Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, Chair; Anita J. Hunter, PhD, RN, CPNP; Edward A. Neuwelt, MD


children & youth, elementary education, longitudinal analysis, nursing, safety behaviors, school-based injury prevention curriculum, unintentional injury


Despite years of legislative and public health efforts, unintentional injury continues to be a serious public health problem and is identified as a major priority on the national health care agenda. The high incidence of unintentional injury in the middle childhood age group is of particular interest due to immaturity of the cognitive, psychosocial, and neurophysical dimensions of the child. The purpose of this study was to examine the effectiveness of a school-based curriculum on improving knowledge and self-reported safety behaviors over time among ethnically and socioeconomically diverse elementary school aged children. The social, cultural, cognitive, and behavioral learning theory of Constructivism informed the study. The learning theories of Vygotsky, Bruner, and Piaget served as the theoretical frameworks for the constructivism theory and helped professionals understand how, why, and when children are cognitively, psychologically, socially, and developmentally at greatest risk for injury and most receptive to learning. A three-year longitudinal, matched comparative, with repeated measures, cohort design was used to evaluate the effectiveness of TFFK intervention. The data to be analyzed were from a quasi-experimental research design. Culturally diverse elementary schools in high injury-risk areas from San Diego Unified and Cajon Valley during the 1999–2002 academic school years were recruited for the study. Ten schools participated, five schools were identified as intervention schools to receive TFFK and five schools that most closely matched the intervention schools on SES, school defined and grade specific reading scores, race/ethnicity composition, and school district were the controls, thus creating five pairs of matched schools. The original cohort of 1,762 students participating in the paired intervention/control study were followed over the three-year longitudinal study. To determine the effectiveness of the TFFK program, a pre-/post-measure design was employed. The primary outcome was a change in total test score from the pre-test to the post-measure, with the post-measure being administered after the intervention. The analysis of the pre-existing data was conducted using the Statistical Package for the Social Sciences (SPSS) (Version 12.0) and included descriptive, univariate and General Linear Model (GLM), multivariate analysis of variance methods, to assess injury-related knowledge and safety behavior change among elementary school subjects receiving the Think First for Kids (TFFK) curriculum compared to control subjects. The overall effect of the curriculum was tested using a GLM repeated measures, analysis of variance procedure for each Cohort A, B, and C. Data analysis of the posttest measure scores demonstrated that the TFFK curriculum led to a statistically significant increase in knowledge and self-reported safety behaviors. The overall trend was for greater improvement in intervention school students when compared to control school students. It is important to recognize that schools not only have direct access to young children, but also have the unique capacity to affect the lives of staff, parents, and the entire community. This study provides empirical evidence that early school-based theory-driven injury prevention education has a positive effect on young children.

Document Type

Dissertation: Open Access



Included in

Nursing Commons