Center for Injury Research and Prevention

Reaching the Remaining 35 Percent of Sub-optimally Restrained Children

June 13, 2013

Who’s at Risk?

Families at risk for not using booster seats typically involve parents/caregivers of children ages 4 to 7 years with any of the following characteristics:

  • They have a high school diploma or less education.
  • They have lower socioeconomic status (SES).
  • They are from minority groups (e.g., Latino/Hispanic, African-American).

Booster seat use among 4- to 7-year-old children increased to 47 percent in 2011, according to the 2011 National Survey on Use of Booster Seats (NSUBS). An additional 18 percent were in forward-facing car seats. However, the NSUBS found that 35 percent of children 4 to 7 years old in the United States were not being properly protected – 25 percent were restrained by seat belts and 10 percent were unrestrained.

To better protect that remaining 35 percent, we developed and evaluated Boosting Restraint Norms (BRN), a community-led social marketing campaign that emerged from a multi-phase line of research conducted at CIRP@CHOP over the past 8 years.

Through a series of peer-reviewed papers, BRN background studies initially described the characteristics of drivers who did not use booster seats for their child passengers ages 4 through 7, then identified barriers and facilitators to booster seat use for these drivers, and finally developed and tested an intervention that could be effectively translated across different cultures. The winning intervention was a video message of “avoid the regret” from a parent whose child was critically injured in a crash, combined with education on the purpose of boosters and how to use them, as well as a free giveaway. This intervention was converted into a community-delivered social marketing campaign and piloted in Norristown, PA. 

A research article published in the journal Traffic Injury Prevention details the evaluation of BRN’s effectiveness at improving booster seat use among a population with relatively low use of booster seats. Six months after the intervention, a direct observational survey revealed that booster seat use in Norristown, where community members delivered BRN, had increased 28 percent compared to pre-intervention observed usage. There was no observed change in the control community, which delivered no campaign during the same period.

Over the past year, CIRP@CHOP has been collaborating with AAA National and three AAA clubs to adapt the campaign for use in other communities. Over the months of April to June 2013, the AAA clubs of Tidewater, VA, Akron, OH, and Southern New England implemented their version of Boosting Restraint Norms. AAA National is assisting the clubs with their program evaluation.

During the planning phase, we stressed to the AAA Clubs’ campaign organizers what we felt was essential to the delivery of the intervention (a 3-minute "Avoid Regret" video, education, booster giveaway) in Norristown:

  • Community group partnerships - Knowing who and where your audience turns to for trusted information to protect their children. In Norristown, it was the public elementary schools, the Department of Health Clinic, WIC, and their Latino Roman Catholic Church.
  • Immersion meetings to develop “Champions” - Identifying and immersing “champions” within these organizations resulted in their distributing flyers in students' parent packets, setting up displays and showing the video on TV monitors in reception areas, and facilitating educational sessions for parents who likely took the message back to their peers. All you need is one motivated, well-informed individual within each community group who will use the campaign materials you provide.
  • Booster seat giveaway event – We realize that most safety programs do not have the budget to provide free booster seats for every at-risk family in a community. The BRN team organized and promoted a single giveaway event that created a general buzz and interest in booster seats. The BRN team worked with manufacturers to provide a limited number of free and discounted seats for giveaway at the event. Community partners distributed flyers promoting the event. Ultimately, 150 parents received a free seat, watched the “Avoid Regret” video and got a brief orientation on the purpose of and installation of their booster seat.

Success does not require expensive ad buys or large-scale events in order to reach families still at-risk for not using booster seats and child safety seats. But success does require extra effort to get to know their communities and to build trust.  A little elbow grease and simple materials, such as flyers copied on colored paper, provided to under-resourced support systems such as schools and community health centers can go far to increase awareness about the purpose and use of booster seats.

So what is next for Boosting Restraint Norms?  Campaign coordinators from the three AAA clubs will provide essential feedback from their implementation pilots on how we can improve the planning guide while maintaining the fidelity of essential components. Research in Action will alert child passenger safety practitioners when BRN becomes available for use in their community. If you don’t already subscribe to this Blog, sign up!

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