Ongoing Study Evaluates Pediatricians’ Effectiveness at Changing Behaviors Associated with Violence Prevention

May 5, 2004

WINSTON-SALEM, N.C. – Although 95 percent of parents think it’s important to control their children’s exposure to television, video games and computers, more than 60 percent have allowed their children to view these media as long as they want, and 30 percent have a television in their child’s bedroom, according to research from Wake Forest University Baptist Medical Center.

At the Pediatric Academic Societies’ meeting May 1-4 in San Francisco, Shari Barkin, M.D., reported preliminary results from a four-year ongoing study on whether health care providers can change parents’ behaviors and help prevent violence.

This first batch of data examines surveys that parents complete during well-child exams. It measures media exposure, gun storage and communication between the parent and health care provider and also measures pediatricians’ levels of comfort and effectiveness in talking with parents about these issues. During well-office visits, parents of children ages 2 to 11 are asked to complete surveys. More than 100 pediatric practices throughout the United States are participating.

“We want to know what’s going to be effective to change families’ behavior and alter the likelihood that their children would become either a perpetrator or a victim of violence,” said Barkin, primary investigator and a pediatrician at Wake Forest Baptist’s Brenner Children’s Hospital.

In 2002, the World Health Organization reported that more children die of violence-related deaths each year than from all other natural causes combined.

“Exposure to violence in the media is a predictor of aggressive behavior in young adults, both men and women,” Barkin said. This has been backed up in studies, including one that followed children for more than 16 years.

The American Academy of Pediatrics (AAP) recommends limiting exposure to media – including computers, video games and television – to two hours a day. However, 65 percent of the nearly 900 parents who have been surveyed so far reported more than that, according to Barkin.

Parents were also asked about gun storage. Of the nearly 900 parents surveyed, 246 own some kind of gun and nearly half are not storing them safely, based on the recommendations of the AAP.

“Storage differs by the type of guns,” Barkin said. “Long gun owners are more likely to store the bullets separately but not lock up their guns. Handgun owners are more likely to store the guns loaded but with gunlocks in place. This information will guide pediatricians who can tailor their gun storage counseling to the specific needs of a family.”

Barkin is also measuring how confident health care providers are in talking about violence prevention and how they perceive their effectiveness. Of the more than 1,600 pediatric providers who responded to surveys from the AAP, about 90 percent said that they were confident discussing discipline techniques and about 76 percent believed they were effective at changing behavior. But, when it came to discussing firearm storage and removal of guns from the home, they had less confidence in their ability to change behaviors. Only 35 percent of providers surveyed felt confident that their counseling would result in guns being stored safely with 17 percent reporting limited perceived effectiveness at asking families to remove guns from their homes to improve child safety.

“If regular visits to the pediatrician are to be used to address these problems, then violence prevention counseling skills need to be made a priority as part of medical school and residency training,” said Barkin.

Barkin received a $2.25 million grant from the National Institute of Child Health and Human Development for the study, which is the first national randomized controlled trial to test the effectiveness of a program for pediatric providers to prevent violence. Physicians will review the parent surveys for trouble spots, reinforce positive behaviors, educate families on problem areas, provide tools and skills for parents, and refer the patient for additional help, if necessary.


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