Three Key Populations in CPS: What Does the Research Say? SafetyBeltSafe U.S.A. Stephanie M. Tombrello, LCSW, CPSTI Executive Director,

Three Key Populations in CPS:

What Does the Research Say?

SafetyBeltSafe U.S.A. www.carseat.org

Stephanie M. Tombrello, LCSW, CPSTI

Executive Director, SafetyBeltSafe U.S.A.

Session Objectives


• To discuss recent research related to CPS and:

Grandparents. Expectant & new moms. DUI and Children: What Can Be Done?

Grandparents: key partners in CPS


“Grandparents and Child Passenger Safety”, Joseph O’Neil, MD, Marilyn Bull M.D., James Slaven, Judith Talty. Accident Analysis & Prevention, e-published 4/30/12

• Method:

Observational surveys of parent and grandparent drivers and their child passenger safety (CPS) practices conducted by CPSTs in 25 locations in Indiana.

3 focus groups to gather opinions on the issue.

Driver questionnaire covered knowledge, practices, beliefs, attitudes toward CPS.

• Numbers: 1758 parents had 2713 children in vehicles; 284 grandparents drove 391 grandchildren.

• .


Findings by observation:

• Both parents and grandparents showed similar rates of choosing an inappropriate seat for the children under 16 in their care: 25%.

• 68.8% of grandparents and 77.6% of parents had at least one error in harness use.

• Grandparents were more likely to have either lower attachments or safety belts too loose: 42.7% vs. 25.5%.

• Grandparents also were more likely to transport children under age 13 in the front seat: 18.6% vs 10.7%




Findings by knowledge shared:

• Grandparents [35.2 %] and parents [46.8%] knew by child age when one shouldn’t put a child in the front seat; were a minority, but more parents knew the correct answer.

• Both parents [25.4%] and grandparents [21.1%] who knew how long to keep children rear facing; were a minority of those surveyed.



Findings in focus groups:

• Grandparents were divided into focus groups based on their relationship to the children: custodial (1 group of 7) vs. intermittent caregivers (2 groups of 10).

• Both groups agreed that CPS was important.• Both groups preferred learning by watching, not reading, and

wanted lighter safety seats, easier to release buckles, size 14 font for instructions, and standardization.



Focus group demographics:

• 54% of participants were over 50 years old. 78% were female.

• 58% were white; 42% African-American. No Latino grandparents volunteered for the focus groups.

• 61% had annual incomes of less than $50,000.



Findings in focus groups:

Custodial grandparents had more physical issues: lifting a heavy baby into the center rear which is recommended but hard for some; arthritis and back pain, vision, mobility, & strength issues, were common complaints that affected behavior.

Key difference: custodial grandparents often had to set standards in CPS for parents; intermittent caregivers were more likely to follow the parents’ lead.



Recommendations from research team:

Working with chapters of AARP to reach grandparents with appropriate messages.

Additional tools for reaching grandparents:

1) More publicity about locations &/or events providing safety seat checkups.

2) Encouraging choices of seats that are lighter, have stiffer harness systems to reduce twisting; easier-to-use buckle systems

3) Encouraging them to have children climb into seats independently once past babyhood.



• About a quarter of children under 5 years old, a third of kids of single fathers, and 40% of Latino children receive child care from grandparents.

• From review of the information and observations, including focus groups, the authors concluded messaging would help: most crashes occur close to home; sitting in safety seats improves child behavior; details about CPS laws.

• Picking up on grandparents’ comments on how they learn and how they struggle with current products/instructions/labels, etc. can shape outreach and patterns of service.

How widespread is this circumstance? What can CPSTs do to help?



“Grandparent Caregivers Unaware of More Recent Safety and Other Recommendations”, Amanda Soong, MD, FAAP & Kathryn C. Hines, MD American Academy of Pediatrics Convention, 10/12/12, New Orleans, LA

• Estimated 2.87 million grandparents provide primary care of their grandchildren, a 20% increase since 2000.

• Study was conducted with 3 support groups for grandparents; 49 surveys were collected.

• Issues in questionnaire were reviewed with grandparents and then assessed for congruence with AAP stipulations as to the current appropriate approaches.



Findings by issue queried:

• CPS question: In which direction should a 9-month, 22 lb. baby face in the car? 24.5% reported forward facing.

• Sleep position question: 33% on stomach; 23% side; 43.8% chose back (correct).

• When should babies start to drink water? 42.9% 2 weeks; 20.4% 2 months; 36.7% 4 or 6 months (AAP: when solid foods are introduced which is generally closer to 4-6 months.)

• Should cribs contain stuffed animals, blankets, pillows as well as mattress and sheet? 49% said yes; only 26.5% said mattress & sheet only.

• Walkers are good for teaching babies to walk: 73.9%; AAP has banished walkers for decades.



Response of research team: Amanda D. Soong, MD, Kathryn C. Hines, MD, Hughes Evans, MD, PhD, Marjorie Lee White, MD, MPPM, MA, Nancy M. Tofil, MD, MEd, Lynn Zinkan, RN, MPH and Amber Youngblood, RN. Presented 10/12/12, AAP National Conference.

• Developed a curriculum for pediatric residents using 5 short lectures plus a simulated well-child visit with dummy and actor in role of caregiving grandparent.

• Topics: demographics of these families, common health issues in the grandparent population: dementia, anticipatory guidance. Simulation cases addressed hearing loss, medication storage, health literacy, and effective communication.

• Residents did history-gathering exercise on the patient who was accompanied by a grandparent caregiver.

Real-world example: Dodgers’ Manager Don Mattingly & newborn son, Louis (Photo: Lori Mattingly)

Mattingly was interviewed by Bill Plaschke, Los Angeles Times, and revealed he is often taken for the baby’s grandparent (age 53).





What are the new baby “rules” that surprise him?

1. ‘the newfangled car seats’, which Mattingly talks about in tones of awe and wonder, as if describing a great pitch or top prospect.

"Can you believe that you can just snap the seat into the base, then, when it’s time to get out, you just snap the seat out of the base and put it right in the stroller?" he said. "I've never seen anything like it.”’

2. Baby monitors: originally only auditory; now camera-equipped, can see baby sleeping.

3. On back to sleep.4. Sing to baby, even if don’t know words to song. 5. Reading "What To Expect The First Year” 6. No use of “baby powder” which might affect infant lungs.

‘Motor Vehicle Safety During Pregnancy’, Catherine J. Vladutiu & Harold B. Weiss, American Journal of Lifestyle Medicine, 10/11

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• Review paper on status of issue: 92,500 pregnant women injured in U. S. car crashes a year.

• Underestimated as often missed if in 1st trimester.

• Leading cause of hospitalization for injury & injury-related death for pregnant women; more driving by women increases risk.

• State-based findings: ER visits in MA and UT found similar rates; WA: injury-related hospitalizations: 30% from MV crashes.

• 60-70% of fetal losses related to placental abruption.

• Unrestrained women: 4 times more likely to lose fetus.

CPS Newbies: Expectant & New Moms

• Computer modeling using anthropometric dummies w/pregnant abdomens shows best restraint combo of shoulder-lap belt and air bag.

• Primary enforcement belt law states: more usage, more protection

• Counseling on proper belt use: CA study indicated only 1/5 received this.

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‘Analysis of Pregnant Occupant Crash Exposure and the Potential Effectiveness of 4-Point Seatbelts in Farside Crashes’, Stefan Duma et al., Proceedings of AAAM, 10/06

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• Reviewed NASS (national database of crash data sampled). Found distribution of crashes: frontal: 53%; farside, 13.5%, nearside, 13.2%; rear, 8%.

• Reviewed restraint use effects: lap belt or nothing vs. shoulder-lap & 4-point belt. More abdominal strain with the latter 2; however, less head injury. More likely to survive, meaning better outcome for fetus.

• “Given the magnitude and severity of pregnant occupant injuries, this study illustrates the need for manufacturers to consider four-point belt systems for this population.”




“Unsafe from the Start: Critical Misuse of Car Safety Seats for Newborns at Initial Hospital Discharge”, Benjamin Hoffman, M D., F.A.A.P. Presented at American Academy of Pediatrics national conference, 10/14. Submitted for publication.

• Observational study conducted at Oregon Health and Science University Hospital, 11/13 – 5/14. Observation of both infant placement & safety seat installation.

• Observation followed by checkup to ensure infants traveled home safely.

• 267 mother-infant pairs, randomly selected (excluding preemies & NICU grads).


Findings:

Most common errors:1. Loose harness: 69%2. Loose installation: 43%3. Wrong angle for seat: 36%4. Retainer clip too low: 34%5. Safety belt unlocked: 23%6. Use of unregulated products: 20%7. Harness located above infant’s shoulders: 18%8. Safety seat too close to back of front seat: 17%9. Unaware of how to adjust the harness: 15%




Demographics:

Problems were more pronounced for those in the following categories:

1. Low income

2. Lower education level

3. Non-white

4. Non-English speaking

5. Unmarried without a partner


Response: Question: Do these findings reflect what you see? SBS data on newborn installations (in orange):




Response:

• Those with contact with a CPS Technician were 13 times more likely to have the baby properly buckled up. But 77% with CPST checkup, still made errors.

• What does this mean for hospital policy?

• How many hospitals have CPSTs on staff or on call?

• What is the risk for liability when, knowing this, hospitals do not have a policy of offering checkup services?

• Where should our focus be in terms of demographics?

Research Focus: DUI & Children


DUI and Children: Some Statistics (MADD)

• 300,000 journeys by drunk drivers each day. 4000 arrests.

• Estimated 46 – 102 million drunk driving trips with child passengers every year.

• 10.3 million people reported driving under influence of drugs (2012).



DUI and Children: Some Statistics cont. (MADD)

• 2013 – 10,076 fatalities, 290,000 injuries.

– 200 child fatalities (17% of total).

– 61% in vehicle with drunk driver.

• Males more likely to drive drunk (15.1% v. 7.9%)… but things are changing…

• 50 – 75% convicted DUI drivers continue to drive on suspended license.

• Significant reduction 1982 – 97; progress since stalled.



• VA, 4/1/15 – baby uninjured in single-vehicle crash. Father arrested for DUI.

• CA, 4/3/15 – 12 yr old killed in single vehicle crash. Unrestrained. Father arrested for DUI, murder.

• CA, 4/3/15 - 5 yr old injured in single vehicle crash. Mother arrested for DUI after trying to leave the child at the scene.

• CA, 4/4/15 – 3 yr old killed, 2 & 10 yr olds seriously hurt in single vehicle crash. Mother arrested; allegedly high on drugs

• GA, 4/5/15 – 3 children ejected, 1 critically injured, after their vehicle is hit by DUI driver.

• OK, 4/6/15 – child & 2 adults killed. Driver of other vehicle arrested for DUI.

• ID, 4/7/15 – 2 children injured, mother partially ejected & critically injured, 2 other adults injured after driver rams another vehicle. Father arrested for DUI.

• CA, 4/10/15 – child & several others injured in head-on collision. Driver of other vehicle arrested for DUI.

• NJ, 4/11/15 – 2- & 4-year-old sisters seriously hurt when father ran stop sign. Father arrested for DUI.

• CA, 4/13/15 – 9-month-old, 2-year-old and mother injured when vehicle caught fire after single vehicle crash. Father arrested for DUI. Children incorrectly restrained.

• CA, 4/14/15 – 4-year-old daughter injured when mother hit a school bus. Child incorrectly restrained.

• ID, 4/19/15 – child injured, driver of other vehicle killed when car crossed the center line. Mother charged with DUI.

• PA – 3 children involved in series of incidents/crashes. Mother now charged with 5 th DUI offence.

A few days in April 2015…



• Child restraint use decreases with age of child and increasing BAC of the driver (Quinlan et al, 2005; Schlotthauer et al, 2011). Restraint use in fatal crashes: 18% for drinking drivers cf. 30% sober drivers.

• 70% of children killed in DUI crashes not restrained. 68% of drivers survive, suggesting crash likely to have been survivable for child (Shults et al, 2005).

