Compliance with the child passenger protection act : effects of a loaner program for low income mothers

To assist low-income families in their effort to comply with the law as well as save children from needless deaths and injuries, a child restraint device loaner program was established in Chattanooga, Tennessee, through the Hamilton County/Chattanooga Health Department. The purpose of this study was to determine the effects of this child restraint loaner program on the attitudes and behaviors of low-income mothers. Specific attention was given to the behavioral and attitudinal differences among mothers in three treatment groups, between mothers who obtained CRDs and mothers who did not obtain CRDs, and between mothers who used CRDs and mothers who did not use CRDs.

The independent variables included the three treatment groups and, in some cases, acquisition and use. The dependent variables included attitudes and behaviors regarding child passenger protection legislation, government intervention, health and safety issues, safety belts, and CRDs.

Participants in the study were assigned systematically to one of three treatment groups according to their hospital stay and were offered the opportunity to obtain CRDs by one of three options: (a) using their personal resources, (b) renting for a small fee, or (c) borrowing at no cost. The sample was drawn from low-income mothers on the maternity ward at Baroness Erlanger Hospital in Chattanooga.

Two levels of quantitative data were collected: the first at the hospital and the second 3 to 8 weeks later from mothers who either attended a special well-child clinic or returned the questionnaire via mail. Qualitative data were collected by means of face-to-face interviews from a smaller subsample of the initial sample. Sample size for the quantitative data was 109 for the first phase and 41 for the second phase; qualitative data were obtained from 25 mothers.

For the quantitative data, differences in beliefs of mothers in the three treatment groups and between the two conditions of the loaner program were tested using multivariate analysis of variance. To determine changes in mothers' attitudes over time, a repeated measures multivariate analysis of variance was used. Chi-square analyses were used to determine differences in beliefs between treatment groups in relation to both acquisition and use. To determine differences in beliefs between mothers in the two loaner program conditions from the qualitative data, the Fisher Exact Probability Test was used.

Mothers who were offered CRDs through the loaner program acquired CRDs more frequently than did mothers who had to obtain them through their own resources. Mothers who paid small fees used the CRDs more than did mothers who got CRDs free. Of the mothers interviewed, more mothers who obtained CRDs also used their safety belts than did mothers who did not obtain CRDs.

No differences in attitudes were found in the initial hospital sample, but in the second phase of data collection the interaction between the loaner program conditions and CRD acquisition was significant. Mothers who had rented CRDs tended to have more positive attitudes about CRDs than did mothers who borrowed them, whereas mothers who chose not to borrow CRDs had more positive attitudes than did mothers who chose not to rent them. The latter group, however, had particularly favorable attitudes about safety belt use. Mothers who acquired CRDs tended to maintain their attitudes about the importance of obtaining CRDs, whereas mothers who did not acquire CRDs tended to respond less positively about the importance of obtaining CRDs after 6 to 12 weeks.

Most interviewed mothers thought the loaner program was a good idea and said their friends would use its services. About 2/3 of the mothers thought only the poor should be allowed to use a loaner program, whereas the rest thought it should be available to anyone. Most mothers suggested that $5 to $10 was a reasonable fee to charge for rental of a CRD.

It was concluded that, left to their own devices, low-income mothers did not obtain CRDs. However, given the opportunity to acquire CRDs from a loaner program, low-income mothers did obtain them. Mothers that paid a small fee tended to use CRDs more than did mothers who got CRDs free. Because acquisition appears to be a barrier for many low-income families, attempts should be made to provide a CRD loaner service, especially when CRD use is mandated by law. More effective public information and education strategies are needed to develop and maintain a positive attitude toward passenger safety.

Further investigation of the issues regarding child passenger safety is needed. A theoretical model for analyzing usage decisions was developed as a basis for further research. Further examination is needed regarding incentives which will increase CRD usage among low-income families. It also is recommended that policy makers who determine rules and regulations should recognize various subcultural differences and consider alternatives which would assist all persons in complying with the laws.