Associations between Knowledge of the Causes and Perceived Impacts of Climate Change: A Cross-Sectional Survey of Medical, Public Health and Nursing Students in Universities in China

Eco-nursing competencies for nurses: A scoping review

Background

Nurses are tasked with addressing the health impacts of climate change. Eco-nursing competencies, covering knowledge, attitudes, and skills related to climate change, equip nurses to actively mitigate and adapt to its effects on health and the environment.

Objective

To synthesize existing literature on eco-nursing roles and competencies for nurses.

Methods

A scoping review of published papers examined nurses' roles and eco-nursing competencies. Databases searched included Academic Search Complete, CINAHL Plus, MEDLINE (PubMed), and Google Scholar. Search terms encompassed climate change and nursing synonyms, limited to English articles up to April 15, 2023. Thematic analysis was used to synthesize findings, delineating roles, and eco-nursing competencies. Results were tabulated.

Results

Out of 445 papers identified, 31 underwent data analysis. These papers highlighted nurses' roles in climate change (42%), along with climate change knowledge and skills (64.5%), and attitudes (13%). Roles encompassed research, education, advocacy, leadership, and clinical practice, with corresponding competencies embedded within existing core competencies for general nurses, nurse specialists, and nurse managers.

Conclusion

The review demonstrates that nurses' roles in climate change necessitate relevant knowledge, attitudes, and skills. Future research should contextualize these roles and eco-nursing competencies based on geographical locations, considering the distinct disease burden in each area.

Registration

The study protocol was registered in the Open Science Framework on 5 March 2023 before conducting the full study https://doi.org/10.17605/OSF.IO/9GC4N.

Tweetable abstract

Amidst growing concerns about climate change, nurses are increasingly tasked with preparing to mitigate its health impacts through the delineation of eco-nursing competencies. These competencies will equip nurses to effectively tackle the health and environmental ramifications of climate change, building upon existing core competencies tailored to various geographic contexts.

Nature-friendly hands: The relationship between nursing students' climate change anxiety, intolerance of uncertainty, and anxiety about the future

AIM/OBJECTIVE

This study examined the relationship between climate change anxiety, intolerance of uncertainty, and future anxiety levels of nursing students.

BACKGROUND

The effects of climate change, an important global problem, on people's emotional and intellectual states are becoming increasingly important. It is important to understand to what extent prospective health professionals, such as nursing students, are affected by such environmental concerns and the possible impact of this level on their professional behaviors to develop an environmentally focused approach to health services.

DESIGN

This study was conducted using a descriptive and correlational design.

METHODS

Students enrolled in the Nursing Undergraduate Program of a university in Turkey in the 2023-2024 academic year participated in the study. The participants were administered a personal information form, climate change anxiety scale, intolerance of uncertainty scale, and future anxiety scale in university students. The data were evaluated using advanced statistical analyses, and relationships were examined.

RESULTS

As a result of these analyses, it was determined that there was a significant relationship between future anxiety and climate change anxiety in university students (R = 0.234, p = .000). In addition, there was a substantial relationship between climate change anxiety and intolerance of uncertainty (R = 0.562, p = .000).

CONCLUSIONS

These findings indicate significant and linear relationships between nursing students' emotional and cognitive states associated with environmental factors such as climate change, uncertainty, and future anxiety. Developing support and interventions in nursing education is crucial to help students cope with these issues and function more effectively in their future professional lives.

Climate change integration in nursing education: A scoping review

BACKGROUND

The environmental impacts of climate change such as extreme weather, affects human physical and mental health; therefore, including climate change and health is important in nursing education. Despite the recognition of the link between climate change and health, this important knowledge has not yet been systematically integrated into nursing curricula, highlighting the need for immediate action to prepare nurses for these emerging human health challenges.

OBJECTIVES

The objective of this review was to gain an overview of the existing literature exploring climate change in nursing curricula and answer following questions: DESIGN: Scoping review.

METHODS

A protocol was created and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-SrC). Five data bases were searched: CINAHL, Academic Search Premier, PubMed, Scopus and Cochraine, in addition to databases, grey literature was searched from different sources (reference lists, Google). A total of 1055 articles were derived from the search and 47 articles were included in this review. After selection results from selected studies on educational interventions and climate change education, and opinion pieces were charted, followed by a team review and consensus on the findings.

CONCLUSION

This review shows the importance of integrating the topic of climate change into nursing curricula. This integration of climate change-related content into nursing curricula is essential for preparing students, not just for their future roles in healthcare, but also their role in policy and climate justice. These results also reflect strong support from students for that integration. But while progress has been made, further research is essential to evaluate the impacts of these teaching strategies on nursing education.

Health science students' preparedness for climate change: a scoping review on knowledge, attitudes, and practices

INTRODUCTION

Climate change (CC) is a global public health issue, and the role of health professionals in addressing its impact is crucial. However, to what extent health professionals are prepared to deal with CC-related health problems is unclear. We aimed to evaluate the knowledge, attitudes, and practices of health students about the CC.

METHODS

We conducted a scoping review through systematic searches in PubMed, Scopus, Web of Science, Proquest, and EBSCO. We included original scientific research with no language or time restrictions. Two authors independently reviewed and decided on the eligibility of the studies, then performed data extraction.

RESULTS

21 studies were included, with a total of 9205 undergraduate nursing, medical, pharmacy, and public health students mainly. Most health science students (> 75%) recognized human activities as the main cause of CC. However, they perceived a lack of knowledge on how to address CC. Moreover, we found inadequate coverage or limited development of CC in related curricula that may contribute to incomplete learning or low confidence in the theoretical and practical concepts of students.

CONCLUSION

The findings of our scoping review suggest that while health sciences students possess a general understanding of CC, there is a significant gap in their knowledge regarding its specific health impacts. To address this gap, there is a need for targeted education and training for future health care professionals that emphasizes the health effects of CC.

Sustainability in radiography education: A case study of a tertiary institution in Zimbabwe

INTRODUCTION

To equip radiographers to tackle the negative impacts of climate change, it is crucial to offer in-depth education on planetary health and sustainability. This study aimed to use a tertiary institution in Zimbabwe as a case study to assess radiography students' views on the integration of sustainability into their curriculum.

METHODS

A quantitative cross-sectional study using a questionnaire took place at a tertiary institution in Harare, Zimbabwe, where students were sampled consecutively. Categorical variables were described using frequencies and percentages. Data analysis was carried out using Stata 13.1.

RESULTS

A total of 96 out of 111 students participated, with an 86% response rate. The majority of students believed in the importance of environmentally friendly radiography practices (90.62%) and felt that sustainability is crucial for better patient care. While sustainability teaching was acknowledged in the curriculum, many students were not confident about the topic in exams. There was no consensus on the preferred methods of teaching sustainability. University lecturers specializing in climate-related fields were seen as the most suitable teachers for sustainability education.

CONCLUSIONS

The curriculum reflects efforts in sustainability education, but student confidence and awareness of climate-focused research units require improvement. Continuous education is crucial to link sustainability awareness with practical implications in radiography. Future studies should investigate tailored teaching methods to engage students effectively in sustainable radiography practices.

IMPLICATIONS FOR PRACTICE

The findings highlight the importance of ongoing education and awareness campaigns to address the disconnect between understanding the importance of sustainability and implementing it effectively in radiography practice.

Planetary health and its relevance in the modern era: A topical review

Planetary health is a relatively new concept that has gained traction in recent years due to the urgent need to address the health of our planet and its inhabitants. It refers to the interdependent health of both humans and the environment, recognizing that the two are inseparable and that the health of one is intricately linked to the health of the other. This article aims to advocate changes in how health care for both the environment and humans is envisaged, and aligned with sustainable development goals using ethically sound, solution-oriented, and practical approaches to education. Rapid industrialization, urbanization, and population growth led to environmental degradation and climate change in this era. These factors have profound implications for human health, with the World Health Organization estimating that 23% of global deaths are linked to environmental factors. Climate change and extreme weather events are exacerbating existing health problems. Air pollution, water pollution, and toxic chemicals are additional environmental factors that add to it and lead to health issues, including non-communicable diseases and death. A collaborative and interdisciplinary approach is needed to address planetary health challenges, including working across sectors and investing in research to understand better the complex interactions between human health and the environment. By promoting sustainable development and protecting the planet's health and inhabitants, we can ensure a healthy future for generations.

