James and Kim used data gathered from Hawaii's Department of Transportation, consisting of police reports on motor-vehicle collisions from 1986-1991. The overall quality of police reports has been higher in Hawaii than in other states, due in large part to Hawaii's small size.

RESULTS

In motor-vehicle collisions involving children, researchers found the following:

• 52.29 percent of infants and 26.29 percent of toddlers were unrestrained,
• 45.84 percent of infants and 20.43 percent of toddlers were restrained in a safety seat, and
• 52.98 percent of toddlers wore seat belts.

The research further showed that as children aged, the use of child-safety seats decreased, despite the fact that Hawaiian law requires all children under three years be restrained by an approved child-safety seat. Specifically, 45.84 percent of infants, 38.34 percent of one-year-olds, and 29.87 percent of two-year-olds were secured in child-safety seats. In addition, when children reached the age of three, both the number of children restrained in child-safety seats and the number of unrestrained children went down. For children over three years of age, the number of seat belts used went up. The researchers concluded that "drivers apparently are inclined to restrain infants, 3- and 4-year-olds properly, but they are less likely to restrain 1- and 2-year-olds properly."

In matters of gender, female children were slightly less likely to be restrained, both as infants and toddlers. Female drivers were more likely to drive with unrestrained toddlers, whereas male drivers were more likely to drive with unrestrained infants. Vehicle-type differences were slight. Statistics showed that infants were more likely to be unrestrained in vans and toddlers more likely to be unrestrained in cars and trucks. Infants were also less likely to be restrained on freeways, in urban areas, and at night. While differences between infants and toddlers in the preceding areas were relatively small, the differences in injuries sustained were significant. James and Kim noted:

The ages of the drivers involved also revealed certain patterns. According to the authors, "[d]rivers between 20 and 34 are far more likely and drivers 35 to 54 are more likely to drive with unrestrained infants and toddlers than younger and older drivers."

The data also revealed that:

• children in automobiles were less likely to be restrained than children in trucks or vans;
• drivers who speed were less likely to restrain child passengers;
• drivers who use seat belts themselves were 27 times more likely to restrain their child passengers.

Overall, the older the child the more likely it was that he or she would be restrained, with the use of child safety seats going down and the use of seat belts going up as the age of the child increased. In general, children who were restrained were less likely to suffer nonincapacitating, incapacitating, or fatal injuries in rollover, rear-end, and broadside crashes.

CONCLUSIONS/IMPLICATIONS/RECOMMENDATIONS

One of the most significant findings of the study involved the correlation between adult seat-belt use and the use of child-safety restraints; namely "child restraint use is very strongly associated with adult-restraint use." In addition, the study showed that child-safety restraints were most effective in preventing injury in head-on, rear-end, and rollover collisions and less significant in broadside collisions. Head-on and rollover crashes have been shown to result in the most serious types of injuries.

The study revealed significant and conclusive facts. The authors pointed out:

Moreover, evidence of misuse was found to be substantial and primarily involved children restrained by seat belts when they should have been restrained by child-safety seats.

This study suggested the need for improvement in child-restraint use, particularly in view of Hawaii's child-restraint law. Efforts at increased education and enforcement of the law are promising. Enforcement is difficult, since police officers cannot readily determine the age of a child passenger and often cannot see a very young child passenger. Therefore, educational programs that encourage compliance with the law may have the most effect in improving child-restraint numbers. Such programs include giving away or loaning child-safety seats, and these programs may need expansion to include seats for older children.

Educational programs should ensure that drivers understand the seriousness of failure to comply with child-safety laws. However, one fact may hold the most promise for designing a successful safety program: adult drivers who use seat belts are more likely to restrain children. This suggests that more efforts are needed to increase adult belt use.