Journal of Pediatric Psychology, Vol. 29, No. 1, 2004, pp. 19-29
© 2004 Society of Pediatric Psychology; all rights reserved
The Role of Fathers in Toddlers' Unintentional Injury Risk
1 Department of Psychology and 2 Center for Educational Responsibility, University of Alabama at Birmingham
All correspondence concerning this article should be addressed to David C. Schwebel, Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, Alabama 35294. Email: schwebel{at}uab.edu.
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Abstract |
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Objectives Previous work suggests that maternal parenting and supervision reduces risk for children's unintentional injuries, but very little research has examined the role of fathers in children's unintentional injury risk. The role of fathers in protecting children from unintentional injury was considered. Methods A prospective longitudinal design predicted injury risk in 181 toddlers from the ages of 6 to 36 months. Predictor variables included child gender and temperament, individual difference factors of the mother and father, and parenting factors of the mother and father. Results Hierarchical regression models suggested that fathers' report of gains to the family from their employment was the strongest predictor of risk of children's unintentional injury. Several other paternal and maternal factors were also modestly related to injury risk. Conclusions Data indicate the need to consider the role of fathers in protecting children from unintentional injuries.
Key words: children; injury; safety; fathers; parenting.
Unintentional injuries are the leading cause of pediatric mortality, causing more deaths in children ages 1–4 years than the next 10 leading causes of death combined (National Safety Council, 2001
). Identification of psychosocial factors that may place children at risk of unintentional injury is of paramount importance to public health. One factor that has emerged as consistently relevant to injury risk, particularly among toddlers, is maternal supervision and monitoring of children (e.g., Gärling & Gärling, 1993; Morrongiello, Midgett, & Shields, 2001; Peterson, Ewigman, & Kivlahan, 1993; Wills et al., 1997).
The mechanism by which maternal supervision and monitoring might prevent children's injuries is hypothesized to be at least twofold (Schwebel & Bounds, 2003). First, mothers who supervise children are likely to verbally and/or physically prevent children from engaging in dangerous activities (Morrongiello & Dawber, 2000; Power, Olvera, & Hays, 2002). Second, children are likely to engage in the environment with greater caution when in the presence of their mothers (Schwebel & Bounds, 2003). Together, these mechanisms create a situation whereby mothers who spend large amounts of time with their children protect those children from injury (Morrongiello et al., 2001).
One notable limitation of previous research is that almost all studies focused on the role of mothers in childhood injury prevention, and it is unclear whether fathers might serve the same protective role. In other domains, fathers play an important role in influencing a wide range of social and cognitive aspects of young children's development (Lamb, 1997a). However, there is evidence that fathers and mothers interact with young children in different ways during their time together (Lamb, 1997b; Lewis, 1997), and these differences may have implications for children's risk for injury. While mothers tend to adopt nurturing roles, fathers play with their toddlers in more physically interactive ways (Lamb, 1997b; Lewis, 1997). Because paternal playful interactions may be more dangerous than maternal nurturing, the present study was developed to examine the role fathers might play in young children's risk for injury.
To test the role of fathers in children's injury risk, a prospective longitudinal design was used to predict subsequent injuries based on characteristics of the child, mother, and father when the child was 6 months old. Two models were constructed, one predicting all of the toddler's injuries from ages 6 to 36 months and the other predicting all of the toddler's injuries that occurred at home from ages 12 to 36 months. We hypothesized that fathers' parenting would contribute to the safety of children after controlling for the role of child, mother, and father individual differences (i.e., child gender and temperament, mother and father personality, and work-related gains and strains on family life). We expected that both maternal and paternal parenting factors would predict children's injury risk, but due to the paucity of previous research speaking directly to the empirical question, we did not make specific hypotheses concerning the intensity of the contribution of fathers' parenting or the relative predictive power of paternal and maternal parenting factors.
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Methods |
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Data Source and Participants
Data came from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care, a longitudinal study of the effects of early child care on children's development. A total of 1364 children were recruited from hospitals in 10 U.S. cities. The sample included 705 boys and 659 girls and was 80% white, 13% African American, and 7% other ethnicities. Mothers had an average of 14.31 years of education. Details on participant recruitment and data collection are available elsewhere (e.g., NICHD Early Child Care Research Network, 1994
, 1998, 2001).
The sample size for the present report was limited by two factors. First, only a subset of the full NICHD Study of Early Child Care sample included sampling of the child's father (n = 429 at 6-month assessment). Fathers were recruited at only 6 of the 10 data collection sites and were excluded if they refused participation or were absent from the household. Second, to be included in the present sample, data were required from several assessment periods during the longitudinal study: maternal questionnaires at 1 month, maternal and paternal questionnaires at 6 months, phone calls or face-to-face interviews at 3-month intervals from 9 through 36 months, and face-to-face contact with families at 6 months. With all exclusion criteria applied, a total of 181 families (89 boys, 92 girls) were available for analysis. Comparisons on demographic variables (child gender, child race, mother's age, mother's education level, father's education level, and family income) between the sample used for the present research and the full NICHD Study sample yielded just two differences: the present sample had a higher percentage of white children (92% vs. 79%), 
2(2) = 17.41 (p <.01), and better-educated mothers (mean of 14.50 years of education vs. 14.00), t(1361) = -3.37 (p <.01). Both differences likely reflect the fact that children of nonwhite and poorly educated mothers are more likely to have fathers who are absent from the home (Hetherington & Stanley-Hagan, 1997; Stephens, 1996).
Measures
As described below, 17 predictor and 2 dependent variables were used in the regression models.
Child Gender
Parents reported child gender during the 1-month assessment period.
Child Temperament
Child temperament was measured at age 6 months through mother report using a shortened version of the Revised Infant Temperament Questionnaire (Carey & McDevitt, 1978). Items were aggregated into a single scale with good internal reliability (Cronbach's 
=.81; Appelbaum, Batten, & Wendell, 1994). High scores represented more difficult temperament (i.e., a child higher in approach, activity, intensity, and mood, and lower in adaptability).
Maternal and Paternal Personality
During the 6-month interview, both mothers and fathers completed personality measures designed to assess three of the Big Five personality traits—neuroticism, extraversion, and agreeableness (Little, Appelbaum, Batten, & Wendell, 1993; Manner, Batten, Appelbaum, & Wendell, 1995). The extraversion and neuroticism scales were derived from the NEO (Neuroticism-Extraversion-Openness) Personality Inventory (NEO-PI; Costa & McCrae, 1985), a widely used self-report measure with good psychometric properties. The neuroticism measure included the subscales for anxiety, hostility, and depression, three of the six subscales of neuroticism in the NEO-PI. The extraversion measure included the subscales for warmth and positive emotions, two of the six extraversion subscales in the NEO-PI. In both cases, the chosen subscales correlate highly with the full-scale measures, as well as other measures of similar constructs (Costa & McCrae, 1985). The measure of agreeableness was derived from the NEO Five-Factor Inventory (NEO-FFI; Costa & McCrae, 1992), a shortened version of the NEO-PI that also is widely used and has good psychometric properties (Costa & McCrae, 1992). The full agreeableness scale from the NEO-FFI was included in the present study.
Maternal and Paternal Strains and Gains from Employment
When children were 6 months old, both mothers and fathers completed the "Combining Work and Family" measure (Marshall & Barnett, 1993) to assess parents' perception of strains and gains arising from their jobs that reflected upon family life. The strains from employment measure comprised the mean of 13 items answered on a 4-point Likert scale and had good internal reliability (Cronbach's =.88 for mothers and.86 for fathers). Sample items included "Your working creates strains for your children" and "Thinking about your children interferes with your performance at work." Higher scores represented greater perceived strains from work that impinged upon the family. The gains from employment scale comprised the mean of 8 items answered on a 4-point Likert scale; it also had good internal reliability (Cronbach's =.88 for mothers and.81 for fathers). Sample items included "The fact that you're working makes you a better parent" and "Having both work and family responsibilities gives your life more variety." Higher scores represented more perceived gains from employment.
Maternal and Paternal Parenting
Two measures assessed maternal parenting. The Infant/Toddler HOME (Home Observation for Measurement of the Environment) Inventory (Bradley & Caldwell, 1988) was conducted when children were 6 months of age to evaluate the home environment. Observers visited the home, interviewed mothers, and made binary decisions concerning various aspects of the home environment based on the visit and interview. A series of factor analyses conducted by the NICHD Study of Early Child Care team yielded a three-factor solution. Of particular interest for our study was the factor labeled "Positive Involvement," which included 6 items from the measure (Little, Appelbaum, Batten, & Wendell, 1994). Example items included "Parent spontaneously vocalizes to child at least twice" and "Parent's voice conveys positive feelings toward child."
The second measure of mother's parenting was a telephone interview conducted when children were 7 months old. Detailed interviews elicited each event that the mother participated in during the course of a day (measure adapted from Juster & Stafford, 1985). Of particular interest for our study was the report of time spent in social interaction with the child, which was computed by summing the times that mothers reported they spent interacting with the child, helping or teaching the child, or going on organized outings with the child (Coleman, Batten, Appelbaum, & Wendell, 1995). Because reports were from a variety of different days (e.g., weekdays, weekends, workdays, nonworkdays), the last reporting day was chosen for analysis.
To evaluate paternal parenting, when children were 6 months old their fathers completed the "My Time as Parent" questionnaire developed for the NICHD Study of Early Child Care. In part 1 of the questionnaire, fathers rated 20 child-care tasks such as changing diapers, reading to the baby, and talking to the baby on a 5-point Likert scale from partner's job to my job. The total involvement scale, which was the mean of 11 items chosen through factor analysis, was used (Cronbach's =.77; Newman, Batten, Appelbaum, & Wendell, 1996). Sample items included "Attending to the baby when he/she cries," "Dressing the baby," and "Taking baby to sitter or day care."
In part 2 of the "My Time as Parent" questionnaire, fathers reported the extent to which 14 household tasks were their responsibility or their partner's responsibility. Factor analyses yielded two factors: internal household tasks (e.g., laundry, cleaning, ironing) and external household tasks (e.g., car maintenance, home repairs, yard work; Newman et al., 1996). The first factor included seven items and the second six; both had moderate internal reliability (Cronbach's =.71 and.56, respectively). High scores represented tasks that were the father's own job.
Injury History
Children's history of injuries requiring professional medical attention was reported by their mothers on a quarterly basis, either through telephone interviews or through interviews during scheduled home visits by experimenters. For the purposes of this study, two measures were used. First, all injuries reported during the 9-month phone assessment through the 36-month visit were summed to create a single measure of all injuries experienced from 6 to 36 months. Second, all injuries that occurred in the child's home that were reported during the 15-month visit through the 36-month visit were summed to create a single measure of injuries incurred at home from 12 to 36 months. Location of injuries was not assessed until the 15-month period.
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Results |
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The analytic plan involved three steps: (a) descriptive statistics of all variables of interest; (b) correlation matrix of all variables of interest; and (c) linear regression models predicting injuries. Descriptive statistics are presented in Table I. There were no significant differences between boys and girls on any variable. Table II presents a correlation matrix of all variables used in the regression models. As shown, there were several strong relations between personality measures, both within and to some extent across spouses as well as between mothers' personality and maternal report of child temperament. Fathers' report of involvement with the child correlated with paternal involvement with internal household chores. The injury measures were not significantly correlated to any predictor variable at the p <.01 level, which was chosen a priori to reduce risk of Type I error given the number of correlations computed.
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The primary analyses were hierarchical linear regression models predicting the two measures of injury. Each was conducted using the same five steps to build a model (see Table III). In the first step, child characteristics were entered, followed successively by mother individual difference factors, mother parenting factors, father individual difference factors, and father parenting factors.
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Both regressions yielded similar results. There were no significant predictors among the child characteristics (Step 1: R2 =.01 for injuries ages 6–36 months, and R2 =.02 for home injuries ages 12–36 months), mother individual differences (Step 2: total R2 =.02,
R2 =.01, for injuries ages 6–36 months; and total R2 =.04; R2 =.02, for home injuries ages 12–36 months), or mother parenting factors (Step 3: total R2 =.02, R2 =.00, for injuries ages 6–36 months; and total R2 =.06, R2 =.02, for home injuries ages 12–36 months). In the fourth step, with the father's individual differences added into the model, paternal gains to family life from employment emerged as a significant predictor of injury risk (Step 4: total R2 =.05, R2 =.03, for injuries ages 6–36 months; and total R2 =.11, R2 =.05, for home injuries ages 12–36 months). On the fifth and final step, when father's parenting factors were added, maternal parenting became a modest predictor of decreased injury risk in the home (Step 5: total R2 =.09, R2 =.04, for injuries ages 6–36 months; and total R2 =.15; R2 =.04, for home injuries ages 12–36 months). However, in both models, paternal parenting traits were the strongest predictors. In particular, the father's gains from employment remained significantly related to increased risk for injury in both models (ß =.17 and.18, p <.05). Father's total involvement with the child was slightly related to decreased risk for injuries from 6 to 36 months (ß = -.17, p <.10), and father's participation in internal and external household chores slightly associated with increased risk for children's injuries in the home from ages 12 to 36 months (ß =.16 and.13, p <.10). |
Discussion |
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Results suggest that fathers play a role in toddlers' safety. Young children whose fathers reported that their family life benefited from their work life had an increased rate of injury. Other paternal and maternal parenting traits played more modest roles in children's injury risk.
The Role of Fathers in Protecting Children from Injury
Individual unintentional injuries are caused by a complex interplay of multiple interpersonal, intrapersonal, and environmental factors. No single predictor or even single set of predictors accounts for a large proportion of the variance in injury risk, but one of the strongest and most consistently identified predictors is the role of mothers and maternal supervision of children (Morrongiello et al., 2001). Supervising mothers recognize dangers in children's environments better than do children themselves (Schwebel & Bounds, 2003) and therefore can intervene to prevent children from attempting dangerous activities (Morrongiello & Dawber, 2000).
Present results provide modest support that fathers might serve in roles similar to those of mothers—fathers' total involvement with their child was related to a slightly reduced risk for unintentional injury—but neither paternal nor maternal involvement with children served a highly protective role for toddler injury risk in this sample. Instead, the strongest predictor of injury in this sample was paternal report of the gains to their family life that they perceived arising from their employment, a finding that contradicts theoretical models (e.g., Zedeck & Mosier, 1990) as well as empirical research (e.g., Kinnunen, Gerris, & Vermuist, 1996) suggesting that a high quality of fathers' work experience typically extends to happiness in their home. It is difficult to speculate what caused this result. Direct influences seem unlikely and third variables that might illuminate findings are unavailable. We tentatively offer two possible explanations, each requiring careful empirical investigation in the future. First, fathers who feel that their jobs benefit family life might have the time and interest to engage in playful interaction with their toddlers. Unlike mothers, fathers tend to play with young children in a rough-and-tumble, physical manner (MacDonald & Parke, 1986), which might occasionally result in childhood injury or lead children to behave in more aggressive or physical manners. Second, fathers who report that their work benefits their family life may be more comfortable financially and therefore expose their children to a wider range of activities. Engagement in a range of novel activities might provide more opportunity for childhood injury.
Other results were also unanticipated. Fathers who reported high levels of involvement with household chores had children with moderately higher rates of injury. One possible explanation concerns the behavior of mothers in households where fathers scored high on measures of intimate involvement and internal household chores. Fathers who are highly involved in household activities, including traditional maternal activities such as internal household chores (cleaning, ironing), may be married to women who are emotionally detached from the family (for reasons ranging from stressful careers to maternal depression) and therefore are less effective supervisors of children. Moderate positive correlations between paternal household chores and maternal neuroticism/strains from employment support this possibility. A second possible explanation is that children with injuries more frequently invoke more family involvement from their fathers. In other words, children who are prone to injury may attract fathers' attention and encourage the fathers to be more involved in household needs.
Also unexpected was the finding that temperament was unrelated to children's risk for injury, which contradicts previous work (e.g., Matheny, Brown, & Wilson, 1971; Matheny, 1991; Schwebel & Plumert, 1999). Due to a large quantity of missing data, the NICHD team summed scores from a number of temperament scales to create a single estimate of children's temperament (Appelbaum et al., 1994). Present results may not replicate previous work because the temperament scale lacked the specificity of temperamental traits used previously.
Study Limitations
This study was opportunistic and exploratory, and therefore had limitations. Available data were originally collected for other purposes, and therefore identical measures were not available to assess mothers' and fathers' time spent with children or to assess mother's and father's parenting skills. Behavioral measures of fathers' parenting were lacking completely, as were measures of some individual differences (e.g., racial/ethnic differences, father-child attachment) that might be of interest. Replications should include other relevant measures, assess mothers' and fathers' parenting through identical measures, and collect data through both questionnaire and behavioral methods.
A related limitation was the sample available for analysis. Though geographically representative, the sample was relatively homogeneous racially and socioeconomically. Further, the sample was necessarily limited to families with fathers at home; this fact, unexplored previously, might explain some of the unanticipated findings. Another limitation is that the study relied upon maternal report of children's injuries requiring professional medical treatment. Although used widely in the literature, such reports are subject to a few problems. First, they are influenced by parental recall biases. Some research suggests that relatively short time periods of assessment are preferable (Harel et al., 1994; Peterson, Harbeck, & Moreno, 1993)—the present study used 3-month intervals—but parents may still intentionally or unintentionally omit report of injuries that children have experienced. Second, such measures are influenced by parents' health care utilization. Parents use differing thresholds to determine whether or not to seek professional medical assistance, and therefore measures of injuries requiring professional medical attention are influenced not just by the extent of the child's injury but also by the threshold that parents use to decide whether to seek professional medical attention. Third, the study relied on maternal report of injuries and did not include a report of father's recall of injuries. Mothers may be influenced by a number of factors in their reporting of injuries—including the amount of time they spend with their child (e.g., mothers might underreport injuries if they tend to spend more time with their children)—that could bias the reported results.
Despite these limitations, the present report represents an initial glimpse of the role that fathers may play in protecting young children from unintentional injury. Future research is essential to continue to pursue methods by which we might prevent unintentional injury, the leading cause of toddler mortality.
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Acknowledgements |
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This study was conducted by the NICHD Early Child Care Research Network supported by NICHD through a cooperative agreement that calls for scientific collaboration between the grantees and the NICHD staff. We thank the NICHD team for sharing their data. The secondary analysis was supported by funds from the Department of Psychology, the School of Social and Behavioral Sciences, the Loyd J. Rockhold Center for Child Development, and the Civitan International Research Center, University of Alabama at Birmingham.
Received December 2, 2002; revision received February 27, 2003; accepted April 30, 2003
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