Systematic review of child passenger safety laws and their associations with child restraint system use, injuries and deaths

Sartin, Emma B; Lombardi, Leah R; Mirman, Jessica H · 2021 · Crossref

DOI: 10.1136/injuryprev-2021-044196

archive: archived pipeline: cataloged verified

Get this paper ↗ (DOI — opens at the source; we link to it, we don't host it)

Summary

This systematic review evaluates the associations between child passenger safety legislation and three key outcomes: child restraint system (CRS) use, correct CRS use, and child passenger injuries or deaths. The study was motivated by the persistent burden of motor vehicle crashes on children and the widespread enactment of safety laws globally, despite high rates of CRS misuse and disparities in usage among racial, ethnic, and socioeconomic minority populations. The authors aimed to characterize how different policies influence these outcomes to inform future policy development and promote equitable safety results. The researchers conducted a systematic search of PubMed and PsycINFO for studies published between January 2004 and December 2020. They identified 19 studies from five countries (United States, Australia, Canada, Chile, and New Zealand) that assessed the impact of legislation on CRS behaviors or crash outcomes. Due to significant variability in study designs and data reporting standards, the authors opted against a meta-analysis, instead providing a detailed narrative synthesis of the findings in accordance with PRISMA guidelines. The review found that legislation is generally positively associated with increased CRS use, improved correct use, and reduced injuries and fatalities. For instance, studies in the U.S. and Canada reported substantial increases in restraint usage following the enactment of booster seat laws, with some U.S. states seeing nearly a three-fold increase in CRS use. Similarly, legislation in Chile and Australia was linked to reductions in injury rates and fatalities. However, the review highlighted critical nuances regarding correct use and equity. Several studies indicated that booster seat legislation sometimes led to premature transitions from harness seats to booster seats, particularly among younger children. Furthermore, the benefits of legislation were not uniformly distributed; studies in the U.S. found that while overall restraint use increased, correct use often declined or remained stagnant among Black and Latino caregivers, as well as those with lower incomes. In contrast, White caregivers saw significant improvements in correct use. The authors conclude that while child passenger safety laws are effective overall, they do not automatically produce equitable outcomes. The findings suggest that legislation alone is insufficient to address disparities in CRS misuse and injury rates among at-risk populations. The review underscores the need for complementary educational initiatives and targeted messaging to ensure accurate information reaches minority and low-income families. Future research must more rigorously evaluate specific legislative types and their differential impacts across demographic groups to support the development of policies that minimize adverse effects and promote transportation equity.

Provenance

The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed.

Summary generated by qwen3.6-27b-prismaquant on 2026-06-25; verification: verified_with_issues.

Topics

Ranked by relevance to this paper. Hover a topic for its definition.

• child passenger safety
• demographic disparities
• seat belt use