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Perspectives in Disease Prevention and Health Promotion State Action to Prevent Motor Vehicle Deaths and Injuries among Children and Adolescents

Motor vehicle fatalities (MVF) are the leading cause of lost years of potential life, and in 1980, accounted for 54,200 deaths (1). The National Transportation Safety Board estimates that although fatalities on American highways decreased by 4% in 1981, reversing a 5-year upward trend, 145 persons, including 12 children, die each day in vehicular collisions (2).

Among children ages 1 to 14, motor vehicle collisions are a major cause of injury and disability and are responsible for 20% of all deaths in that age group. In 1980, approximately 90,000 children under 6 years of age and 800,000 children 6 to 16 years of age were injured by motor vehicles (3). Over half the MVF among 1 to 14 year-olds occur among pedestrians. Of the MVF among 15 to 19 year-olds, 25% involve the teenagers as passengers; in another 25%, teenaged drivers are killed (4).

In an effort to reduce motor vehicle accidents and deaths, states have begun passing legislation pertaining to child restraints, alcohol use, and other issues related to the prevention of motor vehicle deaths and injuries.

Child restraints: In response to statistics indicating that restrained children are 50% to 70% less likely to be injured or killed in an auto accident than unrestrained children (5) and that back seat passengers are less likely to be injured than front seat passengers, 21 states have enacted laws requiring the use of, or have instituted public education programs on, safety seats or belts for children. Tennessee, which passed the first such law, requires parents of children under 4 years of age to use federally approved child restraint systems. The law became effective January 1, 1978, and active enforcement and public education campaigns have increased child restraint use in large metropolitan areas from 9% in 1977 to 32% in 1981. Injury rates in Tennessee among children under 4 years of age have decreased from 440.0 injuries per 100,000 children in 1979 to 306.1/100,000 in 1981, a 30% decrease, while death rates have decreased 55% from 7.72 deaths/100,000 children in 1979 to 3.5/100,000 in 1981 (6).

Sixteen of those 21 states, encompassing over 40% of the American population, have passed laws requiring parents to use car restraints for their children (7). Three (California, Indiana, and Maine) have passed laws requiring state agencies to conduct public information campaigns on the importance of child passenger safety. Hawaii has enacted a state income tax credit for purchase of a child safety restraint. In other states, child restraint legislation is pending.

To prevent motor vehicle deaths and injuries among adolescents and adults, many European countries as well as Australia, Canada, and New Zealand, have implemented mandatory, comprehensive safety belt use laws. In Victoria, Australia, safety belt use increased from approximately 15% to between 80% and 90% after enactment of legislation requiring use by all automobile occupants over age 8, and both MVF and injuries decreased. Although injuries have decreased among passengers under age 17, no decrease in fatalities has been noted (8). Statistics indicate that sustained enforcement and education are necessary to the continued use of restraints. In Ontario, Canada, belt use increased to 80% immediately after enactment of a safety belt use law, then decreased to 50%. When the law was actively enforced, use increased to 66% (9). In the United States, safety belt use by adolescents and adults can reduce fatalities by 50% and injuries by 65% (5). Michigan has introduced legislation requiring safety belts or passive restraints for all drivers and front-seat passengers.

Alcohol use: Half of all deaths from motor vehicle crashes and one-third of accidents in which occupants receive serious injuries involve drivers with blood-alcohol concentrations of 0.10% or higher (10). Other drugs, either independently or in combination with alcohol, also contribute to vehicular accidents. Studies in England have found significant associations between use of minor tranquilizers and serious accidents (11). Consequently, several states have raised their legal drinking ages. In the mid-1970's, when Michigan lowered its legal drinking age to 18, both the number of establishments serving drinks and their hours of operation increased, as did the number of traffic accidents and MVF among 18 to 20 year-olds (12). In response to these findings, Michigan raised its legal drinking age to 21. Connecticut, Maryland, and New York, among others, have also raised their legal drinking ages. In addition, citizens' groups have encouraged state legislatures to pass laws restricting night driving by teenagers, imposing mandatory license suspension for driving while intoxicated, and imposing stiffer penalties for convicted offenders.

Motorcycle helmets: By 1975, as a result of a federal requirement, all but three states had enacted laws requiring helmet use for motorcyclists. In 1976 the federal requirement was repealed, and by 1982, nine states had no helmet laws and 22 had amended theirs to require helmets only for teenaged riders (13). Between 1976 and 1980, deaths from motorcycle accidents increased by 49%. Motorcyclists have a 7-fold greater chance of fatal injury per mile driven than automobile drivers, (14). Over 30% of fatal motorcycle accidents occur among persons under 20 years of age (4). In a recent study conducted by the Minnesota Department of Health, in conjunction with the Minnesota Department of Public Safety, the effects of helmet use were analysed using 159 head injury cases from motorcycle accidents. The protective effects of helmets were evident at all levels of injury severity, and the degree of protection increased with severity; a non-helmeted rider was twice as likely to acquire a minor head injury as a helmeted rider and approximately five times as likely to acquire a severe or critical injury (15).

Education: Other approaches to preventing MVF among teenagers include raising the driving age and instituting comprehensive driver education programs. In Connecticut, a person can only obtain a drivers license before age 18 if he completes an approved driver education course; by eliminating state funding for driver education, Connecticut decreased the number of adolescent drivers and thus the number of 16 and 17 year-olds involved in accidents (16). Programs sponsored by community, professional, and government organizations have indicated the need for research concerning the effectiveness of driver education and the methods of preventing pedestrian injuries/fatalities.

Motor vehicle accidents result not only in morbidity and mortality but also in social and economic losses--health care costs, lost school time, lost work time for parents, rehabilitation costs, and the long-term effects of permanent disability on health, educational achievement, and quality of life. The prevention of vehicular-related injuries and deaths among children and adolescents requires a combination of strategies: designing roads and automobiles to prevent accidents, improving cars and safety seats to reduce the consequences of accidents, eliminating hazards to pedestrians, preventing alcohol and drug use by drivers, and advocating use of child restraints and safety belts. Reported by the Office of Program Planning and Evaluation, Office of the Director, CDC.


  1. National Center for Health Statistics. Annual summary of births, deaths, marriages, and divorces, 1980. In: Monthly vital statistics report, September 17, 1981;29:21.

  2. Transportation fatalities down in 1981. Journal of American Insurance 1982;58:5-6.

  3. National Center for Health Statistics. Current estimates from the National Health Interview Survey, United States, 1980. In: Vital and health statistics 1981;Series 10(139):21.

  4. National Center for Health Statistics. Vital statistics of the United States 1978;II Mortality, Part A.

  5. The National Highway Traffic Safety Administration. Effectiveness and efficiency of safety belt and child restraint usage programs. Washington, D.C.: Department of Transportation, January 1982. (DOT-HS-806-142).

  6. Tennessee Department of Public Health. Child Safety Program, unpublished data, 1982.

  7. National Safety Council. Policy update on child restraint laws. (Alabama, Connecticut, Delaware, Florida, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New York, Nebraska, North Carolina, Rhode Island, Virginia, West Virginia, and Wisconsin) August 1982.

  8. McDermott F, Hough D. Vehicle-occupant fatalitites after legislation for compulsory wearing of seat belts in Australia: different trends between the sexes. Med J Aust 1979;2:571-5.

  9. Paulson JA. The case for mandatory seat restraint laws. Clin Pediatr 1981;20:285-90.

  10. Alcohol, Drug Abuse, and Mental Health Administration. Third special report to the U.S. Congress on alcohol and health. June 1978.

  11. Skegg DCG, Richards SM, Doll R. Minor tranquilizers and road accidents. Br Med J 1979;1:917.

  12. Douglass RL, Millar CW. Alcohol availability and alcohol-related casualities in Michigan 1968-1976. Curr Alcohol 1979;6:303-17.

  13. Motorcycle Industry Council. State motorcycle equipment requirements. Washington, D.C.: Government Relations Office, January 1982.

  14. National Safety Council. Accident Facts, 1981. Chicago: National Safety Council, 1981.

  15. Carr WP, Brandt D, Swanson K. Injury patterns and helmet effectiveness among hospitalized motorcyclists. Minn Med 1981;64:521-7.

  16. Robertson LS. Crash involvement of teenage drivers when driver education is eliminated from high school. Am J Public Health 1980;70:599-603.

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