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.
Full Text
The Full Text of this article is available as a PDF (531.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bearer C. F., Phillips R. Pediatric environmental health training. Impact on pediatric residents. Am J Dis Child. 1993 Jun;147(6):682–684. doi: 10.1001/archpedi.1993.02160300088030. [DOI] [PubMed] [Google Scholar]
- Burstein J. M., Levy B. S. The teaching of occupational health in US medical schools: little improvement in 9 years. Am J Public Health. 1994 May;84(5):846–849. doi: 10.2105/ajph.84.5.846. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cabana M. D., Rand C. S., Powe N. R., Wu A. W., Wilson M. H., Abboud P. A., Rubin H. R. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458–1465. doi: 10.1001/jama.282.15.1458. [DOI] [PubMed] [Google Scholar]
- Demers R. Y., Wall S. J. Occupational history-taking in a family practice academic setting. J Med Educ. 1983 Feb;58(2):151–153. doi: 10.1097/00001888-198302000-00011. [DOI] [PubMed] [Google Scholar]
- Ferguson S. C., Lieu T. A. Blood lead testing by pediatricians: practice, attitudes, and demographics. Am J Public Health. 1997 Aug;87(8):1349–1351. doi: 10.2105/ajph.87.8.1349. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Graber D. R., Musham C., Bellack J. P., Holmes D. Environmental health in medical school curricula: views of academic deans. J Occup Environ Med. 1995 Jul;37(7):807–811. doi: 10.1097/00043764-199507000-00009. [DOI] [PubMed] [Google Scholar]
- Lees R. E. Occupational and environmental health. Preparing residents to treat related illnesses. Can Fam Physician. 1996 Apr;42:594-6, 606-9. [PMC free article] [PubMed] [Google Scholar]
- Levy B. S. The teaching of occupational health in American medical schools. J Med Educ. 1980 Jan;55(1):18–22. doi: 10.1097/00001888-198001000-00002. [DOI] [PubMed] [Google Scholar]
- Levy B. S. The teaching of occupational health in United States medical schools: five-year follow-up of an initial survey. Am J Public Health. 1985 Jan;75(1):79–80. doi: 10.2105/ajph.75.1.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lipscomb J., Burgel B., McGill L. W., Blanc P. Preventing occupational illness and injury: nurse practitioners as primary care providers. Am J Public Health. 1994 Apr;84(4):643–645. doi: 10.2105/ajph.84.4.643. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Musham C., Bellack J. P., Graber D. R., Holmes D. Environmental health training: a survey of family practice residency program directors. Fam Med. 1996 Jan;28(1):29–32. [PubMed] [Google Scholar]
- Novack D. H. Therapeutic aspects of the clinical encounter. J Gen Intern Med. 1987 Sep-Oct;2(5):346–355. doi: 10.1007/BF02596174. [DOI] [PubMed] [Google Scholar]
- Peterson M. C., Holbrook J. H., Von Hales D., Smith N. L., Staker L. V. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992 Feb;156(2):163–165. [PMC free article] [PubMed] [Google Scholar]
- Schenk M., Popp S. M., Neale A. V., Demers R. Y. Environmental medicine content in medical school curricula. Acad Med. 1996 May;71(5):499–501. doi: 10.1097/00001888-199605000-00022. [DOI] [PubMed] [Google Scholar]
- Schuman S. H., Mohr L. J., Jr, Simpson W. M., Jr The occupational and environmental medicine gap in the family medicine curriculum: needs assessment in South Carolina. Part I. J Occup Environ Med. 1997 Dec;39(12):1183–1185. doi: 10.1097/00043764-199712000-00011. [DOI] [PubMed] [Google Scholar]
- Smith R. C., Hoppe R. B. The patient's story: integrating the patient- and physician-centered approaches to interviewing. Ann Intern Med. 1991 Sep 15;115(6):470–477. doi: 10.7326/0003-4819-115-6-470. [DOI] [PubMed] [Google Scholar]
- Szneke P., Nielsen C., Tolentino N. Connecticut physicians' knowledge and needs assessment of environmentally related health hazards--a survey. Conn Med. 1994 Mar;58(3):131–135. [PubMed] [Google Scholar]
- Thompson J. N., Brodkin C. A., Kyes K., Neighbor W., Evanoff B. Use of a questionnaire to improve occupational and environmental history taking in primary care physicians. J Occup Environ Med. 2000 Dec;42(12):1188–1194. doi: 10.1097/00043764-200012000-00014. [DOI] [PubMed] [Google Scholar]
- Zimmerman R. K., Bradford B. J., Janosky J. E., Mieczkowski T. A., DeSensi E., Grufferman S. Barriers to measles and pertussis immunization: the knowledge and attitudes of Pennsylvania primary care physicians. Am J Prev Med. 1997 Mar-Apr;13(2):89–97. [PubMed] [Google Scholar]