Effects of a Booster Seat Education and Distribution Program in Child Care Centers on Child Restraint Use Among Children Aged 4 to 8 Years

Abstract

To compare child care center-based booster seat education and distribution with no intervention when implemented immediately after booster seat legislation. Design: Cluster randomized controlled trial. Setting: Thirty-nine urban child care centers. Participants: Eight hundred fifty-four parents and 1010 children aged 4 to 8 years in vehicles leaving centers. Intervention: We trained 168 staff members at 20 centers to give parents and children messages promoting booster seats and supplied lesson plans, children's activities, and free booster seats. Main Outcome Measures: Observed booster seat use, "good practice" restraint use, and legal restraint use. Results: Parents at intervention centers were more likely to report receiving restraint information from the center (adjusted odds ratio [AOR], 4.06; 95% confidence interval [CI], 2.48-6.67), speaking with staff about booster seats (AOR, 3.95; 95% CI, 2.26-6.88), and using fit to decide when to move children into seat belts (AOR, 3.39; 95% CI, 1.91-5.99). Groups did not differ in proportions using booster seats (44% vs 43%; AOR, 1.03; 95% CI, 0.62-1.73), good practice (42% vs 41%; AOR, 1.11; 95% CI, 0.70-1.74), or legal restraints (65% vs 65%; AOR, 0.79; 95% CI, 0.48-1.31). Results were similar for children aged 4 to 5 and 6 to 8 years. All outcomes were significantly less likely among children riding in pickup trucks or with Hispanic or black drivers. Conclusions: The intervention increased parents' receipt of information from center staff and knowledge about booster seats but not booster seat use. Research is needed to identify methods and messages that will empower center providers to promote booster seats effectively and reach high-risk populations.

Buckle Up Safely (Shoalhaven): A Process and Impact Evaluation of a Pragmatic, Multifaceted Preschool-Based Pilot Program to Increase Correct Use of Age-Appropriate Child Restraints

“…Furthermore, one study trialed a multifaceted approach yet did not find a positive outcome. The authors suggested that high staff and child turnover at the centers may have led to parents receiving inconsistent and infrequent child restraint messages, leading to attenuation of intervention effects (Thoreson et al 2009).…”

Boosting Restraint Norms: A Community-Delivered Campaign to Promote Booster Seat Use

“…Previous studies indicated that low rates of BPB use are related to differences in risk perception, awareness, knowledge, and parenting styles (Simpson et al 2002). Successful interventions reported to increase BPB use in this population include legislation, mass media education, and incentives or the distribution of free BPBs combined with caregiver education (Durbin and the Committee on Injury Violence and Poison Prevention 2011; Ebel et al 2003b;Ehiri et al 2006;Thoreson et al 2009;Winston, Kallan, et al 2007). Though these studies demonstrated that interventions could be successful in improving BPB in minority populations, the sustainability of these programs requires models that rely on community member delivery rather than dependence on researcher-led efforts.…”

A controlled evaluation of the WHO Safe Communities model approach to injury prevention: increasing child restraint use in motor vehicles

“…Community-based models for injury prevention have become an accepted injury prevention strategy, but there are few well-controlled studies that have evaluated these programmes to increase child restraint use 2. A recent community-based programme to increase booster seat use was effective in an Hispanic community but not in a low-income community,3 and another booster seat programme based in day care centres showed an increase in knowledge about booster seats but did not result in increased use of booster seats 4…”