Effectiveness of tribe-driven interventions to improve child passenger safety: The native children always ride safe study (Native CARS)

Background: American Indian and Alaska Native (AIAN) children experience high motor vehicle crash mortality rates and are less likely to be properly restrained relative to other groups. Native CARS is a Community Based Participatory Research (CBPR) study that aims to improve child safety seat use in six Northwest tribes. Methods: We conducted vehicle observation surveys to estimate child restraint use and examined factors associated with proper restraint. Tribes utilized these data along with community member interviews to design and implement interventions. Three tribes implemented interventions; three tribes delayed interventions to serve as controls. The survey was repeated in 2011, and will be conducted again in spring 2013. We evaluated change in child restraint use in intervention tribes relative to control tribes via mixed-effects logistic regression, accounting for clustering by vehicle and site. Results: We observed 1853 children in 2009 and 1812 children in 2011. Intervention tribes demonstrated an increase from 41% to 57% of children properly restrained, significantly greater than the increase observed in control tribes (58% to 64%). The age-adjusted odds of proper restraint increased almost 2.5-fold in the intervention tribes compared to just 1.3 for control tribes (group*time interaction, p=0.005). Most (77%) drivers surveyed were aware of Native CARS media messages. In 2009, 43% of drivers thought a child age 7 or younger could safely use a seat belt, but by 2011, this figure decreased to 26%. Conclusions: Community-driven interventions significantly improved child passenger restraint use, and was well-received by tribes.