Use of child booster seats in motor vehicles following a community campaign: a controlled trial. A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Using a computer kiosk to promote child safety: results of a randomized, controlled trial in an urban pediatric emergency department. Increasing the protection of newborn infants in cars. Sustaining and broadening intervention impact: a longitudinal randomized trial of 3 adolescent risk reduction approaches. A randomized trial of an intervention to prevent lawnmower injuries in children. Behavior change counseling in the emergency department to reduce injury risk: a randomized, controlled trial. A randomized controlled trial of sport helmet interventions in a pediatric emergency department. Interventions in preschools to increase the use of safety restraints by preschool children.
Once children have outgrown car seats, booster seats protect from injury better than lap and shoulder belts alone. However, the majority of children aged 4 to 8 years use only an adult seat belt.
                To evaluate the effectiveness of a multifaceted community booster seat campaign in increasing observed booster seat use among child passengers in motor vehicles.
                Prospective, nonrandomized, controlled community intervention trial.
                The campaign was initiated in 4 communities in the greater Seattle, Wash, area between January 2000 and March 2001. Eight communities in Portland, Ore, and Spokane, Wash, served as control sites. We observed 3609 booster-eligible children (those aged 4-8 years and weighing 18-36 kg [40-80 lb]).
                Observed booster seat use 15 months after the start of the campaign.
                Before the campaign began, 13.3% of eligible children in the intervention communities and 17.3% in the control communities were using booster seats, adjusting for child age, driver seat belt use, and sex of driver. Fifteen months after the start of the campaign, adjusted booster seat use had increased to 26.1% in the intervention communities and 20.2% in the control communities (P =.008 for the difference in time trends between intervention and control communities).
                These data suggest that a multifaceted community education campaign can significantly increase the use of child booster seats. To prevent early adolescent health risk behaviors and to maintain or improve safety behaviors, we compared the effects of 2 interventions, delivered through pediatric primary care practices. The interventions, based on an office systems' approach, sought to prevent early drinking and smoking or to influence bicycle helmet use, gun storage, and seatbelt safety for children who were followed from fifth/sixth grades through eighth/ninth grades.
                Settings and Participants. Twelve pediatric practices in New England were paired according to practice size and assigned randomly within pairs to deliver the multicomponent interventions, which built on pediatric primary care clinicians performing as counselors and role models during health supervision visits and other office encounters.
                One intervention arm focused on alcohol and tobacco use. The other intervention arm focused on gun safety, bicycle helmet, and seatbelt use. Office systems provided infrastructure that supported the clinician's role. Clinician messages encouraged family communication and rule setting about the issues of the middle school years. The intervention was initiated during a health supervision visit and continued for 36 months. Both child and parent received quarterly newsletters to reinforce the clinician messages.
                The primary outcomes were ever drinking alcohol, ever smoking, ever using smokeless tobacco, using a bicycle helmet in the previous year, using a seatbelt in the previous 30 days, and guns in the child's home in locked storage.
                The pediatric practices recruited 85% (N = 3525) of the practices' fifth/sixth grade children and their responding parents. We obtained 36 months' follow-up data on 2183 child-parent pairs. Chart audit verified that the intervention was implemented. Additional data from interviews and surveys showed that parents, children, and pediatric clinicians found the intervention useful. Despite this, comparisons between the 2 study arms show no significant intervention effects in the prevention of alcohol and tobacco use or gun storage or seatbelt safety. There was a negative effect in the alcohol arm. Only bicycle helmet use showed a positive outcome.
                With rigorous evaluation, 2 office interventions failed to produce desired outcomes. Coordinated multiple settings for prevention interventions are probably necessary. The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined.
                A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4-66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics.
                The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reason for the emergency department visit was related to the safety behaviors. Virtually all (93%) intervention parents read at least some of the report; 57% read it all, and 68% discussed it with others. Lower-income intervention parents who read all of the report and discussed it with others were more likely than control parents to practice safe poison storage. Higher-income intervention parents were more likely than control parents to report correct child safety seat use.
                These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority. Recently the American Academy of Pediatrics instituted a major campaign ("The First Ride--A Safe Ride") in order to encourage all parents to use an infant restraint seat for their newborn's first ride in an automobile--the ride home from the hospital. In the present study the effect of the behavior of the hospital staff on parents' use of infant restraint seats was examined. This study involved 30 mother-infant pairs who were selected sequentially from an obstetrics unit and randomly assigned to two groups. A control group was discharged from the obstetrics unit with no particular emphasis on car safety and no loaner restraint seat available. An experimental group was offered a loaner restraint seat at the time of discharge, with a staff person demonstrating how to put the infant into the restraint seat, how to carry the infant in the seat out to the car, and how to fasten the restraint seat in the automobile with the auto lap belt. Correct use of the loaner restraint seat on the first ride home was observed in 67% of the experimental mothers and in none (0%) of the control mothers. Although this difference was no longer significant at four- to six-week follow-up this study points out the short-term impact that hospital staff can have on the parents' use of restraint seats. Additional techniques are needed to maintain parents' use of restraint seats throughout childhood. To determine whether the addition of a parental monitoring intervention (Informed Parents and Children Together [ImPACT]) alone or with "boosters" could enhance (either broaden or sustain or both) the effect of a small group, face-to-face adolescent risk reduction intervention Focus on Kids (FOK).
                A longitudinal, randomized, community-based cohort study was conducted of 35 low-income, community-based, in-town settings. A total of 817 black youths aged 12 to 16 years at baseline were studied. After completion of baseline measures, youths were randomized to receive a face-to-face intervention alone (FOK only), a face-to-face intervention and a parental monitoring intervention (FOK plus ImPACT), or both of the above plus boosters (FOK plus ImPACT plus boosters). Risk and protective behaviors were assessed at 6 and 12 months after intervention.
                At 6 months' follow-up, youths in families that were assigned to FOK plus ImPACT reported significantly lower rates of sexual intercourse, sex without a condom, alcohol use, and cigarette use and marginally lower rates of "risky sexual behavior" compared with youths in families that were assigned to FOK only. At 12 months after intervention, rates of alcohol and marijuana use were significantly lower and cigarette use and overall risk intention were marginally lower among FOK plus ImPACT youths compared with FOK only youths. With regard to the boosters delivered at 7 and 10 months, 2 risk behaviors--use of crack/cocaine and drug selling--were significantly lower among the youths who were assigned to receive the additional boosters compared with youths without the boosters. The rates of the other risk behaviors and intentions did not differ significantly.
                The results of this randomized, controlled trial indicate that the inclusion of a parental monitoring intervention affords additional protection from involvement in adolescent risk behaviors 6 and 12 months later compared with the provision of an intervention that targets adolescents only. At the same time, the results of the present study do not provide sufficient evidence that booster sessions further improve targeted behaviors enough to include them in a combined parent and youth intervention. The U.S. Consumer Product Safety Commission reports about 60,000 emergency room visits for lawnmower injuries annually with 20% to children under 15 years. Employing a randomized pre-post control group design, the current study evaluated a 20-minute video intervention to increase parents' (n = 80) safety awareness and preventive actions. The setting was an outpatient clinic at a Children's Hospital. Differences favoring the intervention group were found for four of six behavior outcomes. For example, the proportion reporting never allowing children near operating mowers increased from half to two-thirds with no change among comparison group parents. In addition, significant increases in severity beliefs were found. The results provide formative support for the video intervention which possesses the key advantages of ease of use and constancy of message. To determine whether a brief session of behavior change counseling (BCC), offered to injured adolescents in the emergency department (ED) as a therapeutic intervention, could be used to change injury-related risk behaviors and the risk of reinjury.
                A randomized, controlled trial.
                Adolescents between 12 and 20 years old who were undergoing treatment for an injury in the ED and who were cognitively able to participate in the intervention.
                An urban ED at a level 1 pediatric trauma center.
                Study participants completed a baseline risk behavior prevalence assessment. Participants were then randomly assigned to receive BCC or routine ED care. Those in the treatment group underwent a brief session of BCC with a study social worker focused on changing an identified injury-related risk behavior (seatbelt use, bicycle helmet use, driving after drinking, riding with an impaired driver, binge drinking, or carrying a weapon). Participants were recontacted 3 months and 6 months after enrollment to assess the prevalence of positive behavior change and the interim occurrence of medically treated injuries.
                We enrolled 631 participants (78% of those eligible) and obtained follow-up for 76% at 3 months and 75% at 6 months. The relative risk of a positive behavior change with respect to seatbelt use was 1.34 (95% confidence interval [CI]: 1.00, 1.79) at 3 months, favoring the intervention group. The relative risk for the same outcome was 1.47 (95% CI: 1.09, 1.96) at 6 months. A positive change in bicycle helmet use was 1.81 (95% CI: 1.02, 3.18) times more likely at 3 months and 2.00 (95% CI: 1.00, 4.00) times more likely at 6 months in the intervention group. There was no effect of the intervention on changes in other target behaviors. Over the 6-month follow-up period, the risk of reinjury requiring medical attention did not differ between treatment groups.
                Brief BCC can be delivered to adolescents undergoing treatment for injury in the ED and can be used to address injury-related risk behaviors. The intervention was associated with a greater likelihood of positive behavior change in seatbelt and bicycle helmet use. This effect lasted over 6 months of follow-up. BCC was not associated with changes in other risk behaviors and could not be shown to significantly reduce the risk of reinjury. To evaluate the effectiveness of 3 competing pediatric emergency department (ED) interventions aiming to increase sport helmet use in a state without helmet legislation.
                A randomized controlled clinical trial was conducted during the 7-month period between April and October 2003 at an urban pediatric ED in a state without current helmet legislation. We enrolled 200 assenting English-speaking children aged 5 to 16 years, admitted to the ED for treatment, and who did not currently own a helmet. Participants were randomized into 3 experimental arms. A control group received usual care, that is, verbal counseling regarding helmet use. Subjects in one treatment arm received a voucher to receive a free helmet that could be redeemed at a different location within the hospital. Subjects in a second treatment arm actually received a free helmet directly in the ED. The main outcome measure was reported helmet use at follow-up, assessed by telephone interviews of both the child and a parent.
                Directly receiving a free helmet in the ED significantly increased reported helmet use relative to the control group; the odds that a parent reported helmet use were nearly 16 times higher (P < 0.01), and the odds that a child reported helmet use were nearly 10 times higher (P < 0.01). Receiving a free helmet also significantly increased reported helmet use when compared with the voucher intervention group. Reported use between the control group and the voucher intervention group was not significantly different.
                Directly receiving a free helmet in the pediatric ED appears to be an effective hospital-based strategy to increase pediatric helmet use. Despite the proven safety value of wearing vehicle safety restraints, people continue to travel without this protection. Legislation requiring the use of safety restraints has been implemented in several countries, including Australia, in an attempt to improve rates of restraint use. In Australia, legislation dramatically increased rates of adult restraint use, yet the rate of restraint use by children remains comparatively low. One of the main reasons for parents not restraining their child is the child's dislike of wearing a restraint, with resultant disruptive behavior. This study compared two interventions implemented within preschools: a coercive intervention aimed at parents and an educational intervention aimed at preschool children. Measures of restraint use were made by direct observation at preschools prior to intervention and again immediately following the 2-week interventions. The safety restraint use of children in the control and coercive intervention groups did not change significantly as a result of intervention. Restraint use of children in the educational intervention group increased 15 percentage points from 60.6% to 75.0%: a significant increase of 25%. This novel intervention approach holds promise as a means of increasing preschool children's use of safety restraints.
Available evidence suggests that interventions to increase use of booster seats among children age four to eight years are effective. Combining incentives (booster seat discount coupons or gift certificates) or distribution of free booster seats with education demonstrated marked beneficial outcomes for acquisition and use of booster seats for four to eight year olds. There is some evidence of beneficial effect of legislation on acquisition and use of booster seats but this was mainly from uncontrolled before-and-after studies, which did not meet the criteria for inclusion in the meta-analysis.