1 table, 1 figure omitted
Motor-vehicle crashes are the leading cause of death among children
aged ≥1 year in the United States,1 and
one in four crash-related deaths among child passengers aged ≤14 years
involves alcohol use.2 To characterize the
occurrence of child passenger deaths involving drinking drivers during 1997-2002,
CDC analyzed data from the Fatality Analysis Reporting System (FARS) of the
National Highway Traffic Safety Administration. This report summarizes the
results of that analysis, which indicated that among the 2,355 children who
died in alcohol-related crashes, 1,588 (68%) were riding with drinking drivers;
the majority of these children were not restrained. To reduce the number of
child fatalities in alcohol-related motor-vehicle crashes, effective interventions
are needed to prevent alcohol-impaired driving and to increase use of child
FARS is a census of fatal motor-vehicle crashes that occur on public
roadways in the United States and result in the death of an occupant or nonoccupant
(e.g., pedestrian or bicyclist) within 30 days of the crash. A fatal motor-vehicle
crash was classified as alcohol related if either a driver or nonoccupant
had a blood alcohol concentration (BAC) of ≥0.01 g/dL. When BACs were not
available, they were imputed from driver and crash characteristics by using
a two-stage estimation procedure.3 A drinking
driver was defined as a driver with a measured or imputed BAC of ≥0.01
g/dL. Child passengers were defined as passengers aged ≤14 years.
During 1997-2002, a total of 9,622 child passengers died in motor-vehicle
crashes; 2,335 (24%) were killed in crashes involving drinking drivers. Of
the 2,061 alcohol-related crashes involving drinking drivers in which children
were killed, 1,624 (79%) involved at least one driver with a BAC of ≥0.08
g/dL (in 31 states as of December 31, 2002, the legal BAC level for drivers
aged ≥21 years is <0.08 g/dL). Of these crashes, 1,238 (60%) occurred
during 6 a.m.–9 p.m.
Of the 2,335 children who died in alcohol-related crashes, 1,588 (68%)
were riding with drinking drivers (Table). The median BAC of the 1,409 drinking
drivers who were transporting children was 0.13 g/dL (range: 0.01-0.65 g/dL).
Of the 1,409 drinking drivers involved in these crashes, 956 (68%) survived.
For all child passenger deaths, including those not involving drinking
drivers, child passenger restraint use decreased as both the child's age and
BAC of the child's driver increased (Figure). Of 1,451 child passengers with
known restraint information who died while riding with drinking drivers, 466
(32%) were restrained at the time of the crash.
RA Shults, PhD, Div of Unintentional Injury Prevention, National Center
for Injury Prevention and Control, CDC.
The findings in this report indicate that during 1997-2002, approximately
390 children died annually in alcohol-related crashes in the United States.
The majority of children who died while riding with drinking drivers were
not restrained at the time of the crash. The majority of drivers in these
crashes survived, suggesting that certain children killed in alcohol-related
crashes might have survived had they been restrained properly. Strong enforcement
of child safety-seat laws and passage of primary enforcement safety-belt laws
(i.e., laws that allow police to stop and ticket a driver solely because an
occupant is unbelted) in all states could further reduce child passenger deaths.
Because 60% of alcohol-related crashes involving child passenger deaths occurred
during 6 a.m.–9 p.m., enforcement activities of child safety-seat and
safety-belt laws (e.g., roadside checkpoints) are needed, especially during
daylight hours. Drinking drivers have higher rates of severe crashes4; for this reason, stricter enforcement of restraint
laws might substantially reduce the number of deaths of children who are transported
by these drivers.
The findings in this report are subject to at least three limitations.
First, because BAC data are imputed for approximately 60% of FARS cases,3 the precision of the reported BACs is reduced.
Second, for crashes in which a child's driver survived, driver alcohol use
might have been underreported because alcohol testing is more complete among
fatalities.5 Finally, information about
restraint use is obtained from police crash reports, which might overreport
To decrease alcohol-related crash fatalities among child passengers,
communities should implement effective strategies to reduce alcohol-impaired
driving, particularly among drivers who transport children. Effective policies
that apply to the general driving population include sobriety checkpoints,7 lower legal BACs (e.g., <0.08 g/dL),7 administrative license suspension,8 and
mandatory substance-abuse assessment and treatment for persons convicted of
driving under the influence of drugs or alcohol.9 Strategies
to deter persons from drinking and driving with children might include lower
legal BAC limits for drivers transporting children and child endangerment
laws that apply to persons who drive while intoxicated with a child in the
vehicle.2 Such laws have been enacted in
35 states10; however, the effectiveness
of these laws has not been evaluated.
Families and caregivers can reduce the risk to child passengers by adopting
a "zero tolerance" policy regarding alcohol consumption when transporting
children. When health-care providers advise caregivers about injury risks
to children, they should counsel against drinking and driving. Health-care
providers treating adults can screen patients for alcohol-related problems
and provide them with brief interventions or refer them to treatment, as needed.
Additional information regarding effective community-based interventions to
increase child safety-seat and safety-belt use and to reduce alcohol-impaired
driving is available from the Task Force on Community Preventive Services
at http://www.thecommunityguide.org. Information about alcohol-impaired
driving and child passenger safety is available from the National Highway
Traffic Safety Administration at http://www.nhtsa.dot.gov. Information
about child endangerment laws is available from Mothers Against Drunk Driving
This report is based on contributions from T Lindsey, National Highway
Traffic Safety Administration, Washington, DC. KP Quinlan, MD, Dept of Pediatrics,
Univ of Chicago, Illinois.
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