Exploring the relationship between nursing students' knowledge and attitudes towards climate change and their psychological distress: a cross-national investigation

BACKGROUND

Climate change poses a worldwide challenge with anticipated exacerbation in the future, resulting in irreversible consequences. Nursing students may be vulnerable to experiencing psychological effects associated with climate change.

AIM

The current study aimed to investigate the relationship between nursing students' knowledge and attitudes toward climate change and their psychological distress.

METHOD

This descriptive cross-sectional study recruited 377 nursing students from three universities located in Saudi Arabia, Jordan, and Egypt in the Middle East. Data collection was conducted using scales for assessing nursing students' knowledge and attitudes towards climate change and their psychological distress. Correlations were assessed and multiple regression analysis was conducted to explore the predictors of students' psychological distress.

RESULTS

The current study showed that knowledge regarding climate change significantly and positively correlated to the attitude toward climate change (r = 0.213), then again, the score of psychological distress significantly and negatively correlated to the score of students' knowledge and attitude regarding climate change (r = - 0.182 and - 0.110 respectively). Regression analyses showed that academic achievement had the strongest positive impact on students' psychological distress, while knowledge regarding climate change and attitude toward climate change had negative impacts (β = 0.381, β=-0.205, and β=-0.045 respectively). Moreover, knowledge and attitude regarding climate change were found to be significant predictors of students' psychological distress, collectively accounting for 18.2% of the observed variance.

CONCLUSIONS/IMPLICATION FOR FUTURE PRACTICE

The findings highlight the importance of incorporating climate change into nursing education programs. By enhancing nursing students' knowledge and attitudes towards climate change, there is potential to reduce their psychological distress. This study underscores the need for curriculum reforms that integrate climate change topics, aiming to foster a well-informed and resilient future nursing workforce.

'You can't really separate these risks, our environment, our animals and us': Australian children's perceptions of the risks of the climate crisis

Perceptions of the risks associated with the climate crisis are shaped by a range of social and political contexts and information sources. While some have expressed concerns about the impact of the spread of climate misinformation through social media platforms on young people, others have shown that the youth climate movement has played a key role in countering misinformation. Despite this, there has been very limited research with children about how they conceptualize the risks associated with the climate crisis, how they receive climate information, and how they understand and apply this to their own and others' lives. The following qualitative study used photo-elicitation techniques and in-depth interviews with Australian children to address this gap. A total of n = 28 children (12-16 years) participated, with four themes constructed from the data using a reflexive approach to thematic analysis. Children were concerned about how the climate crisis would continue to harm their futures and the health of planet and people. They recognized that some groups and countries would experience more risks associated with the climate crisis as compared to others. While they received information from a range of different sources (school, family, social media), they mostly used social media to seek out climate information. They recognized that social media sites could be a source of climate misinformation, and argued that a range of strategies were needed to identify and counter false information about the climate crisis. Children's perspectives must be harnessed to improve information about climate risks and action.

The relationship between nursing students' environmental literacy and awareness of Global Climate Change

OBJECTIVES

This study aims to examine the correlation between environmental literacy and levels of awareness of global climate change in nursing students.

DESIGN

The cross-sectional and correlational design.

SAMPLE

476 undergraduate nursing students METHODS: Data were collected with The Personal Information Form, the Awareness Scale of University Students about Global Climate Change, and Environmental Literacy Scale for Adults in March 2023. Descriptive statistics, correlation, and linear regression analysis (stepwise method) were used to analyze the data.

RESULTS

The mean scores of the Environmental Literacy Scale and the Awareness Scale of University Students about Global Climate Change Scale were 87.31 ± 8.61 and 75.60 ± 14.86, respectively. A positive correlation was found between the awareness of global climate change and environmental literacy (p < 0.05). As participation in meetings on environmental problems, environmental concerns and awareness increased, awareness of global climate change increased.

CONCLUSIONS

Nursing students had high levels of awareness of global climate change and environmental literacy. The awareness of nursing students on climate change and their environmental literacy levels are highly important in protecting public health against the adverse effects of climate change and reducing climate change through effective resource management in health services in the future. It is recommended that integrate courses related to environment health to curriculum of nursing school and in-service training during healthcare. The study draws attention to the Sustainable Development Goals related to climate change.

