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Article Excerpt
Unintentional injury is the leading cause of pediatric mortality among American children, but the role of environmental context remains poorly understood as a risk for child injury. Couched in Bronfenbrenner's (1977) ecological theory, this study analyzed data from a sample of almost 900 children to identify relations between the home and out-of-home child care environments and subsequent risk for injury. Results suggest that both child- and supervisor-oriented factors, as measured at 36 months, predicted children's injuries over the subsequent three years. The role of the mesosystem was supported: parent-related factors predicted children's subsequent injuries in child care and school settings, and child care provider experience predicted children's subsequent injuries at home. Results are discussed from the perspectives of ecological theory and implications for injury prevention.
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Unintentional injury is the leading cause of pediatric mortality among American children, killing more youngsters than the next 20 leading causes of death combined (National Center for Injury Prevention and Control, 2005). Over the past several decades, researchers have made significant progress in identifying and describing many of the behavioral factors that contribute to children's risk for injury (for reviews, see Matheny, 1988; Wazana, 1997), but the role of environmental context--and in particular the role of adult supervision in the home and child care environments--remains poorly understood as a risk for child injury (Morrongiello, 2005).
Theorists dating at least to Kurt Lewin (1951) have emphasized the importance of environmental context on the development of human thought, behavior, and relationships. The premise is deceptively simple: A child does not develop in a vacuum but rather in the presence of places, people, and situations that influence how the individual child thinks, behaves, and acts. Each of those places, people, and situations independently and interactively influences the child's growth and development.
Bronfenbrenner's (1977) ecological model is perhaps the most prominent theory considering the role of the environment on a child's development. Bronfenbrenner described several concentric systems that influence children's development. The most proximal system, the microsystem, includes those contextual environments where the child acts, behaves, and learns; such environments include the child's parents and home, the child's teachers and school, and the child's neighborhood. Mesosystems connect microsystems. Bronfenbrenner suggested that experiences in one microsystem, such as the home, impact behavior and beliefs in a second microsystem, such as the child care center, via the mesosystem. As an example, children who attend child care might be instructed by child care providers to avoid playing near electrical outlets, and this learning might be exhibited not just in the child care environment but also in the home.
The present study was designed to consider the role of environmental context on children's developing risk for injury. The study focuses on relations between microsystem environments--in particular, the child's home and out-of-home child care environment--and subsequent risk for injury. The study also considers the role of mesosystems: How do aspects of the home environment (e.g., parenting) relate to injury risk outside the home (e.g., at child care and school settings) and vice versa?
The Role of the Home Environment on Children's Injury Risk
Aspects of children's homes are among the most prominent risk factors for injury, particularly for toddlers and preschoolers (Morrongiello, 2005). One aspect of safety in the home is the physical environment: Are safety-related structures such as stair gates, fire alarms, and outlet covers installed? Another aspect of the safety in the home environment, and our present focus, is more behavioral: How well are young children supervised by adults in the home? Mothers whose young children experience more injuries are consistently found to permit their toddlers and preschoolers to engage in more dangerous activities (Morrongiello & Hogg, 2004; Morrongiello, Ondejko, & Littlejohn, 2004a, 2004b). A nonrestrictive parenting style is also linked to increased risk of injury during the preschool years (Schwebel, Brezausek, Ramey, & Ramey, 2004).
The Role of the Child Care Environment on Children's Injury Risk
Despite the fact that almost two-thirds of 3- through 5-year-old American children--just under 8 million youngsters--spend their weekdays in child care settings outside the home (Cohen, 2001), the relation between child care environments and children's risk for injury is poorly understood compared to the role of a child's home. Most studies compare risk to children in child care during the hours they attend child care versus risk to children not attending child care during comparable hours when they are at home. These reports tend to suggest that children in child care settings have a lower risk for injury than their counterparts cared for at home (Kopjar & Wickizer, 1996; Kotch et al., 1997; Rivara, DiGuiseppi, Thompson, & Calonge, 1989), although some studies found such results for only younger children (Kopjar & Wickizer, 1996) or for only more minor injuries (Kotch et al., 1997).
