title: Under the influence with a child in the car: implications for child safety and caregiver intervention.
abstract: BACKGROUND
  Injury is the leading cause of death for those aged 1 year to 44 years in the United States, with motor vehicle collisions (MVCs) the leading cause of injury-related deaths. Little data exist on the relationship between caregiver alcohol and drug use at the time of MVC and child passenger outcomes. We examined the relationship between caregiver substance use in MVCs and a number of demographic, crash severity, and medical outcomes for caregivers and children.
  
  
  METHODS
  We identified family groups treated in the emergency department of a regional Level II trauma center after an MVC in a 1-year period from July 1, 2005, to June 30, 2006. The distribution and means of characteristics for substance and nonsubstance users were compared using χ analysis and Student's t tests, respectively.
  
  
  RESULTS
  One in 10 vehicles contained an intoxicated caregiver at the time of MVC. In 363 identified caregivers, intoxication was associated with being male (p < 0.001), lack of safety device use (p = 0.003), rollover (p = 0.008), and ejection (p = 0.016). In the 278 family groups, intoxicated caregivers were related to child ejection (p = 0.009), the need for child hospital admission (p < 0.001), and driver intoxication was related to child lack of restraint (p = 0.045).
  
  
  CONCLUSIONS
  These findings suggest a substantial number of child MVC victims arrive at the emergency room after riding with an intoxicated caregiver. Findings support the need for prevention programs focusing on substance use and driving for male caregivers, and further investigation on the need for screening and intervention for caregivers' risky alcohol and drug use after a child's MVC.
authors.affiliation: Trauma Services, Dell Children's Medical Center of Central Texas, Austin, Texas 78723, USA. kalawson@seton.org
authors.forename: Karla A
authors.initials: KA
authors.lastname: Lawson
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Yuma-Guerrero
authors.forename: Kirk
authors.initials: K
authors.lastname: von Sternberg
authors.forename: Sarah V
authors.initials: SV
authors.lastname: Duzinski
authors.forename: Nilda M
authors.initials: NM
authors.lastname: Garcia
authors.forename: Carlos V
authors.initials: CV
authors.lastname: Brown
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Wakefield
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Crawford
authors.forename: Mary M
authors.initials: MM
authors.lastname: Velasquez
authors.forename: R Todd
authors.initials: RT
authors.lastname: Maxson
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000331:legislation & jurisprudence; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D001336:Automobiles; D017028:Caregivers / Q000331:legislation & jurisprudence*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety / Q000592:standards*; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult