Introduction: Children safety car devices decrease injuries and death in children. A survey conducted in Brazil in 2009 revealed that only 36.1% of children safely transported. In 2010, a Brazilian law was implemented, obligating the use of safety devices. The aim of this study is to evaluate the use of such devices after the law and the eventual reasons for non-use. Methods: A significant sample of Brazilian population aged 18 years or more, which normally carry children until 10 years old answered a survey between August 16 and 25, 2012. The study was conducted in two phases. The first one aimed to raise the proportion and profile of the target population, while the second investigated the children car safety device use (or not). Results: 622 interviews. Children’s transporters are young males (57%), living in a metropolitan area in the South region, concerned about safety and law supervision, with greater education level and income than non-transporters (31%) who are male with lack of information, living in a non-metropolitan area of the Northeast region that would be motivated to use the device by effective law fiscalization or threat of an accident. Conclusion: Two years after the law it is observed that education, income, age, gender and region of origin influence the use/non-use of the safety seats in Brazil. The accident threat and fiscalization are the main reasons for using the device, showing that the lack of information impairs the democratization of its use and the prevention culture has to be enhanced in the country.
Criança Segura—Safe Kids Brazil [
Criança Segura—Safe Kids Brazil empowers families and communities to conduct research, educate adults and children, create safe environments and advocate for effective laws in order to prevent childhood injuries and death. Our strategy is based on communication, mobilization and public policy, working together with the Brazilian Government, private sectors, other NGOs, WHO and universities.
Trauma is the leading cause of children deaths in Brazil (4700 deaths and 125,000 hospitalizations under 14 years of age each year) and traffic accounts for 41% of mortality. One of the greatest achievements of Criança Segura—Safe Kids Brazil is the implementation of the law that obligates children under 10 years of age to be safely transported in proper devices [
The child safety seats for cars significantly reduce the risk of injury in children after motor vehicles collisions [
A survey conducted in Brazil in 2009 revealed that only 36.1% of children were in safety seats [
The mandatory use of child restraint devices in automobiles has been a reality in several countries since the 1980s [
To evaluate the use of children safety devices in Brazil after the law, the eventual reasons for non-use and the profile of users and non-users.
Quantitative research, with a personal approach, in the points of population flow, through of a structured questionnaire. The check was personal (in situ) and also by phone (after the data collection), covering at least 20% of the material of each researcher.
Men and women aged 18 years or more, which normally carry children aged until 10 years old in a car.
The survey was conducted between August 16 and 25, 2012 in Brazil.
The study was conducted in two phases. The first one aimed to raise the proportion and profile of the target population (filter questions), while the second investigated the habits of usage of car safety seat for children (complete questionnaire).
The sample design is representative of the total population aged 18 years or more, based on official information from the 2010 Census (Source: IBGE) [
· Stratification by Federal Unit and size of each city;
· City randomization;
· Point of research randomization.
Sample and margin of error:
The sample was divided into 165 municipalities, by region of the country, in two phases (
The maximum margin of error plus or minus, considering a confidence interval of 95% is:
· 3915 interviews—2 percentage points;
· 622 interviews—4 percentage points.
Weighing: To ensure the representativeness of the universe, weighing was done by geographic regions, type of municipality and economic classification.
622 respondents carry children until 10 years old in the car, with a total of 968 children transported (
Margin of error: the entire sample has an associated error (margin of error). Weighing: the results should be weighted according to the Universe. The weighting is to create a “weight” to each questionnaire in order to equalize the distribution of sample with distribution of universe. If the sample is proportional to the universe this weight is 1 (no need for weighting).
In order to determine the profile, the following variables were analyzed characterizing the Transporters/Non- Transporters Stratification Profile: Economic: Economic Active Population or Non-Economic Active Population (EAP or Non-EAP); Monthly Income: Up to 3 Minimum Wage (MW), 3 - 5 MW, 5 - 10 MW, >10 MW. (Minimum Wage in 2012 = R$622,00 = US$3079—Exchange rate on 16/08/2012, R$1 = US$2,02); Economic Classification: (A, B, C, D and E) adapted from ABEP—Brazilian Association of Research Companies, 2012 [
Results showed that 12% of the Brazilian adult population transport children up to 10 years old in cars, corresponding to 1.5 children ratio transported in cars. In this group, the majority uses the car safety seats (57%), however, above 31% don’t use this device.
. Sample distribution
Region of the country | Phase 1 Population over 18 | Phase 2 Target populationa | ||
---|---|---|---|---|
Absolute | % | Absolute | % | |
Southeast | 1638 | 42 | 285 | 47 |
Northeast | 1134 | 29 | 126 | 18 |
North/Midwest | 606 | 15 | 100 | 14 |
South | 537 | 14 | 111 | 21 |
Total | 3915 | 100 | 622 | 100 |
a: Target population = Population with 18 years or over, that carries children in car.
