Methodology of estimating restraint use in children: roadside observation or parking lot interview survey

Promoting youth occupant restraint based on need

Motor vehicle crashes are a leading cause of death for youth. Appropriate occupant protection significantly reduces these preventable injuries. Secondary field observation survey records were studied to identify populations that would most likely benefit from youth occupant protection programs. Multivariate regression analysis showed that drivers of youth between 4 and 14 years were in need of programs promoting youth and driver occupant restraint use. When these drivers were using seat belts, it was 35 times more likely they had youth occupants in safety restraints. A focus on pickup truck drivers may also give these programs greater efficacy in increasing youth restraint use. This study was limited to a single state, but the approach should be transferable to other jurisdictions where youth occupant protection field observation studies are conducted.

An observational study of child safety seat use in an international safe community: Tehran, Iran

OBJECTIVE

Despite strong evidence of the effectiveness of child safety seats in reducing injuries, the use of these devices in some communities is still rare. The purpose of this study was to determine the prevalence of child safety seat use and the factors influencing its use in the safe community of Tehran.

METHODS

This roadside observational study was conducted in 2015 and 2,178 personal cars with a child under 12 years aboard were observed on Tehran's streets in regard to use of child safety seats. Other variables such as the gender of the driver, driver's age group, type of street, region of municipality, time of day, and day of the week were also collected.

RESULTS

Prevalence of child safety seat use was 4.3% and was significantly higher among women drivers, on freeways, and in municipal regions 1, 4, and 7.

CONCLUSIONS

The prevalence of child safety seat use in Tehran as a most populous member of the international safe community was very low and most children commuted in insecure situations in the vehicle. Therefore, it is proposed that plans should be made to increase the use of child safety seats in international safe communities.

Prevalence and predictors of booster seat use in Alberta, Canada

OBJECTIVE

To determine the prevalence of booster seat misuse in a Canadian province and identify determinants of non-use.

METHODS

A cross-sectional study using parking lot interviews and in-vehicle restraint inspections by trained staff was conducted at 67 randomly selected childcare centres across Alberta. Only booster-eligible children were included in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) are reported using unadjusted and adjusted logistic regression.

RESULTS

Overall, 23% of children were not in a booster seat, and in 31.8% of cases there was evidence of at least one misuse. Non-use increased significantly by age, from 22.2% for children 2 years of age to 47.8% for children 7 years of age (p = 0.02). Children who were at significantly increased risk of booster seat non-use were those in vehicles with drivers who could not recall the booster seat to seatbelt transition point (OR: 4.54; 95% CI: 2.05-10.06) or drivers who were under the age of 30 (OR: 3.54; 95% CI: 1.45-8.62). A front row seating position was also associated with significantly higher risk of nonuse (OR: 18.00; 95% CI: 2.78-116.56). Children in vehicles with grandparent drivers exhibited significantly decreased risk of booster seat non-use (OR: 0.21; 95% CI: 0.05-0.85).

CONCLUSION

Messaging should continue to stress that the front seat is not a safe place for any child under the age of 9 as well as remind drivers of the booster seat to seatbelt transition point, with additional emphasis placed on appealing to parents under the age of 30. Future research should focus on the most effective means of communicating booster seat information to this group. Enacting mandatory booster seat legislation would be an important step to increase both awareness and proper use of booster seats in Alberta.

Challenges in the Accurate Surveillance of Booster Seat and Bicycle Helmet Usage by Children: Lessons from the Field

Motor vehicle collisions and bicycle collisions and falls are a leading cause of death by preventable injury for children. In order to design, implement and evaluate campaigns and programs aimed at improving child safety, accurate surveillance is needed. This paper examined the challenges that confront efforts to collect surveillance data relevant to child traffic safety, including observation, interview, and focus group methods. Strategies to address key challenges in order to improve the efficiency and accuracy of surveillance methods were recommended. The potential for new technology to enhance existing surveillance methods was also explored.

Observed child restraint misuse in a large, urban community: Results from three years of inspection events

PROBLEM

Child restraints (CRs) are vital for optimizing child passenger safety and reducing the risk of pediatric injury and fatality in motor vehicle crashes. However, most CRs are installed improperly.

METHODS

This present study was an assessment of observed instances of CR misuse. Participants were recruited through advertisements for CR inspection events in Los Angeles County, California. Child Passenger Safety Technicians collected information about each child passenger, vehicle, and aspects of CR selection and installation.

RESULTS

Of 693 CRs installed upon arrival, only 3.8% were used with no instances of misuse. The most common misuses were inappropriate use of the top tether and failure to secure the seatbelt in locked mode.

CONCLUSIONS

The majority of observed CRs were installed with instances of misuse. CRs in newer vehicles were less likely to be installed in front of airbags and more likely to have the seatbelt routed inappropriately compared to those in older vehicles. Older children were more likely to be prematurely restrained in the front vehicle seat.

PRACTICAL APPLICATIONS

The majority of CRs are installed improperly. We identified specific instances of CR misuse that are common in a large, urban community and present recommendations to improve child passenger safety practices and education.

