Ask A Researcher

December 2023

Strapped for Safety: Exploring Insights into Car Seat Knowledge Among North Dakota Mothers

Samuel Faraday Saidu and Chelsey Hukriede

Samuel Faraday Saidu is a student at North Dakota State University, pursuing a master’s degree in public health with a specialization in Epidemiology and a sub-plan in maternal and child health. He currently works as a Graduate Research Assistant at the Center for Social Research (CSR). Samuel holds a bachelor’s degree in public health with an emphasis on Health Education and Promotion from Brigham Young University-Idaho.
Chelsey Hukriede is a research specialist with the CSR, providing support to various projects. She is also the Project Coordinator for North Dakota PRAMS, SOARS, and the Fatherhood Experiences Survey. Chelsey received her master’s degree in Sociology from the University of North Dakota.

 

The North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) is a collaborative project of the Centers for Disease Control and Prevention (CDC), the North Dakota Department of Health and Human Services, and the Center for Social Research at North Dakota State University. PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. These data can be used to identify groups of women and infants at high risk for health problems, to monitor changes in health status, and to measure progress towards goals in improving the health of mothers and infants.  

To help disseminate project results, a series of dashboards, PRAMS Points, are being released on a variety of topics. Released topics include: oral health, safe sleep, gestational diabetes, pre-existing diabetes, maternal adverse childhood experiences, postpartum depression, and now car seat awareness.
This article accompanies the newly released PRAMS Points Dashboard regarding car seat awareness among women who recently gave birth in North Dakota. The dashboard uses North Dakota PRAMS data gathered from 2017 through 2021 to examine the various methods women, who recently gave birth, learned to install and use their infant car seats. Dashboards such as this, contribute to the ongoing surveillance efforts that can identify populations at risk and help create and evaluate programming and policies to improve health outcomes for pregnant women, babies, and families in North Dakota.

Car Seat Awareness Background

Nationwide, motor vehicle traffic crashes are a leading cause of death in children under 14 years of age [1]. In 2021, a total of 863 children in the United States died as a passenger in motor vehicles; of these children, 308 were found to be unrestrained [1]. This equates to an average of 3 daily child fatalities in 2021 due to motor vehicle crashes in the United States [1]. The same year, an estimated 445 children sustained injuries as a result of traffic crashes [1]. Among the 50 states, North Dakota had the highest percentage of child traffic fatalities in 2021 at 5.9 percent; the national average of child traffic fatalities was 2.8 percent [1].

Effective use of car seats and booster seats is imperative to minimize the risk of fatalities and injuries in motor vehicle crashes. Parents and guardians play a pivotal role in minimizing these risks by ensuring infants and children are properly secured in car seats that are suitable for their age and size [2]. Research underscores the life-saving potential of proper car seat usage, with a 71 percent reduction in the risk of death for infants under 1 year of age and a 54 percent reduction for toddlers 1 to 4 years old [1].

Despite the proven safety benefits of car seats, misuse remains a significant issue. Research reveals that more than half of the car seats are not installed correctly (59 percent).  Common errors include failing to use the top tether in forward-facing car seats and having car seats and harnesses that are too loose [3]. Raising awareness and providing proper education are essential steps to enhance child car seat safety [4].

To address this critical concern, child restraint laws have been implemented, which mandate that children riding in motor vehicles must be securely buckled into car seats, booster seats, or seat belts appropriate for their age, weight, and height [2]. High-visibility enforcement programs such as 'Click it or Ticket' have significantly enhanced the effectiveness of these laws. Additionally, education programs are available to assist parents in obtaining new car seats and learning how to correctly install and secure their children [2].

The CDC provides recommendations to ensure the proper installation and use of car seats. This includes reading the car seat instruction manual thoroughly, adhering to the manufacturer's guidelines, and having a certified technician inspect the car seat to ensure it is correctly installed—a service that is often provided free of charge. Furthermore, children should continue to use a car seat or booster seat until they meet the height and weight requirements for using a seat belt alone, as recommended by the CDC [2].

Data and Trends

A national study by the American Academy of Pediatrics found that many parents install and use their car seats incorrectly with nearly all parents (93 percent) making at least one critical error buckling their newborn in for the ride home from the hospital [5]. The most common error was buckling their baby in too loosely (68 percent), followed by low placement for the harness clip, which should be at armpit level (33 percent). The correct car seat fit is snugger and with a harness clip higher than most parents feel it should be. Adhering to these guidelines can prevent injuries related to forward momentum and will not allow the shoulder straps to splay outward, ejecting the child from their car seat [5].

In North Dakota, 99.1 percent of women who recently gave birth reported having an infant car seat for their new baby, according to PRAMS data collected from 2017 through 2021. Although most own a car seat, mothers learn how to install their infant car seat in a variety of ways – some methods may provide more precise and appropriate installation and restraint information than others. A ‘gold-standard’ installation involves reading the instruction manual and/or seeking help from a health or safety professional [6].

The PRAMS survey asked women who recently gave birth about ways they learned how to install and use their infant’s car seat. Responses could have included: read instructions, a professional showed me, a friend or family member showed me, figured it out independently, or already knew how to install the seat because they have other children.

Notably, PRAMS data collected from 2017 through 2021 indicated a stark difference between first-time mothers and seasoned mothers (mothers who have other children) in the methods utilized when learning to install and use the infant car seat. Overall, three in five North Dakota mothers (60 percent) read the instructions provided with their infant car seat. Among first-time mothers, 70 percent read the instructions. Among seasoned mothers, 80 percent reported they already knew how to install a car seat.

Learning Methods of Car Seat Installation and Use by Maternal Characteristics

The way mothers learn how to install and use an infant car seat  can vary by maternal characteristics such as age, level of education, household income level, maternal race and ethnicity, Medicaid status, as well as geography (urban or rural). Understanding these variations is crucial for developing targeted interventions and education programs to ensure proper car seat installation and usage.
Findings from North Dakota PRAMS data collected from 2017 to 2021 revealed that how first-time mothers learned to install and use their infant car seat varied by maternal characteristics.

Gold-Standard of Learning How to Install and Use a Car Seat

First-Time Mothers who were most likely to read instructions were women who:

  • Had a bachelor’s degree (77%)
  • Lived in rural North Dakota (74%)
  • Were 20 to 29 years old (72%)
  • Were White (72%)
  • Did not have their prenatal care paid for by Medicaid (72%).

First-Time Mothers who were most likely to have a professional show them were women who:

  • Were of the other racial category (e.g., Black, Asian, multi-races) (53%)
  • Had a master’s, doctorate, or professional degree (48%)
  • Lived in urban areas of North Dakota (46%)
  • Were age 30 and older (44%)
  • Had household incomes of $85,001 or more (44%).

Other Ways Mothers Learned to Install and Use a Car Seat

First-Time Mothers who were most likely to have friends or family show them were women who:

  • Were younger than 20 years old (56%)
  • Had less than a high school diploma (56%)
  • Had their prenatal care paid for by Medicaid (48%)
  • Were American Indian (43%)
  • Had household incomes of $28,000 or less (40%).

First-Time Mothers who were most likely to figure it out themselves were women who:

  • Were Hispanic (35%)
  • Were younger than 20 years old (32%)
  • Had household incomes of $28,000 or less (28%)
  • Had their prenatal care paid for by Medicaid (28%)
  • Lived in rural North Dakota (26%).

Conclusion

Proper car seat installation is crucial for child safety during travel. Although it appears that most mothers have access to a car seat for their infant, there is room for improvement to ensure car seats are used correctly. Data insights from this dashboard can inform targeted education and awareness campaigns to enhance child car seat safety across North Dakota. Ultimately, the goal is to reduce child fatalities and injuries in motor vehicle crashes, making every car ride a safer experience for young passengers.

References

1. National Center for Statistics and Analysis. (2023, May). Children: 2021 data (Traffic Safety Facts. Report No. DOT HS 813 456). National Highway Traffic Safety Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813456
2. Centers for Disease Control and Prevention. (2022, October). Child passenger safety: Get the facts. https://www.cdc.gov/transportationsafety/child_passenger_safety/cps-factsheet.html
3. Safe Kids Worldwide. (2017, September). More than half of car seats are not installed correctly. https://www.safekids.org/post/more-half-car-seats-are-not-installed-correctly
4. Simon, M.R., Korošec, A., and Bilban, M. (2016, November). The influence of parental education and other socio-economic factors on child car seat use. Slovenian Journal of Public Health, 56(1), 55–64. https://doi.org/10.1515/sjph-2017-0008
5. Kling, J. (2014, November). Almost All Infant Car Seats Misused. Medscape Medical News. https://www.medscape.com/viewarticle/833213?0=reg=1
6. California Department of Public Health (2021, April). Car Seat Basics.

About PRAMS

More information about the PRAMS project and PRAMS data can be found at www.hhs.nd.gov/prams.

Explore the NEW PRAMS Points Dashboard today!

Other PRAMS POINTS

• Pregnancy and Oral Health (May 2021)
Gestational Diabetes (July 2022)
Babies Safe Sleep (August 2022)
Preexisting Diabetes (December 2022)
Maternal Adverse Childhood Experiences (August 2023)
Postpartum Depression (October 2023)

 Explore the PRAMS Points Data Visualizations page today!

Ask a researcher archive

Faye Seidler. A New Horizon for LGBTQ+ Population Data
June 2024

Iyobosa Sonia Omoregie and Kendra Erickson-Dockter. Exploring Suicide Rates Among Youth
May 2024

Dean Bangsund and Nancy Hodur. Sugarbeet Industry in the Northern Plains: Economic Contribution in Minnesota and North Dakota.
April 2024

North Dakota Compass. North Dakota Compass Releases the 2024 Compass Points
March 2024

Nicholas Bauroth. City Governance: Commission or Council for Fargo, North Dakota?
February 2024

Ina Cernusca. 2024 Brings a NEW Visualization Tool and Data Updates to the North Dakota State Legislative District Profiles.
January 2024

Samuel Faraday Saidu and Chelsey Hukriede. Strapped for Safety: Exploring Insights into Car Seat Knowledge Among North Dakota Mothers.
December 2023

Debarati Kole and Kendra Erickson-Dockter. A Comprehensive Look at the Multifaceted Risk Factors of Postpartum Depression
October 2023

Valquiria F. Quirino and Avram Slone. COVID-19 pandemic in North Dakota: Significance, progression, and government response.
September 2023

Karen Olson. The Lasting Impact of Maternal Childhood Trauma
August 2023

Avram Slone. The Social Variability of COVID-19 Mortality in North Dakota between March 11th, 2020 and February 13th, 2022
July 2023

Nancy Hodur and Dean Bangsund. Agriculture a Key Driver in the North Dakota economy
June 2023

Karen Olson. Health and Well-Being in North Dakota. Understanding how the five social determinants of health are impacting the ability of North Dakotans to thrive
May 2023

Kendra Erickson-Dockter. North Dakota Compass: 10 years of Measuring Progress and Inspiring Action.
April 2023

Hannah Hanson & Grace Njau. Every Dad Counts: North Dakota Fatherhood Experiences Survey
March 2023

Nancy Hodur. Housing Market Conditions and Declining Homeownership Rates
February 2023

North Dakota Compass. 2022 Recap: Data highlighted throughout the year
January 2023

Kendra Erickson-Dockter. A Look into a Chronic Condition and Pregnancy: Preexisting Diabetes PRAMS Points 2022
December 2022

Nancy Hodur and Karen Olson. Lower-income households and baby boomers, main drivers for North Dakota housing needs in the near term
November 2022

Avram Slone. The Impact of COVID-19 on Group Quarters in North Dakota
October 2022

Chelsey Hukriede. Safe Sleep PRAMS Points 
September 2022

Kendra Erickson-Dockter. Gestational Diabetes PRAMS Points – A NEW Dashboard Format!
August 2022

Aastha Bhandari, Debarati Kole, Dr. Nancy Hodur. Mission Of Mercy: Giving hope through a smile.
July 2022

