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Socioeconomic Characteristics of Pediatric Traumatic Brain Injury Patients. Clin Neurol Neurosurg 2022; 221:107404. [DOI: 10.1016/j.clineuro.2022.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/20/2022]
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Sylvester S, Schwartz JM, Hsu A, Crandall M, Tepas JJ, Yorkgitis BK. Pediatric Safety Restraint Use in Motor Vehicle Crashes at a Level I Safety-Net Trauma Center. J Surg Res 2020; 258:132-136. [PMID: 33010558 DOI: 10.1016/j.jss.2020.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adherence to child passenger safety recommendations is essential to prevent death and injury in children involved in motor vehicle crashes. Parents may not undertake the proper safety measures, which can lead to increase injury. METHODS A safety net, level I trauma center's database was used to identify admitted children (age<15 y/o) involved in motor vehicle crashes over a 2-y period to investigate safety restraint device use and compliance with state recommendations. Variables evaluated were crash characteristics, presence and method of passenger restraint, demographics, Glasgow Coma Scale, and Injury Severity Score. Excluded were patients where restraint characteristics could not be identified and those discharged from the trauma center. RESULTS Eighty patients met inclusion criteria. Thirty-two (40%) children were unrestrained. Safety restraint device was noted in 48 (60%) children with 13 (27.1%) patients improperly restrained. The most common method of improper restraint (6, 46.2%) was traveling in the front seat before the age state law recommends. With respect to proper, improper, and no restraint, age (7.31 ± 14.26, 5.76 ± 3.24, P = 0.36), female sex (17, 8, 13, P = 0.32), low-income status (14, 5, 24, P = 0.28), and race (P = 0.08) did not differ between the groups. The unrestrained children had statistically lower initial Glasgow Coma Scale and higher Injury Severity Score and were more often involved in high-risk mechanism of Injury motor vehicle crashes. CONCLUSIONS Despite recommendations and regulations regarding child passenger safety measures, there are a significant number of children that remain suboptimally restrained who are admitted to a safety-net trauma center. Further research is needed to understand the barriers to increase the compliance with recommendations along with targeted educational campaigns in low-compliance populations.
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Affiliation(s)
- Scott Sylvester
- Department of Surgery, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Jamie M Schwartz
- University of Florida, College of Medicine, Gainesville, Florida
| | - Albert Hsu
- Division of Acute Care Surgery, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Marie Crandall
- Division of Acute Care Surgery, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Joseph J Tepas
- Department of Surgery, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | - Brian K Yorkgitis
- Division of Acute Care Surgery, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida.
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Privette F, Nwosu A, Pope C, Yang J, Pressley J, Zhu M. Factors Associated With Child Restraint Use in Motor Vehicle Crashes. Clin Pediatr (Phila) 2018; 57:1423-1431. [PMID: 29985048 PMCID: PMC6486886 DOI: 10.1177/0009922818786002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Motor vehicle crashes (MVCs) are a leading cause of death among children. Multivariable analyses of age-appropriate child restraint system (CRS) use in the "booster-aged" population are needed. The current study identified factors associated with age-appropriate CRS use in fatal MVCs for children 4 to 7 years old, using 2011 to 2015 data from the Fatality Analysis Reporting System. Of 929 MVC fatalities, 32% of fatally injured children were in an age-appropriate restraint. While age-appropriate CRS use was higher for 4-, 5-, and 6-year-olds relative to 7-year-olds (adjusted relative risk [aRR] = 2.57, 2.51, and 2.18, respectively; p < .01 for each comparison), black children (aRR = 0.62; p < .01) relative to white children, and drivers who had not used a lap-shoulder belt (aRR = 0.40; p < .01) relative to belted drivers were associated with lower levels of age-appropriate CRS use. Our findings underscore the continued importance of communicating best practice guidelines on CRSs to caregivers of young children.
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Affiliation(s)
| | - Ann Nwosu
- Research Institute at Nationwide Childrens Hospital, Center for Injury Research and Policy
| | - Caitlin Pope
- Nationwide Children’s Hospital, Center for Injury Research and Policy
| | - Jingzhen Yang
- Nationwide Children’s Hospital, Center for Injury Research and Policy; Ohio State University Wexner Medical Center, Pediatrics
| | - Joyce Pressley
- Columbia University Department of Health Policy and Management; Columbia University Department of Epidemiology, Center for Injury Epidemiology and Prevention
| | - Motao Zhu
- Nationwide Children’s Hospital, Center for Injury Research and Policy
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Bing JA, Agnew AM, Bolte JH. Compatibility of booster seats and vehicles in the U.S. market. TRAFFIC INJURY PREVENTION 2018; 19:385-390. [PMID: 29271665 DOI: 10.1080/15389588.2017.1417594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to analyze booster and rear vehicle seat dimensions to identify the most frequent compatibility problems. METHODS Measurements were collected from 40 high-back and backless boosters and 95 left rear and center rear row seating positions in 50 modern vehicles. Dimensions were compared for 3,800 booster/vehicle seat combinations. For validation and estimation of tolerance and correction factors, 72 booster installations were physically completed and compared with measurement-based compatibility predictions. Dimensions were also compared to the International Organization for Standardization (ISO) volumetric envelopes of forward-facing child restraints and boosters. RESULTS Seat belt buckles in outboard positions accommodated the width of boosters better than center positions (success rates of 85.4 and 34.7%, respectively). Adequate head restraint clearance occurred in 71.9 to 77.2% of combinations, depending on the booster's head support setting. Booster recline angles aligned properly with vehicle seat cushion angles in 71.5% of combinations. In cases of poor angle alignment, booster angles were more obtuse than the vehicle seat angles 97.7% of the time. Head restraint interference exacerbated angle alignment issues. Data indicate success rates above 90% for boosters being fully supported by the length of the seat cushion and for adequate height clearance with the vehicle roofline. Comparison to ISO envelopes indicates that most boosters on the U.S. market are taller and angled more obtusely than ISO target envelopes. CONCLUSIONS This study quantifies some of the common interferences between boosters and vehicles that may complicate booster usage. Data are useful for design and to prioritize specific problem areas.
