CHILD INJURY PREVENTION: DISPARITIES IN PHYSICIAN GUIDANCE AND PARENT PRACTICE Gregory D. Stevens, Moira Inkelas, Alice A. Kuo, Corinne Peek-Asa, Lynn M. Olson, Neal Halfon. Center for Healthier Children, Families, and Communities, UCLA, Los Angeles, CA; College of Public Health, University of Iowa, Iowa City, IA; Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL.

BACKGROUND: Unintentional childhood injury is the leading cause of mortality and morbidity for children 1-4 years in the US. Most injuries occur at home and many are preventable through simple home safety modifications. Pediatricians have an important role in educating parents about these injury prevention measures.

OBJECTIVE: To describe injury prevention measures (IPMs) used by parents, the frequency of parent-pediatrician anticipatory guidance (AG) about IPMs; and to compare socioeconomic disparities in IPMs taken and in AG received with national pediatrician reports of AG on IPMs.

DESIGN/METHODS: Telephone survey of parents of children 4-35 months, National Survey of Early Childhood Health (NSECH) (year = 2000, n = 2,068) that profiles content and quality of health care for children. Data weighted to be nationally-representative, including adjustment for non-telephone households. National random sample, Periodic Survey #46 of AAP members providing primary care to children 0-3 years (year = 2000, n = 811), designed to query providers about topics similar to the NSECH.

RESULTS: Most parents of young children put plugs in electrical outlets (93.1%) even though other national data show that such injuries are rare. Fewer parents use baby gates and window guards (75.1%), pad hard surfaces (49.9%), or adjust their water thermostat (54.5%), even though falls and scalds are more common household injuries. Not all parents receive guidance on IPMs from their child?s physician; 70.7% report discussing car seats, 57.1% discuss burn prevention, and 52.7% discuss avoiding dangerous situations where injuries can occur. Pediatricians concur with parents on rates of discussion; 74.0% report discussing car seats with most parents and 72.3% discuss dangerous situations. Many parents who did not report IPMs also did not receive injury guidance. Among parents not using preventive padding, for example, only 46.2% had received guidance from their physician (compared to 59.4% among those who used padding), and 21% said that guidance would have been helpful. Disparities persist in guidance and practice according to race/ethnicity, income, maternal education, insurance coverage, and maternal mental well-being.

CONCLUSIONS: Many parents are not utilizing IPMs or receiving AG from physicians for the most common childhood injuries. Moreover, significant disparities in receipt of AG, and utilizing IPMs exist. While pediatricians have limited time to discuss IPMs, many parents want and would benefit from guidance, suggesting a missed opportunity for needed care.