Upon completion of this module the student will be able to:

• discuss chronic disease epidemiology
• define the latency period
• compare and contrast the effects physical stressors, chemicals, behavior, and psychosocial conditions have on health
• define toxicokinetics
• distinguish between the terms idiopathic and cryptogenic.
• discuss the Precautionary Principle
• state two principles from ANA’s Principles of Environmental Health.

The causes of diseases have changed over the last century when death was caused primarily by influenza, pneumonia, tuberculosis, diarrhea, and enteritis.

According to the Centers for Disease Control and Prevention (CDC, 2018) the major causes of death today include:

• heart disease,
• cancer,
• accidents,
• chronic lower respiratory disease.
• cerebrovascular accidents and diseases,
• Alzheimers disease,
• diabetes,
• influenza and pneumonia,
• Nephritis, nephrotic syndrome, and nephrosis,
• Intentional self-harm (suicide).

The epidemiology of chronic diseases involves studying the distribution, determinants, prevention, and control of these disorders.

Chronic diseases develop slowly, usually are less severe than acute conditions, but have a long duration.

The latency period is the period of time before the disease occurs.

According to the CDC (2020) 6 in 10 adults have at least one chronic disease and 4 in 10 adults have two or more. Many chronic diseases are directly related to risk factors such as:

• Tobacco Use/Secondhand smoke
• Poor nutrition
• Lack of physical activity
• Alcohol abuse

Infectious agents such as tuberculosis, syphilis, polio, and leprosy, COVID-19 among others can lead to chronic, debilitating conditions.

Viruses too are able to cause diseases, particularly cancer, by invading cells during replication.

The number of chronic conditions increases with age and decreases with socioeconomic level.

Social environmental issues such as violence, acts of terrorism, and natural disasters predispose one to chronic illnesses.

According to Merrill (2020) factors such as, poverty, fear, stress, economics, and crime also contribute to chronic health problems. Behavior changes, however, can help overcome some of these behavioral and social health issues.

Obesity continues to be a major health problem in this country and leads to chronic health problems such as hypertension, stroke, and obstructive sleep apnea. Although body weight has been linked to a genetic component, there is no reason to avoid exercise and healthy eating.

Sexual behaviors have also lead to chronic illnesses, such as HIV and AIDS. Females who engage in sexual activity at a young age are likely to develop cervical cancer and deliver babies born with sexually transmitted disorders.

Once the causes for these diseases are known, prevention measures can be instituted.

About 14% of all Americans age 18 years and older smoke, 15.6% of men and 12% of women (CDC, 2020). Thousands of high school and middle school students report using one or more tobacco products.  Smoking causes lung cancer 1 in 15 times more often in male smokers than non-smokers and 1 in 17 times more often in female smokers than non-smokers (American Cancer Society, n.d.). Smoking also causes a variety of other human cancers.

About 14% of 12th grade students and 4% of 8th grade students report binge drinking wihin the last 30 days,which puts them at risk for primary liver and breast cancer. Risky behaviors among high school youth and young adults have remained flat (CDC, 2020).

The second leading cause of death among age 14-18 is suicide. The number of high school students who have considered suicide is 18.8%, but the number of those who attempted suicide is at 8.9% and 2.% percent made a suicide attempt requiring medical treatment (CDC, 2020).

Psychosocial conditions are among the most common causes of disability. The disease burden of mental illness is among the highest of all diseases.

Heredity and Chronic Problems

Diseases can be idiopathic (having genetic origins) in nature or cryptogenic (having non-generic origins). Many health problems have a genetic component; osteoporosis is one example. Although they may not be eliminated, one can do much to prevent them. Weight-bearing exercises are an excellent way to increase bone density and prevent osteoporosis.

Unfortunately, prevention is difficult to measure and may not be identifiable when it occurs. We all know that prevention works and that it must be the goal to improve the health of all populations.

In 2007, the American Nurses Association (ANA) published its Principles of Environmental Health (page 16) written by a group of members well versed in environmental health issues and based on various reports (ICN, 1986; Pope, Snyder, & Mood, 1995). The Healthy People 2020 initiative continues to address these environmental health issues including outdoor air quality (airborne toxins), water quality (safe drinking water, beach closings), toxics and waste (pesticide exposures, recycling municipal waste), healthy homes and healthy communities (indoor allergens, radon), infrastructure and surveillance (monitoring diseases caused by environmental exposure), and global environmental health (global burden of disease).

These issues often affect the poor (ANA, 2007) because they live in substandard housing, work in hazardous jobs, and live in major industrial areas. Nurses’ responsibilities extend not only to health disparities but to environmental exposures as well because there is evidence to support that the human body is a reservoir for many toxic chemicals found in the environment. An example is the recent oil spill in the Gulf of Mexico. Scientists are assessing the damage to the wildlife and the environment, but it may be years before the full impact is known.

Global warming will have major environmental health effects including air pollution, heat-related illnesses, extreme weather conditions, and a rise in vector-transmitted diseases to name a few (ANA, 2007). Children, the elderly, and urban poor are particularly at risk (Health and Environmental Control).

The Precautionary Principle developed from a consensus statement in 1998. This principle, with its four central tenets that include taking preventive action when uncertain, placing the burden of proof on those who are the proponents of an activity, exploring alternatives to harmful actions, and increasing the publics involvement in decision-making comes from the German term for âforesight principle, a positive idea (Kriebel et al., 2001). Primary prevention and prudent avoidance mean essentially the same thing.

Principle 2 of the ANA Principles (2007) states that the Precautionary Principle shall help guide nurses to use products and practices that will not harm humans or the environment. Nurses are challenged to protect the most vulnerable and least powerful populations, along with future generations because they have no decision-making power.

The Precautionary Principle came about from efforts to âcombatâ climate change, ecosystem degradation, and resource depletion is slowâ (Kriebel et al., 2001, p. 873) in identifying the potential for catastrophic events. In the last century, the earthâs temperature has risen by 0.6°C causing alterations in marine life and weather patterns. Therefore, the Precautionary Principle may shift the terms of debate and stimulate change. Change has already occurred in the use of cellular telephones in airplanes because these devices interfere with aircraft functions, although this has not yet been proven. The use of pesticides in schools and polyvinyl chloride in childrenâs toys have stemmed from the Precautionary Principle.

Not everyone agrees with the Precautionary Principle. There are people who believe that there is currently enough oversight and regulation of the environment and that we should practice as independent practitioners. Therefore, there is some opposition to the Precautionary Principle.