Road Injury Prevention & Litigation Journal
Copyright © 1998 by TranSafety, Inc.
February 2, 1998
Fax: (360) 335-6402
Studies have shown that injuries kill more children ages 0-19 than any other cause. Injuries in motor vehicle crashes top the list as the leading cause of death for this age group. Each year, car crashes claim the lives of about 1,700 children and 4,500 teenagers. Add to this the nearly 330,000 children and 817,000 teenagers injured every year in car crashes, and the toll is staggering.
One factor inherent in all car crashes involving children is adult responsibility. Adult drivers and passengers are responsible for the safety of children in the car, primarily by seeing to it that children are properly restrained. The National Highway Traffic Safety Administration (NHTSA) has verified that "seat belts and child safety seats [are] very effective in preventing injury." However, this effectiveness is only realized if the restraints are used. A 1997 study found "that child passenger restraint mirrors driver restraint and that unrestrained drivers were most likely to place unrestrained child passengers in the front seat." Given this, it would be helpful to know more about the characteristics of drivers in crashes where children are involved.
In an effort to provide more information in this area, a recent study examined driver characteristics for crashes where children and teenage passengers were injured or killed, particularly those factors related to victim restraint. The results of the study, published by the Association for the Advancement of Automotive Medicine, were discussed by Ted R. Miller, Rebecca S. Spicer, and Diane C. Lestina in their article "Who's Driving When Unrestrained Kids Get Hurt?" Overall, the study revealed that "driver and crash characteristics of 0-14 and 15-19 year-old injury victims are very different." In addition, "though restraint use is higher than teenagers, a large proportion of child victims remain unrestrained." As such, "prevention programs may be most effective if these two populations are addressed separately."
For nonfatal injuries, data were obtained from NHTSA's 1992-93 General Estimates System (GES), "a nationally representative probability sample of crashes in the United States [that] . . . provides information at the crash, the vehicle, and the person level." Data on child and teenage fatalities were obtained from NHTSA's 1992-92 Fatal Accident Reporting System (FARS), which is "a census of all fatal crashes in the United States."
Certain limitations in the study were expected. All information came from police reports, where less severe car crashes are not as likely to be reported. In addition, restraint use tends to be over-reported in police records because occupants falsely report use to avoid citation. In contrast, alcohol use tends to be under-reported, especially in serious, nonfatal-injury crashes. No adjustments were made in the study based on these factors.
Nonfatally Injured Passengers
Of those passengers ages 0-19 who were not fatally injured, almost half (45 percent) were in the 15-19 age category, and just over half (53 percent) were female. Children (ages 0-14) rode in cars driven mostly by older drivers (ages 25-54), whereas teenagers (ages 15-19) were the occupants in cars driven mainly by young drivers under the age of 20. More than half (61 percent) of the children rode with female drivers, whereas the same percentage of teenagers rode with male drivers. When the driver was a male, the crash was more likely to have occurred during the late evening or night, a finding especially true for teenage victims.
Results further showed that the older the injury victim, the more likely he or she was to be unrestrained. For example, 40 percent of teenage victims were unrestrained, compared to 23 percent of 0-4 year-olds. Unrestrained victims on the whole were more likely to be riding at night with young (under 20) male drivers who had been drinking, and who were accompanied by an adult passenger.
Findings also revealed that "injured passenger restraint use corresponds with driver restraint use." An estimated 78 percent of unrestrained children rode with unrestrained drivers; conversely, 79 percent of restrained children rode with a restrained driver. The non-restraint correlation was "especially strong for teenage victims," where 88 percent of unrestrained teenagers rode with an unrestrained driver. Use of restraints was typically lowest in the late evening and during the night.
When an adult passenger was in the car, the victim's age varied. However, when the victim was a child, the adult passenger tended to be a woman, irrespective of the driver's gender. This was not true for teenage victims, where the adult passenger was equally likely to be female or male. The presence of an adult passenger had a significant effect on restraint tendencies, though not a positive one. An adult passenger lowered the odds that the injured child or teenage passenger would be restrained, and this was "especially pronounced for injured teenagers." With no adult passenger, 60 percent of injured children and 78 percent of injured teenagers were seated in the front, but with an adult passenger, these numbers decreased to 19 percent and 37 percent, respectively. Regardless of adult passenger presence, restraint use was lower in the back seat.
Alcohol-involved driving was more a factor at night, and drivers who had been drinking were less likely to have restrained victims. In crashes where children and teenagers were injured, alcohol-involved drivers were more likely to be male and young (ages 20-24). About a third of unsafe driving citations involved violations other than drunk driving. In these cases, cited drivers were more likely to have unrestrained victims, whatever the driver's age.
Overall, the risk factors, such as an alcohol-involved male driving at night, "[were] consistent across driver and victim age groups although their relative importance sometimes varies." Findings also revealed that "unrestrained child and teenage injury victims appear to be a greater problem in the Midwest and possibly the West than in the South and Northeast." In addition, "drivers in suburban areas are significantly more likely to restrain children who get injured than other drivers."
Fatally Injured Passengers
More than half (54 percent) of the fatalities were teenagers ages 15-19, and more than half (55 percent) involved male victims. Most fatalities (77 percent) occurred with a male driver, and this was especially pronounced (86 percent) when the male driver was young (ages 20-24). As with nonfatally injured victims, fatally injured victims ages 15-19 were most likely to be riding with a teenage driver, while younger victims tended to be in cars driven by older (ages 25-54) drivers. Again, the older the victim, the less likely he or she was to be restrained.
Among fatalities, restraint use was lowest at night and highest in the morning, with use decreasing throughout the day. Alcohol was a significant factor in fatality cases: "The proportion of cases that were alcohol-involved was more than five times higher for fatal versus nonfatal child and teenage injuries." In addition, "alcohol-involvement in teenage fatalities is twice that of child fatalities." The teenage factor itself was significant in fatality cases. Sixty-seven percent of all child fatalities occurred with a teenage driver, and 85 percent of the 15-19 year-old fatalities were either with teenage drivers or were driving themselves.
CONCLUSIONS AND RECOMMENDATIONS
The researchers suggested that the "most striking finding" involved the presence of an adult passenger in the car. This passenger "increases the likelihood that child and teenage passengers will be unrestrained if they are injured." The adult-versus-no-adult-passenger factor also affected seat position and restraint use for victims. One finding that "demands further investigation" involves the decrease in restraint use when a child occupies the front seat when an adult passenger is present. Overall, results showed that "the older the victim age group, the greater the discrepancy in restraint use between front and back seat."
Teenage drivers were second to drivers age 20-24 in their involvement with alcohol, despite a legal drinking age of 21. Further, the victims who were most frequently unrestrained were teenagers riding with teenage drivers. The prevalence of the teenage factor indicated that "[p]olicies such as provisional licensing [that] restrict nighttime driving for novice drivers . . . may be effective in decreasing occupant injury."
The study suggested "the need for attention in two areas." First, efforts at "family-focused safety" might be used to increase restraint use when families travel together in cars. Restraint use was actually lower in these instances instead of higher, as might be expected. Second, "peer to peer messages, like those used in successful efforts to reduce teenage drunk driving, may also be effective in changing the belt-use culture among teens." Efforts in both areas "should communicate driver responsibility for the safety of . . . passengers." While certain programs promote child restraint for very young children, few safety programs promote overall occupant restraint use by placing the onus of responsibility where it logically belongs--with drivers.
Copyright © 1998 by TranSafety, Inc.