title: The Environment and Children's Health Care in Northwest China.
abstract: BACKGROUND
  Industrialization in the northwest provinces of the People's Republic of China is accelerating rapid increases in early life environmental exposures, yet no publications have assessed health care provider capacity to manage common hazards.
  
  
  METHODS
  To assess provider attitudes and beliefs regarding the environment in children's health, determine self-efficacy in managing concerns, and identify common approaches to managing patients with significant exposures or environmentally-mediated conditions, a two-page survey was administered to pediatricians, child care specialists, and nurses in five provinces (Gansu, Shaanxi, Xinjiang, Qinghai, and Ningxia). Descriptive and multivariable analyses assessed predictors of strong self-efficacy, beliefs or attitudes.
  
  
  RESULTS
  960 surveys were completed with <5% refusal; 695 (72.3%) were valid for statistical analyses. The role of environment in health was rated highly (mean 4.35 on a 1-5 scale). Self-efficacy reported with managing lead, pesticide, air pollution, mercury, mold and polychlorinated biphenyl exposures were generally modest (2.22-2.52 mean). 95.4% reported patients affected with 11.9% reporting seeing >20 affected patients. Only 12.0% reported specific training in environmental history taking, and 12.0% reported owning a text on children's environmental health. Geographic disparities were most prominent in multivariable analyses, with stronger beliefs in environmental causation yet lower self-efficacy in managing exposures in the northwestern-most province.
  
  
  CONCLUSIONS
  Health care providers in Northwest China have strong beliefs regarding the role of environment in children's health, and frequently identify affected children. Few are trained in environmental history taking or rate self-efficacy highly in managing common hazards. Enhancing provider capacity has promise for improving children's health in the region.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, 227 East 30th Street Rm 109, New York, NY 10016, USA. Leonardo.trasande@Nyumc.org.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
authors.forename: Jingping
authors.initials: J
authors.lastname: Niu
authors.forename: Juansheng
authors.initials: J
authors.lastname: Li
authors.forename: Xingrong
authors.initials: X
authors.lastname: Liu
authors.forename: Benzhong
authors.initials: B
authors.lastname: Zhang
authors.forename: Zhilan
authors.initials: Z
authors.lastname: Li
authors.forename: Guowu
authors.initials: G
authors.lastname: Ding
authors.forename: Yingbiao
authors.initials: Y
authors.lastname: Sun
authors.forename: Meichi
authors.initials: M
authors.lastname: Chen
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Hu
authors.forename: Lung-Chi
authors.initials: LC
authors.lastname: Chen
authors.forename: Alan
authors.initials: A
authors.lastname: Mendelsohn
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Qingshan
authors.initials: Q
authors.lastname: Qu
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services; D002669:Child Welfare; D002681:China; D003625:Data Collection; D004781:Environmental Exposure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires