title: Translating knowledge about environmental health to practitioners: are we doing enough?
abstract: 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.
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. leo.trasande@mssm.edu
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
authors.forename: Nicholas
authors.initials: N
authors.lastname: Newman
authors.forename: Linda
authors.initials: L
authors.lastname: Long
authors.forename: Genevieve
authors.initials: G
authors.lastname: Howe
authors.forename: Beth J
authors.initials: BJ
authors.lastname: Kerwin
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Gahagan
authors.forename: William B
authors.initials: WB
authors.lastname: Weil
mesh_terms: D001249:Asthma / Q000517:prevention & control; D002648:Child; D002658:Developmental Disabilities / Q000517:prevention & control; D004059:Diffusion of Innovation; D004781:Environmental Exposure / Q000517:prevention & control*; D004782:Environmental Health; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007855:Lead Poisoning / Q000517:prevention & control; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D020377:Self Efficacy; D014481:United States