Do tribal child safety seat laws work?

Objectives. Examine relationships between child safety seat use and state and tribal laws among Northwest American Indian child passengers in motor vehicles. Methods. We surveyed vehicles with child passengers in six tribes in Idaho, Oregon, and Washington. Children were classified as properly restrained, incorrectly restrained, or unrestrained. Associations between restraint use and law status were analyzed using binary logistic regression models for clustered data, adjusted for child, driver, and vehicle characteristics. Results. We observed 775 children traveling in 574 vehicles. Three tribes were subject to tribal restraint laws, two tribes were subject to state laws, and one tribe had no restraint law. Children subject to state law were 4.3 times more likely to be properly restrained than children under tribal law or no law. Children under state law were also 6.6 times more likely to be incorrectly restrained than those without a law, while children under tribal law were 2.4 times more likely to be incorrectly restrained than those with no law. Conclusions. Tribal seatbelt laws motivated drivers to use child safety restraints, but were not effective at getting children properly restrained. State laws were more effective than tribal laws at getting children restrained, both correctly and incorrectly. Potential reasons for the observed difference could be higher state fines and higher perceived risk of being ticketed by state, county, or local police. Interventions emphasizing appropriate restraint and enforcement of child passenger safety laws could increase proper child restraint use.