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Sartin EB, Pfeiffer MR, Hartka T, Zonfrillo MR, Vaca FE, Metzger KB, Goodman AM, Curry AE, Myers RK. Congruency of Crash- and Hospital- Reported Injuries Among Child Passengers. Am J Prev Med 2024:S0749-3797(24)00245-9. [PMID: 39025247 DOI: 10.1016/j.amepre.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Prior work has found incongruencies in injury information reported by crash and hospital records. However, no work has focused on child passengers. The objective of this study was to compare crash scene and hospital-reported injury information for crash-involved child passengers. This study also explored injury location and severity by child age and restraint type. METHODS Utilizing linked New Jersey data from 2017 through 2019, the authors identified crash-involved child passengers <13 years old and their injuries in crash and hospital reports. Then, they characterized the congruency of injury frequency, severity, and location, as well as the frequency of injuries by child age and restraint type. Analyses were conducted from December 2023 through February 2024. RESULTS Of 84,060 crash-involved child passengers, crash reports documented 7,858 (9%) children with at least "possible" injuries, while 2,577 (3%) had at least one injury in hospital events. Crash report and hospital data were incongruent for both body region of injury and injury severity. The proportion of children injured increased as children's ages increased and as restraint type progressed. CONCLUSIONS Crash reports overestimated the number of injured child passengers and misrepresented injury severity and locations. Child restraint systems mitigated a child's injury risk. Importantly, injury information documented on crash reports currently informs the allocation of traffic safety resources. These results highlight the importance of improving these reports' accuracy and underscore calls to link administrative datasets for public health efforts.
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Affiliation(s)
- Emma B Sartin
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas Hartka
- Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University; Injury Prevention Center of Rhode Island Hospital, Providence, Rhode Island
| | - Federico E Vaca
- Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anthoni M Goodman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel K Myers
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Al-Wassia HK, Bokhari OK, Aljahdali MA, Bawazier MAN, Basheikh MAB, Alsheekh MA, Alandunesi YT, Hakeem MN, Bamehrez MY, Meisha DE. Use of Child Safety Seat and its Determinants in Jeddah, Saudi Arabia: A Cross-sectional Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:175-181. [PMID: 38764567 PMCID: PMC11098269 DOI: 10.4103/sjmms.sjmms_330_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/24/2023] [Accepted: 02/14/2024] [Indexed: 05/21/2024]
Abstract
Background A child safety seat protects children from injury during motor vehicle accidents (MVAs). However, there is a lack of enforcement of regulation regarding its use in Saudi Arabia. Objectives This study aimed to determine the use of child safety seat and its determinants and barriers in Jeddah, Saudi Arabia. Materials and Methods This cross-sectional study was based on a structured face-to-face interview across Jeddah among families who drove in cars with children aged ≤5 years. The study used stratified multistage random sampling across the population of the governorate of Jeddah. Results A total of 675 parents were included, of which 311 (46.1%) reported having a child safety seat in their vehicle, and only 165 (24.4%) reported its regular use. Awareness levels among parents regarding child safety seat use and its benefits, parents' level of education, family size, family income, and the belief in the need for laws governing child safety seat were key determinants of child safety seat use. Poor awareness among parents regarding the utility of child safety seat in reducing child injuries, low education levels among parents, larger families with multiple children, poor affordability, low family income, and a clear lack of laws mandating the use of child safety seat were identified as key barriers. Conclusions The regular use of child safety seat for children aged ≤5 years is low in even one of the most urban populations of Saudi Arabia. This indicates the need for large-scale awareness drives and stricter implementation of laws enforcing the use of child safety seat in Saudi Arabia.
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Affiliation(s)
- Heidi Kamal Al-Wassia
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar K. Bokhari
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | - Maha Y. Bamehrez
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dalia E. Meisha
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Brown J, Albanese B, Ho C, Elkington J, Koppel S, Charlton JL, Olivier J, Keay L, Bilston LE. Updated population-level estimates of child restraint practices among children aged 0-12 years in Australia, 10 years after introduction of age-appropriate restraint use legislation. Inj Prev 2024; 30:100-107. [PMID: 38050054 DOI: 10.1136/ip-2023-044994] [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: 06/01/2023] [Accepted: 10/13/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Optimal child passenger protection requires use of a restraint designed for the age/size of the child (appropriate use) that is used in the way the manufacturer intended (correct use).This study aimed to determine child restraint practices approximately 10 years after introduction of legislation requiring correct use of age-appropriate restraints for all children aged up to 7 years. METHODS A stratified cluster sample was constructed to collect observational data from children aged 0-12 years across the Greater Sydney region of New South Wales (NSW). Methods replicated those used in a similar 2008 study. Population weighted estimates for restraint practices were generated, and logistic regression used to examine associations between restraint type, and child age with correct use accounting for the complex sample. RESULTS Almost all children were appropriately restrained (99.3%, 95% CI 98.4% to 100%). However, less than half were correctly restrained (no error=27.3%, 95% CI 10.8% to 43.8%, no serious error=43.8%, 95% CI 35.0% to 52.7%). For any error, the odds of error decreased by 39% per year of age (OR 0.61, 95% CI 0.46 to 0.81) and for serious error by 25% per year (OR 0.75, 95% CI 0.60 to 0.93). CONCLUSION The findings demonstrate high levels of appropriate restraint use among children across metropolitan Sydney approximately 10 years after introduction of legislation requiring age-appropriate restraint use until age 7, however, errors in the way restraints remain common. IMPLICATIONS FOR PUBLIC HEALTH Given the negative impact incorrect use has on crash protection, continuing high rates of incorrect use may reduce effectiveness of legislative change on injury reduction.
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Affiliation(s)
- Julie Brown
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bianca Albanese
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Catherine Ho
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Jane Elkington
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Clayton, Victoria, Australia
| | - Judith L Charlton
- Monash University Accident Research Centre, Clayton, Victoria, Australia
| | - Jake Olivier
- School of Mathematics and Statistics, UNSW, Sydney, New South Wales, Australia
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
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Sartin EB, Metzger KB, Curry AE, O'Malley L, Pfeiffer MR, Mansfield JA. Sociodemographic disparities in child restraint selection and variation in child passenger safety information sources. ACCIDENT; ANALYSIS AND PREVENTION 2023; 188:107094. [PMID: 37156072 DOI: 10.1016/j.aap.2023.107094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Marginalized and otherwise vulnerable groups remain at higher risk than their counterparts for not having all of their children appropriately restrained during vehicle trips. Little is known about potential sources of these disparities, however a commonly theorized factor has been where caregivers find or obtain information (i.e., their information sources). The objective of this study was to: (1) characterize caregivers' actual and preferred sources of information related to child passenger safety information, overall and within sociodemographic groups; and (2) determine if, and if so how, sources impact appropriate child restraint use (i.e., child/seat fit). METHODS We conducted an online, cross-sectional survey of US caregivers. Caregivers answered questions about themselves, their child(ren), their child(ren)'s restraint use during trips, and their information sources to learn which seat their child should be using. We used Fisher's exact and Pearson chi-square tests to compare used and preferred sources of information across caregiver demographics (age, education, race/ethnicity), as well as to determine whether information sources were associated with caregivers' appropriate child restraint use. RESULTS A total of 1,302 caregivers from 36 states with 2,092 children completed the survey. The majority (91%) of children were appropriately restrained. More caregivers from marginalized and otherwise vulnerable groups had children inappropriately restrained when compared with their counterparts. We identified multiple differences in both used and preferred information sources by caregivers' age, race/ethnicity, and education level. In addition, we found a trend that caregivers from populations with higher rates of inappropriate use seemingly used fewer information sources. Ultimately, information sources were not associated with appropriate restraint use; however, within vulnerable populations, almost all caregivers had all of their children appropriately restrained if they had used a Child Passenger Safety Technician (CPST)/Inspection Station or their Pediatrician. CONCLUSION Our findings reiterate calls for more tailored interventions and efforts to combat widening disparities in child restraint use and crash outcomes and suggest one promising method may be providing more access to child passenger safety experts. Future studies must untangle the likely complex relationship between information sources and appropriate/accurate child restraint use.
