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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

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This study aimed to measure the knowledge and perceptions of medical, public health, and nursing students about climate change and its impacts, and to identify associations between the knowledge and perceptions. Data were from a nationwide cross-sectional survey of 1387 students sampled in five different regional universities in China (April–May 2017). The knowledge and perceptions of the participants were collected by self-administered questionnaires. We found that most respondents believed that climate change is generally “bad” (83%) and bad for human health (88%), while 67% believed that climate change is controllable. The vast majority of respondents acknowledged illness conditions resulting from poor air quality (95%), heat stress (93%), and extreme weather events (91%) as potential impacts of climate change. Nevertheless, only 39% recognized malnutrition as a consequence of food deprivation resulting from climate change. Around 58% of respondents could correctly identify the causes of climate change. The knowledge of the causes of climate change was not associated with the ability to recognize the health consequences of climate change. However, the knowledge of causes of climate change was a significant predictor of increased awareness of the negative impacts of climate change between the medical and nursing students, although this was not the case among their public health counterparts. Poor knowledge about the causes of climate change is evident among students in China. They are able to recognize the direct links between weather events and health, but less likely to understand the consequences involving complicated pathways. Research and training into the underlying mechanisms of health impacts of climate change needs to be strengthened.
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International Journal of
Environmental Research
and Public Health
Article
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
Lianping Yang 1,† , Wenmin Liao 1,† , Chaojie Liu 2, Na Zhang 1, Shuang Zhong 3,*
and Cunrui Huang 1, *
1
School of Public Heath, Sun Yat-sen University, Guangzhou 510080, China; yanglp7@mail.sysu.edu.cn (L.Y.);
liaowm3@mail2.sysu.edu.cn (W.L.); zhangn23@mail2.sysu.edu.cn (N.Z.)
2School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia;
c.liu@latrobe.edu.au
3Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University,
Guangzhou 510275, China
*Correspondence: amigo-008@163.com (S.Z.); huangcr@mail.sysu.edu.cn (C.H.)
These authors contributed equally to this work.
Received: 9 October 2018; Accepted: 22 November 2018; Published: 26 November 2018
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Abstract:
This study aimed to measure the knowledge and perceptions of medical, public health,
and nursing students about climate change and its impacts, and to identify associations between the
knowledge and perceptions. Data were from a nationwide cross-sectional survey of 1387 students
sampled in five different regional universities in China (April–May 2017). The knowledge and
perceptions of the participants were collected by self-administered questionnaires. We found that
most respondents believed that climate change is generally “bad” (83%) and bad for human health
(88%), while 67% believed that climate change is controllable. The vast majority of respondents
acknowledged illness conditions resulting from poor air quality (95%), heat stress (93%), and extreme
weather events (91%) as potential impacts of climate change. Nevertheless, only 39% recognized
malnutrition as a consequence of food deprivation resulting from climate change. Around 58% of
respondents could correctly identify the causes of climate change. The knowledge of the causes of
climate change was not associated with the ability to recognize the health consequences of climate
change. However, the knowledge of causes of climate change was a significant predictor of increased
awareness of the negative impacts of climate change between the medical and nursing students,
although this was not the case among their public health counterparts. Poor knowledge about the
causes of climate change is evident among students in China. They are able to recognize the direct
links between weather events and health, but less likely to understand the consequences involving
complicated pathways. Research and training into the underlying mechanisms of health impacts of
climate change needs to be strengthened.
Keywords: climate change; health impact; knowledge; perception; university students
1. Introduction
Climate change is imposing one of the biggest global health threats in 21st century [
1
3
]. A lack of
adequate response to climate change can undermine the last half century of gains in global health [
1
].
The health impacts of climate change can be a direct effect of weather events, such as heat stress, floods,
drought and storms, and/or an indirect effect as a consequence of displacement and mental disorders,
air pollution, spread of disease vectors, food insecurity, and malnutrition [1,4,5].
Int. J. Environ. Res. Public Health 2018,15, 2650; doi:10.3390/ijerph15122650 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2018,15, 2650 2 of 14
Health professionals are supposed to play a critical role in mitigating the health risks of climate
change [
6
,
7
]. Physicians, nurses, public health specialists, and health officials should be equipped
with high expertise and take essential responsibilities in protecting populations from the harm of
climate change [
8
]. Millions of patients all over the world seek consultations and treatments from
physicians every day. Physicians also enjoy a high level of recognition and trust in the society.
They are well positioned to exert influence on the society for the common good, advocating for
environment-friendly lifestyles and pro-health public policies [
9
]. Nurses are bound by both clinical
practices and professional ethics to address concerns of their patients and prevent adverse health
outcomes [
10
]. Public health specialists have endeavored to have a broad view on population health.
They can support the implementation of programs and policies in ways that enhance physical and
social environments at the local, national, and international levels [8]. Therefore, the preparedness of
health professionals forms a critical part of the global response to climate change.
University education is a good starting point for preparing health professionals. Mitigation and
adaptation strategies in response to climate change can be taught in universities under the umbrella
of sustainability. Higher education has been widely considered to be critical for the sustainable
development of the world [
11
13
]. Sustainability-related issues, like environmental pollution, climate
change, overconsumption, and exploitation of resources are often addressed through various curricula.
Zsoka et al. [
14
] explored the impacts of environmental education on the environmental knowledge,
attitudes, and “greening” daily activities of high school and university students, and found out that the
focus of environmental education is essential in shaping the attitudes of the students toward sustainable
consumptions. But it remains a great challenge in developing proper strategies for priming medical
students into a “medical mode” that can alter their opinions on the scientific merit of nonmedical
issues [
15
]. Ng et al. highlighted the importance of emphasizing the ethical aspects of corporate
social responsibility in undergraduate education programs for the future professional accounts [
16
].
However, there is a shortage of research documenting effective ways of teaching about sustainability in
universities. University students are still forming their values and beliefs. A one-fits-for-all approach
in acquiring sustainability competences is not feasible [
17
]. Environmental education for students
in health-related disciplines, for example, has to consider the specific contexts of their professions.
Without proper education, they may hold naïve awareness of the potential impact of individual
contributions and feel disempowered for actively engaging in sustainability efforts [
11
]. Chaplin and
Wyton pointed out the importance of understanding and addressing the value-action gap in motivating
university students to engage with sustainability [
12
]. Kagawa suggested that future studies should be
directed towards identifying various means of facilitating pro-sustainability behaviors [18].
Knowledge is a key driver of global actions on climate change [
19
]. Empirical evidence
shows that the public concern about climate change is shaped by their acquired knowledge [
19
21
].
Climate-relevant knowledge appeared important for the public’s willingness to change behaviors
and to accept climate change policies [
21
]. However, not all dimensions of knowledge are equally
influential. Knowledge about the causes of climate change is perhaps the most powerful driver of
concerns about and actions on climate change, although it has been subject to serious debates over
the past few decades in the public and political arenas [
22
,
23
]. A cross-country survey conducted by
Shi and colleagues revealed that a higher level of concerns from the general public on climate change
is associated with their understanding on the causes of climate change [
19
]. Bord et al. found that
causal knowledge of global warming is associated with beliefs and behavioral intentions about climate
change [
24
]. Similar results were also found in a study that was conducted by Tobler et al. [
25
]. Based
on these findings, Shi and colleagues argued that climate change campaigns should have a strong
focus on promoting knowledge about the causes of climate change [21].
There is paucity in the literature documenting the importance of causal knowledge on raising
awareness and competency of health workers in response to the health impacts of climate change.
Although medical, nursing, and public health students are likely to engage in or be exposed to climate
change debates, little is known about how these students incorporate climate change knowledge into
Int. J. Environ. Res. Public Health 2018,15, 2650 3 of 14
their professional learning. There has been an increasing call for teaching about climate change in
medical education [26]. Some medical schools, such as those in the USA, have indeed started to offer
coursework on “climate change and health”. However, it is by no means arranged as a standard
requirement [
27
]. There is a lack of consensus about what should be taught about climate change in
medical, nursing, and public health curricula.
This study aimed to fill the literature gap by conducting a survey in a representative sample
of medical, nursing, and public health students in China. The preparedness of health workforce in
actions on climate change is particularly important for China, because China is highly vulnerable to
global climate change due to its large population size and rapid transition in economic and social
development. Findings of this study may help educational providers to better incorporate climate
change components into their teaching deliveries.
2. Materials and Methods
A nationwide cross-sectional questionnaire survey was conducted on medical, nursing, and public
health students in a representative sample in China during April and May in 2017.
2.1. Study Participants
Senior university students majoring in clinical medicine, nursing, and public health were eligible
to participate in this study. The participants were restricted to those who had one more year to finish
their undergraduate studies: year four in clinical medicine and public health; and, year three in
nursing. These students had already completed all required coursework and were ready for the final
year practice placements. Their completed coursework usually contained two parts: half in relation to
basic biomedicine subjects and half in relation to clinical/professional subjects [28].
