A Randomized Controlled Intervention Promotes Safety Home Environment Among Toddlers

Introduction: Young children are vulnerable to unintentional injuries, especially among low-income families. This project examines whether an 8-session intervention grounded in social cognitive theory (SCT) and focused on improving maternal safety behaviors promotes the home safety among families of toddlers.

Methods: 274 low-income mother-toddler pairs (age 12-30 months) were randomized to safety promotion group or an attention control group (obesity prevention). The safety promotion intervention targeted four common aspects of toddler safety: fire safety, fall prevention, poison control, and car seat safety. The mothers attended a 10 to 12-person small group session 5 times at a community site, and had 3 additional individual sessions with the intervention specialists via telephone. Goal-setting and social support was addressed in the intervention to promote maternal self-efficacy and perceived importance of toddler safety in adopting safety behaviors. At study enrollment (baseline), post-intervention (6 months) and delayed follow-up (12 months), trained research assistants, blinded to study group, visited participants’ homes and completed a 10-item observational checklist of dangers and safety features. Adapted from the Housing and Urban Development's home quality survey and Kids Health Household Safety Checklist, the checklist yielded a total score of the number of home safety problems. Complier average causal effect (CACE) model was performed, assessing intervention effect among the compliers (attending two or more intervention sessions) in the intervention group as compared to the potential compliers in the control group.

Results: The sample was composed of 70% Black, 2% Hispanic, and 22% White mothers. The mean age of the toddlers at baseline was 20 months. The mean number of safety problems was not significantly different between the intervention and control groups at baseline, was marginally significantly lower among intervention group than control group at post-intervention follow up (2.3 (1.3) vs. 2.7 (1.5), p=0.089), and significantly lower at delayed follow up (2.3 (1.2) vs. 2.8 (1.6), p=0.019).  Two-thirds (67%) of the mothers in the safety intervention group were compliers. Compared to the potential compliers in the control group, complier mothers in the intervention group had fewer home safety problems (b=-0.69, SE=0.34, p=0.045) at the delayed follow up, but not at the post-intervention follow up (b=-0.17, SE=0.22, p>0.10), after controlling for baseline number of safety problems and social-demographic covariates.

Conclusions: A safety promotion intervention built on principles of SCT has potential to promote the toddler's home safety environment.