Cigarette smoke tops list of environmental hazards: AAP survey

from the Division of Health Policy Research

Nine out of 10 pediatricians say cigarette smoke is the greatest environmental contributor to the number and/or severity of diseases and conditions among their patients, according to a 1999 Periodic Survey of Fellows.

When asked to rate various environmental hazards, 91 percent of pediatricians said cigarette smoke greatly affects their patients' health. More than half of pediatricians (57 percent) said molds in the home have a great effect on their patients' health; one-third (34 percent) named cockroaches in the home; and 26 percent named lead as a serious health hazard. Other environmental hazards were thought to have a smaller impact on patients' health: 16 percent of pediatricians said carbon monoxide, 15 percent said ozone and 14 percent said pesticides greatly contribute to the number or severity of conditions among their patients.

Pediatricians were asked to assign a public health priority to the reduction or control of various environmental hazards in their practice community. Not surprisingly, pediatricians overwhelmingly named cigarette smoke as the greatest environmental hazard, giving its reduction the highest public health priority. Other hazards named by pediatricians as most in need of reduction or control are dust mites, lead in paint and water, molds in the home and carbon monoxide. (See Table)

Counseling on environmental hazards

Pediatricians in direct patient care were asked to describe how frequently they discuss environmental hazards with adolescent patients with asthma and parents of infants with idiopathic pulmonary hemorrhage.

Adolescents with asthma:

More than half of pediatricians (54 percent) indicated they ask adolescent asthma patients about patient smoking and exposure to tobacco smoke at every visit. About 40 percent said they ask these teens about exposure to pets at every visit and the same proportion does so periodically. Only two out of 10 pediatricians regularly inquire about exposure to other hazards such as pollen, dust mites, outdoor air pollution, mold in the home, or the adolescent's or parents' occupation. Far fewer pediatricians (12 percent) regularly inquire about exposure to cockroaches.

Infants with idiopathic pulmonary hemorrhage:

About two-thirds of pediatricians said they always inquire about exposure to tobacco smoke in the home (68 percent) and other environments (62 percent) when treating an infant with idiopathic pulmonary hemorrhage. Nearly half (47 percent) always ask about cow milk consumption. About four out of 10 said they always ask about molds in the home, exposure to pets, sleeping practices and water damage in the home when treating such infants.

Documenting exposure to tobacco smoke

Overall, about three-fourths of pediatricians reported they routinely record exposure to environmental tobacco smoke in their patients' charts. Thirty-three percent recorded tobacco smoke exposure in a specific place, either within the chart or on the cover, while 41 percent did not record such exposure in any specific place in the chart.

AAP Periodic Survey #42 was conducted from November 1998 to February 1999. Surveys were mailed to a random sample of 1,623 AAP members in the United States, with a response rate of 58 percent. Responses were based on 916 pediatricians (including residents) who provide direct patient care.