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Purpose Between 2007 and 2012 there have been several recommendations that infants and toddlers ride in a car safety seat (CSS) rear facing until 2 years of age. This study reports the effect of these recommendations on the observed direction of travel for infants and toddlers transported in motor vehicles between 2007 and 2012. Methods This is an observational, cross-sectional survey of drivers transporting children collected at 25 convenience locations selected in Indiana during summer 2007 through 2012. Observations were conducted by Certified Child Passenger Safety Technicians. As drivers completed a written survey, the Certified Child Passenger Safety Technician recorded the vehicle seating location, type of restraint, CSS direction and use of the CSS harness or safety belt as appropriate, and demographic data. The infant and toddler9s age and weight were collected. Data from 2007 through 2012 for ages birth through 23 months were compared in order to determine if recommendations impacted observed direction of travel. Results During the study period, the percent of infants and toddlers (birth through 23 months) observed rear facing in a motor vehicle varied from 44.2% (2007) to 59.1% (2012). For infants (birth through 11 months) observed rear facing, it was 85.1% (2009) to 91.6% (2012). The percent of toddlers (12 months through 23 months) observed rear facing ranged from 3.3% (2008) to 18.2% (2012). Conclusions During the study period, the proportion of toddlers rear facing increased approximately 15% (p=0.03). Counselling by primary care providers should continue and be strengthened to increase parent and caregiver awareness of the latest child passenger safety recommendations.

Background Motor vehicle crashes (MVCs) are the leading cause of death among teenagers. Little is known about the content of US paediatrician counselling about teen driving. Objective To examine US paediatrician knowledge, attitudes, and counselling patterns regarding teen driving. Methods A random sample questionnaire was mailed to American Academy of Pediatrics members in 2009 (n=1606; response=875 (55%)). Analysis was limited to 596 paediatricians who provide adolescent checkups. Questions addressed counselling and attitudes towards roles in promoting safe driving. Logistic regression assessed the relationship between counselling topics and practice characteristics. Results Most (89%) respondents provide some counselling about driving. Two topics commonly discussed by paediatricians were seatbelts (87%) and alcohol use (82%). Less frequently discussed were: cell phones (47%), speeding (43%), and dangers of transporting teen passengers (41%). Topics rarely discussed were: night driving (21%), graduated driver licensing laws (13%), safe cars (9%), driver education (9%), fatigue (25%), and parental limit setting (23%). Only 10% ever recommend a parent–teen driver agreement. Paediatricians who had a patient injured or killed in an MVC were more likely to discuss night driving (OR=2.86). Physicians caring for a high proportion of adolescents (OR=1.83) or patients with private insurance (OR=1.85) counsel more about the risks of driving with teen passengers. Conclusions Paediatricians in the USA support counselling on teen driving during routine office visits, but omit many important risk factors. Few recommend parent–teen driver agreements. Methods that help clinicians efficiently and effectively counsel families about teen driving should be developed.

Background Crashes among US novice young drivers remain too high. Addressing this problem, one effective program for parents is Checkpoints, which raises parents’ awareness of risks to their young drivers and offers ways to reduce those risks. But its most effective approach was in driver education classrooms and not widely available. A federally-funded study adapted Checkpoints to a website that could be promoted in several ways. This study promoted the Checkpoints website in brief interventions by Primary Care Practitioners (PCPs), and examined dissemination to/implementation by parents. Methods The website, youngdriverparenting.org (with an interactive parent-teen driving agreement, PTDA) , and brief intervention protocol were developed in collaboration with leadership of Paediatric Research in Office Settings at the American Academy of Paediatrics. PCPs delivered interventions and materials to parents, referred them to the website, and completed follow-up surveys. Google Analytics was used to assess parents’ website use. Results Focus groups of parents/teens determined the website adaptation successful. Most of the 133 PCPs from 16 states reported delivering interventions with fidelity, and thought the program important and feasible. Brief interventions/website referrals, averaging 4.4 minutes, were delivered to 3,465 (87%) of 3,990 eligible parents over an 18-week average in 2012–2013. Website visits (1,453) were made by 42% of parents exposed to the intervention, who spent on average 3.53 minutes viewing an average of 4.2 pages. The PTDA was viewed by 24%, and 10% registered for an interactive PTDA. Conclusions Translation of an evidence-based parent program to a PCP-promoted website was demonstrated. Delivering the brief intervention/website referral was feasible and acceptable to PCPs. This program costs little (its website, training and promotional materials are available) and could be one component of a comprehensive approach to reducing young driver crashes.