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America's Experience with Seat Belt and Child Seat Use

Seat belts and child safety seats work. Yet, fewer than 40 percent of both adults and children who died in traffic crashes were properly restrained.

Seat belts work. They are the most effective means of reducing fatalities and serious injuries when traffic crashes occur and are estimated to save 9,500 lives in America each year. Research has found that lap/shoulder belts, when used properly, reduce the risk of fatal injury to front seat passenger car occupants by 45 percent and the risk of moderate-to-critical injury by 50 percent. For light truck occupants, seat belts reduce the risk of fatal injury by 60 percent and moderate-to-critical injury by 65 percent.

Use rates chart Every 14 seconds someone in America is injured in a traffic crash and every 12 minutes someone is killed. When a traffic crash occurs, occupants are still traveling at the vehicle's original speed at the moment of impact. Just after the vehicle rapidly comes to a complete stop, unbelted occupants slam into the steering wheel, windshield, or other parts of the vehicle's interior. Seat belts are effective in reducing fatalities and injuries caused by this second collision, or "human collision," when the vehicle's occupants hit some part of the vehicle interior or other occupants. Seat belts provide the greatest protection against occupant ejection. In fatal crashes in 1995, only two percent of restrained passenger car occupants were ejected, compared to 25 percent of unrestrained occupants. Ejection from a vehicle is one of the most injurious events that can happen to a person in a crash. Three-quarters of the occupants who are ejected from passenger cars are killed.

While the first seat belts were installed by automobile manufacturers in the 1950s, seat belt use was very low — only 10-15 percent nationwide — until the early 1980s. From 1984 through 1987, belt use increased from 14 percent to 42 percent as a result of the passage of seat belt use laws in 31 states. Then, from 1990 through 1992, belt use increased from 49 percent to 62 percent as a result of a national effort of highly visible enforcement and public education.

Since then, belt use has risen slowly and some states have struggled to maintain seat belt use at current levels. In 1996, belt use nationwide was 68 percent, and ranged across the states from a high of 87 percent in California, to a low of 43 percent in North Dakota. Currently, 49 states, the District of Columbia, Puerto Rico and all the U.S. Territories have seat belt laws. New Hampshire is the only exception. (New Hampshire requires seat belt use up to age 12.) In 38 states, the law provides only for "secondary" enforcement of seat belt violations, requiring an officer to stop a violator for another infraction before issuing a citation for failure to buckle up. Under primary enforcement, a citation can be written whenever a law enforcement officer observes an unbelted driver or passenger. Currently, 11 states, the U.S. Territories, Puerto Rico, and the District of Columbia, all have primary (or "standard") enforcement laws. Maryland recently passed a primary seat belt enforcement law that goes into effect October 1, 1997. California, Georgia, Louisiana, Maryland, the Virgin Islands, and the District of Columbia had secondary enforcement laws, but upgraded their laws to primary enforcement. No state, except the District of Columbia, has a seat belt use law that assesses driver license penalty points. The District of Columbia's new law, after a six-month grace period to educate the public, authorizes the assessment of two penalty points and a $50 fine for a seat belt use violation. The District's new law covers all seating positions.

Seat belt use in the 11 states with primary (standard) seat belt use laws currently averages about 15 percentage points higher than in states with secondary laws. California and Louisiana increased their seat belt use rate by 13 and 18 percentage points, respectively, by upgrading their secondary laws to primary laws. Early reports from Georgia suggest that similar gains will be achieved. Georgia had a use rate of 53 percent near the end of 1995, which fell to 51 percent shortly before the change to primary enforcement on July 1, 1996. After four months of primary enforcement (and despite the media's and law enforcement's attention on the Olympics during that period), statewide use was observed at 62 percent.

State seat belt use rates by law type

To understand why seat belt use is not higher, it is important to understand who does not use seat belts. Americans can be classified as non-users, part-time users, and full-time users.

Non-users represent only 5 to 10 percent of the population, but are the most difficult to convert to seat belt use. High risk drivers are most typically non-users of seat belts. They are more likely than others to drive after drinking, to be involved in a serious crash, and are also the least likely to be responsible for the social and economic consequences of their behavior. These are the drivers who would benefit most from using their seat belts. They often appear to believe that seat belts can cause more harm than good or that government should not mandate behaviors that affect only them. Non-users come from all segments of society but are frequently male, less than 30 years of age, unmarried, and have little or no post-secondary education. They often drive pickup trucks or sport utility vehicles and live in rural areas.

Graphic with states having primary seat belt laws in red Part-time users are often people who believe that seat belts reduce the severity of injury in motor vehicle crashes but who believe that they are not at risk when driving on short, familiar, low speed trips. Many part-time users think of themselves as full-time users because they wear their belts when they believe they are at risk of crash involvement. The greatest gains in seat belt use have been achieved by increasing the number of situations in which part-time users wear their seat belts. Since members of this group already believe that seat belts are beneficial, they may be converted to full-time users through education, but messages must be presented in new ways so part-time users will pay attention.

Almost three-quarters of Americans say they are full-time users. However, of these, almost 10 percent acknowledge that they did not use their seat belts on at least one occasion during the past week and studies have shown that self-reported seat belt use is 12 to 25 percentage points higher than observed use. In NHTSA surveys, full-time users say their primary reason for wearing seat belts is to avoid injury. In NHTSA observational surveys, the female use rate is 10 percentage points higher than the male use rate. Overall seat belt use rates are highest in the suburbs, followed by cities, then rural areas.

A barrier to increasing seat belt use is that many state and local leaders do not understand the linkage of seat belt use to social burdens. The combined costs to government, health care systems, business, and individuals make this a community issue that cannot be ignored or underestimated. Sometimes the failure to recognize that seat belt use reduces deaths, injuries, and costs resulted in the adoption of secondary belt laws in many states. Secondary laws often are not enforced vigorously.

Child safety seats work. Children, especially those under the age of 5, are vulnerable in collisions because of the size and shape of their bodies. The child safety seat is designed to spread the forces of a crash over more of the body for front-facing toddlers, and cradle the fragile neck and back of the rear-facing infant.

Child safety seats are the most effective occupant protection devices used in motor vehicles today. If used correctly, they are 71 percent effective in reducing fatalities in children under the age of 5 and 69 percent effective in reducing the need for hospitalization. Unfortunately, parents and other care givers too often consider child seats inconvenient, out of their financial reach, or too difficult to install. Others are uninformed or misinformed about correct child safety seat use. About 50 percent of children under age 5 who died in crashes were unrestrained. Of the remaining 50 percent, 26 percent were in an adult seat belt which does not provide effective protection for most children under age 5. Others were in a child restraint system, but had not been restrained properly. In studies conducted by NHTSA to observe child safety seat misuse, nearly 80 percent of the child seats observed were misused in one or more ways. In some cases, the seat was not properly attached to the vehicle; in others, the child was not appropriately buckled into the seat.