U.S. Department

of Transportation http://www.nhtsa.dot.gov 

National Highway

Traffic Safety 

Administration

DOT HS 809 247 April 2001 

NHTSA Technical Report

The Effectiveness of Head Restraints

in Light Trucks

This document is available to the public from the National Technical Information Service, Springfield, Virginia 22161.
The United States Government does not endorse products or

manufacturers. Trade or manufacturers’ names appear only

because they are considered essential to the object of this report.
Technical Report Documentation Page

1. Report No.

DOT HS 809 247

2. Government Accession No. 3. Recipient’s Catalog No.

4. Title and Subtitle

The Effectiveness of Head Restraints in Light Trucks

5. Report Date

April 2001

6. Performing Organization Code

7. Author(s)

Marie C. Walz

8. Performing Organization Report No.

9. Performing Organization Name and Address

Evaluation Division, Plans and Policy

National Highway Traffic Safety Administration

Washington, DC 20590

10. Work Unit No. (TRAIS)

11. Contract or Grant No.

12. Sponsoring Agency Name and Address

Department of Transportation

National Highway Traffic Safety Administration

Washington, DC 20590

13. Type of Report and Period Covered

NHTSA Technical Report

14. Sponsoring Agency Code

15. Supplementary Notes

16. Abstract

Federal Motor Vehicle Safety Standard 202 has required head restraints in front outboard positions for all

cars manufactured January 1, 1969 and later, for sale in the United States. The National Highway Traffic

Safety Administration extended the standard to include light trucks (pickup trucks, vans, and sport utility

vehicles with Gross Vehicle Weight Rating less than 10,000 pounds) as of September 1, 1991.

NHTSA’s 1982 evaluation of head restraints in passenger cars estimated a 13 percent overall reduction in

injuries to drivers in rear impacts. The current evaluation, based on data from eight states (Florida,

Indiana, Maryland, Missouri, North Carolina, Pennsylvania, Texas, and Utah) estimates that head restraints

reduced overall injury risk in light trucks in rear impacts by a statistically significant 6 percent.

17. Key Words

head restraint; LTV; light truck; rear impact; rearend collision; Federal Motor Vehicle Safety

Standard; FMVSS 202; statistical analysis;

evaluation; NASS CDS; state data

18. Distribution Statement

Document is available to the public through the

National Technical Information Service, Springfield,

Virginia 22161

19. Security Classif. (Of this report)

Unclassified

20. Security Classif. (Of this page)

Unclassified

21. No. of Pages

 78

22. Price

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized

iii

Table of Contents

Executive Summary v

Chapter 1: Introduction and Background 1

1.1 Evaluation of Head Restraints 1

1.2 Results of Earlier Studies 2

Chapter 2: Injury Reduction and Effectiveness 9

2.1 Data Selection 9

2.1.1 Determination of Vehicles 9

 2.1.1.1 NASS CDS Information 9

 2.1.1.2 Manufacturer Information 10

2.1.2 State Data 11

 2.1.2.1 Selection of States 11

 2.1.2.2 Impact Location 11

 2.1.2.3 Vehicle Information 12

 2.1.2.4 Seat Position and Gender 13

 2.1.2.5 Injury Information 13

2.2 Changes in Rear Impact Injury Rates in Pickup Trucks 15

2.3 Comparison of Rear vs Frontal Impacts in Pickup Trucks 21

2.4 Changes in Injury Rates in Passenger Cars 27

2.4.1 Weighting Passenger Car Counts 28

2.4.2 Changes in Rear Impact Injury Rates in Passenger Cars 34

2.5 Comparison of Rear vs Frontal, Passenger Cars vs Pickup Trucks 37

2.6 Computation of Effectiveness Estimates in a 0% to 100% Head Restraint 

Equipped Fleet 41

2.7 Selection of the Best Estimate of Effectiveness of Head Restraints in Pickup 

Trucks 44

Chapter 3: Effectiveness in Rear Impacts, for Specific Populations and Situations 49

3.1 Male vs Female 49

3.2 Older vs Younger 51

3.3 Vehicle Damage Severity 52

3.4 Rear Impact Location - Center vs Off-Center 56

3.5 Integral vs Adjustable Head Restraints 58

3.6 Pickup Trucks with Back Seats vs Pickup Trucks without Back Seats 63

Chapter 4: Benefits and Costs 65
iv

4.1 Injuries Prevented by Head Restraints in Light Trucks 65

4.1.1 National Estimates of Injured Occupants 65

 4.1.1.1 General Estimates System 65

 4.1.1.2 State Data 66

4.1.2 Injuries Prevented 66

4.2 Cost of Head Restraints in Light Trucks 69
v

Executive Summary

Head restraints have been required at the driver’s and right front passenger’s seats on 

passenger cars manufactured January 1, 1969 and later, for sale in the United States, by 

Federal Motor Vehicle Safety Standard 202. The National Highway Traffic Safety 

Administration extended the standard to light trucks (pickup trucks, vans, and sport utility 

vehicles with Gross Vehicle Weight Rating less than 10,000 pounds) as of September 1, 

1991.

