Parents' knowledge, attitude, and use of child restraints in Shantou, China

Background
China has not adopted national policies for child safety restraints in cars, although children are increasingly traveling in cars.

Objective
To describe child restraint use, and parents’ knowledge of and attitude toward child restraint in Shantou, China.

Methods
An observational study and driver survey on child restraint use was conducted in the Southeast China city of Shantou in 2012. Observational sites included 22 middle schools, 31 primary schools, 24 kindergartens, and 4 hospitals. Drivers were asked about their knowledge of and attitude toward the use of child restraints. In September 2012, multivariate regression was used to evaluate the factors associated with increased child restraint use.

Results
Of 3333 children observed in vehicles, only 22 (0.6%) children were secured in child safety seats or booster seats and 292 (8.7%) children were wearing seatbelts. More than half (n=508, 56.1%) of the infants or toddlers were riding on the laps of adults. Of 1069 drivers who responded to the survey, more than 62% thought it was necessary to use child restraint while traveling in a car. The drivers’ higher education status (OR=1.56, 95% CI=1.07, 2.27) and seatbelt use (OR=4.00, 95% CI=2.56, 6.25) were associated with increased child restraint use. Parents (OR=0.55, 95% CI=0.34, 0.88) and male drivers (OR=0.61, 95% CI=0.46, 0.81) had reduced odds of children properly rear-seated.

Conclusions
Child restraint use is very low in China, although the majority of drivers had positive attitudes about child restraint. These findings indicate that child restraint policies and educational approaches are urgently needed in China.