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Flaura Koplin Winston - One of the best experts on this subject based on the ideXlab platform.
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are mhealth interventions to improve Child Restraint System installation of value a mixed methods study of parents
International Journal of Environmental Research and Public Health, 2017Co-Authors: Linda Fleisher, Danielle Erkoboni, Katherine Halkyard, Emily Sykes, Marisol S Norris, Lorrie Walker, Flaura Koplin WinstonAbstract:Childhood death from vehicle crashes and the delivery of information about proper Child Restraint Systems (CRS) use continues to be a critical public health issue. Safe Seat, a sequential, mixed-methods study identified gaps in parental knowledge about and perceived challenges in the use of appropriate CRS and insights into the preferences of various technological approaches to deliver CRS education. Focus groups (eight groups with 21 participants) and a quantitative national survey (N = 1251) using MTurk were conducted. Although there were differences in the age, racial/ethnic background, and educational level between the focus group participants and the national sample, there was a great deal of consistency in the need for more timely and personalized information about CRS. The majority of parents did not utilize car seat check professionals although they expressed interest in and lack of knowledge about how to access these resources. Although there was some interest in an app that would be personalized and able to push just-in-time content (e.g., new guidelines, location and times of car seat checks), content that has sporadic relevance (e.g., initial installation) seemed more appropriate for a website. Stakeholder input is critical to guide the development and delivery of acceptable and useful Child safety education.
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medicaid based Child Restraint System disbursement and education and the vaccines for Children program comparative cost effectiveness
Ambulatory Pediatrics, 2008Co-Authors: Jesse A Goldstein, Michael J Kallan, Flaura Koplin Winston, Charles C Branas, Sanford J SchwartzAbstract:Objective Low-income Children are disproportionately at risk for preventable motor-vehicle injury. Many of these Children are covered by Medicaid programs placing substantial economic burden on states. Child Restraint Systems (CRSs) have demonstrated efficacy in preventing death and injury among Children in crashes but remain underutilized because of poor access and education. The objective of this study was to evaluate the cost-effectiveness of Medicaid-based reimbursement for CRS disbursement and education for low-income Children and compare it with vaccinations covered under the Vaccines For Children (VFC) program. Methods A cost-effectiveness analysis was performed of Medicaid reimbursement for CRS disbursement/education for low-income Children based on data from public and private databases. Primary outcomes measured include cost per life-year saved, death, serious injury, and minor injury averted, as well as medical, parental work loss, and future productivity loss costs averted. Cost-effectiveness calculations were compared with published cost-effectiveness data for vaccinations covered under the VFC program. Results The adoption of a CRS disbursement/education program could prevent up to 2 deaths, 12 serious injuries, and 51 minor injuries per 100 000 low-income Children annually. When fully implemented, the program could save Medicaid over $1 million per 100 000 Children in direct medical costs while costing $13 per Child per year after all 8 years of benefit. From the perspective of Medicaid, the program would cost $17 000 per life-year saved, $60 000 per serious injury prevented, and $560 000 per death averted. The program would be cost saving from a societal perspective. These data are similar to published vaccination cost-effectiveness data. Conclusion Implementation of a Medicaid-funded CRS disbursement/education program was comparable in cost-effectiveness with federal vaccination programs targeted toward similar populations and represents an important potential strategy for addressing injury disparities among low-income Children.
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effectiveness of Child safety seats vs seat belts in reducing risk for death in Children in passenger vehicle crashes
JAMA Pediatrics, 2006Co-Authors: Michael R Elliott, Michael J Kallan, Dennis R Durbin, Flaura Koplin WinstonAbstract:Objective To provide an estimate of benefit, if any, of Child Restraint Systems over seat belts alone for Children aged from 2 through 6 years. Design Cohort study. Setting A sample of Children in US passenger vehicle crashes was obtained from the National Highway Transportation Safety Administration by combining cases involving a fatality from the US Department of Transportation Fatality Analysis Reporting System with a probability sample of cases without a fatality from the National Automotive Sampling System. Participants Children in two-way crashes occurring between 1998 and 2003. Main Exposure Use of Child Restraint Systems (rear-facing and forward-facing car seats, and shield and belt-positioning booster seats) vs seat belts. Potentially confounding variables included seating position, vehicle type, model year, driver and passenger ages, and driver survival status. Main Outcomes Measure Death of Child passengers from injuries incurred during the crash. Results Compared with seat belts, Child Restraints, when not seriously misused (eg, unattached Restraint, Child Restraint System harness not used, 2 Children restrained with 1 seat belt) were associated with a 28% reduction in risk for death (relative risk, 0.72; 95% confidence interval, 0.54-0.97) in Children aged 2 through 6 years after adjusting for seating position, vehicle type, model year, driver and passenger ages, and driver survival status. When including cases of serious misuse, the effectiveness estimate was slightly lower (21%) (relative risk, 0.79; 95% confidence interval, 0.59-1.05). Conclusion Based on these findings as well as previous epidemiological and biomechanical evidence for Child Restraint System effectiveness in reducing nonfatal injury risk, efforts should continue to promote use of Child Restraint Systems through improved laws and with education and disbursement programs.
