Conducting a child injury prevention RCT in the wake of COVID-19: lessons learned for virtual human subjects research

Unintentional injury is the leading cause of death among children in the United States, and children living in low-income households are particularly at risk for sustaining unintentional injuries. Close parental supervision has been found to reduce young children's risk for injury; however, few studies have examined interventions to increase parental supervision. This paper discusses COVID-19 related modifications that were made to a federally funded randomized controlled trial to reduce low-income children's risk for unintentional injury. The study's procedures (data collection and intervention delivery) had to be transitioned from in-person to a fully virtual format. Modifications that were made to the study included use of: participant cell phones to conduct data collection and intervention sessions; virtual meeting software to conduct sessions with participants and; an online platform to collect questionnaire data. In addition, many modifications were required to complete the in-home observation virtually. In terms of feasibility, the investigators were able to collect all of the data that was originally proposed; however, recruitment and retention was more challenging than anticipated. Lessons learned during the modification process are included to provide guidance to researchers seeking to conduct virtual human subjects research in the future.

A longitudinal study of boys' and girls' injury-risk behaviors and parent supervision during infancy

In most developed nations worldwide, unintentional injury is the leading cause of death for youth 1 through 18 years. Infants are a particularly vulnerable group because motor development enables increased access to hazards, yet they are poorly equipped to assess danger. The current study compared when infants possessed low versus high motor development skills and examined the frequency and type of injury-risk behaviors and parent supervision patterns, as well as modeling how supervision influences injury-risk behaviors across motor development stages and if it does so differentially for boys and girls. Applying a participant-event monitoring method, parents were trained in completing injury-risk behavior diary forms, which they did once the child could move from their seated location on the floor in some way and continued until a month after the child could walk independently. Results revealed few differences between boys and girls in risk behaviors. The overall rate of risk behaviors was greater at high than low motor development stages and there was stability in the rate of individual infant injury-risk behaviors across motor development stages. The same general types of risk behaviors occurred over motor development stages, though about 88% of risk behaviors per se were novel and unfamiliar to parents. Parents supervised boys and girls similarly. However, model testing indicated that greater supervision increased the rate of risk behaviors longitudinally for boys but not girls. Implications for preventing injuries to boys and girls during infancy are discussed.

A longitudinal study of parents' expectations about infants' emerging behaviors and their safety strategies to moderate injury risk

RATIONALE

Unintentional injuries are the leading cause of preventable deaths for children under 19 years of age. Infancy has been identified as a high-risk stage for injury. Throughout infancy, infants acquire increasing motor competencies but have limited capabilities to appraise danger. This longitudinal multi-method study examined parents' expectations about their infant's emerging behaviors and their in-home safety practices when their infants were at two stages of motor development: pre-mobile (i.e. sitting independently) and mobile (i.e. walking independently).

METHODS

At each motor development stage, parents completed an interview and rating scales to report on their infants' current and anticipated (3 months later) behavioral competencies, as well as their own safety practices and anticipated changes in these.

RESULTS AND IMPLICATIONS

Findings revealed that parents engaged in poorer supervision (reduced proximity, decreased attention) when infants were mobile than pre-mobile, while at the same time doing less to constrain their infants' movements around the room when mobile than pre-mobile. At both stages of motor development, parents reported expecting increased unpredictability in how their infants would behave in the upcoming months, due primarily to motor development (pre-mobile infants) or cognitive curiosity (mobile infants). In response, they planned to change their safety practices by decreasing supervision and increasing teaching about safety, despite the young ages of the children. Implications for injury risk to infants and prevention initiatives focusing on parents are discussed.

