PENNSYLVANIA ABUSIVE HEAD TRAUMA PREVENTION PROGRAM

描述（由申请人提供）：虐待性头部创伤（AHT）是最严重的虐待儿童形式，死亡率为13-30%，超过一半的幸存者（1-6）有明显的神经功能障碍。 AHT的发病率估计为23-42/100，000（7-10），平均约为30/100，000。 美国人口为3亿，出生率为每1000人14.1例，这代表美国每年约有1250例。 一个有效的初级预防战略，将减少发病率的AHT可能会挽救许多儿童的生命，并改善许多其他人的生活。 本提案的目的是测试两种简单、低成本的干预措施，根据我们以前的工作，这两种干预措施成功的可能性很高。 为了评估这些干预措施，我们将追求以下四个具体目标： 假设#1：一个以医院为基础的针对宾夕法尼亚州所有新生儿父母的产后一级预防计划将显著降低AHT的发病率。 具体目标1：评估在婴儿出生和出院之间的单一一致时间点提供的基于医院的产后家长教育计划在降低虐待性头部创伤（AHT）发生率方面的有效性。 主要研究者最近在宾夕法尼亚州（PA）建立了一个全州范围的基于医院的AHT一级预防计划。 向父母提供关于新生儿期间婴儿剧烈摇晃的书面和视频材料，并要求他们自愿签署承诺声明（CS），确认他们的参与。 将通过比较向全州儿童虐待登记处报告的AHT病例的发生率与干预前的发生率以及来自多州儿童住院患者数据库（KID）的同期发生率来评估该策略的有效性。 将使用额外的嵌入式时间序列设计和病例队列和假队列分析。 假设#2：“承诺的肖像”8分钟的视频将是干预效果的最重要的调解人;干预效果将更多地归因于犯罪者而不是照顾者行为的变化;干预在高风险家庭中的效果较差。 具体目标#2：确定哪些组成部分（S）是干预的有效性的最重要的中介;确定干预效果是否更直接地与犯罪者或照顾者行为的变化有关;并确定干预在不同社会经济群体中的有效性。 将通过跟踪CS上各组件的暴露情况，评估四个计划组件（宣传册、视频、产科病房海报和与护士教育者的讨论）的相对有效性。 使用病例队列分析，将已确定的AHT病例暴露于该计划每个组成部分的频率与从所有PA出生中随机选择的队列中的相应暴露进行对比。 该项目是否改变了犯罪者的行为， 将通过比较不同犯罪者群体的减少情况以及通过产后父母对父母对改变行为的干预措施的看法的调查，评估如何更好地为婴儿选择照顾者。 最后，将比较这种干预在高风险和低风险家庭中的相对有效性（如通过四个关键人口统计学特征-父母年龄，教育程度，婚姻状况和种族/民族背景-所确定的，这些特征在统计学上与PA中的AHT相关）。

DESCRIPTION (provided by applicant): Abusive head trauma (AHT) represents the most serious form of child abuse with a 13-30% mortality and significant neurological impairment in over half of survivors (1-6). The incidence of AHT is estimated to be 23-42 per 100,000 infants (7-10) with an average of approximately 30 per 100,000 infants. With a United States population of 300 million and a birth rate of 14.1 per 1000 population, this represents approximately 1250 cases annually in the United States. An effective primary prevention strategy that would reduce the incidence of AHT would potentially save the lives of many children and improve the lives of many others. The objective of this proposal is to test two simple, low cost interventions that have a high probability of success based upon our previous work. To evaluate these interventions, we will pursue the following four specific aims: Hypothesis #1: A hospital based post-natal primary prevention program directed to parents of all newborn infants in Pennsylvania will significantly reduce the incidence of AHT. Specific Aim #1: Assess the effectiveness of an established state-wide program of hospital based post-natal parent education about violent infant shaking, provided at a single consistent time point between the infant's birth and hospital discharge, in reducing the incidence of abusive head trauma (AHT). The principal investigator has recently established in Pennsylvania (PA) a statewide hospital based primary prevention program for AHT. Parents are provided written and video materials about violent infant shaking during the newborn period, and are asked to voluntarily sign commitment statements (CS) affirming their participation. The effectiveness of this strategy will be assessed by comparing the incidence of AHT cases reported to a statewide child abuse registry with both pre-intervention rates and with contemporaneous rates derived from the multi-state Kid Inpatient Database (KID). Additional embedded time series design and case cohort and sham cohort analyses will be used. Hypothesis #2: The 'Portrait of Promise' 8-minute video will be the most important mediator of the intervention effect; the intervention effect will be more due to changes in perpetrator rather than caregiver behavior; the intervention will be less effective among high risk families. Specific Aim #2: Identify which component(s) are the most important mediators of the intervention's effectiveness; determine whether the intervention effect is more directly related to changes in perpetrator or caregiver behavior; and determine the effectiveness of the intervention among various socioeconomic groups. The relative effectiveness of four program components (brochure, video, maternity ward posters, and discussion with the nurse educator) will be assessed by tracking exposure to the components on the CS. The frequency with which identified AHT cases are exposed to each component of the program will be contrasted with the corresponding exposure among a randomly selected cohort drawn from all PA births using a case cohort analysis. Whether the program changes perpetrator behavior or teaches parents to better select caregivers for their infant will be assessed by comparing reductions among various perpetrator groups and through post-natal parent surveys of parents' perceptions of the intervention in modifying behaviors. Finally, the relative effectiveness of this intervention among high and low risk families (as identified by four key demographic characteristics - parent age, educational attainment, marital status, and race/ethnic background - shown to be statistically associated with AHT in PA) will be compared.