Interventions for promoting booster seat use in four to eight year olds travelling in motor vehicles

 

Abstract

Background

Public health and traffic safety agencies recommend use of booster seats in motor vehicles for children aged four to eight years, and various interventions have been implemented to increase their use by individuals who transport children in motor vehicles. There is little evidence regarding the effectiveness of these interventions, hence the need to examine what works and what does not.

Objectives

To assess the effectiveness of interventions intended to increase acquisition and use of booster seats in motor vehicles among four to eight year olds.

Search methods

We searched the Cochrane Injuries Group's Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE (January 1966 to April 2005), EMBASE (1980 to April 2005), LILACS, Transport Research Databases (1988 to April 2005), Australian Transport Index (1976 to April 2005), additional databases and reference lists of relevant articles. We also contacted experts in the field.

Selection criteria

We included randomized and controlled before-and-after trials that investigated the effects of interventions to promote booster seat use.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results

Five studies involving 3,070 individuals met the criteria for inclusion in the meta-analysis. All interventions for promoting use of booster seats among 4 to 8 year olds demonstrated a positive effect (relative risk (RR) 1.43; 95% confidence intervals (CI) 1.05 to 1.96). Incentives combined with education demonstrated a beneficial effect (RR 1.32, 95% CI 1.12 to 1.55; n = 1,898). Distribution of free booster seats combined with education also had a beneficial effect (RR 2.34; 95% CI 1.50 to 3.63; n = 380) as did education-only interventions (RR 1.32; 95% CI 1.16 to 1.49; n = 563). One study which evaluated enforcement of booster seat law met the criteria for inclusion in the meta-analysis, but demonstrated no marked beneficial effect.

Authors' conclusions

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.

 

Plain language summary

Interventions for promoting the use of booster seats in four to eight year olds travelling in motor vehicles: how effective are they?

Booster seats are designed for use by children aged four to eight years, while travelling in motor vehicles. They aim to raise the child off the vehicle seat so that the adult seat belt fits correctly and the child can travel in greater comfort and safety. Public health and traffic safety agencies recommend the use of booster seats in children until the vehicle seatbelt fits properly; typically when the child is at least 58 inches tall, has a sitting height of 29 inches and weighs about 80 pounds.

In children aged four to seven years, booster seats are estimated to reduce the odds of sustaining clinically significant injuries during a crash by 59%, when compared to using ordinary vehicle seatbelts. Despite the evidence of effectiveness, many children are not restrained in age-appropriate booster seats.

In light of the strong evidence for the safety benefits of booster seats, interventions specifically aimed at promoting their use have been implemented. To evaluate the effectiveness of such interventions, the authors of this systematic review examined all high quality trials investigating their effect on acquisition and use of booster seats.

The authors found five studies involving a total of 3,070 participants. All interventions investigated by the studies were found to increase the use of booster seats, compared to the group receiving no intervention. The distribution of free booster seats combined with education on their use, had a marked beneficial effect, as did incentives (for example, booster seat discount coupons or gift certificates) combined with education. Education-only interventions also produced beneficial outcomes. One of the studies evaluated the effectiveness of the enforcement of a booster seat law, but did not detect an effect on usage.

The authors concluded that the current evidence suggests that several types of interventions aimed at increasing the use of booster seats among children aged four to eight years, are effective. However, there is still a need for further high quality trials, especially those conducted outside of the USA and Australia, where current research dominates.

 

摘要

背景

改善行進中汽車內4至8歲兒童使用加高座椅的介入措施

公共衛生與交通安全機構建議汽車內的4至8歲兒童使用加高座椅，且已實施各種介入措施以增加個人開車載送兒童時使用。有少量的證據有關這些介入措施的效果，因此需要評估哪些有效，哪些沒有效。

目標

評估企圖增加購買及汽車內4至8歲兒童使用加高座椅之介入措施的效果。

搜尋策略

我們檢索the Cochrane Injuries Group's Specialized Register，the Cochrane Central Register of Controlled Trials，MEDLINE (1966年1月至2005年4月)，EMBASE (1980至2005年4月)，LILACS，Transport Research Databases (1988至2005年4月)，Australian Transport Index (1976至2005年4月)，其他的資料庫與相關文章的參考文獻。我們也連絡該領域的專家。

選擇標準

我們納入調查改善加高座椅使用之介入措施效果的隨機與前後對照試驗。

資料收集與分析

兩名作者分別評估試驗品質並摘錄資料。聯絡研究作者以了解其他資訊。

主要結論

五篇研究符合納入標準以進行統合分析，包含3,070名個案。所有用來改善4至8歲兒童使用加高座椅的介入措施證實有正面效果(relative risk (RR)為1.43；95% confidence intervals (CI)為1.05至1.96)。合併教育的鼓勵措施證實具有有利的效果(RR為1.32，95% CI為1.12至1.55；n = 1,898)。發放免費的加高座椅合併教育的介入措施也有有利的效果(RR為2.34；95% CI為1.50至3.63；n = 380)，同樣地只有教育的介入措施也是(RR為1.32；95% CI為1.16至1.49；n = 563)。一篇評估執行加高座椅律法符合納入進行統合分析標準的研究，但其證實沒有顯著的有利效果。

作者結論

現有的證據認為增加4至8歲兒童使用加高座椅的介入措施是有效的。鼓勵措施(加高座椅的折價券或禮券)或發放免費的加高座椅合併教育的介入措施證實對於購買與4至8歲兒童的使用具有顯著的有利結果。有一些證據關於法律對於購買與加高座椅使用的有利效果，但這主要是來自前後非對照研究的結果，其不符合納入標準以進行統合分析。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

改善行進中汽車內4至8歲兒童使用加高座椅的介入措施：它們的效果如何？加高座椅的設計是用來給行進中汽車內4至8歲的兒童使用。它們的目的是讓兒童加高以離開汽車座椅，使得成人的座椅安全帶能夠正確地貼合兒童身體且兒童在行進途中較為舒適與安全。公共衛生與交通安全機構建議兒童使用加高座椅直到汽車座椅安全帶可以適當地貼合其身體；一般來說當兒童至少58英吋高時，其坐著的高度為29英吋而體重約為80磅。對於4至8歲的兒童，相較於使用普通的汽車座椅安全帶，估計加高座椅可以減少59%事故期間造成長期臨床上重要傷害的勝算。儘管證據的效果，許多兒童並未被限制乘坐適合年齡的加高座椅。鑒於加高座椅其安全效益的有利證據，已實施目的為改善加高座椅使用的介入措施。為了評估這種介入措施的效果，這篇系統性回顧的作者評估所有調查介入措施對於購買與加高座椅使用的高品質試驗。作者發現五篇研究，包含共3,070位研究對象。相較於無介入組，發現所有研究調查的介入措施可以增加加高座椅的使用。發放免費的加高座椅合併教育的介入措施對於它們的使用具有有利的效果，如同鼓勵措施(例如加高座椅的折價券或禮券)合併教育的介入措施。只有教育的介入措施也會造成有利的結果。一篇研究評估執行加高座椅法律的效果，但發現對於使用沒有效果。作者認為目前的證據說明有幾種目的為增加4至8歲兒童使用的介入措施是有效的。然而，仍需要進一步高品質的試驗，尤其建立在美國與澳洲以外之目前研究具有主導地位的國家。