Child Safety Seat Use Research Articles

Analysis of factors influencing family support for child safety seat legislation based on Probit-Adversarial Interpretive Structure model

Objectives In recent years, China’s motorization process has accelerated, urban road traffic has become increasingly complex, and the safety of children has become increasingly prominent. China aims to encourage the use of child safety seats (CSSs) and stipulates in the Law on the Protection of Minors that “Parents or other guardians of minors shall take measures, such as equipping child safety seats.” However, the utilization rate of such seats in China is still low (<5%, 2021), an important reason is the lack of mandatory legislation. This study focuses on developing cities in China that do not have mandatory legislation on the use of CSS, explores the factors that families support child seat legislation, and explores the impact of children’s feedback on the transmission of values within families and the use of CSS in family decisions. Methods Four hundred and eighty-two subjects in several neighborhoods in Changsha City participated in this survey through an online questionnaire. We use the data to do a Probit analysis to find the influencing factors of parental support for child safety seat legislation, and the Adversarial Interpretive Structure model is used to assess the hierarchy of the influencing factors and the relationship between the influence of internal factors. Results The results showed that educational level and children’s feedback are root cause factors; monthly family income, number of children, confidence level in CSS, number of cars, and others’ behavior are intermediate factors; gender, penalty support, and subjective perception expenditure are surface factors. Conclusion Finally, the results have focused recommendations for the direction of child safety seat legislation, focused recommendations for law enforcement, advocacy, and educational interventions, and recommendations for installation training before the use of CSS.

A technological solution to child safety seat errors: Efficacy of the cellular car seat

Objective Although child safety seats are highly effective in preventing injuries, they are frequently misused. Experts have identified two leading “critical misuses”: (1) loose harness straps and (2) loose vehicle attachment at the base. We designed an innovative child safety seat system that educates, instructs, and alarms participants of safety seat errors. The system includes both the Cellular Car Seat (CCS) smartphone app and a network of car seat sensors. Our objective was to determine if CCS system users had fewer child safety seat misuses than users with a child safety seat manual alone. Methods During the study visit, 92 participants completed three safety seat scenarios using a mock vehicle setup, test doll, and a convertible child safety seat: A) fully install a convertible safety seat, B) recognizing/correcting loose harness straps in a seat with intentionally loose straps, and C) recognizing/correcting loose attachment to the vehicle seat at the base in a seat with intentionally loose attachment. Intervention participants (n = 46) were asked to use the CCS app during each scenario and control participants (n = 46) were given only the paper child safety seat manual. For each scenario, researchers determined errors/misuses present at the end of the scenario, time to complete scenario, and tension achieved on the harness straps (collected via load cell). Results Compared with controls, intervention participants had significantly fewer errors and higher average harness tensions for all three scenarios; furthermore, a greater portion achieved a harness tension of 4 newtons. During Scenario A, the rate of loose harness strap errors was more than three times higher for controls and loose base attachment errors almost six times higher. We observed similar trends in Scenario B, with harness strap errors more than double for controls. In Scenario C, the rates of both critical misuse errors were four times higher for controls compared to the intervention group. Conclusions The innovative CCS system was highly effective at reducing child safety seat use errors, especially critical misuses. Reducing critical misuses will decrease injuries and fatalities among crash-involved children. The CCS system can alert families to everyday harnessing and installation errors and provide families and caregivers with ongoing, accessible support.

Analysis of the usage and awareness of child safety seats for children aged 0-6 in Leshan City, Sichuan Province, China.