The purpose of head restraints is to prevent excessive rearward motion of an occupant’s 

head in rear impacts, with the goal of reducing the occurrence of “whiplash” injuries. 

This report examines the effectiveness, benefits, and costs of head restraints in light 

trucks, based on statistical analyses of state crash data from calendar years 1993 through 

1998.

NHTSA’s National Automotive Sampling System (NASS) Crashworthiness Data System 

(CDS) was used to identify if vehicles were equipped with head restraints, by makemodel and model year. Most vans and sport utility vehicles already had head restraints 

long before September 1, 1991. There are few, if any, comparable vehicles without head 

restraints on which to perform an analysis. Therefore, the present analysis was 

necessarily limited to pickup trucks; specifically, to seven high-sales make-models of 

pickup trucks that shifted from few or no head restraints in one model year to most or all 

head restraints in the next year, in 1990, 1991, or 1992. With some uncertainty, the 

effectiveness results for these seven make-models are also assumed to apply to other light 

trucks, such as vans and sport utility vehicles.

While NASS CDS is valuable for identifying what makes and models had head restraints, 

the number of rear-impact crashes is insufficient for statistically significant comparisons 

of injury rates in rear-impact crashes of selected make-models before and after the 

installation of head restraints. Only state crash data files can provide enough cases for 

those comparisons.

The evaluation was based on eight state files of calendar years 1993-98 - Florida, Indiana, 

Maryland, Missouri, North Carolina, Pennsylvania, Texas, and Utah - that are available 

for analysis at NHTSA, which indicate a vehicle’s damage location (rear vs. other), and 

report the make-model or allow its identification via the VIN. The percent of front-seat 

occupants who had any type of injury in rear-impact crashes was compared for pickup 

trucks two model years before and after the installation of head restraints. This 

effectiveness estimate was adjusted for possible biases due to differences in vehicle age, 

and for the fact that a small percentage of the vehicles in the “Before” group had head 

restraints. The analysis comprised 93,954 cases of occupants involved in police-reported 

rear-impact crashes; of these, 23,807 were injured.

While head restraints are designed to reduce whiplash injury, this report examines the 

change in injury rate overall. This was done for several reasons. Whiplash can involve 
vi

so many potential body regions that, when limiting whiplash to cases with only neck or 

back injury, many true whiplash victims are excluded. Conversely, injuries other than 

whiplash can occur in the neck and back regions, with similar coding descriptions. In 

addition, all eight State files analyzed in this evaluation code injuries according to their 

severity: A = “incapacitating injury,” B = “other visible injury,” C = “possible injury.” 

Most of the symptoms associated with whiplash are not visible injuries, and they are 

usually, but not exclusively, coded AC.@ Only three of the state files, Indiana, 

Pennsylvania, and Utah, provide additional injury information: the body region of the 

occupant’s most severe injury and the type of injury (laceration, fracture, complaint of 

pain, etc.). Since the principal analysis of the data must encompass all eight States, it will 

be based on comparing overall injury rates (A + B + C) before and after the installation of 

head restraints.

The principal finding of this study is that:

• Head restraints reduced overall injury risk in light trucks in rear-impact crashes by an 

estimated 6.08 percent. This reduction is statistically significant (confidence bounds: 

3.49 to 8.65 percent).

Analyses also suggested that:

• Head restraints are more effective in pickup trucks with minor, non-towaway damage 

than in those trucks with towaway damage. Injury risk is reduced by an estimated 

7.75 percent (confidence bounds: 2.59 to 12.84) in pickup trucks with minor damage, 

and by 0.33 percent (confidence bounds: -3.92 to 4.53) in pickup trucks with major 

(towaway) damage.

• In these data, the effectiveness of head restraints in reducing injury was about the 

same for:

- Male and female occupants

- Older and younger occupants

- Centered and off-center rear impacts

- Integral and adjustable head restraints

- Pickup trucks with extended cabs and trucks with a cab that ends directly behind 

the front seat

If every light truck on the road (including all pickups, vans, and sport utility vehicles) had 

head restraints in 1999, a total of 14,882 injuries would have been prevented, relative to a 

fleet of light trucks with no head restraints (confidence bounds range from 8,341 to 

21,694). Since 88.40 percent of light trucks were in fact equipped with head restraints by 

then, the actual number of injuries prevented in 1999 was 13,156 (confidence bounds 

range from 7,373 to 19,177).
Chapter 1: Introduction and Background

The purpose of head restraints is to prevent excessive rearward motion of an occupant’s 

head in rear impacts, with the goal of reducing the occurrence of “whiplash” injuries. 

Head restraints have been required on passenger cars manufactured since January 1, 1969 

for sale in the United States, by Federal Motor Vehicle Safety Standard 202. The 

standard was extended to light trucks (pickup trucks, vans, and sport utility vehicles less 

than 10,000 pounds) as of September 1, 1991. An integral (fixed) head restraint must 

have a height of at least 27.5 inches and an adjustable head restraint, when adjusted to its 

highest position, must have a height of at least 27.5 inches. The height is measured along 

the seat back plane from approximately the hip level to the top of the head restraint.

1.1 Evaluation of Head Restraints

The Government Performance and Results Act (GPRA) of 19931 and Executive Order 

12866 (October 1993) require that government agencies evaluate existing programs and 

regulations. The purpose of such an evaluation is to determine the actual benefits (such 

as injuries prevented and damage avoided) and costs of any additional equipment 

required on vehicles due to regulation.

Many safety standards that were originally applied only to passenger cars have been 

extended to light trucks. For situations in which passenger cars and light trucks become 

involved in similar types of crashes, it is plausible that safety measures effective in cars 

would also be effective in light trucks. However, there are design differences between 

cars and light trucks that could result in differing effectiveness of a safety measure for the 

two types of vehicles. In addition, light trucks tend to be driven in different manners and 

situations than are passenger cars, although this is less true today than in the past. 

Increasingly, light trucks (minivans and sport utility vehicles in particular) are purchased 

as a “family” or personal vehicle. 

The NHTSA Final Regulatory Evaluation (FRE), Extension of Head Restraint 

Requirements to Light Trucks, Buses, and Multipurpose Passenger Vehicles with Gross 

Vehicle Weight Rating of 10,000 Pounds or Less, Federal Motor Vehicle Safety Standard 

2022 noted that in 1968, when FMVSS 202 was issued, light truck sales were a much 

smaller portion of the light vehicle market. In 1970, they made up 15.7 percent of the 

light vehicle (passenger cars and light trucks) market. By 1985, this was up to 28.7 

percent. In 1999, they comprised 37 percent of light vehicles on the road and 49 percent 

of new vehicle sales. The increase in sales of light trucks, and their increased use as 

personal transportation, made it urgent to extend some safety standards, which originally 

applied only to passenger cars, to other vehicles.3

Passenger cars manufactured on or after January 1, 1969 are required to have head 

restraints. Since they had been found to successfully prevent injuries, NHTSA extended 

the requirement to light trucks. On September 25, 1989, a Final Rule was published in 

the Federal Register, extending FMVSS 202 to trucks, multipurpose vehicles, and buses 

with gross vehicle weight rating of 10,000 pounds or less.4
2

This report examines the effectiveness, benefits, and costs of head restraints in light 

trucks over calendar years 1993 through 1998. Prior to the September 1989 publication 

of the Final Rule, only a small portion of new domestic pickup trucks was equipped with 

head restraints. Head restraints were installed in many new pickup trucks between the 

1989 publication and the September 1991 effective date. However, the majority of new 

vans and sport utility vehicles were already equipped with head restraints or high seat 

backs potentially meeting the height requirements of FMVSS 202 as early as model year 

1983.

Two types of head restraints are used to meet the requirements of FMVSS 202. Integral 

head restraints usually consist of a seat back high enough to meet the height requirement 

of 27.5 inches, such as “captain’s chairs” and high back bucket seats. An integral head 

restraint may also consist of a separate, padded metal frame attached to the seatback, with 

open areas that enable the driver to “see through.” Adjustable head restraints use a 

separate pad, which is attached to the back of the seat by one or more sliding metal bars. 

The height of the pad is adjustable, but it must be at least 27.5 inches in the top position. 

Ideally, the occupant should adjust the head restraint to the top of the ears or higher. This 

allows the head’s center of gravity to be captured in a rear impact, reducing the relative 

motion between the head and torso. Some adjustable head restraints have an angular 

rotation feature, which allows the occupant to move the restraint closer to the rear of the 

head.

1.2 Results of earlier studies

NHTSA’s 1982 evaluation of head restraints5 in passenger cars found that integral head 

restraints reduced the overall risk of injury to drivers in rear impacts by 17 percent. 

Adjustable restraints reduced the injury risk by 10 percent. It is important to note that 

adjustable restraints were not extended 75 percent of the time, and therefore did not 

achieve their full potential benefits. With the combination of integral and adjustable head 

restraints on the road, the average overall injury reduction was 13 percent, with 

confidence bounds of 7 to 19 percent. The result, had all passenger cars in 1979 been 

equipped with head restraints, would have been 64,000 injuries prevented.

Integral head restraints were found more effective in passenger cars than were adjustable 

head restraints. One factor which probably contributed to the result was that adjustable 

head restraints are frequently left in their lowest position. Other factors may have been at 

work, such as a lack of position locks, difference in backset position, and vehicle 

characteristics. The report also inferred from the limited available data in head restraint 

height that improved benefits could be realized with higher integral head restraints as 

well as requiring a minimum height requirement in the lowest position for adjustable 

head restraints.

Several recent studies6,7, 8 have reaffirmed the long held theory that female occupants to 

be at greater risk for whiplash injuries than are male occupants. There is uncertainty as to 

what the specific cause of this difference is, but it is presumably due to women having 

smaller neck bones and muscles for supporting heads of nearly the same size as men. 

