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&rsquo ; 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.
Other written product issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO reviewed the National Highway Traffic Safety Administration's (NHTSA) new rule on federal motor vehicle safety standards for child restraint systems. GAO noted that: (1) the rule establishes a new federal standard that requires motor vehicle manufacturers to provide motorists with a new way of installing child restraints; (2) vehicles will be equipped with child restraint anchorage systems that are standardized and independent of the vehicle's seat belts; and (3) NHTSA complied with the applicable requirements in promulgating the rule."
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.
Die Zahl der bei Verkehrsunfällen getöteten und verletzten Kinder in Pkw ist in den letzten Jahren erheblich gesunken. Waren 1993, im Jahr der Einführung der gesetzlichen Pflicht zur Nutzung von Kindersitzen noch 128 getötete Kinder zu beklagen, waren es im Jahr 2011 noch 21. Neben einer hohen Sicherungsquote von Kindern im Kindersitz gibt es zahlreiche weitere Ursachen, die diese positive Entwicklung bewirkt haben. So haben sich die gesetzlichen Anforderungen an Kindersicherungssysteme ständig erhöht, wodurch ihre Schutzwirkung verbessert wurde. Genauso verbesserten sich die Sicherheit der Fahrzeuge und die Verkehrsinfrastruktur insgesamt. Dennoch muss festgestellt werden, dass die Quote der Fehlbenutzung (Misuse) von Kindersitzen in den letzten 15 Jahren konstant hoch geblieben ist. Mehr als zwei Drittel aller Kinder sind fehlerhaft im Fahrzeug gesichert, wobei manche dieser Fehler so gravierend sind, dass die Schutzwirkung des Sitzes komplett aufgehoben wird. Hier zeigt sich nach wie vor ein dringender Handlungsbedarf. Die Auswertung einer im Rahmen des EU-Forschungsprojekts CASPER durchgeführten Feldstudie hat ergeben, dass die Fehlbenutzungsquote leicht zurück gegangen ist, inwiefern dabei von einem signifikanten Trend gesprochen werden kann, lässt sich allerdings nicht absehen. Es zeigte sich weiterhin, dass die schlechte Sicherung der Kinder von Eltern in der Regel nicht vorsätzlich geschieht, sondern dass mangelndes Wissen über den richtigen Umgang mit Kindersitzen und ein gering ausgeprägtes Risikobewusstsein zur Fehlbedienung führen. Faktoren wie Zeitmangel und Stress im Moment der Sicherung erhöhen das Fehlbedienungsrisiko. Anhand der Daten von 119 rekonstruierten Pkw-Verkehrsunfällen mit 183 beteiligten kindlichen Insassen konnten Zusammenhänge zwischen bestimmten Fehlbenutzungen und daraus resultierenden Verletzungen gezeigt werden. Genauso konnte nachgewiesen werden, dass für falsch gesicherte Kinder das Risiko für schwere Verletzungen bei einem Unfall deutlich höher ist, als für korrekt gesicherte Kinder. Alle gewonnen Erkenntnisse machen deutlich, dass das Thema der Fehlbenutzung von Kindersitzen nach wie vor aktuell und drängend ist und dass es notwendig ist, dass sich Experten der Kindersicherheit mit diesem Thema befassen. Dafür ist es zunächst erforderlich, dass es in Fachkreisen von den zentralen Begriffen "Fehlbenutzung" und "Fehlerschwere" ein einheitliches Verständnis gibt. Eine experimentelle Untersuchung auf der Fachtagung "Protection of Children in Cars" im Jahr 2011 ergab, dass gleiche Fehler von verschiedenen Fachleuten ganz unterschiedlich bewertet werden. Um diesem Problem zu begegnen wird in der vorliegenden Arbeit eine Definition des Begriffs "Misuse" vorgeschlagen. Darüber hinaus wird ein für Misuseuntersuchungen häufig genutztes Codebook dahingehend überarbeitet und vereinfacht, dass es einerseits in der Praxis der Feldbeobachtung leicht und mit wenig zeitlichem Aufwand zu nutzen ist, andererseits alle wesentlichen Fehler erfasst. Dabei ist es wichtig, dass die Fehler eindeutig beschrieben und bewertet werden, so dass sichergestellt ist, dass verschiedene Beobachter zur gleichen Fehlerbewertung kommen und somit eine Vergleichbarkeit verschiedener Feldstudien gegeben ist. Abschließend enthält die vorliegende Arbeit konkrete Vorschläge, wie der Problematik der Fehlbenutzung begegnet werden sollte. Hier werden insbesondere an den Gesetzgeber Forderungen nach klaren und zwingenden Vorgaben für die Hersteller von Kindersitzen gestellt, auch erscheint es als ratsam, dass das ISOFIX-System derart optimiert wird, dass es zukünftig bessere Chancen hat eine große Marktdurchdringung zu erfahren. ; The number of killed and injured children as vehicle occupants in road accidents has declined significantly in recent years. During 1993, the year when the requirement to use child seats was introduced, 128 children were killed, while in 2011 21 children died in a car. In addition to a high percentage of children secured in a suitable child seat there are many other causes which support this positive