Executive Summary

A comprehensive review of the scientific literature, State and Federal Government reports, and other sources of information was conducted to determine the magnitude of the problem of teen safety belt use and to identify and summarize programs, interventions, and strategies that can potentially increase safety belt use by teens. Nearly 270 documents were reviewed for this report.

It is clear from the statistical data, a comprehensive review of the literature, and discussions with various officials concerned with this issue, that the most promising strategies available to increase safety belt use by teens are likely to be those strategies that have proven to increase safety belt use in the general population. These include the following and are tailored, where appropriate, to the youth situation:


Primary safety belt laws, if highly publicized, have been shown to increase safety belt use in the general population. The National Highway Traffic Safety Administration (NHTSA) recently estimated that adopting primary safety belt laws raises safety belt use by 11 percentage points. Teen belt use is also higher in States with primary safety belt laws. From 1998-2002, teen driver belt use was significantly higher in crashes in states allowing primary enforcement (49%) than in crashes in states allowing only secondary enforcement (30%).114 The evidence suggests that passing primary safety belt laws probably would have the greatest and most immediate effect on teen safety belt use.

A majority of States have adopted graduated driver licensing (GDL) laws with three phases of licensure. Many of the GDL laws either include safety belt use as a provision, and some provide for sanctions if a safety belt violation occurs. However, most teens and most parents are not aware of this requirement in GDL. Most are aware of nighttime restrictions and passenger restrictions, but not the consequences of a safety belt violation. For example, in a recent North Carolina study, 92 percent of the parents and 96 percent of the teens were aware of the nighttime restriction in the GDL, and 82 percent of the parents and 86 percent of the teens were aware of the passenger restriction. However, only 5 percent of the parents and 3 percent of the teens were aware of a safety belt requirement in the GDL law, and that a safety belt violation would affect their graduation to the next phase.56 If safety belt requirements and consequences for safety belt violations are publicized and enforced, this element of GDL could substantially increase safety belt use by teens in the future.

Safety belt violations result in points on the license in only one known jurisdiction in the United States (the District of Columbia). While there is no solid research on this provision to date, the potential for increasing safety belt use rates, especially for teens, is likely if this sanction is adopted, publicized, and enforced by the States.


Highly publicized and visible increased enforcement of safety belt laws has been shown to increase safety belt use in the general population. It is reasonable to assume that teen belt use would increase concomitantly. The highly publicized mobilizations using the Click It or Ticket (CIOT) theme have demonstrated that safety belt use will increase even in secondary enforcement States. If CIOT enforcement is tailored to young drivers (e.g., near high schools, colleges, and recreational facilities) and is publicized over youth-oriented radio and television stations, safety belt use by teens could be substantially increased.

Combined Efforts (comprehensive approaches including two or more strategies)

Four NHTSA Teen Demonstration Projects and other research of strategies that affect teen behavior indicate that combined approaches, such as strengthening safety belt laws, educating the public, publicizing the new or existing law, enforcing the law, and working with community organizations to provide outreach to the public, have good potential to increase safety belt use. Most of the research shows that it takes combined strategies involving education, publicity, visible enforcement, and community outreach to affect behavior in the traffic safety arena.

There are other strategies, which if aimed specifically towards teens, appear to have the potential to increase safety belt use for that population. These include:

Technological Approaches

While enhanced safety belt reminders such as buzzers, lights, and messages on the dashboard are aimed at the general population, they may be particularly effective for teens. Several factors contribute to this assumption, including that teens have a lower safety belt use rate to begin with, they tend to “forget” to buckle up in the car, and they are probably less likely than adults to disengage such systems. Some parents may want to buy cars for their teens equipped with reminder systems to ensure or enhance safety belt use. As more cars are equipped with enhanced reminder systems, the potential for their effect on youth increases.

In-vehicle computer systems already exist to record and monitor safety belt use, speed, and other behaviors. It remains to be seen if parents will purchase vehicles for their teens equipped with these monitors; if so, use of the systems could increase teen safety belt use substantially.

Peer-Led Approaches

Peer-led educational and awareness approaches hold promise in changing youth norms and attitudes about safety belt use. Whether this translates to sustained high-use rates is unclear. There is some evidence that youth-initiated monitoring of safety belt use may have a modest effect on teen belt use. A large program needs to be demonstrated, such as the Mothers Against Drunk Driving (MADD) Youth in Action programs that perform compliance checks on underage purchase of alcohol, to determine if this peer-to-peer strategy could be effective in the safety belt arena.

MADD and other organizations have developed multimedia shows for schools that attempt to persuade youth to wear safety belts and not engage in underage drinking. Some of these shows, which are based on a peer-to-peer message, are in the process of being evaluated for their effectiveness. Thus far, self-reported safety belt use has increased for students exposed to these shows, but it remains to be seen if observational surveys will verify that result.


At least one study showed that brief counseling in a medical setting may increase self-reported safety belt use by teens. If brief interventions in medical settings are used more frequently to reduce abusive drinking and impaired driving, they might also be effective in increasing safety belt use, especially by youth.

Parental Involvement

Parents simply talking to teens about safety belt use, without supporting activities, probably will not be effective. However, parental communication combined with close monitoring and supervision of teen behavior could have an effect. Teens report that their parents have more influence over them than parents think. For example, one State observational survey showed that youths 5 to 15 wore safety belts 72 percent of the time; however, when an adult driver was restrained, the age-5-to-15 passenger was restrained 85 percent of the time. In contrast, another observational survey of older teens (high school age 14 to 18) showed that teens were buckled up only 50-60 percent of the time when an adult dropped them off at school in the morning. While the above study results are inconsistent, other public health areas have indicated that parents can have an influence on risk-taking behavior (e.g., smoking). Therefore, it appears this strategy does have potential for increasing safety belt use by teens.


In summary, proven effective strategies that increase safety belt use in the general population will likely have the most immediate and greatest potential for increasing teen safety belt use. These include upgrading State safety belt laws to primary enforcement and highly publicized enforcement of safety belt use laws. GDL laws that explicitly include requirements for safety belt use in all three phases, and sanctions that prohibit “graduation” to the next licensing phase if there is a safety belt citation, could increase teen belt use substantially. Community programs that combine education, peer-to-peer persuasion, publicized enforcement, and parental monitoring have some potential for increasing teen belt use.

Technological solutions hold promise for the future as well. Enhanced safety belt reminders appear to be effective for all age groups. Safety belt use recorders could allow parents to monitor teens’ behavior, if accepted by the public. Interlock systems, such as not allowing the radio or CD player to turn on until all passengers are wearing safety belts, also hold promise and could be very effective for teens.

Combinations of strategies seem to work better than one strategy alone. A community program including education, diversity outreach, highly publicized enforcement, and parental involvement would likely have a substantial effect on teen belt use. However, these strategies would probably need to be sustained for the effect to last over time. While each strategy is not without barriers, careful planning, implementation, and evaluation can result in effective programs and add greatly to our current knowledge of teen safety belt use.