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Objectives —In an earlier population based surveillance study of pediatric injuries, the rate of Hispanic children injured as pedestrians was 63/100 000 compared with 17/100 000 for non-Hispanic white children. The present study was designed to examine the effect of family, social, and cultural factors on the rate of pedestrian injury in a population of Hispanic children in the southwestern US. Methods —A case-control study of pedestrian injuries among Hispanic children. The sample consisted of 98 children 0–14 years of age hospitalized as a result of a pedestrian injury and 144 randomly selected neighborhood controls matched to the case by city, age, gender, and ethnicity. Cases were compared with controls using conditional logistic regression; in the study design the odds ratio (OR) estimates the incidence rate ratio. Results —The following family and cultural variables were associated with an increased risk of injury: household crowding (OR=2.8, 95% confidence interval (CI) 1.1 to 7.1 for 1.01–1.5 persons per room, compared with ≤ 1.0 persons per room), one or more family moves within the past year (OR 2.2, 95% CI 1.2 to 4.1), poverty (OR 1.9, 95% CI 1.1 to 3.3), and inability of mother (OR 3.6, 95% CI 1.3 to 10) or father (OR 5.6, 95% CI 1.5 to 20) to read well. However, children in single parent households and children whose parents did not drive a car, had less education, or were of rural origin, did not have an increased rate of injury. Conclusions —These results have implications for childhood pedestrian prevention efforts for low income, non-English speaking Hispanic populations, and perhaps for other immigrant and high risk groups. Prevention programs and materials need to be not only culturally sensitive but also designed for those with limited reading skills. In addition, environmental interventions that provide more pedestrian friendly neighborhoods must be considered.

OBJECTIVES: This study was designed to determine the incidence and causes of injury hospitalizations/fatalities to children less than 15 years of age. SETTING: Central Orange County, California. DESIGN: Cases were identified through a population based hospital and coroner's office surveillance system. SUBJECTS: The sample consisted of children 0-14 years of age who were residents of the study area and sustained an injury between 1 January 1991 and 31 December 1992 resulting in hospitalization or death. RESULTS: Over the two year study period, 1361 children 0-14 years of age were hospitalized or died as a result of injury. This represents a crude annual injury rate of 318/100,000 children. Rates were highest for children less than 5 years--this age group sustained the highest rate for eight of nine specific causes of injury. Falls were the leading cause of hospitalizations for all ages. Pedestrian injuries were more common among children 1-4 years and 5-9 years, while bicycle injuries were more common among older children. CONCLUSIONS: This study, one of the first population based studies in a Southern California urban/suburban community, found lower rates of injury hospitalization than studies conducted over a decade ago. These lower rates may reflect changes in hospitalization trends and/or injury prevention programs. Comparisons with more recent studies in inner city communities in the north east also show regional differences in rates and causes. Injury prevention efforts should particularly address the higher injury rates among children less than 5 years of age. This study also illustrates the need for regional and local data to guide injury control.

Pickup trucks have become increasingly popular in the United States, accounting for about one in five vehicles involved in fatal motor-vehicle crashes. A critical factor in these deaths is the practice of carrying passengers in truck cargo areas, which are not designed for this purpose. Each year approximately 200 deaths occur to occupants riding in the back of pickup trucks. Over half the states have laws dealing with preventable injury problem, but these laws vary widely and most are too limited to be effective. We have reviewed existing laws, as well as crash injury data, and we have developed and recommend a model bill. The bill focuses on intended use, restricting passengers to only those portions of a vehicle designed for human transport. We have also conducted and report on a survey of legislative sponsors of pickup truck legislation.

This study compares injuries of restrained and unrestrained 4- to 14-year-olds in nine emergency rooms and the Coroner's office in Orange County, California from 1983 to 1989. Analyses were performed separately for 4- to 9- and 10- to 14-year-olds because of differences related to the fit of the seat belt. Significantly fewer intracranial injuries and a significantly lower mean Injury Severity Score (ISS) were seen between the restrained and unrestrained for 10- to 14-year-olds in the front passenger and back seats; but for 4- to 9-year-olds in the back seat only. These same differences were noted between restrained 4- to 9-year-olds in the back compared with those in the front passenger seat. Except for 4- to 9-year-olds in the front passenger seat, our findings are consistent with similar studies of occupants of all ages. Our results suggest that lap-shoulder belts (primary restraint in front seat) may provide less protection for 4- to 9-year-olds than for 10- to 14-year-olds and adults.

This article critiques studies, such as that reported by Guerin and MacKinnon in the American Journal of Public Health. These studies are urgently needed in order to evaluate the effectiveness of child passenger safety laws. Using motor vehicle traffic accident reports from local police jurisdictions and California Highway Patrol field officers, Guerin and MacKinnon reported an eight percent decrease in injuries to children in the first year (1983) following implementation of the California Child Passenger Safety Law. In considering the implication of this study, however, some of its limitations need to be kept in mind. One limitation is the reliance on police records. Several studies in the past two years have indicated that police report data appear to underestimate the magnitude of motor vehicle injury rates. Furthermore, the impact of child passenger safety laws on the severity and patterns of injury are not reflected in the gross numbers reported in official statistics. Also to be considered is the extent to which the eight percent decrease in injuries reported by Guerin and MacKinnon can be accounted for by factors other than the restraint laws themselves. Another factor to be taken into account is possible misuse of child restraints. Evaluation of the effectiveness of mandatory child restraint use law is complex and requires a variety of measures and methods. Hospital based data systems may provide additional trauma data. However, additional measures would be required including correct restraint use, law enforcement activities and intensity of educational activities.