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Affiliation(s)
- Emma B Sartin
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States.
| | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States
| | - Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States; Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Lauren O'Malley
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States
| | - Julie A Mansfield
- Injury Biomechanics Research Center, The Ohio State University, United States
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Peng Y, Zhang M, Yan S, Li X, Yang J, Fan G, Li L. Evaluation of parental education using biomechanical visualization to increase child restraint use in China. ACCIDENT; ANALYSIS AND PREVENTION 2022; 169:106633. [PMID: 35278847 DOI: 10.1016/j.aap.2022.106633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Despite demonstrated effectiveness of child restraint system (CRS), its use in China is extremely low due to the lack of national legislation requiring the use of CRS, as well as lack of child passenger safety knowledge among caregivers. Implementing an effective intervention is urgently needed to promote the use of CRS. In this study, we primarily evaluated the effectiveness of biomechanical visualization delivered in the context of CRS education to promote CRS use. METHODS We conducted a cluster randomised controlled trial to test the effects of educational intervention programs on increased use of CRS. Participants included caregivers from 8 pre-schools located in two cities (i.e., Chaozhou and Shantou) in China. Following a baseline survey, 8 pre-schools were randomly assigned into 1 of 4 groups with 2 schools in each group: 1) CRS education-only, 2) CRS education with behavioral skill training, 3) CRS education with biomechanical visualization, and 4) control. The primary outcome was CRS use, and the secondary outcomes included scores of child passenger safety-related knowledge and CRS use-related attitudes. The effect of the intervention was assessed among caregivers at two time points: baseline preintervention and 6 months postintervention. RESULTS More than 70% caregivers had never used CRS at baseline. No statistically significant between-group differences CRS use were observed at baseline preintervention (34.2%, 25.4%, 29.6% and 21.9%, respectively, P = 0.18). However, compared to the control group, odds of CRS non-use was significantly lower in caregivers assigned to the CRS education with biomechanical visualization (adjusted odd ratio (AOR) = 0.11, 95% confidence interval (CI) = 0.07-0.17), CRS education with behavioral skill training (AOR = 0.15, 95%CI = 0.10-0.24) and CRS education-only (AOR = 0.26, 95%CI = 0.17-0.41) groups, respectively. Statistically significant differences were also observed in the secondary outcomes postintervention across groups. Specifically, the CRS education with biomechanical visualization and CRS education with behavioral skill training groups had higher mean knowledge change scores than the CRS education-only group (3.3 ± 1.5 vs. 2.9 ± 2.2, p = 0.035 and 3.2 ± 1.9 vs. 2.9 ± 2.2, p = 0.039, respectively). We also observed a significantly higher increase in the attitudes scores in the CRS education with biomechanical visualization group compared with the CRS education-only group (4.7 ± 2.1 vs. 3.5 ± 2.8,p = 0.026). CONCLUSIONS This study shows that both biomechanical visualization and behavioral skill training supplements to education improved understanding of CRS knowledge compared to education only, and all three strategies led to increased CRS use. Importantly, CRS education with biomechanical visualization was shown to be more effective than CRS education alone in improving caregiver's knowledge and attitudes. The use of biomechanical visualization may be an effective supplement to traditional education programs.
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Affiliation(s)
- Yixiang Peng
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
- School of Public Health, Shantou University, Shantou, China
| | | | - Shuzhen Yan
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
- School of Public Health, Shantou University, Shantou, China
- Shenzhen Longhua District Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Xiaogai Li
- KTH Royal Institute of Technology, Sweden
| | - Jingzhen Yang
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Guanhua Fan
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
- School of Public Health, Shantou University, Shantou, China
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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 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] [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.
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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
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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.
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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
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