The environmental history in pediatric practice: a study of pediatricians' attitudes, beliefs, and practices

Our plain-English summary of The environmental history in pediatric practice: a study of pediatricians' attitudes, beliefs, and practices, by N. Kilpatrick, H. Frumkin, J. Trowbridge, et al (Environmental Health Perspectives, 2002).

The study

• Authors: N. Kilpatrick, H. Frumkin, J. Trowbridge, C. Escoffery, R. Geller, L. Rubin, G. Teague, J. Nodvin
• Journal: Environmental Health Perspectives
• Published: 2002;110(8):823-7
• Cited by: 60 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

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.

In plain English

This was a mail survey of Georgia pediatricians about taking an "environmental history", meaning questions to families about hazards a child may be exposed to. In February 2000 the authors mailed questionnaires to 500 randomly selected pediatricians. Of 477 deliverable surveys, 266 were returned (55.8%), and 228 practicing pediatricians were analyzed. Only 34 (14.9%) reported training in environmental history-taking, while 122 (53.5%) reported a past patient seriously affected by an environmental exposure. Most reported routinely asking about cigarette smoking around the child (88.2%) and pets (73.7%). Fewer than 5% reported asking about asbestos, mercury, nitrates, formaldehyde or radon, whether routinely, on clinical suspicion or in response to parental concern. Respondents rated environmental health as important but reported low confidence in taking these histories, and 89% wanted to learn more. The authors concluded there was considerable interest and room for education. They noted that nonresponse may have caused selection bias and that self-report may overstate interest. The study did not measure anyone's asbestos exposure or disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional mail questionnaire survey of physicians (self-reported attitudes, beliefs and practices), analyzed with descriptive statistics
• Who was studied: Practicing pediatricians in Georgia, USA. 500 were randomly selected from 1,375 on the Georgia Chapter of the American Academy of Pediatrics roster. 266 of 477 deliverable surveys were returned (55.8%), and 228 respondents in current pediatric practice were analyzed. The survey was mailed in February 2000.
• Exposure: No exposure was measured. The survey asked how often pediatricians ask families about a list of environmental exposures, including asbestos, mercury, nitrates, formaldehyde, radon, tobacco smoke, pets, drinking water and lead.
• Main results:
  • Of the analyzed pediatricians, 34 (14.9%) reported any specific training in environmental history-taking (fewer than one in five).
  • 53.5% (122) of respondents reported experience with a patient seriously affected by an environmental exposure.
  • Respondents most often reported routinely asking about cigarette smoking around the child (88.2%) and pets in the home (73.7%).
  • Fewer than 5% of respondents reported asking about asbestos, mercury, nitrates, formaldehyde and radon, whether routinely, on clinical suspicion, or in response to parental concern (data not shown).
  • Respondents rated the role of environmental health impacts on children at a mean of 4.30 on a 1 to 5 scale. They rated pediatricians' control over environmental hazards at a mean of 2.78, below the midpoint.
  • Mean self-efficacy (confidence) scores were 2.80, 2.81 and 2.51 on a 1 to 4 scale. These fell between 'somewhat confident' and 'confident'. The authors described this as low self-efficacy.
  • 89% of respondents said they would like to learn more about children's environmental hazards.
  • Urban pediatricians were more likely than rural pediatricians to routinely take a basic environmental history (73.8% vs 60.8%, p = 0.04).
  • The most common information source on environmental exposures was the American Academy of Pediatrics (89.0%).
• The authors' conclusion: The authors concluded that their results indicate considerable interest in pediatric environmental health. They saw considerable opportunity to educate pediatricians and to increase environmental history-taking.
• Limitations the authors state:
  • The response rate of 55.8% may have introduced selection bias.
  • Respondents may have been more interested in the subject than nonrespondents, so the results may overstate pediatricians' interest.
  • Results are self-reported, and respondents may have given the 'right' answer, which could overstate interest.
  • The study assessed attitudes and behaviors, not pediatricians' knowledge.

Topics

Medical terms in this study, explained in our Lexicon: Environmental Exposure.

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