A multistage stratified cluster sampling method was adopted to recruit participants. China has
been officially divided into five geographic regions. One university in each region was identified:
Harbin Medical University in the north, Sichuan University in the west, Sun Yat-sen University in the
south, Fujian Medical University in the east, and Huazhong University of Science and Technology in
the central region. We estimated that a minimal sample size of 250 from each participating university
would be able to meet the requirements of sub-group statistical tests and regression analyses: 110 in
clinical medicine; 80 in public health; and, 60 in nursing in line with the proportion of enrolled students
for each degree program. Students in these participating universities studied in groups from beginning
to completion, each comprising 30–40 members. These groups formed the basic unit for sampling.
We randomly selected two or three groups of students for each major in each participating university
and invited all of the group members to participate in the survey.
2.2. Data Collection
A questionnaire was developed based on the theories of KAP (knowledge, attitudes, and practice)
and rational choice action. These theories hypothesize that individuals may choose a particular course
of action that is in line with their beliefs and preferences, and knowledge plays a crucial role in shaping
these beliefs and preferences [
12
,
29
,
30
]. Human beings are characterized by pursuing the causal
structure of the world that supports cognitive achievements [
31
]. Causal knowledge plays a central
role in the human thoughts [
32
]. It allows people to provide an explanation on the occurrence of an
event and to predict the future events and even the consequences of counterfactuals. This forms the
foundation of reasoning and rational actions.
The questionnaire comprised three sections, with items deriving from the existing
literature
[10,19,3336]
(Table S1). Section One tapped into the general perceptions of the respondents
on the nature and impacts of climate change. Example questions included “whether climate change
is controllable” and “whether climate change is bad for human health”. Respondents were asked
to rate their opinions on a six point Likert scale without a neutral midpoint. Such an approach was
recommended by Maibach et al. to better capture the inclination of the participants [
37
]. Section Two
Int. J. Environ. Res. Public Health 2018,15, 2650 4 of 14
asked the respondents to identify the health impacts of climate change from a list of 12 health-related
problems. These 12 aspects of problems have been widely accepted as potential important health
impacts of climate change [
10
,
34
]. Section Three investigated the knowledge of respondents about
the causes of climate change. A list of four statements [
19
] were presented and the respondents were
asked to judge whether they are true or false. Example statements included “Climate change is mainly
caused by human activities” and “The global CO
2
concentration in the atmosphere has increased
during the past 250 years”.
The questionnaires were distributed by our trained investigators to the classrooms of the selected
groups of students. They were asked to complete the questionnaires independently and returned the
questionnaires to a collection box when they left the classrooms. A total of 1436 questionnaires were
disseminated and 1387 (response rate, 97%) were returned and valid for data analyses.
2.3. Data Analyses
Perceptions on the nature and impacts of climate change were recoded into binary data (“yes vs.
no” or “correct vs. incorrect”) for the purpose of data analyses. The percentage of positive or correct
responses in relation to each item was compared between different streams of students using
χ2
tests.
The ability of respondents to identify the health impacts of climate change was assessed using the
percentage of correct answers related to the 12 listed problems, which was further categorized into
high (
50%) and low (<50%) levels. We also calculated a summed score (0–12), reflecting the total
number of problems that were correctly identified by the respondents. This served as an indication of
the overall ability of an individual to identify climate change related health problems.
Similarly, knowledge of the causes of climate change was assessed using the percentage of correct
answers related to the four tested statements, which was further categorized into high (
50%) and
low (<50%) levels. A summed score (0–4) was calculated to reflect the overall understanding of an
individual on the causes of climate change.
Multivariate logistic regression models were established to examine the associations between
knowledge of the causes of climate change (high vs. low) and perceived impacts of climate change
(“yes or no” on seven questions), controlling for variations in social demographic characteristics
(gender, age, location, household income, and health status). Because multiple indicators (perceived
impacts of climate change as dependent variables) were used in the logistic regression tests, we used
the Bonferroni procedure to adjust the pvalues in regard to the statistical significance of the adjusted
odds ratios (AORs) of causes knowledge [
38
]. We also performed sensitivity tests by introducing the
summed score (0–4) of causes of knowledge into the regression models.
3. Results
3.1. Characteristics of Participants
Of the 1387 respondents, 69% were 21–22 years old and 67% were female. The majority (>80%)
rated their health status as good or very good. The nursing students were more likely to be female
(p< 0.01) and reported lower household income (p< 0.01) (Table 1).
Int. J. Environ. Res. Public Health 2018,15, 2650 5 of 14
Table 1. Demographics of participants by different majors.
Characteristics
All
(n= 1387)
Medical
(n= 644)
Public Health
(n= 430)
Nursing
(n= 313)
n(%) n(%) n(%) n(%)
Region
East 258 18.6 117 18.2 80 18.6 61 19.5
North 308 22.2 156 24.2 79 18.4 73 23.3
Central 248 17.9 107 16.6 84 19.5 57 18.2
West 262 18.9 120 18.6 83 19.3 59 18.9
South 311 22.4 144 22.4 104 24.2 63 20.1
Gender
Female 926 66.8 328 50.9 319 74.2 279 89.1
Male 461 33.2 316 49.1 111 25.8 34 10.9
Age
20 126 9.5 38 6.1 20 5.0 68 23.1
21–22 913 68.9 419 66.7 302 74.8 192 65.3
>22 287 21.6 171 27.2 82 20.3 34 11.6
Monthly household income per capita (¥)
<1000 154 11.2 62 9.8 51 12.0 41 13.1
1000–1999 284 20.7 112 17.6 95 22.4 77 24.6
2000–4999 514 37.5 239 37.6 155 36.6 120 38.3
5000–9999 293 21.4 146 23.0 89 21.0 58 18.5
10,000 127 9.3 76 12.0 34 8.0 17 5.4
Self-rated health
Very good 303 21.9 156 24.2 80 18.6 67 21.4
Good 858 61.9 378 58.7 275 64.0 205 65.5
Medium or poor 226 16.3 110 17.1 75 17.4 41 13.1
3.2. Perceived Impacts of Climate Change
About 67% of respondents believed that climate change is controllable, as compared with 13%
who believed it is uncontrollable. The majority of respondents (>80%) agreed that climate change has
negative impacts on the public in general and for human health specifically. Over 85% of respondents
anticipated serious health impacts of climate change in the next 20 years at the local, national,
and international levels. These perceptions were consistent across different streams of students, except
that the public health students were more likely (p< 0.01) to believe climate change is controllable
(Table 2).
Overall, the respondents were able to identify on average 9.5 problems (SD 2.3) out of a total of
12 related to climate change. The vast majority of respondents acknowledged illness conditions and
service disruptions resulting from poor air quality (95%), heat stress (93%), and extreme weather events
(91%) as potential health impacts of climate change. Nonetheless, only 39% recognized malnutrition
and 64% recognized mental health illness as a consequence of climate change. About 20–30% of
respondents believed that the list of problems were exhaustive. The medical students were more likely
to be able to recognize water-borne infectious disease, food-borne infectious disease, mental health
illness, and malnutrition as a consequence of climate change as compared to their nursing and public
health counterparts (Table 2).
Int. J. Environ. Res. Public Health 2018,15, 2650 6 of 14
Table 2. Perceived impacts of climate change from medical, public health and nursing students.
Perceived Impacts of Climate Change
Medical
(n= 644)
Public Health
(n= 430)
Nursing
(n= 313)
All
(n= 1387) p
n(%) n(%) n(%) n(%)
Climate change is controllable 418 64.9 321 74.7 196 62.6 935 67.4 <0.01
Overall, climate change is bad 546 84.8 359 83.5 253 80.8 1158 83.5 0.30
Climate change is bad for human health 575 89.3 381 88.6 266 85.0 1222 88.1 0.15
Climate change will be serious in my local
community 576 89.4 368 85.6 282 90.1 1226 88.4 0.09
Climate change will be serious in China 619 96.1 413 96.1 298 95.2 1330 95.9 0.79
Climate change will be serious in the world 609 94.6 410 95.4 299 95.5 1318 95.0 0.76
Health consequences of climate change
Air quality-related illness 604 93.8 413 96.1 299 95.5 1316 94.9 0.22
Heat-related illness 596 92.6 407 94.9 283 90.4 1286 92.8 0.07
Disruption of health services by extreme
weather events 585 90.8 396 92.1 282 90.1 1263 91.1 0.62
Cold-related illness 570 88.5 385 89.5 276 88.2 1231 88.8 0.82
Flooding-related displacement 550 85.5 375 87.4 259 82.8 1184 85.5 0.20
Illness related with shortage of water supply 556 86.5 352 82.2 269 86.2 1177 85.1 0.13
Vector-borne infectious disease 541 84.0 359 83.9 249 79.8 1149 83.0 0.23
Water-borne infectious disease 544 84.6 328 76.6 249 79.6 1121 81.0 <0.01
Other health impacts of climatic change 479 76.4 348 82.1 234 76.0 1061 78.1 0.06
Food-borne disease 472 73.4 250 58.1 226 72.2 948 68.4 <0.01
Mental health conditions 443 68.8 255 59.3 185 59.1 883 63.7 <0.01
Malnutrition 282 43.9 141 32.8 117 37.4 540 39.0 <0.01
Total score (Mean ±SD) 9.70 ±2.39 9.36 ±2.20 9.36 ±2.27 9.52 ±2.31 0.03
3.3. Knowledge about the Causes of Climate Change
Overall, the respondents achieved a mean score of 2.31 and 58% correctly identified all of the
answers about the causes of climate change. About 53% medical students, 50% public health students,
and 41% nursing students achieved a high level of knowledge about the causes of climate change: the
differences appeared to be statistically significant (χ2= 11.06, p< 0.01).
