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

Objective To measure the effect of the WHO Safe Communities model approach to increasing child restraint use in motor vehicles. Design Preand post-intervention observations of restraint use in motor vehicles in several sites in the target area, and in a comparison area community. Setting Community; southeast Dallas, Texas, 2003e2005. Interventions A multifaceted approach to increasing use of child safety seats, booster seats and seat belts that included efforts in schools, day care centres, neighbourhoods and a local public clinic, along with child safety seat classes and a low-cost distribution programme. Main outcome measures Prevalence of restraint use among children 0e8 years old riding in motor vehicles. Results In the target area, the adjusted child restraint use increased by 23.9 percentage points versus 11.8 in the comparison area (difference 12.1; 95% CI 9.9 to 14.3), and adjusted driver seat belt use increased by 16.3 percentage points in the target area versus 4.9 in the comparison area (difference 11.4; 95% CI 11.0 to 11.7). Multivariable multilevel analysis showed that the increase in the target area was significantly greater than in the comparison area for child restraint use (OR 1.6; 95% CI 1.2 to 2.2), as well as for driver seat belt use and proportion of children riding in the back seat. Conclusions The Safe Communities approach was successful in promoting the use of child restraints in motor vehicles through a multifaceted intervention that included efforts in various community settings, instructional classes and child safety seat distribution. BACKGROUND Motor vehicle crashes are the leading cause of death for children in theUSA, and one of the leading causes of death of children around the world. Child safety seats (CSSs) have been proven to prevent deaths and injuries among children who are involved in motor vehicle crashes. Community-based models for injury prevention have become an accepted injury prevention strategy, but there are few wellcontrolled studies that have evaluated these programmes to increase child restraint use. A recent community-based programme to increase booster seat usewas effective in anHispanic community but not in a low-income community, 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. One model of community injury prevention is the Safe Communities approach. The Safe Communities model has been adopted in numerous communities around the world, and has been embraced by the World Health Organization (WHO) for more than 20 years as the model for injury prevention, through its official designation of at least 198 sites as ‘WHO Safe Communities’. Dallas, Texas was designated a Safe Community by WHO in 1996, and re-certified in 2007. Although there have been studies evaluating the impact of a few communities using this model, a recent paper reviewing the model pointed to the lack of controlled efficacy trials and the need for more evaluations of this approach to injury prevention. Our study is one of the first controlled evaluations of the effect of the WHO Safe Communities model approach to increasing child restraint use in motor vehicles. METHODS Overview We used the Safe Communities model in an ethnically diverse population in the southeast part of Dallas, Texas, in order to increase child restraint use among children 0e8 years of age, in motor vehicles in that population. In this model, members of the target community are involved in the design and decision-making of injury prevention programmes. The intervention involved a multifaceted, community-based, culturally integrated programme, similar to a strategy that had been successfully developed and implemented in another geographic area of Dallas a few years earlier. We focused our efforts on increasing compliance with Texas state child restraint law, which required children under 4 years old to ride in a child safety seat, and children 4e16 years old to ride either in a child safety seat or a seat belt; we also emphasised the added protection for children 5e8 years old to ride in a booster seat. Collection of observational data of child restraint usage in the target area and in a comparison area where no intervention took place allowed us to use this quasi-experimental observational design to evaluate the research problem: whether the Safe Communities approach resulted in increased child restraint usage. Setting The target population included three zip codes in southeast Dallas County, with a population in the 2000 census of 176 656, including 29% black, 36% Injury Prevention Center of Greater Dallas, Dallas, Texas, USA The Vickery Meadow Youth Development Foundation, Dallas, Texas, USA The Parkland Health & Hospitals System, Dallas, Texas, USA The Texas Transportation Institute, College Station, Texas, USA Correspondence to Gregory R Istre, Injury Prevention Center of Greater Dallas, Dallas, TX, USA; greg.istre@phhs.org Accepted 17 August 2010 Istre GR, Stowe M, McCoy MA, et al. Injury Prevention (2010). doi:10.1136/ip.2010. 027011 1 of 6 Original article IP Online First, published on October 27, 2010 as 10.1136/ip.2010. 027011 Copyright Article author (or their employer) 2010. Produced by BMJ Publishing Group Ltd under licence. group.bmj. com on November 10, 2010 Published by injuryprevention.bmj. com Downloaded from