1
|
Santos J, Grigorian A, Schellenberg M, Matsushima K, Nahmias J, Barros R, Inaba K. Safety/booster seats in pediatric motor vehicle crashes: Public health concern. Am J Emerg Med 2024; 76:180-184. [PMID: 38086184 DOI: 10.1016/j.ajem.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The American Academy of Pediatrics (AAP) guidelines recommend that children ≤12-years-old with height < 145 cm should use safety/booster seats. However, national adherence and clinical outcomes for eligible children involved in motor vehicle collisions (MVCs) are unknown. We hypothesized that children recommended to use safety/booster seats involved in MVCs have a lower rate of serious injuries if a safety/booster seat is used, compared to children without safety/booster seat. METHODS This retrospective cohort study queried the 2017-2019 Trauma Quality Improvement Program database for patients ≤12-years-old and <145 cm (recommendation for use of safety/booster seat per American Academy of Pediatrics) presenting after MVC. Serious injury was defined by abbreviated injury scale grade ≥3 for any body-region. High-risk MVC was defined by authors in conjunction with definitions provided by the Centers for Disease Control and Prevention and the American College of Surgeons Committee on Trauma. RESULTS From 8259 cases, 41% used a safety/booster seat. There was no difference in overall rate of serious traumatic injuries or mortality (both p > 0.05) between the safety/booster seat and no safety/booster seat groups. In a subset analysis of high-risk MVCs, the overall use of safety/booster seats was 56%. The rate of serious traumatic injury (53.6% vs. 62.1%, p = 0.017) and operative intervention (15.8% vs. 21.6%, p = 0.039) was lower in the safety/booster seat group compared to the no safety/booster seat group. CONCLUSIONS Despite AAP guidelines, less than half of recommended children in our study population presenting to a trauma center after MVC used safety/booster seats. Pediatric patients involved in a high-risk MVC suffered more serious injuries and were more likely to require surgical intervention without a safety/booster seat. A public health program to increase adherence to safety/booster seat use within this population appears warranted.
Collapse
Affiliation(s)
- Jeffrey Santos
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Rebecca Barros
- Children's Hospital of Orange County, CHOC Medical Group, Orange, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Shaw KM, West B, Kendi S, Zonfrillo MR, Sauber-Schatz E. Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019. J Pediatr 2022; 250:93-99. [PMID: 35809653 PMCID: PMC11428121 DOI: 10.1016/j.jpeds.2022.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/06/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to examine child deaths in motor vehicle crashes by rurality, restraint use, and state child passenger restraint laws. STUDY DESIGN 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. RESULTS 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 ≤6 years (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]). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Kate M Shaw
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Bethany West
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sadiqa Kendi
- Boston Medical Center, Boston University School of Medicine, Division of Pediatric Emergency Medicine, Boston, MA
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Erin Sauber-Schatz
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
3
|
West BA, Reed MP, Benedick A, De Leonardis D, Huey R, Sauber-Schatz E. Belt fit for children in vehicle seats with and without belt-positioning boosters. TRAFFIC INJURY PREVENTION 2022; 23:488-493. [PMID: 36026460 DOI: 10.1080/15389588.2022.2112676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/09/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of the current study is to use 3D technology to measure in-vehicle belt fit both with and without booster seats across different vehicles among a large, diverse sample of children and to compare belt fit with and without a booster. METHODS Lap and shoulder belt fit were measured for 108 children ages 6-12 years sitting in the second-row, outboard seats of three vehicles from October 2017 to March 2018. Each child was measured with no booster, a backless booster, and a high-back (HB) booster in three different vehicles. Alternative high-back (HB HW) and backless boosters that could accommodate higher weights were used for children who were too large to fit in the standard boosters. Lap and torso belt scores were computed based on the belt location relative to skeletal landmarks. RESULTS Both lap and torso belt fit scores were significantly different across vehicles when using the vehicle belt alone (no booster). In all vehicles, lap belt fit improved when using boosters compared with no booster among children ages 6-12 years in rear seats-with one exception of the HB HW booster in the minivan. Torso belt fit improved when using boosters compared with no booster in the sedan, and torso belt fit improved in the minivan and SUV with the use of HB and HB HW boosters when compared with no booster. CONCLUSIONS Lap and torso belt fit for children ages 6-12 years in rear seats was substantially improved by using boosters. Parents and caregivers should continue to have their children use booster seats until vehicle seat belts fit properly which likely does not occur until children are 9-12 years old. Decision makers can consider strengthening child passenger restraint laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 to improve belt fit and reduce crash injuries and deaths.
Collapse
|
4
|
Andrews AL, Killings X, Oddo ER, Gastineau KAB, Hink AB. Pediatric Firearm Injury Mortality Epidemiology. Pediatrics 2022; 149:184887. [PMID: 35224633 DOI: 10.1542/peds.2021-052739] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Firearm injury is a leading and preventable cause of death for youth in the United States. The Centers for Disease Control and Prevention web-based injury statistics query and reporting system was queried to examine changes in firearm injury mortality among youth aged 0 to 19 from 2001 to 2019. This includes assessment of overall mortality rates, mortality rates based on intent and race/ethnicity, and the proportion of deaths due to homicide, suicide, and unintentional shootings among different age groups. Regression analysis was used to identify significant differences in mortality rate over time between Black and White youth. Deaths due to firearm injury were compared with deaths due to motor vehicle traffic collisions. In 2019, firearm injuries surpassed motor vehicle collisions to become the leading cause of death for youth aged 0 to 19 years in the United States. Homicide is the most common intent across all age groups, but suicide represents a large proportion of firearm deaths in 10- to 19-year-old youth. In 2019, Black youth had a firearm mortality rate 4.3 times higher than that of White youth and a firearm homicide rate over 14 times higher than that of White youth. For each additional year after 2013, the mortality rate for Black youth increased by 0.55 deaths per 100 000 compared with White youth (time by race interaction effect P < .0001). These data indicate the growing burden of firearm injuries on child mortality and widening racial inequities with Black youth disproportionately affected by firearm violence. This public health crisis demands physician advocacy to reduce these preventable deaths among youth.
Collapse
Affiliation(s)
| | - Xzavier Killings
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Kelsey A B Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
5
|
Hauser BM, Hoffman SE, Gupta S, Zaki MM, Xu E, Chua M, Bernstock JD, Khawaja A, Smith TR, Proctor MR, Zaidi HA. Association of venous thromboembolism following pediatric traumatic spinal injuries with injury severity and longer hospital stays. J Neurosurg Spine 2022; 36:153-159. [PMID: 34534962 PMCID: PMC9050628 DOI: 10.3171/2021.3.spine201981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/25/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Venous thromboembolism (VTE) can cause significant morbidity and mortality in hospitalized patients, and may disproportionately occur in patients with limited mobility following spinal trauma. The authors aimed to characterize the epidemiology and clinical predictors of VTE in pediatric patients following traumatic spinal injuries (TSIs). METHODS The authors conducted a retrospective cohort analysis of children who experienced TSI, including spinal fractures and spinal cord injuries, encoded within the National Trauma Data Bank from 2011 to 2014. RESULTS Of the 22,752 pediatric patients with TSI, 192 (0.8%) experienced VTE during initial hospitalization. Proportionally, more patients in the VTE group (77%) than in the non-VTE group (68%) presented following a motor vehicle accident. Patients developing VTE had greater odds of presenting with moderate (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.4-4.8) or severe Glasgow Coma Scale scores (aOR 4.3, 95% CI 3.0-6.1), epidural hematoma (aOR 2.8, 95% CI 1.4-5.7), and concomitant abdominal (aOR 2.4, 95% CI 1.8-3.3) and/or lower extremity (aOR 1.5, 95% CI 1.1-2.0) injuries. They also had greater odds of being obese (aOR 2.9, 95% CI 1.6-5.5). Neither cervical, thoracic, nor lumbar spine injuries were significantly associated with VTE. However, involvement of more than one spinal level was predictive of VTE (aOR 1.3, 95% CI 1.0-1.7). Spinal cord injury at any level was also significantly associated with developing VTE (aOR 2.5, 95% CI 1.8-3.5). Patients with VTE stayed in the hospital an adjusted average of 19 days longer than non-VTE patients. They also had greater odds of discharge to a rehabilitative facility or home with rehabilitative services (aOR 2.6, 95% CI 1.8-3.6). CONCLUSIONS VTE occurs in a low percentage of hospitalized pediatric patients with TSI. Injury severity is broadly associated with increased odds of developing VTE; specific risk factors include concomitant injuries such as cranial epidural hematoma, spinal cord injury, and lower extremity injury. Patients with VTE also require hospital-based and rehabilitative care at greater rates than other patients with TSI.
Collapse
Affiliation(s)
- Blake M. Hauser
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Samantha E. Hoffman
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Saksham Gupta
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Mark M. Zaki
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Edward Xu
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Melissa Chua
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Joshua D. Bernstock
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Ayaz Khawaja
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Timothy R. Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Mark R. Proctor
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Hasan A. Zaidi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA
| |
Collapse
|
6
|
West BA, Yellman MA, Rudd RA. Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates. JOURNAL OF SAFETY RESEARCH 2021; 79:110-116. [PMID: 34847994 PMCID: PMC11428119 DOI: 10.1016/j.jsr.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
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.
Collapse
Affiliation(s)
- Bethany A West
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States.
| | - Merissa A Yellman
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States
| | - Rose A Rudd
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States
| |
Collapse
|
7
|
Sartin EB, Lombardi LR, Mirman JH. Systematic review of child passenger safety laws and their associations with child restraint system use, injuries and deaths. Inj Prev 2021; 27:577-581. [PMID: 34011513 DOI: 10.1136/injuryprev-2021-044196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Many countries and all US states have legislation that mandates how children of certain ages and/or sizes should be restrained in vehicles. The objective of the current systematic review was to describe the associations between legislation and three outcomes: child restraint system use, correct child restraint system use and child passenger injuries/deaths. METHODS Included studies were published between 2004 and 2020 and evaluated associations between child passenger safety laws and the outcomes described above. Three literature searches using three search terms (child passenger safety, car seat use, booster seat use) were completed in PubMed and PsycINFO, with the last search occurring in January 2021. Studies are presented based on the outcome(s) they evaluated. The original protocol for this review is registered with PROSPERO (ID: CRD42019149682). RESULTS Eighteen studies from five different countries evaluating a variety of different types of legislation were included. Overall, positive associations between legislation and the three outcomes were reported. However, there were important nuances across studies, including negative associations between booster seat legislation and correct child restraint use. Further, there were also negative associations between various types of legislation and outcomes for populations with less formal education and lower incomes, and for racial and ethnic minorities. CONCLUSION Overall, child passenger safety legislation appears to be positively associated with child restraint system use, correct child restraint use and child passenger injuries/deaths. However, there is a need to more comprehensively characterise how different types of legislation influence child passenger safety outcomes to promote equitable effects across populations.
Collapse
Affiliation(s)
- Emma B Sartin
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leah R Lombardi
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica H Mirman
- Department of Clinical and Health Psychology, Centre for Applied Developmental Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Hendrie D, Lyle G, Cameron M. Lives Saved in Low- and Middle-Income Countries by Road Safety Initiatives Funded by Bloomberg Philanthropies and Implemented by Their Partners between 2007-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111185. [PMID: 34769702 PMCID: PMC8583449 DOI: 10.3390/ijerph182111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007–2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.
Collapse
Affiliation(s)
- Delia Hendrie
- School of Population Health, Curtin University, Bentley, Perth 6102, Australia;
- Correspondence: ; Tel.: +61-8-9266-9068
| | - Greg Lyle
- School of Population Health, Curtin University, Bentley, Perth 6102, Australia;
| | - Max Cameron
- Monash University Accident Research Centre (MUARC), Clayton, Melbourne 3800, Australia;
| |
Collapse
|
9
|
Pitt TM, Howard AW, HubkaRao T, Hagel BE. The effectiveness of booster seat use in motor vehicle collisions. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106296. [PMID: 34284290 DOI: 10.1016/j.aap.2021.106296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Alberta remains the only province in Canada without booster seat legislation. To date, analyses of booster seat effectiveness compared with seatbelt only use have demonstrated mixed findings using observational data. METHODS This study uses Alberta police collision report data for the years 2010-2016, inclusive. Using a case-control study design, children aged four to eight years, who were reported by police to be injured (cases), were compared with uninjured controls for restraint use (seatbelt, booster seat or no restraint). Logistic regression was used to estimate the relation between booster seat use and injury with adjusted odds ratios (aORs) and 95% confidence intervals (CI), stratified by collision types. RESULTS There were 12,922 children involved in collisions, of whom 570 were injured. Approximately 62% of all children included in the analysis were in a booster seat or safety seat at the time of collision. Crude analysis indicates higher odds of injury for seatbelt wearers compared with booster seat use (OR = 1.21; 95% CI: 1.02-1.44). Front-end vehicle-vehicle collisions, demonstrated higher odds of injury for seatbelt wearers relative to those in booster seats (aOR = 1.46; 95% CI: 1.03-2.07). CONCLUSION This analysis indicates a protective effect of booster seats that varies depending on the type of collision and impact location. These regionally-specific injury data may encourage and inform policy on the use of booster seats. Moreover, stratification by collision type may be necessary to inform analyses on booster seat effectiveness.
Collapse
Affiliation(s)
- Tona M Pitt
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - Andrew W Howard
- Department of Surgery & Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Tate HubkaRao
- Department of Paediatrics, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University Calgary, Calgary, Canada
| | - Brent E Hagel
- Department of Paediatrics, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University Calgary, Calgary, Canada; Sports Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| |
Collapse
|
10
|
West BA, Rudd RA, Sauber-Schatz EK, Ballesteros MF. Unintentional injury deaths in children and youth, 2010-2019. JOURNAL OF SAFETY RESEARCH 2021; 78:322-330. [PMID: 34399929 PMCID: PMC11428120 DOI: 10.1016/j.jsr.2021.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unintentional injuries are the leading cause of death for children and youth aged 1-19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0-19 years have changed during 2010-2019. METHOD CDC analyzed 2010-2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0-19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state. RESULTS From 2010-2011 to 2018-2019, unintentional injury death rates decreased 11% overall-representing over 1,100 fewer annual deaths. However, rates increased among some groups-including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018-2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15-19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010-2011 to 2018-2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)-driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.
Collapse
Affiliation(s)
- Bethany A West
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States.
| | - Rose A Rudd
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States
| | - Erin K Sauber-Schatz
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States
| | - Michael F Ballesteros
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States
| |
Collapse
|
11
|
Deng H, Qiu X, Su Q, Zeng S, Han S, Li S, Cui Z, Zhu T, Xiong Z, Tang G, Tang S. Epidemiology of skeletal trauma and skull fractures in children younger than 1 year in Shenzhen: a retrospective study of 664 patients. BMC Musculoskelet Disord 2021; 22:593. [PMID: 34174865 PMCID: PMC8236158 DOI: 10.1186/s12891-021-04438-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Unintentional injury is one of the top three causes of death for infants. However, the epidemiological studies of skeletal trauma and skull fractures in infants younger than 1 year were poorly understood in China. Therefore, our study aimed to examine accidental and emergency attendance in infants under 1 year. It also tried to determine the prevalence and severity of accident types in infants. Methods A retrospective analysis was performed on the demographic characteristics of infants younger than 1 year with skeletal trauma and skull fractures who visited the Shenzhen Children’s Hospital from January 1, 2016 to December 31, 2019. Age, gender, fracture site and type, mechanism of injury, length of visit, length of hospital stay, hospitalization cost, and treatment methods were analyzed. Results A total number of 675 fractures in 664 infants were included, the median age was 187days (IQR,90-273days), including 394 males and 270 females. The top three fracture sites were the skull (430 sites, 63.70 %), long bones of the limbs (168 sites, 24.89 %), and clavicle (53 sites, 7.85 %). The top three causes of injury were locomotion injuries (256 cases, 38.55 %), falls or trips from low height (from beds, tables, chairs, etc.) (130 cases, 19.58 %), and birth injuries (97 cases, 14.61 %). The greatest amount of fractures occurred in children 1–28 days of life (d) reached a top of 101 cases, followed by 331–365 days, accounting for 15.21 and 10.24 %, respectively. The number of fractures reached a trough of 29 cases in the 29-60d group (4.37 %). And increased again to 65 cases in the 151-180d group (9.79 %). The proportion remained relatively constant at 9 % in the 181-210d group (9.19 %) and 211-240d group (9.64 %). The interval between injury and visiting our hospital was ≤ 72 h in 554 cases. Conclusions Special attention should be given to the demographic characteristics of fractures in infants under 1 year of age, and appropriate outreach should be implemented. For example, health education should be provided to aid in the prevention especially for frequently occurring locomotion injuries, and prompt access to specialist medical care should be recommended for skull fractures, which are prone to delayed treatment. In addition, multidisciplinary collaboration should be implemented in trauma care, while also promoting the establishment of trauma centers in specialist children’s hospitals with a stronger capacity to treat pediatric trauma, and a regional system for pediatric trauma treatment.
Collapse
Affiliation(s)
- Hansheng Deng
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China
| | - Xin Qiu
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China
| | - Qiru Su
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China
| | - Shuaidan Zeng
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China
| | - Shuai Han
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Shicheng Li
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhiwen Cui
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Tianfeng Zhu
- China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.
| | - Gen Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China.
| | - Shengping Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Guangdong Province, Shenzhen, P.R. China. .,Zunyi Medical University, Zunyi, Guizhou Province, P.R. China. .,China Medical University, Shenyang, Liaoning Province, P.R. China.
| |
Collapse
|
12
|
National Surveillance of Injury in Children and Adolescents in the Republic of Korea: 2011-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239132. [PMID: 33297537 PMCID: PMC7731276 DOI: 10.3390/ijerph17239132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
Understanding age-specific injury patterns allows the continued improvement of prevention strategies. This is a retrospective study analyzing the Korea Emergency Department-Based Injury In-depth Surveillance data, including those aged ≤19 years old between January 2011 and December 2017. In this study, we focused on changes in the modes of injury and severity, and prevention potential by dividing the patients into four age groups: group 1 (0-4 years), group 2 (5-9 years), group 3 (10-14 years), and group 4 (15-19 years). The most common mode of injury in younger age groups 1 and 2 was a fall or slip. Most injuries in older age groups 3 and 4 were unintentional and intentional collisions combined. Traumatic brain injuries (2.1%), intensive care unit admissions (1.8%), and overall death (0.4%) were the highest in group 4. The proportions of severe and critical injury (EMR-ISS ≥ 25) were 7.5% in group 4, 3.2% in group 3, 2.5% in group 1, and 1% in group 2. This study presents a comprehensive trend of injuries in the pediatric population in South Korea. Our results suggest the importance of designing specific injury-prevention strategies for targeted groups, circumstances, and situations.
Collapse
|
13
|
Komro KA. The Centrality of Law for Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:1001-1006. [PMID: 32804333 PMCID: PMC7430129 DOI: 10.1007/s11121-020-01155-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kelli A Komro
- Department of Behavioral, Social and Health Education Sciences, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 564, Atlanta, GA, 30322, USA.
| |
Collapse
|
14
|
Dollar NT, Gutin I, Lawrence EM, Braudt DB, Fishman SH, Rogers RG, Hummer RA. The persistent southern disadvantage in US early life mortality, 1965-2014. DEMOGRAPHIC RESEARCH 2020; 42:343-382. [PMID: 32317859 PMCID: PMC7173329 DOI: 10.4054/demres.2020.42.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults. OBJECTIVE This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities. METHODS We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965-2004 and restricted data with state geographic identifiers from 2005-2014. State population (denominator) data come from US decennial censuses or intercensal estimates. RESULTS Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality. CONTRIBUTION Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms.
Collapse
Affiliation(s)
| | - Iliya Gutin
- University of North Carolina at Chapel Hill, USA
| | | | | | | | | | | |
Collapse
|
15
|
Probst J, Zahnd W, Breneman C. Declines In Pediatric Mortality Fall Short For Rural US Children. Health Aff (Millwood) 2019; 38:2069-2076. [DOI: 10.1377/hlthaff.2019.00892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Janice Probst
- Janice Probst is a distinguished professor emerita in the Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, in Columbia
| | - Whitney Zahnd
- Whitney Zahnd is a research assistant professor in the Rural and Minority Health Research Center of the University of South Carolina
| | - Charity Breneman
- Charity Breneman was a postdoctoral fellow in the Rural and Minority Health Research Center of the University of South Carolina at the time the study was performed
| |
Collapse
|
16
|
Benedetti M, Klinich KD, Manary MA, Flannagan CAC. Factors Affecting Child Injury Risk in Motor-Vehicle Crashes. STAPP CAR CRASH JOURNAL 2019; 63:195-211. [PMID: 32311057 DOI: 10.4271/2019-22-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Current recommendations for restraining child occupants are based on biomechanical testing and data from national and international field studies primarily conducted prior to 2011. We hypothesized that analysis to identify factors associated with pediatric injury in motor-vehicle crashes using a national database of more recent police-reported crashes in the United States involving children under age 13 where type of child restraint system (CRS) is recorded would support previous recommendations. Weighted data were extracted from the National Automotive Sampling System General Estimates System (NASS-GES) for crash years 2010 to 2015. Injury outcomes were grouped as CO (possible and no injury) or KAB (killed, incapacitating injury, nonincapacitating injury). Restraint was characterized as optimal, suboptimal, or unrestrained based on current best practice recommendations. Analysis used survey methods to identify factors associated with injury. Factors with significant effect on pediatric injury risk include restraint type, child age, driver injury, driver alcohol use, seating position, and crash direction. Compared to children using optimal restraint, unrestrained children have 4.9 (13-year-old) to 5.6 (< 1-year-old) times higher odds of injury, while suboptimally restrained children have 1.1 (13-year-old) to 1.9 (< 1-year-old) times higher odds of injury. As indicated by the differences in odds ratios, effects of restraint type attenuate with age. Results support current best practice recommendations to use each stage of child restraint (rear-facing CRS, forward-facing harnessed CRS, belt-positioning booster seat, lap and shoulder belt) as long as possible before switching to the next step.
Collapse
|
17
|
Ignacio Nazif-Muñoz J, Nandi A, Ruiz-Casares M. Impact of child restraint policies on child occupant fatalities and injuries in Chile and its regions: An interrupted time-series study. ACCIDENT; ANALYSIS AND PREVENTION 2018; 120:38-45. [PMID: 30081318 DOI: 10.1016/j.aap.2018.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/21/2018] [Accepted: 07/22/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVES We assessed the effectiveness of the child restraint legislation (CRL) introduced in Chile in December 2005 and the National Decree enacted in February 2007, which regulated the technical characteristics of child restraint devices with the goal of reducing child occupant fatalities and severe injuries nationally and within Chile's regions. METHODS An interrupted time-series design was used to measure the effect of CRL and the National Decree on two dependent variables-number of child occupant deaths in traffic collisions and number of child occupants severely injured in traffic collisions per vehicle fleet from 2002 to 2014 (police data). Our analyses compared the incidence of these outcomes in the post-intervention period (2006 to 2014) with the period prior to these interventions (2002-2005) nationally and by region, controlling for several confounders. RESULTS Nationally, the child restraint policies were associated with a 39.3% (95% CI: 4.7; 73.9) reduction in child occupant fatalities, but no significant decrease was observed in child severe injuries. These interventions were associated with a 75.3% (95% CI: 15.6; 135.1) reduction in the rate of child occupant fatalities in the southern regions, and a 32.9% (95% CI: 1.1; 67.0) reduction in the rate of children severely injured in the northern regions. CONCLUSION In the short term, the CRL and the National Decree were associated with fewer child occupant fatalities, at the national level and in the southern regions, and severely injured child occupants in traffic collisions in Chile's northern regions. These results demonstrate a limited temporal and territorial impact. This suggests that to effectively protect vulnerable populations across all territories, efforts should be expanded more consistently and sustained over time.
