Keeping Kids Safe in Cars: Child Passenger Safety Promotion in Aboriginal Communities - Final Report
The aim of this project was to improve current child passenger safety practices in three Manitoba First Nations communities, focusing on the correct use of car seats, booster seats, and seat belts by children and their parents, riding in the rear seat for children 12 years and younger, and not riding in the back of pickup trucks.
Local injury prevention committees coordinated the project at the community level, and the overall project was coordinated by the provincial injury prevention centre. Select community members completed child restraint technician training and conducted baseline assessments of child passenger safety practices using roadside and parking lot surveys. Baseline focus groups were held to explore local beliefs, practices, barriers, and solutions and to tailor the interventions. A brief intervention (correction of errors, individual counselling, and replacement of defective seats) was completed at the time of the parking lot survey. A more comprehensive intervention was implemented in two of the three communities, with the third serving as the control group; these strategies were community-led and tailored to local needs, and both included education and hands-on car seat clinics with a multi-stage car seat available for a $20 fee. Three months following the intervention period, roadside and parking lot surveys and focus groups were repeated to evaluate the effectiveness of these interventions.
The communities embraced the project and plan to continue child passenger safety activities. Feedback was positive from parents, coordinators, community groups and health practitioners. Thirteen individuals from the three communities participated in child restraint technician training; these communities previously had no trained individuals. The overall penetration of the project was high. 90 car seats were distributed through the program for community and personal use; this represents a substantial proportion of the population of children less than 8 years of age.
Baseline restraint was very low, in comparison to other Canadian children, as was driver restraint. Child restraint use increased significantly in the largest community, but not in the other intervention community or the control community. Use increased substantially among infants and toddlers but did not improve for booster seat and seat belt use. Of note, the parents of young children were targeted, which may explain the differential impact on younger children. Logistic regression and multilevel modelling identified driver restraint, child age, and the timing of the observation (pre- vs. post-intervention) as important predictors of restraint use. Predictors of correct use included driver restraint, child age, and rear seating position for children. There was not a significant change in seating position or riding in the back of pickup trucks after the intervention.
The roadside and parking lot surveys provide a very valuable summary of observed and reported child passenger safety practices in these communities. Of particular note are parental perceptions of lack of access to car seats and booster seats, as well as cost barriers, but also low perceived risk of injury and need for using car seats and booster seats. Incorrect use was notable for low chest clips and loose harnesses and placing the seat belt behind the back. Premature graduation to seat belts is common, as is placing children in the front seat.
The project and its evaluation were limited by a number of factors, particularly related to the project's remote location and other environmental factors. The intervention timing and duration was challenging, being in the middle of winter and only three months in duration; this limited recruitment of other community partners and the scope of activities. The original research plan to include methods to identify vehicles for before-after observations was not possible, and limited the potential to identify individual-level improvements in participating vehicles/families. Also, if seats had been distributed to non-users as part of the brief intervention, a more significant impact may have been observed.
There are a number of success factors important to this project that should be taken into consideration for programs in other communities. Future programs should investigate the potential for the "brief" intervention (checkstops with correction of errors "on the spot" and distribution of car seats to non-users). Interaction with individual families in their vehicles may be the most promising method, and is possible with small communities such as these. This project served to raise awareness of the importance of child passenger safety and build community capacity to address this problem. The local expertise and infrastructure that was developed by this project will be important to future success and essential for significant improvement in child passenger safety.
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