development. The legal requirements for child restraint systems have increased constantly affecting an improvement of its protection level, simultaneously the safety of vehicles and traffic infrastructure has improved. However it must be noted that the rate of incorrect use (misuse) of child seats is consistently high in the last 15 years. More than two thirds of all children in the vehicle are not secured correctly, with some of these misuses are so serious that the protective effect of the seat will be cancelled completely. Here is still an urgent need for improvement. The evaluation of a field study, which was conducted in connection with the EU research project CASPER, has shown evidence that the quote of incorrect used child seats has declined slightly. However it is not sure, whether this is a significant trend or just a single result. Another founding from this study is that usually, the poor securing of children by parents is not done intentionally, but more by a lack of knowledge about the correct use of child restraint seats and by a low level of awareness of the misuse risk. Factors such as lack of time and stress during the child securing increase the risk of incorrect use. Based on the data of 119 reconstructed car accidents with 183 involved children as car occupants, the relationships between certain misuse types and resulting injuries have been shown. Additionally it has been shown that for incorrectly restrained children, the risk of serious injuries in an accident is much higher than for properly restrained children. All gained findings reveal that the problem of child seats misuse is still urgent and that it is necessary for experts of child safety to deal with this issue. This requires a common understanding of the central terms of "misuse" and "misuse severity". An experimental investigation on the conference "Protection of Children in Cars" in 2011 has shown that the same misuse will be evaluated by specialists in different ways. To overcome this challenge a definition of "misuse" is proposed in the present thesis. In addition, a frequently used codebook for field studies has been revised and simplified. On the one hand it should be easy to use in the practice of field observation and with little expenditure of time and on the other hand, it should cover all significant types of misuse. It is important that all misuse types are clearly identified and evaluated, to ensure that different observers get the same misuse rating and thus a comparability of different field studies is given. In conclusion, the present thesis includes concrete proposals on addressing misuse of child restraint systems. Here, in particular, to the legislator demands for clear and mandatory requirements for manufacturers of child seats are made, and it seems advisable that the ISOFIX system is optimised in a way that it has a better chance in the future to find a large market penetration.
Background and Aim: About one-third of Iranian children mortality is caused by injuries from which 36% occur due to road traffic injuries. Using child restraint embedded in vehicles can reduce road traffic fatalities by 71% for neonates and 54% for children. Based on its effectiveness in reduction of fatality and prevention of injury severity, child restraint usage mandatory law is a priority. Therefore, this study was conducted to assess opportunities and threats to mandatory law of child restraint usage in Iran. Materials and Methods: Initially, a mixed methods research is carried out by a phenomenological qualitative study, a discussion session by traffic injuries' stakeholders was performed to assess & discuss the opportunities and threats to mandatory law of child restraint usage in Iran, by brain storming method to find the themes in the related topic. A structured questionnaire is later prepared and completed by the stakeholders in the area of road traffic injuries. Assigned scores of 0-100 were considered for each response and analysis of results was performed according to target themes & the total score of the filled questionnaires.Results: Overall, 28 stakeholders participated in the study. According to the stakeholders, traffic police department obtained the highest score of 90 (from 0-100) as an organization to establish the mandatory law of child restraint usage, and acquired the score of 100 for future enforcement and monitoring. As threats and obstacle to the mandatory law of child restraint usage, lack of television and media campaigns and child restraint law and legislation, obtained the highest scores of 85 & 70 respectively. And family sensitivity to their children's health, officials' support and national facilities for broadcasting, and community awareness to use child restraints had the highest scores among existing opportunities and facilities in the country, by scores of 83, 69 and 68 respectively.Conclusion: Due to sensitivity of the family about their children's health & safety, and officials' support to safety establishment through media campaigns, implementation and applicability of child restraint usage laws and legislations, and subsequent enforcement and monitoring seem practical. ReferencesIsna.ir/fa, 13th May 2012.National Center for Statistics and Analysis. 2003, www.nhtsa.dot.gov.Global status report on road safety: time for action. Geneva, World Health Organization, 2009. (www.who.int/violence_injury_prevention/road_safety_status date of access 12 September 2012.Jacobs G, AaronThomas A, Astrop A. Estimating global road fatalities. London: Transport Research Laboratory, (TRL Report 445), First Published 2000, ISSN 0968-4107. Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. BMJ 2002; 324:1139.Ameratunga S, Hijar M, Norton R. Road traffic injuries: confronting disparities to address a global health problem. Lancet 2004; 367:1533-1540.Kopits E, Cropper M. Traffic fatalities and economic growth. Policy Research Working Paper No. 3035. Washington, DC: World Bank; 2003. Available at: http://www.ntl.bts.gov/Lib/24000/24400/24490/25935_wps3 035.pdf. Data of access June 2012.Montazeri A. Road-traffic-related mortality in Iran: A descriptive study. Public Health 2004; 118: 110- 3.Soori H, Masoudinegad M R. Azari R M. Analysis of opportunities and legal obstacle in control of road traffic injury in Iran. Final report. Safety Promotion and Injury Prevention research center of Shahid Beheshti University of Medical Sciences, 2008.Kahane, C. An Evaluation of Child Passenger Safety: The Effectiveness and Benefits of Safety Seats, Washington, DC: National Highway Traffic Safety Administration, U.S. Department of Transportation1986.World report on child injury prevention, World Health Organization 2008. Global Status Report on Road Safety. www.who.int/entity/violence safety./state of road_safety_en.pdf , access28 August.Phyllis F. AGRAN, PAuL F. WEHRL E. Injury Reduction by Mandatory Child Passenger Safety Laws. AJPH 1985; 75(2): 129.Najafi H. Research methodology in educational science and psychology, Tehran, Ahsan, 2007, first edition, page 62.Zaza S, Sleet D A, Thompson R S, Sosin DM , Bolen J C. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med 2001; 21(4 Suppl), 31-47.Desapriya E B, Iwase N, Pike I, Brussoni M, Papsdorf M. Child motor vehicle occupant and pedestrian casualties before and after enactment of child restraint seats legislation in Japan. Inj Control Saf Promot 2004; 11(4): 225-230.Staunton C, Davidson S, Kegler S, DawsonL, Powell K, Dellinger A. Critical gaps in child passenger safety practices, surveillance, and legislation: Georgia, 2001. Pediatrics 2005; 115(2): 372-379.Cameron L, Segedin E, Nuthall G, Thompson J. Safe restraint of the child passenger. J Paediatr Child Health 2006; 42(12): 752-757.Bingham CR, Eby DW, Hockanson HM, Greenspan AI. Factors influencing the use of booster seats: a state-wide survey of parents. Accid Anal Prev. 2006; 38(5):1028-1037.Ehiri J, King W, Ejere H, Mouzon P. Effects of Interventions to Increase Use of Booster Seats in Motor Vehicles for 4-8 Year Olds. Washington, DC: AAA Foundation for Traffic Safety, 2006.GunnVL, Phillippi R M, Cooper WO. Improvement in Booster Seat Use in Tennessee. Pediatrics 2007; 119: 131-136.Winston FK, Kallan MJ, Elliott M R, Xie D, Durbin D R. Effect of Booster Seat Laws on Appropriate Restraint Use by Children 4 to 7 Years Old Involved in Crashes. Archives of Pediatric Adolescent Medicine 2007; 161:270-275.NHTSA. Preliminary Data Indicate That Booster Seat Laws Increase Child Safety Seat Use.Traffic Safety Facts. Traffic Tech, 331. Washington, DC: National Highway Traffic Safety Administration, 2007.Robertson L. Automobile seat belt use in selected countries, states and provinces with and without laws requiring belt use. Accid Anal and Prev 1978; 10:5-10.Stulginskas J V, Pless B. Effects of a seat belt law on child restraint use. Am J Dis Child 1983; 137:582-585. Wagenaar A C, Webster D W. Preventing Injuries to Children Through Compulsory Automobile Safety Seat Use, Pediatrics 1986; 78 (4) : 662-672.Decina LE, Lococo KH, Ashburn W, William B, Rose H J. Identifying Strategies to Improve the Effectiveness of Booster Seat Laws, Draft Final Report, May 2008, www.nhtsa.dot.gov.Connell P M M. An evaluation of the Virginia 2002, Child passenger safety law: determining if the law reduced motor vehicle crash injuries and fatality. Virginia Common wealth University Richmond April, 2009.Seat-belts and child restraints: a road safety manual for decision-makers and practitioners London, FIA Foundation for the Automobile and Society, 2009.Istre G R, Stowe M, McCoy M A, Moore B, Culica D, Womack K N, Anderson R J. Anna B. Preventing unintentional injuries in Indigenous children and youth in Canada .Paediatr Child Health 2012; 17(7):393.
Road traffic crashes are the leading cause of morbidity and mortality in children in South Africa (SA), and are preventable through implementing a systems approach to address the causes. Proper education, child passenger legislation and enforcement of the law are priority actions. It is well known that properly employed seatbelts and child restraints reduce the risk of serious injury and death to children. However, despite campaigns such as 'Arrive Alive' to increase the use of child restraints, a 2008 observational study conducted by Red Cross War Memorial Children's Hospital (RCWMH) in Cape Town, SA, found that a majority of adults and children entering the hospital gates did not use such restraints. It is possible that this was because there was no appropriate child restraint law.
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&prime ; s and 24.5 per 100,000 for 5&ndash ; 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.
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.
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
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.
Analyzing the effect of legislation in children's safety when they travel as motor-vehicle passengers and bicycle riders can allow us to evaluate the effectiveness in transportation policies. The Child Restraint Laws (CRL) and Bicycle Helmet Laws (BHL) were studied by analyzing the nationwide Fatality Analysis Reporting System (FARS) to estimate the fatality reduction as well as drivers' decisions to use Child Restraint Systems (CRS) and bicycle helmets respectively. Differences in legislation could have different effects on traffic fatalities. Therefore, this study presents multiple methodologies to study these effects. In the evaluation of traffic safety issues, several proven statistical models have shown to be effective at estimating risky factors that might influence crash prevention. These proven models and predictive data analysis guided the process to attempt different models, leading to the development of three specific models used in this study to best estimate the effectiveness of these laws. Then, it was found that legislation in Child Safety Policy has consequences in traffic fatalities. A negative binomial model was created to analyze the CRL influence at the state-level in fatal crashes involving children, and showed that legislating on CRS can reduce the number of fatalities by 29% for children aged 5 to 9. Additionally, at the drivers-level a logistic regression model with random effects was used to determine the significant variables that influence the driver's decision to restrain his/her child. Such variables include: driver's restraint use, road classification, weather condition, number of occupants in the vehicle, traffic violations and driver's and child's age. It was also shown that drivers from communities with deprived socio-economic status are less likely to use CRS. In the same way, a binary logistic regression model was developed to evaluate the effect of BHL in bicycle helmet-use. Findings from this model show that bicyclists from states with the BHL are 236 times more likely to wear a helmet compared to those from states without the BHL. Moreover, the bicyclist's age, gender, education, and income level also influences bicycle helmet use. Both studies suggest that enacting CRL and BHL at the state-level for the studied age groups can be combined with education, safety promotion, enforcement, and program evaluation as proven countermeasures to increase children's traffic safety. This study evidenced that there is a lack of research in this field, especially when policy making requires having enough evidence to support the laws in order to not become an arbitrary legislation procedure affecting child's protection in the transportation system. ; 2017-05-01 ; M.S. ; Engineering and Computer Science, Civil, Environmental and Construction Engineering ; Masters ; This record was generated from author submitted information.
Objective: to examine parents' use of child restraint systems (CRS), and determine if parents' knowledge of, attitude toward, and use behavior of child restraint systems have improved following enactment of child restraint use laws in other cities. Design: Observations and a cross-sectional survey of drivers transporting children 17 years and under were conducted at the gate of the schools and parking lots of hospitals in Shantou. Observers recorded the seating location of child passengers, the type of restraint, and appropriate use of CRS and safety belts based on the observation. Knowledge of and attitudes towards use of CRS were reported by the driver following observation. Results: Approximately 6.6% of passengers aged 0–12 were in CRS; rate of forward-facing CRS in children aged 3–5 (9.9%) was higher than rear-facing CRS for children aged 0–2 (1.1%) and booster seat use among children aged 6–12 (0.1%). Children younger than four years old (OR = 3.395, 95% CI = 2.125–5.424), drivers having a college or higher lever education (OR = 2.908, 95% CI = 1.878–4.500) and drivers wearing seatbelt (OR = 3.194, 95% CI = 1.605–6.356) had greater odds of CRS use. Over half (56.6%) of parents might or would use CRS if they could rent CRSs with fees. Conclusions: The rate of CRS is still low in Shantou. Comprehensive public education programs supported by legislation might be an effective way to improve child passenger safety. Renting CRSs to parents could be a new approach to encourage use.
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&ndash ; 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.
