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Seat Belt Use

Indicator Description

Seat belt use measures the percentage of drivers and front-seat passengers that wear seat belts. Data come from the National Highway Traffic Safety Administration (NHTSA) Seat Belt Use in 2012—Use Rates in the States and Territories report.

Related Strategies

Transportation and Health Connection

The use of lap and shoulder belts has been proven to lower the risk of fatal injury to motor vehicle occupants and nearly all states have enacted some form of seat belt law although the strength of the law varies. Seat belt laws are divided into two categories: primary and secondary. Primary seat belt laws allow law enforcement officials to ticket a driver or passenger for not wearing a seat belt, without any other traffic offense present, while secondary seat belt laws allow law enforcement officials to issue a ticket for not wearing a seat belt only when there is another traffic offense cited. With the proven strength of the risk reduction, seat belt use is a strong indicator associated with transportation.

Motor vehicle crashes are a leading cause of death in the United States for the first three decades of American lives (CDC 2012), and the use of seat belts has been shown to be the most effective method for reducing injuries and deaths as a result of crashes (Emergency Nurses Association, 2010). The public health implications of not wearing a seat belt are severe. In 2012, there were 21,667 occupants of passenger vehicles (passenger cars, pickup trucks, vans, and SUVs) who died in motor vehicle traffic crashes; of the 21,667 total occupants killed, only 9,679 were using seat belts (seat belt use was not known for 1,653 occupants) (U.S. DOT National Highway Traffic Safety Administration, 2012). Looking only at occupants where the seat belt status was known, 52% were not using seat belts at the time of the crash (U.S. DOT National Highway Traffic Safety Administration, 2012).

About the Data

NHTSA uses data from the National Occupant Protection User Survey (NOPUS) to estimate seat belt use nationally. This survey is conducted annually by sending trained observers to sampled roadways to observe the behaviors of passengers in motor vehicles (U.S. DOT National Highway Traffic Safety Administration, 2011). The results are based on observational data and involve a complex probability sample. Consequently, the results differ from self-reported state data. Only daytime driving (7 a.m. to 6 p.m.) is reflected in the NOPUS data, and the sample size (1,700 sites) is relatively small (U.S. DOT National Highway Traffic Safety Administration, 2011). However, compared with self-reported data collected by states, the data collected by observation give a stronger indication of actual seat belt use. The NOPUS also involves vigorous and complex estimation procedures and the data have been shown to be statistically significant.

Moving Forward

Research has shown the safety and effectiveness of seat belt use in preventing motor vehicle injuries and fatalities. A study of enforcement related to road traffic injury laws found that seat belt use appears to be the most enforced form of legislation, while speeding laws are the least enforced (Hijar et al., 2010). Seat belt use is higher in states where drivers can be stopped solely for not wearing a restraint (primary enforcement) than in states with secondary enforcement laws (U.S. DOT National Highway Traffic Safety Administration, 2011). In other studies examining young driver behavior, teenaged drivers were 12% less likely to wear seat belts as drivers in states with a secondary seat belt enforcement laws than in states with primary enforcement laws (Garcia-Espana, Winston, Durbin, 2012).

The body of evidence makes for a strong public health and transportation connection and points to specific policies and actions that decision makers can take to improve health outcomes. Public health officials and other stakeholders should carefully analyze the efficacy of interventions implemented within their state and identify opportunities to strengthen efforts to reduce motor vehicle injuries and deaths.


Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2012.

Emergency Nurses Association. 2010 ENA National Scorecard on State Roadway Laws: A Blueprint for Injury Prevention; 2010. *

Garcia-Espana JF, Winston FK, Durbin DR. Safety belt laws and disparities in safety belt use among US high-school drivers. American Journal of Public Health; 2012:102:1128-34. *, †

Hijar M, Perez-Nunez R, Inclan-Valadez C, Silveira-Rodrigues EM. Road safety legislation in the Americas. Pan American Journal of Public Health; 2010:32:70–6. *

U.S. Department of Transportation, National Highway Traffic Safety Administration. Occupant Protection Traffic Safety Facts: 2012 Data; 2012.

U.S. Department of Transportation, National Highway Traffic Safety Administration. Seat Belt Use in 2011 — Overall Results. Safety Facts: Research Notes; 2011.

* Indicates research that supports policies analyzed

 †Indicates research that supports equity or vulnerable populations studied