1. CRICOS No. 00213J Melissa Johns, Alexia Lennon and Narelle Haworth Evidence to Action Symposium Townsville November 2010 Announcement and enactment of legislation improve children’s car seating positions

2. Why explore children’s seating position in cars? Road trauma a major cause of child death and injury 523 child deaths (0-16 yrs) due to road trauma in 5 years 2004 – 2008; Majority (342, 65%) were vehicle passengers Many more non-fatal serious injuries: 2103 for 2006-7 (0- 15yrs) Risk of death or injury ~30% greater for front seat passengers than rear CRICOS No. 00213J

3. What we know Rear seating and use of dedicated Australian Standards child restraint reduces risk of injury Adult seatbelt not suited to child body High proportions of children travel in the front seat Inappropriate restraint use (esp. premature graduation to larger restraint) is common

4. Old vs new legislation Old legislation (1970 - 2010) Public education period (Sept 2009 - March 2010) New legislation (March 2010 - Present) All passengers must be restrained 0-6mo in rear facing infant restraint Children under 12 months must be restrained in a rear facing infant restraint 6mo-12mo in rear facing or forward facing infant restraint All children under 4 years must be seated in the rear 6mo-4yr in forward facing child restraint with an inbuilt harness 4-7y in booster seat with either an H harness or an adult seatbelt 4-7 years must be in rear unless all rear seats are occupied by other children under 7 years

5. The current program of research Purpose: Evaluate effectiveness of new legislation –Are children more likely to sit in the rear seat now than previously? –Are they more likely to wear an age-appropriate restraint? –How easy is it for parents to comply (what are the barriers)? –What more can be done? Design: 2 studies –Study 1-observational 3 time phases (pre-legislation; post announcement; post enactment) –Study 2-intercept interviews 2 time phases (post announcement; post enactment, same parents)

6. Study 1- Observational Three data collection phases: –T1 (before announcement, 2007) –T2 (after announcement but before enactment, 2009-10) –T3 (after the enactment, 2010) Two regional cities: –Toowoomba, Rockhampton Site types –Schools, shopping areas

7. Method High child-passenger volume sites identified in each city (low-med SES suburbs) Criteria: private passenger vehicles with rear seats; no adult front seat passengers Data: –number of child passengers; –seating position; –restraint type (RFinfant, FFCS/booster, adult belt; unrestrained) –restraint fit (adult belts only)

8. Results: Seating position N = 5832 vehicles, 7645 children (aged <12 yrs); Majority single child passenger (65-81%) Overall significant decline in front seating T1 pre-announcement to T2 announcement 30.7% (T1) 24.6% (T2) 22.5% (T3) Little change T2-T3 However patterns varied according to number of child passengers

9. Proportion of children seated in the front seat stratified for time and number child passengers Number of child passengers T1 (%) T2 (%) T3 (%) 131.023.320.3p <.001 231.126.526.4p <.05 3 or more28.626.227.1ns

10. Percentage of children seated in the front seat as a function of the number of children in vehicle and time period

11. Results: restraint type Significant changes in type of restraints used Patterns differed for time phase, number of children Restraint typeT1T2T3 1 child passenger FFCS/booster 36.832.745.0 Adult belt 55.161.947.4 2 child passengers FFCS/booster 22.118.120.4 Adult belt 70.479.071.1 3 child passengers FFCS 23.013.821.9 Adult belt 67.678.572.3

12. Percentage of children using each restraint type as a function of number of child passengers and time period

13. Conclusions Announcement of the legislation had a significant impact on parents’ seating choices for their children. Announcement plus enactment associated with a significant increase in use of dedicated restraints but possibly only for single child vehicles Only with enactment there was an increase in the use of child seats or boosters, suggesting parents are sensitive to the content of the legislation but possibly not the intent..

14. Implications Legislation appears to be effective in altering behaviour at least in regional cities. Room for further education of parents as grasp of intent of legislation is unclear

15. Limitations No estimation of ages of children, hence no estimation of appropriateness of restraint type Higher use of child seats/boosters around shopping centres (due to greater proportion of younger children?) Did not collect data on whether restraints installed or used correctly

16. Acknowledgements Australian Research Council Royal Automotive Club of Queensland

17. References ATSB (2007). Road deaths Australia statistical summary. Canberra: ATSB Brown, J & Bilston, L (2006) Misuse of Child Restraints and Injury Outcome in Crashes Proceedings of the 2006 Australasian Road Safety, Research Policing & Education Conference. Brisbane: Queensland Transport Brown J, McCaskill ME, Henderson M, & Bilston, L. (2006) Serious injury is associated with sub-optimal restraint use in child motor vehicle occupants. Journal of Paediatrics and Child Health;42(6):345-349 DITRD&LG (2009) Road deaths Australia statistical summary. Canberra: DITRD&LG Durbin, D. R., Elliott, M. R., & Winston, F.K. (2003). Belt-position booster seats and reduction in risk of injury among children in vehicle crashes. The Journal of the American Medical Association, 2890(21), 2835-2840 Edwards, S.A., Anderson, R.W.G. & Hutchinson, T.P. A survey of drivers' child restraint choice and knowledge in South Australia. 2006, Centre for Automotive Safety Research (CASR): Adelaide Henley, G. & Harrison, J. 2009 Serious injury due to land transport accidents Australia 2006-07. Canberra: AIHW Lennon, A. (2005) Where do children sit in Australian passenger vehicles? Results of an observational study. Proceedings of the 2005 Road Safety Research, Policing and Education Office of Queensland Parliamentary Council (2010) Transport Operations (Road Use Management-Road Rules) Regulation 2009 (Reprint No 1B). Brisbane: Queensland Parliament. Reeve, KN, Zurynski, YA, Elliott, EJ & Bilston, L (2007) Seatbelts and the law: How well do we protect Australian children? The Medical Journal of Australia 186(12) 635-8 Winston, F. K., Durbin, D. R., Kallan, M. J., & Moll, E. K. (2000). The danger of premature graduation to seat belts for young children. Pediatrics, 105(8), 1179-1183

18. Questions? Mark your Diaries! 10 th National Injury Prevention & Safety Promotion Conference, Brisbane November 2-4 th 2011, Brisbane Convention and Exhibition Centre