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Jarquin-Yañez L, Cruz ET, Martinez-Acuña MI, Calderon-Hernandez J. Perceptions and attitudes about the contribution of the environment to childhood cancer: a pilot study in a medical guild and undergraduate students. BMC MEDICAL EDUCATION 2024; 24:1138. [PMID: 39402539 PMCID: PMC11476317 DOI: 10.1186/s12909-024-05914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/14/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children's health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer. METHODS A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups. RESULTS Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001). CONCLUSIONS In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment.
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Affiliation(s)
- Lizet Jarquin-Yañez
- Academic Unit of Chemical Sciences, Autonomous University of Zacatecas, Jardín Juárez 147, Centro, Zacatecas, Zac, 98000, Mexico
- National Council of Humanities, Sciences and Technologies (CONAHCYT), Insurgentes Sur Avenue # 1582, Credito Constructor, Mexico City, 03940, Mexico
| | - Eunice Tello Cruz
- Center for Applied Research in Environment and Health, CIACYT-Faculty of Medicine, Autonomous University of San Luis Potosí, Avenida Sierra Leona No. 550, Lomas 2nd Section, San Luis Potosí, 78210, SLP, Mexico
| | - Monica Imelda Martinez-Acuña
- Academic Unit of Chemical Sciences, Autonomous University of Zacatecas, Jardín Juárez 147, Centro, Zacatecas, Zac, 98000, Mexico
| | - Jaqueline Calderon-Hernandez
- Center for Applied Research in Environment and Health, CIACYT-Faculty of Medicine, Autonomous University of San Luis Potosí, Avenida Sierra Leona No. 550, Lomas 2nd Section, San Luis Potosí, 78210, SLP, Mexico.
- Global Public Health Program, Schiller Institute for Integrated Science and Society, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
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Subiza-Pérez M, Vrotsou K, Esnal H, Kortajarena M, Mujika A, Marinelarena E, Aizpurua P, Arrue M, Mitxelena X, Larrinaga-Torrontegui U, Apalategi U, Campillo I Lopez F, Ibarluzea J. Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles. ENVIRONMENTAL RESEARCH 2024; 243:117789. [PMID: 38052356 DOI: 10.1016/j.envres.2023.117789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.
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Affiliation(s)
- Mikel Subiza-Pérez
- Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bc 6RJ, Bradford, UK; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, c/ Monforte de Lemos 3-5, Madrid, 280, Spain; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain s/n, 20014, Donostia- San Sebastián, Spain.
| | - Kalliopi Vrotsou
- Osakidetza Basque Health Service, Directorate of Health Care, PC-IHOs Research Group of Gipuzkoa, Spain; Biodonostia Health Research Institute, Primary Care Research Group, San Sebastian, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - Haritz Esnal
- Department of Preventive Medicine and Public Health, University of the Basque Country UPV/EHU, Paseo Dr Beguiristain, 105, 20014, Donostia-San Sebastian, Spain; Emergency Department, Donostia University Hospital, Paseo Dr Beguiristain, 20014, Donostia-San Sebastian, Spain.
| | - Maider Kortajarena
- Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Paseo Doctor Begiristain 105, 20014, Donostia-San Sebastian, Spain.
| | - Agurtzane Mujika
- Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Paseo Doctor Begiristain 105, 20014, Donostia-San Sebastian, Spain.
| | - Eulalia Marinelarena
- Multiprofessional Teaching Unit of Family and Community Care of Gipuzkoa, Gipuzkoa, Spain.
| | - Pilar Aizpurua
- Health Centre of Ondarreta, ESI Donostialdea, Basque Health Service, Avenida de Zumalakarregi, 24, 2008, Donostia-San Sebastian, Spain.
| | - Miren Arrue
- Department of Obstetrics and Gynecology, Donostia University Hospital, Paseo Doctor Begiristain s/n, 20014, Donostia- San Sebastián, Spain.
| | - Xabier Mitxelena
- Health Centre of Ibarra, ESI Tolosaldea, Osakidetza. Basque Health Service, Euskalherria kalea 14, 20400, Ibarra, Spain.
| | - Unai Larrinaga-Torrontegui
- Preventive Medicine, Mendaro Hospital, Debabarrena Integrated Health Organization, Osakidetza. Mendarozabal z/g, 20850, Mendaro, Gipuzkoa, Spain.
| | - Uxune Apalategi
- Biodonostia Health Research Institute, Primary Care Research Group, San Sebastian, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza, Central Services, Multiprofessional Family and Community Care Teaching Unit of Araba, Lakuabizkarra Health Center, 01010, Vitoria-Gasteiz, Spain; Department of Pharmacology, University of the Basque Country UPV/EHU, 20018, Donostia-San Sebastián, Spain.
| | - Ferran Campillo I Lopez
- Pediatric Environmental Health Specialty Unit (PEHSU), Garrotxa Region Pediatric Team, Fundació Hospital d'Olot I Comarcal de la Garrotxa, Avinguda Països Catalans 86, 17800, Olot, Girona, Catalonia, Spain; Vall d'en Bas Primary Healthcare Centre, Garrotxa Region Pediatric Team, Fundació Hospital d'Olot I Comarcal de la Garrotxa, Carrer Doctor Turró, 2, 17176, Sant Esteve d'en Bas, Girona, Girona, Catalonia, Spain; Working Group on Environmental Health, Catalan Society of Pediatrics, Spain; Comitte on Environmental Health, Spanish Association of Pediatrics, Spain.
| | - Jesús Ibarluzea
- Faculty of Psychology, University of the Basque Country UPV/EHU, Avenida Tolosa 70, 20018, Donostia-San Sebastián, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013, Donostia-San Sebastián, Spain.
