A low proportion of Americans use appropriate automobile restraints for their children, according to a study published online Aug. 7 in American Journal of Preventive Medicine.
Child passenger restraints fall short in three specific areas: Few children ride in rear-facing seats after the age of 1 year, fewer than 2% of those aged 7 and older use a booster seat, and too many in all age groups sit in the front seat. In every age group, children of racial minorities showed much lower use of appropriate child passenger restraints than white children.
CDC/Amanda Mills
Few children are using the restraints recommended for their age group.
"The most important finding from this study is that, while age and racial disparities exist, overall few children are using the restraints recommended for their age group, and many children ... are sitting in the front seat," Dr. Michelle L. Macy of the department of emergency medicine, child health evaluation and research unit, University of Michigan, Ann Arbor, said in a press statement accompanying the report.
According to American Academy of Pediatrics guidelines for child passenger safety, children should remain rear facing in safety seats until at least 2 years of age, should transition to a forward-facing car seat with a five-point harness and continue to use it for as long as possible up to the highest weight or height allowed by the manufacturer, should then transition to a booster seat until they fit properly into an adult seat belt (usually age 11 or older), and should always ride in the back seat until age 13.
Dr. Macy and Dr. Gary L. Freed, also of the university, performed a secondary analysis of data collected by the National Highway Traffic Safety Administration in its annual nationwide surveys of the use of child passenger restraints in 2007, 2008, and 2009. This included direct observation of 21,476 children under age 13 as they were driven to community sites such as gas stations, fast food restaurants, recreation centers, and child care facilities, supplemented by brief interviews with the drivers.
The children were recorded as belonging to one of three mutually exclusive categories: those using age-appropriate child passenger restraints, children making a premature transition to restraints appropriate only to older children, and those using no restraints.
A total of 59% of the children were white, 11% were black, 21% were Hispanic, and 9% were of other races.
Overall, the use of appropriate automobile restraints was low. Even in the age group (infants and toddlers) and racial group (whites) most likely to use appropriate child passenger restraints, only 17% of children were found to be restrained according to AAP guidelines that were current at the time of the study.
Nearly all children in every racial group transitioned to a front-facing car seat well before age 2 years.
At ages 4 and 5 years, 16% of whites, 35% of blacks, 26% of Hispanics, and 27% of other racial groups were prematurely transitioned to adult seat belts, the investigators said (Am. J. Prev. Med. 2012 Aug. 7 [doi:10.1016/j.amepre.2012.05.023]).
Many children younger than age 6 were front-seat passengers, and the proportion rose with increasing age, the investigators said. One in seven 6- to 7-year-olds, one-fourth of 8- to 10-year olds, and more than a third of 11- to 12-year-olds rode in the front seat.
Minority race was the most predominant factor associated with inappropriate use of child passenger restraints, demonstrating "that not all children have been reached equally by community-based public education campaigns and the passage of child safety seat laws in 48 states," Dr. Macy and Dr. Freed said.
In this study, racial differences in seat belt use may have been a marker for disparities in socioeconomic status, education, or English proficiency. These factors may have interfered with a family’s ability to own safety seats or to access information on child passenger safety. Culturally specific programs are needed to address these issues, the investigators noted.
Several other factors also correlated with inappropriate use of child passenger restraints. Drivers who failed to use seat belts themselves were much more likely to forgo appropriate restraints for their child passengers. Drivers of cars, as opposed to drivers of vans or sport-utility vehicles, were less likely to use appropriate restraints for their child passengers. And drivers in the Midwest, as opposed to those in the Northeastern U.S., also were less likely to do so.
Child passengers of very young drivers (aged 16-24 years) also were less likely to be using appropriate restraints and more likely to be riding in the front seat. Vehicles with four or more child passengers were more likely to carry unrestrained child passengers and children in the front seat. This last factor might be attributable to the limited number of seat belt positions available in the back seat.