ERIC EJ978258: The Role of Health Education in Addressing Uncertainty about Health and Cell Phone Use--A Commentary

2012·0.08 MB·English

by  ERIC

Commentary
The Role of Health Education in Addressing Uncertainty
about Health and Cell Phone Use—A Commentary
Dhitinut Ratnapradipa, William P. Dundulis, Jr., Dale O. Ritzel, and Abdul Haseeb
Ratnapradipa D, Dundulis Jr WP, Ritzel DO, Haseeb A. The role of health education in addressing uncertainty about health and cell phone
use—a commentary. Am J Health Educ. 2012;43(1):5-7. Submitted February 2, 2011. Accepted August 1, 2011.
Although the fundamental principles of evaluating resources (Competency A).1 An part of a larger body of work? Has the research,
health education remain unchanged, the important role for today’s health educator conducted with sound methodology, been
practice of health education continues to is to teach individuals how to evaluate this replicated with consistent findings? Published
evolve in response to our rapidly chang- vast quantity of health-related information articles address this topic in greater detail.2-4
ing lifestyles and technological advances. and make sense of information that may • Date of research: new research is con-
Emerging health risks are often associated be contradictory, even when coming from stantly updating our knowledge base of
with these lifestyle changes. The purpose of reputable sources. health-related information. When we have
this article is to address the role of health Before we can educate others, we must contradictory information that has all been
educators when scientific uncertainty exists ensure that our own knowledge base is up to through a comparable peer-review process
about these emerging topics. Specifically, the task. Health educators cannot be experts and is of comparable methodological sound-
how can health educators ensure that their in every possible health-related topic. There- ness, we should give more weight to the most
information is both current and credible, fore, we must first hone our own cyber skills current information.
and what can health educators do to edu- to keep up with the constant flow of new, and
• Source bias: Who conducted the research,
cate the public about minimizing potential often contradictory, information on various
risk factors. health-related topics. It would also be benefi-
We are in a constantly-updating infor- cial to maintain a working relationship with Dhitinut Ratnapradipa is an assistant professor
mation age when Internet access provides our academic and professional colleagues in the Department of Health Education and
near-instantaneous access to information who could assist us as subject matter experts Recreation, Southern Illinois University Carbon-
about a variety of health-related topics. for various health-related topics. dale, Pulliam Hall 307, Carbondale, IL 62901;
The ease of contributing to the online store Health educators may find the following E-mail: [email protected]. William P. Dundulis,
of information means that not all sources guiding questions helpful when evaluating Jr. is an Environmental Health Risk Assessment
are of equal weight. Depending on the host information sources for reliability and valid- Toxicologist at the Rhode Island Department of
site, posts may or may not be vetted. Con- ity, as well as to weigh the relevance of any Health, Providence, RI 02908. Dale O. Ritzel
sequently, the health educator must learn conflicting results. is a Professor Emeritus in the Department of
how to keep up with all these changes. As • Methodological strength: What study design Health Education and Recreation, Southern Il-
one of the seven core areas of responsibility was used and why? How were samples selected? linois University, Carbondale, IL 62901. Abdul
for Certified Health Education Specialists How was data collected, analyzed and inter- Haseeb is a resident physician in the Department
(CHES), serving as a health education re- preted? What are the stated limitations of the of Family and Community Medicine, Southern
source person (Responsibility VI) includes research? How broadly can the findings be ap- Illinois University School of Medicine, Carbon-
retrieving information electronically and plied? Are the findings a preliminary study or dale IL 62901.
American Journal of Health Education — January/February 2012, Volume 43, No. 1 5
Dhitinut Ratnapradipa, William P. Dundulis, Jr., Dale O. Ritzel, and Abdul Haseeb
and what are the researchers’ credentials? studies observed an increased risk of brain branes, called meninges, which surround the
Where do the researchers work (government tumors with using a cellular phone for a brain and spinal cord). The World Health
agency, academia, non-profit group, for- time period of ten years or longer.10 On Organization (WHO)13 reports that epi-
profit group, or a combination of these)? Who the other hand, a recent paper by the Inter- demiological studies provide no consistent
funded the research, directly or indirectly? phone Study Group11 noted that no increase evidence of a causal relationship between
What are the stated (and hidden) agendas for in risk of glioma or meningioma was ob- radiofrequency exposure and any adverse
the organization(s)? Where is the research served with use of mobile phones. However, health effect. The sites indicate that the
being published, and what review process was there were suggestions of an increased risk studies reviewed have too many limitations
used to evaluate it before it was published or of glioma at the highest exposure levels, to completely rule out an association, as evi-
posted? If a source is summarizing or provid- but biases such as non-blinding of case denced by the recent announcement by the
ing an overview of research, is all important and control subject status, and differences International Agency for Research on Can-
information included? in response rates between the two groups, cer’s May 31, 2011 press release classifying
We can now proceed to use these tech- prevented a causal interpretation.11 radiofrequency electromagnetic fields from
niques to evaluate one of the current “hot The meta-analysis by Myung et al10 cell phone use as a possible carcinogen.14
topics” in environmental health: Potential highlights some of the criteria outlined Can all this apparently contradictory
health impacts resulting from cell phone use. above. Specifically, these authors assessed information be correct? What is the final
Theoretically, incidence of cancer initiated methodological quality and found that word on any linkage between cell phone
by hand-held cellular phone use would likely the studies by Hardell et al were of higher use and cancer? The jury is still out on this
be in the head and neck area, particularly quality than those by the Interphone group, issue, due in part to the lack of long-term
the brain tissue.5,6 A hypothetical model7 particularly as they related to blinding the epidemiological data. However, given the
has been introduced to explain how non- status of subjects as case or control. These large number of mobile phone users, it is
thermal effects may potentially cause cancer authors also felt the need to highlight the important to investigate, understand and
in long-term cellular phone users via chroni- concern that funding sources may poten- monitor any potential public health im-
cally activating heat shock proteins. The tially influence research design and results. pact. WHO notes that the increasing use
authors of this hypothesis claim that while Many of the studies were conducted within of mobile phones and the lack of data for
heat shock proteins are a normal response to the past five years and so are of comparable mobile phone use over time periods longer
cellular damage, chronic heat shock protein date. The studies by French et al. and ng are than 15 years warrant further research of
expression promotes both metastasis and older, however, and focus more specifically mobile phone use and brain cancer risk.13
oncogenesis. Therefore, the authors imply on the mechanism by which cell phone use WHO suggests that one of the important
that long-term cellular phone usage may potentially causes cancer. All of these studies factors to be considered in future studies is
repeatedly activate heat shock proteins from appear to have been published in reputable the recent popularity of mobile phone use
chronic cellular stress due to non-ionizing peer-reviewed professional journals or as among younger people and a potentially
radiation, ultimately causing cancer. symposia proceedings, and can be assumed longer lifetime of exposure.
There have been a number of case-con- to have some credibility. However, caution These types of situations are where the
trol and meta-analysis studies which appear is advised with respect to references from role of the health educator becomes criti-
to support the argument that cell phone symposia proceedings. The review process cal. We must help others understand that
use can cause cancer.6,8,9 A pool analysis of and selection criteria can often be much despite doing our due diligence to research
two case-control studies concluded that less stringent than a peer-reviewed profes- a health-related topic, we sometimes will
cellular phones increase risk of developing sional journal. not get a definitive answer. Our audience
malignant brain tumors, with the highest An Internet search also identifies in- must also be taught the concept of “prudent
possibility belonging to individuals that formation from the websites of several avoidance” (i.e., minimizing exposure to
have used cellular phones longer than ten organizations (with acknowledged expertise a potential hazard while monitoring the
years.9 Results from another meta-analysis and objectivity in this area) which does not peer-reviewed literature for more current
indicated a higher risk of developing glioma support any link between cell phone use and health-effects information). In the case of
(type of tumor that starts in the brain or cancer. However, these sites were recently cell phone use, the nCI and WHO Fact
spine) and acoustic neuroma (a noncancer- updated to reflect a potential cancer risk. The Sheets provides several exposure criteria
ous or benign, often slow-growing tumor of national Cancer Institute (nCI)12 reports that are easily translated into health educa-
the nerve that connects the ear to the brain) that cell phone users have no increased risk tion tips to limit or reduce exposure,8,9 thus
was associated with use of a cellular phone of two of the most common forms of brain meeting CHES sub-competency VI.C.3 to
for ten plus years.6 Another meta-analysis cancer—glioma and meningioma (a type of assemble educational materials.1 While lim-
which evaluated data from 23 case-control tumor that grows from the protective mem- iting cell phone use (in terms of frequency
6 American Journal of Health Education — January/February 2012, Volume 43, No. 1
Dhitinut Ratnapradipa, William P. Dundulis, Jr., Dale O. Ritzel, and Abdul Haseeb
or duration of calls) may be an obvious 2011;45(3):227-238. analysis of two case-control studies on use of
but impractical suggestion, something 3. Green LW, Glasgow, RE. Evaluating the cellular and cordless telephones and the risk
as simple as using a hands-free device or relevance, generalization, and applicability for malignant brain tumours diagnosed in
speaker phone is a risk reduction. of research: issues in external validation and 1997-2003. Int Arch Occup Environ Health.
In conclusion, today’s health educators translation methodology. Eval Health Prof. 2006;79(8):630-639.
must ensure that their own skills remain 2006;29(1):126-153. 10. Myung SK, Ju W, McDonnell DD, Lee YJ,
adequate to access and evaluate cyber-based 4. Heller RF, Verma A, Gemmell I, Harrison Kazinets G, Cheng CT, et al. Mobile phone use
health-related information. We must also R, Hart J, Edwards R. Critical appraisal for and risk of tumors: a meta-analysis. J Clin Oncol.
update our courses on a regular basis to public health: a new checklist. Public Health. 2009;27(33):5565-5572.
ensure that our students will be receiving 2008;122(1):92-98. 11. The InTERPHOnE Study Group. Brain
both the latest information and the skills to 5. Khurana VG, Teo C, Kundi M, Hardell L, tumour risk in relation to mobile telephone
evaluate any health-related information that Carlberg M. Cell phones and brain tumors: a use: results of the InTERPHOnE interna-
may be published in the future. In the case review including the long-term epidemiologic tional case-control study. Int J Epidemiol. 2010;
of scientific uncertainty, health educators data. Surg Neurol. 2009;72(3):205-214. 39(3):675-694.
can be proactive in educating others about 6. Hardell L, Carlberg M, Soderqvist F, Mild 12. national Cancer Institute. Cell phones
reducing exposure risks on current topics of KH. Meta-analysis of long-term mobile phone and cancer risk. Available at: www.cancer.gov.
concern, even when causation has not been use and the association with brain tumours. Int Accessed June 25, 2011.
clearly established. J Oncol. 2008;32(5):1097-1103. 13. World Health Organization. Electromag-
7. French P, Penny R, Laurence J, McKenzie, D. netic fields and public health: mobile phones
REFERENCES Mobile phones, heat shock proteins and cancer. (Fact sheet no. 193). Available at: www.who.int.
1. national Commission for Health Educa- Differentiation. 2001;67(4-5):93-97. Accessed June 25, 2011.
tion Credentialing, Inc. Responsibilities and com- 8. ng KH. Proceedings of the Interna- 14. International Agency for Research on
petencies for health educators. Available at http:// tional Conference on non-Ionizing Ra- Cancer. Press Release no. 208: IARC classifies
www.nchec.org/credentialing/responsibilities. diation at UnITEn (ICnIR2003). Non-Ionizing radiofrequency electromagnetic fields as possi-
Accessed January 7, 2011. Radiations-Sources, Biological Effects, Emission bly carcinogenic to humans. Available at: http://
2. Cook DA, Levinson AJ, Garside S. Method and Exposures. Electromagnetic Fields and Our www.iarc.fr/en/media-centre/pr/2011/pdfs/
and reporting quality in health professions edu- Health. October 20-22, 2003. pr208_E.pdf. Accessed June 25, 2011.
cation research: a systematic review. Med Educ. 9. Hardell L, Carlberg M, Mild KH. Pooled
American Journal of Health Education — January/February 2012, Volume 43, No. 1 7