Improving Safety-Restraint Use by Children in Shopping Carts: Evaluation of a Store-Based Safety Intervention

Abstract

OBJECTIVE. Approximately 20700 children who are <5 years old are treated in US hospital emergency departments annually for shopping cart–related injuries. The objective of this study was to evaluate the effectiveness of an in-store intervention to increase the use of restraints in shopping carts by children who are <5 years old. METHODS. The study intervention consisted of greeters at the store entrance who encouraged the use of appropriate shopping cart restraints plus the use of a small cash coupon incentive. The study used a preintervention and postintervention design with an untreated “control” group. Three stores served as intervention stores, and 4 stores served as nonintervention stores. Trained study personnel conducted the observations unobtrusively in all 7 stores simultaneously, recording the status of children's restraint use in the shopping cart as caregivers approached store checkout areas. The main outcome measure of the study was the change in the proportion of children who were <5 years old, riding in a shopping cart, and restrained correctly. RESULTS. There were a total of 967 observations, 57% of which were in the 4 nonintervention stores and 43% of which were in the 3 intervention stores. There were 442 observations on the baseline day and 525 on the follow-up day. Interrater reliability was good. Overall, among the 761 cases in which a shopping cart was used, 38% of children were transported in the shopping cart seat with the restraint off or used improperly, and 24% were seated with the restraint used correctly. In the 4 nonintervention stores, the percentage of children who were in shopping carts and restrained correctly increased from 19% at baseline to 31% during the follow-up observation period 1 week later. In the 3 intervention stores, the percentage of correct restraint use among children in shopping carts went from 15% at baseline to 49% after the intervention during the second observation period. The change in correct restraint use among children in shopping carts in intervention stores was significantly greater than that in nonintervention stores. CONCLUSIONS. A safety intervention, consisting of a $2 incentive coupon plus greeters at the store entrance who encouraged the use of appropriate shopping cart restraints, significantly increased the correct use of restraints among young children who rode in shopping carts. The correct use rate increased to 49% in stores with this modest intervention. However, half of the young children in shopping carts remained unrestrained or restrained incorrectly. Higher rates of correct restraint use may occur with a more comprehensive and sustained shopping cart safety intervention. Shopping cart designs that seat children close to the floor and that do not rely on caregiver behavior change and vigilance for injury protection also should be implemented and evaluated as a passive strategy to prevent shopping cart–related injuries to young children.