Monday, August 12, 2019

Smart Safety: Using Psychology to Prevent Accidents

Injuries have overtaken infectious disease as the leading cause of death for children worldwide, and psychologists have the research needed to help predict and prevent deadly childhood mishaps, according to a presentation at the annual convention of the American Psychological Association.

“Many different factors contribute to unintentional injuries, so if we are able to stop just one of these risk factors, the injury could be prevented,” said David C. Schwebel, PhD, of the University of Alabama Birmingham, who presented at the meeting. “By using novel behavioral strategies, we can possibly prevent injuries that have previously been seen as unavoidable accidents.”

Injuries were responsible for the deaths of over 11,000 and emergency room visits by more than 6.7 million American children in 2017, according to the Centers for Disease Control and Prevention. The Global Burden of Disease project estimates that more than 2 million children under age 19 worldwide died as a result of injuries in 2017. While these numbers represent all injuries, the presentation focused on only unintentional injuries (i.e., accidents) instead of intentional injuries such as suicide, homicide and abuse.

Schwebel outlined a model that psychologists could use to reduce accidental injuries in children. The model groups risk factors in three categories: environment-based, caregiver-based and child-based factors. Each category contributes in some form to almost every incident, according to Schwebel, and preventing just one risk factor could stop an injury from occurring.

Environment-based factors can include many different aspects of the environment with which children interact. For example, children could choke on toys if they are not designed well or be harmed in a car accident due to an incorrectly installed car seat.

Schwebel described one case where he and his colleagues reduced an environmental risk by comparing the look and shape of bottles containing either juice or torch fuel. Children were shown many bottles, some with torch fuel and others with juice, and were asked if they would drink them or not. Children tended to identify liquids in clear plastic bottles as drinks and those in opaque containers as not drinks. After the findings were published, there were evident changes in the torch fuel industry as fuel began to be sold in dark opaque bottles.

Caregiver-based factors can involve anyone who is supervising a child, including parents, teachers, babysitters or even lifeguards. According to Schwebel, preschool teachers can often be underpaid and fatigued from the intense work of supervising children all day and sometimes use outdoor playground time as a break for themselves, allowing children to run free, even though the majority of injuries at preschools occur on playgrounds.

“To solve this problem, we developed the Stamp in Safety Program where children wear a nametag, and teachers have stamps to reward the children on their nametags for engaging in safe behavior,” he said. “While on the surface this seems to focus on rewarding children for safe behavior, its primary goal is to get teachers engaged and paying attention.”

Child-based factors include motor skills, how children perceive their environment and how they interact with others. These skills vary greatly by age, so different approaches are needed when confronting risks. For example, 7-year-olds struggle more with the cognitive demands of crossing the street than 14-year-olds. Interventions for child-based factors can include reinforcing common parenting practices such as teaching children how to cross the street safely or showing them how to interact with stray dogs.

How the specific situations targeted for interventions are chosen can be a mixed bag, said Schwebel. For example, the idea for a program on drowning prevention came after Schwebel observed lifeguards while his own kids were playing at a pool. Other intervention ideas are drawn from the personal experiences and ideas brought to him by his students, such as the Stamp in Safety program.

I had a chance to interview Schwebel to learn more.

Why have you gotten involved in the area of psychology and how it relates to safety?
Well, I'm not sure there is a quick and short answer but let me try to give you some of the highlights. It started when I was an undergraduate at Yale. I worked with the distinguished psychologist Jerome Singer and my undergraduate thesis studied a highly theoretical topic of why children in every culture of the world play pretend at about ages 2-4 or so. We were examining whether the pretend play might help children learn about perspectives - how their mind may be different from other people's minds, which can be practiced through pretending. At the same time, I helped Dr. Singer (and also his wife Dr. Dorothy Singer, also a distinguished researcher) to conduct research as part of a contract with the television show Barney. Barney had recently been released and was a huge hit then in the early 1990s, and we were examining the plots to see if they were successfully teaching children the lessons. That contrast, between highly theoretical research about children's pretend play and  perspective-taking, and highly applied research for Barney, impacted me. I realized I liked the applied piece - I wanted to conduct research that helped people live happier, healthier lives.

So I applied for PhD programs to study health psychology - that seemed a way to use psychological science in an applied way. I landed in the laboratory of Dr Jerry Suls at University of Iowa, and studied cardiovascular health (blood pressure, heart rate) and stress. It was a great study, but (a) I missed working with children and (b) I was not excited to learn about physiology and anatomy, which of course is important when you are studying cardiovascular health.

At that point, the happenstance of science played out. I attended a departmental lecture by Dr. Jodie Plumert, a developmental psychologist at Iowa, who was interested in how children judge their ability to complete physical tasks. For example, she looked at how children judge how far they can reach, or step, or jump. She had discovered a surprising link between children overestimating their ability more often (just about all children tend to overestimate, but some more than others) and their injury history. Children who overestimated their own abilities more seemed to get hurt more often. That was led me on the path of studying child injury risk. I ended up doing my dissertation under Dr. Plumert's mentorship in the late 1990s, and have been working in that area ever since. It seems to fit all my goals - it is based on psychological science, I have the pleasure of working with and helping children and families, and I am conducting research that really can help society and improve our health and happiness.

You discuss the example of taking a mental break during a playground visit as actually being a more dangerous time for parents to relax. Can you share other examples of how we may be inadvertently working against ourselves in parenting?

Yes, sure. Just to clarify, most of our research on playgrounds is actually with preschool teachers, not with parents, but I think the same principle applies to parents.

There could be a very long list to answer your question I think the area of distraction is a major one that occurs to me first. Our smartphones are addictive. They help us in so many ways, and parents absolutely should use them to keep us organized, entertained, and connected. But we need to be careful that smartphones don’t take us away from our task of monitoring our children. This is true on playgrounds, but also near water (bathtubs, swimming pools, beaches, and more), near roads (parking lots – see the press release Alicia sent you yesterday), parks, sidewalks), and even in the home (poisoning risks, etc). We need to use our phones only when we know our young children are in a safe place, or someone else is watching them.

Other examples? We can get lazy when we have safety devices installed. Gates to swimming pools only prevent drowning when they are shut. Cabinet locks only prevent poisoning when they are latched. Smoke detectors only prevent burns when they have functioning batteries. Outlet covers only prevent electrocution when they are installed. So buy and use those safety devices to keep children safe.

What are some ways that parents can use psychology to help prevent accidents, even if they haven't studied the subject?
You really don’t need to be an expert to understand how to keep children safe. Parents probably know most of what they should do. First, they should be safe themselves. Our children learn a lot just by watching us. If you don’t use your seat belt, or your bike helmet, your children probably won’t either. Second, we should teach our children about safety. It takes a long time for young children to learn rules, but we need to be patient. We must have rules about safety, and we must consistently enforce them. Use positive words to praise children when they obey the rules, and redirect and remind them to follow rules when they fail to do so. Of course, we need to supervise our children – without distraction – and we can safeguard our environment by using simple devices like cabinet locks, outlet covers, and car seats to protect our children.


Session 3219: “Accidents Are Not Accidental: Using Psychological Science to Prevent Unintentional Child Injuries,”Invited Address, Saturday, Aug. 10,  2 p.m. CDT, Room W181a, Level One-West Building, McCormick Place Convention Center, 2301 S. King Drive, Chicago.

Presentations are available from the APA Public Affairs Office.

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