title: Parent driver characteristics associated with sub-optimal restraint of child passengers.
abstract: OBJECTIVE
  To identify parent driver demographic and socioeconomic characteristics associated with the use of sub-optimal restraints for child passengers under nine years.
  
  
  METHODS
  Cross-sectional study using in-depth, validated telephone interviews with parent drivers in a probability sample of 3,818 vehicle crashes involving 5,146 children. Sub-optimal restraint was defined as use of forward-facing child safety seats for infants under one or weighing under 20 lbs, and any seat-belt use for children under 9.
  
  
  RESULTS
  Sub-optimal restraint was more common among children under one and between four and eight years than among children aged one to three years (18%, 65%, and 5%, respectively). For children under nine, independent risk factors for sub-optimal restraint were: non-Hispanic black parent drivers (with non-Hispanic white parents as reference, adjusted relative risk, adjusted RR = 1.24, 95% CI: 1.09-1.41); less educated parents (with college graduate or above as reference: high school, adjusted RR = 1.27, 95% CI: 1.12-1.44; less than high school graduate, adjusted RR = 1.36, 95% CI: 1.13-1.63); and lower family income (with $50,000 or more as reference: <$20,000, adjusted RR = 1.23, 95% CI: 1.07-1.40). Multivariate analysis revealed the following independent risk factors for sub-optimal restraint among four-to-eight-year-olds: older parent age, limited education, black race, and income below $20,000.
  
  
  CONCLUSIONS
  Parents with low educational levels or of non-Hispanic black background may require additional anticipatory guidance regarding child passenger safety. The importance of poverty in predicting sub-optimal restraint underscores the importance of child restraint and booster seat disbursement and education programs, potentially through Medicaid.
authors.affiliation: Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. flaura@mail.med.upenn.edu
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: Irene G
authors.initials: IG
authors.lastname: Chen
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith
authors.forename: Michael R
authors.initials: MR
authors.lastname: Elliott
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D001334:Automobile Driving; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D010290:Parents / Q000523:psychology*; D016012:Poisson Distribution; D012307:Risk Factors; D012449:Safety; D012622:Seat Belts / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology