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Author Topic: Freakonomics has it wrong with respect to child safety seats
Bob_Scopatz
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After all the hubbub of this "new approach" to analyzing EVERYTHING, I heard that one of the authors did some research into whether child safety seats have marginal benefits that outweigh the costs.

This surprised me. Not because their book didn't seem far reaching, but because I figure that most people who approach the traffic safety data take one look at the list of data limitations and run screaming.

There are only two types of data analysts who use the traffic safety data, in general: Experts who devote their entire lives to it and those who use it once and generally learn the lesson that they don't have the stomach or the time to learn how to use it properly, within its limitations. A subset of this latter group learn this lesson after publication.

The authors of Freakonmics are, sadly, in this subgroup who learn, too late, that they have misused the data and offered an interpretation of it far beyond what the data will support.

They did this because, IMHO, they are experts in a field that uses data all the time and, by jiminy, they KNOW how to use data. I don't dispute that. THey are probably far better statisticians than I aspire to be. Just as many of the epidemiologists who are their "group mates" in misuse of traffic data are far better statisticians than I am.

Where I have it all over them, however, is in methodologies that deal with bad data. And there is no worse data set that I know of than crash data for supporting data analysis. This is because:

1) Police officers who have more important things to do at the scene of a crash are the primary source for all the data.

2) Police officers are known to be unable to spot injury severity based on their own visual inspection (usually all they have to go on).

3) Police officers are not required to record the presence of NON-INJURED people in crashes.

As a result, there is no dataset in the country that can tell us about crash outcomes for people who escape visible injury at the time of the crash. This is, of course, the intent and (if they work) the major effect of child safety seats -- to avoid injury, but especially to avoid the kinds of injury that lead to visible effects.

To give an example, back many years ago, we had early data from crash tests (using dummies and, believe it or not, live people and cadavers) to show that seat belts are probably pretty effective. When we started collecting data on fatal crashes, someone got the bright idea to aggregate data on fatal crashes in which there were two front seat occupants (a driver and one other person) and to examine crashes in which one of these people was belted and one was not. In every case, both people had to have been coded in the crash report -- one person as the fatality and the other as having been injured, but not killed. By using enough cases to randomize the effects of which side of the car (driver versus passenger), size, type of crash, etc., the researchers reached the fairly supportable conclusion that seatbelts have about 15% effectiveness in actual crashes that are severe enough to result in a death. That is, if you wear a belt, you are 15% more likely to be the survivor of a fatal crash than you are if you are unbelted.

It's not great, but it's at least supportable. The nice thing about it is that it's also a reasonable "minimum" estimate of the effectiveness. Often, when you can't find the precise number, it's of value to know it's minimum or maximum. That's what we have to work with.

It is also true that we know comparing seatbelts to other types of safety measures that putting on a seatbelt is still the single most effective thing you can do to protect yourself when riding in a vehicle.

The car seat debate is difficult. There's crash test data (this time using child-sized dummies, not cadavers, or <shudder> real children). It appears that children belted in normal seatbelts ARE at risk for some types of injuries (strangulation and ejection being the most prevalent -- based on crash test info only).

Then we have the data from actual crashes in the real world.

Sadly, we don't have the data to answer the question the same way we would've in the old, early days of safety belts. Think about it. We would ideally want to see a HUGE dataset of crashes in which:

1) There were two children of similar age and size in the back seat of a vehicle.
2) One of the kids must be the fatality, the other must be injured (otherwise we can't guarantee that both would show up in the data)
3) We need to have one of the kids in a car seat, and the other wearing a regular seatbelt.
4) Ideally, we'd know that the car seat was installed properly (sadly, this is not true in 90% of cases in the historical data -- things are better now, but we aren't working with ONLY the most current data because we need LOTS of cases)
5) We need to balance for other factors like: side of the vehicle, type of crash, type of vehicle, whether there was a rollover, and a host of other variables)

Sadly, there just isn't enough data to support the analysis this way.

So, people do other things. Things that, aren't supported by the data.

And they reach conclusions and, in the case of some people, get published before they learn enough about the limitations of the data.

So, we have the problem of conclusions supposedly supported by "expert-level" analysis done by people who are tops in their field. Unfortunately, that field isn't traffic safety.

And the real experts -- the ones who know the data's limitations -- are ignored because the new conclusions are so flashy and make great soundbites.

The Freakonomics folks go on to talk about the marginal utility of child safety seats, using a $200 price tag to show what a horrid imposition the "government" has foisted off on poor unsuspecting parents.

They neglect to mention that in every community in the US, car seats are available to those who can't afford them. In most communities, all one has to do is ask, no proof of financial need is required. In some communities, you have to be on some level of public assistance in order to get a seat for free.

The actual cost of a car seat that is ONLY a car seat, however, is not $200. That's the cost of a baby-transport system that includes a seat base, a seat that doubles as a carrier, a stroller for it to clip into, and maybe even a high-chair that the seat can clip into as well. It's also got leather trim and sports team logos. People can always opt for the high-end thing. But that is not required under any law or policy that I've ever seen.

So, realistically, the cost is $50 or maybe $0. And the effectiveness, even if it is small, is acknowledged to be non-zero.

If we use the LOWEST estimates comparing a cost of a fatality to the cost of the highest level of injury (incapacitating) the data show that there's at least a $100,000 differential. So, for $50, you have a slightly improved chance of avoiding $100,000. In reality, the effectiveness is probably better than that (remember, we work with minimums) and the cost differential is probably higher -- unless the injury is one that results in a need for life-long physical therapy, and multiple surgeries, the cost of a death is still higher than the cost of an injury (these are societal costs including insurance payouts, cost of lost earnings, tax revenue, etc.).

But I'm not an expert in economics. I'll concede that the marginal utility is low, but not zero. As long as the authors of Freakonomics will admit that they didn't consider all the shortcomings of the dataset.

I do have to wonder, however, if experts in the other areas that were tackled by Freakonomics would point out the methodological shortcomings of high-level economic analysis applied to the datasets that they know something more about.

Generalizing from the collosal miss with respect to traffic safety, I suspect the entire enterprise is just a series of mistakes made by neophytes unschooled in the datasets they chose to work with for their bestseller.

[ October 29, 2005, 02:32 PM: Message edited by: Bob_Scopatz ]

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Shan
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The misuse of data and statistics bothers me, too, Bob.

As far as driver and passenger safety and the issue of car seats - if nothing else, we at least have parents able to better focus on driving, because they don't have munchkins crawling over, under, around, and distracting them . . . Which is why mom put my baby brother in a car seat long before it was the law, whereas she knew my sister and I would generally sit still.

Any studies on driver effectiveness, Bob, as it relates to having young passengers safely strapped in and less likely to cause disturbances?

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Bob_Scopatz
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Unfortunately, we have only recently begun to collect data on driver distraction. There are some older data from a sample-based system that would have such things as part of the narrative description from a post-crash investigation. That is incredibly difficult to use and the standard error for estimates derived from that system make it useful in analyzing things that are high-frequency events. For low-frequency things (and I mean they are recorded infrequently, not actually rare in the real sense) the 95% confidence interval around the estimate almost always includes "zero" as a value.

In otherwords, you often can't detect occurrences as being anything but extremely rare statistically, even if we know they happen.

Another issue worth mentioning is that any contributing factor that is based on drivers' self report to law enforcement is biased by the desire of drivers to deflect blame, especially in states that routinely record which driver is "most at fault" or have a practice of issuing citations at the scene of a crash. In those states, it is extremely unlikely that drivers will say things like "My kids were bouncing off the ceiling and I couldn't pay attention to driving," or "I was using my cell phone." (the latter is the one most people are going after these days as the big distraction in vehicles.)

One thing we do know about distraction, however, is that states that have a Graduated Licensing Provision for teen novice drivers that INCLUDES restrictions on the number of other people below the age of 18 who can be in the car while a teen is driving have a lower accident rate for teen drivers. And they have a lower number of crash-related teen deaths and injuries.

For what that's worth, GDL provisions that address "distraction" appear to work.

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Shan
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We have a really sad local case here where a teen disobeyed those rules, and one day after receiving the provisional license drove another teen to a local function. The result was speeding, swerving to miss a deer, and the death of a driver parked on the side of the road.

[Frown]

[ October 29, 2005, 02:50 PM: Message edited by: Shan ]

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ketchupqueen
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There's another set of data when it comes to car seats and injuries. The AAP and the AMA have access to it. It's emergency room reports and doctor's reports that detail exactly how and where children of different ages, using and not using different kinds of restraints, are injured.

And amazingly enough, they recommend using a car seat rear-facing until at least age 1 and 20 lbs. or the maximum allowable length and weight for your car seat after your child is 1, front-facing until the child outgrows the front-facing harness seat, and a belt-positioning booster seat at least until age 8 or 80 lbs.

I think I'll go with that. (Especially since it's also CA law.)

As you said, a basic convertible car seat that will work for a child 7 lbs. to 1 year as rear-facing and then as a front-facing toddler seat is available for $50. A belt-positioning booster seat for older children is available for $15. I consider that a reasonable investment in my child's safety even if using it only increases her safety by a small amount. Most people spend more on half a year's worth of shoes for their child.

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Bob_Scopatz
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kq: I totally agree about the costs.

There are limitations on the ED data, but yes, that stuff is another source that could be used in this situation. States that have a statewide trauma registry system could use it (not just AAP and AMA). The other thing that can be done is at the individual hospital level (level 1 trauma centers have records whether or not there is a statewide trauma center).

One limitation of the ED data, however, would be that they probably don't have reliable information on position in the vehicle. Nor are they likely to have a LOT of cases from which to draw comparisons between injured and non-injured children (they don't see the uninjured ones).

I'm not discounting their conclusions, mind you, but it's a set of data that has its own peculiarities.

It might also, under some circumstances, be thought of as amplifying the effectiveness estimates rather than going for a minimum effect size.

But that has value too. Bracketing the "TRUE" number between some minimum and some maximum value would be very useful.

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ketchupqueen
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quote:
(they don't see the uninjured ones).
Actually, they do. Children in a moderate to severe crash are brought in and checked out, whether they have visible injury or not.
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ketchupqueen
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Oh, AND. I know some people can't even afford that small amount for car seats for their children. Most states either have programs for free or nominal-cost car seats, or can refer you to a non-state-run organization that can get one if you can't afford one. Hospitals sometimes have those programs, too, since most of them won't let you leave without the child in a car seat.
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Bob_Scopatz
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that's correct. There isn't a person in the US who has a legitimate financial excuse for NOT having a car seat, IMHO. There are just too many ways to get them for free if you really want one.
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Bob_Scopatz
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kq, as for them seeing the uninjured kids, that is going to vary widely from state to state and, in some states, county to county and even hospital to hospital. The EMS transport protocols are not uniform by any stretch.

If the docs associate with a particular hospital have enough data, however, they could potentially do some really excellent research on the population of kids coming into their facility.

In many respects that would be better than trying to rely on crash reports from police departments.

Also, ED docs do not always see the fatalities. Again, it depends on the practices in that community, county and/or state.

So, if you were concerned about saved LIVES, as opposed to severity of various injuries, you'd need another data source in addition to ED records.

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Kayla
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Bob, how did you turn ER into ED? Do you need to share anything else with us? We're here for you.

(Of course, ED could be Emergency room Data, but then ED data seems a bit redundant. I can't figure out what else it could me, so can you tell me before it drives me crazy? Oops, too late.)

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ketchupqueen
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quote:
If the docs associate with a particular hospital have enough data, however, they could potentially do some really excellent research on the population of kids coming into their facility.

That's what most of the recommendations are based on, from what I understand-- many studies based in specific geographical areas, compiled by local doctors.
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dkw
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Kayla, ED is Emergency Department. Most of them have more than one room these days. [Wink]
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Kayla
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Thanks dkw. I'm glad it wasn't a subliminal slip. [Big Grin]
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ketchupqueen
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*takes a second*
*gets it*
*howls with laughter* [ROFL]

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Bob_Scopatz
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[Blushing]
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dkw
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You think you're glad . . .
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Bob_Scopatz
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[Blushing] [Blushing] [Blushing]
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ketchupqueen
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You'd think the king of punsters would have seen this coming and either typed out "Emerg. Dept." or used the more understood "ER". [Taunt]
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Shan
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You guys are too much! *grins*

I know in Wa. State, newborns aren't allowed out of the hospital and into a vehicle UNLESS they are properly and securely strapped into a car seat.

Just as an FYI . . .

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erosomniac
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Ugh, does the government seriously provide car seats to the "underpriviledged"? What the hell kind of sense does that make? You can afford an automobile but can't afford a $50 investment in your child's safety?

[Edited because it really was offensive and rude, even if I definitely intended for it to be]

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ketchupqueen
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erosomniac, that's offensive. Sometimes our budget has just balanced once we paid the car payment. There was no wiggle room for anything. Some people have already paid off their car. Most people who have a car need it to get to work. Plus, even if you're going home in someone else's car, you need to have the baby in a car seat.

Your post is offensive and shortsighted and rude.

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Bob_Scopatz
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It's not just the government, by the way. There are major auto manufacturers and car seat manufacturers that give out grants and free products. Chrysler is a major sponsor of car seat education in the US. It's good PR for them and really doesn't cost all that much.

edit to add:

AAA runs the car seat inspector certification program.

