Background: Motor vehicle crashes are the leading cause of mortality for children aged 4-14 in the United States. Many children are driven daily to school, increasing their exposure to potential injury, especially if they are not appropriately restrained. Observing the level of motor vehicle occupant restraint (MVOR) use upon school arrival could lead to valuable information for the development of an injury prevention program targeted to this population. This study compares the rate of MVOR use upon arrival to elementary schools with that at regional intersections. Methods: One hundred thirty-five census tracts in the Denver, Colorado, area were identified and combined into 5 regions. Within each region, 1 controlled intersection and 1 elementary school were observed. Observations were conducted for 1 hour at each of these locations. Results: At intersections, 618 children in private vehicles were observed. MVOR use rate was 71.2% (440/618). At schools, 665 children in private vehicles were observed. MVOR use was 24.8% (165/665). Children arriving at school were less likely to be restrained than those observed at intersections (relative risk: 0.35, 95% CI: 0.30-0.40). Conclusions: Children at elementary schools showed substantially lower MVOR use rates than those observed at controlled intersections. Further investigation is imperative to determine the reason behind the low use of MVOR in children being transported to school. Based on the reasons elicited, interventions emphasizing the importance of always using MVOR can be developed and tailored to meet the educational needs of parents transporting their children to school in private vehicles. (Contains 1 table and 3 figures.)