Evaluating Child Passenger Restraint Use Education.

BACKGROUND: Despite recommendations and laws for child restraint use in motor vehicles, evidence of low restraint use remains, and there is a lack of evidence addressing the effectiveness of restraint use education. OBJECTIVE: This project aims to measure the impact of an education initiative on child passenger restraint use. METHODS: This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5 months from October 2022 to March 2023. Motor vehicle restraint use was collected from occupants arriving at elementary schools during the morning drop-off times. Participants were provided one-on-one education regarding child passenger safety guidelines and state laws. Comparison data were collected 1-3 weeks later at the same schools to evaluate the education provided. RESULTS: A total of 1,671 occupants in 612 vehicles were observed across six schools, with 343 adults and 553 children preintervention and 306 adults and 469 children postintervention. Overall restraint adherence in children improved postintervention from 42.3% to 56.1%, a 32.6% increase (p = < .001). In the primary age group of 4-8 years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p = <.001). CONCLUSIONS: The study results demonstrate that one-on-one education increases child passenger restraint use.

Using change in a seat belt law to study racially-biased policing in South Carolina.

Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.

Would Stronger Seat Belt Laws Reduce Motor Vehicle Crash Deaths?: A Semi-Bayesian Analysis.

BACKGROUND: For policy questions where substantial empirical background information exists, conventional frequentist policy analysis is hard to justify. Bayesian analysis quantitatively incorporates prior knowledge, but is not often used in applied policy analysis. METHODS: We combined 2000-2016 data from the Fatal Analysis Reporting System with priors based on past empirical studies and policy documents to study the impact of mandatory seat belt laws on traffic fatalities. We used a Bayesian data augmentation approach to combine information from prior studies with difference-in-differences analyses of recent law changes to provide updated evidence on the impact that upgrading to primary enforcement of seat belt laws has on fatalities. RESULTS: After incorporating the evidence from past studies, we find limited evidence to support the hypothesis that recent policy upgrades affect fatality rates. We estimate that upgrading to primary enforcement reduced fatality rates by 0.37 deaths per billion vehicle miles traveled (95% posterior interval -0.90, 0.16), or a rate ratio of 0.96 (95% posterior interval 0.91, 1.02), and increased the proportion of decedents reported as wearing seat belts by 7 percentage points (95% posterior interval 5, 8), or a risk ratio of 1.18 (95% posterior interval 1.13, 1.24). CONCLUSIONS: Bayesian methods can provide credible estimates of future policy impacts, especially for policy questions that occur in dynamic environments, such as traffic safety.

Motor vehicle injury prevention in eight American Indian/Alaska Native communities: results from the 2010-2014 Centers for Disease Control and Prevention Tribal Motor Vehicle Injury Prevention Program.

OBJECTIVES: The aim of the study is to increase seat belt (SB) use and reduce motor vehicle (MV) injuries and death; eight tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. STUDY DESIGN: SB use was measured through direct observational surveys and traffic safety activity data. Traffic safety activities included enhanced enforcement campaign events, ongoing enforcement of SB laws, and media. The number of MV injuries (including fatal and non-fatal) was measured through MV crash data collected by police. RESULTS: Percentage change increases in SB use were observed in all eight projects; average annual increases of three projects were statistically significant (ranging from 10% to 43%). Four of the eight projects exceeded their goals for percentage change increases in SB use. Approximately 200 media events and 100 enforcement events focused on SB use were conducted across the eight projects. Five projects had an annual average of ≥100 SB use citations during the project period. MV injuries (fatal and non-fatal combined) significantly decreased in three projects (ranging from a 10% to 21% average annual decrease). CONCLUSIONS: Increases in SB use and decreases in the number of MV injuries can be achieved by tailoring evidence-based strategies to tribal communities.

Effectiveness of child restraints and booster legislation in Israel.

