Seat belt misuse among children transported in belt-positioning booster seats.

Objective: Observe and report seat belt use among children transported in belt-positioning booster seats.
Design: We conducted a cross-sectional, observational survey of children transported in motor vehicles between 2006 and 2007. While drivers completed a survey reporting the child's age, weight and gender, and the driver's age, gender, race, income, education, and relationship to the child; a child passenger safety technician recorded vehicle seating location, restraint type, and use of the car safety seat harness or seat belt as appropriate for the child.
Setting: Twenty-five fast food restaurants and discount department stores throughout Indiana.
Participants: A convenience sample of drivers transporting children younger than 16 years.
Main Exposure: Seat belt use among children transported in belt-positioning booster seats.
Outcome Measure: Seat belt misuse.
Results: Overall, 1446 drivers participated, 2287 children were observed with 564 children in belt-positioning booster seats. At least one seat belt misuse was observed for 64.8% of the children transported. Common misuses were the shoulder belt being placed over the booster seat armrest (35.8%); shoulder belt not at mid-shoulder position (28.5%), seat belt was too loose (24.5%), and the shoulder belt was either behind the child's back (9.1%) or under their arm (10.0%).
Conclusion: There is a high frequency of seat belt misuses among children transported in booster seats. Advice to parents on appropriate car seat selection, and encouragement to parents to supervise seat belt use may decrease misuse.