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. Suboptimal child passenger restraint practices contribute to crash-related injuries, which remain a leading cause of childhood death in the United States. 1 Children who are unrestrained or sitting in the front seat face the greatest risk for death in motor vehicle collisions (MVCs). 2-6 Age-appropriate child safety seat use reduces injury risk by 50% to 75% 7-9 and provides increased protection over seat belts in crashes. 7,9,10 Although child passenger safety practices in the United States have improved over time, [11][12][13] premature transitions to booster seats and seat belts persist, [13][14][15][16][17][18] and racial disparities exist. 8,17,[19][20][21][22][23] Minority children have higher directly observed rates of both being inappropriately restrained 8,20-22 and unrestrained 8,17,19,20 compared with white children. Driver minority race/ethnicity, lower education, and lower household income are associated with driver-repor...