Long-term effects of legislation and local promotion of child restraint use in motor vehicles in Sweden

doi:10.1016/S0001-4575(00)00093-2

Accident Analysis & Prevention

Volume 33, Issue 6, November 2001, Pages 793-797

https://doi.org/10.1016/S0001-4575(00)00093-2 Get rights and content

Abstract

The main objective is to study long-term effects of legislation and promotion of child-restraint use in motor vehicles. Subgoals are to describe the level of restraint use in cars and changes in mortality and morbidity patterns in regard to differences among age groups and geographical areas (morbidity). The study areas were; ‘The First Four’, ‘The Six Counties’, ‘The Rest of Sweden’, and ‘Sweden as a whole’, and the population were two age groups — 0–6 and 7–14 years. The incidence of restraint use comes from observations of car-seat-belt usage. Outcome evaluation was based on hospital-discharge data 1978–1996 and mortality statistics 1970–1996. The level of restraint use for children in the front seat was 97% in 1988 and was equal to 1995. Mortality data shows a decrease of 2.8% on an average per year, 76% over the study period. A significant change over time in the two intervention areas was shown (annual changes of −2.8 and −1.8%), but not in the rest of Sweden. The local authorities that started early with preventive programs, such as safety seat loan schemes and those having an organised safety-promotion program showed a much better improvement than the rest of Sweden. There is a need for appropriate information for local action on childhood injury prevention to accompany national legislation.

Introduction

In Sweden, a majority of child fatalities (under 15 years) are due to injuries and of these about 40% are the result of traffic accidents — about the same rate as in the US (National Board of Health and Welfare, 1996, MMWR, 1991). Children are exposed to high risks in traffic, but despite increased traffic volume it has still been possible to decrease numbers of injuries and deaths. However, the various preventive interventions made have not been fully evaluated.

Sweden consequently has a long and strong tradition in using rearward-facing child safety seats. Every single fatal accident involving a child in a passenger car from January 1, 1992 to July 1, 1997 have been studied by Wenäll (1997). In total there was 79 children killed, but only nine of these were travelling in a rearward-facing seat. In all of those nine cases, extensive occupant compartment intrusion was the cause of death of the child (Wenäll, 1997).

Ruta et al. (1993) found the relative risk for children travelling unrestrained in a car for all injuries combined was 1.7, for head injuries 3.1 and for face injuries 3.0. Wagenaar et al. (1987) published results from mandatory child-restraint laws in 11 states in the US, from 1976 to 1983, showing 20–25% fatality reductions. In a study from New Zealand, Still et al. (1992) estimated that close to half of all child-passenger deaths in Auckland could have been prevented.

Restraints were introduced in Swedish cars for front seats as early as in 1967, but national mandatory use was not put into effect until 1975 (Cedersund, 1997). This was extended to all seats for adults (from 16 years of age) in 1986 and to children (0–15 years of age) in 1988. However, some local-government authorities (Värmland and Malmöhus counties, the city of Malmö (third biggest in Sweden) and the rural municipality of Falköping) voluntarily made interventions for children in 1983, although this was restricted to children 0–9 months of age. Baby seats were offered in those areas free of charge to all families with new-borns through hospitals, child-health care and private dealers. Additionally, information was given on safety in cars and safety measures in general. As early as 1984–1986 all counties in Sweden had adopted the idea of promoting distribution of car restraints.

The main objective of this article is to study long-term effects of legislation and local promotion of child-restraint use in motor vehicles. Subgoals are to describe the level of restraint use for children in cars and to study changes in mortality and morbidity patterns in regard to differences among age groups and geographical areas (morbidity).

Section snippets

Study areas, periods and population

The following study areas were employed for the study:

‘The First Four’; Värmland and Malmöhus counties (regions) and the city of Malmö and Falköping municipality.
‘The Six Counties’; Skaraborg (countywide injury-prevention programs initiated in 1974), Bohus (1986), Stockholm (1987), Östergötland (1988), Uppsala (1992) and Jämtland (1988).
‘The Rest of Sweden’; ‘The Country of Sweden’ minus ‘The Six Counties’ and ‘The First Four’.
‘The Country of Sweden’.

The populations of these areas are shown in

Results

The level of restraint use for children (0–15 year of age) in the front seat of the car in 1988 was 97% (equal to that in 1995) for Sweden as a whole, while for rear seats there was an improvement from 78% in 1988 to 86% in 1995. However, for rear seats the main increase occurred before 1988 (from 17% in 1983) (Cedersund, 1997).

The overall picture in mortality is a decrease on average by 2.8% per year, equivalent to a 76% over 27 years period. This is most evident after 1981 (Fig. 1). There are

Discussion

This study points out that there was a high level of restraint use for children in the front seat and improvement for rear seat since 1983 in Sweden.

The study results show a 76% decrease in mortality over a 27-year period (1970–1996), and a 22% decrease in hospital care due to injuries in childhood related to motor-vehicle crashes over a 19-year period (1978–1996), during which the technology of restraint was introduced and supported by both local long term programs and national legislation.

Acknowledgements

This study was financed and supported by the Western Region of the Swedish National Road Administration and the Municipality of Götene. Liselotte Johansson, Götene, assisted in data collection. We are indebted to Per Santesson, Götene, and Anita Jonson, Skövde, for helping us with the statistical calculations.

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Long-term effects of legislation and local promotion of child restraint use in motor vehicles in Sweden

Abstract

Introduction

Section snippets

Study areas, periods and population

Results

Discussion

Acknowledgements

Accident; Analysis and Prevention

Journal of Clinical Epidemiology

Accident; Analysis and Prevention

Accident; Analysis and Prevention

Regional strategies for injury prevention: Experiences from six countywide programs in Sweden

International Journal for Consumer and Product Safety

Process evaluation of the bassinet restraint loan scheme in Victoria

Australian Paediatric Journal

Use of car restraints for children: size of problem, intervention strategies

Harefuah

Car transportation conditions of pre-school children: use of children's car safety seats

Acta Paediatrics

Effects of North Carolina's mandatory safety belt law on children

Injury Prevention