Identifying Information That Promotes
Belt-Positioning Booster Use
Volume 2: Appendices
1. Report No.
2. Government Accession No.
3. Recipient's Catalog No.
DOT HS 811 019
4. Title and Subtitle
5. Report Date
Identifying Information That Promotes Belt-Positioning Booster Use
Volume II: Appendices
July 2008
7. Authors
8. Performing Organization Report No.
6. Performing Organization Code
Flaura K. Winston, M.D., Ph.D.; Danielle C. Erkoboni
9. Performing Organization Name and Address
10. Work Unit No. (TRAIS)
The Center for Injury Research and Prevention
The Children’s Hospital of Philadelphia
34th and Civic Center Blvd.
Philadelphia, PA 19104
11. Contract or Grant No.
DTNH22-01-C-05845
12. Sponsoring Agency Name and Address
13. Type of Report and Period Covered
Office of Behavioral Safety Research
National Highway Traffic Safety Administration
1200 New Jersey Avenue SE
Washington, DC 20590
Quantitative and qualitative
research conducted July 2003 to
October 2006
14. Sponsoring Agency Code
15. Supplementary Notes
16. Abstract
Many parents with low educational attainment prematurely graduate their children to seat
belt restraint rather than use belt-positioning booster seats. This study aimed to identify
interventions that promoted booster seat use among this population. Focus groups were used to
elicit factors contributing to booster seat nonuse, which informed subsequent intervention
development. A first phase (10 focus groups, n=117) identified parents’ perceived barriers,
benefits, and threats relating to booster seats. These findings were used to identify existing and
create new interventions. A second phase (20 focus groups, n=171) elicited parent’s reactions to
these interventions and provided parents with belt-positioning booster seats and education on their
use. Follow-up interviews were conducted six weeks later.
Lack of education and fear of injury were the primary barriers to booster seat use. Parents
were motivated by interventions that provided clear, concrete messaging relating to use. Parents
favored the intervention that presented a real story detailing a child’s severe injury that could have
been prevented with appropriate restraint. At follow-up, parents credited this intervention with
motivating booster seat use most often Although parent’s cited their child’s lack of comfort and
noncompliance as barriers to use, they were not as motivated by interventions that addressed these
barriers. Effective intervention programs can be created by identifying and addressing factors that
contribute to a population’s intention to use belt-positioning booster seats. In addition, successful
programs must use messages that motivate the target population by addressing their perceived
threats to booster seat nonuse.
17. Key Words
18. Distribution Statement
motor vehicle safety, child safety seat, booster seat,
qualitative research, focus groups
This report is free of charge from the NHTSA
Web site at www.nhtsa.dot.gov
19. Security Classif. (of this report)
Unclassified
20. Security Classif. (of this page)
Unclassified
i
21. No. of Pages
22. Price
Table of Contents
1. Phase 1 Appendices........................................................................ 1
1.1 Phase 1 Recruiting Flyers ..........................................................................................1
1.2 Phase 1 Screening Form.............................................................................................2
1.3 Phase 1 Focus Group Moderator’s Guide..................................................................6
1.4 Phase 1 Consent Form .............................................................................................11
1.5 Phase 1 Participant Information Form .....................................................................13
1.6 Phase 1 Coding Rubric.............................................................................................17
1.7 Phase 1 Focus Group Discussion Summary ............................................................19
2. Phase 3 Appendices .............................................................................................35
2.1 Phase 3 Recruiting Flyers ........................................................................................35
2.2 Phase 3 Screening Form...........................................................................................39
2.3 Phase 3 Focus Group Moderator’s Guide................................................................43
2.4 Phase 3 Consent Form (English and Spanish) .........................................................50
2.5 Phase 3 Participant Information Form (English and Spanish).................................52
2.6 Phase 3 Coding Rubric.............................................................................................64
2.7 Phase 3 List Ranking ...............................................................................................66
2.8 Phase 3 List Ranking Top Five................................................................................67
2.9 Phase 3 List Ranking Discussion Summary ............................................................77
2.10 Phase 3 Focus Group Intervention Discussion Summary......................................90
2.11 Phase 3 Booster Seat Giveaway Consent Form...................................................102
2.12 Phase 3 Booster Seat Giveaway Script ................................................................108
2.13 Phase 3 Booster Seat Giveaway Form .................................................................110
2.14 Phase 3 Post-Discussion Forms (English and Spanish).......................................114
2.15 Follow-Up Telephone Interview Script ...............................................................120
3. Injury Free Coalition For Kids (IFCK) ....................................................131
3.1 IFCK Background Information..............................................................................131
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APPENDIX 1.1:
PHASE 1 RECRUITING FLYERS
1
APPENDIX 1.2:
PHASE 1 SCREENING FORM
Screener Name:
_________________________ City:
Date:
_________________________
____________________
Criteria for Groups (need 10 people per group):
• Race: African American, Hispanic or White (depending on city)
• Parents or stepparents of children 3-6
• Must regularly drive or ride with children in vehicles (excluding public transportation)
• High school or less education.
• Aged 21 and above
• Use car seats or booster seats, at least occasionally OR
• Use safety belts
Why are you holding this focus group?
¾
To find out parents’ opinions about booster seats and young children while riding in
vehicles.
What is a focus group?
¾
An informal discussion with about 10 people. There are no right or wrong answers. We
are looking for opinions. Participation is confidential.
Thank you for calling. My name is ___________ and I work for the Pacific Institute for
Research and Evaluation. We’re recruiting parents for a group discussion at ______________
community center on ___________day/date. We will pay $60 and provide food for parents
who take part in a 2-hour group discussion. I’d like to ask you a few questions to see if you will
be able to participate.
Screening Questions:
1. How did you hear about our study?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. Do you have any children between the ages of 3 and 8 years of age?
Yes
No [THANK AND END]
2
3. Are you the:
birth parent
adoptive parent
step parent
other [THANK AND END]
4. What is your racial or ethnic background? (Continue or end conversation based on
groups needed)
African American/black
Caucasian/White
Hispanic/Latino
Asian/Pacific Islander
Mixed Race
Other
5. (If Hispanic) What language are you most comfortable with?
English
Spanish
Note to screener: Based on your interaction with participant: Could he or she participate
in an English language focus group, or is a Spanish Language group needed?
English
Spanish
6. Are you 21 or older?
Yes
No [THANK AND END]
7. NOT COUNTING public transportation like buses and subways, How often do you
drive or ride with your children in a vehicle,? Is it …
Every day
Several times/week
Several times/month
Several times/year [THANK AND END]
Never [THANK AND END]
8. What is the highest level of education you have completed so far?
Grade school/ Elementary School
Junior School/ Middle School
High School/ GED
College [THANK AND END]
Graduate School [THANK AND END]
Other _______________________ [THANK AND END]
3
While we know that child safety seats, booster seats and seatbelts are a good idea, we also know
that there may be times when they are not used.
For your children aged 3 to 6
9. Do you ever put them in car seats or booster seats when they are in a vehicle?
Yes [Assign to group]
No [GO TO QUESTION 10]
10. Do you ever put them in safety belts when they are in a vehicle?
Yes [Assign to group]
No [THANK AND END]
PROVIDE DETAILS TO THOSE WHO QUALIFY:
A. Because of the nature of the groups and because we do not have child-care, no children will
be allowed (so please don’t bring your kids).
B. I can give you the directions now, and we will follow up by mailing the directions to you,
also. [give directions]
C. May I have your full name, address, and daytime and evening telephone number, where we
can reach you? We will keep this totally private and will only use this information to
contact you about the group discussion.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
D. We have a few suggestions when you come to the group:
a. Please arrive 15 minutes ahead of time.
b. If you cannot make it, please cancel at least 24 hours before the group so that
someone else can take part in the study.
c. Bring your reading glasses, if you need them.
d. Also, before you come to the meeting, please take a moment to write down the type
of child seat you have.
We are glad you’ll be joining us. Please put this on your schedule. We will see you on [DATE].
We will also send you a confirmation letter and directions. Please call me at _____________ if
you have any questions or need to cancel.
4
TO END CONVERSATION FOR SOMEONE WHO DOES NOT QUALIFY:
We appreciate your interest in this project. At this time, we don’t have any openings for you in the focus
groups we are trying to fill. If you’d like to leave your name and number, we will call if we get an
opening.
Name
________________________________
Phone Number
__________________________
Thanks for calling.
5
APPENDIX 1.3:
PHASE 1 FOCUS GROUP MODERATOR’S GUIDE
FOCUS GROUPS MODERATOR’S GUIDE
Note: This is a guide, not a script. Moderators may vary topics and probes to accommodate particular sites and groups.
Introduction
•
•
•
•
•
•
•
•
•
•
Moderator welcomes participants and introduces self and co-facilitator. Introduce any
observers. Explain what CHOP/PIRE is and who is paying for their participation.
Explain the study and the purpose of the group discussion (e.g. to learn more about what
you, as parents of 3-6 year old children, think about how children ride in motor vehicles)
Preview what will happen during the group, when they will be paid, etc.
We are interested in your opinions. There are no right or wrong answers.
Information we collect will be summarized only for this project. What you say will be
kept totally private. We will not use any names or quote anyone by name.
Read and explain the consent form to the participants and answer questions they may
have.
We value the information you will share with us today and want to make sure we capture
all of it. So we will be taping the session and taking notes. If at any time you want to say
something without the recorder on, tell us and we’ll turn it off. Is everyone okay with
that?
This will be an informal discussion.
We will talk for 1½ hours. There will be no formal breaks, but please feel free to get up
at any time to stretch, go to the bathroom (provide location), or get something to eat or
drink (indicate table with refreshments).
We appreciate your input very much. Any questions?
Ground Rules of Group Discussion
•
We would like only one person to talk at a time. But we hope that each of you will speak
up, and tell us your thoughts and feelings, even if they are different from what others
have said. We are interested in both negative and positive comments.
• We know that some of you may have more than one child between the ages of 3-6 years
old. When we ask you about your child, we mean your YOUNGEST child who is
between the ages of 3-6 years.
• Since there are several types of motor vehicles, when we ask about your child in a
VEHICLE, we mean personal automobiles like cars, pick-up trucks, vans, and sports
utility vehicles (SUVs). NOT public transportation vehicles like trains, buses, or taxi
cabs.
6
(Turn on Recorder)
ICEBREAKER
This first question helps highlight the common characteristics of the participants and that they all
have some basis for sharing information.
• “Let’s go around the room, one at a time…”: Ask participants to introduce themselves
with first name only and tell the group the number and ages of their children (note: we
normally have first name “tents” on the table to facilitate the discussion)
Discussion Topics and Probes
I. CHILD’S REACTION TO RESTRAINT
• How active is your child when riding in a vehicle? Describe his or her activities (i.e.,
getting out of CSS/BS/SB or changing seats).
• Who usually has control over how children behave while in the vehicle?
• What are some of the rules that your children must follow when they ride in a vehicle?
How does your child react to these rules?
• How does your child react to being in a restraint (CSS, BPB or seatbelt)? How do you
respond when/if your child fights again using a restraint? (Probe: type of negotiation,
games, bribes, etc.)
• How does your child react when s/he sees other children his/her age riding in a child
safety seat or booster seat? How do you respond to this?
• If your child had a choice to use a CSS or BS, SB or nothing at all, which one do you
think he or she would choose? For what reasons?
II. CPS MESSAGES AND KNOWLEDGE
• Tell me what you’ve heard or know about booster seats? From whom (person, media,
etc)? What did this information mean to you?
• Do you think there is a difference to a child’s safety in whether the child uses a booster
seat or a seat belt (without the child seat)?
• What people (no names, just who it is – like “sister,” or “friend”) or names of groups do
you believe would/would not want you to use a booster seat for your child?
• Is there a booster seat law in your State? What’s the law about CRS use in your State?
Where did you hear about the law? How well do you think the law is enforced?
III. PERCEIVED THREATS AND BARRIERS
• How often do you think about or worry about the possibility of being in a vehicle crash
(parent & child involved)? What triggers these thought or worries?
• In a crash, what are some things that would make your child more likely to be seriously
hurt?
7
• What things do you do to prevent a crash? To prevent your child from being injured?
• What would make it HARD for you to use a booster seat for your child?
VI. PERCEIVED BENEFITS
• What would make it EASY for you to use a booster seat for you child?
• If a hospital in your community OR other health or safety-related agencies (e.g. Girl
Scouts, hospitals, churches) wanted to get people to use booster seats with their children,
how would you recommend they do it? (probe: what would make you want to use one;
not want to use one)
• How do you expect your child to ride in a vehicle when he or she is 7 or 8?
• For Seat belt users Only: What, if anything, would make you consider moving your child
to a booster seat?
IV. PRIOR RESTRAINT USE (For Seat Belt Users Only)
• When did your child start using seat belts regularly (alone) when riding in a motor
vehicle? Why did your child start using seat belts regularly at that time?
• What, if anything, was the child using before going to regular use of a seat belt? How
long was the child using that type of restraint?
• What did your child like/dislike the most about using the CRS? How did you respond
when/if your child fought against using the CRS? (Probe: type of negotiation, games,
bribes etc.)
• When your child moved from the CRS to the seat belt, did you feel there was any
difference in how well protected your child was? If YES, how would you describe the
difference? Would you have preferred an alternative to the seat belt at the time?
