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Injuries

in Children

of Adolescent

Mothers:

Home

Safety

Education

Associated

With

Decreased

Injury

Risk

Elizabeth A. Jordan, MD, PhD*; Anne K. Duggan, ScD; and Janet B. Hardy, MDCM

ABSTRACT. The purpose of this study was to describe the epidemiology of injuries in children of adolescent

mothers (<18 years old at delivery) in Baltimore, MD, and to explore the relationship between maternal receipt of home safety information and child injury. A random sample of 363 adolescent mothers and their children were followed longitudinally by home interview at 3 and 15 months postpartum. Receipt of home safety information and information source were assessed at the 3-month interview. Injuries requiring medical attention were as-sessed at the 15-month interview. Sixty-eight children sustained injuries during follow-up and 14% required hospitalization. Falls and burns predominated as the cause of injury, with burns much more common in girls. The children of mothers who received home safety infor-mation from family and community-based sources by 3 months postpartum had significantly lower risk of injury during follow-up than children of mothers who had not received home safety information. As the number of in-formation sources increased, the injury rate decreased. Further work is needed to examine the most appropriate timing, repetition, format, and content of injury preven-tion education. Pediatrics 1993;91:481-487; injury, infant,

child, adolescent parenting, education, injury prevention,

home safety.

ABBREVIATIONS. WIC, Special Supplementation for Women,

In-fants, and Children; CI, confidence interval; OR, odds ratio.

Injury is the leading cause of death in children

aged 0 to 19 years and accounts for 20% of childhood

hospital admissions. Each year, almost 16 million

in-jured children are seen in emergency departments

across the United States.’ Childhood injuries cost our

nation more than $7.5 billion per year, and future

productivity losses may exceed $8 billion.2 These

data suggest that childhood injury prevention should

be an area of prime concern among pediatricians and

public health officials alike.

Child injury incidence rates are bimodal, with a

peak among 2-3-year-olds and among teenagers.3 Children born to adolescent mothers have higher

in-jury risk than children of older mothers. It is not

clear whether maternal age is an independent risk

From the *Department of Epidemiology. Johns Hopkins University School

of Hygiene and Public Health; and Department of Pediatrics, Johns Hop-kins University School of Medicine, Baltimore, MD.

Received for publication Mar 24, 1992; accepted Oct 13, 1992.

This research was presented at the meetings of the Society for Epidemio-logic Research on June 12, 1990, and at the meetings of the American Public Health Association on October 3, 1990.

Reprint requests to (J.B.H.) Dept of Pediatrics, Johns Hopkins University School of Medicine, 403 N Caroline St. Baltimore, MD 21231.

PEDIATRICS (ISSN 0031 4005). Copyright ©1993 by the American Acad-emy of Pediatrics.

factor for child injury or simply correlated with other child injury risk factors that frequently coexist with

low maternal age such as single parenthood,

unem-ployment, low educational status, and poor urban

environment.5’9

In young children, the majority of injuries occur

within the home setting.3’10” Traditionally,

pediatri-cians dispense home safety information to parents

during office visits. Many home safety educational interventions using a variety of educational formats have been evaluated.122#{176} In general, most of the

in-terventions were successful in raising parental

awareness of household hazards but had only

mod-est effects on household hazard reduction. Only a

few studies have attempted to correlate educational

intervention with injury reduction, most without

great success.12’2#{176} However, a recent study

demon-strated that injury prevention counseling based in

the offices of participating pediatricians was

associ-ated with a decrease in community-wide child injury

rates compared to a control community with no

in-dividualized injury prevention counseling except

those educational programs operating on a

commu-nity-wide basis throughout the state of

Massachu-setts.2’

The impact of home safety education on injury risk

has not been evaluated among adolescent mothers.

The goals of this paper are (1) to describe the

epide-miology of child injuries in a population-based

ran-dom sample of adolescent mothers, and (2) to

de-scribe the relationships between home safety

educational efforts and other maternal and environ-mental characteristics and child injury risk.

