摘要：Objectives. We sought to estimate motor vehicle passenger restraint use among Northwest American Indian children 8 years old or younger and to determine factors associated with using proper (i.e., age and weight appropriate) passenger restraint systems. Methods. We surveyed vehicles driven by members of 6 tribes in Idaho, Oregon, and Washington. Associations between proper restraint and child, driver, and vehicle characteristics were analyzed using logistic regression for clustered data. Results. We observed 775 children traveling in 574 vehicles; 41% were unrestrained. Proper restraint ranged from 63% among infant seat-eligible children to 11% among booster seat-eligible children and was associated with younger child’s age (odds ratio (OR) per year = 0.60; 95% confidence interval (CI) = 0.48, 0.75), seating location (OR front vs rear=0.27; 95% CI=0.16, 0.44), driver seat belt use (OR=2.39; 95% CI=1.51, 3.80), and relationship (OR for nonparent vs parent=0.28; 95% CI=0.14, 0.58). More than half of drivers felt children could use an adult seat belt earlier than recommended guidelines, and 63% did not correctly identify whether their tribe had child safety seat laws. Conclusions. Children in these communities are inadequately restrained. Restraint use was exceedingly low among booster-eligible children and children riding with unrestrained adults. Interventions emphasizing appropriate restraint use and enforcement of passenger safety laws could reduce the risk of injury or death in motor vehicle accidents. Motor vehicle injuries are the leading cause of mortality among American Indian/Alaska Native (AIAN) children aged 1–4 years. 1 For AIAN children aged 8 years and younger, death rates from motor vehicle crashes are 3 times the national average. 2 , 3 AIAN children have an elevated risk for injury or death in a motor vehicle crash. In addition, there may be other factors (e.g., cultural, socioeconomic, political, legal) that hinder child safety seat use among American Indians/Alaska Natives. For example, in some rural communities, there may be very few retailers that carry safety seats, making access for American Indians/Alaska Natives difficult. The use of child safety seats has been proven to reduce child injury and death by 71% for infants and by 54% for toddlers (1–4 years old) in passenger cars. 4 Booster seats reduce the risk of serious injury by 59%. 5 Although all 50 states have enacted child safety seat laws, 6 many children are still inappropriately restrained, 7 – 9 and when restraint use is known, 53% of fatally injured children are completely unrestrained. 4 The enforcement of state child passenger safety laws on reservations is variable and depends on tribal agreements. Few studies have estimated the prevalence of child safety seat use among AIAN children or have ascertained barriers to use. A community child passenger safety assessment conducted among 3 Northwest tribes found that car seat use among children from birth to 4 years of age ranged from 12% to 21%. Car seat use among infants (71%–80%) exceeded use among children aged 1 to 4 years (5%–14%). 10 Restraint use among children age 5 and older was not evaluated, and no detailed information about the proper use of seats was provided. The goals of this study were (1) to estimate the prevalence of appropriate use of child safety seats among American Indian children 8 years old and younger in 6 Northwest tribal communities, (2) to determine child, driver, and vehicle characteristics associated with appropriate restraint of child passengers, and (3) assess driver knowledge of safety seat guidelines and laws in their communities.
