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Use of Seat Belts -- DeKalb County, Georgia, 1986

Injuries associated with motor vehicle collisions are the fourth leading cause of death in the United States and the third leading cause of years of potential life lost (1,2). The use of seat belts has been shown to reduce the number and severity of such injuries (3-5).

To develop local intervention strategies for increasing the use of seat belts in DeKalb County, Georgia (one of several metropolitan Atlanta counties), the DeKalb County Department of Health, the Georgia Department of Human Resources, and CDC conducted two surveys in July 1986. The first was a telephone survey of drivers to determine attitudes regarding the use of seat belts, and the second was an observational survey of automobile occupants to estimate the prevalence of seat-belt use.

Telephone Survey. In the random-digit dialing telephone survey, the sampling frame included all phone numbers with DeKalb County prefixes, Numbers were selected and called up to two times on the evening of the survey. Interviews were conducted only if a licensed driver (greater than or equal to 16 years of age) was available and if the household was a private resident Interviewers submitted disposition sheets for 2,196 calls attempted. Of these, 423 (19%) were eligible for inclusion. An additional 1,230 (56%) numbers were ineligible (e.g., business phones), and no one answered (or line busy) at (25%) numbers. Of the 423 eligible residents contacted, 278 completed the interviews. Results from an additional 59 completed interviews for which call disposition sheets were not submitted were also included in the analysis.

To determine the characteristics of persons not reached in the original survey, interviewers later called up to 10 times a random subsample of 120 nonrespondent numbers; 90 (75%) of these numbers were ineligible. Of the 30 eligible residents contacted, 22 completed interviews. Demographic characteristics of the respondents completing interviews were similar in the two surveys. In comparison with data from the U.S. Bureau of the Census, females were overrepresented (61% vs. 53%) in the original survey, but the median age and racial distributions were similar.

For analysis, failure to use seat belts was defined as a respondent's report that he or she used seat belts sometimes, seldom, or never (3). Overall, 38% (127/337) of respondents did not use seat belts. The proportion of those not using seat belts was higher among males (40% vs. 36%), nonwhites (49% vs. 34%), and persons with less than or equal to12 years of education (45% vs. 33%). Failure to use seat belts was reported by 44% of persons 16-29 years of age, 34% of those 30-59 years of age, and 40% of those greater than 59 years of age. After adjustment was made for the demographic variables, nonwhites were still more likely than whites not to use seat belts (Table). Usage rates varied little by daily number of miles driven or presence of children less than 4 years of age in the respondent's household.

Attitudes regarding use of seat belts are shown in Table 2. Persons who used seat belts were more likely to favor a mandatory-use law than those did not use seat belts (79% vs. 53%). More users (94%) than nonusers (75 %) recognized that wearing a seat belt decreases the risk of injury in a motor vehicle collision.

Reasons cited for failing to use seat belts included travelling a short distance (28%), discomfort (23%), fear of entrapment (13%), not necessary (9%), difficult to wear (6%), and other (21%).

Observational Survey. The observational survey was conducted the morning after the telephone survey at 48 randomly selected intersections with timed traffic signals. While vehicles were stopped, observers -- beginning with the second vehicle in line -- recorded the drivers' use of seat belts. Observers also recorded the use of restraint devices by children who appeared to be less than 4 years old. During the 2-hour survey, occupants of 2,157 vehicles were observed.

Overall, 70% of drivers were not wearing seat belts. Usage patterns by demographic variables (Table 1) were similar to those reported from the telephone survey. Nonwhites, males, and persons judged to be greater than 59 years of age were at highest risk for not wearing seat belts. The proportion of nonusers also rose as vehicle size increased. Drivers of trucks and vans were three times more likely not to wear seat belts than drivers of small (Table 1).

In 61 of the vehicles surveyed, 74 children appeared to be less than 4 years of age. Of these 74, 36 (49%) were seated in child-restraint devices. More children were restrained (52%) in vehicles in which the driver wore a seat belt than were restrained (13%) in other vehicles.

