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Policy Impact: Seat Belts

What's the Issue?

Motor vehicle crashes are the leading cause of death in the first three decades of American’s lives. In 2009 alone, crashes killed over 33,000 people and injured another 2.2 million—more than 70% of these were in passenger vehicles and trucks.1

More than half of the people killed in car crashes were not restrained at the time of the crash.1 Wearing a seat belt is the most effective way to prevent death and serious injury in a crash.

Seat belt use is on the rise. Laws, education, and technology have increased seat belt use from 11% in 19812 to nearly 85% in 20103, saving hundreds of thousands of lives. Yet, about 1 in 7 people still don’t buckle up.

There are proven policies to increase seat belt use and save lives.

In 2009, more than 90 people died in motor vehicle crashes every day.1


What Do We Know?

  • Most drivers and passengers killed in crashes are unrestrained. 53% of drivers and passengers killed in car crashes in 2009 were not wearing restraints.1
  • Seat belts dramatically reduce risk of death and serious injury. Among drivers and front-seat passengers, seat belts reduce the risk of death by 45%, and cut the risk of serious injury by 50%.4
  • Seat belts prevent drivers and passengers from being ejected during a crash. People not wearing a seat belt are 30 times more likely to be ejected from a vehicle during a crash. More than 3 out of 4 people who are ejected during a fatal crash die from their injuries.5
  • Seat belts save thousands of lives each year, and increasing use would save thousands more. Seat belts saved almost 13,000 lives in 2009. If all drivers and passengers had worn seat belts that year, almost 4,000 more people would be alive today.6

These facts show that increasing seat belt use is critical to reduce injury and saving lives.

Most People Killed in Crashes are Drivers or Passengers1

Pie chart illustrating that most people killed in crashes are drivers or passengers of passenger vehicles and trucks - 72% of crash-related fatalties. Other categories are: Motorcyclists 13%, Pedestrians 12%, Pedalcyclists 2%, Other or unknown 1%.


Seat Belts Have Saved an Estimated 255,000 Lives Since 19755

Bar graph illustrating that, in 2008, the cumulative lives saved by seat belts since 1975 is 255,115. From 1975-1997, seat belts saved 100,791 lives. Each year the bar graph gains several thousand lives: 1998 shows 112,471 lives saved; 1999 shows 124,412; 2000 shows 137,294; 2001 shows 150,589; 2002 shows 164,853; 2003 shows 179,948; 2004 shows 195,496; 2005 shows  211,184; 2006 shows 226,642; and 2007 shows 241,865 lives saved.


In one year alone, crash deaths and injuries to drivers and passengers cost $70 billion in medical and lost work costs.7


What Can We Do?

Seat belts protect people from needless death and injury. But whether it is because they are in a hurry, distracted, or they simply forget, many people don’t wear their seat belts, and thousands die as a result. CDC recommends effective, well-enforced seat belt laws to ensure that every person in every seat buckles up on every trip.

Primary enforcement states have seat belt use 9 percentage points higher than secondary states.8


CDC Recommendations

Primary enforcement seat belt laws
Laws requiring seat belt use are either “primary” or “secondary” enforcement laws. Primary enforcement laws allow police officers to pull over drivers and issue tickets just because the drivers—or their passengers— aren’t wearing seat belts. Secondary enforcement laws only allow police officers to issue tickets for seat belt violations if drivers have been pulled over for some other offense.

Road Sign: Fasten Safety Belts - State LawSecondary enforcement significantly limits the ability of officers to enforce seat belt laws. Rates of seat belt use are 9 percentage points higher in primary enforcement states than secondary states.8

If the overall prevalence of seat belt use in states with secondary enforcement laws had matched the higher prevalence in states with primary laws, an additional 7.3 million adults would have buckled up in 2008.8 Increasing the number of states with primary enforcement seat belt laws covering all positions will increase seat belt use and save lives.

Enhanced enforcement of existing seat belt laws
“Enhanced enforcement” programs seek to better support seat belt laws by either increasing the average number of citations each officer issues or by increasing the number of officers on patrol. These measures are supported by publicity campaigns, like the successful “Click It or Ticket” initiative.

Research has shown that enhanced enforcement programs increase seat belt use by a median of 16 percentage points.9 Communities that follow this model and implement these programs will increase seat belt use.

Enhanced enforcement increases seat belt use by a median of 16 percentage points.9

Increased fines for seat belt violations
Well-enforced seat belt laws work because most people would rather buckle up than possibly pay a fine. But in many states, fines for violating seat belt laws are so small that they don’t motivate people to wear their seat belt.

Increasing a seat belt fine from $5 to $100 can increase seat belt use by more than 10 percentage points. Even a modest increase can make a difference— for instance, an increase from $25 to $60 can increase belt use by 3 to 4 percentage points.10

States should consider increasing fines to a level that will encourage seat belt use.


Nineteen States Still Lack a Primary Enforcement Seat Belt Law

The Insurance Institute for Highway Safety maintains current information about state laws, who they cover, and fines.

See alphabetical listing of states with primary seat belt law, secondary seat belt law, and no seat belt law.

US map illustrating states that have primary enforcement, secondary enforcement, and no seat belt laws.


  1. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts: Highlights of 2009 Motor Vehicle Crashes. Washington (DC): NHTSA; 2010. Available at URL:
  2. CDC. Achievements in public health, 1900-1999 motor-vehicle safety: a 20th century public health achievement. MMWR 1999;48:369-74.
  3. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts: Seat Belt Use in 2010—Overall Results. Washington (DC): NHTSA; 2010. Available at URL:
  4. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts: Children. Washington (DC): NHTSA; 2010. Available at URL:
  5. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts: Occupant Protection. Washington (DC): NHTSA; 2009. Available at URL:
  6. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Lives Saved in 2009 by Restraint Use and Minimum-Drinking-Age Laws. Washington (DC): NHTSA; 2010. Available at URL:
  7. Naumann RB, Dellinger AM, Zaloshnja E, Lawrence BA, Miller TR. Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Injury Prev 2010;11:353–360.
  8. Beck LF, West BA. Vital Signs: Motor Vehicle Occupant Nonfatal Injuries (2009) and Seat Belt Use (2008) Among Adults—United States. Centers for Disease Control and Prevention. 2011.
  9. Guide to Community Preventive Services. Use of Safety Belts: Enhanced Enforcement Programs. [cited 2010 Nov 24]. Available at URL:
  10. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Tech: Primary laws and fine levels are associated with increases in seat belt use. Washington (DC): NHTSA; 2010. Available at URL:

Policy Impact is a series of issue briefs from CDC’s Injury Center highlighting key public health issues and important, science-based policy actions that can be taken to address them.

Almost half of all black (45%) and Hispanic (46%) children who died in crashes were not buckled up (2009-2010).
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