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Citation
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Yellman MA, Rodriguez MA, Colunga MI, McCoy MA, Stephens-Stidham S, Brown LS, Istre GR. Traffic Injury Prev. 2018; 19(4): 378-384. |
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Affiliation
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a Injury Prevention Center of Greater Dallas, Parkland Health and Hospital System , Dallas , Texas , USA. |
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Abstract
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OBJECTIVE This study evaluated the effectiveness of a series of one-year, multi-faceted, school-based programs aimed at increasing booster seat use among urban children 4-7 years of age in economically-disadvantaged areas.
METHODS During four consecutive school years, 2011-2015, the Give Kids a Boost (GKB) program was implemented in a total of 8 schools with similar demographics in Dallas County. Observational surveys were conducted at project schools before project implementation (P0), 1-4 weeks after the completion of project implementation (P1), and 4-5 months later (P2). Changes in booster seat use for the three time periods were compared for the 8 project and 14 comparison schools that received no intervention using a non-randomized trial process. The intervention included: 1) train-the-trainer sessions with teachers and parents; 2) presentations about booster seat safety; 3) tailored communication to parents; 4) distribution of fact sheets/resources; 5) walk-around education; and 6) booster seat inspections. The association between the GKB intervention and proper booster seat use was determined initially using univariate analysis. The association was also estimated using a generalized linear mixed model predicting a binomial outcome (booster seat use) for those aged 4 to 7 years, adjusted for child level variables (age, sex, race/ethnicity) and car level variables (vehicle type). The model incorporated the effects of clustering by site and by collection date, to account for the possibility of repeated sampling.
RESULTS In the 8 project schools, booster seat use for children 4-7 years of age increased an average of 20.9 percentage points between P0 and P1 (P0 = 4.8%, P1 = 25.7%; OR = 6.9; 95% CI = 5.5, 8.7; p<0.001), and remained at that level in the P2 time period (P2 = 25.7%; p<0.001, for P0 vs P2) in the univariate analysis. The 14 comparison schools had minimal change in booster seat use. The multivariable model showed that children at the project schools were significantly more likely to be properly restrained in a booster seat after the intervention (OR = 2.7; 95% CI = 2.2, 3.3) compared to the P0 time period and compared to the comparison schools.
CONCLUSION Despite study limitations, the GKB program was positively associated with an increase in proper booster seat use for children 4-7 years of age in school settings among diverse populations in economically-disadvantaged areas. These increases persisted into the following school year in a majority of the project schools. The GKB model may be a replicable strategy to increase booster seat use among school-age children in similar urban settings.
Language: en |