International Journal of Environmental Research and Public Health

Research

13 pages, 580 KiB

Open AccessArticle

Overloaded and Unrestrained: A Qualitative Study with Local Experts Exploring Factors Affecting Child Car Restraint Use in Cape Town, South Africa

by Kate Hunter, Amy Bestman, Madeleine Dodd, Megan Prinsloo, Pumla Mtambeka, Sebastian van As and Margaret Mary Peden

Int. J. Environ. Res. Public Health 2020, 17(14), 4974; https://doi.org/10.3390/ijerph17144974 - 10 Jul 2020

Cited by 7 | Viewed by 2544

Abstract

(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the [...] Read more.

(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the feasibility of a child restraint program and to describe factors influencing child restraint use from the perspectives of clinicians, representatives of non-government agencies, and academics in Cape Town, South Africa. (2) Methods: Qualitative interviews were conducted with 13 experts from government, academic and clinical backgrounds. Findings were analyzed using the COM-B component of the Behaviour Change Wheel and were grouped by the layers of the social-ecological model (individual, relational, community and societal). (COM-B is a framework to explain behaviour change which has three key components; capability, opportunity and motivation), (3) Results: Experts believed that there was a need for a child restraint program that should be staged and multifactorial. Participants described knowledge gaps, perceptions of risk, mixed motivations and limited enforcement of child restraint legislation as key influences of restraint use. (4) Conclusions: The results demonstrate potential areas on which to focus interventions to increase child restraint use in Cape Town, South Africa. However, this will require a coordinated and consistent response across stakeholder groups. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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12 pages, 1029 KiB

Open AccessArticle

The Awareness and Attitude of Parents towards the Legislation of Child Restraint in Two Cities of China

by Ye Jin, Xiao Deng, Pengpeng Ye, Ji Peng, Juanjuan Peng, Lin Lei, Yan Yu and Leilei Duan

Int. J. Environ. Res. Public Health 2020, 17(7), 2405; https://doi.org/10.3390/ijerph17072405 - 01 Apr 2020

Cited by 3 | Viewed by 2272

Abstract

The death of child passengers was one of the leading causes of death among children fatally injured on roads in China. Child restraint can effectively protect child passengers. Mandatory child restraint law has been enacted locally in Shanghai and Shenzhen, two major cities [...] Read more.

The death of child passengers was one of the leading causes of death among children fatally injured on roads in China. Child restraint can effectively protect child passengers. Mandatory child restraint law has been enacted locally in Shanghai and Shenzhen, two major cities in China. In order to understand the public attitude on national legislation in these cities, we conducted a cross-sectional survey with a sample of parents/caregivers with a child aged 0–6 years and own private car from Shanghai and Shenzhen. We used descriptive statistics to describe the distribution of parental awareness and attitudes towards the legislation of child restraint. There were less than 50% parents who were aware of the local legislation of child restraint use. Even though only around 20% of parents were able to respond accurately to the age standard in legislation, among those who knew of the legislation, most of the parents understood that the law had enforcement measures. More than 70% of parents supported the national legislation of child restraint use, and, among them, around 70% supported enforcement and punishment. Thus, the study provided supportive evidence for national legislation, but it also put forward that the work of popularizing law should be strengthened. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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13 pages, 1362 KiB

Open AccessArticle

Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

by Prasanthi Puvanachandra, Aliasgher Janmohammed, Pumla Mtambeka, Megan Prinsloo, Sebastian Van As and Margaret M. Peden

Int. J. Environ. Res. Public Health 2020, 17(6), 1979; https://doi.org/10.3390/ijerph17061979 - 17 Mar 2020

Cited by 5 | Viewed by 3295

Abstract

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite [...] Read more.

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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12 pages, 2084 KiB

Open AccessArticle

Age Differences in Occupant Motion during Simulated In-Vehicle Swerving Maneuvers

by Valentina Graci, Ethan Douglas, Thomas Seacrist, Jason Kerrigan, Julie Mansfield, John Bolte, Rini Sherony, Jason Hallman and Kristy Arbogast

Int. J. Environ. Res. Public Health 2020, 17(6), 1834; https://doi.org/10.3390/ijerph17061834 - 12 Mar 2020

Cited by 3 | Viewed by 2217

Abstract

Background: With active safety and automated vehicle features becoming more available, unanticipated pre-crash vehicle maneuvers, such as evasive swerving, may become more common, and they may influence the resulting effectiveness of occupant restraints, and consequently may affect injury risks associated with crashes. Therefore, [...] Read more.

Background: With active safety and automated vehicle features becoming more available, unanticipated pre-crash vehicle maneuvers, such as evasive swerving, may become more common, and they may influence the resulting effectiveness of occupant restraints, and consequently may affect injury risks associated with crashes. Therefore, the objective of this study was to quantify the influence of age on key occupant kinematic, kinetic, and muscular responses during evasive swerving in on-road testing. Methods: Seat belt-restrained children (10–12 years old), teens (13–17 years old), and adults (21–33 years old) experienced two evasive swerving maneuvers in a recent model sedan on a test track. Kinematics, muscle activity, and seat belt load distribution were determined and analyzed. Results: Compared to teens and adults, children showed greater head and trunk motion (p < 0.03), but similar muscle activation in the into-the-belt direction of swerving. In the out–of-the-belt direction, children showed head and trunk motion more similar to teens and adults (p < 0.02), but with greater muscle activation. Conclusions: Children showed different neuromuscular control of head and trunk motion compared to older occupants. This study highlights differences in the relationship between kinematics and muscle activation across age groups, and provides new validation data for active human body models across the age range. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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14 pages, 1483 KiB

Open AccessArticle

Restraint Factors and Child Passenger Deaths in New South Wales, Australia

by Tom Whyte, Bianca Albanese, Jane Elkington, Lynne Bilston and Julie Brown

Int. J. Environ. Res. Public Health 2020, 17(4), 1147; https://doi.org/10.3390/ijerph17041147 - 12 Feb 2020

Cited by 8 | Viewed by 3026

Abstract

Inappropriate or incorrect use of child restraints can influence crash injury outcome. This study examined the role of restraint factors in child passenger deaths and the effect of legislation requiring appropriate restraint systems up to 7 years old. Data for child (0–12 years) [...] Read more.

Inappropriate or incorrect use of child restraints can influence crash injury outcome. This study examined the role of restraint factors in child passenger deaths and the effect of legislation requiring appropriate restraint systems up to 7 years old. Data for child (0–12 years) passenger deaths occurring in New South Wales (NSW) from 2007 to 2016 were collected by the child death review team including photographs, reports of in-depth crash investigation, witness reports and medical reports. Restraint use, type of restraint, appropriateness of the restraint for the age of the child and correctness of restraint use were examined. The primary contributor to death was determined in each case. Sixty-four child passengers died in NSW during the data period. Twenty-nine (29/64, 45%) were properly restrained. Thirteen children (13/64, 20%) were unrestrained. In 20 cases (20/64, 31%), children were using a restraint that was either inappropriate for their age (6) or not used correctly (14). Restraint factors were a primary contributor in 22 (22/64, 34%) child deaths. Compared to pre-legislation, appropriate restraint use was more common post-legislation (13/22. 59% vs. 30/42, 71%). However, incorrect use was also greater (3/22, 14% vs. 11/42, 26%). Interventions targeting increasing restraint use and reduction of common ‘use’ errors are needed to prevent further restraint factor-related deaths. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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20 pages, 6595 KiB

Open AccessArticle

Child Posture and Belt Fit in a Range of Booster Configurations

by Monica L.H. Jones, Sheila Ebert, Miriam A. Manary, Matthew P. Reed and Kathleen D. Klinich

Int. J. Environ. Res. Public Health 2020, 17(3), 810; https://doi.org/10.3390/ijerph17030810 - 28 Jan 2020

Cited by 13 | Viewed by 2751

Abstract

Belt positioning boosters reduce injury risk for child occupants compared with seat belts alone. While boosters shorten the effective seat length (and thus reduce slouching), “boosting” the child relative to the vehicle interior components also achieves additional safety benefits. First, the increase of [...] Read more.

Belt positioning boosters reduce injury risk for child occupants compared with seat belts alone. While boosters shorten the effective seat length (and thus reduce slouching), “boosting” the child relative to the vehicle interior components also achieves additional safety benefits. First, the increase of the lap belt angle usually improves belt fit across the pelvis and reduces the risk of the occupant slipping (“submarining”) under the belt. Second, the torso belt is re-centered over the bony landmarks of the shoulder for more effective/secure restraint. Third, the child’s head is relocated in a range better protected by side airbags. The objective of this research was to quantify differences in posture and belt fit across a range of booster designs that provide different levels of boosting. Posture and belt fit were measured in 25 child volunteers aged four to 12. Children were measured in three laboratory seating conditions selected to provide a range of cushion lengths and belt geometries. Six different boosters, as well as a no-booster condition, were evaluated. The low height boosters produced postures that were more slouched, with the hips further forward than in other more typical boosters. Lap belt fit in the low height boosters was not meaningfully different from the other boosters. Shoulder belt fit produced by the lowest height booster was similar to the no-booster condition. Belt positioning boosters that boost the child less than 70 mm produced postures similar to the no-booster condition. While lap belt guides on these products can produce a similar static lap belt fit, they may not provide adequate dynamic performance and do not achieve the other benefits that come with raising the child to a more advantageous location relative to interior components and belts. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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Review

Jump to: Research, Other

10 pages, 280 KiB

Open AccessReview

Malaysian Child Restraint Issues: A Brief Narrative Review

by Roszalina Ramli and Siti Salmiah Mohd Yunus

Int. J. Environ. Res. Public Health 2020, 17(6), 1922; https://doi.org/10.3390/ijerph17061922 - 16 Mar 2020

Cited by 3 | Viewed by 2283

Abstract

The child restraint legislation in Malaysia becomes mandatory from 1 January 2020. Prior to commencement of the rule, a survey showed that only 36% of Malaysian parents were aware of the importance of a child restraint system (CRS) and only 27% usage was [...] Read more.

The child restraint legislation in Malaysia becomes mandatory from 1 January 2020. Prior to commencement of the rule, a survey showed that only 36% of Malaysian parents were aware of the importance of a child restraint system (CRS) and only 27% usage was reported during travel. The Malaysian Institute of Road Safety report showed that children transported in private vehicles were the leading groups of casualties among children aged 1 to 4 years old (43.8%) and 5 to 9 years old (30.2%), respectively. We performed a narrative review using the PubMed, ScienceDirect and Google Scholar databases using keywords such as child restraint system, unrestrained injuries, Malaysia and epidemiology. The objectives of this review were: (1) to determine the prevalence on the use of CRS in Malaysia, (2) to evaluate the injuries related to unrestrained children and (3) to show the nation’s preparation towards implementation of the child restraint law. Six papers on prevalence, one paper on injury and six mainstream newspaper were included in this study. The prevalence of a CRS use was shown between 5% to 41.8%. In relation to injury, the only publication from this country showed that among 19 children involved in a car crash, five (26.3%) children had non-craniomaxillofacial (CMF) injuries, ten (52.6%) with CMF injuries only, two (10.5%) with both CMF and non-CMF injuries and two (10.5%) without any injury. Overall, the Injury Severity Score (ISS) range was between 0 to 13 (median, 1.00; interquartile range, 1). Preparation to comply with the best practice of the child restraint law is still ongoing, especially those addressing the issues related to the low-income parents in the country. Due to scarcity of publication and data on the CRS use and injuries related to its non-usage, it is advocated that parallel with the implementation legislation, vigorous forms of public education as well as good data management must be performed and monitored regularly by the road safety authority in this country. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

Other

Jump to: Research, Review

10 pages, 659 KiB

Open AccessProtocol

A Process Evaluation Protocol for Examining the Impact of Instructions for Correct Use of Child Car Seats Designed through a Consumer-Driven Process and Evaluated in a Field-Based Randomised Controlled Trial

by Julie Brown, Jane Elkington, Kate Hunter, Judith L. Charlton, Lynne E. Bilston, Andrew Hayen and Lisa Keay

Int. J. Environ. Res. Public Health 2020, 17(12), 4508; https://doi.org/10.3390/ijerph17124508 - 23 Jun 2020

Cited by 2 | Viewed by 2894

Abstract

The incorrect use of child car seats is common, with significant negative effects on crash protection for child passengers. There is currently little evidence for effective, practical countermeasures for incorrect use. The provision of clear and comprehensible materials on correct use supplied with [...] Read more.

The incorrect use of child car seats is common, with significant negative effects on crash protection for child passengers. There is currently little evidence for effective, practical countermeasures for incorrect use. The provision of clear and comprehensible materials on correct use supplied with restraints at the point of sale could be highly cost-effective and achieve similar benefits to restraint-fitting services or hands-on training; however, routinely supplied instructions in their current form are frequently difficult to understand. We are conducting a randomised controlled trial of the consumer-driven redesign of instructional materials, consisting of an instruction sheet, swing tags and online training videos. This paper presents the protocol that will be used in an innovate process evaluation that will use the primary outcome of overall serious misuse assessed at six months, together with a survey and semi-structured interviews to determine fidelity, dose and outcomes for all intervention participants. The study will assess intervention delivery and external factors that may impact the effectiveness of the intervention, including experience, health literacy, confidence and attitudes. When it has been conducted, this process evaluation will provide enhanced understanding of the mechanisms through which the intervention works or not, aspects of the implementation process key to success of the intervention and insight into how external factors influence the success of the intervention. Full article

(This article belongs to the Special Issue Injury Prevention among Child Occupants)

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