Changes in child restraint practices in Shenzhen, China three years after the enactment of local legislation: two population-based cross-sectional surveys

Background The enactment of child restraint systems (CRSs) legislation is highly effective in increasing CRS practices. However, evidence from low- and middle-income countries is still lacking. This study aimed to assess the changes in CRS practices in Shenzhen, China following the implementation of CRS legislation.Methods Data from two cross-sectional surveys conducted in community health service centres and kindergartens 1 year before and 3 years after the enactment of mandatory CRS legislation in 2015 were used to assess the changes in CRS practices in Shenzhen, China. Temporal changes in CRS practices were investigated, and logistic regression models were performed to examine the differences in CRS practices 3 years after the legislation compared with the period before the legislation.Results The proportion of CRS possession and use increased from 27.8% (1047/3768, 95% CI: 26.4% to 29.3%) to 72.6% (4900/6748, 95% CI: 71.5% to 73.7%) and from 22.9% (864/3768, 95% CI: 21.6% to 24.3%) to 56.3% (3800/6748, 95% CI: 55.1% to 57.5%), respectively, with a decrease of appropriate CRS use from 75.9% (656/864, 95% CI: 72.9% to 78.7%) to 69.7% (2649/3800, 95% CI: 68.2% to 71.2%) after the implementation of CRS legislation.Conclusions The findings indicate a significant improvement in CRS possession and use in Shenzhen, 3 years after the enactment of mandatory CRS legislation. Further efforts to update the local legislation to provide specific guidelines for appropriate CRS use and implement targeted multifaceted interventions are needed to increase optimal CRS practices for better child passenger safety in Shenzhen.