Clinical context	Climate change relationship	Counseling message with rationale
Well-child physical examination	Climate change disproportionately harms children	Anticipatory guidance* “A newer and important topic I'd like to discuss is climate change and health. Since 2019, the American Academy of Pediatrics and more than 100 other health organizations have declared climate change a health emergency.A1 It is estimated that air pollution alone caused more than 68,000 premature deaths in the United States in 2018, and worsening air quality is only one out of nine ways that climate change is hurting people and disproportionately hurting our children.A2–A4 So, just as I want children to eat healthy foods and to wear their seatbelts, we now know that decreasing energy use, increasing energy efficiency, and supporting clean energy initiatives are also important ways to improve children's health. Do you have any questions?” Rationale Draws on respected health organization(s) Sends a local, personalized message Emphasizes protecting childrenA5
Seasonal allergy visit	Climate change increases pollen counts and lengthens the duration of allergy season	After reviewing medical options for treatment and prevention “It's clear that climate change is increasing pollen counts and lengthening the allergy season.A6 It's important to do what we can to improve our own energy use and to support clean energy initiatives when discussing allergy treatment.” Rationale Connects health impact with fossil fuel overconsumption
Asthma visit General, for children and adolescents	Climate change and the causes of climate change create particulate matter that worsens lung disease	After reviewing medical options for treatment “Avoiding triggers is important for controlling asthma, and for many people, they feel better when they stay indoors when outdoor air quality is poor. Many weather websites track ground-level ozone, which is one of the air pollutants that can worsen asthma, so you know when to stay indoors if possible. If you must go outside, when possible, stay on routes that avoid busy roads. Also, for monitoring personal exposure to air pollution, consumer-grade, low-cost air-quality monitors and sensors can empower you to make changes in indoor air quality.” “You can help improve the air we breathe:  Drive less  Improve your home's energy efficiency and replace your gas stove with a convection oven  If you rent, we can give you information to share with your landlord on how to get assistance to repair your windows and roof and remove mold if present (eTable B)  Support clean energy initiatives at home, which is important to clean our air and help people with asthma  We need a lot of important actions from adults, organizations, and government leaders to clean our air; however, many of your own actions to address climate change can help improve air quality and help us live our best lives.” Rationale Positive, actionable messaging
Questions from patients “What can I do to help stop climate change? How can I help protect my community from the negative effects of climate change?”	Individuals can take several actions to support climate change mitigation; together, individuals can directly improve a community and influence changes in legislation and regulations that benefit everyone	Explanation “Fixing climate change requires all of us to work together. One of the most important things you can do is to talk about climate change, clean energy, and health with your friends, family, and elected officials. Information from the World Health Organization describes actions you can take.”A7 “You can also try the following steps:  Purchase fewer items  Reuse/repurpose as many products as possible  Save energy: switch to LED lighting, turn off lights, use fewer electronics, decrease screen time, use energy-efficient appliances, wash fewer loads of laundry  Use public transit or walk; if you drive, try to accelerate more slowly and stay within speed limits  Decrease food waste; use composting  Join organizations that help communities decrease pollution.” Rationale Emphasizes a broad spectrum of individual actions and resources
Addressing bias concerns from patients “So now you are telling me how to vote?!”	Climate change is still politically divisive in the United States and discussing this topic may upset some people	Explanation “I'm definitely not trying to bring politics into my clinic. My job is to give you recommendations on the actions you can take to improve your health and the health of others. It's now clear that climate change is harming people, and it is disproportionately hurting children, pregnant people, unborn children, older adults, economically disadvantaged communities, rural populations, and communities of color. Many major medical organizations, including the American Academy of Family Physicians and the American Medical Association, have declared climate change a health emergency because of the health harms that it causes.A1 I see many people who have conditions that are made worse by climate change, including conditions such as [insert name of condition affected by climate change]. Voting is a personal decision, and I won't tell you how to vote. I am here to provide you with sound medical advice and information so you can decide what is important for your health. What questions or concerns do you have?” Rationale Emphasizes health, not politics Empowers patient and makes the message personally relevant