We are aware of just two published studies that consider the influence of child care on children's risk for injury not just during their time at child care but also after they return home. In the first, random-digit telephone dialing was used to sample 1775 households with children under age 5 (Gunn, Pinsky, Sacks, & Schonberger, 1991). Replicating other work, risk of injury for children attending child care during the time at child care was lower than that of children not attending child care during the time at home. However, children who attended child care had a slightly higher overall risk for injury than did children who did not attend child care, presumably because they experienced disproportionately more injuries at home. Potential moderating factors such as parent, child care center, and child traits were not considered. A more recent report yielded different results (Schwebel, Brezausek, & Belsky, 2006). That study, which used data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care, followed more than 1,000 children from birth until age 6. Those children who spent more time in child care, whether at child care settings or family day care settings, had a reduced overall risk for injury in all settings. This finding held true even after a wide range of child and family variables were controlled and no matter what the observed quality of the child care center was.
The Role of Mesosystems in Children's Risk for Injury
Our recent report that children who spend more time in child care might have reduced overall risk for injury across settings (Schwebel et al., 2006) offers initial evidence that the mesosystem between child care settings and home environments might play a critical role in children's safety. Mesosystems, historically understudied in the developmental literature (Cicchetti & Aber, 1998), function in a number of ways to influence development but are particularly influential as children develop through the preschool years because this is the developmental stage when children begin to act with greater independence from adults (Bronfenbrenner, 1979). Translated to the topic of injury prevention, if children learn safe ways to behave during toddlerhood and early development--whether at home or a child care environment--they might transfer these lessons to safe behaviors over the subsequent years as they develop independence. Failure to learn appropriate rules early in development could lead to increased risk for injury.
Parents recognize the growing independence of their children through the preschool years and, probably erroneously but in response to their children's development nonetheless, tend to reduce their use of supervision and environmental manipulation to protect their preschoolers' safety (Garling & Garling, 1995; Gralinski & Kopp, 1993; Morrongiello et al., 2004b). In one longitudinal study, for example, parents' reminders about safety rules peaked when children were just 13 months old, after which rule reminders decreased over the subsequent year and stabilized until children completed preschool (Gralinski & Kopp, 1993). Children who do not learn rules about safety during the early preschool years are likely to have elevated risk of injury in the upper preschool and early school years, especially if they are poorly supervised by adults who have erroneously assumed that children at that age can behave in a safe manner when left alone (Peterson, Ewigman, & Kivlahan, 1993).
The Present Study
A wide range of intrapsychic, interpersonal, and environmental factors influence children's risk for injury between the ages of 3 and 6 years. This study focuses on aspects of the home and child care environments, with a particular focus on the quality of supervision that children receive in each of those contextual environments. This focus is justified by research suggesting that exposure to rules and lessons on safe behavior influence preschool-aged children's safety (Morrongiello, Midgett, & Shields, 2001), as does the quality of adult supervision they receive (Morrongiello, 2005; Schwebel et al., 2004; Schwebel et al., 2006).
We also consider the role of children themselves. Children inevitably influence the contexts in which they engage (Boyce, Frank, Jensen, & MacArthur Foundation Research Network on Psychopathology and Development, 1998; Sameroff, 1983; Steinberg & Avenevoli, 2000), and therefore it is critical to consider not just the influence of supervisors in environmental contexts but also the role of children's own individual differences and behaviors. Individual differences in gender (e.g., Morrongiello, 1997); family socioeconomic status, or SES (Matheny, 1988); oppositionality and externalizing behaviors (e.g., Rowe, Maughan, & Goodman, 2004; Schwebel, Speltz, Jones, & Bardina, 2002) and temperament (e.g., Schwebel & Barton, 2006; Schwebel & Plumert, 1999) have been identified as correlates to children's risk for injury in early childhood and are therefore included in the present study.
The present study was developed with two primary objectives in mind. First, we sought to extend previous work concerning the role of the microsystems in which most preschool-aged children spend the most time--the home and child care environments--on their subsequent risk for injury. Do child-oriented or supervisor-oriented factors serve as stronger correlates to children's injury risk? Do factors of the microsystem--parenting strategies, child care provider experience, and so on-relate to injury risk? Following ecological theory, we predicted that qualities of all supervisors would correlate to children's risk for injury in all environments measured.
Second, we considered the role of the mesosystem between children's...
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