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The Environment in Pediatric Practice: A Study of New York Pediatricians’ Attitudes, Beliefs, and Practices towards Children’s Environmental Health

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Abstract

Chronic diseases of environmental origin are a significant and increasing public health problem among the children of New York State, yet few resources exist to address this growing burden. To assess New York State pediatricians self-perceived competency in dealing with common environmental exposures and diseases of environmental origin in children, we assessed their attitudes and beliefs about the role of the environment in children’s health. A four-page survey was sent to 1,500 randomly selected members of the New York State American Academy of Pediatrics in February 2004. We obtained a 20.3% response rate after one follow-up mailing; respondents and nonrespondents did not differ in years of licensure or county of residence. Respondents agreed that the role of environment in children’s health is significant (mean 4.44 ± 0.72 on 1–5 Likert scale). They voiced high self-efficacy in dealing with lead exposure (mean 4.16–4.24 ± 0.90–1.05), but their confidence in their skills for addressing pesticides, mercury and mold was much lower (means 2.51–3.21 ± 0.90–1.23; p < 0.001). About 93.8% would send patients to a clinic “where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns.” These findings indicate that New York pediatricians agree that children are suffering preventable illnesses of environmental origin but feel ill-equipped to educate families about common exposures. Significant demand exists for specialized centers of excellence that can evaluate environmental health concerns, and for educational opportunities.

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Notes

  1. Consent was implied by completion of the form and/or verbal contribution. Attendance at each focus group was strictly voluntary and participation was at the discretion of the attendee. The Institutional Review Board of the Mount Sinai School of Medicine exempted the community meetings from review.

References

  1. Centers for Disease Control. Health, United States, 2004. National Center for Vital Statistics. Available at: http://www.cdc.gov/nchs/hus.htm Accessed January 20, 2004.

  2. Haggerty R, Rothman J. Child Health and the Community. New York: Wiley; 1975.

    Google Scholar 

  3. Centers for Disease Control. Surveillance for asthma—United States, 1960–1995. MMWR. 1998;47(SS-1):1–28.

    Google Scholar 

  4. Robison LL, Buckley JD, Bunin G. Assessment of environmental and genetic factors in the etiology of childhood cancers: the Childrens Cancer Group epidemiology program. Environ Health Perspect. 1995;103(suppl 6):111–116.

    Article  PubMed  Google Scholar 

  5. Schechter CB. Re: Brain and other central nervous system cancers: recent trends in incidence and mortality. J Natl Cancer Inst. 1999;91:2050–2051.

    Article  PubMed  CAS  Google Scholar 

  6. Devesa SS, Blot WJ, Stone BJ, Miller BA, Tarone RE, Fraumeni JF Jr. Recent cancer trends in the United States. J Nat Cancer Inst. 1995;87:175–182.

    Article  PubMed  CAS  Google Scholar 

  7. Laraque D, Trasande L. Lead poisoning: successes and 21st century challenges. Pediatr Rev. 2005;26:435–443.

    PubMed  Google Scholar 

  8. Bertrand J, Mars A, Boyle C, Bove F, Yeargin-Allsopp M, Decoufle P. Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics. 2001;108(5):1155–1161.

    Article  PubMed  CAS  Google Scholar 

  9. Trasande L, Landrigan PJ, Schechter CB, Falk R. Environmental Pollutants and Disease in New York States Children: Estimates of Morbidity, Mortality and Costs for Lead Poisoning, Asthma, Cancer and Developmental Disabilities. Platform Presentation, Eastern Society of Pediatric Research, March 5, 2005.

  10. Opler MG, Brown AS, Graziano J, et al. Prenatal lead exposure, delta-aminolevulinic acid, and schizophrenia. Environ Health Perspect. 2004 Apr;112(5):548–552.

    Article  PubMed  CAS  Google Scholar 

  11. Wasserman GA, Liu X, Popovac D, et al. The Yugoslavia Prospective Lead Study: contributions of prenatal and postnatal lead exposure to early intelligence. Neurotoxicol Teratol. 2000 Nov–Dec;22(6):811–818.

    Article  PubMed  CAS  Google Scholar 

  12. Dietrich KN, Krafft KM, Bornschein RL, et al. Low-concentration fetal lead exposure effect on neurobehavioral development in early infancy. Pediatrics. 1987 Nov;80(5):721–730.

