<ul><li>Summer 2010 </li></ul><ul><li>Location: Stark County Health Department </li></ul><ul><li>Faculty Preceptor: Clair ...
<ul><li>Initial interest was sparked by Bachelor’s degree in Human Development and Family Studies and concentration in Fam...
<ul><li>In 2007, a study published in  Injury Prevention  1  concluded that:  </li></ul><ul><ul><ul><li>-Rear facing car s...
<ul><li>In 2009, an article in the  British Medical Journal 2   made the recommendation that physicians should begin advis...
<ul><li>Finally, a study done by the NHTSA 4  found that 21% of children under 12 months or 20lbs were not rear facing as ...
 
<ul><li>Estimate the level of rear and forward facing compliance in Stark County </li></ul><ul><li>Examine the Theory of P...
 
<ul><li>Measures were developed using “Constructing a TPB Questionnaire: Conceptual and Methodological Considerations” man...
<ul><li>Example scales: </li></ul>Strongly Agree  Neutral  Strongly Disagree I plan to place my child in a rear facing car...
 
<ul><li>For the sake of time and space I was able to obtain information on: </li></ul><ul><ul><ul><li>-perceived  suscepti...
<ul><li>Example scales: </li></ul>Strongly Agree  Neutral  Strongly Disagree Getting into a car accident is a real possibi...
<ul><li>Survey was administered at: </li></ul><ul><li>Safe Kids Day Stark County-4 </li></ul><ul><li>Stark County HD WIC P...
<ul><li>Survey was administered to parents or caregivers with children under 24 months </li></ul><ul><li>2 page paper surv...
 
<ul><li>94% were mothers </li></ul><ul><li>77% were between the ages of 20-34 years (M=28) </li></ul><ul><li>89% of the re...
<ul><li>57% had an income of less than $25,000 </li></ul><ul><li>21% had an income of $25,000-$50,000 </li></ul><ul><li>36...
<ul><li>32% of respondents got information about car seat placement from professionals such as physicians, hospitals, or t...
Complier Type Frequency Percent Non Complier 8 7.3 Forward Complier 30 27.3 Rear Complier 58 52.7 Super Complier 8 7.3 Tot...
<ul><li>62.7% were under 12 months old and 37.7% were over 12 months old </li></ul><ul><li>58.2% were 20lbs or below and 3...
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 ...
Table 2. Correlation Analysis of Theory of Planned Behavior Variables Variable Attitude Subjective Norm Perceived Control ...
Table Regression Analysis Predicting Intent to Rear Face for 24 Months Variable R 2 B beta sig Attitude .571 .332 .267 .00...
Theory of Planned Behavior Comparison of Means Table N Mean 95% Confidence Interval for Mean Beta Sig. Lower Bound Upper B...
 
Table. Regression Analysis Predicting Behavior and Health Belief Model Constructs Variable R 2 B beta sig Perceived Suscep...
N Mean 95% Confidence Interval for Mean Sig. Lower Bound Upper Bound Susceptibility Non Complier 6 2.2500 .6671 3.8329 For...
 
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Where do  you get information a...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Where do  you get information a...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Has your healthcare provider re...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Has your healthcare provider re...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Highest level  of education  at...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier Highest level  of education  at...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier What is your family income leve...
Cross tabulation Complier Total Non Complier Forward Complier Rear Complier Super Complier What is your family income leve...
 
<ul><li>Rate of compliance at 87%. </li></ul><ul><li>Rate of non compliance is 7% </li></ul><ul><li>Theory of Planned beha...
<ul><li>Doctors, hospitals, fire depts. ,and trained individuals are important places for rear compliers to get informatio...
<ul><li>Was not able to obtain adequate information on HBM for proper analysis </li></ul><ul><li>Self report questionnaire...
 
 
<ul><li>Henary B, Sherwood C, Crandall J, et al. Car safely seats for children: rear facing for best protection.  Injury P...
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Rear Facing Car Seat Invesigation

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Rear Facing Car Seat Invesigation

