Child Passenger Safety Behaviors in Latino Communities

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.

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.

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

INTRODUCTION

Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study.

METHODS

Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0-17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year.

RESULTS

Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger.

CONCLUSION

These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.

Overloaded and Unrestrained: A Qualitative Study with Local Experts Exploring Factors Affecting Child Car Restraint Use in Cape Town, South Africa

(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the feasibility of a child restraint program and to describe factors influencing child restraint use from the perspectives of clinicians, representatives of non-government agencies, and academics in Cape Town, South Africa. (2) Methods: Qualitative interviews were conducted with 13 experts from government, academic and clinical backgrounds. Findings were analyzed using the COM-B component of the Behaviour Change Wheel and were grouped by the layers of the social-ecological model (individual, relational, community and societal). (COM-B is a framework to explain behaviour change which has three key components; capability, opportunity and motivation), (3) Results: Experts believed that there was a need for a child restraint program that should be staged and multifactorial. Participants described knowledge gaps, perceptions of risk, mixed motivations and limited enforcement of child restraint legislation as key influences of restraint use. (4) Conclusions: The results demonstrate potential areas on which to focus interventions to increase child restraint use in Cape Town, South Africa. However, this will require a coordinated and consistent response across stakeholder groups.

Research on Injury Disparities: A Scoping Review

Background: Research on disparities in traumatic injury has not been well characterized, limiting understanding of gaps in research and development of successful interventions. We conducted a scoping review to identify and synthesize research on disparities in intentional and unintentional traumatic injuries.

Methods: The review was guided by PRISMA Extension for Scoping Reviews. PubMed, PsycINFO, Web of Science, and CINAHL and systematic reviews from 2007 to 2017 were searched. Eligible articles were peer reviewed; conducted in the United States; and reported on clearly defined physical trauma and disparity, defined by Cochrane PROGRESS-Plus criteria. One reviewer assessed article titles and a second reviewer validated the inclusion with a random sample. Abstract and full-text review by two reviewers determined final inclusion.

Results: Of 7382 unique articles screened, 653 articles were included; inter-rater agreement was high (K=0.995). Studies reported on disparities in the acute hospital setting (104) or postacute/rehabilitation (86), with fewer focused on prevention (57) and policy development (6). Research methods used were quantitative (593) with 25 intervention studies, qualitative (45), qualitative/quantitative (7), and community-based participatory research (8). Age ranges of included studies were all ages (124), adults (318), pediatric/youth/adolescents (172), and older adults (40). Racial disparities were most commonly measured (439 studies); 38 created a white/nonwhite binary. Other commonly measured disparities were place of residence (122), insurance (111 studies), gender (89), age (75), and socioeconomic status measures (61). Disparities were noted in all of the categories. Studies commonly aggregated all types of traumatic injuries (129) or all types of violence (105).

Conclusions: The extant injury literature lacks research on prevention and policy to address disparities. Many studies aggregated types of trauma and patient groups, preventing an understanding of distinctions between groups and potential interventions. Intervention and community-based research strategies were limited. Future research can better specify measurement of understudied equity categories, trauma types and intent, and racial groups.

Car seat education: A randomized controlled trial of teaching methods

OBJECTIVE

To determine if a less labor-intensive video-based program for teaching car seat installation can be as effective as the traditional didactic lecture component.

METHODS

This is a randomized controlled trial of caregivers seeking car seat education. Caregivers were assigned to didactic or video-based social learning classes. The didactic class involved live lecture; the social learning class included a brief lecture and the video, Simple Steps to Child Passenger Safety, utilizing social learning principles. Proficiency in child passenger safety was evaluated pre- and post-class via: (1) 5-question confidence assessment; (2) 15-question knowledge test; and (3) 5-part car seat installation demonstration. Data were analyzed to compare post-class assessment scores between teaching modalities using pre-test scores as covariates, and correlation of participant confidence and knowledge with installation ability.

RESULTS

526 individuals registered and were randomized. A total of 213 arrived for class with 103 randomized to didactic teaching and 111 to social learning. Didactics and social learning groups showed similar increases in post-class confidence, knowledge, and installation ability. In the pre-class assessment, 16% of participants in each group installed the car seat correctly. After controlling for baseline installation ability, correct post-class car seat installation did not vary between groups (mean difference = 0.001; p = 0.964). Among participants with high scores on the knowledge assessment, only 57% could demonstrate correct car seat installation (r_s = 0.160, p = 0.023).

CONCLUSION

Video-based social learning methodology, which requires less time and resources, was as effective in teaching child passenger safety as didactic lecture. Both teaching methods significantly improved proficiency in child passenger restraint. Car seat installation knowledge is only weakly correlated with proper installation ability and proper installation remains a challenge, even after education.

"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

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.

Who Seeks Cita Con El Doctor? Twelve Years of Spanish-Language Radio Program Targeting U.S. Latinos

Purpose. Spanish-dominant Latinos make up 13% of the U.S. population, and this group is poorer and faces multiple threats to health compared with the general population. Additionally, Spanish speakers face challenges accessing health information that is often not available in Spanish. This study provides a descriptive epidemiology of a unique, low-cost health information source: the longest-running U.S.-based Spanish-language call-in radio health education program. Method. From the universe of all calls 1999 to 2011, stratified random sampling yielded 1,237 analyzed calls, which were manually coded for caller sex, age, proxy status, and health concern. Descriptive statistics were used to examine basic demographics of callers and call topics overall and by sex and proxy caller status. Results. Among all calls, the top three call-generating health topics were specific symptoms/conditions, sexual/reproductive health, and gastrointestinal concerns. The top nine topics were consistent among women, men, and proxy callers; however, relative frequency of topics varied across groups. Nearly one quarter of calls were initiated on behalf of someone, generally a child, spouse or sibling, or parent. Sixty percent of callers were women; women made 70% of proxy calls. Conclusion. Understanding the differences in information seeking behaviors, information needs, and source preferences is important for determining where and how to disseminate health information and may help explain disparities in knowledge and health outcomes. The radio talk show format provides a uniquely personal, culturally sensitive channel for meeting health information needs of a vulnerable population while leveraging the cost-effectiveness and wide reach of a mass medium.

Evaluation of a child passenger safety class in increasing parental knowledge

BACKGROUND

Child passenger restraint systems have been found to greatly reduce the risk of injury and death among child passengers. However, nearly half of the children who died in 2009 as a result of motor vehicle crashes were completely unrestrained. Our global hypothesis is that parents and other caregivers failed to restrain children due to a lack of child passenger seat education and practice. In this report, we postulate that a car seat class will improve the basic understanding of child passenger safety. The objective of the study was to evaluate the effectiveness of a car seat class in increasing parental knowledge about child passenger safety.

METHODS

Car seat classes were held at a Level 1 pediatric trauma center every other Tuesday for ten months. The curriculum consisted of: child passenger safety laws discussion, a 21-min video on the use of child safety seats followed by a 15-min discussion about the video, 15min of discussing the different types of car seats, and hands-on training on how to properly install and use child restraints. Free car seats were provided to eligible parents. The pre-test was administered at the beginning of class and the post-test at the end of the class. McNemar's test and a paired t-test were used to compare pre- and post-test scores. Test scores were also stratified by language spoken.

RESULTS

Forty-four classes were held and a total of 491 parents/caregivers attended the classes. An increase in knowledge was found for all survey questions. Mean knowledge score for the post-test was 3.10 points higher compared to the mean knowledge score from the pre-test. Mean difference in knowledge scores for English-speaking participants were higher than Spanish-speaking participants.

CONCLUSION

Lack of knowledge and low risk perception have frequently been cited as barriers for the use of child passenger restraints. Our intervention attempted to eliminate these barriers. We found that this intervention was effective at increasing parental knowledge about child passenger safety. The results of this study may be used to design and implement future interventions in multicultural settings.

Social prejudice hindering proper use of car safety seats

The compliance of parents with child passenger safety (CPS) has been mainly explained by their level of knowledge. Social, ethnic and cultural factors have not been investigated in detail. This study investigated the rate of compliance of parents with CPS guidelines, as well as the factors hindering it. Parents of infants aged 2-10 days were enrolled. The proportions of families obtaining a car safety seat (CSS; 57%) and complying with CPS recommendations (2%) were very low. Most of the parents thought CSS were harmful for infants (mother, 57%; father, 63%), despite having already purchased one. Parents believed their children to be too small to use CSS and cannot sit in CSS because they should lie flat on their backs at all times. These prejudices may be due to the social and cultural circumstances specific to Turkey, or corresponding findings may be found in countries with similar socioeconomic status.

Discrepancies between knowledge and practice of childhood motor vehicle occupant safety in Nova Scotia--a population-based study

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.

Levels of reconstruction as complementarity in mixed methods research: a social theory-based conceptual framework for integrating qualitative and quantitative research

Like other areas of health research, there has been increasing use of qualitative methods to study public health problems such as injuries and injury prevention. Likewise, the integration of qualitative and quantitative research (mixed-methods) is beginning to assume a more prominent role in public health studies. Likewise, using mixed-methods has great potential for gaining a broad and comprehensive understanding of injuries and their prevention. However, qualitative and quantitative research methods are based on two inherently different paradigms, and their integration requires a conceptual framework that permits the unity of these two methods. We present a theory-driven framework for viewing qualitative and quantitative research, which enables us to integrate them in a conceptually sound and useful manner. This framework has its foundation within the philosophical concept of complementarity, as espoused in the physical and social sciences, and draws on Bergson’s metaphysical work on the ‘ways of knowing’. Through understanding how data are constructed and reconstructed, and the different levels of meaning that can be ascribed to qualitative and quantitative findings, we can use a mixed-methods approach to gain a conceptually sound, holistic knowledge about injury phenomena that will enhance our development of relevant and successful interventions.

La Clínica del Pueblo: a model of collaboration between a private media broadcasting corporation and an academic medical center for health education for North Carolina Latinos

La Clínica del Pueblo, a health education collaboration between the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine and Qué Pasa Media, Inc., disseminates culturally appropriate health information to the North Carolina (NC) Latino community. The program includes a weekly radio show and corresponding newspaper column addressing four areas: childhood health, adult health, safety, and utilization. The radio show format includes a didactic presentation followed by a call-in question and answer period. Over 200 consecutive weeks of programming have been completed, averaging 11 calls per show. A Latino healthcare resource guide and hotline also provide resource information. Participant demographic information indicates that 50% of the target population comes from Mexico, 60% are women, and 70% of the community is younger than 38 years. There was an increase in the use of the media as a source of health information over the course of the project, from an initial 33% of respondents to 58% in the last survey. Listenership to La Clínica del Pueblo displayed a pronounced increase (18% initial survey to 55% in last survey, P < 0.05). We also observed a statistically significant increase in medical knowledge from initial survey to the last survey (P < 0.001). By multiple regression analysis, we identified 4 predictors of medical knowledge: order of surveys (1 < 3, P < 0.001), education level (P < 0.0001), female gender (P < 0.01) and radio listenership (P < 0.05). The first three variables predicted higher scores; however, radio listening recognition of our radio program was more common among individuals who had lower scores. In conclusion, La Clínica del Pueblo is a model for a novel approach that can reach the Latino community to improve medical knowledge and possibly affect health behaviors in a positive manner.

The importance of cultural competency in general pediatrics

PURPOSE OF REVIEW

There is a growing awareness of the importance of cultural competency in pediatrics. The authors review the most recent studies that examine the impact of cultural competency on general pediatric care, explore cultural beliefs and practices affecting clinical care, and describe culturally sensitive interventions designed to address racial/ethnic health disparities.

RECENT FINDINGS

The beneficial effects of cultural competency embrace health outcomes, quality of care, and patient satisfaction, while failure to consider language and culture can have serious adverse consequences for clinical care, including patient safety and healthcare access. A five-component model of cultural competency has been developed, and a growing literature details an array of normative cultural values, folk illnesses, parent beliefs/practices, and provider behaviors that can have a profound impact on pediatric care. Culturally sensitive interventions are being developed to lessen racial/ethnic health disparities.

SUMMARY

A goal for the pediatrician is to provide culturally competent healthcare by using trained medical interpreters with limited English-proficient families, being familiar with normative cultural values that affect the healthcare of commonly encountered racial/ethnic groups, and asking about folk illness beliefs and ethnomedical treatments.

Factors Influencing Booster Seat Use in a Multiethnic Community: Lessons for Program Implementation

Based on the local incidence and severity of motor vehicle occupant injuries, the authors' community and hospital injury prevention partnership identified child passenger safety for 4-to-8-year-old children as a priority. They designed a booster seat promotion campaign using an integrated social cognition model of health behavior. A series of focus groups were held with low-income African American, Somali, and Vietnamese parents to understand determinants of booster seat use in these communities. Deficits in understanding about the purpose of booster seats were seen in all groups, and concerns about cost and self-efficacy varied in important ways. Although legislation is an important tool in motivating child passenger restraint, most families saw safety as the prime reason to use booster seats with their children. These results illustrate the use of qualitative data to adapt a theory-based intervention to the needs of specific communities.

Booster seat use in an inner-city day care center population

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.