Recruiting New Pilot Programs
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Car Seat Community Benefit Program
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The “Car Seat Community Benefit” is part of our Community Benefit programs. It is designed for hospitals and providers, where physicians can refer expectant patients, who are in their 31st to 35th week of pregnancy. The referral begins with a consultation and educational training by a National Highway Traffic Safety Administration (NHTSA) certified child passenger safety technician (CPST). The CPST continues as a 24/7 resource contact for the patient.
The program's educational approach utilizes an evidenced-based and equitable, remote telehealth Behavioral Skills Training (BST) package. The CPST is also trained in applying BST and is a Master Certified Health Education Specialist (MCHES). The CPST assists and trains the parent or caregiver with their individual car seat(s) and motor vehicle(s). The program was developed and evaluated as a project of the State of California, California Strategic Highway Safety Plan (SHSP)/Caltrans (2020) in Occupant Protection (2015-2019 and 2020-2024). The purpose was to address the problem of critical car seat misuse and provide services to the general population, in addition to underserved, rural, Native American, and military base communities (Veterans Medical Centers, Tricare).
The program helps to achieve the objectives of the National Roadway Safety Strategy, Road to Zero (National Roadway Safety Strategy, n.d.). It was scientifically evaluated by the SHSP team, in collaboration with Public Health Behavior Solutions/Pro Consumer Safety and in the Department of Psychology at the University of Southern California. It was designed for hospitals, birthing centers, and other medical practitioners who treat women who are, or plan to become pregnant and provide individualized car seat education and training, including post-patient injury prevention services to enhance community benefits.
If you represent a hospital or are a healthcare provider, and would like further information, the following describes how the Car Seat Community Benefit program can benefit your facility, patients, and their community. Dr. James DeCarli, Public Health Behavior Solutions/Pro Consumer Safety, 323-491-6197.
The program's educational approach utilizes an evidenced-based and equitable, remote telehealth Behavioral Skills Training (BST) package. The CPST is also trained in applying BST and is a Master Certified Health Education Specialist (MCHES). The CPST assists and trains the parent or caregiver with their individual car seat(s) and motor vehicle(s). The program was developed and evaluated as a project of the State of California, California Strategic Highway Safety Plan (SHSP)/Caltrans (2020) in Occupant Protection (2015-2019 and 2020-2024). The purpose was to address the problem of critical car seat misuse and provide services to the general population, in addition to underserved, rural, Native American, and military base communities (Veterans Medical Centers, Tricare).
The program helps to achieve the objectives of the National Roadway Safety Strategy, Road to Zero (National Roadway Safety Strategy, n.d.). It was scientifically evaluated by the SHSP team, in collaboration with Public Health Behavior Solutions/Pro Consumer Safety and in the Department of Psychology at the University of Southern California. It was designed for hospitals, birthing centers, and other medical practitioners who treat women who are, or plan to become pregnant and provide individualized car seat education and training, including post-patient injury prevention services to enhance community benefits.
If you represent a hospital or are a healthcare provider, and would like further information, the following describes how the Car Seat Community Benefit program can benefit your facility, patients, and their community. Dr. James DeCarli, Public Health Behavior Solutions/Pro Consumer Safety, 323-491-6197.
Background and Evidence-Base
COMMUNITY RISKS AND NEEDS
Injury and Fatality Risks Among Newborns and Child Passengers
The correct use of car seats is known to reduce the risk of fatality by 71% for infants and newborns (National Highway Traffic Safety Administration, 2022). Even with improved safety regulations for car seats and motor vehicle manufactures, child passenger safety laws, and dedicated educational efforts by certified CPST, the critical misuse of car seats continue to be a public health challenge. This puts newborns at risk of injury and fatality during motor vehicle crashes.
The correct use of car seats must be fully understood by parents and caregivers in order for their car seat to protect their child. Healthy People 2023 objectives report that the reduction in the proportion motor vehicle occupant deaths among those who were not buckled properly shows “little or no detectable change”, compared to Healthy People 2020 objectives. Furthermore, the reduction of deaths from motor vehicle crashes, compared to Health People 2020 objectives, are reported as “getting worse” (Office of Disease Prevention and Health Promotion. [n.d.]). These findings solidify the need for an effective educational approach to reduce critical misuse and reduce the risk of injury and fatality among newborn babies and other child passengers.
Misuse of Car Seats
Car seat education requires a hands-on, one-on-one, detailed approach by a CPST. Kuroiwa et al. (2018) found that the didactic educational approach, even with a demonstration, is shown to increase knowledge. It is important to note however, that knowledge is not correlated with proper installation and use. This further contributes to misuse. Misuse is defined as any type of car seat installation or use that compromises the protection of the child passenger during a motor vehicle collision (Raymond et al., 2018).
Misuse is caused by varying designs of car seats and motor vehicles, a variety of installation methods, misunderstood instructions, inattention to safety, time pressure, and short driving distance (Mathieu et al, 2014; Wegner and Girasek, 2003). It is also associated with racial and socioeconomic disparities. Critical misuse rates are more common among, parents and caregivers of color, those with lower income and education, those living in rural and Native American communities, and among Medicare patients (Hafner, et al., 2017; Hamann et al., 2022; Lapidus et al., 2013; Lee et al., 2019; Privette et al., 2018; Rangel et al., 2008). This group is also shown to exhibit less awareness on the importance of correct car seat use, having access to services, and are less likely to participate in community car seat check- up events and NHTSA fitting stations.
Misuse doubles the risk of injury and fatality among newborns, compared to those children whose car seat was properly installed and the child correctly restrained (Durbin, 2005; Hoffman et al., 2016). In 2020, 139,042 children were injured and 755 killed in traffic collisions. Among these fatalities, restraint use was known for 680 occupants, and of those, 286 (42%) of these children were unrestrained (National Highway Traffic Safety Administration (NHTSA), 2022). Critical misuse of car seats is also responsible for infant and toddler suffocation-related fatalities. This occurs when the child is inside the car seat while the vehicle is in motion (non-crash), or when the vehicle temporarily stopped or parked. This is due to incorrect positioning, harness straps to lose or tight, incorrect use of newborn insert, bulky clothing, or towels around the baby for support which increases suffocation risks. Liaw et al. (2019) found in a longitudinal study of 11,779 infant sleep-related fatalities (median age 2-months), 348 (3%) died in car seats. Furthermore, over 90% of the time, car seats were not being used according to instructions. This is consistent with the U.S. Consumer Product Safety Commission that reported over 8000 infants are taken to hospital emergency departments for injuries sustained in car seats, other than during a motor vehicle crash (Parikh and Wilson, 2010).
In 2021, of the 3,664,292 babies born in the United States, despite a slight increase of home births compared to pre COVID-19 pandemic, most were born in a hospital (Gregory et al., 2022; Osterman et al., 2021). A study by Hoffman et al. (2016), discovered a misuse rate of 93% among newborns after being discharged from the hospital. Further, in a study of 2,448 expectant parents between 2015 and 2021, 96% believed they had installed their car seat correctly, however 97% were found to be incorrect when not educated by a CPST (Brown et al., 2011; DeCarli et al. [in review]).
Reaching and educating expectant parents and caregivers
The American Academy of Pediatrics, Patient Education, Car Safety Seats Guide (2021), recommend that women who are pregnant, work with a CPST before their baby is born. Generally, it is recommended that women who are pregnant and their partners, consult with a CPST between their 31st and 38th week of pregnancy. This provides sufficient time to make sure that they have a car seat that is compatible to their vehicle and child and be trained accordingly. Women who are pregnant generally receive basic car seat resources (finding a CPST, etc.) during antenatal care. While women who are pregnant and their partners who attend antenatal care, report they value this information, also overwhelmed with resources and recommendations. The Agency for Healthcare Research and Quality (2020) has found that 40-80% of medical information that patients are provided during office visits is forgotten, and 50% of what is retained, is incorrect. DeCarli, Aclan, Lindgren, and Diaz (in review) found similar results where expectant parents reported a value of these resources but became overwhelmed from too much information. Studies have shown the most frequent source of information valued by women during pregnancy are from healthcare professionals, ranking the highest, followed by informal sources (family and friends), and the Internet (Ghiasi, 2021).
To reduce critical misuse and increase the mastery of skills required for correct car seat use and installation, DeCarli et al (in-review) found that among 2,448 expectant parents and caregivers, when education was delivered with Behavioral Skills Training (BST), misuse decreased by 97% and sustained zero misuse at a 12-month evaluation. It was also found that these participants reported higher self-confidence with their car seat and became a safety advocate in their community. This was despite race and socio-economic, education, and language status.
While virtual telehealth was used prior to the COVID-19 pandemic, it has become a standard of practice and welcomed among expectant parents. Its effectiveness has also been validated. A systematic review of scientific literature found no significant difference in clinical outcomes between virtual telehealth and in-person among women who were pregnant. Furthermore, studies also find that a virtual telehealth approach reduced travel time, clinic wait times, no-show rates, and risk of infectious disease exposure. It also increased self-accountability and adherence, especially among expectant parents and caregivers (DeCarli et al (in review); Ghimire et al., 2023; Kendi et al., 2023).
Injury and Fatality Risks Among Newborns and Child Passengers
The correct use of car seats is known to reduce the risk of fatality by 71% for infants and newborns (National Highway Traffic Safety Administration, 2022). Even with improved safety regulations for car seats and motor vehicle manufactures, child passenger safety laws, and dedicated educational efforts by certified CPST, the critical misuse of car seats continue to be a public health challenge. This puts newborns at risk of injury and fatality during motor vehicle crashes.
The correct use of car seats must be fully understood by parents and caregivers in order for their car seat to protect their child. Healthy People 2023 objectives report that the reduction in the proportion motor vehicle occupant deaths among those who were not buckled properly shows “little or no detectable change”, compared to Healthy People 2020 objectives. Furthermore, the reduction of deaths from motor vehicle crashes, compared to Health People 2020 objectives, are reported as “getting worse” (Office of Disease Prevention and Health Promotion. [n.d.]). These findings solidify the need for an effective educational approach to reduce critical misuse and reduce the risk of injury and fatality among newborn babies and other child passengers.
Misuse of Car Seats
Car seat education requires a hands-on, one-on-one, detailed approach by a CPST. Kuroiwa et al. (2018) found that the didactic educational approach, even with a demonstration, is shown to increase knowledge. It is important to note however, that knowledge is not correlated with proper installation and use. This further contributes to misuse. Misuse is defined as any type of car seat installation or use that compromises the protection of the child passenger during a motor vehicle collision (Raymond et al., 2018).
Misuse is caused by varying designs of car seats and motor vehicles, a variety of installation methods, misunderstood instructions, inattention to safety, time pressure, and short driving distance (Mathieu et al, 2014; Wegner and Girasek, 2003). It is also associated with racial and socioeconomic disparities. Critical misuse rates are more common among, parents and caregivers of color, those with lower income and education, those living in rural and Native American communities, and among Medicare patients (Hafner, et al., 2017; Hamann et al., 2022; Lapidus et al., 2013; Lee et al., 2019; Privette et al., 2018; Rangel et al., 2008). This group is also shown to exhibit less awareness on the importance of correct car seat use, having access to services, and are less likely to participate in community car seat check- up events and NHTSA fitting stations.
Misuse doubles the risk of injury and fatality among newborns, compared to those children whose car seat was properly installed and the child correctly restrained (Durbin, 2005; Hoffman et al., 2016). In 2020, 139,042 children were injured and 755 killed in traffic collisions. Among these fatalities, restraint use was known for 680 occupants, and of those, 286 (42%) of these children were unrestrained (National Highway Traffic Safety Administration (NHTSA), 2022). Critical misuse of car seats is also responsible for infant and toddler suffocation-related fatalities. This occurs when the child is inside the car seat while the vehicle is in motion (non-crash), or when the vehicle temporarily stopped or parked. This is due to incorrect positioning, harness straps to lose or tight, incorrect use of newborn insert, bulky clothing, or towels around the baby for support which increases suffocation risks. Liaw et al. (2019) found in a longitudinal study of 11,779 infant sleep-related fatalities (median age 2-months), 348 (3%) died in car seats. Furthermore, over 90% of the time, car seats were not being used according to instructions. This is consistent with the U.S. Consumer Product Safety Commission that reported over 8000 infants are taken to hospital emergency departments for injuries sustained in car seats, other than during a motor vehicle crash (Parikh and Wilson, 2010).
In 2021, of the 3,664,292 babies born in the United States, despite a slight increase of home births compared to pre COVID-19 pandemic, most were born in a hospital (Gregory et al., 2022; Osterman et al., 2021). A study by Hoffman et al. (2016), discovered a misuse rate of 93% among newborns after being discharged from the hospital. Further, in a study of 2,448 expectant parents between 2015 and 2021, 96% believed they had installed their car seat correctly, however 97% were found to be incorrect when not educated by a CPST (Brown et al., 2011; DeCarli et al. [in review]).
Reaching and educating expectant parents and caregivers
The American Academy of Pediatrics, Patient Education, Car Safety Seats Guide (2021), recommend that women who are pregnant, work with a CPST before their baby is born. Generally, it is recommended that women who are pregnant and their partners, consult with a CPST between their 31st and 38th week of pregnancy. This provides sufficient time to make sure that they have a car seat that is compatible to their vehicle and child and be trained accordingly. Women who are pregnant generally receive basic car seat resources (finding a CPST, etc.) during antenatal care. While women who are pregnant and their partners who attend antenatal care, report they value this information, also overwhelmed with resources and recommendations. The Agency for Healthcare Research and Quality (2020) has found that 40-80% of medical information that patients are provided during office visits is forgotten, and 50% of what is retained, is incorrect. DeCarli, Aclan, Lindgren, and Diaz (in review) found similar results where expectant parents reported a value of these resources but became overwhelmed from too much information. Studies have shown the most frequent source of information valued by women during pregnancy are from healthcare professionals, ranking the highest, followed by informal sources (family and friends), and the Internet (Ghiasi, 2021).
To reduce critical misuse and increase the mastery of skills required for correct car seat use and installation, DeCarli et al (in-review) found that among 2,448 expectant parents and caregivers, when education was delivered with Behavioral Skills Training (BST), misuse decreased by 97% and sustained zero misuse at a 12-month evaluation. It was also found that these participants reported higher self-confidence with their car seat and became a safety advocate in their community. This was despite race and socio-economic, education, and language status.
While virtual telehealth was used prior to the COVID-19 pandemic, it has become a standard of practice and welcomed among expectant parents. Its effectiveness has also been validated. A systematic review of scientific literature found no significant difference in clinical outcomes between virtual telehealth and in-person among women who were pregnant. Furthermore, studies also find that a virtual telehealth approach reduced travel time, clinic wait times, no-show rates, and risk of infectious disease exposure. It also increased self-accountability and adherence, especially among expectant parents and caregivers (DeCarli et al (in review); Ghimire et al., 2023; Kendi et al., 2023).
COMMUNITY NEEDS AND BENEFITS
Newborns and toddlers are vulnerable when in a car seats. With effective training among parents and caregivers on installation and use, this reduces the risk of injury and fatality among newborn babies and other child passengers. Addressing the patients’ community’s social needs, outside of the clinical care and provider facility, can be a challenge but is highly needed (Chandrashekar, et al., 2022). The Car Seat Community Benefit program provides community benefits by enhancing the health of the community and reducing the burden of government and community injury prevention services (NHCS - Community Benefit, n.d.; What Counts as Community Benefit, n.d.-b). These include:
COMMUNITY BENEFIT VALUE
The Car Seat Community Benefit program provides a community benefit value by providing benefits to vulnerable populations and other benefits to the broader community.