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The influence of harness type on Child Restraint System misuse
Annual proceedings. Association for the Advancement of Automotive Medicine, 2002Co-Authors: Kristy B Arbogast, Dennis R Durbin, Shannon D. Morris, Flaura Koplin WinstonAbstract:The objective of this study was to quantify the relationship between harness type and the prevalence of Child Restraint System (CRS) misuse. Data were collected at 21 Child safety seat clinics between August, 1997 and November, 1998 in southeastern Pennsylvania and southern New Jersey. The main outcome measured was the prevalence of CRS misuse for each of the three most common harness types. Of the 438 convertible CRS evaluated, 89% demonstrated at least one form of misuse. This rate of misuse did not vary by harness type: 5-points (89%), T-shields (87%), and tray-shields (93%). However specific misuses were more common for specific harness types. Having marked/ twisted harness straps was more common among five-point harnesses. T-shields were more commonly recalled, due mainly to the high market share of a particular T-shield CRS recalled for defects with the shield buckle and harness retractor mechanism. Although not statistically significant, there was a trend towards not using a chest clip when necessary in both tray-shields and T-shields when compared to five-point harnesses. This study confirmed a high prevalence of CRS misuse and extended previous results by demonstrating that this misuse is consistent across CRS harness designs. The data further suggest specific design improvements for each harness design based on the particular pattern of misuse.
John Bolte - One of the best experts on this subject based on the ideXlab platform.
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System providing automated feedback improves task learning outcomes during Child Restraint System crs installations
Traffic Injury Prevention, 2020Co-Authors: Julie Mansfield, John BolteAbstract:The objective was to build and test an automated, interactive educational System to teach adults how to install a Child Restraint System (CRS) into a vehicle seat. The automated feedback System (AF...
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evaluation of interventions to make top tether hardware more visible during Child Restraint System crs installations
Traffic Injury Prevention, 2019Co-Authors: Julie Mansfield, Yadetsie N Zaragozarivera, Gretchen Baker, John BolteAbstract:AbstractObjectives: The objective of the study is to determine whether specific Child Restraint System (CRS) or vehicle conditions improve top tether attachment rates during volunteer installations.Methods: A factorial randomized controlled trial was designed to evaluate 4 different experimental categories: (1) Color of tether adjuster casing (black or red), (2) labeling on tether adjuster casing (labeled with “Tether: Use for forward-facing” or unlabeled), (3) storage location of tether (bundled in a rubber band on the back of CRS or Velcroed over the forward-facing belt path), and (4) labeling in vehicle (labeled under head Restraint and below anchor or unlabeled). Ninety-six volunteers were randomly assigned to one combination of conditions. One installation per volunteer was completed. The primary outcome measure was acceptable attachment of the top tether to the tether anchor. The secondary outcome measure was overall secureness of the installation. Pearson’s chi-square tests were used to identify si...
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usability of non standard lower anchor configurations for Child Restraint System crs installation
Traffic Injury Prevention, 2018Co-Authors: Julie Mansfield, Yadetsie N Zaragozarivera, John BolteAbstract:AbstractObjectives: The objective of this study was to determine whether the amount of tension required for proper Child Restraint System (CRS) installation varies with lower anchor spacing and to ...
