Factors associated with child safety seat use in Bangkok Metropolitan Region, Thailand

To understand factors associated with proper child safety seat (CSS) use in the Bangkok Metropolitan Region (BMR), Thailand, after the child restraint legislation and to provide evidence to inform policy for increasing proper CSS use.

A cross-sectional study was conducted. Primary caregivers of at least one child aged 0-6 years or height 135 cm or less, who own a car, reside in BMR, and achieve literacy in the Thai language were included. The recruitment was done by distributing posters with QR codes to access information sheets and online self-administered questionnaires both online and offline (Pediatrics outpatient and postpartum units at Ramathibodi Hospital; 273 public early childhood centers; and 102 kindergartens in Bangkok) between April and December 2024. The questionnaire comprised questions regarding demographic data, knowledge, attitude, practice, and other information about CSS. Data were compared between the proper and improper CSS users via Stata version 17.

330 respondents with a median (Q1, Q3) age of 38 (34, 41) years were included; most were female (83.2%) and residents of Bangkok (68.7%). Two hundred ninety-six respondents (89.7%) reported CSS usage, with 170 respondents reporting regular use (51.5%). Among respondents, 135 (40.9%) were categorized as proper users (regularly use an age-appropriate type of CSS and locate it on the back seat). Logistic regression showed factors associated with proper CSS used were higher household income (OR 9.97, 95%CI: [4.06-24.52], p < 0.001) and barriers to using CSS including child-related barriers (OR 0.10, 95%CI: [0.05-0.22], p < 0.001), caregivers-related barriers (OR 0.19, 95%CI: [0.04-0.99], p = 0.049), and car-related barrier (OR 0.38, 95%CI: [0.15-0.92], p = 0.031). The leading reported barriers to CSS use were children's refusal (42%) and the high cost of CSS (23%). The trusted sources of information regarding CSS were social media/internet (43%) and healthcare providers (34%). Respondents preferred educational intervention for improving knowledge (22%) and tax deduction policy (17%) to help increase CSS use.

After the child restraint legislation, the proper usage of CSS to ensure child safety was still low. Factors associated with proper CSS usage included higher household income and barriers to using CSS. Multilevel interventions and policies were suggested to address the issues. Further research could be done to evaluate the effectiveness of those measures and their impacts on increasing proper CSS usage in Thailand.