Self-reported factors that influence rear seat belt use among adults

Introduction: While seat belt use among front seat occupants has significantly increased overtime a substantial usage gap still exists between front and back seat occupants. This study aims to identify factors that predict rear seat belt use among adult back seat passengers. Methods: We examined data from the 2016 Motor Vehicle Occupant Safety Survey, conducted by the National Highway Traffic Safety Administration, to determine the influence of front seat belt use, support of and belief of rear seat belt use laws, peer perception of seat belt use, nighttime belt use, and demographic factors on self-reported rear seat belt use. Rao-Scott chi-squared tests were used to determine significant associations between self-reported rear belt use and each predictor. Multivariate logistic regression was used to calculate adjusted odds ratios and determine the influence of significant predictors on rear seat belt use. Sampling weights were applied to produce nationally representative estimates; all statistical significance tests accounted for the complex survey design. Results: Among adults who reported riding in the back seat, 63% reported always using a rear seat belt. Front seat belt use, support and belief of state seat belt laws, nighttime seat belt use, age, and education were significantly associated with rear seat belt use. Multivariate regression results showed that adults who supported rear seat belt laws, reported front seat belt use and believed their state has a rear seat belt law were significantly more likely to report full-time use in the back seat. Conclusions: Seat belt laws and front seat belt use had the strongest association with reporting full-time use in the back seat. Practical Applications: Increasing familiarity with existing laws directed towards rear seat belt use as well as increasing awareness about the benefits of seat belts in all seating positions may help improve rear seat belt use.     

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

Introduction: Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt. Method: Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none). Results: Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region). Conclusions: Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.     

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes

Abstract

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles.

Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004–2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014–2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records.

Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality.

Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment.     

The safest seat: effect of seating position on occupant mortality

INTRODUCTION: This study investigated the survival rates of occupants of passenger cars involved in a fatal crash between 2000 and 2003. METHODS: The information from every fatal crash in the United States between 2000 and 2003 was analyzed. Variables such as seat position, point of impact, rollover, restraint use, vehicle type, vehicle weight, occupant age, and injury severity were extracted from the Fatality Analysis Reporting System (FARS). Univariate and a full logistic multivariate model analyses were performed. RESULTS: The data show that the rear middle seat is safer than any other occupant position when involved in a fatal crash. Overall, the rear (2(nd) row) seating positions have a 29.1% (Univariate Analysis, p<.0001, OR 1.29, 95% CI 1.22 - 1.37) increased odds of survival over the first row seating positions and the rear middle seat has a 25% (Univariate Analysis, p<.0001, OR 1.25, 95% CI 1.17 - 1.34) increased odds of survival over the other rear seat positions. After correcting for potential confounders, occupants of the rear middle seat have a 13% (Logistic Regression, p<.001, 95% CI 1.02 - 1.26) increased chance of survival when involved in a crash with a fatality than occupants in other rear seats. CONCLUSION: This study has shown that the safest position for any occupant involved in a motor-vehicle crash is the rear middle seat. IMPACT ON INDUSTRY: The results of this research may impact how automobile manufacturers look at future rear middle seat designs. If the rear seat was to be designed exactly like its outboard counterparts (headrest, armrests, lap and shoulder belt, etc.) people may choose to sit on it more often rather than waiting to use it out of necessity due to multiple rear seat occupants.     

Automated recognition of rear seat occupants' head position using Kinect™ 3D point cloud

IntroductionChild occupant safety in motor-vehicle crashes is evaluated using Anthropomorphic Test Devices (ATD) seated in optimal positions. However, child occupants often assume suboptimal positions during real-world driving trips. Head impact to the seat back has been identified as one important injury causation scenario for seat belt restrained, head-injured children (Bohman et al., 2011). There is therefore a need to understand the interaction of children with the Child Restraint System to optimize protection.MethodNaturalistic driving studies (NDS) will improve understanding of out-of-position (OOP) trends. To quantify OOP positions, an NDS was conducted. Families used a study vehicle for two weeks during their everyday driving trips. The positions of rear-seated child occupants, representing 22 families, were evaluated. The study vehicle – instrumented with data acquisition systems, including Microsoft Kinect™ V1 – recorded rear seat occupants in 1120 driving 26 trips. Three novel analytical methods were used to analyze data. To assess skeletal tracking accuracy, analysts recorded occurrences where Kinect™ exhibited invalid head recognition among a randomly-selected subset (81 trips). Errors included incorrect target detection (e.g., vehicle headrest) or environmental interference (e.g., sunlight). When head data was present, Kinect™ was correct 41% of the time; two other algorithms – filtering for extreme motion, and background subtraction/head-based depth detection are described in this paper and preliminary results are presented. Accuracy estimates were not possible because of their experimental nature and the difficulty to use a ground truth for this large database. This NDS tested methods to quantify the frequency and magnitude of head positions for rear-seated child occupants utilizing Kinect™ motion-tracking.ResultsThis study's results informed recent ATD sled tests that replicated observed positions (most common and most extreme), and assessed the validity of child occupant protection on these typical CRS uses.SummaryOptimal protection in vehicles requires an understanding of how child occupants use the rear seat space. This study explored the feasibility of using Kinect™ to log positions of rear seated child occupants. Initial analysis used the Kinect™ system’s skeleton recognition and two novel analytical algorithms to log head location.Practical applicationsThis research will lead to further analysis leveraging Kinect™ raw data – and other NDS data – to quantify the frequency/magnitude of OOP situations, ATD sled tests that replicate observed positions, and advances in the design and testing of child occupant protection technology.     

State-level seat belt use in the United States, 2011–2016: Comparison of self-reported with observed use and use by fatally injured occupants

Introduction: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. Objective: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011–2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. Results: During 2011–2016, national self-reported seat belt use ranged from 86–88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = −0.77). Conclusion: National self-reported seat belt use remained essentially stable during 2011–2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.     

Association Between NCAP Ratings and Real-World Rear Seat Occupant Risk of Injury

Objective: Several studies have evaluated the correlation between U.S. or Euro New Car Assessment Program (NCAP) ratings and injury risk to front seat occupants, in particular driver injuries. Conversely, little is known about whether NCAP 5-star ratings predict real-world risk of injury to restrained rear seat occupants. The NHTSA has identified rear seat occupant protection as a specific area under consideration for improvements to its NCAP. In order to inform NHTSA's efforts, we examined how NCAP's current 5-star rating system predicts risk of moderate or greater injury among restrained rear seat occupants in real-world crashes.

Methods: We identified crash-involved vehicles, model year 2004–2013, in NASS-CDS (2003–2012) with known make and model and nonmissing occupant information. We manually matched these vehicles to their NCAP star ratings using data on make, model, model year, body type, and other identifying information. The resultant linked NASS-CDS and NCAP database was analyzed to examine associations between vehicle ratings and rear seat occupant injury risk; risk to front seat occupants was also estimated for comparison. Data were limited to restrained occupants and occupant injuries were defined as any injury with a maximum Abbreviated Injury Scale (AIS) score of 2 or greater.

Results: We linked 95% of vehicles in NASS-CDS to a specific vehicle in NCAP. The 18,218 vehicles represented an estimated 6 million vehicles with over 9 million occupants. Rear seat passengers accounted for 12.4% of restrained occupants. The risk of injury in all crashes for restrained rear seat occupants was lower in vehicles with a 5-star driver rating in frontal impact tests (1.4%) than with 4 or fewer stars (2.6%, P =.015); results were similar for the frontal impact passenger rating (1.3% vs. 2.4%, P =.024). Conversely, side impact driver and passenger crash tests were not associated with rear seat occupant injury risk (driver test: 1.7% for 5-star vs. 1.8% for 1–4 stars; passenger test: 1.6% for 5 stars vs 1.8% for 1–4 stars).

Conclusions: Current frontal impact test procedures provide some degree of discrimination in real-world rear seat injury risk among vehicles with 5 compared to fewer than 5 stars. However, there is no evidence that vehicles with a 5-star side impact passenger rating, which is the only crash test procedure to include an anthropomorphic test dummy (ATD) in the rear, demonstrate lower risks of injury in the rear than vehicles with fewer than 5 stars. These results support prioritizing modifications to the NCAP program that specifically evaluate rear seat injury risk to restrained occupants of all ages.     

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.

Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.

Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers.

Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.     

Teens and seat belt use: What makes them click?

ProblemMotor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt.MethodsUsing data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with always wearing a seat belt.ResultsOnly 51% of high school students living in 38 states reported always wearing a seat belt when riding as a passenger; prevalence varied from 32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to always wear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased.DiscussionSeat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups.Practical applicationsThis study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.     

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

Methods

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

Results

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

Discussion

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.     

Determinants of seat belt use: A regression analysis with FARS data corrected for self-selection

IntroductionWe develop a methodology to use FARS data as an alternative to NOPUS in estimating seat belt usage. The advantages of using FARS over NOPUS are that (i) FARS is broader because it contains more variables relevant for policy analysis, (ii) FARS allows for easy multivariate regression analysis, and finally, (iii) FARS data is more cost-effective.MethodologyWe apply a binary logit model in our analysis to determine the likelihood of seat belt usage given various occupant, vehicle, and built environment characteristics. Using FARS data, we derive coefficient estimates for categories such as vehicle occupants' age and night time seat belt use that observational surveys like NOPUS cannot easily provide.ResultsOur results indicate that policies should focus on passengers (as opposed to drivers), male and young vehicle occupants, and that law enforcement should focus on pick-up trucks, rural roads, and nights. We find evidence that primary seat belt laws are effective.ConclusionsAlthough this is primarily a methodological paper, we present and discuss our results in the context of public policy so that our findings are relevant for road safety practitioners, researchers, and policymakers.     

Injuries in Full-Scale Vehicle Side Impact Moving Deformable Barrier and Pole Tests Using Postmortem Human Subjects

Objective: To conduct near-side moving deformable barrier (MDB) and pole tests with postmortem human subjects (PMHS) in full-scale modern vehicles, document and score injuries, and examine the potential for angled chest loading in these tests to serve as a data set for dummy biofidelity evaluations and computational modeling.

Methods: Two PMHS (outboard left front and rear seat occupants) for MDB and one PMHS (outboard left front seat occupant) for pole tests were used. Both tests used sedan-type vehicles from same manufacturer with side airbags. Pretest x-ray and computed tomography (CT) images were obtained. Three-point belt-restrained surrogates were positioned in respective outboard seats. Accelerometers were secured to T1, T6, and T12 spines; sternum and pelvis; seat tracks; floor; center of gravity; and MDB. Load cells were used on the pole. Biomechanical data were gathered at 20 kHz. Outboard and inboard high-speed cameras were used for kinematics. X-rays and CT images were taken and autopsy was done following the test. The Abbreviated Injury Scale (AIS) 2005 scoring scheme was used to score injuries.

Results: MDB test: male (front seat) and female (rear seat) PMHS occupant demographics: 52 and 57 years, 177 and 166 cm stature, 78 and 65 kg total body mass. Demographics of the PMHS occupant in the pole test: male, 26 years, 179 cm stature, and 84 kg total body mass. Front seat PMHS in MDB test: 6 near-side rib fractures (AIS = 3): 160–265 mm vertically from suprasternal notch and 40–80 mm circumferentially from center of sternum. Left rear seat PMHS responded with multiple bilateral rib fractures: 9 on the near side and 5 on the contralateral side (AIS = 3). One rib fractured twice. On the near and contralateral sides, fractures were 30–210 and 20–105 mm vertically from the suprasternal notch and 90–200 and 55–135 mm circumferentially from the center of sternum. A fracture of the left intertrochanteric crest occurred (AIS = 3). Pole test PMHS had one near-side third rib fracture. Thoracic accelerations of the 2 occupants were different in the MDB test. Though both occupants sustained positive and negative x-accelerations to the sternum, peak magnitudes and relative changes were greater for the rear than the front seat occupant. Magnitudes of the thoracic and sternum accelerations were lower in the pole test.

Conclusions: This is the first study to use PMHS occupants in MDB and pole tests in the same recent model year vehicles with side airbag and head curtain restraints. Injuries to the unilateral thorax for the front seat PMHS in contrast to the bilateral thorax and hip for the rear seat occupant in the MDB test indicate the effects of impact on the seating location and restraint system. Posterolateral locations of fractures to the front seat PMHS are attributed to constrained kinematics of occupant interaction with torso side airbag restraint system. Angled loading to the rear seat occupant from coupled sagittal and coronal accelerations of the sternum representing anterior thorax loading contributed to bilateral fractures. Inward bending initiated by the distal femur complex resulting in adduction of ipsilateral lower extremity resulted in intertrochanteric fracture to the rear seat occupant. These results serve as a data set for evaluating the biofidelity of the WorldSID and federalized side impact dummies and assist in validating human body computational models, which are increasingly used in crashworthiness studies.     

Ninety five percent: an evaluation of law, policy, and programs to promote seat belt use in Washington state

Seat belt use in Washington state was 83% in 2001. In 2002, a series of law, policy, and program initiatives coalesced to produce a dramatic increase in seat belt use. Washington enacted a primary enforcement seat belt, the Chief of the Washington State Patrol made safety belt enforcement one of the core missions of that agency, and Washington participated in the national Memorial Day Click It or Ticket program during May 2002 and continued the program into 2003. Evaluation of these initiatives was accomplished through observation surveys of seat belt use, analysis of seat belt violation data, and analysis of data on traffic deaths of motor vehicle occupants. The major findings were that there was a two- to three-fold increase in enforcement of the seat belt law, belt use rates increased to 93% in 2002 and again to 95% in 2003, and motor-vehicle occupant fatalities decreased by 13%. IMPACT ON PRACTICE AND POLICY: The primary seat belt law and Click It or Ticket program activities were critical factors in increasing belt use in Washington state. Media and enforcement programs targeting seat belt use can be very effective in raising the belt use rate, but a long-term commitment to continuation of these program activities is essential. Other states implementing new primary seat belt laws should consider delivering a Click It or Ticket campaign prior to the effective date of the primary law and continuing these activities during subsequent months and years.     

Compatibility of booster seats and vehicles in the U.S. market

Objective: The objective of this study was to analyze booster and rear vehicle seat dimensions to identify the most frequent compatibility problems.

Methods: Measurements were collected from 40 high-back and backless boosters and 95 left rear and center rear row seating positions in 50 modern vehicles. Dimensions were compared for 3,800 booster/vehicle seat combinations. For validation and estimation of tolerance and correction factors, 72 booster installations were physically completed and compared with measurement-based compatibility predictions. Dimensions were also compared to the International Organization for Standardization (ISO) volumetric envelopes of forward-facing child restraints and boosters.

Results: Seat belt buckles in outboard positions accommodated the width of boosters better than center positions (success rates of 85.4 and 34.7%, respectively). Adequate head restraint clearance occurred in 71.9 to 77.2% of combinations, depending on the booster's head support setting. Booster recline angles aligned properly with vehicle seat cushion angles in 71.5% of combinations. In cases of poor angle alignment, booster angles were more obtuse than the vehicle seat angles 97.7% of the time. Head restraint interference exacerbated angle alignment issues. Data indicate success rates above 90% for boosters being fully supported by the length of the seat cushion and for adequate height clearance with the vehicle roofline. Comparison to ISO envelopes indicates that most boosters on the U.S. market are taller and angled more obtusely than ISO target envelopes.

Conclusions: This study quantifies some of the common interferences between boosters and vehicles that may complicate booster usage. Data are useful for design and to prioritize specific problem areas.     

Improving the Chest Protection of Elderly Occupants in Frontal Crashes Using SMART Load Limiters

Objective: To determine whether varying the seat belt load limiter (SBL) according to crash and occupant characteristics could have real-world injury reduction benefits in frontal impacts and, if so, to quantify those benefits.

Methods: Real-world UK accident data were used to identify the target population of vehicle occupants and frontal crash scenarios where improved chest protection could be most beneficial. Generic baseline driver and front passenger numerical models using a 50th percentile dummy were developed with MADYMO software. Simulations were performed where the load limiter threshold was varied in selected frontal impact scenarios. For each SBL setting, restraint performance, dummy kinematics, and injury outcome were studied in 5 different frontal impact types. Thoracic injury predictions were converted into injury probability values using Abbreviated Injury Scale (AIS) 2+ age-dependent thoracic risk curves developed and validated based on a methodology proposed by Laituri et al. (2005). Real-world benefit was quantified using the predicted AIS 2+ risk and assuming that an appropriate adaptive system was fitted to all the cars in a real-world sample of recent frontal crashes involving European passenger cars.

Results: From the accident data sample the chest was the most frequently injured body region at an AIS 2+ level in frontal impacts (7% of front seat occupants). The proportion of older vehicle front seat occupants (>64 years) with AIS 2+ injury was also greater than the proportion of younger occupants. Additionally, older occupants were more likely to sustain seat belt–induced serious chest injury in low- and moderate-speed frontal crashes. In both front seating positions, the low SBL provided the best chest injury protection, without increasing the risk to other body regions. In severe impacts, the low SBL allowed the driver to move dangerously close to the steering wheel. Compared to the driver side, greater ride-down space on the passenger side gave a higher potential for using the low SBLs. When applying the AIS 2+ risk reduction findings to the weighted accident data sample, the risk of sustaining an AIS 2+ seat belt injury changed to 0.9, 4.9, and 8.1% for young, mid, and older occupants, respectively, from their actual injury risk of 1.3, 7.6, and 13.1%.

Conclusions: These results suggest the potential for improving the safety of older occupants with the development of smarter restraint systems. This is an important finding because the number of older users is expected to increase rapidly over the next 20 years. The greatest benefits were seen at lower crash severities. This is also important because most real-world crashes occur at lower speeds.     

Restraint use and seating position among children less than 13 years of age: Is it still a problem?

Introduction

The purpose of this study was to calculate national estimates and examine the extent to which children prematurely use adult seat belts and ride in the front seat of a vehicle during a 30 day period.

Methods

Data were obtained from a nationally representative cross-sectional random-digit-dial telephone survey that included child-specific questions on motor vehicle restraint use and seating position.

Results

Among children less than 13 years, parents reported an estimated 618,337 who rode unrestrained and more than one million who rode in the front seat of a vehicle at least some of the time in the past 30 days. During the same time period, close to 11 million children 8 years and younger reportedly used only adult seat belts.

Discussion

Our results highlight the need for continued outreach to parents regarding optimal restraint use and rear seating position for children every trip, every time.     

A Simulation Study on the Efficacy of Advanced Belt Restraints to Mitigate the Effects of Obesity for Rear-Seat Occupant Protection in Frontal Crashes

Objective: Recent field data analyses have shown that the safety advantages of rear seats relative to the front seats have decreased in newer vehicles. Separately, the risks of certain injuries have been found to be higher for obese occupants. The objective of this study is to investigate the effects of advanced belt features on the protection of rear-seat occupants with a range of body mass index (BMI) in frontal crashes.

Methods: Whole-body finite element human models with 4 BMI levels (25, 30, 35, and 40 kg/m²) developed previously were used in this study. A total of 52 frontal crash simulations were conducted, including 4 simulations with a standard rear-seat, 3-point belt and 48 simulations with advanced belt features. The parameters varied in the simulations included BMI, load limit, anchor pretensioner, and lap belt routing relative to the pelvis. The injury measurements analyzed in this study included head and hip excursions, normalized chest deflection, and torso angle (defined as the angle between the hip–shoulder line and the vertical direction). Analyses of covariance were used to test the significance (P <.05) of the results.

Results: Higher BMI was associated with greater head and hip excursions and larger normalized chest deflection. Higher belt routing increased the hip excursion and torso angle, which indicates a higher submarining risk, whereas the anchor pretensioner reduced hip excursion and torso angle. Lower load limits decreased the normalized chest deflection but increased the head excursion. Normalized chest deflection had a positive correlation with maximum torso angle. Occupants with higher BMI have to use higher load limits to reach head excursions similar to those in lower BMI occupants.

Discussion and Conclusion: The simulation results suggest that optimizing load limiter and adding pretensioner(s) can reduce injury risks associated with obesity, but conflicting effects on head and chest injuries were observed. This study demonstrated the feasibility and importance of using human models to investigate protection for occupants with various BMI levels. A seat belt system capable of adapting to occupant size and body shape will improve protection for obese occupants in rear seats.     

Driver and front passenger injury in frontal crashes: Update on the effect of unbelted rear occupants

Purpose: This is a study of the influence of an unbelted rear occupant on the risk of severe injury to the front seat occupant ahead of them in frontal crashes. It provides an update to earlier studies.

Methods: 1997–2015 NASS-CDS data were used to investigate the risk for severe injury (Maximum Abbreviated Injury Score [MAIS] 4+F) to belted drivers and front passengers in frontal crashes by the presence of a belted or unbelted passenger seated directly behind them or without a rear passenger. Frontal crashes were identified with GAD1 = F without rollover (rollover ≤ 0). Front and rear outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4+F was determined using the number of occupants with known injury status MAIS 0+F. Standard errors were determined.

Results: The risk for severe injury was 0.803 ± 0.263% for the driver with an unbelted left rear occupant and 0.100 ± 0.039% with a belted left rear occupant. The driver's risk was thus 8.01 times greater with an unbelted rear occupant than with a belted occupant (P <.001). With an unbelted right rear occupant behind the front passenger, the risk for severe injury was 0.277 ± 0.091% for the front passenger. The corresponding risk was 0.165 ± 0.075% when the right rear occupant was belted. The front passenger's risk was 1.68 times greater with an unbelted rear occupant behind them than a belted occupant (P <.001). The driver's risk for MAIS 4+F was highest when their seat was deformed forward. The risk was 9.94 times greater with an unbelted rear occupant than with a belted rear occupant when the driver's seat deformed forward. It was 13.4 ± 12.2% with an unbelted occupant behind them and 1.35 ± 0.95% with a belted occupant behind them.

Conclusions: Consistent with prior literature, seat belt use by a rear occupant significantly lowered the risk for severe injury to belted occupants seated in front of them. The reduction was greater for drivers than for front passengers. It was 87.5% for the driver and 40.6% for the front passenger. These results emphasize the need for belt reminders in all seating positions.     

Assessing characteristics related to the use of seatbelts and cell phones by drivers: Application of a bivariate probit model

IntroductionThe effects of cell phone use and safety belt use have been an important focus of research related to driver safety. Cell phone use has been shown to be a significant source of driver distraction contributing to substantial degradations in driver performance, while safety belts have been demonstrated to play a vital role in mitigating injuries to crash-involved occupants.MethodThis study examines the prevalence of cell phone use and safety belt non-use among the driving population through direct observation surveys. A bivariate probit model is developed to simultaneously examine the factors that affect cell phone and safety belt use among motor vehicle drivers.ResultsThe results show that several factors may influence drivers' decision to use cell phones and safety belts, and that these decisions are correlated.Practical applicationsUnderstanding the factors that affect both cell phone use and safety belt non-use is essential to targeting policy and programs that reduce such behavior.