Skip to main content

Health Professionals’ Environmental Health Literacy

Abstract

Health care providers play an important role in communicating health risks to patients, community residents, and public health agencies. For their own patients, the role of the provider could include taking an environmental health (EH) history, answering patient questions about exposures, providing anticipatory guidance to prevent exposures, and remaining alert to the possibility of toxicants or other environmental influences causing acute or chronic illness. However, few clinicians feel confident in discussing environmental risks, although patients rate them of high concern. There is ample evidence from clinician surveys and case reports of EH trainings to show that health professionals are not sufficiently literate in EH. This is also evident in community-engaged research projects. Lack of training and knowledge on the links between environment and health and lack of available clinical tools for both provider and patient education contribute to the inattention to this topic in the clinical, public health, and community settings. Health professionals likely have no experience in dealing with local officials and the general public in affected communities, nor with outside agencies, yet they may be called upon to give information and guidance to those parties that extend beyond their own patients. In this sense, they become part of a broader public health network in which the community is the patient. This chapter reviews health professionals’ current environmental health literacy (EHL) from the academic to community arenas, and focuses on examples of success and opportunities for expansion.

Keywords

  • Physicians
  • Nurses
  • Speech-language pathologists
  • Environmental health literacy
  • Environmental factors in health
  • Medical education
  • Health education
  • Health communication
  • Toxic chemicals
  • Health policy

Research reported in this publication was supported by the National Institute Of Environmental Health Sciences of the National Institutes of Health under Award Number T32ES023769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This publication was supported by the cooperative agreement award number U61TS000238-04 from the Agency for Toxic Substances and Disease Registry (ATSDR). I was also supported by the US National Institute of Environmental Health Sciences (NIEHS) (grants P01 ES018172 and P50ES018172) and the USEPA (grants RD83451101 and RD83615901), as part of the Center for Integrative Research on Childhood Leukemia and the Environment (CIRCLE). Its contents are the responsibility of the authors and do not necessarily represent the official views of ATSDR, EPA, or NIEHS.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-94108-0_8
  • Chapter length: 33 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   119.00
Price excludes VAT (USA)
  • ISBN: 978-3-319-94108-0
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   159.99
Price excludes VAT (USA)
Hardcover Book
USD   159.99
Price excludes VAT (USA)
Fig. 8.1
Fig. 8.2
Fig. 8.3
Fig. 8.4
Fig. 8.5
Fig. 8.6
Fig. 8.7
Fig. 8.8
Fig. 8.9

References

  • Altman, R., Brody, J., Rudel, R., Morello-Frosch, R., Brown, P., & Averick, M. (2008). Pollution comes home and pollution gets personal: Women’s experience of household toxic exposure. Journal of Health and Social Behavior, 49, 417–435.

    CrossRef  Google Scholar 

  • Amico, A., Davie, A., & Dalton, M. (2016). “The PFC Contamination at Pease: A Community Perspective.” Presentation at Local environmental action conference March 13, 2016. Boston, MA, Northeastern University.

    Google Scholar 

  • Association of American Medical Colleges (AAMC). (2010). 2010 medical school graduation questionnaire: all schools summary report: fınal. https://www.aamc.org/download/140716/data/2010_gq_all_schools.pdf

  • Association of American Medical Colleges (AAMC). (2018). Number of medical schools including topic in required courses and elective courses: environmental health. https://www.aamc.org/initiatives/cir/406462/06a.html

    Google Scholar 

  • Balshem, M. (1993). Cancer in the community: Class and medical authority. Washington, DC: Smithsonian Institution Press.

    Google Scholar 

  • Baron, S., Sinclair, R., Payne-Sturges, D., Phelps, J., Zenick, H., Collman, G. W., et al. (2009). Partnerships for environmental and occupational justice: Contributions to research, capacity and public health. American Journal of Public Health, 99, S517–S525.

    CrossRef  Google Scholar 

  • Brody, J. G., Morello-Frosch, R., Brown, P., Rudel, R. A., Altman, R. G., Frye, M., Osimo, C. C., Perez, C., & Seryak, L. M. (2007). Is it safe? New ethics for reporting personal exposures to environmental chemicals. American Journal of Public Health, 97, 1547–1554.

    CrossRef  Google Scholar 

  • Brody, J. G., Dunagan, S. C., Morello-Frosch, R., Brown, P., Patton, S., & Rudel, R. A. (2014a). Reporting individual results for biomonitoring and environmental exposures: Lessons learned from environmental communication case studies. Environmental Health, 13, 40.

    CrossRef  Google Scholar 

  • Brody, J. G., Kripke, M. L., Kavanaugh-Lynch, M. H., & Forman, J. R. M. R. (2014b). Breast cancer and environmental research. Science, 344, 577.

    CAS  CrossRef  Google Scholar 

  • Brown, P., & Kelley, J. D. (1996). Physician’s knowledge, attitudes, and practices regarding environmental health hazards. Industrial & Environmental Crisis Quarterly, 9(4), 512–542.

    CrossRef  Google Scholar 

  • Brown, P., & Mikkelsen, E. J. (1990). No safe place: Toxic waste, leukemia, and community action. Berkeley: University of California Press.

    Google Scholar 

  • Brown, P., McCormick, S., Mayer, B., Zavestoski, S., Morello-Frosch, R., Gasior, R., & Senier, L. (2006). ‘A lab of our own’: Environmental causation of breast cancer and challenges to the dominant epidemiological paradigm. Science, Technology, and Human Values, 31, 499–536.

    CrossRef  Google Scholar 

  • Brown, P., Brody, J. G., Morello-Frosch, R., Tovar, J., Zota, A. R., & Rudel, R. A. (2012). Measuring the success of community science: The northern California household exposure study. Environmental Health Perspectives, 120, 326–331.

    CrossRef  Google Scholar 

  • Burke, M. G., & Miller, M. D. (2011). Practical guidelines for evaluating lead exposure in children with mental health conditions: Molecular effects and clinical implications. Postgraduate Medicine, 123(1), 160–168.

    CrossRef  Google Scholar 

  • California Environmental Health Tracking Program. (2017). Imperial county community air monitoring project. Richmond, CA. http://www.cehtp.org/page/imperial_county

  • Cluss, P. A., & Moss, D. (2002). Parent attitudes about pediatricians addressing parental smoking. Ambulatory Pediatrics, 2, 485–488.

    CrossRef  Google Scholar 

  • Council on Environmental Health. (2012). Policy statement: Pesticide exposure in children. Pediatrics, 130(6), e1757–e1763.

    CrossRef  Google Scholar 

  • Curtis, K., & Wilding, B. C. (2007). “Is it in us? Toxic trespass, regulatory failure & opportunities for action.” Commonweal biomonitoring resource center, coming clean body burden work group.

    Google Scholar 

  • DePue, J. D., McQuaid, E. L., Koinis-Mitchell, D., Camillo, C., Alario, A., & Klein, R. B. (2007). Providence school asthma partnership: School-based asthma program for inner-city families. Journal of Asthma, 44, 449–445.

    CrossRef  Google Scholar 

  • Di Renzo, G. C., et al. (2015). International federation of gynecology and obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals. International Journal of Gynecology & Obstetrics. https://doi.org/10.1016/j.ijgo.2015.09.002

  • Edelstein, M. (1988). Contaminated communities: The social and psychological impacts of residential toxic exposure. Boulder: Westview Press/Perseus Books.

    Google Scholar 

  • Emmett, E., Zhang, H., Shofer, F., Rodway, N., Desai, C., Freeman, D., & Hufford, M. (2009). Development and successful application of a ‘Community-First’ communication model for community-based environmental Health Research. Journal of Occupational and Environmental Medicine, 51(2), 146–156.

    CrossRef  Google Scholar 

  • Eskenazi, B., Bradman, A., & Castorina R. (1999). Exposures of children to organophosphate pesticides and their potential adverse health effects. Environmental Health Perspectives, 107(Suppl 3), 409–419.

    Google Scholar 

  • Friedrich, M. J. (2017). Medical community gathers steam to tackle climate’s health effects. JAMA, 317(15), 1511.

    CAS  CrossRef  Google Scholar 

  • Fung, A., & O’Rourke, D. (2000). Reinventing environmental regulation from the grassroots up: Explaining and expanding the success of the toxics release inventory. Environmental Management, 25, 115–127.

    Google Scholar 

  • Gallup. (2014). Gallup poll. U.S. Views on honesty and ethical standards in professions. http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx

  • Gehle, K. S., Crawford, J. L., & Hatcher, M. T. (2011). Integrating environmental health into medical education. American Journal of Preventive Medicine, 41(4S3), S296–S301.

    CrossRef  Google Scholar 

  • Hernberg, S. (2000). Lead poisoning in a historical perspective. American Journal of Industrial Medicine., 38, 244–254.

    CAS  CrossRef  Google Scholar 

  • Hoover, E. (In press). The River is in Us: Fighting Toxics in a Mohawk Community. Minneapolis: University of Minnesota Press.

    Google Scholar 

  • Hoover, E., Renauld, M., Edelstein, M., & Brown, P. (2015). Social science contributions to transdisciplinary environmental health. Environmental Health Perspectives., 123, 1100–1106.

    CrossRef  Google Scholar 

  • Ibanez, G., Zabar, J., Cadwallader, J., Rondet, C., Lochard, M., & Magnier, A. M. (2015). Views of general practitioners on indoor environmental health risks in the perinatal period. Frontiers in Medicine, 2(32). https://doi.org/10.3389/fmed.2015.00032

  • Kilpatrick, N., Frumkin, H., Trowbridge, J., Escoffery, C., Geller, R., Rubin, L., Teague, G., & Nodvin, J. (2002). The environmental history in pediatric practice: A study of pediatricians’ attitudes, beliefs, and practices. Environmental Health Perspectives, 110(8), 823–827.

    CrossRef  Google Scholar 

  • Kovarik, W. (2005). Ethyl-leaded gasoline: How a classic occupational disease became an international public health disaster. International Journl of Occupational and Environmental Health, 11, 4.

    Google Scholar 

  • Kreuter, M. W., Chheda, S. G., & Bull, F. C. (2000). How does physician advice influence patient behavior? Evidence for a priming effect. Archives of Family Medicine, 9, 426–433.

    CAS  CrossRef  Google Scholar 

  • Lai, P. Y., Cottingham, K. L., Steinmaus, C., Karagas, M. R., & Miller, M. D. (2015). Arsenic and rice: Translating research to address health care providers’ needs. The Journal of Pediatrics, 167(4), 797–803.

    CrossRef  Google Scholar 

  • MA Department of Public Health. (2017). Make smoking history. http://makesmokinghistory.org/quit-now/for-providers. Accessed 25 May 2017.

  • Mayer, B., Brown, P., & Morello-Frosch, R. (2010). Labor-environmental coalition formation: Framing and the right-to-know. Sociological Forum, 25, 745–768.

    CrossRef  Google Scholar 

  • McCormick S., Brown P., & Zavestoski S. (2003). The Personal Is Scientific, the Scientific Is Political: The Public Paradigm of the Environmental Breast Cancer Movement. Sociological Forum, 18(4), 545–576.

    Google Scholar 

  • McCurdy, L. E., et al. (2004). Incorporating environmental health into pediatric medical and nursing education. Environmental Health Perspectives, 112(17), 1755–1760. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1253669/

    CrossRef  Google Scholar 

  • Mello, S., & Hovick, S. R. (2016). Predicting behaviors to reduce toxic chemical exposures among new and expectant mothers: The role of distal variables within the integrative model of behavioral prediction. Health Education & Behavior, 43(6), 705–715. https://www.ncbi.nlm.nih.gov/pubmed/27179287

    CrossRef  Google Scholar 

  • Miller, M. D., & Marty, M. A. (2012). Childhood - A time period uniquely vulnerable to environmental exposures. In R. H. Friis (Ed.), The Praeger handbook of environmental health. Santa Barbara: Praeger.

    Google Scholar 

  • Miller, M., & Solomon, G. (2003). Environmental risk communication for the clinician. Pediatrics, 112, 211–217.

    Google Scholar 

  • Moss, D., Cluss, P. A., Mesiano, M., & al, e. (2006). Accessing adult smokers in the pediatric setting: What do parents think? Nicotine & Tobacco Research, 8, 67–75.

    CrossRef  Google Scholar 

  • Nardini, C. (2014). The ethics of clinical trials. Ecancermedicalscience, 8, 387. https://doi.org/10.3332/ecancer.2014.387.

    CrossRef  Google Scholar 

  • Needleman, H. L. (1992). Salem comes to the National Institutes of Health: Notes from inside the crucible of scientific integrity. Pediatrics, 90, 977–981.

    CAS  Google Scholar 

  • Needleman, H. L., Tuncay, O., & Shapiro, I. M. (1972). Lead levels in deciduous teeth of urban and suburban American children. Nature, 235, 111–112.

    CAS  CrossRef  Google Scholar 

  • Needleman, H. L., Gunnoe, C., Leviton, A., et al. (1979). Deficits in psychological and classroom performance in children with elevated dentine lead levels. The New England Journal of Medicine, 300, 689–695.

    CAS  CrossRef  Google Scholar 

  • NEETF – Health professionals and Environmental Health Education Position Statement. (2004). https://www.neefusa.org/resource/health-professionals-and-environmental-health-education-position-statement

  • Quandt, S. A., Doran, A. M., Rao, P., Hoppin, J. A., Snively, B. M., & Arcury, T. A. (2004). Reporting pesticide assessment results to farmworker families: Development, implementation, and evaluation of a risk communication strategy. Environmental Health Perspectives, 112, 636.

    CrossRef  Google Scholar 

  • Roberts, J. R., & Gitterman, B. A. (2003). Pediatric environmental health education: A survey of US pediatric residency programs. Ambulatory Pediatrics, 3(1), 57–59.

    CrossRef  Google Scholar 

  • Rodgers, K. M., Udesky, J. O., Rudel, R. A., & Brody, J. G. (2018). Environmental chemicals and breast cancer: An updated review of epidemiological literature informed by biological mechanisms. Environmental Research, 160, 152–182.

    CAS  CrossRef  Google Scholar 

  • Sackett, D. L., Rosenberg, W. M. C., Gray, J. A., Haynes, B. R., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.

    CAS  CrossRef  Google Scholar 

  • Schell, L. M., & Tarbell, A. M. (1998). Commentary: A partnership study of PCBs and the health of Mohawk youth: Lessons from our past and guidelines for our future. Environmental Health Perspectives, 106(Supplement 3), 833–840.

    Google Scholar 

  • Stein, J., Schettler, T., Rohr, B., Valenti, M. (2008). Environmental threats to healthy aging. Greater Boston physicians for social responsibility and science and environmental health network, www.agehealthy.org

  • Stotland, N. E., Sutton, P., Trowbridge, J., Atchley, D. S., Conry, J., Transande, L., Gerbert, B., Charlesworth, A., & Woodruff, T. J. (2014). Counseling patients on preventing prenatal environmental exposures- a mixed-methods study of obstetricians. PLoS One, 9(6), e98771.

    CrossRef  Google Scholar 

  • Taylor, D. K., Lepisto, B. L., Lecea, N., Ghamrawi, R., Bachuwa, G., LaChance, J., & Hanna-Attisha, M. (2017). Surveying resident and faculty physician knowledge, attitudes, and experiences in response to public lead contamination. Academic Medicine, 92(3), 308–311.

    CrossRef  Google Scholar 

  • Trasande, L., Boscarino, J., et al. (2006a). The environment in pediatric practice: A study of New York pediatricians’ attitudes, beliefs, and practices towards Children’s environmental health. Journal of Urban Health, 83(4), 760–772.

    CrossRef  Google Scholar 

  • Trasande, L., Schapiro, M. L., Falk, R., Haynes, K. A., Behrmann, A., Vohmann, M., Stremski, E. S., Eisenberg, C., Evenstad, C., Anderson, H. A., & Landrigan, P. J. (2006b). Pediatrician attitudes, clinical activities, and knowledge of environmental health in Wisconsin. WMJ, 105(2), 45–49.

    Google Scholar 

  • Trasande, L., Newman, N., Long, L., Howe, G., Kerwin, B. J., Martin, R. J., Gahagan, S. A., & Weil, W. B. (2010). Translating knowledge about environmental health to practitioners: Are we doing enough? Mount Sinai Journal of Medicine, 77(1), 114–123.

    CrossRef  Google Scholar 

  • Trasande, L., et al. (2014). The environment and children’s health care in Northwest China. BMC Pediatrics, 14, 82.

    CrossRef  Google Scholar 

  • Vega, V., Milagros, C., Brown, P., Murphy, C., Figueroa, A., Cordero, J., & Alshawabkeh, A. (2016). Community engagement and research translation in Puerto Rico’s northern karst region: The PROTECT superfund research program. New Solutions, 26, 475–495.

    CrossRef  Google Scholar 

  • Warren, C. (2000). Brush with death: A social history Of lead poisoning. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Wilding, B. C., Curtis, K., & Welker-Hood, K. (2009). Hazardous chemicals in health care: A snapshot of chemicals in doctors and nurses. Physicians for social responsibility.

    Google Scholar 

  • Woodruff, T. J., Sutton, P., & The Navigation Guide Work Group. (2011). An evidence-based medicine methodology to bridge the gap between clinical and environmental health sciences. Health Affairs, 30(5), 931–937. https://doi.org/10.1377/hlthaff.2010.1219.

    CrossRef  Google Scholar 

  • Zachek, C. M., Miller, M. D., Hsu, C., Schiffman, J. D., Sallan, S., Metayer, C., & Dahl, G. V. (2015). Children’s cancer and environmental exposures: Professional attitudes and practices. Journal of Pediatric Hematology/Oncology, 37(7), 491–497.

    CrossRef  Google Scholar 

  • Zimmerman, E., Borkowski, C., Clark, S., & Brown, P. (n.d.) Under review. Education speech-language pathologists working in early intervention on environmental health.

    Google Scholar 

Download references

Acknowledgement

The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701-4. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Phil Brown .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2019 The Author(s)

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Brown, P., Clark, S., Zimmerman, E., Valenti, M., Miller, M.D. (2019). Health Professionals’ Environmental Health Literacy. In: Finn, S., O'Fallon, L. (eds) Environmental Health Literacy. Springer, Cham. https://doi.org/10.1007/978-3-319-94108-0_8

Download citation