V. CURRENT RESTRAINT USE
Thinking about your youngest child between the ages of 3 and 6…
• What kind of restraint do you use for your child?
• Are there any recent changes in the type of restraint used? If yes, why?
• How long do you think your child will use the type of restraint he/she currently uses?
What will he/she use next?
• Under what circumstances would your child NOT use a restraint?
• For seat belt users only: How does the seat belt fit your child? What, if anything, do you
or your child do with the seat belt to make the child more comfortable?
• For Booster Seat Users Only: Do you have any advice for parents about using boosters?
CARD SORT EXERCISE
We’re going to take a few minutes to do something different now. We are going to pass out a
piece of paper. At the top of this paper, we want to know what type of restraint you use for your
youngest child between the ages of 3 and 6. First, please check whether it is a child seat, a
8
booster seat, a seatbelt or you don’t know. Next, if you are using a child restraint, please circle
the picture that looks most like the one your child uses. Don’t put your name on the paper
because we’re going to be collecting it later.
Now, we are going to pass out an envelope to each of you. In the envelope, there are cards with
words on them that you might use to describe the good and bad things about using a child
restraint for your child. I am going to read through the words on the cards and you will pick out
the ones that you agree with and put them to the side.
Read list of words:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Comfortable
Uncomfortable
Safe
Unsafe
Easy to use
Hard to use
Light weight
Heavy
Easy to move to another car
Hard to move to another car
Inexpensive
Expensive
Good features, such as cup-holders
No features
Takes up too much space
Child dislikes
Enables child to see out of window
Child likes
Child thinks it's a “big kid” seat
Child thinks it's a “baby” seat
Keeps child under control
Child can easily get out
Easy to put in car
Hard to put in car
9
[After reading through list]: Put only the cards that you chose back into the envelope and leave
the other ones on the table. Please hand in the envelope.
Discussion:
• What are the good/bad things about using a restraint for your child all the time/some of
the time? (i.e. child-related issues/reasons/advice to parents, purchasing/obtaining a seat,
placing it in car, etc)?
• What does your child like/dislike the most about using a restraint?
• For car/booster seat users only: In what cases would your child ride in a seat belt rather
than in a child safety seat or booster seat? What motivates you to put your child back
into a child safety seat or booster seat the next time you are in the car?
Summary and Closing
•
•
•
•
Moderator Summary/Key Points
Are there any final comments?
Thank participants
Distribute cash envelopes; have participants sign the receipts
10
APPENDIX 1.4:
PHASE 1 CONSENT FORM
Research Consent Form
Building on Findings of the Partner’s Study –
Identifying Interventions that Promote Child Restraint Use
Purpose: You are being invited to participate in a research study to find out information about
what parents think and believe about using child safety seats (such as infant seats and booster
seats) for their children, when traveling in motor vehicles (personal automobiles: cars, pick-up
trucks, vans, and sports utility vans [SUVs]). You will also be asked about what ideas you might
have to help parents improve their use of child safety seats for their children.
Selection of Subjects: You have been asked to be a part of this study because motor vehicle
crashes are a leading cause of death and acquired disability among children in the United States.
The use of child safety seats reduces the risk of injury and death, but many children, especially
those 4-8 years old, often ride in motor vehicles, while in child safety seats that are used
incorrectly, inappropriately, or without using them at all. As parents of children ages 4-8 years
old, the information that you can provide is very important and may be used to guide the
development of programs to examine and promote the use of child safety seats. Focus groups
recruited to participate in this study will include at least two groups from the Children’s Hospital
of Philadelphia, totaling at least 16-20 participants.
Procedures: This study has two parts and will last about two hours. In the first part, you will
complete a registration form and a brief questionnaire. You will be asked to answer a series of
questions about how you feel about using a child safety seat for your child, when traveling in a
motor vehicle. You will also be asked information about your background and factors or things
that influence your use of a child safety seat for your child. This part of the session will take
about ½ hour to complete. The second part of the study is an open focus group discussion that
will last about 1½ hours. You will be asked about your thoughts and beliefs on topics such as the
risk of children traveling in motor vehicles without being in a child safety seat, and the benefits
of using a child safety seat for your child when traveling in a motor vehicle. Although specific
questions will be directed to the entire group, you are encouraged to answer individually and
respond freely.
Notes will be taken on the responses provided and the session will be audio taped. Members of
the research team from the Children’s Hospital of Philadelphia will observe focus group
sessions. This will take place by using a room with a one-way mirror. If this type of room is not
available, the sessions will be video taped so that team members can observe through a television
monitor located in another room. Note taking, audiotaping, and observations for this part of the
study, is necessary, so that your information is not lost or misunderstood for future use. Any
videotaping or audiotaping that takes place will be destroyed at the close of the study.
Potential Risks: The possible risk of being a part of this study is that you may be upset due to
some of the personal questions asked, and/or the nature of motor vehicle occupant injury-related
11
facts provided. If you are too uncomfortable by the facts provided, you are to notify the staff
immediately. Also, if you are uncomfortable answering any question on the written
questionnaire, you may skip it and write “too personal” in the margin.
Benefits: You will benefit directly from being a part of this study. Benefits that you will receive
include: 1) your answers to the questions, which are very important, may be used to guide the
development of programs to examine and promote child safety seat use; and 2) you will be given
important information about the use of child safety seats for your children
Alternatives: The alternative to participating in this study is not to participate.
Confidentiality: All information collected in this study, including videotapes (if session is taped)
and audiotapes, will be kept strictly confidential, as permitted by law. If any publication results
from this research, you will not be identified by name. Your name will not be placed on the
questionnaire. Instead a code number will be used. You will not be identified by your last name
on the audiotapes or videotapes to ensure confidentiality. All information will be kept in a secure
location. Audiotapes will be destroyed at the close of the study. Any videotaping that takes place
will be destroyed after the research team observes group sessions.
The research team and other staff at The Children's Hospital of Philadelphia, the Pacific Institute
for Research and Evaluation (company conducting focus groups), the Institutional Review Board
at The Children's Hospital of Philadelphia, the sponsor (National Highway Traffic Safety
Administration) and any government agencies involved in the oversight of this research may
have access to information that identifies you as a subject in this research. PIRE will store
audiotapes and videotapes. The PI and Co-PI will be responsible for maintaining all of the
collected participants’ personal information and all data collected from the Participant
Information Collection Instrument in a locked file cabinet that will be located in TraumaLink, at
CHOP.
Financial Considerations: There are no financial costs for you to be a part of this study. You will
be paid $60.00 for being in this study.
Questions: All of your questions should be answered to your satisfaction before you consent to
participate in this study, but if you have any further questions about the study you may call Dr.
