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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