A hazardous society? Individual versus community responsibility in cancer prevention. Third annual Matthew B. Rosenhaus Lecture

Highlighting Contributions of Behavioral and Social Sciences in Advancing Public Health: Where We've Come, Where We're Headed

CONTEXT

Social and behavioral sciences, a cross-disciplinary field that examines the interaction among behavioral, biological, environmental, and social factors, has contributed immensely to some public health achievements over the last century. Through collaboration with community organizations and partners, social and behavioral scientists have conducted numerous program interventions involving community engagement and advocacy efforts at the local, state, federal, and international levels.

CONTRIBUTIONS OF SOCIAL AND BEHAVIORAL SCIENCES

This article traces select historical underpinnings of the applications of social and behavioral sciences theories and evidence to public health and highlights 4 areas in which health education specialists have distinctly contributed to public health achievements by building on theory and evidence. Applied social and behavioral sciences have formed the basis of various health education interventions. These 4 areas include the following: (1) Theory, Model Development, and the Professionalization of Health Education; (2) Participation and Community Engagement; (3) Health Communication; and (4) Advocacy and Policy.

DISCUSSION

We present contemporary challenges and recommendations for strengthening the theory, research, and practice of health education within the context of social and behavioral sciences in addressing emerging public health issues.

Cancer prevention in the workplace and natural environment. A review of etiology, research design, and methods of risk reduction

Guidelines for developing programs in cancer prevention and reduction of risk related to occupational and environmental carcinogens are provided in this review, which includes a summary of experimental and epidemiologic research designs for assessing potential etiologic agents, an overview of known occupational and environmental carcinogens, and a summary of general approaches to risk reduction. This review includes human cancer risks in the workplace and in the natural environment, which encompasses air pollution, water pollution, and hazardous waste disposal. Fourteen tables present the following: (1) established and probable carcinogens that may be encountered in the workplace, as contaminants of air or water, or as hazardous waste; (2) regulated carcinogens; (3) primary sources of exposure; (4) research designs; and (5) risk reduction methods. The interactive effects of multiple exposures are discussed as they relate to etiology and prevention. The importance of federal regulation is emphasized, as well as the need to understand the potential for cancer prevention in the context of broader economic, political and social issues.

Immunocytochemical localization of benzo(a)pyrene-DNA adducts in human tissue

Specimens of human lung, uterine cervix, ovary, and placenta were studied for the presence of benzo(a)pyrene 7,8-diol 9,10 epoxide (BPDE)-DNA adducts by using rabbit anti-BPDE-DNA antibody and light microscopic immunocytochemistry. BPDE-DNA antigenicity was detected in the bronchial epithelial cells, cervical epithelium, oocytes, luteal cells, corpora albicans, and hyalinized media of arteries within the ovaries and trophoblastic cells of the placental villi. In conjunction with immunoassay detection of BPDE-DNA adducts in human peripheral blood lymphocytes, this study demonstrates that a variety of human tissues can metabolize and bind the ubiquitous carcinogen benzo(a)pyrene. The identification and localization of this carcinogen-DNA antigenicity in various tissues and cells may not only help in monitoring exposed persons but also give insight to organ site carcinogenesis, transplacental carcinogenesis, and teratogenesis.

Identification of environmental carcinogens utilizing T-cell mediated immunity

There now exists a very large body of information that directly links the exposure to certain environmental factors with the ultimate development of specific types of human cancer. For this reason, a number of tests possessing varying degrees of biological complexity have been devised with the intent to first identify, and then ultimately reduce the risk of exposure to tumor causing agents. The presently employed chronic whole animal tests generally accepted as measures of human carcinogenicity have certain limitations in that they are lengthy to perform, very expensive, and require complicated pathological examinations of the various tissues. Consequently, there exists a need for short-term whole animal bioassays that can serve to complement such lengthy chronic studies; we are proposing that one such a test can be developed through utilizing procedures that have been designed for evaluating T-cell immunological responses.

Can human behavior be modified?

Human behavior is constantly being modified, though not as rapidly or always in the direction that health professionals might wish. In cancer prevention and detection programs, human behavior is modified by several common interrelated methods: the mass media; face-to-face communications; risk-immunization measures; economic forces; and the enactment of laws and regulations. Information and education are the preferred methods and have over a period of time achieved encouraging results. Further emphasis should focus on improving communication skills of health professionals, especially physicians; the promotion of hospital health education programs; and the support of more effective school health education programs. They should keep the public informed about the latest scientific advances while guarding against oversimplifying scientific facts that can be misinterpreted. They must be aggressive in the battle against cancer quackery, and they must keep abreast of the self-care and self-help movements, supporting those that contribute to cancer prevention and detection.

The detection of carcinogenic effects in man

Apart from the so-called short-term or in vitro test and the animal experiment, epidemiology represents the third method for detecting carcinogenic effects. Epidemiological methodology constitutes the sole possibility of studying in man cancerous diseases and the influence of noxae suspected to be carcinogenic. The three main approaches of epidemiological research--descriptive, analytic, and experimental epidemiology--are confronted and their importance for tracking down cancer is explained by means of examples.

Radiation equivalency of 1, 2-dimethylhydrazine in rats

A scale based upon the induction of anti-tumor cellular immune responses has been described which relates the in vivo mutagenic/carcinogenic potential of an environmental agent with that of ionizing radiation. Such a potential (radiation equivalency) has now been determined in rats for the gastrointestinal carcinogen 1, 2,-dimethylhydrazine as compared with the effects induced by X-irradiation of only the small intestine. The preliminary results suggest that such scales may be readily constructed based upon environmental immunology concepts which relate the potential hazard of an agent to be weighed alongside the maximum allowable population limits of ionizing radiation.

Shaping the future of health education: from behavior change to social change

The view that individual behavior change is the primary goal of health education presents several serious problems. Although individual behavior does contribute to health and disease, social organization is perhaps a more powerful influence. The use of behavior change as the primary tool for health education raises grave ethical issues. Health education which seeks to change individual behavior has also failed to have a significant impact on public health. An alternative strategy is health education for social change. The goal of this approach is to involve people in collective action to create health promoting environments and life-styles. Several contemporary models for and principles characteristic of health education for social change are described.

The role of the pathologist in environmental medicine and public health

The present paper summarizes the role of the morbid anatomist and clinical pathologist in environmental carcinogenesis. It points out that in the past he has contributed considerably to the identification of rare tumors and their etiology. He has an important role to play in the future in providing more accurate data on which epidemiology studies can be developed. The view is also expressed that it is highly important that modern pathologists have an understanding of toxicologic and pharmacologic techniques and their potential application to biologic material in order that they may be in a position to correlate and develop multidisciplinary approaches to the identification of environmental hazards. Some of these approaches are illustrated and their potential developments outlined.