Child Restraint Use in Canadian Provinces With and Without Legislation in 2010

Objectives: When used correctly, child safety seats reduce the risk of injury to a child passenger compared to seat belts. The objectives of this study are to (1) describe restraint use among Canadian children ages 4-8 years in 2010; (2) compare child safety seat use between provinces with new legislation (post-2006), old legislation (pre-2006), and without legislation; and (3) compare child safety seat use rates from 2006 to 2010. Methods: Roadside observational surveys of child restraint use were performed in 2006 and 2010 using a nationally representative stratified sample. Proportions of restraint use, correct use (i.e., child safety seats and booster seats) in 4- to 8-year-old children was examined between 3 groups: provinces with new legislation (i.e., child safety seat legislation that included implementation of specific legislation for booster seat use for child passengers ages 4-8 years), old legislation, and no legislation. Results: There were 4048 children observed as passengers in motor vehicles. In provinces with new legislation, 84 percent (95% confidence interval [CI], 72.2-90.8) of children were restrained compared to 94.9 percent (95% CI, 93.0-96.7) in provinces with old legislation, and 81.8 percent (95% CI, 77.3-86.3) in provinces without legislation. Correct use of child restraint was 54.1 percent (95% CI, 48.0-60.3) in provinces with new legislation, 29.5 percent (95% CI, 25.9-33.2) in provinces with old legislation, and 52.0 percent (43.0-61.0) in provinces without legislation in 2010. Conclusion: The findings from this study suggest that child safety seat legislation has an impact on restraint use in Canada. Despite the increase in rates of child safety seat use in provinces with new legislation and stable rates in provinces with old legislation, use rates remain low. Injury prevention strategies including further surveillance, interventions, and enforcement of restraint use in children are important to decrease motor vehicle related injury and death.