Just my luck: How children's causal attributions contribute to injury prevention

PURPOSE

Traumatic injury in children, particularly adolescents, is both frequently and costly. In this study, we directly examined children's causal attributions for the recent traumas and asked them to propose prevention strategies of their own. We predict that children who attribute their injuries to their own actions, rather than an external force such as luck, will be more likely to develop strategies to avoid trauma in the future.

METHODS

All children aged 10 -18 years who presented to a Level 1 pediatric trauma center at an urban children's hospital over a ten-month period were identified and presented with a series of structured interview questions. They were asked to describe the cause of their injuries, whether they believed them to be avoidable, and what strategies, if any, they thought might have prevented their trauma.

RESULTS

46 children with an average age of 13.4 years were surveyed and the responses of 44 children were analyzed. Most injuries resulted from sports (24) or motor vehicle accidents (14). The remaining injuries were due to burns (4) and falls (2). Twelve (27%) children believed that their own behavior was to blame for their injuries. 32 children ascribed their injuries to circumstances outside of their control with the majority (30, 94%) viewing themselves as "unlucky." Children who accepted fault for injury and children who thought their accident was avoidable were more likely to be able to formulate a strategy for preventing future injury. Children who thought their accident was avoidable were also more likely to accept fault for it.

CONCLUSION

Children surveyed denied their own culpability and preferred to attribute their injuries to bad luck. Moreover, children who believed themselves to be simply unlucky were less able than others to propose strategies that might prevent further injury.

Antenatal and early childhood exposures associated with non-fatal infant injury: evidence from a longitudinal birth cohort in New Zealand

OBJECTIVE

To identify antenatal and early childhood exposures of unintentional injury among infants in New Zealand (NZ).

METHOD

The theoretical life-course framework of child injury prevention domains was utilised to analyse data from a prospective longitudinal NZ birth cohort (Growing Up in NZ). Risk and protective factors for injury were identified using Robust Poisson regression models.

RESULT

Among children included for the analysis(n=6304), 52% were male, 55% were born to European mothers, and 37% lived in a household with high levels of deprivation. Mothers reported that 6% of infants (n=406) had sustained at least one injury by 9 months. Multivariate analysis showed injury risk among single mothers with antenatal depression were more than twice that (IRR=2.20) of children of mothers with partners and without depression.

CONCLUSION

Understanding antenatal risk and protective factors for infant injury will assist in implementing injury prevention programmes or modifying the existing policies that affect these vulnerable age groups.

The impact of children's temperament on recurrent unintentional injuries: the role of paternal parenting styles as a mediator

Background

Unintentional injuries (UIs) pose a threat to the health of children all over the world and are a major global health problem. The recurrence of UIs are influenced by the host itself or environmental factors. Children's temperament and paternal parenting styles (PPS) are important potential factors for poor health outcomes, including recurrent unintentional injuries (recurrent UIs). Therefore, exploring the relationship among these variables may help reduce the likelihood of recurrent UIs in children.

Purpose

To elucidate the mediating effect of PPS in the relationship of children's temperament characteristics and recurrent UIs among children.

Methods

By multistage random cluster sampling method, a total of 2,850 pupils in grades four and five from 10 different schools were included. The survey included the characteristics of UIs in the past year, parenting styles, and children's temperament. Structural equation modeling (SEM) was used to examine the possible mediating effect of PPS between children's temperament and recurrent UIs.

Results

In this study, the incidence rate of recurrent UIs was 3.8%. In temperament, children with recurrent UIs had higher mean scores than the non-recurrent UIs group (t = -3.40, -3.52, -3.45, respectively; p < 0.001) in the activity, predictability, persistence. Meanwhile, the scores of negative PPS (punishing, over-interference, rejection, and overprotection) were higher in the recurrent UIs group than in the non-recurrent UIs group (t = -5.78, -5.05, -5.56, and -3.29; p < 0.001, < 0.001, < 0.001, < 0.001, respectively). Using a stepwise binary logistic regression model, grade (OR = 0.23, 95% CI [0.12-0.41], p < 0.001), activity (OR = 1.61, 95% CI [1.14-2.26], p = 0.007) and over-interference (OR = 2.28, 95% CI [1.37-3.80], p = 0.002) had a significant independent relationship with recurrent UIs. The SEM results indicated that children's temperament was significantly related to negative PPS (β = 0.26, p < 0.001) and recurrent UIs (β = 0.11, p = 0.029). The results of the bootstrap test confirmed the significance of the mediating effect of PPS (β = 0.06, p < 0.001) between children's temperament and recurrent UIs.

Conclusions

These results suggest that negative PPS plays an important role in mediating children's temperament and recurrent UIs. It is essential to consider PPS when creating tailored intervention programs to reduce children's recurrent UIs.

Risk factors of unintentional injury among children in New Zealand: a systematic review

OBJECTIVE

To identify contemporary studies investigating multifaceted and inter-linked contributory frameworks for unintentional injuries among children in New Zealand.

METHODS

A literature review was performed in seven databases. Studies published in English up to February 2020 reporting risk factors for child injury in New Zealand were included. Eligible study designs included: cohort, case-control and case-crossover studies. The quality of studies was assessed using the GATE frame tool. The PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) reporting guidelines were followed.

RESULTS

Thirteen studies fulfilled the inclusion criteria, dating from 1977 to 2008. The factors associated with child injury (0 to 14 years) included socioeconomic disadvantage, number of children, younger maternal age and sole parents. Vehicle speed and traffic volume were associated with an increased risk of driveway-related pedestrian injury.

CONCLUSION

The review findings have reinforced the need for cross-agency action to address the social determinants of child injury. Implications for public health: Contemporary longitudinal studies are needed to assist in understanding how the interactions between children, family and their wider societal context affect their risk of experiencing injury over time.

Keeping children safe: a model for predicting families at risk for recurrent childhood injuries

OBJECTIVE

Existing research on recurrent unintentional injury (UI) focuses on the individual child rather than family risks. This study developed a statistical model for identifying families at highest risk, for potential use in targeting public health interventions.

STUDY DESIGN

A retrospective birth cohort study of hospital and emergency room (ER) medical records of children born in Ziv hospital between 2005 and 2012, attending ER for UI between 2005 and 2015, was conducted.

METHODS

Using national IDs, we assigned children to mothers and created the family entity. Data were divided into two time periods. Negative binomial regression was used to examine predictive factors in the first period for recurrent child UI in the second period. Sensitivity analyses were conducted to examine the model's robustness.

RESULTS

Eight predictive factors for child injury (P < 0.05) were found: male gender, the number of UI visits, the number of illness visits, age 36-59 months, birth weight <1500 g, maternal ER visits, siblings' UI visits, and the number of younger siblings. Some predictive factors are documented in the literature; others are novel. Five were significant in all sensitivity analyses.

CONCLUSIONS

These factors can assist in predicting risk for a child's repeat UI and family's cumulative UI risk. The model may offer a valuable and novel approach to targeting interventions for families at highest risk.