# Tiny Cargo, Big Deal! An Adaptive ED-Based eHealth Intervention to Promote Correct and Consistent Size-Appropriate Child Passenger Safety Behaviors and Reduce Disparities

> **NIH NIH R01** · LURIE CHILDREN'S HOSPITAL OF CHICAGO · 2021 · $560,429

## Abstract

PROJECT SUMMARY
Motor vehicle collisions (MVCs) remain the leading cause of unintentional injury deaths among children in the
United States (U.S.) and racial/ethnic minority children are disproportionately impacted as suboptimal child
passenger safety behaviors are more prevalent in some communities. Existing universal approaches to
promote child passenger safety have fallen short of ensuring that all child passengers are correctly using size-
appropriate child passenger restraints according to guidelines published by the American Academy of
Pediatrics and the National Highway Traffic Safety Administration. Precision prevention programs are urgently
needed to improve child passenger safety behaviors among caregivers who have not been responsive to
guidelines, laws, and public education campaigns. The proposed research will test the efficacy of Tiny Cargo,
Big Deal (TCBD), an emergency department (ED)-based precision prevention intervention grounded in Self-
Determination Theory. TCBD integrates personalized counseling based on principles of motivational
interviewing (MI) and eHealth components including a tailored educational web application (app) and short
message service (SMS) communications with the goal of improving child passenger safety. We hypothesize
that by providing tailored child passenger safety education and personalized skills for restraint use in a manner
that supports autonomous motivation the TCBD intervention will be more efficacious than universal
approaches (laws/guidelines) for realizing correct use of size-appropriate child passenger restraints. The
primary outcomes, size-appropriate restraint use and the Child Passenger Safety Score (CPaSS), will be
assessed with direct observation at scheduled, in-person appointments and remote observation of digital
photographs submitted by caregivers in response to unscheduled text messages. We will test our hypothesis
using a randomized adaptive trial design with the following aims: Aim 1: To refine and verify the reliability of
elements in the 100-point CPaSS, a novel composite measure of child passenger safety. Aim 2: To test the
efficacy of the TCBD intervention compared to usual care for improving primary outcomes [i.e., size-
appropriate restraint (dichotomous) and CPaSS-D (numeric)] at 6 and 12 months. Aim 3: To use latent growth
curve models to identify characteristic trajectories for the CPaSS-R observed in digital photographs over the 12
study months and assess for correlates of the trajectory types. This innovative, theoretically grounded research
will have long-standing impact on child passenger safety by informing the best methods to increase correct use
of size-appropriate child restraint systems among caregivers of diverse backgrounds at the point they interact
with the health care system. The work has the potential for wide-scale implementation in the ED and for
translation to primary care offices, schools, and community settings with an ultimate goal of eliminating child...

## Key facts

- **NIH application ID:** 10242737
- **Project number:** 5R01HD092594-04
- **Recipient organization:** LURIE CHILDREN'S HOSPITAL OF CHICAGO
- **Principal Investigator:** Michelle Lea Macy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $560,429
- **Award type:** 5
- **Project period:** 2018-09-17 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10242737

## Citation

> US National Institutes of Health, RePORTER application 10242737, Tiny Cargo, Big Deal! An Adaptive ED-Based eHealth Intervention to Promote Correct and Consistent Size-Appropriate Child Passenger Safety Behaviors and Reduce Disparities (5R01HD092594-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10242737. Licensed CC0.

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