Pediatric residents' attitudes and behaviors related to counseling adolescents and their parents about firearm safety.

BACKGROUND Firearms 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. OBJECTIVES To 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. DESIGN Cross-sectional survey. PARTICIPANTS Pediatric residents from 9 programs in the mid-Atlantic region. RESULTS Of 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. CONCLUSIONS To 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.