OBjECTIVES: To measure the prevalence of self-reported and observed use of booster seats in children aged 4-9 in Winnipeg, and to identify reasons for use and non-use of booster seats in order to develop a well targeted intervention to increase use. METhODS: Random digit dial telephone survey of Winnipeg residents over the age of 18 performed by a local survey company. A total of 134 participants were surveyed. Respondents had at least two children, with at least one child between the ages of

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... 9. A concurrent observational study of occupant restraint was used for comparison. Vehicles with child occupants were observed at 29 traffic intersections across Winnipeg by trained observers. Child age was estimated and coded by age groups (infant, toddler, booster age, older) and type of restraint recorded. RESuLTS: The observational study examined 1720 vehicles and documented 19.3% booster seat use. Self-reported booster seat use was 74.5%. The average age of children "always" using a booster seat was 6.0 years, and the average age of children "never" using a booster seat was 7.9 years. There was a significant negative correlation between the age of the child and the frequency of booster seat use, with younger children more likely to use a booster seat (Kendall's tau b = -0.469; p= 0.0001). The leading reasons for use of booster seats included perceived increased safety (100%), and legislation (82.6%). The most common reasons for non-use included believing the child was too big (85.4%), lack of legislation (50%), and peers not using one (66.7%). The most commonly cited factors to increase use included legislation (85.4%) and having booster seats built into vehicle (62.5%). CONCLuSIONS: Self-reported rates of booster seat use are high, but observed rates are quite low. Reported use decreases with increasing age. There are multiple reasons for use and non-use of booster seats. Multi-faceted intervention programs involving education, distribution and legislation could be improved by knowledge of parental attitudes and decision-making factors.