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Effectiveness: 4 Star Cost: Varies
Use: Unknown
Time: Varies

Seat belt use rates have increased substantially over the years. Today, most drivers and passengers wear their seat belts. Nationally, daytime seat belt use was 90.4% in 2021, and 23 States, the District of Columbia, and 3 U.S. Territories reported observed seat belt use rates of 90% or higher (NCSA, 2022a). High seat belt use was achieved through a combination of strong occupant restraint laws, HVE programs (e.g., CIOT), and programs targeting those less likely to wear their seat belts.

However, research shows that seat belt use is not universally high. NHTSA’s NOPUS provides NHTSA’s official measure of nationwide seat belt use overall and reports seat belt use by other factors such as age, race, and gender. The 2021 NOPUS found lower seat belt use rates among males and occupants 16 to 24, groups that have consistently been identified as having lower restraint use (Boyle, 2022).

NHTSA’s 2016 National Motor Vehicle Occupant Safety Survey (MVOSS) found similar patterns with young drivers, rural drivers, and pickup truck drivers, all reporting lower seat belt use (Spado et al., 2019).

An in-depth examination conducted in Louisiana of driver factors underlying self-reported seat belt use found that, in addition to demographic factors, driver motivations and habits were strong correlates of belt use (Schneider et al., 2017). Internal (want to) and external (have to) motivations to wear a seat belt along with having a well-formed habit of buckling up early in a trip were associated with 100% belt use. Motivated drivers who were nevertheless inconsistent seat belt users typically lacked well-formed seat belt use habits and routines.

Most non-seat belt users report wearing seat belts at least some of the time. In NHTSA’s 2016 national MVOSS, only 0.2% of drivers said they never used their seat belts and another 1% said they rarely used seat belts (Spado et al., 2019). Passenger seat belt use also appears to be strongly associated with driver belt use (Han, 2017). The most frequent reasons given by drivers for not wearing a belt were that they: were only driving a short distance (68%), forgot (36%), found the belt uncomfortable (33%), were driving on low-speed roadways (22%), or were in a rush (21%) (Spado et al., 2019). (Drivers were able to give more than one reason for not wearing a belt so the percentages do not add up to 100%.)

Riding as a backseat passenger is another factor that affects seat belt use. In one survey, 72% said they always use their belt in the back seat, compared to 91% who said they always use their belt when seated in front (Jermakian & Weast, 2018). An analysis of data from the 2016 MVOSS found that 63% of rear-seat passengers reported being full-time users, 26% reported being part-time users, and 11% reported being non-users (Spado et al., 2019). The factors that had the strongest association with rear belt use included support for rear-belt laws, using a belt in the front seat, and belief that their State has a rear-belt law.


Communications and outreach campaigns directed at low-belt-use groups are common, but no summary is available.


Communications and outreach campaigns directed at low-belt-use groups have been demonstrated to be effective for targeted programs that support, and are supported by, enforcement.  

Trauma Nurses Talk Tough, originally developed in Oregon in 1988, is a seat belt diversion program implemented by trauma nurses in a hospital setting that targets drivers who have been ticketed for not wearing a seat belt. The program was implemented in Robeson County, North Carolina, a diverse county whose seat belt rates were consistently lower than the rest of the State. Those who went through the program were more likely to have a positive outlook on the use of seat belts. Following the program, observed seat belt use increased significantly in the county at eight survey locations (from 81% to 86%) and two additional sites (from 69% to 78%) (Thomas et al., 2014).

A variety of low-belt-use groups have been targeted by countermeasure efforts. These are discussed in separate sections below.

Young Males

High-visibility enforcement programs generally have been effective in increasing seat belt use. Their publicity messages and placement can be directed at specific lower-belt-use groups. The 2013 CIOT campaign targeted 18- to 34-year old males and found they showed greater increases in awareness of seat belt enforcement activity and seat belt checkpoints than the general population (14% versus10% for seat belt enforcement, and 10% versus 7% for seat belt checkpoints, respectively) (Nichols, Chaffe, Solomon, & Tison, 2016).The target group did not show significant increases in awareness of the CIOT slogan (5%), messages to buckle up (6%), or perceived risk of a ticket (6%), while the general population showed significant increases in these indices (6%, 8%, and 5%, respectively). The small sample size for the target group may have contributed to not finding significant increases among this group for some indices.