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Tambasco D, Franklin M, Harris SA, Tibout P, Doria AS. A geospatial assessment of industrial releases and pediatric neuroblastic tumours at diagnosis: A retrospective case series. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2024; 78:455-470. [PMID: 38190263 DOI: 10.1080/19338244.2023.2291734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
Environmental risk factors associated with malignancy of pediatric neuroblastic tumours are not well-known and few studies have examined the relationship between industrial emissions and neuroblastic tumour diagnosis. A retrospective case series of 310 patients was evaluated at a tertiary hospital in Toronto, Canada between January 2008, and December 2018. Data from the National Pollutant Release Inventory (NPRI) were used to estimate exposure for a dozen chemicals with known or suspected carcinogenicity or embryotoxicity. Comparative analysis and predictive logistic regression models for malignant versus benign neuroblastic tumours included variables for residential proximity, number, and type of industries, mean total emissions within 2 km, and inverse distance weighted (IDW) quantity of chemical-specific industrial emissions estimated within 10 and 50 km of cases. No significant difference was seen between malignant and benign cases with respect to the mean nearest residential distance to industry, the number or type of industry, or the mean total quantity of industrial emissions within a 2 km radius of residential location of cases. However, there were statistically significant differences in the interpolated IDW emissions of dioxins and furans released between 1993 and 2019 within 10 km. Concentrations were significantly higher in malignant neuroblastic tumours at 1.65 grams (g) toxic equivalent (TEQ) (SD 2.01 g TEQ) compared to benign neuroblastic tumours at 1.13 g TEQ (SD 0.84 g TEQ) (p = 0.05). Within 50 km 3 years prior to diagnosis, malignant cases were exposed to higher levels of aluminum, benzene, and nitrogen dioxide (p = 0.02, p = 0.04, and p = 0.02 respectively). Regression analysis of the IDW emissions within a 50 km radius revealed higher odds of exposure to benzene for malignant neuroblastic tumours (OR = 1.03, CI: 1.01-1.05, p = 0.01). These preliminary findings suggest a potential role of industrial emissions in the development of malignant pediatric neuroblastic tumours and underscore the need for further research to investigate these associations.
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Affiliation(s)
- Domenica Tambasco
- Department of Family and Community Medicine, Women's College Hospital, Environmental Health Clinic and University of Toronto, Toronto, Ontario, Canada
| | - Meredith Franklin
- Department of Statistical Sciences and School of the Environment, University of Toronto, Toronto, Ontario, Canada
| | - Shelley A Harris
- Divisions of Epidemiology & Occupational and Environmental Health, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Pauline Tibout
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Keten HS. The knowledge levels of medical interns on childhood cancers. Postgrad Med 2022; 134:675-679. [PMID: 35700166 DOI: 10.1080/00325481.2022.2090184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to determine the knowledge levels of medical interns on childhood cancers (CC). METHODS This study included a total of 302 interns from the Gaziantep University School of Medicine between 15th-20 October 2021. A questionnaire consisting of 47 knowledge questions prepared from the literature was performed to all final year medical students to measure their overall knowledge level. All questions with right answers scored one point. RESULTS The knowledge scores of participants ranged between 13 and 47 with a mean score of 37.74 ± 7.51 (women = 37.11 ± 7.95, men = 38.34 ± 7.03). The knowledge level was similar between men and women (p = 0.158). The interns who had completed their final year pediatric internship (p = 0.44) and ones who stated that they had recieved adequate training in terms of CC (p = 0.011) had significantly higher knowledge scores. Of the risk factors for CC, most commonly known were genetic diseases (n = 296, 98.0%) and radiation exposure (n = 296, 98.0%). Enlarged lymph nodes (n = 290, 96.0%) and palpable abdominal mass (n = 286, 94.7%) were the symptoms interns were most commonly aware about. CONCLUSIONS We found that the interns were seriously lacking knowledge about CC. Training has a positive effect on CC knowledge of the interns hence, the curriculum should be rearranged properly to improve this issue. A significant portion of interns do not consider their knowledge on CC as adequate and demand for further training. Insufficient familiarity regarding the symptoms of CC may lead to delays in early diagnosis. It is of significant importance that the Ministry of Health and its stakeholders generate projects informing especially the healthcare professionals and the public regarding risk factors and the symptoms of CC.
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Affiliation(s)
- Hamit Sirri Keten
- Department of Family Medicine, Medical Faculty, Gaziantep University, Gaziantep, Turkey
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Green R, Lanphear B, Phipps E, Goodman C, Joy J, Rihani S, Flora D, Till C. Development and Validation of the Prevention of Toxic Chemicals in the Environment for Children Tool: A Questionnaire for Examining the Community's Knowledge of and Preferences Toward Toxic Chemicals and Children's Brain Development. Front Public Health 2022; 10:863071. [PMID: 35646798 PMCID: PMC9130721 DOI: 10.3389/fpubh.2022.863071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Early-life exposures to toxic chemicals can adversely impact brain development. Understanding people's knowledge of the impact of toxic chemicals on brain development is critical to reduce widespread exposure to chemicals. Yet it is unknown what people know about risks of toxic chemicals and how to reduce exposures. We developed and validated the questionnaire, PRevention of Toxic chemicals in the Environment for Children Tool (PRoTECT), to examine people's knowledge and attitudes about the influence of toxic chemicals on child development. We used best practices for developing and validating scales. First, we drafted items to assess knowledge of the impact of toxic chemicals on brain development, levels of concern regarding exposures, and preferences for prevention of neurodevelopmental disorders. Second, we received feedback on item clarity from five focus groups consisting of 46 community participants. In addition, 17 experts completed a content validity scale for each item and provided qualitative feedback. We administered the revised 18-item questionnaire to 190 participants of child-bearing age for scale development, and using exploratory factor analysis, we found evidence for a four-factor model of PRoTECT, RMSR = 0.05, of which 16 of the 18 items had adequate content validity with loadings >0.40 on a derived factor. We discuss future directions and applications of PRoTECT.
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Affiliation(s)
- Rivka Green
- Department of Psychology, York University, Toronto, ON, Canada
| | - Bruce Lanphear
- Faculty of Health, Simon Fraser University, Burnaby, BC, Canada
| | - Erica Phipps
- Prenatal Environmental Health Education (PEHE) Collaboration, University of Ottawa, Ottawa, ON, Canada
| | - Carly Goodman
- Department of Psychology, York University, Toronto, ON, Canada
| | - Jasmine Joy
- Department of Psychology, York University, Toronto, ON, Canada
| | - Samer Rihani
- Faculty of Health, Simon Fraser University, Burnaby, BC, Canada
| | - David Flora
- Department of Psychology, York University, Toronto, ON, Canada
| | - Christine Till
- Department of Psychology, York University, Toronto, ON, Canada
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Joseph N, Kolok AS. Assessment of Pediatric Cancer and Its Relationship to Environmental Contaminants: An Ecological Study in Idaho. GEOHEALTH 2022; 6:e2021GH000548. [PMID: 35310467 PMCID: PMC8917512 DOI: 10.1029/2021gh000548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 05/31/2023]
Abstract
The primary aim of this study was to determine the degree to which a multivariable principal component model based on several potentially carcinogenic metals and pesticides could explain the county-level pediatric cancer rates across Idaho. We contend that human exposure to environmental contaminants is one of the reasons for increased pediatric cancer incidence in the United States. Although several studies have been conducted to determine the relationship between environmental contaminants and carcinogenesis among children, research gaps exist in developing a meaningful association between them. For this study, pediatric cancer data was provided by the Cancer Data Registry of Idaho, concentrations of metals and metalloids in groundwater were collected from the Idaho Department of Water Resources, and pesticide use data were collected from the United States Geological Survey. Most environmental variables were significantly intercorrelated at an adjusted P-value <0.01 (97 out of 153 comparisons). Hence, a principal component analysis was employed to summarize those variables to a smaller number of components. An environmental burden index (EBI) was constructed using these principal components, which categorized the environmental burden profiles of counties into low, medium, and high. EBI was significantly associated with pediatric cancer incidence (P-value <0.05). The rate ratio of high EBI profile to low EBI profile for pediatric cancer incidence was estimated as 1.196, with lower and upper confidence intervals of 1.061 and 1.348, respectively. A model was also developed in the study using EBI to estimate the county-level pediatric cancer incidence in Idaho (Nash-Sutcliffe Efficiency = 0.97).
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Affiliation(s)
- Naveen Joseph
- Idaho Water Resources Research InstituteUniversity of IdahoMoscowIDUSA
| | - Alan S. Kolok
- Idaho Water Resources Research InstituteUniversity of IdahoMoscowIDUSA
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Waters AR, Warner EL, Vaca Lopez PL, Kirchhoff AC, Ou JY. Perceptions and knowledge of air pollution and its health effects among caregivers of childhood cancer survivors: a qualitative study. BMC Cancer 2021; 21:1070. [PMID: 34592955 PMCID: PMC8482574 DOI: 10.1186/s12885-021-08739-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Emerging research suggests that survivors of childhood and adolescent cancers are at risk for morbidity and mortality associated with air pollutants. However, caregiver perceptions of the effects of air pollution are unknown. Thus, to address this gap we described caregivers' perceptions of air pollution's impact on general population health and specifically on childhood cancer survivors, and caregivers' air pollution information-seeking and exposure reduction behaviors. METHODS Participants were Utah residents, ≥18 years, and caregiver of a childhood cancer survivor who had completed treatment. Semi-structured interviews were conducted with caregivers to describe their perspectives on air quality, how air pollution impacts health (general population and survivor health), and their information seeking and exposure reduction behaviors. Interviews were recorded, transcribed, and analyzed through two rounds of structured coding. RESULTS Caregivers (N = 13) were non-Hispanic white and primarily females (92.3%) between 30 and 49 years old (46.2%). Most families lived within the Wasatch Front (69.2%), the main metropolitan of Utah. Two categories emerged pertaining to caregiver's perceptions of air pollution: 1) Limited awareness about the health effects of air pollution, and 2) Unsuccessful information seeking and minimal exposure reduction behaviors. All caregivers held negative perceptions of air pollution in Utah, but most were unaware of how pollution affects health. While some families limited air pollution exposure by avoiding outdoor activity or physically leaving the region, few practiced survivor-specific exposure reduction. Nearly half of caregivers worried about potential effects of air pollution on survivor health and wanted more information. CONCLUSIONS Despite negative perceptions of air pollution, caregivers were divided on whether air pollution could impact survivor health. Few caregivers engaged in exposure reduction for their cancer survivor. As air pollution levels increase in the U.S., continued research on this topic is essential to managing cancer survivor respiratory and cardiovascular health.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
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Goldman RH, Zajac L, Geller RJ, Miller MD. Developing and implementing core competencies in children's environmental health for students, trainees and healthcare providers: a narrative review. BMC MEDICAL EDUCATION 2021; 21:503. [PMID: 34560874 PMCID: PMC8464086 DOI: 10.1186/s12909-021-02921-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/01/2021] [Indexed: 05/29/2023]
Abstract
Knowledge of the health impacts of environmental exposures (such as pollution disasters, poor air quality, water contamination, climate change) on children's health has dramatically increased in the past 40 years. The World Health Organization (WHO) estimated that 23% of all deaths worldwide were attributable to the environment, and 26% of deaths in children less than 5 years old could be prevented with removal of environmental risks factors. Yet, little has permeated medical education, leaving pediatric providers ill equipped to address these issues. To address this gap, members from the Pediatric Environmental Health Specialty Units, a United States nationwide network of academically affiliated experts who have created numerous environmental health educational materials and programs, have identified fifteen core environmental health (EH) competencies needed by health care providers to enable them to effectively address environmental health concerns. These competencies can serve as the foundation for the development and implementation of relevant educational programs. The core EH competencies are based upon these foundational elements: 1) Definition of "children's environmental health" that describes how environmental exposures (positive and negative) in early life influence the health and development in childhood and across the entire human life span 2) Children are not "little adults" and so have unique vulnerabilities to environmental hazards; 3) Environmental health inequities exist, causing some children to have a disproportionate amount of unhealthy exposures and consequently a greater risk of adverse effects; 4) Climate change will translate to numerous adverse health effects that will particularly affect children worldwide. In this article, the authors describe the core environmental health competencies and provide resources, online tools, strategies, and examples targeted to all levels of training and practice to better enable leaders and educators to bring this important content to the forefront.
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Affiliation(s)
- Rose Hannah Goldman
- Department of Medicine, Cambridge Health Alliance, Cambridge Massachusetts, Cambridge Hospital, Macht Center 427, Cambridge, MA, 02139, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Lauren Zajac
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Robert J Geller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mark D Miller
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, California, San Francisco, USA
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Becker A, Tawk R, Kiros G, Suther S, Hilliard A, Gragg R, Close F, Harris CM. Physician Training Related to Environmental Hazards near Ash Superfund Sites. EUROPEAN JOURNAL OF ENVIRONMENT AND PUBLIC HEALTH 2021; 5:em0086. [PMID: 34746647 PMCID: PMC8568049 DOI: 10.21601/ejeph/11096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physicians do not receive formal environmental health training in medical schools. The objectives of this study were to provide health care providers with basic environmental medicine training to better advise, treat or refer patients in the community and to observe any differences in the environmental medicine learning gains pre/post- test assessment. To rectify the problem of the lack of physicians' training related to environmental hazards, we conducted an environmental health workshop which targeted physicians living near Health Zone 1, Superfund ash sites. Fifty health care providers from both St. Vincent Family Medicine and Department of Health, Duval County Health Department (DOH-Duval) participated in a pre-test survey before the training and a post-test survey following the training. We used a non-parametric Wilcoxon Signed-Rank test to compare pre- and post- knowledge of training participants. At the 10% level of significance, the number of incorrect answers significantly declined in the post-training survey compared to the pre-training survey for all participants from both facilities combined (p=0.083). Site-specific analysis show, while a significant difference was found for participants from the St. Vincent's site (p=0.084), the difference for participants from the DOH-Duval site was not significant (p = 0.102), although the number of incorrect answers declined. The training resulted in learning gains for the 50 participants and the evaluations were very positive with 100% of physicians recommending this training to other health care providers. Additionally, training participants gave a high mark for the environmental medicine pocket guide. In 2019, the ash sites are 90% remediated and cleanup is expected to be completed in 2022. There is still a need for additional training for physicians due to other active sites (i.e., Kerr-McGee) in the community. This study highlights the importance of providing environmental hazards training to physicians and the approach by which it could be delivered effectively.