  1. 3. <ul><li>Summer 2010 </li></ul><ul><li>Location: Stark County Health Department </li></ul><ul><li>Faculty Preceptor: Clair Bourguet </li></ul><ul><li>Community Preceptor: Amanda Kelly </li></ul><ul><li>Title: Health Educator-Injury Prevention Program Coordinator-Safe Kids Stark County </li></ul><ul><li>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 </li></ul>
  2. 4. <ul><li>Initial interest was sparked by Bachelor’s degree in Human Development and Family Studies and concentration in Family Life Education </li></ul><ul><li>The concept of “extended rear facing” car seat use was introduced to me after my daughter was born </li></ul>
  3. 5. <ul><li>In 2007, a study published in Injury Prevention 1 concluded that: </li></ul><ul><ul><ul><li>-Rear facing car seats are more effective than forward facing car seats in protecting restrained children aged 0-23 months. </li></ul></ul></ul><ul><ul><ul><li>-The benefit of rear facing car seats was also evident when only children ages 12-23 months were included. </li></ul></ul></ul><ul><ul><ul><li>-Data showed that protection of rear facing in side impact crashes was best. </li></ul></ul></ul><ul><ul><ul><li>-The authors recommend parents prolong the use of rear facing car seats for best protection. </li></ul></ul></ul>
  4. 6. <ul><li>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. </li></ul><ul><li>In 2009, the American Academy of Pediatrics 3 published in its Parents Plus publication that: </li></ul><ul><ul><ul><li>“ 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.” </li></ul></ul></ul>
  5. 7. <ul><li>Finally, a study done by the NHTSA 4 found that 21% of children under 12 months or 20lbs were not rear facing as recommended </li></ul><ul><li>Very little investigation into rear facing beyond 12 months </li></ul><ul><li>Use findings for social marketing campaigns </li></ul><ul><li>Reduce injury and death in children 0-24 months in motor vehicle crashes </li></ul>
  6. 9. <ul><li>Estimate the level of rear and forward facing compliance in Stark County </li></ul><ul><li>Examine the Theory of Planned Behavior and Health Belief Model relationship to car seat placement compliance </li></ul><ul><li>Examine demographic factors that influence car seat placement compliance </li></ul>
  7. 11. <ul><li>Measures were developed using “Constructing a TPB Questionnaire: Conceptual and Methodological Considerations” manual </li></ul><ul><li>Intention, subjective norms, perceived behavioral control and intention all measured with Likert scale statements </li></ul><ul><li>Attitude-measured with a semantic differential scale with oppositional adjectives </li></ul><ul><li>Direct measures were used for all constructs </li></ul>
  8. 12. <ul><li>Example scales: </li></ul>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
  9. 14. <ul><li>For the sake of time and space I was able to obtain information on: </li></ul><ul><ul><ul><li>-perceived susceptibility of a car accident </li></ul></ul></ul><ul><ul><ul><li>-perceived severity of injury in a car accident </li></ul></ul></ul><ul><ul><ul><li>-perceived benefits of rear facing car seat placement </li></ul></ul></ul>
  10. 15. <ul><li>Example scales: </li></ul>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
  11. 16. <ul><li>Survey was administered at: </li></ul><ul><li>Safe Kids Day Stark County-4 </li></ul><ul><li>Stark County HD WIC Program-67 </li></ul><ul><li>Alliance City WIC Office-18 </li></ul><ul><li>Stark Louisville WIC-6 </li></ul><ul><li>A Wonder World-Learning Center-11 </li></ul><ul><li>Early Childhood Resource Center-4 </li></ul><ul><li>Total of 110 surveys </li></ul>
  12. 17. <ul><li>Survey was administered to parents or caregivers with children under 24 months </li></ul><ul><li>2 page paper survey </li></ul><ul><li>Majority of participants filled out while waiting in WIC office </li></ul><ul><li>Average time to complete was 5-10 minutes </li></ul><ul><li>No identifying information collected </li></ul>
  13. 19. <ul><li>94% were mothers </li></ul><ul><li>77% were between the ages of 20-34 years (M=28) </li></ul><ul><li>89% of the respondents identify as Caucasian </li></ul><ul><li>36% report the highest education level obtained was a high school diploma </li></ul><ul><li>44% reported working either part or full time </li></ul><ul><li>31% report being stay at home caregivers </li></ul><ul><li>21% report being students </li></ul>
  14. 20. <ul><li>57% had an income of less than $25,000 </li></ul><ul><li>21% had an income of $25,000-$50,000 </li></ul><ul><li>36% were single, 38% were married, and 23% were in a relationship but not married </li></ul><ul><li>47% had 1 child, 32% had 2 children </li></ul>
  15. 21. <ul><li>32% of respondents got information about car seat placement from professionals such as physicians, hospitals, or the fire department </li></ul><ul><li>25% got information from the car seat manual or books </li></ul><ul><li>12% got information from family or friends </li></ul><ul><li>11% got information from the internet/online </li></ul><ul><li>75% report that a physician had not recommended rear facing for 24 months </li></ul>
  16. 22. 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
  17. 23. <ul><li>62.7% were under 12 months old and 37.7% were over 12 months old </li></ul><ul><li>58.2% were 20lbs or below and 37.3% were greater than 20lbs </li></ul><ul><li>62.7% were placed rear facing, 36.7% were forward facing </li></ul><ul><li>40.7% of children ride in the car 7 days per week on average </li></ul>
  18. 24. 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
  19. 25. 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)
  20. 26. 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
  21. 27. 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
  22. 29. 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
  23. 30. 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
  24. 32. 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
  25. 33. 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
  26. 34. 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
  27. 35. 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
  28. 36. 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
  29. 37. 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
  30. 38. 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
  31. 39. 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
  32. 41. <ul><li>Rate of compliance at 87%. </li></ul><ul><li>Rate of non compliance is 7% </li></ul><ul><li>Theory of Planned behavior demonstrated high predictive value for both intention and actual behavior </li></ul><ul><li>HBM lacked significance, possibly due incomplete measures </li></ul><ul><li>More investigation is needed for HBM </li></ul>
  33. 42. <ul><li>Doctors, hospitals, fire depts. ,and trained individuals are important places for rear compliers to get information </li></ul><ul><li>Keep reinforcing rear facing, especially to 24 months </li></ul><ul><li>Verbal messages may be more effective for non compliers </li></ul><ul><li>Target low education and low income populations </li></ul>
  34. 43. <ul><li>Was not able to obtain adequate information on HBM for proper analysis </li></ul><ul><li>Self report questionnaire </li></ul>
  35. 46. <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>O’Keefe L. What to consider when positioning car seats for toddlers. AAP News . April 2009:30(12) </li></ul><ul><li>Study: Parents moving kids out of car seats too soon. Safety & Health [serial online]. October 2, 2009;6. </li></ul>

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