Approximately 20% of US child passenger deaths from 1982 through 2010 involved an alcohol-impaired driver, typically the child’s own driver.1,2 The higher the blood alcohol concentration (BAC) of the child’s driver, the less likely the child passenger who died was restrained in the crash.1,3 Although most states have enacted legislation to prevent children from riding with drinking drivers, these laws have not been shown to be effective in protecting children.4 The National Highway Traffic Safety Administration reported that traffic fatalities increased during the pandemic,5 and that about 1 in 5 child passenger deaths in 2020 involve an alcohol-impaired driver.6 Through an analysis of national crash data for the past decade, we provide an update on this topic.
Methods
We analyzed the 2011–2019 Fatality Analysis Reporting System (FARS) Final Files and the 2020 Annual Report Files (ARF) from the National Highway Traffic Safety Administration regarding all child passengers (aged <15 years) who died in motor vehicle traffic crashes. FARS is a census of fatal motor vehicle traffic crashes in the United States that occur on public roadways and result in the death of a road user within 30 days of the crash. We analyzed whether child passengers died while being driven by an alcohol-impaired driver or in crashes with an impaired driver in another vehicle in the crash. Alcohol involvement is documented in FARS through a chemical BAC result. If a measured BAC is unknown, BAC measures in the FARS are obtained through an established multiple imputation method.7 As in our previous reports, approximately 50% of the BACs were imputed. However, limiting the analysis to just those crashes with measured BACs did not change the associations reported.1,3
Results
In the United States from 2011 through 2020, 7944 child passengers died in motor vehicle traffic crashes, of which 1755 (22%) died in crashes involving an alcohol-impaired driver (BAC ≥0.08 g/dL). Among those child passengers who died in crashes involving an alcohol-impaired driver, 1124 (64%) died while riding in the same vehicle as an impaired driver. This proportion did not meaningfully change over the study period (Fig 1), whereas the fatality rate of child passengers killed while riding with an impaired driver increased modestly during this time (Fig 1). The majority of these child passengers were unrestrained when they died. For all the child passengers who died during the study period, restraint use generally decreased as both their driver’s BAC and the child’s age increased (Fig 2). A total of 772 (69%) of impaired drivers survived the crash that killed their child passenger. The majority of these fatal crashes involved a single vehicle (670 [60%]) and occurred at night (734 [65%]).
Fatality rate for child passengers killed while being transported by alcohol-impaired drivers and proportion of all child passenger deaths involving an impaired driver in which child was transported by an impaired driver—United States, 2010–2020.
Fatality rate for child passengers killed while being transported by alcohol-impaired drivers and proportion of all child passenger deaths involving an impaired driver in which child was transported by an impaired driver—United States, 2010–2020.
Restraint use among child passengers who died by child’s age and blood alcohol concentration of child’s driver—United States, 2011–2020.
Restraint use among child passengers who died by child’s age and blood alcohol concentration of child’s driver—United States, 2011–2020.
Compared with drivers who had not consumed alcohol but who had a child passenger fatality in their vehicle, alcohol-impaired drivers were more likely to be male (54% vs 44%), have been previously convicted of driving under the influence (DUI) (5% vs 1%), and not have had a valid driver’s license (35% vs 22%) at the time of the crash.
Discussion
In the most recent decade, child passengers have continued to die in crashes involving alcohol-impaired drivers, typically their own drivers. The majority of these children were unrestrained in the crash in which they died and were less likely to be restrained as their driver’s BAC increased. Previous progress on this problem1 has stalled, and the recent increasing trend in child passenger deaths, which was not deterred by the pandemic lockdown, is alarming.
Preventing these deaths deserves renewed attention. Although most states have passed child endangerment laws that provide enhanced penalties for DUI while transporting a child,8 these laws have not been shown to be effective, are not consistently enforced, and are hampered by plea agreements and adjudication.4 Existing laws to reduce alcohol-impaired driving need to be revised for effectiveness, and new measures specifically aimed at protecting child passengers endangered by their own impaired driver need to be developed and evaluated. Possible interventions include wider use of measures to address alcohol-impaired driving, a factor in 31% of all traffic fatalities,9 such as an expanded use of alcohol ignition interlock devices for drivers convicted of DUI, lowering current BAC limits, and programs for repeat offenders, may help to protect children driven by impaired drivers. Future research should also address the contribution of drugged driving to child endangerment because reports show that adults who drive children after using cannabis perceive this behavior to be less risky than drinking and driving.10
Drs Quinlan, Romano, and Kelley-Baker conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.
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