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Disparities in age-appropriate child passenger restraint use among children aged 1 to 12 years
Michelle L Macy1, Rebecca M Cunningham, Ken Resnicow
1Department of Emergency Medicine.
Insights
Racial disparities in child safety seat and booster seat use persist, even after accounting for socioeconomic factors. Targeted interventions are needed to improve child passenger safety for all children, especially older ones.
Area of Science:
- Pediatric Safety
- Public Health
- Socioeconomic Disparities
Background:
- Racial disparities in child safety seat usage are documented.
- Previous research has not fully accounted for socioeconomic factors influencing these disparities.
Purpose of the Study:
- To investigate if socioeconomic status and information sources modify racial differences in age-appropriate restraint use.
- To identify specific areas for improving child passenger safety.
Main Methods:
- A cross-sectional survey of 601 parents of children aged 1-12 years was conducted.
- Data included self-reported safety practices, demographics, and information sources.
- Direct observation of restraint use was performed on a subset of children.
Main Results:
- White parents reported higher use of car seats and booster seats compared to nonwhite parents.
- Adjusted analysis showed white parents had higher odds of reporting age-appropriate restraint use.
- Booster seat use was low (<30%) for children 8-12 years old who were ≤4 feet, 9 inches tall.
Conclusions:
- Racial disparities in child passenger restraint use for children under 8 years require focused interventions.
- Improving booster seat and seat belt use, along with rear seating practices, can enhance safety for older children.
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%, κ = 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.
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