Violators of a Child Passenger Safety Law

Phyllis F. Agran, MD, MPH; Craig L. Anderson, PhD, DHSc; and Diane G. Winn, RN, MPH
ABSTRACT. Background. Nonuse of child car safety
seats (CSSs) remains significant; in 2000, 47% of occupant
fatalities among children <5 years of age involved unrestrained children. Nonusers and part-time users of CSSs
represent small proportions of the US population that
have not responded to intervention efforts. Our study
examined the factors contributing to nonuse or part-time
use of CSSs and the effects of exposure to a class for
violators of the California Child Passenger Safety (CPS)
law.
Methods. Focus groups (in English and Spanish) were
conducted with individuals cited for violation of the law
(N 24). A thematic analysis of notes made by an observer, supplemented by audiotapes of the sessions, was
conducted. In addition, a study of the effects of exposure
to a violator class on knowledge and correct CSS use was
conducted among violators. Certified CPS technicians
conducted the classes and interviews. Subjects were parents cited as the driver with a child of 20 to 40 pounds,
between 12 and 47 months of age. One hundred subjects
recruited from the class were compared with 50 subjects
who did not attend a class. Follow-up home interviews,
with inspection of CCS use, were conducted 3 months
after payment of the fine and completion of all court
requirements. Fishers exact test was used for 2 2 tables, because some of the tables had small cell sizes. The
Mann-Whitney rank sum test was used for child restraint
use, knowledge, and correct use scales, because some of
these variables were not normally distributed. Linear and
logistic regression models were used to examine the effects of several variables on these parameters.
Results. Factors influencing CSS nonuse were 1) lifestyle factors, 2) transportation and trip circumstances, 3)
nonparent or nondriver issues, 4) parenting style, 5)
childs behavior, and 6) perceived risks of nonuse. Violator subjects were mostly Hispanic and female, with
incomes of less than $30 000 per year. Those exposed to
the class (citation and education group) scored 1 point
higher on a knowledge test and had 1 more item correct
on a CSS use instrument than did the group not exposed
to the class (citation only group). In the logistic model,
the citation and education group scored higher on the 2
items that were corrected by the instructor during the
class.
Conclusion. Our focus group study of CPS law violators revealed that multiple complex factors influence
consistent use of a CSS. The interplay of the particular
vehicle, the trip circumstances, and family/parent/child
factors affected the use of a CSS at the time of parent
From the University of California, Center for Health Policy and Research,
Child Injury and Traffic Safety Research Group, Irvine, California.
Received for publication Jun 30, 2003; accepted Jan 6, 2004.
Address correspondence to Phyllis F. Agran, MD, MPH, 100 Theory, Ste
110, University of California, Irvine, Center for Health Policy and Research,
Child Injury and Traffic Safety Research Group, Irvine, CA 92697-5800.
E-mail: pagran@uci.edu
PEDIATRICS (ISSN 0031 4005). Copyright 2004 by the American Academy of Pediatrics.

citation. Addressing transportation issues and parenting

skills in CPS programs is necessary. Among parents who
had been ticketed for not restraining their children, exposure to a violator class demonstrated some benefit,
compared with a fine alone. Correct CSS use improved
most on items corrected by the instructor. Violator classes
that include hands-on training show promise for improving rates of correct use of CSSs. Pediatrics 2004;114:
109 115; child injury, child passenger safety, car seat law,
violators of child passenger safety law.
ABBREVIATIONS. CSS, car safety seat; CPS, child passenger
safety.

he first US child passenger safety (CPS) law

was passed in Tennessee in 1978. Since that
time, all states and the District of Columbia
have enacted mandatory child restraint use laws,
albeit with significant variations in provisions, exemptions, and gaps in coverage.1 The laws in all
except 1 state cover children through 4 years of age.
Evidence-based studies have revealed the effectiveness of CPS laws in increasing child restraint use and
reducing the numbers of both fatal and nonfatal
injuries.2
Car safety seat (CSS) use rates of 90% have been
achieved as a result of multiple strategies, including
education, media campaigns, public policies mandating use, and enforcement of laws.3 Estimates of
effectiveness with respect to reductions in the numbers of deaths in motor vehicle crashes with CSS use
are 71% for infants and 54% for children 1 to 4 years
of age.4 The full benefits of CSS use have not been
realized because of high rates of misuse.59 Nonuse
remains a significant issue; in 2000, 47% of passenger
occupant fatalities among children 5 years of age
involved unrestrained children.10
Nonusers and part-time users of CSSs represent
small proportions of the population that have not
responded to intervention efforts. Disparities in the
use of occupant protection systems remain. Lower
rates of restraint use and higher occupant fatality
rates have been detected among Hispanics and African Americans and among low-income US populations.1119 Vaca et al20 found that lower income,
fewer years of education, and lack of fluency in
English were associated with less knowledge of child
occupant protection issues. Others21,22 reported similar findings. The readability of CSS manuals has
been found to be above the literacy level of most
Americans, which may affect the proper use of CSSs
among some populations.23
Educational programs to increase CSS use have
PEDIATRICS Vol. 114 No. 1 July 2004

109

demonstrated mixed results. Education with CSS

distribution has been an effective strategy in the
general population.2 Hands-on education has resulted in higher rates of correct use, compared with
education alone.24 Community-based programs in
Latino populations have demonstrated increased
rates of both child CSS and seat belt use.15,25 To our
knowledge, there have been no studies of programs
for those ticketed for nonuse.
At the time of this study, the California CPS law
required children 4 years of age and 40 pounds to
be properly secured in a CSS meeting federal standards. (The law was subsequently revised to require
the use of a CSS until 6 years of age or 60 pounds.)
The law provides for primary enforcement and imposes a fine of $100 and added penalty assessments
(total of $271) for violation of California Vehicle
Code section 27360.26
This study was designed to examine the factors
contributing to nonuse or part-time use of a CSS and
the effects of exposure to a violator class for those
cited for violation of the California CPS law. Our
intent was to compare knowledge and correct use
between parents/drivers who were cited and exposed to a class and those who were cited and not
exposed to a class.
METHODS
Study Design
This study involved 2 phases. First, focus groups were conducted with individuals who had been cited for violation of the
CPS law. Results from the focus groups were used to guide the
development of a study of an existing violator class for CPS law
violators.

Focus Group Study

Three focus groups (6 10 participants in each) were conducted.
Two groups were conducted in English and 1 was conducted in
Spanish. Participants were recruited from among violators registering for a class required by several courts in Los Angeles County
(Family Safety in the Car, conducted by Passenger Safety Services,
Whittier, CA). The focus group sessions were 90 minutes long and
occurred just before the violator class. Facilitators familiar with
child occupant protection and child development led the groups.
Topics included CSS ownership and use, difficulties with CSS use,
and reasons for nonuse. We completed a thematic analysis of notes
made by an observer, supplemented by audiotapes of the sessions.
The University of California institutional review board approved
the protocol.

Study of Effects of Exposure to Violator Class

We compared CSS use and knowledge among CSS violators
who received a citation and were required to attend an educational class (citation and education group) with use and knowledge among violators who received a citation in a nearby jurisdiction that did not require attendance at an educational class
(citation group). Subjects were cited between October 1998 and
June 2000, and the study was restricted to parents who had been
cited as drivers for failure to restrain their own children. The
children for whom the citation was issued were required to weigh
20 to 40 pounds and to be 12 to 47 months of age at the expected
time of follow-up assessment, 3 months after payment of the fine
and completion of all court requirements. These criteria were
selected to identify a group of parents with children who were
required to be restrained in a CSS and who would be expected to
use a forward-facing CSS with a harness. CSSs included convertible and combination seats.
Subjects for the citation and education group were recruited
from later sessions of the same mandatory educational program

