© 2009 American Public Health Association DOI: 10.2105/AJPH.2009.160903
Michael D. Decker is with the Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, and the Medical Affairs Department, Sanofi Pasteur USA, Swiftwater, Pennsylvania. Correspondence: Reprint requests should be sent to Michael D. Decker, MD, MPH, Medical Affairs Department, Sanofi Pasteur, Swiftwater, PA 18370 (e-mail: reprints@deckerfamily.org).
I appreciated the analysis by Rice and Anderson of the effectiveness of child restraint systems.1 Tennessee was the first state to require the use of child restraint devices, doing so in 1978, and an analysis of their effectiveness in preventing death and preventing or reducing injury was published in 1984.2 That study demonstrated restraint devices to be associated with an 11-fold reduction in risk of death, whereas children traveling in the arms of an adult were exposed to risk of injury or death comparable to that of children left entirely unrestrained (a result that led to the removal of the
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