I. Introduction

A. The Leading Cause of Death for Teens—Motor Vehicle Crashes

The leading cause of death for young people 16 to 20 years old is motor vehicle crashes.¹⁶² The teen traffic crash death rate—more than 5,000 teen deaths per year—is high no matter how it is calculated (per 100,000,000 vehicle miles traveled by teens; per 100,000 licensed teen drivers; or per 100,000 teens in the population). ²⁵⁹ The teen population in the United States has increased 12 percent since 1993 and is expected to increase another 7 percent by 2005. ¹⁶⁷ Unless effective measures are implemented, it can be expected that teen deaths will increase commensurately.

B. Safety Belt Use Among Teens and Contributing Factors

One of the major reasons teens are killed or seriously injured when involved in traffic crashes is lack of safety belt use. A recent safety belt use survey (for 2002) indicates that only 69 percent of 16- to 24-year-olds use safety belts, compared to 82 percent of children and 76 percent of adults 25 to 69. ⁶² The Fatality Analysis Reporting System (FARS) ²⁵⁹ shows that more than two-thirds of teen occupants killed in crashes are not wearing safety belts. An observational survey conducted at high school parking lot entrances found that almost half (46%) of high school students were not belted when riding with an adult, even when half of the adults they were driving with were belted. ⁹⁰

C. Effectiveness of Safety Belts in Reducing Injury and Fatalities in Motor Vehicle Crashes

The wearing of safety belts saved an estimated 14,164 lives in 2002. If 85 percent of passenger vehicle occupants older than age 4 wore safety belts, an additional 2,701 lives could have been saved in 2002, ²⁶⁸ totaling 16,865 lives. Unbelted drivers account for 75 percent of impaired-driving fatalities. Safety belts reduce the chances of being killed or seriously injured in a motor vehicle crash by almost 50 percent, ²⁶⁸ because they prevent ejection from the vehicle, spread forces from the crash over a wide area of the body, allow the body to slow down gradually, and protect the head and spinal cord from serious injury. Most teens are taught this in driver’s education classes and are well aware of the benefits of wearing safety belts.

D. Economic Costs of Not Wearing Safety Belts

Almost 85 percent of all medical costs for crash victims fall on society, and not on the individuals involved. Medical costs for unbelted crash victims are 50 percent higher than for those who are belted. Employer health care spending on crash injuries is nine billion dollars annually. Another nine billion dollars is spent on sick leave and life and disability insurance for crash victims.²⁵⁵

E. Attitudes of Teens Regarding Safety Belt Use

According to the 2003 Motor Vehicle Occupant Safety Survey (MVOSS) sponsored by NHTSA, teen drivers are less likely to wear a safety belt “all the time” (79%) than older drivers (84%).¹⁵ About one-half (47%) of 16-20-year-olds reported they agreed that safety belts “were as likely to harm as to help,” compared to 34 percent of those 21-64. Teens were also more likely to agree that a crash close to home was usually “not as serious” (30%), that wearing a safety belt makes them “worry more about being in an accident” (27%), and that they would feel “self-conscious if they were going against the group norm in wearing safety belts” (30%) than older drivers, according to the MVOSS.

Research also shows that when a driver of a motor vehicle wears a safety belt, a toddler in that vehicle also is restrained 86 percent of the time. However, when the driver is not restrained, toddlers in that vehicle are only restrained 24 percent of the time. ⁶⁴ Thus, parents play an important role in conditioning youth to wear safety belts. The percentage of teens who say in surveys that they “rarely or never wore safety belts” ranges from 8 to 27 percent, depending upon the State. ²⁷ This generation of teenagers mostly have been brought up in child safety and booster seats, and have been exposed to safety belt use laws and education. More teens are subject to GDL laws and policies concerning safety belt use than ever before. Yet teens do not wear safety belts at adult rates.

F. Socioeconomic Impact of Non-Belt Use Among Teens

While it is important that people of all ages wear safety belts, it is especially important for teenagers because their crash rate is extremely high. Every 9 seconds, someone is injured in a traffic crash and every 13 minutes, someone is killed in a traffic crash. Safety belts presently save about 11,000 lives a year in America. Wearing a safety belt is the best protection against drunk, tired, or aggressive drivers. As safety belt use increases from 70 to 85 percent, 5,300 lives will be saved and 100,000 injuries prevented each year. This would save society almost $7 billion dollars each year in direct costs.²⁶⁸

G. The Problem Presented by Teenage Failure to Buckle Up

Teenage safety belt wearing rates from observational and crash-involvement studies consistently show lower wearing rates compared to older adults. Surveys indicate from observations that teens wear safety belts at rates 5-15 percent less often than most older adult age groups. The FARS²⁵⁹ indicates that 63 percent of fatally injured teens in crashes were not wearing safety belts, compared to 55 percent for older adult (21 and older) occupant fatalities.

