Academic journal article Environmental Health Perspectives

The Environmental History in Pediatric Practice: A Study of Pediatricians' Attitudes, Beliefs, and Practices. (Children's Health Articles)

Academic journal article Environmental Health Perspectives

The Environmental History in Pediatric Practice: A Study of Pediatricians' Attitudes, Beliefs, and Practices. (Children's Health Articles)

Article excerpt

We conducted a mail survey of practicing pediatricians in Georgia to assess their knowledge, attitudes, and behaviors regarding recording patients' environmental histories. Of 477 eligible pediatricians, 266 (55.8%) responded. Fewer than one in five reported having received training in environmental history-taking. Pediatricians reported that they strongly believe in the importance of environmental exposures in children's health, and 53.5% of respondents reported experience with a patient who was seriously affected by an environmental exposure. Pediatricians agreed moderately strongly that environmental history-taking is useful in identifying potentially hazardous exposures and in helping prevent these exposures. Respondents reported low self-efficacy regarding environmental history-taking, discussing environmental exposures with parents, and finding diagnosis and treatment resources related to environmental exposures. The probability of self-reported history-taking varied with the specific exposure, with environmental tobacco smoke and pets most frequently queried and asbestos, mercury, formaldehyde, and radon-rarely queried. The pediatricians' preferred information resources include the American Academy of Pediatrics, newsletters, and patient education materials. Pediatricians are highly interested in pediatric environmental health but report low self-efficacy in taking and following up .on environmental histories. There is considerable opportunity for training in environmental history-taking and for increasing the frequency with which such histories are taken. Key words: children's environmental health, clinical history, environmental history, environmental medicine, medical history. Environ Health Perspect 110:823-827 (2002). [Online 8 July 2002]

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Children confront a wide range of potential hazards in the environment and are especially susceptible to toxic effects because of their developing organ systems, immature biologic defenses, and increased exposure due to small size, diet, behaviors, and other factors (1). Public concern for these exposures is high (2), and patients frequently ask their physicians about the health effects of environmental exposures (3). In recent years the intersection of pediatrics and environmental health, or "children's environmental health," has attracted considerable attention (4). This field has been defined as "the diagnosis, treatment, and prevention of illness due to perinatal and pediatric exposures to environmental hazards," together with "the creation of healthy environments for children" (5).

Clinical practice plays an important role in advancing and protecting children's environmental health. Health care providers such as pediatricians can help limit children's exposures to environmental hazards by educating parents, identifying hazardous exposures, diagnosing and treating children, and advocating for prevention (6). However, physicians have little training in environmental health (7). A series of studies by Levy assessing the extent of teaching in occupational and environmental medicine in U.S. medical schools (8-10) and a more recent study focusing exclusively on environmental medicine (11) found a fairly stable pattern: about one in four schools offer no instruction at all in this area, and of schools that do, the mean number of hours of instruction over 4 years is < 10. Over two-thirds of medical school deans reported that the emphasis on environmental medicine in their schools' curricula is "minimal" (12). A similar pattern prevails in residency training (13-17).

The clinical history is an essential part of data collection and doctor-patient communication (18-22). The environmental history (questions eliciting the parents' concerns and probing potential environmental hazards to which a child is exposed) is readily included in the routine medical history (23-25). …

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