Patient Attitudes Toward Issues
of Environmental Health (cont'd)

Introduction

Public interest in the environment and the environment's impact on health, coalescing with the publication of Silent Spring in 1962, is significant in the United States (Baxter 1990). More recently, Rosenblatt introduced an “ecobiopsychosocial” perspective from which to approach patient care (Rosenblatt 1997), taking into account the increasing role that environmental degradation plays in human health. This perspective examines human health in four dimensions, thus acknowledging the combined and interactive roles of biological, psychological, social, and environmental factors.

A handful of studies have examined the potential place of the environment in medical school curricula. Academic deans reported that expected competency levels in environmental medicine were only low to moderate for graduating medical students. Most (70%) of the deans stated that their curricula placed only minimal emphasis on environmental health (Graber, et. al. 1995), often combining this discipline with occupational health. Although interested in environmental issues (Kasma-Ronkainen and Virokannas 1996), medical students rated the environmental medicine component of their training the least important out of nine components (Sokas, et. al. 1993).

High levels of public interest in environmental issues as they relate to health have been assumed on the basis of levels of environmental activism (Howe 1990; Kipen and Craner 1992). Only on rare occasions within the medical literature, however, have patients been asked directly about their general environmental concerns. The purpose of this descriptive study was to define the level of interest and concern of primary care patients regarding a variety of environmental issues. In addition, major sources of environmental information were evaluated, as was the level of trust placed in each of these sources. From this information, a better understanding may be achieved from which to direct future medical education and physician involvement in the environmental health of their patients.

Methods

Questionnaire Design

A 14-item, three-page questionnaire was developed and administered to a convenience sample of adult (18 years of age) patients at four University of Wisconsin-Madison Department of Family Medicine affiliated clinics. Two clinics (Wingra and Northeast) represented urban patient populations, whereas the others were dominated by suburban (Verona) or rural (Belleville) populations.

Five questions permitted demographic analysis of the study sample. The remaining questions allowed for a general assessment of patient attitudes toward a number of environmental issues and concerns. Specifically, the questions examined:

• 1) The level of patient interest and concern regarding each of seven environmental issues (air quality, water quality, radiation, population growth, land use, biodiversity, and food quality).
• 2) The level to which patients felt environmental problems affected their health and well-being and that of their families.
• 3) Major sources of environmental information.
• 4) The level of patient trust in these sources. Patients were also given the opportunity to rate the environmental knowledge level of their physician, the adequacy of education that they had received from their physician concerning each of seven environmental issues, and whether they would want more environmental education from their physician. Each question was presented in a 7-point Likert scale or multiple-selection format.

Patients were approached by a research assistant (JCM) in clinic waiting rooms and given a short explanation of the research project before being invited to participate. A cover letter was also included with the questionnaire to further explain the project, its purpose, and the confidential nature of responses. Questionnaires were returned to the research assistant before or after the patient's appointment, depending on the length of time in the waiting room.

Questionnaire Analysis

Descriptive statistics were employed for the initial analyses of the patient responses and demographic data. Composite levels of interest and of adequacy of information received were calculated for each patient by totaling the responses to the seven environmental issues and dividing by seven, thus yielding a continuous scale from 1 to 7. Analysis of variance (ANOVA) was used to assess the relationships among continuous variables. Significance among discreet variables was tested using two statistics.

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References