The difference occurs in spite of the fact that men, on average, are taller than women, and 

therefore less likely to be adequately protected by an adjustable head restraint left in a 
3

low position. A study in the Rochester, New York area found that, accounting for age, 

vehicle damage severity, curb weight, and wheelbase, female drivers had 1.54 times the 

risk of neck pain compared to male drivers.6 One study7 found women to be at higher 

risk regardless of seat position, height, or age. However, another study9 found that the 

higher risk for women appeared to be due to gender-based differences in height, and to a 

lesser extent occupant mass, head circumference, neck strength, and initial angle of the 

torso. Although females are at greater risk, head restraints have been found to offer 

greater reductions in “whiplash” injuries to females.10

Another recent study8 found that neck injuries were more common for drivers whose car 

was hit in the rear center rather than a rear corner, as well as in crashes involving more 

severe damage. The location of the impact, as well as damage severity, may have both 

been related to change in velocity, which could not be directly measured.

Originally, whiplash was thought to be principally the result of extreme hyperextension 

of the neck muscles, tendons, or ligaments, causing them to tear or strain. Today the 

consensus of the biomedical community is that whiplash can occur within the normal 

range of motion. Whiplash injuries may have symptoms that last only a few days or 

weeks. More severe cases of whiplash, which result in longer lasting symptoms, are 

likely to involve neurological damage. However, the injury mechanism is not clearly 

established. One theory states that damage is due to the rapid changes that occur in 

spinal column pressure10.

The height of the head restraint and the horizontal distance from the back of the head 

appear to be important factors in injury reduction. The Insurance Institute for Highway 

Safety (IIHS) published a report in 1999 on neck injuries in rear-impacts11. One 

observation made was that, in a rear impact, if the relative motion of the occupant’s head 

and torso is minimized, it is unlikely that whiplash will occur. Therefore, the best head 

restraints are those that are positioned close to the occupant’s head.

The Farmer, et al study8 used the IIHS ratings in an analysis. Head restraints were rated 

as Good, Acceptable, Marginal, or Poor. Other factors, such as gender, age, direction of 

impact, crash location, repair cost, and damage severity, were also included in the 

analysis. It was found that in the very few models in which head restraints rated “Good,” 

they were associated with less likelihood of neck injury than those rated “Poor,” but the 

difference was only significant among women.

In 1995, NHTSA looked at the relative position of occupant’s heads and head restraints 

for 282 vehicles3. The top of 59 percent of adjustable restraints were at or above the 

occupant’s ear, while for integral restraints the value was 77 percent. Overall, a larger 

percentage of integral restraints were positioned in such a way as to decrease the potential 

of a whiplash injury. In addition, half of the adjustable head restraints were in their 

lowest position. (This is an improvement from the 75 percent observed in the 1982 

study.) The likelihood of a whiplash injury could have been reduced in 75 percent of 

these cases by raising the head restraint.
4

Head restraint position and seat back stiffness were studied in rear impacts.12 The 

authors believe that the whiplash injury mechanism is not fully understood, but the 

motions thought to be involved are:

Ramping Up – the straightening of the spine and lifting upward of the head that 

occurs in the initial to middle period of the impact

Head Retraction – the abrupt backward movement of the head relative to the 

torso, and

Neck Extension – the hyperextension of the neck as the head moves backward.

In their study of head and neck motion, human volunteers were used to examine all three 

motions. In addition, dummies were used to examine neck extension in 25 km/h delta-v 

impacts. The seats used in the testing varied stiffness in the upper (torso) and lower 

(pelvic) area. One additional seat had a head restraint that moved both forward and 

upward in response to force from the occupant in the crash. A standard car seat was also 

included for comparison. The authors found that the Neck Injury Criterion (NIC) 

decreased as seatback stiffness was reduced, especially for the upper area.

However, previous research has shown that if a head restraint is not present or is poorly 

positioned, a weak or yielding seat back allows the torso and head to move rearward in 

unison, thus reducing the occurrence of whiplash.13 Conversely, as a seat is made stiffer, 

head restraints become more effective because, as the seat back restrains the torso, the 

head restraint must be present to restrain the head.

Foret-Bruno14, using an accident database containing 8,000 involved vehicles, concluded 

that as seat backs have become stiffer, head restraints have become more effective at 

reducing neck injuries. When seat backs are weak and bread upon rear impact, the head 

restraint may not become involved in altering occupant kinematics.

A report15 by Maher reviewed earlier papers and examined head restraint measurements. 

It was found that, in some cases, the horizontal displacement increased as the vertical 

height of the head restraint increased. Maher recommends higher seat backs or head 

restraints.

Head restraint design varies a great deal, and clearly affects the ability of the restraint to 

reduce injury. In addition, the seat adjustment and stiffness also appear to be a factor in 

injury reduction. Height requirements, both for the highest as well as lowest position for 

adjustable restraints, could further reduce injuries. Research continues in an attempt to 

improve head restraints as well as the seats to which they are attached.

It is the consensus of the biomechanics community that whiplash injuries, due to rear 

impact crashes, occur because of the movement of the head and neck relative to the torso. 

Research has shown that reducing the gap between the occupant’s head and the head 

restraint reduces the movement of the head relative to the torso, which would lower the 

rate of “whiplash” injuries.

As noted earlier, the FMVSS 202 currently requires the head restraint have a minimum 

height of 27.5 inches in the highest position. There is currently no US requirement for 
5

the lowest position. Integral head restraints, of course, have only one position. 

Adjustable head restraints are frequently left in the lowest position, effectively defeating 

the purpose of the standard. In contrast, requirements adopted in 1998 require European 

vehicles to be equipped with head restraints that are at least 29.5 inches in the lowest

position – higher than the US requirement for the highest position.6

On January 4, 2001, NHTSA published a proposed rulemaking16 to upgrade FMVSS 202. 

The proposed new standard would require head restraints to be higher, closer to the head, 

and available in rear as well as front outboard positions. Specifically, the proposed new 

rule would require:

• rear outboard head restraints.

• front seat head restraints in all passenger vehicles (passenger cars, pickups, vans, 

and utility vehicles) to be capable of achieving a height where the top of the head 

restraint is least 800 mm (31.5 inches) above the H-point (which represents the 

normally seated 50th male hip point).

• a lower limit on height - all required head restraints (both front and back seat) 

could not be less than 750 mm (29.5 inches) from the H-point. 

• for front outboard seating positions, the distance between the back of the head 

form representing the position of a 50th percentile head, in a normally seated 

position, and the head restraint (defined as backset) be no farther than 50 mm (2 

inches) in any adjustment position.

The height requirements are intended to prevent whiplash injuries by requiring that head 

restraints be high enough, and closer to the head, to limit the movement of the head and 

neck. Improvements made as a result of the upgraded standard would be expected to 

reduce injuries overall.
6

Chapter 1 Footnotes

1. Government Performance and Results Act of 1993. Public Law 103-62. August 3, 

1993.

2. Final Regulatory Evaluation: Extension of Head Restraint Requirements to Light 

Trucks, Buses, and Multipurpose Passenger Vehicles with Gross Vehicle Weight 

Rating of 10,000 Pounds or Less, Federal Motor Vehicle Safety Standard 202, 

NHTSA, Office of Plans and Policy, Office of Regulatory Analysis and Evaluation, 

July, 1989.

3. Head Restraints - Identification of Issues Relevant to Regulation, Design, and 

Effectiveness. National Highway Traffic Safety Administration, Office of 

Crashworthiness Standards, Light Duty Vehicle Division. November 4, 1996.

4. Federal Register, Vol. 54, September 25, 1989, p. 39183.

5. Kahane, Charles J. An Evaluation of Head Restraints: Federal Motor Vehicle Safety 

Standard 202. Technical Report No. DOT HS 806 108. Washington” National 

Highway Traffic Safety Administration, 1982.

6. Chapline, Janella F., Ferguson, Susan A., Lillis, Robert P., Lund, Adrian K., 

Williams, Allan F. “Neck Pain and Head Restraint Position Relative to the Driver’s 

Head in Rear-End Collisions.” Accident Analysis and Prevention, Vol. 32, No. 2, 

2000, pp.287-298.

7. Jakobsson, Lotta, Lundell, Bj`rn, Norin, Hans, Isaksson-Hellman, Irene. “WHIPS B

Volvo=s whiplash protection study.” Accident Analysis and Prevention, Vol. 32, No. 

2, 2000, pp.307-320.

8. Farmer, Charles M., Wells, JoAnn K., Werner, John V. “Relationship of Head 

Restraint Positioning to Driver Neck Injury in Rear-end Crashes.” Accident Analysis 

and Prevention, Vol. 31, No. 6, 1999, pp. 719-728.

9. Siegmund, Gunter P., Heinrichs, Bradley E., Wheeler Jeffrey B. “The Influence of 

Head Restraint and Occupant Factors on Peak Head/Neck Kinematics in Low-Speed 

Rear-End Collisions.” Accident Analysis and Prevention, 31, No. 4, 1999, pp 393-

407.

10. O’Neill, Brian. “Head Restraints – the Neglected Countermeasure. Accident Analysis 

and Prevention 32, No. 2, March 2000, pp.143-150.

11. Insurance Institute for Highway Safety. “Special Issue: Neck Injuries in Rear-End 

Crashes.” Status Report, Vol. 34, No. 5, May 22, 1999.

12. Watanabe, Yoichi, Ichikawa, Hideaki, Kayama, Osamu, Ono, Koshiro, Kaneoka, 

Koji, Inami, Satoshi. “Influence of Seat Characteristics on Occupant Motion in Low-
7

Speed Rear Impacts.” Accident Analysis and Prevention, Vol. 31, No. 6, 1999, pp. 

243-250.

13. Molino, Louis. Determination of Moment-Deflection Characteristics of Automobile 

Seat Backs. Light Duty Vehicle Division, Office of Crashworthiness Standards, 

National Highway Traffic Safety Administration, November 25, 1998.

14. Foret-Bruno, J.Y; Dauvilliers, F; Tarriere, C. Influence of The Seat and Head Rest 

Stiffness on the Risk of Cervical Injuries in Rear Impact. Paper 91-S8-W-19, 

Proceedings of the13th ESV Conf. in Paris, France, US DOT, NHTSA, HS 807 991, 

1991

15. Maher, Jason. “Report Investigation the Importance of Head Restraint Positioning in 

Reducing Neck Injury in Rear Impact.” Accident Analysis and Prevention, Vol. 31, 

No. 6, 1999, pp. 299-306.

16. Preliminary Economic Assessment and Regulatory Flexibility Analysis: FMVSS No. 

202 Head Restraints for Passenger Vehicles. National Highway Traffic Safety 

Administration, Plans and Policy, Office of Regulatory Analysis and Evaluation. 

December, 2000.
8
9

Chapter 2: Injury Reduction and Effectiveness

Analyses of data from eight states indicate that head restraints in pickup trucks have 

reduced the frequency of injuries in rear-impact crashes. State data from 1993 through 

1998, the six most recent years available, were examined. Overall, the introduction of 

head restraints in pickup trucks reduced injuries in rear-impact crashes by about six

percent. This effectiveness estimate takes into account the age effect of vehicles, as well 

as the fact that some vehicles had head restraints before the requirement took effect.

2.1 Data Selection

2.1.1 Determination of Vehicles

FMVSS 202 required light trucks and vans less than 10,000 pounds to be equipped with 

head restraints as of September 1, 1991. While head restraints were required for model 

year 1992 and later light trucks (manufactured after September 1, 1991), many of these 

vehicles came equipped with head restraints as either standard or optional equipment in 

earlier years. It was necessary to determine the presence or absence of head restraints of 

each light truck by model year.

The National Automotive Sampling System (NASS) Crashworthiness Data System 

(CDS) collects data on a sample of approximately 5,000 police-reported towaway crashes 

annually. Among the data collected are information on head restraint presence and type 

(integral or adjustable), and the Vehicle Identification Number (VIN). The CDS data 

collection manual states, “The head restraints can be of any design but must meet the 

requirements of FMVSS 202.”1 The VIN was used to determine the make, model, and 

model year of light trucks and vans in the CDS data for calendar years 1988 through 1999 

(the most recent year currently available).

2.1.1.1 NASS CDS Information

In order to evaluate the effectiveness of head restraints, it would be necessary to compare 

injury rates in vehicles with head restraints to the same make and model vehicles before 

having been equipped with head restraints. CDS data were used to determine which 

specific models went from having a small (no more than 25) to a large (at least 75) 

percent of head restraint equipped vehicles in successive years. In addition, it was 

required that there be at least two years of data for both the low and high percentage 

model years. Five vehicles, all domestic pickup trucks, met these criteria:

Chevrolet C/K / GMC Sierra Series

Chevrolet S/T / GMC Sonoma Series

Dodge D/W

Dodge Dakota

Ford Ranger

In the CDS data, approximately five percent of the Chevrolet C/K and GMC Sierra trucks 

had head restraints in model years 1990 and 1991. The Chevrolet S/T and GMC Sonoma 
10

trucks were about 20 percent equipped in those years. All of these General Motors trucks 

were 100 percent head restraint equipped from model year 1992 on (as noted in the data 

as well as required by FMVSS 202).

Dodge Dakotas and D/W series trucks had no head restraints through 1989. From 1990 

on, all Dakotas were equipped with head restraints. The Dodge D/W 100 series were also 

shown in the CDS data to be equipped 100% of the time from 1990 on. Data on the 

Dodge D/W 200/300 series, however, had only two observations for model year 1990 –

one with a head restraint and one without. From 1991 on, all Dodge D/W series were 

equipped with head restraints. It was decided that, when the Dodge D/W 200/300 series 

trucks could be distinguished from other Dodge D/W trucks, model year 1990 would not 

be used. Instead, model years 1991 and 1992 date would be used as the “equipped” 

years. While this violated the requirement for using successive years, it was felt that it 

would be the best way to most accurately represent the data while permitting a larger set 

of data for analysis.

CDS data showed Ford Rangers having head restraints approximately 24 percent of the 

time for model years 1989 and 1990. The average for model years 1991 and 1992 was 

94% equipped. Since FMVSS 202 required all vehicles built September 1, 1991 and later 

to be equipped with head restraints, the unequipped Rangers must have been model year 

1991’s or early 1992’s.

All Chevrolet/GMC and Dodge pickups in the given model years were included in the 

analysis. Although involving different models (Chevrolet C/K and S/T, GMC Sierra and 

Sonoma, and Dodge D/W and Dakota), all pickup trucks by the respective manufacturers 

became predominately equipped with head restraints in the same model year. Ford 

Rangers are included in the present analysis, but the F150/250/350 Series pickups are not. 

Head restraints were introduced in the F-Series pickups more slowly, so that there is no 

clear transition year. Thus, we excluded them from the analysis.

Vans and sport utility vehicles are also considered “Light Trucks” and are covered under 

the revision of FMVSS 202. However, those vehicles that were in production in model 

year 1992 already had head restraints on most or all vehicles in all earlier years of 

production. There are no comparable vehicles without head restraints on which to 

perform an analysis. Therefore, the present analysis is necessarily limited to pickup 

trucks.

2.1.1.2 Manufacturer Information

Data on presence and type of head restraint by vehicle make and model year were 

requested from the domestic manufacturers (DaimlerChrysler, Ford, and General 

Motors). It was necessary to verify the data obtained from NASS CDS. It was also 

desirable to further investigate, particularly vehicles other than pickup trucks, for any 

possible additional with/without head restraint comparisons. The data from the 

manufacturers validated what had been concluded from the NASS CDS data.
11

2.1.2 State Data

The injury rate for each type of pickup would be determined using the two years of data 

before head restraints were installed, and compared to rate during the two years following 

installation. While NASS CDS is valuable for identifying what makes and models had 

head restraints, the number of rear-impact crashes is insufficient for statistically 

meaningful analysis of injury rates in this analysis. Because specific vehicles (rather than 

“all passenger vehicles”) were used, a two-year span would not provide sufficient data for 

a reliable estimate of injury rate. Furthermore, in NASS CDS, only data on crashes 

involving at least one vehicle towed from the scene are collected. While this is useful for 

investigating more serious crashes, the majority of injuries in rear-impact crashes occur 

in non-towaway crashes. Using the NASS CDS data would require an adjustment to 

account for non-towaway crashes. State data are available as a more inclusive source to 

use in examining patterns of injuries in rear-impact crashes.

2.1.2.1 Selection of States

In order to perform the analysis of injury rates in rear impact crashes, there were several 

requirements of the data. It would be necessary to determine make, model, and model 

year of vehicles. This could be done by either having those variables present on the file, 

or decoding the VIN if it were present. It would also be necessary to determine the 

impact location for the vehicle, in order to determine which vehicles sustained a rear 

impact.

NHTSA currently has data from 17 states available for analysis. Of these, California, 

Georgia, Illinois, New Mexico, Ohio, and Washington do not code a point of impact for 

the vehicle. Kansas did not code a vehicle impact point before 1997. Michigan and 

Virginia code neither a VIN nor the vehicle make or model. The remaining eight state 

files were used in the analysis: Florida, Indiana, Maryland, Missouri, North Carolina, 

Pennsylvania, Texas, and Utah. These states had a combined population of 73,512,899 as 

of July, 1999, about 27 percent of the total population of the United States. According to 

1998 data, the most recent available, these eight states account for 9,452,980 registered 

pickup trucks, about 26 percent of the national total. State data from calendar years 1993 

to 1998 were analyzed.

2.1.2.2 Impact Location

Each state has its own way of coding data. For example, some states code impact 

location by clock point positions, while others use descriptions such as “front” or “left 

rear.” The following table shows how rear impact was defined by each state. Also noted 

are the definitions used for “frontal impact,” since these were used in the analysis as a 

control group.
12

State Rear Impact Frontal Impact

Florida Point of Impact 7, 8, 9 Point of Impact 1, 2, 14

Indiana Initial Point of Impact 5, 6, 7 Initial Point of Impact 1, 2, 3

Maryland Initial Impact and Vehicle 

Damage Area1 both 7-12, or one 

is blank and the other is 7-12

Initial Impact and Vehicle Damage 

Area1 both 1-4,15,16, or one is 

blank and the other is 1-4, 15, 16

Missouri Vehicle Damage Area 7, 8, 9 Vehicle Damage Area 1, 2, 14

North Carolina TAD1 10-13 TAD1 1-4

Pennsylvania Initial Impact Point 5, 6, 7 Initial Impact Point 1, 11, 12

Texas Damage Scale B--, LB-, RB- Damage Scale F--, LF-, RFUtah Damage Areas 1 and 2 both 7-9, 

or one is blank and the other 7-9

Damage Areas 1 and 2 both 1-3, or 

one is blank and the other 1-3

Rear and frontal crashes were defined solely using the above criteria. Data were not 

limited to two vehicle crashes, so it is possible that some collisions involved impacts 

and/or damage to more than one area of a vehicle. The damage area coded on the state 

file is the one used for the analysis.

2.1.2.3 Vehicle Information

Six of the eight state data files used in the analysis contain the VINs. This enables the 

make, model, and model year of the vehicle to be accurately determined based on a 

program developed by NHTSA staff. For five of these states (Florida, Maryland, North 

Carolina, Pennsylvania, and Utah), this was the sole method of determining vehicle 

information.

