Use of Child Booster Seats in Motor Vehicles Following a Community Campaign

A Controlled Trial

Ebel, Beth E. MD, MSc, MPH
Koepsell, Thomas D. MD, MPH
Bennett, Elizabeth E. MPH, CHES
Rivara, Frederick P. MD, MPH

Departments of Pediatrics (Drs Ebel and Rivara) and Epidemiology (Drs Koepsell and Rivara), and Harborview Injury Prevention and Research Center (Drs Ebel, Koepsell, and Rivara), University of Washington, Seattle; and Children's Hospital and Regional Medical Center, Seattle, Wash (Ms Bennett).

Corresponding Author and Reprints: Beth E. Ebel, MD, MSc, MPH, Division of General Pediatrics, University of Washington, Harborview Injury Prevention and Research Center, 325 Ninth Ave, Box 359960, Seattle, WA 98104 (e-mail: [email protected]).

Author Contributions:Study concept and design: Ebel, Koepsell, Bennett, Rivara.

Acquisition of data: Ebel.

Analysis and interpretation of data: Ebel, Koepsell, Rivara.

Drafting of the manuscript: Ebel.

Critical revision of the manuscript for important intellectual content: Koepsell, Bennett, Rivara.

Statistical expertise: Ebel, Koepsell.

Obtained funding: Bennett, Rivara.

Administrative, technical, or material support: Ebel, Koepsell, Bennett, Rivara.

Study supervision: Ebel, Bennett, Rivara.

Funding/Support: This work was supported in part by the National Highway Traffic Safety Administration, Washington, DC, the Robert Wood Johnson Foundation, Princeton, NJ, and the Ambulatory Pediatrics Association, McLean, Va.

Acknowledgment: We thank the Washington Traffic Safety Commission, the Safety Restraint Coalition, and the members of the Washington State Booster Seat Coalition for their contributions.

JAMA: The Journal of the American Medical Association 289(7):p 879-884, February 19, 2003.

Context

Once children have outgrown car seats, booster seats protect from injury better than lap and shoulder belts alone. However, the majority of children aged 4 to 8 years use only an adult seat belt.

Objective

To evaluate the effectiveness of a multifaceted community booster seat campaign in increasing observed booster seat use among child passengers in motor vehicles.

Design

Prospective, nonrandomized, controlled community intervention trial.

Setting and Participants

The campaign was initiated in 4 communities in the greater Seattle, Wash, area between January 2000 and March 2001. Eight communities in Portland, Ore, and Spokane, Wash, served as control sites. We observed 3609 booster-eligible children (those aged 4–8 years and weighing 18–36 kg [40–80 lb]).

Main Outcome Measure

Observed booster seat use 15 months after the start of the campaign.

Results

Before the campaign began, 13.3% of eligible children in the intervention communities and 17.3% in the control communities were using booster seats, adjusting for child age, driver seat belt use, and sex of driver. Fifteen months after the start of the campaign, adjusted booster seat use had increased to 26.1% in the intervention communities and 20.2% in the control communities (P = .008 for the difference in time trends between intervention and control communities).

Conclusion

These data suggest that a multifaceted community education campaign can significantly increase the use of child booster seats.