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FIELD ACTION REPORT |
Gregory R. Istre, Mary A. McCoy, Linda Fanning, and Martha Stowe are with Injury Prevention of Greater Dallas, Dallas, Tex. Gregory R. Istre is also with PID Associates, Dallas, Tex. Katie N. Womack is with the Texas Transportation Institute, College Station. Laurette Dekat is with the Department of Pediatrics and the Department of Community and Family Medicine, University of Texas Southwestern Medical Center, Dallas.
Correspondence: Requests for reprints should be sent to Gregory R. Istre, MD, Injury Prevention of Greater Dallas, PO Box 36067, Dallas TX 75235.
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ABSTRACT |
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The use of restraints in motor vehicles is less common in minority and low-income populations than in the general population. A preliminary survey of Hispanic preschool-aged children in west Dallas, Tex, conducted in 1997 showed much lower child restraint use (19% of those surveyed) than among preschool children of all races in the rest of the city (62%).
Because there are few reports of successful programs to increase child restraint use among Hispanics, we undertook to implement and evaluate such a program. The program was conducted by bilingual staff and was tailored for this community. It was successful in increasing both child restraint use and driver seat belt use.
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INTRODUCTION |
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Information obtained from focus groups of Hispanic parents in the community led to development of a program tailored to that population. Activities were carried out at neighborhood parties and in a local community health center, local day care centers, churches, community centers, and botanicas (stores that sell traditional Hispanic remedies and often employ a folk healer). Child safety seats were distributed through parent education classes in a variety of locations.
Child motor vehicle restraint use was evaluated through structured observational surveys, which showed a significant increase in child restraint use in the community. By 2000, restraint use among Hispanic preschool-aged children attending the clinic (72%) had surpassed use in a comparison population of preschool-aged children in the rest of Dallas (69%).
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THE PROGRAM |
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We used the Safe Communities model to develop community interventions.6 Components of the program are listed in Table 1
. The interventions were developed from standardized educational programs, with modifications based on information obtained from 6 focus groups in the Hispanic community. These included establishing a child safety seat loaner program, educating parents in small classes, identifying mothers as authority figures to help communicate the message, addressing the issue of fatalism or destiny, and using videos that graphically showed what happens to a child held on an adult's lap in a car crash.
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Child safety seat classes were conducted in Spanish and English in the target area throughout the project, beginning in May 1997. The classes were taught by certified child passenger safety technicians and were held biweekly at the only county-sponsored community primary care health center in the target area and at other locations in the community on request. Parents were required to attend an hour-long training class on the proper use and installation of child safety seats before they received a seat. They were asked to pay a $10 deposit for the seat, but they were not denied a seat if they were unable to pay. More than 3000 child safety seats were distributed to Hispanic families in the target area during the survey period.
Interventions also were implemented in several day care centers and neighborhoods in the target area (Table 1
). A key component was the traffic safety workshops, which included information about vehicle safety, driver's licenses, immigration, and social security laws, as well as demonstrations of proper installation of child safety seats. At local schools, churches, and neighborhood events, a Hispanic policewoman known as La Protectora ("The Protector")9 held classes in Spanish and English for parents and children to explain child safety laws and procedures. Information was also provided through activities at churches, community centers, and botanicas. Trained bilingual staff, most of whom were also residents of the target area, conducted all activities.
KEY FINDINGS
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EVALUATION |
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A total of 7413 observations among preschool-aged Hispanic children (<5 years) were conducted from 1997 through 2000: 2246 (30%) at the health center, 2735 (37%) at day care centers, and 2432 (33%) at grocery store parking lots. Additionally, 4137 comparison observations were done by TTI on preschool-aged children of all races in other parts of Dallas.
Child restraint use among preschool-aged Hispanic children increased significantly in all 3 settings between 1997 and 2000 (P < .0001 by 
2 for trend; Figure 1). By 2000, use of restraints among Hispanic children attending the health center was higher than use in the rest of the city as measured in the TTI survey (72% vs 68%). There was substantially higher use among younger children (from birth to 1 year) than among children aged 2 to 4 years (Figure 2). Nevertheless, the trend of increasing use was significant in all 3 settings and for both age groups (P < .001 by 2 for trend).
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2 for trend), whereas the TTI survey showed little change in driver seat belt use for other parts of Dallas (not significant). There was a strong association between child restraint use and driver seat belt use at all the observation sites. The association remained strong after results were stratified by year, setting, age of the child, and type of vehicle (summary risk ratio = 5.7, 95% confidence interval = 5.0, 6.4; P < .0001). |
DISCUSSION |
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Several caveats are in order. First, although we found a significant increase in child restraint use in the community (as measured by the grocery store and day care center surveys), use in the community remained significantly lower than use at the health center, indicating that there is much work still to be done. Some of the increase in restraint use at the health center may have been due to a "social desirability" effect—parents who knew they were going to the health center, the primary site of the intervention activities, may have been more likely to practice car seat safety.
Second, although the overall trend was relatively flat, there were some fluctuations in restraint use in the rest of Dallas from year to year, which may have reflected other community factors at work that influenced child restraint use. Third, the predominant impact of the program in the overall community (as measured by the surveys in grocery store parking lots) was seen among children younger than 2 years. Finally, the program may not be generalizable to other populations and ethnic groups.
Despite these possible shortcomings, the program appears to have been successful. With a multifaceted program, child restraint use and driver seat belt use in the Hispanic population may reach levels that equal or exceed those of the general population.
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Acknowledgments |
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We are indebted to Salvador Manzo and Isabel Colunga, who performed observational surveys; Dawn Cano and Martha Maldonado for their work at the health center and in the community; Allen Bolton for his work in guiding the early stages of the project; the staff of the Texas Transportation Institute for data from the annual child restraint surveys for Texas; physicians, nurses, and staff of the deHaro Saldivar Health Center for their dedication to these ongoing safety interventions (in particular, Esperanza Martinez and Antonia Garza, who maintained the sign-up lists for classes); the directors and staff of the day care centers and the managers of the grocery stores in the study; Mike West and the Texas Dept of Transportation and the members of the Safe Riders program of the Texas Department of Health for their roles in acquiring child safety seats for the program; Paul Boumbulian and Ron Anderson for their support of the many prevention efforts of the IPC; the Dallas Police Department and Debra Rafferty for implementing the La Protectora program in the Hispanic community; the staff and members of Avance Dallas and Wesley-Rankin Community Center for their partnership in reaching the Hispanic community; and Kristen Howell for reviewing the manuscript.
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Footnotes |
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Accepted for publication February 18, 2002.
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References |
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
