• Younger children are more likely to be restrained appropriately compared to older children. • 81.7% of seat belt only users had not yet reached the recommended height of 57 in. • Gaps in knowledge persisted for parents of 4–10-year-olds, despite previous attendance at seat checks. • Certain populations might benefit from targeted interventions for specific types of risky behaviors. Introduction: Seat belts and booster seats are effective at reducing the risk of death and injury for pediatric occupants of motor vehicles. The objective of this study was to conduct an online survey of booster seat-aged children to define appropriate versus inappropriate restraint use, identify high-risk behaviors, explore reasons for transitioning to new methods of restraint, and determine whether seat checks or riding with other drivers affects restraint behaviors. Method: A total of 3,026 parents and primary caregivers of children ages 4–10 years in the United States completed an online survey about their child’s passenger restraint type, knowledge and usage habits, reasons for using the restraint, and family demographics. Restraint type was categorized as appropriate or inappropriate based on reported child height and weight. Descriptive statistics, multivariable regressions, and chi-square tests were used to identify trends associated with various populations. Results: Restraint types were reported as rear-facing or forward-facing harness restraint (21.0%), booster seat (49.1%), seat belt alone (26.0%), and unrestrained (3.9%). Younger children were significantly more likely to be appropriately restrained and always seated in the rear seat compared to older children. Most “seat belt only” users (81.7%) had not yet reached the recommended height of 57 in.. Non-parent primary caregivers, those of lower socioeconomic levels, and Black Non-Hispanic families were significantly more likely to have children in an inappropriate restraint type. Allowing children to sit in the front row was significantly more likely among parents, especially highly educated males. Attendance at car seat checks was associated with appropriate restraint use, although gaps in booster seat-related knowledge persisted. Conclusion: Many children in the current study transitioned restraint types before meeting the recommended height or weight milestones, especially for the transition from booster to seat belt alone. Practical Applications: This work identifies populations who might benefit from targeted interventions for specific types of risky behaviors. Innovative intervention strategies should be explored.
Mansfield et al. (Fri,) studied this question.