Parental risk perceptions of childhood pedestrian road safety: a cross cultural comparison

INTRODUCTION: This cross-sectional community-based randomized telephone survey, aimed to compare the parental risk perceptions on childhood pedestrian road safety among three different major community language speaking groups and the mainstream English speaking Australians in Sydney, Australia. METHOD: This was a community-based telephone survey with subjects randomly selected from the population of specific cultural languages in Sydney. RESULTS: Results indicated that Chinese and Arabic speaking parents or caregivers perceived the road environments as significantly less hazardous for their 4-12 year old children as pedestrians when compared with Vietnamese and English speaking parents. This was true even after adjusting for the age of child, socioeconomic status, and the living environments of respondents. CONCLUSION: The implication of the results was discussed in light of possible application to childhood safety behavior across different cultures. IMPACT TO THE INDUSTRY: The results obtained have highlighted the importance of cultural factors in risk perceptions, and safety behaviors. Cultural differences in risk perceptions should be taken into consideration in the design of safety education programs.     

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.     

Children’s fear in traffic and its association with pedestrian decisions

Introduction: Research on risk for child pedestrian injury risk focuses primarily on cognitive risk factors, but emotional states such as fear may also be relevant to injury risk. The current study examined children's perception of fear in various traffic situations and the relationship between fear perception and pedestrian decisions. Method: 150 children aged 6–12-years old made pedestrian decisions using a table-top road model. Their perceived fear in the pedestrian context was assessed. Results: Children reported greater emotional fear when they faced quicker traffic, shorter distances from approaching traffic, and red rather than green traffic signals. Children who were more fearful made safer pedestrian decisions in more challenging traffic situations. However, when the least risky traffic situation was presented, fear was associated with more errors in children’s pedestrian decisions: fearful children failed to cross the street when they could have done so safely. Perception of fear did not vary by child age, although safe pedestrian decisions were more common among the older children. Conclusions: Children’s emotional fear may predict risk-taking in traffic. When traffic situations are challenging to cross within, fear may appropriately create safer decisions. However, when the traffic situation is less risky, feelings of fear could lead to excessive caution and inefficiency. Practical applications: Child pedestrian safety interventions may benefit by incorporating activities that introduce realistic fear of traffic risks into broader safety lessons.     

Increasing the safety of children's vehicle travel: from effective risk communication to behavior change

INTRODUCTION: When installed and used correctly, child safety seats reduce the risk of fatal injury by 71% for infants and 54% for toddlers. However, four out of five safety seats are unintentionally misused. Yet, parents fail to participate in safety-seat checks and other child seat interventions aimed at correcting misuse. METHOD: Such lack of participation is the focus of this article, which argues that most caregivers are na?ve to their own vulnerability for misusing their child's seat. Research on risk perception is discussed as a guide to understanding both the high misuse rate and the lack of participation in interventions designed to correct this public safety problem. RESULTS AND IMPACT: A comprehensive intervention plan that incorporates risk communication techniques for maximum parental participation is proposed that includes three essential components: (a) establishing community locations for parents to turn for safety seat advice, (b) making these locations well known to the public, and (c) increasing caregivers' perceptions of risk of misusing their children's seats.     

Risk for household safety hazards: Socioeconomic and sociodemographic factors

IntroductionMany unintentional injuries to young children occur in the home. The current study examines the relation between family socioeconomic and sociodemographic factors and risk factors for home injury.MethodsPresence of household hazards was examined in 80 families with toddler-aged children. Parental ability to identify household hazards in pictures was also assessed. ANOVAs and Pearson product–moment correlations examined the relationship between presence of household hazards, knowledge to identify hazards, and factors of yearly family income, parental age, parental education, parental marital status, child ethnicity, and the number of children living in the home.ResultsA greater number of hazards were found in the homes of both the lowest and highest income families, but poorer knowledge to identify household hazards was found only among parents of the lowest income families and younger parents. Across family socioeconomic status, parent knowledge of hazards was related to observed household hazards.ConclusionsThe relationship between family income and risk for injury is complex, and children of both lower and higher SES families may be at risk for injury.Practical applicationsWhile historically particular focus has been placed on risk for injury among children in low income families, injury prevention efforts should target reducing presence of household hazards in both high and low SES families.     

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.     

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.     

Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5–10 years

Background: Understanding parents’ concussion-related knowledge and attitudes will contribute to the development of strategies that aim to improve concussion prevention and sport safety for elementary school children. This study investigated the association between parent- and child-related factors and concussion symptom knowledge and care-seeking attitudes among parents of elementary school children (aged 5–10 years). Methods: Four hundred parents of elementary school children completed an online questionnaire capturing parental and child characteristics; concussion symptom knowledge (25 items, range = 0–50; higher = better knowledge); and concussion care-seeking attitudes (five 7-point scale items, range = 5–35; higher = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher score levels. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) excluding 1.00 were deemed statistically significant. Results: Select parent and child characteristics were associated with higher score levels for both outcomes. For example, odds of better knowledge level in parents were higher with increased age (10-year increase aOR = 1.59; 95% CI = 1.10–2.28), among females (aOR = 3.90; 95% CI = 2.27–6.70), and among white/non-Hispanics (aOR = 1.79; 95%CI = 1.07–2.99). Odds of more positive concussion care-seeking attitude levels were higher among parents with a college degree (aOR = 1.98; 95%CI = 1.09–3.60). Child sports participation was not associated with higher score levels for either outcome. Conclusions: Certain elementary school parent characteristics were associated with parents’ concussion symptom knowledge and care-seeking attitudes. While the findings suggest providing parents with culturally and demographically relevant concussion education might be helpful, they also emphasize the importance of ensuring education/prevention regardless of their children’s sports participation. Practical Applications: Pediatric healthcare providers and elementary schools offer an optimal community-centered location to reach parents with this information within various communities.     

Factors related to youth self-efficacy for injury prevention bicycle skills

Introduction: Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child’s self-efficacy for injury prevention skills. Method: Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly. Results: In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills. Conclusions: These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy’s strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.     

How mothers parent their children with behavior disorders: implications for unintentional injury risk

INTRODUCTION: This study was designed to test the role of parental supervision in explaining why children with behavior disorders have increased risk of unintentional injury. METHOD: Children referred to a pediatric behavior disorders clinic and their mothers were unknowingly observed in a "hazard room" environment that housed several items that appeared dangerous but actually were altered to be safe. RESULTS: Mother and child behavior in the hazard room was correlated to parent-, teacher-, and observational-reports of children's externalizing behavior patterns, children's injury history, and mother's parenting styles. Maternal ignoring of children's dangerous behavior in the hazard room was the strongest correlate to children's injury history. CONCLUSIONS: Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury.     

Modeling crash severity by considering risk indicators of driver and roadway: A Bayesian network approach

Introduction: Traffic crashes could result in severe outcomes such as injuries and deaths. Thus, understanding factors associated with crash severity is of practical importance. Few studies have deeply examined how prior violation and crash experience of drivers and roadways are associated with crash severity. Method: In this study, a set of risk indicators of road users and roadways were developed based on their prior violation and crash records (e.g., cumulative crash frequency of a roadway), in order to reflect certain aspect or degree of their driving risk. To explore the impacts of those indicators on crash severity and complex interactions among all contributing factors, a Bayesian network approach was developed, based on citywide crash data collected in Kunshan, China from 2016 to 2018. A variable selection procedure based on Information Value (IV) was developed to identify significant variables, and the Bayesian network was employed to explicitly explore statistical associations between crash severity and significant variables. Results: In terms of balanced accuracy and AUCs, the proposed approach performed reasonably well. Bayesian modeling results indicated that the prior crash/violation experiences of road users and roadways were very important risk indicators. For example, migrant workers tend to have high injury risk due to their dangerous violation behaviors, such as retrograding, red-light running, and right-of-way violation. Furthermore, results showed that certain variable combinations had enhanced impacts on severity outcome than single variables. For example, when a migrant worker and a non-motorized vehicle are involved in a crash happening on a local road with high cumulative violation frequency in the previous year, the probability for drivers suffering serious injury or fatality is much higher than that caused by any single factor. Practical applications: The proposed methodology and modeling results provide insights for developing effective countermeasures to reduce crash severity and improve traffic system safety performance.     

Behavior of children and accompanying adults at a pedestrian crosswalk

Children and accompanying adults were observed while using a pedestrian crosswalk on the way to or from kindergarten or primary school. The results of this study corroborate earlier findings that accompaniment was less than complete, that adults can set much better examples in various respects and that accompanied children often show no awareness of actively participating in the road crossing task. The solution provided by a two-dimensional scaling analysis of child and adult behavioral data illustrates that adults perform better in some respects than children, but not in all. From the results of this study, five recommendations are made concerning topics that need more emphasis in road safety programs aimed at parents.     

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.     

Young driver risk in relation to parents' retrospective driving record

PROBLEM: Parents are an important potential influence on the driving safety of their children. This study examined the relationship of parental driving record on male and female offspring's at-fault collision risk. METHOD: Drivers aged 16-21 on the date of full licensure were selected from driver records and a matching process was used to identify putative parents in two-parent households. Poisson regression models were developed to predict at-fault collisions of male and female youth in the three years following full licensure from parents' at-fault collisions, speeding offenses, and other moving offenses in the four years prior to children's licensure. One set of models examined the relative risk associated with increasing numbers of maternal and paternal at-fault collisions and offenses. Other models examined the joint versus separate maternal and parental contributions. RESULTS: Controlling for region of residence, both mothers' and fathers' at-fault collisions were associated with an increased risk in both male and female youth at-fault collisions. Mothers' and fathers' speeding offenses were also associated with increased relative risk of at-fault collisions for both sons and daughters, while fathers' other moving offenses increased collision risk for sons but not daughters. DISCUSSION: Further research is required to identify how parental driving risk is transmitted to children. IMPACT ON INDUSTRY: (a) Parents of young children should be informed of their role in influencing their children's future driving risk; (b) The results identify risk factors that could be of interest to licensing authorities and the insurance industry.     

