Search

Rationale Infancy is a time of elevated risk of injury. Past research has focused mostly on the type of injuries, leaving many gaps in knowledge about contextual information that could aid in injury prevention planning. Methods In this longitudinal study, a participant-event recording method was used in which mothers tracked their infants’ home injuries through three motor development stages (sitting up independently, crawling, and walking). A contextual analysis elucidated where injuries occurred, their type and severity, the infant’s and parent’s behaviors at the time, if the infant had done the risk behavior before and been injured, the level of supervision, and the nature of any safety precautions parents implemented following these injuries. Results Injuries occurred as often in play as in nonplay areas and were due to physically-active nonplay activities more so than play activities; mothers were often doing chores. Bumps and bruises were the most common types of injuries. As infants became more mobile, supervision scores declined and injury severity scores increased. Infants had done the risk behavior leading to injury previously about 60% of the time, with higher scores associated with parents implementing fewer preventive actions in response to injury. When mothers did implement a safety precaution, greater injury severity was associated with more modifications to the environment and increased supervision; teaching about safety was infrequent. Conclusion Implications of these results for injury prevention messaging are discussed.

Physical risk-taking is associated with increased risk of unintentional injury, a global health challenge and the leading cause of death for children in the United States. To assess risk and develop prevention programs, valid tools to assess children’s physical risk-taking are needed. No ecologically valid behavioral measures are widely available. This study describes the development and validation of the “Activity Room” to measure children’s physical risk-taking while presenting low risk of actual injury. Participants were 59 children aged 4 to 6 years old (51% female; 51% non-Hispanic White) and their parents. Children completed two tasks to assess physical risk-taking: (a) vignettes (short stories presenting risk situations) and (b) the “Activity Room” (unsupervised engagement for 5 min in a room with apparatus designed to stimulate potential physical risk-taking). Parents responded to a questionnaire concerning children’s active play behaviors. Correlational analyses evaluated convergent validity of the Activity Room risk-taking outcome. The Activity Room proved feasible; all children engaged eagerly and safely. Convergent validity was demonstrated through two strategies. First, risk-taking in the Activity Room correlated with observed play behaviors, such as climbing and falling. Second, risk-taking in the Activity Room correlated with children’s risk-taking responses in the vignettes and with parent-reported child risk-taking. Results indicate the Activity Room task is a valid technique to assess young children’s risk-taking in an ecologically valid real-world behavioral task. Incorporation of the task as an assessment tool may benefit a range of studies investigating children’s physical risk-taking behavior, risky decision-making, and child injury prevention strategies.

ObjectiveUnintentional injuries are the leading cause of death for children under 19 years of age. For preschoolers, many injuries occur in the home. Addressing this issue, this study assessed if a storybook about home safety could be effective to increase preschoolers’ safety knowledge and reduce their injury-risk behaviors.MethodsApplying a randomized controlled trial design, normally developing English speaking preschool children (3.5–5.5 years) in Southwestern Ontario Canada were randomly assigned to the control condition (a storybook about healthy eating, N = 30) or the intervention condition (a storybook about home hazards, N = 29). They read the assigned storybook with their mother for 4 weeks; time spent reading was tracked, and fidelity checks based on home visits were implemented.ResultsComparing postintervention knowledge, understanding score, and risk behaviors across groups revealed that children who received the intervention were able to identify more hazards, provide more comprehensive safety explanations, and demonstrate fewer risky behaviors compared with children in the control group (ηp2 = 0.13, 0.19, and 0.51, respectively), who showed no significant changes over time in safety knowledge, understanding, or risk behaviors. Compliance with reading the safety book and fidelity in how they did so were very good.ConclusionsA storybook can be an effective resource for educating young children about home safety and reducing their hazard-directed risk behaviors.

Purpose The current study examined the impact on children’s street crossing behaviors of not having auditory-based information about traffic when crossing streets. Method Using a fully-immersive virtual reality system, numerous indices of children’s street crossing behaviors were measured both when they had auditory-based information about traffic and when this was lacking. Results The lack of traffic sounds did not influence the inter-vehicle gap size that children crossed into but it did result in slower initiations and, ultimately, more high-risk outcomes (close calls and hits). Conclusion Traffic sounds significantly contribute to enhance children’s safety when crossing streets. Cars with reduced sounds (e.g., electric) and anything that interferes with children accessing auditory-based traffic information (e.g., wearing headphones) could increase their risk of pedestrian injury.

In most developed nations worldwide, unintentional injury is the leading cause of death for youth 1 through 18 years. Infants are a particularly vulnerable group because motor development enables increased access to hazards, yet they are poorly equipped to assess danger. The current study compared when infants possessed low versus high motor development skills and examined the frequency and type of injury-risk behaviors and parent supervision patterns, as well as modeling how supervision influences injury-risk behaviors across motor development stages and if it does so differentially for boys and girls. Applying a participant-event monitoring method, parents were trained in completing injury-risk behavior diary forms, which they did once the child could move from their seated location on the floor in some way and continued until a month after the child could walk independently. Results revealed few differences between boys and girls in risk behaviors. The overall rate of risk behaviors was greater at high than low motor development stages and there was stability in the rate of individual infant injury-risk behaviors across motor development stages. The same general types of risk behaviors occurred over motor development stages, though about 88% of risk behaviors per se were novel and unfamiliar to parents. Parents supervised boys and girls similarly. However, model testing indicated that greater supervision increased the rate of risk behaviors longitudinally for boys but not girls. Implications for preventing injuries to boys and girls during infancy are discussed.

Objectives Much research has examined how parents manage safety issues for young children, however, little is known about how they do so in the preadolescent years when children’s demand for autonomy increases. The current study focused on youth in this transition stage (10–13 years) and examined parent–child disagreements about safety, including how parents learn of these, react to these, and resolve these (Aim 1), if the parent–child relationship or sex of the child impacts these processes (Aim 2), and the nature and reasons why children intentionally keep safety-relevant secrets from their parents (Aim 3). Methods A short-term longitudinal design was applied. Parents initially completed questionnaires and, with their child, retrospectively recalled safety disagreements. Over the next month, parents tracked safety disagreements and children tracked secrets they withheld from parents. Results The findings revealed significant gender differences: Daughters were more likely than sons to spontaneously disclose safety issues to their parents, and parents were more likely to discuss the issue and provide teaching to daughters than sons. Relationship quality emerged as an important factor, particularly for boys: A positive parent–child relationship predicted increased parental teaching in response to a safety-relevant issue for boys only. Children kept secrets from their parents about safety-relevant information in order to maintain their autonomy and independence. Conclusion Parent–child disagreements about safety are influenced by the positive nature of the parent–child relationship and differ for sons and daughters.

Supervisory neglect, like all forms of maltreatment, is a complex public health issue. There is no uniform definition of supervisory neglect and this creates challenges for measurement and identifying caregivers at risk. In this article definitional and measurement issues are discussed, as well as challenges in conceptualizing prevention. The benefits of a more comprehensive assessment approach that uses multiple and varied measures and focuses on judging supervisory capacity are elucidated. Moreover, contextualizing judgements about supervisory capacity within the broader realm of parenting competency (e.g., strengths in parenting) can elucidate the breadth and nature of interventions needed to assist the child and his/her family. We suggest that the prevention of supervisory neglect is likely to achieve the greatest success when it is placed within the broader context of child health promotion and a Public Health approach that emphasizes comprehensive, ecologically-sensitive, and systematic multi-level interventions is applied. The saying goes that ‘It takes a village to raise a child’, but it may also ‘take a village to protect a child’.

Rationale Unintentional injuries are the leading cause of preventable deaths for children under 19 years of age. Infancy has been identified as a high-risk stage for injury. Throughout infancy, infants acquire increasing motor competencies but have limited capabilities to appraise danger. This longitudinal multi-method study examined parents' expectations about their infant's emerging behaviors and their in-home safety practices when their infants were at two stages of motor development: pre-mobile (i.e. sitting independently) and mobile (i.e. walking independently). Methods At each motor development stage, parents completed an interview and rating scales to report on their infants’ current and anticipated (3 months later) behavioral competencies, as well as their own safety practices and anticipated changes in these. Results and Implications Findings revealed that parents engaged in poorer supervision (reduced proximity, decreased attention) when infants were mobile than pre-mobile, while at the same time doing less to constrain their infants’ movements around the room when mobile than pre-mobile. At both stages of motor development, parents reported expecting increased unpredictability in how their infants would behave in the upcoming months, due primarily to motor development (pre-mobile infants) or cognitive curiosity (mobile infants). In response, they planned to change their safety practices by decreasing supervision and increasing teaching about safety, despite the young ages of the children. Implications for injury risk to infants and prevention initiatives focusing on parents are discussed.

Objective Unintentional injuries, the leading cause of death for American children, are caused by a range of psychosocial factors, including risk behavior. One factor that may impact child risk-taking is modeling of superhuman risk-taking from superhero media, both immediately following superhero exposure and based on lifetime exposure and engagement. Methods Fifty-nine 5-year-olds were randomly assigned to view either a 13-min age-appropriate superhero television show or a comparable nonsuperhero show. After the viewing, children engaged in three risk-taking measures: (a) activity room, unsupervised play for 5 min with assortment of apparently dangerous items that might encourage child risk-taking; (b) picture sort, 10 illustrations of children in risk situations, with participant response concerning intended risk-taking in that situation; and (c) vignettes, 10 stories presenting situations with varying degrees of risk, with participant response on intended choice. Parents completed questionnaires concerning children’s long-term superhero media exposure and individual superhero engagement (e.g., if child’s most recent Halloween costume was of a superhero). Correlations and regressions evaluated effects of immediate superhero exposure, lifetime superhero exposure, and lifetime superhero engagement on children’s risk-taking. Results Mixed results emerged. Lifetime superhero exposure was significantly related to children’s risk-taking outcomes in two bivariate (vignettes and picture sort) and one multivariate (picture sort) model. Neither immediate superhero exposure nor lifetime superhero engagement was strongly related to risk-taking. Conclusions Children’s lifetime superhero exposure may influence children’s risk-taking. Given American children’s substantial media exposure, research should continue to unpack the role of superhero media on children’s unintentional injury and other health risk behaviors.

Objective: The aims of this study were to determine if children's perception of peers' behavioral norms for crossing streets relates to their personal norms for doing so and if children's self-reports about crossing relates to their actual crossing in a virtual traffic situation. Method: Children (8–10 years, N = 86) completed questionnaires about peer's norms and their personal norms about crossing streets, and also reported on their recent crossing behaviors. These self-reports about crossing were then related to children's actual crossing behaviors measured using a fully immersive virtual reality (VR) system. Results: Children's perception of peers' behavioral norms for crossing related to their personal norms for doing so, and their norms related to their reports of how they have crossed in the past few weeks. When crossing virtual streets, children with higher scores on self-reports about risky crossing behaviors selected smaller (riskier) inter-vehicle gap sizes to cross into, showed less start delay (less time appraising traffic before starting), and experienced more hits. Conclusion and practical applications: Children's perception of peers' behavioral norms for crossing are relevant to their crossing behaviors and may be one way that peers elevate children's risk of pedestrian injury. Children's self-reports about crossing risk may be useful for identifying at-risk youth and strategically targeting interventions to these children.

Objective Boys experience more injuries as pedestrians than girls. The aim of this study was to compare how boys and girls cross streets in order to identify factors that differentially influence their injury risk as pedestrians. Methods Using a fully immersive virtual reality (VR) system interfaced with a 3D movement measurement system, various measures of children’s street-crossing behaviors were taken. Results At the start of the crossing, boys selected smaller (riskier) inter-vehicle gaps to cross into than girls. Subsequently, as they crossed, they showed greater attention to traffic, shorter start delay, and more evasive action than girls, which are strategies that could reduce risk as a pedestrian. Despite these efforts, however, boys experienced more hits and close calls than girls. Conclusion To enhance their safety as pedestrians, girls adopt a proactive approach and select larger inter-vehicle gaps to cross into, whereas boys apply a reactive approach aimed at managing the risk created by having selected smaller (riskier) gaps. Girls’ proactive approach yielded safer outcomes than boys’ reactive strategy.

Statement of Purpose The current study aimed to determine whether delivering framed safety messages (gain-framed, loss-framed, and no frame) in poster format reduced physical risk-taking behaviours when children were in a positive mood. Previous research has shown that when in an elevated positive mood state, children engage in more risk behaviours than when in a neutral mood state, which leads to greater risk of injury (Morrongiello et al., 2014). Research in this area is particularly important for school-aged children, who are becoming increasingly independent and more vulnerable to injury outside of the home (Morrongiello et al., 2013). Method/Approach 28 children (7–9 years old) were exposed to a message (gain-frame, loss-frame, or no frame (control) message) regarding play behaviours on a specific risk-taking measure (an obstacle course). Children’s risk-taking was measured before and after a positive mood has been induced, and the impact of framed safety messaging on risk-taking behaviours was examined. Results Results indicated the positive mood induction was successful and led to increased risk taking when participants were in a positive mood. Both gain- and loss- framed messages differentially counteracted this mood effect and led to reduced risk taking, but the loss-framed message reduced risky behaviours to a level significantly lower than the participants’ baseline risk-taking behaviours. Conclusions Results demonstrate that even in a positive mood, children can be influenced to engage in safer play behaviours with the use of message framing (particularly loss-framed messaging). Significance and Contributions to Injury and Violence Prevention Science Given that physical risk taking was mitigated by framed safety posters (particularly loss-framed posters) even when children were in a positive mood, framed posters may be a cost-effective and useful intervention in places like public parks, where children are often happy and inclined to engage in increased risk-taking.

Statement of Purpose Unintentional injuries are a serious concern for young children, frequently resulting in disability and death. Safety interventions that target the child as an agent of change are needed, particularly because parents cannot constantly supervise. The present study examined whether a storybook can educate about home hazards and reduce the hazard-directed risk behaviours of children aged 3.5 to 5.5 years. Methods Preschoolers were randomly assigned to the control condition (a storybook about healthy eating) or the intervention condition (a storybook about home hazards) and were required to read the assigned storybook with their mother for four weeks. Results Comparing children’s pre- and post-intervention knowledge and risk behaviours indicated that children in the intervention condition were able to identify more hazards, provide more comprehensive explanations, and demonstrate less risky behaviours, in comparison to those in the control group. Hence, the storybook improved both safety knowledge and behaviors. Conclusion Together, the findings suggest that a storybook can be an effective resource in educating young children about home safety and promoting safety practices that are likely to reduce risk of injury. Significance The findings indicate that engaging children in reading a storybook about home hazards with their parents can not only increase their knowledge but also reduce their hazard-directed risk behaviors at home.

Statement of Purpose Framed safety messages (gain- or loss- framed) can counteract the increase in risk taking that occurs when children are in a heightened positive mood. In previous research, framed safety messages have consisted of behaviourally targeted messages that emphasize avoiding risk behaviors leading to specific injuries and outcomes. The current study examined whether more general warning messages in framed contexts had a differential effect on reducing risk taking in children when in a heightened positive mood. Methods/Approach 39 children (7–9 years) were exposed to a safety message (gain- or loss-frame) regarding play behaviors on an obstacle course. Children’s risk-taking running the obstacle course was measured before and after a positive mood induction. Results Participants who were exposed to loss-framed safety messages in both the general and behaviorally targeted groups demonstrated a significantly lower level of risk taking compared to baseline, whereas participants who were exposed to gain-framed safety messages in both groups performed at baseline levels. Regardless of whether children were exposed to general or behaviorally specific messages, gain and loss messaging counteracted the increase in risk taking when in a positive mood, but loss messages produced greater reductions in risk taking than gain messages. Conclusion The results indicate that general messages can be as effective as behaviorally specific messages. Moreover, the loss-framed safety message had a greater effect on reducing risk-taking in children when in a heightened positive mood than the gain-framed safety message. Significance and Contributions The results suggest that placing an emphasis on specific risk-taking behaviors and outcomes is not necessary in order to reduce risk-taking behaviours in school-aged children during play situations. This makes this intervention approach feasible to apply in situations in which there are a variety of potential risk behaviors which makes targeting a specific one likely to limit effectiveness of the intervention.

OBJECTIVES Research shows that school-aged children are at high risk of pedestrian injury when they cross streets with peers. How peers exert their influence is unknown. Using a fully immersive virtual reality pedestrian environment, this study examined the impact of peers on children's pedestrian behaviors. METHODS 137 children were assigned either to a control, peer observer, or peer-safety or peer-risky modeling condition. Street-crossing behaviors were measured twice (baseline, postbaseline), with group comparisons (control vs. test condition) of postbaseline scores conducted. RESULTS Children who observed a peer modeling risky behaviors imitated this. No significant influences were found in the peer observation or safe modeling conditions. CONCLUSIONS Peers may elevate other children's risk of pedestrian injury through modeling risky crossings. Implications for prevention are discussed.

Background Skiing and snowboarding are popular activities among Canadian youth and these sports have evolved to include certain risk behaviours such as listening to music, using terrain parks, and video recording yourself or others. The objective of this study was to determine the prevalence of these risk behaviours and identify factors that are associated with the risk behaviours. Methods Using focus group methodology, a questionnaire was developed to capture aspects of the Theory of Planned Behaviour. A cross-sectional study was conducted where the questionnaire was administered to youth aged 13–18 during two winter seasons at two ski hills in Manitoba, Canada. Results The sample was comprised of 735 youth (mean age 14.9; 82.1% male, 83.6% snowboarding). The most common behavior was using the TP (83.1%), followed by listening to music that day (36.9%), and video recording that day (34.5%). Youth had significantly higher odds of listening to music that day if they planned to next time (OR 19.13; 95% CI: 10.62, 34.44), were skiing or snowboarding alone (OR 2.33; 95% CI: 1.10, 4.95), or thought listening to music makes skiing or snowboarding more exciting or fun or makes them feel more confident (OR 2.30; 95% CI: 1.31, 4.05). They were less likely to if they believed that music made it more difficult to hear or talk to others (OR: 0.35; 95% CI: 0.18, 0.65). Youth had significantly higher odds of using the terrain park if they believed that terrain parks were cool, challenging, or fun (OR: 5.84; 95% CI: 2.85, 11.96) or if their siblings used terrain parks (OR: 4.94; OR: 2.84, 9.85). Those who believed that terrain parks were too busy or crowded (OR: 0.31; 95% CI: 0.16, 0.62) were less likely to use them. Youth had significantly higher odds of video recording that day if they reported that they plan to video record next time (OR: 8.09, 95% CI: 4.67, 14.01) or if they were skiing or snowboarding with friends (OR: 3.65, 95% CI: 1.45, 9.18). Youth had significantly higher odds of video recording that day if they agreed that recording makes them try harder and improved their tricks (OR: 3.34, 95% CI: 1.38, 8.08) compared to those who neither agreed nor disagreed. Youth were less likely to record themselves that day if their friends did not do so (OR: 0.36; 95% CI: 0.16, 0.80). Conclusion Common predictors of engaging in risk behaviours suggest that injury prevention programs may not have to be specific to each behaviour. Some strategies for injury prevention are suggested.

Background Everyday pain experiences (minor bumps/scrapes) are common in early childhood and create frequent opportunities for socialization of pain behaviors. Nevertheless, everyday pain during the formative toddler period has been largely overlooked. Aims The aim of the current study was to describe the frequency and nature of toddlers’ everyday pain experiences, child and parent responses, and the relationship between child characteristics (age, sex, temperament) and responses. Methods Fifty-two children aged 12–32 months and their parents were observed at an indoor play facility. Using an observational checklist, trained observers recorded children’s everyday pain incidents and associated child and parent responses. Results Overall, 101 pain incidents were observed, the majority of which evoked low levels of pain and distress, which resolved after 1 min. Pain incidents occurred at a rate of 1.02 incidents/child/hour, with 81% of children experiencing at least one incident, which is higher than previous research with preschoolers and daycare staff. Common parent responses included a range of verbal (reassurance) and nonverbal (staying closer, hugging/kissing child) behaviors. Boys were more likely to not exhibit any protective behaviors. Parents were more likely to pick up older toddlers. Conclusions Future research should examine the link between self-reported and observed parent responses to child pain in everyday and clinical contexts.

There has been a great deal of research aimed at understanding the causes of child pedestrian injury. Many different methods have been employed with the goal of designing simulations that produce rigorous assessment of children’s behaviors without putting children at risk of actual pedestrian injury. Most research has assessed children’s pre-crossing decision making and extrapolated crossing outcome measures from estimates of mean walking speed. This study explores the nature and extent of measurement bias that is introduced when average walking speed is used to produce estimates of outcomes versus measuring actual in-road behavior directly. Using a within-subjects design and a fully immersive virtual reality pedestrian simulator, both measures were taken. Comparisons based on regression models revealed the extent of differences in results produced by measurement bias. Results indicated that measurement bias is produced when average walking speed is used such that hits and high risk crossings are overestimated and missed opportunities are underestimated, resulting in an overall overestimate of children’s risk for pedestrian injury. The discussion highlights how these two measurement approaches emphasize different underlying processes as determinants of child pedestrian injury risk.

Objectives Parents play an important role in keeping their children safe. However, this becomes more difficult during preadolescence as children seek greater autonomy away from the direct supervision of adults. The current study focused on preadolescent youth (10–13 years) and examined parent–child disagreements about safety, with a focus on determining if child temperament attributes moderate the relation between how parents learn of these and resolve these disagreements. Methods A short-term longitudinal design was used. Parents and children retrospectively recalled safety disagreements together and then independently completed questionnaires about these. Parents then tracked disagreements over 1 month. Results The behavioral attributes of inhibitory control and risk-taking propensity both moderated the relationships between parental source of knowledge of safety disagreements and subsequent methods of resolution. Conclusion Safety-promotion messaging for parents of preadolescents may need to be tailored based on child attributes to maximize effectiveness.

Unintentional injuries are the leading cause of death for young children and many result from them doing injury-risk behaviors in the home. There are a number of questionnaire measures of injury-risk behaviors for children 2 years and older, but none that apply during infancy. The current study addressed this gap. Parents completed the new Infant/Toddler-Injury Behavior Questionnaire when infants were pre-mobile (sitting independently) and mobile (walking independently), with diary measures of injuries and risk behaviors taken continuously throughout this period. Validated questionnaire measures of chaos and routines in the home were also completed. The IT-IBQ showed positive associations with injuries, risk behaviors, and degree of chaos in the home, and was negatively associated with family routines. The results provide evidence for criterion validity and suggest that the new measure holds promise as one that can aid in identifying infants who are likely to engage in injury-risk behaviors.

In most industrialized countries, injuries are the leading cause of death for children 1 through 18 years of age. For infants, many injuries occur in the home when they are acquiring new motor milestones. Thus, as infants' motor competencies change with development, creating increasing opportunities for them to interact with hazards, parent safety strategies need to adapt in synchrony in order to sustain a safe ecological niche and prevent injuries. The present study examined parent safety practices when infants were pre-mobile (i.e., capable of sitting independently) and mobile (i.e., capable of walking independently), with the goal being to examine how parents alter these practices in the context of changes in infant motor capabilities, what motivates these parenting changes, and how well they work to prevent injuries. For pre-mobile infants, parents often used devices to constrain their infants' movements and they did so primarily for convenience; mobile infants were seldom constrained. Supervision was a safety strategy applied at both stages, but parents maintained greater proximity for pre-mobile than mobile infants. Environmental modifications were also used for mobile infants. Parental supervision was negatively associated with injuries in the preceding month, whereas environmental modifications were positively associated with injuries. Parents at both stages rated their infants' behaviors as highly predictable but expected them to become less predictable in the near future. However, they also anticipated reducing supervision and increasing teaching during this timeframe. Implications of these findings for injury prevention are discussed.

