Child Passenger Safety Technician Research Articles

Child passenger safety: Implementation and evaluation of a virtual educational intervention for parents and caregivers

ObjectiveThe objective of this project was to determine how a virtual educational intervention on Child Passenger Safety (CPS) impacts post-intervention knowledge and self-efficacy levels. MethodsThe intervention included watching a video related to CPS and completing a virtual car seat check with a certified Child Passenger Safety Technician (CPST). A quantitative pre- and post-test project design was utilized. Self-efficacy was measured using a confidence assessment and knowledge level was measured with a comprehension test. Participants were included if they had access to the internet, were English speaking, and parents or caregivers of children aged 12 years or younger. The program was active between February and April of 2021. Out of 58 individuals who expressed interest in participating in the program, the completion rate was 41 %. There were 24 participants who completed all steps of the intervention with a range in days to completion of 59 days. ResultsA video-based education intervention combined with completing a virtual car seat check with a CPST was shown to have a statistically significant impact on the knowledge and self-efficacy levels surrounding the use and installation of Child Safety Seats (CSSs) by parents and caregivers. There were a total of 34 car seats that were assessed during the virtual car seat checks and results showed that 65.6% of the car seats that were assessed on arrival had at least 1 error present. In whole, there were 34 car seat errors identified by the CPSTs throughout this project timeline. ConclusionsA video-based educational intervention combined with a virtual car seat check with a certified CPST has a positive impact on the knowledge and self-efficacy levels of participants. The data analysis shows the project was a successful and meaningful intervention to promote improvements in the field of CPS. This study design allows for the implementation of additional resources and supports for CPS within rural areas and at-risk populations and can help to address public health issues related to a lack of resources based on geographic location.

Child restraint systems: Understanding confidence in proper use and addressing the need for education

ObjectiveTo quantify the extent of proper local child restraint system (CRS) use and to better understand changes to the level of self-reported confidence with increased CRS installations. With the goal being to improve safety for children travelling in personal vehicles across London, ON and the region. MethodsPublic CRS clinics were initiated by Injury Prevention staff after they obtained the Child Passenger Safety Technician certification. Additionally, an online survey was commissioned targeting Ontario parents who had installed at least one CRS in the last five years. ResultsFrom September 2018 to September 2019, 96 comprehensive CRS checks were performed, with 29% of systems found to be installed correctly. Survey results showed a high level of reported confidence with CRS installation (N = 514, 70% female, 43% one child). Parents who had installed only one CRS reported higher confidence in their first install, compared to parents who had installed two or more systems. ConclusionsThe error rate with CRS installation and use seen in London, Ontario and the region, is similar to that reported in previous research. Survey results showed high levels of self-reported confidence in CRS use, especially for parents who have installed only one CRS. There presents a need to better understand the root cause of the discrepancy between level of confidence and proper CRS use and to expand our understanding of CRS knowledge retention and transferability to subsequent systems.

Sociodemographic disparities in child restraint selection and variation in child passenger safety information sources

PurposeMarginalized and otherwise vulnerable groups remain at higher risk than their counterparts for not having all of their children appropriately restrained during vehicle trips. Little is known about potential sources of these disparities, however a commonly theorized factor has been where caregivers find or obtain information (i.e., their information sources). The objective of this study was to: (1) characterize caregivers’ actual and preferred sources of information related to child passenger safety information, overall and within sociodemographic groups; and (2) determine if, and if so how, sources impact appropriate child restraint use (i.e., child/seat fit). MethodsWe conducted an online, cross-sectional survey of US caregivers. Caregivers answered questions about themselves, their child(ren), their child(ren)’s restraint use during trips, and their information sources to learn which seat their child should be using. We used Fisher’s exact and Pearson chi-square tests to compare used and preferred sources of information across caregiver demographics (age, education, race/ethnicity), as well as to determine whether information sources were associated with caregivers’ appropriate child restraint use. ResultsA total of 1,302 caregivers from 36 states with 2,092 children completed the survey. The majority (91%) of children were appropriately restrained. More caregivers from marginalized and otherwise vulnerable groups had children inappropriately restrained when compared with their counterparts. We identified multiple differences in both used and preferred information sources by caregivers’ age, race/ethnicity, and education level. In addition, we found a trend that caregivers from populations with higher rates of inappropriate use seemingly used fewer information sources. Ultimately, information sources were not associated with appropriate restraint use; however, within vulnerable populations, almost all caregivers had all of their children appropriately restrained if they had used a Child Passenger Safety Technician (CPST)/Inspection Station or their Pediatrician. ConclusionOur findings reiterate calls for more tailored interventions and efforts to combat widening disparities in child restraint use and crash outcomes and suggest one promising method may be providing more access to child passenger safety experts. Future studies must untangle the likely complex relationship between information sources and appropriate/accurate child restraint use.

Randomised feasibility trial of a virtual intervention to address infant car seat misuse

BackgroundSerious car seat installation errors occur at high rates in infants and children. These errors significantly increase the risk of child injury in a motor vehicle crash, and few interventions...

Impact of Child Passenger Safety Education for Pediatric Nurses.

Hospital-based child passenger safety education is effective in decreasing car seat misuse. Although child passenger safety training has been studied with pediatricians, emergency physicians, and emergency nurses, there is a lack of literature regarding child passenger safety training performed by pediatric nurses. The purpose of this study was to determine the effect of a 30-min child passenger safety education session on pediatric nurses' child passenger safety knowledge and confidence. This was a pre- and posttest comparison study of pediatric nurses' knowledge and confidence levels following child passenger safety training in a pediatric trauma center in New York State conducted from September 2018 to March 2019. Registered nurses from the neonatal intensive care unit, pediatric intensive care unit, general pediatric unit, and mother-baby unit participated in the study. The intervention was a single 30-min child passenger safety training session provided by a certified child passenger safety technician. A demographic questionnaire and 11-question pre- and posttest surveys were used. Data were compared using the t test, the chi-square test, and Fisher's exact tests. A total of 133 nurses participated, of which 97% were female and 50% were White. Posttest scores significantly increased (3.83; 95% CI [3.1, 3.7], t = 22.54, p≤ .001) in nurses' child passenger safety knowledge and confidence after a 30-min modular educational session. Passenger safety training increased pediatric nurses' knowledge and confidence to provide child passenger safety education to families and caregivers. Child passenger safety education is recommended for all nurses who are expected to provide child passenger safety education regardless of unit location.

Consumer usability of flexible vs. rigid lower anchor hardware in infant child restraint system (CRS) installations

Objectives Child restraint systems (CRS) can be installed using the Lower Anchors and Tethers for CHildren (LATCH) system. Two different types of lower anchors (LA) are available on CRS in the United States: (1) traditional flexible webbing LA, or (2) rigid LA, which is similar to the European ISOFIX system. The objective of this study is to evaluate consumer usability of flexible vs. rigid LA on infant CRS bases. Methods Thirty adult volunteers were recruited to install one infant CRS base with flexible LA and one infant CRS base with rigid LA into two different vehicles apiece, for a total of four installations per participant. One vehicle had easily accessible LA hardware and the other vehicle had less accessible LA hardware. A Child Passenger Safety Technician (CPST) inspected each installation and recorded any misuse or errors. Participants were asked to share their opinions and preferences on the two types of LA via written survey and verbal interview. Outcome variables include the number of errors committed, consumer preference, and ease of use (measured by time spent on each installation and participant feedback) of each LA system. Results Rigid LA installations resulted in higher rates of correct installation compared to flexible LA (72% correct vs. 47% correct, χ2 = 7.761, p = 0.0053). Participants reported better physical ease-of-use and higher confidence with rigid LA compared to flexible (Likert scale with Wilcoxon signed rank test, two-tailed, for paired data: p = 0.0326 and p = 0.0023, respectively). Rigid LA was faster to install during users’ second installation of each CRS compared to flexible (p = 0.0007) but was not faster during the first installation (p = 0.1165, matched-pair two-tailed t-tests). This indicates that each CRS required about the same amount of time for participants to familiarize themselves with the system, but once familiar, the rigid LA system was faster to install. Overall, 24/30 participants (80%) preferred rigid LA to flexible. Self-reported sociodemographic factors suggest that the participant sample was skewed toward highly-educated, white, native English speakers. Conclusions The rigid LA system was preferred by this group of consumers for installation of the base of infant CRS. The lower rate of installation errors suggests that rigid LA may help reduce the reported high rates of incorrect LA installation in vehicles in the US.

