Emergency Department Visits for Pedestrians Injured in Motor Vehicle Traffic Crashes - United States, January 2021-December 2023.

Traffic-related pedestrian deaths in the United States reached a 40-year high in 2021. Each year, pedestrians also suffer nonfatal traffic-related injuries requiring medical treatment. Near real-time emergency department visit data from CDC's National Syndromic Surveillance Program during January 2021-December 2023 indicated that among approximately 301 million visits identified, 137,325 involved a pedestrian injury (overall visit proportion = 45.62 per 100,000 visits). The proportions of visits for pedestrian injury were 1.53-2.47 times as high among six racial and ethnic minority groups as that among non-Hispanic White persons. Compared with persons aged ≥65 years, proportions among those aged 15-24 and 25-34 years were 2.83 and 2.61 times as high, respectively. The visit proportion was 1.93 times as high among males as among females, and 1.21 times as high during September-November as during June-August. Timely pedestrian injury data can help collaborating federal, state, and local partners rapidly monitor trends, identify disparities, and implement strategies supporting the Safe System approach, a framework for preventing traffic injuries among all road users.

Belt fit for children in vehicle seats with and without belt-positioning boosters.

OBJECTIVE: The purpose of the current study is to use 3D technology to measure in-vehicle belt fit both with and without booster seats across different vehicles among a large, diverse sample of children and to compare belt fit with and without a booster. METHODS: Lap and shoulder belt fit were measured for 108 children ages 6-12 years sitting in the second-row, outboard seats of three vehicles from October 2017 to March 2018. Each child was measured with no booster, a backless booster, and a high-back (HB) booster in three different vehicles. Alternative high-back (HB HW) and backless boosters that could accommodate higher weights were used for children who were too large to fit in the standard boosters. Lap and torso belt scores were computed based on the belt location relative to skeletal landmarks. RESULTS: Both lap and torso belt fit scores were significantly different across vehicles when using the vehicle belt alone (no booster). In all vehicles, lap belt fit improved when using boosters compared with no booster among children ages 6-12 years in rear seats-with one exception of the HB HW booster in the minivan. Torso belt fit improved when using boosters compared with no booster in the sedan, and torso belt fit improved in the minivan and SUV with the use of HB and HB HW boosters when compared with no booster. CONCLUSIONS: Lap and torso belt fit for children ages 6-12 years in rear seats was substantially improved by using boosters. Parents and caregivers should continue to have their children use booster seats until vehicle seat belts fit properly which likely does not occur until children are 9-12 years old. Decision makers can consider strengthening child passenger restraint laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 to improve belt fit and reduce crash injuries and deaths.

Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019.

OBJECTIVE: The objective of the study was to examine child deaths in motor vehicle crashes by rurality, restraint use, and state child passenger restraint laws. STUDY DESIGN: 2015-2019 Fatality Analysis Reporting System data were analyzed to determine deaths and rates by passenger and crash characteristics. Optimal restraint use was defined using age and the type of the restraint according to child passenger safety recommendations. RESULTS: Death rates per 100 000 population were highest for non-Hispanic Black (1.96; [1.84, 2.07]) and American Indian or Alaska Native children (2.67; [2.14, 3.20]) and lowest for Asian or Pacific Islander children (0.57; [0.47, 0.67]). Death rates increased with rurality with the lowest rate (0.88; [0.84, 0.92]) in the most urban counties and the highest rate (4.47; [3.88, 5.06]) in the most rural counties. Children who were not optimally restrained had higher deaths rates than optimally restrained children (0.84; [0.81, 0.87] vs 0.44; [0.42, 0.46], respectively). The death rate was higher in counties where states only required child passenger restraint use for passengers aged ≤6 years (1.64; [1.50, 1.78]) than that in those requiring child passenger restraint use for passengers aged ≤7 or ≤8 years (1.06; [1.01, 1.12]). CONCLUSIONS: Proper restraint use and extending the ages covered by child passenger restraint laws reduce the risk for child crash deaths. Additionally, racial and geographic disparities in crash deaths were identified, especially among Black and Hispanic children in rural areas. Decision makers can consider extending the ages covered by child passenger restraint laws until at least age 9 to increase proper child restraint use and reduce crash injuries and deaths.

Examining Patterns of Driving Avoidance Behaviors Among Older People Using Latent Class Analysis.

Objectives: Some older drivers choose to avoid certain situations where they do not feel confident driving. Little is known about the process by which older drivers may use avoidance in transitioning to non-driving. Methods: We analyzed 2015 ConsumerStyles data for 1198 drivers aged 60+. Driving patterns were examined by sociodemographic and driving characteristics. Avoidance classes were characterized by latent class analysis. Results: Among drivers 60+, 79% reported driving 3+ days/week and 84% reported good to excellent health. We identified four driving avoidance classes (low, mild, moderate, and high). High- (versus low-) avoidance drivers were more likely female, 75+, not White/non-Hispanic, and to have income <$25,000/year. Discussion: Avoidance of selected driving behaviors may be one component of a multi-step process supporting the transition to non-driving. Drivers displaying avoidance behaviors may be receptive to resources to prepare for this transition and minimize negative health and quality of life outcomes that accompany driving cessation.

Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates.

BACKGROUND: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. OBJECTIVE: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). METHODS: Estimates of child restraint use from two online, cross-sectional surveys-FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults-were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child's restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0-4 years, forward-facing CSS use for children aged 2-7 years, booster seat use for children aged 5-12 years, and seat belt use for children aged 9-12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. RESULTS: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5-94.1) (FallStyles) and 89.4% (CI: 85.5-93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9-91.3) (Estilos) and 84.4% (CI: 79.0-88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7-79.0) (FallStyles) to 59.7% (CI: 55.0-64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1-81.0) (Estilos) to 57.2% (CI: 51.2-63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups.

Unintentional injury deaths in children and youth, 2010-2019.

BACKGROUND: Unintentional injuries are the leading cause of death for children and youth aged 1-19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0-19 years have changed during 2010-2019. METHOD: CDC analyzed 2010-2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0-19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state. RESULTS: From 2010-2011 to 2018-2019, unintentional injury death rates decreased 11% overall-representing over 1,100 fewer annual deaths. However, rates increased among some groups-including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018-2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15-19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010-2011 to 2018-2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)-driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.

Older Adults' Attitudes About Future Mobility Changes and the Usefulness of Mobility Assessment Materials.

OBJECTIVES: To understand older adults' attitudes about future mobility and usefulness of mobility assessment materials. METHODS: Data came from a telephone survey of 1,000 older adults aged 60-74 years. After answering baseline questions, respondents received mobility assessment materials, then completed follow-up interviews. Respondents were asked about future mobility challenges. During baseline and follow-up, subjects were asked four questions about their mobility as they aged which measured thinking about mobility, thinking about protecting mobility, confidence in protecting mobility, and motivation to protect mobility. Differences in percent of respondents' attitudes between baseline and follow-up and 95% confidence intervals were calculated. RESULTS: Driving (42%) was the most commonly reported challenge. Significant increases from baseline to follow-up in thinking about mobility (25%), thinking about protecting mobility (39%), and confidence in protecting mobility (29%) were reported. DISCUSSION: Brief mobility assessment materials can encourage older adults to consider future mobility. Planning for changes can prolong safe mobility.

Motor vehicle injury prevention in eight American Indian/Alaska Native communities: results from the 2010-2014 Centers for Disease Control and Prevention Tribal Motor Vehicle Injury Prevention Program.

OBJECTIVES: The aim of the study is to increase seat belt (SB) use and reduce motor vehicle (MV) injuries and death; eight tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. STUDY DESIGN: SB use was measured through direct observational surveys and traffic safety activity data. Traffic safety activities included enhanced enforcement campaign events, ongoing enforcement of SB laws, and media. The number of MV injuries (including fatal and non-fatal) was measured through MV crash data collected by police. RESULTS: Percentage change increases in SB use were observed in all eight projects; average annual increases of three projects were statistically significant (ranging from 10% to 43%). Four of the eight projects exceeded their goals for percentage change increases in SB use. Approximately 200 media events and 100 enforcement events focused on SB use were conducted across the eight projects. Five projects had an annual average of ≥100 SB use citations during the project period. MV injuries (fatal and non-fatal combined) significantly decreased in three projects (ranging from a 10% to 21% average annual decrease). CONCLUSIONS: Increases in SB use and decreases in the number of MV injuries can be achieved by tailoring evidence-based strategies to tribal communities.

Characteristics of Single Vehicle Crashes with a Teen Driver in South Carolina, 2005-2008.

OBJECTIVE: Teens' crash risk is highest in the first years of independent driving. Circumstances surrounding fatal crashes have been widely documented, but less is known about factors related to nonfatal teen driver crashes. This study describes single vehicle nonfatal crashes involving the youngest teen drivers (15-17 years), compares these crashes to single vehicle nonfatal crashes among adult drivers (35-44 years) and examines factors related to nonfatal injury producing crashes for teen drivers. METHODS: Police crash data linked to hospital inpatient and emergency department data for 2005-2008 from the South Carolina Crash Outcomes Data Evaluation System (CODES) were analyzed. Nonfatal, single vehicle crashes involving passenger vehicles occurring on public roadways for teen (15-17 years) drivers were compared with those for adult (35-44 years) drivers on temporal patterns and crash risk factors per licensed driver and per vehicle miles traveled. Vehicle miles traveled by age group was estimated using data from the 2009 National Household Travel Survey. Multivariable log-linear regression analysis was conducted for teen driver crashes to determine which characteristics were related to crashes resulting in a minor/moderate injury or serious injury to at least one vehicle occupant. RESULTS: Compared with adult drivers, teen drivers in South Carolina had 2.5 times the single vehicle nonfatal crash rate per licensed driver and 11 times the rate per vehicle mile traveled. Teen drivers were nearly twice as likely to be speeding at the time of the crash compared with adult drivers. Teen driver crashes per licensed driver were highest during the afternoon hours of 3:00-5:59 pm and crashes per mile driven were highest during the nighttime hours of 9:00-11:59 pm. In 66% of the teen driver crashes, the driver was the only occupant. Crashes were twice as likely to result in serious injury when teen passengers were present than when the teen driver was alone. When teen drivers crashed while transporting teen passengers, the passengers were >5 times more likely to all be restrained if the teen driver was restrained. Crashes in which the teen driver was unrestrained were 80% more likely to result in minor/moderate injury and 6 times more likely to result in serious injury compared with crashes in which the teen driver was restrained. CONCLUSIONS: Despite the reductions in teen driver crashes associated with Graduated Driver Licensing (GDL), South Carolina's teen driver crash rates remain substantially higher than those for adult drivers. Established risk factors for fatal teen driver crashes, including restraint nonuse, transporting teen passengers, and speeding also increase the risk of nonfatal injury in single vehicle crashes. As South Carolina examines strategies to further reduce teen driver crashes and associated injuries, the state could consider updating its GDL passenger restriction to either none or one passenger <21years and dropping the passenger restriction exemption for trips to and from school. Surveillance systems such as CODES that link crash data with health outcome data provide needed information to more fully understand the circumstances and consequences of teen driver nonfatal crashes and evaluate the effectiveness of strategies to improve teen driver safety.

Attitudes toward mandatory ignition interlocks for all offenders convicted of driving while intoxicated.

INTRODUCTION: Ignition interlocks are effective in reducing alcohol-impaired driving recidivism for all offenders, including first-time offenders. Despite their effectiveness, interlock use among persons convicted of driving while intoxicated from alcohol (DWI) remains low. This cross-sectional survey of U.S. adults assessed public support for requiring ignition interlocks for all convicted DWI offenders including first-time offenders. The goal was to update results from a similar 2010 survey in light of new state requirements and increased interlock installations. METHODS: Questions were included in the Porter Novelli FallStyles survey, which was fielded from September 28 to October 16, 2015. Participants were the 3,536 individuals who provided an opinion toward requiring ignition interlocks for all offenders. For analyses, opinion toward requiring interlocks for all offenders was dichotomized into 'agree' and 'neutral/disagree.' To handle missing data, 10 imputed datasets were created and pooled using fully conditional specification (FCS). RESULTS: Fifty-nine percent of adults supported requiring interlocks for all DWI offenders. Multivariate analysis revealed that persons who did not report alcohol-impaired driving (AID) were 60% more likely to support requiring interlocks than those who reported AID. Having heard of interlocks also increased support. Support was generally consistent across demographic subgroups. CONCLUSIONS: Interlocks for all offenders have majority support nationwide in the current survey, consistent with previous reports. Support is lowest among those who have reported alcohol-impaired driving in the past 30days. These results suggest that communities with higher levels of alcohol-impaired driving may be more resistant to requiring ignition interlocks for all convicted DWI offenders. Future studies should examine this association further. Practical applications: These results indicate that the majority of adults recognize DWI as a problem and support requiring interlocks for all offenders.

How do older adult drivers self-regulate? Characteristics of self-regulation classes defined by latent class analysis.

PROBLEM: Motor-vehicle crashes were the second leading cause of injury death for adults aged 65-84years in 2014. Some older drivers choose to self-regulate their driving to maintain mobility while reducing driving risk, yet the process remains poorly understood. METHODS: Data from 729 older adults (aged ≥60years) who joined an older adult ride service program between April 1, 2010 and November 8, 2013 were analyzed to define and describe classes of driving self-regulation. Latent class analysis was employed to characterize older adult driving self-regulation classes using driving frequency and avoidance of seven driving situations. Logistic regression was used to explore associations between characteristics affecting mobility and self-regulation class. RESULTS: Three classes were identified (low, medium, and high self-regulation). High self-regulating participants reported the highest proportion of always avoiding seven risky driving situations and the lowest driving frequency followed by medium and low self-regulators. Those who were female, aged 80years or older, visually impaired, assistive device users, and those with special health needs were more likely to be high self-regulating compared with low self-regulating. CONCLUSIONS AND PRACTICAL APPLICATIONS: Avoidance of certain driving situations and weekly driving frequency are valid indicators for describing driving self-regulation classes in older adults. Understanding the unique characteristics and mobility limitations of each class can guide optimal transportation strategies for older adults.

Driving self-regulation and ride service utilization in a multicommunity, multistate sample of U.S. older adults.

OBJECTIVES: This study examined a multicommunity alternative transportation program available 24 hours a day, 7 days a week, for any purpose, offering door-through-door service in private automobiles to members who either do not drive or are transitioning away from driving. Specific aims were to describe the characteristics of members by driving status and ride service usage of these members. METHODS: Data came from administrative records maintained by a nonprofit ride service program and include 2,661 individuals aged 65+ residing in 14 states who joined the program between April 1, 2010, and November 8, 2013. Latent class analysis was used to group current drivers into 3 classes of driving status of low, medium, and high self-regulation, based on their self-reported avoidance of certain driving situations and weekly driving frequency. Demographics and ride service use rate for rides taken through March 31, 2014, by type of ride (e.g., medical, social, etc.) were calculated for nondrivers and drivers in each driving status class. RESULTS: The majority of ride service users were female (77%) and aged 65-74 years (82%). The primary method of getting around when enrolling for the transportation service was by riding with a friend or family member (60%). Among the 67,883 rides given, nondrivers took the majority (69%) of rides. Medical rides were the most common, accounting for 40% of all rides. CONCLUSIONS: Reported ride usage suggests that older adults are willing to use such ride services for a variety of trips when these services are not limited to specific types (e.g., medical). Further research can help tailor strategies to encourage both nondrivers and drivers to make better use of alternative transportation that meets the special needs of older people.

Child safety and booster seat use in five tribal communities, 2010-2014.

PROBLEM: Motor-vehicle crashes are a leading cause of death for American Indian/Alaska Natives (AI/AN) including AI/AN children. Child safety seats prevent injury and death among children in a motor-vehicle crash, yet use is low among AI/AN children. METHODS: To increase the use of child safety seats (CSS; car seats and booster seats), five tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. Increased CSS use was evaluated through direct observational surveys and CSS event data. CSS events are used to check the installation, use, and safety of CSS and new CSS can be provided. RESULTS: CSS use increased in all five programs (ranging from 6% to 40%). Four out of five programs exceeded their goals for increased use. Among the five communities, a total of 91 CSS events occurred resulting in 1417 CSS checked or provided. CONCLUSIONS AND PRACTICAL APPLICATIONS: Evidence-based child passenger safety interventions are both feasible in and transferable to tribal communities.

Assistive device use and mobility-related factors among adults aged≥65years.

INTRODUCTION: Examining how assistive device (cane, walker) use relates to other mobility factors can provide insight into older adults' future mobility needs. METHODS: Data come from the Second Injury Control and Risk Survey, Phase 2 (ICARIS2-P2), conducted from March 2007 to May 2008. Prevalence estimates were calculated for older adults (aged ≥65) and multivariable logistic regression was used to explore associations between assistive device use and mobility-related characteristics. RESULT: Compared with non-users, assistive device users were more likely to report a recent fall (AOR 12.0; 95% CI 4.9-29.3), limit walking outside due to concerns about falling (AOR 7.1; 95% CI 2.6-19.1), be unable to walk outside for 10min without resting (AOR 3.3; 95% CI 1.1-9.3), and be no longer driving (AOR 6.7; 95% CI 2.0-22.3). CONCLUSION: Assistive device users have limited mobility and an increased risk for fall injury compared with non-users. PRACTICAL APPLICATION: Effective fall prevention interventions, and innovative transportation options, are needed to protect the mobility of this high-risk group.

Health Care providers and Teen Driving Safety: Topics Discussed and Educational Resources Used in Practice.

Traffic crashes are the leading cause of death among teens. Health care providers have an opportunity to address what works to keep teens safe on the road during the patient visit. An online survey was conducted of 1088 health care providers who saw patients at or near driving age. The survey assessed which road safety topics were discussed and which types of educational products were used most often. Family and general practice physicians represented 44.3% of the sample, followed by pediatricians (22.5%), nurse practitioners (17.6%), and internists (15.5%). Nearly all respondents (92.9%) reported addressing one or more driving safety factors (seat belt use, nighttime driving, fatigue, teen passengers, alcohol/drug use, speeding/reckless driving, and cell phone use/texting) with adolescent patients and/or their parents. Seat belt use was reported more often (83.7%) than other topics. The use of parent-teen driving agreements, a known effective intervention, was reported by less than 10% of respondents. Since health care providers expressed interest in receiving written resource materials, distribution of parent-teen driving agreements to health care providers might encourage greater uptake and use of this effective intervention.

ATV riding and helmet use among youth aged 12-17†years, USA, 2011: results from the YouthStyles survey.

BACKGROUND: National estimates of all-terrain vehicle (ATV) riding patterns among youth in the USA are lacking. METHODS: We analysed the 2011 YouthStyles survey to estimate the proportion of 12-17 year olds in the USA who had ridden an ATV at least once during the past 12 months and summarise their patterns of helmet use. RESULTS: Of the 831 youth respondents, an estimated 25% reported riding an ATV at least once during the past year. The proportion of youth living outside of a Metropolitan Statistical Area who reported riding an ATV was twice that of those living inside of a Metropolitan Statistical Area. Males and females reported similar proportions of riding at least once during the past year, but among riders, the proportion of males who rode ≥6 times was triple that of females. Only 45% of riders reported always wearing a helmet, and 25% reported never wearing a helmet. The most frequent riders had the lowest consistent helmet use, with 8 of 10 youth who rode ≥6 times during the past year not always wearing a helmet. CONCLUSIONS: ATV riding appears to remain popular among youth in the USA, particularly in rural areas, and consistent helmet use while riding is low. A more thorough understanding of gender differences in ATV riding patterns among youth and perceived risks and benefits of both safe and unsafe riding practices might help inform future ATV injury prevention efforts.

Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle-related injuries.

A previous analysis of National Vital Statistics System data for 2003-2007 that examined disparities in rates of motor vehicle-related death by race/ethnicity and sex found that death rates for American Indians/Alaska Natives were two to four times the rates of other races/ethnicities. To address the disparity in motor vehicle-related injuries and deaths among American Indians/Alaska Natives, CDC funded four American Indian tribes during 2004-2009 to tailor, implement, and evaluate evidence-based road safety interventions. During the implementation of these four motor vehicle-related injury prevention pilot programs, seat belt and child safety seat use increased and alcohol-impaired driving decreased. Four American Indian/Alaska Native tribal communities-the Tohono O'odham Nation, the Ho-Chunk Nation, the White Mountain Apache Tribe, and the San Carlos Apache Tribe-implemented evidence-based road safety interventions to reduce motor vehicle-related injuries and deaths. Each community selected interventions from the Guide to Community Preventive Services and implemented them during 2004-2009. Furthermore, each community took a multifaceted approach by incorporating several strategies, such as school and community education programs, media campaigns, and collaborations with law enforcement officers into their programs. Police data and direct observational surveys were the main data sources used to assess results of the programs. Results included increased use of seat belts and child safety seats, increased enforcement of alcohol-impaired driving laws, and decreased motor vehicle crashes involving injuries or deaths. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion as an example of a program that might be effective for reducing motor vehicle-related injury disparities in the United States. The Guide to Community Preventive Services recognizes these selected interventions as effective; this report examines the feasibility and transferability for implementing the interventions in American Indian/Alaska Native tribal communities. The findings in this report underscore the effectiveness of community interventions to reduce motor vehicle crashes among selected American Indian/Alaska Native communities.

Vital signs: restraint use and motor vehicle occupant death rates among children aged 0-12 years - United States, 2002-2011.

BACKGROUND: Motor vehicle crashes are a leading cause of death among children in the United States. Age- and size-appropriate child restraint use is the most effective method for reducing these deaths. METHODS: CDC analyzed 2002­2011 data from the Fatality Analysis Reporting System to determine the number and rate of motor-vehicle occupant deaths, and the proportion of unrestrained child deaths among children aged <1 year, 1­3 years , 4­7 years, 8­12 years, and for all children aged 0­12 years. Age group­specific death rates and proportions of unrestrained child motor vehicle deaths for 2009­2010 were further stratified by race/ethnicity. RESULTS: Motor vehicle occupant death rates for children declined significantly from 2002 to 2011. However, one third (33%) of children who died in 2011 were unrestrained. Compared with white children for 2009­2010, black children had significantly higher death rates, and black and Hispanic children both had significantly higher proportions of unrestrained child deaths. CONCLUSIONS: Motor vehicle occupant deaths among children in the United States have declined in the past decade, but more deaths could be prevented if restraints were always used. IMPLICATIONS FOR PUBLIC HEALTH: Effective interventions, including child passenger restraint laws (with child safety seat/ booster seat coverage through at least age 8 years) and child safety seat distribution plus education programs, can increase restraint use and reduce child motor vehicle deaths.

Motor vehicle-related deaths - United States, 2005 and 2009.

Motor vehicle crashes are a leading cause of death for children, teenagers, and young adults in the United States. In 2009, approximately 36,000 persons were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally. Approximately 4.3% of all American Indian/Alaska Native (AI/AN) deaths and 3.3% of all Hispanic deaths were attributed to crashes, whereas crashes were the cause of death for <1.7% of blacks, whites, and Asian/Pacific Islanders (A/PI).