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American Academy of Pediatrics
Article

The Effect of Passenger Airbags on Child Seating Behavior in Motor Vehicles

Eve Wittenberg, Toben F. Nelson and John D. Graham
Pediatrics December 1999, 104 (6) 1247-1250; DOI: https://doi.org/10.1542/peds.104.6.1247
Eve Wittenberg
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Toben F. Nelson
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John D. Graham
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Abstract

Objective. The purpose of this study was to determine the effect of the presence of passenger airbags on places where children sit when traveling in motor vehicles.

Methodology. An observational and driver interview survey of 503 passenger vehicles was conducted in five New England states at randomly selected long- and short-distance travel sites during the summer of 1998. Each vehicle was occupied by at least 1 child <13 years of age. Seating position, vehicle information, and driver and passenger characteristics were collected. Logistic regression analysis was used to identify the association between the presence of passenger airbags in vehicles and the seating positions of children.

Results. Controlling for the effects of the driver and vehicle characteristics, children <13 years of age were less likely to be observed riding in the front right seat when a passenger airbag was present in the vehicle (odds ratio: .34; 95% confidence interval: .19–.61). Of the vehicles carrying children, 23% had at least 1 child riding in the front seat. Children rode in the front seat in 17% of vehicles with a passenger airbag, and in 30% of those without a passenger airbag. Half of all vehicles without a teenage or adult passenger carried a child in the front seat. In 91% of vehicles with a child riding in the front seat, there was at least one available seat in the rear. Driver safety belt use, younger child age, and the presence of an adult passenger in the vehicle were all associated with children being seated in the rear.

Conclusions. Some New England drivers are protecting children from the risks of passenger airbags by seating them in the rear. There remains, however, a substantial number of children who are being exposed to the risk of passenger airbag deployment.

  • airbags
  • motor vehicle
  • children
  • seating position
  • behavior change

As of model year 1998, driver and passenger (dual) airbags are required standard equipment in all passenger cars sold in the United States. Of the current fleet of passenger cars and light trucks, 30% (nearly 60 million vehicles) are estimated to have passenger airbags.1 In the years ahead, it is expected that worldwide sales of vehicles with passenger airbags will increase rapidly.

Recent data from real world crash experiences have revealed both the dangers and benefits of airbags.2–5 Airbags have been seen to effectively protect adults from fatalities but to pose hazards to children.2 Unrestrained children seated in the front are at particular risk of airbag-induced fatalities because of their small physical stature and their proximity to the airbag housing after precrash braking.5 Current estimates of the frequency of children riding in the front seat range from one quarter to one third of children <13 years of age.6–8 Children are more likely to be seated in the front seat when they are riding alone with the driver and when the driver is unrestrained.8 As of June 1, 1999, 78 child deaths in relatively low speed crashes have been attributed directly to airbag deployment.9 Although technological improvements promise better protection, current (fully powered) airbag designs may fatally injure as many as 162 children per year (when all vehicles on the road have passenger airbags), unless protective steps are taken.10

The response to the discovery of the risk of passenger airbags to children has been threefold: educational campaigns, legislative mandates, and improvements in technology. Educational campaigns to discourage seating children in front of airbags have been directed at both new car buyers and the general public. New cars have airbag safety precautions displayed prominently on sun visors or glove compartments, as well as precautionary information in the owner's manual. Automobile manufacturers have mailed information to owners of vehicles with passenger airbags, informing them of the hazard to children. And private and public agencies have launched major media campaigns to educate drivers. Legislatively, Rhode Island, Delaware, and North Carolina have mandated that young children sit in the back seat. Technological advances have already produced less aggressive airbags in recent model years, and manufacturers are beginning to introduce novel systems that are able to detect the size, position, and belt-use of passengers and adjust deployment characteristics accordingly.

Regardless of how fast the technology improves, it is certain that nearly 60 million vehicles with fully powered passenger airbag systems (lacking any sensing and deployment adjustment capabilities) will be driven and available for resale in the United States over the next 10 or more years. These vehicles pose a hazard to children that can be alleviated by relocating children to the rear seat. Behavior change is critical to reducing this risk to children. This study examines the relationship between driver and vehicle characteristics and seating location of children. The results provide an indication of the current magnitude of airbag exposure to children traveling in motor vehicles and information to target seating behavior interventions.

METHODS

Sample

Long-distance and local travelers in five New England states (Connecticut, Maine, Massachusetts, New Hampshire, and Vermont) were included in the sample. Passenger cars and light trucks, including sport utility vehicles, full-size vans, and minivans, comprised the vehicles observed. Data were collected from June to August of 1998 at highway service stations/information areas and nonhighway fast-food restaurants. Rhode Island was excluded from the sample because of its law on child-seating position, which is being evaluated in a separate study.

Ten highway sites were chosen at random from 60 possible sites identified through lists of highway service stations and information areas provided by state transportation departments or from current road maps. Four sites in Connecticut, three in Massachusetts, two in Maine, and one in Vermont were selected.

Local travel sites were chosen by stratifying all postal zip codes in the region (total of 1611) into quintiles by median household income (from the 1990 US Census). Zip codes with <500 children <3 years of age (from the 1990 Census) were excluded from the sampling frame, leaving ∼240 eligible zip codes. Seventeen zip codes were chosen randomly from the income strata, and one fast food restaurant was selected from each. Three zip codes were selected from each of the four higher income strata, and five from the lowest income stratum, over sampling this stratum to increase the analytic power of the socioeconomic variables.

Survey Instrument

The survey instrument was composed of observational elements and a driver interview. Observational methods were used to reduce distortion and social desirability effects in the responses (ie, people tend to underreport behaviors that are considered undesirable, or even illegal, such as not wearing a seat belt or seating a child in front of an airbag11). Observed variables included vehicle type, number and position of occupants, and driver safety belt use. Child safety restraint use was not observed because proper usage could not be determined by simple observation.

The driver interview consisted of face-to-face questions on the ages of child passengers and vehicle characteristics. The driver's perception of whether his or her vehicle had a passenger airbag was collected in addition to the observation of an airbag housing in the vehicle (where possible). Driver perception was collected because seating behavior may be influenced more by the belief that an airbag exists than by whether one actually does. Because seat belt use and other safety behaviors have been seen to vary by socioeconomic status, questions on income, education and race were included in the interview.12,,13 To improve response rates, these questions were presented in written form to each driver to complete independently.11

Data Collection

Observations and interviews were conducted by individual interviewers working in teams of 2 or 3 per site. Interobserver reliability, using a similar data collection method, was established previously by Graham and colleagues.6 Observations were collected at the highway sites on weekends between the hours of 10am and 4 pm, and at local travel sites on weekdays and weekends from ∼11 am to 2 pmand/or from 4 pm to 7 pm, depending on traffic volume. At each location, every vehicle carrying children who appeared to be <13 years of age was invited to participate in the interview part of the survey (at 13 years of age children approach the physical size of adults4). Observational data were obtained for all vehicles entering data collection sites, regardless of their willingness to participate in the survey.

The instrument was pilot-tested at one highway and one local travel site, and refined before final data collection began. Approval for conduct of the survey was obtained from the Harvard School of Public Health Internal Review Board. Participation was voluntary, and all subjects provided informed consent to participate.

Analysis

Logistic regression was used to analyze the data using SAS Version 6.12 (SAS Institute, Cary, NC).14 Whether a child was seated in the front passenger seat was the outcome of interest (the dependent variable) in the model. The presence of a passenger airbag was the primary effect evaluated.

A model was built by the following steps:15 all potential covariates were tested for their univariate association with the dependent variable using a Pearson χ2 test of association (or a Mantel-Hanzel test for trend with categorical variables). Those variables significant at the P < .10 level in the univariate analysis were tested for inclusion in the multivariate model using a Wald test (inclusion criterion ofP < .05). Inclusion based on confounding between variables left out of the model and the main effect also was considered. Collinearity in the model was evaluated by assessing the impact of including or excluding all combinations of correlated covariates (measured with a Pearson correlation coefficient) on the other parameter estimates. All pair-wise interactions between the main effect and covariates in the final model were considered. Final model fit was assessed using the deviance statistic.

Observations containing missing data on one or more of the covariates in the final model were eliminated from the analysis rather than the data imputed. Analysis of the missing data suggests that no bias was introduced by this approach.

RESULTS

Survey Participants

A total of 711 passenger cars and light trucks carrying at least 1 child were approached during the data collection period; 509 agreed to participate, and 202 refused. Of the 509 vehicles, 6 had incomplete data on the number or location of children present, leaving a usable sample of 503. The response rate to the survey was 71.6% (ie, percentage of all drivers solicited who agreed to participate). Of the drivers, 72% wore safety belts, half were male, 75% were between 25 and 44 years of age, 60% had a college or postgraduate education, 59% reported an annual household income of $45 000 or more, and 76% were white. The vehicles were on average 4.8 years old, half were purchased new, and almost all (96%) had at least one back row of seats (Table 1).

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Table 1.

Characteristics of Respondents and Nonrespondents to Survey

The participants were similar to the nonparticipants in all respects (including the proportion of vehicles with a child riding in the front seat) with one important exception: drivers in the sample were more likely to be wearing safety belts than those who refused to participate (71.9% of participants vs 57.7% of nonparticipants; P< .001).

Descriptive Results

Approximately one quarter (23.4%) of all vehicles carried a child in the front right seat, although this varied by airbag presence. Only 17% of vehicles with dual airbags did so, whereas 30% of vehicles without dual airbags did. Approximately half (47.9%) of all vehicles had dual airbags (as reported by the driver, >90% of driver-reported airbags were confirmed by interviewer observation of an airbag housing). Nearly all (90.8%) of the vehicles observed with a child seated in the front had at least one available, empty seat in the rear. If an adult or teenage passenger was in the car, the percentage of vehicles carrying a child in the front seat declined to 6% from 51% if there were no adult/teenage passengers (in 38.9% of vehicles there were no adult/teenage passengers).

Child seating also varied by driver safety belt use. Overall, 72% of drivers were belted. A child was seated in the front in 19.8% of the vehicles in which the driver was belted, and in 36.2% of vehicles in which the driver was not belted (P ≤ .001).

Logistic Regression Model

The multivariate model revealed that the presence of dual airbags was associated with a reduced chance of a child being seated in the right front seat (odds ratio [OR]: .34; 95% confidence interval [CI]: .19–.61; P = .0002), adjusting for the presence of a teenage/adult passenger(s), driver safety belt use, child age, and driver education. Children <13 years of age were 95% less likely to be seated in the front seat if there was at least 1 adult or teenage passenger in the vehicle (OR: .05; 95% CI: .03–.10;P = .0001). They were approximately one half as likely to be seated in the front seat if the driver wore a safety belt (OR: .46; 95% CI: .26–.83; P = .0104). Conversely, if any child in the vehicle was >6 years of age, that vehicle was almost three times as likely to have a child riding in the front seat as vehicles carrying exclusively children ≤6 years of age (OR: 2.71; 95% CI: 1.52–4.85; P = .0008). Multivariate results are shown in Table 2.

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Table 2.

Multivariate Logistic Regression Model: Probability of Observing a Child in the Front Right Seat

Socioeconomic status is indicated by driver and vehicle characteristics. Driver income, education, and gender were univariately predictive of seating behavior, as was the age of the vehicle. None of these was significant in the multivariate model by the Wald test (P ≤ .05), but each was significant by a likelihood ratio test (χ2 ≤ .05). These variables were all significantly correlated with each other, and likely measured a similar underlying factor. Driver education was selected from the group to represent socioeconomic status in the model.

DISCUSSION

Airbags are a mixed blessing: they are protective for adults and dangerous for children. Engineering advances may improve this situation, but a large number of existing vehicles will perpetuate the problem for the next decade. Behavior change is the most practical response to reduce the risk of airbags to children. Proper restraint use in the front reduces the risk of injury or fatality to children, but elimination of the airbag hazard requires rear seating of children.

This study found that although some drivers are responding to the hazard of passenger airbags by seating children in the rear, at least 1 in 6 New England drivers still seat children in front of airbags. Children traveling with unbelted drivers, children traveling alone with 1 parent, and children >6 years of age are at elevated risk of being seated in the front. This finding suggests that 1) drivers may be heeding the message of airbags being most hazardous to younger children; and 2) child seating behavior may be understood by drivers as a safety consideration, judging from the positive association between safety belt use and rear seating.

Educational efforts to increase child restraint use have been successful in the past,16 suggesting that child seating behavior may be similarly malleable. European experience demonstrates that seating position can be influenced through rear-seating legislation.6 In addition, our recent unpublished analyses suggest that media and informational campaigns regarding airbag hazards to children have resulted in behavior change. Thus, educational and legislative approaches are valid potential avenues to achieve changes in parental and child behavior.

Study limitations may have caused an underestimation of the safety risk for children posed by passenger airbags. Self-selection of more safety conscious drivers into the sample, exclusion of rural areas, and overrepresentation of highly educated and higher income drivers suggest that the true rate of front seating of children in New England in vehicles both with and without passenger airbags may be higher than our findings. In addition, New England has been seen to have less front seating of children than other regions of the country,6,,7therefore the national level of front seating of children is likely higher than the level we found.

Future research should explore the importance of socioeconomic factors in seating behavior in a larger sample. This hypothesis is important in predicting the risk airbags pose to children in the used car market, in which the current fleet will exist for years to come. The motivational factors that affect seating behavior are also worthy of investigation. Redesigned airbags already are being introduced into the fleet, and on/off switches are approved and somewhat available to consumers, yet little is known about their effects on the seating behavior of children.5 Advanced airbags might have the perverse effect of causing more children to sit in the front seat, or confusing parents about the risk of the airbags in their particular vehicle. Research directed toward these trends and developments is critical to inform the policy and education communities on child safety and risk prevention.

ACKNOWLEDGMENTS

This work was funded by the Harvard Center for Risk Analysis.

We thank the data collection interns: Elizabeth Kirkland, Janel Lansphere, Tim Maxwell, Mark Paustenbach, and Jacqueline Rutherford.

Helpful comments on earlier drafts were provided by Donald Bischoff, Mary Ann Chirba-Martin, Maria Segui-Gomez, Alan Zaslavsky, and 2 anonymous reviewers.

Footnotes

    • Received March 17, 1999.
    • Accepted July 7, 1999.
  • Reprint requests to (E.W.) Harvard Center for Risk Analysis, 718 Huntington Ave, Boston, MA 02115. E-mail:ewittenb{at}hsph.harvard.edu

OR =
odds ratio •
CI =
confidence interval

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The Effect of Passenger Airbags on Child Seating Behavior in Motor Vehicles
Eve Wittenberg, Toben F. Nelson, John D. Graham
Pediatrics Dec 1999, 104 (6) 1247-1250; DOI: 10.1542/peds.104.6.1247

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The Effect of Passenger Airbags on Child Seating Behavior in Motor Vehicles
Eve Wittenberg, Toben F. Nelson, John D. Graham
Pediatrics Dec 1999, 104 (6) 1247-1250; DOI: 10.1542/peds.104.6.1247
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