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Prior to the COVID-19 pandemic, nearly 60% of children under 5 years of age were cared for in out-of-home child care arrangements in the United States. Thus, child care provides an opportunity to identify and address potential child maltreatment. However, during the pandemic, rates of reporting child maltreatment decreased-likely because children spent less time in the presence of mandated reporters. As children return to child care, states must have regulations in place to help child care providers prevent, recognize and report child maltreatment. However, little is known about the extent to which state regulations address child maltreatment. Therefore, the purpose of this cross-sectional study was to assess state regulations related to child maltreatment and compare them to national standards.We reviewed state regulations for all 50 states and the District of Columbia for child care centres ('centres') and family child care homes ('homes') through 31 July 2021 and compared these regulations to eight national health and safety standards on child maltreatment. We coded regulations as either not meeting, partially meeting or fully meeting each standard.Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations consistent with the standards requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes.Generally, states lacked regulations related to the prevention, recognition and reporting of child maltreatment for both centres and homes. Encouraging states to adopt regulations that meet national standards and further exploring their impact on child welfare are important next steps.

Objective This study piloted a patient education and decision aid tool about prescription pain relievers to determine potential impact on: comfort receiving an opioid prescription; knowledge about opioids; decisional conflict about whether to take an opioid; and shared decision making with the prescribing physician. Methods Patients with acute pain were recruited from two emergency departments (ED), and randomized to complete the tool (N = 65) or a time-matched control (N = 59) on a tablet. Data collection involved: a baseline survey; a post-test immediately following the assigned program; a discharge survey after seeing the physician; and a 6-week follow-up survey. Results Knowledge increased and comfort receiving an opioid decreased as hypothesized, but did not reach statistical significance. Despite the lack of knowledge differences, the tool had significant positive impact on patients feeling more informed and experiencing less decisional conflict. Shared decision making with the prescribing physician was not impacted. Conclusion A patient decision aid can help ED patients feel more informed and less conflicted about prescription pain relievers but did not impact shared decision-making. Practice Implications Patient education programs implemented in the ED should consider engaging physicians in the program to help to promote patient-centered approaches in the treatment of acute pain.

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. Given the lack of educational interventions for urban youth, our research team created a youth-informed, culturally relevant educational video on bike helmet safety, which was informed by focus groups with Baltimore City youth. This video, You Make the Call, linked the concept of use of cases to protect phones to use of helmets to protect heads and can be viewed at http://bit.ly/2Kr7UCN . The impact of the video as part of an intervention (coupled with a free helmet, fit instructions, and a parent guidance document) was tested with 20 parent–child dyads. The majority (80%) of youth (mean age 9.9 ± 1.8 years) reported not owning or wearing a helmet. At 1-month follow-up (n = 12, 60% response rate), helmet use was higher in the five youth reporting bike-riding after the intervention; 100% “always” used helmets compared to 0% preintervention. There were increases in youth reporting that parents required helmet use (35% pre vs. 67% post) and that is was possible to fall when bike-riding (60% pre vs. 92% post). These pilot results support the use of this video and educational intervention along with further evaluation in a larger sample size. This youth-informed and culturally tailored approach could be explored as a strategy to address other pediatric injury topics.

Head injuries are a leading cause of death and disability in children, accounting for numerous emergency department (ED) visits. It is unclear how the COVID-19 pandemic has influenced healthcare utilization for pediatric head injuries. We hypothesize that the proportion of ED visits attributable to head injury and severity will increase during the COVID-19 era. Retrospective study using electronic health record data to compare proportion and severity of head injury for children 0–21 years of age from three urban mid-Atlantic EDs in the pre-COVID-19 era (March–June 2019) and COVID-19 era (March–June 2020). Controlling for confounders, logistic regression analyses assessed ORs of head injury outcomes. The χ2 analyses identified differences in patient characteristics. The proportion of head injury visits within the ED population significantly increased during the COVID-19 era (adjusted OR (aOR)=1.2, 95% CI 1.1 to 1.4). Proportion of visits requiring hospitalization for head injury increased by more than twofold in the COVID-19 era (aOR=2.3, 95% CI 1.3 to 4.3). Use of head CT imaging did not significantly change in the COVID-19 era (aOR=1.0, 95% CI 0.7 to 1.6). The proportion of ED visits and hospitalizations for head injury increased during the COVID-19 era. This could be due to changes in the level of supervision and risk exposures in the home that occurred during the pandemic, as well as differences in postinjury care, level of awareness regarding injury severity, and threshold for seeking care, all of which may have influenced pediatric healthcare utilization for head injuries.

Introduction Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management. Methods A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre–post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits. Results The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed. Conclusion The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine.

Little is known about parents’ perceptions and prevention strategies regarding childhood falls. In this qualitative study using semi-structured interviews, we sought to describe parental reports of child fall experiences, concerns, and prevention strategies in the home. Sixteen parents with at least one child younger than 18 months were asked about their awareness of fall risks, falls experienced by the child, fall concerns, prevention strategies, and where in the home the child spends time throughout the day. Seven themes emerged: (1) “falls are unexpected,” (2) “role of the physical environment,” (3) “children’s temperament and developmental stage,” (4) “physical barriers and baby products,” (5) “addressing walking surfaces,” (6) “modifying the height of a fall,” and (7) “supervision.” Parents are aware of in-home fall hazards and actively use strategies to lessen fall risk. Anticipatory guidance should promote evidence-based and evidence-informed prevention strategies and augment effective strategies some parents use to lower fall risk.