Newborns and toddlers are vulnerable when in a car seats. With effective training among parents and caregivers on installation and use, this reduces the risk of injury and fatality among newborn babies and other child passengers. Addressing the patients’ community’s social needs, outside of the clinical care and provider facility, can be a challenge but is highly needed (Chandrashekar, et al., 2022). The Car Seat Community Benefit program provides community benefits by enhancing the health of the community and reducing the burden of government and community injury prevention services (NHCS - Community Benefit, n.d.; What Counts as Community Benefit, n.d.-b). These include:
- Supporting community health improvement services that improve community health beyond patient care. It provides health education regarding motor vehicle occupant car seat and injury prevention consultation and services to each referred patient. It also enhances and contributes to community family education resource centers.
- Relieving the burden of government and other community injury prevention services, among expectant parents and post-patient care who depend on NHTSA car seat inspection stations and education classes provided by public health departments, law enforcement, hospitals, and community-based organizations.
COMMUNITY BENEFIT VALUE
The Car Seat Community Benefit program provides a community benefit value by providing benefits to vulnerable populations and other benefits to the broader community.
- Other benefits to vulnerable populations – Provide post-hospital care with car seat services and injury prevention resources to the expectant parent and caregiver. This reduces the risk of motor vehicle injury and fatality among newborn babies and other child passengers. It also effectively provides access to care among people of color, those with low education and income, and rural and Tribal communities.
- Other benefits to the broader community – Empower expectant parents on maintaining that their car seat is secure and ensuring that their newborn is restrained properly as they grow. This empowerment improves mastery of skills, the understanding on the dangers of misuse, and results in participants becoming car seat safety advocates in their community.
Car Seat Community Benefit Program
The “Car Seat Community Benefit” program provides hospitals, birthing centers, and healthcare providers with a car seat education and injury prevention service that improves patient care, and post-patient care, and provides a sustainable and equitable, benefit to the community. It also addresses a broader public health problem of critical car seat misuse and health disparities and contributes to Road To Zero deaths strategy, by reducing the risk of motor vehicle occupant injury and fatality among newborns and other child passengers (National Roadway Safety Strategy. [n.d.]).
PROCESS
While the process can be tailored to specific hospitals and providers, the following is a general process:
1. The hospital or healthcare provider contracts with Public Health Behavior Solutions/Pro Consumer Safety (Pro Consumer Safety) to have physicians refer expectant patients to the program between the 31st and 38th week of pregnancy.
2. The patient calls Pro Consumer Safety to schedule a telehealth appointment to begin car seat consultation and education. Car seat education is provided by a CPST trained in BST and a Master Certified Health Education Specialist (MCHES).
3. Pro Consumer Safety submits an invoice to the hospital or healthcare provider for the cost of providing services.
4. Pro Consumer Safety remains a resource for each patient for future car seat or child safety assistance.
If you represent a hospital, or birthing center, or are a healthcare provider and would like further information on how you can begin to refer expectant patients to the Car Seat Community Benefit program, please call Dr. James DeCarli, with Public Health Behavior Solutions/Pro Consumer Safety at 323-491-6197.
PROCESS
While the process can be tailored to specific hospitals and providers, the following is a general process:
1. The hospital or healthcare provider contracts with Public Health Behavior Solutions/Pro Consumer Safety (Pro Consumer Safety) to have physicians refer expectant patients to the program between the 31st and 38th week of pregnancy.
2. The patient calls Pro Consumer Safety to schedule a telehealth appointment to begin car seat consultation and education. Car seat education is provided by a CPST trained in BST and a Master Certified Health Education Specialist (MCHES).
3. Pro Consumer Safety submits an invoice to the hospital or healthcare provider for the cost of providing services.
4. Pro Consumer Safety remains a resource for each patient for future car seat or child safety assistance.
If you represent a hospital, or birthing center, or are a healthcare provider and would like further information on how you can begin to refer expectant patients to the Car Seat Community Benefit program, please call Dr. James DeCarli, with Public Health Behavior Solutions/Pro Consumer Safety at 323-491-6197.
References
Agency for Healthcare Research and Quality (2020). Use the Teach-Back Method: Tool #5. Content last reviewed September 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html
Brown, J., Finch, C. F., Hatfield, J., & Bilston, L. E. (2011). Child Restraint Fitting Stations reduce incorrect restraint use among child occupants. Accident Analysis & Prevention, 43(3), 1128–1133. https://doi.org/10.1016/j.aap.2010.12.021
Car Safety Seats Guide. (2021). Pediatric Patient Education.
https://doi.org/10.1542/peo_document208
Chandrashekar, P., Gee, R. E., & Bhatt, J. (2022). Rethinking Community Benefit Programs—A New Vision for Hospital Investment in Community Health. Journal of General Internal Medicine, 37(5), 1278–1280. https://doi.org/10.1007/s11606-021-07324-0
Durbin DR, Chen I, Smith R, Elliott MR, Winston FK. Effects of seating position and appropriate restraint use on the risk of injury to children in motor vehicle crashes. Pediatrics. 2005;115(3):e305‐e309. https://doi:10.1542/peds.2004-1522
Ghiasi A. Health information needs, sources of information, and barriers to accessing health information among pregnant women: a systematic review of research. J Matern Fetal Neonatal Med. 2021;34(8):1320-1330. https://doi:10.1080/14767058.2019.1634685
Ghimire S, Martinez S, Hartvigsen G, Gerdes M. Virtual prenatal care: A systematic review of pregnant women's and healthcare professionals' experiences, needs, and preferences for quality care. Int J Med Inform. 2023;170:104964. https://doi:10.1016/j.ijmedinf.2022.104964
Gregory ECW, Osterman MJK, Valenzuela CP. Changes in home births by race and Hispanic origin and state of residence of mother: United States, 2019–2020 and 2020–2021. National Vital Statistics Reports; vol 71 no 8. Hyattsville, MD: National Center for Health Statistics. 2022. DOI: https://dx.doi.org/10.15620/cdc:121553.
Hafner JW, Kok SJ, Wang H, et al. Child Passenger Restraint System Misuse in Rural Versus Urban Children: A Multisite Case-Control Study. Pediatr Emerg Care. 2017;33(10):663-669. https://doi:10.1097/PEC.0000000000000818
Hoffman, B. D., Gallardo, A. R., & Carlson, K. F. (2016). Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge. The Journal of Pediatrics, 171, 48–54. https://doi.org/10.1016/j.jpeds.2015.11.047
Hamann CJ, Missikpode C, Peek-Asa C. Trends in pediatric passenger restraint use by rurality and age in Iowa, 2006-2019. Traffic Inj Prev. 2022;23(1):23-28. https://doi:10.1080/15389588.2021.1995603
Kendi S, Taylor MF, Thomas B, et al. Randomised feasibility trial of a virtual intervention to address infant car seat misuse. Inj Prev. 2023;29(1):29-34. https://doi:10.1136/ip-2022-044660
Kuroiwa, E., Ragar, R. L., Langlais, C. S., Baker, A., Linnaus, M. E., & Notrica, D. M. (2018). Car seat education: A randomized controlled trial of teaching methods. Injury, 49(7), 1272–1277. https://doi.org/10.1016/j.injury.2018.05.003
Lapidus, J., Smith, N. M., Lutz, T., & Ebel, B. E. (2013). Trends and Correlates of Child Passenger Restraint Use in 6 Northwest Tribes: The Native Children Always Ride Safe (Native CARS) Project. American Journal of Public Health. https://doi.org/10.2105/ajph.2012.300834
Lee G, Pope CN, Nwosu A, McKenzie LB, Zhu M. Child passenger fatality: Child restraint system usage and contributing factors among the youngest passengers from 2011 to 2015. J Safety Res. 2019;70:33-38. https://doi:10.1016/j.jsr.2019.04.001
Liaw P, et al. Pediatrics. May 20, 2019, https://doi.org/10.1542/peds.2018-2576).
Mathieu R, Peter S, Yvan C, Philippe L. National roadside survey of child restraint system use in Belgium. Accid Anal Prev. 2014;62:369-376. https://doi:10.1016/j.aap.2013.08.021
National Highway Traffic Safety Administration (NHTSA) (Ed.). (2022). Traffic Safety Facts 2020: Children (DOT HS 813 285). Traffic Safety Facts 2020. Retrieved February 6, 2023, from https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813285
National Roadway Safety Strategy. (n.d.). US Department of Transportation. https://www.transportation.gov/NRSS
NHCS - Community Benefit. (n.d.). https://www.cdc.gov/nchs/nhcs/community_benefit.htm
Office of Disease Prevention and Health Promotion. (n.d.). Injury Prevention - Healthy People 2030 | health.gov. Transportation. Retrieved February 13, 2023, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/injury-prevention
Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2021. National Vital Statistics Reports; vol 72, no 1. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: https://dx.doi.org/10.15620/cdc:122047.
Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003-2007. Pediatrics. 2010;126(2):352-357.
https://doi.org/10.1542/peds.2010-0333
Privette F, Nwosu A, Pope CN, Yang J, Pressley JC, Zhu M. Factors Associated With Child Restraint Use in Motor Vehicle Crashes. Clin Pediatr (Phila). 2018;57(12):1423-1431. https://doi:10.1177/0009922818786002
Rangel SJ, Martin CA, Brown RL, Garcia VF, Falcone RA Jr. Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance. J Pediatr Surg. 2008;43(1):200-207. https://doi:10.1016/j.jpedsurg.2007.09.045
Raymond, P. (2018, July). Additional Analysis of National Child Restraint Use Special Study: Child Restraint Misuse (DOT HS 812 527). Traffic Safety Facts: Research note. https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/13648-additional_analysis_of_ncruss_071718_v3_tag.pdf
Strategic Highway Safety Plan (SHSP) | Caltrans. (2020-2024). https://dot.ca.gov/programs/safety-programs/shsp
Wegner, M. V., & Girasek, D. C. (2003). How Readable Are Child Safety Seat Installation Instructions? Pediatrics, 111(3), 588–591. https://doi.org/10.1542/peds.111.3.588
What Counts as Community Benefit. (n.d.-b). https://www.chausa.org/communitybenefit/what-counts
Agency for Healthcare Research and Quality (2020). Use the Teach-Back Method: Tool #5. Content last reviewed September 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html
Brown, J., Finch, C. F., Hatfield, J., & Bilston, L. E. (2011). Child Restraint Fitting Stations reduce incorrect restraint use among child occupants. Accident Analysis & Prevention, 43(3), 1128–1133. https://doi.org/10.1016/j.aap.2010.12.021
Car Safety Seats Guide. (2021). Pediatric Patient Education.
https://doi.org/10.1542/peo_document208
Chandrashekar, P., Gee, R. E., & Bhatt, J. (2022). Rethinking Community Benefit Programs—A New Vision for Hospital Investment in Community Health. Journal of General Internal Medicine, 37(5), 1278–1280. https://doi.org/10.1007/s11606-021-07324-0
Durbin DR, Chen I, Smith R, Elliott MR, Winston FK. Effects of seating position and appropriate restraint use on the risk of injury to children in motor vehicle crashes. Pediatrics. 2005;115(3):e305‐e309. https://doi:10.1542/peds.2004-1522
Ghiasi A. Health information needs, sources of information, and barriers to accessing health information among pregnant women: a systematic review of research. J Matern Fetal Neonatal Med. 2021;34(8):1320-1330. https://doi:10.1080/14767058.2019.1634685
Ghimire S, Martinez S, Hartvigsen G, Gerdes M. Virtual prenatal care: A systematic review of pregnant women's and healthcare professionals' experiences, needs, and preferences for quality care. Int J Med Inform. 2023;170:104964. https://doi:10.1016/j.ijmedinf.2022.104964
Gregory ECW, Osterman MJK, Valenzuela CP. Changes in home births by race and Hispanic origin and state of residence of mother: United States, 2019–2020 and 2020–2021. National Vital Statistics Reports; vol 71 no 8. Hyattsville, MD: National Center for Health Statistics. 2022. DOI: https://dx.doi.org/10.15620/cdc:121553.
