Effects of Booster Seat Laws on Injury Risk Among Children in Crashes

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1 Effects of Booster Seat Laws on Injury Risk Among Children in Crashes SAE Government / Industry Meeting Washington, DC January 26, 2012 Angela H. Eichelberger, Ph.D.

2 Co-authors Aline O. Chouinard Jessica S. Jermakian

3 Boosters can improve 3-point belt fit

4 Percentage of children 4-8 reported as using child safety seats Motor Vehicle Occupant Safety Survey, forward-facing with harness 80 highback or backless booster

5 Percentage of children 4-7 observed using child safety seats National Survey on the Use of Booster Seats, forward-facing with harness 80 highback or backless booster

6 Enactment of booster seat laws in the U.S. effective year cumulative number of states to date 47

7 Child restraint or booster seat laws in the U.S. December 2011 WA OR CA NV ID MT UT AZ WY CO NM ND SD NE KS OK TX MN IA MO AR LA WI IL MS MI IN OH KY TN AL GA VT NY PA WV VA NC SC NH ME MA NJ RI CT DE MD DC 3 & younger 4 & younger AK FL 5 & younger 6 & younger 7 & younger 8 & younger HI

8 Prior research on effectiveness of booster seat laws Effects on restraint use Children 4-7 were 39 percent more likely to use boosters or child restraints in U.S. states with booster seat laws than in states without laws Booster use increased after laws amended in the following U.S. states: Wisconsin, Tennessee, and New York Effects on injuries Children 3-8 who were covered by laws were less likely to be hospitalized for motor vehicle injuries than children not covered by laws In New York State, the per capita injury rate before and after the booster seat law decreased 18 percent among 4-6 year-olds

9 Study objectives and methods To examine changes in the per capita rates of Restraint use of children in crashes Rear seat use of children in crashes Children injured in crashes Before-after design with comparison group (ages 9-12) Change in per capita rates among booster-age children before and after law changes Adjusted rate ratio = O / E O is the number of booster-age children using child seats, rear seats, or injured in crashes after law changes E is the expected number of booster-age children using child seats, rear seats, or injured in crashes after law changes, adjusted for changes in comparison group

10 Data sources State Data System (SDS) Collection of state crash files coded from police crash reports in the United States Injury severity, restraint use, and seating position for children who were vehicle occupants in crashes States were chosen based on whether amended laws covered children through at least age 7, and 2 years of data were available before and after law change U.S. Census Bureau population data Estimates by single years of age used to calculate population-based rates

11 Study states Age groups required to use child restraints or booster seats state prior law new law affected by law change Missouri, Pennsylvania, and Wisconsin 3 and younger 7 and younger 4-7 North Carolina 4 and younger 7 and younger 5-7 Wyoming 4 and younger 8 and younger 5-8

12 Percent of restraint use among children in crashes before and after law changes Five study states combined seat belt only child safety seat (harness or booster) before law after law before law after law children ages 4-8 targeted by law upgrades comparison group of children ages 9-12

13 Changes in child safety seat use among booster-age children in crashes in five study states Adjusted for changes in restraint use among children ages 9-12 state observed expected Missouri 7,819 2,551 North Carolina 12,070 3,637 Pennsylvania 4,886 1,372 Wisconsin 6,188 3,184 Wyoming total 31,557 10,862 adjusted rate ratio (95% CI) 3.07 ( ) 3.32 ( ) 3.56 ( ) 1.94 ( ) 5.09 ( ) 2.91 ( )

14 Percent of front- and rear-seating among children in crashes before and after laws Five study states combined rear seat front seat 0 before law after law before law after law children ages 4-8 targeted by law upgrades comparison group of children ages 9-12

15 Changes in rear seating among booster-age children in crashes in five study states Adjusted for changes in rear seat use among children ages 9-12 state observed expected adjusted rate ratio (95% CI) Missouri 14,015 11,618 North Carolina 21,148 20,815 Pennsylvania 8,837 8,712 Wisconsin 10,575 10,499 Wyoming 1,281 1,114 total 55,856 52, ( ) 1.02 ( ) 1.01 ( ) 1.01 ( ) 1.15 ( ) 1.06 ( )

16 Observed and expected booster-age children injured during the 2 years after the law changes Adjusted for changes in injury rate among children ages 9-12 state observed expected Missouri 1,815 1,946 North Carolina 3,799 3,971 Pennsylvania 1,798 1,905 Wisconsin 1,351 1,433 Wyoming total 8,995 9,469 adjusted rate ratio (95% CI) 0.93 ( ) 0.96 ( ) 0.94 ( ) 0.94 ( ) 1.08 ( ) 0.95 ( )

17 Observed and expected booster-age children with fatal or incapacitating injuries after law changes Adjusted for changes in injury rate among children ages 9-12 state observed expected Missouri North Carolina Pennsylvania Wisconsin Wyoming total adjusted rate ratio (95% CI) 0.78 ( ) 1.08 ( ) 0.95 ( ) 0.68 ( ) 0.54 ( ) 0.83 ( )

18 Conclusions Amendments to existing child restraint laws adding a booster seat requirement appear to be effective in the United States Among children covered by laws Use of child safety seats increased Placement of children in rear seats increased Injuries were reduced, particularly serious injuries

19 Dedicated to reducing deaths, injuries, and property damage on the highway

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