• 2x risk of injury of non-DUI crashes. Injury risk highest in 4 – 7 yr olds (70.8% v. 44.9%) (Schlotthauer, 2011)

• Most child-involved DUI crashes during the day or evening (Shults et al, 2005).



‘Female drivers increasingly involved in impaired driving crashes: actions to ameliorate the risk’, F. Vaca, E. Romano & J. Fell, Academy of Emergency Medicine 21 (2014), 1485 – 1492

• National Roadside Survey (2007) findings on impaired drivers.• Rates of DUI declined from 1996 in men and women, but more steeply in men.• 2010 – fatal DUI crashes, 19% female drivers. 68% very high BACs (male 69%).

Overall women drivers still significantly less likely than men to be very intoxicated.

• # of fatalities per 100,000 licensed drivers dropped substantially for men, remained the same for women.

• 1998 – 2012 – increase in DUI arrests 92.6% female; 8.6% male.• Greatest increase – young women (discussed but not quantified)• Traffic safety problems “no longer a male domain”.



VW Tsai, CL Anderson, FE Vaca, ‘Alcohol involvement among young female drivers in U.S. fatal crashes: unfavourable trends’, Injury Prevention 16, (2010), 17-20

• Similar findings. Rate of alcohol-related fatal crashes in young female drivers (19 – 24) has increased.

• Abuse of prescription medications also much higher in young women than young men.

• Largest increase in highest BAC category.• Increase weekdays AND weekends.



‘Transporting Young Passengers While Impaired: The State of the Law’, S. Thomas, T. Kelley-Baker, E. Romano, R. Treffers, C.L. Cannon, Health Behavior & Policy Review (2014) 1:4, 265-277

• Examination of DUI codes and child endangerment laws across the U.S.

• 42 of 51 jurisdictions specifically address DUI-child endangerment in statutes (enhanced penalties or separate offenses).

• Most protective policies not available in most jurisdictions

• No significant relationship in strength of DUI-child endangerment laws and number of child fatalities in DUI crashes.





Maine OUI (Operating Under the Influence) Law

• Minor in vehicle is aggravating factor; enhanced penalties apply (275-day additional suspension; additional jail time first offence only).

• Minor defined as under 21.

• Child endangerment charges apply.

• For drivers under 21, any measurable alcohol results in loss of license for 12 months.

DUI & Children: What can be Done


New York’s Leandra’s Law: a national model for DUI Child Endangerment Law?

• Comprehensive DUI child endangerment law enacted in N Y in 2009.

• Felony to drive drunk with child passenger in vehicle

• Key provisions: 1st time offenders: may be charged with class E felony (up to 4 yrs in prison) BAC .08 or greater – automatic suspension of license pending prosecution. All drivers convicted of misdemeanor or felony DWI (regardless of whether

child in vehicle) must install and maintain ignition interlock for at least 6 months in addition to any prison term.

Causing death of a child through DUI – Class B felony (up to 25 yrs in prison). Causing injury – Class C felony (up to 15 yrs in prison)

DUI & Children: What can be Done


• Strengthen DUI laws to similar standard as NY.

• Enforce robustly, charge properly and prosecute effectively.

• Education programs (incl. judicial education programs) bringing the attention of families and professionals to this ongoing problem.

• Many professionals working with families do not know that adults the age of parents cause child deaths by driving impaired with child in vehicle.

• Refer to child protective services; investigate thoroughly

• Courts to support divorced and separated parents in making safe transport arrangements and protect children when parents are driving impaired.

• Establish a habit of buckling up in the child from the beginning; teach children to buckle themselves up as early as possible.

• Encourage local media to report cases, highlight the general issue.

Further Information

SafetyBeltSafe U.S.A.

P.O. Box 553, Altadena, CA 91003310/222-6860

800/745-SAFE 800/747-SANOwww.carseat.org


Documents

Three Key Populations in CPS: What Does the Research Say? SafetyBeltSafe U.S.A. Stephanie M. Tombrello, LCSW, CPSTI Executive Director,