
through the data system and clearinghouse program es-
tablished under section 486A, or through other appro-
priate means.’’. 
TITLE 
II—COLLECTION 
AND 
ANALYSIS OF DATA ON TOXIC 
SHOCK SYNDROME 
SEC. 201. FINDINGS. 
The Congress finds as follows: 
(1) Of the cases of toxic shock syndrome in the 
United States, approximately 50 percent are related 
to tampon use and approximately 50 percent occur 
in nonmenstruating women and in men and children. 
(2) The Centers for Disease Prevention and 
Control has estimated that between one and two of 
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every 100,000 women 15 to 44 years of age will de-
velop the syndrome. 
(3) Epidemiological data on cases of toxic shock 
syndrome are not systematically collected in the 
United States, and information on cases seldom 
travels beyond the victim’s circle of family and 
friends. Toxic Shock Syndrome is a nationally 
notifiable disease that States report to the Centers 
for Disease Prevention and Control, but the report-
ing by the States is voluntary. 
(4) According to the Council of State and Ter-
ritorial Epidemiologists, as of 2006, only 39 States 
required reporting of streptococcal and non-strepto-
coccal toxic shock syndrome to State health officials. 
(5) The last active surveillance of toxic shock 
syndrome occurred in 1987 only in four States and 
surveying 12 million people. National surveillance is 
conducted through the National Electronic Tele-
communications Systems. 
(6) The Centers for Disease Prevention and 
Control and the States should cooperate to collect 
and analyze such data. Increasing the amount of in-
formation on toxic shock syndrome will lead to in-
creased awareness about the disease in the medical 
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community, and may also lead to an increased un-
derstanding of the causes of the syndrome. 
SEC. 202. CENTERS FOR DISEASE CONTROL AND PREVEN-
TION; ESTABLISHMENT OF PROGRAM FOR 
COLLECTION AND ANALYSIS OF DATA ON 
TOXIC SHOCK SYNDROME. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by inserting after sec-
tion 317T the following section: 
‘‘SEC. 317U. COLLECTION AND ANALYSIS OF DATA ON 
TOXIC SHOCK SYNDROME. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall carry out a program to collect, analyze, and 
make available data on toxic shock syndrome, including 
data on the causes of such syndrome. 
‘‘(b) NATIONAL INCIDENCE AND PREVALENCE.—In 
carrying out the program under subsection (a), the Sec-
retary shall to the extent practicable determine the na-
tional incidence and prevalence of toxic shock syndrome. 
‘‘(c) COOPERATION WITH STATES.—The Secretary 
may carry out the program under subsection (a) directly 
and through grants to States and local health depart-
ments. 
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2012 through 2016.’’. 
Æ 
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