METHODS

The data for this study were collected as part of a longitudinal

study on health care and community resource use by pregnant and

parenting adolescents (<18 years at delivery) in Baltimore,

MD.22’21 The target population, enumerated through livebirth cer-tificates, consisted of all Baltimore City residents aged 17 years or

younger who gave birth in Baltimore in 1983. The study

popula-tion (N = 529) was selected through stratified random sampling

by maternal age, race, and parity to ensure sufficient sample si7e

in these subgroups for comparisons. The mothers were contacted

by mail shortly after delivery to elicit study participation. Three

hundred eighty-nine mothers permitted a home interview when

their infants were approximately 3 months of age, for a 74%

re-sponse rate. A second home interview was conducted with 363 of

the mothers when their infants were approximately 1 5 months of

age, for a 93% follow-up rate.

The home interviews, conducted by trained interviewers

expe-rienced with the urban adolescent population, focused primarily

on knowledge of, access to, use of, and satisfaction with various

community resources, including birth control/family planning,

(2)

demo-30

25

20

15

10

5

.

Ca

cx:

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0

0 2 4 6 8 10 12 14 16 18

Age (Months)

482 INJURIES IN CHILDREN OF ADOLESCENT MOTHERS

graphic characteristics, household structure, educational attain-ment and goals, paternal characteristics, and financial indepen-dence.

At the 3-month interview, the mothers were asked whether they

had ever received information about how to make their house safe

for a baby, and if so, to identify the source(s) of that information.

At the 15-month interview, mothers were asked to describe child

injuries since birth that had required a visit to a physician. From the mother’s descriptive account of the child’s injury, information

was coded on age at the time of injury, body part(s) injured, and

cause and consequences of the injury. Injury causes were coded

using codes E800 to E999 of the 9th revision of the International

Classification of Diseases, Injuries, and Causes of Death. In the case of multiple injuries, the most severe injury was coded. Injury severity

was judged based on the type of injury sustained and extent of

medical intervention required.

The National Center for Health Statistics recommends 3 months

as the optimum recall period for injuries resulting from motor

vehicle accidents24 and 4 weeks for accidental injuries in general.25

Because the 12-month period of recall used here was substantially

longer, maternal reports were compared with medical records for

children enrolled in Hopkins pediatric clinics. Close agreement

was found in both the number of injuries reported and their

de-scription.

The data were analyzed using the SAS statistical package.26

Weighting was applied to correct for disproportionate sampling so

that the results could be extrapolated to the city-wide adolescent

parent population. Chi-square and t tests were used to test for

differences between groups for categorical and continuous

van-ables, respectively. For multivaniable analyses, all covaniates were

transformed into binary (0, 1) variables. Multiple logistic

regres-sion modeling was performed by stepwise backward elimination;

variables were retained in the model if P < .10. Likelihood ratio tests were used to assess significance in multiple logistic regres-sion modeling after each variable was removed individually.27

RESULTS

Representativeness of Sample

Study nonparticipants at the first interview did not differ significantly from study participants in

preg-nancy and birth characteristics, including

birth-weight, 1- and 5-minute Apgar scores, gestational

age, method of delivery, presence of complications during pregnancy, trimester of initiation of prenatal care, and medical assistance status. The mothers lost to follow-up by the second interview were less likely

to receive Special Supplementation for Women,

In-fants, and Children (WIC) after delivery (P = .002),

more likely to have another child (P = .02), and more likely to have dropped out of school prior to the 1983

pregnancy (P = .01) than mothers who stayed in the

study. However, those lost to follow-up were not

significantly different on the following variables:

re-ceipt of home safety information; receipt of welfare, food stamps, or medical assistance; age; race; marital status; mean infant birth weight; or household struc-ture.

Descriptive Epidemiology of Injuries

Over the average follow-up time of 16 months

(range 13 to 20 months), 74 injuries requiring physi-cian visits occurred in 68 children. Six children had 2 injuries, and no child had more than 2. The overall

injury rate was 14.9 per 100 person-years. Through I

year of life, the risk of injury was 12.2%. As so few children were injured more than once, the remainder of the paper will focus on the first injury sustained during follow-up.

The risk of injury was low during the first 6

months of life but increased steadily thereafter (Fig

1). Nineteen percent of boys and 18% of girls were

injured (P = .89), and 13% of infants of 2500 g birth

weight were injured compared to 19% of infants

weighing more than 2500 g at birth (P .26).

The causes of first injury are listed in Table I. The

cause of first injury differed by gender and

ap-proached statistical significance (P = .08). Falls

ac-counted for 53% of the injuries. Boys were more

likely than girls to be injured in falls. More than half of the falls were from one level to another (21/37), and 12 of these falls involved stairs and steps.

Thirty percent of injured children were burned.

Girls were much more likely than boys to experience burns. The vast majority of burns in this population were caused by contact with hot surfaces including, in order of frequency, clothing irons, curling irons,

space heaters, ovens, and hot water pipes. There

were no flame burns, and only two children were

burned by hot liquids.

Other causes of injury, including accidental

poi-soning, choking on food, near drowning, and being

struck by a falling object, were more common in boys than girls. No children were injured in motor vehicle accidents.

Table 2 describes the body site injured and injury severity. The head was the site of injury for at least

49% of the children. Most of the head injuries were

minor, although one child suffered a concussion, and several had severe burns to the face.

Fig 1. Cumulative injury risk in

chil-dren of adolescent mothers, adjusted for length of follow-up.

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*Values are percentages.

TABLE 2. Characteristics of First Injury During Follow-up

c/c Of Injured Children (n = 68)

13.6 0.0 6.1 0.9 9-5 38.3 7-4 6.8 5.0 10.8 2.9 12.4 43.6 5.9 19.7 2.0 9.5 19.4

TABLE 1. Ca use of First Injury D uring Follow-u p by Gendcr*

Cause of Injury Boys Girls Total

(n = 36) (n = 32) (n = 68)

Fall 58 46 53

Burn 19 43 30

Other 23 11 17

Characteristic Hospitalization Injury consequence Death Fracture Concussion

Laceration requiring sutures Abrasions, contusions First-degree burn

Second-degree burn

Third-degree burn

Burn, unknown degree

Other

Unspecified

Body part(s) injured Head only

Head and other sites Arms only

Upper torso only Legs only Unspecified

Although most of the injuries were minor in

na-ture, 14% of injured children required hospitalization with a median length of stay of 3 nights (range 1 to 30

nights). There were no known deaths due to injury in

this population. The majority of children experienced mild lacerations, bruises, or first-degree burns, but 12% of injuries could not be classified due to lack of detail regarding injury consequence and severity.

The majority of injured children were taken to the

emergency department for initial treatment (78%),

while fewer were taken to hospital or

community-based public clinics (16%) or a private physician’s office (6%).

Maternal Characteristics and Infant Injury

This sample of adolescent mothers was

represen-tative of the adolescent parent population in

Balti-more. The majority of mothers were 16 or 17 years of

age (78%), single (95%), and black (82%). Most

moth-ers were economically disadvantaged; although

more mothers qualified for welfare support, 68%

ac-tually reported receiving welfare payments.

Twenty-two percent of mothers had dropped out of school

prior to conception, and of those in school at concep-tion, only 53% were still enrolled in school by

deliv-ery. Thirteen percent of mothers had a child prior to

the birth of the study infant. Seventy-nine percent of

the adolescent mothers lived with their own

moth-ers, often in crowded conditions.

Table 3 summarizes the relationships from

bivari-ate analyses between maternal characteristics from

the first interview and risk of injury. The only factor

associated with a reduction in injury risk at the 5%

level was receipt of home safety information by the

3-month interview. The children of mothers who

re-ported receipt of home safety information by the first interview were significantly less likely to he injured

than children of mothers who reported receiving no

home safety information. The unadjusted relative

risk of injury was 0.63 for children of mothers who

received home safety information compared to those

who did not (95% confidence interval [CU 0.41 to

0.97).