Collapse
Affiliation(s)
- José Ignacio Nazif-Muñoz
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|
18
|
Asbridge M, Ogilvie R, Wilson M, Hayden J. The impact of booster seat use on child injury and mortality: Systematic review and meta-analysis of observational studies of booster seat effectiveness. ACCIDENT; ANALYSIS AND PREVENTION 2018; 119:50-57. [PMID: 29990613 DOI: 10.1016/j.aap.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/19/2018] [Accepted: 07/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine through systematic review and meta-analysis of observational studies if booster seats, compared to seatbelts alone, reduce injury and mortality from motor vehicle collisions among child passengers four to eight years of age. METHODS A comprehensive search of several data sources (including Medline, Embase, and PsycINFO) was conducted from inception to December 2016, to retrieve relevant publications in any language and from any geographic region. Data extraction was completed by two independent reviewers, capturing: study details, population characteristics, exposure (booster seat compared to seat belt use), outcomes (injury and fatality), and all associations reported between the exposure and outcomes. Risk of bias assessment was completed by two reviewers using the QUIPS tool. Meta-analysis of sufficiently similar studies was conducted using random effects models. RESULTS Eleven observational studies were included in qualitative syntheses. The systematic review and meta-analysis found no association between booster seat use, compared to seatbelts, and reduced injury (4 studies, OR 1.03; 95% CI 0.53-1.99) or fatality (2 studies, OR 0.91; 95% CI 0.73-1.13). CONCLUSIONS Evidence on booster seat effectiveness to protect against injury and mortality in real-world conditions is limited. This review identified the need for high quality studies assessing the effects of different models of booster seats on children of varying ages and weights.
Collapse
Affiliation(s)
- Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Rachel Ogilvie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria Wilson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
19
|
Huseth-Zosel AL. Parental perceptions of child placement within vehicles: a focus group study. Int J Inj Contr Saf Promot 2018; 25:279-283. [DOI: 10.1080/17457300.2018.1431942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
20
|
Park GJ, Ro YS, Shin SD, Song KJ, Hong KJ, Jeong J. Preventive effects of car safety seat use on clinical outcomes in infants and young children with road traffic injuries: A 7-year observational study. Injury 2018; 49:1097-1103. [PMID: 29631724 DOI: 10.1016/j.injury.2018.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/01/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Road traffic injury (RTI) is one of the major mechanisms of injury leading to high disability and case-fatality in infants and children. Proper car safety seat use can reduce fatal outcomes in pediatric patients with RTI; however, the use rate is still low. This study aimed to measure the preventive effects of car safety seat use on clinical outcomes among infants and young children injured from RTI. METHODS A multicenter cross-sectional study was conducted using the Emergency Department-based Injury In-depth Surveillance (EDIIS) registry from 23 EDs between Jan 2010 and Dec 2016. All pediatric patients who were under 6 years of age and who sustained RTI in a vehicle with fewer than 10-seats were eligible. Primary and secondary endpoints were intracranial injury and mortality. We calculated the adjusted odds ratio (AOR) of the car safety seat for related outcomes adjusting for potential confounders. RESULTS Among 5545 eligible patients, 1452 (26.2%) patients were in car safety seats at the time of the crash (12.5% in 2010 to 33.9% in 2016, p-for-trend <0.01), and 104 (1.9%) patients had intracranial injuries. The patients using car safety seats were less likely to have intracranial injuries compared with the patients not using car safety seats (0.8% vs. 2.2%, AOR: 0.31 (0.17-0.57)). However, there was no significant difference in mortality between the two groups (0.4% vs. 0.6%, AOR: 0.50 (0.20-1.25)). CONCLUSION Use of the car safety seat has significant preventive effects on intracranial injury. Public health efforts to increase use of car safety seats for infants and young children are needed to reduce the burden of RTI.
Collapse
Affiliation(s)
- Gwan Jin Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| |
Collapse
|
21
|
Benedetti M, Klinich KD, Manary MA, Flannagan CA. Predictors of restraint use among child occupants. TRAFFIC INJURY PREVENTION 2017; 18:866-869. [PMID: 28429962 DOI: 10.1080/15389588.2017.1318209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES 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.
Collapse
Affiliation(s)
- Marco Benedetti
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| | - Kathleen D Klinich
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| | - Miriam A Manary
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| | - Carol A Flannagan
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| |
Collapse
|
22
|
Beck LF, Nguyen DD. School transportation mode, by distance between home and school, United States, ConsumerStyles 2012. JOURNAL OF SAFETY RESEARCH 2017; 62:245-251. [PMID: 28882273 PMCID: PMC5624310 DOI: 10.1016/j.jsr.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 04/06/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Motor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5-18years) travel to and from school and, among those living ≤1mile of school, to explore the role of school bus service eligibility on school travel mode. METHODS We used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ≤1mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling. RESULTS Almost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ≤1mile (48.1%, PV to school; 41.3%, PV to home). Among those living ≤1mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p<0.001)] and from school (aPR: 5.36; p<0.001). CONCLUSIONS Regardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration. PRACTICAL APPLICATIONS Given the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel.
Collapse
Affiliation(s)
- Laurie F Beck
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Hwy NE, MS F62, Atlanta, GA 30341, USA.
| | - Daniel D Nguyen
- Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| |
Collapse
|
23
|
Anderson DM, Carlson LL, Rees DI. Booster Seat Effectiveness Among Older Children: Evidence From Washington State. Am J Prev Med 2017; 53:210-215. [PMID: 28427953 PMCID: PMC5522634 DOI: 10.1016/j.amepre.2017.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics has recommended that children as old as 12 years use a booster seat when riding in motor vehicles, yet little is known about booster seat effectiveness when used by older children. This study estimated the association between booster use and injuries among children aged 8-12 years who were involved in motor vehicle crashes. METHODS Researchers analyzed data on all motor vehicle crashes involving children aged 8-12 years reported to the Washington State Department of Transportation from 2002 to 2015. Data were collected in 2015 and analyzed in 2016. Children who were in a booster seat were compared with children restrained by a seat belt alone. Logistic regression was used to adjust for potential confounders. RESULTS In unadjusted models, booster use was associated with a 29% reduction in the odds of experiencing any injury versus riding in a seat belt alone (OR=0.709, 95% CI=0.675, 0.745). In models adjusted for potential confounders, booster use was associated with a 19% reduction in the odds of any injury relative to riding in a seat belt alone (OR=0.814, 95% CI=0.749, 0.884). The risk of experiencing an incapacitating/fatal injury was not associated with booster use. CONCLUSIONS Children aged 8-12 years involved in a motor vehicle crash are less likely to be injured if in a booster than if restrained by a seat belt alone. Because only 10% of U.S. children aged 8-12 years use booster seats, policies encouraging their use could lead to fewer injuries.
