Since the enactment of the Kentucky child restraint law in 1982, the number of motor vehicle–occupant deaths among children aged 0–4 years has decreased 37%. A substantial proportion of this decline is attributed to the increased use of child safety seats (CSSs); in 1995, use of CSSs in Kentucky was 72%. In 1996 in the United States, although approximately 85% of infants and 60% of children aged 0–4 years were restrained, approximately 80% of CSSs were used improperly. The effectiveness of CSSs in preventing death and injury is reduced when they are used incorrectly. To estimate the rate for improper use of CSSs, the Kentucky Injury Prevention and Research Center analyzed data from observations and inspections of vehicles entering the main community shopping center parking lot during 1 day in each of two rural counties. This report summarizes the results of this study, which indicate that most children in CSSs were restrained improperly.

In both counties, an inspection area was set up within the parking lot, and two observers were placed at the entrance; other entrances were closed by traffic safety cones. Observers completed a survey form for each vehicle containing an occupant appearing to be aged 4 years, and every other vehicle with an occupant appearing to be aged 4 years was asked to participate in the interview/inspection process. When a driver agreed to participate, a consent form was signed and one researcher interviewed the driver and a second inspected the CSS. Interviews consisted of 16 questions related to the driver, the CSS, and the reason for the trip. Inspections addressed the type of CSS, position(s) of child(ren) in the vehicle, type of vehicle, and whether the CSS was used properly.

A total of 232 motor vehicles with an occupant aged £4 years were observed at the two sites. Of the 116 vehicles that were eligible for interview/inspection, 77 (66%) drivers agreed to participate. There were 87 child occupants in the 77 vehicles; 62 (81%) of the drivers were female, and 54 (70%) of the drivers were mothers of the children.

Of the 87 children, 69 (79%) were restrained, and 17 (20%) were restrained properly; 14 (16%) of the children were unrestrained. The restraint status of the remaining four children was undetermined because they were unrestrained at the time of inspection; although the adult occupants reported the children had been restrained before the inspection and interview, these four were not included in the analysis. A total of 73 instances of improper use were observed among the 52 improperly restrained children.

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