Motor Vehicle Injury Child Safety Seats: Laws Mandating Use
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends child safety seat laws to increase their use.
The full CPSTF Finding and Rationale Statement and supporting documents for Motor Vehicle Injury Child Safety Seats: Laws Mandating Use are available in The Community Guide Collection on CDC Stacks.
Intervention
Child safety seat laws require children use federally approved infant or child safety seats when riding in a motor vehicle. Requirements vary by state based on a child’s age, weight, and height. Enforcement guidelines and penalties also vary, though law enforcement in all states can stop drivers if child passengers are not properly restrained.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of nine studies (search period through March 1998).
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.
Summary of Results
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
- 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?
Implementation Considerations and Resources
- Engage partners throughout the process. Building support from the ground up can help secure policies that reinforce healthy behaviors in the community.
- Demonstrate why the policy is important. Use CPSTF findings and recent surveillance data to show partners how policies have been effective, and explain how strengthening them could further improve health outcomes in their community.
- Educate stakeholders. Keep the media, community influencers, and policymakers informed about child passenger safety to help communicate messages that are accurate and timely.
- Keep messages brief and to the point. Use graphics, figures, or infographics to clearly demonstrate how the intervention can improve health outcomes.
- Extend your communication reach by working through partners who have the most credibility with key audiences.
- Pay attention to sustainability. Continue to monitor child passenger safety seat use and share findings.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.