Injury Prevention in a Home Visitation Population

家访人群的伤害预防

• 批准号: 8051477
• 负责人: KIERAN J PHELAN
• 金额: $ 63.2万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-28 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8051477
• 关键词: Injury; Prevention; Home; Visitation; Population

DESCRIPTION (provided by applicant): Injury remains the leading cause of morbidity and mortality for U.S. children after the first year of life and the home is the leading location of injury for younger U.S. children. Previous trials have failed to achieve comprehensive and durable installation of home safety products to reduce exposure to injury hazards in the indoor environments of young children. Children of mothers who are eligible and enrolled in home visitation programs and children of mothers with elevated depressive symptoms have been shown to be at risk of injury in the home. Inadequate maternal supervisory behavior has been shown to increase the risk of home injury. One specific aim of this proposal is to test the efficacy of the installation of multiple, passive measures (i.e. cabinet locks, stairgates, smoke detectors, etc.) to reduce exposure to injury hazards in the homes of young children of first-time mothers and subsequent medically-attended injury. The primary outcome will be a 50% reduction in medically-attended injury due to a reduction in injury hazard exposure in children who are randomized to the intervention compared with the control group over a 24-months follow-up. A second aim is to identify sub-groups of mothers and children who benefit most from the intervention by examining potential moderators of maternal depressive symptoms, the intensity of supervisory behavior, and child temperament and activity, on the intervention and subsequent injury outcomes. We will recruit 1000 children of first-time, low-income mothers who are participating in a home visitation program. These children, at 3 to 8 months of age, will be randomized to a home safety installation intervention (experimental group) or a Reach Out and Read program (control group). The leading mechanisms of residential injury resulting in an emergency visit for US children are: cutting/piercing, struck/strike, fall, poison, and burns. Exposure to hazards related to these injury mechanisms will be modified by the comprehensive installation of safety products. At baseline and annual follow-up we will use the HOME Injury Survey, a 55-item validated instrument to quantify unintentional injury hazards in the indoor environment of homes with young children, to quantify hazards and to direct the installation intervention. This proposal will test the efficacy of an intervention to reduce exposure to injury hazards in the home and subsequent preventable and medically attended injury in young children of first-time, impoverished mothers. Residential injury results in more than 1.7 million emergency visits in children younger than 5 years of age annually in the U.S. resulting in over $3 billion in medical care costs and $800 per emergency visit. Therefore, interventions that can effect sizable reductions in childhood injury in the home could result in substantial reductions in pain and suffering while saving potentially hundreds of millions of dollars in healthcare costs. PUBLIC HEALTH RELEVANCE: Narrative This proposal will test the efficacy of an intervention to reduce exposure to injury hazards in the home and subsequent preventable and medically attended injury in young children of first-time, impoverished mothers. As residential injury results in more than 1.7 million emergency visits in children less than 5 years of age each year in the U.S. resulting in more than $3 billion in medical costs including $800 per emergency visit, interventions that can effect sizable reductions could result in substantial reductions in pain and suffering while saving potentially hundreds of millions of dollars in healthcare costs. The proposal is focused on a compelling population of households of at-risk mothers and their children less than 4 years of age.

描述（由申请人提供）：伤害仍然是美国儿童一岁后发病和死亡的主要原因，而家庭是美国幼儿受伤的主要场所。之前的试验未能实现家庭安全产品的全面、持久安装，以减少幼儿在室内环境中遭受伤害的危险。符合资格并参加家访计划的母亲的孩子以及抑郁症状加重的母亲的孩子已被证明在家里有受伤的风险。母亲监督行为不足已被证明会增加家庭伤害的风险。该提案的一个具体目的是测试安装多种被动措施（即柜锁、楼梯门、烟雾探测器等）的有效性，以减少首次母亲和母亲的幼儿在家中遭受伤害的危险。随后的医疗伤害。主要结果是，在 24 个月的随访中，与对照组相比，随机接受干预组的儿童受伤危险暴露减少，导致医疗伤害减少 50%。第二个目标是通过检查母亲抑郁症状的潜在调节因素、监督行为的强度以及儿童的气质和活动对干预和随后的伤害结果的影响，确定从干预中受益最大的母亲和儿童亚组。我们将招募 1000 名首次当母亲的低收入母亲的孩子参加家访计划。这些 3 至 8 个月大的儿童将被随机分配到家庭安全安装干预（实验组）或“接触和阅读”计划（对照组）。导致美国儿童紧急就诊的住宅伤害的主要机制是：割伤/刺伤、撞击/击打、坠落、中毒和烧伤。通过全面安装安全产品，可以改变与这些伤害机制相关的危险。在基线和年度随访中，我们将使用家庭伤害调查，这是一种经过 55 项验证的工具，用于量化有幼儿的家庭室内环境中的意外伤害危险，量化危险并指导安装干预。该提案将测试干预措施的有效性，以减少首次贫困母亲的幼儿在家中遭受伤害危险以及随后可预防和医疗护理的伤害。在美国，每年有超过 170 万名 5 岁以下儿童因住宅伤害而接受紧急就诊，导致医疗费用超过 30 亿美元，每次紧急就诊费用高达 800 美元。因此，能够大幅减少儿童在家中受伤的干预措施可能会大幅减少疼痛和痛苦，同时可能节省数亿美元的医疗费用。 公共卫生相关性：叙述 本提案将测试干预措施的有效性，以减少首次贫困母亲的幼儿在家中遭受伤害危险以及随后可预防和医疗护理的伤害。在美国，每年有超过 170 万名 5 岁以下儿童因住宅伤害而接受紧急就诊，造成超过 30 亿美元的医疗费用，其中每次紧急就诊 800 美元，因此，能够大幅减少医疗费用的干预措施可能会带来大幅减少承受痛苦和痛苦，同时可能节省数亿美元的医疗费用。该提案主要针对高危母亲及其 4 岁以下子女的家庭这一引人注目的群体。