Self-reported seatbelt use,United States, 2002–2010: Does prevalence vary by state and type of seatbelt law?

ProblemMotor-vehicle crashes are a leading cause of death in the United States. Seatbelts are highly effective in preventing serious injury and death in the event of a crash. Not all states have primary enforcement of seatbelt laws.MethodsData from the 2002, 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seatbelt use by state and type of state seatbelt law (primary vs. secondary enforcement).Results and discussionSelf-reported seatbelt use among adults in the United States increased steadily between 2002 and 2010, with the national prevalence reaching 87% in 2010. Overall, seatbelt use in 2010 was 9 percentage points higher in the states with primary enforcement laws than in the states with secondary enforcement laws (89% vs. 80%). Impact on industry: Primary enforcement seatbelt laws and enhanced enforcement of seatbelt laws are proven strategies for increasing seatbelt use and reducing traffic fatalities.     

Effect on fatality risk of changing from secondary to primary seat belt enforcement

BACKGROUND: Most seat belt use laws originally passed in the United States contained language restricting enforcement to drivers already stopped for some other reason. States that have since removed this secondary enforcement restriction have reported increased seat belt use. The purpose of the present study was to estimate the effect of these law changes on driver fatality rates. METHOD: Trends in passenger vehicle driver death rates per billion miles traveled were compared for 10 states that changed from secondary to primary seat belt enforcement and 14 states that remained with secondary enforcement. RESULTS: After accounting for possible economic effects and other general time trends, the change from secondary to primary enforcement was found to reduce annual passenger vehicle driver death rates by an estimated 7% (95% confidence limits 3.0-10.9). CONCLUSION: The majority of U.S. states still have secondary enforcement laws. If these remaining secondary laws were amended, an estimated 696 deaths per year could be prevented.     

Impaired driving enforcement practices among state and local law enforcement agencies in the United States

IntroductionAlcohol-impaired driving (DUI) persists as a substantial problem, yet detailed data on DUI enforcement practices are rarely collected. The present study surveyed state and local law enforcement agencies about their DUI enforcement activities.MethodTelephone interviews were conducted with law enforcement liaisons in state highway safety offices. Officers from a nationally representative sample of municipal, county, and state law enforcement agencies were also interviewed about their agency's DUI enforcement activities, including the types of enforcement, frequency of use, and whether activities were publicized. Response rates were 100% among law enforcement liaisons, 86% among county agencies, 93% among municipal agencies, and 98% among state agencies.ResultsBased on the highway safety office survey, 38 states conducted sobriety checkpoints in 2011. Nationally, 58% of law enforcement agencies reported that they conducted or helped conduct sobriety checkpoints during 2011–12, with 14% of all agencies conducting them monthly or more frequently. The vast majority (87%) of agencies reported conducting dedicated DUI patrols. However, dedicated DUI patrols were less likely to be publicized than checkpoints. Less than a quarter of agencies reported using passive alcohol sensors to improve detection of alcohol-impaired drivers.ConclusionsResults show that 38 states conducted sobriety checkpoints in 2011, little changed from a previous survey in 2000. Despite evidence of effectiveness, many agencies do not conduct frequent, publicized DUI enforcement or use passive alcohol sensors.Practical applicationsThe survey suggests that there are several areas in which impaired driving enforcement could be improved: increasing the frequency of special enforcement, such as sobriety checkpoints and/or dedicated patrols; publicizing these efforts to maximize deterrent effects; and using passive alcohol sensors to improve detection of alcohol-impaired drivers.     

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

Methods

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

Results

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

Discussion

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.     

Underage drinking: frequency, consequences, and interventions

OBJECTIVES: To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions. METHODS: We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed. RESULTS: In the United States, 19% of youth ages 12-20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16-18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15-16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based. CONCLUSIONS: Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.     

Medical review process and license disposition of drivers referred by law enforcement in Virginia

IntroductionMedically at-risk drivers come to the attention of licensing authorities through referrals from a variety of sources, including: physicians, family members, court systems, and law enforcement. A recently sponsored project by the National Highway Traffic Safety Administration examined a training intervention for law enforcement to increase their awareness of medical conditions and medications that impair driving and the procedures for reporting these drivers in Virginia.MethodA component of this project included an evaluation of the medical review process and licensing outcomes for 100 drivers randomly selected from a pool of over 1,000 drivers referred from law enforcement officers to the Virginia Department of Motor Vehicles over a 6-month period in 2007 and 2008 prior to any training program intervention.ResultsKey findings from the evaluation of 100 drivers referred for medical review by law enforcement were as follows. Over two-thirds of the drivers came to the attention of the referring officer because they were involved in a crash. The most prevalent indications of a medical condition or functional impairment provided by law enforcement for these referrals were: loss of consciousness, blackout, or seizures (28%); disorientation, confusion, and mental disability (16%); and physical impairments (8%). Eighty-eight percent of the drivers received some type of licensing action (e.g., restriction, suspension, or periodic review). Only 12% of the referred drivers did not require any licensing action.ConclusionsLaw enforcement provides a vital role in the identification and referral of medically impaired drivers to licensing authorities for reexamination. Training programs can inform law enforcement officers of the signs of medical impairment (both on-road behavior, and physical and psychological clues once a driver has been pulled over), and procedures for reporting their observations and concern for safety to licensing authorities.Impact on IndustryReexamination of drivers with functional and medical impairments and any consequent restrictions and/or periodic reporting requirements can improve the safety and mobility of these drivers, and the motoring public as well.     

Self-Reported Seat Belt Use in Four Countries: A Telephone Survey

A telephone survey was conducted in four countries in November 1998 to compare drivers in the United States with those in Australia, Canada, and the United Kingdom regarding their attitudes toward seat belts and belt use laws. More than 90 percent of the 2251 respondents said they thought seat belts are effective, but self-reported belt use was significantly lower in the United States than in the other countries. Respondents in Australia and the United Kingdom had similar views about what they thought were important reasons for using seat belts and had the highest self-reported use. Reasons given for using belts by Canadian and US respondents were quite similar to one another, yet US respondents had significantly lower self-reported use rates, a difference thought to be due to vigorous enforcement of the law in Canada. US drivers were less likely than Australian and UK drivers to say they used belts out of habit, to avoid a ticket, or because it is required by law and more likely to say they used belts for situational reasons. US drivers were least likely to be in favor of belt use laws. Canadian drivers reported the most experience being checked by police for belt use and were most likely to think that nonusers would be caught. US drivers in primary enforcement jurisdictions were more likely than those in secondary jurisdictions to think that drivers not using belts would be caught and more likely to say they always used belts. Results of this survey indicate that seat belt use in the United States could be increased by adoption of primary enforcement laws and highly visible enforcement programs of the type used in Canada, and that seat belt use could be increased in all countries by increasing the penalties for nonuse.     

Implementation of Washington State's zero tolerance law: patterns of arrests, dispositions, and recidivism

OBJECTIVES: Zero tolerance (ZT) laws have been effective in reducing alcohol-related crashes among underage drivers. However, enforcement in some states has not been rigorous, and ZT offenses may not be viewed as serious offenses. On July 1, 1994, the state of Washington implemented a ZT law that allowed police to request a test for alcohol on suspicion of either a ZT or driving-under-the-influence (DUI) offense. The present study examined effects of the ZT law on arrests and case dispositions among underage offenders as a function of blood alcohol concentration (BAC) and post-law patterns of recidivism. METHODS: Times-series analyses examined the effects of the ZT law on trends in arrests of underage drivers between 1991 and 1999. Based on arrest records matched with driver's license records, the effects of the law on dispositions of alcohol-related offenses among underage drivers were examined, and rates of recidivism among underage offenders were examined for the period following the ZT law. RESULTS: There was a substantial increase in arrests of underage drivers beginning immediately after implementation of the ZT law, especially among drivers with low BACs. The types of court or administrative dispositions received by underage offenders changed markedly after the ZT law was implemented. Underage offenders with lower BACs became far more likely to receive alcohol-related convictions and/or license suspensions. However, the percentage of underage offenders with higher BACs receiving DUI convictions declined as some of these offenders received the lesser ZT disposition. After the ZT law, underage offenders with BACs of 0.10 g/dL or higher were more likely to recidivate than those with lower BACs, but appreciable proportions of drivers were re-arrested for another alcohol offense, whatever the BAC and however they were penalized. CONCLUSIONS: Implementation of Washington's law indicates that a ZT law can increase the likelihood that an underage person will be sanctioned for drinking and driving. However, recidivism remains an issue as more than one in four underage drivers arrested with low BACs subsequently were re-arrested.     

Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews

BACKGROUND: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor-vehicle crashes. This paper summarizes the systematic reviews of two interventions to increase safety belt use: primary enforcement safety belt laws and enhanced enforcement of safety belt laws. The reviews were previously published in the American Journal of Preventive Medicine. METHODS: We conducted the systematic reviews using the methodology developed for the Guide to Community Preventive Services. RESULTS: These reviews provide strong evidence that primary laws are more effective than secondary laws in increasing safety belt use and decreasing fatalities and that enhanced enforcement is effective in increasing safety belt use. Increases in belt use are generally highest in states with low baseline rates of belt use. DISCUSSION: Primary safety belt laws and enhanced enforcement programs tend to result in greater increases in usage rates for target groups with lower baseline rates. Concerns regarding public opposition to these interventions may impede their implementation in some jurisdictions. However, surveys indicate that a substantial majority of the public supports implementation of both primary laws and enhanced enforcement programs. CONCLUSION: Based on the strong evidence for effectiveness of primary safety belt laws and enhanced enforcement programs, the Task Force on Community Preventive Services recommended that all states enact primary safety belt laws and that communities implement enhanced enforcement programs.     

Sobriety checkpoint and open container laws in the United States: Associations with reported drinking-driving

Objective: The objective of this study was to assess how 2 types of drinking-driving laws—permitting sobriety checkpoints and prohibiting open containers of alcohol in motor vehicles—are associated with drinking-driving and how enforcement efforts may affect these associations.

Methods: We obtained 2010 data on state-level drinking-driving laws and individual-level self-reported drinking-driving from archival sources (Alcohol Policy Information System, NHTSA, and Behavioral Risk Factor Surveillance System). We measured enforcement of the laws via a 2009 survey of state patrol agencies. We computed multilevel regression models (separate models for each type of law) that first examined how having the state law predicted drinking-driving, controlling for various state- and individual-level covariates; we then added the corresponding enforcement measure as another potential predictor.

Results: We found that states with a sobriety checkpoint law, compared with those without a law, had 18.2% lower drinking-driving; states that conducted sobriety checks at least monthly (vs. not conducting checks) had 40.6% lower drinking-driving (the state law variable was not significant when enforcement was added). We found no significant association between having an open container law and drinking-driving, but states that conducted open container enforcement, regardless of having a law, had 17.6% less drinking-driving.

Conclusion: Our results suggest that having a sobriety checkpoint law and conducting checkpoints as well as enforcement of open containers laws may be effective strategies for addressing drinking-driving.     

Graduated driver licensing restrictions: awareness, compliance, and enforcement in North Carolina

PROBLEM: This study examined the extent to which critical restrictions in North Carolina's graduated driver licensing (GDL) system are known, adhered to, and enforced. METHOD: Teenagers and their parents were recruited as they applied for either an intermediate or full license at 1 of 23 licensing offices. Telephone interviews were conducted with 900 teenagers and their parents. RESULTS: Awareness of North Carolina's night and passenger restrictions was very high among both parents and teenagers. Ten percent of teenagers reported violating the night restriction without their parents' knowledge, and 15% had done so with their parents' approval. Only 4% of parents reported allowing their teenagers to drive with more than one teenage passenger, but 19% of teenagers reported that they were allowed to do this. Violations of the passenger restriction without parental knowledge were more common than violations of the night restriction (22% vs. 10%, respectively). Among teenagers who violated restrictions without their parents' knowledge, most reported doing so only once or a few times. Teenagers expressed little concern about detection, although a majority reported driving more carefully to avoid police notice. Neither parents nor teenagers knew much about police enforcement of GDL restrictions. To obtain a sense of the views of law enforcement officers, informal interviews were conducted with 20 officers from five diverse communities and the state highway patrol. These officers were highly supportive of GDL but unfamiliar with many of the specific provisions. Moreover, enforcement of GDL restrictions did not appear to be a high priority. IMPACT ON INDUSTRY: There is a need to increase the belief among teens (and parents) that police are enforcing GDL restrictions in their community; law enforcement participation in well-publicized traffic safety enforcement efforts would likely produce this result.     

