Longitudinal evaluation of a statewide network of hospital programs to improve child passenger safety.

As a project begun in 1979 to improve child passenger safety, a statewide network of hospital-based car safety seat rental and education programs was implemented by a coalition of volunteers, nurses, physicians, and state agencies. A car safety seat program was established at every hospital delivering newborns. To evaluate the effectiveness of this network of programs, 1,846 newborns (87% of hospital discharges) were observed at discharge at ten hospitals during 33 observation studies from 1979 to 1984. Mean correct car safety seat usage increased from less than 21% in 1979 to 82% in 1984. Concurrently, use of the dangerous lap or arms position decreased from 70% preprogram to 6% postprogram, and incorrect car safety seat usage decreased from 28% to 3%. In addition 1,597 children from 0 to 3 years of age were observed at an annual county fair from 1982 to 1984. Use of either a vehicle seat belt alone or car safety seat with harness and seat belt increased from 34% in 1982 to 67% in 1984. Car safety seat and seat belt misuse occurred in 42% of infants less than 1 year of age and 20% of children 1 to 3 years of age. These findings suggest that a network of hospital-based car safety seat rental and education programs is an effective means of improving the passenger safety of newborns, infants, and young children.