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Increases in booster seat use among children of low income families and variation with age
  1. R Apsler1,
  2. S W Formica2,
  3. A F Rosenthal3,
  4. K Robinson4
  1. 1Rhode Island Hospital Injury Prevention Center, Harvard Medical School
  2. 2Social Science Research and Evaluation, Inc
  3. 3Rhode Island Hospital Injury Prevention Center
  4. 4University of Vermont College of Medicine
  1. Correspondence to:
 Dr Robert Apsler
 84 Mill Street, Lincoln, MA 01773-1706, USA;


Objectives: To increase booster seat use among low income parents.

Design/methods: A pre-test/post-test design conducted in nine daycare centers with post-test observations four to eight weeks after the intervention.

Intervention: Parents who participated in an educational training received free seats, educational programs were provided to all daycare staff and children, and signs in parking lots informed parents about child restraints. At seven centers, new policies recommended compliance with state restraint laws. Parents at four centers randomly chosen from the seven received financial incentives if observed using booster seats.

Main outcome measure: The percent of children aged 4–8 riding in booster seats.

Results: Pre-test observations of 185 4–8 year olds found 56% riding unrestrained and fewer than 3% riding in booster seats. After the intervention, observation of 146 children found the number riding in booster seats increased to 38% and the number observed without restraints decreased to 26%. Most booster seat use occurred with 4 and 5 year olds. No 7 or 8 year olds rode in booster seats. Changing center policies to recommend compliance with state restraint laws and an offer of financial incentives appeared to have no additional impact.

Conclusions: Booster seat usage among low income families can be increased dramatically, though use decreases with age. Providing free seats accompanied by training may be sufficient without the need for additional intervention.

  • protective devices
  • child restraints
  • low income population
  • booster seats

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