Abstract Body: Introduction
Pediatric out-of-hospital cardiac arrest (OHCA) survival remains low, with disparities in the provision of bystander CPR (BCPR). Prior studies suggest that comfort performing CPR and perceived barriers may differ by sociodemographic factors, but parent-specific data are limited. We aimed to evaluate the association of race, ethnicity, and socioeconomic status (SES) with CPR comfort and perceived barriers to BCPR among parents and guardians.

Methods
We conducted a cross-sectional survey of parents and guardians at primary care clinics and community sites between June 2024 and June 2025. The primary outcome was self-reported comfort performing CPR on a child experiencing cardiac arrest (Likert scale 1–5). Exposures included self-identified race, ethnicity, and SES (composite of income, education, and employment). Secondary outcomes included reported barriers to CPR. Analyses included unadjusted and age-adjusted linear regression for CPR comfort and Kruskal-Wallis tests for group differences in perceived barriers.

Results
A total of 212 (80%) participants (50% Black, 15% Hispanic, 15% White, 45% lowest SES) met inclusion criteria. In unadjusted and adjusted models, race/ethnicity was not significantly associated with BCPR comfort. SES was significantly associated with BCPR comfort in both unadjusted (β = 0.27, p < 0.001) and adjusted (β = 0.26, p < 0.001) models. The most frequently cited barriers to BCPR were lack of CPR training (43%), fear of harming the child (24%), and fear of legal consequences (18%). Lower SES was associated with hesitancy to call 911 and fear of police interaction (p < 0.01).

Conclusion
Parents of a lower SES self-report being less comfortable performing CPR as compared to parents of a higher SES. The most frequently cited barriers to BCPR include lack of CPR training, fear of harming the child, and fear of legal consequences. These findings underscore the importance of interventions tailored to social and sociopolitical contexts to address specific barriers to BCPR and reduce disparities in pediatric BCPR provision.