Discordance between age- and size-based criteria of child passenger restraint appropriateness

Objectives: In this study, we sought to accomplish the following objectives: to (1) calculate the percentage of children considered appropriately restrained across 8 criteria of increasing restrictiveness; (2) examine agreement between age- and size-based appropriateness criteria; (3) assess for changes in the percentage of children considered appropriately restrained by the 8 criteria between 2011 (shortly after updates to U.S. guidelines) and 2015.

Methods: Data from 2 cross-sectional surveys of 928 parents of children younger than 12 years old (n = 591 in 2011, n = 337 in 2015) were analyzed in 2017. Child age, weight, and height were measured at an emergency department visit and used to determine whether the parent-reported child passenger restraint was considered appropriate according to 8 criteria. Age-based criteria were derived from Michigan law and U.S. guidelines. Weight, height, and size-based criteria were derived from typical restraints available in the United States in 2007 and 2011. The percentage appropriate restraint use was calculated for each criterion. The kappa statistic was used to measure agreement between criteria. Change in appropriateness from 2011 to 2015 was assessed with chi-square statistics.

Results: Percentage appropriate restraint use varied from a low of 19% for higher weight limits in 2011 to a high of 91% for Michigan law in 2015. Agreement between criteria was slight to moderate. The lowest kappa was for Michigan law and higher weight limits in 2011 (κ = 0.06) and highest for U.S. guidelines and lower weight limits in 2011 (κ = 0.60). Percentage appropriate restraint use was higher in 2015 than 2011 for the following criteria: U.S. guidelines (74 vs. 58%, P < .001), lower weight (57 vs. 47%, P = .005), higher weight (25 vs. 19%, P = .03), greater height (39 vs. 26%, P < .001), and greater size (42 vs. 30%, P = .001).

Conclusions: The percentage of children considered to be using an appropriate restraint varied substantially across criteria. Aligning the definition of appropriate restraint use with current U.S. guidelines would increase consistency in reporting results from studies of child passenger safety in the United States. Potential explanations for the increased percentage of children considered appropriately restrained between 2011 and 2015 include adoption of the updated U.S. guidelines and the use of child passenger restraints with higher weight and height limits.     

Evaluation of give kids a boost: A school-based program to increase booster seat use among urban children in economically disadvantaged areas

Objective: This study evaluated the effectiveness of a series of 1-year multifaceted school-based programs aimed at increasing booster seat use among urban children 4–7 years of age in economically disadvantaged areas.

Methods: During 4 consecutive school years, 2011–2015, the Give Kids a Boost (GKB) program was implemented in a total of 8 schools with similar demographics in Dallas County. Observational surveys were conducted at project schools before project implementation (P₀), 1–4 weeks after the completion of project implementation (P₁), and 4–5 months later (P₂). Changes in booster seat use for the 3 time periods were compared for the 8 project and 14 comparison schools that received no intervention using a nonrandomized trial process.

The intervention included (1) train-the-trainer sessions with teachers and parents; (2) presentations about booster seat safety; (3) tailored communication to parents; (4) distribution of fact sheets/resources; (5) walk-around education; and (6) booster seat inspections.

The association between the GKB intervention and proper booster seat use was determined initially using univariate analysis. The association was also estimated using a generalized linear mixed model predicting a binomial outcome (booster seat use) for those aged 4 to 7 years, adjusted for child-level variables (age, sex, race/ethnicity) and car-level variables (vehicle type). The model incorporated the effects of clustering by site and by collection date to account for the possibility of repeated sampling.

Results: In the 8 project schools, booster seat use for children 4–7 years of age increased an average of 20.9 percentage points between P₀ and P₁ (P₀ = 4.8%, P₁ = 25.7%; odds ratio [OR] = 6.9; 95% confidence interval [CI], 5.5, 8.7; P < .001) and remained at that level in the P₂ time period (P₂ = 25.7%; P < .001, for P₀ vs. P₂) in the univariate analysis. The 14 comparison schools had minimal change in booster seat use. The multivariable model showed that children at the project schools were significantly more likely to be properly restrained in a booster seat after the intervention (OR = 2.7; 95% CI, 2.2, 3.3) compared to the P₀ time period and compared to the comparison schools.

Conclusion: Despite study limitations, the GKB program was positively associated with an increase in proper booster seat use for children 4–7 years of age in school settings among diverse populations in economically disadvantaged areas. These increases persisted into the following school year in a majority of the project schools. The GKB model may be a replicable strategy to increase booster seat use among school-age children in similar urban settings.     

Supervisor expediency to employee expediency: The moderating role of leader–member exchange and the mediating role of employee unethical tolerance

We utilize social learning theory to test the role‐modeling effect of supervisor expediency (i.e., a supervisor's use of unethical practices to expedite work for self‐serving purposes). In particular, we examine the relationship between supervisor expediency and employee expediency, as moderated by leader–member exchange (LMX) and mediated by employee unethical tolerance. We predict that employees are more likely to model their supervisors' expedient behaviors when their relationship is characterized by high‐LMX (a high‐quality exchange relationship that is rich in socioemotional support). Furthermore, we argue that supervisor expediency, especially when LMX is high, influences employees' attitudes of unethical tolerance, which then affects employees' expedient behaviors. Across 2 multisource field studies and a third time‐lagged field study, we found general support for our theoretical predictions. Theoretical and practical implications are discussed.     

Influence of coagulation mechanisms and floc formation on filterability

Minimizing particles in water is a key goal for improving drinking water quality and safety.The media filtration process,as the last step of the solid–liquid separation process,is largely influenced by the characteristics of flocs,which are formed and controlled within the coagulation process.In a laboratory-based study,the impacts of the physical characteristics of flocs formed using aluminum sulfate on the filtration treatment of two comparative water samples were investigated using a photometric dispersion analyzer and a filterability apparatus.In general,the optimum dosage for maximizing filterability was higher than that for minimizing turbidity under neutral p H conditions.For a monomeric aluminum-based coagulant,the charge neutralization mechanism produced better floc characteristics,including floc growth speed and size,than the sweep flocculation mechanism.In addition,the charge neutralization mechanism showed better performance compared to sweep flocculation in terms of DOC removal and floc filterability improvement for both waters,and showed superiority in turbidity removal only when the raw water had high turbidity.For the different mechanisms,the ways that floc characteristics impacted on floc filterability also differed.The low variation in floc size distribution obtained under the charge neutralization mechanism resulted in the flocs being amenable to removal by filtration processes.For the sweep flocculation mechanism,increasing the floc size improved the settling ability of flocs,resulting in higher filter efficiency.