A Brief Intervention to Increase Size-Appropriate Child Passenger Restraint Use

描述（由申请人提供）：尽管乘客安全有了很大改善，但机动车碰撞（MVCs）仍然是一岁以后儿童死亡的主要原因。2007年，1至12岁的儿童在居住期间死亡的人数超过了死于心脏病、流感/肺炎或败血症的人数。通过持续使用尺寸合适的儿童乘客约束装置，可以大大减少由车祸造成的死亡和重伤。仍然有10%的儿童完全不系安全带，大约四分之一的儿童没有使用适合他们体型的推荐安全带。需要新的方法来激励那些没有一直为1到12岁的孩子使用合适尺寸的乘客约束装置的父母改变行为。急诊科（ED）访问提供了独特的机会，可以接触到难以进入通常提供儿童伤害预防信息的初级保健机构的弱势儿童及其父母。急诊科的动机性访谈（MI）已被用于鼓励高危患者的各种健康行为。然而，MI之前并没有对儿童乘客安全促进计划进行评估。该职业发展奖将为梅西博士提供额外的技能和高级研究培训，以开发和评估基于ed的干预措施，利用MI技术和以患者为中心（例如，有针对性和量身定制）的打印材料，以促进正确和一致地使用合适尺寸的儿童乘客约束装置。梅西博士在她经验丰富的多学科指导团队的指导下制定了拟议的研究和职业发展计划，该团队包括行为改变、伤害预防和儿科健康服务研究领域的专家。该建议分为四个阶段：(1)对寻求ED护理的1至12岁儿童家长的调查数据进行受众细分分析，以确定不同的儿童乘客约束使用亚群体，从而制定有针对性的干预措施；(2)与家长进行焦点小组讨论，以深入了解第一阶段确定的小组，并试点测试针对这些小组的儿童乘客安全信息；(3)制定干预材料，包括简短的MI信息、有针对性的信息表和量身定制的小册子；(4)采用2x2析因设计进行干预的随机试点试验，以检验基于ed的MI和定制打印材料对一致使用合适尺寸的儿童乘客约束装置的独立和加性影响。梅西博士的职业发展活动将包括针对受众细分的统计分析的正式培训，定性方法，以及与ED环境中行为干预的设计和实施相关的先进理论和应用技术。通过正式的课程学习，与她高素质的指导团队的互动，以及拟议项目的执行，梅西博士将获得知识和技能，成为一名独立的研究人员和儿童伤害预防教育干预方面的专家。

DESCRIPTION (provided by applicant): Motor vehicle collisions (MVCs) remain a leading cause of death among children after the first year of life despite substantial improvements in passenger safety. In 2007, more children ages 1 to 12 years died as occupants in MVCs than died of heart disease, influenza/pneumonia, or sepsis. Deaths and severe injuries from MVCs can be reduced significantly through the consistent use of size-appropriate child passenger restraints. Still 10% of children ride completely unrestrained and roughly one-quarter do not use the recommended restraint for their size. New approaches are needed to motivate behavior change among parents who do not consistently use size-appropriate passenger restraints for their 1- to 12-year-old children. Emergency department (ED) visits represent unique opportunities to reach vulnerable children and their parents who have difficulty accessing the primary care settings where childhood injury prevention information is commonly provided. Motivational interviewing (MI) in the ED has been used to encourage a variety of health behaviors among at-risk patients. However, MI has not been previously evaluated for child passenger safety promotion programs. This career development award will provide Dr. Macy with the additional skill set and advanced research training required to develop and evaluate an ED-based intervention utilizing MI techniques and patient-centered (e.g., targeted and tailored) print materials to promote the correct and consistent use of size-appropriate child passenger restraints. Dr. Macy has developed the proposed research and career development plans under the guidance of her experienced multidisciplinary mentoring team that includes experts in the fields of health communications for behavior change, injury prevention, and pediatric health services research. The proposal is organized into 4 phases: (1) audience segmentation analysis of survey data obtained from parents of 1- to 12-year-old children seeking ED care in order to identify distinct child passenger restraint use subgroups for the development of targeted interventions; (2) focus groups with parents in order to obtain an in-depth understanding of the subgroups identified in Phase 1 and to pilot test child passenger safety messages intended for these subgroups; (3) development of intervention materials including brief MI messages, targeted information sheets, and tailored brochures; and (4) randomized pilot trial of the intervention utilizing a 2x2 factorial design to examine the independent and additive effects of ED-based MI and tailored print materials on the consistent use of size-appropriate child passenger restraints. Dr. Macy's career development activities will include formal training in statistical analysis for audience segmentation, qualitative methods, and advance theories and applied techniques related to the design and implementation of behavioral interventions in the ED setting. Through formal coursework, interaction with her highly qualified mentoring team, and the execution of the proposed project, Dr. Macy will acquire the knowledge and skills to become an independent researcher and expert in ED-based interventions for pediatric injury prevention. PUBLIC HEALTH RELEVANCE: Preventable injuries sustained by child occupants in motor vehicle collisions are a significant and costly public health concern. Child passenger restraint systems have proven effective in reducing the risk of injury and death associated with a motor vehicle collision, yet there are few evidence-based approaches to promote the correct and consistent use of the size-appropriate child passenger restraint. By using successful strategies for behavior change, including motivational interviewing and personalized health communication, the proposed intervention could remarkably improve passenger safety among children who contact the health system through the emergency department.