To investigate the current situation of child safety seat use and children's cognition of safe riding in Leshan City, and to provide a basis for the promotion and application of child safety seats in Leshan City. From November 2021 to February 2022, a total of 500 car-owning families who visited or were hospitalized in the department of pediatrics of our hospital were surveyed by self-filling questionnaire method. Through the investigation of personal situation, family situation, travel habits, use of child safety seat, cognition of safe riding, etc., the influencing factors of possession and use of child safety seat and cognition were analyzed. The ownership rate of car seats was 57.8%, the use rate was 47.6%, and the always use rate was 18.8% among all families with children surveyed. There were no statistically significant differences in the use rate and always use rate of child safety seats among different genders of children, parents' education background, and car ownership price. The use rate and constant use rate of child safety seats in urban households were significantly higher than those in rural areas. When the main driver was the mother, the use rate of child safety seats was higher, and the difference was statistically significant. From the perspective of cognition, the use rate and constant use rate of the child safety seat of parents with correct cognition were 64.5% and 25.7% respectively, while the use rate and constant use rate of the child safety seat of parents with incorrect cognition were only 11.1% and 4.3%, which were significantly lower than those with correct cognition, and the difference was statistically significant. In terms of cognition, 10.4% of parents think it is safe for children to sit in the back seat with adults in their arms, and 9.0% of family members think it is safe for children to sit in the back seat with seat belts alone. At present, the ownership rate, utilization rate, and parents' correct cognition of child safety seats in Leshan City are all at a low level, and there is a lack of regional legal guidance, so the safety situation of children in cars is worrying. To effectively improve the use of child safety seats, the promotion of child safety seats should be promoted from three aspects: improving parents' cognition, forming good traffic habits, and legal guidance.

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.

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

A child safety seat protects children from injury during motor vehicle accidents (MVAs). However, there is a lack of enforcement of regulation regarding its use in Saudi Arabia. This study aimed to determine the use of child safety seat and its determinants and barriers in Jeddah, Saudi Arabia. This cross-sectional study was based on a structured face-to-face interview across Jeddah among families who drove in cars with children aged ≤5 years. The study used stratified multistage random sampling across the population of the governorate of Jeddah. A total of 675 parents were included, of which 311 (46.1%) reported having a child safety seat in their vehicle, and only 165 (24.4%) reported its regular use. Awareness levels among parents regarding child safety seat use and its benefits, parents' level of education, family size, family income, and the belief in the need for laws governing child safety seat were key determinants of child safety seat use. Poor awareness among parents regarding the utility of child safety seat in reducing child injuries, low education levels among parents, larger families with multiple children, poor affordability, low family income, and a clear lack of laws mandating the use of child safety seat were identified as key barriers. The regular use of child safety seat for children aged ≤5 years is low in even one of the most urban populations of Saudi Arabia. This indicates the need for large-scale awareness drives and stricter implementation of laws enforcing the use of child safety seat in Saudi Arabia.

Knowledge and Attitude Toward Child Safety Seat Use in Saudi Arabia: A Cross-Sectional Study.

Background Car safety seats (CSS) are a well-established strategy to reduce injuries and fatalities among children involved in road traffic accidents. However, the use of CSS is generally low globally due to limited knowledge of its benefits. This study assessed parents' knowledge and attitudes toward CSS in Saudi Arabia. Methods This cross-sectional study used an online self-administered survey distributed among residents in different regions of Saudi Arabia to assess their knowledge and attitude toward CSS. Data were analyzed using the statistical package for the social sciences (SPSS) version 23.0(IBM Corp., Armonk, NY). Results A total of 383 Saudi residents participated in the study. The mean age was 37.14 ±9.10 years, with a female predominance (62.1%, n=238). One-third of the participants were from the western region of Saudi Arabia (30.3%, n=109). Non-use of CSS was reported by 25.8% of the participants, while 11.7% reported that they rarely used CSS. The mean total knowledge score was 2.15 (range 0 -3). A lower knowledge score was significantly associated with a lower educational level (p=0.008), not having information regarding CSS (p=0.005), none or rare use of CSS by the parent (p<0.001), and the use of media or self-education as a source of information regarding CSS (p=0.002). The mean attitude score was 12.52 (range 4 -20). The attitude score was significantly associated with gender (p=0.002), education (p=0.014), number of children (p=0.005), monthly family income (p=0.028), use of CSS by people other than the parent (p<0.001), information about CSS use in the car (p<0.002), source of information (p<0.001), and use of CSS by the parent (p<0.001). Conclusions The knowledge and attitude of the Suadi population towardCSS use are inadequate, highlighting the need to enhance awareness and understanding of the importance of CSS use.

Child Safety Seat‒Use Behavior Among Parents of Newborns: A Trans-Theoretical Model‒Guided Intervention in Shantou, China, 2021.

We evaluated the effect of a trans-theoretical model-based intervention on child safety seat (CSS)‒use behaviors among parents of newborns in Shantou, China. Parents' knowledge, attitude, and self-efficacy scores on CSS use were significantly higher at one, three, and six months after the intervention compared with scores at baseline. Parents' stage of CSS use also advanced as the intervention progressed. The trans-theoretical model‒based intervention and evidence generated from this study may provide guidance for future individualized interventions to improve CSS use. (Am J Public Health. 2023;113(12):1271-1275. https://doi.org/10.2105/AJPH.2023.307415).

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

BackgroundLack 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.MethodsUsing 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.ResultsThe 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).ConclusionsMost 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.

The use of car safety seats for children in China: A questionnaire survey based on the theory of planned behavior

Objective The purpose of this study was to analyze the psychological characteristics underlying Chinese parents’ behaviors in using child car seats and to understand their decision-making processes. Based on the theory of planned behavior (TPB), three extended variables of perceived accident severity, perceived benefits, and perceived barriers were introduced. From the perspective of social psychology, the psychological factors that influence parents’ use of child car seats and their interrelationships were explored. Methods A questionnaire was designed to collect data, including information on demographic characteristics, basic components of the TPB, and relevant extension variables. Using on online survey, 585 valid questionnaires were collected. Structural equation modeling was used to calibrate the data, and multiple group analysis was performed on the demographic variables. Results The extended TPB can effectively explain and predict parents’ behaviors when using children’s car seats. The results of the model show that parents’ positive attitudes toward child safety seats (CSSs), others’ recognition of their own use and perceptual control of the use of CSSs increase their willingness to use CSSs. Parents’ willingness to use has a positive impact on the use of CSSs. Additionally, for the three extended variables introduced, perceived benefit significantly promoted parental intention and behavior to use CSS for children; perceived barriers significantly reduced parental use of CSS; and perceived accident severity had no significant effect on parental use of CSS. Conclusions This study established the validity of the extended TPB model in predicting parents’ behaviors in using car seats for their children. In addition, the current findings may provide a theoretical basis for policy development to promote CSS use.

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 &lt; 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.

Will Smart Improvements to Child Restraints Increase Their Popularity?

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

Modelling factors that impact the use of child safety seats for nursery school travel

Children, as one of the most vulnerable road user groups, are exposed to a high risk of traffic crash-related injuries and fatalities. Children’s incomplete physical and cognitive development leads to inaccurate detection of traffic hazards and inadequate road crossing decisions. When young children travel as car occupants, their body structures are immature, and restraint over larger and sometimes different body areas is necessary. Therefore, children’s vulnerability as car occupants is subject to their age and physical development. This research investigates factors influencing child car seat usage, particularly child restraint systems or booster seats, for commuting to nursery schools. An experimental study was conducted in three suburbs of Athens, Greece, with distinctive socioeconomic status (SES) and built environment characteristics. For this purpose, a self-administered parental questionnaire was completed for 734 children attending municipality nursery schools, exploring the traffic safety practices for preschool children, child-parent interactions, the parent’s risk perception, behaviour, and knowledge of traffic safety. Responses reveal that the surveyed children—irrespective of the residence area—travel to the nursery school mainly as car occupants (89.6% overall, ranging between 84.8% for the area with the lowest SES and 96.1% for the area with the highest SES). In addition, the results indicate that three-quarters of the children are often placed in a car seat, while almost one-quarter are never restrained. Regression and structural equation models are estimated and used to examine factors affecting the usage of child safety seats. Finally, conclusions are drawn, along with suggestions to overcome the limitations and complete this research with ongoing and future data collection and analyses.

Analysis of the factors influencing parents’ support for child safety seat legislation in Nanjing

Objective Although the use of child safety seats can effectively ensure the safety of children in cars, the utilization rate of such seats in China is still low (<5%, 2021). Therefore, it is urgent to promote the use of child safety seats. The goal of this study was to examine the factors affecting parents' support for child safety seat legislation. Methods Data were collected via 1200 questionnaires distributed in several community hospitals in Nanjing. We used the data to do a multivariate logistic regression analysis to find the influencing factors of parental support for child safety seat legislation. Results On the whole, the respondents had low support for legislation mandating the installation of child safety seats. Although only 5.83% of the respondents expressed opposition to the relevant legislation, more than 40% expressed a neutral attitude rather than a supportive attitude. Multinomial logistic regression analyses revealed that gender, monthly household income, educational level, number of children in the family, comprehension of child safety seat-related publicity information, and cognition of children’s riding safety significantly affected parents' support for child safety seat legislation. In addition to gender and cognition of children's riding safety, other influential factors had significant positive impacts on legislative support for compulsory installation of child safety seats. Conclusion These results have implications for making more effective recommendations to advance child safety seat legislation and keep child passengers safe.

Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates

Background: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. Objective: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). Methods: Estimates of child restraint use from two online, cross-sectional surveys—FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults—were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child’s restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0–4 years, forward-facing CSS use for children aged 2–7 years, booster seat use for children aged 5–12 years, and seat belt use for children aged 9–12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. Results: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5–94.1) (FallStyles) and 89.4% (CI: 85.5–93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9–91.3) (Estilos) and 84.4% (CI: 79.0–88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7–79.0) (FallStyles) to 59.7% (CI: 55.0–64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1–81.0) (Estilos) to 57.2% (CI: 51.2–63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups.

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

Objective: Road traffic accidents are a global issue and serious threat for public health. Children are at high risk of serious injury or death from motor vehicle crashes. Child safety seats (CSSs) can reduce the risk of death and serious injury in children. This study was done to determine the prevalence of child safety seat use in vehicles and the factors influencing their use in a safe society (Tehran, Iran) in 2015.Methods: In this cross-sectional study, 804 parents with children under 12 years old who owned private cars were questioned in different areas of Tehran. A questionnaire included demographic data, and 2 specific questionnaires were used for families that used a CSS and those did not use a CSS. Univariate and multivariate binary logistic regression analyses were conducted. Crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated. All analyses were carried out using SPSS 21.Results: The prevalence of child safety seat use was 18.7% and was significantly higher among parents with an income greater than 50 million rials/month, parents who received child safety seat recommendations, parents living in the north of Tehran, and fathers with more driving experience. Age, weight, and height of children were also factors that influenced the use of child safety seats. The most common reasons for parents to use child safety seats was awareness about the benefits of this device and fear of harm to the child, and the most common reasons for nonuse were child intolerance while sitting in the seat and cost.Conclusion: The prevalence of child safety seat use in Tehran is very low, and most parents are not aware of the importance of child safety seats. Comprehensive programs, including legislation, law enforcement, public education, and publicity to promote the benefits of using CSSs, in Tehran can be an effective step toward increasing the use of child safety devices.

Factors affecting use and nonuse of child safety car seats in Gorgan, Iran

Objective: Motor vehicle accidents, which are among the main causes of child mortality in Iran and the Middle East, impose staggering costs for the community. Ignoring use of safety devices for children in most motor vehicle crashes will lead to death or serious injury. Because few studies have been performed on effective and predictive factors regarding use of child safety seats, the purpose of this study was to examine the factors affecting the use and nonuse of child safety seats, along with the factors that can facilitate how a child safety seat is used.Method: This study was conducted in the urban area of Gorgan using a questionnaire. Through random selection, 204 parents with at least one child, aged 8 years or younger, reported their knowledge about the benefits of using a child safety seat.Results: The results showed that 80% of parents never use a child safety seat, and 13% always use a child safety seat. More than 93% thought that it was necessary to make usage of the child safety seat obligatory. In addition, 80% of parents believed that a child safety seat prevents children from injury in crashes. In addition, 38% of parents were not aware of child safety devices and child safety, less than 20% said that they did not use a child safety seat because their spouse did not support its use, and 28% of them thought that a child safety seat does not affect the safety of the child. In general, 91% of parents reported that if child safety seat use were mandated, the frequency of use would increase. A law on the use of child safety seats is a very important variable in their use, which can enhance the chance of using a child safety seat by 6.5 times.Conclusion: Special instructions should be developed to create incentive strategies for using a child safety seat. Mandating the use of a child safety seat, equipping cars with a child safety seat, encouraging children to use it, and providing continuous education and training are important factors for increasing the use of child safety seats.

Mapping Child Safety Seat Use in Cases of Fatal or Incapacitating Child Motor Vehicle Injury in Cook County, Illinois from 2011 to 2015.

Child safety seat use reduces the risk of fatal injury by 71% for infants and 54% for toddlers, yet more than one-third of child passengers killed in traffic crashes in the US are unrestrained. Nearly half (47%) of crash injuries occur within 5 miles of the injured person's home. Mapping the location of motor vehicle crashes resulting in serious or fatal injury to unrestrained child passengers may pinpoint high-risk neighborhoods. Illinois Department of Transportation data were used to map crashes that resulted in a fatal or incapacitating injury to a child passenger (age 0 to 8) in Cook County, IL from 2011 to 2015. Maptitude® Geographic Information System (GIS) software was used to identify hot spots of unrestrained child passenger injury on the South Side and West Side of Chicago. Of 174 zip codes in Cook County, 3 zip codes on the South Side of Chicago (60620, 60621; 60628) accounted for 11% of the total unrestrained fatalities and incapacitating injuries among children. Results of this study reveal the feasibility of detecting geographic disparities in child passenger safety at the zip code and neighborhood level and indicate the potential for more targeted allocation of resources.

Safety awareness and use of child safety seats among parents after the legislation in Shanghai

PurposeTo investigate the changes and underlying mechanisms in parents' safety awareness and the use of child safety seats after the mandatory legislation in Shanghai city, China. MethodsThis study was carried out by Shanghai Key Laboratory of Environment and Children's Health using a multi-stage, simple random sampling method. Volunteers with children aged 0–12 months were recruited. Child safety seats were sent to each volunteer's family. Telephone encounters and/or on-site visits were used to collect data from parents using a phased survey on children's safety during car use. ResultsAmong all respondents, 91.2% had heard of motor vehicle accidents involving children, and 97.2% could describe the appropriate use of a safety seat to minimize the risk of child injury in a collision. Among 1078 families with newborns, awareness of child safety seats was 91.9%. There were 86% patients aware that new laws and regulations have been released regarding the use of child safety seats, and 98.5% of them plan to comply with the new laws. Moreover, 61% patients think that taxis should be routinely equipped with child safety seats. ConclusionThe parents in Shanghai obtained a high level of awareness of children's traffic safety after the introduction of child safety seats legislation, and had a positive experience related to the use of child safety seats. Taxi may be an important area of focus for implementation of child traffic safety. Traffic safety laws and regulations with further impact should be continuously studied.

Use of child safety seats during transportation of newborns

PurposeChild safety seats (CSS) are critical for the protection of children, in case of motor vehicle accidents. Although the national legislation mandates that all newborns must be placed in an appropriately installed CSS during transportation, people often do not perceive the importance of CSS and do not use it as recommended. The purpose of this survey was to understand the use of CSS for the safe transport of newborns from hospital to home. MethodsWe interviewed parents of newborn infants, using a structured questionnaire, at the time of their discharge from Cheil General Hospital & Women’s Health Care Center, between May 2014 and July 2014. ResultsA total of 403 participants were interviewed. The rate of CSS use was only 14.9%. Overall, 76.4% of the families interviewed were not aware about the recommendations on CSS use for newborns when travelling in a car. The provision of education on using CSS significantly influenced their rate of use. Parents who were educated about mounting the CSS in a car used it more as compared with others (25.7% vs. 12.2%) (P=0.002). Furthermore, if parents had heard about the importance or necessity of CSS, they used it more than others did (19.5% vs. 10.6%, P=0.032). ConclusionDespite the legal regulation, most parents transport their newborn infants without a CSS while traveling from hospital to their home. The rate of CSS use was influenced by parental education and their knowledge about its necessity. Education programs for parents must be reinforced to increase the CSS use.

Educating parents to support children’s road safety: a review of the literature

ABSTRACTThis narrative review synthesised the limited work that has been carried out into road safety education targeting parents. Parent education appeared to have a positive impact on child safety seat use and children’s bike helmet use, but results regarding the impact of parent education on pedestrian safety were mixed. The review highlighted important gaps in the literature. A key gap being identifying effective ways to engage parents of low socioeconomic and ethnic minority backgrounds. Further, another gap is understanding effective ways to engage and support parents of children with additional needs to build their children’s road safety skills. There is some evidence that parent education has a positive impact on these “at-risk” groups, but little work on how to engage with these groups and the type of parent education required.