Unintentional poisoning exposures: how does modeling the opening of child-resistant containers influence children's behaviors?

OBJECTIVE: Unintentional poisoning in the home is a risk for children. Over-the-counter medicinal products in child-resistant containers (CRC) are common causes of pediatric poisoning. The current study examined children's abilities to open three types of CRC mechanisms (twist, flip, and push) and corresponding control containers, comparing their ability to do so spontaneously and after explicit modeling. The study also examined if inhibitory control (IC) was associated with children's overall score for spontaneous openings. METHOD: Children 5-8 years old were randomly assigned to one of three mechanism conditions (between-participants factor): twist, flip, and push, with each child experiencing both a risk and a control container (within-participants factor) having that mechanism. Children were first left alone with a container (measures: engagement with container, spontaneous opening) for up to 2 min and subsequently observed an adult explicitly model opening the container before the child was asked to do so (measure: opening after modeling). RESULTS: Children were more engaged with and likely to spontaneously open control containers than CRCs, though some (4%-10%) also opened CRCs. After modeling, significantly more children opened each of the three types of CRCs, with nearly all children opening the push mechanism CRC. IC positively predicted children being more engaged with and spontaneously opening more containers. CONCLUSIONS: Implications for improving pediatric poison prevention are discussed.

A Pilot Randomized Trial Evaluating the Cool 2 Be Safe Junior Playground Safety Program for Preschool Children.

OBJECTIVE: Unintentional injury is the leading cause of death to children worldwide, and playgrounds pose a significant risk of injury. Those aged 5 and 6 years are particularly vulnerable to playground injuries. Previous interventions have typically targeted environmental modifications or increased supervision to reduce playground injuries; however, minimal research has focused on implementing behavioral interventions that seek to change children's safety knowledge and risk-taking behaviors on the playground. The current randomized trial addressed these gaps in the literature and sought to increase preschool children's hazard awareness skills and knowledge of unsafe playground behaviors and decrease their intentions to engage in risk-taking behaviors on the playground. METHOD: A total of 77 children aged 5 and 6 years were tested at a laboratory on a university campus, using a parallel group design, with 38 randomized to the playground intervention group and 39 randomly assigned to a control group. The intervention was manualized and delivered to small groups of children (3-5) over several sessions. RESULTS: Statistical analyses revealed significant group differences. Intervention experience led to significant increases in hazard awareness skills and knowledge of unsafe playground behaviors, and significant decreases in children's risk-taking behavioral intentions, whereas those in the control group showed no significant changes in these scores. Attention scores for those in the intervention group highlighted that the program content was successful in maintaining children's attention and engagement, and memory scores indicated excellent retention of lesson content. CONCLUSION: The program shows promise in addressing the issue of unintentional playground injuries in young children.

Returning to sport after injury: the influence of injury appraisals and post-traumatic stress symptoms on adolescent risk-taking intentions post-injury.

OBJECTIVE: How youth think about injury risk can affect their decisions about whether to engage in behaviors that can lead to injury. Appraisals also influence the development of post-traumatic stress symptoms (PTSS), which occur in approximately 20% of children after a medically treated injury. The current study examined how the injury appraisals of youth are associated with the development of PTSS post-skateboarding injury, and if PTSS or perceived benefits of the sport are also associated with youths' intentions to return to the sport. METHOD: One hundred three youth who had a medically treated skateboarding injury within the last year provided survey data on injury appraisals, PTSS, the benefits of skateboarding, and intentions to return to the sport. RESULTS: A two-stage moderated statistical mediation path model was specified. In the first stage, there was a positive relationship between pain at injury and PTSS, which was attenuated by the moderator, perceived bad luck. PTSS fully mediated the association between perceived pain at the time of injury and intentions to return to skateboarding. In the second stage of the mediation model, the moderator perceived benefits of skateboarding, reversed the negative relationship between PTSS and intentions to return to skateboarding. CONCLUSIONS: Skateboarders are a group at risk for injury that can lead to PTSS, and they also are likely to return to the sport despite PTSS. This research identifies factors that impact the decision to return to skateboarding after injury. Limitations of the study and implications for mental health support and injury prevention are provided.

A Feasibility Randomized Trial Evaluating Safe Peds: A Virtual Reality Training Program to Teach Children When to Cross Streets Safely.

OBJECTIVE: Injury as pedestrians is a leading contributor to childhood deaths. This study evaluated the effectiveness of Safe Peds, a fully immersive virtual reality training program to teach children when to cross street safely, with the focus on a number of foundational skills and practicing these in traffic situations of varying complexity. METHODS: Children 7-10 years old were randomly assigned to a control (N = 31) or intervention (N = 26) group. Eligibility criteria included English speaking and typically developing. Testing took place on campus. All children completed pre- and post-testing measures, with those in the intervention group receiving training in between. Training comprised 1 session with 3 phases for a total of up to 1.5 hr and was tailored to each child's performance over trials. On each trial, children decided when to cross and fully executed this crossing, with measures automatically taken by the system as they did so. RESULTS: Negative binomial regression and analysis of covariance tests were applied, predicting post-test scores while controlling for pre-test scores, age, and sex. The intervention was effective in improving children's street crossing skills, including stopping and checking skills (stop at the curb, look left/right/left, check for traffic before crossing the yellow line), and choosing safe inter-vehicle gaps. Children in the control group did not show significant improvements in any crossing skills. CONCLUSIONS: The Safe Peds program effectively teaches children skills to support their deciding when to safely cross in a variety of traffic situations. Implications for pedestrian injury are discussed.

Adolescents at the skatepark: identifying design features and youth behaviours that pose risk for falls.

BACKGROUND: Skateboarding is an increasingly popular leisure activity for youth, yet injuries due to falls are common. This study aimed to identify the features at skateparks and tricks performed by youth that pose an increased risk of falls in skateboarders. METHOD: Video recordings were unobtrusively taken at a large skatepark of youth designated as young (11-15 years) or old (16-20 years). Videos were coded to identify the popular skatepark features used and tricks performed, and to assign a fall severity outcome rating for each feature and each type of trick attempted. RESULTS: The results identify features and tricks that pose increased risk of falling for youth at skateparks. CONCLUSIONS: Implications for injury prevention are discussed, including a consideration of environmental (skatepark design) and individual (youth behaviour) factors relevant to reducing skateboarding injuries due to falls among youth.

Adolescents' Perspectives on Skateboarding and Injury Risk: The Benefits Outweigh the Risks.

OBJECTIVE: Skateboarding is an increasingly popular sport among youth, despite the fact that children and adolescents are the age groups most frequently injured when skateboarding. A greater understanding of the psycho-social factors that motivate participation in skateboarding, including why youth return to the sport after serious injury from skateboarding, is needed to inform injury prevention efforts. This study addressed that gap in knowledge. METHODS: Twenty-six Canadian adolescent skateboarders 14-17 years of age (20 males and 6 females) who had previously sustained medically attended injuries while skateboarding participated in individual interviews to explore their perspectives on skateboarding and injury risk, including reasons for returning to the sport after injury. RESULTS: Thematic analyses revealed that participants perceived many unique benefits from skateboarding, including interpersonal benefits, mental and physical health benefits, pleasure, personal growth, and identity development. Participants uniformly identified that a major drawback was the risk of injury, with trickle-down effects of injury including a loss of social contacts (e.g., missing friends), challenges to individual identity from not participating, and injury-specific negative outcomes (e.g., pain, physical limitations). When exploring reasons participants returned to the sport and to the trick or activity that precipitated their injury, the primary theme identified was that the benefits of skateboarding significantly outweighed the costs associated with potential re-injury. CONCLUSION: Results paint a nuanced picture of psycho-social factors that impact youths' skateboarding and decisions to return to the sport after injury. Implications for injury prevention are discussed.

Sex Differences in the Relation Between Supervision and Injury Risk Across Motor Development Stages: Transitioning From Infancy Into Toddlerhood.

