Background Between the 2011–2012 and 2014–2015 school years, the Injury Prevention Centre of Greater Dallas (IPC) implemented Give Kids a Boost (GKB), a one-year, multi-faceted, school-based booster seat program in a total of 8 target schools in the Dallas area. Through the program, the IPC trained school staff and parents to be booster seat champions. Together, they conducted parent presentations, provided fact sheets and tailored communication, educated parents at dismissal, and offered inspection stations. This study aimed to evaluate the effectiveness of all of the IPC’s GKB projects in increasing booster seat use among children 4–7 years of age in motor vehicles.

Methods The IPC conducted observation surveys at target and comparison schools before project implementation (pre-intervention, P₀), 1–4 weeks after project implementation (early post-intervention, P₁), and 4–5 months after project implementation (late post-intervention, P₂). Observations were conducted at morning drop-off times near school entrances. A standardised form was used to document the child’s restraint use, age/race/gender, seating position, vehicle type, and driver belt use. P₀, P₁, and P₂ time periods were analysed to compare the changes in booster seat use across each project. Observations were conducted in the same manner at the comparison schools, which received no intervention.

Results In the 8 target schools, booster seat use for children 4–7 years of age increased an average of 20.9 percentage points between P₀ and P₁ (P₀ = 4.8%, P₁ = 25.7%; O.R.= 6.9, 95% CI: 5.5 to 8.7; P < 0.001). Comparison schools (n = 14) experienced no change in booster seat use (P₀ = 4.7%, P₁ = 4.9%; O.R.= 1.0, 95% CI: 0.8 to 1.3; P = 0.4). In 3 of the 4 years, booster seat use remained at a high level at the P₂ time period (P₂ = 31.5%).

Conclusions The GKB program has been effective in increasing booster seat use in motor vehicles for children ages 4–7 in varied school settings. These increases persisted into the following school year in a majority of the projects.