title: The impact of new legislation on child restraint system (CRS) misuse and inappropriate use in Australia.
abstract: OBJECTIVE
  The current study aimed to investigate the incidence of child restraint system (CRS) misuse and/or inappropriate use of CRS through an Australian CRS inspection program conducted by CRS fitting specialists between October 2004 and October 2011 and to determine whether CRS misuse and/or inappropriate use of CRS changed following new Australian legislation regarding CRS and motor vehicle restraint use for children aged 7 years and under.
  
  
  METHODS
  Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, a CRS fitting specialist inspected each child in their CRS while in their vehicle and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use of the child restraint(s) and or system(s).
  
  
  RESULTS
  Results are based on the inspection of 2674 CRS. Of all of the CRS inspected, the majority (79%) were reported as having at least one instance of misuse and/or inappropriate use. The most common forms of CRS misuse and/or inappropriate use observed were harness strap errors (twisted, poorly adjusted, and/or incorrectly positioned, 41%), seat belt errors (incorrectly routed, twisted, and/or incorrectly adjusted, 32%), and a missing or incorrect fitting of the gated buckle/locking clip (24%). Significant differences were found across the proportion of CRS misuse and/or inappropriate use across restraint types (infant restraint/forward-facing CRS/convertible [birth to 18 kg] CRS/convertible [8-26 kg] CRS/boosters [booster seat/cushion/booster with harness combination]), χ(2)(4) = 147.852, P < .001. CRS misuse and/or inappropriate use were most prevalent among convertible CRS (birth to 18 kg; 87%), forward-facing CRS (85%), and convertible CRS (8-26 kg; 81%), compared to infant restraints (73%) and booster seats (booster seats/cushions/boosters with H-harness combination; 65%). There was no significant difference in the proportion of CRS with misuse and/or inappropriate use across the pre- and post-legislation period (80% vs. 77%), χ(2)(1) = 1.545, P > .5.
  
  
  CONCLUSIONS
  Based on the findings of the current study, it was concluded that, despite the introduction of new, definitive CRS legislation, CRS misuse and/or inappropriate use remains widespread in Australia. The findings highlight the need for CRS education and legislation that include information on correct CRS use, as well as information on appropriate CRS use, in order to provide specialized protection for child vehicle occupants in the event of a motor vehicle crash.
authors.affiliation: Monash University Accident Research Centre, Monash University, Melbourne, Victoria 3800, Australia. Sjaanie.Koppel@monash.edu
authors.forename: S
authors.initials: S
authors.lastname: Koppel
authors.forename: J L
authors.initials: JL
authors.lastname: Charlton
authors.forename: C M
authors.initials: CM
authors.lastname: Rudin-Brown
mesh_terms: D001315:Australia; D002648:Child; D057207:Child Restraint Systems / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004868:Equipment Failure / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D012149:Restraint, Physical / Q000295:instrumentation / Q000331:legislation & jurisprudence*