Papers

Preventing dog bites in children: randomised controlled trial of an educational intervention

Simon Chapman, associate professor ^a,  John Cornwall, consultant ^b,  Joanne Righetti, consultant ^b,  Lynne Sung, consultant ^b. 

^a Department of Public Health and Community Medicine, University of Sydney, Sydney, NSW 2000, Australia, ^b Delta Society Australia, 6/3 Spring Street, Sydney, NSW 2000, Australia

Correspondence to: S Chapman Simonc{at}pub.health.usyd.edu.au

Dog bites are a major cause of injury, particularly in children. ^{1 2} Guidelines on prevention are generally unevaluated and include controls on high risk breeds, keeping dogs on a leash, animal training, and educating dog owners. ^{3 4} However, there are no evaluations of interventions designed to teach people how to avoid being attacked by a dog.

"Prevent-a-Bite" is an educational programme designed for primary school children.⁵ The programme aims to instil precautionary behaviour around dogs, assuming that this might reduce the incidence of attacks. A randomised controlled trial of the efficacy of the intervention was conducted in Australian children aged 7-8 years who were presented with an unsupervised opportunity to approach a strange dog.

	Participants, methods, and results

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Eight primary schools in metropolitan Sydney were randomly selected to participate in the trial. All agreed. The schools were cluster randomised into intervention and non-intervention control schools (four in each group), and two classes in each school were then selected to participate. Altogether 346 children aged 7-8 years took part. The study was approved by the human ethics committee of the University of Sydney.

The intervention consisted of a 30 minute lesson conducted by an accredited dog handler. The handler and dog demonstrated various "dos and don'ts" of behaviour around dogs, such as how to recognise friendly, angry, or frightened dogs and how children should approach dogs and owners when they wanted to pat a dog. Children practised patting the dog in the correct manner (that is, asking permission, approaching slowly, extending the hand palm down, patting the dog under the chin and on the chest, avoiding eye contact, walking away slowly and quietly) and precautionary and protective body posture to adopt when approached or knocked over by a dog. They were also told when not to disturb even a friendly, known dog (for example, when it is sleeping, eating, tied up, or in a car). A resource kit for teachers, which included activities to be undertaken before and after the demonstration, was also distributed.

Seven to 10 days after participating in the programme, children in the intervention schools were let out to play unsupervised in the school grounds. A docile Labrador dog was tethered five metres away from its owner, who was disguised as a tradesman. The children were not told that the dog was there and were videotaped by a hidden camera for 10 minutes. Children in control schools were let out to play in similar circumstances, but they had not received the intervention.

The number of children who breached the proscribed behaviours was tallied from the videotape by three authors, one of whom was blind to the intervention or control status of each school. When the three reviewers differed in their scoring of whether an approach to the dog should be recorded as a breach of the guidelines, the videotape was reconsidered and scored as a breach only if all observers agreed.

Children who had received the intervention displayed appreciably greater precautionary behaviour than children in the control schools (table). They were circumspect, typically observing the dog from a distance. Most of the children in the control group (118 of 149, 79%) patted the dog without hesitation and tried to excite it, while only a few (18 of 197, 9%) of the children who had received the intervention patted the dog, and they did this surreptitiously or after a considerable period of careful assessment only.

	Comment

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The Prevent-a-Bite educational intervention increased appreciably the precautionary behaviour of young children around strange dogs in the short term. Further research is needed to determine whether the programme is able to influence children's behaviour in the longer term, and whether "booster" interventions can help sustain this behaviour, observations in contexts outside school would show a similar magnitude of effect, and wide adoption of the programme would reduce the number of children bitten by dogs.

	Acknowledgments

   Contributors: SC designed the study, analysed the video record, wrote the first draft, and is guarantor. JC convened the group that planned and conducted the trial and contributed comments on the paper. JR conducted the intervention, analysed the video record, and helped write the paper. LS organised school participation, analysed the video record, and helped write the paper.

	Footnotes

Competing interests: JC, JR, and LS are paid consultants to the Delta Society of Australia. SC has been paid an honorarium and travel expenses for speaking at a meeting about the intervention.

Funding: This study was funded by a small grant to SC's department by the Delta Society Australia Ltd.

The CONSORT checklist is available on the BMJ's website

	References

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1.	Thompson PG. The public health impact of dog attacks in a major Australian city. Med J Aust 1997; 167: 129-132[Medline].
2.	Sacks JJ, Kresnow M, Houston B. Dog bites: how big a problem? Injury Prev 1996; 2: 52-54[Abstract].
3.	Bandow JH. Will breed-specific legislation reduce dog bites? Can Vet J 1996; 37: 478-482[Medline].
4.	Patrick GR, O'Rourke KM. Dog and cat bites: epidemiologic analyses suggest different prevention strategies. Public Health Rep 1998; 113: 252-257[Medline].
5.	The Delta dog safe project. Delta News , 1999;No 4:7. www.vetevents.com/delta/archives/news4j.htm#story (accessed 10 May 2000).

(Accepted 6 March 2000)