Curbing kids' risk-taking behavior

Jul 1 2008

Educating kids and their parents about the importance of wearing a helmet when riding a bike, and buckling up and riding in the back seat of the car, could help to cut down the more than 30 million injury-related emergency room visits that occur each year in the United States.

And one of the best places to teach families about injury prevention is in pediatric trauma centers and emergency departments, say researchers at the University of Michigan C.S. Mott Children's Hospital.

Their study - now online and set to be published in the July issue of The Journal of Trauma Injury, Infection, and Critical Care - shows that screenings and brief interventions for at-risk kids admitted to pediatric trauma centers and their parents provides them with the information needed to help curb risky behavior and even prevent future injury.

In fact, 97 percent of families involved in the study were able several months after their intervention to recall information about how seat belts save lives, and the importance of placing kids in the back seat of a car and having them wear bicycle helmets.

"We know that children who are admitted to a trauma center for treatment of an injury tend to be more likely to engage in high-risk behavior," says study lead author Peter F. Ehrlich, M.D., M.H.S., director of the Pediatric Trauma Center at C.S. Mott Children's Hospital. "So when we have them in our care, it provides us with an opportunity, or a 'teachable moment,' to provide an intervention to counter risky behavior that could result in injury."

These "teachable moments," Ehrlich says, can be used for any risk-taking behavior, and do not necessarily have to be focused on the condition that brought the child in for medical treatment.

Ehrlich and his colleagues studied the effectiveness of such screenings and interventions for bicycle and car safety risk-related behavior at two level one pediatric trauma centers: C.S. Mott Children's Hospital and West Virginia University Children's Hospital. Both hospitals have several hundred patients, ages 7 to 17, admitted each year to their pediatric trauma services. At U-M, 7,000 children are seen in the emergency department each year for injuries.

As part of the study, children were screened based on the Centers for Disease Control and Prevention recommendations for bicycle and car safety. Those who revealed that they do not always wear a bike helmet or a seat belt - or, if under age 12, do not always sit in the back seat of the car - received a brief intervention. Not always wearing a bike helmet was the most commonly reported risk-taking behavior.

Interventions were led by a trained therapist at each hospital, and occurred after the patient had received medical treatment. The interventions included separate conversations with the patient and his parent/guardian about car and bicycle safety practices, adverse consequences of continued risk-taking behavior, and recommendations to improve their adherence to car and bike safety regulations. The families were also provided with written materials.

After three month, the families that took part in the interventions were contacted for follow-up interviews. Those interviews revealed:

• 79 percent of the families found the information provided during the intervention to be helpful.
• 53 percent reported that they learned something from the intervention.
• 75 percent felt the trauma center or emergency department was a good place to learn more about car and bicycle safety.
• While all parents reported having prior knowledge about the importance of seat belts and bike helmets, 100 percent of the families with children younger than 12 had not been educated about the importance of having children in this age group sit in the back seat of a car.

. 24 percent of children who had a positive screening test and underwent the intervention had changed their behavior (e.g. they were now using a bike helmet). This finding in particular, Ehrlich says, is very promising: For every 10-percent increase in helmet use, there could be an approximately 9 percent to 11 percent reduction in head and facial/scalp injuries.

"We found that the pediatric trauma center is a feasible location for conducting an injury prevention intervention. Families found the information helpful and in many cases made important life changes as a result. Plus, the intervention did not interfere with the patient flow in the hospital, and was well-supported by the health care team," says Ehrlich, associate professor, Department of Pediatric Surgery at the U-M Medical School.

Based on results from this study, Ehrlich says a preclinical trial should be conducted to determine if there should be broad implementation of screening and intervention programs in pediatric trauma centers and emergency departments.

In addition to Ehrlich, study co-authors were Peter Ehrlich, M.D.; Samuel Swisher-McClure, M.D., MS; and Ron Maio, D.O., MS.

Funding: American Pediatric Surgery Association Foundation

Reference: The Journal of Trauma Injury, Infection, and Critical Care, Vol. 65, No. 1

http://www.umich.edu