Form NHTSA Form 1174 NHTSA Form 1174 Child Passenger Safety Survey

OMB Control No. 2127-xxxx

Expiration date xx/xx/xxxx

Child Passenger Safety Survey

This collection of information is VOLUNTARY and will be used for formative purposes only so that we may develop and evaluate programs designed to reduce the number of traffic-related injuries and deaths. We will not collect any personal information that would allow anyone to identify you. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-xxxx. Public reporting for this collection of information is estimated to be approximately 75 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Instructions: Please choose the best answer for each item. Answer as best as you can even if you are not sure.

SECTION I: Restraint Selection Scenarios

Each of the following questions presents a child safety scenario. Please choose the best answer that you think will keep the child as safe as possible.

1. One of your friends calls you to ask when their baby should be moved from a rear-facing car seat to a forward-facing car seat. When should you tell your friend to move their baby to a forward-facing car seat? When the child’s legs are beginning to look “crowded” (i.e., folding at knees) 1 year old and at least 20 pounds W hen the child is 18 months old A child should remain rear-facing as long as possible to the weight or height limits for the seat, even up to 2 years old.
2 . Your cousin thinks it is time to move their child into a booster seat and asks you when it is safe to do this. When should you tell your cousin it is safe to move their child from a forward-facing car seat with harnesses to a booster seat? 2 years old 3 years old 4 years old 5 years old 6 years old At 30 pounds Once the child’s feet can touch the floorboard Once the child has reached the top height/weight limits for the harnesses
3. Your child is asking you when he/she can just use a seat belt when riding in vehicles. When can your child safely use a seat belt only? 5 years old 6 years old 8 years old 10 years old 12 years old At 80 pounds Once he/she is 4 feet tall O nce he/she is in the third grade Once the seat belt fits properly in every way appropriate
4. Your child is 1 year old. She weighs 21 pounds and is 29 inches tall. Based on current safety recommendations, which seat would be most appropriate for her? Rear-facing car seat with harnesses Forward-facing car seat with harnesses Booster seat Seat belt in the back seat Seat belt in the front seat Either a or b
5. Your child is 11 years old. He weighs 85 pounds and is 4 feet 10 inches (58 inches) tall. Based on current safety recommendations, which seat would be most appropriate for him? Rear-facing car seat with harnesses Forward-facing car seat with harnesses Booster seat Seat belt in the back seat Seat belt in the front seat Either d or e
6. Your child is 19 months old. He weighs 26 pounds and is 27 inches tall. Based on current safety recommendations, which seat (assuming he is within the weight and height limits for the seat) would be most appropriate for him? Rear-facing car seat with harnesses Forward-facing car seat with harnesses Booster seat Seat belt in the back seat Seat belt in the front seat Either b or c
7. Your child is 4 years old. She weighs 36 pounds and is 3 feet (36 inches) tall. Based on current safety recommendations, which seat would be most appropriate for her? Rear-facing car seat with harnesses Forward-facing car seat with harnesses Booster seat Seat belt in the back seat Seat belt in the front seat Either b or c
8. Your child is 9 years old. He weighs 63 pounds and is 4 feet 3 inches (51 inches) tall. Based on current safety recommendations, which seat would be most appropriate for him? Rear-facing car seat with harnesses Forward-facing car seat with harnesses Booster seat Seat belt in the back seat Seat belt in the front seat Either d or e
	SECTION II: Knowledge Survey The following items test your knowledge of safety restraints. Please indicate the extent you agree or disagree with each statement.		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		The seat belt’s primary purpose is to prevent being thrown from the vehicle.	1	2	3	4	5
		Seat belts are not enough to protect 7 year old children in crashes.	1	2	3	4	5
		It is safe for an 11 year old to ride in the front seat.	1	2	3	4	5
		A child should remain in a booster seat until the vehicle seat belt fits properly, or until the child is 4 feet 9 inches tall.	1	2	3	4	5
		The purpose of a booster seat is to position a seat belt properly on a child.	1	2	3	4	5
		Booster seats are recommended for many children older than 8 year-olds.	1	2	3	4	5
		The seat belt provides the same basic protection as a booster seat.	1	2	3	4	5
		Seat belts are made to fit adults only.	1	2	3	4	5
		Because of frontal airbags, children age 10 or older are better protected in the front seat than the back seat of vehicles.	1	2	3	4	5
		A child is safer in the back seat.	1	2	3	4	5
		A 14-month-old child is too big for a rear-facing safety seat.	1	2	3	4	5
		A child should be in a rear-facing safety seat until the maximum height and weight limits of the safety seat.	1	2	3	4	5
		A rear-facing seat helps keep a child’s body aligned in a crash.	1	2	3	4	5
		A forward-facing car seat with a harness provides the same basic protection as a booster seat.	1	2	3	4	5
		A forward-facing car seat with a harness should be used up to maximum height and weight limits for the harness.	1	2	3	4	5

	SECTION III: Threat and Efficacy Perceptions Please indicate the extent you agree or disagree with each statement. **NOTE: Restraint = Use of a child safety seat, booster seat or safety belt		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		I believe that using poorly fitted child restraint/safety belts has serious negative consequences.	1	2	3	4	5
		If improperly restrained, it is likely that my child will get hurt in a car crash.	1	2	3	4	5
		If I use the correct restraint for my child’s size, my child is less likely to get injured in a car crash.	1	2	3	4	5
		I can easily use the right restraint for my child to prevent injury in a car crash.	1	2	3	4	5
		I believe using a restraint that isn’t recommended for my child’s size is extremely harmful.	1	2	3	4	5
		I believe it is severely risky for a child to be transitioned to a seat belt before the belt fits them correctly.	1	2	3	4	5
		It is possible that my child will get an injury due to improper restraint in a car crash.	1	2	3	4	5
		I believe that allowing a child to ride in the front seat earlier than age 13 is extremely harmful.	1	2	3	4	5
		I have the skills and knowledge needed to use the correct restraint to reduce my child’s chances of injury in a car crash.	1	2	3	4	5
		I believe that turning a child seat forward earlier than age 2 has serious negative consequences.	1	2	3	4	5
		I am able to use the recommended restraint for my child to prevent him/her from getting injured in a car crash.	1	2	3	4	5
		I believe using child restraints/safety belts that are too big or too small for my child is dangerous.	1	2	3	4	5
		If not appropriately restrained, my child is at risk for getting unnecessarily injured in a car crash.	1	2	3	4	5
		Properly fitted child restraints/safety belts work to prevent unnecessary injury in a car crash.	1	2	3	4	5
		I believe that using a booster seat for a child that should still be in a harnessed seat has serious negative consequences.	1	2	3	4	5
		Using a properly fitted child restraint/safety belt is effective in preventing injury in a car crash.	1	2	3	4	5

	SECTION IV: Attitudes We would like to know your honest opinions about certain safety trends. Please indicate the extent you agree or disagree with each statement.		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		I find it unnecessary to make a 10-year-old child ride in the back seat when nobody is in the front passenger seat.	1	2	3	4	5
		Booster seats are an important step between car seats and safety belts.	1	2	3	4	5
		For most 3 –year-olds, I think a booster seat is just as safe as a safety seat with harnesses.	1	2	3	4	5
		I find booster seats to be unnecessary after a child is 8-years-old.	1	2	3	4	5
		It is important to always buckle up kids even if you’re just going around the corner.	1	2	3	4	5
		I think that keeping kids rear-facing until age 2 is a good idea.	1	2	3	4	5
		Rear-facing a child past the first birthday seems harmful because there is not enough room for their legs.	1	2	3	4	5
		As long as my child is buckled in some way, I don’t believe the restraint type or how it is installed really matters that much.	1	2	3	4	5

	SECTION V: Stated Intentions We would like to know your honest answers about what you would do in these situations. Please indicate the extent you agree or disagree with each statement.		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		I will purchase whatever type of seat needed for my child.	1	2	3	4	5
		I will require that my child rides in the back seat until age 13.	1	2	3	4	5
		I will follow the current child passenger safety recommendations.	1	2	3	4	5
		I will seek additional information to make sure my kids are restrained properly.	1	2	3	4	5
		I will make sure my child uses the recommended restraint every time they are in the car.	1	2	3	4	5
		If my child were an infant today, I would probably keep him/her in a rear-facing seat until the upper weight and height limits for the seat are reached (even up to age 2).	1	2	3	4	5
		If my child were a toddler today, I would probably keep him/her in a harnessed seat until they have reached the maximum weight and height limits of the seat.	1	2	3	4	5
		If my child were in first grade today, I would probably keep him/her in a booster seat until 4 feet 9 inches tall.	1	2	3	4	5
I		If my child were a fifth grader today, I would probably make him/her ride in the back seat until age 13.	1	2	3	4	5

	SECTION VI: Installation Questions (THIS SECTION USED FOR STUDY 2 ONLY) The following items ask about installation and use of safety restraints. Please indicate the extent you agree or disagree with each statement.		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		A rear-facing safety seat should be at a 75 degree angle when installing into a vehicle.	1	2	3	4	5
		A LATCH system and seat belt should be used together when installing infant and toddler safety seats.	1	2	3	4	5
		Harness straps should be threaded through the seat above the shoulders when using a forward-facing car seat.	1	2	3	4	5
		When using infant and toddler safety seats, the harness chest clip should be fastened at armpit level.	1	2	3	4	5
		When installing infant and toddler seats tightly in a vehicle, seat movement should be restricted to 2 inches of movement.	1	2	3	4	5
		For kids in boosters and seat belts, lap-only seat belts are safe for use.	1	2	3	4	5
		Top tether straps can be used with the seat belt or lower anchors to reduce forward movement in a crash.	1	2	3	4	5
		Harness straps should be fastened loosely for comfort.	1	2	3	4	5

SECTION VII: Judgments of Relevance and Acceptability (THIS SECTION USED FOR POST-TEST ONLY)

We would like your assessment of the car safety materials that were presented to you today. Please answer the following questions as completely, carefully and candidly as possible.

9. How would you rate the overall quality of the materials that were presented to you today?

4 Excellent

3 Good

2 Fair

1 Poor

9. How would you rate the clarity of the materials that were presented to you today?

4 Excellent

3 Good

2 Fair

1 Poor

9. Was the information presented in an organized and coherent manner?

4 Yes, definitely

3 Somewhat

2 Not entirely

1 No, not at all

9. Were the materials interesting to you?

4 Very Interesting

3 Interesting

2 Not very interesting

1 Not interesting at all

9. Were the materials relevant to your needs?

4 Very relevant

3 Somewhat relevant

2 Not very relevant

1 No, not at all relevant

9. How much did you learn from the materials?

4 A great deal

3 Gained some knowledge

2 Gained little knowledge

1 Nothing

9. How useful would you say the materials will be to you in the future?

4 Extremely Useful

3 Somewhat useful

2 Not very useful

1 Not at all useful

9. How likely will the materials you received cause a change in your behavior?

4 Extremely Likely

3 Likely

2 Not very likely

1 Not at all likely

9. Was the amount of information given today appropriate for you?

4 Yes, definitely

3 Somewhat

2 Not very much

1 No, not at all

9. Comments/suggestions about the materials: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SECTION VIII: Demographic Questionnaire (THIS SECTION USED FOR POST-TEST ONLY)

The following questions allow us to describe (as a group) the population that completed our study. We appreciate your providing us this information.

9. What is your gender?

   1. Male

   2. Female

9. Are you of Hispanic, Latino or Spanish origin?

   1. Yes

   2. No

9. What is your race? Please select one or more.

   1. American Indian or Alaska Native

   2. Asian

   3. Black or African American

   4. Native Hawaiian or Other Pacific Islander

   5. White

78. How old are you? ________

78. How many children do you have?

    1. 0

    2. 1

    3. 2

    4. 3

    5. 4

    6. 5

    7. 6+

78. For those children under 13, please specify for your three youngest children:

Child 1 Child 2 Child 3

a. Age of each child: 0-12 mos 0-12 mos 0-12 mos

1-3 yrs 1-3 yrs 1-3 yrs

4-7 yrs 4-7 yrs 4-7 yrs

8-12 yrs 8-12 yrs 8-12 yrs

Child 1 Child 2 Child 3

b. Estimated weight of each child: ______ lbs. ______ lbs. ______ lbs.

c. Estimated height of each child: ______ in. ______ in. ______ in.

Child 1 Child 2 Child 3

d. Current safety restraint used: Rear Facing Car Seat Rear Facing Car Seat Rear Facing Car Seat

Forward Fac. Car Seat Forward Fac. Car seat Forward Fac. Car Seat

Booster seat Booster seat Booster seat

Seat belt Seat belt Seat belt

78. What is your annual family income?

    1. $0-$15,999

    2. $16,000 - $24,999

    3. $25,000 - $49,999

    4. $50,000 - $99,999

    5. $100,000+

    6. Decline to answer

78. What is your highest level of education?

    1. Grade school

    2. Some high school

    3. High school diploma/GED

    4. Some college

    5. 2-year degree/trade school

    6. Bachelor’s degree

    7. Graduate degree
       
       

79. In the last 30 days, how often have you used a seat belt?

    1. Always

    2. Fairly often

    3. Not very often

    4. Never

78. What do you think is the most effective method to distribute information about child safety seats/restraints? (Check up to 2 preferences)

1. Television

2. Internet

3. Smartphone/Tablet application

4. Email

5. Radio

6. Postal mail

7. Brochures/flyers

8. Billboards

9. Consumer reviews

10. Other:____________________________________

78. Who or where do you go to for your information about child safety seats/restraints? (Check all that apply)

1. My child’s school

2. Doctor’s office

3. Friends

4. Family

5. Public Health Department

6. Website

7. Fire station

8. Police station

9. Store where purchased seat

10. Other: ______________________________________________

11. None of the above

78. Have you ever had a child seat/restraint inspected by a Child Passenger Safety technician for correct installation (e.g., at a fire station, police station, seat-check event)?

    1. Yes

    2. No

NHTSA Form 1174