Awarded Grant to Prevent Violence and Violence-Related Injury


Our 2000-01 North Carolina (NC) study revealed serious abusive head trauma (AHT) among children under 2 years old at a rate of 17.0/100,000 children per year. Twenty-six percent died. A second study revealed that 2.6% of NC and SC parents admit shaking children < 2 for discipline. Other work has revealed the central role of infant crying in triggering shaking by caregivers. A multi-agency Leadership Committee in NC has developed a plan to implement and evaluate an AHT prevention program designed to prepare parents and other caregivers to deal with infant crying. The intervention will educate parents about normal infant crying patterns, how to respond to crying, and the dangers of shaking. We propose to disseminate “The Period of PURPLE Crying” curricula developed by the National Center on Shaken Baby Syndrome in a manner designed to reach every new parent three times. Building upon randomized controlled studies in Seattle and Vancouver, we will examine the effectiveness of this approach in NC over five years (~125,000 births / year). We anticipate reducing the numbers of children hospitalized or dying from AHT by at least 50%. The Leadership Committee plans to deliver this curriculum three ways. One, nurses will educate the parents of every newborn including discussion, a video, and a booklet about infant crying in the newborn nursery at all 86 hospitals/birthing centers in NC. Two, county health departments, pediatricians, and family physicians, will provide a second dose of the intervention in prenatal classes and/or at 2-week well-child checks. Third, the National Center on Shaken Baby Syndrome and the UNC School of Journalism and Mass Communications will develop a media campaign to be delivered statewide addressing social norms about shaking and reinforcing program messages directly and through family and friends To evaluate these efforts, we propose six strategies: 1) active surveillance with all 11 PICU’s and the Medical Examiner’s Office (OCME) to measure the incidence of AHT in North Carolina and look for a change in ratio of intentional and unintentional traumatic brain injury in young children from our earlier study; 2) two anonymous surveys of parents to see if the rate of shaking parents reported in the earlier survey is declining from our prior study; 3) a time series analysis using hospital, OCME, and KID national hospital discharge records to examine the trends in AHT cases from 1999-2011, before and during the program; 4) process evaluation of the delivery of the messages through a survey of nurseries to measure intervention fidelity and a random-digit-dial phone survey of new parents to assess program reach ; 5) a nested case-control study of AHT cases, compared to other hospitalized brain injured children under age 2 to examine receipt of intervention, in context of family composition, and other family stressors and 6) an economic analysis to examine program costs and benefits. Anticipated support from two foundations will enable this statewide effort to be a rigorous evaluation of program delivery, effectiveness, costs, and benefits.