title: Knowledge and practice of childhood motor vehicle restraint use in Nova Scotia: phase II.
abstract: OBJECTIVE
  To examine changes to knowledge and practice of childhood motor vehicle restraint (CMVR) use in Nova Scotia after the implementation of stricter car seat and new booster seat (BS) legislation in 2007.
  
  
  METHODS
  A random telephone survey of households (at least one child <12 years) was performed in 2004 and 2010. Logistic regression determined variables independently associated with correct knowledge and/or practice of CMVR use.
  
  
  RESULTS
  Families were surveyed in the pre- (N=426 families, 728 children) and post- (N=453 families, 723 children) legislative periods. Reported appropriate use of forward-facing car seats (FFCSs) and BSs increased significantly (74-92% and 58-95%, respectively). After adjusting for covariates, the post-law period remained a significant predictor of increased knowledge of when to graduate to a BS or a seat belt alone (SB) (OR:1.4(95% CI:1.0-2.0) and 1.9(1.4-2.7), respectively), which was significantly associated with correct use. The strongest independent predictor of the correct use of FFCSs and BSs was the post-law period (OR:14(3.0-68) and 43(17-114), respectively). With regards to rear-facing car seats (RFCSs), new legislation and associated social marketing on graduating from a rear-facing car seat was not associated with increases in correct practice.
  
  
  CONCLUSIONS
  Legislation, combined with social marketing at the time of introduction, is an effective means to educate parents on when to graduate from a FFCS and the importance of BSs while also influencing parents to use them, though not for RFCS graduation. The known protective effect of BSs dictates the need for all regions in Canada to adopt comprehensive BS legislation.
authors.affiliation: Division of Pediatric General Surgery and IWK Trauma Care Program, IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: Natalie.yanchar@iwk.nshealth.ca.
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Yanchar
authors.affiliation: Provincial Coordinator, Injury Prevention and Control, Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada. Electronic address: Julian.Young@gov.ns.ca.
authors.forename: Julian B
authors.initials: JB
authors.lastname: Young
authors.affiliation: Faculty of Medicine, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: donald.langille@dal.ca.
authors.forename: Donald B
authors.initials: DB
authors.lastname: Langille
mesh_terms: D000328:Adult; D002648:Child; D057207:Child Restraint Systems / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D018986:Motor Vehicles; D009674:Nova Scotia; D010290:Parents; D012622:Seat Belts / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Booster seats; Child; Child restraint systems/utilization; Health knowledge/attitudes/practice; Parents/education