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）：意外伤害是美国儿童死亡和残疾的主要原因，而家庭是最常见的伤害地点。基于临床的预期指导已被证明可以改善知识和实践，但对伤害率没有影响。以家庭为基础的行为矫正更加有效，伤害减少了 26%。尽管专家认为被动干预对于减少伤害最有效，但目前还没有安装多个安全装置来减少意外住宅伤害的对照试验。此外，人们对家长监督在预防或减少住宅伤害方面的决定因素和作用知之甚少。 该项目的第一个具体目标涉及设计、实施和分析一项为期 36 个月的前瞻性随机对照试验，以减少住宅意外伤害。纵向数据的意向治疗分析将涉及对从出生到 36 个月大的儿童（居住伤害风险最高的群体）进行重复测量。在二次分析中，我们将检查父母监督水平的干预效果，以测试父母监督程度较低的家庭的效果是否更大。 第二个具体目标将研究父母监督的因果决定因素及其对意外住宅伤害的最终影响。使用监督的理论模型，在第一个具体目标中开发的数据以及经过验证的照顾者特征测量，例如母亲抑郁症（贝克抑郁量表）、父母健康控制点和儿童伤害风险行为（伤害行为检查表），将用于检验监督的决定因素。意外住宅伤害将通过整合住宅危险的数量、看护者对住宅安全的信念、看护者的控制源和抑郁、监督的数量和质量以及儿童受伤风险行为来建模。将开发一个结构方程模型，将家长监督、居住危险负担和儿童伤害风险行为结合起来，以解释居住伤害。母亲的抑郁症和其他照顾者的特征反过来会解释父母的监督。 这些研究为我提供了通过多学科方法了解伤害预防和居住监督的经验和专业知识。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发展伤害控制科学。除了评估控制住宅伤害的被动安全措施外，研究结果还将使我能够评估家长监督对意外住宅伤害的影响。该奖项所积累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提供必要的技能。