Child safety seat use in six Northwest American Indian communities: Baseline measures from the Native Children Always Ride Safe project

Background: Motor vehicle crashes are the leading cause of death for American Indian (AI) children. Proper use of age-appropriate child restraint systems can substantially reduce fatal injuries. Methods: We surveyed vehicles containing children age eight years old or younger traveling on or near six Northwest tribal reservations in spring, 2009. Drivers estimated the age and weight for each child passenger and we observed the type of restraint being used. We asked drivers their opinions about child safety seats and seat belt use in the community. Results: We collected information on 1854 children traveling in 1207 vehicles, 49% of whom were properly restrained, 29% were unrestrained, and 22% were incorrectly restrained. Sixty-one percent of drivers were wearing a seat belt. Children at increased risk of riding unrestrained or incorrectly restrained included six and seven year old children (odds ratio [OR]=9.1) and children who were riding: with an unrestrained driver (OR=3.5), with someone other than his or her own parent (OR=2.4), in areas with weak or no child passenger safety laws (OR=3.4), in trucks (OR=2.4), and with drivers age 50 or older (OR=2.3). Discussion: Data from this survey serve as a baseline to gauge the impact of interventions planned in the participating tribes. In addition, the six partner tribes will use formative data collected from elicitation interviews and focus groups to identify target areas for intervention. Results from this observational survey were also compared to a similar survey conducted in these same tribes in 2003.