The Effects of Gendered Parenting on Child Development Outcomes: A Systematic Review

Gender role development occurs in the earliest months and years of a child's life. Parental attitudes, behaviours and modelling are likely to play a significant role in this process; however, to date no review has been conducted to consolidate knowledge of the effects of differential parenting on child development. This systematic review aimed to investigate the evidence for differential parenting behaviours based on child gender that affect child development, across six areas (vocalisation, socialisation, play, toys, dress and décor). Searches were conducted for English article using four databases: psycINFO, CINAHL, Sociological Abstract, and SCOPUS. The inclusion criteria were biological or adoptive parents, of a typically developing child aged below five, using any parenting behaviour or strategies that differed by child gender. 45 studies were included in this systematic review (14 vocalisation, 21 socialisation, 7 play, 3 toys). A variety of gender-differentiated parenting behaviours and child outcomes were examined. The review found evidence that parents do respond differently to their children. Parents vocalised differently, used different socialising strategies, played differently and provided different toys to their sons and daughters. This differential parenting was associated with some differences in child development across child gender, including differences in child vocalisation, displays of affect, pain responses, compliance, toy play and aggression. However, the overall quality of the evidence, the lack of longitudinal studies and the heterogeneous nature of the outcomes examined suggest the need for a systematic approach to examining the nature and effects of differential parenting on children's development.

Understanding Infants' In-Home Injuries: Context and Correlates

RATIONALE

Infancy is a time of elevated risk of injury. Past research has focused mostly on the type of injuries, leaving many gaps in knowledge about contextual information that could aid in injury prevention planning.

METHODS

In this longitudinal study, a participant-event recording method was used in which mothers tracked their infants' home injuries through three motor development stages (sitting up independently, crawling, and walking). A contextual analysis elucidated where injuries occurred, their type and severity, the infant's and parent's behaviors at the time, if the infant had done the risk behavior before and been injured, the level of supervision, and the nature of any safety precautions parents implemented following these injuries.

RESULTS

Injuries occurred as often in play as in nonplay areas and were due to physically-active nonplay activities more so than play activities; mothers were often doing chores. Bumps and bruises were the most common types of injuries. As infants became more mobile, supervision scores declined and injury severity scores increased. Infants had done the risk behavior leading to injury previously about 60% of the time, with higher scores associated with parents implementing fewer preventive actions in response to injury. When mothers did implement a safety precaution, greater injury severity was associated with more modifications to the environment and increased supervision; teaching about safety was infrequent.

CONCLUSION

Implications of these results for injury prevention messaging are discussed.

Parent-Child Disagreements About Safety During Preadolescence

OBJECTIVES

Much research has examined how parents manage safety issues for young children, however, little is known about how they do so in the preadolescent years when children's demand for autonomy increases. The current study focused on youth in this transition stage (10-13 years) and examined parent-child disagreements about safety, including how parents learn of these, react to these, and resolve these (Aim 1), if the parent-child relationship or sex of the child impacts these processes (Aim 2), and the nature and reasons why children intentionally keep safety-relevant secrets from their parents (Aim 3).

METHODS

A short-term longitudinal design was applied. Parents initially completed questionnaires and, with their child, retrospectively recalled safety disagreements. Over the next month, parents tracked safety disagreements and children tracked secrets they withheld from parents.

RESULTS

The findings revealed significant gender differences: Daughters were more likely than sons to spontaneously disclose safety issues to their parents, and parents were more likely to discuss the issue and provide teaching to daughters than sons. Relationship quality emerged as an important factor, particularly for boys: A positive parent-child relationship predicted increased parental teaching in response to a safety-relevant issue for boys only. Children kept secrets from their parents about safety-relevant information in order to maintain their autonomy and independence.

CONCLUSION

Parent-child disagreements about safety are influenced by the positive nature of the parent-child relationship and differ for sons and daughters.

The Impact of Children's Temperament on How Parents Resolve Safety Disagreements During Preadolescence

OBJECTIVES

Parents play an important role in keeping their children safe. However, this becomes more difficult during preadolescence as children seek greater autonomy away from the direct supervision of adults. The current study focused on preadolescent youth (10-13 years) and examined parent-child disagreements about safety, with a focus on determining if child temperament attributes moderate the relation between how parents learn of these and resolve these disagreements.

METHODS

A short-term longitudinal design was used. Parents and children retrospectively recalled safety disagreements together and then independently completed questionnaires about these. Parents then tracked disagreements over 1 month.

RESULTS

The behavioral attributes of inhibitory control and risk-taking propensity both moderated the relationships between parental source of knowledge of safety disagreements and subsequent methods of resolution.

CONCLUSION

Safety-promotion messaging for parents of preadolescents may need to be tailored based on child attributes to maximize effectiveness.