Population-level estimates of child restraint practices among children aged 0-12 years in NSW, Australia
- Brown, Julie, Hatfield, Julie, Du, Wei, Finch, Caroline, Bilston, Lynne
- Authors: Brown, Julie , Hatfield, Julie , Du, Wei , Finch, Caroline , Bilston, Lynne
- Date: 2010
- Type: Text , Journal article
- Relation: Accident Analysis and Prevention Vol. 42, no. 6 (2010), p. 2144-2148
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: This cross-sectional study provides population-referenced data on the restraints used and the extent of incorrect restraint use, among child vehicle passengers aged 0-12 years in NSW, Australia. A multistage stratified cluster sampling plan was used to randomly select vehicles from baby/child health clinics, pre-schools/day care centres, and primary schools across NSW to undergo detailed inspection of restraints used by child occupants within those vehicles. Overall, there were very high restraint usage rates (>99% of sampled children) but fewer than one quarter of children were using the correct size-appropriate restraints. Incorrect use (51.4%) was as common as inappropriate use (51.2%). Incorrect use was highest among users of dedicated child restraint systems (OR 16.0, 95% CI 6.9-36.0), and was more likely among those using size-appropriate restraints than those using inappropriate restraints (OR 1.8 95% CI 1.1-3.2); and among convertible restraints than those designed for a single mode of use (OR 1.5 95% CI 1.2-1.7). As incorrect use substantially reduces the protection from injury that is offered by child restraints, it is important that future strategies to reduce casualties among child occupants target both inappropriate and incorrect use. © 2010 Elsevier Ltd. All rights reserved.
- Authors: Brown, Julie , Hatfield, Julie , Du, Wei , Finch, Caroline , Bilston, Lynne
- Date: 2010
- Type: Text , Journal article
- Relation: Accident Analysis and Prevention Vol. 42, no. 6 (2010), p. 2144-2148
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: This cross-sectional study provides population-referenced data on the restraints used and the extent of incorrect restraint use, among child vehicle passengers aged 0-12 years in NSW, Australia. A multistage stratified cluster sampling plan was used to randomly select vehicles from baby/child health clinics, pre-schools/day care centres, and primary schools across NSW to undergo detailed inspection of restraints used by child occupants within those vehicles. Overall, there were very high restraint usage rates (>99% of sampled children) but fewer than one quarter of children were using the correct size-appropriate restraints. Incorrect use (51.4%) was as common as inappropriate use (51.2%). Incorrect use was highest among users of dedicated child restraint systems (OR 16.0, 95% CI 6.9-36.0), and was more likely among those using size-appropriate restraints than those using inappropriate restraints (OR 1.8 95% CI 1.1-3.2); and among convertible restraints than those designed for a single mode of use (OR 1.5 95% CI 1.2-1.7). As incorrect use substantially reduces the protection from injury that is offered by child restraints, it is important that future strategies to reduce casualties among child occupants target both inappropriate and incorrect use. © 2010 Elsevier Ltd. All rights reserved.
Relative benefits of population-level interventions targeting restraint-use in child car passengers
- Du, Wei, Finch, Caroline, Hayen, Andrew, Bilston, Lynne, Brown, Julie, Hatfield, Julie
- Authors: Du, Wei , Finch, Caroline , Hayen, Andrew , Bilston, Lynne , Brown, Julie , Hatfield, Julie
- Date: 2010
- Type: Text , Journal article
- Relation: Pediatrics Vol. 125, no. 2 (2010), p. 304-312
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Objectives: Because public health resources for injury prevention are limited, methods for comparing competing strategies are needed. We aimed to estimate potential injury reductions for 4 population-level interventions that target restraint practices for child car passengers aged 0 to 12 years. Methods: Population-attributable risk fraction (parf) is a populationlevel estimate of excess risk from exposure to a risk factor. Parfs were calculated for each intervention scenario by using published age-specific mortality/injury relative-risk estimates; restraint practices among injured child car passengers from police-collected data; and observational data for correctness of restraint use in new south wales, australia. Parf reductions were estimated for population uptakes of 25%, 50%, and 75%. Results: Assuming a 50% population uptake, (1) promoting ageappropriate restraint use could prevent additional fatalities (5.1%, infants; 3.4%, 1- To 6-year-olds) and nonfatal injuries (3.2%, infants; 16.2%, 1- To 6-year-olds) compared with promoting any restraint use; (2) further encouraging correct age-appropriate restraint use could also prevent additional fatalities (9.1%, infants; 14.3%, 1- To 6-year-olds) and nonfatal injuries (9.2%, infants; 10.7%, 1- To 6-year-olds); and (3) for children aged 7 to 12 years, promoting correct use of restraints could prevent an additional 3.4% fatalities and 3.1% nonfatal injuries compared with promoting any restraint use. Conclusions: Interventions that target child passenger-restraint practices offer population-level benefits in terms of reduction in fatalities and injuries. These tangible benefits call for action internationally, not only to promote restraint use but correct age-appropriate restraint use for child car passengers. Copyright © 2010 by the American Academy of Pediatrics.
