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.     

Standardized error severity score (ESS) ratings to quantify risk associated with child restraint system (CRS) and booster seat misuse

Objective: Although numerous research studies have reported high levels of error and misuse of child restraint systems (CRS) and booster seats in experimental and real-world scenarios, conclusions are limited because they provide little information regarding which installation issues pose the highest risk and thus should be targeted for change. Beneficial to legislating bodies and researchers alike would be a standardized, globally relevant assessment of the potential injury risk associated with more common forms of CRS and booster seat misuse, which could be applied with observed error frequency—for example, in car seat clinics or during prototype user testing—to better identify and characterize the installation issues of greatest risk to safety.

Methods: A group of 8 leading world experts in CRS and injury biomechanics, who were members of an international child safety project, estimated the potential injury severity associated with common forms of CRS and booster seat misuse. These injury risk error severity score (ESS) ratings were compiled and compared to scores from previous research that had used a similar procedure but with fewer respondents. To illustrate their application, and as part of a larger study examining CRS and booster seat labeling requirements, the new standardized ESS ratings were applied to objective installation performance data from 26 adult participants who installed a convertible (rear- vs. forward-facing) CRS and booster seat in a vehicle, and a child test dummy in the CRS and booster seat, using labels that only just met minimal regulatory requirements. The outcome measure, the risk priority number (RPN), represented the composite scores of injury risk and observed installation error frequency.

Results: Variability within the sample of ESS ratings in the present study was smaller than that generated in previous studies, indicating better agreement among experts on what constituted injury risk. Application of the new standardized ESS ratings to installation performance data revealed several areas of misuse of the CRS/booster seat associated with high potential injury risk.

Conclusions: Collectively, findings indicate that standardized ESS ratings are useful for estimating injury risk potential associated with real-world CRS and booster seat installation errors.     

Reality and risk of contact-type head injuries related to bicycle-mounted child seats

Objective

The authors have treated numerous children who have been injured by falling from bicycle-mounted child seats. Despite the greatly increased use of such seats, the understanding of their risk and the importance of helmet use remains alarmingly poor. The objective of this study was to confirm the risk of bicycle-mounted child seats and to evaluate the efficacy of helmets, seat belts, and back seat height in terms of preventing or mitigating contact-type head impacts that occur in falls from bicycle-mounted child seats.

Materials and methods

Biometrical dummy tests were performed to examine contact-type head injuries in falls from stationary bicycles. A bicycle with an anthropometric test dummy placed in a bicycle-mounted child seat was tipped over. Each test was repeated three times and three-dimensional acceleration was measured using accelerometer. Head Injury Criteria (HIC) were calculated and the respective influences of a helmet, a seat belt, and increased height of the back of the seat on such impacts were evaluated.

Results

Only helmets unequivocally lowered maximal acceleration and/or HIC values with statistical significance. The seat belt lowered HIC values as long as it was used with the high-back seat. Only when the dummy wore a helmet sitting in a high-back seat did the HIC show less than the threshold of 570 for three-year-old children. The HIC showed the lowest score of 161.5 when the dummy wore both a helmet and a seat belt sitting in a high-back seat.

Conclusions

Riders in bicycle-mounted child seats definitely have higher risks of contact-type head injuries. In transporting a child on a bicycle-mounted child seat, parents must use both a child-bicycle helmet and a high-back child seat at least; a seat belt is highly recommended as long as it is used with the other safety devices.

Impact on Industry

The bicycle-mounted child seat should have a high enough back and an appropriate seat belt to protect the head of the child from a contact-type injury.     

Ride-hailing with kids: Who’s got their back?

Introduction: As transportation network companies (TNC) are on the rise, assessing the safety of children traveling in these vehicles is imperative. For this reason, this study developed and adopted a scoring system to assess states’ safety standards for children traveling in TNC vehicles. Methods: The scoring was based on two parameters pertaining to child car seat laws for TNCs: clarity and stringency. For each parameter, three criteria that could impact child safety in TNC vehicles were formulated. If a state met a certain criterion it got 1 point and 0 otherwise. The authors gathered all the necessary information by reviewing state statutes in Nexus Uni, a legal research database. These reviews took place between December 2019 and October 2020, and this study evaluated state laws in effect on October 28, 2020. Results: During this assessment, the authors observed a lack of clarity in state child car seat laws, which could compromise safety of children traveling in TNC vehicles. For clarity of laws, Georgia and Indiana received the highest scores (3 out of 3 points), while 16 states scored only 1 point, which was the lowest score in this category. In terms of stringency of laws, Pennsylvania received the highest score (3 out of 3 points), while Indiana scored the least (0 points). Conclusions: Besides one state (Oregon), all other states defined TNCs in their state laws. All states except for Indiana and Washington required child car seats in TNC vehicles. The responsibility for child car seat use was clearly defined in 35 states. The fine for child car seat violation was $50 or more in 28 states. Practical Application: This study will help TNCs, policymakers, and stakeholders identify states that need to improve their standards for child safety in TNC vehicles, and comprehensively address the issue.     

Teaching infant car seat installation via interactive visual presence: An experimental trial

Objective: A large portion of child restraint systems (car seats) are installed incorrectly, especially when first-time parents install infant car seats. Expert instruction greatly improves the accuracy of car seat installation but is labor intensive and difficult to obtain for many parents. This study was designed to evaluate the efficacy of 3 ways of communicating instructions for proper car seat installation: phone conversation; HelpLightning, a mobile application (app) that offers virtual interactive presence permitting both verbal and interactive (telestration) visual communication; and the manufacturer's user manual.

Methods: A sample of 39 young adults of child-bearing age who had no previous experience installing car seats were recruited and randomly assigned to install an infant car seat using guidance from one of those 3 communication sources.

Results: Both the phone and interactive app were more effective means to facilitate accurate car seat installation compared to the user manual. There was a trend for the app to offer superior communication compared to the phone, but that difference was not significant in most assessments. The phone and app groups also installed the car seat more efficiently and perceived the communication to be more effective and their installation to be more accurate than those in the user manual group.

Conclusions: Interactive communication may help parents install car seats more accurately than using the manufacturer's manual alone. This was an initial study with a modestly sized sample; if results are replicated in future research, there may be reason to consider centralized “call centers” that provide verbal and/or interactive visual instruction from remote locations to parents installing car seats, paralleling the model of centralized Poison Control centers in the United States.     

Characterizing the child passenger safety workforce in Michigan: A statewide survey in 2015

Objective: In this study, we assessed the number of child passenger safety technicians (CPSTs) in Michigan over 4 years and characterized the CPST workforce in 2015 to identify factors associated with high productivity and longevity in the field.

Methods: We determined the number of CPSTs and those newly certified using lists from the Michigan Office of Highway Safety Planning (OHSP) from 2012 to 2015. We conducted a statewide survey of Michigan CPSTs in October 2015. Analyses were conducted in 2016. The survey assessed demographic characteristics, reasons to enter the field and maintain certification, and motivations to conduct seat checks. We used CPST-reported time devoted to seat checks and average number of seats checked per month to create a composite “activity level” variable. We examined activity levels across several characteristics.

Results: The number of CPSTs ranged from 941 to 980 over the study period, with approximately 200 new certifications annually. In 2015, surveys were started by 496 of 962 eligible CPSTs and 427 submitted complete responses. CPST-instructors had a higher response rate than CPSTs in general (89 vs. 49%, P < .0001). The majority of respondents were women (71%) and self-identified as white (88%). More than one third were 35–44 years old. Just 7% were comfortable checking seats using a language other than English. “Personal reasons” were most often cited motivation for becoming a CPST and maintaining certification. Natural fit/job enhancement were more common reasons to maintain certification than become a CPST. Time and distance had the greatest influence on seat check participation. Perceived need, appointments vs. drop-in, and employer factors were very influential for 10–15% of CPSTs. Few CPSTs considered free food and payments/giveaways very influential. About 40% of respondents were considered high-activity (>24 seats checked/year), one third medium-activity (5 to 24 seats checked/year), and one quarter low-activity (<5 seats checked/year). High-activity CPSTs most commonly reported both being paid and volunteering their time to check seats, worked with a Safe Kids coalition, worked in law enforcement or social services, and had recertified at least once. Motivation to participate in seat checks did not vary with activity level.

Conclusions: Understanding the demographic characteristics and motivations of CPSTs can help Michigan OHSP recruit and retain a workforce dedicated to increasing the safety of child passengers. Agencies hosting seat checks can use these results to align the strategies they employ to incentivize CPSTs to serve in their communities with the factors that have the greatest influence on CPST participation.     

An observational study of child safety seat use in an international safe community: Tehran,Iran

Objective: Despite strong evidence of the effectiveness of child safety seats in reducing injuries, the use of these devices in some communities is still rare. The purpose of this study was to determine the prevalence of child safety seat use and the factors influencing its use in the safe community of Tehran.

Methods: This roadside observational study was conducted in 2015 and 2,178 personal cars with a child under 12 years aboard were observed on Tehran's streets in regard to use of child safety seats. Other variables such as the gender of the driver, driver's age group, type of street, region of municipality, time of day, and day of the week were also collected.

Results: Prevalence of child safety seat use was 4.3% and was significantly higher among women drivers, on freeways, and in municipal regions 1, 4, and 7.

Conclusions: The prevalence of child safety seat use in Tehran as a most populous member of the international safe community was very low and most children commuted in insecure situations in the vehicle. Therefore, it is proposed that plans should be made to increase the use of child safety seats in international safe communities.     

The safety implications of vehicle seat adjustments

INTRODUCTION: The goal of this study was to gather information on the preferred front seat position of vehicle occupants and to determine the impact of variation in seat position on safety during crashes. METHOD: The study evaluated the relationship between seat position and occupant size using the chi-square test and compared the risk of severe injury for small females and large males with regard to forward and rearward seat position using logistic regression. RESULTS: While smaller drivers sat closer to the steering wheel than larger drivers, front passengers of all sizes used similar seat positions. Additionally, the risk of injury was higher for small, unbelted females in rearward seat positions and large males (belted and unbelted) in forward seat positions. CONCLUSIONS: Occupants who adjust their seats to positions that are not consistent with required federal tests are at a greater risk for severe injury in a crash.     

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.     

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.     

Seat strength in rear body block tests

Purpose: This study collected and analyzed available testing of motor vehicle seat strength in rearward loading by a body block simulating the torso of an occupant. The data were grouped by single recliner, dual recliner, and all belts to seat (ABTS) seats.

Methods: The strength of seats to rearward loading has been evaluated with body block testing from 1964 to 2008. The database of available tests includes 217 single recliner, 65 dual recliner, and 18 ABTS seats. The trends in seat strength were determined by linear regression and differences between seat types were evaluated by Student's t-test. The average peak moment and force supported by the seat was determined by decade of vehicle model year (MY).

Results: Single recliner seats were used in motor vehicles in the 1960s to 1970s. The average strength was 918 ± 224 Nm (n = 26) in the 1960s and 1,069 ± 293 Nm (n = 65) in the 1980s. There has been a gradual increase in strength over time. Dual recliner seats started to phase into vehicles in the late 1980s. By the 2000s, the average strength of single recliner seats increased to 1,501 ± 335 Nm (n = 14) and dual recliner seats to 2,302 ± 699 Nm (n = 26). Dual recliner seats are significantly stronger than single recliner seats for each decade of comparison (P < .001). The average strength of ABTS seats was 4,395 ± 1,185 in-lb for 1989–2004 MY seats (n = 18). ABTS seats are significantly stronger than single or dual recliner seats (P < .001). The trend in ABTS strength is decreasing with time and converging toward that of dual recliner seats.

Conclusions: Body block testing is an quantitative means of evaluating the strength of seats for occupant loading in rear impacts. There has been an increase in conventional seat strength over the past 50 years. By the 2000s, most seats are 1,700–3,400 Nm moment strength. However, the safety of a seat is more complex than its strength and depends on many other factors.     

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.     

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

Introduction: Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt. Method: Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none). Results: Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region). Conclusions: Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.     

Investigation of Child Restraint System (CRS) Compatibility in the Vehicle Seat Environment

Objective: Child restraint system (CRS) misuse is common and can have serious consequences to child safety. Physical incompatibilities between CRS and vehicles can complicate the installation process and may worsen CRS misuse rates. This study aims to identify the most common sources of incompatibility between representative groups of CRS and vehicles.

Methods: Detailed dimensional data were collected from 59 currently marketed CRS and 61 late model vehicles. Key dimensions were compared across all 3,599 theoretical CRS/vehicle combinations and the most common predicted incompatibilities were determined. A subset of 34 physical installations was analyzed to validate the results.

Results: Only 58.2% of rear-facing (RF) CRS/vehicle combinations were predicted to have proper agreement between the vehicle's seat pan angle and the CRS manufacturers’ required base angle. The width of the base of the CRS was predicted to fit snugly between the vehicle's seat pan bolsters in 63.3% of RF CRS/vehicle combinations and 62.2% of forward-facing (FF) CRS/vehicle combinations. FF CRS were predicted to be free of interaction with the vehicle's head restraint in 66.4% of combinations. Roughly 90.0% of RF CRS/vehicle combinations were predicted to have enough horizontal clearance space to set the front seat in the middle its fore/aft slider track. Compatibility rates were above 98% regarding the length of the CRS base compared to the length of the vehicle seat pan and the ability of the top tether to reach the tether anchor. Validation studies revealed that the predictions of RF CRS base angle range vs. seat pan angle compatibility were accurate within 6%, and head restraint interference and front row clearance incompatibilities may be more common than the dimensional analysis approach has predicted.