Exploring medical students' perceptions and understanding of the health impacts of climate change: a qualitative content analysis

BACKGROUND

Climate change has been identified as the greatest threat to global health in the twenty-first century, with its unfavorable health consequences being among its impacts on humans. Exploring the perspectives and understanding of healthcare professionals and service providers concerning climate change becomes imperative. The aim of this study is to investigate the perceptions and understanding of final-year medical students regarding the health impacts of climate change on individuals and the healthcare system using a qualitative content analysis.

METHODS

This study employed a qualitative content analysis approach. Face-to-face interviews were conducted with the aid of an interview guide to explore the students' awareness, understanding, and attitudes towards the impacts of climate change on public health and the healthcare system. The collected interview data were subsequently organized into codes, categories, and subcategories based on the students' perspectives and attitudes towards climate change.

RESULTS

Fifteen medical intern students were interviewed for this study, and the qualitative findings were categorized into 3 categories, 23 subcategories, and 229 codes. The study's findings revealed various health impacts of climate change, which were classified into three main categories, including environmental effects with 8 subcategories, socio-economic effects with 8 subcategories, and health effects with 7 subcategories. The study's findings revealed medical students' perceptions of various health impacts of climate change and These findings suggest that medical student understand that climate change has significant impacts on individuals' health and society, mainly through environmental degradation, increased risks, and climate-related disasters, which ultimately lead to adverse health outcomes.

CONCLUSIONS

The perspectives of medical students in this study indicate that climate change may not have a direct and immediate impact on the health of individuals and communities. However, it can significantly influence their health and socio-economic well-being by exacerbating or causing environmental problems, increasing the risk of weather-related events and natural disasters, ultimately leading to adverse health outcomes. While the medical students' perspectives on the health impacts of climate change are indeed broad, incorporating scientific knowledge about this topic into the medical curriculum and educating students on how to deal with patients affected by these consequences can have a significant impact on health management. This proactive approach, despite the students' already comprehensive understanding, can enhance their preparedness to address the health effects of climate change and contribute to strengthening the healthcare system's resilience in the face of climate-related challenges.

Barriers to climate change and health research in India: a qualitative study

OBJECTIVES

Almost a quarter of the global burden of disease and mortalities is attributable to environmental causes, the magnitude of which is projected to increase in the near future. However, in many low- and middle-income settings, there remains a large gap in the synthesis of evidence on climate-sensitive health outcomes. In India, now the world's most populous country, little remains known about the impacts of climate change on various health outcomes. The objective of this study is to better understand the challenges faced in conducting climate change and health research in Puducherry, India.

DESIGN AND SETTING

In this study, we employed key informant interviews to deepen the understanding of the perceived research barriers in Puducherry. The findings were analysed using data-driven qualitative thematic analysis to elaborate the major perceived barriers to conducting environmental health research.

PARTICIPANTS

This study was conducted among 16 public health professionals, including medical researchers, and professionals involved in environmental policies and planning in Puducherry.

RESULTS

We identify three key barriers faced by public health professionals as key stakeholders, namely: (1) political and institutional barriers; (2) education and awareness barriers; and (3) technical research barriers. We show there is a need, from the professionals' perspective, to improve community and political awareness on climate change and health; strengthen technical research capacity and collaboration among researchers; and strengthen health surveillance, resource allocation and access to health data for research.

CONCLUSION

Evidence informed policies and interventions are a key element in the adaptation response for countries. In the context of the paucity of data on environmental health from India, despite recognised climate change related health vulnerabilities, these findings could contribute to the development and improvement of relevant interventions conducive to a strong research environment.

Integrating climate change and health topics into the medical curriculum - a quantitative needs assessment of medical students at Heidelberg University in Germany

Objectives

Climate change (CC) is of major importance for physicians as they are directly confronted with changing disease patterns, work in a greenhouse gas intensive sector and can be potential advocates for healthy people on a healthy planet.

Methods

We assessed third to fifth year medical students' needs to support the integration of CC topics into medical curricula. A questionnaire with 54 single choice-based items was newly designed with the following sections: role perception, knowledge test, learning needs, preference of educational strategies and demographic characteristics. It was administered online to students at Heidelberg medical faculty. Data sets were used for descriptive statistics and regression modelling.

