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Motor Vehicle Injury – Child Safety Seats: Laws Mandating Use

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of nine studies (search period through March 1998).

The review was conducted on behalf of the CPSTF by scientists from CDC’s Division of Unintentional Injury Prevention with input from a team of specialists in systematic review methods and experts in research, practice, and policy related to motor vehicle injury prevention.

Context

All 50 states, the District of Columbia, Guam, the Northern Mariana Islands, and the Virgin Islands have child safety seat laws in place. Each law specifies the children they cover in terms of age, height, weight, or a combination of these factors.

Summary of Results

More details about study results are available in the published evidence review pdf icon [PDF - 2.43 MB].

The systematic review included nine studies.

  • Fatal injuries decreased by a median of 35% (3 studies)
  • Fatal and nonfatal injuries combined decreased by a median of 17% (5 studies)
  • Observed child safety seat use increased by a median of 13 percentage points (3 studies)
  • Among the studies that evaluated the laws’ effects on injury rates, researchers found no differences in the effect size based on the age of children who were required to be in safety seats.

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.

Applicability

The results of these studies should be applicable to most child passengers in the United States. More specific information on applicability is not available because none of the studies looked at age, sex, race, socioeconomic status, or regional differences within states.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

  • Does the effectiveness of child safety seat laws vary depending on the requirements of different state laws?
  • Does effectiveness of laws vary depending on the intensity and visibility of regular enforcement in the state?
  • Would the threat of being charged with contributory negligence if an unrestrained child is killed or injured in a motor vehicle crash change the effectiveness of the law?
  • What role does information about laws play in compliance rates?
  • How can the effectiveness of a child safety seat law be maintained over time?
  • Is the intervention likely to increase or reduce misuse of child safety seats?
  • Are child passenger safety laws equally effective in all populations (e.g., racial and ethnic minorities, high- and low-income populations, or behavior change-resistant populations)?
  • Are laws effective in populations that already have high baseline safety seat use rates?
  • What are intervention costs?
  • Are child passenger safety laws cost-saving?
  • What is the return on investment for these interventions?

Study Characteristics

  • Laws evaluated in the included studies reported the following characteristics:
    • Primary enforcement. All laws allowed for primary enforcement, that is, a driver could be stopped for the sole purpose of being cited and fined for failure to comply with the child safety seat law.
    • Age requirements. The laws applied to children of various ages (e.g., some applied to children up to the age of 1 year, whereas others applied to children up to the age of 5 years).
    • Seating position. One study specified that the law applied only to children in the front seat; the remainder of the studies did not specify seating requirements.
    • Penalties. The various laws allowed for penalties, ranging from an oral warning to a $25 fine.
  • Studies evaluated the effectiveness of child safety seat laws enacted between 1978 and 1986 in all 50 states.
  • None of the studies examined other activities related to child safety seat laws, such as programs to lend seats to low-income families, levels of enforcement, or publicity about the law.

Publications

Zaza S, Sleet DA, Elder RW, Shults RA, Dellinger A, Thompson RS. Response to letter to the editor. American Journal of Preventive Medicine. 2002;22:330-1.

Sleet DA. Evidence based injury prevention: guidance for community action. In: Australian Third National Conference on Injury Prevention and Control. Australian Third National Conference on Injury Prevention and Control. Brisbane, Queensland, Australia; 1999.