Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Eight-year outcome of implementation of abusive head trauma prevention Ronald G. Barr a, ⁎ , Marilyn Barr b , Fahra Rajabali c , Claire Humphreys c , Ian Pike d , Rollin Brant e , Jean Hlady f , Margaret Colbourne f , Takeo Fujiwara g , Ash Singhal h a Department of Pediatrics, University of British Columbia; Canadian Institute for Advanced Research; British Columbia Children’s Hospital Research Institute, Canada b National Center on Shaken Baby Syndrome, United States c British Columbia Children’s Hospital Research Institute, Canada d Department of Pediatrics, University of British Columbia; British Columbia Children’s Hospital Research Institute, Canada e British Columbia Children’s Hospital Research Institute; Department of Statistics, University of British Columbia, Canada f Department of Pediatrics, University of British Columbia, Canada g Global Health Promotion, Tokyo Medical and Dental University, Japan h Department of Neurosurgery, University of British Columbia, Canada ARTICLE INFO Keywords: Abusive head trauma Shaken baby syndrome Prevention Parental education Crying Shaking Infant abuse ABSTRACT Low incidence rates and economic recession have hampered interpretation of educational pre- vention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective- prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2–4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for < 12-month-olds from 10.6 (95% CI: 8.3–13.5) to 7.1 (95% CI: 4.8–10.5) or, for < 24-month-olds, from 6.7 (95% CI: 5.4–8.3) to 4.4 (95% CI: 3.1–6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42–1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for < 24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program. https://doi.org/10.1016/j.chiabu.2018.07.004 Received 25 March 2018; Received in revised form 26 June 2018; Accepted 2 July 2018 ⁎ Corresponding author at: Evidence to Innovation, British Columbia Children’s Hospital, 4480 Oak Street, F508, Vancouver, BC, V6H 3V4, Canada. E-mail address: ronaldgbarr@gmail.com (R.G. Barr). Child Abuse & Neglect 84 (2018) 106–114 0145-2134/ © 2018 Elsevier Ltd. All rights reserved. T