Unintentional injuries are the leading cause of death among children. The American Academy of Pediatrics Council on Injury, Violence and Poison Prevention has established guidelines to promote safety among young children, including preventing burns, falls, poison ingestion, drowning, and promoting traffic safety. However, little is known about safety promotion among toddlers. The proposed investigation takes advantage of a unique opportunity. In a randomized trial of obesity prevention among caregivers of toddlers, we developed and implemented a safety promotion intervention as an attention control group, based on the principles of the TTM and social learning theory and focused on goal setting, using active strategies to promote self- efficacy and decisional balance. The purpose of this proposed project is to conduct secondary analyses of the effect of the toddler safety promotion intervention on toddler environmental safety and the stage of change among caregivers of toddlers. This study has two specific aims. The first is to assess the effect of the safety intervention on promoting safety (environmental safety and maternal stage of change) among toddlers.
The second aim i s to identify the mediating and moderating factors for the intervention effect. The overall goal of this project is to identify effective strategies to promoe safety among toddlers. Based on the findings of this R03, an R01 application will propose the development of an effectiveness trial of an improved safety promotion intervention among toddlers under field conditions.
Low-income toddler age children are at an increased risk for unintentional injuries. Assessment of the effect of a randomized safety promotion and identification of the mechanisms underlying the effect will inform future cost-effective interventions targeting toddlers. SPECIFIC AIMS: Unintentional injuries are the leading cause of death among children 2, 3. Among young children, the rate of injury increases with age, peaking at 15-17 months 4. The American Academy of Pediatrics Council on Injury, Violence and Poison Prevention (COIVPP 5) has established guidelines to prevent common injuries among young children, including burns, falls, poison ingestion, drowning, and traffic safety. The Trans theoretical Model (TTM 6) has been used effectively to prevent risk behaviors 7-10 and may be an effective model to promote toddler safety. The TTM proposes five stages of health behavior change: precontemplation, contemplation, preparation, action, and maintenance. Transition between stages of behavior change is thought to occur through self-efficacy (confidence in implementing specific behaviors) and decisional balance (evaluation of the perceived benefits and barriers to implementing specific behaviors) 11, 12. Personal characteristics, including depressive symptoms, can interfere with motivation and caregiving routines, including safety practices 13,14, potentially by inhibiting mothers' ability to develop te self-efficacy and decisional balance processes necessary to implement recommended safety behaviors. The proposed investigation takes advantage of a unique opportunity. In a randomized trial of obesity prevention among caregivers of toddlers completed in 2012, we developed and implemented a toddler safety promotion intervention as an attention control group. Caregivers randomized to the safety group received an 8-session intervention focused on four common causes of toddler injuries: fire safety, fall prevention, poison control, and car seat safety. Based on the principles of the TTM and social cognitive theory, the intervention focused on goal setting, using active strategies to promote self-efficacy and decisional balance. Funding (USDA and NICHD) was for analysis of obesity prevention, not for analysis of the toddler safety promotion intervention. The proposed investigation is a secondary analysis of the effect of the toddler safety promotion intervention on toddler environmental safety and the stage of change among caregivers of toddlers. In addition, the investigation will examine the mediating effects of self-efficacy and decisional balance and whether the effects of the intervention are modified by maternal characteristics, specifically, depressive symptoms. Aim 1: To assess the effect of the safety intervention on promoting safety among toddlers. Hypothesis 1a: The safety intervention group is more likely to improve environmental safety for toddlers at the post-intervention follow-up and delayed follow-up (6 months following the intervention), compared to the comparison group. Hypothesis 1b: The safety intervention group is more likely to be in the action or maintenance stage of change, rather than in the pre-contemplative, contemplative, or planning stage at the post-intervention follow-up and delayed follow-up, compared to the comparison group. Aim 2: To assess whether maternal self-efficacy and perceived importance of toddler safety (based on decisional balance) mediate the effect of the safety intervention on environmental safety and safety stage of change. Hypothesis 2a: The effect of the safety intervention on toddler's environmental safety and maternal safety stage of change is mediated through maternal self-efficacy related to toddler safety. Hypothesis 2b: The effect of the safety intervention on toddler's environmental safety and maternal safety stage of change is mediated through maternal perceived importance of toddler safety. Aim 3: To assess whether maternal depressive symptoms moderate the effect of the safety intervention on environmental safety and safety stage of change. Hypothesis 3: The effect of the safety intervention on environmental safety and stage of change is stronger among mothers in trajectories of low depressive symptoms, compared to mothers in trajectories of high depressive symptoms.
| Wang, Yan; Gielen, Andrea C; Magder, Laurence S et al. (2018) A randomised safety promotion intervention trial among low-income families with toddlers. Inj Prev 24:41-47 |
