Translating Knowledge About Environmental Health to Practitioners: Are We Doing Enough?

Background: Practitioners see a large number of children affected by environmental exposures each year. A national network of pediatric environmental health specialty units has been established to strengthen prevention capacity, yet the effectiveness of that translational resource has not been assessed. Methods: We supplemented a qualitative systematic review of previous assessments of healthcare provider capacity with a self-administered Survey sent to the membership of the Michigan chapter of the American Academy of Pediatrics. We mailed Surveys twice between October 2007 and January 2008 and obtained a 39.4% response rate. Results: Our systematic review identified 8 relevant studies, all of which relied on self-report questionnaires and surveys. Recognizing this methodological weakness, we found that national and state samples consistently identified significant gaps in self-efficacy and knowledge about environmental hazards across a broad range of child care providers. in the Michigan Survey, respondents voiced high self-efficacy in dealing with lead and second-hand smoke, but confidence in managing pesticide, mercury, mold, polychlorinated biphenyl, and air pollution exposures was much lower (P < 0.0001). Pediatricians routinely referred affected patients to lead/toxicology clinics and allergist/immunologists but not to the regional pediatric environmental health specialty unit. Conclusions: Gaps persist in practitioner knowledge about environmental health nationwide and across disciplines. Despite methodological weaknesses, educational opportunities and other efforts should be studied to determine best practices for enhancing the evaluation of environmental health concerns in children. Mt Sinai J Med 77:114-123, 2010. (C) 2010 Mount Sinai School of Medicine