The effect of punishment and feedback on correcting erroneous behavior.

INTRODUCTION: Understanding the consequences of non-punitive sanctions and feedback for nonintentional deviations (i.e., errors) is important to effective safety policy. This study aims to address a lack of research on the effects of punishment and feedback on correcting erroneous behavior in the context of multitasking. METHOD: A Multi-Attribute Task Battery (MATB-II) was employed to simulate the demands of aviating, an important area of applied safety. Sixty participants were randomly assigned to one of four experimental groups (no intervention, punishment, feedback, punishment + feedback) and asked to perform the MATB-II. Punishment, feedback, and punishment + feedback decreased error and increased performance, with punishment alone having the greatest effect. RESULTS: The results highlight the need for behavioral consequences or feedback to reduce erroneous behavior. PRACTICAL APPLICATIONS: From an applied perspective, these results have implications for policy and training.

Associations between walkability and pedestrian related injuries is modified by sociodemographic characteristics.

BACKGROUND: Walkability scores have been developed to measure how well the characteristics of the physical environment support walking. However, because pedestrian safety is not taken into account, areas that have higher Walk Scores could be associated with more walking and also more pedestrian-related injury. We aimed to explore the association between Walk Score and pedestrian-related injury in Sydney. METHOD: Pedestrian-related injuries from 2010 to 2018 in Sydney were identified in the New South Wales Combined Admitted Patient Epidemiology Data. Walk Score was used to measure area-level walkability in Sydney statistical division. Regression models were used to examine the association between Walk Score, pedestrian-related injury, length of hospital stay (LOS) and injury severity. RESULT: Among people aged ≤64 years, there was no significant association between walkability score and pedestrian-related injury. Among people aged ≥ 65 years, walkability score was significantly positively associated with pedestrian-related injury, which peaked at Somewhat Walkable. For most disadvantaged areas, the risk of pedestrian-related injury was highest for areas that were classified as Somewhat Walkable. For moderately disadvantaged areas, the risk of pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas. For the least disadvantaged areas, there was no significant association between walkability score and pedestrian-related injury. For LOS among people aged ≥ 65 years or in the most disadvantaged areas, it peaked at Somewhat Walkable areas. For injury severity, the risk of serious pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas among people aged 16-64 years. CONCLUSION: For the majority of the population, built environment characteristics that are considered to make walking attractive also make it safer, offsetting any exposure-related increase injury risk. However, this is not the case for people aged ≥ 19 years, and those living in socioeconomically disadvantaged areas. Incorporating measures of pedestrian safety in walkability scores may create an impetus to ensure that the built environment is designed to support the safety of pedestrians from these groups.

The effect of broadband noise on learning and dynamic decision-making and how cognitive workload and sex moderate its effect.

The aim of this research was to examine how broadband noise which is present in many workplaces affects dynamic decision-making. The effect of potential moderating factors, cognitive workload and sex, were also examined. Forty-eight participants (24 females) with an average age of 27.38 years (SD = 12.34) were asked to complete a dynamic decision-making task over three consecutive-days. Independent variables were Noise (Broadband - 0dBA vs. 75dBA above background) and Cognitive Workload (Low vs. High, manipulated via presence of a secondary task). Among females, broadband noise significantly impaired performance in low workload, but significantly improved performance in high workload. In contrast, among males broadband noise had no significant effect on overall performance. From an applied perspective, understanding the interaction between noise, cognitive workload and sex allows for the design of a training environment to ensure maximum performance by all staff.

At what stages of licensing do graduated driver licensing systems reduce crashes? Example from Queensland, Australia.

Evaluations of new graduated licensing systems (GLS) commonly examine pre-post young driver crash rates relative to another driver group. This comparison approach is important to account for other influences on crashes over time, but has limited ability to determine which GLS components are most effective and at what stage during the licensing process. We previously identified declines in young driver crashes in Queensland, Australia, following introduction of a new GLS in 2007. The objective of the current research was to conduct complementary modelling to identify at what points through the licensing process had particular GLS policies contributed to reductions. Crash trends were explored for learner and provisional drivers under the new GLS versus previous system for three time periods relative to the month of acquiring a provisional licence: the preceding learner period, the first month of provisional licensure (when crashes typically peak), and the overall provisional period. Interrupted time series analyses were conducted for the log ratio of crashes per 10,000 licensed (learner and provisional) drivers with the total number of licensed drivers as an offset. The greatest declines were found in the first month of licensure, with indications that a longer learner period, higher supervised driving hours, and a new provisional night-passenger restriction were key contributors to provisional crash reductions. There was also some indication that a restriction on all phone use reduced crashes during the learner period. We conclude that time series analysis focusing on licensing stage, rather than calendar time only, offers a complementary approach to analysing GLS effectiveness by better identifying where and how changes impact crashes.

Associations between graduated driver licensing and road trauma reductions in a later licensing age jurisdiction: Queensland, Australia.

The success of driver graduated licensing systems (GLS) is demonstrated primarily in jurisdictions that licence at young ages with requirements expiring at age 18. In Australia, GLS requirements typically apply for all applicants aged under 25. In 2007, the Queensland licensing system was strengthened, extending the learner and introducing a 100-hour supervised driving requirement, introducing restrictions on passenger carriage at night and high-powered vehicles for provisional drivers, and on phone use for all novice drivers (learner and provisional). The objective of the current research was to evaluate whether these changes were associated with reductions in crashes (all) and killed-and-serious-injury (KSI) crashes involving novice drivers, and respective casualties. Government licensing and police crash records were linked and interrupted time series analysis was used to examine potential shifts in crash trends by rates of licensed drivers per month. Substantial declines were found in novice driver crashes (13.1% per year; 95%CI -0.0130, -0.0096), crash casualties (13.9% per year; 95%CI -0.0137, -0.0101), KSI crashes (5.4% per year; 95%CI -0.0080, -0.0046) and associated casualties (5.2% per year; 95%CI -0.0075, -0.0039). Compared to the total licensed driver population, declines in crashes (3.0% per year; 95%CI -0.0027, -0.0007) and crash casualties (2.9% per year; 95%CI -0.0029, -0.0006) but not KSI outcomes were observed. More narrowly, declines were found for provisional-licensed driver crashes (9.3% per year; 95%CI -0.0096, -0.0063) and KSI crashes (3.6% per year; 95%CI -0.0004, -0.0128) that were approximately 2.6% and 1.2% greater than respective declines for 25-29-year-old open-licensed drivers. Substantial declines also were observed in novice driver single-vehicle, night, passenger and alcohol crashes. Overall, these results demonstrate that GLS can be effective in a later age licensing jurisdiction. However, KSI outcomes were limited. Modelling research is recommended on ways to further strengthen Queensland's GLS to achieve greater trauma reductions.

The effects of training impulse control on simulated driving.

There is growing interest in young driver training that addresses age-related factors, including incompletely developed impulse control. Two studies investigated whether training of response inhibition can reduce risky simulated driving in young drivers (aged 16-24 years). Each study manipulated aspects of response inhibition training then assessed transfer of training using simulated driving measures including speeding, risky passing, and compliance with traffic controls. Study 1 (n = 65) used a Go/No-go task, Stop Signal Task and a Collision Detection Task. Designed to promote engagement, learning, and transfer, training tasks were driving-relevant and adaptive (i.e. difficulty increased as performance improved), included performance feedback, and were distributed over five days. Control participants completed matching "filler" tasks. Performance on trained tasks improved with training, but there was no significant improvement in simulated driving. Study 2 enhanced response inhibition training using Go/No-go and SST tasks, with clearer performance feedback, and 10 days of training. Control participants completed testing only, in order to avoid any possibility of training response inhibition in the filler tasks. Again performance on trained tasks improved, but there was no evidence of transfer of training to simulated driving. These findings suggest that although training of sufficient interest and duration can improve response inhibition task performance, a training schedule that is likely to be acceptable to the public does not result in improvements in simulated driving. Further research is needed to investigate whether response inhibition training can improve risky driving in the context of real-world motivations for risky driving.

The impact of environmental factors on cycling speed on shared paths.

BACKGROUND: Despite the importance of cycling speed on shared paths to the amenity and safety of users, few studies have systematically measured it, nor examined circumstances surrounding it. METHODS: Speed was measured for 5421 riders who were observed cycling on shared paths across 12 metropolitan and regional locations in Sydney, Australia. Multivariate regression analysis was carried out to examine rider and environmental factors that contribute to riders cycling above the median speed. RESULTS: The study found that observed riders travelled at a median speed of 16km/h (mean 18.4km/h). Nearly 80% of riders travelled at 20km/h or less and 7.8% at speeds of more than 30km/h. Riders were significantly less likely to cycle above the median speed on shared paths that had an average volume of over 20 pedestrians/hour. Riders were significantly more likely to travel above the median speed on paths that had a centreline (OR: 1.71, 95% CI: 1.41-2.07), on wider paths (over 3.5m) (OR: 1.34, 95% CI: 1.12-1.59) and on paths with visual segregation between cyclists and pedestrians. Visual segregation, where cycling and walking areas are differentiated by the type of material or by paint colour used, was the strongest predictor of travelling above median speed on shared paths (OR: 3.9, 95% CI: 3.1-4.8). CONCLUSIONS: The findings suggest that riders adjust their speeds to accommodate pedestrians and path conditions. Path characteristics that support separation from pedestrians may allow relatively higher speeds, and associated amenity, without substantial loss of safety.

An examination of the relationship between measures of impulsivity and risky simulated driving amongst young drivers.

The risky driving of young drivers may owe in part to youthful motivations (such as experience-seeking, authority rebellion, desire for peer approval) combined with incompletely developed impulse control. Although self-reported impulsiveness has been positively associated with self-reports of risky driving, results based on objective measures of response inhibition (e.g., Go/No-go tasks) have been inconclusive. The present study examined interrelationships between measures of response inhibition, self-report impulsiveness scales, and responses to events during a simulated drive that were designed to detect impulsive, unsafe behaviours (e.g., turning across on-coming traffic). Participants were 72 first-year Psychology students. More speeding and "Unsafe" responding to critical events during simulated driving were associated with poorer impulse control as assessed by commission errors during a Go/No-Go task. These results consolidate evidence for a relationship between impulse control and risky driving amongst young drivers.

Transport cyclists and road rules: what influences the decisions they make?

OBJECTIVE: To determine the level of adherence by transport cyclists to road rules in traffic situations and their reasons for non-adherence. DESIGN: The Safer Cycling Study was a prospective cohort study of transport and recreational cyclists. Over 2000 cyclists were recruited between March and November 2011. SUBJECTS AND SETTING: 770 Transport cyclists aged 18 years and older, who lived in New South Wales, Australia. Participants completed a baseline questionnaire plus provided data during a further six survey weeks over 12 months. In one of their survey weeks, cyclists were asked how often they infringed road rules and what contributory factors led to their road rule infringement. Data were collected via web-based online questionnaires. METHODS: Quantitative data were analysed descriptively. Qualitative data were analysed to identify themes derived from the text. RESULTS: Riding on the footpath and red light infringement were the most commonly reported road rule breaches. Poor infrastructure design was the most frequently identified contributing factor to road rule breaches, followed by the speed of motorised traffic and the behaviour of other road users. CONCLUSIONS: A transport network needs to facilitate cyclists of all capabilities to reach their required destination in a safe and timely manner, and encourage compliance with the road rules.

Thrill and adventure seeking as a modifier of the relationship of perceived risk with risky driving among young drivers.

Risky driving contributes to road trauma, a leading cause of mortality among young people. Health-relevant behaviour models suggest a negative relationship between risky driving and perceived risk of its outcomes. However, high sensation seekers may value the "thrill" of the risk, and positive associations between sensation seeking and risky driving have been observed. This is the first study to examine whether aspects of sensation seeking modify the relationship between perceived risk and risky driving. Young drivers in metropolitan Sydney and rural New South Wales [NSW] (n=797) completed a survey relating to one of the four risky driving behaviours (speeding, drink-driving, driving while fatigued, and failing to wear a seatbelt). Results suggest that the Thrill and Adventure Seeking subscale of Zuckerman's (1994) Sensation Seeking Scale moderate the relationship of perceived risk with risky driving - indicating a negative relationship for low-scores, but not high-scorers, on the TAS subscale. Thus, road safety campaigns that emphasize the riskiness of a particular behaviour may be of limited benefit to thrill and adventure seekers.

A qualitative approach using the integrative model of behaviour change to identify intervention strategies to increase optimal child restraint practices among culturally and linguistically diverse families in New South Wales.

OBJECTIVES: To qualitatively explore barriers to optimal child restraint use using the integrative behaviour change model in culturally and linguistically diverse (CALD) communities in New South Wales (NSW), Australia. METHODS: A semi-structured discussion was used to conduct 11 language specific focus groups in Arabic, Assyrian, Cantonese, Mandarin, Vietnamese and Turkish. Translated transcriptions were analysed using the major concepts of the integrative behaviour change model. RESULTS: Restraint use intent among CALD community carers is related to perceived safety of their children and complying with the law. While most participants appreciated the safety benefits of correct and appropriate use, a minority did not. Child restraint legislation may positively influence social norms, and enforcement appears to increase parental self-efficacy. However, concerns over child comfort may negatively influence both norms and self-efficacy. There are clear deficits in knowledge that may act as barriers as well as confusion over best practice in safely transporting children. Large family size, vehicle size and cost appear to be real environmental constraints in CALD communities. CONCLUSION: Determinants of intent and deficits in knowledge in this diverse range of CALD communities in NSW Australia are similar to those reported in other qualitative studies regardless of the population studied. This indicates that key messages should be the same regardless of the target population. However, for CALD communities there is a specific need to ensure access to detailed information through appropriate delivery strategies and languages. Furthermore, practical constraints such as cost of restraints and family size may be particularly important in CALD communities.

Impairment of a speed management strategy in young drivers under high cognitive workload.

BACKGROUND: A training method known as Episodic training has shown promise in reducing speeding behavior in young drivers (Prabhakharan and Molesworth, 2011). The present study aimed to investigate how cognitive resources are utilized to implement this behavioral change. METHOD: 60 participants were randomly divided into four groups and completed a simulated training drive in Week 1 followed by a 10km simulated test drive in Week 2. As part of the test drive, two groups were asked to complete a secondary task (mental arithmetic task) in addition to the test drive. RESULTS: The results indicated that implementing a speed management strategy elicited by Episodic training was successful in isolation, but came at a cognitive trade-off when performed in conjunction with a secondary task. CONCLUSION: From an applied perspective, these results suggest driver training programmes should compartmentalize driver training in order to reduce the cognitive load experienced by trainee drivers, and hence facilitate in driver skill acquisition.

Development and evaluation of an intervention to reduce rip current related beach drowning.

The objective of this research was to evaluate a campaign to improve beachgoer recognition of calm-looking rip currents, known to contribute to surf drowning. Posters, postcards, and brochures conveying the message "Don't get sucked in by the rip" were distributed in an intervention area. Beachgoers were interviewed in this and a similar control area one year before and immediately after the intervention (respective response rates: 69.9% and 82.3%), Consenting respondents were sent follow-up questionnaires after approximately 6 months and 55% responded. In the intervention area, 28.8% of post-intervention, and 57.2% of follow-up respondents, had seen our campaign. At post-intervention, intervention respondents demonstrated improvement (relative to baseline) in intentions to swim away from a calm-looking rip, ability and confidence in identifying a rip, intention never to swim at unpatrolled beaches, and responses to being caught in a rip, compared to the control respondents. Similar improvements were observed post-intervention for respondents in the intervention area who had seen our campaign (relative to those who had not), and at 6 month follow-up for intervention respondents (relative to control respondents). The relatively brief print-based campaign was effective in warning beachgoers about calm-looking rips.

Exposure-based cycling crash, near miss and injury rates: the Safer Cycling Prospective Cohort Study protocol.

INTRODUCTION: There are clear personal, social and environmental benefits of cycling. However, safety concerns are among the frequently cited barriers to cycling. In Australia, there are no exposure-based measures of the rates of crash or 'near miss' experienced by cyclists. DESIGN AND SETTING: A prospective cohort study over 12 months, with all data collected via web-based online data entry. PARTICIPANTS: Two thousand adults aged 18 years and older, living in New South Wales (Australia), who usually bicycle at least once a month, will be recruited from March to November 2011. METHODS: In the 12 months following enrolment, cyclists will be surveyed on six occasions (weeks 8, 16, 24, 32, 40 and 48 from the week of the enrolment survey). In these survey weeks, cyclists will be asked to provide daily reports of distance travelled; time, location and duration of trips; infrastructure used; crashes, near misses and crash-related injuries. Information on crashes and injuries will also be sought for the intervening period between the last and current survey. A subsample of participants will receive bicycle trip computers to provide objective measurement of distance travelled. DISCUSSION: This study protocol describes the prospective cohort study developed to assess near misses, crashes and injuries among cyclists by time and distance travelled and by type of infrastructure used, with recruited participants entering data remotely using the internet. We expect to be able to calculate event rates according to exposure overall and for different infrastructure types and to report in-depth information about event causation.

Child Restraint Fitting Stations reduce incorrect restraint use among child occupants.

This study evaluated the effectiveness of the NSW Restraint Fitting Station Network in preventing incorrect use of rearward facing and forward facing child restraints. The way children used restraints was observed randomly as they arrived at observation sites during a cross-sectional ecological study across New South Wales, Australia. Trained researchers examined restraint system installation once the child left the vehicle. A structured interview was also conducted with the driver. Logistic regression was used to examine the association between parental report of ever having the restraint checked at a Restraint Fitting Station and whether or not the restraint was used correctly, while controlling for potential confounders and accounting for the complex sample design. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The results demonstrated that children of respondents who did not use Restraint Fitting Stations were 1.8 times more likely to be incorrectly using their restraints (95% CI 1.1-2.8) than children of Restraint Fitting Station users. Regardless of whether or not a Restraint Fitting Station had been used, there was a trend towards a greater likelihood of incorrect restraint use as the length of restraint ownership increased (OR 1.3 95% CI 1.0-1.7). These results are important for developing strategies aimed at reducing child occupant casualties by reducing the rate of incorrect restraint use, and support programs encouraging the use of Restraint Fitting Stations and similar services as a countermeasure to incorrect use.

The characteristics of incorrect restraint use among children traveling in cars in New South Wales, Australia.

OBJECTIVE: This study aims to provide population estimates of incorrect restraint use among children aged 0-12 traveling in cars in New South Wales (NSW) and describe the errors occurring in different restraint types. METHODS: Observations of randomly selected children and restraints were conducted in situ by trained researchers at sites statewide. Observation sites were randomly selected using a multistage stratified sample plan. Restraint use errors were recorded and analyzed by severity of error and restraint type using complex survey analysis techniques. RESULTS: One in two children was incorrectly restrained, and 38 percent in a serious manner. Multiple errors were common (31% of children). Both installation and "securing" errors were common, with installation errors more common in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats) than single-mode restraints (odds ratio [OR] 4.3; 95% confidence interval [CI] 1.7-10.8). Multiple errors were more common in convertible restraints (OR 3.6; 95% CI 1.9-7.0). The most frequently observed errors were excessive seat belt slack (>25 mm), incorrect belt routing, nonengagement of the seat belt buckle, very loose harness (>25 mm slack), harness off the shoulder, nonuse of belt guides, sash belt worn under the arm, and very twisted harnesses and belts (>2 twists). For rearward- and forward-facing restraints the highest priorities in terms of frequency and degradation in crash protection are errors related to harness use. For booster seat users the most important are those related to correct seat belt and belt guide use. For seat belt users, errors related to correct positioning of the sash belt are key. CONCLUSIONS: The results indicate that many errors are currently occurring in the way children are using restraints, as well as problems associated with the way child restraint systems are installed in vehicles. Incorrect use is particularly problematic in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats). Different priorities, in terms of the frequency and potential degradation in crash protection due to incorrect use for different restraint types, exist and these are important for those designing countermeasures to this problem.

Beachgoers' beliefs and behaviours in relation to beach flags and rip currents.

BACKGROUND: Coastal drownings claim on average 82 people per year in Australia. Beach flags are a primary safety strategy used on beaches. They are located away from rip currents, which are the main beach hazard affecting swimmers. Little is known about the behavioural and motivational factors associated with people choosing where to swim in relation to flags and rips. AIMS: To assess the beliefs and behaviours of beachgoers in relation to beach flags and rip currents. METHODS: Beachgoers at beaches in NSW were interviewed about their swimming beliefs and behaviours. They were asked to indicate on pictures depicting beach scenarios involving beach flags and fixed rip currents, where they would and would not swim. Logistic regression analysis was undertaken to determine predictors of correct and incorrect swimming behaviour. RESULTS: Beachgoers who are aged from 30 to 49 years (OR 0.34, 95% CI 0.16, 0.74, p=0.006) are less likely to choose to swim between the flags than other swimmers. In addition, beachgoers who are at the beach with children are significantly more likely to choose to swim between the flags (OR 2.74, 95% CI 1.39, 5.40, p=0.004). Beachgoers with basic knowledge about rip currents are significantly more likely to swim away from the rip (OR 11.59, 95% CI 5.89, 22.81, p<0.001). DISCUSSION AND CONCLUSIONS: Ocean swimmers aged from 30 to 49 years may choose to swim outside the flags, though they may not necessarily be swimming in the rip. Swimming outside of the flags may be linked with experience. The flags appear to be attractive to parents and carers of children. Whilst the flags indicate a relatively safe area of the beach, it is still vitally important for parents and carers to supervise children in this area. Basic rip current knowledge is an essential component in developing national interventions aimed at reducing coastal drowning. Beachgoers clearly need to know what a rip looks like in order to actively avoid swimming in it.

Population-level estimates of child restraint practices among children aged 0-12 years in NSW, Australia.

This cross-sectional study provides population-referenced data on the restraints used and the extent of incorrect restraint use, among child vehicle passengers aged 0-12 years in NSW, Australia. A multistage stratified cluster sampling plan was used to randomly select vehicles from baby/child health clinics, pre-schools/day care centres, and primary schools across NSW to undergo detailed inspection of restraints used by child occupants within those vehicles. Overall, there were very high restraint usage rates (>99% of sampled children) but fewer than one quarter of children were using the correct size-appropriate restraints. Incorrect use (51.4%) was as common as inappropriate use (51.2%). Incorrect use was highest among users of dedicated child restraint systems (OR 16.0, 95% CI 6.9-36.0), and was more likely among those using size-appropriate restraints than those using inappropriate restraints (OR 1.8 95% CI 1.1-3.2); and among convertible restraints than those designed for a single mode of use (OR 1.5 95% CI 1.2-1.7). As incorrect use substantially reduces the protection from injury that is offered by child restraints, it is important that future strategies to reduce casualties among child occupants target both inappropriate and incorrect use.

Trends in the incidence of hospitalisation for injuries resulting from non-traffic crashes in New South Wales, July 1998 to June 2007.

OBJECTIVE: To describe changes in the incidence of hospitalised injury for New South Wales residents involved in non-traffic crashes for the period 1 July 1998 to 30 June 2007. DESIGN, SETTING AND PARTICIPANTS: This study identified 37 480 NSW residents admitted to hospitals for injuries resulting from non-traffic crashes from the NSW Admitted Patients Data Collection during the study period. Injury rates were calculated by applying 2001 census-derived estimates of NSW population figures as the denominator, and directly adjusting to the age distribution of the 2001 Australian population. The significance of trends in rates was assessed by the per cent change annualised estimator. MAIN OUTCOME MEASURES: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, travel mode and severity of injuries. RESULTS: The annual rate of hospitalisation for injury showed a significant increase of 0.7% per annum (95% CI, 0.2% to 1.2%) for NSW residents involved in non-traffic crashes over 10 years. Annual hospitalisation rates for serious injuries increased by 2.2% (95% CI, 0.9% to 3.6%). The hospitalised injury rate for motorcyclists and pedal cyclists increased significantly by 3.3% per annum (95% CI, 2.4% to 4.2%) and 3.7% (95% CI, 2.6% to 4.9%), respectively, but the rate declined significantly for car occupants and pedestrians by - 8.3% per annum (95% CI, - 9.5% to - 7.0%) and - 2.2% (95% CI, - 4.2% to - 0.2%) respectively. CONCLUSIONS: The rate of hospitalisation for injury from non-traffic crashes increased significantly over time for NSW residents from 1998-99 to 2007-08, especially for serious injuries and injuries to motorcyclists and pedal cyclists. These findings call for continuing and specific effort to prevent road non-traffic injuries.

Relative benefits of population-level interventions targeting restraint-use in child car passengers.

OBJECTIVES: Because public health resources for injury prevention are limited, methods for comparing competing strategies are needed. We aimed to estimate potential injury reductions for 4 population-level interventions that target restraint practices for child car passengers aged 0 to 12 years. METHODS: Population-attributable risk fraction (PARF) is a population-level estimate of excess risk from exposure to a risk factor. PARFs were calculated for each intervention scenario by using published age-specific mortality/injury relative-risk estimates; restraint practices among injured child car passengers from police-collected data; and observational data for correctness of restraint use in New South Wales, Australia. PARF reductions were estimated for population uptakes of 25%, 50%, and 75%. RESULTS: Assuming a 50% population uptake, (1) promoting age-appropriate restraint use could prevent additional fatalities (5.1%, infants; 3.4%, 1- to 6-year-olds) and nonfatal injuries (3.2%, infants; 16.2%, 1- to 6-year-olds) compared with promoting any restraint use; (2) further encouraging correct age-appropriate restraint use could also prevent additional fatalities (9.1%, infants; 14.3%, 1- to 6-year-olds) and nonfatal injuries (9.2%, infants; 10.7%, 1- to 6-year-olds); and (3) for children aged 7 to 12 years, promoting correct use of restraints could prevent an additional 3.4% fatalities and 3.1% nonfatal injuries compared with promoting any restraint use. CONCLUSIONS: Interventions that target child passenger-restraint practices offer population-level benefits in terms of reduction in fatalities and injuries. These tangible benefits call for action internationally, not only to promote restraint use but correct age-appropriate restraint use for child car passengers.