Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
We were pleased to see the excellent article on child and family safety device affordability by country income level by Hendrie et al (2004).1 International research has shown that the use of child restraint seats (CRS) significantly reduces the risk and severity of injuries resulting from motor vehicle crashes.2 In the USA proper use of CRS is estimated to prevent approximately 53 000 injuries and 500 fatalities among children under 5 years.3 This conclusion is supported by one systematic review.4 Consequently, CRS laws and enhanced enforcement programs are “strongly recommended” interventions.
In contrast, in Japan the public health significance of motor vehicle injuries among children has not been adequately appreciated. This is despite the fact that from 1991 to 2002 there were 3582 motor vehicle crash related fatalities and 552 794 injuries involving children aged 0–5 years.5
There are several reasons for the lack of CRS use among Japanese. Compared with salaries of North American and European families, the Japanese average family income is higher. Nevertheless, the majority of parents perceive prices of CRS as comparatively higher than in other countries.
A CRS in Japan is costly—approximately US$250–400. Thus government subsidies would be necessary to increase affordability and motivation to use by parents.
This process would be expensive, but when measured against public health benefits it is clearly worthwhile.5 Arguably, a moral obligation exists to offer subsidies that give all children a fair chance of surviving to adulthood.1 One example of the efficacy of subsidies was seen in 1982–84 when the Swedish government introduced a child seat lending scheme. This resulted in 67% of children using car seats on short trips and 73% on long trips and to a subsequent decrease in MV injuries.6
In other motorized countries, CRS use is widely prevalent and child passenger safety has long been a priority. In contrast, Japanese policy makers and parents are not fully aware of the safety benefits of CRS. A survey carried out by the Japan Automobile Federation in 1998 revealed that only 8.5% of parents used CRS.2 Similarly, a recent national observational survey jointly conducted by the National Police Agency (NPA) and Japan Automobile Federation (JAF) found that seven out of 10 CRS were loosely fitted.7
Greenberg-Seth et al demonstrated that a community based intervention quickly increases proper CRS use but that improvements are greatest in high income areas.8 Education and enforcement are commonly proposed for injury control but few such activities have been initiated in Japan. We suggest that media education campaigns be initiated and properly evaluated to monitor changes in CRS safety awareness and use.