    PubMed  CAS  Google Scholar 

  13. Baghurst PA, Robertson EF, McMichael AJ, Vimpani GV, Wigg NR, Roberts RR. The Port Pirie cohort study: lead effects on pregnancy outcome and early childhood development. Neurotoxicology. 1987 Fall;8(3):395–401.

    PubMed  CAS  Google Scholar 

  14. Grandjean P, Budtz-Jorgensen E, White RF, et al. Methylmercury exposure biomarkers as indicators of neurotoxicity in children age 7 years. Am J Epidemiol. 1999;150:301–305.

    PubMed  CAS  Google Scholar 

  15. Grandjean P, Weihe P, White RF, et al. Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicol Teratol. 1997 Nov–Dec;19(6):417–428.

    Article  PubMed  CAS  Google Scholar 

  16. Kjellstrom T, Kennedy P, Wallis S, et al. Physical and Mental Development of Children With Prenatal Exposure to Mercury From Fish. Stage II: Interviews and Psychological Tests at Age 6. Solna, Sweden: National Swedish Environmental Protection Board; 1989 (Report 3642).

  17. Kjellstrom T, Kennedy P, Wallis S, Mantell C. Physical and Mental Development of Children With Prenatal Exposure to Mercury From Fish. Stage I: Preliminary Tests at Age 4. Solna, Sweden: National Swedish Environmental Protection Board; 1986 (Report 3080).

  18. National Research Council. Toxicological Effects of Methylmercury. Washington, District of Columbia: National Academy; 2000.

    Google Scholar 

  19. National Research Council. Pesticides in the Diets of Infants and Children. Washington, District of Columbia: National Academy; 1993.

    Google Scholar 

  20. Weitzman M, Gortmaker S, Walker DK, Sobol A. Maternal smoking and childhood asthma. Pediatrics. 1990;85:505–511.

    PubMed  CAS  Google Scholar 

  21. Lupton C, Burd L, Harwood R. Cost of fetal alcohol spectrum disorders. Am J Med Genet. 2004 May 15;127C(1):42–50.

    Article  PubMed  Google Scholar 

  22. Mocarelli P, Marocchi AM, Brambilla P, et al. Clinical laboratory manifestations of exposure of dioxin in children. A six year study of the effects of an environmental disaster near Seveso, Italy. JAMA. 1986;256:2687–2695.

    Article  PubMed  CAS  Google Scholar 

  23. Jacobson JL, Jacobson SW. Intellectual impairment in children exposed to polychlorinated biphenyls in utero. N Engl J Med. 1996;335:783–789.

    Article  PubMed  CAS  Google Scholar 

  24. Centers for Disease Control. Third National Report on Human Exposure to Environmental Chemicals. Atlanta: Centers for Disease Control, 2005. Available at: http://www. cdc.gov/exposurereport Accessed August 26, 2005.

  25. U.S. Environmental Protection Agency. Chemicals-in-commerce information system. Chemical Update System Database; Washington, District of Columbia, 1998.

  26. Office of Pollution Prevention and Toxic Substances, U.S. EPA. Chemical hazard data availability study: what do we really know about the safety of high production volume chemicals? Washington, District of Columbia; 1998.

  27. U.S. Environmental Protection Agency. NPL Sites in New York, NPL, Superfund, U.S. EPA. Available at: http://www.epa.gov/superfund/sites/npl/ny.htm Accessed March 1, 2006.

  28. U.S. Environmental Protection Agency. Toxics Release Inventory (TRI) Program. Available at: http://www.epa.gov/tri/ Accessed March 1, 2006.

  29. Division of Solid and Hazardous Materials, New York State Department of Environmental Conservation. Final Annual Report for New York State Pesticide Sales and Applications, 2001. Available at: http://www.dec.state.ny.us/website/dshm/prl/prl2001.pdf Accessed May 29, 2004.

  30. New York State Department of Environmental Conservation. Ambient Air Quality Monitoring Networks. Available at: http://www.dec.state.ny.us/website/dar/baqs/monitor.html Accessed March 1, 2006.

  31. Association of Occupational and Environmental Clinics. Pediatric Environmental Health Specialty Units. Available at: http://www.aoec.org/PEHSU.htm Accessed August 26, 2005.

