Not long after Winston and her colleagues founded the Center for Injury Research and Prevention at The Children’s Hospital, the center joined with State Farm Insurance Companies to establish Partners for Child Passenger Safety (CHOP), a motor vehicle crash surveillance system specific to crashes involving children. One of its initial findings showed that older children were less likely to the appropriate restraints for their age, increasing the threat of injury or death.
The center began a public campaign through the media, legislative efforts, and the public health community to increase booster seat awareness. By 2001, its research showed a rapid increase in booster seat use among children between the ages of four and eight. At the start of the study, only 51percent children enrolled were correctly restrained at the time of a crash. By the end of the study period, the percentage had risen to 78 percent. And by 2007, most U.S. children through the age of eight were using child safety restraints, according to the center.
As part of this work, CHOP’s injury center also has been involved in upgrading 48 state laws and two federal laws regarding booster seats and has created a website in English and Spanish, providing child traffic safety information.
Center researchers also have conducted research to find out why parents fail to use seat belt positioning booster seats, and developed a video based on what they learned to encourage booster seat use. “It’s not enough to improve the safety seat technology,” Winston says. “We have to understand how parents interact with technology to ensure that they also know how to use it, and will use it.”
The same video, originally developed for American parents, also was effective when dubbed in Mandarin and aired in China. Booster seat use among the study participants in Beijing increased from 15 percent to 85 percent. “The results were dramatic,” Winston says.
“It’s very important to remember that the vast majority of child injuries happen in countries with emerging economies that lack the wealth of evidence-based prevention strategies available in developed countries,” she adds. “We wanted to see if the same intervention, proven effective in the U.S., could be replicated in Beijing, where they are adding about 1,500 new cars every day. They had the same issues there as in the United States. Parents didn’t know the importance of booster seats or how to use booster seats, and didn’t have access to them. China is a major manufacturer of booster seats, but they are mostly exported to the U.S. and other countries. We can come up with all these high-tech solutions, but need to think how to make them affordable, accessible, and mainstream in other countries.”
The center uses a multidisciplinary approach, drawing upon a team of experts from epidemiology, biostatistics, engineering, behavioral sciences, outreach, public policy and public health.
The center’s biomechanical engineers, for example, conduct research to help the automotive industry develop more accurate pediatric test crash dummies based on more than a decade of research into real-world accidents using innovative research methods. In one study, engineers partnered with clinicians in CHOP’s pediatric intensive care unit, using sensors to study the forces applied to children’s chests during CPR, thus leading to a better understanding of how a child’s chest interacts with a seat belt or car seat harness when crash forces are applied.
The scientists concluded that children’s bone structure and soft tissue respond much differently to crash forces than those of an adult, and recommended design improvements that would better represent an actual child’s body mechanics, including the head and brain, the neck and spine, the abdomen and the chest and rib cage. These body areas account for the most serious and frequently seen injuries children suffer in car accidents.
Until now, child crash dummies have just been smaller sized versions of adult dummies,” Arbogast says. “But their body composition is much different from an adult’s. They are developing organisms, and this can make them much more vulnerable to certain injuries in a crash than an adult.”