Validation of a home safety questionnaire used in a randomised controlled trial

Keeping our children safe: piloting a hospital-based home-visitation program in Israel

Background

Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI (‘Keeping our Children Safe; SHomrim Al BetIchut Yeladenu’) program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families’ home-safety.

Methods

The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the ‘Beterem’ checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of each visit.

Results

352 of 773 eligible families agreed to be contacted. 135 participated, 98 completed both home visits. Significant improvement in home-safety items was observed 4 months after the first visit (14 [IQR12-16]) vs. (17 [IQR15-19]; p < 0.001), accompanied by an overall increase in home safety (Mean ± SD 71.9% ± 9.5% vs. 87.1% ± 8.6%; p < 0.001). 64% reported greater awareness of dangers, 60% affirmed home was safer, and 70% valued the equipment. No difference was found in the prevalence of injuries (14 of 98 families prior and 8 after the visit; p = 0.17). Home visitors reported benefiting from the experience of working with disadvantaged families.

Conclusion

The program, which included recruitment in a hospital emergency setting and use of healthcare students as home visitors, was successfully implemented and accompanied by significant improvement in home safety with a non-significant trend of child injury decrease.

A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes?

Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive-compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive-compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities.

Relationship Between Home Safety and Prevalence of Falls and Fear of Falling Among Elderly People: a Cross-sectional Study

Introduction:

Falls and fear of falling are considered as the major factors affecting the elderly’s disabilities, so that most of these individuals often find their homes as a safe environment.

Aim:

The aim of this study was to evaluate the relationship between home safety and prevalence of falls and fear of falling among older adults.

Materials and Methods:

This cross-sectional study was conducted on 450 elderly people who lived in Bojnrud, Northeast of Iran, from December 2016 to July 2017 using cluster sampling method. A demographic characteristics questionnaire, Fall Efficiency Scale-International (FES-I)questionnaire, and Home Safety Checklist were employed as research instruments.

Results:

Out of the study population, 157 individuals (35.7%) had a history of falls in the past one year. The mean score for fear of falling in the elderly people examined was 29.14±11.07 and the same value for home safety status was equal to 11.31±4.17. The mean score for fear of falling was significantly correlated with history of falls in older adults (p<0.0001). There was also a statistically significant relationship between home safety status and prevalence of falls and fear of falling in the elderly (p<0.0001). Besides, the results of logistic regression analysis showed that fear of falling could be estimated by 29-51%, taking the history of falls in the last 12 months and home safety mean score into account (p<0.0001).

Conclusion:

Home safety status and demographic variables could have effects on falls and fear of falling in elderly individuals. Therefore, putting these factors together, older adults at the risk of further falls can be identified and provided with trainings through planning and appropriate interventions to prevent the incidence of falls and their negative consequences among them.

Safe summers: Adapting evidence-based injury prevention into a summer curriculum

BACKGROUND

Unintentional injury is the leading cause of death for those aged 0 years to 19 years. St. Louis Children's Hospital created Safety Land, a comprehensive injury prevention intervention which is provided during summer months. This program uses a life-size board game to teach safety education to children in ages 5 years to 11 years. The purpose of this study was to evaluate the effect of Safety Land on safety knowledge in children that participated in the intervention.

METHODS

St. Louis Children's Hospital identified ZIP codes with the highest use of the emergency room for injury. Daycares and summer camps within these ZIP codes were targeted for the Safety Land intervention. A multiple choice pretest and posttest survey was designed to measure knowledge change within program participants. Students were selected for testing based on site availably. Within these sites, a convenience sample of children was selected for pretesting and posttesting. Safety Land staff conducted the pretest a week before the intervention, and the posttest was administered the week after the intervention. A total knowledge score was calculated to determine overall knowledge change. Descriptive statistics and independent-samples t tests were conducted to determine statistical significance of change in knowledge (p < 0.05) for each question.

RESULTS

Between May 2014 and August 2016, 3,866 children participated in Safety Land. A total of 310 children completed the pretest and 274 completed the posttest. Mean test scores increased from 66.7% to 85.1% and independent-samples t test of the total knowledge score was significant (p < 0.05) between pretest and posttest values.

CONCLUSION

Findings suggest that this intervention is effective in increasing the knowledge of safety behaviors for children receiving the curriculum during the summer months. Further research should focus on long-term behavior changes in these youth.

Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Background

Unintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.

Aim

To increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.

Methods

Six work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.

Results

Modifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.

Limitations

Our case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.

Conclusions

Our studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.

Future work

Further randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.

Trial registration

Current Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.

Funding

The National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

The 4Rs of Aquatic Rescue: educating the public about safety and risks of bystander rescue

From 1980 to 2014, 87 persons drowned in New Zealand while attempting to rescue others; all incidents occurred in open water and most (80%) fatalities were male. While bystander rescue has been promoted as a way of preventing drowning, little is known about the knowledge base that informs potential rescuers. This study utilized a family water safety programme to promote a resource entitled the 4Rs of Aquatic Rescue. Participants (n = 174) completed a pre-intervention survey and were then provided with information and access to electronic resources on safe bystander rescue techniques. Most respondents (71%) had never been taught rescue techniques, and males were more confident of their rescue ability. Upon completion of the programme, significant differences were evident in respondents' understanding of rescue safety, but this did not translate to greater confidence or disposition towards performing a rescue. Ways of promoting bystander safety around water are discussed and recommendations for future studies are made.

Child injury: Does home matter?

This study examined the relationship between home risk and hospital treated injury in Australian children up to five years old. Women with children between two and four years of age enrolled in the Environments for Healthy Living (EFHL): Griffith Birth Cohort Study were invited to complete a Home Injury Prevention Survey from March 2013 to June 2014. A total home risk score (HRS) was calculated and linked to the child's injury related state-wide hospital emergency and admissions data and EFHL baseline demographic surveys. Data from 562 households relating to 566 child participants were included. We found an inverse relationship between home risk and child injury, with children living in homes with the least injury risk (based on the absence of hazardous structural features of the home and safe practices reported) having 1.90 times the injury rate of children living in high risk homes (95% CI 1.15-3.14). Whilst this appears counter-intuitive, families in the lowest risk homes were more likely to be socio-economically disadvantaged than families in the highest risk homes (more sole parents, lower maternal education levels, younger maternal age and lower income). After adjusting for demographic and socio-economic factors, the relationship between home risk and injury was no longer significant (p > 0.05). Our findings suggest that children in socio-economically deprived families have higher rates of injury, despite living in a physical environment that contains substantially fewer injury risks than their less deprived counterparts. Although measures to reduce child injury risk through the modification of the physical environment remain an important part of the injury prevention approach, our study findings support continued efforts to implement societal-wide, long term policy and practice changes to address the socioeconomic differentials in child health outcomes.

Measuring behaviours for escaping from house fires: use of latent variable models to summarise multiple behaviours

Background

This paper reports the development and testing of a construct measuring parental fire safety behaviours for planning escape from a house fire.

Methods

Latent variable modelling of data on parental-reported fire safety behaviours and plans for escaping from a house fire and multivariable logistic regression to quantify the association between groups defined by the latent variable modelling and parental-report of having a plan for escaping from a house fire. Data comes from 1112 participants in a cluster randomised controlled trial set in children’s centres in 4 study centres in the UK.

Results

A two class model provided the best fit to the data, combining responses to five fire safety planning behaviours. The first group (‘more behaviours for escaping from a house fire’) comprised 86 % of participants who were most likely to have a torch, be aware of how their smoke alarm sounds, to have external door and window keys accessible, and exits clear. The second group (‘fewer behaviours for escaping from a house fire’) comprised 14 % of participants who were less likely to report these five behaviours. After adjusting for potential confounders, participants allocated to the ‘more behaviours for escaping from a house fire group were 2.5 times more likely to report having an escape plan (OR 2.48; 95 % CI 1.59–3.86) than those in the “fewer behaviours for escaping from a house fire” group.

Conclusions

Multiple fire safety behaviour questions can be combined into a single binary summary measure of fire safety behaviours for escaping from a house fire. Our findings will be useful to future studies wishing to use a single measure of fire safety planning behaviour as measures of outcome or exposure.

Trial registration number: NCT 01452191. Date of registration 13/10/2011

A Brief Educational Intervention Improves Medication Safety Knowledge in Grandparents of Young Children

BACKGROUND AND OBJECTIVES

Increasing grandparent-grandchild interactions have not been targeted as a potential contributing factor to the recent surge in pediatric poisonings. We hypothesized that in grandparents with a young grandchild, a single educational intervention based on the PROTECT "Up & Away" campaign will improve safe medication knowledge and storage at follow-up from baseline.

METHODS

This prospective cohort study validated the educational intervention and survey via cognitive debriefing followed by evaluation of the educational intervention in increasing safe medication storage. Participants had to read and speak English and have annual contact with one grandchild ≤ 5-years-old. Participants were recruited from a convenience sample of employees in a regional healthcare system. They completed a pre-intervention survey querying baseline demographics, poisoning prevention knowledge, and medication storage, followed by the educational intervention and post-intervention survey. Participants completed a delayed post-intervention survey 50-90 days later assessing medication storage and poisoning prevention knowledge. Storage sites were classified as safe or unsafe a priori; a panel classified handwritten responses.

RESULTS

120 participants were enrolled; 95 (79%) completed the delayed post-intervention survey. Participants were predominantly female (93%) and white (76%); 50% had a clinical degree. Participants averaged 1.9 grandchildren. Initially, 23% of participants reported safe medication storage; this improved to 48% after the intervention (OR 6.4; 95% CI = 2.5-21.0). 78% of participants made at least one improvement in their medication storage after the intervention even if they did not meet all criteria for safe storage. Participants also demonstrated retention of poisoning prevention knowledge.

CONCLUSIONS

This brief educational intervention improved safe medication storage and poisoning prevention knowledge in grandparents of young children; further evaluation of this intervention is warranted.

Validity of parent's self-reported responses to home safety questions

The aim of the study was to describe the validity of parent's self-reported responses to questions on home safety practices for children of 2-4 years. A cross-sectional validation study compared parent's self-administered responses to items in the Home Injury Prevention Survey with home observations undertaken by trained researchers. The relationship between the questionnaire and observation results was assessed using percentage agreement, sensitivity, specificity, positive predictive value, negative predictive value and intraclass correlation coefficients. Percentage agreements ranged from 44% to 100% with 40 of the total 45 items scoring higher than 70%. Sensitivities ranged from 0% to 100%, with 27 items scoring at least 70%. Specificities also ranged from 0% to 100%, with 33 items scoring at least 70%. As such, the study identified a series of self-administered home safety questions that have sensitivities, specificities and predictive values sufficiently high to allow the information to be useful in research and injury prevention practice.

Validation of a home safety questionnaire used in a series of case-control studies

Objective

To measure the validity of safety behaviours, safety equipment use and hazards reported on a questionnaire by parents/carers with children aged under 5 years participating in a series of home safety case-control studies.

Methods

The questionnaire measured safety behaviours, safety equipment use and hazards being used as exposures in five case-control studies. Responses to questions were compared with observations made during a home visit. The researchers making observations were blind to questionnaire responses.

Results

In total, 162 families participated in the study. Overall agreement between reported and observed values of the safety practices ranged from 48.5% to 97.3%. Only 3 safety practices (stair gate at the top of stairs, stair gate at the bottom of stairs, stairs are carpeted) had substantial agreement based on the κ statistic (k=0.65, 0.72, 0.74, respectively). Sensitivity was high (≥70%) for 19 of the 30 safety practices, and specificity was high (≥70%) for 20 of the 30 practices. Overall for 24 safety practices, a higher proportion of respondents over-reported than under-reported safe practice (negative predictive value>positive predictive value). For six safety practices, a higher proportion of respondents under-reported than over-reported safe practice (negative predictive value<positive predictive value).

Conclusions

This study found that the validity of self-reports varied with safety practice. Questions with a high specificity will be useful for practitioners for identifying households who may benefit from home safety interventions and will be useful for researchers as measures of exposures or outcomes.

Effectiveness of web-based tailored advice on parents' child safety behaviors: randomized controlled trial

BACKGROUND

Injuries at home are a major cause of death, disability, and loss of quality of life among young children. Despite current safety education, required safety behavior of parents is often lacking. To prevent various childhood disorders, the application of Web-based tools has increased the effectiveness of health promotion efforts. Therefore, an intervention with Web-based, tailored, safety advice combined with personal counseling (E-Health4Uth home safety) was developed and applied.

OBJECTIVE

To evaluate the effect of E-Health4Uth home safety on parents' safety behaviors with regard to the prevention of falls, poisoning, drowning, and burns.

METHODS

A randomized controlled trial was conducted (2009-2011) among parents visiting well-baby clinics in the Netherlands. Parents were randomly assigned to the intervention group (E-Health4Uth home safety intervention) or to the control condition consisting of usual care. Parents in the intervention condition completed a Web-based safety behavior assessment questionnaire; the resulting tailored safety advice was discussed with their child health care professional at a well-baby visit (age approximately 11 months). Parents in the control condition received counseling using generic safety information leaflets at this well-baby visit. Parents' child safety behaviors were derived from self-report questionnaires at baseline (age 7 months) and at follow-up (age 17 months). Each specific safety behavior was classified as safe/unsafe and a total risk score was calculated. Logistic and linear regression analyses were used to reveal differences in safety behavior between the intervention and the control condition at follow-up.

RESULTS

A total of 1292 parents (response rate 44.79%) were analyzed. At follow-up, parents in the intervention condition (n=643) showed significantly less unsafe behavior compared to parents in the control condition (n=649): top of staircase (23.91% vs. 32.19%; OR 0.65, 95% CI 0.50-0.85); bottom of staircase (63.53% vs. 71.94%; OR 0.69, 95% CI 0.53-0.88); top and bottom of staircase (68.94% vs. 78.28%; OR 0.62, 95% CI 0.48-0.81); storage of cleaning products (30.33% vs. 39.91%; OR 0.67, 95% CI 0.53-0.85); bathing of the child (23.46% vs. 32.25%; OR 0.65, 95% CI 0.51-0.84); drinking hot fluids (34.84% vs. 41.73%; OR 0.76, 95% CI 0.61-0.96); using rear hotplates (79.34% vs. 85.27%; OR 0.67, 95% CI 0.50-0.90); and the total risk score in which a higher score indicates more unsafe behavior (mean 13.63, SD 6.12 vs. mean 15.34, SD 6.07; beta -1.59, 95% CI -2.26 to -0.93). There were no significant differences for other specific behaviors between the two study conditions.

CONCLUSIONS

Compared to generic written materials, the E-Health4Uth home safety intervention seems more effective in promoting parents' safety behavior for safe staircases, storage of cleaning products, bathing, drinking hot fluids, and cooking. This study supports the application of Web-based, tailored, safety advice for the prevention of unintentional injuries in the youth health care setting.

TRIAL REGISTRATION

Nederlands Trial Register: NTR1836; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1836 (Archived by WebCite at http://www.webcitation.org/6MPIGQxpx).

Multicentre cluster randomised controlled trial evaluating implementation of a fire prevention Injury Prevention Briefing in children's centres: study protocol

BACKGROUND

The UK has one of the highest fatality rates for deaths from fire-related injuries in children aged 0-14 years; these injuries have the steepest social gradient of all injuries in the UK. Children's centres provide children under five years old and their families with a range of services and information, including home safety, but their effectiveness in promoting injury prevention has yet to be evaluated. We developed a fire prevention intervention for use in children's centres comprising an Injury Prevention Briefing (IPB) which provides evidence on what works and best practice from those running injury prevention programmes, and a facilitation package to support implementation of the IPB. This protocol describes the design and methods of a trial evaluating the effectiveness and cost-effectiveness of the IPB and facilitation package in promoting fire prevention.

METHODS/DESIGN

Pragmatic, multicentre cluster randomised controlled trial, with a nested qualitative study, in four study centres in England. Children's centres in the most disadvantaged areas will be eligible to participate and will be randomised to one of three treatment arms comprising: IPB with facilitation package; IPB with no facilitation package; usual care (control). The primary outcome measure will be the proportion of families who have a fire escape plan at follow-up. Eleven children's centres per arm are required to detect an absolute difference in the percentage of families with a fire escape plan of 20% in either of the two intervention arms compared with the control arm, with 80% power and a 5% significance level (2-sided), an intraclass correlation coefficient of 0.05 and assuming outcomes are assessed on 20 families per children's centre. Secondary outcomes include the assessment of the cost-effectiveness of the intervention, other fire safety behaviours and factors associated with degree of implementation of the IPB.

DISCUSSION

This will be the first trial to develop and evaluate a fire prevention intervention for use in children's centres in the UK. Its findings will be generalisable to children's centres in the most disadvantaged areas of the UK and may also be generalisable to similar interventions to prevent other types of injury.

TRIAL REGISTRATION

http://NCT01452191 (date of registration: 13/10/2011).

Healthy Homes/Healthy Kids: a randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5-10 year olds

Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.

Using the pediatric emergency department to deliver tailored safety messages: results of a randomized controlled trial

OBJECTIVE

This study aimed to evaluate the impact of a computer kiosk intervention on parents' self-reported safety knowledge as well as observed child safety seat, smoke alarm use, and safe poison storage and to compare self-reported versus observed behaviors.

METHODS

A randomized controlled trial with 720 parents of young children (4 months to 5 years) was conducted in the pediatric emergency department of a level 1 pediatric trauma center. Enrolled parents received tailored safety information (intervention) or generic information (control) from a computer kiosk after completing a safety assessment. Parents were telephoned 4 to 6 months after the intervention to assess self-reported safety knowledge and behaviors; in-home observations were made 1 week after the telephone interview for a subset of 100 randomly selected participants. Positive and negative predictive values were compared between the intervention and control groups.

RESULTS

The intervention group had significantly higher smoke alarm (82% vs. 78%) and poison storage (83% vs 78%) knowledge scores. The intervention group was more likely to report correct child safety seat use (odds ratio, 1.36; 95% confidence interval, 1.05-1.77; P = 0.02). Observed safety behaviors were lower than self-reported use for both groups. No differences were found between groups for positive or negative predictive values.

CONCLUSIONS

These results add to the limited literature on the impact of computer tailoring home safety information. Knowledge gains were evident 4 months after intervention. Discrepancies between observed and self-reported behavior are concerning because the quality of a tailored intervention depends on the accuracy of participant self-reporting. Improved measures should be developed to encourage accurate reporting of safety behaviors.

First-time parents are not well enough prepared for the safety of their infant

BACKGROUND

Unintentional falls and poisonings are major causes of death and disability among infants. Although guidelines are available to prevent these injuries, safety behaviours are not performed by parents, causing unnecessary risks. Little is known about safety behaviours of first-time parents and whether they behave according to these guidelines. AIMS/OBJECTIVES/PURPOSE: The objective of this study was to compare safety behaviours of first-time parents with those of non-first-time parents and to determine correlates of unsafe behaviour of parents of infants. We used self-report questionnaires to assess safety behaviours in a cross-sectional study sample.

METHODS

A total of 1439 parents visiting a preventive youth healthcare centre in the Netherlands were invited to complete a questionnaire with regard to the prevention of falls and poisonings. Parents were categorized into first-time parents and non-first-time parents. Correlates of parents' child safety behaviours were determined using multiple logistic regression analyses.

RESULTS/OUTCOME

Most respondents were mothers (93.2%); 48.2% of families were first-time parents. The mean age of the infants was 7.2 months (SD 1.1; range 4-12), 51.8% were boys, and 34.5% of infants could crawl. First-time parents were more likely not to have a stair gate installed (OR 16.46; 95% CI 12.36-21.93); were more likely to store cleaning products unsafely (OR 4.55; 95% CI 3.59-5.76); and were more likely to store medicines unsafely (OR 2.90; 95% CI 2.31-3.63) than non-first-time parents. First-time parents were more likely to not have a window guard installed (OR 1.52; 95% CI 1.08-2.15) (all P<0.05).

DISCUSSION/CONCLUSION

First-time parents are not well prepared for the safety of their infant, causing unnecessary risks. The various parents' safety behaviours were influenced by different variables, for example, age of the infant, crawling of the infant, mother's educational level, mother's ethnicity, self-efficacy, vulnerability, severity.

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.

Home safety practices in an urban low-income population: level of agreement between parental self-report and observed behaviors

Home-related injuries are overrepresented in children from low-income households. The objectives of this study were to determine frequencies of home safety behaviors and the level of agreement between parental self-report and observed safety practices in low-income homes. In a prospective, interventional home injury prevention study of 49 low-income families with children <5 years old, a trained home visitor administered baseline parental home safety behavior questionnaires and assessments. There was high agreement between caregiver self-report and home visitor observation for lack of cabinet latch (99%, 95% confidence interval [CI] = 88%-99%) and stair gate use (100%, 95% CI = 88-100%). There was lower agreement for the safe storage of cleaning supplies (62%, 95% CI = 46%-75%), sharps (74%, 95% CI = 59%-85%), and medicines/vitamins (83%, 95% CI = 69%-92%) because of the overreporting of safe practices. Self-reports of some home safety behaviors are relatively accurate, but certain practices may need to be verified by direct assessment.

Association between smokefree laws and voluntary smokefree-home rules

BACKGROUND

More states and localities are passing restrictions on smoking in public places and workplaces.

PURPOSE

To determine what, if any, association exists between enactment of strong laws making public places or workplaces smokefree on adoption of voluntary smokefree-home policies, particularly whether such laws are associated with increased smoking at home.

METHODS

Logistic regressions were used to estimate the OR of a person living with a 100% smokefree-home rule as a function of individual characteristics, household composition, and whether or not the residential region is covered by clean indoor air laws. The data came from successive waves of the Tobacco Use Supplement to Current Population Survey (TUS-CPS) for the years 1992-2007, and the American Nonsmokers' Rights Foundation database of state and local government clean indoor air laws. Analysis was conducted in 2010 and 2011.

RESULTS

Living in a county fully covered by a 100% clean indoor air law in workplaces or restaurants or bars is associated with an increased likelihood of having a voluntary 100% smokefree-home rule both for people living with smokers (OR=7.76, 95% CI=5.27, 11.43) and not living with smokers (OR=4.12, 95% CI=3.28, 5.16).

CONCLUSIONS

Strong clean indoor air laws are associated with large increases in voluntary smokefree-home policies both in the homes with and without smokers. These results support the hypothesis of norm spreading of clean indoor air laws.

Risk compensation in children's activities: A pilot study

BACKGROUND

The intent of protective equipment (PE) in sports and leisure activities is to reduce injuries. However, some postulate that any safety measure prompts riskier behaviour, a phenomenon known as 'risk homeostasis' or 'risk compensation.' This study explores one approach to examining this in children. The rationale for this pilot study was to establish if children between six and 16 years old could answer questions about risk-taking sensibly and which questions, if any, could be eliminated; to establish the reliability of response; and to determine the numbers needed for a definitive study.

METHODS

Sixty-three children with nonsevere injuries, ages six to 16 years, were interviewed while waiting to be seen at the Montreal Children's Hospital emergency department. An interviewer administered a questionnaire comprising three sections. The first part only applied to those who were injured in an activity for which some form of PE was available (n=19). The second part examined customary risk-taking behaviour using the thrill and adventure seeking scales of a standardized questionnaire (Zuckerman) (n=63). The third section posed hypothetical questions about likely risk-taking when using PE to those who had engaged in such activities (n=58).

RESULTS

The approach and questionnaire proved feasible with this age group. The responses suggest that children wearing PE were more likely to report increased risk-taking than those who did not wear PE. For most of the hypothetical questions, the majority also reported changes toward riskier behaviour when using PE. However, those wearing PE scored lower on the thrill and adventure seeking scale, suggesting that they are, by nature, less venturesome.

CONCLUSION

The results indicate that risk compensation may modify the effectiveness of PE for children engaged in sports and leisure activities. Conversely, the findings also suggest that those wearing PE may be a cautious subgroup.

Safety practices in relation to home ownership among urban Mexican immigrant families

We examined home safety hazards, comparing renter- to owner-occupied housing among urban, immigrant Mexican families.

METHODS

Interviews and home inspections were conducted among urban, Spanish-speaking immigrant families with children. We estimated weighted hazard prevalence and used logistic regression to compare owner- and renter-occupied homes. Of 313 eligible households, 250 (80%) enrolled. Respondents were predominantly Mexican-born (99%), low income (72.6%) and lower education (92.3%). Most homes had fire, burn, fall, poisoning, electrocution and fire escape hazards, including high tap water temperatures (76.4%; 95% CI: 69.0, 83.7%), no working smoke alarms (60.0%; 51.3, 68.8%), slippery bathtub/shower surfaces (58.7%; 49.9, 67.5%), blocked fire escape routes (55.9%; 47.2, 64.5%) and child-accessible medications (71.0%; 60.1, 81.3%). After adjustment for sociodemographics, fire escape (OR = 8.8; 95% CI: 2.8, 27.7), carbon monoxide poisoning (OR = 2.9; 1.4, 6.2) and drowning (OR = 3.5; 1.3, 9.4) hazards were more likely in owner- than renter-occupied homes. Housing age and type explained most differences. Many urban, immigrant Spanish-speaking families live in unsafe homes. For this population, housing safety programs should be targeted based on housing age and type rather than tenure.

A randomized controlled trial of home injury hazard reduction: the HOME injury study

OBJECTIVE

To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices.

DESIGN

A nested, prospective, randomized controlled trial.

SETTING

Indoor environment of housing units.

PARTICIPANTS

Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study. Among 8878 prenatal patients, 1263 (14.2%) were eligible, 413 (32.7%) agreed to participate, and 355 were randomly assigned to the intervention (n = 181) or control (n = 174) groups.

INTERVENTION

Installation of multiple passive measures (eg, stair gates, cabinet locks, and smoke detectors) to reduce exposure to injury hazards. Injury hazards were assessed at home visits by teams of trained research assistants using a validated survey.

MAIN OUTCOME MEASURE

Modifiable and medically attended injury (ie, telephone calls, office visits, and emergency visits for injury).

