Of the 1,500 questionnaires mailed, 301 were completed, and 15 were returned as undeliverable. The overall response rate was therefore 301 of a possible 1,485 respondents, or 20.3%. After excluding 24 questionnaires from respondents who reported that they were not currently in pediatric practice, the final sample analyzed consisted of 277 practicing pediatricians.
The mean age (± SD) was 44.3 ± 12.7 years, and the mean number of years in practice was 13.7 ± 12.0 (Table ). The respondents were about equally divided between men and women and were also equally divided between public, community clinics and private, primary care practices. Specialties were also represented, including neonatology, adolescent medicine, pediatric cardiology, gastroenterology, and allergy. About one-half of the respondents reported that ≥50% of their patients were enrolled in Medicaid or public-funded assistance.
Description of respondents and their practices
Only one in five respondents reported having had any training in environmental history-taking (20.2%). Almost all of the respondents (93.5%) reported a past experience with a patient who had been affected by an environmental exposure, such as a case of lead poisoning. Less than one half of respondents (46.9%) had a copy of the AAP’s Handbook of Pediatric Environmental Health.
Table presents data on attitudes, beliefs, and self-efficacy regarding environmental history-taking. Pediatricians agreed relatively strongly that environmental history-taking would help parents protect their children from hazardous environmental exposures and would help identify exposures related to health concerns (mean ± SD = 4.07 ± 0.75). There was overwhelming disagreement with the statement, “Conducting an environmental history on all my patients would not be necessary” (mean ± SD = 1.57 ± 0.73).
Pediatricians’ self-reported attitudes, beliefs, and self-efficacy regarding environmental health
Respondents generally indicated that they attach considerable importance to environmental exposures. The “role of environmental health impacts on children” yielded a mean score of 4.44, and “assessing environmental exposures through history-taking in pediatric practice” yielded a mean score of 4.09. Pediatricians showed a tendency to believe that the magnitude of children’s environment-related illness is increasing (mean 3.76). However, the responses suggested little belief that pediatricians have control over environmental health hazards, with the mean score (2.89) falling below the midpoint of the continuum.
Respondents voiced high levels of self-efficacy for history-taking, discussing lead exposures with parents, and finding diagnosis and treatment resources related to lead exposures, with all three items having mean values greater than four. For pesticide, mercury and mold exposures, the mean responses were much lower (all p < 0.001 compared with equivalent questions for lead).
Figure shows data on the pediatricians’ self-reported interview practices. Of the 277 respondents, 139 (50.2%) routinely took a history as part of the well-child visit that included asking about cigarette smoking around the child, parental occupation and housing (Table ). A high percentage of respondents reported routinely asking about cigarette smoking around the child (93%), pets in the home (78%), lead (83%), sun exposure (80%), parental/teen occupation (73%), and home injury prevention (72%). Routine inquiry usually elicited the highest frequency of asking about environmental, exposure although for molds, parental inquiry had triggered more questions than had routine history-taking or physician inquiry. Fewer than 10% of respondents reported asking about pesticides, mercury, polychlorinated biphenyls, asbestos, radiation exposure, nitrates, radon, arsenic, volatile organic compounds, formaldehyde, and phthalates in response to any of the three triggers.
Percentage of pediatricians reporting asking about individual exposures routinely, and the frequency of physician and parental concerns.
Frequencies of pediatrician activities, attitudes, beliefs, and self-efficacy regarding environmental health
The most common source of information on environmental exposures pediatricians identified was the AAP (89.9%). Other important sources included professional literature (71.8%), government agencies (57.8%), health departments (57.8%), lectures/grand rounds (49.5%), and government websites (47.3%). About 88.1% of respondents affirmed that they would like to learn more about children’s environmental health. When asked about sources they would find most helpful in obtaining further information, the responses were similar: guidelines from the AAP (72.6%), patient education materials (52.0%), specialist presentations (46.9%), continuing medical education classes (38.3%), newsletters (34.7%) and journals (31.8%).
Relatively few pediatricians (9.4%) knew about the PEHSU (Table ) or made referrals to the PEHSU (3.0%). All of the referrals reported came from respondents from New York City, Hudson Valley and Long Island (data not shown). Despite the relatively low referral rate to the PEHSU, demand for clinical referral resources was extremely high. 93.8% of respondents would refer patients to a clinic “where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns.”