Routine assessment of family and community health risks: parent views and what they receive.
OBJECTIVE
To examine the prevalence of parent-provider discussions of family and community health risks during well-child visits and the gaps between which issues are discussed and which issues parents would like to discuss.


METHODS
Data came from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 children aged 4 to 35 months. The outcome measures were 1) the reported discussions with pediatric clinicians about 7 family and community health risks and 2) whether the parent believes that pediatric clinicians should ask parents about each risk.


RESULTS
Most parents believe that pediatric providers should discuss topics such as smoking in the household, financial difficulties, and emotional support available to the parent. However, with the exception of "household smoking," fewer than half of parents have been asked about these topics by their child's clinician. Parents of black and Hispanic children were more likely than parents of white children to be asked about several of these issues, as were parents of the youngest children and those with publicly financed health insurance. The greatest gap between parents' views and their reports of discussion with the clinician occur for parents of white children and older children. Among parents who hold the view that a topic should be discussed, parents of white and older children are less likely than others to report discussing some or all family and community health risks.


CONCLUSIONS
The low frequency of discussions for many topics indicates potential unmet need. More universal surveillance of parents with young children might ensure that needs are not missed, particularly given that strong majorities of parents view family and community topics, with the exception of community violence, as appropriate for discussion in clinic visits.
Kogan
Michael D
MD
Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland 20857, USA. mkogan@hrsa.gov
Schuster
Mark A
MA
Yu
Stella M
SM
Park
Christina H
CH
Olson
Lynn M
LM
Inkelas
Moira
M
Bethell
Christina
C
Chung
Paul J
PJ
Halfon
Neal
N
D000704:Analysis of Variance; D001294:Attitude to Health; D002660:Child Guidance; D002669:Child Welfare; D002675:Child, Preschool; D005006:Ethnicity; D005195:Family Relations; D015438:Health Behavior; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D010290:Parents; D010372:Pediatrics; D011368:Professional-Family Relations; D011787:Quality of Health Care; D018570:Risk Assessment; D012309:Risk-Taking; D012959:Socioeconomic Factors; D014481:United States