Safety Of Child Passengers In Motor Vehicles PDF Download

Motor vehicle crash (MVC) related injuries remain the leading cause of death among children in the US. Age and size appropriate child restraint systems reduce the risk of MVC-related injuries. The American Academy of Pediatrics recommends that children who outgrow harness-based car seats should continue to use booster seats until they reach 57 inches tall. Many countries and US states have enacted legislation to promote the use of child restraint systems. However, the premature transition from using booster seats to seat belts is a public health hazard to children. The overarching goal of this dissertation was to examine the motor vehicle safety of child passengers by investigating the premature transition from booster seats to seat belts. The findings could be used to promote the appropriate use of child restraint systems and improve child passenger safety. The first aim of this dissertation (Chapter 3) was to compare the effectiveness of booster seats versus seat belts in protecting children aged 4 to 8 involved in MVCs. This chapter utilized data from Ohio Crash Outcome Data Evaluation System (CODES) from 2013 to 2016. By using propensity score methods with robust Poisson regression analysis, we found that children with booster seats had an 11% lower risk for overall MVC-related injuries, an 18% lower risk for moderate to severe injury, and a 59% lower risk for sustaining abdominal injury compared to those with seat belts alone. The second aim (Chapter 4) was to evaluate the impact of Ohio’s booster seat law on child restraint use and MVC-related injuries. We included 18 years (2000-2017) of Ohio police accident report data and utilized an interrupted time series analysis with the generalized least-squares method. Our results indicated that Ohio’s booster seat law was associated with an 18% increase in the proportion of age appropriate restraint use among children aged 4-7 years involved in MVCs, with this increase in usage occurring immediately after implementing the Ohio booster seat law and sustaining over several years. We also observed a negative association between the law and MVC-related injuries, though the statistical association was not reached at the significance level of 0.05. The third aim (Chapter 5) was to explore factors that influence parents' decision-making on their children’s transition from booster seats to seat belts. We conducted 20 semi-structured interviews virtually with parents whose first child made the transition within the last year. We audio-recorded and transcribed all the interviews. This study identified three child-related themes and five parent-related themes associated with parents’ decision-making on transitioning from booster seats to seat belts. We also found that the internet was the most common information source when parents sought child passenger safety knowledge. The majority of participants were aware of the Ohio booster seat law and used the law as a guideline, but misunderstanding and misinterpretation existed regarding age and height requirements. This dissertation demonstrates that using booster seats could reduce injuries among children aged 4-8 involved in MVCs. Children who prematurely transition to seat belts have a higher risk of MVC-related injuries. Ohio’s statewide booster seat law was effective in promoting the age appropriate restraint use of children at booster seat age, even though the law was secondary enforcement. This dissertation also highlighted the importance of redesigning educational materials to improve parents/caregivers’ knowledge and practice regarding correctly transitioning their children from booster seats to seat belts.