To the Editor.

The recent article by Stevens et al concerning a pediatric practice-based trial of drinking, smoking, bicycle helmet, gun, and seatbelt safety promotion in office practice is a well-designed study for which the authors should be congratulated. It adds to a now-growing number of studies that demonstrate that counseling directed at preteens and teens may not be an effective strategy. Although I certainly agree with the authors’ conclusion, as it is totally consistent with the existing literature, the authors unfortunately imply that their experience with preteens may be relevant to counseling efforts directed at parents of younger children, which is the major focus of the American Academy of Pediatrics TIPP (The Injury Prevention Program).

It is important to keep in mind that TIPP is primarily directed at parents of younger children and that motivated parents will engage in protective behaviors. A comprehensive review of study of...

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