problem, and increased efforts must be made to secure additional financial ...... St Ives hosted Year 11 students from schools in the Hills district undertaking the pilot ...... captured on a secure server and copies of the Interactive Highway Code ...
Road Safety for Infants, Children and Young People – Road safety in the first 1,000 weeks of life Ian Faulks
Julia Irwin (Editors)
Proceedings of an international conference held at Parliament House, Sydney New South Wales 2-3 August 2007
December 2008
Road Safety for Infants, Children and Young People – Road safety in the first 1,000 weeks of life
Proceedings of an international conference held in Sydney, New South Wales 2-3 August 2007
Ian Faulks Julia Irwin (Editors)
2
REPORT DOCUMENTATION PAGE Report
Report Date
SPAI 2007-24 / 2
December 2008
Pages 554
Title and Subtitle Road safety for infants, children and young people – Road safety in the first 1,000 weeks of life. Proceedings of an international conference held in Parliament House, Macquarie Street, Sydney, New South Wales 2-3 August 2007.
Editors Ian Faulks & Julia Irwin
Performing Organisations Safety and Policy Analysis International Pty Limited PO Box 140, Wahroonga NSW Australia 2076
Sponsoring Organisation Australasian College of Road Safety P O Box 198 MAWSON A.C.T. 2607 Australia
Abstract The 2007 annual conference of the Australasian College of Road Safety was focused on “Infants, Children and Young People, and Road Safety”, reflecting the inaugural 2007 UN Global Road Safety Week theme, and aiming to review indicators and trends in injury involving infants, children and young people, examine the current research into aspects of road safety affecting infants, children and young people, explore projections for the future development of the road transport system and the likely impacts on the safety of infants, children and young people in all areas of road use, and consider possible strategies for enhancing road safety for infants, children and young people, now and into the future. The papers presented at the conference addressed these general objectives. A key aspect of the conference was the presentation of the outcomes of a Youth Assembly, held in Geneva as part of the Global Road Safety Week. The papers presented at the conference allowed for consideration of an additional number of themes, particularly passenger protection for infants and children.
Keywords ROAD SAFETY, INFANTS, CHILDREN, YOUTH, YOUNG PEOPLE, ADOLESCENCE, UNITED NATIONS, GLOBAL ROAD SAFETY, NOVICE DRIVERS, DRIVER LICENSING, OCCUPANT PROTECTION, PASSENGER, SCHOOL BUS, PEDESTRIAN SAFETY, CYCLING
Citation This report may be cited as: Faulks, I.J. & Irwin, J.D. (Eds.) (2008). Road safety for infants, children and young people – Road safety in the first 1,000 weeks of life. Proceedings of an international conference held in Parliament House, Macquarie Street, Sydney, New South Wales 2-3 August 2007. Report SPAI 2007-24/1. Wahroonga, NSW: Safety and Policy Analysis International.
Disclaimer The views expressed in this reportof proceedings are those of the editors and authors, and do not necessarily represent the views or policy of the client.
3
4
Sponsors
5
6
Foreword Ian Faulks Safety and Policy Analysis International and Department of Pyschology, Macquarie University Julia Irwin Department of Pyschology, Macquarie University The road safety of infants, children and youth encompasses dramatic periods of development and maturaton, with a transition from total dependency changing to independence occurring over a timescale measured in decades. Three major phases can be discerned over this time: • A period of passivity in infancy, with a strong focus on occupant protection of babies and young children; • A period of change, as children become more independent and mobile as pedestrians and bicyclists, yet still retaining major passive characteristics as a vehicle passenger; and • A period of independence as young people, when teenagers enter into the driver licensing system as novice, or beginning, drivers and become primarily responsible for their own mobility Through these phases, infants, children and young people experience the constraints of safety systems in vehicles and on roadways that have been designed to protect them from harm in motor evcile crashes, are exposed to the modelling of both safe and unsafe road behaviours in real life and in entertainment, and experience educational interventions and public advertising created to increase their knowledge and effect attitudinal change towards safer road behaviour. It is a time of immense challenge for legislators, for policy makers, program developers, and communities to ensure the safety of infants, children and young people as road users within road transport systems. These challenges include the liveability of urban environments, tension between motorised and non-motorised transport, ageing road transport and mass transit infrastructure, the likely passing of peak oil, and the challenge of developing viable non-petroleum fuel sources. The Australasian College of Road Safety held its 2007 annual conference at 2-3 August 2007, at Parliament House, Sydney, on the theme of infants, children and young people, and road safety. The conference reflected the inaugural 2007 UN Global Road Safety Week, and was the major event to mark the Global Road Safety Week in Australia The inaugural UN Global Road Safety Week was held over 23-29 April 2007, with key global events: • World Youth Assembly for Road Safety, 23-24 April 2007, where young delegates from all regions of the world gathered to exchange ideas and adopted a resolution calling for action on road safety.
7
•
Second Global Road Safety Stakeholders' Forum, 25 April 2007, where representatives of governments, United Nations agencies, civil society and the private sector met to share perspectives and ways to advance road safety efforts around the world. The conference allowed the unique opportunity of bringing together colleagues with expertise in road safety from academe, government, non-government organisations and advocacy groups from around the Asian region. Many road safety issues affecting infants, children and young people were highlighted, along with discussions on innovative strategies and policies to address road trauma. A feature of the Australasian College of Road Safety 2007 annual conference was a review of the outcomes of a Youth Assembly, held in Geneva as part of the Global Road Safety Week Australian representatives who attended the World Youth Assembly for Road Safety reported to the national conference on the outcomes arising from the Assembly. This was also the mechanism that has been adopted for the Canadian Youth Road Safety conference, held in 6-8 June 2007, in conjunction with the Canadian Multidisciplinary Road Safety Conference. The Australasian College of Road Safety 2007 annual conference was held at a very opportune time, as new rules for P-plate drivers in New South Wales came into effect from 1 July 2007, and the new NSW Centre for Road Safety also commenced operation on that date. The Australasian College of Road Safety 2007 national conference was the first major road safety event where these important initiatives could be described and discussed.
Objectives The objectives of the conference were: • To review indicators and trends in injury involving infants, children and young people • To examine the current research into aspects of road safety affecting infants, children and young people. • To explore projections for the future development of the road transport system and the likely impacts on the safety of infants, children and young people in all areas of road use. • To consider possible strategies for enhancing road safety for infants, children and young people, now and into the future. The opening and keynote addresses outlined national and New South Wales initiatives concerning motor vehicle trauma associated with infants, children and young people. More than three dozen papers were presented that addressed particular issues affecting the road safety of infants, children and young people.
8
Opening session The opening speakers were: Mr Ian Faulks, Safety and Policy Analysis International and Conference Chairman Welcome – “Infants, children and young people, and road safety” Hon Jim Lloyd MP, Australian Government Minister for Local Government, Territories and Roads Ministerial speech – “National perspective on the road safety challenges faced by infants, children and young people” Hon. Eric Roozendaal MLC, New South Wales Minister for Roads Ministerial speech – ”A New South Wales perspective on the road safety challenges faced by infants, children and young people” Both the Federal and State Ministers indicated their strong support for initiatives that addressed the road safety of infants children and young people, with the Hon Jim Lloyd MP commenting, in particular, on school bus passenger safety initiatives, and the Hon. Eric Roozendaal MLC highlighting the innovative New South Wales advertising campaign ‘Little Pinky’ targeting inappropriate and illegal behaviour by young drivers.
Keynote speeches The keynote speakers were Commissioner Gillian Calvert Keynote speech – “The big picture of road safety for children and young people in New South Wales” Gillian Calvert is the New South Wales Commissioner for Children and Young People, and Convenor of the New South Wales Child Death Review Team. The Commission is an independent organisation that works with others to make New South Wales a better place for children and young people. Gillian also is the chair the board of the Injury Risk Management Research Centre at the University of New South Wales. Associate Professor Lyn Fragar Keynote speech – “The safety of infants, children and young people” Lyn Fragar founded the Australian Centre for Agricultural Health and Safety at Moree in northern New South Wales. The Centre for Agricultural Health and Safety aims to make primary producers and the wider community more aware of the dangers on farms, including the off-road use of motor vehicles that involve children. Her work has, in particular, examined the off-road use of motor vehicles by children and young people as part of argicultural work and in the context of farming life.
9
Special sessions In addition to the general conference sessions, there were three special sessions held during the conference, addressing: • Australia’s contribution to the inaugural UN Global Road Safety Week held in April 2007; • Road safety education for children and youth, with presentations on the Youth Road Trauma Forum, an initiative of NRMA Motoring & Services and Westmead Hospital Trauma Service and Rescue Ed, an initiative of the New South Wales Fire Brigades; and • The safety of infants and children in cars. As well, a satellite seminar to the Australasian College of Road Safety 2007 annual conference was held on Wednesday 1 August 2007. This was the first Australian conference on intelligent speed adaptation (ISA). An immediate consequence of that seminar was the formation of a national working party to promote the development of this technology, in which Australian companies are world leaders with fully commercialised products in the marketplace for Australian drivers that offer advisory ISA (warnings to drivers about speed limits) and fully active ISA (where the vehicle is limited to speeds that cannot exceed the speed limits or zoningds for that road location).
Conference awards A feature of the conferences organised by the Australasian College of Road Safety are the awards given to a conference paper by a new researcher and to the best presentation of a conference paper given in general sessions. The 2007 national conference awards were given to: The award for the best presentation of a conference paper given in general sessions was given to Kathryn Henderson, of Kids with a Voice, for her paper: “Improving the safety of kiss and drop zones at schools: The Stay Safe Rangers at Balgowlah Public School” As well, certificates of appreciation were awarded to Harriet Lugsdin and Dylan Poole, both Year 6 students at Balgowlah Public School in 2007, in recognition of their contribution in presenting the Safe Safe Rangers program to the conference. The new researcher award was given to Tahera Anjuman and Chowdhury Kawsar Arefin Siddiqui, of the Accident Research Center at the Bangladesh University of Engineering and Technology, for their conference paper: “The road safety situation for children in Bangladesh”
10
Media The conference generated considerable media interest, notably in the areas of road safety associated with occupant protection for bus occupants, safe travel around schools, gender differences in driver distraction, and hoon behaviour by young drivers.
11
12
Acknowledgments The preparation, organisation and conduct of an international conference requires the integration of many different agencies and organisations, and the teamwork of individuals.
Sponsors The Australasian College of Road Safety is particularly grateful to the major support and sponsorship received from: NRMA Motoring & Services Australian Transport Safety Bureau Britax Australia (Safe-n-Sound) NRMA-ACT Road Safety Trust. NSW Motor Accidents Authority The NSW Motor Accidents Authority provides the Sydney Chapter of the Australasian College of Road Safety with an annual grant to conduct seminars, conferences and workshops on issues of road safety and injury prevention, and these grant monies were also used to support the conference.
Organising and Program Committee The Organising and Program committee for the conference on infants, children and young people, and road safety comprised: Mr Ian Faulks, Safety and Policy Analysis International (Chairman) Dr Sarah Redshaw, Driving Cultures Mr Michael Griffiths, Road Safety Solutions Ms Anne Deans, Youthsafe Mr Graham Orr, Professional Association of Road Safety Officers Dr Mavis Duncanson, NSW Commission for Children and Young People Ms Liz de Rome, LdeR Consulting Mr Jeff McDougall, Australian Driver Trainers Association Professor Mark Stevenson, George Institute for International Health
13
Administrative assistance Administrative assistance to support the conference was provided by: Ms Kerry Fitzgerald, President, Australasian College of Road Safety, 2006-07 Mr Geoff Horne, Mr Allan Armistead, and Ms Jacki Percival, of the Australasian College of Road Safety national office
Conference assistance Assistance during the conference was provided by: Mr Geoff Horne, Australasian College of Road Safety NSW Parliament House catering, security, and attendant staff.
14
Contents FOREWORD
7
Ian Faulks Partner, Safety and Policy Analysis International, and Honoary Associate, Department of Psychology, Macquarie University Julia Irwin Director of Undergraduate Studies, Department of Psychology, Macquarie University
ACKNOWLEDGMENTS
13
IMPROVING GLOBAL ROAD SAFETY— NOTE BY THE UNITED NATIONS SECRETARY-GENERAL, 14 AUGUST 2007, ON IMPROVING GLOBAL ROAD SAFETY
21
OPENING AND WELCOME
35
Mr Ian Faulks - Conference Chairman Partner, Safety and Policy Analysis International, and Honorary Associate, Department of Psychology, Macquarie University “Welcome - Road safety for infants, children and young people – Road safety in the first 1,000 weeks of life”
KEYNOTE ADDRESS
45
Gillian Calvert Commissioner, NSW Commission for Children and Young People Convenor, New South Wale Child Death Review Team Chair, New South Wales Injury Risk Management Research Centre, University of New South Wales “The big picture of road safety for children and young people in New South Wales”
UN ROAD SAFETY WEEK, 23-29 APRIL 2007
57
Kofi A. Annan The United Nations for Global Road Safety Week, 23-29 April 2007 – Immediate Past Secretary General’s message on the occasion of the first UN Global Road Safety Week, 23-29 April 2007
59
15
Youth Declaration for Road Safety
63
Joel Tucker & Leanne Hucker World Youth Assembly for Road Safety – The Australian Delegation
69
Australian Automobile Association Road safety and young Australians: Background information for Australia’s delegates to the UN World Youth Assembly for Road Safety
77
Tahera Anjuman & Chowdhury Kawsar Arefin Siddiqui Accident Research Center, Bangladesh University of Engineering and Technology The road safety situation for children in Bangladesh
99
GENERAL PAPERS
113
Cathy Rutter and Len Woodman Sydney 2030: A city safe for children
115
Lisa Buckley & Mary Sheehan Road safety and injury prevention programs in the high school curriculum: Key considerations with examples from the SPIY Program
131
David W. Soole, Mary Sheehan & Vic Siskind Reaching high-risk adolescents in a school setting: Is it possible?
149
Lyle Schefe From preschool to Year 12, a preparation for driving.
165
Graham Smith Driver education for young drivers
171
Michelle Whelan & Jennie Oxley The development of “Going Solo: A resource for parents of P–plate drivers”
177
Julia D. Irwin, Louise Geaghan & Eugene Chekaluk Gender differences in simulated driving tasks for young drivers using mobile telephones
187
Trevor Bailey Self-awareness and self-monitoring: important components of best educational practice for novice drivers
207
Ian Faulks & Julia Irwin Rotary young driver programs: The ‘U-Turn The Wheel – You Choose’ program, and the RYDA program
225
16
John McDonough The NSW Fire Brigades ‘RescuED’ road safety education program for high schools
241
David Bamford, Graham Syme, David Tynan & Ian Faulks Traffic offender programs: A successful intervention with young drivers
257
Michael Paine, Kathryn Henderson & Ian Faulks Improving the safety of kiss and drop zones at schools: The Stay Safe Rangers at Balgowlah Public School
269
Jennifer Oxley, Melinda Congiu, Michelle Whelan, Angelo D’Elia & Judith Charlton Identifying ‘at-risk’ child pedestrians and improving their road crossing skills
279
Leon Hain Child safety at unacceptable high risk to and from schools, or do governments regard pupils lives as disposable?
293
Narelle Haworth & Angela Nielson Motor scooters and mopeds – a growing attraction for young people
301
T. P. Hutchinson, A. D. Long, & C. N. Kloeden Child bicyclist traffic casualties in South Australia
309
Joanne Kemp The relationship between youth celebrations and road trauma in young people
325
Sarah Redshaw Men, driving culture and speed
329
Nerida Leal, Barry Watson, Kerry Armstrong Mark King Enhancing road safety for young drivers: How graduated driver licensing initiatives can complement “anti-hooning” legislation
339
Will Murray, Barry Watson & Ian Faulks Targeting road safety interventions at young workers and family members through the workplace
351
ABSTRACTS only Bill Noonan The Transport Workers Union - Pedestrian and bus safety program and DVD
367
Rebecca Ivers The role of parents in driver education
369
17
Jeff McDougall Driving instructors, schools, parents and communities
371
SPECIAL SESSION: INFANTS AND CHILDREN IN CARS
373
Lynne Bilston & Julie Brown Inappropriate restraint use by child occupants - injury implications and factors in inappropriate use
375
Trudy Stewart & Alexia Lennon Parents’ knowledge and use of child restraints in regional and rural New South Wales: Results from a survey.
385
Julie Brown & Lynne Bilston Misuse of restraints by child occupants
395
Heidi Stewart City of Stirling child car restraint fitting, installing and demonstrations
413
Michael Paine, Julie Brown, Lynne Bilston, Michael Griffiths & Nimmi Magadera Rear seat occupant safety
429
Wei Du, Lynne Bilston, Julie Hatfield, Caroline Finch & Andrew Hayen Increased hospitalised abdominal and spinal cord injury risk by age in child motor vehicle passengers in New South Wales
437
Basuki Suratno, Soames Job, Dan Leavy, Julie Brown, Michael Paine, Nimmi Magedara, Paul Kelly, Michael Griffiths, Jack Haley & Michael Case The Australian Child Restraint Evaluation Program
445
R. W. G. Anderson & T. P. Hutchinson Many children progress from one type of restraint to the next at too small a size: Should advice to parents be simple and based on child age, with variation in child size accommodated by overlaps in restraint specifications?
477
Lynne Bilston & Julie Brown Improving child restraint design – upcoming changes in restraint standards and remaining challenges
487
ABSTRACT only Michael Lumley How Australian child restraints compare with overseas products
18
497
THE AUSTRALASIAN COLLEGE OF ROAD SAFETY
499
THE NATIONAL CONFERENCES OF THE AUSTRALASIAN COLLEGE OF ROAD SAFETY
501
APPENDIX – THE WORLD HEALTH ORGANISATION (2007) REPORT ON YOUTH AND ROAD SAFETY
503
19
20
Improving global road safety— Note by the Secretary-General 14 August 2007 In August 2007, the United Nations' (UN) Secretary-General, Ban Ki-Moon, released his first report to the UN General Assembly on progress in international road safety. The report summarised the achievements of the United Nations Road Safety Collaboration, a network of more than 40 agencies facilitated by the World Health Organization. The report also highlighted a series of good practice manuals developed by partners from the UN Road Safety Collaboration designed to address risk factors for road traffic injuries such as drink driving, seat-belts, helmets, speed, and visibility. The Secretary-General hereby transmits the report on improving global road safety, prepared by the World Health Organization in consultation with the regional commissions and other partners of the United Nations Road Safety Collaboration.
21
22
Report on improving global road safety, prepared by the World Health Organization in consultation with the regional commissions and other partners of the United Nations Road Safety Collaboration Ban Ki-Moon United Nations (UN) Secretary-General
Summary The present report, prepared by the World Health Organization in consultation with the regional commissions and other partners of the United Nations Road Safety Collaboration, provides an update on the status of implementation of the recommendations made in General Assembly resolution 60/5 on improving global road safety. The report describes how collaborative advocacy efforts made over the past two years at the international level have served to increase awareness about road safety at the national and international levels. It describes the number of technical products that have been developed during the period that, once implemented, will offer great potential to slow the trend of increasing road traffic deaths, injuries and disabilities. It concludes by proposing a number of recommendations for consideration by the Assembly that would facilitate the implementation of effective interventions known to improve road safety at the national level.
I. Introduction 1. Road traffic injuries are a major public health problem and a leading cause of death, injury and disability around the world. Each year nearly 1.2 million people die and millions more are injured or disabled as a result of road crashes, mostly in the urban areas of developing countries. Road traffic injuries are the leading cause of death globally for those between 10 and 24 years of age. 2. Not only are road traffic injuries a major health concern they also threaten to reverse the developmental gains made in many countries. At the household level, they can place a severe financial strain on families, who often have to absorb the direct medical and rehabilitation costs, as well as the indirect costs created by a victim’s inability to continue earning, or by the reallocation of work within his/her career. At the national level, road traffic injuries place a heavy burden on a country’s economy through the direct impacts on health care and rehabilitation services as well as through the indirect costs. The annual costs of road traffic crashes in low income and middle-income countries are estimated to be
23
between $65 billion and $100 billion, more than the total annual amount received in development aid. 3. Road traffic injuries can, however, be prevented. This can be achieved by acting on a number of factors that have been identified as increasing the risk of traffic-related injuries, including inappropriate and excess speed, non-use of seat belts and child restraints, drinking and driving, non-use of helmets by riders of two wheeled motorized vehicles, poorly designed or insufficiently maintained road infrastructure and vehicles that are old, not well maintained or that lack safety features. Regulatory and other actions that address these risk factors have led to dramatic decreases in road crashes in many countries. The provision of emergency trauma care services has also been shown to be important in mitigating the negative impacts of road traffic crashes. Similarly, experience from around the world has identified that the creation of a lead agency on road safety and an accurate assessment of a country’s road safety situation are important steps that need to be taken to effectively tackle road traffic injuries. 4. On World Health Day 2004, the World Health Organization (WHO) and the World Bank jointly launched the World Report on Road Traffic Injury Prevention. The report stresses the role of many sectors in the prevention of road traffic injuries and describes the fundamental concepts of road traffic injury prevention, the magnitude and impact of road traffic injuries, the major determinants and risk factors and effective intervention strategies. As such, it serves as both an advocacy tool and a technical document containing six major recommendations on what countries can do to address the problem of road traffic injuries. 5. In April 2004, the United Nations adopted resolution 58/289, entitled “Improving global road safety”, which recognized the need for the United Nations system to support efforts to address the global road safety crisis. The resolution invited WHO, working in close cooperation with the regional commissions, to act as coordinator on road safety issues within the United Nations system. It also underlined the need for a further strengthening of international cooperation, taking into account the needs of developing countries, to deal with issues of road safety. 6. In May 2004, the World Health Assembly adopted resolution WHA 57.10, in which it accepted the General Assembly’s invitation for WHO to act as the coordinator on road safety issues. The resolution on road safety and health also called upon Member States to prioritize road safety as a public health issue and to take steps to implement measures that are known to be effective in reducing road traffic injuries. 7. In October 2005, the General Assembly adopted resolution 60/5, in which the Assembly further reinforced the call for Member States to pay increased attention to road traffic injury prevention. In that resolution, the Assembly invited the regional commissions and WHO to jointly organize the first United Nations Global Road Safety Week (23-29 April 2007) and invited Member States to recognize the third Sunday in November of every year as the World Day of Remembrance for Road Traffic Victims.
24
II. United Nations Road Safety Collaboration 8. In accordance with the coordination mandate conferred upon it by the General Assembly, WHO has worked closely over the past three years with the regional commissions to facilitate the development of what is now referred to as the United Nations Road Safety Collaboration, a group comprised of United Nations and international road safety organizations. As of June 2007, the group comprised eight organizations of the United Nations system, including WHO, the World Bank, the five regional commissions and the United Nations Children’s Fund (UNICEF). Twenty-nine other international agencies working in road safety, with a broad range of skills and experience, are also represented. The number and range of sectors represented by participating organizations (Governments, non-governmental organizations, donors, research agencies and the private sector) from the transport, health and safety sectors attest to the broad support for this collaborative effort. 9. To date, the Collaboration has met biannually, a total of six times. Where possible, meetings each year have alternated between WHO headquarters in Geneva and the offices of a regional commission. The goal of the Collaboration, developed through mutual consensus by participants, is to facilitate international cooperation (including at a regional level) among agencies of the United Nations system and other international partners to implement General Assembly resolution 58/289 and the recommendations contained in the World Report on Road Traffic Injury Prevention, and thereby support country programmes. A number of objectives to meet the goal have also been identified, including assessing the road safety situation and the existing facilities of countries to address the problem; developing guidance and support for effective road safety interventions; providing capacity development on road safety issues; advocating and encouraging the demand for road safety; strengthening global and regional coordination on road safety; and improving the safety of United Nations fleets for all road users. To that end, a number of working groups have been created to address the implementation of the specific objectives.
III. Products of the United Nations Road Safety Collaboration A. Provision of technical support 10. The Collaboration has developed the first products in a series of “how to” manuals that provide guidance to countries on how to implement some of the recommendations identified in the World Report on Road Traffic Injury Prevention. The manuals are practical and user-friendly, providing step-by-step guidance on the implementation of specific interventions. They are being developed collaboratively by a consortium of four partners, including WHO, the Global Road Safety Partnership, the FIA Foundation for the Automobile and Society and the World Bank, but also incorporate expertise from other members of the Collaboration. Two manuals have been produced: one, on implementing helmet-wearing programmes into place; and the other on programmes to reduce drinking and driving. Manuals on other topics are being developed by the Collaboration, including on controlling inappropriate and excessive speed; the use of seat belts and child restraints; the creation of a lead agency on road safety; ways to collect road traffic injury data; and guidelines for safer road infrastructure.
25
11. Following the development of the good practice guides on helmet use and on drinking and driving, partners in the Collaboration have been involved in launching and implementing the good practices in countries. For example, workshops on helmet use have been held in Cambodia, the Lao People’s Democratic Republic, Thailand and Viet Nam, organized by Governments in collaboration with the Global Road Safety Partnership, the Asia Injury Prevention Foundation, Handicap International, WHO and other partners, and funded by the Global Road Safety Initiative. The workshops have involved numerous stakeholders from a range of sectors and aimed to get participants to develop national plans of action on helmet use. As part of the launches and workshops, situational studies were conducted in the project countries. The studies included collecting data on helmet-wearing rates and assessing knowledge, markets and standards and resulted in a set of appropriate actions for consideration. The manuals have been translated into local languages and published locally. With the support of the Global Road Safety Initiative, the Global Road Safety Partnership is now working on training programmes that aim to build local capacity for police enforcement and for public education campaigns promoting awareness of helmet use and of drinking and driving. 12. A number of steps have been taken towards achieving the Collaboration’s objective of improving the fleet safety of the United Nations and of other participating organizations. For example, the Fleet Forum’s fleet safety training project will soon be launched, with the aim of encouraging aid and development agencies to make road safety a priority for their own staff and to implement policies and strategies to reduce road traffic crashes within their organizations. In addition, other partners are engaging with large multinational corporations to examine how strategies to reduce road traffic crashes can be introduced and to develop ways of benchmarking the progress made by organizations relative to each other. It is envisaged that such projects will feed into the development of a good practice guide on fleet safety. B. Policy 13. In May 2007, the World Health Assembly adopted its first resolution on emergency care systems. In resolution WHA 60.22, the World Health Assembly draws the attention of Governments to the need to strengthen pre-hospital and emergency trauma care systems (including mass casualty management efforts) and describes a number of steps Governments can take. In addition, it invites WHO to scale up its efforts to support countries. The resolution will serve as a basis to increase efforts to strengthen trauma care systems. 14. In June 2006, a report of the Commission for Global Road Safety, Make Roads Safe: A New Priority for Sustainable Development, was launched in London. The Commission was created by the FIA Foundation for the Automobile and Society in 2005 and is chaired by Lord Robertson, former Secretary-General of the North Atlantic Treaty Organization. The report uses the World Report on Road Traffic Injury Prevention as its basis and advocates greater support for the implementation of its recommendations. The report frames road safety as a development issue and aims to bring it to the attention of key policymakers. The objectives of the report are to increase and sustain funding for road safety efforts over a 10-year period and to increase earmarked investment in road safety within road infrastructure projects. It
26
also calls for a ministerial meeting on road safety to be held under the auspices of the United Nations in the near future, followed by a series of policy discussions in countries. 15. The Working Party on Road Traffic Safety of the Economic Commission for Europe has focused on the revision of the consolidated resolution on road traffic. In the resolution, the Working Party aims to enhance road safety by providing recommendations to Governments on issues on which a legally binding consensus cannot be achieved or by providing a level of detail greater than that contained in either the Vienna Convention on Road Traffic or in the European Agreement supplementing it. In this context, the Working Party on Road Traffic Safety has adopted new provisions, including on driving under the influence of alcohol, improving bicycle, motorcycle and moped safety, increasing seat belt usage, safety of pedestrians and driving at night. Work has continued on issues related to driving permits, communication and road safety campaigns, daytime running lamps, speed, mobile phones, the safety of children, the contents of first-aid kits, special rules concerning certain categories of vehicles and driving instruction. The World Forum for Harmonization of Vehicle Regulations has also adopted new Economic Commission for Europe (ECE) and global regulations on a number of components to improve vehicle safety and motorcycle safety worldwide. 16. The Intergovernmental Agreement on the Asian Highway Network came into force in 2005 and includes a commitment by parties to give full consideration to issues of road safety. This was followed, in 2006, by the Ministerial Declaration on Improving Road Safety in Asia and the Pacific, which includes a goal to save 600,000 lives and prevent a commensurate number of serious injuries on the roads of Asia and the Pacific over the period 2007 to 2015. Subsequently, in May 2007, the Economic and Social Commission for Asia and the Pacific (ESCAP) adopted resolution 63/9, in which it encourages members and associate members to continue to act upon the recommendations contained in the ministerial declaration of the previous year. C. Advocacy 1. First United Nations Global Road Safety Week 17. In resolution A/60/5, the General Assembly invited the regional commissions and the World Health Organization to organise jointly the first United Nations Global Road Safety Week to serve as a platform for global, regional and national activities to raise awareness about road safety issues, and to convene the second Stakeholders’ Forum for Global Road Safety in Geneva. 18. The first United Nations Global Road Safety Week was held from 23 to 29 April 2007. The Week focused on young road users and aimed to raise awareness about the societal impact of road traffic injuries, highlighting the risks for children and young people, and to promote action around such key factors as helmets, seat belts, drinking and driving, speeding and visibility. 19. A number of technical documents were developed to be launched for the Week. The WHO report entitled Youth and Road Safety provided new data on the magnitude of the problem among those under 25 years of age, while highlighting the specific interventions
27
that can be implemented to reduce road traffic injuries among that group. At the regional level, too, a number of documents highlighted aspects of the problem pertinent to different regions, including one entitled, “A framework for national road safety campaigns in the countries of the Economic Commission for Europe”, issued by ECE. The International Federation of Red Cross and Red Crescent Societies, in collaboration with the Global Road Safety Partnership, also used the occasion of the Week to launch a new publication, entitled Practical Guide on Road Safety: a Toolkit for National Red Cross and Red Crescent Societies. 20. The World Youth Assembly for Road Safety was the key global event of the Week, and was held at the United Nations headquarters in Geneva on 23 and 24 April. Over 400 young people from 100 countries attended the meeting, which served to provide an opportunity to share experiences and create a global network of young road safety advocates. The youth delegates also developed and adopted a declaration entitled “Youth declaration for road safety” and agreed to a 10-step plan for the follow-up to the Assembly. At the closing of the World Youth Assembly, the Declaration was presented to Sheika Haya Rashed Al Khalifa, President of the General Assembly. The Youth Assembly also provided the opportunity to show the results of a short-film competition on road safety, which was coordinated by the non-governmental organizations Laser Europe and Prevention Routière Internationale, and a youth essay competition launched by UNICEF on road safety. The financial contributions of the European Commission, the FIA Foundation for the Automobile and Society and the Governments of the Netherlands, Norway and Italy enabled the World Youth Assembly to be held. 21. The momentum among youth, generated by the Youth Assembly, rapidly led to tangible outputs. Notably, it resulted in an international network of youth who are motivated to address the issue in their countries and are communicating electronically to share their ideas and experiences. Upon their return, a number of young delegates took steps to implement the Declaration: for example, the Canadian delegates set up a youth national committee for future work on road safety; the Zambian delegate submitted the Declaration to all relevant ministries (health, community development, and transport) and followed up with appointments; in Algeria, the Declaration was printed in national newspapers; in Belize, the Ministry of Education agreed to include road safety in primary and secondary school curricula. 22. The second Stakeholders’ Forum for Global Road Safety, organized by the Global Road Safety Forum, was held in Geneva and brought together United Nations delegates, ministers and representatives of national departments in transport, health, law enforcement and foreign relations, stakeholders from non-governmental organizations and the private sector. Participants expressed their support for the United Nations Road Safety Collaboration, the conclusions of the report of the Commission for Global Road Safety, the World Bank Global Road Safety Facility and a ministerial conference on global road safety, held under the auspices of the United Nations. 23. Hundreds of national and regional events were also held worldwide on the occasion of the first United Nations Global Road Safety Week. Examples include the European Commission’s first European Road Safety Day, in Brussels, which involved 400 young participants from over 30 countries; the rally for safer roads, in London, organized by the
28
“Make roads safe” campaign; the Asian mayors policy dialogue for the promotion of environmentally sustainable transport in cities, held in Kyoto, Japan; the Asia Injury Prevention Foundation’s helmet-wearing campaign in Viet Nam; the development of road safety education programmes for schools in Turkey, organized by local partners; the multisectoral forum on road safety in China; the launch of the good practice manual on drinking and driving in Ghana and Namibia by the Global Road Safety Partnership; the launch of the new road traffic legislation in Cambodia, organized by Handicap International; the “Fatality free Friday” campaign, in Australia; and the adoption of a ministerial declaration on road safety in Abu Dhabi. 2. Other advocacy activities 24. The “Make roads safe” campaign is a global advocacy strategy to increase awareness about road safety, while highlighting the need for road safety to be considered as a development issue. Based on the recommendations of the report Make Roads Safe: A New Priority For Sustainable Development, the campaign stresses the economic as well as human costs of road deaths, while advocating the need for increased investment in that area. The campaign has been heavily endorsed by celebrities and leaders worldwide including the former Prime Minister of the United Kingdom of Great Britain and Northern Ireland, Tony Blair, who supported the campaign; and Archbishop Desmond Tutu, who called on political leaders and the Group of Eight countries to take action on road safety during the African launch of the “Make roads safe” campaign in South Africa. 25. In resolution 60/5, the General Assembly invited Member States and the international community to recognize the third Sunday in November of every year as the World Day of Remembrance for Road Traffic Victims. Over the past few years, an increasing number of countries around the globe have held events on the Day, ranging from interfaith ceremonies to tree-planting memorials, to using the media for increased coverage of road crash victims and their families. Some countries, such as the United States of America, have started to explore the possibility of officially recognizing the World Day of Remembrance for Road Crash Victims at the national level. As an aid to countries in planning events for the Day, the European Federation of Road Traffic Victims and WHO have developed a guide entitled World Day of Remembrance for Road Traffic Victims: A Guide For Organizers. In addition, the Association for Safe International Road Travel and WHO have developed a document containing the testimonials of those affected by road crashes. Faces Behind the Figures: Voices of Road Crash Victims and Their Families is a powerful advocacy tool that illustrates the human suffering associated with each of the cited road traffic statistics. 26. There has been an increase in the number of non-governmental organizations involved in international road safety efforts and in the extent of their cooperation with other partners within the Collaboration. As well as representing the victim’s perspective in international road safety work, organizations have been involved in research and in the implementation of technical interventions. For example, Handicap International conducted an assessment of helmet-wearing use by motorcyclists in Cambodia and has been active in advocacy resulting in new legislation on helmet use in the country; and the Asia Injury Prevention Foundation has an active helmet distribution programme in Viet Nam.
29
D. Regional meetings 27. Over the past two years, partners in the Collaboration have facilitated regional meetings on road safety. These include: (a)
A ministerial conference on transport, organized by the Economic and Social Commission for Asia and the Pacific and held in Busan, Republic of Korea. Ministers of the Asia-Pacific region adopted the Ministerial Declaration on Improving Road Safety in Asia and the Pacific;
(b) An African road safety conference, jointly organized by the Economic Commission for Africa and WHO in Accra. The conference objectives included advancing the development of national plans of action, planning the implementation of the recommendations of the World Report on Road Traffic Injury Prevention, and addressing how to mobilize resources. A ministerial round table of transport and health ministers was also held, wherein delegates adopted the Accra Declaration, which committed ministers to working together to stop the growing epidemic of death and injuries on African roads; (c)
The Economic Commission for Latin America and the Caribbean, the National Road Safety Council of Costa Rica, the FIA Foundation for the Automobile and Society, the Pan American Health Organization, the Inter-American Development Bank, the World Bank and the Global Road Safety Forum sponsored the first Latin American and Caribbean road safety stakeholders forum in San José, in September 2006. Participants from throughout the region planned actions for road safety in the Americas and adopted the Declaration of San José, which includes a call for a regional committee to help the countries of the region collaborate on road safety;
(d) A number of regional road safety meetings have taken place in the Eastern Mediterranean region. Most recently, a regional training course for ministry of health injury prevention focal points for the Eastern Mediterranean region was held in Cairo in December 2006. Jointly organized by the Economic and Social Commission for Western Asia and the WHO Eastern Mediterranean Regional Office, the conference aimed to increase capacity in the region in a number of areas, including road traffic injury prevention. E. Data collection and research 28. As part of a series of good practice guides (see section below on technical support), a working group within the Collaboration has begun to develop a good practice guide on road traffic injury data collection. The guide will focus on how to make optimum use of imperfect data, including by guiding the reader on how to conduct surveys, and quick analyses, while aiming put a long-term surveillance system into operation. It will further offer the reader a minimum data set and will present good practices on various types of information gathering from around the world. Finally, it will show how data can be used. 29. As more and more countries take steps to improve their road safety situation, there is a growing need for a global tool to measure progress towards implementing the recommendations of the World Report on Road Traffic Injury Prevention at the national level and to allow countries to assess their road safety situation, both internally over time and in
30
relation to other countries. One component of such an assessment would be the use of observational surveys that would allow countries to quickly collect invaluable information about their helmet and seat belt wearing rates, as well drinking and driving levels. Towards this end, a group of members of the Collaboration have developed the first component of such a tool, in defining the methodology to conduct simple observational studies on helmetwearing rates. F. Financial support 30. The World Bank’s Global Road Safety Facility was set up in 2006 to support global, regional and country efforts that would lead to reductions in road deaths and injuries in low- and middle-income countries. The Facility’s mission includes activities directed at strengthening road safety strategies and institutional capacities in their target countries. The Facility, which is now administering grants, has two streams of funding: one for global road safety initiatives and the other for supporting country programmes. Financing at the country level has now commenced with stand-alone activities and through complementing new and existing multilateral development bank projects targeting road safety. So far, contributions to the Facility have been made by the FIA Foundation for the Automobile and Society and the Governments of Sweden and the Netherlands. 31. Financial support for the Collaboration has been provided by the Governments of Sweden and the United States, the World Bank Global Road Safety Facility and SCANIA. Facility grants to date include funding to members of the Collaboration, including the WHO Department of Injuries and Violence Prevention, the Global Road Safety Partnership and the Global Road Safety Forum. The Global Road Safety Initiative has also continued to provide support for the implementation of the good practice manuals in target countries.
IV. Conclusions and recommendations 32. Road traffic injuries continue to be an important public health and development issue. Trends in many countries, in particular low- and middle-income countries, suggest that the problem could become noticeably worse within the next decade. Despite increased awareness of the issue, there is a pressing need for greater effort and resources to be directed towards the problem. 33. Over the past three years, considerable progress has been made at the international, regional and national levels to improve road safety. There has been increased coordination at the international level, which has fostered the exchange of ideas between sectors and facilitated coordinated action. A number of products have been developed to provide technical support to countries in implementing effective interventions: Governments in many countries have continued to increase data collection and prevention efforts and strengthen services for those affected; some agencies of the United Nations system have started to take steps to improve road safety policies within their own organizations; and there has been increased action in the area from within the private sector. There has also been increased collaboration with victims’ organizations and other non-governmental organizations working in road safety. These organizations have collaborated with other
31
partners to produce a number of products which, by portraying the human side of road traffic crashes, fill an important gap. Furthermore, there has been some progress made towards consolidating the process whereby funds targeted at road safety efforts are distributed, as exemplified by the creation of the Global Road Safety Facility. 34. The World Health Assembly called for an increased focus by member States on emergency trauma care services. This is an important step which should lead to improvements in pre-hospital and hospital care. 35. Activities of the Collaboration in the short term include continuing to develop the remaining good practice guides; providing technical support for implementation of road safety projects in low- and middle-income countries; and promoting continued global and regional advocacy for road safety. Towards the aim of continuing the working cooperation developed, it is envisaged that members of the Collaboration will continue to meet regularly; between those meetings, WHO will continue to facilitate communication through regular contacts with participants and via the Collaboration website. It is also envisaged that working groups will maintain regular contact among themselves between meetings. 36. Despite progress in addressing the issue of road safety collectively within and beyond the United Nations system, these are preliminary steps and much remains to be done. In the countries where the issue of road safety has been put firmly on the political agenda, it is important that the momentum gained not be lost. In countries where road safety remains neglected, the international community needs to find ways to encourage efforts to reduce road traffic injuries and to make national Governments aware of the need to integrate road safety into their transport and health policies. Finally, although considerable progress has been made within many international settings to increase awareness of road safety issues, it is still not on the agenda of most of the development organizations and lending institutions. 37. At a regional level, partners of the Collaboration have successfully taken action to provide opportunities for discussion among regional leaders on the best ways for countries to cooperate around road safety issues. Nonetheless, there is no global platform for a ministerial exchange of information and strategies on road safety. A number of agencies have called for a ministerial conference on road safety, to be held under the auspices of the United Nations, which would review progress in international road safety, including the implementation of the recommendations contained in the World Report on Road Traffic Injury Prevention and General Assembly resolutions on road safety. 38. Levels of funding for road safety are still not commensurate with the scale of the problem, and increased efforts must be made to secure additional financial support for road safety projects. In particular, road infrastructure interventions for improving road safety remain big challenges for developing countries, where underinvestment is illustrated by the very high social returns for safety interventions. The World Bank Global Road Safety Facility is an important tool for mobilizing such urgently needed support. 39. There is an ongoing need for a mechanism by which to measure the progress that countries are making on the implementation of interventions known to reduce road traffic
32
injuries, as described in the recommendations of the World Report on Road Traffic Injury Prevention. 40. It is therefore recommended that the General Assembly: (a)
Reaffirm its commitment to addressing the global road safety crisis;
(b) Reaffirm its desire for WHO to continue its role as coordinator of road safety within the United Nations system, working in close collaboration with the regional commissions, encourage Member States to support road safety efforts, and facilitate the ability of Member States to obtain financial, political and technical support; (c)
Call upon Member States to develop programmes and action plans in road safety, noting that the programmes should be seen to be profitable investments for Governments to undertake. Such programmes should adopt a broad perspective on road traffic injury prevention that pays particular attention to the safety needs of vulnerable road users, including through improvements in public transport and road space for pedestrians and cyclists;
(d) Encourage Member States to continue using the World Report on Road Traffic Injury Prevention as a framework for road safety efforts and implementing its recommendations, including the establishment of a lead agency on road safety and the development of a national action plan to reduce road traffic injuries; (e)
Encourage Member States to pay particular attention to such risk factors as the non-use of seat belts and child restraints, the non-use of helmets, drinking and driving and inappropriate and excessive speed, and to the development of appropriate infrastructures, including by passing and enforcing legislation, conducting necessary awareness-raising campaigns and implementing appropriate methods to monitor and evaluate existing interventions;
(f)
Encourage Member States that have not yet done so to adhere to the Convention on Road Traffic and the Convention on Road Signs and Signals and to implement them as key strategies for improving road safety in their countries;
(g) Support efforts by organizations and bodies of the United Nations system for the development and use of tools with which progress on the implementation of road safety initiatives can be measured; (h) Encourage Member States to continue strengthening intersectoral dialogue on road traffic injury prevention, and to support efforts to hold a ministerial conference on road safety, under the auspices of the United Nations, which would review progress in international road safety, including the implementation of the recommendations contained in the World Report on Road Traffic Injury Prevention and in the General Assembly resolutions on road safety; (i)
Call upon Member States to continue raising awareness about road safety at the international and national levels through the organization of advocacy events and by scaling up existing efforts to reflect the magnitude of the problem, in particular by encouraging observation of the World Day of Remembrance of Road Traffic Victims and by inviting WHO, in collaboration with the regional commissions, to organize the second United Nations Global Road Safety Week;
(j)
Call upon development institutions and the international community at large to consider road safety as an integral part of the international development agenda;
33
(k) Encourage agencies of the United Nations system and other international organizations with large fleets to take steps towards addressing fleet safety within their organizations; (l)
Acknowledge the importance of the World Bank Global Road Safety Facility as a means to increase the resources needed to address road safety in low- and middleincome countries;
(m) Encourage Member States to strengthen efforts to improve emergency trauma care and rehabilitation services within their countries; (n) Request that the Secretary-General report to the General Assembly at its sixty-fourth session.
34
Opening Session and Welcome
35
36
Infants, children and young people, and road safety: road safety in the first 1,000 weeks weeks of life Welcoming remarks at the opening of the Australasian College of Road Safety 2007 National Conference Ian Faulks Safety and Policy Analysis International, Psychology, Macquarie University
and
Department
of
The Australasian College of Road Safety 2007 national conference is about road safety policy, programs and practices as they affect infants, children and young people. The conference has, as a subtitle, road safety in the first 1,000 weeks weeks of life—the first 7,000 days, which equates to about 19 years and 2 months. This period covers infancy, childhood, and almost all of the teenage years. It covers a person’s minority, a quaint term that defines the period from birth to 18 years as being before adulthood (legally, adulthood is achieved on a person’s 18th birthday in Australia and New Zealand). For many, it covers the period we call adolescence, a term first coined by G. Stanley Hall; for some, adolescence is a period extending well into the third decade of life, and it is sometimes suggested that there are men who never leave this stage of life! The focus on infants, children and young people is an elastic rather than rigorous categorisation. In 1990, in a speech to the British Association for the Advancement of Science, Michael Young noted that “. . .People’s birthdays are no longer just private affairs: they are public events which they have to repeatedly declare in public to show they are entitled to go to school, to have sexual intercourse, to buy alcohol, to marry, to vote and much else besides”. It is easy to forget that it is an arbitrary decision when it is decided that a child to be fit for school at the age of 5 years, when it is declared that a person is able to vote at 18 years of age, or when it is determined that a person is able to be licensed to drive a car in most Australian jurisdictions at the age of 16 years under supervision or instruction and drive unaccompanied from the age of 17 years. The recent focus on human neuromaturation – initially developed in the context of debates over juvenile justice and punishment – has been popularised in road safety circles through statements about teenagers’ risk propensity and lack of impulse control. We may see the neuromaturation debate give rise to claims for restricting driver licensing to ages later than 17 or 18 years of age, or restricting legal access to alcohol until 20 or 21 years of age. But underpinning this debate about neuromaturation is a sensing that developmental milestones based on birth date do not adequately reflect individual variations in growth and competency.
37
The concept of a person as ‘young’, and its implications for road safety, may extend well beyond the first 1,000 weeks of life. For example, if a young person enters and progresses through the NSW graduated driver licensing system at the earliest possible ages, they do not exit until their 21st birthday—almost 100 weeks after the first 1,000 weeks of life. Statistical collections of road use and road trauma, which are the practical facts about road safety matters, often are structured to report on age categories such as under 16 years, under 18 years, and 17-21 or 17-25 years, reflecting the concerns and importance of the transition from ‘not driving’ to ‘driving’ in the occurrence of road trauma. The documentation for the UN Global Road Safety Week has referred to people aged 5-25 years, reflecting yet another categorisation about the ages encompassed in the phrase ‘infants, children and young people’ that is not limited to within the first 1,000 weeks of life. What can we say about the period of 1,000 weeks? If you google the term, you find that: • 1,000 weeks is a period of time used by insurers in calculating permanent disability ratings for injuries; • 1,000 weeks is used by electronics engineers in estimates of failure rates; • 1,000 weeks is used by financial planners and economists in long term forecasting of investment returns; • 1,000 weeks is a time period used in estimating incidence densities, such as in clinical drug trials where event rates (number of events per 1000 patient weeks of exposure); and in what might well be confronting to some attending this conference: • if you are in your late 50s, you have about 1,000 weeks of life left if you live the average lifespan of your age cohort. But most importantly, 1,000 weeks is more-or-less the time period that most people in Australia and New Zealand take from birth until they commence to enter and interact with the adult world—for us, 1,000 weeks truly encompasses infancy, childhood and youth. The impetus for addressing the road safety of infants, children and young people is the “shortening of life” that is associated with road trauma, for a small but tragic number whose experience of this first stage of 1,000 weeks of life is a final and fatal experience, or who suffer such trauma that their remaining life is one of permanent disability. When statistical measures of injuries are costed, a common method of comparative measurement is ‘years of productive life lost’. For the infants, children and young people who die or receive lifelong disabling injuries in road crashes, the cost as measured in proiductive life is very high. Our literary heritage, and the ongoing research into human development, both consider the process of birth, growth and eventual death to be composed of recognisable divisions or phases, often referred to as the “ages of man”. For some, there can be a division of people's lives into four stages: the first is young people's years in full-time education and parental care; the second when independence in career and finances is tempered by family and other commitments; the third is the ‘empty nester’ phase, when a person is still independent but without strong family, career and other commitments; and a fourth stage is when a person enters a state of relative dependency and there is a need for care. A decade ago, when media and community interest in ‘road rage’ and aggressive driving was first prominent, it was recognised that Sophocles’ “Oepidus the King” (sometimes
38
referred to as “Oedipus Rex”), was a story that incorporated road rage, as Oedipus became involved in a fatal dispute about the right of way and who must yield at a crossroads. In the ensuing fight he killed his unrecognized father Laertes. Oedipus soon after solves the riddle of the Sphinx: ‘What goes on four feet, then two feet, and three, But the more feet it goes on the weaker it be?’, saving the city state of Thebes from the ravages of that monster (an alternative statement of the riddle of the Sphinx is ‘What is the creature that walks on four legs in the morning, two legs at noon, and three in the evening?’) and is rewarded with the kingship and marriage to Jocasta, the recently widowed queen and, unknown to both, his mother. The story is tragic. For our purpose today, the answer to the riddle of the Sphinx, “A man”, reflects a three stage division of a person’s life through crawling infancy, the upright stance of childhood and adulthood, and the infirmity of old age when a person is reliant on a walking stick for support and movement. Among the other themes in the powerful story of Oedipus, the idea of definable stages of man was recognised and accepted by ancient Greek audiences almost two and a half thousand years ago (as were the circumstances that we now recognise as ‘road rage’). In our modern time, the development of the University of the Third Age from its inception in Toulouse, France, in the 1970s reflects general recognition of the divisions of human life. The University of the Third Age, or U3A, is an international movement which promotes and practises lifelong learning by providing low cost educational opportunities for retired people in a relaxed and informal environment. The concept of people being in the First, Second or Third Ages of life, based on their economic circumstance, derives from French thinking outlined in the 1962 report of the Laroque Commission for the Study of the Problem of Old Age. In this report, the First Age is that of socialisation, the Second Age is of work and child rearing, and the Third Age is of independent post-work (in the 1990s, Peter Laslett, working in the United Kingdom, suggested the addition of a Fourth Age, or dependent older age). But, of course, the most prominent exposition of the divisions of human life is Shakespeare’s seven ages of man, as stated by Jacques in “As You Like It” (Act II, Scene 7), and it is perhaps the most eloquent: All the world's a stage, And all the men and women merely players: They have their exits, and their entrances; And one man in his time plays many parts, His acts being seven ages. At first, the infant, Mewling and puking in the nurse's arms; Then the whining schoolboy, with his satchel, And shining morning face, creeping like snail Unwillingly to school: and then, the lover, Sighing like furnace, with a woeful ballad Made to his mistress' eyebrow: Then, a soldier; Full of strange oaths, and bearded like a pard, Jealous in honour, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon's mouth: and then, the justice; In fair round belly, with good capon lin'd,
39
With eyes severe, and beard of formal cut, Full of wise saws and modern instances, And so he plays his part: The sixth age shifts Into the lean and slipper'd pantaloon; With spectacles on nose, and pouch on side; His youthful hose well sav'd, a world too wide For his shrunk shank; and his big manly voice, Turning again to childish treble, pipes And whistles in his sound: Last scene of all, That ends this strange eventful history, Is second childishness, and mere oblivion; Sans teeth, sans eyes, sans taste, sans everything.
Shakespeare’s first stage of man is that of infancy. One of the exciting aspects of research into infancy, childhood and youth has been the initiation of major longitudinal studies of development over the past few decades, and these types of studies are yeilding valuable information about infancy, childhood and youth. Such studies include the Millennium Cohort Study, tracking the lives of nearly 19,000 children born in 2000/2001 in the United Kingdom. In just one observation reported from this study, one in six of these 'millennium babies' were living with their mother only at nine months of age – and of these, almost half see their father at least once a week but about four in ten have no contact with their father at all. The effect of such psychosocial factors as contact with the father are being examined in other longitudical studies that have a direct bearing on road safety, including the work of Jean Shope and her colleagues at the University of Michigan Transportation Research Institute, who have conducted a longitudinal study of at-risk drinking, risky driving, and drink driving among several Michigan high school graduating classes of 1991–1994 (with data collection commencing in Grade 5 in 1984 and continuing through grade 12). In Australasia, there have been a number of longitudinal studies of infants, children and young people. A 2001 report of the Committee on Children and Young People of this parliament, titled “The development of wellbeing in children – some aspects of research and comment on child and adolescent development” is the proceedings of a seminar, held here at Parliament House in Sydney, on 7 March 2001. This seminar was co-sponored by the Commission for Children and Young People in New South Wales, and featured a keynote presentation on the Christchurch Health and Development Longitudinal Study, which has involved more than 1,000 children from birth in 1980, and focuses on how a child’s longer term health, behaviour, abilities, and opportunities can be affected by family breakdown, sexual and physical abuse, health, and unemployment. Other longitudinal studies discussed at the seminar include the Western Australia Child Health Survey and the Aboriginal Child Health Survey. Another interesting and current study is the DRIVE project at the George Institute for International Health, which is following more than 20,000 young drivers in New South Wales as they progress in the early phases of graduated driver licensing in their later teenage years and early twenties. This study is not only examining crash involvement and traffic offences alone, but is looking for related correlations with factors such as parental involvement, suicidal ideation, the effect of living in regional and rural areas as opposed to metropolitan areas, and so on. As well, there is also the Australian Temperament Project, which is a large longitudinal study of children’s development that began in 1983 with the enrolment of a representative sample of 2443 infants and their families from urban and rural
40
areas of Victoria. As with the Michigan study by Jean Shope and her colleagues, the Australian Temperament Project investigates pathways to psychosocial adjustment from childhood to adulthood and the influence of personal, family and environmental factors, and similarly there are likely to be interesting crossovers from these long term studies into safety behaviours and the risk of road trauma. Shakespeare’s second and third stages of man relate to the experience of childhood and its impact on adult outcomes, and to the development of new relationships and new cognitions and emotions after puberty. These stages relate strongly to the new information emerging from the longitudinal studies of infants, children and young people being undertaken in Australia, New Zealand, and elsewhere. A keynote speech this morning will be presented by Ms Gillian Calvert, the current New South Wales Commissioner for Children and Young People. Another keynote speech for this conference will be presented tomorrow morning by Associate Professor Lyn Fragar, Director of the Australian Centre for Agricultural Health and Safety, located in Moree, in the rural inland of New South Wales. The planning and design for the conference was to challenge attendees on issues affecting the safety of children and young people associated with the use of roads and motor vehicles. Our understanding of these issues can be limited by arbitrary restrictions associated, in particular, with the definition of a road or road-related injury. This means, unfortunately, that hazardous situations involving motor vehicles that may be likely faced by children and young people may not be understood, or even recognised, as they occur in circumsatnces that result in them not being considered to satisfy the definition of road trauma. The conference is thus intended to provide perspectives on the ubiquity of motor vehicle use involving children and young people, not just in the road transport system but across a wide range of contexts including access to and within private property and non-road lands that are publicly accessible by motor vehicles (e.g., parking facilities), farming and agriculture, other work-related areas, and in sporting and recreation facilities. A recent, and now well documented, example of this phenomenon is the occurrrence of driveway injury to infants associated with the use of motor vehicles. Injury can also occur to children and young people in parking areas. This is an area where Commissioner Calvert has made an important contribution. Another area of injury to children and young people is associated with the use of motor vehicles in farming and agriculture and paediatric injury. This is an area where Associate Professor Fragar has similarly made an important contribution. For those who prefer their conference presentations to be in close alignment with existing government policies and published road safety strategies, this conference may be challenging. As the Conference Chair, I have effected a decision that any member of the Australasian College of Road Safety has a right to present a view at the national conference, and that no one member has more of a right to present a view than another. I have no doubt that some may find some of the presentations at this conference to be based on dubious claims, unsupported by evidence, or perhaps irrelevant. That may well be the case, and I reserve my private views on some of the papers, but the exposition of diverse and conflicting views faciltitates scrutiny and debate, both on the conference floor and later in response to the proceedings. It is important to remind ourselves that College members were
41
invited to present views that they find personally important. I am aware that the position I have adopted as Conference Chair is not held by some senior figures in the practice of road safety in Australia, nor is it the view of some members of the National Executive of the College. Nonetheless, my previous experience as the Conference Chair for the 2005 national conference in driver distraction, where similar doubts were strongly expressed as to the relevance of the subject theme to road safety prior to what is now recognised as a highly successful and forward-focused conference, leads me to favour the promotion rather than limitation of discussion. I believe that the College has a role, often unrecognised, to provide a venue as an "early warning system" on issues that may affect road safety and the occurrence and severity of road trauma, and a feature of “early warnings” is that they typically do not fit within recognised orthodoxy. Across the several decades of my work in road safety, I have been, and I remain, ever mindful of the comments of William Haddon in an interview published in the Journal of American Insurance in the September-October 1969 issue, where first, he says, "we need to have research or, as I prefer to put it, practical fact finding .... The second thing that we need to do is to get both the facts of the present, the ones that we already know, and the new facts that come to our attention, disseminated to people in a position to use them, to profit from them, and to put them to work as a basis of their own activities with respect to highway safety. The third thing that we need to do, and all of these are either under way to some extent or are now beginning to get under way, is to help with innovations in the field .... It's regrettable that much of the scientific information of the past few years has just never reached many people." Haddon’s remarks continue to resonate now, almost forty years later. The politics of road safety action in Australasia has historically involved a strong and collegiate bipartisan approach, with very few exceptions. This is the case today, and will be reflected in the opening addresses to be given by the Hon. Jim Lloyd MP, Australian Government Minister for Local Government, Territories and Roads, and the Hon. Eric Roozendaal MLC, the New South Wales Minister for Roads, representing the Federal Liberal-National government and the State Labor government, respectively. As well, the New South Wales Opposition Leader, Mr Barry O’Farrell MP, is the sponsor for the use of this venue in the New South Wales Parliament. I invite delegates explore our historic surrounds, as the New South Wales Parliament is the first legislature in Australia, with parts of the building complex dating from the early 1900s. I am advised that the Chief Attendants of both the Legislative Assembly and the Legislative Council will facilitate guided tours of the chambers and other public spaces. I am aware that some of the delegates today have already done so, when they attended the First Australasian Seminar on Intelligent Speed Adaptation in this theatre yesterday, Wednesday 1 August 2007, as a satellite workshop to this Australasian College of Road Safety 2007 National Conference. The Australasian College of Road Safety is delighted to have financial support for the conference from NRMA Motoring & Services, the Australian Transport Safety Bureau, the NRMA-ACT Road Safety Trust, and Safe ’n Sound (Britax), and I invite you to visit the exhibits in the theatre foyer. To conclude, it is my privilege as the Conference Chairman to welcome you to the Australasian College of Road Safety 2007 National Conference: Infants, children and young people, and road safety, subtitled road safety in the first 1,000 weeks weeks of life. It is my
42
earnest wish that both the speakers and delegates will find the matters presented to be informative and challenging to our thinking. Our focus for the next two days is youth— perhaps, in a future annual conference, the College might consider what I regard as the complementary theme of road safety issues affecting people of an older age and the impact of oldness on the occurrence and severity of road trauma.
43
44
The big picture of road safety for children and young people in New South Wales Commissioner Gillian Calvert New South Wales Commission for Children and Young People
Good morning everyone, and thank you for the chance to be with you today. I was delighted to accept this invitation to speak to you this morning on such an important issue. Before I continue, I would like to acknowledge the traditional owners of this land, and pay my respect to their elders and heritage. I’m pleased to see many familiar faces in the audience today. For those who don’t know me, my name is Gillian Calvert and I’m the Commissioner for Children and Young People in New South Wales. I also convene the New South Wales Child Death Review Team, and chair the board of the Injury Risk Management Research Centre at the University of New South Wales. In all these roles, I am keenly interested in what is being done to make our roads safer for children and young people.
Introduction We are here today because we know that on a per-capita basis, children and young people are significantly over represented in transport-related death and injury data. There can be no doubt that as a society we have a collective responsibility to reduce the rates at which children and young people die or experience serious injury and lasting disability as a result of transport-related trauma. The questions I want to raise with you today are about the best ways to do that. Do we have the right focus? Which of our interventions are working and which are not? Are we seeing the whole issue in context, or responding to the traumatic experiences of a few? Are we crowding the debate on road safety with adult perspectives and interpretations of the issue? From my point of view as the New South Wales Children’s Commissioner, the first consideration in this work is actively including children and young people in decisionmaking on the subject. Young people are not mute on issues like these and deserve to be heard. They know their own world and are our most savvy advisors on practical ways to reach and influence young audiences.
45
If the measures we develop to help young people are to succeed, they must be developed in partnership with young people at every stage.
Children and young people in perspective The last census recorded New South Wales as having one million, seven hundred and forty thousand children and young people in their first thousand weeks of life. They make up twenty-seven percent of the total population in our State - that’s one child or young person for every three adults. As these kids move through their first 1000 weeks, they traverse key developmental milestones in their early years, their time at school, adolescence and transition to adulthood. Today, I want to look at how this developmental process intersects with our human urge to move and travel. I know that, in the course of this conference you’ll be hearing a number of excellent papers on a variety of particular areas of interest and concern. I want to use this session as an opportunity to explore the broader context in which our concerns arise, to consider how we can work to engage with children and young people in developing safer environments.
Children and young people on the move Movement is fundamental to development from the beginning of life. Babies don’t stay put for very long. Rolling, crawling, walking, running, cycling, riding, driving – movement is the human condition. Soon after birth most Australian babies are placed in a car for the trip home from the hospital. Children are driven to visit friends and relatives, to daycare and school, soccer practice and music lessons. They quickly become self propelled – crawling and toddling, pushing along on a trike, running next door to visit a friend, walking and cycling to school. As they get older they catch buses and trains and eventually add motors of their own to their range of movement options.
Early years One of kids’ key needs in their earliest years is to be surrounded by nurturing adults. US developmental neuro-psychiatrist Bruce Perry believes the ideal ratio for raising kids is four adults with a committed interest in each child. Nurture is clearly not the role of the parent alone. Making and maintaining broader family connections frequently involves travel, sometimes lots of it. It would be interesting to map, for any group of pre-school children in Australia, how many cars they travel in, in the course of a week or a month. Mum’s car and Dad’s, Gran’s and Granddad’s, the farm ute and the car taken to town, the nanny’s or babysitter’s car, the friends who car pool for trips to day care, swimming lessons or kiddy gym, relatives
46
who provide a ride to mosque or market. And then to add in all the other ways in which children move through their world, the bikes, buses, trains and planes. My counterpart in Scotland, Kathleen Marshall, headlined the following quote from a fouryear-old in her first annual report: ‘Everyone should be able to see a duck on a sunny day’. It’s a great little image, and it’s packed with meaning. Unpack it a bit and it becomes evident that to achieve this goal, everyone must have parks in their communities and time to visit them. A child will need someone who can take them there during the day. It might mean a car trip and so an appropriate restraint, or a stroller and a street with a sealed pavement. Outings like this are essential building blocks for a child’s development, but arriving safely can still be a challenge. In 2005, the Child Death Review Team found that four transport-related deaths of children and young people in New South Wales may have been prevented by appropriate restraint use. Injury data from Westmead Children’s Hospital shows that none of the children who experienced serious or fatal injury were using appropriate restraints for their age or size, whereas those who were optimally restrained experienced minor injury at most. I’m sure you’re well aware of such data, but it bears frequent repeating. It’s estimated that, before the Work Choices amendment, an Australian factory worker needed to work 5.3 hours to pay for a child restraint, and 1 hour to pay for a cycle helmet. This is a comparatively good result, given that workers in some countries need three or four weeks of factory work to pay for a child restraint and even a helmet costs half a day’s wage (Hendrie, Miller, Orlando, Spicer, Taft, Consunji & Zaloshnja, 2004). Within Australia, however, access to and use of safety devices may vary considerably between population groups. For a factory worker with three children or more, whose employment status may be insecure in the current economic climate, the relative proportion of the family income required to keep their children safe can be significant. This is especially so if the spacing of children means that a new baby arrives before the oldest child is ready to move into a booster seat, requiring purchase of an additional restraint. Though most Australian parents and caregivers say they consider restraints worth the money, price has been cited as an issue for up to ten per cent (Reeve, Zurynski, Elliot & Bilston, 2007). On a population basis, this translates to a large number of children whose safety could be being compromised by socio-economic constraints. Child restraint use is also lower in our rural areas. Farmsafe Australia has identified poor use of farm vehicles and motorcycles as a major cause of child deaths and injuries. While a focus on road transport safety is appropriate for all Australian children, it’s important to remember the off-road issues that are particularly relevant for children and young people in rural and regional communities. Personal stories on this subject can be more powerful than statistics, however damning, in achieving the culture shift we need. Here’s one such story from a Tasmanian woman named Ara Popowski:
47
“We have been dairy farming for twelve years. We have six children who have all been carted around with us on the farm until recently when our sixth child who is three and a half fell off his little seat on the tractor when it went through a big hole. My husband looked down to see why the tractor wasn't going forward and there was our little boy lying right in front of the back tyre. It has really made us reassess our routine and safety procedures. We got a second chance. Our tip is … just because we've always done it that way is a terrible reason to continue” (Farmsafe, 2007). There is concern, and appropriately so, about correct fitting and use of restraints. In addressing these concerns, it's important not to overlook the less common but significantly more risky issue of non-use of restraints. A figure of 92 per cent of kids in child restraints in Australia sounds impressive, but this also means we have eight per cent of kids unrestrained (Reeve et al., 2007). Using 2006 census data this equates to almost 70,000 children aged under ten in New South Wales alone not using any restraint in a motor vehicle. I applaud the current initiatives to develop a national child restraint standard, but our tardiness in getting to this point is inexcusable. This new initiative provides an ideal opportunity to develop good legislation that, combined with good information and distribution strategies, will have a significant impact on the prevalence of restraint use and on injury levels.
Off to school We hear a lot about the fact that children are increasingly being driven to school, as parents and caregivers become more anxious about the risks of walking or cycling in urban environments. Paradoxically, of course, this increased traffic flow increases the risks for those who do still walk or cycle. New South Wales has attempted to address this issue by making mandatory 40 km/h zones outside schools at times students are arriving and departing. There is little evidence of the effectiveness of this approach, certainly not in regard to compliance. It’s an example of an attempt to tailor an intervention to address an aspect of a problem rather than the problem itself. In this case, what’s called for is more general traffic calming measures combined with consistent, enforceable and enforced speed limits across the board. Despite the increase in car transport, cycling and walking remain important ways for school-aged kids to move around the community. At least one in five still walk regularly to school in most areas. As kids reach school age, their social networks broaden and their pattern of movement spreads to include visits to friend’s houses or the local shops. Many parents remember with anxiety their child’s first solo trip to the shop for an ice-cream or their first unsupervised bike ride. These milestones will usually be accompanied by a lot of parental preparation and rehearsal beforehand and debriefing afterward.
48
Interaction with adults is a key component of safety on the road at these ages. Early school years are a time of mastering many new skills. It’s a time of eager learning and cognitive growth. Letters become words. Numbers connect and symbols become invested with meaning. Road signs convey messages that can be understood for the first time. Not surprisingly, research shows what any person who knows kids can tell you – their skill in finding safe places to cross the road increases with age and maturity. Yet one group of researchers recently found that year six students showed the same competence as adults in identifying safe and dangerous places to cross the road, and that at times children’s road crossing judgements were less risky than adults (Tabibi & Pfeffer, 2003). These sorts of findings should be ringing alarm bells for us. Kids can learn safe practices and adults can unlearn them, and undermine their kids’ progress by setting a poor example. Children, we know, can quickly learn the skills they need to navigate more independently in their neighbourhoods. Kids can also assist their younger peers to avoid distraction and make safer choices on the road. The relatively few studies that have sought their views show how well kids understand the risks they face as they move and travel within their environments. Researchers Green and Hart (1998) asked groups of 7 to 11 year olds how to prevent accidents. They chanted in chorus ‘look left and right before you cross the road’ and other warnings and prohibitions they’d been taught by parents and teachers. But these kids also indicated that they gave critical acceptance to such generalised advice, which they found inadequate in many circumstances. In relation to cycling, for example, they said they use their own judgement and experience in deciding whether or not to comply with what they have been taught, or in dealing with conflicting advice from adults, as illustrated in the following discussions about riding on the road: Carl: Parents say don’t ride on the road Facilitator: And do you ride on the road? Carl: Yeah! Facilitator: And why do you do that? Carl: ‘Cos there’s not that many cars come up and down our road… Tim: …We get told not to ride on the road but this policeman walked along one time and then said ‘why are you riding on the pavement?’ … he said ‘cos it’s not fair for the other people who are walking, and go ride on the roads’. That’s why I ride on the road now. Green and Hart concluded that safety strategies should ‘build on the strengths and competencies … that children already possess’. They also note that a more integrated approach to risk management, rather than stressing ‘dangers’ in isolation, is more likely to resonate with children’s own perceptions.
49
Getting older, travelling further and faster As kids reach adolescence, their milestones include developing a sound self-image and personal identity. Young people are developing their identity as drivers under intense scrutiny these days. The observation that young people are over-represented in rates of transport-related trauma is most often framed in one of two ways. It’s either a ‘young driver problem’, the idea that young drivers as a group are a problem or it’s the ‘problem young driver’, certain problematic kids, mainly boys, whose attitudes and behaviour must be altered to effect any change. ‘P plater’ is often used as a synonym for danger in both generalisations. You don’t read headlines that say ‘fully-licensed driver kills two in crash’. Public and media attention on young drivers often focuses on licensing issues. Graduated licensing systems have gained much attention and have shown genuinely positive results in reducing the incidence and impact of road crashes for novice drivers. The most common component of graduated systems is an extended period of supervised driving. It’s not surprising that this is effective; experience is the best answer to inexperience, and inexperience is a major contributor to risk. But even here, on what seems our safest ground, there are assumptions at work we need to consider. There’s an assumption that every young person has available to them an adult with a clean drivers’ licence and a registered vehicle, who’s competent to instruct a learner and who has 120 hours free to give lessons. This is not the reality for some kids particularly disadvantaged kids. Let me illustrate. Kids from poor families where there are weak familial relationships are already vulnerable. The 120 hours requirement may add to this risk. They don’t have access to 120 hours of supervised driving so they just drive and end up in the criminal justice system with all the problems that brings. Further the lack of a licence restricts their learning and job opportunities. And as a community we haven’t compensated for this when introducing the 120 hour requirement. Another area of intense focus is specific restrictions on P Plate drivers, but again many of these measures may have unintended consequences. Restrictions can limit exposure to difficult driving situations, rather than encouraging supervised opportunities to learn to manage risk. It is traumatic and awful when children die and we want to prevent it. However we need to be thoughtful when we look at how we prevent it. We need to think about less obvious impacts of our choices. How much do we limit the many others to prevent the deaths of a very few. These are very difficult issues. Many young people see restrictions as a punishment that can limit their access to work, study and social activities, especially for those who live further from urban centres. Curfews, vehicle power and passenger restrictions can have also have uneven impacts.
50
Better enforcement of existing legislation and general road safety improvements are more likely to produce better outcomes. But where restrictions are brought in, it’s important that they’re developed in consultation with young people, and that their effect is monitored to see that they don’t create disadvantage for particular sectors of the community. The National Road Safety Action Plan identifies four research-based action areas required to achieve a significant step down in the Australian road toll: safer speeds, safer roads and roadsides, safer vehicles and safer road users. All of these action areas are relevant to all road users, as we can see in Table 1. It is important to note also that young people are injured not only as drivers, but in the full range of transport related incident types. In the 2005 calendar year, young people in New South Wales aged 15-17 years were over-represented in deaths as passengers, pedestrians, drivers and motor cyclists, and one of the three pedal cyclists who died was also in this age group.
Society and culture Beyond the immediate attributes of the child or young person and their family lie factors in our society that impact deeply on road safety. The beliefs that influence young people’s behaviour on the road reflect those of the general population. Some of these beliefs are useful and some are dangerously wrong, like the idea that accidents are random events that can’t be prevented. It is important for us to remember that kids operate in an environment largely created for them by adults. It’s adults who design and market motor vehicles to a predominantly adult new car market. We drive the demand curve for alcohol production and consumption. We create the advertising and the television shows that glamorise risky behaviour.
Table 1. Relevance of road safety priority action areas to road user groups. Adapted from Australian Transport Council (2006), p.44, Figure 8
Safer
Walkers & Cyclists
Passengers: Drivers: Indigenous & Old & Young Old & Young rural users
Speeds
Υ
Υ
Υ
Υ
Roads
Υ
Υ
Υ
Υ
Vehicles
Υ
Υ
Υ
Υ
Behaviour
Υ
Υ
Υ
Υ
51
We have to remember that the problems kids encounter on the road are problems we’ve generated as a society. It will always be easier to assign individual blame than to develop social responses, but it’s only the latter that will have lasting effect.
Fast wheels Newstead, amongst others, has argued that road trauma could be drastically reduced if every car on the road had all the safety features currently available (Newstead, Delaney, Watson & Cameron, 2004). But of course young drivers with the least experience are the least likely to be driving cars with such features. As well as having the least money to spend, young drivers are typically the most susceptible to sales practices. Kids can be duped into buying cars that are unroadworthy, as found in a recent injury prevention surveillance project in New South Wales (Mid North Coast Aboriginal Health Partnership, 2001). Providing every L plater or every new parent with a brand new, state of the art vehicle is obviously unrealistic as an intervention. But there are some practical ways to make it more likely that novice drivers and parents of young families have a safer pool of vehicles to choose from. About half of the new cars purchased in Australia are part of business or agency fleets, and typically enter the general used car market after two to three years. Many people in this room have an opportunity to contribute to the safety of the Australian light car fleet, and to improve the range of cars available to Australian families and to young drivers, simply by advocating within your organisations for the purchase of the safest vehicles in each class for the corporate fleet. Taking road safety seriously, at a State or national level, may also mean investing in incentives for companies and agencies to purchase safe vehicles and for manufacturers to use proven design features in every vehicle. Once again though, there is much that can be done with basic cultural change. Young people are a mirror of the values and culture of our society in their desire for fast wheels. Driving through the Sydney CBD every second bus stop bears this image (Figure 1). This says something not only about manufacturers and advertisers, but also about us as consumers. Even in this audience, I wonder what questions we asked, or what features we looked for in our most recent vehicle purchase. The Australian Transport Council noted in 2006 that ‘general speed management measures are very important to novice driver safety’ but young drivers ‘are unlikely to comply with speed limits if they observe that older and more experienced drivers do not do so’.
52
Figure 1. Billboard photographed in Crown Street, Sydney, July 2007.
One for the Road This is equally true in relation to alcohol and fatigue and other factors. Young people are criticised for replicating the unsafe behaviour they see practiced by adults all around them. Competing media images offer markedly different views about social standards on alcohol. Alcohol industry advertisements convey mixed messages to enjoy alcohol and drink responsibly. Content analysis of advertisements for alcohol found no reference to negative effects, although numerous benefits were shown including, in order of frequency: camaraderie, masculinity, flavour, escape, femininity, romance, adventure, refreshment, relaxation, and elegance (Shanahan, Elliot & Dahlgren, 2000). The producers of Famous magazine found it appropriate to distribute alcohol flavoured lip gloss to the readers of a recent edition of a ‘youth title’. In a review of driving behaviour in television programming, Atkin found that twenty per cent of driving scenes depicted speeding, with far more positive than negative outcomes. Only four of 869 scenes showed drivers buckling their seatbelts or wearing them while driving. Such portrayals normalise risky behaviour (Atkin, 1989, cited by Shanahan et al., 2000).
53
The challenge for us as a community is to change our collective behaviour and provide a single, safe example for kids if we want to achieve lasting improvements in road safety, for kids and for us all.
Working together: Research and policy This conference is a welcome opportunity to reflect on the interaction between the disciplines and professions that work separately and together on this issue. Effective cooperation between fields offers obvious benefits, but also poses challenges. From my viewpoint, we need to constantly question the way our separate efforts intersect and look for ways to work together more consciously, particularly in deciding what questions are asked at the research stage and how research findings are applied in practice. One area that deserves more attention is the need for children and young people to be included in our deliberations and decision-making. I congratulate the New South Wales Government for putting this into practice with developing policy, executing that policy and designing communication messages. I also congratulate the conference organisers for including youth delegates in this event. There are many serious questions that need investigation about the effects of road transport and road trauma on kids. We know little about the effect of adult injuries on kids and families. We know less about how a child’s injuries impact on parents or siblings. There’s also very little published literature in this country on the relationships between road trauma and injury or disability. In all these areas, kids’ viewpoints need to be heard. We might consider how many papers being presented in this two day conference have included kids in their research or have sought kids’ viewpoints. Listening directly to kids will give us more understanding of the contextual factors that influence behaviour. Pressure to make a certain number of deliveries each shift might have induced a young pizza deliverer to exceed the speed limit. Extended rostered hours might contribute to a young truck driver’s decision to use stimulants. We cannot consider children and young people in isolation from their families, and friends, and neighbourhoods. Relationships, movement between households and localities, tasks and responsibilities all need to be taken into account. We need research that makes sense of events in their social context. Not just when and where an incident occurred, but why. What are the circumstances in which a normally careful parent will drive unsafely? How do people manage the issue of restraints when they use several vehicles, or if there are extra children in the car? Is a convoy of cars driven by solo teenagers safer or more dangerous than five in one vehicle with a designated driver? In reporting research findings, it’s not enough to know if a solution is effective – we need to know how, under what conditions, and in what contexts a given solution will work best. Arai et al. noted in 2005 that scientific journals show systematic deficiencies in reporting the
54
context, methods and details of implementation (Arai, Roen, Roberts & Popay, 2005). This in turn makes it difficult for policy makers to know how findings in one area will apply in another. Just because it worked in Oakland, doesn’t mean it will work in Oakhampton or in Oxley. And equally, in our policy development, we need to integrate research findings with the knowledge that comes from frontline practice and local experience. We have to monitor the real effects of the policies we put in place. Will increasing the requirement from 50 to 120 hours of supervised driving for learners help or will some young people just give up on the idea of getting a license altogether? Are young women more or less safe because of the passenger curfews between 11p.m. and 5 a.m.? Have we, as some people worry, traded off road safety for young males with increased risk of assault on young women? Combining an objective assessment of such issues with the actual experience of young drivers will help us find practical and cost effective ways for every young person to gain the experience they need to become safety-conscious drivers.
Conclusion For our youngest children it is mainly adults who make decisions about places to go, how to get there and how fast to travel. Adults choose the car and the child restraint, and do the driving. Adults build the environment in which that travel takes places. Older children and teenagers make more decisions on their own, but continue to travel in family vehicles, over roadways and footpaths designed and built by adults, surrounded by our influences. As adults and as researchers and policy makers, we have an opportunity to use a wider view of road safety in the first 1000 weeks of life to reframe this picture. We can work together with kids, their families and their communities to provide supportive environments, positive models of behaviour and constructive responses to the problems they face. Our best interventions will take account of the diversity of children and young people’s experience. Rather than only making decisions for those in their first 1000 weeks of life, I encourage you to also make your decisions with the people who are living those 1000 weeks. Their knowledge of their own lives is our best guide to outcomes that promote safety and wellbeing in the widest sense. I encourage each and every one of you to live out your passion for road safety for our youngest citizens with a broad, unblinkered vision that involves our kids as key contributors to the development of appropriate interventions. Thanks and all the best for what I’m sure will be a fantastic conference.
55
References Arai, L., Roen, K., Roberts, H. & Popay, J. (2005). It might work in Oklahoma but will it work in Oakhampton? Context and implementation in the effectiveness literature on domestic smoke detectors. Injury Prevention, 11, 148-151. Australian Transport Council (2006). National Road Safety Action Plan, 2007 and 2008. Canberra, ACT: Australian Transport Council. Farmsafe (2007) Child safety on farms. www.farmsafe.org.au. Accessed 11 July 2007. Green, J. & Hart, L. (1998). Children's views of accident risks and prevention: A qualitative study. Injury Prevention, 4, 14-21. Hendrie, D., Miller, T.R., Orlando, M., Spicer, R.S., Taft, C., Consunji R. & Zaloshnja, E. (2004). Child and family safety device affordability by country income level: an 18 country comparison. Injury Prevention 10, 338-343 Mid North Coast Aboriginal Health Partnership. (2001). Mid North Coast Aboriginal Injury Surveillance Project Report: Pride, Respect and Responsibility. Sydney: NSW Health Injury Prevention Policy Unit. Newstead, S., Delaney, A., Watson, L. & Cameron, M. (2004). A model for considering the ‘total safety’ of the light passenger vehicle fleet. MUARC Report 228. Clayton, Vic.: Monash University Accident Research Centre. Reeve, K.N., Zurynski, Y.A., Elliot, E.J. & Bilston, L. (2007). Seatbelts and the law: How well do we protect Australian children. Medical Journal of Australia 186, 635-638. Shanahan, P., Elliot, B & Dahlgren, N. (2000). Review of public information campaigns addressing youth risk-taking. Hobart: National Youth Affairs Research Scheme. Tabibi, Z. & Pfeffer, K. (2003). Choosing a safe place to cross the road: the relationship between attention and identification of safe and dangerous road-crossing sites. Child: Care, Health and Development 29, 237-244.
56
Session on the UN Road Safety Week 23-29 April 2007
57
58
The United Nations for Global Road Safety Week, 23-29 April 2007 Immediate Past Secretary General’s message on the occasion of the first UN Global Road Safety Week, 23-29 April 2007 Kofi A. Annan
The First United Nations Global Road Safety Week is an important opportunity for improving safety for the hundreds of millions of young people who travel the world's roads every day. Since World Health Day 2004 and subsequent discussions in the United Nations General Assembly, governments and their partners have paid increased attention to road safety. But we still have a long way to go. Road traffic crashes kill nearly 1.2 million people worldwide every year, and injure millions more. They are the second leading cause of death for people aged 5 to 25, with devastating impact on families and communities. Among this age group, young men -- as pedestrians, cyclists, motorcyclists, novice drivers and passengers -- are nearly three times more likely to be killed or injured on the roads than young women. Fortunately, there is a growing recognition that road traffic injuries can be prevented. It has been demonstrated in a number of countries that by acting on key factors, in particular drink driving, speeding, the wearing of helmets and seat-belts, and road design and infrastructure, a significant number of lives and financial resources can be saved even as motorization continues to rise.
59
Road safety is no accident. Road safety happens through the deliberate efforts of many individuals and many sectors of society, governmental and non-governmental alike. Every one of us has a role to play: ministers of transport, health and education; health care providers; automobile associations; educators; students; insurers; vehicle manufacturers; the media and victims of road traffic crashes and their families. But a strong commitment at the political level is crucial. Today's success stories often result from a decision at the highest level of government to improve safety on the road. Through the World Youth Assembly for Road Safety -- the key global event of the First United Nations Global Road Safety Week -- the World Health Organization, UN Regional Commissions and their partners are giving a voice to young people. Let us listen to their advice. And let us improve safety on the world's road, for their sake and for ours.
Objectives for Global Road Safety Week 2007 The objectives established by The United Nations for Global Road Safety Week 2007: • Raise awareness about the societal impact of road traffic injuries, highlighting the risks for young road users. • Promote action around key factors which have a major impact on preventing road traffic injuries: helmets, seat belts, drink driving, speeding and infrastructure. The slogan for the First United Nations Global Road Safety Week 2007 -- "Road Safety is No Accident“ -- highlights the fact that road safety happens not by accident, but through the deliberate efforts on the part of many individuals and many sectors of society governmental and nongovernmental alike.
Around the World Road traffic injuries are the second leading cause of death for young people aged 5–25 years. The highest rate of fatalities in the 0–25 age range occur among young road users in lowincome and middle-income countries, particularly in Africa and the Eastern Mediterranean. Males account for 75% of all road traffic fatalities among those under 25 years of age. In low-income and middle-income countries, the young road users most likely to be involved in a crash are vulnerable road users – pedestrians, cyclists, motorcyclists and passengers of private and public transport – with regional variability. In high-income countries those most at risk are drivers.
60
It is estimated that every year road traffic crashes cost US$ 518 billion globally. In low-income and middle-income countries, road traffic crashes cost an estimated US$ 100 billion, which exceeds the total amount received by these countries in overseas development assistance.
Road traffic injury mortality rates (per 100,000 population) in WHO regions, 2002
Source: World Health Organization. 2006. First United Nations Road Safety Week.
Key issues The World Health Organization has identified five key issues: 1. Road traffic injuries are a major global public health and development problem. Their magnitude is expected to rise considerably in the years ahead. Nearly 1.2 million people worldwide die as a result of road traffic collisions every year, representing more than 2.1% of global mortality, and comparable to the number of deaths caused by major killers such as malaria and tuberculosis. Millions more are injured and often remain disabled for life. Around 85% of deaths from road traffic crashes occur in lowincome and middle-income countries, at a cost of 1%–1.5% of gross national product annually. Without action, road traffic deaths and disabilities are likely to rise due to increasing motorization. 2. Road traffic injuries greatly impact upon young lives. Road traffic injuries are the second leading cause of death for people aged 5–25 years. Among this age group, young men – pedestrians, cyclists, motorcyclists, novice drivers and
61
passengers – are nearly three times more likely to be killed or injured on the roads than young women. 3. Road traffic injuries can be prevented. In some countries, the number of road traffic injuries has declined, despite increasing motorization. By acting on a number of factors, in particular drink-driving, speeding, helmets, seat-belts and road design and infrastructure, many lives and financial resources can be saved. 4. Road safety is no accident. Road safety happens through the deliberate efforts of many individuals and many sectors of society – governmental and nongovernmental alike. Political commitment is paramount. Today’s success stories often result from a decision at the highest level of government to improve road safety. 5. International cooperation is crucial to strengthening national road safety efforts. International cooperation can strengthen national road safety efforts through the sharing of information and lessons from successful strategies and programmes, and by mobilizing additional resources. International cooperation can also help to ensure that road safety is among the top priorities on the public health and development agendas of countries around the world.
World Youth Assembly on Road Safety 23-24 April 2007, Geneva, Switzerland Youth delegates from more than 100 countries, including 8 from Australia, met in Geneva, Switzerland, to discuss a declaration regarding the improvement of road safety among youth. On 24 April 2007, the Assembly adopted the Youth Declaration for Road Safety. The Declaration was agreed by the delegates to the World Youth Assembly, who commit to taking practical measures to improve road safety and call upon other young people to do the same. The declaration calls on all young people to "stand up and participate in local and national campaigns and programmes" and urges adults to do more. The declaration also calls for more political will at national and community level to tackle road safety. It urges schools and universities to teach young people about safety, bartenders to serve alcohol responsibly, media to report more widely and more responsibly about the lack of road safety, and celebrities and the entertainment industry not to glamourize speed and to wear seatbelts and helmets.
62
Youth Declaration for Road Safety Adopted by the Youth Delegates from more than 100 countries at the World Youth Assembly for Road Safety, Geneva, Switzerland, 2007. You get a phone call to inform you that your friend has been seriously injured in a car crash on his way home from a late night party.You are one of the first to hear. You rush to the hospital, but by the time you reach there, your friend has already died. You don’t even have a chance to say goodbye. You have to tell your other friends that they have lost a buddy but you don’t know what to say. They are devastated. You witness a crash on a rural road. Two little girls are walking along the roadside and are struck by a speeding vehicle. You and a few other passersby frantically try to find them transport to the local hospital. It takes more than an hour for them to reach the hospital and the services there are inadequate. Both little girls die on that same day. You return home traumatized by the incident, wishing you could have done more to save their lives. You are among a group of school children on a class field trip. The school bus is packed with more than 50 of your excited classmates. The road is long and dangerous, the weather conditions are very poor and seat-belts in the bus are absent. The bus driver, who has been drinking alcohol, loses control of the bus on an embankment, and it swerves off the road into a ditch. Four boys and three girls are killed instantly, among them one of your dearest friends. Many of the children are severely injured. Think about these tragedies for a moment… Each day, more than 3000 lives are abruptly ended because of a road traffic crash while many more people survive but are left with life-changing injuries. In a split second, a crash transforms lives forever through the loss of beloved fathers and mothers, sons and daughters, brothers and sisters, grandchildren, colleagues, classmates and friends. Each and every one of these deaths causes immense pain and suffering. Some emotional wounds never heal. Now imagine that you could turn back time and prevent these tragedies from happening in the first place. If your friend had been wearing his seat-belt, if the vehicle had not been speeding and had been properly maintained, if the little girls had a safer place to walk and had been more visible, if the bus driver had not been driving while under the influence of alcohol, if the state of the road had not been so poor, if appropriate medical services had been available… There are so many actions that could have been taken. We cannot turn back time and save those who have already died on our roads, but we can prevent such needless losses of life occuring in the future. Together we can make road crashes history.
63
Background Globally road traffic injuries are the leading cause of death for youth aged between 10 and 24 years. Of the 1.2 million people who lose their lives in road traffic crashes each year, almost a third of them are youth under the age of 25 years. More than 90% of these fatal crashes occur in low-income and middle income countries. In these settings, road users most likely to be involved in a crash are pedestrians, cyclists, motorcyclists, and passengers, while in high-income countries they are drivers. The cost of road crash injuries is estimated to be between 1% - 1.5% of the gross national product in low-income and middle-income countries, increasing to 2% in high-income countries. If no action is taken, road traffic deaths are predicted to escalate exponentially in the years ahead.
Opening Against this background, we, the youth of the world, the future leaders and hope for tomorrow, have gathered at the World Youth Assembly for Road Safety on 23-24 April 2007 in Geneva, Switzerland. We have written and adopted this declaration to make every young man and woman in the world aware of the global problem of road traffic injuries, show our commitment to address the problem, and urge the world to take action to prevent road crashes. We can no longer accept that the lives of our friends and family members are senselessly destroyed on the road. Because road traffic injuries and deaths can be predicted and therefore prevented, the world has an obligation to stop them. As potential victims of road traffic crashes, we, the youth of the world, stand up for ourselves and call for the right to travel safely on the world’s roads. Being young road users ourselves, we know what is on the minds of our peers, their likes and dislikes and the kind of messages that will reach them. Therefore, we need to be listened to when road safety initiatives are being developed and implemented.
Our commitment We, the young people of the world, have respect for our lives. Because life is so fragile, we have to do our best to live safely and encourage others to do the same. We realize that road safety has as much to do with a safe road environment as with safe driving behaviour. With respect to road safety in particular, we fully acknowledge the importance of youth involvement to make road safety a reality. We call for awareness among all youth on the high risks they run in becoming involved in road traffic crashes on the world’s roads. We call upon all youth to serve as role models on the road and to promote road safety among their friends and families - particularly their younger brothers and sisters. Specifically, we ask all youth to never drive under the influence of alcohol and drugs, shun speeding, refrain from aggressive behaviour on the roads, use helmets when riding on motorcycles and bicycles, wear seat-belts when travelling in motor vehicles, and ensure that they are visible when walking or cycling on the roads. Furthermore, we call upon all youth to stand up and participate in local, national and international road safety campaigns and programmes. It is
64
our responsibility as emerging young leaders to stand up and do our part in demanding our safety on the worlds roads. Our efforts alone do not suffice! We therefore must also call upon our parents and guardians, our schools and universities, the communities where we live, the policy-makers in government throughout the world, community-based organizations active in road safety, private sector companies, the media, celebrities and the entertainment sector, to take responsibility and work together with us.
Parents and guardians We, the youth of the world, remind our parents and guardians that our risk of dying on the road is very high. You are the ones we completely rely on when we are young. You are not only our parents and guardians, but you are also our heroes and our mentors. However, we call upon you to create a safe environment for us when we are on the road, and to serve as role models for safe road traffic behaviour. Teach the rules of the road and good road safety practice to our younger brothers and sisters and buckle them up in child restraints when you are driving. Teach us from a young age about our vulnerability as pedestrians and cyclists - encourage us to wear seat-belts, reflectors and helmets. Support us as we learn how to drive and provide supervision so that we can gain on-road driving experience under a range of conditions, including in the rain, at night and in traffic. We call upon you to help raise a generation of responsible road users.
Educational institutions We, the youth of the world, see educational institutions as very important. They give us the knowledge and skills which we need to live happy, healthy and productive lives. Hence, we request you, our school administrators and teachers to include road safety in our school curricula from an early age; to ensure that our surroundings and routes to school are safe; and to encourage the use of safe school buses. We call upon you to organize regular road safety activities at schools, and create opportunities for us to engage in road safety programmes. We further call upon university administrators to promote and develop courses and programmes on road safety and to conduct and publish more research on road traffic injury prevention.
Community leaders We, the youth of the world, appeal to community leaders to create safe communities for everyone. We believe that local authorities play a leading role in ensuring road safety and in supporting groups that promote road safety. We ask you not to forget the survivors of road traffic crashes but aim to provide better care and services for them and involve them in advocacy campaigns and other road safety initiatives. We also call upon you to encourage youth to be active in community road safety groups and initiatives. We call upon you, the owners and managers of bars, clubs and discos to serve alcohol responsibly.
65
Policy-makers We, the youth of the world, demand that governments acknowledge road traffic injuries as a major public health and development problem and place road safety higher on political agendas. We call upon you to take leadership in providing safety and quality in our road infrastructure. Therefore, we call upon you to ensure safe and affordable public transportation options that are accessible by all. We also urge you to create a national plan for road safety, and appoint a lead agency which has leaders responsible for its implementation and coordination. We demand you to enact and enforce road traffic laws, and boost your investment of financial resources to make safer roads. We urge that you provide affordable access to emergency health care and services for victims of road crashes. We further urge you to acknowledge the importance of the involvement of youth in road traffic policy-making and implementation and encourage partnerships with other jurisdictions and road safety organizations.
Community-based organizations We, the youth of the world, ask community-based organizations including faith-based, sports-related and youth organizations, to create a broader awareness among our families and friends about the magnitude of the road traffic injury problem and the main factors which place people at risk. Because road traffic trauma affects individuals, friends and families, and ultimately the entire community we live in, we encourage you to promote road safety and adopt the most effective channels to make messages heard, involve road crash survivors and youth in programmes, and promote policies that work. We further call upon you to collaborate as much as possible with other organizations which are active in road safety initiatives.
Private companies We, the youth of the world, call upon you, the managers of private companies to acknowledge your social responsibility in developing safe products and to market your products responsibly. Being young and more at risk, there is a tendency for some of us to seek sensation including through speeding and drink-driving. When your advertisements glamorize speed and encourage the excessive use of alcohol, you give us the impression that we can afford to take risks! We therefore ask vehicle manufacturers to divert more resources towards the development and promotion of safer vehicles and alcohol companies to increase the promotion of responsible drinking and avoid marketing to the youngest of us. We further call upon insurance companies to promote the benefits of safe road traffic behaviour and develop effective and efficient insurance policies. We also call upon owners of public transport companies to ensure their vehicles and driver behaviour are as safe as possible. We call upon the private sector as a whole to establish joint funding for road safety campaigns and to develop safe driving policies for their employees.
66
Media We, the youth of the world, are greatly influenced by media, particularly youth-oriented media, and the lifestyles that the media portrays. As such, we call upon you, the journalists and leaders of the media to address road traffic injuries as a global health and development problem that affects millions of lives each year. We depend on you to make our voices heard. We particularly ask you to report responsibly and accurately on the traumatic consequences of road traffic crashes and to broadcast advertisements for responsible road traffic behaviour as often as you broadcast advertisements to sell products. We call upon you to use the most appropriate media to attract the attention of youth. We also call upon you to promote road safety by featuring stories of young road traffic survivors and their families and by highlighting best practices in road safety. We call upon you to ensure that private companies refrain from showing advertisements or TV shows that glamorize speeding and drink-driving during times when youth might be watching.
Celebrities and the entertainment industry We, the youth of the world, call upon celebrities and the entertainment world to actively promote road safety. Our behaviour is often influenced by celebrities in the sport, film, music and art industries. We therefore call upon you, artists and celebrities to realize the impact that you can have on youth. We ask you to serve as role models by promoting safe road traffic behaviour, such as always wearing a seatbelt or helmet and not drink-driving and speeding, not only in your professional roles but also in your personal lives.
The Life of this Declaration In conclusion, we, the youth of the world, declare our commitment to actively pursue the demands of this Declaration to ensure its impact. We will not allow it to remain ink on paper. From the moment we adopt the Declaration, it will go around the world like the Olympic flame, carried by youth on all continents, to enlighten countries, one by one, with the voice of the youth calling for action. We want to make the roads of the world safer and more secure, not only for ourselves, but for everyone and for the generations to come.
67
68
World Youth Assembly for Road Safety – The Australian Delegation Joel Tucker Royal Automobile Club Queensland Leanne Hucker NRMA Motoring & Services
The first ever World Youth Assembly for Road Safety took place on 23-24 April 2007, at the Palais des Nations in Geneva, Switzerland. The World Youth Assembly was the key global event for the first United Nations Global Road Safety Week – the theme of which was ‘young road users, including young drivers’. The Assembly was organised and lead by young people from around the world. It was modelled on the format of the UN General Assembly and the World Health Assembly. The Assembly was attended by almost 400 young delegates from some 100 countries, with many working in road safety. Eight young Australians attended the World Youth Assembly for Road Safety as the Australian delegation to this important event. The Assembly allowed young people interested in road safety from around the world to share experiences and ideas and identify ways to strengthen their road safety efforts at home. The ‘crowning’ achievement of the Assembly was the formal adoption of the Youth Declaration for Road Safety, which was developed by youth delegates attending the Assembly and calls for action to be taken by a range of stakeholders, to improve road safety. This presentation will provide a brief overview of the Australian delegation’s experience at the first World Youth Assembly for Road Safety, the Assembly outcomes, and the Youth Declaration for Road Safety.
The Youth Declaration for Road Safety was agreed by the delegates to the World Youth Assembly, who commit to taking practical measures to improve road safety and call upon other young people to do the same. The declaration calls on all young people to "stand up and participate in local and national campaigns and programmes" and urges adults to do more. The declaration also calls for more political will at national and community level to tackle road safety. It urges schools and universities to teach young people about safety, bartenders to serve alcohol responsibly, media to report more widely and more responsibly about the lack of road safety, and celebrities and the entertainment industry not to glamourize speed and to wear seatbelts and helmets. The official report of the proceedings at the World Youth Assembly for Road Safety can be found at: http://whqlibdoc.who.int/publications/2007/9241595116_eng.pdf
69
Further information relating to the Youth Declaration for Road Safety can be found at: http://www.who.int/roadsafety/week/activities/global/youth/declaration/en/index.ht ml The Australian delegation comprised: Anna Chalko (VIC – TAC) Melissa Hann (NSW – NRMA) Leanne Hucker – (NSW – NRMA) Elise Klein (VIC – UN/Reach) Sian Parker (TAS – Road Safety Task Force) Joel Taggart (SA - City of Salisbury) Dimitra Tapsas (VIC – RACV) Joel Tucker (QLD – RACQ)
70
71
72
73
74
75
76
Road safety and young Australians: Background information for Australia’s delegates to the UN World Youth Assembly for Road Safety Australian Automobile Association The Australian Automobile Association, the motoring clubs – particularly, NRMA, RACV, RACQ, RAASA and RACT – and the Australian government supported the attendance of a delegation of eight Australian youth ambassadors UN Assembly on Youth Road Safety in Geneva in April 2007. The delegation presented to the Global Forum on road safety and young Australians, and reported back to a range of Australian stakeholders and audiences.
The key issues 5 people die and 60 are seriously injured on Australian roads every day In 2006, 1,603 people were killed on Australian roads. Some 22,000 people were admitted to hospital with serious injures as a result of road crashes. Road crashes in Australia are estimated to cost approximately $17 billion annually—or $46 million every day. This is equivalent to 2.3% of Australia’s GDP. One young person dies on the road every day In 2006, 552 people aged 25 years or younger were killed on Australian roads (34% of all deaths). Males represented three in four young people killed in 2006. Road injury is the main cause of unintentional death and hospitalisation among young people. About ¾ of all preventable deaths among 15-19 year olds are due to transport injury. Young people (especially males) are over represented Some groups of young people are at especially high risk. In 2006 people aged 20 to 25 accounted for 17% of total road deaths but only 8% of the population. Males in this age group accounted for 13% of total deaths but only 4% of the population, while females in this group accounted for 3% of total deaths and 4% of the population. Figure 1 plots death rates per 100,000 population by age group. It illustrates the high relative risk for young people, especially young males.
77
Figure 1 Road death rates by age group in 2006 (per 100,000 population)
Figure 2 Road death rates for people under 25 years of age (per 100,000 population), 2006
78
When population size is taken into account, there is also significant variation in road death rates for young people across the States and Territories. The highest rate is in the Northern Territory, and the lowest rate is in the ACT (see Figure 2). Some states do better than others Table 1 shows that the number of young people killed differs significantly between the States and Territories.
Table 1 Numbers of people aged 0 to 25 killed in road crashes by State and Territory
NSW VIC QLD SA WA TAS NT ACT TOTAL
2006 184 100 110 34 80 26 16 4 554
% 33% 18% 20% 6% 14% 5% 3% 1% 100%
Young drivers are at greatest risk In 2006, 763 drivers were killed on the roads— young drivers accounted for 231 (30%) of these deaths. Taking into account distances driven, young drivers are significantly more likely to be killed than other drivers. As shown in Figure 3, drivers aged 17 to 20 are over 11 times more likely to be killed than drivers aged 40 to 44. Why are young drivers at greatest risk? The following characteristics are often cited as contributing factors to the increased risk of young drivers: • late teen and early twenties years are often associated with experimentation, impulsiveness and risk taking. These traits sometimes lead to young drivers overestimating their own abilities and underestimating the risk associated with driving. The research has repeatedly found that young drivers, particularly males, are more likely to speed, race and drink alcohol than other drivers; • young drivers often have not yet developed the skills necessary to handle complex traffic environments or judge risky situations properly. This can lead to situations
79
• • •
like driving too fast for the conditions, following too closely behind other vehicles and running red lights; and young drivers frequently travel during high-risk hours (late night, early morning and weekends), and often with passengers in the vehicle. Passengers are associated with increased crash risk because they can distract the driver and because young drivers are typically more susceptible to peer pressure than older drivers.
Figure 3 Relative risk of death per kilometre traveled by age group, 1998 to 2000 Young people as passengers In 2006, 335 passengers were killed on the roads—young people accounted for 183 (55%) of these deaths. Passenger deaths and injuries tend to be especially high among 16 to 19 year olds because they often spend a lot of time traveling as passengers—rather than driving, walking or bicycling—and they often travel in vehicles driven by young drivers. Young pedestrians In 2006, 227 pedestrians were killed on the roads— young people accounted for 55 (24%) of these deaths.
80
Child pedestrian deaths and injuries increase with age, particularly when schooling commences— the time at which children begin to travel independently. Most child pedestrian deaths result from an error made by the child. In 1999, 28 out of 33 pedestrians killed aged 16 years and younger were assessed as solely responsible for initiating the crash. Some of the characteristics of young children which mean they are at risk of being killed while walking include: • they have under-developed peripheral vision; • they lack the ability to accurately judge the speed and distance of a moving vehicle; • they are easily distracted; and • because they are small, drivers sometimes have difficulty seeing them. On the other hand, compared to teenagers, young children are more likely to try and obey rules, less likely to deliberately take risks and less likely to take drugs and alcohol—which is significant contributing factor for pedestrian deaths among older people. Driveways also present a risk for young children. On average, one child is killed or seriously injured in a driveway each week. Most driveway deaths: • involve a toddler; • happen at or near the child’s home; • involve a male driver; and • involve a large vehicle, such as a 4WD or van. Sedans are involved in only around 20% of cases. On your bike In 2006, 39 bicyclists were killed on the roads—young people accounted for 11 (28%) of these deaths, and all of these were males. There are many similarities between pedestrian and bicycle deaths for young people. Children tend to begin bicycling more often when they begin school, and for the reasons that mean young children are at risk while walking also apply to bicycling. Young motorcyclists In 2006, 238 motorcyclists (both riders and pillions) were killed on the roads—young people accounted for 74 (31%) of these deaths. Nearly all the young motorcyclists killed were males (96%). On a distance traveled basis, the death rate of motorcyclists is very high—between 1998 and 2002, the death rate per kilometre traveled was between 18 and 25 times that of motor vehicle occupants. Motorcyclists have a higher death rate than other road users for two key reasons: • as a group, they are more likely to take risks. This is especially so for young riders; and
81
•
they do not have the physical protection that motor vehicle occupants have.
Motorcycle registrations have grown rapidly in recent years, partly because there has been a trend in older riders returning to motorcycling or getting a motorcycle for the first time. For example, in the five years to 2005, the number of motorcycles registered on Victorian roads doubled. There is therefore a risk that motorcycle crashes also increase rapidly.
Driver Passenger Pedestrian Motorcyclist Bicyclist Total
Under 25
Rest of pop
Total
231 183 55 74 11 554
532 152 172 164 28 1048
763 335 227 238 39 1602 *
Under 25 as % of total 30% 55% 24% 31% 28% 35%
Table 2 Numbers of people killed in road crashes by road user type, 2006 * 1 person was of unknown age
What’s being done by governments? Road crashes are preventable Australia in one of the countries that has been able to reduce road deaths and injuries, despite the number of vehicles on the road increasing. This is a result of concerted efforts by governments at all levels, non-government organisations (including the AAA motoring clubs), and the vehicle industry. Policies aimed at stamping out drink driving, enforcing seat belt and helmet use, discouraging speeding, building safer cars, and constructing safer road infrastructure have all played an important role in improving safety. But more needs to be done. The safe system approach Australia has been at the forefront of the development of the ‘safe system’ approach to road safety. The safe system recognises the need for safer drivers in safer vehicles on safer roads.
82
Figure 4 Road deaths since 1925
The following principles broadly underline the safe system approach to road safety: • mistakes, errors of judgment and poor driving decisions are intrinsic to humans. The road safety system needs to be designed and operated to account for this; • people who behave with criminal disregard for the safety of others should expect tough policing and tough penalties; • safety can be built into the system in a comprehensive and systematic fashion, not just having the apparent problem areas patched up; and • the ‘engineered’ elements of the system - vehicles and roads - can be designed to be compatible with the human element, perhaps taking lessons from motor racing that while crashes will occur, the total system is designed to minimise harm. National Road Safety Strategy… Australia has a National Road Safety Strategy (NRSS), which was adopted by the Australian Transport Council (ATC) in November 2000, and commenced in January 2001. The ATC comprises road and transport Ministers from the Federal Government and each State and Territory Government. The Strategy provides a framework for coordinating the road safety efforts of governments and other organisations involved in road safety (such as the Australian Automobile Association, Bicycle Federation of Australia etc). The key target of the Strategy is a 40% reduction in the national road fatality rate from 9.3 deaths per 100,000 population in 1999 to no more than 5.6 in 2010. … but we are behind target By the end of 2006, the national road fatality rate was 7.8 per 100,000 population. Although this is substantially lower than the rate of 9.3 when the Strategy started, it is well behind the
83
expected prorate rate of 6.9. Notably, until the end of 2004, the death rate was generally on track to meet the 2010 target. Since then however, the fatality rate has actually increased.
Figure 5 Road death rate vs national target (deaths per 100,000 pop) Why are we behind target? Within the NRSS, a series of Action Plans have been developed on a biannual basis. The 2007-08 Plan provides an analysis of the potential reasons why Australia is behind the NRSS target: • growth in the number of kilometres traveled on the roads is higher than expected; • with the exception of Victoria, speed management improvements have been incremental; • investment in road infrastructure has remained fairly constant; greater investments are needed in order to produce greater benefits; • the uptake of technology to encourage seat belt use and increase speed awareness (such as audible alerts) and the installation of electronic stability control in new cars has been slower than anticipated; and • other factors such as ‘learning effects’, whereby motorists learn where enforcement is likely to occur and driver distraction, including the use of mobile phones, has increased. Young people and the national strategy The current Action Plan takes the approach that broad road safety measures, such as making roadsides safer, improving vehicle occupant protection and targeting drink and drug driving, are particularly important since they hold promise not only for vulnerable road user groups, such as young people, but also the wider population. Nevertheless, the Action Plan does identify some actions that are specific to novice drivers—who are also generally young drivers.
84
Highest-impact actions • Implement and evaluate best practice educational programs and graduated licensing systems for novice drivers. • Encourage community and industry participation in key graduated licensing initiatives. • Increase public awareness of the safety benefits for novice drivers of: o extensive supervised experience before solo driving is permitted; and o limiting access to higher risk driving, such as late night driving, driving with peer passengers, and drinking and driving. Supporting actions • Develop better methods for engaging young people in road safety issues. • Monitor and report on research into novice driver development, risk factors, and the effectiveness of different interventions. Novice driver performance indicators • Monitor crash and injury incidence for the 17–25 year age group, including data on crash circumstances. • Establish and report on a matrix of graduated licensing provisions. State and Territory strategies Each State and Territory also has a road safety strategy that is specific to the State or Territory and which broadly aligns with the National Strategy. These strategies can found at the following addresses: • NSW, Road Safety 2010: www.rta.nsw.gov.au • VIC, arrive alive!: www.vicroads.vic.gov.au • QLD, Road Safety Strategy 2004-2011: www.transport.qld.gov.au • SA, Road Safety Strategy 2003-2010: www.transport.sa.gov.au • WA, Road Safety Strategy, 2003-2007: www.officeofroadsafety.wa.gov.au • TAS, Road Safety Strategy, 2002-2006: www.transport.tas.gov.au • NT, Road Safety Strategy, 2004-2010: www.ipe.nt.gov.au
85
•
ACT, Road Safety Strategy, 2001-2005: www.tams.act.gov.au
National novice driver education trial In December 2004, the Australian Government sponsored a Young Driver Forum, at which the Transport Ministers of the Australian, New South Wales and Victorian Governments announced a trial of a special novice driver education program involving 14,000 young drivers in New South Wales and Victoria. A further 14,000 will be selected for a control group. The trial will be the largest of its kind ever undertaken. The program will provide novice drivers with an understanding of their own limitations and an insight into how they can reduce the risks they face on the road. It is to be aimed at reducing the shocking number of young deaths on Australia's roads. The trial will be jointly funded by the three governments, the Victorian Transport Accident Commission (TAC), the Federal Chamber of Automotive Industries (FCAI), NRMA Insurance and the Royal Automobile Club of Victoria (RACV). At the time of writing, contracts for the development of the curriculum, the operational management of the trial and evaluation of the trial were being finalised. The trial is due for completion in 2010. Recent initiatives for young drivers All of the States and Territories in Australia now have some form of Graduated Licensing Scheme (GLS) scheme in place or planned for implementation. A summary of the schemes as they stood in mid-2006 is provided in a separate Australian Automobile Association document on motoring clubs’ initiatives in driver training and education. Many of the schemes have evolved throughout recent years, and some of the most recent initiatives are summarised below. New South Wales From 1 July 2007: • P1 drivers—those on their first year red P plates—will only be able to carry one passenger under the age of 21 between 11pm and 5am. • Any P1 driver caught speeding will automatically lose their driver’s licence for at least three months. • All mobile phone use will be banned for P1 drivers. • P plates will have to be displayed on the exterior of cars—and not, for example, inside the windscreen. • The mandatory period of supervised driving for Learner drivers will increase from 50 to 120 hours. The 120 hours includes a requirement of 20 hours of night supervised on-road driving. • All Learner drivers will have to have their L plates for a minimum of one year before they can apply for a P plate licence (the minimum age for L’s is 16). This is a 100 per
86
cent increase on the current six month minimum while the validity of the Learner’s licence will also be extended from three to five years. • A new test focusing on hazard perception and how novice drivers respond to these hazards will be introduced. The test has been developed by the Roads and Traffic Authority (RTA) to prepare new drivers for a more demanding driving environment and ensure they have the basic skills for a lifetime of safe driving. Additionally, the RTA will release two new resources to support all NSW high schools to teach driver education for years 9 and 10, and years 11 and 12 students. A new TV advertising campaign targeting P plate drivers, working in conjunction with NSW Police’s Operation Novus, has also begun. For more information: www.rta.nsw.gov.au Victoria Victoria is implementing the following changes to its GDL scheme in three phases between 1 January 2007 and 1 July 2008. From 1 January 2007: • Licence loss mandatory at (or above) a Blood Alcohol Concentration (BAC) of 0.05. • After paying fines and having their licence cancelled, P-platers, and any driver under 26 caught driving with a blood alcohol concentration of 0.07 or higher, now will have an alcohol interlock fitted to their vehicle for a minimum of six months when they return to driving. • A person under the age of 26 years who holds any driver licence must have the licence in his or her possession at all times while driving or in charge of a motor vehicle. From 1 July 2007: • No mobile phone use, hands free or hands held, or any messaging of any kind. • For learners under 21 years of age, a minimum of 120 hours of supervised driving experience (including 10 hours at night) with an official practice diary and declaration to be signed by the learner and supervising driver. From 1 July 2008: • Drink-driving offenders will have to fit an alcohol ignition interlock for a minimum of six months when re-licensed. • Restrictions on driving high powered vehicles such as eight cylinder cars, cars with turbocharged or supercharged engines, and nominated high performance sixcylinder cars. Offences will attract a fine and three demerit points. • For P1 drivers, no towing (unless for work or if under instruction). • For P1 drivers, any licence suspension, drink driving offence with a BAC up to 0.05, or drug driving offence, will result in an extension of the P1 period for six months, plus the period of suspension. A passenger limit will apply for the balance of the P1 period. • For P2 drivers, any licence suspension, drink driving offence with a BAC up to 0.05, or drug driving offence, will result in an extension of the P2 period for six months, plus the period of suspension. For more information: http://www.arrivealive.vic.gov.au
87
Queensland Changes to the Queensland GLS will be rolled out from 1 July 2007 and include the following: • Lowering the minimum learner age to 16 and extending the licence period to 12 months. • Gaining 100 hours of certified, supervised driving experience for under-25 learners. • Restricting all mobile phone use, including hands-free, blue-tooth accessories and loudspeaker functions, for learner and P1 provisional licence holders under 25. • Restricting mobile loud-speaker functions for supervisors and passengers of learner and P1 provisional licence holders under 25, while they are being instructed. • Motorbike learners will be required to hold a car provisional licence for 12 months before obtaining a motorbike learner licence. • Introduction of a two-phased P1 and P2 provisional licence system. • Compulsory L plates and P plates (a red plate for P1 and green plate for P2). • Peer passenger restrictions (only carrying one passenger aged under 21) from 11pm to 5am for P1 under 25. • High-powered vehicle restrictions for provisional drivers under 25. • After 12 months on P1, licence holders must pass a hazard perception test to progress to P2. • Late night driving and other restrictions for disqualified and suspended young drivers. For more information: http://www.transport.qld.gov.au/Home/Licensing/Learn_to_drive/Young_drivers/ South Australia From 31 October 2006, L and P plate drivers in South Australia disqualified from driving ‘regress’ through the GDL scheme. After disqualification Learner's Permit drivers go backwards to: • passing the Learner's Permit Theory Test again, prior to being re-issued with a permit.
88
• passing the Basic Ridersafe course if you are a motorcyclist. • holding the permit for a total period of nine months. After disqualification P1 Provisional Licence drivers go backwards to: • applying for a Learner's Permit (no theory test required). • passing a practical driving test again (Vehicle on Road Test, Competency Based Training or Advanced Ridersafe), prior to being reissued with another P1 licence. After disqualification P2 Provisional licence drivers go backwards to: • being issued with a P1 Provisional licence. • passing the Hazard Perception Test again before regaining their P2 licence. For more information: http://www.stopthink.sa.gov.au/stopthink/l_p_licence_regression.asp Western Australia New provisions of the Western Australian novice driver scheme are: • Restricting driving between midnight and 5 am for the first six months; • Restricting passengers under 25 in the first six months of the probationary period; • Zero BAC (Blood Alcohol Content) for learner and P-plate drivers for the entire twoyear Pplate period; • A graduated demerit point system – no more than three demerit points for the first year and no more than seven for the second; • Six months minimum on Learner Phase Two; • Learner’s permit to be valid for three years – instead of the one; and, • Tightened requirements for supervisory drivers, including zero BAC. For more information: http://www.officeofroadsafety.wa.gov.au Northern Territory In 2006, the NT Government announced a raft of new road safety initiatives that affect all road users from 1 January 2007. Penalties for a range of road safety related offences will be increased: • drink driving infringement penalties for offences under 0.08 will double; • speeding infringement penalties will double and a new infringement penalty of $500 for travelling more than 45 km/h above the speed limit will be introduced; • seatbelt penalties will double; • penalties for disobeying red traffic lights will double and penalties for disobeying yellow traffic lights will be increased; and • penalties for not displaying an L or P plate when required will double. Speed limits will be introduced: • a 130 km/h speed limit will apply where signed on the Stuart, Barkly, Victoria and Arnhem Highways; and • a new default 110 km/h limit will apply on all other rural roads unless otherwise signposted. A dedicated NT Police traffic branch known as the Northern Traffic Operations was launched on 18 December 2006. In terms of young drivers specifically, the government will develop a comprehensive GLS. In the knowledge that a comprehensive GLS will not be implemented before 2008, the government will take the following initial steps:
89
•
provide for a minimum Learner licence period of 12 months, including for motorcycle licences, for all drivers under the age of 25 and six months for drivers 25 years or older; • provide for a Provisional licence period of two years or 12 months for drivers 25 years or older; and • mobile phone use in any form while driving be prohibited during the Learner and Provisional phases. The government will also develop of a road safety education curriculum as part of the transition to Year 10 curriculum framework. For more information: http://www.saferroadusers.nt.gov.au Anti-hoon legislation Anti-hoon laws are in place throughout most of Australia. The laws are designed to deter offences such as excess noise, street racing, refusal to leave a public place, exhibitions of acceleration and burn-outs. The key feature of the laws is that they enable police to have the offender’s vehicle towed and impounded (usually for 48 hours for first time offenders) at the offender’s expense. The laws generally target at younger drivers. In Victoria, an average of nearly five vehicles a day have been impounded since the laws were introduced in July 2006. According to Victoria Police crash studies, hoon driving contributed to 41 serious crashes between January 2003 and November 2004, resulting in 28 deaths. Random roadside drug testing There has been a longstanding prohibition on drug driving in Australian States and Territories. However, in December 2003, Victoria passed landmark legislation that enables Police to conduct random roadside drug testing for THC and methylamphetamine. According to VicRoads, a driver who has recently consumed cannabis or an amphetamine based substance is at the same risk of having a crash as a driver with a blood alcohol concentration above 0.05. A driver caught driving while under the influence of drugs for the first time is fined $322 and loses three demerit points.
Similar laws were introduced in South Australia in July 2006. In South Australia between 2003 and 2005, more than 23% of drivers or riders killed and tested for the presence of the drugs THC, methylamphetamine and ecstasy, had detectable levels of one or a combination of these drugs.
90
Other States and Territories have been monitoring the success of the Victorian and South Australian schemes. From July 2007, Western Australia is expected to implement random roadside tests. Speed in advertising In August 2002, the Federal Chamber of Automotive Industries (FCAI) introduced the Voluntary Code of Practice for Motor Vehicle Advertising (the Code). This was largely in response to government and community concerns that vehicle advertising was undercutting road safety messages, particularly on speed. The Code is administered by the independent Advertising Standards Board (ASB).
The Code was last reviewed in August 2006 by the Australian Transport Safety Bureau (ATSB), with input from state and territory road safety agencies, the Australian Automobile Association (AAA), the FCAI and its member companies and the ASB. The ATSB also consulted with the members of the National Road Safety Strategy Panel. The review found that the Code has reduced the depiction of unsafe or inappropriate driving behaviours in vehicle advertisements. Independent research by CARRS-Q lends support to these observations. Furthermore, while trends in complaint numbers are not a reliable indicator, the continued low number of advertisements attracting complaint is an encouraging sign. However, all stakeholders strongly affirmed the need for continued monitoring and review of industry self regulation.
91
What’s being done by the clubs? Who are the motoring clubs? The Australian Automobile Association (AAA) represents Australia’s motoring clubs, who have a combined membership of some 6.5 million, making AAA one of the largest consumer organisations in Australia. Club NRMA, NSW & ACT RACV, VIC RACQ, QLD RAA, SA RAC, WA RACT, TAS AANT
Members 2,400,000 1,600,000 1,300,000 562,000 521,000 103,000 15,000
Driver training and education Australia’s motoring clubs play an active role in providing driver training and education for young people. During 2005, the clubs delivered the following services: Learner/novice/supervisor lessons 134,300 Learner’s test website hits 840,000 Youth/high school sessions 5,250 CDs distributed 20,000 Magazine readership 31 million Young / novice driver training A number of the motoring clubs offer professional driving lessons specifically tailored for learner drivers, and focused on the underlying values, attitudes and thought processes that form the basis of safe driving. Instructors take participants through a mixture of classroom discussion and practical on-road activities conducted in a range of real traffic environments. Training is often tailored to individual needs and can include personalised reports. Parents and supervising drivers are also catered for, as clubs provide them with important information and useful advice on how to help their learner become a safe and responsible driver. By way of acknowledgement for the important role supervising drivers’ play, the RACV’s Parent Plus program offers an incentive to encourage parents/carers to attend one of the early sessions with the learner driver. As another example, RACT is Tasmania’s largest statewide novice driver training provider, employing 12 driving instructors and delivering some 18,000 lessons a year.
92
Driver education and awareness Education programs delivered to senior school students are designed to improve their road safety behaviour and attitudes. Australia’s motoring clubs ensure their road safety education programs are integrated into the school curriculum. Transmission – senior secondary students learn about road safety and use their imagination to create a Community Service Announcement for television. Winning entries are produced and aired on metropolitan and regional commercial television stations in Victoria. In 2006, more than 100 secondary schools are participating in this program. Radio Transmission – following in the footsteps of the outstanding success of the Transmission program, senior secondary students create and record a Community Service Announcement script for commercial radio broadcast. School visits – senior school students receive tips on getting their licence, a quick quiz, giveaways to keep interest levels high, and audio/visual material especially targeted for audiences on the verge of finishing school. The RACWA provides nearly 600 such presentations to high schools each year. Youth & Road Trauma forums – dramatic crash rescue re-enactments presented to 4,000 senior school students on each occasion, involving all emergency services, interactive displays on vehicle safety (seatbelts, airbags, ESC, tyres), drug and alcohol teams, Red Cross, guest speakers with a brain injury resulting from a crash, and demonstrations of 40km/h and 60km/h stopping distances in wet and dry conditions. free2go – designed for Year 12 students and 17 year olds, free2go offers a range of specially tailored club benefits and road safety advice for young people as they prepare to gain their licence and buy their first car. Online resources Each club has specific web pages and some have completely dedicated websites for young and novice drivers, as well as for young people who are yet to obtain their licence.
93
Online tests, based on the questions that appear in a jurisdiction’s official Learner driver tests, are one of the easiest ways to increase the chance of passing a Learner’s permit examination by practising for the written component of a driving test.
The RAA’s animated, interactive online Learner driver’s quiz is consistently the most frequently visited section of the club’s website, recording more than 70,000 visits a month. Friends can even challenge one another to beat their scores! The RACQ also offers older drivers an online self assessment about their health, driving and other relevant issues which, based on the responses given, automatically generates information and advice on safety issues that the participant may need to address. Extensive information can be downloaded from many club websites, on: • Applying for a licence – Learner’s, Provisional and motorcycle • Conditions for licence holders – Learners including motorcycle, and Provisional • Getting your Open/Full licence • Graduated Licensing Systems • Infringement penalties and demerit points • How to select a driving instructor • Making the most of professional instruction Driving simulators NRMA Motoring & Services has opened a learner driving school incorporating two hightech driving simulators, imported from The Netherlands, to teach absolute novices how to drive a manual vehicle. The Safer Driving School offers learner drivers the opportunity to take their very first lessons in the totally safe environment of a driving simulator, then gradually move to on-road lessons with experienced instructors in vehicles that exactly match the platform used in the simulators.
94
DVDs & CDs Tightrope: your future is in the balance A film designed to help Year 12 students think about the choices they have to make every time they get in a car, whether as a driver or a passenger. This film is available to all Queensland high schools, universities, community and youth organisations. Safer Driving Although ideal for novice drivers, safety techniques and road rules are relevant to anyone interested in becoming a safer driver, regardless of age or experience. It is an equally valuable resource for company fleets and driving schools. SHIFT 2nd Gear An award-winning, interactive multimedia CD that demonstrates the complexity of driving forms part of the NSW school curriculum. Young and aspiring drivers can put themselves in the driver’s seat, make certain decisions for themselves, and then see the consequences of their actions. Advice & information – handbooks, guides, fact sheets The clubs produce facts sheets on every road safety issue imaginable! Getting There: A comprehensive guide for those who are teaching someone to drive. This booklet provides important information on how to be a passenger in your own car and how to help get a learner driver on the road to success. Getting There is widely distributed by road safety officers during Graduated Licensing System workshops. RACQ Refresh: A handbook designed to help all drivers drive safely for longer by covering issues such as road rules, safe driving techniques, and sharing the road. Research The DRIVE Study – supported by NRMA Motoring & Services and being undertaken by the Institute for International Health, is the largest study in the Southern Hemisphere to examine the driver training method, mental health, attitude, gender, region and much more for 20,000 new P-plate drivers. Participants are subsequently being ‘tracked’ to determine crash involvement. Transforming Drivers – a joint NRMA Motoring & Services/University of Western Sydney/Australian Research Council study exploring messages derived by young people from media representations of cars and driving and road safety campaigns. The first component of the study also examined cultural and gender influences. In the Driver’s Seat: - understanding young adults’driving behaviour (2005) – findings from the Australian Temperament Project, a longitudinal study of the development and
95
wellbeing of 1135 Victorians from infancy to young adulthood. A joint project between the Australian Institute for Family Studies, RACV and the Transport Accident Commission, the study identified factors and pathways associated with risky driving, crash involvement and speeding offences. Fatigue and Young Drivers (2006) – emphasised the importance of lifestyle and motivational factors in driving while tired. Driver Behaviour Survey (2005) – NRMA Motoring & Services/Monash University research into the effects of text messaging on the driving performance of young and novice drivers. Young Drivers and Road Safety (2004) – looked to gain a better understanding of some of the underlying issues contributing to the involvement of young drivers in crashes. A range of hypotheses was tested, along with possible remedial measures. Young Driver Licensing (2005) – This RACV report aimed to contribute to the debate and ultimately the development of measures to reduce the crash involvement of young Victorian drivers. National road safety programs The Australian Automobile Association also supports and coordinates the clubs’ roles in three significant road safety programs: ANCAP, UCSR and AusRAP. Although these programs don’t focus specifically on young people, safer cars and safer roads benefit all road users.
Australasian New Car Assessment Program (ANCAP) ANCAP crashes new cars in a controlled environment and awards them a star rating for how well they will protect the car’s occupants and any pedestrians. Four key tests are used: frontal, side impact, pole impact and pedestrian. For more information: http://www.ancap.com.au
96
Used Car Safety Ratings (UCSR) Drawing on crash records from over 1.7 million police-reported crashes in New Zealand and Australia between 1987 and 2004, the used car safety ratings are calculated according to a car’s potential to protect drivers and harm other road users. Ratings are provided for 305 vehicle models. For more information: http://www.aaa.asn.au/ downloads/ucsr06.pdf Australian Road Assessment Program (AusRAP) AusRAP produces maps showing the risk of road crashes that cause deaths and injuries and rates roads for safety. It highlights improvements that could be made to roads to reduce the likelihood of crashes—and to make those that do happen survivable. For more information: http://www.ausrap.org
Bibliography AAA, 2006, Driver Training and Education Capabilities ACT Government, Drug Driving and Crashes – an overview ATC, National Road Safety Strategy 2001-10; and National Road Safety Action Plan 2007-08 ATSB Fatal Road Crash Database ATSB, 2004, Road Safety in Australia, A Publication Commemorating World Health Day 2004 ATSB, 2006, Compliance with the Revised FCAI Voluntary Code of Practice for Motor Vehicle Advertising Review SA Government, Fact Sheet: Drivers Now Tested for Illegal Drugs VicRoads, Arrive Alive! WA Office of Road Safety, Drug Driving YouthSafe NSW, Transport Injury Fact Sheet
97
98
The road safety situation for children in Bangladesh Tahera Anjuman & Chowdhury Kawsar Arefin Siddiqui Accident Research Center (ARC), Bangladesh University of Engineering and Technology (BUET) The children are highly vulnerable in the traffic situation compared with many other countries of the world. The incidence of overall child involvement in road accident fatalities in Bangladesh is found to be very high, accounting for about twenty two percent. An elaborate analysis of accident data collected from police with a study period of seven year (1998-2004) it is evident that the involvement of children below 15 years of age in road accident fatalities is much higher than those in other developing countries. Of the total child fatalities of road accidents, on an average nearly eighty percent involved as pedestrians with the dominant age group of 5-10 years and thirteen percent of all children were bicycle users. Indeed, about one- third of total pedestrian fatalities are children under the age of 15 years. They are the dominant age group of pedestrian fatalities. The female child pedestrians are disproportionately higher than the male child pedestrians. It is found that almost thirty two percent for female child and twelve percent male child are involved in road traffic accidents. This paper aims to discuss the child safety issue which deserves urgent attention by addressing the special needs and requirements of the children. Significant reduction of accidents and injuries is possible through a safety conscious and systematic application of countermeasures encompassing traditional three E'sEngineering Enforcement and Education. Also the role of road safety education for children is discussed because it is essential for effective and sustained prevention of accidents and injuries in the longer term. The safety of the vulnerable road users especially children must be sufficiently catered for in the road safety engineering strategies and principles.
INTRODUCTION In many OECD countries, road-related crashes are the number one killer of children under the age of 15. In fact, the number of children killed per annum on the roads in OECD countries was halved between 1984 and 2000. Nevertheless, at current rates, one child out of every 2 100 will die before their 15th birthday in a road-related incident, and a considerably higher number will suffer severe injuries or lifelong disabilities. The variation of children's road traffic fatality rates among the OECD countries are depicted in figure 1. Latest studies (WHO) suggest that "there are 1.2 million deaths from road traffic injuries each year in the world, 88 percent occurring in the developing world. For every death, there are far greater numbers of injuries- four persons with severe/permanent disabilities, ten persons requiring
99
hospital admission, and thirty persons requiring emergency room treatment. The economic costs of this epidemic are enormous, ranging from 1 to 5 percent of GDP for every nation. And the problem is expected to accelerate” (Mackay, 2003). In Bangladesh vulnerable road users accounted for nearly 75 percent of road accidents. Pedestrian alone are responsible for 48% of urban accidents and 47% of rural accidents. In urban areas, pedestrian accounted nearly 62 percent of the total fatalities. Of the total pedestrian death nearly one-third are children under 16 years of age. In fact, children under 16 years of age represent about 21 percent of all fatalities (MAAP5). Indeed, the recent UNICEF study revealed that the road traffic injuries are the leading causes of fatalities to children age group of 10-14 years. This clearly demonstrates the high risk of children in traffic accidents in Bangladesh. This paper discusses the current situation of child safety problem in Bangladesh and also focuses on a safety conscious and systematic application of countermeasures encompassing traditional three E's- Engineering Enforcement and Education.
Figure 1: Total Traffic Fatality Rate among Children aged 0-14. (Mean for 1996-2000) (Source: OECD Observer, 2004)
RISK LEVEL OF CHILDREN IN ROAD ACCIDENTS IN BANGLADESH The national road accidents statistics in Bangladesh (Road Safety Cell, 2001, cited in Maniruzzaman & Mitra, 2005) revealed a serious threat to the children. The incidence of overall child involvement in road accident fatalities in Bangladesh is found to be very high, accounting for about 21 percent. This involvement of children under 15 years of age in road accident fatalities is much higher than those in other developing countries. It is important to
100
note that compared to industrialized countries, the proportion of fatalities to under 15 years of age in developing countries is approximately two and half times higher. Of the total child fatalities of road accidents, nearly 82 percent involved as pedestrians with the dominant age group of 5-10 years. Indeed, about one- third of total pedestrian fatalities are children under the age of 15 years. They are the dominant age group of pedestrian fatalities. The female child pedestrians are disproportionately higher than the male child pedestrians (44.6% Vs 28.9%). ROAD SAFETY SITUATION FOR CHILDREN IN BANGLADESH The Accident Research Centre (ARC) of Bangladesh identified pedestrians as the most vulnerable road user’s group in developing countries like Bangladesh. The incidence of risk of children in road accident is also very serious in Bangladesh. Children, in general, are involved in more accidents in developing countries than those in developed countries. Every year more about three thousand people are killed in road accidents (according to the reported data) in Bangladesh and 21% (Table 1) of them are children. But this figure is only about 4% in the developed countries. Figure 1 shows the children fatalities rates in different countries including Bangladesh.
Percent of Children Fatalities in Different Countries 25%
21%
15% 10% 4%
5%
de sh B an gl a
U SA T A h vg ai (E lan d xc ep tB d)
U K
an y
G er m
Ja pa n
ly Ita
lia
Ca na da Fr an ce
0% A us tra
Percent
20%
Country Name Figure 2: Percentage of Children Fatalities in Different Countries (Source: IRTAD-2005 and ESCAP-2006)
101
Table 1: Children Fatalities and Injuries in Bangladesh (1998-2004)
Year
Total Fatalities
1998 1999 2000 2001 2002 2003 2004
2358 2893 3058 2388 3053 3334 3150
Avg
2891
Fatalities (known age) 1911 2266 2299 1665 1831 2024 1741
Children Fatalities
Per cent
Total Injuries
Injuries (known age)
Children Injuries
Per cent
414 440 473 343 385 395 371
22 19 21 21 21 20 21
3297 3469 3485 2565 3285 3740 3026
2398 2459 2265 1506 1446 1667 1249
238 217 225 175 137 172 115
10 9 10 12 9 10 9
1962 403 21 3267 1856 (Source: Police reported MAAP Database)
183
10
Children Accident in Urban and Rural Areas Children fatality rates in rural and urban areas are significant among all aged groups of people. Children in rural areas are more vulnerable to road accident than those in urban areas (Figure 2). Fatality rate in rural areas (74%) is about three times higher than those of the urban areas (26%).
Comparison Fatalities and Injuries in Urban and Rural Area 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Rural Urban
Fatalities
Injuries
Figure 2: Comparison of Fatalities and Injuries in Urban and Rural Area (1998-2004) (Source: Police reported MAAP Database)
The Distribution of Fatalities and Injuries by Road Classes The distribution of fatalities and injuries involving children by road classes is shown in Figure 3. It can be seen that 37 percent of the children fatalities occurred on the National Highways, which is about one third of the total children fatalities. From Figure 3 it is also seen that the National Highways contributing at least 37% of all children fatalities is two
102
times higher than those Urban Roads (16%) whilst children injury rates are more or less same for both in National Highways and Urban Roads (32%).
Distribution of Children Fatalities and Injuries as Road Class 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Rural Road Feeder Road Regional Highway City Road National Highway
Child fatalities
Child injuries
Figure 3: Distribution of Children Fatalities and Injuries as Road Classes (1998-2004) (Source: Police reported MAAP Database) Child Fatality/Injury by Age Group It is important to determine which age groups of children who are dominant in accidents. Table 2 presents the distribution of children fatalities and injuries by different age groups. The dominant age group of 6-10 years in fatalities, 51 percent, perhaps reflects their inability to cope with the complexity of traffic. However this needs further investigations. The 11-15 years age group also predominates in casualties. Table 2: Age-wise Distribution of Children Fatalities and Injuries (1998-2004) Children Fatalities Age 0--5 541 6--10 1436 11--15 844 (Total) 2821
%
Injuries
%
19% 51% 30% 100%
223 506 549 1279
17% 40% 43% 100%
(Source: Police reported MAAP Database)
103
Hourly Distribution of Child Fatalities and Injuries In Figure 4 the time distribution of child fatalities and injuries are presented which shows that child casualties peaked during 10-12 noon with the high level of their involvement during the entire day period. Child Fatalities and Injuries at Differnt Time of the Day 25% 20% 15% 10% 5% 0% 6.0-8.0 am
8.0-10.0 am
10.0-12.0 noon
12.0-2.0 pm
2.0-4.0 pm 4.0-6.0 pm 6.0-8.0 pm 8.0-10 pm
10.0-12.0 pm
Time, hours
Fatalites
Injuries
Figure 4: Hourly Distribution of Child Fatalities and Injuries (1998-2004) (Source: Police reported MAAP Database) The periods with the greatest involvement of children in accidents thus seem to be related with the school activities. Again these aspects require further examination. THE RISK OF CHILDREN AS ROAD USERS Children as pedestrians Children as pedestrians are more likely to fall in accidents than those of passengers or bicyclists. In many developing countries, pedestrians are particularly vulnerable groups of road users. In Asia, Africa, the Caribbean and the Middle East, more than 40 percent of reported road accident deaths are pedestrians, compared to only about 15 percent in Europe and the United States (IRTAD, TRL). Furthermore, certain pedestrians, such as the young, have been identified as being especially at risk in these road accidents. Accidents involving children less than 16 years of age on average contribute to 20 percent of pedestrian fatalities in developing countries making them a major safety issue and cause for concern (IRTAD, TRL). For Bangladesh, about 50% of reported road accident deaths and 17% of reported road accident injuries are pedestrians. Among them, the children pedestrian fatality rate is 32% and injury rate is 25%; that is, one third of the pedestrians dying in road accidents are under the age 16 years, which is very large in amount. It is of particular concern that, children pedestrian fatalities are 80% of the total estimated children fatalities (Table 3). From the analysis, it has been found that children are more vulnerable to road accidents as pedestrians.
104
Table 3: Child Pedestrian Fatality in Bangladesh
Year
Pedestrian Fatalities (known age)
1998 1999 2000 2001 2002 2003 2004 Average
1013 1174 1148 859 967 1016 916 1013
Child Pedestrian Fatalities
Child Percent among all Fatalities
Child Percent as Pedestrians of total Child Fatalities
326 363 376 282 308 323 284 323
32% 31% 33% 33% 32% 32% 31% 32%
79% 83% 79% 82% 80% 82% 77% 80%
(Source: Police reported MAAP Database)
Table 4: Distribution of Child Pedestrian Fatalities and Injuries in Different Actions (1998-2004) Pedestrian Fatalities Percent Injuries Percent action On Road Edge 1055 47 305 48 Crossing Road 680 30 155 24 On Road 179 8 43 7 Playing on or 101 4 17 3 beside Road Others 244 11 114 18 Total 2259 100 634 100 (Source: Police reported MAAP Database) Distribution of Child Pedestrian Fatalities and Injuries in Different Actions
Every year about 32% children die in road accidents as pedestrians. Although investigators have categorized pedestrian actions leading to injury into more than 30 types, relatively few actions account for the majority of injuries in children. “On road edge or shoulder” types of injuries, in which the child walks along roadside or shoulder, account for 47% of the total injuries among children. “Crossing Road” types of injuries, in which the child crosses the road at an intersection or other place, account for 30% of the total injuries among children. This two are the major causes of children pedestrian road accidents in Bangladesh. The percentage of accidents due to playing on or besides roads is about 4% (see Table 4).
105
Distribution of Child Pedestrian Fatalities and Injuries by Sex Fatality and injury rates of boys is about more than two times than those of girls. As pedestrians, male children fatality rate is 64% and injury rate is 68%, whereas it is 36% and 32% respectively in case of female children (Figure 5).
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Female Male
Fatalities
Injuries
Figure 5: Distribution of Children Pedestrian Fatalities and Injuries by Sex (1998-2004) (Source: Police reported MAAP Database) Distribution of Child Pedestrian Fatalities and Injuries by Age Group From the age wise distribution of fatality and injury of child pedestrian it is evident that the age group 6-10 is the most vulnerable of all and contributes almost 56% of all child fatalities (see Table 5).
Table 5: Age-wise Distribution of Children Pedestrian Fatalities and Injuries (1998-2004) Children Fatalities Age 0--5 408 6--10 1216 11--15 561 (Total) 2185
%
Injuries
%
19% 56% 25% 100%
66 261 197 524
13% 50% 37% 100%
Children as passengers In Bangladesh, 37% of fatalities and 63% of injuries, due to road accidents, are passengers. On average, children as passenger represented about 10 percent of the passenger fatalities (Table 6).
106
Table 6: Passenger Fatality and Child Fatality in Bangladesh Passenger Children fatalities Total Fatalities Total Percent with Year Passenger Percent fatalities as known fatalities Passenger age 1998 2358 848 36 692 78 11 1999 2893 1079 37 864 70 8 2000 3058 1212 40 917 89 10 2001 2388 859 36 599 52 9 2002 3053 1059 35 670 69 10 2003 3334 1243 37 777 67 9 2004 3079 1142 37 627 81 13 Average 2880 1063 37 735 72 10 Source: Police reported MAAP Database Children and Bicyclists Total bicyclist accidents in Bangladesh are 1038 (in the years between 1998-2004), which is 4% of the total accidents. Of the total fatalities the bicyclist represents 4 percent. Among the total bicyclist fatalities, the children involvement is 13 percent, which is 2 percent of the total child fatalities. THE RISK TO CHILD SAFETY ON ROADS It is not just a question of safety aids such as child safety seats in cars, bicycle helmets or pedestrian crossings. Education, training and publicity can help children develop into safe, active and independent road users, as well as helping drivers and other adults make the roads a safer place for children. Improvements to the man-made environment beyond their homes can also facilitate children’s safe mobility. This paper has tried to look at the current situation in child safety on the roads in Bangladesh, as well as the latest research results and examples of best practice to portrait how child casualties can be reduced still further. There is indication that traffic accidents tend to predominate over diseases as the single biggest threat to the children in many developing countries and the threat of road accidents to children will further increase with increases in motorization and urbanization. Several factors as outlined below contribute to the risks to children in developing countries (ADB 1996): (1) both speed and volume of motor vehicles will increase, especially on rehabilitated roads. (2) roadside friction will continue as poor land use planning, operational control, and limited road space lead to conflicting uses of road and road margins; (3) road improvements tend to focus on motor vehicle requirements and not on pedestrian needs.
107
(4) (5)
traffic police can offer only limited help as they are poorly equipped to control motor vehicle traffic and not properly trained to consider pedestrian needs; and most parents are unable to provide road safety training to children as they themselves never received any such training and even if they did, traffic conditions have changed dramatically since their childhood. CHILD ROAD SAFETY IMPROVEMENT OPTIONS
The main focus of child road safety might be highlighted on successful programs and strategies that could be adopted by the developing countries like Bangladesh to improve children's safety on the roads and to identify possible further improvements. The success in improving safety for children on road in Bangladesh could be achieved through combined measures to address the behavior of all road users, to improve the road environment and to design vehicles that better protect both their occupants and those at risk outside the vehicle. Child road safety policy and practice should focus three key areas: education, training and publicity; the road environment; and vehicle standards and safety equipment particularly emphasizing safety of children as pedestrians. Education, training and publicity Educational measures need to be modified to the child’s stage of development, starting with practical training pedestrians as pedestrians, then bicyclist skill, and increasingly involving higher-level skills to match children’s increasing independence as pedestrians, passengers and bicyclists. All road users have a duty to keep children safe, so it is also important to target drivers through training and publicity and to make parents aware of their key role in improving the safety of their children. In particular, parents are important role models for their children and can inculcate safe behavior as pedestrians and passengers. Children in the road environment Helping children and other road users to adapt their behavior in order to interact safely with traffic in the road environment is only part of what is needed to keep children safe. Traffic engineers, urban designers and planners have a duty to design systems that take account of children’s mobility needs, travel behavior and differences in perceptual and reactive capabilities in order to maximize their safety and mobility. Children cannot be expected to comprehend aspects of the built environment and react to stimuli in the same way as adults. Vehicle standards and safety equipment The third element to children’s road safety is the design of vehicles and safety equipment. Vehicle standards cover both “primary safety” measures that reduce the risk of a crash occurring and “secondary safety” measures that are designed to prevent or minimize injury
108
in a crash. It is these secondary safety measures that are most likely to be specifically designed to increase child safety. Regulatory and engineering measures Vulnerable road users are much more susceptible to accidents when vehicle speeds are high and can even suffer fatal injuries in accidents with motor vehicles at moderate speeds. Thus the most critical and effective measure which should be immediately adopted in every country is to reduce and control speeds particularly in urban areas. This measure alone will greatly reduce the overall number of road deaths as shown by the experience all over the world (e.g. the number of fatalities was reduced by 32% in urban areas after speed limits of 50 km/h were enacted and strictly enforced in Hungary). Education and Training for the Children Young children do not have the skills to stay safe in traffic. They often can’t see past parked cars and they don’t have the experience to judge the speed and distance of an oncoming car. Parents and carers should teach children good traffic safety habits early. Also, parents should be awarded for their child’s school or pre-school to consider road safety education programs. Children learn about road safety by watching others. Every parent should always set a good example in front of them. The following tips will help to in assisting children to be safe in traffic. ¾ Children up to five years of age. Always carefully supervise your children in traffic situations: • Hold your child’s hand when you are near cars. • Explain what you are doing when you cross the road together. This helps your child to understand how you decide when it is safe to cross. • Set a good example for your child to copy. • Involve your child in choosing safe places to play. • Ensure your child always rides on the footpath or a bicycle track with supervision. • Make sure you get your child in and out of the car on the kerb side. • Insist that children wear an appropriate and properly adjusted child restraint or seat belt on every car trip. • Ask your child’s pre-school to run a road safety program. ¾ From five to nine years of age. Supervise your child at all times near traffic: • Talk about signs and traffic lights. Identify and discuss places where it is safe to cross the road. • Teach you child how to cross roads using the ‘stop, look, listen and think’ process - stop at the kerb, look and listen for traffic and then decide whether it is safe to cross. Take the trip to school together along the safest footpaths and use safe crossing places. • Supervise your child on the way to and from school.
109
• • • •
Limit bike riding to parks, playgrounds or schoolyards and on the footpath with supervision - never on the road without an adult. Insist that your child wears an approved helmet when riding a bike. Insist that your child wears an appropriate and properly adjusted seat belt or child restraint on every car trip. Ask at your child’s school what traffic safety programs are being taught.
¾ From 10 to 13 years of age. Children of this age can cope more safely in traffic on their own, but you can still help: • Check that your child always ‘stops, looks, listens and thinks’ when crossing the road. • Tell your child about road laws in simple terms. Go for rides and walks together. • Plan safe routes to school and places your child often visits. • Talk about where the child can safely ride. • Insist that an approved bicycle helmet is worn. • Make sure your child wears colours that are easy to see. • Insist that properly adjusted seat belts are worn on every car trip. The following points need careful considerations regarding children road safety• Young children do not have the skills to be in road traffic on their own. • An adult should always be with children in traffic situations. • Children learn road safety habits by watching and copying others, so set a good example. • Explain traffic movement, road safety and road rules to your child • Make sure your children wear helmets when riding and are properly secured when travelling in cars. CONCLUSIONS The safety of the vulnerable road users especially children must be sufficiently catered for in the road safety engineering strategies and principles. Vulnerable road users are much more susceptible to accidents when vehicle speeds are high and can even suffer fatal injuries in accidents with motor vehicles at moderate speeds. Thus the most critical and effective measure which should be immediately adopted in every country is to reduce and control speeds particularly in urban areas. This measure alone will greatly reduce the overall number of road deaths as shown by the experience all over the world (e.g. the number of fatalities was reduced by 32% in urban areas after speed limits of 50 km/h were enacted and strictly enforced in Hungary). REFERENCES Asian Development Bank (ADB) (1997), “Vulnerable road users in the Asia Pacific region”, Regional Technical Assistance in Road Safety (RETA 5620) Draft Report. Asian Development Bank.
110
Asian Development Bank (ADB) (1996), “Road safety guidelines for Asia and Pacific Region”, Regional Technical Assistance Project Draft 2 Report, Asian Development Bank. Economic and social development in Asia and the Pacific (ESCAP) SECRETARIAT (2006), “Status of Road Safety in Asia”, May 2006, Bangkok” Hoque, M. M. (1992), "Pedestrian Safety in Dhaka", proceedings of the 7th Road Engg. Association of Asia and Australasia Conference, Singapore, June 1992. Hoque, M.M. (1993), "Strategies for road safety: the Bangladesh situation", Proc. The Third International Conference on Safe Communities, Harstad, Norway, 6-8 June 1994. Hoque, M.M., (2000), “Road Planning and engineering for promoting pedestrian safety in Bangladesh”, Proceedings of 10th Road Engineering Association of Asia and Australasia Conference, Tokyo, September 2000. Hoque, M. M. (2003), “Injuries from Road Traffic Accidents: A Serious Health Threat to the Children”, World Health Day 2003 Hoque, M. M., Mahmud, S. M. S., Iqbal, M. (2007), “Involvement of Children in Road Traffic Accidents in Bangladesh”, A preliminary research report (in preparation), Accident Research Centre (ARC), BUET, Dhaka, Bangladesh. Malini, E., Victor, D. J. (1990), “Road safety education for children”, Karunya Institute of Technology, Coimbatore & Indian Institute of Technology, Madras Mackay, M. (2003), “Global Road Traffic Injuries: An Overview of the Problem”, UN Technical Briefing – May 29, 2003. Maniruzzaman, K.M. & Mitra, R. (2005), ”Road accidents in Bangladesh”. IATSS Research, 29 (2), 71-73. Organisation for Economic Co-operation and Development (OECD), Road Transport Research (2005), “International Road Traffic and Accident Database (IRTAD)”, Accident Statistics, OECD/BAST Organisation for Economic Co-operation and Development (OECD) (2004), “Keeping Children Safe in Traffic”, – ISBN-92-64-10629-4 © OECD 2004 Organisation for Economic Co-operation and Development (OECD) (2004), "OECD Observer", Policy Brief, May 2004 Quimby, A. (2001), “Teaching children in developing countries to be safe road users”, TRL Limited (International Division), UK.
111
112
General papers
113
114
Sydney 2030: A city safe for children Cathy Rutter & Len Woodman City of Sydney The City of Sydney’s vision for 2030 is to develop a city safe for children. As suggested by the internationally renowned urban architect, Jan Gehl, a city safe for children would mean a city safe for all. A safe city is one where children can play, interact and travel safely within the city’s environment. A safer environment is one that provides appropriate conditions for children to walk, ride and travel around with minimal risk. The City of Sydney has embarked on a long term program that will address pedestrian amenity and safety through urban design and transport management strategies. Road safety is a major factor in achieving this vision for Sustainable Sydney 2030. The City of Sydney’s Road Safety Programs will be closely aligned to the needs of the City’s population over the next two decades. The objective is to provide long term sustainable programs that will develop a road safety culture to encourage road safety from birth through to adulthood. This paper will provide an overview of the current research on facilitating and promoting pedestrian and cyclist movement in a city environment, and plans to achieve the Sustainable Sydney 2030 vision, including the role of road safety strategic planning.
BACKGROUND The City of Sydney covers 26 square kilometres of the most densely developed part of Australia. Like many cities around the world, Sydney is experiencing increasing levels of motor vehicle traffic. Like many cities, the City of Sydney has collected a lot of data on motor vehicle movement and little on pedestrian movement. It is not until recent years urban planners from around the world realised that pedestrians have been largely invisible in the planning process in many international cities. The City of Sydney is home to 158,000 residents and global corporations with 360,000 jobs. On an average day it is estimated that there are over 600,000 people in the City including visitors and students. By 2030 it is estimated that there will be 70,000 more residents and 90,000 more workers. According to the 2006 Census, there has been a 21% increase in population with 27,500 more residents since 2001 with many households not owning a car. There are more people living and working in the City, with up to 34% of these residents walking to work. The number of households without a vehicle has dramatically increased since 2001. The number of people walking to work has increased, however, the number of vehicles driving within and through the City and on the arterial road system continues to increase.
115
Approximately 7% of residents in the City of Sydney are children under the age of 15 years. Since 2001, there has been an 11% increase in the number of children under the age of five years and a dramatic decrease in children aged 5 to 19 years (18% decrease of 5 to 9 year olds; 27% decrease in 10 to 14 year olds; 3.5% decrease in 15 to 19 year olds). Sustainable Sydney 2030 is the City of Sydney’s long term vision for a sustainable future with city transport one of the key focus areas for this vision. The City of Sydney aspires to be a “connected City” connecting people and places by developing efficient transport infrastructure and services to and within the city. There will be a strong emphasis on encouraging walking and cycling as the first choice for people to move about the city.
ISSUES Roads in urban areas and the inner city are not just for motor vehicle traffic, they are also for the movement of pedestrians and cyclists.
Potential conflict between pedestrians and vehicles With over 600,000 people in Sydney on a typical weekday pedestrians and motor vehicles are competing for space. Pedestrians represent a high proportion of road injuries in the City of Sydney, accounting for 28% of road injuries in 2004 compared to 11% for the rest of the metropolitan area. With an increased number of residents walking to work and more vehicles travelling within and through the City, there is a concern of greater conflict between pedestrians and vehicles.
Child development and road safety Child development affects children and young people’s ability to be safe in traffic environments. Young children are small and are difficult for drivers to see. They are also fragile, therefore injuries are more likely to be severe. Children are developing their peripheral vision and the ability to identify the direction of sound, which impacts their ability to observe traffic conditions. Young children are unable to judge the speed and distance of moving vehicles, limiting their ability to identify how long it will take them to cross the road safely. Young drivers have a tendency to underestimate perceived risks, which puts them at greater risk of being involved in road accidents. The increased number of City residents under the age of 5 years demonstrates the need to develop campaigns to raise awareness of road safety issues for young children.
116
The decline in the number of City residents aged 5 to 19 years suggests that parents may have moved to a different area because the City is perceived to be an inappropriate environment for children. It seems that the City is perceived to be unfriendly for children.
Children as pedestrians Figure 1 shows the number of pedestrian accidents that involved children up to 19 years of age. 80
70
60
50
40
30
No. of accidents
20
10
0 2001
2002
2003
2004
2005
Year 0-4 years
5-9 years
10-14 years
15-19 years
Total
Figure 1. Pedestrian accidents by age (2001-2005)
Overall, the number of pedestrian accidents involving children up to 19 years of age has been declining over the 2001 to 2005 period. This is in line with the general trend for this period. However there are still more nearly fifty young people injured each year. The majority of these accidents involve children aged 15 to 19 years. There are a number of possible reasons why children at this age group are more likely to be in pedestrian accidents: •
These children are more independent and are more likely to be in a traffic environment without adult supervision;
•
Many cannot drive or do not have access to a vehicle;
•
A small number of the children in this age group work in the City (they represent 3% of the entire workforce in the City), and a large number of them study in the City. This makes this age group more like to walk in the City; and
•
There are more children in this age group who live in the City of Sydney, compared to other age groups.
117
Figure 2 shows a break down of the available data to indicate when accidents involving children as pedestrians occur. Children under 15 years are more likely to be involved in pedestrian accidents during the day time on any given day of the week, whilst children aged 15 to 19 years are more likely to be involved during the afternoons and late evenings to the early hours of the mornings on Wednesdays, Fridays and Saturdays.
80
70
60
50
40
30
20
No. of accidents
10
0 06:01-10:00
10:01-14:00
14:01-18:00
18:01-22:00
22:01-06:00
Time 0-4 years
5-9 years
10-14 years
15-19 years
Figure 2. Pedestrian accidents by age and time (2001-2005)
This relates to the activities undertaken by children in the age groups. Under 10 most children are supervised as they travel around the City. From 10 to 14 many children are still supervised to some degree. The peak time for accidents is during the afternoon which corresponds with school leaving times. From 15 onwards children have a desire for more entertainment and distances travelled may also become greater. Visiting friends after school until later in the day and going to a variety of functions, or just ‘hanging out’ all become part of this age groups activities.
Young drivers While the City has a very low level of car ownership there will still be a demand for young people wanting to drive. Young people in the City generally have the same desire to drive as those outside of an urban and inner-city environment. In addition many young people travel into the CBD as workers or for shopping and entertainment.
118
Figure 3 shows that there has been a decline in young drivers being involved in car accidents, however, they are still highly represented in the total number of crashes. 200 180
No. of accidents
160 140 120 100 80 60 40 20 0 2001
2002
2003
2004
2005
Year 16 years
17 years
18 years
19 years
Total
Figure 3. Car accidents involving young drivers - by age (2001-2005)
Figure 4 shows that on average around 45 crashes each year involve a 19 year old driver. These high numbers of crashes are possibly because young people are still developing their ability to perceive risks and hazards and have limited driving experience. This is generally reflected in crash data throughout New South Wales and Australia as a whole and indicates that although car ownership is relatively low there is still a safety issue that needs to be addressed.
Speed in the City There are different speed limits around the City, from 10km/h in Shared Zones to 50km/h Urban Speed Limit. For the Inner-City and CBD environment 50km/h is perceived as inappropriate and that the speed limit should be reduced. Police have observed that some motorists speed at traffic signals in order to avoid a red signal, or as soon as they have the green signal. This creates high risk situations for pedestrians, particularly those who are less mobile, such as young children, the elderly and people with disabilities. The City of Sydney supports changing the speed limit in the Sydney CBD to 40 km/h as part of the Road and Traffic Authority’s high pedestrian area program. With the long shopping strips, entertainment areas and areas of large numbers of workers it is clear that the Sydney CBD needs lower speed limits. A lower speed limit gives a signal to drivers that there are special reasons to slow down – such as pedestrians and cyclists. Lower speeds give drivers, pedestrians and cyclists more time to react in a potential collision situation and enables drivers to stop in a much shorter distance.
119
60
Number of Crashes
50
40
30
20
10
0 1
4
7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 Age
Figure 4. Car accidents per year by driver’s age (2001-2005) Research in Australia and internationally shows that a maximum of 30 km/h is desirable if we are to reduce the incidence of serious injuries or death to pedestrians and cyclists. However, for New South Wales, the Roads and Traffic Authority has set 40 km/h as appropriate speed for areas of high pedestrian activity.
INTERNATIONAL EXAMPLES OF ADDRESSING PEDESTRIAN NEEDS Many international cities have experienced a continued increase in motor vehicle traffic with consequent negative impacts on pedestrian access and safety. Since the introduction of motor vehicles, urban planners in many international cities have focused on facilitating motor vehicle movements while pedestrians have been neglected. Furthermore, some cities seem to be designed as places to work, rather than places to visit, for recreation or to live. As a result, some of these cities do not cater for families with children, the elderly, or the disabled. In recognition of their failure to accommodate pedestrians and the needs of different groups in society, some cities have conducted studies on how to improve pedestrian facilities and make their city safer and more sustainable by reducing motor vehicle traffic and promote walking, cycling and public transport. The following are examples of studies conducted in some international cities aiming to improve pedestrian facilities and make their city safer and more sustainable.
120
Copenhagen An increase in motor vehicle traffic in the 1950’s and 1960’s caused road safety concerns due to higher conflicts between motor vehicles and pedestrians on the narrow city streets of Copenhagen and degradation of the urban environment. Improvement to pedestrian facilities in the City of Copenhagen began in 1962, when its main street, Strøgen, was turned into a pedestrian only street. Improvements to the city’s pedestrian environment were implemented gradually over time, such as more pedestrian only and pedestrian priority streets. In order to make these improvements, the City of Copenhagen needed to reduce the amount of traffic within the city by: •
Reducing the number of lanes on arterial roads into the city, using the space for bus and bicycle lanes instead;
•
Gradual reduction of parking space in the city (2-3% per year); and
•
Providing new metro mass transit lines to provide better access to the inner city from outer areas.
The city is now attractive for a variety of user groups by developing spaces and activities to meet their needs with flow on economic benefits to businesses. The strategies used by the City of Copenhagen proved successful. The amount of pedestrian and cyclist movement has increased over the years due to providing a safer environment, through the reduction of motor vehicle traffic volumes, and developing an attractive city that encourages walking and cycling.
London In 2004, London commissioned a public spaces study to examine selected traffic, pedestrian and cycling environments in order to find solutions to achieve a better balance between the different road users and improved the urban environment. The general increase of motor vehicle traffic in Greater London has led to poorer conditions for pedestrians and cyclists, despite improvements in central London as a result of the congestion charge. The study identified the following issues: •
Motor vehicles dominate the streetscape, conflicting with other road users;
•
Poor walking conditions for pedestrians;
•
Pedestrians often crossing roads away from designated facilities, also when the lights were against them; and
•
Poor conditions for cyclists and little awareness of cyclists’ needs by other users.
These issues are compounded by the lack of data on pedestrian movement, exposing the fact that pedestrians have been largely invisible in the planning process prior to 2004.
121
London’s pedestrian facilities were inadequate for the levels of pedestrian movement in the city. There are various features on the streets and paths that posed potential risks to pedestrians including: •
Crowding on footpaths and narrow footpaths
•
Guard railings and inappropriately placed street furniture on footpaths creating an obstacle course for pedestrians
•
Difficult pedestrian crossings and lack of connections
•
Poor access for parents with strollers and people with limited mobility.
Numerous road safety campaigns have been implemented in London to advise pedestrians on safety and how to behave in traffic. All these campaigns serve a good purpose as they put pedestrian safety on the agenda. However, these campaigns do not produce solutions to improve walking conditions and fail to eliminate some of the problems such as the lack of facilities which are reasons for pedestrians putting themselves at risk. As a result of the study, London is recommended to create a better balance between all road users by: •
Continuing with the congestion charge;
•
Reducing through traffic;
•
Creating new patterns for goods deliveries;
•
Encouraging public transport and walking;
•
Improving conditions for walking;
•
Creating pedestrian streets and pedestrian priority streets where many people already walk; and
•
Reducing the amount of parking spaces within the city.
Reduction in motor vehicle traffic was perceived as important because if there is too much traffic, the environment deteriorates, the space for pedestrians becomes limited, more accidents happen and results in increased fears for pedestrians.
ADDRESSING PEDESTRIAN NEEDS IN AUSTRALIA Melbourne In 1994, a study of public spaces and public life in the City of Melbourne, conducted by the internationally renowned urban architect, Jan Gehl, and his team identified the city as an unpleasant environment for people. The City of Melbourne was criticised for having an empty and useless city centre. People would go to the city centre during the business hours. However the city centre was a deserted place after hours. There had been a downward trend in CBD commercial activity and employment prior to 1994.
122
Jan Gehl’s study offered the City of Melbourne information on the types of activity that occurred in the city’s public places and set targets for attracting more pedestrians to the city. In 1994, the recommendations for the City of Melbourne were to improve the pedestrian network and encourage pedestrian activity. The strategies to improve the pedestrian network include: •
Develop better links between to the city centre;
•
Introduce wider footpaths;
•
Relieve overcrowding on the footpaths of smaller streets and attract more activity to the wider streets; and
•
Offer good quality pedestrian access and high amenity.
The strategies to encourage pedestrian activity include: •
Make the public spaces attractive;
•
Increase the city’s ornamental and feature lighting;
•
Ensure that valuable historic environments are retained, restored, respected and interpreted;
•
Provide easy, safe access for people with disabilities;
•
Increase the number and seating capacity of outdoor cafes to promote street activity;
•
Discourage through traffic;
•
Widen footpaths and convert centre-of-road parking into safer, more attractive medians;
•
Develop a lively city at night; and
•
Increase the number of festivals, events and street markets.
Since the study was conducted in 1994, the City of Melbourne has implemented many changes to address the problems. In 2004, Jan Gehl and his team conducted a follow up study and identified the following successes achieved by the City of Melbourne: •
A larger residential community - 830% increase in the number of residents in the City of Melbourne.
•
Improved streets for public life - the number of pedestrian priority public space has increased, the laneways are more attractive and accessible, and the footpaths have been widened.
•
New squares, promenades and parks - there was 71% more space for people and activities on streets and squares in 2004, compared to 1994.
•
A revitalised network of lanes and arcades - accessible and active lanes, arcades and alleys increased from 300 metres to 3.4 kilometres.
123
•
More places to sit and pause - 117% increase in the number of outdoor seats since 1993.
•
A 24-hour city with more attractions and places to go - new major attractions, such as the Melbourne Exhibition Centre, the Crown Casino, the Melbourne Museum, and the Melbourne Aquarium. Evening and weekend activities and attractions have also increased, creating a livelier and safer city, day and night.
•
Better cycle and public transport access - on-road cycle lanes have been established on many roads entering the CBD with a network of high quality off-road dedicated cycle paths along rivers, bay and rail corridors. Tram travel and safety improved by the establishment of tram ‘superstops’ at key destinations and interchange points. There are plans to improve streets adjacent to railway stations in order to better cope with the high pedestrian activity around those areas.
The study conducted in 2004 suggests that although the City of Melbourne has achieved remarkable success since 1994, it can also do more to: •
Expand and improve the pedestrian network;
•
Improve the cycle network;
•
Develop better links to public transport;
•
Reduce traffic volumes;
•
Upgrade streets adjacent to major transport and retail corridors;
•
Improve linkages to outer city areas; and
•
Extend city improvements to adjacent neighbourhoods.
Sydney The City of Sydney has identified pedestrian needs as a key to improving the City and is a prime element of Sustainable Sydney 2030. Walking is a sustainable form of transport that is good for the environment and also has significant health benefits in addressing obesity, cardiovascular and other noncommunicative diseases which are becoming more prevalent in modern society. The ease and comfort that pedestrians are able to move about the City of Sydney is a major issue for the City to address especially for people with disabilities. Gehl Architects from Denmark have been engaged to recommend measures to transform the City’s public spaces. This involves undertaking extensive public space and public life analysis to form a qualitative and quantitative view of how people use public areas. Data has been collected on people and activities taking place and the characteristics including weather conditions and the quality of the public space together with physical features, seating, lighting, pavement and signage.
124
This work will provide the basis to identify solutions for specific public spaces and associated implementation programs and also guide and inform the City as it improves the pedestrian network. Gehl Architects have developed the following 12 quality criteria in the design of public places: •
Road safety – pedestrian facilities etc;
•
Safe from crime – passive surveillance;
•
Climate protection – trees, awnings etc;
•
Space for walking – footway width, uncluttered etc;
•
Stopping opportunities;
•
Seating opportunities;
•
Lighting and opportunities for views and vistas;
•
Noise free environment to allow talking etc;
•
Inviting people activity and play;
•
Scale – human dimensions;
•
Use positive aspects of climate (shade in summer and solar access in winter), and
•
Architecturally well designed.
The City is currently awaiting the initial findings of Jan Gehl’s study.
ROAD SAFETY AND SUSTAINABLE SYDNEY 2030 Long term strategic planning is necessary to develop a safety culture approach to life. Training young children to become safety conscious adults is considered one way to develop this culture. By teaching children adults also learn. As safety conscious adults in 2030, parents and others will then be well placed to pass on this mindset to the young people of that time. To successfully develop this safety culture, the City of Sydney will target two key community groups – the residents and the working community, which makes up 600,000 people in the City every day. Sustainable Sydney 2030 is a commitment to Sydney’s future, ensuring the next generation inherits a city that is liveable, workable, attractive and sustainable. The City can provide information to help educate parents and children in road safety and promote the use of safer and more sustainable transport modes. The community can be engaged through community groups, child care centres, schools and other Council facilities such as libraries.
125
The City also aims to promote road safety through major city businesses. Many City businesses employ several thousand employees and have well developed employee care programs such as child care facilities and professional development programs. By law they all have Occupational Health and Safety programs. Linking road safety into these programs and working more with City businesses there is potential for road safety programs to be accessed by up to a quarter of a million people who work in the City. CASE STUDY: An example of a CBD business working with the City is Westpac Bank on Kent Street, Sydney. A new building was constructed on Kent Street in 2005 to accommodate 5,000 employees. Access to the new building is from a mid-block entrance between Erskine Street and Napoleon Street. Many employees travel to work via Wynyard Station and use a narrow underground footway from the station to Kent Street where the footway opens on to Kent Street across a fourlane road opposite the Westpac entrance. The pedestrian desire line created an unsafe high risk crossing situation. The City of Sydney worked with Westpac and the Roads and Traffic Authority to install a signalised crossing at this location. In the process the City and Westpac developed a very good working rapport. A large organisation such as this has child care facilities and many staff have children learning to drive. By liaising with the City’s road safety officers Westpac can include road safety as part of their employee care commitment.
Action plans and programs From 2007 the City’s road safety action plans and projects are being developed with longterm sustainability as the guiding factor. Road Safety Officers provide input on urban planning and development of transport issues. Cities around the world have identified that controls on motor vehicle usage are essential strategies to make their city pedestrian and bicycle friendly and safe. To improve safety for both pedestrians and cyclists, the City of Sydney will continue to lobby for lower speed limits as the City develops its pedestrian and cycling plans. The City of Sydney has requested a reduced 40 km/h speed limit for the Sydney CBD. The City will also propose to increase the number of Shared Zones, with a 10 km/h speed limit, particularly in the laneways that link main street and access buildings around the city. Many of these laneways can be developed into effective pedestrian areas providing improved pedestrian safety and amenity. In addition there are inner-city roads currently signed as 60 km/h that would benefit from a reduction to a 50 km/h urban speed limit. Outside of the Sydney CBD there are many areas that will benefit from reduced traffic impact. To achieve this the City of Sydney is implementing an extensive program of Local Area Traffic Management schemes throughout the Local Government Area. These schemes
126
will make residential areas much better in terms of pedestrian and cycling amenity and help to improve public transport access. Child road safety will become increasingly important as the census data shows more children are being born in the City. The City of Sydney accommodates around 36 schools of which 25 cover the ages 5-12 (Kindergarten to year 6). While the in-school road safety curriculum is not within the scope of work for the City’s Road Safety Officers, the City is working with agencies such as the NSW Department of Education and Training to influence the way children travel to school. These programs also include working with the Sydney South West Area Health Service and TravelSmart. This generally involves encouraging parents and children to use of public transport and to walk. Over a longer term, the objective is to get parents to make adjustments to their travel arrangements for the benefit of their children in terms of health and safety. This in turn will lead to an improvement in the parents’ health and safety. There is also likely to be cost saving benefits as we encourage people to reduce their reliance on using motor vehicles where alternatives are available. The census data shows that the largest group representing children is that of 15 to 19 year olds. This translates into a continuing demand for young driver education. Whilst the City will continue to work towards reducing the level of car ownership there will still be a demand from young people to want to drive motor cars. The City has programs in place that assists young drivers to get through the Graduated Licensing Scheme where their personal situation does not give them access to a suitable car. The key objective of these programs is to help young people, especially from the Aboriginal community, to be better equipped to access employment. The road safety outcome is the development of safer drivers who in turn can influence other young drivers.
Prioritising road users A clearly defined hierarchy of road user priorities is an essential tool in transport planning. If road users are prioritised by the type or mode then the environment can be enhanced to cater for those with the greater needs. In an inner-city and CBD environment, pedestrians should be given the highest priority, followed by cyclists and public transport. This will have potential road safety benefits, especially for children. Urban design and transport demand management strategies are key focus areas that underpin the Sustainable Sydney 2030 strategy. Road Safety Officers working with the strategic planning team ensure road safety is considered from the strategy and design stage to develop a safer city. The City of Sydney is a signatory to the WALK 21 International Charter for Walking (WALK21, July2006) and will work to provide an improved pedestrian environment through better designed and managed spaces and places for people. More open spaces and better pedestrian amenity will give people a better sense of ownership of inner-city areas. People
127
will be encouraged to walk or cycle as a first choice to travel around the City as it becomes more accessible and safe. It is anticipated that the initial work of Jan Gehl in Central Sydney will lead to Sydney being a place that is desirable for people to live, work and visit as a matter of choice because it offers places that are comfortable, safe and enjoyable. Sustainable Sydney 2030 will expand this to the growing areas of the City, such as Green Square and other developments that encourage more residents and places to work and visit. This work will help to transform Sydney into an accessible world class city similar to Paris, London or New York.
CONCLUSION Reducing the demand for non-essential motor vehicles, promoting the use of sustainable transport and improving the quality and safety of public spaces throughout the City of Sydney will provide great improvements for pedestrian safety. This will be further enhanced by long term road safety education and promotion programs aimed at all sectors but with emphasis on the people who have made a choice to live in the City. They will represent the families that will grow up within a culture of safe living and safe travel. The working community will be aware of the changes that will take place, with community consultation involving businesses and workers. Many businesses are aware that an improved environment is desirable for them as it makes the working life of all staff more comfortable and this will enhance productivity and make it enjoyable to work and live in the City. The City is awaiting the report from Jan Gehl’s Public Spaces and Public Life study which will guide the City towards the Sustainable Sydney 2030 vision and act as a catalyst for improvement in pedestrian amenity and safety. This report will also help inform the Pedestrian Strategy and Action Plan and influence the City’s Road Safety Strategy, Cycle Strategy and Integrated Transport Strategy. Sustainable Sydney 2030 provides a unique opportunity for the City of Sydney to view road safety holistically, by integrating road safety planning, education and promotion with strategic planning. The outcome will be a city safer for children (and therefore everyone else) by 2030, where there is a general safety culture amongst all residents, workers and visitors. Road safety will be well-integrated into the City’s overall policies and plans, leading to safer people and a safer environment.
SUGGESTED READINGS WALK21 (2006). International Charter for Walking. Gehl Architects (2004). Towards a fine City for People – Public Spaces and Public Life – London 2004.
128
Gehl Architects (1996). Public Spaces Public Life – Copenhagen 2004. City of Melbourne in collaboration with Gehl Architects (2004) Places for People – Melbourne 2004.
129
130
Road safety and injury prevention programs in the high school curriculum: Key considerations with examples from the SPIY Program Lisa Buckley & Mary Sheehan Centre for Accident Research & Road Safety – Queensland (CARRS-Q), Queensland University of Technology Many adolescents partake in transport-related risk-taking that leads to injury. A curriculum based program that decreased adolescent risk-taking behaviours might enable a reduction in the burden of injury. The development of such a program requires careful consideration of a number of factors to ensure a higher likelihood of program effectiveness. The aim of this paper is to identify many of the factors that have been previously demonstrated in the research literature to underlie effective programs. This literature tends to be primarily based on alcohol and drug prevention goals. Key concepts in the design of such programs along with examples from the design of the Skills for Preventing Injury in Youth (SPIY) program are presented. Specifically the concepts include; the selection of target behaviours and participants for change, processes and content which are socio-culturally and developmentally appropriate, approaches facilitated by teachers and developed using established theories as well as consideration of program duration and evaluation. The transportrelated risk-taking behaviours that give rise to adolescent injury are potentially amenable to intervention. An understanding of how high schools might be involved in such interventions provides valuable information regarding the prevention and harm minimisation of injury. Conclusions of this paper will be drawn with regard to methods and processes for behaviour change and the challenges faced in implementing such strategies with the SPIY program. Future research and policy implications will also be discussed.
Introduction This paper aims to highlight information and processes necessary for the design of a high school curriculum program to improve adolescent road safety. Key components of program design are identified with an example of how such components were applied to the recently developed Skills for Preventing Injury in Youth (SPIY) program. The key components of effective programs were identified from reviewing effective curriculum-based programs, particularly in the drug and alcohol field. The key issues that are explored in this paper include; whether programs can target multiple risk-taking behaviour, be universally implemented among school-based adolescents and be informed
131
by theory. Also included is a discussion regarding the use of interactive methods compared with non-interactive communication methods, the ‘dose’ or intensity of the program, the facilitator and evaluation considerations. Firstly, however a brief overview of the program is presented.
Brief Overview of the SPIY Program The SPIY program was designed with the assistance of St John Ambulance and through collaborations with researchers from the Centre for Accident Research and Road Safety Queensland. The intervention program was implemented in the high school curriculum of Health classes in a sample of South-East Queensland state education schools. It aimed to develop skills in injury prevention and control (including those regarding transport-related injuries) and it combined first aid training with cognitive behavioural prevention strategies. The program targeted change in reducing adolescent risk-taking behaviour and encouraged adolescents to protect their friends from engaging in risk-taking behaviour. The SPIY program was primarily a set of classroom activities structured to be delivered over eight weeks of 50 minute lessons. Typically each lesson included the presentation of a risktaking and injury scenario, an introduction to the management of first aid for the resulting injury and a cognitive behavioural strategy for preventing the risk-taking behaviour including through protecting friends. The first aid material was included to provide a context for the severity of injury consequences and the serious nature of risk-taking behaviour. Additional processes such as teacher training, teacher’s manual and a student workbook were designed to support the effective delivery of activities in the curriculum. The program design however required a number of careful considerations and these are discussed in the following sections.
Selecting the Target Behaviour for Change Some program researchers have suggested that it could be more economical and more effective to target change in more than one risk-taking behaviour within a single program (Aspler, Formica, Fraster, & McMahan, 2006; Dryfoos, 1991; Nigg, Allegrante, & Ory, 2002). They raise the question, “Is it valuable to work on multiple behaviours simultaneously or should one behavior be addressed at a time?” (Nigg et al., 2002, p672). This approach stresses the similarities in risk-taking behaviours in attempts to change or modify injury outcomes. Realistically the authors raise the issue that schools, “are less interested in having to adopt a separate health promotion program for every separate target behavior or risk factor” (Nigg et al., 2002, p. 676). The multiple risk-taking behaviours selected as targets for change of the SPIY program design went beyond a single road safety issue and included drink driving, riding with a drink driver, riding with a dangerous driver, unlawful use of a motor vehicle, motorbike use, risky bicycle use, interpersonal violence and risky behaviour around water. Aspler et al. (2006) suggested that two conditions are necessary for a multi-target behaviour change program; that is, commonality in the target predictor for change and evidence of clustering
132
of the target behaviour. The SPIY program was developed from extensive preliminary research that is not reviewed here (however see, Sheehan et al., 1996; Western, Lynch, & Ogilvie, 2003).
Selecting the Target Participants: School-based Adolescents There are a number of programs which target change among significant peripheral groups while ultimately hoping to change the risk-taking behaviour of adolescents. Such programs are attempting indirect behaviour change. For example, Perry and colleagues targeted parental change, community wide change in addition to curriculum components for the adolescents in her extensive Project Northland (Perry et al., 2002). In the evaluation there were differences in the effectiveness of the various components with the community components being less effective when compared with the parent component and the curriculum component on self-reported measures of alcohol use (Stigler, Perry, Komro, Cudeck, & Williams, 2006). However, most commonly the adolescents themselves are the direct targets for change. The vast majority of 14 year olds (the target age of SPIY participants) attend school on a regular basis and thus targeting adolescents in that environment represents an efficient and practical way to reach a large number of adolescents in one attempt (Samples & Aber, 1998). The approach also avoids some of the difficulties associated with identifying a location, ensuring attendance, and facilitating transport (Guerra, Tolan, & Hammond, 1994). There are multiple meta-analyses and reviews which indicate that curriculum can provide an effective mechanism for behaviour change among adolescents (Fields & McNamara, 2003; Tobler et al., 2000; Tobler & Stratton, 1997). The SPIY program aimed to target change with regard to reducing school-based adolescents own risk-taking behaviour as well as increasing their protective behaviour toward friends.
Socio-culturally Relevant Material There is a requirement for behaviour change programs to be based on the needs of the target group. Adolescents need to feel that a program is relevant for them and, in order to engage students’ interest, the program must be meaningful and developmentally appropriate (Buckley & Sheehan, 2004). It is important that ethnically and culturally appropriate language and materials are considered particularly in applying strategies cross-culturally for example, U.S. based programs and ideas to Australia. According to Nation et al. (2003), the relevance of a program to participants appears to be a primary concern to producing positive outcomes in programs. They suggest that the concept of relevance includes understanding local norms and cultural practices and that culturally relevant refers to both the surface structure of language and the deep structure of sensitive cultural factors influencing development and receptiveness to intervention material and processes. Tobler and Stratton (1997) in their review of drug education programs suggested that some programs failed to produce an effect of reduced alcohol use because student interest was not obtained. In these cases activities were not considered
133
developmentally appropriate or the activities were abstract and not meaningful. Further, many of the effective programs refer to early developmental research or represent developmentally appropriate work. There is a critical formative phase of research that should occur prior to the implementation of a program to facilitate the inclusion of relevant material (McBride, 2003; Perry, 1999). This research might involve focus groups or interviews with target groups (for example, school staff, students or parents) so that the content and activities can be effectively tailored to the adolescents who experience the program and thus increase the likelihood that material is developmentally appropriate and meaningful (Coatsworth, Szapocznik, Kurtines, & Santisban, 1997; McCord & Tremblay, 1992). Activities in the SPIY program were written to focus on risk-taking behaviours and situations that were identified as relevant to the target group. Further, the program material was written in a language consistent with that expressed by adolescents. This information was obtained from focus groups and interviews with local high school teachers (including those in the target schools), curriculum and policy experts, school administrators as well as students in the target schools but in a previous cohort, high risk adolescents and older (Year 12) students of the target schools. The information from young people was directly applied to program content through the use of scenarios. The scenarios were designed to provide the opportunity for the practical application of skills to situations that were relevant and meaningful. Part of the strategy of the SPIY program was to provide situations and characters within the scenarios that were as relevant to the target audience as possible without requiring participants of the program to divulge their own potentially illegal behaviour in class. As such, the scenarios were based on the findings of the focus groups or from other real case material for less common injuries such as head, neck and spinal injuries. The characters were based on an amalgamation of the traits of adolescents who have influenced the content of the narratives as well as a combination of events and outcomes. Perry (1999) suggested that the greater the detail and user-friendly the presentation the easier it will be to implement the program. The information in the SPIY program also reflected process issues pertinent to adolescents, for example keeping independent activities short and purposeful as well as being limited in dependence on the written word to help maintain and focus attention. The focus group discussions among adolescents thus aided in understanding how concepts might be operationalised in terms of the content of material and processes of implementation.
Recognising Change through Adolescent Development Adolescence is a unique developmental period and corresponds with great change in skills and experiences. Several reviewers have indicated that program material needs to be appropriately tailored to the skill levels of the adolescent with regard to their intellectual, cognitive and social development (Steinberg, 2004). For example, during adolescence the relationship with friends changes whereby there is increasing importance during the
134
developmental period of friends affecting behaviour (Armsden & Greenberg, 1987). Such social development and cognitive representation of peers was carefully considered in the design of the SPIY program particularly with regard to the aim of increasing protective behaviour toward friends. The less common approach of aiming to employ adolescents as a protective factor was based on research such as that by Prinstein and his colleagues’ (2001) which found friends’ prosocial behaviour was negatively associated with adolescent risk-taking behaviour. Further, research by Smart and Stoduto (1997) found that adolescents report that they protect their friends. About one-third of their adolescent sample reported they intervened to prevent their peers’ drug use.
Universal, Selective and Targeted Programs A related concern with regard to selecting target individuals is whether to implement a program to all adolescents in a given population, to those adolescents with a characteristic that puts them at an elevated likelihood of engaging in risk-taking behaviour or to the adolescents that at an individual level have an identified risk. This approach can be understood in terms of universal, selective and indicated approaches to program design. Universal prevention strategies address an entire population regardless of the level of risk or current risk-taking behaviour. The aim of such an approach is to reach a large number of individuals at once and develop adolescents’ skills and strategies so that they have sufficient competence to prevent or reduce engagement in risk-taking behaviour (Leshner, 1997). This approach is typically taken with curriculum-based programs. Another important consideration is the level of engagement in risk-taking behaviour of the target individuals, that is, with regard to program design, "Should the program target the prevention of a behaviour not yet performed or should the target be the secondary prevention of an established behaviour?" Whilst there might be face validity in targeting individuals at a similar stage of change it is probably only rarely that this will be possible in universal prevention programs such as those conducted through curriculum in schools (Buckley & Sheehan, 2004; Perry, 1999). Most injury prevention and control programs will probably have to be targeted to a group that will include adolescents at different stages of involvement in risk-taking behaviour. For example, some adolescents of the same age might never have consumed alcohol, others might have experimented, whilst others may drink more regularly. Hence a program designed to prevent injury associated with drink driving through school curriculum will be attempting to change the behaviour of participants at potentially different stages of the change process (Buckley & Sheehan, 2004; Longabaugh et al., 2001). As such it is possible that the efficacy of programs may be analysed by separately examining the program’s impact on recipients at different stages and then comparing the impact of the program on high risk and low risk adolescents. Further a related concern was highlighted in the multiple evaluations undertaken by Botvin et al. (2004) following the implementation of their school-based intervention. They found that attrition rates were significantly higher for participants already engaged in alcohol use at baseline.
135
The overall involvement of adolescents in risk-taking behaviour can be understood from local prevalence data which can help draw attention to the stage of involvement in risktaking behaviour of target adolescents (McBride, 2003). McBride (2003) suggests that the most effective strategy in identifying an appropriate intervention point is to understand the rates of risk-taking behaviour in the local region. The developmental research for the SPIY program found that in targeting adolescents that were younger than driver licensing age there was still a number who had engaged in the risk-taking behaviour. Students in Year 9 were chosen as they represented an appropriate target age group for the aims of the SPIY program. This age target was established after discussions with teachers and extensive review of prevalence literature which identified this as an age at which adolescents were beginning to have some experience with the target risk-taking behaviours yet they were typically not established behaviours. The Year 9 Health curriculum also provided appropriate links for the aims of the program. There are several authors who suggest that linking with existing curriculum and minimising disruption to the established school program will enhance the likelihood of fidelity by teachers to the program (Fagan & Mihalic, 2003; Farrell, Meyer, & White, 2001). The SPIY program was designed to integrate into the school curriculum. The Health and Physical Education (HPE) curriculum in Queensland provided a natural link given one of the messages of learning within the HPE curriculum includes, "investigative and learner-centred strategies (that) are most effective in enabling learners to make informed choices and to take actions that support their own and others’ health and wellbeing." (p 10, Queensland School Curriculum Council, 1999). Thus students are encouraged in this curriculum to engage in behaviours that protect themselves and others from injury.
The Importance of a Theory-driven Program “A theory is a system of assumptions and rules to describe, predict and explain the nature of specified phenomena” (Nigg & Jordon, 2005, pg 292). A theory or conceptual framework is needed to describe and outline both the content and process of an intervention design. The decision regarding the content of the program requires the selection of a framework that previously has been shown to predict, with consistency and strength, the target behaviour (or behaviours). Nigg et al (2002) argues that behaviour change theories do more than just explain behaviour but explain the why and how of change, therefore the theory must not only outline the relevant constructs to manipulate and test, it must also bring these constructs to a logically derived posited outcome. The presence of logic, internal consistency and plausibility as enhanced by the use of a theoretical design may increase the likelihood of compliance with the implementation by the school and program facilitator. According to Fagan and Malic (2003) program implementers (such as teachers) who see an intervention as logical are more likely to adhere to instructions and follow program directions. The theoretical basis to design thus has clear implications for implementation success of the program. The SPIY program drew on the Theory of Planned Behavior (TPB, Ajzen, 1985) to conceptualise and evaluate change in risk-taking behaviour and protective behaviour.
136
Although research is lacking with regard to the TPB and friends’ protective behaviour, there is evidence of the TPB adequately explaining risk-taking behaviour (Crane-Ross, Tisak, & Tisak, 1998; Epstein, Botvin, & Spoth, 2003; Norman, Bennett, & Lewis, 1998; Unger, 2001). The selection of an evidence-based theoretical paradigm or framework to inform the presentation strategies is also required. This framework is to direct the delivery of the program, that is, provide a guiding framework to answer ‘how’ to implement the chosen content. There is very little research that is concerned with comparing different theoretical approaches to process design while keeping the content constant (Buckley & Sheehan, 2004). However, many of the well-evaluated behaviour change programs (Botvin, Baker, Dusenbury, Tortu, & Botvin, 1990; Perry et al., 1996; Sheehan et al., 1996) generally have used psychological principles of social learning and cognitive behavioural presentation strategies. The SPIY program process used cognitive behavioural strategies which posit that behaviour is learnt through modelling, imitation and reinforcement and uses techniques such as instruction and demonstration, behavioural rehearsal, supportive feedback, social reinforcement and extended practice as part of the process of the intervention to implement the chosen content. The SPIY program used a number of cognitive behavioural strategies that aimed to produce change in the TPB constructs. Fishbein and Ajzen (2005) suggest that some cognitive behavioural techniques may be suitable for a program in which the content is designed using the TPB. In particular, they suggest that a reasoned discussion of negative beliefs of the targeted behaviour could be incorporated into changing the TPB constructs to produce change. One of the advantages of the cognitive behavioural approach is the flexibility of available strategies to affect change. A wide variety of techniques can be used to affect change in cognitions and behaviour and a selection can implemented in any one intervention program. Thus depending on the context of the intervention and the target of behavioural change different strategies may be applied. It is up to the program designers to select methods which fit best with the target context and environment of the proposed intervention.
Program Strategies: The Importance of Interactive Participation Several meta-analyses of substance programs reached a conclusion that interactive programs are more effective than information only or affect-targeted programs (see Cuijpers, 2002; Tobler & Stratton, 1997). For example, using Socratic methods that have a high degree of student interaction and include greater skills training (Sussman, Rohrbach, Patel, & Holiday, 2003). Such methods typically require the active involvement of participants rather than information presented didactically in lecture format (Tobler & Stratton, 1997). Effective programs thus may require training for example in practising alternative less-harmful behaviours, assertiveness and role playing new skills. The effective programs provided active hands on experience and increased skills for participants when they are tailored clearly and explicitly to program goals (Durlak & Wells, 1997). The meta-analysis by Tobler and Stratton (1997) identified interactive programs to be at least twice, and up to four times, more effective than non-interactive programs. McBride (2003) suggested that the exchange of
137
ideas and experiences provides a critical catalyst for change in that there is an opportunity to practice new skills and obtain feedback on the skills that are practiced. As an example of an interactive process from the SPIY program, in one lesson a role play exercise was included whereby students were to create alternative endings (or beginnings) to the scenario whereby there would be less chance of injury. That is, students were to find any place in the original script that would provide an alternative ending of less harm. A discussion was to follow whereby the realism of the alternative endings was evaluated as a group. The discussion and acting included consideration of the role of the friendship group present in the scenario. Students examined factors that influence the likelihood of risktaking behaviour and considered an alternative behaviour that they feel has a lower likelihood of risk for injury and were thus to consider behavioural strategies to prevent injury. This lesson sought to draw students’ attention to the few barriers to, and potential ease with which students could perform preventive and low risk behaviours. The target theoretical construct focused on the presence of factors that support or obstruct the ability to perform the behaviour. Rehearsal and demonstration of the ability to prevent risk-taking can be part of an effective way to reduce risk-taking behaviour (Ellickson, 1993) and helps strengthen adolescent’s belief that they can perform alternative lower risk behaviour.
Facilitator There are number of different options in the choice of a program facilitator that have a demonstrated effect on reducing risk-taking behaviour, for example peers, college students, general classroom teachers, health education specialist teachers, mental health professionals, researchers, and law enforcement officers. Whilst few programs generally do not test the effect of different deliverers there are some exceptions such as Botvin (2000). Further, Cuijpers (2002) compared the overall effect of programs delivered by different individuals through a meta-analysis. She found that peer-led programs (typically same age or a few years older) to be somewhat more effective than adult-led programs (such as those delivered by teachers, mental health workers, researchers). According to the author, there were large differences between the effectiveness studies, with some indicating greater effects for the adult-led programs and others for the peer-led programs. In terms of face validity, it would appear that the programs which are delivered by individuals perceived as peers might have high relevance because of their clear direct association with the social and normative aspects of the target behaviour for change. Some recent meta-analysis of school based prevention programs show support for the effectiveness of peer-led programs (for example, Cuijpers, 2002). However Tobler et al (2000) concluded that peer-led programs were no more effective than programs delivered by teachers or mental health workers. The review did contain a very broad definition and included the opportunity for peer interaction among class members as part of the definition of peer-led. The authors suggested that it was the peer interaction that was the important variable in effectiveness not merely the presence or absence of a peer leader. Further peer-
138
led programs are often require greater intensity in training as peers don’t always have skills in behaviour management that teachers, for example, already have. Training is a necessary component of effective curriculum program (Monahan, 1995). Ennet et al. (2003) found that around two-thirds of the substance use programs in their review used effective content but only about one-sixth used demonstrated effective delivery methods. Those teacher-leaders with most recent professional training and who felt comfortable with interactive methods, were most likely to use effective delivery methods compared with those with a larger time gap between professional training and less comfort with facilitating interactive methods. Thus this research suggests that a skilled teacher with adequate training is needed. According to Nation et al. (2003) the effectiveness of a program can be enhanced when facilitators are sensitive, competent and have received sufficient training in both the program content and process. However, even with sufficient training, effectiveness can be compromised by staff turnover (Fagan & Mihalic, 2003; US Department of Justice, 1995), and by school climate and principal support (Fagan & Mihalic, 2003) amongst other factors. Gingiss et al. (2006) highlighted methods of training to increase teachers’ adherence including technical assistance and coaching. Strategies recommended to foster teacher commitment should include: checklists and guidelines (Wandersman et al., 1998), recruitment and training of staff champions (Roberts-Grey, Solomon, Gottlieb, & Kelsey, 1998), templates for assessing modification, incentives, on-site coaching (Gingiss et al., 2006) workshops for implementers (Kam, Greenberg, & Walls, 2003), and fully documented manuals (Mowbray, Holter, Teague, & Bybee, 2003). Training is required to impart knowledge, skills and desire (Fagan & Mihalic, 2003; Perry, 1999). Thus beyond transference of knowledge of operations and delivery, training can help foster commitment to the program and generate enthusiasm. Trained teachers compared with untrained teachers were more likely to fully implement a program and implement a program with greater fidelity (McCormick, Steckler, & McLeroy, 1995) and this appears to correspond with improved outcomes for students (Ross, Luepker, Nelson, Saavedra, & Hubbard, 1991; Taggart, Bush, Zuckerman, & Theiss, 1990). The SPIY program included a teacher training program on the delivery of strategies and activities. This training program was developed in conjunction to the teacher’s manual. All Year 9 Health classroom teachers attended a one-day workshop to discuss the rationale and the implementation of the content and strategies. Perry’s (1999) suggestion that stipends for training are needed to cover substitutes or locums and that training should not be held after hours or on weekends were followed. The goal of the teacher training in the SPIY program was to ensure quality of program delivery and increase standardisation of delivery. Teacher training included the presentation of information on the content and the encouragement of skill development such as facilitating group discussions and role-plays. Perry (1999) suggests that the training itself should be designed to be interesting, active as well as informative and skills building. Teachers who facilitated the SPIY program were made aware of the aims of the research program and of the intervention and a clear rationale was presented regarding each individual activity and overall aims. Although the SPIY program is manual-based and
139
provides a detailed script of activities, teachers were encouraged to deliver material to meet the immediate needs of the individual adolescents in their classroom in order promote discussion. The training thus was essential to encourage consistency in activities, aims, and strategies. In addition to the teacher training and teacher’s manual, there was additional supportive material in the SPIY program including a student workbook. The students were each provided with a workbook that was used during each of the lessons except lesson 1. The workbooks were divided into sections for each subsequent lesson and typically contained the relevant scenario (with text and a pictorial representation). Basic information regarding first aid, activity worksheets and some space for simple pen and paper tasks were also provided. The workbooks were distributed by teachers at the beginning of the lesson and collected again at the end of the lesson to ensure that all students had their workbook for each week.
‘Dose’ Evidence for a required ‘dose’ for intervention effectiveness has not yet been established. In this case dose refers to the amount and intensity of program material, for example the number and length of sessions (Buckley & Sheehan, 2004). Programs vary widely in duration and length from a brief single hour session to multiple sessions with boosters in following years (Loveland-Cherry, 2005). Typically effective interventions include a follow-up or booster session in order to enhance the durability of impact (Buckley & Sheehan, 2004; Loveland-Cherry, 2005; Nation et al., 2003). Research from the field of drink driving interventions (Wells-Parker, Bangert-Drowns, McMillen, & Williams, 1995) suggests that programs of longer duration are not necessarily more effective however systematic programs that are spread over time [say one hour programs run weekly for ten weeks] are more likely to demonstrate behaviour change (Buckley & Sheehan, 2004). In practice it is rare that extended periods of time are available from schools and even the most formally structured research interventions are rarely delivered exactly as designed (Gottfredson, 2001). Research by Gottfredson regarding implementation indicated that only one-quarter to one-half of programs outside a research development and testing phase were implemented similarly to research programs in terms of type and number of session offered.
Efficacy and Effectiveness Research Although there is evidence from a growing body of research that interventions are effective in well-controlled settings, Glasgow et al. (2003) suggest that few of these are consistently and effectively implemented and supported in non-research based contexts. The authors suggest that the slow translation of research findings to practice is a result of different underlying logic and assumptions fundamental to efficacy and effectiveness research. Efficacy research aims to ascertain the impact of an intervention under ideal conditions, that is, asks the question, “Can the intervention work?” In contrast effectiveness research asks,
140
“Does the intervention work under routine conditions?” (Buckley & Sheehan, 2004). The strict standardisation of circumstances that is needed in efficacy research creates greater confidence that any findings are attributed to the intervention (Streiner, 2002). On the other hand, the goal of effectiveness research is to understand whether an intervention works within a broadly defined population and set of circumstances. Glasgow et al (2003) suggest that the characteristics of a successful intervention in efficacy research is fundamentally different from the characteristics of interventions in effectiveness research. They assert that characteristics such as intensity, complexity and standardisation reflect efficacy research contrasting with effectiveness research which is said to require broad appeal and adaptability. The SPIY program was primarily effectiveness research. Attempts were made to develop resources that have a greater chance of continuing to be implemented without the support of research funding. Effectiveness research should ascertain whether an intervention is successful in the ‘real world’. The drawback to effectiveness research is that an insignificant result runs the risk prematurely rejecting the program. This rejection might be under the assumption that the program could not be successful rather than for any number of reasons such as, poor selection, implementation or adherence (Streiner, 2002).
Evaluation Issues The implementation of a program as anticipated by the designers is not guaranteed and this is true even when adopting a program already established as best practice. Instead, the adoption of such programs in different settings to the original evaluations has met with a wide variety of outcomes (Fagan & Mihalic, 2003). Durlak and Wells (1997) highlighted that there are few reports on program implementation. In their review of more than 1200 published studies of adolescent behaviour change programs, only 5% reported data on program implementation. According to Dumas et al. (2001) the demonstration of fidelity to the program represents a key methodological requirement and is critical in the evaluation and understanding of the effectiveness of the research. Fidelity in the context of program design refers to the degree to which components are deliverable in a comparable manner to all participants as true to conceptual theory and the goals of the underlying research. Both the content and process elements to the program must include methods that enhance the likelihood of fidelity. It is the extent to which researchers understand fidelity to the program that enables the differentiation between implementation failure and program failure (Harachi, Abbott, Catalano, Haggerty, & Fleming, 1999). Battistich et al (1996) found stronger effects of programs (of drug use and delinquency prevention) whereby there was a high degree of implementation of the program material as designed. Rohrbach, Graham and Hansen (1993) found that high integrity to the program's design was associated with immediate positive outcomes regarding lower substance use. In this study the integrity to program design was associated with teachers who had fewer years of teaching experience, strong self-efficacy, enthusiasm, preparedness, and their principal's encouragement.
141
An outcome evaluation is necessary to understand the effectiveness of the program and beyond effectiveness evaluation it can also help in guiding decisions about future developments of the program. The choice of methods of the evaluation design, outcome measures and any moderator variables stem from the chosen theory that guided program development and the program aims (Farrell et al., 2001). Design issues such as selecting units of analysis (school versus individual), randomisation of treatment and control groups and follow-up procedures depends also on the resources available for evaluation, including school resources. Further the selection of outcome measures depends on the theoretical basis of the program, with appropriate attitudinal measures or knowledge measures reflecting the contents of the individual program. Measures of the behavioural outcomes should reflect the target goals for change including target behaviours. Measurements should include items with strong psychometric properties that reflect the age, cultural and demographic characteristics of the target population (Glanz, Rimer, & Lewis, 2002). The evaluation of the SPIY program included both an outcome evaluation and process evaluation. The process evaluation involved focus groups with students and teachers and aimed to, firstly understand adolescents' and teachers’ perspectives of the SPIY program and secondly adolescents’ and teachers’ perceptions of change in participants’ attitudes and behaviour after involvement in the SPIY program. In addition, an observer was employed to identify adherence to the material, the response of students to the material, and the way in which teachers altered the material. An outcome evaluation was also included whereby there was a comparison with an assessment at post-intervention follow-up and six months after completion of the program with baseline measures and relative to a non-intervention control group. The outcome evaluation included an assessment of change in risk-taking behaviour and injury as well as the processes that were theoretically expected to change in the program.
Conclusions The paper highlighted key components to be considered in effective program design. It is suggested that it is possible to target behaviour change toward multiple risk-taking behaviours. Further according to the research, the program goal should acknowledge that the target for change considers the target individuals, and their developmental and cultural needs. In order to understand the overall developmental stage and socio-cultural environment of the target adolescents focus groups appear an appropriate data collection method. These findings were used in the SPIY program to ascertain issues regarding culture, language and meaning of injury, risk-taking behaviour and risk and protective factors from the perspective of the target adolescents. An effectiveness trial provides an understanding of the real-world implementation of the program and can be tailored toward increasing the likelihood schools would be involved and continue to use the program without the involvement of researchers. There is evidence that teachers can be effective facilitators, that the dose of the program should include a booster session and that the program should be theory driven. There are however a number of challenges with regard to the development of high school curriculum programs that were evident through the design of the SPIY program. Primarily
142
these issues focused on the demands of making best use of finite resources and working with the many competing demands within schools. Competing demands within the school curriculum placed restrictions on the amount of material able to be included in a program. However by integrating material into existing curriculum requirements and targeting a reduction in similar risk-taking behaviours within a single program, it increases the potential for greater coverage of material. An important policy implication regarding the integration of material into the school curriculum thus indicates for education departments and schools to recognise value in the learning and skills associated with a road safety curriculum program. The high school curriculum is not the only way to promote road safety. To ensure a greater reach of the messages additional methods of delivery, beyond the curriculum might be enlisted, perhaps through targeting change at a community, parental or teacher level. Although identification and discussion of such approaches were not the aim of this paper, future research might examine how the curriculum approach can best be integrated with other delivery processes. Developing a curriculum program that is relevant to target individuals requires much preliminary research with one of the challenges in this area being the additional costs that such a process incurs. Whilst it is necessary for programs to be relevant to the target audience, the development of pertinent material highlights the great resources and time that are need to be invested in creating worthwhile road safety curriculum. Similarly investment must be made in the training of program facilitators. The research, particularly from evaluations of alcohol and drug curriculum programs, clearly indicates the need for interactive programs. The skills needed of facilitators must not be under-estimated as without their appropriate delivery the effectiveness of the program is greatly compromised and thus appropriate resources and energy allocated to training is required. Any curriculum program must be evaluated both with regard to the way in which it was implemented according to program aims regarding target outcomes and with regard to its effectiveness. Although the evaluation of the SPIY program used an observer rating as a method of data collection, future research might examine less intrusive methods of assessing fidelity. This element of process evaluation is in addition to whether the program created change in the target behaviours and the processes that were identified by theory to create the change in the target behaviours. Previous school-based behaviour change programs have had modest success. This paper looked at the core components of behaviour change programs aimed at adolescent risktaking behaviour change. In a meta-review of reviews of interventions researchers asserted that effective programs, “were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socio-culturally relevant, included outcome evaluation, and involved well trained staff”(Nation et al., 2003, p.449). Although road safety curriculum in high school settings requires some careful consideration there should still be optimism for its impact in improving road safety.
143
References Ajzen, I. (1985). From decisions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action-control: From cognition to behavior (pp. 11-39). New York: Springer. Armsden, G. C., & Greenberg, M. T. (1987). The inventory of parent and peer attachment: Individual differences and their relationship to psychological wellbeing in adolescence. Journal of Youth and Adolescence, 16, 427-454. Aspler, R., Formica, S., Fraster, B., & McMahan, R. (2006). Promoting positive adolescent development for at-risk students with a student assistance program. Journal of Primary Prevention, 27, 533-555. Battistich, V., Schaps, E., Watson, M., & Solomon, D. (1996). Prevention effects of the Child Development Project: Early findings from an ongoing multisite demonstration trial. Journal of Adolescent Research, 11, 12-35. Botvin, G. J. (2000). Preventing illict drug use in adolescents: Long-term follow-up data from a randomised control trial of a school populations. Addictive Behaviors, 25(5), 764774. Botvin, G. J., Baker, E., Dusenbury, L., Tortu, S., & Botvin, E. (1990). Preventing adolescent drug abuse through a mutlimodal cognitive-behavioral approach: Results of a threeyear study. Journal of Consulting & Clinical Psychology, 58, 437-446. Buckley, L., & Sheehan, M. (2004). Behaviour change programs. In R. McClure, M. Stevenson & S. McEvoy (Eds.), In The Scientific Basis of Injury Prevention and Control. Melbourne: IP Communications. Coatsworth, J., Szapocznik, J., Kurtines, W., & Santisban, D. (1997). Cuturally competent psychosocial interventions with antisocial problem behavior in Hispanic youth. In D. Stoff, J. Breiling & J. Maser (Eds.), Handbook of Antisocial Problem Behavior. New York: John Wiley & Sons. Crane-Ross, D., Tisak, M. S., & Tisak, T. (1998). Aggression and conventional rule violation among adolescents: Social-reasoning predictors of social behavior. Aggressive Behavior, 24, 347-365. Cuijpers, P. (2002). Peer-led and adult-led school drug prevention: A meta-analytic comparison. Journal of Drug Education, 32, 107-119. Dryfoos, J. G. (1991). Adolescents at Risk. Oxford: Oxford University Press. Dumas, J. E., Lynch, A. M., Laughlin, J. E., Phillips Smith, E., & Prinz, R. J. (2001). Promoting intervention fidelity. Conceptual issues, methods and preliminary resutls from the Early Alliance Prevention Trial. American Journal of Preventive Medicine, 20, 38-48.
144
Durlak, J. A., & Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytical review. American Journal of Community Psychology, 25, 207-214. Ennett, S. T., Ringwalt, C. L., Thorne, J., Rohrback, L. A., Vincus, A., Simons-Rudolf, A., et al. (2003). A comparison of current pracitce in school-based substance use prevention programs with meta-analysis findings. Prevention Science, 4, 1-14. Epstein, J. A., Botvin, G. J., & Spoth, F. (2003). Which psychosocial factors are related to drinking among rural adolescents? Journal of Child and Adolescent Substance Abuse, 13. Fagan, A. A., & Mihalic, S. (2003). Strategies for enhancing the adoption of school-based prevention programs: Lessons learned from the blueprints for violence prevention replications of the Life Skills Training program. Journal of Community Psychology, 31, 235-253. Farrell, A. D., Meyer, A. L., & White, K. S. (2001). Evaluation of Responding in Peaceful and Positive Ways (RIPP): A school-based prevention program for reducing violence among urban adolescents. Journal of Clinical Child Psychology, 30, 451-463. Fields, S. A., & McNamara, J. R. (2003). The prevention of child and adolescent violence: A review. Aggression and Violent Behavior, 8, 61-91. Fishbein, M., & Ajzen, I. (2005). Theory-based behavior change interventions: Comments on Hobbis and Sutton. Journal of Health Psychology, 10, 27-31. Gingiss, P. M., Roberts-Grey, C., & Boerm, M. (2006). Bridge-It: A system for predicting implementation fidelity for school-based tobacco prevention programs. Prevention Science, 7, 197-207. Glanz, K., Rimer, B., & Lewis, F. (2002). Theory, research and practice: Interrelationships. San Francisco, CA: Jossey-Bass. Glasgow, R., Lichtenstein, E., & Marcus, A. (2003). Why don't we see more translation of health promotion research to practice? American Journal of Public Health, 93, 12611268. Gottfredson, D. C. (2001). Schools and delinquency. Cambridge: Cambridge University Press. Guerra, N. G., Tolan, P. H., & Hammond, W. R. (1994). Prevention and treatment of adolescent violence. In L. D. Eron, J. H. Gentry & P. Schelegel (Eds.), Reason to hope: A psychosocial perspective on violence and youth. Washington: American Psychological Association.
145
Harachi, T. W., Abbott, R. D., Catalano, R. F., Haggerty, K. P., & Fleming, C. B. (1999). Opening the black box: Evaluation measures to assess implemention and theory building. American Journal of Community Psychology, 27, 711-732. Kam, C., Greenberg, M., & Walls, C. (2003). Examining the role of implementation quality in school-based prevention using the PATHS curriculum. Prevention Science, 4, 55-63. Leshner, A. I. (1997). Research meets the challenge of preventing drug use among young people. NIDA Notes. Director's Column, 12. Retrieved 8 May 2007, from www.drugabuse.gov/NIDA_Notes/NNVol12N3?DirrepVol12N3.html Longabaugh, R., Woolard, R. F., Nirenberg, T. D., Minugh, A. P., Becker, B., Clifford, P. R., et al. (2001). Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Journal of Studies on Alcohol, 62, 806-816. Loveland-Cherry, C. J. (2005). Chapter 5. Alcohol, children, and adolescents. Annual Review of Nursing, 23, 135-179. McBride, N. (2003). A systematic review of school drug education. Health Education Research, 18, 729-742. McCord, J., & Tremblay, R. E. (1992). Preventing antisocial behavior: Interventions from birth through adolescence. New York: Guilford. McCormick, L., Steckler, A., & McLeroy, K. (1995). Diffusion of innovation in schools: A study of adoption nd implementation of school-based tobacco prevnetion curricula. American Journal of Health Promotion, 9, 210-219. Monahan, J. (1995). Thinking positively: Using positive affect when designing health messages. In E. Mailbach & R. Parrott (Eds.), Designing Health Messages. Thousand Oaks, CA: Sage. Mowbray, C., Holter, C., Teague, G., & Bybee, D. (2003). Fidelity criteria: Development, measurement, and validation. American Journal of Evaluation, 24, 315-340. Nation, M., Crusto, C., Wandersman, A., Kumpfer, K., Seabolt, D., Morrissey-Kane, E., et al. (2003). What works in prevention: Principles of effective prevention programs. American Psychologist, 58, 449-456. Nigg, C., Allegrante, J., & Ory, M. (2002). Theory-comparison and multiple-behavior research: Common themes advancing health behavior research. Health Education Research, 17, 670-679. Nigg, C. R., & Jordon, P. J. (2005). Commentary: It's a difference of opinion that makes a horserace... Health Education Research, 20, 291-293.
146
Norman, P., Bennett, P., & Lewis, H. (1998). Understanding binge drinking among young people: An application of the Theory of Planned Behaviour. Health Education Research, 13, 163-169. Perry, C. L. (1999). Creating health behavior change: How to develop community-wide programs for youth. Thousand Oaks, CA: Sage. Perry, C. L., Williams, C. L., Komro, K. A., Veblen-Mortenson, S., Stigler, M. H., Munson, K. A., et al. (2002). Project Northland: Long-term outcomes of community action to reduce adolescent alcohol use. Health Education Research, 17, 117-132. Perry, C. L., Williams, C. L., Veblen-Mortenson, S., Toomey, T. L., Komro, K. A., Anstine, P. S., et al. (1996). Project Northland: Outcomes of a community wide alcohl use preveniton program during early adolescence. Prinstein, M. J., Boergers, J., & Spirito, A. (2001). Adolescents' and their friends' health-risk behavior: Factors that alter or add to peer influence. Journal of Pediatric Psychology, 26, 287-298. Queensland School Curriculum Council. (1999). Health and Physical Education: Years 1 to 10 Syllabus. Brisbane, Australia: Queensland Government. Roberts-Grey, C., Solomon, T., Gottlieb, A., & Kelsey, E. (1998). Evaluation of Heart Partners: A strategy for promoting effective diffusion of school health programs. Journal of School Health, 68, 106-110. Rohrbach, L. A., Graham, J. W., & Hansen, W. B. (1993). Diffusion of a school-based substance abuse prevention program: Predictors of program implementation. Preventive Medicine, 22, 237-260. Ross, J. G., Luepker, R. V., Nelson, G. D., Saavedra, P., & Hubbard, B. M. (1991). Teenage health teaching modules: Impact of teacher training on implementation and student outcomes. Journal of School Health, 61, 31-35. Samples, F., & Aber, L. (1998). Evaluations of school-based violence prevention programs. In D. S. Elliott, B. A. Hamberg & K. R. Williams (Eds.), Violence in American schools: A new perspective. New York: Cambridge University Press. Sheehan, M., Schonfeld, C., Ballard, R., Schofeld, F., Najman, J., & Siskind, V. A. (1996). A three year outcome evaluation of a theory based drink driving education program. Journal of Drug Education, 26(395-412). Smart, R. G., & Stoduto, G. (1997). Interventions by students in friends' alcohol, tobacco, and drug use. Journal of Drug Education, 27, 213-222. Steinberg, L. (2004). Risk taking in adolescence. What changes and why? Annals of New York Academy of Science, 1021, 51-58.
147
Stigler, M. H., Perry, C. L., Komro, K. A., Cudeck, R., & Williams, C. L. (2006). Teasing apart a multiple component approach to adoelscent alcohol prevention: What worked in Project Northland? Prevention Science, 7, 269-280. Streiner, D. (2002). The 2 'Es' of research: Effectiveness and efficacy. Canadian Journal of Psychiatry, 47, 552-556. Sussman, S., Rohrbach, L. A., Patel, R., & Holiday, K. (2003). A look at interactive classroombased drug abuse prevention program: Interacitve contents and suggestions for research. Journal of Drug Education, 33, 355-368. Taggart, V. S., Bush, P. J., Zuckerman, A. E., & Theiss, P. K. (1990). A process evaluation of the District of Columbia "Know Your Body" project. Journal of School Health, 60, 6066. Tobler, N. S., Roona, M. R., Ochshorn, P., Marshall, D. G., Streke, A. V., & Stackpole, K. M. (2000). School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention, 20, 275-336. Tobler, N. S., & Stratton, H. H. (1997). Effectiveness of School-based drug prevention programs: A meta-analysis of the research. Journal of Primary Prevention, 18, 71-128. Unger, J. B. (2001). Peer influences and susceptibility to smoking in Californian adolescents. Substance Use and Misuse, 36, 551-571. US Department of Justice. (1995). Delinquency prevention works: Program summary. Washington: Author. Wandersman, A., E, M., Davino, K., Seybolt, D., Crusto, C., Nation, M., et al. (1998). Comprehensive quality programming and accountability: Eight essential strategies for implementing successful prevention programs. Journal of Primary Prevention, 19, 3-25. Wells-Parker, E., Bangert-Drowns, R., McMillen, R., & Williams, M. (1995). Final results from a meta-analysis of remdial interventions with drink/drive offenders. Addiction, 90, 907-926. Western, J., Lynch, M., & Ogilvie, E. (2003). Understanding youth crime: An Australian study. Aldershop, Hampshire: Ashgate Publishing Ltd.
148
Reaching high-risk adolescents in a school setting: Is it possible? David W. Soole, Mary Sheehan & Vic Siskind Centre for Accident Research and Road Safety - Queensland (CARRS-Q) Queensland University of Technology The social cost of delinquency, drug use and injury among adolescents is extensive and highlights the need for interventions aimed at preventing such behaviour among children and adolescents. The potential benefits associated with saving one high-risk youth have been estimated to be a large as $2.7 million (Cohen, 1998). High-risk adolescents engage in a number of risky traffic-related behaviours such as underage driving and motorcyle riding on public roads, driving or motorcycle riding after drinking, and bicycle riding after drinking or without a helmet. This paper examines whether a schoolbased injury prevention program implemented in several South East Queensland high schools and delivered to Grade 9 students, successfully reached adolescents classified as high-risk. Results suggest that of 391 students in intervention schools who provided baseline or data 24.9% (n = 88) were classified as high-risk adolescents and a further 22.9% (n = 81) as medium-highrisk. Of these youth, 64.8% of high-risk and 75.3% of medium-high-risk adolescents received the program and were retained to one-month follow-up. Preliminary results provide some evidence of the effectiveness to not only reach high-risk adolescent youth, but to also engage their participation in an injury prevention program implemented in high-schools
Introduction Injuries are the leading cause of death and hospitalisation among adolescents in Australia (Australian Institute of Health and Welfare, 2006) and this trend has been present for over a decade (Jolly, Moller, Volkmer, 1993). Furthermore, it is a trend that is mirrored globally (Blum & Nelson-Mmari, 2004). The cumulative impact of adolescent injuries, both fatal and non-fatal, has considerable social costs (Hambidge, Davidson, Gonzales & Steiner, 2002). Of particular concern is the sheer prevalence of non-fatal injuries compared to fatal injuries. In a study conducted in the United States, adolescent hospitalisations were conservatively estimated to be more than 40 times more prevalent than fatal injuries and emergency department visits more than a thousand times more likely (Fraser, 1996). In 2004-05, almost a quarter of young Australians reported having sustained an injury in the previous four weeks (ABS, 2006). The most common types of injury among young Australians were cuts (33% of all injuries reported), hitting or being hit by something (16% of those reporting injury), and low falls (19% of those reporting injury). Burns and bites or
149
stings accounted for 6.5 percent of reported injuries each, while physical attacks constituted only 2.3 percent of injuries (ABS, 2006). Death and hospitalisation rates as a result of injury were significantly higher among males and Indigenous youth (Australian Institute of Health and Welfare, 2006). Adolescence has been described as a time of exploration of various behaviours, including physical risk-taking, alcohol use, and even criminal activity (Caces, Stinson & Harford, 1991). While risk taking is often regarded as a normal part of adolescent development (Jessor, 1983) it does increase the likelihood of risk for injury. A number of studies have highlighted the association of risk-taking, delinquency and alcohol use to injury in adolescence, with delinquent adolescents having higher unintentional injury rates than nondelinquent youth (Conseur, Rivara & Emanuel, 1997; Jelalian, et al., 2000; Junger & Wiegersma, 1995). A study linking hospital discharge data with juvenile justice records for adolescents aged 13 to 17 years in the state of Washington showed that hospitalisation for injury was 2.7 times greater for male and 1.6 times greater for female offenders than nonoffenders (Conseur, et al., 1997). Delinquent adolescents also seem to be at greater risk for transport related injuries. In a study of male adolescents from an all-boys high school in the United States, it was found that boys with conduct problems were almost twice as likely to report having experienced a motor vehicle related injury in the 6 months prior to the study (Jelalian, et al., 2000). Furthermore, high-risk behaviours are consistently found to be correlated, lending support to the notion of a “syndrome” of problem behaviour in adolescence (Donovan & Jessor, 1985; Donovan, Jessor & Costa, 1988; Jessor & Jessor, 1977). A number of criminological theories have been applied to deviant behaviour among children and adolescents to attempt to explain the phenomenon. Ajzen’s Theory of Planned Behaviour (TPB) takes into account peer relationships and is perhaps the most appropriate. According to the TPB, adolescent behaviour is influenced by beliefs regarding (i) peers’ expectations (Subjective Norms), (ii) the outcome and evaluation of the outcome of a behaviour (Attitude Toward the Behaviour) and (iii) barriers or facilitators to performing the behaviour (Perceived Behavioural Control). According to the TPB, these three beliefs lead to the formation of intent to perform a particular behaviour. Intent, along with an adolescent’s actual control, then influences the performance of the behaviour (Ajzen, 2002). Prior research has suggested a plethora of risk factors that are predictive of an increased likelihood of delinquency and antisocial behaviour. Gender has been found to be significantly associated with delinquent and antisocial behaviour, with males more likely to engage in such behaviours than their female counterparts (Jelalian et al., 1997; Nichols, Graber, Brooks-Gunn & Botvin, 2006; Sheehan, Siskind & Schoenfeld, 2004). Other risk factors include poor parent-child attachments (Allen, et al., 2002; Allen, Moore, Kuperminc, & Bell, 1998; Cooper, Shaver, & Collins, 1998) as well as poor parenting skills, poor parental supervision, family dysfunction and familial criminality history (Griffin, Botvin, Scheier, Diaz & Miller, 2000; Hanlon, et al., 2004; Sheehan, et al., 2004). Poor selection of peerattachments, such as associating oneself most strongly with deviant peers who hold negative attitudes to authority and typically show a high frequency of alcohol use, can also heighten the risk of delinquency and other problem behaviours (Dishion, French, & Patterson, 1995; Hanlon, et al., 2004; Kandel, 1986; Sheehan, et al., 2004; Vitaro, Tremblay, &
150
Bukowski, 2001) have also been shown to be associated with delinquent behaviour, as have poor adjustment to the school environment and a low sense of academic achievement (Hanlon, et al., 2004). Finally, inappropriate approaches to the regulation of emotions, such as such avoidance coping (Cooper, Wood, Orcutt & Albino, 2003), sensation-seeking (Greene, Krcmar, Walters, Rubin & Hale, 2000) and impulsivity have also been cited as significant risk factors (Romero, Luengo & Sobral, 2001). The concept of ‘use of leisure time’ has been discussed in the literature as providing some explanation for the relationship between delinquency and injury (see Junger and Wiegersma, 1995 for a review). Delinquent adolescents are reported to spend more time in unsupervised peer oriented activities, and to participate less in more conventional and structured activities than non-delinquent adolescents. The unsupervised and unstructured nature of their leisure time means delinquent adolescents find themselves with increased opportunity to participate in risky or criminal activities which may lead to injury (Junger and Wiegersma, 1995). As well as delinquency, the literature describes a number of other factors associated with adolescent injury rates. One established finding is that adolescent males experience more injuries than do adolescent females (AIHW, 2003; Jelalian, et al., 1997). During the period 1993-94 to 2000-01, injury hospitalisation rates for young Australian males were twice that of females (AIHW, 2003). Emergency Department data from the US also shows that unintentional injury rates for males are double that for females (Spirito, et al., 1997). The explanation for this discrepancy may be that adolescent males participate more in the risktaking behaviours that lead to injury (AIHW, 2003). Adolescence is often the time of onset of alcohol use, considered to be one of the most significant risk factors for injury (Lowenfels & Miller, 1984). A number of risk factors have been identified for onset of alcohol use in adolescence including conflict within the family (Caughlin & Malis, 2004; Ellickson et al., 2001), parent and peer modelling of health-risk behaviours and poor parental supervision (Beal, Ausiello & Perrin, 2001) and access to substances in the home (Resnick et al., 1998). Furthermore, impulsiveness and sensation seeking (Donohew & Hoyle, 1999; Wulfert, 2002), participation in deviant activities (O’Malley, Johnston & Bachman, 1998; Vicary et al., 1998) and poor academic performance and school misconduct (Bryant et al., 2003; Diego, Field & Sanders, 2003; Thomas & Hsiu, 1993) have also been identified as risk factors. Protective factors include disapproval of health-risk behaviours by parents and peers (Beal, et al., 2001) interest in school and academic achievement (Bryant et al., 2003; Resnick et al., 1998), adequate parental supervision, family connectedness and the interest of ones parents in academic performance (Beal, et al., 2001; Bryant et al., 2003; Resnick et al., 1998) and religiosity (Wallace, et al., 2003). It has been reported that most adolescents in developed countries have had experience with alcohol use and that as many as a third report at least one occasion of alcohol abuse (Sells & Blum, 1996). Healey (2000), in an Australian study, reported that 80% of surveyed high school students reported past alcohol use, with one third reporting use in the week prior to the survey. Another Australian study reported similar results with half of the surveyed adolescents having consumed alcohol within the week prior to the survey and 35%
151
reporting at least one occasion of hazardous consumption (White, Hill & Effendi, 2002). In yet another Australian study, Miller and Draper (2001) reported that approximately one third of surveyed adolescents are regular drinkers of alcohol (at least once per week), while a further 40% report occasional alcohol use. While the frequency of adolescent drinking is often much lower than that of adults, they tend to drink larger amounts on the occasions they do drink (Bauman & Phongsavan, 1999). This is disconcerting regarding the evidenced association between alcohol use and traffic crashes, suicides and violent behaviour (English, 1995; Hewitt, Elliott & Shanahan, 1995; King & Ghaziuddin, 1996; Lynskey, 2001; Pickett, et al., 2005) as well as other unintentional injuries (Cherpitel, 1993). Indeed, some have argued that alcohol use is the most significant risk factor for injury (Lowenfels & Miller, 1984). Alcohol consumption increases injury risk through increasing exposure to dangerous circumstances or through a direct biological effect which reduces perceptions of and responses to dangerous circumstances (Li & Baker, 1994). Transport related mortality and injury is a serious problem among adolescents and is inexplicably associated with risk taking behaviour (Moon, Meyer & Grau, 1999). Transportrelated accidents are the most common cause of injury-related mortality among young Australians, making up 32% of all adolescent deaths (ABS, 2006). Transport related accidents are also the leading cause of hospitalisation among young people (AIHW, 2003). Young people are no doubt overrepresented in Australian road crashes, however of particular concern is the issue of underage drivers. A number of Australian studies have reported findings suggesting underage driving is relatively prevalent. Stevenson and Palamara (2001) found that almost a quarter of surveyed Western Australian young drivers had considerable experiences with driving on a public road prior to obtaining their learners license. In another study, 35% of unlicensed high school students reported having driven a car on a public road in the past year (Sheehan, et al., 1996). Crashes among underage drivers are often serious, with evidence from one study suggesting 84% result in injury or death of the driver (Lam, 2003). Some have suggested that greater frequency of risky driving among young drivers somewhat explains adolescent crash statistics. Indeed, Fergusson, Swain-Campbell and Horwood (2003) reported that 90% of surveyed New Zealand licensed drivers aged between 18 and 21 had engaged in some form of risky driving. Furthermore, risky driving behaviour and transport related injury have been found to be associated with other high risk behaviours such as substance use, drink driving, underage drinking and unlawful use of a motor vehicle (Fergusson, Swain-Campbell & Horwood, 2003). A number of risk factors have been found to be associated with traffic crashes and driving related offences among young drivers. These include substance use (Shope, 2001), peer modelling of health-risk behaviours and a toleration of deviance (Shope, Raghunathan & Patil, 2003) as well as risk taking and sensation seeking (Jelalian et al., 2000). Protective factors include adequate parental supervision, modelling of health-risk behaviours and family connectedness (Shope, 2001; Shope, Waller & Lang, 1996) and association with prosocial peers (Shope, Waller & Lang, 1996).
152
Drink driving and riding with drink drivers are also risk behaviours that can lead to transport related injuries among adolescents. A number of studies have highlighted the increased risk of a traffic accident associated with higher blood alcohol levels of the driver and suggested that this risk is even greater among less experienced younger drivers (Hingson, 1996; Zador, Krawchuck & Voas, 2000). Studies have reported disturbing statistics regarding exposure to having driven with a driver under the influence. In an Australian study 52% of surveyed students had been a passenger in a vehicle driven by a drink driver in the past month (Sheehan, et al., 1996). In a US study, one third of adolescents reported having been in a vehicle operated by a drink driver within the month prior to being surveyed (Kadel, 1998). Furthermore, 27% of adolescents in the Australian study reported having ridden a bicycle after drinking alcohol. Prevalence rates for driving a car or motorbike after drinking were considerably lower, with 6% and 7% of adolescents reporting these behaviours, respectively (Sheehan, et al., 1996). A number of risk factors associated with drink driving or being a passenger in a vehicle operated by someone under the influence have been evidenced in prior research. These include impulsiveness (Stanford et al., 1996), sensation seeking (Arnett, 1990), tolerance of deviance (Bingham & Shope, 2004), normative beliefs and expectancies regarding physical risks, friends’ disapproval, punishment avoidance and locus of control (Grube & Voas, 1996), school misconduct (Barnes & Welte, 1988), poor academic performance (MacKinnon et al., 1994; Williams, Lund & Preusser, 1986), greater levels of alcohol use (Bingham & Shope, 2004; Wechsler, Rohman, Kotch & Idelson, 1984), earlier age of drinking onset (Hingson et al., 2002) and participation in deviant activities (Williams, Lund & Preusser, 1986). Protective factors include greater levels of academic achievement and religiosity (O’Malley and Johnston, 1999). An associated problem is driving under the influence of illicit drugs. In Australia illicit drug use among adolescents is far less common than use of alcohol or tobacco, however one study reported that as many as a third of Australian adolescents have used marijuana, around a quarter have used inhalants and 8% have used amphetamines (Miller & Draper, 2001). Driving after use of marijuana has been shown to increase crash involvement of young drivers (Hingson, 1982) and as many as half of adolescents surveyed in one particular American study reported having been a passenger in a vehicle driven by someone under the influence of marijuana and a substantial proportion had driven under the influence of illicit substances themselves (Wechsler, et al., 1984). Studies involving risk factors for adolescent drug-driving are not as common as those for drink driving, however Bingham and Shope (2004) have shown that drug-driving can be predicted by adolescent marijuana use, greater alcohol misuse and tolerance of deviance. The social cost of delinquency, drug use and injury among adolescents is extensive and highlights the need for interventions aimed at preventing delinquency and antisocial behaviour among children and adolescents. This is especially true for high-risk youth who are at-risk of becoming embroiled in a life of delinquency, substance abuse and participation in risky behaviours that can have a cost on the community running into the millions. In an American study, Cohen (1998) reported that the potential benefits associated with saving one high-risk youth can amount to between $1.7 and $2.3 million. Indeed, even a more conservative estimate would be strong evidence of the necessity of prevention programs for
153
high-risk youth. The present study investigates the ability of a high-school based injury prevention program (Skills for Preventing Injury in Youth - SPIY) to reach high-risk adolescents.
The Intervention Program: Skills for Preventing Injury in Youth (SPIY) The current research investigates the design and implementation of an injury prevention program for adolescents. The program, called ‘Skills for Preventing Injury in Youth’ (SPIY), was designed to target adolescents in Year 9, who are typically 13-14 years old. Prior to the development of the program, a workshop was held with teachers, guidance officers and school based youth health nurses from several South-east Queensland high schools, who suggested that Year 9 students would be the ideal target of a school-based injury and risk taking prevention program. The literature also suggests that adolescents are beginning to think about and experiment with risk taking behaviour at this age, making it an ideal time to challenge their perceptions of involvement in such behaviour. The program content was based on the results of several research studies conducted in Queensland and Western Australia by Sheehan, Palamara and colleagues (Palamara & Stevenson, 2003; Sheehan, Siskind & Schonfeld, 2004; Stevenson, Palamara, Morrison, & Ryan, 2001; Western et al., 2003). The results of these studies suggested targeting specific risk-taking behaviours that are frequently associated with injury in adolescents. These behaviours, which became the program’s targets for change, included risky bicycle and motorcycle use, interpersonal violence, underage use of a motor vehicle, riding as passengers of risky drivers, and risky behaviour around water. Targeting multiple risk taking behaviours in intervention programs has been recommended by a number of researchers, including Pickett, Garner, Boyce and King (2002). The program content was guided by the Theory of Planned Behaviour (Ajzen, 2002), which takes the peer relationship into account. Along with peer protection and injury prevention components, the SPIY program included lessons in first aid. Teaching first aid to adolescents provides them with the skills to manage and control emergency situations and injuries with which they are confronted. Incorporating first aid theory and practice into an injury prevention program may also give adolescents further insight into the potential consequences of risk taking behaviour. The first aid skills selected to be taught as part of the program reflect the more common and potentially serious injuries experienced by adolescents, including treatment of bleeding, fractures, burns, shock, head and spinal injuries, and performing resuscitation. The program was therefore designed to enable students to develop skills in both injury prevention and control, by combining first aid training with cognitive behavioural prevention strategies. The program consisted of eight lessons, delivered weekly in Year 9 health classes by the class teachers. Each of the lessons was structured similarly. Initially, a scenario would be presented to the class, which involved a group of friends participating in a risk taking behaviour which results in injury. The first half of each lesson would then involve first aid theory and practice, with students learning how to treat the injuries presented in the scenario. The second half of each lesson then focused on prevention, with
154
class activities, including discussions and role plays, being used to assist students to consider methods of protecting their peers and preventing risk taking behaviour and associated injury.
Method Participants and Procedure All Year 9 students (n = 450) at two state high schools in South-east Queensland participated in the SPIY program. The Index of Relative Socio-Economic Advantage/ Disadvantage, derived from the 2001 Census, were noted for the areas in which the schools are located. The Index is constructed from measures of educational attainment, income, employment and occupation, and ranges from 1-10, with low values indicating disadvantage and high values indicating relative advantage. One of the participating schools was located in a disadvantaged area, with an index score of 1, while the second school was located in a relatively advantaged area, with an index score of 8 (Australian Bureau of Statistics, 2005). Ethical approval to conduct the research was initially obtained from the University Ethics Committee and from Education Queensland and individual school principals. As the program was incorporated into the Year 9 health curriculum, parental consent was not required for student participation. Prior to the implementation of the SPIY program, Year 9 health teachers at the participating schools attended a training session, to maximise consistency in program delivery across health classes. The program lessons were then delivered by the teachers in their health classes over eight consecutive weeks. Each lesson varied in length from 52-70 minutes, according to the schools’ allocation for class time. The core lesson material was designed to be delivered within 52 minutes, with supplementary material available for longer lessons. As part of the program evaluation, a questionnaire was administered to school students in the week prior to the intervention implementation. Immediately following the intervention, all schools broke for two weeks (Easter holidays). In the week following this break, a follow up questionnaire was administered to the program and control school students, a total of one month later. The questionnaire consisted of scales measuring demographic information, relationships with peers, parents and teachers, risk taking behaviour, the school environment, attitudes toward police, and injury. Only results derived from the Australian Self-Report Delinquency Scale, (ASRDS) will be presented in this paper. The ASRDS is a 37-item questionnaire developed by Mak (1993) and updated by Western, Lynch and Ogilvie (2003). The items list risk behaviours and participants are required to respond regarding whether they have engaged in each of these behaviours during the past three months. For the purposes of this research additional changes to those made by Western et al. (2003) were made to the instrument to better accommodate the intended targets. Wording of some items were adjusted and additional behaviours of particular interest to the study were added, such as a number of transport-related risk behaviours.
155
Results Of the 450 participating students suitable data was available for 424. Males constituted 50.1% of the sample and the mean age at baseline was 13.41 (sd = .51). A total of 256 students provided both baseline and one-month follow-up data, with a further 98 providing baseline data only and 70 providing one-month follow-up data only. Demographic data did not differ substantially between the 256 matched and 168 unmatched students. Males made up 50.8% of the matched sample and 49.1% of the unmatched sample. Mean ages were 13.43 (sd = .52) and 13.36 (sd = .48) for the matched and unmatched students, respectively. Prevalence rates for selected substance use and risky transport related behaviour are reported in Table 1 below for all those students providing baseline (n = 391). Use of inhalants and marijuana (8.8% and 8.2%, respectively) was more common then inappropriate use of medication and more serious illicit substances. Substantial prevalence rates of risky transport related behaviour were reported for having ridden a bicycle on the road without a helmet (50.9%), having been a passenger with someone driving dangerously (25.4%), having been a passenger with someone who is drink driving dangerously (22.7%), having driven a motorbike on the road (19.8%), and having driven a car on the road (15%). While less prevalent a number of students also reported having driven a car or motorbike above the speed limit (13.1%), having ridden a bicycle after drinking (11%) and having driven a car or motorbike after drinking (6%). Risk categories were developed using reported prevalence rates of the entire sample on the ASRDS. The prevalence rate of each item across the entire baseline sample was inversed and inversed scores were then summed across all items for each individual. For students with less than one third missing data, their total inverse ASDRS score was scaled up. Those with more than one third missing data (n = 26) were excluded from the analysis. Those students with a total inverse ASDRS score of zero (no participation in any of the high-risk activities) were classified as low-risk. The remaining students were divided into tertiles and classified as low-medium risk, medium-high risk, or high risk. Of the 391 students providing baseline data 95 (26.8%) were classified as low risk, 90 (25.4%) as low-medium risk, 81 (22.9%) as medium-high risk and 88 (24.9%) as high risk. Chi-square analysis revealed a significant gender difference (p 60 km/hr or equivalent damage severity); medium (40 km/h < Δv < 60 km/hr or equivalent); and, low (Δv < 40 km/h or equivalent).
Table 1: Quality of Use Definitions Quality of Use Appropriate & Correct (Optimal) Appropriate & Incorrect Inappropriate & Correct Inappropriate & Incorrect Suboptimal Most suitable restraint for size
Definition Using most suitable restraint for size and restraint correctly Using most suitable restraint for size but restraint incorrectly Not using most suitable restraint for size and restraint correctly Not using most suitable restraint for size but restraint incorrectly Inappropriate and/or incorrect use
using using using using
Up to 18kg: forward facing child restraint (CRS) Height 18kg: Booster
Quality of restraint use for each child was assessed as appropriate and correct; appropriate and incorrect; inappropriate and correct; and, inappropriate and incorrect as defined in Table 1. Comparisons were made between correctly and incorrectly restrained children regardless of appropriateness. Therefore the incorrectly restrained group consisted of both inappropriate and appropriately restrained children, and likewise the correctly restrained group consisted of both inappropriate and appropriately restrained children. Injury data were coded using the Abbreviated Injury Scale (1990 revision), and Injury Severity Scores (ISS) were calculated based on these codes. The association between restraint quality and injury outcome was explored in terms of the maximum abbreviated injury score (MAIS) and the injury severity score. Cases were grouped into minor injuries and moderate/serious injuries using MAIS. Minor injury was defined as having a MAIS of less than 2. Moderate/serious injury was defined as having an MAIS equal to or greater than 2. Three levels of injury outcome were investigated using ISS. These were minor injury (ISS >4); moderate injury (ISS>9); and severe injury (ISS>15).The association between restraint quality and injury categories was explored using Pearson’s chi-square statistic. Unadjusted Odd Ratio (OR) and 95% confidence intervals (CI) were also estimated for serious injuries by restraint quality, and adjusted for crash severity using the Mantel-Haenszel pooled estimate test. Ethical approval for this work was obtained from the Human Ethics Committee of the Children’s Hospital at Westmead and the Human Research Ethics Committee of the University of NSW.
398
Laboratory Work The laboratory work being presented consists of preliminary studies from a project where real world crashes were reconstructed. Our study of misuse is ongoing with laboratory work simulating the types of misuse identified in the field based investigation study. The aim of this work is to determine the reduction in effectiveness of crash protection introduced by the various forms of incorrect use. For the purposes of this paper, potential injury mechanisms in children using restraints incorrectly in the most common serious modes of incorrect use observed in the field and crash studies seen to date are presented. These were investigated through a series of 6 laboratory tests. Full details of these tests can be found in Bilston et al (29, 30) and Brown et al (19). A test matrix reproduced from Brown et al (19) is provided in Table 2. Head accelerations, neck loads and moments measured during these tests have been presented elsewhere (19). The potential injury mechanisms in the modes of misuse studied are demonstrated here through comparisons of dummy motion between the incorrect and correct mode of restraint.
Table 2: Laboratory Test matrix Test
Dummy Restraint Configuration
Impact Direction
1
HIII 6
Full frontal
2
HIII 6
3
HIII 3
4
HIII 3
5
HIII 3
6
HIII 3
Incorrect use of adult lap/sash belt Correct use of adult lap/sash belt Incorrect use of lap/sash belt with booster Correct use of lap/sash belt with booster Incorrect use of harness in forward facing CRS Correct use of harness in forward facing CRS
Full frontal Full frontal Full frontal Full frontal Full frontal
Velocity Change (km/h)
Peak Deceleration (g)
30.3
15.0
31.2
14.7
34.5
18.9
34.4
18.9
34.0
17.0
33.8
16.9
Results Field Misuse Study Data collection commenced February 2007 and is ongoing. Data collection is expected to be complete by December 2007. To date data has been collected for 135 children (41% female, 59% male) aged 0 – 6 years. The age distribution (in terms of age at next birthday) is shown in Figure 1.
399
Figure 1: Age distribution among data collected to date
The distribution of restraints seen in the study is shown in Figure 2. All but one child (99%) were using some form of restraint. However, some form of incorrect use was observed in 61% of the cases. The proportion of incorrect use seen in each type of restraint is shown in Figure 3. In looking at Figure 3, note that to date there have only been a small number of children observed to be using rearward facing restraints (8 cases) and child safety harnesses (2 cases). Some form of incorrect use was observed in 5 of the 8 rearward facing infant restraints, and both child safety harnesses seen thus far. Among the other types of restraint, the greatest proportion of incorrect use is occurring in forward facing restraints (65%), followed by booster seats (60%). Children using adult seat belts are demonstrating the lowest levels of incorrect use (48%), but even in this type of restraint, incorrect use is being observed in almost half of the children. Note that incorrect use associated with installing the restraint and associated with using the restraint is lumped together in this analysis. Later analyses conducted with the complete data set will separate this out. Preliminary classifications of the severity of the incorrect use have been undertaken. Using these classifications of minor, moderate and serious incorrect, the severity of incorrect use by restraint type is shown in Figure 4. This shows that about 50% of the incorrect use seen in forward facing child seats and rear ward facing infant restraints is minor. In contrast, much less of the incorrect use seen in seat belts and boosters is minor, with more than 50% having potentially serious consequences in a crash. Of those small numbers of rearward facing infant restraints seen so far, the 2 cases of incorrect use have involved; (i) a twisted and slightly loose internal harness (classified as minor severity) and, (ii) a restraint where there was no seat belt used to anchor the restraint (classified as serious incorrect use).
400
Figure 2: Restraint Type Distribution
Figure 3: Incorrect Use by Restraint Type
401
Figure 4: Severity of Incorrect Use by Restraint Type Both child safety harnesses seen in the sample so far were being used incorrectly. In one case the harness had been over tightened so that the lap belt sat high across the child’s abdomen (classified as moderate severity). In the other case the harness had been over tightened in a similar manner but in this case, the lap belt was also extremely loose (classified as serious incorrect use). Both forms of incorrect use would increase the risk of submarining and abdominal injury in a frontal crash. Examples of the types of incorrect use and their preliminary severity classifications for forward facing child restraints, boosters and seat belts are shown in Tables 4, 5 and 6 respectively.
Table 3: Incorrect Use in Forward Facing Child Restraints (*assumed to be minor – impact needs to be tested in laboratory) Minor Slightly loose harness Shoulder height problem Baby liner still in use* Rebound bar still in place* Seat belt locker not activated* Seat belt locker not used* Plastic keepers on harness not used* Seat belt fouling harness Gated buckle used incorrectly*
Moderate Moderately loose harness Slack in top tether Moderate belt routing problem Slack in belt system
Serious Very loose harness No belt anchoring seat Shoulder straps so low not on shoulder No top tether
Twist in top tether
Seat belt not engaged Arms completely out of harness Problem with top tether anchorage
Seat belt loose
402
Table 4: Incorrect Use of Booster Seats (*assumed to be minor – impact needs to be tested in laboratory) Minor
Moderate
Twisting of belt No top tether*
Not using lap belt guide Sash guide not being used
Top tether problem* Using harness when not suitable*
Serious Positioning of sash over or under arm Not using sash Anti-submarining clip not used Sash guide placed incorrectly resulting in poor fit
Table 5: Incorrect Use of Seat Belts (*assumed to be minor – impact needs to be tested in laboratory) Minor
Moderate
Twisting of belt
Slack in belt system
Serious Sash not being used or being used incorrectly
Real World Study From the retrospective review of crashes there were 142 restrained children for whom correctness of restraint use could be determined and who sustained an injury. Of these 5% were identified to have been using their restraint incorrectly. Across this sample, one quarter of the children sustained moderate to severe (AIS 2+) injuries. In terms of ISS, 25% scored over 4 (ISS>4); 15% scored over 9 (ISS>9); and 10% scored over 15 (ISS>15). Comparing injury outcomes for correctly and incorrectly using their restraints, there were significantly more children moderately to seriously injured when using their restraints incorrectly (p15 (p15) than those using their restraints correctly (95% CI 1.1-39.6). There was also a greater proportion of head and spinal injuries among those incorrectly restrained (unadjusted OR for head injury in incorrectly restrained 10.5, 95% CI 1.2–90.3, adjusted 11.0 5% CI 0.92–130.8; unadjusted OR for spinal injury 6.8, 95% CI 1.4–33.1, adjusted OR 6.3, 95% CI 1.2–32.2). All cases of incorrect use seen in this sample involved serious forms of incorrect use. This involved failure to correctly use the internal harness system of a forward facing child restraint, or the sash part of the adult belt (while using a booster seat of an adult belt alone);and, in one case a forward facing child restraint was not correctly attached to the vehicle. In all but one case there was evidence of head contact. In two children this resulted in severe brain injury. High spinal injuries were sustained by three of the children aged less than 5 years. In one 7 year old child for whom incorrect use was identified, there were significant
403
lumbar spine fractures and associated abdominal injury, as well as evidence of head contact. Intrusion was not a factor in any of these crashes. All involved frontal impacts and children seated in the rear. Three example cases have been selected to exemplify the potential catastrophic consequences of serious modes of misuse. These cases illustrate serious modes of incorrect use in a forward facing child restraint, a booster seat, and an adult belt. Case 1: Forward Facing Child Restraint This 2 year old child sustained a complete transaction of the spinal cord at C4 resulting in death together with external bruising under the left chin and over the left flank. The internal harness system of the restraint was being used incorrectly (excessive slack and possibly one arm out). The child was seated in the left rear seat. The vehicle in which the child was travelling was involved in a head-on collision with a similar sized passenger vehicle. The impact was offset to the right, and the Δv was estimated to be approximately 60 km/h. This resulted in substantial damage to the front of the vehicle involving the front bonnet, A pillar, driver’s door, and B pillar. There was no intrusion in the child’s seating position, and this compartment remained relatively intact. The child’s injuries occurred as a direct result of the excessive upper torso and head excursion allowed from the incorrect use of the harness. The most serious injuries sustained by the elderly adult front seat occupants were multiple rib fractures. Had this child been correctly using the internal harness, it is unlikely there would have been any significant injuries. Case 2: Booster Seat This 4½ year old was appropriately using a booster seat in the left rear of vehicle that was involved in a high severity impact with a heavy vehicle. The child’s vehicle crossed onto the wrong side of the road when the driver fell asleep while travelling at 80-90 km/h, and partially under rode the front of an oncoming truck. While there was substantial damage to the vehicle and significant compromise of the front seat compartment, the rear seating positions remained fully intact. The front seat driver was injured but survived with relatively moderate injuries. However the child sustained extensive life threatening head and spinal injuries. The booster’s sash guide was tied down to a luggage tie-down point separate to the booster seat. During the impact, this resulted in the sash being pulled from the child’s shoulder, and there was no effective restraint of the upper torso. This child’s injuries were a direct result of the excessive upper torso and head excursion allowed by this form of misuse. As in Case 1, had this child been correctly restrained it is unlikely such serious injuries would have occurred.
Case 3: Adult Belt This child was almost 8 years old and using a lap sash seat belt in the right rear. The vehicle in which the child was travelling was involved in a speed, high severity frontal impact with another passenger vehicle. The injuries sustained included a swollen lip and a loose tooth indicating a head contact. The child also sustained grazing over the upper abdomen indicative of a sash that had been incorrectly placed under the right arm rather than over the
404
middle of the right shoulder. This was associated with underlying internal abdominal injury together with lumbar spine fracture with rupture of spinal ligaments and spinal nerve root damage. Laboratory Work Full results from the six laboratory tests being presented here have been presented elsewhere (19). These tests were conducted to simulate outcomes in correctly and incorrectly used restraints. The modes of incorrect use simulated replicate those serious modes observed in both the field inspection and crash studies and illustrated above. Forward Facing Child Restraints – Failure to use internal harness correctly This test compared the differences in motion observed during a frontal impact when the internal harness of a forward facing child restraint is used correctly and when it is not. A Hybrid III 3 year old dummy is used as a surrogate for a 3 year old child. The incorrect use simulated involved non use of one shoulder harness. This form of incorrect use resulted in the head of the dummy being allowed to travel a greater distance. This is demonstrated in the comparison of head displacement shown in Figure 5.
Figure 5: Comparison of head displacement in a correctly and incorrectly used forward facing restraint. The serious from of incorrect use simulated results in greater head excursion.
Still photographs from the point of maximum excursion taken from high speed video are shown in Figure 6. These illustrate how this form of incorrect use results in a greater risk of head and neck injury. Head contact occurs when the head and neck are in tension, and explains the catastrophic high spinal injuries observed in the field with this form of misuse.
405
Figure 6: Comparison of motion at point of maximum excursion in a correctly and incorrectly used forward facing restraint. The serious from of incorrect use simulated results in the head and neck being at a greater risk of injury.
Booster Seats – Failure to use sash correctly Excessive upper torso and head motion also occurs with incorrect belt use in a booster seat, see Figure 7. This test illustrates the difference in protection provided to a surrogate for a 6 year old child using a booster seat when the sash part of the adult seat belt is and is not used correctly.
Figure 7: Comparison of head displacement in correctly and incorrectly used booster seats. The serious from of incorrect use simulated results in greater head excursion.
406
The resulting motion is shown in Figure 8. Contact with the seat in front prevents extreme upper body flexion around the lap portion of the belt, but the head contact that occurs while the neck is in tension explains the potential for catastrophic upper spinal injuries as seen in the field with this form of misuse.
Figure 8: Comparison of motion at point of maximum excursion in a correctly and incorrectly used booster seat The serious from of incorrect use simulated results in the head and neck being at a greater risk of injury. Seat belts – Failure to use sash correctly
Figure 9: Comparison of head displacement in a correctly and incorrectly used adult belt. The serious from of incorrect use simulated results in greater head excursion.
407
This test compares the motion of a Hybrid III 6 year old dummy in an incorrectly and correctly worn adult lap/sash belt. From Figure 9 it is clear that this form of incorrect use also results in greater head excursion. However, as shown in Figure 10 it there is also substantially more upper body flexion when the lap-sash belt is worn incorrectly. The lack of effective upper torso restraint acts to concentrate the seat belt loads across the abdomen like a lap only belt and explains the abdominal and lumbar spine injuries seen in the field study.
Figure 10: Comparison of motion at point of maximum excursion in a correctly and incorrectly used adult seat belt. The serious from of incorrect use simulated results in greater head and upper torso motion and a greater a greater risk of head, abdominal and spine injury.
Discussion & Conclusions While using some form of restraint reduces the chance of being injured in a crash, suboptimal restraint reduces the level of protection provided. There are two forms of suboptimal restraint; inappropriate restraint choice and the incorrect use of a restraint system. Other studies conducted by our group and others (24-26) have reported that inappropriate use is widespread among Australian children. Based on the preliminary observations from this ongoing field study of misuse currently being conducted in NSW, it appears that a substantial proportion of children aged 1 – 6 years are also using their restraints incorrectly. Current educational strategies and proposed legislative changes are aimed at reducing inappropriate use and encouraging child occupants to use the most suitable form of restraint for their size. The preliminary observations regarding incorrect use indicate that there is need to address not only the types of restraint being used, but the way in which restraints are used. This is particularly important in the current climate. The goal of proposed legislative changes regarding the type of restraints used by child occupants is to reduce child occupant casualties. Unless the level of incorrect use can be kept to a minimum, such
408
measures will not achieve significant results. In 2004, Desapriya et al investigated the effectiveness of legislation requiring the use of child restraints for children up to 5 years introduced into Japan in 2000. These authors found there was no reduction in casualty numbers following the introduction of this legislation citing incorrect use as a likely reason. The preliminary results from our misuse field study indicate that there are a range of misuse types occurring. In forward facing child restraints most incorrect use would have only minor implications in a crash. In contrast, most of the incorrect use seen in booster seats has the potential for serious consequences in a crash. More detailed analysis in this regard will be conducted when data collection is complete. These results will assist in prioritizing the modes of incorrect use that need to be addressed. From the preliminary observations, and the observations from our crash and laboratory studies it is clear however that there is a need to develop countermeasures against the incorrect use of the internal harness in forward facing seats, and the sash when using booster seats or adult belts alone. There are primarily two current countermeasures for incorrect child restraint use operating in Australia. The Child Restraint Fitting Station Network was designed specifically as a countermeasure to incorrect use and has been operating since 1985. The Restraint Fitting Station Network targets problems associated with the correct fitment of restraints into vehicles. There is also scope for this network to be a source of information related to the correct securing of a child within a restraint system. In a recent random telephone survey of approximately 400 homes in NSW with 615 children aged 10 or younger, parents and carers were asked about their use of the Fitting Station Network. Two thirds of parents/carers of children using rearward facing restraints reported getting assistance from a fitting station; but only just over half of forward facing restraints users, and approximately 20% of booster seat users (Brown et al, unpublished data). This suggests there is scope for more widespread use of this resource, both in terms of providing correct installations and correct usage information. Use of the fitting station network is being recorded in this current study, to determine whether this reduces restraint misuse. Since its inception, the Australian Child Restraint Evaluation Program (CREP) has included an assessment of the usability of child restraints. A recent review of the assessment procedures used in the program recommended major enhancements to the procedures. These changes were adopted, and the most recent series of CREP includes the updated ease of use assessments (28). The aim of the ease of use assessments in CREP is to encourage manufacturers to simplify methods of restraint installation and the way a child needs to be secured within a restraint. Moreover, it is hoped that design based strategies will be developed to provide restraint systems that are difficult to use incorrectly. For CREP to be effective, consumers must be well informed of the purpose of the program and the results of the evaluations. Widespread promotion of CREP results is a strategy that could be adopted by practitioners as a countermeasure to incorrect use. This would also work to educate consumers of the importance of the correct use of restraints. In the longer term, preventing incorrect use is likely to be most effectively achieved through changes to restraint design. There is a continuing need for the investigation and development of restraint designs that not only minimize the propensity for incorrect use but actually prevent incorrect use. Such features could include reminders, indicators, self-adjusting harnesses, just to name a few. Alternatively, requirements for such features could be introduced through amendments to Australian Standards and possibly Australian Design Rules related to vehicles.
409
In conclusion, the observations being made in the field by our group highlights the need for urgent increased attention to the problem of incorrect use. In particular results obtained to date suggest that the way children use the internal harness of child restraint systems and the sash belt of adult seat belt systems (either alone or in combination with a booster) require immediate attention. Failure to educate parents on the correct use of restraints could potentially negate the benefits of appropriate restraint use laws and guidelines.
Acknowledgments Julie Brown is supported by a grant from the Australian Research Council and partner funding from the Motor Accidents Authority of NSW and the Roads and Traffic Authority of NSW. Lynne Bilston is supported by an NHMRC Senior research fellowship, Misuse Field Study Funding for this study is being provided by a grant from the Australian Research Council and partner funding from the Motor Accidents Authority of NSW and the Roads and Traffic Authority of NSW. The authors wish to acknowledge the other chief collaborators in this work, Professor Caroline Finch, University of Ballarat and Dr Julie Hatfield, University if NSW. Thanks also to those assisting with data collection, Paul Kelly, Mike Vernon, Keith Pearce and Nimmi Magadera; and the numerous primary schools, pre-schools, long day care centres and early childhood health centres where data collection is taking place. Crash study This work was funded by the NSW Motor Accidents Authority. Thanks also to Dr Michael Henderson, Dr Mary McCaskill, and Marijke Oomens for their collaboration and assistance with this work. Laboratory work Preliminary work reconstructing misuse seen in the crash study was funded by the NSW Motor Accidents Authority. Ongoing misuse studies are being funded a grant from the Australian Research Council and partner funding from the Motor Accidents Authority of NSW and the Roads and Traffic Authority of NSW. The authors would like thank Dr Mick Yuen for his contributions to this work; the NSW RTA’s Crashlab and Holden for the use of their child dummies.
References 1. Partyka, S. Lives saved by child restraints from 1982 through 1987. 12th ESV Washington, DC, National Highway Traffic Safety Administration. 1989 2. Osberg JS, Di Scala C. Morbidity among pediatric motor crash victims:the effectiveness of seat belts. Am J Public Health 1992;82:422-5 3. Henderson, M., J. Brown, et al.” Injuries to restrained children”. 38th Annual Conference of the Association for the Advancement of Automotive Medicine, Lyon, France. 1994 4. Johnston, C., F. Rivara, et al. "Children in car crashes: analysis of data for injury and use of restraints." Pediatrics 93(6 Pt 1): 960-5.1994
410
5. Isaksson-Hellman, I., L. Jakobsson, et al. (1997). Trends and effects of child restraint systems based on Volvo's Swedish accident database. 2nd Child Occupant Symposium, Orlando, Florida, USA, Society of Automotive Engineers (SAE), Warrendale, Pennsylvania, USA. 6. Rivara, F. P., T. D. Koepsell, et al. "Effectiveness of automatic shoulder belt systems in motor vehicle crashes." JAMA 283(21): 2826-8. 2000 7. Halman SI, Chipman M, Parkin PC, Wright JG. Are seat belt restraints as effective in school age children as in adults? A prospective crash study. BMJ. 2002;324 8. Valent, F., G. McGwin, Jr., et al. "Restraint use and injury patterns among children involved in motor vehicle collisions." Journal of Trauma-Injury Infection & Critical Care. 52(4): 745-51.2002 9. Durbin, D. R., M. R. Elliott, et al. "Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Children in Vehicle Crashes." JAMA 289(21): 2835-2840. 2003 10. Arbogast, K. B., Cornejo, R. A., Kallan, M. J., Winston, F. K., Durbin, D. R. “Injuries to children in forward facing child restraints” 46th Annual Proceedings/Association for the Advancement of Automotive Medicine, 213-30 11. Khaewpong N, Nguyen TT, Bents FD, Eichelberger MR, Gotschall CS & Morissey R “Injury severity in restrained children in motor vehicle crashes” SAE 95271 in Proceedings 39th STAPP Car Crash Conference Society of Automotive Engineers Warrendale PA 1995 12. Bull MJ, Stroup KB, Gerhart S “Misuse of car safety seats” Pediatrics 81:98, 1988 13. Graham CJ. Kittredge D. Stuemky JH. Injuries associated with child safety seat misuse. [Journal Article] Pediatric Emergency Care. 8(6):351-3, 1992 Dec 14. Gotschall, C. S., M. R. Eichelberger, et al. Injury patterns associated with child restraint misuse. 2nd Child Occupant Protection Symposium, Orlando, Florida, USA, Society of Automotive Engineers (SAE). 1997 15. Weinstein, E. B., M. M. Sweeney, et al. “The effect of size appropriate and proper restraint use on injury severity of children.” 2nd Child Occupant Protection Symposium, Orlando, Florida, USA, Society of Automotive Engineers (SAE), Warrendale, Pennsylvania, USA. 1997 16. Hummel, T., K. Langwieder, et al. Injury risks, misuse rates and the effect of misuse depending on the kind of child restaint system. 2nd Child Occupant Protection Symposium, Orlando, Florida, USA, Society of Automotive Engineers (SAE), Warrendale, Pennsylvania, USA. 1997 17. Brown J, Bilston L, McCaskill, M. Henderson, M. “Identification of injury mechanisms in children aged 2-8 years in motor vehicle accidents” NSW Motor Accidents Authority Research Report, 2005 18. Brown J., McCaskill, ME., Henderson M., Bilston LE “Serious injury is associated with suboptimal restraint use in child motor vehicle occupants” Journal of Paediatrics and Child Health 42(6) 345–349, 2006 19. Brown J., Bilston LE “Misuse of Child Restraints and Injury Outcome in Crashes” Proceedings 2006 Road Safety Research, Policing and Education Conference, October, Gold Coast, Queensland, 10p. 2006
411
20. Weber, K, in UMTRI Research Review. 2000, University of Michigan Transportation Research Institute. 1-28. 21. Paine, M and H Vertsonis. in 17th Enhanced Safety of Vehicles Conference. 2001. Amsterdam, The Netherlands. 22. Paine, M, in Research report. 1998, New South Wales Roads and Traffic Authority: Sydney. 23. Lalande, S, F Lagault, and J Pedder. in 18th Enhanced Safety of Vehicles Conference. 2003. Nagoya, Japan. 24. Bilston LE, Hatfield J, Finch C, Brown J “Restraint usage by Australian children – what are they using and why?” Proceedings 2006 Road Safety Research, Policing and Education Conference, October, Gold Coast, Queensland, 7p. 2006 25. Edwards SA, RWG Anderson, TP Hutchinson “A survey of drivers’ child restraint choice and knowledge in South Australia” CASR012 Centre for Automotive Safety Research, The University of Adelaide May 2006 pp44 26. Charlton, J., Koppel, S. Fitzharris, M. Congiu, M. & Fildes, B “Factors that influence children’s booster seat use” MUARC Report 250 pp93 April 2006 27. Desapriya, E.B.R. Iwase, N, Pike, I, Brussoni, M. Papsdorf, M Child motor vehicle occupant and pedestrian casualties before and after enactment of child restraint seats legislation in Japan. Inj Control Saf Promot. 2004 Dec;11(4):225-230 28. Brown J, Paine M, Paine D, Kelly P, Griffiths M, Magadera N. Haley J. Case M “Revised assessment protocols and scoring methods for the Australian child restraint evaluation program” 20th ESV Conference, pp10 Lyon 2007 29. Bilston L E., Yuen M, Brown J “Bilston LE, Yuen M, Brown J “Reconstruction of Crashes Involving Injured Child Occupants” NSW Motor Accidents Authority Research Report,pp53, 2005 30. Bilston LE, Yuen M, Brown J “Reconstruction of Crashes Involving Injured Child Occupants: The Risk of Serious Injuries Associated with Sub-Optimal Restraint Use May Be Reduced by Better Controlling Occupant Kinematics” Traffic Injury Prevention, 8 (1 ): 47 – 61, 2007
412
City Of Stirling child car restraint fitting, installing and demonstrations Heidi Stewart City of Stirling In Western Australia, transport related injury is a leading cause of death and serious injury in children aged 0-14 years (Injury Control Program, 1997). In Western Australia between 1993 and 2003 an average of nine child passengers died each year, 186 were hospitalised and 200 presented at Princess Margaret Hospital for Children with injuries from vehicle crashes. The effectiveness of restraints preventing death and injury of infants and children can be impaired if the use of restraints are not installed correctly, use of damaged restraints and not appropriate for the size and weight of the child. A survey by Kidsafe in Western Australia (1998) found that 62% of child car restraints were fitted incorrectly. In 2006, the City of Stirling developed a Child Car Restraint Fitting and Checking programme to focus on enhancing road safety for infants and children. This project recognised and addressed the need to: • Increase community knowledge of the effectiveness of appropriate child restraints in preventing death and injury; • Increase the ability of parents/guardians to choose restraints that are appropriate for the size and weight of their child; • Improve the skills of parents and carers to correctly install their appropriate and safe child car restraint in their motor vehicle • Provide a regular bi-monthly checking station to residents to ensure child car restraints are installed and fitted correctly This paper will examine the need for a Child Car Restraint Fitting and Checking Service, the evaluation of the project and discuss future plans for increasing the sustainability and reach of such a programme.
Background Road transport injury is the leading cause of death in Western Australia for children aged 014 years. It is also the second largest cause of hospitalisation for this age group (Injury Control Program, 1998). From 1993-2003, an average of nine children vehicle passengers died each year, 186 were hospitalised in Western Australia and about 200 presented to the Emergency Department of Princess Margaret Hospital with injuries received in vehicle crashes. Many child injuries and fatalities in vehicle crashes could be prevented through the appropriate use of child restraints. A major risk factor for children is the incorrect fitting of a child car restraint (Henderson, 1994). A survey undertaken by Kidsafe WA (1998) indicated that 62% of child car restraints were fitted incorrectly. This supports US studies where they found that a large number of children were occupying car seats that were not installed correctly (e.g. Anonymous, 1995, 1998; Decin & Knoebel, 1997). It is therefore seen that any intervention to increase the use of child car restraints must also consider increasing the incidence of correct fitting.
413
Studies indicate that there are several primary reasons for non-use of child car restraints. These include inadequate access to child restraints (Injury Control Program, Health Department of WA, 1998), lack of knowledge about which child car restraint to use, parents being forgetful or are in a hurry to get somewhere, too many passengers in a car, and short journeys (Gielen et al., 1984; Margolis et al., 1992; Webb et al., 1988). Children aged from 3-14 years have the lowest restraint use (Webb et al., 1988) and children at 4-6 years of age are likely to find car restraints uncomfortable (Road and Traffic Authority Road Safety Bureau, 1991). Significant increases in child car restraint use and in adult seatbelt use have been observed when children are rewarded when their parents are reminded to restrain them in vehicles (Bowman et al., 1987, Roberts & Fanurik, 1986, Roberts & Layfield, 1987). Non-use of restraints is a major contribute to road trauma, although it is recognised to be very effective is reducing death and severe injuries in a crash. In WA in 2002, 22% of vehicle occupants who were killed in a police attended road crash were known not to be wearing a seatbelt. The Western Australian Road Safety Strategy "Arriving Safely" focuses on those issues and actions with the greatest potential to reduce road trauma as proven by significant research. It has identified that "not using seat belts and child restraint is a major contributor to road trauma despite their proven effectiveness in preventing deaths and serious injuries" (Road Safety Council of Western Australia, 2003, p. 16). The strategy states that public education about the importance of correct fitting of child restraints, the implementation of state-wide education and checking system for the use of fitted child restraint and encouragement of local communities to have regular child restraint fitting checks will contribute to a reduction in road trauma on WA Roads by increasing restraint use by the population (Road Safety Council of Western Australia 2003, p.16). A report by Turner et al (2005) found in a systematic review of the literature that there was some evidence that community-based programmes for increasing child safety restraints and or reducing motor vehicle occupant protection are effective. Of the eight programmes evaluated, three reported considerable improvements with either injury outcomes or increased use of car restraints. Another study found the same reduction in injury rates in the intervention community and limitations in the evaluation methodology of the other four programmes required their results to be interpreted with caution (Turner et al 2005) Kidsafe WA first piloted Child Car Restraint Checking in 1998 which lead to the development of the BankWest Rural Child Restraint Programme and periodic Free Child Car Restraint Checking Stations conducted by RoadWise Committee's. In 2001 periodic free checking stations ceased whilst the establishment of the training for Type 1 fitters was developed, however community demand for the service was so strong that Kidsafe developed a centre based child car restraint fitting and checking service. Kidsafe WA recommended that a state-wide network of authorised fitting stations were required to meet community demand for child restraint checking and fitting, but there is a need for appropriate training of fitters, quality assurance of authorised fitting services and overall coordination by a body that holds knowledge, expertise and skills in the content area (Wicks & Leeds). The BankWest Rural Car Restraint Project was implemented in 1999 and aimed to reduce the mortality rate and severity of injury due to non-restraint use in rural WA drivers and passengers. Specific to child car restraints the project aimed to increase the compliance of parents with restraint use, increase parents knowledge about appropriate restraints, increase
414
use of child car restraints and increase the number of child restraint in cars that are installed correctly. Strategies used to meet these objectives included parent education and the provision of information in appropriate locations, implementation of a child car restraint checking service and an incentive campaign that rewarded adults and children for wearing a restraints. These strategies were based on evidence that information and education strategies would be seen as supporting those strategies shown to be more effective at increasing restraint use such as enforcements, incentives and child restraint checking services. Whilst outcome measures have not been reported the project was effective in that it achieved positive self-reported behaviour change in parents reached (Coastal & Wheatbelt Public Health & Injury Control Program 2000) In 2005 the establishment of accredited training for Type 1 fitters was finalised and implementation began. The City's Road Safety Advisory Committee identifies the fitting of child car restraints as a priority area for action and has included the activity in their 2005/06 Action Plan. As a result the committee has designed the current programme for implementation during 05/06 (City of Stirling 2004). A survey commissioned by Kidsafe NSW, identified incorrect fitting of restraints as a major risk factor for injury involved in road crashes. In 1997 a survey by Kidsafe Act, found that 80% of child restraints incorrectly fitted to the car and in 1998 a survey by Kidsafe WA found that 62% of child restraint were fitted incorrectly. In 1997 the Health Department of WA conducted an observational survey of child restraint use in 33 sites in both rural and metropolitan WA . The study showed that although 80% were wearing restraints correctly 20% were not. In the event of a vehicle crash, the poorly fitted or adjusted restraints is likely to result in the infant/child impacting with parts of the vehicle interior with resulting impact injuries. There is also the possibility that the infant/child may slide down through the seatbelt which can result in strangulation injuries and in injuries to the head, spinal cord and body. The infant/child may also be completely ejected from the restraint. (Child Car Restraint Manual, 2005)
Introduction The City of Stirling have conducted their own programmes on combating road safety for infants and children. A series of programmes have been run and are increasing to meet demand and new objectives. In 2005 the establishment of accredited training for Type 1 fitters was finalised and implementation began and the City of Stirling’s Road Safety Officer became an accredited Type 1 Fitter. The City of Stirling then established their first formalized Child Car Restraint Fitting and Checking programme, running bi-monthly for the City of Stirling residents. The programme, a year on, can now run on word of mouth and in-house produced flyers to surrounding hospitals, anti-natal classes and baby retail and hire stores. Demonstration workshops are also conducted for mothers groups, playgroups and at kindergartens. These are particularly successful in highlighting the importance of a correctly installed child car restraint.
415
Joining with surrounding councils has also been successful in providing additional checking and fitting events, joining the councils, and allowing longer events to occur. Four councils, including the City of Stirling have joined together to conduct annual checking events in each respective council. Child Car Restraint programmes are incredibly effective and needed, and can continue to be increased in sustainability and reach.
Objectives • • •
To increase knowledge in parents and carers about appropriate use of child car restraints for their children's weight and size. To improve the skills of parents and carers so that they are able to correctly install their appropriate and safe child car restraint in their motor vehicle To increase the use of safe child car restraints which are attached to safe anchorage points by parents and carers.
The objective of the project is to increase the number of parents and carers who use appropriate, safe and correctly fitted child car restraints, by holding regular fitting activities for residents of the City of Stirling. This meets the WA State Road Safety Strategy “Arriving Safely” in a number of areas in Increasing Restraint Use.
Target Public • • •
Parents and careers of young children under 32kg who need to be in a restraint Children Service Provider Employees Managers and Owners Expecting parents
Methods used Bi-monthly fitting and installing programme The City of Stirling holds twice monthly checking and installing appointment days. Additional checking and installing is available as per demand for agencies involved with child care, health, socialisation and education. All services were conducted to meet the requirements outlined in the Type 1 Child Car Restraint Fitting Manual and as such a copy of the checklist completed with all restraints checked was sent to the Child Car Restraints Project Officer at RoadWise, WA Local Government Association. Demonstrations and Workshops Educational presentations at child services facilities, events, community groups and playgroups to demonstrate the safety points and the correct fitting of child car restraints, through using a physical restraint and educational tools. This enables the workshop to be interactive and hands on, allowing a wider understanding by using verbal and demonstration as communication tools. The method in physically demonstrating a correct
416
child car restraint is effective with groups that are culturally diverse, and parents who are more task/action orientated rather than audio. The diversity is reflected, as the workshop can be adapted to each target audience. Through the practical workshops families gain an increased understanding on correct restraint usage and installation to ensure the wellbeing of children working with residents in the City of Stirling.
Joint child car restraint project This project promotes and run four annual free child car restraint fitting and checking events combining the four councils. The checking runs from 9-12pm for four days in the year, each council supplying a location each year. The four councils are working together to contribute to a reduction in the number of children killed and seriously injured as a result of traffic crashes. Through checking child car restraints we are increasing the number of parents and carers who use appropriate, safe and correctly fitted child car restraints.
Promotion Promotional resources included newspaper advertising in three community newspapers, which are distributed in over 30 suburbs in the metropolitan area. (Appendix 1). Council websites media releases for respective local newspapers, in-house promotion and public relations activities were utilized Corflute signage was used as directional and promotional signage (Appendix - 6) Brochures and Litter bags were also produced as promotional items (Appendix – 7 and 8) A tool kit was purchased to aid our checking and installation at the checking events, including spanners, anchorage fittings, extension straps and a H harness. Flyers for the Demonstration workshops were produced in-house and distributed to all relevant contacts (Appendix 9)
Evaluation Appropriate evaluation is an essential requirement of any road safety project, an evaluation linking directly to the objectives was developed in the early planning stages. The evaluation plan is as follows Process Evaluation • • • •
Record the number of parents and carers attending the events including number of child car restraints fitted and checked at the events To record the title and number of educational materials that are distributed to parents and carers Record copies of advertising in local newspapers Record for each appointment how they were made aware of the service
417
• • • • • • • •
Record the number of posters distributed and their locations Record the number of promotional material distributed Keep copies of the information placed on the councils websites To record the total number of restraints checked over 12 month period Record the of referrals to the Child Restraints Information Line Keep a hard copy record of the Child Car Restraint Fitting Service Checklist and record the faults found Record the number of faults found Record the number of unsafe restraints and anchorage points identified during fitting activities.
Impact Evaluation •
• •
Questionnaire distributed to all parents are carers who have their child car restraint checked with a true and false section to measure parents knowledge about appropriate child car restraint use. Collate details collected in the Child Car Restraint Fitting Service Checklist regarding appropriate restraint use Questionnaire distributed to all parents and carers who have their child car restraint checked that measures the benefits of the service and event and satisfaction of the client
Results Results as follows are to date, and will alter as the programmes continue. The programme has been running for over a year allowing concurrent results. Of the total amount of child car restraints checked, 36% of child car restraints were unsafe. This included, incorrect anchorage point used, restraint over 10 years old, restraint not of Australian Standards, wrong seat belt path, top tether and harness strap twists (see Figure 1).
Figure 1: Child car restraints checked and fitted.
418
Of the total amount of child car restraints fitted and checked in the localised child car restraint programme, 56% of child car restraints were installed by the City of Stirling Type 1 Fitter with the remaining 44% checked (see Figure 2).
Figure 2: Unsafe restraints.
The most effective form of promotion for the campaign was newspaper advertising, initially. Once the programme has been running for a year, in-house produced flyers distributed to baby retail stores, hospitals and anti-natal classes are the best form of advertising.
Discussion 56% of parents would rather their child car restraint fitted by a professional, demonstrating the need for a child car restraint fitting and checking programme. Of the 44% of child car restraints that were installed by parents and checked through the programme, 36% of restraints were recorded as unsafe. The cost of child car restraints is also an issue and is likely to be a constraint in buying them. The issue of affordability of child car restraints and resultant lower usage of child car restraints in the age group 4 – 6 has been raised in previous research (Health Department Report, 1997). Continuing the current programmes and increasing to improve and research new projects to focus on infant safety is imperative.
Next steps The City of Stirling is seeking to acquire funding for a project to allow child car restraints available to those from low socio-economic areas in the council; Increase the amount of Type 1 Fitters in the City of Stirling, including experts from CaLD (Culturally and Linguistically Diverse) backgrounds; and Create demonstration cards, translated into various languages for installing restraints. Increasing restraint use is a key priority outlined in the WA Road Safety Strategy. The City of Stirling has been running a successful child car restraint programme for a year. Every first
419
and third Monday of every month the City’s Road Safety Officer checks and installs child car restraints. These days are fully booked at least two weeks in advance and the catchment of the parents attending are from selected areas of the City of Stirling from affluent backgrounds. This project aims to improve access to child car restraints in the remote areas of the City of Stirling and increase knowledge on the importance on correct fitting of child restraints. We also wish to improve the sustainability of a child car restraint education and checking system by increasing the number of certified Type 1 Fitters in the City of Stirling, including those working with CaLD communities and effectively reach local communities. The project is needed in our community to improve the knowledge of parents and carers installing a child car restraint. Education must be provided to parents on how to correctly install and to provide confidence and assurance to re-install their child car restraint. The City of Stirling holds a high amount of parents from CaLD backgrounds and this education will be provided to these parents also, through culturally specific demonstration cards. The demonstration cards will help parents with step-by-step instructions to follow the correct installation of their child car restraint. By increasing the amount of certified Type 1 Fitters in the City of Stirling the population will be effectively be reached by both increasing the amount of certified fitters and including fitters from a range of cultural backgrounds. By increasing the availability of child car restraints to parents will address the issue of incorrectly or unused restraints for children for those with lower incomes.
In summary The City of Stirling Child Car Restraint programme aims to contribute to a reduction in the number of children killed and seriously injured as a result of traffic crashes by increasing the number of parents and carers who use appropriate, safe and correctly fitted child car restraints through education and promotion strategies and a child car restraint fitting and checking service. The City's Road Safety Officer has successfully attended the Child Car Restraint Type 1 Fitters Training Course conducted by RoadWise and it a registered Type 1 Fitter. The City formalised a child car restraint fitting and checking programme by holding twice monthly checking appointment days and conducting checking stations and education presentations at child services facilities and events. This resulted in devoted checking days and checking being made available as per demand for agencies involved with child care, health, socialisation and education. The Department of Community Development funded a demonstration restraint for the City of Stirling’s Road Safety Officer to conduct demonstration presentations on the importance of restraints and how a restraint works. The City of Stirling, joined with the Town of Cambridge, City of Subiaco and the Town of Vincent to promote and run four annual free child car restraint fitting and checking events combining the four councils. The objectives of such programmes were to:
420
• • • •
Increase community knowledge of the effectiveness of appropriate child restraints in preventing death and injury; Increase the ability of parents/guardians to choose restraints that are appropriate for the size and weight of their child; Improve the skills of parents and carers to correctly install their appropriate and safe child car restraint in their motor vehicle Provide a regular bi-monthly checking station to residents to ensure child car restraints are installed and fitted correctly
Through the programme it was shown that such a programme is in high demand. This was evident through the high amount of bookings, client satisfaction, 56% of the restraints being fitted and 36% of the restraints checked being unsafe. Recommendations • •
•
•
Replication of this programme is recommended in other areas to increase the safety of children Local government representatives, Child care centre staff, maternity hospital staff, child restraints retailers should be encouraged to become Type 1 Fitters and refer parents to Type 1 Fitters. Brochures and information leaflets on child car safety and age appropriate restraints should be available through local schools, kindergartens, playgroups, mothers groups, hospitals, anti-natal classes, child health centres, baby retail and hire stores and child care centres. Increase a focus on CaLD (Culturally and Linguistically Diverse) communities in education the importance of correctly fitted child car restraints.
Acknowledgments Funding for the City of Stirling Child Car Restraint Project project was provided by the Community Road Safety Grants Programme, administered by RoadWise on behalf of the Road Safety Council and the National Safety Council of WA Trust Fund (administered by the RAC). Funding for purchase of demonstration restraint was provided by the Department for Community Development. I would also like to acknowledge the strong support and active participation of Dianella Child Health Centre, Mirrabooka Community Health Centre, Hamersley Child Health Centre, Inglewood Child Health Centre, Happy Days Playgroup Inc., BabyWest Balcatta, DL CaLD Ref Group, Toys R US, City of Stirling Road Safety Advisory Committee, St John of God Hospital, Osborne Park Hospital, Scarborough Child Health Centre, Kidz Kingdom, Smith’s Lake Precinct, Department of Health, Pram City’s Baby Discount Centre, Scarborough Primary School, Mirrabooka Police Station, City of Stirling Women’s Refuge, Granny Apples Child Care Centre, Edmund Rice, Mirrabooka, Balga Primary School, Wanslea Family Centre, Mirrabooka Migrant Resource Centre, Centrelink, RoadAware, Town of Cambridge, City of Subiaco, Town of Vincent and many more people and organizations that have committed their time and effort this project.
421
References Anonymous. (1995). Child safety seat changes. Consumers Research Magazine, 78, 6. Anonymous. (1998). Kentucky mirrors national trend in misuse of child safety seats. Nations Health, 28, 7. Anonymous. (2003) Type 1 Child Car Restraint Fitting Manual Bowman, J. A., Sanson-Fisher, R. W. & Webb, G. R. (1987). Interventions I pre-schools to increase the use of safety restraints by pre-school children. Pediatrics,79, 103-109. Coastal & Wheatbelt Public Health & Injury Control Program Health Department of WA (2000). BankWest Rural Car Restraint Project. September. Health Department of WA Decina, L. E. Knoebel , K. Y. (1997). Child safety seat misuse patterns in four states. Accident Analysis & Prevention, 29, 125-132. Gielen, A. C., Eriksen, M. P., Daltroy, L. H. & Rost, R. (1984). Factors associated with the use of child restraint devices. Health Education Quarterly, 11, 195-205. Henderson, M. (1994). Children in car crashes: An in-depth study of car crashes in which occupants were injured. Child Accident Prevention Foundation of Australia (New South Wales). Injury Control Program (1997). Child car restraint use in W.A. December. Disease Control, Health Department of Western Australia. Injury Control Program (1998). Report on the Kimberley child car restraint project. Phase 1 Retail and community availability. Disease Control, Health Department of Western Australia. Kidsafe WA (1998). Free child restraint checking service: Report of findings. September. Margolis, L. H. Wegenaar, A. C. & Molnar, L. J. (1992). Use and misuse of automobile child restraint devices. American Journal of Disease of Children, 146,361-366. Road and Traffic Authority Road Safety Bureau (1991). A study of Non-English speaking background attitudes and knowledge about seat belts and child restraints. Consultant report CR2/91. Road Safety Advisory Committee, (2004) City of Stirling Road Safety Advisory Committee 2005/06 Action Plan. Turner C, McClure, Nixon J, Spinks Anneliese (2005). Community based programs to promote car seat restraints in children 0-16 years – a systematic review. Accident Analysis and Prevention, 37, 77-83. Webb, G. R., Sanson-Fisher, R. W. & Bowman, J. A. (1988). Psychosocial factors related to parental restraint of pre-school children in motor vehicles. Accident Analysis and Prevention, 20, 87-94. Road Safety Council of Western Australia. 2003, Arriving Safely: Road Safety Strategy for Western Australia 2003-2007, Office of Road Safety, Perth, Western Australia. Wicks & Leeds (2003) Operating a Child Car Restraint Fitting Service in Perth Western Australia, Paper presented at the 2003 Road Safety Research, Policing and Education Conference, Darling Harbour, Sydney, Australia.
422
Appendices 1. 2. 3. 4. 5. 6. 7. 8. 9.
Newspaper Advertising Poster for localised events Poster for joint event Flyer for localised events Flyer for joint event Corflute signage Brochures Litter bags Flyers for Demonstration workshops
423
Appendices 1. Newspaper Advertisement
2. Poster for localised event
3. Poster for joint Event
424
4. Flyer for Localised Event
5. Flyer for joint Event
6. Coreflute signage
425
7. Brochure
426
8. Promotional Litter Bag
9. Flyer for Demonstration workshops
10. Photographs
427
428
Rear seat occupant safety Michael Paine Vehicle Design & Research Julie Brown, Lynne Bilston Prince of Wales Medical Research Institute, University of New South Wales Michael Griffiths & Nimmi Magadera Road Safety Solutions More than half of the occupants of rear seats in cars and other light passenger vehicles are children and yet most rear seats appear to be designed for large adults. Where a child seat or boosters seat is not used, the seat dimensions often result in the child slouching forward so their knees reach the seat edge. This causes the lap portion of the seat belt to ride up into the abdomen region, with greatly increased risk of internal injuries in a crash. Rear seat belt geometry is also rarely optimal for children, with the sash portion either falling off the shoulder or crossing the neck. Rear seat belt systems are not as advanced as modern front seat belt systems. Seat belt pretensioners, load limiters and height adjustable upper anchorages are extremely rare. In theory the rear seat should be the safest location in the vehicle but, in practice, the benefits are not as great as they could be. Indeed, a US study found that occupants older than 50 years were safer in the front seat due to the risk of thorax injury from rear seat restraint systems. There are no regulations that test the dynamic performance of rear seat restraint systems and only infant dummies in child restraint systems are located in the rear seat for NCAP crash tests. We present a case for including a small adult or large child dummy in NCAP frontal crash tests.
429
About 10% of crashed vehicles in the USA have rear seat occupants and more than half are children. I will be briefly reviewing the research into the safety of these rear seat occupants. What do regulations require? Do New Car Assessment Programs (NCAP) assess rear occupant protection? Anthropometry Accident studies Crash research
*Vehicle safety regulations do not require a dummy in the rear seat for dynamic test of the restraint system *Rear seat belt anchorage location and seat belt strength mostly based on 1970s research *No requirement for 3 point seat belt in centre rear seat
430
*Euro NCAP and ANCAP have child dummies in child restraints for crash tests - but no assessment of compatibility between vehicle and child restraint or ease of installation. *IIHS has 5% female dummy in rear seat for side impact tests but not frontal test. The IIHS test is the only one that looks at side impact protection for adults in rear seats. Other NCAPs should look at this test. * NHTSA and Japan NCAP looking at adult dummies in the rear seat
This chart shows child height vs weight. The US recommendation is that children should use a booster seat until they are 145cm tall. Children over 26kg are too heavy for current Australian booster seats but most are too short for correct use of an adult seat belt. As you will hear in a later talk, the Australian booster standard is being reviewed to cater for larger children but there will still be a gap in optimum protection.
431
Children between 7 and 10 years of age are using seat belts without boosters and so are suboptimally restrained
* Research shows that all car rear seats are too deep for most children and many are too deep for small adults. This chart shows the seated knee length for children and the results of surveys of typical car seats *Too short a seat results in a slouched seating position *Lap portion of seat belt rides up, risking abdomen injury *MRI have also found problems with the sash belt falling off the shoulder or rubbing the neck
432
ANCAP could assess the seat and seat belts for older children or small adults, based on PoW MRI research and encourage better geometry. Discourage lap-only seat belts.
Volvo recently announced this optional rear seating system. It can be adjusted to two heights and the cushion depth suits child. NCAPs should give recognition to such innovative systems.
433
To encourage more appropriate restraint use for older children a ride-height line for car rear seats has been suggested. Children and adults are familiar with similar systems at amusements parks and it is easier to reason with a child if there is a physical indicator.
This chart shows that for most age groups the rear seat is about 50% safer than the front seat - this can be expected because the survival space is less likely to be compromised in the rear. However, recent accidents studies have found that people over 50 are much more likely to suffer serious chest injuries in the rear seat than the front seat. The main cause of these injuries is loading from the seat belt (but they are still much better o! than having no seat belt).
434
There have been several major features that have reduced the risk of injury to front seat occupants over the last 15 years, aside from the obvious front airbag. 1. A pretensioner in the retractor associated with the sash portion of the seat belt tightens the seat belt and reduce the jarring loads due to slack 2. A pretensioner in the buckle assembly reduces slack in the lap portion of the seat belt and helps the seat belt engage the pelvic bones. 3. Load limiters that are usually built into the retractor, allow some controlled payout of the webbing to help limit the maximum loads applied to the chest by the seat belt 4. The structure of the seat base is designed to engage the dummy thighs and take some of the forward forces. This also reduces the risk of submarining.
It is worth looking at anti-submarining in more detail. The dummy hips have rotated, allowing the lap belt to ride over the pelvic bones and load the abdomen - a dangerous condition. The antisubmarining pan in most front seats helps to prevent this motion. Here is a seat pan that has been loaded in a crash. A few vehicles have this type of seat pan in the rear seat. Most don’t and occupants are exposed to unnecessary risk of abdomen and spinal injury.
435
Without pretensioners, load limiters and anti-submarining seats the seat belts loads for rear seat occupants are often noticeably higher than those for the front seat. As a result, dummy chest deflection tends to be higher for the rear seat occupant. Older occupants are more susceptible to these high chest deflections, as evidenced by the US accident statistics. However, they also put younger occupants at unnecessary risk.
This is the 64K offset crash test, conducted in Australia, Europe, Japan and the USA. Australasian NCAP could replace one of the two rear-seat child restraints with a small adult female dummy. Injury risk, lap-belt positioning and tendency to submarine could be then assessed and a rear seat occupant rating published. The photograph is from a research test undertaken by Japan NCAP and it is likely that they will soon include the adult dummy in the rear seat. With current rear seat restraints there is a risk that the rear seat dummy will slip out of the seat belt and strike the occupant in front. This would render the front dummy injury measurements unusable. For this reason it may be best to locate the dummy on the passenger side since the front passenger dummy is less important in this type of test.
436
Increased hospitalised abdominal and spinal cord injury risk by age in child motor vehicle passengers in New South Wales Wei Du NSW Injury Risk Management Research Centre, University of New South Wales Julie Hatfield, NSW Injury Risk Management Research Centre, University of New South Wales Lynne Bilston Prince of Wales Medical Research Institute, University of New South Wales Caroline Finch School of Human Movement and Sport Sciences, University of Ballarat Andrew Hayen School of Public Health, University of Sydney, NSW Australia
437
438
439
440
441
442
443
444
The Australian Program
Child
Restraint
Evaluation
Basuki Suratno, Soames Job, Dan Leavy NSW Centre for Road Safety, Roads and Traffic Authority Julie Brown Prince of Wales Medical Research Institute, University of New South Wales Michael Paine Vehicle Design & Research Nimmi Magedara, Paul Kelly, Michael Griffiths Road Safety Solutions Jack Haley NRMA Motoring & Services Michael Case RACV A consumer information based child restraint evaluation program has been operating in Australia since 1992. The underlying philosophy is to influence consumers and to provide motivation for manufacturers to market products that are at least equal to the best currently available, and that offer protection above the minimum requirements of the Australian Standard for child restraints (AS 1754).The assessment and evaluation procedures used in this program were recently reviewed and as a result, the assessment protocols and scoring methods have been significantly enhanced. This paper presents the revised assessment methods currently being used in the Australian Child Restraint Evaluation Program and presents representative results from the most recent series. These results indicate a number of areas where specific attention to improvements in the packaging and design of child restraints would be warranted. These include features related to reducing the likelihood of misuse and the level of protection provided in crashes. In particular the results suggest there is substantial scope for improving the performance of convertible child restraints and booster seats. The importance to the program of ensuring CREP results are readily available to consumers and encouraging consumers to use this information in making their purchasing decisions in also discussed.
445
Background A consumer based child restraint evaluation program (CREP) had been operating in Australia since 1992. The Roads and Traffic Authority of NSW (RTA), the National Roads and Motorists Association (NRMA) and the Australian Consumers’ Association (ACA) combined their resources to design and implement the initial child restraint evaluation program. This was the first time a consumer based strategy had ever been applied to child restraints. Up until the late 1980’s, the Australian market for child restraint systems, particularly forward facing child seats, was dominated by locally developed Australian made products. Because they were locally based, these products were designed to do well and were tested against the requirements of the Australian Standard, which, because it has had top tether availability in new vehicles since 1976, was able to demand higher performance requirements than overseas products. In the late 1980’s, a variety of developments in the child restraint industry indicated that there was a possible trend toward the use of imported products which were adapted to satisfy the requirements of the Australian Standard. Road safety authorities and child safety stakeholders foresaw that a possible outcome of this was that there could be a shift in protection offered by product. The likely shift was from locally developed product which exceeded the Australian Standard by considerable margins, to adapted imported product which could meet the local Standards with lower margins. Such a development had the potential to reduce the overall level of protection offered to children in crashes. This was a matter of considerable concern to the New South Wales Roads & Traffic Authority, and based on their recent experience with the adoption of a consumer program for car safety (known as the Australian New Car Assessment Program, NCAP), it appeared that their best chance to prevent such a development was to establish a consumer program for child restraint systems which could provide science based information to consumers on which child restraints offered the highest level of protection in dynamic tests simulating crashes, and which were the easiest to use. The underlying philosophy of CREPs to influence consumers and to provide motivation for manufacturers to market products that are at least equal to the best currently available, and that offer protection above the minimum requirements (in this case Australian Standard for child restraints: AS 1754). Assessment of dynamic performance in simulated impacts more severe than that required by the Australian Standard, and more stringent assessment criteria than the requirement of this Standard have been a vital ingredient of the program since its inception. By assessing performance at levels beyond that required by the standard, variations in the performance of the restraints on the market become clear. Evidence from the field clearly shows that a restraint must be used correctly for the highest levels of protection to be achieved. Further more, misuse of child restraints is a common problem [512]. Reducing the propensity for misuse through improved restraint design is therefore a priority. In acknowledgement of this, since its inception CREP has also included an assessment of the ease of use of restraints on the market. The first iteration of this program comprised of three assessment units; an assessment of dynamic crash performance, for which the RTA took responsibility; an evaluation of ease of installation and use, the trials for which were designed and conducted by the ACA; and an
446
assessment of vehicle compatibility, which came under the control of the NRMA. Since the initial program, the assessment methods have evolved significantly. Over the last few years, the value of using this type of program to drive improvements in the level of protection provided to children in cars has been recognised by lead road safety agencies in North America and Europe. The Insurance Corporation British Columbia (Canada), the USA’s National Highways Traffic Safety Administration, (NHTSA) and the Consumer Union (CU) (a North American organisation), developed more advanced ease-ofuse assessment models for CRS assessment [2,3]. This development, together with concerns that the CREP dynamic performance assessment may not be keeping pace with the Australian New Car Assessment Program (ANCAP) led to a review of the CREP assessment procedures in 2005. The outcome of this review were more comprehensive and less time consuming ease-of-use assessment protocols, and a revised dynamic test protocol with innovative scoring protocols [4]. Australia is currently the only country in the world using such sophisticated assessment protocols for both ease of use and dynamic assessment of child restraints. This paper briefly describes these assessment protocols and scoring methods. Exemplary results obtained using these protocols are also presented demonstrating the variation in performance that currently exists in child restraints on the Australian Market. These types of variations highlight the scope for improvement in the design of Australian Child Restraints.
Methodology Dynamic Test The performance of each child restraint was assessed in a series of frontal and side impacts. Performance was measured against criteria set out in the dynamic assessment protocols. These include a selection from the dynamic test requirements of AS/NZS 1754-2004 and the unique requirements developed specifically for CREP. Full details of these criteria can be found at http://tinyurl.com/29me5k. A horizontal crash sled was used to produce the deceleration pulses. Frontal Test In past CREP assessments, two frontal impacts were conducted, one at the same severity as the Australian Standard (49km/h, 20g), and one at a higher severity of 56km/h and 34g. In the first series of CREP, all restraints were subjected to both tests. However in all previous series since then, booster seats have been excluded from the higher severity test due to concerns regarding the robustness of the test dummy. Booster cushions (i.e. booster seats with no back) have not been included in the program since the first series of CREP. Review of results obtained from these earlier evaluations found no worthwhile information was being gained from the lower severity frontal impact test. As a consequence the 49km/hr test has been dropped, and all restraints, including booster seats, are now subjected to the 56km/h test with a 34g pulse. Dummy choice in the frontal test is based on the mass of the dummy being equal to or above the upper end of the mass limit for each type of restraint. The TNO P3/4 (9kg), a surrogate for a 9 month old infant, is used for rearward facing restraints with upper mass limit of 9kg; the TNO P11/2 (11kg), a surrogate for an 18 month old child, for rearward facing restraints
447
with upper mass limit of 12kg; the TNO P6 (22kg), a surrogate for a 6 year old child for forward facing restraints (upper mass limit of 18kg); and the TNO P10 (32kg), a surrogate for a 10 year old child, for booster seats (upper mass 26kg). The sled was calibrated in accordance with AS 3629.1 to produce a deceleration pulse as near as practicable to the maximum (34g) allowed by AS 3629.1 and a velocity change of 56 km/h. Side Impact Test To date, side impact performance in CREP has involved subjecting child restraints to two simulated side impacts: one test at 90o and another at 45o. The pulse used is the same as that required by the Australian Standard. To increase the severity of the test, a simulated side door structure was positioned adjacent to the test seat. The door structure replicates a simplified rear door of a sedan, in shape and size, and is static. Since the last CREP series and prior to the review of assessment procedures, the Australian Standard test methods and performance requirements in side impact were modified to also include the side door structure. This differs from the CREP door in that a poly carbonate inner door skin replaces the metal one used in CREP. Except for this detail, the 90o CREP side impact test now replicates the Standard test. The Standard also now requires all restraints (other than booster cushions) to prevent head contact with the door. However for forward facing restraints and booster seats, the dummies specified by the Standard represent children at the lower end of the CRS size range, in terms of seated height. For this reason, the 90o test continues to be included in the CREP assessment, but the dummies used are chosen to better represent the seated height of children at the upper end. For forward facing restraints, tests are conducted with a TNO P3 the seated height of which was modified to 605mm, representing a 4 year old. Similarly, the booster seats were tested with the seated hight of a TNO P6 increased by 40 mm, representing a 50th percentile 8 year old. Assessments were made on the absence or presence of head contact as well as the degree of head containment. During the review of the original procedures, the 45o test was also found to be providing limited information useful in discriminating between the performances of the restraints. As a consequence, the 45o test has been replaced with one that more closely resembles a US NCAP side impact - that is at 66o. The same dummies and performance aspects assessed in the 90o test are used in the 66o. All restraints are subjected to both these tests. Booster cushions (i.e. boosters without backs) remain excluded from CREP assessment. At this stage, the side impact test pulse remains at 32 km/h and 17g as per the requirements of AS 3629.1. Review of recent Australian NCAP side impact data suggests that this is an adequate severity. Precautions were taken to minimise the effects of the sled’s motion on the dummy and the device being tested, as the sled accelerated away from rest, without modifying the way in which the device operated, nor the response of the dummy to the test pulse. Scoring Protocol In earlier versions of CREP, ranking and scoring of results consisted of, “preferred buy” ratings being given to a number of devices in each restraint type category. These were awarded to restraints that performed well in a number of areas; however the method was
448
relatively subjective. The recent review of the program determined that there was significant scope for development of a more objective rating system that included formal documentation of objective protocols. A ratings system similar in methodology to the system being used in the ease of use assessment (and based on the method used by NHTSA) was therefore developed. The features being assessed in the dynamic component are divided into a set of performance categories. Within each category, there are a set of items or individual Performance Aspects (PA). Each PA has been given a weighted factor between 1 and 4 based on their importance in terms of offering crash protection in the real world. A numerical scale of 4 (good) to 0 (unacceptable) is used to rate the outcome for each PA. Scores for each PA are obtained by multiplying the outcome score by the weight for that PA. Category scores are arrived at by adding the scores obtained for that category and calculating what percentage this is of the maximum possible score for that category. Each category is then awarded an A, B, C or D ranking based on the breakpoints set out in Table 1.
Table 1. Ranking Score Calculations – CREP Dynamic Testing mance Aspect’ Set Score Score m of the ‘PA’ set scores as percentages ‘ set score ≥ 83% of maximum ‘PA’ scores that could be obtained for the divided by the number of sets ≥ 83% set m of the ‘PA’ set scores as percentages ‘ set score < 83% but ≥ 67% maximum ‘PA’ scores that could be divided by the number of sets ≥ 67% obtained for the set but < 83% m of the ‘PA’ set scores as percentages ‘ set score < 67% but ≥ 50% of maximum ‘PA’ scores that could be divided by the number of sets ≥ 50% obtained for the set but < 67% ‘ set score < 50% of maximum ‘PA’ m of the ‘PA’ set scores as percentages scores that could be obtained for the divided by the number of sets < 50% set
These breakpoints have been set on the basis that any device scoring less than or equal to 50% of the maximum score is judged as ‘unacceptable’ and given a ‘D’ ranking. The range between 50% and 100% has then been divided into 3 equal ranges. There is also one limiting rule applied to category and overall rankings. This rule is that if any device receives two or more ‘0’ scores (i.e. an ‘unacceptable’) score that device can not be awarded an A or B ranking for that category or for an overall ranking. Stage 4 of CREP introduced two new Performance Aspects in evaluating CRS i.e. ‘Crash Energy Management – Torso’, henceforth referred to as ‘Torso Energy Management’ (TEM) and ‘Crash Energy Management – Head’ is henceforth referred to as Head Energy Management (HEM), for infant restraints in frontal testing. TEM complements the previous performance aspect of ‘Load Distribution’. Both TEM and load distribution are assessed using the outputs from a tri-axial accelerometer in the dummy’s chest. How well a restraint manages energy in the torso region of a crash dummy is usually only explored using the peak resultant chest acceleration. However, this type of measure does not take into account
449
the duration of the load. A measure that looks at the torso acceleration and the time over which these accelerations are felt would be a much better indication of how well a restraint system was managing the energy in the torso region. For this reason, the algorithm used to calculate HIC36 using resultant head accelerations over a 36ms time interval was used to evaluate the ‘Torso energy Management’ or TEM. Ease of Use Test Review of results from earlier releases of the Australian CREP demonstrated that while substantial comparative information was collected about the ease of use of restraints on the Australian market (showing there were considerable differences between products), little information regarding the outcome of these assessments was actually communicated to the public. Furthermore, the methods used relied wholly upon expert opinion and were not documented in an objective way. Following this review, significant changes were made to the ease of use evaluations and a methodology developed that allows for more objective rating of features weighted on their likely impact on reducing misuse, and the types of misuse that are influenced. This method is heavily based on the current North American ease of use rating schemes [3]. The full details ease of use criteria can be found at http://tinyurl.com/29me5k The protocol is similar to that used by NHTSA [3] with additional assessments of some features and a modified feature assessment ranking. This method requires each feature listed within five ‘categories’ to be assessed individually. The ‘categories’ are: Packaging, Instructions, Labels, Securing/ Releasing the Child, and, Securing/Releasing the restraint within the vehicle (the latter was not used for booster ratings). Good, Acceptable, Marginal and Poor ratings were recorded for each feature according to the criteria set out for that feature, and where necessary additional comments were made. Results were stored within an electronic database. Digital photographs of each restraint and relevant components were taken. Initially, it was intended to use the same scoring protocol as NHTSA [3]. In this method each feature within each category is assigned a weighting factor of 3, 2 or 1 according to risk of injury and severity of misuse. The features associated with the highest risk of severe injury if misuse occurs are given a 3 weighting. A numerical scale is also used to score the assessment outcome for each feature, with 3 points equating to good, 2 points to acceptable and 1 point to marginal and zero for poor. Under the NHTSA method, the two numbers are then multiplied together to provide a feature score (from 9 to zero). The scores within each category are then summed and divided by the sum of the applicable fixed weighting factors to provide a weighted average score. Similarly, an overall weighted average score is obtained by dividing the sum of all feature scores by the sum of all fixed weighting factors. The NHTSA weighted average will always be between 1 and 3 and within this range either ‘C’ ‘B’ or ‘A’ ratings are awarded for scores of < 1.7, 1.7 but < 2.4 and 2.4 – 3, respectively. This approach to scoring had never been attempted in Australia. For this reason, results obtained using this ranking procedure, were carefully examined prior to finalization of the scoring protocol. Early analysis revealed that the "A, B, C" ratings did not usefully discriminate between products. This was contrary to the outcomes from direct observation of restraints during assessment, which identified significant differences. In particular most categories and overall ratings came out a "B" under the tripartite method. To overcome these problems, the weighted average method has been modified to allow A, B, C, and D ratings
450
to be assigned for each category and for the overall performance to be based on a quartile ranking system. In addition, a weighting factor of 4 was introduced to provide for design features that were innovative and effective in reducing the propensity for misuse - in effect a "wish list". An example is "Audible and visual indication that harness is adjusted correctly" (no such devices are available for Australian CRS at this time). Under the NHTSA ranking method the range between the maximum and minimum value (with minimum value being 1/3 of the maximum value) is divided into 3 equal segments. Breakpoints are therefore 80% of the maximum score and above for A, 57% of the maximum score and above for B and below 57% for C. Our modification involves dividing this same range (i.e. range between maximum and 1/3 of the maximum) into four, so that breakpoints become 83% of maximum and above for A, 67% and above for B, 50% and above for C. Anything less than 50% results in a D. In the case of the overall rating, it was decided to assign equal weights to each category, since safety related issues are inherent in the weights assigned to each feature within a category. Therefore an overall percentage was calculated from the average of the category percentages. The overall rating for a mode (forward or rear facing) was based on the same quartile breakpoints (83%, 67% and 50%). For convertibles, an overall rating was based on the worst mode rating. The process for determining scores and ratings is graphically illustrated in Figure 1. Test Specimens Assessments for recent series of CREP (Stage 4) were divided into two phases, Stage 4A and 4B. In stage 4A, 17 makes and models from two manufacturers were evaluated. The restraint systems tested include two rearward facing CRSs (Type A), five convertible rearward facing and forward facing CRSs (Type A/B), three forward facing child restraints (Type B), two convertible forward facing and booster CRSs (Type B/E), and five booster seats (Type E). In stage 4B, the remaining commercially available child restraint systems in Australia were tested. These restraints consist of 14 makes and models from six manufacturers which include five convertible rearward facing and forward facing restraints (Type A/B), one convertible forward facing and booster system (Type B/E), and eight booster seats (Type E). The restraints were selected at random from stock in the manufacturers’ warehouses and retail outlets
Results In this paper, the makes and models of the restraints are withheld but they will be published in the official Buyer’s Guide to Child Restraints in stakeholder websites when ready.
451
Figure 1. Ease-of-use rating process Dynamic Test Frontal Tests Frontal tests were performed on each individual restrain system. The tests were performed at sled speed of 56 km/h and 34g.
452
Rearward Facing Restraints For rearward facing child restraints, eight Performance Aspects (PA’s) were assessed, these include: 1. Head Retention; 2. Dummy Retention; 3. Upward and Rotational Displacement Of the CRS In Rebound; 4. CRS Security and Integrity; 5. Load Distribution; 6. Torso Energy Management (TEM); 7. Head Energy Management (HEM), and 8. Adjuster Slip The first four PA’s are weighted three as they are the most significant measures in protecting the occupant. Load distribution, head energy management and Torso Energy management are assigned weighting factors of two. Adjuster Slip is weighted to one. In head retention, the dummy’s head appeared to be well supported by the restraint throughout the impact phase of the test in all but one of the tests. Video footage analysis showed that pre-impact, the test dummy’s head was completely exposed (See Figure 2). Accordingly, the device was assigned a ‘PA’ score of zero. Each of the remaining devices was assigned the maximum possible score of four.
Figure 2. Head exposure allowed by one of the restraints in frontal test.
453
Eleven out of the twelve devices were able to meet the head displacement requirements of AS/NZS 1754-2004 in this more severe test. The restraint that could not achieve this was assigned a PA score of zero. The extent of upward motion can be seen in Figure 4. Although the remaining eleven devices were able to meet requirement of the AS 1754, the performance of one of the restraints was superior to those of the other devices. This restraint exhibited excellent control over rotation, with the dummy’s head remaining below plane BE in Figure 3 and at least part of the device remaining in contact with the test rig seat cushion, during rebound (see Figure 5). For its performance it was assigned a PA score of four.
Figure 3. Figure 4.1 from AS/NZS 1754-2004 showing head excursion limits.
454
Figure 4. Child restraint showing head upward excursion above the plane CD in Figure 3.
Figure 5. Child restraint showing the best head upward excursion.
455
The remaining restraints allowed the dummy’s head to move within area between planes BE and CD shown in Figure 3. The extent to which head excursion occurred can be seen in Figures 6.
Figure 6. Child restraint showing head upward excursion within area between planes BE and CD in Figure 3.
Forward Facing Restraints A total of 16 forward facing child seats were evaluated in both Stage 4A and 4B. For frontal test, seven performance aspects were assessed in forward facing restraints, which include: 1. Forward head excursion 2. dummy retention 3. Upward Displacement of CRS in Rebound 4. CRS retention and integrity 5. Head Energy Management 6. Operation of Quick Release Device 7. Adjuster Slip In forward facing restraints in frontal crashes, forward head excursion is the most significant performance aspect. This performance describes how well the restraint system manages dummy deceleration and is highly correlated with real world crash protection. For this reason, it is weighted maximum value of four. The remaining PA’s are weighted with the values of three, two and one.
456
No pre-defined limits of head excursion performance were set. Instead, the revised protocols allow for an objective comparison of restraint performance. Head excursion is recorded and scores assigned based on the range of excursions obtained. The best score four (4) is given to that restraint with the minimum excursion, the next best three (3) to those within 50mm of that excursion, and so on. The lowest forward head excursion was recorded 1016 mm as shown in Figure 7 for which it was assigned a score of 3. In Figure 7 the back of the restraint can be seen to be almost parallel to the seat back of the test rig. There were significant differences between this restraint and the poorer performing devices. Figure 8 illustrates one of the poorer performing restraints where there was 100mm more head excursion. In this Figure the upwards rotation of the base of the restraint that underlies the extreme head excursion can be seen.
Figure 7. The lowest measurement of forward head excursion in Stage 4 series.
457
Figure 8. The highest measurement of forward head excursion in Stage 4 series. Similarly, head energy management is scored using the range of HIC36 scores obtained. The range is divided into 3 and the best score given to those devices in the lowest third and the worse score given to those in the highest third. The results are shown in Figure 9.
Figure 9. HIC values for forward facing CRS in frontal tests.
458
Booster Seats Booster seats aim to improve the fit of adult lap sash belt and their performance, particularly in frontal impact should be assessed in these terms. A total of 16 booster seats were evaluated in frontal impact test. Four Performance Aspects for booster seats were assessed, these include: 1. Dummy Retention; 2. Submarining; 3. Seat Belt Sash Strap Location, and 4. Booster Seat Security and Integrity In frontal impact tests, a high priority was placed on the pre impact and during impact positioning of the sash and lap parts of the belt. High scores of four (4) were given when the pre impact position of the sash was across and in contact with the dummy’s shoulder and chest prior; and the lap portion of the belt remains in place over the dummy’s pelvic region, during the impact phase of the test. Unacceptable (0) scores were given to those restraints that failed to meet these criteria and there was no criterion in between. Submarining is the most common problem in booster seats, therefore, it was assigned a weighting factor of 4. A score of 4 was given to devices where the seat belt lap strap remains in place over the dummy’s pelvic region during the impact phase. Unacceptable (0) scores were given to devices where the dummy moves forward and down during the impact phase so that the seat belt is repositioned above the dummy’s abdominal region. Devices with anti submarining clips were clearly superior in controlling the position of the seat belt lap strap. In these devices, the lap belt remained in contact with the upper part of the legs throughout the event (see Figure 10). Those devices were assigned a score of 4. In the tests involving devices without anti submarining clips, the lap belt appeared to move up onto the dummy’s lower torso (see Figure 11) or into the gap between the legs and the torso. Dummy retention in booster seats included three possible scores. A high score for complete retention and an unacceptable (0) score for complete ejection if the dummy’s torso came free of the sash during the impact phase. A third low score (1) was available if the dummy’s torso rotated so that it was only partially restrained by the sash. Six out of sixteen restraints were unable to maintain contact between the occupant’s shoulder and the seat belt sash strap as shown in Figure 12. Although most of those restraints were fitted with a sash guide mounted behind the dummy’s shoulder, however, it disengaged the sash strap and failed to perform its function. For this performance those restraints were scored 0. The remaining restraints appeared instrumental in maintaining contact between dummy’s shoulder and seat belts, therefore they were assigned PA score of 4.
459
Figure 10. Booster seat showing lap strap kept in place over dummy’s upper thighs by antisubmarining clip.
460
Figure 11. Booster seat showing lap strap riding-up over dummy’s lower torso
461
Figure 12. Booster seat showing dummy’s shoulder disengaged the sash strap.
462
Side Impact Tests To provide high levels of protection in side impact, child restraint systems need to minimise contact between occupants and the vehicle interior and, if contact occurs, minimise the severity of that contact. The greatest priority is head protection. Rearward Facing Restraints
Figure 13 Rearward facing child restraint system showing good protection in 90o side impact test. In 66o side impact test no head strike was observed in any of the rearward facing restraints. In comparison to the 90o side impact tests, there were fewer devices that exposed the dummy’s head to the risk of a head strike. This indicates that the 90o test is more onerous in this regard and that for this reason it should be retained in future iterations of the program.
Forward Facing Restraints In the 90o side impact tests, head strikes on the door structure or window were observed in almost all devices. Only one device was able to prevent a head strike, however, even in this device the dummy’s head moved beyond the edge of side wing. Accordingly, the device’s PA score was reduced to one. Figure 15 illustrates a typical case of head strike.
463
Figure 14 Rearward facing child restraint system showing head exposure above the top edge of side wing in 90o side impact test.
464
Figure 15 Typical head strike in some of forward facing child restraints in 90o side impact test.
465
In the 66o side impact tests on some of the restraints both shoulder straps remained in position during the impact phase of the test. However, the left-hand shoulder strap slipped completely off the shoulder during rebound. Consequently, these devices were assigned PA scores of 1. Booster Seats From the sixteen booster seats tested in 90o side impact, only one device was able to prevent a head strike on the door structure, for which it was assigned a ‘PA’ score of four. The remaining devices all allowed the dummy’s head to strike the door structure; therefore, each device scored unacceptable (0). Figure 16 shows a typical head strike on booster seats.
Figure 16 Typical head strike in some of booster seats in 90o side impact test.
466
Following the 66o side impact tests, the inboard side wing of some restraints was found to have broken away from the main body of the enclosure, but to have remained inside the cover. This failure, which appears to have occurred when the side wing was struck by the dummy’s torso during rebound, may have been a factor in the dummy’s head or head and upper torso moving beyond the inboard side structure of the device. This in turn may have been a factor in the seat belt sash strap disengaging the upper torso. Therefore these devices were assigned PA scores of 1 and the remaining device scores of 4.
Ease-of-Use Assessment Due to results of CREP stage 4B ease-of-use assessment have not been finalised, the following findings are examples drawn from stage 4A only. Exemplar overall ease of use results are shown below in Figures 17-19. As shown in these results all restraints assessed in this series scored an overall B or C rating. While the protocols allowed for discrimination across the spread of results, the spread was still relatively small. Rather than a reflection of the protocols, this is likely due to the fact that less than half of the currently available restraints have been tested and most of these were from a single manufacturer. Therefore instruction booklets and labels etc have the same format.
Figure 17 Ease-of-Use overall results for Boosters.
467
Figure 18 Ease-of-Use overall results for forward facing child seats.
Figure 19 Ease-of-Use overall results for rearward facing infant restraints.
468
The fact that no restraint achieved an ‘A’ rating reflects the scope for improving features that would influence the propensity for misuse. At this stage only the overall rating score is published in public documents, and available on stakeholder websites. However, scores from the individual categories (shown in Figures 2022) provide more detailed information, both regarding the comparative performance and the scope for improvement. Rearward Facing Restraints Figure 20 illustrates exemplar results for rearward facing infant restraints. Most of the rearward facing restraints on the market in Australia is convertibles. The need for installation in two different ways results in potential for confusion around the correct seat belt path and is reflected in these results. Similarly there were significant differences in the ease of achieving and maintaining proper use of the restraint between the rearward facing restraints assessed. There was also a broad range of scores in the label category. The poorer performers demonstrated a need for attention to the following issues • colour coding seat belt paths, labels and instructions for the different modes • easy removal of covers and rethreading of the harness system • improved positioning and clarity of labels.
Figure 20 Ease-of-Use category results for rearward facing infant restraints.
469
All devices could be improved through the provision of feedback mechanisms to indicate correct use. Forward Facing Restraints Exemplar results for forward facing seats are shown in Figure 21. There was one restraint that clearly stood above in terms of ease of installation, with the correct belt path being much easier to achieve than it was in all of the other restraints. Similar problems with labelling and instructions to that observed among the rearward facing seats were also apparent in the forward facing restraints. There were also substantial differences in features related to achieving proper use of the internal harness system,
Figure 21 Ease-of-Use category results for forward facing child seat.
The poorer performers demonstrated a need for attention to the following issues • complexity of achieving correct seat belt path • colour coding seat belt paths, labels and instructions for the different modes • easy removal of covers and rethreading of the harness system • improved positioning and clarity of labels. As with rearward facing restraints, all devices could be improved through the provision of feedback mechanisms to indicate correct use.
470
Booster Seats Since there is little involved in installing a booster seat into a vehicle, and so there was no assessment of features related to installation in these types of restraints. Exemplar results from the other categories assessed are shown in Figure 20 and illustrate distinct differences between restraints.
Figure 22 Ease-of-Use category results for boosters
While securing a child within a booster seat is relatively uncomplicated, evidence form the field suggest that misuse of the sash is high among booster seat users. There is therefore a need for booster seat manufacturers to provide restraints that will assist in minimising this form of misuse. The scope for manufacturers to do this is reflected in the low scores for this category shown in Figure 22. Booster seats are also required to serve children over a wide range of seated heights. Many seats assessed in Stage 4A failed to do this. There was also some variation in the labelling and instruction categories for the same types of reasons discussed for rearward and forward facing restraints. More so than the other types of restraints, the boosters also demonstrated distinct differences in the quality of packaging. This was primarily in regard to the level and clarity of information supplied concerning which children should be using boosters. Premature graduation from booster seats to seat belts, and from forward facing child seats to booster seats are widespread problems in the field [11-12]. Providing this sort of information on packaging would greatly assist parents in making good choices at the point of purchase.
471
The poorer performers demonstrated a need for attention to the following issues • features to assist in reducing misuse of the sash belt • assistance in the correct use of features designed to achieve correct belt fit • accommodation of children within the full spectrum of anthropometry for which booster seats use is required • colour coding seat belt paths, labels and instructions for the different modes • improved positioning and clarity of labels. • Improved clarity and information on packaging Finally, it is important to note that not all restraints currently on the Australian market were assessed to the new protocols and that the exemplar results presented in the above Figures are a sample of the restraints that have been assessed thus far.
Discussion and Conclusion The overriding objective of a program such as CREP is to provide children with improved levels of crash protection - beyond the minimum required by the Standard. Firstly the program aims to influence consumers to buy restraints which rate well, and avoid the restraints which do not. This secondly provides an economic incentive for manufacturers to develop and market better performing products. Thirdly, to assist manufacturers, the program provides detail of where their products rate well and where they do not. Therefore it also provides useful step-by-step guidance on where and how the product needs to be improved. For the program to achieve its objective there must be wide dissemination of the results, and the results must be in a format that is useful to the consumer. Experience from other vehicle safety advocacy programs, such as the Australasian New Car Assessment Program, and the Used Car Safety Ratings shows that consumers want complex scoring information distilled into a simple form they can understand. In this case, it was felt that the dynamic and ease of use scores were quite different and should be presented separately. This would enable consumers to make their own judgement if they thought one factor was more important than the other. Following the release of the results from Stage 4A, newspaper coverage was been widespread, demonstrating that the information from this program is appreciated in a range of areas, including maternity hospitals, child injury prevention groups and parent/consumer groups. There is an ongoing significant level of enquiry to telephone information lines that confirms that the CREP stakeholders are strongly associated in the public's mind with the distribution of child restraint rating information. This type of attention underlies the effectiveness of the program. In the past, based on consumer feedback, it appears that CREP programs have had a major effect on shaping consumer purchases. The RTA and NRMA reported that the CREP brochures for earlier stage of CREP were the most popular brochures they had. Many retailers reported that consumers only wanted to
472
purchase the restraints shown as performing well in the program’s brochures, and many retailers reported that consumers sought exchanges and refunds on products which were not reported as performing well in CREP 1 and 2. Child safety stakeholders are dependent upon influencing the purchasing power of consumers to persuade manufacturers to keep better performing products on the market. Retail outlets are where this power is exercised. A potential enhancement of the overall program would be to develop training and information programs targeted at these types of potential information sources. An important part of the consumer evaluation process is to provide guidance to manufacturers regarding where the highest priority areas for significant gains in performance lie. This recent series of ease of use assessments has indicated a number of features where specific attention is warranted. These include; • provision of information regarding correct and appropriate use in languages other than English on packaging and within instruction booklets, • one page pictorial set up and usage guides, • better clarity in diagrams such that the information contained with diagrams on packaging, labels and in instructions books conveys all necessary information with no need to read any additional text, • placement of labels on restraints in the vicinity of the task to which they refer, and • colour coding of instructions, labels and seat belt routing (particularly for individual modes of use in convertible restraints). The incorrect use of in-built harness systems (in forward facing and rearward facing restraints) and the sash of seat belts (in booster seats) are areas raising concern in the field. There is a need to encourage manufacturers to optimise their designs to reduce the propensity for this form of misuse. Bonus points were available in this series for restraints that provided some means of warning when the harness/belt was being used incorrectly (or conversely some feedback system denoting correct use). No restraints currently have any features like this and this would be one area where manufacturers could gain some edge for future programs. Of note, there was a substantial difference in the head excursion allowed between the best and the worst performing forward facing restraints. Overall, the results suggest there is specific scope for improving the performance of; • convertible child restraints generally, • booster seats, particularly those that do not incorporate adequate sash guides and crotch straps, and • forward facing and booster seats in side impact, particularly in the head protection provided in side impact at the upper end of their mass limits. While consumer information-based assessment programs focusing on child restraint design are likely to enhance the ease of use and dynamic performance of child restraints, the child restraint is only one piece of the protective system in the real world. There is also a need to encourage vehicle manufacturers to improve the ease of installing and using child restraint systems in specific models of vehicle and the development of effective strategies to achieve this is required. One possible measure raised in the past is the addition of some form of child restraint compatibility assessment to programs such as NCAP. An example of a possible scoring system is outlined by Brown et al [13].
473
Acknowledgements The authors would like to acknowledge the NSW Roads and Traffic Authority Crashlab for the conduct of the dynamic performance testing. The Australian CREP is funded by the NSW Roads and Traffic Authority, NRMA Motoring & Services and Royal Automobile Club of Victoria (RACV). The views expressed in this paper are not necessarily those of the NSW Roads and Traffic Authority.
References [1]
ISO/TC 22/SC 12WG 1N649 (2003) “Road vehicles - Child Restraint systems – Compilation of safety regulations and standards.” September, 2003
[2]
Pedder, J., Hillebrandt, D. and Christensen. L., “Usability Rating of Child Restraints”. 6th World Conference on Injury Prevention and Control, Montreal, May 2002
[3]
NHTSA, US Department of Transportation “Consumer Information Regulations; FMVSS; Safety rating Program for Child Restraint Systems; Notice and Final Rule” Federal Register Part II. Vol. 67 No 214:67448-67465 November 5, 2001
[4]
Brown J, Kelly P, Griffiths M “Review of the Australian Child Restraint Evaluation Program” Report prepared for the RACV, NRMA Motoring & Services and the NSW Roads and Traffic Authority April 2005.
[5]
Weinstein EB, Sweeney MM, Garber M, et al. “The effect of size appropriate and proper restraint use on injury severity of children”. In: 2nd Child Occupant Protection Symposium; 1997; (SAE); 1997. p. 181-186
[6]
Eby DW. Kostyniuk LP. “A statewide analysis of child safety seat use and misuse in Michigan”. Accident Analysis & Prevention. 31(5):555-66, 1999
[7]
Paine M and Vertsonis H (2001) 'Surveys of child restraint use in New South Wales', in proceedings of 17th Enhanced Safety of Vehicles Conference, Netherlands 2001.
[8]
Lalande S, Lagault F, Pedder J.”Relative degradation of safety to children when automotive restraint systems are misused”. In proceedings of 18th Enhanced Safety of Vehicles Conference; 2003; Nagoya, Japan; 2003. p. Paper No 85
[9]
Decina LE. Lococo KH. “Child restraint system use and misuse in six states.” Accident Analysis & Prevention. 37(3):583-90, 2005 May
[10] Brown J., and Bilston L.E., “Misuse of Child Restraints and Injury Outcome in Crashes” in Proceedings 2006 Australasian Road safety Research Policing and Education Conference” October, 2006 [11] Winston FK. Chen IG. Elliott MR. Arbogast KB. Durbin DR. “Recent trends in child restraint practices in the United States”. Pediatrics. 113(5):e458-64, 2004 May. [12] Brown J and Bilston LE. High Back Boosters: In the field and in the laboratory. 50th Annual Conference American Association of Automotive Medicine, Chicago 2006.
474
[13] Brown J, Griffiths M, Paine M “Effectiveness of child restraints: The Australian Experience” Research Report 06/02 prepared for Australian New Car Assessment Program, June 2002 http://tinyurl.com/yrorg9
475
476
Many children progress from one type of restraint to the next at too small a size: Should advice to parents be simple and based on child age, with variation in child size accommodated by overlaps in restraint specifications? R. W. G. Anderson & T. P. Hutchinson Centre for Automotive Safety Research, University of Adelaide Published surveys of child in-vehicle restraint use demonstrate that many children are in an inappropriate type of restraint. In particular, children tend to progress from a forward-facing child restraint to a booster seat at too small a size, and from a booster seat to an adult belt at too small a size. Standards for child restraints are written in terms of their weight, not their age. That leads to advice to parents emphasising the child’s weight as the criterion for selecting a type of restraint. This has unfortunately led to advice becoming complicated and confusing. Children tend to want to progress to the next restraint earlier rather than later, and take advantage of lack of clarity. Moreover, many parents do not know the weight of their child. In this paper, we explore what might be the consequences of very simple advice, such as: change the type of restraint at 6 months, 4 years, and 8 years. Obviously, children differ in size. This may be allowed for by writing the Standard so that the restraint is suitable both for a small-for-age child at the youngest age and a large-for-age child at the oldest age. Our method uses the distribution of children’s weights at different ages. Given that, and given also the range of weights for which each restraint is appropriate, we work out how many children would be in an inappropriate restraint if progression were at particular ages. This turns out to be much less than the number observed under the current regime of weight-based advice.
1. Introduction Published surveys of child in-vehicle restraint use demonstrate that many children are in an inappropriate type of restraint. In particular, children tend to progress from a forwardfacing child restraint to a booster seat at too small a size, and from a booster seat to an adult belt at too small a size. We noticed this when conducting a survey of what types of restraints are used (Edwards et al., 2006; Anderson et al., 2006). In that survey, we did not actually measure children’s weights --- but, knowing how old they were, we did some calculations and came to the conclusion that any reasonable assumption about weights-for-age makes clear a mismatch between their weights and the restraints they used. There is plenty of other evidence of this (Apsler et al., 2003; Decina and Knoebel, 1997; Ebel et al., 2003; Ramsey et al., 2000; Charlton et al., 2006). We also found that many parents (or, more correctly, many drivers of the cars transporting the children) did not know the weights of their children. For a review of child restraints with particular reference to Australia, see Reeve et al. (2007).
477
Child restraints are designed to be suitable for children within a certain weight range, not an age range, and the Standards are written that way. Thus it might seem natural for advice to parents to emphasise the child’s weight as the criterion for selecting a type of restraint. Unfortunately, this has led to advice becoming complicated and confusing. Children tend to want to progress to the next restraint earlier rather than later, and the fact that this happens so frequently may be because they take advantage of lack of clarity. And, as already mentioned, many parents do not know the weight of their child. This has also been found in other child restraint surveys and in different contexts (Apsler et al., 2003; Leffler and Hayes, 1997; Harris et al., 1999). Very likely, there are some places where parents do know the heights and weights of their children, e.g., Japan, where there is thrice-yearly measurement by school nurses (Sekine et al., 2002). In this paper, we explore what might be the consequences of very simple advice, such as: change the type of restraint at 6 months, 4 years, and 8 years. Obviously, children differ in size --- but this may be allowed for by writing the Standard so that the restraint is suitable both for a small-for-age child at the youngest age and a large-for-age child at the oldest age. Our method uses the distribution of children’s weights at different ages. Given that, and given also the range of weights for which each restraint is appropriate, we work out how many children would be in an inappropriate restraint if progression were at particular ages. This turns out to be much less than the number observed under the current regime of weight-based advice. We have given another account of this work in Anderson and Hutchinson (2007). The remaining Sections of this paper are as follows. 2. Restraints and Standards for restraints. 3. Formulation of the question, and method of answering it. 4. Choice of transition age. 5. Results: Transition from infant capsule to FFCR. 6. Results: Transition from FFCR to booster seat. 7. Transition from booster seat to adult belt. 8. Effect of change to Standards. 9. Overview of different methods of illustration. 10. Discussion. 11. Concluding remarks.
2. Restraints and Standards for restraints In Australia, the main types of in-vehicle child restraint are as follows. • Infant capsule (rearward-facing infant restraint), known as type A1. • Forward-facing child restraint (FFCR), which has an integral harness --- type B. • Booster seat (or booster cushion), which positions the child so that an adult seatbelt can be used safely. (Some booster seats have a back.) This is known as type E. Australian Standard 1754 specifies that these must respectively be suitable for children weighing 0-9 kg, 8-18 kg, and 14-26 kg. Elsewhere in the world, standards have been written differently, and not necessarily in ways that are easily comparable to Australian practice. But, roughly speaking, the European Union employs weight ranges of 0-10 kg, 9-18 kg, and 15-25 kg, and the U.S.A. employs weight ranges of 5-22 lb, 20-40 lb, and 40+ lb.
478
Historically, standards for child restraints have not been well coordinated with Standards for adult seatbelts. It is tacitly assumed that children will graduate to an adult belt at 7 or 8 years --- but at this age, they are appreciably smaller than a 5th percentile adult female, which is the smallest size that adult belts have to be satisfactory for. Furthermore, in practice, adult belts are used for many children as young as 4.
3. Formulation of the question, and method of answering it 3.1 The question If children changed from one restraint to another at a specific age, how many would be in the wrong restraint? Notice this question refers to a sharp transition age --- no mention of an age range or a weight range. Once this question is formulated, the general lines by which we proceed become clear. • We need to know how many of the children younger than the transition age are too big for the first restraint. • And we need to know how many of the children older than the transition age are too small for the second restraint. We assume that a particular type of restraint, such as an FFCR, is suitable for a particular range of weights of children, and unsuitable for other weights. Unsuitable does not mean utterly unsafe, and suitable does not mean ideal. The analysis below could be modified by utilizing a “suitability function”, but that would be unnecessarily complicated for present purposes. (In effect, we are assuming suitability is 1 for some range of weights, and 0 for other weights.) Instead of weight, the analysis could be adapted to height, or sitting height, or shoulder width, provided data on these measurements were available. Again, we do not pursue this possibility. We also assume that the distribution of children’s weights at different ages is known. Specifically, we will assume that the data from the Centers for Disease Control and Prevention in the U.S.A. (Ogden et al., 2002) can be used. In this dataset, children are disaggregated by sex and one-month cohorts of age. Are the sizes of boys very different from those of girls? Do children from different ethnic backgrounds differ much in size? The data that we have seen suggest that differences are not sufficient for it to be worthwhile destroying the simplicity of advice in order to tailor it to a particular sex or ethnicity. Notation concerning the restraint. A child changes from restraint A to a larger restraint B at age y. Restraint A is satisfactory for children whose weight u is a or less. Restraint B is satisfactory for a child whose weight u is b or greater. Notation concerning the child. In the ith month of life, the child is in one-month cohort i. For this cohort, the proportion of children whose weight is less than u is Fi(u). Change from restraint A to B occurs at the end of month y. The function F. For fixed i and regarded as a function of u, F describes the variability of children at a given age; statisticians would call it the cumulative distribution function of
479
weight. For fixed u, F decreases as a function of i: it reflects the growth of children with age by describing the falling proportion who are smaller than a given weight u. 3.2 The answer At this point, we consider we have covered the difficult part of the topic, setting up the question. Once this has been stated --- with no fuzziness from a weight range or an age range, or doubts about whether a restraint is as suitable for a child close to the transition as it is for a child in the middle of its specified range, and with disaggregation of children into age bands of one month each --- working out the answer proceeds smoothly. First, consider children younger than y. These are in restraint A. The proportion of cohort i who are too big for restraint A is 1-Fi(a). The relevant one-month cohorts are those up to and including y. The total number of children (in units of the number in a single month cohort) is ∑1 [1-Fi(a)], where ∑1 denotes summation from i = 1 (or the previous transition) up to i = y. Second, consider children older than y. These are in restraint B. The proportion of cohort i who are too small for restraint B is Fi(b). The total number of children is ∑2 Fi(b), where ∑2 denotes summation from i = y+1 up to the next transition. The total number of children who are either younger than y but too big for A, or older than y but too small for B, is the sum of these, ∑1 [1-Fi(a)] + ∑2 Fi(b). This total is a function of y, a, and b. Given these, and knowing the function Fi(u) from Ogden et al. (2002) or some other source, the total may easily be worked out.
4. Choice of transition age The quantities a and b reflect the Australian Standard and are characteristic of the restraints available. Standards can be rewritten and restraints can be redesigned, but the easier issue to tackle is what the age y should be. As y increases, the number of children in A but actually too big for it increases, and the number in B but actually too small for it decreases: there is a trade-off. It is possible to identify an age at which the sum is minimised. In principle, this could be generalised to a total unsuitability score, but we doubt whether anyone knows how the unsuitability of being (say) 2 kg too heavy for one restraint compares with the unsuitability of being 1 kg too light for another, and so we do not pursue this. We simply assume that if a restraint satisfies a Standard, it is suitable for the weight range mentioned in the Standard and unsuitable for other weights.
480
5. Results: Transition from infant capsule to FFCR 5.1 Step 1: Consider one particular choice of transition age For the transition from infant capsule to FFCR, in Australia a is 9 kg and b is 8 kg. Suppose that the transition age is y = 6 months. Boys, cohorts 1 to 4. Very few of these are too big for an infant capsule (i.e., exceed 9 kg). Boys, cohort 5. Some 2 per cent of these exceed 9 kg. Boys, cohort 6. Some 8 per cent of these exceed 9 kg. Boys, cohort 7. Some 43 per cent are too small for an FFCR (i.e., are less than 8 kg). Boys, cohort 8. Some 25 per cent are less than 8 kg. Boys, cohort 9. Some 13 per cent are less than 8 kg. Boys, cohort 10. Some 6 per cent are less than 8 kg. And so on. Total misclassification is 103 per cent of a one-month cohort of boys, made up of 10 per cent who were too big for the infant capsule in the month or two before the transition, and 93 per cent who were too small for the FFCR in the months after transitioning. Thus the total misclassification is around 9 per cent of boys in their first year of life. A similar calculation can be made for girls. 5.2 Step 2: Repeat the calculations for different transition ages The calculations can be repeated for different choices of the transition age y (5 months, 7 months, 8 months, and so on). There are two forms of visual presentation of the results that are quite helpful. • Having calculated the total number of children (in units of one-month cohorts) who are too large for restraint A and the total number who are too small for restraint B, these numbers can be plotted one against the other, the different data points corresponding to different ages of transition, y. As y increases, so the first of these numbers increases and the second decreases: there is a trade-off between them. One wants to select the point on the graph that is closest to the origin, i.e., where the sum of these proportions is minimized. (If it is considered plausible that one type of misclassification is more serious than the other, one could consider a generalized sum is which one misclassification is given more importance than the other.) • The sum can be plotted against transition age y. Naturally, this presupposes that one is comfortable with the idea that the two types of misclassification are equally important. It turns out that the sum is minimised at 7 months for boys and 9 months for girls. The improvement from 6 months is not great enough that we would recommend changing from this, however. See Table 1.
481
6. Results: Transition from FFCR to booster seat The method of calculation for the transition from a forward-facing child restraint to a booster seat is similar to that in Section 5, and some results are in Table 2.
7. Transition from booster seat to adult belt As mentioned in Section 2, there has been something of a disconnect between Standards for child restraints and Standards for adult seatbelts. This has become of concern to an increasing number of people in recent years, with it being suggested that an adult belt is only suitable once the child has reached 145 cm in height. Possible solutions include: ensuring that adult belts are suitable for smaller people than the 5th percentile adult female (e.g., the average 7 year old), developing booster seats suitable for bigger children (e.g., the average 12 year old), or a compromise between these strategies. To proceed with an analysis similar to those for earlier transitions, we would need to know how unsatisfactory a standard booster seat is as a function of weight (over the range 26-40 kg, say), and also how unsatisfactory an adult belt is as a function of height (over the range 120-145 cm, say). But this probably goes beyond what can be confidently supported.
Table 1. Numbers of children misclassified (in units of a one-month cohort), for various choices of the transition age from an infant capsule to an FFCR. Age of transition, y months
6 9 12
Number of children misclassified To big for the Too small for the first restraint second restraint 0.06 0.80 2.74
1.53 0.31 0.04
Total
1.59 1.11 2.78
Table 2. Numbers of children misclassified (in units of a one-month cohort), for various choices of the transition age from FFCR to booster seat. Age of transition, y months
36 48 60
Number of children misclassified To big for the Too small for the first restraint second restraint 011 1.22 5.45
4.09 0.70 0.04
482
Total
4.20 1.92 5.49
8. Effect of change to Standards The calculations above take a and b as known, and examine what effect y has. To complement this, we might suppose that y has been fixed at some memorable and convenient age (such as 4 years), and ask how a and b affect the proportion of children misclassified. • Comparison can be made of the present Australian, European, and U.S. Standards. • And we may examine what would be the effect of a change to a and/or b in the Australian context. See Anderson and Hutchinson (2007) for more on this. If a exceeds b, there is overlap in the weight ranges for successive restraints. This is the case for some Standards but not for others. Overlap will mean that a sharp age transition will lead to fewer misclassifications by weight. Thus having an FFCR suitable up to 40 lb and a booster seat suitable only from 40 lb upward, as in the U.S.A., is not well-suited to a sharp age transition. (However, we are simplifying what the U.S. system is, and may be exaggerating the unsuitability.) Children vary more when they are older and bigger than when they are younger and smaller. Consequently, a given amount of overlap (e.g., 1 kg) is more useful at a younger age and smaller size. For the FFCR-to-booster transition in Australia, a is 18 kg and b is 14 kg. If y = 48 months were chosen as the transition age, the number of children misclassified would be about 2 one-month cohorts (Table 2). Keeping y the same, if a were 19 kg and b were 13 kg, the number of children misclassified would be reduced to about 0.8 one-month cohorts. Once one has programmed the calculation, it is easy to compute the result for a grid of values of a and b. Then the results can be presented as, for example, a contour plot. The effect of specifying different a and b in the Standard can then easily be seen.
9. Overview of different methods of illustration It may be useful to list a number of ways of illustrating the calculations and their results that have been mentioned, either implicitly or explictly. • There is variability in the size of children at any given age. This is described by F, regarded as a function of u for fixed i; statisticians would call F the cumulative distribution function of weight. (See Section 3.1.) • Children grow. This is described by F, regarded as a function of i for fixed u. (See Section 3.1.) • As different transition ages are considered, so the proportions of children too big for restraint A and too small for restraint B vary in opposite directions. They can be plotted one against the other to demonstrate the trade-off. (See Section 5.2.) • The two proportions of misclassifications can be added together and plotted versus transition age. (See Section 5.2.) • Greater overlap in the weight ranges for successive restraints (i.e., b exceeding a to a greater extent) will mean fewer misclassifications. This can be shown by, for example, a contour plot, the axes being a and b. (See Section 8.)
483
10. Discussion The implication of the way we worded the central question (Section 3.1) is that advice to parents can be very simple and directive. For example, it might be to switch the child from one restraint to the next at 6 months, 4 years, and 8 years. No mention of weights, no mention of ranges, no mention of big-for-age or small-for-age. (We can imagine that it would be appropriate to include information about where to find expert assistance if the child is very unusually sized or shaped, or if there are closely-spaced children in the family.) The Standards describing successive restraints would need to have overlapping weight ranges, so that a big-for-age child can use restraint A and a small-for-age child can use restraint B. We are placing the responsibility for exercising expertise --- accommodating the range of different sizes and shapes of children --- with the designer and manufacturer of the restraint, not with the parent. That seems to us to be entirely appropriate. To some people working with child restraints, our line of argument comes as a bit of a shock. A particular restraint is designed for children within a certain weight range, and perhaps within a range of lengths or sitting heights or shoulder widths, and it seems obvious that for a particular child, a restraint should be selected on that basis. Our response is in two parts. First, surveys show that many children --- the majority of children in some age bands --- are in an unsuitable restraint. The present system of restraints and their promotion to parents does not seem to be working very well. Second, we point to examples of present-day publicity and educational materials directed to parents. These often have a lot of numbers on them --- weights, ages, perhaps heights --- and to us it is not surprising that parents get confused (even if they know their child’s weight, which many do not). Actually, we have examined some publicity material from a decade or two ago, and in some respects it resembles what we are suggesting, giving prominence to non-overlapping ranges of age. We should address two possible weaknesses in our argument. • First, it could be that for designers and manufacturers, it would be very difficult if Standards prescribed an overlap of weights. We are fairly confident in dismissing this. There are small overlaps in the Australian and European Standards at present, and informal discussions lead us to believe the overlaps could be made a little greater without difficulty. Indeed, the dummy specified in the Australian Standard for dynamic testing of the FFCR weighs 22 kg, even though the specification otherwise requires suitability for an 18 kg child. • Second, our calculations assume compliance with the directions to graduate the child from one restraint to the next at a particular age. It could be said that it is not fair to compare results from a theory that assumes compliance with results observed in the real world where many parents and children are not complying with the advice available. We cannot give a complete answer to this, in the sense of proving that there would be compliance with firm directives. We can only appeal to common sense notions that clear advice is easier to understand than complicated advice, that advice in terms of something that parents know (child’s age) is better than advice in terms of something parents often do not know (child’s weight), and that similar factors apply in respect of children’s wishes and demands.
484
11. Concluding remarks In the title of this paper, we asked a question. Should advice to parents be simple and based on child age, with variation in child size accommodated by overlaps in restraint specifications? At such an early stage of considering this, we do not want to positively advocate a “yes”. We go no further than noting that our calculations have not established that this would be a silly strategy. Using weight as the criterion seems like common sense when the restraint itself is in one’s mind. But if the problem lies with parents’ and children’s knowledge and their utilisation of that knowledge, the simplicity and salience of age increase its attraction as a criterion. The present situation, with a high rate of premature graduation to a booster seat and to an adult belt, is unsatisfactory. We are suggesting a strategy for remedying this that puts the child’s age --- well known to adults and highly salient to children --- at centre-stage. What we have done is: • Demonstrate in our survey and by reference to other surveys that there is a problem at present. • Formulate a question concerning what might happen if there were sharp ages of transition. • Answer that question, finding that the proportion of misclassified children would be low with the present Australian Standards, and could be even lower if there were greater overlap in the weight ranges of different types of restraint. • Informally check with experts on restraint design and manufacture that they do not regard greater overlap as impracticable. What we have not done is: • Prove that there would indeed be good compliance with sharp ages of transition. Regarding the last point, the natural first step, before taking matters further, would be to listen to what experts on the promotion of health advice to the general public have to say about the merits or otherwise of simple directives based on child age.
Acknowledgements The Centre for Automotive Safety Research receives core funding from the Motor Accident Commission (South Australia) and the Department for Transport, Energy and Infrastructure (South Australia). The views expressed in this report are those of the authors and do not necessarily represent those of the University of Adelaide or the sponsoring organisations.
References Anderson RWG, Edwards SA, and Hutchinson, TP 2006. Results and implications of a survey of child restraint use in South Australia. Proceedings of the Australasian Road Safety Research, Policing and Education Conference. Gold Coast, Queensland: Able Video and Multimedia.
485
Anderson RWG and Hutchinson TP 2007. The feasibility of age-based criteria for child restraint selection. Proceedings of the 20th International Technical Conference on the Enhanced Safety of Vehicles, Paper 07-0220-O. http://www-nrd.nhtsa.dot.gov/ departments/nrd-01/esv/20th/esv20.htm Apsler R, Formica SW, Rosenthal AF, and Robinson K 2003. Increases in booster seat use among children of low income families and variation with age. Injury Prevention 9: 322325. Charlton J, Koppel S, and Fitzharris, M 2006. Factors that influence children’s booster seat use. Report 250, Monash University Accident Research Centre. Decina LE and Knoebel KY 1997. Child safety seat misuse patterns in four states. Accident Analysis and Prevention 29: 125-132. Ebel BE, Koepsell TD, Bennett EE, and Rivara FP 2003. Too small for a seatbelt: Predictors of booster seat use by child passengers. Pediatrics 111: e323-e327. Edwards SA, Anderson RWG, and Hutchinson TP 2006. A survey of drivers’ child restraint choice and knowledge in South Australia. Report CASR012, Centre for Automotive Safety Research, University of Adelaide. Harris M, Patterson J, and Morse J 1999. Doctors, nurses, and parents are equally poor at estimating pediatric weights. Pediatric Emergency Care 15: 17-18. Leffler S and Hayes M 1997. Analysis of parental estimates of children's weights in the ED. Annals of Emergency Medicine 30: 167-170. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, and Johnson CL 2002. Centers for Disease Control and Prevention 2000 growth charts for the United States: Improvements to the 1977 National Center for Health Statistics version. Pediatrics 109: 45-60. Ramsey A, Simpson E and Rivara FP 2000. Booster seat use and reasons for nonuse. Pediatrics 106: 20-24. Reeve KN, Zurynski YA, Elliott EJ, and Bilston L 2007. Seatbelts and the law: How well do we protect Australian children? Medical Journal of Australia 186: 635-638. Sekine M, Yamagami T, Hamanishi S, and Kagamimori S 2002. Accuracy of the estimated prevalence of childhood obesity from height and weight values reported by parents: Results of the Toyama birth cohort study. Journal of Epidemiology 12: 9-13.
486
Improving child restraint design – upcoming changes in restraint standards and remaining challenges Lynne Bilston & Julie Brown Prince of Wales Medical Research Institute, University of New South Wales The Australian/New Zealand child restraint Standard, AS/NZS 1754 is recognised as one of the most rigorous worldwide, and there are major changes being currently being introduced to accommodate larger and older children in child restraints. This paper outlines these changes and explains the rationale behind the changes. How these relate to proposed legislation changes is also presented. Key changes include the provision of booster seats for children up to 8-10 years of age, and weight up to 36kg, increased from 26kg in the current Standard; increases in weight limits for forward-facing seats; additional side impact testing requirements; and the phasing out of booster cushions. Future challenges for the Standard such as specialist anchorage systems (e.g. ISOFIX/LATCH) and improved labelling and ease of use requirements will also be discussed.
Introduction The performance of dedicated child restraints in Australia is governed by two standards, AZ/NZS 1754 and its sister AS/NZS 3629.1. This is a mandatory standard in Australia, while New Zealand accepts restraints tested to alternative international standards in addition to these. This paper reviews the current Standard, outlines the areas of the current Standard where enhancements are possible, and presents a number of recently proposed changes together with the principles behind their development Future challenges and remaining issues are also outlined.
Brief History1 The first Australian standard for child restraints, AS E46, was issued in 1970. The development of this Standard directly addressed inadequacies of devices that were being used to carry children in cars at that time. The key requirements of this standard were related to structural integrity and labeling. Restraint types for three size ranges of children were included. These were infant carriers for children from 0-9kg; chair/harnesses for children from 9-18kg and harnesses for children 18-36kg. This first version of the standard also required child restraints to be secured at three attachment points. AS E46 was extensively rewritten and released in 1975 as AS1754 (1975). This revision added dynamic performance requirements to improve the level of protection being provided in crashes, and 1
The history of child restraint development in Australia is reviewed by Lang et al (2002)
487
extended the restraint type designations covered by the standard from 3 to 6 types. These basically included infant restraints, forward facing and rear ward facing child restraints and harnesses. There was no provision for booster seats. Initially, restraint type designations were devised on the basis of how children were being carried in cars. Infants from birth to approximately 6 to 9 months of age were normally carried in a recumbent or semi-recumbent positions; over 6 to 9 months until 3 ½ to 4 years it was thought that children could be carried in a seating position if suitably supported, but were unlikely to be able to sit still for long if left alone; and over 3 ½ to 4 years children could be carried on the vehicle seat without support. Weight ranges corresponding to these age ranges were used to provide guidelines for restraint designers. Type designations therefore included mass limits and age based guidelines. In latter versions of the Standard age based guidelines were dropped from the type designations. Booster seats were introduced into the standard in 1978. Their primary purpose at this time was as a device that would allow small children to see out of the vehicle window. Overtime, their potential benefit in providing a transitional form of restraint between forward facing child restraints and adult seat belts became clear. Initial definitions for this type of restraint were for carrying children between 9 and 38kg. There have been a number of changes to this range in subsequent versions of the Standard. Currently the range is 14 to 26kg. The inclusion of the requirement for three point anchorage in the Australian Standard since its inception has particular historical importance. This requirement, together with its matching Australian design rules (ADR34, in 1974), ensured the provision of standardized tether anchorage locations in sedans, and is the basis for the unique long standing widespread use of top tethers in Australia.
Key Features of the Current Standard The current Australian and New Zealand Standard has provision for several classes of restraints. These include rear facing infant restraints (Type A), forward-facing toddler restraints (Type B), rear facing toddler restraints (Type D), seat belt converters (Type C), and booster seats (Type E). Restraints may combine these types, converting from one type to another. Currently, the design requirements for these seats are based largely on weight ranges: 0-9 or 12kg for infant restraints, 8-18kg for toddler restraints, and 14-26kg for booster seats. Key design features of restraints specified by AS/NZS 1754 include the requirement for top tether straps (Types A, B, D, and boosters over 2kg) to control forward excursion of the restraint, a single point of harness adjustment (Types A,B,D) to simplify harness tightening, double crotch straps (Types A,B,D) to prevent loading of the genital region and submarining. An ancillary benefit of the top tether requirement was the almost universal installation of child restraints in the rear seat. Requirements for booster seats under the standard are much less prescriptive. Dynamic testing of restraints under the current AS/NZS 1754 include frontal, side, rear and inverted protocols. Table 1 below outlines which tests are required for which restraints. The frontal test is conducted at 49km/hr, the side and rear impact tests at 32km/hr and the inverted test at 16km/hr. The side impact test is conducted either with or without a door
488
structure – the latter allows for determining whether the head of the dummy is adequately contained within the restraint.
Restraint Type Type Infant restraints
Side Impact Side Impact with door without door A 9mo or 18mo 9mo or18mo TARU dummy dummy ejection dummy
Type B toddler restraints Type C and E converters Type D Toddler restraints Type E booster seats
Frontal
9mo dummy and 6yo dummy 3yo and 10yo dummy 9mo dummy and 6yo dummy 3yo, 6yo, 10yo dummy
9mo dummy
Rear
Inverted
TARU TARU ejection and ejection 9mo or 18mo dummy dummy
9 mo dummy
3yo dummy 9mo dummy
9 mo dummy 6 yo dummy
3yo dummy 3 yo dummy (not cushions)
6 yo dummy with spacer
Table 1: Current Dynamic Test Requirements
Currently, restraints must include instructions on restraint use in the packaging, a prominent label to warn parents not to leave child unattended in the restraint, and some warnings on use of the restraint. The restraint itself must be marked with the weight range for which the restraint is suitable, illustrated instructions for use, including harness adjustment, and situations in which the restraint must not be used.
Scope for improvement of the current standard Despite its reputation for being one of the most rigorous child restraint standards internationally, there are a number of areas where enhancements to the current requirements would significantly improve the level of protection provided to Australian children in crashes. 1. No support for dedicated lower anchorage systems for child restraints (ISOFIX/LATCH). The European union countries have adopted a standard for rigid attachment of child restraints into vehicles, ISOFIX, using a pair of U-shaped bars fixed into the join between the rear seat cushion and seat back. Restraints have latches that clip rigidly onto these bars and firmly attach the restraint to the car, not requiring the use of a seat belt to secure the restraint. North America have adopted an alternative flexible system, which uses the same anchorage points in the vehicle, but secures the restraint using lengths of seat belt webbing, either attached to either side of the restraint, or looping through the back like a lap-only belt. These must be used with a top-tether, hence the name Lower Anchors and Tethers for Child restraints (LATCH). The original intention of these systems was to simplify child restraint installation and reduce installation misuse due to incorrect seat belt routing or excessive
489
slack. Local research has shown that ISOFIX in particular has the potential to improve performance in side impact crashes (Kelly et al, 1995; Brown et al, 1997; Bilston et al, 2004; Brown et al 2004; Charlton et al, 2004; Bilston et al, 2005). Neither system is currently supported in AS/NZS 1754, 2. Limited control over internal restraint geometry to match child anthropometry. Currently, there are requirements for restraints to “accommodate” specific dummies, which ensures that restraints are usually wide enough to accommodate the target age ranges, and there are controls over harness slot heights to provide suitable harness positioning over the shoulders. However, there is no requirement for restraint back height to ensure that suitable head protection in rear impacts is available, and indeed there is evidence that current restraint heights may not be sufficient for the target age ranges, encouraging premature graduation from one restraint type to another (Bilston et al, 2007). This has been noted to be a particular problem for polystyrene booster seats and some older “compact” convertible rear/forwardfacing seats. 3. Overlap in weight ranges between forward-facing toddler restraint and booster seats. There is 4kg overlap in the weight ranges for Type B (8-18kg) and Type E (14-26kg), which has had the unintended effect of encouraging premature graduation to booster seats by children as young as 2 years old, as soon as they reach 14kg (Edwards et al, 2006; Bilston et al, 2006). It has been suggested that recommending restraint use by age would be a more effective method of matching restraints to children than the current weight-based classes (Anderson et al, 2007). 4. Upper weight limit for boosters. The current upper weight limit for boosters specified in the Standard is 26kg. This equates approximately to the 50th percentile for 8 year olds, but many children reach 26kg well before turning 8. This limit was originally designed to limit the overall boosted height of the child to reduce the risk of head strikes on the roof. However, there is now substantial evidence that acceptable adult belt fit is not achieved for children until 11-13 years of age (approximately 145cm in height), and this limit leaves children over 26kg without a suitable restraint. 5. Side impact tests are only performed using the smallest relevant dummy, not the largest relevant dummy. For example, forward-facing restraints (Type B) are currently only tested with the 9 month dummy in side impact with the door. Recent studies have shown that this does not ensure that head contact with the door is prevented for the 3 year old dummy in these restraints. Requiring restraints to be tested with a dummy at the upper end of the recommended size range would address this issue. 6. Booster cushions are exempt from side impact test with the door. Not surprisingly, booster cushions (i.e. booster seats without any side structures) do not provide lateral protection or postural support for children. 7. Booster seat performance tests do not relate to how well these restraints position the belt, either statically or dynamically. The primary benefit of a booster seat, when used with a 3point belt, is to position the sash belt over the centre of the shoulder and across the bony parts of the torso, and the lap belt low across the upper thighs, thus preventing seat-belt related abdominal, lumbar spine and cervical spine injuries. There are no requirements in the Standard that address the ability of a booster to do this. Recent results from the Australian Child Restraint Evaluation Program (CREP), demonstrated that many currently approved booster seats do not perform well in this regard, despite meeting the current
490
standard (Brown et al, 2007) and this is consistent with a couple of recent high-profile cases in which serious abdominal injuries occurred in children using booster seats locally, and also reported overseas (Jermakian et al, 2007). 8. Scope for improved anti-misuse measures. Field studies have indicated that child restraint misuse is a common problem. While some forms of misuse tend not to have great consequences for injury outcome, some forms of misuse can substantially reduce the protective capacity of the restraints. These include errors in restraint installation such as tether or seat belts being excessively slack or not used, and errors in placing the child in the restraint, such as slack or unbuckled harnesses etc. In addition to alternative methods of securing restraints such as ISOFIX or LATCH, there is scope to strengthen the already existing anti misuse features (such as the single point of harness adjustment) by making harness adjustment easier, providing indicators of harness slack or non-use, and more clearly defining belt routing, particularly in convertible restraints where there may be more than one belt route. More visible labels warning against common high risk types of misuse, and provision of information in pictogram form which may improve comprehension for non-English speakers are also desirable. 9. Confusion over which restraints are suitable for children of different ages. This was partially addressed in point 4 above. The current focus on weight ranges for restraints, while essential to provide engineering design specifications, is confusing for families. Recent research has shown that many parents do not understand what restraint their child should be using, and in many cases do not know their child’s weight and height. The addition of recommended age ranges, plus closer specification of the geometry of the restraints (see #2 above) to ensure that the majority of children who are within the recommended age ranges actually fit in the restraints could clarify this for parents. This also links into recently proposed changes to the Australian Road Rules, which suggests that restraint use by children be mandated by age.
Proposed Changes Some of the issues outlined in the previous section have been begun to be addressed in a recent draft edition of AS/NZS. Key changes in this draft include: 1. New restraint class of boosters to accommodate older children. The most substantial change in the draft edition is the development of a new class of booster seats (Type F) to accommodate children from 4-10 years (18-36kg). Key aspects of this new restraint class include more rigorous controls on seat belt positioning (including dynamic position) to prevent submarining and ensure the seat belt fits snugly across child’s torso; external geometry requirements to ensure that the overall boosted height of the child does not exceed that of an average adult (to limit the change of head strikes on the roof), control over the external geometry of the restraint to make it easier to fit into the rear seat of cars alongside other restraints, and provide access to the seat belt buckle; and a requirement for lateral postural support of the torso. 2. Geometry requirements to ensure adequate height and harness slot locations for target age ranges. All restraint types now have to meet minimum internal seat back height requirements to ensure that toddler restraints will provide rear head support for children up to their 4th birthday, and booster seats for children up to the 9th birthday. For toddler restraints, there are slightly revised shoulder slot locations to match.
491
3. Changed weight ranges to reduced premature graduation to boosters. The weight ranges for toddler restraints (Types B,D) are proposed to change to 8-20kg and booster seats (Types E,D) will commence at 18kg, to reduce the number of children who are prematurely graduating to booster seats in the 14-18kg range. 4. Addition of age ranges to type designations and labels. Approximate age ranges have been added to restraint labels, packaging and instructions to simplify restraint selection for parents. 5. Belt path colour coding. To make it clearer where the seat belt should go in restraints, and to clarify which path to use when, colour-code belt paths for different restraint types have been introduced. This means that a convertible rear/forward-facing restraint will have the belt path for rear-facing mode marked in blue, and the path for forward-facing mode will be marked in orange. Booster seat belt paths will be marked in yellow. 6. Addition of bigger dummies in side impact test. Toddler restraints (Type B,D) will now be tested in side impact with a door using a 3 year old dummy boosted slightly to match a 4 year old child. The new booster seats (Type F) will be tested with both the 3 year old dummy and the 10 year old dummy. 7. Removal of booster cushions. The removal of the exemption of booster cushions from the side impact test will effectively mean they cannot comply with the new standard. 8. Controls on tether location on restraint. There are new requirements for whether the tether attaches to the restraint, to make sure it is attached on the upper back of the restraint, as locations lower down reduce tether effectiveness. 9. Controls on seat belt length needed to install restraint. There have been reports of problems installing some restraints in vehicles due to inadequate seat belt length. A new procedure has been developed that will ensure that all restraints should be able to be installed in a vehicle with the minimum legal seat belt length.
Implications for Legislation and Restraint Guidelines A number of the specific items outlined above will facilitate the return of age-based restraint recommendations, and even legislation. The introduction of age ranges on the packaging and labeling of restraints (#4 above) will provide parents with clearer guidelines about when to use specific restraints for their children. The National Transport Commission recently released a draft regulatory impact statement and draft model legislation that would require the use of a rearward-facing infant seat until at least 6 months, a forward or rearward facing safety seat with inbuilt harness until 4 years, and a booster seat until 7 years of age. That report also foreshadowed the desirability of raising the age for safety seat use to 5 years and requiring booster seats up to 145cm in height once suitable restraints are available. For such age-based child restraint legislation to be practical, restraints to suit all children within the regulated ages must be widely available, and clear messages about which restraint to use for children of specific ages must be provided. The specification of restraint geometry in the revised standard (#2 above) has been done with the potential
492
legislative changes in mind. The newly specified restraint geometry should accommodate children up to the 95th percentile in seated height to use a Type B or D child restraint up to their 5th birthday, and a booster seat up to their 9th birthday. Increases in upper weight limits (#3) will also assist in accommodating a wider range of children in restraints, although a proportion of children on their 5th birthday will exceed the 20kg weight limit on forward-facing restraints. Importantly, the introduction of the new class of booster seats for older children will allow changes to legislation to require booster use beyond the 7th birthday once these restraints become more widely available.
Future Challenges If finally accepted, these changes will improve the protection afforded by Australian child restraints, and address many of the issues outlined above. However, there are a number of remaining issues not addressed by this new draft Standard. These include: 1. ISOFIX/LATCH. This issue remains outstanding. Part of the problem with this issue has been that the child restraint standard must match an Australian Design Rule to specify the in-vehicle anchorage points, and there is a need to ensure that the adoption of any version of this system does not result in a degradation in the level of protection currently provided. Issues being worked through include the desire to harmonise vehicle standards internationally; the location and number of these in-vehicle anchorage (two pairs or three in the rear seat), the strength of these anchorages and the implications for tether anchorage locations; and choice of restraint attachment type (rigid or flexible). There have also been a number of reports from other countries where these systems have been adopted that indicate that rather than reducing misuse, some versions of these systems are increasing misuse problems. The challenge to the Australian Standard is to incorporate the features of ISOFIX/LATCH that will improve the side impact protection offered by Australian restraints without degrading current levels of protection in other impact types, and ensuring the propensity for misuse is minimized. 2. Type C and Type E converters. These are add-on child harnesses that provide dual shoulder restraint (Type C) and other forms of belt positioning device (Type E). Currently requirements for these devices are ill-defined and have limited performance criteria. For example, there is no requirement that either of these devices keep the lap belt from riding up into the abdomen or prevent submarining. Better performance requirements for these devices are required. 3. Integrated child restraints in vehicles. A number of overseas vehicle designs incorporate integrated child restraints, most commonly integrated booster seats. These are not covered under either the current child restraint standard or an Australian Design Rule. The status of these devices needs to be clarified, and if possible, performance requirements for these restraints be developed. 4. Enhancing requirements related to reducing the propensity for misuse. While the current draft is starting to address this important issue with belt path colour-coding and improved labelling, there is scope for further improvement, as noted above.
493
Conclusions The draft revised AS/NZS includes some substantial changes, particularly the development of booster seats for larger children (Type F). It also tightens the requirements for side impact performance and restraint geometry. Performance requirements for booster seats have been tightened significantly also. The changes also clear the path for age-based restraint selection instead of weight-based recommendations. This ties into changes to the Australian Road Rules which are currently being finalized, which will mandate restraint use by age. However, there is still work to be done to incorporate dedicated attachment systems for restraints and reduce the propensity for restraint misuse. Please note that this paper outlines changes that are included in a DRAFT edition of AS/NZS 1754, and it may change prior to issuing of the revised Standard.
Acknowledgements The authors would like to thank the other members of CS085 working group for discussions about various aspects of the Standard – past, present and future. Lynne Bilston is supported by an NHMRC Senior research fellowship, and Julie Brown is supported by a grant from the Australian Research Council and partner funding from the Motor Accidents Authority of NSW and the Roads and Traffic Authority of NSW.
References Anderson RWG, Hutchinson TP “The feasibility of age-based criteria for child restraint selection” Paper number 07-0220 Proceedings 20th ESV Conference June Lyon pp 10 2007 Bilston, L, Brown, J, “The potential for improved side impact protection in Australian child restraints” Motor Accidents Authority Research Report pp 133 April, 2004 Bilston, LE, Brown, J, Kelly, P “Improved protection for children in forward facing restraints during side impacts” Traffic Injury Prevention 6 (2) 135-146, 2005 Bilston LE, Hatfield J, Finch C, Brown J “Restraint usage by Australian children – what are they using and why?” Proceedings 2006 Road Safety Research, Policing and Education Conference, October, Gold Coast, Queensland, 7p. 2006 Bilston LE, Sagar N, “Geometry of rear seats and child restraints compared to child anthropometry.” Submitted. Brown, J., Kelly, P, Griffiths, M, “A Comparison of Alternative Methods for Child Restraint Anchorage in Side Impact” 2nd Child Occupant Protection Symposium, Florida, Society of Automotive Engineers pgs 87 - 92., 1997 Brown J., Huot M, Kelly P, Bilston L “Improved Side Impact Protection For Australian Child Occupants” Proceedings 2004 Road Safety Research, Policing and Education Conference, 14-16 November, Perth, Western Australia, Vol 2, 10p. 2004
494
Brown J, Paine M, Paine D, Kelly P, Griffiths M, Magadera N, Haley J, Case M “Revised assessment protocols and scoring methods for the australian child restraint evaluation program”Paper No 07-0490, Proceedings 20th ESV Conference June Lyon pp 10 2007 Charlton, J., Fildes, B., Laemmle, R., Smith, S. & Douglas, F. “A preliminary evaluation of child restraint crash performance with three anchorage systems in a Holden Commodore”, Proceedings 2004 Road Safety Research, Policing and Education Conference, 14-16 November, Perth, Western Australia, Vol 2, 10p. 2004 Edwards SA, RWG Anderson, TP Hutchinson “A survey of drivers’ child restraint choice and knowledge in South Australia” CASR012 Centre for Automotive Safety Research, The University of Adelaide pp44 May 2006 Jermakian JS, Kallan MJ, Arbogast, KB, “Abdominal injury risk for children seated in belt positioning booster seats”. Proceedings of the 20th ESV Conference, June, Lyon, 2007. Kelly, P., Brown, J, Griffiths, M “Child restraint performance in side impacts with and without top tethers and with and without rigid attachment (Canfix)” International Research Conference on Biomechanics of Injury, Brunnen, Switzerland, pgs 75-90. 1995. Lang D, Paine M, Griffiths M and Brown J). “Protecting children in car crashes: Lessons from Australia”. Australian Automobile Association. (available on www.aaa.asn.au/issinfo/crs_effectiveness_13pg.pdf), 2002.
495
496
How Australian child restraints compare with overseas products Michael Lumley Britax Childcare Products Pty. Ltd. Child Restraints in Australia have been made to the Australian Standard which is considered tougher than other standards used in other countries. The presentation and paper proposes to consider the types of child restraints that are available and will compare their design and performance as required by differing standards. These standards have a significant effect on the design of a child restraint. The effects of changes to the various standards, rules of use and market pressures have affected these restraints in different countries over the year. The Australian Standard AS/NZS1754 has more design restrictions than other standards and requires the use of certain design features such as tether straps and the recent introduction of testing for side impact that provides improved safety for the child. The differences and benefits of the Australian Standard will be explained by research that Britax Australia has conducted in the past to demonstrate the benefit of tether and the provision of side impact protection. A proposed revision to the Australian Standard is available for public review which will allow larger booster seats. Research conducted by Britax will be used explain the proposed changes of dummy size for Type B and E child restraints and the effect these changes will have on these products. This research will support the proposed changes to the Australian Standards and will show the improvements in safety that can be achieved for side crashes. In reviewing the differences between the various standards, the emphasis will be to show both strengths and deficiencies of key attributes, including the additional dynamic testing required by the Australian Standard and the requirements for dummy performance required by ECEr44 and FMVSS213.
EDITOR’S NOTE: Abstract only. No paper was received and the presentation slides are not available.
497
498
Australasian College of Road Safety Promoting and implementing improved road safety practices Patron: Her Excellency Ms Quentin Bryce AC Governor-General of the Commonwealth of Australia
The Australasian College of Road Safety was established in 1988 as an association for individuals and organisations working in or interested in support road safety. The College is multidisciplinary in its membership, and values experience as much as academic qualifications in its members. Members come from a wide range of disciplines including engineers, epidemiologists, road trauma specialists, researchers, driver trainers, enforcement agencies, policy makers, industry representatives, motoring associations, insurance companies and many other who have a stake in road safety. The objectives of the Australasian College of Road Safety are: • To foster communication, cooperation and support among workers in road safety; • To disseminate information on road safety and traffic education; • To encourage community groups to work for the reduction of the road toll; • To encourage the professional assessment, evaluation and monitoring of road safety programs and to promote those most effective in reducing road trauma; • To provide a forum for the promotion of workable road safety programs; and • To encourage the provision of care and support for victims of road trauma. To achieve these objectives, the Australasian College of Road Safety undertakes a wide range of activities, including: • Australasian conferences and seminars, often in partnership with related organisations; • An annual Visiting Lecture program; • State Chapter programs such as local seminars, forums, and guest lecturers; • Workshop series; • The development and promotion of policies on road safety issues, supported by well-attested evidence, respected research and, where appropriate, acknowledged expertise;; • Submissions to Federal, State and Territory governments on road safety issues; and • The promotion of best practice in all facets of road safety. The Australasian College of Road Safety has established several State, Territory and Regional Chapters. Although there are some Australasian-wide activities that are organised each year, most of the College’s activities take place at the Chapter level.
499
500
The national conferences of the Australasian College of Road Safety An important national activity for the Australasian College of Road Safety is the development of the Australasian conferences and seminars. These national conferences have often been organised in partnership with parliamentary road safety committees (e.g., the STAYSAFE Committee in New South Wales, the Road Safety Committee inn Victoria, and the Travelsafe Committee in Queensland). The Australasian College of Road Safety national conference program, in contrast to the annual Road Safety Research, Enforcement and Education conferences and other regular road safety conferences in Australia and New Zealand, provides an opportunity to focus on, and evaluate specific topics. Furthermore, the Australasian College of Road Safety national conferences typically provide an opportunity for College members—Members, Associate Fellow, and Fellow—to present their research, commentaries and views on important road safety issues without restriction. It has been the policy of several organisers of the national conferences to accept all proposed papers for oral or poster presentation, thus enabling a diversity of viewpoints to be aired and debated. Previous national conferences conducted by the College have focussed on issues such as community road safety, young drivers, pedestrian safety, and distracted driving: • Infants Children & Young People and Road Safety - 2007 • Pedestrian & Cyclist Safety - 2006 • Driver Distraction - 2005 • Safer Drivers & Riders - 2002 • Pedestrian Safety 1998 • Young Drivers - 1997 • Road Safety in the Community - 1995 Some proceedings have been published and are available from the National Office, including: Ian J. Faulks and Julia D. Irwin (Eds.) (2008). Road safety for infants, children and young people. Proceedings of an international conference held in Parliament House, Macquarie Street, Sydney, New South Wales 2-3 August 2007. Wahroponga ,NSW: Safety and Policy Analysis International. Ian J. Faulks, Michael Regan, Mark Stevenson, John Brown, Allan Porter and Julia D. Irwin (Eds.) (2007). Distracted driving: Proceedings of an international conference on distractions in driving, Sydney, Australia, 2-3 June 2005. Canberra, ACT: Australasian College of Road Safety. Kerry P. Smith, Barry G. Aitken and Raphael H. Grzebieta (Eds.) (1998). Proceedings of the conference on pedestrian safety. Canberra, ACT: Australasian College of Road Safety.
501
Ian J.Faulks, Ken B. Smith and Kerry P. Smith (Eds.) (1997). Conference on young drivers. Sydney, NSW: Parliament of New South Wales. Australian College of Road Safety (1995). Road Safety in the community Conference Proceedings. Canberra ACT; Australian College of Road Safety.
502
APPENDIX – The World Health Organisation (2007) Report on youth and road safety
503