The characteristics of incorrect restraint use among children traveling in cars in New South Wales, Australia
- Brown, Julie, Hatfield, Julie, Du, Wei, Finch, Caroline, Bilston, Lynne
- Authors: Brown, Julie , Hatfield, Julie , Du, Wei , Finch, Caroline , Bilston, Lynne
- Date: 2010
- Type: Text , Journal article
- Relation: Traffic Injury Prevention Vol. 11, no. 4 (2010), p. 391-398
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Objective: This study aims to provide population estimates of incorrect restraint use among children aged 0-12 traveling in cars in New South Wales (NSW) and describe the errors occurring in different restraint types. Methods: Observations of randomly selected children and restraints were conducted in situ by trained researchers at sites statewide. Observation sites were randomly selected using a multistage stratified sample plan. Restraint use errors were recorded and analyzed by severity of error and restraint type using complex survey analysis techniques. Results: One in two children was incorrectly restrained, and 38 percent in a serious manner. Multiple errors were common (31% of children). Both installation and "securing" errors were common, with installation errors more common in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats) than singlemode restraints (odds ratio [OR] 4.3; 95% confidence interval [CI] 1.7-10.8). Multiple errors were more common in convertible restraints (OR 3.6; 95% CI 1.9-7.0). The most frequently observed errors were excessive seat belt slack (>25 mm), incorrect belt routing, nonengagement of the seat belt buckle, very loose harness (>25 mm slack), harness off the shoulder, nonuse of belt guides, sash belt worn under the arm, and very twisted harnesses and belts (>2 twists). For rearwardand forward-facing restraints the highest priorities in terms of frequency and degradation in crash protection are errors related to harness use. For booster seat users the most important are those related to correct seat belt and belt guide use. For seat belt users, errors related to correct positioning of the sash belt are key. Conclusions: The results indicate that many errors are currently occurring in the way children are using restraints, as well as problems associated with the way child restraint systems are installed in vehicles. Incorrect use is particularly problematic in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats). Different priorities, in terms of the frequency and potential degradation in crash protection due to incorrect use for different restraint types, exist and these are important for those designing countermeasures to this problem. © 2010 Taylor & Francis Group, LLC.
- Authors: Brown, Julie , Hatfield, Julie , Du, Wei , Finch, Caroline , Bilston, Lynne
- Date: 2010
- Type: Text , Journal article
- Relation: Traffic Injury Prevention Vol. 11, no. 4 (2010), p. 391-398
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Objective: This study aims to provide population estimates of incorrect restraint use among children aged 0-12 traveling in cars in New South Wales (NSW) and describe the errors occurring in different restraint types. Methods: Observations of randomly selected children and restraints were conducted in situ by trained researchers at sites statewide. Observation sites were randomly selected using a multistage stratified sample plan. Restraint use errors were recorded and analyzed by severity of error and restraint type using complex survey analysis techniques. Results: One in two children was incorrectly restrained, and 38 percent in a serious manner. Multiple errors were common (31% of children). Both installation and "securing" errors were common, with installation errors more common in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats) than singlemode restraints (odds ratio [OR] 4.3; 95% confidence interval [CI] 1.7-10.8). Multiple errors were more common in convertible restraints (OR 3.6; 95% CI 1.9-7.0). The most frequently observed errors were excessive seat belt slack (>25 mm), incorrect belt routing, nonengagement of the seat belt buckle, very loose harness (>25 mm slack), harness off the shoulder, nonuse of belt guides, sash belt worn under the arm, and very twisted harnesses and belts (>2 twists). For rearwardand forward-facing restraints the highest priorities in terms of frequency and degradation in crash protection are errors related to harness use. For booster seat users the most important are those related to correct seat belt and belt guide use. For seat belt users, errors related to correct positioning of the sash belt are key. Conclusions: The results indicate that many errors are currently occurring in the way children are using restraints, as well as problems associated with the way child restraint systems are installed in vehicles. Incorrect use is particularly problematic in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats). Different priorities, in terms of the frequency and potential degradation in crash protection due to incorrect use for different restraint types, exist and these are important for those designing countermeasures to this problem. © 2010 Taylor & Francis Group, LLC.