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Affiliation(s)
- Alan Becker
- Florida A&M University, College of Pharmacy, Pharmaceutical Sciences and Institute of Public Health 1515 Martin Luther King, Jr., Tallahassee, FL 32307
| | - Rima Tawk
- Florida A&M University, College of Pharmacy, Pharmaceutical Sciences and Institute of Public Health 1515 Martin Luther King, Jr., Tallahassee, FL 32307
| | - Gebre Kiros
- Florida A&M University, College of Pharmacy, Pharmaceutical Sciences and Institute of Public Health 1515 Martin Luther King, Jr., Tallahassee, FL 32307
| | - Sandra Suther
- Florida A&M University, College of Pharmacy, Pharmaceutical Sciences and Institute of Public Health, Economic, Social and Administrative Pharmacy. 1515 Martin Luther King, Jr., Tallahassee, FL 32307
| | | | - Richard Gragg
- Florida A&M University, School of the Environment. 1515 Martin Luther King, Jr., Tallahassee, FL 32307
| | - Fran Close
- Florida A&M University, College of Pharmacy, Pharmaceutical Sciences and Institute of Public Health. 1515 Martin Luther King, Jr., Tallahassee, FL 32307
| | - Cynthia M Harris
- Florida A&M University, College of Pharmacy, Pharmaceutical Sciences, Institute of Public Health. 1515 Martin Luther King, Jr., Tallahassee, FL 32307
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Kligler B, Pinto Zipp G, Rocchetti C, Secic M, Ihde ES. The impact of integrating environmental health into medical school curricula: a survey-based study. BMC MEDICAL EDUCATION 2021; 21:40. [PMID: 33419439 PMCID: PMC7796639 DOI: 10.1186/s12909-020-02458-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/16/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Inclusion of environmental health (EH) in medical education serves as a catalyst for preparing future physicians to address issues as complex as climate change and health, water pollution and lead contamination. However, previous research has found EH education to be largely lacking in U.S. medical education, putting future physicians at risk of not having the expertise to address patients' environmental illnesses, nor speak to prevention. METHODS Environmental health (EH) knowledge and skills were incorporated into the first-year medical school curriculum at Hackensack Meridian School of Medicine (Nutley, New Jersey), via a two-hour interactive large group learning module with follow up activities. Students completed the Environmental Health in Med School (EHMS) survey before and after the year 1 EH module. This survey evaluates medical students' attitudes, awareness and professionalism regarding environmental health. In year 2, students completed the Environmental Health Survey II, which measured students' perceptions of preparedness to discuss EH with future patients. The research team created both surveys based upon learning objectives that broadly aligned with the Institute of Medicine six competency-based environmental health learning objectives. RESULTS 36 year 1 students completed both the pre and post EHMS surveys. McNemar's test was used for paired comparisons. Results identified no statistically significant changes from pre to post surveys, identifying a dramatic ceiling. When comparing year 2, EHS II pre-survey (n = 84) and post-survey (n = 79) responses, a statistically significant positive change in students' self-reported sense of preparedness to discuss environmental health with their patients following the curriculum intervention was noted. CONCLUSIONS Our conclusion for the EHMS in Year 1 was that the current generation of medical students at this school is already extremely aware of and concerned about the impact of environmental issues on health. Through the EHS II in Year 2, we found that the six-week environmental health module combining didactic and experiential elements significantly increased medical students' self-reported sense of preparedness to discuss environmental health issues, including climate change, with their patients.
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Affiliation(s)
- Benjamin Kligler
- The Deirdre Imus Environmental Health Center®, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Genevieve Pinto Zipp
- Department of Interprofessional Health Sciences & Health Administration, School of Health and Medical Sciences, Seton Hall University, Nutley, NJ, USA
| | | | | | - Erin Speiser Ihde
- The Deirdre Imus Environmental Health Center®, Hackensack University Medical Center, Hackensack, NJ, USA.
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Castner J, Amiri A, Huntington-Moskos L. Applying the NIEHS translational research framework (NIEHS-TRF) to map clinical environmental health research trajectories. Nurs Outlook 2020; 68:301-312. [PMID: 32273105 PMCID: PMC9875864 DOI: 10.1016/j.outlook.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 01/27/2023]
Abstract
Background: There is a need for comprehensive planning tools and exemplars for clinical environmental health research programs. The National Institute of Environmental Health Sciences Translational Research Framework (NIEHS-TRF), as a comprehensive research activity mapping framework, promises to fill this gap in program planning and communication tools. Objective: The objective is a proof of concept demonstration to apply the NIEHS-TRF as a research project and career trajectory cartography framework. Methods: We utilized case series examples to apply the NIEHS-TRF as a project/career cartography framework. After a tailored research mission statement is clarified, the four step process in the NIEHS-TRF application includes 1) identifying research categories and activities (depicted visually by rings/nodes) that link to research program deliverables, 2) within each category (visual ring), linking specific works and program outcomes to activities (visual nodes), 3) coherently depicting visually as an overall map, and 4) developing recommended improvements for the NIEHS-TRF for research program cartography utility. Results: Successful mapping of a research project plan in a training grant application, a summary of an individual trajectory of research, and a community-initiated project was completed with mapping visualizations. The exercise facilitated purposeful planning and communication to describe common translational goals, progress, and targeted need for interdisciplinary collaboration. Discussion: Utilizing the NIEHS-TRF as a mapping tool for research program planning enabled unique insights into strengths, gaps, collaboration opportunities, and applications for environmental health nursing. This research project, career, and community-initiated research program trajectory mapping communication tool promises to accelerate impact and advancement through purposeful and clear planning for ongoing research activities along the translational continuum.
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Affiliation(s)
| | - Azita Amiri
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama, USA
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12
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Ackermann S, Fischer M. Telomere Maintenance in Pediatric Cancer. Int J Mol Sci 2019; 20:E5836. [PMID: 31757062 PMCID: PMC6928840 DOI: 10.3390/ijms20235836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Telomere length has been proposed as a biomarker of biological age and a risk factor for age-related diseases and cancer. Substantial progress has been made in recent decades in understanding the complex molecular relationships in this research field. However, the majority of telomere studies have been conducted in adults. The data on telomere dynamics in pediatric cancers is limited, and interpretation can be challenging, especially in cases where results are contrasting to those in adult entities. This review describes recent advances in the molecular characterization of structure and function of telomeres, regulation of telomerase activity in cancer pathogenesis in general, and highlights the key advances that have expanded our views on telomere biology in pediatric cancer, with special emphasis on the central role of telomere maintenance in neuroblastoma. Furthermore, open questions in the field of telomere maintenance research are discussed in the context of recently published literature.
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Affiliation(s)
- Sandra Ackermann
- Department of Experimental Pediatric Oncology, University Children’s Hospital of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Matthias Fischer
- Department of Experimental Pediatric Oncology, University Children’s Hospital of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
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Bijlsma N, Cohen MM. Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice. Environ Health Prev Med 2018; 23:19. [PMID: 29769039 PMCID: PMC5956903 DOI: 10.1186/s12199-018-0709-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/03/2018] [Indexed: 12/26/2022] Open
Abstract
Background Most clinicians feel ill-equipped to assess or educate patients about toxicant exposures, and it is unclear how expert environmental medicine clinicians assess these exposures or treat exposure-related conditions. We aimed to explore expert clinicians’ perspectives on their practice of environmental medicine to determine the populations and toxicants that receive the most attention, identify how they deal with toxicant exposures and identify the challenges they face and where they obtain their knowledge. Methods A qualitative study involving semi-structured interviews with expert environmental clinicians in Australia and New Zealand was conducted. Interviews were recorded and transcribed, and themes were identified and collated until no new themes emerged. Results Five dominant themes emerged from 16 interviews: (1) environmental medicine is a divided profession based on type of practice, patient cohort seen and attitudes towards nutrition and exposure sources; (2) clinical assessment of toxicant exposures is challenging; (3) the environmental exposure history is the most important clinical tool; (4) patients with environmental sensitivities are increasing, have unique phenotypes, are complex to treat and rarely regain full health; and (5) educational and clinical resources on environmental medicine are lacking. Conclusions Environmental medicine is divided between integrative clinicians and occupational and environmental physicians based on their practice dynamics. All clinicians face challenges in assessing toxicant loads, and an exposure history is seen as the most useful tool. Standardised exposure assessment tools have the potential to significantly advance the clinical practice of environmental medicine and expand its reach across other clinical disciplines.
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Affiliation(s)
- Nicole Bijlsma
- RMIT, School of Health and Biomedical Sciences, PO Box 71, Bundoora, Victoria, 3083, Australia.
| | - Marc Maurice Cohen
- RMIT, School of Health and Biomedical Sciences, PO Box 71, Bundoora, Victoria, 3083, Australia
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15
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Yi J, Kim MA, Parsons BG, Wu YP. Why did I get cancer? Perceptions of childhood cancer survivors in Korea. SOCIAL WORK IN HEALTH CARE 2018; 57:300-314. [PMID: 29436970 PMCID: PMC5927584 DOI: 10.1080/00981389.2018.1436113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored whether and how childhood cancer survivors in Korea ask and resolve the question of what may have caused their cancer. Thirty-one childhood cancer survivors participated in in-depth interviews about their self-questioning process in this regard. The findings indicate that Korean childhood cancer survivors pondered this question alone due to the stigma attached to cancer in the family and society. Their answers included internal factors (doing "bad things," having unhealthy eating habits, engaging in magical thinking, having a stress-prone personality, or having a biological susceptibility) or external factors (stressors, random events, the environment, or medical conditions). How they perceived the cause of cancer had an impact on aspects of their current lives. Psychosocial care standards or guidelines are needed in regard to the provision of a safe environment in which Korean cancer survivors and their parents can share their perceptions and process their thoughts.
