Caregiver supervision and child-injury risk: I. Issues in defining and measuring supervision; II. Findings and directions for future research.

OBJECTIVE To discuss the role of caregiver supervision in child-injury risk, with attention given to definitional and methodological issues and outlining important questions to be addressed in future research. METHODS Analysis, synthesis, and critique of existing literature. RESULTS Comparisons across studies are difficult because of insufficient specificity regarding what constitutes supervision. Hence, a multi-dimensional definition of supervision is developed based on the literature. Numerous issues arise when attempting to measure supervision and these are extensively discussed, along with reporting on the recent development of two questionnaire measures of supervision (Beliefs About Supervision Questionnaire and Parent Supervision Attributes Profile Questionnaire) that have shown good validity and hold promise for addressing the problem of measuring caregiver supervision in reliable and valid ways. A review of the findings on relations between supervision and child-injury risk reveals that many substantive questions remain unanswered. A number of recommendations for future research are given and a conceptual model is presented that focuses attention on the need for research that examines how factors interact to influence child-injury risk. This model has relevance not only for research but also for prevention and serves to emphasize the complementary nature of environment-oriented and person-oriented approaches to child-injury prevention. CONCLUSION Direct evidence linking supervision to child-injury risk is scarce and many important questions remain unanswered. Based on the conceptual model presented, in future research it is important to examine how supervision interacts with other key factors to influence children's risk of injury.