Risk and protective factors for falls on one level in young children: multicentre case-control study

Background: Childhood falls are an important global public health problem, but there is a lack of evidence about their prevention. Falls on one level result in considerable morbidity and they are costly to health services. Objective: To estimate odds ratios for falls on one level in children aged 0-4 years for a range of safety behaviours, safety equipment use and home hazards. Design, setting and participants: Multicentre case-control study at hospitals, minor injury units and general practices in and around 4 UK study centres. Participants included 582 children less than 5 years of age with a medically attended fall injury occurring at home and 2460 controls matched on age, sex, calendar time and study centre. Main outcome measure: Fall on one level. Results: Cases’ most common injuries were bangs on the head (52%), cuts or grazes not needing stitches (29%) or cuts or grazes needing stitches (17%). Comparing cases to community controls in the adjusted analyses, significant findings were observed for only 2 exposures. Injured children were significantly less likely to live in a household without furniture corner covers (adjusted odds ratio (AOR) 0.72, 95%CI 0.55, 0.95), or without rugs and carpets firmly fixed to the floor (AOR 0.76, 95% CI 0.59, 0.98). Conclusions: We did not find any safety practices, use of safety equipment or home hazards associated with a reduced risk of fall on one level. Our findings do not provide evidence to support changes to current injury prevention practice

Stages of development and injury patterns in the early years: a population-based analysis

BACKGROUND: In Canada, there are many formal public health programs under development that aim to prevent injuries in the early years (e.g. 0–6). There are paradoxically no population-based studies that have examined patterns of injury by developmental stage among these young children. This represents a gap in the Canadian biomedical literature. The current population-based analysis explores external causes and consequences of injuries experienced by young children who present to the emergency department for assessment and treatment. This provides objective evidence about prevention priorities to be considered in anticipatory counseling and public health planning. METHODS: Four complete years of data (1999–2002; n = 5876 cases) were reviewed from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an ongoing injury surveillance initiative. Epidemiological analyses were used to characterize injury patterns within and across age groups (0–6 years) that corresponded to normative developmental stages. RESULTS: The average annual rate of emergency department-attended childhood injury was 107 per 1000 (95% CI 91–123), with boys experiencing higher annual rates of injury than girls (122 vs. 91 per 1000; p < 0.05). External causes of injury changed substantially by developmental stage. This lead to the identification of four prevention priorities surrounding 1) the optimization of supervision; 2) limiting access to hazards; 3) protection from heights; and 4) anticipation of risks. CONCLUSION: This population-based injury surveillance analysis provides a strong evidence-base to inform and enhance anticipatory counseling and other public health efforts aimed at the prevention of childhood injury during the early years

Assessing Causality in the Relationship Between Adolescents’ Risky Sexual Online Behavior and Their Perceptions of this Behavior

The main aim of this study was to investigate the causal nature of the relationship between adolescents’ risky sexual behavior on the internet and their perceptions of this behavior. Engagement in the following online behaviors was assessed: searching online for someone to talk about sex, searching online for someone to have sex, sending intimate photos or videos to someone online, and sending one’s telephone number and address to someone exclusively known online. The relationship between these behaviors and adolescents’ perceptions of peer involvement, personal invulnerability, and risks and benefits was investigated. A two-wave longitudinal study among a representative sample of 1,445 Dutch adolescents aged 12–17 was conducted (49% females). Autoregressive cross-lagged structural equation models revealed that perceived peer involvement, perceived vulnerability, and perceived risks were all significant predictors of risky sexual online behavior 6 months later. No reverse causal paths were found. When the relationships between perceptions and risky sexual online behavior were modeled simultaneously, only perceived peer involvement was a determinant of risky sexual online behavior. Findings highlight the importance of addressing peer involvement in future interventions to reduce adolescents’ risky sexual online behavior

Influence of safety gear on parental perceptions of injury risk and tolerance for children's risk taking

Objectives: Risk compensation theory has been shown to relate to how individuals behave in areas such as traffic safety and consumer product safety. The present study examines whether risk compensation theory applies to parents' judgments about school age children's permissible risk taking under non-safety gear and safety gear conditions for seven common play situations. The extent of the child's experience with the activity and parental beliefs about safety gear efficacy were examined as possible moderators of extent of children's risk taking allowed by parents. Method: A telephone interview was used to obtain each parent's ratings of permissible risk taking by their child (for example, speed at which child is allowed to cycle, height allowed to climb to on a climber) under safety gear and no gear conditions, and ratings of child experience and gear efficacy. Results: Results confirmed risk compensation operated under all seven play situations, resulting in parents reporting they would allow significantly greater risk taking by their children under safety gear than non-safety gear conditions. Children with more experience with the activities were to be allowed greater risk taking, even when not wearing safety gear. Parents who believed more strongly in the efficacy of the safety gear to prevent injuries showed greater risk compensation. No sex differences emerged in any analyses. Conclusion: Results highlight the need to communicate to parents that safety gear moderates injury risk but does not necessarily guarantee the prevention of injury, particularly if children are allowed greater risk taking when wearing safety gear

Measuring parent attributes and supervision behaviors relevant to child injury risk: examining the usefulness of questionnaire measures

Objective: This study aimed to identify self report questionnaire measures of parent attributes and behaviors that have relevance for understanding injury risk among children 2–5 years of age, and test a new Parent Supervision Attributes Profile Questionnaire (PSAPQ) that was developed to measure aspects of protectiveness and parent supervision. Methods: Naturalistic observations were conducted of parents' supervision of children on playgrounds, with questionnaires subsequently completed by the parent to measure parent education, family income, parent personality attributes, attributes relevant to parent supervision, and beliefs about parents' control over the child's health status. These measures were then related to children's risk taking and injury history. Results: Visual supervision, auditory supervision, and physical proximity were highly intercorrelated, indicating that parents employed all types of behaviors in service of supervision, rather than relying predominantly on one type of supervisory behavior. Physical proximity was the only aspect of supervision behavior that served a protective function and related to children's risk taking behaviors: parents who remained close to their children had children who engaged in less risk taking. On questionnaires, parents who reported more conscientiousness, protectiveness, worry about safety, vigilance in supervision, confidence in their ability to keep their child safe, and belief in control over their child's health had children who showed less risk taking and/or experienced fewer injuries. The new PSAPQ measure was associated with specific aspects of supervision as well as children's risk taking and injury history. Conclusions: This study reveals several parent attributes and behaviors with relevance for child injury risk that can be measured via self report questionnaires, including the new PSAPQ