The impact of adolescent exposure to medical marijuana laws on high school completion, college enrollment and college degree completion.

BACKGROUND: There is concern that medical marijuana laws (MMLs) could negatively affect adolescents. To better understand these policies, we assess how adolescent exposure to MMLs is related to educational attainment. METHODS: Data from the 2000 Census and 2001-2014 American Community Surveys were restricted to individuals who were of high school age (14-18) between 1990 and 2012 (n=5,483,715). MML exposure was coded as: (i) a dichotomous "any MML" indicator, and (ii) number of years of high school age exposure. We used logistic regression to model whether MMLs affected: (a) completing high school by age 19; (b) beginning college, irrespective of completion; and (c) obtaining any degree after beginning college. A similar dataset based on the Youth Risk Behavior Survey (YRBS) was also constructed for confirmatory analyses assessing marijuana use. RESULTS: MMLs were associated with a 0.40 percentage point increase in the probability of not earning a high school diploma or GED after completing the 12th grade (from 3.99% to 4.39%). High school MML exposure was also associated with a 1.84 and 0.85 percentage point increase in the probability of college non-enrollment and degree non-completion, respectively (from 31.12% to 32.96% and 45.30% to 46.15%, respectively). Years of MML exposure exhibited a consistent dose response relationship for all outcomes. MMLs were also associated with 0.85 percentage point increase in daily marijuana use among 12th graders (up from 1.26%). CONCLUSIONS: Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.

Examining the relative effectiveness of different message framing strategies for child passenger safety: recommendations for increased comprehension and compliance.

BACKGROUND: Age-appropriate child restraints and rear seating dramatically reduce injury in vehicle crashes. Yet parents and caregivers struggle to comply with child passenger safety (CPS) recommendations, and frequently make mistakes when choosing and installing restraints. The purpose of this research was to evaluate various methods of framing CPS recommendations, and to examine the relative effectiveness on parents' knowledge, attitudes, and behavioral intentions related to best practices and proper use of child restraints. Emphasis framing is a persuasion technique that involves placing focus on specific aspects of the content in order to encourage or discourage certain interpretations of the content. METHOD: A 5 (flyer group) X 2 (time) randomized experiment was conducted in which 300 parent participants answered a pre-survey, viewed one of four flyer versions or a no-education control version, and completed a post-survey. Surveys measured CPS knowledge, attitudes, perceptions of efficacy and risk, and behavioral intentions. The four flyers compared in this study all communicated the same CPS recommendations, but several versions were tested which each employed a different emphasis frame: (1) recommendations organized by the natural progression of seat types; (2) recommendations which focused on avoiding premature graduation; (3) recommendations which explained the risk-reduction rationale behind the information given; or (4) recommendations which were organized by age. In a fifth no-education (control) condition, participants viewed marketing materials. RESULTS: Analyses of covariance and pairwise comparisons indicated the risk-reduction rationale flyer outperformed other flyers for many subscales, and significantly differed from no-education control for the most subscales, including restraint selection, back seat knowledge, rear-facing knowledge and attitudes, total efficacy, overall attitudes, and stated intentions. CONCLUSIONS: This research provides insight for increasing caregiver understanding and compliance with CPS information. Recommendations for the field include communicating the rationale behind the information given, using behavior-based directives in headers, avoiding age-based headers, and incorporating back-seat positioning directives throughout.

Tweens at risk: examining car safety practices in four economically disadvantaged urban elementary schools in Virginia.

INTRODUCTION: Children aged 8- to 12-years-old ("tweens") are at high risk for crash injury, and motor vehicle crashes are their leading cause of death. METHOD: Data are presented from behavioral observations (N=243), surveys (N=677), and focus groups (N=26) conducted with tweens attending four urban elementary schools in Virginia. The populations assessed were predominantly black (77.9%) and economically disadvantaged (61.9%). RESULTS: Focus groups revealed a number of inconsistencies in and misconceptions about safety practices. Among the 677 tweens who completed anonymous surveys, the majority (58.1%) reported wearing their seat belts "not very much at all" or "never." Many students (47.8%) reported usually sitting in the front seat or sitting in the front and back seats equally. This is despite the fact that most (92.0%) knew that the back seat was the safest place to sit. Of the 243 tweens observed in vehicles, 65.0% were unrestrained and 60.1% were seated in the front passenger seat. IMPACT ON INDUSTRY: Findings of this study shed light on the great disparity between the national rates for child safety practices and those of children living in an economically disadvantaged urban school district. Additional intervention programs that are culturally appropriate and specifically target this age group are needed.

