DataBank Indicator

Download Report

In 2013, seat belts or other car safety restraints were used by 89 percent of children under age eight, a statistically significant decrease from a high of 91 percent in 2012.

Importance

Motor vehicle accidents are the leading cause of death for children and youth ages 5 to 24, [1] and the use of seat belts and child safety restraints greatly reduces the chance of fatalities and serious injuries in motor vehicle crashes.[2] Seat belt use reduces the risk of fatal injury by 45 percent;[3] while child safety seats reduce the risk of fatal injury by 71 percent.[4] Although only five percent of people injured in accidents were not wearing seatbelts, 42 percent of those killed were not wearing one.[5]

According to the latest recommendations by the National Highway Traffic Safety Administration, all children through age 12 should ride in the back seat of a vehicle. Young children up to three years of age should be in a rear-facing safety seat, until their height or weight reaches limits set by the seat’s manufacturer, when they should switch to a forward-facing car seat. Children ages four to seven should be in a forward-facing car seat with a harness, until they have outgrown manufacturers’ limits, at which time they should switch to a booster seat. Between ages eight and 12, children should remain in booster seats until they are big enough to have a seat belt fit properly.[6]

In 2013, 10 percent of infants (under a year old) were not in rear-facing car seats, 17 percent of toddlers ages one to three were not in a car seat (rear- or forward-facing), and 33 percent of children ages four to seven were not properly protected.[7] In a recent analysis, four- to seven-year-old children in states with booster seat laws had a lower risk of dying as occupants in motor vehicle crashes than those in states without such laws.[8]

Trends

45_fig1The percentage of youth ages 16 to 24 using seat belts has increased, from 53 percent in 1994 to 81 percent in 2009. The proportion has remained steady since then, and was at 83 percent in 2013.

Between 2002 and 2007, the percentage of children ages eight to 15 years old who were restrained fluctuated between 81 and 84 percent. Between 2007 and 2013, however, the proportion increased from 82 to 89 percent.

For children younger than eight, after a dip between 2002 and 2004, the percentage who were restrained increased, from 82 percent in 2004 to 91 percent in 2012. However, the proportion decreased to 89 percent in 2013. (Figure 1) Among infants, the percentage observed using restraints increased from 88 percent in 1994 to 99 percent in 2012, though most of this increase was in the 1990s. In 2013, the proportion was 98 percent.  (Appendix 1)

Differences by Age

45_fig2Among children under age eight, the youngest children are most likely to use seat belts or restraints. In 2013, 98 percent of infants, 95 percent of children ages one to three, and 91 percent of children ages four to seven used a safety seat, seat belt, or other restraint. Among older children and youth, 89 percent of children ages eight to fifteen, and 83 percent of youth ages 16 to 24, used seat belts in 2013.  (Figure 2)

Differences by Race/Hispanic Origin

A recent nationwide study of children ages birth to 12 who died as occupants in motor vehicle accidents, found that black and Hispanic children were less likely to be using restraints than white children. Studies of injury data, as well as observational studies, find lower use of restraints among black children, compared with white children; and, in self-reported data, both black and Hispanic children are less likely than white children to be using restraints.[9]

Differences by Driver and Vehicle Characteristics

45_fig3Children are more likely to use seatbelts or other restraints when riding in a car where the driver is using a seat belt. In 2013, 91 percent of children under age eight used seat belts or other restraints in cars with a belted driver, compared with 68 percent where the driver was not using a seat belt. Ninety percent of children riding in a car with a female driver were restrained, compared to 87 percent of children riding in a car with a male driver. Children riding in vans or SUVs were the most likely to be in restraints (91 percent), followed by children in passenger cars (87 percent) and pickup trucks (76 percent). (Figure 3)

Differences by Region

In 2013, among children younger than eight, children living in the South were the least likely to be belted (81 percent) and children in the West were the most likely to be belted (92 percent). Children in the Northeast and Midwest were in the middle (89 percent, each).  (Appendix 1)  Regional disparities were also apparent for older children: in 2003 (the most recent data available), only about half (49 percent) of children ages eight to 15 living in the South wore a seat belt when
riding in the front seat, compared with 88 percent of children in the Northeast.[10]

State and Local Estimates

Trend estimates on the percentage of high school students who reported they never or rarely wore seat belts (while riding in a car driven by someone else) are available from the Youth Risk Behavior Survey (YRBS).

International Estimates

None available.

National Goals

Through its Healthy People 2020 initiative, the federal government has set several national goals to increase the percentage of children under age 13 using age-appropriate vehicle restraints, with different goals for different age groups. Additionally, there is a goal to increase the use of safety belt use in the population as a whole, from 84 percent in 2009 to 92.4 percent in 2020, and to reduce traffic fatalities from 13.8 to 12.4 deaths per 100,000 population.

More information is available here.  (Goals IVP-13 to16)

What Works to Make Progress on This Indicator

The National Highway Traffic Safety Administration (NHTSA) recommends that states adopt “primary” safety belt laws—that is, ones that allow law enforcement to issue citations for violations, even in the absence of evidence of other infractions. NHTSA also recommends including requirements for safety belt use in laws regarding graduated driver licensing, and prohibitions on “graduating” to the next level of licensing if the driver has a seat belt citation.[11]

The Centers for Disease Control and Prevention offers child passenger safety tips to health care providers, parents and caregivers, and states and communities.

Information for parents on finding a car seat that right for their child is available at Parents Central.

Related Indicators

Definition

Most observational data were collected at intersections with a stop sign or stop light. If a child or youth was observed in a child restraint or using a seat belt, he or she was counted as using a seat belt or restraint. Restraints include a rear-facing safety seat, front-facing safety seat, high-backed booster seat, seat-belt or backless booster seat. Observations were made by trained observers at various roadways. For age-specific data on children under eight, data were collected by interview and observation at gas stations, fast food restaurants, day care centers, and recreation centers.

Data Sources

Age-specific data for children under age eight for 2011-2013: Pickrell, T. M., & Choi, E-H. (2014). The 2013 National Survey of the Use of Booster Seats. (Report No. DOT HS 812 037). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/812037.pdf

All other data for 2013: Pickrell, T. M. & Liu, C. (2015). Occupant Restraint Use in 2013: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 812 080). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/812080.pdf.

All other data for 2011 -2012: Pickrell, T. M. (2014). Occupant Restraint Use in 2012: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 811 872). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811872.pdf.

Age-specific data for children under age eight for 2009: National Highway Traffic Safety Administration. (2010). The 2009 National Survey of the Use of Booster Seats. DOT HS 811 377. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811377.pdf

All other data for 2009-2010: National Highway Traffic Safety Administration. (2011). Occupant restraint use in 2010: Results from the National Occupant Protection Use Survey, Controlled Intersection Study. DOT HS 811 527. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811527.pdf

Data for children and youth ages 8 to 24, 2002-2009: National Highway Traffic Safety Administration. (2010). Occupant restraint use in 2009: Results from the National Occupant Protection Use Survey, Controlled Intersection Study. DOT HS 811 414. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811414.pdf

Age-specific data for children under age eight for 2007-2008: National Highway Traffic Safety Administration. (2009). Child restraint use in 2008:Use of correct restraint types. DOT HS 811 132. Available at http://www-nrd.nhtsa.dot.gov/Pubs/811132.pdf

All other data for 2007-2008: National Highway Traffic Safety Administration. (2009) Child restraint use in 2008: Overall results. DOT HS 811 135. Available at: http://www-nrd.nhtsa.dot.gov/PUBS/811135.PDF

All other data for 2005-2006: Glassbrenner, D. & Ye, J. (2007). Child restraint use in 2006 – Overall results. DOT HS 810 737. U.S Department of Transportation, National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/810737.pdf

All other data for 2002-2004: Glassbrenner, D. (2005). Child restraint use in 2004: Overall results. DOT HS 809 845. U.S Department of Transportation, National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/809845.pdf

Data for 1994-2000: Bondy, N. & Glassbrenner, D. (2001). National Occupant Protection Use Survey: 2000 Controlled Intersection Study. DOT HS 809 318. U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/809318.pdf.

Raw Data Source

Age specific data for children under age eight:
National Survey of the Use of Booster Seats (NSUBS), National Highway Traffic Safety Administration.

All other data: National Occupant Protection Use Survey (NOPUS), National Highway Traffic Safety Administration.

http://www-nrd.nhtsa.dot.gov/

1994 1996 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Total 88 82 82 84 89 87 88 89 91 91 89
Age1
Under 1 year old 88 85 97 95 99 98 98 98 98 99 98 99 98 99 98
1 to 3 years old 94 93 89 89 96 92 96 94 96 96 95
1 to 4 years old 61 60 91 91
4 to 7 years old 83 73 76 78 85 89 87 83 90 87 91
Belt Status of Driver
Belted 92 86 85 87 92 92 91 92 95 93 91
Unbelted 72 50 60 58 61 54 66 64 67 73 68
Gender of Driver
Female 92 82 84 82 90 88 89 90 91 91 90
Male 91 82 79 86 86 85 87 87 92 92 87
Region
Northeast 87 69 76 81 88 82 87 89 94 93 89
Midwest 86 79 77 82 88 85 90 91 90 92 89
South 92 87 79 80 85 83 82 82 84 88 81
West 86 84 91 93 94 93 95 93 96 93 92
Urbanization
Urban 84 78 80 73 85 85 86 80 92 89 85
Suburban 85 84 83 87 91 89 89 91 92 92 91
Rural 87 80 83 84 86 83 87 89 90 91 87
Type and time of day
Weekday 89 83 82 84 90 88 88 90 90 91 89
Rush hour 90 80 86 78 91 90 88 90 92 92 90
Non-rush hour 87 85 78 89 89 86 88 90 89 89 89
Weekend 85 79 83 83 86 85 88 87 94 92 88
Type of car
Passenger cars 88 78 76 78 88 86 84 86 87 89 87
Vans and SUVs 91 88 92 91 91 90 93 92 97 94 91
Pickups 77 71 79 86 76 73 80 84 83 91 76
Type of seat
Front seat 83 72 88 86 75 74 74 81 72 70 66
Rear seat 90 83 82 83 90 88 89 90 93 92 90
1994 1996 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Restraint Use by Infants1
Front-facing car seat 66 48 49 36 14 12 15 11 7
Rear-facing car seat 32 45 45 48 81 86 83 86 90
High-back booster seat 1 0 N/A N/A N/A N/A N/A N/A N/A
Belt or backless booster 1 4 1 11 N/A N/A N/A N/A N/A
No restraint observed 1 2 2 2 2 1 2 2 2
Restraint Use by Toddlers1
Front-facing car seat 62 62 66 67 73 72 76 75 73
Rear-facing car seat 4 6 6 3 3 2 3 7 10
High-back booster seat 16 2 5 4 9 11 11 9 7
Belt or backless booster 13 22 13 15 11 7 7 5 6
No restraint observed 6 7 11 11 4 8 4 4 5
Restraint Use by Booster-age1 Children
Front-facing car seat 9 13 12 16 13 12 14 18 20
Rear-facing car seat 1 N/A N/A N/A N/A N/A N/A N/A N/A
High-back booster seat 6 2 8 3 22 26 24 25 26
Belt or backless booster 67 58 56 59 50 51 49 46 44
No restraint observed 17 27 24 22 15 11 13 10 9
– Data not available.1 Before 2007, NHTSA published the child restraint use rates by age based on the data from the NOPUS. For the years 2007-2011, NHTSA’s published estimates of child restraint use by age came from the National Survey of the Use of Booster Seats (NSUBS). Since information about age is obtained by interviews in NSUBS and through visual assessment in NOPUS, the former is more accurate.

Sources: Data for 1994-2000: Bondy, N. & Glassbrenner, D. (2001). National Occupant Protection Use Survey: 2000 Controlled Intersection Study. DOT HS 809 318. U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/809318.pdf. Data for 2002-2004: Glassbrenner, D. (2005). Child restraint use in 2004: Overall results. DOT HS 809 845. U.S Department of Transportation, National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/809845.pdf. Data for 2005-2006: Glassbrenner, D. & Ye, J. (2007). Child restraint use in 2006 – Overall results. DOT HS 810 737. U.S Department of Transportation, National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/810737.pdf. Age-specific data for 2007-2008: National Highway Traffic Safety Administration. (2009). Child restraint use in 2008:Use of correct restraint types. DOT HS 811 132. Available at http://www-nrd.nhtsa.dot.gov/Pubs/811132.pdf. All other data for 2007-2008: National Highway Traffic Safety Administration. (2009) Child restraint use in 2008: Overall results. DOT HS 811 135. Available at: http://www-nrd.nhtsa.dot.gov/PUBS/811135.PDF. Age-specific data for children under age eight for 2009: National Highway Traffic Safety Administration. (2010). The 2009 National Survey of the Use of Booster Seats. DOT HS 811 377. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811377.pdf. All other data for2009-2010: National Highway Traffic Safety Administration. (2011). Occupant restraint use in 2010: Results from the National Occupant Protection Use Survey, Controlled Intersection Study. DOT HS 811 527. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811527.pdf. Age-specific data for children under age eight for 2011-2013: Pickrell, T. M., & Choi, E-H. (2014). The 2013 National Survey of the Use of Booster Seats. (Report No. DOT HS 812 037). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/812037.pdf All other data for 2011 -2012: Pickrell, T. M. (2014). Occupant Restraint Use in 2012: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 811 872). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811872.pdf. All other data for 2013: Pickrell, T. M. & Liu, C. (2015). Occupant Restraint Use in 2013: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 812 080). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/812080.pdf.

Appendix 2 – Percentage of Children and Youth Using Safety Restraints, by Age Group, Selected Years, 1994-2013

1994 1996 1998 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Age
0 to 7 years old 88 82 82 84 89 87 88 89 91 91 89
5 to 15 years old 58 65 72 66
8 to 15 years old 82 81 84 81 84 82 83 84 84 88 87 89
16 to 24 years old 53 50 57 69 69 75 77 78 76 77 80 81 79 79 80 83
– Data not available.Sources: Data for 1994-2000: Bondy, N. & Glassbrenner, D. (2001). National Occupant Protection Use Survey: 2000 Controlled Intersection Study. DOT HS 809 318. U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/809318.pdf. Data for 2002-2009: National Highway Traffic Safety Administration. (2010). Occupant restraint use in 2009: Results from the National Occupant Protection Use Survey, Controlled Intersection Study. DOT HS 811 414. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811414.pdf. Data for 2010 -2011: Pickrell, T. M., & Ye, T. J. (2013). Occupant Restraint Use in 2011: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 811 697). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811697.pdf. Data for 2012: Pickrell, T. M. (2014). Occupant Restraint Use in 2012: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 811 872). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/811872.pdf Data for 2013: Pickrell, T. M. & Liu, C. (2015). Occupant Restraint Use in 2013: Results from the National Occupant Protection Use Survey Controlled Intersection Study. (Report No. DOT HS 812 080). Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/812080.pdf.

 

Endnotes


[1]National Center for Injury Prevention and Control. (2015). WISQARS (online data tool): Leading causes of death reports, national and regional, 1999 – 2013. Available at: http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html.

[2]National Highway Traffic Safety Administration. (2012). Occupant protection. Traffic Safety Facts: 2010, DOT HS 811 619.http://www-nrd.nhtsa.dot.gov/Pubs/811619.pdf

[3]Ibid.

[4]Lawrence E. Decina, Kathy H. Lococo, and Charlene T. Doyle. (2004). Child Restraint Use Survey: LATCH Use and Misuse. National Center for Statistics and Analysis, National Highway Traffic Safety Administration, Washington, DC 20590. Report No. DOT HS 810 679. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/810679.PDF

[5]National Highway Traffic Safety Administration. (2014). 2012 Traffic Safety Facts, DOT HS 812 032. http://www-nrd.nhtsa.dot.gov/Pubs/812032.pdf

[6]National Highway Traffic Safety Administration. (2011). Car seat recommendations for children. Available at:http://www.nhtsa.gov/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20Files/4StepsFlyer.pdf.

[7]Pickrell, T. M. & Ye, T. J. (2014). The 2013 National Survey of the Use of Booster Seats, DOT HS 812 037. Washington, DC: National Highway Traffic Safety Administration. Available at: http://www-nrd.nhtsa.dot.gov/Pubs/812037.pdf.

[8]Mannix, R., Fleegler, E., Meehan, W. P., Shutzman, S. A., Hennelly, K., Nigrovic, L., & Lee, L. K. (2012).  Booster seat laws and fatalities in children 4 to 7 years of age. Pediatrics, 130(6), 996-1002. Available at: http://dx.doi.org/10.1542/peds.2012-1058.

[9]Sauber-Schatz, E. K., West, B. A., & Bergen, G. (2014). Vital Signs: Restraint use and motor vehicle occupant death rates among children aged 0-12 years—United States, 2002-2011. MMWR, 63(5), 113-118.

[10]Glassbrenner, D. (2004). Safety Belt Use in 2003-Demographic Characteristics. U.S. Department of Transportation,
National Highway Traffic Safety Administration, National Center for Statistics and Analysis, DOT HS 809 729. Available online:http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2004/809729.pdf.

[11]Fell, J. C., Baker, T. K., McKnight, A. S., Brainard, K., Langston, E., Rider, R., Levy, D., and Grube, J. (2005). Increasing teen safety belt use: A program and literature review. Washington, DC: National Highway Traffic Safety Administration.

Suggested Citation:

Child Trends Databank. (2015). Seat belt use. Available at: https://www.childtrends.org/?indicators=seat-belt-use

 Last updated: March 2015

Subscribe to Child Trends

Short weekly updates of recent research on children and youth.