Unintentional injury is the leading cause of death and disability in US children, and the home is the single most common location of injury. Clinic-based anticipatory guidance has been shown to improve knowledge and practices, but it has had no effect on injury rates. Home-based, behavior modification has been more effective, resulting in a 26 percent reduction in injuries. Although experts believe passive interventions are most effective at reducing injuries, there are no controlled trials of installing multiple safety devices to reduce unintentional residential injury. Furthermore, the determinants and effects of parental supervision in preventing or reducing residential injury are poorly understood. The first specific aim of this project involves the design, conduct, and analysis of a prospective 36-month randomized controlled trial to reduce residential unintentional injury. The intention-to-treat analyses of the longitudinal data will involve repeated measures, following children from birth to 36 months of age, the group at highest risk for residential injuries. In secondary analyses, we will examine the effect of the intervention by levels of parental supervision to test whether the effect was greater for households with lower parental supervision. The second specific aim will examine causal determinants of parental supervision and its ultimate effects on unintentional residential injury. Using a theoretical model of supervision, data developed in the first specific aim together with validated measures of caregiver traits such as maternal depression (Beck Depression Inventory), parental health locus of control, and child injury-risk behavior (Injury Behavior Checklist), will be used to examine determinants of supervision. Unintentional residential injury will be modeled by integrating the quantity of residential hazards, caregiver beliefs about residential safety, caregiver locus of control and depression, the quantity and quality of supervision, and child injury-risk behavior. A structural equation model incorporating parental supervision, the burden of residential hazards and children's injury-risk behaviors to explain residential injury will be developed. Maternal depression and other caregiver characteristics will in turn, explain parental supervision. These studies provide me with experience and expertise to understand injury prevention and residential supervision through a multidisciplinary approach. This proposal will leverage the support and resources of the Cincinnati Center for Children's Environmental Health to further the science of injury control. In addition to assessment of passive safety measures to control residential injury, the results will enable me to assess the effect of parental supervision on unintentional residential injuries. The experience and data developed in this award will provide the skills necessary to become an independent clinical investigator in the areas of childhood injury control and supervision.