Ina Cernusca.Households with children have been disproportionately affected by the COVID-19 pandemic, especially in the first year of the pandemic.
May 2022

Andy Wiese and Karen Olson. One Health System’s Approach to Improving Community Health. Understanding what the 2021 Community Health Needs Assessment Conducted by Sanford Health means for population health
April 2022

Mariel Lopez-Valentin and Grace Njau. North Dakota Title X, Family Planning Needs Assessment
January 2022

Nancy Hodur and Dean Bangsund. North Dakota Lignite Energy Industry Workforce
December 2021

Ina Cernusca. Vaccine Acceptance and Hesitancy in North Dakota
October 2021

Nancy Hodur and Karen Olson. Rural Communities Will Benefit from a New Cooperative in Walsh County
September 2021

Matt Schmidt and Grace Njau. COVID-19 Trends Among North Dakota Children, March 2020 – March 2021
August 2021

Kendra Erickson-Dockter and Ina Cernusca. COVID Hardship on North Dakota Households: New study on the impacts on North Dakota households that lost employment income during the pandemic
July 2021

Chelsey Hukriede and Kendra Erickson-Dockter. NEW! PRAMS Points – A Brief Infographic using North Dakota PRAMS Survey Data
May 2021

North Dakota Compass: A look inside the 2021 Compass Points
April 2021

Ina Cernusca: Households with children are disproportionately affected by the COVID-19 pandemic
March 2021

Ina Cernusca: Differences in COVID-19 Risk Factors at District Level
February 2021

Kendra Erickson-Dockter, Chelsey Hukriede, and Grace Njau: An Introduction to the North Dakota Study of Associated Risks of Stillbirth (SOARS)
October 2020

Karen Ehrens: North Dakota Families are Facing Food and Other Hardships in the Wake of COVID-19 Pandemic, and Helpers Respond
September 2020

Ina Cernusca: Taking the pulse of North Dakota households during the COVID-19 pandemic.
July 2020

Nancy Hodur:Challenges of Grocery Stores in Rural North Dakota
May 2020

North Dakota Compass:2020 Compass Points: Measuring progress. Inspiring action.
March 2020

Amy Tichy:Student Veterans in the College Classroom.
February 2020

North Dakota Compass:North Dakota Compass launches the 2020 State Legislative District Profiles
January 2020

Grace Njau, Nancy Hodur:&Chelsey Hukriede: Risk Behaviors among Women with a Recent Live Birth in North Dakota: Findings from the 2017 North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
November 2019

Ina Cernusca:& Karen Olson: Behind the scenes – The story of the North Dakota State Legislative District Profiles
October 2019

Ina Cernusca: Key demographic trends in North Dakota.
August 2019

Karen Olson: The 30th edition of the Annie E. Casey Foundation’s KIDS COUNT® Data Book finds that 175,772 children will shape the future of a more diverse North Dakota.
July 2019

Shweta Arpit Srivastava & Dr. Ann Burnett: “Giving rope and pulling it back”: Parental dilemmas to prevent adolescent substance use
June 2019

Ina Cernusca: 2019 Compass Points: Setting direction for improving the quality of life in North Dakota
May 2019

Joshua Marineau and Onnolee Nordstrom: Learning from Fargo -- An Exploration of the Fargo-Moorhead Entrepreneurial Ecosystem
March 2019

Nancy Hodur: Improving Oral Health for Older Adults in North Dakota
November 2018

Rachelle Vettern: Engaging Volunteers across Generations
October 2018

Karen Olson: The 2018 KIDS COUNT® Data Book reveals strengths and challenges for children in North Dakota – and emphasizes that an inaccurate census in 2020 threatens to worsen existing challenges for North Dakota youth
July 2018

Lori Capouch: Is food access a concern in rural North Dakota?
May 2018

Deb Nelson: Williston Basin 2016: Employment, Population, and Housing Forecasts – An Overview
January 2018

Karen Olson: North Dakota among Top 10 States in Country for Child Well-Being
July 2017

Nancy Hodur: SEAL!North Dakota: A School Dental Sealant Program
June 2017

Grace Njau: A Brief Introduction to the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
April 2017

Ina Cernusca: North Dakota’s Women study: A brief overview
March 2017

Dean Bangsund: Effects of Fargo-Moorhead Area Diversion on Spring Planting for Producers
February 2017

Deb Nelson: Vision West: Leading, Educating, and Collaborating to Mobilize the 19 Western North Dakota Counties Towards Resilience and Prosperity
December 2016

Nancy Hodur: North Dakota Statewide Housing Needs Assessment: A Brief Overview of the Population and Housing Forecast component
November 2016

Social Isolation: Experiential Narratives of African Refugee Women in the Fargo-Moorhead Community
September 2016

Sean Brotherson: Father Involvement and the Future of Children and Families
July 2016

Carol Cwiak: Bakken Oil: What Have We Learned and What Will We Do Differently Next Time
June 2016

Jessica Creuzer: The Changing Face of Western North Dakota: What are the Effects of Increased Travel from Energy Development
April 2016

ND Compass: City Profiles
February 2016

ND Department of Health: Making Change Happen
January 2016

Jennifer Weber: A Bold New Direction for the North Dakota University System - The NDUS Edge Dashboards
December 2015

Wendy Troop-Gordon: What Has Science Taught Us About Bullying?
November 2015

ND Compass: A Look at the Youngest North Dakotans
October 2015

Kendra Erickson-Dockter: Growing Older in North Dakota
September 2015

Michael Ziesch: Data You Can Trust: The Labor Market Information Center
August 2015

Malini Srivastava and Troy Raisanen: efargo: City Scale Sustainability
July 2015

Kevin Iverson: The State Repository of Census Information- The North Dakota Census
June 2015

Wonwoo Byun: Reducing Sedentary Behavior is a Key for Obesity Prevention in Children
May 2015

Kathryn Gordon: The Science of Suicide Prevention
April 2015

ND Compass: Tell a Story with Data! The Importance of Crade-to-Career Success
March 2015

Abby Gold: Community Food Systems: Food Charters and More
February 2015

Heather Fuller-Iglesias: The Importance of Recognizing the Role of Social Support in Human Development Across the Lifespan
January 2015

Michael Carbone: Using Data to End Homelessness
December 2014

Randal Coon: Tribal Colleges Contribute to the State's Economy
November 2014

Deb White: Women's Representation in Elected Office
October 2014

Randal Coon: Pull Factors Measure Retail Trade Performance
September 2014

Karen Olson: North Dakota ranks Well Nationally with Regard to Overall Child Well-Being; However, Substantial Opportunities for Improvement Exist
August 2014

Julie Garden-Robinson: Guard Against Grilling Gaffes: Healthy Grilling and Food Safety Tips
July 2014

Michael Noone: Extreme Weather Patterns- North Dakota Has It All
June 2014

Kathleen Tweeten: Why All Community Development Decisions Should Use the Community Capitals Framework
May 2014

Clayton Hilmert: Stress effects on pregnancy: The impact of the 2009 Red River flood on birth weight
April 2014

Karen Ehrens: Food Deserts and how they impact North Dakota
March 2014

Gretchen Dobervich and Kendra Erickson-Dockter: New Geographic Profiles: How they can work for you
February 2014

Compass Staff: "New Compass Team Brings Changes in 2014"
January 2014

Donna Grandbois: "Fargo-Moorhead American Indian Community-Sponsored Health Needs Assessment"
November 2013

Karen Olson: "North Dakota KIDS COUNT - why it counts for you
October 2013

Nancy Hodur: "Western North Dakota School Administrators Face Challenges"
August 2013

Megan Chmielewski: "Annual population estimates tell interesting stories about North Dakota's growth patterns"
July 2013

Ramona Danielson: "Learn how to make the ND Compass website work for you"
May 2013

Karen Olson: "About the American Community Survey (ACS)"
February 2013

North Dakota Compass

Center for Social Research
North Dakota State University

Compass created by:
Wilder Research

© 2024. All rights reserved.