title: Factors affecting tether use and correct use in child restraint installations.
abstract: BACKGROUND
  Field studies show that top tethers go unused in half of forward-facing child restraint installations.
  
  
  METHODS
  In this study, parent volunteers were asked to use the Lower Anchors and Tethers for Children (LATCH) to install child restraints in several vehicles to identify tether anchor characteristics that are associated with tether use. Thirty-seven volunteers were assigned to four groups. Each group tested two forward-facing child restraints in four of 16 vehicle models. Logistic regression models were used to identify predictors of tether use and correct use.
  
  
  RESULTS
  Subjects used the tether in 89% of the 294 forward-facing child restraint installations and attached the tether correctly in 57% of the installations. Tethers were more likely to be used when the anchor was located on the rear deck as typically found in sedans compared with the seatback, floor, or roof. Tethers were less likely to be attached correctly when there was potentially confusing hardware present. No vehicle tether hardware characteristics or vehicle manual directions were associated specifically with correct tether routing and head restraint position.
  
  
  CONCLUSIONS
  This study provides laboratory evidence that specific vehicle features are associated with tether use and correct use.
  
  
  CONCLUSIONS
  Modifications to vehicles that make tether anchors easier to find and identify likely will result in increases in tether use and correct use.
authors.affiliation: Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201, United States. Electronic address: jjermakian@iihs.org.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Jermakian
authors.affiliation: University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109, United States.
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Klinich
authors.affiliation: University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109, United States.
authors.forename: Nichole R
authors.initials: NR
authors.lastname: Orton
authors.affiliation: University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109, United States.
authors.forename: Carol A C
authors.initials: CA
authors.lastname: Flannagan
authors.affiliation: University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109, United States.
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Manary
authors.affiliation: University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109, United States.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Malik
authors.affiliation: University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109, United States.
authors.forename: Prabha
authors.initials: P
authors.lastname: Narayanaswamy
mesh_terms: D000328:Adult; D000368:Aged; D001336:Automobiles; D002648:Child; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010290:Parents; D012622:Seat Belts / Q000592:standards*; D012959:Socioeconomic Factors
keywords: Child passenger safety; Child restraints; Children; LATCH; Tether