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Affiliation(s)
- Julie A Bing
- a Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, The Ohio State University , Columbus , Ohio
| | - Amanda M Agnew
- a Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, The Ohio State University , Columbus , Ohio
| | - John H Bolte
- a Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, The Ohio State University , Columbus , Ohio
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Yuma-Guerrero P, Orsi R, Lee PT, Cubbin C. A systematic review of socioeconomic status measurement in 13 years of U.S. injury research. JOURNAL OF SAFETY RESEARCH 2018; 64:55-72. [PMID: 29636170 PMCID: PMC10372816 DOI: 10.1016/j.jsr.2017.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/09/2017] [Accepted: 12/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13years in observational research studies. DESIGN & METHODS This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002. RESULTS Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n=73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n=70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002). CONCLUSIONS There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES. PRACTICAL APPLICATIONS Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.
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Affiliation(s)
- Paula Yuma-Guerrero
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States.
| | - Rebecca Orsi
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States
| | - Ping-Tzu Lee
- Colorado State University, College of Health and Human Sciences, School of Social Work, 127 Education, 1586 Campus Delivery, Fort Collins, CO 80523-1586, United States
| | - Catherine Cubbin
- The University of Texas at Austin, School of Social Work, Austin, TX, United States
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Hunter K, Keay L, Clapham K, Brown J, Bilston LE, Lyford M, Gilbert C, Ivers RQ. "He's the Number One Thing in My World": Application of the PRECEDE-PROCEED Model to Explore Child Car Seat Use in a Regional Community in New South Wales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101206. [PMID: 28994725 PMCID: PMC5664707 DOI: 10.3390/ijerph14101206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 12/04/2022]
Abstract
We explored the factors influencing the use of age-appropriate car seats in a community with a high proportion of Aboriginal families in regional New South Wales. We conducted a survey and three focus groups with parents of children aged 3–5 years enrolled at three early learning centres on the Australian south-east coast. Survey data were triangulated with qualitative data from focus groups and analysed using the PRECEDE-PROCEED conceptual framework. Of the 133 eligible families, 97 (73%) parents completed the survey including 31% of parents who reported their children were Aboriginal. Use of age-appropriate car seats was reported by 80 (83%) of the participants, and awareness of the child car seat legislation was high (91/97, 94%). Children aged 2–3 years were less likely reported to be restrained in an age-appropriate car seat than were older children aged 4–5 years (60% versus 95%: χ2 = 19.14, p < 0.001). Focus group participants highlighted how important their child’s safety was to them, spoke of the influence grandparents had on their use of child car seats and voiced mixed views on the value of authorised child car seat fitters. Future programs should include access to affordable car seats and target community members as well as parents with clear, consistent messages highlighting the safety benefits of using age-appropriate car seats.
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Affiliation(s)
- Kate Hunter
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Lisa Keay
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kathleen Clapham
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Julie Brown
- Neuroscience Research Australia and University of New South Wales, NSW 2052, Sydney, Australia.
| | - Lynne E Bilston
- Neuroscience Research Australia and University of New South Wales, NSW 2052, Sydney, Australia.
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Marilyn Lyford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Celeste Gilbert
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Rebecca Q Ivers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
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Cicchino JB, Jermakian JS. Vehicle characteristics associated with LATCH use and correct use in real-world child restraint installations. JOURNAL OF SAFETY RESEARCH 2015; 53:77-85. [PMID: 25934000 DOI: 10.1016/j.jsr.2015.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 02/25/2015] [Accepted: 03/18/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The objective of this study was to determine if vehicle features associated with LATCH ease-of-use in laboratory studies with volunteers predict LATCH use and misuse in real-world child restraint installations. METHOD Vehicle characteristics were extracted from prior surveys of more than 100 top-selling 2010-13 vehicles. Use and correct use of LATCH was determined from records of more than 14,000 child restraint installations in these vehicles that were inspected by child passenger safety technicians at Safe Kids car seat checkup events during 2010-12. Logistic regression was used to examine the association between vehicle features and use and correct use of lower anchors and top tethers, controlling for other relevant installation features. RESULTS Lower anchors were more likely to be used and correctly used when the clearance angle around them was greater than 54°, the force required to attach them to the lower anchors was less than 178N, and their depth within the seat bight was less than 4cm. Restraints were more likely to be attached correctly when installed with the lower anchors than with the seat belt. After controlling for lower anchor use and other installation features, the likelihood of tether use and correct use in installations of forward-facing restraints was significantly higher when there was no hardware present that could potentially be confused with the tether anchor or when the tether anchor was located on the rear deck, which is typical in sedans. CONCLUSIONS There is converging evidence from laboratory studies with volunteers and real-world child restraint installations that vehicle features are associated with correct LATCH use. PRACTICAL APPLICATIONS Vehicle designs that improve the ease of installing child restraints with LATCH could improve LATCH use rates and reduce child restraint misuse.
