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Glob Pediatr Health. 2015; 2: 2333794X15615773.
Published online 2015 November 5. doi:  10.1177/2333794X15615773
PMCID: PMC4784642

Traffic Safety–Related Priorities for Preteens and Adolescents

Extending Occupant Protection Messaging to Children Ages 8 to 15 Years

Significant progress has been made in reducing the number of motor vehicle crash (MVC) injuries among young children in the United States. From 1996 to 2012, there was a 55% decline in MVC fatalities and a 53% decline in MVC injuries among children ages 14 and younger.1-3 Despite this success, maintaining appropriate restraint use as children age continues to be a challenge. In 2013, 2% of children under the age of 1 year were observed to be unrestrained in a national observational study. In comparison, 11% of children ages 8 to 12 years were observed to be unrestrained.4

The objective of this study was, for children 8 to 15 years, to (a) identify current programs addressing occupant protection and (b) develop a set of priority questions to address gaps in research, education, and communication for occupant protection.

Methods

In March 2014, a 10-question survey was distributed to a child passenger safety practitioner network through a monthly newsletter to child passenger safety technicians managed by Safe Kids Worldwide. The objective of the survey was to identify any existing occupant protection safety education or programming for children ages 8 to 15 years. Respondents were asked if they were a Certified Child Passenger Safety Technician, and if they were involved in programs that educate parents, caregivers, and children in 3 age groups (8-10 years, 11-12 years, and 13-15 years). Open-ended questions were asked to describe the programs, and challenges and barriers they experienced when implementing or developing programs to reach this audience.

In April 2014, approximately 100 child passenger safety advocates attended the in-person workshop, “Out of Boosters—The New Frontier: Extending Occupant Protection Messaging to Reach Kids 8 to 15,” at the Lifesavers National Conference on Highway Safety. A normative group process was used to solicit information from the audience of practitioners and prioritize suggestions. Participants identified needs of children ages 8 to 10 years, 11 to 12 years, and 13 to 15 years.5 Following a series of presentations on child development, injury patterns, available research, and an existing program that was identified from the premeeting survey, a series of 8 predetermined questions (Table 1) were posed regarding gaps in research, education, and communication. Attendees identified gaps in, and strategies to improve, these 3 areas for the 3 age groups.

Table 1.
Question prompts for attendees of workshop, “Out of Boosters–The New Frontier: Extending Occupant Protection Messaging to Reach Kids 8 to 15,” April 2014.

All research activities were deemed exempt from review by our institutional review board.

Results

Fifty-two participants from 28 states responded to the premeeting survey. Two states (Utah and Kansas) were identified by respondents to the presurvey as providing occupant protection safety education or programming for children ages 8 to 15 years.

Eighty-four research, 120 education, and 101 communication responses were recorded from the workshop posters, extracted and condensed to between 3 and 5 concepts for research, education, and communication. Responses were distilled into priority topics identified in Table 2.

Table 2.
Research, education, and communication priorities identified in responses from workshop attendees

Discussion

The workshop identified several priority themes across age groups in the areas of research, education, and communication relating to occupant behaviors for children ages 8 to 15 years.

Research Priorities

Participants identified a need to better understand how to drive behavior change among parents and children, especially for at-risk and vulnerable groups. In particular, participants highlighted the need to explore the role of parental authority in restraint use for their children. Another identified research priority was determining the proportion of children over the age of 8 who should be using booster seats given their height. The 2013 National Survey of the Use of Booster Seats (NSUBS) found that 59% of children who were 37 to 53 inches tall were riding in car seats or booster seats; the remainder used seat belts (32%) or were unrestrained (8%).4 Additionally, more research is needed to explore successful education and messaging to vulnerable groups: in 2013 the highest rate of restraint use among children ages 8 to 12 years was among white non-Hispanics (95%) and the lowest was among black non-Hispanics (69%).4 Other vulnerable populations not captured in the NSUBS, but identified as possible high risk by conference participants, include divorced and young parents.