Flaura K. Winston at (215) 590-3118 or Dr. Edith M. Simpson at (215) 898-2280. If you have
any questions about the rights of research subjects, you may call Lynn Bevan in the Office of
Research Regulatory Affairs at 215-590-2830.
Voluntary Consent: You are free to withdraw or refuse your consent, or to discontinue your
participation in this study at any time without jeopardizing the care that you and your child may
receive now or in the future from the Children’s Hospital of Philadelphia.
I voluntarily give my consent to participate in this research study. I understand I will be given a
copy of this consent form.
Subject’s Name: _________________________________ (please print)
Subject’s Signature: ______________________________ Date: _________________
Person Obtaining Consent: ________________________ Date: _________________
12
APPENDIX 1.5:
PHASE 1 PARTICIPANT INFORMATION FORM
PHASE ONE
PARTICIPANT INFORMATION FORM
We would like to learn a little more about you. We will not use your name with this information.
If you don’t want to answer a question, you can skip to the next one. All answers will be kept
private and confidential. Please DO NOT PLACE YOUR NAME on any part of this form. Let
us know if you have any questions.
Section 1. Information About You
1. How old are you? ________ years.
2. Are you?
Living with partner
Single, never married
Separated
3. Are you?
Married
Divorced
Other:__________________
African American/Black
Hispanic/Latino
Asian/Pacific Islander
White
Mixed Race
Other:__________________
4. Do you work outside the home?
No (If No, go to # 5)
full time?
IF YES: Do you work
Yes
part-time?
What is your job title? ______________________________________
5. What are the ages of your children that live with you? ____
6. Do you drive a vehicle?
Yes
____
____
No
IF YES: Is there a vehicle that you usually drive?
Yes
No
7. What make (like Honda or Toyota) and year of vehicle do you drive most of the time?
Make: ___________________ Year: __________
8. What type of vehicle do you drive the most?
Car
Pick-up Truck
SUV
Other ____________________
13
Van
____
____
Section 2. Children in Vehicles
When we ask about your child, we mean your YOUNGEST child between 3 & 6 years old.
9. Of all my children, between 3 and 6 years old, my YOUNGEST child is ______ years old.
10. Not counting buses and subways, in the past 3 months, how often did you and your child
usually ride together in a vehicle?
Almost every day
A few times a week
Never
A few times a month
Don’t know
11. Of these times, how often were you the driver?
Always
Sometimes
Never
Rarely
Don’t know
12. Who usually decides where your child sits in the vehicle?
You
spouse/partner
no one
child
other: __________
13. Who usually decides whether your child sits in a car seat, a booster seat, uses a seatbelt, or
uses nothing?
You
spouse/partner
no one
child
other: __________
14. The next page shows photos of booster seats. Have you ever used a booster seat for your
child?
Yes
No
Never heard of a booster seat until now.
15. In the past 3 months, how often has your child used any of the following?
For example, if you child usually uses a booster seat when he or she is in your car, but
occasionally rides in another car with a seat belt, then you would answer "Sometimes"
to Booster seat and "rarely" to seat belt only.
A. Car Seat
Always
Sometimes
Never
Rarely
Don’t know
14
B. Booster Seat
Always
Sometimes
Never
Rarely
Don’t know
C. Seat Belt Only
Always
Sometimes
Never
Rarely
Don’t know
16. In the past week, how many days did you drive or ride in the car with your child?
Number of Days _______
17. In the past week, how often did your child use any of the following?
A. Car Seat
Number of Days ________
B. Booster Seat
Number of Days ________
C. Seat Belt Only
Number of Days ________
18. In the next 3 months, how often do you expect that your child will use any of the following?
A. Car Seat
Always
Sometimes
Never
Rarely
Don’t know
B. Booster Seat
Always
Sometimes
Never
Rarely
Don’t know
C. Seat Belt Only
Always
Sometimes
Never
Rarely
Don’t know
15
WHAT IS A BOOSTER SEAT?
A booster seat raises your child up so the seat belt fits right.
These are common types of booster seats:
16
APPENDIX 1.6:
PHASE 1 CODING RUBRIC
I.
Concepts and characteristics that describe participants in general terms
A. Child passenger safety information
1.
2.
3.
4.
5.
Child passenger safety messages received by respondents
Sources of CPS messages
Respondents’ knowledge of CPS
Source of CPS knowledge
Why and when changes from one type of restraint to another
a. How to use a booster seat
b. Child passenger safety laws and fines
c. Situational influences
i. Child’s activity in car
ii. Other drivers’ behavior
iii. When unrestrained
B. Personality characteristics
C. Perceived driving skills
C. Past behavior
E. Previous experiences
II.
Fundamental concepts on which summary concepts build
A. Perceived threats
B. Perceived benefits
1.
2.
3.
4.
5.
Why child likes booster seat
Why child likes child safety seat
Why parents like booster seat
Why parents like child safety seat
Positive outcomes
C. Perceived barriers
1.
2.
3.
4.
5.
6.
Why child doesn’t like booster seat
Why child doesn’t like child safety seat
Why parents don’t like booster seat
Why parents don’t like child safety seat
What child prefers as restraint
Obstacles to CRS use
17
D. Current behavior
E. People who matter
F. Control beliefs
1. Who has control over behavior?
2. Control over preventing crash or injury
G. Perceived self-efficacy
1. Rules in the vehicle
2. Discipline strategies to maintain safe behavior
3. Child’s reaction to rules
III.
Intermediate summary concepts that pull together fundamental concepts
A. Behavioral beliefs
B. Outcome evaluation
1. Enforcement of laws
C. Normative beliefs
1. People who don’t interfere with safety behaviors
2. People who support safety behaviors
3. People who interfere with safety behaviors
D. Motivation to comply
E. Subjective norm
F. Perceived behavioral control
18
APPENDIX 1.7:
PHASE 1 FOCUS GROUP DISCUSSION SUMMARY
Child passenger safety (CPS) knowledge
General CPS knowledge held by respondents
Largely, the CPS messages held by participants were unclear and lacked focus on important
details. Many parents cited misinformation or conflicting information, especially relating the
age at which children should be moved from one type of restraint to another.
Examples:
A: Because there are some, like one that my son has, it says that from twenty pounds, twenty or twentyfive pounds, up to ten years.
A: I imagine the booster seat is up to seven years.
A: I had heard that up to eight or nine years they had to use the regular seat, the safety seat, and the booster
one is for the ten or eleven-year-olds, I think that's what I heard.
A: I know it's up to six years.
A: From there on it's the seat belt...
A: Yes, me too. Up to six years. (Langley Park, Hispanic Females)
A: Listen, I didn't know, but since I'm here learning, after 5 children, thank God! It's because I never drove
before. She says that it depends on the weight, because I have my 6-year-old daughter and my 3-year
old son, and the daughter outweighs the son by 5 pounds, and I buckle her in normally with a regular
seatbelt, just like mine, and she's 6 and weighs 44 pounds and the boy weighs 39 pounds and he rides
in a car seat. (Little Rock, Hispanic Females)
Parents took height and weight into greater consideration than age when making decisions
about what type of restraint to use.
Examples:
A: But it also depends on the weight, the size, because if you have a child who is really thin and is 7 or 8
years old, if he is so light then yes, he has to ride curled up in a booster seat.
(Little Rock, Hispanic Females)
A: That's what they told me when they gave me the seat, that’s why they gave me the seats based on what
they weighed; the police gave me the seats. (Little Rock, Hispanic Females)
Q:
A:
A:
A:
A:
How will you know when to move your child into a booster seat? Or, I'm sorry, a seatbelt?
A seatbelt? The weight.
Height.
What is the height and weight?
Oh, goodness, I don't know. (Cincinnati, African American Females)
Other parents chose to base their restraint decisions on factors outside of their child’s height,
weight, and age.
Examples:
Q: Okay, for those of you who have more than one child between the ages of three and six, what's the
difference in how they are restrained in the car? Is there any difference that one of them could be in a
booster seat and one could be in a car seat?
A: One's in a booster seat.
19
Q: What's the difference? Is it an age thing? Is it the weight thing? Is it just the way they want to do it?
A: They've got like different spots where they like to sit.
A: Attitude. (Cincinnati, African American Females)
Many White parents expressed that when their children complained about a child restraint,
they became worn down and eventually changed from a CRS to something more
comfortable. Tired of constant opposition, these parents admitted to giving in to their
children against their better judgment.
Examples:
A: There's not enough room, that's why they're supposed to say 65 pounds, but I finally just took my
daughter out of a booster seat, and she's six, she's getting ready to be seven. And I'm like, "I'm done
playing this game." I mean she's really tall. (Cincinnati, White Females)
A: Um-hmm. She'd climb all over the car. She just wanted to sit in the seatbelt, so we tried it, and she's
real good about it.
A: Probably a sense of being, you know, a little bit grown-up. They don't have to use the baby seat
anymore. They're not babies. They can just sit like the big people. (Cincinnati, White Females)
The majority of participants did hold several key safety messages to be true. Almost all
participants agreed that children should not be seated in the front of the motor vehicle and
that infants should be restrained in backward facing car seats.
Examples:
A: See, I don't let any children ride in the front with me.
Q: Without being restrained.
A: They don't ride in the front, period. Because of the airbag, and you know, with the underweight thing,
you know. (Cincinnati, African American Females)
Q:
A:
A:
A:
A:
A:
In a crash, are there things that would make your child more likely to get seriously hurt?
Air bags.
I think so.
If you have them in the front.
Uh-huh.
Their arms stuck out the window. (Cincinnati, African American Females)
A:
A:
A:
A:
Right. I think that's even unsafe. I mean, you know, that makes it more unsafe.
Um-hmm. That's right.
Right, they say you should put it in backwards.
It depends on the position of the seat you have, that is to say, if it's a baby seat, it's a bad position to
have it in, facing toward the front, isn't it? (Cincinnati, African American Females)
Knowledge on CPS laws and fines
Participants were often unclear about child passenger safety laws and fines. Many were
unsure whether state laws were in place governing car seat and booster seat use, and several
maintained that penalties existed for improper restraint regardless of an existing law. In cases
where participants all agreed that law was in place, they often could not agree what the law
specified.
Examples:
Q: And what is the law?
A: You have to be 60 pounds, 50 pounds-50 or 60 pounds.
20
A: They start out, I think in the city limits, the tickets is $210. But from $210 to like anywhere from 400
and something dollars.
A: And then if you don't pay, you'reA: That's if you don't have your child restrained.
A: Yeah, or you not having a seatbelt.
A: And then if you don't pay, you have a certain amount of days to pay. And then it doubles after that.
A: You've got seven days, and then if you don't pay in the seven days, it doubles. If you don't pay it in the
next seven, you've got a warning. (Cincinnati, African American Females)
Q: Okay. And do you know what that law is?
A: It's under so many pounds.
A: Forty pounds and four years old or something.
A: You've got to have them facing the rear.
A: Under 40 pounds? Is it four years old or 40 pounds?
A: Under 40 pounds they got to be facing the rear.
A: Yeah. And they used to turn them around after a weight.
A: One and over 40 pounds, in the car facing front.
Q: Does anybody know what the fine is? I'm just curious.
A: A thousand dollars.
A: A couple hundred, isn't it?
A: A thousand dollars if your child is not in a car seat. However many kids are not in a car seat that is
supposed to be in a car seat, it's a thousand dollars a child.
A: It's supposed to be the parent of the child, but whoever the driver is. Or if there are two adults in the
front, they ask whose child, and they give the ticket to that person. But if it's one personA: They usually don't give the ticket, they be so much. That's why they keep giving you warnings
(Cincinnati, African American Females)
Knowledge on the safety benefits of child restraints
The majority of parent participants insisted that there would be no situation where their
children would ride unrestrained, as a result of two factors: concern for their child’s safety
and fear of fines and tickets.
Examples:
A: And then to just see a car wreck, you know? I mean that just like puts more thought on your brain to
make you want to look on your child and worry. (Cincinnati, African American Females)
A: And my son wants to get up there kind of with me. And I won't sit my daughter in the middle of
nobody's car. She got to be able to get on the end, and if we don't have a car seat, well, we don't usually
go. My friend doesn’t like that. She comes to get us to go to the mall; she does not like that. She's,
"Well, I don't got no," "Well, we ain't going." Because their car seat is in their daddy's car and we're
not going. And I don't have no money to pay for no ticket. (Cincinnati, African American Females)
A: Yeah, and I don't need another ticket. That hurt my pocket real bad!
(Little Rock, African American Females)
A: Lock them in a car seat, make sure they are always, before you get in the car, check their seatbelt, make
sure they're properly buckled down in their seatbelt … I know, I'm real cautious, because I just got a
ticket once, $250. Child, I mean, out of their seatbelt. (Little Rock, African American Females)
Participants shared their experiences of having an unrestrained child receive injuries during a
crash. These incidents and other likes them, encouraged parents to restrain their children
properly, by emphasizing the importance of appropriate restraint in motor vehicles.
