Effects of a primary care-based intervention on violent behavior and injury in children
Effects of a primary care-based intervention on violent behavior and injury in children
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DOI：
10.1542/peds.2004-0693
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发表时间：
2004-10-01
期刊：
影响因子：
8
通讯作者：
Ireland, M
中科院分区：
文献类型：
--
作者：
Borowsky, IW;Mozayeny, S;Ireland, M
Objective.虽然许多主要的卫生保健组织提出了关于医生在预防青少年暴力中的作用的建议，但在初级保健环境中预防暴力策略的有效性仍有待于经验检验。我们进行了一项随机对照试验，以评估基于办公室的干预对儿童暴力行为和暴力相关伤害的影响。年龄在7到15岁之间的儿童，在8个儿科诊所就诊，在简短的社会心理筛查测试中得分为阳性（n = 224），被随机分配到干预组（临床医生在访问期间看到了筛查测试结果，并向临床医生提供了一个基于电话的育儿教育计划，作为父母的转介资源）或对照组（临床医生没有看到筛选测试结果）。与对照组相比，在研究入组后9个月，干预组的儿童表现出攻击行为减少（校正的平均差异：-1.71; 95%置信区间[CI]：-2.89至-0.53），违法行为（校正的平均差异：-0.71; 95%CI：-1.28至-0.13）和注意力问题（校正的平均差异：-1.02; 95%CI，-1.77至-0.26）。干预组的孩子有较低的父母报告的欺凌率（调整后的比值比：4.43; 95% CI：1.87-10.52），（调整后的比值比：1.79; 95% CI：1.11-2.87），以及需要医疗护理的战斗相关损伤（校正比值比：4.70; 95%CI：1.33-16.59）和儿童报告的欺凌受害（校正比值比：3.23; 95%CI：1.96-5.31）。以初级保健为基础的干预措施，包括社会心理筛查和提供育儿教育资源，可以减少青少年的暴力行为和伤害。
Objective. Although many major health care organizations have made recommendations regarding physicians' roles in preventing youth violence, the efficacy of violence prevention strategies in primary care settings remains to be empirically tested.Methods. We conducted a randomized, controlled trial to evaluate the effects of an office-based intervention on children's violent behaviors and violence-related injuries. Children 7 to 15 years of age who presented at 8 pediatric practices and scored positive on a brief psychosocial screening test (n = 224) were randomly assigned to an intervention group ( clinicians saw the screening test results during the visit and a telephone-based parenting education program was made available to clinicians as a referral resource for parents) or a control group ( clinicians did not see the screening test results).Results. Compared with control subjects, at 9 months after study enrollment, children in the intervention group exhibited decreases in aggressive behavior ( adjusted mean difference: - 1.71; 95% confidence interval [CI]: - 2.89 to - 0.53), delinquent behavior ( adjusted mean difference: - 0.71; 95% CI: - 1.28 to - 0.13), and attention problems ( adjusted mean difference: - 1.02; 95% CI, - 1.77 to - 0.26) on the Child Behavior Checklist. Children in the intervention group had lower rates of parent-reported bullying ( adjusted odds ratio: 4.43; 95% CI: 1.87-10.52), physical fighting ( adjusted odds ratio: 1.79; 95% CI: 1.11-2.87), and fight-related injuries requiring medical care ( adjusted odds ratio: 4.70; 95% CI: 1.33-16.59) and of child-reported victimization by bullying ( adjusted odds ratio: 3.23; 95% CI: 1.96-5.31).Conclusions. A primary care-based intervention that includes psychosocial screening and the availability of a parenting education resource can decrease violent behavior and injury among youths.