The Status Of Occupant Protection In America

Vehicle occupants account for 87 percent of all traffic deaths. When used properly, safety belts help prevent deaths and reduce injuries. In 2002, safety belts prevented an estimated 14,164 fatalities, saving more than $50 billion in medical care, lost productivity, and other injury-related costs. If ALL passenger vehicle occupants over age 4 were restrained in safety belts, an additional 7,153 lives could have been saved in 2002.

Motor Vehicle Crashes—The Scope of the Problem
In 2001, deaths and injuries resulting from motor vehicle crashes were the leading cause of death for persons of every age from 4 through 33-years-old. On average, every 13 minutes, someone in America dies in a motor-vehicle-related crash, and every 10 seconds, someone is injured. In 2002, traffic crashes claimed 42,815 lives and resulted in nearly 3 million injuries. Each year, crashes lead to about 4 million emergency department visits and 500,000 hospitalizations. Approximately 2 million Americans are disabled by crashes each year.

Potential Benefits of Safety Belt Use
Increasing the national safety belt use rate from 75 percent (the rate observed in 2002) to 90 percent would:

  • Prevent an estimated 4,100 fatalities annually.

  • Prevent an estimated 60,000 serious injuries annually.

  • Prevent an estimated 50,000 minor injuries annually.

  • Save our economy approximately $11.6 billion annually.

The economic cost-savings cited above are derived from reduced productivity losses, property damage, medical costs, rehabilitation costs, legal and court costs, emergency services costs, insurance administration costs, traffic delay, and reduced costs to employers.

The Effectiveness of Safety Belts
From 1975 through 2002, safety belts are estimated to have saved 164,753 lives. Research has shown that lap/shoulder belts, when used properly, reduce the risk of fatal injury to front-seat passenger car occupants by 45 percent and the risk of moderate to critical injury by 50 percent. For light-truck occupants, safety belts reduce the risk of fatal injury by 60 percent and moderate-to-critical injury by 65 percent.

Safety belts are 80-percent effective in reducing fatalities in light trucks (including sport utility vehicles [SUVs]) during rollover crashes. They also help prevent individuals from being totally ejected during a crash, thus reducing the risk of a fatal injury. Despite the effectiveness of safety belts in preventing injuries and fatalities, 59 percent of passenger vehicle occupants killed in 2002 were unrestrained.

The Effectiveness of Child Safety Seats
Child safety seats, when used correctly, are extremely effective in preventing injuries and deaths during crashes. From 1975 through 2002, an estimated 6,567 young lives were saved by child restraint systems. An estimated 376 lives of children under age 5 were saved in 2002 alone. If 100 percent of children younger than 5 years of age were properly placed in child safety seats, an estimated 485 lives (that is, an additional 109 lives) could have been saved in 2002.

Research on the effectiveness of child safety seats has found them to reduce fatal injury in passenger cars by 71 percent for infants and 54 percent for toddlers. For infants and toddlers in light trucks, the corresponding reductions are 58 percent and 59 percent, respectively. In 2002, 459 children younger than 4 years of age were killed in passenger vehicle crashes. Of these fatalities, 185 children (or 40 percent) were totally unrestrained.

In spite of these high use rates, the challenge of educating parents and other caregivers on the correct use of child restraints still remains. According to data from the National SAFE KIDS Campaign, the vast majority of child restraints are used incorrectly. The campaign analyzed errors identified while checking nearly 38,000 child safety seats and safety belts from February 2001 to May 2002.

Overall, 81.6 percent of the child restraints were used incorrectly, with an average of three errors per restraint. The SAFE KIDS data found the highest proportion of errors in rear-facing infant seats and forward-facing toddler seats with harnesses, as follows:

  • The safety belt did not lock the seat tightly for 62 percent of children in rear-facing seats and 67 percent of children in forward-facing seats.

  • Harness straps were loose for 65 percent of children in rear-facing seats and 67 percent of children in forward-facing seats.