Several maternal factors were marginally

associ-ated with risk of child injury. Children living in a

household where other young children were present

had lower injury risk. The children of mothers who

reported failing grades in school prior to pregnancy

were almost twice as likely to he injured compared to

those whose mothers reported passing grades.

Chil-dren whose parents were married were at higher risk

of injury than children of unmarried parents; the

highest risk of injury occurred in the subgroup of

children whose parents were married at the first

in-terview and had separated or divorced by the second

interview. Variables not associated with injury

in-cluded mother’s age; race; parity; source of prenatal or pediatric care; number of well-child care visits; receipt of welfare, medical assistance, food stamps,

or WIC; number of adults in the household; and the

presence of the infant’s maternal grandmother or

grandfather in the household.

Early Receipt of Home Safety Information

Overall, 73% of the adolescent mothers reported

receipt of home safety information by the 3-month

postpartum interview. Many mothers reported

re-ceiving home safety information from multiple

sources. Health professionals provided information

to 71% of young mothers during prenatal and early

pediatric care. The infant’s maternal grandmother

was another common source of home safety

infor-mation (59%), followed by school professionals

(27%), other family members (26’), and other

sources (8%).

The relationship between number of home safety

information sources and injury risk is shown in Fig 2.

The risk of child injury decreased as the number of

home safety information sources increased ( Trend

Test, P = .006).

Receipt of home safety information was associated

with decreased numbers of falls and burns but not

other types of injuries (Table 4). Hospitali7ation for injury was not associated with receipt of home safety information.

Several maternal characteristics were associated

with decreased likelihood of receiving home safety

information (Table 5). Twenty-seven percent of

young mothers reported that they had not received

any home safety information by 3 months

postpar-turn. Mothers who were less likely to receive home

safety information were more likely to have dropped out of school at any time but especially before

preg-nancy and were more likely to have received failing

grades in school. The young mothers who did not

receive home safety information were more often

(4)

TABLE 3. Maternal Characteristics at Baseline and Risk of Injury During Follow-up

Characteristic Total

No.

% of Children P RR* 95% CIt

Injured

Mother’s age at delivery

13-15y

l6-l7y

81

281

15

20

.40 1.0

1.3 0.7-2.3

Parity

I 315 18 .71 0.9 0.5-1.6

2 48 21 1.0

Race

Black 296 18 .19 1.0

White 67 24 1 .4 0.9-2.3

Education

In school during pregnancy 192 18 .55 1.0

Dropped out during pregnancy 92 16 0.9 0.5-1.6

Dropped out before pregnancy 79 23 1 .3 0.8-2.1

Grades before pregnancy

Passing 340 18 .08 1.0

Failing 16 36 2.0 1.0-4.0

Marital status

Never married 344 18 .13 0.6 0.3-1.1

Ever married 19 32 1.0

Infant’s grandmother lives in household

Yes 285 20 .37 1.0

No 77 15 0.6 0.4-1.4

Other children in household besides siblings

Yes 104 14 .11 0.7 0.4-1.1

No 256 21 1.0

Mother receives welfare

Yes 245 18 .47 1.0

No 117 21 1.2 0.8-1.8

Source of health care

None 6 0 .39 0.0

Adolescent parenting clinic 44 16 0.9 0.4-1.8

Other clinic 275 19 1.0

Private physician 38 26 1 .4 0.8-2.5

Health care payment

Medicaid 193 15 .18 1.0

Private insurance 80 24 1.4 0.9-2.4

Self/no assistance 90 22 1.6 0.9-2.6

Mother received home safety information by 3 months

postpartum

Yes 266 16 .04 0.63 0.4-0.9

No 96 26 1.00

30

20

10

0 1 2 3 4 5 6

484 INJURIES IN CHILDREN OF ADOLESCENT MOTHERS

*Relative risk.t Confidence interval.

Fig 2. Risk of child injury during

fol-low-up by total number of home safety

information sources.

0

a)

C

V .C

0

health clinics. Maternal age, parity, marital status, and presence of other children in the household were not associated with maternal receipt of home safety

information.

Number of Information Sources

Multivariate Analysis

Since receipt of home safety information varied on

several maternal characteristics, some of which

dem-onstrated a weak association with injury, multiple

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TABLE 4. Causes of First Injury by Receipt of Home Safety Information

Cause of Injury Received Home Safety Information, No. (%)

Yes(n=266) No(n=96)

Fall 22(8.3) 13(13.5)

Burn 12(4.5) 9(9.4)

Other 9(3.4) 3(3.1)

Not injured 223(83.8) 71 (74.0)

logistic regression modeling was applied to assess

the independence of the relationship between home

safety information and injury and to explore possible

multiplicative interactions between home safety

in-formation and other variables. The protective

rela-tionship between home safety information and

in-jury risk remained significant at P < .05 after

controlling for race; maternal age; parity; school

grades; marital status; receipt of welfare; medical

as-sistance; WIC, or food stamps; infant gender and

birth weight; and presence of other young children or

infant’s maternal grandmother in the household.

Af-ter individual elimination of variables from a fully saturated logistic regression model, the final model contained variables associated with injury at P < .10

and included receipt of home safety information,

presence of the infant’s maternal grandmother in the

household, and marriage by 3 months postpartum.

The adjusted odds ratio (OR) for home safety

infor-mation was 0.48 with a 95% CI of 0.3 to 0.9. Marriage at the time of the first interview was a marginally

significant risk factor for injury (OR = 2.93, 95% CI

I .0 to 8.6), as was presence of the infant’s

grand-mother in the household (OR = I .92, 95% CI 0.9 to

4.2). No multiplicative interactions were found

be-tween home safety information and the other

van-ables listed above.

DISCUSSION

The findings in this study are based on a random

sample of the adolescent mother population in a

de-fined geographic area and are believed to be

repre-sentative of this community’s infant injury morbid-ity. Several factors might have led to underestimates of injury morbidity. First, it is possible that injuries

resulting from child abuse may have been

underre-ported. Even in the absence of abuse or neglect,

mothers might have underreported injuries they

feared would suggest maltreatment. Among mothers

whose children received care within our institution,

we did not find underreporting of injuries

docu-mented in the medical record. In addition to

under-reporting, barriers to care might have reduced our

estimates of morbidity. By definition, injuries were

TABLE 5. Characteristics of Mothers Associated W (HSI) by 3 Months Postpartum

ith Failure to Receive Home Safety Information

Characteristic Total

No.

Did Not

Receive HSI, %

P

Mother’s age at delivery

13-15y 16-17y

Parity I

81 280

314

22 28

27

.26

.54

2 48 23

Race

Black 296 23 .002

mWhite 66 42

Education

In school during pregnancy Dropped out during pregnancy Dropped out before pregnancy Grades before pregnancy

Passing Failing Marital status

191 93 78

339 16

21 71 62

26 44

.009

.10

Never married 343 26 .78

Ever married 19 29

Infant’s grandmother lives in household

Yes 285 22 .000

No 76 46

Other children in household besides siblings

Yes 104 22 .20

No 256 28

Mother receives welfare

Yes 244 22 .004

No 116 36

Source of health care

None 5 44 .03

Adolescent parenting clinic Other clinic

44 274

10 30 Private physician

Health care payment Medicaid

38

193

20

78 .11

Private insurance 80 28

(6)

486 1NJURIES IN CHILDREN OF ADOLESCENT MOTHERS limited to those for which medical care was sought.

it is uncertain how often mothers did not seek

needed care or were unable to obtain it.