  32. Forman J. Personal communication. December 2004.

  33. New York State Health Department. Appendix B—Promoting Lead Free Children in New York State: A Report of Lead Exposure Status Among New York Children, 2000–2001. Available at: http://www.health.state.ny.us/nysdoh/lead/exposure_report/resource_centers.htm Accessed March 1, 2006.

  34. Ferre Institute. Pregnancy Risk Network: A NY State Teratology Information Service. Available at: http://www.pregnancyrisknetwork.org/ Accessed March 1, 2006.

  35. New York State Health Department. NYS Occupational Health Clinic Network—Protecting the Workers. Available at: http://www.health.state.ny.us/nysdoh/environ/occupate.htm Accessed March 1, 2006.

  36. University of Rochester Environmental Health Sciences Center. Perinatal Environmental and Drug Exposure Consultation Service. Available at: http://www2.envmed.rochester.edu/envmed/ehsc/outreach/PEDECS.html Accessed June 21, 2004.

  37. New York State Health Department. New York Regional Poison Control Centers. Available at: http://www.health.state.ny.us/nysdoh/poisoncontrol/index.htm Accessed June 21, 2004.

  38. Pew Charitable Trusts. Public Opinion Research on Public Health, Environmental Health and the Country’s Public Health Capacity to Adequately Address Environmental Health Problems. Philadelphia: Pew Charitable Trusts; 1999.

    Google Scholar 

  39. Szneke P, Nielsen C, Tolentino N. Connecticut physicians’ knowledge and needs assessment of environmentally related health hazards: a survey. Conn Med. 1994;58:131–135.

    PubMed  CAS  Google Scholar 

  40. Kilpatrick N, Frumkin H, Trowbridge J, et al. The environmental history in pediatric practice: a study of pediatricians’ attitudes, beliefs, and practices. Environ Health Perspect. 2002 Aug;110(8):823–827.

    PubMed  Google Scholar 

  41. Laraque D. Personal communication, 2005.

  42. George Dunkel, District I American Academy of Pediatrics. Personal Communication.

  43. New York State Counties and Regions. Available at: http://www.iloveny.com/search/regions_index.asp Accessed January 3, 2005.

  44. New York State Department of Education. Online Verification Services. Available at: http://www.op.nysed.gov/opsearches.htm Accessed January 3, 2005.

  45. Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med. 2001 Jan;20(1):61–67.

    Article  PubMed  CAS  Google Scholar 

  46. Paula Davis, Association of Occupational and Environmental Clinics, February 2006, Personal communication.

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Acknowledgements

This research was supported by the New York Community Trust. We are deeply grateful to Dr. Marie Casalino of District II (New York State) American Academy of Pediatrics for her assistance with obtaining membership rosters and with survey distribution. We also appreciated the input of Ms. Lauri Boni, Drs. Carl Johnson and Shuba Kamath in piloting versions of the survey prior to distribution. Drs. Landrigan, Graber, Galvez, Trasande and Forman are all members of the Mount Sinai PEHSU that is referenced in this manuscript.

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Correspondence to Leonardo Trasande MD, MPP.

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Trasande, Graber, Falk, Galvez, Moline, Forman, and Landrigan are with the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA; Trasande, Boscarino, Graber, Galvez, Forman, Laraque, and Landrigan are with the Department of Pediatrics, Mount Sanai School of Medicine, New York, NY, USA; Boscarino and Moline are with the Department of Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA; Boscarino is with the Center for Health Research, Geisinger Heath System, Danville, PA, USA; Schechter is with the Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Dunkel and Geslani are with the American Academy of Pediatrics, District II, NY Chapter 2, New York, NY, USA and the American Academy of Pediatrics, District II, NY Chapter 3, New York, NY, USA; Kaplan-Liss is with the Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA; Miller is with the Department of Obstetrics & Gynecology, and of Pathology and Clinical Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Miller and Korfmacher are with the Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Carpenter is with the Institute for Health and the Environment, University at Albany, Rensselaer, NY, USA; Balk is with the Department of Pediatrics, Division of General Pediatrics, Children’s Hospital at Motefiore, Albert Einstein College of Medicine, Bronx, NY, USA; Frumkin is with the National Center for Environmental Health, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

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Trasande, L., Boscarino, J., Graber, N. et al. The Environment in Pediatric Practice: A Study of New York Pediatricians’ Attitudes, Beliefs, and Practices towards Children’s Environmental Health. JURH 83, 760–772 (2006). https://doi.org/10.1007/s11524-006-9071-4

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