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Predicting Clinician Injury Prevention Counseling for Young Children
Shari Barkin, MD, MSHS;
Arlene Fink, PhD;
Lillian Gelberg, MD, MSPH
Arch Pediatr Adolesc Med. 1999;153:1226-1231.
Background Injury is the primary cause of morbidity and mortality in children and an important topic for counseling.
Objective To describe and explain clinicians' reported counseling behavior during the well-child examinations for children aged 5 years and younger on the following 4 injury prevention topics: motor vehicle crashes, toxic ingestion, drowning, and firearm injuries.
Methods A random sample of 465 pediatricians, family physicians, and pediatric nurse practitioners in an urban setting received mailed questionnaires; 325 (69.9%) responded. Multivariate logistic regression predicting counseling on each injury prevention topic was performed.
Results Most reported discussing motor vehicle occupant protection (66.2%) and toxic ingestion prevention (62.1%) during the well-child examination. Only 31.8% stated they counseled on drowning prevention and 15.7%, on firearm injury prevention. Knowledge of injury mortality and morbidity rates was not associated with counseling. For most topics, female respondents were more likely to counsel than male respondents (motor vehicle crash odds ratio [OR], 2.24 [P = .03]; toxic ingestion OR, 1.82 [P = .05]; drowning OR, 1.97 [P = .04]). Health maintenance organization settings predicted injury prevention counseling for most topics (motor vehicle crash OR, 2.52 [P = .04]; toxic ingestion OR, 2.77 [P = .01]; firearm injury OR, 2.97 [P = .001]). Clinicians placing lower importance on counseling were less likely to counsel on drowning and firearm injury (drowning OR, 0.73 [P = .006]; firearm injury OR, 0.58 [P<.001]).
Conclusions Clinicians' knowledge of local injury epidemiology did not influence their counseling on these topics. Clinicians and their patients might benefit by using programs such as The Injury Prevention Program to help them standardize their approach to injury prevention counseling during the routine well-child examination.
From the Departments of Health Services (Dr Barkin), Medicine and Public Health (Dr Fink), and Family Medicine (Dr Gelberg), University of California–Los Angeles, Los Angeles. Dr Barkin is now with the Department of Pediatrics, Wake Forest University Baptist Medical Center, Winston-Salem, NC.
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