Introduction/objective Persons living in rural areas are at great risk of motor vehicle injury, as are children ages 4–7 years when prematurely graduated to seat belts designed for adults. Social marketing, individual decision-making and community engagement models were integrated to increase booster seat use through an accepted sport in rural communities. We report on lessons learnt from a multi-state study in the USA.

Methods A non-randomised controlled design was used. Intervention strategies included building child passenger safety resources, tailored print media, community presentations and local spokespersons. Restraint was assessed for all children <15 years at the sport setting. Car seats were provided at no cost. Control communities received only brochures. Trained community volunteers assisted staff in conducting pre/post intervention observational surveys.

Results Twenty rural communities participated. Community members were engaged at every site to increase community access. Study communities with pre-existing child restraint resources were less engaged in planning and implementation than communities with few resources. Participation from parents varied according to buy-in from team coaches. Frequent communication and a personal presence in the study communities were critical factors to participation and interest. Weather and unanticipated events competing for community interests occurred. The project increased capacity and resources for sustained child passenger safety efforts in engaged communities.

Conclusions The study was successful in generating local support and resources for child restraint. Flexibility and personal connections with local leaders increased volunteer recruitment and community involvement. Efforts are ongoing to sustain community interest.