title: Injuries in child care centers: gender-environment interactions.
abstract: OBJECTIVE
  To examine child characteristics (age, gender) and child care center environments (socioemotional quality, physical safety) that jointly predict injuries for preschool children.
  
  
  METHODS
  A two year prospective study of 360 preschool children, ages 2-6 years, was conducted in four urban child care centers. Composite scores for center quality and physical safety were derived from on-site observations, and injury rates were based on teacher reports. Poisson regression analyses examined age, gender, center quality, center safety, and the interactions of gender with quality and safety as predictors of injury incidence over one child year.
  
  
  RESULTS
  Age was significantly associated with injury rates, with younger children sustaining higher rates. An interaction between gender and center quality also significantly predicted injury incidence: girls in low quality centers experienced more injuries, while girls in high quality centers sustained fewer injuries than their male peers. Finally, an interaction between gender and center safety showed that girls in high safety centers sustained more injuries than boys, while girls in low safety centers sustained fewer injuries.
  
  
  CONCLUSIONS
  Injuries occur even in relatively safe environments, suggesting that in child care settings, the socioemotional context may contribute, along with physical safety, to the incidence of injury events. Further, gender specific differences in susceptibility to environmental influences may also affect children's vulnerability and risks of injuries. The prevention of injuries among preschool children may thus require attention to and modifications of both the physical and socioemotional environments of child care.
authors.affiliation: University of California, San Francisco School of Nursing, Department of Family Health Care Nursing, 94143-0606, USA. abbeyalk@uclink4.berkeley.edu
authors.forename: A
authors.initials: A
authors.lastname: Alkon
authors.forename: D R
authors.initials: DR
authors.lastname: Ragland
authors.forename: J M
authors.initials: JM
authors.lastname: Tschann
authors.forename: J L
authors.initials: JL
authors.lastname: Genevro
authors.forename: P
authors.initials: P
authors.lastname: Kaiser
authors.forename: W T
authors.initials: WT
authors.lastname: Boyce
mesh_terms: D017677:Age Distribution; D002140:California / Q000453:epidemiology; D002648:Child; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D017751:Safety Management / Q000592:standards*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control