The effects of a mandatory child restraint law on injuries requiring hospitalization

Effects of changes in earned income tax credit: Time-series analyses of Washington DC

Poverty has numerous deleterious effects on health, and the Earned Income Tax Credit (EITC) is the major policy tool used to alleviate poverty in the U.S. We evaluate effects of four distinct changes in earned income tax credit law in Washington, DC on maternal behaviors and infant outcomes. An interrupted time-series design was used with 312 monthly measures from 1990 through 2015 analyzed in 2018 (total n = 225,933 births). States with no EITC were included as the comparison group; analyses involved ARIMA modeling. Outcomes were derived from birth certificates, and included percent of live births below 2500 g, mean birth weight, mean gestation weeks, first trimester prenatal care, and maternal smoking during pregnancy. We found a pattern of significant improvements across all three infant outcome measures, with the size of the effect estimate monotonically matching the magnitude of the tax credit—ranging from a 1.9 (-2.9, -0.9) reduction in rate per 100 births of low birth weight for the smaller 10% credit, to a 4.7 (-5.4, -4.0) reduction with the 40% credit. Results for maternal smoking and prenatal care were mixed. Results suggest that earned income tax credit policies improve birth outcomes; mechanisms for this effect deserve further study.

Car restraints and seating position for prevention of motor vehicle injuries in Greece

The protective effect of child restraint and the relative safety of front and rear seating in a population where children often travel unrestrained was assessed in a population based case-control study. The cases were all 129 children aged 0-11 years injured as car passengers in a motor vehicle accident who contacted, during 1996, one of the two major children's hospitals in Athens; emergency cases are accepted by the two hospitals on alternate days throughout the year, thus generating a random sample of children injured as car passengers. The prevalence of the studied exposures in the study base was estimated from an inspection survey comprising a random sample of 191 children of the same age who travelled in passenger cars. The survey was conducted by medical staff from our centre in collaboration with the road traffic police. Odds ratios (ORs) were calculated after adjustment for confounding factors through the Mantel-Haenszel procedure. The OR for injury was 3.3 among unrestrained children compared with restrained children (comparison essentially limited to children aged 0-4 years) and 5.0 for children seated in the front compared with those seated in the rear (comparison essentially limited among unrestrained children). Protective effect estimates derived from this analytical study suggest that in Greece about two thirds of all childhood injuries from car crashes could have been avoided through the regular use of a proper child restraint. The data also indicate that, in the absence of a child restraint system, a rear seating position conveys substantial protection and could explain the low mortality of children as car passengers in Greece, a country which is characterised by a high overall road traffic mortality as well as a high childhood accident mortality.

Effects of North Carolina's mandatory safety belt law on children

OBJECTIVES

To assess the effect of the North Carolina law mandating that all front seat passengers use a safety belt on children 4 through 15 years of age.

METHODS

North Carolina collision reports, completed by local police or the state highway patrol for crashes with greater than $500 worth of damage, were analyzed using time series analysis on the monthly percentage of deaths and serious injuries between January of 1980 and February of 1994.

RESULTS

Following the 1985 implementation of the law, children 4 to 15 years of age experienced a 42% decline in deaths and serious injuries.

CONCLUSIONS

The mandatory safety belt law in North Carolina has been associated with a decline in deaths and serious injuries. Additional research in needed to assess the seat belt behaviors of this age group as well as the specific effects of seat belt use using outcome measures more precise than those available in police crash reports.

Promoting law enforcement for child protection: a community analysis

The Colorado Occupant Protection Project (COPP) intervention provided police with brief instruction concerning the importance of citations for drivers' failure to use child safety seats and special coupons to accompany citations. Coupons were exchangeable by drivers for a safety seat and brief training in its use, plus a waiver of the $50 citation fine. Over 4.5 years of archival records were employed, using an ABA design and a comparison community to evaluate the program. Few tickets were issued for nonuse of safety seats during the 3-year baseline in either community. Citations for nonuse of safety seats increased to over 50 per month during the intervention period at the test site, whereas rates remained essentially zero at the comparison site. After the COPP intervention was removed at the intervention site, citation rates for nonuse of safety seats decreased to about 15 per month. Differences between intervention conditions and settings were statistically significant. During the intervention, officers were 44 times more likely to write citations than were controls. Results suggested that a behavioral program can increase police citation writing for child protection purposes.