Sudden Infant Death Syndrome is a leading cause of mortality in infants, and pediatric providers can influence caregiver infant safe sleep practices. We described the content of safe sleep counseling by pediatric providers and examined pediatric provider and caregiver factors that may be related to the delivery of safe sleep counseling.A sample of mothers and providers enrolled in the Safe Start Study, a randomized controlled trial assessing a safe sleep intervention, were audio-recorded during the 2-week well child visits (WCV) at a large urban pediatric practice in Baltimore, Maryland from October 2015 to April 2017. Provider counseling content related to infant sleep was transcribed and coded based on American Academy of Pediatrics (AAP) policy statement Grade A recommendations. Maternal reported infant sleep practices were defined by items on an interviewer administered survey. Multivariate logistic regression analyses were used to examine the relation between maternal reported infant sleep practices and provider counseling.Most, 92%, of WCVs included at least 1 safe sleep topic, but there was inconsistency in content delivered based on AAP recommendations. Yet, only 12% of WCVs included all 4 components of ABC counseling. Maternal report of infant sleeping with a person or an object in sleep space was associated with decreased odds of receiving counseling on alone no person, no objects (adjusted odds ratio: 0.34, 95% confidence interval: 0.13, 0.90).Pediatric provider counseling on safe sleep is inconsistent across AAP recommendations demonstrating a need for enhanced provider education and a more standardized approach to assess infant sleep practices.

Context Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. To our knowledge, this is the first study to report on the effectiveness of Facebook advertising and automated telephone calls as population-level strategies to encourage an injury prevention behavior. Objective We examine the effectiveness of Facebook advertising and automated telephone calls as strategies to enroll individuals in Baltimore City's Fire Department's free smoke alarm installation program. Participants We directed our advertising efforts toward Facebook users eligible for the Baltimore City Fire Department's free smoke alarm installation program and all homes with a residential phone line included in Baltimore City's automated call system. Design The Facebook campaign targeted Baltimore City residents 18 years of age and older. In total, an estimated 300 000 Facebook users met the eligibility criteria. Facebook advertisements were delivered to users' desktop and mobile device newsfeeds. A prerecorded message was sent to all residential landlines listed in the city's automated call system. Results By the end of the campaign, the 3 advertisements generated 456 666 impressions reaching 130 264 Facebook users. Of the users reached, 4367 individuals (1.3%) clicked the advertisement. The automated call system included approximately 90 000 residential phone numbers. Participants attributed 25 smoke alarm installation requests to Facebook and 458 to the automated call. Conclusion Facebook advertisements are a novel approach to promoting smoke alarms and appear to be effective in exposing individuals to injury prevention messages. However, converting Facebook message recipients to users of a smoke alarm installation program occurred infrequently in this study. Residents who participated in the smoke alarm installation program were more likely to cite the automated call as the impetus for their participation. Additional research is needed to understand the circumstances and strategies to effectively use the social networking site as a tool to convert passive users into active participants.

Unintentional injuries are currently the leading cause of death among US children older than one. As many children spend significant time in non-parental child care, these injuries often occur outside of the home. This study examined US state early care and education (ECE) regulations related to injury prevention. We reviewed ECE regulations for child care centers and family child care homes through August 2018 for all 50 states and DC ("states"). We compared these regulations to six components from two national health and safety standards on injury prevention ("standards"). One state had regulations that met all six standards for both centers and homes; sixteen states had regulations that met at least five for both. Most states required child care providers to be trained in emergency preparedness (42 for centers; 38 for homes) or first aid including CPR (50 for centers; 46 for homes). Additionally, most states required providers in centers and homes to notify parents (47 and 41, respectively) and the state (40 and 41, respectively) when a child was injured; these requirements varied greatly in both the timing and manner of notification. Two-thirds of states required that providers keep copies of a completed injury form on the premises. However, few states (5 for centers, 3 for homes) required providers to take corrective action after an injury. Although most states had some injury prevention regulations, they varied greatly across states. More states should require corrective action after an injury to help prevent future injuries from occurring.

Statement of purpose Falls are the leading cause of emergency department visits among children less than five years old. Parents are encouraged to supervise their children and provide a safe environment to prevent injuries, but there are few evidence-based interventions to prevent child falls. This analysis aimed to identify factors related to unintentional nonfatal fall injuries in children under five. Methods/Approach Data about children under five years who experienced a fall in 2015 were extracted from the National Electronic Injury Surveillance System All Injury Program. The case narratives were reviewed and coded for what the child fell from, fell onto, the fall action (i.e. tripped, dropped, rolled), and the precipitating event leading up to the fall. Results In 2015, an estimated 121,531 infants ( Conclusion Infants primarily fall from beds; toddlers and preschoolers fall most often from standing by slipping or tripping. Significance Understanding the circumstances of fall injuries can help identify new opportunities for prevention and intervention.

Background Prior to the COVID-19 pandemic, 44% of all reported injuries in U.S. households occurred in the home. Spending more time at home due to the pandemic may increase the number of home injuries. Methods A nationally representative sample of 2011 U.S. adults were surveyed online between June 17 – June 29, 2020. Propensity score weighting and T-tests were used. Results Twenty-eight percent (28%) of households reported a home injury or ingestion during the pandemic; 13% reported experiencing both. Injuries were most often due to falls (32%). Medication ingestions were reported by 6%; household product ingestions were reported by 4%. Relative to households that experienced no injuries or ingestions, those that reported either or both were more likely to: be in urban areas, have household incomes > $100,000, and have children living in them. Among households reporting more time spent at home, those with children were significantly more likely than those without to report an injury or ingestion. Conclusions Results help target prevention messages while U.S. families are continuing to work and learn remotely. During this pandemic and future stay-at-home orders, there is a need for public health efforts to prevent home injuries and ingestions.

Background: Previous work has demonstrated discrepancies between self-reported and observed smoke alarm functionality. This study aimed to improve self-report of smoke alarm status. Methods: Participants were asked if they had: 1) any working smoke alarm; and 2) a working smoke alarm on every level of their home (Brief Form). Subsequently, parents answered an Extended Form prompting them to consider each level and how they knew the smoke alarms were functioning. Results: 554 participants completed both forms. On the Brief Form, 96% of participants reported having any smoke alarm and 92% reported having a working alarm on every level. On the Extended Form, 85% of parents reported having any smoke alarm and 73% reported having a working alarm on every level. Conclusion: Prompting residents to consider the presence and functionality of smoke alarms on each level of their home increased the opportunity to provided tailoired communication to improve smoke alarm coverage.

