Effectiveness of public health practices against shaken baby syndrome/abusive head trauma in Japan.
OBJECTIVE
Previous studies have demonstrated the effectiveness of educational materials on infant crying to change caregivers' knowledge and behaviours related to shaken baby syndrome or abusive head trauma (SBS/AHT) using selected samples in randomized controlled trials. This study investigated the impact of public health practices to prevent SBS/AHT in Japan through the use of educational materials.


METHODS
Cross-sectional study.


METHODS
The intervention was comprised of two parts: (1) the screening of an educational DVD at a prenatal class; and (2) the distribution of a public health pamphlet at a postnatal home visit. Expectant parents watched a DVD (The Period of PURPLE Crying) about the features of infant crying and recommended behaviours (walking away if frustrated in the event of unsoothable crying, sharing information on crying with other caregivers) at a preterm parenting class held at eight months' gestation. A postnatal home-visit service was implemented in which a maternity nurse distributed a pamphlet to explain information about infant crying. Before the four-month health check-up, a self-administered questionnaire was distributed to assess exposure to these public health practices and outcome variables (i.e. infant crying knowledge, walk-away and information-sharing behaviours), and responses were collected at the four-month health check-up (n = 1316). The impacts of these interventions on outcome variables were analysed by comparing those exposed to both interventions, either intervention and neither intervention after adjusting for covariates.


RESULTS
Crying and shaking knowledge were significantly higher among women exposed to the public health practices, with a dose-response relationship (both P < 0.001). Further, walk-away behaviour during periods of unsoothable crying was higher among the intervention group. However, sharing information about infant crying with other caregivers was less likely among the intervention group.


CONCLUSIONS
The impact of educational materials in public health practice on knowledge of crying and shaking, and walk-away behaviour in Japan had a dose-response relationship; however, an increase in sharing information with other caregivers was not observed.
Department of Social Medicine, National Research Institute for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan. Electronic address: fujiwara-tk@ncchd.go.jp.
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D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000193:education* / Q000523:psychology / Q000706:statistics & numerical data; D002649:Child Abuse / Q000517:prevention & control*; D006259:Craniocerebral Trauma / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003448:Crying / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D010174:Pamphlets; D010290:Parents / Q000193:education* / Q000523:psychology; D015397:Program Evaluation; D015980:Public Health Practice; D038642:Shaken Baby Syndrome / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014742:Videodisc Recording; D055815:Young Adult
Abusive head trauma; Crying; Intervention; Japan; Public health; Shaken baby syndrome