Table 3.

Examples of exposures associated with altered risk (increased or decreased) for developing childhood leukemia and co-benefits of improved health outcomes by clinical and public health actions.

Exposure	Health Impacts other than Childhood Leukemia	Clinical Recommendations	Public Health Activities
Pesticides	Neurobehavioral disorders, asthma, adverse birth outcomes, adult cancer, reproductive toxicity	American Academy of Pediatrics recommends Integrated Pest Management, exposure reductions. Advocates clinicians become familiar with acute and chronic/subclinical effects and provide anticipatory guidance	Integrated Pest Management recommended by U.S. EPA and cooperative extension services
Tobacco	Respiratory disease and asthma, adverse birth outcomes, cardiovascular disease, adult cancers, neurocognitive disorders, sudden infant death syndrome	Smoking cessation, avoidance of secondhand smoke universally recommended	National and local tobacco control programs, cessation hotlines
Air Pollution (including traffic related)	Includes: Preterm birth, decreased birth wt., asthma and respiratory development, cardiovascular dis., neurobehavioral disorders	Less amenable to individual action. Recommendations to restrict outdoor activities during high air pollution days (AirNow.gov). Avoid wood fires.	Many programs for air pollution reduction. Local programs to encourage walking and biking. No idle zones, replacement of old diesel vehicles. School siting regulations.
Folate (risk reduction) supplementation/ healthy diet	Inadequate folate early in pregnancy associated with neural tube defects, increase in autism risk, other birth defects	Preconception or prenatal folate supplementation recommended by American College of Obstetrics and Gynecology and American Academy of Family Physicians and others	Fortification of supplementation recommended by U.S. Preventive Services Task Force
Breastfeeding (risk reduction)	Sudden infant death syndrome, diarrhea, bacteremia, otitis media, childhood obesity, respiratory infection204	Promote breastfeeding as the norm, develop skills to assess and collaborate with obstetrical community and certified counselors, serve as advocates for breastfeeding	2011 Surgeon General's Call to Action to Support Breastfeeding: Actions for non-governmental organizations, government, employers, etc. All states have breastfeeding coalitions, programs to promote and support breastfeeding in minority communities205