Reported by: M Smith, GN Bohan, MD, DeKalb County District No. 3, Unit No. 5; T McKinley, RK Sikes, DVM, MPH, State Epidemiologist, Georgia Dept of Human Resources. Div of Injury Epidemiology and Control, Div of Chronic Disease Control, Center for Environmental Health; Div of Nutrition, Center for Health Promotion and Education; Div of Surveillance and Epidemiologic Studies, Div of Field Services, Epidemiology Program Office; Epidemic Intelligence Service Class of 1986, CDC.

Editorial Note

Editorial Note: Because of differences in study design, sampling techniques, and the population surveyed, the prevalence estimates of seat-belt use described above differ from those reported in previous studies involving Georgia residents (6). In the DeKalb County telephone survey, 62% of the respondents reported using seat belts, compared with 39% of those from Georgia's 1986 Behavioral Risk Factor Survey (6).

Despite such differences, the two surveys reported here identified commonly acknowledged risk factors associated with failure to use seat belts. In previous telephone surveys and direct observational studies of motor vehicle occupants, males, nonwhites, persons in younger (less than or equal to 24 years) and older (greater than59 years) age groups, persons with less than 12 years of education, and drivers of trucks, vans, and large cars have been found less likely to use seat belts (3,7).

The proportion of persons failing to use seat belts, as determined by direct observation, was nearly double that estimated from the telephone survey (Table 1). A similar discrepancy between observed and self-reported usage rates has been noted by other investigators (8,9). Although self-report surveys, compared with observational surveys, tend to underestimate failure to use seat belts, their use permits the collection of demographic and behavioral data that may aid in the development of intervention strategies (2). As illustrated here, demographic variables associated with failure to use seat belts were similar in the telephone and the observational surveys.

Although Georgia does not have a mandatory-use law for older children and adults, over two-thirds of the telephone survey respondent -- including a majority of those who reportedly did not use seat belts -- were in favor of such a law. The implications of this finding are unclear, but similar results have been reported in other studies, i.e., more respondents have favored passage of mandatory-use laws than have reported that they use seat belts (9-11).

Laws mandating the use of seat belts represent one of several strategies developed to reduce the costly morbidity and mortality associated with motor vehicle collisions. Other interventions include use of passive restraints (e.g., air bags), design changes in vehicles and highways, enforcement of existing traffic laws, and public education (2).

There is a continuing need to educate the public about the efficacy of seat belts in preventing injuries. Furthermore, as shown here, efforts must be made to dispel certain misconceptions. For example, short-distance travel is not necessarily safer than long-distance travel. It is well known that many motor vehicle collisions occur while the drivers are travelling short distances (12). Regarding the fear of entrapment, despite the notion that "being thrown clear" of a vehicle has a protective effect in a collision, fatality rates for occupants ejected from vehicles are 40 times greater than rates for occupants not ejected (13).

Since July 1984, a Georgia law has required that child-restraint devices be used for children less than4 years of age (or seat belts for those 3-4 years of age). Nonetheless, in this survey observers reported that less than half of the children concerned were seated in restraint devices. Similar usage rates have been reported in other states from 2 to 5 years after enactment mandatory child-restraint laws (4,14). One Public Health Service prevention objective for 1990 is to have health care providers instruct parents in the appropriate use of child-restraint devices (15). Physicians have stressed that such instruction should be an integral part of prenatal care (16). The results of these surveys indicate that educational efforts should be continued.


  1. National Center for Health Statistics. Annual summary of births, marriages, divorces, and deaths: United States, 1984. Monthly Vital Statistics Rep 1985;33(13):20-1.

  2. CDC. Seat belt use -- United States. MMWR 1986;35:301-4.

  3. Goldbaum GM, Remington PL, Powell KE, Hogelin GC, Gentry EM, the Behavioral Risk Factor Surveys Group. Failure to use seat belts in the United States: the 1981-1983 Behavioral Risk Factor Surveys. JAMA 1986;255:2459-62.

  4. Decker MD, Dewey MJ, Hutcheson RH Jr, Schaffner W. The use and efficacy child restraint devices. JAMA 1984;252:2571-5.

  5. Newman RJ. A prospective evaluation of the protective effect of car seat bel


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