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Motor Vehicle Injury – Child Safety Seats: Distribution and Education Programs


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 10 studies (search period through March 1998).

The review was conducted on behalf of the CPSTF by scientists from CDC’s Division of Unintentional Injury Prevention with input from a team of specialists in systematic review methods and experts in research, practice and policy related to motor vehicle injury prevention.

Summary of Results

More details about study results are available in the published evidence review pdf icon [PDF - 2.43 MB].

The systematic review included 10 studies.

  • Proper use of child safety seats increased by a median of 23 percentage points (10 studies)
  • Possession of safety seats increased by a median of 51% (5 studies)

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.


Results of this review should be applicable to families of any socioeconomic status and ethnic background across the United States. Evaluated programs were effective in a variety of urban, suburban, and rural settings.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Are distribution programs sponsored by medical care organizations more or less effective than programs implemented by other organizations (e.g., insurance companies or community organizations)?
  • Are low-cost rental programs any more or less effective than free loan programs?
  • Do hospital discharge policies requiring that newborns be restrained in an approved device increase the effectiveness of distribution programs?
  • Do interventions increase or reduce misuse of child safety seats?
  • What is the role of community-wide or individual education in facilitating the effectiveness of other interventions distribution programs?
  • Are these interventions equally effective in all populations within a state (e.g., racial and ethnic minorities, high- and low-income populations, or behavior change-resistant populations)?
  • How must the content and methods of the educational components of interventions be altered to work in different populations?
  • Are these interventions effective in populations that already have high baseline safety seat use rates?
  • Do programs targeted at parents of infants improve the rate at which parents buy or use child safety seats for children older than 1 year?
  • What is the cost of interventions?
  • Are interventions cost-saving?
  • What is the return on investment?

Study Characteristics

  • Included studies evaluated programs that provided free loaner child safety seats, low-cost rentals, or direct giveaways.
  • Programs gave parents information on how to use the seats correctly. This educational component varied considerably across programs in terms of content, length, intensity, and type of teaching method.
    • Some programs provided lectures, brochures, or pamphlets on how to use the safety seat. Other programs used more active educational and behavioral techniques, such as discussions, problem solving, demonstrations, or rehearsal of correct use.
  • Programs were implemented in hospitals, clinics, and homes and through insurance companies.
  • Programs primarily targeted parents of infants rather than older children.
  • Studies were conducted in the United States, Canada, Australia, and Sweden.


Zaza S, Sleet DA, Elder RW, Shults RA, Dellinger A, Thompson RS. Response to letter to the editor. American Journal of Preventive Medicine. 2002;22:330-1.

Sleet DA. Evidence based injury prevention: guidance for community action. In: Australian Third National Conference on Injury Prevention and Control. Australian Third National Conference on Injury Prevention and Control. Brisbane, Queensland, Australia; 1999.