Who is driving when unrestrained children and teenagers are hurt?
Introduction
Injury is the leading killer of children and teenagers. Each year, more children aged 1–14 die from injury than from all childhood diseases combined (Baker et al., 1992). Three out of every four deaths of young adults aged 15–24 result from injury (Baker et al., 1992). In addition, for every child fatally injured, approximately 35 children are hospitalized, and 1,050 are treated in the emergency department. These non-fatal injuries can be disabling and disfiguring.
The leading cause of injury fatalities among 1–19-year-olds is motor vehicle crashes (Baker et al., 1996). Annually, approximately 1,700 children aged 0–14 and 4,500 teenagers aged 15–19 are fatally injured in crashes. About 330,000 children and 817,000 teenagers are non-fatally injured. These injuries result in an estimated $88 billion in good health lost, plus $5 billion in medical spending (Miller et al., 1998).
In order for injury prevention initiatives to be effective, they must be based on accurate information. In the case of motor vehicle crashes, prevention can take the form of laws passed (seat belt laws, drunk driving laws), environmental modifications (safer highway `furniture'), engineering developments (air bags), and behavioral modification (getting people to buckle up or drive defensively). Many effective interventions incorporate two or more of these categories.
Injured child passengers are the innocent victims in crashes. The driver or another adult in the vehicle has the responsibility to respect traffic laws. The majority of teenage passengers injured were traveling in vehicles driven by a peer. As teenagers begin driving, they accept the responsibility to keep their passengers safe. Occupant restraint use (seat belts and child safety seats) is very effective in preventing injury (NHTSA, 1984NHTSA, 1996). The driver protects his or her passengers by making sure that they are properly restrained.
To design child and teenage motor vehicle occupant injury interventions that effectively address driver issues, we need to know more about crash-involved drivers. Edwards and Sullivan (1997)find that child passenger restraint mirrors driver restraint and that unrestrained drivers were most likely to place unrestrained child passengers in the front seat. A literature review for the past 10 years revealed no studies of driver characteristics in crashes where children were injured.
This paper examines driver characteristics in crashes where child and teenage motor vehicle passengers were injured, in particular factors that influence whether or not the injured victim was restrained. We look at the driver's age, sex, alcohol use, and citation for violation; whether another adult was in the car; victim age, sex, and seating position; circumstances of the crash such as time of day and road-type; and finally, restraint use of the victim and the driver.
Section snippets
Methods
Since teenagers are overrepresented in motor vehicle crash injury counts, their characteristics may mask those of importance in 0–14-year-old victims. We therefore broke the heterogenous 0–19-year-old victim age group into two: children (ages 0–14) and teenagers (ages 15–19).
We used the National Highway Traffic Safety Administration's (NHTSA) 1992–1993 General Estimates System (GES) (NHTSA, 1994a) data to examine crashes where child and teenage passengers were non-fatally injured. These data
Non-fatally injured passengers
Excluding drivers, 45% of estimated non-fatally injured passengers ages 0–19 in 1992–1993 were 15–19-year-olds, 21% were 10–14, 19% were 5–9, and 15% were 0–4. Fifty-three per cent were female.
Driver age and sex differed considerably for child versus teenage victims. Child passengers who were injured rode primarily with 25–54-year-old drivers, whereas teenagers who were injured rode primarily with drivers under age 20 (Fig. 1, Table 2). Sixty-one per cent of children who were injured rode with
Limitations
Using motor vehicle crash data, we examined driver and crash characteristics of injured child and teenage occupants. The GES crash data lack information about driver and passenger characteristics in general; our study was confined to injured children and teenagers. Characteristics that reduce the risk of a crash or of injury if a crash occurs, such as restraint use and safe driving behavior, were under-represented in our data. We therefore could not determine which children were most at risk of
Acknowledgements
Grant MCJ-113A36-01 from the Office of Maternal and Child Health, DHHS and NHTSA and grant AA09812-02 from the National Institute on Alcohol Abuse and Alcoholism supported this research. All estimates and opinions are the authors' alone.
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