Author's personal copy Accident Analysis and Prevention 47 (2012) 30–35 Contents lists available at SciVerse ScienceDirect Accident Analysis and Prevention j ourna l ho me pa ge: www.elsevier.com/locate/aap Marital conﬂict and ﬁfth-graders’ risk for injury  David C. Schwebel a,∗ , David L. Roth b , Marc N. Elliott c , Alyna T. Chien d,e , Sylvie Mrug a , Eva Shipp f , Patricia Dittus g , Kimberly Zlomke h , Mark A. Schuster c,d,e a Department of Psychology, University of Alabama at Birmingham,USA b Department of Biostatistics, University of Alabama at Birmingham,USA c RAND, Santa Monica, CA, USA d Division of General Pediatrics, Department of Medicine, Children’s Hospital Boston, Boston, MA, USA e Department of Pediatrics, Harvard Medical School, Boston, MA, USA f Texas A&M Health Science Center School of Rural Public Health, College Station, TX, USA g Centers for Disease Control and Prevention, Atlanta, GA, USA h Department of Psychology, University of South Alabama,USA a r t i c l e i n f o Article history: Received 17 January 2011 Received in revised form 12 July 2011 Accepted 5 January 2012 Keywords: Injury Safety Marital conﬂict Fifth graders Parenting a b s t r a c t Background: Injuries are the leading cause of morbidity and mortality for American children. Marital conﬂict has been associated with a range of negative health outcomes, but little is known about how marital conﬂict may inﬂuence risk of injury among children. We hypothesized marital conﬂict would be related to increased youth injury risk after controlling for relevant demographic and parenting covariates. Methods: A community sample of 3218 ﬁfth-graders recruited from three US locales was utilized. Ordinal logistic regression models were used to predict the frequency of unintentional injuries from marital conﬂict while adjusting for demographics, parenting factors (nurturance, communication, involvement with youth), and family cohesion. Results: Higher levels of marital conﬂict were associated with higher rates of injury that required profes- sional medical attention (OR = 1.20, 95% CI 1.06, 1.35 per standard deviation). The same association held after inclusion of all covariates in a multivariate ordinal logistic regression model. Conclusions: Parental marital conﬂict is associated with higher rates of injuries requiring professional medical attention in preadolescent children. © 2012 Elsevier Ltd. All rights reserved. 1. Introduction Injuries are the leading cause of morbidity and mortality for American children. Annually, pediatric injuries lead to approxi- mately 14,000 deaths and 8.6 million emergency room encounters in the United States (National Center for Injury Prevention and Con- trol [NCIPC]). Additionally, it is estimated that each year the United States spends over $8 billion on the medical treatment of pediatric injuries (Sattin and Corso, 2007).  Author Notes. The Healthy Passages Study is funded by the Centers for Dis- ease Control and Prevention, Prevention Research Centers (Cooperative Agreements U19DP002663, U19DP002664, and U19DP002665). The ﬁndings and conclusions in this report are those of the authors and do not necessarily represent the ofﬁcial posi- tion of the Centers for Disease Control and Prevention. Thanks to Martha Hovater for data analysis support. Communication should be directed to David C. Schwebel, Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd., CH 415, Birmingham, AL 35294 USA or by e-mail to schwebel@uab.edu. ∗ Corresponding author at: Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham AL 35294, USA. Tel.: +1 205 934 8745; fax: +1 205 975 6110. E-mail address: schwebel@uab.edu (D.C. Schwebel). Identifying risk factors for pediatric injury is complex, as injuries are believed to be caused by a wide range of developmental, psy- chosocial and environmental factors (Schwebel and Gaines, 2007). Among the strongest behavioral correlates of pediatric injury risk is the role of parenting behavior (Schwebel and Gaines, 2007). High quality parental supervision and monitoring is particularly associated with lower pediatric injury risk among toddlers and preschoolers (Morrongiello, 2005; Morrongiello et al., 2004, 2006; Schwebel and Bounds, 2003), and even among children at elevated risk for injury due to temperamental or psychopathological traits (Schwebel et al., 2004). Given the importance of parental supervision and monitoring in early childhood, one might suspect that high levels of parent marital conﬂict would be related to increased pediatric injury risk throughout development. This association might emerge via multi- ple causal pathways. Marital conﬂict is known to inﬂuence multiple aspects of individual and family health (Fincham, 2003; Karney and Bradbury, 1995). Parents occupied with frequent disputes are likely to be cognitively and/or physically distracted from parent- ing duties. They may become self-focused, irritable, and worried about their own personal relationships. These cognitions and dis- tractions may result in inconsistent enforcement of safety-relevant rules, inadequate monitoring of children’s behavior, poor modeling 0001-4575/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.aap.2012.01.005