Proper passenger restraint use linked to parental race

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1. White parents of children seen in Michigan emergency departments were more likely than nonwhite parents to report the use of age-appropriate child restraints in motor vehicles independent of socioeconomic factors.

2. A majority of parents of children over the age of 8, regardless of race, reported not always using age-appropriate booster seats.

Evidence Rating: 3 (Average)

Study Rundown: Motor vehicle crash-related injuries are the leading cause of death during childhood in the United States. Proper use of age-appropriate restraints reduces mortality, but compliance is far from optimal. To improve adherence, better understanding of the socioeconomic and cultural factors contributing to appropriate restraint use is necessary. This study adds to previous research indicating the role of race in use of child passenger restraints.  Parents of children 1-12 years of age, and treated at one of two Michigan emergency rooms were surveyed on the use of age-appropriate child restraints as defined by Michigan law. This data was validated in a subset of participants by direct observation of the restraint device in the vehicle by research assistants. A majority of parents of children over the age of 8, regardless of race, reported not always using age-appropriate booster seats. The generalizability of the data is limited by potential selection bias as only those parents in select emergency departments were surveyed. This study highlights several disparities that should be addressed in order to effectively targeted passenger restraint education.

Click to read the study in Pediatrics

Relevant Reading:  Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes

Study Author, Dr. Michelle L. Macy, MD, MS, talks to 2 Minute Medicine: The University of Michigan, Department of Emergency Medicine, The Child Health Evaluation and Research Unit, Division of General Pediatrics, The University of Michigan Injury Center

“Car crashes remain a leading cause of death for children in the United States. Children who are most severely injured in crashes tend NOT to be using recommended restraints. Health care providers can play an important role in changing this. Car seats, booster seats, and seat belts, used consistently and properly, can reduce crash-related injuries and have contributed to declining death rates.

Racial disparities in child safety seat use have persisted over time. We were surprised to find that racial disparities were not explained by differences in socioeconomic status or child passenger safety information sources.  Just one quarter of parents surveyed recalled receiving car safety information at their child’s last regular checkup.  Although many topics must be covered during a child’s doctor visit, our results show a continued need to address both the seat location and type of restraint to use with parents of 1 to 12 year olds.”

In-Depth [cross-sectional survey]: A total of 669 parents of children aged 1-12 years, seen at one of two emergency departments completed a survey on age-appropriate child passenger restraint use. The questionnaire asked study participants to identify their race, education, family income, and child restraint use; including use of seatbelts, booster seats and car seats. The study sample self-identified as 63.1% non-Hispanic white, 26.8% non-Hispanic black, 4.8% Hispanic, and 5.3% non-Hispanic other race. Of the initial study cohort, 131 parents had their child restraints verified by in-car inspection. White parents compared with nonwhite parents were significantly more likely to report consistent, age-appropriate restraint use for children ages 1-3 and 4-7 (85.3% vs 61.3%, 88.5% vs 69.1%, P<.001). In children over the age of 8, a minority of parents reported always using a booster seat (27.3% white, 28.6% nonwhite).

By Laurel Wickberg and Leah H. Carr
Reviewed by William V. Raszka, MD

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