American Indian and Alaska Native (AI/AN) children experience the highest motor vehicle injury mortality rates in the United States, yet child restraint use in Northwest tribal communities is not well characterized. This study examined child, driver, and vehicle factors associated with proper, incorrect, and non-use of restraints among AI/AN children aged 1–8 years using data from the 2003 Northwest Tribal Child Safety Seat Project. Observations and driver interviews from six tribes were analyzed using logistic regression with clustering adjustments. Only 29% of children were properly restrained, while 41% were unrestrained. Proper restraint use was strongly associated with seat eligibility, driver seat belt use, parental drivers, and seat belt laws. Results highlight substantial risk due to incorrect and non-restraint use and underscore the need for targeted, community-based child passenger safety interventions in tribal communities.
