Optimism Bias and Parental Views on Safety
The purpose of this integrative literature review is to improve anticipatory guidance in early childhood by reviewing the influence of optimism bias on parents' views about safety and beliefs about their children's risk for unintentional injuries. This article reviews the theory of optimism bias and recent research utilizing optimism bias to explain parental health-related behaviors. The three articles in this literature review find a link between optimism bias and parents' failure to implement safety behaviors. Currently, there is no tool to measure a parent's level of optimism bias concerning the risk of unintentional injury to his or her child. It is important for primary care providers to try and identify optimism bias in parents and address it as a barrier to implementation of safety recommendations. More research should be dedicated to developing screening tools to identify optimism bias in parents and interventions to help them accept their children's vulnerability.
The incidence and prevalence of unintentional in juries in young children living in the United States should be of concern to parents, primary care providers (PCPs), and the general public. Statistics on injuries reveal the vulnerability of all children, especially when recommended safety measures are not taken. In 2010, nonfatal, unintentional injuries totaled 3,270,938 for children between 1 and 7 years of age (Centers for Disease Control and Prevention [CDC], National Center for Injury Prevention and Control, WISQARS Web-Based Injury Statistics Query and Reporting System, 2012b). Between the years 2000 and 2009, unintentional injuries were the leading cause of death for children in the same age group (CDC, National Center for Injury Prevention and Control, WISQARS Web-Based Injury Statistics Query and Reporting System, 2012a). According to the organization Safe Kids USA, part of a worldwide non-profit organization focused on preventing childhood accidental injuries, in the year 2000, medical costs of unintentional injuries to children under 10 years old in the United States totaled $5.7 billion (Safe Kids USA, National Safe Kids Campaign [NSKC], 2004).
One approach to understanding the reasons such a large number of children are injured and even killed each year has been to research the personal and environmental characteristics that in crease children's chances of injury. Researchers have examined children's temperament (Schwebel & Plumert, 1999), family stressors (such as maternal depression) (Mulvaney & Kendrick, 2006), social inequalities (Shenassa, Stubbendick, & Brown, 2004), parents' supervision practices (Morrongiello, Corbett, McCourt, & Johnston, 2006), and parents' understanding of children's safety risks (Bruce, Lake, Eden, & Denney, 2004). These data have been used to develop interventions that attempt to address the problem at the national, community, and family levels (Damashek & Peterson, 2002). Public health officials and individual providers have used legislation, education, and behavioral training to increase awareness of safety behaviors, and each intervention has resulted in varying degrees of successes and failures (Damashek & Peterson, 2002; Stone & Pearson, 2009).
Despite all the interventions developed and tried, PCPs may be the only source of safety information for parents. Research findings on childhood safety indicate anticipatory guidance and par ental safety behaviors are linked, and anticipatory guidance should be part of all well-child visits (Gardner, 2007; Hagan, Shaw, & Duncan, 2008; Nelson, Wissow, & Cheng, 2003; Stone & Pearson, 2009). The Injury Prevention Program (TIPP) from the American Academy of Pediatrics (AAP) is one example of a program that has been developed at the primary care level to address the issue of unintentional injuries (AAP, 1994). TIPP helps health care providers focus anticipatory guidance on children's most likely causes of injury by age, both with counseling schedules and with surveys that can be completed by families (AAP, 1994). In addition, the AAP has provided pediatric practitioners with age-specific guides to anticipatory guidance through the book Bright Futures, Guidelines for Health Supervision of Infants, Children, and Adolescents (Hagan et al., 2008).
Although these tools are helpful to practitioners, research studies have concluded that simply handing out pamphlets, posting safety information in health care pro vider's offices, or providing safety education without incentives are not always successful in changing caregiver behaviors (Damashek & Peterson, 2002; Nansel et al., 2002). Unfortunately, due to cost and availability, not all families will have access to more successful safety programs that incorporate education with home visits and other incentives (Kendrick, Barlow, Hampshire, Stewart-Brown, & Polnay, 2008). There fore, understanding why anticipatory guidance given during routine health visits often fails to change parents' behaviors is important.
Researchers have examined the possibility that parents fail to implement safety interventions despite possessing the knowledge to do so because of their inability to appreciate their children's vulnerability to injury (Brown, Roberts, Mayes, & Boles, 2005; Gaines & Schwebel, 2009; Will & Geller, 2004). Parents may possess an optimism bias that leads them to believe that the chances of experiencing undesired events, such as physical harm, are less for their children than for other children (Brown et al., 2005). This optimism bias has been identified in cases where parents have been warned against a dangerous behavior, such as bed sharing and the possible risk of suffocation (Chianese, Ploof, Trovato, & Chang, 2009) or leaving children unattended in bathtubs and the risk of drowning (Lee & Thompson, 2007); however, they continue to engage in these behaviors. Pediatric health care providers in the primary care setting can improve the effectiveness of anticipatory guidance during well child visits by identifying and addressing optimism bias and helping parents understand their children's vulnerability to unintentional injury.
Abstract and Introduction
Abstract
The purpose of this integrative literature review is to improve anticipatory guidance in early childhood by reviewing the influence of optimism bias on parents' views about safety and beliefs about their children's risk for unintentional injuries. This article reviews the theory of optimism bias and recent research utilizing optimism bias to explain parental health-related behaviors. The three articles in this literature review find a link between optimism bias and parents' failure to implement safety behaviors. Currently, there is no tool to measure a parent's level of optimism bias concerning the risk of unintentional injury to his or her child. It is important for primary care providers to try and identify optimism bias in parents and address it as a barrier to implementation of safety recommendations. More research should be dedicated to developing screening tools to identify optimism bias in parents and interventions to help them accept their children's vulnerability.
Introduction
The incidence and prevalence of unintentional in juries in young children living in the United States should be of concern to parents, primary care providers (PCPs), and the general public. Statistics on injuries reveal the vulnerability of all children, especially when recommended safety measures are not taken. In 2010, nonfatal, unintentional injuries totaled 3,270,938 for children between 1 and 7 years of age (Centers for Disease Control and Prevention [CDC], National Center for Injury Prevention and Control, WISQARS Web-Based Injury Statistics Query and Reporting System, 2012b). Between the years 2000 and 2009, unintentional injuries were the leading cause of death for children in the same age group (CDC, National Center for Injury Prevention and Control, WISQARS Web-Based Injury Statistics Query and Reporting System, 2012a). According to the organization Safe Kids USA, part of a worldwide non-profit organization focused on preventing childhood accidental injuries, in the year 2000, medical costs of unintentional injuries to children under 10 years old in the United States totaled $5.7 billion (Safe Kids USA, National Safe Kids Campaign [NSKC], 2004).
One approach to understanding the reasons such a large number of children are injured and even killed each year has been to research the personal and environmental characteristics that in crease children's chances of injury. Researchers have examined children's temperament (Schwebel & Plumert, 1999), family stressors (such as maternal depression) (Mulvaney & Kendrick, 2006), social inequalities (Shenassa, Stubbendick, & Brown, 2004), parents' supervision practices (Morrongiello, Corbett, McCourt, & Johnston, 2006), and parents' understanding of children's safety risks (Bruce, Lake, Eden, & Denney, 2004). These data have been used to develop interventions that attempt to address the problem at the national, community, and family levels (Damashek & Peterson, 2002). Public health officials and individual providers have used legislation, education, and behavioral training to increase awareness of safety behaviors, and each intervention has resulted in varying degrees of successes and failures (Damashek & Peterson, 2002; Stone & Pearson, 2009).
Despite all the interventions developed and tried, PCPs may be the only source of safety information for parents. Research findings on childhood safety indicate anticipatory guidance and par ental safety behaviors are linked, and anticipatory guidance should be part of all well-child visits (Gardner, 2007; Hagan, Shaw, & Duncan, 2008; Nelson, Wissow, & Cheng, 2003; Stone & Pearson, 2009). The Injury Prevention Program (TIPP) from the American Academy of Pediatrics (AAP) is one example of a program that has been developed at the primary care level to address the issue of unintentional injuries (AAP, 1994). TIPP helps health care providers focus anticipatory guidance on children's most likely causes of injury by age, both with counseling schedules and with surveys that can be completed by families (AAP, 1994). In addition, the AAP has provided pediatric practitioners with age-specific guides to anticipatory guidance through the book Bright Futures, Guidelines for Health Supervision of Infants, Children, and Adolescents (Hagan et al., 2008).
Although these tools are helpful to practitioners, research studies have concluded that simply handing out pamphlets, posting safety information in health care pro vider's offices, or providing safety education without incentives are not always successful in changing caregiver behaviors (Damashek & Peterson, 2002; Nansel et al., 2002). Unfortunately, due to cost and availability, not all families will have access to more successful safety programs that incorporate education with home visits and other incentives (Kendrick, Barlow, Hampshire, Stewart-Brown, & Polnay, 2008). There fore, understanding why anticipatory guidance given during routine health visits often fails to change parents' behaviors is important.
Researchers have examined the possibility that parents fail to implement safety interventions despite possessing the knowledge to do so because of their inability to appreciate their children's vulnerability to injury (Brown, Roberts, Mayes, & Boles, 2005; Gaines & Schwebel, 2009; Will & Geller, 2004). Parents may possess an optimism bias that leads them to believe that the chances of experiencing undesired events, such as physical harm, are less for their children than for other children (Brown et al., 2005). This optimism bias has been identified in cases where parents have been warned against a dangerous behavior, such as bed sharing and the possible risk of suffocation (Chianese, Ploof, Trovato, & Chang, 2009) or leaving children unattended in bathtubs and the risk of drowning (Lee & Thompson, 2007); however, they continue to engage in these behaviors. Pediatric health care providers in the primary care setting can improve the effectiveness of anticipatory guidance during well child visits by identifying and addressing optimism bias and helping parents understand their children's vulnerability to unintentional injury.