title: Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance.
abstract: OBJECTIVE
  Little is known regarding the patterns of appropriate restraint use among minority children involved in motor vehicle collisions. The purpose of this study was to characterize patterns of restraint use among children hospitalized after motor vehicle collision and to examine the effects of race and socioeconomic status on compliance.
  
  
  METHODS
  All children admitted to our level I trauma center over a 10-year period were identified. Patterns of appropriate restraint use were compared between African American (AA) and white children. Compliance was also compared between children insured with Medicaid (as a surrogate for socioeconomic status) and those with private insurance coverage.
  
  
  RESULTS
  One thousand two hundred sixty-eight patients were included with an overall restraint use of 44.8% with only 20.3% restrained properly. Compared with white children, AAs were significantly less likely to be properly restrained (12.7% vs 22.2%, P < .001) or to be restrained by any means (28.8% vs 48.7%, P < .001). The greatest disparity between groups was observed in the use of car seats (16.0% vs 47.4%, P < .001). Medicaid patients were less likely to be restrained compared with those with commercial insurance (40.6% vs 48.3%, P = .022); however, race remained a significant predictor of noncompliance after controlling for the effect of insurance status.
  
  
  CONCLUSIONS
  These data demonstrate an alarming trend because nearly 80% of all children in our study were improperly restrained. Marked disparities in compliance were observed in the AA population even after controlling for insurance coverage. Future studies will need to further characterize the complex interplay between race and socioeconomic status with proper restraint use.
authors.affiliation: Division of Pediatric and Thoracic Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.forename: Colin A
authors.initials: CA
authors.lastname: Martin
authors.forename: Rebeccah L
authors.initials: RL
authors.lastname: Brown
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D018986:Motor Vehicles; D011050:Policy Making; D011336:Probability; D011482:Protective Devices / Q000706:statistics & numerical data*; D011640:Public Policy; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology