Fall Injury Interventions
There are an estimated 25,000 injuries each year from shopping carts
in the United States.28 Over 60% involve children under the age of five years. The majority
of injuries are caused by falling out of the carts, striking against an object while
riding a cart, or becoming caught between objects while playing in a cart basket.29 A
series of 10 children from the UK found that all had head injuries and 30% required
In another series from the U.S., 18% of emergency department patients had fractures
and 79% had injuries to the head.28 One intervention
is the use of belts. The interventions evaluated were programs to increase belt
use; unfortunately, no programs have evaluated the impact of belt use on injury
Review of programs to increase belt use in shopping carts:
|Ferrari and Baldwin, 1989|
Study design and target population
|Non equivalent control group study.
One store was control and other 2 stores were intervention
Children under 40 inches or children who looked like a toddler
|Three supermarkets some of which had
carts and some of which did not. Educational prompts to use carts with the belts
consisted of marking equipped carts with tape, placing them separately in store,
fliers prompting their use, message over the public address system every 10-20
Personal contact by an employee explaining use of belts was
|Belt use as observed by study personnel|
|Belt use increased from 1.1% at baseline
to 14.4% with prompt-only to 51.3% at prompt plus personal contact (p<.001).
For non-use, OR=0.07 (0.01-0.21) for prompt group vs. baseline and
OR=0.01 (0.00-0.21 for prompt plus personal contact.
Study quality and conclusions
|The intervention was successful in
increasing seat belt use in shopping carts.
While not randomized, this is a good controlled study with
observations of outcomes.
Summary of shopping cart injury prevention studies
The study by Ferrari and Baldwin indicates that educational interventions can increase
the use of seat belts on shopping carts. Unfortunately, no studies have been done
to indicate that these belts are effective in decreasing injuries. The case series
by Smith found that 8 of 62 injured children were properly belted, but were injured
when the cart tipped over. Thus, belts alone without redesign of the carts may not
be successful in eliminating these injuries.
Recommendations on seat belts in shopping carts
These cannot be recommended at the present since there are no data evaluating their
Recommendations for future research
A study on the effectiveness in reducing injuries is needed. This can be done as
a case-control study or even as a large cohort study in large supermarkets.