Child Restraint System Use Research Articles

Child restraint system use in China, comparing theory of planned behavior, prototype willingness model, and integrative model

BackgroundAlthough the child restraint system (CRS) helps safeguard children's bodies, its use is currently at an exceedingly low rate in China. Also, there is a dearth of research from a psychological perspective on the factors that affect CRS usage. The theory of planned behavior (TPB) and prototype willingness model (PWM) are two of the main decision-making paradigms that have been extensively used in the research on risk-taking behavior. The rational and emotional aspects of decision-making are both covered by these theories. Two facets of decision-making, including the rational and the social-reactive, are studied by these theories. MethodsThis study investigated psychological factors that impact Chinese parents’ usage of CRS. Three models were compared and analyzed in the study: the TPB, the PWM, and an integrative model (which integrates the TPB and the PWM). ResultsThe integrative model has the highest explanatory strength and the TPB model has slightly lower explanatory strength than the PWM model; the effect of behavioral willingness on behavior is greater than the effect of behavioral intention on behavior. Prototype, perceived behavioral intention, and subjective norm are important factors influencing parents’ use of CRS.

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.

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.

Frequency of child restraint system use and parental knowledge of such systems in western China.

This study investigated the frequency of child restraint system (CRS) use in cars and assessed parental knowledge and attitudes toward such restraint systems in western China. Cross-sectional survey. This cross-sectional survey was conducted between December 2021 and January 2022. Hospitals and kindergartens were convenience sampling selected, and parents with cars were asked whether they owned and used CRS. Parents' knowledge and attitudes toward such systems were also determined. Factors associated with CRS were explored using binary logistic regression. A total of 4764 questionnaires were distributed to parents with children 0-6 years old. Among the 4455 responses received, 50.8% of the respondents owned CRS, and most of which were front-facing child seats (42.0%). Less than half (44.4%) reported using a CRS sometimes, but only 19.6% used it all the time. The possession and use of a CRS varied significantly with the parental education level, age of the child, place of residence, number of children, family income, travel frequency, and travel distance. Logistic regression analysis showed that the frequency of car travel with a child and monthly family income significantly affected CRS use. Most parents (85.2%) perceived that adult seat belt in cars are effective at protecting their children in the event of a crash. The most frequent reason for not using a CRS was the tendency for children to travel in the car less often. Although approximately half of the respondents owned a CRS, most of them used it rarely, if at all. Educating parents about safe ways for children to ride in a car and use of safety belts may promote CRS use.

Use of child restraint systems in the Gulf region: a systematic review.

Use of child restraint systems in the Gulf region: a systematic review.

Investigating Parents’ Attitudes towards the Use of Child Restraint Systems by Comparing Non-Users and User Parents

In developing countries, there are no laws to enforce child safety seat use, so there is still a very low rate of use. This study aimed to understand parents’ attitudes toward CRS use based on the health belief model (HBM) theory. To find realistic policies encouraging the use of CRSs, the model was split into two sub-models: a group of parents using a CRS (CRS user) and a group of parents not using a CRS (CRS non-user). Using confirmatory factor analysis (CFA), structural equation modeling (SEM), and measurement invariance (MI) to test the differences between the two parent groups, the CFA results indicated that there were six constructs based on the HBM. According to the individual models of SEM, in the CRS non-user model, no significant latent construct was found to affect the use of CRSs, whereas in the CRS user model, the perceived severity and the cues to action were significant for using a CRS (p < 0.05). The MI results indicated that the attitudes of the two parent groups were different. The recommendations for policies obtained from the study results include promotion aimed toward increasing safety awareness, public relations regarding CRS usefulness, and pricing strategies from the government sector.

Analysis of factors influencing the use of child restraint system by parents of children aged 0–6 years: an information, motivation, behavioral skills model-based cross-sectional study

BackgroundChildren's injuries from traffic accidents have been identified as a global public health issue. Child restraint system (CRS) is a useful tool for lowering the risk of injury to children. Nevertheless, CRS usage is really low in China. The goal of the current study was to investigate the use of CRS after the legislation revised in China and to explore the influencing factors based on Information, Motivation, and Behavioral Skills model (IMB).MethodsThe study is a cross-sectional survey of parents who took their 0 to 6-year-old children for seeking primary care services at the Children Preventive Health Care Clinic of a tertiary hospital in Shandong Province, China. Parents were invited to complete the self-administered questionnaire between March and June 2022, including their knowledge, motivation, and behavioral skills, use behavior of CRS and socio-demographics. Ordinal logistic regression was used to explore the factors associated with CRS use by using SPSS software (version 26.0).ResultsIn total, 442 parents participated in the study; 56.1% (n = 201) of the parents utilized CRS for their child passengers, however only 29.0% used CRS frequently. The result of logistic regression analysis show that parents with junior college (OR = 0.398, 95%CI: 0.185 ~ 0.857), possessing a high family economic status(OR = 0.225, 95%CI: 0.088 ~ 0.578), being trained on children’s unintentional injuries(OR = 0.435,95%CI: 0.272 ~ 0.695), and having high scores on CRS riding mode cognition(OR = 0.476, 95%CI: 0.368 ~ 0.616), CRS type cognition(OR = 0.519, 95%CI: 0.392 ~ 0.689), CRS use motivation(OR = 0.392, 95%CI: 0.295 ~ 0.520) and installation skills(OR = 0.559, 95%CI:0.411 ~ 0.761) were the main factors promoting the usage of CRS.ConclusionsThis study found that the use of CRS can be increased by improving parents' knowledge, motivation and behavior skills and hence related educational programs is necessary for increasing CRS use in China.

Assessment of the effectiveness of parent-targeted interventions for the use of child restraint systems: a systematic review and meta-analysis.

It is essential to implement parent-targeted interventions to increase the use of child restraint systems (CRS) and thus reduce the injuries and deaths of children due to motor vehicle collisions. To optimize future intervention designs, this meta-analysis sought to quantify the effects of parent-targeted interventions and explore potential intervention moderators. Studies met inclusion criteria if they included a parents-targeted intervention that focused on increasing CRS use for children, published from the inception of the databases to January 2022, were systematically retrieved from the PubMed, Embase, Cochrane library, Web of Science, Sinomed, Wanfang, and CNKI databases. Next, 2 researchers independently screened the retrieved articles, evaluated their quality according to the Cochrane Tool, and extracted the data. Finally, Stata12.0 was used for the meta-analysis. Heterogeneity was examined with I2, stratified analyses, and meta-regression. Of the 1,690 articles retrieved, 9 studies, comprising 22,329 parents of children aged 0-12 years, were ultimately included in the analysis. The results of the meta-analysis showed that the CRS use rate of the intervention group was 1.62 times higher than that of the control group [95% confidence interval (CI): 1.25-2.11, Z=3.616, P<0.001], indicating the positive effect of parent-targeted interventions on promoting the use of CRS. The subgroup analysis found that interventions guided by behavioral theories increased the use of CRS (odds ratio: 1.44, 95% CI: 1.27-1.63, n=5). The difference in the use of CRS between the groups in the studies that were not guided by theories was not statistically significant, indicating that interventions guided by behavioral theories may be the source of the heterogeneity. Risk of bias was low in most studies. It is necessary to conduct interventions with parents to increase the use of CRS. The effects on CRS use appear to differ depending on whether the interventions are guided by behavioral theories. In-depth research needs to be conducted to explore the characteristics of the interventions, especially those guided by different behavioral theories, to reduce child vehicle injuries.

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.

State and city laws governing the use of child restraint systems in rideshare vehicles and taxicabs: requirements and responsibility

ObjectivesTo identify, describe and critique state and local policies related to child passenger safety in for-hire motor vehicles including ridesharing and taxis.MethodsWe used standard legal research methods to collect policies...

Practice in child restraint system use among attendees of Well-baby clinics in Jeddah, Saudi Arabia.

