Motor Vehicle Injury Child Safety Seats: Education Programs When Used Alone

The CPSTF finding is based on evidence from a systematic review of six studies (search period through March 1998).

The review was conducted on behalf of the CPSTF by scientists from CDC’s Division of Unintentional Injury Prevention with input from a team of specialists in systematic review methods and experts in research, practice and policy related to motor vehicle injury prevention.

More details about study results are available in the published evidence review.

The systematic review included six studies.

• Programs that targeted parents (3 studies) and children (1 study) did not significantly increase correct use of child passenger safety seats.
• The remaining two studies evaluated programs that targeted different types of professional groups (i.e., healthcare providers and law enforcement officers) and used different outcome measures; it was not possible to draw conclusions.

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• What amount and quality of educational content are necessary to improve knowledge, attitudes, and behaviors?
• What are appropriate educational messages 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 do any of the following?
  • 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
• Does education alone increase or reduce misuse of child safety seats?
• What is the role of education in facilitating the effectiveness of other interventions (e.g., legislation, loaner programs)?
• What is the cost of interventions?

• Included studies were implemented in hospitals, preschools, and work sites. Interventions targeted specific populations (parents, children, or professional groups).
• Educational programs for parents focused only on safety seat use among infants; none of the programs looked at the effect of education for parents of older children.
• Urban and suburban populations of low, middle, and upper socioeconomic status were represented in some of the studies.

Effectiveness Review

Analytic Framework see Figure 1 on page 32

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table – Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Arneson SW, Triplett JL. Riding with Bucklebear: an automobile safety program for preschoolers. J Pediatr Nurs 1990;5:115 22.

Christophersen ER, Sosland-Edelman D, LeClaire S. Evaluation of two comprehensive infant car seat loaner programs with 1-year follow-up. Pediatrics 1985;76:36 42.

Goebel JB, Copps TJ, Sulayman RF. Infant car seat usage. Effectiveness of a postpartum educational program. JOGN Nurs 1984;13:33 6.

Lavelle JM, Hovell MF, West MP, Wahlgren DR. Promoting law-enforcement for child protection: a community analysis. J Appl Behav Anal 1992;25:885 92.

Tietge NS, Bender SJ, Scutchfield FD. Influence of teaching techniques on infant car seat use. Patient Educ Couns 1987;9:167 75.

Wolf D, Tomek DJ, Stacy RD, Corbin DE, Greer DL. Promoting hospital discharge of infants in safety seats. J Community Health 1995;20:345 57.

The following outlines the search strategy used 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.

The reviews of interventions to reduce motor vehicle-related injury reflect systematic searches of multiple databases as well as reviews of reference lists and consultations with experts in the field. The team searched six computerized databases (MEDLINE, Embase, Psychlit, Sociological Abstracts, EI Compendex, and Transportation Research Information Services [TRIS]), which yielded 10,958 titles and abstracts for articles, book chapters, reports, and published papers from the Association for the Advancement of Automotive Medicine proceedings about safety belts, alcohol-impaired driving or child passenger safety. Studies were eligible for inclusion if:

• They were published from the originating date of the database through June 2000 (March 1998 for child safety seat interventions)
• They involved primary studies, not guidelines or reviews
• They were published in English
• They were relevant to the interventions selected for review
• The evaluation included a comparison to an unexposed or less-exposed population
• The evaluation measured outcomes defined by the analytic framework for the intervention

The search strategy specific to child passenger safety is not available.

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.