The study, released today (Tuesday, Sept. 24) by the campus's Traffic Safety Center, was conducted to collect baseline data on child safety seat use as part of a larger child passenger safety initiative at California's public hospitals and health care systems.

Researchers surveyed 515 adults who were leaving a public hospital or clinic in California for the first time with a new baby, or who were coming to the hospital or clinic for routine pediatric exams for children ages six and under. They then accompanied the adults to the cars to observe how they secured the children in child safety seats. In all, researchers observed 463 children from October 2001 to June 2002.

Among their findings:

* Fourteen percent of children observed were not secured at all in a child safety seat.

* Eighty-four percent of adults surveyed reported knowledge of a new state law (SB 567) that took effect Jan. 1, 2002, that specifies the use of booster seats for children ages four to six, or who weigh 40-60 pounds. However, only 54 percent reported using booster seats consistently.

* Even when children were secured in a car safety or booster seat appropriate for their age and weight, there were other significant errors in how the children were restrained.

* Errors in properly restraining children include not positioning the harness clip at the child's armpit level (62 percent), not securing the safety seat tightly enough to the vehicle by the safety belt (69 percent) and not fastening the harness strap tightly enough (60 percent).

The percentage of children using a child safety seat in this study is in line with results from statewide surveys. The rate of child safety seat misuse in the study also closely mirrors national statistics, which show that four out of five child safety seats are used incorrectly.

"It is clear from this survey that there is more need for training and resources for helping people keep children safe as passengers," said David Ragland, adjunct professor of epidemiology at UC Berkeley's School of Public Health, director of UC Berkeley's Traffic Safety Center and co-author of the report. "Parents and caregivers are having a hard time figuring out how to correctly use child safety seats. This report shows where the gaps in knowledge are."

Researchers presented the results of the report on Sept. 24 at the California Conference on Childhood Injury Control in Sacramento.

The UC Berkeley report is part of a two-year, $1.5 million Child Passenger Safety Initiative launched in 2001 and funded by the California Office of Traffic Safety through the state's Business, Transportation and Housing Agency. The California Health Care Safety Net Institute, affiliated with the California Association of Public Hospitals and Health Systems (CAPH), heads the initiative in collaboration with the UC Davis Medical Center.

Through the program, seven public hospitals and health systems in California are establishing child passenger safety education efforts that specifically address the needs of underserved populations.

"Prior studies have shown that the majority of patients in public hospitals have certain barriers to using child safety seats properly," said Jill Cooper, program manager of UC Berkeley's Traffic Safety Center and lead author of the report. "Child safety seats can be expensive, especially for low-income people. People who don't speak English may also face barriers in gaining access to information about proper use of child safety seats."

According to figures from CAPH, 76 percent of the patients in the state's public hospitals are people of color, and 70 percent are low-income or uninsured.

"Patients treated at public hospitals are primarily low-income people of color," said Wendy Jameson, director of the California Health Care Safety Net Institute and co-author of the report. "Traditionally, low-income, culturally-diverse families have been left behind the child injury prevention movement in California. We felt that the health care system would be a natural vehicle to reach populations who may otherwise not have opportunities to learn about child passenger safety."

The report was also co-authored by Kara MacLeod, research associate at UC Berkeley's Traffic Safety Center.

The seven hospitals participating in the initiative are the Contra Costa Regional Medical Center in Martinez; Monterey County Health Department/Natividad Medical Center in Salinas; San Joaquin General Hospital in French Camp; UC San Diego Medical Center in San Diego; Olive View-UCLA Medical Center in Sylmar; LAC/USC Medical Center in Los Angeles and Martin Luther King, Jr./Drew Medical Center in Los Angeles.

Four hospitals - located in Contra Costa, Monterey, San Joaquin and Los Angeles counties - participated in the baseline study.

The initiative to improve child passenger safety includes parent education, training programs for pediatric health care providers to counsel parents and caregivers about child passenger safety, distributing free or low-cost car seats to low-income families, and providing car seat check-ups to parents.

In 1999, as many as 3,000 children who had been injured in motor vehicle collisions were treated at California's public hospitals. Statewide in 2000, 7,473 passengers ages six and under were injured, and 75 child passengers died from motor vehicle crashes and collisions. More than half of the children who died were not restrained.

Most new cars sold in the United States are now equipped with a restraint system that makes it easier for parents to properly install child safety seats. The system, known as LATCH for Lower Anchors and Tethers for Children, was designed and tested by the National Highway Traffic Safety Administration. As of Sept. 1, new child safety seats, with the exception of booster seats, have to be compatible with the LATCH system.

"Technological advances in automobile and safety seat engineering to reduce safety seat misuse are sorely needed," said Jameson. "However, low-income families may not be able to afford new cars and safety seats, so the need continues for additional education about keeping children safe in cars."