title: Trends and correlates of child passenger restraint use in 6 Northwest tribes: the Native Children Always Ride Safe (Native CARS) project.
abstract: OBJECTIVE
  We compared proportions of children properly restrained in vehicles in 6 Northwest American Indian tribes in 2003 and 2009, and evaluated risks for improper restraint.
  
  
  METHODS
  During spring 2009 we conducted a vehicle observation survey in Oregon, Washington, and Idaho tribal communities. We estimated the proportions of children riding properly restrained and evaluated correlates of improper restraint via log-binomial regression models for clustered data.
  
  
  RESULTS
  We observed 1853 children aged 12 years and younger in 1207 vehicles; 49% rode properly restrained. More children aged 8 years and younger rode properly restrained in 2009 than 2003 (51% vs 29%; P < .001). Older booster seat-eligible children were least likely to ride properly restrained in 2009 (25%). American Indian children were more likely to ride improperly restrained than nonnative children in the same communities. Other risk factors included riding with an unrestrained or nonparent driver, riding where child passenger restraint laws were weaker than national guidelines, and taking a short trip.
  
  
  CONCLUSIONS
  Although proper restraint has increased, it remains low. Tribe-initiated interventions to improve child passenger restraint use are under way.
authors.affiliation: Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, OR 97201, USA. jlapidus@npaihb.org
authors.forename: Jodi A
authors.initials: JA
authors.lastname: Lapidus
authors.forename: Nicole Holdaway
authors.initials: NH
authors.lastname: Smith
authors.forename: Tam
authors.initials: T
authors.lastname: Lutz
authors.forename: Beth E
authors.initials: BE
authors.lastname: Ebel
mesh_terms: D002648:Child; D057207:Child Restraint Systems / Q000639:trends*; D002675:Child, Preschool; D005260:Female; D006293:Health Promotion; D006306:Health Surveys; D006801:Humans; D007061:Idaho; D007198:Indians, North American; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009922:Oregon; D012307:Risk Factors; D012622:Seat Belts / Q000331:legislation & jurisprudence / Q000639:trends*; D014861:Washington