RESULTS

The mean age of children at intervention was 6.3 months. Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years (P < .004). There was no difference in the rate for all medically attended injuries in intervention children compared with controls: 14.3 injuries (95% confidence interval [CI], 9.7-21.1 injuries) vs 20.8 injuries (95% CI, 14.4-29.9 injuries) per 100 child-years (P = .17); but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries (95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03).

CONCLUSION

An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00129324.

Validation of a HOME Injury Survey

BACKGROUND

There are no validated observational surveys to assess injury hazards in the home environment.

OBJECTIVE

To evaluate the reproducibility and reliability of a survey quantifying home injury hazards for children.

METHODS

A nested cohort of children in the intervention arm of the Home Observations and Measures of the Environment (HOME) Study trial were analysed. The number and density of hazards were quantified by research assistants in the homes of participants at a baseline visit (BHV) for four high-risk rooms (kitchen, main activity room, child's bathroom and child's bedroom) and stairways and later at an intervention planning visit (IPV) for the four high-risk rooms and entire household. Statistical analysis included Pearson correlation, Bland-Altman analysis of agreement, analysis of variance and kappa statistics.

RESULTS

There were 163 households with measurements at BHV and IPV. The number and density of hazards for the four high-risk rooms correlated significantly between BHV and IPV (r = 0.50 and 0.75, respectively). The number and density of hazards for the four high-risk rooms correlated significantly with that for the whole household at the IPV (r = 0.17 and 0.52, respectively). The number of injury hazards was significantly higher in the kitchen than in the other high-risk rooms, whereas density was highest in the child's bathroom. Inter-rater reliability between research assistants, as measured by the kappa statistic, was excellent with a mean of 0.81.

CONCLUSIONS

The HOME Injury Survey was a reliable and replicable tool for quantifying residential injury hazards. The density of injury hazards was a more stable and valid measure than the number of injury hazards.

Why do parents with toddlers store poisonous products safely?

Unintentional poisoning is a major cause of nonfatal injuries in children aged 0-24 months. Associations between self-reported habits on the child safe storage of medication and cleaning products and family, and psychosocial factors were assessed, using a model based on the Protection Motivation Theory. By identifying correlates of safety behavior in this manner, more insight in factors which influence this behavior is obtained. Health promotion activities in order to promote safety behavior should address these factors in order to increase the effectiveness of the health message. Data were gathered from a cross-sectional survey using self-administered questionnaires, mailed to a population sample of 2470 parents with toddlers. The results indicate that the promotion of safe storage of medication and cleaning products should address the family situation, personal cognitive factors as well as social factors. Interventions should particularly focus on parents' self-efficacy of storing poisonous products in a child safe manner and on the vulnerability of their child in their home concerning an unintentional poisoning incident.

Does targeting injury prevention towards families in disadvantaged areas reduce inequalities in safety practices?

Inequalities in childhood injury and safety practices exist, but there is little evidence that targeted interventions can reduce such inequalities. This study examines the effect of a home safety intervention on reducing inequalities in safety practices using a secondary analysis of data from a randomized controlled trial. Families with children <5 years from disadvantaged areas were randomized to receive a standardized health visitor safety consultation and free or low-cost safety equipment fitted in the home or to usual care. The impact of the intervention in terms of stair gate use and functioning smoke alarms was compared by ethnic group, maternal age, housing tenure, family type and receipt of state-provided means-tested benefits at 1-year follow-up. Marked inequalities were found for both safety practices by each socio-economic characteristic prior to the intervention. The intervention significantly reduced inequalities in stair gate use by housing tenure (P = 0.006) and receipt of benefits (P = 0.04), but did not reduce inequalities in functioning smoke alarms. We conclude that a home safety intervention targeted at deprived areas addressing the barriers of cost and needing help to fit equipment was only partially successful in reducing inequalities in safety practices. Other strategies will be required to reduce inequalities especially in relation to functioning smoke alarms.

An ethnography of low-income mothers' safeguarding efforts

PROBLEM

Children living in lower-income environments are at greater risk for unintentional injuries. However, little is known about the safety practices of mothers living in low-income situations.

METHOD

This ethnographic study explored the child safeguarding experiences of low-income mothers using in-home interviews and observations.

RESULTS

Mothers' safeguarding efforts included cognitive and emotional work, child directed work, and work directed at the physical and social environments. Factors that influenced the women's safeguarding included the quality of the indoor space, availability of safe play space, traffic hazards, sibling interactions, child care supports, relationships with neighbors, and trust in community services.

DISCUSSION

These findings have implications for the conceptualization of safeguarding practices and provide insight about the experiences of mothers living on low-incomes.

IMPACT ON INDUSTRY

When developing safety interventions, program planners should consider the views and practices of mothers as well as contextual factors in the physical and social environments.

Assessing psychosocial correlates of parental safety behaviour using Protection Motivation Theory: stair gate presence and use among parents of toddlers

Unintentional injury due to falls is one of the main reasons for hospitalization among children 0-4 years of age. The goal of this study was to assess the psychosocial correlates of parental safety behaviours to prevent falls from a staircase due to the lack of or the lack of adequate use of a stair gate. Data were collected from a cross-sectional survey using self-administered questionnaires mailed to a population sample of 2470 parents with toddlers. Associations between self-reported habits on the presence and use of stair gates and family and psychosocial factors were analysed, using descriptive statistics and multiple regression models, based on Protection Motivation Theory. The presence of stair gates was associated with family situation, perceived vulnerability, response efficacy, social norms and descriptive norms. The use of stair gates was associated with family situation, response efficacy, self-efficacy and perceived advantages of safe behaviour. The full model explained 32 and 24% of the variance in the presence of stair gates and the use of stair gates, respectively, indicating a large and medium effect size. Programmes promoting the presence and adequate use of stair gates should address the family situation, personal cognitive factors as well as social factors.

Preventing product-related injuries: a randomized controlled trial of poster alerts

BACKGROUND

The Product Safety Programme (PSP) of Health Canada is responsible for preventing product-related injuries. If PSP decides a product is dangerous, it can publicize its dangers, prohibit, or control its distribution; but for child products, the preferred option is to publicize its concerns. In the past, this included sending posters to paediatricians' offices and, more recently, placing alerts on the PSP website. This study examines the effectiveness of this process.

METHODS

15 Montreal paediatricians participated in a modified crossover randomized trial. During a randomly chosen intervention week, two product-related notices were posted in the paediatricians' waiting area. In the following or preceding week, these notices did not appear. Parents were interviewed by telephone to determine if they saw the posters and acted on the information received.

RESULTS

We interviewed 808 parents (86%) of the 940 who agreed to participate. Of these, only 16% of the intervention and less than 1% of the control group reported seeing the posters. There were no differences in reported changes in behaviours related to the notices. These findings are unchanged after taking account of socio-economic status. No parents cited the posters, websites, or paediatricians as their main source of information about dangerous products.

CONCLUSION

Product safety notices, whether sent to paediatricians' practices or posted on a website, cannot be relied upon to reach parents of preschool age children. Other approaches require consideration, such as increasing the power of PSP to regulate product safety.

Presence and use of stair gates in homes with toddlers (11-18 months old)

BACKGROUND

The aim of this study was to assess demographic correlates of the presence and use of stair gates in homes with toddlers.

METHODS

In 2004, self-administered questionnaires were mailed to 2470 parents with toddlers living in both urban and rural areas (response rate 70.1%). The questionnaires were sent by the youth healthcare providers that the parents visited regarding their toddler.

RESULTS

In total, 83% of the parents reported to have at least one stair gate installed; however, 50% of these parents reported that they did not always close the stair gate. Households with a non-Dutch ethnic mother, one child, a female child, a young child or a child who cannot crawl, were less likely to have a stair gate. Households with one child, a toddler who cannot walk, and a mother with a higher educational level were less likely to use the gate adequately.

CONCLUSIONS

This study shows that parents of toddlers often report to have a stair gate; however, in homes with a gate the parents do not necessarily use the gate adequately. Different demographic characteristics were shown to be correlated with both having a stair gate and the use of a stair gate.

Preventing product-related injuries: a randomized controlled trial of poster alerts

BACKGROUND

The Product Safety Programme (PSP) of Health Canada is responsible for preventing product-related injuries. If PSP decides a product is dangerous, it can publicize its dangers, prohibit, or control its distribution; but for child products, the preferred option is to publicize its concerns. In the past, this included sending posters to paediatricians' offices and, more recently, placing alerts on the PSP website. This study examines the effectiveness of this process.

METHODS

15 Montreal paediatricians participated in a modified crossover randomized trial. During a randomly chosen intervention week, two product-related notices were posted in the paediatricians' waiting area. In the following or preceding week, these notices did not appear. Parents were interviewed by telephone to determine if they saw the posters and acted on the information received.

RESULTS

We interviewed 808 parents (86%) of the 940 who agreed to participate. Of these, only 16% of the intervention and less than 1% of the control group reported seeing the posters. There were no differences in reported changes in behaviours related to the notices. These findings are unchanged after taking account of socio-economic status. No parents cited the posters, websites, or paediatricians as their main source of information about dangerous products.

CONCLUSION

Product safety notices, whether sent to paediatricians' practices or posted on a website, cannot be relied upon to reach parents of preschool age children. Other approaches require consideration, such as increasing the power of PSP to regulate product safety.

Studying injury prevention: practices, problems, and pitfalls in implementation

This prospective, randomized, controlled trial was conducted to determine feasibility and effectiveness of a chronic care model approach to injury prevention compared with standard anticipatory guidance. Enrolled caregivers of children aged 0 to 5 years received focused counseling from a physician and health assistant, educational handouts, phone follow-up, and access to free safety devices and automobile restraint evaluations. Only 35.1% of eligible parents participated. Home visits were completed at 6 months to observe safety practices. Injuries were gleaned from parent report and medical record review. Safety practices were evaluated in 27 households. Chart review showed no significant difference in the number of medically attended injuries between groups (P = 0.6). The impact of the chronic care model on injury prevention in primary care could not be determined with certainty. Evaluating effectiveness of injury prevention strategies on actual safety practices with direct observation is challenging.

How children with special needs travel with their parents: observed versus reported use of vehicle restraints

OBJECTIVES

The difficulties entailed in transporting children with special physical and behavioral needs could influence child restraint misuse and nonuse within this population. Although parental interview is often used to assess child vehicle restraint use, little research had been performed to validate this approach, and none has been done in the special-needs population. The objectives of this study were to assess the prevalence of nonuse and misuse of child restraints in the special-needs population and to assess the validity of using parental report as a measure of child restraint use.

METHODS

Restraint use in 115 children with special needs, aged 0 to 18 years, was observed on their arrival at the parking lot of the Alyn Hospital Pediatric Rehabilitation Center in Jerusalem. The observation noted type of restraint used or absence thereof. If a restraint was used, correct use/misuse was recorded. In 94 cases, the parents were interviewed later that day in the clinic.

RESULTS

Seventy percent of the children were observed as traveling unrestrained or with a restraint that was grossly misused to the extent that it provided no meaningful protection. The remaining children were observed displaying a variety of errors in the selection or use of the restraint that compromised their safety to varying degrees. Analysis of the observation results versus parental reporting revealed a 44% overreporting of child restraint use. Sensitivity was 71%, and specificity was 86%.

CONCLUSIONS

The high prevalence of restraint nonuse and misuse within the special-needs population defines this as a population at risk and emphasizes the need for intervention. Cautious interpretation is required of information acquired from parental reporting of child restraint use. The results of this study should raise awareness among professionals working with children with special needs as to the need for tailored assessment and intervention in the area of child-passenger safety.

Validating self reported home safety practices in a culturally diverse non-inner city population

OBJECTIVE

To determine the validity of face to face, self reported responses to questions about the presence of safety devices and use of safety practices in the home aimed at preventing unintended injuries to preschool aged children.

METHODS

The authors invited families with children enrolling in a medium sized Midwestern US community Head Start program to participate in a randomized study of home safety practices. Participation involved consenting parents (n = 452) completing an initial questionnaire during Head Start enrollment or in their home. Project staff conducted home inspections to confirm parental responses to 16 questions. Only inspections conducted within 34 days of questionnaire completion (n = 259) were included in the validation study. Parents were told that the home visit would assess the need for safety devices, but were not informed of the validation aspect of the study.

RESULTS

Sensitivities were generally high for all 16 safety practices, whereas negative predictive value and specificity varied considerably. Positive predictive value was also high for most practices, and did not vary by ethnicity. Answers provided by parents in their home were different and more reliable than those provided by parents interviewed at school (p = 0.001).

CONCLUSIONS

Use of safety devices and practices by parents of preschool aged children reported in a face to face interview are generally reliable. Reliability increases if the interview is conducted in the home. Parents may also be more willing to report potential problems if they perceive they may receive corrective assistance.

Unsafe storage of poisons in homes with toddlers

BACKGROUND

The objective of this project was to assess the current nature and level of preventive actions that parents take to avoid unintentional poisoning among toddlers (11-18 months old).

METHODS

In 2004, we conducted a cross-sectional observational survey with self-administered questionnaires among parents with toddlers (n=1,722). Data were obtained on storage locations of medicines and cleaning products and supervision of children.