Educational Priorities

A common theme among identified educational priorities was the need to explore effective interventions in occupant protection for older children and adolescents, such as peer-to-peer models. Interventions that successfully promote other health behaviors include youth-led education workshops, empowerment interventions, and school-based programs with adult presenters.6,7

Communications Priorities

A common priority for all age groups was identifying how to reach older children and adolescents, and their parents, with impactful occupant protection messages about booster seat use, belt use, and riding in the back seat. Existing research has focused on communication and teen driving; a parent-based intervention to improve parent communication with teens was found to have a positive effect on reducing risky driving scores.8 Another priority area for participants was the use and utility of applications for smartphones. However, apps may be more appropriate for reaching caregivers than adolescents and teens; a study found that caregivers were more likely to search for health-related topics on their phone and have medical apps than teens.9 Social marketing campaigns have been found to be effective in increasing booster seat utilization rates when combined with caregiver education and distribution of booster seats;10 extrapolating such campaigns to children out of boosters, but not yet driving, may be potentially successful.

The results from this preconference workshop indicate that there is interest and need in the traffic safety community to develop and evaluate interventions to promote safe occupant behaviors in children ages 8 to 15 years. Further efforts can focus on priorities in the areas of research, education, and communications, with the ultimate goal of reducing the number of MVC-related injuries and deaths in children and adolescents.

Footnotes

Author Contributions: RWF: contributed to conception and design; contributed to acquisition; drafted manuscript; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy. LW: contributed to conception and design; contributed to acquisition; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy. TW: contributed to conception and design; contributed to acquisition; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy. CG: contributed to conception and design; contributed to acquisition; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy. JHD: contributed to conception and design; contributed to acquisition; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy. MRZ: contributed to conception and design; contributed to acquisition; drafted manuscript; critically revised manuscript; gave final approval; agrees to be accountable for all aspects of work ensuring integrity and accuracy.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

1. National Highway Traffic Safety Administration. Fatality Analysis Reporting System, 2012. Motor vehicle occupant (person type 1, 2, 9), ages 14 and under, fatal injuries (injury severity 4). http://www.nhtsa.gov/FARS. Accessed July 17, 2014.
2. National Highway Traffic Safety Administration. Traffic safety facts 1996: Children (HS 96F2). http://www-nrd.nhtsa.dot.gov/Pubs/96Children.pdf. Published 1996. Accessed October 23, 2015.
3. National Highway Traffic Safety Administration. Traffic safety facts 2012: Children (DOT HS 812011. http://www-nrd.nhtsa.dot.gov/Pubs/812011.pdf. Published April 2014. Accessed October 23, 2015.
4. Pickrell TM, Choi EH. The 2013. National Survey of the Use of Booster Seats (DOT HS 812 037). http://www-nrd.nhtsa.dot.gov/Pubs/812037.pdf. Published June 2014. Accessed October 23, 2015.
5. Kuhn M, Lam J. Increasing seat belt use among 8-to 15-year-olds: Volume I: Findings (DOT HS 810 965). http://www.nhtsa.gov/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20Files/810965.pdf. Published May 2008. Accessed October 23, 2015.
6. Bulanda JJ, Bruhn C, Byro-Johnson T, Zentmyer M. Addressing mental health stigma among young adolescents: evaluation of a youth-led approach. Health Soc Work. 2014;39:73-80. [PubMed]
7. Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev. 2013;(4):CD001293. [PubMed]
8. Peek-Asa C, Cavanaugh JE, Yang J, Chande V, Young T, Ramirez M. Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving. BMC Public Health. 2014;14:777. [PMC free article] [PubMed]
9. Singh A, Wilkinson S, Braganza S. Smartphones and pediatric apps to mobilize the medical home. J Pediatr. 2014;165:606-610. [PubMed]
10. Bryant-Stephens T, Garcia-Espana JF, Winston FK. Boosting restraint norms: a community-delivered campaign to promote booster seat use. Traffic Inj Prev. 2013;14:578-583. [PubMed]

Articles from Global Pediatric Health are provided here courtesy of SAGE Publications