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BACKGROUND: Premature graduation to an adult seatbelt is common and detrimental to optimal crash protection. While there is an existing tool (the 5-step test) to support a parent's decision to graduate their child, its effectiveness is unknown. The aim of this study was to evaluate the 5-step test. METHOD: A randomised controlled design was used. Participants were parents of children aged 7-12 years. After exposure to information about the 5-step test or control material, participants assessed belt fit in three seating conditions and 'thought aloud' while making their assessment. Seating conditions provided a good, poor and partially good seatbelt fit based on the child's anthropometry. Participants were also assessed on their knowledge of good seatbelt fit criteria. RESULTS: Participants exposed to the 5-step test (n=18) had significantly improved their knowledge of the criteria required to achieve good seatbelt with, on average, 1.0 higher score in the 6-point assessment (95% CI 0.23 to 1.7, p=0.012) than those in the control group. There was also a greater percentage of participants in this group (44.4% intervention vs 27.8% control) who made accurate decisions about seatbelt fit, but this difference did not reach significance (OR 2.08, 95% CI 0.52 to 8.34). CONCLUSION: The results demonstrate that the 5-step test is effective in improving knowledge but are inconclusive about its effectiveness in promoting accurate decision-making. However, the proportion of participants making accurate decisions in the intervention group remained low. This suggests that parents may require greater assistance than what is currently provided.

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OBJECTIVE: Automatic Emergency Braking (AEB) has a direct impact on the effectiveness of the restraint systems in providing protection toward child occupants. The objective is to evaluate the effectiveness of Q6 and PIPER 6-year-old models in predicting the kinematic responses of child models, and further to quantify and analyze the child injuries during a frontal crash with and without AEB. METHODS: The finite element model of a booster seat has been validated through a full vehicle test. Based on the validated finite element model, two sled test finite element models for the rear seat booster seat with Q6 and PIPER 6-year-old models were constructed. AEB condition was imposed on above the two models and the kinematic responses of sitting posture including head, neck and chest have been compared in detail. The peak head displacement and neck curvature of Q6 dummy and PIPER 6-year-old models have been compared with the test data from child volunteers. Based on the child model with better predictive capability for kinematic response under AEB, child injuries were evaluated and analyzed for the 50 km/h frontal crash test with and without AEB. Last, this study discussed the effects of internal neck and chest structure difference between Q6 and PIPER 6-year-old models on child kinematic response and the injury risks. RESULTS: Under AEB condition, PIPER 6-year-old model has higher head displacement and lower trunk displacement than Q6 dummy model, and the peak head displacement and neck curvature of PIPER 6-year-old model are similar to the test data of child volunteers. During the 50 km/h frontal crash simulation with pre-crash AEB, the HIC15, Head acceleration 3 ms, Nij decrease 43.7%, 19.6% and 28.8%, respectively and the chest deflection increases 15.5% compared to the simulation without AEB. CONCLUSIONS: This study shows that PIPER 6-year-old model is more suitable for the quantification of sitting posture change under AEB due to its higher biofidelity. The pre-crash AEB can substantially reduce the head, neck injuries. But it also increases the chest injury due to the chest pre-compression. Future efforts are recommended to lower the child chest injury by integrating AEB with active pre-tensioning seatbelts.

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BACKGROUND: Older children are at an increased risk of injury due to less commonly being in an appropriate child safety seat (CSS). Proper installation and consistent use of CSSs can significantly reduce child and infant automobile injuries. While research exists around parent behaviours concerning CSS use (or lack), little research takes place at the county level to identify normative beliefs as they contribute to risk factors. METHODS: Through a mixed-methods approach, this evaluation retrospectively determines the Salt Lake County Health Department's impact on CSS usage, as well as identify normative parent behaviours that impact CSS usage. RESULTS: Results indicated that parents' level of education and being in the car with family/friends was significantly associated with overall CSS usage. DISCUSSION: More research is needed to specify parent normative beliefs around CSS use (or lack).

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BACKGROUND AND OBJECTIVES: Correct child car restraint use significantly reduces risk of death and serious injury in motor vehicle crashes, but millions of US children ride with improper restraints. We created a tablet-based car restraint educational intervention using Computer Intervention Authoring Software (CIAS) and examined its impact on knowledge and behaviours among parents in the paediatric emergency department (PED). METHODS: This was a non-blinded, randomised controlled trial of parents of PED patients ages 0-12 years. Participants were evaluated for baseline car restraint knowledge and behaviour. The intervention group completed an interactive tablet-based module, while the control group received printed handouts on car restraint safety. After 1 week, both groups received a follow-up survey assessing changes in car restraint knowledge and behaviour. Logistic regressions determined predictors of knowledge retention and behavioural changes. Parents in the CIAS group were also surveyed on programme acceptability. RESULTS: 211 parents completed the study with follow-up data. There was no significant difference in baseline car restraint knowledge (74.3% correct in intervention, 61.8% in control, p=0.15), or increase in follow-up restraint knowledge. Significantly more intervention-group caregivers reported modifying their child's car restraint at follow-up (52.5% vs 31.8%,p=0.003), and 93.7% of them found CIAS helpful in learning to improve car safety. CONCLUSION: Parents had overall high levels of car restraint knowledge. Using CIAS led to positive behavioural changes regarding child car restraint safety, with the vast majority reporting positive attitudes towards CIAS. This novel, interactive, tablet-based tool is a useful PED intervention for behavioural change in parents. TRIAL REGISTRATION NUMBER: NCT03799393.

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INTRODUCTION: The American Academy of Pediatrics (AAP) guidelines recommend that children ≤12-years-old with height < 145 cm should use safety/booster seats. However, national adherence and clinical outcomes for eligible children involved in motor vehicle collisions (MVCs) are unknown. We hypothesized that children recommended to use safety/booster seats involved in MVCs have a lower rate of serious injuries if a safety/booster seat is used, compared to children without safety/booster seat. METHODS: This retrospective cohort study queried the 2017-2019 Trauma Quality Improvement Program database for patients ≤12-years-old and <145 cm (recommendation for use of safety/booster seat per American Academy of Pediatrics) presenting after MVC. Serious injury was defined by abbreviated injury scale grade ≥3 for any body-region. High-risk MVC was defined by authors in conjunction with definitions provided by the Centers for Disease Control and Prevention and the American College of Surgeons Committee on Trauma. RESULTS: From 8259 cases, 41% used a safety/booster seat. There was no difference in overall rate of serious traumatic injuries or mortality (both p > 0.05) between the safety/booster seat and no safety/booster seat groups. In a subset analysis of high-risk MVCs, the overall use of safety/booster seats was 56%. The rate of serious traumatic injury (53.6% vs. 62.1%, p = 0.017) and operative intervention (15.8% vs. 21.6%, p = 0.039) was lower in the safety/booster seat group compared to the no safety/booster seat group. CONCLUSIONS: Despite AAP guidelines, less than half of recommended children in our study population presenting to a trauma center after MVC used safety/booster seats. Pediatric patients involved in a high-risk MVC suffered more serious injuries and were more likely to require surgical intervention without a safety/booster seat. A public health program to increase adherence to safety/booster seat use within this population appears warranted.

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OBJECTIVE: Booster seat use among the general population remains relatively low, despite their effectiveness in preventing injury among children when involved in motor vehicle collisions. Given the prevention of injuries that booster seats provide, understanding the factors that hinder or facilitate the use of these seats is critical, particularly in communities that are often overlooked when conducting general population studies. To date, no studies have examined the prevalence and predictors of booster seat use among Indigenous peoples in Canada. The purpose of this study was to examine the use of booster seat use among Indigenous peoples across Canada and the factors that impact their use. METHODS: Data were collected from a survey of participants from First Nations communities and organizations serving Indigenous peoples nationwide. Hypotheses arising from known predictors of booster seat use across the general population were tested using logistic regression models. RESULTS: The strongest predictor of booster seat use, even when all other study factors were accounted for, was the reduction of barriers related to the use of booster seats, such as a child's resistance to being placed or staying in the passive safety restraint or a parent, guardian, or other caregiver being unwilling to use or unsure of how to install/setup the booster seat. CONCLUSION: Most Indigenous participants consistently used booster seats to safely secure children being transported in vehicles. However, this compliance rate is well below that of the general population. Accessibility and affordability of child safety restraints and/or children's refusal to use booster seats, as well as having more than 1 child to secure, were identified as mitigating factors. Access to and the affordability of booster seats, coupled with clear and understandable information on how to use them, are critical components to compliance. Raising awareness among Indigenous peoples communities regarding the importance of using booster seats is imperative. To achieve this, Indigenous peoples must lead discussions to ensure that child safety strategies not only are based on research and best practices but are culturally connected and community driven. Through meaningful collaboration, vehicle-related injuries and mortality among Indigenous children can be significantly reduced.

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BACKGROUND: Lack 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. METHODS: Using 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. RESULTS: The 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). CONCLUSIONS: Most 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.

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Booster seats reduce injury in motor vehicle crashes, yet they are used less frequently than car seats and seat belts. Primary care providers are well positioned to educate and encourage families to use booster seats. We aimed to assess how a booster seat distribution program affected the documentation of restraint usage and anticipatory guidance at well-child visits at a pediatric primary care practice. We performed a retrospective chart review of patients aged 4 to 12 years from June to December in 2019 and 2020, representing before and after a booster seat program. The most frequently documented restraints in 2019 and 2020 were seat belts (51% vs 30%), booster seats (25% vs 27%), and not documented/unclear (17% vs 25%) (P < .001). The program significantly increased referrals for booster seats (P < .001). Despite significant differences in the proportion of children in each restraint category, overall booster seat use was similar between years.

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OBJECTIVE: The purpose of the current study is to use 3D technology to measure in-vehicle belt fit both with and without booster seats across different vehicles among a large, diverse sample of children and to compare belt fit with and without a booster. METHODS: Lap and shoulder belt fit were measured for 108 children ages 6-12 years sitting in the second-row, outboard seats of three vehicles from October 2017 to March 2018. Each child was measured with no booster, a backless booster, and a high-back (HB) booster in three different vehicles. Alternative high-back (HB HW) and backless boosters that could accommodate higher weights were used for children who were too large to fit in the standard boosters. Lap and torso belt scores were computed based on the belt location relative to skeletal landmarks. RESULTS: Both lap and torso belt fit scores were significantly different across vehicles when using the vehicle belt alone (no booster). In all vehicles, lap belt fit improved when using boosters compared with no booster among children ages 6-12 years in rear seats-with one exception of the HB HW booster in the minivan. Torso belt fit improved when using boosters compared with no booster in the sedan, and torso belt fit improved in the minivan and SUV with the use of HB and HB HW boosters when compared with no booster. CONCLUSIONS: Lap and torso belt fit for children ages 6-12 years in rear seats was substantially improved by using boosters. Parents and caregivers should continue to have their children use booster seats until vehicle seat belts fit properly which likely does not occur until children are 9-12 years old. Decision makers can consider strengthening child passenger restraint laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 to improve belt fit and reduce crash injuries and deaths.

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OBJECTIVE: It is often assumed that a child restraint with a five or six-point internal harness provides greater protection for children in frontal crashes than a booster seat with a lap-sash seat belt. However, most research comparing these restraint types has focused on protection for children aged up to approximately 3-4 years of age. Recently, harnessed child restraints for older children up to approximately 8 years of age have become available, but there is little data on their performance compared to booster seats for children over 4 years of age. This study aimed to compare frontal crash performance of a series of harnessed child restraints for children aged 4-8 years to booster seats. METHODS: Four large harnessed child restraints (Type G in the Australian Standard, AS/NZS 1754:2013) and six high back booster seats (Type E in AS/NZS 1754:2013) were tested in frontal impact on a deceleration sled. Head and pelvis accelerations were recorded and head excursions were measured from high speed video. RESULTS: Head excursion was an average of 92 mm greater in the large harnessed child restraints than the high back booster seats. The initial position of the head in Type G restraints, an average of 58 mm further forward compared to Type E boosters, was the main contributor to the larger head excursion during impact. Conversely, peak head accelerations in the impact phase were, on average, 37.2 g lower in the large harnessed child restraints than the high back booster seats. CONCLUSIONS: These data suggest that recommendations for harnessed restraints and booster seats for children aged 4-8 years is not as obvious as is sometimes assumed. Harnessed restraints allow greater head excursion in frontal impacts, potentially increasing the chances of head impacts, especially in vehicles with limited clearance between the restraint and the seat in front. The likelihood, and types of, incorrect use that occur in each restraint type, the vehicle occupant space, and the restraint's crash performance under ideal conditions should be considered in recommending restraints for these older children.

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Seating configurations for autonomous driving will include reclined front seated occupants, which may expose child occupants seated directly behind to head impacts even in pre-crash scenarios. This study used mathematical modelling to investigate head contact for second-row child occupants seated behind a reclined front-seat during an automatic emergency braking (AEB) scenario. Although characterized by low speed (<1 m/s), head contacts were observed for a seatbelt-restrained 10-year-old and a 6-year-old in a low-back booster when the front-seat was reclined and in an aftward track position. Future seating configurations should consider the potential for head contact by second-row child occupants during crash-avoidance scenarios.

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OBJECTIVES: The objective was to understand how the use or nonuse of the Lower Anchors and Tethers for Children (LATCH) system affects the performance of booster seats during frontal impacts. METHODS: Sixteen frontal impact sled tests were conducted at 24.8 ± 0.3 g and 50.1 ± 0.2 kph. A production vehicle seat buck was attached to the sled. Four high-back boosters or combination seats in high-back booster mode and two backless booster models were tested. Each booster model was installed two different ways: using the LATCH system ("LATCH" installation) and without using the LATCH system ("non-LATCH" installation). All installations used a 3-point seat belt with retractor in emergency locking mode (ELR) to restrain a Hybrid III 6-year-old anthropomorphic test device (ATD). The retractor, belt webbing, buckle, vehicle seat cushion, and booster were replaced after each test. Some conditions were tested twice to establish repeatability. ATD and booster responses were compared between LATCH and non-LATCH tests. RESULTS: Using LATCH reduced the forward movement of the booster itself by 32.3% to 71.5% compared to non-LATCH installations. Differences in most other metrics were small and often within the range of normal test-to-test variation. Forward movements of the ATD head and heel were similar between LATCH and non-LATCH tests (typically less than 10% difference). HIC36 values trended slightly higher for LATCH installations compared to non-LATCH installations (0.8% to 17.2%). Chest resultant accelerations were typically 7.3% to 21.2% higher for LATCH installations, except for one booster for which it was lower with LATCH. Chest deflections trended higher for LATCH installations compared to non-LATCH installations for the backless boosters (6.9% to 14.1%). For high-back boosters, chest deflection was similar between installation conditions (less than 5% difference). Shoulder belt loads showed the greatest reductions when LATCH installations included a top tether (12.9% to 20.8%). Instances of the ATD submarining under the lap belt were not observed in these tests. CONCLUSIONS: Overall, the differences in kinematics and injury metrics were small between boosters installed using LATCH vs. non-LATCH.

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Objective: There is little data defining safe transport protocols for spica-casted children. A single earlier study demonstrated the presence of a body cast alters kinematics and injury metrics during simulated side-impact crashes. Since then, the National Highway Transportation Safety Administration (NHTSA) proposed a new side-impact test protocol for evaluating child restraints. This test is more severe than the earlier tests, as it simulates an impact with a door intruding into the occupant space. As no currently available child restraint system (CRS) able to accommodate a spica-casted child has been evaluated using these updated testing criteria, the objective of this study was to evaluate current restraint options in simulated side-impact collisions using an anthropomorphic test device (ATD) modeled after a 3-year-old.Methods: Four commercially available CRSs able to accommodate a spica-casted Q3s side-impact ATD were selected for testing. Side-impact testing was performed using casted and uncasted ATDs in compliance with the NHTSA proposed side-impact test. High-speed photography and ATD instrumentation were used to measure selected injury criteria.Results: HIC15 values were highest in CRSs with less robust side wings, such as the Merritt WallenburgTM (HIC15 = 1,373), which allow for the occupant to interact with the intruding door panel. Head contact with the door panel was found to correspond with high resultant neck peak force. Pelvic acceleration magnitudes were greatest for the uncasted tests. Casted tests with a CRS that included an armrest were associated with greater torso rotation in the frontal plane with the left shoulder moving toward the door panel.Conclusions: The presence of a spica cast alters injury metrics in side-impact testing. Spica specific child safety seats are not yet optimized for side-impact with door intrusion. This is due to a lack of adequate side cushion wings, which may place both casted and uncasted occupants at increased likelihood for injury through head contact with an intruding door. Additional work is needed to improve the safety of CRSs for both casted and uncasted children in side-impact collisions.

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Objective: To systematically review and summarize articles evaluating the effectiveness of child restraint system (CRS) interventions targeting parents/caregivers' knowledge of, overall rates of and/or proper use of CRSs published in a recent time period.Methods: Using multiple databases, we identified peer-reviewed journal articles published between January 1, 2007 and December 31, 2018 using selected key search terms. Inclusion criteria were: (1) evaluation of an intervention/program for child passenger safety targeting a parent or caregiver of a child (2) quantitative data-based results (i.e., change in knowledge, behavior, or observed outcomes), (3) English-language, and (4) peer-reviewed journal publication. Through a systematic review process and peer consensus, n = 23 articles met inclusion criteria. References of these articles were reviewed for inclusion using the same process and n = 12 additional articles were identified.Results: A total of n = 35 articles met inclusion criteria. Of the n = 35 articles, n = 9 were randomized controlled trials (RCTs), n = 4 were cluster RCTs, n = 11 were nonrandomized trials, and n = 11 were pretest post-test studies. Types of interventions included face-to-face education (n = 26), web/video-based education (n = 8) or written educational materials (n = 1). Of the articles reviewed, n = 20 involved distribution of free or subsidized CRSs to some or all subjects. N = 20 articles involved trained CRS technicians and/or CRS installation check-points. In terms of outcomes measured, n = 3 articles assessed changes in knowledge of CRS use, n = 22 assessed changes in CRS behaviors (which includes self-report or observed behavior change), and n = 10 assessed changes in both CRS knowledge and behaviors. All articles (n = 3) that measured changes in knowledge as their only outcome demonstrated positive effects while articles measuring behavioral outcomes (self-report or observed) (n = 32) had mixed results.Conclusions: This review included a wide range of articles of heterogeneous methodologies, sample sizes, and outcomes measured. Although different approaches to CRS interventions were effective in increasing awareness and knowledge, the effects on CRS use behaviors - whether self-reported or observed - were mixed. Future research is needed to increase appropriate CRS use and reduce the burden of motor vehicle crash-related injuries among children.

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Objective: Precrash occupant motion may affect head and trunk position and restraint performance in a subsequent crash, particularly for young children. Others have studied seat belt-restrained adult drivers and adult and adolescent passengers in precrash maneuvers. For younger children, optimal restraint includes a belt-positioning booster seat, which in precrash maneuvers may contribute in unique ways to the overall body motion. Therefore, the objective of this study was to quantify booster-seated child occupant kinematic, kinetic, and muscle responses during precrash maneuvers and characterize booster movement with respect to the overall occupant kinematics.Methods: Vehicle maneuver tests were conducted with a recent model year sedan at the Transportation Research Center Inc. (TRC, Marysville, Ohio). Three precrash vehicle maneuvers were simulated: Automated and manual emergency braking (AEB and MEB) and oscillatory swerving or slalom (SLA). Each maneuver was repeated twice for each participant. Seven 6- to 8-year-old booster-seated children participated in the study and all subjects were seated in the right rear seat. Vehicle dynamics (i.e., motion, position, and orientation) were measured with an inertial and Global Positioning System navigation system (Oxford RT 3003). Kinematic data from human volunteers were collected with an 8-camera 3D motion capture system (Optitrack Prime 13 200 Hz, NaturalPoint, Inc.). Photoreflective markers were placed on participants' head and trunk. Electromyography (EMG; Trigno EMG Wireless Delsys, Inc., 2,000 Hz) sensors were placed on bilateral muscles predicted to be most likely involved in bracing behaviors.Results: Children demonstrated greater head and trunk velocity in MEB (head 123.7 ± 13.1 cm/s, trunk 77.6 ± 14.1 cm/s) compared to AEB (head 45.31 ± 11.5 cm/s, trunk 27.1 ± 5.5 cm/s; P < .001). Participants also showed greater head motion in MEB (18.9 ± 1.4 cm) vs. AEB (15.1 ± 4.8 cm) but the differences were not statistically significant (P < .1). Overall, the booster seats themselves did not move substantially (<3 cm) in the braking maneuvers. During the SLA, however, the booster seat moved laterally up to 5 cm in several subjects, contributing substantially to peak trunk (6.5-14.0 cm) and head (9.9-21.4 cm) excursion during the maneuver. Booster-seated children also exhibited a greater activation of biceps and deltoid muscles and abdominal and middle trapezii muscles than the sternocleidomastoids during these maneuvers.Conclusions: The quantification of booster seat motion and neuromuscular control and the relationship between kinematics and muscle activation in booster-seated children in precrash maneuvers provides important data on the transition between the precrash and crash phases for this young age group and may help identify opportunities for interventions that integrate active and passive safety.

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Objective: In this study, we assessed the number of child passenger safety technicians (CPSTs) in Michigan over 4 years and characterized the CPST workforce in 2015 to identify factors associated with high productivity and longevity in the field. Methods: We determined the number of CPSTs and those newly certified using lists from the Michigan Office of Highway Safety Planning (OHSP) from 2012 to 2015. We conducted a statewide survey of Michigan CPSTs in October 2015. Analyses were conducted in 2016. The survey assessed demographic characteristics, reasons to enter the field and maintain certification, and motivations to conduct seat checks. We used CPST-reported time devoted to seat checks and average number of seats checked per month to create a composite "activity level" variable. We examined activity levels across several characteristics. Results: The number of CPSTs ranged from 941 to 980 over the study period, with approximately 200 new certifications annually. In 2015, surveys were started by 496 of 962 eligible CPSTs and 427 submitted complete responses. CPST-instructors had a higher response rate than CPSTs in general (89 vs. 49%, P < .0001). The majority of respondents were women (71%) and self-identified as white (88%). More than one third were 35-44 years old. Just 7% were comfortable checking seats using a language other than English. "Personal reasons" were most often cited motivation for becoming a CPST and maintaining certification. Natural fit/job enhancement were more common reasons to maintain certification than become a CPST. Time and distance had the greatest influence on seat check participation. Perceived need, appointments vs. drop-in, and employer factors were very influential for 10-15% of CPSTs. Few CPSTs considered free food and payments/giveaways very influential. About 40% of respondents were considered high-activity (>24 seats checked/year), one third medium-activity (5 to 24 seats checked/year), and one quarter low-activity (<5 seats checked/year). High-activity CPSTs most commonly reported both being paid and volunteering their time to check seats, worked with a Safe Kids coalition, worked in law enforcement or social services, and had recertified at least once. Motivation to participate in seat checks did not vary with activity level. Conclusions: Understanding the demographic characteristics and motivations of CPSTs can help Michigan OHSP recruit and retain a workforce dedicated to increasing the safety of child passengers. Agencies hosting seat checks can use these results to align the strategies they employ to incentivize CPSTs to serve in their communities with the factors that have the greatest influence on CPST participation.

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BACKGROUND: Little is known about the barriers to use of child car seats in Australian Aboriginal communities, or the acceptability of programs to increase appropriate car seat use. This formative evaluation sought to consult and partner with Aboriginal Community Controlled Health Services (ACCHS) to develop and evaluate the feasibility and acceptability of a program intended to improve optimal use of child car seats. METHODS: Focus groups were conducted with parents and carers of Aboriginal children to identify the barriers and facilitating factors for child car seat use, and staff of two ACCHS were interviewed to inform program development. Following the implementation of the resulting multi-faceted program, consisting of staff training, education, hands-on demonstrations and a subsidised car seat distribution scheme, interviews were conducted to assess process issues and acceptability with 13 staff members. RESULTS: Parents and carers in the focus groups reported a lack of awareness of child car seat use, confusion about the right car seats for different aged children but agreed about the importance of safety and community responsibility to keep children safe in cars. Interviews with service staff informed an approach to deliver relevant information. Information and resources were delivered to families, while the car seat distribution scheme supplied 33 families with child car seats. Following the conclusion of the program, staff reported that the program was relevant to their role. They also valued the car seat distribution scheme. Staff training in selection and installation of car seats increased confidence in staff knowledge. CONCLUSIONS: We developed a program to promote child car seat use in ACCHS, which focused on developing capacity, made use of existing infrastructure and developed resources for use in this setting. The program shows promise as a means to promote child car seat use in Aboriginal communities; however, the impact on child car seat use will need to be evaluated in a larger scale prospective trial.

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Suboptimal compliance with child restraint system (CRS) recommendations can increase risk for injury or death in a motor vehicle crash. The purpose of this study was to examine scenarios associated with incomplete CRS use and non-use in children ages 4⁻10 years. We used a cross-sectional online survey with a convenience sample of parent/caregivers from the United States, age ≥18 years, with a child age 4⁻10 years in their home, who could read and spoke English, and drove child ≥6 times in previous three months. We used descriptive statistics and Mann-Whitney U to describe and compare the distribution of responses to situational use of CRSs among car seat users and booster seat users. We also used descriptive statistics and the Mann-Whitney U to describe and compare the distribution of responses to carpooling items among booster seat users and non-booster seat users. There were significant differences among those who reported most often using booster seats (n = 282) and car seats (n = 127) in situations involving rental cars, driving just around the corner, car too crowded to fit the CRS, not enough CRSs in the vehicle, the CRS is missing from the car, or the child is in someone else's car without a CRS (p < 0.05). Among those who reported most often using booster seats and who carpooled other children (n = 159), 71.7% (n = 114) always used a booster seat for their own child. When carpooling other children, booster seat users were significantly more likely to use booster seats for other children ages 4⁻10 than the non-booster seat users (p < 0.01). Continued education and programs surrounding CRS use is critical, particularly for children who should be in booster seats.

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OBJECTIVES: To examine characteristics associated with cell phone use while driving by parents and caregivers of children ages 4-10 years. STUDY DESIGN: National cross-sectional online survey with a convenience sample (March 2017-April 2017). INCLUSION CRITERIA: Parent/caregiver of a child age 4-10 years in their home, age ≥18 years, read and spoke English, and drove child ≥6 times in previous 3 months. Adjusted logistic regression analyses were modeled for outcome measures of previous 3-month self-report cell phone use while driving with the child. RESULTS: The analytic sample was n = 760. In the previous 3 months, 47% of parent/caregivers talked on a hand-held phone, 52.2% talked on a hands-free phone, 33.7% read texts, 26.7% sent texts, and 13.7% used social media while driving with their child in the vehicle. Compared with those who always used their typical child restraint system, participants who did not always use were more likely to talk on a hands-free phone (aOR 1.97, 95% CI 1.26-3.09), read a text (aOR 1.74, 95% CI 1.11-2.73), send a text (aOR 1.65, 95% CI 1.04-2.62), and use social media (aOR 2.92, 95% CI 1.73-4.94) while driving. Higher income, not wearing a seat belt (driver) on every trip, and driving under influence of alcohol also were associated with various types of cell phone use while driving. CONCLUSIONS: Inconsistent child restraint system use, lack of seat belt use, and driving under the influence of alcohol are associated with parent/caregiver cell phone use while driving. Screening and education related to parental driving behaviors should include addressing multiple risk behaviors.

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OBJECTIVE: To increase the protection of child passengers in crashes preceded by evasive steering, understanding of how children interact with the seat belt in such situations is essential. This study aims to quantify child kinematics and describe child-to-restraint interaction during evasive steering maneuvers. METHODS: Eighteen child volunteers (aged 5-10) were seated on the rear seat of a passenger vehicle. A professional driver made repeatable sharp turns at 50 km/h. Children were restrained by the seat belt on a booster cushion (BC) and on an integrated booster cushion (IBC). Kinematics of the nasion and upper sternum were analyzed with video tracking software and shoulder belt (SB) engagement and position were evaluated. RESULTS: Children moved laterally inboard, and SB-to-body interaction was influenced by booster and stature. Shorter children displayed initial SB positions closer to the neck with less instances of gap between the SB and the lower torso, resulting in more curved belt paths on the IBC. On the BC, shorter children had less of the SB in contact with the torso and straight belt paths were observed throughout steering. Taller children generally had the SB initially mid-shoulder with less instances of gap, resulting in curved belt paths at initial and maximum displacements on both boosters. Children loaded the shoulder belt by axially rotating their torso into the SB more often on the IBC compared to BC. The SB generally stayed on the shoulder, with 89% of slip-off instances occurring for shorter children on the BC. Shorter children on the BC had the largest average inboard nasion displacement (120 mm). Taller children on the BC had the lowest average inboard displacement of the nasion (100 mm). All children initially displaced on average 90 mm inboard with their upper sternum. CONCLUSIONS: Initial SB position on the shoulder and torso differed with booster and stature, which influenced how children engaged with the seat belt during steering. Children with less SB initially in contact with the torso moved laterally behind the belt, resulting in straighter SB paths and outboard motion of the SB on the shoulder (often ending far out or slipped off). When more of the SB was initially in contact with the torso, children tended to engage the SB more, moving with the belt and causing the SB path to become more curved, resulting in less inboard head displacement and less outboard motion of the SB on the shoulder. Enhanced understanding of how evasive steering affects the kinematic response of children provides valuable data for protection of children in real-world situations.

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