Conclusion: Indications for effectiveness
Legislation goes hand-in-hand with product modification; that is, manufacturers are required to change the style or design of their products to decrease children’s risk (i.e., exposure) of choking/suffocation. For example, written warnings of suffocation hazard on plastic bags.
The one study that evaluated several legislative interventions on choking and suffocation found significant reductions in death rates (per million children) from suffocation due to entrapment in refrigerators and suffocation from plastic bags. It is unclear the degree to which the legislation was responsible for the significant reduction in deaths.
Note: Harborview Injury Prevention & Research Center has written a review on 'Best Practices - Choking, Aspiration, and Suffocation Interventions'. They discuss three prevention interventions; 1) education, 2) legislation, and 3) product modification. Concerning legislation they only mentioned the article of Kraus (1985). They formulated their own conclusions based on the outcomes of this article. These additional comments are also included in this evidence statement. The link to the review of the Harborview Injury Prevention & Research Center is: http://depts.washington.edu/hiprc/practices/topic/suffocation/legislation.html.
Recommendations (for research & practice)
Suggestions for future research:
There is very little research available on evaluated studies of legislation. More research (using experimental designs) needs to be conducted on this topic.
Suggestions for practice and policy:
Legislaton that removes the risk of choking should be implemented wherever possible.
Review Date: 20/09/2011
Articles (reviews) and reports were included that were published between 1980 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute. Only one relevant article, dating from 1985, was found.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in the summer of 2010.
Effectiveness of measures to prevent unintentional deaths of infants and children from suffocation and strangulation (version 1.0)
Jess F. Kraus (1985)
Prevention of choking among children : policy statement (version 1.0)
Committee on Injury, Violence, and Poison Prevention (2010)