H. Theories on Why Teens Fail to Buckle Up

There are many theories presented in the scientific literature^{5 181 133} on why teens have low safety belt use rates and high traffic-crash rates. Briefly, among the most frequently cited theories are the following:

• Inexperience: It takes time to learn how to drive a vehicle, how to drive under various circumstances and conditions, and how to react in emergency situations. Thus, the high crash involvement rate for teens. Many teens who don’t wear safety belts have not been in a crash yet and have not experienced the forces and energy involved firsthand.
  
  
• Immaturity: Teens lack the maturity of most adults. Studies show that youth are more likely to engage in riskier behaviors while driving.
  
  
• Immortality: Teens tend to underestimate risks of driving and crashing, and exhibit an “optimistic bias.” They do not think they will get into a crash, so they do not think they need protection if they are involved in a crash.
  
  
• Emotionality: This trait is sometimes termed as “raging hormones.” Teen emotions affect their thinking and subsequent behavior, such as “forgetting” to wear safety belts.
  
  
• Sensation Seeking: Many teens are adventurous and tend to seek out excitement. Not wearing a safety belt is a thrill to some of them.
  
  
• Risk Taking: Many teens take greater risks in all areas of life than their adult counterparts. Because teens do not yet understand the risks involved in certain behaviors, nor the potential consequences, they often tend to act impulsively.
  
  
• Power of Friends: Teens, especially high school students, are greatly influenced by their peers. If peers do not wear safety belts, they probably will not either. If peers chastise them for wearing a safety belt, many teens will unbuckle it.
  
  
• Power of Parents: Parental permissiveness or strictness could be a factor related to changing teens’ behavior. Teens with parents who are persistent and monitor teen belt use are more likely to buckle up.
  
  
• Distractions: There is some evidence that teens are more easily distracted while driving, especially when they have other teen passengers. Note the lower teen safety belt use rates when they are accompanied by passengers (figure 1).

Figure 1: Safety Belt Use and Number of Passengers in the
Vehicle – States with Secondary Laws (Source: FARS)

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I. Key Programs and Interventions

NHTSA’s Integrated Project Teams Report (IPT) on Initiatives to Address Safety Belt Use²⁶¹ discusses various approaches to increasing safety belt use in general. The following strategies described in that report and other reports all have potential for increasing teen safety belt use.

Safety belt use laws. Primary and secondary enforcement laws and the strengthening of other components of the laws (e.g., types of vehicles, locations and ages of occupants covered by laws, the use of fines, and points on the license, etc.) can all have an effect on teen safety belt use^{e.g. 32}. Note the effect of teen wearing rates as a function of their States’ safety belt laws (figure 2).

Figure 2: Safety Belt Use by 16- to 20-Year-Old Drivers in Fatal Crashes as a Function of State Safety Belt Laws (FARS)

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High-visibility enforcement. Special Traffic Enforcement Programs (STEPs), Click It or Ticket mobilizations, and other enforcement programs have been shown to increase safety belt use by teens.

Increased sanctions. Increased sanctions for safety belt violations including increased fines and points on the driver’s license have significant potential to increase teen safety belt use.

Incentive programs. Rewarding teens for buckling up via high school reward programs and insurance incentives have been shown to increase teen safety belt use.

Parental management. Programs for parents to monitor teens more closely and establish restrictions on teen driving, including safety belt use, number of passengers, and curfews also have potential for increasing teen belt use^{e.g. 146}.

School and employer policies. The effects of school and employer policies on safety belt use by teens have not been evaluated, but could have some limited effect.

Vehicle strategies. The effects of reminders, safety belt use monitoring devices, ignition interlock devices and improvements in comfort and convenience on teen belt use need to be explored.

Other public health interventions. Information on the effects of other public health interventions that have worked to change the risky behavior of teens, such as antismoking campaigns, safe sex, and zero tolerance for drinking and driving, may be important to increasing teen safety belt use.

With this as background, there is an urgent need for an accurate definition of the teen safety belt use problem, a summary of the various programs and approaches that have been conducted to increase safety belt use by teens, and recommendations for future research and programs that have the potential to increase safety belt use by teens.