Child Restraint Use Research Articles

Child Restraint Use and Seating Position of Child Passengers in Motor Vehicles and Their Correlations: Application of a Random-Effects Bivariate Probit Model

Motor vehicle crashes are a leading cause of death and injury for children aged under 8 years. In the U.S.A., while some states are showing increases in the proportion of child restraint device use, only around half of child passengers aged from 4 to 7 years are being properly restrained. This study was undertaken to identify the factors contributing to the proper child restraint use and child passenger’s seating position through the direct observation surveys of more than 10,000 child passengers in 2015 and 2018 in Michigan. A bivariate probit model with random effects was developed to identify simultaneously the contributing factors for the proper restraint use and seating position of child passengers, accounting for the unobserved heterogeneity in the data. The bivariate framework is able to account for the correlation of the two dependent variables in the study. The results show that the two dependent variables are positively correlated, and this correlation is strongly significant. The key factors simultaneously influencing proper child restraint use and appropriate seating position of the child passenger include the age of the child, the number of child passengers in the vehicle, driver belt use, driver gender, age, and race, vehicle type, stratum, weather, and the time of the day and week. However, factors such as county-specific population, income, and education, and the type of location did not have any significant association with either child restraint use or the seating position of the child passenger.

Restraint Use for Child Occupants in Dubai, United Arab Emirates.

The overall objective of the current study was to investigate the behaviours and knowledge of parents/carers in relation to safe child occupant travel in the Emirate of Dubai in the United Arab Emirates (UAE). A community survey was completed by 786 participants who were responsible for the safety of 1614 children (aged 10 years and younger). The survey included questions related to the type, frequency and appropriateness of restraint use for their eldest child. Overall, 24 percent of participants reported that they ‘never/almost never’ restrained their eldest child while travelling in a motor vehicle, with this proportion increasing with child age. For example, though 89 percent of participants reported that they restrained their infants (<1 year) in an ‘appropriate’ restraint for their age, this rate was much lower for children aged between 5 and 7 years (10%). Overall, these findings suggest that a large proportion of child occupants, especially those aged five years and older, are not appropriately restrained in vehicles, and therefore are at an increased risk of death or serious injury in the event of a crash. Future research will validate this self-reported child restraint use data with objective data from observations of real-world child restraint use behaviour in the UAE.

Database selection matters: A case study in child restraint use and injury patterns using North Carolina motor vehicle traffic crash report and trauma registry data

Objective While proper restraint use is protective against motor traffic vehicle crash (MVTC)-associated morbidity and mortality, it is inconsistently measured across health and MVTC data sources. This project addresses this gap by assessing differences in child restraint measures between two North Carolina (NC) datasets and comparing the utility of these sources to evaluate patterns of child restraint use and associated health outcomes. Methods We analyzed 2018 NC MVTC and NC Trauma Registry (NCTR) data for children ≤15 years old, both separately and as linked MVTC-NCTR records. We calculated mean and standard deviation for continuous variables and frequency and proportion for categorical variables. Among linked records, we compared reported restraint use and performed age-adjusted logistic regression to estimate associations between restraint use and severe injury. Results A lower proportion of pediatric MVTC victims were reported as unrestrained in the MVTC (14.7%) versus NCTR (25.8%) data. Among linked MVTC-NCTR records, only 41.3% featured perfect concordance of restraint information between datasets. Among linked records, child restraint was reported for 31.3% of children, while the NCTR data allowed more granular coding of child restraint (30.3% overall), including child booster seat (13.5%), child car seat (8.7%), infant car seat (4.8%), and unrestrained in child car seat (3.4%). Age-adjusted regression analyses of the linked data revealed that lap/shoulder seatbelt use was significantly associated with lower likelihood of severe injury compared to being unrestrained whether informed by MVTC (OR = 0.39; 95% CI: 0.16, 0.93) or NCTR (OR = 0.38; 95% CI: 0.15, 0.96) data. While the association between reported use of a child car seat and severe injury was not statistically significant in the MVTC data (OR = 0.50; 95% CI: 0.19, 1.32), child car seat use reported in the NCTR data revealed a significant association (OR = 0.16; 95% CI: 0.03, 0.93). Conclusions Linked crash and trauma center data allow for identifying important patterns of restraint use among pediatric passengers in MVTCs. Dataset-dependent differences in measuring restraint use have critical public health implications and illustrate the importance of careful dataset selection prior to analysis, as the use of different data sources may impact overall study conclusions.

Evaluation of parental education using biomechanical visualization to increase child restraint use in China

IntroductionDespite demonstrated effectiveness of child restraint system (CRS), its use in China is extremely low due to the lack of national legislation requiring the use of CRS, as well as lack of child passenger safety knowledge among caregivers. Implementing an effective intervention is urgently needed to promote the use of CRS. In this study, we primarily evaluated the effectiveness of biomechanical visualization delivered in the context of CRS education to promote CRS use. MethodsWe conducted a cluster randomised controlled trial to test the effects of educational intervention programs on increased use of CRS. Participants included caregivers from 8 pre-schools located in two cities (i.e., Chaozhou and Shantou) in China. Following a baseline survey, 8 pre-schools were randomly assigned into 1 of 4 groups with 2 schools in each group: 1) CRS education-only, 2) CRS education with behavioral skill training, 3) CRS education with biomechanical visualization, and 4) control. The primary outcome was CRS use, and the secondary outcomes included scores of child passenger safety-related knowledge and CRS use-related attitudes. The effect of the intervention was assessed among caregivers at two time points: baseline preintervention and 6 months postintervention. ResultsMore than 70% caregivers had never used CRS at baseline. No statistically significant between-group differences CRS use were observed at baseline preintervention (34.2%, 25.4%, 29.6% and 21.9%, respectively, P = 0.18). However, compared to the control group, odds of CRS non-use was significantly lower in caregivers assigned to the CRS education with biomechanical visualization (adjusted odd ratio (AOR) = 0.11, 95% confidence interval (CI) = 0.07–0.17), CRS education with behavioral skill training (AOR = 0.15, 95%CI = 0.10–0.24) and CRS education-only (AOR = 0.26, 95%CI = 0.17–0.41) groups, respectively. Statistically significant differences were also observed in the secondary outcomes postintervention across groups. Specifically, the CRS education with biomechanical visualization and CRS education with behavioral skill training groups had higher mean knowledge change scores than the CRS education-only group (3.3 ± 1.5 vs. 2.9 ± 2.2, p = 0.035 and 3.2 ± 1.9 vs. 2.9 ± 2.2, p = 0.039, respectively). We also observed a significantly higher increase in the attitudes scores in the CRS education with biomechanical visualization group compared with the CRS education-only group (4.7 ± 2.1 vs. 3.5 ± 2.8,p = 0.026). ConclusionsThis study shows that both biomechanical visualization and behavioral skill training supplements to education improved understanding of CRS knowledge compared to education only, and all three strategies led to increased CRS use. Importantly, CRS education with biomechanical visualization was shown to be more effective than CRS education alone in improving caregiver’s knowledge and attitudes. The use of biomechanical visualization may be an effective supplement to traditional education programs.

Adequacy of Emergency Department Documentation of Child Restraint Use After a Motor Vehicle Crash.

There are limited data on how often providers collect and document adequate restraint information in children seen in the emergency department (ED) after motor vehicle crashes (MVCs). The objectives of this study are to determine (1) how often adequate child restraint information to determine age-appropriate use is documented after MVC; (2) the frequency of incorrect use of the child restraint when adequate details are documented; and (3) for those discharged from the ED with identified incorrect use, the frequency of provision of information on child passenger safety (CPS). Retrospective chart review of visits of children younger than 13 years with an International Classification of Diseases, Tenth Revision code for MVC to an urban, academic, level 1 pediatric trauma center, from October 2015 to September 2018. Adequate documentation of child restraint use was defined as identification of location of the child in the car (front vs rear row), type of restraint used, and forward or rear facing for children 24 months or younger. A total of 165 visits qualified for inclusion. There was adequate documentation in 46% of visits. Of those, incorrect child restraint use was identified in 49%. Of discharged patients with incorrect use, 10% had documentation of provision of CPS information. Adequate details to determine proper age-appropriate restraint use are documented in only half of ED visits for MVC. Very few are given CPS instructions on discharge, even when incorrect use has been identified. Identification of incorrect restraint use in the ED is an opportunity for a teachable moment that is being underused.

Comparative performance of rearward and forward-facing child restraint systems with common use errors: Effect on crash injury risk for a 1-year-old occupant

Objective To compare how errors in child restraint use influence crash injury risk in rearward and forward-facing restraints for a 1-year old occupant. Methods Three convertible child restraint systems (CRS) were subjected to frontal dynamic sled tests at 56 km/h in rearward-facing and forward-facing modes in a correct use (baseline) condition and in five incorrect use conditions: loose securing belt, loose harness, partial harness use, top tether slack, and three minor errors. Excursion, head, and chest 3 ms resultant acceleration, HIC15, and neck forces and moments of a Q1 anthropomorphic test device (ATD) seated in the restraints were measured. The effect of incorrect use on each outcome and restraint type was analyzed. Results The influence of errors varied across different outcome variables, the three restraints tested and orientation modes. Excursion increased in four of five incorrect use conditions in both rearward and forward-facing orientations. A very loose harness increased four of five outcome variables in at least one forward-facing restraint, whereas only excursion was increased when rearward-facing. Overall, there tended to be a more negative effect of incorrect use (demonstrated through increases in outcome variables compared to the baseline) in the forward-facing orientation. Conclusions Overall, errors in use tended to have a larger negative impact on forward-facing restraints than rearward-facing restraints. Given the widespread nature of errors in use, this adds further weight to arguments to keep children rearward-facing to 12 months of age and older. The results also highlight a variation in response to errors across differently designed restraints, suggesting the influence of errors may be minimized by restraint design that is more resistant to errors.

Child restraint use in motor vehicles in Shanghai, China: a multiround cross-sectional observational study

ObjectivesWhile appropriate child restraint use in motor vehicles can reduce the risk of injuries or deaths, few previous studies have assessed child restraint practice in China. We aim to describe...

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0–17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.

Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates

Background: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. Objective: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). Methods: Estimates of child restraint use from two online, cross-sectional surveys—FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults—were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child’s restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0–4 years, forward-facing CSS use for children aged 2–7 years, booster seat use for children aged 5–12 years, and seat belt use for children aged 9–12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. Results: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5–94.1) (FallStyles) and 89.4% (CI: 85.5–93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9–91.3) (Estilos) and 84.4% (CI: 79.0–88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7–79.0) (FallStyles) to 59.7% (CI: 55.0–64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1–81.0) (Estilos) to 57.2% (CI: 51.2–63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups.

ROAD TRANSPORT CRASHES AND SOCIO-ECONOMIC INDICATORS: A CASE OF NIGERIA

The aim of this study is to provide basis for the understanding of transport crashes as affected by socio-economic indicators with a view to providing basis for road safety policies for transport management and control in Nigeria. The objectives were to (i) examine the trend of road transport crashes in Nigeria from 1960 to 2010, (ii) identify the socio-economic development indicators and incidences that are related to road transport crashes in Nigeria, (iii) examine the road transport safety measures aimed at reducing road transport crashes and (iv) assess the contributions and challenges of road safety related agencies in the reduction of road transport crashes. Except for annual life expectancy, other socio-economic development indicators had relationship with road transport crashes in Nigeria (R2 = 0,956, p = 0.000, P<0.05). The model of this study was defined as follows: RTC= 8047.7 + 0.041(GDP) - 0.000000812 (FDI) + 0.0006 (population) - 0.0005 (vehicle) + 0.199 (telecom) – 0.388 (road length) + 0.016 (wages) – 0.001 (goods by road). The road transport safety counter measures have reduced transport crashes by these percentages: use of seat belt (35 percent), standard speed limit signs (18 percent), speed limiters/governors (14.4 percent), use of child restraints (12.9 percent), issuance of standard licence (12 percent) and reflective pavement marking (7.7 percent). Insufficient funding (34 percent), political challenges/interferences (26 percent), lack of modern equipment and logistics (16 percent), poor training and retraining of road safety personnel (10 percent), and security challenges (8 percent) constituted the challenges of road transport crash related agencies in the reduction of road transport crashes. The study concluded that national socio-economic development indicators (Gross Domestic Product, Foreign Direct Investment, Population, Vehicle, Telecommunication, Wages, Road Length and Tonnage of Goods) have a significant relationship with road transport crashes except the annual life expectancy.

Road User Attitudes and Their Reported Behaviours in Abuja, Nigeria

The continuous increases in the numbers of road traffic crashes (RTC) over the years, especially in developing countries, have been a source of worry. The majority of the RTC are attributed to road user behaviours exhibited by the drivers. This study sets out to investigate the road user attitudes and behaviours in Abuja, Nigeria. A total of 1526 questionnaires were distributed, of which 321 questionnaires were completed and returned. The questionnaires tried to understand four major road user behaviours, namely use of seatbelts, drink driving, use of mobile phone while driving, and use of child restraints. The results after analysing the questionnaires showed that the majority of the road users in Abuja showed high non-compliance with the use of seatbelts, either when driving or when being driven. About 64% of the respondents admitted to not using seatbelts. Results from the cross-tabulation process showed that the high non-compliance to seatbelt usage was statistically associated with young, single road users. Around one-third of Abuja road users admitted to drink driving. Road users who were married engaged in more frequent drink driving than road users who were single, and the association was statistically significant. A high percentage of Abuja road users admitted to using mobile phones while driving and 55.8% of the total respondents admitted to not using child restraints while driving. A lack of child restraints was statistically associated more with male road users than female road users. It is recommended that stricter enforcement of road safety laws should be undertaken and that the government should provide road safety agents with the right equipment (e.g., speed guns, breathalyzers) that would aid road safety agents to perform their duties effectively in order to curb the excessive bad road user behaviours in Abuja.

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

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

The relationship between Brazilian legislation on the mandatory use of restraint devices for zero- to four-year-old children in vehicles and the numbers of injured and dead in traffic accidents

The scope of this article is to address the relationship between mandatory restraint devices and hospitalizations and deaths of zero- to four-year-old age children in traffic accidents in Brazil. Based on the mandatory use of child restraint devices for children up to 4 years of age under Brazilian traffic legislation in 2010, the authors apply data from the DataSUS and Denatran databases to analyze the time series of hospitalizations and deaths of zero- to four-year-old age children in traffic accidents between September 2005 and August 2015. Two cut-off sample periods were examined, the first consisting of an analysis from 2005 to 2015, which was subsequently subdivided into two samples, namely before and after the requirement. The results of both cut-off sample periods suggest that demands concerning the use of restraint devices led to decreased hospitalizations and deaths of children due to traffic accidents in the zero- to four-year-old age group, with a prevalence of decreased rates of hospitalization over deaths.

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...

Pediatric Seat Belt Use in Motor Vehicle Collisions: The Need for Driver Education Programs

By statute, pediatric passengers transported in motor vehicles need to be appropriately restrained. The National Highway Traffic Safety Administration (NHTSA) estimates that currently only 2% of children do not wear safety restraints. This study aimed primarily to evaluate the use of pediatric restraints (seat belts) in motor vehicle collisions (MVCs) transported to our Level I pediatric trauma center (PTC) compared with historical NHTSA controls. A 4-year review utilized our Level I PTC registry for patients younger than 16 years, involved in an MVC. Appropriate booster seat/child restraints were verified by EMS, fire rescue, and patient/family. Odds ratios were used to compare occurrences and χ for categorical values with significance defined as p <.05. A total of 685 pediatric patients in MVCs were admitted to our PTC during the study period. Only 39 of 685 (5.7%) pediatric patients were in restraints. Based on the NHTSA historical controls, 671 of 685 (98%) children would have been expected to be using restraints (5.7% vs. 98%, p < .01). The odds ratio of lack of use of child restraints or seat belts in pediatric trauma population was markedly higher compared with NHTSA historical controls (odds ratio 793.9, 95% confidence interval: 427.02-1475.98, p < .0001). Astonishingly low rates of child restraints and seat belt use in pediatric patients in MVCs, requiring admission to a PTC, indicate the need for better injury prevention programs, and parental or driver education on risks associated with lack of restraints.

Overloaded and Unrestrained: A Qualitative Study with Local Experts Exploring Factors Affecting Child Car Restraint Use in Cape Town, South Africa.

(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the feasibility of a child restraint program and to describe factors influencing child restraint use from the perspectives of clinicians, representatives of non-government agencies, and academics in Cape Town, South Africa. (2) Methods: Qualitative interviews were conducted with 13 experts from government, academic and clinical backgrounds. Findings were analyzed using the COM-B component of the Behaviour Change Wheel and were grouped by the layers of the social-ecological model (individual, relational, community and societal). (COM-B is a framework to explain behaviour change which has three key components; capability, opportunity and motivation), (3) Results: Experts believed that there was a need for a child restraint program that should be staged and multifactorial. Participants described knowledge gaps, perceptions of risk, mixed motivations and limited enforcement of child restraint legislation as key influences of restraint use. (4) Conclusions: The results demonstrate potential areas on which to focus interventions to increase child restraint use in Cape Town, South Africa. However, this will require a coordinated and consistent response across stakeholder groups.

Assessing the Effect of a Pre-Birth Child Passenger Safety Educational Intervention on Appropriate Child Restraint Use

Background Motor vehicle crashes (MVC) are the leading cause of death for US children. Twenty one percent of children under 4 years killed in MVCs were unrestrained. Appropriate use of child restraints in infants and toddlers, booster seats and safety belts in older children prevents most MVC-related deaths. When used correctly child restraints significantly reduce the risk of serious injury or death. An estimated 328 children under 5 years were saved by child restraints …

Assessing the Effect of a Pre-Birth Child Passenger Safety Educational Intervention on Appropriate Child Restraint Use

Assessing the Effect of a Pre-Birth Child Passenger Safety Educational Intervention on Appropriate Child Restraint Use

Seatbelt and child restraint use among vehicle occupants in Ho Chi Minh City: an observational study in Vietnam

This paper presents the trend of seatbelt use, disaggregated by vehicle occupants, in Ho Chi Minh City between 2016 and 2018. We conducted statistical analyses to identify the determinants of seatbelt use, including the effect of a new fine imposed against seatbelt law violation in the rear seats that became effective in January 2018. Seatbelt use was observed in at least half of all vehicle occupants, and drivers were more likely to use seatbelts than passengers. Only 4.4% of children younger than 5-years and 2.5% of 5 to12-year-olds used a child restraint system. Seatbelt use increased among all occupants after the imposed fine, especially among rear-seat passengers. Imposing new or increasing fixed penalties, with enforcement and public education, may increase seatbelt use to prevent road traffic injuries.

Saving lives through vehicle safety

Saving lives through vehicle safety