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Top tether effectiveness during side impacts
2018Co-Authors: Jordan Majstorovic, Eric Dahle, John Bolte, Julie Bing, Yun-seok KangAbstract:Objective: Few studies have looked at the effectiveness of the top tether during side impacts. In these studies, limited anthropomorphic test device (ATD) data were collected and/or few side impact scenarios were observed. The goal of this study was to further understand the effects of the top tether on ATD responses and Child Restraint System (CRS) kinematics during various side impact conditions. Methods: A series of high-speed near-side and far-side sled tests were performed using the FMVSS213 side impact sled buck and Q3s ATD. Tests were performed at both 10° and 30° impacts with respect to the pure lateral direction. Two Child Restraints, CRS A and CRS B, were attached to the bench using flexible lower anchors. Each test scenario was performed with the presence and absence of a top tether. Instrumentation recorded Q3s responses and CRS kinematics, and the identical test scenarios with and without a top tether attachment were compared. Results: For the far-side lateral (10°) and oblique (30°) impacts, top tether attachment increased resultant head accelerations by 8–38% and head injury criterion (HIC15) values by 20–140%. However, the top tether was effective in reducing lateral head excursion by 5–25%. For near-side impacts, the top tether resulted in less than 10% increases in both resultant head acceleration and HIC15 in the lateral impact direction. For near-side oblique impacts, the top tether increased HIC15 by 17.3% for CRS A and decreased it by 19.5% for CRS B. However, the injury values determined from both impact conditions were below current injury assessment reference values (IARVs). Additionally, the top tether proved beneficial in preventing forward and lateral CRS rotations. Conclusions: The results show that the effects of the top tether on Q3s responses were dependent on impact type, impact angle, and CRS. Tether attachments that increased head accelerations and HIC15 values were generally counterbalanced by a reduction in head excursion and CRS rotation compared to nontethered scenarios.
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investigation of Child Restraint System crs compatibility in the vehicle seat environment
Traffic Injury Prevention, 2015Co-Authors: Julie A Bing, John Bolte, Amanda M AgnewAbstract:Objective: Child Restraint System (CRS) misuse is common and can have serious consequences to Child safety. Physical incompatibilities between CRS and vehicles can complicate the installation process and may worsen CRS misuse rates. This study aims to identify the most common sources of incompatibility between representative groups of CRS and vehicles.Methods: Detailed dimensional data were collected from 59 currently marketed CRS and 61 late model vehicles. Key dimensions were compared across all 3,599 theoretical CRS/vehicle combinations and the most common predicted incompatibilities were determined. A subset of 34 physical installations was analyzed to validate the results.Results: Only 58.2% of rear-facing (RF) CRS/vehicle combinations were predicted to have proper agreement between the vehicle's seat pan angle and the CRS manufacturers’ required base angle. The width of the base of the CRS was predicted to fit snugly between the vehicle's seat pan bolsters in 63.3% of RF CRS/vehicle combinations and...
Kristy B Arbogast - One of the best experts on this subject based on the ideXlab platform.
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The influence of Child Restraint lower attachment method on protection offered by forward facing Child Restraint Systems in oblique loading conditions
2018Co-Authors: Hans W Hauschild, John R Humm, Narayan Yoganandan, Matthew R Maltese, Frank A. Pintar, Bruce Kaufman, Kristy B ArbogastAbstract:Objective: The research objective was to quantify the influence of Child Restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax injury metrics for a Child occupant secured in a forward-facing Child Restraint System (FFCRS) in oblique side impacts. Methods: Fifteen sled tests were conducted with a Q3s seated in an FFCRS secured to the center position on a production small SUV bench seat. Three lower attachment methods were evaluated: rigid ISOFIX, a flexible single loop lower anchors and tethers for Children (LATCH) webbing routed through the vehicle belt path of the FFCRS, and dual flexible LATCH webbing attachments on either side of the FFCRS. All were tested with and without a tether with one repeat test in each test condition. The same model FFCRS was used for all tests; only the attachment method varied. The vehicle bench seat was fixed on the sled carriage at 80° (from full frontal). The input pulse was the proposed FMVSS 213 side impact pulse scaled to a 35 km/h delta-v. Two-way analysis of variance (ANOVA) was used to evaluate the effect of lower attachment and tether use on 3 outcome metrics: lateral head excursion, neck tension, and neck lateral bending. Data included anthropomorphic test dummy (ATD) head excursions, head linear accelerations and angular velocities, neck loads and moments, thoracic accelerations, lateral chest deflections, lower anchor loads, and tether webbing loads. ATD head kinematics were collected from 3-dimensional motion capture cameras. Results: Results demonstrated a reduction in injury measures with the rigid ISOFIX and dual webbing attachment compared to the single webbing attachment with decreased lateral head excursions (331, 356, and 441 mm for the rigid ISOFIX, dual webbing, and single webbing Systems, respectively, P
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caregivers use of Child passenger safety resources and quality of future Child Restraint System installations
Safety, 2017Co-Authors: Jessica Hafetz Mirman, Dennis R Durbin, Kristy B Arbogast, Kristi Metzger, Sara J Seifert, Mark R ZonfrilloAbstract:Objectives: Child Restraint System (CRS) misuse is common. We characterized caregivers’ use of Child passenger safety informational and instructional resources and determined whether there were differences in the quality of CRS installations associated with prior exposure to specific resources as evaluated in a standardized CRS installation environment. Methods: Caregivers completed self-report surveys and installed a forward-facing CRS in a controlled environment. Installations were evaluated for security (tightness) and accuracy (no errors) by a Child passenger safety technician (CPST). Results: CRS manuals were the most common way caregivers learned to install a CRS. Primary care providers (PCP)s were the most frequently endorsed source of CRS safety information. There was no strong pattern of associations between prior exposure to resources and installation quality (security or accuracy), although some evidence supports protective effects of learning from CPSTs; 13% (19 out of 151) installations were secure and 57% (86 out of 151) installations were accurate. Conclusions: A focus on developing effective and lasting behavioral interventions is needed.
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protection of Children in forward facing Child Restraint Systems during oblique side impact sled tests intrusion and tether effects
Traffic Injury Prevention, 2016Co-Authors: Hans W Hauschild, John R Humm, Narayan Yoganandan, Bruce A Kaufman, Matthew R Maltese, Frank A. Pintar, Kristy B ArbogastAbstract:ABSTRACTObjective: Testing was conducted to quantify the kinematics, potential for head impact, and influence on head injury metrics for a center-seated Q3s in a forward-facing Child Restraint System (FFCRS) in oblique impacts. The influences of a tether and intruded door on these measures were explored.Methods: Nine lateral oblique sled tests were conducted on a convertible forward-facing Child Restraint seat (FFCRS). The FFCRSs were secured to a bench seat from a popular production small SUV at the center seating position utilizing the lower anchor and tether for Children (LATCH). The vehicle seat was fixed on the sled carriage at 60° and 80° from full frontal (30° and 10° forward rotation from pure lateral) providing an oblique lateral acceleration to the Q3s and FFCRS. A structure simulating an intruded door was mounted to the near (left) side of vehicle seat. The sled input acceleration was the proposed FMVSS 213 lateral pulse scaled to a 35 km/h delta-V. Tests were conducted with and without the tet...
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Protection of Children in forward-facing Child Restraint Systems during oblique side impact sled tests: Intrusion and tether effects
2016Co-Authors: Hans W Hauschild, John R Humm, Narayan Yoganandan, Matthew R Maltese, Frank A. Pintar, Bruce Kaufman, Jinyong Kim, Kristy B ArbogastAbstract:Objective: Testing was conducted to quantify the kinematics, potential for head impact, and influence on head injury metrics for a center-seated Q3s in a forward-facing Child Restraint System (FFCRS) in oblique impacts. The influences of a tether and intruded door on these measures were explored. Methods: Nine lateral oblique sled tests were conducted on a convertible forward-facing Child Restraint seat (FFCRS). The FFCRSs were secured to a bench seat from a popular production small SUV at the center seating position utilizing the lower anchor and tether for Children (LATCH). The vehicle seat was fixed on the sled carriage at 60° and 80° from full frontal (30° and 10° forward rotation from pure lateral) providing an oblique lateral acceleration to the Q3s and FFCRS. A structure simulating an intruded door was mounted to the near (left) side of vehicle seat. The sled input acceleration was the proposed FMVSS 213 lateral pulse scaled to a 35 km/h delta-V. Tests were conducted with and without the tether attached to the FFCRS. Results: Results indicate the influence of the tether on kinematics and injury measures in oblique side impact crashes for a center- or far-side-seated Child occupant. All tests without a tether resulted in head contact with the simulated door, and 2 tests at the less oblique angle (80°) with a tether also resulted in head contact. No head-to-door contact was observed in 2 tests utilizing a tether. High-speed video analysis showed that the head moved beyond the CRS head side wings and made contact with the simulated intruded door. Head injury criterion (HIC) 15 median values were 589 without the tether vs. 332 with the tether attached. Tests utilizing a tether had less lateral head excursion than tests without a tether (median 400 vs. 442 mm). Conclusion: These tests demonstrate the important role of the tether in controlling head excursion for center- or far-side-seated Child occupants in oblique side impact crashes and limiting the head injury potential with an intruded door. The tether may not influence the kinematics of a near-side-seated occupant as strongly where the vehicle door or side structure interacts with the CRS and influences its motion. The results indicate that there may be an opportunity to improve Child head kinematics and head protection in oblique side impacts through different CRS attachment methods and/or alternative vehicle side structure protection or padding.