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Affiliation(s)
- Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Min Ah Kim
- Department of Social Welfare, Myongji University, Seoul, Republic of Korea
| | | | - Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
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16
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Shah S, Wong S, Bearer C, Brumberg H. Environmental health reform in a synthetic world. Pediatr Res 2017; 82:373-375. [PMID: 28700570 PMCID: PMC5730070 DOI: 10.1038/pr.2017.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/07/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Shetal Shah
- Maria Fareri Children’s Hospital, New York Medical College, Division of Neonatology, Department of Pediatrics, 100 Woods Road, C-225A, Valhalla, NY 10595
| | - Shale Wong
- University of Colorado Denver School of Medicine, Aurora, Colorado, United States
| | | | - Heather Brumberg
- New York Medical College - Division of Neonatology, Department of Pediatrics and Public Health, Maria, Fareri Children’s Hospital, Valhalla, New York
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Elliott EG, Trinh P, Ma X, Leaderer BP, Ward MH, Deziel NC. Unconventional oil and gas development and risk of childhood leukemia: Assessing the evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 576:138-147. [PMID: 27783932 PMCID: PMC6457992 DOI: 10.1016/j.scitotenv.2016.10.072] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 05/17/2023]
Abstract
The widespread distribution of unconventional oil and gas (UO&G) wells and other facilities in the United States potentially exposes millions of people to air and water pollutants, including known or suspected carcinogens. Childhood leukemia is a particular concern because of the disease severity, vulnerable population, and short disease latency. A comprehensive review of carcinogens and leukemogens associated with UO&G development is not available and could inform future exposure monitoring studies and human health assessments. The objective of this analysis was to assess the evidence of carcinogenicity of water contaminants and air pollutants related to UO&G development. We obtained a list of 1177 chemicals in hydraulic fracturing fluids and wastewater from the U.S. Environmental Protection Agency and constructed a list of 143 UO&G-related air pollutants through a review of scientific papers published through 2015 using PubMed and ProQuest databases. We assessed carcinogenicity and evidence of increased risk for leukemia/lymphoma of these chemicals using International Agency for Research on Cancer (IARC) monographs. The majority of compounds (>80%) were not evaluated by IARC and therefore could not be reviewed. Of the 111 potential water contaminants and 29 potential air pollutants evaluated by IARC (119 unique compounds), 49 water and 20 air pollutants were known, probable, or possible human carcinogens (55 unique compounds). A total of 17 water and 11 air pollutants (20 unique compounds) had evidence of increased risk for leukemia/lymphoma, including benzene, 1,3-butadiene, cadmium, diesel exhaust, and several polycyclic aromatic hydrocarbons. Though information on the carcinogenicity of compounds associated with UO&G development was limited, our assessment identified 20 known or suspected carcinogens that could be measured in future studies to advance exposure and risk assessments of cancer-causing agents. Our findings support the need for investigation into the relationship between UO&G development and risk of cancer in general and childhood leukemia in particular.
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Affiliation(s)
- Elise G Elliott
- Yale School of Public Health, Yale University, 60 College St., New Haven, CT 06520, USA
| | - Pauline Trinh
- Yale School of Public Health, Yale University, 60 College St., New Haven, CT 06520, USA
| | - Xiaomei Ma
- Yale School of Public Health, Yale University, 60 College St., New Haven, CT 06520, USA
| | - Brian P Leaderer
- Yale School of Public Health, Yale University, 60 College St., New Haven, CT 06520, USA
| | - Mary H Ward
- National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD 20850, USA
| | - Nicole C Deziel
- Yale School of Public Health, Yale University, 60 College St., New Haven, CT 06520, USA..
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Kriebel D, Hoppin PJ, Jacobs MM, Clapp RW. Environmental and Economic Strategies for Primary Prevention of Cancer in Early Life. Pediatrics 2016; 138:S56-S64. [PMID: 27940978 DOI: 10.1542/peds.2015-4268i] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/24/2022] Open
Abstract
This article summarizes the evidence for environmental toxic exposures contributing to cancers in early life, focusing on the most common cancer sites in this age group. It provides examples of widespread avoidable exposures to human carcinogens through air, water, and food and then describes recent examples of successful initiatives to reduce exposure to chemicals linked to these cancer sites, through government policy, industry initiatives, and consumer activism. State government initiatives to reduce toxic chemical exposures have made important gains; the Toxics Use Reduction Act of Massachusetts is now 25 years old and has been a major success story. There are a growing number of corporate initiatives to eliminate toxics, especially carcinogens, from the products they manufacture and sell. Another important opportunity for cancer prevention is provided by online databases that list chemicals, their toxicity, and lower-toxicity alternatives; these can be used by businesses, health care institutions, consumers, and workers to reduce exposures to chemicals of concern. The article concludes by inviting pediatricians and public health professionals to include elimination of carcinogen exposures in their work to promote primary prevention of cancer in early life.
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Affiliation(s)
- David Kriebel
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Polly J Hoppin
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Molly M Jacobs
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Richard W Clapp
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts
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Metayer C, Dahl G, Wiemels J, Miller M. Childhood Leukemia: A Preventable Disease. Pediatrics 2016; 138:S45-S55. [PMID: 27940977 PMCID: PMC5080868 DOI: 10.1542/peds.2015-4268h] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 01/26/2023] Open
Abstract
In contrast to most pediatric cancers, there is a growing body of literature, nationally and internationally, that has implicated the role of several environmental indoor and outdoor hazards in the etiology of childhood leukemia. For example, exposures to solvents, traffic, pesticides, and tobacco smoke have consistently demonstrated positive associations with the risk of developing childhood leukemia. Intake of vitamins and folate supplementation during the preconception period or pregnancy has been demonstrated to have a protective effect. Despite the strength of these findings, the dissemination of this knowledge to clinicians has been limited. Some children may be more vulnerable than others as documented by the high and increasing incidence of childhood leukemia in Hispanics. To protect children's health, it is prudent to establish programs to alter exposure to those factors with well-established associations with leukemia risk rather than to suspend judgment until no uncertainty remains. This is particularly true because other serious health outcomes (both negative and positive) have been associated with the same exposures. We draw from historical examples to put in perspective the arguments of association versus causation, as well as to discuss benefits versus risks of immediate and long-term preventive actions.
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Affiliation(s)
- Catherine Metayer
- School of Public Health, University of California, Berkeley, Berkeley, California;
| | - Gary Dahl
- School of Medicine, Stanford University, Stanford, California; and
| | - Joe Wiemels
- Department of Epidemiology and Biostatistics, and
| | - Mark Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, San Francisco, California
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Whitehead TP, Metayer C, Wiemels JL, Singer AW, Miller MD. Childhood Leukemia and Primary Prevention. Curr Probl Pediatr Adolesc Health Care 2016; 46:317-352. [PMID: 27968954 PMCID: PMC5161115 DOI: 10.1016/j.cppeds.2016.08.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Leukemia is the most common pediatric cancer, affecting 3800 children per year in the United States. Its annual incidence has increased over the last decades, especially among Latinos. Although most children diagnosed with leukemia are now cured, many suffer long-term complications, and primary prevention efforts are urgently needed. The early onset of leukemia-usually before 5 years of age-and the presence at birth of "pre-leukemic" genetic signatures indicate that pre- and postnatal events are critical to the development of the disease. In contrast to most pediatric cancers, there is a growing body of literature-in the United States and internationally-that has implicated several environmental, infectious, and dietary risk factors in the etiology of childhood leukemia, mainly for acute lymphoblastic leukemia, the most common subtype. For example, exposures to pesticides, tobacco smoke, solvents, and traffic emissions have consistently demonstrated positive associations with the risk of developing childhood leukemia. In contrast, intake of vitamins and folate supplementation during the preconception period or pregnancy, breastfeeding, and exposure to routine childhood infections have been shown to reduce the risk of childhood leukemia. Some children may be especially vulnerable to these risk factors, as demonstrated by a disproportionate burden of childhood leukemia in the Latino population of California. The evidence supporting the associations between childhood leukemia and its risk factors-including pooled analyses from around the world and systematic reviews-is strong; however, the dissemination of this knowledge to clinicians has been limited. To protect children's health, it is prudent to initiate programs designed to alter exposure to well-established leukemia risk factors rather than to suspend judgment until no uncertainty remains. Primary prevention programs for childhood leukemia would also result in the significant co-benefits of reductions in other adverse health outcomes that are common in children, such as detriments to neurocognitive development.
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Affiliation(s)
- Todd P Whitehead
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA.
| | - Catherine Metayer
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA
| | - Joseph L Wiemels
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA
| | - Amanda W Singer
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Mark D Miller
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA; Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA
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Miller MD, Valenti M, Schettler T, Tencza B. A Multimedia E-Book-A Story of Health: Filling a Gap in Environmental Health Literacy for Health Professionals. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:A133-A136. [PMID: 27479986 PMCID: PMC4975592 DOI: 10.1289/ehp222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Narrative approaches and storytelling are emerging as powerful health promotion tools that can spark interest, increase understanding of determinants of health, and translate complex science. A Story of Health, a multimedia e-book with continuing education credits was designed to harness the power of storytelling to increase environmental health literacy. Health professionals are a key audience. They recognize that patients may be suffering from preventable illnesses of environmental origin but often feel ill-equipped to educate individuals and families about risks associated with common exposures. A Story of Health seeks to fill this gap and help readers develop the competencies they need in order to help patients make informed choices, reduce health risks, improve quality of life, and protect the environment. Americans rate nurses and medical doctors as having the highest honesty and ethical standards of all professions. These medical professionals can play a key role in changing patterns of patient behavior and influencing public policies. The e-book provides an easily accessible method of developing environmental health competency. The multimedia format with graphical interpretations allows for quick reviews of topics or for more in-depth analysis via links to additional resources. The CE evaluations have been overwhelmingly positive.
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Affiliation(s)
- Mark D. Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco, California, USA
- California Environmental Protection Agency, Oakland, California, USA
| | - Maria Valenti
- Collaborative on Health and the Environment, Bolinas, California, USA
| | - Ted Schettler
- Science and Environmental Health Network, Ames, Iowa, USA
| | - Brian Tencza
- Environmental Medicine Branch, Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA.
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