Results

72.4% of students (N=170, 56.2% female, 76% aged 20-24 years) (strongly) agreed that physicians carry a responsibility to address CC in their work setting while only 4.7% (strongly) agreed that their current medical training had given them enough skills to do so. Knowledge was high in the area of CC, health impacts of CC, vulnerabilities and adaptation (70.1% correct answers). Knowledge gaps were greatest for health co-benefits and climate-friendly healthcare (55.5% and 16.7% of correct answers, respectively). 79.4% wanted to see CC and health included in the medical curriculum with a preference for integration into existing mandatory courses. A multilinear regression model with factors age, gender, semester, aspired work setting, political leaning, role perception and knowledge explained 45.9% of variance for learning needs.

Conclusion

The presented results encourage the integration of CC and health topics including health co-benefits and climate-friendly healthcare, as well as respective professional role development into existing mandatory courses of the medical curriculum.

Climate change and health in international medical education - a narrative review

Objective

Climate change is a key threat to human health worldwide. Accordingly, medical education should prepare future physicians for climate-associated hazards and corresponding professional challenges. Currently, this is not yet implemented across the board. The aim of this review is to present (I) the knowledge and (II) the attitudes of medical students and physicians towards climate change and (III) the expectations of medical education as formulated by medical students. In addition, the available literature will be used to look at (IV) global teaching activities, (V) international learning goals and learning goal catalogues, and (VI) applied teaching methods and formats. This review should simplify and, considering the urgency of the topic, accelerate the design of future teaching activities.

Methodology

The paper is based on a selective literature search supplemented by a topic-guided internet search.

Results

Knowledge about the causes and concrete health consequences of climate change seems to be incomplete. The majority of medical students consider human health to be at risk from climate change and the health sector to be inadequately prepared. A majority of surveyed medical students would like to see teaching about climate change. It is evident that internationally, teaching projects on climate change and climate health, as well as topic-specific learning objectives and learning goal catalogues, have been developed and integrated into medical education.

Conclusion

There is a need for and acceptance of teaching climate change in the medical curriculum. This literature review can assist in the development and implementation of new teaching formats.

"Climate Change and Health?": Knowledge and Perceptions among Key Stakeholders in Puducherry, India

Climate change has far-reaching impacts on human health, with low- and middle-income countries, including India, being particularly vulnerable. While there have been several advances in the policy space with the development of adaptation plans, little remains known about how stakeholders who are central to the strengthening and implementation of these plans perceive this topic. We conducted a qualitative study employing key interviews with 16 medical doctors, researchers, environmentalists and government officials working on the climate change agenda from Puducherry, India. The findings were analysed using the framework method, with data-driven thematic analysis. We elucidated that despite elaborating the direct and indirect impacts of climate change on health, there remains a perceived gap in education and knowledge about the topic among participants. Knowledge of the public health burden and vulnerabilities influenced the perceived health risks from climate change, with some level of scepticism on the impacts on non-communicable diseases, such as cardiovascular diseases. There was also a felt need for multi-level awareness and intervention programmes targeting all societal levels along with stakeholder recommendations to fill these gaps. The findings of this study should be taken into consideration for strengthening the region's climate change and health adaptation policy. In light of limited research on this topic, our study provides an improved understanding of how key stakeholders perceive the impacts of climate change on health in India.

Climate change and health risks in Mukuru informal settlement in Nairobi, Kenya - knowledge, attitudes and practices among residents

BACKGROUND

Residents of informal settlements in Sub-Sahara Africa (SSA) are vulnerable to the health impacts of climate change. Little is known about the knowledge, attitudes and practices (KAP) of inhabitants of informal settlements in SSA regarding climate change and its health impacts. The aim of this study was to investigate how inhabitants of an informal settlement in SSA experience climate change and its health impacts and assess related knowledge, attitudes and practices. The study was conducted in Mukuru informal settlement in Nairobi City County, Kenya.

METHODS

A cross-sectional study was conducted in September 2021 using a structured, semi-closed KAP questionnaire. Inclusion criteria were ≥ 18 years of age and living in one of the three main sections in Mukuru: Kwa Njenga, Kwa Reuben or Viwandani. By spinning a pen at the geographic centre of each section, a random direction was selected. Then, in every second household one individual was interviewed, creating a representative mix of ages and genders of the local community. To assess participant characteristics associated with climate change knowledge multivariable logistic regression was used. Thematic content analysis was performed for qualitative responses.

RESULTS

Out of 402 study participants, 76.4% (n = 307) had heard of climate change before the interview, 90.8% (n = 365) reported that climate change was affecting their community, and 92.6% (n = 372) were concerned with the health-related impact of climate change. Having lived in Mukuru for more than 10 years and living in a dwelling close to the riverside were factors significantly associated with having heard of climate change before (aOR 3.1, 95%CI 1.7 - 5.8 and aOR 2.6, 95%CI 1.1 - 6.1, respectively) and experiencing a climate change related impact on the community (aOR 10.7, 95%CI 4.0 - 28.4 and aOR 7.7; 95%CI 1.7 - 34.0, respectively). Chronic respiratory conditions, vector-borne diseases, including infectious diarrhoea, malnutrition and cardiovascular diseases were identified by respondents as climate related health risks.

CONCLUSIONS

Most respondents were knowledgeable about climate change and were experiencing its (health-related) impact on their community. This study provides insights which may prove useful for policy makers, intervention planners and researchers to work on locally adapted mitigation and adaption strategies.

[Validity and Reliability of the Korean Version of the Climate, Health, and Nursing Tool]

PURPOSE

Climate change has various negative effects on human health, which has resulted in increased burden on the health care system. Nurses contribute significantly to assessing climate-related health risks and creating a healthy environment. This study aimed to evaluate the reliability and validity of the Korean version of the Climate, Health, and Nursing Tool (K-CHANT) to measure nurses' awareness, motivation, concern, and behaviors at work and at home regarding climate change and health.

METHODS

The 22 items of English CHANT were translated into Korean with forward-backward translation techniques. Internal consistency reliability, test-retest reliability, and construct validity using confirmatory factor analysis were performed using SPSS WIN (25.0) and AMOS (26.0). Survey data were collected from 220 master's, doctoral, and post-doctoral nursing students.

RESULTS

The K-CHANT consists of 20 items across 5 domains. Two items of the original CHANT were excluded because of low content validity index and standardized regression weights. The internal consistency reliability of the K-CHANT, assessed by Cronbach's αá was .81, with an intraclass correlation coefficient of .66~.90. The five subscales model was validated by confirmatory factor analysis (SRMR < .08, RMSEA < .08, AGFI > .70, CFI > .70).

CONCLUSION

The K-CHANT has satisfactory construct validity and reliability to measure nurses' awareness, motivation, concern, and behaviors at work and at home regarding climate change and health. Future research should examine nurses' perceptions and behaviors related to the health effects of climate change and develop an action plan to improve it.

A mixed method study on global warming, climate change and the role of public health nurses from the perspective of nursing students

AIM

This study aims to evaluate the knowledge and awareness of the nursing students taking the Public Health Nursing course about global warming, climate change, the impact on health and the role of the public health nurse.

DESIGN

The study is a mixed method study that includes descriptive data and focus group discussions on global warming, the effects of climate change and the role of the public health nurse.

METHODS

The data were collected from the nursing faculty of a university located in the Central Anatolia region, where agricultural lands are widespread and climate change effects are most commonly observed. The data were collected from 154 undergraduate senior nursing students between February 2020 and May 2020. Firstly, the students completed the Global Warming Questionnaire that includes 26 items about global warming, climate change, their effects and the role of the public health nurse. Secondly, some students (n = 19) selected through the purposive sampling method participated in online focus group meetings.

RESULTS

Our study revealed that 87.7% of the students know the main cause of climate change. The mean scale scores of the students who watch documentaries on the environment, who participate in activities related to the environment, and who know that climate change, sustainable development and health services are closely related were found to be statistically significantly higher (p ≤ 0.005). The views of the students on global warming and the environment were analyzed in focus group interviews according to five themes (global warming perception; the impact of global warming on health; methods of protection; roles of nurses; nursing education).

CONCLUSION

Global warming and climate change are sensitive and important issues that cannot be evaluated considering only knowledge level.

IMPACT

Global warming, climate change, their effects on health and the roles and responsibilities of nurses need to be included in the nursing curricula so that health professionals who can take measures against global warming, climate change and their health effects can be educated.

