Child restraint system use and misuse in six states.

This project addressed use and misuse of child restraint systems (CRS) in the nation. CRS use and critical misuse observations were collected in the Fall of 2002 for 5527 children less than 36 kg (80 pounds) in 4126 vehicles in six states: Arizona, Florida, Mississippi, Missouri, Pennsylvania, and Washington. Results showed that 62.3% of these children were restrained in a CRS; 25.9% were restrained in a safety belt (SB); and 11.8% were unrestrained. By weight class, CRS use was 97.1% for children less than 9 kg (20 pounds); 86.4% for children between 9 and 18 kg (20 and 40 pounds); 41.7% for children between 18 and 27 kg (40 and 60 pounds); and 10.9% for children between 27 and 36 kg (60 and 80 pounds). Overall critical CRS misuse was 72.6%. Most common critical misuses were loose harness straps and loose vehicle SB attachment to the CRS. Other types of CRS misuses were also observed and recorded in the study. Recommendations are provided for field observation techniques, periodic monitoring, and research for education and enforcement strategies.