An Evidence Based Overview of Parental Supervision and Childhood Injury Risk Presented Feb 16, 2010 At the ICPHSO Annual Meeting by Michael Corbett, M.A.

Overview How serious is the childhood injury problem? How serious is the childhood injury problem? How do we define supervision and does it help reduce child injuries? How do we define supervision and does it help reduce child injuries? What is the nature and scope of supervision? What is the nature and scope of supervision? What other factors are important predictors of injury and how do these relate to supervision? What other factors are important predictors of injury and how do these relate to supervision?

The Burden of Childhood Injury Unintentional childhood injury #1 cause of death and a leading cause of hospitalization Unintentional childhood injury #1 cause of death and a leading cause of hospitalization In the US, 73,000 children (0-19) died of unintentional injury between 2000 and 2005 In the US, 73,000 children (0-19) died of unintentional injury between 2000 and ,000 under the age of 10 23,000 under the age of 10 92,000 children a year permanently disabled 92,000 children a year permanently disabled 39,000 children a day require medical treatment 39,000 children a day require medical treatment Large majority of pre-school aged injuries occur in the home Large majority of pre-school aged injuries occur in the home 40% related to consumer products 40% related to consumer products 90% may be preventable 90% may be preventable

What is Caregiver Supervision? Not as simple as it may seem Not as simple as it may seem Generally measured as: Generally measured as: Attention to child Attention to child Proximity to child Proximity to child Continuity of supervision Continuity of supervision Relevance to injury risk is key Relevance to injury risk is key

Does Supervision Reduce Childhood Injuries? Current finds suggest supervision does protect children Current finds suggest supervision does protect children Observational, self-report (questionnaire, interview, diary recording, ER data) coroners reports all show links between caregiver supervision and child injury Observational, self-report (questionnaire, interview, diary recording, ER data) coroners reports all show links between caregiver supervision and child injury

The Home Supervision Study Parents tracked supervision for 10 days Parents tracked supervision for 10 days Recorded both “in-view” and “out-of-view” supervision Recorded both “in-view” and “out-of-view” supervision Supervision rating scales assessed watching, listening and checking in Supervision rating scales assessed watching, listening and checking in

Results Who is Supervising and to What Degree? Mothers primary supervisor most (78%) of the time and dads less so (16%) Mothers primary supervisor most (78%) of the time and dads less so (16%) On average children were supervised 96% of the time On average children were supervised 96% of the time Younger children left unsupervised less often than older (1% vs 8%) Younger children left unsupervised less often than older (1% vs 8%) Level of Supervision Under Different Circumstances Children in-view more than out of view (80% vs 20%) Children in-view more than out of view (80% vs 20%) Higher level of supervision when children were in view than out of view Higher level of supervision when children were in view than out of view Older children more likely to be out of view than younger Older children more likely to be out of view than younger Higher level of supervision for young than older children when out of view Higher level of supervision for young than older children when out of view Telephone interviews - younger children had been seen by a parent within a shorter period of time (2.2.mins) than older children (4.4 mins) Telephone interviews - younger children had been seen by a parent within a shorter period of time (2.2.mins) than older children (4.4 mins) When Left Alone Alone without supervision more often in the living room/family room than kitchen/dining or bathroom: Boys (76%) more than girls (28%) Alone without supervision more often in the living room/family room than kitchen/dining or bathroom: Boys (76%) more than girls (28%)

Significance Results suggest that children are left completely unsupervised some portion of the time Results suggest that children are left completely unsupervised some portion of the time Children are often supervised from a distance and out of view Children are often supervised from a distance and out of view Children are routinely supervised in ways that could lead to injury Children are routinely supervised in ways that could lead to injury Child attributes, parental beliefs/personality traits are important contributing factors Child attributes, parental beliefs/personality traits are important contributing factors

Child Characteristics Gender has important implications for supervision and injury Gender has important implications for supervision and injury Boys experience more injuries than girls Boys experience more injuries than girls Boys act in way that elevate injury risk so require greater levels of supervision Boys act in way that elevate injury risk so require greater levels of supervision Parents do not supervise boys more closely Parents do not supervise boys more closely Parents socialize boys differently Parents socialize boys differently

Child Characteristics Impulsivity, risk taking, highly active and/or sensation seeking, lack behavioral control or are high on behavioral intensity = more injuries Impulsivity, risk taking, highly active and/or sensation seeking, lack behavioral control or are high on behavioral intensity = more injuries Parents supervised these children more Parents supervised these children more Behaviorally intense children: more injuries at low supervision than at high Behaviorally intense children: more injuries at low supervision than at high Behaviorally controlled children: low levels of injury even at reduced levels of supervision Behaviorally controlled children: low levels of injury even at reduced levels of supervision Sensation seekers: supervision is not enough Sensation seekers: supervision is not enough Parents must be in tune with their child’s behavior and development Parents must be in tune with their child’s behavior and development Highest risk at developmental milestones Highest risk at developmental milestones

Parental Characteristics Personality and beliefs influence supervision and injury Personality and beliefs influence supervision and injury Neuroticism associated with more injuries Neuroticism associated with more injuries Conscientiousness with fewer injuries Conscientiousness with fewer injuries Mothers high on protectiveness, vigilance, confidence and worry have children with fewer injuries Mothers high on protectiveness, vigilance, confidence and worry have children with fewer injuries Mothers high in vigilance show closer supervision Mothers high in vigilance show closer supervision Beliefs about leaving children unattended for longer periods are associated with more injuries Beliefs about leaving children unattended for longer periods are associated with more injuries

Summary Supervision is a key parental strategy for reducing childhood injuries related to consumer products Supervision is a key parental strategy for reducing childhood injuries related to consumer products Product developers should be aware that supervision does not always offer adequate protection Product developers should be aware that supervision does not always offer adequate protection Products specifically for boys are more likely to pose a threat than products for girls because of riskier behaviour and inadequate supervision Products specifically for boys are more likely to pose a threat than products for girls because of riskier behaviour and inadequate supervision Parental beliefs about supervision can be important to influence in safety awareness messaging Parental beliefs about supervision can be important to influence in safety awareness messaging Full understanding of supervision and injury risk must consider child, parent and environmental characteristics and their interactions Full understanding of supervision and injury risk must consider child, parent and environmental characteristics and their interactions