Primary injury prevention policies and mortality from motor vehicle crashes among children and adolescents in the United States: From safety behaviors to healthy environments

Abstract Introduction & Objective. Unintentional injuries from motor-vehicle crashes are the leading cause of death among children ages one to 19. On average, 4,500 children die every year from motor-vehicle crashes in the U.S., with total lifetime injury costs estimated at more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices and alcohol, high speeds, and built environments that promote vehicle performance. The objective of this research is to evaluate the effects that primary prevention policies have had on reducing mortality from motor-vehicle crashes among children and adolescents in the U.S. Methodology. Retrospective study using panel data from 1997 to 2005 from all 50 states and the District of Columbia. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the US Census Bureau, the Atlas of Presidential Elections and the US Bureau of Labor Statistics. I used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. Results. The analysis included a total of 32,893 child fatalities from MVCs. States that allowed fines greater than $50 for lack of restraint use experienced significant reductions in mortality as well as states with laws allowing the use of red light cameras. Graduate licensing programs requiring a minimum age of 16 for the intermediate-level experienced mortality reductions as much as 90 percent compared with a minimum age of 14. Rural local and urban roads also showed important effects in mortality from MVCs compared with rural arterial roads. Higher posted speeds on local roads were associated with reductions of up to 87 percent compared with lower speeds. Conclusion. This research focuses on the effects that laws have on mortality, but not on how effectively these laws are implemented and/or enforced. This is an important limitation, since the existence of a law says nothing about how effectively the law is implemented and, more importantly, how effectively the law is enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health