Building Capacity to Address Children s Environmental Health Leyla Erk McCurdy National Environmental Education Foundat

1. Building Capacity to Address Children�s Environmental HealthLeyla Erk McCurdyNational Environmental Education FoundationNational Hispanic Medical Association Annual Conference 2010

2. Private, non-profit organization chartered by Congress Provide knowledge to trusted and credible professionals who amplify messages to national audiences to solve everyday environmental problems. Together, we generate lasting positive change.

3. Goal:�Advance environmental knowledge among health professionals in order to improve public health,�with a special emphasis on children and other populations disproportionately impacted by environmental pollutants.� Through development of national agendas, educational programs, and strategic partnerships, we facilitate the integration of environmental health into health care provider education and practice.

4. Environmental Health

5. Children and Environmental Health Children are more susceptible than adults to environmental hazards because they: Eat more food, drink more fluids, and breathe more air in proportion to their body weight. Developing organ systems are less able to detoxify toxic chemicals. Play close to the ground, put objects in their mouths.

6. Environmental Health Disparities Racial and ethnic minorities or low-income families are disproportionately exposed to a variety of environmental�hazards, leading to�higher rates of adverse health outcomes. Hispanics, African Americans, and American Indians are dramatically disadvantaged relative to whites�in health�status. Some, but not all, environmental health disparities�are associated with socioeconomic status. Other factors include discrimination in health care system and�social stresses.

7. Recommendations Environmental justice and specific environmental hazards should be the focus of educational efforts to improve understanding of these issues among community residents and health professionals: Enhance health professional�s knowledge of environmental health and justice issues Increase the number of health professionals specializing in environmental and occupational medicine, and Improve the awareness and understanding of these issues by the general public

8. Need for Health Care Provider Environmental Education

9. Pediatric Environmental History Initiative Multi-year initiative to integrate environmental history taking into clinical practice Provides tools and resources for taking an environmental history Developed by experts Built on current scientific literature and existing tools

10. Pediatric Environmental History Initiative Pediatric Environmental History Forms: The Screening Environmental History and Additional Categories and Questions Fact Sheet Primer Training PowerPoint Links to Additional Resources

11. Initiativa para la Historia Pedi�trica Ambiental La Historia Pedi�trica Ambiental: La Historia Ambiental Exploratoria y Categor�as y Preguntas Adicionales Iniciativa para una Historia Pedi�trica Ambiental Introducci�n a la Historia Pedi�trica Ambiental Historia Medica Ambiental en Pedi�trica (PPT) Recursos Adicionales en Espa�ol

12. Asthma Disparities and Children The burden of asthma falls on children disproportionately African American and�Puerto Rican children bear the greatest burden of asthma Hispanic children are almost twice as likely to be hospitalized for asthma than white children UPDATED Statistics: CDC 2006 Vital Statistics- http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf (for statistics on # of diagnosed children) CDC Asthma Impact on Children - http://www.cdc.gov/asthma/children.htm (for last two statistics on this slide) UPDATED Statistics: CDC 2006 Vital Statistics- http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf (for statistics on # of diagnosed children) CDC Asthma Impact on Children - http://www.cdc.gov/asthma/children.htm (for last two statistics on this slide)

13. Goal: integrate environmental management of asthma into pediatric health care A long-term effort led by a steering committee of experts involving several partners Guidelines for environmental management of pediatric asthma for primary health care providers Action plan for integration into medical and nursing school curricula and clinical practice

14.  Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers Founded upon scientific literature and best current practices Authored by expert steering committee and peer-reviewed Developed for providers of pediatric primary care: pediatricians, family physicians, internists, pediatric nurse practitioners, pediatric nurses, and physician assistants Founded upon the National Asthma Education and Prevention Program Guidelines. Our goal is that this document is used in conjunction with the clinical and pharmacological components. Built upon the scientific literature and best current practices The documents are targeted to primary care providers. For the purposes of this program and other NEETF programs, the definition includes pediatricians, family physicians, interests, as well as pediatric nurse practitioners, pediatric nurses and physician assistants.Founded upon the National Asthma Education and Prevention Program Guidelines. Our goal is that this document is used in conjunction with the clinical and pharmacological components. Built upon the scientific literature and best current practices The documents are targeted to primary care providers. For the purposes of this program and other NEETF programs, the definition includes pediatricians, family physicians, interests, as well as pediatric nurse practitioners, pediatric nurses and physician assistants.

15. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers Endorsed/Supported by: Academic Pediatric Association American Academy of Pediatrics American Association of Colleges of Nursing Association of Faculties of Pediatric Nurse Practitioners National Association of Pediatric Nurse Practitioners Founded upon the National Asthma Education and Prevention Program Guidelines. Our goal is that this document is used in conjunction with the clinical and pharmacological components. Built upon the scientific literature and best current practices The documents are targeted to primary care providers. For the purposes of this program and other NEETF programs, the definition includes pediatricians, family physicians, interests, as well as pediatric nurse practitioners, pediatric nurses and physician assistants.Founded upon the National Asthma Education and Prevention Program Guidelines. Our goal is that this document is used in conjunction with the clinical and pharmacological components. Built upon the scientific literature and best current practices The documents are targeted to primary care providers. For the purposes of this program and other NEETF programs, the definition includes pediatricians, family physicians, interests, as well as pediatric nurse practitioners, pediatric nurses and physician assistants.

16. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

17. Components Educational competencies Environmental history form Environmental intervention guidelines Sample Patient Flyers and References Strategies for integrating into health care provider curricula and clinical practice Supplemented by online Training PowerPoint and list of resources with web-links All components available in Spanish

18. Pediatric Asthma Faculty Champions 5 Medical faculty training others and integrating content

19. Pediatric Asthma Champions

20. Obesity Epidemic ? Pediatric overweight 17% of US children (~ 12.5 million) are obese Obesity prevalence increased by 10% for US children from 2003 to 2007, and increased by 24% among Hispanic children Odds of obesity and overweight are twice as high for black and Hispanic children than white children ? Type-2 diabetes ? Hypertension ? Risk factors for cardiovascular disease Sedentary lifestyle and little outdoor activity contribute to increased risk for these conditions

21. Children and Nature Initiative Goal: Connect children with nature for health benefits Create Nature Champions and build capacity among pediatric health care providers to be leaders in prescribing nature

22. Children and Nature Initiative Pilot Sites

23. Children and Nature Resources Children�s Health and Nature Fact Sheet Health Care Provider Kits: Pediatric Environmental History Form, Prescription Pads, Patient�Flyers PowerPoint �Improved Health from the Natural Environment: Where's the Evidence?� by James R. Roberts, MD, MPH Peer-reviewed Publications Using nature and outdoor activity to improve children�s health--McCurdy, Winterbottom, Mehta, Roberts. Current Problems in Pediatric and Adolescent Health Care 2010;40 (in press)� Building on Partnerships: Reconnecting Kids With Nature for Health Benefits�Kruger, Nelson, Klein, McCurdy, Pride, Ady. Health Promotion Practice (in press) Webpage with links to Additional Resources

24. National Strategies for Health Care Providers: Pesticides Initiative A long-term initiative to integrate pesticide knowledge into health professionals� education and practice Implementation Plan Case Statement: The Need for Pesticide Education for Health Care Providers National Pesticide Competency Guidelines for Medical and Nursing Education National Pesticide Practice Skills Guidelines for Medical and Nursing Practice National Forum Proceedings

25. National Pesticide Practice Skills Guidelines for Medical and Nursing Practice Translated into Spanish by the Migrant Clinicians Network

26. Additional Environmental Health Resources PowerPoint Presentations on: Taking an Environmental History to Address Children�s Unique Vulnerabilities to Environmental Health Risks Environmental Tobacco Smoke Exposure to Ultraviolet Light Lead and Mercury

27. Contact Information Leyla Erk McCurdy Senior Director, Health & Environment National Environmental Education Foundation 4301 Connecticut Avenue,�Suite 160 Washington DC, 20008 Phone: 202-261-6488 Email: lmccurdy@neefusa.org