Pickup Truck Drivers

Between 2004 and 2007 several States conducted Buckle Up in Your Truck paid advertising campaigns targeting pickup truck occupants. Messaging focused on the dangers of riding unrestrained in a truck and increased seat belt enforcement efforts. Two programs were conducted immediately preceding a CIOT campaign. Increases in observed seat belt use ranging from 2% to 14% were seen following the program (Nichols et al., 2009; Solomon, Chaffe, & Cosgrove, 2007).

Rural Drivers

NHTSA’s Region 5 implemented a Rural Demonstration Program (RDP) prior to the May 2005 CIOT mobilization. The goal of the RDP was to evaluate strategies for increasing seat belt usage in rural areas. Paid media was used to notify rural residents that seat belt laws were being enforced. Active enforcement was included during the initial phase in three of the six Region 5 States (Illinois, Indiana, Ohio), but only the paid media component was implemented in the remaining 3 States (Minnesota, Michigan, Wisconsin). During the Demonstration Project phase, States that had intensified enforcement had significant increases in usage in their targeted rural areas (Nichols et al., 2007). All six Region 5 States intensified enforcement during the CIOT mobilization, but States that had intensified enforcement during the Demonstration Project showed substantially greater overall statewide gains during the CIOT phase than did the States that had not intensified enforcement during the RDP.

More recent evaluations of rural programs following the HVE model have yielded mixed results. An evaluation of Rural Initiatives conducted in Missouri and Kansas showed positive outcomes (Thomas & Blomberg, 2016). These States ran multi-wave HVE campaigns focused on rural counties from Spring 2009 to Spring 2010. The evaluations indicated that seat belt use in the rural Missouri counties increased from 66.4% to 69.2%, while seat belt use in the rural Kansas counties increased from 61% to 70%. However, not all counties covered by the program experienced significant increases. Driver awareness of the targeted seat belt safety messages also increased following local media campaigns. A multi-State RDP that covered rural parts of Florida, Georgia, and Tennessee was less successful (Nichols, Chaffe, Solomon, & Tison, 2016). It included an HVE model paired with paid and earned media in four waves from November 2008 to May 2010, and it overlapped with annual CIOT campaigns. The RPD increased driver awareness of rural seat belt messages and the perceived risk of getting a ticket for driving unrestrained. Seat belt use increased in all 3 States but was only significantly greater than at control locations in Georgia. Concurrent, statewide CIOT may have muted the differences relative to control, and the greater effectiveness in Georgia may have been partially attributable to the broader awareness among drivers of seat belt check points (Nichols, Chaffe, Solomon, & Tison, 2016).

Tribal Communities

A multifaceted program was implemented on the Pine Ridge Indian Reservation (PRIR) in South Dakota to address the reservation’s high proportion of fatal motor vehicle crashes and chronically low seat belt use rates (Amiotte et al., 2016). Although the PRIR was covered by an existing primary seat belt law adopted by the Oglala Sioux Tribe, the law was rarely enforced by PRIR tribal courts and law enforcement officers stopped issuing seat belts tickets. This contributed to seat belt use rates that were as low as 10% across the PRIR. The program implemented by the PRIR included data collection on belt use, increased policing resources and enforcement, funding for a traffic court to enforce seat belt citations, funding for injury prevention specialists to address child restraint usage, and outreach activities involving local media and school programs. These efforts resulted in a 34% increase in observed seat belt use on the PRIR from 2007 to 2013.

Another study used a similar multifaceted approach for increasing seat belt use in eight tribal communities. Communities combined enforcement, education, awareness raising activities, and media campaigns. Observational data was collected in each community for 4 years and all eight communities saw increases in observed seat belt use. Additionally, motor vehicle crashes decreased for seven of eight communities and injuries decreased for five. The study identified four considerations important for tailoring evidence-based strategies in tribal communities: (1) time enforcement campaigns to the community (not necessarily aligned with national campaigns); (2) use language and imagery that reflect the community; (3) involve local people in media and education events; and (4) use project coordinators who are American Indian/Alaska Natives (Crump et al., 2019).

Many of these programs were conducted a decade or more ago when seat belt use rates were lower overall. Additionally, communication methods have changed dramatically over the past 2 decades. Common advertising or communication strategies today were not common when many of these programs took place. While these programs were important for raising seat belt use rates to the numbers we see today, it is unlikely that they would have a similar effect if done today.


Costs vary depending on program quality and delivery. Paid advertising can be expensive.

Time to implement:

A good media campaign will require 4 to 6 months to plan and implement.