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.     

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.     

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.     

Impact of primary safety belt laws on alcohol-related front-seat occupant fatalities: five case studies

OBJECTIVE: Impaired drivers and other high-risk road users are less likely to use their safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety belt laws have been shown to increase wearing rates for daytime non-crash-involved drivers and their front-seat passengers, little evidence is available on the effect these laws have on belt usage by crash-involved drinking drivers and their passengers. METHODS: This study evaluated the influence of primary safety belt law upgrades from secondary laws on front-seat occupants of passenger cars driven by drinking drivers in fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The outcome measures used to evaluate these law upgrades were (1) the change in safety belt usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger cars driven by drinking drivers. RESULTS: Four of the five states demonstrated increases in safety belt use by front-seat occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to primary safety belt laws. Three states (California, Michigan, and Washington) experienced significant reductions in the number of front-seat occupant fatalities in vehicles driven by drinking drivers. CONCLUSIONS: The adoption of primary law upgrades was associated with significant increases in safety belt use (four of five states) and significant reductions in fatalities among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles driven by drinking drivers) in three of the five states studied.     

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.     

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.     

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.     

Characteristics of drivers not using seat belts in a high belt use state

A study was undertaken in North Carolina to determine the characteristics of the minority of drivers who were not using seat belts following an extensive publicity/enforcement campaign, which had increased statewide use to 80%. Vehicles and drivers whose seat belt use was observed at sites across North Carolina were matched against Division of Motor Vehicles registration and driver history files for vehicle owners. The study file consisted of those observed drivers who matched the owners with respect to sex, race, and approximate age. The results of this investigation indicate that nonuse of seat belts was associated with males; younger age (<35); older vehicles (pre-1985); vehicles other than cars, especially pickups; and poor driving records. Telephone survey information indicated that nonusers were less likely to have health care coverage, more likely to acknowledge having consumed large amounts of alcohol in the past year, and more likely to have an arrest record. When asked about enforcement of the belt use law, many nonusers said that they would not respond to higher fines but they would respond to driver license points. To change the belt use behavior of this hard-core nonuser population, it well may be necessary as was done in Canada to combine publicity/enforcement campaigns with driver license points as a penalty for nonuse.     

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.     

Automatic safety belt use in Michigan: A two-year follow-up

The use of automatic safety belts among motorists throughout the state of Michigan was examined as part of a broader direct observation survey to measure compliance with the state's mandatory belt use law. Use of the most common types of automatic belt systems were measured: the nonmotorized detachable three-point lap and shoulder belt system, and the two-belt system with either a motorized shoulder belt and manual lap belt or a nonmotorized shoulder belt and manual lap belt. Belt use rates in vehicles with and without air bags were also compared. A total of 1,367 drivers and front-right passengers were observed with automatic belt systems between June 1 and July 11, 1992. Use of nonmotorized detachable three-point lap and shoulder belt systems was 72.3%. Lap belt use of motorized shoulder and manual lap belt systems was 70.5%. Lap belt use of nonmotorized shoulder and manual lap belt systems was 60.2%. Of all motorized and nonmotorized shoulder belt and manual lap belt systems observed, 94.5% had the shoulder belts connected.     

State-level seat belt use in the United States, 2011–2016: Comparison of self-reported with observed use and use by fatally injured occupants

Introduction: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. Objective: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011–2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. Results: During 2011–2016, national self-reported seat belt use ranged from 86–88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = −0.77). Conclusion: National self-reported seat belt use remained essentially stable during 2011–2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.     

Committing driving violations: An observational study comparing city, town and village

Introduction

This article compares observed driving behavior in a city, a town, and a village.

Method

Unobtrusive observations were made at intersections in each residential type. Five violation types were observed: (a) not wearing a seat belt (seat belt violation); (b) not using a safety seat for a child (safety seat violation for children); (c) not using a speaker while speaking on the phone (on-phone violation); (d) failing to comply with a ‘give way’ sign (‘give way’ sign violation); and (e) stopping in an undesignated area (undesignated stop violation). It was expected that in accordance with the anonymity hypothesis that the bigger residential areas' rate of traffic violations would be higher. The effects of the residential type, drivers' gender, and age were assessed using the multiple regression model. The stepwise method of evaluation was employed. The model converged on step 3 (Adjusted R square = 0.039). Residential type and gender contributed significantly to the model. Results: Consistent with prior research, male drivers committed more violations than female drivers. Chi-square analyses were used to test the distribution of violations by the settlement types. Overall, more drivers committed violations in the two small residential areas than in the city, with 30% of city drivers, 43% of town drivers, and 51% of village drivers committing at least one violation (χ2 (2) = 37.65, p < 0.001). Moreover, in the town and the village, a combination of one or more violations was committed more often than in the city (χ2 (1) = 34.645, p < 0.001). Accordingly, more drivers committed violations in the two small settlements (48.4%) than in the city (30.6%). Possible explanations for the observed results were provided in the Discussion section.

Impact on Industry

The conclusions of this paper are that drivers in small villages tend to disobey traffic laws. Therefore, efforts have to be made in companies to take this issue in consideration while running fleets in companies located in small places far from the center.     

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.     

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.     

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.     

Recent estimates of safety belt use

The National Occupant Protection Use Survey (NOPUS) has shown that safety belt use in the United States has increased steadily over the past decade. Increases have been consistent since 2000, when the National Highway Traffic Safety Administration, in partnership with the Air Bag & Seat Belt Safety Campaign, increased its encouragement of states to implement highly visible enforcement programs. In 2003, significant increases were found in the South; in secondary law states; in all types of vehicles; during both weekdays and weekends; and during both rush-hours and non-rush-hours. In spite of these increases, use remains significantly lower in secondary law states; pickup trucks; the Northeast; and the Midwest. The differences between primary and secondary law states and between pickups and other passenger vehicles have been consistent from year to year. A controlled intersection study, which is part of the NOPUS, has shown that safety belt use has increased for both sexes, for nearly all age groups, and for all races for which data are available. Finally, the NOPUS suggests that children are 3-4 times as likely to be unrestrained when riding with an unbuckled driver as when driving with a buckled driver.     

Predictive models of safety belt use: a regression analysis of MVOSS data

A substantial portion of the U.S. population fails to regularly use their safety belts. The explanations for the differential belt use have addressed, for example, socioeconomics, state law, attitudes, and perceived likelihood of being ticketed. The current analyses create predictive models of safety belt use. Using NHTSA's Motor Vehicle Occupant Safety Surveys (Years 1998 and 2000; N = 9577), variables related to belt use were entered into backward stepwise logistic regressions to produce two predictive models (Demographic and Attitudinal) of safety belt use (Always versus Not always). The results indicated that belt use is a complicated issue as there were several interactions between variables. The Demographic predictive model contained main effects for, law types, socioeconomics, population density, a gender-law type interaction, and a three-way interaction between age, marital status, and vehicle type. The Attitudinal model included perceived effectiveness of the belt, fatalistic attitudes, and an interaction between perceived effectiveness of the belt and perceived risk of being ticketed. These models survived a multinomial logistic regression when belt use was parsed into three categories (Always, Part-time, and Infrequent). In addition to variables that affect belt use, the results suggested that the structure of "belt use" as a psychological/behavioral construct is more complicated than once thought. Specifically, a dichotomous breakdown of belt use (Always and Not always) oversimplifies the construct because the predictor factors sometimes affect "part-time" belt users differently than "infrequent" belt users (compared to "full-time" users). Many of the factors included in the models have been previously shown to impact belt use, but the interaction effects--indicating a more complicated relationship between these variables than previously suggested--may contribute to a better understanding of safety belt use.     

Attitudes toward a primary seat belt law among adults in a rural state with a secondary seat belt law

Problem

Enforced primary seatbelt laws can reduce morbidity and mortality associated with motor-vehicle crashes. Constituent support is an important factor associated with legislator voting behavior toward injury prevention laws. Little is known about attitudes toward a primary seat belt law among adults in rural states without a primary seat belt law.

Methods

Data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, a telephone survey of a representative sample of adults in Montana, were used to assess attitudes toward a primary seat belt law.

Results

Sixty-one percent of respondents supported a primary seat belt law. Using multiple logistic regression analyses, women (AOR 1.87; 95% CI 1.49-2.36), persons aged 65 years and older (1.45; 1.06-1.96), American Indians (2.71; 1.55-4.75), those with health insurance (1.51; 1.07-2.14), and those who reported always wearing their seat belt (4.05; 3.14-5.21) were more likely to support a primary seat belt law than respondents without these characteristics.

Conclusions

The majority of adults in a rural state support a primary seat belt law.     

Effectiveness and driver acceptance of the Honda belt reminder system

OBJECTIVE: Prior research suggests that vehicle-based seat belt reminder systems can produce moderate increases in belt use rates. However, these findings were based on a limited set of Ford vehicles in one geographic location. As more vehicles with reminder systems enter the market, it is important to determine their effectiveness as well as acceptance by consumers. The present study investigated the effectiveness of Honda's belt reminder system. METHODS: Driver belt use was observed unobtrusively as drivers brought their Honda vehicles to dealerships for service. Drivers also were asked to complete a mail-in survey designed to elicit their experience with the system. RESULTS: Belt use was significantly higher among drivers of vehicles with belt reminders compared with drivers of vehicles without reminders (90 vs. 84 percent). Use rates in vehicles with reminders were higher among both male and female drivers and in all vehicle types observed. Drivers of the Honda vehicles with belt reminders viewed the system very favorably, and nearly 90 percent said they would want one in their next vehicle. The reminder was perceived to be most effective by part-time belt users; 81 percent of part-time users said they now use belts more often, compared with 32 percent of respondents who said they always use belts and 18 percent who use belts occasionally. CONCLUSION: Belt reminders in Honda as well as Ford vehicles are increasing. Although the increase is moderate (5.6 percentage points), on a national level it could have prevented at least 736 driver deaths in 2004.