Safety Restraint Research Articles

A note on Tesla's revised safety report crash rates

Between June 2018 and December 2023, Tesla released quarterly safety reports citing average miles between crashes for Tesla vehicles. Prior to March 2021, crash rates were categorized as (1) with their SAE Level 2 automated driving system Autopilot engaged, (2) without Autopilot but with active safety features such as automatic emergency braking, and (3) without Autopilot and without active safety features. In January 2023, Tesla revised past reports to reflect their new categories of with and without Autopilot engaged, in addition to making small adjustments based on recently discovered double counting of reports and excluding previously recorded crashes that did not meet their thresholds of airbag or active safety restraint activation. The revisions are heavily biased towards no-active-safety-features—a surprising result given prior research showing that drivers predominantly keep most active safety features enabled. As Tesla's safety reports represent the only national source of Level 2 advanced driver assistance system crash rates, clarification of their methods is essential for researchers and regulators. This note describes the changes and considers possible explanations for the discrepancies.

Identifying neonatal transport research priorities: a modified Delphi consensus

ObjectivesWith increasing advances in neonatal transport, a focused research strategy is required to increase the evidence base towards providing optimal care. We aimed to identify the most important neonatal transport...

Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions

ObjectivesSafety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study...

Exploring variations and temporal instability of factors affecting driver injury severities between different vehicle impact locations under adverse road surface conditions

The adverse road surface condition has been identified as an important factor resulting in serious casualties and property losses in traffic accidents, and there is a tremendous need to uncover the interaction mechanism between deteriorating road surfaces and vehicle impact locations on the driver injury severity at a disaggregate level. In this paper, three groups of random parameters logit models with heterogeneity in means (and variances) are developed to investigate the unobserved heterogeneity and temporal stability of the determinants affecting driver injury severity outcomes across different damage locations among single-vehicle crashes that occurred under adverse weather conditions. A three-year crash dataset gathered from January 1, 2015, to December 31, 2017, in Ohio is utilized. Three crash injury severity categories including no injury, minor injury, and severe injury are identified as outcome variables, while crash characteristics, driver characteristics, temporal characteristics, vehicle characteristics, roadway characteristics, and environment characteristics are regarded as potential predictors influencing driver injury severities. Additionally, likelihood ratio tests and marginal effects are used to assess the temporal instability and impact location non-transferability of the explanatory variables. The results indicate an overall temporal and locational instability of model estimates while several determinants are identified to have consistent effects on injury severity outcomes such as animal-involved collisions, old drivers, safety restraint usage, female drivers, physically impaired drivers, and vehicles with insurance. This study also quantifies and characterizes the net effect of year-to-year and location-to-location shifts through probability differences between out-of-sample predictions and within-sample observations. Varying magnitudes and inconsistent directions of distribution characteristics (mean, skewness, kurtosis, and prediction accuracy) in the probability differences across different impact locations over time are captured. Moreover, this study indicates that the non-transferability of collision locations has a greater impact on the prediction accuracy than the temporal instability. The findings could potentially serve as a reference for transportation administrators to formulate effective safety strategies to better protect drivers from adverse-road-related crashes.

Comparison of Head, Neck, and Chest Injury Risks between Front and Rear-Seated Hybrid III 50th-Percentile Male ATDs in Matched Frontal NCAP Tests

<div>The objective of this study was to compare head, neck, and chest injury risks between front and rear-seated Hybrid III 50th-percentile male anthropomorphic test devices (ATDs) during matched frontal impacts. Seven vehicles were converted to rear seat test bucks (two sedans, three mid-size SUVs, one subcompact SUV, and one minivan) and then used to perform sled testing with vehicle-specific frontal NCAP acceleration pulses and a rear seated (i.e., second row) Hybrid III 50th male ATD. Matched front seat Hybrid III 50th male ATD data were obtained from the NHTSA Vehicle Crash Test Database for each vehicle. HIC15, Nij, maximum chest acceleration, and maximum chest deflection were compared between the front and rear seat tests, as well as between vehicles with conventional and advanced three-point belt restraint systems in the rear seat. Additionally, a modified version of the NCAP frontal star rating was calculated for the front and rear seat tests. All injury metrics, except for chest acceleration, were higher in the rear seat compared to the front. In addition, injury thresholds were exceeded or nearly exceeded in the rear seat for Nij in three vehicles, chest acceleration in one vehicle, and chest deflection in three vehicles, while no thresholds were exceeded in the front seat. When comparing advanced and conventional restraints in the rear seat, all injury metrics were higher in the vehicles with conventional restraints. All vehicles with conventional restraints in the rear had a star rating of 1, while those with advanced restraints in the rear ranged from 2 to 3. Conversely, all vehicles had 5 stars for the front seat, except one that had 4 stars. Overall, these data highlight the disparity between front and rear seat occupant protection and the benefits of advanced rear seat safety restraints, and the need for future testing.</div>

Factors associated with booster seat use among Indigenous peoples in Canada

Objective Booster seat use among the general population remains relatively low, despite their effectiveness in preventing injury among children when involved in motor vehicle collisions. Given the prevention of injuries that booster seats provide, understanding the factors that hinder or facilitate the use of these seats is critical, particularly in communities that are often overlooked when conducting general population studies. To date, no studies have examined the prevalence and predictors of booster seat use among Indigenous peoples in Canada. The purpose of this study was to examine the use of booster seat use among Indigenous peoples across Canada and the factors that impact their use. Methods Data were collected from a survey of participants from First Nations communities and organizations serving Indigenous peoples nationwide. Hypotheses arising from known predictors of booster seat use across the general population were tested using logistic regression models. Results The strongest predictor of booster seat use, even when all other study factors were accounted for, was the reduction of barriers related to the use of booster seats, such as a child’s resistance to being placed or staying in the passive safety restraint or a parent, guardian, or other caregiver being unwilling to use or unsure of how to install/setup the booster seat. Conclusion Most Indigenous participants consistently used booster seats to safely secure children being transported in vehicles. However, this compliance rate is well below that of the general population. Accessibility and affordability of child safety restraints and/or children’s refusal to use booster seats, as well as having more than 1 child to secure, were identified as mitigating factors. Access to and the affordability of booster seats, coupled with clear and understandable information on how to use them, are critical components to compliance. Raising awareness among Indigenous peoples communities regarding the importance of using booster seats is imperative. To achieve this, Indigenous peoples must lead discussions to ensure that child safety strategies not only are based on research and best practices but are culturally connected and community driven. Through meaningful collaboration, vehicle-related injuries and mortality among Indigenous children can be significantly reduced.

Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children.

Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC. A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint. Inappropriately restrained patients were older (5.1years v. 3.6yrs, P < .001) and weighed more (44.1lbs v. 35.3lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different. African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences.

Car Safety Seats and Restraints for Children in Al Ahsa, Saudi Arabia: Knowledge, Attitudes, and Practices

Background: Injuries caused by road traffic are a significant public health concern. In the 0-12-year age group, among the leading causes of death, unintentional injuries are considered the second and main cause of morbidity due to the safety of children in cars. According to statistics, approximately 4.7% of deaths in Saudi Arabia are caused by road traffic, while fatalities from road traffic do not exceed 1.7% in Australia, the United Kingdom, or the United States. Road traffic injuries killed more people in Saudi Arabia than in any other country with a high income. Aim: In this study, parents' knowledge, attitudes, and practices were evaluated regarding child safety regarding child car seats in Al Ahsa community. Methods: A cross?sectional descriptive study was done from November 10 to December 31, 2022. The data were collected using a 19-question survey. A convenience sampling of 379 samples was conducted. Results: In one-quarter of the participants, (24.8%) had the wrong answer when we asked them whether it is safer to hold a newborn baby in their arms than placing them in baby car safety seats, while (5.8%) did not know what is safe. Regarding the knowledge about the right way to put the car safety seat for children aged 2-4 years, near to one quarter (23%) answered wrong answer, while (11.1%) did not know how to fix it in the car. In relation to fixing the car safety seat for children aged below 2 years, only half the participants (54.6%) knew the right way. The mean score of knowledge was 3.37/5 with Std dev. ±1.52.in relation to practices and attitudes, (11.9%) said that the child is afraid to sit in the back seats, while (68.3%) said they do. (92.9%) of respondents believe that child safety seats are important. (14%) reported not using the seatbelt for children while (18.7%) reported using it sometimes. (67.3%) of those surveyed reported using seatbelts for all their children under the age of eight. There were (66.6%) of participants with acceptable knowledge and attitude scores, while (31.4%) had low scores. Parents' education level and their knowledge level were found to be significantly correlated. Parents' knowledge about care safety increased with the number of children, but there was no significant correlation between knowledge level and gender or number of children. Conclusion: According to the study, car safety seat noncompliance includes multiple variables that can be modified. The study could raise awareness by focusing on a major public health issue and providing outreach on child safety in cars. Residents of Al Ahsa generally had a positive attitude and good knowledge of car safety seats.

Safe Pediatric Ground Ambulance Transport

Background: Ambulance crashes that result in child injury or death are preventable with the use of proper restraints. This systematic review assesses aspects relevant to the proper use of pediatric restraints: EMS professionals’ resources and training, knowledge, attitudes, and behaviors. It also identifies barriers to using restraints.&#x0D; Methods: PubMed and Web of Science were searched using free-text search terms between the years 2000 and 2020. Inclusion criteria included human research, pediatric population, ambulance as the mode of transportation, peer-reviewed journals, and English full-texts. After initial screening and inclusion, a snowball methodology was used to further identify potentially relevant articles. The methodology was carried out by two independent reviewers. &#x0D; Results: The original search yielded 80 publications after de-duplication between databases, and two additional articles were identified independently of the search through snowball sampling. Four publications met inclusion criteria for final analysis. Two studies were survey-based among EMS personnel aiming to identify knowledge, behaviors, and barriers to child transport. One study used qualitative data collection by interviews of ambulance personnel. The final study was a combination of survey and observational data. Of note, there were no studies that evaluated an intervention.&#x0D; Conclusion: Based on this review, there is a lack of research in the realm of safe pediatric ambulance transport. There is a need for quality improvement studies to address the barriers that were identified by previous literature and to improve the overall safety and compliance of pediatric safety restraints during transportation to the hospital.

Efficient simulation strategy to design a safer motorcycle

This work presents models and simulations of a numerical strategy for a time and cost-efficient virtual product development of a novel passive safety restraint concept for motorcycles. It combines multiple individual development tasks in an aggregated procedure. The strategy consists of three successive virtual development stages with a continuously increasing level of detail and expected fidelity in multibody and finite element simulation environments. The results show what is possible with an entirely virtual concept study—based on the clever combination of multibody dynamics and nonlinear finite elements—that investigates the structural behavior and impact dynamics of the powered two-wheeler with the safety systems and the rider’s response. The simulations show a guided and controlled trajectory and deceleration of the motorcycle rider, resulting in fewer critical biomechanical loads on the rider compared to an impact with a conventional motorcycle. The numerical research strategy outlines a novel procedure in virtual motorcycle accident research with different levels of computational effort and model complexity aimed at a step-by-step validation of individual components in the future.

A Bayesian Approach to Examine the Impact of Pavement Friction on Intersection Safety

The safety of intersections has been the focus of many studies since intersections are considered hazardous zones of road networks. Identifying the main contributing factors of severe traffic crashes at intersections is crucial to implementing appropriate countermeasures. We investigated the major contributing factors to crash injury severity at intersections, particularly pavement surface friction. Nine years of intersection crash data in Wyoming have been analyzed for this study. The random forest technique was employed to identify the importance of critical variables influencing crash injury severity risk. Subsequently, a Bayesian ordinal probit model was applied to examine the relationships between crash injury severity risk and these crash contributing factors. As per the random forest model’s results, pavement friction has a strong impact on crash injury severity risk along with using safety restraints, intersection type, signalized or unsignalized, reckless driving, and crash type. The results of the Bayesian model demonstrated that higher pavement surface friction levels and proper use of restraints reduced the likelihood of severe injury. Based on these findings, several countermeasures may be proposed, such as those pavement friction requirements, driver’s education, and traffic law enforcement to mitigate injury severity concerns at intersections.

Single-Vehicle Run-Off Road Crashes Because of Cellphone Distraction: Finding Patterns with Rule Mining

A wide array of literature strongly indicates a higher likelihood of roadway departure because of cellphone use; however, patterns of associative attributes in single-vehicle run-off-road (SVROR) crashes because of cellphone distraction remained unexplored. Using the association rule mining (ARM) method, this study aimed to identify the variable categories that concurrently occur in such crashes, visualize the structures representing those concurrent associations, and discuss the crash patterns associated with different severity types. The SVROR crashes with cellphone use by the driver at fault were highlighted to be strongly connected to non-usage of safety restraints, weekends, both lighted and unlighted dark conditions, two-lane highways without physical separation, roadway curves, and so forth. Alongside several attributes, non-usage of restraints was strongly associated with fatal and both incapacitating and non-incapacitating injury crashes. The findings of this study can benefit the determination of suitable countermeasures to prevent cellphone-related SVROR crashes.

Child safety restraint patterns in Moldova

Objective The Republic of Moldova has one of the European region’s highest road traffic injury rates and also has an increase in motorization and exposure of children as vehicle passengers. This study describes child restraint use, and parents’ knowledge and attitudes toward child restraint based on observations in Chisinau, the country’s capital and largest city. The study aims to describe the use of child restraints and to compare data with existing standards of good practice. Methods An observational study on child safety restraint use was conducted in 2018. Observational sites included 22 early education institutions, where drivers (n = 611) and child passengers (n = 710) were observed. Observations were conducted as motor vehicles parked or pulled to a stop near the early education institutions and included a driver survey on knowledge and attitudes toward restraint legislation and child safety behavior. Results Of the 710 child passengers observed, 462 (65.1%) were appropriately restrained, 145 (20.4%) were seated in restraints inappropriate for the child and 103 (14.5%) of children were unrestrained. Younger children (0-3 year-old) were 7 times more likely to be properly restrained compared with children with ages between 4 and 6 (OR 1.92, 95% CI 1.15 to 3.22). Two-thirds out of 609 observed drivers with full study data, N = 431 (70,8%), knew about the mandatory legislation on using child safety restraints in the Republic of Moldova. The drivers using child safety restraints responded that they used them because of their safety features, and the major reason for nonuse was high price/affordability. Conclusion This study, the first to document child safety restraint use among children, indicates that much progress has been made, in that the majority of children are restrained and most drivers of children are aware of safety policies. However, progress can be made to increase knowledge and motivation to safely transport children, and to ensure safety seats are affordable and available. These data will be an important foundation on which to advocate for increased safety activities, child restraint policies, educational approaches in Moldova and to monitor progress over time.

Postural analysis of side impact WorldSID 50th ATD in highly reclined seats

Objective The anthropomorphic test device (ATD) used in NCAP frontal impact, the Thor 50th, has undergone substantial changes for safety restraint systems testing of upcoming autonomous vehicles (AVs), resulting in the Thor-AV 50 M. Likewise, a deep analysis of the ATD for lateral impacts, the WorldSID 50th, is needed to determine the requirements it has to fulfill to accurately replicate the human body response under lateral impact. This study sets out general considerations regarding the WorldSID 50th ATD design in order to assess its suitability for AV testing scenarios. Methods The WorldSID 50th ATD was placed in a driver seat at a conventional upright driving posture. Relevant body landmarks and angles as well as profile streams of the mockup and the ATD were recorded. The seatback was then reclined stepwise. The ATD was repositioned and the recording procedure repeated at every posture until the seatback was fully reclined. Examination of the ATD assemblies and hinge mechanisms was performed, searching for limitations that could result on inadequate positioning or performance under impact. An eventual SAEJ3016 Level 3 cross-legged posture (SAE J3016, 2021) was considered for examination as well. Results Most relevant anthropometric constraints were noticed at the abdomen and the shoulder and neck assemblies: At the abdomen, a gap between the pelvis and the lower torso appeared at seatback recline angles larger than 30°, likely promoting belt intrusion in case of a test event, and the lumbar spine rubber deformed progressively in a manner that might cause tearing damage. The number and arrangement of the shoulder clevis detents, on the other hand, did not allow the arm to be placed at intermediate positions. Finally, the current neck bracket design allowed head orientation only along the sagittal plane. The head could neither be level at seatback angles larger than 43° nor be placed resting on the head restraint for seatback angle values larger than 59°. Conclusions The WorldSID ATD stands as an accurate 50th percentile human being surrogate in upright and low/mid reclined postures. Some limitations that might constrain its use in AV scenarios, though, appeared at mid/high reclined positions. Hence, design updating of the lumbar, neck and shoulder clevis assemblies, and the implementation of instrumented lower abdomen and lower arms assemblies should be taken into consideration.

Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions

Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community. We retrospectively queried a level 1 trauma registry for pediatric (0-18y) MVC patients from October 2013 to December 2018. Demographic and clinical variables were recorded. Data regarding appropriate restraint use by age group were examined. Four hundred thirty-four cases of pediatric MVC were identified. Overall, 53% were improperly restrained or unrestrained. Sixty-two percent of car seat age and 51% of booster age children were improperly restrained or unrestrained altogether. Fifty-nine percent of back seat riding, seatbelt age were improperly restrained/unrestrained, with 26% riding in the front. Fifty-one percent of seatbelt-only adolescents were not belted. Black, non-Hispanic children were more often improperly restrained/unrestrained compared to Hispanics (63% versus 48%, P=0.001). Improperly restrained/unrestrained children had higher injury severity (10% versus 4% Injury Severity Score > 25, P=0.021), require operative/interventional radiology (33% versus 19%, P=0.001), and be discharged to rehabilitation or skilled nursing facility (5.2% versus 1.5%, P=0.033). Mortality in adolescents was higher among those unrestrained (5.2% versus 0.8%, P=0.034). Although efforts to improve adherence to restraint regulations have greatly increased in the last decade, more than half of children in MVC are still improperly restrained. Injury prevention services and community outreach is essential to educate the most vulnerable populations, especially those with infants and toddlers, on adequate motor vehicle safety measures in our community.

State and city laws governing the use of child restraint systems in rideshare vehicles and taxicabs: requirements and responsibility

ObjectivesTo identify, describe and critique state and local policies related to child passenger safety in for-hire motor vehicles including ridesharing and taxis.MethodsWe used standard legal research methods to collect policies...

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study

BackgroundDespite recognition of the neurologic and psychiatric complications associated with SARS-CoV-2 infection, the relationship between coronavirus disease 19 (COVID-19) severity on hospital admission and delirium in hospitalized patients is poorly understood. This study sought to measure the association between COVID-19 severity and presence of delirium in both intensive care unit (ICU) and acute care patients by leveraging an existing hospital-wide systematic delirium screening protocol. The secondary analyses included measuring the association between age and presence of delirium, as well as the association between delirium and safety attendant use, restraint use, discharge home, and length of stay.MethodsIn this single center retrospective cohort study, we obtained electronic medical record (EMR) data using the institutional Epic Clarity database to identify all adults diagnosed with COVID-19 and hospitalized for at least 48-h from February 1-July 15, 2020. COVID-19 severity was classified into four groups. These EMR data include twice-daily delirium screenings of all patients using the Nursing Delirium Screening Scale (non-ICU) or CAM-ICU (ICU) per existing hospital-wide protocols.ResultsA total of 99 patients were diagnosed with COVID-19, of whom 44 patients required ICU care and 17 met criteria for severe disease within 24-h of admission. Forty-three patients (43%) met criteria for delirium at any point in their hospitalization. Of patients with delirium, 24 (56%) were 65 years old or younger. After adjustment, patients meeting criteria for the two highest COVID-19 severity groups within 24-h of admission had 7.2 times the odds of having delirium compared to those in the lowest category [adjusted odds ratio (aOR) 7.2; 95% confidence interval (CI) 1.9, 27.4; P = 0.003]. Patients > 65 years old had increased odds of delirium compared to those < 45 years old (aOR 8.7; 95% CI 2.2, 33.5; P = 0.003). Delirium was associated with increased odds of safety attendant use (aOR 4.5; 95% CI 1.0, 20.7; P = 0.050), decreased odds of discharge home (aOR 0.2; 95% CI 0.06, 0.6; P = 0.005), and increased length of stay (aOR 7.5; 95% CI 2.0, 13; P = 0.008).ConclusionsWhile delirium is common in hospitalized patients of all ages with COVID-19, it is especially common in those with severe disease on hospital admission and those who are older. Patients with COVID-19 and delirium, compared to COVID-19 without delirium, are more likely to require safety attendants during hospitalization, less likely to be discharged home, and have a longer length of stay. Individuals with COVID-19, including younger patients, represent an important population to target for delirium screening and management as delirium is associated with important differences in both clinical care and disposition.

Child restraint use in motor vehicles in Shanghai, China: a multiround cross-sectional observational study

ObjectivesWhile appropriate child restraint use in motor vehicles can reduce the risk of injuries or deaths, few previous studies have assessed child restraint practice in China. We aim to describe...

Trends in pediatric passenger restraint use by rurality and age in Iowa, 2006–2019

Objective Pediatric restraint use has increased over time in the United States, but motor vehicle crashes remain a leading cause of death for children under age 18. Age-appropriate use of safety restraints (safety seats, booster seats, seat belt) and statewide child restraint laws can greatly reduce injury or death in the event of a crash. Surveillance of pediatric restraint use and compliance with policy can inform prevention efforts. This study aims to examine time trends in pediatric restraint use and compliance with pediatric passenger laws in Iowa by rurality and age. Methods Fourteen years of Iowa observational pediatric restraint use data (2006–2019) are included in this cross-sectional study. Proportions of restrained youth by year, age, and rurality (rural, urban) were calculated. Log-linear models were used to compute the Annual Percent Change (APC) by year to explore trends in restraint use over time by rurality and by age group. Results A total of 42,007 observed pediatric passengers with complete data from 2006 to 2019 were included in this study. Restraint use increased across all years and all age groups observed, with the largest increases among the older pediatric age groups. However, restraint use was consistently highest among the youngest child passengers. With all study years combined, the odds of being compliantly restrained were 13% lower in rural areas (OR = 0.87, 95% CI = 0.80, 0.95) compared to urban areas. Conclusions Restraint use was lower in rural areas and among older pediatric passengers, suggesting targeted efforts to increase restraint use among these groups may have the greatest impact on overall occupant protection.

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0–17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.