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

Marta Kopańska, Damian Frej, Małgorzata Wasacz · Frontiers in Public Health · 2026

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%

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