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February 1998

Social Determinants of Pediatric Residents' Injury Prevention Counseling

Author Affiliations

From the Injury Prevention Research Center and the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill. Dr Cohen is now with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Ga.

Arch Pediatr Adolesc Med. 1998;152(2):169-175. doi:10.1001/archpedi.152.2.169

Background  Social norms imparted by preceptors and the requirements necessary to pass American Board of Pediatrics' examinations are potentially important contributors to physician behavior.

Objective  To explore the relationships between perceived professional norms regarding injury prevention and the injury prevention topics discussed, and counseling strategies employed, by pediatric residents.

Design  A self-administered survey.

Setting  All 5 North Carolina pediatric residency programs.

Participants  Physicians training in pediatrics or medicine-pediatrics in these programs (N=160, 72% response rate).

Main Outcome Measure  Correlation between perceived professional norms and self-reported content of injury prevention counseling and use of behavior change strategies.

Results  Although 95% of the pediatric residents reported counseling all or almost all parents with children younger than 1 year about car seat use, only 19% reported counseling this many parents about gun safety. Of the 7 behavior change strategies that residents were asked about, respondents were most likely to report "showing approval for safe behaviors" to all or almost all parents (78%). Two thirds reported asking all or almost all parents about the safety of their homes. Pediatric residents' reported injury prevention counseling was correlated with their perceived professional norms regarding such counseling for most of the content areas and behavior change strategies.

Conclusions  Perceived professional norms regarding injury prevention are related to pediatric residents' counseling. Preceptors should be aware that they transmit professional norms to residents. Also, the American Board of Pediatrics can increase residents' attention to injury prevention by informing them that it will be a topic included in the board examination.