110

VIOLATORS OF A CPS LAW

from which the focus groups were recruited. The class was 2 hours
long and included a videotaped presentation, a discussion, and a
classroom inspection of the violators CSSs, with correction of any
errors in the harness slot position or reclining position. Violators
paid a $30 fee to attend the class. None of the violators had been
cited at a police checkpoint.
Subjects for the citation group were recruited from areas near
the jurisdictions of the courts that required violators to attend the
educational program. We attempted to recruit these subjects in 4
ways, as follows: 1) an announcement of the study was included
in courtesy notices that reminded violators to pay their fines; 2) an
interviewer attempted to recruit violators coming to the court
building to pay their fines; 3) police officers were asked to distribute a flyer to violators when they were cited; and 4) direct recruitment was conducted at police-operated CSS checkpoints. Almost
all of the subjects in the citation group were recruited at police
checkpoints.
Follow-up home interviews and CSS inspections were scheduled 3 months after payment of the fine and completion of all
court requirements. Parents were requested to have the car and
child present, with the assumption that CSS users would also have
the car seat available. The University of California, Irvine, institutional review board approved the protocol. The interviews included questions regarding usual CSS use, CSS use on the last trip,
and hassles associated with CSS use and assessment of the
installation of the CSS, including the fit of the CSS to the car and
to the child for whom the citation was issued.
We asked the respondents about their childrens usual restraint
use in 4 categories (child CSS, seat belt, unrestrained, or lap), with
5 responses to describe the frequency of use (never, seldom,
sometimes, almost always, or always). We identified 4 groups of
responses. The first group included respondents who said that
their children were always restrained in a CSS. The remaining
respondents were divided into those who reported that their
children were always restrained, sometimes with a seat belt; seldom or sometimes restrained; or never or rarely restrained.
Correct CSS use was assessed by the interviewer, who was a
National Highway Traffic Safety Administration-certified CPS
technician. The assessment used a procedure and form developed
by SafetyBeltSafe USA (Torrance, CA). Twelve specific items of
correct use were coded from the form. We divided these into 2
items that were corrected in the classroom inspection (use of
appropriate harness slots and adjustment of the CSS to the proper
angle for the child) and 10 items that were addressed in the class
instruction.
Fishers exact test was used for 2 2 tables, because some of the
tables had small cell sizes. The Mann-Whitney rank sum test was
used for child restraint use, knowledge, and correct use scales,
because some of those variables were not normally distributed.
Linear and logistic regression models were used to examine the
effects of several factors on those variables.

RESULTS
Focus Group Study

The 3 focus groups included 24 individuals who

had been cited for violation of the California CPS
law. Eighteen of those individuals were parents and
20 were drivers. Eighty-three percent of the citations
were for children 2 or 3 years of age. Nearly all
participants knew that children should be restrained,
but there was variability in knowledge regarding the
specific features of the law. Almost all of the parents
owned a CSS. Most were inconsistent users, with a
number restraining children 4 years of age with
seat belts.
Respondents reported several lifestyle and transportation issues that could lead to CSS nonuse. Many
respondents did not have reliable transportation and
frequently needed to obtain rides with others. In
such situations, the respondents thought that the CSS
would be an imposition on the person providing the
ride. In some situations, the vehicle was too small to

accommodate all of the passengers and the childs

CSS.
For a number of respondents, CSS nonuse was
attributed to the circumstances of a particular trip.
Respondents with 1 vehicle sometimes left the CSS
in 1 vehicle and the child traveled in another car, or
the CSS was in a vehicle that was being repaired.
Unexpectedly obtaining a ride in a private vehicle
after leaving home via public transportation was
another situation that resulted in CSS nonuse.
In addition to parents, other caregivers were cited
for transporting children without CSSs. In some situations, the other caregiver did not have a CSS and
the parents did not leave the CSS when they left the
child. Some drivers who had given a ride to a parent
who had no CSS were cited, and some drivers were
cited when another passenger took the child out of
the CSS.
Parenting factors influenced nonuse. Some parents
in the same family differed with respect to the importance of CSS use or were inconsistent in their
requirements that a child travel in a CSS. Parents also
gave in to children who resisted CSS use, often
citing a need to keep the child quiet to avoid distracting the driver. Parents also thought it was necessary
to remove fidgety or sleepy children from the CSS.
Child factors were cited as reasons for nonuse of a
CSS. The reasons cited included the child not wanting to sit in the car seat or refusing. Beginning at
age 2 to 2.5 years, children often wanted to ride like
older children, using seat belts.
Although all focus group members knew that CSSs
are protective, many did not seem to perceive the
risks of nonuse. Many respondents did not expect to
be in a crash and thought that seat belts were adequate protection for their children. One respondent
did not use the CSS at night, thinking that a police
officer could not see into the car in the dark.
In summary, 6 factors influenced nonuse, namely,
1) lifestyle circumstances, 2) circumstances of particular trips, 3) nonparent or nondriver issues, 4) parenting style, 5) childs behavior, and 6) risks related
to CSS nonuse not being perceived. For these nonusers, the competing factors identified in the focus
groups outweighed the perceived benefits of CSS
use. Nonownership was not a problem.
Study of Effects of Exposure to Violator Class

We recruited 100 violators who received education

and 50 who did not. Eleven interviews were exTABLE 1.

cluded, 2 for which the referent child had not yet

reached the first birthday, 2 for which the child had
passed the fourth birthday, and 7 for which the child
weighed 40 pounds but was 4 years of age. A
total of 91 violators attended the class and 48 did not.
Most members of both groups were female, and
most were Hispanic (Table 1). However, greater proportions of the citation group were female and were
30 years of age. Nearly one-half of the interviews
were conducted in Spanish. Nearly one-half of the
citation group and three-fifths of the citation and
education group had annual household incomes of
less than $30 000. Approximately 80% of respondents
in both the citation group and the citation and education group said that they always used a seat belt.
The mandated fine for violation of the California
CPS law, including court costs, was $271. One hundred eighteen violators reported the amounts of their
fines.
At the time of follow-up assessment, there was
little difference in reported restraint use rates between the groups (Table 2). More than one-half of the
violators in each group reported that they always
used a CSS. An additional 15% of the violators in
each group reported that their children were always
restrained, although sometimes with a seat belt. Approximately one-fourth of the children were reported
to be seldom or sometimes restrained. Only 3 violators admitted that their children were never or rarely
restrained, and none of those violators owned a CSS.
At the time of follow-up assessment, the citation
and education group scored 1 point higher than the
citation group on a knowledge scale composed up of
10 agree/disagree statements (Table 3). More than
90% of each group responded correctly to 4 statements, regarding an adult restraining an infant in
arms, the importance of CSSs for toddlers, the modified California CPS law (effective 2000), and the
necessity of seat belts in cars with airbags. Three
statements received correct responses from 90% of
the subjects and from a greater proportion of the
citation and education group, compared with the
citation group, ie, those addressing the appropriateness of restraining a 10-month-old child weighing 23
pounds in a forward-facing CSS, the legality of restraining a 3-year-old child weighing 45 pounds with
a seat belt, and the protection of children by airbags.
In a linear model of the knowledge score (data not
shown), the citation and education group scored 1
point higher than did the citation group, and none of

Subject Characteristics
No./Responses, %

Female
Age 30 y
Hispanic origin
Spanish language interview
Annual income less than $30 000
Respondent reported always
using seat belt

Citation
Only

Citation and
Education

38/48 (79)
30/48 (62)
38/48 (79)
21/48 (44)
23/48 (48)
40/48 (83)

50/91 (55)
36/91 (40)
82/91 (90)
42/91 (46)
55/89 (62)
69/91 (76)

P (Fishers
Exact Test)

.005
.01
.12
.86
.15
.39

ARTICLES

111

TABLE 2.
ment

Reported Child Restraint Use at Follow-Up AssessNo., %

Always restrained in CSS

Always restrained, sometimes
with a seat belt*
Seldom or sometimes
restrained
Never or rarely restrained

Citation Only
(n 48)

Citation and
Education
(n 91)

30 (62)
7 (15)

51 (56)
12 (13)

8 (17)

28 (31)

3 (6)

0 (0)

P .51, rank sum test.

