Prevalence and predictors of booster seat use in Alberta, Canada

Abstract

OBJECTIVE: To determine the prevalence of booster seat misuse in a Canadian province and identify determinants of non-use. METHODS:A cross-sectional study using parking lot interviews and in-vehicle restraint inspections by trained staff was conducted at 67 randomly selected childcare centres across Alberta. Only booster-eligible children were included in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) are reported using unadjusted and adjusted logistic regression. RESULTS:Overall, 23% of children were not in a booster seat, and in 31.8% of cases there was evidence of at least one misuse. Non-use increased significantly by age, from 22.2% for children 2 years of age to 47.8% for children 7 years of age (p = 0.02). Children who were at significantly increased risk of booster seat non-use were those in vehicles with drivers who could not recall the booster seat to seatbelt transition point (OR: 4.54; 95% CI: 2.05-10.06) or drivers who were under the age of 30 (OR: 3.54; 95% CI: 1.45-8.62). A front row seating position was also associated with significantly higher risk of nonuse (OR: 18.00; 95% CI: 2.78-116.56). Children in vehicles with grandparent drivers exhibited significantly decreased risk of booster seat non-use (OR: 0.21; 95% CI: 0.05-0.85). CONCLUSION:Messaging should continue to stress that the front seat is not a safe place for any child under the age of 9 as well as remind drivers of the booster seat to seatbelt transition point, with additional emphasis placed on appealing to parents under the age of 30. Future research should focus on the most effective means of communicating booster seat information to this group. Enacting mandatory booster seat legislation would be an important step to increase both awareness and proper use of booster seats in Alberta.KEY WORDS: Child restraint systems; seatbelts; booster seats; car seats La traduction du résumé se trouve à la fin de l'article.Can J Public Health 2016;107(2):e155-e160 doi: 10.17269/CJPH.107.5254F or children to travel safely in an automobile, specialized restraint devices are required. Canadian guidelines state that in order to keep children safe in the vehicle they must be in a rear-facing seat until they weigh at least 22 lbs (10 kg), a forwardfacing seat until they weigh at least 40 lbs (18 kg) and a booster seat until they weigh at least 80 lbs (36 kg). 1 Parents are encouraged to keep children within each stage as long as possible, according to either these guidelines or the instructions specific to their seat. 1 In keeping with these national guidelines, all Canadian provinces with the exception of Alberta have enacted mandatory legislation addressing all three seat types and transition points. In Alberta, rear-facing and forward-facing seats are required by law, whereas booster seat use until at least 80 lbs (36 kg) carries a recommendation only. 2 Booster seats reposition the height and angle of the seatbelt tightly across the chest and lower on the waist, increasing protection from injury and death in the event of...