Determinants of child safety seat use among parents in an International Safe Community, Tehran, Iran

Use of Child Safety Seat and its Determinants in Jeddah, Saudi Arabia: A Cross-sectional Study

Background

A child safety seat protects children from injury during motor vehicle accidents (MVAs). However, there is a lack of enforcement of regulation regarding its use in Saudi Arabia.

Objectives

This study aimed to determine the use of child safety seat and its determinants and barriers in Jeddah, Saudi Arabia.

Materials and Methods

This cross-sectional study was based on a structured face-to-face interview across Jeddah among families who drove in cars with children aged ≤5 years. The study used stratified multistage random sampling across the population of the governorate of Jeddah.

Results

A total of 675 parents were included, of which 311 (46.1%) reported having a child safety seat in their vehicle, and only 165 (24.4%) reported its regular use. Awareness levels among parents regarding child safety seat use and its benefits, parents' level of education, family size, family income, and the belief in the need for laws governing child safety seat were key determinants of child safety seat use. Poor awareness among parents regarding the utility of child safety seat in reducing child injuries, low education levels among parents, larger families with multiple children, poor affordability, low family income, and a clear lack of laws mandating the use of child safety seat were identified as key barriers.

Conclusions

The regular use of child safety seat for children aged ≤5 years is low in even one of the most urban populations of Saudi Arabia. This indicates the need for large-scale awareness drives and stricter implementation of laws enforcing the use of child safety seat in Saudi Arabia.

Predictors of parents' use of child restraint systems: Evidence from China

OBJECTIVE

Child restraint systems (CRS) can significantly lower the chance of child harm and death. Despite the benefit of CRS, their use in developing countries is low. Therefore, examining the factors that affect parents' use of CRS is essential.

METHODS

In this study, the associations of demographic characteristics and the exogenous constructs in the health belief model (HBM) and the theory of planned behavior (TPB) with parents' CRS use were investigated with structural equation modeling.

RESULTS

Demographic factors alone explained 23.1% of the variance in CRS use. The model's explanatory power increased greatly when exogenous constructs were incorporated from the HBM and TPB. Having a college degree, knowledge about CRS, perceived susceptibility, self-efficacy, and attitude significantly impacted parents' use of CRS.

CONCLUSIONS

The use of CRS in China is still low. Much effort should be done to increase the use of CRS in China, including education, and publicity.

Parents' knowledge and socio-demographic determinants toward child's restraint system use

BACKGROUND

Lack of protection or improper protection, is one of the most important reasons of child passenger's death and injury in traffic crashes. Based on what we see on the roads, Iranian children are unrestrained inside the car. The aim of this study was to investigate children restrained system (CRS) use rate, its socio-demographic determinants and parents' knowledge toward CRS use among Iranian parents.

METHODS

Using multi-stage cluster sampling and direct in filed method of observation, the behavior of 700 children in cars was observed in the current cross-sectional study. Socio-demographic determinants and parents' knowledge, toward using the CRS were evaluated using questionnaires. The study was performed from July to August 2019 in Tabriz city, northwestern Iran.

RESULTS

The rate of child safety seat (CSS) use was 15.1% CI 95%:(12.5%,18.0%), and the rate of booster use was 0.6%; CI 95%:(4.3%,8.0%). The majority of parents [e.g. 64.3%; CI 95%: (60.7%,67.9%)], had low knowledge about the use of CRS. The most important reasons for not using CRS was lack of laws and policies [e.g. 59.7%; CI 95%:(12.5%,18.0%)], lack of knowledge [e.g.59.6%; CI 95%:(57.9%, 63.3%)] and the high cost of CRS [e.g. 57.6%; CI 95%:(53.81%,61.2%)]. The most important predictors of not using CRS were the child's age, parental knowledge, and the socioeconomic status of the household (p < 0.05).

CONCLUSIONS

Most children did not have CRS. The parents with higher education and those with higher socioeconomic status had higher rate of CRS use. Based on the low rate of CRS use and poor parental knowledge about it, education of parents toward boosters use and benefits of using CRS, enforcing mandatory laws and ploicies for CRS use in Iran, and allocation of government subsidies to low-income families for purchasing CRS are suggeted as essential strategies to increase CRS use.

Will Smart Improvements to Child Restraints Increase Their Popularity?

In developing countries, child safety seat use remains low, which contributes to the consistently high rate of child injuries and deaths in traffic accidents. In order to protect the safety of child passengers, it is necessary to improve the public acceptance of child restraints. We improved the shortcomings of the traditional child restraints by adding some new features: 1, tightening Isofix automatically; 2, using temperature sensing, a high-temperature alarm, automatic ventilation, and cooling; 3, using pressure sensing, if the child is left alone it will set off the car alarm; 4, voice control to adjust the angle of the backrest; 5, the seat can be folded into the trunk. These functions make human-computer interaction more humane. The authors collected changes in parental acceptance of child restraints using the interview method and questionnaires. We found that acceptance increased significantly after making intelligent improvements to the child restraints. The authors used the Technology Acceptance Model to identify the key caveats influencing users' use of intelligent child restraints. Performance expectations, effort expectations, social influence, convenience, and hedonic motivation positively and significantly impacted the willingness to use intelligent child restraints, so the authors suggest that these points should be emphasized when promoting the product. The current study findings have theoretical and practical implications for smart child restraint designers, manufacturers, sellers, and government agencies. To better understand and promote child restraint, researchers and marketers can analyze how people accept child restraint based on our research model.

Maintenance mechanisms of child restraint system use based on the health action process approach theory: Evidence from China

OBJECTIVE

Adherence to the use of child restraint system (CRS) can greatly reduce child casualties in road traffic accidents. This study aims to develop the behavior maintenance model of CRS use based on the health action process approach (HAPA) theory to explore the maintenance mechanisms, suggesting appropriate intervention strategies.

METHODS

Adopting the multi-stage stratified cluster random sampling method, a cross-sectional survey for guardians recruited from kindergarten and primary school was conducted using the questionnaire developed based on the HAPA theory in Nanjing, China, and 1135 valid samples were finally obtained. Rigorous analysis procedures of the partial least squares structural equation modeling (PLS-SEM) method were applied by using SmartPLS3.3.2 software.

RESULTS

The results confirmed that action self-efficacy (β = 0.479, P < 0.001) and negative outcome expectancy (β = -0.187, P < 0.001) were valid predictors of intention in the non-intentional stage, intention (β = 0.488, P < 0.001) and maintenance self-efficacy (β = 0.334, P < 0.001) contributed significantly to action planning in the intentional stage, while action planning (β = 0.470, P < 0.001) and recovery self-efficacy (β = 0.256, P < 0.001) jointly determined behavior maintenance in the action stage. It was also revealed that action planning fully mediated the relation between intention and behavior maintenance (β = 0.229, P < 0.001).

CONCLUSION

Based on the above mechanisms, interventions aimed at the stages of non-intention, intention, and action should be designed and implemented, with the participation of the government, automobile dealers, and communities to promote the maintenance of improved CRS use behavior.

Family readiness for evidence-based injury prevention and car seat safety in Jordan

Primary prevention involves developing positive health behaviours designed to avert adverse health outcomes, whereas evidence-based primary prevention adopts practices that reduce illness and injury. This study's objective was to determine whether families in Jordan would adopt car safety measures after participating in an evidence-based injury prevention programme. Parents of children attending a regional government hospital in Jordan took part in an evidence-based educational class on child car restraints and car safety, six months later follow-up phone calls were made to see if the parents implemented the knowledge obtained in the class. Fifty families participated in the injury prevention class. The results showed that the evidence-based class on child restraint systems led to the adoption of the three interventions by the parents. At the time of the class 45% of parents allowed their infants to sit in the front seat, in the lap of an adult, this was reduced to 12%, being a 33% reduction. In addition, for children aged 6-12 using a seat belt in the back seat, the parents reported that their children using a seat belt increased from 13% to 70%. Finally, parents who participated were more likely to use a child car seat.