Passenger Restraint Use Research Articles

Evaluating Child Passenger Restraint Use Education.

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. This project aims to measure the impact of an education initiative on child passenger restraint use. This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5months 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 1-3weeks later at the same schools to evaluate the education provided. 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 4-8years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p =<.001). The study results demonstrate that one-on-one education increases child passenger restraint use.

Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019

The objective of the study was to examine child deaths in motor vehicle crashes by rurality, restraint use, and state child passenger restraint laws. 2015-2019 Fatality Analysis Reporting System data were analyzed to determine deaths and rates by passenger and crash characteristics. Optimal restraint use was defined using age and the type of the restraint according to child passenger safety recommendations. Death rates per 100 000 population were highest for non-Hispanic Black (1.96; [1.84, 2.07]) and American Indian or Alaska Native children (2.67; [2.14, 3.20]) and lowest for Asian or Pacific Islander children (0.57; [0.47, 0.67]). Death rates increased with rurality with the lowest rate (0.88; [0.84, 0.92]) in the most urban counties and the highest rate (4.47; [3.88, 5.06]) in the most rural counties. Children who were not optimally restrained had higher deaths rates than optimally restrained children (0.84; [0.81, 0.87] vs 0.44; [0.42, 0.46], respectively). The death rate was higher in counties where states only required child passenger restraint use for passengers aged ≤6years (1.64; [1.50, 1.78]) than that in those requiring child passenger restraint use for passengers aged ≤7 or ≤8 years (1.06; [1.01, 1.12]). Proper restraint use and extending the ages covered by child passenger restraint laws reduce the risk for child crash deaths. Additionally, racial and geographic disparities in crash deaths were identified, especially among Black and Hispanic children in rural areas. Decision makers can consider extending the ages covered by child passenger restraint laws until at least age 9 to increase proper child restraint use and reduce crash injuries and deaths.

A naturalistic study of passenger seating position, posture, and restraint use in second-row seats

Objective The objective of the current study was to increase scientific understanding of rear-seat passenger seating position, postures, CRS use, and belt use through a naturalistic study. A secondary objective was to compare data from vehicles used in ride-hailing with data from other vehicles. Method Video cameras were installed in the passenger cabins of the vehicles of 75 drivers near the center of the windshield. The video data were downloaded after the vehicles were operated by their owners for two weeks. Video frames were sampled from near the ends and in the middle of each trip, and at five-minute intervals in trips longer than 15 min. A total of 7,323 frames with second-row passengers were manually coded. Results A total of 444 unique second-row passengers were identified in video frames from 1,188 trips taken in 65 of the 75 vehicles in the study. Two of the vehicles that were driven for commercial ride-hailing during the study period accounted for 199 (45%) of the passengers. Considering multiple passengers in some trips, a total of 1,899 passenger-trips were identified. For passengers not using child restraint systems (CRS), the belt use rate was 65% in the non-ride-hailing vehicles versus 32% among passengers in the ride-hailing vehicles. No CRS use was observed in the ride-hailing vehicles. Among children using backless boosters, the shoulder belt was lateral to the clavicle or under the arm in 26% of frames. Among belted passengers not using CRS, the belt was lateral to the clavicle or on the neck about 6% of the time. Belted passengers not using CRS were observed leaning to the left or right about 27% of the time, with leaning away from the shoulder belt more common than leaning into the belt. Conclusions This study is the first to report seating position, posture, and belt fit observations for a large naturalistic sample of second-row passengers that includes adult occupants. The data suggest that low rear seat belt use rates remain a concern, particularly in ride-hailing vehicles. Non-nominal belt placement and posture may also be common in second-row seating positions.

Observed relationships between driver and passenger restraint use in the front and rear seats

Objective Seat belt usage has increased substantially since the 1960s, yet driver use continues to affect passenger usage. Recent observational restraint use findings for Maryland will examine the relationship between driver and passenger usage, including adults and children in the rear seat. Methods Analyses were based on observational front and rear seat studies administered in parallel from 2016 to 2019. A statistically rigorous front seat project yielded weighted results among drivers and outboard passengers. A study of adults and children in the rear seat was based on a convenience sample of vehicles. Restraint usage results were presented as frequencies and proportions among occupants with known belt use, along with the 95% confidence interval for overall rates. Results Overall restraint usage rates averaged 90.9% in the front seat study and 81.1% in the rear seat sample. In vehicles with two front seat occupants and a belted driver, the proportion of belted passengers averaged 93.0% over four years. However, among unbelted drivers, only 41.6% of passengers were belted on average. In the rear seat study, an average of 82.7% were belted in vehicles driven by a restrained driver, differing for children (92.0%) versus adults (70.4%). Analysis of vehicles with an unbelted driver revealed an average of 45.0% of belted rear seat occupants, with a considerable difference for children (65.0%) compared with adults (21.0%). Conclusions Observational seat belt studies in Maryland in recent years have shown that, despite overall rates above 80%, passenger use in both the front and rear seats is associated with driver restraint use.

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.

Ride-Share Use and Child Passenger Safety Behaviors: An Online Survey of Parents.

Ride-share services are increasingly used for transportation, but little is known about ride-share use and passenger safety behaviors among parents of children for whom child restraint systems (CRS) are recommended. Our objectives were to characterize ride-share use with children and examine passenger restraint use in ride-share. A cross-sectional survey, distributed to the TurkPrime Parent Panel using Amazon Mechanical Turk (MTurk), was designed to assess ride-share and passenger safety behaviors. After screening, adult parents of minor children were invited to complete the full survey about transportation behaviors. Descriptive and chi-square statistics were calculated. Logistic regression was conducted to test for characteristics associated with suboptimal restraint use in ride-share. Of 655 screened parents, 162 had no minor children, 43 had incomplete responses or failed an attention check question. Of 450 parents with minor children, 309 (68.7%) used ride-share in the past year and 73.1% of parents who use ride-share did so with their child(ren). Ride-share use with children was most common on vacation. Among parents of children age ≤8 years, 49% reported always using their child's CRS when traveling in ride-share. Suboptimal restraint use in rideshare was associated with child age (3-8 years compared with <3 years), larger family size, and attitudes and behaviors that tolerate suboptimal CRS use. This study identifies an opportunity to promote use of CRS in ride-share services. Child passenger safety messaging, education, policy, enforcement of legislation, and CRS design will need to be adapted as ride-share services become more widely adopted.

Child Passenger Helmet and Restraint Use: A Comparative Analysis From 10 Cities

Child Passenger Helmet and Restraint Use: A Comparative Analysis From 10 Cities

Child restraint use and hospital-reported injuries among crash-involved child passengers

Several states have enacted legislation addressing child passenger restraint use. In New Jersey (NJ), children <2 years are required to remain in rear-facing child restraints and passengers <4 year...

Prevalence of child passenger restraint use in Shantou, China from 2012 to 2017

BackgroundChild passenger safety is an important public health problem in China. This study aimed to examine the prevalence of child passenger restraint use while riding in a car in the city of Shantou in China from 2012 to 2017.MethodsThree large-scale cross-sectional observational studies were conducted in 2012, 2015 and 2017, respectively. The observation sites included randomly selected hospitals, kindergartens, and primary and secondary schools. The outcome measures included the changes in percentages of seating position (e.g., front vs. rear), whether sitting on lap, and use of child restraint systems (CRS) or seat belts by year and by age group. Descriptive statistics, Chi-square tests and logistic regression were used to address the study aims.ResultsA total of 9858 commuting children aged 17 and younger were observed in passenger cars in Shantou, China during the study. The proportion of children aged 0–5 sitting on adult’s lap decreased from 26.6% in 2012 to 24.6% in 2017, while the proportion of CRS use among the children sitting in the rear row increased among children aged 0–5 (from 0.7% in 2012 to 14.2% in 2017) and children aged 6–11 (from 0.7% in 2012 to 2.4% in 2017). Comparing children aged 0–11 in 2012, children in the same ages were less likely to sit in the front row in 2015 (OR = 0.42, 95%CI = 0.37, 0.48) and in 2017 (OR = 0.27, 95%CI = 0.23, 0.31). Children aged 0–11 were more likely to sit in the rear row with CRS use in 2015 (OR = 8.50, 95%CI = 5.44, 13.28) and in 2017 (OR = 10.95, 95%CI = 7.02, 17.08) comparing with children in the same ages in 2012. As for children aged 12–17, they were more likely to use seat belt in 2017 (OR = 1.40, 95%CI = 1.06, 1.85) compared with those children in 2012.ConclusionsWhile child passenger safety behaviors improved from 2012 to 2017 in Shantou, China, more efforts are needed to protect child passengers from injuries.

Pediatric Restraint Use and Injury in New York City Taxis Compared with Other Passenger Vehicles

