The Parent Supervision Attributes Profile Questionnaire: a measure of supervision relevant to children's risk of unintentional injury

Can children measure their own vision? A comparison of three new contrast sensitivity tests

PURPOSE

To investigate the feasibility of children measuring their own contrast sensitivity using a range of tablet- and paper-based tests.

METHODS

Forty children aged 5-15 years with amblyopia (N = 10), bilateral vision impairment (N = 10) or good vision (N = 20) measured their own vision on a screen-based optotype test (Manifold), a gamified vision test (PopCSF) and a paper-based test (Spotchecks) in a laboratory with minimal supervision. Completion rate, test-retest repeatability, test duration and participants' preferences were recorded for each test.

RESULTS

Most participants (36/40) were able to perform all three tests. All tests were correlated with clinically measured visual acuity and contrast sensitivity (p < 0.001). The 95% coefficient of repeatability was 0.30 dB for Manifold, 0.29 dB for PopCSF and 0.13 dB for Spotchecks. All tests differentiated between children with reduced contrast sensitivity and control participants. PopCSF and Spotchecks were also able to differentiate between children with amblyopia and those with good vision. Median test time was 152, 130 and 202 s for Manifold, PopCSF and Spotchecks, respectively. Twenty-two participants preferred the PopCSF test, 10 preferred Spotchecks and 6 preferred Manifold. Thirty-nine out of the 40 children (98%) said they would measure their own vision at home using at least one of these tests every month.

CONCLUSIONS

Children and young people can test their own contrast sensitivity with repeatable results. Of these three tests, the most repeatable was Spotchecks, the quickest was PopCSF and participants' favourite was PopCSF. Nearly all of the participants said they would be willing to use at least one of the three tests at home.

Child injuries in Lebanon: assessing mothers' injury prevention knowledge attitude and practices

BACKGROUND

Childhood injury is a neglected public health problem with a sizeable burden on children's well-being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothers' Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothers' supervision.

METHODS

This cross-sectional study recruited mothers of children aged up to 10 years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothers' KAP toward childhood injuries using self-administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes.

RESULTS

A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12 months, mostly sustained by males (53.8%) and children aged 5-10 years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospitalized children were more likely to be males and older than 5 years (p < 0.001). More than one-third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non-working mothers, accounting for possible confounders (p = 0.001).

CONCLUSION

Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers' KAP toward child injury prevention. Further studies are recommended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries.

The Families First Program to Prevent Child Abuse: Results of a Cluster Randomized Controlled Trial in West Java, Indonesia

The Families First parenting program is a 10-week paraprofessional-administered adaptation of the Positive Discipline in Everyday Parenting program for West Java, Indonesia. It has not been tested in a randomized controlled trial. The objective was to evaluate the effects of Families First on physical and emotional punishment. We conducted a cluster randomized controlled trial and randomly assigned 20 rural and urban villages in West Java, Indonesia, to intervention or waitlist. Caregivers of children aged 0-7 years in intervention villages received Families First. Between 2017 and 2018, measurements were taken before randomization, immediately post-intervention, and 6 months post-intervention. Primary outcome was presence versus absence of caregiver-reported physical or emotional punishment immediately post-intervention. Intention-to-treat regression models accounted for clustering within villages and were run to compare between groups. Participants and study personnel could not be blinded. There were 374 caregivers in the 10 intervention villages and 362 in the 10 waitlist villages included in the trial and in outcome analyses. The intervention did not result in a lower proportion of intervention families using punishment immediately post-intervention (odds ratio [OR] for physical or emotional punishment immediately post intervention = 1.20 (95% CI 0.79-1.82). There were no significant differences for positive and involved parenting, setting limits, and opinion on discipline, but caregivers in the intervention group had significantly lower odds of using positive discipline (OR = 0.65 (95% CI 0.53-0.80). Families First did not prevent punishment in a setting with low levels of reported punishment but should be tested in a setting with higher levels or among people selected for risk or presence.

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.

Paving the Way for Outdoor Play: Examining Socio-Environmental Barriers to Community-Based Outdoor Play

Outdoor play and independent, neighborhood activity, both linked with healthy childhood development, have declined dramatically among Western children in recent decades. This study examines how social, cultural and environmental factors may be hindering children’s outdoor and community-based play. A comprehensive survey was completed by 826 children (aged 10–13 years) and their parents from 12 schools (four each urban, suburban and rural) from a large county in Ontario, Canada. Five multilevel regression models, controlling for any school clustering effect, examined associations between outdoor play time per week and variable sets representing five prevalent factors cited in the literature as influencing children’s outdoor play (OP). Models predicted that younger children and boys were more likely to spend time playing outdoors; involvement in organized physical activities, other children nearby to play with, higher perception of benefits of outdoor play, and higher parental perceptions of neighborhood social cohesion also predicted more time in outdoor play. Time outdoors was less likely among children not allowed to play beyond home without supervision, felt they were ‘too busy’ with screen-based activities, and who reported higher fears related to playing outdoors. Study findings have important implications for targeting environmental, cultural and policy changes to foster child-friendly communities which effectively support healthy outdoor play.

