The Need to Promote Occupant Restraint Use for Children, Youth and Young Adults

The use of occupant restraints must be reinforced at an early age to reduce the disproportionately high rates of death and injury that teens and young adults experience in motor vehicle crashes. But parents cannot bear the burden by themselves. In communities across the country, health professionals, law enforcement officers, educators, elected officials and public employees, and every adult, not just parents, must develop the social and legal infrastructures necessary to make safety belt use a lifelong habit. (See Appendix A for statistics on the number of children and youth who were killed in 2003 in motor vehicle crashes in each State.)

Passenger vehicle occupant fatality and injury rates (per 100 million vehicle miles traveled [VMT]) have declined slightly during the past 10 years (see Chart 2 below).

Chart 2 Occupant Fatality and Injury Rates, 1994-2003 Per 100 Million VMT, in Passenger Vehicles

Thousands of children and young adults continue to be killed and injured in motor vehicle crashes. A total of 7,034 children and youth from birth to age 20 were killed and approximately 700,000 were injured in passenger vehicle crashes in 2003. Despite widespread public education campaigns promoting the use of proper occupant restraints, nearly 50 percent of children 4 to 7 and 66 percent of children 8 to 15 who were killed in passenger vehicle crashes in 2003 were unrestrained. Charts 3 and 4 illustrate the toll that motor vehicle crashes take on our children and youth, particularly among those 16 to 20.

Adult Safety Belt Use Makes a Difference

Chart 3 Occupant Fatalities in 2003 By Age, in Passenger Vehicles

Chart 4 Occupant Injured in 2003 By Age, in Passenger Vehicles

Research conducted by NHTSA on occupant protection use from 1994 to 2003 confirms there is a strong positive correlation between the restraint use of an adult driver and that of young children in the vehicle. Among fatally injured children from birth to 15, the research revealed the following:

• The probability of being unrestrained was nearly four times greater for infants and toddlers when the child was with an unrestrained driver, versus being with a restrained driver.
  
  
• When drivers were unrestrained, 63 percent of children up to age 3 were also unrestrained; conversely, when a driver was wearing a safety belt, 25 percent of children up to 3
  were unrestrained.
  
  
• Among fatally injured children 4 to 7, 80 percent were unrestrained when the driver was unrestrained; conversely, when the driver was wearing a safety belt, 35 percent of children 4 to 7 were unrestrained.
  
  
• Among fatally injured children 8 to 15, 90 percent were unrestrained when the driver was unrestrained. Conversely, when the driver was wearing a safety belt, 45 percent of children 8 to 15 were unrestrained.

Exhibit 1 illustrates the relationship between driver and child restraint use in crashes in which a child was fatally injured.

Exhibit 1 Driver and Child Restraint Use in Fatal Crashes Involving Children from
Birth to 15, 1994-2003

This strong association between parental and child restraint use speaks to the importance of maintaining ongoing programs and outreach for children, youth, and parents to encourage the use of occupant restraints. NHTSA’s 2003 Motor Vehicle Occupant Safety Survey (MVOSS) further illustrates this need. In the 2003 MVOSS, researchers asked respondents their level of agreement with the statement, “I have a habit of wearing a seat belt because my parents insisted I wear them when I was a child.” Among people 16 to 24, 69 percent either strongly agreed or somewhat agreed with this statement.

Occupant Restraints for All Age Groups Save Lives

Most of the people who die in motor vehicle crashes are vehicle occupants (less than one-fourth of fatalities caused by crashes involve pedestrians, pedalcyclists, and motorcyclists). Safety
belts and child safety seats have been designed to protect drivers and passengers from death and injury during a crash. But these restraints cannot save lives if they are not used. See Appendix B—Passenger Vehicle Occupants Killed in Motor Vehicle Crashes, by State and Restraint Use, 2003.

• In 2003, child restraints saved the lives of 446 children age 4 and under.
  
  
• Child safety seats are 71 percent effective in reducing fatalities among infants (less than 1-year-old) and 54 percent effective for toddlers (1- to 4-years-old) in passenger cars.⁶ For infants and toddlers in light trucks, the effectiveness in reducing fatalities is 58 percent and 59 percent, respectively.
  
  
• Among passenger vehicle occupants over 4 years old, safety belts saved an estimated 14,903 lives in 2003.
  
  
• Booster seat use substantially reduces the risk of injury for children 4- to 8-years-old; however, most children in this age group are currently (and very often incorrectly) restrained by safety belts designed for adults. A recent study by Children's Hospital of Philadelphia (CHOP) found that the use of belt-positioning booster seats lowers the risk of injury to children in crashes by 59 percent, compared with the use of vehicle safety belts.⁷
  
  
• According to NHTSA’s The Economic Impact of Motor Vehicle Crashes 2000, the use of safety belts saved society $585 billion in medical care, lost productivity, and other injury-related economic costs (since 1975).
  