In New York City (NYC), as in several other U.S. cities, pediatric occupant restraint laws exempt rear-seated passengers in vehicles-for-hire from those that apply to private vehicles. This study compares rear-seated infant, child, adolescent, and teen passenger restraint use and injury in taxis compared with other passenger vehicles. New York State Department of Health Crash Outcome Data Evaluation System (CODES) was analyzed for rear-seated pediatric passengers aged 0–19 years traveling in taxis ( n = 1,631) or other passenger vehicles ( n = 21,984) involved in a crash in NYC 2011–2013. CODES is a probabilistically linked data set comprising emergency department, hospitalization, and Department of Motor Vehicle crash data. Bivariate and multivariable logistic regression odds ratios (OR) are reported with 95% CI. Taxi passenger restraint use was lower than in other passenger vehicles (51.2% vs. 86.7%, p &lt; 0.0001). Use of a child restraint for ages &lt; 8 years was low (5.9%) and one-tenth that of other passenger vehicles. Multivariable adjusted odds of restraint use was 9.80 (8.2–11.7) for other passenger vehicles compared with taxis. Compared with passengers in other vehicles, passengers in taxi crashes were twice as likely to be moderately or severely injured ( p &lt; 0.0001) and twice as likely to have traumatic brain injury ( p = 0.0070). This study documents lower restraint use and higher injury, including traumatic brain injury, for pediatric taxi passengers compared with other passenger vehicles. Improved data systems, surveillance, and enforcement are needed to improve restraint use and reduce injury in children and teens, particularly those in vehicles-for-hire.

Factors Associated With Unrestrained Young Passengers in Motor Vehicle Crashes.

We analyzed 2011-2015 Fatality Analysis Reporting System and National Automotive Sampling System data and included vehicles with a young passenger (≤19 years old) in a crash. Driver and passenger characteristics were compared by using bivariate analyses separately for fatal and nonfatal crashes. Logistic regression analyses were performed on a combined data set to predict passenger restraint use. In unadjusted bivariate models, unrestrained drivers had a higher probability of having an unrestrained passenger across all passenger age groups for both fatal and nonfatal crashes. In multivariate logistic regression models that included both fatal and nonfatal crashes and were adjusted for several driver and passenger characteristics, unrestrained drivers had a higher risk of having an unrestrained young passenger across all age groups. In both fatal and nonfatal crashes, a driver being unrestrained is a strong predictor of the child passenger also being unrestrained. Policy and regulation to better ensure that drivers are properly restrained (eg, expanding primary seat-belt laws to all states) may serve as effective means for increasing rates of proper child-occupant-restraint use.

Dissemination of a Child Passenger Safety Program Through Trauma Center-Community Partnerships.

Improper child passenger restraint use contributes to higher pediatric motor vehicle collision morbidity and mortality among cultural minority populations. Child passenger safety education improves caregiver knowledge of restraint use, but effective interventions require culturally specific programming. The purpose of this study was to evaluate the effectiveness of a child passenger safety education program culturally adapted through a pediatric trauma center's community partnerships. A nonexperimental observational cohort study using program evaluation data for the child passenger safety education programs during a 24-month period. Paired pretest/posttest self-reported survey responses measured changes in caregiver knowledge and self-efficacy of restraint use. Data were analyzed by class location and by caregiver language using a paired t test and Wilcoxon's signed ranks test. A total of 1,795 paired survey responses were collected in English, Spanish, or Russian. An increase in mean knowledge scores occurred overall, with a difference in mean of 0.565 (SE = 0.022, 95% CI [0.521, 0.607]). Stratification by class site and by language reflected significant increases in median scores, but findings were variable by study group. Pretest median scores for self-efficacy of restraint use were high for all groups, but the increases in posttest medians were also significant across groups (p ≤ .001). Caregiver knowledge and self-efficacy for child passenger restraint use increased after participation in the community classes. The pediatric trauma center's community partnerships facilitated uptake and adaption of the child passenger safety education programs and increased the injury prevention outreach to minority communities.

A comparative analysis of child passenger restraint use in China and the United States.

Few published studies have examined child passenger safety practices across countries. This study compared the prevalence and associated factors of child passenger restraint use among children, aged 0 to 17 in the state of Iowa in the United States, and the city of Shantou in China. Child restraint use observations were conducted in Iowa and in Shantou in 2012, respectively, among child passengers. Observations in Iowa were conducted at randomly selected gas stations, while in Shantou observations were completed at randomly selected schools or medical clinics. Research observers approached the driver, observed restraint use, and collected brief survey data. A total of 3049 children from Iowa and 3333 children aged 0 to 17 years from Shantou were observed. For children aged 0 to 3 years, only 0.1% were compliantly restrained in Shantou as compared to 95.9% in Iowa. The proportion of children who were compliantly restrained in Shantou increased with age, but generally decreased with age in Iowa. In Shantou, 36.0% of children aged 0 to 3 were sitting in the front seat as compared to only 1.7% of children of the same age in Iowa. Driver seat belt use was significantly associated with child restraint in both Iowa and Shantou; the association was stronger in Iowa than Shantou for all age groups. A significantly higher prevalence of children who were not appropriately restrained was observed in Shantou than in Iowa. Our findings support the need of mandatory child safety restraint use legislation in China.

Optimising the patient compartment design of ambulances in Qatar

Background: The ambulance patient compartment is a working environment where paramedics provide care to patients at times of distress. It needs to meet a number of functional requirements under various conditions whilst being practical and safe for its occupants. Their design varies greatly internationally and often nationally. This study aims to review the current design of Qatar's ambulances to ensure the safe journey of its users whilst making it very appropriate for patient care delivery during transport. Methods: This study was ethically approved as a quality improvement project. The literature was extensively reviewed with regards to patient compartment design. Three focus groups sessions were organised each with 8 experienced participants out of a total population of 800–900 paramedics, to examine the current ambulance patient compartment layout. Results: The focus group sessions conducted with a total of 24 paramedics, each with over a year of experience as independent practitioner, identified that improvements can be made to the current ambulance design for patient care and paramedic safety, including the different positioning of consumables and equipment, altered seat design, modified storage cabinets, and the use of better passenger restraints. It was also identified that improving the quality of driving skills through training and education will also have a positive impact on safety and comfort. Conclusions: It has been recognised that current practitioners' (users) involvement, as opposed to managers, is critical to the appropriate design of the ambulance patient's compartment. They have valuable feedback to provide on the current design from a practical aspect but do not always have their own safety in mind. Based on our study findings the recommendations are to introduce a structured driver-training programme and begin a process of redesigning the patient compartment to test the above recommendations using prototyping and simulation techniques to minimise costs and maximise benefits.

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.

Reasons for Child Passenger Nonrestraint in Motor Vehicles

Objective: Although child passenger restraint use in motor vehicles has increased, there is an important minority of children who remain unrestrained. The goal of this study was to identify the frequency of and under what circumstances parents keep their children unrestrained.Methods: A cross-sectional, online survey was distributed to parents and caregivers of children 10 years old and younger. Survey participants were asked about child restraint practices, including frequency of and reasons for nonuse of restraints. Parents were specifically asked how acceptable it would be to keep their child unrestrained in certain situations.Results: One thousand two hundred eighty-five parents and guardians responded to the survey and 1,002 completed it; 23.8% (95% confidence interval [CI], 21.3–26.6%) of respondents said they had driven with their child not fully restrained on at least one occasion. Approximately 1 in 5 parents strongly or somewhat agreed that it would be acceptable to keep their child unrestrained in certain situations, including a short drive, in a rush, an inadequate number of restraints, riding in a taxi, if somebody was holding the child, and as a reward for a child. Parents were more likely to agree that it was acceptable to keep their child unrestrained under nearly all circumstances listed if they were male, ages 18–29, with a graduate school education, in the $100,000+ income bracket, or Latino.Conclusions: There are certain situations for which parents find it acceptable to leave their children unrestrained. This has implications for targeted child passenger safety efforts designed to maximize consistent restraint use.

Roadside observation of child passenger restraint use

Background: Despite legislation and research evidence supporting the use of childhood vehicle restraints, motor vehicle crashes remain the leading cause of injury, death and disability among Canadian children. Methods: Working in collaboration with trained car seat specialists and police officers, roadside checks were conducted to observe correct use of child restraints. Results: Of the 1323 child vehicle restraints inspected, 99.6% of the children were restrained, 91% were in the correct seat, and 48% of restraints were correctly installed. The seat/restraint types most used incorrectly used were booster seats (31%) and seat belts (53%). The majority of incorrectly installed or fitted seats (55%) were forward facing. Common errors in installation and fit included the seat not being secured tightly enough to the vehicle, incorrect tether strap use, the harness not being tight enough, and/or the chest clip being in the wrong place. Conclusions: The greatest proportion of incorrect seat use was among those children who transitioned to a seat belt too soon. The greatest proportion of installation and fit errors were among forward facing seats. Researchers recommend: 1) targeting parents with older children (ages 3 and above) regarding transitioning too soon from forward facing seats to booster seats, and from booster seats to seat belts; 2) targeting parents with younger children regarding correct installation of rear facing and forward facing seats; 3) collaborating with police officers to review the most common errors and encourage observation at roadside checks; and 4) creating community awareness by way of roadside checks.

Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources. A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1- to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law. Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents. Regardless of race, <30% of 8- to 12-year-old children who were ≤4 feet, 9 inches tall used a booster seat. White parents had higher adjusted odds (3.86, 95% confidence interval 2.27-6.57) of reporting age-appropriate restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, κ = 0.74) between parent report of their child's usual restraint and the observed restraint at emergency department discharge. Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children <8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children.

Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

The Impact of State-Level Graduated Driver Licensing Policy on Rates of Unlicensed Driving and Passenger Restraint Use: Can Stricter Legislation Foster a Culture of Safety?

Motor vehicle collisions account for over two million emergency department (ED) visits per year, disproportionately affecting teens and young adult drivers. Graduated driver licensing (GDL) programs attempt to mitigate the increased crash risk of new drivers. Increased restrictions, however, could steer new drivers towards driving unlicensed, a high-risk behavior that has been shown to adversely affect passenger safety behaviors like restraint use.