1. Car Seat Placement Investigation Investigator: Abrea Johnson BA, MPH student, NEOUCOM Faculty Advisor: Claire Bourguet PhD, Community and Behavioral Health Dept., NEOUCOM Community Preceptor: Amanda Kelly BA, CHES, Coordinator-Safe Kids Stark County, Health Educator-Injury Prevention Program at the Stark County Health Department

2. Background Initial interest was sparked by Bachelor’s degree in Human Development and Family Studies, concentration in Family Life Education. The topic of “extended rear facing” was introduced to me after my daughter was born. A 2007 article in Injury Prevention1concluded 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. The benefit of rear facing car seats is particularly great in side crashes. The authors recommend parent prolong the use of rear facing car seats for best protection.

3. Background An article in the British Medical Journal made the recommendation that physicians should begin advising parents to rear face children to the age of 4.2 The American Academy of Pediatrics published in its Parents Plus3 publication that: “Toddlers should remain rear-facing in a convertible car seatuntil they have reached the maximum height and weightrecommended for the model, or at least the age of 2.” Yet, the AAP has not changed it guidelines or recommendations and they often contradict themselves on their website. Finally, a study done by the NHTSA found that 21% of children under 12 months or 20lbs were not rear facing as recommended.4

4. Study Objectives There are several objectives of the study including: -Estimate the prevalence of rear facing car seat placement in children ages 0-24 months. -Use the Theory of Planned Behavior and the Health Belief Model to indentify correlations between health beliefs and actions of parents regarding car seat placement. -Identify any demographic correlations between car seat placements and health beliefs and actions.

5. Health Belief Model The Health Belief Model (HBM) focuses on the areas in the chart above.

7. perceived severity of injury in a car accident

8. perceived benefits of rear facing car seat placement

9. perceived barriers (combined with theory of planned behavior questions so they are general)

10. The survey will ask respondents to rate on a scale how strongly they agree or disagree with a statement from the model

11. Examples of statements include:-Getting into a car accident is a real possibility -My child is safer in a rear facing car seat position in a car accident -I don’t worry about getting into a car accident

12. Theory of Planned Behavior

13. Theory of Planned Behavior The Theory of Planned Behavior (TPB) focuses on the health beliefs in the picture. I focused in all the areas above using two different types of measures. The first is a scale just like the HBM that asks respondents how strongly they agree or disagree with a statement. The second is a scale with two opposite feelings toward rear facing car seat placement on each end.

15. I am confident that I could place my child in a rear facing car seat position for 24 months

16. My significant other or spouse wants me to rear face for 24 months- Placing my child in a rear facing car seat position for 24 months is:

17. The Survey Is for parents or caregivers that care for children ages 24 months or younger Is completely anonymous, do not collect any identifying information Is completely optional Is completely private Anyone that becomes upset with anything on the survey should be advised to speak to the investigator or a Safe Kids personnel member.

18. The Survey Script: “Hi, my name is _________________. I am helping a public health student from NEOUCOM conduct a survey on car seat placement. The survey is completely anonymous and voluntary and takes about 5 minutes. You can skip questions that make you uncomfortable, or may choose to stop at anytime. It will not affect your eligibility of WIC benefits/Safe Kids classes/car seat checks. If you have any questions or concerns please feel free to ask any a Safe Kids personnel. Would you like to participate?” A verbal response and a completed survey will serve as a consent to participate.

19. Conclusion Very little investigation has been done into rear facing car seat placement beyond 12 months of age. I hope to learn what influences parents’ choices in car seat placement by investigating psychosocial, behavioral, and demographic factors. The findings have the potential to influence the development of car seat safety education and marketing campaigns. The ultimate goal is to reduce the injury and death rates of children 0-24 months in motor vehicle crashes.

20. References Henry 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. 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. 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