Despite high incidence, high annual cost, and a disproportionate burden among children, dog bite prevention education and research to date has been limited. Many US national organizations advocate consistent dog bite prevention recommendations, however large scale dissemination of these messages is rare, and it is unknown whether children have gleaned the necessary knowledge to maximize the effectiveness of the recommendations. The results of our study help to answer this question by determining what a sample of children know about dog bite prevention. Further, we identify factors associated with this knowledge and describe parental desires and acceptance regarding this type of prevention education.
Our results show a notable lack of awareness and knowledge regarding dog bite prevention among children, as nearly half of child participants failed a dog bite prevention knowledge test based on well-accepted dog bite prevention recommendations. Moreover, based on parent/guardian responses, less than one third of children had ever received formal dog bite prevention education. Others have shown that children who are educated on safe-dog interactions act more safely around dogs,19,20
and a recent Cochrane review of dog bite interventions found that although there is no direct evidence linking dog bite education to decreased dog bite rates, “educating children who are less than 10 years … could improve their knowledge, attitude and behavior towards dogs.”21
Given this potential for education to prevent unsafe behavior combined with the magnitude of the child knowledge deficits and lack of formal education found in our study, we propose that universal dog bite prevention interventions have the potential to prevent these injuries and alleviate the unnecessary burden of dog bites on the US health care system.
Additionally, our findings contribute to knowledge about dog bite risk factors. We demonstrated that younger children and those with non-white parents/guardians may be at higher risk of a dog bite as they tended to have lower dog bite prevention knowledge scores. Thus, it is not surprising that younger children are highly vulnerable to dog bites, possibly because their prevention knowledge is significantly lower than older children. The trends associated with race noted in our results, while not previously recognized in epidemiologic studies,2,22
may still imply a potential disparity in injury risk. Research to understand the possible association between these sociodemographic factors and dog bite prevention knowledge is necessary to elaborate any causes and consequences of this disparity. Further, whether knowledge differences actually translate to differences in injury risk and outcome requires exploration, thus we echo the Cochrane review statement of needing “high quality studies that measure dog bite rates as an outcome.”21
Interestingly, some experiential factors which one might assume would have an effect on dog bite prevention knowledge - such as current or prior dog ownership, previous dog bite in the family, prior dog bite education and parent-child communication about safe practices around dogs - did not reveal significant correlation in our analysis. Possible reasons for these findings are: (1) dog ownership does not necessarily equate to knowledge of how to prevent dog bites, evidenced by the fact that the majority of dog bites to children are by familiar dogs;23
(2) having an experience of a dog bite does not mean that the victim or their family member has subsequently learned how to prevent dog bites; and (3) reports from children regarding their prior education and/or parent-child communication about dog bite prevention are not generalizable as it is difficult to know the specific type of education experienced, and/or if appropriate dog bite prevention messages have been communicated.
Lastly, our results suggest that dog bite prevention interventions would be well received. Even thoughnearly 90% of parents/guardians recognized the need and indicated a desire for their families to be educated about how to minimize the risk of dog bites, over 70% didn’t know where to they could go to learn this information. The majority indicated that both the pediatrician’s office and the ED would be good settings in which to conduct this intervention. Identifying the ED as a place for public health prevention programs is consistent with trends in disease screening,24,25
and brief intervention research;25,28
thus EDs should consider providing dog bite prevention information and education.
It is important to interpret the results of our study within the context of its limitations. First, this study was conducted in a convenience sample of patients in a single busy pediatric ED that is the region’s only major pediatric trauma. Although the study sample had similar demographics to our overall ED population, it is possible that this sample does not reflect the local population or other ED populations, and/or that certain groups may seek non-urgent care in the ED more frequently. Thus generalizability might be questioned and we would encourage validation of our findings in other settings. Second, though the test questions used in our study were based on dog bite prevention recommendations espoused by several national organizations, questions have not been validated and it is unclear if participants would respond to real situations in a similar manner as stated in response to hypothetical scenarios. Additionally, althoughdog bite recommendations are typically stated in the negative tense (e.g. “Do not pet a dog that is behind a fence”, and “Do not pet a dog that is eating”), the correct answers for all of the pictoral questions were “No”, which might lead some test-takers to reconsider their answer. Further research on dog bite prevention knowledge would benefit from validation and careful assessment of any knowledge test used. Third, because this test was the first of its kind, an arbitrary cut-off for passing the test was made and it is expected that a lower passing threshold would result in fewer children failing the test. Even though we didnotvalidate this cut-off, we replicated all of our analysis using a linear regression with the continuous test result as the dependent variable, and no differences were observed between the two modeling strategies, suggesting the choice of cut-off did not adversely affect interpretation of our results. Lastly, it is unknown whether knowledge of dog bite prevention actually decreases the number or severity of dog bites. Althoughdog bite prevention education recommendations are consistent, we are not aware of any studies that explore an association between prevention knowledge and dog bite incidence. Evidence demonstrating a benefit of prevention interventions on reducing the incidence of injury would be persuasive in translating our recommendations for dog bite prevention intervention into practice.
Despite alarming injury statistics, children aged 5-15 in our sample population often lacked the knowledge to minimize the risk of dog bites and few had received formal dog bite prevention education. In this study, younger children and children with non-white parents had a greater knowledge deficit than older children and children with white parents. We conclude that this may place younger children and those with non-white parents at greater risk of dog bites. The vast majority of parents in our study recognized the need for dog bite prevention education and indicated health care settings as appropriate venues for providing it. Our findings reinforce that dog bite prevention education should be included in injury prevention discussions with children and parents. Further research on this topic will be helpful in addressing this problem and discovering other strategies and interventions to reduce dog bite injuries and outcomes in children.