Factors associated with child safety seat use in Bangkok Metropolitan Region, Thailand

To understand factors associated with proper child safety seat (CSS) use in the Bangkok Metropolitan Region (BMR), Thailand, after the child restraint legislation and to provide evidence to inform policy for increasing proper CSS use. A cross-sectional study was conducted. Primary caregivers of at least one child aged 0–6 years or height 135 cm or less, who own a car, reside in BMR, and achieve literacy in the Thai language were included. The recruitment was done by distributing posters with QR codes to access information sheets and online self-administered questionnaires both online and offline (Pediatrics outpatient and postpartum units at Ramathibodi Hospital; 273 public early childhood centers; and 102 kindergartens in Bangkok) between April and December 2024. The questionnaire comprised questions regarding demographic data, knowledge, attitude, practice, and other information about CSS. Data were compared between the proper and improper CSS users <i>via</i> Stata version 17. 330 respondents with a median (Q1, Q3) age of 38 (34, 41) years were included; most were female (83.2%) and residents of Bangkok (68.7%). Two hundred ninety-six respondents (89.7%) reported CSS usage, with 170 respondents reporting regular use (51.5%). Among respondents, 135 (40.9%) were categorized as proper users (regularly use an age-appropriate type of CSS and locate it on the back seat). Logistic regression showed factors associated with proper CSS used were higher household income (OR 9.97, 95%CI: [4.06–24.52], <i>p</i> &lt; 0.001) and barriers to using CSS including child-related barriers (OR 0.10, 95%CI: [0.05–0.22], <i>p</i> &lt; 0.001), caregivers-related barriers (OR 0.19, 95%CI: [0.04–0.99], <i>p</i> = 0.049), and car-related barrier (OR 0.38, 95%CI: [0.15–0.92], <i>p</i> = 0.031). The leading reported barriers to CSS use were children’s refusal (42%) and the high cost of CSS (23%). The trusted sources of information regarding CSS were social media/internet (43%) and healthcare providers (34%). Respondents preferred educational intervention for improving knowledge (22%) and tax deduction policy (17%) to help increase CSS use. After the child restraint legislation, the proper usage of CSS to ensure child safety was still low. Factors associated with proper CSS usage included higher household income and barriers to using CSS. Multilevel interventions and policies were suggested to address the issues. Further research could be done to evaluate the effectiveness of those measures and their impacts on increasing proper CSS usage in Thailand.

本研究旨在探究泰国曼谷都会区（Bangkok Metropolitan Region, BMR）在儿童约束装置相关立法实施后，与儿童安全座椅（Child Safety Seat, CSS）正确使用相关的影响因素，并为提升儿童安全座椅正确使用率的政策制定提供循证依据。本研究采用横断面调查设计，纳入标准为：拥有私家车、居住于曼谷都会区、具备泰语读写能力，且家中至少有1名0~6岁或身高≤135cm儿童的主要照护者。
研究于2024年4月至12月期间开展招募工作，采用线上线下结合的方式：通过张贴带有二维码的海报，引导受试者获取知情同意书并填写线上自填式问卷；线下招募点位包括拉玛泰博迪医院（Ramathibodi Hospital）的儿科门诊与产后病房、273家公立早教中心，以及曼谷市内102所幼儿园。
调查问卷涵盖人口统计学资料、儿童安全座椅相关知识、态度、行为及其他相关信息。研究采用Stata 17版统计软件，对正确使用与未正确使用儿童安全座椅的受试者数据进行比较分析。
最终纳入330名有效受访者，其年龄中位数（四分位数间距）为38（34，41）岁；绝大多数为女性（83.2%），且以曼谷居民为主（68.7%）。296名受访者（89.7%）报告曾使用儿童安全座椅，其中170名（51.5%）报告规律使用该装置；135名受访者（40.9%）被归类为正确使用者，即规律使用符合儿童年龄适配类型的儿童安全座椅且将座椅安装于车辆后排座位。
logistic回归（Logistic Regression）分析显示，与儿童安全座椅正确使用相关的因素包括较高的家庭收入（比值比（Odds Ratio, OR）=9.97，95%置信区间（Confidence Interval, 95%CI）：4.06~24.52，P<0.001），以及儿童安全座椅使用障碍相关因素：儿童相关障碍（OR=0.10，95%CI：0.05~0.22，P<0.001）、照护者相关障碍（OR=0.19，95%CI：0.04~0.99，P=0.049）、车辆相关障碍（OR=0.38，95%CI：0.15~0.92，P=0.031）。
受访者报告的儿童安全座椅使用主要障碍为儿童抗拒（42%）与儿童安全座椅购置成本高昂（23%）。儿童安全座椅相关信息的可信来源为社交媒体/互联网（43%）与医疗保健服务提供者（34%）。受访者偏好的提升儿童安全座椅使用行为的干预措施包括知识科普教育（22%）与税收减免政策（17%）。
研究结果显示，在儿童约束装置相关立法实施后，曼谷都会区儿童安全座椅的正确使用率仍处于较低水平。与正确使用儿童安全座椅相关的因素包括较高的家庭收入与各类使用障碍。本研究建议采用多维度干预措施与政策以改善该现状，未来可开展相关研究评估此类措施的有效性及其对泰国儿童安全座椅正确使用率的提升效果。