. Children sample
Children transported in car safety seat | Sample | |
---|---|---|
Absolute | Margin of errora | |
Yes | 604 | 4 % p. |
No | 364 | 5 % p. |
Total | 968 | 3 % p. |
a: Maximum margin of error plus or minus (in percentage points), considering a confidence interval of 95%.
Transporters/Non-Transporters Stratification Profile is represented in
The general profile of children transporters is people with a mean level of education higher than Brazilian population and, with a better economic status and familiar income (
The general profile of children transporters, when compared with non-children transporters, is people living in big cities, with a better familiar income and economic status, and with a higher mean level of schooling (
Children transported in cars are balanced in gender distribution and most (67%) are up to 5 years. The non-
. Economic classification adapted from ABEP—Brazilian Association of Research Companies, 2012 [15] . Data based on 2010 socioeconomic survey— IBOPE [14]
Class | Average family income gross amount in Reais (R$)a |
---|---|
A | 10672 |
B | 3491 |
C | 1282 |
D | 714 |
E | 477 |
a: Exchange rate on 16/08/2012 (R$1 = US$2,02).
. Transporters/non-transporters stratification profile by Economic Active Population (EAP), monthly incomea, economic classificationb and scholarity in percentage
Transporter | Non-transporter | General population | |||
---|---|---|---|---|---|
Occupation | EAP | 85 | 85 | 70 | |
Non-EAP | 15 | 15 | 30 | ||
Monthly Incomea | Up to 3 MW | 31 | 41 | 61 | |
From 3 to 5 MW | 30 | 34 | 19 | ||
From 5 to 10 MW | 21 | 17 | 10 | ||
More than 10 MW | 13 | 7 | 5 | ||
Economic Classificationb | A | 7 | 3 | 3 | |
B | 55 | 43 | 25 | ||
C | 36 | 50 | 50 | ||
D | 2 | 4 | 20 | ||
Scholarity | Fundamental | 29 | 39 | 48 | |
Medium | 47 | 45 | 39 | ||
Superior | 47 | 45 | 39 | ||
Total | 604 | 364 | 968 | ||
a: Minimum Wage (MW) in 2012 = R$622,00 = US$307,9—Exchange rate on 16/08/2012 (R$1 = US$2,02). b: Economic Classification: Criteria Brazil of Economic Classification from ABEP—Brazilian Association of Research Companies, 2012 [
. Transporters/Non-transporters stratification profile by geographic region, nature of the municipality, gender and age in percentage
Transporter | Non-transporter | General population | |||
---|---|---|---|---|---|
Geographic region | Southeast | 47 | 43 | 43 | |
Northeast | 18 | 25 | 28 | ||
North/Midwest | 15 | 18 | 15 | ||
South | 20 | 14 | 14 | ||
Nature of the municipality | Metropolitan area | 41 | 31 | 39 | |
Non-metropolitan area | 59 | 69 | 61 | ||
Gender | Male | 71 | 77 | 48 | |
Female | 29 | 23 | 52 | ||
Age | 18 - 24 years | 14 | 9 | 16 | |
25 - 34 years | 32 | 27 | 25 | ||
35 - 44 years | 30 | 38 | 20 | ||
45 years or older | 24 | 27 | 39 | ||
Total | 604 | 364 | 968 | ||
. Comparison between children transporters and general Brazilian population
Brazilian population (18 years or more) | Children transporter | |
---|---|---|
Mean age | 41 years old | 38 years old |
Mean level of schooling | 48% (Basic education) | 24% (Superior education) |
Economic levela | Class C (50%) | Class B (55%) |
Familiar Income (US$) | about 1000 | about 2000 |
a: Economic Classification: Criteria Brazil of Economic Classification from ABEP—Brazilian Association of Research Companies, 2012 [
. Comparison between children transporters and non-children transporters
Children transporters (57%) | Non-children transporters (31%) | |
---|---|---|
Mean age | 37 years old | 40 years old |
Mean level of schooling | 29% (Superior education) | 39% (Basic education) |
Economic levela | Class B (60%) | Class C (50%) |
Familiar Income (US$) | about 2.150 | about 1.620 |
Region | metropolitan area | Non-metropolitan area |
a: Economic Classification: Criteria Brazil of Economic Classification from ABEP—Brazilian Association of Research Companies, 2012 [
using of the equipment is more significant among children aged between 8 and 10 years.
In most cases the child safety seat is installed in the middle seat back, in other situations, child is not a transporter with safety seat, aside of the driver (
The results show that the use of the children safety seat has grown up since the entry into force of the law, but it still reveals differences of using of the device that is influenced by some important variables that must be considered. Despite their effectiveness in reducing injury in motor vehicle collisions, the law enforcement is a barrier for the coercion of the legislation on the car safety seat.
A previous study conducted by Criança Segura—Safe Kids Brazil in 2010 showed that before the law only 32% of parents transported their children with safety devices [
In Brazil, there is no data that shows the percentage of children that was using or not using the safety seat device in an accident followed by death, but the present research can show a general scenario of the use/non-use of the safety seat device and analyze its effects on the mortality rate.
Despite of this great achievement, in general, 57% of the adults transport children in the device, in Brazil. In China, where there is no child safety seat law, 64.8% of adult use a safety restraint for their children [
Car safety seat laws in the United States have been found to be effective; children between the ages of 4 and 7 in states with seat laws were 39% more likely to be correctly restrained than those in other states [
In Brazil, the entry into force of the seat law was in 2010 and two years later we could have an overview of the use/non-use and the reasons for that. In such a diversified country under geography, social and economic disparities, the profiles of both groups (transporters and non-transporters) are different. Transporters have more favorable conditions than the general population (
Education level and better comprehension of the necessity of the car safety seat may be important reasons for transporters. Higher income and the access to the device and other resources are important factors that influence the use of the children seat. The younger age is associated with transporters, and maybe, in this case, older adults are more resistant to accept new changes, like the seat safety law. The participation in the labor market gives more benefits to the employee compared to workers in the informal economy, without labor benefits. The participation of the children transporters in the labor market is more expressive, with greater presence of employees and entrepreneurs among the population and greater proportion in economically active population, particularly those who take part in the formal labor market, which reveals a strong correlation with car ownership and greater economic conditions.
The region of origin is an important variable, as showed in
This data is consistent to the study of the National Highway Traffic Safety Administration (NHTSA) [
Profile of adults who transport children (in seat/don’t transport/both (optional)) in percentage according to region
results.
The proportion of man is greater and they are younger when compared to the adult Brazilian population. Those that transport children up to 10 years old in cars present greater education level compared to the Brazilian population in general (
Once purchasing the car safety seat for children, the majority of adults carrying children declare that always does, every day, in every situation. The everyday use of the equipment increases according to the economic level and is most significant among people who have family income above 3 minimum wages.
Besides the law supervision, other important factors that influence the non-use of a safety seat were the physical size of the child and the small size of the seat followed by the short way route and high price of the device. Like in a Chinese study [
In general, there is an overall low proportion of U.S. child passengers using the age-appropriate restraint and many are placed at risk by sitting in the front seat [
In Canada, Simniceanu et al. (2013) [
According a survey developed by Agran, Anderson & Winn (2005) [
Apsler et al. (2003) [
In a review about this practice Ehiri et al. (2006) [
The use of the car safety seat for transporting children is more significant in the South region (24% use and 14% don’t use), while the non-using transporters are more frequent in the Northeast (25% use and 15% don’t use) and in non-metropolitan areas (69% use and 53% don’t use).
The continued use of the equipment is strongest in the South and in Metropolitan areas, while the use on roads is more significant among those who live in the countryside and in the Southeast and Northeast. A group of respondents who have both habits, to carry and not carry children on the car safety seat (13%) was identified (
In Brazil, the metropolitan region of the South of the country was the region where the use of the car safety seat was more common, mainly in children until 5 years old and for security reasons. In South, 70% transport only 1 child, while in North/Midwest 44% transport from 2 to 3 children.
In the South, the group that use car safety seat has greater awareness, mainly to children between 8 - 10 years old, and is composed by younger people, with more years of study and greater income, compared with the group that doesn’t use the car safety seat.
In non-metropolitan areas, such as the Northeast of the country, a combination of factors were observed: lack of information concerning age limits and different sizes of car safety seats, older children, security and the use of the device during short paths, as well as the deficient fiscalization, resulting in greater non-use in children aged between 8 and 10 years old.
This can be explained by the law that obligates the use of the device for children until 7 years old, and due to the physical size of children above 8 years old, that difficult the use too. In this reality, more supervision of the law adherence or the threat of an accident are the motivator facts for the using of the car safety seat for people that in this region are, generally, older, with less years of study and less income, compared with the group that use the car safety seat.
Results showed that security is the reason for 94% of the transporters to carry children on car safety seats. For 37%, the law/obligation is the main reason. The comfort of the children is the main reason for 13% of the people, and 3% carry children on car safety seat because this device does not permit disturbing the attention of the driver.
Among those that don’t carry children in car safety seat, the main reason are related to the occurrence of a future accident, increased supervision, if children were smaller and long travels (
Among Brazilians that transport children up to 10 years in cars, the majority declare that they accommodates kids in proper devices (57%), three out of ten transporters do not use this equipment (31%) and 13% claim to have both habits (carry the children in the seat and without seat)
Most children transported without car safety seat stay in the middle back seat or in the back seat, without fixed place (
Pan et al. (2012) [
Reasons that influence the use of the safety seat (among those that don’t carry children in safety seats) in percentage
Profile of the location of the carried child/not carried child in car safety seats
In conclusion, although there is a law that regulates child safe transportation with proper devices in Brazil, there is need to improve information and fiscalization in a country where there is no prevention culture and in which people still don’t see prevention as best care for their children.