Partners for

Child Passenger Safety

“Tween” Passengers:
Center for Injury Research and Prevention
At The Children’s Hospital of Philadelphia
Risk factors for
and State Farm Insurance Companies
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

5
Fatality rate

4 1975
1994
3
1999
2 2004
1
0
<5 5 to 9 10 to 15
Age group (years)
Source: FARS, NASS
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 Telephone
Selection Interviews

CHOP/ Crash
SF
PENN Database

Case Crash
Selection Investigations
PCPS surveillance
Front row seating 1999-2004

60%
55% 54%
50%
% of Children

40% 35% 13 to 15
34%
9 to 12
30%
4 to 8
19%
20% 0 to 3

10%
7%
5% 3%
0%
'99 '00 '01 '02 '03 '04

No progress for 9-12 year olds

PCPS Surveillance
Injuries in 2004*

40 • Ç injury rate with Ç age

– Adult driver and young
30
Injuries
teens: injury rate 36 per
per 20 1000
1,000
10 • Head most common
in crashes
– Child: 11 per 1000
0
Age group – Driver: 16 per 1000
0 to 3 4 to 8 • Point of impact:
9 to 12 13 to 15
Adult driver – 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% 4%
Risk of Injury

Risk of Injury
3% 71% Reduction 3% 59% Reduction
2% 2%

1% 1%

0% 0%
Seat Belt Forward Seat Belt Booster
facing CSS Seat

Arbogast et al. Accid Anal Prev ‘04 Durbin et al. JAMA ‘03
Age-appropriate restraint
Seat belts once they fit properly
8 to 12 year olds

6%
5%
? % Reduction
Risk of 4%
Injury
3%
2%
1%
0%
Unrestrain. Belted

PCPS, 2005
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%
Face 22.3%

Chest 3.8% Neck/ Back/ Spine

1.3%
Abdomen 5.7%
Upper extremity
10.5%

1.7% risk of injury Lower Extremity 2.6%

Results
Risk Factors for Injury
8-12 year olds OR (95% CI)
n=973 with injury
(Weighted Risk)
Weight
50-74 lbs. 329 (1.5%) 0.5 (0.2, 1.1)
75-99 lbs. 374 (1.7%) 0.6 (0.3, 1.3)
100-124 lbs. 194 (1.6%) 0.5 (0.2, 1.2)
125-149 lbs. 76 (2.8%) Reference
Seat Belt Type
Lap/shoulder 790 (1.6%) Reference
Lap Only 149 (2.1%) 1.3 (0.9, 1.8)
Intrusion 360 (7.6%) 7.0 (5.1, 9.7)
No intrusion 613 (1.2%) Reference
Results
Risk Factors for Injury
8-12 year olds OR (95% CI)
n=973 with injury
(Weighted Risk)
Vehicle Type
Passenger Car 542 (2.0%) Reference
Minivan 189 (1.1%) 0.6 (0.4, 0.7)
SUV 150 (1.6%) 0.8 (0.5, 1.3)
Pickup Truck 77 (2.0%) 1.0 (0.5, 2.3)
Driver Age
< 25 years 69 (3.2%) 2.0 (1.3, 3.2)
> 25 years 904 (1.6%) Reference
Driver restraint use
Restrained 921 (1.6%) Reference
Unrestrained 52 (4.6%) 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 • Current vehicle seat

belts do not provide
6% optimal protection as
5% defined by performance
Injury 70% Reduction
Risk 4%
of child restraints
3% – Set the target at
2% <1% injury risk
1% • How do we achieve
0% this?
Unrestrain. Belted

PCPS, 2005
New Developments
8-12 Year Olds
• Development of 10 yr old
ATD
• New regulation requiring
L/S belts in all rear seat
positions
• Rear row seat belt
10 y.o. ATD 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
Serious Injury to Child Passengers
6
5
5
4.3
Percentage Injury

2 1.5

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)

350

300
Number of fatalities

250
20 & older
200
16 to 19
150 Under 16
100

50

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Child age
FARS 2003
In-depth Analysis #3
Child fatalities by driver age (n=1777)

350

300
Number of fatalities

250
20 & older
200
16 to 19
150 Under 16
100

50

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Child age
FARS 2003
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 89 147 401 637

(14.0) (23.1) (63.0)

Urban 76 234 830 1140

(6.7) (20.5) (72.8)

* % 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, hillsu@email.chop.edu