Jennifer D. Blitvich

Parent/Caregiver supervision and child injury: a systematic review of critical dimensions for understanding this relationship

This study reviewed the relationship between recognized dimensions of supervision and childrens injuries based on Saluja et als (Injury Control and Safety Promotion. 2004;11:17–22) hierarchal model of supervision strategies. A systematic review of peer-review studies was done with the earliest records available to 2007. There were 112 potentially relevant articles identified; 31 studies met all inclusion criteria. Reported studies were categorized according to the dimensions of supervision they addressed. Studies were not evenly distributed across the dimensions. There was evidence from the study that directly linking dimensions of supervision to child injury risk and outcomes is scarce. Future studies should consider attention, proximity, and continuity of supervision to provide a holistic understanding of the relationship between supervision and injury.

Measuring children's self-reported sport participation, risk perception and injury history: development and validation of a survey instrument.

Despite the health benefits associated with childrens sport participation, the occurrence of injury in this context is common. The extent to which sport injuries impact childrens ongoing involvement in sport is largely unknown. Surveys have been shown to be useful for collecting childrens injury and sport participation data; however, there are currently no published instruments which investigate the impact of injury on childrens sport participation. This study describes the processes undertaken to assess the validity of two survey instruments for collecting self-reported information about child cricket and netball related participation, injury history and injury risk perceptions, as well as the reliability of the cricket-specific version. Face and content validity were assessed through expert feedback from primary and secondary level teachers and from representatives of peak sporting bodies for cricket and netball. Test-retest reliability was measured using a sample of 59 child cricketers who completed the survey on two occasions, 3-4 weeks apart. Based on expert feedback relating to face and content validity, modification and/or deletion of some survey items was undertaken. Survey items with low test-retest reliability (κ≤0.40) were modified or deleted, items with moderate reliability (κ=0.41-0.60) were modified slightly and items with higher reliability (κ≥0.61) were retained, with some undergoing minor modifications. This is the first survey of its kind which has been successfully administered to cricketers aged 10-16 years to collect information about injury risk perceptions and intentions for continued sport participation. Implications for its generalisation to other child sport participants are discussed.

Methodological approaches used to assess the relationship between parental supervision and child injury risk

Objective: To describe and rate the quality of methodological approaches used to measure parental supervision in relation to injury risk in children aged 0–14 years. Design: A systematic review of the literature related to supervision and injury risk. Methods: A comprehensive search of electronic databases from the earliest records available to the end of 2007, and supplemental hand-searching of relevant journals, reference lists of studies identified through database searches, and bibliographies of systematic and non-systematic reviews. A classification scale was used to rate the methodological quality of studies. Results: 30 papers met the inclusion criteria. They varied substantially in quality, and no meta-analyses or randomised controlled trials were identified. Fifteen studies used self-report approaches, asking parents or care givers to report through recording diaries, interviews and questionnaires and were considered of low quality; 11 studies reconstructed injury outcomes retrospectively. Observational studies were conducted in both laboratory and natural settings (n = 6), and these studies were generally of higher quality than self-report methods. Conclusions: The quality of many supervision and child injury risk studies is low to moderate. Further development of methodological approaches is needed to improve studies of the relationship between supervision and child injury risk.

Preventing adolescent drowning: Understanding water safety knowledge, attitudes and swimming ability. The effect of a short water safety intervention

Worldwide, epidemiological data indicate that children are a high-risk group for drowning and while progress has been made in understanding toddler drownings, there is a lack of empirical evidence regarding the drowning risk and protective factors inherent for adolescents and young adults. This study used a self-report questionnaire to establish swimming and water safety knowledge and attitudes of young adults and objectively measured their actual swimming ability using formal practical testing procedures. Participants then completed a short, 12-week intervention that encompassed swimming, survival and rescue skills, along with water safety knowledge applicable to a range of aquatic environments. Knowledge, attitudes and swimming ability were then re-measured following the intervention to evaluate its effectiveness. The Wilcoxon matched pairs signed ranks test was performed to detect whether there were significant differences between knowledge, attitude and swim ability scores pre-intervention and post-intervention. A total of 135 participants completed the baseline and follow up questionnaire and all practical testing. Results indicated that these young adults had a very low level of water safety knowledge pre-intervention, although the majority had sound swimming and water safety skills and attitudes. Overall, significant improvements were evident in knowledge (p<0.001) and swim ability (p<0.001) post-intervention, although no changes were observed in attitudes (p=0.079). Previous participation in formal swimming lessons and/or swimming within the school curriculum had no significant impact on water safety knowledge, skills or attitudes of these young adults, and there were few significant gender differences. While it is important to conduct further studies to confirm that these findings are consistent with a more representative sample of young adults, our findings are the first to provide empirical evidence of the value of a comprehensive aquatic education program as a drowning prevention strategy for young adults.

Observations of caregiver supervision of children at beaches: identification of factors associated with high supervision

Objective To identify independent factors associated with caregiver supervision levels at beaches. Methods Children (aged 1–14 years) engaged in beach play and their caregivers were observed at Australian beaches during September–April, 2008/09. Caregiver, child, and environmental factor data were collected and recorded on a validated observation instrument. The main outcome of interest was a continuous measure of supervision. After adjusting for potential clustering by beach/state, multivariable linear regression was used to identify independent factors associated with caregiver supervision. Results Four independent predictors of supervision and one interaction effect (child age by the caregiver and child position on beach) were identified. Caregivers who were supervising from a different position to where the child was playing were less likely to provide high supervision, as were older caregivers (>35 years) compared to younger caregivers (≤34 years). Compared to children playing alone, children playing with one, or two or more others were less likely to receive high supervision, and children aged 1–4 years were likely to receive higher supervision than older children. Conclusion This study provides new knowledge about underlying factors associated with the level of caregiver supervision in beach settings. Future studies should continue to explore independent predictors of supervision so that effective programmes, which focus on caregiver supervision, can be targeted to address poor supervision practices.

Adapting an established measure of supervision for beach settings. Is the parent supervision attributes profile questionnaire reliable

The Parent Supervision Attributes Profile Questionnaire (PSAPQ), developed to measure aspects of caregiver supervision and protectiveness and previously applied within playgrounds and in the home, was modified for implementation in a beach setting. To assess the test–retest reliability of the PSAPQ beach modification (PSAPQ-BEACH), 20 caregivers completed the PSAPQ-BEACH twice, over a mean interval of 18 days (range 10–24). The test–retest reliability and internal consistency of the PSAPQ-BEACH scores were compared to those of the PSAPQ. All scores on the PSAPQ-BEACH were higher than the PSAPQ, providing evidence that the questionnaire remains reliable after its adaptation to beach settings.

Waterslide exit velocities, user behaviours and injury prevention

Pool patrons enjoy waterslides and centre managers attest to their role in increasing pool attendances. One centre reported a 50% attendance increase in the month following installation of a new slide (Barbieri 2000). However, the inclusion of waterslides increases injury risk and steps are required to minimize this risk. Whilst most waterslide injuries are minor, such as cuts, abrasions and dental injuries (Stokes 1985), some are serious, including paralysis from spinal injury (Baggoley and Radford 1983). Collision with other users is a common cause of injury (Gordon and Stevens 1988).

Long term retention of safe diving skills

This short report describes a 20-month follow-up of safe diving skills, extending the 8-month retention period previously published in this journal. Thirty-four recreational swimmers with poor diving skills were evaluated before and immediately after a diving skills intervention program. Twenty-two returned for the eight-month follow-up evaluation and 16 returned 20 months post. As with the earlier study, Treadwater, Deck, Block and Running dives were video-recorded, and maximum depth, distance, velocity, entry angle and flight distance were compared. Underwater hand and arm positions were examined. Pre-intervention, a breaststroke arm action before maximum depth occurred in 18% of all dives and 38% of Treadwater dives. This was eliminated post-intervention, improving head protection. The Treadwater dive elicited the greatest mean maximum depth, and ANOVA showed depth for this entry decreased (improved) following intervention and remained shallower at the eight-month and 20-month post follow-ups. The Block dive also became shallower following intervention while the Deck dive remained unchanged. As seven 10-minute skills sessions resulted in shallower dives with safer hand and arm positions, and these skills were retained over a 600 day non-practice period, it is reliable to consider that the inclusion of safe diving skills in learn-to-swim programs can provide a diving spinal cord injury prevention strategy.

Acquisition of Knowledge, Attitudes and Behaviours that Contribute to Water Competence: High-Income Countries

Water safety literature has many epidemiological studies, and for high-income countries at least, the demographics and risk factors for drowning are well established. In spite of the introduction of a multitude of measures designed to reduce drowning, a review of current literature shows that to date, evaluations of the effectiveness of water safety interventions are scarce. Worldwide, key stakeholders have implemented various intervention programmes but few have been evaluated. Those which have, typically examine recall of messages rather than changes in skills, knowledge, attitudes and behaviours. At the same time, it should be realised that the impact of interventions on the drowning rate is particularly difficult to measure at least in high-income countries, where drowning is a relatively rare event. Also it seems unrealistic to expect that changes to rates become apparent after a single intervention. To date, home swimming pool fencing appears to be one of the only areas where evidence is available that demonstrates a reduction in drowning figures.