Lower the risk of Childhood Cancer by decreasing exposure to pesticides.

Lowering the Risk of Childhood Cancer by Decreasing Exposure to Pesticides
Name of the Student
Name of the Professor
Abstract
Pesticides are routinely used in agricultural and domestic household settings for controlling pests. However, the health hazards imposed by different pesticides are an area of global concern. The risk of childhood cancer is strongly associated with residential pesticide exposure. The article presented a research proposal on reducing the risk of childhood cancer (related to pesticide exposure) in at-risk individuals. The prevalence of childhood cancer in Pennsylvania is also higher than the U.S. national average. The proposed study would include participants belonging to a chosen demographical area. The chosen demographical area for the present study would be Philadelphia, 19104. The proposed research would implement a pesticide control program in at-risk individuals. The study would explore the risk of childhood cancer by reducing the level of pesticide exposure and addressing different health determinants in at-risk individuals. In the near future, the proposed mitigation program might prevent the risk of cancer in at-risk individuals. Hence, the proposed study may help policymakers in framing guidelines for reducing the risk of childhood cancer. On the other hand, the research proposal is viable, cost-effective and feasible within the stipulated period of two years.
Keywords: Childhood cancer, mitigation strategies, research proposal, residential pesticide exposure, Philadelphia 19104
Lowering the Risk of Childhood Cancer by Decreasing Exposure to Pesticides
Introduction
Pesticides are compounds that are used for managing and eradicating pests.

They are often classified based on the type of pests eradicated by the specific compound(Booth et al., 2015). Pesticides are classified as fungicides (pesticides that eradicate fungi), herbicides (pesticides that eradicate herbs), weedicides (pesticides that eradicate toxic weeds and shrubs), rodenticide (pesticides that eradicate rodents) and insecticides (pesticides that eradicate insects) (Booth et al., 2015). On the other hand, pesticides are also classified according to their chemical nature (Booth et al., 2015). The “organochlorine pesticides” and “organophosphate pesticides” are examples of chemical classification of pesticides (Booth et al., 2015).
Pesticides are routinely used in agricultural and household settings for controlling pests. Pest control is mandated for preventing different diseases in plants and animals. It is also necessary for increasing the agricultural yield of different crops. Hence, pest control is an integral step in ensuring economic development. However, the health hazards imposed by pesticides are an area of global concern. Health hazards of different pesticides are well documented. Organochlorines and organophosphates are well known for their neurotoxicity. Different pesticides increase the risk of cancer in at-risk individuals (Booth et al., 2015).
Children are highly sensitive to the health risks of pesticide. The health risks of pesticide in children include different types of cancer, neurological deficits and congenital malformations. Children are sensitive to carcinogenic potential of pesticides due to various factors. The risk of childhood cancer (related with pesticide exposure) is significantly high in individuals below the age of four years. Increased risk of childhood cancer is significantly correlated with a reduction in pesticide metabolism and biotransformation. In fact, different health determinants predispose the risk of childhood cancer (Turner et al., 2010). Hence, there is a global consensus on reducing the use of carcinogenic pesticides in urban and rural settings (Turner et al., 2010).
The World Health Organization (WHO) has acknowledged the carcinogenic potential of glyphoshate (an active ingredient used for lawn care products) (Chen et al., 2015). Glyphoshate has been categorized under Group 2A (probably carcinogenic to humans) based on its carcinogenic potential (Chen et al., 2015). The WHO also indicated that 2, 4-DDT (isolated from weed and feed products) is also carcinogenic (Chen et al., 2015). Turner et al (2010) conducted a meta-analysis of 15 studies related with residential use of pesticides and the risk of cancer in children. The authors indicated that the prevalence of childhood leukemia was correlated with residential use of pesticides. Moreover, the prevalence of childhood leukemia was also correlated with pesticide exposure in utero (Turner et al., 2010).
Greenop, Peters and Bailey (2013) indicated that risk of childhood brain cancer is strongly associated with pesticide exposure before conception. Moreover, pesticide exposure during pregnancy also increases the risk of childhood brain tumor. Children are exposed to pesticides in both urban and rural settings (Chen et al., 2015). In urban settings, children are exposed to residential pesticides through pest control services, pest repellants and different food items. Residential exposure to pesticides was associated with a 47% increased risk of leukemia in children (Chen et al., 2015). On the other hand, exposure to outdoor pesticides increased the risk of brain tumor by 26% in at-risk individuals (Chen et al., 2015). Chen et al. (2015) reported that residential pesticide exposure increased the risk of childhood cancer. The authors also implicated that the type of cancer is strongly associated with the type/class of the pesticide and the location of application of the pesticide (Chen et al., 2015).
Peer reviewed studies have indicated that glyphosate containing herbicides could be mutagenic even at very low concentrations (Turner et al., 2010). Mutation and single nucleotide polymorphism might account for increased prevalence of childhood cancers. Increased residential pesticide exposure during pregnancy is strongly correlated with increased risk of acute leukemia (AL) and Non-Hodgkin’s lymphoma. Studies have indicated that boys are more prone to childhood cancer compared to their female counterparts (Turner et al., 2010). Different pesticides have been correlated with the increased risk of childhood cancer (Turner et al., 2010).
The location of application of pesticides and the class of pesticides used are equally important in predisposing the risk of childhood cancer. Glyphosate, Dicamba and 2, 4-DDT pesticides are commonly used in lawns (Turner et al., 2010). On the other hand, Fipronil is commonly used as indoor and outdoor baits. Permethrin is a common constituent of commercially available mosquito-repellants (Chen et al., 2015). All such pesticides have been implicated in the genesis of childhood cancer (Turner et al., 2010). Studies have indicated that adoption of organic diet compared to conventional diet reduces the risk of pesticide exposure and childhood cancer (Morgan et al., 2014). This is because conventional diet contains higher amounts of organophosphate pesticides. In fact, the amount of organophosphate pesticides is significantly lower in organic diet compared to conventional diet (Morgan et al., 2014).
The CDC (Center for Disease Control) endorsed that children belonging to the age range of 6-11 years have higher pesticide concentration in their body (Chevrier et al., 2011). Bio-monitoring studies have indicated that almost 15% children (with recent exposure to lawn pesticides), belonging to the age range of 3-7 years, have increased concentrations of 2, 4- DDT in their body (Chevrier et al., 2011). Breakdown products of organophosphate pesticides were noted in 98.7% children whose parents applied lawn pesticides. Studies indicated that 2, 4- DDT that is applied to lawn drifts is often tracked indoors (Turner et al., 2010). DDT easily settles in dust and is carried indoors (Turner et al., 2010). Morgan, Wilson and Chuang (2014) conducted a study on 129 preschool children (belonging to the age range of 20 months to 66 months) for evaluating the status of pesticide exposure. The authors concluded that preschool children are at increased risk of exposure to pyrethroids, organophosphates and organochlorines (Morgan et al., 2014).
This article reflects a research proposal on reducing the risk of childhood cancer (related to pesticide exposure) in at-risk individuals. The proposed research would explore the possibilities of lowering the risk of childhood cancer by reducing exposure to pesticides. Moreover, the proposed research would also evaluate the health determinants that predispose the risk of childhood cancer. Evaluation of the predisposing risk factors would help to isolate the confounding variables for the proposed study. These measures would help to identify the interaction of pesticide exposure with different confounding variables in increasing the risk of childhood cancer. Hence, the proposed study may help policy-makers in reducing the risk of childhood cancers, which are associated with pesticide exposure.
Statement of Need
Between 1975 and 2011, there has been a significant increase in the prevalence of childhood cancer across the United States (Chen et al., 2015). The nation witnessed a 55% annual increase in the prevalence of childhood leukemia (Turner et al., 2010). However, 90% of these individuals have a good prognosis, and chances of survival are quite high (Chen et al., 2015). Different studies have indicated that environmental hazards are one of the major causes of childhood leukemia (Turner et al., 2010, Chen et al., 2015). The common environmental hazards of childhood leukemia include exposure to ionizing radiation, solvents and pesticides, polychlorinated biphenyls (PCBs) and tobacco smoke (Turner et al., 2010). It is contended that different factors predispose the risk of childhood cancer. Children have higher levels of dermatological and dietary exposure to pesticides. Moreover, a high body surface/body weight ratio and increased consumption of food and water (with respect to body size) predisposes the risk of childhood cancer. Children belonging to rural or urban settings are exposed to pesticides in utero or through breast milk. Pesticide drifts and contamination also increases the risk of childhood cancer (Chen et al., 2015).
