A prospective, non-randomized study design was used. The settings used were (a) a pediatric urban health center, and (b) two Women, Infants and Children offices in Milwaukee, Wisconsin. Participants included 11,566 surveys collected over 18 months that spanned the pre-legislation and post-legislation time periods from February 2006 through August 2008. The study set out to assess appropriate child passenger restraint. The results showed that the changes in adjusted proper restraint usage rates for infants between the pre-law, grace period, and post-fine periods were 94%, 94%, and 94% respectively. For children 1-3 years old, the adjusted proper usage rates were 65%, 63%, and 59%, respectively. And for children 4-7 years old, the rates were 43%, 44% and 42%, respectively. There was a significant increase in premature booster seat use in children who should have been restrained in a rear- or forward-facing car seat (10% pre-law, 12% grace period, 20% post-fine; p < 0.0005). There was no statistically significant change over time in unrestrained children (2.1%, 1.7%, 1.7%, p = 0.7, respectively). The passage of a strengthened child passenger safety law with fines did not significantly improve appropriate restraint use for 0-7 year olds, and appropriate use in 1-7 year olds remained suboptimal with a majority of urban children inappropriately restrained. Although the number of unrestrained children decreased, we identified an unintended consequence of the legislation a significant increase in the rate of premature belt-positioning booster seat use among poor, urban children. (A) Reprinted with permission from Elsevier.
Abstract