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Racial differences in child safety restraint use in Tennessee
  1. V L Gunn1,
  2. R M Phillippi2,
  3. W O Cooper1
  1. 1Department of Pediatrics, Child and Adolescent Health Research Unit, Division of General Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
  2. 2Department of Pediatrics, Emergency Medical Services for Children, Division of Pediatric Critical Care, Vanderbilt University School of Medicine, Nashville, TN, USA
  1. Correspondence to:
 Dr V L Gunn
 Department of Pediatrics, Child and Adolescent Health Research Unit, Vanderbilt University School of Medicine, AA-0216 MCN, 1215 21st Avenue South, Nashville, TN 37232-2504, USA; veronica.gunn{at}


Objectives: To evaluate the appropriate use of child safety restraints (CSR) in black and white children.

Design: Cross sectional, observational study of drivers of children age 0–10 years involving an on-site vehicle and CSR inspection and brief driver interview.

Results: Data were obtained on 244 white and 204 black children; results were stratified by race due to effect modification of race on driver restraint use and CSR use. Twenty four percent of black and 13% of white child passengers aged 4–10 years were completely unrestrained (p = 0.003). Of the 168 black and 220 white child passengers aged 0–10 years who were restrained, 64% of black and 58% of white children had inappropriate restraint use. Appropriate CSR use was significantly lower in 4–8 year old passengers compared with appropriately restrained children aged <4 years and 9–10 years (p<0.0001 for both black and white child passengers).

Conclusions: Black child passengers and all child passengers aged 4–8 years are at increased risk of being inappropriately restrained. Educational efforts should address specific barriers to booster seat use in these populations.

  • CSR, child safety restraint
  • car seats
  • child passenger safety
  • injury disparities

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  • Competing interests: none.