21
Examples:
A: Or that using the car seat can prevent. Because, for example, the truth is I'm always really forgetful
about the car seat and, try to remember, eh, we went to Houston and my cousin arrived really
frightened because there had just been an accident and the little kid wasn't in a car seat, he went flying
and all and the mother ... well, the kid died instantly and they arrested the woman for not having her
child buckled into a car seat, and this is what I always think about, so if they would tell you what you
can avoid by putting your child in the car seat, I think that it makes you much more careful.
(Little Rock, Hispanic Females)
A: Well, we were rear-ended, when they were a six-year-old and a year and a half, by a dump truck. So
every time I get in the car I'm paranoid. I'm in the rearview mirror the whole time.
(Cincinnati, White Females)
A: Buckle in the kids, but most of the time or sometimes we don't do it because they don't want to sit, they
cry, they struggle, or they want to look out the window and in order to not fight, okay, get in the back
or do it yourself, okay my girl climbs in herself, but it's happened to me that all of a sudden I'm on the
freeway and I hit the brakes and she went "smack!". "Oh, Mommy, you told me to put on my seat
belt!" I tell her, "you see?" We're both frightened, both of us, but yes, it's happened to me.
(Little Rock, Hispanic Females)
Participant’s current child restraint behavior
Most participants stated that under no circumstances would their child go unrestrained; they
did, however, differ on what they considered appropriate restraint. Many considered some
form of restraint, even if not optimal, significantly better than none at all.
Examples:
A: Of course there's a difference, it's much safer to use the car seat than to ride with only a seat belt. Or if
they don't wear anything, much less. (Langley Park, Hispanic Females)
A: Yes, because when, sometimes there are accidents, the first thing they ask is whether the child was
buckled up in a safety seat, isn't it? So it's pretty important. It's for the child's safety.
(Langley Park, Hispanic Females)
A: Or, you take the car seat out and let them sit in the seatbelt, and try to tighten the seatbelt in as tight as
you can. You know, I mean...
Q: Well, you just alluded to my next question I was going to ask, how does the seatbelt fit the child? I
mean do you have to do a lot of adjusting to get it to fit, or do theyA: No, it depends on the child's size.
A: It depends on the child's size and the car.
A: But sometimes, you know, seatbelts, they got seatbelts to where they only adjust to the child, and then
they've got some seatbelts where you've got to pull them and adjust them yourself.
(Cincinnati, African American Females)
Factors that affect participants’ restraint behaviors
Perceived threats
Participants were fearful that their children would be injured in a crash as a result of being
restrained sub-optimally. Parents were also concerned that their children would distract them,
if they were not restrained properly. In addition, parents continued to emphasize their fear of
encounters with police officers. Parents found the high penalties associated with restraining
one’s child inappropriately to be an important consideration when deciding how to restrain
their children.
22
Examples:
A: With my daughter I say, "Do you want them to give me a ticket? Do you want me to get a ticket?" and
she says, "No, Mami." (Little Rock, Hispanic Females)
A: But it's just that its pure chance, I think that it's luck if, if, that is, you're going along and if the police
happen to be checking, but if they don't see you, because if he sees he tickets you. It's happened to me.
(Little Rock, Hispanic Females)
A: Because let's think about it, if he goes in the car seat, and there's an accident, the seat isn't going to
move that easily, and also, if he's just seated, or maybe with the seat belt, it could be that in an instant,
in the crash it could be that the seat belt isn't that safe or that it could be, it could be a little loose, that
he comes out, or if he's not wearing a seat belt, well, God shield me, it will be worse.
(Langley Park, Hispanic Females)
A: I think they would be, you know, if we were in an accident, them not being, they won't be, if they
weren't in their, the booster seat, I think about, you know - I know they can get hurt even, you know, in
the booster seat, or whatever, but if they weren't in one, you know, it would be worse.
(Little Rock, African American Females)
A: I think I worry about the, if we are in an accident, and they were in just a seatbelt, what type of damage
that would be done on the neck and shoulder, versus them being in the booster seat and the seatbelt is
strapped across their chest more, and not on the neck. (Little Rock, African American Females)
Perceived benefits
Parents emphasized their child’s comfort or contentedness as a benefit resulting from booster
seat use. Parents emphasized that their children had a better view of through the window
while in a booster seat. Children also were happy to have a designated seat; parents noted
that their children enjoyed the responsibility of their own seat, and the comfort they were
provided by not having to be squeezed in an overcrowded car. Children also expressed that
they felt like “big” boys or girls in a booster seat.
Examples:
A: Sitting up high.
A: Yeah, sitting up high.
A: Yep, they have to keep doing just like, "That's my town." Look back and have the little hand swings,
you know. (Little Rock, African American Females)
A: Mine likes the fact that the seat’s his. His brothers have their seats, and he has his seat.
A: That's how my son is, because my daughter's not in a car seat or a booster seat anymore, and my fouryear-old is. And then when she has to get in there and I have my niece and my nephew, and they all are
saying, "Right here." And he's like, "Not my seat." [Laughter.] "I've got my seat, y'all are squished over
there, but I've got my seat." (Cincinnati, White Females)
A: Because the booster seat is more like an adult seat belt. You know, it can grow with them, and the
seatbelt, as they get 5-year-old, a 6-year-old, it can cross over it just like the front can do. So it's more, I
think at about 5 or 6, they want to sit in the front, because they know that the moms or dads seatbelt can
go over across. But the booster seat has a seatbelt go across it too.
A: Make them think they're older.
A: Right. And they think like they older, instead of being babies.
A: Well it gives them that peace of mind like, "I'm grown up now," yeah.
(Cincinnati, African American Females)
A: Yeah, they are all high, makes your child feel more privileged and seem like they're more of a big child
because they don't have to be in a baby seat, but they're still in a car seat. Tell them how it makes the
child feel, and how the child could see out the window more and have more room, they don't feel all
stuffed in this little car seat. (Little Rock, African American Females)
23
Again, parents emphasized that the primary benefits of child restraints were their ability to
keep children safe. Other benefits included: that boosters were easy to use, lightweight,
inexpensive, and prevented arguing between their children.
Examples:
Q: Do you think your child is safer in a booster seat or a seatbelt?
A: Booster seat.
A: Um-hmm. (Cincinnati, African American Females)
A: The main reason to use the safety seats is for security, to save their life if there is an accident, or that's
the main reason and to keep the children from standing up or leaning out the window, if they're not
using a car seat or the booster, because they always tend to stand up, they're restless.
(Little Rock, Hispanic Females)
A: They like more gadgets. The more gadgets or toys on the car seat or booster seat, the better. You know
what I mean, keep them more quiet, at least for a little while till you get where you're going. So the
more little toys they've got, the more better.
A: Or pockets and cup holders.
A: Yeah.
A: Cup holders and pockets. Because they can stick toys in there.
A: They forget things in there, and when you on that long drive, they pull they out like, "I found this toy!"
(Cincinnati, African American Females)
Participants found that booster seats reduced conflict regarding seat choice among siblings
and greatly expedited the process of assembling their children in the car. An additional
important benefit for parents was the peace of mind they received from knowing their child
was in a booster.
Examples:
A: He just sort of identified that as it can be your seat, or different, could be your seat. Or when Nicholas is
with us, he's like, "Nicholas is there." He just, I think he might be a little bit jealous, but mostly he just
identifies that as somebody else's seat. And I think that, you know, the good might be, "That's my seat,
and that's Mommy's seat."
A: Everybody has their assigned seats.
A: Yeah. Just like at the dinner table, everybody sits at the same spot, and they have their seat.
A: So it makes him, there's no confusion on where I want to sit when I get in the car today.
A: Right. (Cincinnati, White Females)
A: One of the other big benefits is, if your kid isn't in the booster seat, if they're not tall enough, which 4'9"
is how tall they should be before they go into a seatbelt. They can get seatbelt syndrome, because the
belt, the lap belt is up higher on their abdomen instead of being down over their hips. And so like your
hips are hard, and the seatbelt should go there, but the booster seat helps position it there. Because if the
seatbelt were on their belly, it's all organs and soft stuff in there, and if you get in a wreck, then it can
burst organs and cause all sorts of internal damage. And that's one of the major benefits to a booster
seat. (Little Rock, African American Females)
Perceived barriers
Parents expressed that their children did not like to be restrained, and as a result, the children
often complained that boosters were hot, itchy, too tight, and generally uncomfortable. Many
participants cited giving in to their child’s complaints, and allowing them to ride in a seatbelt,
or unrestrained.
24
Examples:
A: Well, but sometimes when it squeezes them it bothers them ... that's why they don't want to, but you
have to do it for safety. (Langley Park, Hispanic Females)
A: You know what bothers them sometimes? For example, if you've your car to clean it and it's hot, they
get in and their seat is hot, "No! It's hot!" they say, "It's burning me." (Little Rock, Hispanic Females)
Q: Is it that they, do you think it's because, one, that that is just restraining them, or is it actually
uncomfortable do you think?
A: Both.
A: "It's choking me! It's choking me!" My daughter used to do that.
A: I think every one, and then you're choking.
A: It was with the ones that went like that. "I'm choking." (Cincinnati, African American Females)
A: It could be around the child's side, and it really, it still can be uncomfortable. Because if you have a tall
kid that has to fit in a car seat, it's uncomfortable.
A: Right.
A: No matter how you strap it in, they don't hardly know where to move.
(Cincinnati, African American Females)
The groups also included participants who were skeptical about the benefits of any form of
restraint and were especially wary of booster seats. Parents in Little Rock clung to the fear
that in a crash their child, if restrained in a booster seat, would be trapped in the car.
Examples:
Q: Do you think your child is safer in a booster seat or a seatbelt?
A: Seatbelt.
A: Seatbelt.
A: I don't know. (Cincinnati, African American Females)
A: Um-hmm. I'm going to get into a car accident, the car is going to catch on fire, and I ain't going to be
able to get the seatbelt off me.
A: Right. Yeah.
A: I'm afraid if I've got a seatbelt.
A: Or pressure on it like in a river or something, and you ain't got no knife.
(Cincinnati, African American Females)
Q: Does anybody else have anything they want to add on that? That you think that, right now you think
that the kids are safer in a seatbelt, is that what I'm getting, the idea? At least for most of you, but some
of you think that the booster seat is moreA: I'm not sure.
A: It depends. Really, I don't know.
A: Because you can be safe in a car seat, or you can be safe in a seatbelt, and you can be unsafe in either
one. (Cincinnati, African American Females)
A: Oh, by weight. No but what you were saying about the booster seats, some booster seats don't work.
Some booster seats ain't, they don't have any safety.
A: Security.
A: Security like, they have to this one booster seat where it goes across their waist and you put the seatbelt
across the booster seat and you strap it in. If you would have a car accident, the booster seat would fall
out, because it has no security, it has no-it's not tightened in. I was in a car accident and my godson
was in one of them car seats, and the car seat slipped out.
A: You mean the kind that has like a bar that comesA: Yeah, he just sits in it, you snap it closed.
A: And you stick the seatbelt through it like this, and you tighten the seatbelt like to the seat. So every time
you get out, you have to retighten it, but it's not-it's not secure.
Q: You don't' think it's secure enough.
A: No. (Cincinnati, African American Females)
25
Some participants were well versed in the benefits of restraint in a motor vehicle and simply
had reservations booster seats. These participants felt the car seat held their children more
securely, because the car seat did not solely rely on the vehicle’s seatbelt.
Examples:
A: The car seat is safer because it's more strapped. You've got the harness or the overhead. So, but, then
again, it's also getting him ready for when he has to come out of a car seat, in a way booster, because
when he'd sit in the back seat, when he's old enough to sit in the back seat without either/or, it's still
going to be wrapped around his stomach. So I feel like it's just getting him ready for when he's able to
get out of a car seat and just wear a seatbelt only. (Little Rock, African American Females)
A: I think it depends on the booster seat, because besides new modern technology of booster seats, some of
them weren't-back in the day, I don't think they were safer than seatbelts.
Q: Um-hmm. But you think the technology is improved now, that they are-it's notA: They're safer, but in my opinion now, I think a seatbelt might be safer because, especially if it's a good
one that crosses right here and here. (Cincinnati, African American Females)
A: I think myself I don't need it. I mean, I can't-if it's not safe for them, I mean I'd rather keep them in a
car seat until they just can't car seat no more, for safety reasons. And I never really thought about it until
now, if the booster seat really is safe. Because I know they're safe when I'm driving. And I know how I
drive, you know, having been in a couple of accidents too, but not as my fault. But I don't feel the
booster seats would be very safe, and that I would let my kids outgrow a car seat.
(Little Rock, African American Females)
A: I wouldn't promote a booster seat because I wouldn't know how safe it is. But I, like I say, I'm doing
good with promoting a car seat. I think car seats really work. I mean car seats, they usually strap and
plus you've got that little holsters that you can stick a strap down in the car, if you have a van, that keep
those car seats really safe. (Little Rock, African American Females)
Lack of education was the most significant obstacle to booster seat use. Some parent
participants did not feel that they knew enough about boosters to make a well-informed
decision on whether to sue them or not. A minority of respondents needed clarification on the
definition of a booster seat and was not aware that booster seats for automobiles existed.
Examples:
A: Because I seriously didn't know what a booster seat, I really thought Wendy's or at home
A: Yeah. But that's what they call them at a restaurant.
A: Um-hmm.
Q: Booster seats, yeah.
A: Um-hmm. I'm not going to fit one of them in my car.
A: Because I used them high chairs.
A: That's what they called, high chairs. That's what we called them.
(Cincinnati, African American Females)
A: I know car seat a little, but I didn't think about booster seats.
A: I didn't know, I thought all of them could sit in a car seat.
A: I don't either.
A: Car seat, yeah.
A: So I didn't know anything about a booster seat, I thought it was just the next level from a car seat, but
still a car seat. (Little Rock, African American Females)
Children’s behavior was also an obstacle for parents concerning to CRS use. This behavior
was suggested in three forms: distracting their parent driver; removing their restraints;
fighting in the vehicle. Very few of parents cited having pleasant experiences while riding
with their children.
26
Examples:
A: Five minutes after you put them in the car, he's asleep.
A: Oh, mine's, yeah.
A: They usually have little toys that they can play with in the car until-unless they throw it, and then they
all get taken away. (Cincinnati, White Females)
A: Well, mine, they do pretty good. I always keep like books and stuff in the car.
Q: So they're not very active, moving around and things.
A: I have a van, so it's like roomy in there, so they, yeah they're pretty good for that part.
(Cincinnati, Black Females)
Parents felt that their children learned how to remove their CRS easily, which evolved into a
barrier for parents attempting to restrain their children appropriately and to keep them safe.
Examples:
A: Oh, my kids learned very early how to get those suckers off. My daughter did the same-both of my
kids, they learned before they were three years old how to get out of theirs, because they-the ones that
snap right here.
A: All they've got to do is take it off and you've got to push the button and jerk down. And they've seen
Mommy do it so many times, they're not dumb, they watch. (Cincinnati, White Females)
A: They usually like to jump around, get out of the car seat. It's hard for me to do that because I always
have to pull over, put them back in the car seat-because I have two of them that-well, three of them
that's in a car seat.
A: Oh, my goodness.
A: And it's hard. With my five-year-old, I don't even put her in a car seat or a booster, I put her in a
seatbelt. It's just too hard. They're always jumping around in the front and the back. It is so hard!
(Cincinnati, White Females)
Changes from one type of restraint to another were explained to be impermanent or based on
situational influences. Parents reported using seatbelts for children normally in car or booster
seats only when space confines and availability allowed.
Examples:
A: If we're getting a ride, or if there's too many children in the car.
A: Yeah.
A: Usually it's when like if you're getting a ride from somebody, you know, if they say, "I'll give you a
ride," you know I, you don't have a car seat on you all the time, you might be walking down the street,
and it could be somebody you know getting ready to ride past your house or whatever, and you ride
with them, you don't always have a car seat with you. (Cincinnati, African American Females)
A: Well, once I had to pick up a lot of people and there wasn't enough room for the car seat, and I took it
out. And he's got twin, two of my nieces, because there wasn't enough room, and everybody had to go.
A: Before I got my mom the car seat, if she forgot to get it out of my car, or she didn't have it, then she'd
have to ride with the safety belt on.
Q: Is there any other circumstances that your child would be in a seatbelt only?
A: If they was in a car with someone other than myself. (Little Rock, African American Females)
A: For example, when ... I don't know if this only happens with my children, when some family member
comes and wants to take them out, for example, Grandma, and ...
A: There's no room.
A: Of course! Or she doesn't have the booster seat, my husband has it, for example, and it's not there, then
she takes her just like that with her...
Q: With the seatbelt.
A: Yes, with the seatbelt. (Little Rock, Hispanic Females)
27
Influences from people who matter
Sources of CRS information
Participants mentioned several different media from which they obtained information about
child passenger safety. Most parents looked to prominent community-based figures such as
law enforcement and medical professionals for information on how best to restrain their
children.
Examples:
A: The doctor's office has a lot of stuff.
A: My doctor, my kids, they have an African-American pediatrician, and she keeps me informed on
everything. Just like the booster seats, y'all, if some of y'all parents don't know how to handle car seats
or nothing, y'all take your kids to Children's Hospital, they give you seats. So that's how I got my baby's
seat, because I didn't have no money. And I just, she said, "Hon, well, do you have a car seat?" You've
got to watch the little video. Okay, I watched the video, answered the questions too. If it's free, instead
of $50, $60, honey. But, they've got a lot going on. People don't know
(Cincinnati, African American Females)
A: Often, too, in the kids' schools they send you the brochure.
A: Yes, in school, because in Soledad School they sent me the brochure. (Little Rock, Hispanic Females)
A: In this state program there the police teach you and they buckle them in pretty tight, because they taught
me how to install a car seat and if it's loose on my child I don't seat him, I get up above it, insert the belt
behind and make it pretty tight, and that's when I see that my seat isn't moving, because that class tells
you how to fasten in a seat. (Little Rock, Hispanic Females)
A: If they're not buckled in correctly, and we've had the thing back this way, you can take your car over to
Children's Hospital and they will check your safety seat and make sure that it's, you know, in
appropriate. And I like the fact that, with the hospitals now before you leave, you have to have your car
seat, and they come out and inspect it and make sure that it is in correctly. So, I just worry about her,
because she is so grown, and I have to tell my mom, like when she's driving with her, "Just make sure
she's sits down and [uses her transport?]." Because I bought my mom a safety seat, and I have my own
safety seat now because she will not sit down. They were like twenty dollars and I was like, "Okay, I'm
just going to have to break down and just do this and get it," because she is a handful.
(Little Rock, African American Females)
Parents also wished to receive information about restraint from programs like Head Start and
Moms of Healthy Babies. Other trusted sources include family members with young
children.
Examples:
A: And I participated with Booster America, it was a thing UAMS had, they sponsored the, you know, car
seat checks. And I knew about the booster seats thing and making sure they're properly installed
because if they're not properly installed, it doesn't make any sense putting them in there. You know,
they're not really properly safe. It's a lot to install the car seat and the booster seat, you know, you have
to really make sure they're installed properly. (Little Rock, African American Females)
A: I heard it from my Moms for Healthy Babies coordinator.
A: It's a mobile van that goes around and helps mothers.
A: Young teen mothers.
A: Single parents. (Cincinnati, African American Females)
A: And since your kids are in, if they're in Head Start, Head Start helps you know, you with some
information on booster seats. (Little Rock, African American Females)
28
Participants noted that they were most attentive toward messages from television and radio
commercials, movie theater previews, health programs in clinics or stores, and billboards.
Examples:
A: On the news, the TV, the store, the doctor's office, the newspapers, the radio, everywhere.
(Cincinnati, African American Females)
A: Yeah, television commercials, you know, they were having the car seat checks at like Wal-Mart,
UAMS, any type of fairs that they had, you know, they always had a car seat check point or something
like that. If they was having the Greek Festival, they had a car seat checkpo