Perceptions of injury prevention and familial adjustment among mothers of teen parents

IntroductionInjury is a leading cause of death for infants and children. Teen mothering has been shown to put children at increased risk of injury. The mothers of teen parents often play a predominant role in the lives and caregiving of the children born to their children.MethodThis article presents the findings of three focus groups conducted with 21 mothers of teen parents. Grounded theory methodology was used to explore family dynamics and how they relate to injury prevention beliefs and practices regarding infants and children.ResultsOur findings revealed the difficulty mothers of teen parents and the teens themselves have in adjusting to the knowledge of the pregnancy. Unique barriers to injury prevention were also uncovered.ConclusionsOur findings provide evidence for the need of a multigenerational approach to programs aimed at improving the safety and well-being of children in this context.     

Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden

The aim of this study is to explore the manner in which different measures of original socioeconomic position (SEP) influence road traffic injuries (RTIs) among young car drivers in Sweden. The study consists of young people age 16-23. Subjects were taken from the Swedish Population and Housing Census of 1990 (n=727,995), and followed up by a search for cases of injury to car drivers in Sweden's National Hospital Discharge Register over the years 1991-96 (n=1,599). Household SEP was measured using social class, education, and disposable income. Relative risks were estimated by Poisson regression and population attributable risks were computed for each measure of SEP. Children of unskilled workers, of the self-employed, and of farmers, as well as children of parents with compulsory education only showed an increased risk of injury as car drivers compared to children in the highest socioeconomic group and children of highly educated parents. By contrast, level of household disposable income was found not to vary with RTI among young drivers. Twenty-five percent of the injuries could be avoided if all young people had the injury rate of the highest socioeconomic group, and 29% if all young people had the injury rate of those with highly educated parents. The reduction of risk differences based on household SEP calls for consideration of factors related to both differential exposure and differential susceptibility, which may be addressed in driver education.     

Soccer,concussions, and safety: Perceptions of parents of youth soccer participants

Introduction: The rate of concussions in youth soccer is among the highest of all youth sports. Parents play an important role in caring for their children and making decisions regarding whether they should participate in a sport, such as soccer, where concussions are well known. This study examined parental perceptions regarding: (a) coaches’ role in concussion management, (b) heading restriction policies, and (c) overall concussion risk and participation issues. Method: Online surveys were completed by 419 parents of youth soccer players who participated in the largest U.S. youth soccer programs nationwide. Results: Findings indicated 44.5% of the respondents had considered keeping their children from playing organized soccer and 47.2% were concerned about a potential decline in youth soccer participation due to concussions. Nearly 69% of responding parents agreed that heading should be banned for participants 10 years old or younger, while 56.5% thought heading should not be limited for participants 13 or older. Only 35% of parents were very confident about their child’s coach’s ability to properly identify concussions and remove those suspected of a concussion from play. Parents’ socioeconomic status (SES), soccer coaching and playing experience, and previous history of concussion(s) were key predictors of greater perceived risk about concussions. Conclusions: Findings from this study shed light on parents’ perceptions about concussions and related safety issues in youth soccer. Understanding what parents believe about concussions is vital to preserve youth soccer participation and can be used to strengthen education and policies that promote a safer environment for youth sport participants. Practical Applications: Youth soccer coaches can benefit from stronger, comprehensive educational efforts at the league/club level. Additionally, parents of youth athletes who are in the lower SES communities should be targeted to receive concussion safety information and/or interventions that would improve their knowledge, attitude, and practices regarding concussion safety.     

Socioeconomic status and the occurrence of non-fatal child pedestrian injury: Results from a cross-sectional survey

This study is to examine the contribution of socioeconomic status (SES) to the risk of nonfatal pedestrian injury among children. The sample was obtained from two urban cities of China using multi-staged randomized sampling. Information was collected by respondents’ reporting using self-administrative way in the classroom under the guidance of interviewers. A logistic regression analysis was applied to examine the associations between SES and nonfatal children pedestrian injury. The results showed that boys and children aged 10 had significantly increased odds of suffering nonfatal pedestrian injury. Migrant children were at higher risk of being injured. Students whose mothers’ educational levels were either less than secondary school or postgraduate were more likely to sustain injury. Children who were from wealthier families or poorer families easily suffered from injury compared to children from middle families. Children living with grandparents, or siblings, or a single father, or a single mother were all at increased risk of injury. The possible causes or pathways of these SESs’ impacts on pedestrian injury were explored in discussion. This study suggests that SESs are important determinants of nonfatal pedestrian injury among children in China.     

Adult opinions about the age at which children can be left home alone, bathe alone, or bike alone: Second Injury Control and Risk Survey (ICARIS-2)

ProblemThis study describes adult opinions about child supervision during various activities.MethodsData come from a survey of U.S. adults. Respondents were asked the minimum age a child could safely: stay home alone; bathe alone; or ride a bike alone. Respondents with children were asked if their child had ever been allowed to: play outside alone; play in a room at home for more than 10 minutes alone; bathe with another child; or bathe alone.ResultsThe mean age that adults believed a child could be home alone was 13.0 years (95% CI = 12.9-13.1), bathe alone was 7.5 years (95% CI = 7.4-7.6), or bike alone was 10.1 years (95% CI = 10.0-10.3). There were significant differences by income, education, and race.DiscussionAssessing adult's understanding of the appropriate age for independent action helps set a context for providing guidance on parental supervision. Guidelines for parents should acknowledge social norms and child development stages.Impact on IndustryKnowledge of social norms can help guide injury prevention messages for parents.     

Youth on racial minority operated U.S. farms, 2008: Demographics and injuries

IntroductionTo obtain injury surveillance data for youth on racial minority operated farms, the National Institute for Occupational Safety and Health developed the Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS) in collaboration with the U.S. Department of Agriculture.MethodsUsing a regionally stratified telephone survey of U.S. minority operated farm households, M-CAIS data were collected for youth less than 20 years of age.ResultsThere were an estimated 37,443 youth living on racial minority operated U.S. farms in 2008, almost half (46%) of these youth worked on the farm. Racial minority farm operators hired 6,443 youth, and reported an estimated 775,991 youth relative and other visitors on the farm. These youth suffered an estimated 516 injuries (5.9 injuries/1000 farms).ConclusionsHousehold youth had an injury rate of 7.8 injuries/1000 household youth and a work-related injury rate of 6.9 injuries/1000 working household youth.Practical applicationsThe research enables agricultural safety and health researchers, practitioners, and educators to identify priorities and design trainings and interventions to minimize the risk of farm hazards to youth on racial minority farm operations in the United States.     

Parental supervision and discomfort with children walking to school in low-income communities in Cape Town,South Africa

Objective: The risk of pedestrian injury is compounded for children living in low-income communities due to factors such as poor road and pedestrian infrastructure, reliance on walking as a means of transport, and compromised supervision. Parents play an important role in child pedestrian safety. The primary objective of this study was to examine the effects of child pedestrian variables on parental discomfort with regard to letting their child walk to and from school and on the frequency of adult supervision.

Methods: A cross-sectional study was conducted using a convenience sample from 3 schools participating in a pedestrian safety school initiative. The schools are situated in low-income, high-risk communities in the City of Cape Town. A parent survey form was translated into isiXhosa and sent home with learners to those parents who had consented to participate. The response rate was 70.4%, and only parents of children who walk to and from school were included in the final sample (n = 359). Child pedestrian variables include the time taken to walk to school, parental rating of the child's ability to safely cross the road, and the frequency of adult supervision.

Results: More than half of parents reported that their child walked to and from school without adult supervision. About 56% of children took less than 20 min to walk to school. Most parents (61%) were uncomfortable with their child walking to school, although the majority of parents (55.7%) rated their child's ability to cross the road safely as better or significantly better than average (compared to peers). The parents did not perceive any differences in pedestrian risk factors between boys and girls or between younger (6–9 years) and older (10–15 years) children. The time spent by a child walking to school and parents' perceptions of their child's road-crossing ability were found to be significant predictors of parental discomfort (in letting their child walk). Younger children and children who spent less time walking were more likely to be supervised by an adult.

Conclusions: Many South African schoolchildren have to navigate the roads without adult supervision from a young age. Caregivers, especially in low-income settings, often have limited options with regard to getting their child to school safely. Regardless of the child's age and gender, the time that they spend on the roads is an important factor for parents in terms of pedestrian safety.     

Parental knowledge of concussion: Evaluation of the CDC's “Heads up to parents” educational initiative

Background: Potential negative outcomes associated with sport-related concussion drive the need for resources to educate parents about prevention, recognition, and management of concussion in the youth athlete. Parents play a critical role in the recognition and management of concussion for their child. Purpose: This study aims to (a) investigate current knowledge of concussion among parents whose children age 5–18 years play a club sport and (b) identify effects of an online video versus online print educational intervention on concussion knowledge change and learning. Methods: 140 parents whose children played a club sport answered questions regarding their knowledge of sport-related concussion pre- and post-random assignment to an educational intervention: CDC Concussion Awareness video or CDC Concussion Fact Sheet for Parents. Results: Participating parents demonstrated a moderate level of pre-intervention knowledge, but critical gaps in knowledge were identified. Knowledge of concussion improved slightly following intervention regardless of intervention type. Conclusions: This study confirms the presence of gaps in knowledge of concussion in parents whose children play club sports. Without the protection of concussion legislation, those athletes who participate in club sports are at particular risk due to lack of concussion knowledge and education. This study confirms that education can have a positive impact on parental knowledge of concussion. Practical applications: Pre-knowledge of concussion is the greatest predictor of post-knowledge of concussion, therefore pre-assessment of target audience knowledge followed by a custom educational intervention taking into account principles of adult learning, would be the most beneficial to increasing concussion knowledge.     

Who's not driving among U.S. high school seniors: A closer look at race/ethnicity,socioeconomic factors,and driving status

Objectives: We examined associations among race/ethnicity, socioeconomic factors, and driving status in a nationally representative sample of >26,000 U.S. high school seniors.

Methods: Weighted data from the 2012 and 2013 Monitoring the Future surveys were combined and analyzed. We imputed missing values using fully conditional specification multiple imputation methods. Multivariate logistic regression modeling was conducted to explore associations among race/ethnicity, socioeconomic factors, and driving status, while accounting for selected student behaviors and location. Lastly, odds ratios were converted to prevalence ratios.

Results: 23% of high school seniors did not drive during an average week; 14% of white students were nondrivers compared to 40% of black students. Multivariate analysis revealed that minority students were 1.8 to 2.5 times more likely to be nondrivers than their white counterparts, and students who had no earned income were 2.8 times more likely to be nondrivers than those earning an average of ≥$36 a week. Driving status also varied considerably by student academic performance, number of parents in the household, parental education, census region, and urbanicity.

Conclusions: Our findings suggest that resources—both financial and time—influence when or whether a teen will learn to drive. Many young people from minority or lower socioeconomic families who learn to drive may be doing so after their 18th birthday and therefore would not take advantage of the safety benefits provided by graduated driver licensing. Innovative approaches may be needed to improve safety for these young novice drivers.     

Racial disparities in parent knowledge of concussion and recognition of signs and symptoms

Introduction: Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. Methodology: This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. Results: Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ± 4.55 (85.6% correct)], and African American parents/guardians [35.15 ± 4.97, 78.1% correct)] were identified (F_(1,172) = 4.82, p = 0.03). Conclusion: Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.     

Knowledge,attitudes, and behaviors related to child safety restraint in citizens of Shenzhen Municipality,China, and the associations between these factors

Objective: A child safety restraint (CSR) is an effective measure to reduce the risk of child injury from traffic collisions. This study aims to explore knowledge, attitudes, and behaviors regarding CSRs in a Chinese population.

Methods: A cross-sectional survey regarding CSR use was conducted from April to May 2014 in Shenzhen municipality. Respondents were parents who had at least one child 0 to 6 years of age and owned a car. These parents provided a self-report of demographic characteristics as well as information about their knowledge, attitudes, and behaviors toward CSR use.

Results: Most respondents had a fair level of knowledge about CSRs, with higher mean knowledge scores demonstrated among the respondents who were male, had an advanced degree, had a higher income, owned an expensive car, had an older child, drove frequently with children, and routinely drove greater distances with children. In addition, most respondents had a more positive attitude toward CSR use, with a higher mean attitude score among those who had an advanced degree, owned an expensive car, drove frequently with children, and routinely drove greater distances with children. However, some myths regarding CSR use also existed (e.g., parents can effectively protect their children in a car collision by holding them, they are not required to purchase the CSR for child safety if there is no mandatory provision by law, among others). Among 3,768 respondents who had at least one child and a car, 27.8% (1,047) had a CSR and 22.9% (864) used the CSR. A logistic regression model showed the likelihood of CSR ownership to be higher if respondents drove frequently or greater distances and was dependent on both the education level of the respondents and the age of the children. The frequency of CSR use increased as the age of children decreased (P = .0274). Respondents who owned a CSR and those who frequently used CSRs had higher mean knowledge and mean attitude scores.

