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Urrechaga EM, Cioci AC, Allen MK, Saberi RA, Gilna GP, Turpin AG, Perez EA, Ford HR, Sola JE, Thorson CM. Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions. J Surg Res 2022; 273:57-63. [PMID: 35030430 DOI: 10.1016/j.jss.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community. METHODS We retrospectively queried a level 1 trauma registry for pediatric (0-18 y) MVC patients from October 2013 to December 2018. Demographic and clinical variables were recorded. Data regarding appropriate restraint use by age group were examined. RESULTS Four hundred thirty-four cases of pediatric MVC were identified. Overall, 53% were improperly restrained or unrestrained. Sixty-two percent of car seat age and 51% of booster age children were improperly restrained or unrestrained altogether. Fifty-nine percent of back seat riding, seatbelt age were improperly restrained/unrestrained, with 26% riding in the front. Fifty-one percent of seatbelt-only adolescents were not belted. Black, non-Hispanic children were more often improperly restrained/unrestrained compared to Hispanics (63% versus 48%, P = 0.001). Improperly restrained/unrestrained children had higher injury severity (10% versus 4% Injury Severity Score > 25, P = 0.021), require operative/interventional radiology (33% versus 19%, P = 0.001), and be discharged to rehabilitation or skilled nursing facility (5.2% versus 1.5%, P = 0.033). Mortality in adolescents was higher among those unrestrained (5.2% versus 0.8%, P = 0.034). CONCLUSIONS Although efforts to improve adherence to restraint regulations have greatly increased in the last decade, more than half of children in MVC are still improperly restrained. Injury prevention services and community outreach is essential to educate the most vulnerable populations, especially those with infants and toddlers, on adequate motor vehicle safety measures in our community.
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Affiliation(s)
- Eva M Urrechaga
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Alessia C Cioci
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Megan K Allen
- University of Miami Miller School of Medicine, Miami, Florida
| | - Rebecca A Saberi
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Gareth P Gilna
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexa G Turpin
- University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Henri R Ford
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Chad M Thorson
- Dewitt-Daughtry Family Department of Surgery. Divisions of Pediatric Surgery & Trauma and Acute Care Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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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.
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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
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Sartin EB, Long DL, McDonald CC, Stavrinos D, Clay OJ, Mirman JH. Evaluating disparities in child occupant protection using a proportion-eliminated approach to mediation. TRAFFIC INJURY PREVENTION 2021; 22:252-255. [PMID: 33688773 DOI: 10.1080/15389588.2021.1885652] [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: 07/05/2020] [Revised: 12/16/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE While there are clear racial/ethnic disparities in child restraint system (CRS) use, to date no studies have identified mediators that quantitatively explain the relationship between race and CRS use. Therefore, the objective of this study was to provide an example of how a proportion-eliminated approach to mediation may be particularly useful in understanding the complex relationship between race and CRS use. METHODS Sixty-two mothers with a child between 4-8 years old completed a survey and had their CRS use assessed by a Child Passenger Safety Technician using a structured assessment based on the 2018 American Academy of Pediatrics' Best Practice guidelines. Recruitment and data collection occurred in Birmingham, Alabama between June 2018 and January 2019. We used chi-squared tests, logistic regressions, and a proportion-eliminated approach to mediation to compare our variables of interest and to estimate the amount of the association between racial group membership and errors in restraint use that may be explained by sociodemographic, psychosocial, and parenting variables. RESULTS Before mediation, Nonwhite mothers in this sample had a 7.38 greater odds of having an error in CRS use than White mothers. Mediation analyses indicated that being married and self-reported seatbelt use explained 47% and 35% of the effect of race on CRS use errors, respectively. CONCLUSION A proportion-eliminated approach to mediation may be particularly useful in child passenger safety research aiming to inform the development of interventions tailored for racial minority populations.
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Affiliation(s)
- Emma B Sartin
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Despina Stavrinos
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica H Mirman
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Gielen AC, Bishai DM, Omaki E, Shields WC, McDonald EM, Rizzutti NC, Case J, Stevens MW, Aitken ME. Results of an RCT in Two Pediatric Emergency Departments to Evaluate the Efficacy of an m-Health Educational App on Car Seat Use. Am J Prev Med 2018; 54:746-755. [PMID: 29656914 DOI: 10.1016/j.amepre.2018.01.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting. STUDY DESIGN This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted. SETTING/PARTICIPANTS Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area. INTERVENTION A theory-based, stage-tailored educational program, Safety in Seconds v2.0TM, delivered on a mobile app. MAIN OUTCOME MEASURES Four car seat behaviors: (1) having the correct restraint for the child's age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child's restraint inspected by a child passenger safety technician. RESULTS At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p<0.01) for using the correct car seat; 2.37 (p<0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p<0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p<0.01) and having the car seat inspected (OR=1.73, p<0.01). CONCLUSIONS Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education. TRIAL REGISTRATION Clinical Trial Registration # NCT02345941.
