Child passengers killed in reckless and alcohol-related motor vehicle crashes

Key factors associated with parents' illegal engagement with their smartphones while driving their children

This study aimed to examine the key factors associated with parents' and caregivers' illegal engagement with their smartphones while driving with their children aged 10 years and younger. Five hundred and ten participants completed an online survey (M = 40.4 years, SD = 6.9, Range = 20.0-69.0 years; Female: 79.2%). Most participants reported that they 'never' accessed social media, talked or composed a text on their smartphone (while handheld) while driving with their children (88.0%, 85.3%, and 80.0%, respectively). However, it was interesting to note that more than one-quarter of the sample reported that they had read a text message or used an app on their handheld smartphone while driving their children (36.3%, and 28.6%, respectively). The results of a logistic regression model showed that participants': age, severity of nomophobia (the fear of being without a mobile phone), and self-reported engagement in other risky driving behaviours (i.e., errors, violations) were significantly associated with illegal engagement with their smartphone while driving their child aged 10 years and younger. With the growing prevalence of mobile phone use and the impact of distraction due to child occupants, it is important to consider the compounded effect of these factors on driver performance, as well as the influence of driver risk-taking behaviour while engaging with smartphones and the consequences of this on children who observe this behaviour.

The prevalence and excess mortality risk of driving with children

INTRODUCTION

The presence of passengers can affect the driving behavior of motor-vehicle operators. Child passengers present unique motivations to drive more safely, as well as opportunities to distract drivers. Because motor-vehicle crashes are an important cause of premature childhood mortality, this study assesses whether adult drivers with child passengers are more or less likely to cause a fatal crash.

METHOD

Data include fatal crashes involving one or two vehicles from 2007 to 2017 in the U.S. Fatality Analysis Reporting System. We apply methods developed by Levitt and Porter (2001) and Dunn and Tefft (2020) -the LPDT approach- to estimate the risk that adult drivers (21 years or older) with at least one child passenger (15 year or younger) cause a fatal crash relative to adults without child passengers.

RESULTS

Childhood crash exposure when traveling with an adult driver is low: 0.78% of vehicle miles traveled by adults included a child passenger. Nevertheless, adult drivers with child passengers were significantly more likely to cause a fatal crash than adult drivers without child passengers. The estimated risk of causing a single-vehicle crash was 6.2 times higher among the full sample of adults, 7.2 times higher among female drivers, and 5.0 times higher among drivers 25-44 years old.

CONCLUSIONS

Despite their relatively low crash exposure, child passengers are associated with much greater risk of causing a fatal crash.

PRACTICAL APPLICATIONS

This study not only informs about the need to develop interventions to remind parents and adult drivers of the risks associated with driving children, but also reminds researchers about the enormous potential of the LPDT approach when applied to traffic safety issues.

Factors Affecting Child Injury Risk in Motor-Vehicle Crashes

Current recommendations for restraining child occupants are based on biomechanical testing and data from national and international field studies primarily conducted prior to 2011. We hypothesized that analysis to identify factors associated with pediatric injury in motor-vehicle crashes using a national database of more recent police-reported crashes in the United States involving children under age 13 where type of child restraint system (CRS) is recorded would support previous recommendations. Weighted data were extracted from the National Automotive Sampling System General Estimates System (NASS-GES) for crash years 2010 to 2015. Injury outcomes were grouped as CO (possible and no injury) or KAB (killed, incapacitating injury, nonincapacitating injury). Restraint was characterized as optimal, suboptimal, or unrestrained based on current best practice recommendations. Analysis used survey methods to identify factors associated with injury. Factors with significant effect on pediatric injury risk include restraint type, child age, driver injury, driver alcohol use, seating position, and crash direction. Compared to children using optimal restraint, unrestrained children have 4.9 (13-year-old) to 5.6 (< 1-year-old) times higher odds of injury, while suboptimally restrained children have 1.1 (13-year-old) to 1.9 (< 1-year-old) times higher odds of injury. As indicated by the differences in odds ratios, effects of restraint type attenuate with age. Results support current best practice recommendations to use each stage of child restraint (rear-facing CRS, forward-facing harnessed CRS, belt-positioning booster seat, lap and shoulder belt) as long as possible before switching to the next step.

Drivers with child passengers: distracted but cautious?

OBJECTIVE

A remarkable portion of children's traffic-related deaths occurred when travelling in as passengers in vehicles, but so far, few studies have focused on crash characteristics and crash risks of drivers with child passengers. It has been assumed that drivers with child passengers drive responsibly, but on the contrary, children in vehicles can distract drivers, increasing crash risks. In this study, we examined fatal crash characteristics and fatal crash risks of drivers with child passengers.

METHODS

Fatal crash data from the U.S. Fatality Analysis Reporting System (FARS) for 1996-2015 were used. Only passenger-vehicle drivers aged 23-46 years old were included in the analysis because they represent the typical age of drivers with 0-9-year-old child passengers in the database. Prevalence of crash characteristics and the odds of being at fault were examined for drivers with only child passengers and compared to drivers with only adult passengers, with no passengers and with both adult and child passengers. Analyses were done separately for intersection crashes and non-junction crashes.

RESULTS

Female drivers were involved in twice as many fatal crashes alone with child passengers compared to male drivers. Drivers with only child passengers were more often reported as being inattentive, but for them, risk-taking behaviours were less typical than for drivers without child passengers. Our results showed that these differences were more evident in non-junction crashes than in intersection crashes. When risk-taking behaviours were controlled, both male and female drivers with only child passengers had higher odds of being at fault than drivers with adult passengers (with or without children) in non-junction crashes, but these differences were not significant in intersection crashes.

CONCLUSIONS

Drivers with child passengers represent a specific driver population. They have a higher tendency to engage in distractions while driving, but they have fewer risk-taking behaviour-related fatal crashes compared to drivers with no child passengers. Our results indicate that the effects of child-passenger-related distractions on fatal crash risks are more relevant outside intersections, presumably because drivers may try to self-regulate their interactions with child passengers and focus on driving in more demanding traffic situations.

Young females at risk while driving with a small child

INTRODUCTION

Previous research suggests that young mothers with little driving experience are at risk when driving with a small child passenger. In this study we examined the prevalence, characteristics and risk of fatal motor vehicle crashes involving an infant passenger under the age of one among female drivers of different ages.

METHODS

We used crash data from the US Fatality Analysis Reporting System for 1994-2013. The prevalence of fatal crashes involving infants was examined by age of female drivers and compared to the number of births among mothers of a similar age. The essential characteristics of the crashes were described, and the odds of being at fault were determined for young (16-24-year-olds) and older female drivers (25-39-year-olds) with an infant passenger or with no passengers.

RESULTS

The prevalence of fatal crashes involving infant passengers was higher among young female drivers in relation to the number of births among mothers of a similar age than among older females. Young female drivers with an infant passenger were more often at fault than older drivers (aOR=1.83, 95%, CI=1.52, 2.20). Their vehicles were older and smaller and they used proper safety seats for infants less often than the older drivers. In addition, young female drivers with an infant passenger but with no adult passenger in the vehicle were more often at fault than young female drivers with no passengers (aOR=1.27, 95% CI=1.06, 1.51). Both young and older female drivers' crashes involving an infant passenger typically occurred in ordinary driving conditions, but these drivers with infant passengers were more often reported as having fallen asleep or inattentive than those with no passengers. The presence of an adult passenger in addition to an infant passenger lowered female drivers' odds of being at fault, regardless of the driver's age.

CONCLUSIONS

Young females driving with an infant passenger, probably most often mothers, are at an elevated risk of a fatal crash, especially when they drive alone with an infant. The protective effect of an adult passenger suggests that another adult in the vehicle can assist the driver by taking care of the infant and enabling the driver to focus on driving.

Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis

OBJECTIVE

To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality.

STUDY DESIGN

Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers <15 years of age involved in fatal MVCs, defined as crashes on US public roads with ≥1 death (adult or pediatric) within 30 days. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100 000 children and percentage of children who died of those in fatal MVCs. Unit of analysis was US state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome.

RESULTS

Of 18 116 children in fatal MVCs, 15.9% died. The age-adjusted, MVC-related mortality rate per 100 000 children varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate of 0.94). Predictors of greater age-adjusted, MVC-related mortality rate per 100 000 children included greater percentage of children who were unrestrained or inappropriately restrained (P < .001) and greater percentage of crashes on rural roads (P = .016). Additionally, greater percentages of children died in states without red light camera legislation (P < .001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1100 pediatric deaths averted over 5 years.

CONCLUSIONS

MVC-related pediatric mortality varied by state and was associated with restraint nonuse or misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality.

An Examination of the Effectiveness of Child Endangerment Laws in Preventing Child Fatalities in Alcohol-Involved Motor Vehicle Crashes

OBJECTIVE

The aim of this study was to assess the impact of U.S. child-endangerment laws on the prevalence of child passengers fatally injured in motor vehicle crashes in which the adult driver was drinking.

METHOD

We used data from the 2002-2012 Fatality Analysis Reporting System. We conducted both bivariate and multivariate analyses using Heckman selection models.

RESULTS

After adjusting for several cofactors, including driver demographics and blood alcohol concentration, child seat positioning, and seat belt laws, we found that passing a DUI child-endangerment law may have no impact at all on the likelihood of finding impaired drivers among those driving with children.

CONCLUSIONS

There are a number of reasons why DUI child-endangerment laws have not been effective in saving the lives of young passengers who are driven by adult drinking drivers. These reasons include lack of publicity and education, as well as issues related to enforcement. Potential solutions are suggested that include examining sanctions and strengthening of DUI child endangerment laws.

Child passengers injured in motor vehicle crashes

INTRODUCTION

During 2010, 171,000 children aged 0-14 were injured in motor vehicle crashes. Despite the severity of the problem, research has been limited, and most of what we know about these children emanates from fatal crash databases.

METHOD

Using information from the General Estimates System, this effort examines the occurrence of non-fatal crashes among children aged 0-14 over the last decade.

RESULTS

We found that about 1% of the non-injured children in the file had been driven by a driver who was positive for alcohol. This percentage climbed to about 2% among children who had suffered injuries. Compared with the proportion of alcohol-positive drivers at the time of the crash, the proportion of drivers who sped or failed to obey a traffic signal was significantly higher.

PRACTICAL APPLICATIONS

The finding that drinking and driving with children did not decrease over time questions the adequacy of the extant child endangerment laws.

Transporting Young Passengers While Impaired: The State of the Law

OBJECTIVE

This study sought to expand public health knowledge about the legal and policy aspects of DUI-child endangerment laws, and analyze the extent to which jurisdictions give priority to the protection of children.

METHODS

We performed original legal research to locate and code driving-under-the-influence (DUI)-child endangerment laws across the 50 states and the District of Columbia, enabling us to compile a baseline legal dataset.

RESULTS

Only 42 of the 51 jurisdictions address DUI-child endangerment in their statutes. Of the jurisdictions that do, the most comprehensive policies and those most protective of the safety of child passengers are not available in many jurisdictions. However, we found no significant relationship between the strength (comprehensiveness) of DUI-child endangerment laws and the proportion of child fatalities by a driver with a BAC ≥.08.

CONCLUSIONS

Additional work needs to be done to improve state laws on DUI-child endangerment. The 9 jurisdictions that do not directly address this public health harm can enact laws to do so, and the 42 jurisdictions that already have laws can enhance their approaches to prioritize the protection of children. We suggest that future research include a close examination of the impact of DUI-child endangerment laws.