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Affiliation(s)
- Jessica B Cicchino
- Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201, USA.
| | - Jessica S Jermakian
- Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201, USA
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Hauschild HW, Humm JR, Pintar FA, Yoganandan N, Kaufman B, Maltese MR, Arbogast KB. The Influence of Enhanced Side Impact Protection on Kinematics and Injury Measures of Far- or Center-Seated Children in Forward-Facing Child Restraints. TRAFFIC INJURY PREVENTION 2015; 16 Suppl 2:S9-S15. [PMID: 26436248 DOI: 10.1080/15389588.2015.1064116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the influence of forward-facing child restraint systems' (FFCRSs) side impact structure, such as side wings, on the head kinematics and response of a restrained, far- or center-seated 3-year-old anthropomorphic test device (ATD) in oblique sled tests. METHODS Sled tests were conducted utilizing an FFCRS with large side wings and with the side wings removed. The CRS were attached via LATCH on 2 different vehicle seat fixtures-a small SUV rear bench seat and minivan rear bucket seat-secured to the sled carriage at 20° from lateral. Four tests were conducted on each vehicle seat fixture, 2 for each FFCRS configuration. A Q3s dummy was positioned in FFCRS according to the CRS owner's manual and FMVSS 213 procedures. The tests were conducted using the proposed FMVSS 213 side impact pulse. Three-dimensional motion cameras collected head excursion data. Relevant data collected during testing included the ATD head excursions, head accelerations, LATCH belt loads, and neck loads. RESULTS Results indicate that side wings have little influence on head excursions and ATD response. The median lateral head excursion was 435 mm with side wings and 443 mm without side wings. The primary differences in head response were observed between the 2 vehicle seat fixtures due to the vehicle seat head restraint design. The bench seat integrated head restraint forced a tether routing path over the head restraint. Due to the lateral crash forces, the tether moved laterally off the head restraint reducing tension and increasing head excursion (477 mm median). In contrast, when the tether was routed through the bucket seat's adjustable head restraint, it maintained a tight attachment and helped control head excursion (393 mm median). CONCLUSION This testing illustrated relevant side impact crash circumstances where side wings do not provide the desired head containment for a 3-year-old ATD seated far-side or center in FFCRS. The head appears to roll out of the FFCRS even in the presence of side wings, which may expose the occupant to potential head impact injuries. We postulate that in a center or far-side seating configuration, the absence of door structure immediately adjacent to the CRS facilitates the rotation and tipping of the FFCRS toward the impact side and the roll-out of the head around the side wing structure. Results suggest that other prevention measures, in the form of alternative side impact structure design, FFCRS vehicle attachment, or shared protection between the FFCRS and the vehicle, may be necessary to protect children in oblique side impact crashes.
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Affiliation(s)
- Hans W Hauschild
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - John R Humm
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Frank A Pintar
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Narayan Yoganandan
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Bruce Kaufman
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
- b Neurosurgery , Children's Hospital of Wisconsin , Milwaukee , Wisconsin
| | - Matthew R Maltese
- c The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
- d University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania
| | - Kristy B Arbogast
- c The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
- d University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania
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Macy ML, Butchart AT, Singer DC, Gebremariam A, Clark SJ, Davis MM. Looking Back on Rear-Facing Car Seats: Surveying US Parents in 2011 and 2013. Acad Pediatr 2015; 15:526-33. [PMID: 25576520 PMCID: PMC4469629 DOI: 10.1016/j.acap.2014.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 10/04/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to determine the age at which US parents first turned their child's car seat to face forward and information sources used to make that decision at the time of the release of the 2011 guidelines for child passenger safety and 30 months later. METHODS We administered 2 separate cross-sectional Web-based surveys of nationally representative panels of US parents in May 2011 and November 2013. Survey participation rate was 54% in both years. Parents of children ≤4 years old responded to questions about transitioning from rear-facing to forward-facing car seats (n = 495 in 2011; n = 521 in 2013). RESULTS In 2011, 33% of parents of 1- to 4-year-old children who had been turned to face forward (n = 409) turned at or before 12 months and 16% turned at 2 years or older. In 2013, 24% of parents of 1- to 4-year-old children who had been turned to face forward (n = 413) turned at or before 12 months and 23% turned at 2 years or older. Car seat packaging and clinicians were the most common information sources. Demographic characteristics associated with turning to face forward at or before 12 months of age in 2011 (parent age, education, household income, rural residence) were not significantly associated with transitioning at or before 12 months in 2013. CONCLUSIONS Delaying the transition to a forward-facing car seat still represents an opportunity to improve passenger safety in the United States. As common sources of information, clinicians may be influential in a parent's decision to turn their child's car seat to face forward.
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Affiliation(s)
- Michelle L. Macy
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Amy T. Butchart
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Dianne C. Singer
- The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Achamyeleh Gebremariam
- The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Sarah J. Clark
- The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Matthew M. Davis
- The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan,The Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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Zonfrillo MR, Ferguson RW, Walker L. Reasons for Child Passenger Nonrestraint in Motor Vehicles. TRAFFIC INJURY PREVENTION 2015; 16 Suppl 2:S41-S45. [PMID: 26436241 PMCID: PMC4602401 DOI: 10.1080/15389588.2015.1040115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Mark R. Zonfrillo
- Center for Injury Research and Prevention and Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Macy ML, Cunningham RM, Resnicow K, Freed GL. Disparities in age-appropriate child passenger restraint use among children aged 1 to 12 years. Pediatrics 2014; 133:262-71. [PMID: 24420814 PMCID: PMC3904276 DOI: 10.1542/peds.2013-1908] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources. METHODS A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1- to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law. RESULTS Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents. Regardless of race, <30% of 8- to 12-year-old children who were ≤4 feet, 9 inches tall used a booster seat. White parents had higher adjusted odds (3.86, 95% confidence interval 2.27-6.57) of reporting age-appropriate restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, κ = 0.74) between parent report of their child's usual restraint and the observed restraint at emergency department discharge. CONCLUSIONS Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children <8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children.
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Affiliation(s)
- Michelle L. Macy
- Department of Emergency Medicine,,The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, and,The University of Michigan Injury Center, Ann Arbor, Michigan
| | - Rebecca M. Cunningham
- Department of Emergency Medicine,,The University of Michigan Injury Center, Ann Arbor, Michigan
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan; and
| | - Gary L. Freed
- Department of Emergency Medicine,,The Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, and
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Brown J, Keay L, Hunter K, Bilston LE, Simpson JM, Ivers R. Increase in best practice child car restraint use for children aged 2-5 years in low socioeconomic areas after introduction of mandatory child restraint laws. Aust N Z J Public Health 2013; 37:272-7. [DOI: 10.1111/1753-6405.12070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Perinatal implications of motor vehicle accident trauma during pregnancy: identifying populations at risk. Am J Obstet Gynecol 2013; 208:466.e1-5. [PMID: 23439323 DOI: 10.1016/j.ajog.2013.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/02/2013] [Accepted: 02/20/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between restraint use, race, and perinatal outcome after motor vehicle accidents (MVAs) during pregnancy. STUDY DESIGN The Duke Trauma Registry and medical records were searched for information on pregnant women at >14 weeks' gestation who were involved in an MVA and who received care through the Emergency Department and the Obstetric Units. Between January 1994 and December 31, 2010, 126 women were identified. Variables that were collected included type of trauma, gestational age at presentation, and delivery outcomes. A prognostic study was performed that evaluated the associations between maternal demographics, details of the accident that included restraint use, and maternal treatment that was related to the accident in relationship to perinatal outcome. RESULTS There was no difference in the mean age or median gravidity or parity by race among pregnant women who were cared for after an MVA. There was no difference in mean age or racial distribution between women who were restrained compared with women who were unrestrained; unrestrained women were more likely to be nulliparous. Unrestrained women were more likely to require nonobstetric surgery that was related to the trauma. The overall rate of placental abruption was 6%. There were 6 intrauterine fetal deaths, 3 each in the unrestrained (25%) and restrained groups (3.5%; P = .018). Airbags deployed in 17 accidents. Among the 7 women with placenta abruption, 4 women (57%) experienced air bag deployment. CONCLUSION Lack of restraint use during pregnancy is associated with an increased risk of fetal death.
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Weaver NL, Brixey SN, Williams J, Nansel TR. Promoting correct car seat use in parents of young children: challenges, recommendations, and implications for health communication. Health Promot Pract 2013; 14:301-7. [PMID: 22991278 PMCID: PMC3629542 DOI: 10.1177/1524839912457567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Injuries involving motor vehicles continue to be the biggest threat to the safety of children. Although child safety seats (CSS) have been established as a central countermeasure in decreasing injury risk, the majority of parents do not use the correct car seat correctly. There are many challenges in promoting correct car seat use, which itself is a complex behavior. To advance this critical protective behavior, the public health community would benefit from clarifying CSS messaging, communicating clearly, and addressing the conflicting recommendations of product use. In this article, we present current challenges in promoting CSS use and draw on health communication and other fields to offer recommendations for future work in this area.
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Keay L, Hunter K, Brown J, Bilston LE, Simpson JM, Stevenson M, Ivers RQ. Child restraint use in low socio-economic areas of urban Sydney during transition to new legislation. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:984-991. [PMID: 22921907 DOI: 10.1016/j.aap.2012.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 07/27/2012] [Accepted: 08/01/2012] [Indexed: 06/01/2023]
Abstract
Child restraints protect a young child against injury in crashes but best practice child restraint use is low in Australia, particularly among lower socio-economic groups. We investigated factors associated with restraint use to inform the development of education and distribution programmes to support new Australian legislation on child passengers among families in low socio-economic areas of metropolitan Sydney. We interviewed a parent or carer of 1160 children aged 2-5 years enrolled at one of 28 early childhood centres in low socio-economic areas of urban Sydney. Appropriate child restraint use was defined as a forward facing child restraint (FFCR) for 2-3 year olds and a FFCR or booster seat for children aged 4 years or more. Predictors of self-reported appropriate use were explored using logistic regression. Analysis was conducted on one child from each family in the target age range (2-5 years): 586 (51%) were male and the mean age was 3.5 (Standard Deviation 0.8) years. There were 432 (45%) families with annual income below $60,000, 248 (22%) spoke a language other than English at home and 360 (33%) had 3 or more children. Fifty-four percent of carers indicated that their 2-3 year old children travelled in a FFCR. Inappropriate use among children in this age group was more likely when the carer was <36 years (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.08-2.45), in families with ≥3 children (OR 1.64, 95% CI 1.10-2.44) and when the carer believed that a booster seat was just as safe as a FFCR (OR 2.98, 2.05-4.32). Eight-eight percent of carers of 4-5 year olds reported use of a booster seat or FFCR. Non-use was associated with low household income (OR 3.10, 95% CI 1.67-5.75), in families with ≥3 children (OR 2.03, 95% CI 1.09-3.76) and families where a language other than English is spoken at home (OR 2.39, 95% CI 1.10-5.21). Non-English speaking families had less awareness of the new law and poorer knowledge of safety benefits of child restraints. They also had lower household incomes and more concerns about cost of child restraints and booster seats. These findings can inform development of interventions to promote best practice child restraint use, which will reach non-English speaking families in this region. They also confirm the importance of economic and logistic barriers to best practice child restraint use.
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Affiliation(s)
- Lisa Keay
- The George Institute for Global Health, The University of Sydney, Level 7, 341 George Street, Sydney, NSW 2000, Australia.
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Baron-Epel O, Magid A, Bord S, Assi N, Klein M, Levi S. Child restraint safety practices among Arab children in Israel. TRAFFIC INJURY PREVENTION 2013; 14:194-197. [PMID: 23343029 DOI: 10.1080/15389588.2012.698446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Because the rate of injury and mortality from car crashes among Arab children is higher than among Jewish children in Israel, this study assesses the patterns of age-appropriate child restraint system (CRS) use in Arab towns in Israel. METHODS From October 2010 to September 2011, 4396 children ages 0 to 14 were observed while seated in vehicles in 9 Arab towns and villages in Israel. RESULTS Among infants aged 0 to 1 year old, 31.2 percent were observed in an age-appropriate restraint, whereas among children aged 1 to 4 years, only 12.4 percent were age-appropriately restrained. Children aged 5 to 9 were observed to have the lowest levels of age-appropriate restraint use (1.3%). The variation between the various villages was large and dependent on the age of the child. CONCLUSIONS The low rates of CRS use may explain to some degree the high rates of injury and mortality of Arab children in car crashes. These low rates indicate that previous interventions have not been successful in increasing restraint use in the Arab community in Israel and there is a need to plan targeted interventions specifically for this population. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.
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Affiliation(s)
- Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
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Lapidus JA, Smith NH, Lutz T, Ebel BE. Trends and correlates of child passenger restraint use in 6 Northwest tribes: the Native Children Always Ride Safe (Native CARS) project. Am J Public Health 2012; 103:355-61. [PMID: 23237177 DOI: 10.2105/ajph.2012.300834] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared proportions of children properly restrained in vehicles in 6 Northwest American Indian tribes in 2003 and 2009, and evaluated risks for improper restraint. METHODS During spring 2009 we conducted a vehicle observation survey in Oregon, Washington, and Idaho tribal communities. We estimated the proportions of children riding properly restrained and evaluated correlates of improper restraint via log-binomial regression models for clustered data. RESULTS We observed 1853 children aged 12 years and younger in 1207 vehicles; 49% rode properly restrained. More children aged 8 years and younger rode properly restrained in 2009 than 2003 (51% vs 29%; P < .001). Older booster seat-eligible children were least likely to ride properly restrained in 2009 (25%). American Indian children were more likely to ride improperly restrained than nonnative children in the same communities. Other risk factors included riding with an unrestrained or nonparent driver, riding where child passenger restraint laws were weaker than national guidelines, and taking a short trip. CONCLUSIONS Although proper restraint has increased, it remains low. Tribe-initiated interventions to improve child passenger restraint use are under way.
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Affiliation(s)
- Jodi A Lapidus
- Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, OR 97201, USA.
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18
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Child passenger safety practices in the U.S.: disparities in light of updated recommendations. Am J Prev Med 2012; 43:272-81. [PMID: 22898120 DOI: 10.1016/j.amepre.2012.05.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/08/2012] [Accepted: 05/29/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children are best protected in motor vehicle collisions when properly using the appropriate restraint and sitting in a rear row. Racial and ethnic disparities have been reported in injury statistics and use of any restraint; however, predictors of safety seat use, being unrestrained, and sitting in the front seat have not been explored previously. PURPOSE To determine factors associated with child passenger safety practices by race/ethnicity in a national sample of child passengers aged <13 years. METHODS Secondary analysis conducted in 2011 of the 2007, 2008, and 2009 National Survey of the Use of Booster Seats in which child passenger restraint use was observed directly. Age-stratified, survey-weighted chi-square and logistic regression analyses were conducted. RESULTS Restraint use was observed for 21,476 children aged <13 years. A decline in child safety seat use and increase in being unrestrained were observed with increasing child age. In multivariate analyses, race/ethnicity, unrestrained drivers, and sitting in the front seat were associated with lower odds of child safety seat use among children aged <8 years. Older child age was associated with sitting in the front seat and being unrestrained. The presence of multiple child passengers was associated with lower odds of sitting in the front but higher odds of being unrestrained. CONCLUSIONS Few children use the recommended child passenger restraints. Understanding the reasons for the suboptimal child passenger restraint practices identified in this study is essential for the development of effective programs to reduce or eliminate preventable motor vehicle collision-related injuries.
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Yanchar NL, Kirkland SA, LeBlanc JC, Langille DB. Discrepancies between knowledge and practice of childhood motor vehicle occupant safety in Nova Scotia--a population-based study. ACCIDENT; ANALYSIS AND PREVENTION 2012; 45:326-333. [PMID: 22269516 DOI: 10.1016/j.aap.2011.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 07/22/2011] [Accepted: 07/27/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine discrepancies between knowledge and practice of childhood motor vehicle restraints (CMVRs) and vehicle seating position amongst parents within the province of Nova Scotia. DESIGN Random telephone survey. SETTING The Canadian province of Nova Scotia. SUBJECTS Four hundred and twenty-six households with at least one child under the age of 12 years, totaling 723 children. MAIN OUTCOME MEASURES The proportion of parents whose children who should be in a specific stage of CMVR and sitting in the rear seat of the vehicle, and who demonstrate correct knowledge of that restraint system and seating position, yet do not use that restraint system/seating position for their child (demonstrate practice discrepant from their knowledge). RESULTS Awareness of what restraint system to use is good (>80%). However, knowledge of when it is safe to graduate to the next stage is low (30-55%), most marked for when to use a seatbelt alone. Awareness of the importance of sitting in the rear seat of a vehicle was universal. Discrepancies between knowledge and practice were most marked with booster seats and rear-seating of older children. Factors influencing incorrect practice (prematurely graduated to a higher-level restraint system than what is appropriate for age and weight) included lower household income, caregiver education level, and knowledge of when to graduate from forward-facing car seats and booster seats. Incorrect practice was also more commonly observed amongst children of weight and/or age approaching (but not yet reaching) recommended graduation parameters of the appropriate CMVR. CONCLUSIONS Discrepancies between knowledge and practice are evident through all stages of CMVRs, but most marked with booster seats. The roles of lower socioeconomic status and gaps in CMVR legislation, in influencing discrepant practice, must be acknowledged and suggest the need for targeted education concurrent with development of comprehensive all-stages CMVR policies.
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Affiliation(s)
- Natalie L Yanchar
- Division of Pediatric General Surgery, IWK Health Centre, 5850 University Avenue, Halifax, NS, Canada B3 J 3G9.
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Macy ML, Clark SJ, Freed GL, Butchart AT, Singer DC, Sasson C, Meurer WJ, Davis MM. Carpooling and booster seats: a national survey of parents. Pediatrics 2012; 129:290-8. [PMID: 22291115 DOI: 10.1542/peds.2011-0575] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Booster seat use among school-aged children has been consistently lower than national goals. In this study, we sought to explore associations between parental experiences with booster seats and carpooling. METHODS We conducted a cross-sectional Web-based survey of a nationally representative panel of US parents in January 2010. As part of a larger survey, parents of 4- to 8-year-old children responded to 12 questions related to booster seats and carpooling. RESULTS Of 1612 parents responding to the full survey (response rate = 71%), 706 had a 4- to 8-year-old child and 681 met inclusion rules. Most parents (76%) reported their child used a safety seat when riding in the family car. Of children reported to use seat belts, 74% did so in accordance with their state law. Parent report of child safety seat use was associated with younger child age and with the presence of state booster seat laws. Sixty-four percent of parents carpool. Among parents who carpool and whose children use a child safety seat: 79% indicated they would always ask another driver to use a booster seat for their child and 55% reported they always have their child use their booster seat when driving friends who do not have boosters. CONCLUSIONS Carpooling is a common driving situation during which booster seat use is inconsistent. Social norms and self-efficacy are associated with booster seat use. Clinicians who care for children should increase efforts to convey the importance of using the size-appropriate restraint for every child on every trip.
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Affiliation(s)
- Michelle L Macy
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
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21
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Cunningham CE, Bruce BS, Snowdon AW, Chen Y, Kolga C, Piotrowski C, Warda L, Correale H, Clark E, Barwick M. Modeling improvements in booster seat use: a discrete choice conjoint experiment. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:1999-2009. [PMID: 21819828 DOI: 10.1016/j.aap.2011.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 03/30/2011] [Accepted: 05/17/2011] [Indexed: 05/31/2023]
Abstract
Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.
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Affiliation(s)
- Charles E Cunningham
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L9C 7N4, Canada.
| | - Beth S Bruce
- Faculty of Health Professions, Dalhousie University, Halifax, Canada
| | - Anne W Snowdon
- Odette School of Business, University of Windsor, Windsor, Canada
| | - Yvonne Chen
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L9C 7N4, Canada
| | | | - Caroline Piotrowski
- Department of Family Social Sciences, University of Manitoba, Winnipeg, Canada
| | - Lynne Warda
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Heather Correale
- School of Nursing, University of Northern British Columbia, British Columbia, Canada
| | - Erica Clark
- School of Nursing, University of Northern British Columbia, British Columbia, Canada
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22
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Ivers RQ, Keay L, Brown J, Bilston LE, Hunter K, Simpson JM, Stevenson M. Buckle up safely: a cluster randomised trial to evaluate the effectiveness of a pre-school based program to increase appropriate use of child restraints. BMC Public Health 2011; 11:16. [PMID: 21211053 PMCID: PMC3024224 DOI: 10.1186/1471-2458-11-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic crashes for car occupants are a leading cause of death and serious injury in children from high and middle income countries globally. Correct use of appropriate child restraints can significantly reduce death and serious injury but there is a need for well powered trials to examine effectiveness of programs to increase optimal child restraint practices. The aim of this trial is to examine the effectiveness of a comprehensive intervention to increase the use of appropriate child restraints, and decrease incorrect use of child restraints in pre-school aged children traveling in cars. METHODS AND DESIGN A cluster randomised controlled trial will be conducted, involving 28 pre-school or childcare centres in low income areas of Sydney, Australia, over one calendar year. The intervention is an educational program involving an in-service for centre staff, distribution of educational materials to parents, a parent workshop demonstrating restraint use, subsidised restraints for parents in need, and vouchers for a free restraint checking service. Blinded assessors will observe restraint use at all centres at the end of the calendar year. Data will be analysed on an intention-to-treat basis; the primary analysis will compare the proportion of each of the two outcome measures (use of appropriate restraints, and incorrect use of restraints) at each centre between intervention and control groups. Detailed process evaluation will be conducted, including examination of implementation and utilisation of various elements of the program by both centres and families. DISCUSSION This assessor blinded cluster randomised trial is powered to provide credible evidence about the efficacy of an education and distribution program in a pre-school setting to increase appropriate use, and decrease incorrect use of child restraints. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12609000612213.
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Affiliation(s)
- Rebecca Q Ivers
- The George Institute for Global Health, The University of Sydney, Sydney, Australia.
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Sayegh R, Bradley D, Vaca FE. Pediatric obesity in motor vehicle collisions. J Emerg Nurs 2010; 36:501-3. [PMID: 20837228 DOI: 10.1016/j.jen.2010.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rockan Sayegh
- Center for Trauma and Injury Prevention Research, University of California, Irvine Medical Center, Orange, CA, USA
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Du W, Finch CF, Hayen A, Bilston L, Brown J, Hatfield J. Relative benefits of population-level interventions targeting restraint-use in child car passengers. Pediatrics 2010; 125:304-12. [PMID: 20064863 DOI: 10.1542/peds.2009-1171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Because public health resources for injury prevention are limited, methods for comparing competing strategies are needed. We aimed to estimate potential injury reductions for 4 population-level interventions that target restraint practices for child car passengers aged 0 to 12 years. METHODS Population-attributable risk fraction (PARF) is a population-level estimate of excess risk from exposure to a risk factor. PARFs were calculated for each intervention scenario by using published age-specific mortality/injury relative-risk estimates; restraint practices among injured child car passengers from police-collected data; and observational data for correctness of restraint use in New South Wales, Australia. PARF reductions were estimated for population uptakes of 25%, 50%, and 75%. RESULTS Assuming a 50% population uptake, (1) promoting age-appropriate restraint use could prevent additional fatalities (5.1%, infants; 3.4%, 1- to 6-year-olds) and nonfatal injuries (3.2%, infants; 16.2%, 1- to 6-year-olds) compared with promoting any restraint use; (2) further encouraging correct age-appropriate restraint use could also prevent additional fatalities (9.1%, infants; 14.3%, 1- to 6-year-olds) and nonfatal injuries (9.2%, infants; 10.7%, 1- to 6-year-olds); and (3) for children aged 7 to 12 years, promoting correct use of restraints could prevent an additional 3.4% fatalities and 3.1% nonfatal injuries compared with promoting any restraint use. CONCLUSIONS Interventions that target child passenger-restraint practices offer population-level benefits in terms of reduction in fatalities and injuries. These tangible benefits call for action internationally, not only to promote restraint use but correct age-appropriate restraint use for child car passengers.
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Affiliation(s)
- Wei Du
- the George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, New South Wales 2050, Australia.
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Brixey S, Ravindran K, Guse CE. Legislating child restraint usage -Its effect on self-reported child restraint use rates in a central city. JOURNAL OF SAFETY RESEARCH 2010; 41:47-52. [PMID: 20226950 DOI: 10.1016/j.jsr.2009.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 11/18/2009] [Accepted: 12/15/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the effect of the newly enacted child passenger safety law, Wisconsin Act 106, on self-report of proper restraint usage of children in Milwaukee's central city population. METHOD A prospective, non-randomized study design was used. The settings used were (a) a pediatric urban health center, and (b) two Women, Infants and Children offices in Milwaukee, Wisconsin. Participants included 11,566 surveys collected over 18 months that spanned the pre-legislation and post-legislation time periods from February 2006 through August 2008. RESULTS The study set out to assess appropriate child passenger restraint. The results showed that the changes in adjusted proper restraint usage rates for infants between the pre-law, grace period, and post-fine periods were 94%, 94%, and 94% respectively. For children 1-3years old, the adjusted proper usage rates were 65%, 63%, and 59%, respectively. And for children 4-7years old, the rates were 43%, 44% and 42%, respectively. There was a significant increase in premature booster seat use in children who should have been restrained in a rear- or forward-facing car seat (10% pre-law, 12% grace period, 20% post-fine; p<0.0005). There was no statistically significant change over time in unrestrained children (2.1%, 1.7%, 1.7%, p=0.7, respectively). CONCLUSIONS The passage of a strengthened child passenger safety law with fines did not significantly improve appropriate restraint use for 0-7year olds, and appropriate use in 1-7year olds remained suboptimal with a majority of urban children inappropriately restrained. Although the number of unrestrained children decreased, we identified an unintended consequence of the legislation - a significant increase in the rate of premature belt-positioning booster seat use among poor, urban children. IMPACT ON INDUSTRY The design of child restraint systems maximizes protection of the child. Increasing reports of misuse is a call to those who manufacture these child passenger restraints to improve advertising and marketing to the correct age group, ease of installation, and mechanisms to prevent incorrect safety strap and harness placement. To ensure accurate and consistent use on every trip, car seat manufacturers must ensure that best practice recommendations for use as well as age, weight, and height be clearly specified on each child restraint. The authors support the United States Department of Transportation's new consumer program that will assist caregivers in identifying the child seat that will fit in their vehicle. In addition, due to the increase in premature graduation of children into belt-positioning booster seats noted as a result of legislation, promoting and marketing booster seat use for children less than 40 pounds should not be accepted. Child passenger safety technicians must continue to promote best practice recommendations for child passenger restraint use and encourage other community leaders to do the same.
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Affiliation(s)
- Suzanne Brixey
- Department of Pediatrics and Injury Research Center, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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26
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Evaluating the Educational Component of a Hospital-Based Child Passenger Safety Program. ACTA ACUST UNITED AC 2009; 67:S30-3. [DOI: 10.1097/ta.0b013e3181a93512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Motor Vehicle Occupant Injury and Related Hospital Expenditures in Children Aged 3 Years to 8 Years Covered Versus Uncovered by Booster Seat Legislation. ACTA ACUST UNITED AC 2009; 67:S20-9. [DOI: 10.1097/ta.0b013e3181951a90] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Collarile P, Valent F, Di Bartolomeo S, Barbone F. Changes in child safety restraint use and parental driving behaviours in Italy. Acta Paediatr 2008; 97:1256-60. [PMID: 18474067 DOI: 10.1111/j.1651-2227.2008.00876.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the changes in prevalence of child-restraint correct use, level of parental information and parental driving behaviours in a population of North-Eastern Italy 2 years after a previous survey. METHODS A mail survey of 514 families with children <12 years. We examined the prevalence of child restraint correct use, level of parental information, parental driving behaviours and the concordance between the responses to the current and previous survey. Multivariable logistic regression was used to identify factors influencing correct restraint use. RESULTS Habitual restraint use was reported for 92.5% of children. The frequency of habitual use decreased with increasing child's age (p = 0.0143). Among children 3-7 years, correct restraint use was lower than in the previous survey (p = 0.0039). Increased child's age was associated with decreased likelihood of correct restraint use. Previous correct restraint use and parental information on child restraints, and current parental seat belt use were positively associated with correct use. In the last 2 years, only 17.5% of families have received information on transport safety. Most parents declared to comply with traffic regulations. CONCLUSION In our study area, the use of child restraints is common, although non-habitual use is reported, especially among older children. The information on transport safety is insufficient. Law enforcement and information campaigns could further enhance parental compliance with traffic regulations.
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Affiliation(s)
- Paolo Collarile
- Cattedra di Igiene ed Epidemiologia, Università degli Studi di Udine, Italy
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29
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Mahler SA, Thoma T. Commentary: Speaking Up and Reaching Out. Ann Emerg Med 2008; 52:166-7. [DOI: 10.1016/j.annemergmed.2008.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koppel S, Charlton JL, Fitzharris M, Congiu M, Fildes B. Factors associated with the premature graduation of children into seatbelts. ACCIDENT; ANALYSIS AND PREVENTION 2008; 40:657-666. [PMID: 18329418 DOI: 10.1016/j.aap.2007.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 09/04/2007] [Accepted: 09/06/2007] [Indexed: 05/26/2023]
Abstract
This study investigated the factors associated with the premature graduation into seatbelts for Australian children aged 4-11 years. From 699 child restraint use questionnaires, 195 children were identified as meeting the booster seat height-weight criteria (height: 100-145 cm and weight: 14-26 kg). Of these children, 44% were correctly traveling in a booster seat, while 56% had been moved prematurely into a seatbelt. A multivariable logistic regression model showed that there were a number of key predictors associated with the premature graduation to seatbelts. For example, children who were moved prematurely into a seatbelt were more likely to be older, have other children travelling in the vehicle and have younger parents compared to children appropriately restrained in a booster seat. In addition, there was a significant interaction between vehicle type and parent's household income. Based on the findings of this study, a number of recommendations are made for strategies to enhance appropriate restraint use for this age group, as well as for future research.
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Affiliation(s)
- Sjaanie Koppel
- Monash University Accident Research Centre, Building 70, Monash University, VIC 3800, Australia.
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Rangel SJ, Martin CA, Brown RL, Garcia VF, Falcone RA. Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance. J Pediatr Surg 2008; 43:200-7. [PMID: 18206483 DOI: 10.1016/j.jpedsurg.2007.09.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 09/02/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE Little is known regarding the patterns of appropriate restraint use among minority children involved in motor vehicle collisions. The purpose of this study was to characterize patterns of restraint use among children hospitalized after motor vehicle collision and to examine the effects of race and socioeconomic status on compliance. METHODS All children admitted to our level I trauma center over a 10-year period were identified. Patterns of appropriate restraint use were compared between African American (AA) and white children. Compliance was also compared between children insured with Medicaid (as a surrogate for socioeconomic status) and those with private insurance coverage. RESULTS One thousand two hundred sixty-eight patients were included with an overall restraint use of 44.8% with only 20.3% restrained properly. Compared with white children, AAs were significantly less likely to be properly restrained (12.7% vs 22.2%, P < .001) or to be restrained by any means (28.8% vs 48.7%, P < .001). The greatest disparity between groups was observed in the use of car seats (16.0% vs 47.4%, P < .001). Medicaid patients were less likely to be restrained compared with those with commercial insurance (40.6% vs 48.3%, P = .022); however, race remained a significant predictor of noncompliance after controlling for the effect of insurance status. CONCLUSIONS These data demonstrate an alarming trend because nearly 80% of all children in our study were improperly restrained. Marked disparities in compliance were observed in the AA population even after controlling for insurance coverage. Future studies will need to further characterize the complex interplay between race and socioeconomic status with proper restraint use.
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Affiliation(s)
- Shawn J Rangel
- Division of Pediatric and Thoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Cincinnati, OH 45229, USA
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Brixey S, Guse CE, Meurer J. Booster seat use in an inner-city day care center population. TRAFFIC INJURY PREVENTION 2008; 9:238-242. [PMID: 18570146 DOI: 10.1080/15389580801958471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine use and knowledge of belt positioning booster seats by drivers transporting children from day care centers in the central city of Milwaukee, Wisconsin. METHODS A prospective, direct observational, community-based, exploratory study was undertaken in May 2005. Eighteen day care centers in urban Milwaukee that met the predetermined criteria, including > 10 children ages 4-8 enrolled, were invited to participate. Volunteer observers, including Spanish-speaking members, from community organizations were trained in proper placement by certified car seat technicians. Teams visited sites, completed a standardized survey form with drivers who agreed to participate, and observed the type and placement of restraint in which each child was placed. RESULTS Of 841 children observed, 283 were determined to be booster-seat eligible. Only 21% were in the appropriate restraint. Latino, African American, and older children were significantly less likely than white and younger children to be appropriately restrained. Appropriate restraint use was more frequent among those living in the proper ZIP codes with higher median incomes. CONCLUSIONS This is the first observational study of booster seat use in this Milwaukee population with appropriate restraint use varying widely from reported state and national data. The low rates of appropriate booster seat use, particularly by Latino and African American caregivers and those living in low-income neighborhoods, in this large metropolitan center supports the need for further study and targeted interventions.
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Affiliation(s)
- Suzanne Brixey
- Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Milwaukee, Wisconsin, USA.
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King WD, Monroe K, Applegate J, Cole-Farmer J. The impact of education, legislation and service on Alabama child passenger safety. ACTA ACUST UNITED AC 2007; 63:S25-8. [PMID: 17823580 DOI: 10.1097/ta.0b013e31812f5e7a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Winston FK, Erkoboni D, Xie D. Identifying Interventions That Promote Belt-Positioning Booster Seat Use For Parents With Low Educational Attainment. ACTA ACUST UNITED AC 2007; 63:S29-38. [PMID: 17823581 DOI: 10.1097/ta.0b013e31812f5ebb] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many parents with low educational attainment prematurely graduate their children to seat belt restraint rather than use belt-positioning booster seats. This study aimed to identify interventions that promoted booster seat use among this population. METHODS This multi-site study used focus groups to elicit contributing factors to booster seat non-use, which informed subsequent intervention development. A first phase (10 focus groups, N = 117) identified parents' perceived barriers, benefits, and threats relating to belt-positioning booster seats. These findings were used to identify existing and create new interventions. A second phase (20 focus groups, n = 171) elicited parent's reactions to these interventions and provided parents with belt-positioning booster seats and education on their use. Follow-up interviews were conducted six weeks later. RESULTS Lack of education and fear of injury were the primary barriers to belt-positioning booster seat use. Parents were motivated by interventions that provided them with clear, concrete messaging relating to use. Parents favored the intervention that presented a real story detailing a child's severe injury that could have been prevented with appropriate restraint. At follow-up, parents credited this intervention with motivating booster seat use most often. Although parent's cited their child's lack of comfort and non-compliance as barriers to use, they were not as motivated by interventions that addressed these barriers. CONCLUSIONS Effective intervention programs can be created by identifying and addressing factors that contribute to a population's intention to use belt-positioning booster seats. In addition, successful programs must utilize messages that motivate the target population by addressing their perceived threats to booster seat non-use.
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Affiliation(s)
- Flaura K Winston
- The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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