Evaluation of the Rhode Island Child Restraint Law

In Rhode Island, a law went into force July 1, 1980, requiring drivers to transport children who are in the front seats of vehicles in properly used child restraints. In the fourth month of the law, restraint use and travel in rear seats had increased moderately; the net result was an increase in proper restraint use in rear seats (11 to 23 per cent) and a decrease in unrestrained, front seat travel (41 to 26 per cent). (Am J Public Health 1981;71:742-743.)     

Seating patterns on the Washington, DC Metro Rail System.

Research on human tolerance in crashes has found that rear-facing seating offers increased protection over forward seating. However, rearward seats are only available in limited settings. In this study, passengers were observed and seating preferences recorded on the Washington Metropolitan Rail System (Metro). Only 25 per cent of adults faced rearward compared to 66 per cent of children. Since children appear willing to face rearward, rear-facing seating in school buses and other vehicles might be acceptable to them and provide safety benefits as well.     

Motor-vehicle occupant fatalities and restraint use among children aged 4-8 years--United States, 1994-1998

In the United States, more children aged 4-8 years die as occupants in motor-vehicle-related crashes than from any other form of unintentional injury (1). To reduce the number of deaths and injuries caused by motor-vehicle-related trauma, child passengers in this age group should be restrained properly in a vehicle's back seat (2). To characterize fatalities, restraint use, and seating position among occupants aged 4-8 years involved in fatal crashes, CDC analyzed 1994-1998 data from the Fatality Analysis Reporting System (FARS), which is maintained by the National Highway Traffic Safety Administration (NHTSA). This report summarizes the results of that analysis, which indicate that during 1994-1998, little change occurred in the death rate, restraint use, and seating position among children aged 4-8 years killed in crashes.     

Factors associated with front row seating of children in motor vehicle crashes

BACKGROUND: Current safety guidelines recommend that children age 12 or younger sit in the rear seat of passenger vehicles. However, front row seating among these children remains common. To develop future educational and other interventions to decrease front row seating of young children, it is important to examine factors associated with this behavior. METHODS: We identified factors associated with front row seating of children 12 years of age or younger using data from a cross-sectional study of children who were the single passenger in crashes of insured vehicles in 15 U.S. states. Data were collected by insurance claims records and a telephone interview. A probability sample of 3775 crashes representing 27678 crashes with child occupants was collected between 1 December 1998, and 30 November 2002. Multivariate Poisson regression was used to identify specific child, driver, and vehicle characteristics associated with front row seating. RESULTS: When children were the sole occupants in the vehicle, approximately 1 in 3 (31%) sat in the front seat. The child's age and restraint use, the driver's age and relationship to the child passenger, the type of vehicle, and the presence of a passenger airbag were all associated with front row seating. CONCLUSIONS: Educational interventions can be tailored to address the specific needs of subgroups of drivers and children to reduce front row seating. In addition, these data could be used to support legislative interventions to limit front row seating of younger children when a teenager is driving.     

Using head-on collisions to compare risk of driver death by frontal air bag generation: a matched-pair cohort study

US air bag regulations were changed in 1997 to allow tests of unbelted male dummies in vehicles mounted and accelerated on sleds, resulting in longer crash pulses than rigid-barrier crashes. This change facilitated depowering of frontal air bags and was intended to reduce air bag-induced deaths. Controversy ensued as to whether sled-certified air bags could increase adult fatality risk. A matched-pair cohort study of two-vehicle, head-on, fatal collisions between drivers involving first-generation versus sled-certified air bags during 1998-2005 was conducted by using Fatality Analysis Reporting System data. Sled certification was ascertained from public information and a survey of automakers. Conditional Poisson regression for matched-pair cohorts was used to estimate risk ratios adjusted for age, seat belt status, vehicle type, passenger car size, and model year for driver deaths in vehicles with sled-certified air bags versus first-generation air bags. For all passenger-vehicle pairs, the adjusted risk ratio was 0.87 (95% confidence interval: 0.77, 0.98). In head-on collisions involving only passenger cars, the adjusted risk ratio was 1.04 (95% confidence interval: 0.85, 1.29). Increased fatality risk for drivers with sled-certified air bags was not observed. A borderline significant interaction between vehicle type and air bag generation suggested that sled-certified air bags may have reduced the risk of dying in head-on collisions among drivers of pickup trucks.     

Work-related roadway crashes--United States, 1992-2002

The risk for roadway crashes associated with driving or riding in a motor vehicle at work affects millions of persons in the United States. In 2001, approximately 4.2 million U.S. workers were classified as motor-vehicle operators (Bureau of Labor Statistics [BLS], unpublished data, 2001). Workers who use motor vehicles to perform their jobs include those who operate vehicles owned or leased by their employers and those who drive personal vehicles for work purposes. To characterize fatal occupational roadway crashes and identify workers at highest risk for fatality, CDC analyzed data for 1992-2002 from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration and the Census of Fatal Occupational Injuries (CFOI) of BLS. This report summarizes the results of that analysis, which indicated that roadway crashes were the leading cause of occupational fatalities and that workers in transportation-related occupations were at highest risk. Effective strategies to prevent motor-vehicle-related crashes in the general public also can reduce work-related crashes. Employers should promote safe driving through vehicle selection and company policy.     

Seat-belt use and non-use in adults in Slovenia

AIM: To identify population groups at risk of non-use of seat belts in front and rear seats in order to enable more focused planning of preventive actions in Slovenia. METHODS: The national health behaviour survey of 15,379 adults aged 25-64, carried out in 2001; response rate 64%; 9043 questionnaires eligible for analysis. The observed outcomes: non-use of seat belts in the front and rear seats. Logistic regression was used for relating gender, age, education level, socio-economic factors and geographical region to the observed outcomes. RESULTS: Non-use of seat belts in the front seats: 5.7%; the highest odds: males (OR(males vs. females)= 1.89, p < 0.001), aged 25-29 (OR(25-29 vs. 50-59) = 2.68, p < 0.001), the lowest education level (OR(uncompleted primary vs. university education) = 2.77, p = 0.001), upper social class (OR(upper vs. lower) = 3.54, p = 0.014), western Slovenia (OR(western vs. eastern) = 1.31, p = 0.027). Non-use of seat belts in the rear seats: 65.2%; the highest odds: aged 25-29 (OR(25-29 vs. 6-64) = 2.83, p < 0.001), vocational (OR(vocational vs. university education) = 1.36, p = 0.005) and secondary education level (OR(secondary vs. university education) = 1.36, p = 0.003), western Slovenia (OR(western vs. eastern) = 1.37, p < 0.001). CONCLUSIONS: Both observed outcomes are a problem particularly in younger age groups with secondary education level or lower, living in western Slovenia; non-use of seat belts in the front seats also in males and in upper social class.     

Causal influence of car mass and size on driver fatality risk

OBJECTIVES: This study estimated how adding mass, in the form of a passenger, to a car crashing head-on into another car affects fatality risks to both drivers. The study distinguished the causal roles of mass and size. METHODS: Head-on crashes between 2 cars, one with a right-front passenger and the other with only a driver, were examined with Fatality Analysis Reporting System data. RESULTS: Adding a passenger to a car led to a 14.5% reduction in driver risk ratio (risk to one driver divided by risk to the other). To divide this effect between the individual drivers, the author developed equations that express each driver's risk as a function of causal contributions from the mass and size of both involved cars. Adding a passenger reduced a driver's frontal crash fatality risk by 7.5% but increased the risk to the other driver by 8.1%. CONCLUSIONS: The presence of a passenger reduces a driver's frontal crash fatality risk but increases the risk to the driver of the other car. The findings are applicable to some single-car crashes, in which the driver risk decrease is not offset by any increase in harm to others. When all cars carry the same additional cargo, total population risk is reduced.     

Drivers aged 16 or 17 years involved in fatal crashes --- United States, 2004-2008

Motor vehicle crashes are the leading cause of death among teens in the United States, accounting for approximately one third of deaths in this age group. Crash risk is highest during the first years of independent driving. To characterize trends in fatal crashes involving drivers aged 16 or 17 years, CDC analyzed data from the Fatality Analysis Report System (FARS) for 2004-2008. This report summarizes the results of that analysis, which indicated that, during 2004-2008, a total of 9,644 passenger vehicle drivers aged 16 or 17 years were involved in fatal crashes. During that period, the annual population-based rate for drivers aged 16 or 17 years involved in fatal crashes declined 38%, from 27.1 per 100,000 population in 2004 to 16.7 in 2008. By state, 5-year annualized rates for drivers aged 16 or 17 years involved in fatal crashes ranged from 9.7 per 100,000 population in New Jersey and New York to 59.6 in Wyoming. To further reduce fatal crashes involving young drivers, states should periodically reexamine and update graduated driver licensing (GDL) programs, and communities should vigorously enforce laws on minimum legal drinking age, blood alcohol concentration (BAC), and safety belt use, all of which can reduce the number of fatal crashes among young drivers.     

Vehicle crash mortality in the Kimberley region, 1990 to 1994: the role of open–load–space passengers in utility trucks

Abstract: Coroner's reports, police records and the state crash database provided information on 65 crash fatalities in the Kimberley region of Western Australia from 1990 to 1994. Passengers travelling in the open load space of utility trucks comprised 18 per cent of fatalities. Open–load–space passenger fatalities were associated with open highway or community access road travel. The fatality rate for the region was 41.5 per 100 000 population and the rate ratio for Aboriginal to non–Aboriginal fatalities was 2.5. Only 50 of the 65 identified deaths were included in official crash statistics. State crash statistics do not provide information on the position of passengers in road crashes.     

Fatal car fires from rear-end crashes: the effects of fuel tank placement before and after regulation.

A federal standard for fuel tank integrity in cars was applied to 1977 and subsequent models. National data indicate that fatalities per 10,000 occupants in rear-end crashes of small cars, where fire was the most harmful event, were reduced by approximately 57% if the fuel tank was located behind the rear axle and 77% if the tank was situated directly above or in front of the rear axle.     

Estimates of motor vehicle seat belt effectiveness and use: implications for occupant crash protection.

Estimates of the effectiveness of seat belts, when used, in reducing motor vehicle occupant deaths vary widely. A recently publicized claim by one analyst that seat belts reduce vehicle occupant deaths 70-80 per cent is based on studies found to contain fundamental systematic error. Deaths occur only 50 per cent less often to belted compared to nonbelted vehicle occupants in crashes, according to previously unanalyzed data from three U.S. states during recent years. New belt systems would be about 60 per cent effective with 100 per cent use. But surveys of observed belt use in 1975 U.S. cars indicate that two-thirds of drivers were not using belts. Prospects for widespread adoption and enforcement of belt use laws in the U.S. are not encouraging. Substantial reductions in fatal and other injuries would result from the adoption of requirements mandating automatic (passive) protection for front seat occupants in crashes with forward decelerations.     

Association of first- and second-generation air bags with front occupant death in car crashes: a matched cohort study

First-generation air bags entail a decreased risk of death for most front seat occupants in car crashes but an increased risk for children. Second-generation air bags were developed to reduce the risks for children, despite the possibility of decreasing protection for others. Using a matched cohort design, the authors estimated risk ratios for death for use of each generation of air bag versus no air bag, adjusted for seat position, restraint use, sex, age, and all vehicle and crash characteristics, among 128,208 automobile occupants involved in fatal crashes on US roadways during 1990-2002. The authors then compared adjusted risk ratios (aRRs) between the two generations of air bags. Among front seat occupants, the aRR for death with a first-generation air bag was 0.90 (95% confidence interval (CI): 0.86, 0.94); the aRR with a second-generation air bag was 0.89 (95% CI: 0.79, 1.00) (p = 0.83 for comparison of aRRs). Among children under age 6 years, the aRR with a first-generation air bag was 1.66 (95% CI: 1.20, 2.30), while the aRR with a second-generation air bag was 1.10 (95% CI: 0.63, 1.93) (p = 0.20 for comparison of aRRs). The differences in aRRs between first- and second-generation air bags among other subgroups were small and not statistically significant.     

Work-related fatalities in the agricultural production and services sectors, 1980-1989

A total of 6,727 workers died of work-related injuries in the agricultural production and agricultural services sectors between 1980 and 1989, as established by data from the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system. The agricultural production sector accounted for the higher fatality rate (22.9 deaths per 100,000 workers), due largely to deaths caused by machinery and motor vehicles. The leading cause of death in the agricultural services sector was being struck by falling objects, primarily trees. Fatality rates were highest in the East South Central United States and lowest in the New England states. Blacks had the highest fatality rate (26.4 deaths per 100,000 workers) while workers other than white or black had the lowest rate (18.9 per 100,000 workers). Males were at higher risk of death than females, with the 65 years of age and older male group having the highest rate (60.5 deaths per 100,000 workers). Males 16-24 years of age exhibited the largest decrease in their average annual fatality rate during the 10-year period, down to 7.2 from 20.6 deaths per 100,000 workers. Possible reasons for this decrease are suggested.     

Obesity and risk for death due to motor vehicle crashes

OBJECTIVES: We examined the role of body mass index (BMI) and other factors in driver deaths within 30 days after motor vehicle crashes. METHODS: We collected data for 22 107 drivers aged 16 years and older who were involved in motor vehicle crashes from the Crashworthiness Data System of the National Automotive Sampling System (1997-2001). We used logistic regression and adjusted for confounding factors to analyze associations between BMI and driver fatality and the associations between BMI and gender, age, seatbelt use, type of collision, airbag deployment, and change in velocity during a crash. RESULTS: The fatality rate was 0.87% (95% confidence interval [CI]=0.50, 1.24) among men and 0.43% (95% CI=0.31, 0.56) among women involved as drivers in motor vehicle crashes. Risk for death increased significantly at both ends of the BMI continuum among men but not among women (P<.05). The association between BMI and male fatality increased significantly with a change in velocity and was modified by the type of collision, but it did not differ by age, seatbelt use, or airbag deployment. CONCLUSIONS: The increased risk for death due to motor vehicle crashes among obese men may have important implications for traffic safety and motor vehicle design.     

Ambulance crash-related injuries among Emergency Medical Services workers--United States, 1991-2002

Ambulance crashes are one of many hazards faced by Emergency Medical Services (EMS) personnel. Although no complete national count of ground ambulance crashes exists, the total number of fatal crashes involving ambulances can be ascertained by using the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS). To characterize risk factors for EMS workers involved in ambulance crashes, CDC's National Institute for Occupational Safety and Health (NIOSH) and NHTSA investigated three case reports of ambulance crashes. This report summarizes these investigations, presents surveillance data, and discusses recommendations for prevention measures. NIOSH is identifying and testing alternative measures to reduce injury risk for EMS workers.     

Extremely low birth weight (less than 1000 gram) and early postnatal weight gain in preterm infants

Improving survival of extremely low birthweight (< 1000 g) preterm infants opens the practical issues of their postnatal nutrition and growth. The authors studied nutrition and weight gain in 16 extremely low birthweight preterm infants (birthweight: 890 +/- 22 g, gestational age: 28.0 +/- 0.2 week, mean +/- SEM) during the first 12 weeks of life. Milk of the mother, or fortified pooled human milk or preterm infant formula was fed. The preterm infants approximated their birthweight by the end of the 3rd week of life (21st day: 866 +/- 29 g). Body weight expressed as per cent of birthweight was 109 +/- 2% at the end of the 4th, 176 +/- 7% at the end of the 8th and 275 +/- 6% at the end of the 12th week of life. Weight gain during the 1st to 8th postnatal weeks was compared to the mean in utero weight gain of foetuses with identical gestational age, gender and weight percentile position. Cumulative weight gain of preterm infants during the first 8 weeks of life was significantly lower than that of the theoretical controls (76 +/- 7% versus 136 +/- 2%, per cent of the initial value, preterm versus control, p < 0.0001). Additional weight gain of preterm infants was lower than that of the controls on the 1st to 5th weeks of life (g/kg/day, 1st week: -14.4 +/- 1.6 versus 16.7 +/- 0.5, p < 0.0001; 5th week: 13.3 +/- 1.2 versus 16.4 +/- 0.3, p < 0.05), there were no differences between the two groups on the 6th and 7th weeks, whereas preterm infants gained significantly more weight on the 8th week of life than the theoretical control value (18.2 +/- 0.9 versus 14.0 +/- 0.2, p < 0.001). These data indicate that the first weeks of life represent an especially important period for the improvement of the nutrition of extremely low birthweight preterm infants.     

Risks older drivers face themselves and threats they pose to other road users

BACKGROUND: Although there is an ever increasing literature on older drivers, there is no comprehensive up-to-date presentation of how older drivers are impacted by traffic safety, and how they impact the road safety of others. METHODS: This paper uses 1994-1996 US data to determine how many rates related to traffic safety depend on the age and sex of road users (fatalities, fatalities per licensed driver, etc.) Threats drivers pose to other road users are estimated by driver involvement in pedestrian fatality crashes. RESULTS: It is found that renewing the licence of a 70-year-old male driver for another year poses, on average, 40% less threat to other road users than renewing the license of a 40-year-old male driver. The fatality risks drivers themselves face generally increase as they age, with the increased risk of death in the same severity crash being a major contributor. If this factor is removed, crash risks for 70-year-old male drivers are not materially higher than for 40-year-old male drivers; for female drivers they are. CONCLUSIONS: Most driver rates increase substantially by age 80, in many cases to values higher than those for 20-year-olds. Given that a death occurs, the probability that it is a traffic fatality declines steeply with age, from well over 20% for late teens through mid twenties, to under one per cent at age 65, and under half a per cent at age 80.     

Circulating and secretory antibodies to specific food proteins in adults

Indirect enzyme-linked immunosorbent assays (ELISA) for the detection of antibodies to gliadin, beta-lactoglobulin and ovalbumin have been developed. Specific antibody immunoglobulin levels were quantified. Serum and saliva samples were collected from twenty normal subjects and measured for the presence of specific antibodies. For each subject food intake was calculated from a 7-d weighed food inventory record. The total IgG level was 14.2 +/- 4.3 mg/ml (mean +/- s.d.). Levels of beta-lactoglobulin IgG were significantly lower than ovalbumin IgG levels (130 +/- 130 micrograms/ml versus 637 +/- 703 micrograms/ml, P less than 0.01). Gliadin IgG levels were also significantly lower than ovalbumin IgG levels (262 +/- 398 micrograms/ml versus 637 +/- 703 micrograms/ml, P less than 0.05). However, no significant difference was observed between gliadin and ovalbumin IgA levels in the subjects (29 +/- 39 per cent versus 56 +/- 122 per cent). A significant correlation was observed between ovalbumin IgG levels in serum and dietary intake of egg protein (r = 0.46, P less than 0.05). No other significant correlations were observed.     

An assessment of the California Child Passenger Restraint Requirement.

To evaluate the California Child Passenger Restraint Law requiring children under four years of age to be transported in car seats, we examined monthly injury and fatality levels from January 1978 to December 1983 for children 0-3 and 4-7 years of age using Box-Jenkins time series models. A significant 8.36 per cent reduction in injuries was found for the 0-3 year old age group, but no significant reduction in injuries was found for 4-7 year olds. No significant reduction in fatalities was found for either age group. A similar analysis of injuries and fatalities in Texas, a state without a car seat law, showed no significant reductions in either injuries or fatalities. There was no change in the number of California 0-3 year olds in the years after the law was enacted.