Validation of a parent survey for reporting child injuries

Longitudinal and Concurrent Effortful Control as Predictors of Risky Bicycling in Adolescence: Moderating Effects of Age and Gender

OBJECTIVE

Collisions between bicycles and motor vehicles are one of the leading risk factors for injury and death in childhood and adolescence. We examined longitudinal and concurrent effortful control (EC) as predictors of risky bicycling behavior in early- to mid-adolescence, with age and gender as moderators. We also examined whether EC was associated with parent-reported real-world bicycling behavior and all lifetime unintentional injuries.

METHODS

Parent-reported EC measures were collected when children (N = 85) were 4 years old and when they were either 10 years (N = 42) or 15 years (N = 43) old. We assessed risky bicycling behavior by asking the adolescents to bicycle across roads with high-density traffic in an immersive virtual environment. Parents also reported on children's real-world bicycling behavior and lifetime unintentional injuries at the time of the bicycling session.

RESULTS

We found that both longitudinal and concurrent EC predicted adolescents' gap choices, though these effects were moderated by age and gender. Lower parent-reported early EC in younger and older girls predicted a greater willingness to take tight gaps (3.5 s). Lower parent-reported concurrent EC in older boys predicted a greater willingness to take gaps of any size. Children lower in early EC started bicycling earlier and were rated as less cautious bicyclists as adolescents. Adolescents lower in concurrent EC were also rated as less cautious bicyclists and had experienced more lifetime unintentional injuries requiring medical attention.

CONCLUSION

Early measures of child temperament may help to identify at-risk populations who may benefit from parent-based interventions.

Sex Differences in the Relation Between Supervision and Injury Risk Across Motor Development Stages: Transitioning From Infancy Into Toddlerhood

Rationale

Addressing a notable gap in research on injuries during infancy, this longitudinal study examined sex differences in the relationship between parents’ typical levels of supervision and infants’ injuries across motor development stages.

Method

Parents were recruited and completed biweekly phone calls about their infant’s motor skills. Once the infant was able to sit up independently, then a home visit was scheduled. Applying a participant-event monitoring method, parents were taught to complete diary forms (injury, supervision), which they started doing once the child could move from their seated location on the floor in some way (e.g., roll, crawl). Recordings continued until a month after the child could walk independently. Data (injury, supervision) were averaged within each motor development stage (low, high), and associations across stages were examined.

Results

Model testing indicated that supervision level moderated the relation between injury rate across motor development stages, but the strength of this association varied by sex of the child. More intense supervision predicted lower injury rates for girls more so than for boys.

Conclusions

Although the emergence of motor milestones has been associated with increased risk of injury during infancy, the current findings indicate that greater supervision can reduce this risk. However, supervision alone is not as effective to moderate injury risk for boys as it is for girls. Thus, for boys, additional strategies (e.g., hazard removal) may also be warranted to maximize reduction in their risk of injury as they acquire increasing motor skills.

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.

Validation of a measure of injury-risk behaviors in the first 2 years of life: Infant/Toddler-Injury Behavior Questionnaire (IT-IBQ)

Unintentional injuries are the leading cause of death for young children and many result from them doing injury-risk behaviors in the home. There are a number of questionnaire measures of injury-risk behaviors for children 2 years and older, but none that apply during infancy. The current study addressed this gap. Parents completed the new Infant/Toddler-Injury Behavior Questionnaire when infants were pre-mobile (sitting independently) and mobile (walking independently), with diary measures of injuries and risk behaviors taken continuously throughout this period. Validated questionnaire measures of chaos and routines in the home were also completed. The IT-IBQ showed positive associations with injuries, risk behaviors, and degree of chaos in the home, and was negatively associated with family routines. The results provide evidence for criterion validity and suggest that the new measure holds promise as one that can aid in identifying infants who are likely to engage in injury-risk behaviors.

Validation of Parent-Reported Injuries to Their Children

OBJECTIVE

Injury is a leading cause of emergency department visits, disability, and death in children. This study examined the sensitivity and specificity of parental report of children's specific injuries.

METHODS

A prospective validation study was conducted in 3 urban pediatric emergency departments from August 2010 to July 2011. Parents of injured children completed a survey at 2-weeks following the emergency department visit, and their responses were compared to injury data that were abstracted from medical records.

RESULTS

Parent surveys were completed for 516 injured children. Sensitivities were ≥0.75 for all fractures and ≥0.88 for extremity and skull fractures. Internal organ injuries were generally less accurately reported by parents than fractures. Specificity estimates all exceeded 0.95.

CONCLUSIONS

This telephone-administered and mailed self-administered survey enabled parents to accurately report specific head and extremity injuries.

PRACTICAL APPLICATIONS

This survey may be a useful tool for pediatric injury surveillance activities.

Extending the value of police crash reports for traffic safety research: collecting supplemental data via surveys of drivers

BACKGROUND

Police crash reports have been used to advance motor vehicle safety research, though their value is limited by their focus on the crash event rather than outcomes of the crash.

OBJECTIVE

To develop and evaluate the effect of enhanced recruitment methods, including a monetary incentive, on response rates of drivers identified on police reports in a national MVC surveillance system.

METHODS

The National Automotive Sampling System-General Estimates System (NASS-GES) was used to identify passenger vehicle crashes between 1 July and 30 October 2012 involving drivers ≥16 years old with at least one child occupant ≤17 years old. We collected data from the driver via self-administered hardcopy or interviewer-administered telephone surveys. Within each survey mode, half the drivers were randomly assigned to receive a small monetary incentive. Response rates were calculated overall, and by mode of survey administration and incentive condition.

RESULTS

495 drivers were eligible, and 127 completed the survey, yielding an overall response rate of 25.7% (95% CI 21.8% to 29.5%). The response rate across the two modes was higher for those who received an incentive than for those who did not (35.6% vs 15.7%, p<0.01). The highest response rate (45.9%) was for drivers allocated to the telephone survey who received an incentive.

CONCLUSIONS

The NASS-GES provides a surveillance system from which cases of interest can be identified and supplemental data collected via surveys of drivers identified on police reports. We adapted procedures commonly used in public health surveillance systems, including monetary incentives and branded recruitment materials, to improve driver response rates.