{"doi":"10.1111/acem.70187","title":"Premature Child Restraint System Transitions and Child Opportunity Index Among Emergency Department and Urgent Care Visits in Metropolitan Chicago","abstract":"Motor vehicle collisions (MVC) remain a leading cause of death for children younger than 10 in the United States (US). Suboptimal child passenger safety practices contribute to increased risk of severe injury or fatality for children in an MVC [1]. With more than 1,300,000 children under age 13 seen in the emergency department (ED) for evaluation and care of MVC injuries, ED providers are credible experts in the prevention and treatment of injuries. Therefore, the ED setting can be a place of heightened awareness of injury risk and serve as a contact point in the healthcare system to emphasize primary injury prevention strategies with patients and families, including the use of car seats and seat belts [2]. The ED can also play a role in connecting caregivers to community resources. Household income, caregiver education, race, and ethnicity are associated with suboptimal child passenger safety practices, which include premature transition to a less protective seat, riding unrestrained, or riding in the front seat before age 13 [3]. However, injury prevention research that focuses on individual-level markers of socioeconomic status (SES) or race and ethnicity overlooks the potential relationship between community-level resources and safety behaviors. The Child Opportunity Index (COI) 3.0 [4] is a composite measure of 44 indicators related to children's neighborhood opportunity and resource quality based on US census tract location, including social and economic, education, and health and the environment domains. To increase efficiency and lower the burden of ED-based primary injury prevention strategies on social workers, nurses and providers, we aimed to explore how community context, as represented by ZIP code-level COI (1-very low, to 5-very high), relates to premature child passenger restraint system (CRS) transitions in Chicago as a potential variable to identify patients for targeted screening and intervention. We expected lower COI to be associated with higher rates of premature transition given prior literature noting a higher prevalence of premature transition for children of lower SES and Black or Hispanic/Latine racial and ethnic backgrounds. Data were collected through pre-recruitment screening for the Tiny Cargo, Big Deal! clinical trial (Lurie Children's IRB #2020-3274). This analysis focused on surveys completed January 2021–August 2022, the period during which demographic questions were available in the screening survey. Screening of caregivers occurred electronically, during or after their 6-month to 10-year-old child's ED or urgent care visit to four locations in Chicago and its surrounding suburban areas [5]. Children living in Cook County, IL ZIP codes (n = 1568) were selected for regression analysis, narrowed to city of Chicago ZIP codes (n = 60) for mapping. Child age, weight, and height were extracted from the electronic health record (EHR). The caregiver's demographics (age, highest level of education, and household income); noted CRS used, or “usual” CRS if the child used multiple types of restraints; and child seating location were included from the surveys. Caregiver-reported home ZIP code was linked to metro-normed COI levels (very low, low, moderate, high, very high) which were extracted both overall and in the three COI domains (social and economic, education, and health and the environment). Race and ethnicity are excluded from COI calculations to isolate the structural features of neighborhoods and because race and ethnicity are concentrated at low and high ends of COI distributions [4]. We therefore excluded race, ethnicity, and preferred language from our analyses. Our primary outcome was premature transition, defined as the caregiver-reported usual CRS being recommended for a child who is larger or older than the study child. For example, a child using a booster seat when they would still fit in a forward-facing car seat with an internal harness. Caregiver-reported CRS use was categorized as a","journal":"Academic Emergency Medicine","year":2025,"id":580201,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9575,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":701274,"name":"Mech Frazier","orcid":null,"position":1,"is_corresponding":false},{"id":625472,"name":"Michelle L. Macy","orcid":"0000-0003-4401-7384","position":2,"is_corresponding":false},{"id":665350,"name":"Arthi Kozhumam","orcid":"0000-0002-0401-3189","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":null,"created_at":"2026-07-19T02:58:38.868285Z","pmid":"41194313","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}