Purpose Safety in Seconds (SIS) is a smartphone app that has demonstrated effectiveness at changing injury prevention behaviors. The aim of this analysis was to understand how parents engaged with each component of the app and determine if there was an association between app usage and behaviors. Methods Parents of children aged 4–7 visiting the pediatric emergency room in the two participating sites (regardless of the reason for the visit) were recruited. Study participants downloaded the SIS app onto their smartphone and were randomized receive car seat or fire safety information. Both groups completed a 10-minute assessment about their safety knowledge and behaviors and received tailored feedback relevant to their study group. The app contained a portal with educational links and sent monthly push notification reminders for parents to interact with the app. Parents completed follow-up assessments at 3- months and 6-months. Results Among the 602 parents completing all follow up points, 37% visited each page of the report, 19% emailed the report to themselves or someone else, and 33% visited the Parent Portal. Among 555 parents reporting at least one unsafe behavior at baseline, 130 (23.5%) changed their safety behaviors and reported no unsafe behaviors at the 6-month follow up. Those changing their behavior had more mean clicks (24 vs. 18; p Conclusion Smartphone applications hold potential for changing behaviors that are known to improve child passenger safety.

OBJECTIVES The objectives of this study were to estimate the prevalence of cell phone and computer use among urban families bringing their children to an emergency department and to determine which technologies parents prefer to use to receive health information. METHODS We visited 2 pediatric emergency departments in Baltimore, Md, and Little Rock, Ark. A convenience sample of parents of children 8 years old or younger completed a self-administered survey in the waiting area. RESULTS Two hundred thirty-eight surveys were completed. Respondents were primarily female (83%), less than 35 years old (74%), and had at least a high school diploma or General Educational Development (94%). Forty-three percent were employed full time. A majority (95%) of respondents reported owning a cell phone, with most (88%) owning a smartphone and 96% reported having some internet access. Of cell phone owners, 91% reported daily text messaging activity. Over half (63%) of respondents reported having computer internet access at home; 31% reported having internet access at work. Patterns of behavior and preferences emerged for both cell phone and computer use. Respondents were more likely to check their email (75% vs 50%, P < 0.0001) and access the internet (78% vs 67%, P = 0.002) with a smartphone rather than their computer. CONCLUSIONS Both cell phones and computers are prevalent and used among urban families seen in pediatric emergency departments, offering new ways to deliver health information to these often underserved populations. Providers aiming to deliver health information should consider smartphone applications, text message-based programs, and email to communicate with their patients.

The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting.This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted.Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area.A theory-based, stage-tailored educational program, Safety in Seconds v2.0Four car seat behaviors: (1) having the correct restraint for the child's age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child's restraint inspected by a child passenger safety technician.At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p0.01) for using the correct car seat; 2.37 (p0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p0.01) and having the car seat inspected (OR=1.73, p0.01).Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education.Clinical Trial Registration # NCT02345941.

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. We recruited eleven 8- to 15-year-old youth to participate in focus groups to inform the creation of a video promoting helmet use. Key emerging themes included that youth were responsible for keeping themselves safe and that most youth had cell phones with cases to protect them. A video was created that linked the concept of use of cases to protect phones to use of helmets to protect heads. Soliciting information from urban youth was helpful for developing this educational video.

Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer-reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription. Among patients who suffer an OPR-related death, approximately 1.8% of the OPR pills given to the decedents will have come from the ED. In addition to the need for more research, the existing literature suggests an urgent need for interventions in the ED to reduce OPR misuse and diversion.

An urban fire department has been distributing free smoke alarms for more than 30 years. A community-academic partnership was developed to conduct a community intervention trial as part of the fire department's home visiting program. The trial comprised 170 canvassing events held across 12 census tracts; half of the census tracts were assigned to the treatment condition and received prepromotion of the home visit events. The objectives of this analysis were to identify environmental and programmatic predictors of 1) whether someone would be at home at the time of a visit, and 2) if at home, whether the resident would participate. A separate multilevel analysis was conducted to address each objective. The canvassing event served as the first level to account for variation in implementation of the program, with the census tract as the second level. All environmental and program characteristics were included as fixed effects in both models. Throughout 170 events, 8080 eligible residential addresses were visited, of which 3216 had someone at home, and 2197 homes participated in the program. Canvassing events held on weekends and during the evening hours was associated with higher odds of a resident being at home. Canvassing events without rain and held in the treatment census tract areas was associated with higher odds of resident participation. Environmental and programmatic factors can impact the reach of home visiting programs. These findings can contribute to emerging best practices for fire department home visiting programs.

This study describes the characteristics of opioid prescriptions for pediatric patients discharged from the emergency department (ED) with acute injuries, including type, formulation, quantity dispensed, and associations with patient age group and prescriber level of training. This retrospective cohort study enrolled all acutely injured patients receiving opioid prescriptions at discharge from an urban academic pediatric ED in a 1-year period. Electronic medical records were reviewed to abstract clinical and prescription data and prescriber level of training. Descriptive statistics were used for analysis. We identified 254 patients with injuries who received opioid prescriptions at ED discharge during the study period (mean age 9.5 years, 65% male). The most common injury was fracture (71%). Oxycodone was the opioid most frequently prescribed (96.1%). Liquid formulations were prescribed in 51.6% of cases. The median number of doses prescribed per prescription was 12 (SD±9.1), with a range of 1–50. Residents wrote 72.9% of prescriptions and prescribed more doses than non-residents (15.5 vs 12.2, p=0.01). Post-graduate year 2 (PGY2) residents prescribed more doses than PGY1 or PGY3+ residents. Our data show wide variation in the number of opioid doses prescribed to acutely injured pediatric patients at ED discharge and frequent use of liquid formulation; both factors may place this population at risk for accidental ingestion. These findings also support the development of pediatric clinical guidelines to define appropriate quantities of opioids to prescribe, promote poisoning prevention strategies, and design post-graduate education for medical trainees about safe prescribing practices.

