National Social Marketing Centre

The programme used a mix of methods to encourage and enable use of child safety
seats among Hispanic parents. The interventions were developed using the Safe
Communities model, which uses a ‘bottom up’ approach and has four distinguishing
characteristics:

1. injury data analysis from multiple sources of data
2. expanded partnerships
3. resident involvement
4. an integrated and comprehensive injury control system.

Interventions included a child safety seat purchase scheme, small training classes for
parents, and community engagement activities. The interventions were delivered through
the local primary care health centre, day care centres, and community venues in the
target neighbourhood.

Health centre
Hour-long training classes on the proper use and installation of child safety seats were
conducted in Spanish and English in the target area throughout the programme,
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 centre in the target area and at other locations in the community on request.
Classes were advertised through the local health clinic, at churches, community centres
and botanicas (traditional healers), and on local Spanish-language radio and television
shows. The classes were free and parents were offered the incentive of a car seat for a
low cost of $10 if they attended. These car seats were subsidised by a separate grant
obtained from the Texas Department of Transportation. More than 3000 child safety
seats were distributed to Hispanic families in the target area during the survey period.

Class instructors participated in health fairs and special events sponsored by the health
centre – as well as distributing pamphlets, they conducted child safety seat inspections
and demonstrations.

Pediatricians at the health centre reinforced the importance of using child safety seats by
distributing ‘prescriptions’ for proper child safety seat use to patients. These were
prescription pads that had been pre-printed with instructions for parents to get a car seat
for their child, and a phone number they could call to sign up for a class.

Day care centres
A week-long intervention for children, parents, and day care staff included seat belt
demonstrations, colouring contests, child safety seat training for day care centre
employees, and traffic safety workshops for parents. It emphasised the importance of
seat belt use by parents, as well as use of child safety seats.

Three local mothers were hired as liaisons to promote child safety seat use over a nine-
week period in five day care centres. Liaisons were responsible for developing an
ongoing relationship with the day care centres and implementing interventions tailored to
the centres’ needs and interests. Strategies developed by the liaisons included
information booths, raffles and games designed to promote child safety seat use.

Neighbourhoods

• Interventions implemented in several neighbourhoods in the target area included
  neighbourhood block parties, health fairs, child safety seat inspections, traffic safety
  workshops, and delivery of educational messages at local festivals
• The traffic safety workshops were delivered by IPC staff and included information
  about vehicle safety, driver's license and traffic laws, immigration and social security
  laws, and proper installation and use of child safety seats
• At local schools, churches, and neighborhood events, a Hispanic policewoman
  known as La Protectora (‘The Protector’) held classes in Spanish and English for
  parents and children to explain child safety laws and procedures. Her role of La
  Protectora was funded by a grant from the Texas Department of Transportation to
  the police department
• Educational pamphlets on child safety seat and seat belt use were distributed through
  local botanicas, churches, and community centres

Analysis of existing Department of Transportation research indicated that populations of
new immigrants, including those residing in areas of West Dallas, were at high risk of
traffic crashes. This was due to a variety of factors, such as language barriers, traffic
signage, speeding, alcohol use and seat belt non-use.

In order to explore why child safety seat use was so low amongst Hispanic populations,
the IPC facilitated a total of 14 focus groups, each ranging in size from seven to 14
participants recruited from community groups. These were held during the first three
months of the grant to inform the design of the programme.

Since use of child safety seats was not part of the tradition or culture of the Hispanic
community in the target area, all the programme components aimed to incorporate
various aspects of Hispanic culture. For example, to address the issue of fatalism (“It’s in
God’s hands”) in the Hispanic community, priests were asked to bless the child safety
seats in a ceremony before they were distributed. Pamphlets about the programme were
distributed through local botanicas, churches, and community centres. Educational
information about child safety seats were presented on local Spanish-language radio and
television shows.

To address the language barrier faced by the target population, activities were conducted
in Spanish and English and classes were taught by bilingual child passenger safety
technicians. To increase the relevance and impact of the programme, activities
addressed issues of importance to the community other than child safety restraints, such
as immigration.

Focus groups with members of the Hispanic community provided a range of insights to
help guide programme development:

• Fatalism/destiny: the belief that any potential accidents were ‘in God’s hands’
• Lack of similar regulations in immigrants’ native countries: individuals who had
  recently immigrated to the U.S. were particularly unaware of child restraint laws and
  their importance
• Language barriers prevented individuals from being able to read and understand
  existing child car safety literature
• Lack of information: parents did not realise the importance of child safety seats and
  many believed that their child was safest in their arms
• Perceived safety: parents believed that they were safe drivers and therefore less
  likely to be in an accident
• Lack of enforcement of child restraint laws meant that parents were more likely to
  dismiss the use of child car seats
• Mothers were identified as authority figures in Hispanic communities. The
  programme therefore focused on engaging with mothers to help communicate the
  campaign message to the rest of the community

The primary aim of the programme was to increase the use of child safety restraints in
motor vehicles in a Hispanic neighborhood of Texas. The secondary goal was to reduce
the number of child fatalities due to lack of child safety restraint use.

Since IPC did not have access to morbidity data and the number of deaths was too small
to prove a significant change, observations of child restraint use was used as the main
indicator for the programme’s impact.

Three adjacent zip codes (75208, 75211 and 75212) in the west sector of Dallas were
chosen as the target areas because of their predominately Hispanic population
(population 110 000, 60 per cent Hispanic). Preliminary observational surveys of child
restraint use in this area had shown that child restraint use among Hispanic preschool-
aged children was lower than 20 per cent in several settings in these zip codes. This was
compared to a rate of 62 per cent child restraint use in the rest of Dallas and around 60
per cent use in the state of Texas. 

Hispanic parents, particularly mothers of young children, were targeted primarily through
the local health clinic, which serves a lower socio-economic population. They were also
targeted through community venues such as churches and community centres.

Several key barriers were identified to increasing car seat use amongst the target
audience:

• Lack of information on the child restraint laws, the importance of using car seats
  and how to properly install and use them. This was especially true for families who
  had recently immigrated to the U.S., as regulations were likely to be different in their
  native countries.
• Language barriers prevented some parents from being able to read and understand
  existing child car safety literature.
• Resistance from some children to having to sit in a child safety seat.
• Practical issues. Car seats were considered too expensive, and their bulky designs
  meant they took up too much space in the vehicle and were inconvenient to transfer
  from vehicle to vehicle.

The programme sought to overcome these barriers and promote the ‘benefits’ of car seat
use:

• Through a range of bilingual training and engagement sessions and educational
  materials, parents were informed of the importance of using child safety seats, how
  to properly install the seats into their vehicles, and how to keep children in the car
  seats
• Car seats were offered to parents cheaply for a $10 fee. The minority of workshop
  attendees who could not afford to pay were not charged for the car seat

 The main factors that competed with the programme’s goal of increasing car seat use
among Hispanic populations include:

• Perceived sense of safety: parents tended to believe that they were safe drivers
  and therefore less likely to be involved in an accident, particularly when making
  ‘short’ trips
• Religion and fatalism: the prominence of religion in Hispanic culture gave some
  parents a fatalistic view and belief that any potential accidents were ‘in God’s hands’.
  Using child safety seats would therefore have very little impact on changing their
  destiny

The training workshops sought to highlight the importance of using child safety seats
during all car trips, regardless of length of travel, and made use of videos that graphically
showed what happens to a child held on an adult’s lap in a car crash.

Rather than dismissing the religious and cultural beliefs of the target group, the
programme enlisted the support of local priests to bless the car seats before they were
given to parents.

The Health Belief Model underpins this campaign. This model suggests that a person’s
willingness to change their behaviour is based on perceived susceptibility to risk;
perceived severity of risks; perceived benefits of taking protective action; perceived
barriers that might frustrate this intention; and cues to action.

This programme sought to understand Hispanic cultural values to address inaccurate
perceptions about car safety, vehicular-related child injury and death, and to reinforce the
importance of child seats for protecting against injury and fatality.