The influence of parental education and other socio-economic factors on child car seat use

Knowledge and Attitude Toward Child Safety Seat Use in Saudi Arabia: A Cross-Sectional Study

Background Car safety seats (CSS) are a well-established strategy to reduce injuries and fatalities among children involved in road traffic accidents. However, the use of CSS is generally low globally due to limited knowledge of its benefits. This study assessed parents' knowledge and attitudes toward CSS in Saudi Arabia. Methods This cross-sectional study used an online self-administered survey distributed among residents in different regions of Saudi Arabia to assess their knowledge and attitude toward CSS. Data were analyzed using the statistical package for the social sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results A total of 383 Saudi residents participated in the study. The mean age was 37.14 ±9.10 years, with a female predominance (62.1%, n=238). One-third of the participants were from the western region of Saudi Arabia (30.3%, n=109). Non-use of CSS was reported by 25.8% of the participants, while 11.7% reported that they rarely used CSS. The mean total knowledge score was 2.15 (range 0 -3). A lower knowledge score was significantly associated with a lower educational level (p=0.008), not having information regarding CSS (p=0.005), none or rare use of CSS by the parent (p<0.001), and the use of media or self-education as a source of information regarding CSS (p=0.002). The mean attitude score was 12.52 (range 4 -20). The attitude score was significantly associated with gender (p=0.002), education (p=0.014), number of children (p=0.005), monthly family income (p=0.028), use of CSS by people other than the parent (p<0.001), information about CSS use in the car (p<0.002), source of information (p<0.001), and use of CSS by the parent (p<0.001). Conclusions The knowledge and attitude of the Suadi population toward CSS use are inadequate, highlighting the need to enhance awareness and understanding of the importance of CSS use.

Parents' Knowledge, Attitudes, and Practices Regarding Baby Walkers, Baby Car Seats, Oral Health, and Child Screen Time in Saudi Arabia: A Cross-Sectional Study

Background Awareness of age-appropriate milestones and developmental stages is crucial for parents to identify any potential delays or concerns early on and seek appropriate interventions. This study aimed to assess the knowledge, attitudes, and practices of caregivers in Saudi Arabia regarding baby walkers, baby car seats, early dental visits, and screen time for young children. Methods A cross-sectional survey was conducted among parents in Saudi Arabia using a structured questionnaire. A convenience and snowball sampling method was employed to recruit participants from various regions of the country. The questionnaire aimed to assess parents' knowledge regarding the recommended use of baby walkers and baby car seats, their awareness of the importance of early dental visits, and their understanding of appropriate screen time guidelines. Additionally, the survey explored parents' practices toward these recommendations. Descriptive statistics were used to analyze the data, and associations between variables were examined using the chi-squared test. Results A total of 1318 participants were included. The analysis revealed that the majority of the participants (n=1066,81.3%) use a baby walker, while only (n=292,22.3%) consider that they should never be used. Overall, (n=388,29.6%) of the participants never used a car seat for their infants or children. In terms of early childhood dental visits, approximately (n=518,39.5%) of the participants reported actually taking their child to the dentist within the recommended timeframe. Regarding screen time for children, (n=148,11.3%) of the participants reported that their children spend >5 hours daily in front of the screen.  Conclusions Raising parents' awareness about recent childcare recommendations and safe practices is crucial for promoting optimal child development, preventing health problems, facilitating evidence-based decision-making, reducing risks, enhancing parental confidence and empowerment, and nurturing positive parent-child relationships.

Factors associated with booster seat use among Indigenous peoples in Canada

OBJECTIVE

Booster seat use among the general population remains relatively low, despite their effectiveness in preventing injury among children when involved in motor vehicle collisions. Given the prevention of injuries that booster seats provide, understanding the factors that hinder or facilitate the use of these seats is critical, particularly in communities that are often overlooked when conducting general population studies. To date, no studies have examined the prevalence and predictors of booster seat use among Indigenous peoples in Canada. The purpose of this study was to examine the use of booster seat use among Indigenous peoples across Canada and the factors that impact their use.

METHODS

Data were collected from a survey of participants from First Nations communities and organizations serving Indigenous peoples nationwide. Hypotheses arising from known predictors of booster seat use across the general population were tested using logistic regression models.

RESULTS

The strongest predictor of booster seat use, even when all other study factors were accounted for, was the reduction of barriers related to the use of booster seats, such as a child's resistance to being placed or staying in the passive safety restraint or a parent, guardian, or other caregiver being unwilling to use or unsure of how to install/setup the booster seat.

CONCLUSION

Most Indigenous participants consistently used booster seats to safely secure children being transported in vehicles. However, this compliance rate is well below that of the general population. Accessibility and affordability of child safety restraints and/or children's refusal to use booster seats, as well as having more than 1 child to secure, were identified as mitigating factors. Access to and the affordability of booster seats, coupled with clear and understandable information on how to use them, are critical components to compliance. Raising awareness among Indigenous peoples communities regarding the importance of using booster seats is imperative. To achieve this, Indigenous peoples must lead discussions to ensure that child safety strategies not only are based on research and best practices but are culturally connected and community driven. Through meaningful collaboration, vehicle-related injuries and mortality among Indigenous children can be significantly reduced.

Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center

Background

Motor vehicle collisions (MVCs) are a significant safety issue in the United States. Young children are disproportionally impacted by car accidents and suffer high rates of injuries and mortality. When used properly, car seats have been found to reduce the severity of injuries. However, individuals from low-income areas often do not have access to education or car seats compared to those in suburban or higher income areas. Therefore, the goal of the present study was to measure the effectiveness of a car seat program in an urban, Level I Pediatric Trauma Center on caregiver car seat knowledge.

Methods

Caregivers (N = 200) attended a single, one-hour car seat educational program with a Child Passenger Safety Technician (CPST). The sessions included educational and hands-on components, where caregivers were asked to complete a seven-item pre-post knowledge assessment. For completion of the course, caregivers received a car seat for their child.

Results

A paired t-test revealed that the workshop significantly increased caregiver knowledge from pre-post: t (199) = − 12.56, p < .001; d = 1.27. McNemar’s Chi-Square analyses displayed that caregivers increased in all knowledge categories (p < .001).

Conclusions

While caregivers in urban areas or in low-income areas may have less access to resources, hospital-led car seat courses can increase knowledge of proper car seat usage in these communities. These findings should be used to establish programs in hospitals in areas where these resources are not readily available to caregivers.

An Adapted Child Safety Seat Hassles Score Is Associated With Suboptimal Child Passenger Safety Behaviors Among Parents

OBJECTIVE

We modified the Child Safety Seat (CSS) Hassles Scale to characterize CSS hassles in a diverse population and test for associations between hassles and caregiver-reported child passenger safety behaviors.

METHODS

Secondary analysis of a 2-site survey of caregivers seeking emergency care for their ≤10-year-old child in 2015. Caregivers answered questions regarding CSS hassles, child passenger safety behaviors, and demographics. Size-appropriate restraint use was defined by the American Academy of Pediatrics (AAP) 2011 Guidelines for Child Passenger Safety. We tested for associations between the number of hassles and adherence to AAP guidelines (including the consistent use of a size-appropriate CSS, travel in a back seat, and never traveling unrestrained).

RESULTS

There were 238 caregivers included in analyses. Overall, caregivers endorsed a median of 5 hassles (interquartile range 2, 8). Half (50.8%) of caregivers endorsed child passenger safety behaviors that were nonadherent to AAP guidelines. Compared with caregivers reporting no hassles, there was an increased odds of not adhering to AAP child passenger safety guidelines for each additional hassle reported (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI] 1.03, 1.19). In addition, a higher number of hassles was associated with the inconsistent use of a size-appropriate CSS (aOR 1.15; 95% CI 1.06, 1.25) and as sometimes traveling unrestrained (aOR 1.13; 95% CI 1.03, 1.23).

CONCLUSIONS

Caregivers who reported more CSS hassles were more likely to report behaviors that were not adherent to AAP guidelines. Addressing CSS hassles may provide solutions for nonadherence of AAP child passenger safety guidelines.

Awareness, perception and experience on child restraint system (CRS) and its legislation among Malaysian parents with newborns

Objective: The aim of this study was to explore parents' awareness and usage of CRS, incentives and challenges in CRS use, as well as their perception about potential CRS legislation in Malaysia.Methods: This was a cross-sectional study conducted in a public tertiary care center in Northern Malaysia. A self-developed researcher-assisted questionnaire was developed in English and translated into Malay language, to explore parents' awareness ad CRS usage, as well as the incentives and barriers in CRS use. Parents of a newborn were conveniently sampled, excluding parents with pre-term newborn or those without a car. Upon obtaining written informed consent, the parents were allowed to answer the questionnaire within 20 minutes, assisted by the researchers. Parents who were found not using CRS for their newborn were given a digital pamphlet with CRS-related information via mobile devices.Results: A total of 200 parents were approached and 193 of them consented to participate in this study. The majority of the parents (87.6%) were aware of CRS, but only half of them (57.0%) provided a CRS for their current newborn. From 100 CRS users, most of them used a CRS for "child's safety" purposes (84.5%). Among 83 CRS nonuser, nearly half of them (45.8%) perceived that it is adequate to carry their child during traveling without using a CRS. When exploring previous experience in using CRS among all parents (n = 193), more than half of them (63.9%) faced difficulty as their child refused to use the CRS. More than half (54.9%) of all parents were not aware about the possible CRS legislation in Malaysia. However, the majority of them (90.7%) agreed with the implementation of CRS law.Conclusions: Although majority of the parents were aware about CRS, but only half had a CRS for their current newborn. Most of the parents supported CRS legislation in Malaysia, but assistance will be required to help them through challenges related to CRS use.

Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

Are There Changes in Inequalities in Injuries? A Review of Evidence in the WHO European Region

Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim of this article. Between and within-country studies from the WHO European Region that investigate changes in social inequalities in injuries over time or in recent decades were sought in PubMed, Scopus, and Web of Science. Of the 27 studies retained, seven were cross-country and 20 were country-specific. Twelve reported changes in inequalities over time and the remaining 15 shed light on other aspects of inequalities. A substantial downward trend in injuries is reported for all causes and cause-specific ones—alongside persisting inequalities between countries and, in a majority of studies, within countries. Studies investigate diverse questions in different population groups. Depending on the social measure and injury outcome considered, many report inequalities in injuries albeit to a varying degree. Despite the downward trends in risk levels, relative social inequalities in injuries remain a persisting public health issue in the European Region.