A b
st
r a ct
L itt le
is
k
n ow
n ab
o ut h
e alt h
c a r ep
r o vid
e r e ng
ag
em
e nt
a nd in
t
e r e st i
nth
eh
e alt h
ef fe c
t
s of h
um
a nin
d
u c ed
e n vir o n
m
e nt
al
a nd
e c o sy
st
em d
eg
r ad
at io n
(
H I E D
)
.A
s u r v ey
of 2 1 7 7 m
em b
e r s of t h
eW
il d
e r n e s sM
ed ic a
l S
o cie
t y
(W
M S
)
w
a s c om p l
eted
tob
ett
e rd
ef i
n et h
e s c op
e ,i
nte r e s
t
a nd
at t it
ud
e s of t h
e s eh
e alt h
c a r ep
r o vid
e r s ab
o ut t h
e ad
v e r s eh
um
a nh
e al th
ef fe c
ts
of H I E D
.D
at
aw
a s a n aly
z ed
f
r om t h
e6 6 5
r e sp
o n s e s , a r e sp
o n s e r at
e of 3 5
%
.R
e s ults
d
em
o n st
r at
eh
e alt h
c a r ep
r o vi d
e r sid
e nt ify
ala r
g
e n um b
e r of h
e alt h
eff
e ct
s a s s o cia
t
ed w it h
e n vi
r o nm
e nt
al
a nd
e c o sy
st
em d
eg
r ad
at io n
.O
v e r8 0
%
of
r e sp
o nd
e nts
r ep
o rt t h
at H I E D h
a s af fe c
t
ed
theh
e alt
h
of
ap
at ie n
tt h
ey h
a v e c a r ed f
o r,6 0
%
r ep
o rt
ap
at ie n
t h
a s a sk
ed
ab
o ut H IE D
af fe c
ti
ng
t h
eir
h
e al th
, a nd 9 3
%
r ep
o rt t h
at t h
ey d
o n ot d i
st
ri b
ut
ein
f
o rm
at io n
t
op
at ie n
t
s ab
o ut
H I E D
.7 6
.1
%
of
r e sp
o nd
e nt
sb
el ie v e o r s
t
r o ng ly b
elie v e
t h
at t h
e r eis
a n u nf
ulf i ll
ed
n e ed
f
o rin
f
o rm
at io n a n
d
ed
u c at io n a
b
o ut t h
e ad
v e r s eh
e alt h
ef fe c
ts o
f H IE D
.R
e sp
o nd
e nt
s r ep
o rt C M E
,j
o u r n al
a rtic
le s a n
d m
ed ic a
l
s ch
o ols
/
r e si d
e n cy
p
r og
r am
s a st h
eb
e st m
et h
od
sf
o r r ais
in
g h
e alt h p
r ofe s s
io n a
l
aw
a r e n e s s .R
e s ul ts
in
d ic a
te a s
t
r o ng h
e alt h p
r of
e s sio n a
l b
el ie
f in
h
e alt h
ef f
e ct
s of H I E D
,T
ab l
e of C
o nt
e ntsS
e ct i
o nP
ag
eA b
st
r a ct
2
T
ab l
e of F ig
u r e s a nd T
ab l
e4
A
ck
n ow l
ed g
em
e nt
5
I
ntr od
u cti
o n6
D
e sig
n a nd S
am p l
e7
R
e s ult
s a nd D i
s c u s si
o n8
D i
s c u s si
o n/ C
o n cl
u si
o n2 9
D i
r e ct i
o n sf
o rF
ut
u r eS t
ud y
3 1
R
ef
e r e n c e s3 2
L i
st
of T
ab l
e sT
ab l
eN
um
b
e rP
ag
eT
ab le
1
O
c c up
at i
o n of R
e sp
o nd
e nt
s9
T
ab le
2
S
elf
-R
ep
o rt
ed M
ed ic a
l S p
e cia
lt
y
of R
e sp
o nd
e nt
s9
T
ab le
3
R
e sp
o nd
e ntH
om
eC
o u nt
rie s
1 2
T
ab le
4
T
op i
c sd is c u s s e
d b y H
e alt h C
a r eP
r o vi d
e r s1 6
T
ab le
5
A d
v e r s eh
e alth
ef fe c
t
s of H I E D
a nd F
r eq
u e n cy
2 1
T
ab le
d
G
r o up
s a nd O
rg
a ni
z at io n s
P
r o vid
ed
0
1 9 /
Q
2 0
2 3
T
ab l
e7
G
r o up
s a nd In
d iv
id
u als a
d d
r e s sin
g H IE D
2
4
L i
st
of F i g
u r e sF i
g
u r eN
um
b
e rP
ag
eF i g
u r e1
A
g
eD is
t
ri b
ut io n o
f R
e sp
o nd
e nt
s8
F i g
u r e2
R
e sp
o nd
e nt G
e og
r ap h i
c al D is
t
rib
ut io n
1 1
F ig
u r e3
H IE D
af f
e ct
ed h
e alt h
of p
at ie n
t?
1
2
F ig
u r e4
H IE D
af f
e ct
ed h
e alt h
of f
am i ly /f
rie n
d
1
3
F ig
u r e5
P
at i
e nt
a sk
ed
af f
e ct
s of H IE D ?
14
F ig
u r e6
H
ow
of
te n a sk
ed
ab
o utH IE D ?
14
F i g
u r e7
D
oy
o ud is c u s s
H I E D
a sf
a ct
o rin
il ln e s s
?
15
F i g
u r ed
S
o u r c e s of In
f
o rm
at io n a
b
o ut H IE D
17
F i g
u r e9
D
oy
o ud is
t
rib
ut
ein
f
o ab
o ut H IE D ?
18
F i g
u r e1 0
S
o u r c e of E d
u c at io n a
l M
at
e ria
ls
19
F i g
u r e1 1
S t
r e ng th
of C
a u s al C
o n n e ct io n s
2 0
F i g
u r e1 2
H
e alt h E f f
e cts
d i
r e ctly
r ela
t
ed to
H I E D
2 0
F i g
u r e13
B
el ie
f
of
W
o rl d w id
ei m p
a ct of
s ele c
t
ed t
op i
c s2 2
F i g
u r e14
C h
a ng
e s c o r e s c u r r e nt
a nd p
ote n
t ia
l in
f lu e n c e
2 3
F i g
u r e1 5
E le c
te
d
r ep
r e s e nt
at iv e c o n
t
a ct
2
5
F ig
u r e1 6
U
nf
ulf i l le
d
n e ed f
o rin
f
o rm
at io n a n
d
ed
u c ati
o n2 6
F i g
u r e1 7
Im p
o rt
a n c e of t
e a ch i
ng
ab
o ut H IE D
2 7
F ig
u r e1 8
I
nf
o rm
at io n s o u r c e s
u s ed f
o rH I E D
2 7
A
ck
n ow le
d g
em
e nts :I w
o uld li k
et
ot h
a nk t h
eE
x e c utiv e
B
o a rd
of t h
eW
i ld
e r n e s sM
ed i
c al S
o cie
ty f
o r th
eg
e n e r o u sd
o n at io n o
f t h
ei
rm
em b
e r s em
ai l
ad d
r e s s e s a nd th
em
em b
e r s of
th
eW
i ld
e r n e s sM
ed ic a
l S
o cie
ty w h
ot
o ok t im
et
o sh
a r et h
ei
r op i
nio n s
.I w
o uld
als o
l i k
et
ot h
a nk T
e r e s aE d w
a rd
sf
r om th
eO d
um In s
t it
ut
ef
o rR
e s e a r ch i
nS
o cia
l
S
cie n c e
f
o rh
e rh
el p w it h
s u rvey d
e sig
n , ed it i
ng
a nd
u s e of t h
e o nli
n e s u r v ey
t
o ols
.F in a
lly
,I w
o uld l i ke
t
ot h
a nk t h
e n um
e r o u sin
d iv
id
u als
w it h w h
om I h
a v eh
ad
C h
a p te rO
n eI
nt
r od
u ct i
o n :D
e sp it
e ag
r ow i
ng b
od y
of l it
e r at
u r ed
em
o n st
r at i
ng
n um
e r o u sh
e alt h
ef f
e ct
s a s s o ci
at
ed w it h
e n vi
r o nm
e nt
al
c o nt
am i
n at i
o n a nd d
eg
r ad
at i
o n, e n vi
r o nm
e nt
al
h
e al th i
s n ot
at
op i
ct
a ug h t w it h m
u ch
em p h
a si
si
nm
ed i
c al
s ch
o ol
^"^I
n a n1 9 9 5
r e vi
ew
of
e n vi
r o nm
e nt
al
ed
u c at i
o ni
nm
ed i
c al
s ch
o ol
s,G
r ab
e r a nd
M
u sh
am
^w
r ot
e , "T h
e r el
eg
at i
o n of
e n vi
r o nm
e nt
al m
ed i
ci
n e ed
u c at i
o nt
o ah
a nd f
ul
of
el
e ct i
v e c o u r s e si
n am i
n o rity
of m
ed i
c al
s ch
o ol
si ll
u st
r at
e st h
at t h i
s s ub
j
e ct i
s c o n sid
e r ed p
e rip h
e r al
a nd
u nim p
o rt
a nt b y m
ed i
c al
ed
u c at
o r s a nd
p h y
si
ci
a n s ."
A
c c o rd i
ng t
ot h
e2 0 0 6 A m
e ri
c a nA
c ad
em y
of M
ed i
c al C
oll
eg
e s u r v ey
, o nly 7 1
of 1 2 5 m
em b
e r s ch
o ol
sh
a v et h
et
op i
ci
n cl
ud
ed i
n a r eq
ui
r ed
c o u r s e , a nd 4 3
.6
%
of g
r ad
u ati
ng
st
ud
e nt
sf
elt t h
et i m
ed
e v ot
ed t
ot h
e s ub
j
e ct
i
n ad
eq
u at
e^.I
n1 9 9 9
,t h
eI
n st it
ut
e of M
ed i
ci
n e^
r e
p
o rt
ed
,"
I
nm
o st
[
U
.S
.]
m
ed i
c al
s ch
o ol
s,t h
e a v e r ag
e cl
a s s r o om
ti m
ef
o r o c c up
at i
o n al
a nd
e n vi
r o nm
e nt
al
m
ed i
ci
n e c om b i
n ed i
s a n e st im
a ted 6 h
o u r s. "I
n a2 0 0 7
s u r v ey
^,9 3
%
of 2 2 8
c u r r e nt m
ed i
c al
st
ud
e nt
sb
eli
e v ed t h
eh
e alt h
ef f
e ct
s of
e n vi
r o nm
e nt
al
ch
a ng
e a nd d
eg
r ad
a ti
o nw
o uld b
ep
e rti
n e nt t
ot h
ei
rf
ut
u r em
ed i
c al p
r a ct i
c e .R
e c e nt ly
, aW
o rld H
e alt h O
rg
a ni
z at i
o n r ep
o rt
^
s
t
at
ed t h
at
n e a rly
o n eq
u a rt
e r of g l
ob
al d
e at h
s a nd t
ot
al d i
s e a s eb
u rd
e n c a nb
e att
ri b
ut
ed t
o e n vi
r o nm
e nt
al
a nd
e c o sy
st
em
ch
a ng
e.G i
v e nt h i
sb
a ck d
r op
.T h
eI
n st it
ut
e of M
ed i
ci
n e(
l O M
)
,t h
eA m
e ri
c a nM
ed i
c al A
s s o ci
at i
o n a nd t h
eA m
e ri
c a nA
c ad
em y
of P
ed i
at
ri
c s^ "h
a v e all
c al l
ed f
o rm
o r et
r ai
ni
ng
a nd
ed
u c a ti
o ni
n th
e a r e a of
e n vi
r o nm
e nt
al h
e alt h
.T h
el O M
^
r e
p
o rt
f
o u nd
,"
t h
e r ei
s at
r em
e nd
o u s n e ed t
o ed
u c at
eh
e al th
c a r ep
r o vi d
e r s ab
o ut t h
ep
ot
e nt i
al
e n vi
r o nm
e nt
al i m p
a ct
s a nd
c o n c e r n s a nd
,m
o st i m p
o rt
a nt ly
,t
oi
n v ol
v et h
e s ep
r o vid
e r si
nt h
ed i
s s em i
n at i
o n of
a c c u r at
ei
nf
o rm
at i
o n ab
o ut l
o c al
e n v
i
r o nm
e nt
al h
e al th i
s s u e s"
M
cC
all
ey
a nd C
a s s eP
^ a rg
u ed p h y
si
ci
a n sh
a v e sp
e ci
al
r e sp
o n si b i l ity t
ow
o rk f
o rt h
ep
r e v e nt i
o n of g l
ob
al
e n vi
r o nm
e nt
al d
am
ag
e .D
e sp it
et h i
s n e ed
,p
r eve ntativ
em
ed i
c al
s e rvi
c e s a r e of t
e nli m i
ted b y
h
e alt h i
n s u r e r sf
o rp
at i
e nt
s a nd p
o o rly
r ei m b
u r s ed f
o rp h y
si
ci
a n s , s o c o u n s el i
ng
of h
e alt h
c o n s eq
u e n c e sd
u et
o e n vi
r o nm
e nt
al
e xp
o s u r e sm
