Seat Laws Research Articles

Child passenger safety: potential impact of the Washington State booster seat law on childcare centers

Objectives: To examine factors associated with compliance and with perceived readiness for the new Washington State booster seat law, and to identify perceived barriers to compliance among licensed childcare centers....

Reviews of evidence regarding interventions to increase use of child safety seats

Background: In 1998, nearly 600 child occupants of motor vehicles aged younger than 4 years died in motor vehicle crashes. Yet approximately 29% of children aged 4 years and younger do not ride in appropriate child safety seat restraints, which, when correctly installed and used, reduce the need for hospitalization in this age group by 69% and the risk of death by approximately 70% for infants and by 47% to 54% for toddlers (aged 1 to 4 years). Methods: The systematic review development team reviewed the scientific evidence of effectiveness for five interventions to increase child safety seat use. For each intervention, changes in the use of child safety seats or injury rates were the outcome measures evaluated to determine the success of the intervention. Database searching was concluded in March 1998. More than 3500 citations were screened; of these citations, 72 met the inclusion criteria for the reviews. Results: The systematic review process identified strong evidence of effectiveness for child safety seat laws and distribution plus education programs. In addition, community-wide information plus enhanced enforcement campaigns and incentive plus education programs had sufficient evidence of effectiveness. Insufficient evidence was identified for education-only programs aimed at parents, young children, healthcare professionals, or law enforcement personnel. Conclusions: Evidence is available about the effectiveness of four of the five interventions we reviewed. This scientific evidence, along with the accompanying recommendations of the Task Force elsewhere in this supplement, can be a powerful tool for securing the resources and commitment required to implement these strategies.

The effectiveness review trials of Hercules and some economic estimates for the stables

The literature on motor vehicle safety is vast. Consequently the review effort reported in this supplement was Herculean in scope and difficulty. It introduced me to many solid and important effectiveness studies. At the same time, it occasionally omitted effectiveness studies that I cite. Returning to my sources heightened my appreciation of the Task Force on Community Preventive Service’s (the Task Force) trials. The first trial was finding the studies. Two examples are informative. A National Center for Health Statistics publication 1 finds that 92% of low-income parents who own child safety seats use them routinely. That report, however, covers a wide range of parental safety practices. It lacks keywords and is not indexed. Again, an article in an economics journal 2 uses confidential 1983 National Personal Transportation Survey microdata to analyze how people make decisions about using motor vehicle safety equipment. The paper includes a logit regression explaining child seat use. One explanator is residence in a state with a child safety seat use law (in force in 1983 in 15 states housing 38.5% of the 934 respondents with children under age 5). The model focuses on the influence of individual factors like parent age, income, and education on seat use decisions, but in the process it produces the best extant evaluation of the impact those laws had on seat use. It finds that laws increased seatbelt use by 42.3%, with 17.7% diverted from belts and 24.6% restrained for the first time. These findings, however, are by-products. They do not appear in the abstract and merit only one sentence in the text. To the author, a restraint law was just another regression coefficient. How could a systematic search find these studies? The Task Force’s second trial was evaluations measuring different outcomes of comparable interventions. Despite many sound evaluations, the number using any single measure sometimes was dangerously small. Seemingly anomalous meta-analytic effectiveness estimates sometimes resulted. Most notably, when most child seat laws passed, child seat effectiveness was about 54% against fatalities and 52.5% against nonfatal injuries. 3 So child seat laws should decrease deaths and injuries proportionally and by roughly half the amount that use increases. Yet, in the studies reviewed in Table 2 of Zaza et al., 4 laws decrease deaths and injuries combined by 17.3% but decrease deaths alone by 35% and increase use by just 13% (24% if we add the Blomquist study 2 ). By dividing deaths and injuries by effectiveness, we can convert the estimates to compatible units. Doing so reveals that one study, which found 57.3% effectiveness against fatalities, must have been analyzing effectiveness among seat users (or else laws brought 100% seat use). Across the remaining studies including Blomquist, it appears that use increased by 35% at the median, reducing deaths and injuries by 18%. The third trial, which the Task Force handled extremely well, was co-mingled interventions. States do not legislate for the convenience of evaluators. Especially when attacking impaired driving, they often simultaneously implement a package of interventions. The Task Force had to reject some otherwise sound evaluations because studies either could not separate the effects of packaged changes or attributed improved outcomes to a subset of the actual package. It is unclear if we even should try to separate impacts of package components. Synergy may heighten their yield.

THE EFFECTIVENESS OF CHILD SAFETY SEAT LAWS IN THE FIFTY STATES

ABSTRACTThis study evaluates the effectiveness of state child safety seat laws in the United States. Data for all fifty states for the period 1975 to 1994 are used. Pooled time series analysis is employed to estimate a model of the rate of fatalities suffered by children ages 0–5 years as occupants in automobile crashes. The occupant fatality rate for children 6–11 years of age is used as a comparison group to control for other trends not introduced in the estimated models. The results show that child safety seat policies have significantly reduced fatality rates among children 0–5 years of age. For each additional year of age covered by a state statute, this fatality rate drops 4.8%. A similar reduction in the fatality rate of the older age cohort (6–11 years old) was not observed.

Update for the Pediatrician on Child Passenger Safety: Five Principles for Safer Travel

For many parents, the confusion about how best to restrain their children and the myriad of restraint types that are available can be a major source of frustration. Child safety seat inspectors and advocates whose full-time job is to educate parents, caregivers, and advocates find it challenging to stay current with developments and changes in child occupant protection. For pediatricians who work less frequently and less intensively with child safety seats, the challenge of staying current with information is monumental. However, understanding a few basic principles of child safety seat usage and knowing when and where to refer families for additional information can help pediatricians provide parents and caregivers with the information they need to effectively restrain their children in motor vehicles. Significant reduction of deaths of children in motor vehicle crashes, especially those involving children <5 years old, has occurred over the past 20 years.1 This has been largely attributable to improvement in child safety seat and vehicle design, intense educational efforts of safety specialists and health professionals, and enforcement of child safety seat laws. Pediatricians have played a prominent role in this process from the early efforts of the First Ride/Safe Ride program of the American Academy of Pediatrics and continue to do so through the formation of policy recommendations and dissemination of public education materials. National statistics show that 80% to 90% of child safety seats are used incorrectly or misused.2,3 Although many of these misuses are minor, other misuses are considered gross and may render the child safety seat “virtually useless.”4,5 It is common to find child safety seats installed in family vehicles with multiple misuses, and this can collectively degrade performance of the child safety seat. Most parents assume that simply placing their child in a safety seat, placing the seat in …

The value of time and the effect of fines on child car safety seat usage

We report the results of a survey on child car safety seat usage and test the hypothesis that the opportunity cost of time is a significant determinant of proper seat use: We find that parents with high wage rates are less likely to properly use a car seat. We predict that a fine of $1775 along with a certainty of being apprehended once in a four year period would be needed to induce 95% compliance with child car safety seat laws.

Experimental evaluation of public policy: the case of state legislation for child passenger safety.

Observations of children in automobiles were made in seven states before and after implementation of legislation requiring use of child passenger safety devices. Increases in safe seating for children covered by state laws and children under 1 year old were observed in three of the five states implementing legislation during this study. Decreases in safe seating for these age groups were observed in two states, however. Increases in safe seating for children from 1 to 5 years old were observed in four of these five states. Although methodological limitations require cautious interpretation, these data suggest the impact child safety seat laws may have on compliance. Implications of this research for policies on child passenger safety and the importance of exploiting naturally occurring public experiments are discussed.

Beer Taxes, the Legal Drinking Age, and Youth Motor Vehicle Fatalities

The responsiveness of motor vehicle death rates of youths aged fifteen through twenty-four to variations in the cost of beers as reflected by differences in State excise tax rates on beer is investigated. Evidence for this age group is provided on the extent to which declining real beer excise taxes have contributed to increases in fatal motor vehicle crashes and on the extent to which increases in real beer taxes can serve as a potent instrument in the antidrinking campaign. The effect of an increase in the legal drinking age on youth motor vehicle deaths is also examined.

Psychosocial Factors in Child Safety Restraint Use1

Within the past 3 years, a majority of states have passed laws requiring children riding in automobiles to be properly restrained in safety devices. Several studies indicate that such laws have only a modest effect on the number of children being properly protected. To determine factors associated with safety restraint use a telephone interview survey was conducted with 211 residents of a state that has had a child safety restraint law in effect for two years. Several hypotheses derived from the Health Belief Model were tested. The model was generally supported, but will require some revision to explain a routine and repetitive behavior such as safety seat use. While strong general resistance to government intervention in family behavior was found, this did not translate into resistance of safety seat laws.