* Eighteen of 19 reported that the child was nearly always in a
CSS.

the variables shown in Table 1 was related to the

score.
All subjects were asked to have the child and the
vehicle present at the time of the home interview,
and we expected that the CSS would be present if the
child and the vehicle were present. Thirty-five of 48
citation group subjects (73%) and 78 of 91 citation
and education group subjects (86%) had a CSS
present at the time of the interview (P .07) (Table
4). Of the 26 subjects who did not have a CSS present
at the time of the interview, 23 reported that they had
a CSS appropriate for the childs weight. (Most of
those subjects reported that the CSS was in a vehicle
that was not present, and 1 refused an inspection of
the CSS.) Three parents, all in the citation group,
reported that they had no CSS (the same subjects
who reported that their children were always unrestrained) (Table 2).
Among the CSSs that were present, 7 were not
appropriate for the child (Table 4). Three were infant
seats being used for children weighing 20 pounds,
and 4 were damaged or had missing parts. Six subjects did not demonstrate the CSS with the child in
the vehicle; these cases included 3 cases in which the
child was not present, 1 case in which the child
refused, and 2 cases in which the vehicle was not
present. In addition, 6 CSSs were not comparable to
the convertible and combination CSSs used by the
majority of subjects, including 1 infant seat (used by
a 12-month-old child who weighed 20 pounds), 2
belt-positioning boosters used without harnesses,
and 3 shield boosters. Therefore, there were 94 complete demonstrations of convertible and combination
car seats. A logistic model comparing these 94 subjects with the other 45 subjects did not indicate statistical significance (data not shown, P .10).
Table 5 presents the numbers and percentages of
subjects who correctly used the CSS for each of 12
items, among subjects with a full demonstration of
an appropriate convertible or combination CSS. The
citation and education group demonstrated a total
score of 1.0 more correct item, compared with the
citation group. A greater proportion of subjects were
correct regarding 2 specific points of use, ie, using
the appropriate harness slots and adjusting the harness snugly. Corrections during the classroom inspection, rather than education, might have been

112

VIOLATORS OF A CPS LAW

responsible for the higher rate of correct use of harness slots. However, with exclusion of items 1 and 2
(the 2 items corrected during the inspection), the
citation and education group still scored 0.5 points
higher.
Logistic models were used to compare subjects
with both items 1 and 2 correct and subjects with
either item incorrect (Table 6). A second model compared subjects with 8 correct responses on items 3
through 12 and subjects with 8 correct responses
(Table 7). For the 2 items that were corrected in the
classroom inspection, membership in the citation
and education group was strongly associated with a
higher score, and none of the demographic variables
was significantly related to the score. None of the
variables predicted higher scores on the other 10
items.
A linear model of the scores on items 3 through 12
(data not shown) yielded results similar to those of
the logistic model shown in Table 7, except that age
of 30 years was the only significant predictor of
higher scores. No linear model was constructed for
the scores on items 1 and 2 because 58% of the
subjects had scores of 2, the highest possible.
DISCUSSION

Our focus group study of CPS law violators provided information on multiple transportation- and
parenting-related factors that affect CSS use. All except a few of the individuals ticketed for a CSS
violation owned a CSS, and all agreed that a CSS was
protective. However, the CSS was not used at the
time of citation because of unexpected conditions or
factors. The reasons were grouped into the following
categories: lifestyle circumstances, vehicle- or tripspecific circumstances, nonparent drivers, parenting
style, and child behavior on the particular trip. Older
vehicles without functioning seat belt systems required to secure a CSS, smaller vehicles with more
passengers than seating positions, reliance for a ride
on someone who was unable to accommodate the
CSS, and child resistance to use were some issues
detected in our focus group study.
Our study of exposure to a violator class revealed
that CPS knowledge was high among violators of the
CPS law, irrespective of exposure to the class. Those
exposed to the class scored slightly higher on a CSS
knowledge test and in an inspection of CSS use.
Items on the CSS use scale that were corrected by the
CPS technician at the class (hands-on correction)
were correct more frequently among those who attended the class than among those who did not, with
controlling for demographic factors. The most promising part of the class was the hands-on component.
Our study examined exposure to a program and
did not evaluate a specific curriculum designed to
increase knowledge and use of a CSS. It seems that
development, implementation, and evaluation of a
curriculum that addresses transportation barriers
and parenting skills and provides hands-on training
is indicated.
Unlike the mandatory class attended by the violators we studied, current law provides the option for

TABLE 3.

CSS and Car Safety Knowledge

Statement

No. Correct, %

1. A 10-mo-old child weighing 23 lb should

ride facing forward*
2. An adult restrained with a seat belt,
holding a 7-lb infant tightly in arms, can
prevent injury in a 15-mph crash.*
3. If a child is 3 y of age and 45 lb, it is legal
to use a seat belt.*
4. CSSs are as important for toddlers as they
are for infants.
5. For a child 4 y of age and 40 lb, seat
belts provide the best protection.*
6. Infants can be moved to a forward-facing
car seat when they can sit up on their
own.*
7. A CSS, no matter how it is used, will
protect a child in a crash.*
8. California law requires a child 4 y of age
and 40 lbs to be restrained in a CSS even
if the parent is not in the vehicle.
9. Seat belts are not necessary in cars with
airbags.*
10. Passenger-side airbags protect children
12 y of age.*
Total score

Citation Only
(n 48)

Citation and
Education
(n 91)

29 (60)

74 (81)

.01

45 (94)

86 (95)

1.00

22 (46)

82 (90)

.001

47 (98)

88 (97)

1.00

6 (12)

19 (21)

.25

33 (69)

55 (60)

.36

25 (52)

55 (60)

.37

48 (100)

90 (99)

1.00

45 (94)

91 (100)

.04

29 (60)

77 (85)

.003

6.9

7.9

.001

* Correct response is disagree.

TABLE 4.

CSS Present and Demonstrated

No.
CSS Present at Interview
Appropriate
Full Demonstration

Citation and education

Citation only
Total

Convertible or
Combination

Infant or
Booster Seat

64
30
94

6
0
6

low-income parent violators to attend a CPS class in

lieu of a monetary fine. Implementation of this provision is variable. Two issues emerge, ie, violator
classes are not always recommended (at the discretion of the judge) and a violator must take the time to
appear in court. For low-income working parents
who may not be able to take the time off work, this
strategy seems problematic. Referral to violator
classes should be handled administratively, without
requiring a court appearance.
This study did not use a representative sample of
violators but instead used a convenience sample. We
do not know whether those cited for violation of the
CPS law are representative of all violators. We were
unable to recruit the case and control subjects with
the same methods and in the same jurisdictions, and
there were demographic differences between the
groups.
At the follow-up home visits, we relied on reported CSS use and observed direct installation for a

Partial or
Refused
Demonstration
5
1
6

CSS Not Present at

Interview
Not
Appropriate

Reported
to Have
CSS

Reported
No CSS

3
4
7

13
10
23

0
3
3

subsample that met inclusion criteria. We were not

able to observe the actual frequency of use.
A limitation was a sample size decrease from
knowledge testing to CSS inspection, because not all
subjects had the CSS and the car available at the time
of the home visit. In addition, the demonstration
inclusion criteria eliminated some cases (if the CSS
was not a forward-facing model, for example). This
exclusion was performed because the correct use of
different types of CSSs varies and we needed standard measures for correct use. Those who completed
the demonstration may not be representative of the
entire group.
CONCLUSIONS

Our focus group study of CPS law violators revealed that multiple complex factors influence consistent use of a CSS. The interplay of the particular
vehicle, the trip circumstances, and family/parent/

ARTICLES

113

TABLE 5.

Correct CSS Use

Item

No. Correct, %

1. Harness slots used are appropriate for

child.
2. CSS is adjusted to proper angle for
child.
3. Harness straps are correctly positioned
and buckled.
4. Harness is adjusted snugly.
5. Retainer clip is present (if required),
positioned, and threaded correctly.
6. Crotch strap is between legs, close to
body, and not too tight.
7. Vehicle belt is attached to correct part of
CSS.
8. Child faces proper direction.
9. Seat moves 2 in when pushed
vigorously forward and sideways.
10. Straps are threaded and secured per
instructions.
11. Harness adjusts properly.
12. Locking clip is present (if required) and
used correctly, and seat belt is in correct
locking mode (if adjustable).
Total score (correct items)
Score for items 1 and 2
Score for items 312

TABLE 6.
Odds Ratios for Score of 2 for Items 1 and 2, by
Logistic Regression
Variable

Odds
Ratio

95% Confidence
Interval

Citation and education and

citation groups
Female
Age 30 y
Hispanic origin
Spanish language
interview
Annual income less than
$30 000
Respondent always used
seat belt

8.5

2.627.2

2.1
0.7
0.6
0.9

0.76.0
0.32.0
0.12.7
0.32.7

0.4

0.11.1

0.5

0.21.6

P .006 (likelihood-ratio test for model), n 92.

TABLE 7.
Odds Ratios for Score of 8 for Items 3 to 12, by
Logistic Regression
Variable

Odds
Ratio

95% Confidence
Interval

Citation and education and

citation groups
Female
Age 30 years
Hispanic origin
Spanish-language
interview
Annual income less than
$30 000
Respondent always used
seat belt

2.7

0.98.2

0.7
0.4
0.6
1.0

0.21.8
0.21.2
0.12.8
0.32.9

1.6

0.64.3

3.2

1.010.6

P .05 (likelihood-ratio test for model), n 92.

child factors affected CSS use at the time of parent

citation. Addressing transportation issues and parenting skills in CPS programs is necessary. Among
parents ticketed for not restraining their children,
114

VIOLATORS OF A CPS LAW

Citation Only
(n 30)

Citation and
Education
(n 64)

13 (43)

58 (91)

.001

20 (67)

50 (78)

.31

30 (100)

63 (98)

1.00

0 (0)
4 (13)

20 (31)
17 (27)

.001
.19

30 (100)

63 (98)

1.00

30 (100)

61 (95)

.55

29 (97)
7 (23)

63 (98)
16 (25)

.54
1.00

30 (100)

59 (92)

.17

30 (100)
23 (77)

64 (100)
58 (91)

1.00
.11

8.2
1.1
7.1

9.2
1.7
7.6

.001
.001
.04

exposure to a violator class demonstrated some benefit, compared with a fine alone. Correct CSS use
improved most on items corrected by the instructor.
Violator classes that include hands-on training show
promise for improving rates of correct CSS use.
ACKNOWLEDGMENTS
This study was supported by grant R49/CCR 915456-01 from
the Centers for Disease Control and Prevention, National Center
for Injury Prevention and Control. Its contents are solely the
responsibility of the authors and do not necessarily represent the
official views of the National Center for Injury Prevention and
Control.
We thank Liz Perez, our research assistant, for conducting the
surveys and interviews and Cheryl Kim for providing access to
the violator classes.

REFERENCES
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FANTASY AND REALITY ABOUT SUVs

[When buying a car] theres this notion that you need to be high. Thats a
contradiction, because people who buy these SUVs know that if you are high there
is more chance of a rollover. But at a [subcortical] level they think, If Im bigger
and taller, Im safer. . . . [T]hats the puzzle of what has happened to the automobile world: feeling safe has become more important than actually being safe.

Gladwell M. Big and bad. New Yorker. January 12, 2004

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