ay b
e r ed
u c ed t
o af
ew p
a s si
ng
c om m
e nt
s.V
e ry f
ew
st
ud i
e s of p h y
si
ci
a n a nd
ot h
e rh
e alt h p
r of
e s si
o n al k
n ow l
ed g
e ab
o ut
e n vi
r o nm
e nt
al h
e alt h h
a v eb
e e np
ub l i
sh
ed
a nd t h
e s e st
ud i
e sh
a v eu n
if
o rm l y d
em
o n st
r at
ed p
r of
e s si
o n al
a nd m
ed i
c al
st
ud
e ntb
el i
ef i
n th
eim p
o rta n c e of t
ak i
ng
a n e n vi
r o nm
e nt
al h i
st
o ry
, a sig
nif i
c a ntd i
s c om f
o rtw i
th t
ak i
ng
a ne n v
i
r o nm
e nt
al h i
st
o ry
, al
a ck
of
ed
u c at i
o n al m
at
e ri
al
sf
o rb
ot h p h y
si
ci
a n s a nd
p
at i
e nt
s, a nd
ap
r ef
e r e n c ef
o r r ef
e r ri
ng p
ati
e nt
st
o sp
e ci
alt y
c e nt
e r sf
o r c a r e of
e n vi
r o nm
e nt
al h
e al th i
s s u e s^' ^' ^ ^■^ ^
T h
ep
u rp
o s e of t h i
s te ch
ni
c al
r ep
o rt i
s tom
o r ef
ul ly
e xp l
o r e th
e at
tit
ud
e sa n
d b
el i
ef
s of
e xp
e ri
e n c ed
, cli
ni
c al h
e alt h p
r of
e s si
o n al
st
ow
a rd
st h
e ad
v e r s ee
f f
e ct
s of
e n vi
r o nm
e nt
al d
eg
r ad
at i
o n a nd
e c o sy
st
em d
e st
r u ct i
o nb y
e x am i
ni
ng
t
h
e a t tit
ud
e s a nd b
el i
ef
s of t h
eh
e alt
h
ef f
e ct
s of h
um
a ni
nd
u c ed
e nvi
r o nm
e nt
al
d
eg
r ad
at i
o n(
H IE D
)
i
n7 6 4 h
e al th p
r of
e s si
o n al
sm
em b
e r s of th
eW
il d
e r n e s sM
ed i
c al S
o ci
ety
.C h
a pt
e rT
w
oD
e sig
n a nd S
am p l
e :S
u r v e yD
e si
g n a nd D i
st
rib
uti
o n :A 3 0
-q
u e stio n s u r v ey w
a sd
e v el
op
ed
, ed it
ed
a nd d i
st
rib
ut
ed
to a sm
all p i l
ot g
r o up
f
o r c om m
e nt
s.B
a s ed
o n c om m
e nt
sf
r om
r e vi
ew
e r s,f
o u rq
u e st i
o n sw
e r ed i
s c a rd
ed d
u et
o am b ig
uit y
a nd t h
ef i
n al
s u r v ey w
a s sh
o rt
e n ed t
o2 6 q
u e st i
o n sF
o u rq
u e st i
o n s a sk
ed d
em
og
r ap h i
ci
nf
o rm
at i
o nt
o a s c e rt
ai
n ag
e, o c c up
at i
o n,m
ed i
c al
sp
e ci
alty
a nd
st
at
e a nd /
o r c o u nt
ry
of
r e si d
e n c eT h
e r em
ai
nd
e r of t h
eq
u e st i
o n s ad d
r e s s ed t h
ef
oll
ow i
ng
a r e a s :W
e r e r e sp
o nd
e nts th i
nk i
ng
ab
o ut t h
e ad
v e r s eh
e alt h
eff
e ct
s of
e n vi
r o nm
e nt
al
c
h
a ng
e? If
s o,w h
at i
s s u e sw
e r e of i
nt
e r e st t
ot h
e r e sp
o nd
e nt
s? A
r ep
at i
e nt
sa s
k i
ng
ab
o ut t h
e ad
v e r s eh
e alt h
ef f
e ct
s of
e n vi
r o nm
e nt
al d
eg
r ad
at i
o n? If
s o,w h
at
a r et h
ey
a sk i
ng ?
W
h
at
s o u r c e s of i
nf
o rm
at i
o n a r et h
e r e sp
o nd
e nt
s c u r r e nt ly
u s
i
ng f
o r ed
u c at i
o n? T h
eq
u e st i
o n s al
s o ad d
r e s s ed b
el i
ef
s of w h
om
a nd w h
at
ag
e n ci
e s a r e c u r r e nt ly
ad d
r e s si
ng t h
ei
s s u e of
ad
v e r s eh
e alt h
ef f
e ct
s of
e n vi
r o nm
e nt
al d
eg
r ad
at i
o n, a nd w h
o c o uld m
o r e ef f
e ct i
v ely
ad d
r e s st h
e s ei
s s u e s .I
nt h
e s u r v ey h
um
a n-i
nd
u c ed
e n vi
r o nm
e nt
al d
eg
r ad
at i
o n(
H I E D
)
w
a sd
ef i
n ed i
nt h
e s u r v ey
a s n eg
at i
v ei m p
a ct
s of h
um
a n s a nd h
um
a n a ct i
vit i
e s up
o nt h
e n at
u r al
a nd m
a n-m
ad
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r o nm
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,
i
n cl
ud i
ng t h
ep l
a nt
a nd
a nim
al
c o
m m
u ni ti
e st h
at i
nh
ab it t h
e e n vi
r o nm
e nt
.E
a ch q
u e st i
o nw
a sp
r e s e nt
ed
a s ei th
e r aY
e s/ N
oq
u e st i
o n,5
-p
oi
nt L i k
e rt
s c a
l
e , o rf
r e et
e xt
a n sw
e rb
o xf
o rm
at
.T h
e s u r v ey w
a sf
o rm
att
ed f
o r a nd d i
strib
ut
ed
u si
ng t h
eZ P
r o s u r v ey t
o ol
(
M
a rk
etT
o ol
s ,I
n c .S
a nF
r a n ci
s c o ,C A
)
u nd
e r ali
c e n s ef
o rT h
eO d
um I
n st i t
ut
ef
o rR
e s e a r ch i
nS
o ci
al S
ci
e n c e at U N C C h
ap
el H i ll
.I
n vit
at i
o n st
op
a rti
ci p
at
ew
e r ed i
st
rib
ut
ed
vi
a e-m
ail
a nd i
n cl
ud
ed
al
et t
e r of i
nt
r od
u ct i
o n e xp l
ai
ni
ng th
ep
u rp
o s e of t h
e st
ud y
.A U R L l i
nk w
a sp
r o vi d
ed i
n e a ch i
n vit
at i
o n a nd
s el
e ct i
o n of t h
el i
nk
w
o uld p
r e s e nt t h
ei
n vit
e ew i th t h
e s u r v ey
.T h
r e e r em i
nd
e r sw
e r e s e nt
vi
a em
ai l t
on o n-r e s
p
o nd
e ntsb
ef
o r e cl
o si
ng t h
e s u r v ey
.R
e s ult
sw
e r e a n aly
z ed
u si
ng
a nE
x c el
sp
r e ad
sh
e et
a nd J M P S
tati
sti
c al
S
of tw
a r e(
S A S I
n st it
ut
e)
.T h
e st
ud y
a nd
s up p
o rt i
ng m
at
e ri
al
sw
e r e ap p
r o v ed b y
t h
eU N C P
ub l i
cH
e alt h IR B
(
S t
ud
y #
0 6
-0 2 4 1
)
.