Conclusions: The results of this study indicate that RF CRS base angles and front row clearance space, as well as FF CRS head restraint interference, are frequent compatibility concerns. These results enable manufacturers, researchers, and consumers to focus their attention on the most relevant CRS/vehicle incompatibility issues in today's market.     

Occupant responses in conventional and ABTS seats in high-speed rear sled tests

Objective: This study compared biomechanical responses of a normally seated Hybrid III dummy on conventional and all belts to seat (ABTS) seats in 40.2 km/h (25 mph) rear sled tests. It determined the difference in performance with modern (≥2000 MY) seats compared to older (<2000 MY) seats and ABTS seats.

Methods: The seats were fixed in a sled buck subjected to a 40.2 km/h (25 mph) rear sled test. The pulse was a 15 g double-peak acceleration with 150 ms duration. The 50th percentile Hybrid III was lap–shoulder belted in the FMVSS 208 design position. The testing included 11 <2000 MY, 8 ≥2000 MY, and 7 ABTS seats. The dummy was fully instrumented, including head accelerations, upper and lower neck 6-axis load cells, chest acceleration, thoracic and lumbar spine load cells, and pelvis accelerations. The peak responses were normalized by injury assessment reference values (IARVs) to assess injury risks. Statistical analysis was conducted using Student's t test. High-speed video documented occupant kinematics.

Results: Biomechanical responses were lower with modern (≥2000 MY) seats than older (<2000 MY) designs. The lower neck extension moment was 32.5 ± 9.7% of IARV in modern seats compared to 62.8 ± 31.6% in older seats (P =.01). Overall, there was a 34% reduction in the comparable biomechanical responses with modern seats. Biomechanical responses were lower with modern seats than ABTS seats. The lower neck extension moment was 41.4 ± 7.8% with all MY ABTS seats compared to 32.5 ± 9.7% in modern seats (P =.07). Overall, the ABTS seats had 13% higher biomechanical responses than the modern seats.

Conclusions: Modern (≥2000 MY) design seats have lower biomechanical responses in 40.2 km/h rear sled tests than older (<2000 MY) designs and ABTS designs. The improved performance is consistent with an increase in seat strength combined with improved occupant kinematics through pocketing of the occupant into the seatback, higher and more forward head restraint, and other design changes. The methods and data presented here provide a basis for standardized testing of seats. However, a complete understanding of seat safety requires consideration of out-of-position (OOP) occupants in high-speed impacts and consideration of the much more common, low-speed rear impacts.     

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0–17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.     

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.     

Observed child restraint misuse in a large,urban community: Results from three years of inspection events

ProblemChild restraints (CRs) are vital for optimizing child passenger safety and reducing the risk of pediatric injury and fatality in motor vehicle crashes. However, most CRs are installed improperly.MethodsThis present study was an assessment of observed instances of CR misuse. Participants were recruited through advertisements for CR inspection events in Los Angeles County, California. Child Passenger Safety Technicians collected information about each child passenger, vehicle, and aspects of CR selection and installation.ResultsOf 693 CRs installed upon arrival, only 3.8% were used with no instances of misuse. The most common misuses were inappropriate use of the top tether and failure to secure the seatbelt in locked mode.ConclusionsThe majority of observed CRs were installed with instances of misuse. CRs in newer vehicles were less likely to be installed in front of airbags and more likely to have the seatbelt routed inappropriately compared to those in older vehicles. Older children were more likely to be prematurely restrained in the front vehicle seat.Practical ApplicationsThe majority of CRs are installed improperly. We identified specific instances of CR misuse that are common in a large, urban community and present recommendations to improve child passenger safety practices and education.     

Child safety and booster seat use in five tribal communities, 2010–2014

ProblemMotor-vehicle crashes are a leading cause of death for American Indian/Alaska Natives (AI/AN) including AI/AN children. Child safety seats prevent injury and death among children in a motor-vehicle crash, yet use is low among AI/AN children.MethodsTo increase the use of child safety seats (CSS; car seats and booster seats), five tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010–2014. Increased CSS use was evaluated through direct observational surveys and CSS event data. CSS events are used to check the installation, use, and safety of CSS and new CSS can be provided.ResultsCSS use increased in all five programs (ranging from 6% to 40%). Four out of five programs exceeded their goals for increased use. Among the five communities, a total of 91 CSS events occurred resulting in 1417 CSS checked or provided.Conclusions and practical applicationsEvidence-based child passenger safety interventions are both feasible in and transferable to tribal communities.