Background A national survey reported driver and front passenger seat belt use to be high in Japan, 98.9% and 95. 9% respectively in 2019. On the other hand, back seat safety belt use is alarmingly low at 39.2%. Child restraint seat (CRS) use has been mandatory since 2000, yet the survey reported the rate of use in 2019 to be only 70.5% for children under the age of 6. Additionally, the rate of use for 5-year-old children is dangerously low at 48%. The purpose of this study was to determine rear passenger seat belt use and CRS use on short-distance trips on local roads in a regional area of Japan.

Methods A cross-sectional survey using self-report questionnaires was performed at 78 nursery schools throughout Aomori prefecture. A descriptive analysis was performed on selected variables.

Results A total of 3021 valid responses (71.1% response rate) were returned. The number of respondents who always wore a seat belt traveling short-distance on local streets as a backseat passenger was significantly low (25.7%). Consistent CRS use on short trips using local roads was also considerably low with an average of 72.7%.

Conclusion Rear passenger seat belt use is very low, as is CRS use on short-distance trips on local roads in Aomori prefecture. Parents’ seat belt use as a backseat passenger may be affecting their behavior toward CRS use.

Learning Outcomes Interventions to increase the protection of children as passengers may need to address parents’ perceptions of rear-seat safety.