Self-reported seatbelt use, United States, 2002–2010: Does prevalence vary by state and type of seatbelt law?
DOI: 10.1016/j.jsr.2012.10.010
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Summary
This study examines trends in self-reported seatbelt use among U.S. adults from 2002 to 2010, specifically analyzing whether prevalence varies by state and the type of seatbelt enforcement law in place. The research is motivated by the fact that motor-vehicle crashes are a leading cause of death for individuals aged 5–34, and while seatbelts significantly reduce injury and fatality risks, not all states enforce primary seatbelt laws. Primary enforcement allows police to stop drivers solely for unbelted occupants, whereas secondary enforcement permits citations only after a stop for another violation. The authors utilized data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based, random-digit-dialed telephone survey of noninstitutionalized civilian adults aged 18 and older. Data were analyzed from survey years 2002, 2006, 2008, and 2010, as the seatbelt question was not included in 2000 or 2004. Respondents were asked how often they use seatbelts, with prevalence defined as those who reported "always" wearing them. States were stratified by their seatbelt law status in July 2010 (primary vs. secondary enforcement), with New Hampshire, which had no adult seatbelt law, grouped with secondary law states. Prevalence estimates and confidence intervals were calculated using SUDAAN to account for complex sampling designs. Results indicate that national self-reported seatbelt use increased steadily from 80% in 2002 to 87% in 2010. In 2010, seatbelt use was 9 percentage points higher in states with primary enforcement laws (89%) compared to those with secondary laws (80%). State-level usage in 2010 ranged from 62% in North and South Dakota to 94% in California. Eleven states and the District of Columbia achieved usage rates of 90% or higher in 2010, all of which had primary laws. Although usage increased in both law categories, the disparity remained significant; if secondary law states had matched primary law state usage in 2010, an additional 4.6 million adults would have been belted. Notably, 54% of unbelted adults lived in states with secondary laws, despite these states representing only 24% of the adult population. The authors conclude that primary enforcement laws are a proven strategy for increasing seatbelt use and reducing traffic fatalities. They estimate that if all states had primary laws, nearly 450 lives, 12,000 nonfatal injuries, and $1.6 billion in societal costs could have been saved in 2009 alone. The study acknowledges limitations, including the exclusion of wireless-only households (which may overestimate usage as younger adults have lower compliance) and potential social-desirability bias in self-reported data. Despite these limitations, the findings reinforce that primary enforcement and enhanced law enforcement are critical for improving occupant safety.
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| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | Crossref | — | — | 1 | 2026-06-25 |
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| tag | success | vector_similarity | — | — | 6 | 2026-06-26 |
| verify | partial | — | — | — | 1 | 2026-06-26 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified_with_issues.
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- Empirical Findings: observational prevalence