Child Restraint Laws Research Articles

How Safe Are Nepal’s Roads? A Study of Road Safety Legislation and WHO Standards

Around the world, traffic accidents result in significant catastrophes. The consequences of traffic accidents go far beyond the immediate suffering of the individuals involved. This paper aims to examine the road safety legislation and WHO standards adopted in Nepal. The paper is based on secondary data and policy documents related to road safety and WHO standards in the context of Nepal. It presents Nepal’s road network, significant improvements in road safety indicators, and encouraging advancements in road safety. The study finds five major areas for improvement in road safety laws in Nepal: seat-belt regulations, helmet laws, speed laws, child restraint laws, and drinking and driving laws. The study also reveals that Nepal’s current regulatory framework needs to be improved by monitoring actual appropriate helmet fastening and standardization. There is a lack of precise BAC restrictions for drivers and insufficient speed limits under WHO recommendations. Nepal’s child restraint rules also need to be expanded to include seat belt usage in all cars and forbid children from sitting in the front seats. To close those regulatory gaps and protect Nepalese citizens’ safety on the roads, it ends by providing a strict set of recommendations, such as increased enforcement, public awareness campaigns, and changes to road design and concrete making plans. Policymakers, researchers, and stakeholders working to promote street safety measures in Nepal and abroad would find great assistance from this article, which offers a detailed examination and smart recommendations.

Seat belt laws and prevalence of use among high school students in the United States

To examine the association between state seat belt laws and the prevalence of seat belt use among a nationally representative sample of teenagers in the United States, taking into consideration state-specific child restraint laws that could affect teenagers of different ages. Data were from the 2019 state Youth Risk Behavior Survey. We estimated prevalence ratios using modified Poisson regression with robust variance estimates to evaluate associations between state seat belt laws and seat belt use. Among, 81,929 high school students under 18 from 36 states, 56% always wore a seat belt when someone else was driving. Relative to students in states with secondary enforcement of seat belt laws, students living in states with primary enforcement were 5% more likely (aPR=1.05, 95% CI: 0.99, 1.11), and students covered by a child restraint law were 6% more likely to always wear a seat belt (aPR=1.06, 95% CI: 0.99, 1.12) after adjusting for age, sex, race/ethnicity, and graduated driver licensing laws. States with secondary seat belt enforcement should consider upgrading seat belt laws to potentially improve the prevalence of seat belt use among adolescents, potentially reducing injuries and deaths due to motor vehicle crashes.

Global road safety 2010–18: An analysis of Global Status Reports

BackgroundRoad traffic injuries (RTIs) pose a significant health burden with 1.35 million individuals dying on the world's roads annually. Nearly a decade ago, based on agreed road safety indicators, global commitments were encouraged to dramatically reduce this burden as part of the United Nation's Decade of Action for Road Safety 2011–2020. MethodsThe analysis was based on global level data from three Global Status Reports on Road Safety published by the World Health Organization in 2013, 2015, and 2018. A total of 161 countries that consistently reported statistics for all three reports were included in the analysis. Descriptive analyses, t-test, Wilcoxon rank-sum test, and Spearman's rank correlation were performed to evaluate past and current trends in road traffic deaths and countries’ progress in achieving key road safety indicators. ResultsWe found no significant decline in global road traffic death rates from 2010 to 2016 and in fact, death rates increased in low-income countries (LICs) and the African Region. Death rates were highly dependent on income level of the country, with deaths higher in low- and middle-income countries (LMICs) when compared to high-income countries (HICs). We found that the strength of enforcement of speed laws and child restraint laws increased from 2011 to 2017. However, we did not find a correlation between enforcement of the five key prevention policies (speeding, drink-driving, seatbelts, helmets, and child restraints) and death rate. In terms of advancement in achieving key road safety indicators, there was slow progress in adopting most of the recommended policies and practices based on the five pillars (road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response). ConclusionDespite global efforts during the past decade, road traffic deaths remain disproportionally high in LMICs and African countries as shown by global reports, and progress in achieving global road safety indicators is slow. Countries need to greatly accelerate the implementation of interventions proven to reduce RTIs in order to meet the goals of the second Decade of Action for Road Safety.

Global diffusion of three road safety policies, 1964\u20132015

Global convergence of public policies has been regarded as a defining feature of the late twentieth century. This study explores the generalizability of this thesis for three road safety measures: (i) road safety agencies; (ii) child restraint laws; and (iii) mandatory use of daytime running lights. This study analyzes cross-national longitudinal data using survival analysis for the years 1964–2015 in 181 countries. The first main finding is that only child restraint laws have globally converged; in contrast, the other two policies exhibit a fractured global convergence process, likely as the result of competing international and national forces. This finding may reflect the lack of necessary conditions, at the regional and national levels, required to accelerate the spread of policies globally, adding further nuance to the global convergence thesis. A second finding is that mechanisms of policy adoption, such as imitation/learning and competition, rather than coercion, explain more consistently global and regional convergence outcomes in the road safety realm. This finding reinforces the idea of specific elective affinities, when explaining why the diffusion of policies may or not result in convergence. Lastly, by recognizing fractured convergence processes, these results call for revisiting the global convergence thesis and reintegrating more consistently regional analyses into policy diffusion and convergence studies.

Trends in pediatric passenger restraint use by rurality and age in Iowa, 2006–2019

Objective Pediatric restraint use has increased over time in the United States, but motor vehicle crashes remain a leading cause of death for children under age 18. Age-appropriate use of safety restraints (safety seats, booster seats, seat belt) and statewide child restraint laws can greatly reduce injury or death in the event of a crash. Surveillance of pediatric restraint use and compliance with policy can inform prevention efforts. This study aims to examine time trends in pediatric restraint use and compliance with pediatric passenger laws in Iowa by rurality and age. Methods Fourteen years of Iowa observational pediatric restraint use data (2006–2019) are included in this cross-sectional study. Proportions of restrained youth by year, age, and rurality (rural, urban) were calculated. Log-linear models were used to compute the Annual Percent Change (APC) by year to explore trends in restraint use over time by rurality and by age group. Results A total of 42,007 observed pediatric passengers with complete data from 2006 to 2019 were included in this study. Restraint use increased across all years and all age groups observed, with the largest increases among the older pediatric age groups. However, restraint use was consistently highest among the youngest child passengers. With all study years combined, the odds of being compliantly restrained were 13% lower in rural areas (OR = 0.87, 95% CI = 0.80, 0.95) compared to urban areas. Conclusions Restraint use was lower in rural areas and among older pediatric passengers, suggesting targeted efforts to increase restraint use among these groups may have the greatest impact on overall occupant protection.

The Awareness and Attitude of Parents towards the Legislation of Child Restraint in Two Cities of China.

The death of child passengers was one of the leading causes of death among children fatally injured on roads in China. Child restraint can effectively protect child passengers. Mandatory child restraint law has been enacted locally in Shanghai and Shenzhen, two major cities in China. In order to understand the public attitude on national legislation in these cities, we conducted a cross-sectional survey with a sample of parents/caregivers with a child aged 0–6 years and own private car from Shanghai and Shenzhen. We used descriptive statistics to describe the distribution of parental awareness and attitudes towards the legislation of child restraint. There were less than 50% parents who were aware of the local legislation of child restraint use. Even though only around 20% of parents were able to respond accurately to the age standard in legislation, among those who knew of the legislation, most of the parents understood that the law had enforcement measures. More than 70% of parents supported the national legislation of child restraint use, and, among them, around 70% supported enforcement and punishment. Thus, the study provided supportive evidence for national legislation, but it also put forward that the work of popularizing law should be strengthened.

Malaysian Child Restraint Issues: A Brief Narrative Review.

The child restraint legislation in Malaysia becomes mandatory from 1 January 2020. Prior to commencement of the rule, a survey showed that only 36% of Malaysian parents were aware of the importance of a child restraint system (CRS) and only 27% usage was reported during travel. The Malaysian Institute of Road Safety report showed that children transported in private vehicles were the leading groups of casualties among children aged 1 to 4 years old (43.8%) and 5 to 9 years old (30.2%), respectively. We performed a narrative review using the PubMed, ScienceDirect and Google Scholar databases using keywords such as child restraint system, unrestrained injuries, Malaysia and epidemiology. The objectives of this review were: (1) to determine the prevalence on the use of CRS in Malaysia, (2) to evaluate the injuries related to unrestrained children and (3) to show the nation’s preparation towards implementation of the child restraint law. Six papers on prevalence, one paper on injury and six mainstream newspaper were included in this study. The prevalence of a CRS use was shown between 5% to 41.8%. In relation to injury, the only publication from this country showed that among 19 children involved in a car crash, five (26.3%) children had non-craniomaxillofacial (CMF) injuries, ten (52.6%) with CMF injuries only, two (10.5%) with both CMF and non-CMF injuries and two (10.5%) without any injury. Overall, the Injury Severity Score (ISS) range was between 0 to 13 (median, 1.00; interquartile range, 1). Preparation to comply with the best practice of the child restraint law is still ongoing, especially those addressing the issues related to the low-income parents in the country. Due to scarcity of publication and data on the CRS use and injuries related to its non-usage, it is advocated that parallel with the implementation legislation, vigorous forms of public education as well as good data management must be performed and monitored regularly by the road safety authority in this country.