Background:The systematic use of child restraint system (CRS) while driving has been promoted by the WHO to improve road safety.Objectives:To assess the levels of practice in CRS use for children aged ≤5 years among mothers attending the Well-baby clinics and to explore the associated factors and attitudes.Methods and Material:A cross-sectional study was conducted among mothers visiting the Well-baby clinics at five primary health care centers in Jeddah, Saudi Arabia, using a multistage stratified-cluster sampling. Practice in CRS was assessed by interviewing the participants regarding the availability of a CRS in their car, usage frequency for a child <5 years, and alternative child-sitting methods. Sociodemographic data, further road safety parameters, and attitudes were analyzed as independent factors of adequate practice using multivariate logistic regression.Results:Of the 192 included mothers, eight (4.2%) had a history of accident while driving with a child. Majority of the participants (62.5%) declared not having their cars equipped with a CRS and used inappropriate car-sitting methods. Of the 37.5% who had CRS in their cars, 27.1% declared using it always or frequently. Adequate practice in CRS was independently associated with mother’s age (OR = 0.91, P = 0.09), low (OR = 0.10, P = 0.001) and moderate family income (OR = 0.23, P = 0.012), and the belief that CRS is not essential while driving with children (0.32, P = 0.023).Conclusions:There is inadequate practice in child road safety among families attending the Well-baby clinics in Western Saudi Arabia, which is associated with several misconceptions and negative attitudes towards the utility of CRS.

Child safety in cars: An observational study on the use of child restraint systems in The Netherlands

Objective To minimize children’s injuries due to car accidents, children must be transported in approved child restraint systems (CRS). The European Union optimized child protection by implementing R129 legislation for CRS in 2013. However, compliance with CRS recommendations after introduction of this newer standard has been scarcely evaluated. The main objectives of this study were to determine the prevalence of various types of CRS misuse and to investigate the use of ISOFIX and i-Size seats and parental knowledge regarding safe transportation of children in cars 5 years after the introduction of the newer R129 standard. Methods During a cross-sectional observational study in the summer of 2018, parking lots of sites in the Netherlands were visited by researchers. Arriving or departing Dutch drivers who transported children under 9 years old were interviewed by means of a questionnaire and the misuse of CRS was directly observed using a checklist. Misuse was defined as CRS inappropriate for the child (based on height and weight) and/or CRS wrongly installed in the car and/or child improperly restrained in CRS. Results In total, 392 drivers and 470 children were included in the study. Results showed that 83% of the children were transported with at least 1 misuse of their CRS: 7% of the CRS were inappropriate for the child, 49% of the CRS were wrongly installed in the car, and 59% of the children were improperly restrained in a CRS. Most CRS were installed using the seat belt (88%) compared to ISOFIX (12%). ISOFIX usage did not result in less CRS installation misuse (P = .338). The number of observed i-Size CRS was low (n = 13, 3%). Most drivers were familiar with ISOFIX (76%), but only 13% of the drivers had heard of i-Size. Conclusions For 9 out of 10 children, CRS misuse was observed. Many children were transported in an appropriate CRS, but various mistakes were made when installing the CRS in the car and restraining children in the CRS. Moreover, ISOFIX usage did not result in statistically significant less CRS installation misuse compared to traditional seat belt usage, and i-Size CRS are still rather unknown 5 years after their introduction.

The rate of child restraint system use among children aged under six years in China.

The child restraint system (CRS) for vehicles is designed to provide specialized protection for children in the event of a crash. The aim of the study was to investigate the rate of CRS use and analyze the factors associated with CRS use among children aged under six years in China, and to provide further insight into developing strategies for promoting public health education. This is a cross-sectional study. The study sites were 36 primary healthcare institutions in 12 provinces across China, and the participants were 34,503 guardians of children aged 0-6 years. Guardians who owned private cars were included and completed surveys about their experience using CRS. Odds ratios and 95% confidence intervals were calculated using multivariate logistic regression models. The overall rate of CRS use among children aged under six years in China was 17.3%. Multivariate logistic regression analysis revealed that living in an urban area, low age of the child, guardians having higher education and being looked after by parents had a significant positive association with CRS use among children aged under six years. This study confirms that there is a low rate of CRS use among children aged under six years in China, highlighting the considerable need for CRS use education, advocacy and promotion of increasing use.

