摘要：Objectives. 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. Despite advances in restraint technology and improved laws, motor vehicle injury still remains the leading cause of death for children aged between 3 and 14 years. 1 American Indian and Alaska Native (AI/AN) children experience higher mortality rates from motor vehicle crashes than other races, nearly twice the national average. 2,3 This is, in part, a result of riding unrestrained or improperly restrained in vehicles. According to 2002 Fatal Accident Reporting System data, fewer fatally injured occupants were restrained in crashes that occurred in tribal jurisdictions (16%) than in crashes that occurred in other areas of the nation (38%). 4 In a 2003 vehicle observation survey, the majority of AI/AN children were observed riding unrestrained (41%) or improperly restrained (30%) in 6 Northwest tribal communities (Idaho, Oregon, and Washington). 5 In that study, only 11% of booster seat–eligible children were properly restrained. These figures were much lower than those reported for other populations during the same time frame. 6,7 Less frequent use of proper restraints among AI/AN children may be a result of a combination of factors, 7–11 and AI/AN parents and other caregivers who travel with unrestrained or improperly restrained children face barriers to consistent use that may differ from those in other US communities. These would likely include legal and law enforcement differences, 12,13 but could also include cultural beliefs, family and community structure, geographic location, and economic factors. 5 In response to data from the 2003 study, 5 the 6 participating Northwest tribes collaborated to form Native Children Always Ride Safe (Native CARS), a community-initiated intervention study designed to improve child passenger restraint use in tribal communities. We present data from a vehicle observation study conducted in 2009 in these tribes. We contrasted data from the 2003 and 2009 surveys to determine change in proper restraint over time, and examined correlates of improper restraint from the 2009 data to help inform intervention planning in the tribes.
