PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1259
Preteen Counseling
To the Editor.—
The recent article by Stevens et al1 concerning a pediatric practice-based trial of drinking, smoking, bicycle helmet, gun, and seatbelt safety promotion in office practice is a well-designed study for which the authors should be congratulated. It adds to a now-growing number of studies that demonstrate that counseling directed at preteens and teens may not be an effective strategy. Although I certainly agree with the authors’ conclusion, as it is totally consistent with the existing literature, the authors unfortunately imply that their experience with preteens may be relevant to counseling efforts directed at parents of younger children, which is the major focus of the American Academy of Pediatrics TIPP (The Injury Prevention Program).
It is important to keep in mind that TIPP is primarily directed at parents of younger children and that motivated parents will engage in protective behaviors. A comprehensive review of study of counseling parents of young children, which included several studies using TIPP materials, clearly demonstrated the effectiveness of primary care-based counseling of parents of young children.2 Counseling parents to protect their child is a substantially different task than attempting to modify the behavior of preteen and teens. Most research has demonstrated that older children are best educated using social influence models rather than an adult- directed counseling intervention.3 Injury prevention is a complex endeavor that must be approached differently for different ages of patients. Although it may be relatively easy to modify parental behaviors, as the authors have shown, changing the behavior of children and adolescents may not be a workable strategy.
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Joel L. Bass, MD
Newton-Wellesley Hospital
Newton, MA, 02462
E-mail: jbass{at}partners.org
REFERENCES
- Stevens MM, Olson AL, Gaffney CA, Tosteson TD, Mott LA, Starr P. A pediatric, practice-based randomized trial of drinking and smoking prevention and bicycle helmet, gun and seatbelt safety promotion.
Pediatrics.2002; 109
:490
–497[Abstract/Free Full Text]
- Bass JL, Christoffel KK, Widome M, et al. Childhood injury prevention counseling in primary care settings: a critical review of the literature.
Pediatrics.1993; 92
:544
–550[Abstract/Free Full Text]
- American Academy of Pediatrics.
Substance Abuse: A Guide for Health Professionals. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2002:143–174
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
