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      Has Child Restraint System Use Increased among Parents of Children in Shantou, China?

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          Objective: to examine parents’ use of child restraint systems (CRS), and determine if parents’ knowledge of, attitude toward, and use behavior of child restraint systems have improved following enactment of child restraint use laws in other cities. Design: Observations and a cross-sectional survey of drivers transporting children 17 years and under were conducted at the gate of the schools and parking lots of hospitals in Shantou. Observers recorded the seating location of child passengers, the type of restraint, and appropriate use of CRS and safety belts based on the observation. Knowledge of and attitudes towards use of CRS were reported by the driver following observation. Results: Approximately 6.6% of passengers aged 0–12 were in CRS; rate of forward-facing CRS in children aged 3–5 (9.9%) was higher than rear-facing CRS for children aged 0–2 (1.1%) and booster seat use among children aged 6–12 (0.1%). Children younger than four years old (OR = 3.395, 95% CI = 2.125–5.424), drivers having a college or higher lever education (OR = 2.908, 95% CI = 1.878–4.500) and drivers wearing seatbelt (OR = 3.194, 95% CI = 1.605–6.356) had greater odds of CRS use. Over half (56.6%) of parents might or would use CRS if they could rent CRSs with fees. Conclusions: The rate of CRS is still low in Shantou. Comprehensive public education programs supported by legislation might be an effective way to improve child passenger safety. Renting CRSs to parents could be a new approach to encourage use.

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          Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions.

          Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however, is unclear. The authors developed a coding system to identify the ecological levels that health promotion programs target and then applied this system to 157 intervention articles from the past 20 years of Health Education & Behavior. Overall, articles were more likely to describe interventions focused on individual and interpersonal characteristics, rather than institutional, community, or policy factors. Interventions that focused on certain topics (nutrition and physical activity) or occurred in particular settings (schools) more successfully adopted a social ecological approach. Health education theory, research, and training may need to be enhanced to better foster successful efforts to modify social and political environments to improve health.
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            Reviews of evidence regarding interventions to increase use of child safety seats.

            In 1998, nearly 600 child occupants of motor vehicles aged younger than 4 years died in motor vehicle crashes. Yet approximately 29% of children aged 4 years and younger do not ride in appropriate child safety seat restraints, which, when correctly installed and used, reduce the need for hospitalization in this age group by 69% and the risk of death by approximately 70% for infants and by 47% to 54% for toddlers (aged 1 to 4 years). The systematic review development team reviewed the scientific evidence of effectiveness for five interventions to increase child safety seat use. For each intervention, changes in the use of child safety seats or injury rates were the outcome measures evaluated to determine the success of the intervention. Database searching was concluded in March 1998. More than 3500 citations were screened; of these citations, 72 met the inclusion criteria for the reviews. The systematic review process identified strong evidence of effectiveness for child safety seat laws and distribution plus education programs. In addition, community-wide information plus enhanced enforcement campaigns and incentive plus education programs had sufficient evidence of effectiveness. Insufficient evidence was identified for education-only programs aimed at parents, young children, healthcare professionals, or law enforcement personnel. Evidence is available about the effectiveness of four of the five interventions we reviewed. This scientific evidence, along with the accompanying recommendations of the Task Force elsewhere in this supplement, can be a powerful tool for securing the resources and commitment required to implement these strategies.
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              Parents' knowledge, attitude, and use of child restraints, Shantou, China.

              China has not adopted national policies for child safety restraints in cars, although children are increasingly traveling in cars. To describe child restraint use, and parents' knowledge of and attitude toward child restraint in Shantou, China. An observational study and driver survey on child restraint use was conducted in the Southeast China city of Shantou in 2012. Observational sites included 22 middle schools, 31 primary schools, 24 kindergartens, and 4 hospitals. Drivers were asked about their knowledge of and attitude toward the use of child restraints. In September 2012, multivariate regression was used to evaluate the factors associated with increased child restraint use. Of 3333 children observed in vehicles, only 22 (0.6%) children were secured in child safety seats or booster seats and 292 (8.7%) children were wearing seatbelts. More than half (n=508, 56.1%) of the infants or toddlers were riding on the laps of adults. Of 1069 drivers who responded to the survey, more than 62% thought it was necessary to use child restraint while traveling in a car. The drivers' higher education status (OR=1.56, 95% CI=1.07, 2.27) and seatbelt use (OR=4.00, 95% CI=2.56, 6.25) were associated with increased child restraint use. Parents (OR=0.55, 95% CI=0.34, 0.88) and male drivers (OR=0.61, 95% CI=0.46, 0.81) had reduced odds of children properly rear-seated. Child restraint use is very low in China, although the majority of drivers had positive attitudes about child restraint. These findings indicate that child restraint policies and educational approaches are urgently needed in China. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

                Author and article information

                [1 ]Injury Prevention Research Center, Medical College of Shantou University, 22 Xin Ling Road, Shantou 515041, China; yufangyixuelhq@ (H.L.); xxliu2014@ (X.L.)
                [2 ]Center for Injury Research and Policy, The Ohio State University, Columbus, OH 43205, USA; Ginger.Yang@
                [3 ]The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China; xjchen@
                Author notes
                [* ]Correspondence: lpli@ ; Tel.: +86-754-8890-0467; Fax: +86-754-8855-0372
                Role: Academic Editor
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                International Journal of Environmental Research and Public Health
                28 September 2016
                October 2016
                : 13
                : 10
                27690070 5086703 10.3390/ijerph13100964 ijerph-13-00964
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (


                Public health

                parents, child restraint system (crs), attitude, knowledge


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