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Naturalistic driving study of rear seat Child occupants: Quantification of head position using a Kinect™ sensor
2016Co-Authors: Kristy B Arbogast, Katarina Bohman, Sjaan Koppel, Jinyong Kim, Helen Loeb, Jonny Kuo, Judith L CharltonAbstract:Objective: Restraint performance is evaluated using anthropomorphic test devices (ATDs) positioned in prescribed, optimal seating positions. Anecdotally, humans—Children in particular—assume a variety of positions that may affect Restraint performance. Naturalistic driving studies (NDSs), where cameras and other data acquisition Systems are placed in a vehicle used by participants during their regular transportation, offer means to collect these data. To date, these studies have used conventional video and analysis methods and, thus, analyses have largely been qualitative. This article describes a recently completed NDS of Child occupants in which their position was monitored using a Kinect sensor to quantify their head position throughout normal, everyday driving trips. Methods: A study vehicle was instrumented with a data acquisition System to measure vehicle dynamics, a set of video cameras, and a Kinect sensor providing 3D motion capture at 1 Hz of the rear seat occupants. Participant families used the vehicle for all driving trips over 2 weeks. The Child occupants' head position was manually identified via custom software from each Kinect color image. The 3D head position was then extracted and its distribution summarized by seat position (left, rear, center) and Restraint type (forward-facing Child Restraint System [FFCRS], booster seat, seat belt). Results: Data from 18 families (37 Child occupants) resulted in 582 trips (with Children) for analysis. The average age of the Child occupants was 45.6 months and 51% were male. Twenty-five Child occupants were restrained in FFCRS, 9 in booster seats, and 3 in seat belts. As Restraint type moved from more to less Restraint (FFCRS to booster seat to seat belt), the range of fore–aft head position increased: 218, 244, and 340 mm on average, respectively. This observation was also true for left–right movement for every seat position. In general, those in the center seat position demonstrated a smaller range of head positions. Conclusions: For the first time in a naturalistic setting, the range of head positions for Child occupants was quantified. More variability was observed for those restrained in booster seats and seat belts than for those in FFCRS. The role of activities, in particular interactions with electronic devices, on head position was notable; this will be the subject of further analysis in other components of the broader study. These data can lead to solutions for optimal protection for occupants who assume positions that differ from prescribed, optimal testing positions.
Chaochen Zhang - One of the best experts on this subject based on the ideXlab platform.
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multi objective optimization of Child Restraint System for vehicle side impact
Jixie Gongcheng Xuebao Chinese Journal of Mechanical Engineering, 2011Co-Authors: Jikuang Yang, Xingmei Yang, Chaochen ZhangAbstract:The head and thorax of the Child occupant are mainly injured regions in passenger car side impacts. In order to reduce the injury risks of head and thorax, a multi-objective optimization design of Child Restraint System (CRS) and side airbag is conducted in terms of CRS safety performances. A mathematical model of a Child occupant in side collision is developed by using MADYMO software and the validity of the model is evaluated by comparing results between simulation and sled test. For the purpose of minimizing accelerations of Child head and thorax, a sensitivity analysis of the design variables is conducted using the orthogonal design of experiment (DOE) and analysis of variance. The primary design variables are therefore determined, including material permeability of side airbag, location of top tether in X-direction and stiffness coefficient of lower anchorage. The objective functions for accelerations of Child head and thorax are generated with second-order multinomial regression equations in terms of the determined design variables. Optimization is carried out byusing non-dominated sorting genetic algorithm II (NSGA-II). The optimized configuration of the CRS is obtained by further analysis based on the Pareto-optimal solutions. The results indicate that main design parameters of Child Restraint System are material permeability 0.037 of side airbag, location −0.25 m of top tether in X-direction, stiffness coefficient 0.5 of lower anchorage. Under the optimized condition, the peak value of head acceleration is minimized by about 24 percent. The peak value of thorax acceleration is declined by about 30 percent.
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Multi-objective optimization of Child Restraint System for vehicle side impact
2009Co-Authors: Chaochen Zhang, Xiaohan Yang, Jikuang YangAbstract:To minimize head and thorax injuries of Child passengers in side impact, multi-objective optimization design of vehicle Child Restraint System (CRS) was conducted. The mathematical model of Child seat, side airbag and Child was developed and its validity was verified. Based on the validated model we performed the optimization containing design of experiments, parameter sensitivity analysis, full factorial design (FFD) and optimization using non-dominated sorting genetic algorithm (NSGA-II). The results indicated that location of top tether in X-direction, stiffness coefficient of lower anchorage and materials permeability of side airbag have significant influence on Child passengers head and thorax protection. After optimization the three parameters could achieve reasonable configuration, meanwhile, Child passengers head and thorax accelerations were controlled on low level.
Matthew P Reed - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of ISO CRS Envelopes Relative to U.S. Vehicles and Child Restraint Systems
2015Co-Authors: Miriam A Manary, Kathleen D Klinich, Matthew P ReedAbstract:Objectives: The objectives of this study are to use computer simulation to evaluate the International Organization for Standardization (ISO) 13216-3:2006(E) Child Restraint System (CRS) envelopes relative to rear seat compartments from vehicles and CRSs in the U.S. market, investigate the potential compatibility issues of U.S. vehicles and CRSs, and demonstrate whether necessary modifications can be made to introduce such a System into compatibility evaluations between U.S. vehicles and CRSs.Methods: Three-dimensional geometry models for 26 vehicles and 16 convertible CRS designs developed previously were used. Geometry models of 3 forward-facing and 3 rear-facing CRS envelopes provided by the ISO were built in the current study. The virtual fit process closely followed the physical procedures described in the ISO standards.Results: The results showed that the current ISO rear-facing envelopes can provide reasonable classifications for CRSs and vehicles, but the forward-facing envelopes do not represent products currently in the U.S. market. In particular, all of the selected vehicles could accommodate the largest forward-facing CRS envelope at the second-row seat location behind the driver seat. In contrast, half of the selected CRSs could not fit within any of the forward-facing ISO CRS envelopes, mainly due to protrusion at the rear-top corner of the envelope. The results also indicate that the rear seat compartment in U.S. vehicles often cannot accommodate a large portion of convertible CRSs in the rear-facing position. The increased demand for vehicle fuel economy and the recommendation to keep Children rear-facing longer may lead to smaller cars and larger CRSs, which may increase the potential for fit problems.Conclusions: The virtual classifications indicated that contact between the forward-facing CRSs and the head Restraints in the rear seats as well as that between the rear-facing CRSs and the back of the front seats is a main concern regarding the compatibility between the vehicles and the CRSs. Therefore, modification of the current ISO forward-facing CRS envelopes will likely to be necessary to ensure that they are useful for the U.S. market.
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effects of Child Restraint System features on installation errors
Applied Ergonomics, 2014Co-Authors: Kathleen D Klinich, Sheila M Ebe, Paul Gree, Miriam A Manary, Carol A C Flannaga, Laura A Malik, Matthew P ReedAbstract:This study examined how Child Restraint System (CRS) features contribute to CRS installation errors. Sixteen convertible CRS, selected to include a wide range of features, were used in volunteer testing with 32 subjects. Subjects were recruited based on their education level (high or low) and experience with installing CRS (none or experienced). Each subject was asked to perform four Child Restraint installations in the right-rear passenger seat of a 2006 Pontiac G6 sedan using a crash dummy as a Child surrogate. Each subject installed two CRS forward-facing (FF), one with LATCH and one with the vehicle seatbelt, and two CRS rear-facing (RF), one with LATCH and one with the seatbelt. After each installation, the experimenter evaluated 42 factors for each installation, such as choice of belt routing path, tightness of installation, and harness snugness. Analyses used linear mixed models to identify CRS installation outcomes associated with CRS features. LATCH connector type, LATCH strap adjustor type, and the presence of belt lockoffs were associated with the tightness of the CRS installation. The type of harness shoulder height adjuster was associated with the rate of achieving a snug harness. Correct tether use was associated with the tether storage method. In general, subject assessments of the ease-of-use of CRS features were not highly correlated with the quality of their installation, suggesting a need for feedback with incorrect installations. The data from this study provide quantitative assessments of some CRS features that were associated with reductions in CRS installation errors. These results provide Child Restraint designers with design guidelines for developing easier-to-use products. Research on providing effective feedback during the Child Restraint installation process is recommended.