Where children sit in cars: the impact of Rhode Island's new legislation

OBJECTIVES: This study evaluated the impact of Rhode Island's legislation requiring children younger than 6 years to sit in the rear of motor vehicles. METHODS: Roadside observations were conducted in Rhode Island and Massachusetts in 1997 and 1998. Multivariate regression was used to evaluate the proportion of vehicles carrying a child in the front seat. RESULTS: Data were collected on 3226 vehicles carrying at least 1 child. In 1998, Rhode Island vehicles were less likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant changes in child passenger seating behavior occurred in Massachusetts during that period. CONCLUSIONS: Rhode Island's legislation seems to have promoted safer child passenger seating behavior.     

Restraint use among northwest American Indian children traveling in motor vehicles

OBJECTIVES: We sought to estimate motor vehicle passenger restraint use among Northwest American Indian children 8 years old or younger and to determine factors associated with using proper (i.e., age and weight appropriate) passenger restraint systems. METHODS: We surveyed vehicles driven by members of 6 tribes in Idaho, Oregon, and Washington. Associations between proper restraint and child, driver, and vehicle characteristics were analyzed using logistic regression for clustered data. RESULTS: We observed 775 children traveling in 574 vehicles; 41% were unrestrained. Proper restraint ranged from 63% among infant seat-eligible children to 11% among booster seat-eligible children and was associated with younger child's age (odds ratio (OR) per year = 0.60; 95% confidence interval (CI) = 0.48, 0.75), seating location (OR front vs rear=0.27; 95% CI=0.16, 0.44), driver seat belt use (OR=2.39; 95% CI=1.51, 3.80), and relationship (OR for nonparent vs parent=0.28; 95% CI=0.14, 0.58). More than half of drivers felt children could use an adult seat belt earlier than recommended guidelines, and 63% did not correctly identify whether their tribe had child safety seat laws. CONCLUSIONS: Children in these communities are inadequately restrained. Restraint use was exceedingly low among booster-eligible children and children riding with unrestrained adults. Interventions emphasizing appropriate restraint use and enforcement of passenger safety laws could reduce the risk of injury or death in motor vehicle accidents.     

Seating position in cars and fatality risk.

Fatality risk in passenger cars according to seating position (front versus rear; left versus center or right) was examined using Fatal Accident Reporting System (FARS) data for 1975 through 1985. Comparing the fatality risk of unrestrained occupants matched in sex and age (within three years) revealed effects attributable to seating position, and not to occupant characteristics correlated with use of different seats. Fatality risk to drivers was the same as fatality risk to right front passengers to within 1 per cent; this was so for crashes in all directions and for frontal crashes. Fatality risk in rear seats was (26 +/- 2) per cent lower than in front seats, and lower in center compared to outboard seats by (22 +/- 4) per cent for front seats and (15 +/- 4) per cent for rear seats. The center rear seat was associated with the lowest fatality risk.     

Coverage gaps in seat belt use laws.

Some seat belt use laws exempt occupants in certain seating positions and in certain types of vehicles, or both. A state-by-state analysis was conducted of the extent to which passenger vehicle occupants killed before the laws went into effect would have been covered by the laws subsequently passed. Only five states had laws that covered all passenger vehicle occupants; the majority excluded 4 to 8 per cent and six states excluded 14 per cent or more. More inclusive laws can reduce injuries and save lives.     

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.     

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.     

Fatal Passenger Vehicle Crashes With At Least 1 Driver Younger Than 15 Years: A Fatality Analysis Reporting System Study

CONTEXT: A small number of fatalities continue to occur due to motor vehicle crashes on highways in which at least 1 passenger vehicle (automobile, van, or small truck) is driven by a child younger than 15 years. PURPOSE: The purpose of this study was to extend previous work suggesting that such crashes occur frequently in the Southern states and have relatively high rates in rural areas in the South and Great Plains. METHODS: This study utilizes data for the 5-year period 1999-2003 from the National Highway Transportation Safety Administration's online Fatality Analysis Reporting System. All cases were identified in which at least 1 conventional passenger vehicle in a fatal crash was being driven by a child younger than 15 years. FINDINGS: During the 5-year period, 350 fatal crashes occurred with at least 1 driver younger than 15 years involved. Twenty-one of these drivers were licensed (11) or driving with a learner's permit (10). A total of 987 individuals in 419 vehicles were involved in these crashes, and 402 deaths resulted (1.16 deaths/crash). These crashes occurred primarily in Texas, Florida, Arkansas, and Arizona, but the highest rates per 100,000 children were found in North and South Dakota and predominantly in a band of Intermountain and Plains states. There was a strong correlation between crash rates and several measures of rurality. CONCLUSIONS: Crashes involving young, largely unlicensed, drivers account for about 70 deaths yearly.     

Air bags and passenger fatality according to passenger age and restraint use

BACKGROUND: Some children have been killed by air bags, leading to advice that young children should not sit in front of an active air bag. METHODS: We conducted a case-control study to estimate the association of passenger air bag presence with death, according to passenger age and seat belt use. We used data from crashes on U.S. public roads in 1992 through 1998. Cases (N = 20,987) were front seat passengers who died, and controls (N = 69,277) were a sample of survivors. RESULTS: Among restrained passengers, the adjusted relative risk of death for those with a passenger air bag was 0.79 (95% confidence interval [CI] = 0.66-0.94); for children 12 years or younger, the adjusted relative risk was 1.04 (0.65-1.67) [corrected], and for adults 20 years or older it was 0.75 (0.62-0.91) [corrected]. Among unrestrained passengers, the adjusted relative risk was 1.03 (CI = 0.81-1.30); for children 12 years or younger the adjusted relative risk was 1.37 (0.84-2.21) [corrected], and for adults 20 years or older it was 0.96 (0.75-1.24). CONCLUSIONS: Passenger air bags may be a hazard to unrestrained children and of little benefit to unrestrained adults. Our results support the advice that children younger than 13 years should not sit in front of an active air bag.     

Age and injury severity

This study aims at showing if and to what extent injury severity in frontal car crashes increases with the age of front seat occupants. Data on 2658 belted drivers and front seat passengers in Volvo private car series 140, 240 and 740/760, involved in frontal crashes were extracted from the Volvo Car Crash Register. The results show that the risk of injury resulting in "medical observation" does not increase systematically with age. However, the risk of fracture with any localization is more than three times higher among those aged 65-74 than in those aged 18-24, and the risk of fracture in the rib cage is nearly eleven times higher among the older than in the younger age group. It can be concluded that the incidence of specific types of injuries - as exemplified with fractures of any localization and fractures in the rib cage - increases with advancing age.     

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.     

Vital Signs: Restraint Use and Motor Vehicle Occupant Death Rates Among Children Aged 0–12 Years — United States, 2002–2011

Background

Motor vehicle crashes are a leading cause of death among children in the United States. Age- and size-appropriate child restraint use is the most effective method for reducing these deaths.

Methods

CDC analyzed 2002–2011 data from the Fatality Analysis Reporting System to determine the number and rate of motor-vehicle occupant deaths, and the proportion of unrestrained child deaths among children aged <1 year, 1–3 years, 4–7 years, 8–12 years, and for all children aged 0–12 years. Age group–specific death rates and proportions of unrestrained child motor vehicle deaths for 2009–2010 were further stratified by race/ethnicity.

Results

Motor vehicle occupant death rates for children declined significantly from 2002 to 2011. However, one third (33%) of children who died in 2011 were unrestrained. Compared with white children for 2009–2010, black children had significantly higher death rates, and black and Hispanic children both had significantly higher proportions of unrestrained child deaths.

Conclusions

Motor vehicle occupant deaths among children in the United States have declined in the past decade, but more deaths could be prevented if restraints were always used.

Implications for Public Health

Effective interventions, including child passenger restraint laws (with child safety seat/booster seat coverage through at least age 8 years) and child safety seat distribution plus education programs, can increase restraint use and reduce child motor vehicle deaths.     

Walking, cycling and transport safety: an analysis of child road deaths

OBJECTIVE: To examine trends in road death rates for child pedestrians, cyclists and car occupants. DESIGN: Analysis of road traffic injury death rates per 100 000 children and death rates per 10 million passenger miles travelled. SETTING: England and Wales between 1985 and 2003. PARTICIPANTS: Children aged 0-14 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Death rates per 100,000 children and per 10 million child passenger miles for pedestrians, cyclists and car occupants. RESULTS: Death rates per head of population have declined for child pedestrians, cyclists and car occupants but pedestrian death rates remain higher (0.55 deaths/100,000 children; 95% confidence interval [CI] 0.42 to 0.72 deaths) than those for car occupants (0.34 deaths; 95% CI 0.23 to 0.48 deaths) and cyclists (0.16 deaths; 95% CI 0.09 to 0.27 deaths). Since 1985, the average distance children travelled as a car occupant has increased by 70%; the average distance walked has declined by 19%; and the average distance cycled has declined by 58%. Taking into account distance travelled, there are about 50 times more child cyclist deaths (0.55 deaths/10 million passenger miles; 0.32 to 0.89) and nearly 30 times more child pedestrian deaths (0.27 deaths; 0.20 to 0.35) than there are deaths to child car occupants (0.01 deaths; 0.007 to 0.014). In 2003, children from families without access to a vehicle walked twice the distance walked by children in families with access to two or more vehicles. CONCLUSIONS: More needs to be done to reduce the traffic injury death rates for child pedestrians and cyclists. This might encourage more walking and cycling and also has the potential to reduce social class gradients in injury mortality.     

Predictors of seat-belt use among school-aged children in two low-income Hispanic communities

OBJECTIVES: To examine the prevalence of seat belt use among school-aged children in low-income Hispanic communities. METHODS: We conducted unobtrusive observations of school-aged children (aged 5 to 12 years) traveling to and from nine elementary schools in two communities. We documented vehicle type, and belted status and seating position of children, driver, and other passengers. Results are presented as percentages with 95% confidence intervals (CIs). RESULTS: We observed 3651 children, of which restraint use could be determined for 2741. Overall, 29% of children were using seat belts. By seating location, 58% were in the front seat with 40% belted, and 42% were in the back seat with 14% belted. Children were most likely to be restrained when traveling in the front seat (40.0%, CI=37.6-42.5); traveling with a belted driver (42.4%, CI=40.0-44.8); or traveling without additional passengers (40.3%, CI=37.0-43.7) CONCLUSIONS: Seat belt use among children from this study population was below the national average and was alarmingly low among children in the back seat. While traveling, being belted in the back seat provides the most protection in a collision. Prevention efforts need to be based on an understanding of the barriers to restraint use for children traveling in the back seat.     

Seat Belt Use Among Overweight and Obese Adolescents

Motor vehicle crashes are the leading cause of death for adolescents. Previous studies with adults found an association between weight status and decreased use of seat belts. Research has also found significantly higher morbidity and mortality rates in obese individuals who are involved in motor vehicle crashes. If these relationships hold true in obese adolescents they represent additional risk factors for complications from motor vehicle trauma. Given the prevalence of obesity in adolescents (17.4%) and the increased risk of harm associated with obese individuals involved in motor vehicle crashes, this study explored whether there was an association between obesity in adolescents and their use of seat belts. Initial investigation found that rarely/never wearing seat belts was significantly greater for African Americans (22.6%), 18 years of age or older (19.4%), lived with adults other than both parents (15.7%), and males (15.4%). Bivariate logistic regression analysis controlling for demographic variables found that there was no statistically significant difference between overweight and normal weight adolescents. However, obese students were 1.72 times as likely as normal weight students to never or rarely wear their seat belts when riding in a car as a passenger. In particular, obese females and obese students in the middle school age ranges were statistically significantly more likely than normal weight students to never or rarely wear their seat belts.     

Trends and Correlates of Child Passenger Restraint Use in 6 Northwest Tribes: The Native Children Always Ride Safe (Native CARS) Project

Objectives. We compared proportions of children properly restrained in vehicles in 6 Northwest American Indian tribes in 2003 and 2009, and evaluated risks for improper restraint.Methods. During spring 2009 we conducted a vehicle observation survey in Oregon, Washington, and Idaho tribal communities. We estimated the proportions of children riding properly restrained and evaluated correlates of improper restraint via log-binomial regression models for clustered data.Results. We observed 1853 children aged 12 years and younger in 1207 vehicles; 49% rode properly restrained. More children aged 8 years and younger rode properly restrained in 2009 than 2003 (51% vs 29%; P < .001). Older booster seat–eligible children were least likely to ride properly restrained in 2009 (25%). American Indian children were more likely to ride improperly restrained than nonnative children in the same communities. Other risk factors included riding with an unrestrained or nonparent driver, riding where child passenger restraint laws were weaker than national guidelines, and taking a short trip.Conclusions. Although proper restraint has increased, it remains low. Tribe-initiated interventions to improve child passenger restraint use are under way.Despite advances in restraint technology and improved laws, motor vehicle injury still remains the leading cause of death for children aged between 3 and 14 years.1 American Indian and Alaska Native (AI/AN) children experience higher mortality rates from motor vehicle crashes than other races, nearly twice the national average.2,3 This is, in part, a result of riding unrestrained or improperly restrained in vehicles. According to 2002 Fatal Accident Reporting System data, fewer fatally injured occupants were restrained in crashes that occurred in tribal jurisdictions (16%) than in crashes that occurred in other areas of the nation (38%).4In a 2003 vehicle observation survey, the majority of AI/AN children were observed riding unrestrained (41%) or improperly restrained (30%) in 6 Northwest tribal communities (Idaho, Oregon, and Washington).5 In that study, only 11% of booster seat–eligible children were properly restrained. These figures were much lower than those reported for other populations during the same time frame.6,7 Less frequent use of proper restraints among AI/AN children may be a result of a combination of factors,7–11 and AI/AN parents and other caregivers who travel with unrestrained or improperly restrained children face barriers to consistent use that may differ from those in other US communities. These would likely include legal and law enforcement differences,12,13 but could also include cultural beliefs, family and community structure, geographic location, and economic factors.5In response to data from the 2003 study,5 the 6 participating Northwest tribes collaborated to form Native Children Always Ride Safe (Native CARS), a community-initiated intervention study designed to improve child passenger restraint use in tribal communities. We present data from a vehicle observation study conducted in 2009 in these tribes. We contrasted data from the 2003 and 2009 surveys to determine change in proper restraint over time, and examined correlates of improper restraint from the 2009 data to help inform intervention planning in the tribes.     

Occupant- and crash-related factors associated with the risk of whiplash injury

PURPOSE: Given that a motor vehicle crash (MVC) had occurred, to evaluate whether occupant- and crash-related factors, such as age, gender, seating position and type of MVC are associated with the risk of whiplash injury. METHODS: A study of occupants in cars covered by motor insurance at one of the largest insurance companies in Sweden, was undertaken during a one-year period. The study population comprised all occupants in cars exposed to an MVC in which at least one occupant was injured (n = 7120). Adjusted estimates of the relative risk of whiplash injury, associated with the different factors, were calculated by means of binomial regression analysis. RESULTS: Considering different MVCs, rear-end collisions were associated with the highest relative risk of whiplash injury when compared with side impacts (1.82; 95% CI 1.68-1.96), while drivers showed the strongest association with respect to seating position when compared with passengers in the rear seat (1.78; 95% CI 1.60-1.97). Females had a somewhat higher relative risk of whiplash injury than males (1.20; 95% CI 1.16-1.25). Regarding age, the relative risk was moderately increased across the different age groups when compared with the oldest age group. No interaction was observed on the additive scale. CONCLUSIONS: Given that an MVC had occurred, subjects exposed to a rear-end collision and drivers had a substantial increased risk of whiplash injury, while age and gender were of minor importance.     

Child passenger deaths involving drinking drivers--United States, 1997-2002

Motor-vehicle crashes are the leading cause of death among children aged >/=1 year in the United States, and one in four crash-related deaths among child passengers aged 相似文献   

Knowledge and Behaviors of Physicians and Caregivers About Appropriate Child Passenger Restraint Use

The object of this research was to ascertain caregivers’ and physicians’ knowledge, behaviors, and comfort levels regarding child passenger safety restraint transitions with belt positioning booster seats (BPB). A targeted survey of physicians caring for 4–8 year olds plus convenience sampling surveys of caregivers across an urban community was conducted. Data revealed 42% of physicians and 47% of caregivers did not know that motor vehicle crashes are the leading cause of death in children in this age group. Only 34% of caregivers consistently placed children in booster seats; 48% reported receiving physician information about proper restraint; 67% reported wanting to learn about proper restraint; and 36% wanted such information from physicians. Caregivers who recalled physician questions about restraints were three times more likely than others to use booster seats correctly. 70% of physicians reported asking about child restraint in vehicles in this age group. However, only 48% were very comfortable with knowing when to recommend booster seats, 43% reported having received no training in child passenger safety, and only 37% knew where to refer caregivers for more information. Physicians need more information about appropriate child passenger safety restraints as children grow and ways to deliver and reinforce the message so that it is retained to improve community health. Caregivers indicate willingness to learn, but providers miss many opportunities to teach.     

Child Passenger Safety in the Somali Communities of Columbus,Ohio

Children (particularly low-income minorities and refugees) are at high risk for serious injury or death from motor vehicle crashes. Interpreter-assisted data collection included key informant interviews, focus groups and face-to-face surveys with the Somali community of Columbus, Ohio about child passenger safety. Measurements included prevalence of child safety seats use, awareness and knowledge of and barriers to proper use in order to inform development, implementation, and initial evaluation of a culturally-appropriate intervention for Somali families. Somali parents regarded child passenger safety as an important topic, but many reported improper restraint behaviors of one or more children and/or did not have an adequate number of child safety seats. Few parents reported having child safety seats installed by a professional technician. Child passenger safety practices in the Somali communities of Columbus are a public health concern that should be addressed with culturally-appropriate interventions.     

Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants — United States, 2012

Background

Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States.

Methods

CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs.

Results

In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012.

Conclusions

Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED.

Implications for Public Health

Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs.