title: Use of top tethers with forward-facing child restraints: observations and driver interviews.
abstract: OBJECTIVE
  Despite the safety benefits, many parents do not use top tethers with forward-facing child restraints. Detailed information was collected about why parents are not using tethers.
  
  
  METHODS
  The sample included 479 drivers who had forward-facing child restraints installed in passenger vehicles equipped with tether anchors. The survey was conducted primarily at shopping centers, recreation facilities, child care facilities, car seat check events, and health care facilities in mostly suburban areas surrounding Philadelphia, Washington, DC, Fredericksburg (VA), and Seattle. Drivers were surveyed about their knowledge and use of tethers and experience with child restraints. Tether use was observed to verify whether tethers were being used correctly.
  
  
  RESULTS
  Fifty-six percent of forward-facing child restraints were installed with the tether; 39% were installed with the tether used correctly. The tether was used with 71% of LATCH lower anchor installations and 33% of seat belt installations. Drivers who installed child restraints without tethers most often said they did not know about the tether or how to use it.
  
  
  CONCLUSIONS
  Although the tether use rate was slightly higher in the current research than in previous studies, many parents and caregivers still use forward-facing child restraints without attaching the tether. Because the main problem is lack of awareness of the tether or how to use it, public education should focus specifically on the safety benefits of tethers and how to use them.
  
  
  CONCLUSIONS
  Information about why caregivers fail to use top tethers is potentially useful to child restraint manufacturers, child passenger safety technicians, and others who work with parents to improve motor vehicle safety.
authors: Insurance Institute for Highway Safety, 988 Dairy Road, Ruckersville, VA 22968, United States. Electronic address: aeichelberger@iihs.org.
authors: Angela H
authors: AH
authors: Eichelberger
authors: TransAnalytics, LLC, Quakertown, PA, United States.
authors: Lawrence E
authors: LE
authors: Decina
authors: Insurance Institute for Highway Safety, 1005 N Glebe Rd., Suite 800, Arlington, VA 22201, United States.
authors: Jessica S
authors: JS
authors: Jermakian
authors: Insurance Institute for Highway Safety, 1005 N Glebe Rd., Suite 800, Arlington, VA 22201, United States.
authors: Anne T
authors: AT
authors: McCartt
mesh_terms: D001334:Automobile Driving / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D004219:District of Columbia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D015370:Infant Equipment; D010290:Parents / Q000523:psychology*; D015143:Philadelphia; D011482:Protective Devices; D036301:Qualitative Research; D012622:Seat Belts / Q000706:statistics & numerical data*; D013383:Suburban Population; D014768:Virginia; D014861:Washington
keywords: Child restraints; Interviews; LATCH; Observations; Tether use