Multimodal Intervention and Child Passenger Safety Guideline Adherence in Young Children: A Sequential,...

Area of Science:

• Public Health
• Pediatrics
• Behavioral Science

Background:

• Suboptimal child passenger safety behaviors are prevalent despite available child restraint systems (CRS).
• National guidelines and state laws mandate the use of CRS for child passenger safety.

Purpose of the Study:

• To compare the Tiny Cargo, Big Deal, Abróchame Bien, Cuídame Bien (TCBD/ABCB) intervention with enhanced usual care (EUC) for 6-month guideline adherence.
• To assess the 12-month maintenance effect of the intervention.
• To evaluate outcomes from a sequential, multiple-assignment, randomized trial (SMART) phase 2 based on intervention intensity.

Main Methods:

• A randomized clinical trial using a SMART design was conducted across four sites in Chicago, Illinois.
• Eligible caregivers (aged 6 months to <11 years) spoke English or Spanish, owned a smartphone, and reported suboptimal safety behaviors.
• Phase 1 compared basic TCBD/ABCB (remote motivational interviewing [MI] + mobile health [mHealth]) with EUC. Phase 2 involved rerandomizing nonadherent participants to high-intensity or low-intensity interventions.

Main Results:

• At 6 months, 47.1% of caregivers receiving TCBD/ABCB were guideline adherent versus 32.2% receiving EUC (absolute difference, 13.1%; P=.007).
• Twelve-month follow-up showed significant maintenance effects (adjusted prevalence difference, 39.2%; P<.001).
• In phase 2, high-intensity TCBD/ABCB showed no significant difference compared to low-intensity TCBD/ABCB (adjusted prevalence difference, -3.9%; P=.59).

Conclusions:

• The TCBD/ABCB intervention significantly improved adherence to child passenger safety guidelines.
• The intervention demonstrated lasting effects for caregivers who were adherent at the 6-month mark.
• This remote, precision prevention approach may be adaptable for addressing leading causes of child mortality in various settings.