In the United States, cancer is a major cause of death in children belonging to the age range of 5 to 14 years (Chen et al., 2015). Epidemiological studies have confirmed the risk of childhood cancer with increased exposure to pesticides (Turner et al., 2010). However, the dose-dependent relationship between the level of exposure and prevalence of cancer is not appropriately elucidated. Studies indicate that pesticide exposure increases the risk of leukemia, brain cancer, neuroblastoma and non-Hodgkin’s lymphoma in children (Turner et al., 2010). However, the cause-and-effect-relationships of such observations are strongly questioned due to the implementation of weak research protocols and inappropriate statistical measures (Morgan et al., 2014, Booth et al., 2015). The proposed study would implicate the cause-and- effect- relationships between the different risk factors (including pesticide exposure) with the prevalence of childhood cancer (Chen et al., 2015).
Philadelphia is situated in the southeast part of Pennsylvania, United States. The prevalence of all- cause cancer in Pennsylvania is higher than the national average (www. zip-codes.com). Moreover, the prevalence of childhood cancer in Pennsylvania is also higher than the U.S. national average (www. zip-codes.com). The prevalence of cancer in individuals below the age of 15 years is 17.1. Philadelphia, 19104 is a purely urban area and is inhabited by individuals belonging to different ethnic backgrounds (www. zip-codes.com). The chosen demographical area (Philadelphia, 19104) houses a relatively younger population. Almost 8% of the total population of chosen demographical area (Philadelphia, 19104) falls below the age of nine years. On the other hand, 4% and 46% of the total population of Philadelphia, 19104 fall within the age groups of 10 to 17 years and 18 to 24 years respectively (www. zip-codes.com). The chosen demographical area is dominated by White Hispanics. White Hispanics constitute 42% of the total population followed by White non-Hispanics (36%), Asian Hispanics (13%) and Asian non-Hispanics (7%) (www. zip-codes.com) Individuals belonging to the age range of 20 to 34 years represented a larger proportion of white non-Hispanic and Asian non-Hispanic population compared to black non-Hispanic and Hispanic population (www. zip-codes.com). On the other hand, children belonging to the age range of 0 to 4 years are mostly Black non-Hispanics (46%) (www. zip-codes.com).
Between 2000 and 2012, maximum population growth was witnessed within the age range of 45 and 64 years. The decline in growth was mostly witnessed within the age range of 5 to 14 years and beyond 65 years (www. zip-codes.com). The growth was mostly witnessed across Hispanics and non-Hispanic Asians. The decline was mostly witnessed across white non-Hispanics. Hence, children and adolescents occupy a major proportion of the total population in the chosen demographic area (www. zip-codes.com). The employment status of the chosen demographical area indicates that most individuals are employed in the educational industry (41%). On the other hand, 26% individuals are engaged as professionals or run individual business (www. zip-codes.com). Most of these businesses are related to the wholesale and retail industry (www. zip-codes.com).
The educational status of the chosen demographical area indicates that around 53% of the total population is either baccalaureates or graduates (www. zip-codes.com). The major mode of transport within the chosen demographical area is public transportation. The average annual household income in the chosen demographical area is around 40,000 U.S. Dollars. In fact, 67% households in the chosen demographic area have an annual income of less than 30, 000 U.S. Dollars. Therefore, the average household income in Philadelphia, 19104 could be considered quite low. Hence, the chosen demographic area and the target population are quite appropriate for the proposed research (www. zip-codes.com).
Different factors increase the risk of pesticide exposure in children (Turner et al., 2010). Childhood behaviors are the major predisposing risk factors for increased pesticide exposure in children. Crawling behavior and proximity to the floor predispose children to the increased risk of pesticide exposure (Turner et al., 2010). Therefore, the risk of dermal and inhalation exposure to pesticides is higher in children compared to their adult counterparts. Children are exposed to contaminants and pesticides present in floor carpets, floors, and soil (Chevrier et al., 2011). Moreover, children with delayed milestones are at greater risk of ingesting pesticides through the consumption of non-food items like soil and toys (Booth et al., 2015).