Hafner JW, Kok SJ, Wang H, et al. Child Passenger Restraint System Misuse in Rural Versus Urban Children: A Multisite Case-Control Study. Pediatr Emerg Care. 2017;33(10):663-669. https://doi:10.1097/PEC.0000000000000818
Hoffman, B. D., Gallardo, A. R., & Carlson, K. F. (2016). Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge. The Journal of Pediatrics, 171, 48–54. https://doi.org/10.1016/j.jpeds.2015.11.047
Hamann CJ, Missikpode C, Peek-Asa C. Trends in pediatric passenger restraint use by rurality and age in Iowa, 2006-2019. Traffic Inj Prev. 2022;23(1):23-28. https://doi:10.1080/15389588.2021.1995603
Kendi S, Taylor MF, Thomas B, et al. Randomised feasibility trial of a virtual intervention to address infant car seat misuse. Inj Prev. 2023;29(1):29-34. https://doi:10.1136/ip-2022-044660
Kuroiwa, E., Ragar, R. L., Langlais, C. S., Baker, A., Linnaus, M. E., & Notrica, D. M. (2018). Car seat education: A randomized controlled trial of teaching methods. Injury, 49(7), 1272–1277. https://doi.org/10.1016/j.injury.2018.05.003
Lapidus, J., Smith, N. M., Lutz, T., & Ebel, B. E. (2013). Trends and Correlates of Child Passenger Restraint Use in 6 Northwest Tribes: The Native Children Always Ride Safe (Native CARS) Project. American Journal of Public Health. https://doi.org/10.2105/ajph.2012.300834
Lee G, Pope CN, Nwosu A, McKenzie LB, Zhu M. Child passenger fatality: Child restraint system usage and contributing factors among the youngest passengers from 2011 to 2015. J Safety Res. 2019;70:33-38. https://doi:10.1016/j.jsr.2019.04.001
Liaw P, et al. Pediatrics. May 20, 2019, https://doi.org/10.1542/peds.2018-2576).
Mathieu R, Peter S, Yvan C, Philippe L. National roadside survey of child restraint system use in Belgium. Accid Anal Prev. 2014;62:369-376. https://doi:10.1016/j.aap.2013.08.021
National Highway Traffic Safety Administration (NHTSA) (Ed.). (2022). Traffic Safety Facts 2020: Children (DOT HS 813 285). Traffic Safety Facts 2020. Retrieved February 6, 2023, from https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813285
National Roadway Safety Strategy. (n.d.). US Department of Transportation. https://www.transportation.gov/NRSS
NHCS - Community Benefit. (n.d.). https://www.cdc.gov/nchs/nhcs/community_benefit.htm
Office of Disease Prevention and Health Promotion. (n.d.). Injury Prevention - Healthy People 2030 | health.gov. Transportation. Retrieved February 13, 2023, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/injury-prevention
Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2021. National Vital Statistics Reports; vol 72, no 1. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: https://dx.doi.org/10.15620/cdc:122047.
Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003-2007. Pediatrics. 2010;126(2):352-357.
https://doi.org/10.1542/peds.2010-0333
Privette F, Nwosu A, Pope CN, Yang J, Pressley JC, Zhu M. Factors Associated With Child Restraint Use in Motor Vehicle Crashes. Clin Pediatr (Phila). 2018;57(12):1423-1431. https://doi:10.1177/0009922818786002
Rangel SJ, Martin CA, Brown RL, Garcia VF, Falcone RA Jr. Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance. J Pediatr Surg. 2008;43(1):200-207. https://doi:10.1016/j.jpedsurg.2007.09.045
Raymond, P. (2018, July). Additional Analysis of National Child Restraint Use Special Study: Child Restraint Misuse (DOT HS 812 527). Traffic Safety Facts: Research note. https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/13648-additional_analysis_of_ncruss_071718_v3_tag.pdf
Strategic Highway Safety Plan (SHSP) | Caltrans. (2020-2024). https://dot.ca.gov/programs/safety-programs/shsp
Wegner, M. V., & Girasek, D. C. (2003). How Readable Are Child Safety Seat Installation Instructions? Pediatrics, 111(3), 588–591. https://doi.org/10.1542/peds.111.3.588
What Counts as Community Benefit. (n.d.-b). https://www.chausa.org/communitybenefit/what-counts