Age-specific parental knowledge of restraint transitions influences appropriateness of child occupant restraint use
- Bilston, Lynne, Finch, Caroline, Hatfield, Julie, Brown, Jill
- Authors: Bilston, Lynne , Finch, Caroline , Hatfield, Julie , Brown, Jill
- Date: 2008
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 14, no. 3 (2008), p. 159-163
- Full Text:
- Reviewed:
- Description: Objective: To determine the factors that influence appropriate restraint usage by child occupants across the age range for which any type of child restraint may be appropriate (0-10 years). Design: Randomized household telephone survey. Setting: Statewide survey, New South Wales, Australia. Subjects: Parents or carers of children aged 0-10 years. Main outcome measures: Parental reporting of appropriateness of child restraint. Methods: Demographic information and data on age, size, restraint practices, parental knowledge of child occupant safety, and attitude to restraint use was collected using a structured interview. Data were analysed using logistic regression after cluster adjustment. Results: Inappropriate restraint use by children was widespread, particularly in children aged 2+ years. Overall, parental knowledge of appropriate ages for restraint transitions was associated with increased likelihood of appropriate restraint use. Lower levels of formal parental education, larger families, parental restraint non-use, and parent/child negotiability of restraint use were predictors of inappropriate restraint use. For particular child age subgroups, the parental knowledge that predicted appropriate restraint use was specific to that age group. Most parents felt that they knew enough to safely restrain their child, despite widespread inappropriate restraint use. Conclusions: Parents are more likely to make appropriate restraint choices for their children if they possess restraint knowledge specific to their children's age and size. Educational campaigns may be most effective when they provide information for specific ages and transition points. Strategies to overcome parents' misplaced confidence that they know enough to restrain their children safely are also indicated.
- Description: C1
- Authors: Bilston, Lynne , Finch, Caroline , Hatfield, Julie , Brown, Jill
- Date: 2008
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 14, no. 3 (2008), p. 159-163
- Full Text:
- Reviewed:
- Description: Objective: To determine the factors that influence appropriate restraint usage by child occupants across the age range for which any type of child restraint may be appropriate (0-10 years). Design: Randomized household telephone survey. Setting: Statewide survey, New South Wales, Australia. Subjects: Parents or carers of children aged 0-10 years. Main outcome measures: Parental reporting of appropriateness of child restraint. Methods: Demographic information and data on age, size, restraint practices, parental knowledge of child occupant safety, and attitude to restraint use was collected using a structured interview. Data were analysed using logistic regression after cluster adjustment. Results: Inappropriate restraint use by children was widespread, particularly in children aged 2+ years. Overall, parental knowledge of appropriate ages for restraint transitions was associated with increased likelihood of appropriate restraint use. Lower levels of formal parental education, larger families, parental restraint non-use, and parent/child negotiability of restraint use were predictors of inappropriate restraint use. For particular child age subgroups, the parental knowledge that predicted appropriate restraint use was specific to that age group. Most parents felt that they knew enough to safely restrain their child, despite widespread inappropriate restraint use. Conclusions: Parents are more likely to make appropriate restraint choices for their children if they possess restraint knowledge specific to their children's age and size. Educational campaigns may be most effective when they provide information for specific ages and transition points. Strategies to overcome parents' misplaced confidence that they know enough to restrain their children safely are also indicated.
- Description: C1
- Du, Wei, Hayen, Andrew, Bilston, Lynne, Hatfield, Julie, Finch, Caroline, Brown, Julie
- Authors: Du, Wei , Hayen, Andrew , Bilston, Lynne , Hatfield, Julie , Finch, Caroline , Brown, Julie
- Date: 2008
- Type: Text , Journal article
- Relation: Archives of Pediatrics & Adolescent Medicine Vol. 162, no. 11 (Nov 2008), p. 1085-1089
- Full Text:
- Reviewed:
- Description: Objective: To investigate the association between restraint use and death in rear-seated child passengers and to examine whether the estimated association varies by restraint type and age. Design: Matched cohort study. Setting: All reported crashed passenger vehicles with at least 2 rear-seated child passengers of whom at least 1 died from the US Fatality Analysis Reporting System for 1998 to 2006. Participants: Rear-seated child passengers aged 2 to 6 years. Interventions: Three models of restraint use: (1) no restraint use, any restraint use; (2) no restraint use, recorded improper restraint use (including improper use of seat belts or child restraints, use of shoulder-only seat belts, and use of an unknown type of restraint), any other restraint use; and (3) no restraint use, improper restraint use, seat belts, and child restraints. Main Outcome Measure: Death within 30 days of a crash. Results: Compared with no restraint use, being restrained reduced the risk of death in rear-seated child passengers (relative risk [RR], 0.33; 95% confidence interval [CI], 0.22-0.49). Compared with improper restraint use, any other restraint use reduced the risk of death (RR, 0.46; 95% CI, 0.20-0.63). The RR of death for using child restraints compared with seat belts was 0.91 (95% CI, 0.57-1.14). Child restraints performed slightly better in fatality risk reduction in children aged 2 to 3 years (RR, 0.24; 95% CI, 0.09-0.33) than in children aged 4 to 6 years (RR, 0.32; 95% CI, 0.11-0.44) compared with traveling unrestrained. Conclusions: This study demonstrates the protective effects of restraints for child passengers and highlights the importance of using restraints correctly.
Comparison of methods to correct the miscounting of multiple episodes of care when estimating the incidence of hospitalised injury in child motor vehicle passengers
- Du, Wei, Hayen, Andrew, Finch, Caroline, Hatfield, Julie
- Authors: Du, Wei , Hayen, Andrew , Finch, Caroline , Hatfield, Julie
- Date: 2008
- Type: Text , Journal article
- Relation: Accident Analysis and Prevention Vol. 40, no. 4 (2008), p. 1563-1568
- Full Text:
- Reviewed:
- Description: This study evaluates the performance of different case selection criteria to account for multiple episodes of care when estimating the hospitalisation rate due to road trauma amongst children. The internally linked NSW Inpatient Statistics Collection (ISC) dataset for the period between 1st July, 2000 and 30th June, 2003 was used to identify the "single" episode of care for each hospitalised child motor vehicle passenger residing in NSW. We used two hospitalised injury definitions of a case based on (1) all-diagnoses and (2) principal diagnosis only. We then developed case selection criteria, based on (a) linkage methods only available from linked ISC datasets; (b) selected variables available in both the linked and unlinked ISC datasets, to exclude repeat episodes of care for an injury. Changes in the estimated hospitalisation rate, and sensitivity and specificity, were calculated for each selection criteria compared to the findings from linkage methods as the "gold standard". None of the correction methods for multiple episodes of care was clearly superior in terms of incidence estimation, sensitivity, and specificity concurrently. However, the correction criterion which is optimal may vary depending on different study objectives and different types of hospitalised injuries. © 2008 Elsevier Ltd. All rights reserved.
