BOX 7.1 Child Passenger Safety Seats: An Example of the Lessons Learned and the Challenges Faced in Implementing an Efficacious Injury Prevention Strategy

Child passenger safety seats were developed to protect children and are known to be efficacious in reducing the risk of death and injury in car crashes. From 1988 to 1995, the motor vehicle occupant death rate declined 18 percent for children less than 1 year of age. (SAFE KIDS, 1998b).

The efforts contributing to the increase in the use of safety seats are indicative of the multiple approaches needed to implement injury prevention measures and include:

  • legislatively mandated child seat use in all states and the District of Columbia;

  • education of police regarding enforcement of child passenger safety laws;

  • development of a national certification program to train child passenger safety specialists;

  • development and dissemination of educational and technical material for health care practitioners, safety professionals, car dealers, and the general public;

  • advances in crash testing technology and biomechanics that led to specific safety requirements;

  • establishment of low-cost safety-seat loaner programs;

  • increases in hospital policies requiring discharge of newborns in child safety seats;

  • investment by corporate entities (e.g., Johnson & Johnson, General Motors, Allstate, State Farm) in national campaigns such as SAFE KIDS;

  • provision of technical assistance, seed funds, and mini grants to local agencies by state governor highway safety offices and state health departments; and

  • policy statements on the use of child occupant restraints by professional organizations such as the American Academy of Pediatrics, the American Public Health Association, and the American School Health Association.

Given the success of this intervention, there are still problems in implementation. It is estimated that 35 percent of children 4 years old and under are riding unrestrained and that nearly 80 percent of children riding in child safety seats are improperly restrained (SAFE KIDS, 1998b). In short, even proven injury prevention interventions require a multifaceted approach. A reduction in injuries is achieved only after a long period of intervention and sustained attention to the issue.

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