P
a rt i
ci p
a nt
s :T h
eW
i ld
e r n e s sM
ed i
c al S
o ci
ety
(W
M S
) (
w w w
.w m
s.o rg
)
w
a s ch
o s e n a s as a
m p l
e of h
e alt h p
r of
e s si
o n al
sf
o rt h
e st
ud y
.T h
eW
i ld
e r n e s sM
ed i
c al S
o ci
ety i
s a2 5 0 0
-m
em b
e r o rm
a ny
sp
e ci
alti
e s a nd i
sw id
el y g
e og
r ap h i
c al ly d i
strib
ut
ed
.T h
em i
s si
o n st
at
em
e nt
o
f t h
eW
M S
stat
e sh
e al th p
r of
e s si
o n al m
em b
e r s "c o
m b i
n e th
ei
rp
r of
e s si
o nw i
th
t h
ei
rp
a s si
o nf
o rt h
ew ild
e r n e s s " a nd f
o c u s e s o n ed
u c at i
o nf
o rt
r e ati
ng m
ed i
c al
p
r ob l
em
s e n c o u nt
e r ed i
nt h
ew i ld
e r n e s s.T h i
sg
r o up w
a s s el
e ct
ed b
e c a u s e of t h
ew i d
ed i
v e r si ty
of m
em b
e r s a nd t h
eb
eli
ef t h
at
W
M S m
em b
e r sw
o uld p
o s s e s sh ig h
a
w
a r e n e s s of
ad
v e r s eh
e alth
ef f
e ct
s of
e n vi
r o nm
e nt
al d
eg
r ad
at i
o nd
u et
ot h
ei
ri
nt
e r e st i
nt h
e n at
u r al
wo rl d
.It w
a s r e a s o n ed t h
at if t h i
sg
r o up h
ad lit t l
ea
w
a r e n e s s ,i
nt
e re st
o r a c c e s st
o ed
u c at i
o n al m
at
e ri
al
s, ot h
e rp h y
si
ci
a n s a nd
h
e alth p
r of
e s si
o n al
sm
ay h
a v e e v e nl
e s s aw
a r e n e s s,i
nt
e r e st
o r a c c e s st
oe
d
u c ati
o n al m
at
e ri
al
s.E
-m
ai l i
n vit
at i
o n sw
e r e s e nt t
o2 1 7 7 m
em b
e r s of t h
e
W
M S
.T h
e r ew
e r e6 6 5
c om p l
ete a nd 9 9 p
a rti
al
r e sp
o n s e sf
o r a r e sp
o n s e r at
e of 3 5
%
.C h
a pt
e rT h
r e eR
e s ul t
s a nd D i
s c u s si
o n :T h
eq
u e sti
o n n um b
e r s , at t im
e s, ap p
e a r o ut
of
o rd
e rt
o al l
ow g
r o up i
ng
of
sim i l
a ro r r e
l
at
ed t
op i
c s .O
rig i
n al
n um b
e ri
ng
of t h
eq
u e st i
o n sw
a sp
r e s e r v ed
to al l
ow
e a s
y
r ef
e r e n c et
oq
u e st i
o n si
nt h
e o rig i
n al
s u r v ey
.S
om
el im it
ed d i
s c u s si
o n ap p
e a r si
nth i
s s e ct i
o n,t
o al l
ow
c om p
a ri
s o n of
r e s ult
st
oo
t h
e r st
ud i
e s.A m
o r ed
et
ai l
ed d i
s c u s si
o n ap p
e a r si
nC h
ap t
e r4
.D
em
og
r ap h i
c s :Q
u e st i
o n2 3
:F i g u r e 1:
A ge d istri bu t io n of Re spo n de nts co
m
pa red to n a t ion a l a ge d istr i bu t io n o f P h ysicia n sN = 6 5 7
4 0 0%
3 5 0%
3 0 0%
2 5 0%
20 0%
1 5.0%
1 0.0%
5 0%
0 0%
INat io n al D istri but io n ISamp le D istri but io n
Le s s t han 3 5 3 5
-4 -4 ye a r s 4 5
-5 4 ye a r s 5 5
-6 4 ye ars More t han 6 5
ye ars ye ars
Pe r c e nt
T h
eg
r ap
h
ab
o v e sh
ow
sh
ow
st h
e ag
ed i
st
rib
ut i
o n of t h
e r e sp
o nd
e ntsc o
m p
a r ed t
ot h
e n at i
o n al
ag
ed i
st
ri b
ut i
o n of p h y
si
ci
a n s .T h
e r e sp
o nd
e nt
s am p l
ed
em
o n st
r at
e s aw i d
e r a ng
e of
ag
e s, a nd i
s si m i l
a rt
ot h
e n at i
o n al
ag
ed i
st
o
f p h y
sic
i
a n s .T h
e r e sp
o nd
e nt
s am p l
ein
th is
s u r v ey
sh
ow
st h
el
a rg
e st
d iff
e r e n c e sin
t h
e4 5
-5 4 y
e a r a nd g
r e at
e rt h
a n6 5 y
e a r s ol d
ag
eg
r o up
s.T h
eu n
d
e r r ep
r e s e nta
ti
o n of
r e sp
o nd
e nt
sin
t h
eg
r e at
e rth
a n6 5 y
e a r-old
ag
eg
r o up
m
ay b
ed
u et
ot h
ef
a ct t h
at m
o r ep h y
sic
ia n s o v e r
6 5
a r e n ot in a c
t iv e
p
r a ct i
c ea n
d
th
u sm
ay
n ot k
e ep
up m
em b
e r sh i p
sin
m
ed ic a
l
s o cie
t ie s s u c
h
a st h
eW
i ld
e r n e s sM
ed ic a
l S
o cie
t y
.Q
u e st i
o n2 4
:T h
et
ab le
b
elo
w
sh
ow
st h
e o c c up
