Behavioral Aspects of Pediatric Home Injury Prevention

1. Behavioral Aspects of Pediatric Home Injury Prevention David C. Schwebel, Ph.D. Department of Psychology, University of Alabama at Birmingham

2. Pediatric Injuries in the Home • Injuries: leading cause of child death in most countries, causing more deaths in USA than next 10 leading causes of death combined • At least half of pediatric injuries occur in the home • Young children are particularly vulnerable • Exposure (spend more time in home) • Risks related to child development – falls, poisoning, burns, drowning, etc.

3. Injuries in the Home • But even adolescents and adults are vulnerable

4. Adolescent Injuries in the Home Descriptive Data on Safety of Homes with Adolescents (N = 42)  Safety Measure % at risk  Fire/Burns Exposed electrical wires 20 No smoke detector functioning in home 15 No fire extinguisher present in home 54 Carbon Monoxide Poisoning No carbon monoxide detector present 88 Alcohol Alcohol present in home 56 Alcohol present in unlocked location 31 Firearms Firearm present in home 38 Firearm unlocked in home 29 Fireworks Fireworks present and unlocked 6 Tripping Electrical cords exposed 21 Rug or other floor covering peeling up 14 Outdoor Stairways/Rails/Porches Items littering outdoor stairways 14 Broken or absent handrails 22 Porch rail unstable or missing 11  From Schwebel, D. C., Gilliland, M. J., & Moore, J. G. (2009). Physical environment of the home and adolescent injury risk. International Emergency Nursing, 17, 47-51.

5. Behavioral Strategies for Home Injury Prevention • Many strategies can and do work • Most strategies overlap and should be used concurrently • Targeting children • Targeting parents • Targeting the home environment

6. Targeting Children • Must consider development – cognitive, perceptual, motor, inhibition, and more • Prevention can take many forms • Developing safe decision-making skills • Learning and obeying safety-related rules • Developing inhibition • Having safe home environment to engage within • Interacting with safe objects (e.g., toys)

7. Examples from my Laboratory • Teaching children safe behaviors • Training 7-8 year old children safe street-crossing behavior • Training 3-6 year old children how to safely interact with their pet dogs

8. Targeting Parents • Changing adult habits is not easy! • Prevention can take many forms • Improved supervision – intervene when danger emerges • Model safe behaviors • Simply be present, and children will act more cautiously

9. Example from my Laboratory • Parent presence causes children to act more cautiously • Children (ages 6-8) complete 4 physical tasks, sometimes set within their ability and sometimes beyond their ability • Parents stand silently in the room half the time, either for first sets of trials or last sets of trials

10. Results: Influence of Parents on Child Decision-Making From Schwebel, D. C., & Bounds, M. L. (2003). The role of parents and temperament on children’s estimation of physical ability: Links to unintentional injury prevention. Journal of Pediatric Psychology, 28, 505-516.

11. Conclusions: Influence of Parents • The mere presence of parents seems to cause children to make more cautious decisions • That influence seems to persist after parents leave the room • Results replicated at pedestrian setting, in street-crossing task • Results form theoretical basis for playground intervention, Stamp-in-Safety program

12. Targeting the Home Environment • Industry must produce safe toys, cribs, and other items children interact with • Dangerous items for young children must be kept away from those young children • Parents must safeguard the environment • They must recognize what is dangerous so they know what to safeguard • They must know how to safeguard what is dangerous • They must actually do the work of safeguarding

13. Example from my Laboratory • Simulated rooms arranged: living room, toddler’s bedroom, bathroom • 70 hazards to young children placed in the rooms • First-time parents of 1-2 year old children asked to identify hazards to toddlers • QUESTION: Do parents recognize what is dangerous to their children?

14. Hazards by the Sink

15. Results Setting Hazards Recognized Bedroom (of 20) 8.18 (3.56) Bathroom (of 15) 8.31 (2.20) Living Room (of 35) 16.69 (4.36) Full “House” (of 70) 33.18 (8.47) ANSWER: No…at least not as much as we’d hope From: Gaines, J., & Schwebel, D. C. (2009). Recognition of home injury risks by novice parents of toddlers. Accident Analysis and Prevention, 41, 1070-1074.

16. Conclusions: Home Environment • Parents may not even recognize the risks to children present in the homes • Interventions will need to either: • Educate parents about the risks present OR • Create environments that are safe without parent intervention • (OR both)

17. Summary • Behavioral strategies to prevent child injury in the home can take many forms • Target children • Target parents • Target the home environment • Multidisciplinary, multifaceted, international efforts are needed

18. Acknowledgments • ICPHSO for inviting me to speak today • Adolescent risks: Janice Gilliland, Jeffrey Moore (co-authors); Macie Brown, Mary Cotton, Danielle DeLuna, Christal Montgomery, Brandi Robinson (data collection & processing) • Pedestrian Safety Training: Award Number R01HD058573 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (Funding). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. Staff: Katie Byington, Ivory Dale, Aaron Davis, Kane Jones, Rosalyn King, Megan Knauss, Jordan Mizzell, Elizabeth O’Neal, Meredith Renfroe, Katie Sack, Ksenia Shingareva, Jasmine Stanford, Bryanna Tate; IT: Aeron Gault, Joan Severson, Matt Schikore, Digital Artefacts • Dog Safety Training: Blue Dog Trust (funding); Staff: Ivory Dale, Aaron Davis, Kane Jones, Rosalyn King, Megan Knauss, Jordan Mizzell, Elizabeth O’Neal, Meredith Renfroe, Katie Sack, Jasmine Stanford, Bryanna Tate; Collaborators: Barbara Morrongiello, Melissa Bell, Julia Stewart • Parent presence and child risk-taking: Marjorie Bounds (co-author); Oni Hasan-McDade, Natasha Holloway, Sheryl Roque, Julie Sherrod, Adam Summerlin (data collection & processing) • Parent recognition of hazards: Joanna Gaines (co-author); Songul Abay, Danielle Dulion Pitts, Jessica Meservy, Nina Reynolds (data collection & processing)