Traffic Safety Facts

Traffic Tech – Technology Transfer Series

U.S. Department of Transportation 1200 New Jersey Avenue SE., Washington, DC 20590

National Highway Traffic Safety Administration

Number 382 February 2010

Reducing Nonuse of Restraints by Children Ages 5 to 7

Background

NHTSA’s “Misuse of Child Restraints” study (DOT HS 809 

671) identified high rates of unrestrained children of booster 

seat age and weight. This project was undertaken in response 

to those findings, selecting 5- to 7-year-olds to target because 

of the higher rate of nonuse in that age range. The study 

objective was to suggest solutions to the problem of unrestrained children riding in motor vehicles.

Method

The study methodology entailed: (1) a literature review to 

identify factors associated with children’s nonuse of occupant restraints and potential interventions; (2) discussions 

with key informants to identify barriers to restraint use in 

this child population, and to recommend strategies to reduce 

nonuse; (3) a brainstorming session with experts to propose 

and prioritize strategies to reduce nonuse among identified 

high-risk populations; and (4) focus groups in four cities with 

adults observed transporting unrestrained children ages 5 to 

7 to discuss strategies to increase restraint use. The obtained 

information encompassed not just nonuse but also improper 

use (e.g., using a seat belt instead of a booster seat). 

Literature Review

Populations at higher socioeconomic levels are more likely 

to use child safety seats and booster seats than those at lower 

socioeconomic levels. In addition, research has shown child 

occupants of White drivers more likely than occupants of 

African-American and Latino drivers to use child safety seats 

and booster seats and less likely to be unrestrained. Findings 

regarding other demographic variables related to the driver 

have varied across studies and years. Regarding the child, 

the older and heavier the booster-seat-age child, the lower 

the likelihood the child will be riding in a child safety seat or 

booster seat.

Studies have found a number of factors to be associated with 

improper child restraint use including low perceived injury 

risk to the child, resistance by the child to using a booster 

seat, challenges to using a booster seat due to vehicle design 

or too many passengers, and cultural barriers among some 

groups. In addition, child restraint use has been found to be 

lower when the driver was unrestrained. The presence of a 

State booster seat law corresponds with a higher percentage 

of children using booster seats.

Studies have shown increases in child safety seat use from 

community-wide information and enhanced enforcement 

campaigns. The challenge of educational programs is to 

overcome the reasons parents and caregivers provide for not 

restraining their children when they ride in motor vehicles. 

Educational programs about booster seats and the child 

restraint law combined with booster seat giveaways have 

been successful in increasing booster seat use at pre-school 

programs in lower socioeconomic communities. Most educational programs aimed at increasing restraint use by young 

children have focused on parents and caregivers, using 

a multitude of strategies including rewards, one-to-one 

instruction, and distribution of educational material. Studies have shown that these programs on their own – without 

booster seat laws, enforcement, or loaner programs – have 

had little to mild success.

Discussions With Key Informants

The participating child passenger safety (CPS) professionals estimated that approximately 20% of the booster seat 

age children they observe—generally during car seat check 

events—are unrestrained. Although they reported encountering unrestrained children in all kinds of communities, 

their greatest concern was the number of unrestrained children among minorities, recent immigrants, and low income 

households. They also commonly observed unrestrained 

children in pickup trucks, older vehicles, and vehicles with 

many passengers. 

The CPS professionals noted that many parents and caregivers are unfamiliar with child restraint laws, have limited 

knowledge of proper restraint use, perceive minimal risk, 

report they cannot afford a booster seat or do not know where 

to buy one, or are permissive when children complain about 

being restrained. They also mentioned situational factors 

associated with booster-seat-age children riding unrestrained. 

Parents have told the CPS professionals it’s inconvenient to 

use booster seats, they are in a hurry, the booster seat does 

not fit in the back seat of the vehicle (because of other passengers or other child safety seats), there is no shoulder belt in 

the back middle seat to use with a booster seat, and children 

often disconnect the vehicle seat belt from its position over 

the booster seat. 
The CPS professionals were asked about their programs to 

encourage booster seat use. They said their programs emphasize injury and fatality as a result of failure to use proper 

restraints, and in many minority communities the programs 

include booster seat giveaways. They also convey the message that children ages 4 to 7 must be properly secured in 

booster seats until they are at least 8 years old or 4’ 9” tall. 

Brainstorming Session

A major theme from this session was that in many families, 

the children are “calling the shots.” Parents and caregivers 

need to reclaim authority in the area of safety. Parents also 

face a developmental barrier at this age as children want 

to be independent. They do not want to sit in booster seats 

because of peer pressure. The experts mentioned that people 

who don’t use restraints themselves and who don’t restrain 

their children don’t consider the possibility of being in a 

crash. They also said that low perceived risk is why many 

part-time users only restrain themselves and their children 

on longer trips. The experts stated that messages need to 

emphasize the necessity of buckling up on every trip. 

Other barriers to booster seat use included cost, lack of 

enforcement, and lack of a booster seat law. Participants 

who worked in law enforcement cited lack of judicial followthrough as a barrier for officers in writing tickets for booster 

seat violations. 

A consensus opinion was that individual differences in the 

target audience were larger than group differences, resulting 

in a need for a palette of messages. Such a palette of strategies to inform parents and caregivers should include message content that focuses on safety, risk, and enforcement.

Focus Groups

The focus group findings reinforced themes uncovered in 

the earlier phases of the study: Confusion about what proper 

child restraint means, unfamiliarity with booster seats and 

how they work, logistical difficulties in using booster seats, 

children’s resistance to using the seats, and perceived lack of 

enforcement of the child restraint law.

Participants were asked to rank six strategies in terms of 

their perceived ability to motivate appropriate restraint 

use by children ages 5 to 7. They ranked education as most 

effective, based on their perceptions that inconsistent use or 

nonuse results from innocent ignorance among people who 

would otherwise be dedicated to their children’s safety. The 

participants suggested using schools to reach children and 

their parents, and providing teachers with simple and clear 

material. They also suggested using law enforcement officers as guest speakers, and public safety events as venues 

for teaching about child restraint use, especially where goods 

and services relating to children are provided. Communication was the second-ranked strategy, as participants believed 

most people would use child restraints if they fully understood the risks of not doing so. They believed it important 

to raise the sense of (injury) risk, eliminate confusion about 

what restraint to use, educate the public on the law and associated penalties, and raise the level of concern about getting 

caught by law enforcement. 

Greater enforcement of the child restraint law ranked third, 

followed by demonstration of proper child restraint use, 

and a stronger child restraint law. Assistance to low-income 

households ranked sixth (it was perceived as being adequately addressed). Participants thought enforcement of the 

child restraint law would be more effective if the following 

conditions were met: Greater public knowledge of the law’s 

provisions; a perceived increase in efforts to enforce the law 

(e.g., greater use of checkpoints and more publicity about 

their existence); and a substantial increase in fine amounts 

and applied points. 

How to Order

For a copy of Identifying Strategies to Reduce the Percentage of Unrestrained Young Children (40 pages plus appendices) prepared by TransAnalytics, LLC, write to the Office 

of Behavioral Safety Research, NHTSA, NTI-130, 1200 New 

Jersey Avenue SE., Washington, DC 20590, or send a fax to 

202-366-7394, or download from www.nhtsa.gov. Alan Block 

was the project manager for this study. 

TRAFFIC TECH is a publication to disseminate information 

about traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as you 

wish. If you would like to receive a copy, contact Dr. Angela 

Eichelberger, Editor, by sending a fax to 202-366-7394, or e-mail 

angela.eichelberger@dot.gov. 

1200 New Jersey Avenue SE., NTI-130

Washington, DC 20590