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A Systematic Review on the Impact of Hot and Cool Executive Functions on Pediatric Injury Risks: a Meta-Analytic Structural Equation Modeling Approach

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Abstract

Injury is a leading cause of morbidity and mortality among children in the USA. Understanding the impact of executive functions (EFs) on the risk of injuries is crucial for developing effective interventions. However, literature has failed to examine the relationship between multiple EFs and injury domains. The present paper quantitatively synthesized research on cool and hot EFs and children’s intentional and unintentional injury risks using a novel meta-analytic structural equation modeling (MASEM) approach. A systematic review was conducted in the following databases: PsycINFO, Scopus, SafetyLit, Cochrane Central, and PubMed (Medline). After screening titles, abstracts, and full texts, a total of 31 studies were eligible for the MASEM analysis. One-stage MASEM was conducted on six conceptualized path analysis models according to the complexity of exogenous and endogenous variables. The MASEM models suggested that hot and cool EFs were negatively associated with children’s risk of injury or injury-related risk behaviors regardless of mean age and proportion of females. Among cool EF skills, inhibitory control, but not working memory or cognitive flexibility, was significantly associated with risks of unintentional injuries. Emotion regulation was the dominant hot EF skill examined in the literature and was found significantly associated with risks of non-suicidal self-injuries (NSSIs). EF has a significant impact on children’s risk of both unintentional and intentional injuries. Future research should focus on the combined force of hot and cool EF on children’s risks of injuries and injury-related risk behaviors.

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Notes

  1. Note that missing data in the moderators are not allowed for one-stage MASEM. In this meta-analysis, five studies had missing data on mean age and two studies had missing data on the proportion of females. These studies were removed from the moderation analyses.

  2. Problems with estimating between-studies variances of correlation coefficients among emotion regulation, inhibitory control, and NSSI (i.e., negative variances) were encountered. Thus, between-studies variances were all constrained to be zero, indicating that a fixed-effect MASEM model was applied.

  3. Negative between-studies variances of correlation coefficients among the three cool EFs and the risk of unintentional injury were encountered. Thus, between-studies variances were all constrained to be zero.

  4. \({R}^{2}\) indicated the proportion of variance reduction when the moderator was included in the model. The variance with the moderator was very close to zero, which led to \({R}^{2}\) of 1.00. But this value should be interpreted with caution, because the variance without the moderator in the model was very small (i.e., .001).

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  1. Nayantara Kurpad and David A. Schena contributed equally.

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  1. Department of Psychology, University of Massachusetts Lowell, Coburn Hall, 850 Broadway St, Lowell, MA, 01854, USA

    Jiabin Shen, Yan Wang, Nayantara Kurpad & David A. Schena

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  1. Jiabin Shen
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Shen, J., Wang, Y., Kurpad, N. et al. A Systematic Review on the Impact of Hot and Cool Executive Functions on Pediatric Injury Risks: a Meta-Analytic Structural Equation Modeling Approach. Prev Sci 23, 366–377 (2022). https://doi.org/10.1007/s11121-021-01271-2

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