• Barry S Solomon, Anne K Duggan, Daniel Webster, and Janet R Serwint.
• The Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine, Baltimore, MD 21287, USA. bsolomo@jhmi.edu
• Arch Pediat Adol Med. 2002 Aug 1;156(8):769-75.

BackgroundFirearms continue to be a major cause of mortality in adolescence. Although the American Academy of Pediatrics strongly encourages pediatricians to counsel adolescents and their parents on firearm safety, few residency programs educate their trainees in this area. More in-depth information is needed to design effective educational interventions.ObjectivesTo determine the attitudes, beliefs, and practices of pediatric residents regarding firearm safety counseling and to compare their counseling practices for adolescents and parents of adolescents during health maintenance visits.DesignCross-sectional survey.ParticipantsPediatric residents from 9 programs in the mid-Atlantic region.ResultsOf the 322 respondents (76% response rate), few believed that it is not a pediatrician's responsibility to counsel, that their patients are not at risk for firearm injury, and that children are safer with a gun in the home. However, only 50% reported routine counseling, and more than 20% reported almost never counseling adolescents and their parents on firearm safety. Barriers included inadequate training (38%), insufficient time (26%), and a lack of preceptor expectation (13%). The strongest predictors for counseling adolescents included the belief that gun-related media coverage influences counseling practice, level of training, and personal experience with guns in the home. The strongest predictors for counseling parents of adolescents were the belief in the media's influence on counseling practice, perceived counseling effectiveness, and discomfort with firearm safety counseling.ConclusionsTo increase counseling practices, clinical preceptors should aim to strengthen residents' comfort in counseling and to develop specific ways to enhance their perceived effectiveness in counseling parents.

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