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A controlled evaluation of the WHO Safe Communities model approach to injury prevention: increasing child restraint use in motor vehicles
  1. Gregory R Istre1,
  2. Martha Stowe1,2,
  3. Mary A McCoy1,
  4. Billy J Moore3,
  5. Dan Culica3,
  6. Katie N Womack4,
  7. Ron J Anderson3
  1. 1Injury Prevention Center of Greater Dallas, Dallas, Texas, USA
  2. 2The Vickery Meadow Youth Development Foundation, Dallas, Texas, USA
  3. 3The Parkland Health & Hospitals System, Dallas, Texas, USA
  4. 4The Texas Transportation Institute, College Station, Texas, USA
  1. Correspondence to Gregory R Istre, Injury Prevention Center of Greater Dallas, Dallas, TX, USA; greg.istre{at}


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.

  • Injury prevention
  • safe communities
  • child safety seat
  • epidemiology
  • evaluation
  • community
  • evaluation
  • passenger
  • restraint
  • safe community

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  • Funding Funding was provided, in part, through a grant (R49/CCR622400-01) from the Centers for Disease Control and Prevention, who had no role in any aspect of the study, and did not review or approve the manuscript.

  • Competing interests None.

  • Patient consent Informed consent was obtained from parents enrolled in the safety seat classes.

  • Ethics approval This study was conducted with the approval of the University of Texas Southwestern Medical Center, Dallas, Texas, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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