Evaluating disparities in child occupant protection using a proportion-eliminated approach to mediation

OBJECTIVE

While there are clear racial/ethnic disparities in child restraint system (CRS) use, to date no studies have identified mediators that quantitatively explain the relationship between race and CRS use. Therefore, the objective of this study was to provide an example of how a proportion-eliminated approach to mediation may be particularly useful in understanding the complex relationship between race and CRS use.

METHODS

Sixty-two mothers with a child between 4-8 years old completed a survey and had their CRS use assessed by a Child Passenger Safety Technician using a structured assessment based on the 2018 American Academy of Pediatrics' Best Practice guidelines. Recruitment and data collection occurred in Birmingham, Alabama between June 2018 and January 2019. We used chi-squared tests, logistic regressions, and a proportion-eliminated approach to mediation to compare our variables of interest and to estimate the amount of the association between racial group membership and errors in restraint use that may be explained by sociodemographic, psychosocial, and parenting variables.

RESULTS

Before mediation, Nonwhite mothers in this sample had a 7.38 greater odds of having an error in CRS use than White mothers. Mediation analyses indicated that being married and self-reported seatbelt use explained 47% and 35% of the effect of race on CRS use errors, respectively.

CONCLUSION

A proportion-eliminated approach to mediation may be particularly useful in child passenger safety research aiming to inform the development of interventions tailored for racial minority populations.

Validation of the Turkish Parent Supervision Attributes Profile Questionnaire

Aim:

The most common cause of death in childhood is unintentional injury. Most childhood injuries occur when children are under the supervision of caregivers. There is no valid and reliable instrument for measuring the parents’ supervision attributes in Turkey. The aim of this study was to adapt the Parent Supervision Attributes Profile Questionnaire to Turkish.

Material and Methods:

This research was methodological. The data were collected through a questionnaire that consisted of 11 questions about the demographic and socioeconomic characteristics of the family and the Turkish Parent Supervision Attributes Profile Questionnaire. The Questionnaire, developed by Morrongiello and House, is a 5-point Likert-type scale and consists of 29 items. High scores obtained from the scale, which has no cut-off, indicate a high supervisory behavior. The language adaptation and content validity of the scale were completed by experts. Confirmatory factor analysis was used for construct validity. Reliability was tested by internal consistency coefficients.

Results:

Five hundred sixty people participated in the study, 81.9% of whom were mothers. The mean age of the mothers was 33.8±4.6 years and the mean age of the fathers was 37.2±5.1 years. The percentage of university graduates was 56.8% among mothers and 53.9% among fathers. According to the confirmatory factor analysis, the fit index values were as follows: Standardized Root Mean Square Residual =0.097, Goodness of Fit Index =0.80, Root Mean Square Error of Approximation =0.089, Comparative Fit Index =0.88, Non-Normed Fit Index =0.87. The fit index values were moderate and confirmed 4-factor structure. It was found that the internal consistency coefficient calculated for reliability was 0.75 for the whole scale and ranged between 0.57 and 0.79 for the subscales.

Conclusion:

The Turkish Parent Supervision Attributes Profile Questionnaire is a valid and reliable measurement tool. Further research is needed to determine the current situation regarding supervisory behaviors.

S.A.F.E.R. Near Water: An Intervention Targeting Parent Beliefs About Children's Water Safety

OBJECTIVE

The current study aimed to develop, implement, and evaluate the S.A.F.E.R. Near Water program, an evidence-based and theory-driven intervention targeting parent beliefs relevant to keeping children safe around water.

METHODS

A nonrandomized trial was conducted. Parents with children aged two through five years who were enrolled in lessons either at a public or private swim organization in Ontario, Canada were recruited and nonrandomly assigned to either an Intervention (N = 92) or Control (N = 150) condition. All parents completed the same questionnaire measures two times over the course of their child's swim lesson session period, once at the beginning (preintervention) and again at the end (postintervention; approximately 9-15 weeks later). Questionnaires assessed parents' perceptions related to supervision, child drowning risk, water safety, and optimism bias. Parents in the Intervention condition participated in S.A.F.E.R. Near Water, an educational water safety program comprising in-person seminars, informational handouts, and posters.

RESULTS

The S.A.F.E.R. Near Water program was associated with increased knowledge in targeted areas and effectively communicated most of the intended messages. A series of primary regression analyses revealed that parents receiving S.A.F.E.R. Near Water demonstrated improvements in: beliefs about the value of supervision; judgments about children's swim skills and drowning risk; and perceptions related to swim lessons and children's supervision needs (sr2 range: 0.22-0.38).

CONCLUSION

These findings provide support for the feasibility and usefulness of a multifaceted, parent-focused, educational program delivered alongside children's swim programming to promote closer adult supervision of children around water.

Parent supervision attributes profile questionnaire (PSAPQ) for young children: psychometric properties of the Chinese version

Background

In China, thousands of children die from unintentional injury each year: the incidence rate of injury is from 19.4 to 64.3% which is the leading cause of mortality for children. An important factor to injury may be inadequate supervision. Thus, a linguistic and culturally appropriated, validated instrument to measure the supervision of children in Chinese primary caregiver is important and necessary. The purpose of this study was to translate and test the psychometric properties of the Chinese version of the Parent Supervision Attributes Profile Questionnaire (C-PSAPQ).