Conclusions: This observational study found that although the majority of respondents had fair levels of knowledge and positive attitudes, they had lower rates of CSR ownership and use. Therefore, efforts at developing opportunities to expand public awareness of CSR use should be made to improve child passenger safety practices and eliminate child injury caused by traffic collisions.     

Parent driver characteristics associated with sub-optimal restraint of child passengers

OBJECTIVES: To identify parent driver demographic and socioeconomic characteristics associated with the use of sub-optimal restraints for child passengers under nine years. METHODS: Cross-sectional study using in-depth, validated telephone interviews with parent drivers in a probability sample of 3,818 vehicle crashes involving 5,146 children. Sub-optimal restraint was defined as use of forward-facing child safety seats for infants under one or weighing under 20 lbs, and any seat-belt use for children under 9. RESULTS: Sub-optimal restraint was more common among children under one and between four and eight years than among children aged one to three years (18%, 65%, and 5%, respectively). For children under nine, independent risk factors for sub-optimal restraint were: non-Hispanic black parent drivers (with non-Hispanic white parents as reference, adjusted relative risk, adjusted RR = 1.24, 95% CI: 1.09-1.41); less educated parents (with college graduate or above as reference: high school, adjusted RR = 1.27, 95% CI: 1.12-1.44; less than high school graduate, adjusted RR = 1.36, 95% CI: 1.13-1.63); and lower family income (with $50,000 or more as reference: <$20,000, adjusted RR = 1.23, 95% CI: 1.07-1.40). Multivariate analysis revealed the following independent risk factors for sub-optimal restraint among four-to-eight-year-olds: older parent age, limited education, black race, and income below $20,000. CONCLUSIONS: Parents with low educational levels or of non-Hispanic black background may require additional anticipatory guidance regarding child passenger safety. The importance of poverty in predicting sub-optimal restraint underscores the importance of child restraint and booster seat disbursement and education programs, potentially through Medicaid.     

Reasons for Child Passenger Nonrestraint in Motor Vehicles

Objective: Although child passenger restraint use in motor vehicles has increased, there is an important minority of children who remain unrestrained. The goal of this study was to identify the frequency of and under what circumstances parents keep their children unrestrained.

Methods: A cross-sectional, online survey was distributed to parents and caregivers of children 10 years old and younger. Survey participants were asked about child restraint practices, including frequency of and reasons for nonuse of restraints. Parents were specifically asked how acceptable it would be to keep their child unrestrained in certain situations.

Results: One thousand two hundred eighty-five parents and guardians responded to the survey and 1,002 completed it; 23.8% (95% confidence interval [CI], 21.3–26.6%) of respondents said they had driven with their child not fully restrained on at least one occasion. Approximately 1 in 5 parents strongly or somewhat agreed that it would be acceptable to keep their child unrestrained in certain situations, including a short drive, in a rush, an inadequate number of restraints, riding in a taxi, if somebody was holding the child, and as a reward for a child. Parents were more likely to agree that it was acceptable to keep their child unrestrained under nearly all circumstances listed if they were male, ages 18–29, with a graduate school education, in the $100,000+ income bracket, or Latino.

Conclusions: There are certain situations for which parents find it acceptable to leave their children unrestrained. This has implications for targeted child passenger safety efforts designed to maximize consistent restraint use.     

Social environment versus cycling competency predicting risk-taking in 11- to 13-year-old cyclists in The Netherlands

Abstract

Objectives: From age 12 onwards, cycling injuries begin rising in The Netherlands. A known contributing factor is younger children’s underdeveloped competency to deal with complex and hazardous traffic situations, and their exposure to such situations strongly increases after transitioning to secondary school. Little is known about intentional risk-taking as a contributing factor. In this developmental stage, children become increasingly vulnerable because of intentional risk-taking, affecting their safety and health. The incidence, predictors in the child’s social environment, and trends of such risks are systematically monitored; for instance, for alcohol use, smoking, and cyber bullying. Such monitors do not include risky road behavior. This exploratory field study examined the frequency of intentional risky cycling, its relationship with the perceived social environment, and relative to cycling competency measured as the ability to detect emerging hazards quickly.

Methods: Three hundred thirty-five students between 11 and 13 years of age (51% male) completed computerized tests of hazard perception skill and surveys on crashes, risk-taking, peer pressure, perceived risk-taking by parents or friends, and exposure to risky driving as passenger.

Results: Frequent risk-taking was associated with higher crash frequency. Stepwise regression confirmed that children who more often took risks on the road were also more sensitive to peer pressure, had more often been passengers of risky drivers, had parents and friends who exhibited risky behaviors in traffic more often, and perceived hazards as less dangerous but, in contrast to expectations, did not do worse on the detection of hazards. The predictors explained 28% of the variance in total risk-taking but varied from 6 to 20% depending on the specific risk-taking behavior concerned.

Conclusions: At least 20% of children sometimes or more often take risks in traffic. Children who feel peer pressure to behave in a risky manner, observe parents and friends behaving in a risky manner in traffic, and have been exposed as passengers to risky driving more often take risks in traffic themselves. These results provide support for including items on risky road behavior in health monitors and to design interventions that address the risk factors in the child’s perceived social environment.     

“If I know when you will arrive,I will let you walk to school:” The role of information technology

Introduction: Providing a sense of supervision for parents may facilitate their children’s involvement in physical outdoor activities, such as walking to school. Information technology (IT) solutions could bring more parental supervision, which in turn has the potential to enhance the proportion of walking trips to school. This study aimed to examine the role of a proposed hypothetical IT solution that gives parents real-time information about children’s entrance to and exit from the school, for the intention of parents letting their children walk to school. Method: A total of 820 questionnaires were distributed among pupils aged 7–9-years across 28 elementary schools to be completed by their parents (82% return rate). Results: Compared to the group of walking pupils, increased parental intention to let their children walk to school under the proposed solution could be explained by considerably more variables in the group of pupils who did not walk to school. The findings revealed that increased parental intention was higher among the walking pupils compared to the non-walking pupils. For the non-walking pupils, enhancement of walking facilities across the school area could potentiate the use of the proposed solution by the parents, which in turn may increase the proportion of walking on school trips. In addition, boy pupils, the pupils whose parents evaluated walking more favorable, those from lower socioeconomic backgrounds, and those living in close proximity to the school could more likely benefit by shifting from non-walking to walking modes of travel, after implementation of the solution.     

Factors affecting use and nonuse of child safety car seats in Gorgan,Iran

Objective: Motor vehicle accidents, which are among the main causes of child mortality in Iran and the Middle East, impose staggering costs for the community. Ignoring use of safety devices for children in most motor vehicle crashes will lead to death or serious injury. Because few studies have been performed on effective and predictive factors regarding use of child safety seats, the purpose of this study was to examine the factors affecting the use and nonuse of child safety seats, along with the factors that can facilitate how a child safety seat is used.

Method: This study was conducted in the urban area of Gorgan using a questionnaire. Through random selection, 204 parents with at least one child, aged 8?years or younger, reported their knowledge about the benefits of using a child safety seat.

Results: The results showed that 80% of parents never use a child safety seat, and 13% always use a child safety seat. More than 93% thought that it was necessary to make usage of the child safety seat obligatory. In addition, 80% of parents believed that a child safety seat prevents children from injury in crashes. In addition, 38% of parents were not aware of child safety devices and child safety, less than 20% said that they did not use a child safety seat because their spouse did not support its use, and 28% of them thought that a child safety seat does not affect the safety of the child. In general, 91% of parents reported that if child safety seat use were mandated, the frequency of use would increase. A law on the use of child safety seats is a very important variable in their use, which can enhance the chance of using a child safety seat by 6.5 times.

Conclusion: Special instructions should be developed to create incentive strategies for using a child safety seat. Mandating the use of a child safety seat, equipping cars with a child safety seat, encouraging children to use it, and providing continuous education and training are important factors for increasing the use of child safety seats.     

Local vs. national: Epidemiology of pedestrian injury in a mid-Atlantic city

Objective: Understanding pedestrian injury trends at the local level is essential for program planning and allocation of funds for urban planning and improvement. Because we hypothesize that local injury trends differ from national trends in significant and meaningful ways, we investigated citywide pedestrian injury trends to assess injury risk among nationally identified risk groups, as well as identify risk groups and locations specific to Baltimore City.

Methods: Pedestrian injury data, obtained from the Baltimore City Fire Department, were gathered through emergency medical services (EMS) records collected from January 1 to December 31, 2014. Locations of pedestrian injuries were geocoded and mapped. Pearson's chi-square test of independence was used to investigate differences in injury severity level across risk groups. Pedestrian injury rates by age group, gender, and race were compared to national rates.

Results: A total of 699 pedestrians were involved in motor vehicle crashes in 2014—an average of 2 EMS transports each day. The distribution of injuries throughout the city did not coincide with population or income distributions, indicating that there was not a consistent correlation between areas of concentrated population or concentrated poverty and areas of concentrated pedestrian injury. Twenty percent (n = 138) of all injuries occurred among children age ≤14, and 22% (n = 73) of severe injuries occurred among young children. The rate of injury in this age group was 5 times the national rate (Incident Rate Ratio [IRR] = 4.81, 95% confidence interval [CI], [4.05, 5.71]). Injury rates for adults ≥65 were less than the national average.

Conclusions: As the urban landscape and associated pedestrian behavior transform, continued investigation of local pedestrian injury trends and evolving public health prevention strategies is necessary to ensure pedestrian safety.     

Parental risk perceptions of childhood pedestrian road safety

Problem: Pedestrian injury is a major hazard to the health of children in most developed countries, including Australia. In a previous study it was found that parental road risk perception is a significant factor associated with their modeling of safe behavior as pedestrians. This study aimed to investigate factors that affect parental road risk perception. Method: This cross-sectional population-based randomized telephone survey aimed to study factors associated with risk perception on pedestrian road safety among parents with young children aged 4–12 years. Results: Five factors were found to be significantly associated with parental risk perception. They included age of child, sex of parent, employment of parent, living environment, and previous injury experience. The results suggested that the age of the child contributed greatest to the variance explained by the regression model. However, other factors remained significant even after adjusting for each other. Discussion: Results were discussed in light of the design and development of childhood pedestrian road safety campaigns. Impact on industry: Parental risk perceptions determine their safe road modeling behavior. In this study, significant factors that affect parental road risk perception have been identified. The information obtained can be used in the design of road safety programs that aim at changing the road risk perception of parents.     

Parental awareness and perception for correct use of child restraint systems and airbags in Brazil

Objective: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil.

Methods: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags.

Results: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags.

Conclusion: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.     

Using interactive virtual presence to support accurate installation of child restraints: Efficacy and parental perceptions

IntroductionChild restraint systems (car seats) reduce injury risk for young children involved in motor-vehicle crashes, but parents experience significant difficulty installing child restraints correctly. Installation by certified child passenger safety (CPS) technicians yields more accurate installation, but is impractical for broad distribution. A potential solution is use of interactive virtual presence via smartphone application (app), which permits “hands on” teaching through simultaneous and remote joint exposure to 3-dimensional images.MethodIn two studies, we examined the efficacy of remote communication via interactive virtual presence to help parents install child restraints. Study 1 was conducted at existing car seat checkpoints and Study 2 at preschools/daycare centers. In both cases, existing installations were assessed by certified CPS technicians using an objective coding scheme. Participants then communicated with remotely-located certified CPS technicians via a smartphone app offering interactive virtual presence. Technicians instructed participants to install child restraints and then the installation was inspected by on-site technicians. Both before and after the remote interaction, participants completed questionnaires concerning perception of child restraints and child restraint installation, self-efficacy to install child restraints, and perceived risk of injury to children if they were in a crash.ResultsIn both studies, accuracy of child restraint installations improved following the remote interaction between participants and certified CPS technicians. Together, the two samples achieved a weighted average of 90% correct installations across a multi-point inspection. Both samples reported increased self-efficacy to install child restraints and altered perceptions about the accuracy of the child restraint installations in their vehicles.ConclusionsFindings support use of interactive virtual presence as a strategy to realize accurate installation of child restraints.Practical applicationsInteractive virtual presence between certified CPS technicians and the public via smartphone app has potential to improve proper child restraint installations broadly, including to vulnerable and underserved rural populations.