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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.

--> Joel L. Bass, MD
Newton-Wellesley Hospital
Newton, MA, 02462
E-mail: jbass{at}partners.org

REFERENCES

1. 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]
2. 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]
3. American Academy of Pediatrics. Substance Abuse: A Guide for Health Professionals. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2002:143–174

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PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Bass, J. L. Search for Related Content PubMed PubMed Citation Articles by Bass, J. L. Social Bookmarking                         What's this?