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Affiliation(s)
- Andrea C Gielen
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - David M Bishai
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elise Omaki
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Wendy C Shields
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eileen M McDonald
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicholas C Rizzutti
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James Case
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Molly W Stevens
- Pediatric Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mary E Aitken
- General Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas
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Sung KM, Kim SC, Jeon HJ, Kwak YS, Youn YH, Lee KH, Park JC, Choi JH. Injury Analysis of Child Passenger According to the Types of Safety Restraint Systems in Motor Vehicle Crashes. JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.3.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kang Min Sung
- Department of Emergency Medicine, Konkuk University School of Medicine, Konkuk University Hospital, Seoul, Republic of Korea
| | - Sang Chul Kim
- Department of Emergency Medicine, Konkuk University School of Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Hyuk Jin Jeon
- Department of Emergency Medicine, Konkuk University School of Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Yeong Soo Kwak
- Department of Emergency Medicine, Konkuk University School of Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Young Han Youn
- Department of Mechatronics, Korea University of Technology & Education, Cheonan, Republic of Korea
| | - Kang Hyun Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jong Chan Park
- Traffic Accident Analysis Division, National Forensic Service, Wonju, Republic of Korea
| | - Ji Hun Choi
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Adopting child restraint laws to address child passenger injuries: Experience from high income countries and new initiatives in low and middle income countries. Injury 2015; 46:933-4. [PMID: 26003092 DOI: 10.1016/j.injury.2015.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Klinich KD, Manary MA, Flannagan CAC, Ebert SM, Malik LA, Green PA, Reed MP. Effects of child restraint system features on installation errors. APPLIED ERGONOMICS 2014; 45:270-277. [PMID: 23731627 DOI: 10.1016/j.apergo.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 02/06/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
This study examined how child restraint system (CRS) features contribute to CRS installation errors. Sixteen convertible CRS, selected to include a wide range of features, were used in volunteer testing with 32 subjects. Subjects were recruited based on their education level (high or low) and experience with installing CRS (none or experienced). Each subject was asked to perform four child restraint installations in the right-rear passenger seat of a 2006 Pontiac G6 sedan using a crash dummy as a child surrogate. Each subject installed two CRS forward-facing (FF), one with LATCH and one with the vehicle seatbelt, and two CRS rear-facing (RF), one with LATCH and one with the seatbelt. After each installation, the experimenter evaluated 42 factors for each installation, such as choice of belt routing path, tightness of installation, and harness snugness. Analyses used linear mixed models to identify CRS installation outcomes associated with CRS features. LATCH connector type, LATCH strap adjustor type, and the presence of belt lockoffs were associated with the tightness of the CRS installation. The type of harness shoulder height adjuster was associated with the rate of achieving a snug harness. Correct tether use was associated with the tether storage method. In general, subject assessments of the ease-of-use of CRS features were not highly correlated with the quality of their installation, suggesting a need for feedback with incorrect installations. The data from this study provide quantitative assessments of some CRS features that were associated with reductions in CRS installation errors. These results provide child restraint designers with design guidelines for developing easier-to-use products. Research on providing effective feedback during the child restraint installation process is recommended.
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Affiliation(s)
- Kathleen D Klinich
- University of Michigan Transportation Research Institute, Ann Arbor, MI 48109, USA.
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Brown J, Keay L, Hunter K, Bilston LE, Simpson JM, Ivers R. Increase in best practice child car restraint use for children aged 2-5 years in low socioeconomic areas after introduction of mandatory child restraint laws. Aust N Z J Public Health 2013; 37:272-7. [DOI: 10.1111/1753-6405.12070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Keay L, Hunter K, Brown J, Simpson JM, Bilston LE, Elliott M, Stevenson M, Ivers RQ. Evaluation of an education, restraint distribution, and fitting program to promote correct use of age-appropriate child restraints for children aged 3 to 5 years: a cluster randomized trial. Am J Public Health 2012; 102:e96-102. [PMID: 23078492 DOI: 10.2105/ajph.2012.301030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated an education, distribution, and fitting program for increasing age-appropriate and correct child restraint use. METHODS We performed a cluster randomized trial involving 28 early childhood education centers in low socioeconomic status areas in Sydney, Australia. The main outcome was optimal restraint use defined as age-appropriate restraints, installed into the vehicle correctly and used correctly. RESULTS One service withdrew after randomization, so data are presented for 689 child passengers, aged 3 to 5 years, from 27 centers. More children attending intervention centers were optimally restrained (43% vs 31%; P = .01; allowing for clustering). More 3-year-olds were using forward-facing seats rather than booster seats, more 4- to 5-year-olds were using booster seats instead of seat belts alone, and there were fewer errors in use at intervention centers. Among non-English-speaking families, more children attending intervention centers were optimally restrained (43% vs 17%; P = .002; allowing for clustering). CONCLUSIONS The program increased use of age-appropriate restraints and correct use of restraints, which translates to improved crash injury protection. Multifaceted education, seat distribution, and fitting enhanced legislation effects, and the effect size was larger in non-English-speaking families.
