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A randomised safety promotion intervention trial among low-income families with toddlers
  1. Yan Wang1,2,
  2. Andrea C Gielen3,
  3. Laurence S Magder2,
  4. Erin R Hager1,2,
  5. Maureen M Black1,4
  1. 1Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
  3. 3The Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4RTI International, Research Triangle Park, North Carolina, USA
  1. Correspondence to Dr Yan Wang, Department of Pediatrics, University of Maryland School of Medicine, 737 W. Lombard Street, Room 167, Baltimore, MD 21201, USA; ywang{at}


Background Toddler-aged children are vulnerable to unintentional injuries, especially those in low-income families.

Objective To examine the effectiveness of an intervention grounded in social cognitive theory (SCT) on the reduction of home safety problems among low-income families with toddlers.

Methods 277 low-income mother–toddler dyads were randomised into a safety promotion intervention (n=91) or an attention-control group (n=186). Mothers in the safety promotion intervention group received an eight-session, group-delivered safety intervention targeting fire prevention, fall prevention, poison control and car seat use, through health education, goal-setting and social support. Data collectors observed participants' homes and completed a nine-item checklist of home safety problems at study enrolment (baseline), 6 and 12 months after baseline. A total score was summed, with high scores indicating more problems. Linear mixed models compared the changes over time in home safety problems between intervention and control groups.

Results The intent-to-treat analysis indicated that the safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the 12-month follow-up (between-group difference in change over time β=−0.54, 95% CI −0.05 to −1.03, p=0.035), with no significant differences at the 6-month follow-up.

Conclusions A safety promotion intervention built on principles of SCT has the potential to promote toddlers' home safety environment. Future studies should examine additional strategies to determine whether better penetration/compliance can produce more clinically important improvement in home safety practices.

Trial registration number NCT02615158; post-results.

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  • Contributors YW received funding to conduct data analyses on the effect of safety promotion intervention among toddlers. She conducted the literature review, data analyses, drafted the initial manuscript and revised the manuscript. ACG advised on the analytic methods and critically revised the manuscript. LSM advised on the analytic methods and critically revised the manuscript. EH contributed to the conceptualisation and revisions of the manuscript. MMB received funding to conduct the randomised parallel group trial. She advised on the analytic methods and critically reviewed and revised the whole manuscript. All authors approved the submission of the final manuscript.

  • Funding This study was funded by National Institute of Child Health and Human Development (NICHD) R03HD077156 (principal investigator YW), R01HD056099 (principal investigator: MMB) and U.S. Department of Agriculture (USDA) CREES 2005-04808 (principal investigator: MMB).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical review boards of University of Maryland, Baltimore, ethic review boards from Maryland Department of Health and Mental Hygiene.

  • Provenance and peer review Not commissioned; externally peer reviewed.