Methods

This is a two-phase study. In phase I, the C-PSAPQ was produced by for- and back-ward translation. A total of 296 primary caregivers of 3–6 years old children were invited to participate in the second phase of the psychometric study. In order to assess the reliability of the C-PSAPQ, internal consistency and test-retest methods were performed. Additionally, construct validity was examined by using confirmatory factor analysis (CFA). The averaged variance extracted (AVE) and Bootstrap were used to test the convergent and to discriminate validity. The concurrent validity was assessed by evaluating the association between the self-reported C-PSAPQ and naturalistic observations.

Results

The Cronbach’s α and intraclass correlation coefficients were acceptable for the C-PSAPQ and four subscales. The CFA supported a 4-factor loading model; however, the convergent validity was not acceptable (AVE < .5 for two subscales). The concurrent validity was supported.

Conclusions

Due to the unacceptable convergent validity of the C-PSAPQ, an exploratory factor analysis is needed to ensure that the same trait is measured by its indicators in different cultures.

Comparison of risk engagement and protection survey (REPS) among mothers and fathers of children aged 6-12 years

BACKGROUND

Parental attitudes regarding child safety and risk engagement play important roles in child injury prevention and health promotion efforts. Few studies have compared mothers' and fathers' attitudes on these topics. This study used the risk engagement and protection survey (REPS) previously validated with fathers to compare with data collected from mothers.

METHODS

Multi-group confirmatory factor analysis was used with a sample of 234 mothers and 282 fathers. Eligible parents had a child 6-12 years attending a paediatric hospital for an injury-related or other reason. We tested the factor structure of the survey by examining configural, metric and scalar invariance. Following this, mothers' and fathers' mean scores on the two identified factors of child injury protection and risk engagement were compared.

RESULTS

Comparing mothers' and fathers' data showed the two-factor structure of the REPS held for the mothers' data. Comparing mean scores for the two factors suggested that fathers and mothers held equivalent attitudes. For the combined sample, parent injury protection attitude scores were significantly higher for daughters versus sons. In addition, attitude scores were significantly lower for injury protection and higher for risk engagement among parents born in Canada compared with those who were not.

CONCLUSIONS

The REPS allows for valid assessment of injury protection and risk engagement factors for fathers and mothers. Mothers conceptualised the two factors as distinct concepts, similar to fathers. The REPS can be used to inform parenting programme development, implementation and evaluation.

Modification to a systematically braided parent-support curriculum: Results from a feasibility pilot

OBJECTIVES

There are a variety of parent-support programs designed to improve parenting and, thereby,the safety and well-being of children. Providers trained in multiple programs are likely to select components of interventions they feel will meet the needs of the families they serve leaving out aspects they deem unnecessary orredundant. In so doing, the fidelity of the evidence-based program is at risk. A potential solution is systematic braiding in which evidence-based programs are combined such that the fidelity to each original model and its implementation are maintained.

METHODS

Drawing on qualitative feedback from a prior iteration, this paper discusses results of a feasibility and acceptability pilot of a modified version of the systematically braided Parents as Teachers and SafeCare at Home (PATSCH) curriculum This modification removed a provider-perceived "redundant" portion from the original PATSCH curriculum. A pre-post design (N=18) was used to evaluate the efficacy of the modified curriculum.

RESULTS

Significant improvements were seen in trained parent behaviors surrounding home safety and child health. There was also improvement in self-reported parenting behaviors, the portion of the braided curriculum removed, suggesting that the PAT curriculum adequately teaches these skills. Providers and parents were highly satisfied with themodified curriculum.

CONCLUSIONS

If a curriculum is modified to reflect provider and parent preferences, then the potential for delivery without fidelity is minimized.

Understanding pathways to social inequalities in childhood unintentional injuries: findings from the UK millennium cohort study

BACKGROUND

Childhood unintentional injuries (UI) are common but continue to happen more often to children living in less advantaged socioeconomic circumstances (SEC). Our aim was to explore how early life factors mediate the association between SEC and UIs, using the UK Millennium Cohort Study.

METHODS

We calculated risk ratios (RR) and 95% confidence intervals (95%CI) for parental report of UI occurring between age 3 and 5 years, using Poisson regression according to family income as a measure of SEC. We explored potentially mediating pathways by controlling associations between SEC and UI for groups of early life risks in three domains: factors that may influence environmental safety, supervision and the MCS child's abilities and behaviours.

RESULTS

Twenty eight percent of children had a UI from 3 to 5 years old. Children from the lowest income quintile were more likely to be injured compared to those from the highest (RR 1.20 95%CI 1.05, 1.37). Sequentially controlling for early life factors that may influence environmental safety (RR 1.19 95%CI 1.02, 1.38), then supervision (RR 1.18, 95%CI 1.02, 1.36), and finally adding child's behaviour and abilities (RR 1.15, 95%CI 1.00, 1.34) into the model reduced the RR by 5, 10 and 25% respectively.

CONCLUSIONS

Addressing factors that may influence environmental safety and supervision, and the child's abilities and behaviours only partly explains the increased UI risk between the highest and lowest income quintiles. Further research is required to explore factors mediating associations between SEC and specific mechanisms and types of injuries.

Protocol for a cluster randomised controlled trial evaluating a parenting with home visitation programme to prevent physical and emotional abuse of children in Indonesia: the Families First Programme

INTRODUCTION

Every year, up to 1 billion children are victims of violence worldwide. Most child abuse takes place in the context of punishment. The Families First Programme, an adaptation of the Positive Discipline in Everyday Parenting Programme to the West Java context, is a parenting support programme anchored on children's rights that gives parents guidance on child development, parenting and positive discipline practices. This trial will evaluate the effectiveness of the Families First Programme compared with a waitlist control group.

METHODS AND ANALYSIS

This is a pragmatic, parallel-group, stratified, cluster-randomised controlled trial. Twenty rural and urban villages in the Cianjur District, Indonesia, involving 720 caregivers of children up to 7 years of age, will be randomised. Villages will receive either a parenting programme consisting of 10 group sessions and four home visits over 3 months and standard community health and social services or just the latter. After completion of the trial period, the programme will be offered to those in the delayed group. Outcome data will be collected before randomisation (baseline), immediately postintervention (3 months postrandomisation) and 6 months later (9 months postrandomisation). The primary outcome will be frequency of physical and emotional punishment as measured by a weighted sum from three self-report items. Primary outcome analysis will use Poisson regression with generalised estimating equations and assess the interaction between intervention and time over baseline and 3 and 9 months postrandomisation assessments. Concurrent process evaluation will be conducted to assess programme satisfaction and facilitators and barriers to the implementation of the programme generalisable to other settings.

ETHICS AND DISSEMINATION

Ethics approval was obtained from McGill University and Universitas Katolik Indonesia Atma Jaya. Results will be published in peer-reviewed journals and presented at scientific conferences and events for decision-makers, including in the participating communities.

TRIAL REGISTRATION NUMBER

NCT03374761.

Parental supervision and discomfort with children walking to school in low-income communities in Cape Town, South Africa

OBJECTIVE

The risk of pedestrian injury is compounded for children living in low-income communities due to factors such as poor road and pedestrian infrastructure, reliance on walking as a means of transport, and compromised supervision. Parents play an important role in child pedestrian safety. The primary objective of this study was to examine the effects of child pedestrian variables on parental discomfort with regard to letting their child walk to and from school and on the frequency of adult supervision.

METHODS

A cross-sectional study was conducted using a convenience sample from 3 schools participating in a pedestrian safety school initiative. The schools are situated in low-income, high-risk communities in the City of Cape Town. A parent survey form was translated into isiXhosa and sent home with learners to those parents who had consented to participate. The response rate was 70.4%, and only parents of children who walk to and from school were included in the final sample (n = 359). Child pedestrian variables include the time taken to walk to school, parental rating of the child's ability to safely cross the road, and the frequency of adult supervision.

RESULTS

More than half of parents reported that their child walked to and from school without adult supervision. About 56% of children took less than 20 min to walk to school. Most parents (61%) were uncomfortable with their child walking to school, although the majority of parents (55.7%) rated their child's ability to cross the road safely as better or significantly better than average (compared to peers). The parents did not perceive any differences in pedestrian risk factors between boys and girls or between younger (6-9 years) and older (10-15 years) children. The time spent by a child walking to school and parents' perceptions of their child's road-crossing ability were found to be significant predictors of parental discomfort (in letting their child walk). Younger children and children who spent less time walking were more likely to be supervised by an adult.

CONCLUSIONS

Many South African schoolchildren have to navigate the roads without adult supervision from a young age. Caregivers, especially in low-income settings, often have limited options with regard to getting their child to school safely. Regardless of the child's age and gender, the time that they spend on the roads is an important factor for parents in terms of pedestrian safety.

Social Cognition, Child Neglect, and Child Injury Risk: The Contribution of Maternal Social Information Processing to Maladaptive Injury Prevention Beliefs Within a High-Risk Sample

Objective

Inadequate supervision has been linked to children's injuries. Parental injury prevention beliefs may play a role in supervision, yet little theory has examined the origins of such beliefs. This study examined whether mothers who perpetrated child neglect, who as a group provide inadequate supervision, have more maladaptive beliefs. Then, it tested a social information processing (SIP) model for explaining these beliefs.

Methods

SIP and injury prevention beliefs were assessed in disadvantaged mothers of preschoolers (N  =  145), half with child neglect histories.

Results

The neglect group exhibited significantly more maladaptive injury prevention beliefs than comparisons. As predicted, SIP was linked to beliefs that may increase injury risk, even after accounting for relevant sociodemographic variables.

Conclusions

Findings support the link of beliefs to injury risk and suggest that specific cognitive problems may underlie these beliefs. Future work should further validate this model, which may inform enhancements to prevention efforts.

Risk Engagement and Protection Survey (REPS): developing and validating a survey tool on fathers' attitudes towards child injury protection and risk engagement

INTRODUCTION

Fathers play a unique role in keeping children safe from injury yet understanding of their views and attitudes towards protecting children from injury and allowing them to engage in risks is limited. The purpose of this study was to develop and validate an instrument to measure fathers' attitudes towards these two constructs.

METHODS AND FINDINGS

An instrument was developed that used prior qualitative research to inform item generation. The questions were assessed for content validity with experts, then pilot-tested with fathers. The survey was completed by 302 fathers attending hospital with their child for an injury or non-injury reason. Results of confirmatory factor analysis identified eight items relating to the protection from injury factor and six items relating to the risk engagement factor. Correlation between the two factors was low, suggesting these are two independent constructs.

CONCLUSIONS

The Risk Engagement and Protection Survey offers a tool for measuring attitudes and assisting with intervention strategy development in ways that reflect fathers' views and promotes a balanced view of children's needs for safety with their needs for engaging in active, healthy risk-taking.

Supervising for Home Safety Program: A Randomized Controlled Trial (RCT) Testing Community-Based Group Delivery

Objective

The individually delivered Supervising for Home Safety (SHS) program improves caregivers' injury-related beliefs and supervision practices. The current randomized controlled trial used a group delivery in a community setting and assessed program impact, feasibility, and acceptance.

Methods

Caregivers of 2-5-year-olds were randomized to receive either the SHS or an attention-matched control program.

Results

In the SHS group only, there were increases from baseline to postintervention in the following: beliefs about children's vulnerability to injury, caregiver preventability of injuries, and self-efficacy to do so; readiness for change in supervision; and watchful supervision. Face-to-face recruitment by staff at community organizations proved most successful. Caregivers' satisfaction ratings were high, as was caregiver engagement (95% completed at least seven of the nine sessions).

Conclusion

The SHS program can be delivered to groups of caregivers in community settings, is positively received by caregivers, and produces desirable changes that can be expected to improve caregivers' home safety practices.

The Safety Assessment Measure for persons with traumatic brain injury: Item pool development and content validity

BACKGROUND

Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future.

OBJECTIVE

To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries.

METHOD

Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity.

RESULTS

The Safety Assessment Measure is comprised of 6 primary scales - Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations - in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who have sustained moderate or severe TBI. The scale item pools encompass a broad spectrum of everyday activities that pose risk in the home and community and were rated as having excellent levels of content validity.

CONCLUSIONS

The Safety Assessment Measure scales and items cover a broad range of instrumental activities of daily living that can increase the risk of unintentional injuries or harm. Empirical evidence suggests that the Safety Assessment Measure items have excellent content validity. Future research should use modern psychometric methods to examine each scale unidimensionality, model fit, and precision.

The association of the rapid assessment of supervision scale score and unintentional childhood injury

Supervisory neglect is often considered in medical settings when a child presents with an unintentional injury. The Rapid Assessment of Supervision Scale (RASS) is a clinical decision-making tool for the assessment of supervision of young children. As the next step in the development of the RASS, we assessed the association of RASS scores with unintentional injury. This study was a secondary analysis of data from a case-crossover study, which examined the association of parental supervision and unintentional injury in children. Data on supervision characteristics for 3 time periods for each child were available, that is, one injury scenario and two "control" time periods when no injury occurred. Blinded to injury status, four raters independently evaluated adequacy of supervision in 132 supervision scenarios using the RASS. The individual RASS scores of the four raters and the group (mean) RASS score of the four raters were evaluated for associations with injury status. Individual scores from three of the four raters demonstrated significant associations of increasing RASS scores with injury. Increasing group RASS scores (odds ratio = 2.8; 95% confidence interval [1.5, 5.1]) were associated with greater likelihood of injury. Further testing may result in a tool that aids medical personnel in the evaluation of adequacy of supervision.

Supervision and risk of unintentional injury in young children

OBJECTIVE

Assess the association between caregiver supervision and acute unintentional injury in young children; evaluate whether lower levels of supervision result in more severe injury.

METHODS

A case cross-over study was conducted. Parents of children aged ≤4 years whose injuries required emergency department (ED sample) treatment or admission to the hospital (inpatient sample) were interviewed. Information on supervision (3 dimensions: proximity, attention, continuity) at the time of injury and 1 h before the injury (control time) was collected. An overall supervision score was created; a higher score indicates closer supervision. Hospital admission served as a proxy for injury severity. ORs and 95% CIs were calculated.

RESULTS

Interviews were completed by 222 participants; 50 (23%) were in the inpatient sample. For each supervision dimension the inpatient sample had higher odds of injury, indicating effect modification requiring separate analyses for inpatient and ED samples. For both samples, proximity 'beyond reach' was associated with the highest odds of injury; compared with 1 h before injury, children were more likely to be beyond reach of their caregiver at the time of injury (inpatient sample: OR 11.5, 95% CI 2.7 to 48.8; ED sample: OR 2.9, 95% CI 1.8 to 4.9). Children with lower supervision scores had the greatest odds of injury (inpatient sample: OR 8.0, 95% CI 2.4 to 26.6; ED sample: OR 3.3, 95% CI 1.9 to 5.6).

CONCLUSIONS

Lower levels of adult supervision are associated with higher odds of more severe injury in young children. Proximity is the most important supervision dimension for reducing injury risk.

Reliability and validity of a new instrument to measure tolerance of everyday risk for children

BACKGROUND

A modicum of everyday risk provides opportunities for children to extend the limits of their competence. However, increasingly negative perceptions of risk have led to risk-averse behaviours in adults, including severely restricting children's play. The degree to which risk in play is tolerated by adults impacts on the lives and experiences of children. However, no measure of adult tolerance to everyday risk exists. The purpose of this study was to develop a valid and reliable instrument examining adults' tolerances of risk during children's play.

METHODS

A 31-item survey of risk tolerance was developed based on a Norwegian model of risky play; 100 parents and teachers of children aged 3 to 13 years completed the instrument. Data were subjected to Rasch analysis. Psychometric properties of the data were examined.

RESULTS

Iterative analyses produced an instrument with goodness of fit statistics in the acceptable range, a logical item hierarchy, person separation index >2 and reliability index of 0.87. There was a strong positive relationship between participants' self-perceived risk tolerance and scores on the instrument, and between the age of the child and scores on the instrument.

CONCLUSIONS

The Tolerance of Risk in Play Scale (TRiPS) yields valid and reliable data for measuring the success of interventions to change adults' everyday risk beliefs, and for exploring the impact of adults' risk tolerance on children's play and development.

Child injury control: trends, themes, and controversies

Injury is a major cause of morbidity and mortality among US children, and an important driver of health status globally. Despite its enormous burden, injury is preventable. Over the last 10 years, significant progress has been made in the reduction of unintentional injury among US children. However, aggregate trends mask important disparities by age group, region, and injury mechanism. Basic and translation research is needed to develop and test prevention strategies to address these new or recalcitrant problems. Motor vehicle occupant injury has fallen to historic lows, but challenges remain in protecting novice drivers and managing the distraction of new technologies. Injury to pedestrians has also declined, but likely as a result of decreased exposure as fewer children walk. This calls for a broader public health perspective to promote activity while enhancing safety. Deaths due to drowning are common and illustrate the difficulty in measuring and promoting appropriate supervision. Environmental modification and use of protective products may be a more appropriate response. Concussion in sport is another challenging issue: public health laws promote identification and appropriate management of concussed athletes, but less progress has been made on primary prevention of these injuries. Unintentional poisoning is on the rise, attributable to misuse of, and overdose with, prescription opioids. Injury deaths to infants are also increasing. This trend is driven in part by better death investigation that classifies more sleep-related deaths as suffocation events. Finally, we examine a sample of cross-cutting themes and controversies in injury control that might be amenable to empiric evaluation.

Cross-cultural adaptation and validation of the Portuguese version of the Parental Supervision Attributes Profile Questionnaire

OBJECTIVES

To cross-culturally adapt and validate the Portuguese version of the Parental Supervision Attributes Profile Questionnaire (PSAPQ). The PSAPQ is a measure of parental supervision, which has not been translated and adapted into any language other than English.

METHODS

The Portuguese version was the result of forward/backward translations, consensus panels and pretesting. Reliability and internal consistency were assessed using Cronbach's α, intraclass correlation coefficient (ICC) and confirmatory factor analysis (CFA) in adults with different educational levels.

RESULTS

Cronbach's α (α=0.70-0.79) and ICC (>0.75) were acceptable in three of four factors. The results of CFA (χ(2)/df=2.243; CFI=0.951; GFI=0.96; RMSEA=0.056; P(RMSEA ≤ 0.05)=0.222) suggest a good adjustment between the factors.

CONCLUSIONS

The Portuguese version of PSAPQ showed acceptable psychometric properties. This study evidenced some vulnerabilities of the fate subscale, emphasising the need for further investigation of the effects of the educational level of the parents.

A wicked problem: early childhood safety in the dynamic, interactive environment of home

Young children being injured at home is a perennial problem. When parents of young children and family workers discussed what influenced parents' perceptions and responses to child injury risk at home, both "upstream" and "downstream" causal factors were identified. Among the former, complex and interactive facets of society and contemporary living emerged as potentially critical features. The "wicked problems" model arose from the need to find resolutions for complex problems in multidimensional environments and it proved a useful analogy for child injury. Designing dynamic strategies to provide resolutions to childhood injury, may address our over-dependence on 'tame solutions' that only deal with physical cause-and-effect relationships and which cannot address the complex interactive contexts in which young children are often injured.

The perils of overprotective parenting: fathers' perspectives explored

BACKGROUND

The dominant discourse of popular media appears to paint a disparaging picture of parents deemed overly concerned about their children's safety. Child injury prevention interventions frequently focus on influencing parenting behaviours. Fathers are increasingly involved in childcare, highlighting the need to understand their perspectives on overprotective parenting as it relates to considerations of injury prevention while actively engaged with their children.

METHODS

Qualitative interviews were carried out with 32 fathers of children aged 2-7 years in a Canadian urban setting. Interview questions investigated fathers' injury prevention attitudes and practices, and their beliefs regarding overprotection. Data analysis was guided by grounded theory methods.

RESULTS

Fathers noted the subjective nature of overprotection, citing family, social and situational factors that shaped their views. Fathers viewed overprotective parents as experiencing excessive fears that were manifested in lack of willingness to risk physical or psychological injury. They described overprotective parenting as including over-involvement in and excessive restriction of children's activities; and expressed concerns that the results of these behaviours would be children lacking self-confidence and crucial life skills.

CONCLUSION

Fathers viewed as problematic overprotective parenting behaviours that limit access to opportunities for physical risk taking in an attempt to prevent mostly minor injuries. The injury prevention field may benefit from considering fathers' perspectives when designing programmes to minimize the likelihood that safety initiatives may be perceived as promoting overprotection of children. Framing safety messages in ways that align with fathers' views could involve promoting appropriate protection and encouraging an active lifestyle.

The First-aid Advice and Safety Training (FAST) parents programme for the prevention of unintentional injuries in preschool children: a protocol

BACKGROUND

Unintentional injury is the leading cause of preventable death in children in the UK, and 0-4-year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent-child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children.

METHODS

A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme.

DISCUSSION

This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is non-stigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention.

Men on Fathering in the Context of Children’s Unintentional Injury Prevention

Injuries are a leading cause of death for children, and parental safety behaviors are fundamental to child injury prevention. Fathers’ perspectives are largely absent. Our novel research connects masculinities, fathering, and childhood injury. Sixteen fathers of children aged 2 to 7 years in two Canadian urban settings participated in photo-elicitation interviews detailing activities they enjoyed with their children and concerns regarding child safety. Participants described how elements of risk, protection, and emotional connection influenced their approach to fathering as it related to injury prevention. Most men considered engaging children in risk as key to facilitating development and described strategies for protecting their children while engaging in risk. Many men identified how the presence of an emotional connection to their children allowed them to gauge optimal levels of risk and protection. There exists a tremendous opportunity to work with fathers to assist in their efforts to keep their children safe.

Supervision to prevent childhood unintentional injury: developmental knowledge and self-efficacy count

Caregiver developmental knowledge was tested as a moderator of the association between caregiver-perceived self-efficacy and perceived supervision to prevent childhood unintentional injury. Caregivers (N = 123; 95 mothers and 28 fathers) of children (M = 3.5 ± 1.2 years, 49.6% female, 80.8% Caucasian) were recruited from pediatric primary care offices and local message boards. All caregivers completed self-report questionnaires on perceived self-efficacy, developmental knowledge, and perceived supervision to prevent injury. Separate hierarchical linear regression models were conducted to test moderation for mothers and fathers. The interaction effect of perceived self-efficacy and developmental knowledge significantly predicted maternal-perceived supervision, R (2) change = .06, F(1, 86) = 6.76, p < .01. No significant findings were detected for fathers. Models of studying injury prevention that consider complex cognitive-behavioral interactions and their potential modifiable role in the development of injury-prevention practices may elucidate upon the attitude-practice gap currently identified in the literature.

Development of the BACKIE questionnaire: a measure of children's behaviors, attitudes, cognitions, knowledge, and injury experiences

OBJECTIVE

The objective of this study was to develop a standardized questionnaire (BACKIE) that would assess the Behaviors (B), Attitudes (A), Cognitions (C), Knowledge (K), and Injury Experiences (IE) that elementary-school children possess pertaining to seven types of injuries, including: falls; motor vehicle collisions; burns; drowning; choking/suffocation; poisoning; and bicycle/pedestrian injuries.

METHODS

Over 500 children in grades two through seven completed the questionnaire, with a sub-sample repeating it two months later to assess test-retest reliability of the measure.

RESULTS

Psychometric assessment of the instrument revealed acceptable internal and test-retest reliabilities and results of a Confirmatory Factor Analysis provided support for the hypothesized factor structure.

CONCLUSION

Having a psychometrically sound measure that allows one to assess attitudes, cognitions, and knowledge is an essential first step to exploring the relative influence of these factors on children's risk and safety practices.

Child Injury: The Role of Supervision in Prevention

As the leading cause of death and major contributor to hospitalization for children, unintentional injury is a significant health problem in the United States. How supervision influences children’s risk of injury has been of interest for some time, and much progress has been made recently to address definitional and measurement issues pertaining to supervision. Increasing evidence supports the notion of a general relationship between increased supervision and decreased injury risk, but also reveals that child behavioral attributes and environmental characteristics can interact with level of supervision to affect injury risk, making it challenging to develop guidelines regarding what constitutes “adequate” supervision. Further research is needed to explore if and how children’s risk of injury varies with different supervisors (eg, mothers vs fathers vs older siblings) and how these relations change as a function of children’s developmental level. Recent research has identified messaging approaches that are effective to invoke a commitment to more closely supervising young children at home. Examining how these messages affect actual supervisory practices is an essential next step in this research and can support the development of evidence-based programs to improve supervision and reduce children’s risk of injuries.

Injuries in preschool classrooms

Purpose

The primary purpose of this paper is to examine the kinds of injuries that preschool teachers working in Indiana, USA, believed to be the most common in their preschool (3‐6 year olds) classrooms, the causes of such injuries, and the most important precautions they take to prevent them. Also examined are the measures the teachers take when an injury occurs.

Design/methodology/approach

A total of 155 preschool teachers take part in the research by completing a questionnaire. The data are analyzed using basic descriptive statistics.

Findings

On the question of what constituted the most important classroom injury prevention measure, 26 percent of the respondents report “close supervision of children”, 24 percent select “ensuring classroom safety”, 23 percent pick “cautioning children”, 17 percent choose “setting and enforcing rules” in the classroom, 7 percent select “modeling for social behavior” and 3 percent “safe gross motor activities”. With respect to action taken when an injured occurs, 36.1 percent of the respondents report “first aid”, 15.5 percent “comforting children”, 11.6 percent “referring children to school nurse” and “writing injury report”, 10.3 percent “cautioning against running and pushing”, 8.4 percent “explaining injury to children” (8.4 percent) and 6.5 percent “checking the nature of injury”.

Originality/value

This study sheds light on injury causation in preschool classrooms as well as management of such injuries. Results from this data can be used in helping to improve preschool teachers' knowledge of injury in general and of classroom injury in particular.

Parent/Caregiver supervision and child injury: a systematic review of critical dimensions for understanding this relationship

This study reviewed the relationship between recognized dimensions of supervision and children's injuries based on Saluja et al's (Injury Control and Safety Promotion. 2004;11:17-22) hierarchal model of supervision strategies. A systematic review of peer-review studies was done with the earliest records available to 2007. There were 112 potentially relevant articles identified; 31 studies met all inclusion criteria. Reported studies were categorized according to the dimensions of supervision they addressed. Studies were not evenly distributed across the dimensions. There was evidence from the study that directly linking dimensions of supervision to child injury risk and outcomes is scarce. Future studies should consider attention, proximity, and continuity of supervision to provide a holistic understanding of the relationship between supervision and injury.

Brief report: Young children's risk of unintentional injury: a comparison of mothers' and fathers' supervision beliefs and reported practices

OBJECTIVE

There is increasing interest in understanding how parent supervision influences young children's risk of injury, but nearly all of this research has been conducted with mothers. The present study compared first-time mothers' and fathers' supervisory beliefs and reported practices, and related these scores to parental reports of their child's history of injuries.

METHODS

Mothers and fathers of children 2-5 years each independently completed a telephone interview and previously validated questionnaires about their supervisory beliefs and practices and their child's history of injuries.

RESULTS

Mothers and fathers provided similar reports of their child's injuries (minor, medically attended) and scored similarly on various supervision indices. Despite these similarities, the way mothers' and fathers' supervision indices related to children's injury history scores differed. Children's frequency of minor and medically attended injuries was predicted from maternal supervisory scores but not from paternal scores.

CONCLUSIONS

Maternal supervision has more impact on children's risk of injury than paternal supervision, possibly because mothers spend more time with children than fathers.

Interactions between child behavior patterns and parent supervision: implications for children's risk of unintentional injury

Unintentional injuries are the leading cause of death for children. Prior research has implicated both child behavioral attributes and parent supervisory patterns as risk factors. The present study assessed interactions between these two risk factors and determined whether supervision moderates the relation between child attributes and injury. Mothers completed questionnaire measures of child attributes and supervisory patterns and also recorded how they supervised their young child (2-5 years) at home on each of 10 randomly selected days within a 3-week period. Results provide support for the moderating effect of supervision: Supervision interacted with some child attributes to elevate children's risk of medically attended injury and with other attributes to decrease injury risk. Implications for preventing childhood injuries are discussed.

Maternal depression, child behavior, and injury

BACKGROUND

Few data exist on the effect of maternal depression on child injury outcomes and mediators of this relationship.

OBJECTIVE

To examine the relationship between mothers' depressive symptoms and medically attended injuries in their children and the potential mediating role of child behavior.

DESIGN/METHODS

A cohort of mother-child dyads from the National Longitudinal Study of Youth followed from 1992 to 1994. The primary exposure variable was maternal depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale in 1992. Child behavior was assessed by the Behavior Problems Index externalizing subscale. Logistic regression was used to examine the relationship between depressive symptoms, child behavior, and injury reported in the prior year in 1994.

RESULTS

94 medically attended injuries were reported in the 1106 children (8.5%); two-thirds were sustained in the home environment. Maternal depressive symptoms significantly increased the risk of child injury; injury risk increased 4% for every 1-point increase in depressive symptoms (adjusted OR 1.04, 95% CI 1.01 to 1.08, p=0.02). Increasing maternal depressive symptoms also increased the risk of externalizing behavior problems (adjusted OR 1.06, 95% CI 1.03 to 1.09), but externalizing behavior problems did not significantly mediate the relationship between maternal symptoms and child injury.

CONCLUSIONS

Increasing depressive symptoms in mothers was associated with an increased risk of child injury. Child behavior did not significantly mediate the association between maternal depressive symptoms and child injury in this cohort. Greater recognition, referral, and treatment of depressive symptoms in mothers may have effects on child behavior and injury risk.

Older siblings as supervisors: does this influence young children's risk of unintentional injury?

Unintentional injury is a leading cause of death and hospitalization of young children. Many of these injuries occur in the home when children presumably are being supervised. This study focused on the under-explored issue of sibling supervision in the home, drawing on data collected from a sample of Canadian mothers. Mothers in this sample completed a structured telephone interview and mailed back questionnaires to provide information about the nature and extent of sibling supervision that occurs in the home, as well as the younger child's injury history. Results indicated that older siblings supervise younger ones about 11% of their mutual wake time, with children typically playing and parents usually doing other chores during this time. Time spent with siblings as supervisors was positively related to the supervisee's history of injuries suggesting that sibling supervision may elevate younger children's risk of injury. However, the behavior of the supervisee contributed to risk more so than that of the supervisor. Specifically, sibling supervisors were reported to utilize the same types of strategies as their mother and father in their efforts to supervise and persuade younger children to stop things that could lead to injury. However, poor compliance by the younger child when the older sibling was supervising predicted injury. Implications for childhood injury and directions for future research are discussed.