Synthetic pesticides with low toxic profile are being increasingly used in commercial settings (Turner et al., 2010). On the other hand, Integrated Pest management has been encouraged and promoted across agricultural settings. Alternative methods of pest control (including mechanical, cultural and biological measures) are also effective in reducing the use and exposure to harmful pesticides (Turner et al., 2010). However, adoption of alternative strategies and implementation of IPM is quite low in practical settings (Chevrier et al., 2011). Different factors contribute to the lower rate of adoption of these strategies. Lack of awareness on pest control measures and lack of knowledge on the harmful effects of pesticides are the major limiting factors in reducing the prevalence of pesticide exposure in children (Turner et al., 2010). On the other hand, cultivation of genetically modified crops (GM crops) has increased over the past few decades. GM crops are more insect and microbe resistant and promises greater yield than crops which are cultivated through traditional methods (Turner et al., 2010). These crops also form the basis of organic diet. Hence, increased cultivation of GM crops and increased awareness amongst concerned stakeholders may reduce the risk of pesticide exposure in at-risk individuals (Chen et al., 2015).
Assessment
Evidence suggests that the risk of childhood cancer is strongly correlated with pesticide exposure (Turner et al., 2010). On the other hand, the risk of childhood cancer is also influenced by different determinants of health (Turner et al., 2010). However, the dose-dependent relationship between the level of pesticide exposure and risk of childhood cancer is not appropriately elucidated (Turner et al., 2010). However, different studies have reported that pesticide exposure increases the risk of leukemia, brain cancer, neuroblastoma and non-Hodgkin’s lymphoma in children ((Turner et al., 2010, Chen et al., 2015). On the other hand, mitigation strategies for pesticide exposure are often inadequate or inappropriate (Turner et al., 2010). Different socioeconomic and physical determinants of health also increase the risk of childhood cancers (Turner et al., 2010). Hence, the proposed research would explore the risk of childhood by reducing the level of pesticide exposure and addressing different health determinants in at-risk individuals.
The risk of any disease is strongly influenced by different determinants of health (Turner et al., 2010). Health determinants are referred as those factors that can predispose or prevent the risk of a specific disease/s. Health determinants are broadly classified under three domains. These domains include socioeconomic environment, physical environment, and personal characteristics of an individual (Turner et al., 2010). The socioeconomic determinants include social and financial status of an individual or a family. It is contended that higher socioeconomic status is strongly associated with reduced risk of certain diseases and vice-versa. On the other hand, lower educational attainment is a major contributor to poor health (Turner et al., 2010).
It is contended that low educational attainment is strongly correlated with lack of awareness on the etiology of a disease. Hence, individuals and families with low educational attainments are at increased risk of different diseases (Turner et al., 2010). Factors like gender, age and ethnicity are also the key social determinants of health. The physical determinants of health include the environmental parameters surrounding an individual. For example, safe potable water, reduced air pollution, healthy workplaces and clean communities reduce the risk of different diseases (Chen et al., 2015).
Employability is another determinant of good health. Employed individuals are at decreased risk of various diseases compared to their unemployed counterparts. Individuals and families who have greater access to social support networks are at decreased risk of different diseases (Turner et al., 2010). The personal determinants of health include genetic, behavioral and physiological traits of an individual. For example, certain diseases are inherited over different generations. However, the risk of such diseases is strongly mediated by environmental parameters. Personal behaviors like dietary habits, physical activity, coping skills and substance abuse also predispose the risk of various diseases (Booth et al., 2015).
Accessibility to appropriate health care services is also one of the major determinants of health. It is contended that greater accessibility to preventive and screening healthcare services reduces the risk of different diseases (Chen et al., 2015). Physiological parameters like body weight, stature, and body mass index are key determinants of health (Chen et al., 2015). Different issues would be explored through the present study.
Theoretical Framework for the Proposed Assessments
A reduction in pesticide exposure in household settings may reduce the risk of childhood cancer in urban children. Moreover, lifestyle and dietary modifications may reduce exposure to pesticides. All these factors may play an integrated role in reducing the risk of childhood cancer (Chen et al, 2015). Accessibility to preventive healthcare services and increased awareness may reduce the risk of childhood cancer.
Criteria for the Proposed Assessments
Any difference in the prevalence/incidence of childhood cancer before and after implementation of the pesticide control program.
Prediction of risk of childhood cancer from the different health determinants (including the level of pesticide exposure).