Most respondents accepted the general truth of increasing earth temperature (64%), increasing
CO
2
in the atmosphere (75%), and the contribution of human activities to climate change (77%).
However, only 16% of respondents were able to identify details about the change in CO
2
concentrations
over the past few centuries (Table 3).
Int. J. Environ. Res. Public Health 2018,15, 2650 7 of 14
Table 3. Correct answers on the causes of climate change from medical, public health, and nursing students.
Causes of Climate Change All Medical Public Health Nursing p
n%n%n%n%
Climate change is mainly caused by human activities 1071 77.3 508 78.9 333 77.4 230 73.7 0.17
The global CO2concentration in the atmosphere has increased during the past 250 years 1034 74.7 484 75.2 321 75.0 229 73.2 0.80
The last century’s global increase in temperature was the largest during the past 1000 years 880 63.6 420 65.2 285 66.4 175 56.5 0.01
Today’s global CO
2
concentration in the atmosphere has already occurred in the past 650,000 years
217 15.7 94 14.6 75 17.5 48 15.4 0.45
Total score (Mean ±SD) 2.31 ±1.01 2.34 ±1.02 2.36 ±1.01 2.18 ±0.98 0.02
Int. J. Environ. Res. Public Health 2018,15, 2650 8 of 14
3.4. Associations between Knowledge on the Causes and Perceived Impacts of Climate Change
The logistic regression models showed that there was no significant association between the
knowledge on the causes of climate change and the ability of the respondents to recognize climate
change related health problems (Table 4).
However, a higher level of knowledge about the causes of climate change was a significant
predictor of increased awareness of the negative impacts of climate change, in particular among the
medical students (with an AOR ranging from 1.83 for “climate change is controllable” to 9.18 for “health
impacts of climate change will be serious in China”). However, among the public health students,
knowledge on the causes of climate change did not appear as a significant predictor of increased
awareness on the negative impacts of climate change. Among the nursing students, the knowledge
level was only a significant predictor of the overall perception on the negative impacts of climate
change. The sensitivity tests produced consistent results, although the AORs changed (Tables S31–S34).
Table 4.
Associations between understandings of the causes of climate change and perceived impacts
of climate change: results from logistic regression analyses 1.
Perceived Impacts of Climate Change
Adjusted Odds Ratio (95% Confidence Interval) of Respondents with a
High (vs. Low) Level of Understanding on the Causes of Climate Change
All Medical Public Health Nursing
Climate change is controllable (yes vs. no) 1.68 ** 1.83 ** 1.38 1.81
(1.32–2.14) (1.29–2.60) (0.85–2.25) (1.07–3.06)
Overall, climate change is a bad thing (yes
vs. no)
2.16 ** 1.98 ** 2.33 2.94 **
(1.57–2.96) (1.24–3.17) (1.28–4.24) (1.44–5.99)
Climate change is bad for human health
(yes vs. no)
1.83 ** 2.18 ** 1.47 2.11
(1.28–2.60) (1.27–3.75) (0.75–2.85) (1.00–4.50)
Health impacts of climate change will be
serious in my local community (yes vs. no)
2.07 ** 3.45 ** 1.16 2.08
(1.44–2.99) (1.93–6.17) (0.62–2.15) (0.85–5.07)
Health impacts of climate change will be
serious in China (yes vs. no)
5.40 ** 9.18 ** 2.86 5.55
(2.60–11.24) (2.65–31.76) (0.83–9.87) (1.12–27.49)
Health impacts of climate change will be
serious in the world (yes vs. no)
4.00 ** 6.30 ** 1.97 4.29
(2.17–7.39) (2.47–16.02) (0.68–5.67) (0.87–21.17)
Ability to recognize health consequences of
climate change (high vs. low)
1.30 1.45 1.27 1.22
(1.04–1.64) (1.03–2.04) (0.83–1.95) (0.74–2.01)
1
Controlled for influences of region, gender, age, discipline (only in the model involving all respondents), income,
and health status. ** Bonferroni adjusted p< 0.01.
4. Discussion
There was an overwhelming belief in the respondents that climate change is generally “bad” and
bad for human health. However, only 60% of the respondents could correctly identify the causes
of climate change. On average, the respondents identified nine health problems that were related
to climate change out of a total of 12 in the list. Knowledge on the causes of climate change is not
associated with the ability to recognize the health consequences of climate change. Nevertheless, it is
a significant predictor of increased awareness of the medical and nursing students on the overall
negative impacts of climate change.
Higher education can and should play an important role in raising awareness and shaping the
attitudes and practices of the new generations toward actions on sustainability. The values and
behaviors of university students with the sustainability agenda are important within the climate
change context. There are some university initiatives that are known as greening the curriculum [
39
].
Chaplin and Wyton found that university students tend to accept the importance of sustainable living,
yet their understanding is usually at a very low level and there is a shortage of actions [
12
]. It is critical
to close the gap between knowledge, values, and actions [11].
Int. J. Environ. Res. Public Health 2018,15, 2650 9 of 14
4.1. Perceptions about Climate Change and Its Health Impacts
Overall, perceptions on the impacts of climate change are consistent across the three streams of
students. They all anticipated increasing consequences of climate change in the near future at the
local, national, and international levels. However, the immediate health challenges that are associated
with extreme weather events (e.g., heat stress and service disruptions) are more likely to attract their
attentions when compared with those indirect, more complex, and long lasting health consequences
(e.g., changing ecosystem).
It appears that it is less likely that these students would adopt a global view on the impacts of
climate change. Mental health conditions and malnutrition, which are often a result from population
displacement (e.g., climate refugees), came to the bottom on the list of recognized health challenges that
are associated with climate change. This phenomenon is not unique in China. People’s concerns are
naturally connected with their past experiences and the environment in which they grow up. Empirical
evidence shows that the world is experiencing increasing catastrophic weather events over the past
few decades. However, these events appear in various forms in different locations [
1
]. Air quality
related illness is the most recognizable health problem in this study, perhaps because air pollution has
been an extraordinary environmental problem in China [
40
]. By contrast, in Ethiopia, health science
students reported flooding, drought, and increasing temperature as the most prominent impacts of
climate change [
41
]. In the USA, local health officers considered extreme hot weather and wildfire as
the most serious threat of climate change [34].
The medical and nursing students in this study demonstrated a lower level of confidence on the
prospect of controlling climate change than their public health counterparts. This may be a reflection
of the limitations of their professional training: medical and nursing students are usually better
equipped with skills for individual actions than those for collective actions [
18
]. The weak confidence
on collective actions may eventually jeopardize the ability of medical and nursing professionals to
play an imperative role in the debate of and actions on climate change [
42
]. On the other hand, we
found that the public health students were less likely to be able to identify water-borne infectious
disease, food-borne infectious disease, mental health conditions, and malnutrition as a consequence of
climate change as compared with their medical and nursing counterparts. This is not surprising given
the recent trend of public health education, shifting from a focus on disease prevention to a focus on
health promotion. Public health professionals are becoming more interested in social, environmental
and behavioral determinants of health, which are usually associated with multiple disease conditions.
Internationally, there are increasing numbers of public health professionals without a qualification of
biomedical training [10,34].
4.2. Low Level of Knowledge on the Causes of Climate Change
Overall, the students demonstrated a low level of knowledge about the causes of climate change,
with 58% giving correct answers to all of the four knowledge questions as compared with an average
of 60% in the general public revealed in a cross-country study [
19
]. The nursing students had a lower
level of knowledge than their medical and public health counterparts. It is not clear whether this is
caused by the differences in educational programs or the differentiations in professional functions
and cultures.
