Previously submitted to: JMIR Public Health and Surveillance (no longer under consideration since Feb 11, 2026)
Date Submitted: Sep 7, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Abstract Background: Correct child restraint system (CRS) use is a proven road safety intervention that significantly reduces injury and mortality in children. In Iran, usage rates remain low despite legislation, particularly among socioeconomically disadvantaged families. Factors such as parental knowledge, risky driving behaviors, and perceived barriers may shape adoption patterns. Objective: To examine associations between parental knowledge, socioeconomic-demographic factors, and correct CRS use, and assess whether risky driving behaviors and perceived barriers mediate these associations in Alborz County, Iran. Methods: We conducted a community-based cross-sectional survey (May–July 2024) across five comprehensive health centers. 700
ABSTRACT
Background:
Correct child restraint system (CRS) use is a proven road safety intervention that significantly reduces injury and mortality in children. In Iran, usage rates remain low despite legislation, particularly among socioeconomically disadvantaged families. Factors such as parental knowledge, risky driving behaviors, and perceived barriers may shape adoption patterns.
Objective:
To examine associations between parental knowledge, socioeconomic-demographic factors, and correct CRS use, and assess whether risky driving behaviors and perceived barriers mediate these associations in Alborz County, Iran.
Methods:
We conducted a community-based cross-sectional survey (May–July 2024) across five comprehensive health centers. 700 parents of children under 10 years were selected via multistage cluster sampling. CRS use was evaluated via self-report and vehicle inspection. Parental knowledge and perceived barriers were measured using validated scales, and risky driving behaviors via an adapted questionnaire. Multivariable logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) using Stata 17.
Results:
Correct CRS use occurred in 14.7% of participants, highest in children under 2 years (28.4%). Medium SES (aOR=2.73; 95% CI: 1.11–6.21) and high SES (aOR=4.75; 95% CI: 2.16–10.49) predicted correct use. Higher parental knowledge (aOR=1.58 per unit, 95% CI: 1.22–2.04), fewer risky driving behaviors (aOR=0.43, 95% CI: 0.25–0.72), and fewer perceived barriers (aOR=0.18, 95% CI: 0.09–0.36) were significant. Gender and number of children were not associated.
Conclusions:
CRS use in Alborz County is critically low. Policies integrating enforcement, education, and subsidies are needed, particularly in low-resource settings. Clinical Trial: Not applicable.
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