RESULTS

Overall, 50.1% of the toddlers were exposed to unsafe storage of possible poisonous products in the home. Parents were more likely to store medicines safely than cleaning products, and products were most often stored unsafely in the kitchen, where children were left unattended most often (69%). Households with one child were associated with unsafe storage of both medicines and cleaning products. Lower educational level of the mother and unemployment of the mother were both associated with safe storage of medicines. Mother's ethnicity, the child's ability to walk, and the education level of the father were associated with storage of cleaning products.

CONCLUSIONS

The results of this study are an important first step for the development of effective interventions to reduce unintentional poisoning in toddlers' homes.

Do maternal depressive symptoms, stress and a lack of social support influence whether mothers living in deprived circumstances adopt safety practices for the prevention of childhood injury?

BACKGROUND

Maternal depressive symptoms are common, as are childhood injuries, particularly among the socio-economically disadvantaged. Maternal depression may be associated with lesser engagement in injury prevention practices. Providing support to mothers can reduce the risk of child injury, but the mechanism by which this occurs is unclear. The aim of this study was to examine the relationship between maternal depressive symptoms, social support and stress, and engagement in home safety practices to prevent injuries to pre-school children living in socio-economically deprived families in the UK.

METHODS

Three questionnaires were posted to mothers of young children living in deprived areas in the city of Nottingham, UK, who were enrolled in the control group of a randomized controlled trial (RCT). The questionnaires assessed socio-demographic characteristics at baseline; depressive symptoms, perceived social support and self-reported stress 21 months later and engagement in home safety practices 24 months post baseline. The mothers in the control group received no intervention. Main outcome measures were the use of fireguards, stair gates, smoke alarms, window locks and safe storage of medicines, sharp objects and cleaning products.

RESULTS

One-third (36.4%) of mothers reported depressive symptoms. The most widely adopted safety practices were safe storage of medicines (93.5%) and use of smoke alarms (86.2%). The majority of mothers did not use fireguards (60.7%) or store sharp objects safely (63.8%). Depressive symptoms were not independently associated with any of the seven safety practices. Mothers reporting some lack of social support were more likely not to store medicines safely [odds ratio, OR, 4.08 (95% confidence interval, CI, 1.79-9.30) compared with those reporting no lack of social support] and mothers reporting moderate or large amounts of stress were more likely not to store sharp objects safely [OR 1.77 (95% CI 1.11-2.83) compared with mothers reporting no or little stress] after controlling for confounders.

CONCLUSIONS

Our results suggest that depressive symptoms, stress and a lack of social support are not important influences on the adoption of safety practices by mothers living in deprived areas in the UK, at least in the short term. Further work is required to explore the effects of chronic maternal depressive symptoms on the adoption of safety practices.

Parents' perceptions, attitudes and behaviours towards child safety: a study in 14 European countries

Injury is the leading cause of death for children 0- 19 years of age in Europe, accounting for 3.1 deaths per 10 000 children per year. The youngest children of the ages 0-4 years require the most protection in this age group, with 2.5 injury-related deaths per 10 000 children in Europe annually. As parents are the primary caregivers of children, it is necessary to learn more about parents' perceptions, attitudes and behaviours towards child safety. This study presents the findings of a 14-country study in Europe on this theme. A quantitative survey of parents of children aged 5 years or under was performed in 14 EU member states in order to enable better targeting of prevention efforts aimed at educating parents. The total sample size was 2088. The results show that 95% of parents reported that they personally take measures to avoid accidental injury to their children. Their top concern with regard to safety of their children was children being hit by a car. The most common response, when asked why some parents find it difficult to protect their children from accidental injury, was not being able to watch their children constantly. Lack of awareness or knowledge about the causes of accidents was the second response. Two-thirds of parents would like to see more help from the government to prevent childhood injuries. Three-quarters of parents agreed that child injuries can be avoided. It was concluded that parents want to be better informed about the causes of child accidents and about actions they and society can take to reduce injury-related risks to children.

Relationships between child, family and neighbourhood characteristics and childhood injury: a cohort study

There has been little research into the role of neighbourhood effects in childhood injury. We report results from a cohort study, comprising 1717 families (2357 children aged 0-7 years) registered at 47 general practices in Nottingham, UK. Multi-level Poisson regression examined relationships between electoral ward (neighbourhood), family and child characteristics and medically attended injury rates. Primary care attendance rates were higher for children in rented accommodation and those aged 2-3 years. An n-shaped relationship was found between geographical access to services and the primary care attendance rate. Accident and Emergency (A&E) department attendance rates were higher amongst boys, children in rented accommodation, with a teenage mother, aged 2-5 years and living in wards with a higher number of parks and play areas. They were lower for children whose families had a smoke alarm. Hospital admission rates were higher amongst children living in more deprived wards and wards with higher violent crime rates. They were lower in children whose families had smoke alarms, stair gates and stored sharp objects safely. Primary care and A&E attendance rates varied significantly between families. Variation between wards in the A&E attendance rate was explained by family characteristics. We conclude that characteristics of wards, families and children are associated with medically attended childhood injury rates. This study did not find a neighbourhood effect for A&E attendances that could not be explained by family level characteristics. Studies with greater power and a measure of injury severity independent of health service utilisation are needed to explore the relationship between neighbourhood effects and more severe injuries. The greater variation in injury rates vary between families than between neighbourhoods suggests reducing inequalities in injury rates may be achieved more effectively by focussing prevention at families rather than neighbourhoods, but in practice interventions at both levels are likely to be necessary.

Validation of parent self reported home safety practices

OBJECTIVES

To evaluate the validity of parents' self reported home safety practices concerning smoke detectors, bike helmets, car seats, and water heater temperature.

SETTING

Parents of children 12 years old and under whose child had made at least one visit to a study clinic in the years 2000-2003.

METHODS

As part of a randomized controlled trial to improve patient provider communication and preventive practices, parents' responses to telephone interview were compared with observations of safety practices during a home visit. Home visits were completed within nine weeks of the telephone interview. Parents were not told that the visit was part of a validation study and home visit observers were unaware of the interview responses. The authors calculated sensitivities, specificities, positive and negative predictive values, and their corresponding confidence intervals.

RESULTS

Sensitivity (0.78 to 0.98) and positive predictive values (0.75 to 1.00) were high for all items. Specificities and negative predictive values were more variable and the highest estimates (specificity 0.95 to 1.00, negative predictive value 0.95 to 0.97) were for car seat types.

CONCLUSIONS

The results suggest that parent self report practice of certain injury prevention behaviors (owning a car seat, hot water temperatures) is reliable, whereas self reports on other practices (working smoke detectors, properly fitting bike helmets) may be overstated.

How useful are home safety behaviours for predicting childhood injury? A cohort study

Little work has examined the utility of home safety behaviours in predicting childhood injury. This study examines the relationship between safety behaviours and child injury using a cohort of 1717 families, with 2357 children aged 0-7 years. Safety behaviours, and sociodemographic and family characteristics were measured using a validated questionnaire, and medically attended injuries were ascertained from medical records. Hospital admission rates were lower amongst children from families with fitted and working smoke alarms [incidence rate ratio (IRR) 0.55, 95% confidence interval (CI) 0.31-0.96], who stored sharp objects safely (IRR 0.44, 95% CI 0.23-0.84) and who had fitted stair gates (IRR 0.57, 95% CI 0.31-1.03). Not having a stair gate and not storing sharp objects safely had high sensitivities and negative predictive values for predicting hospital admission. These findings are unlikely to be explained by reductions in the risk of injuries these items are designed to prevent. Families with a range of safety behaviours may also be 'safer' in other ways. Further exploration of factors that may explain lower injury rates in these families is required. Information on safety behaviours may be useful for targeting and monitoring injury prevention activity.

Engagement in safety practices to prevent home injuries in preschool children among white and non-white ethnic minority families

OBJECTIVE

To examine engagement in home safety practices to prevent injuries in preschool children among white and non-white ethnic minority families.

DESIGN

A self completion postal questionnaire assessed sociodemographic characteristics and engagement in home safety practices.

SETTING

Deprived areas in the city of Nottingham, United Kingdom.

SUBJECTS

3906 caregivers of children aged under 5 years.

MAIN OUTCOME MEASURES

Use of fireguards, stair gates, smoke alarms, window locks and safe storage of medicines, sharp objects, and cleaning products.

RESULTS

Of the 3906 families, 3805 gave their ethnic origin of which 16.5% classed themselves as from a non-white ethnic minority. The safety practices most commonly adopted by respondents were safe storage of medicines (87.9%) and use of smoke alarms (72.3%). Respondents from non-white ethnic minorities were significantly less likely to adopt all safety practices except they were less likely than whites to store sharp objects unsafely (odds ratio (OR) 0.68, 95% confidence interval (CI) 0.56 to 0.84). Those from non-white ethnic minorities were significantly more likely to indicate that they "did not know they could get" fireguards (adjusted OR 6.01, 95% CI 2.64 to 13.65), stair gates (adjusted OR 4.47, 95% CI 1.53 to 13.05), and cupboard locks (adjusted OR 3.96, 95% CI 2.77 to 5.66) than whites. They were also significantly more likely to say they would need help fitting fireguards (adjusted OR 1.98, 95% CI 1.03 to 3.81), stair gates (adjusted OR 3.61, 95% CI 2.11 to 6.17), and cupboard locks (adjusted OR 1.88, 95% CI 1.39 to 2.54).

CONCLUSIONS

Our results support the hypothesis that families from non-white ethnic minorities are less likely to engage in some safety practices and illustrate inequalities in access to information regarding the availability and fitting of safety equipment. Further work is required to examine the association between adoption of safety practices and injury rates in children from non-white ethnic minorities.

Providing child safety equipment to prevent injuries: randomised controlled trial

OBJECTIVE

To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas.

DESIGN

Randomised controlled trial.

SETTING

47 general practices in Nottingham.

PARTICIPANTS

3428 families with children under 5.

INTERVENTION

A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks.

MAIN OUTCOME MEASURES

Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices.

RESULTS

No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95% confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years' follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small.

CONCLUSIONS

The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.

A randomized, clinical trial of a home safety intervention based in an emergency department setting

OBJECTIVE

To assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers' behaviors and practices related to home safety.

METHODS

We conducted a randomized, clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatric ED for evaluation of an acute unintentional injury sustained in the home. After completing a structured home safety questionnaire via face-to-face interview, caregivers were randomly assigned to receive either comprehensive home safety education and free safety devices or focused, injury-specific ED discharge instructions. Participants were contacted by telephone 2 months after the initial ED visit for repeat administration of the safety questionnaire. The pretest and posttest questionnaires were scored such that the accrual of points correlated with reporting of safer practices. Scores were then normalized to a 100-point scale. The overall safety score reflected performance on the entire questionnaire, and the 8 category safety scores reflected performance in single areas of home injury prevention (fire, burn, poison, near-drowning, aspiration, cuts/piercings, falls, and safety device use). The main outcome was degree of improvement in safety practices as assessed by improvement in safety scores.

RESULTS

The intervention group demonstrated a significantly higher average overall safety score at follow-up than the control group (73.3% +/- 8.4% vs 66.8% +/-11.1) and significant improvements in poison, cut/piercing, and burns category scores. Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices.

CONCLUSIONS

This educational and device disbursement intervention was effective in improving the home safety practices of caregivers of young children. Moreover, the ED was used effectively to disseminate home injury prevention information.

Interventions for promoting smoke alarm ownership and function

BACKGROUND

Residential fires caused at least 67 deaths and 2,500 non-fatal injuries to children aged 0-16 in the United Kingdom in 1998. Smoke alarm ownership is associated with a reduced risk of residential fire death.

OBJECTIVES

We evaluated interventions to promote residential smoke alarms, to assess their effect on smoke alarm ownership, smoke alarm function, fires and burns and other fire-related injuries.

SEARCH STRATEGY

We searched the Cochrane Controlled Trials Register, Cochrane Injuries Group database, MEDLINE, EMBASE, PsycLIT, CINAHL, ERIC, Dissertation Abstracts, International Bibliography of Social Sciences, ISTP, FIREDOC and LRC. Conference proceedings, published case studies, and bibliographies were systematically searched, and investigators and relevant organisations were contacted, to identify trials.

SELECTION CRITERIA

Randomised, quasi-randomised or nonrandomised controlled trials completed or published after 1969 evaluating an intervention to promote residential smoke alarms.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed trial quality.

MAIN RESULTS

We identified 26 trials, of which 13 were randomised. Overall, counselling and educational interventions had only a modest effect on the likelihood of owning an alarm (OR=1.26; 95% CI: 0.87 to 1.82) or having a functional alarm (OR=1.19; 0.85 to 1.66). Counselling as part of primary care child health surveillance had greater effects on ownership (OR=1.96; 1.03 to 3.72) and function (OR=1.72; 0.78 to 3.80). Results were sensitive to trial quality, however, and effects on fire-related injuries were not reported. In two non randomised trials, direct provision of free alarms significantly increased functioning alarms and reduced fire-related injuries. Media and community education showed little benefit in non randomised trials.

REVIEWER'S CONCLUSIONS

Counselling as part of child health surveillance may increase smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give-away programmes apparently reduce fire-related injuries, but these trials were not randomised and results must be interpreted cautiously. Further efforts to promote smoke alarms in primary care or through give-away programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes.