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Background: Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all Sudden Unexpected Infant Deaths (SUID) and are leading causes of post-neonatal deaths. Risk reduction strategies, including supine sleep position and safe sleep environment, are critical for prevention. Teen mothers, especially those in rural, poor, southern states, are at higher risk due to low compliance with recommendations. Methods: We will conduct a randomized trial to test a tailored educational intervention on the sleep-related safety behaviors of teen mothers. In one study arm, the intervention will include not only the teen mothers but also senior caregivers (SCGs) to assess the influence they have in the decision-making of young mothers regarding infant health and safety. Our hypotheses are H1) teen mothers exposed to intervention will be more likely than controls to adopt safe sleep practices, and H2) teen mothers will be more likely to use those practices when they and their mothers or other significant female senior caregivers also participate in safe sleep education. Discussion: Better understanding of the mediating role of female SCGs in the health decision of young mothers for their children may have implications for interventions addressing important health problems.

Firearms contribute substantially to leading causes of death among US children ages 10-19 (suicide and homicide). Safe storage of guns is important but poorly adopted. This study sought to understand knowledge, attitudes, beliefs, and firearm storage practices among parents living in households with firearms. Focus groups (FG) were conducted with gun-owning parents/guardians in three US states with high firearm ownership. Participants also completed an anonymous survey which included demographic characteristics, previous gun education, purpose of gun ownership, and storage practices. Eight FG were conducted with 57 parents. 74% of participants stored at least one firearm unlocked, with many loaded. Overall risk perception for firearm injury was low. Many participants believed modeling responsible use within the family would demystify the presence of a firearm and decrease accidental shootings. There was strong perception that safe storage interferes with personal protection needs, especially for handguns. Trigger locks were considered a nuisance and rarely used. Parents were confident in their youth's ability to handle guns safely and did not believe that safe storage would deter suicide. Preferred messengers for safe storage education were military or law enforcement rather than physicians. Participants advocated for safe storage education paired with hands-on use education. Gun-owning parents supported safety education and endorsed education from nonmedical sources. Education about suicide prevention may improve adoption of safe storage by parents. These results will inform the development of a firearm safe storage campaign with improved acceptability for communities with high firearms use and ownership.

Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: white infant mortality remaining at 2:1 for the last decade. Smartphone technology provides a convenient and accessible tool for injury prevention anticipatory guidance among at-risk communities.Materials and Methods:A convenience sample of pregnant teen mothers who own a smartphone. During a 1-month postnatal home visit, a safe sleep environment survey was administered, infant sleep practices were observed, and mothers trained to take and submit standard infants’ sleep environment photographs. Photographs were independently assessed for inter-rater reliability (IRR) across five sleep safety domains (primary outcome): sleep location, surface, position, presence of soft items, and hazards near the sleep area. Expert and novice coders IRR was measured using Cohen’s kappa coefficient (K). Sleep safety correlation between photographs and observation, and parent report and observation was determined.Results:Sixteen (57.1%) mothers completed the home visit. Most parents reported infants sleeping supine (78.5) in parents’ bedroom (85.9%). Photographs demonstrated sleep position, soft items without the baby present, and hanging toys had perfect agreement across all three coder pairs. Safe sleep experts’ IRR demonstrated perfect agreement for sleep location, position, and soft items. While 83.8% of parents were observed putting their infants down to sleep on their back, 78.5% of parents reported doing the same and 82.4% of the photographs demonstrated supine infant sleep position.Conclusion:Using photographs, coders can reliably categorize some key infant sleep safety aspects, and photograph sleep safety is comparable to parent report and direct observation.

Purpose Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all Sudden Unexpected Infant Deaths (SUID). The American Academy of Pediatrics (AAP) recommendations describe the safest environments to protect infants. This study compared parent responses on the Newborn Sleep Safety Survey and observational assessments ( N = 72) of infant sleep environments in families thought to be at high-risk for non-compliance with AAP recommendations. Design and Methods A naturalistic study of participants enrolled in two home visitation support programs was used. Observed risks ranged from 36.6% (never use pacifier) to 4.3% (never use firm mattress). Results Results comparing report to observation demonstrated acceptable concordance. Five items had fair concordance (Kappa > .4), four showed moderate concordance (Kappa > .6), and one excellent concordance (Kappa > .8). Although direct observation of safety behaviors is the gold standard in the injury prevention field, direct observation is logistically difficult, time consuming, and costly. Conclusions Research and interventions aimed at a reduction of Sudden Infant Death Syndrome (SIDS) and suffocation require accurate assessment of the infant sleep environment. This study provides acceptable evidence for the use of the Newborn Sleep Safety Survey as an alternative to direct observation to assess parent adherence to recommendations. Limitations are discussed. Practical Implications This study provided evidence of the usefulness of the Newborn Sleep Safety Survey , a parent survey of infant sleep environments. This tool will provide medical and research professionals a reliable, inexpensive tool to evaluation of the quality of sleep environments using a standard definition.

The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity.Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity.Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests.The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching).TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.

Background Firearms contribute substantially to leading causes of death to US children ages 10–19 (suicide and homicide). Approximately 38% of US households have a firearm and many homes with children Objective To better understand knowledge, attitudes, beliefs, and firearm storage practices among youth living in households with firearms to support development of interventions to lower unsupervised child access to firearms. Methods We conducted focus groups (FG) of youth living in households of gun owners residing in 3 US states with high firearm ownership rates. Moderator guides framed discussions that included participant views about firearm storage, suggestions for messaging and dissemination methods for a safe storage campaign. Data were managed using HyperRESEARCH (v2.8.3). Transcribed data were coded to identify important themes. Prior to FG, subjects completed an anonymous survey to record demographic characteristics, gun ownership, use, and storage practices. Results 6 FG were conducted, including 30 youth ages 12–17 living in homes with firearms. Practical firearms training including safe storage information was endorsed. Acceptable sources of safety information were military and law enforcement. Youth did not support prevention messages in medical care contexts. Youth reported detailed awareness of firearm availability in their homes and violations of family rules about gun handling. Means restriction was not perceived as an effective way to prevent suicide and other gun injury. Conclusions Youth in households with gun owning parents supported safety education but their perception of risk from firearms in their homes was low. Firearm safety counselling was most acceptable from nonmedical sources and in context of ongoing training programs. Further education about the value of lethal means restriction is needed storage by this population.

OBJECTIVES/SPECIFIC AIMS: To explore rural African American parents’ and their community advisors’ perspectives on the Safety Baby Shower’s acceptability, feasibility, and adaptability. METHODS/STUDY POPULATION: Collaborating with a local community organization, we explored community advisors’ and expectant women’s SBS experiences to understand intervention delivery and adoption in a rural underserved community (RUC). The Consolidated Framework for Implementation Research guided our data collection and analysis using focus groups and key informant interviews. We used directed content analysis to generate themes and sub codes. RESULTS/ANTICIPATED RESULTS: Five focus groups (21 participants) and one key informant interview were conducted. Identified barriers that hinder feasibility and acceptability included resources, time/ flexibility, intervention location, cultural norms and beliefs, and the lack of a birthing hospital in the county. “Baby proofing”, “reinforcement products” and “teaching sleep safety on the same day as infant clinical appointment” are expectant mothers’ exemplars for what comes to their minds when asked to think about safety baby showers. To improve feasibility, both community advisors and expectant mothers suggested adaptations ranging from decentralizing or rotating intervention location, using different delivery sites such as churches, scheduling intervention outside business hours, to incorporating intervention into school health fairs and barbeque events. Social media emerged as a facilitator, and integrating safe sleep education into personal baby showers emerged as an implementation strategy. DISCUSSION/SIGNIFICANCE OF IMPACT: The community advisors and expectant mothers identified a wide spectrum of potential adaptations that have potential to improve safe sleep knowledge and practices. In the next study phase, identified themes will inform intervention adaptation and suggested implementation strategies will support uptake of the adapted SBS. Identifying transformative implementation strategies and conducting a community-informed SBS adaptation using a collective decision-making process between intervention experts and local community partners will support improved safety baby shower delivery, adoption and sustainability in RUCs.

Current American Academy of Pediatrics recommendations regarding transition from child safety/booster seat to adult safety belt use indicate that children should be at least 4 feet 9 inches, 8 years old, or 80 pounds. Proper fit in the vehicle seat, assessed with a five-point fit test, should also be met. Although most children reach 4 feet 9 inches around age 8 years, each child and vehicle presents a unique combination; thus a child may not fit appropriately in all vehicle types using only the 4 feet 9 inches requirement.We enrolled children, aged 7 years to 12 years, into our study. Height, weight, and demographic data were obtained. A Child Passenger Safety Technician then performed the five-point fit test in each of a uniform lineup of five vehicles. Data were collected on fit in the standard vehicle seat and also in a booster seat. We set 90% as the threshold proportion of children who meet all criteria for proper fit to validate current recommendations of a height of 4 feet 9 inches.Data were collected on 388 children. The percentage of 90% proper fit was met in the compact car and small sport-utility vehicle (SUV). However, only 80 (77%) of 104 students (p0.0001) that were 4 feet 9 inches or higher fit properly in the large SUV, only 87 (83%) of 105 students (p = 0.02) fit properly in the pickup truck, and only 91 (89%) of 102 students (p = 0.74) fit properly in the minivan.Substantial proportions of children meeting current height guidelines for an adult seat belt do not meet safety requirements for fit, especially in larger, commonly used vehicles (large SUVs and trucks). This emphasizes the need for evaluation of fit by a trained personnel and/or development of standard back seat dimensions in all vehicles for maximum safety.Epidemiologic study, level III; Therapeutic study, level V.

Statement of Purpose To pilot a protocol that evaluates the safety of an infant’s sleep environment using photographs taken with a smartphone. Methods Participants were a convenience sample of teen mothers aged 13 to 19 years who owned a smartphone and who had an infant younger than 4 months of age. A safe sleep environment survey was administered during a postnatal home visit. During the visit, teen mothers were trained to take and submit standard photographs of their infant’s sleep environment. One month after the home visit, teen mothers were prompted via text message to send photographs of the infants’ current sleep environment. Study staff independently assessed the photographs across five domains of infant sleep safety, including sleep location, surface, position, presence of soft items, and hazards near the sleep area. The primary outcome was inter-rater reliability between coders, measured using Cohen’s Kappa coefficient (ae∼). Results Three coders assessed photographs from nine participants. The inter-rater reliability was strong for four of the five domains assessed: sleep location Kappa (ae∼)=0.74, sleep position ae∼=1.00 and sleep surface ae∼=1.00. The inter-rater reliability for recognition of various soft items in the sleep area varied from ae∼=0.69 for loose bedding to ae∼=1.00 for pillows. Identification of other hazards near the sleep area (cords, blinds, etc) had a lower inter-rater reliability (ae∼=0.42). Conclusions Using photographs, coders can reliably categorise some key safety aspects of infant sleep areas, but further study is needed to fully characterise sleep environments using photographs alone. Development of a detailed coder guide is planned for use in a larger study. Significance and Contributions to Injury and Violence Prevention Science Photography has potential utility in the evaluation of injury prevention interventions as an alternative to labour intensive and intrusive home visits.

BACKGROUND: Booster seats reduce mortality and morbidity for young children in car crashes, but use is low, particularly in rural areas. This study targeted rural communities in 4 states using a community sports-based approach. OBJECTIVE: The Strike Out Child Passenger Injury (Strike Out) intervention incorporated education about booster seat use in children ages 4-7 years within instructional baseball programs. We tested the effectiveness of Strike Out in increasing correct restraint use among participating children. METHODS: Twenty communities with similar demographics from 4 states participated in a nonrandomized, controlled trial. Surveys of restraint use were conducted before and after baseball season. Intervention communities received tailored education and parents had direct consultation on booster seat use. Control communities received only brochures. RESULTS: One thousand fourteen preintervention observation surveys for children ages 4-7 years (Intervention Group [I]: N = 511, Control [C]: N = 503) and 761 postintervention surveys (I: N = 409, C: N = 352) were obtained. For 3 of 4 states, the intervention resulted in increases in recommended child restraint use (Alabama +15.5%, Arkansas +16.1%, Illinois +11.0%). Communities in 1 state (Indiana) did not have a positive response (-9.2%). Overall, unadjusted restraint use increased 10.2% in intervention and 1.7% in control communities (P = .02). After adjustment for each state in the study, booster seat use was increased in intervention communities (Cochran-Mantel-Haenszel odds ratio 1.56, 95% confidence interval [1.16-2.10]). CONCLUSIONS: A tailored intervention using baseball programs increased appropriate restraint use among targeted rural children overall and in 3 of 4 states studied. Such interventions hold promise for expansion into other sports and populations. Language: en

Children ages 8-12 years, also called "Tweens," demonstrate a number of risk factors for motor vehicle injury, including lack of restraint use and front seating position, yet few interventions have targeted this group. We implemented a school-based educational intervention designed to increase awareness and encourage safer transportation of these children.A local school collaborated with the study team to develop educational materials based on the school mascot and allowed use of school-based media (bulletin boards, closed circuit TV, and newsletters) to deliver key messages about restraint use and back seating position. Selected students participated in delivering the message and in evaluation activities, increasing peer support for the program. Evaluation consisted of surveys of reported and observed restraint use and rear seating for children and restraint use for parents before and after the educational intervention.School support for the program was excellent and student enthusiasm was high. Parent awareness of safe positioning for children improved, with parents endorsing seat belts alone versus seat belts with a booster seat for children ages 5-8 falling from 37% to 25% (p0.004). Child report of restraint use increased from 78% to 89% (p0.001). Reported exposure to the campaign messages was high with 77% of parents and 89% of students recalling the campaign at the end of the year. Observed restraint use for both adults and children was somewhat lower than reported use. Restraint use by parents was about 80% both before and after the intervention. Restraint use by children increased from 71% to 91% (0.001). No changes were noted in front seating position for children.Short term positive changes in observed restraint use and knowledge about safer transportation of children were encouraging. Further study of the program, including a controlled study of the intervention, are needed to demonstrate longer term effectiveness.

Objective: To discuss the successes and challenges associated with the implementation of a post-traumatic stress disorder (PTSD) screening tool in two pediatric emergency departments (ED). Methods: The STEPP screening tool has been developed previously on an inpatient population of motor vehicle trauma patients. It was applied here to the general ED population at two different pediatric trauma centers. Nurse screeners were trained and a convenience sample of patients with unintentional injuries who met study criteria were screened in the ED. Feedback from nurse screeners was obtained. Results: The process of implementing a screening tool to identify patients and their families significantly at risk for PTSD symptomatology presented some barriers, but overall acceptability of the process was high for both the emergency department staff and the patient. Recommendations for others considering implementation of screening programs in the ED are offered. Conclusions: Future research using screening protocols in the ED should, in their design, attempt to capitalize on the successes identified in the current protocol and circumvent barriers also encountered.

BACKGROUND: The burden of all-terrain vehicle (ATV)-related injuries and deaths in the pediatric population has increased dramatically during the past decade. Brain injuries represent a large proportion of these injuries and are the leading cause of death among those injured. Despite the risk involved in operating these vehicles, helmet use remains low. The aim of this study was to identify and understand common barriers and facilitators to helmet use among ATV users. METHODS: Focus groups were conducted in Arkansas with adolescent and adult ATV users to discuss ATV and safety equipment use. Standard methods of qualitative research were used to interpret focus group data. Moderator guides were framed using the Health Belief Model of behavior change. Transcript-based analysis was used, and data were managed using HyperRESEARCH (version 2.8.3). The transcribed data were coded to identify important themes. RESULTS: Eleven focus groups were conducted with 58 participants, who discussed ATV use patterns, current safety practices, and barriers to helmet use. Major themes were a lack of perceived risk with operating an ATV and lack of perceived severity of injury resulting from ATV crashes. Participants discussed other barriers to helmet use including helmet discomfort and inconvenience. Suggested solutions included passage of helmet laws for riders younger than 18 years, helmet redesign, and development of visual aids/crash simulations to convey the dangers of ATV use. CONCLUSION: This study identifies a gap in risk perception among ATV users. Injury prevention should focus on education about risks of engaging in unsafe ATV behaviors and the danger of the vehicles themselves. Language: en

An ATV (All-terrain vehicle) is a gasoline powered, fast moving off road vehicle often used for farming and industrial activities as well as recreational activities. The popularity of this type of vehicle has increased over the last decade with more than 10 million in use today. Most ATVs are designed for only single rider even though the seat of the ATV may appear big enough to carry a passenger. The presence of an additional person on a single person ATV greatly affects its dynamic handling characteristics. This change increases the risk of a crash and subsequent injuries to both riders. ATV crashes involving climbing and descending on steep hills are common. Lateral rollover crashes are often the result of riding an ATV at a high speed on uneven terrain. The presence of passenger on a single person ATV during these conditions changes the rider impact kinematics and resulting injury outcome, as the ATV behaves differently in the presence of an additional person. The computational model of a single person, adult-sized ATV, as developed previously for the study of child injury prevention, was used for this study. The multi-body computational model of this ATV was developed using biodynamic code MADYMO. This computational model was validated against the laboratory test for its dynamic and suspension characteristics. The tilt table test and the drop test were employed to compare the computational model result. This computer model was used to simulate the crash mechanism involving climbing and descending steep hills with two people on the ATV. This model was also used to simulate the lateral rollover of ATV with two people. The rider and the additional passenger on this single rider ATV were modeled using a 50th percentile male and a 5th percentile female. The two rider simulation was compared with single rider simulation for similar terrain and ATV speed to gain insight about the influence of this additional passenger weight on the crash kinematics of the ATV and the rider. These simulations will also be used in the future to generate more visually dramatic videos for educational intervention for ATV safety programs and other injury prevention activities.Copyright © 2012 by ASME

Background Millions of all-terrain vehicles (ATV) are used around the world for recreation by both adults and youth. This increase in use has led to a substantial increase in the number of injuries and fatalities each year. Effective strategies for reducing this incidence are clearly needed; however, minimal research exists regarding effective educational interventions. Objective This study was designed to assess rural ATV riders9 preferences for and assessment of safety messages. Methods 13 focus group discussions with youth and adult ATV riders were conducted. 88 formative research participants provided feedback on existing ATV safety materials, which was used to develop more useful ATV safety messages. 60 evaluative focus group participants critiqued the materials developed for this project. Results Existing ATV safety materials have limited effectiveness, in part because they may not address the content or design needs of the target population. ATV riders want educational and action-oriented safety messages that inform youth and adult riders about their responsibilities to learn, educate and implement safety behaviours (eg, appropriate-sized ATV, safety gear, solo riding, speed limits, riding locations). In addition, messages should be clear, realistic, visually appealing and easily accessible. Newly designed ATV safety materials using the acronym TRIPSS (training, ride off-road, impairment, plan ahead, safety gear, single rider) meet ATV riders9 safety messaging needs. Conclusions To reach a target population, it is crucial to include them in the development and assessment of safety messages. Germane to this particular study, ATV riders provided essential information for creating useful ATV safety materials.

Better insights into ATV crash mechanisms are needed to facilitate effective prevention strategies. Rollover crashes and resulting injuries represent major problems associated with ATVs. These problems are aggravated with the rider is a young child, since all ATVs are rider active machines. Serious injuries associated with child use of adult ATVs are an increasing problem in the United States and other countries. The computational technique is used to develop a detailed adult size ATV. The computational model is developed using the biodynamic code MADYMO. Laboratory tests are conducted on the ATV to extract the dynamic characteristics of the ATV. The ATV model developed features a detailed suspension system. The computational model confidence is increased using a digitized surface to create the rigid body model. The computational ATV model is validated for its lateral stability using a laboratory tilt table test. The suspension system is validated using a drop test on a rigid floor. This validated model is used to simulate and understand crashes and parameters affecting the injury outcome. A Hybrid III six year old dummy is used during the laboratory tilt table test and for initial crash simulations. This paper demonstrates the methodology used to develop a crash analysis for an ATV driven by a six year old child. The computation model is used to recreate a forward flip rollover crash scenario.Copyright © 2011 by ASME

Objective: A variety of educational efforts, policies, and regulations have been adopted to reduce all-terrain vehicle (ATV) injury in children. Despite this, ATV use by children continues and serious injuries are common. The purpose of this study was to investigate the knowledge, practices, and beliefs of ATV users to help develop effective educational strategies to promote safer ATV use. Design: Focus groups were conducted to characterize participant ATV use and safety awareness as well as to explore avenues for prevention. Feedback on draft ATV safety public service announcements was elicited. Themes of transcribed focus group data were summarized. Setting: Rural state with high ATV use and injury rates. Subjects: Adult and adolescent ATV users. Interventions: None. Main outcome measures: Summaries of focus group discussions. Results: ATV riders frankly discussed current use and safety behaviors and were aware of some ATV risks. Youths felt that age specific regulation was unlikely to be a helpful strategy. Participants endorsed messages demonstrating graphic consequences as likely to get the attention of young riders regarding risks. Educational settings were suggested, including hunter and driver safety classes. Conclusions: Efforts to improve ATV safety awareness should clearly show pediatric ATV injury risk and safety practices. Campaigns must also show realistic understanding of current use practices to be credible for users. Messages emphasizing the consequences of ATV use were endorsed as most likely to have impact. Approaches based on age based restrictions were considered unrealistic and alternative strategies were suggested.

Introduction All terrain vehicle (ATV) injuries are increasing among rural children and adolescents. Methods to effectively promote ATV safety messages are not well described. The purpose of this study was to determine the feasibility of using a movie theatre as a venue for ATV injury prevention. Methods A public service announcement on ATV safety was shown in a rural movie theatre in Arkansas, USA, for a period of 8 weeks in the summer, 2009. Patrons were asked to complete exit surveys by trained volunteers. The survey tested the recall of messages in the movie previews, including the ATV announcement. χ 2 was used to determine statistical significance. Results 703 movie patrons completed the survey; 508 reported arriving in the theatre before the previews started and 195 reported arriving after the previews. Of those arriving before the previews, 75% recalled an ATV safety message versus. 23% of those who arrived after the previews (p Conclusions This trial demonstrated that an ATV safety message shown in a rural movie theatre is associated with rates of recall higher than commercial advertising shown in the same preview and is associated with high rates of agreement with the primary safety message. This strategy may be effective in spreading injury prevention messages.

Introduction All-terrain vehicle (ATV) injury is an increasingly severe problem in children and adolescents. The purpose of this study was to describe foot injuries associated with ATV use in children. Methods Arkansas Children9s Hospital has had an inpatient trauma registry since 1993. The registry was searched in June 2006 to identify pediatric patients hospitalized with foot injuries associated with ATV use. The charts of the identified patients were abstracted and deidentified. The study was approved by the UAMS IRB. Results Ten patients were identified. The mean age was 5.6 years (21 months to 14 years), with six males and four females. Six patients were 3 years or younger, and three of these were driving the ATV. The mechanism of injury was six had a foot caught in the chain, two had a foot caught under a tire, one had a foot between a fence and the ATV, and one had a foot caught between a tree and the ATV. Eight of the children had forefoot injuries with multiple toe amputations, five involving the great toe. Two had associated crush injuries of the foot, and one sustained an open ankle fracture. Mean length of initial hospital stay was 7 days (range 1-15 days). Two patients had repeat hospitalization, eight had two or more surgical procedures, and four had infections requiring antibiotics. The mean charge for the initial hospital stay was $12,323.00. Conclusion Children, whether riding or driving ATVs, can experience serious foot injury, resulting in permanent disfigurement, disability, and substantial expense. Younger children, who are usually unable to reach the floorboards of these vehicles, are at increased risk of serious foot injuries and should not ride adult ATVs.