Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

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%, k = 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. Pediatrics 2014; 133: 262-271