For safety belts, the most common errors were:

  • The shoulder belt was not over the center of shoulder (78.9 percent).

  • The child’s legs did not bend over the vehicle seat without slouching (75.1 percent).

  • Lap belt was not over upper thighs (70.6 percent).

Additional information on these findings is available at

State and Regional Trends in Safety Belt Use
According to NHTSA’s National Occupant Protection Use Survey (NOPUS), safety belt use continued an upward trend in 2002, reaching 75 percent—its highest level since national surveys began in 1994. Up 2 percentage points from 2001, this increase in belt use translates into an additional 6 million users and the saving of approximately 500 lives. States with primary safety belt laws averaged an 80-percent belt use rate, while States with secondary laws averaged a 69-percent use rate. Primary safety belt laws allow a police officer to stop a vehicle in which passengers are not in compliance with the State safety belt law.

Three States and Puerto Rico had safety belt use rates that were 90 percent or higher in 2002: California (91 percent), Hawaii (90 percent), Washington (93 percent), and Puerto Rico (91 percent). The District of Columbia and 12 States had rates that were 80 percent or higher: District of Columbia (85 percent), Iowa (82 percent), New Jersey (81 percent), New Mexico (88 percent), New York (83 percent), North Carolina (84 percent), Oregon (88 percent), Maryland (86 percent), Michigan (83 percent) Texas (81 percent), Utah (80 percent), and Vermont (85 percent). The majority of States that have usage rates above 80 percent also have enacted primary enforcement safety belt use laws.

Of special note, Washington was the only State that passed a primary law in 2002 and the State’s safety belt use rate rose 10 percentage points, from 83 percent in 2001 to 93 percent in 2002.

The Northeast, historically the lowest region for safety belt use, showed the largest gain in safety belt use, up 8 percentage points from 2001 to 69 percent in 2002. However, drivers and passengers in the West still buckle up at the highest rate nationwide at 79 percent—up 2 percentage points from 2001. The South maintained the 76-percent usage rate it achieved in 2001, up 7 percentage points from 2000, while the Midwest showed an increase from 72 percent in 2001 to 74 percent in 2002.

National Trends and Initiatives in Child Passenger Safety
Restraint use by young children reached record levels in 2002. NHTSA’s observational studies (NOPUS) showed that 99 percent of infants and 94 percent of toddlers were restrained. Occupant fatalities for children under age 5 declined by 9 percent in 2002. For the first time, the number of fatalities among this age group dropped below 500, to 459. This continued decrease in the number of child occupant deaths is in large part due to the significant increase in child restraint use since the Buckle Up America campaign began. In 1996, just before the campaign began, restraint use among infants (1- to 12 months of age) was 85 percent and only about 60 percent of toddlers (1- to 4-years-old) were restrained while riding in vehicles.

In spite of the strides that have been made, the need for ongoing outreach and education remains. NHTSA’s 2002 NOPUS surveys also showed that too many young children—15 percent of infants, 10 percent of 1-3-year-olds, and 29 percent of 4- to 7-year-olds continue to be placed in the front seat, which is the most dangerous seating position.

Restraint Use Among Older Children
The odds of injury for children riding in booster seats were 59 percent lower than the risks children face when using safety belts alone, according to a study published in the June 4, 2003, edition of the Journal of the American Medical Association. The study, conducted by Partners for Child Passenger Safety (PCPS), a research project at The Children’s Hospital of Philadelphia, and supported by State Farm Mutual Automobile Insurance Company, examined insurance claim data from December 1998 through May 2002 concerning 3,616 crashes in 15 States involving 4,243 children. The study also found that none of the 4- to 7-year-olds who were in belt-positioning booster seats had any injuries to the abdomen, neck, spine, and back. Such injuries did occur, however, in children who used safety belts alone.

The PCPS study also found that only 16 percent of 4-year-olds, 13 percent of 5-year-olds, and 4 percent of 6- and 7-year-olds were using booster seats. NHTSA recommends that children who have outgrown child safety seats be properly restrained in booster seats from about age 4 and 40 pounds to at least age 8, unless they are 4 feet 9 inches tall.

National Strategy to Increase Booster Seat Use
In 2002, NHTSA published National Strategy to Promote Booster Seat Use, modeled after the four elements of the BUA campaign. That document called for the expansion of current occupant restraint initiatives to: 1) promote the use of booster seats for 4- to 8-year-old children and 2) increase the use of occupant restraints for all children. A major focus of the strategy is the need to inform the public that the safest occupant restraint for 4- to 8-year-old children is an age/size-appropriate, belt-positioning booster seat.

To obtain national input for developing the strategy, on June 6, 2001, NHTSA announced a public meeting and request for comments in the Federal Register. Many of the tools and tactics that shaped the development of the document came from docket comments, along with recommendations obtained during the public meeting.

New Rule for the Annual Rating of Child Safety Seats
During 2002, NHTSA announced issuance of a final rule to begin a program for the annual rating of child safety seats based on their ease of use by consumers. (In early 2003, NHTSA began posting ease-of-use ratings for child safety seats on the agency’s Web site.) NHTSA also will publish a brochure listing all of its ease-of-use ratings. Under the new rating system, child safety seats, including booster seats, will each be given an overall “A,” “B,” or “C” ease-of-use rating. Such letter grades will also be used to rate seats in each of five categories:

  • Whether the seat is pre-assembled or requires assembly after purchase.

  • Clarity of labeling attached to the seat.

  • Clarity of written instructions on the seat’s proper use.

  • Ease of installation of the seat in a vehicle.

  • Ease of securing a child correctly in the seat.

Full Implementation of LATCH
Lower Anchors and Tethers for Children (LATCH) is a restraint system designed to work independently of the vehicle safety belt system and to make it easier to install a child safety seat correctly. Once it has been fully phased in, NHTSA estimates that the LATCH system will eliminate as much as half of the misuse associated with the incorrect installation of child safety seats.

Since September 1, 2000, all vehicle manufacturers have been required to install a top tether anchor to secure forward-facing child safety seats. Most child safety seats come equipped with a top strap or tether that attaches to the tether anchor.

As of September 1, 2002, nearly all newly manufactured passenger vehicles were also required to have lower anchors installed in at least two rear seating positions. In addition, also as of September 1, 2002, all new child safety seats were required to come equipped with a pair of lower attachments that fasten to the vehicle anchors.

On August 28, 2002, NHTSA Administrator Dr. Jeffrey W. Runge joined with officials from DaimlerChrysler, Graco Children’s Products, and Toys R Us/Babies R Us to call the public’s attention to the new LATCH requirements, to explain their benefits and demonstrate their use. The event received extensive media coverage and boosted public awareness about this important new technology.

Reductions in Child Deaths from Air Bags
From 1996-2001, the rate of child air bag deaths declined a remarkable 96 percent, despite a five-fold increase in the number of passenger air-bag-equipped vehicles on the road, according to the Air Bag & Safety Belt Safety campaign (a Buckle Up America partner organization). Based on the number of rear-seated fatalities and a conservative 30 percent estimated effectiveness of moving children to the rear seat, research has found that more than 1,700 child deaths have been prevented since 1996 (an average of about 340 per year).

Air bags contributed to 1 child fatality for every 8.9 million-passenger air bags in 2000, compared with 1 child fatality for every 870,000 passenger air bags in 1996. In 1996, 26 children were killed by air bags; in 2000, 9 were killed. Nearly all the children killed were either completely unrestrained or improperly buckled in the front seat.

This reduction in deaths is another positive outcome of many of the activities undertaken as part of the Buckle Up America campaign. These activities include the passage of stronger State safety belt and child restraint laws, stepped-up law enforcement, and intense public education about air bag safety.

On September 1, 2003, 20 percent of all new motor vehicles sold in the United States must be equipped with advanced air bag technologies and by September 1, 2006, the requirement will apply to all new light trucks and cars.