Motor vehicle collisions (MVCs) remain a leading cause of death among children after the first year of life despite substantial improvements in passenger safety. In 2007, more children ages 1 to 12 years died as occupants in MVCs than died of heart disease, influenza/pneumonia, or sepsis. Deaths and severe injuries from MVCs can be reduced significantly through the consistent use of size-appropriate child passenger restraints. Still 10% of children ride completely unrestrained and roughly one-quarter do not use the recommended restraint for their size. New approaches are needed to motivate behavior change among parents who do not consistently use size-appropriate passenger restraints for their 1- to 12-year-old children. Emergency department (ED) visits represent unique opportunities to reach vulnerable children and their parents who have difficulty accessing the primary care settings where childhood injury prevention information is commonly provided. Motivational interviewing (MI) in the ED has been used to encourage a variety of health behaviors among at-risk patients. However, MI has not been previously evaluated for child passenger safety promotion programs. This career development award will provide Dr. Macy with the additional skill set and advanced research training required to develop and evaluate an ED-based intervention utilizing MI techniques and patient-centered (e.g., targeted and tailored) print materials to promote the correct and consistent use of size-appropriate child passenger restraints. Dr. Macy has developed the proposed research and career development plans under the guidance of her experienced multidisciplinary mentoring team that includes experts in the fields of health communications for behavior change, injury prevention, and pediatric health services research. The proposal is organized into 4 phases: (1) audience segmentation analysis of survey data obtained from parents of 1- to 12-year-old children seeking ED care in order to identify distinct child passenger restraint use subgroups for the development of targeted interventions;(2) focus groups with parents in order to obtain an in-depth understanding of the subgroups identified in Phase 1 and to pilot test child passenger safety messages intended for these subgroups;(3) development of intervention materials including brief MI messages, targeted information sheets, and tailored brochures;and (4) randomized pilot trial of the intervention utilizing a 2x2 factorial design to examine the independent and additive effects of ED-based MI and tailored print materials on the consistent use of size-appropriate child passenger restraints. Dr. Macy's career development activities will include formal training in statistical analysis for audience segmentation, qualitative methods, and advance theories and applied techniques related to the design and implementation of behavioral interventions in the ED setting. Through formal coursework, interaction with her highly qualified mentoring team, and the execution of the proposed project, Dr. Macy will acquire the knowledge and skills to become an independent researcher and expert in ED-based interventions for pediatric injury prevention.

Public Health Relevance

Preventable injuries sustained by child occupants in motor vehicle collisions are a significant and costly public health concern. Child passenger restraint systems have proven effective in reducing the risk of injury and death associated with a motor vehicle collision, yet there are few evidence-based approaches to promote the correct and consistent use of the size-appropriate child passenger restraint. By using successful strategies for behavior change, including motivational interviewing and personalized health communication, the proposed intervention could remarkably improve passenger safety among children who contact the health system through the emergency department.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Haverkos, Lynne
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University of Michigan Ann Arbor
Emergency Medicine
Schools of Medicine
Ann Arbor
United States
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Smiley, Mary L; Bingham, C Raymond; Jacobson, Peter D et al. (2018) Discordance between age- and size-based criteria of child passenger restraint appropriateness. Traffic Inj Prev 19:326-331
Zonfrillo, Mark R; Macy, Michelle L; Cook, Lawrence J et al. (2016) Anticipated resource utilization for injury versus non-injury pediatric visits to emergency departments. Inj Epidemiol 3:12
Macy, Michelle L; Butchart, Amy T; Singer, Dianne C et al. (2015) Looking Back on Rear-Facing Car Seats: Surveying US Parents in 2011 and 2013. Acad Pediatr 15:526-33
Macy, Michelle L; Zonfrillo, Mark R; Cook, Lawrence J et al. (2015) Patient- and Community-Level Sociodemographic Characteristics Associated with Emergency Department Visits for Childhood Injury. J Pediatr 167:711-8.e1-4
Kroeker, Amber M; Teddy, Amy J; Macy, Michelle L (2015) Car seat inspection among children older than 3 years: Using data to drive practice in child passenger safety. J Trauma Acute Care Surg 79:S48-54
Macy, Michelle L; Carter, Patrick M; Bingham, C Raymond et al. (2014) Potential distractions and unsafe driving behaviors among drivers of 1- to 12-year-old children. Acad Pediatr 14:279-86
Macy, Michelle L; Cunningham, Rebecca M; Resnicow, Ken et al. (2014) Disparities in age-appropriate child passenger restraint use among children aged 1 to 12 years. Pediatrics 133:262-71
Macy, Michelle L; Clark, Sarah J; Freed, Gary L et al. (2012) Carpooling and booster seats: a national survey of parents. Pediatrics 129:290-8
Macy, Michelle L; Freed, Gary L (2012) Child passenger safety practices in the U.S.: disparities in light of updated recommendations. Am J Prev Med 43:272-81