The main objective of this article is to study long-term effects of legislation and local promotion of child-restraint use in motor vehicles. Subgoals are to describe the level of restraint use for children in cars and to study changes in mortality and morbidity patterns in regard to differences among age groups and geographical areas (morbidity). The level of restraint use for children (0-15 year of age) in the front seat of the car in 1988 was 97 per cent (equal in 1995) for Sweden as a whole, while for rear seats there was an improvement from 78 per cent in 1988 to 86 per cent in 1995. However, for rear seats the main increase occurred before 1988 (from 17 per cent in 1983) (Cedersund 1997). The number of fatalities were 564, and by age group 294 (0-6) and 270 (7-14) respectively. The overall picture for incidence in mortality is a decrease on average by 2.8 per cent per year, equivalent to 76 per cent over a 27 year period. This is most evident after 1981. There are no significant differences between the two age groups (0-6 and 7-14 years). There has been a significant decrease in hospital admissions for Sweden as a whole during the period. The average annual decrease is 1.15 per cent for the whole study group, 22 per cent over the study period, and there are significant decreases for the whole group and the age-group 7-14 years. Frequency, incidence (/1.000) for children (0-14 years) hospital discharged due to car occupancy in motor-vehicle accidents (all diagnoses) in Sweden 1978-96, by year and geographic area, show a significant change over time in "The First Four" (annual change - 2.8 per cent) and in "The Six Counties" (annual change -1.8 per cent), but not in the rest of Sweden (annual change -0.4 per cent). Accordingly, there has been a decrease in the number of hospitalisations, but more so in the intervention areas, and less so in Sweden as a whole (-1.1 per cent) It can be concluded that there is a need for continuous and appropriate information, including instructions on how to properly install restraint in cars, and implement long term local action on childhood injury prevention to accompany legislation. The local authorities in specific geographic areas that first started preventive programs, such as safety seat loan schemes, and organised local action programs were found to be more successful in achieving injury reduction for their community's children. National legislation on its own is not as effective. (A) For the covering abstract of the conference see ITRD no 207828. The reprints are also available at the web - http://www.vti.se/pdf/reports/K18APart1.pdf; http://www.vti.se/pdf/reports/K18APart2.pdf and http://www.vti.se/pdf/reports/K18APart3.pdf.
Samenvatting