Introduction CDC estimated more than 87,000 fire/burn injuries in 2017 among children 0–15 years old. Scald burns are the most common form of burn injury for children in the United States and are estimated to cost $44 million annually. Understanding the circumstances surrounding burn incidents and caretakers’ responses to them are needed to better guide prevention and education offerings. Methods We used a mixed methods approach to better understand pediatric scald burn mechanisms along with caregivers’ general knowledge, first aid responses and ability to accurately report characteristics of their child’s injury. Caregivers of children < 15 year old attending a burn follow up clinic with their child were recruited. Participants completed a 39-item, iPad-based survey that captured information about the circumstances, location and cause of the scald burn, whether first aid was provided, and caregiver/child demographics. With permission of the caregiver, the child’s medical record was accessed to collect burn descriptors (e.g., burn severity, total body surface area (TBSA), etc) to compare with parent self-report. Data collection occurred between May 2018 - May 2019. The study was approved by our institutional review board. Results Surveys were completed by 55 parents; 75% agreed to medical record review. The typical respondent was the female caregiver (80%) with more than a high school education (67%). The typical burn incident occurred in the kitchen (60%) of the family’s home (80%) and in the presence of the caregiver (71%). Seventy percent of respondents reported applying first aid; among those, 50% administered the proper first aid (using cool water on the burn) despite most (44%) reporting feeling “not confident” in the ability to do so. More than half (53%) didnot know their child’s TBSA; of those who did, self-reported TBSA ranged from 1 to 50%. Medical record review revealed that only 5 participants accurately reported their child’s TBSA. Conclusions Our data reveal that most scald burns occurred in the kitchen, of the child’s home, and in the presence of a caretaker. Half received incorrect first aid and few parents could accurately report their child’s TBSA. These results support the need to strengthen primary prevention offerings and improve parents’ understanding of their child’s burn injury. Applicability of Research to Practice The results of this research can help guide education efforts for primary prevention programs related to pediatric scald burn injuries. Furthermore, results can guide education practices for caregivers of children being treated for a scald burn injury.

ObjectiveTo develop a tool to assess the safety of the home environment that could produce valid measures of a child’s risk of suffering an injury.MethodsTool development: A four-step process was used to develop the CHASE (Child Housing Assessment for a Safe Environment) tool, including (1) a literature scan, (2) reviewing of existing housing inspection tools, (3) key informants interviews, and (4) reviewing the National Electronic Injury Surveillance System to determine the leading housing elements associated with paediatric injury. Retrospective case–control study to validate the CHASE tool: Recruitment included case (injured) and control (sick but not injured) children and their families from a large, urban paediatric emergency department in Baltimore, Maryland in 2012. Trained inspectors applied both the well-known Home Quality Standard (HQS) and the CHASE tool to each enrollee’s home, and we compared scores on individual and summary items between cases and controls.ResultsTwenty-five items organised around 12 subdomains were included on the CHASE tool. 71 matched pairs were enrolled and included in the analytic sample. Comparisons between cases and controls revealed statistically significant differences in scores on individual items of the CHASE tool as well as on the overall score, with the cases systematically having worse scores. No differences were found between groups on the HQS measures.ConclusionProgrammes conducting housing inspections in the homes of children should consider including the CHASE tool as part of their inspection measures. Future study of the CHASE inspection tool in a prospective trial would help assess its efficacy in preventing injuries and reducing medical costs.

This study of pediatric emergency department medical records explores children’s unintentional home injuries and parents’ reports of the cause of the injury, what could have prevented it, and changes made in homes afterward.

Background Between 1999–2016 in the U.S., more than 200,000 drug overdose deaths occurred involving prescription opioids. Emergency departments (EDs) contribute to the problem; 42% of opioids prescribed in EDs are misused. Interventions aimed at providers decrease rates of ED opioid prescribing but little is know about how to reduce patient demand. Objectives To evaluate feasibility of patient decision aid (PDA) on use of prescripedopioids among sample of adult patients in one Maryland and one West Virginia ED; to determine impact of PDA on patients’ knowledge, decisional conflict, preference for opioid, and storage and disposal practices. Methods Participants were randomized to intervention group (IG, N=65) or control group (CG, N=59). After triage and before seeing treating clinician, IG participants completed PDA and CG participants completed time-matched Health Risk Assessment (HRA) on iPad. Data were collected at enrollment (baseline), after completing PDA/HRA (post-test), after seeing treating clinician (discharge), and 6-weeks after discharge (follow-up). Findings. From baseline to discharge, no significant difference emerged between IG and CG in patient comfort with the three different pain treatment options (opioid, non-opioid, and no prescription) or in knowledge scores. IG patients reported significantly greater reduction in decisional conflict about pain medication preference, and felt more informed about options. No difference emerged in proportions who received opioid prescription between study groups, or in shared decision-making about their prescription. Among 16 patients who were discharged with opioid prescription and got it filled, 31% stored with latch/lock and 25% disposed inappropriately. Conclusions and Policy Implications While the PDA was well received by patients and easy to integrate into busy ED settings, it did not significantly reduce prescribing. Patients’ decisional conflict and feeling informed were significantly positively impacted. More work is needed to identify effective ways to reduce demand and educate patients about opioid safe use, storage and disposal.

Objective. This study assesses parents’ literacy skills and evaluates how literacy levels influenced the effectiveness of a health communication intervention designed to improve safety knowledge in low-income, urban families. Methods. A total of n = 450 parents of children aged 4 to 66 months completed the Rapid Estimate of Adult Literacy in Medicine (REALM) and participated in a randomized trial of an injury prevention intervention delivered via computer kiosk in a pediatric emergency department. A safety knowledge test was administered by telephone 2 to 4 weeks later. Results. More than one-third of parents were assessed by the REALM to have marginal (30%) or inadequate (8%) reading levels; the remaining 62% of parents had adequate reading levels. REALM scores were independently associated with knowledge gains for poison storage and smoke alarms. Conclusions. Participants reading level had an independent and significant effect on safety knowledge outcomes. Literacy level should be considered in all patient education efforts.

BACKGROUND: Safety centers (SCs) are hospital-affiliated outlets that provide families with safety products and personalized education about preventing injuries. Roughly 40 SCs are in operation across the United States, but no single model for staffing, supplying, or sustaining them has emerged. The project aimed to determine the feasibility of a centralized database for SC evaluation as the first step toward growing this proven intervention. METHODS: An Expert Advisory Committee was convened to determine data collection elements and procedures. Representatives from nine hospital-based SCs collected data about car seat and bike helmet sales and education provided between August 1, 2013, to December 31, 2013. RESULTS: A total of 645 study-related safety products were distributed at cost (72%), below cost (10%), or for free (19%). Education was provided for 96% of all products distributed, including receipt of print materials (81%) and product demonstrations (83%). Visitors to SCs were usually referred by a hospital provider (34%), followed by word of mouth (24%) and walk-in (22%). Seven of nine SCs were able to contribute data. Stability of SCs and capacity of staff emerged as facilitators of centralized data collection feasibility. CONCLUSION: We demonstrate that centralized data collection is feasible and that information to compare centers can be obtained. However, for more meaningful comparisons to emerge and to enable all SCs the ability to participate, support is needed institutionally for staff to be able to capture data and nationally to grow and sustain a database that represents the broader diversity of topics and services offered. Language: en

OBJECTIVES To describe safe storage practices and beliefs among adults who have used a prescription opioid pain reliever (OPR) in the past year; to compare practices and beliefs among those living with younger ( METHODS A survey was administered to a nationally representative sample of adults reporting OPR use in the previous 12 months and who had children RESULTS Among 681 adults who completed our survey and reported having children in their home, safe storage was reported by 32.6% (95% confidence interval [CI], 21.4–43.8) of those with only young children, 11.7% (95% CI, 7.2–16.2) among those with only older children, and 29.0% (95% CI, 18.3–39.8) among those with children in both age groups. Among those asked to answer survey questions thinking about only their oldest child, the odds of reporting safe storage decreased by half as perceived barriers increased (0.505; 95% CI, 0.369–0.692), increased twofold as efficacy increased (2.112; 95% CI, 1.390–3.210), and increased (1.728; 95% CI, 1.374–2.174) as worry increased. CONCLUSIONS OPRs are stored unsafely in many households with children. Educational messages should address perceived barriers related to safe storage while emphasizing how it may reduce OPR access among children.

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1–3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses’ relationships with clients made it easier for them to gain access to families who are often described as “hard-to-reach”. Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.

Background: We report on a social marketing campaign conducted in Baltimore homes to promote carbon monoxide (CO) alarms including the use of community outreach, vouchers, and a mobile van to increase availability. This article focuses on the impact of the vouchers and measures the price sensitivity of individuals in their willingness to obtain a CO alarm. Methods: The study provided all 712 participants a health education message about the importance of CO alarms. Then each received one of five randomly selected vouchers that would make the price of a CO alarm US$0, US$5.50, US$11.00, US$16.50, or US$22.00 and that could be redeemed at mobile van that was parked in their neighborhood. Results: The study found that the more the CO alarm was discounted, the more likely the voucher was to be redeemed. Discounting the price to US$0 had a larger effect than any other price point. Individuals who already owned CO alarms were more influenced by the free price point than individuals who did not have CO alarms at baseline, and some of these individuals appear to have installed more than one CO alarm in their dwelling. Homes with children were less likely and homes with older adults were more likely to redeem the vouchers. Conclusion: Making CO alarms free has the largest impact on the total number of CO alarms distributed. Individuals who already had CO alarms are more attracted to free CO alarms than individuals with no CO alarm.

Background Smoke alarms have been demonstrated to reduce the risk of death in fire. It is recommend that families develop and practice fire escape plans. This study aims to utilise a smartphone app, Safety In Seconds, to deliver a theory-based tailored education to improve fire safety practices of parents in Little Rock, Arkansas and Baltimore, Maryland Methods Parents of children aged 4–7 visiting the paediatric emergency room in the two participating sites (regardless of the reason for the visit) were recruited. With assistance from a research assistant study participants downloaded the Safety In Seconds app onto their smartphone and were randomised to the intervention (fire safety) or control (car seat) group. Both groups completed a 10 min assessment about their safety knowledge and behaviours and received tailored feedback relevant to their study group. The app contained a portal with educational links and sent monthly push notification reminders for parents to interact with the app. Parents completed follow-up assessments at 3 months and 6 months. Results A total of n=1129 parents were enrolled, and 742 (66%) completed the 6 month follow-up survey. At follow-up relative to the CG, parents in the IG were more likely to report having long-life lithium battery smoke alarms (22% vs 16%; p=0.03) and having practiced a fire escape plan (65% vs. 71%; p=0.08). Conclusions Smartphone applications may be a promising tool to improve home safety behaviours.

