Open Access Open Badges Research article

The Environment and Children’s Health Care in Northwest China

Leonardo Trasande12345*, Jingping Niu6*, Juansheng Li6, Xingrong Liu6, Benzhong Zhang6, Zhilan Li6, Guowu Ding6, Yingbiao Sun6, Meichi Chen6, Xiaobin Hu6, Lung-Chi Chen2, Alan Mendelsohn13, Yu Chen23 and Qingshan Qu2

Author Affiliations

1 Department of Pediatrics, New York University School of Medicine, 227 East 30th Street Rm 109, New York, NY 10016, USA

2 Department of Environmental Medicine, New York University School of Medicine, New York, USA

3 Department of Population Health, University School of Medicine, New York, NY, USA

4 NYU Wagner School of Public Service, New York, NY, USA

5 NYU Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health, New York, NY, USA

6 Lanzhou University School of Public Health, Lanzhou, Gansu, China

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BMC Pediatrics 2014, 14:82  doi:10.1186/1471-2431-14-82

Published: 27 March 2014



Industrialization in the northwest provinces of the People’s Republic of China is accelerating rapid increases in early life environmental exposures, yet no publications have assessed health care provider capacity to manage common hazards.


To assess provider attitudes and beliefs regarding the environment in children’s health, determine self-efficacy in managing concerns, and identify common approaches to managing patients with significant exposures or environmentally-mediated conditions, a two-page survey was administered to pediatricians, child care specialists, and nurses in five provinces (Gansu, Shaanxi, Xinjiang, Qinghai, and Ningxia). Descriptive and multivariable analyses assessed predictors of strong self-efficacy, beliefs or attitudes.


960 surveys were completed with <5% refusal; 695 (72.3%) were valid for statistical analyses. The role of environment in health was rated highly (mean 4.35 on a 1-5 scale). Self-efficacy reported with managing lead, pesticide, air pollution, mercury, mold and polychlorinated biphenyl exposures were generally modest (2.22-2.52 mean). 95.4% reported patients affected with 11.9% reporting seeing >20 affected patients. Only 12.0% reported specific training in environmental history taking, and 12.0% reported owning a text on children’s environmental health. Geographic disparities were most prominent in multivariable analyses, with stronger beliefs in environmental causation yet lower self-efficacy in managing exposures in the northwestern-most province.


Health care providers in Northwest China have strong beliefs regarding the role of environment in children’s health, and frequently identify affected children. Few are trained in environmental history taking or rate self-efficacy highly in managing common hazards. Enhancing provider capacity has promise for improving children’s health in the region.

Children’s environmental health; Practice; Self-efficacy; Survey; Air pollution; Industrializing world