Restraint use and injury in forward and rear-facing infants and toddlers involved in a fatal motor vehicle crash on a U. S. Roadway

BackgroundUse of appropriate child passenger safety restraints reduces injury in infants, with rear facing restraints favored over forward facing. In 2011, the American Academy of Pediatrics (AAP) began recommending that infants and children under the age of 2 years be restrained in a rear-facing seat installed in the vehicle’s rear seat. This study examines the practice of rear-facing restraints pre- and post-AAP recommendations for children under 2 years.MethodsData from the Fatality Analysis Reporting System (FARS) from 2008 to 2015 were used to examine restraint status and injuries in rear-seated infants and toddlers aged 0 to less than 2 years involved in fatal collisions (n = 4966). Subpopulation analyses were conducted on 1557 children with seat facing direction recorded. Multivariable logistic regression was used to generate odds ratios (OR) with 95% confidence intervals (CI). Covariates considered for inclusion in the multivariable model included passenger characteristics (age, gender, seating position), driver characteristics (age, gender, seat belt status, alcohol status, drug status, previous traffic violations), vehicle characteristics (vehicle type), and crash-level characteristics (day/night, weekday/weekend, rush hour, expressway/surface street, urban/rural).ResultsApproximately 6.7% (330 of 4996) of infants and toddlers were unrestrained with mortality that was approximately triple that of restrained infants (40.0% vs 13.7%, P < 0.0001). In multivariable adjusted models, predictors of an infant being unrestrained included unrestrained driver (OR: 3.17, 95% CI: 2.38–4.21), driver aged less than 20 years (OR: 2.18, 95% CI: 1.42–3.34), driver alcohol use (OR: 2.21, 95% CI: 1.42–3.44), center-seated infant (OR: 1.55, 95% CI: 1.19–2.03) and weekday crash (OR: 1.52, 95% CI: 1.12–2.01). Of all rear-seated children whose restraint status were reported (4966), rear-facing restraint use increased from 5.0% to 23.2% between 2008 and 2015 (P < 0.0001). The odds of rear-facing restraint use increased after introduction of the AAP guideline among infants aged 0 to < 1 year old (OR: 2.12, 95% CI: 1.46–3.10) and among toddlers aged 1 to < 2 years old (OR: 1.97, 95% CI: 1.03–3.79).ConclusionTrends in the use of rear-facing child restraints improved over the timeframe of this study, but remain low despite the introduction of AAP guidelines and the strengthening of child restraint laws.

Road traffic injuries measures in the Eastern Mediterranean Region: findings from the Global Status Report on Road Safety - 2015.

:Background:The Eastern Mediterranean Region has the second highest road traffic fatality rate in the world. This article presents the epidemiology of road traffic injuries and the preventive measures in Eastern Mediterranean Region taken by the different World Health Organization member states compared to the rest of the world.Methods:This is a secondary data analysis addressing the Global Status Report on Road Safety published by the World Health Organization in 2015. Data are from 180 countries covering 6.97 billion people of the world’s population, of which 21 Eastern Mediterranean Region of World Health Organization member states with about 595 million population were included and were analyzed. From 22 countries in the region, 21 are presented and Syria has not reported any data on road traffic injuries.Results:Eastern Mediterranean Region member states contribute to 9.69% of all global fatal road traffic injuries (19.9 per 100 000 population compared to the same rate in the European region with 9.3), while these countries account for 7.4% of the world’s population and have about 5.6% of the world’s vehicles on their roads. More than 90% of the Eastern Mediterranean Region countries have passed mandatory seat-belt laws for both front-seat and rear-seat passengers and making helmet use obligatory; and only 27% have child restraint laws; half percent have an emergency room injury surveillance system. All countries have a national drink-driving law; and certain speed limits but there is no distinction between rural and urban areas, and the latter lack adequate speed restrictions.Conclusions:Although the Eastern Mediterranean Region member states have some important preventive measures recommended by World Health Organization, considerable efforts are still needed to optimize the enforcement of existing road safety laws. The maximum urban speed limit should be reduced in many countries. Sufficient attention should be paid to the needs of pedestrians, cyclists and motorcyclists, who together make up about 50% of Eastern Mediterranean Region road traffic deaths.

