Source Of Safety Information Research Articles

Power to the people: why person-generated health data are important for pharmacoepidemiology.

Person-generated health data (PGHD) are valuable for studying outcomes relevant to everyday living, for obtaining information not otherwise available, for long-term follow-up, and in situations where decisions cannot wait for traditional clinical research to be completed. While there is no dispute that these data are subject to bias, insights gained may be better than having an information void, provided the biases are understood and addressed. People will share information known uniquely to them about exposures that may affect drug tolerance, safety, and effectiveness (eg, nonprescription and complementary medications, alcohol, tobacco, illicit drugs, exercise, etc). Patients may be the best source of safety information when long-term follow-up is needed (eg, the 5- to 15-year follow-up required for some gene therapies). Validation studies must be performed to evaluate what people can accurately report and when supplementary confirmation information is needed. However, PGHD has already proven valuable in quantifying and contrasting COVID-19 vaccine benefits and risks and for evaluating disease transmission and the accuracy of COVID-19 testing. Going forward, PGHD will be used for patient-measured and patient-relevant outcomes, including for regulatory purposes, and will be linked to broader health data networks using tokenization, becoming a mainstay for signals about risks and benefits for diverse populations. This article is part of a Special Collection on Pharmacoepidemiology.

Unsafe care inresidential settings forolder adults: a content analysis ofaccreditation reports.

Residents of aged care services can experience safety incidents resulting in preventable serious harm. Accreditation is a commonly used strategy to improve the quality of care; however, narrative information within accreditation reports is not generally analysed as a source of safety information to inform learning. In Australia, the Aged Care Quality and Safety Commission (ACQSC), the sector regulator, undertakes over 500 accreditation assessments of residential aged care services against eight national standards every year. From these assessments, the Aged Care Quality and Safety Commission generates detailed Site Audit Reports. In over one-third (37%) of Site Audit Reports, standards relating to Personal and Clinical Care (Standard 3) are not being met. The aim of this study was to identify the types of resident Safety Risks that relate to Personal and Clinical Care Standards not being met during accreditation or re-accreditation. These data could inform priority setting at policy, regulatory, and service levels. An analytical framework was developed based on the World Health Organization's International Classification for Patient Safety and other fields including Clinical Issue (the issue related to the incident impacting the resident, e.g. wound/skin or pain). Information relating to safety incidents in the Site Audit Reports was extracted, and a content analysis undertaken using the analytical framework. Clinical Issue and the International Classification for Patient Safety-based classification were combined to describe a clinically intuitive category ('Safety Risks') to describe ways in which residents could experience unsafe care, e.g. diagnosis/assessment of pain. The resulting data were descriptively analysed. The analysis included 65 Site Audit Reports that were undertaken between September 2020 and March 2021. There were 2267 incidents identified and classified into 274 types of resident Safety Risks. The 12 most frequently occurring Safety Risks account for only 32.3% of all incidents. Relatively frequently occurring Safety Risks were organisation management of infection control; diagnosis/assessment of pain, restraint, resident behaviours, and falls; and multiple stages of wounds/skin management, e.g. diagnosis/assessment, documentation, treatment, and deterioration. The analysis has shown that accreditation reports contain valuable data that may inform prioritization of resident Safety Risks in the Australian residential aged care sector. A large number of low-frequency resident Safety Risks were detected in the accreditation reports. To address these, organizations may use implementation science approaches to facilitate evidence-based strategies to improve the quality of care delivered to residents. Improving the aged care workforces' clinical skills base may address some of the Safety Risks associated with diagnosis/assessment and wound management.

An examination of the interplay of message framing and vaccine safety information sources on COVID-19 vaccination promotion

An examination of the interplay of message framing and vaccine safety information sources on COVID-19 vaccination promotion

Sociodemographic disparities in child restraint selection and variation in child passenger safety information sources

PurposeMarginalized and otherwise vulnerable groups remain at higher risk than their counterparts for not having all of their children appropriately restrained during vehicle trips. Little is known about potential sources of these disparities, however a commonly theorized factor has been where caregivers find or obtain information (i.e., their information sources). The objective of this study was to: (1) characterize caregivers’ actual and preferred sources of information related to child passenger safety information, overall and within sociodemographic groups; and (2) determine if, and if so how, sources impact appropriate child restraint use (i.e., child/seat fit). MethodsWe conducted an online, cross-sectional survey of US caregivers. Caregivers answered questions about themselves, their child(ren), their child(ren)’s restraint use during trips, and their information sources to learn which seat their child should be using. We used Fisher’s exact and Pearson chi-square tests to compare used and preferred sources of information across caregiver demographics (age, education, race/ethnicity), as well as to determine whether information sources were associated with caregivers’ appropriate child restraint use. ResultsA total of 1,302 caregivers from 36 states with 2,092 children completed the survey. The majority (91%) of children were appropriately restrained. More caregivers from marginalized and otherwise vulnerable groups had children inappropriately restrained when compared with their counterparts. We identified multiple differences in both used and preferred information sources by caregivers’ age, race/ethnicity, and education level. In addition, we found a trend that caregivers from populations with higher rates of inappropriate use seemingly used fewer information sources. Ultimately, information sources were not associated with appropriate restraint use; however, within vulnerable populations, almost all caregivers had all of their children appropriately restrained if they had used a Child Passenger Safety Technician (CPST)/Inspection Station or their Pediatrician. ConclusionOur findings reiterate calls for more tailored interventions and efforts to combat widening disparities in child restraint use and crash outcomes and suggest one promising method may be providing more access to child passenger safety experts. Future studies must untangle the likely complex relationship between information sources and appropriate/accurate child restraint use.

The side effects of COVID-19 vaccines: A cross-sectional study in the eastern region of Libya

Purpose: Patient-reported data is an important source of safety information. The aim of this study was to describe the side effects of COVID-19 vaccines used in Libya, compare them, and find the association of these with different factors. Materials and Methods: A cross-sectional study was conducted in the eastern part of Libya. Adults who got one or two doses of any COVID-19 vaccine were included. The questionnaire was distributed online via social media, and also distributed as paper form to increase the responses. Results: In total, 1779 adults, (53.7%) females completed the questionnaire. The mean age of participants was 39.87±14.99. Generally, females experienced side effects slightly higher compared to males (75.7% and 68.8% respectively). Overall, the prevalence of side effects was slightly higher in participants aged ≤40 years compared to those aged >40 years (76.5% and 66.6% respectively). However, this difference was found to be statistically significant (p=0.001). The side effects were more common among those previously infected with COVID-19 than those not (78.5% and 21.5%, respectively; p=0.001). The side effects were more common among those, who received the Sputnik V and the Sinopharm vaccine compared to other types. The most common side effect was fever (41.1%), (47.3%) for the Sputnik V vaccine. Conclusion: The side effects of COVID-19 vaccines used in Libya are generally mild and selflimiting. The most common side effect was fever, which was more prominent among females and the younger age group of participants. Also, the side effects were more common among those, who received the Sputnik V vaccine. (Open J Bio Med Res 2022;1:19-27.)

When Safety Data Sheets are a Safety Hazard

Over the past several decades, Material Safety Data Sheets (MSDSs) and, more recently, Safety Data Sheets (SDSs) have become a valuable source of safety information for both industry and academia. They provide chemists with important data on reactivity, toxicity, decomposition byproducts, etc., thus preventing various chemical accidents. Conversely, when the SDS contains erroneous information, serious accidents can ensue. This article provides examples of erroneous statements found in SDSs and analyzes their origins. Several measures are also proposed to improve the quality of SDSs.

Information literacy skills are required in finding reliable toxicological information resources

Chemicals are a part of modern life, but they are potentially hazardous. Consumers, regulatory authorities, information specialists, researchers, students, and toxicologists need access to evidence-based safety information about chemicals either in their ordinary life or in their work to protect their own health, that of other co-workers and ultimately the environment in which we all live. The most important open sources of safety information are databases such as PubMed and PubChem and open access scholarly journals, as well as websites of regulatory authorities and research institutions. This paper discusses the need for toxicological information literacy and its contents for all to identify reliable information. Reliable open access sources for toxicological information of chemicals are also provided.

Benefits of Patient/Caregiver Engagement in Adverse Drug Reaction Reporting Compared With Other Sources of Reporting in the Inpatient Setting: A Systematic Review.

Clinicians learn from prior adverse events through pharmacovigilance allowing for improved medication safety in the medication use process; therefore, adverse drug reaction (ADR) reporting needs to be maximized. This systematic review was conducted to determine whether engaging patients/caregivers in ADR reporting during a patient's hospitalization provides further information about ADRs not obtained from traditional sources of reporting (i.e., voluntary reporting, medical record review). This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A literature search was conducted from January 2018 to June 2019 in PubMed, CINAHL, and Embase. Studies were included if they were (i) conducted in the inpatient setting, (ii) surveyed patients/caregivers, (iii) compared patient/caregiver reporting with another source of reporting, and (iv) evaluated ADRs. Studies completed in an outpatient setting or nursing home were excluded. A total of 11 studies were included. Sources of ADR information from patient/caregiver were obtained through interviews, surveys, questionnaires, or open-ended responses. Patient reporting was compared with medical record reports (7 articles) and health care professional reporting (4 articles). Approximately 11% to 35% of ADRs reported from patients were not identified through voluntary reporting by health care professionals, and 5.6% to 66% of ADRs obtained from patient reporting were not provided in the medical record. Patients/caregivers are important sources of safety information to improve system and practice of medication use that may not be recorded by other surveillance methods. Administrators and clinicians need to determine the best approach to integrate patients/caregivers into routine reporting for optimal engagement.

Survey on Information Seeking Behaviour of Local Miners in Lead Poison Affected Areas of Anka and Maru Local Government Areas of Zamfara State, Nigeria

This study surveyed the information seeking behaviour of the local miners in the lead poison affected areas of Anka and Maru local Government areas of Zamfara state.
 This study adopted survey research design, 245 local miners in the affected area were used as population of the study, and simple random sampling technique was used for the study. Self-structured questionnaire were used as instrument for data collection from respondents The instruments were validated by three experts who found the instrument valid for the study after making some corrections.
 The major findings of this study indictaed that local miners needs information on accidents associated with mining such as drowning, tumbling, suffocation, rock fall and how to improve thier work through the use of modern facilities with 87% respectively. lack of access to sources of safety information, lack of time, ignorance, language barrier, cost of information and lack of infrastructures.
 Recommendations includes: Government agencies need to consider how to provide better safety information services to the local miners in the area under study, and whether to make knowledge on the use of safety equipment a necessary requirement for qualifying to participate in mining activities. Adequate penalties for failure to comply with government regulations may be required to compel the local miners to ensure compliance with safety rules and regulations.
 The paper’s originality lies in the information needs of the local miners in the lead poison affected areas of Anka and Maru local Government areas of Zamfara state, Nigeria.

Barriers to the use of patient safety information sources by community pharmacies.

When patient safety information is communicated across a regulatory jurisdiction or country, the potential to enhance the safety of community pharmacy practice is significant. While there currently exists a number of sources for patient safety information (e.g., websites, safety bulletins, online tools), knowledge of the barriers that may inhibit the use of such information sources within community pharmacies is limited. This research explores community pharmacy manager use of Canadian patient safety information sources and the barriers that may limit the use of such sources. A qualitative research study design using semi-structured interviews was conducted with 15 community pharmacy managers in the Halifax Regional Municipality of Nova Scotia, Canada. The study explored how pharmacists access and engage a variety of information sources, including corporate intranets, websites, and tools provided by third party data base repositories. Interview data were analyzed using thematic analysis. Five general barriers were identified: lack of time to access information sources and its contents; too many sources of available information; too much information not relevant to community pharmacy practice; complexity navigating online information sources; and lack of community pharmacy involvement in source design. While pharmacies do use safety information sources to enhance practice safety, their ability to incorporate this information is inhibited by their general lack of time available to access and read safety information, lack of knowledge about where to get this information, and lack of tailored information for the community pharmacy context. Future initiatives should address increasing information awareness of available sources, consolidating and reducing information overload of such sources, and packaging information to better fit with pharmacists' needs.

Accessibility and Trustworthiness of Food Safety Information Sources and Channels in Ghana

Accessibility and Trustworthiness of Food Safety Information Sources and Channels in Ghana

Which food safety information sources do Italian consumers prefer? Suggestions for the development of effective food risk communication

This study investigated which information sources Italian consumers use most frequently when they have a question about food safety in order to obtain useful insights to inform food risk communication. In 2011, a national survey was conducted targeting Italian people responsible for purchasing and preparing food for their households. Respondents’ choices of information sources on food safety were correlated with their socio-demographic and behavioural characteristics, their levels of objective knowledge, their levels of trust towards some authorities and their levels of self-perception regarding risk exposure. Our data analysis identified those information channels that are most likely to reach Italians actively seeking information. Mass media (radio/television/newspapers) were the most frequently used information source, followed by the Internet. Age, educational qualification, employment status, geographical area, family status and objective knowledge were the variables that influenced the choice for information sources used by the Italian population. The frequency of buying food products, the frequency of eating put and the frequency of cooking also showed a dependency relation. The profiles of those who actively seek information were also outlined. Among these, the Mass media users’ and the Internet users’ profiles were further analysed. Results show that Italian consumers do actively seek information about food safety, revealing that food safety continues to be a concern for the Italian consumers. Their interest in this topic represents an opportunity for public health authorities to address an audience of receptive consumers. Such information will be valuable in the design of targeted communication campaigns to increase consumers’ knowledge and awareness of food safety issues and will help authorities to choose the most effective channels through which to deliver key messages.

Factors Influencing the Use of a Mobile App for Reporting Adverse Drug Reactions and Receiving Safety Information: A Qualitative Study

IntroductionA mobile app may increase the reporting of adverse drug reactions (ADRs) and improve the communication of new drug safety information. Factors that influence the use of an app for such two-way risk communication need to be considered at the development stage.ObjectiveOur aim was to reveal the factors that may influence healthcare professionals (HCPs) and patients to use an app for two-way risk communication.MethodsFocus group discussions and face-to-face interviews were conducted in the Netherlands, Spain and the UK. Patients with type 2 diabetes mellitus, patients with a rare disease or their caregivers and adolescents with health conditions were eligible to participate. HCPs included pharmacists, paediatricians, general practitioners, internists, practice nurses and professionals caring for patients with a rare disease. Patients and HCPs were recruited through various channels. The recorded discussions and interviews were transcribed verbatim. The dataset was analysed using thematic analysis and arranged according to the Unified Theory of Acceptance and Use of Technology.ResultsSeven focus group discussions and 13 interviews were conducted. In total, 21 HCPs and 50 patients participated. Identified factors that may influence the use of the app were the type of feedback given on reported ADRs, how ADR reports are stored and the type of drug news. Also mentioned were other functions of the app, ease of use, type of language, the source of safety information provided through the app, security of the app, layout, the operating systems on which the app can be used and the costs.ConclusionsFurther research is needed to assess associations between user characteristics and the direction (positive or negative) of the factors potentially influencing app use.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-016-0494-x) contains supplementary material, which is available to authorized users.

Pharmacovigilance and Biomedical Informatics: A Model for Future Development

PurposeThe discipline of pharmacovigilance is rooted in the aftermath of the thalidomide tragedy of 1961. It has evolved as a result of collaborative efforts by many individuals and organizations, including physicians, patients, Health Authorities, universities, industry, the World Health Organization, the Council for International Organizations of Medical Sciences, and the International Conference on Harmonisation. Biomedical informatics is rooted in technologically based methodologies and has evolved at the speed of computer technology. The purpose of this review is to bring a novel lens to pharmacovigilance, looking at the evolution and development of the field of pharmacovigilance from the perspective of biomedical informatics, with the explicit goal of providing a foundation for discussion of the future direction of pharmacovigilance as a discipline. MethodsFor this review, we searched [publication trend for the log10 value of the numbers of publications identified in PubMed] using the key words [informatics (INF), pharmacovigilance (PV), phar-macovigilance þ informatics (PV þ INF)], for [study types] articles published between [1994-2015]. We manually searched the reference lists of identified articles for additional information. ImplicationsBiomedical informatics has made significant contributions to the infrastructural development of pharmacovigilance. However, there has not otherwise been a systematic assessment of the role of biomedical informatics in enhancing the field of pharmacovigilance, and there has been little cross-discipline scholarship. Rapidly developing innovations in biomedical informatics pose a challenge to pharmacovigilance in finding ways to include new sources of safety information, including social media, massively linked databases, and mobile and wearable wellness applications and sensors. With biomedical informatics as a lens, it is evident that certain aspects of pharmacovigilance are evolving more slowly. However, the high levels of mutual interest in both fields and intense global and economic external pressures offer opportunities for a future of closer collaboration.

Assessing food safety knowledge and preferred information sources among 19–29 year olds

Foodborne illness is a common and costly cause of gastroenteritis in Canada. Although high rates are expected in vulnerable populations, young adults experience a surprisingly high rate of foodborne illness. While research has indicated that young adults are undereducated in food safety, studies examining the knowledge of young Canadians, as well as approaches to improve their education, have not been conducted. An online questionnaire containing 33 questions was distributed to young adults in Canada via social media, questioning their food preparation knowledge, high risk activity knowledge, food safety information sources, and demographics. Of the 334 surveys completed, 307 were used to create the data set for this study. This study indicated that food safety knowledge in young Canadian adults (aged 19–29) is low. Common causes of foodborne illness were overlooked or not often recognized. For example, 4 °C – 60 °C was identified as an unsafe holding temperature by 41.0% of respondents; the safe internal temperature for chicken (74 °C) was identified by 38.8% of respondents. Multivariable logistic regression modeling indicated that food safety knowledge scores (proportion of questions answered correctly) were higher among females (OR = 1.20; 95% CI: 1.06, 1.37), those with previous food safety training (OR = 1.25; 95% CI: 1.09, 1.43), and those who indicated that they do not seek information about food safety from their family or friends (OR = 1.28; 95% CI: 1.12, 1.47). These results suggest the need for stronger, more targeted food safety education programs, aimed specifically at young adults. Although previous research indicated that social media may be a primary venue for education, most respondents did not desire to receive food safety information via social media at all. As such, food safety education programs targeted at this population will likely need to be multi-platform, and involve traditional and social media approaches.

Insulin pump risks and benefits: an analysis of the EASD/ADA joint statement

Insulin pump risks and benefits: an analysis of the <scp>EASD</scp>/<scp>ADA</scp> joint statement

Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting and research needs. A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error or a combination of these. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycaemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycaemia. Nevertheless, the available evidence on the safety and efficacy of CSII remains limited. The European Association for the Study of Diabetes (EASD) and American Diabetes Association (ADA) have therefore joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. We found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilised due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices, EUDAMED) is not publicly accessible. Many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. The clinical studies required by regulators prior to marketing are small and over-reliant on bench testing in relation to 'predicate' products. Once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real-world setting; such data could provide vital information to help healthcare teams to educate and support users, and thereby prevent AEs. As well as requiring more from the manufacturing companies, we call for public funding of more research addressing clinically important questions in relation to pump therapy: both observational studies and clinical trials. At present there are significant differences in the regulatory systems between the USA and European Union at both pre- and post-marketing stages; improvements in the European system are more urgently required. This statement concludes with a series of recommended specific actions for 'meknovigilance' (i.e. a standardised safety approach to technology) which could be implemented to address the shortcomings we highlight.

Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is an important and evolving form of insulin delivery, which is mainly used for people with type 1 diabetes. However, even with modern insulin pumps, errors of insulin infusion can occur due to pump failure, insulin infusion set (IIS) blockage, infusion site problems, insulin stability issues, user error, or a combination of these. Users are therefore exposed to significant and potentially fatal hazards: interruption of insulin infusion can result in hyperglycemia and ketoacidosis; conversely, delivery of excessive insulin can cause severe hypoglycemia. Nevertheless, the available evidence on the safety and efficacy of CSII remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. We found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilized due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices [EUDAMED]) is not publicly accessible. Many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. The clinical studies required by regulators prior to marketing are small and over-reliant on bench testing in relation to "predicate" products. Once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real-world setting; such data could provide vital information to help health care teams to educate and support users and thereby prevent AEs. As well as requiring more from the manufacturing companies, we call for public funding of more research addressing clinically important questions in relation to pump therapy: both observational studies and clinical trials. At present, there are significant differences in the regulatory systems between the US and European Union at both pre- and postmarketing stages; improvements in the European system are more urgently required. This statement concludes with a series of recommended specific actions for "meknovigilance" (i.e., a standardized safety approach to technology) that could be implemented to address the shortcomings we highlight.

Reply to magnetic resonance imaging‐based diagnosis of progressive multifocal leukoencephalopathy in a patient with non‐Hodgkin lymphoma after therapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab

Disseminating timely information concerning serious adverse drug reactions is difficult. This is the mission of the Southern Network on Adverse Reactions (SONAR). Dima et al from Romania described a patient with non-Hodgkin lymphoma who was treated with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (CHOP-R regimen) who developed speech and motor dysfunction. Magnetic resonance imaging identified white matter defects. Cerebrospinal fluid (CSF) analysis did not identify JC virus (John Cunningham virus). An empirical diagnosis of rituximab-associated progressive multifocal leukoencephalopathy (PML) was made. Recently proposed PML diagnostic criteria from the Neuro-infectious Disease Section of the American Academy of Neurology require evidence of clinical disease progression, imaging, and JC virus (histopathologically or in the CSF).1 If full criteria are not met, then alternative diagnoses need to be investigated. Access to relevant publications may not have been available in Romania, including our case series and review of PML.2,3 The product label also does not report this information.4 Although >300 individuals with rituximab-associated PML have been reported to regulatory authorities, the label does not report this. The label also does not describe that in the setting of a suggestive magnetic resonance imaging scan and a negative CSF evaluation for JC virus, a second lumbar puncture or a brain biopsy should be considered. Finally, emerging data have identified a low baseline PML rate in patients with lymphoma, but a 5-fold increased rate in patients treated with rituximab and chemotherapy.5 We thank Dima et al for reporting this case, thereby reinforcing the observation that the most available source of safety information is the product label.

Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources. A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1- to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law. Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents. Regardless of race, <30% of 8- to 12-year-old children who were ≤4 feet, 9 inches tall used a booster seat. White parents had higher adjusted odds (3.86, 95% confidence interval 2.27-6.57) of reporting age-appropriate restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, κ = 0.74) between parent report of their child's usual restraint and the observed restraint at emergency department discharge. Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children <8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children.