This proposal is in response to PA-0 1-044 for research on Emergency Medical Services for Children. We propose to evaluate a theoretically driven and innovative brief intervention for child safety delivered in the Pediatric Emergency Department (PED) of the Johns Hopkins Hospital, which serves a high risk, inner city population. The intervention will address the use of car safety seats, working smoke alarms, and safely stored poisons because these are effective countermeasures known to help prevent the leading causes of childhood injury, namely motor vehicle occupant injuries, house fire deaths and injuries, and poisonings. The intervention, based on the stage-based model of behavior change known as the Precaution Adoption Model, combines well established principles of health communication with new computer technology.
The specific aims of this proposed research are as follows: 1) Evaluate the effects of a brief, computer-tailored intervention on home and motor vehicle safety practices among parents with children from birth through five years of age who are being seen in the pediatric emergency department; 2) Determine whether and to what extent parent's anxiety level and children's injury history moderate the effects of the intervention; and 3) Using the Precaution Adoption Model (PAM) stages, describe parents' readiness to adopt home and motor vehicle safety practices and how this changes over time. A randomized controlled trial will be conducted, involving 1000 families with young children. Parents will be randomly assigned to receive either the Safety in Seconds program or a child immunization message, both of which will be delivered via a computer kiosk in the PED waiting room. The primary outcome measures will be the PAM stages and safety practices collected by in-home observation two weeks after the PED visit. Six months after the PED visit parents will receive a telephone interview to re-assess PAM stage, and to document injuries and """"""""near misses"""""""". Medical records will also be reviewed to collect injury data. Both intention-to-treat and exposure analyses will be used to evaluate the intervention. Multi-variate logistic and polytomous regression techniques will be used to assess the effect of parental anxiety and child injury history. Findings from this study will contribute to a better understanding of how behavioral sciences theories explain parents' safety practices. By examining the extent to which parent anxiety during the visit interferes with the delivery of effective communication, we will also gain new knowledge about whether a PED visit does in fact provide an important """"""""teachable moment"""""""" for injury prevention. Finally, results will demonstrate how innovative health communications technologies can be used to reduce the risk of injuries among vulnerable children. With the ever growing access to computers in medical care settings, the Safety in Seconds program should be readily adaptable to other pediatric emergency department settings that serve vulnerable populations.
