National survey of pediatricians' violence prevention counseling

Background: Recommendations for child health care providers to counsel pati ents and their families on violence prevention have been issued by a number of major health care organizations. Objective: To assess the knowledge, attitudes, training, and practices of p ediatricians concerning violence prevention counseling in the areas of fami ly violence, discipline, television viewing, peer violence, and guns in the home. Design: Survey. Participants: A national random sample of 1350 pediatricians, divided equal ly among residents in their final year of training, practitioners who had c ompleted their residency training within the last 5 years, and those who ha d completed their training more than 5 years ago. Main Outcome Measures: Knowledge, attitudes, training, and current practice s regarding violence prevention counseling. Results: The overall response rate was 41%. When providing health supervisi on to patients, most pediatricians never or rarely screen for family and co mmunity violence, peer violence, and weapons. For example, 68% of residents and 73% of practitioners never or rarely screen for domestic violence, 56% of residents and 67% of practitioners never or rarely ask adolescents abou t their involvement in physical fighting, and 54% of residents and 56% of p ractitioners never or rarely identify families who have guns in the home. R egarding preparation for providing violence prevention counseling, 76% of r esidents and 83% of practitioners rated their training as inadequate. Recei ving training in the prevention of child/adolescent violence in medical sch ool (P < .001), residency (P < .001), or fellowship/continuing medical educ ation (P = .002) were major determinants of more frequent violence preventi on counseling. Pediatricians who believed that parents rarely or never foll ow through on a physician's advice about safe gun storage, switching to non violent disciplining techniques, or limiting their child's television viewi ng were less likely to ask or advise patients in these areas. Conclusions: Pediatricians are not adequately prepared to provide violence prevention counseling, and few currently screen for exposure to family and community violence, peer violence, and access to weapons. Comprehensive inf ormation about violence prevention should be integrated into medical educat ion, and the efficacy of violence prevention counseling strategies should b e evaluated.