Predictors of restraint use among child occupants

ABSTRACTObjectives: The objective of this study was to identify factors that predict restraint use and optimal restraint use among children aged 0 to 13 years.Methods: The data set is a national sample of police-reported crashes for years 2010–2014 in which type of child restraint is recorded. The data set was supplemented with demographic census data linked by driver ZIP code, as well as a score for the state child restraint law during the year of the crash relative to best practice recommendations for protecting child occupants. Analysis used linear regression techniques.Results: The main predictor of unrestrained child occupants was the presence of an unrestrained driver. Among restrained children, children had 1.66 (95% confidence interval, 1.27, 2.17) times higher odds of using the recommended type of restraint system if the state law at the time of the crash included requirements based on best practice recommendations.Conclusions: Children are more likely to ride in the recommended type of child restraint when their state's child restraint law includes wording that follows best practice recommendations for child occupant protection. However, state child restraint law requirements do not influence when caregivers fail to use an occupant restraint for their child passengers.

The role of traffic law enforcements in the relationship between cultural variables and traffic fatality rates across some countries of the world

The aims of the present study were to investigate whether cultural variables are related to law enforcements as well as traffic fatality rates and to examine the role of law enforcements of five risk factors for road safety (i.e., national speed law, national drink-driving law, national motorcycle helmet law, national seat-belt law, and national child restraint law) in the relationship between cultural variables and traffic fatality rates across countries of the world. The aggregated data of the study included Hofstede’s cultural dimensions, Schwartz’s value dimensions, law enforcements of five risk factors for road safety, gross national income per capita, and traffic fatality rates for 97 countries of the world. The results showed that most of the cultural variables were associated with law enforcements of five risk factors for road safety and traffic fatality rates of countries. By bootstrapping, among Hofstede’s cultural dimensions, it was found that the indirect effects of long-term orientation (LTO) on fatality rates (FR) through speed, helmet, and child restraint enforcements were significant, separately. Among Schwartz’s value dimensions, the indirect effects of embeddedness on fatality rates through speed and child restraint enforcements were significant, separately. Intellectual autonomy had also significant indirect effects on fatality rates via speed and child restraint enforcements, separately. Finally, it was found that the indirect effects of affective autonomy on fatality rates through speed and helmet enforcements were significant, separately.

Mid-term assessment of the decade of action for road safety: Progress made, yet at a slow rate.