INTRODUCTION: 96 countries in the world have enacted child restraints and booster legislation (CRBL). Yet, findings regarding the effectiveness of CRBLs are mixed. The current study is the first to examine the association between Israel's CRBL, implemented in November 2004, and the traffic injury and fatality rates among children aged 0-9 years. We extend on previous studies by accounting for risk exposure and by comparing populations of children affected by the legislation to those who were not. METHODS: We used an interrupted time series design of kilometre driven-based traffic injury rates for children aged 0-4 years and children aged 5-9 years using childred aged 10-14 years as a comparison group. We estimated the effects of Israel's CRBL using monthly injury and fatality count data from the Israeli Central Bureau of Statistics. The sample includes all child vehicle occupants injured and killed in crashes in Israel between January 2003 and December 2011. RESULTS: Children aged 0-4 years experienced a 5.17% yearly reduction in traffic injury rate (incidence rate ratio (IRR): 0.94(95% CI 0.92 to 0.96); p=0.000), and the injury rate for children aged 5-9 years was associated with a 4.10% yearly reduction (IRR: 0.95(95% CI 0.93 to 0.98); p=0.001). The comprehensive CRBL implemented in Israel was associated with a 6.3% (95% CI -7.2% to5.5%; p=0.001) reduction in traffic injuries and fatalities for children aged 0-9 years. CONCLUSION: This is the first study comparing traffic injury rates per kilometre driven for motor vehicle-occupant children before and after the implementation of the CRBL in Israel.

States Consider Cameras and Seat Belts to Increase School Bus Safety.

(1) More than 25 million children ride in a school bus every weekday in the U.S. (2) School buses are the safest way to transport students. (3) Nearly 60 school bus passengers died in crashes, and almost 100 pedestrians under 18 were killed in crashes related to school transportation, between 2007 and 2016.

The impact of child restraint legislation on the incidence of severe paediatric injury in Chile.

BACKGROUND: The objective of this study is to determine the association between Chile's 2005 child restraint legislation (CRL) and the incidence of severe paediatric motor vehicle-related injury. METHODS: We analysed motor vehicle injury data from Chile's Road Safety Commission from 2000 to 2012 to determine the association between Chile's 2005 CRL and severe paediatric injury. Using Poisson time-series models we assessed the effect of the law on two outcome variables: (1) severely injured children per vehicle fleet; and (2) severely injured children per population. RESULTS: Chile's 2005 CRL is significantly associated with a 24% reduction in severely injured children per vehicle, and 19% reduction in severely injured children per population in the 1st year of its enactment. In 2007 this law is also significantly associated with a 17% decrease in severely injured children per vehicle, and with an 11% decrease in severely injured children per population. However, this legislation had a short-term effect since no reductions in severely injured children per vehicle were observed after 2009 and no reductions for severely injured children per population were registered after 2008. CONCLUSIONS: This is the first study to examine the association between CRL and severe paediatric injury in a Latin-American country. This study suggests that Chile's CRL was only effective in the short term. To support this type of reforms in the long term, other measures such as police enforcement, public information campaigns and involvement of public health professionals in educating parents about the benefits of using child restraints should be considered.

Evaluation of the five-year Bloomberg Philanthropies Global Road Safety Program in the Russian Federation.

Road traffic injuries are a leading cause of morbidity and mortality in the world. In Russia, a road safety program was implemented in Lipetskaya and Ivanovskaya oblasts (regions) as part of a 10-country effort funded by Bloomberg Philanthropies. The program was focused on increasing seat belt and child restraint use and reducing speeding. The primary goals of this monitoring and evaluation study are to assess trends in seat belt use, child restraint use, and speed compliance in the two oblasts over the 5 years and to explore the overall impact of the program on road traffic injury and death rates. Primary data via roadside observations and interviews, and secondary data from official government sources were collected and analyzed for this study. Our results indicate significant improvements in seat belt wearing and child seat use rates and in prevalence of speeding in both intervention oblasts. The observations were consistent with the results from the roadside interviews. In Lipetskaya, restraint use by all occupants increased from 52.4% (baseline, October 2010) to 77.4% (final round, October 2014) and child restraint use increased from 20.9% to 54.1% during the same period. In Ivanovskaya, restraint use by all occupants increased from 48% (baseline, April 2012) to 88.7% (final round, October 2014) and child restraint use increased from 20.6% to 89.4% during the same period. In Lipetskaya, the overall prevalence of speeding (vehicles driving above speed limit) declined from 47.0% (baseline, July 2011) to 30.4% (final round, October 2014) and a similar pattern was observed in Ivanovskaya where the prevalence of speeding decreased from 54.6% (baseline, March 2012) to 46.6% (final round, October 2014). Through 2010-2014, the road traffic crash and injury rates per 100,000 population decreased in Lipetskaya oblast (191.5 and 246.9 in 2010 and 170.4 and 208.6 in 2014, respectively) and slightly increased in Ivanovskaya oblast (184.4 and 236.0 in 2010 and 186.7 and 243.4 in 2014, respectively). These road safety improvements are associated with the program that enabled a combined focus on policy reform, legislation, enforcement, advocacy, education, and data collection and use. However, the existence of other road safety efforts, lack of data from comparable regions, and unavailability of risk factor-specific data make it difficult to attribute these changes to the program.

Ambulance Crash in a Rural Area of Thailand.

BACKGROUND: Ambulance crashes delay patient transfer and endanger patients, ambulance crews, and other road users. In low- and middle-income countries, where motor vehicle crash rates are typically high, ambulances have a high risk of being involved in a crash. This case report describes an ambulance crash in Thailand to elucidate modifiable problems in current protocols and practices of emergency medical services. CASE REPORT: In November 2016, a 28-year-old male driver of an ambulance died in a crash while transferring a female patient with dizziness to a rural hospital. The driver and another ambulance crew member were sitting in the front seats unrestrained. The other occupants were in the patient compartment unrestrained. The driver was driving the ambulance within the speed limit. He made a sharp turn trying to evade a dog, and the ambulance crashed head-on into a roadside tree. The cabin sustained severe damage, and the occupants in the patient compartment were struck against the compartment wall and were struck by unsecured equipment and the stretcher. The driver sustained a severe brain injury. The other occupants, including the female patient, sustained minor injuries. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case raises safety issues concerning the following aspects of ambulance operations in low- and middle-income countries: speed limit, safety device use, seatbelt use, securing equipment, and vehicle safety standards. Systematic measures to change protocols or even legislation, as well as data collection, are required to address these issues.

Announcement: Click It or Ticket Campaign - May 23-June 5, 2016.

Click It or Ticket is a national campaign coordinated annually by the National Highway Traffic Safety Administration to increase the proper use of seat belts. In 2014, more than 21,000 passenger vehicle occupants died in motor vehicle crashes in the United States; 49% were unrestrained at the time of the crash (1). An additional 2.4 million occupants (restrained and unrestrained) were treated in emergency departments for nonfatal crash-related injuries (2).

Motor Vehicle Crash Fatalities in States With Primary Versus Secondary Seat Belt Laws: A Time-Series Analysis.

BACKGROUND: Motor vehicle crashes (MVCs) remain a leading cause of injury-related deaths in the United States. Primary seat belt laws allow vehicle occupants to be ticketed solely for not wearing seat belts, and secondary laws allow ticketing only for failure to wear seat belts in the setting of other violations. OBJECTIVE: To determine the association between MVC fatality rates and primary versus secondary seat belt laws. DESIGN: Retrospective time-series analysis. SETTING: United States, 2001 to 2010. PARTICIPANTS: MVC fatalities in occupants aged 10 years or older identified in the Fatality Analysis Reporting System. MEASUREMENTS: Population-based rates of fatal crashes. RESULTS: There were 283 183 MVC fatalities in occupants aged 10 years or older from 2001 to 2010 (overall rate, 13.0 per 100 000 persons). In 2001, the mean fatality rate was 14.6 per 100 000 persons, 16 states had primary seat belt laws, and 33 states had secondary laws. In 2010, the mean fatality rate was 9.7 per 100 000 persons, 30 states had primary seat belt laws, and 19 states had secondary laws. In the multivariate regression model, states with primary seat belt laws had lower MVC fatality rates than states with secondary laws (adjusted incidence rate ratio, 0.83 [95% CI, 0.78 to 0.90]). LIMITATION: Only fatalities were analyzed from the database, and the degree of law enforcement could not be ascertained. CONCLUSION: States with primary seat belt laws had lower rates of MVC fatalities than those with secondary laws. Adoption of primary seat belt laws may offer optimal occupant protection. PRIMARY FUNDING SOURCE: None.

Caregivers' confidence in performing child safety seat installations: what matters most?

BACKGROUND: Although effective when used correctly, child restraint systems (CRS) are commonly misused. Caregivers must make accurate judgements about the quality of their CRS installations, but there is little research on the psychological, technological, or contextual factors that might influence these judgements. METHODS: Seventy-five caregivers were observed installing a CRS into a vehicle and completed self-report surveys measuring risk appraisals, previous utilisation of CRS resources, task difficulty, and confidence that the CRS was installed correctly. RESULTS: Approximately 30% of caregivers installed the CRS inaccurately and insecurely, but reported that it was correctly installed. Predictors of confidence were ease of use (ß=0.47) and exposure to CRS resources (ß=-0.34). Installation errors and CRS security were unrelated to caregivers' confidence. CONCLUSIONS: An interdisciplinary approach is needed to understand factors influencing caregivers' judgements about their installations, optimise channels to connect caregivers to CRS resources, and to design safety technologies in light of these findings.

Seatbelt usage: is there an association with obesity?

Wearing a seatbelt can prevent motor vehicle crash deaths. While primary seatbelt laws are designed to encourage vehicle passengers to wear seatbelts by allowing law enforcement officers to issue tickets when passengers do not wear seatbelts, discomfort may discourage obese individuals from wearing a seatbelt. The objective of this study is to assess the association between state-level obesity and seatbelt usage rates in the US, and to examine the possible role played by seatbelt laws in these associations. The strength of the association between obesity rates, seatbelt usage, and primary seatbelt laws at the state level is investigated using data from 2006 to 2011. Linear regression analysis is employed. This model estimates that increasing the obesity rate by 1% in a state where a primary seatbelt law (by which law enforcement officers can issue a ticket when seatbelts are not worn) is in effect is associated with a 0.06% decrease in seatbelt usage. However the same percentage of increase in the obesity rate in a state where no primary seatbelt law is in effect is associated with a 0.55% decrease in seatbelt usage. The magnitude of the statistical association between state obesity rates and state-level seatbelt usage is related to the existence of a primary seatbelt law, such that obesity has less impact on seatbelt usage in states where primary seatbelt laws are in effect.

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.

Factors associated with the enactment of safety belt and motorcycle helmet laws.

It has been shown that road safety laws, such as motorcycle helmet and safety belt laws, have a significant effect in reducing road fatalities. Although an expanding body of literature has documented the effects of these laws on road safety, it remains unclear which factors influence the likelihood that these laws are enacted. This study attempts to identify the factors that influence the decision to enact safety belt and motorcycle helmet laws. Using panel data from 31 countries between 1963 and 2002, our results reveal that increased democracy, education level, per capita income, political stability, and more equitable income distribution within a country are associated with the enactment of road safety laws.

Safety belt laws and disparities in safety belt use among US high-school drivers.

OBJECTIVES: We compared reported safety belt use, for both drivers and passengers, among teenagers with learner's permits, provisional licenses, and unrestricted licenses in states with primary or secondary enforcement of safety belt laws. METHODS: Our data source was the 2006 National Young Driver Survey, which included a national representative sample of 3126 high-school drivers. We used multivariate, log-linear regression analyses to assess associations between safety belt laws and belt use. RESULTS: Teenaged drivers were 12% less likely to wear a safety belt as drivers and 15% less likely to wear one as passengers in states with a secondary safety belt law than in states with a primary law. The apparent reduction in belt use among teenagers as they progressed from learner to unrestricted license holder occurred in only secondary enforcement states. Groups reporting particularly low use included African American drivers, rural residents, academically challenged students, and those driving pickup trucks. CONCLUSIONS: The results provided further evidence for enactment of primary enforcement provisions in safety belt laws because primary laws are associated with higher safety belt use rates and lower crash-related injuries and mortality.

Road safety legislation in the Americas.

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

Progress in reducing road-related deaths and injuries in Irish children.

The aim was to study road-related injuries and fatalities in under 15 year olds in two time periods (1996-2000 and 2004-2008 inclusive) to assess whether progress has been made via cross-sectoral efforts to reduce this injury toll in Ireland. For pedestrian and car-related accidents, police assistance is required and at the time a detailed CT 68 form is completed by the attending officer and sent to the Road Safety Authority for analysis. Details re the severity of injury, light and road conditions and safety measures such as seat belt or car restraint use, seat position and helmet use if a cyclist were recorded. Injuries were sub-classified as fatalities, serious (detained in hospital, fractures, severe head injury, severe internal injuries or shock requiring treatment) or minor. All data for the two time periods was entered onto an SPSS database. A concerted national campaign re road safety media campaign allied to random breath testing, penalty points for driving offences, on the spot fines for speeding and far greater police enforcement took place between the two time frames and continues to this day. When looked at as most likely estimates of death ratios the results were found to be statistically significant with an overall p value of < 0.0001 CI [0.39, 0.69]. When broken down into specific age ranges all were significant apart from the 0-3 age range with a p value of 0.69 CI [0.26, 1.1]. The most significant changes were found in the 7-9 years, 10-12 and 13-15 year age ranges with p values of < 0.0001, 0.0002 and 0.0007 respectively. When results were compared between the two cohorts, car occupant fatalities between both groups dropped by 36%. Pedestrian injuries dropped from 1719 to 1232, pedestrian fatalities decreased by almost 50% as did serious pedestrian injuries from 261 down to 129. Cyclist fatalities saw the most significant fall (76%) with a dramatic reduction in cyclist injuries from 25 down to 6 (63%). The 13-15 year old age group had the highest mortality and morbidity in both cohorts. Documented restraint use was less than 70% in both cohorts. A national road safety campaign, greater police enforcement and a cultural change has seen road-related injuries in children drop very significantly (by 50%) over the two time periods and this campaign should continue.

Epidemiology of head injury in the United Arab Emirates.

BACKGROUND: Head injury increases mortality in trauma patients. We aimed to study the epidemiological and clinical features of head injury in Al-Ain city, United Arab Emirates (UAE). METHODS: Trauma patients with head injury who were admitted to Al- Ain Hospital for more than 24 hours and those who died in the hospital were included in the study. Data were prospectively collected from March 2003 - March 2006. RESULTS: 589 patients were studied, and 521 were males (88.3%). The median (range) age was 30 (1-89) years. The most common mechanism of injury was road traffic collision (67.1%) followed by fall from height (11.9%). Head injury was mild in 82.2% of patients, moderate in 5.7%, and severe in 12.1%. 20.9% of patients were admitted to the intensive care unit. 35 patients died (overall mortality 5.9%). Patients who died had significantly higher Injury Severity Score (p<0.0001), lower Glasgow Coma Scale (p<0.0001), and higher Abbreviated Injury Scale of the head (p<0.0001). CONCLUSION: Motor vehicle collision was the main mechanism of head injury in the UAE followed by fall from height. Legislation for compulsory seatbelt usage and helmet usage by bicyclists and motorcyclists should be adopted. A safe work environment and preventive measures at work should be introduced.

Booster seat legislation: does it work for all children?

OBJECTIVE: To assess the impact of a booster seat law in Wisconsin on booster seat use in relation to race, ethnicity and socioeconomic status. METHODS: A longitudinal study in Milwaukee County, Wisconsin, involving repeated direct observational assessments of booster seat use rates by child passengers aged 4-7 years over five time periods, before and after legislation mandating booster seat use. RESULTS: Overall, booster seat use increased from 24% to 43%, whereas proper restraint use increased pre to post-legislation from 21% to 28%. Proper use increased after legislation in white, but not in black or Latino children. White individuals had a proper booster use increase from 48% to 68% over the time period of the study. Black children's proper use dropped from 18% to 7% over the study period and Latino children's proper use rates were stable at 10%. Driver-reported household income had a significant impact on overall use, but not on proper use. CONCLUSIONS: Racial/ethnic minority groups and those of lower socioeconomic status have significantly lower use and proper use of booster seats. Legislation may increase the total use of booster seats but not necessarily the correct use of the restraint, particularly in racial/ethnic minorities.