Child restraint use in Canadian provinces with and without legislation in 2010

OBJECTIVES

When used correctly, child safety seats reduce the risk of injury to a child passenger compared to seat belts. The objectives of this study are to (1) describe restraint use among Canadian children ages 4-8 years in 2010; (2) compare child safety seat use between provinces with new legislation (post-2006), old legislation (pre-2006), and without legislation; and (3) compare child safety seat use rates from 2006 to 2010.

METHODS

Roadside observational surveys of child restraint use were performed in 2006 and 2010 using a nationally representative stratified sample. Proportions of restraint use, correct use (i.e., child safety seats and booster seats) in 4- to 8-year-old children was examined between 3 groups: provinces with new legislation (i.e., child safety seat legislation that included implementation of specific legislation for booster seat use for child passengers ages 4-8 years), old legislation, and no legislation.

RESULTS

There were 4048 children observed as passengers in motor vehicles. In provinces with new legislation, 84 percent (95% confidence interval [CI], 72.2-90.8) of children were restrained compared to 94.9 percent (95% CI, 93.0-96.7) in provinces with old legislation, and 81.8 percent (95% CI, 77.3-86.3) in provinces without legislation. Correct use of child restraint was 54.1 percent (95% CI, 48.0-60.3) in provinces with new legislation, 29.5 percent (95% CI, 25.9-33.2) in provinces with old legislation, and 52.0 percent (43.0-61.0) in provinces without legislation in 2010.

CONCLUSION

The findings from this study suggest that child safety seat legislation has an impact on restraint use in Canada. Despite the increase in rates of child safety seat use in provinces with new legislation and stable rates in provinces with old legislation, use rates remain low. Injury prevention strategies including further surveillance, interventions, and enforcement of restraint use in children are important to decrease motor vehicle related injury and death.

National roadside survey of child restraint system use in Belgium

In September 2011 the Belgian Road Safety Institute (BRSI) conducted its first roadside survey of child restraint system (CRS) use and misuse. The aim of this study was to obtain population-bases estimates of the prevalence of use and misuse of CRS and to identify predictors of misuse on the basis of observations in real traffic conditions. The survey was conducted on randomly selected sites across the country, stratified across various types of journeys. The principal parameters analysed were: the characteristics of the children and the car drivers, type of journey, types of CRS and types of misuse. The sample consisted of 1461 children (under 135cm) for whom the conditions of restraint were observed in detail and the driver was interviewed. At least 50% of the children were not correctly restrained and 10% were not restrained at all. The most significant factors associated with CRS use were the use of a seatbelt by the driver (31% of unrestrained children for unbelted drivers, compared to 7% for belted drivers - only 32% of correctly restrained children for unbelted drivers compared to 54% for belted drivers), whether the CRS was bought in a specialized shop (only 27% of misuse compared to 45% of misuse for CRS both in supermarkets) and the age of the children. The proportion of correctly restrained children (appropriate without misuse, the bottom category in the figure) has a roughly curvilinear relation with age; decreasing from 75% at age 0 to 24% at age 8 and going back up to 63% at age 10. Although the sample of ISOFIX users was small (n=76), it appears that the ISOFIX system reduced misuse significantly. Most of the drivers were ignorant of their own errors concerning the inappropriateness and/or misuse of the CRS or they were remiss and underestimated the risk. The three main reasons given by the drivers to explain or justify the misuse noticed were: low attention level to safety (inattention, time pressure, and short distance), the child's resistance to be restrained, children restraining themselves and problems with the CRS. The present results suggest little or no change in the level of correct CRS use over the last five years and clearly reveal the unacceptably high levels of incorrect and/or inappropriate CRS use. This calls for campaigns and other actions to inform and motivate the population.

Restraint use and seating position among child car passengers: an observational study in Shanghai

Child passenger restraint practices in China are poorly characterized and few direct observational studies have been performed. This study aims to describe child passenger restraint use and to investigate factors influencing the restraint practices. A cross-sectional observational study was conducted at toll-gates in Shanghai during an 11-day period in June in 2009. A pro-forma observation checklist was used to collect data related to restraint use by child passengers aged ≤ 12 years, restraint use by drivers, and the number of child passengers traveling in passenger cars registered in Shanghai. Adjusted risk ratios (RR) comparing those children who were properly rear seated with those in other positions (front seat, on adult's lap) and any restraint use with no restraint use were evaluated using multivariate binomial regression with robust variance estimation. Among 967 children observed, 44.1% of children were in suboptimal seating positions (i.e., 12.2% in the front seat and 31.9% in adult laps) and 93.9% were unrestrained. Children aged ≤ 4 years (RR: 0.35, 95% Confidence Interval: 0.28-0.44), and those who were the only child in a car (RR: 0.84, 95% confidence interval: 0.74-0.96) had a lower likelihood of being properly rear seated. Children traveling with unrestrained drivers (RR: 0.09, 95% confidence interval: 0.01-0.60) were less likely to be restrained. This study demonstrates low restraint use and common suboptimal seating positions for child passengers in China and relates these to driver restraint use. These findings support the need for targeted programs to improve child restraint practices in China.

Modeling improvements in booster seat use: a discrete choice conjoint experiment

Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.