Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Brief report
Advocacy for booster seat legislation in Florida: a lesson in politics and policy formation R Sterling Haring,1 Shannon Frattaroli,2 Eric B Schneider,3 M Becker Holland,4 Jon S Vernick2 1
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 2 Department of Health Policy and Management, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 3 Surgery Department, Johns Hopkins Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 4 Junior Leagues of Florida, State Political Action Committee, Gainesville, Florida, USA Correspondence to R Sterling Haring, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Hampton House, 594 Baltimore , Maryland 21205, US; [email protected] Received 25 June 2014 Revised 10 October 2014 Accepted 13 November 2014 Published Online First 1 December 2014
To cite: Haring RS, Frattaroli S, Schneider EB, et al. Inj Prev 2015;21: 137–139.
ABSTRACT MVCs are a major contributor to child injury and death. Infant restraint seats and child booster seats have been shown to reduce the odds of severe injury or death when used correctly. While all states have mandated the use of these restraint systems, the age at which a child can be legally restrained using an adult seat belt varies from state to state. Efforts to strengthen Florida’s weak child restraint laws have failed for more than a decade; in the 2014 legislative session, advocates succeeded in raising the state’s age requirement from 3 years to 5 years. While many factors contributed to this year’s success, some key elements included efficient communication of supporting data, a strong and broad advocacy network and the leveraging of election year political rivalries. Efforts to further strengthen the law will continue into future legislative sessions.
BACKGROUND MVC-related injury is among the leading causes of injury-related death in the USA. In 2012 alone, MVCs accounted for over 33 000 deaths.1 The development of seat belts, airbags and other safety devices, as well as legislation mandating seat belt use have been very effective at reducing MVC-related morbidity and mortality among adult populations.2 3 Similarly, strong evidence supporting the use of child seats has helped to establish such devices as the status quo for the youngest of children (typically ages 0–3 years), leading to dramatic reductions in MVC-related injury among children in that age group when compared with unrestrained children (OR: 2.7, 95% CI 2.40 to 3.1).4 5 Indeed, developments such as these have been among the great public health successes of our time.6 Adequately protecting older children, however, has proven to be more challenging. Traditional adult seat belts are designed to rest low on the hips, holding the pelvic bones in place in the event of a collision. When children are restrained in adult seat belts, the lap belt can ride up onto the child’s abdomen during a crash, increasing the risk of a so-called ‘fulcrum’ fracture of the lumbar spine or other internal injuries.7 8 Such injuries can lead to paralysis or even death. In response to this risk, belt-positioning booster seats have been developed. These devices, now widely available, have been shown to reduce the risk of serious injury among 4–8-year-old children by up to 45%, and professional groups such as the American Academy of Pediatrics have encouraged their use.9–11 Accordingly, most states (48 states, as of January 2014) have developed legislation requiring
the use of age-appropriate restraints, including booster seats, in motor vehicles.12 While state laws on the subject are consistent in many aspects, there is significant variation in the upper age included in booster seat mandates (figure 1); the national mean age cut-off is 6.4 years, and the median is 7 years.13 On the older end of the age range, several states require booster seats to be used until age 8. However, Florida, until 2014, required no specialised restraint after age 3. This was the lowest age requirement among child passenger restraint laws in the 50 states. This article presents a case report of the events leading up to and surrounding the passage of a booster seat law in Florida.
EFFORTS TO CHANGE FLORIDA LAW Several iterations of what has been dubbed the ‘booster seat bill’ had been considered in the Florida Legislature since the Junior Leagues of Florida first advocated for it in 2001. The bill’s supporters demonstrated their dedication and work ethic in each year’s effort, but the endeavour was missing some key components, including effective reference documents for legislators and a broad base of vocal support, as outlined below. A new bill was introduced in the 2014 legislative session.14 That bill initially mandated the use of approved child booster seats up to either age 7 or specified height and weight requirements.
COMPONENTS OF FLORIDA ADVOCACY EFFORTS Organisers supporting the 2014 booster seat bill had worked hard to establish a broad-based coalition of support for the bill. The Florida Booster Seat Coalition counted among its members the Junior Leagues of Florida, Florida Medical Association, the Florida Hospital Association, the Florida Trial Attorneys Association, several local governments and school districts, hospitals, fire districts and businesses such as the American Automobile Association (AAA). With over 60 member organisations throughout the state, the Coalition represented many thousands of Floridians. Policy interventions can be easier to pass when precedent exists in other jurisdictions.15–17 The Coalition wisely designed their bill to resemble current laws in neighbouring states (eg, Tennessee and Georgia), and pointed to regional political and cultural similarities for support.
WHAT WAS MISSING The breadth of the Coalition had been the chief asset of bill supporters, but many of the
Haring RS, et al. Inj Prev 2015;21:137–139. doi:10.1136/injuryprev-2014-041350
137
Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Brief report
Figure 1 Distribution of state booster seat age requirements by age. The distribution of age requirements for state booster seat laws. Ages shown are inclusive (eg, children up to and including age eight are required to use booster seats).
organisations were members in name only; aside from a handful of ardent supporters, few members actively participated in the legislative effort. The bill’s supporters were also keenly aware that a successful policy change would require convincing data, and they remained ready to provide a number of statistics from the relevant literature when asked. Without an effective issue brief or convincing ‘leave-behind’ material, recruiting neutral legislators to the cause proved a difficult task. Such a document would provide a concise and effective message to the target audience in a manner most useful for policymakers.
THE SUCCESSFUL APPROACH After 13 years of failed attempts, the 2014 legislative session saw the successful passage of a booster seat bill in both houses of the Florida Legislature. Governor Rick Scott signed the bill into law on 24 June of the same year. For the 2014 session, bill supporters addressed the missing pieces of their previous approach. First, we (RSH and MBH were among the supporters) conducted a literature review and gathered data on MVC-related morbidity and mortality from the CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS) and from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration (NHTSA). We then analysed those data to identify fatal and nonfatal trends. Floridians with personal stories about child passenger safety were identified through personal connections and by reaching out through online social networks such as Facebook. Over a 2-month period in late 2013, we combined their stories and pictures with statistics from both the analysis and the literature review into a single cohesive, readable document. Due to the extensive use of the term ‘booster seat’ in past unsuccessful attempts, we avoided the use of the term when compiling the document (as in all other communications). On behalf of the Florida Booster Seat Coalition, we then distributed that document, during face-to-face meetings and via email, to Florida state legislators and stakeholders known to have an interest in child passenger safety. The bill’s sponsor, Representative Keith Perry, also distributed the document. Second, the Booster Seat Coalition translated the diversity of its membership into a loud voice for change. While the leadership of the Florida Medical Association and Florida Osteopathic 138
Medical Association opted not to actively support the bill, the student members of those organisations, recruited through the student-level governance of those bodies, were eager to offer their support. Students from Florida’s eight medical schools contacted key committee chairs throughout the 2014 legislative session to encourage the bill’s addition to committee agendas; these new voices, combined with those of the persistent activists who had kept the movement going for well over a decade, were able to persuade key policymakers, including committee chairs, to move the bill forward. Third, and perhaps most critical, the importance of booster seat use for older children was effectively brought to the attention of the governor. After years of gubernatorial disinterest, bill supporters reached out to the campaign office of influential former Florida Governor Charlie Crist in February 2014. Governor Crist, who was engaged in a close race for a new term as governor, was responsive and eager to support an issue that was clearly important to the variety of organisations represented by the Florida Booster Seat Coalition. His responsiveness sparked the interest of his opponent, incumbent Governor Rick Scott. Within weeks of Governor Crist’s commitment to support the booster seat bill, the office of Governor Scott invited the bill’s sponsor to discuss the issue. The Governor’s strong support that followed brought with it support from the speaker of the Florida House and the Senate president, virtually ensuring the bill’s success.
COMPROMISE ALONG THE WAY Despite strong support for the Senate companion bill as originally introduced, HB 225 faced some difficulty in committee. Some legislators were hesitant to embrace the perceived complexity of some of the more detailed clauses contained in other state booster seat laws, including height and weight requirements for children to be covered. Unlike their colleagues in the Senate, House committee chairs responsible for setting meeting agendas were hesitant to raise the age requirement for booster seats by as much as 5 years. After continued debate, the bill was brought up for discussion in committee, but only after it was amended to lower the age requirement from 8 years to 5 years. The prospect of raising the age limit via amendment in the 2015 legislative session was agreed upon as a means of compromise. Senate supporters were initially reluctant to weaken their bill after garnering support for the original language that included children up to 8 years. As a result, for a short period in April, the impasse threatened to end the bill’s prospects altogether. In the end, however, all parties agreed that raising the requirement to 5 years represented a meaningful improvement over current statute, and both bills were amended accordingly. Amendments to raise the age above 5 years are currently being drafted.
CONCLUSION Effective policy intervention requires a combination of a comprehensive approach, a convincing rationale that includes a solid evidence base, a strong team and, perhaps most importantly, a well-timed strategy. In this case, the organisation of a vocal coalition and evidence-based messages that were effectively communicated proved to be invaluable components for a successful campaign. By building on the strong work of previous years, Florida’s Booster Seat Coalition was able to oversee passage of a much-needed update to current legislation. As with all such interventions, a willingness to compromise and build on incremental victories was key. While increasing the age for mandated use of a booster seat from 3 to 5 years of age represents an important improvement Haring RS, et al. Inj Prev 2015;21:137–139. doi:10.1136/injuryprev-2014-041350
Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Brief report in public safety, it is important to note that legislative and community supporters have expressed a commitment to implementing future amendments to the bill that would ultimately increase the mandated age for booster seat use to 8 years. This case report is based on the observations and experiences associated with one law in one state. Despite these limitations, there are valuable lessons to be learnt from this case—including the importance of perseverance and value of capitalising on an election-year opportunity—that can be applied to other injury prevention advocacy efforts.
contributed to the revision and final approval of the paper. RSH takes responsibility for the content of the paper. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES 1 2
What is already known on this topic
3
It has been thoroughly established in medical and public health literature that booster seats reduce the risk of injury and death when used properly. It has further been established that policies mandating the use of booster seats are effective as a means of legislative intervention.
4 5
6 7
What this study adds
8 9
Designing booster seat legislation and overcoming obstacles inherent in the legislative process is a multifaceted problem with a myriad of possible solutions. This study contributes the experience of one successful legislative intervention in the nation’s third-most populous state.
10
11 12
Acknowledgements The authors would like to thank Kristy Arbogast at the Children’s Hospital of Philadelphia for sharing her expertise on the biomechanics of automobile injury and her passion for child safety seats. The authors would like to give special thanks to Karen Morgan, Jim Millican, Mary-Lynn Cullen, Leslie Kroeger, Natasha Diemer, Clint Shouppe and many others for their hard work and dedication to the cause. Contributors RSH and JSV designed the paper; RSH and MBH contributed to data collection; RSH, SF, EBS and JSV contributed to evaluation. All parties significantly
13 14 15 16 17
CDC—Costs of Crash Deaths—Motor Vehicle Safety—Injury Center. http://www. cdc.gov/motorvehiclesafety/statecosts/ (accessed 15 Dec 2013). Crandall CS, Olson LM, Sklar DP. Mortality reduction with air bag and seat belt use in head-on passenger car collisions. Am J Epidemiol 2001;153:219–24. Braver ER, Ferguson SA, Greene MA, et al. Reductions in deaths in frontal crashes among right front passengers in vehicles equipped with passenger air bags. JAMA 1997;278:1437–9. Berg MD, Cook L, Corneli HM, et al. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics 2000;105:831–5. Ekman R, Welander G, Svanström L, et al. Long-term effects of legislation and local promotion of child restraint use in motor vehicles in Sweden. Accid Anal Prev 2001;33:793–7. Centers for Disease Control and Prevention. Motor vehicle safety: a 20th century public health achievement. Morb Mortal Wkly Rep 1999;48:369–74. Howland WJ, Curry JL, Buffington CB. Fulcrum fractures of the lumbar spine: transverse fracture induced by an improperly placed seat belt. JAMA 1965;193:240–1. Gumley G, Taylor TK, Ryan MD. Distraction fractures of the lumbar spine. J Bone Joint Surg Br 1982;64-B:520–5. Arbogast KB, Jermakian JS, Kallan MJ, et al. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 2009;124:1281–6. Elliott MR, Kallan MJ, Durbin DR, et al. Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med 2006;160:617–21. American Academy of Pediatrics. Policy statement—child passenger safety. Pediatrics 2011;127:788–93. Governors Highway Safety Association. Child passenger safety laws. Governors Highway Safety Association, 2014. http://www.ghsa.org/html/stateinfo/laws/ childsafety_laws.html Florida House of Representatives. HB 239: Child Safety Booster Seat Act. 2001. Florida House of Representatives. HB 225: Child safety devices in motor vehicles. 2014. Bennett CJ. What is policy convergence and what causes it? Br J Polit Sci 1991;21:215–33. Wallack L, Winett L, Lee A. Successful public policy change in California: firearms and youth resources. J Public Health Policy 2005;26:206–26. Teret S, Alexander G, Bailey L. The passage of Maryland’s gun law: data and advocacy for injury prevention. J Public Health Policy 1990;11:26–38.
Incidentally shoots self then sues store A former police officer has filed suit against a hunting store after shooting off his own argued, finger because an employee gave him a loaded gun. The officer argues, argued, ‘Under no circumstances should they have had a loaded weapon in a display case’.
Increasing number of police killed There was a 56% increase in the number of police killed on duty in 2014 in the USA. This may be related to tension between the public and police after several shootings of unarmed African-Americans by white police officers.
Haring RS, et al. Inj Prev 2015;21:137–139. doi:10.1136/injuryprev-2014-041350
139
Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Advocacy for booster seat legislation in Florida: a lesson in politics and policy formation R Sterling Haring, Shannon Frattaroli, Eric B Schneider, M Becker Holland and Jon S Vernick Inj Prev 2015 21: 137-139 originally published online December 1, 2014
doi: 10.1136/injuryprev-2014-041350 Updated information and services can be found at: http://injuryprevention.bmj.com/content/21/2/137
These include:
References Email alerting service
This article cites 13 articles, 4 of which you can access for free at: http://injuryprevention.bmj.com/content/21/2/137#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Brief report
Advocacy for booster seat legislation in Florida: a lesson in politics and policy formation R Sterling Haring,1 Shannon Frattaroli,2 Eric B Schneider,3 M Becker Holland,4 Jon S Vernick2 1
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 2 Department of Health Policy and Management, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 3 Surgery Department, Johns Hopkins Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 4 Junior Leagues of Florida, State Political Action Committee, Gainesville, Florida, USA Correspondence to R Sterling Haring, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Hampton House, 594 Baltimore , Maryland 21205, US; [email protected] Received 25 June 2014 Revised 10 October 2014 Accepted 13 November 2014 Published Online First 1 December 2014
To cite: Haring RS, Frattaroli S, Schneider EB, et al. Inj Prev 2015;21: 137–139.
ABSTRACT MVCs are a major contributor to child injury and death. Infant restraint seats and child booster seats have been shown to reduce the odds of severe injury or death when used correctly. While all states have mandated the use of these restraint systems, the age at which a child can be legally restrained using an adult seat belt varies from state to state. Efforts to strengthen Florida’s weak child restraint laws have failed for more than a decade; in the 2014 legislative session, advocates succeeded in raising the state’s age requirement from 3 years to 5 years. While many factors contributed to this year’s success, some key elements included efficient communication of supporting data, a strong and broad advocacy network and the leveraging of election year political rivalries. Efforts to further strengthen the law will continue into future legislative sessions.
BACKGROUND MVC-related injury is among the leading causes of injury-related death in the USA. In 2012 alone, MVCs accounted for over 33 000 deaths.1 The development of seat belts, airbags and other safety devices, as well as legislation mandating seat belt use have been very effective at reducing MVC-related morbidity and mortality among adult populations.2 3 Similarly, strong evidence supporting the use of child seats has helped to establish such devices as the status quo for the youngest of children (typically ages 0–3 years), leading to dramatic reductions in MVC-related injury among children in that age group when compared with unrestrained children (OR: 2.7, 95% CI 2.40 to 3.1).4 5 Indeed, developments such as these have been among the great public health successes of our time.6 Adequately protecting older children, however, has proven to be more challenging. Traditional adult seat belts are designed to rest low on the hips, holding the pelvic bones in place in the event of a collision. When children are restrained in adult seat belts, the lap belt can ride up onto the child’s abdomen during a crash, increasing the risk of a so-called ‘fulcrum’ fracture of the lumbar spine or other internal injuries.7 8 Such injuries can lead to paralysis or even death. In response to this risk, belt-positioning booster seats have been developed. These devices, now widely available, have been shown to reduce the risk of serious injury among 4–8-year-old children by up to 45%, and professional groups such as the American Academy of Pediatrics have encouraged their use.9–11 Accordingly, most states (48 states, as of January 2014) have developed legislation requiring
the use of age-appropriate restraints, including booster seats, in motor vehicles.12 While state laws on the subject are consistent in many aspects, there is significant variation in the upper age included in booster seat mandates (figure 1); the national mean age cut-off is 6.4 years, and the median is 7 years.13 On the older end of the age range, several states require booster seats to be used until age 8. However, Florida, until 2014, required no specialised restraint after age 3. This was the lowest age requirement among child passenger restraint laws in the 50 states. This article presents a case report of the events leading up to and surrounding the passage of a booster seat law in Florida.
EFFORTS TO CHANGE FLORIDA LAW Several iterations of what has been dubbed the ‘booster seat bill’ had been considered in the Florida Legislature since the Junior Leagues of Florida first advocated for it in 2001. The bill’s supporters demonstrated their dedication and work ethic in each year’s effort, but the endeavour was missing some key components, including effective reference documents for legislators and a broad base of vocal support, as outlined below. A new bill was introduced in the 2014 legislative session.14 That bill initially mandated the use of approved child booster seats up to either age 7 or specified height and weight requirements.
COMPONENTS OF FLORIDA ADVOCACY EFFORTS Organisers supporting the 2014 booster seat bill had worked hard to establish a broad-based coalition of support for the bill. The Florida Booster Seat Coalition counted among its members the Junior Leagues of Florida, Florida Medical Association, the Florida Hospital Association, the Florida Trial Attorneys Association, several local governments and school districts, hospitals, fire districts and businesses such as the American Automobile Association (AAA). With over 60 member organisations throughout the state, the Coalition represented many thousands of Floridians. Policy interventions can be easier to pass when precedent exists in other jurisdictions.15–17 The Coalition wisely designed their bill to resemble current laws in neighbouring states (eg, Tennessee and Georgia), and pointed to regional political and cultural similarities for support.
WHAT WAS MISSING The breadth of the Coalition had been the chief asset of bill supporters, but many of the
Haring RS, et al. Inj Prev 2015;21:137–139. doi:10.1136/injuryprev-2014-041350
137
Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Brief report
Figure 1 Distribution of state booster seat age requirements by age. The distribution of age requirements for state booster seat laws. Ages shown are inclusive (eg, children up to and including age eight are required to use booster seats).
organisations were members in name only; aside from a handful of ardent supporters, few members actively participated in the legislative effort. The bill’s supporters were also keenly aware that a successful policy change would require convincing data, and they remained ready to provide a number of statistics from the relevant literature when asked. Without an effective issue brief or convincing ‘leave-behind’ material, recruiting neutral legislators to the cause proved a difficult task. Such a document would provide a concise and effective message to the target audience in a manner most useful for policymakers.
THE SUCCESSFUL APPROACH After 13 years of failed attempts, the 2014 legislative session saw the successful passage of a booster seat bill in both houses of the Florida Legislature. Governor Rick Scott signed the bill into law on 24 June of the same year. For the 2014 session, bill supporters addressed the missing pieces of their previous approach. First, we (RSH and MBH were among the supporters) conducted a literature review and gathered data on MVC-related morbidity and mortality from the CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS) and from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration (NHTSA). We then analysed those data to identify fatal and nonfatal trends. Floridians with personal stories about child passenger safety were identified through personal connections and by reaching out through online social networks such as Facebook. Over a 2-month period in late 2013, we combined their stories and pictures with statistics from both the analysis and the literature review into a single cohesive, readable document. Due to the extensive use of the term ‘booster seat’ in past unsuccessful attempts, we avoided the use of the term when compiling the document (as in all other communications). On behalf of the Florida Booster Seat Coalition, we then distributed that document, during face-to-face meetings and via email, to Florida state legislators and stakeholders known to have an interest in child passenger safety. The bill’s sponsor, Representative Keith Perry, also distributed the document. Second, the Booster Seat Coalition translated the diversity of its membership into a loud voice for change. While the leadership of the Florida Medical Association and Florida Osteopathic 138
Medical Association opted not to actively support the bill, the student members of those organisations, recruited through the student-level governance of those bodies, were eager to offer their support. Students from Florida’s eight medical schools contacted key committee chairs throughout the 2014 legislative session to encourage the bill’s addition to committee agendas; these new voices, combined with those of the persistent activists who had kept the movement going for well over a decade, were able to persuade key policymakers, including committee chairs, to move the bill forward. Third, and perhaps most critical, the importance of booster seat use for older children was effectively brought to the attention of the governor. After years of gubernatorial disinterest, bill supporters reached out to the campaign office of influential former Florida Governor Charlie Crist in February 2014. Governor Crist, who was engaged in a close race for a new term as governor, was responsive and eager to support an issue that was clearly important to the variety of organisations represented by the Florida Booster Seat Coalition. His responsiveness sparked the interest of his opponent, incumbent Governor Rick Scott. Within weeks of Governor Crist’s commitment to support the booster seat bill, the office of Governor Scott invited the bill’s sponsor to discuss the issue. The Governor’s strong support that followed brought with it support from the speaker of the Florida House and the Senate president, virtually ensuring the bill’s success.
COMPROMISE ALONG THE WAY Despite strong support for the Senate companion bill as originally introduced, HB 225 faced some difficulty in committee. Some legislators were hesitant to embrace the perceived complexity of some of the more detailed clauses contained in other state booster seat laws, including height and weight requirements for children to be covered. Unlike their colleagues in the Senate, House committee chairs responsible for setting meeting agendas were hesitant to raise the age requirement for booster seats by as much as 5 years. After continued debate, the bill was brought up for discussion in committee, but only after it was amended to lower the age requirement from 8 years to 5 years. The prospect of raising the age limit via amendment in the 2015 legislative session was agreed upon as a means of compromise. Senate supporters were initially reluctant to weaken their bill after garnering support for the original language that included children up to 8 years. As a result, for a short period in April, the impasse threatened to end the bill’s prospects altogether. In the end, however, all parties agreed that raising the requirement to 5 years represented a meaningful improvement over current statute, and both bills were amended accordingly. Amendments to raise the age above 5 years are currently being drafted.
CONCLUSION Effective policy intervention requires a combination of a comprehensive approach, a convincing rationale that includes a solid evidence base, a strong team and, perhaps most importantly, a well-timed strategy. In this case, the organisation of a vocal coalition and evidence-based messages that were effectively communicated proved to be invaluable components for a successful campaign. By building on the strong work of previous years, Florida’s Booster Seat Coalition was able to oversee passage of a much-needed update to current legislation. As with all such interventions, a willingness to compromise and build on incremental victories was key. While increasing the age for mandated use of a booster seat from 3 to 5 years of age represents an important improvement Haring RS, et al. Inj Prev 2015;21:137–139. doi:10.1136/injuryprev-2014-041350
Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Brief report in public safety, it is important to note that legislative and community supporters have expressed a commitment to implementing future amendments to the bill that would ultimately increase the mandated age for booster seat use to 8 years. This case report is based on the observations and experiences associated with one law in one state. Despite these limitations, there are valuable lessons to be learnt from this case—including the importance of perseverance and value of capitalising on an election-year opportunity—that can be applied to other injury prevention advocacy efforts.
contributed to the revision and final approval of the paper. RSH takes responsibility for the content of the paper. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES 1 2
What is already known on this topic
3
It has been thoroughly established in medical and public health literature that booster seats reduce the risk of injury and death when used properly. It has further been established that policies mandating the use of booster seats are effective as a means of legislative intervention.