- Authors: Du, Wei , Hayen, Andrew , Finch, Caroline , Hatfield, Julie
- Date: 2008
- Type: Text , Journal article
- Relation: Accident Analysis and Prevention Vol. 40, no. 4 (2008), p. 1563-1568
- Full Text:
- Reviewed:
- Description: This study evaluates the performance of different case selection criteria to account for multiple episodes of care when estimating the hospitalisation rate due to road trauma amongst children. The internally linked NSW Inpatient Statistics Collection (ISC) dataset for the period between 1st July, 2000 and 30th June, 2003 was used to identify the "single" episode of care for each hospitalised child motor vehicle passenger residing in NSW. We used two hospitalised injury definitions of a case based on (1) all-diagnoses and (2) principal diagnosis only. We then developed case selection criteria, based on (a) linkage methods only available from linked ISC datasets; (b) selected variables available in both the linked and unlinked ISC datasets, to exclude repeat episodes of care for an injury. Changes in the estimated hospitalisation rate, and sensitivity and specificity, were calculated for each selection criteria compared to the findings from linkage methods as the "gold standard". None of the correction methods for multiple episodes of care was clearly superior in terms of incidence estimation, sensitivity, and specificity concurrently. However, the correction criterion which is optimal may vary depending on different study objectives and different types of hospitalised injuries. © 2008 Elsevier Ltd. All rights reserved.
Trends in hospitalisation rates for road traffic injuries in child motor vehicle passengers in New South Wales, July 1998 June 2005
- Du, Wei, Finch, Caroline, Hayen, Andrew, Hatfield, Julie
- Authors: Du, Wei , Finch, Caroline , Hayen, Andrew , Hatfield, Julie
- Date: 2007
- Type: Text , Journal article
- Relation: Medical Journal of Australia Vol. 187, no. 9 (Nov 2007), p. 515-518
- Full Text:
- Reviewed:
- Description: Objective: To analyse changes in the incidence of injuries requiring hospitalisation for child passengers in motor vehicle crashes. Design, setting and participants: Population-based study of children (aged 0-15 years) residing in New South Wales and admitted to hospital for injuries resulting from a traffic crash in the period 1 July 1998 - 30 June 2005, identified from the NSW Inpatient Statistics Collection. Main outcome measures: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, severity of injuries, and injury sites and types. Results: 2297 children were hospitalised for injuries sustained in a motor vehicle crash over the study period. The overall hospitalisation rate for injuries was relatively constant, with a non-significant decline of -0.4% (95% Cl, -3.1% to 2.3%). The rate of hospitalisation for serious injuries also declined non-significantly (-5.5% [95% Cl, -11.8% to 1.1%]). Only hospitalisation rates for traumatic brain injuries declined significantly (-11.1% [95% Cl, -19.0% to -2.8%]) over the study period. Conclusion: The rate of hospitalisation for injuries to NSW-resident child motor vehicle passengers due to traffic crashes has not significantly decreased. High hospitalisation rates and the subsequent burden to the community and public health system make further injury prevention efforts for child motor vehicle passengers a priority.
- Description: C1
- Description: 2003005874
- Authors: Du, Wei , Finch, Caroline , Hayen, Andrew , Hatfield, Julie
- Date: 2007
- Type: Text , Journal article
- Relation: Medical Journal of Australia Vol. 187, no. 9 (Nov 2007), p. 515-518
- Full Text:
- Reviewed:
- Description: Objective: To analyse changes in the incidence of injuries requiring hospitalisation for child passengers in motor vehicle crashes. Design, setting and participants: Population-based study of children (aged 0-15 years) residing in New South Wales and admitted to hospital for injuries resulting from a traffic crash in the period 1 July 1998 - 30 June 2005, identified from the NSW Inpatient Statistics Collection. Main outcome measures: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, severity of injuries, and injury sites and types. Results: 2297 children were hospitalised for injuries sustained in a motor vehicle crash over the study period. The overall hospitalisation rate for injuries was relatively constant, with a non-significant decline of -0.4% (95% Cl, -3.1% to 2.3%). The rate of hospitalisation for serious injuries also declined non-significantly (-5.5% [95% Cl, -11.8% to 1.1%]). Only hospitalisation rates for traumatic brain injuries declined significantly (-11.1% [95% Cl, -19.0% to -2.8%]) over the study period. Conclusion: The rate of hospitalisation for injuries to NSW-resident child motor vehicle passengers due to traffic crashes has not significantly decreased. High hospitalisation rates and the subsequent burden to the community and public health system make further injury prevention efforts for child motor vehicle passengers a priority.
- Description: C1
- Description: 2003005874
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