1. The Child Passenger Safety Technician Technical Webinar will begin at 10:00 am SafetyBeltSafe U.S.A. www.carseat.org Please remember to mute your phone – BUT DO NOT PUT US ON HOLD!!! Thank you!

2. California Department of Public Health Vehicle Occupant Safety Program with the support of California Office of Traffic Safety Child Passenger Safety Technician Technical Webinar September 12, 2014 SafetyBeltSafe U.S.A. www.carseat.org Stephanie M. Tombrello, LCSW, CPSTI Kate Quirk, PhD, CPSTI

3. Topics Training Opportunities/Tools for Techs Recall Announcement Research Focus: Can We Prevent Misuse? New Safety Seats Conference Update: Kidz in Motion Research Review: Traffic Safety Facts; Autos for Teens, ATVs CEU Process + SafetyBeltSafe U.S.A. www.carseat.org

4. Training Opportunities: L.A. County SafetyBeltSafe U.S.A. www.carseat.org Educator Workshop (3 CEUS for Techs, 6 for nurses):  Tuesday, September 16, Family Health Center, Long Beach Safety Seat Checkup:  Saturday, September 20, Harbor-UCLA Medical Center, Torrance National CPS Certification Course – Winter 2015, dates TBA + Please mute your phone – but don’t put the line on hold – thank you.

5. New Recall Recaro ProSport combination seat Mfr dates: 6/16/10 - 1/31/13 Problem: exhibited excessive head excursion if installed with lower anchors ONLY. Call 888/973-2276 for new instructions & labels to discontinue use of lower anchors at 40 lbs., not 52 lbs., as originally indicated if the top tether were used as expected. + Please mute your phone – but don’t put the line on hold – thank you. SafetyBeltSafe U.S.A. www.carseat.org

6. Research in Focus: The Disconnect: Competence vs. Confidence in CPS + Please mute your phone – but don’t put the line on hold – thank you. Caregivers’ Confidence in Performing Car Seat Installations: What Matters Most, Jessica Mirman et al., CHOP, Injury Prevention, 8/13 Motivation for Study: Field evidence: high levels of incorrect use (SBS USA data 90%+) Telephone survey evidence: high levels of confidence among caregivers of safety of way transport children In-depth study of competence and confidence based on 68 parents, 8 grandparents, 7 other caregivers.

7. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org The Setting: Choice between provided minivan or own vehicle; all but 1 chose minivan. Caregiver installed seat and assessed their installation within 30 minutes using combination seat & specially summarized instructions. Findings: All either gave up or installed in time frame; MEDIAN length of time was 3 minutes. Accurate installation – 53 % (77% used belt, 14% LATCh; 8% both) Secure attachment – 16% No assessment of harness use

8. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Findings (continued): Caregivers were asked additional questions. Less concern about risk of crash or injury = more confidence in accuracy of installation. More concern about risk of crash or injury = less confidence in installation AND more formal sources of information consulted in learning to buckle up their own children. Conclusion: With misperception rampant, parents not in the know are unlikely to seek out help. + Please mute your phone – but don’t put the line on hold – thank you.

9. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org The Effects of Child Restraint System Features on Installation Errors, Kathy Klinich et al., Applied Ergonomics #45, (2014) Setting: Detailed laboratory study of subjects doing 4 complete installations. 16 safety seats used with carefully varied exposures so that learning & other factors would not weight 1 model more than others. Models evaluated on 17 features for ease-of-use. Each model installed at least twice in each subject group & 8 times overall. Each caregiver installed twice w/belt & twice w/lower anchors, initially being able to choose way.

10. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Setting (continued): Caregivers asked to assess their installations, to rate features for usefulness, & queried re. types of children who could use each seat. CPST assessed installations, using pinch test and 1-inch movement test as well as detailed measurements. 42 factors were assessed in the “checkup”. Findings: Factors about caregiver with impact Education: effect on tight installation & correct belt path Experience w/seats: effect on tight installation & snug harness Only 1 participant with both lower education & experience got a tight attachment. Men more likely to get seat & harness snug. + Please mute your phone – but don’t put the line on hold – thank you.

11. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Findings: Tight installation Subjects didn’t learn between 1 st & 4 th installations Direction of seat had no effect on error rate (28% FF, 32% RF) No effect from use of lower anchors vs. belt. What helped? LOCKOFFS: RF: 50% tight vs 18% without; FF: 32% vs. 24% Push-on lower anchor connectors (but much more complex picture here) Recommendations: self-tightening best; push-on next; how come out of box affected correct attachment: better if hooked on safety seat, not “hanging”.

12. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Findings: Snug Harness Type very important: 85.7% for tabs on harness “infinite slide” 53.8% side knobs Tether use Forward-facing: Tether storage method was key feature for appropriate use: 83% hook-on to seat 63% compartment 50% pouch Rear-facing: 10% were to be used RF weren’t; 10% weren’t to be used but were. 49.2% rethread 46.7% rotate levers 14.3% side handles + Please mute your phone – but don’t put the line on hold – thank you.

13. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Findings: Choice- lower anchors vs. belts for 1 st 2 trials of 4: No participant factor predicted choice. One participant used both methods incorrectly in all in 4 trials for RF installations. Harnessing (dummy used): 53% correct. No participant or seat factors predicted choice. Even the difference of 83% correct for experienced vs. 65% for inexperienced wasn’t. Retainer clip: 95% used; 98% threaded correctly; 53% at armpit level. No significant predictive pattern. Correct angle of recline: 91% FF, 66% RF. RF error mostly too upright. No significant predictive pattern.

14. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Key Findings Attachment routing: Lower anchor attachments: key was need for rerouting between RF & FF. Re-routing required: 78% correct; not required: 96% correct. No predictor for correct belt use. Belt: 3 categories: 46% unlocked; 35% locked correctly; 19% locked but not as instructed. Instruction use: no predictive link. 92% used seat manual 21% used vehicle owner’s manual (35% 1 st trial; 8% by 4 th trial) + Please mute your phone – but don’t put the line on hold – thank you.

15. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Findings: Installation time: Inexperienced took twice as long as experienced caregivers. Average time: 33 minutes, lower anchor install 28 minutes, belt. Education level non-factor.

16. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org Knowledge of correct use: Correct answers on match between hypothetical child & particular seat: 95% for 5 y/o, 37-lb. child & RF seat. 21% for 4-lb. 3 day old & RF seat. Scary answer: 12% would put 3-day-old in FF seat. Length of manual linked with some correct answers pattern but some better w/lengthier and some, shorter manual. Tended to get more correct answers for FF if just finished FF trial, ditto for RF. Perceived ease-of-use: no linkage to correct use. + Please mute your phone – but don’t put the line on hold – thank you.

17. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org The Findings: Summary Disconnect between competence & confidence continues without feedback on errors. Safety seat features can help to reduce errors: lock-offs, infinite slide harnesses, tethers & lower anchors visibly attached to seat on arrival, lower anchors with feedback mechanisms & no need to re- route to achieve correct path for lower attachments. Fit with other studies: findings similar to field studies, reports from checkups. Dilemma: how to do hands-on training with every parent/every child. Consider integrating Ride Safe from the Start from SBS USA

18. Research in Focus: Impact on CPS Knowledge of Safety Seat Checkups SafetyBeltSafe U.S.A. www.carseat.org A Lifesavers presentation by Dana Walraven, Cook Children’s Hospital, Ft. Worth, TX With access to professional data collectors, team decided to measure retention of best practice over 3 months by attendees at checkups. Sample: over 11 months, gathered 300 participants from 683 checkups (44% response) 75% were mothers 80% were ages 22-40 83% were white or Latino 94% had at least HS education 92% safety seats with harnesses, 8% boosters + Please mute your phone – but don’t put the line on hold – thank you.

19. Research in Focus: Impact on CPS Knowledge of Safety Seat Checkups SafetyBeltSafe U.S.A. www.carseat.org Findings: Messages recalled by respondents 96% tight installation 90% retainer clip level 85% pinch test for harness snugness 75.7% expiration time period ( 15.5% didn’t know; 8% said there wasn’t one ) 91% high confidence in checkup station 98% believed they learned new information 98% believe child was now better protected 2.7% in crash since checkup

20. New Seats SafetyBeltSafe U.S.A. www.carseat.org Britax ClickTight convertible range + Please mute your phone – but don’t put the line on hold – thank you.

21. New Seats SafetyBeltSafe U.S.A. www.carseat.org Britax ClickTight convertible range

22. New Seats SafetyBeltSafe U.S.A. www.carseat.org Britax ClickTight convertible range: 5 – 40 lbs. rear-facing; 20 – 65 lbs. forward-facing 7 recline positions, RF and FF recline indicators; 2- position crotch strap; no-rethread harness Do not use with Ford inflatable safety belts for the time being. Lower anchor use:  Boulevard & Marathon – 35 lbs. RF, 40 lbs. FF  Advocate 30 lbs. RF, 35 lbs. FF + Please mute your phone – but don’t put the line on hold – thank you.

23. New Seats SafetyBeltSafe U.S.A. www.carseat.org Britax ClickTight convertible range: Additional Features Boulevard & Advocate: Click Safe harness indicator & 14-position headrest Marathon: 12-position headrest Boulevard & Advocate: significant height increase over previous versions of the same type – top harness slot height increase & RF height limit now 1” below inner head restraint (not outer shell)

24. New Seats SafetyBeltSafe U.S.A. www.carseat.org Clek Fllo: 14 – 50 lbs. RF, 22 – 65 lbs. FF & able to sit unassisted 9-year expiration 4 harness slots; dual harness loops Optional anti-rebound bar Lock-offs Lower anchor use: 35 lbs. RF, 40 lbs. FF + Please mute your phone – but don’t put the line on hold – thank you.

25. New Seats SafetyBeltSafe U.S.A. www.carseat.org Graco Argos 80 Elite: Harness: 20 – 80 lbs. Booster: 30 – 120 lbs. (highback); 40 - 120 at least 4 yrs old (backless) 10-year expiration No re-thread harness; 5-position headrest 3 recline positions Lock-offs Lower anchor use: 45 lbs.

26. New Seats SafetyBeltSafe U.S.A. www.carseat.org Graco Milestone: 3-in-1: 5 – 40 lbs RF. 20 – 65 lbs. FF; 30 – 100 lbs & age 3 booster No re-thread harness 10-position headrest Lower anchor use: 42 lbs. + Please mute your phone – but don’t put the line on hold – thank you.

27. New Seats SafetyBeltSafe U.S.A. www.carseat.org Recaro Performance Coupe: Rear-facing-only, 4 – 35 lbs 6-year expiration No re-thread harness; 5-position headrest; 2 crotch positions Safety Stripe system to reveal harness twists Infant insert 4 – 12 lbs.

28. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org “Inspecting the Inspection; What the Data Reveal”, M. Louzon, J. O’Neil, MD, J. Talty, Automotive Safety Program, Indianapolis, IN (also reported at Lifesavers) Data collected from 121 permanent fitting stations in 63 of 92 IN counties; 75% located in fire depts., law enforcement sites, hospitals Purpose of checkup form: to guide checkup; reduce liability; enable reconstruction of inspection; data collection + Please mute your phone – but don’t put the line on hold – thank you.

29. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org Data from 9048 checkups in 7738 vehicles (2011-12) Demographics:  79% white; 9% Latino  51% of families received public assistance of some kind; 35%: less than $20,000 annual income.  Avg. family size: 3.6 members; related to checkup majorities– majority for prenatal (44%) or child under 1 (22%).

30. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org How seat/child arrived:  Seat belted in: 60%; 23% LATCHed; 5%, both.  Moving more than 1 inch: 59%; wrong angle: 22%  14% tether use  Harness errors: 47% too loose; 18% at wrong level vis a vis shoulders; 47% chest clip incorrect level. + Please mute your phone – but don’t put the line on hold – thank you.

31. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org Startling Findings: Rear facing on arrival and departure: Under 12 months: 95% on arrival, 98% on leaving 12-17 months: decreased from 76% on arrival to 72% leaving 18-23 months: remained at 33% These figures were especially ironic as Marilyn Bull, MD of Riley Children’s Hospital was a major researcher on benefits of rear-facing travel to at least age 2. Follow-up: emphasis in Technician training on importance of rear- facing for reducing injury.

32. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org Findings: 2 - 3 year olds: increase from 61% in seats with internal harnesses to 85%. 4 – 8 year olds:  On arrival: 16% unrestrained; 17% belt only  On leaving: 75% in boosters, 22% in seats with harnesses 9 - 13 year olds:  On arrival: 15% unrestrained; 50% belt only  On leaving: nearly 60% in boosters 21% arrived in used seats. 39% left in a different seat, of which 85% were donated by sites. + Please mute your phone – but don’t put the line on hold – thank you.

33. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org Other Findings: Missing information on form: common issue with checkup forms. Improvements in form design and recording needed. Referral sources: startled to find friend/family was by far most common source (3260); next closest: hospitals (1121) SUMMARY: data analysis shows area need to increase outreach, improve recording, improve putting theory into action. Valuable as benchmark for IN and for other areas to use for comparison.

34. Research Review: NHTSA Traffic Safety Facts 2012 SafetyBeltSafe U.S.A. www.carseat.org 1168 children 0 – 14 killed (3% increase from 2011) 169,000 children injured (1% decrease from 2011) 3 killed, 462 seriously injured every day 33,561 total traffic fatalities; children 3%. Largest decrease – 8 – 14 years + Please mute your phone – but don’t put the line on hold – thank you.

35. Research Review: NHTSA Traffic Safety Facts 2012 SafetyBeltSafe U.S.A. www.carseat.org Restraint use: 4888 child passengers involved in fatal crashes. 18% unrestrained. 40% fatalities unrestrained. 298 child fatalities under 5 – 31% unrestrained. Children under 5 years – estimated 284 lives saved. Estimated potential additional lives saved through 100% safety seat use – 58.

36. Research Review: Costs of Motor Vehicle Crashes SafetyBeltSafe U.S.A. www.carseat.org NHTSA Report – Blincoe, Miller, Zaloshnja, & Lawrence (2014), ‘The Economic and Societal Impact of Motor Vehicle Crashes, 2010’. (Report No. DOT HS 812 013). 2010 – total economic cost of motor vehicle crashes: $277 billion Includes lifetime economic costs of 32,999 fatalities, 3.9 million non-fatal injuries, 24 million damaged vehicles. Total value of societal harm (including quality-of-life valuations) $871 billion. + Please mute your phone – but don’t put the line on hold – thank you.

37. Research Review: Vehicles: Good Choices for Teens SafetyBeltSafe U.S.A. www.carseat.org Status Report, Vol. 49, No. 5 Special Issue: Vehicles for Teens, July 16, 2014 Design for Choosing: Principles built on comparative fatality statistics No “muscle cars” to tempt teen drivers to speed, race, etc. Vehicles with electronic stability control essential. Heavier vehicles; exclude mini or small cars. Highest safety ratings possible, including side-impact protection, good test results on moderate overlap crashes, good head restraints, NHTSA 4-5 Stars on NCAP tests.

38. Research Review: Vehicles: Good Choices for Teens SafetyBeltSafe U.S.A. www.carseat.org Key Data: Telephone survey: 83% of parents buy used cars or share older vehicles already owned by family. $9800 average price, but median price only $5300. Hard to find safest cars under $5300. Risks to Teens: Comparison of fatality rates for 15-17 year olds with 35-50 year olds: Teens: 29% in mini-cars, 82% older vehicles Adults: 20% mini-cars, 77% older vehicles + Please mute your phone – but don’t put the line on hold – thank you.

39. Research Review: Vehicles: Good Choices for Teens SafetyBeltSafe U.S.A. www.carseat.org Vehicle Recommendations: Both Best and Good Choices among all types of vehicles meeting IIHS criteria but few at $5300 median or less: Best Choices, lowest cost: $7300 (Volvo XC90, ‘05 or earlier) Good Choices, lowest cost: $4600 (Kia Sedona, ‘06 or later)

40. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org “ATV riding and helmet use among youth aged 12–17 years, USA, 2011: results from the YouthStyles survey”, R. A. Shults & B. A. West, Injury Prevention, published online 6/10/14 Based on YouthStyles online survey conducted by Porter, Novelli. ATV defined as 3- or 4-wheel vehicle ridden astride and meant for use on non-paved roads; may weigh up to 1000 lbs. 10.6 million 4-wheel ATVs in U.S. [Note: often have replaced horses in rural areas.] Subgroup of 12-17 year olds whose parents answered HealthStyles online survey earlier in 2011. Weighted survey included 833 teens. + Please mute your phone – but don’t put the line on hold – thank you.

41. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org Focus: how much travel on ATVs by teens? Asked for estimate in months; review of data led to focus on differences among those stating “never” vs. one trip vs. 6 or more trips. Grouping of answers on frequency of helmet use led to always vs. not always (including the range from never to nearly always).

42. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org Findings: grouped by gender U.S. regions (northeast, mid-west, south, west) urban (50,000 population or more) vs rural Overall, 25% rode at least once in past year but varied from 23- 28% by region and on urban/rural axis: 22% vs 44% Helmet use: 45% Always, 10% Seldom, 25% Never + Please mute your phone – but don’t put the line on hold – thank you.

43. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org Helmet Use: additional findings by subgroup ‘Always’: Gender: Male & female: 45% Location: Urban, 47% vs. rural, 39% Frequency of riding:  once a year: 68%;  2-5 times/year: 48%;  6 or more times annually: too few to establish meaningful % (not always, 81%) 3 times as many males as females rode 6 or more times in year: data link to prevalence of death/injury for males

44. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org Size of the Problem: Consumer Product Safety Commission statistics 30 years from 1982: 12,391 fatalities, 24% for children under age 16; 2008 (most recent year with firm, final data): 14% of 755 deaths were under age 16. Emergency room visits: 2012 – 107,900 of which 25% were under 16. + Please mute your phone – but don’t put the line on hold – thank you.

45. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org Social issues: Consumer Product Safety Commission recommends: Youth under 16 not ride adult-sized ATVs Helmets be used No passengers be carried. No truly effective method so far for achieving goals so far. Most state laws exclude private property, have many options for not prosecuting violations. Dealers only must “try their best” not to sell adult-sized ATVs for youth use!

46. CEUs SafetyBeltSafe U.S.A. www.carseat.org 1 CEU awarded by Safe Kids To claim:  www.carseat.org  Click on Calendars, Professional and Technician Training, California Technical Teleconference, Request for CEU  Download form, complete & email to i0680@hotmail.com  Verification Code: ATV1982

47. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org “Quantifying CRS Compatibility in the Vehicle Seat Environment” Presented by Julie Bing, OH State Univ.; research collaboration with Children’s Hospital of Philadelphia Data gathered on 61 vehicles & 59 safety seats, encompassing all main categories of each. Collected 94 data points per vehicle & 40 per safety seat. 3600 measurements. Goal: benchmark for industries. Seek any basis for incorrect use due to design factors. Focus not on comparing individual seats/cars for ease-of-use. BUT gives areas for parents to explore when choosing seats.

48. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org 6 categories of findings: A.Width along bight of vehicle seat (not including side bolsters) Very similar % fit: 63.3% RF, 62.2% FF Rear-facing-only seats: 90%+ fit vs. less than 40% of 3-in-1 seats Question to be answered with crash testing: although narrow bases fit better in seat pans of cars, would wider bases provide better protection?

49. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org B.Vehicle seat support for safety seat base: 80% recommended by most manufacturers; 100% by some. Close to 99% of vehicle seats provided 80% support for safety seat bottoms but only 71% offered 100% support. (Other research by Klinich indicates no need to have full support; only 1 seat fell off & it passed FMVSS 213.)

50. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org C.Fit of RF & FF seats when front passenger seat is fully back, partway back, fully forward.  RF seats: 15.3% for fully back; 73.2%, partway; 95.8% forward.  FF: accounting for child leg room: back: 78.2%; partway,98%; forward, 100%.

51. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org D.Correct angle rear facing: Startling: for 7 seats, could not achieve correct angle because needed vehicle seat pan flatter, i.e. less than the 7.1-degree angle which was least slanted angle of all vehicle seats. Only 58.2% could be angled properly:  37.6%: too upright; 4.2% too flat with consequences of potential airway closure & crash pressure on head and shoulders respectively. E. Belt buckle resting on plastic edge of RF belt path: Appears to have been addressed. 90.5% successfully fitted, especially good for convertible safety seats. Only small trucks had less than 80% successful fits.

52. Conference Report: Kidz in Motion SafetyBeltSafe U.S.A. www.carseat.org F. Head restraint interference with correct fit of FF safety seats: Frustrating issue as new standard for head restraints meant to protect teens and adults. Removable head restraints MAY lead to non-replacement when needed. With head restraints in place: 66.4% fit. Future research: plans include sled testing with pool noodles in use & repeat of percentage of seat support needed for safety seat crash performance.