The perceived compatibility of safety and production expectations in hazardous occupations

INTRODUCTION: Safety hazards are unavoidable in many work environments. Employees must be both productive and safe, however, conflicting safety and production demands can negatively affect safety, production, or both. The employee's perception of the compatibility of management's safety and production expectations is a possible predictor of such consequences. This paper defines "safety-production compatibility" and describes how measures of safety-production compatibility, as well as safety pressure and production pressure, were developed. METHOD: We used LISREL structural equation modeling to test the influences of safety-production compatibility, safety pressure, and production pressure on safe work behavior and interference with performing other work tasks. The 239 study participants were workers employed in diverse but hazardous occupations. RESULTS: Pressure to work safely was positively associated with safe work behavior. The perceived compatibility of safety and production demands positively influenced safe work behavior and reduced the interference of safety hazards performing other tasks. Safety-production compatibility was also found to mediate the relationship between trust in management and safe work behavior. CONCLUSIONS: The results of this field study suggest increased compatibility, and thus less conflict, between safety and production demands influences safe work behavior and the interference of safety hazards with performing other work tasks. More broadly, the worker's reaction to multiple work demands is a safety and performance influence. IMPACT ON INDUSTRY: Safety management efforts that focus only on the hazards fail to eliminate many accidents because accidents arise from many factors including technology, safety climate, social influences, production, and safety demands. This study suggests that workers differ in their perception of the compatibility of safety and production demands. These differences will show up in safe work behavior, influencing the effectiveness of safety management efforts and the trust workers have in management's concern for safety.     

Supervision of young children in parking lots: Impact on child pedestrian safety

Introduction: Pedestrian injuries are a significant pediatric public health concern worldwide. Younger children are at particular risk for pedestrian injuries in parking lots, but there is limited research regarding children's pedestrian behaviors in parking lots. Method: This study examined children's behaviors and safety risks in parking lots through unobtrusive and unannounced observation of 124 children ages 2–10 years and their adult supervisors as they crossed a parking lot from their parked vehicle into a community recreation center. Results: Adult supervision was inadequate: over 67% of children 10 years of age and younger were unsupervised in the parking lot at some point between the vehicle parking and the child entering into the building. Approximately 90% of all children were outside of arm's length of the accompanying adult at some point while in the parking lot. Additionally, children exited the vehicle prior to the adult in over 50% of observations. Age was associated with safety risk, with older children being unsupervised more often than younger ones. Conclusions: Adult supervision of children in a parking lot setting was poor, creating significant safety risks. In addition, many children failed to follow basic pedestrian safety practices themselves, such as looking for moving cars. Injury prevention strategies should be implemented. Practical applications: As researchers gain better understanding about the safety risks for children in parking lots, interventions could target adult and child behaviors through improved supervision, altered perception of risk, and mandated behavioral guidelines for child behavior, such as how and when children exit vehicles in parking lots.     

Bicyclist injury severity in traffic crashes: A spatial approach for geo-referenced crash data to uncover non-stationary correlates

Introduction: Bicyclists are among vulnerable road users with their safety a key concern. This study generates new knowledge about their safety by applying a spatial modeling approach to uncover non-stationary correlates of bicyclist injury severity in traffic crashes. Method: The approach is Geographically Weighted Ordinal Logistic Regression (GWOLR), extended from the regular Ordered Logistic Regression (OLR) by incorporating the spatial perspective of traffic crashes. The GWOLR modeling approach allows the relationships between injury severity and its contributing factors to vary across the spatial domain, to account for the spatial heterogeneity. This approach makes use of geo-referenced data. This study explored more than 7,000 geo-referenced bicycle--motor-vehicle crashes in North Carolina. Results: This study performed a series of non-stationarity tests to identify local relationships that vary substantially across the spatial domain. These local relationships are related to the bicyclist (bicyclist age, bicyclist behavior, bicyclist intoxication, bicycle direction, bicycle position), motorist (driver age, driver intoxication, driver behavior, vehicle speed, vehicle type) and traffic (traffic volume). Conclusions: Results from the regular OLR are in general consistent with previous findings. For example, an increased bicyclist injury severity is associated with older bicyclists, bicyclist being intoxicated, and higher motor-vehicle speeds. Results from the GWOLR show local (rather than global) relationships between contributing factors and bicyclist injury severity. Practical Applications: Researchers and practitioners may use GWOLR to prioritize cycling safety countermeasures for specific regions. For example, GWOLR modeling estimates in the study highlighted the west part (from Charlotte to Asheville) of North Carolina for increased bicyclist injury severity due to the intoxication of road users including both bicyclists and drivers. Therefore, if a countermeasure is concerned with the road user intoxication, there may be a priority for the region from Charlotte to Asheville (relative to other areas in North Carolina).     

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.     

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.     

Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers

INTRODUCTION: To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. METHODS: Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. RESULTS: Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. CONCLUSIONS: In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. IMPACT ON INDUSTRY: Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.