Environmental evaluation for workplace violence in healthcare and social services

PROBLEM: Federal policy recommends environmental strategies as part of a comprehensive workplace violence program in healthcare and social services. The purpose of this project was to contribute specific, evidence-based guidance to the healthcare and social services employer communities regarding the use of environmental design to prevent violence. METHOD: A retrospective record review was conducted of environmental evaluations that were performed by an architect in two Participatory Action Research (PAR) projects for workplace violence prevention in 2000 and, in the second project in 2005. Ten facility environmental evaluation reports along with staff focus group reports from these facilities were analyzed to categorize environmental risk factors for Type II workplace violence. RESULTS: Findings were grouped according to their impact on access control, the ability to observe patients (natural surveillance), patient and worker safety (territoriality), and activity support. DISCUSSION: The environmental assessment findings reveal design and security issues that, if corrected, would improve safety and security of staff, patients, and visitors and reduce fear and unpredictability. IMPACT ON INDUSTRY: Healthcare and social assistance employers can improve the effectiveness of violence prevention efforts by including an environmental assessment with complementary hazard controls.     

Frequency and determinants of recommended workplace violence prevention measures

PROBLEM: Limited information exists concerning adoption of workplace violence prevention measures by employers and the factors influencing their adoption. METHODS: A weighted sample of North Carolina workplaces (n=210) in operation January 1994 through March 1998 was used to estimate prevalence of 18 measures and identify community and workplace predictors of having >/=5 recommended measures. RESULTS: Location in a metropolitan area most strongly predicted presence of >/=5 administrative safety measures while a history of workplace violence and being in a high crime area were negatively associated. Belonging to an industry considered to be high-risk for workplace homicide was most strongly associated with having >/=5 environmental safety measures. DISCUSSION: Factors influencing high prevalence of violence prevention measures were related to business type, violence history, and location. Knowledge of factors influencing adoption of recommended workplace violence prevention measures can help tailor interventions to diverse industry settings. IMPACT ON INDUSTRY: An important contribution to the understanding and mitigation of workplace homicide is knowledge of the extent of implementation of recommended workplace violence prevention guidelines and factors influencing their adoption. Identifying factors that influence the prevalence and adoption of workplace violence safety interventions can help to tailor development of interventions to address the issue of workplace homicide across diverse industry settings.     

The application of the psychological contract to workplace safety

INTRODUCTION: Psychological contracts of safety are conceptualized as the beliefs of individuals about reciprocal safety obligations inferred from implicit or explicit promises. Although the literature on psychological contracts is growing, the existence of psychological contracts in relation to safety has not been established. The research sought to identify psychological contracts in the conversations of employees about safety, by demonstrating reciprocity in relation to employer and employee safety obligations. The identified safety obligations were used to develop a measure of psychological contracts of safety. METHOD: The participants were 131 employees attending safety training sessions in retail and manufacturing organizations. Non-participant observation was used to collect the data during safety training sessions. Content analysis was used to analyze the data. Categories for coding were established through identification of language markers that demonstrated contingencies or other implied obligations. RESULTS: Direct evidence of reciprocity between employer safety obligations and employee safety obligations was found in statements from the participants demonstrating psychological contracts. A comprehensive list of perceived employer and employee safety obligations was compiled and developed into a measure of psychological contracts of safety. A small sample of 33 safety personnel was used to validate the safety obligations. CONCLUSIONS AND IMPACT ON INDUSTRY: Implications of these findings for safety and psychological contract research are discussed.     

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers

Introduction: Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries. Methods: We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts. Results: Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19–21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22–24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14–18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were “struck by/against” (35.6%) and “work-related musculoskeletal disorders (WMSDs)” (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare. Conclusions: This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.     

Assessment of the living and workplace health and safety conditions of site-resident construction workers in Tehran,Iran

Objectives. The purpose of this study was to assess living and workplace safety conditions of construction workers in Tehran, Iran. Methods. This cross-sectional study was conducted among 410 construction sites in a municipal area of Tehran whose municipal building permits were issued in 2011. Data on ventilation, workplace safety and hygiene were collected by direct observation and interviews with site foremen. Noise levels were estimated from 10 sound-level-meter stations in the municipality area. Results. Lack of ventilation in the workers’ rooms was abundant. Bathrooms were unhygienic and minimum requirements such as lighting and ventilation did not exist in 80% of the cases. In nearly 50% of large construction sites, sewage and garbage disposal were inappropriate. Elevator safety was poor at all sites and no measures for fall prevention were present in over 88% of active construction sites. This study showed that the mean 24-h equivalent continuous sound level L_eq was over 70?dB in 80% of the sites during weekdays. Conclusions. The results of this study revealed poor health and safety living and working conditions of construction workers in Tehran.     

Analysing workplace violence towards health care staff in public hospitals using alternative ordered response models: the case of north-eastern Turkey

The main objective of this article is to determine key factors that may have a significant effect on the verbal abuse, emotional abuse and physical assault of health care workers in north-eastern Turkey. A self-administered survey was completed by 450 health care workers in three well-established hospitals in Erzurum, Turkey. Because of the discrete and ordered nature of the dependent variable of the survey, the data were analysed using four distinctive ordered response models. Results revealed that several key variables were found to be a significant determinant of workplace violence, such as the type of health institution, occupational position, weekly working hours, weekly shift hours, number of daily patient contacts, age group of the respondents, experience in the health sector, training against workplace violence and current policies of the hospitals and the Turkish Ministry of Health.     

The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

Objective

To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws.

Methods

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed.

Results

MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.

Conclusions

The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21.

Impact on Industry

Lowering the drinking age to 18 will increase highway crash deaths among young people.     

Evaluation and comparison of the Chinese policy context for safety-related psychological health in the workplace: Realities,gaps and challenges

Work-related psychological health problems have become a major challenge for occupational health and safety (OHS) management. Hard and soft policy systems could be employed to guarantee that this issue is taken seriously and solved effectively. However, in China, compared with the European Union (EU) and Australia, few experts have reviewed the policies related to this area. Thus, a comparative analysis was performed to investigate the hard and soft law policies associated with safety-related psychological health in the workplace based on approved criteria. A total of 21 policies (16 hard and 5 soft) were evaluated, and the current realities were discovered. Then, by comparing the actual situation in China with that of countries with well-developed policy systems in this area, extant gaps and future challenges were observed. The results showed that both hard and soft policies addressed the topic, but all of them had rather low scores. The policy system is far from perfect and is still in its infancy in China, and there are great gaps between China and countries with more developed systems related to this topic. Filling these gaps may involve encountering some challenges in the future. Based on the analysis, some specific suggestions are recommended to promote the policy system and improve OHS management from the perspective of psychological health related to work.     

Repeatability of electromyography normalization of the neck and shoulder muscles in symptomatic office workers

Purpose. The purpose of the study was to examine the repeatability of electromyography (EMG) normalization in office workers with neck and shoulder symptoms. Methods. Fifteen female office workers with neck/shoulder symptoms were recruited to participate in two separate days of testing. Maximum voluntary isometric contraction (MVIC) was used for the normalization of EMG data on the following muscles: cervical erector spinae, upper trapezius, lower trapezius and anterior deltoid. Repeatability was calculated using the intra-class correlation (ICC), relative standard error of measurement (%SEM) and relative coefficient of variation (%CV). Results. Peak root mean square (rms) and median frequency (MF) showed good to high repeatability in the UT, AD and CES (ICC?=?0.87–0.95, %SEM=?2.65–9.48, %CV=?0.2–5.9). The repeatability of peak rms was good (ICC?=?0.87, %SEM?=?12.56, %CV?=?3.3) and the MF of the LT was fair (ICC?=?0.76, %SEM?=?5.71, %CV?=?2.9). Conclusion. Peak rms and MF from the MVIC normalization method can be measured with sufficient repeatability in symptomatic office workers.     

Trends and characteristics of animal-vehicle collisions in the United States

Introduction

Since 1990, fatal animal-vehicle collisions (AVCs) in the United States have more than doubled. This paper examines annual AVC trends in the United States over a 19-year period, seasonal and diurnal patterns of AVC risk, the geographic distribution of crash risk by state, and the association between posted speed limit and AVC crash risk in darkness.

Method

AVCs were compiled from the Fatality Analysis Reporting System (FARS) and the General Estimates System (GES) for the years 1990-2008 to examine annual crash trends for fatal and nonfatal crashes. Seasonal trends for fatal AVCs were examined with the aggregated FARS dataset; seasonal trends for fatal and nonfatal AVCs were also examined by aggregating four years of Michigan crash data. State-by-state distributions of fatal AVCs were also described with the aggregated FARS dataset. Finally, the relationship between posted speed limit and the odds that a fatal or nonfatal AVC occurred in darkness were examined with logistic regressions using the aggregated FARS and Michigan datasets.

Results

Between 1990 and 2008, fatal AVCs increased by 104% and by 1.3 crashes per trillion vehicle miles travelled per year. Although not all AVCs involve deer, daily and seasonal AVC crash trends follow the general activity pattern of deer populations, consistent with prior reports. The odds that a fatal AVC occurred in darkness were also found to increase by 2.3% for each mile-per-hour increase in speed; a similar, albeit smaller, effect was also observed in the aggregated Michigan dataset, among nonfatal crashes.

Conclusion

AVCs represent a small but increasing share of crashes in the United States. Seasonal and daily variation in the pattern of AVCs seem to follow variation in deer exposure and ambient light level. Finally, the relative risk that a fatal and nonfatal AVC occurred in darkness is influenced by posted speed limit, suggesting that a driver's limited forward vision at night plays a role in AVCs, as it does in pedestrian collisions.

Impact on Industry

The association between speed limit and crash risk in darkness suggests that AVC risk might be reduced with countermeasures that improve a driver's forward view of the road.     

83家井工煤矿在岗农民工尘肺病现状调查及预防对策研究

为调查井工煤矿在岗农民工尘肺病防治现状并提出对策措施,采用分层整群抽样调查方法对4省（市）的83家井工煤矿进行调研,调查内容包括:职业卫生管理现状、职业健康监护与尘肺病诊断资料、X线胸片、农民工基本情况、职业卫生知识知晓情况、社会保险待遇等。调查结果显示:83家井工煤矿的职业病危害防治工作领导小组设置率和管理制度制定率均为100%,但制度内容和职业卫生培训缺乏针对性;粉尘危害防治费用平均为吨煤0.18元/月;采煤和掘进工作面的总尘浓度约为1.02～49.5 mg/m3;在岗检查时,农民工肺部异常的检出率高于正式工,在岗农民工疑似尘肺病检出率为7.94%,农民工尘肺病平均发病工龄14.47 a±6.79 a,平均发病年龄42.56岁±5.80岁,与正式工相比,农民工发病工龄短、发病年龄小。因此,建议政府从法规标准建设、探索职业健康责任险、加大监管力度等方面,企业从强化主体责任意识、源头治理及农民工职业卫生培训等方面,加强农民工尘肺病的防治工作。     

中国与美国矿山救护标准的比对分析

近些年来随着国内矿山事故的频繁发生,矿山救护发挥着越来越重要的作用。矿山救护标准是保障矿山救护工作顺利进行的重要技术规范。本文通过分析中国和美国矿山救护标准的现状,从矿山救护的组织机构、队员条件、技术支持、经费来源、技能培训五个方面分别对两国矿山救护标准中的具体技术指标进行比对分析,总结出我国与美国矿山救护标准之间的异同。另外通过对我国矿山救护体系建设现状的分析,指出我国矿山救护体系存在的一些不足。最后在比对分析结果及矿山救护体系建设现状分析的基础之上,为我国矿山救护标准的发展提供参考意见,包括：注重标准的动态性与实用性;加强对应急救援指挥体系引发社会成本的研究;加强队伍建设,增强应急救援综合能力;改革管理体制,理顺管理渠道等。     

Sleeping with a broken promise: The moderating role of generativity concerns in the relationship between psychological contract breach and insomnia among older workers

This paper examines the relationship between psychological contract breach and insomnia among older workers (aged 40 years and up). Drawing upon the conservation of resources theory, we conceptualize breach as a stressful event characterized by a perceived threat, failure to gain, or actual loss of valued resources, which increases psychological distress and insomnia. Moreover, we hypothesized that older workers' generativity concerns would act as a personal resource that would buffer the negative impact of breach. We tested our proposed model in 2 studies (Study 1 = 123; Study 2 = 168) of employee–spouse dyads. Results revealed that psychological distress mediated the relationship between psychological contract breach and insomnia. These mediated relationships were significant for those with low, but not for those with high levels of generativity concerns. These effects remained significant even after controlling for perceived organizational support (i.e., a social exchange mechanism). Theoretical and practical implications are discussed.     

美国引导企业合规的经验及启示

美国环境保护署(EPA)在引导企业主动守法上经验丰富。在顶层设计上,EPA的国家合规计划(NCIs)明确要求鼓励企业守法并给予帮助,在《清洁空气法》《小企业监管和执法公平法案》等相关法律中要求设立技术和环境合规协助项目,并通过成立合规协助中心或专家团队等方式为企业提供技术咨询支持。在鼓励企业自主守法方面,制定了国家环境表现跟踪计划(ENPT)、环境审计自我报告制度,并通过适当的激励措施鼓励企业自主守法。在通过社会监督引导企业环境守法方面,政府及时公开执法与守法历史在线数据库、有毒物质释放清单,并要求上市公司在公开的信息中包含环境财务事项信息。美国引导企业合规的模式与经验,对于我国深化环境执法改革,落实企业治污的主体责任,打赢打好污染防治攻坚战有重要的参考价值。     

Epidemiology of alcohol and drug screening among pedestrian fatalities in the United States, 2014–2016

Objective: U.S. pedestrian fatalities increased by 25% between 2010 and 2015. Risk factors include distractions, the built environment, urbanization, economic variables, and weather conditions. Of interest is the role of alcohol and drugs in premature death among pedestrians. This study sought to explore the prevalence of substance use screenings among pedestrian fatalities in the United States between 2014 and 2016.

Methods: Data were collected from the Fatality Analysis Reporting System provided by the NHTSA. Pedestrian crash variables included demographics as well as information regarding alcohol or drug testing status. Frequency and cross-tabulation tables were constructed to assess the prevalence of screening by person, place, and time. Log-linear analyses were completed to explore age, race, and sex differences. A 3-year examination period was used to control for yearly fluctuations and to incorporate an increasing trend in cases.

Results: Pedestrian fatalities accounted for 84% of all deaths among vulnerable road users during the examination period. Those most at risk were white males between the ages of 45 and 64. Over all states, 74.7% of fatalities were tested for alcohol and 67.1% were tested for drugs; further, 66.5% of cases were tested for both alcohol and drugs and 24.8% were tested for neither substance. Cases screened for both alcohol and drugs ranged from 2.9% in North Carolina to 95.7% in Nevada and those testing for neither substance ranged from a high of 68.9% in Indiana to a low of 1.1% in Maryland. Log-linear regression revealed significant differences in alcohol screening by age and race but not by sex. Differences in drug screening were not identified for any demographic variable. Fatalities tested for alcohol were significantly more likely to be tested for drugs; only 8.2% were screened solely for alcohol and 0.05% were screened for drugs alone.

Conclusions: Preventive strategies become more important as pedestrian crashes and fatalities increase. Risk reduction in the form of policy change, alterations to the built environment, or interdisciplinary approaches to injury prevention is dependent upon best evidence supported in part by more deliberate and consistent screening.     

Validity of police-reported alcohol involvement in fatal motor carrier crashes in the United States between 1982 and 2005

Objective

To examine the validity of police-reported alcohol data for drivers involved in fatal motor carrier crashes.

Material and Methods

We determined the availability of blood alcohol concentration (BAC) and police-reported alcohol data on 157,702 drivers involved in fatal motor carrier crashes between 1982 - 2005 using Fatality Analysis and Reporting System (FARS) data. Drivers were categorized as motor carrier drivers if they operated a vehicle with a gross vehicle weight rating of greater than 26,000 pounds. Otherwise, they were classified as non motor carrier drivers. The sensitivity and specificity of police-reported alcohol involvement were estimated for both driver types.

Results

Of the 157,702 drivers, 18% had no alcohol information, 15% had BAC results, 42% had police-reported alcohol data, and 25% had both. Alcohol information varied significantly by driver, crash, and vehicle characteristics. For example, motor carrier drivers were significantly more likely (51%) to have BAC testing results compared to non motor carrier drivers (31%) (p < 0.001). The sensitivity of police-reported alcohol involvement for a BAC level ≥ 0.08 was 83% (95% CI 79%, 86%) for motor carrier drivers and 90% (95% CI 89%, 90%) for non motor carrier drivers. The specificity rates were 96% (95% CI 95%, 96%) and 91% (95% CI 90%, 91%), respectively.

Conclusions

The sensitivity and specificity of police-reported alcohol involvement are reasonably high for drivers involved in fatal motor carrier crashes. Further research is needed to determine the extent to which the accuracy of police-reported alcohol involvement may be overestimated because of verification bias.

Impact on the Industry

Based on the results of this study, the federal government should continue to work with states to strengthen their strategies to increase chemical testing of all drivers involved in fatal crashes.     

Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors

Introduction

Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury.

Objectives

This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation.

Methods

This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household.

Results

Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country.

Conclusions

While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. Impact on industry: minimal.     

Impact of improving vehicle front design on the burden of pedestrian injuries in Germany,the United States,and India

Objective: European car design regulations and New Car Assessment Program (NCAP) ratings have led to reductions in pedestrian injuries. The aim of this study was to evaluate the impact of improving vehicle front design on mortality and morbidity due to pedestrian injuries in a European country (Germany) and 2 countries (the United States and India) that do not have pedestrian-focused NCAP testing or design regulations.

Methods: We used data from the International Road Traffic and Accident Database and the Global Burden of Disease project to estimate baseline pedestrian deaths and nonfatal injuries in each country in 2013. The effect of improved passenger car star ratings on probability of pedestrian injury was based on recent evaluations of pedestrian crash data from Germany. The effect of improved heavy motor vehicle (HMV) front end design on pedestrian injuries was based on estimates reported by simulation studies. We used burden of disease methods to estimate population health loss by combining the burden of morbidity and mortality in disability-adjusted life years (DALYs) lost.

Results: Extrapolating from evaluations in Germany suggests that improving front end design of cars can potentially reduce the burden of pedestrian injuries due to cars by up to 24% in the United States and 41% in India. In Germany, where cars comply with the United Nations regulation on pedestrian safety, additional improvements would have led to a 1% reduction. Similarly, improved HMV design would reduce DALYs lost by pedestrian victims hit by HMVs by 20% in each country. Overall, improved vehicle design would reduce DALYs lost to road traffic injuries (RTIs) by 0.8% in Germany, 4.1% in the United States, and 6.7% in India.

Conclusions: Recent evaluations show a strong correlation between Euro NCAP pedestrian scores and real-life pedestrian injuries, suggesting that improved car front end design in Europe has led to substantial reductions in pedestrian injuries. Although the United States has fewer pedestrian crashes, it would nevertheless benefit substantially by adopting similar regulations and instituting pedestrian NCAP testing. The maximum benefit would be realized in low- and middle-income countries like India that have a high proportion of pedestrian crashes. Though crash avoidance technologies are being developed to protect pedestrians, supplemental protection through design regulations may significantly improve injury countermeasures for vulnerable road users.     

Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates

Background: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. Objective: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). Methods: Estimates of child restraint use from two online, cross-sectional surveys—FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults—were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child’s restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0–4 years, forward-facing CSS use for children aged 2–7 years, booster seat use for children aged 5–12 years, and seat belt use for children aged 9–12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. Results: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5–94.1) (FallStyles) and 89.4% (CI: 85.5–93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9–91.3) (Estilos) and 84.4% (CI: 79.0–88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7–79.0) (FallStyles) to 59.7% (CI: 55.0–64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1–81.0) (Estilos) to 57.2% (CI: 51.2–63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups.