Agency for Healthcare 

Medical Expenditure Panel Survey Research and Quality 

STATISTICAL BRIEF #62 

December 2004 

Characteristics of Persons Who 

Seldom or Never Wear Seat Belts, 

2002 

May Chu 

Introduction 

Seat belt use is the most effective means of reducing fatal and 

nonfatal injuries in motor vehicle crashes.1 Seat belt use increases 

the survival rate of drivers involved in fatal motor vehicle accidents. The U.S. Surgeon General has indicated that safety and 

injury prevention must be among our highest public health 

priorities as a nation. His emphasis includes a national commitment to reducing injuries and deaths from motor vehicle crashes 

involving the failure to use seat belts. 

One of the National Highway Traffic Safety Administration’s goals 

related to motor vehicle occupant injury is to increase national 

seat belt use to 90 percent by the year 2005 (from 68 percent in 

1996).2

 The Healthy People 2010 objectives include a similar goal, 

to increase the use of seat belts from 69 percent (in 1998) to 92 

percent.3 

The nonuse or limited use of seat belts is a risk behavior associated with age as well as various other demographic characteristics. Using data from the Household Component of the 2002 

Medical Expenditure Panel Survey (MEPS-HC), this Statistical 

Brief examines a number of characteristics associated with the 

reported nonuse or limited use of seat belts among persons 

between the ages of 16 and 64 in the U.S. civilian noninstitutionalized population during 2002. All comparisons presented are 

statistically significant at the 0.05 level. 

1 Note from the Surgeon General [Motor Vehicle Occupant Injury]. Satcher, D., 

American Journal of Preventive Medicine, 2001; 21(4S), pp 1–2. http://www.ncbi. 

nlm.nih.gov/books/bv.fcgi?rid=hstat3.chapter.5877. 

2 National Highway Traffic Safety Administration (NHTSA). Presidential Initiative to 

Increase Seat Belt Use Nationwide, available at http://www.nhtsa.dot.gov/people/ 

injury/airbags/Archive-04/PresBelt/index.html. 

3 U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. 2 

vols. Washington, DC: U.S. Government Printing Office, November 2000. 

(Objective 15–19). 

Highlights 

� Overall, among persons 16–64 

years of age in 2002, 87.7 percent reported always or nearly 

always using seat belts when 

driving or riding in a car, 6.9 

percent reported sometimes 

using seat belts, and 5.4 percent 

reported seldom or never using 

seat belts. 

� Young adults were the most 

likely to not (or seldom) use seat 

belts when driving or riding in a 

car. The 19–21 (6.1 percent) and 

22–29 (6.7 percent) age groups 

had the highest rates of seat belt 

nonuse. 

� Males were about three times as 

likely to not (or seldom) use seat 

belts as females within both the 

19–21 and 22–29 age groups. 

� Those in poor/near poor (6.9 

percent) and low income families (6.0 percent) were more 

likely to not (or seldom) use seat 

belts than those in middle/high 

income families (5.0 percent). 

� Those covered by public insurance only (7.6 percent) or lacking insurance coverage entirely 

(7.1 percent) were 1.6 and 1.5 

times as likely, respectively, to 

not (or seldom) use seat belts as 

those with private health insurance coverage (4.8 percent). 

� Those with less than a high 

school education (6.1 percent) 

and those having completed high 

school (7.5 percent) were 1.7 

and 2.1 times as likely, respectively, to not (or seldom) use seat 

belts as those with some college 

education (3.6 percent). 

� Persons living in nonmetropolitan 

areas were more than twice as 

likely to not (or seldom) use seat 

belts as those in large metropolitan areas. 
Findings 

Overall, based on the 2002 MEPS-HC, among persons 16–64 years of age, 87.7 percent reported always 

or nearly always using seat belts when driving or riding in a car (figure 1). Another 6.9 percent reported 

sometimes using seat belts, while 5.4 percent reported seldom or never using seat belts when driving or 

riding in a car. The rate of seat belt nonuse or limited use increases from 3.3 percent within the 16–18 

age group to about twice that rate within the 19–21 (6.1 percent) and the 22–29 (6.7 percent) age groups 

(figure 2). Nonstudents age 19–21 are four times as likely to not (or seldom) wear seat belts as their 

student counterparts (12.1 percent compared to 3.0 percent, data not shown). With respect to gender, 

within the 19–21 and the 22–29 age groups, males were about three times as likely to not (or seldom) use 

seat belts as females (9.2 percent versus 2.9 percent and 10.1 percent versus 3.3 percent, respectively). 

In addition to age and gender, other characteristics are also associated with the nonuse or limited use of 

seat belts. With respect to family income, those in poor/near poor families (6.9 percent) and low income 

families (6.0 percent) were more likely to not (or seldom) use seat belts than those in middle/high (5.0 

percent) income families (figure 3). Seat belt nonuse or limited use also varied by health insurance 

coverage. Those covered by public insurance only (7.6 percent) or lacking insurance coverage entirely 

(7.1 percent) were 1.6 and 1.5 times as likely, respectively, to not (or seldom) use seat belts as those with 

private health insurance coverage (4.8 percent) (figure 4). Variation in seat belt nonuse or limited use by 

education level was evident as well. Those with less than a high school education (6.1 percent) and those 

having completed high school (7.5 percent) were 1.7 and 2.1 times as likely, respectively, to not (or 

seldom) use seat belts as those with some college education (3.6 percent) (figure 5). 

The population density of the area in which people reside is also associated with seat belt nonuse. 

Persons living in small metropolitan areas were 1.7 times as likely to not (or seldom) use seat belts as 

those in large metropolitan areas (figure 6). Those living in nonmetropolitan areas were more than twice 

as likely to not (or seldom) use seat belts as those in large metropolitan areas. 

Data Source 

This Statistical Brief examines the preventive care data that were collected in Rounds 3 and 5 of the 2002 

MEPS-HC. The data set contains a sample of 39,165 persons with a response rate of about 65 percent. 

Missing data were under 1 percent and were excluded from the analysis. 

Definitions 

Poverty-level categories, based on thresholds developed by the U.S. Bureau of the Census 

– If family income is less than 100 percent of the poverty-level income, persons in the family are 

considered to be “poor.” 

– If family income is 100 percent or more but less than 125 percent of the poverty-level income, 

persons in the family are considered to be “near poor.” 

– If family income is 125 percent or more but less than 200 percent of the poverty-level income, 

persons in the family are considered to be “low income.” 

– If family income is 200 percent or more but less than 400 percent of the poverty-level income, 

persons in the family are considered to be “middle income.” 

– If family income is 400 percent or more of the poverty-level income, persons in the family are 

considered to be “high income.” 

Health insurance status 

Respondents were asked about health insurance coverage for themselves and all household members at 

each round of interviewing. Persons were classified according to whether they had any private health 

insurance, had public coverage only, or were always uninsured during the survey year. 

– Any private insurance: This group includes those who had individual or group plan coverage for 

medical or related expenses, including TRICARE (which covers retired members of the uniformed 

services and the spouses and children of active-duty military) and prepaid health plans (such as 

health maintenance organizations) but excluding extra cash coverage plans, medical benefits linked 

only to specific diseases (dread disease plans), and casualty benefit plans (such as automobile 

insurance) at any time during the survey year. 
– Public insurance only: This group includes persons who were not covered by private insurance but 

who were covered by Medicare, Medicaid/SCHIP, and other State and local medical assistance 

programs. 

– Uninsured: Persons with neither public nor private insurance coverage at any time during the survey 

year were classified as uninsured. 

Education level 

A person’s educational attainment was indicated by the number of completed years of education and 

grouped into three categories: 1) less than high school (persons with fewer than 12 completed years of 

education), 2) high school graduate (persons with exactly 12 completed years of education), and 3) at 

least some college (persons with greater than 12 completed years of education). 

Place of residence 

Large metropolitan statistical areas (MSAs) are metropolitan areas with at least one million residents. 

Small MSAs are metropolitan areas with fewer than 1 million residents. Non–MSAs are considered to be 

nonurban places. 

Seat belt use 

The survey question regarding seat belt use was posed as follows:

“When (PERSON) drive(s) or ride(s) in a car, would (PERSON) say (PERSON) wear(s) a seat belt...”

The response categories included Always, Nearly Always, Sometimes, Seldom, Never, or Never drives or 

rides in a car. For the purposes of analysis in this brief, the categories were combined as Always or 

Nearly Always, Sometimes, and Seldom or Never. The “Never drives or rides in a car” category was 

excluded from the analysis (0.8 percent of respondents).

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1406) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS-HC survey design, sample design, and methods used to minimize 

sources on nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. Available on the MEPS Web site at 

http://meps.ahrq.gov/mepsweb/data_files/publications/mr1/mr1.shtml 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. Available on the MEPS Web site at 

http://meps.ahrq.gov/mepsweb/data_files/publications/mr2/mr2.shtml 

Suggested Citation 

Chu, M. Characteristics of Persons Who Seldom or Never Wear Seat Belts, 2002. Statistical Brief #62. 

December 2004. Agency for Healthcare Research and Quality, Rockville, MD. 

http://meps.ahrq.gov/mepsweb/data_files/publications/st62/stat62.pdf 
Expenditure Panel Survey, 2002 

87.7 

6.9 5.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

always/nearly always sometimes seldom/never 

overall % 

Percent 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical 

Figure 1. Use of seat belts among the 16-64 age population, 2002 

Expenditure Panel Survey, 2002 

Figure 2. Seldom or never use seat belts within 

5.2 5.2

3.3 

6.1 

6.7 

7.7 

3.9 

9.2 

10.1 

7.5 

2.9 2.6 

3.3 

2.9 3.0 

0 

2 

4 

6 

8 

10 

12 

19-21 30-44 45-64 

overall males females 

Percent 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical 

the 16–64 age population by age and gender, 2002 

16-18 22-29 
Expenditure Panel Survey, 2002 

by poverty level, 2002 

6.0 

6.9 

5.4 

5.0 

0 

1 

2 

3 

4 

5 

6 

7 

8 

overall poor/near poor low income 

% seldom/never 

Percent 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical 

Figure 3. Non-seatbelt use within the 16–64 age population 

middle/high income 

Expenditure Panel Survey, 2002 

health insurance coverage, 2002 

7.1 

5.4 

4.8 

7.6 

0 

1 

2 

3 

4 

5 

6 

7 

8 

overall any private public only uninsured 

% seldom/never 

Percent 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical 

Figure 4. Non-seatbelt use within the 16–64 age population by 
Expenditure Panel Survey, 2002 

by educational attainment level, 2002 

3.6 

5.4 

6.1 

7.5 

0 

1 

2 

3 

4 

5 

6 

7 

8 

overall <12 years 12 years >12 years 

% seldom/never 

Percent 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical 

Figure 5. Non-seatbelt use within the 16–64 age population 

Expenditure Panel Survey, 2002 

by place of residence, 2002 

8.8 

5.4 

3.8 

6.6 

0 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

overall non-MSA 

% seldom/never 

Percent 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical 

Figure 6. Non-seatbelt use within the 16–64 age population 

MSA-large MSA-small