Use and misuse of automobile child restraint devices.

OBJECTIVE To determine demographic, social, and behavioral characteristics that are associated with correct child restraint device (CRD) use. DESIGN Cross-sectional. SETTING Fast-food restaurant parking lots in southeastern Michigan. PARTICIPANTS Children younger than age 4 years and their drivers. SELECTION PROCEDURES Consecutive sample. INTERVENTION None. MEASUREMENTS/MAIN RESULTS Seven hundred seventeen child passengers were observed for 11 dimensions of CRD use and 661 of their drivers were interviewed. Three hundred ninety-four (55%) of the children were in CRDs, but 248 (63%) of those children were incorrectly restrained. A 43-point misuse index was constructed based on scores assigned for different types of misuse. Seven variables (ie, age of child, race of parent, driver as a parent, days driving, number of occupants, perceived comfort of CRDs, and belief that the social norm supports CRD use) were highly predictive of CRD use. In contrast, only three factors (ie, age of child, education of the driver, and knowledge of the CRD law) were minimally predictive of correct use. CONCLUSIONS Since correct use of CRDs represents such a complex behavior, the best strategy to address the widespread problem of CRD use may be through the design of less complicated CRDs.