Evaluating interventions that promote the use of rear seats for children

Objective: To evaluate interventions that promote the use of the rear seat among children riding in motor vehicles. Search Strategies: Using the Cochrane Collaboration search strategy, we searched in electronic databases and reference lists of past reviews and review articles. We also searched among studies from government and research agencies in the United States and abroad, and contacted experts in the field. Selection Criteria: Studies for selection had to be evaluations of interventions in defined populations, with a clear description of the program and the outcomes evaluated. Outcomes had to be measured in an objective manner, and there needed to be a comparison group. Data Collection and Analysis: Six studies met the selection criteria. Changes in the proportion of observed children traveling in the rear seats before and after the implementation of the intervention were the and main outcome of interest. Main Results: Two studies evaluating the effectiveness of educational campaigns promoting the use of the rear seat found increases in the proportion of children riding in the rear seats, but only in one study were the increases statistically significant (from 86% to 91%). The four remaining studies reported changes in seating location as a side effect of legislation requiring child restraint use among children traveling in the front seats. In two of these four studies, the percentage of children riding in the rear seats significantly increased from 49% to 62% and from 88% to 98%. In the remaining two studies there were small, but not statistically significant, changes in the proportion of children riding in the rear seats, with percentages remaining around 60% and 85%. Conclusions: Interventions aimed at promoting the use of rear seats by children traveling in motor vehicles have been rare. Only one educational program whose only objective was to promote rear seating location was found and this 1973 Danish study had a positive impact. The other educational campaign, a pilot program that also focused on improving child restraint use, had no significant impact in promoting seating of children in the rear. We did not find any evaluation of legislation prohibiting children to sit in the front seats. Legislation requiring proper child restraint use in the front seats (and thus, compelling unrestrained children to seat in the rear) has produced, for the most part, a nonsignificant increase in the proportions of children sitting in the rear.