Municipality-Level Checklist to Promote Parental Behaviors Related to Prevention of Unintentional Injury in Young Children: A Multilevel Analysis of National Data.

Makiko Sampei,Naho Morisaki,Zentaro Yamagata,Tsuguhiko Kato,Kevin Y Urayama,Yuka Akiyama,Aurelie Piedvache,Ryoji Shinohara,Naoki Kondo,Junko Saito

doi:10.2188/jea.je20190079

Abstract

BackgroundUnintentional injury is a major cause of morbidity and mortality among young children in developed countries. In this national study, we examined the role of municipality-level safety checklist implementation for reducing risky child-safety-related parental behaviors.MethodsNationwide data were collected to evaluate the impact of the Healthy Parents and Children 21 initiative of the Japanese government. Questionnaires related to safety checklist implementation were administered to a random sample of municipal offices and to parents at the child’s routine 1.5-year health exam on parental behaviors related to child safety. Adjusting for municipality and individual-level variables, multilevel analysis was used to examine the relationship between municipality checklist implementation (4-month health exam) and six child-safety-related parental behaviors at the 1.5-year health exam.ResultsFamilies (n = 23,394) across 371 municipalities in Japan were included in this study; 5.6% of municipalities implemented a child safety intervention. Living in a municipality with a checklist intervention was associated with reduction in certain risk behaviors (not keeping tobacco/ashtray and candy out of the reach of infants, not using a car seat, not having a lock on bathing room door). However, after additionally taking into account municipality-level residual effects, only the “tobacco” behavior showed association with municipality of residence (Interval odds ratio, 0.25–0.94) and others were weak in the context of other potential municipality-level influences.ConclusionsA municipality-level intervention taking a checklist-based approach at the 4-month health exam in Japan appears to promote certain child safety behaviors in parents with children around 1.5 years of age.

Highlights

Injuries are a major cause of death among children in developed countries, accounting for up to about 40% of all deaths during childhood.[1]
We evaluated the relationship between living in a municipality where an infant safety checklist was administered at the 4-month health examination and childsafety-related parental behaviors
Statistical analysis First, we described the prevalence of each risk behavior in families, overall and grouped by checklist implementation status, and showed the median prevalence across municipalities and interquartile range (IQR)

Summary

Introduction

Injuries are a major cause of death among children in developed countries, accounting for up to about 40% of all deaths during childhood.[1] In Japan, unintentional injury is a major cause of mortality among children aged 0 to[14] years, leading to about 300 deaths each year.[2] During the past decade, advancements in medical technology have led to reductions in mortality due to unintentional injuries in Japan, from 525 deaths in 2000 to 157 deaths in 2016 among children aged 0–4.2 the number of ambulatory visits by children 0 to 14 years old has remained relatively constant at approximately 46,900 (0.3%) and 42,100 (0.3%) in 2005 and 2014, respectively.[3]. Unintentional injury is a major cause of morbidity and mortality among young children in developed countries. In this national study, we examined the role of municipality-level safety checklist implementation for reducing risky child-safetyrelated parental behaviors

Methods

Results

Conclusion