Seasonal variation in fall-related emergency department visits by location of fall – United States, 2015

Introduction: In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller. Methods: Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older. Results: Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65–74 year age group. Conclusions: In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation. Practical Implications: These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.     

Aging without injury in the United States requires action today

Introduction: In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. Methods: Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. Results: In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. Conclusions: Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.     

Driving self-regulation and ride service utilization in a multicommunity,multistate sample of U.S. older adults

Objectives: This study examined a multicommunity alternative transportation program available 24 hours a day, 7 days a week, for any purpose, offering door-through-door service in private automobiles to members who either do not drive or are transitioning away from driving. Specific aims were to describe the characteristics of members by driving status and ride service usage of these members.

Methods: Data came from administrative records maintained by a nonprofit ride service program and include 2,661 individuals aged 65+ residing in 14 states who joined the program between April 1, 2010, and November 8, 2013. Latent class analysis was used to group current drivers into 3 classes of driving status of low, medium, and high self-regulation, based on their self-reported avoidance of certain driving situations and weekly driving frequency. Demographics and ride service use rate for rides taken through March 31, 2014, by type of ride (e.g., medical, social, etc.) were calculated for nondrivers and drivers in each driving status class.

Results: The majority of ride service users were female (77%) and aged 65–74 years (82%). The primary method of getting around when enrolling for the transportation service was by riding with a friend or family member (60%). Among the 67,883 rides given, nondrivers took the majority (69%) of rides. Medical rides were the most common, accounting for 40% of all rides.

Conclusions: Reported ride usage suggests that older adults are willing to use such ride services for a variety of trips when these services are not limited to specific types (e.g., medical). Further research can help tailor strategies to encourage both nondrivers and drivers to make better use of alternative transportation that meets the special needs of older people.     

The 2001 National Household Travel Survey: a look into the travel patterns of older Americans

INTRODUCTION: The main objective of this paper is to highlight travel patterns of older adults living in the United States as depicted in the 2001 National Household Travel Survey (NHTS). The NHTS is a national data collection program sponsored by the Bureau of Transportation Statistics and the Federal Highway Administration. It is the first national comprehensive household survey of both daily and long-distance travel, allowing for analysis of the full continuum of personal travel by Americans. To better understand the transportation needs of older Americans, it is useful to examine how travel patterns differ across age groups. The intent is to present basic travel characteristics of older adults (age 65+) and allow for comparisons with younger adults (ages 19-64). Travel-related characteristics of older adults in the United States: Results of the 2001 survey showed that older Americans travel extensively and rely on personal vehicles as heavily as their younger counterparts. Older Americans conduct 89% of their travel in personal vehicles. CHARACTERISTICS OF DAILY TRIPS TAKEN BY OLDER ADULTS: Older adults tend to be less mobile in that they take fewer trips, travel shorter distances, and have shorter travel times. This pattern is even more pronounced among older women. They are also more likely to suffer from self-reported medical conditions that further limit their travel. Characteristics of long-distance travel by older adults: Older men and women take long-distance trips at about the same rates and show a strong preference for using personal vehicles. And, while men and women take an equal percentage of their trips by air, older women show a strong preference for bus travel. CONCLUSIONS: Although older Americans travel extensively, they are less mobile than their younger counterparts. This pattern is more pronounced among older women and among those with self-reported medical conditions that affect their ability to travel outside their home. Older women consistently take the least number of trips per day, have the lowest driving rates, travel the shortest distances, and are more likely to report medical conditions that limit their travel. For men and women who have to give up driving, alternative means of transportation becomes a necessity. Yet, use of alternative transportation is relatively low; excluding personal vehicle and walking, all other means of transportation account for about 2% of daily travel. Further, of those with medical conditions that affect their travel, only about 12% use special transportation services such as dial-a-ride.     

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.     

Preferred modes of travel among older adults: What factors affect the choice to walk instead of drive?

Introduction

There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics.

Methods

This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving.

Results

Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR = 1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR = 1.53; 95% CI = 1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem.

Discussion

Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.     

Factors and challenges of driving reduction and cessation: A systematic review and meta-synthesis of qualitative studies on self-regulation

Introduction: Older adults are at a greater risk of injury and death in a motor-vehicle accident. While the ability to drive safely can be challenging with aging, the concept of self-regulation and associated support system have attracted more attention in recent years, especially in developed countries. This review describes the mechanism and summarizes the potential factors that influenced self-regulation of driving amongst older adults to provide new insights into a broader framework for transportation and safe mobility. Methods: We systematically searched 12 online databases for qualitative studies exploring the experiences of older adults aged 60 years and above on their decision to self-regulate their driving. Thematic synthesis was performed to identify elements influencing driving reduction and cessation. The confidence profile of each findings from the meta-synthesis was appraised using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool. Results: A total of 17 studies representing views of 712 older adults from four countries were included. Three major themes were identified with each representing a transition phase that can either facilitate or hinder older drivers from ceasing completely or reducing their driving, when transitioning from pre-decision phase to post-cessation phase. Conclusions: Our findings suggest that there is a mismatch between the current traffic collation prevention measures, such as age-specific mandatory license renewal system and travel needs of older adults. As such, it is time for the authorities, researchers, and public from various fields and perspectives to collaborate, sustain, and improve safety and mobility in older adults. Practical applications: Adequate regulations and guidelines from the medical community and legal authorities are warranted to assist older adults and caregivers. Social support (e.g., feedback, assurance, or transportation support) from family members, friends, and healthcare professionals are crucial for a smooth transition. Provision of alternative transportations in rural areas are needed and future interventions should focus on engaging and educating older adults to consider alternative transportation modes for mobility. Age-specific mandatory license renewal procedure can be useful in screening for at-risk groups.     

Driving and alternatives: older drivers in Michigan

Method: A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive. Results: Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years. Impact on industry: Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.     

Traffic safety culture and prosocial driver behavior for safer vehicle-bicyclist interactions

Introduction: Bicyclist safety is a growing concern as more adults use this form of transportation for recreation, exercise, and mobility. Most bicyclist fatalities result from a crash with a vehicle. Often, the behaviors of the driver are responsible for the crash. Method: This survey study of Montana and North Dakota residents (n = 938) examined the influence of traffic safety culture on driver behaviors that affect safe interactions with bicyclists. Results: Prosocial driver behavior was most common and appeared to be intentional. Intention was increased by positive attitudes, normative perceptions, and perceived control. However, normative perceptions appear to offer the most opportunity for change. Practical Application: Strategies that increase perceptions that prosocial driver behavior is normal may increase prosocial intentions, thereby increasing bicyclist safety.     

Teaching older drivers to navigate GPS technology

Background and objectives: New technologies are being implemented in motor vehicles. One key technology is the electronic navigation system (ENS) that assists the driver in wayfinding, or actually guides the vehicle in higher level automation vehicles. It is unclear how older adults interact with ENSs and the best approach to train older adults to use the devices. The objectives of this study were to explore how older drivers interacted with an ENS while driving on live roadways and how various training approaches impacted older drivers’ ability to accurately enter destinations into the ENS. Research design and methods: In Experiment 1, 80 older drivers navigated unfamiliar routes using an ENS or paper directions and completed a series of ENS destination entry tasks. In Experiment 2, 60 older drivers completed one of three training conditions (ENS video only, ENS video with hands-on training, placebo) to examine the impacts of training on destination entry performance. Results and discussion: Driving performance was aided by the use of the ENS, but many older drivers had difficulty entering destinations into the device (Experiment 1). The combined video with hands-on ENS training resulted in the best overall destination entry performance (Experiment 2). Practical applications: The results suggest older drivers may experience problems entering destinations into ENSs, but training can improve performance. These performance issues may be especially important as more vehicle features require interaction with computer systems to select destinations or other automation related features. Further research is needed to determine how to prepare the next generation of older drivers who will interact with technologies aimed at increasing mobility.     

How do older adult drivers self-regulate? Characteristics of self-regulation classes defined by latent class analysis

ProblemMotor-vehicle crashes were the second leading cause of injury death for adults aged 65–84 years in 2014. Some older drivers choose to self-regulate their driving to maintain mobility while reducing driving risk, yet the process remains poorly understood.MethodsData from 729 older adults (aged ≥ 60 years) who joined an older adult ride service program between April 1, 2010 and November 8, 2013 were analyzed to define and describe classes of driving self-regulation. Latent class analysis was employed to characterize older adult driving self-regulation classes using driving frequency and avoidance of seven driving situations. Logistic regression was used to explore associations between characteristics affecting mobility and self-regulation class.ResultsThree classes were identified (low, medium, and high self-regulation). High self-regulating participants reported the highest proportion of always avoiding seven risky driving situations and the lowest driving frequency followed by medium and low self-regulators. Those who were female, aged 80 years or older, visually impaired, assistive device users, and those with special health needs were more likely to be high self-regulating compared with low self-regulating.Conclusions and practical applicationsAvoidance of certain driving situations and weekly driving frequency are valid indicators for describing driving self-regulation classes in older adults. Understanding the unique characteristics and mobility limitations of each class can guide optimal transportation strategies for older adults.     

Injury-severity analysis of lane change crashes involving commercial motor vehicles on interstate highways

Introduction: One of the challenging tasks for drivers is the ability to change lanes around large commercial motor vehicles. Lane changing is often characterized by speed, and crashes that occur due to unsafe lane changes can have serious consequences. Considering the economic importance of commercial trucks, ensuring the safety, security, and resilience of freight transportation is of paramount concern to the United States Department of Transportation and other stakeholders. Method: In this study, a mixed (random parameters) logit model was developed to better understand the relationship between crash factors and associated injury severities of commercial vehicle crashes involving lane change on interstate highways. The study was based on 2009–2016 crash data from Alabama. Results: Preliminary data analysis showed that about 4% of the observed crashes were major injury crashes and drivers of commercial motor vehicles were at-fault in more than half of the crashes. Acknowledging potential crash data limitations, the model estimation results reveal that there is increased probability of major injury when lane change crashes occurred on dark unlit portions of interstates and involve older drivers, at-fault commercial vehicle drivers, and female drivers. The results further show that lane change crashes that occurred on interstates with higher number of travel lanes were less likely to have major injury outcomes. Practical Applications: These findings can help policy makers and state transportation agencies increase awareness on the hazards of changing lanes in the immediate vicinity and driving in the blind spots of large commercial motor vehicles. Additionally, law enforcement efforts may be intensified during times and locations of increased unsafe lane changing activities. These findings may also be useful in commercial vehicle driver training and driver licensing programs.     

Driver licensing,motor-vehicle crashes,and moving violations among older adults

IntroductionDriving is important for well-being among older adults, but age-related conditions are associated with driving reduction or cessation and increased crash risk for older drivers. Our objectives were to describe population-based rates of older drivers’ licensing and per-driver rates of crashes and moving violations.Methods: We examined individual-level statewide driver licensing, crash, and traffic citation data among all New Jersey drivers aged ≥ 65 and a 35- to 54-year-old comparison group during 2010–2014. Rate ratios (RR) of crashes and moving violations were estimated using Poisson regression.Results: Overall, 86% of males and 71% of females aged ≥ 65 held a valid driver’s license. Older drivers had 27% lower per-driver crash rates than middle-aged drivers (RR: 0.73, 95% CI: 0.73, 0.74)—with appreciable differences by sex—but 40% higher fatal crash rates (RR: 1.40 [1.24, 1.58]). Moving violation rates among older drivers were 72% lower than middle-aged drivers (RR: 0.28 [0.28, 0.28]).Conclusion: The majority of older adults are licensed, with substantial variation by age and sex. Older drivers have higher rates of fatal crashes but lower rates of moving violations compared with middle-aged drivers.Practical applications: Future research is needed to understand the extent to which older adults drive and to identify opportunities to further reduce risk of crashes and resultant injuries among older adults.     

Special Report from the CDC: Strengthening social connections to prevent suicide and adverse childhood experiences (ACEs): Actions and opportunities during the COVID-19 pandemic

Introduction: During this time ofintensified hardship and disruption due to the SARS-CoV-2 (COVID-19) pandemic, communities, practitioners, and state and local governments have had to rapidly implement and adapt strategies that support mental health and wellbeing during a global pandemic. Prior to the COVID-19 pandemic, suicide was the 10th leading cause of death in the United States, and at least half of the top 10 leading causes of death have been associated with adverse childhood experiences (ACEs). A number of established risk factors for suicide and ACEs may have been exacerbated by the pandemic, including loneliness and lack of connectedness. Method: This article briefly considers the effects of COVID-19 on social connection and outlines the importance of adapting and developing programming and resources that address suicide and ACEs prevention during a time of infrastructure disruption. Practical Applications: The COVID-19 pandemic has affected the ways that many individuals are able to safely interact and socially connect due to public health prevention strategies implemented to slow the spread of COVID-19. Local, city, and state government, community organizations, and public health and medical practitioners should consider the adaptation and development of existing and new programming, resources, and activities that support and strengthen social connection. In addition to implementing programs, policies may help address systemic and structural barriers to social connection, such as access to parks and open space, public transportation, or digital connectivity.     

Are parents ready to use autonomous vehicles to transport children? Concerns and safety features

Introduction: This study addressed a gap in the literature – the potential of using autonomous vehicles (AV) to enhance children’s mobility. Prior studies documented the perceived benefits and concerns about this prospect, but did not examine the features in AV and support mechanisms that are desired by potential users. Method: An on-line survey was used to collect public opinions within the United States. In the survey, willingness to use AVs for this use case was asked twice to assess if participants changed their mind after being asked about concerns related to this prospect and importance of car features. A combination of statistical and machine-learning methods were used to profile individuals with high versus low post-willingness and to identify variables that differentiated the two groups. Results: Results indicated that respondents who were lower on their post-willingness to use AVs to transport children were more concerned about how AVs would protect children, how someone could harm the children inside, and whether there would be someone at the destination. In addition, they were less in favor of technology, older in age, and rated car features such as having a designated adult waiting at destination, a camera, and a microphone as relatively required (as opposed to optional). These results highlight potential users’ needs and requirements as they think about AVs in the context of parent–children mobility practices. Practical Applications: Relevant stakeholders should develop deployment and implementation plans while taking into account ridership contexts and vulnerable road users who can benefit from enhanced mobility.     

Statistical modeling of cargo tank truck crashes: Rollover and release of hazardous materials

Introduction: Cargo Tank Trucks (CTTs) are a primary surface transportation carrier of hazardous materials (hazmat) in the United States and CTT rollover crashes are the leading cause of injuries and fatalities from hazmat transportation incidents. CTTs are susceptible to rollover crashes because of their size, distribution of weight, a higher center of gravity, and the surging and sloshing of liquid cargo during transportation. This study identified and quantified the effects of various factors on the probability of rollover and release of hazmat in traffic crashes where a CTT was involved. Method: Bayesian Model Averaging (BMA)-based logistic regression models were estimated with rollover and hazmat release as the binary response variables, and crash, truck, roadway, environment, and driver characteristics as the explanatory variables. 2010–2016 police-reported CTT-involved crash data from Nebraska and Kansas was utilized. Receiver Operating Characteristic (ROC) curves confirmed appropriateness of the modeling approach for inference and prediction on the crash dataset. Results: CTTs are more likely to rollover in crashes while turning and changing lanes relative to going straight; side impacts (side collisions) and severe crosswinds increased the likelihood of rollovers; tractor and semi-trailer body style decreased the probability of rollover, while truck tractors are more prone to rollovers; collisions with fixed objects and higher posted speeds increased the rollover probability; rollovers and intersection crash locations increased the likelihood of hazmat release. Conclusions: The findings can assist stakeholders (policy-makers, private shippers, and CTT drivers) in restricting CTTs’ operations for safety; scheduling, routing, and fleet planning; and low-level decision-making (e.g., emergency stopping or local routing). Practical Applications: This study identified and quantified the effects of different factors on the conditional probability of rollover and release of hazmat in CTT-involved crashes. The findings may assist stakeholders in decision-making towards safe operations of CTTs for transportation of hazmat.     

Recent trends and demographics of pedestrians injured in collisions with cyclists

Introduction: Despite extensive media coverage of pedestrians who are injured in collisions with cyclists, little systematic inquiry has been carried out on this topic. This study examines the incidence of pedestrian injuries due to collisions with cyclists in the United States and in New York State and New York City (NYC) from 2005 to 2018. Method: The study rests on national data derived from the Nationwide Emergency Department Sample (NEDS) and state and local data gathered by the Statewide Planning and Research Cooperative System (SPARCS). A negative binomial regression analysis was performed on the state and local data to measure the simultaneous effects of demographic variables on the incidence of pedestrian injuries. The study also mapped the incidence of injuries in NYC neighborhoods. Results: Pedestrian injuries due to collisions with cyclists declined at both the national and state and local levels from 2005 to 2018. The decline was particularly pronounced among school-aged children. In NYC, the distribution of injuries was concentrated in certain neighborhoods. Conclusions: Possible explanations for the decline in injuries include the change in the age composition of NYC’s population, the greater level of physical inactivity among school-aged children, stricter enforcement of traffic laws, and, importantly, improvements in the cycling infrastructure. Practical Applications: Cycling as a mode of transportation is continuing to grow in popularity, particularly in large cities in the United States and Europe. With this upsurge in popularity, it is important to create a safe environment for all road users. Improvements in the cycling infrastructure (especially the installation of protected bike lanes) reduce hazards not only to cyclists but to pedestrians as well.     

To reduce or to cease: A systematic review and meta-analysis of quantitative studies on self-regulation of driving

Introduction: The ability to remain safe behind the wheels can become arduous with aging, yet important for sustaining local travel needs. This review aimed to explore safe mobility issues involving older adults and gain a broad understanding of older drivers' self-regulatory driving practices and motivators behind such behavioral changes, including strategies adopted to reduce or cease driving while maintaining safe mobility. Methods: A systematic literature search was performed on 11 online databases for quantitative studies describing self-regulation of driving amongst older adults aged 60 years and above from database inception until December 2018. Data were described narratively and, where possible, data were pooled using random-effects meta-analysis. Results: Of the 1556 studies identified, 54 studies met the inclusion criteria and 46 studies were included in the meta-analyses. All included studies examined car drivers only. Older adults who were single or female were found to be at higher odds of driving cessation. Physical fitness, mental health, social influence, and support systems received by older adults were important driving forces influencing mobility and adjustments made in their travel patterns. Conclusions: Driving self-regulation amongst older adults is a multifaceted decision, impacting mobility and mental health. Therefore, future interventions and support systems should not only create opportunities for retaining mobility for those who have ceased driving, but also promote better psychological and social well-being for regulators and for those who are transitioning from driving to non-driving status. Practical applications: (a) Engage and educate older adults about self-regulation, including strategies that can be adopted and non-car mobility options available. (b) Expand the research focus to explore potential interactions of factors facilitating or hindering the transition process to develop a more comprehensive framework of self-regulation. (c) Encourage ongoing research to formulate, monitor, and evaluate the effectiveness of policies and interventions implemented. (d) Expand the research horizon to explore and understand the perspectives of older adults from developing countries.     

The effects of primary prevention policies on mortality from motor-vehicle crashes among children in the United States

Introduction: Every year, 4500 children die in motor-vehicle crashes in the United States, with estimated costs of more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices, alcohol, high speeds, and built environments. Methodology: This is a retrospective study using U.S. panel data from 1997 through 2005. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the U.S. Census Bureau, the Atlas of Presidential Elections, and the U.S. Bureau of Labor Statistics. This study used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. Results: A total of 32,893 children died in motor-vehicle crashes (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% compared with a minimum age of 14. Higher posted speeds were associated with higher mortality rates, particularly on local roads. Conclusion: This research focuses on the effects injury prevention laws have on mortality, but not on how effectively these laws are implemented and/or enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health. Practical applications: Design appropriate education and training programs in road safety, implement effective road safety interventions and improve traffic safety legislation.