title: Improvement in booster seat use in Tennessee.
abstract: OBJECTIVE
  Tennessee enacted an enhanced child safety restraint law in July 2004, which included new requirements for booster seat use among 4- to 8-year-old children. The goal of this study was to evaluate the appropriate use of child safety restraints and knowledge of the enhanced law before and after its implementation.
  
  
  METHODS
  On-site child safety restraint assessments and brief driver interviews for cars with passengers 0 to 8 years of age were conducted at 34 sites in 3 urban counties in Tennessee. Assessments were conducted 2 to 3 months before implementation of the law and 1 year after implementation of the law. Appropriateness of restraint use was defined on the basis of language in the enhanced law.
  
  
  RESULTS
  Data were obtained for 1247 child passengers transported by 1191 drivers; 333 of the children were 0 to 3 years of age, and 914 were 4 to 8 years of age (the primary age group targeted by the enhanced law). Significant improvement in appropriate booster seat use was seen for 4- to 8-year-old passengers after implementation (39%), compared with use before implementation (29%). There was no improvement in the rate of appropriate restraint use for younger children (<4 years of age) after implementation. Black passengers 4 to 8 years of age were twice as likely as white child passengers to be unrestrained, before and after implementation. Seventy-nine percent of drivers reported awareness of the new restraint law after implementation; the majority of drivers obtained information from television advertisements.
  
  
  CONCLUSIONS
  Improvements in booster seat use were seen after adoption of an enhanced state law requiring use; however, racial differences in restraint use persisted among 4- to 8-year-old passengers. Additional study of barriers to booster seat use among drivers of black child passengers and unrestrained children is warranted.
authors.affiliation: Department of Pediatrics, Child and Adolescent Health Research Unit, Vanderbilt University School of Medicine, AA-0216 MCN, 1215 21st Ave South, Nashville, TN 37232-2504, USA. veronica.gunn@vanderbilt.edu
authors.forename: Veronica L
authors.initials: VL
authors.lastname: Gunn
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Phillippi
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
mesh_terms: D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000706:statistics & numerical data*; D018986:Motor Vehicles; D012622:Seat Belts / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D013714:Tennessee; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American