Rear Facing Car Seat Invesigation
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Rear Facing Car Seat Invesigation

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    Rear Facing Car Seat Invesigation Rear Facing Car Seat Invesigation Presentation Transcript

    •  
    •  
      • Summer 2010
      • Location: Stark County Health Department
      • Faculty Preceptor: Clair Bourguet
      • Community Preceptor: Amanda Kelly
      • Title: Health Educator-Injury Prevention Program Coordinator-Safe Kids Stark County
      • Competencies: A:4-10, C:3,7-9, D:3,5,6,8,10 E:1,2,4,5 F:3,8, G:1-10, H:4,6-9, J:2,3,5,9-11, K:1-3,5, L:2,4,6,7
      • Initial interest was sparked by Bachelor’s degree in Human Development and Family Studies and concentration in Family Life Education
      • The concept of “extended rear facing” car seat use was introduced to me after my daughter was born
      • In 2007, a study published in Injury Prevention 1 concluded that:
          • -Rear facing car seats are more effective than forward facing car seats in protecting restrained children aged 0-23 months.
          • -The benefit of rear facing car seats was also evident when only children ages 12-23 months were included.
          • -Data showed that protection of rear facing in side impact crashes was best.
          • -The authors recommend parents prolong the use of rear facing car seats for best protection.
      • In 2009, an article in the British Medical Journal 2 made the recommendation that physicians should begin advising parents to rear face children to the age of 4 based on a literature review.
      • In 2009, the American Academy of Pediatrics 3 published in its Parents Plus publication that:
          • “ Toddlers should remain rear-facing in a convertible car seat until they have reached the maximum height and weight recommended for the model, or at least the age of 2.”
      • Finally, a study done by the NHTSA 4 found that 21% of children under 12 months or 20lbs were not rear facing as recommended
      • Very little investigation into rear facing beyond 12 months
      • Use findings for social marketing campaigns
      • Reduce injury and death in children 0-24 months in motor vehicle crashes
    •  
      • Estimate the level of rear and forward facing compliance in Stark County
      • Examine the Theory of Planned Behavior and Health Belief Model relationship to car seat placement compliance
      • Examine demographic factors that influence car seat placement compliance
    •  
      • Measures were developed using “Constructing a TPB Questionnaire: Conceptual and Methodological Considerations” manual
      • Intention, subjective norms, perceived behavioral control and intention all measured with Likert scale statements
      • Attitude-measured with a semantic differential scale with oppositional adjectives
      • Direct measures were used for all constructs
      • Example scales:
      Strongly Agree Neutral Strongly Disagree I plan to place my child in a rear facing car seat position for 24 months (Intention) 1 2 3 4 5 My doctor wants me to rear face for 24 months (Social Norms) 1 2 3 4 5 Placing my child in a rear facing car seat position for 24 months is all my decision (PBC) 1 2 3 4 5 Easy (Attitude) 1 2 3 4 5 Hard Important (Attitude) 1 2 3 4 5 Not Important
    •  
      • For the sake of time and space I was able to obtain information on:
          • -perceived susceptibility of a car accident
          • -perceived severity of injury in a car accident
          • -perceived benefits of rear facing car seat placement
      • Example scales:
      Strongly Agree Neutral Strongly Disagree Getting into a car accident is a real possibility (Susceptibility) 1 2 3 4 5 My child could get badly injured if in a car accident (Severity) 1 2 3 4 5 My child is safe when in a rear facing car seat position (Benefits) 1 2 3 4 5
      • Survey was administered at:
      • Safe Kids Day Stark County-4
      • Stark County HD WIC Program-67
      • Alliance City WIC Office-18
      • Stark Louisville WIC-6
      • A Wonder World-Learning Center-11
      • Early Childhood Resource Center-4
      • Total of 110 surveys
      • Survey was administered to parents or caregivers with children under 24 months
      • 2 page paper survey
      • Majority of participants filled out while waiting in WIC office
      • Average time to complete was 5-10 minutes
      • No identifying information collected
    •  
      • 94% were mothers
      • 77% were between the ages of 20-34 years (M=28)
      • 89% of the respondents identify as Caucasian
      • 36% report the highest education level obtained was a high school diploma
      • 44% reported working either part or full time
      • 31% report being stay at home caregivers
      • 21% report being students
      • 57% had an income of less than $25,000
      • 21% had an income of $25,000-$50,000
      • 36% were single, 38% were married, and 23% were in a relationship but not married
      • 47% had 1 child, 32% had 2 children
      • 32% of respondents got information about car seat placement from professionals such as physicians, hospitals, or the fire department
      • 25% got information from the car seat manual or books
      • 12% got information from family or friends
      • 11% got information from the internet/online
      • 75% report that a physician had not recommended rear facing for 24 months
    • Complier Type Frequency Percent Non Complier 8 7.3 Forward Complier 30 27.3 Rear Complier 58 52.7 Super Complier 8 7.3 Total 104 94.5 Missing 6 5.5 Total 110 100.0
      • 62.7% were under 12 months old and 37.7% were over 12 months old
      • 58.2% were 20lbs or below and 37.3% were greater than 20lbs
      • 62.7% were placed rear facing, 36.7% were forward facing
      • 40.7% of children ride in the car 7 days per week on average
    • Table 1. Descriptive Statistics for TPB Study Measures Mean SD Range Attitude 2.16 1.0 1-5 Subjective Norms 3.36 1.15 1-5 Perceived Control 2.46 1.24 1-5 Intention 2.87 1.31 1-5
    • Table 2. Correlation Analysis of Theory of Planned Behavior Variables Variable Attitude Subjective Norm Perceived Control Intention Attitude 1.00 Subjective Norm .58* 1.00 Perceived Control .75* .66* 1.00 Intention .78* .76* .80* 1.00 *is significant at .01 level (2-tailed)
    • Table Regression Analysis Predicting Intent to Rear Face for 24 Months Variable R 2 B beta sig Attitude .571 .332 .267 .002 Subjective Norms .564 .341 .311 .000 Perceived Control .611 .429 .414 .000 Total .765 .000 N=81
    • Theory of Planned Behavior Comparison of Means Table N Mean 95% Confidence Interval for Mean Beta Sig. Lower Bound Upper Bound Intention Mean Non Complier 6 4.3333 3.6979 4.9688 -.520 .000 Forward Complier 28 3.7679 3.3856 4.1501 Rear Complier 58 2.4655 2.1474 2.7836 Super Complier 8 2.0625 1.1031 3.0219 Total 100 2.9100 2.6495 3.1705 Attitude Mean Non Complier 5 3.2500 1.9514 4.5486 -.268 .007 Forward Complier 22 2.4773 2.0236 2.9310 Rear Complier 53 1.9104 1.6747 2.1460 Super Complier 7 2.2500 .9558 3.5442 Total 87 2.1580 1.9429 2.3732 Norms Mean Non Complier 6 4.5000 3.8841 5.1159 -.472 .000 Forward Complier 25 4.0000 3.6108 4.3892 Rear Complier 55 2.8727 2.5918 3.1537 Super Complier 7 2.9524 2.2093 3.6954 Total 93 3.2867 3.0545 3.5190 PBC Mean Non Complier 5 3.3000 2.0126 4.5874 -.437 .000 Forward Complier 22 3.3864 2.9078 3.8649 Rear Complier 51 2.0784 1.7711 2.3857 Super Complier 7 1.9286 .7825 3.0747 Total 85 2.4765 2.2087 2.7442
    •  
    • Table. Regression Analysis Predicting Behavior and Health Belief Model Constructs Variable R 2 B beta sig Perceived Susceptibility .009 -.067 -.088 .364 Perceived Severity .012 -.073 -.096 .272 Benefits .012 -.055 -.076 .300 Total .034 N=81
    • N Mean 95% Confidence Interval for Mean Sig. Lower Bound Upper Bound Susceptibility Non Complier 6 2.2500 .6671 3.8329 Forward Complier 28 2.1964 1.9106 2.4822 Rear Complier 57 2.0351 1.7652 2.3050 Super Complier 8 1.9375 1.0596 2.8154 Total 99 2.0859 1.8921 2.2796 .836 Perceived Severity Non Complier 5 2.6000 1.4894 3.7106 Forward Complier 28 2.2857 1.9301 2.6414 Rear Complier 58 2.0776 1.8160 2.3391 Super Complier 8 2.1875 1.2679 3.1071 Total 99 2.1717 1.9779 2.3656 .599 Benefits Non Complier 6 2.5833 1.4139 3.7527 Forward Complier 26 2.7500 2.2816 3.2184 Rear Complier 52 2.4135 2.1524 2.6746 Super Complier 8 2.4375 1.5885 3.2865 Total 92 2.5217 2.3113 2.7322 .584
    •  
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Where do you get information about car seat placement? doctors/hospitals/fire dept/trained personnel 1 (.03) 7 (.22) 22 (.69) 2 (.29) 32 family/friends/social groups 0 (.0) 3 (.30) 6 (.60) 1 (.10) 10 manual/book/magazines/professional literature 3 (.11) 8 (.30) 13 (.48) 3 (.11) 27 online/internet 1 (.11) 1 (.11) 6 (.67) 1 (.11) 9 other 1 (.20) 0 (.0) 4 (.80) 0 (.0) 5 Total 6 19 51 7 83
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Where do you get information about car seat placement? doctors/hospitals/fire dept/trained personnel 1 (.03) 7 (.22) 22 (.69) 2 (.29) 32 family/friends/social groups 0 (.0) 3 (.30) 6 (.60) 1 (.10) 10 manual/book/magazines/professional literature 3 (.11) 8 (.30) 13 (.48) 3 (.11) 27 online/internet 1 (.11) 1 (.11) 6 (.67) 1 (.11) 9 other 1 (.20) 0 (.0) 4 (.80) 0 (.0) 5 Total 6 19 51 7 83
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Has your healthcare provider recommended you place your child in a rear facing car seat position for 24 months? Yes 2 (.09) 0 (.0) 19 (.83) 2 (.09) 23 No 6 (.08) 28 (.36) 38 (.49) 6 (.08) 78 Total 8 28 57 8 101
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Has your healthcare provider recommended you place your child in a rear facing car seat position for 24 months? Yes 2 (.09) 0 (.0) 19 (.83) 2 (.09) 23 No 6 (.08) 28 (.36) 38 (.49) 6 (.08) 78 Total 8 28 57 8 101
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Highest level of education attained Some high school 1 (.09) 3 (.27) 7 (.64) 0 (0) 11 High school diploma or GED 5 (.14) 8 (.22) 22 (.60) 2 (.05) 37 Some college 2 (.05) 11 (.27) 26 (.63) 2 (.05) 41 College graduate 0 (.0) 6 (.43) 4 (.29) 4 (.29) 14 Total 8 28 59 8 103
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Highest level of education attained Some high school 1 (.09) 3 (.27) 7 (.64) 0 (0) 11 High school diploma or GED 5 (.14) 8 (.22) 22 (.60) 2 (.05) 37 Some college 2 (.05) 11 (.27) 26 (.63) 2 (.05) 41 College graduate 0 (.0) 6 (.43) 4 (.29) 4 (.29) 14 Total 8 28 59 8 103
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier What is your family income level? Less than $25,000 7 (.12) 16 (.26) 37 (.61) 1 (.02) 61 $25,000-$50,000 0 (.0) 8 (.38) 11 (.52) 2 (.10) 21 $50,000-$75,000 0 (.0) 0 (.0) 4 (.80) 1 (.20) 5 $75,000-$100,000 0 (.0) 3 (.60) 1 (.20) 1 (.20) 5 $100,000 and above 0 (.0) 2 (.40) 1 (.20) 2 (.40) 5 Total 7 29 54 7 97
    • Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier What is your family income level? Less than $25,000 7 (.12) 16 (.26) 37 (.61) 1 (.02) 61 $25,000-$50,000 0 (.0) 8 (.38) 11 (.52) 2 (.10) 21 $50,000-$75,000 0 (.0) 0 (.0) 4 (.80) 1 (.20) 5 $75,000-$100,000 0 (.0) 3 (.60) 1 (.20) 1 (.20) 5 $100,000 and above 0 (.0) 2 (.40) 1 (.20) 2 (.40) 5 Total 7 29 54 7 97
    •  
      • Rate of compliance at 87%.
      • Rate of non compliance is 7%
      • Theory of Planned behavior demonstrated high predictive value for both intention and actual behavior
      • HBM lacked significance, possibly due incomplete measures
      • More investigation is needed for HBM
      • Doctors, hospitals, fire depts. ,and trained individuals are important places for rear compliers to get information
      • Keep reinforcing rear facing, especially to 24 months
      • Verbal messages may be more effective for non compliers
      • Target low education and low income populations
      • Was not able to obtain adequate information on HBM for proper analysis
      • Self report questionnaire
    •  
    •  
      • Henary B, Sherwood C, Crandall J, et al. Car safely seats for children: rear facing for best protection. Injury Prevention [serial online]. December 2007;13(6):398-402. Available from: Academic Search Complete, Ipswich, MA. Accessed July 20, 2010.
      • Watson E, Monteiro M. Advise use of rear facing child car seats for children under 4 years old. BMJ: British Medical Journal [serial online]. June 20, 2009;338(7709):1496-1497. Available from: Academic Search Complete, Ipswich, MA. Accessed July 20, 2010.
      • O’Keefe L. What to consider when positioning car seats for toddlers. AAP News . April 2009:30(12)
      • Study: Parents moving kids out of car seats too soon. Safety & Health [serial online]. October 2, 2009;6.