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Background and objectivesCrash injury risk is reduced when a child correctly uses an appropriate restraint; however, incorrect restraint use remains widespread. The aim of this study was to determine whether product information developed using a user-driven approach increases correct child restraint use.MethodsWe conducted a two-arm double-blinded parallel randomised controlled trial in New South Wales, Australia 2019–2021. Participants were current drivers who were either an expectant parent or a parent of at least one child residing in the greater Sydney metropolitan area who were interested in purchasing a new child restraint. The intervention was user-driven product information consisting of instructions printed on an A3 sheet of paper, swing tags with key reminders and a video accessed via Quick Response codes printed on the materials. The control group received a postcard summarising legal child restraint requirements. The primary outcome was the correctness of child restraint use observed during home visit approximately 6 months after restraint purchase. Correct use was defined as no serious error or <2 minor errors. The secondary outcome was a count of observed errors.Results427 participants were recruited. Home visits were conducted for 372 (190 intervention and 182 control). Correct use was more common in the intervention group (37.4%) compared with the control group (24.2%, p=0.006). Participants receiving the intervention were 1.87 times more likely to correctly use their restraint than those in the control group (95% CI 1.19 to 2.93).ConclusionsThe results provide evidence for the effectiveness of user-driven instructions as a countermeasure to restraint misuse.Trial registration numberACTRN12617001252303.

Background Child passenger safety is an important public health problem in China. This study aimed to examine the prevalence of child passenger restraint use while riding in a car in the city of Shantou in China from 2012 to 2017. Methods Three large-scale cross-sectional observational studies were conducted in 2012, 2015 and 2017, respectively. The observation sites included randomly selected hospitals, kindergartens, and primary and secondary schools. The outcome measures included the changes in percentages of seating position (e.g., front vs. rear), whether sitting on lap, and use of child restraint systems (CRS) or seat belts by year and by age group. Descriptive statistics, Chi-square tests and logistic regression were used to address the study aims. Results A total of 9858 commuting children aged 17 and younger were observed in passenger cars in Shantou, China during the study. The proportion of children aged 0–5 sitting on adult’s lap decreased from 26.6% in 2012 to 24.6% in 2017, while the proportion of CRS use among the children sitting in the rear row increased among children aged 0–5 (from 0.7% in 2012 to 14.2% in 2017) and children aged 6–11 (from 0.7% in 2012 to 2.4% in 2017). Comparing children aged 0–11 in 2012, children in the same ages were less likely to sit in the front row in 2015 (OR = 0.42, 95%CI = 0.37, 0.48) and in 2017 (OR = 0.27, 95%CI = 0.23, 0.31). Children aged 0–11 were more likely to sit in the rear row with CRS use in 2015 (OR = 8.50, 95%CI = 5.44, 13.28) and in 2017 (OR = 10.95, 95%CI = 7.02, 17.08) comparing with children in the same ages in 2012. As for children aged 12–17, they were more likely to use seat belt in 2017 (OR = 1.40, 95%CI = 1.06, 1.85) compared with those children in 2012. Conclusions While child passenger safety behaviors improved from 2012 to 2017 in Shantou, China, more efforts are needed to protect child passengers from injuries.

Objectives. We evaluated an education, distribution, and fitting program for increasing age-appropriate and correct child restraint use. Methods. We performed a cluster randomized trial involving 28 early childhood education centers in low socioeconomic status areas in Sydney, Australia. The main outcome was optimal restraint use defined as age-appropriate restraints, installed into the vehicle correctly and used correctly. Results. One service withdrew after randomization, so data are presented for 689 child passengers, aged 3 to 5 years, from 27 centers. More children attending intervention centers were optimally restrained (43% vs 31%; P = .01; allowing for clustering). More 3-year-olds were using forward-facing seats rather than booster seats, more 4- to 5-year-olds were using booster seats instead of seat belts alone, and there were fewer errors in use at intervention centers. Among non–English-speaking families, more children attending intervention centers were optimally restrained (43% vs 17%; P = .002; allowing for clustering). Conclusions. The program increased use of age-appropriate restraints and correct use of restraints, which translates to improved crash injury protection. Multifaceted education, seat distribution, and fitting enhanced legislation effects, and the effect size was larger in non–English-speaking families.

Objectives. To evaluate the effectiveness of parent-based child restraint system (CRS) education and hands-on CRS installation training. Methods. We conducted a randomized trial with cluster sampling from May 2016 to January 2017 in 6 selected kindergarten classes in Shantou and Chaozhou, China. Parents were randomly assigned to receive 1 of the 3 study conditions: CRS education only, CRS education plus hands-on CRS installation training, or control (child electricity safety). Results. Three months after the intervention, significantly higher CRS use was reported in the CRS education plus hands-on CRS installation training group than was reported in the control group (41.2% vs 18.5%; P = .011). However, no significant difference in CRS use was found between the CRS education only and the control groups (26.7% vs 18.5%; P = .33). The ratings on child passenger safety awareness increased significantly in both intervention groups but remained unchanged in the control group after the intervention. Conclusions. The CRS education plus hands-on CRS installation training increased the use of child restraints, but the CRS education only condition did not. Both intervention methods helped to improve child passenger safety awareness.

