Increasing Seat Belt Use

The proper use of seat belts is one of the most effective ways to reduce injuries and deaths in motor vehicle crashes, reducing the risk by approximately 50%. After seat belt laws first went into effect in U.S. in the 1980s, there has been a significant increase in seat belt use. In 2017, it is estimated that seat belts saved the lives of nearly 15,000 people.

Rural residents are less likely to use seat belts and rural areas have higher death rates due to drivers and passengers being unrestrained by a seat belt. Evidence-based strategies and promising approaches for increasing seat belt use include primary and secondary seat belt enforcement laws, and enhanced enforcement programs.

Primary and Secondary Seat Belt Enforcement Laws

The Community Preventive Services Task Force (CPSTF) recommends seat belt laws to increase rates of seat belt use and prevent injuries from motor-vehicle crashes. Seat belt laws are separated into primary enforcement laws and secondary enforcement laws.

Primary enforcement laws allow police officers to stop vehicles and issue a ticket when they notice that drivers and/or passengers are not using seat belts.
Secondary enforcement laws allow police officers to stop vehicles and issue a ticket to enforce seat belt use only when the vehicles are being stopped for another traffic violation.

The Community Preventive Services Task Force (CPSTF) found that primary enforcement laws are more effective at reducing injuries.

Every state in the U.S., except for New Hampshire, has primary or secondary laws that require seat belt use when riding in motor vehicles. The Insurance Institute for Highway Safety maintains a list of seat belt and child seat laws and enforcement type by state. In states with primary enforcement laws, seat belt use has been found to be higher than in states with secondary enforcement laws and these primary laws have also been found to prevent more deaths.

Enhanced Enforcement Programs

Enhanced enforcement programs layer on additional strategies to increase seat belt use, to supplement existing laws. These strategies go above and beyond normal enforcement approaches and may include increased outreach about seat belt use and increasing the number of police officers who patrol and identify people not wearing seat belts.

County Health Rankings & Roadmaps has identified enhanced seat belt enforcement programs as scientifically supported to make a difference in preventing traffic-related injuries. CPSTF also recommends enhanced enforcement programs as evidence-based to increase the use of seat belts.

Examples of Programs that Focus on Increasing Seat Belt Use

The High Five Rural Traffic Safety Project, implemented by the Arkansas Highway Safety Office, aims to decrease deaths and injuries from traffic crashes. This multifaceted prevention project involves a partnership of several statewide agencies and organizations, including the University of Arkansas, Arkansas State Police, and the Arkansas Department of Transportation. The project involves an educational component about the most common causes of crashes, prevention strategies such as the use of seat belts, as well as enforcement of seat belt use laws in the state.
Click It or Ticket and Border to Border are national public outreach educational campaigns coupled with enforcement efforts through the National Highway Traffic Safety Administration (NHTSA) to increase seat belt use. Border to Border addresses seat belt use enforcement which is implemented through the Highway Patrol in states. As an example, the Utah Department of Public Safety adapted Click It or Ticket campaign materials and created a website with a downloadable toolkit and YouTube videos about crash-related injury prevention featuring characters from popular movies to capture a wide audience.
The Hopi Tribe in Arizona provides a variety of public health programs for tribal members, including education around seat belt use, education for child safety seat use and distribution of seats, and seat belt enforcement strategies on local roads. In 2011, the Hopi tribe received funding from the Centers for Disease Control and Prevention (CDC) to implement a multifaceted motor vehicle injury prevention program. One element of the program involved partnering with local law enforcement that set up checkpoints to monitor and enforce seat belt use, and to revise and adopt seat belt use laws in the area.
The Washington State Traffic Safety Commission (WTSC) partners with tribal governments and other agencies in the state to increase seat belt use and prevent traffic crashes and injuries. WTSC has created educational content on their website, including culturally relevant materials and videos, to educate about the importance of seat belt use using the message “Lock in the Future”.
The Together for Life Program, through the Utah Department of Public Safety's Highway Safety Office, complements Utah's primary seat belt law. The goal of the program is to improve traffic safety culture in rural communities throughout the state. The program identified local champions in every rural county to promote the program and work together to adapt messaging and resources to fit each unique community. Since implementing the program, there have been significant increases in seat belt use in many of these communities.

Implementation Considerations

Educational programs addressing seat belt use can take several months of preparation for planning and implementation. The costs of the program will vary depending on the type of program and its specific components. For example, printing campaign flyers to raise awareness about seat belt use to post around the community may require different resources than filming educational videos for distribution. Embedding programs into other community events and providing education in a variety of locations can increase reach of the program.

Further, behavior change is a complicated and complex process, and it may be challenging to convince people who are accustomed to not using seat belts to begin doing so when driving or riding as a passenger.

Enforcement of seat belt laws can also be a challenge, since it requires police officers taking time away from other dedicated activities. At the same time, local officials may be hesitant to participate in some of these enforcement programs and awareness campaigns if they do not feel that there is broad support in the community. Finding ways to get local organizations, businesses, and schools involved in educational and awareness campaigns and promoting enforcement can build momentum and support for these safety efforts.

Resources to Learn More

Expanding the Seat Belt Program Strategies Toolbox: A Starter Kit for Trying New Program Ideas
Document
Provides examples of multiple strategies for increasing seat belt use, including high school service-learning programs, hospital discharge programs, targeted online advertising, online learning, and product/message placement.
Organization(s): U.S. Department of Transportation, National Highway Traffic Safety Administration
Date: 10/2016

Seat Belts
Website
Overview of information about seat belt usage with a focus on seat belt safety for adolescents and adults, including pregnant women. Provides statistics about the consequences of not using seat belts.
Organization(s): U.S. Department of Transportation, National Highway Traffic Safety Administration

Transportation Safety - Seat Belts
Website
Provides information and resources about the importance of seat belt usage in preventing injuries and death during motor vehicle crashes. Offers data by state showing adult usage, and death rates by age and sex. Describes state strategies effective at improving seat belt and car seat use by children, and discusses rural and urban differences in seat belt use.
Organization(s): Centers for Disease Control and Prevention

Tribal Motor Vehicle Injury Prevention (TMVIP): Best Practices Guide
Document
Provides evidence-based strategies and lessons learned from American Indian/Alaska Native Tribes and Tribal Organizations regarding motor vehicle injury prevention. Describes the community response to address these injuries, and importance of commitment, collaboration, and evaluation for program implementation.
Author(s): Letourneau, R.J., & Crump, C.E.
Organization(s): Centers for Disease Control and Prevention
Date: 2016