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Impact of Adult Safety-Belt Use on Restraint Use Among Children less than 11 Years of Age -- Selected States, 1988 and 1989

Motor-vehicle crashes are the leading cause of death among children and young adults in the United States and account for more than 1 million years of potential life lost before age 65 annually (1). Child safety seats and safety belts can substantially reduce this loss (2). From 1977 through 1985, all 50 states passed legislation requiring the use of child safety seats or safety belts for children. Although these laws reduce injuries to young children by an estimated 8%-59% (3,4), motor-vehicle crash-related injuries remain a major cause of disability and death among U.S. children (1), while the use of occupant restraints among children decreases inversely with age (84% usage for those aged 0-4 years; 57%, aged 5-11 years; and 29%, aged 12-18 years) (5). In addition, parents who do not use safety belts themselves are less likely to use restraints for their children (6). To characterize the association between adult safety-belt use and adult-reported consistent use of occupant restraints for the youngest child aged less than 11 years within a household, CDC analyzed data obtained from the Behavioral Risk Factor Surveillance System (BRFSS) during 1988 and 1989. This report summarizes the findings from this study.

Data were available for 20,905 respondents aged greater than or equal to 18 years in 11 states* that participated in BRFSS -- a population-based, random-digit-dialed telephone survey -- and administered a standard Injury Control and Child Safety Module developed by CDC. Of these respondents, 5499 (26%) had a child aged less than 11 years in their household. Each respondent was asked to specify the child's age and the frequency of restraint use for that child. The two categories of child restraint and adult safety-belt use in this analysis were 1) consistent use (i.e., always buckle up) and 2) less than consistent use (i.e., almost always, sometimes, rarely, or never buckle up). Data were weighted to provide estimates representative of each state. Software for Survey Data Analysis (SUDAAN) (7) was used to calculate point estimates and confidence intervals. Statistically significant differences were defined by p values of less than 0.05.

Each of the 11 states had some type of child restraint law. Of these, six (Arizona, Kentucky, Maine, Nebraska, Rhode Island, and West Virginia) had no law requiring adults to use safety belts; four (Idaho, Maryland, Pennsylvania, and Washington) had a secondary enforcement mandatory safety-belt law (i.e., a vehicle had to be stopped for a traffic violation before a citation for non-use of safety belts could be issued); and one state (New York) had a primary enforcement mandatory safety-belt law (i.e., vehicles could be stopped for a safety-belt law violation alone). In nine states, child-passenger protection laws included all children aged less than 5 years, but the other two states used both age and size of the child as criteria for mandatory restraint use. The analysis in this report subgrouped states into 1) those having a law requiring adult safety-belt use (law states), and 2) those without such a law (no-law states).

Overall, 21% of children aged less than 11 years reportedly were not consistently restrained during automobile travel. Both child restraint use and adult restraint use were significantly higher (p less than 0.05, chi-square test) in law states than in no-law states (81.1% versus 74.3% and 58.7% versus 43.2%, respectively).

High rates of restraint use for children aged less than or equal to 1 year were reported by both adults indicating consistent and less than consistent safety-belt use (Figure 1). Adults with consistent use reported high rates of child-occupant restraint use regardless of the child's age (range: 95.5% for 1-year-olds to 84.7% for 10-year-olds). In comparison, for adults reporting less than consistent safety-belt use, the rate of child-occupant restraint use declined sharply by the age of the child (range: 93.1% for 1-year-olds to 28.8% for 10-year-olds). When comparing children of consistent adult safety-belt users with children of less than consistent adult safety-belt users, 95% confidence intervals overlap for the two youngest age groups (i.e., aged less than 1 and 1 year).

Reported child-occupant restraint use in law states generally exceeded that in no-law states, regardless of age of child (Table 1). In addition, higher adult educational attainment was significantly associated with increased restraint use for children, a factor that has also been associated with increased adult safety-belt use (8).

Reported by: National Center for Injury Prevention and Control; National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report are consistent with others indicating that adults who do not use safety belts themselves are less likely to employ occupant restraints for their children (6,9). Because these nonbelted adults are at increased risk of crashing and more likely to exhibit other risk-taking behaviors, children traveling with them may be at greater risk for motor-vehicle injury (10).

Educational attainment of adult respondents was inversely associated with child restraint use in this report. Accordingly, occupant-protection programs should be promoted among parents with low educational attainment. Because low educational attainment is often associated with low socioeconomic status, such programs should be offered to adults through health-care facilities that serve low-income communities or through federal programs (i.e., Head Start) that are directed at parents with young children.

Injury-prevention programs emphasize restraining young children. In addition, however, efforts must be intensified to protect child occupants as they become older. Parents, especially those with low educational attainment, those who do not consistently wear safety belts, and those from states that do not have mandatory safety-belt use laws, should be encouraged to wear safety belts and to protect their children by using approved child safety seats and safety belts. Finally, the increased use of restraints among children may increase their likelihood of using safety belts when they become teenagers -- the age group characterized by the lowest rate of safety-belt use and the highest rate of fatal crashes (5).


  1. CDC. Childhood injuries in the United States. Am J Dis Child 1990;144:627-46.

  2. Partyka SC. Papers on child restraints: effectiveness and use. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1988; report no. DOT-HS-807-286.

  3. Guerin D, MacKinnon D. An assessment of the California child passenger restraint requirement. Am J Public Health 1985;75:142-4.

  4. Hall W, Orr B, Suttles D, et al. Progress report on increasing child restraint usage through local education and distribution programs. Chapel Hill, North Carolina: University of North Carolina at Chapel Hill, Highway Safety Research Center, 1983.

  5. National Highway Traffic Safety Administration. Occupant protection trends in 19 cities. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1991.

  6. Wagenaar AC, Molnar LJ, Margolis LH. Characteristics of child safety seat users. Accid Anal Prev 1988;20:311-22.

  7. Shah BV, Barnwell BG, Hunt PN, LaVange LM. Software for Survey Data Analysis (SUDAAN) version 5.50 {Software documentation}. Research Triangle Park, North Carolina: Research Triangle Institute, 1991.

  8. Lund AK. Voluntary seat belt use among U.S. drivers: geographic, socioeconomic and demographic variation. Accid Anal Prev 1986;18:43-50.

  9. Margolis LH, Wagenaar AC, Molnar LJ. Use and misuse of automobile child restraint devices. Am J Dis Child 1992;146:361-6.

  10. Hunter WW, Stutts JC, Stewart JR, Rodgman EA. Characteristics of seatbelt users and non-users in a state with a mandatory use law. Health Education Research 1990;5:161-73.

    • Arizona, Idaho, Kentucky, Maine, Maryland, Nebraska, New York, Pennsylvania, Rhode Island, Washington, and West Virginia.

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