David Schwebel | University of Alabama at Birmingham (original) (raw)

Papers by David Schwebel

Traffic Injury Prevention, Jun 22, 2016

Journal of Pediatric Psychology

Objective The preschool years represent a stage of rapid human development, hallmarked by explori... more Objective The preschool years represent a stage of rapid human development, hallmarked by exploring the environment through gross and fine motor movement and imaginative pretend play. This exploration is developmentally appropriate but also presents risks for injury, the leading cause of death for preschool-aged children. Common injuries reflect exploration and risk-taking exhibited during play, and play may be particularly risky when children imitate risky models like superheroes. Frequent exposure and subsequent identification with superheroes are concerning because the media glorifies superheroes, creating social learning effects on children and promoting play situations where children may attempt superhuman abilities and hurt themselves. This study examined the relations between pretend play, superhero identification, and children’s risk-taking. Methods One hundred five children aged 4–5 years old were randomly assigned to either a superhero- or school-themed, story-based protoc...

Journal of Pediatric Psychology

Objective Unintentional injuries, the leading cause of death for American children, are caused by... more Objective Unintentional injuries, the leading cause of death for American children, are caused by a range of psychosocial factors, including risk behavior. One factor that may impact child risk-taking is modeling of superhuman risk-taking from superhero media, both immediately following superhero exposure and based on lifetime exposure and engagement. Methods Fifty-nine 5-year-olds were randomly assigned to view either a 13-min age-appropriate superhero television show or a comparable nonsuperhero show. After the viewing, children engaged in three risk-taking measures: (a) activity room, unsupervised play for 5 min with assortment of apparently dangerous items that might encourage child risk-taking; (b) picture sort, 10 illustrations of children in risk situations, with participant response concerning intended risk-taking in that situation; and (c) vignettes, 10 stories presenting situations with varying degrees of risk, with participant response on intended choice. Parents complete...

Journal of Safety Research

The Lancet Global Health

Background More than 3 billion people do not have access to clean energy and primarily use solid ... more Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2•1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution.

PLOS ONE

Liquid laundry capsules have been involved in multiple poisoning incidents with young children in... more Liquid laundry capsules have been involved in multiple poisoning incidents with young children in the home. There are a range of contributing factors for these incidents, including influences from industry, culture, home environments, and parenting/supervision. There also are influences from children’s behaviour and decisions in reaction to potential hazards. Previous research examined the influence of capsule product appearance and colour on children’s behaviour around hazardous household items, but little research examines the influence of product size. This research explored if differences in the size of liquid laundry capsules result in different levels of toddler interaction. We compared two commercially available capsule designs that are identical in physical appearance but differ in physical size. Our research was conducted using three studies: Study 1, forced-choice test in an out-of-context laboratory setting; Study 2, an ecologically-valid, simulated real-world setting rep...

The Lancet Public Health

Background Globally, transport and unintentional injuries persist as leading preventable causes o... more Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31•1 million DALYs (of which 16•2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34•4% (from 17•5 to 11•5 per 100 000) for transport injuries, and by 47•7% (from 15•9 to 8•3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80•5% to 42 774 for transport injuries and by 39•4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16•7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48•5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0•2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.

Journal of Pediatric Psychology

ObjectiveChild pedestrian injuries represent a global public health burden. To date, most researc... more ObjectiveChild pedestrian injuries represent a global public health burden. To date, most research on psychosocial factors affecting children’s risk of pedestrian injury focused on cognitive aspects of children’s functioning in traffic. Recent evidence suggests, however, that emotional aspects such as temperament-based fear and anger/frustration, as well as executive function-based emotional decision making, may also affect children’s safety in traffic. This study examined the role of emotions on children’s pedestrian behavior. Three hypotheses were considered: (a) emotion-based temperament factors of fear and anger/frustration will predict children’s risky decisions and behaviors; (b) emotional decision making will predict risky pedestrian decisions and behaviors; and (c) children’s pedestrian decision making will mediate relations between emotion and risky pedestrian behavior. The role of gender was also considered.MethodsIn total, 140 6- to 7-year-old children (M = 6.7 years, SD ...

Journal of Safety Research, 2021

Bulletin of The World Health Organization, 2009

Introduction Paraffin, also known as kerosene, is among the most frequently used fuels for cookin... more Introduction Paraffin, also known as kerosene, is among the most frequently used fuels for cooking, lighting and heating among people living in low-income communities lacking electricity in low- and middle-income countries. Paraffin is relatively. inexpensive to produce and consume and a wide range of appliances are equipped to burn it, but it can endanger human health from burns and poisoning. Risks Paraffin is highly flammable and can lead to fires originating from malfunctioning paraffin appliances; improper placement of appliances (e.g. near curtains or tablecloths); use of polluted paraffin (since paraffin is highly explosive when mixed with water or other fuels); use of paraffin by children or intoxicated individuals; homicide, assault, suicide or arson attempts; and many other causes. Fires can be particularly dangerous in low-income urban communities, where dwellings are densely located and constructed of flammable materials such as wood and cardboard. Young children are at ...

Journal of Prevention and Health Promotion, 2021

Physical risk-taking is associated with increased risk of unintentional injury, a global health c... more Physical risk-taking is associated with increased risk of unintentional injury, a global health challenge and the leading cause of death for children in the United States. To assess risk and develop prevention programs, valid tools to assess children’s physical risk-taking are needed. No ecologically valid behavioral measures are widely available. This study describes the development and validation of the “Activity Room” to measure children’s physical risk-taking while presenting low risk of actual injury. Participants were 59 children aged 4 to 6 years old (51% female; 51% non-Hispanic White) and their parents. Children completed two tasks to assess physical risk-taking: (a) vignettes (short stories presenting risk situations) and (b) the “Activity Room” (unsupervised engagement for 5 min in a room with apparatus designed to stimulate potential physical risk-taking). Parents responded to a questionnaire concerning children’s active play behaviors. Correlational analyses evaluated c...

Journal of pediatric psychology, 2021

The Lancet, 2021

Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reducti... more Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Bill & Melinda Gates Foundation.

Nature, 2019

Educational attainment is an important social determinant of maternal, newborn, and child health1... more Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the ...

Nature, 2019

Since 2000, many countries have achieved considerable success in improving child survival, but lo... more Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geograp...

Lancet (London, England), Oct 8, 2016

In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...

Transportation Research Part F-traffic Psychology and Behaviour, Sep 1, 2014

Injury Prevention, Nov 17, 2022

Traffic Injury Prevention, Jun 22, 2016

Journal of Pediatric Psychology

Objective The preschool years represent a stage of rapid human development, hallmarked by explori... more Objective The preschool years represent a stage of rapid human development, hallmarked by exploring the environment through gross and fine motor movement and imaginative pretend play. This exploration is developmentally appropriate but also presents risks for injury, the leading cause of death for preschool-aged children. Common injuries reflect exploration and risk-taking exhibited during play, and play may be particularly risky when children imitate risky models like superheroes. Frequent exposure and subsequent identification with superheroes are concerning because the media glorifies superheroes, creating social learning effects on children and promoting play situations where children may attempt superhuman abilities and hurt themselves. This study examined the relations between pretend play, superhero identification, and children’s risk-taking. Methods One hundred five children aged 4–5 years old were randomly assigned to either a superhero- or school-themed, story-based protoc...

Journal of Pediatric Psychology

Objective Unintentional injuries, the leading cause of death for American children, are caused by... more Objective Unintentional injuries, the leading cause of death for American children, are caused by a range of psychosocial factors, including risk behavior. One factor that may impact child risk-taking is modeling of superhuman risk-taking from superhero media, both immediately following superhero exposure and based on lifetime exposure and engagement. Methods Fifty-nine 5-year-olds were randomly assigned to view either a 13-min age-appropriate superhero television show or a comparable nonsuperhero show. After the viewing, children engaged in three risk-taking measures: (a) activity room, unsupervised play for 5 min with assortment of apparently dangerous items that might encourage child risk-taking; (b) picture sort, 10 illustrations of children in risk situations, with participant response concerning intended risk-taking in that situation; and (c) vignettes, 10 stories presenting situations with varying degrees of risk, with participant response on intended choice. Parents complete...

Journal of Safety Research

The Lancet Global Health

Background More than 3 billion people do not have access to clean energy and primarily use solid ... more Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2•1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution.

PLOS ONE

Liquid laundry capsules have been involved in multiple poisoning incidents with young children in... more Liquid laundry capsules have been involved in multiple poisoning incidents with young children in the home. There are a range of contributing factors for these incidents, including influences from industry, culture, home environments, and parenting/supervision. There also are influences from children’s behaviour and decisions in reaction to potential hazards. Previous research examined the influence of capsule product appearance and colour on children’s behaviour around hazardous household items, but little research examines the influence of product size. This research explored if differences in the size of liquid laundry capsules result in different levels of toddler interaction. We compared two commercially available capsule designs that are identical in physical appearance but differ in physical size. Our research was conducted using three studies: Study 1, forced-choice test in an out-of-context laboratory setting; Study 2, an ecologically-valid, simulated real-world setting rep...

The Lancet Public Health

Background Globally, transport and unintentional injuries persist as leading preventable causes o... more Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31•1 million DALYs (of which 16•2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34•4% (from 17•5 to 11•5 per 100 000) for transport injuries, and by 47•7% (from 15•9 to 8•3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80•5% to 42 774 for transport injuries and by 39•4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16•7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48•5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0•2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.

Journal of Pediatric Psychology

ObjectiveChild pedestrian injuries represent a global public health burden. To date, most researc... more ObjectiveChild pedestrian injuries represent a global public health burden. To date, most research on psychosocial factors affecting children’s risk of pedestrian injury focused on cognitive aspects of children’s functioning in traffic. Recent evidence suggests, however, that emotional aspects such as temperament-based fear and anger/frustration, as well as executive function-based emotional decision making, may also affect children’s safety in traffic. This study examined the role of emotions on children’s pedestrian behavior. Three hypotheses were considered: (a) emotion-based temperament factors of fear and anger/frustration will predict children’s risky decisions and behaviors; (b) emotional decision making will predict risky pedestrian decisions and behaviors; and (c) children’s pedestrian decision making will mediate relations between emotion and risky pedestrian behavior. The role of gender was also considered.MethodsIn total, 140 6- to 7-year-old children (M = 6.7 years, SD ...

Journal of Safety Research, 2021

Bulletin of The World Health Organization, 2009

Introduction Paraffin, also known as kerosene, is among the most frequently used fuels for cookin... more Introduction Paraffin, also known as kerosene, is among the most frequently used fuels for cooking, lighting and heating among people living in low-income communities lacking electricity in low- and middle-income countries. Paraffin is relatively. inexpensive to produce and consume and a wide range of appliances are equipped to burn it, but it can endanger human health from burns and poisoning. Risks Paraffin is highly flammable and can lead to fires originating from malfunctioning paraffin appliances; improper placement of appliances (e.g. near curtains or tablecloths); use of polluted paraffin (since paraffin is highly explosive when mixed with water or other fuels); use of paraffin by children or intoxicated individuals; homicide, assault, suicide or arson attempts; and many other causes. Fires can be particularly dangerous in low-income urban communities, where dwellings are densely located and constructed of flammable materials such as wood and cardboard. Young children are at ...

Journal of Prevention and Health Promotion, 2021

Physical risk-taking is associated with increased risk of unintentional injury, a global health c... more Physical risk-taking is associated with increased risk of unintentional injury, a global health challenge and the leading cause of death for children in the United States. To assess risk and develop prevention programs, valid tools to assess children’s physical risk-taking are needed. No ecologically valid behavioral measures are widely available. This study describes the development and validation of the “Activity Room” to measure children’s physical risk-taking while presenting low risk of actual injury. Participants were 59 children aged 4 to 6 years old (51% female; 51% non-Hispanic White) and their parents. Children completed two tasks to assess physical risk-taking: (a) vignettes (short stories presenting risk situations) and (b) the “Activity Room” (unsupervised engagement for 5 min in a room with apparatus designed to stimulate potential physical risk-taking). Parents responded to a questionnaire concerning children’s active play behaviors. Correlational analyses evaluated c...

Journal of pediatric psychology, 2021

The Lancet, 2021

Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reducti... more Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Bill & Melinda Gates Foundation.

Nature, 2019

Educational attainment is an important social determinant of maternal, newborn, and child health1... more Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the ...

Nature, 2019

Since 2000, many countries have achieved considerable success in improving child survival, but lo... more Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geograp...

Lancet (London, England), Oct 8, 2016

In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...

Transportation Research Part F-traffic Psychology and Behaviour, Sep 1, 2014

Injury Prevention, Nov 17, 2022

Accident Analysis & Prevention, 2016

Child pedestrian injuries are a leading cause of mortality and morbidity across the United States... more Child pedestrian injuries are a leading cause of mortality and morbidity across the United States and the world. Repeated practice at the cognitive-perceptual task of crossing a street may lead to safer pedestrian behavior. Virtual reality offers a unique opportunity for repeated practice without the risk of actual injury. This study conducted a pre-post within-subjects trial of training children in pedestrian safety using a semi-mobile, semi-immersive virtual pedestrian environment placed at schools and community centers. Pedestrian safety skills among a group of 44 seven- and eight-year-old children were assessed in a laboratory, and then children completed six 15-minute training sessions in the virtual pedestrian environment at their school or community center following pragmatic trial strategies over the course of three weeks. Following training, pedestrian safety skills were re-assessed. Results indicate improvement in delay entering traffic following training. Safe crossings did not demonstrate change. Attention to traffic and time to contact with oncoming vehicles both decreased somewhat, perhaps an indication that training was incomplete and children were in the process of actively learning to be safer pedestrians. The findings suggest virtual reality environments placed in community centers hold promise for teaching children to be safer pedestrians, but future research is needed to determine the optimal training dosage.