Injury Prevention in a Home Visitation Population

家访人群的伤害预防

• 批准号: 8517779
• 负责人: KIERAN J PHELAN
• 金额: $ 53.71万
• 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/8517779
• 关键词: 4 year old; 5 year old; Accidental Injury; Accounting; Age-Months; Area; Behavior; Burn injury; Child; Child Behavior; Child Development; Childhood; Childhood Injury; Clinic; Clinic Visits; Complex; Control Groups; Cost Savings; Devices; Education; Emergency Situation; Employee Strikes; Enrollment; Environment; Equipment; Expenditure; Exposure to; Health Care Costs; Healthcare; Home environment; Home visitation; Household; Housing; Injury; Intention; Intervention; Knowledge; Life; Location; Low income; Measures; Medical; Medical Care Costs; Mentored Patient-Oriented Research Career Development Award; Morbidity - disease rate; Mothers; Outcome; Pain; Parenting Education; Poison; Population; Psychology; Public Health; Randomized; Randomized Controlled Trials; Reading; Recruitment Activity; Reporting; Research Personnel; Risk; Safety; Smoke; Surveys; Symptoms; Temperament; Testing; Time; Translating; Treatment Efficacy; United States; Visit; base; cost; cost effective; density; depressive symptoms; design; detector; effective intervention; efficacy testing; experience; falls; follow-up; group intervention; hazard; high risk; injury prevention; instrument; intervention effect; meetings; mortality; prevent; primary outcome; programs; public health relevance; success

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生命第一年后发病率和死亡率的主要原因，而房屋是年轻儿童受伤的领先地点。先前的试验未能实现全面耐用的家庭安全产品安装，以减少幼儿室内环境中受伤危害的暴露。符合条件并参与家庭探视计划的母亲的孩子，并且抑郁症状升高的母亲的孩子被证明是家庭受伤的风险。孕产妇的监督行为不足可以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（即机柜锁，楼梯，烟雾探测器等）的功效，以减少初次母亲的幼儿和随后的医学受伤的幼儿中受伤危害的暴露。主要结果将是由于与对照组在24个月的随访中相比，与对照组相比，由于随机分配干预的儿童的损伤危险暴露而减少了医疗损害50％。第二个目的是通过检查母亲抑郁症状的潜在主持人，监督行为的强度以及儿童气质和活动，在干预以及随后的伤害结果中，确定从干预中受益最大的母亲和儿童的亚组。我们将招募1000名参加家庭探视计划的首次低收入母亲的孩子。这些儿童在3至8个月大时将被随机分为家庭安全安装干预措施（实验组）或触手可及和阅读计划（对照组）。导致我们儿童紧急拜访的住宅伤害的主要机制是：切割/刺穿/罢工，跌倒，毒药和烧伤。安全产品的全面安装将改变与这些伤害机制有关的危害。在基线和年度随访时，我们将使用家庭伤害调查，这是一种经过55项验证的工具，在带幼儿的房屋的室内环境中量化无意的伤害危害，量化危害并指导安装干预措施。该提案将测试干预措施的功效，以减少房屋中的伤害危害，随后在首次贫困的母亲的幼儿中可预防和医疗受伤。在美国，每年5岁以下儿童的住院伤害导致超过170万次紧急访问，导致超过30亿美元的医疗费用和每次紧急访问800美元。因此，可能导致房屋儿童伤害大幅减少的干预措施可能会导致疼痛和痛苦大幅减轻，同时节省可能数亿美元的医疗保健费用。 公共卫生相关性：叙述这一建议将测试干预措施减少家庭危害危害的疗效，并随后在初次贫穷的母亲的幼儿中预防和医疗受伤。由于住宅伤害导致美国每年不到5岁以上的儿童紧急拜访，导致超过30亿美元的医疗费用，包括每次紧急访问800美元，这些干预措施可能会导致大量减少的痛苦和痛苦减少，同时节省数百万美元的医疗保健费用。该提案的重点是令人信服的高危母亲及其儿童不到4岁的家庭。