Determinants of Usage of Age-Appropriate Child Safety Seats in Connecticut

158 Pages·2015·1.7 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2015
Determinants of Usage of Age-Appropriate Child
Safety Seats in Connecticut
Giuseppina Mendillo Violano
Walden University
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Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Giuseppina Mendillo Violano

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Angela Prehn, Committee Chairperson, Public Health Faculty
Dr. Jennifer Oliphant, Committee Member, Public Health Faculty
Dr. Gudeta Fufaa, University Reviewer, Public Health Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract
Determinants of Usage of Age-Appropriate Child Safety Seats in Connecticut
by
Giuseppina Mendillo Violano

MSPH, Southern Connecticut State University, 1989
BSN, Quinnipiac College, 1986

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
May 2015
Abstract
In the United States, motor vehicle crashes are one of the leading causes of unintentional
injury death and disability for children ages 1–15 years. Despite local, state, and federal
legislative and educational efforts, children continue to be restrained improperly and thus
face harm. Identifying behaviors and barriers that place child occupants at risk is crucial
for implementing focused, injury-prevention programs and policies. The purpose of this
study was to evaluate the effectiveness of Connecticut’s child passenger safety law that
was strengthened in 2005. This study involved a multifactorial approach to predicting
child seat use, guided by Roger’s diffusion of innovations as the theoretical framework.
The analysis determined if there was a difference in the prevalence of car seat use before
as compared to after law implementation and identified variables that best predicted the
use of car seats and premature transition to a seat belt. Using Connecticut’s Crash Data
Repository, a logistic regression analysis indicated that car seat use was 1.3 times more
likely post law (OR 0.75; 95% CI: 0.65-0.86) and that in particular, children ages 4, 5,
and 6 (combined) were most positively affected by the law (OR 0.67; 95% CI 0.54-0.82).
Driver sex, crash time of day, child age, and child seating position were all determined to
be significant predictors of whether or not a child was in a child safety seat.
Additionally, these variables were also determined to be predictors of early transition to
use of a lap/shoulder belt (versus child seat). The social change implication of this study
is that identifying predictors of car seat use and early transition helps to formulate and
implement injury prevention measures that could in turn help to decrease medical costs,
save lives, and prevent injuries.
Determinants of Usage of Age-Appropriate Child Safety Seats in Connecticut
by
Giuseppina Mendillo Violano

MSPH, Southern Connecticut State University, 1989
BSN, Quinnipiac University, 1986

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
May 2015
Dedication
I am grateful for such an incredible family. First and foremost, I would like to
start by thanking my parents for instilling the importance of an education at an early age,
the strength and inspiration to persevere despite adversity, and the courage to bring our
family to this land of opportunity. Papà, I miss you more than words can say and hope
that you can somehow celebrate this great accomplishment with me. Mamma, thank you
for being the strong woman that you are and for your unwavering support and
encouragement over the years. Ti voglio tanto bene!
I would like to thank my husband Paul for all of his support. Thank you for all
your love and words of encouragement and for helping to keep a routine in our home—
load after load of laundry, sink after sink of dishes, countless meals, taking the kids to
their practices, games, doctor’s appointment, and clothes shopping. This dream would not
be a reality without all of your support, love, and encouragement. Ti amo per sempre!
You are my ribbon in the sky!
I would like to thank my daughters Cristina, Marcella, Giana, and Daniela for all
their support and understanding in my request for the countless hours of silence so that I
could focus on completing this project. I hope this project has instilled the importance of
education and perseverance upon the four of you. I cannot wait to provide you with my
undivided attention, support, and encouragement you all need and deserve to realize your
potential and your dreams. I love each of you more than words can say!!
Acknowledgments
I would like to thank and acknowledge Dr. Angela Prehn, my dissertation chair
for her support, encouragement, gentle pushes, reality checks, and, most of all, patience
in helping me realize my lifelong dream of completing my doctorate degree. I could
never have accomplished this in my wildest dreams without you!! You are everything
and more that I could have ever asked for in a chair! I would like to also thank Dr.
Jennifer Oliphant and Dr. Gudeta Fufaa for their willingness to be a part of my
committees, for their valuable contributions, and for making this research project
possible. I would also like to thank and acknowledge my past chair, Dr. Regina Galer-
Unti for numerous pep talks and intuitiveness in this project. Mille grazie!! I would also
like to acknowledge Dr. Eric Jackson and Dr. Neil Chaudhary for educating me on
everything I ever wanted to know about Connecticut Crash Data and for always being
responsive to my need for help. Lastly, I would like to acknowledge my best friends,
Luciano and Dora Morra, Linda Roney and my sisters Anna and Grace, my bother-in-
laws Frank and Carmen, my niece, Lisamaria and her husband Christopher, and nephews
Antonio, Giuseppe, Alessandro, and Luca for believing in me and being my personal
cheerleaders when I needed it the most. I love each of you!!

Ora e’ il tempo di festeggiare!!!
Table of Contents
List of Tables .......................................................................................................................v
Chapter 1: Introduction to the Study ....................................................................................1
Introduction ....................................................................................................................1
Background ....................................................................................................................3
Evolution of Vehicle Occupant Safety ..........................................................................6
Advocacy Efforts .................................................................................................... 9
Connecticut Law ................................................................................................... 12
Problem Statement .......................................................................................................14
Purpose of the Study ....................................................................................................14
Research Hypotheses and Questions ...........................................................................15
Theoretical Framework ................................................................................................16
Nature of the Study ......................................................................................................20
Definitions of Key Terms ............................................................................................21
Dependent Variable .............................................................................................. 21
Independent Variables .......................................................................................... 21
Types of Child Restraint Systems ......................................................................... 22
Assumptions .................................................................................................................25
Scope and Delimitations ..............................................................................................25
Limitations ...................................................................................................................26
Significance of the Study and Implication for Social Change .....................................27
Summary ......................................................................................................................29
i
Chapter 2: Literature Review .............................................................................................30
Introduction and Organization of the Review ..............................................................30
Diffusion of Innovations Model and Connecticut’s Child Safety Seat
Legislation........................................................................................................30
Search Strategies ..........................................................................................................33
Legislation....................................................................................................................34
Health Behavior Response to Legislative Regulations ................................................38
Costs ..........................................................................................................................41
Safety Seat Use ............................................................................................................43
Proper Use ....................................................................................................................47
Child Safety Seat Selection and Premature Graduation ..............................................49
Seating Positions in Motor Vehicles ............................................................................51
Time of Day .................................................................................................................54
Misuse. .........................................................................................................................54
Driver Demographics and Impact on Child Restraint Use ..........................................56
Driver age and seatbelt use ................................................................................... 57
Driver socioeconomic status ................................................................................. 59
Driver gender and alcohol use .............................................................................. 60
Vehicle Type ................................................................................................................61
Summary ......................................................................................................................62
Chapter 3: Methodology ....................................................................................................64
Introduction ..................................................................................................................64
ii
Study Design ................................................................................................................65
Methods........................................................................................................................67
Target Population, Setting, and Sample .......................................................................68
Inclusion and Exclusion Criteria ..................................................................................68
Instrumentation and Database ......................................................................................69
Variables ......................................................................................................................73
Data Analysis ...............................................................................................................76
Limitations to the Study ...............................................................................................80
Ethical Protection and Concerns ..................................................................................81
Summary ......................................................................................................................82
Chapter 4: Results ..............................................................................................................84
Introduction ..................................................................................................................84
Data Collection ............................................................................................................84
Discrepancies in Coding ..............................................................................................88
Results. .........................................................................................................................91
Research Question 1 ............................................................................................. 92
Research Question 2 ............................................................................................. 96
Research Question 3 ........................................................................................... 101
Summary ....................................................................................................................106
Chapter 5: Discussion ......................................................................................................108
Introduction ................................................................................................................108
Interpretation of Findings ..........................................................................................110
iii