153 Is child restraint legislation effective in Shenzhen, China?

Background A growing body of literature from high-income countries has indicated that the enactment of child restraint systems (CRS) legislation is a highly effective way to increase the use of CRS. However, evidence from low- and middle-income countries is still lacking. Objective This study aims to assess the effectiveness of local legislation regarding mandatory CRS use for child passengers enacted in 2015 in Shenzhen, China. Methods Data from two cross-sectional surveys conducted in community health service centers and kindergartens one year before and three years after the enactment of mandatory CRS legislation were used in this analysis. Temporal changes in CRS practices were investigated. Logistic regression models were used to examine the differences in CRS practices three years after the enactment of the legislation compared to the period before the legislation. Results A total of 3768 participants from 17 pre-legislation sites and 6748 from 48 post-legislation sites were included. The proportion of CRS possession and use increased from 27.8% (1047/3768, 95% CI: 26.4% to 29.3%) to 72.6% (4900/6748, 95% CI: 71.5% to 73.7%) and from 22.9% (864/3768, 95% CI: 21.6% to 24.3%) to 56.3% (3800/6748, 95% CI: 55.1% to 57.5%), respectively, with a decrease of appropriate CRS use from 75.9% (656/864, 95% CI: 72.9% to 78.7%) to 69.7% (2649/3800, 95% CI: 68.2% to 71.2%) after the implementation of CRS legislation. Significant differences in the distribution of the types of CRS by age group between the pre- and post-legislation samples were found. Conclusions The findings indicate a significant improvement in CRS possession and use in Shenzhen, three years after the enactment of mandatory CRS legislation. Further efforts to update the local legislation to provide specific guidelines for appropriate CRS use and implement targeted multifaceted interventions are needed to increase optimal CRS practices to realize its full benefit for better child passenger safety in Shenzhen. Meanwhile, this study also provides supportive evidence for the introduction of national laws mandating CRS use in China.