Climate change, air pollution, and allergic respiratory diseases: a call to action for health professionals

Rising emissions of greenhouse gases in the atmosphere have warmed the planet substantially and are also accompanied by poor air quality. The increased prevalence of allergic airway disease worldwide can be partially attributed to those global environmental changes. Climate change and air pollution pose adverse impacts on respiratory allergies, and that the mechanisms are complex and interactive. Adverse weather conditions, such as extreme temperatures, can act directly on the respiratory tract to induce allergic respiratory illnesses. Thunderstorms and floods can alter the production and distribution of aeroallergens while wildfires and dust storms increase air pollution, and therefore indirectly enhance health risks. Concentrations of particulate matter and ozone in the air have been projected to increase with climate warming and air stagnation, and the rising temperatures and CO₂ increase pollen, molds, and spores, which escalate the risk of allergic respiratory diseases. The synergistic effects of extreme heat and aeroallergens intensify the toxic effect of air pollutants, which in turn augment the allergenicity of aeroallergens. With the Earth's climate change, migration of humans and plants shift the living environments and allergens of susceptible people. Urban residents are exposed to multiple factors while children are sensitive to environmental exposure. Since climate change may pose many unexpected and persistent effects on allergic respiratory diseases, health professionals should advocate for effective mitigation and adaptation strategies to minimize its respiratory health effects.

Perception and knowledge of the effect of climate change on infectious diseases within the general public: A multinational cross-sectional survey-based study

Infectious diseases are emerging and re-emerging due to climate change. Understanding how climate variability affects the transmission of infectious diseases is important for both researchers and the general public. Yet, the widespread knowledge of the general public on this matter is unknown, and quantitative research is still lacking. A survey was designed to assess the knowledge and perception of 1) infectious diseases, 2) climate change and 3) the effect of climate change on infectious diseases. Participants were recruited via convenience sampling, and an anonymous cross-sectional survey with informed consent was distributed to each participant. Descriptive and inferential analyses were performed primarily focusing on the occupational background as well as nationality of participants. A total of 458 individuals participated in this study, and most participants were originally from Myanmar, the Netherlands, Spain, United Kingdom and the United States. Almost half (44%) had a background in natural sciences and had a higher level of knowledge on infectious diseases compared to participants with non-science background (mean score of 12.5 and 11.2 out of 20, respectively). The knowledge of the effect of climate change on infectious diseases was also significantly different between participants with and without a background in natural sciences (13.1 and 11.8 out of 20, respectively). The level of knowledge on various topics was highly correlated with nationality but not associated with age. The general population demonstrated a high awareness and strong knowledge of climate change regardless of their background in natural sciences. This study exposes a knowledge gap in the general public regarding the effect of climate change on infectious diseases, and highlights that different levels of knowledge are observed in groups with differing occupations and nationalities. These results may help to develop awareness interventions for the general public.

Local actions to health risks of heatwaves and dengue fever under climate change: Strategies and barriers among primary healthcare professionals in southern China

BACKGROUND

Climate change and extreme weather poses significant threats to community health, which need to be addressed by local health workforce. This study investigated the perceptions of primary healthcare professionals in Southern China on individual and institutional strategies for actions on health impacts of climate change and the related barriers.

METHODS

A mixed methodological approach was adopted, involving a cross-sectional questionnaire survey of 733 primary healthcare professionals (including medical doctors, nurses, public health practitioners, allied health workers and managers) selected through a multistage cluster randomized sampling strategy, and in-depth interviews of 25 key informants in Guangdong Province, China. The questionnaire survey investigated the perceptions of respondents on the health impacts of climate change and the individual and institutional actions that need to be taken in response to climate change. Multivariate logistic regression models were established to determine sociodemographic factors associated with the perceptions. The interviews tapped into coping strategies and perceived barriers in primary health care to adapt to tackle challenges of climate change. Contents analyses were performed to extract important themes.

RESULTS AND CONCLUSION

The majority (64%) of respondents agreed that climate change is happening, but only 53.6% believed in its human causes. Heat waves and infectious diseases were highly recognized as health problems associated with climate change. There was a strong consensus on the need to strengthen individual and institutional capacities in response to health impacts of climate change. The respondents believed that it is important to educate the public, take active efforts to control infectious vectors, and pay increased attention to the health care of vulnerable populations. The lack of funding and limited local workforce capacity is a major barrier for taking actions. Climate change should be integrated into primary health care development through sustainable governmental funding and resource support.

Medical, nursing, and physician assistant student knowledge and attitudes toward climate change, pollution, and resource conservation in health care

BACKGROUND

Climate change and pollution generated by the health care sector impose significant public health burdens. This study aimed to assess medical, nursing and physician assistant student knowledge and attitudes regarding climate change, pollution from the health care sector, and responsibility for resource conservation within professional practice.

METHODS

In February-March, 2018, medical, nursing, and physician assistant students at Yale University (1011 potential respondents) were sent a 17-question online Qualtrics survey. Data analysis included descriptive statistics, as well as Fisher's exact test and logistic regression to assess associations between variables of interest and the personal characteristics of gender, age, geographic place of origin, school, and year in school (among medical students).

RESULTS

The response rate was 28% (280 respondents). 90% felt that physicians, nurses, and physician assistants have a responsibility to conserve resources and prevent pollution within their professional practice. 63% agreed or strongly agreed that the relationship between pollution, climate change, and health should be covered in the classroom and should be reinforced in the clinical setting. 57% preferred or strongly preferred reusable devices. 91% felt lack of time and production pressure, and 85% believed that lack of education on disease burden stemming from health care pollution, were barriers to taking responsibility for resource conservation and pollution prevention. Women and physician assistant students exhibited a greater commitment than men and medical students, respectively, to address pollution, climate change, and resource conservation in patient care and professional practice.

CONCLUSION

We found that health professional students are engaged with the concept of environmental stewardship in clinical practice and would like to see pollution, climate change, and health covered in their curriculum. In order for this education to be most impactful, more research and industry transparency regarding the environmental footprint of health care materials and specific clinician resource consumption patterns will be required.

Global Change: a Public Health Researcher's Ethical Responsibility

PURPOSE OF REVIEW

Loss of biodiversity and globalized environmental degradation result in planetary-scale changes which impact human societies.

RECENT FINDINGS

This paper highlights the urgency for public health researchers to integrate a global change perspective into their daily work. The public health community needs to answer several questions, e.g., how to weight the health of present and future generations; how to balance between the possible immediate adverse impacts of mitigating climate change vs long-term adverse impacts of global change; how to limit the environmental impacts of public health intervention; and how to allocate resources. Public health practitioners are faced with a moral responsibility to address these challenges. Key elements to ensure long-lasting, innovative global change and health solutions include (i) empowering the population; (ii) tailoring the framing of global change and health impacts for different stakeholders; (iii) adopting less conservative approaches on reporting future scenarios; (iv) increasing accountability about the health impacts of mitigation and adaptation strategies; and (v) recognizing the limits of science.

The Unique Role of Medical Students in Catalyzing Climate Change Education

Climate change is a well-recognized threat to human health with impacts on every organ system and with implications for disease processes across subspecialties. Climate-driven environmental exposures influence the pathophysiologic underpinnings of disease emphasized in the pre-clinical years of medical school. While medical schools are beginning to offer climate change and health electives, medical education is lagging in providing fundamental climate-and-health content to adequately prepare the next generation of physicians for the challenges that they will face in the provision of healthcare and the prevention and treatment of disease. This perspective piece highlights the unique role of medical students in catalyzing the incorporation of climate content into the pre-clinical medical school curriculum and provides topics for disseminated curricular integration with the concepts emphasized in the pre-clinical years of medical education.

Global Change: a Public Health Researcher's Ethical Responsibility

PURPOSE

Loss of biodiversity and globalized environmental degradation result in planetary-scale changes which impact human societies.

RECENT FINDINGS

This paper highlights the urgency for public health researchers to integrate a global change perspective into their daily work. The public health community needs to answer several questions, e.g., how to weight the health of present and future generations; how to balance between the possible immediate adverse impacts of mitigating climate change vs. long-term adverse impacts of global change, how to limit the environmental impacts of public health intervention; and how to allocate resources. Public health practitioners are faced with a moral responsibility to address these challenges. Key elements to ensure long-lasting, innovative global change and health solutions include (i) empowering the population, (ii) tailoring the framing of global change and health impacts for different stakeholders, (iii) adopting less conservative approaches on reporting future scenarios, (iv) increasing accountability about the health impacts of mitigation and adaptation strategies, and (v) recognizing the limits of science.