(it requires certification because, sadly, so many people do not install the car seats properly.)

[ October 29, 2005, 07:10 PM: Message edited by: Bob_Scopatz ]

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jexx
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When we took Christopher home from the hospital, a nurse came out to the car to make sure our carseat was installed properly. Oh, and we couldn't take him home unless we had a carseat for him, either.

I remember seeing an episode of "Mad About You" when they had their baby in a taxi without a carseat. Am I remembering wrong, or is it not a requirement to have a baby in a carseat in a taxi? That just seems bass-ackwards.

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Bob_Scopatz
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It depends on the laws in a given state or community. It's a patchwork quilt of laws in the US.

But it wouldn't surprise me to find out that taxicabs are exempt from carseat requirements in many places.

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Farmgirl
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Bob, as a former emergency scene worker (EMT) and a family member of law enforcement, I can't agree with your intial post more. Every single thing you say is correct.

I wonder if there is a way they could also garner some local news reports, because I have noticed locally, at least, that more news stations are reporting information on crashes as to whether or not everyone was buckled.

Just the other day, for instance, I heard a news report on a local radio station that talked about a fatality accident. Both parents riding in the front seat, unbuckled, were killed. The infant riding in the rear seat, buckled into a car seat, was unhurt.

In a way your post reminds me of the old conundrum puzzle the kids were given in school. I won't get this exactly right -- but something to the effect of "a country decided to outfit its soldiers with helmets to protect their heads -- something it had not done previously. However, in the next battle, there were three times as many head injury patients in the hospital than in the previous battle without helmets. Why is that?"

Of course, the answer is -- in the previous battle, they were fatalities!, not injuries. I'm amazed how many people don't get that.

Farmgirl

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Teshi
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In September they really strengthened the child-seat safety laws in Ontario.
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theamazeeaz
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This reminds me of how carmakes love to point out that ABS does not prevent accidents statistics. As my dad likes to say, no one phones the cops to say they lost control of their car, but regained it when the ABS kicked in.
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Bob_Scopatz
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Yep.

And to a certain extent, a freakonomics type analysis should work. At the macro level, you would expect that deaths of children would be reduced over time, just like we'd expect deaths of people wearing seatbelts to decline over time.

The mistake that many new users of traffic data make is getting very alarmed when they see that over years the number (and proportion) of dead people wearing belts (or children in car seats) is actually rising. And it's precisely because compliance wasn't instantly at 100%.

I'm not accusing the freakonomics guys of making this stupid a mistake. They aren't that ill-informed. But we see that kind of thing in print all the time and it just makes life tough because every time someone has to go explain it to decision-makers so they don't do stupid things like repeal safety belt or child seat laws based on methodologically unsound research.

I'm giving a talk about this at an upcoming meeting and I really kind of like the fact that I can bring it up to date by presenting Freakonomics as a case in point. Usually, I just use research that I've reviewed as part of the meeting and leave off the names. Or talk about bad stuff that specific advocacy groups have promoted as "research."

And I will say that the Freakonomics guys are correct when they say that sometimes advocacy groups have slanted their analyses. I've seen it with alcohol laws, cell phone bans, and support for mass transit. Stuff that just doesn't pass the laugh test. Except that newspapers pick it up and run major stories about how going from .10 BAC laws to .08 BAC laws will save hundreds of lives per year, or how cell phones are a leading cause of crashes, or that cities without mass transit show a higher proportion of citizens dying in automobile crashes than cities with mass transit.

(I love that last one. I wrote to the people promoting that research to point out that cities WITH mass transit have a MUCH HIGHER proportion of deaths of citizens in mass transit accidents than do cities without mass transit. I bet there are cities out there with ZERO mass transit deaths! Think of the lives saved!)

To me, none of these people are making mistakes in their statistical technique. It's all either in their research method or in their explanation of their results (or both).

And it almost always comes about because they don't consider the alternative explanations of their own data. If they had, they would've realized, usually (being honest folk for the most part) that the study they performed really doesn't answer the question they asked.

[/high horse]

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Toretha
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ersomniac- maybe they can't afford a car and need a carseat. People who get friends to drive them to work are still going to need to bring their kids places IN CARS.

Down here often you need a car just to have a job, cause public transportation sucks. Doesn't mean the people who have them aren't below poverty line, it just means they've found ways to manage it because if they don't they lose what job they have. Crappy cars, usually, but cars. It's not a sign of wealth to have a car.

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Mama Squirrel
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We were behind a car on the freeway a couple of weeks ago. There was a child in a car seat. That was good, but what was bad was that everytime there was a curve the car seat tilted to the side a few inches. It scares me every time I see something like that. I also hate it when I see the handle of the infant seat up while it is in the car. The handle should be down people!
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ketchupqueen
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Actually, the handle should be either all the way up or all the way down-- no where in between.

At least, that's what the instructions on our Graco carrier seat say.

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erosomniac
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quote:
It's not just the government, by the way. There are major auto manufacturers and car seat manufacturers that give out grants and free products. Chrysler is a major sponsor of car seat education in the US. It's good PR for them and really doesn't cost all that much.
A business-related decision is worlds different to me than the gov't distributing free car seats.

quote:
ersomniac- maybe they can't afford a car and need a carseat. People who get friends to drive them to work are still going to need to bring their kids places IN CARS.
That's true.

quote:
Down here often you need a car just to have a job, cause public transportation sucks. Doesn't mean the people who have them aren't below poverty line, it just means they've found ways to manage it because if they don't they lose what job they have. Crappy cars, usually, but cars. It's not a sign of wealth to have a car.
I think I'm just bitter because I've watched way, way too many people take advantage of gov't "support" systems, justifying it to themselves however they want. People getting food stamps because they're too lazy to work. People extending their food stamp allotment by lying to the gov't. People lying on their taxes or getting paid under the table to avoid them, then going and using a library or other public service. People and their families lying in an attempt to get college financial aid grants.

It really, really, REALLY bothers me. So much so that I am completely and totally in favor of removing ALL public support systems (yes, every single one) and implementing privatized everything.

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ketchupqueen
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That's ridiculous. You obviously haven't been following the saga of me trying to get prenatal care.
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fugu13
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Clearly removing the support from people who need it is far preferable to keeping support under the few people who exploit it.
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Mama Squirrel
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quote:
Actually, the handle should be either all the way up or all the way down-- no where in between.
The handle should be all the way up when carrying the child around and all the way down in the car. If it is up in the car and the car rolls it can splinter and stab the child in the seat.
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Vána
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quote:
The handle should be all the way up when carrying the child around and all the way down in the car.
Thank you, Mama Squirrel, I was just going to say that.

Also, Bob, Safe Kids Worldwide is the certifying body now, as of January 2005. I have my recertification letter and card right here in front of me. I wanted you to know that so you can refer people to the right agency.

And yes, there is a huge need for certified Child Passenger Safety technicians because the current statistics tell us that 4 out of 5 car seats are installed incorrectly, and that fifth one is usually a belt positioning booster. Of course, some of those seats only have minor installation mistakes, but the fact is that for the most part, even if you've read your car's manual and your child seat's manual, you still might not know that your seat is installed incorrectly. The directions are usually complicated and hard to understand. If it was easy, we wouldn't need a four day class to get our certification. [Smile]

This seems like a good place to plug having your seat inspected. Preferably, you will have it inspected every time you reinstall it (or, of course, if you get a new seat). You can find technicians in your area at Seatcheck.org. Or if you're in the area, just call me. [Smile]

Oh, one more thing before I get back to work, about cheap/free car seats. It is very strongly recommended that you not purchase a car seat at garage sales or second-hand stores like Goodwill. There is no way to know the history of the seat, which means you do not know if it has been in a crash before. There is not always visible damage to a seat that has been in a crash, but it can still be weakened. Also, seats that are over six years old should not be used, regardless of crash history.

Aside from deterioration/damage issues, the answer to "which seat is the best?" is always "the seat that fits your child, fits your car, and fits your budget." Those are your guidelines. Every single seat on the market has passed exactly the same safety standards. The price increases, as Bob pointed out, cover frills, not safety.

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Vána
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Hmm. I didn't intend to kill this thread...
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Bob_Scopatz
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Thanks VAiNA...(wow, I can't type that name at all!)

I didn't know that about SafeKids, Worldwide. I knew the people at AAA personally who took on the certification task back in the day. I just assumed that AAA was still doing it, even though those folks have left the building. My company helped them figure out their spreadsheet software (well, it was really kind of a bandaid, but it got the certs printed, and that was the crucial thing).

Anyway, thanks for the update.

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ketchupqueen
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quote:
The handle should be all the way up when carrying the child around and all the way down in the car. If it is up in the car and the car rolls it can splinter and stab the child in the seat.
Then how come my car seat instructions list two safe positions for use in the car?
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Bob_Scopatz
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The manufacturer HATES your children.
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ketchupqueen
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[Eek!] [Cry]
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