Sir, Globally, road traffic injuries have been acknowledged as one of the predominant causes accounting for the deaths of millions of people, disability, impaired quality of life, catastrophic expenditures, and reduced productivity.[1] In fact, every year close to 1.25 million people die owing to road traffic accidents worldwide while another 20–50 million individuals are exposed to nonfatal injuries/disabilities.[2] Further, road traffic injuries have been identified as the most common cause of death among young people in the age-group of 15–29 years, and almost 90% of the overall deaths are being reported from low and middle-income nations.[1,2] Even though road traffic injuries are preventable, they were never prioritized in the global health agenda for decades together.[3] In fact, by adhering to basic preventive measures such as wearing a good quality helmet, seat-belt, and using infant seats, a significant reduction in the risk of mortality can be achieved in the event of a crash.[2,4] Despite, all this confirmatory evidence, <50 nations worldwide have a mandatory law to encourage wearing of helmets, while only 53 nations have a child restraint law in place.[4] On a similar note, only 13% of the global population are residing in those regions which have a restriction on the speed limits.[4] Acknowledging the magnitude of the problem, its universal distribution, and higher rates of mortality among the vulnerable road users, the United Nations declared the current decade as a Decade of Action for Road Safety (2011–2020).[1] The ultimate aim was to save the lives of millions of people by bringing about an improvement in the safety of roads and vehicles, making road users more responsible, and expanding the reach of emergency services.[1,4] Further, the recently adopted sustainable development goals have also set a target to reduce the number of deaths attributed to road traffic injuries by 50% by the year 2020.[2] To gauge the progress toward road safety, the findings of a recently released report by the World Health Organization have suggested that despite an increase in the number of vehicles worldwide, the number of road traffic deaths has stabilized.[4] The recent trend clearly suggests that strategies for road safety (viz., improvement in legislations, stringent enforcement, making roads and vehicles safer, etc.,) has delivered encouraging outcome, nevertheless, the rate of progress is extremely slow.[4] Further, protection of road users has emerged as a major concern as the risk of death in a road traffic crash is predominantly determined by the place of accident and adherence to the safety measures.[4,5] In fact, it has been identified that close to fourth-fifth of the vehicles sold worldwide fail to meet basic safety standards, which is a real threat to the lives of road users.[2] On a positive note, a number of nations are implementing measures to make the road safer by enforcing laws pertaining to a motorcycle helmet, child restraints, seatbelts, drink – driving, and speed.[2] The success obtained in most of the developed nations reflect that road traffic injuries can be prevented, provided the program managers are committed enough to act in a holistic manner by involving all the concerned sectors.[2,3] At the same time, the utility of proper planning by incorporation of road safety measures, designing of safer infrastructure/safe vehicles; improving postcrash responses, and implementing measures to encourage healthy road user behavior through public awareness and enforcement of appropriate laws, can deliver sustainable results.[1,2,3,4,5] To conclude, the deaths attributed to road traffic injuries are a major public health concern worldwide, and it is high time that all stakeholders should prioritize it and work in a concerted manner to improve the road safety standards and reduce the risk of deaths among road users. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Roadside observational surveys of restraint use by young children in Qatar: Initial results and recommendations

In a report by the WHO Eastern Mediterranean Region(1), the non-use of child restraints for children was identified as a key risk factor that can be addressed by the adoption and enforcement of legislation that will increase their use. Currently, there are no child restraint laws in Qatar. The objective of the study is to report baseline data on child restraint use and to provide evidence to inform the passage of child passenger restraint laws in Qatar. This roadside observational survey was conducted as part of the Young Kids in Safe Seats Project funded by the Qatar Foundation. Trained observers conducted roadside observations of passenger restraint use in vehicles with children, less than 5 years, at 12 sampling sites. Standard data was collected per observation: seating position, restraint used and appropriateness of restraint used. Of 2232 observations of young child passengers: 41% were properly restrained, 21% improperly restrained and 38% unrestrained, 10.9% were on an adult’s lap. The most common seating location was right second row followed by left second row. These 2 locations also had the highest rates of proper restraint use. The positions with the lowest restraint use were the front and second row middle seat. One in 9 children observed was illegally seated in the front row, most on the lap of an adult [38.3%] or unrestrained [34.4%]. This is the first observational study in Qatar that measures child restraint rates in children younger than 5. Less than half of these children are traveling safely. Priority areas for intervention include: enforcement of existent laws banning children in the front seat, education about the risks for children in an adult’s lap and encouraging the proper use of age/size appropriate restraint systems. These findings can inform the development of national child passenger restraint laws. Reference: 1. Road safety in the Eastern Mediterranean Region Facts from the Global Status Report on Road Safety 2013.

Did Child Restraint Laws Globally Converge? Examining 40 Years of Policy Diffusion

Objective: The objective of the current study is to determine what factors have been associated with the global adoption of mandatory child restraint laws (ChRLs) since 1975.Methods: In order to determine what factors explained the global adoption of mandatory ChRLs, Weibull models were analyzed. To carry out this analysis, 170 countries were considered and the time risk corresponded to 5,146 observations for the period 1957–2013. The dependent variable was first time to adopt a ChRL. Independent variables representing global factors were the World Health Organization (WHO) and World Bank's (WB) road safety global campaign; the Geneva Convention on Road Traffic; and the United Nation's (UN) 1958 Vehicle Agreement. Independent variables representing regional factors were the creation of the European Transport Safety Council and being a Commonwealth country. Independent variables representing national factors were population; gross domestic product (GDP) per capita; political violence; existence of road safety nongovernmental organizations (NGOs); and existence of road safety agencies. Urbanization served as a control variable. To examine regional dynamics, Weibull models for Africa, Asia, Europe, North America, Latin America, the Caribbean, and the Commonwealth were also carried out.Results: Empirical estimates from full Weibull models suggest that 2 global factors and 2 national factors are significantly associated with the adoption of this measure. The global factors explaining adoption are the WHO and WB's road safety global campaign implemented after 2004 (P <.01), and the UN's 1958 Vehicle Agreement (P <.001). National factors were GDP (P <.01) and existence of road safety agencies (P <.05). The time parameter ρ for the full Weibull model was 1.425 (P <.001), suggesting that the likelihood of ChRL adoption increased over the observed period of time, confirming that the diffusion of this policy was global. Regional analysis showed that the UN's Convention on Road Traffic was significant in Asia, the creation of the European Transport Safety Council was significant in Europe and North America, and the global campaign was in Africa. In Commonwealth and European and North American countries, the existence of road safety agencies was also positively associated with ChRL adoption.Conclusions: Results of the world models suggest that the WHO and WB's global road safety campaign was effective in disseminating ChRLs after 2004. Furthermore, regions such as Asia and Europe and North America were early adopters since specific regional and national characteristics anticipated the introduction of this policy before 2004. In this particular case, the creation of the European Transport Safety Council was fundamental in promoting ChRLs. Thus, in order to introduce conditions to more rapidly diffuse road safety measures across lagging regions, the maintenance of global efforts and the creation of road safety regional organizations should be encouraged. Lastly, the case of ChRL convergence illustrates how mechanisms of global and regional diffusion need to be analytically differentiated in order better to assess the process of policy diffusion.

Rear-facing child car seats: are laws requiring them effective?

INTRODUCTION: Motor vehicle crashes are a leading cause of death in children aged ≤ 2 years in the U.S. The American Academy of Pediatrics advised that children should remain in rear-facing child car seats to mitigate injury from the most common type of severe collision (frontal). Several states have passed laws following these recommendations. Methods: In 2013 publicly available statutes and comprehensive motor vehicle fatality data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System database were used to investigate whether there is a relationship between motor vehicle crash fatality rates for children under 1 year of age and state laws regulating the direction of car seat placement. States with known rear-facing car seat laws in place were analyzed in a two-step approach in 2014. Simple fatality rates per 100 million vehicle miles were calculated with 95% Poisson CIs. A negative binomial count model for infant deaths was calculated, with state fixed effects, adjusted for the exposure of vehicle miles in each state by year. Results: Unadjusted models showed a protective mortality effect for rear-facing car seat laws, while adjusted models demonstrated no beneficial effect. Implications: This preliminary study suggests that state rear-facing child restraint laws may be having an impact on infant motor vehicle mortality; however the current model is unable to determine their relative contribution given the overall decline in traffic mortality. Language: en

Advocacy for booster seat legislation in Florida: a lesson in politics and policy formation.

MVCs are a major contributor to child injury and death. Infant restraint seats and child booster seats have been shown to reduce the odds of severe injury or death when used correctly. While all states have mandated the use of these restraint systems, the age at which a child can be legally restrained using an adult seat belt varies from state to state. Efforts to strengthen Florida's weak child restraint laws have failed for more than a decade; in the 2014 legislative session, advocates succeeded in raising the state's age requirement from 3 years to 5 years. While many factors contributed to this year's success, some key elements included efficient communication of supporting data, a strong and broad advocacy network and the leveraging of election year political rivalries. Efforts to further strengthen the law will continue into future legislative sessions.

Road Traffic Fatalities Analysis in AEC Countries

Based on a Global Status Report on Road Safety in 2009 [ and in 2013 [, 2007 and 2010 Road Traffic Fatalities (RTFs) data for ASEAN Economic Community (AEC) countries were analyzed and compared, respectively. In this research, both reported and estimated RTFs per 100,000 populations showed relatively low correlation with Gross National Incomes (GNIs) per capita among AEC countries. In contrast, the reported and estimated RTFs per 1,000 vehicles showed reasonably high correlation with both GNIs per capita and number of vehicles per 1,000 populations. The greater the GNIs per capita and/or number of vehicles per 1,000 populations, the lower the reported and estimated RTFs per 1,000 vehicles are. As GNI per capita increases, the proportion of 4-wheeled motor vehicles will rise and the proportion of 2-and 3-wheeled motor vehicles will decline. Therefore, 2-and 3-wheeled motor vehicles were the main contributor to RTFs. The improvement of the adoption and enforcement of national road safety legislation can be generally realized. However, only high income countries (including Singapore and Brunei Darussalam) clearly showed the high performances and only these two countries has adopted and enforced the child-restraint law.

Mandatory Child Restraints: A KAP Study among Parents and Nursery Instructors

Aims: New road traffic injury (RTI) laws in Iran still neglects the importance of child restraint in automobiles. The objective of this study is to determine the Knowledge, Attitude and Practice (KAP) on the mandatory use of child restraint among parents and nursery instructors. Study Design: An observational KAP study Place and Duration of the Study: City of Tehran capital of Iran, between June 2013 and November 2013. Methodology: An observational KAP study was carried out (using a self-administered questionnaire and a Likert scale) on 403 parents, which children were less than 13 years old and nursery instructors both residing in Tehran by a stratified randomized sampling. Twelve elementary schools and six nurseries were selected randomly. Validity and reliability of questionnaires were determined using the content validity and test re-tests. Subjects were selected randomly and data was collected by trained interviewers, after obtaining consent forms from the subjects. Results: The majority (71%) of parents was female, aged 36.7±5.6 (range: 25-59). Half of the parents did not have any knowledge about child restraint laws and its implementation in the country. The knowledge among subjects about different kinds of child restraints, according to the child’s age and weight, was 22.6%. Only 28% of subjects use child restraints for their children. A significant difference was observed between subjects' use of

Increase in best practice child car restraint use for children aged 2–5 years in low socioeconomic areas after introduction of mandatory child restraint laws

To examine changes in child car restraint practices in low socioeconomic areas following the introduction of mandatory child car restraint legislation in New South Wales (NSW), Australia. Data from two cross-sectional studies of child car restraint use at pre-schools, early childhood centres and primary schools before and after the introduction of legislating mandatory age-appropriate car restraint use for children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2-5 years were observed in their vehicles as they arrived at observation sites (107 pre-legislation, 360 post-legislation). Multilevel logistic regression was used to examine changes in observed age-appropriate and correct use of car restraints. Age-appropriate car restraint use was higher post-legislation than pre-legislation. After controlling for child's age, parental income, language spoken at home and adjusting for clustering, the odds of children being appropriately restrained post-legislation were 2.3 times higher than in the pre-legislation sample, and the odds of them being correctly restrained were 1.6 times greater. Results indicate an improvement in car restraint practices among children aged 2-5 in low socioeconomic areas after introduction of child restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal child car restraint use.

Effects of Booster Seat Laws on Injury Risk Among Children in Crashes

Objective: Belt-positioning booster seats have been shown to reduce injury risk among child passengers aged 4 to 8 in motor vehicle crashes. To encourage the use of booster seats, many states have enacted laws that require the use of either a child restraint with internal harness or a belt-positioning booster seat, but the specific age range covered by the laws varies by state. Previous studies have found evidence that booster seat laws are effective in reducing injury risk among children, but these studies primarily have included states with younger age requirements (e.g., ages 4–6) for booster seats. The objective of the present study was to examine the effectiveness of booster seat laws in several states that cover children through age 7 or 8. Methods: Police-reported crash data from 5 states—Missouri, North Carolina, Pennsylvania, Wisconsin, and Wyoming—were used to compare population-based injury rates, restraint use, and seating position among children before and after booster seat laws. The pre-law period was comprised of the 2 calendar years prior to the year of enactment of the booster seat law, and the post-law period was comprised of the 2 calendar years after the year of the effective start of the booster seat law. Effectiveness estimates were adjusted using a comparison group of children aged 9 to 12 in the same states who were not covered by the booster seat laws. Results: Among children in crashes who were affected by law changes in the 5 study states, the per capita rate of children using child safety seats (either a harnessed child restraint or booster seat) increased nearly 3 times, and the per capita rate of children riding in rear seats increased 6 percent after the booster seat laws were implemented. Booster seat laws were associated with a 5 percent reduction in the per capita rate of children who sustained injuries of any severity and a 17 percent reduction in the per capita rate of children who sustained fatal or incapacitating injuries. Conclusions: Results provide evidence that booster seat laws are effective in increasing the use of child safety seats, increasing the placement of children in rear seats, and reducing injuries, especially severe injuries, among children covered by the laws. [Supplementary materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention for the following free supplemental resource(s): Appendix – Population, counts of children injured, and injury rates per 10,000 population for each state before and after amendments strengthening child restraint laws.]