Correlation between the risks of childhood cancer (related to pesticide exposure) is with compliance to the proposed pesticide control program.
Proposal for the Healthcare Solution
Procedure and Instruments for Designing the Healthcare Solution
Standardized questionnaires would be implemented for collecting the subjective and objective responses of the study participants. Clinical data would be based on objective records. The study participants would be interviewed on the pattern of pesticide usage in household settings. Pesticide exposure would be assessed as usage of insect repellants, frequency of accessing pest control services and consumption of food items that have increased concentration of pesticides. The major health determinants that would be incorporated in the logistic regression include educational attainment of parents, socioeconomic parameters (like annual family income and accessibility to preventive healthcare services), physical and personal parameters of the child (like age, sex, ethnicity, body weight, body surface area, dietary habits, hygienic habits and physical activity). The environmental health determinants would include probable risk of pesticide exposure.
Proposed Healthcare Solution
The pesticide control program would be designed based on the logistic regression analysis. Such findings would provide the framework for selecting the health determinants, which are associated with childhood cancer. Pesticide control program would aim to increase the awareness on reducing exposure to pesticides and inculcation of healthy behaviors both on the part of parents and at-risk children. The compliance with pesticide control program would be evaluated through subjective and objective parameters. The subjective parameters would include responses of parents on the pesticide usage in household settings, hygienic behaviors of concerned individuals, adoption of healthy diet and accessibility to healthcare services. The objective parameters would include level of physical activity, average calorie intake, and obesity amongst concerned stakeholders (children).
The study participants would be educated on the importance of practicing appropriate hygienic principles in household settings. They would be sensitized in adopting healthy lifestyle habits for themselves and their children. The target population would be encouraged to consume healthy food and indulge in regular physical activity. They should also be encouraged to access preventive healthcare services. Moreover, the target population should be discouraged from frequent use of insect-repellants and from accessing pest control services.
Evaluating the Effectiveness of the Healthcare Solution
The effectiveness of the healthcare solution would be evaluated through different subjective and objective parameters. The subjective parameters would include the responses of study participants, while the objective parameters would include epidemiological data. The epidemiological data that would be explored include prevalence and incidences of childhood cancer during the study period and during the period of follow-up.
Details of the Proposed Research
The proposed research would evaluate the predisposing risk factors for childhood cancer. Evaluating the predisposing risk factors would help to isolate the different risk factors that might be related with the genesis of childhood cancer. Moreover, such measures would also help to identify the interaction of pesticide exposure with different confounding variables in predisposing the risk of childhood cancer. The proposed study would help policymakers in framing guidelines for reducing the prevalence of childhood cancer. The proposed study will also endorse the need for implementing a mitigation program for reducing pesticide exposure, in at-risk individuals. The proposed study would be conducted for two years. The detailed plan of the proposed research is tabulated in Table 1.
Timeline for the Proposed Research
Period Detail of Activities
1 months to 2 months Literature Search and Literature Review. Based on findings the proposed research would be designed and modified. Literature review would involve visiting websites and offline libraries.
2 months to 4 months Census data on the incidence of different childhood cancers would be collected from the national registries for the selected demographic location and personal surveys on target population.
4 months to 6 months Conducting structured interviews with study participants
6 months to 8 months Explaining the Pesticide Control Program to the targeted study population
8 months to 10 months Implementing and Monitoring the implementation of the Pesticide Control Program
10 months to 12 months Data analysis of Pilot results
13 months to 16 months Trouble shooting and modification of the program
Implementation and monitoring of the modified program
16 months to 18 months Monitoring of the modified program and Surveys
18 months to 20 months Monitoring of the modified program and Surveys
20 months to 23 months Monitoring of the modified program and Surveys
24th month Final Data Analysis and verification of census data from national registries. Final research thesis and completion of dissertation
Table 1: Detailed Framework of the Proposed Research
A follow-up study would also be conducted in the 5th year after the termination of the proposed research. The follow-up study would help to assess the success or failure of the pesticide control program in the long run. In the follow-up study, different statistical and public health databases would be accessed to evaluate the prevalence of childhood cancer in the target population.
Priorities and Strategies
The priority of the proposed research is to implement the “Pesticide Control Program” in at-risk individuals. Rapid introduction of the “Pesticide Control Program” would help to mitigate the risk of childhood cancer in at-risk population. The underpinning principle of the “Pesticide Control Program” would be to address the lack of awareness and knowledge amongst concerned stakeholders. The strategies for implementing the “Pesticide Control Program” are:
The concerned stakeholders would be sensitized and educated on alternative measures of pest control measures and on the harmful effects of pesticides on children. .
The stakeholders would comply with hygienic principles aimed at reducing the residential exposure to pesticides.
Outcome Measures to be Assessed
The benefits of the proposed intervention program would be assessed from different perspectives. These perspectives include;
The prevalence and incidence of childhood cancer after implementation of the “Pesticide Control Program”.
The compliance of the targeted stakeholders with the “Pesticide Control Program.”
Adoption of alternative methods of pest control.
Reduction in pesticide usage.
Key Disciplines and People Represented in the Proposal
The people who would be primarily engaged in the proposed research are the study participants and the research staff. The research staff would belong to specialty of nursing and medicine. The role of the nursing staff would be to implement the “Pesticide Control Program” in the selected demographic location. A consulting physician would be involved in assessing and diagnosing the risk of childhood cancer in at-risk individuals. As a DNP-advanced practicing nurse, I would lead the proposed research. Hence, my major role would be to ensure improvement initiatives, quality care and development of evidence-based practice for reducing the prevalence of childhood cancer.
Key Resources for the Proposed Study
The study participants could be appropriately selected from the demographic location. Moreover, the proposed research would address a significant health issue. Hence, public cooperation and support from the Federal Government would be accessible.
Anticipated limitations of the proposal
The anticipated limitations for the proposed study include:
After the conclusion of the proposed research, the study participants might not comply with the “Pesticide Control Program.”
The proposal did not include financial implications on study participants for adopting the “Pesticide Control Program.”
Proposed Outcomes
The proposed research would help to isolate the different risk factors related with the genesis of childhood cancer. Moreover, it would also help to identify the interaction of pesticide exposure with different risk factors in predisposing the risk of childhood cancer. The proposed study would help policy makers in framing guidelines for reducing the prevalence of childhood cancer. The study will also endorse the need for implementing a mitigation program for reducing pesticide exposure in at-risk individuals.
Financial and Budgetary Implications
Since the study would mainly evaluate subjective parameters the cost of instrumentation and infrastructural support would be minimal. Moreover, most of the data for the proposed study and the follow-up study would be based on secondary data analysis. Secondary data would be collected from different online journals and government websites. Hence, cost of accessing data would be minimal too. The major financial implications associated with proposed study are travelling expenses for accessing the target population within the selected demographic area. The miscellaneous expenditures would include printing and stationary expenses. Such expenses would be incurred to prepare brochures on the “Pesticide Control Program.” The details of budgetary implications are provided in Table 2.
Budget Heads Allocations Required Implications
On-line journals (free and paid) 600 U. S. Dollars Secondary data would be collected from different online journals and government websites.
Traveling Allowances 800 U.S. Dollars Travelling expenses would be incurred for accessing the target population.
Miscellaneous expenditures 400 U.S. Dollars Printing and stationary expenses for preparing brochures on the “Pesticide Control Program.”
Total 1800 U.S. Dollars Conclusion
Residential pesticide exposure is strongly associated with the risk of childhood cancer. However, few studies have portrayed the cause-and-effect-relationships between the level of pesticide exposure and the risk of developing childhood cancer. Moreover, mitigation strategies for preventing the prevalence of childhood cancer are often inadequate and inappropriate. The key issues that increase the risk of childhood cancer include a lack of awareness and ignorance on harmful effects of pesticides.
The proposed research would help to identify the risk factors associated with the genesis of childhood cancer. The proposed research would explore the impact of an intervention program in reducing the prevalence of childhood cancer. The proposed “Pesticide Control Program” is assumed to prevent the risk of childhood cancer in at-risk individuals. Finally, the proposed study would help policy makers in framing guidelines for reducing the prevalence of childhood cancer. Moreover, the proposed research has the potential to elucidate and address health issues in children. The proposed mitigation program might prevent the risk of cancer in at-risk individuals in the near future. The research proposal is viable, cost-effective and feasible to be completed within the stipulated period of two years.
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