at io n s o
f
th
e r e sp
o nd
e ntsto
t h
e s u r v ey
.T
ab le
1
:O
c c up
at io n o
f R
e sp
o nd
e nt
sOc c u pat io n Numbe r Pe r c e nt
P h ysicia n 42 5 64 5 %
Med ic alStude nt 81 1 2 3 %
Ot he r 5 5 8 3 %
P h ysicia n As sista nt 3 6 5 5%
E M T / Pa r amed ic 2 6 3 9%
Nu r s e 2 0 3 0 %
Nu r s e Pr a ct it io n e r 1 6 2 4%
N
e a rl y 6 5
%
id
e ntif ie
d t h
em
s elv e s
a sp h y
si
cia n s
a nd
a n ot h
e r1 2
%
a sm
ed ic a
l
s
t
ud
e nt
s.T h
eO t h
e r c at
eg
o ry
c o nt
ain e
d
aw i d
e v a rie
t y
of
o c c up
at io n s
,i
n clu
d i
ng
r eti
r ed p h y
si
cia n s
,P A
st
ud
e nt
s,d i
et ic
ia n s
,la
w y
e r/ p h y
si
cia n s
, a nd P h D
s .T
ab le
2 b
elo
w l is
ts
t h
e s elf
-r ep
o rt
ed m
ed ic a
l
sp
e cia
lt y
of t h
e r e sp
o nd
e nt
s.T
ab le
2
:S
elf
-r ep
o rt
ed M
ed i
c al
S
p
e cia
l ty
of R
e sp
o nd
e nt
sSpe cialt y Pe r c e nt of Re spo nde nts
Eme rge n cy Med icin e 2 9 8 %
Fam ily Pr a ctic e 1 7 7%
A n e sthe sia 7 7%
Inte r n al M edicin e 6 6%
Su rge ry 5 4%
Ped iatric s/Ne o n atolog y 4 8%
Ca rd iolog y 3 1%
Crit ic alCa r e 2 6 %
Stude nt 2 4%
W
ilde r n e s s/ Remote Med icin e 1 9%F lig h t / M ilita ry Med icin e 1 7%
Radiolog y 1 5 %
O B / G Y N 1 4 %
Psych iatry 1 4 %
Otola ryngolog y 1 2 %
Tr a v el Med icin e 1 2%
To xic olog y 1 0%
PMR 1 0 %
Infe ct io u s D is e a s e 0 9 %
Patholog y 0 9 %
Spo rts Medicin e 0 7 %
E me rge n cy Med ic al Se r v ic e s 0 7%
De rmatolog y 0.5%
Podiatry 0 5%
Oc c upat io n al Med icin e 0 3%
Ma n ageme nt 0 3%
On c olog y 0 3 %
Op t hamolog y 0 3%
Ga str o e nte r olog y 0 3%
Ot he r 0 3%
Ne u r ology 0 2%
Nu r s e Pr a ct itio n e r 0 2%
A lle rg y 0 2%
Pub lic He alt h 0 2 %
De nt ist 0 2%
P h ysicia n As sista nt 0 2%
T h
e r e sp
o nd
e nt
s am p l
e sh
ow
s ag
r e at d
e al
of d i
ve r si ty w i
th
r eg
a rd t
om
ed ic a
l
sp
e cia
lty
,t h
u sg i
vin
g t h
e s u r v ey
ab
r o ad
sp
e cia
lty b
a s e .C
om p
a r ed
ton a
t io n a
l d
at
a o nt h
ed is
t
rib
ut i
o n of p h y
sic
ia n s
,t h
e r e sp
o nd
e nt
s am p l
eh
ad t h
em
o st
o v e r r ep
r e s e nt
at io n
b y t h
e sp
e cia
lt i
e s of E m
e rg
e n cy M
ed ic
i
n e(
2 6
.5
%
m
o r ein s a
m p l
eth
a n n at io n a
l ly
)
.F
am i ly P
r a ct ic e
(
8
.6
%
m
o r ein s a
m p l
et h
a n n at io n a
l ly
)
a n
d t h
em
o st
u nd
e r- r ep
r e s e nt
atio n
b y I
nt
e r nis
t
s(
1 0
.4
%
l
e s sin
t h
e s am p l
et h
a nn a
t io n a
l ly
)
.T h
e o v e r-r ep
r e s e nt
at io n o
f E m
e rg
e n cy M
ed ic
i
n ep h y
sic
ia n s
is
n ot
u n e xp
e ct
ed g i
v e nt h
a t em
e rg
e n cy p h y
sic
ia n s
a r e u s u all y t h
ef ir s
t p h y
sic
i
a n st
oh
a v e c o nt
a ct w it h
o ut d
o o r a nd
e n vir o n
m
e nta
l in
j
u rie s a n
d
a r em
o r eli k
ely t
ob
ein v o
lv e
d w it h
s e a r ch
a nd
r e s c u ete a
m
s .F
u rt h
e rm
o r e,
m
a ny
s elf
-s c
h
ed
ule
w
o rk
s
h if ts a n
d h
a v efe
w
o n-c al l
r e sp
o n si b i l it ie s
,t h
u s a r e ab le
t
op
a rti
ci p
ate
in
m
ult i
-d
ay
o utd
o o r a ct iv
i ti
e sm
o r e e a sily th
a n ot h
e rh
e alt h
c a r ep
r o vid
e r s.T h
e s efa c
t
o r sm
ay m
ak
eit m
o r el ik
ely f
o rE m
e rg
e n cy M
ed ic
in e
p h y
sic
ia n s
t
ob
elo n
g t
ot h
eW
M S t h
a n ot h
e rp h y
sic
ia n s
.r ^
^
:^ ^:Q
u e st io n
2 6
:F i gu r e 2:
Re s po n de n t Geo gr ap h ic a l D istr i but ion Co
m
pa r e d t o Nat io n a l P h ysic ia n D istri bu t io nN= 5 8 6
3 0 0%
e
a.
