Irene G Chen

University of Pennsylvania, Philadelphia, PA, United States

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Publications (9)12.19 Total impact

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    ABSTRACT: To identify parent driver demographic and socioeconomic characteristics associated with the use of sub-optimal restraints for child passengers under nine years. Cross-sectional study using in-depth, validated telephone interviews with parent drivers in a probability sample of 3,818 vehicle crashes involving 5,146 children. Sub-optimal restraint was defined as use of forward-facing child safety seats for infants under one or weighing under 20 lbs, and any seat-belt use for children under 9. Sub-optimal restraint was more common among children under one and between four and eight years than among children aged one to three years (18%, 65%, and 5%, respectively). For children under nine, independent risk factors for sub-optimal restraint were: non-Hispanic black parent drivers (with non-Hispanic white parents as reference, adjusted relative risk, adjusted RR = 1.24, 95% CI: 1.09-1.41); less educated parents (with college graduate or above as reference: high school, adjusted RR = 1.27, 95% CI: 1.12-1.44; less than high school graduate, adjusted RR = 1.36, 95% CI: 1.13-1.63); and lower family income (with $50,000 or more as reference: <$20,000, adjusted RR = 1.23, 95% CI: 1.07-1.40). Multivariate analysis revealed the following independent risk factors for sub-optimal restraint among four-to-eight-year-olds: older parent age, limited education, black race, and income below $20,000. Parents with low educational levels or of non-Hispanic black background may require additional anticipatory guidance regarding child passenger safety. The importance of poverty in predicting sub-optimal restraint underscores the importance of child restraint and booster seat disbursement and education programs, potentially through Medicaid.
    Traffic Injury Prevention 12/2006; 7(4):373-80. · 1.04 Impact Factor
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    ABSTRACT: To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.
    Journal of Safety Research 02/2006; 37(3):299-306. · 1.29 Impact Factor
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    ABSTRACT: To describe the trip characteristics of vehicle crashes involving children, and to examine the effect of situational factors on front row seating or inappropriate restraint for young children. A cross sectional study was conducted on children <16 years in crashes of insured vehicles in 15 US states, with data collected using insurance claims records and a telephone interview. A descriptive analysis of the characteristics of vehicle crashes involving children was performed. Multivariate Poisson regression was used to identify situational factors associated with inappropriate restraint or front row seating. These data suggest that children were traveling in vehicles involved in crashes that occurred under usual driving circumstances-that is, closer to home (60%), on a local road (56%), during normal daytime hours (71%), within areas with relatively lower posted speed limits (76%). Compared with children involved in morning crashes, those in daytime crashes (RR = 1.65, 95% CI 1.13 to 2.49) or in night-time crashes (RR = 1.63, 95% CI 1.09 to 2.67) were more likely to be sitting in the front seat. Children involved in night-time crashes were more likely to be inappropriately restrained (RR = 1.12, 95% CI 1.01 to 1.22) than those in daytime crashes. Children riding with two or more additional passengers were more likely to be inappropriately restrained (RR = 1.12, 95% CI 1.02 to 1.27) than those with no other passengers. Educational initiatives should aim to increase the perception that parents have about the potential crash risk of everyday trips. Some situational characteristics of trips were associated with inappropriate restraint and front row seating behaviors for young children.
    Injury Prevention 09/2005; 11(4):219-24. · 1.76 Impact Factor
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    ABSTRACT: The first aim was to examine the relationship between driver's age (novice teens, older teens, and adults) and child passenger's restraint status, front row seating, and injury risk. The second aim was to explore whether there was an excess injury risk to child passengers in teen crashes compared to those in adult crashes by examining the contributing factors. A cross sectional study involving telephone interviews with insured drivers in a probability sample of 12 163 crashes involving 19 111 children was conducted. Sequential logistic regressions were employed. Among child passengers aged 4-8, appropriate restraint was <1% for novice teens, 4.5% for older teens, and 23.6% for adults. Front row seating for children <13 years was more common in the novice teen group (26.8%) than in the other two groups. Compared with children riding with adults, those with both teen groups experienced excess injury risk. After adjusting for crash severity, there was a 43% reduction in the odds ratio (OR) for novice teens (OR 1.58, 95% confidence interval (CI) 1.14 to 2.19) and a 24% reduction for older teens (OR 2.15, 95% CI 1.42 to 3.26). After adjusting for vehicle type, child's restraint status and front row seating, there was a further 19% reduction in the OR for novice teens (OR 1.37, 95% CI 1.00 to 1.88) and a further 13% reduction for older teens (OR 1.74, 95% CI 1.14 to 2.66). These findings suggest ways in which graduated driver licensing laws may be further enhanced to better protect child passengers from the excess injury risk associated with teen crashes.
    Injury Prevention 02/2005; 11(1):12-7. · 1.76 Impact Factor
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    ABSTRACT: Previous work identified a similar risk of injury for children seated on the struck side and center rear in side impact crashes in passenger cars. In order to further explain this finding, we investigated the effect of sharing the rear row with other occupants on injury risk and delineated differences in injury patterns among the seat positions. These analyses, conducted from a large child specific crash surveillance system, included: children 4-15 years old, rear seated, seat belt restrained, in a passenger car, and in a side impact crash. Injury risk was compared among each rear seat position stratified by the presence of other occupants on the rear row. Occupants are at an increased risk of injury if they sit alone on their row as compared to sitting with other occupants. Patterns of injuries distinct to each seat position were delineated.
    Annual proceedings / Association for the Advancement of Automotive Medicine. Association for the Advancement of Automotive Medicine 02/2005; 49:229-43.
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    ABSTRACT: Several studies have characterized the benefits of rear seating on injury outcome in children. While most studies have focused on frontal impacts, our previous work demonstrated that these benefits apply to side impacts as well. In this earlier study, however, results indicated that among those rear seated, the side impact injury risk did not vary by seat position, i.e. those on the struck side had similar injury risk to those on the non-struck side. In that study, the center rear occupants were grouped with the non-struck side occupants, and compared with the struck side. The present analyses built upon that previous work and sought to further explore and explain those results by studying the effect of the three distinct rear seat positions (struck-side, center, non-struck-side) in side impacts in a sample limited to seat belt restrained children. Data were obtained from a probability sample of 592 children, representing 6370 children, 4-15 years of age who were enrolled in an on-going crash surveillance system which links insurance claims data to validated telephone survey and crash investigation data. The sample was limited to children restrained by seat belts involved in side impact crashes and seated in the rear seating rows. The risk of injury was calculated for each seating position - struck, center or non-struck side of the crash. Injuries were defined as scalp and facial lacerations, facial bone fractures, and all other AIS 2 and greater injuries. Risk of injury was lower to children seated on the non-struck-side (1.4%) as compared to those on the struck-side (2.6%) (OR:0.55 95% CI: 0.33 0.93). Of interest, the injury risk to children seated on the struck side (2.6%) was roughly equal to that of those in the center rear position (3.0 %) (OR: 1.15, 95% CI: 0.50, 2.66). Accounting for differences in child age did not change the aforementioned results. These results highlight the elevated injury risk for children in center rear seating position in side impacts, and suggest that the injury mitigation approach is unique to that of the other rear seating positions.
    01/2005;
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    ABSTRACT: This study, describing the overall patterns of acute healthcare resource utilization by child crash victims (age 15 years and younger), was conducted between 28 July 1999 and 30 November 2000 as part of an on-going large-scale, child-specific crash surveillance system, Partners for Child Passenger Safety: insurance claims from 15 states and the District of Columbia function as the source of subjects, with telephone survey and on-site crash investigations serving as the primary sources of data. A probability sample of 4862 eligible crashes with 7368 child occupants formed the study sample. Our results suggest that for every 1000 children involved in crashes, 3 are hospitalized; 108 are treated and released from an emergency department (ED); 48 are evaluated in a physician's office, urgent care center, or other facility; and 841 receive no care at all. Comprehensive surveillance systems for motor vehicle crashes must capture children treated in physicians' offices, emergency departments, and other healthcare facilities in order to provide accurate estimates of the impact on the health care system related to motor vehicle trauma.
    Accident Analysis & Prevention 08/2004; 36(4):507-11. · 1.87 Impact Factor
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    ABSTRACT: To assess the success of recent outreach activities to promote appropriate child restraint in motor vehicles by examining trends in restraint types used by children under age 9 in 3 large regions of the United States. Cross-sectional study was conducted of children who were under age 9 and in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 8730 crashes involving 10,195 children, representing 128 291 crashes involving 149,820 children, was collected between December 1, 1998, and November 30, 2002. Parent report was used to determine restraint type used in the crash. Logistic regression models were used to analyze the secular trend of restraint type use. Overall, for children under age 9, seat belt use decreased significantly from 49% to 36% between 1998 and 2002; for 7- and 8-year-olds, from 97% to 92%; and for 3- to 6-year-olds, from 63% to 34%. Concurrently, gains were achieved in overall child restraint use from 49% to 63%, for 7- and 8-year-olds, from 2% to 5%; and for 3- to 6-year-olds, from 35% to 65%. Child restraint use remains stable for children from birth to 2 years of age (from 97% in 1998 to 98% in 2002). Both the use of child safety seat and belt positioning booster seat increased significantly, whereas shield booster seat use decreased significantly. Although considerable achievements have been realized over a short period of time, substantial inappropriate restraint still remains: 62% of children aged 4 to 8 remain inappropriately restrained in adult seat belts. Parents hear safety messages when they are relevant to their children. As a result, sustained efforts about appropriate restraint must continue to maintain and improve the gains achieved in appropriate child restraint use. The additional benefits realized by recent changes in child restraint laws remain to be evaluated.
    PEDIATRICS 06/2004; 113(5):e458-64. · 4.47 Impact Factor
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    ABSTRACT: From 1999 to 2002, 32% fewer US children between 9 and 36.4 kg (20-80 lb) were restrained inappropriately in seat belts and the most prevalent form of restraint shifted from seat belts to child restraints with harnesses. There was a significant increase in the use of combination child restraint/booster seats with harnesses by children 9.1-18.1 kg (20-40 lb). Among children weighing 14.1-18.1 kg (31-40 lb), the inappropriate use of seat belts and shield boosters decreased. Among children weighing 18.6-27.2 kg (41-60 lb), the use of belt-positioning booster seats increased while the inappropriate use of seat belts decreased. Of note, by the end of 2002, 27% of children weighing between 18.6 and 22.7 kg (41-50 lb) were restrained in child restraints with harnesses. These children were of weights typically above the manufacturer's recommended limit. Despite progress, substantial inappropriate restraint still remains and continued investment in outreach efforts is necessary. The risk of injury for heavier children in child restraints with harnesses should be monitored.
    Annual proceedings / Association for the Advancement of Automotive Medicine. Association for the Advancement of Automotive Medicine 02/2003; 47:313-28.

Publication Stats

114 Citations
12.19 Total Impact Points

Institutions

  • 2004
    • University of Pennsylvania
      • Center for Clinical Epidemiology and Biostatistics
      Philadelphia, PA, United States
  • 2003–2004
    • The Children's Hospital of Philadelphia
      • Department of Pediatrics
      Philadelphia, PA, United States