There has been a strong consensus in the scientific community that global warming has increased
significantly in the last century due to human activities [
43
]. Nonetheless, we found a significant level of
disagreement in the student respondents with the scientific conclusion: more than 35% disagreement on
global warming and more than 25% disagreement on CO
2
changes in the past 250 years. Internationally,
there are around 17% of the public respondents (age over 20) that do not think the CO
2
concentration
changed and 36% that do not perceive the temperature increase [
19
]. Therefore, university students
did not show higher correct consensus when compared to the general public.
Int. J. Environ. Res. Public Health 2018,15, 2650 10 of 14
4.3. Higher Level of Knowledge on the Causes of Climate Change Is Associated with Higher Awareness of the
Negative Impacts of Climate Change
Some researchers argued that a good understanding about the causes of climate change is essential
for motivating health professionals to embrace eco-friendly practices and advocate for green and
healthy lifestyles: they have to believe in human causes to climate change [
43
,
44
]. In Pakistan,
the public perception on climate change is shaped by their knowledge relating to heat waves within
a climate change context [
45
]. Medical students should be educated to endorse the importance of
containing CO
2
emissions so that they can develop confidence and be empowered to play an active role
in global actions on climate change [
1
,
27
]. Indeed, a higher level of knowledge on the causes of climate
change is a significant predictor of increased awareness on the negative impacts of climate change.
This is particularly true for medical students, as revealed in this study. Knowledge and perceptions are
usually considered as prerequisites for the general public to adapt to climate change [46].
However, knowledge on the causes of climate change by itself is not enough to enhance the skills of
medical, public health, and nursing students in recognizing and mitigating health harms resulting from
climate change. We found that knowledge on the causes of climate change is not associated with the
ability of the students to recognize climate change related health problems. Kahan and colleagues [
47
]
also found that knowledge has limited effects on people’s perceptions on climate change, let alone
behavioral changes. Grimm [
31
] concluded that causal knowledge can lead to skill gains, but only
under certain conditions. Hagmayer and Witteman proposed a Causal-explanation-based Decision
Making (CDM) framework, which describes when and how causal knowledge and reasoning should
be used in decision making for better outcomes [
32
]. They pointed out that the CDM framework
aligns well with the clinical reasoning of health professionals. It is important to note that the causal
knowledge about climate change measured in this study does not entail understandings about the
underlining mechanisms of the potential health impacts of climate change. Our limited understanding
on these mechanisms may jeopardize the effect of the causal knowledge on the skill gains of the
students in recognizing climate change related health problem.
It appears that knowledge on the causes of climate change may have varied effects on different
health professionals. In this study, we found that the knowledge on the causes of climate change
has no significant associations with perceived impacts of climate change in public health students.
However, it is a significant predictor of perceived negative impacts of climate change in medical
students, as is consistent with findings of a study on the general public across six countries [
19
].
Since different health professionals play a different role in climate change actions, some researchers
have called for developing different approaches, such as teaching, learning, and assessment approaches
in integrating climate change topics into the teaching curricula for medical, nursing, and public health
students [27,48,49].
4.4. Implications on Teaching and Research into Health Impacts of Climate Change
Health professionals can play various roles at different levels in global actions on climate
change [
50
]. At the individual level, they identify the patients and those who are in high risks
of developing health problems as a consequence of climate change. They take consideration of the
environmental factors in treating and preventing relevant disease conditions. At the practice level,
they need to be conscious of the environmental impacts of their business operations and engaged in
reduction of CO
2
footprints. At the population level, they are role models of the community and they
advocate social and environmental actions for improving population health [50,51].
Obviously, different skill sets are required for competent performance of the above roles [
48
]. It is
evident from this study that the students lack a global and systems view on health impacts of climate
change despite high awareness of the negative impacts of climate change. They have difficulties
in recognizing health problems that are indirectly linked to climate change through more complex
pathways, including those that are associated with population displacement and changing ecosystems.
In the literature, there have been discussions about how to reinforce knowledge on the interaction
Int. J. Environ. Res. Public Health 2018,15, 2650 11 of 14
between climate change and human health in medical education [
48
]. However, such education
programs have to adopt a global view. It is not ethical for health professionals to constrain services to
the concerns of their local patients only, and ignore the broader problems that are experienced by those
from the “other parts of the world” as a result of climate change [
51
]. Meanwhile, teaching into climate
change has to be meaningful and bear close connections with the reality the health professionals
are facing [
26
]. China is not a migrant country. The concept of climate refugee may sound alien to
many health professionals in China. However, the recent transition of China’s economy has witnessed
dramatic growth in population movements (e.g., rural-to-urban and region-to-region migrations) and
changes in ecosystems (e.g., the three gorges dam). In recent years, China has also accelerated its
international health assistance activities to other countries. As a result, health professionals in China
have been increasingly exposed to many health challenges that are similar to some of the problems
resulting from climate change. It would be a reasonable choice to combine the considerations of
development and climate change in teaching deliveries [26].
No doubt, climate change should be integrated into the curricula for medical, public health,
and nursing students [
52
]. Nevertheless, this is by no means a simple and straightforward task.
There are a number of challenges: (1) Medical curricula have already been overcrowded [
27
];
(2) We need to apply different pedagogies in teaching for different health professionals [
44
]; (3) Our
understanding on the mechanisms of health impacts of climate change is still limited; and, (4) There is
a serious shortage of academic staff in medical, public health, and nursing schools who are competent
in teaching and research into the area of climate change. At this stage, most “climate change” education
programs have restricted contents to the trend and causes of climate change. Although this is important
for raising awareness and building motivations for actions, it is far less than enough to empower
health professionals to engage in actions on climate change. Research into the underlying mechanisms
of health impacts of climate change needs to be strengthened. There is also a need to change the
culture of professional practices: health professionals need to see themselves as an integral part of
the global action on climate change. Environmental education is important [
53
,
54
], but it needs to
be integrated into the professional education programs as a higher order of learning beyond the
confines of professional knowledge and skills [
16
]. Teaching about climate change typically takes a
wider sustainability focus [
18
,
48
]. The Higher Education Academy (HEA) in the UK developed some
examples about skills and knowledge that are necessary for an “action-oriented, sustainability literate”
graduate [18].
To our knowledge, this is the first national study to explore the knowledge and perceptions on
climate change of medical, public health and nursing students in China. Similar studies are also
limited in the international literature. There are some limitations in this study. The study instrument
was developed based on the few available literature. The reliability and validity of the instrument
are subject to further scrutiny. The study adopted a cross-sectional design. No causal relationships
can be drawn from the results. In addition, perceptions can be shaped by many factors, including
culture, values and religious belief, just to name a few. Unfortunately, many of these data were either
unavailable or hard to measure due to a lack of reliable measurement instruments. Furthermore,
this study was undertaken in China. Precautions should be taken in attempts to generalize the findings
to other countries. However, China’s medical education system has borrowed experiences from many
other countries. It has become increasingly aligned with international standards. Lobell et al. point
out that Asia and Africa are likely to suffer similar problems due to the same likelihood of large
food-insecure human populations [
55
]. Future studies are warranted to explore the effective ways
of incorporating climate change contents into medical curricula. There is also a need to develop a
more comprehensive instrument to assess competencies of health professionals in dealing with climate
change and its health impacts.
Int. J. Environ. Res. Public Health 2018,15, 2650 12 of 14
5. Conclusions
Medical, public health, and nursing students in China are highly aware of the negative impacts
of climate change; but, it is evident that they have poor knowledge about the causes of climate
change. The students are able to recognize the direct links between weather events and health; but,
they are less likely to be able to understand the consequences of climate change involving complicated
pathways. A higher level of knowledge on the causes of climate change is a predictor of increased
awareness on the negative impacts of climate change; but, the ability to recognize health consequences
of climate change is not associated with knowledge on the causes of climate change. Although a good
understanding on the causes of climate change by itself is important, it is not enough to get health
professionals prepared to cope with climate change consequences. Training and research into the
underlying mechanisms of health impacts of climate change needs to be strengthened.
Supplementary Materials:
The following materials are available online at http://www.mdpi.com/1660- 4601/
15/12/2650/s1. Table S1: Questionnaire items and sources, Table S2: Responses to questions about impacts
of climate change, Tables S3–S30: Details of multivariate logistic regression models, Tables S31–S34: Sensitive
analysis from a different coding scheme.
Author Contributions:
Conceptualization, L.Y., S.Z. and C.H.; Data curation, W.L. and N.Z.; Formal analysis, L.Y.
and C.L.; Funding acquisition, S.Z. and C.H.; Methodology, L.Y., W.L., C.L. and C.H.; Writing–original draft, L.Y.;
Writing–review & editing, C.L. and N.Z. All authors approved the final version to be published.
Acknowledgments:
This work was supported by grants from the National Key R&D Program of China
(2018YFA0606204); National Natural Science Foundation of China (No. 71603292); Guangdong Natural
Science Foundation (No. 2016A030310162); Guangdong Special Fund for Science and Technology Development
(No. 2017A070707002) and Guangdong Province Medical Science and Technology Research Foundation
(A2016245).
Conflicts of Interest: The authors declare no conflict of interest.
References
1.
Watts, N.; Adger, W.N.; Agnolucci, P.; Blackstock, J.; Byass, P.; Cai, W.; Chaytor, S.; Colbourn, T.; Collins, M.;
Cooper, A.; et al. Health and climate change: Policy responses to protect public health. Lancet
2015
,386,
1861–1914. [CrossRef]
2. Robbins, A. Health consequences of climate change interventions. Lancet 2015,386, 1819. [CrossRef]
3.
McIver, L.; Kim, R.; Woodward, A.; Hales, S.; Spickett, J.; Katscherian, D.; Hashizume, M.; Honda, Y.; Kim, H.;
Iddings, S.; et al. Health Impacts of Climate Change in Pacific Island Countries: A Regional Assessment
of Vulnerabilities and Adaptation Priorities. Environ. Health Perspect.
2015
,124, 1707–1714. [CrossRef]
[PubMed]
4.
Astrom, C.; Orru, H.; Rocklov, J.; Strandberg, G.; Ebi, K.L.; Forsberg, B. Heat-related respiratory hospital
admissions in Europe in a changing climate: A health impact assessment. BMJ Open
2013
,3, e001842.
[CrossRef] [PubMed]
5.
Tawatsupa, B.; Yiengprugsawan, V.; Kjellstrom, T.; Seubsman, S.A.; Sleigh, A.; Thai Cohort Study Team.
Heat stress, health and well-being: Findings from a large national cohort of Thai adults. BMJ Open
2012
,
2, e001396. [CrossRef] [PubMed]
6.
Gill, M.; Stott, R. Health professionals must act to tackle climate change. Lancet
2009
,374, 1953–1955.
[CrossRef]
7. Roberts, I.; Stott, R. Doctors and climate change. Lancet 2010,376, 1801–1802. [CrossRef]
8.
Winkler, M.S.; Roosli, M.; Ragettli, M.S.; Cisse, G.; Muller, P.; Utzinger, J.; Perez, L. Mitigating and adapting
to climate change: A call to public health professionals. Int. J. Public Health
2015
,60, 631–632. [CrossRef]
[PubMed]
9.
Moser, A.M.; Stigler, F.L.; Haditsch, B. Physicians’ responsibility for planetary health. Lancet Planet. Health
2017,1, e56. [CrossRef]
10.
Polivka, B.J.; Chaudry, R.V.; Mac Crawford, J. Public health nurses’ knowledge and attitudes regarding
climate change. Environ. Health Perspect. 2012,120, 321–325. [CrossRef] [PubMed]
11.
Whitley, C.T.; Takahashi, B.; Zwickle, A.; Besley, J.C.; Lertpratchya, A.P. Sustainability behaviors among
college students: An application of the VBN theory. Environ. Educ. Res. 2018,24, 245–262. [CrossRef]
Int. J. Environ. Res. Public Health 2018,15, 2650 13 of 14
12.
Chaplin, G.; Wyton, P. Student engagement with sustainability: Understanding the value-action gap. Int. J.
Sustain. High. Educ. 2014,15, 404–417. [CrossRef]
13.
Eagle, L.; Low, D.; Case, P.; Vandommele, L. Attitudes of undergraduate business students toward
sustainability issues. Int. J. Sustain. High. Educ. 2015,16, 650–668. [CrossRef]
14. Zsoka, A.; Szerenyi, Z.M.; Szechy, A.; Kocsis, T. Greening due to environmental education? Environmental
knowledge, attitudes, consumer behavior and everyday pro-environmental activities of Hungarian high
school and university students. J. Clean. Prod. 2013,48, 126–138. [CrossRef]
15.
Prasad, V.; Thistlethwaite, W.; Dale, W. Effect of clinical vignettes on senior medical students’ opinions of
climate change. South. Med. J. 2011,104, 401–404. [CrossRef] [PubMed]
16.
Ng, A.W.; Leung, T.C.H.; Lo, J.M.K. Developing Sustainability Competence for Future Professional
Accountants: The Integrative Role of an Undergraduate Program. World Sustain. Ser. 2017. [CrossRef]
17.
Lambrechts, W.; Ghijsen, P.W.T.; Jacques, A.; Walravens, H.; Van Liedekerke, L.; Van Petegem, P. Sustainability
segmentation of business students: Toward self-regulated development of critical and interpretational
competences in a post-truth era. J. Clean. Prod. 2018,202, 561–570. [CrossRef]
18.
Kagawa, F. Dissonance in students’ perceptions of sustainable development and sustainability: Implications
for curriculum change. Int. J. Sustain. High. Educ. 2007,8, 317–338. [CrossRef]
19.
Shi, J.; Visschers, V.H.M.; Siegrist, M.; Arvai, J. Knowledge as a driver of public perceptions about climate
change reassessed. Nat. Clim. Chang. 2016,6, 759–762. [CrossRef]
20. Corner, A. Psychology: Science literacy and climate views. Nat. Clim. Chang. 2012,2, 710–711. [CrossRef]
21.
Shi, J.; Visschers, V.H.; Siegrist, M. Public Perception of Climate Change: The Importance of Knowledge and
Cultural Worldviews. Risk Anal. 2015,35, 2183–2201. [CrossRef] [PubMed]
22.
Krosnick, J.A.; Holbrook, A.L.; Lowe, L.; Visser, P.S. The origins and consequences of democratic citizens’
policy agendas: A study of popular concern about global warming. Clim. Chang. 2006,77, 7–43. [CrossRef]
23.
Lorenzoni, I.; Pidgeon, N.F. Public views on climate change: European and USA perspectives. Clim. Chang.
2006,77, 73–95. [CrossRef]
24.
Bord, R.J.; O’Connor, R.E.; Fisher, A. In what sense does the public need to understand global climate change?
Public Underst. Sci. 2000,9, 205–218. [CrossRef]
25.
Tobler, C.; Visschers, V.H.M.; Siegrist, M. Consumers’ knowledge about climate change. Clim. Chang.
2012
,
114, 189–209. [CrossRef]
26.
Maxwell, J.; Blashki, G. Teaching about Climate Change in Medical Education: An Opportunity. J. Public
Health Res. 2016,5, 673. [CrossRef] [PubMed]
27.
Friedrich, M.J. Medical Community Gathers Steam to Tackle Climate’s Health Effects. JAMA
2017
,317,
1511–1513. [CrossRef] [PubMed]
28.
Jing, M.A.; Yue, Y.-G. Medical Education System in European and American Countries Enlightenments on
the Current Medical Education Reform in Our Country. Med. Innov. China 2014,11, 75–78.
29.
James, H.; Handu, S.S.; Al Khaja, K.A.J.; Otoom, S.; Sequeira, R.P. Evaluation of the knowledge, attitude
and practice of self-medication among first-year medical students. Med. Princ. Pract.
2006
,15, 270–275.
[CrossRef] [PubMed]
30.
Johnston, J.M.; Leung, G.M.; Fielding, R.; Tin, K.Y.K.; Ho, L.M. The development and validation of a
knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching
and learning. Med. Educ. 2003,37, 992–1000. [CrossRef] [PubMed]
31. Grimm, S.R. Understanding as Knowledge of Causes. Synth Libr. 2014,366, 329–345. [CrossRef]
32.
Hagmayer, Y.; Witteman, C. Chapter Four- Causal Knowledge and Reasoning in Decision Making.
In Psychology of Learning and Motivation; Ross, B.H., Ed.; Academic Press: Cambridge, MA, USA, 2017;
Volume 67, pp. 95–134.
33.
Lee, T.M.; Markowitz, E.M.; Howe, P.D.; Ko, C.Y.; Leiserowitz, A.A. Predictors of public climate change
awareness and risk perception around the world. Nat. Clim. Chang. 2015,5, 1014–1020. [CrossRef]
34.
Bedsworth, L. Preparing for climate change: A perspective from local public health officers in California.
Environ. Health Perspect. 2009,117, 617–623. [CrossRef] [PubMed]
35.
Wei, J.; Hansen, A.; Zhang, Y.; Li, H.; Liu, Q.; Sun, Y.; Bi, P. Perception, attitude and behavior in relation to
climate change: A survey among CDC health professionals in Shanxi province, China. Environ. Res.
2014
,
134, 301–308. [CrossRef] [PubMed]
Int. J. Environ. Res. Public Health 2018,15, 2650 14 of 14
36.
Roser-Renouf, C.; Maibach, E.W.; Li, J. Adapting to the Changing Climate: An Assessment of Local Health
Department Preparations for Climate Change-Related Health Threats, 2008–2012. PLoS ONE
2016
,11,
e0151558. [CrossRef] [PubMed]
37.
Maibach, E.W.; Kreslake, J.M.; Roser-Renouf, C.; Rosenthal, S.; Feinberg, G.; Leiserowitz, A.A. Do Americans
Understand That Global Warming Is Harmful to Human Health? Evidence from a National Survey.
Ann. Glob. Health 2015,81, 396–409. [CrossRef] [PubMed]
38.
McDonald, J.H. Handbook of Biological Statistics, 3rd ed.; Sparky House Publishing: Baltimore, MD, USA, 2014.
39.
Hopkinson, P.; Hughes, P.; Layer, G. Sustainable graduates: Linking formal, informal and campus curricula
to embed education for sustainable development in the student learning experience. Environ. Educ. Res.
2008,14, 435–454. [CrossRef]
40. Lancet, O. Climate change and non-communicable diseases. Lancet Oncol. 2016,17, 1. [CrossRef]
41.
Nigatu, A.S.; Asamoah, B.O.; Kloos, H. Knowledge and perceptions about the health impact of climate
change among health sciences students in Ethiopia: A cross-sectional study. BMC Public Health
2014
,14, 587.
[CrossRef] [PubMed]
42.
Duvivier, R.J.; Watts, N.R.; Rukavina, S.; Kaduru, C.J. Doctors talk climate change–students take action.
Lancet 2011,377, 995. [CrossRef]
43.
Ding, D.; Maibach, E.W.; Zhao, X.Q.; Roser-Renouf, C.; Leiserowitz, A. Support for climate policy and societal
action are linked to perceptions about scientific agreement. Nat. Clim. Chang. 2011,1, 462–466. [CrossRef]
44.
Green, E.I.; Blashki, G.; Berry, H.L.; Harley, D.; Horton, G.; Hall, G. Preparing Australian medical students
for climate change. Aust. Fam. Physician 2009,38, 726–729. [PubMed]
45.
Rauf, S.; Bakhsh, K.; Abbas, A.; Hassan, S.; Ali, A.; Kachele, H. How hard they hit? Perception, adaptation
and public health implications of heat waves in urban and peri-urban Pakistan. Environ. Sci. Pollut. Res. Int.
2017,24, 10630–10639. [CrossRef] [PubMed]
46.
Akompab, D.A.; Bi, P.; Williams, S.; Grant, J.; Walker, I.A.; Augoustinos, M. Heat Waves and Climate Change:
Applying the Health Belief Model to Identify Predictors of Risk Perception and Adaptive Behaviours in
Adelaide, Australia. Int. J. Environ. Res. Public Health 2013,10, 2164–2184. [CrossRef] [PubMed]
47.
Kahan, D.M.; Peters, E.; Wittlin, M.; Slovic, P.; Ouellette, L.L.; Braman, D.; Mandel, G. The polarizing impact
of science literacy and numeracy on perceived climate change risks. Nat. Clim. Chang.
2012
,2, 732–735.
[CrossRef]
48.
Bell, E.J. Climate change: What competencies and which medical education and training approaches?
BMC Med. Educ. 2010,10, 31. [CrossRef] [PubMed]
49.
Leffers, J.; Levy, R.M.; Nicholas, P.K.; Sweeney, C.F. Mandate for the Nursing Profession to Address Climate
Change through Nursing Education. J. Nurs. Scholarsh. 2017,49, 679–687. [CrossRef] [PubMed]
50.
Kreslake, J.M.; Sarfaty, M.; Roser-Renouf, C.; Leiserowitz, A.A.; Maibach, E.W. The Critical Roles of Health
Professionals in Climate Change Prevention and Preparedness. Am. J. Public Health
2017
,108, S68–S69.
[CrossRef] [PubMed]
51.
Shin, G.Y.; Manuel, R.J. Healthcare professionals must “think globally, act locally” on climate change. BMJ
2016,355, i5686. [CrossRef] [PubMed]
52.
Shaman, J.; Knowlton, K. The Need for Climate and Health Education. Am. J. Public Health
2017
,108, S66–S67.
[CrossRef] [PubMed]
53.
Varela-Losada, M.; Vega-Marcote, P.; Perez-Rodriguez, U.; Alvarez-Lires, M. Going to action? A literature
review on educational proposals in formal Environmental Education. Environ. Educ. Res.
2016
,22, 390–421.
[CrossRef]
54.
Mosher, H.R.; Desrochers, M. The effects of information regarding sustainability issues and behavioral
self-management instruction on college students’ energy conservation. Int. J. Sustain. High. Educ.
2014
,15,
359–370. [CrossRef]
55.
Lobell, D.B.; Burke, M.B.; Tebaldi, C.; Mastrandrea, M.D.; Falcon, W.P.; Naylor, R.L. Prioritizing climate
change adaptation needs for food security in 2030. Science 2008,319, 607–610. [CrossRef] [PubMed]
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... Voices from the health sector have been further amplified during the COVID-19 pandemic [19]. In this context, various studies have been conducted worldwide to understand about the views of health professionals and workers on climate change as a health issue, for instance, from China (among public health and nursing students [20] and public health nurses [21]), the USA (among nurses [22] and physicians [23]), and Italy (among healthcare professionals and students [24]). The study conducted in China among the public health and nursing students [20] found that 88% of the respondents recognised that climate change was bad for human health, and 67% believed that the impacts of climate change are controllable. ...
... In this context, various studies have been conducted worldwide to understand about the views of health professionals and workers on climate change as a health issue, for instance, from China (among public health and nursing students [20] and public health nurses [21]), the USA (among nurses [22] and physicians [23]), and Italy (among healthcare professionals and students [24]). The study conducted in China among the public health and nursing students [20] found that 88% of the respondents recognised that climate change was bad for human health, and 67% believed that the impacts of climate change are controllable. Findings from another recent large, multinational survey of health professionals (n = 4654) from 12 health professional organisations (medical and nursing) around the world revealed that participants understood that climate change is happening (95%) and that it was caused by human activities (81%), that climate change was an important and growing cause of health impacts in their patients (77%) as well as for future generations (93%), and recognised that they have a responsibility to create awareness among the public (86%) and policymakers (90%) about climate change and its health effects [25]. ...
... Similar findings were reported from a survey from China where higher awareness about heat-(92.8%) and cold-related illness (88.8%) as compared to mental impacts (63.7%) were reported [20]. Following a similar pattern, the majority of the participants were aware of climate change manifestations such as floods, droughts, cyclones, forest fires, change in rainfall pattern and sea level rise, but only half of the participants were aware of climate-induced migration (56.0%) and social conflicts (49.7%) as manifestations. ...
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Introduction Climate change is one of the greatest global health challenges of the 21st Century. India is especially vulnerable to climate change due to its geographic location, climate-sensitive livelihoods and prevalent health concerns. In that context, the healthcare workforce plays a critical role in addressing climate change and its health effects. While some initiatives are underway to equip the healthcare workforce in India, their understanding and interest to engage with this challenge was unknown. We conducted a cross-sectional study to assess the knowledge, attitudes and practices related to climate change and health among the healthcare workforce in India (i.e., community health workers, doctors, etc.). Methods A structured questionnaire was administered to participants between October and December, 2020. The collected data (n=3062) were analyzed descriptively. Results We found that although knowledge about climate change and its immediate health effects due to exposure to heat (80.9%), cold (79.2%) and disease vectors (79.1%) were prevalent among the respondents, awareness about the delayed or indirect health effects such as malnutrition was relatively low (58.4%). Several participants reported an interest to learn more about climate change, for instance, about linkages between infectious disease outbreaks and climate change (72.7%), and the role of health professionals in creating awareness on climate change (43.9%). Conclusions While additional research is needed to understand the roles and motivations of various healthcare actors to address these challenges, our findings are encouraging towards further interventions in this area. Our study also provided insights on the preferences regarding the communication media and material on climate change and health by the healthcare workforce. There is a need to enable climate-resilient health systems in India and in other countries that are disproportionately vulnerable to climate change, and studies such as this one can help in that direction.
... Similar findings about vector-borne diseases were reported in the studies of Sulistyawati S et al. [11] (81%) and Yang L et al. (84%). [19] However only 38% of participants in the study by Sulistyawati S et al. [11] and 1.7% of participants in the study by Hampshire K et al. [20] among medical students in US have responded cardiovascular diseases as a health impact of climate change. ...
... Despite the recent studies showing climate change as a greater contributor to child malnutrition than poverty and poor sanitation, only a half (50%) of our study participants knew that climate change can also cause malnutrition. [21] Similar findings were reported in a study conducted among the medical students by Yang L et al. [19] in China, where only 39% of the subjects identified association between climate change and malnutrition. ...
... Majority (97%) of our study participants agreed that human activities contribute to global warming. Similar findings were reported by Yang L et al., [19] (78.9%), and a study conducted in Karachi by Jamal M et al. [24] (91.6%) among the medical students. Most (86%) of the participants agreed that global warming is a current and future problem. ...
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... In our study, the majority of nursing students stated that they are aware of what climate change is and the causes of climate change. Yang et al. (2018) reported that nursing students have a lower level of knowledge about the effects of climate change on health than their colleagues in the field of medicine and public health (Yang et al., 2018). In contrast, Liao et al. (2019) stated that students in China are aware of climate change (Liao et al., 2019). ...
... In our study, the majority of nursing students stated that they are aware of what climate change is and the causes of climate change. Yang et al. (2018) reported that nursing students have a lower level of knowledge about the effects of climate change on health than their colleagues in the field of medicine and public health (Yang et al., 2018). In contrast, Liao et al. (2019) stated that students in China are aware of climate change (Liao et al., 2019). ...
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Background: Today's nursing students will always face the health effects of climate change in the coming years. Methods: This research was carried out with students (N=148) between 1-May 2021-1 June 2021 and no sample selection was made. As a data collection form, a questionnaire containing the descriptive characteristics of the students and a questionnaire on climate change developed by the researchers were used. Results: 19.6% of the students gave the answer of university education as a climate change information source. Students stated that they could take effective actions towards the effects of climate change on health (p=0.038) and that they should be well prepared for the effects of climate change on health (p=0.032). Conclusions: Although nursing students have embraced their role in responding to climate change, they think that they are not adequately prepared at school.
... Literature have illustrated that gaining new and reinforcing existing knowledge expands and strengthens understanding (Großmann & Wilde, 2019). This may result to increased awareness (Bergman, 2016;Karatas & Gürbüz, 2016) and changes in perceptions (Aksit et al., 2018;Vereijken et al., 2018;Yang et al., 2018) influencing values (Aksit et al., 2018;Garrison et al., 2015;Sancho Larrañaga, 2015), beliefs (Doménech-Betoret et al., 2017;C.-L. Wang & Liou, 2017) and attitudes (Syed Hassan, 2018), hence changing behaviors (Bergman, 2016). ...
Thesis
The increasing number, intensity, and unpredictability of natural hazards all over the world has increased the call and consensus to integrate disaster risk reduction in existing school curricula such as the science curriculum of the Philippine basic education programme. Considering that disaster risk reduction is an emerging concern, it brings a number of opportunities and challenges in the education sector including public schools. This multiphase study was aimed at developing a model of a science teacher professional development on disaster risk reduction for public school teachers in Biliran Province, the Philippines. Study 1 attempted to explore the implementation of disaster risk reduction in schools specifically the integration and teaching of disaster risk reduction in science from grades 3 to 10 through document analysis of key curriculum documents and interviews of key stakeholders including the disaster risk reduction coordinator, school principals, science teachers, and students whose selection was guided by the theoretical sampling principles of the Grounded theory. Informed by the results of Study 1, Study 2 attempted to measure the influence of technological, pedagogical, and content knowledge, as well as values, beliefs, and norms on teaching disaster risk reduction from among 189 science teachers selected through cluster sampling. Results of Study 2 together with existing guidelines from the Department of Education informed Study 3 that attempted to develop a contextualized model of a science teacher professional development on disaster risk reduction through Delphi process participated by ten purposively selected experts. Content and thematic analysis of key disaster risk reduction curriculum documents and the science curriculum of the Philippine basic education programme revealed opportunities for disaster risk reduction in the science curriculum while interviews revealed the lacking contextualized and localized teacher professional development and the lacking specific guidelines and procedure for systematic integration of disaster risk reduction in science, therefore its frequent inclusion and emphasis in teaching is left to the prerogative of the teachers. Related thereto, the influence of technological, pedagogical, and content knowledge, as well as values, beliefs, and norms on teaching disaster risk reduction from among science teachers was probed and measured and analysed through partial least squares-structural equation modeling. Results revealed the positive significant influence of technological, pedagogical, and content knowledge on teaching disaster risk reduction and the influence of values, beliefs, and norms on teaching disaster risk reduction conformed to the Value-Belief-Norm Theory of environmentalism. Finally, a model on science teacher professional development on disaster risk reduction was developed using the 4As (anchor, add, apply, away) of the dialogue learning approach validated through the Delphi process.
... However, Tobler et al. (2012) suggests that lack of knowledge is not the main barrier to action because awareness might produce changes in the behavior since other structural barriers are involved. Moreover, the study developed by Yang et al. (2018) concludes that knowledge is an essential factor and predictor of people's awareness toward actions. Therefore, knowledge is an essential factor in predicting behavior and supporting climate change policy (O'Connor et al., 1999). ...
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Today climate change has become one of the most significant challenges for the scientific community because the impact on people's behavior is based on how climate change is communicated. Consequently, the number of studies and publications on climate change communication in Ecuador is still zero, is a topic that has not been installed as a component of basic plans, programs, or strategies actions within the Ecuadorian government. The study focuses on college students from six different universities in the province of Manabí, Ecuador, considering that they become leaders and decision-makers in the future. Therefore, exploring climate change communication among Ecuador's college students through an analysis of knowledge, risk perception, emotions, attitudes, and behavior is a topic of deep interest to develop strategies by creating initiatives to enhance a better awareness among society. This research has a quantitative approach to measure variables in a specific population proposing a model that is the first to have been conducted in Ecuador to understand the reasons behind why college students' have particular behavior towards climate change. Therefore, descriptive and statistical regression analysis was conducted using IBM SPSS and an online survey sent via Qualtrics platform. The results from 577 responders show that Ecuador's college students do not have good environmental behavior due to the lack of clear and accurate information on this problem. Although students are aware and worried about climate change threats, they are willing to implement more sustainable activities. Regression statistical results show that attitude, risk perception, and emotion impact statistically and significantly on predicting the behavior of Ecuador's college students towards climate change. Even though knowledge is a factor that does not show statistical and significant values to predict it. One of the reasons why knowledge cannot impact behavior is because climate change communication involves mental and social factors, which require multiple factors associated with each other that lead a person to behave appropriately. Hence, it is necessary to produce an overview of the situation to wake up central and local governments to develop climate change communication strategies through universities to promote the importance of good environmental practices and motivate students to implement them.
... Por parte de las instituciones de salud vincular la importancia de los impactos del cambio climático, el compartir experiencias exitosas puede beneficiar la fuerza laboral y la reducción de costos (Macpherson & Hill, 2017). En esa medida la formación básica, avanzada y continua para los profesionales sanitarios debe complementarse de forma rápida e integral con formatos de enseñanza y aprendizaje en sostenibilidad ambiental (Kotcher et al., 2021;Wabnitz et al., 2021;Yang et al., 2018;Salahodjaev, 2018). ...
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Hospitals are institutions that operate permanently, requiring the consumption of resources and inputs, which permanently generate waste, atmospheric emissions and discharges that will generate major impacts on society and ecosystems. Health personnel is a fundamental actor to mitigate these impacts from the actions in each of the health care services. For this reason, we intend to design a training program in environmental sustainability focused on education for the development of business practices and sustainable communities for the health personnel of the 199 health institutions linked to the Global Network of Green and Healthy Hospitals (Global Network) in Colombia. For its development, a research process was carried out in three phases: the first phase identified the linkage of environmental issues in the training programs of health sciences and the advances in the environmental management of the hospitals linked to the Global Network. For the second phase, a rigorous review of the scope of the scientific literature was carried out, which was analyzed together with the results of the interviews conducted with those responsible for environmental management linked to the Global Network in hospitals in Nariño, Valle del Cauca, Cundinamarca and Bogotá D.C. as evidence-based knowledge for the design of the training program. In the third phase, the business environment was assessed for the design of the business and environmental management system of the Growing Up Foundation organization for the execution of the training program, evaluating its financial feasibility for its development. Among the results, there is evidence of the lack of training of sanitary personnel in environmental issues, and there are important commitments to waste management, chemical substances and leadership. On the other hand, the literature reports the weakness of health professionals who have the tools to contribute to mitigate environmental impacts. A training program with five (5) training levels is proposed. For the third phase, a business and environmental management system is designed for the Growing Up Foundation organization, having the possibility of its execution since the proposal presents operational and financial feasibility.
... This investigation supports the findings of (Freije et al., 2016;Yang et al., 2018). Parashar et al. (2013) also discovers similar finding in their work. ...
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Climate Change is unequivocal and occurring at an alarming pace. Increasing greenhouse gas emissions, their concentration in the atmosphere and increased energy absorption have resulted in changes in climate. This study was a cross sectional study conducted from April 12th to May 12th, 2021. The survey was conducted online using Google form that was circulated via "WhatsApp" groups and emails received from the University admissions office. This study comprises of students in their; first year 26.5%, second year 22.8%, third year 17.9% and fourth-year students 32.8%. Students from the school of Medicine and allied health science showed a satisfactory knowledge of 67% towards the causes of global warming. Students from the school of Engineering also demonstrated a satisfactory knowledge towards the impact of global warming 61% and its solution 69%. In conclusion, students at the University of The Gambia demonstrated a satisfactory understanding of the causes of global warming (63%) and a fair awareness of the consequences (52%) and remedies to global warming (54%). We recommend that, climate change awareness course should be incorporated into the curriculum of the University of The Gambia and should be made mandatory for every student.
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Our study aims to understand how students of various backgrounds and academic fields retrieve information on Climate Change (CC) and highlights their knowledge on the main causes and consequences of CC, and on the role of healthcare workers in the fight towards this threat. A cross-sectional study was performed between January and December 2020 through an online questionnaire enrolling a total number of 480 university students. The questionnaire is divided in two sections with a total number of 20 questions. Univariable and multivariable analyses were performed to investigate the relationship between the answers and socio-demographic variables. Statistical significance was set at a p-value < 5%. More than 80% of the sample identifies the increase in Earth's temperature (95.0%), melting of ice caps (89.4%), rising of sea levels (81.8%), and the more frequent occurrence of climate-related natural disasters as major consequences of CC. Across courses of study, the frequency on how CC is addressed differs (p<0.001): students belonging to the medical field addressed the issue less frequently (31.5%) compared to humanities students (49.0%) and science and technology students (63.4%). The study shows that students of medical field are less prepared and less aware of the consequences and causes of CC than students in other faculties. Since CC will play a role in every aspect of patients' lives, barriers to health care will have to be overcome through the knowledge and skills acquired during undergraduate courses.
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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.
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This article adds insights in students' attitudes toward sustainability, with specific focus on students inbusiness management/marketing. It builds upon a number of conceptual interpretations and barriers forchange in higher education for sustainable development, followed by the concept of sustainability competences and the students’ perspectives. A segmentation study is developed in order to frame the variety of student dispositions of sustainability attitudes, based on a survey among 458 students in business management/marketing. Four different segments of students are discovered, according to their attitudes toward sustainability issues: moderate problem solvers; pessimistic non-believers; optimistic realists; and convinced individualists. The results of the segmentation study reveal that a one-fit-for-all approach in acquiring sustainability competences is not feasible. This calls for a diversity in approaches to prepare students in dealing with the complexity and uncertainty of sustainability issues, oriented toward more self-regulated learning, and developing critical and interpretational competences.
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Climate change is a burgeoning public health concern, with implications for chronic health conditions; nutrition and food security; food-, water-, and vector-borne diseases; and social disruption, injuries, displacement, and death associated with extreme weather.(1) Climate change is contributing to health disparities in the United States by having a disproportionate impact on low-income individuals, some communities of color, and those with higher vulnerability to chronic health conditions.(1) Moreover, these vulnerabilities can co-occur. (Am J Public Health. Published online ahead of print October 26, 2017: e1-e2. doi:10.2105/AJPH.2017.304044).
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Heat waves threaten human health given the fast changing climatic scenarios in the recent past. Adaptation to heat waves would take place when people perceive their impacts based on their knowledge. The present study examines perception level and its determinants resulting in adaptation to heat waves in Pakistan. The study used cross-sectional data from urban and peri-urban respondents of Faisalabad District. The study employs a health belief model to assess risk perception among the respondents. Logistic model is used to determine factors affecting level of knowledge, perception and adaptation to heat waves. Around 30% of peri-urban respondents have a low level of knowledge about the fatal impacts of heat waves. Risk perception of heat waves is very low among urban (57%) and peri-urban (66%) respondents. Households’ knowledge on heat waves is significantly related to age, gender, education, wealth and access to health services. Determinants of perception include knowledge of heat waves, age and joint effect of marital status and knowledge while income level, family size, urban/peri-urban background, perceived barriers, perceived benefits and cues to action significantly affect adaptation to heat waves. To reduce deadly health impacts, mass awareness campaigns are needed to build perception and improve adaptation to heat waves.
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While Value-Belief-Norm (VBN) theory has been widely applied to various populations, it has seldom been tested on college students. This study extends VBN theory to examine what socio-psychological factors influence sustainability behaviors among university students. Undergraduate students are an interesting and novel population, as they are still forming their values and beliefs, and therefore may be more open to engage in sustainability efforts. This study assessed five sustainability behaviors: (a) support for political candidates who say they will strengthen environmental policies, (b) recycling, (c) electricity use, (d) food selection, and (e) transportation choices. Findings support the notion that one’s values matter in environmental decision-making, but that different values are associated with different behaviors. Those who adhere to biospheric and altruistic values were more likely to engage in a range of sustainability behaviors whereas those who adhere to egoistic values were less likely to engage in most behaviors. Those who adhere to traditional or openness to change values showed mixed results. We discuss the theoretical application, practical recommendations for behavior change campaigns, and offer suggestions for future research.
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With the increasing understanding that climate change is already affecting and will continue to affect human health,(1,2) health professionals, governments, businesses, and the general public must proactively address both climate change and its implications for public health. The observed and anticipated effects of climate change on human health are myriad and will affect both the vulnerable and the broader public. Examples of direct effects include overall elevated temperatures that generally exacerbate chronic disease morbidity and mortality and changing patterns and increased frequency of heat waves that lead to more acute heat stress-related morbidity and mortality.(3) Some of the indirect outcomes of climate change include alterations of vector-borne disease transmission dynamics, degradation and destabilization of air and water quality, and stress to mental health. More complex downstream effects include disruption of agriculture and food security, reduced water availability, and conflict over limited resources. (Am J Public Health. Published online ahead of print October 26, 2017: e1-e2. doi:10.2105/AJPH.2017.304045).
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Purpose: The adverse health effects from climate change demand action from the nursing profession. This article examines the calls to action, the status of climate change in nursing education, and challenges and recommendations for nursing education related to climate change and human health. Organizing construct: Discussion paper. Findings: The integration of climate change into nursing education is essential so that knowledge, skills, and insights critical for clinical practice in our climate-changing world are incorporated in curricula, practice, research, and policy. Our Ecological Planetary Health Model offers a framework for nursing to integrate relevant climate change education into nursing curricula and professional nursing education. Nursing education can offer a leadership role to address the mitigation, adaptation, and resilience strategies for climate change. Conclusions: An ecological framework is valuable for nursing education regarding climate change through its consideration of political, cultural, economic, and environmental interrelationships on human health and the health of the planet. Knowledge of climate change is important for integration into basic and advanced nursing education, as well as professional education for nurses to address adverse health impacts, climate change responses policy, and advocacy roles. Clinical relevance: For current and future nurses to provide care within a climate-changing environment, nursing education has a mandate to integrate knowledge about climate change issues across all levels of nursing education. Competence in nursing practice follows from knowledge and skill acquisition gained from integration of climate change content into nursing education.
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Normative causal decision theories argue that people should use their causal knowledge in decision making. Based on these ideas, we argue that causal knowledge and reasoning may support and thereby potentially improve decision making based on expected outcomes, narratives, and even cues. We will summarize findings from empirical research, which indicate that decision makers use their causal knowledge and reasoning when making a choice. Focusing on decision making in mental health, we will also show that at least sometimes the outcomes resulting from a chosen action can be improved by taking causal knowledge into account. In the second part of the chapter, we propose a structured process describing when and how decision makers should use causal knowledge and reasoning in decision making: the Causal-explanation–based Decision Making framework. Mental health will again be our exemplary domain. We will end by arguing that our model may serve as a blueprint for a rational model for clinical decision making, which may also guide future research.
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Nearly 30 years ago, Alexander Leaf, MD, drew a bold analogy. Changes brewing in climate and the environment, he wrote, may be just as harmful to human health as nuclear war.
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To instigate the conception of sustainability in education, it takes a top-down commitment from the administration of a tertiary institution as well as a bottom-up initiative stimulating interests of its faculty and students to collaborate learning proactively. This Chapter aims to develop a conceptual framework that adopts a model of knowledge development for the attraction of sustainability competence of a new generation of professional accountants. A personal knowledge management model is advocated for students of a tertiary education program to develop their explicit and tacit knowledge needed for sustainability competence. Through a case study of an undergraduate program in accountancy in Hong Kong, it highlights the integrative role of an undergraduate program that is designed with an emphasis on the ethical aspects of corporate social responsibility (CSR) and knowledge about sustainability. Standalone compulsory and elective courses integrated with a program of learning and teaching activities with involvement of students would engender a dynamic process for sustainability competence as a higher order of learning beyond the confines of vocational education. The significance of pertinent faculty research activities and transferring contemporary knowledge about sustainability with local relevance is pointed out.