7.2 Inspection Stations

The misuse of child restraints has been a concern for many years. Some programs have been implemented to provide parents and other caregivers with “hands-on” assistance and education about the proper installation and use of child restraints in an effort to combat widespread misuse. CPS inspection stations, sometimes called “fitting stations,” are places or events where parents and caregivers can receive this assistance from certified CPS technicians. Certification courses for child safety seat checks are available through the National Child Passenger Safety Certification Program (http://cert.safekids.org).

Inspection stations in urban communities may be effective in reaching households that improperly use child restraints. One study conducted in Los Angeles that reached out to parents and caregivers using advertisements found that vehicles visiting the inspection stations had a rate of child restraint misuse of 96.2% (Bachman et al., 2016). Examples of misuse included inappropriate use of the top tether, older children prematurely restrained in front seats, and seat belts routed incorrectly. While this rate was substantially higher than the 46% misuse rate observed in the nationally representative NCRUSS sample (Greenwell, 2015), some of this difference likely reflects a broader definition of misuse in the Los Angeles study as the determination of misuse was based on American Academy of Pediatrics (AAP) best practice recommendations. It is also possible that the households targeted in this community study had particularly high misuse rates. The Los Angeles inspection station study found that factors such as child age, child weight, and vehicle year led to systematic instances of child restraint misuse and should be considered when conducting inspections and addressing deficiencies in restraint use (Bachman et al., 2016).

Use: Child restraint inspection stations have become common components of State and local child passenger safety programs. As of 2018 more than 10,000 inspection stations were registered with NHTSA (see www.nhtsa.gov/equipment/car-seats-and-booster-seats#installation-help-inspection for locations).

Effectiveness: One study found that child restraint inspection events sponsored by Safe Kids Worldwide held at car dealerships, hospitals, retail outlets and other community locations positively changed parents’ behavior and increased their knowledge over a 6-week follow-up period. Children arriving at the second event were restrained more safely and more appropriately than they were at the first (Dukehart et al., 2007). Another small study found that attending inspection stations may be more effective for increasing restraint use in children older than 4 (Kroeker et al., 2015). Specifically, children in this age range were more likely to depart the inspection in a restraint configuration that was more appropriate for their size and weight than prior to the inspection. Inspection stations were included in a multifaceted program to increase child restraint use in five tribal communities. At inspection stations, child restraint seats were checked, replaced, and re-installed if needed, and new seats were provided to caregivers that did not have them. Although the specific contribution of the inspection stations was not assessed, the full program resulted in four of the five tribes exceeding their overall restraint-use goals—some by a substantial margin.

Another study evaluated whether a “hands-on” educational intervention makes a difference in whether or not parents correctly use their child restraints. All study participants received a free child restraint and education, but the experimental group also received a hands-on demonstration of correct installation and use of the child restraint in their own vehicles. Parents who received this demonstration were also required to demonstrate in return that they could correctly install the restraint. Follow-up observations found that the intervention group was four times more likely to correctly use their child restraints than was the control group (Tessier, 2010).

An evaluation of the child restraint fitting station network in New South Wales, Australia, found that children whose parents attended a fitting station were significantly more likely to be properly restrained than children whose parents had not visited a fitting station. While specific to Australia, these results suggest similar benefits are possible in the United States (Brown et al., 2011).

Costs: Program costs will depend on the size of the target audience, the components of the program, and the level of services offered. Since permanent inspection stations listed on NHTSA’s locator must have a currently certified child passenger safety technician on site during the posted hours, costs for maintaining the service includes personnel costs as well as operational expenses.

Time to implement: Complete programs typically require several months to plan and implement.

Other issues:

• Programs to make child restraints available at low cost: One of the issues identified when child passenger safety laws were being considered was the costs associated with obtaining child restraints. Because of this, many State and local organizations initiated programs to make child restraints available at low or no cost to parents through child restraint loan or rental programs (Zaza et al., 2001). Since then, the popularity of these programs has decreased significantly as child restraints have become more readily available and funding for such programs scarce. A recent study by CDC, however, found that child safety seat distributions—in combination with other evidence-based practices—may have contributed to significant increases in proper child restraint use in five American Indian/Alaskan Native tribal communities (Billie et al., 2016; West & Naumann, 2014). From 2010 to 2014 all five communities conducted distribution of child safety seats along with educational programs and enhanced enforcement practices. All communities reported increases in observed use of child safety seats (ranging from 6% to 40%) with four communities exceeding their initial goals. A meta-analysis of five studies (four from the United States conducted from 2000 to 2005 and one from Australia conducted in 1987) assessed the effectiveness of interventions in increasing the use of booster seats for children between 4 and 8 years old (Ehiri et al., 2006). Offering incentives such as free booster seats or discount coupons combined with education on the risk of using adult seat belts instead of booster seats, as well as education-only interventions, were all found effective in increasing use when compared to no interventions. An Australian study (Bowman et al., 1987) found no evidence of increased use in booster seats due to law enforcement practices. Zaza et al. (2001) conducted a systematic review of evidence of effectiveness for five interventions, including child restraint distribution programs. Evidence suggests child restraint distribution coupled with education can be effective. However, the studies evaluated were mostly from the 1980s when child passenger safety laws were first being passed and the availability and costs of child restraints were much different. Louis and Lewis (1997) conducted a project to increase child restraint use in low-income minority families. Families in the program were divided into two study groups with both groups receiving free child restraints. One group also received education regarding child restraint use. The results of the study reported that distributing child restraints resulted in increased long-term use among a low-use population.
• Availability of CPS Technicians: The overall availability of CPS technicians throughout a State is a consideration in this countermeasure. A study conducted in Michigan compared where CPS technicians lived and worked to where the greatest needs existed, as defined by at-risk children under 9 (Macy et al., 2016). In general, there was a reasonable match between where the CPS technicians were located and where the most at-risk children resided. In most counties, the estimated distance that families traveled from home to the nearest seat check location was less than 10 miles. However, there were still many counties that had too few technicians to adequately meet local needs. Training new CPS technicians at underserved locations may be an important part of maintaining the effectiveness of this countermeasure. Digital access to CPS technicians is a potential solution. A small study in Florida provided parents with phone apps to interact directly with CPS technicians located elsewhere, to receive help installing child seats (Schwebel et al., 2017). The results reported that the accuracy of installations improved significantly compared to the installation prior to the instruction, and that parents felt more confident about the installation.

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