title: Evaluation of North Carolina child care safety regulations.
abstract: BACKGROUND
  The goal of this study was to track any changes in injuries and injury hazards during the first 3.5 years of implementation of the North Carolina Child Care Commission's 1996 playground safety regulations.
  
  
  METHODS
  All reports (n=5402) of medically attended injuries in regulated child care settings in North Carolina during the period 1 January 1997 through 30 June 2000 were reviewed and analyzed. A total of 294 playground safety inspections were conducted in November and December 1998 in randomly selected North Carolina child care centers, and the playground safety inspections were repeated in 76 child care centers in August 2000. Finally, in 1999 a 1992 child care center director self assessment of safety features in classrooms was sent to the directors of 291 of the 294 centers.
  
  
  RESULTS
  The annual rate of reported, medically attended injuries occurring in regulated child care facilities in North Carolina declined by 22% from 1997 to 1999. The playground safety inspections in the year 2000 revealed that, for nine of 10 playground concerns and 12 of 18 playground safety hazards, average ratings were equal to or better than those of 1998. Finally, the director surveys revealed no dramatic changes in classroom safety hazards since 1992.
  
  
  CONCLUSIONS
  This study represents the first time that the authors are aware of that a significant decline in state-wide child care injury rates has been associated with improved regulation of playground safety in the US.
authors.affiliation: Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, 27599, USA. jonathan_kotch@unc.edu
authors.forename: J B
authors.initials: JB
authors.lastname: Kotch
authors.forename: J M
authors.initials: JM
authors.lastname: Hussey
authors.forename: A
authors.initials: A
authors.lastname: Carter
mesh_terms: D002648:Child; D002654:Child Care / Q000331:legislation & jurisprudence*; D002656:Child Day Care Centers / Q000331:legislation & jurisprudence / Q000592:standards / Q000639:trends; D004779:Environment Design / Q000592:standards; D006801:Humans; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D010988:Play and Playthings / Q000293:injuries*; D012307:Risk Factors; D012449:Safety / Q000331:legislation & jurisprudence*; D011795:Surveys and Questionnaires