Statement of purpose This paper reports the effectiveness of the scald prevention intervention on knowledge, self reported prevention behaviours and observed home water temperature. Methods/approach Safe Start is a three-group randomised controlled trial comparing a scald prevention intervention delivered by health education staff (Intervention Group, IG) as part of the 2 week well child visit (WCV) and an attention-matched control group (Control Group, CG) that received a safe sleep prevention intervention, and a standard of care group (Standard of Care Group, SG). A baseline survey was completed in the clinic at the 2 week WCV; follow up surveys were completed in the home at 4–6 weeks. Results 149 participants were enrolled and completed a follow-up interview. The typical participant was a 26 year old African American (90%) mother living in a rental property (87%) receiving medical assistance (80%) with at least a high school education (58%). Compared to the attention matched control and standard of care groups, the intervention group demonstrated increased knowledge on 5 of 9 individual scald risk items and the overall knowledge score (74% (IG)vs. 48%–46%) correct, p=0.00). The IG parents were more likely to report water heater testing behaviour (45% (IG) vs. 11%–7%, p=0.00), and bath thermometer usage (82% (IG) vs. 17% and 8,% p=0.00), Differences were not found between group on home water temperatures. Significance Implementing this intervention is a promising way to reduce the risk of scald burns to infants primarily through increased knowledge and self reported testing behaviours of bath water. Future work needs to focus on barriers to changing the hot water temperature at the water heater, given that 51% of participants in our group had unsafe water temperatures at follow-up.

Purpose Bicycle helmet use has increased in the past three decades, but roughly only half of all cyclists wear helmets. Use is lowest among minority children, among children whose parents have less than a high school education and among poor children. Methods We conducted focus groups with urban youth aged 8 to 15 to better understand their perceptions of barriers and facilitators to helmet use, and to solicit their preferences for a video to promote helmet use to urban youth. We partnered with students from two urban schools to produce a 4 min promotional video. Finally, we tested the impact of the video coupled with receipt of a free helmet and proper fit instructions with families attending a paediatric well-child care clinic in our city. Results Two focus groups were completed with a total of 11 youth in November 2016. Several important themes emerged that informed the video, including that youth were responsible for keeping themselves safe and that most youth had cell phones (and used cases to protect them). A video script was finalised in February 2017 that asked youth why they protect their phones but not their heads/brains with a helmet. We will enrol at least 25 parent-child dyads in our full intervention: viewing video, receiving helmet and fit instruction, and completing baseline and two follow up surveys. The pilot will be completed by September 2017. Conclusions Soliciting information from urban youth is important to developing an effective and persuasive bike helmet promotion video. Significance We must develop persuasive and creative ways to encourage urban youth to wear helmets to reduce bike related injury disparities.

Purpose Although child safety seats are known to reduce the risk of death from motor vehicle crashes, use among children 4–7 years old remains low and misuse is widespread. The aim of this prospective randomised trial was to test the efficacy of a smartphone app, Safety In Seconds 2.0, which delivered theory-based tailored education about child safety seats to parents in Little Rock, Arkansas and Baltimore, Maryland Methods Parents of children aged 4–7 visiting the paediatric emergency room in the two participating sites (regardless of the reason for the visit) were recruited. Study participants downloaded the Safety In Seconds app onto their smartphone and were randomised to the intervention (car seat) or control (fire safety) group. Both groups completed a 10 min assessment about their safety knowledge and behaviours and received tailored feedback relevant to their study group. The app contained a portal with educational links and sent monthly push notification reminders for parents to interact with the app. Parents completed follow-up assessments at 3 months and 6 months. Results A total of n=1129 parents were enrolled, and 742 (66%) completed the 6 month follow-up survey. At follow-up relative to the CG, IG parents were more likely to report using the correct child safety seat for their child’s age and size (OR=1.8; p Conclusions/Significance Smartphone applications hold potential for changing behaviours that are known to improve child passenger safety.

BackgroundFew randomised controlled trials (RCTs) have been conducted to improve infant sleep practices. There is limited research on how best to integrate safe sleep information into routine paediatric anticipatory guidance delivered at well child visits (WCVs). This protocol paper describes the design of the Safe Start Study, which aims to evaluate the impact of safe sleep interventions on parents’ knowledge, beliefs and behaviours related to creating and maintaining a safe sleep environment for their infants.MethodsSafe Start is a three-group RCT comparing a safe sleep health education intervention delivered as part of the 2-week WCV, an attention-matched control group that receives a scald burn prevention intervention, and a standard of care group. A baseline survey is completed at the 2-week WCV; follow-up surveys and observations are completed in the home at 2–4 weeks and 2–3 months. Participants include mother–baby dyads attending a large urban paediatric primary care practice and their paediatricians. Primary outcomes are self-reported behaviours (baby sleeps alone, on back, in crib and in a smoke-free environment), observations of the sleep environment, paediatricians’ anticipatory guidance counselling about safe sleep and participants’ reported exposure to an existing city-wide safe sleep campaign.DiscussionProviding a theory-driven and evidenced-based safe sleep intervention is both a research and a clinical practice priority. This study will advance the application of educational and environmental interventions in the primary care setting to improve the safety of infant sleep environments in high-risk families.Trial registration numberNCT03070639; Pre-results.

This study assesses the disclosure rates of African American new mothers regarding their infants’ unsafe sleep practices by analyzing the mothers’ responses during separate encounters with a research assistant, health educator, and pediatrician.

Although smoke alarms with lithium batteries are often marketed as '10-year alarms', on average, these alarms do not remain functional for 10 years. This paper describes self-reported reasons for non-working lithium-battery alarms 6-9 months following a smoke alarm installation programme. Data presented are for a cohort of 754 homes that participated in the installation programme and subsequently completed follow-up. A total of 1487 smoke alarms were installed. At follow-up, 126 alarms (8%) were missing and 37 (3%) were observed to be non-working. Of the non-working alarms, residents reported that they had been disabled 57% of the time. Reasons for disabling the alarms most often included that the battery was chirping (38%) or that it sounded while someone was cooking (24%). Smoke alarm installation programmes using lithium-battery alarms should consider highlighting education about smoke alarm maintenance, the hush feature and resources to replace alarms that malfunction soon after installation.

Although water heater manufacturers adopted a voluntary standard in the 1980s to preset thermostats on new water heaters to 120°F, tap water scald burns cause an estimated 1500 hospital admissions and 100 deaths per year in the United States. This study reports on water temperatures in 976 urban homes and identifies water heater and household characteristics associated with having safe temperatures. The temperature of the hot water, type and size of water heater, date of manufacture, and the setting of the temperature gauge were recorded. Demographic data, including number of people living in the home and home ownership, were also recorded. Hot water temperature was unsafe in 41% of homes. Homeowners were more likely to have safer hot water temperature (120°F) than renters (63 vs 54%; P.01). For 11% of gas water heaters, the water temperature was130°F, although the gauge was set at less than 75% of its maximum setting. In a multivariate logistic regression, electric water heaters were more likely to have safe hot water temperatures than gas water heaters (odds ratio R=4.99; P.01). Water heaters with more gallons per person in the household were more likely to be at or below the recommended 120°F. Our results suggest that hot water temperatures remain dangerously high for a substantial proportion of urban homes despite the adoption of voluntary standards to preset temperature settings by manufacturers. This research highlights the need for improved prevention strategies, such as installing thermostatic mixing valves, to ensure a safer temperature.

OBJECTIVES:To describe safe storage practices and beliefs among adults who have used a prescription opioid pain reliever (OPR) in the past year; to compare practices and beliefs among those living with younger (METHODS:A survey was administered to a nationally representative sample of adults reporting OPR use in the previous 12 months and who had children RESULTS:Among 681 adults who completed our survey and reported having children in their home, safe storage was reported by 32.6% (95% confidence interval [CI], 21.4–43.8) of those with only young children, 11.7% (95% CI, 7.2–16.2) among those with only older children, and 29.0% (95% CI, 18.3–39.8) among those with children in both age groups. Among those asked to answer survey questions thinking about only their oldest child, the odds of reporting safe storage decreased by half as perceived barriers increased (0.505; 95% CI, 0.369–0.692), increased twofold as efficacy increased (2.112; 95% CI, 1.390–3.210), and increased (1.728; 95% CI, 1.374–2.174) as worry increased.CONCLUSIONS:OPRs are stored unsafely in many households with children. Educational messages should address perceived barriers related to safe storage while emphasizing how it may reduce OPR access among children.

Background Although proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents9 use of child restraints and smoke alarms. Methods SIS is a multisite randomised controlled trial. Participants are parents of children aged 4–7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child9s age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan. Discussion Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use. Trial registration number NCT02345941; Pre-results.

OBJECTIVES: Living in substandard housing may be one factor that increases the risk of fire and burn injuries in low-income urban environments. The purposes of this study are to (1) describe the frequency and characteristics of substandard housing in urban homes with young children and (2) explore the hypothesis that better housing quality is associated with a greater likelihood of having working smoke alarms and safe hot water temperatures. METHODS: A total 246 caregivers of children ages 0 to 7 years were recruited from a pediatric emergency department and a well-child clinic. In-home observations were completed by using 46 items from the Housing and Urban Development’s Housing Quality Standards. RESULTS: Virtually all homes (99%) failed the housing quality measure. Items with the highest failure rates were those related to heating and cooling; walls, ceilings, and floors; and sanitation and safety domains. One working smoke alarm was observed in 82% of the homes, 42% had 1 on every level, and 62% had safe hot water temperatures. For every increase of 1 item in the number of housing quality items passed, the odds of having any working smoke alarm increased by 10%, the odds of having 1 on every level by 18%, and the odds of having safe hot water temperatures by 8%. CONCLUSIONS: Many children may be at heightened risk for fire and scald burns by virtue of their home environment. Stronger collaboration between housing, health care, and injury prevention professionals is urgently needed to maximize opportunities to improve home safety.

The Healthy Howard Health Plan (HHHP) is an innovative health access plan providing healthcare and health coaching to previously uninsured adults in Howard County, Maryland. HHHP members who enrolled in HHHP between January 2009 to June 2010 are followed over time using a variety of self-reported data collection tools including a health risk assessment (HRA), the SF-12, a measure of health status, and the PAM, patient activation measure. We describe their unmet health needs, demographics, health status and behaviors at baseline and we describe changes in health-related behaviors over time. Demographic and baseline HRA results for 700 individuals who enrolled over the first 18 months reveal HHHP members generally were racially diverse (white: 37 %; African American: 23 %, and Asian: 30 %), married (50 %) females (59 %). Most (62 %) have a family income between 121 and 200 % of the federal poverty level, and were without health insurance for more than 1 year (56 %). Self-reported health and behaviors for 163 plan members who completed initial and follow up HRAs revealed increases in physical activity, fruit and vegetable consumption, and health status. Statistically significant differences were found in patient activation from baseline to follow up (44 vs 58 %, p value 0.0005). Patient demographics, health status, and health behaviors of these newly insured Americans may help policy makers and care providers prepare to meet their needs. We noted improvements in certain self-reported health behaviors and health status, suggesting participation in the Plan is associated with positive health impacts for some Plan members.

Objectives Many residential fire deaths occur in homes with no or non-functioning smoke alarms (SAs). Self-reported SA coverage is high, but studies have found varying validity for self-report measures. The authors aim to: (1) determine over-reporting of coverage, (2) describe socio-demographic correlates of over-reporting and (3) report reasons for over-reporting. Methods The authors surveyed 603 households in a large, urban area about fire safety behaviours and then tested all SAs in the home. 23 participants who over-reported their SA coverage were telephoned and asked about why they had misreported. Results Full coverage was reported in 70% of households but observed in only 41%, with a low positive predictive value (54.2%) for the self-report measure. Most over-reporters assumed alarms were working because they were mounted or did not think a working alarm in a basement or attic was needed to be fully protected. Conclusions If alarms cannot be tested, researchers or those counselling residents on fire safety should carefully probe self-reported coverage. Our findings support efforts to equip more homes with hard-wired or 10 year lithium battery alarms to reduce the need for user maintenance.

This paper presents a cross-sectional study examining the influence of neighborhood violence on multiple aspects of mothers’ health. While the influence of neighborhood violence on health is important to understand for all populations, mothers are especially important as they play a key role in protecting their children from the consequences of violence. Three hundred and ninety-two Baltimore City mothers of children 5 years and younger completed a self-administered survey that included questions about perceptions of their safety as well as their personal experiences with neighborhood violence. Separate models were run to compare the relationship between each measurement of neighborhood violence and five diverse health-related determinants and outcomes: self-reported health status, smoking, exercise, average hours of sleep a night, and sleep interruption. Controlling for mother’s age, child’s age, maternal education, and marital status, mothers with high exposure to neighborhood violence were twice as likely to report poorer health, smoking, never exercising, and poor sleep habits. Maternal perception of neighborhood safety was not related to any of the assessed health-related determinants and outcomes. This study emphasizes the importance of measuring exposure to neighborhood violence rather than solely assessing perceived safety. Neighborhood violence was a common experience for mothers in this urban sample, and should be considered by health professionals in trying to understand and intervene to improve the health of mothers and their children.

Reducing deaths and disability from injury will require pervasive and successful injury prevention efforts in both community and clinical settings. Examples of interventions in the clinical setting include access to and instruction on using safety products, and screening and brief interventions for alcohol problems, intimate partner violence, or child maltreatment. The objectives of this study were to identify and describe injury prevention programs used in emergency departments in one state, to describe facilitators to implementation of these programs, and to suggest ways for overcoming barriers. Language: en

Objective: Hot water scalds continue to pose a serious threat in the home, causing over 1,500 hospital admissions and 100 deathseach year in the United States. We aimed to determine whether households who participated in an enhanced home safety visitdemonstrated improved safety behaviors about hot water compared to homes receiving a standard home visit. This communityintervention trial took place between April 2010 and April 2011. Methods: Hot water temperature and self-reported prevention behaviors were recorded at a baseline visit, and retested 6-9 months later in a follow-up visit. Residents whose hot water temperatures remained at an unsafe temperature were asked whythey did not adjust the temperatures. Demographic data were also recorded. Results: A total of 708 households participated. No significant difference emerged between the two study groups in the proportionof households observed to have adjusted their hot water temperature to safe levels between the baseline and follow-up visits ( t = 1.24; P = .22). Residents who received the enhanced education were more likely to report testing their water temperature (27% vs. 11%; P < .01) and turning their hot water temperature below 120°F (43% vs. 32%; P = .08). Among those who had unsafetemperature levels and did not reduce the water temperature, the most common reason (26%) offered was that they “liked it hot”. Conclusions: These results demonstrate that water temperatures are unsafe in many urban homes. The effect of educationalinterventions may be mitigated by personal preferences of hot water temperature.

OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined. METHODS. A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4–66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics. RESULTS. The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reason for the emergency department visit was related to the safety behaviors. Virtually all (93%) intervention parents read at least some of the report; 57% read it all, and 68% discussed it with others. Lower-income intervention parents who read all of the report and discussed it with others were more likely than control parents to practice safe poison storage. Higher-income intervention parents were more likely than control parents to report correct child safety seat use. CONCLUSIONS. These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority.

Summary Background Despite the requirement for and endorsement of injury prevention efforts among U.S. trauma centres, little is known about the breadth and depth of their current activities. Methods A survey was sent to eligible institutions in the National Inventory of Trauma Centres to better describe how level I and II centres are fulfilling their injury prevention requirement, to identify the barriers to conducting prevention activities, and to determine trauma centre personnel's interest in enhancing their prevention role. Results A total of 268 trauma centres (60%) completed the survey. Only 19% reported having an injury prevention director/coordinator but more than half of centres reported participating in 9 of 11 injury prevention activities, including participating in community events (97%), sending speakers to local schools (89%), and preparing or distributing educational materials (84%). Lack of time (68%), dedicated funding (68%), and an injury prevention specialist (45%) were the most frequently cited barriers to conducting injury prevention activities. Injury prevention collaborations were reported with safety groups (24%) and with emergency medical services, fire and police (23%). Trauma centres partnered less frequently with academic institutions (11%) and local or state health departments (16%). Topics and formats for injury prevention training as well as training barriers were also explored. Conclusions Improved partnerships and linkages with established agencies and organisations at the local and state levels could assist trauma centres in leveraging their more limited resources and expertise to offer state-of-the-art injury prevention programs and policies. As low- and middle-income countries are developing or strengthening their trauma systems, they should be encouraged to view injury prevention as a fundamental responsibility.

Objective The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps. Methods Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990. Results Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention. Conclusions There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.

OBJECTIVE. To shed light on the extent to which childhood obesity affects the types of appropriate child safety seats for young children, by providing an estimate of the number of US children whose weight renders them unable to use safely the majority of child safety seat types currently available. METHODS. The types of appropriate child safety seats were assessed by using National Highway Traffic Safety Administration 2005 Child Safety Seat Ease of Use Ratings. Estimates of the numbers of children weighing above the maximal weight for those child safety seats were calculated by using the tabulations of growth curves based on National Health and Nutrition Examination Survey 1999 to 2000 data that were assembled by the National Center for Health Statistics and the US Census for the year 2000. RESULTS. A total of 283305 children 1 to 6 years of age would have a difficult (if not impossible) time finding a safe child safety seat because of their age and weight. The vast majority of these children are 3 years of age and weigh >40 lb (182661 children). For these children, there are currently only 4 child safety seat types available, each of which costs between $240 and $270. CONCLUSIONS. This study determined that there is limited availability of child safety seat types for the ever-increasing number of obese young children. There are substantial numbers of children who weigh more than the upper weight limit for most currently available child safety seats. While we await reductions in the childhood obesity epidemic, options for maximizing the protection of obese children in automobiles must be identified.