The Impact of Legislation on Child Booster Seat Use in Manitoba

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1 The Impact of Legislation on Child Booster Seat Use in Manitoba Development and Evaluation of a Policy Framework to Analyze the Impacts of Injury Prevention Legislation Lynne Warda 1,2, Caroline Piotrowski 1, Curt Pankratz 3, Tiffany Wengel 1, Janelle Curtis 4 1 University of Manitoba, 2 Winnipeg Regional Health Authority Injury Prevention Program, 3 University of Winnipeg, 4 Manitoba Healthy Living and Seniors

2 Background In June 2012, Bill 8 amended the Highway Traffic Act and mandated the use of booster seats for children under age 9, 80 pounds, or 4ft 9 in Booster seat use: 14.7% in % in 2012 New law: Aug 8,

3 Theoretical Framework Issue: broad range of intended and unintended impacts of IP legislation Injury prevention: pyramid, policy indicators Health policy: variety of specific impact assessment methods and tools Health equity: different methods and tools Can these be combined? How? 3

4 Research Questions Will the new legislation increase booster seat use and reduce injuries associated with premature graduation to seat belts? Will disparities in parental knowledge, booster seat use, and injuries increase or decrease? What other impacts will children/families, organizations, and government experience? 4

5 Objectives To develop a framework to summarize the impacts of injury prevention legislation, incorporating criteria that reflect: the traditional hierarchy of injury outcomes principles of health policy impact assessment principles of health equity impact assessment To apply the framework to booster seat legislation in Manitoba 5

6 Methods Framework search (injury, policy, equity) Literature search Environmental scan Review of published and grey literature Baseline data collection (pre-legislation) Booster seat use observations Injuries (deaths, hospitalizations, correct use) Cost (lowest price, urban/rural) Access 6

7 Observations 27 traffic intersections throughout Winnipeg (2 sites in each of WRHA s 12 Community Areas and three busy shopping centers) Chosen based on proximity to schools, traffic volume, presence of a traffic light or stop sign Transport Canada s method for periodic child restraint surveillance Pairs of trained and experienced observers 7

8 Results - Frameworks Injury prevention (1) Pyramid/Traditional approach Familiar, intuitive Health policy and health equity (1) National Collaborating Centre for Health Policy Morestin F, Gauvin FP, Hogue MC, & Benoit F. (2010). Method for Synthesizing Knowledge about Public Policies. Montreal: National Collaborating Centre for Healthy Public Policy. Simpson S, Mahoney M, Harris E, Aldrich R, Stewart-Williams J: Equity-Focused Health Impact Assessment: A tool to assist policy makers in addressing health inequalities. Environmental Impact Assessment Review 2005, 25:

9 Injury outcome (A) Actual injuries 1. Fatal injury 2. Hospitalized injury 3. Emergency department treated injury 4. Any medically treated injury (B) Surrogate indicators associated with injuries 1. Observed behavior 2. Environmental changes 3. Policy changes 4. Self reported behavior 5. Knowledge, attitude, and beliefs Source: Dannenberg AL, Fowler CJ. Evaluation of interventions to prevent injuries: an overview. Injury Prevention Jun;4(2):

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12 Results Booster Seat Use 14.7% (2010), 20.8% (2011), 31.4% (2012) 12

13 Results - Injury Deaths (Manitoba, 8 year average): 3.5/year Hospitalization Major trauma, 4 year average: 7/year Manitoba, 10 year average: 38/year Injury Collisions (MPI, 5 year average): 26/year Proportion of children injured who were properly restrained? Number of cases of disabling seatbelt injury 13

14 Results - Cost Lowest price of a no-back booster seat Online retailers (total price including shipping for Winnipeg and 3 rural/remote addresses) Sears, CdnTire, Wal-Mart, Toys R Us,Target First week of every month + sales flyers Average price pre-legislation at 4 major retailers 3 months pre-legislation was $22.38 (range $ ) 14

15 Results - Access Low cost programs: none Free booster seats: WRHA, 50/year Loan program: developed as a result of the new law 15

16 Conclusions This work has allowed us to: Develop a greater understanding of health equity impact assessment and apply to new IP legislation Document the full range of the impacts of the new law on individuals, organizations and government Identify and address disparities and barriers early Future work: Complete the post-legislation analyses Apply to bicycle helmet legislation and other laws 16

17 Thank you! Questions? 17

Traffic Safety Facts. Children. 2003 Data. Motor vehicle crashes are the leading cause of death for children from 2 to 14 years old.

Traffic Safety Facts. Children. 2003 Data. Motor vehicle crashes are the leading cause of death for children from 2 to 14 years old. Traffic Safety Facts 2003 Data DOT HS 809 762 Children Motor vehicle crashes are the leading cause of death for children from 2 to 14 years old. In 2003, there were more than 60 million children under