Mortality reduction with air bag and seat belt use in head-on passenger car collisions

To assess the efficacy of occupant protection systems, the authors measured the mortality reduction associated with air bag deployment and seat belt use for drivers involved in head-on passenger car collisions in the United States. They used a matched case-control design of all head-on collisions involving two passenger cars reported to the Fatality Analysis Reporting System in 1992-1997, and driver mortality differences between the paired crash vehicles for air bag deployment and seat belt use were measured with matched-pair odds ratios. Conditional logistic regression was used to adjust for multiple effects. There were 9,859 head-on collisions involving 19,718 passenger cars and drivers. Air bag deployment reduced mortality 63% (crude odds ratio (OR) = 0.37, 95% confidence interval (CI): 0.32, 0.42), while lap-shoulder belt use reduced mortality 72% (OR = 0.28, 95% CI: 0.25, 0.31). In a conditional logistic model that adjusted for vehicle (rollover, weight, age) and driver (age, sex) factors, air bags (OR = 0.71, 95% CI: 0.58, 0.87) and any combination of seat belts (OR = 0.25, 95% CI: 0.22, 0.29) were both associated with reduced mortality. Combined air bag and seat belt use reduced mortality by more than 80% (OR = 0.18, 95% CI: 0.13, 0.25). Thus, this study confirms the independent effect of air bags and seat belts in reducing 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.     

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.     

Characteristics of Crashes With Farm Equipment That Increase Potential for Injury

CONTEXT: Crash fatality and injury rates are higher on rural roadways than other roadway types. Although slow-moving farm vehicles and equipment are risk factors on rural roads, little is known about the characteristics of crashes with farm vehicles/equipment. PURPOSE: To describe crashes and injuries for the drivers of farm vehicles/equipment and non-farm vehicles involved in an injury crash. Passengers are not included in this analysis. METHODS: Injury crashes were included that involved a farm vehicle/equipment and at least one non-farm vehicle reported in Iowa Department of Transportation crash data from 1995 to 2004. Odds ratios were calculated through logistic regression to identify increased odds for injury among drivers of non-farm vehicles and farm vehicles/equipment. We examined frequently occurring crash characteristics to identify crash scenarios leading to the highest odds for injury. FINDINGS: Non-farm vehicle drivers were 5.23 times more likely to be injured than farm vehicle/equipment drivers (95% CI = 4.12-6.46). The absence of restraint use was a significant predictor of injury for both farm vehicle/equipment drivers (OR = 2.85; 95% CI = 1.14-7.13) and non-farm vehicle drivers (OR = 2.53; 95% CI = 1.54-4.15). Crash characteristics increasing the odds of injury for non-farm vehicle drivers included speeding, passing the farm vehicle/equipment, driving on a county road, having a frontal impact collision, and crashing in darkness. Ejection was the strongest predictor of injury for the farm vehicle/equipment driver. CONCLUSION: Non-farm vehicle drivers were much more likely to be injured than farm vehicle/equipment drivers, suggesting that farm vehicle/equipment crash prevention should be a priority for all rural road users. Prevention strategies that reduce motor vehicle speed, assist in safe passing, increase seat belt use, and increase conspicuousness of the farm vehicle/equipment are suggested.     

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.     

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.     

Increasing the use of child restraints in motor vehicles in a Hispanic neighborhood

The use of restraints in motor vehicles is less common in minority and low-income populations than in the general population. A preliminary survey of Hispanic preschool-aged children in west Dallas, Tex, conducted in 1997 showed much lower child restraint use (19% of those surveyed) than among preschool children of all races in the rest of the city (62%). Because there are few reports of successful programs to increase child restraint use among Hispanics, we undertook to implement and evaluate such a program. The program was conducted by bilingual staff and was tailored for this community. It was successful in increasing both child restraint use and driver seat belt use.     

Seat belt use among American Indians/Alaska Natives and non-Hispanic whites

BACKGROUND: Accidents (including motor vehicle injuries) are a leading cause of death among American Indians/Alaskan Natives (AI/AN). The purpose of this study was to examine geographic variation and the existence of a seat belt law on seat belt use among AI/AN and non-Hispanic whites (NHW). METHODS: Self-reported seat belt behavior data from the 1997 and 2002 Behavioral Risk Factor Surveillance System were analyzed in 2006-2007 and were restricted to AI/AN (n=4,310 for 2002, and n=1,758 for 1997) and NHW (n=193,617 for 2002, and n=108,551 for 1997) aged 18 years and older. RESULTS: Seat belt non-use varied significantly across geographic regions for both AI/AN and NHW. For example, AI/AN living in the Northern Plains (odds ratio [OR]=12.4, 95% confidence interval [CI]=6.5-23.7) and Alaska (OR=10.3, 95%CI=5.3-19.9) had significantly higher seat belt non-use compared to AI/AN living in the West. In addition, compared to those residing in urban areas, those living in rural areas were 60% more likely in NHW and 2.6 times more likely in AI/AN not to wear a seat belt. Both AI/AN and NHW living in states without primary seat belt laws were approximately twice as likely to report seat belt non-use in 2002 as those living in states with primary laws. In states with primary laws enacted between 1997 and 2002, AI/AN experienced greater decline in seat belt non-use than NHW. CONCLUSIONS: Seat belt use among AI/AN and NHW varied significantly by region and urban-rural residency in 2002. Primary seat belt laws appear to help reduce regional and racial disparities in seat belt non-use.     

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.     

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.     

Children with Special Physical Health Care Needs: Restraint Use and Injury Risk in Motor Vehicle Crashes

Physical disabilities may affect a child passenger’s fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007–2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0–15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0–8 and 9–15 years, respectively). A greater proportion of children with SPHCN aged 0–8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9–15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0–8 years: OR 1.27, 95% CI: 0.48–3.33; children aged 9–15 years: OR 1.51, 95% CI: 0.38–6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0–8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.     

The Effectiveness of Child Restraint Systems for Children Aged 3 Years or Younger During Motor Vehicle Collisions: 1996 to 2005

Objectives. We estimated the effectiveness of child restraints in preventing death during motor vehicle collisions among children 3 years or younger.Methods. We conducted a matched cohort study using Fatality Analysis Reporting System data from 1996 to 2005. We estimated death risk ratios using conditional Poisson regression, bootstrapping, multiple imputation, and a sensitivity analysis of misclassification bias. We examined possible effect modification by selected factors.Results. The estimated death risk ratios comparing child safety seats with no restraint were 0.27 (95% confidence interval [CI] = 0.21, 0.34) for infants, 0.24 (95% CI = 0.19, 0.30) for children aged 1 year, 0.40 (95% CI = 0.32, 0.51) for those aged 2 years, and 0.41 (95% CI = 0.33, 0.52) for those aged 3 years. Estimated safety seat effectiveness was greater during rollover collisions, in rural environments, and in light trucks. We estimated seat belts to be as effective as safety seats in preventing death for children aged 2 and 3 years.Conclusions. Child safety seats are highly effective in reducing the risk of death during severe traffic collisions and generally outperform seat belts. Parents should be encouraged to use child safety seats in favor of seat belts.Motor vehicle collisions are the leading cause of unintentional injury and death among children aged 1 year or older in the United States. In 2005, 510 children aged 3 years or younger were killed in traffic crashes.¹ Restraint systems have long been recognized as an important intervention to reduce the likelihood of serious injury during traffic collisions. The use of child safety seats for children aged 3 years or younger has been required, with few exceptions, in all 50 states and the District of columbia since 1985.^2,3 Safety seat use rates are high for these children: among children younger than 1 year, safety seat use increased from 88% in 1994⁴ to 93% in 2006,⁵ and among children aged 1 to 3 years, use increased from fewer than 50% in 1994⁴ to 91% in 2006.⁵Hertz⁶ obtained the most widely used estimates of child restraint effectiveness in preventing fatalities in an analysis of 1988 to 1994 National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS) data. Hertz used a double-pair comparison method⁷ to estimate that child restraints in passenger cars and light trucks reduced fatality risk by 54% and 59%, respectively. Her work updated a similar analysis by Partyka.⁸ Neither of these studies provided confidence intervals (CIs) or other measures of uncertainty.Despite being based on crash data that are now 14 to 20 years old, Hertz''s estimates are widely cited in research and prevention programs.^9–11 Since these data were collected, car seat use for toddlers has increased, seating in the rear seat has increased,¹² and forward-facing child safety seats have changed from predominantly t-shield and overhead shield designs^13,14 to almost exclusively 5-point harness designs.¹⁵Two studies examined the effects of child safety seats on nonfatal injury risk using accident claim data and interviews of drivers insured by a large US insurance company.^16,17 Arbogast et al.¹⁶ reported that, compared with seat belts, forward-facing car seats reduced serious injury occurrence among children aged 1 to 3 by 78%. Winston et al.¹⁷ found that, among children aged 2 to 5 years, child restraints reduced the risk of serious injury by 71% and the risk of head injury by 76%, compared with seat belts.¹⁷ A major limitation of these studies is possible bias because of incorrect restraint use information provided by parents.In a more recent analysis of 1975 to 2003 FARS fatality data, Levitt¹⁸ reported that, among children aged 2 to 6 years riding in passenger vehicles, child safety seats were effective but no more effective than seat belts. He calculated fatality risk reductions of 44% to 67% for various restraints.Other studies have estimated child restraint effects on the risk of injury or death using the Crashworthiness Data System. Elliott et al.¹⁹ compared fatalities in FARS with survivors in the Crashworthiness Data System. They found a 21% lower risk of death for children aged 2 to 6 years restrained in safety seats than for children aged 2 to 6 years using seat belts. These findings are comparable to those of Partyka⁸ and Hertz⁶ regarding the relative effectiveness of these restraints. Elliot et al. did not compare the effectiveness of safety seats or of seat belts with traveling unrestrained. Zaloshnja et al.²⁰ reported 82% lower odds of any injury for children aged 2 and 3 years restrained in safety seats than for those in seat belts.The literature contains great variability in estimates of child restraint system effectiveness, and little is known about how crash, vehicle, and personal characteristics influence the ability of safety seats to prevent death and about whether effectiveness has changed over time. Our objective in this study was to provide updated estimates of the effectiveness of child safety seat use in reducing death risk among children 3 years or younger and to assess the modification of effectiveness by selected characteristics.     

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.     

The driver's role in fatal two-car crashes: a paired "case-control" study.

This population-based study examines drivers' characteristics associated with driving errors that resulted in fatal motor vehicle crashes. Routinely collected data from the Fatal Accident Reporting System were used to assess whether a driver initiated the crash (case) or was passively involved (control) in 6,506 two-car collisions (81% of 7,993 eligible events). A paired comparison of cases and controls avoided confounding by environmental factors, exposure to traffic, and differences in case fatality. The strongest predictor of crash initiation is alcohol (odds ratio (OR) = 11.5; 95% confidence interval (CI) 9.57-13.9). Odds ratios are elevated even at the lowest blood alcohol concentration levels and increase dramatically as alcohol levels rise. Drivers aged 40-49 years are least likely to initiate crashes; odds ratios rise in a U-shaped manner to 3.35 in teenagers (95% CI 2.72-4.13) and to 22.1 in drivers over 80 years (95% CI 14.2-34.5). Other risk factors for initiating a fatal crash are the following: not wearing a seat belt (OR = 1.54; 95% CI 1.35-1.75), driving without a valid driver's license (OR = 2.16; 95% CI 1.72-2.73), and having had a crash within the last year (OR = 1.21; 95% CI 1.07-1.38). Driving errors leading to fatal crashes do not occur at random, but are associated with specific driver characteristics. The risk factors for crash initiation among crash-involved drivers are similar to risk factors for crash involvement found in other studies. These findings suggest that driving errors often explain high rates of crash involvement, invite further use of crash initiation in traffic injury research, and underscore the value of population-based registries for analytic epidemiology.     

Use of restraint devices to prevent collision injuries and deaths among welfare-supported children.

Evidence that death and injury rates for young children involved in automobile collisions could be reduced if children were restrained prompted the State of Tennessee to pass the nation's first child passenger law, a law that became effective in January 1978. Although similar laws have now been enacted throughout the United States, usually restraint devices are not provided to low-income groups who may have difficulty affording them. Few studies have examined the use of such devices by welfare recipients. A total of 56 black women, receiving Medicaid and residing in inner city Memphis, were interviewed about their use of passenger restraints during automobile travel for their children ages 0-3 years. About two-thirds of the mothers interviewed said they rarely or never used child passenger restraint devices when transporting their child. Children age 3 years were significantly less likely to be transported in child restraint devices than younger children. Women who had received welfare payments for 3 years or more or who made fewer than one automobile trip a week with their child were significantly less likely to use child passenger restraints. These results suggest that, in spite of child passenger laws, automobile restraint devices are not used for a high percentage of children ages 0-3 years receiving medical care under State and Federal Medicaid programs. Since treatment costs are paid under these programs when children are injured in collisions, program administrators may have strong incentives to increase the proportion of these children being restrained while traveling in motor vehicles.     

Child Safety Programs: Implications Affecting Use of Child Restraints

Automobile deaths have been identified as the leading cause of death for children between the ages of one and fourteen. Those children who are unrestrained as passengers are at particularly high risk to injury and death. School health and safety programs need to include an understanding of this problem and implement efforts to increase restraint usage. A study of parental seatbelt and child passenger restraint use was conducted to identify frequency of use and behavioral and attitudinal factors influencing use of child restraints. Self-reported data of driver seatbelt use at all times was 19.0%, and the use of a child restraining device was 49.6%. Data recorded in a previous observational study noted a driver seatbelt usage rate of 14.2% and use of a child restraining device at 25.6%. Major reasons for non-use of seatbelts by drivers included discomfort and restricted movement. Reasons for non-use of child restraints focused upon the dislike and discomfort of the child for the restraint.     

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.     

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.)     

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.     

Seat belt use among drinking drivers in Minnesota.

OBJECTIVES. Among the reasons cited for recent declines in alcohol-related traffic fatalities is the enactment of seat belt use laws by most states. It is suspected that drinking drivers are less likely to comply with such laws, although evidence on the relationship between belt use and drinking by drivers is sparse and conflicting. The purpose of this study was to examine the relationship of drinking to driver seat belt use. METHODS. Observational, self-report, and chemical breath test data were collected on nighttime drivers in 16 Minnesota communities during September, 1990. RESULTS. Drivers with an illegal blood alcohol concentration (> or = 100 mg/dL) were substantially less likely to be wearing a seat belt (odds ratio [OR] = 2.17). Belt use was also more common among females (OR = 2.02) and before midnight (OR = 1.47). Males who had been drinking were less likely to be belted. Belt use was related to drinking before, but not after, midnight. Belt use was not related to drinking status among college graduates, but it was strongly related to drinking status among those with less education. CONCLUSIONS. The present findings provide further argument for rapid implementation of passive countermeasures (airbags) and for development of creative, carefully focused interventions to target high-risk populations.