Peer-reviewed article

Determinants of child restraint system selection and installation practices: implications for injury prevention and public health implementation.

Kopańska M, Frej D, Wasacz M · 3 Jun 2026

Abstract

Road traffic injuries remain a leading cause of death and serious harm among children, and a substantial proportion of this burden occurs among child passengers. Despite clear safety recommendations, incorrect installation and suboptimal child restraint system (CRS) selection remain widespread, representing a persistent public health implementation gap. Against this backdrop, the present study examined determinants of CRS selection decisions and self-reported installation and use practices, with a particular focus on how selection and retail-support experiences relate to intention to choose the same CRS again. A cross-sectional online survey (Google Forms) was conducted from February to December 2024, yielding 3,750 questionnaires, of which 1,150 complete cases were included in analysis. Descriptive statistics were supplemented with chi-square tests (Cramér's V) and multivariable logistic regression (odds ratios, 95% CI) for top-box intention to choose the same CRS again ("yes/probably yes"). Price (58.1%), seat weight (48.2%), and installation method (46.1%) were the most frequently reported selection determinants, while safety tests (28.3%) and comfort (26.4%) were less commonly cited. ISOFIX solutions predominated (74.6%), with installation most often behind the driver (45.0%) and a notable share on the front seat (25.4%). Intention to choose the same CRS again was low (27.4% top-box; 62.3% negative). Seller installation demonstration was associated with intention to choose the same CRS again (χ2 = 22.82, p = 0.0036; V = 0.100), whereas reported child discomfort was not (p = 0.9378). In logistic regression, only age 26-35 years (vs. 18-25) predicted top-box intention to choose the same CRS again (OR = 1.42, 95% CI 1.05-1.91), with overall low explanatory power (McFadden pseudo-R2 = 0.0167). The findings suggest that economic and usability considerations outweigh explicitly stated safety criteria, and that closing the implementation gap requires stronger, scalable support for correct CRS selection and installation.