Protecting Older Child Passengers
Rural, Bismarck, North Dakota

Project Type: Rural community education with an educational program targeting agencies that work with children 4 to 8 years old

State Law at Time of Project Implementation: North Dakota law did not require booster seats during the time that the project was implemented. Safety seats were required for children younger than age 4. A child safety seat was not required if all of the vehicle's safety belts were in use. Note: North Dakota's child restraint law was upgraded on August 1, 1999, to require restraint use for children through the age of 17. Before that date, the law covered children through age 10.

Purpose: To conduct an areawide outreach and education program on occupant protection, supplemented by the integration of child passenger safety education into health-related programs that serve 4- to 8-year-old children.

Primary Audience(s): Parents of young children, 4- to 8-year-olds, junior and senior high school students, and health- and education-related professionals

Project Reach: Bismarck, North Dakota, and the surrounding counties of Morton, Grant, Oliver, Sioux (including part of the Standing Rock Indian Reservation), and Mercer.

Project Description: This project examined effective ways to promote the use of booster seats and safety belts in a rural community. In addition to a multimedia awareness program, the project developed classroom materials for booster-seat-aged children. It also trained health-related professionals to assess the proper child restraint needs of young children, conducted safety belt education and incentive programs in junior and senior high schools, and conducted outreach (including the distribution of low-cost booster seats) to parents.

Key Project Elements: Though listed sequentially, implementation of these elements occurred at different times throughout the project:

• Data collection to obtain baseline and followup measures of booster seat use.

• Development of a puppet show and print materials for preschool and kindergarten children, including a booster seat song.

• Development of an interactive skit to teach children older than 5 years of age about booster seat use.

• Development of a "Protecting Older Child Passengers" Advisory Committee comprising individuals representing public and private-sector organizations from the five-county area.

• Integration of a booster seat education program into existing programs of the Custer District Health Unit. (The Health Unit includes programs that target low-income families, such as WIC and Health Track. It also includes other nursing services, such as immunizations, newborn visits, and preschool screenings.)

• Encouraging health-related professionals to become certified CPS technicians.

• A multimedia public awareness and information campaign, including public service advertising and collateral materials.

• Setting up child passenger safety displays at county fairs.

• Community child safety seat/booster seat inspection clinics.

• Obtaining support from an independent body shop to install tether hardware in older vehicles.

• Distribution of free and low-cost booster seats.

• Providing written information and calling law enforcement agencies to encourage the enforcement of the new child restraint law.

• Conducting a safety belt education and incentive program for junior and senior high school students.

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Qualitative Research Findings

A focus group discussion about booster seat use with 15 participants (including parents, grandparents, childcare providers, and Head Start staff) provided the following information:

Positive aspects of using booster seats

Safety
Elevating child to see out of window
Child's comfort with improved belt fit

Negative aspects/issues

Child thinking it's a "baby seat"
Children not able to understand the idea of correct use of safety belts
Difficulty finding information about booster seats
Lack of availability in local stores
Compatibility issues (seats not fitting in the car)

General issues

The need to enforce current laws
Promoting the idea that not buckling up is negligence
Providing child safety seats to low-income families
Conducting child safety seat inspections at childcare centers

Project Evaluation Methods: Pre- and post-observational surveys at a childcare center, Head Start program, and elementary school were conducted. The project team used process measures to document the reach and level of participation in most aspects of the project. Feedback from the teachers who used the booster seat education program with elementary school children was used to modify the materials.

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Key Programmatic Findings and Lessons Learned

• Booster seat promotion should be done in the context of an overall comprehensive child passenger safety program.

• Nonuse of restraints is still an issue. Many children were observed riding unrestrained in the front and back seat. A number of children were observed wearing backpacks and unable to properly wear safety belts. The issue of not wearing a backpack while riding in vehicles may have to be addressed in educational materials.

• It doesn't suffice to simply make booster seats available. The use of booster seats must be marketed to parents and children.

• Crash epidemiology should be incorporated into healthcare curricula (nursing, physical therapy, chiropractic, medical). The coordinator had to explain crash dynamics and how restraints work to prevent injury when conducting passenger safety training and outreach with these groups.

• In rural communities—
  
  Find a well-respected community member to promote your message.
  
  It is difficult to conduct observational studies with young children because they are often bused to Head Start or kindergarten programs.

• Integrating child passenger safety into existing health-related services is an effective way to sustain a program once the funding runs out. Public health nurses are an excellent resource for providing this type of information.

• Establishing a permanent child safety seat clinic is an important component of any ongoing effort to promote child passenger safety. By obtaining a local sponsor, the Bismarck-Mandan Safety Council was able to ensure the performance of ongoing monthly child safety seat checkups. Two local dealerships will continue to provide monthly child safety seat check clinics.

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