Association Between Unintentional Child Injury in the Home and Parental Implementation of Modifications for Safety

Bridging the Gap: Parental Supervision as a Mediator Between Home Environment and Unintentional Injuries in Children Under 3 Years

Objectives

Unintentional home injuries pose a serious risk to children under 3 years. While parental supervision and home environment are key factors influencing these injuries, few studies have explored the correlation between them. This study aimed to examine the relationship between home environment, parental supervision, and unintentional home injuries, and to investigate whether parental supervision mediates this relationship.

Methods

This study, conducted in Shanghai, China from June to August in 2023, using a convenience sample. Paper questionnaires were distributed to 600 parents of children, assessing unintentional injuries, parent supervision (using parent supervision attributes profile questionnaire), in-home environmental risk scale and demographic variables. A bootstrap test was applied to assess the mediating role of parental supervision.

Results

Both in-home environment risks and parental supervision were significantly related to unintentional home injuries in children under 3. Moreover, parental supervision was found to partially mediate the relationship between environmental risks and injuries, explaining 14.2% of the total effect.

Conclusion

Children under 3 were highly vulnerable to unintentional home injuries. Enhancing parental supervision may reduce the impact of environmental risks on injury occurrence. These findings offer practical guidance for health practitioners, underscoring the value of community-based interventions and tailored educational programs for injury prevention. Future research should explore intervention effectiveness and long-term outcomes.

Using online social networks to provide a parental health-education intervention for preventing unintentional injuries among children aged 0-3 years: A randomized controlled trial and social network analysis in Shanghai, China

Introduction

Unintentional injury among children represents a major public health problem. Online-social-network-based parental-health-education is a potential way to reduce child unintentional injuries. The study aimed to explore the mechanisms by which online-social-network-based health education may reduce the unintentional injuries among children aged 0-3 years.

Methods

We conducted a participant-blinded, randomized controlled, online-social-network-based health-education intervention study from March 2019 to February 2020 in Shanghai. We established four WeChat groups (two intervention groups and two control groups). For the intervention groups, a doctor's assistant regularly delivered information regarding unintentional injuries among children, and community childcare doctors answered parents' questions concerning their children's health, including unintentional injuries. Meanwhile, the control groups did not receive any information from the assistant. The study selected one intervention group and one control group and compared the ego network and whole network indicators to determine the differences between the intervention and control groups.

Results

In the intervention and control groups, 64.5% and 31.9% of the members, respectively, engaged in communication, and 1,736 and 273 records, respectively, were obtained. Regarding ego network, the doctor showed the largest network in the intervention group, and the size of the intervention group's network was twice that of the control group; the number of ties in the intervention group was nine times that of the control group. Fourteen and four parents in the intervention and control group played an active role, respectively. Regarding centrality, all WeChat groups were loose and multiple centers existed. Regarding subgroup cohesion, the intervention group had 28 cliques with 27 members, and the control group had 4 cliques with 4 members. For structural hole, 23.7% and 7.5% members in the intervention and control group actively participated in interactions, respectively, having strong control and influence over other parents; 69.2% and 59.1% members in the intervention and control group, respectively, had values of < 1.000, showing that they had strong ability to cross-jump structural holes.

Discussion

Online-social-networks-based health education interventions could enhance communication among parents, and between parents and community childcare doctors, and also shorten the social distance between them. Thus, online-social-network-based parental-health-education-intervention can be a feasible and generalizable means of preventing unintentional injuries among children.

Effectiveness of WeChat-group-based parental health education in preventing unintentional injuries among children aged 0-3: randomized controlled trial in Shanghai

BACKGROUND

Unintentional injuries to children are a major public health problem. The online social media is a potential way to implement health education for caregivers in online communities. Using WeChat, a free and popular social media service in China, this study evaluated the effectiveness of social online community-based parental health education in preventing unintentional injuries in children aged 0-3.

METHODS

We recruited 365 parents from two community health centers in Shanghai and allocated them into intervention and control groups randomly. Follow-up lasted for one year. The intervention group received and followed their WeChat group and a WeChat official account for dissemination of reliable medical information. The control group received only the WeChat group.

RESULTS

Between the intervention and control groups, changes in unintentional injuries (OR = 1.71, 95% CI: 1.02-2.87, P = .04), preventability (β = 0.344, 95% CI: 0.152-0.537, P &lt; .001), daily supervision behavior (β = 0.503, 95% CI: 0.036-0.970, P = .04), and behaviors for preventing specific injuries (β = 2.198, 95% CI: 1.530-2.865, P &lt; .001) were significantly different, and change in first-aid skills for treating a tracheal foreign body were nearly significant (P = .06).

CONCLUSIONS

The WeChat-group-based parental health education can reduce the occurrence of unintentional child injuries by improving parents' skills, beliefs, and behaviors. Online social communities promote health education and reduce unintentional injuries among children.

TRIAL REGISTRATION

ChiCTR1900020753. Registered on January 17, 2019.

Parents' attitudes as mediators between knowledge and behaviours in unintentional injuries at home of children aged 0-3 in Shanghai, Eastern China: a cross-sectional study

OBJECTIVE

Parental behaviours are important in preventing unintentional injury at home among young children. Previous research showed an inconsistent relationship between knowledge and behaviours, indicating that the mechanisms may vary for different behaviours. This study aimed to examine the mediating roles of different attitudes in the mechanism of knowledge acting on different behaviours.

DESIGN

Cross-sectional study.

SETTING

Eastern China.

PARTICIPANTS

Participants were recruited using stratified community-based sampling. A total of 488 parents of children aged 0-3 years participated in the study and 476 (97.5%) valid questionnaires were recovered.

PRIMARY OUTCOME MEASURES

Parents' knowledge, attitudes (including injury attribution, preventability and responsibility) and behaviours (including supervision behaviours, risky behaviours and providing a safe home environment).

RESULTS

The results of mediation analysis showed that the mediator variables were different for different behaviours and that all associations were positive. Parents' knowledge (β 0.19, 95% CI 0.13 to 0.24) and attitude of injury attribution (β 0.37, 95% CI 0.21 to 0.46) were directly associated with risky behaviours. Attitude of preventability was directly associated with parents' supervision behaviour (β 0.27, 95% CI 0.14 to 0.40). Parents' attitude of preventability mediated the positive association between knowledge, attitudes of injury attribution and responsibility, and supervision behaviours, as well as providing a safe home environment. In addition, the occurrence of child injuries at home was directly associated with home environment (β -0.41, 95% CI -0.82 to -0.01).

CONCLUSIONS

The current findings confirm that attitudes play varying mediating roles between knowledge and different behaviours. An important recommendation is that parents' attitudes, especially towards preventability and responsibility, need to be considered when health providers develop health education programmes targeted at improving parental supervision behaviours and providing a safe home environment.

Prevention of domestic accidents in childhood: knowledge of caregivers at a health care facility

OBJECTIVE

To analyze caregivers' knowledge about prevention of domestic accidents in early childhood and its association with education level.

METHODS

This is a cross-sectional study conducted in a Primary Care Unit in Niterói with caregivers (convenience sample) of children under 6 years old. To classify the knowledge, we adopted the Positivity Index; to verify the association between the variable "schooling" and knowledge, the chi square test was used; statistically significant results: p < 0.05.

RESULTS

A total of 256 caregivers participated; 93.5% showed adequate knowledge. In the individual items, the knowledge (100%) about prevention of accidents with sharp toys, firearms, intoxication by products stood out; and less frequently (64.5%), the knowledge of the information contained in the Child's Health Booklet. There was no statistically significant association (p = 0.237) between education and knowledge. Conclusion: The caregivers presented knowledge about the prevention of domestic accidents, and this was not associated with the level of education.

Short-term outcomes in children following emergency department visits for minor injuries sustained at home

Background

Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes.

Methods

Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression.

Results

The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97).

Conclusions

Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Systematic review of child restraint system interventions (2007-2018)

Objective: To systematically review and summarize articles evaluating the effectiveness of child restraint system (CRS) interventions targeting parents/caregivers' knowledge of, overall rates of and/or proper use of CRSs published in a recent time period.Methods: Using multiple databases, we identified peer-reviewed journal articles published between January 1, 2007 and December 31, 2018 using selected key search terms. Inclusion criteria were: (1) evaluation of an intervention/program for child passenger safety targeting a parent or caregiver of a child (2) quantitative data-based results (i.e., change in knowledge, behavior, or observed outcomes), (3) English-language, and (4) peer-reviewed journal publication. Through a systematic review process and peer consensus, n = 23 articles met inclusion criteria. References of these articles were reviewed for inclusion using the same process and n = 12 additional articles were identified.Results: A total of n = 35 articles met inclusion criteria. Of the n = 35 articles, n = 9 were randomized controlled trials (RCTs), n = 4 were cluster RCTs, n = 11 were nonrandomized trials, and n = 11 were pretest post-test studies. Types of interventions included face-to-face education (n = 26), web/video-based education (n = 8) or written educational materials (n = 1). Of the articles reviewed, n = 20 involved distribution of free or subsidized CRSs to some or all subjects. N = 20 articles involved trained CRS technicians and/or CRS installation check-points. In terms of outcomes measured, n = 3 articles assessed changes in knowledge of CRS use, n = 22 assessed changes in CRS behaviors (which includes self-report or observed behavior change), and n = 10 assessed changes in both CRS knowledge and behaviors. All articles (n = 3) that measured changes in knowledge as their only outcome demonstrated positive effects while articles measuring behavioral outcomes (self-report or observed) (n = 32) had mixed results.Conclusions: This review included a wide range of articles of heterogeneous methodologies, sample sizes, and outcomes measured. Although different approaches to CRS interventions were effective in increasing awareness and knowledge, the effects on CRS use behaviors - whether self-reported or observed - were mixed. Future research is needed to increase appropriate CRS use and reduce the burden of motor vehicle crash-related injuries among children.

Preventing unintentional injuries in US early care and education: Are state regulations sufficient?

Unintentional injuries are currently the leading cause of death among US children older than one. As many children spend significant time in non-parental child care, these injuries often occur outside of the home. This study examined US state early care and education (ECE) regulations related to injury prevention. We reviewed ECE regulations for child care centers and family child care homes through August 2018 for all 50 states and DC ("states"). We compared these regulations to six components from two national health and safety standards on injury prevention ("standards"). One state had regulations that met all six standards for both centers and homes; sixteen states had regulations that met at least five for both. Most states required child care providers to be trained in emergency preparedness (42 for centers; 38 for homes) or first aid including CPR (50 for centers; 46 for homes). Additionally, most states required providers in centers and homes to notify parents (47 and 41, respectively) and the state (40 and 41, respectively) when a child was injured; these requirements varied greatly in both the timing and manner of notification. Two-thirds of states required that providers keep copies of a completed injury form on the premises. However, few states (5 for centers, 3 for homes) required providers to take corrective action after an injury. Although most states had some injury prevention regulations, they varied greatly across states. More states should require corrective action after an injury to help prevent future injuries from occurring.