Falls from a height are a leading cause of injury for children globally, yet few effective prevention strategies have been developed. For young children, serious falls occur mostly in the home, which implicates caregivers’ safety practices in prevention. This qualitative study examined parents’ views about this issue. Parents of 1 through 4 year olds participated in focus groups and provided opinions about in-home falls, including preventability, facilitators and barriers to falls’ prevention, and strategies for prevention. Results revealed that parents were surprised about the frequency of serious falls affecting young children. They recognized that children falling from heights (stairs and off furniture) posed risk of head injury, but varied in beliefs about preventability of falls. They emphasized teaching safe practices (stairs) and enforcing rules (prevent hazardous actions on furniture), but did not use or favor stair gates. Barriers to prevention included wanting children to be active and i...

Purpose The current study examined how wearing a heavy backpack influences children’s street crossing behaviors. Method Using a fully-immersive virtual reality system, numerous indices of children’s street crossing behaviors (7−13 years) were measured both when wearing a heavy backpack (12% of bodyweight) and when not doing so. Results A heavy backpack slowed walking speed. However, any potential increase in risk from this was counteracted by compensatory actions that included: the selection of larger inter-vehicle gaps to cross into; greater efficiency in initiating the crossing (reduced start delay); and increased walking speed when in the path of the approaching vehicle. Ultimately, there was no greater risk outcome (time left to spare) compared to children’s performance when not wearing a backpack. There were no age or sex differences. Conclusion When tested in ways that preserve perceptual-motor coupling in traffic situations, children strategically responded to maintain their safety despite wearing a heavy backpack that slowed their walking speed. Previous conclusions that a backpack increases pedestrian injury risk is likely an artifact of the testing method used.

Objective The current study aimed to develop, implement, and evaluate the S.A.F.E.R. Near Water program, an evidence-based and theory-driven intervention targeting parent beliefs relevant to keeping children safe around water. Methods A nonrandomized trial was conducted. Parents with children aged two through five years who were enrolled in lessons either at a public or private swim organization in Ontario, Canada were recruited and nonrandomly assigned to either an Intervention (N = 92) or Control (N = 150) condition. All parents completed the same questionnaire measures two times over the course of their child’s swim lesson session period, once at the beginning (preintervention) and again at the end (postintervention; approximately 9–15 weeks later). Questionnaires assessed parents’ perceptions related to supervision, child drowning risk, water safety, and optimism bias. Parents in the Intervention condition participated in S.A.F.E.R. Near Water, an educational water safety program comprising in-person seminars, informational handouts, and posters. Results The S.A.F.E.R. Near Water program was associated with increased knowledge in targeted areas and effectively communicated most of the intended messages. A series of primary regression analyses revealed that parents receiving S.A.F.E.R. Near Water demonstrated improvements in: beliefs about the value of supervision; judgments about children’s swim skills and drowning risk; and perceptions related to swim lessons and children’s supervision needs (sr2 range: 0.22–0.38). Conclusion These findings provide support for the feasibility and usefulness of a multifaceted, parent-focused, educational program delivered alongside children’s swim programming to promote closer adult supervision of children around water.

Objective Pedestrian injury is a leading cause of injury-related mortality for children. This pilot randomized controlled trial tested the efficacy of a training program to teach where and how to cross safely. Methods Using fully immersive virtual reality technology, 142 children 7-10 years of age were recruited, with 130 completing crossing measures before (pretest) and immediately after (posttest) training. Training comprised 1.5 hr, was tailored to each child's performance over trials, and focused on either where to cross (n = 44 children completed testing) or how to cross safely (n = 43); corresponding control groups comprised 22 and 21 children, respectively. Following training, children in the intervention groups completed additional tasks to test conceptual knowledge and generalization of learning. Children in the control groups spent the same time as those in training groups but played a video game that used the same game controller but provided no training in street crossing. Results The primary outcomes were errors in crossing at posttest, controlling for pretest error scores. Children in the intervention group made from 75% to 98% fewer errors at posttest than control children for all pedestrian safety variables related to where and how to cross safely, with effect sizes (incidence rate ratios) varying between 0.02 and 0.25. They also showed a generalization of what they had learned and applied this knowledge to novel posttraining situations. Conclusion Training within a virtual pedestrian environment can successfully improve children's conceptual understanding and crossing behaviors for both where and how to cross streets safely.

OBJECTIVE: The aim of this longitudinal study was to examine gender differences in children's hazard-directed behaviors when the parent was absent and determine whether parent reactions when present differentially influences boys' and girls' subsequent behaviors. METHOD: Children and parents were video recorded in their home when a contrived burn hazard ('Gadget') was within view and reach of the child and the parent was sometimes present and absent. Videos were coded for teaching- and discipline-focused reactions by parents when children approached the Gadget in the parent's presence and children's hazard-directed behaviors when the parent was absent. Data were gathered monthly for a period of up to 6 months. RESULTS: Multilevel regression analyses examining temporal relationships between parents' reactions (teaching, discipline) and children's hazard-directed behaviors when the parent was absent revealed significant gender differences. For boys, reductions in hazard-directed behaviors over time were predicted from high teaching or low discipline reactions, with low teaching and high discipline reactions maintaining injury-risk behaviors over time. For girls, reductions in hazard-directed behaviors over time were predicted from low teaching or high discipline reactions, with high teaching and low discipline reactions maintaining injury-risk behaviors over time. CONCLUSION: To moderate young boys' injury-risk behaviors, caregivers should avoid frequent discipline-focused reactions in favor of frequent teaching when the child engages in injury-risk behaviors. For girls, however, frequent discipline-focused reactions reduced injury-risk behaviors over time more effectively than frequent teaching-focused reactions that sustained girls' interest in the hazard. Implications for injury prevention are discussed. (PsycINFO Database Record Language: en

OBJECTIVE: To test the feasibility, acceptability and preliminary impact of Parents and Tots Together (PTT), a family-based obesity prevention intervention, in Canada. PARTICIPANTS: Canadian parents of preschoolers (aged 2–5 years). SETTING: Ontario Early Years centres in southwestern Ontario. INTERVENTION: A pilot randomized controlled trial involving 48 parents who received either the PTT intervention ( n = 27) or an attention-matched control home safety intervention ( n = 21). To evaluate the feasibility of PTT, we assessed participant retention and outcome evaluation completion rates. To evaluate acceptability, we assessed program attendance and parents’ responses to program satisfaction surveys. To evaluate preliminary impact, we assessed children’s body mass index (BMI) at baseline, after intervention (end of 9-week intervention) and at 9-month follow-up. As well, at each time point, parents completed surveys assessing stress and self-efficacy related to parenting, children’s sleep, activity, TV viewing and diet. OUTCOMES: Retention rates were high in the intervention (93%) and control (84%) study arms, and 87% of parents reported that they would highly recommend PTT to a friend. At 9-month follow-up, intervention parents reported lower parenting stress ( β ＾ = 15.83, 95% confidence interval [CI] -29.57, -2.07, p = 0.02) and greater self-efficacy in managing their child’s behaviour ( β ＾ = 0.16, 95% CI 0.002, 0.33, p = 0.05) than control parents. PTT had minimal influence on children’s weight-related behaviours and BMI. CONCLUSIONS: The results suggest that PTT can feasibly be implemented and tested in the Canadian context. Preliminary impact results suggest that the program may be effective in changing general parenting; however, program content should be modified to adequately address children’s weight-related behaviours.

Home injuries are a leading cause of mortality and morbidity for young children. Most programs that aim to improve their knowledge of home safety have been narrowly focused on one injury type and/or required specialized personnel for delivery. The purpose of the current study was to evaluate the effectiveness of a new Safety Detective Program that was designed to teach young children (4-6 years) about several types of home safety hazards and unsafe behaviors, with the program delivered in a classroom setting by non-experts based on manualized training. The current study used a randomized group, pre-post design to evaluate the effectiveness of the program to increase children's knowledge and understanding of home safety hazards and injury-risk behaviors to avoid. Children participated in six structured sessions, covering burns, falls, drowning, and poisoning. Each session involved play-based activities (storybook, song, and game or craft) to teach main messages about hazards and injury-risk behaviors, a take home activity, and a parent information sheet about the injury type covered that day. An individually administered photo-sort task with follow-up interview was used to measure intervention and control group participants' knowledge and understanding of injury-risk behaviors before and after program delivery. Children in the intervention, but not the control, group exhibited significant gains in their knowledge and understanding of home safety hazards and injury-risk behaviors to avoid, establishing the effectiveness of the program. This evaluation indicates that the Safety Detective Program can be delivered in classrooms without requiring specialized personnel or extensive training and with positive changes obtained. The program holds much promise as a means of improving kindergarten children's understanding of a broad range of home hazards and injury-risk behaviors that are relevant to their safety.

OBJECTIVE: This study evaluated a new online training program, Safe Sibs, aimed at improving supervision knowledge and behaviors of sibling supervisors. METHOD: Participants included older children (7-11 years) and their younger siblings (2-5 years). A randomized controlled trial design was used, with older siblings randomly assigned to either an intervention or wait-list control group. Before and after either the intervention or wait-list period, older siblings completed measures of supervision knowledge and their supervision behaviors were unobtrusively observed when with their younger sibling. RESULTS: Compared with the control group, the intervention group showed significant improvements in supervision knowledge (child development, knowledge of effective supervision practices, injury beliefs, intervention-specific knowledge) and in some aspects of supervision behavior (frequency of proactive safety behaviors to prevent supervisee access to injury hazards). CONCLUSIONS: Although adult supervision is ideal, this new program can support older children to become more knowledgeable and improved supervisors of younger ones. Language: en

Purpose Children in middle childhood are at an increased risk for injury in pedestrian environments. This study examined whether they are capable of showing evasive action (ie, adjusting crossing speed) to avoid injury when crossing streets. Methods The study used a fully immersive virtual reality (VR) system interfaced with a three-dimensional movement measurement system so that the actual crossing behaviour of 7–10-year-old children under different traffic conditions could be precisely measured. Relating outcomes to that which would have been obtained based on using the approach of estimating walking speed and assuming a constant speed provided insights into the realised benefits of the current movement monitoring VR system. Results Controlling for age and sex, children showed evasive action, crossing more quickly as traffic conditions became more risky. Using an average and assuming a constant walking speed underestimated actual walking speed, failing to capture evasive action and leading to overestimation of children being hit compared with the actual incidence of hits. Conclusions VR technology is a valuable tool for assessing child pedestrian behaviour. However, systems need to allow the child to cross the street so their level of pedestrian skill is appropriately measured. The current findings provide the first evidence that children are capable of implementing evasive action in reaction to risky traffic conditions.

Objective Because young children are often injured in their homes, identifying ways to motivate caregivers to engage in practices that promote children’s safety is important. The current RCT addresses this issue, with the primary aim being to evoke improvements in caregivers’ supervision of young children in the home. The current study used a group delivery in a community setting and assessed program impact, feasibility, and acceptance of the Supervising for Home Safety (SHS) program ‘“ a previously proven-effective program when delivered to caregivers individually (Morrongiello, Sandomierski, Zdzieborski, & McCollum, 2012; Morrongiello, Zdzieborski, Sandomierski, & Munroe, 2013). Methods Caregivers of 2–5 year olds were randomised to receive either the SHS or an attention-matched control program. Programs were delivered in a community centre using a group format (~10 per group), with delivery based on a manual. Fidelity checks were conducted weekly. Results In the SHS group only, there were increases from baseline to post-intervention in: beliefs about - children’s vulnerability to injury, caregiver preventability of injuries, and self-efficacy to do so; readiness for change in supervision; and watchful supervision. Face-to-face recruitment by staff at community organisations proved most successful. Caregivers’ satisfaction ratings were high, as was caregiver engagement (95% completed at least 7 of the 9 sessions). Conclusion The SHS program can be delivered to groups of caregivers in community settings, is positively received by caregivers, and produces desirable changes that can be expected to improve caregivers’ home safety practices. Effects were as good as when the program was delivered individually. Significance and Contribution The SHS program is the only program proven to improve caregivers’ supervision of young children in the home. The multiple delivery formats increases the implementation options and potential applicability (e.g., home visiting, parenting groups). Broad dissemination of the program is the future focus.

Purpose This intervention study examined whether exposure to a peer safety norm could counteract the increase in risk taking children show when in an elevated positive mood state. Methods Risk taking (intentions, behaviours) was measured in a neutral and positive (induced experimentally) mood state. Before completing the tasks in a positive mood, 120 children 7–10 years were exposed to either a safety norm or a control audio. Results The control audio had no effect on risk taking: children showed an increase in risk taking and intentions when in a positive compared to neutral mood, replicating past research. In contrast, exposure to the safety norm counteracted this effect: children actually showed a decrease in risk taking and intentions when in a positive compared to neutral mood. Conclusion Manipulating children’s exposure to social norms can be an effective strategy for reducing injury-risk behaviours even when they are in an elevated positive mood state. Significance This study is an important step towards identifying strategies to reduce risky play behaviours that can lead to injury in school-aged children. The influence of other children, as well as elevated mood, have both been identified as substantial risk factors for injury during the school years, so examining how peer relationships can help to mitigate the increase in risk taking when children are in a positive mood is important. The manipulation of children’s perceptions of peer social norms is a prevention strategy that can be applied across a broad age range and to numerous situations where risk behaviours are likely to lead to injury (e.g., sports). The current findings, therefore, have important implications for preventing childhood injuries.

Statement of purpose Most research exploring parental safety practices has focused on parents of children who are two years and older. Surprisingly little is known about home safety practices used for infants, and more specifically how these may change following the transition across developmental milestones. The aim of the study was to identify social-cognitive factors that affect home safety practices parents’ may use as precautionary measures to prevent six types of common injuries to infants (burns, cuts, drowning, falls, poisoning, and strangulation/suffocation/choking), and to determine if these may vary depending on an infant’s level of motor development. Methods Infants were recruited when they were pre-mobile (i.e., sitting independently) and then tracked until they could walk independently (i.e., taking at least three steps). A structured interview was conducted with parents on two separate occasions, when the infant was pre-mobile and again when they were mobile, to examine participants’ use of home safety practices. The interview requested that parents indicate which of 17 in-home safety practices they implement as a precautionary measure to prevent six types of common childhood injuries, and follow-up ratings assessed the social-cognitive factors (severity, benefit, effort, vulnerability, social norms) that motivated each practice. Results Results indicated that parent’s engagement in safety precautions varied significantly with mobility level and as a function of injury type. In addition, the social-cognitive factors that influence parental home safety practices differ for each type of injury and vary with the child’s level of mobility development. Significance Thus, intervention programs that aim to reduce different types of injury by promoting the use of parent safety practices will need to target varied social-cognitive factors. It will be important to structure prevention strategies around a child’s level of motor-development and to consider the social-cognitive factors related to particular types of injury and their perceived severity.

Past research confirms that parents extend much effort to teach their young children about safety, but little is known about this process. The present study examined mothers' use of teaching as a strategy to manage young children's risk of home injury and how this impacts children's hazard interactions. Mothers of three-year-olds completed an in-home room-by-room interview in which they identified injury hazards that concern them, reported on use of teaching to manage risk of injury from these hazards, rated children's understanding of these safety issues and compliance with behavioral guidelines regarding these safety issues, and reported on children's recent interactions with these hazards. They also completed questionnaire measures of how difficult the child is to manage and the child's typical level of risk taking. RESULTS revealed that children's understanding of safety impacted both their compliance and hazard interactions, moderating the impact of risk taking on compliance and also the impact of children's difficult-to-manage score on hazard interactions. These findings demonstrate that teaching strategies need to effectively enhance children's understanding of the safety issue in order to reduce children's risk of hazard interactions. Language: en

Motor vehicle collisions are the leading cause of death in youth aged 15–19. Research has consistently shown that driver education programs do not result in safer youth driving. Indeed, the biggest predictor of collisions involving youth is parental history of collisions. The current study examined how parental modeling of and teaching about risky driving behaviors related to youth practices within four domains of risky driving (aggressive, substance use, distracted, moving violations), and evaluated whether the Prototype-Willingness Model explains links from parent to teen driving practices. Participants (N = 432) were undergraduate students (mean age 18 years, age range 17–22 years) who had obtained their G2 driver's license within the past year; the G2 driver's license allows youth to drive alone on all municipal roads, with some restrictions on their blood alcohol level and the number of passengers they can carry. Results revealed that parental modeling was more predictive than parental teaching for all domains of risky driving examined. Youth whose parents modeled risky driving behaviors were found to be more likely to have engaged in those risky driving behaviors in the past, as well as to be more willing to engage in the behaviors in the future. The Prototype-Willingness Model was not a good fit to explain these relations. Findings from this study highlight the role parents play in the development of youth risky driving practices.

Objective This study compared boys’ with girls’ hazard-directed behaviors at home when the mother was present and absent from the room. Methods Videos were coded for how children reacted to a contrived burn hazard (‘Gadget’), maternal verbalizations to children about the hazard, and children’s compliance with directives to avoid the hazard. Children’s behavioral attributes (risk-taking tendency, inhibitory control) and maternal permissive parenting style were also measured. Results Boys engaged in more hazard-directed behaviors when the mother was present than absent, whereas girls’ risk behaviors did not vary with caregiver presence and was comparable with how boys behaved when the parent was absent. Mothers emphasized reactive communications, and boys received significantly more of these than girls. Permissiveness was associated with fewer statements explaining about safety. Children high in inhibitory control showed fewer hazarddirected behaviors and greater compliance with parent communications, whereas those high in risk-taking propensity showed more hazard-directed behaviors and less compliance. Conclusions The hazard-directed behaviors of boys and girls vary with caregiver context, with boys reacting to parent presence with increased risk taking. Depending on child attributes, different supervision patterns are needed to keep young children safe in the presence of home hazards.