Our estimate of injury risk in I-year-olds (12.2%) is

similar to McCormick and coworkers’ estimates of

injury risk in 1-year-old normal birth weight infants (11.3) and low birth weight infants (11.4%) of moth-ers I7 years of age in a multiarea study.5

As in other studies of young children, falls

pre-dominated as the cause of injury. in this population,

the incidence of burns was higher than reported by

other studics3”#{176}’ .2o; however, increased burn

fre-qucncy in children of teenage mothers has been doc-umcntcd.4.b An interesting finding in our study is that hot liquids were responsible for causing burns in

only 2 children, while 20 children were burned by

hot surfaces, primarily clothing irons and curling

irons. The fact that girls were more likely than boys to be burned may reflect the female child’s attempt to

imitate the mother’s grooming habits or

uninten-tional burns inflicted by the mother while trying to

curl the child’s hair. A better understanding of burn

epidemiology in children, including more

knowl-edge about the frequency and practices surrounding use of instruments with hot surfaces in households, is needed to promote child injury prevention.

Maternal receipt of home safety information by 3

months postpartum was associated with a 37% re-duction in risk of child injury. It is important to note that no injuries occurred before the first interview at

3 months postpartum, so there was no temporal bias

between receipt of home safety information and

in-jury risk. In other words, receipt of home safety

in-formation by 3months postpartum was not the result

of the child’s having been injured during that inter-val.

Most of the injuries sustained in this population

were not serious; however, the fact that 14% of

in-jured children required hospitalization cannot be

ig-nored. Receipt of home safety information was

asso-ciated with reduced number of injuries but was not

associated with decreased hospitalization rates.

However, since the number of serious injuries and

hospitalizations was low, the power to detect an

as-sociation with receipt of home safety information was not optimal.

Several circumstances suggest that the association

between home safety information and lower risk of

injury is not spurious. First, the observed trend

be-tween number of information sources and lower

in-jury risk would be highly unlikely if the association

between home safety information and injury were

spurious or due to some other factor that was not

measured. Second, the independent association

be-tween receipt of home safety information and

de-creased injury risk after controlling for

socioeco-nomic, educational, and household differences

provides further evidence for consistency in the

re-lationship.

Repetition of information as an aid to learning is a

concept that has long been embraced by the health

education community. in this study, it was clear that repetition of information from different sources,

in-cluding both health professionals and non-health

professionals, was associated with the lowest risk of

injury. While health professionals are probably the

foremost injury educators for parents, other sources

may provide important reinforcement of injury

pre-vention concepts.

Some important points could not be addressed in

this study. Information was not available regarding

the content, quality, or educational methods used to

dispense home safety information. Given the

spec-trum of health care sources used by this population, it is likely that a variety of educational vehicles was

used, including verbal instruction, discussion, and

written materials. Mothers who received home safety

information by 3 months postpartum probably

con-tinued to receive similar information from their

health care providers, parents, and other family

members. It is also likely that many of the mothers

who had not received home safety information by 3

months postpartum may have received some

infor-mation in the following months. Validation of receipt of home safety information was not possible. Finally,

it was not possible to rule out selection bias as a

confounder. Unrecognized characteristics of the

mother may have influenced her interest in injury

prevention.

Studies evaluating the efficacy of injury education

are plagued by many factors: inability to employ a

comparison group that receives no education,

diffi-culty establishing previous knowledge and

aware-ness of injury risk, inability to control injury

educa-tion from outside sources, and the need for large

sample sizes to evaluate the relationship between

education and injury incidence. This study, while ob-servational and simplistic in the attempt to correlate receipt of injury education to injury risk, nevertheless suggests that early receipt of home safety education is associated with decreased risk of injury during the

subsequent 12 months. The difference between these

two groups may demonstrate the effect of early,

re-peated information; many of these mothers were

“safety conscious” prior to delivery or early in the

postpartum period. Perhaps the early introduction of

home safety information helped these mothers learn

safety-promoting behaviors as they learned other

parenting skills.

More than one fourth of our population reported

that they had not received home safety information

by 3

months postpartum. These young women were

less likely to have frequent contact with the medical

and educational communities and were more likely

to be living away from their parents. It is important

to identify mothers who are less likely to receive

injury prevention information through the

tradi-tional channels and make efforts to reach these

young women through other means.

The medical community should strive to meet

5ev-eral objectives with respect to reducing the frequency

of injury in childhood. One, public awareness of the

risks, consequences, and possibilities for prevention of injury should be increased. Two, further research

is needed to elucidate relationships between

knowl-edge of home safety and adult behavior

modifica-tion. Three, further knowledge about the effect of

home safety information content and format, timing,

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repetition, and childhood developmental context on actual injury prevention is needed for methodologi-cal purposes. Finally, research focusing on the cost-effectiveness of health professional and nonprofes-sional efforts toward preventing injury is required for effective program planning.

ACKNOWLEDGMENTS

This work was supported by grant 000906-03-0, Office of

Ado-lescent Pregnancy Programs, US Department of Health and

Hu-man Services; the Maryland State Department of Human

Re-sources; and the Governor’s Council on Adolescent Pregnancy.

We gratefully acknowledge the technical assistance provided

by Shelby Roth. We thank Adolfo Correa-Villasenor, Penelope

Keyl, Modena Wilson, and Bernard Guyer for their critical review

of the manuscript.

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17. Thomas KA, Hassanein RS, Christophersen ER. Evaluation of group well-child care for improving burn prevention practices in the home.

Pediatrics. 1984;74:879-882

18. Gallagher 55, Hunter P, Guyer B. A home injury prevention program for children. Pediatr Cli?: North Am. 1985;32:95-112

19. Katcher ML. Evaluation of a multi-media injury control program. Am I Public Health. 1987;77:1195-1197

20. Kelly B, Scm C, McCarthy PL. Safety education in a pediatric primary care setting. Pediatrics. 1987;79:818-824

21. Bass JL, Mehta KA, Ostrovsky M. Childhood injury prevention in a

suburban Massachusetts population. Public Health Rep. 1991;106:437-442 22. Hardy JB, Duggan AK, Flagle CD. Resource use by pregnant and

parent-ing adolescents. Final report to the Office of Adolescent Pregnancy

Programs, Washington, DC, Grant APR-000906-03-0

23. Hardy JB, Duggan AK, Masnyk K, Pearson C. Fathers of children born to young urban mothers. Fan, Plan?: Perspect. 1989;21:159-163, 187 24. National Center for Health Statistics. Optimum Recall Period for Reporting

Persons Injured iii Motor Vehicle Accidents. Vital and Health Statistics, Series 2, No. 50. Rockville, MD: Health Services and Mental Health Administration; April 1972. US Dept of Health, Education, and Welfare publication (HSM) 72:1050

25. Massey JT, Gonzalez VE Optimum recall periods for estimating acci-dental injuries in the National Health Interview Survey. In: Proceedings

of the American Statistical Association, Social Statistics Section; 1976 26. Cary, NC: SAS Institute Inc

27. Breslow NE, Day NE. Statistical Methods in Cancer Research: The Analysis of Case-Control Studies. Lyons, France: International Agency for Research on Cancer; 1980;1:205-210

28. Larson CP, Pless lB. Risk factors for injury in a 3-year-old birth cohort. AJDC. 1988;142:1052-1057

NO KIDDING!

Lawyers are moving from a profession to a trade, with a corresponding decline

in ethics, and they are developing many of the attitudes exhibited by used car

dealers. . .Suits against hospitals and doctors, which went up 300-fold since the

1970’s, increased doctors’ medical insurance premiums more than 30-fold for some.

We have more lawyers per 100,000 people than any other society in the world. We

have almost three times as many lawyers per capita as Britain, with whom we share

a common law system.

Former Chief Justice Warren E. Burger. In a Review of: Olson WK. The Litigation Explosion. New York:

EP Dutton; 1991 . The New York Times. May 12, 1991.

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1993;91;481

Pediatrics

Elizabeth A. Jordan, Anne K. Duggan and Janet B. Hardy

Decreased Injury Risk

Injuries in Children of Adolescent Mothers: Home Safety Education Associated With

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1993;91;481

Pediatrics

Elizabeth A. Jordan, Anne K. Duggan and Janet B. Hardy

Decreased Injury Risk

Injuries in Children of Adolescent Mothers: Home Safety Education Associated With

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The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

References

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