Lifesavers Comparisons

Partners for Child Passenger Safety Center for Injury Research and Prevention At The Children’s Hospital of Philadelphia and State Farm Insurance Companies

“Tween” Passengers: Risk factors for injury and fatality Suzanne Hill Program Director, Advocacy and Outreach Center for Injury Research & Prevention The Children’s Hospital of Philadelphia

What I will cover • Define “tweens” – FARS/NASS data on ‘tweens

• Partners for Child Passenger Safety (PCPS) data on ‘tweens – What is PCPS? – Injuries to older children in seat belts – Role of teen drivers in injury and fatality risk

What I will cover • Define “tweens” – FARS/NASS data on ‘tweens

• Partners for Child Passenger Safety (PCPS) data on ‘tweens – What is PCPS? – Injuries to older children in seat belts – Role of teen drivers in injury and fatality risk

Who are “Tweens”?

The forgotten child in highway safety • Children ages 8 through 15 years • Gap in federal safety standards • State child occupant restraint laws stop short – ages 4-5 years in 17 states – 6-8 years in 33 other states.

• Many seat belt laws omit rear seat, – some secondary enforcement

NHTSA fatality data Trends in fatality rates

Child MV deaths per 100,000 6

Fatality rate

5 1975 1994 1999 2004

4 3 2 1 0 <5

5 to 9 Age group (years)

Source: FARS, NASS

10 to 15

NHTSA fatality data Tweens in 2004 • Among 8-15 year old occupants – 1,262 killed, 152,000 injured – Fatalities increased by 3.7 percent over 2003

• Among 8-15 year old occupants killed – Ages 8-12 years – 48% unrestrained – Ages 13-15 years – 68% unrestrained

Source: NHTSA’s 2004 Annual Assessment and 2004 Traffic Safety Facts

What I will cover • Define “tweens” – FARS/NASS data on ‘tweens

• Partners for Child Passenger Safety (PCPS) data on ‘tweens – What is PCPS? – Injuries to older children in seat belts – Role of teen drivers in injury and fatality risk

Partners for Child Passenger Safety CHOP’s data source – 8th year • Unique academic/ industry research partnership • Largest study of children in MVC – 377,000 crashes – 557,000 children

• Inclusion Criteria – Child occupant < 16 years of age – State Farm insured – Model year > 1990

Partners for Child Passenger Safety Study design • Exposure-based surveillance system – All children in all crashes – Validated survey with driver – Provides the context for in-depth results

• Augmented by crash investigations – Provides detail needed by engineers

• Interdisciplinary analysis • Involvement of end-users

Partners for Child Passenger Safety

Methods Case Selection SF

Telephone Interviews Crash Database

CHOP/ PENN Case Selection

Crash Investigations

PCPS surveillance

Front row seating 1999-2004 60%

55%

54%

% of Children

50% 40%

35%

34%

30% 20% 10%

19% 7% 3%

5%

0% '99

'00

'01

'02

'03

'04

No progress for 9-12 year olds

13 to 15 9 to 12 4 to 8 0 to 3

PCPS Surveillance Injuries in 2004*

• Ç injury rate with Ç age

40

– Adult driver and young teens: injury rate 36 per 1000

30

Injuries per 20 1,000 10 in crashes 0 0 to 3 9 to 12 Adult driver

• Head most common Age group 4 to 8 13 to 15

– Child: 11 per 1000 – Driver: 16 per 1000

• Point of impact: – Child injuries most common in side impacts

*PCPS injury= AIS2+ and facial lacerations (requires medical attention)

Age-appropriate restraint Child safety seats and boosters 12 to 47 months old

4 to 7 years old 4%

71% Reduction

3% 2% 1% 0%

Risk of Injury

Risk of Injury

4%

59% Reduction

3% 2% 1% 0%

Seat Belt

Forward facing CSS

Arbogast et al. Accid Anal Prev ‘04

Seat Belt

Booster Seat

Durbin et al. JAMA ‘03

Age-appropriate restraint Seat belts once they fit properly 8 to 12 year olds 6% 5%

Risk of Injury

? % Reduction

4% 3% 2% 1% 0% Unrestrain.

PCPS, 2005

Belted

What I will cover • Define “tweens” – FARS/NASS data on ‘tweens

• Partners for Child Passenger Safety (PCPS) data on ‘tweens – What is PCPS? – Injuries to older children in seat belts – Role of teen drivers in injury and fatality risk

In-depth Analysis #1

Injuries to older children in belts • To describe characteristics of 8-12 year old children in seat belts • To identify risk factors for injury • To identify most common characteristics of injured children

Results

Risk of Injury to belted 8-12 year olds Head 53.8% Chest 3.8% Abdomen 5.7%

1.7% risk of injury

Face 22.3% Neck/ Back/ Spine 1.3% Upper extremity 10.5% Lower Extremity 2.6%

Results

Risk Factors for Injury 8-12 year olds n=973 with injury (Weighted Risk)

OR (95% CI)

Weight 50-74 lbs. 75-99 lbs. 100-124 lbs. 125-149 lbs.

329 (1.5%) 374 (1.7%) 194 (1.6%) 76 (2.8%)

0.5 (0.2, 1.1) 0.6 (0.3, 1.3) 0.5 (0.2, 1.2) Reference

Seat Belt Type Lap/shoulder Lap Only

790 (1.6%) 149 (2.1%)

Reference 1.3 (0.9, 1.8)

Intrusion No intrusion

360 (7.6%) 613 (1.2%)

7.0 (5.1, 9.7) Reference

Results

Risk Factors for Injury 8-12 year olds n=973 with injury (Weighted Risk)

OR (95% CI)

Vehicle Type Passenger Car Minivan SUV Pickup Truck

542 (2.0%) 189 (1.1%) 150 (1.6%) 77 (2.0%)

Reference 0.6 (0.4, 0.7) 0.8 (0.5, 1.3) 1.0 (0.5, 2.3)

Driver Age < 25 years > 25 years

69 (3.2%) 904 (1.6%)

2.0 (1.3, 3.2) Reference

Driver restraint use Restrained Unrestrained

921 (1.6%) 52 (4.6%)

Reference 3.0 (1.3, 7.1)

Summary of Analysis #1 Injuries to older children in belts

• 8-12 year olds account for 29% of all children in crashes – 1 in 9 uses a lap belt only – One third sit in the front seat

• Injury risk higher than younger children in CSS (1.7 vs. <1%) – Head and face injuries predominate

• Risk factors for injury – – – –

Lap only belts Crash severity Young drivers Unrestrained drivers

Recommendation

Reduce injuries to belted children 8 to 12 year olds 6% 5%

Injury Risk 4%

70% Reduction

3% 2% 1% 0% Unrestrain.

PCPS, 2005

Belted

• Current vehicle seat belts do not provide optimal protection as defined by performance of child restraints – Set the target at <1% injury risk • How do we achieve this?

New Developments 8-12 Year Olds

10 y.o. ATD

• Development of 10 yr old ATD • New regulation requiring L/S belts in all rear seat positions • Rear row seat belt adjusters • Need to monitor for effectiveness

What I will cover • Define “tweens” – FARS/NASS data on ‘tweens

• Partners for Child Passenger Safety (PCPS) data on ‘tweens – What is PCPS? – Injuries to older children in seat belts – Role of teen drivers in injury and fatality risk

In-depth Analysis #2

Young drivers and risk to child passengers • Exemptions in GDL for transporting child family members, however… • Teen drivers 2xs more likely to have children in front seat than adult drivers • Novice teen drivers 3x’s more likely to have unrestrained child passengers • Increased crash severity compared to adults

Source: Chen et al., Injury Prevention, 2004

Results

Young drivers and risk to child passengers

Percentage Injury

6 5

Serious Injury to Child Passengers 5 4.3

4 3 2

1.5

1 0 <=17 years

18-19 years

>=20 years

Driver Age • Child passengers are 3xs more likely to sustain serious injuries in crashes with teen drivers than with adult drivers

Recommendation

Young driver risk to children • Parents are traditional target of CPS efforts • Should future CPS efforts target teens?

In-depth Analysis #3

Child fatalities by driver age (n=1777)

Number of fatalities

350 300 250 20 & older

200

16 to 19

150

Under 16

100 50 0 1

FARS 2003

2 3

4

5 6

7

8 9 10 11 12 13 14 15

Child age

In-depth Analysis #3

Child fatalities by driver age (n=1777)

Number of fatalities

350 300 250 20 & older

200

16 to 19

150

Under 16

100 50 0 1

FARS 2003

2 3

4

5 6

7

8 9 10 11 12 13 14 15

Child age

Results

Child fatalities with young drivers (< 19 yrs) • 546 or 31% all child fatalities in 2003 – – – –

459 (84%) were 12 to 15 year olds 52 (10%) were 2 to 11 year olds 35 (6%) were aged ≤1 year 116 (21%) were themselves drivers

Source: FARS, 2003

Results

Child fatalities with drivers ≤15 years 165 child fatalities • 116 (70%) were themselves drivers • 157 (95%) were between 12 to 15 years

Source: FARS, 2003

Results

Child fatalities with drivers ≤15 years • Occurred in 37 states – 161 in states that allow driving <16 years – 4 in states that do NOT allow driving <16 years

• 70% unlicensed – Based on state laws, most were eligible for at least learner permit

Source: FARS, 2003

Policy Background

State differences in legal driving age (6/05) • Learner permit eligibility – Most common: 15 years old (22 states) – Youngest: 14 years old (6 states) – Oldest: 16 years old (8 states)

• Driver license eligibility – Most common: 16 years old (32 states) – Younger: <16 years old (7 states) ➘ 14 years 3 months (1 state) – Older: >16 years old (12 states)

Results

Urbanicity* of driver residence Child fatalities (freq., %) ≤15

16-19

20+

Total

Rural

89 (14.0)

147 (23.1)

401 (63.0)

637

Urban

76 (6.7)

234 (20.5)

830 (72.8)

1140

* % urban-rural zip codes in driver’s county of residence

Recommendations Policy & practice

• Primary seat belt laws • Graduated Driver Licensing passenger restrictions • Need to broaden CPS education targets – Non-parent young people who drive children – Parent transfer of learning to young drivers

Recomendations Research

• High incidence of fatalities with unlicensed drivers ≤15 years, especially in rural areas – Crash circumstances? – Purpose of trip? – Child access to passenger vehicle?

Recommendations Engineering

• Improved vehicle and vehicle restraint design – lower injury risk below 1% for 8-12 year olds

Partners for Child Passenger Safety Resources • Consumer Web site: – www.chop.edu/carseat

• Professional Web site: – www.chop.edu/traumalink

• Contact: – Suzanne Hill, [email protected]