Evaluation of a multifaceted, school-based intervention to increase booster seat use

Purpose: A small randomized controlled trial was conducted to evaluate a multifaceted intervention designed to increase appropriate booster seat use among elementary school students.

Methods: Four elementary schools in two Texas cities were randomized to either receive or not receive a series of activities designed to promote appropriate booster seat use. Intervention activities included: information presented to parents and children, free booster seat installation, and reminders from police officers and the school principal. Trained volunteers observed more than 1,500 children age 4 to 7 years and their use of vehicle restraints as they were driven to the four schools. For 99.5% of the children observed in vehicles, the observer was able to identify whether the child was appropriately restrained in a booster seat (1551/1559).

Results: Chi-squared tests indicated that appropriate booster seat use among children at the intervention and control schools was comparable at baseline, but significantly differed at one- and three-month follow ups. Multivariable logistic regression models were conducted to examine the effect of receiving the intervention on appropriately using a booster seat at one- and three-month follow-ups, adjusting for baseline booster seat use rates at each school. These models indicated that children at the intervention schools had 1.7 and 2.1 times the odds of being appropriately restrained in a booster seat at the one- and three-month follow-up compared to control schools (p < 0.01).

Conclusions: This study adds to the body of research literature showing that booster seat distribution and education programs increase appropriate use.