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Carey Conley Thomson, MD, MPH; Kevin Roberts, MS; Andrew Curran, BA; Louise Ryan, PhD; Rosalind J. Wright, MD, MPH

Arch Pediatr Adolesc Med. 2002;156:818-823.

Background  Effective screening for exposure to violence (ETV) in the pediatric setting depends on informant reliability and recognition of patients at increased risk. Pediatricians screening for children's ETV often rely on parent reporting.

Hypothesis  That there would be poor caretaker-child concordance given that children would report events occurring outside the home not witnessed by the caretaker and that ETV would be higher among immigrant families.

Objectives  To examine concordance between caretaker and child self-report of the child's ETV in a preadolescent population and to explore factors related to increased risk.

Design  Community-based survey.

Setting  Urban community health center.

Participants  One hundred sixty-five caretaker-child pairs.

Methods  The ETV was assessed by means of a standardized interview questionnaire on location and frequency of ETV. A Rasch model was used to develop summary scores of ETV (frequency and severity).

Results  Caretaker-child concordance on reports of child's ETV was poor. The statistics ranged from –0.04 for seeing someone knifed to 0.39 for witnessing a shooting. Children reported ETV more often in their neighborhood or at school, whereas caretakers reported more events near or at home. Univariate predictors of child's self-reported ETV were female sex (ß ± SE, –10.1 ± 4.6; P = .03) and caretaker being divorced (ß ± SE, 12.6 ± 6.0; P = .04). In multivariate analyses, country of origin predicted child's ETV, adjusting for child's age and sex, and caretaker educational status and marital status.

Conclusions  Caretakers and their children have poor agreement on reports of the child's ETV. Intervention strategies around ETV should include assessment of the child independent of caretaker report for preadolescents. Screening may be more effective if pediatricians are aware of factors related to increased risk, including immigration status and caretaker marital status.

From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (Drs Thomson and Wright and Mr Curran), and Pulmonary and Critical Care Unit, Massachusetts General Hospital, Department of Medicine (Dr Thomson), Harvard Medical School, Department of Biostatistics, Harvard School of Public Health (Mr Roberts and Dr Ryan), and Pulmonary and Critical Care Division, Beth Israel Deaconess Medical Center (Dr Wright), Boston, Mass.

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