RATIONALE: Addressing a notable gap in research on injuries during infancy, this longitudinal study examined sex differences in the relationship between parents' typical levels of supervision and infants' injuries across motor development stages. METHOD: Parents were recruited and completed biweekly phone calls about their infant's motor skills. Once the infant was able to sit up independently, then a home visit was scheduled. Applying a participant-event monitoring method, parents were taught to complete diary forms (injury, supervision), which they started doing once the child could move from their seated location on the floor in some way (e.g., roll, crawl). Recordings continued until a month after the child could walk independently. Data (injury, supervision) were averaged within each motor development stage (low, high), and associations across stages were examined. RESULTS: Model testing indicated that supervision level moderated the relation between injury rate across motor development stages, but the strength of this association varied by sex of the child. More intense supervision predicted lower injury rates for girls more so than for boys. CONCLUSIONS: Although the emergence of motor milestones has been associated with increased risk of injury during infancy, the current findings indicate that greater supervision can reduce this risk. However, supervision alone is not as effective to moderate injury risk for boys as it is for girls. Thus, for boys, additional strategies (e.g., hazard removal) may also be warranted to maximize reduction in their risk of injury as they acquire increasing motor skills.

A RCT Testing If a Storybook Can Teach Children About Home Safety.

OBJECTIVE: Unintentional injuries are the leading cause of death for children under 19 years of age. For preschoolers, many injuries occur in the home. Addressing this issue, this study assessed if a storybook about home safety could be effective to increase preschoolers' safety knowledge and reduce their injury-risk behaviors. METHODS: Applying a randomized controlled trial design, normally developing English speaking preschool children (3.5-5.5 years) in Southwestern Ontario Canada were randomly assigned to the control condition (a storybook about healthy eating, N = 30) or the intervention condition (a storybook about home hazards, N = 29). They read the assigned storybook with their mother for 4 weeks; time spent reading was tracked, and fidelity checks based on home visits were implemented. RESULTS: Comparing postintervention knowledge, understanding score, and risk behaviors across groups revealed that children who received the intervention were able to identify more hazards, provide more comprehensive safety explanations, and demonstrate fewer risky behaviors compared with children in the control group (ηp2 = 0.13, 0.19, and 0.51, respectively), who showed no significant changes over time in safety knowledge, understanding, or risk behaviors. Compliance with reading the safety book and fidelity in how they did so were very good. CONCLUSIONS: A storybook can be an effective resource for educating young children about home safety and reducing their hazard-directed risk behaviors.

Short- and Long-Term Effects of Superhero Media on Young Children's Risk-Taking Behaviors.

OBJECTIVE: Unintentional injuries, the leading cause of death for American children, are caused by a range of psychosocial factors, including risk behavior. One factor that may impact child risk-taking is modeling of superhuman risk-taking from superhero media, both immediately following superhero exposure and based on lifetime exposure and engagement. METHODS: Fifty-nine 5-year-olds were randomly assigned to view either a 13-min age-appropriate superhero television show or a comparable nonsuperhero show. After the viewing, children engaged in three risk-taking measures: (a) activity room, unsupervised play for 5 min with assortment of apparently dangerous items that might encourage child risk-taking; (b) picture sort, 10 illustrations of children in risk situations, with participant response concerning intended risk-taking in that situation; and (c) vignettes, 10 stories presenting situations with varying degrees of risk, with participant response on intended choice. Parents completed questionnaires concerning children's long-term superhero media exposure and individual superhero engagement (e.g., if child's most recent Halloween costume was of a superhero). Correlations and regressions evaluated effects of immediate superhero exposure, lifetime superhero exposure, and lifetime superhero engagement on children's risk-taking. RESULTS: Mixed results emerged. Lifetime superhero exposure was significantly related to children's risk-taking outcomes in two bivariate (vignettes and picture sort) and one multivariate (picture sort) model. Neither immediate superhero exposure nor lifetime superhero engagement was strongly related to risk-taking. CONCLUSIONS: Children's lifetime superhero exposure may influence children's risk-taking. Given American children's substantial media exposure, research should continue to unpack the role of superhero media on children's unintentional injury and other health risk behaviors.

