Childhood Residential Injury and Caregiver Supervision

儿童住宅伤害和看护者监督

• 批准号: 7047790
• 负责人: KIERAN J PHELAN
• 金额: $ 15.38万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-01 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7047790
• 关键词: caregivers; clinical research; clinical trials; household; human subject; infant human (0-1 year); injury prevention; longitudinal human study; mother child interaction; patient oriented research; preschool child (1-5); questionnaires

DESCRIPTION (provided by applicant): Unintentional injury is the leading cause of death and disability in US children, and the home is the single most common location of injury. Clinic-based anticipatory guidance has been shown to improve knowledge and practices, but it has had no effect on injury rates. Home-based, behavior modification has been more effective, resulting in a 26 percent reduction in injuries. Although experts believe passive interventions are most effective at reducing injuries, there are no controlled trials of installing multiple safety devices to reduce unintentional residential injury. Furthermore, the determinants and effects of parental supervision in preventing or reducing residential injury are poorly understood. The first specific aim of this project involves the design, conduct, and analysis of a prospective 36-month randomized controlled trial to reduce residential unintentional injury. The intention-to-treat analyses of the longitudinal data will involve repeated measures, following children from birth to 36 months of age, the group at highest risk for residential injuries. In secondary analyses, we will examine the effect of the intervention by levels of parental supervision to test whether the effect was greater for households with lower parental supervision. The second specific aim will examine causal determinants of parental supervision and its ultimate effects on unintentional residential injury. Using a theoretical model of supervision, data developed in the first specific aim together with validated measures of caregiver traits such as maternal depression (Beck Depression Inventory), parental health locus of control, and child injury-risk behavior (Injury Behavior Checklist), will be used to examine determinants of supervision. Unintentional residential injury will be modeled by integrating the quantity of residential hazards, caregiver beliefs about residential safety, caregiver locus of control and depression, the quantity and quality of supervision, and child injury-risk behavior. A structural equation model incorporating parental supervision, the burden of residential hazards and children's injury-risk behaviors to explain residential injury will be developed. Maternal depression and other caregiver characteristics will in turn, explain parental supervision. These studies provide me with experience and expertise to understand injury prevention and residential supervision through a multidisciplinary approach. This proposal will leverage the support and resources of the Cincinnati Center for Children's Environmental Health to further the science of injury control. In addition to assessment of passive safety measures to control residential injury, the results will enable me to assess the effect of parental supervision on unintentional residential injuries. The experience and data developed in this award will provide the skills necessary to become an independent clinical investigator in the areas of childhood injury control and supervision.

描述（由申请人提供）：无意的伤害是美国儿童死亡和残疾的主要原因，房屋是受伤的最常见位置。已显示基于诊所的预期指导可以改善知识和实践，但对伤害率没有影响。基于家庭的行为修改更有效，导致伤害减少了26％。尽管专家认为被动干预措施最有效地减少了伤害，但是没有对安装多种安全装置来减少无意居民伤害的对照试验。此外，对预防或减少住宅损伤的父母监督的决定因素和影响知之甚少。 该项目的第一个具体目的涉及一项前瞻性36个月随机对照试验的设计，行为和分析，以减少住宅无意伤害。纵向数据的意向性治疗分析将涉及重复措施，因为儿童从出生到36个月大，该组受到住院伤害的最高风险。在次要分析中，我们将通过父母监督的水平来检查干预措施的影响，以测试对父母监督较低的家庭的影响是否更大。 第二个特定目的将检查父母监督的因果决定因素及其对无意间造成损害的最终影响。使用理论的监督模型，将在第一个特定目标中开发的数据以及经过验证的护理人员特征的措施，例如母体抑郁症（Beck抑郁量表），父母的健康基因座位和儿童伤害风险行为（伤害行为清单），可用于检查监督的确定因素。无意的住宅伤害将通过整合住宅危害的数量，对住宅安全的信念，控制和抑郁症的看法，监督的数量和质量以及儿童伤害风险行为来建立模型。一个结构性方程模型，其中包含父母监督，住宅危害的负担以及儿童的伤害风险行为，以解释住宅受伤。孕产妇抑郁症和其他照顾者的特征将依次解释父母的监督。 这些研究为我提供了经验和专业知识，可以通过多学科的方法来了解预防伤害和居住的监督。该提案将利用辛辛那提儿童环境健康中心的支持和资源来进一步控制伤害科学。除了评估被动安全措施以控制住宅伤害外，结果还将使我能够评估父母监督对无意间住宅伤害的影响。该奖项中开发的经验和数据将为成为儿童伤害控制和监督领域的独立临床研究者所必需的技能。