King W, Monroe K, Applegate J, Cole-Farmer J. The impact of education, legislation and service on Alabama child passenger safety. J Trauma. 2007;63(3):S25-S28.
The identification of motor vehicle crashes (MVCs) as the leading cause of death and disability for children in the United States has lead to increased efforts in creating and maintaining Child Passenger Safety (CPS) educational programs. This article presents a model approach to improving CPS in Alabama through enhanced caregiver education, increased public awareness, and the improvement of existing seatbelt and child restraint legislation. A modified form of a model known as the 4 E's approach, education, environmental modification, engineering, and enforcement, was applied as a framework to maximize positive impact on child restraint use, MVC death, and serious injury. The authors identified a 2-fold purpose of their study: (1) to prospectively evaluate the effect of the model approach in the intermediate outcomes of child restraint usage and improved legislation; and (2) to prospectively evaluate changes in child passenger death and serious injury in child passengers younger than 10 years.
REVIEW
Using a 3-pronged model approach consisting of education, legislation, and services, the authors hypothesized that the use of this model approach in Alabama would increase child passenger restraint use, resulting in decreased child passenger death and serious traumatic injury.
The educational component consisted of a statewide multimedia campaign providing information on correct CPS restraint use. A toll-free hotline was established to provide information and consultation on proper child passenger restraint use. A training and certification program aimed at educating CPS technicians and creating CPS fitting stations was developed.
Legislative initiatives, such as supporting the passage of the Alabama Primary Seat Belt Law and clarification of important areas in the state CPS law, composed the second component of the model approach.
Services developed by the authors included 22 car seat fitting stations throughout Alabama, train the trainer classes certifying CPS instructors and technicians, and the hotline mentioned above.
The researchers utilized a pre- and postintervention study design. Statistical analyses for the preintervention years (1994-1999), and the postintervention years (2000-2005), found that the median child restraint usage increased from 58.5% to 85.8% after the implementation of the interventions. This was found to be statistically significant using the Mann-Whitney U test. The decline in the median number of serious injuries to children was also statistically significant, decreasing from 1,522 injuries in the preintervention period to 1,329 injuries in the postintervention period. Median MVC deaths did decline from 36.5 to 32, but was not found to be statistically significant. By using the Federal Highway Administration estimates, the authors were able to calculate the median annual cost savings resulting from the decrease in child passenger deaths and injuries in Alabama as $26,376,960. This was found to be a return of approximately $75.00 for every $1.00 spent on the CPS program.
The authors identify some limitations to their study. State- and nationwide educational activities aimed at improving CPS and increasing seatbelt and car seat use were ongoing throughout the study period and may have resulted in false-positive or false-negative results. Variables, such as Alabama state population, vehicle miles traveled, Alabama state speed limits, and traffic legislation, were not controlled by the authors and may have had an impact on study results, although the authors feel that this impact would be minimal at best because most of the changes in these areas during the study period were very small.
COMMENTARY
Programs directed at increasing proper use of child restraint systems and improving CPS can have a positive impact in the communities where these are instituted. The model approach developed by the authors, consisting of an educational, a legislative, and a service element, reinforced the positive impact that a comprehensive intervention can have on the safety of child passengers by improving child restraint use and decreasing MVC injury. Injury prevention programs should include education on child restraint systems and supportive services, such as fitting stations and certified car seat technicians, and provide opportunities for providers to participate in legislative activities. Trauma nurses have a unique responsibility to positively impact the safety of a vulnerable population and be proponents of programs and legislature that will support and maintain injury prevention and safety initiatives.