MPC
Research Projects (2009-10)

Identifying Number

MPC-335

Project Title

Misinformation Contributing to Safety Issues in Vehicle Restraints for Children

University

North Dakota State University

Project Investigator

Andrea Huseth

Description of Project Abstract

Lack of restraint use or misuse of restraints for children, especially those under the age of 13, is a real concern. Despite laws requiring the use of child safety seats in all 50 states, many children still do not travel safely in cars (www.iihs.org). Between 2000 and 2005 (2005 is the most recent year for leading causes of death), motor vehicle crashes were the number one cause of death of children between the age of 1 and 12 (WISQARS). Between 2000 and 2005 47 deaths among North Dakota's children aged 1 to 12 were cause by unintentional injury (WISQARS). Motor vehicle deaths accounted for 40 percent of those unintentional injury deaths. Of the 80 children under the age of 12 killed in motor vehicle crashes between 2003 and 2007 (2007 is the most recent year available for motor vehicle fatalities), 6 or approximately 8 percent were improperly restrained in the vehicle (FARS). It is possible that some of these deaths would have been prevented by having the children properly restrained within the vehicle.

In the United States in 2007, more than one-quarter (28%) of children younger than age 1 were not in rear-facing seats although the recommendation is than infants be kept rear-facing until a minimum of age one and at least 20 pounds (Glassbrenner, 2008). Also, 44 percent of children who are 20-40 pounds were not in the recommended front-facing safety seats, with 8 percent totally unrestrained (Glassbrenner, 2008). In addition, more than half of children aged 12 or younger who are 37 to 53 inches tall were not in safety seats or boosters, and 16 percent were totally unrestrained. More than 85 percent of children aged 12 or younger who are 54 to 56 inches tall were not in safety seats or boosters, and 15 percent were totally unrestrained (Glassbrenner, 2008).

The ND Department of Health, Injury Prevention Program conducts biannual child restraint observation surveys throughout the state of North Dakota. According to a recent report released by the Injury Prevention Program (2007), in 2006, at least 18 percent of children aged 12 or younger were improperly restrained or were totally unrestrained in the vehicle in which they were riding, while more than 19 percent were improperly seated in the front of the vehicle. During the survey, the ND Department of Health did not track restraint misuse. However, surveyors were encouraged to provide additional comments regarding their findings. The following are some of the most common issues they found:

1. Shoulder belt placed behind the child's back.
2. Shoulder belt under the arm.
3. Child too small for booster seat.
4. Loose seat belts.
5. Booster seat being used with a lap-only seat belt.
6. Children younger than one year of age riding in integrated child restraints.
7. Misused car seats.

Lack of or improper parental education regarding proper child restraint within vehicles could be resulting in increased misuse of child restraints and lack of restraint use. This misinformation could be the result of a general lack of child passenger protection knowledge among people who should be well-informed. Parents are not only getting incorrect information, they are getting conflicting messages from multiple sources, such as sales associates, friends, family, manufacturer labels, even health care providers. Much research has been done on the fact that incorrect information given at retail stores selling safety seats and at health care facilities may actually contribute to misuse (Will, 2002). Ramsey et al (2000) found that the most common reason that parents of older children (aged 4 to 8) inadequately restrain their child in motor vehicles was misinformation. Parents were relying on information they received at well-child visits when their child was an infant or toddler, and haven't been updated with information relevant for their older child.

Studies indicate physician knowledge of car seat safety is relatively low (McKay and Curtis, 2002; McKay, 2008; Will, 2002; Rothenstein et al, 2004). Is misinformation better than no information at all? Is the simple fact that parents are attempting to restrain their children within vehicles enough? Improper use of child safety seats may decrease the effectiveness of those seats in preventing injuries or death. When properly used, child safety seats are estimated to reduce fatalities by 71 percent and injury by more than 50 percent (McKay and Curtis, 2002). However, to be effective, the seat must be properly installed and the child must be fully restrained within it (McKay and Curtis, 2002).

There are also studies that show physicians infrequently counsel their patients regarding child passenger safety issues (Williams et al, 2001; Rothenstein et al, 2004; AAP, 2001). A study conducted by the American Academy of Pediatrics (AAP) in 2001 found that nearly 90 percent of pediatricians report discussing passenger restraint systems with at least 75 percent of parents of children younger than 12 months old at least once and 76 percent reported discussing this topic with most parents of toddlers (AAP, 2001). However, the proportion of parents counseled on child passenger safety decreases as the child's age increases. And relatively few providers acknowledged providing information on this topic at every well-child visit.

Determining current knowledge-levels of health care providers regarding child passenger safety issues and frequency of counseling on this topic would highlight problem areas in relation to misinformation being disseminated to parents/caregivers or lack of information being disseminated to parents/caregivers.

Project Objectives

The goal of this project is to determine 1) the percent of health care providers in North Dakota (specifically pediatricians and family practitioners) providing any anticipatory guidance regarding child safety seats and proper child occupant restraint within a vehicle , 2) whether health care providers are providing accurate anticipatory guidance regarding child safety seats and proper child occupant restraint within a vehicle, 3) barriers to discussing child passenger safety during well-child checkups, and 3) if there is a difference in the knowledge of child vehicle occupant safety between parents who provider discussed this topic with them, versus parents whose provider did not discuss the topic.

How will this be accomplished?

1. By evaluating well-child visits to health care providers (specifically pediatricians and family practitioners) within North Dakota, from the parent's perspective and from the health care provider's perspective.
2. By evaluating the knowledge-base of health care providers within North Dakota regarding North Dakota child occupant protection laws and recommendations.

Project Approach/Methods

Surveys will be used to gather information on child passenger safety education practices of physicians, and child passenger safety knowledge levels of parents. UGPTI will invite health care facilities from around the state of North Dakota to participate in the study. Pediatricians and family practitioners from participating facilities will be surveyed. UGPTI will work with the participating health care facilities to survey parents whose children (aged 12 or younger) have recently had a well-child check up.

The health care provider survey will attempt to obtain information such as:

1. What is the knowledge level of practicing health care providers regarding proper child vehicle occupant safety?
2. What are their habits in regard to anticipatory guidance for child passenger safety?
3. What are barriers that exist that prevent them from discussing child passenger safety?
4. Have they ever participated in a child safety seat training class?

The parent survey will attempt to obtain information such as:

1. Was child vehicle occupant safety discussed by their health care provider at their most recent well-child visit? At ANY well-child visit?
2. What is the knowledge level of parents regarding proper child vehicle safety?
3. How does the knowledge level differ between parents whose provider did discuss child vehicle occupant safety versus parents whose provider did not discuss this topic?

Tasks:

1. Background/prep work.
2. Obtain parent and health care provider contact information.
3. Survey design and distribution.
4. Analyze data.
5. Create summary reports for various audiences.

MPC Critical Issue(s) Addressed by the Research

1. Human factors

Contributions/Potential Applications of Research

Limited information exists regarding health care provider knowledge about child passenger safety and provider counseling regarding this topic. To this researcher's knowledge, there have been no studies done and no information gathered regarding these topics specific to North Dakota providers. This information will add to the body of knowledge regarding child passenger safety education, increase the understanding of the frequency of child passenger safety counseling at well-child visits, increase the understanding of barriers to providing anticipatory guidance to parents at well-child visits, and provide an understanding of the impact of child passenger safety counseling provided at well-child visits.

Technology Transfer Activities

A research report providing a summary of findings which can be used by traffic safety organizations, such as the ND Department of Health, ND Department of Transportation, and Safe Kids of Fargo-Moorhead, to help develop and expand current child occupant protection courses to target health care providers within North Dakota. The research will also be presented to local audiences and submitted for research conference presentation and journal publication.

Time Duration

July 1, 2009 through June 30, 2010

Total Project Cost

$12,443.00

MPC Funds Requested

$6,222.00

TRB Keywords

Traffic safety, child passenger safety, behaviors, occupant protection, education

References:

• American Academy of Pediatrics. 2001. Periodic Survey of Fellows #49 - Counseling on Automobile Passenger Safety. http://www.aap.org/research/periodicsurvey/ps49/htm
• Bull, MJ, and J Sheese. 2000. Update for the pediatrician on child passenger safety: Five principles for safer travel. Pediatrics 106: 1113-1116.
• Glassbrenner, D and TJ Ye. 2008. Child restraint use in 2007 - Use of correct child restraint types. Traffic safety facts. Research Note. DOT HS 810 895. National Highway Traffic Safety Administration website.
• Insurance Institute for Highway Safety. Child Restraint Laws. http://www.iihs.org/laws/ChildRestraint.aspx
• McKay, MP. 2008. Commentary: Use the Right Restraint! Annals of Emergency Medicine 51: 207-209.
• North Dakota Department of Health, Injury Prevention Program. 2007. How North Dakota Kids Ride: Child Passenger Safety Observation Report.
• North Dakota Department of Transportation. 2008. North Dakota 2007 Crash Summary.
• Ramsey, A, E Simpson, and FP Rivara. 2000. Booster seat use and reasons for nonuse. Pediatrics 106: e20.
• Rothenstein, J, A Howard, P Parkin, A Khambalia, and C Macarthur. 2004. Community paediatricians' counseling patterns and knowledge of recommendations relating to child restraint use in motor vehicles. Injury Prevention 10: 103-106.
• Will, KE. 2002. Evaluating an actively caring for KIDS process: A behavioral-community program to reduce child safety-seat misinformation and misuse. Unpublished dissertation.
• Williams, AF, SA Ferguson, and DM De Leonardis. 2001. Physician counseling about safe vehicle travel for children. Journal of Safety Research 32: 149-156.