A Cross-Sectional Geographic Information Systems Study of a Pediatric Emergency Department Child Restraint System Distribution Program

IntroductionA pediatric ED program sought to promote injury prevention through distribution of child restraint systems. Program funds are paid for child passenger safety technician certification of all personnel. Pediatric emergency nurses distributed child restraint systems at hospital discharge and dedicated technicians at fitting stations. Researchers described program characteristics, developed a baseline understanding of program outreach using geographic information systems, and evaluated adherence to manufacturer guidelines with a sensitivity analysis. MethodsThis retrospective cross-sectional study used distribution forms linked to hospital records from 2013 to 2016. Testing for differences used nonparametric methods. Median values and interquartile ranges for weight and height of children were compared with manufacturer guidelines. Geographic information systems visualized recipients’ street addresses and motor vehicle crashes on an underlying base map. ResultsThere were 312 child restraint systems distributed: of which 179 (57.4%) at the hospital, 126 (40.4%) at fitting stations, and 7 (2.2%) missing a location. Among those on Medicaid, 64.4% received a child restraint system at the hospital compared with 35.6% at fitting stations (χ2 = 5.40, P < .02). Fitting stations had limited outreach to rural residents. Finally, results from the sensitivity analysis showed that devices were issued according to manufacturer guidelines. DiscussionDespite the workplace pressures of clinical care, pediatric emergency nurses delivered educational information and demonstrated hands-on installation at similar rates to dedicated technicians. Distribution of child restraint systems through the hospital reached a uniquely underserved population. Further research should investigate methods to improve fitting station outreach among Medicaid recipients.

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

BackgroundMotor 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.MethodsCaregivers (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.ResultsA 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).ConclusionsWhile 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.

Evaluating disparities in child occupant protection using a proportion-eliminated approach to mediation

Objective While there are clear racial/ethnic disparities in child restraint system (CRS) use, to date no studies have identified mediators that quantitatively explain the relationship between race and CRS use. Therefore, the objective of this study was to provide an example of how a proportion-eliminated approach to mediation may be particularly useful in understanding the complex relationship between race and CRS use. Methods Sixty-two mothers with a child between 4-8 years old completed a survey and had their CRS use assessed by a Child Passenger Safety Technician using a structured assessment based on the 2018 American Academy of Pediatrics’ Best Practice guidelines. Recruitment and data collection occurred in Birmingham, Alabama between June 2018 and January 2019. We used chi-squared tests, logistic regressions, and a proportion-eliminated approach to mediation to compare our variables of interest and to estimate the amount of the association between racial group membership and errors in restraint use that may be explained by sociodemographic, psychosocial, and parenting variables. Results Before mediation, Nonwhite mothers in this sample had a 7.38 greater odds of having an error in CRS use than White mothers. Mediation analyses indicated that being married and self-reported seatbelt use explained 47% and 35% of the effect of race on CRS use errors, respectively. Conclusion A proportion-eliminated approach to mediation may be particularly useful in child passenger safety research aiming to inform the development of interventions tailored for racial minority populations.

System providing automated feedback improves task learning outcomes during child restraint system (CRS) installations

Objectives The objective was to build and test an automated, interactive educational system to teach adults how to install a child restraint system (CRS) into a vehicle seat. Methods The automated feedback system (AFS) consisted of a mockup vehicle fixture, convertible CRS, and doll. Sensors were implemented into the equipment so that forward-facing (FF) CRS installation errors could be detected. An interactive display monitor guided users through the CRS installation process and alerted them when steps were done incorrectly. Sixty adult volunteers were recruited and randomized into either the treatment group or the control group. The treatment group used the AFS to guide them through a practice installation. The control group also completed a practice installation using the same equipment fixture without the feedback feature turned on; they only had standard printed instruction manuals to guide their tasks. Then, participants from both groups completed a second CRS installation in a real vehicle with standard instruction manuals only. The frequencies and types of errors in all the installations were evaluated by a Child Passenger Safety Technician (CPST). Error rates were compared between the treatment and control groups using lower-tailed t-tests and Pearson’s chi-square tests. Error rates were evaluated considering minor and serious errors together and also considering serious errors alone. Results Compared to the control group, participants who trained with the AFS exhibited fewer overall errors (minor and serious) in their fixture installations (p < 0.0001) as well as their follow-up vehicle installations (p < 0.0001). Specifically, participants in the treatment group had fewer errors in choosing an installation method, locking the seat belt (SB), tightening the SB or lower anchors (LA), and tightening the harness (p = 0.0002, p = 0.0003, p = 0.0084, and p = 0.0098, respectively, compared to control group during follow-up vehicle installations). The treatment group also performed significantly better than the control group when only serious errors were considered. Conclusions An automated feedback system is an effective way to teach basic CRS installation skills to users.

Results of an RCT in Two Pediatric Emergency Departments to Evaluate the Efficacy of an m-Health Educational App on Car Seat Use

The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting. This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted. Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area. A theory-based, stage-tailored educational program, Safety in Seconds v2.0TM, delivered on a mobile app. Four car seat behaviors: (1) having the correct restraint for the child's age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child's restraint inspected by a child passenger safety technician. At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p<0.01) for using the correct car seat; 2.37 (p<0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p<0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p<0.01) and having the car seat inspected (OR=1.73, p<0.01). Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education. Clinical Trial Registration # NCT02345941.

Child seat belt guidelines: Examining the 4 feet 9 inches rule as the standard.

Current American Academy of Pediatrics recommendations regarding transition from child safety/booster seat to adult safety belt use indicate that children should be at least 4 feet 9 inches, 8 years old, or 80 pounds. Proper fit in the vehicle seat, assessed with a five-point fit test, should also be met. Although most children reach 4 feet 9 inches around age 8 years, each child and vehicle presents a unique combination; thus a child may not fit appropriately in all vehicle types using only the 4 feet 9 inches requirement. We enrolled children, aged 7 years to 12 years, into our study. Height, weight, and demographic data were obtained. A Child Passenger Safety Technician then performed the five-point fit test in each of a uniform lineup of five vehicles. Data were collected on fit in the standard vehicle seat and also in a booster seat. We set 90% as the threshold proportion of children who meet all criteria for proper fit to validate current recommendations of a height of 4 feet 9 inches. Data were collected on 388 children. The percentage of 90% proper fit was met in the compact car and small sport-utility vehicle (SUV). However, only 80 (77%) of 104 students (p < 0.0001) that were 4 feet 9 inches or higher fit properly in the large SUV, only 87 (83%) of 105 students (p = 0.02) fit properly in the pickup truck, and only 91 (89%) of 102 students (p = 0.74) fit properly in the minivan. Substantial proportions of children meeting current height guidelines for an adult seat belt do not meet safety requirements for fit, especially in larger, commonly used vehicles (large SUVs and trucks). This emphasizes the need for evaluation of fit by a trained personnel and/or development of standard back seat dimensions in all vehicles for maximum safety. Epidemiologic level 1.

Caregivers’ Use of Child Passenger Safety Resources and Quality of Future Child Restraint System Installations

Objectives: Child Restraint System (CRS) misuse is common. We characterized caregivers’ use of child passenger safety informational and instructional resources and determined whether there were differences in the quality of CRS installations associated with prior exposure to specific resources as evaluated in a standardized CRS installation environment. Methods: Caregivers completed self-report surveys and installed a forward-facing CRS in a controlled environment. Installations were evaluated for security (tightness) and accuracy (no errors) by a child passenger safety technician (CPST). Results: CRS manuals were the most common way caregivers learned to install a CRS. Primary care providers (PCP)s were the most frequently endorsed source of CRS safety information. There was no strong pattern of associations between prior exposure to resources and installation quality (security or accuracy), although some evidence supports protective effects of learning from CPSTs; 13% (19 out of 151) installations were secure and 57% (86 out of 151) installations were accurate. Conclusions: A focus on developing effective and lasting behavioral interventions is needed.

Child Passenger Safety Technician Consultation in the Pediatric Primary Care Setting.

Correct use of a child safety seat (CSS) can reduce the risk of fatal motor vehicle crash-related injury by up to 71%; however, misuse rates for CSS are as high as 70%. We recruited 189 caregivers at 2 large suburban pediatric office practices; 94 in the intervention group and 95 in the control group. All participants completed a baseline survey and received a CSS safety brochure. Intervention participants had their CSS installation checked at enrollment by a certified child passenger safety (CPS) technician. Follow-up was conducted 4 months post enrollment. Intervention group participants had a 21.3% reduction in critical misuse at follow-up, whereas control participants critical misuse rate at follow-up was identical to the intervention group at baseline. A consult with a certified CPS technician, at the time of a routine visit to the pediatrician, resulted in a reduction in CSS misuse rates.

Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour

BackgroundAlthough proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains...

Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge

To estimate prevalence of car safety seat (CSS) misuse for newborns on hospital discharge; and to identify potential risk and protective factors for CSS misuse. We randomly sampled 291 mother-baby dyads from the newborn unit of an academic health center. Participants completed a survey and designated someone (themselves or another caregiver) to position their newborn in the CSS and install the CSS in their vehicle. Certified child passenger safety technicians assessed positioning and installation using nationally standardized criteria. To examine factors associated with CSS misuse, we used logistic regression to compute ORs and 95% CIs. A total of 291 families (81% of those eligible) participated. Nearly all (95%) CSSs were misused, with 1 or more errors in positioning (86%) and/or installation (77%). Serious CSS misuse occurred for 91% of all infants. Frequent misuses included harness and chest clip errors, incorrect recline angle, and seat belt/lower anchor use errors. Families with mothers of color (OR, 6.3; 95% CI, 1.8-21.6), non-English language (OR, 4.9; 95% CI, 1.1-21.2), Medicaid (OR, 10.3; 95% CI, 2.4-44.4), or lower educational level (OR, 4.5; 95% CI, 1.7-12.4) were more likely to misuse CSSs. However, families that worked with a child passenger safety technician before delivery were significantly less likely to misuse their CSSs (OR, 0.1; 95% CI, 0.0-0.4). Nearly all parents of newborn infants misused CSSs. Resources should be devoted to ensuring families with newborns leave the hospital correctly using their CSS.

Multi-sectorial collaboration on child passenger safety promotion

Background: Traffic injury is a major risk factor among children • Traffic injury is a leading cause of injuries among Chinese children aged 0 to 14.1 • Nowadays, family car ownership has reached 60 million in China2 Objectives: • Raise the public awareness on child passenger safety and correct usage of car seats, especially among parents through multi-sectorial collaboration Methods: • Introduce global evidence-based safety messages and technology into China • Maximize limited resources to enhance the program impact by collaboration with multi-sectors Results: • Public Awareness - Launched an ad by collaboration of Shanghai Police and had the ad aired on all the bus lines in Shanghai - Held media events with a private sector support, advocating in-and around the car safety for children, which gained 121 media reports • Education to parents and children - Educational curriculum was developed for education to parents and children by a support from a private sector - The curriculum was delivered to over 1000 kindergarten teachers • Correct usage of the car seat - “Child Passenger Safety Technician (CPST)” course was introduced into China, with 34 technicians in China now - With supports from Police, CDC, Education Bureau and a hospital, we held 4 check events, checked over 40 cars. - Four car seat check stations were set-up. Conclusion: With the multi-sectorial collaboration, we were able to have the ad to the public with free of charge, to have the curriculum covering all Shanghai kindergartens and to have the car seat check station set-up, too. Reference: 1. NCNCD Child of China CDC, Safe Kids China, Injury Prevention Promotion, 2012. 2. People's Health Publishing House, NCNCD of China, Safe Kids China, Child Passenger Safety, 2014

A School-Hospital Partnership Increases Knowledge of Pedestrian and Motor Vehicle Safety.

Pedestrian and motor vehicle-related injuries are leading causes of morbidity and mortality in children. Trauma centers have specialized resources to conduct interventions that improve the safety of whole communities. In the present study, we evaluated the effectiveness of a school-hospital partnership in increasing knowledge of pedestrian and motor vehicle safety among students and parents in a large, urban community. Staff from a Level I pediatric trauma center conducted educational interventions in an urban public school district. Elementary school students participated in a pedestrian safety program, middle school students completed a community safety program, and high school students learned about the dangers of drunk and distracted driving. Students completed pre- and post-tests. Parents in the neighboring community received child passenger safety education at two child restraint (CR) inspection events. A total of 2203 students participated at a total of nine schools. Post-test scores were significantly higher than pre-test scores for students in all three age groups and within each grade level. At CR inspection events, 67 CRs were inspected, 49 (73 %) of which were replaced with new age- and weight- appropriate CRs. The most common instance of improper CR use was loose CR fit in vehicle seat (33 %). All 120 observed instances of misuse were corrected by a certified Child Passenger Safety Technician. Educational interventions effectively increased knowledge of pedestrian and motor vehicle safety among students and parents. We have demonstrated the utility of a school-hospital partnership for furthering knowledge of safety in an urban community.

Ambulance Transport of Noncritical Children

Safe ambulance transport of children presents unique challenges. Our study describes child passenger restraint practices during ambulance transport, Emergency Medical Service (EMS) providers' knowledge, training, and use of child passenger restraint devices (CRD). A child passenger safety technician (CPST) recorded restraint used for pediatric ambulance transport. The CPST assessed and documented type of CRD used, securement, and whether the child was properly restrained. EMS providers' knowledge, training, and CRD use for ambulance transport were assessed. The study period spanned July 2009 to July 2010; 63 EMS personnel were interviewed and 40 children were observed. Approximately 75% of emergency medical technicians surveyed felt their knowledge of pediatric transport was adequate. Fourteen percent allowed a stable patient to be transported via parent's lap. Twelve percent were transported unrestrained. None of the 11 patients, birth to 3 years, were found to be transported correctly. Study findings supports education and training of EMS personnel to improve the safe ambulance transport of children.

Are parents following the recommendations for keeping children younger than 2 years rear facing during motor vehicle travel?

PurposeBetween 2007 and 2012 there have been several recommendations that infants and toddlers ride in a car safety seat (CSS) rear facing until 2 years of age. This study reports...