407 - Understanding Suboptimal Child Passenger Safety Practices in Crashes with Fatalities: Child, Neighborhood, and Policy Factors

Publication Number: 407.6564

Arthi Kozhumam, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Mech Frazier, Northwestern University The Feinberg School of Medicine, Evanston, IL, United States; Mario M.. Landa, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Michelle Macy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Motor vehicle collisions (MVCs) are a leading cause of injury death in childhood. Despite strong evidence of the safety benefits of child restraint systems (CRS), age and size-based guidelines from the American Academy of Pediatrics (AAP), and state laws for CRS use, suboptimal CRS use remains a common and persistent problem.

Objective: To identify child, neighborhood, and policy characteristics that are associated with suboptimal restraint use and seating location among child passengers < 11 years old (yo) in MVCs with a fatality.

Design/Methods: Cross sectional study of county-level age-appropriate CRS use among children < 11yo with a known restraint and seating location status from the National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS), 2010-2021. Age-appropriate restraint use was based on AAP guidelines (Table 1). Outcome: suboptimal child passenger safety practices (restraint use and seating location). Predictors: Child Opportunity Index (COI) of crash county, child age group, previous violations of driver, vehicle occupancy, maximum CRS and seatbelt fines for first offense, and state accordance with AAP guidance. Race is presented in descriptive analysis as it was previously associated with fatal crash outcomes. County-level crash hotspots were calculated using the Getis-Ord-Gi* statistic weighted by population of children < 11yo. Descriptive statistics and odds ratios were calculated.

Results: Of 47,992 total MVCs with child passengers in FARS: 17,213 (35.9%) had children < 11yo with a known restraint and seating position (6143 (35.7%) in a CRS, 7641 (44.4%) in a belt), and 3429 (19.9%) unrestrained, with 2144 (12.4%) sitting in the front seat. 5681 (45.9%) children in a CRS or seatbelt were suboptimally restrained. 14.3% of children who were unrestrained were in the front seat of a vehicle. Among 3454 fatally injured children, 2160 (62.5%) were restrained in a CRS or belt (1203 (55.7%) suboptimally), 1294 (37.5%) were unrestrained, and 568 (16.17%) were in the front seat. Racial and ethnic disparities in appropriateness widened with increasing age (Table 1). Suboptimal use was highest for fatalities and for children aged 5-7, varying across county (Figure 1). Child age (5-7) and vehicle over passenger capacity were the strongest predictors of suboptimal use (Table 2).

Conclusion(s): Further work is needed to characterize identified hotspots of suboptimally restrained children in fatal crashes. These may represent opportunities for geographically targeted environmental, policy, and educational interventions to promote child passenger safety.

Restraint appropriateness for children involved in crashes with a fatality
*Note: Race and ethnicity is only available for fatally injured passengers, therefore n, %, and totals that include race and ethnicity apply only to fatalities. Green highlight represents restraint considered appropriate for that age group.

Factors associated with suboptimal child passenger safety behaviors for children in crashes with a fatality
*Note: Based on standard vehicle type seat configurations we determined vehicles under, at or over seating capacity (e.g., a sedan has 5 seats and was under capacity if there were 4 or fewer occupants).

Crash hotspots in relation to suboptimal child passenger safety behaviors


Restraint appropriateness for children involved in crashes with a fatality
*Note: Race and ethnicity is only available for fatally injured passengers, therefore n, %, and totals that include race and ethnicity apply only to fatalities. Green highlight represents restraint considered appropriate for that age group.

Factors associated with suboptimal child passenger safety behaviors for children in crashes with a fatality
*Note: Based on standard vehicle type seat configurations we determined vehicles under, at or over seating capacity (e.g., a sedan has 5 seats and was under capacity if there were 4 or fewer occupants).

Crash hotspots in relation to suboptimal child passenger safety behaviors