Environmental Health Questionnaire

• Consider having each patient fill it out one time, especially if you live in area where people have concerns about the environment.
• When the presenting symptoms seem unusual; for instance, weight loss, irritability, and “gripe”, or flu-like symptoms, along with tremor – possibility of mercury poisoning.
• When an illness fails to respond to standard therapy; for instance, prolonged rhinorrhea which is non-allergic and non-infectious – consider indoor air pollution as a source of upper airway irritation.
• When environmental factors may exacerbate a common disease with a complex etiology; for instance, environmental asthma triggers such as dust mites, mold, and outdoor air pollution or headache triggered by inadequate ventilation indoors.

Environmental Health Questionnaires
There are a number of excellent sources of environmental health questionnaires. These include the following:

• The National Environmental Education Training Foundation (NEETF) questionnaire exists in two parts and is focused on assessment of asthma triggers in the environment children spend time such as the home or at school.
• The Agency for Toxic Substances and Disease Registry (ATSDR) has a case studies in environmental medicine series. The module on “Pediatric Environmental Health” covers the broad topic to include special susceptibilities of children, and environmental exposures common to children. “Taking a Pediatric Exposure History” discusses anticipatory guidance, inclusion of environmental factors in differential, and instruction on taking an environmental history, environmental illness testing, and referral.
• The Texas Childhood Lead Poioning Prevention Program (TX CLPPP) had recently designed a simplified questionnaire to be adminstered to parents of children who are being monitored for blood lead.