The Association Between Psychosocial and Demographic Characteristics of the Mother, Child, and Mother-Child Dyad and Unintentional Injury in Young, Low- Income Children By Katy Payne, MSW

Background Unintentional injury in children is a major public health problem. Takes more lives of than all childhood diseases combined Ages 1-4 most commonly injured by drowning, motor vehicle occupant injury, falls, burns, and airway obstruction Costs and estimated $347 billion annually

Statement of Problem Despite injury prevention efforts a small number of children continue to be unintentionally injured. Even though parents know how to protect their children but do not incorporate safety behaviors into everyday life (Attitude-Practice Gap).

Hypothesis Characteristics of the mother, child, and the quality of their interaction are associated with unintentional injury

Early Head Start Federally funded by the Administration for Children and Families Serves families at or below the poverty line Pregnant women Children from birth to 36 months Child development and promoting healthy families is focus of program.

The EHS Research and Evaluation Project ( ) Randomized Control Trial 2,977 families participated 1,503 treatment families 1,474 comparison families Treatment families received EHS services. Comparison families agreed to not use EHS services but could use other “birth to three” style programs.

Data Maternal Demographic Age Race Living arrangement Education level EHS enrollment Maternal Psychosocial Reported stress in parenting role knowledge of typical child development Feelings of mastery Support from family and friends Frequency of ED use Child Demographic Gender Eligible for EI Services Cognitive development Insurance Status Mother-Child Dyad Quality of maternal-child interactition Mother’s score Child’s score

Home Safety Devices # Yes Outlet covers57.3 % Safety gates70.7% Safe windows50.2 % Car seat83.4 % Number for local poison control27.4 % Smoke Alarm73.4 % Syrup of Ipecac23.1 %

Statistical Analysis Poisson Regression Exposure time was defined as number of months the child was enrolled in EHS and thus at risk for an unintentional injury requiring and ED visit. Five models analyzed separately Final model included variables significant at the 0.1

Results of Each Model Maternal Demographic Age Race Living arrangement Maternal Psychosocial Frequency of ED visits for non-injury purposes Maternal-Child Dyad Child NCAT Score Car seat Child Demographic Insurance Status Home Safety Devices Car Seat

Final Model Results RR (95% CI)Direction of Effect Maternal age.95 (.91,.99)Older < Maternal race African American.50 (.34,.86)Non-white < Hispanic.39 (.22,.70) Other.26 (.08,.82) Living arrangement Living with children alone 1.55 (1.04, 2.32)Single > Frequency of ED use Minimal ED use 1.80 (1.23, 2.64)Higher Use > Frequent ED use 5.93 (3.33, 10.57) Child NCAT Score.93 (.87,.99)Higher Score <

Conclusions High child NCAT scores suggest that the child who is very vocal, especially in situations that are stressful and potentially dangerous, are able to keep themselves safe from injury. The presence of home safety devices may not be enough to eliminate unintentional injury requiring an ED visit.

Limitations Most of the significant findings were based on variables that were parent report. Parent recall of their child’s injuries is generally inaccurate. Information on the nature or severity of the injury was not available. Information on causation not available.

Implications for Public Health Practice Traditional injury prevention methods paired with efforts to increase quality of interaction and communication between caregiver and child may further reduce the number of unintentional injuries in young children.

Acknowledgements Grateful thanks to My committee: Colleen Huebner, PhD, MPH Committee Chair Brian Johnston, MD, MPH Fred Rivara, MD, MPH Andy Bogart, MA and Umer Khan My family and friends This study was supported in part by grant T76 MC from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.

Obligatory Cute Kid Pictures