Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Age-appropriate child safety seat use in the United States is suboptimal, particularly among children older than 1 year. Minority children have higher rates of inappropriate child safety seat use based on observational studies. Explanations for observed differences include socioeconomic factors. WHAT THIS STUDY ADDS:White parents reported greater use of age-appropriate child safety seats for 1-to 7-year-old children than nonwhite parents. Race remained a significant predictor of age-appropriate restraint use after adjusting for parental education, family income, and information sources. abstract OBJECTIVE: Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources. METHODS:A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1-to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law. RESULTS:Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1-to 3-year-olds and booster seats for 4-to 7-year-olds compared with nonwhite parents. Regardless of race, ,30% of 8-to 12-year-old children who were #4 feet, 9 inches tall used a booster seat. White parents had higher adjusted odds (3.86, 95% confidence interval 2.27-6.57) of reporting age-appropriate restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, k = 0.74) between parent report of their child' s usual restraint and the observed restraint at emergency department discharge.CONCLUSIONS: Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children ,8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children.