4 5
6 7
What this study adds
8 9
Designing booster seat legislation and overcoming obstacles inherent in the legislative process is a multifaceted problem with a myriad of possible solutions. This study contributes the experience of one successful legislative intervention in the nation’s third-most populous state.
10
11 12
Acknowledgements The authors would like to thank Kristy Arbogast at the Children’s Hospital of Philadelphia for sharing her expertise on the biomechanics of automobile injury and her passion for child safety seats. The authors would like to give special thanks to Karen Morgan, Jim Millican, Mary-Lynn Cullen, Leslie Kroeger, Natasha Diemer, Clint Shouppe and many others for their hard work and dedication to the cause. Contributors RSH and JSV designed the paper; RSH and MBH contributed to data collection; RSH, SF, EBS and JSV contributed to evaluation. All parties significantly
13 14 15 16 17
CDC—Costs of Crash Deaths—Motor Vehicle Safety—Injury Center. http://www. cdc.gov/motorvehiclesafety/statecosts/ (accessed 15 Dec 2013). Crandall CS, Olson LM, Sklar DP. Mortality reduction with air bag and seat belt use in head-on passenger car collisions. Am J Epidemiol 2001;153:219–24. Braver ER, Ferguson SA, Greene MA, et al. Reductions in deaths in frontal crashes among right front passengers in vehicles equipped with passenger air bags. JAMA 1997;278:1437–9. Berg MD, Cook L, Corneli HM, et al. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics 2000;105:831–5. Ekman R, Welander G, Svanström L, et al. Long-term effects of legislation and local promotion of child restraint use in motor vehicles in Sweden. Accid Anal Prev 2001;33:793–7. Centers for Disease Control and Prevention. Motor vehicle safety: a 20th century public health achievement. Morb Mortal Wkly Rep 1999;48:369–74. Howland WJ, Curry JL, Buffington CB. Fulcrum fractures of the lumbar spine: transverse fracture induced by an improperly placed seat belt. JAMA 1965;193:240–1. Gumley G, Taylor TK, Ryan MD. Distraction fractures of the lumbar spine. J Bone Joint Surg Br 1982;64-B:520–5. Arbogast KB, Jermakian JS, Kallan MJ, et al. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 2009;124:1281–6. Elliott MR, Kallan MJ, Durbin DR, et al. Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med 2006;160:617–21. American Academy of Pediatrics. Policy statement—child passenger safety. Pediatrics 2011;127:788–93. Governors Highway Safety Association. Child passenger safety laws. Governors Highway Safety Association, 2014. http://www.ghsa.org/html/stateinfo/laws/ childsafety_laws.html Florida House of Representatives. HB 239: Child Safety Booster Seat Act. 2001. Florida House of Representatives. HB 225: Child safety devices in motor vehicles. 2014. Bennett CJ. What is policy convergence and what causes it? Br J Polit Sci 1991;21:215–33. Wallack L, Winett L, Lee A. Successful public policy change in California: firearms and youth resources. J Public Health Policy 2005;26:206–26. Teret S, Alexander G, Bailey L. The passage of Maryland’s gun law: data and advocacy for injury prevention. J Public Health Policy 1990;11:26–38.
Incidentally shoots self then sues store A former police officer has filed suit against a hunting store after shooting off his own argued, finger because an employee gave him a loaded gun. The officer argues, argued, ‘Under no circumstances should they have had a loaded weapon in a display case’.
Increasing number of police killed There was a 56% increase in the number of police killed on duty in 2014 in the USA. This may be related to tension between the public and police after several shootings of unarmed African-Americans by white police officers.
Haring RS, et al. Inj Prev 2015;21:137–139. doi:10.1136/injuryprev-2014-041350
139
Downloaded from http://injuryprevention.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Advocacy for booster seat legislation in Florida: a lesson in politics and policy formation R Sterling Haring, Shannon Frattaroli, Eric B Schneider, M Becker Holland and Jon S Vernick Inj Prev 2015 21: 137-139 originally published online December 1, 2014
doi: 10.1136/injuryprev-2014-041350 Updated information and services can be found at: http://injuryprevention.bmj.com/content/21/2/137
These include:
References Email alerting service
This article cites 13 articles, 4 of which you can access for free at: http://injuryprevention.bmj.com/content/21/2/137#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