Objectives. We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints. Methods. In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly. Results. This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR] = 3.66; 95% confidence interval [CI] = 1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR = 0.14; 95% CI = 0.07, 0.30) or being from a family with more than 2 children (AOR = 0.34; 95% CI = 0.17, 0.67). Conclusions. Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.

Using data from two postpartum depression randomized trials, we examined the association between postpartum depressive symptoms and parenting practices among a diverse group of mothers. We examined the association between safety practices (back sleep position, car seat use, smoke alarm), feeding practices (breastfeeding, infant intake of cereal, juice, water), and health care practices (routine well child and Emergency Room (ER) visits) with 3-month postpartum depressive symptoms assessed using the Edinburgh Depression Scale (EPDS ≥10). Fifty-one percent of mothers were black or Latina, 33 % had Medicaid, and 30 % were foreign born. Depressed mothers were less likely to have their infant use back sleep position (60 vs. 79 %, p  < .001), always use a car seat (67 vs. 84 %, p  < .001), more likely to feed their infants water, juice, or cereal (36 vs. 25 %, p  = .04 respectively), and to bring their babies for ER visits (26 vs. 16 %, p  = .03) as compared with non-depressed mothers. In multivariable model, depressed mothers remained less likely to have their infant use the back sleep position, to use a car seat, and to have a working smoke alarm in the home. Findings suggest the need to intervene early among mothers with depressive symptoms and reinforce positive parenting practices.

This paper assesses the effectiveness of child safety seat laws in the United States, Over the past 35 years, these laws have steadily increased mandatory child safety seat restraint ages. We exploit state-year level variation in the age until which children are required to ride in child safety seats to estimate triple difference models using Fatality Analysis Reporting System (FARS) data from 1975 to 2011. Our findings show that increasing the age thresholds is effective in increasing the actual age of children in safety seats. Across the child-age distribution, restraint rates increase by between 10 and 30 percentage points or by between 50 and 170 percent, in the long run. We also estimate the impact of the child safety seat laws on the likelihood that a child dies in a fatal accident. We find that the laws saved up to 39 children per year. Finally, we find that the laws primarily induce compliant parents to switch from traditional seatbelt use to child safety seat use, with only small effects among parents who do not restrain their children.

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 low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents' use of child restraints and smoke alarms.MethodsSIS is a multisite randomised controlled trial. Participants are parents of children aged 4–7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child's age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan.DiscussionFinding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use.Trial registration numberNCT02345941; Pre-results.

Childhood death from vehicle crashes and the delivery of information about proper child restraint systems (CRS) use continues to be a critical public health issue. Safe Seat, a sequential, mixed-methods study identified gaps in parental knowledge about and perceived challenges in the use of appropriate CRS and insights into the preferences of various technological approaches to deliver CRS education. Focus groups (eight groups with 21 participants) and a quantitative national survey (N = 1251) using MTurk were conducted. Although there were differences in the age, racial/ethnic background, and educational level between the focus group participants and the national sample, there was a great deal of consistency in the need for more timely and personalized information about CRS. The majority of parents did not utilize car seat check professionals although they expressed interest in and lack of knowledge about how to access these resources. Although there was some interest in an app that would be personalized and able to push just-in-time content (e.g., new guidelines, location and times of car seat checks), content that has sporadic relevance (e.g., initial installation) seemed more appropriate for a website. Stakeholder input is critical to guide the development and delivery of acceptable and useful child safety education.

Purpose The biofidelity of anthropomorphic test devices directly affects the evaluation of safety performance of child restraint systems. The purpose is to enhance the biofidelity of Q3 child dummy by chest structure reconstruction for the accurate prediction of the child injuries during a frontal crash. Methods The finite element model of Q3 child dummy restrained in impact shield child restraint systems was validated through a frontal sled test. Based on the validated sled test simulation models, the comparative biofidelity analyses between Q3 model and PIPER 3-year-old human model were conducted by the quantitative kinematic and biomechanical analyses. The internal chest structure difference between Q3 and PIPER 3-year-old human model is discussed, and the absence of the heart, lungs, and great vessels in the Q3 dummy leads to the low biofidelity; therefore, the chest structure and cardiopulmonary model of Q3 dummy were reconstructed to enhance the biofidelity. Results In comparison to the original Q3 model, the chest deflection, head forward displacement, and neck bending angle of the reconstructed Q3 model increased by 38.5, 2.2, and 17%, respectively, and the upward displacement of the hip decreased by 49%. The head swing degree of the reconstructed Q3 model is dramatically reduced during the rebound process, and the injury assessment criteria of the head, chest, and pelvis can reach more than 95% of the level of the PIPER 3-year-old human model. Conclusions This study shows that the chest reconstruction can significantly improve the biofidelity of the Q3 dummy, and future study is recommended to optimize the spinal structures of the Q3 model for further enhancement of biofidelity.