Understanding Infants' In-Home Injuries: Context and Correlates.

RATIONALE: Infancy is a time of elevated risk of injury. Past research has focused mostly on the type of injuries, leaving many gaps in knowledge about contextual information that could aid in injury prevention planning. METHODS: In this longitudinal study, a participant-event recording method was used in which mothers tracked their infants' home injuries through three motor development stages (sitting up independently, crawling, and walking). A contextual analysis elucidated where injuries occurred, their type and severity, the infant's and parent's behaviors at the time, if the infant had done the risk behavior before and been injured, the level of supervision, and the nature of any safety precautions parents implemented following these injuries. RESULTS: Injuries occurred as often in play as in nonplay areas and were due to physically-active nonplay activities more so than play activities; mothers were often doing chores. Bumps and bruises were the most common types of injuries. As infants became more mobile, supervision scores declined and injury severity scores increased. Infants had done the risk behavior leading to injury previously about 60% of the time, with higher scores associated with parents implementing fewer preventive actions in response to injury. When mothers did implement a safety precaution, greater injury severity was associated with more modifications to the environment and increased supervision; teaching about safety was infrequent. CONCLUSION: Implications of these results for injury prevention messaging are discussed.

The Impact of Children's Temperament on How Parents Resolve Safety Disagreements During Preadolescence.

OBJECTIVES: Parents play an important role in keeping their children safe. However, this becomes more difficult during preadolescence as children seek greater autonomy away from the direct supervision of adults. The current study focused on preadolescent youth (10-13 years) and examined parent-child disagreements about safety, with a focus on determining if child temperament attributes moderate the relation between how parents learn of these and resolve these disagreements. METHODS: A short-term longitudinal design was used. Parents and children retrospectively recalled safety disagreements together and then independently completed questionnaires about these. Parents then tracked disagreements over 1 month. RESULTS: The behavioral attributes of inhibitory control and risk-taking propensity both moderated the relationships between parental source of knowledge of safety disagreements and subsequent methods of resolution. CONCLUSION: Safety-promotion messaging for parents of preadolescents may need to be tailored based on child attributes to maximize effectiveness.

Understanding Sex Differences in Children's Injury Risk as Pedestrians.

OBJECTIVE: Boys experience more injuries as pedestrians than girls. The aim of this study was to compare how boys and girls cross streets in order to identify factors that differentially influence their injury risk as pedestrians. METHODS: Using a fully immersive virtual reality (VR) system interfaced with a 3D movement measurement system, various measures of children's street-crossing behaviors were taken. RESULTS: At the start of the crossing, boys selected smaller (riskier) inter-vehicle gaps to cross into than girls. Subsequently, as they crossed, they showed greater attention to traffic, shorter start delay, and more evasive action than girls, which are strategies that could reduce risk as a pedestrian. Despite these efforts, however, boys experienced more hits and close calls than girls. CONCLUSION: To enhance their safety as pedestrians, girls adopt a proactive approach and select larger inter-vehicle gaps to cross into, whereas boys apply a reactive approach aimed at managing the risk created by having selected smaller (riskier) gaps. Girls' proactive approach yielded safer outcomes than boys' reactive strategy.

Sustained Reductions in Children's Risk Taking from Peer-Communicated Behavioral Safety Norms.

OBJECTIVE: This research examined whether the positive effects of a peer-communicated social norm that reduces risk-taking behaviors persist over time and if a reminder of this peer-communicated safety message has any impact on this outcome. METHODS: Positive mood in 7- to 9-year olds was induced experimentally and risk taking intentions and behaviors were measured when the child was in a positive and neutral mood state and after they had been exposed to either a safety or neutral peer-communicated social norm message. A few weeks later, half of the participants who experienced the safety social norm message were exposed to a reminder of this message via a slogan and risk-taking measures were taken again when in a heightened positive mood state. RESULTS: Exposure to a safety norm successfully counteracted the increase in risk taking associated with a positive mood state. These effects persisted for several weeks regardless of whether the children were exposed to a reminder. CONCLUSION: Manipulating peer social norms holds promise as an approach to produce reductions in children's risk taking and these effects persist at least over several weeks.

Parent-Child Disagreements About Safety During Preadolescence.

OBJECTIVES: Much research has examined how parents manage safety issues for young children, however, little is known about how they do so in the preadolescent years when children's demand for autonomy increases. The current study focused on youth in this transition stage (10-13 years) and examined parent-child disagreements about safety, including how parents learn of these, react to these, and resolve these (Aim 1), if the parent-child relationship or sex of the child impacts these processes (Aim 2), and the nature and reasons why children intentionally keep safety-relevant secrets from their parents (Aim 3). METHODS: A short-term longitudinal design was applied. Parents initially completed questionnaires and, with their child, retrospectively recalled safety disagreements. Over the next month, parents tracked safety disagreements and children tracked secrets they withheld from parents. RESULTS: The findings revealed significant gender differences: Daughters were more likely than sons to spontaneously disclose safety issues to their parents, and parents were more likely to discuss the issue and provide teaching to daughters than sons. Relationship quality emerged as an important factor, particularly for boys: A positive parent-child relationship predicted increased parental teaching in response to a safety-relevant issue for boys only. Children kept secrets from their parents about safety-relevant information in order to maintain their autonomy and independence. CONCLUSION: Parent-child disagreements about safety are influenced by the positive nature of the parent-child relationship and differ for sons and daughters.

S.A.F.E.R. Near Water: An Intervention Targeting Parent Beliefs About Children's Water Safety.

OBJECTIVE: The current study aimed to develop, implement, and evaluate the S.A.F.E.R. Near Water program, an evidence-based and theory-driven intervention targeting parent beliefs relevant to keeping children safe around water. METHODS: A nonrandomized trial was conducted. Parents with children aged two through five years who were enrolled in lessons either at a public or private swim organization in Ontario, Canada were recruited and nonrandomly assigned to either an Intervention (N = 92) or Control (N = 150) condition. All parents completed the same questionnaire measures two times over the course of their child's swim lesson session period, once at the beginning (preintervention) and again at the end (postintervention; approximately 9-15 weeks later). Questionnaires assessed parents' perceptions related to supervision, child drowning risk, water safety, and optimism bias. Parents in the Intervention condition participated in S.A.F.E.R. Near Water, an educational water safety program comprising in-person seminars, informational handouts, and posters. RESULTS: The S.A.F.E.R. Near Water program was associated with increased knowledge in targeted areas and effectively communicated most of the intended messages. A series of primary regression analyses revealed that parents receiving S.A.F.E.R. Near Water demonstrated improvements in: beliefs about the value of supervision; judgments about children's swim skills and drowning risk; and perceptions related to swim lessons and children's supervision needs (sr2 range: 0.22-0.38). CONCLUSION: These findings provide support for the feasibility and usefulness of a multifaceted, parent-focused, educational program delivered alongside children's swim programming to promote closer adult supervision of children around water.

Effects of Peers on Child Pedestrian Behaviors in a Virtual Traffic Context.

OBJECTIVES: Research shows that school-aged children are at high risk of pedestrian injury when they cross streets with peers. How peers exert their influence is unknown. Using a fully immersive virtual reality pedestrian environment, this study examined the impact of peers on children's pedestrian behaviors. METHODS: 137 children were assigned either to a control, peer observer, or peer-safety or peer-risky modeling condition. Street-crossing behaviors were measured twice (baseline, postbaseline), with group comparisons (control vs. test condition) of postbaseline scores conducted. RESULTS: Children who observed a peer modeling risky behaviors imitated this. No significant influences were found in the peer observation or safe modeling conditions. CONCLUSIONS: Peers may elevate other children's risk of pedestrian injury through modeling risky crossings. Implications for prevention are discussed.

A Pilot Randomized Controlled Trial Testing the Effectiveness of a Pedestrian Training Program That Teaches Children Where and How to Cross the Street Safely.

Objective: Pedestrian injury is a leading cause of injury-related mortality for children. This pilot randomized controlled trial tested the efficacy of a training program to teach where and how to cross safely. Methods: Using fully immersive virtual reality technology, 142 children 7-10 years of age were recruited, with 130 completing crossing measures before (pretest) and immediately after (posttest) training. Training comprised 1.5 hr, was tailored to each child's performance over trials, and focused on either where to cross (n = 44 children completed testing) or how to cross safely (n = 43); corresponding control groups comprised 22 and 21 children, respectively. Following training, children in the intervention groups completed additional tasks to test conceptual knowledge and generalization of learning. Children in the control groups spent the same time as those in training groups but played a video game that used the same game controller but provided no training in street crossing. Results: The primary outcomes were errors in crossing at posttest, controlling for pretest error scores. Children in the intervention group made from 75% to 98% fewer errors at posttest than control children for all pedestrian safety variables related to where and how to cross safely, with effect sizes (incidence rate ratios) varying between 0.02 and 0.25. They also showed a generalization of what they had learned and applied this knowledge to novel posttraining situations. Conclusion: Training within a virtual pedestrian environment can successfully improve children's conceptual understanding and crossing behaviors for both where and how to cross streets safely.

Using Peer Communicated Norms About Safety to Reduce Injury-Risk Behaviors by Children.

Objective: This study examined whether exposure to a safety norm could counteract the increase in risk taking children show when in an elevated positive mood state. Methods: Risk taking (intentions, behaviors) was measured in a neutral and positive (induced experimentally) mood state. Before completing the tasks in a positive mood, 120 children 7-10 years were exposed to either a safety norm or a control audio. Results: The control audio had no effect: children showed an increase in risk taking and intentions when in a positive mood compared with a neutral mood, replicating past research. In contrast, exposure to the safety norm counteracted this effect: children showed a decrease in risk taking and intentions when in a positive mood compared with a neutral mood. Conclusion: Manipulating children's exposure to social norms can be an effective strategy for reducing injury-risk behaviors even when they are in an elevated positive mood state.

Supervising for Home Safety Program: A Randomized Controlled Trial (RCT) Testing Community-Based Group Delivery.

Objective: The individually delivered Supervising for Home Safety (SHS) program improves caregivers' injury-related beliefs and supervision practices. The current randomized controlled trial used a group delivery in a community setting and assessed program impact, feasibility, and acceptance. Methods: Caregivers of 2-5-year-olds were randomized to receive either the SHS or an attention-matched control program. Results: In the SHS group only, there were increases from baseline to postintervention in the following: beliefs about children's vulnerability to injury, caregiver preventability of injuries, and self-efficacy to do so; readiness for change in supervision; and watchful supervision. Face-to-face recruitment by staff at community organizations proved most successful. Caregivers' satisfaction ratings were high, as was caregiver engagement (95% completed at least seven of the nine sessions). Conclusion: The SHS program can be delivered to groups of caregivers in community settings, is positively received by caregivers, and produces desirable changes that can be expected to improve caregivers' home safety practices.

Using a Virtual Environment to Examine How Children Cross Streets: Advancing Our Understanding of How Injury Risk Arises.

PURPOSE: To examine how risk of injury can arise for child pedestrians. METHODS: Using a highly immersive virtual reality system interfaced with a 3-D movement measurement system, younger (M = 8 years) and older (M = 10 years) children's crossing behaviors were measured under conditions that introduced variation in vehicle speed, distance, and intervehicle gaps. RESULTS: Children used distance cues in deciding when to cross; there were no age or sex differences. This increased risk of injury in larger intervehicle gaps because they started late and did not monitor traffic or adjust walking speed as they crossed. In contrast, injury risk in smaller intervehicle gaps of equal risk (i.e., same time to contact) occurred because crossing behavioral adjustments (starting early, increasing walking speed while crossing) were not sufficient. CONCLUSIONS: Dependence on distance cues increases children's risk of injury as pedestrians when crossing in a variety of traffic situations.