CHAPTER ONE
INTRODUCTION

1.1 Background of the Study

Leukemia is a malignant disease of the blood forming tissues that is characterized by unsustainable growth of abnormal white blood cells with important implications for morbidity and mortality in the adult and working population. This group of blood-forming cancer cells includes acute and chronic, and AML and ALL are often documented in occupational cohorts exposed to cancer-causing agents. Acute leukemias usually develop rapidly, affecting immune function and also often requiring intensive chemotherapy whereas chronic forms, such as chronic myelogenous leukemia (CML) are much slower, but still destroy physiological homeostasis (Zhang et al., 2024). The clinical implications vary from anemia, increased susceptibility to infection to systemic organ dysfunction and long term treatment sequelae, and impose substantial personal, social and economic burden (Medeni et al., 2025). With this range of health consequences, leukemia is not only a clinical problem but also a health issue at the population level, especially where both environmental and occupational exposures to substances and situations that may increase the risk occur.

Globally, a range of chemical and physical hazards related to leukemogenesis have been enhanced globally by industrialization and technological progress, which increases occupational exposure. For example, according to international surveillance data, benzene, ionizing radiation, and some heavy metals play an important role in the increase of leukemia cases among exposed workforces (Samsel et al., 2024). The International Agency for Research on Cancer has listed occupational exposure to benzene, formaldehyde, and ionizing radiation as carcinogens to humans with an increased risk for AML and other hematological malignancies (Barbey et al., 2024). Secondly, new findings on multinational cohorts also indicate that this risk is further enhanced by the long-term exposure to petrochemical fumes and solvent mixtures (Lee et al., 2023). Consequently, occupational leukemia is a critical aspect of work related disease burden, as there are patterns across industrial sectors where there is a higher predominance of exposure to chemicals and radiological exposures (Gillani et al., 2025). These international trends support the importance of placing occupational hazard in the context of the environments of health in general.

In Nigeria, rapid industrial development has resulted in a variety of employment opportunities but has also made us concerned about the exposures to potential carcinogens in the workplace. National occupational health records, although limited, indicate that workers in the chemical, manufacturing and energy sectors are exposed to frequent contact with dangerous substances such as benzene, toluene and other organic solvents (Akpan et al., 2025). Similarly, Rivers State, especially Port Harcourt, has a concentration of oil, gas, and petroleum industries with which come sustained emissions of volatile organic compounds and particulate matter (Debelu et al., 2025). The urban industrial environment in Port Harcourt has therefore been the subject of scholarly interest because of its ambient and occupational exposures, and studies of this city have reported high levels of biomarkers of toxic exposures among industrial workers and compared with unexposed populations (Dodos et al., 2025). This local situation supports the convergence of industry and the health of the workers, in which exposures to carcinogens can be ubiquitous and unreported.

Workplace environmental hazards common in industrial work environments consist of a complex mixture of airborne chemicals, heavy metals, and radiation by products of manufacturing and processing operations. Benzene, which is a component of crude oil and solvent mixtures, is converted to active species which cause DNA damage and chromosomal abnormalities involved in leukemogenesis (Kwak et al., 2020). Formaldehyde which is used in resins and as a disinfectant has also been associated with myeloid malignancies by means of genomic instability and immune modulation (Fatima et al., 2021). Additional hazards such as ethylene oxide and ionizing radiation which have alkylating and strand breaking properties respectively further implicates them in hematological malignancy (Zamri et al., 2023). Environmental sampling studies have supported the ubiquity of these agents in industrial settings and they often document levels that are above the recommended occupational exposure limits (Sirois and Owens, 2021). Such evidence demonstrates the importance of environmental contaminants as a risk factor for leukemia among industrial workers.

Previous studies on occupational and environmental factors that can lead to leukemia have found links between exposure to hazardous workplace and increased risk of developing leukemia, while also examining how workers perceive the risks. There have been epidemiological studies conducted in petrochemical and manufacturing sectors in which positive correlations of cumulative benzene exposure with AML incidence have been established (Jimenez Alcantar et al., 2025). Parallel investigations report that however, worker awareness of specific carcinogenic risks vary greatly, which is often affected by education level, safety training and organizational safety culture (Elkhalifa et al., 2025). Perceptual studies show that a number of industrial workers may underestimate long term health risks against chronic low dose exposures, where there may be acute symptoms of concern (Alnees et al. 2025). This disparity between the measured risk and the perceived susceptibility shows the importance of the understanding of subjective risk perceptions as an integral part of occupational health research (Vivarelli et al. 2025). Integrating empirical information on exposure with perceptual information about how occupational hazards are experienced and internalized by workers provides a more complete picture of the worker's experience of occupational hazards.

In the particular case of Port Harcourt's industrial labor force, the complex mix of environmental pollutants, work, and worker consciousness makes this an interesting subject for special study. Industrial employees in this region are routinely exposed to petrochemical emissions and solvent vapors that are known contributors to hematological toxicity but there is scarce empirical documentation of how workers perceive their exposure and associated health risks (Akpan et al., 2025). Understanding such perceptions is important since they influence safety protocol-related attitudes, compliance with safety measures, and participation in health surveillance programs (Gillani et al., 2025). Given this background, the current research is driven by the need to clarify the relationship between perceived environmental and occupational risk factors with leukemia among industrial workers in Port Harcourt, Rivers State in order to provide a basis for targeted occupational health interventions and evidence-based policy formulation.

1.2 Statement of the Problem

Industrial workers in Port Harcourt, Rivers State, are regularly exposed to a range of dangerous chemicals and pollutants and occupational stress factors as a result of the high concentration of oil, gas and manufacturing industries in the area. Substances like benzene, formaldehyde, toluene and other volatile organic compounds are common in such work environments and are well-known contributors of hematological malignancies, including leukemia (Akpan et al., 2025; Debelu et al., 2025). Despite the known toxicological risk of these agents, there is a paucity of research on the perception of industrial workers with respect to their exposure to these carcinogens. The current gap in knowledge restricts the understanding of whether workers are aware of the potential health implications if they are exposed for a long period of time or able to contextualize such risks within their daily activities on the job (Sirois & Owens, 2021; Jimenez-Alcantar et al., 2025). This paucity of understanding of perceived risk poses significant problems in evaluating the impact of awareness (or lack of awareness) on leukemia susceptibility among this workforce.

Many industrial workers in Port Harcourt may not be properly informed about the individual carcinogens that exist in their working environment or the severity of the exposure levels. Studies in similar industrial environments have indicated that lack of knowledge about the hazards of chemicals and long-term effects of occupational exposures may lead to underestimation of individual risk (Elkhalifa et al., 2025; Alnees et al., 2025). Such underestimation can affect individual attitudes towards safety practices including consistent use of personal protective equipment, following safety protocols, as well as following routine health screenings. Consequently, the workers who underestimate the risks related to hazardous chemical exposure may unknowingly risk increasing their vulnerability to leukemia and compound both the individual and public health burdens. This situation emphasizes the crucial importance of the investigation of the role of perceptions of risk in occupational behavior and health outcomes in industrial settings where carcinogenic exposures are common.

Furthermore, empirical studies that examine the link between perceived environmental and occupational risks and protective behaviors among industrial workers in Port Harcourt is limited. Few studies have systematically explored the relationship between workers' awareness of chemical dangers and environmental pollutants and their health searching behaviors, safety regulation adherence and industrial workplace health program participation (Gillani et al., 2025; Zamri et al., 2023). Without such data, it is difficult to know if gaps in knowledge and risk perception are contributing to sub-optimal protective behavior, leaving workers more vulnerable to getting leukemia and related occupational illnesses. This deficit limits the ability of policymakers, occupational health practitioners and industry regulators to implement interventions that are targeted to the real needs and perceptions of the workforce.

In the absence of specific information about perceived risks in workers, public health policy and workplace safety policies may be inadequate to address the environmental and occupational factors that determine leukemia. Interventions that are not designed with the perception of employees towards the hazards are at risk of not being effective or being poorly adopted because compliance is often affected by awareness, understanding and personal risk assessment (Vivarelli et al., 2025; Barbey et al., 2024). Therefore, studying the perception of industrial workers in Port Harcourt to their environmental and occupational exposure is important in the design of targeted intervention that would lead to better safety compliance and ultimately, incidence of leukemia in this high-risk group.

1.3 Objective of the Study

The broad aim of this study is to assess perceived environmental and occupational risk factors associated with leukemia among industrial workers. The specific objectives are as follows;

1. To assess the level of awareness of leukemia among industrial workers in Port Harcourt, Rivers State.

2. To identify perceived environmental risk factors associated with leukemia among industrial workers in the study area.

3. To examine perceived occupational risk factors associated with leukemia among industrial workers in Port Harcourt.

4. To assess the use of workplace safety measures and protective practices among industrial workers in the study area.

1.4 Research Questions

The study will be guided by the following questions

1. What is the level of awareness of leukemia among industrial workers in Port Harcourt, Rivers State?

2. What are the environmental risk factors associated with leukemia among industrial workers in the study area?

3. What are the occupational risk factors associated with leukemia among industrial workers in Port Harcourt?

4. What is the use of workplace safety measures and protective practices among industrial workers in the study area?

1.5  Research Hypotheses

Ho1: There is no significant environmental risk factors associated with leukemia among industrial workers in the study area.

Ho2: There is no significant occupational risk factors associated with leukemia among industrial workers in Port Harcourt.

Ho3: There is no significant use of workplace safety measures and protective practices among industrial workers in the study area.

1.6 Significance of the Study

The findings of this study are expected to benefit many stakeholders in the industrial and public health sectors in Port Harcourt, Rivers state to a great extent. The industrial workers themselves are primary beneficiaries as the study will raise awareness and understanding of the environmental and occupational risk factors for leukemia. Better understanding of such risks can help improve the ability of workers to follow preventive practices and safety protocols and to seek medical care in a timely manner. This increased awareness may also lead to a culture of personal and collective responsibility for workplace safety, which contributes to less exposure to carcinogenic substances in the work environment and lower incidence of leukemia in the work force.

Occupational health practitioners and occupational safety managers in industrial facilities will also benefit from the study since empirical data about the perceptions of workers to environmental and chemical hazards will be produced. This information can help to inform the design of targeted training programs, safety interventions and health promotion initiatives that are responsive to awareness levels and perceived vulnerabilities of employees. Understanding gaps in risk perception helps in implementing better communication strategies and making the necessary policy changes to ensure protection strategies are practical as well as embraced by the workforce, thus leading to improved occupational health outcomes.

Policy makers and regulatory authorities have much to learn from these in order to enhance occupational safety standards as well as enforcement mechanisms. Evidence from this study can help guide the regulations in relation to specific environmental and occupational hazards that are relevant to industrial workers in Port Harcourt. In addition, the findings can be used by public health agencies to develop community-based interventions, track trends in exposure and implement early screening programs in high-risk worker populations. This strategy will guarantee that interventions will be founded on data and are locally applicable as well as aligned to the preventive health and industrial safety agendas.

1.7 Scope of the Study

The study aims at the determination of perceived environmental and occupational risk factors of leukemia among industrial workers in Port Harcourt, Rivers State, especially their awareness of risk factors, perception of risk factors and safety practices. Empirically, the research studies the level of knowledge workers have on leukemia, specific environmental risks such as chemical pollutants and industry emissions, and occupational exposures such as solvents, radiation and work-stressors that may play a role in susceptibility to the disease. In addition, the study measures the adoption and use of protective measures and compliance with workplace safety protocols and relates these behaviors to the level of perceived risk. Geographically, the research is limited to industrial facilities located within the urban community of Port Harcourt in Rivers State, Nigeria, which is a major industrial and urban center, home to industrial facilities including petrochemical plants, manufacturing plants and oil related industrial facilities. This localized focus enables detailed contextual analysis of the worker perceptions and occupational health practice in a high-risk industrial environment.

1.8 Definition of Terms

Perceived Environmental Risk: The subjective evaluation of the potential danger within the work environment as perceived by workers in industry by the presence of environmental hazards such as chemical pollutants, airborne toxins, or other industrial contaminants which may promote the development of leukemia.

Perceived Occupational Risk: The extent of awareness and individual assessment by workers on their exposure to workplace hazards such as chemicals, radiation and stressors that can predispose workers to developing leukemia.

Leukemia: This is a collective of cancerous diseases that impact blood and bone marrow and are marked by indiscipline growth of abnormal white blood cells which may undermine immune system and health in general.

Industrial Workers: Workers who are involved with manufacturing, petrochemical, oil, gas and other industrial workers in Port Harcourt, Rivers State exposed to occupational and environmental hazards.

Occupational Health and Safety Practices: Measures, procedures and behaviors implemented in the workplace to minimize exposure to risks and protect the health of workers such as the use of personal protective equipment, the use of safety protocols, and participation in health monitoring programs.

Environmental Pollutants: Chemical or physical agents found in the work or surrounding environment that may have toxic effect e.g. benzene, formaldehyde, toluene and particulate matter linked to the functioning of industrial activities.

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