The characteristics of incorrect restraint use among children traveling in cars in New South Wales, Australia
- 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
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- 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.
Evidence to support changes to child restraint legislation
- Authors: Du, Wei , Finch, Caroline , Bilston, Lynne
- Date: 2008
- Type: Text , Journal article
- Relation: Medical Journal of Australia Vol. 189, no. 10 (2008), p. 598
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Association between different restraint use and rear-seated child passenger fatalities a matched cohort study
- 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
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- 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.
Population-level estimates of child restraint practices among children aged 0-12 years in NSW, Australia
- 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
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- 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
- 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
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- 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.