BACKGROUND: Past research has shown that increased injury risk for supervisees during sibling supervision is in part due to the supervision practices of older siblings. METHODS: The current study used a photo sorting task to examine older siblings' recognition of injury-risk behaviours, their perceived likelihood of supervisees engaging in, or being injured while engaging in, these behaviours, and awareness of past risk-taking behaviours of supervisees. Mothers completed the same measures and an interview about sibling supervision in the home. RESULTS: Mothers reported that sibling supervision occurred most frequently in the kitchen, living room, and children's bedrooms, for approximately 39 min/day, and that the more time the children spent together in a room, the more frequently the older sibling supervised the younger one. The most common reasons mothers gave for why sibling supervision was allowed included beliefs that the older child knows about hazards and unsafe behaviours and that the child could provide adequate supervision. Photo sort results revealed that older siblings were able to correctly identify about 98% of risk behaviours, with these scores significantly higher than what mothers expected (79%). However, compared with mothers, older siblings were less aware of risk behaviours that their younger siblings had engaged in previously. In addition, mothers rated supervisees as 'fairly likely' both to engage in risk behaviours and to experience an injury if they tried these behaviours, whereas sibling supervisors rated both supervisee risk behaviour and injury outcomes as 'not likely' to occur. CONCLUSION: Older siblings showed good knowledge of hazards but failed to realize that younger children often engage in injury-risk behaviours. Efforts to improve the supervision practices of sibling supervisors need to include changing their perception of supervisees' injury vulnerability and potential injury severity, rather than targeting to increase knowledge of injury-risk behaviours per se. Language: en

Background Despite advances in prevention, injuries remain a leading cause of morbidity and mortality among children. Supervision is often cited as an important determinant of child safety. Aims/Objectives/Purpose Assess the association between caregiver supervision and acute unintentional injury in young children. Methods We interviewed parents of children ≤age 4 whose injuries required Emergency Department (ED) treatment or admission to the hospital, to collect information on supervision (proximity, attention, continuity) at the time of injury and 1 h before the injury). Hospital admission was a proxy for injury severity. Case-crossover analyses were conducted. Results/Outcomes Interviews were completed by 222 participants; 50 (23%) were parents of children admitted to the hospital. For each dimension of supervision assessed, children admitted to the hospital were at higher risk of injury; proximity was associated with the highest risk. Compared to 1 h prior to injury, children were more likely to be beyond reach of their caregiver at the time of injury (OR 11.5, 95% CI 2.7 to 48.8 for children admitted to the hospital; OR 2.9, 95% CI 1.8 to 4.9 for children treated in the ED). Injury risk was highest for children with the least supervision; the magnitude of this association was higher for children admitted to the hospital (OR 11.5, 95% CI 2.7 to 48.8) than for children treated in the ED (OR 3.5, 95% CI 2.0 to 6.0). Significance/Contribution to the Field Less vigilant supervision increases risk of serious injury in young children. Proximity may be the most important supervision dimension for assessing child injury risk. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text of the published article is available: Inj Prev 2015;21:e63-e70 doi:10.1136/injuryprev-2013-041128

Teaching safety rules is a common practice but little is known about this. Fifty-eight parents of children 2 to 2.5 or 3 to 3.5 years of age reported on the safety rules they have, the factors that prompted these rules, the strategies used to teach these rules, and how they react to noncompliance with these rules. Results revealed more safety rules for children in the older group than the younger group, and greater emphasis on teaching the rule than teaching the basis for the rule at younger than older ages. Only about half the rules restricted the child from doing the risk behavior completely, whereas the remaining rules allowed for the behavior under certain circumstances. Parents assumed safety rules would prevent injuries and mostly implemented rules in reaction to evidence of injury risk. Parents equated noncompliance with not understanding, assuming that if children understood they would comply. Implications for childhood injury risk are discussed.

Falls from playground equipment during play are a leading cause of injury for elementary school children. Changes to playground design and surfacing materials can reduce injury risk. However, there is also a need for intervention programs to reduce risky play behaviors by children that are associated with falls. The Cool 2 Be Safe program was developed based on past research that identified effective strategies for targeting injury beliefs that predict risk behaviors on playgrounds among individually tested elementary school children. The current study evaluated the effectiveness of delivering these activities as an integrated program and in a group format in after school programs organized by Boys and Girls Clubs of Canada. The clubs were provided all program and extensive training materials, and a webinar training session was conducted for facilitators. Observations of sessions provided data on fidelity of program delivery. Pre- and post-intervention data assessing children's injury beliefs were collected via survey, with children participating in four structured activity sessions in small groups between premeasures and post-measures. The training materials proved to be quite effective; observational data indicated 88 % compliance with the procedures. Comparing children's pre- and post-responses revealed positive changes in injury-risk beliefs that have been shown to predict reduced risk taking on playgrounds. This initial evaluation suggests that the Cool 2 Be Safe community program holds much promise as a means for addressing the issue of fall-risk behaviors by elementary school children on playgrounds.

OBJECTIVE: The present study examined the effect of child gender and maternal depressive symptoms on routine supervisory practices of mothers longitudinally. METHOD: Self-report supervision practices were obtained at various time points from 3 months through 3 years of age. RESULTS: From 3 to 36 months, the quantity of time mothers reported supervising decreased from 7.1 to 6.3 hours, and the proportion of time spent in an intense style decreased from 63 to 46%, whereas that spent in a peripheral style increased from 14 to 32%. Mothers reported more time supervising girls and a greater proportion of this was in an intense style. Mothers with elevated depressive symptoms reported more time supervising but a lower proportion in an intense style. CONCLUSION: Over the first 36 months of life, routine patterns of supervision change and these vary as a function of maternal depression symptoms and child gender. Implications for child injury risk are discussed. Language: en

Objectives Young children are at particular risk for dog bite injuries. This study examined parents’ supervision of and reactions to their children in the vicinity of an unfamiliar dog. Methods A pre/post intervention/control group randomized design assessed whether exposure to The Blue Dog, a dog bite prevention and education program, positively impacted parent behaviors. Results No group differences in pre or post-intervention measures emerged, indicating that The Blue Dog did not evoke improvements in parents’ behaviors. Generally, parents showed risky reactions and encouraged children to interact with the dog, even though they knew very little about the dog's safety or disposition. Supervision measures (proximity, watching) remained unchanged (watching) or more lax (proximity) across sessions. Conclusions The results highlight the importance of targeting parent behavior, not just child behavior, in programs that aim to reduce risk of childhood dog bites. The Blue Dog did not effectively change parent behavior.

These are commentaries on a Cochrane review, published in the issue of EBCH, first published as: Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD005014. DOI: 10.1002/14651858.CD005014.pub3. Language: en