Ninety five percent: an evaluation of law, policy, and programs to promote seat belt use in Washington state

Seat belt use in Washington state was 83% in 2001. In 2002, a series of law, policy, and program initiatives coalesced to produce a dramatic increase in seat belt use. Washington enacted a primary enforcement seat belt, the Chief of the Washington State Patrol made safety belt enforcement one of the core missions of that agency, and Washington participated in the national Memorial Day Click It or Ticket program during May 2002 and continued the program into 2003. Evaluation of these initiatives was accomplished through observation surveys of seat belt use, analysis of seat belt violation data, and analysis of data on traffic deaths of motor vehicle occupants. The major findings were that there was a two- to three-fold increase in enforcement of the seat belt law, belt use rates increased to 93% in 2002 and again to 95% in 2003, and motor-vehicle occupant fatalities decreased by 13%. IMPACT ON PRACTICE AND POLICY: The primary seat belt law and Click It or Ticket program activities were critical factors in increasing belt use in Washington state. Media and enforcement programs targeting seat belt use can be very effective in raising the belt use rate, but a long-term commitment to continuation of these program activities is essential. Other states implementing new primary seat belt laws should consider delivering a Click It or Ticket campaign prior to the effective date of the primary law and continuing these activities during subsequent months and years.     

Drivers' opinions of enforcement and incentive strategies to promote safety belt use

During a nationwide campaign to promote safety belt use among military personnel, a field study was conducted at 12 military bases in the Netherlands. Enforcement and incentive programs were varied among military bases. A written survey was administered to personnel of these bases. The survey contained items concerning reported belt use, motivation to use a safety belt, attitudes toward legislation, public information, enforcement and incentive strategies, and awareness of the campaign. The results showed that enforcement was clearly a better accepted countermeasure than rewarding drivers for the use of safety belts. Respondents from bases exposed to the incentive treatment tend to have relatively more positive opinions of incentives than those exposed to the enforcement treatment. Two independent dimensions were present in the response patterns: one representing opinions of enforcement and the other of incentives/rewards.     

Forfeiture programs in California: why so few?

PROBLEM: It is estimated that at least 75% of suspended or revoked drivers continue to drive illegally. In states like California, there are also a substantial and growing number of people who drive without ever having been licensed. Some states, such as Ohio and California, have enacted vehicle impoundment and forfeiture programs as sanctions to reduce these offenses. Published evaluations indicate that vehicle impoundment laws reduce recidivism and crash rates. However, vehicle forfeiture programs have been less successful, mostly because of low levels of enforcement. METHOD: Police officers and district attorneys from 17 jurisdictions were interviewed by phone or in person to determine current enforcement levels and impediments to more aggressive application of statutory authority. RESULTS AND DISCUSSION: The survey found that most California jurisdictions are enforcing vehicle impoundments for first-time offenders. However, very few jurisdictions were enforcing the vehicle forfeiture law for repeat offenders. Among the reasons for not enforcing the vehicle forfeiture law was a perception that it was too time-consuming and/or not a priority among prosecutors. However, a number of authorities indicated that the simple vehicle impoundment procedure is often functionally equivalent to forfeiture because many drivers fail to retrieve the vehicle at the end of the impoundment period. IMPACT ON INDUSTRY: Vehicle impoundment programs are effective mechanisms in deterring illicit driving, and states should be encouraged to initiate vehicle impoundment laws. States could achieve even greater safety benefits if vehicle forfeiture sanctions were extensively used for repeat offenders. However, based on California's experience, the incremental benefits of vehicle forfeiture (over vehicle impoundment) may not be very great.     

Predictors of rear seat belt use among U.S. adults, 2012

IntroductionSeat belt use reduces the risk of injuries and fatalities among motor vehicle occupants in a crash, but belt use in rear seating positions is consistently lower than front seating positions. Knowledge is limited concerning factors associated with seat belt use among adult rear seat passengers.MethodsData from the 2012 ConsumerStyles survey were used to calculate weighted percentages of self-reported rear seat belt use by demographic characteristics and type of rear seat belt use enforcement. Multivariable regression was used to calculate prevalence ratios for rear seat belt use, adjusting for person-, household- and geographic-level demographic variables as well as for type of seat belt law in place in the state.ResultsRear seat belt use varied by age, race, geographic region, metropolitan status, and type of enforcement. Multivariable regression showed that respondents living in states with primary (Adjusted Prevalence Ratio (APR): 1.23) and secondary (APR: 1.11) rear seat belt use enforcement laws were significantly more likely to report always wearing a seat belt in the rear seat compared with those living in a state with no rear seat belt use enforcement law.Conclusions and practical applicationsSeveral factors were associated with self-reported seat belt use in rear seating positions. Evidence suggests that primary enforcement covering all seating positions is an effective intervention that can be employed to increase seat belt use and in turn prevent motor vehicle injuries to rear-seated occupants.     

Teens and seat belt use: What makes them click?

ProblemMotor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt.MethodsUsing data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with always wearing a seat belt.ResultsOnly 51% of high school students living in 38 states reported always wearing a seat belt when riding as a passenger; prevalence varied from 32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to always wear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased.DiscussionSeat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups.Practical applicationsThis study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.     

Cross-sectional study of road accidents and related law enforcement efficiency for 10 countries: A gap coherence analysis

Objective: Road crashes are considered as the eighth leading causes of death. There is a wide disparity in crash severity and law enforcement efficiency among low-, medium-, and high-income countries. It would be helpful to review the crash severity trends in these countries, identify the vulnerable road users, and understand the law enforcement effectiveness in devising efficient road safety improvement strategies.

Method: The crash severity, fatality rate among various age groups, and law enforcement strategies of 10 countries representing low-income (i.e., India and Morocco), medium-income (i.e. Argentina, South Korea, and Greece), and high-income (i.e., Australia, Canada, France, the UK, and the United States) are studied and compared for a period of 5 years (i.e., 2008 to 2012). The critical parameters affecting road safety are identified and correlated with education, culture, and basic compliance with traffic safety laws. In the process, possible road safety improvement strategies are identified for low-income countries.

Results: The number of registered vehicles shows an increasing trend for low-income countries as do the crash rate and crash severity. Compliance related to seat belt and helmet laws is high in high-income countries. In addition, recent seat belt– and helmet-related safety programs in middle-income countries helped to curb fatalities. Noncompliance with safety laws in low-income countries is attributed to education, culture, and inefficient law enforcement.

Conclusion: Efficient law enforcement and effective safety education taking into account cultural diversity are the key aspects to reduce traffic-related injuries and fatalities in low-income countries like India.     

Requiring belt use as part of a school parking permit program: does it increase students' belt use?

OBJECTIVE: Teenagers have very high motor vehicle crash rates, and their use of seat belts is generally lower than that of adults. A potential school-based strategy to increase teenagers' belt use is a policy making parking privileges contingent on belt use by student drivers and their passengers. This study evaluated the effects of implementing a school belt policy. METHODS: The effects of a belt policy were evaluated during the 2003-2004 school year at high schools in two states: Connecticut, a state with a primary enforcement belt law and high belt use rates, and Mississippi, a state with a secondary enforcement law and generally low use rates. Both schools enforced the policy, and violations resulted in a graduated set of penalties leading to the potential loss of parking privileges. Baseline and post-policy belt use rates were obtained from observation surveys of student drivers and their teenage passengers coming to and from school. Changes in belt use were examined relative to belt use trends at comparison schools without a belt policy. Implementation of the policies also was monitored. RESULTS: In Mississippi, among students arriving at school in the morning, driver belt use increased from 42% before the policy to 67% about 6 months after; passenger belt use increased from 16% to 61%, although sample sizes were small. These increases were significantly larger than expected, based on belt use trends at the comparison school in Mississippi. In Connecticut, where 86% of drivers and 79% of their passengers already were belted prior to the policy, there was no significant change. Both schools publicized and monitored the belt policy, and most enforcement occurred in the morning as students arrived at school. CONCLUSIONS: Based on a small-scale application of a belt policy at two schools in different states, a school belt policy may have stronger effects in states where belt use is low. Strong penalties and enforcement are essential elements of an effective policy. Adequate resources and commitment are needed for schools to implement and monitor the type of strong policy needed to sustain high belt use rates. Replication of this study in additional schools appears warranted.     

The association between enforcement and seat belt use

A statistical association is found between the number of traffic citations for belt law violations versus observed belt use. Also, belt use is higher in primary enforcement states where officers issue such citations for belt law violations alone. In secondary enforcement states officers issue such citations only after stopping motorists for another reason. Most belt laws provide for secondary enforcement. Enforcement data were confined to the highway patrol in each state (local arrest data are rarely compiled statewide). Belt use data were based on observational surveys conducted in each belt law state.     

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

Introduction: Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt. Method: Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none). Results: Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region). Conclusions: Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.