Motor Vehicle Injury Child Safety Seats: Community-Wide Information and Enhanced Enforcement Campaigns
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends community-wide information and enhanced enforcement campaigns based on sufficient evidence of their effectiveness in increasing child safety seat use.
The full CPSTF Finding and Rationale Statement and supporting documents for Motor Vehicle Injury Child Safety Seats: Community-Wide Information and Enhanced Enforcement Campaigns are available in The Community Guide Collection on CDC Stacks.
Intervention
Community-wide information and enhanced enforcement campaigns include mass media, information and publicity, public displays about safety seats, and special strategies such as checkpoints, dedicated law enforcement officials, or alternative penalties (e.g., informational warnings instead of citations).
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of 4 studies (search period through March 1998).
Study Characteristics
- Included studies evaluated campaigns that provided information on the importance and correct use of child safety seats through paid advertisements, public service announcements, commentaries by community leaders on local television and radio programs, newspaper articles and editorials, displays of safety seats in public locations, and direct mailings.
- In three studies conducted in states with existing child safety seat laws, the campaigns also incorporated special enforcement components, such as traffic checkpoints, assignment of law enforcement officers dedicated to enforcing the safety seat use law, and alternative penalties in place of citations (for example, informational warnings or vouchers to waive fines if a safety seat is purchased).
- Campaigns were conducted in cities, suburbs, and states in the U.S., Canada, and Australia and involved populations at all socioeconomic levels.
- Numerous community organizations and government agencies such as public safety and public health offices, schools, advocacy organizations, and parent groups worked together to design and implement the campaigns.
- Campaigns were directed at parents of children from birth to 11 years of age; none of the studies reported the racial or ethnic makeup of the study population.
Summary of Results
Four studies qualified for the review.
- Child safety seat use: increased by a median of 12 percentage points (interquartile interval: 3.8 to 21 percentage points; 4 studies)
Summary of Economic Evidence
An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.
Applicability
Results should be applicable to variety of settings and populations in the United States, including those of mixed socioeconomic status.
Evidence Gaps
The following outlines evidence gaps for reviews of these interventions to increase use of child safety seats: Laws Mandating Use; Community-Wide Information and Enhanced Enforcement Campaigns; Distribution and Education Programs; Incentive and Education Programs; Education Programs When Used Alone.
Results from the Community Guide review indicate sufficient or strong evidence of effectiveness for four interventions (i.e., child safety seat laws, community-wide information and enhanced enforcement campaigns, distribution programs, and incentive programs). Insufficient evidence was found to determine the effectiveness of education programs alone for increasing child safety seat use. Several important research issues about the effectiveness of these interventions remain.
Does effectiveness of the intervention change when specific elements are changed? For example:
- Does the effectiveness of child safety seat laws vary depending on the requirements of different state laws?
- Does effectiveness of laws vary depending on the intensity and visibility of regular enforcement in the state?
- Would the threat of being charged with contributory negligence if an unrestrained child is killed or injured in a motor vehicle crash change the effectiveness of the law?
- What role does information about laws play in compliance rates?
- Are distribution programs sponsored by medical care organizations more or less effective than programs implemented by other organizations (e.g., insurance companies or community organizations)?
- Are low-cost rental programs any more or less effective than free loan programs?
- Are different incentives needed for different devices (e.g., infant safety seats, child seats, booster seats, safety belts)?
- What is the relative effectiveness of different incentives (e.g., direct rewards related to restraint use vs. chances to win prizes)?
What is the long-term effectiveness of each intervention? For example:
- How can the effectiveness of a child safety seat law be maintained over time?
- Can incentive programs improve long-term use of child safety seats? If so, what kind of reward schedule and distribution method is necessary to maintain positive effects?
How effective are various combinations of these four interventions? For example:
- Does enhanced enforcement provide marginal benefit to that provided by legislation?
- Do hospital discharge policies requiring that newborns be restrained in an approved device increase the effectiveness of distribution programs?
- Because the effectiveness of education alone has not been established, basic research questions remain. For example:
- What amount and quality of content are necessary to improve knowledge, attitudes, and behaviors?
- What are appropriate educational contents and methods for delivery to children at various developmental stages?
- What are the appropriate outcomes to measure when educating young children about the use of child safety seats?
- Is education alone effective to:
- Increase parental use of child safety seats?
- Increase children’s independent use of child safety seats?
- Increase enforcement of child safety seat laws by law enforcement officials?
- Encourage hospital personnel to develop and enforce policies about child safety seat use?
Implementation Considerations and Resources
- Community-wide information and enhanced enforcement campaigns can increase public awareness of child safety seat laws and support other child passenger safety interventions.
- Enhanced enforcement might increase detection and arrest for alcohol-impaired driving and other offenses.
- Potential barriers noted by the Task Force include the following:
- Costs of developing and disseminating public information and educational material (including television and radio announcements)
- Enlisting the support and cooperation of the media, police departments, and other community leaders
- Training enforcement personnel about the importance of enforcing child-restraint device laws
- Increased burden on court systems that handle additional offenders
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.