A controlled evaluation of the WHO Safe Communities model approach to injury prevention: increasing child restraint use in motor vehicles.

Objective: To measure the effect of the WHO Safe Communities model approach to increasing child restraint use in motor vehicles.

Design: Pre- and post-intervention observations of restraint use in motor vehicles in several sites in the target area, and in a comparison area community.

Setting: Community; southeast Dallas, Texas, 2003-2005.

Interventions: A multifaceted approach to increasing use of child safety seats, booster seats and seat belts that included efforts in schools, day care centres, neighbourhoods and a local public clinic, along with child safety seat classes and a low-cost distribution programme.

Main Outcome Measures: Prevalence of restraint use among children 0-8 years old riding in motor vehicles.

Results: In the target area, the adjusted child restraint use increased by 23.9 percentage points versus 11.8 in the comparison area (difference 12.1; 95% CI 9.9 to 14.3), and adjusted driver seat belt use increased by 16.3 percentage points in the target area versus 4.9 in the comparison area (difference 11.4; 95% CI 11.0 to 11.7). Multivariable multilevel analysis showed that the increase in the target area was significantly greater than in the comparison area for child restraint use (OR 1.6; 95% CI 1.2 to 2.2), as well as for driver seat belt use and proportion of children riding in the back seat.

Conclusions: The Safe Communities approach was successful in promoting the use of child restraints in motor vehicles through a multifaceted intervention that included efforts in various community settings, instructional classes and child safety seat distribution.