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Motor Vehicle Injury – Child Safety Seats: Incentive and Education Programs


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 4 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.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 2.44 MB].

The systematic review included 4 studies.

  • Observed child safety seat use increased by a median of 9.9 percentage points (4 studies).
    • Observations were made between 1 and 4.5 months after programs were conducted.
    • Baseline rates were similarly low for all 4 studies (median 26 percentage points).

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.


Results should be applicable to a variety of populations and settings using a variety of rewards.

Evidence Gaps

The 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?)

  • 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)?
  • 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?
  • Do interventions increase or reduce misuse of child safety seats?
  • Are interventions equally effective in all populations within a state (e.g., racial and ethnic minorities, high- and low-income populations, or behavior change-resistant populations)?
  • How must the content and methods of the educational components of interventions be altered to work in different populations?
  • Are interventions effective in populations that already have high baseline safety seat use rates?
  • Do programs targeted at parents of infants improve the rate at which parents buy or use child safety seats for children older than 1 year?
  • Are incentive programs effective in settings other than those studied (e.g., state motor vehicle inspection stations) or when implemented by other organizations (e.g., community groups or local businesses)?
  • What is the cost of interventions?
  • Are interventions cost saving?
  • What is the return on investment?

Study Characteristics

  • To receive rewards, parents had to show correct use of safety seats.
  • Rewards used in the included studies ranged from inexpensive trinkets, stickers, or coupons for fast food meals or movies to relatively expensive prizes donated by community merchants.
  • In all programs, larger rewards were provided to randomly selected eligible participants. Some programs also gave smaller rewards to all eligible participants.
  • All of the evaluated programs included educational components of varying intensity. Some programs only provided information about the reward program itself; others provided information about existing laws and the importance of using safety seats.
  • Programs also varied in how they provided information. Some relied on brochures or other printed materials; others used more interactive educational and behavioral techniques, such as supervised practice of correct safety seat use, signed pledge cards, and educational videos.
  • Incentive and education programs were implemented in daycare centers and community-wide among a variety of target populations (children and parents of children aged 6 months to 12 years, all socioeconomic groups, urban and rural populations, white and African-American populations) with similar positive effects.


Zaza S, Sleet DA, Elder RW, Shults RA, Dellinger A, Thompson RS. Response to letter to the editor. American Journal of Preventive Medicine. 2002;22:330-1.

Sleet DA. Evidence based injury prevention: guidance for community action. In: Australian Third National Conference on Injury Prevention and Control. Australian Third National Conference on Injury Prevention and Control. Brisbane, Queensland, Australia; 1999.