Child restraint system use and its associated factors in Shenzhen

Child restraint system (CRS) is effective to protect child passenger safety in a motor vehicle crash. However, research on CRS is limited and the use rate of CRS is not high in China. We carried out a cross-sectional study to examine the use of CRS and its associated factors in Shenzhen. Via the method of cluster random sampling, parents who had at least one child aged 0 to 6 and owned a car from nine community health service centers and eight kindergartens were invited to complete the self-administered questionnaire during April and May 2014, including their knowledge of, attitude toward, and use behavior of CRS and socio-demographics. Multivariable logistic regression was used to explore the factors associated with CRS use. A total of 3768 parents participated in the survey, with a mean age of 33.94. Parents’ knowledge and attitude regarding CRS were fair, with the mean score of 3.07 and 3.33 out of 6, respectively, and only 22.8% of them used CRS for their child passengers. Children aged below 3 years, drivers owing expensive cars and wearing seatbelts, and parents with higher knowledge and attitude scores had greater likelihoods to use CRS. Moreover, trip frequency and distance were also significantly associated with CRS use. The findings indicate that the use rate of CRS is low in Shenzhen and parents have fair levels of knowledge and attitude regarding CRS use. Comprehensive public education programs and legislative interventions are urgently required to increase the use of CRS and ensure child passenger safety in Shenzhen

Influence of seat belt use behavior and road traffic crash experience on the use of child restraint systems: A step further

Seat belts and child restraint systems (CRS) are important in-car safety components capable of preventing serious injuries and death in the event of a car crash. Low rates of seat belt and CRS use persist globally, particularly in the Kingdom of Saudi Arabia (KSA). In an effort to better understand and subsequently improve seat belt and CRS use rates, this study analyzed the factors influencing seat belt and CRS use behavior in the Eastern Province (EP) of KSA, including the connection between seat belt and CRS use and road traffic crash experience.This cross-sectional study was based on a survey of 3,421 male and female participants regarding their seat belt and CRS use behavior. Respondents were classified into four CRS use categories: cautious, helplessly negligent, ignorantly negligent, and deliberately negligent. Chi-squared tests were used to determine significant associations among seat belt use, seat belt belief, prior crash experience, CRS use, and demographic variables. Multinomial nominal logistic regression was used to estimate the odds ratios for classification in one of the three negligent vs. cautious CRS use categories as a function of demographic variables, prior road traffic crash experience, and belief in and use of seat belts.Results of this study indicated a modest improvement in the rate of seat belt use in KSA’s EP, however, a significant proportion of respondents reported only sometimes or never using their seat belt. A significant proportion of respondents were also classified in one of the three negligent CRS use categories. Respondents who reported using a seat belt sometimes or never were 2.67, 2.60, and 3.48 times more likely to be categorized as deliberately negligent, ignorantly negligent, or helplessly negligent in their CRS use, respectively, than respondents who reported always using their seat belts. Respondents who reported being previously involved in a car crash or a near crash were also more likely to be classified in one of the three negligent CRS use categories than respondents who reported no prior road traffic crash experience. Previous involvement in a car crash was also found to be associated with lower seat belt and CRS use rates.These findings suggest a need for increased seat belt law enforcement by the KSA’s Traffic Police Department, as well as additional seat belt and CRS use awareness campaigns targeting individuals with prior road traffic crash experience by the KSA’s Ministry of Communications through the Road Transport Department. This study can serve as a reference for future studies that aim to understand the factors and implications related to seat belt use and belief, CRS use, and road traffic crash experience.

Understanding context sensitivity regarding the use of child restraint systems in daily life in Japan

• One’s behavior is highly sensitive to his or her social and physical environment. • Investigated CRS use, perceived severity, and context sensitivity. • About 25% of the parents let their child out of the car seat when resisted. • Over 30% of the survey participants’ child sat in a car seat with no safety straps. • Behavior settings affect CRS use behavior significantly.

A Study on the Use and Misuse of Child Restraint System (CRS) in Malaysia

&#x0D; &#x0D; &#x0D; In car crashes, children are more likely to suffer more severe injuries than adults. For prevention, Child Restraint System (CRS) is normally used. However, inappropriate use of CRS may exacerbate injury risks. This research aims to determine the prevalence of CRS use and misuse among car owners, especially those travelling with children aged 11 years and below. A total of 178 parents were interviewed and 267 children were observed. Overall, only 12.7% children were properly restrained in CRS for their size, with the correct installation and appropriate seating position. Prior to CRS law implementation, initiatives such as awareness campaigns, community based programs and CRS clinics should be introduced.&#x0D; &#x0D; &#x0D;

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.

So much nuance: A qualitative analysis of parental perspectives on child passenger safety

Objective To explore barriers and facilitators to optimal child restraint system (CRS) use for diverse parents of newborn infants and to obtain input from parents on the use of technology-assisted remote car seat checks as tools for promoting optimal CRS use. Methods Parents were recruited using purposive sampling. Interviews were conducted with English- or Spanish-speaking parents with a full term newborn and regular access to a car. Interviews were conducted by phone, and recorded and transcribed verbatim. Interviews were conducted until thematic saturation was reached. Data were organized for analysis using Atlas.ti, and codes grouped by theme using constant comparison. Results 30 parents were enrolled. Barriers and facilitators to optimal CRS use were classified into three themes, as were thoughts on the pros and cons regarding remote car seat checks. Themes on barriers and facilitators included motor vehicle and CRS features (such as age and size of the motor vehicle and presence of the Lower Anchors and Tethers for Children LATCH system), resources (availability, accessibility, and accuracy of resources), and parental factors (parental emotions and characteristics). Themes related to pros and cons of remote car seat checks included the ability (and challenge) of remote car seat checks to identify and correct errors, the potential use of remote car seat checks in certain situations (such as CRS transitions and periods of growth), and convenience of remote car seat checks (including increased availability and ease of access). Subthemes with further detail were arranged within each theme identified. Conclusion From a parent perspective, there are several identified barriers and facilitators of optimal CRS use. Although car seat checks were identified as a resource, in-person accessibility was an issue, and there were mixed opinions on technology-assisted remote car seat checks. These results provide a foundation for additional study on targeted interventions, including remote interventions for which there is an increased need due to the COVID-19 pandemic.

The Prevalence of Child Restraint System Use and Pattern of Child Transportation in Buraidah City.

Background:The motor vehicle crash (MVC) is a major cause of injuries and deaths among children worldwide. The child restraint system (CRS) is designed to protect children from injury and death if passengers are involved in MVC.Objectives:To determine the prevalence of CRS use for children aged 5 years and below and to explore the pattern of child transportation inside cars in Buraidah, Saudi Arabia.Methods:A cross-sectional study was conducted using a self-administered questionnaire distributed among parents attending primary healthcare centers. Simple random sampling was used to select 330 participants. The survey was conducted from January to March 2020.Results:A total of 135 (40.9%) respondents had CRS available in their cars, and only 51 (15.5%) participants reported using it ‘always’. Child discomfort, difficulty in handling CRS, and being unaware of CRS importance were the commonly reported reasons of not using CRS. The most common practiced mode of transportation, in case of not using CRS, was seating the child in the front seat on an adult lap. Twenty-eight (8.2%) respondents experienced a MVC while driving with a child; half (53.6%) of these were not using CRS at the time of the accident. Less than half (47.1%) of the participants were aware of the CRS law in Saudi Arabia.Conclusion:The prevalence of using CRS is low. Creating awareness among parents and strict implementation of the CRS law can lead to increase in the use of CRS which will lead to prevention of traffic-related injuries and deaths among children.