Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. e85-e91 (doi:10.1542/peds.2005-2211)
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Development of a Child Safety Seat Hassles Scale in a Largely Low-Income Latino Population

Phyllis F. Agran, MD, MPH, Craig Anderson, PhD, DrSc and Diane G. Winn, RN, MPH

Department of Emergency Medicine, Center for Trauma and Injury Prevention Research, University of California Irvine, Orange, California

OBJECTIVE. High rates of use of child safety seats have been achieved. A remaining challenge in child passenger safety is to reach the Healthy People 2010 objective of child safety seat use to 100%. Several factors have been reported to influence child safety seat use. A child safety seat Hassles Scale was developed to explore hassles that are associated with child safety seat nonuse.

METHODS. Focus groups with violators of the California Child Passenger Safety Law provided data to construct the 29-item Hassles Scale. The scale was used in an interview that was conducted with 132 parents who were cited for violation of the law and whose children were 12 to 47 months of age and weighed 20 to 40 pounds. Interviews were conducted 3 months after parents paid the fine for the citation. Each hassle was rated 0 to 3 on frequency and intensity. Parent report of child safety seat use was obtained. Factor analysis was used to construct subscales. Relationship of subscale frequency and intensity scores to reported child safety seat use was assessed with linear regression.

RESULTS. The sample was 86% Latino, 45% Spanish-speaking, and 55% with income <$30000. Thirty-one percent of the parents reported that the child did not now always use a child safety seat. Four subscales were identified: child, crowding/inconvenience, busy, and vehicle. Only the frequency of the child subscale items (eg, resists, gets out of seat) and the frequency and the intensity of the crowding/inconvenience subscale items (eg, child safety seat takes up too much room, too many passengers) were related to child safety seat nonuse. Sixty-nine percent agreement with parent report of child safety seat use was achieved using only the frequency scores for the 9 items in the 2 subscales child and crowding/inconvenience, compared with 65% for the 29-item scale.

CONCLUSIONS. In this low-income largely Latino population of violators, self-report of "always using a child safety seat" when transporting their child was low (59%). Child safety seat nonuse was related to hassles that are associated with child behaviors and vehicle crowding/inconvenience. The child safety seat Hassles Scale documented barriers and difficulties with the use of a child safety seat in a high-risk population for nonuse. These concepts can be explored by clinicians and others who work to increase consistent child safety seat use. Additional evaluation and development of the instrument requires validation for its use as a screening or educational tool.

Key Words: child safety seats • hassles associated with child safety seats • child passenger safety violators

Abbreviations: CSS—child safety seat • CPS Law—Child Passenger Safety Law

Accepted Feb 13, 2006.