2 5 0%
2 0 0%
1 5 0%
10.0%
5 0%
0.0 %
c
i
>''
<55
.
^^
^
" ^^
^
(yI Re spo nde nt Samp le
INat io n al D istri but io n
o
^ * ^
--^
. h °
-
J
".
<
^
A m
aj
o rity
of
r e sp
o nd
e nt
s r e si d
ein
t h
eU
nite
d S t
ate s
a nd t h
eg
e og
r ap h i
cd is
t
ri
b
uti
o n of
r e sp
o nd
e nt
s c om p
a r ed w it h t h
e n at io n a
l d is
t
rib
ut io n o
f p h y
sic
ia n s
a
p p
e a r sin
t h
eg
r ap h
ab
o v e.O
v e r al l
,
t h
e r e sp
o nd
e nt
s am p l
ed
em
o n st
r at
e s ab
r o ad U
nit
ed S t
at
e sd is
t
ri b
ut io n
.T h
ed
at
a sh
ow
st h
ela r
g
e st o v e r r ep
r e s e nt
at i
o n of
r e sp
o nd
e nts
f
r om t h
eM
o u nt
ai
n st
ate s
(
A Z
,C O
,ID
,M T
,N V
,N M
,U T
a nd
W
Y
)
a nd t h
el
a rg
e st
u nd
e rr e
p
r e s e nt
at io n
f
r om t h
eN
ew E
ng l
a nd
a nd M i d d l
eA tl
a nt ic
S t
at
e s(
C T
,M E
,M A
,N H
,N J
,N Y
,P A
,R l
a nd V T
)
.T h
e o v e r-r ep
r e s e nta
t i
o n of m
o u nta
in r e
g i
o n r e sp
o nd
e nt
sm
ay b
e a c c o u nt
ed f
o rb y d
e sir e
t
oliv e
w it h i
n clo s e a n
d
e a sy
a c c e s st
ow i ld
e r n e s s a ct iv
it ie s
t h
at m
ay b
e ap
ri
o rit y
am
o ng m
em b
e r s of t h i
s s am p l
ep
op
ula
t io n
.T h
e r ew
e r e5 4 in
t
e r n at io n a
l
r e sp
o nd
e nt
sto
t h
e s u r v ey
a nd h
om
e c o u nt
ry d
at
af
o rt h
e s e r e sp
o nd
e nt
s ap p
e a rb
elo
w
.T
ab l
e3
:R
e sp
o nd
e nt H
om
eC
o u nt
ri
e sO
ut
sid
e of U
nit
ed S t
at
e sCo u ntry Numbe r of Re spo nde nts
Ca n ada 2 1
Au str alia
United K ing dom
Fr a n c e
New Z e ala nd
Belg ium Br a zil Ho ng Ko ng
Italy
Lu x em bo u rg
Nethe rla nds
Au stria
Brit ish Ind ia n Oc e a n
Te r rito rie s
Ge rm a ny
Singapo r e
Sw itz e rla nd
Q
u e st i
o n1
:F i gu r e 3 :
Ha s H I E D D ir e c tl y A f fe cte d the He a lth o r
W
e l l- Be in g
of a Patie nt Yo u Have Ca r e d Fo r?
n = 7 1 8
2 0
%
S Oo/o
E i
g
h ty
p
e r c e nt
of t h
ep h y
si
ci
a n sw h
o r e sp
o nd
ed
r e c og
ni
z ed th
at
s om
ef
o rm
of h
um
a n c r e at
ed
e n vi
r o nm
e nt
al
o r e c o sy
st
em
ch
a ng
eh
a s ad
v e r s el y
a
f f
e ct
ed t h
eh
e alt h
o rw
el l b
ei
ng
of
ap
at i
e nt t h
ey h
a v et
r e at
ed
.T h
eh i g h
p
e r c e nt
ag
e of h
e al
th p
r of
e s si
o n al
s a n sw
e ri
ng y
e s tot h i
sq
u e st i
o ni
nd i
c at
e st h
at
am
o ng t h i
sg
r o up m
o st h
a v e s om
e r e c og
nit i
o n of t h
eb
r o ad
r a ng
e of
ad
v e r s eh
e alt h
ef f
e ct
s c r e at
ed b y h
um
a ni m p
a ct
up
o nth
e e n vi
r o nm
e nt
.T h
ew i d
e r a ng
e of
s
p
e c ialt
i
e s of
t he re sp
ond
e ntsi m p
lie s ef f
e cts a r e spre ad
a cro s s aw id
e v a ri
ety
of
cl in ic a lil l
ne s s .T h
e s e r e s ult
sd if f
e rf
r om
a stud y b y K i lp
atri
ck
^ ^t h
atf
o u nd 5 3
.5
%
of 2 2 5
r e s
p
o nd
e nt p
ed i
at
ri
ci
a n sh
ad p
a st
e xp
e ri
e n c ew it h
ap
at i
e nt
af f
e ct
ed b y
a ne n v
i
r o nm
e nt
al
to xi
n.A 2 0 0 7
s u r v ey
^
o
f 2 0 1
c u r r e nt m
ed i
c al
st
ud
e nt
sw i th
cli
ni
c al
e x
p
e ri
e n c ef
o u nd 7 2
%
h
ad
exp
e ri
e n c ew it h
ap
at i
e nt
af f
e ct
ed b y H IE D
.T h
ed if f
e r e n c ef
r om t h
eK i l p
atri
ck
st
ud y m
ay b
ed
u e to th
em
o r ei
n cl
u si
v ed
ef i
nit i
o n of H IE D i
nth
e c u r r e nt
st
ud y
c om p
a r ed t
o u s e of t h
et
e rm
e n vi
r o nm
e nt
al
t
o xi
n .Q
u e s ti
o n2
: # iv /\
F i g
u r e4
:D
oy
o ub
el i
e v eH I E D H
a sA f f
e ct ed t h
eH
e al t h
o rW
cB
ei
ng
of
aM
em
b
e r of Y
o u rF
am
i l y
o rS
om
e o n eY
o u.
K
n ow
?