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Affiliation(s)
- Lisa Keay
- The George Institute for Global Health and the Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Child passenger safety practices in the U.S.: disparities in light of updated recommendations. Am J Prev Med 2012; 43:272-81. [PMID: 22898120 DOI: 10.1016/j.amepre.2012.05.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/08/2012] [Accepted: 05/29/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children are best protected in motor vehicle collisions when properly using the appropriate restraint and sitting in a rear row. Racial and ethnic disparities have been reported in injury statistics and use of any restraint; however, predictors of safety seat use, being unrestrained, and sitting in the front seat have not been explored previously. PURPOSE To determine factors associated with child passenger safety practices by race/ethnicity in a national sample of child passengers aged <13 years. METHODS Secondary analysis conducted in 2011 of the 2007, 2008, and 2009 National Survey of the Use of Booster Seats in which child passenger restraint use was observed directly. Age-stratified, survey-weighted chi-square and logistic regression analyses were conducted. RESULTS Restraint use was observed for 21,476 children aged <13 years. A decline in child safety seat use and increase in being unrestrained were observed with increasing child age. In multivariate analyses, race/ethnicity, unrestrained drivers, and sitting in the front seat were associated with lower odds of child safety seat use among children aged <8 years. Older child age was associated with sitting in the front seat and being unrestrained. The presence of multiple child passengers was associated with lower odds of sitting in the front but higher odds of being unrestrained. CONCLUSIONS Few children use the recommended child passenger restraints. Understanding the reasons for the suboptimal child passenger restraint practices identified in this study is essential for the development of effective programs to reduce or eliminate preventable motor vehicle collision-related injuries.
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Preventing motor vehicle crashes related spine injuries in children. World J Pediatr 2011; 7:311-7. [PMID: 22015724 DOI: 10.1007/s12519-011-0327-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 06/14/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) is a devastating event that results in permanent disability for injured children. Among all etiologies of SCI, motor vehicle crashes (MVCs) are the leading cause and account for 29% of all traumatic SCIs in children. We tried to evaluate types and mechanisms of MVC-related spinal column and spinal cord injuries, risk factors, safety issues and legislation. DATA SOURCES A literature review was performed using PubMed from 1966 to 12th April 2010 with the following key words: children OR pediatric, spine, injury OR trauma, restraint, seat belt, motor vehicle, road OR traffic, collision OR crash, safety. Cross referencing of discovered articles was also performed. RESULTS Risk factors for MVC-related SCI include single vehicle crashes, vehicle rollover, and ejection of the passenger from the vehicle. Any anatomic region of the spinal cord may be injured as a result of MVC and may vary according to the type of accident and restraint system usage. Increasing use of three-point seat belts, which are more protective than isolated lap seat belts, has decreased the incidence of MVC-related SCI. There is evidence that airbag use without seatbelt use is associated with an increased risk of cervical spine fractures with or without SCI. Vehicle designers need to give more attention to the prevention of vehicle rollover and to improve occupant protection when rollover occurs. CONCLUSIONS MVC is a common cause of SCI in children; therefore, paying attention to risk factors and modes of prevention is important. As MVC-related SCI can lead to permanent disability, prevention and education play an important role in decreasing childrens' morbidity and mortality. Making behavior, roads and vehicles safer can significantly reduce MVC-related SCI in children.
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Cunningham CE, Bruce BS, Snowdon AW, Chen Y, Kolga C, Piotrowski C, Warda L, Correale H, Clark E, Barwick M. Modeling improvements in booster seat use: a discrete choice conjoint experiment. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:1999-2009. [PMID: 21819828 DOI: 10.1016/j.aap.2011.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 03/30/2011] [Accepted: 05/17/2011] [Indexed: 05/31/2023]
Abstract
Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.
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Affiliation(s)
- Charles E Cunningham
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L9C 7N4, Canada.
| | - Beth S Bruce
- Faculty of Health Professions, Dalhousie University, Halifax, Canada
| | - Anne W Snowdon
- Odette School of Business, University of Windsor, Windsor, Canada
| | - Yvonne Chen
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L9C 7N4, Canada
| | | | - Caroline Piotrowski
- Department of Family Social Sciences, University of Manitoba, Winnipeg, Canada
| | - Lynne Warda
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Heather Correale
- School of Nursing, University of Northern British Columbia, British Columbia, Canada
| | - Erica Clark
- School of Nursing, University of Northern British Columbia, British Columbia, Canada
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