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Seat Belt Laws

Seat belt laws and enhanced enforcement increase seat belt use, thereby reducing crash-related injuries. Seat belt use reduces serious crash-related injuries and deaths by about half, and seat belt laws and enforcement strategies have been proven to increase seat belt use. Primary enforcement seat belt laws allow law enforcement officers to stop vehicles if a driver or passenger is not wearing a seat belt. Secondary enforcement seat belt laws require law enforcement officers to have some other reason for stopping a vehicle before citing a driver or passenger for not using a seat belt. The most comprehensive seat belt policy is a primary enforcement seat belt law that covers all occupants, regardless of where they are sitting in the vehicle.

CDC reports that, as of August 1, 2013,

  • 17 states and the District of Columbia had a primary enforcement seat belt law covering all seating positions
  • 16 states had a primary enforcement seat belt law covering only the front seats
  • 17 states had a secondary enforcement seat belt law or no law

Enhanced seat belt enforcement campaigns include increased publicity and other strategies, such as increased resources or staffing, coupled with existing seat belt enforcement efforts. The publicity components of enhanced enforcement campaigns aim to increase public awareness of heightened enforcement and the importance of wearing a seat belt. Enhanced enforcement campaigns include supplemental patrols, an increased number of officers on patrol, or targeted patrols, which aim to increase citations during regularly scheduled patrols.

Related Transportation and Heath Tool Indicators

How can this strategy result in health benefits?

  • Improve safety
  • Reduce motor vehicle-related injuries and fatalities

How has this worked in practice?

Demonstration of the "Trauma Nurses Talk Tough" Seat Belt Diversion and Increased Enforcement Program in North Carolina

North Carolina has a primary seat belt law and relatively high fines and fees. The North Carolina Governor’s Highway Safety Program implemented and evaluated a Trauma Nurses Talk Tough (TNTT) program in Robeson County to address persistently lower than average seat belt usage rates of around 80% in the county. The study period ran from April 1, 2010 to June 30, 2011.

The TNTT program was originally developed in a hospital in Portland, Oregon. It focuses on educating people on how to avoid and reduce health risks. Emergency room or trauma nurses in Robeson County taught the course at the main hospital in the area. The nurse who developed the Oregon TNTT program led the effort in Robeson County, using many of the same materials from the original program. The course covers the proper use of seat belts and child safety seats, the costs of non-use of seat belts, the effects of alcohol and speed, and the physics of crashes. Nurses share real-life stories of people who have been injured from behaviors such as not wearing seat belts, and highly graphic visuals are used.

Increased enforcement efforts were coordinated with program implementation. During the 15-month study period, local, county, and state law enforcement officials issued 10,358 citations for seat belt and child safety seat violations, an increase of 29% from the same period 2 years prior. Half of those people who received citations and were eligible to attend the course did so, exceeding program expectations. Participants received a certificate of course completion and could use this to have a seat belt citation dismissed by the county. A statistically significant increase in observed seat belt use from baseline was noted at 10 observation sites in the county. The results of this study support the combination of high-visibility enforcement and a diversion classroom-based brief intervention as a means of increasing seat belt use in a predominately rural, low seat belt-use area.

Where can I learn more?

CDC’s 2013 Prevention Status Report for Motor Vehicle Injuries provides statistics about seat belt laws and data and research supportive of seat belt laws and seat belt use.

The Guide to Community Preventive Services (the Community Guide): What Works to Promote Health addresses laws mandating the use of seat belts, enhanced enforcement programs, and studies of seatbelt effectiveness on the site Motor Vehicle-Related Injury Prevention: Use of Safety Belts.

NHTSA sponsors the Click it or Ticket and Buckle Up campaigns and provides information and data to increase the use of seat belts and other occupant protection.

County Health Rankings and Road Maps provides information on methods for making communities healthier, including a description of the connection between seat belt laws, enhanced enforcement, and health.

Evidence base

Beck LF, West BA. Vital signs: nonfatal, motor vehicle–occupant injuries (2009) and seat belt use (2008) among adults—United States. Morbidity and Mortality Weekly Report 2011;59:1681-6.

Centers for Disease Control and Prevention (CDC). Motor Vehicle Injuries PSR|2013. State, Tribal, Local, and Territorial Public Health Professionals Gateway; 2014.

Community Preventative Services Task Force. The Guide to Community Preventive Services (The Community Guide): Motor Vehicle-Related Injury Prevention.

Dinh-Zarr TB, Sleet DA, Shults RA, Zaza S, Elder RW, Nichols JL, Thompson RS, Sosin DM, Task Force on Community Preventive Services. Reviews of evidence regarding interventions to increase the use of safety belts. American Journal of Preventive Medicine 2001;21(4S):48-65.

Glassbrenner D, Starnes M. Lives saved calculations for seat belts and frontal air bags. Washington, DC: NHTSA, U.S. DOT. DOT HS 811 206; 2009.

Kahane C. Fatality reduction by safety belts for front-seat occupants of cars and light trucks. Washington, DC: NHTSA, U.S. DOT. DOT HS 809 199; 2000.

Miller TR, Levy DT. Cost-outcome analysis in injury prevention and control: Eighty-four recent estimates for the United States. Medical Care 2000;38(6):562-82.

Shults RA, Elder RW, Sleet DA, Thompson RS, Nichols JL. Primary enforcement seat belt laws are effective even in the face of rising belt use rates. Accident Analysis and Prevention 2004;36(3):491-3.

Shults RA, Nichols JL, Dinh-Zarr TB, Sleet DA, Elder RW. 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. Journal of Safety Research 2004;35(2):189-96.

Thomas FD, Blomberg RD, Fairchild J, Cosgrove L. Demonstration of the Trauma Nurses Talk Tough seat belt diversion program in North Carolina. Washington, DC: NHTSA, U.S. DOT. DOT HS 811 873; 2014.

University of Wisconsin Population Health Institute. Enhanced seat belt enforcement programs. County Health Rankings and Roadmaps; 2014.