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Motor Vehicle Occupant Protection
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There is a strong positive correlation between the restraint use of an adult driver and that of young children in the vehicle.The Need To Promote Occupant Restraint Use for Children, Youth, and 16- to 20-Year-Olds

The use of occupant restraints must be reinforced at an early age to reduce the disproportionately high rates of death and injury that young adults ages 16 to 20 experience in motor vehicle crashes. But parents cannot bear the burden by themselves. In communities across the country, health professionals, law enforcement officers, educators, elected officials, and every adult, not just parents, must develop the social and legal infrastructures necessary to make safety belt use a lifelong habit. (See Appendix A for statistics on the number of children and youth from birth to age 20 who were killed in 2002 in motor vehicle crashes in each State.)

Passenger vehicle occupant fatality and injury rates have declined slightly during the past 10 years (see Chart 2 below).

Chart 2 Occupant Fatality and Injury Rates, 1993-2002
Per 100 Million VMT, In Passenger Vehicles

Chart 2 Occupant Fatality and Injury Rates, 1993-2002 - Click to view text only versiond

Rates shown in Chart 2 are calculated by dividing the number of killed or injured occupants by the number of passenger vehicle miles traveled in the United States.

However, thousands of children through age 20 continue to be killed and injured in motor vehicle crashes. A total of 7,410 children and youth from birth to age 20 were killed and approximately 730,000 were injured in passenger vehicle crashes in 2002. Despite widespread public education campaigns promoting the use of proper occupant restraints, nearly 50 percent of children 4 to 7 years of age and 55 percent of children 8 to 15 years of age who were killed in passenger vehicle crashes in 2002 were unrestrained. Charts 3 and 4 illustrate the toll that motor vehicle crashes take on our children and youth, particularly among those in the 16- to 20-year-old age group.

Chart 3 Occupant Fatalities in 2002
By Age, In Passenger Vehicles

Chart 3 Occupant Fatalities in 2002 - Click to view text only versiond

Chart 4 Occupants Injured in 2002
By Age, In Passenger Vehicles

Chart 4 Occupants Injured in 2002 - Click to view text only versiond

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Adult Safety Belt Use Makes a Difference

Research conducted by NHTSA about national occupant protection use from 1991 to 2001 confirms that there is a strong positive correlation between the restraint use of an adult driver and that of young children in the vehicle.5, 6 Among fatally injured children from birth to 15 years of age, the research revealed the following:

  • The probability of being unrestrained was nearly four times greater for infants and toddlers when the child was with an unrestrained driver, versus being with a restrained driver.

  • When drivers were unrestrained, 68 percent of children up to 3 years of age were also unrestrained; conversely, when a driver was wearing a safety belt, 28 percent of children up to 3 years of age were unrestrained.

  • Among fatally injured passengers ages 4 to 7, 84 percent were unrestrained when the driver was unrestrained; conversely, when the driver was wearing a safety belt, 36 percent of children ages 4 to 7 were unrestrained.

  • Among fatally injured child passengers 8 to 15 years old, 91 percent were unrestrained when the driver was unrestrained. Conversely, when the driver was wearing a safety belt, 46 percent of children 8 to 15 were unrestrained.

Exhibit 1 illustrates the relationship between driver and child restraint use in crashes in which a child was fatally injured.

Exhibit 1 Driver and Child Restraint Use in Fatal Crashes Involving Children From Birth to 15 Years of Age

  Percentage Unrestrained by Age Group
<0-3 4-7 8-15
Driver Unrestrained 68% 84% 91%
Driver Restrained 28% 36% 46%

This strong acknowledgment of the effect of parental influence on safety belt use speaks to the necessity of maintaining ongoing programs and outreach for children, youth, and parents to encourage the use of occupant restraints. NHTSA’s 2003 Motor Vehicle Occupant Safety Survey (MVOSS) further illustrates this need. In the 2003 MVOSS, researchers asked respondents their level of agreement with the statement, “I have a habit of wearing a seat belt because my parents insisted I wear them when I was a child.” Among persons 16 to 24 years of age, 69 percent either strongly agreed or somewhat agreed with this statement.

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Occupant Restraints for All Age Groups Save Lives

The probability of being unrestrained was nearly four times greater for infants and toddlers when the child was with an unrestrained driver, versus being with a restrained driver.Most of the people who die in motor vehicle crashes are vehicle occupants (less than one-fourth of fatalities caused by crashes involve pedestrians, bicyclists, and motorcyclists). Safety belts and child safety seats have been designed to protect drivers and passengers from death and injury during a crash. But these restraints cannot save lives if they are not used. See Appendix B—Passenger Vehicle Occupants Killed in Motor Vehicle Crashes, by State and Restraint Use, 2002.

  • In 2002, among passenger vehicle occupants over 4 years old, safety belts saved an estimated 14,164 lives. Child restraints saved the lives of 376 children.

  • From 1975 to 2002, safety belts prevented an estimated 164,753 fatalities.

  • According to NHTSA’s The Economic Impact of Motor Vehicle Crashes 2000, the use of safety belts saved society $585 billion in medical care, lost productivity, and other injury-related economic costs (since 1975).

  • Child safety seats are 71 percent effective in reducing fatalities among infants (younger than 1 year old) and 54 percent effective for toddlers (1 to 4 years old) in passenger cars.7 For infants and toddlers in light trucks, the effectiveness in reducing fatalities is 58 percent and 59 percent, respectively.

  • Booster seat use substantially reduces the risk of injury for children 4 to 8 years old; however, most children in this age group are currently restrained by safety belts designed for adults. A recent study by Children's Hospital of Philadelphia found that the use of belt-positioning booster seats lowers the risk of injury to children in crashes by 59 percent, compared with the use of vehicle safety belts.8

  • When lap/shoulder safety belts are used properly, they reduce the risk of fatal injury to front-seat occupants riding in passenger vehicles by 45 percent and the risk of moderate-to-critical injury by 50 percent. For light-truck front-seat occupants, safety belts reduce the risk of fatal injury by 60 percent and the risk of moderate-to-critical injury by 65 percent.

  • Ejection from the vehicle is one of the most harmful events that can happen to a person in a crash. In passenger vehicle crashes in which someone died in 2002, 73 percent of occupants who were completely ejected were killed. Safety belts are effective in preventing total ejections. In 2002, in crashes in which someone was killed, only 1 percent of the occupants reported to have been using restraints were totally ejected, compared with 30 percent of unrestrained occupants (in passenger vehicles).

  • Nearly 30 percent of 16- to 20-year-old occupants were killed when they were ejected during a crash, compared with 22 percent of the general population. This increased percentage for 16- to 20-year-old occupants further illustrates the need to promote safety belt use in this age group. See Chart 5.

Chart 5 Occupant Fatalities in 2002
By Age and Ejection Status, In Passenger Vehicles

Chart 5 Occupant Fatalities in 2002 - Click to view text only versiond

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Closing the Gaps in Occupant Restraint Laws Can Save Young Lives

All States (except New Hampshire) have adult safety belt laws and all States have child restraint laws requiring the driver to restrain children of specified ages in approved child restraint devices or safety belts. These laws, however, do not cover all occupants in all seating positions.

In the majority of States, laws concerning the use of child restraint devices cover children only up to age 4, and laws concerning the use of adult safety belts cover only front-seat occupants, leaving large groups of children uncovered by any occupant protection law. For example, in some States, a 10-year-old can ride legally in the back seat without being secured because, at this age and in this seating position, the child is not covered by either the child restraint law or the safety belt law. Appendix C contains information on State child restraint laws.

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Primary Enforcement Laws Help Protect Children of All Ages

Although child restraint laws are primary laws, which allow a law enforcement officer to stop a vehicle and issue a citation for an unrestrained driver or passenger, the safety belt laws in the majority of States are secondary enforcement laws. This means that a police officer cannot stop a driver for the sole purpose of enforcing the use of occupant restraints. Rather, a police officer can write a ticket for not using occupant restraints only if he or she stops the vehicle for another driving infraction. See Exhibit 2 for a map of States with primary and secondary laws.

Exhibit 2 States With Primary and Secondary Safety Belt Laws

Exhibit 2 States With Primary and Secondary Safety Belt Laws - Click to view text only versiond

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Booster Seat Use Saves Lives and Reduces the Risk of Injury

In 2002, only 33 percent of 4- to 7-year-old passenger vehicle occupants who were killed in crashes were restrained. Persuading parents to place their children in any kind of occupant restraint would undoubtedly reduce the number of children killed or seriously injured. In addition, children who have outgrown child safety seats, but are too small to ride safely in adult belts, should be properly restrained in booster seats until they are at least 8 years old, unless they are 4 feet 9 inches tall. If placed in adult safety belts prematurely, children can suffer serious internal injuries, slip out of the safety belt, or be ejected from the vehicle during a crash.

Booster seat use substantially reduces the risk of injury for children 4 to 8 years old; however, most children in this age group are currently restrained by safety belts designed for adults. In the 2002 study by Children's Hospital of Philadelphia (CHOP), only 16 percent of 4-year-olds, 13 percent of 5-year-olds, and 4 percent of 6- and 7-year-olds were using booster seats.

The CHOP study found that the use of belt-positioning booster seats lowers the risk of injury to children in crashes by 59 percent compared with the use of vehicle safety belts. The study also found that none of the 4- to 7-year-olds who were in belt-positioning booster seats had any injuries to the abdomen, neck, spine, or back. Yet, such injuries did occur in children who used safety belts alone.

Children who are 4 feet 9 inches tall before their eighth birthday may be ready for adult belts. They can start using a safety belt when they can place their back firmly against the vehicle seat back cushion with their knees bent over the vehicle seat cushion.

When this booklet was published, 26 States and the District of Columbia had enacted provisions in their child restraint laws mandating booster seat or appropriate restraint use for older children passengers. They are AR, CA, CO, DE, DC, GA, IA, IL, IN, LA, ME, MD, MT, NE, NH, NJ, NV, OK, OR, PA, RI, SC, TN, VA, VT, WA, and WY. See Exhibit 2 for a map of States that mandate booster seat or appropriate restraint use by older passengers. A number of other States are considering legislation that would require similar upgrades for booster-age child passengers.


5NHTSA Research Note: The Relationship Between Driver and Child Passenger Restraint Use Among Fatally Injured Child Passengers Ages 0-15, NCSA, March 2003.

6NHTSA Research Note: The Relationship Between Driver and Child Passenger Restraint Use Among Infants and Toddlers, NCSA, March 2003.

7Passenger cars are one of two vehicle types included in the passenger vehicle category. Passenger cars and light trucks combined make up passenger vehicles.

8Winston FK, Journal of the American Medical Association. Partners for Child Passenger Safety (PCPS), The Children’s Hospital of Philadelphia, June 4, 2003.

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Table of Contents

Introduction

The Need To Promote Occupant Restraint Use for Children, Youth, and 16- to 20-Year-Olds
Adult Safety Belt Use Makes a Difference
Exhibit 1: Driver and Child Restraint Use in Fatal Crashes Involving Children From Birth to 15 Years of Age
Occupant Restraints for All Age Groups Save Lives
Closing the Gaps in Occupant Restraint Laws Can Save Young Lives
Primary Enforcement Laws Help Protect Children of All Ages
Exhibit 2: States With Primary and Secondary Safety Belt Laws
Booster Seat Use Saves Lives and Reduces the Risk of Injury

Facts About Children and Youth

Facts About Young Adults Ages 16 to 20

Appendices

For Additional Information

Charts