Challenges and opportunities for promoting booster seat use: progressive dissemination of a high-threat message.

Motivating parents to take certain safety precautions when traveling with their children remains challenging for advocates. Caregivers of booster-aged children are particularly difficult to reach because they do not consider their children to be of "safety-seat" age and have inherently low perceptions of vulnerability to crash injury. Unfortunately, most booster seat programs fail to adequately motivate their intended population because they are primarily informational in nature and rely on caregivers to seek out and attend to the information. In this article, interventions using threat appeal tactics and progressive dissemination methods are recommended to effectively target participation and perceptions of vulnerability among this population. Recent research on risk communication indicates that threat appeals are supported when they contain high threat and high efficacy components. Threat appeal tactics are particularly desirable when perception of vulnerability is low, as is the case with parents of booster-aged children. In addition to theoretical arguments for more aggressive intervention approaches, a case example is presented wherein such techniques were used to promote booster seat use. The intervention resulted in significant increases in knowledge, risk-reduction attitudes, sense of efficacy, and observed booster seat use. Through use of progressive dissemination methods, the intervention has reached an audience of 431,600 people and counting.

Measuring injury risk perceptions: feasibility of a Risk Estimation Scale.

OBJECTIVES: To develop a scale for measuring parental perceptions of childhood injury risk. METHODS: The Worry Assessment and Risk Estimation (WARE) Scale was administered to 256 parents/guardians to examine reliability, factor structure, and perception of risk. RESULTS: The WARE Scale has high internal consistency reliability (alpha = .89). Parents underestimated scenarios with high injury/death rates and overestimated scenarios with low injury/death rates. CONCLUSIONS: Risk estimation measures such as the WARE Scale have great potential as research tools and may be modified to suit researchers' needs.

Evaluation of the Boost 'em in the Back Seat Program: using fear and efficacy to increase booster seat use.

OBJECTIVES: Recent research supports the use of high-threat messages when they are targeted appropriately and designed to promote high efficacy as well as fear. This research examined the effectiveness of using a novel threat-appeal approach to encourage parents to place their children in booster seats and rear seats of vehicles. METHOD: A 6-min video-intervention was created and evaluated at after-school/daycare centers via an interrupted time series design with similar control sites for comparison. Caregivers (N=226) completed knowledge and practice surveys and fear and efficacy estimations related to childhood motor vehicle hazards. Researchers observed booster-seat and rear-seat use in study site parking lots. RESULTS: Compared to baseline and control assessments, the treatment groups' child passenger safety knowledge, risk-reduction attitudes, behavioral intentions, sense of fear related to the hazard, and sense of efficacy related to the recommended behaviors increased significantly. Further, observed overall restraint use and booster-seat use increased significantly following the intervention. CONCLUSIONS: Applying high-threat messages to child passenger safety interventions is promising and has the potential to be adapted to other health risk areas.

Child passenger safety and the immunity fallacy: Why what we are doing is not working.

Motivating parents to take certain safety precautions when traveling with their children remains an elusive challenge for advocates, as caregiver naiveté contributes to poor parental participation in safety-seat checks, low booster-seat use, poor adherence to rear-seat positioning, and intermittent safety-belt use. Because of inherent human biases and unfortunate characteristics of vehicle travel, it is argued that most caregivers possess an immunity fallacy, or a reduced perception of risk for motor vehicle injury to their children. Consequently, traditionally designed child passenger safety campaigns, which are primarily informational, fail to have an impact on most parents. Rather, for maximum behavioral success, injury prevention messages must shock and surprise parents into paying attention to something they would normally dismiss as unimportant.

Increasing the safety of children's vehicle travel: from effective risk communication to behavior change.

INTRODUCTION: When installed and used correctly, child safety seats reduce the risk of fatal injury by 71% for infants and 54% for toddlers. However, four out of five safety seats are unintentionally misused. Yet, parents fail to participate in safety-seat checks and other child seat interventions aimed at correcting misuse. METHOD: Such lack of participation is the focus of this article, which argues that most caregivers are naïve to their own vulnerability for misusing their child's seat. Research on risk perception is discussed as a guide to understanding both the high misuse rate and the lack of participation in interventions designed to correct this public safety problem. RESULTS AND IMPACT: A comprehensive intervention plan that incorporates risk communication techniques for maximum parental participation is proposed that includes three essential components: (a) establishing community locations for parents to turn for safety seat advice, (b) making these locations well known to the public, and (c) increasing caregivers' perceptions of risk of misusing their children's seats.