The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

Objective

The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994–2002.

Methods

Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at ‘baseline’, sex, and immigration status were added into the model as control variables. Three age groups were examined: young = 12–29.9; middle-aged = 30–59.9 and old = 60–85 years of age. The total sample size was 16,093.

Results

A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals.

Conclusions

Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety.     

Marital conflict and fifth-graders’ risk for injury

Background

Injuries are the leading cause of morbidity and mortality for American children. Marital conflict has been associated with a range of negative health outcomes, but little is known about how marital conflict may influence risk of injury among children. We hypothesized marital conflict would be related to increased youth injury risk after controlling for relevant demographic and parenting covariates.

Methods

A community sample of 3218 fifth-graders recruited from three US locales was utilized. Ordinal logistic regression models were used to predict the frequency of unintentional injuries from marital conflict while adjusting for demographics, parenting factors (nurturance, communication, involvement with youth), and family cohesion.

Results

Higher levels of marital conflict were associated with higher rates of injury that required professional medical attention (OR = 1.20, 95% CI 1.06, 1.35 per standard deviation). The same association held after inclusion of all covariates in a multivariate ordinal logistic regression model.

Conclusions

Parental marital conflict is associated with higher rates of injuries requiring professional medical attention in preadolescent children.     

Pediatric short-distance household falls: biomechanics and associated injury severity

Objectives

Short-distance household falls are a common occurrence in young children, but are also a common false history given by caretakers to conceal abusive trauma. The purpose of this study was to determine the severity of injuries that result from accidental short-distance household falls in children, and to investigate the association of fall environment and biomechanical measures with injury outcomes.

Methods

Children aged 0–4 years who presented to the Emergency Department with a history of a short furniture fall were included in the study. Detailed case-based biomechanical assessments were performed using data collected through medical records, interviews, and fall scene investigations. Injuries were rated using the Abbreviated Injury Scale (AIS). Each case was reviewed by a child abuse expert; cases with a vague or inconsistent history and cases being actively investigated for child abuse were excluded.

Results

79 subjects were enrolled in the study; 15 had no injuries, 45 had minor (AIS 1) injuries, 17 had moderate (AIS 2) injuries, and 2 had serious (AIS 3) injuries. No subjects had injuries classified as AIS 4 or higher, and there were no fatalities. Children with moderate or serious injuries resulting from a short-distance household fall tended to have fallen from greater heights, have greater impact velocities, and have a lower body mass index than those with minor or no injuries.

Conclusion

Children aged 0–4 years involved in a short-distance household fall did not sustain severe or life-threatening injuries, and no children in this study had moderate or serious injuries to multiple body regions. Biomechanical measures were found to be associated with injury severity outcomes in short-distance household falls. Knowledge of relationships between biomechanical measures and injury outcomes can aid clinicians when assessing whether a child's injuries were the result of a short-distance fall or some other cause.     

Parental influence on adolescent compliance with graduated driver licensing conditions and crashes as a restricted licensed driver: New Zealand Drivers Study

Aim

To examine the influence of parental knowledge of, and support for graduated driver licensing (GDL) conditions, parental management of adolescent driving and parental driving behaviour on adolescent compliance with GDL conditions and crashes as a restricted licence driver.

Method

This research was part of the New Zealand Drivers Study (NZDS), a prospective cohort study of 3992 newly licensed car drivers. NZDS participants were recruited at the learner licence stage, with follow-up aligned with the GDL stages. At the restricted licence stage 1200 parents of NZDS adolescents, aged 15–17 years at learner licensure, were recruited and completed interviews. 895 of these adolescents progressed to their full licence and completed the full licence interview. These 895 parent–adolescent pairs were the study population in this research. Topics examined included parental knowledge of, and support for GDL conditions, management of adolescent driving (driving rules, adolescent vehicle ownership, delaying licensure), and their own driving behaviours. Outcomes examined were adolescent compliance with GDL restricted licence conditions (night-time and passenger), and crashes as a driver during the restricted licence stage.

Results

After controlling for other variables, factors independently associated with adolescent low compliance with GDL conditions were: low parental knowledge of conditions, parents’ implementing few driving rules, adolescent vehicle ownership, and parent crash involvement. Factors independently associated with adolescents being a crash involved driver were: parents’ actively delaying licensure, adolescent vehicle ownership, and parent crash involvement.

Conclusion

There is increasing recognition of the importance of parental involvement in adolescent driving. The results show that parents are influential in determining adolescent compliance with GDL and risk of crash. Parents can have considerable positive influence on their adolescent's driving through ensuring compliance with the components of GDL, limiting vehicle ownership and by modelling safe driving behaviours.     

Examining parents’ behaviors and supervision of their children in the presence of an unfamiliar dog: Does The Blue Dog intervention improve parent practices?

Objectives

Young children are at particular risk for dog bite injuries. This study examined parents’ supervision of and reactions to their children in the vicinity of an unfamiliar dog.

Methods

A pre/post intervention/control group randomized design assessed whether exposure to The Blue Dog, a dog bite prevention and education program, positively impacted parent behaviors.

Results

No group differences in pre or post-intervention measures emerged, indicating that The Blue Dog did not evoke improvements in parents’ behaviors. Generally, parents showed risky reactions and encouraged children to interact with the dog, even though they knew very little about the dog's safety or disposition. Supervision measures (proximity, watching) remained unchanged (watching) or more lax (proximity) across sessions.

Conclusions

The results highlight the importance of targeting parent behavior, not just child behavior, in programs that aim to reduce risk of childhood dog bites. The Blue Dog did not effectively change parent behavior.     

Early identification of children at risk of unintentional injury: A sensation seeking scale for children 2-5 years of age

Objective

Sensation seeking is a personality attribute associated with injury in school-age children, adolescents, and adults. This study aimed to develop and evaluate the psychometric properties of a questionnaire measure of sensation seeking for young children 2-5 years of age.

Methods

Items tapping aspects of sensation seeking (Novelty Seeking, Behavioral Intensity, Thrill Seeking) were developed, content validation was completed by child development experts, and 72 parents then completed the Sensation Seeking Scale for Young Children (SSSYC) twice (3 months intervening) to establish internal and test-retest reliabilities. To assess criterion validity, scores were related to children's preferences for high versus low sensation seeking activities, their free play behavior in an indoor playroom, and to children's history of unintentional injuries.

Results

Indices of internal reliability and test-retest reliability were good and questionnaire scores positively correlated with sensation seeking behaviors during free play, preferences for high versus low sensation seeking activities, and injury measures, providing support for criterion validity.

Conclusion

This initial evaluation of the SSSYC suggests that it is a psychometrically sound measure of sensation seeking. This scale may be useful for identifying high sensation seekers at young ages, providing the opportunity for early intervention to prevent unintentional injuries.     

The impact of a home visitation programme on household hazards associated with unintentional childhood injuries: A randomised controlled trial

Background

The continued high mortality and morbidity rates for unintentional childhood injuries remain a public health concern. This article reports on the influence of a home visitation programme (HVP) on household hazards associated with unintentional childhood injuries in a South African low-income setting.

Methods

A randomised controlled trial (n = 211 households) was conducted in a South African informal settlement. Community members were recruited and trained as paraprofessional visitors. Four intervention visits were conducted over 3 months, focusing on child development, and the prevention of burn, poison, and fall injuries. The HVP, a multi-component intervention, included educational inputs, provision of safety devices, and an implicit enforcement strategy. The intervention effect (IE) was measured with a standardised risk assessment index that compared post-intervention scores for intervention and control households.

Results

A significant reduction was observed in the hazards associated with electrical and paraffin appliances, as well as in hazards related to poisoning. Non-significant changes were observed for burn safety household practices and fall injury hazards.

Conclusions

This study confirmed that a multi-component HVP effectively reduced household hazards associated with electrical and paraffin appliances and poisoning among children in a low-income South African setting.     

Relations between temperamental fear and risky pedestrian behavior

Objective

Child pedestrian injury poses a significant global public health challenge. This study examines relations between temperamental fear and children’s risky pedestrian behavior, utilizing mediation analytic strategies to study underlying mechanisms of the hypothesized relation.

Methods

As part of a larger study, 240 seven- and eight-year-old children completed 30 crossings in a virtual reality (VR) pedestrian environment. Three pedestrian behaviors were considered: start gap (lag after a traffic gap appears before child initiates crossing into the gap), time to contact (TTC; gap between avatar and the lead oncoming vehicle), and hits (collisions with vehicles in simulated crossings). Temperamental fear was measured by parent report.

Results

Fearful children were more likely to be struck by virtual vehicles, and the relation between fear and risky pedestrian behaviors was mediated by start gap and TTC. Specifically, children who were temperamentally more fearful were more likely to hesitate before initiating crossing, which led to shorter gaps between themselves and the oncoming vehicle, hence causing them to be more likely to be hit by virtual vehicles. Gender interacted with fear, such that fearful girls were most likely to be hit.

Conclusions

Both temperamental fear and gender influenced the risk of child pedestrian injuries. Delayed entry into traffic and shorter gaps between children and oncoming vehicles may underlie this relation. Future research should explore how these factors might influence the effectiveness of prevention programs.     

Personality subtypes of young moped drivers, their relationship to risk-taking behavior and involvement in road crashes in an Austrian sample

Objective

This study aimed to identify subtypes of young moped drivers and analyze how these subtypes are involved in risk preferences and road crashes.

Design

A group of Austrian teenage moped drivers (213, 28% girls) completed an online questionnaire about moped usage, injuries, driving style, inattention, impulsivity, and personality according to the Five-Factor Model of Personality and Cloninger's model of personality.

Results

A cluster analysis yielded four types of moped drivers. One type was characterized by a high level of neuroticism, the second type was characterized by a risky personality and a risky driving style, the third type had a more cautious driving style, and the fourth type was characterized by a risky personality and high levels on inattention and impulsivity.

Conclusions

Our conclusions suggest that young moped drivers should not be perceived as a homogenous group, according to measures of injury prevention and intervention.     

Supervisor vs. employee safety perceptions and association with future injury in US limited-service restaurant workers

Objectives

Many studies have found management commitment to safety to be an important construct of safety climate. This study examined the association between supervisor and employee (shared and individual) perceptions of management commitment to safety and the rate of future injuries in limited-service restaurant workers.

Methods

A total of 453 participants (34 supervisors/managers and 419 employees) from 34 limited-service restaurants participated in a prospective cohort study. Employees’ and managers’ perceptions of management commitment to safety and demographic variables were collected at the baseline. The survey questions were made available in three languages: English, Spanish, and Portuguese. For the following 12 weeks, participants reported their injury experience and weekly work hours. A multivariate negative binomial generalized estimating equation model with compound symmetry covariance structure was used to assess the association between the rate of self-reported injuries and measures of safety perceptions.

Results

There were no significant relationships between supervisor and either individual or shared employee perceptions of management commitment to safety. Only individual employee perceptions were significantly associated with future employee injury experience but not supervisor safety perceptions or shared employee perceptions.

Conclusion

Individual employee perception of management commitment to safety is a significant predictor for future injuries in restaurant environments. A study focusing on employee perceptions would be more predictive of injury outcomes than supervisor/manager perceptions.     

A prospective study of children aged <16 years in motor vehicle collisions in Norway: Severe injuries are observed predominantly in older children and are associated with restraint misuse

Objective

The implementation of the compulsory wearing of seat belts (SBs) for children and improvements in child restraint systems have reduced the number of deaths and severe injuries among children involved in motor vehicle (MV) collisions (MVCs). Establishing the characteristics predictive of such injuries may provide the basis for targeted safety campaigns and lead to a further reduction in mortality and morbidity among children involved in MVCs. This study performed a multidisciplinary investigation among child occupants involved in MVCs to elucidate injury mechanisms, evaluate the safety measures used and determine the characteristics that are predictive of injury.

Methods

A prospective study was conducted of all child occupants aged <16 years involved in severe MVCs in south-eastern Norway during 2009–2013. The exterior and interior of the MVs were investigated and the injured children were medically examined. Supplementary information was obtained from witnesses, the crash victims, police reports, medical records and reconstructions. Each case was reviewed by a multidisciplinary team to assess the mechanism of injury.

Results

In total, 158 child occupants involved in 100 MVCs were investigated, of which 27 (17%) exhibited Abbreviated Injury Scale (AIS) scores of 2+ injuries and 15 (9%) exhibited AIS 3+ injuries. None of the children died. Of those with AIS 2+ injuries (n = 27), 89% (n = 24) were involved in frontal impact collisions and 11% (3/27) were involved in side impacts. Multivariate analysis revealed that restraint misuse, age, the prevailing lighting conditions and ΔV were all independently correlated with AIS 2+ injuries. Safety errors were found in 74% (20/27) of those with AIS 2+ injuries and 93% (14/15) of those with AIS 3+ injuries. The most common safety error was misuse of restraints, and in particular loose and/or improperly positioned SBs.

Conclusion

The risk of injury among child occupants is significantly higher when the child occupants are exposed to safety errors within the interior of the vehicle. Future campaigns should focus on the prevention of restraint misuse and unsecured objects in the passenger compartment or boot.     

Examining the relative effectiveness of different message framing strategies for child passenger safety: Recommendations for increased comprehension and compliance

Background

Age-appropriate child restraints and rear seating dramatically reduce injury in vehicle crashes. Yet parents and caregivers struggle to comply with child passenger safety (CPS) recommendations, and frequently make mistakes when choosing and installing restraints. The purpose of this research was to evaluate various methods of framing CPS recommendations, and to examine the relative effectiveness on parents’ knowledge, attitudes, and behavioral intentions related to best practices and proper use of child restraints. Emphasis framing is a persuasion technique that involves placing focus on specific aspects of the content in order to encourage or discourage certain interpretations of the content.

Method

A 5 (flyer group) X 2 (time) randomized experiment was conducted in which 300 parent participants answered a pre-survey, viewed one of four flyer versions or a no-education control version, and completed a post-survey. Surveys measured CPS knowledge, attitudes, perceptions of efficacy and risk, and behavioral intentions. The four flyers compared in this study all communicated the same CPS recommendations, but several versions were tested which each employed a different emphasis frame: (1) recommendations organized by the natural progression of seat types; (2) recommendations which focused on avoiding premature graduation; (3) recommendations which explained the risk-reduction rationale behind the information given; or (4) recommendations which were organized by age. In a fifth no-education (control) condition, participants viewed marketing materials.

Results

Analyses of covariance and pairwise comparisons indicated the risk-reduction rationale flyer outperformed other flyers for many subscales, and significantly differed from no-education control for the most subscales, including restraint selection, back seat knowledge, rear-facing knowledge and attitudes, total efficacy, overall attitudes, and stated intentions.

Conclusions

This research provides insight for increasing caregiver understanding and compliance with CPS information. Recommendations for the field include communicating the rationale behind the information given, using behavior-based directives in headers, avoiding age-based headers, and incorporating back-seat positioning directives throughout.     

Cyclists’ clothing and reduced risk of injury in crashes

Introduction

A majority of cyclists’ hospital presentations involve relatively minor soft tissue injuries. This study investigated the role of clothing in reducing the risk of cyclists’ injuries in crashes.

Methods

Adult cyclists were recruited and interviewed through hospital emergency departments in the Australian Capital Territory. This paper focuses on 202 who had crashed in transport related areas. Eligible participants were interviewed and their self-reported injuries corroborated with medical records. The association between clothing worn and injury was examined using logistic regression while controlling for potential confounders of injury.

Results

A high proportion of participants were wearing helmets (89%) and full cover footwear (93%). Fewer wore long sleeved tops (43%), long pants (33%), full cover gloves (14%) or conspicuity aids (34%). The primary cause of injury for the majority of participants (76%) was impact with the ground. Increased likelihood of arm injuries (Adj. OR = 2.06, 95%CI: 1.02–4.18, p = 0.05) and leg injuries (Adj. OR = 3.37, 95%CI: 1.42–7.96, p = 0.01) were associated with wearing short rather than long sleeves and pants. Open footwear was associated with increased risk of foot or ankle injuries (Adj. OR = 6.21, 95%CI: 1.58–23.56, p = 0.01) compared to enclosed shoes. Bare hands were associated with increased likelihood of cuts, lacerations or abrasion injuries (Adj. OR = 4.62, 95%CI: 1.23–17.43, p = 0.02) compared to wearing full cover gloves. There were no significant differences by fabric types such as Lycra/synthetic, natural fiber or leather.

Conclusions

Clothing that fully covers a cyclist’s body substantially reduced the risk of injuries in a crash. Coverage of skin was more important than fabric type. Further work is necessary to determine if targeted campaigns can improve cyclists’ clothing choices and whether impact protection can further reduce injury risk.     

Antecedents and consequences of pediatric dog-bite injuries and their developmental trends: 101 cases in rural China

Objective

Study the contextual antecedents and consequences of pediatric dog bites in rural China.

Methods

A total of 101 caregivers from rural Anhui Province, China, whose children had suffered dog-bite injuries in the past year, participated in a structured interview about the circumstances, antecedents and consequences of their child's injury.

Results

Contextual circumstances identified frequently included outside-home environment and presence of peers but not adult supervisors. Frequent antecedents were dogs’ initiation of the encounter, children walking to/from school, and dogs unleashed. Consequences to children identified frequently were rabies vaccines, restricted activity, and fear of dogs. Developmental trends emerged, with bite circumstances differing by children's ages.

Conclusions

These results offer data on common antecedents and consequences of pediatric dog bites in rural China, a necessary prerequisite for development of empirically supported prevention programs in a vulnerable population.     

The role of parental alcohol consumption on driving under the influence of alcohol: results from a longitudinal, nationally representative sample

Purpose

Many studies have examined the role of peer and parental alcohol use on drinking behaviors among adolescents. Few studies, however, have examined parental influences on driving under the influence (DUI) of alcohol. The current study uses data from a longitudinal study to examine the role of parental alcohol use during adolescence on the risk for DUI among young adult men and women.

Methods

Data were derived from 9559 adolescents and young adults who participated in the National Longitudinal Study of Adolescent Health (Add Health) Waves I and III. Survey logistic regression was used to examine the relationship between multilevel risk and protective factors and self-reported DUI. Analyses were stratified by gender and frequency of parental alcohol consumption to understand the role of parental alcohol use on risk for DUI among their youth.

Results

Risk and protective factors for DUI were very similar among men and women. Parental alcohol use significantly predicted DUI among women (OR = 1.39, p < 0.01) and men (OR = 1.33, p < 0.05). When parents did not report alcohol use, peer alcohol use significantly increased risk for DUI for both women (OR = 1.26, p < 0.05) and men (OR = 1.31, p < 0.001). When parents reported alcohol use, however, peer alcohol use was not a significant independent predictor.

Conclusions

Findings suggest remarkable similarities in risk and protective factors for DUI across gender groups. For men and women, parental alcohol consumption was a risk factor for DUI. Peers’ alcohol use predicted DUI only when parents did not use alcohol.     

Evaluation of a child passenger safety class in increasing parental knowledge

Background

Child passenger restraint systems have been found to greatly reduce the risk of injury and death among child passengers. However, nearly half of the children who died in 2009 as a result of motor vehicle crashes were completely unrestrained. Our global hypothesis is that parents and other caregivers failed to restrain children due to a lack of child passenger seat education and practice. In this report, we postulate that a car seat class will improve the basic understanding of child passenger safety. The objective of the study was to evaluate the effectiveness of a car seat class in increasing parental knowledge about child passenger safety.

Methods

Car seat classes were held at a Level 1 pediatric trauma center every other Tuesday for ten months. The curriculum consisted of: child passenger safety laws discussion, a 21-min video on the use of child safety seats followed by a 15-min discussion about the video, 15 min of discussing the different types of car seats, and hands-on training on how to properly install and use child restraints. Free car seats were provided to eligible parents. The pre-test was administered at the beginning of class and the post-test at the end of the class. McNemar's test and a paired t-test were used to compare pre- and post-test scores. Test scores were also stratified by language spoken.

Results

Forty-four classes were held and a total of 491 parents/caregivers attended the classes. An increase in knowledge was found for all survey questions. Mean knowledge score for the post-test was 3.10 points higher compared to the mean knowledge score from the pre-test. Mean difference in knowledge scores for English-speaking participants were higher than Spanish-speaking participants.

Conclusion

Lack of knowledge and low risk perception have frequently been cited as barriers for the use of child passenger restraints. Our intervention attempted to eliminate these barriers. We found that this intervention was effective at increasing parental knowledge about child passenger safety. The results of this study may be used to design and implement future interventions in multicultural settings.     

Child bystanding: A risk factor for injury and identifying its’ determinants on midwestern agricultural operations

Background

Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operations. We evaluated the incidence and determinants of associated bystander injuries in the Regional Rural Injury Study-II (RRIS-II).

Methods

The RRIS-II followed 32,601 people (∼85% of eligible) from rural communities in the Midwest for 1999 and 2001, using six-month recall periods, and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews. Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury, while controlling for potentially confounding variables.

Results

Nearly 60% of all 425-child injury cases (<20 years) responded to sometimes/frequently bystanding in six out of seven different agricultural environments (e.g., workshops, animal areas, etc.) Multivariate regression analyses, with odds ratios and 95% confidence intervals, showed increased odds of injury for bystanding near used (1.5; 1.1, 1.9) or stored (1.4; 1.1, 1.8) machinery, and near fields and barnyards (1.4; 1.0, 1.9). Further, multivariate analyses revealed increased odds of bystanding for parental beliefs, such as: child age (1.4; 1.0, 2.0) near stored equipment. Parental levels of strictness were also evaluated and showed decreased odds of bystanding when the parents were not strict about the child's wearing a seatbelt near used equipment (0.5; 0.3, 1.0). Households with only one child had decreased odds of bystanding for five of the exposures while there was an increased odds of bystanding near animals for households with five or more children.

Conclusions

Although parents cannot child-proof their operations, it is important for them to understand the apparent odds of and risks associated with bystanding. Children can have injury odds similar to adults in this environment; therefore, it is necessary to examine parental factors that may be associated with children's likelihood of bystanding in high-risk work environments.     

Hospitalized head injuries in agricultural settings: Who are the vulnerable groups?

Objectives

The goal of this study was to identify subgroups of the farm population that are particularly vulnerable to head injury.

Methods

A retrospective case series of hospitalized head injuries was assembled from a national registry of agricultural injuries. Vulnerable subgroups were identified based on a priori criteria and the causes and consequences of their injuries were profiled.

Results

Three distinct subgroups of farm people were identified as being vulnerable: (1) farm children under the age of 10, injured most frequently by a fall from a structural height (42.5%); (2) females 10–19 years, injured most frequently by large animals (68.8%), mainly horses, and (3) men over age 60 years, who were injured by a diversity of mechanized and animal-related external causes.

Conclusion

This identification of vulnerable groups provides foundational information from which to develop and direct prevention efforts.     

Evaluation of child safety seat checkpoint events

Objective

To determine the effectiveness of child safety seat checkpoints in generating change in child restraint practice to reduce the prevalence and extent of misuse.

Methods

Child safety seats underwent an initial checkpoint evaluation and participants received a training session. Participants were asked to return within 6–12 months to a checkpoint for follow-up evaluation. During each visit, a data collection sheet was used to assess the participants’ use of their child safety seat, and to subsequently calculate a restraint misuse score to characterize the child safety seat's usage before and after the intervention.

Results

During the period of study, 42 participants underwent both the initial and follow-up child safety seat check. Before the intervention, at least one misuse was identified in 100% of installed child safety seats. After the intervention, there was a significant reduction in the proportion of rear-facing child safety seats (18.8%) and forward-facing child safety seats (64.0%) that had at least one misuse (p < 0.001). Almost all (93.4%) of those using rear-facing child safety seats and the majority (64.0%) of those using forward-facing child safety seats improved their safety score as measured after the intervention.

Conclusions

Although misuse was universally observed, child safety seat checkpoint events were successful in improving usage practices.