Tiny Cargo, Big Deal! An Adaptive ED-Based eHealth Intervention to Promote Correct and Consistent Size-Appropriate Child Passenger Safety Behaviors and Reduce Disparities

项目总结 机动车碰撞(MVC)仍然是儿童意外伤害死亡的主要原因 美国(美国)种族/少数民族儿童作为次优儿童受到的影响不成比例 乘客安全行为在一些社区更为普遍。现有的通用方法来实现 促进儿童乘客安全未能确保所有儿童乘客正确使用尺寸- 根据美国科学院发布的指南，适当的儿童乘客约束 儿科和国家公路交通安全管理局。精准预防计划迫在眉睫 需要改善儿童乘客的安全行为，因为照顾者对 指导方针、法律和公共教育活动。这项拟议的研究将测试微型货物的功效， Big Deal(TCBD)，一种基于急诊科(ED)的精准预防干预措施，立足于自我 决定论。TCBD基于激励原则整合个性化咨询 访谈(MI)和电子健康组件，包括定制的教育Web应用程序(APP)和Short 信息服务(短信)通信，目的是提高儿童乘客的安全。我们假设 通过提供量身定做的儿童乘客安全教育和个性化的乘车技能， 这支持了自主动机TCBD的干预将比普遍的更有效 实现正确使用适合大小的儿童乘客约束的方法(法律/指南)。这个 主要结果，适当大小的安全带使用和儿童乘客安全评分(CPaSS)将是 通过预约的直接观察、面对面的预约和远程数字观察进行评估 照顾者在回复计划外短信时提交的照片。我们将检验我们的假设 采用随机化自适应试验设计，目的如下：目标1：完善和验证 100点CPaSS中的要素，这是一项衡量儿童乘客安全的新综合指标。目标2：测试 TCBD干预与常规护理在改善主要结局方面的疗效比较[即，大小- 在6个月和12个月时适当限制(二分)和CPaSS-D(数字)]。目标3：利用潜在增长 识别在12个月的数字照片中观测到的CPaSS-R特征轨迹的曲线模型 研究几个月并评估轨迹类型的相关性。这一创新的、理论上扎根的研究 通过告知增加正确使用的最佳方法，将对儿童乘客的安全产生长期影响 在不同背景的照顾者之间进行互动时，使用适合大小的儿童约束系统 与医疗保健系统的关系。这项工作有可能在教育署广泛推行，并可 翻译到初级保健办公室、学校和社区环境，最终目标是消除儿童 乘客安全差距和减少儿童因MVC而受伤的数量。

PROJECT SUMMARY Motor vehicle collisions (MVCs) remain the leading cause of unintentional injury deaths among children in the United States (U.S.) and racial/ethnic minority children are disproportionately impacted as suboptimal child passenger safety behaviors are more prevalent in some communities. Existing universal approaches to promote child passenger safety have fallen short of ensuring that all child passengers are correctly using size- appropriate child passenger restraints according to guidelines published by the American Academy of Pediatrics and the National Highway Traffic Safety Administration. Precision prevention programs are urgently needed to improve child passenger safety behaviors among caregivers who have not been responsive to guidelines, laws, and public education campaigns. The proposed research will test the efficacy of Tiny Cargo, Big Deal (TCBD), an emergency department (ED)-based precision prevention intervention grounded in Self- Determination Theory. TCBD integrates personalized counseling based on principles of motivational interviewing (MI) and eHealth components including a tailored educational web application (app) and short message service (SMS) communications with the goal of improving child passenger safety. We hypothesize that by providing tailored child passenger safety education and personalized skills for restraint use in a manner that supports autonomous motivation the TCBD intervention will be more efficacious than universal approaches (laws/guidelines) for realizing correct use of size-appropriate child passenger restraints. The primary outcomes, size-appropriate restraint use and the Child Passenger Safety Score (CPaSS), will be assessed with direct observation at scheduled, in-person appointments and remote observation of digital photographs submitted by caregivers in response to unscheduled text messages. We will test our hypothesis using a randomized adaptive trial design with the following aims: Aim 1: To refine and verify the reliability of elements in the 100-point CPaSS, a novel composite measure of child passenger safety. Aim 2: To test the efficacy of the TCBD intervention compared to usual care for improving primary outcomes [i.e., size- appropriate restraint (dichotomous) and CPaSS-D (numeric)] at 6 and 12 months. Aim 3: To use latent growth curve models to identify characteristic trajectories for the CPaSS-R observed in digital photographs over the 12 study months and assess for correlates of the trajectory types. This innovative, theoretically grounded research will have long-standing impact on child passenger safety by informing the best methods to increase correct use of size-appropriate child restraint systems among caregivers of diverse backgrounds at the point they interact with the health care system. The work has the potential for wide-scale implementation in the ED and for translation to primary care offices, schools, and community settings with an ultimate goal of eliminating child passenger safety disparities and reducing the number of childhood injuries from MVCs.