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，在超过一半的幸存者(1-6)中有13%-30%的死亡率和严重的神经损伤。据估计，AHT的发病率为每100,000名婴儿中有23-42名(7-10岁)，平均每100,000名婴儿中约有30名。美国有3亿人口，出生率为每1000人14.1人，这意味着美国每年约有1250例病例。一项有效的初级预防战略将减少AHT的发生率，这可能会挽救许多儿童的生命，并改善许多其他儿童的生活。这项建议的目标是测试两种简单、低成本的干预措施，它们在我们之前工作的基础上具有很高的成功概率。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：针对宾夕法尼亚州所有新生儿父母的基于医院的产后初级预防计划将显著降低AHT的发生率。具体目标#1：评估已建立的全州范围内关于婴儿剧烈摇晃的医院产后父母教育计划的有效性，该计划在婴儿出生和出院之间的单一一致时间点提供，以减少虐待性头部创伤(AHT)的发生率。首席研究员最近在宾夕法尼亚州(PA)建立了一个以全州医院为基础的AHT初级预防计划。向父母提供关于新生儿期间剧烈摇晃的书面和视频材料，并要求父母自愿签署承诺声明(CS)，确认他们的参与。这一战略的有效性将通过比较向全州范围的虐待儿童登记报告的AHT病例的发生率与干预前的比率和来自多个州的儿童住院数据库(KID)的同期比率来评估。将使用其他嵌入式时间序列设计以及病例队列和假队列分析。 假设2：《许诺画像》8分钟的视频将是干预效果的最重要中介；干预效果更多地是由于犯罪者的改变，而不是照顾者的行为；干预在高危家庭中效果较差。具体目标2：确定哪些因素(S)是干预效果的最重要中介因素；确定干预效果是否与行为人或照顾者行为的变化更直接相关；并确定干预在不同社会经济群体中的有效性。四个项目组成部分(宣传册、视频、产房海报和与护士教育人员的讨论)的相对有效性将通过跟踪CS上这些组成部分的暴露情况进行评估。通过病例队列分析，确定的AHT病例接触方案每个组成部分的频率将与从所有PA出生中随机选择的队列中相应的暴露频率进行对比。无论该计划是改变犯罪者的行为还是教导父母 为了更好地为婴儿选择照顾者，将通过比较不同犯罪者群体之间的减少以及通过产后父母调查父母对干预改变行为的看法来评估。最后，将比较这种干预在高风险家庭和低风险家庭中的相对有效性(通过四个关键的人口学特征-父母年龄、教育程度、婚姻状况和种族/民族背景-表明在统计上与宾夕法尼亚州的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.