Collapse
Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics, Montana State University, Bozeman, Montana.
| | | | - Daniel I Rees
- Department of Economics, University of Colorado Denver, Denver, Colorado
| |
Collapse
|
24
|
Klinich KD, Benedetti M, Manary MA, Flannagan CA. Rating child passenger safety laws relative to best practice recommendations for occupant protection. TRAFFIC INJURY PREVENTION 2017; 18:406-411. [PMID: 27574894 DOI: 10.1080/15389588.2016.1203427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND State laws regarding child passenger protection vary substantially. OBJECTIVES The objective of this study was to develop a scoring system to rate child passenger safety laws relative to best practice recommendations for each age of child. METHODS State child passenger safety and seat belt laws were retrieved from the LexisNexis database for the years 2002-2015. Text of the laws was reviewed and compared to current best practice recommendations for child occupant protection for each age of child. RESULTS A 0-4 scale was developed to rate the strength of the state law relative to current best practice recommendations. A rating of 3 corresponds to a law that requires a restraint that is sufficient to meet best practice, and a rating of 4 is given to a law that specifies several options that would meet best practice. Scores of 0, 1, or 2 are given to laws requiring less than best practice to different degrees. The same scale is used for each age of child despite different restraint recommendations for each age. Legislation that receives a score of 3 requires rear-facing child restraints for children under age 2, forward-facing harnessed child restraints for children aged 2 to 4, booster seats for children 5 to 10, and primary enforcement of seat belt use in all positions for children aged 11-13. Legislation requiring use of a "child restraint system according to instructions" would receive a score of 1 for children under age 2 and a 2 for children aged 2-4 because it would allow premature use of a booster for children weighing more than 13.6 kg (30 lb). CONCLUSIONS The scoring system developed in this study can be used in mathematical models to predict how child passenger safety legislation affects child restraint practices.
Collapse
Affiliation(s)
- Kathleen D Klinich
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| | - Marco Benedetti
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| | - Miriam A Manary
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| | - Carol A Flannagan
- a University of Michigan Transportation Research Institute , Ann Arbor , Michigan
| |
Collapse
|
25
|
Billie H, Crump CE, Letourneau RJ, West BA. Child safety and booster seat use in five tribal communities, 2010-2014. JOURNAL OF SAFETY RESEARCH 2016; 59:113-117. [PMID: 27846994 PMCID: PMC6487655 DOI: 10.1016/j.jsr.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
PROBLEM Motor-vehicle crashes are a leading cause of death for American Indian/Alaska Natives (AI/AN) including AI/AN children. Child safety seats prevent injury and death among children in a motor-vehicle crash, yet use is low among AI/AN children. METHODS To increase the use of child safety seats (CSS; car seats and booster seats), five tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. Increased CSS use was evaluated through direct observational surveys and CSS event data. CSS events are used to check the installation, use, and safety of CSS and new CSS can be provided. RESULTS CSS use increased in all five programs (ranging from 6% to 40%). Four out of five programs exceeded their goals for increased use. Among the five communities, a total of 91 CSS events occurred resulting in 1417 CSS checked or provided. CONCLUSIONS AND PRACTICAL APPLICATIONS Evidence-based child passenger safety interventions are both feasible in and transferable to tribal communities.
Collapse
Affiliation(s)
- Holly Billie
- National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States.
| | - Carolyn E Crump
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Robert J Letourneau
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bethany A West
- National Center for Injury Prevention and Control, CDC, Atlanta, GA, United States
| |
Collapse
|
26
|
Bohman K, Jorlöv S, Zhou S, Zhao C, Sui B, Ding C. Misuse of booster cushions among children and adults in Shanghai-an observational and attitude study during buckling up. TRAFFIC INJURY PREVENTION 2016; 17:743-749. [PMID: 26891340 DOI: 10.1080/15389588.2016.1143554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Traffic crashes are one of the leading causes of fatalities among Chinese children. Booster cushion usage in China is low, and there are no studies showing how a population with limited experience handles booster cushions during buckling up. The purpose of this study was to evaluate the handling of and explore the attitudes toward booster cushions among children, parents, and grandparents in Shanghai. METHODS An observational study including a convenience sample of 254 children aged 4-12 years was conducted in 2 passenger cars at a shopping center in Shanghai. Parents, grandparents, or the children themselves buckled up the child on 2 types of booster cushions, a 2-stage integrated booster cushion (IBC) and an aftermarket booster cushion (BC). The test participants were observed during buckling up, first without and then with instructions. The test leaders conducted structured interviews. RESULTS Ninety-eight percent of the uninstructed participants failed to buckle up without identified misuse on the aftermarket booster cushion and 31% of those uninstructed on the integrated booster cushion. The majority of misuse was severe, including placing the belt behind the arm and the lap belt routing above the guiding loops. Instruction reduced misuse to 58% (BC) and 12% (IBC), respectively, and, in particular, severe misuse. Some misuse was related to limited knowledge of how to buckle up on the booster cushion, and some misuse was intentional in order to reduce discomfort. The participants, both children and adults, reported that they preferred the IBC due to good comfort and convenience. Safety was reported as the main reason for adults using booster cushions in general, whereas children reported comfort as the most important motivation. CONCLUSIONS Education is needed to ensure frequent and correct use of booster cushions in China and to raise safety awareness among children and adults. Furthermore, it is important that the booster cushions offer intuitively correct usage to a population with limited experience of booster cushions. This is the first study published on the handling of and attitude toward booster cushions after child restraints laws were introduced in Shanghai 2014.
Collapse
Affiliation(s)
- Katarina Bohman
- a Autoliv Research , Vårgårda , Sweden
- b Karolinska Institutet , Department of Clinical Neuroscience , Stockholm , Sweden
| | | | | | | | - Bo Sui
- c Autoliv , Shanghai , China
| | | |
Collapse
|
27
|
Golonka RP, Dobbs BM, Rowe BH, Voaklander D. Prevalence and predictors of booster seat use in Alberta, Canada. Canadian Journal of Public Health 2016; 107:e155-e160. [PMID: 27526212 DOI: 10.17269/cjph.107.5254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/20/2016] [Accepted: 01/30/2016] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Richard P Golonka
- School of Public Health, University of Alberta, 4075 Research Transition Facility, Edmonton, AB, T6C 2R3, Canada
| | - Bonnie M Dobbs
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, 4075 Research Transition Facility, Edmonton, AB, T6C 2R3, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, 4075 Research Transition Facility, Edmonton, AB, T6C 2R3, Canada.
| |
Collapse
|
28
|
Liu X, Yang J, Cheng F, Li L. Newborn Parent Based Intervention to Increase Child Safety Seat Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080777. [PMID: 27490562 PMCID: PMC4997463 DOI: 10.3390/ijerph13080777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/14/2016] [Accepted: 07/14/2016] [Indexed: 11/16/2022]
Abstract
This paper intends to assess the effect of a maternity department intervention on improvement of knowledge and use of child safety seats (CSS) among newborn parents. An intervention study included three groups (one education plus free CSS intervention group, one education only group, and one control group). The participants were parents of newborns in the maternity department of two hospitals. Both of the intervention groups received a folded pamphlet of child passenger safety, a height chart and standardized safety education during their hospital stay after giving birth. The education plus free CSS intervention group received an additional free CSS and professional installation training at hospital discharge. The control group received a pamphlet with educational information about nutrition and food safety. Three months after enrollment, a telephone follow-up was conducted among participants in the three groups. Data on child passenger safety knowledge, risky driving behaviors, and use of CSS were evaluated before and after the intervention. A total of 132 newborn parents were enrolled in the study; of those, 52 (39.4%) were assigned into the education plus free CSS intervention group, 44 (33.3%) were in the education intervention only group, and 36 (27.3%) were in the control group. No significant differences existed in demographics among the three groups. There was a significant difference in newborn parents' child passenger safety knowledge and behaviors in the three groups before and after the intervention. In addition, the CSS use increased significantly in the education plus free CSS group after the intervention compared to parents in the education only or control groups. Education on safety, combined with a free CSS and professional installation training, were effective at increasing newborn parents' knowledge and use of CSS. Future studies with larger sample sizes and longer follow-up are needed to determine a long-term effect of the intervention.
Collapse
Affiliation(s)
- Xiangxiang Liu
- Injury Prevention Research Center, Medical College of Shantou University, 22 Xin Ling Road, Shantou 515041, China.
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Fuyuan Cheng
- Injury Prevention Research Center, Medical College of Shantou University, 22 Xin Ling Road, Shantou 515041, China.
| | - Liping Li
- Injury Prevention Research Center, Medical College of Shantou University, 22 Xin Ling Road, Shantou 515041, China.
| |
Collapse
|
29
|
Brubacher JR, Desapriya E, Erdelyi S, Chan H. The impact of child safety restraint legislation on child injuries in police-reported motor vehicle collisions in British Columbia: An interrupted time series analysis. Paediatr Child Health 2016; 21:e27-31. [PMID: 27429577 DOI: 10.1093/pch/21.4.e27] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/OBJECTIVE Motor vehicle collisions (MVCs) remain a leading cause of death and serious injury in Canadian children. In July 2008, British Columbia introduced child safety seat legislation that aimed to reduce the number of children killed or injured in MVCs. This legislation upgraded previous child seat legislation (introduced in 1985) and affected children zero to three and those four to eight years of age. The objective of the present study was to evaluate the effectiveness of this legislation. METHODS Deidentified police reports for all MVCs involving zero- to 14-year-olds (2000 to 2012) were used to compare injury rates, booster seat use, and seating position among children before and after booster seat laws. An interrupted time series design was used to estimate the effect of the new law on injuries among children zero to three and four to eight years of age. Estimates were adjusted using children nine to 14 years of age as controls. RESULTS The booster seat law was associated with a 10.8% (95% CI 2.7% to 18.9%) reduction in the monthly rate of injuries in four- to eight-year-old children (P=0.01). This was equivalent to a decrease of 14.3 injuries per 1,000,000 children. Similarly, the monthly injury rate among children zero to three years of age decreased by 13.0% (95% CI 1.5% to 24.6% [9.8 injuries per 1,000,000]; P=0.03). CONCLUSION The results provide evidence that British Columbia's new child safety restraint law was associated with fewer injuries among children covered by the new laws.
Collapse
Affiliation(s)
- Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| | - Ediriweera Desapriya
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
30
|
Weatherwax M, Coddington J, Ahmed A, Richards EA. Child Passenger Safety Policy and Guidelines: Why Change Is Imperative. J Pediatr Health Care 2016; 30:160-4. [PMID: 26518731 DOI: 10.1016/j.pedhc.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/01/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022]
|
31
|
Liu X, Yang J, Chen X, Li L. Knowledge, Attitudes and Behaviors on Child Passenger Safety among Expectant Mothers and Parents of Newborns: A Qualitative and Quantitative Approach. PLoS One 2016; 11:e0146121. [PMID: 26735974 PMCID: PMC4703300 DOI: 10.1371/journal.pone.0146121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/13/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the knowledge, attitudes, and intended behaviors about use of child safety seats among parents of newborns and explore expectant mothers' views and decisions regarding child safety seats use. METHODS A cross-sectional survey and semi-structured interview were conducted in the maternity departments of two hospitals in China. Parents of newborns were recruited after delivery and surveyed on their knowledge, attitudes and behaviors regarding child safety seats use. Pregnant women were also interviewed to learn about their views and decisions regarding child safety seats use. Both quantitative and qualitative methods were used to analyze the data collected. RESULTS Of a total of 242 parents of newborns recruited in the quantitative survey, 202 (83.5%) parents had heard of child safety seats and 149 (61.6%) parents reported they would use child safety seats for their babies. Parents' knowledge, car ownership, occupation, and income were significantly associated with their decision regarding use of child safety seats. Three themes were identified from the qualitative interview of 30 pregnant women: (1) the pregnant women perceived child passenger safety as important; (2) the car ownership and price and quality of child safety seats were major influencing factors of their decisions on use of child safety seats; and (3) lack of awareness and lack of laws requiring use were perceived to contribute to low use of child safety seats in China. CONCLUSION Lack of knowledge and awareness on child passenger safety were found to be two most important factors associated with low use of child safety seats. Effective interventions are urgently needed to improve parents' knowledge before laws are enacted and implemented.
Collapse
Affiliation(s)
- Xiangxiang Liu
- Injury Prevention Research Center, Medical College of Shantou University, 22 Xin Ling Road, Shantou, 515041, China
| | - Jingzhen Yang
- Injury Prevention Research and Police Center, The University of Iowa, Iowa City, Iowa, Columbus, Ohio, 43205, United States of America
| | - Xiaojun Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Liping Li
- Injury Prevention Research Center, Medical College of Shantou University, 22 Xin Ling Road, Shantou, 515041, China
- * E-mail:
| |
Collapse
|
32
|
Sauber-Schatz EK, Thomas AM, Cook LJ. Motor Vehicle Crashes, Medical Outcomes, and Hospital Charges Among Children Aged 1-12 Years - Crash Outcome Data Evaluation System, 11 States, 2005-2008. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2015; 64:1-32. [PMID: 26426527 DOI: 10.15585/mmwr.ss6408a1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM Motor vehicle crashes are a leading cause of death among children. Age- and size-appropriate restraint use is an effective way to prevent motor vehicle-related injuries and deaths. However, children are not always properly restrained while riding in a motor vehicle, and some are not restrained at all, which increases their risk for injury and death in a crash. REPORTING PERIOD 2005-2008. DESCRIPTION OF THE SYSTEM The Crash Outcome Data Evaluation System (CODES) is a multistate program facilitated by the National Highway Traffic Safety Administration to probabilistically link police crash reports and hospital databases for traffic safety analyses. Eleven participating states (Connecticut, Georgia, Kentucky, Maryland, Minnesota, Missouri, Nebraska, New York, Ohio, South Carolina, and Utah) submitted data to CODES during the reporting period. Descriptive analysis was used to describe drivers and child passengers involved in motor vehicle crashes and to summarize crash and medical outcomes. Odds ratios and 95% confidence intervals were used to compare a child passenger's likelihood of sustaining specific types of injuries by restraint status (optimal, suboptimal, or unrestrained) and seating location (front or back seat). Because of data constraints, optimal restraint use was defined as a car seat or booster seat use for children aged 1-7 years and seat belt use for children aged 8-12 years. Suboptimal restraint use was defined as seat belt use for children aged 1-7 years. Unrestrained was defined as no use of car seat, booster seat, or seat belt for children aged 1-12 years. RESULTS Optimal restraint use in the back seat declined with child's age (1 year: 95.9%, 5 years: 95.4%, 7 years: 94.7%, 8 years: 77.4%, 10 years: 67.5%, 12 years: 54.7%). Child restraint use was associated with driver restraint use; 41.3% of children riding with unrestrained drivers also were unrestrained compared with 2.2% of children riding with restrained drivers. Child restraint use also was associated with impaired driving due to alcohol or drug use; 16.4% children riding with drivers suspected of alcohol or drug use were unrestrained compared with 2.9% of children riding with drivers not suspected of such use. Optimally restrained and suboptimally restrained children were less likely to sustain a traumatic brain injury than unrestrained children. The 90th percentile hospital charges for children aged 4-7 years who were in motor vehicle crashes were $1,630.00 and $1,958.00 for those optimally restrained in a back seat and front seat, respectively; $2,035.91 and $3,696.00 for those suboptimally restrained in a back seat and front seat, respectively; and $9,956.60 and $11,143.85 for those unrestrained in a back seat and front seat, respectively. INTERPRETATION Proper car seat, booster seat, and seat belt use among children in the back seat prevents injuries and deaths, as well as averts hospital charges. However, the number, severity, and cost of injuries among children in crashes who were not optimally restrained or who were seated in a front seat indicates the need for improvements in proper use of age- and size-appropriate car seats, booster seats, and seat belts in the back seat. PUBLIC HEALTH ACTIONS Effective interventions for increasing proper child restraint use could be universally implemented by states and communities to prevent motor vehicle-related injuries among children and their resulting costs.
Collapse
Affiliation(s)
- Erin K Sauber-Schatz
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | | | | | | |
Collapse
|
33
|
Macpherson AK, Brussoni M, Fuselli P, Middaugh-Bonney T, Piedt S, Pike I. An evaluation of evidence-based paediatric injury prevention policies across Canada. BMC Public Health 2015; 15:707. [PMID: 26208854 PMCID: PMC4514983 DOI: 10.1186/s12889-015-1986-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policies to reduce injury among Canadians can be controversial and there is variability in the enactment of injury prevention laws across the country. In general, laws are most effective when they are based on good research evidence, supported by widespread public awareness and education, and maintained by consistent enforcement strategies. The purpose of this study was to document and compare key informants' perceptions of the quality, awareness, and enforcement of three evidence-based paediatric injury prevention policies (bicycle helmet legislation, child booster seat legislation, graduated driver licensing) among Canadian provinces and territories. METHODS We identified best practices related to each policy, then developed an online survey to ascertain the extent to which each jurisdiction's policy aligned with best practices, whether experts believed that the public was aware of the policy and whether it was enforced. The survey was distributed using a snowball sampling strategy to key informants across Canada. RESULTS Thirty-eight key informants responded to the bicycle helmet survey, with 73 and 35 key informants for the booster seat and graduated driver licensing surveys, respectively. Respondent's perceptions of the policies varied substantially. Key informants indicated that residents are not always aware of legislation, and legislation is not consistently enforced. These results suggest that child health policy is not always guided by evidence. CONCLUSIONS There was variation between evidence and the policies related to paediatric injury prevention among Canadian provinces and territories. Experts generally rate their policies more highly when they align with evidence and best practice. There is room for improvement and harmonization of injury prevention policies.
Collapse
Affiliation(s)
- Alison K Macpherson
- 337 Bethune College, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
| | - Mariana Brussoni
- Department of Pediatrics, University of British Columbia, F508-4480 Oak Street, Vancouver, BC, V6H 3 V4, Canada.
| | - Pamela Fuselli
- Parachute Canada, 150 Eglinton Avenue East, Suite 300, Toronto, ON, M4P 1E8, Canada.
| | | | - Shannon Piedt
- British Columbia Injury Research and Prevention Unit, F508-4480 Oak Street, Vancouver, BC, V6H 3 V4, Canada.
| | - Ian Pike
- Department of Pediatrics, University of British Columbia, F508-4480 Oak Street, Vancouver, BC, V6H 3 V4, Canada.
| |
Collapse
|