How do mothers with young children perceive endocrine-disrupting chemicals?: an exploratory qualitative study

Article information

Womens Health Nurs. 2023;29(4):337-347

Publication date (electronic) : 2023 December 28

doi : https://doi.org/10.4069/kjwhn.2023.11.28

SoMi Park¹, ChaeWeon Chung^,2

¹Wonju College of Nursing, Yonsei University, Wonju, Korea

²College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: ChaeWeon Chung College of Nursing, Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8482 E-mail: chungcw@snu.ac.kr

Received 2023 August 30; Revised 2023 November 26; Accepted 2023 November 28.

Abstract

Introduction

Endocrine-disrupting chemicals (EDCs) are compounds that interfere with normal hormone function. They are primarily synthesized for industrial solvents, electronics, personal care products, plastics, and pesticides, and they include polychlorinated biphenyls, bisphenol A, phthalates, dioxins, DDT (dichlorodiphenyltrichloroethane), and others [1,2]. Since EDCs are ubiquitous in our living environment, their effects can be seen at all stages of life, including in developing fetuses, and persistent exposure to EDCs and the accumulation of EDCs in the human body can lead to health problems in children and adults [1,3]. Particularly, exposure to bisphenol A and polybrominated diphenyl ethers during pregnancy is associated with intrauterine growth restriction [4], higher levels of anxiety, depression, aggression, hyperactivity, and behavioral problems in children [5], and persistent lower cognitive abilities from the ages of 2 to 8 years [6], as well as lower attention levels and executive functioning at the ages of 9 to 12 years [7]. More importantly, constant exposure to EDCs in the environment can lead to the early onset of puberty and breast cancer [8], obesity, diabetes, thyroid dysfunction, and infertility [3,9]. Thus, it is critical to be aware of environmental hazards and the life-long health impacts of EDCs beginning in the early stages of life.

In this regard, parents are primarily responsible for protecting children from exposure to EDCs [10]. As children grow up, parents play multiple roles in the formation of their health behaviors by educating their children, acting as role models, and influencing their cognitive and behavioral characteristics [11]. Many studies have shown that parenting practices, particularly mothers’ parenting styles, influence their child(ren)'s body weight, diet, physical activity, and eating behaviors [12,13]. Due to the important role of mothers in families and social environments for protecting children from various harmful conditions, mothers should be engaged to and supported to guide children's health practices. Nevertheless, there is little research on the perception of EDCs among mothers, who tend to be children’s primary caregivers. Mothers are known, however, to share information about EDCs through social networking services [14]. It is important to understand mothers’ real experiences; what and how they are concerned about EDCs, what kind of matters they come across, and how they take care of it during childrearing. Therefore, a qualitative approach was considered appropriate for addressing the aims of this study exploring perspectives and ideas about EDCs among Korean mothers with young children, particularly as primary caregivers. This study aimed to explore the perceptions of EDCs among mothers with young children to provide a basis for parental education to enhance parents’ awareness concerning the risks of EDCs, particularly in a way that meets parents’ needs and expectations concerning childcare.

Methods

Results

The general characteristics of the 12 mothers are presented in Table 1.

Table 1.

Demographic characteristics of the mothers and their children

The average age was 34.3 years (range: 23–41 years), and the average number of children was 1.6 (range: 1–3). In terms of financial status, 11 mothers (91.7%) considered themselves middle-class, and six mothers (41.7%) were employed. Two mothers reported having thyroid disease and asthma, and there were four children diagnosed with precocius puberty or atopic dermatitis diagnosed with precocious puberty and atopic dermatitis, respectively.

A total of 288 major statements were identified in the interviews and after repeated reading of transcripts, 87 meaning units were found to be significant. A total of 25 condensed meaning units were then generated based on the interpretation of underlying meanings, which were further categorized into 10 subcategories and four categories. The mothers’ experiences of EDCs defined in the analysis were ‘Knowledgeable yet contrasting ideas regarding EDCs,’ ‘Negative health impact, but more so for children,’ ‘Inaction or trying to minimize exposure,’ and ‘Need for early, reliable resources and social change’ as shown in Table 2.

Table 2.

Experiences of endocrine-disrupting chemicals (EDCs) among mothers with young children

Discussion

The study explored the perceptions about EDCs from the perspectives of mothers with young children using qualitative content analysis. Exposure to EDCs is known to occur through food, water, dermal contact, and inhalation [17], and the mothers in this study accurately recognized the transmission routes of EDCs. The mothers in this study, possibly due to their recent experiences of pregnancy and childrearing, were able to identify most of the possible routes of transmission, including the umbilical cord from the mother to the fetus. However, four of the mothers did not believe EDCs caused any bad consequences and decomposed gradually in the body. As suggested in prior literature [18] perceived EDCs as low risk since they are invisible and ubiquitous in daily life. As most of the mothers correctly perceived, EDCs accumulate and persist in organisms and the environment, and they may cause clinically observable and, when possible, measurable effects [19]. Thus, the long-term consequence of EDCs must be accurately shared with the public over time. Labeling consumer products with information would be a good way to increase risk perception, which has been observed to be effective in women of childbearing age [20]. As indicated in a previous study of 406 Korean adults [21], better knowledge about the environment would influence people to purchase more pro-environmental products.

The second distinct perception was about the relationship between EDCs and health problems. The mothers assumed that the vulnerability of children was much higher due to a higher chance of extended exposure to EDCs, which could potentially engage mothers to have more interest in preventive behaviors through future education and intervention. Therefore, it is important to provide information to reproductive aged women concerning the timing of exposure to EDCs, since developing fetuses and neonates are most vulnerable to endocrine disruption [22]. Indeed, many diseases and disorders are now considered to be related to prenatal exposure to EDCs, such as premature birth [23], autism [24], allergies [25], and congenital abnormalities [26]. While the mothers acknowledged various health problems due to EDCs, seven of the participants were optimistic that health problems due to EDCs would only happen to them in the distant future. Although EDCs have a very long half-life in the body and their adverse effects manifest at later ages [17], it is still important for parents to maintain a healthy lifestyle to prevent diseases and to be role models for their children. Above all, optimism hinders people from engaging in preventive health behaviors [27,28]. Thus, strategies need to be devised to minimize inaccurately optimistic views and increase awareness about the potential health consequences of EDC exposure.

The extent to which the mothers in this study understood the health impacts of EDCs appeared to correspond to their proactive behaviors to avoid the harms of EDCs. The mothers’ actions to avoid exposure to EDCs mostly related to their children’s health problems, even at the time of pregnancy and childbirth, rather than their own health issues. However, the mothers tended to maintain their lifestyles due to the convenience of using products with EDCs, which was similar to the findings of a study about the attitudes of young adult women in Korea concerning EDCs [29]. Mothers of young children are generationally accustomed to a high-convenience lifestyle and tend to consume more fast foods or processed foods and disposable products. Unconscious exposure to EDCs occurs through various routes of transmission. In particular, dietary intake accounts for more than 90% of total exposure to EDCs [30]. Therefore, mothers must understand their own vulnerability and health risks related to EDCs and ultimately make sustainable behavioral changes, especially as the primary caregiver of their child(ren) [31].

One of the main categories from the interviews with the mothers was that they required various ways to reduce their exposure to EDCs, such as actions based on the precautionary principle, regulatory actions, scientific evidence, and changes in the awareness of the general population about EDCs on social media. These varied demands indicate that detailed and concrete strategies that are applicable at the individual, public, and government levels are needed. Media, which comprise a major source of information, are an important determinant of risk perception [18,32] Media is noteworthy, not only to ensure that the public maintains a positive attitude toward precautionary measures [33] but also as an easy and effective way to guide the public to improve their knowledge, perception, and behaviors [34,35]. Therefore, media strategies are needed to disseminate how EDCs evoke negative hormonal mechanisms in the human body and how behavioral changes could lead to positive changes to protect people from the harms of EDCs.

Our study also found a strong need for early education about EDCs for children to establish positive life habits to prevent EDC exposure. The mothers anticipated more significant educational effects in their children rather than in themselves and expected their children to influence themselves. Life habits developed in early childhood affect the way individuals observe and respond to others’ health habits and can influence that individual’s family members to acquire knowledge, skills, and attitudes to improve their health [36]. A previous study found that children aged 4 to 5 years who had learned about passive smoking prevention insisted that their family members quit smoking [37]. Thus, environmental education during early childhood would be an effective strategy for influencing children to grow up with good health habits and also inspire behavioral changes in their parents. Information technology such as virtual reality would be a suitable mode to raise awareness of EDCs as well as to reduce exposure to EDCs.

It is possible that mothers with more interest in EDCs could have possibly participated in the study due to their own or their children’s health problems such as asthma, atopic dermatitis, or precocious puberty. Thus, it could be a possible bias and future studies should explore a wider range of perceptions of mothers.

In conclusion, mothers in this study were knowledgeable about EDCs and actively needed further education and support. While they tended to focus more on the health impact of EDCs on their children and were optimistic about their health risks, paying less attention to their preventive behaviors.

As strategies to prevent exposure to EDCs are urgently needed, prenatal education programs could include the topic of EDC exposure and its health impacts, particularly the routes of exposure not only to the mother but to the fetus. Also, parents and teachers need to be prepared in advance with accurate information and preventive strategies, to enable them to guide their young children to apply awareness, knowledge, and preventive behavioral habits in their daily lives. Overall, education programs to improve the publics general understanding of EDCs and the consequences of EDC exposure for students, health professionals (especially in endocrinology, pediatric, and maternity clinics) and laypersons are needed. Healthcare professionals should also provide the public with practical guidelines for health behaviors related to EDCs. It is also important to keep in mind that this requires political will to limit the use of these chemicals and develop and implement remediation technologies.

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