Children's Environmental Health Faculty Champions Initiative: A Successful Model for Integrating Environmental Health into Pediatric Health Care

Although adults and children alike are at risk for developing disease from hazardous exposures, children have special vulnerabilities in regard to their exposures and responses to the environment. In proportion to their size, they breathe in more air, drink more water, and eat more food than adults (Landrigan et al. 2002). Moreover, although children < 5 years of age make up only 12% of the world’s population, it is estimated that 43% of the total burden of disease attributable to environmental factors falls on them (Garbino 2005). In the United States alone, the total annual cost for environmentally attributable childhood disease is $54.9 billion (Landrigan et al. 2002). Despite the economic cost and increased incidence of environmental exposure–related disease in children, pediatric medical and nursing education currently lacks the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat diseases caused by environmental exposures (McCurdy et al. 2004). Most medical schools and residency programs spend a limited amount of time on environmental aspects of disease (Graber et al. 1995; Roberts and Gitterman 2003). In fact, a study of environmental medicine content in U.S. medical schools found that 75% of schools require only about 7 hours of study in environmental medicine over the 4 years of medical school (Schenk et al. 1996). Furthermore, a study of chief residents of U.S. pediatric residency programs found that fewer than half of pediatric programs routinely include pediatric environmental health (PEH) issues in their curriculum, other than lead poisoning and environmental exacerbation of asthma (Roberts and Gitterman 2003). Several studies of health care professionals have identified the need for increased environmental health education. Kilpatrick et al. (2002) distributed a survey to pediatricians in Georgia to assess their knowledge, attitudes, and behaviors regarding patients’ environmental histories. Although more than half of the surveyed pediatricians reported having seen a patient with health issues related to environmental exposures, fewer than one in five had received training in environmental history-taking. Respondents reported low self-efficacy regarding environmental history-taking, discussing environmental exposures with parents, and finding diagnosis and treatment resources related to environmental exposures. Trasande et al. (2006a, 2006b, 2008) modeled Kilpatrick et al.’s (2002) survey assessing pediatricians attitudes, beliefs, and practices regarding pediatric environmental health, distributing the survey to pediatricians in New York, Wisconsin, and Minnesota in three separate studies. Results of each study were consistent, with pediatricians in all three states reporting a high interest in PEH issues yet feeling ill equipped to discuss common exposures and environmentally related illnesses with patients and their families. Balbus et al. (2006) found that most pediatricians and nurses felt poorly prepared to answer questions from patients on pesticides. This need for improvements in health care professionals’ environmental health knowledge has been expressed by leading health institutions. The Institute of Medicine recommends the integration of environmental health concepts into all levels of medical and nursing education (Pope and Rall 1995; Pope et al. 1995). Furthermore, the “Health Professionals and Environmental Health Education Position Statement” (Rogers 2004), which calls on health care providers to increase their knowledge of environmental health issues and recommends the creation of faculty champions as an effective strategy for integration of environmental health knowledge into health care professionals’ education and practice, has been endorsed by > 30 leading health professional and public health institutions including the American Academy of Pediatrics, American Association of Colleges of Nursing, American College of Preventive Medicine, American Nurses Association, and American Public Health Association (NEEF 2009). Few studies have evaluated the effectiveness of programs that incorporate PEH into curricula and practice. The purpose of this study is to evaluate the National Environmental Education Foundation’s (NEEF) Children’s Environmental Health Faculty Champions Initiative, which was designed to build health professional capacity to address children’s environmental health issues. We anticipate that the program will enhance the development of effective strategies to produce health care professionals competent in PEH.