Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e15-e25 (doi:10.1542/peds.2007-2611)
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ARTICLE

Is Office-Based Counseling About Media Use, Timeouts, and Firearm Storage Effective? Results From a Cluster-Randomized, Controlled Trial

Shari L. Barkin, MD, MSHSa, Stacia A. Finch, MAb, Edward H. Ip, PhDc, Benjamin Scheindlin, MDd, Joseph A. Craig, MDe, Jennifer Steffes, MSWb, Victoria Weiley, MISb, Eric Slora, PhDb, David Altman, PhDf and Richard C. Wasserman, MD, MPHb,g

a Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
b Pediatric Research in Office Settings, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
c Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
d Burlington Pediatrics, Burlington, Massachusetts
e Rocky Mountain Youth Clinics, Denver, Colorado
f Center for Creative Leadership, Greensboro, North Carolina
g Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont

OBJECTIVE. The objective of this study was to determine whether patients' families' violence-prevention behaviors would be affected by their primary care practitioner's use of a violence-prevention clinical intervention during the routine well-child examination.

METHODS. In this cluster-randomized, controlled trial (2002–2006), 137 Pediatric Research in Office Settings practices were randomly assigned and initiated patient recruitment for either an office-based violence-prevention intervention or a control group (educational handout on literacy promotion provided). Primary caregivers of children who were aged 2 to 11 years and presented for a well-child visit were surveyed at baseline and 1 and 6 months. Practitioners were trained to (1) review a parent previsit summary regarding patient-family behavior and parental concern about media use, discipline strategies, and children's exposure to firearms, (2) counsel using brief principles of motivational interviewing, (3) identify and provide local agency resources for anger and behavior management when indicated, and (4) instruct patient-families on use of tangible tools (minute timers to monitor media time/timeouts and firearm cable locks to store firearms more safely where children live or play). Main outcomes were change over time in self-reported media use <120 minutes per day, use of timeouts, and use of firearm cable locks.

RESULTS. Generalized estimating equation analysis revealed a significant effect at 6 months for decreased media use and safer firearm storage. The intervention group compared with the control group showed an increase in limiting media use to <120 minutes per day. There was no significant effect for timeout use. There was a substantial increase in storing firearms with cable locks for the intervention group versus a decrease for the control group.

CONCLUSIONS. This randomized, controlled trial demonstrated decreased media exposure and increased safe firearm storage as a result of a brief office-based violence-prevention approach.

Key Words: randomized • controlled trial • violence prevention • primary care • effect

Abbreviations: PROS—Pediatric Research in Office Setting • AAP—American Academy of Pediatrics • IRB—institutional review board • SC—Safety Check • MI—motivational interviewing • ICC—intraclass correlation coefficient • GEE—generalized estimating equation

Accepted Jan 18, 2008.


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