Yearly Survey Brings Awareness to Alarming Decrease in Use of Child Car Seats in Hawai’i

Posted on May 31, 2016 in All IPCS News, traffic safety

Yearly Survey Brings Awareness to Alarming Decrease in Use of Child Car Seats in Hawaii

Lisa Dau, BSN, RN, CPSTI- Injury Prevention Coordinator-Kapiolani Medical Center for Women & Children, KIPC and Safe Kids Hawaii

Karen Tessier, PhD, RN, CPSTI – Child Passenger Safety Program Coordinator-KIPC, Assistant Professor-UH Manoa, Department of Nursing


The Hawaii child restraint law requires children birth to 3 years of age to ride in a child car seat, and children 4-7 years of age to ride in either a child car seat or booster seat.  Research shows that child car seats reduce fatal injury by 71% for infants and by 54% for toddlers (NHTSA, 2009).

Each year, Dr. Karl Kim of the University of Hawaii Department of Urban and Regional Planning (DURP) conducts observational surveys of child restraint use in Hawaii for the Hawaii State Department of Transportation. The observations are done in all counties in the state.  The study’s aim is to evaluate car seat use compliance for infants (less than 1 year) and toddlers (1-3 years), and back seat belt use among youth (4-16 years) (Kim & Sawyer, 2016).

Kim has been conducting these child restraint observational studies for the Department of Transportation since 1991.  The observations were conducted at 15 neighborhood shopping centers statewide (8 on Oahu, 2 on Maui, 3 on the island of Hawaii and 2 on Kauai). A total of 593 observations of infants and toddlers, and 926 youth were done in 2016 (Kim & Sawyer, 2016).

This year’s overall child car seat use rate of 55% brings an alarming awareness to the injury prevention community of the lowest use since 2001 (43%) (Kim & Sawyer, 2016). The data not only reflect the lowest use rate in 15 years, but also the fifth year in a row of a steep decline in use of child car seats (2011-91%, 2012-88%, 2013-81%, 2014-75%, 2015-56%, and 2016-55%) (Kim & Sawyer, 2016).

On a positive note, 2016 saw an increased use of infant restraints from 2015 (from 87% to 92%).  However, the toddler use rate has continued to be a disappointment with each year declining from the highest use rate back in 2012 at 90% down to 47% in 2016.  These rates pale in comparison to national rates of 98% for infants and 96% for toddlers, with an overall national average of 91% (NHTSA, 2011).

In comparing locations, Hilo and Maui had the lowest rates for infant restraints (33% and 66% respectively) and Oahu had the lowest for toddlers (43%).  Hilo and Kauai both saw the highest rates for toddlers (both greater than 70%) and Oahu had the highest use for infants (94%) (Kim & Sawyer, 2016).  Although the infant use rate is above 90% and seems to be swinging in a positive direction from the previous year, it’s the toddler rates that continue to be a major concern for the safety of our children in vehicles.

According to Dan Galanis, PhD, epidemiologist for the Hawaii Department of Health, “ for ages birth to 17 years, there were 22 deaths and 136 hospitalizations over a 5 year period from 2010 to 2014, and 2,354 emergency department visits over the 4 year period from2011to 2014.”  With the overall child car seat use rate down to 55%, one could wonder if these rates (death, hospitalization and ED) will increase.

In Hawaii there are child passenger safety inspection stations on all the major islands (Oahu, Maui, Kauai and Hawaii), and many opportunities throughout the year for parents and caregivers to get education and assistance on proper installation and use of car seats at various community events.  Most of the inspection stations are partially funded by the Hawaii State Department of Transportation. Eight of the Oahu sites (Kapiolani Medical Center for Women & Children, The Queens Medical Center, Kaiser Permanente, Tripler Army Medical Center, Castle Medical Center, Waianae Coast Comprehensive Health Center, Kalihi Palama Health Center, and Marine Corp Base Hawaii) are in partnership with Keiki Injury Prevention Coalition (KIPC).  All county police departments have officers trained and certified as child passenger safety technicians, and they conduct many traffic enforcement check points throughout the state.  Despite this enforcement and education, the number of children being properly restrained in child car seats has declined to the lowest level in years.

Kim and Sawyer (2016) identified 5 recommendations based on the findings of the 2016 observational study: 1) add more enforcement, public education, and public information programs in order to increase toddler compliance rates, especially in locations (Ewa and Waianae) where rates of child car seat use are the lowest; 2) increase public awareness in all Hawaii counties; 3) conduct further analysis; 4) add additional sites and observations so results are statistically significant, and 5) modify data collection to include more accurate depiction of child restraint rates to other areas besides shopping malls.

As advocates, and certified child passenger safety technicians/instructors for more than 20 years, it is saddening and alarming to watch the child restraint use rates decline over the past several years.  Now is the time for all of us to work together as safety advocates, and build capacity of certified child passenger safety technicians to use their knowledge and skills to spread the word about the importance of keeping our children safe while traveling.  We must ensure visitors to our islands also follow the law to make travel safe for all who come here.  The Statewide Child Passenger Safety Coordinators and others on the team have identified areas of priority to include: increasing education and awareness through media (social, PSA, local media), producing educational materials in Pacific Islander, Spanish and Asian languages, among others, increasing enforcement, and increasing educational opportunities for vulnerable populations.


  • Kim, K., & Sawyer, J. (2016). Results of the 2016 Hawaii Child Restraint Use Survey.  Department of Urban and Regional Planning, University of Hawaii at Manoa.
  • National Highway Traffic Safety Administration’s (NHTSA) National Center for Statistics and Analysis (NCSA). (2011). “The 2011 National Survey of the Use of Booster Seats” DOT HS 811 718. Washington, D.C.
  • National Highway Traffic Safety Administration’s (NHTSA) National Center for Statistics and Analysis (NCSA). (2009). “Traffic Safety Facts: Children.” DOT HS 811 135. Washington, D.C.