N
=7 2 0
4 1
%
M
o st h
e alt h
c a r ep
r o vid
e r sw
o uld
a ct t
o r ed
u c e o r el im i
n at
e ri
sk t
of
am i ly
a n
d f
ri
e nd
s of
e n vi
r o nm
e nt
al
e xp
o s u r e st h
at m
ay
ad
v e r s ely
af f
e ct h
e al th
a nd
w
el l
-b
ei
ng
N
e a rly 6 0
%
of h
e al
th p
r of
e s si
o n al
r e sp
o nd
e ntst
oth
e s u r v ey b
el i
e v eH IE D
h
a s ad
v e r s el y
aff
e ct
ed
af
am i ly m
em b
e r o rf
ri
e nd
.T h i
sm
ay
s ug g
e st t h
at t h
eh
e alt h
ef f
e ct
s of H I E D
a r ep
e r v a si
v ei
nt h
e e n vi
r o nm
e nt
a nd
o ut
of t h
e r a ng
e of
p
ot
e nt i
al
c o nt
r ol
of h
e alt h
c a r ep
r of
e s si
o n al
s.T h
e r e s ult
s of t h i
sq
u e st i
o nm
u st b
ei
nt
e rp
r et
ed
c a ut i
o u sly b
e c a u s e of
n o n r e s
p
o n s eb i
a s.It m
ay b
em
o r eli k
ely t h
at t h
o s ew h
o r e sp
o nd
ed t
ot h
e s u r v ey
e
l
e ct
ed t
op
a rt i
cip
at
ei
nth
e s u r v ey b
e c a u s eth
ey h
ad
af
am il y m
em b
e r o rf
ri
e nd
w h
oh
a sb
e e n af f
e ct
ed b y H I E D
.Q
u e sti
o n3
:#
:F i g u r e 5 : Ha v e a n y of yo u r pat ie nts a s i< ed yo u ho
w
H I E D af fe cts their he al t h o rw
el l-b eing ?
n = 7 0 3
3 9
%
6 1O/
0
P
at i
e nt i
nq
ui
ry t
o ap h y
si
ci
a n ab
o ut
ap
o s sib l
e c a u s at i
v em
e ch
a ni
sm
of
i ll
n e s s c a nb
e ap
r o xy m
e a s u r e of t h
eg
e n e r al p
ub l i
c'
s a
w
a r e n e s s o r ed
u c at i
o nr e
g
a rd i
ng t h
ep
ot
e nt i
al
c a u s at i
v e ag
e nt
.P
at i
e nt q
u e st i
o n s c a n al
s op
r o vid
es
ig
nif i
c a nt im p
et
u sf
o rt h
ep h y
si
ci
a nt
ob
e c om
em
o r ek
n ow l
ed g
e ab l
e ab
o ut
at
op i
cT h
e r e s ult
s of
Q
u e st i
o n3
sh
ow th
at
o v e r6 0
%
of
W
M S
r e sp
o nd
e nt
sh
a v eb
e e n a sk
ed b y t h
ei
rp
at i
e nt
s ab
o ut H IE D
af f
e ct i
ng t h
ei
rh
e alt h
o rw
el l
-b
ei
ng
.Q
u e st i
o n4
:F igu r e 6 :
H o
w
of te n a r e yo u a sked abo ut H I E D a s c a u s a t iv e fa cto r in i l ln e s s ? n = 4 4 460 0 0%
5 0 0 0%
5 2 0 3%
4 1 8 9%
4 0 0 0%
g 3 0 0 0%
2 0 0 0%
1 0 0 0%
5.0 8%
0.0 0%
O f te n Oc c a sio n al ly Ra r ely
Q
u e st i
o n4
sh
ow
st h
ed i
st
ri b
ut i
o n of t h
ef
r eq
u e n cy
of h
e alt h p
r of
e s si
o n al
sb
ei
ng
a s
k
ed
ab
o ut
ad
v e r s e eff
e ct
s of H IE D
.T h
e r e s ult
s sh
ow
sl i
g
h t ly
o v e r5 2
%
of
r e s
p
o nd
e nt p h y
si
ci
a n s a r e a sk
ed
o c c a si
o n al ly
a nd
slig h tl y
o v e r6
%
a r eb
ei
ng
a s
k
ed
of t
e n r eg
a rd i
ng H IE D
a s a c a u s e of p
at i
e nt i l l
n e s s .Q
u e sti
o n s3
a nd 4 t
og
et h
e r s e em t
o s ug g
e st t h
at p
at i
e nt
s a r e aw
a r e, c o n c e r n ed
a nd be g in n ing to a s k qu e s t io n s of t he ir he a lt h c a r e pr ofe s s io n a ls r e ga rd ing
a
d
v e r s eh
e al t h
eff
e ct
s of H IE D
.Q
u e st i
o n s5
a nd 6
:F i gu re 7 :
Do y ou d is c u s s
w
i t h yo u r pa t ie n ts H I E D a s ac a u s a t iv e fa c to r in t he ir i l ln es s ?
n = 6 9 0
4 6
%
5 4
%
H
e alt h p
r of
e s si
o n al
r e sp
o nd
e nt
sw
e r e ab
o ut
eq
u al ly d i
vid
ed i
nw h
et h
e rt h
ey d i
s c u s s ed H IE D
a s a c a u s at i
v ef
a ct
o ri
nil l
n e s s.G i
v e nt h
eb
r o ad d
ef i
nit i
o n of
H IE D it i
s n ot
s u rp
ri
si
ng th
at
n e a rly h
alf
of
r e sp
o nd
e nt
s r ep
o rt
ed d i
s c u s si
ng t h
ei
s s u eA
s u r v ey
of N
ew Y
o rk
st
at
ep
ed i
at
ri
ci
a n sb y T
r a s a nd
e^ ^f
o u nd p
ed i
at
ri
ci
a n sr e
p
o rt
ed i
nq
ui
ri
e si
nt
o e n vi
r o nm
e nt
al
e xp
o s u r e s8 3
%
of t h
et i m
ef
o rl
e ad t
ol
e s st h
a n1 0
%
of t h
et i m
ef
o rp
e st i
cid
e s,m
e r c u ry
, a nd
v ol
ati l
e o rg
a ni
c c om p
o u nd
s(
V O C
s)
.T h
e4 6
%
of
r e sp
o nd
e nt
si
nt h
e c u r r e nt
st
ud y w h
oi
nd i
c at
ed t h
ey h
a v ed i
s c u s s ed
H IE D w it h t h
ei
rp
ati
e nt
s a s a c a u s at i
v ef
a ct
o ri
nt h
ei
ri l l
n e s sw
e r e a sk
ed w h
at
t h
ey d i
s c u s s ed
.T h
ef
r eq
u e n cy t
ab l
eb
el
ow
sh
ow
st h
e4 2 1 t
op i
c sli
st
ed b y th
er e s
p
o nd
e nt
s.A
st h m
aw
a st h
em
o st
c om m
o nt
op i
cd i
s c u s s ed
,f
ol l
ow
ed b y i
nf
e cti
o u sd i
s e a s er
i
sk
, ch
em i
c al
e xp
o s u r e , sm
ok i
ng
,p
ol l
ut i
o n,f
o s si l f
u el
em i
s si
o n s a nd
o z o n e .T h
e r e sp
o nd
e ntsd
em
o n str at
eb
ot h
al
a rg
e n um b
e r a nd
v a ri
e ty
of
top i
c sd i
s c u s s ed
, alt h
o ug h m
a ny
a r e ad d
r e s s ed b y
o nly
a sm
al l h
a nd f
ul
of p h y
si
ci
a n s .S
e v e r al
r e sp
o nd
e nt
s r ep
o rt
ed d i
s c u s si
ng
e c o sy
st
em
ch
a ng
e(
i
n v a si
v e sp
e ci
e s,l
o s s of b i
od i
v e r sit y
,g l
a ci
al m
elt i
ng
)
eff
e ct
s up
o nh
e alt h
.T
ab l
e4
:T
op i
c sd i
s c u s s ed b y H
e al
th C
a r eP
r of
e s si
o n al
s of t h
e ad
ve r s eh
e alt h
e
ff
e ct
s a nd
c a u s ati
v ef
a ct
o r s of H IE D
a nd t h
ef
r eq
u e n cy m
e nt i
o n ed
.N
=
4 3 6
Top ic Fr equ e ncy T op ic Frequ e n cy
Asthma 1 3 1 Nois e
Infe ctio u s D is e a s e 34 Anim al
W
a steGe n e r alChemic al Expo s u r e 30 Fo od A ddit iv e s
Smok ing 2 8 Home C hem ic als
Ge n e r al Pollut io n 21 Le ad
Fo s sil Fu el Emis sio n s 1 7 Indo o r Mold
Oz o n e 15 Oc c upat io n al Expo s u r e s
G lobal
W
a rm ing 1 2 Rad iat io nS mog 12 Se afo od Co ntamin at io n
Me r c u ry 1 1 Lo s s of B iodiv e r sit y
Pe st icide s 1 1 Lo s s of Natu r al Are a s/
W
ild S pa c e sSo cial/ Sp iritu al/ Me ntal He alt h E f fe cts 1 1 La c kof c o nta ct w it h n atu r al wo rld Indo o r A ir Pollut io n 1 0 Spr aw l
Se c o nd Ha nd Smoke D ioxin
Ca n c e r s He avy Metals
Pa rt ic ulate M atte r in A ir Pha rma c e ut ic als in
W
ate rAlle rge n In c r e a s e Rado n
Defo r e statio n Ur a nium
Fo r e st F ir e S moke Dep let io n of Se a L ife
De c r e a s ed En vir o nme ntal Qu alit y Inva siv e S pe cie s
Sick build ing Syndr ome Dr o ug h t
Antibiot ic s Gla c ial M elting
Eme rg ing Infe ct io u s D is e a s e s Sal init y of La nd
Ge n et ic Mod if ic at io n of Fo ods
W
a ste Pr odu ct io nHo rmo n e s in
W
ate r a nd Fo od A lte r n at iv e En e rg yQ
u e sti
o n7
:F i g u r e 8 :
He a lth Pr ofe s s ion a l So u r c e s of I nfor
m
a tio nRe ga rd in g H u
m
a n I n du c ed En v ir o nm
e n ta lDe g r a da t io n 1 6 0
-i^
J
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-1^
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s< ^
"
^
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^
J
^
O
^
J
'3 4 1 i
nd i
vid
u al
sp
r o vid
ed 4 3 2
r e sp
o n s e sf
o rt h
ef
r e et
e xt b
o x a sk i
ng
, "W
h
at
s o u r c e s o
f i
nf
o rm
at i
o n r eg
a rd i
ng H I E D d
oy
o u u s e?
"
T h
e r e sp
o n s e sw
e r ec o
m b i
n ed t
o c r e at
e af
r eq
u e n cy t
ab l
e a nd t h
eh i
st
og
r am
ab
o v e .T h i
sd
at
a sh
o ul d
n ot b
e c o nf
u s ed w it h p
r ef
e r e n c e of
u s e o rq
u al ity
of t h
ei
nf
o rm
at i
o n s o u r c e s .M
ed i
c al
j
o u r n al
s we r et h
em
o st f
r eq
u e ntl y
ci t
ed
s o u r c e of
i
nf
o rm
at i
o n,f
oll
ow
ed b y
n ew
sp
ap
e r s a nd g
e n e r al m
ed i
a s o u r c e s .T h
e ot h
e rl i
st
ed
s o u r c e s
w
e r e u s ed w it h m
u ch l
e s sf
r eq
u e n cy
.It i
s r em
a rk
ab l
eth
at C
o nt i
n ui
ng
M
ed i
c al E d
u c at i
o n(
C M E
)
c o u r s e sw
e r e n ot m
e nt i
o n ed
a s a s o u r c e of i
nf
o rm
at i
o ng i
v e nth
at h
e alt h p
r of
e s si
o n al
si
nth
eU
nit
ed S t
at
e sp
a rt i
ci p
at
ed i
n o v e r1 0
.4
m il l i
o nh
o u r s of
n o n-j
o u r n al b
a s ed C M E
a ct i
vit i
e si
n2 0 0 5
^\
K i lp
at
ri
ck
^ ^i
n a s u r v ey
of 2 2 8 p
r a ct i
ci
ng G
e o rg i
ap
ed i
at
ri
ci
a n sf
o u nd 8 9
%
li
st
ed p
r of
e s si
o n al
s o ci
et i
e s a s a s o u r c e of i
nf
o rm
at i
o n ab
o ut
ch i ld
r e n'
s
e n v
i
r o nm
e nt
al h
e alt h
,f
ol l
ow
ed b y p
r of
e s si
o n al l it
e r at
u r e at 6 7
.5
%
a nd
g
o v e r nm
e nt
ag
e n ci
e s at 5 8
.5
%
.M
a s sm
ed i
aw
a s u s ed b y 2 7
.2
%
a nd t h
ei
nt
e r n et
b y 1 6
.7
%
.
T h
ed if f
e r e n c e sb
etw
e e nt h
et w
o s u r v ey
sm
ay
r ef l
e ct
s am p l
e si
z ea n