Researchers seek ways to reduce children's injury risk

In a study aimed at identifying ways to reduce children's injury risk by improving parents' home-safety practices, researchers at the Johns Hopkins Bloomberg School of Public Health conclude that safety counseling coupled with convenient access to reduced-cost products increased parents' safety practices while visits to the home by a community health worker did not. The study appears in the January 2002 issue of the Archives of Pediatric and Adolescent Medicine.

"Our previous research showed that when pediatricians provide enhanced safety counseling, their patients' parents were more satisfied with the advice they received, yet no more likely to actually follow it. We realized that families needed additional services to help them follow their pediatricians advice," explains lead author Andrea Gielen, ScD, a professor of health policy and management and deputy director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health. "We built the Children's Safety Center to provide parents with easy access to the recommended safety products, and we developed a home visiting program to further reduce the barriers parents face in carrying out their pediatricians' advice. This study found that the combination of pediatric counseling and visits to the Children's Safety Center was successful in increasing safety practices, but there was no added benefit of the home visiting program."

Dr. Gielen and her colleagues focused on five safety practices important for families with young children: using smoke alarms, safely storing poisonous substances; having ipecac syrup in the house for poisoning emergencies; using smoke alarms, using safety gates on stairs, and having safe tap-water temperatures. These safety practices address some of the leading injury hazards to low income, urban children.

Participants in the study were parents of children six months or age or younger, who were randomly assigned to one of two groups. The first group received standard-intervention, consisting of pediatric counseling by a physician who was specially trained and would refer the parent to the Children's Safety Center (CSC). At the CSC, parents could purchase safety products at reduced cost and receive personalized education from professional health educators with expertise in injury prevention.

The second group received enhanced-intervention, consisting of the counseling and referral to the CSC as well as a home visit by a community health worker who assessed injury hazards and made recommendations about appropriate safety products and practices.

The researchers then conducted follow-up interviews and observations to assess the number of safety practices in each home. The results showed no difference between the standard- and enhanced-intervention groups in the adherence rates of safety practices, indicating that the home-visits did not increase the likelihood that parents would be able to follow the safety advice they were given.

However, there were significant differences between families who visited the CSC and those who did not. CSC visitors had higher adherence rates for all safety practices except for smoke alarms (more than 80 percent of both groups had at least one working smoke alarm). Three or more of the five safety practices were observed for 34 percent of the CSC visitors compared with only 17 percent of the nonvisitors.

"While this particular study does not indicate the actual impact of the improved safety practices on injury reduction, it does provide insight into what will and what will not have an impact on parents once they leave their child's pediatrician," notes Eileen McDonald, MS, co-author and program director of the CSC. "The use of the Children's Safety Center can double the use of safety practices in the home, which will no doubt decrease the rate of injuries to some degree."

Dr. Gielen adds that while the success of the use of a facility like the Children's Safety Center appears promising, the overall rates of most of the safety practices were still distressingly low, pointing to an urgent need for further research and improvements.