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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1934-1943

SUPPLEMENT ARTICLE

Routine Assessment of Family and Community Health Risks: Parent Views and What They Receive

Michael D. Kogan, PhD^*, Mark A. Schuster, MD, PhD^,,||, Stella M. Yu, ScD^*, Christina H. Park, PhD^¶, Lynn M. Olson, PhD^#, Moira Inkelas, PhD^**, Christina Bethell, PhD, MPH, MBA, Paul J. Chung, MD and Neal Halfon, MD, MPH^,**

^* Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
Department of Pediatrics, University of California at Los Angeles, Los Angeles, California
Department of Health Services, School of Public Health, University of California at Los Angeles, Los Angeles, California
^|| RAND Corporation, Los Angeles, California
^¶ ANASYS, Inc
^# American Academy of Pediatrics, Elk Grove Village, Illinois
^** Department of Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, California
Child and Adolescent Health Measurement Initiative, Kaiser NW Center for Health Research

Objective. To examine the prevalence of parent–provider discussions of family and community health risks during well-child visits and the gaps between which issues are discussed and which issues parents would like to discuss.

Methods. Data came from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 children aged 4 to 35 months. The outcome measures were 1) the reported discussions with pediatric clinicians about 7 family and community health risks and 2) whether the parent believes that pediatric clinicians should ask parents about each risk.

Results. Most parents believe that pediatric providers should discuss topics such as smoking in the household, financial difficulties, and emotional support available to the parent. However, with the exception of "household smoking," fewer than half of parents have been asked about these topics by their child’s clinician. Parents of black and Hispanic children were more likely than parents of white children to be asked about several of these issues, as were parents of the youngest children and those with publicly financed health insurance. The greatest gap between parents’ views and their reports of discussion with the clinician occur for parents of white children and older children. Among parents who hold the view that a topic should be discussed, parents of white and older children are less likely than others to report discussing some or all family and community health risks.

Conclusion. The low frequency of discussions for many topics indicates potential unmet need. More universal surveillance of parents with young children might ensure that needs are not missed, particularly given that strong majorities of parents view family and community topics, with the exception of community violence, as appropriate for discussion in clinic visits.

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Key Words: quality of care • health risk • health supervision • psychosocial counseling • children

Abbreviations: AAP, American Academy of Pediatrics • NSECH, National Survey of Early Childhood Health • OR, odds ratio

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Received for publication Oct 20, 2003; Accepted Jan 13, 2004.

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