  
• When lap/shoulder safety belts are used properly, they reduce the risk of fatal injury to front-seat occupants riding in passenger cars by 45 percent and the risk of moderate-to-critical injury by 50 percent. For light-truck front-seat occupants, safety belts reduce the risk of fatal injury by
  60 percent and the risk of moderate-to-critical injury by 65 percent.⁸
  
  
• Ejection from passenger vehicles is one of the most harmful events that can happen to people during a crash. In passenger vehicle crashes in which someone died in 2003, 74 percent of occupants who were completely ejected from the vehicle were killed. Safety belts are effective in preventing total ejections. In 2003, in crashes in which someone was killed, only 1 percent of the occupants using restraints were totally ejected, compared with 29 percent of unrestrained occupants.
  
  
• Nearly 30 percent of 16- to 20-year-old occupant fatalities were ejections, compared with 22 percent for the general population, illustrating the need to promote safety belt use in this age group. See Chart 5.

Chart 5 Occupant Fatalities in 2003 By Age and Ejection Status, inPassenger Vehicles

Closing the Gaps in Occupant Restraint Laws Can Save Young Lives

Every State except New Hampshire has adult safety belt laws and all States have child restraint laws requiring drivers to restrain children in approved, age-appropriate child restraint devices or safety belts. In some States, though, these laws do not cover all occupants in all seating positions (rear seats).

In some States, laws concerning the use of child restraint devices cover children only up to age 4, and laws concerning the use of adult safety belts cover only front-seat occupants, leaving some children uncovered by any occupant protection law. For example, in some States, a 10-year-old can ride legally in the back seat without being secured because, at this age and in this seating position, the child is not covered by either the child restraint law or the general (front-seat-only) safety belt law. Appendix C contains information on State child restraint laws.

Primary Enforcement Laws Help Protect Children of All Ages

Although child restraint laws are “primary” laws (laws that allow law enforcement officers to stop vehicles and issue citations for unrestrained drivers or passengers), the safety belt laws in many States are “secondary” enforcement laws. This means that police officers cannot stop drivers for the sole purpose of enforcing the use of occupant restraints. Rather, police officers can write tickets for not using occupant restraints only if they stop vehicles for another driving infraction. See Exhibit 2 for a map of States with primary and secondary laws that were enacted at the time of this publication.

Booster Seat Use Saves Lives and Reduces the Risk of Injury

In 2003, 51 percent of 4- to 7-year-old passenger vehicle occupants who were killed in crashes were restrained. Persuading parents to place their children in any kind of occupant restraint would undoubtedly reduce the number of children killed or seriously injured. In addition, children who have outgrown child safety seats, but are too small to ride safely in adult belts, should be properly restrained in booster seats until they are at least 8 years old, unless they are 4 feet 9 inches tall. If placed in adult safety belts prematurely, children can suffer serious internal injuries, slip out of the safety belt, or be ejected from the vehicle during a crash.

Booster seat use substantially reduces the risk of injury for children 4 to 8; however, most children in this age group are currently restrained by safety belts designed for adults. In the 2002 study by Children’s Hospital of Philadelphia (CHOP), 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.⁹

The CHOP study found that the use of belt-positioning booster seats lowers the risk of injury to children in crashes by 59 percent compared with the use of vehicle safety belts. 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, or back. Yet, such injuries did occur in children who used safety belts alone.⁹

Children who are 4 feet 9 inches tall before their 8th birthday may be ready for adult belts. They can start using safety belts when they can place their backs firmly against the vehicle seat-back cushion with their knees bent over the vehicle seat cushion.

As this booklet is published, 38 States and the District of Columbia had enacted provisions in their child restraint laws requiring the use of a booster seat or other appropriate restraint device by children who have outgrown their forward-facing child safety seats, but who are still too small to use an adult safety belt system correctly. The following jurisdictions have enacted these lifesaving provisions: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Iowa, Illinois, Indiana, Kansas, Louisiana, Maine, Maryland, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming. See Exhibit 2 for a map of States that mandate booster seats or appropriate restraint use by older passengers. A number of other States are considering legislation that would require similar upgrades for booster-seat-age child passengers. For up-to-date information on booster seats and State laws visit www.boosterseat.gov.

Exhibit 2 States With Primary and Secondary Safety Belt Laws, 2003

⁶ Passenger cars are one of the vehicle types included in the passenger vehicle category.

⁷ Durbin, D., Elliott, M., and Winston, F. Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Children in Vehicle Crashes. Journal of the American Medical Association, Vol 289 (21), 2835-2840, June 2003.

⁸ Traffic Safety Facts 2003, Occupant Protection, the National Highway Transportation Safety Administration, DOT 809765.

⁹ Durbin, D., Elliott, M., and Winston, F. Belt-Positioning Booster Seats and Reduction in Risk of Injury Among Children in Vehicle Crashes. Journal of the American Medical Association, Vol 289 (21), 2835-2840, June 2003.