Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Health Indicator(s) from Statistics Canada and CIHI | Corresponding Indicator(s) from Other Sources | Data Sources |  Alternative Data Sources | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Definitions | Cross-References to Other Indicators | Cited References | Changes Made | Acknowledgements

• Use of car seats and/or restraint for children aged less than 1 year
• Use of car seats and/or restraint for children aged 1-3 years
• Use of car seats and/or restraint for children aged 4-7 years
• Use of seat belts for children aged 8-11 years

• Proportion of households whose children less than 1 year travel in the back seat of the car in a rear facing car seat "all of the time"
• Proportion of households whose children (1-3 years) travel in the back seat of the car in a forward facing car seat "all of the time"
• Proportion of households whose children (4-7 years) travel in a booster seat in the back seat "all of the time"
• Proportion of households whose children (8-11 years) travel wearing a seatbelt

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.

• Board of Health Outcome (Prevention of Injury and Substance Misuse): the board of health shall conduct epidemiological analysis of surveillance data....in the areas of injury and substance misuse outcomes, including road and off-road safety (of pedestrians, cyclists, drivers and occupants)...and drinking and driving.
• Board of Health Outcome (Foundational Standard): the public, community partners and health care providers are aware of relevant and current population health information

• The board of health shall conduct epidemiological analysis of surveillance data....in the areas of road and off-road safety

• None

• None 

*Year module was first available. Classification of modules, (i.e. core, core rotating, optional, seasonal), and selection of modules by health units varies by year. Please refer to RRFSS the website (RRFSS Inventory) for details. 

• None

• Users should refer to the most recent RRFSS Manual of Operations for a complete list of RRFSS analysis guidelines.
• Denominator Data - cell size less than 30 not to be released (based on unweighted data).
• Numerator Data - cell size less than 5 not to be released (based on unweighted data).
• Coefficients of variation (CV) should be calculated for every estimate. The following categories determine the release of the data:
• CV between 0 and 16.5:  estimate can be released without qualification.
• CV between 16.6 and 33.3:  estimate can be released with qualification:  interpret with caution.  High variability.
• CV greater than 33.3:  estimate should not be released, regardless of the cell size.
• 95% confidence intervals should accompany all released estimates.  If estimates are close to 0 or 100% and the simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2^nd edition computation for skewed estimates should be employed.
• Weighting:
• General household weight will be applied for questions related to the individual. 
• Household weight is to be applied for questions about households when we wish to determine the population/number of people affected. 
• Household weight is not to be applied for child proxy questions (bicycle helmet use, car seat safety), dog and cat immunization modules, or other questions that relate to the household rather than the respondent. 
• Household weights are not required to be recalculated for sub-population based questions; for example mammography in women ages 35+ years and 50-74 years.
• If the weights supplied with the data set (health unit wave specific, health unit cumulative total, all health units combined wave specific, all health units combined cumulative total) are not appropriate for the required analysis, then a time-specific weight must be calculated.  For example, a new weight is required for all seasonal modules.
• If the cell size of ‘Don't Know' responses is 5% or greater, ‘Don't Know' responses should be included in the denominator of the analyses and reported separately.
• If the cell size of ‘Refusal' responses is 5% or greater, ‘Refusal' responses should be included in the denominator of the analyses and reported separately.
• When an indicator is being compared between groups (e.g. health units, time periods, gender), if any one group has ‘Don't Know' and/or ‘Refusal' responses that are 5% or greater, ‘Don't Know' and/or ‘Refusal' responses should be included in the denominator of the analyses and reported separately for all groups.
• A provincial sample is not available with the RRFSS.

• Age groups (parents): < 20, 20-29, 30+
• Sex (parents): male, female and total
• Geographic areas: RRFSS-participating health units that chose the 'Car Seat Safety' and 'Booster Seat Safety' modules (Varies by wave. Check documentation)

• Motor vehicle injuries are one of the leading causes of injury-related death for Canadian children (1).
• When installed correctly, putting a child in the appropriate restraint for their stage of physical development can reduce their risk of injury or death by as much as 74 per cent (2).
• Car seats have been shown to reduce the risk of death by 71 per cent for infants under age one and reduce the risk of death by 54 per cent for children ages one to four (3), while booster seats provide up to 60 per cent more protection than seat belts alone (4).
• The most appropriate restraint system should be chosen based on a child's weight and height (5). Age is used as a proxy for a child's weight and height as RRFSS does not collect this information. Booster seats may be appropriate for some 4 to 7 year olds but not all.  
• Please note it is highly recommended, though not legislated, that a booster seat or car seat be placed in the back seat of a vehicle (6).

• Car Seat - A small removable seat that is equipped with a restraining device or harness and can be fastened to the seat of a vehicle for securing young children.
• Booster Seat - A car seat for a small child that lifts the child by several inches, designed for use with an adult seat belt.

• Motor Vehicle Traffic Collisions Injuries (Section 4C. Injury Prevention and Substance Abuse Prevention)
• Alcohol-related Injury and Mortality from Motor Vehicle Traffic Collision (Section 4C. Injury Prevention and Substance Abuse Prevention)
• Cellphone Use While Driving (Section 4C. Injury Prevention and Substance Abuse Prevention)
• Seat Belt Use (Section 4C. Injury Prevention and Substance Abuse Prevention)

1. Safe Kids Canada [homepage on the Internet]. Toronto: Safe Kids Canada; c1999-2012 [cited 2012 Jan 14]. About injuries. Available from: http://www.safekidscanada.ca/Professionals/Safety-Information/About-Injuries/Index.aspx.
2. Biagioli F. Proper use of child safety seats. Am Fam Physician. 2002 [cited 2012 Jan 14];65(10):2085-90. Available from: http://www.aafp.org/afp/2002/0515/p2085.pdf.
3. Starnes M. Lives saved calculations for infants and toddlers. Traffic Safety Facts Research Notes DOT HS 809778. Washington: National Highway Traffic Safety Administration; 2005 [cited 2012 Jan14]. Available from: http://www-nrd.nhtsa.dot.gov/Pubs/809778.pdf.
4. Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA. 2003 [cited 2012 Jan 14];289(21):2835-40. Available from: http://jama.jamanetwork.com/article.aspx?articleid=196677.
5. Ministry of Transportation [homepage on the Internet]. Toronto: Queen's Printer for Ontario; c2009[updated 2012 Jun 22; cited 2012 Jul 9]. Safe & secure: Choosing the right car seat for your child. Available from: http://www.mto.gov.on.ca/english/safety/carseat/choose.shtml.
6. Safe Kids Canada. Car seat and booster seat legislation chart. Toronto: Safe Kids Canada; 2008 [cited 2012 Jan 14]. Available from: http://www.safekidscanada.ca/Professionals/Advocacy/Documents/26794-BoosterSeatLegislationChart.pdf.