Missouri also includes the VIN on its data file. However, it is missing or invalid a large 

percentage of the time. Therefore, the Vehicle Type and Make variables on the Missouri 

file were used, in addition to the VIN, to select vehicles for inclusion in the analysis. For 

those cases where the VIN was not valid, vehicles with a Vehicle Type of 17 (Pickup 

Truck) and Make of Chevrolet, GMC, or Dodge were included. Recall that, except for 

Ford, all pickup trucks of a specific manufacturer in the selected model years were 

included in the analysis. Since there is no Model variable on the Missouri file, Fords 

could not be selected this way, since there was no way to distinguish between Rangers 

and the F-Series trucks.
13

Indiana and Texas files do not contain VIN. Vehicles in the Indiana file were selected 

using the variables Vehicle Type (2, Pickup Truck), Make, and Model. For Chevrolet, 

GMC, and Dodge, all vehicles of the appropriate Vehicle Type were included, even when 

the model was unknown. Vehicles in Texas were selected based on the Body Type (30, 

Pickup and 38, Pickup with Camper) and the Make/Model (MK_MDL) variables. Since 

make and model are combined in a single variable, this meant that a vehicle coded as 

Body Type “pickup truck” with, for example, “GMC Not Listed or unknown” or “ Dodge 

Truck” as the Make/Model, were included in the analysis. However, only those coded 

specifically as “Ford Ranger” could be included.

2.1.2.4 Seat Position and Gender

Five of the states collect data in such a way that permits analysis by both gender and seat 

position. That is, both drivers and right front passengers (occupants in seating positions 

that now require head restraints) are documented regardless of whether or not an injury 

occurred. Florida records right front passengers even when they are uninjured, but 

records gender for drivers only. Both Indiana and Missouri record data on right front 

passengers only when they are injured. This prohibits their use in determining injury 

rates.

Therefore, the data used in the present analysis contains drivers and right front passengers 

for all states except Indiana and Missouri, where only drivers are analyzed. The only 

exception is when gender is considered, at which time Florida right front passengers are 

excluded.

Another factor worth noting is that the analysis put no age or height requirements on the 

occupant data - all drivers and, where possible, right front passengers were included. 

Presumably, a head restraint would add protection only for those occupants whose head 

was above the actual seat back. Smaller stature occupants (including children) would not 

be affected by the addition of a head restraint, and consequently their injury rates would 

remain unchanged regardless of the presence of head restraints. For this reason, 

effectiveness estimates generated by this analysis can be considered conservative, since 

some proportion of the occupants should be unable to show improvement in terms of 

injury reduction. On the other hand, Indiana and Missouri could have relatively higher 

effectiveness rates than they would have if right front passengers were able to be 

included. Since the analysis in these states is drivers only, many of the younger, shorter 

occupants [viz., child passengers] are excluded, providing a larger proportion of 

occupants with injury reduction potential.

2.1.2.5 Injury Information

Head restraints are designed to prevent “whiplash” injuries in rear impact collisions. 

Whiplash, however, is not in itself an injury, but a body motion that causes a group of 

symptoms difficult to define and even more difficult to encode in data files. The most

direct symptoms of whiplash are neck pain and stiffness. Nevertheless, symptoms can 

occur in many other areas of the body due to spinal cord or nerve involvement. 

Therefore, headache, sight and hearing disturbances, pain or weakness in the arms and/or 

upper back, and concussion-like symptoms often accompany whiplash. Visible, 
14

superficial injuries due to contact with vehicle components, such as lacerations, 

contusions, and abrasions, are generally not called “whiplash.”

All eight State files analyzed in this evaluation code injuries according to their severity: 

A = “incapacitating injury,” B = “other visible injury,” C = “possible injury.” Most of 

the symptoms associated with whiplash are not visible injuries, and they are usually, but 

not exclusively, coded AC.@ Only three of the files, Indiana, Pennsylvania, and Utah, 

provide additional injury information: the body region of the occupant’s most severe 

injury and the type of injury (laceration, fracture, complaint of pain, etc.).

Since the principal analysis of the data must encompass all eight States, it will be based 

on comparing overall injury rates (A + B + C) before and after the installation of head 

restraints.

Whiplash can involve so many potential body regions that, when limiting whiplash to 

cases with only neck or back injury, many true whiplash victims are excluded. 

Conversely, injuries other than whiplash can occur in the neck and back regions, with 

similar coding descriptions. It is not possible to determine conclusively that all minor 

neck and/or back injuries indicate whiplash, while all other types of injury imply no 

whiplash.

Another complication with an analysis of whiplash injuries lies in how injury data tend to 

be coded. When the state data files include injury information, data on only a single 

injury is included for each occupant. Typically, this is the most serious injury. Head 

injuries, for example, are considered more serious than neck or back injuries. Therefore, 

if head restraints are indeed preventing and minimizing whiplash injuries, this could 

result in less severe injuries being coded where more severe injuries were being 

prevented. For example, a case of whiplash before the installation of head restraints 

might have involved a severe headache and a stiff neck, both common symptoms of 

whiplash. Conceivably, this same crash, once head restraints were installed, might have 

resulted only in the stiff neck. However, in the first case, a head injury would have been 

noted in the data file, while in the second, a neck injury. Thus, what in reality would be 

an occurrence of a head restraint reducing injury severity would look, in the data, as an 

increased rate of neck injury.

In addition, NHTSA’s state data are obtained from the police accident report. Medical or 

hospital records are not examined. Whiplash injuries could potentially be overlooked due 

to a delayed onset of symptoms. Because of these limitations of data coding, the 

preferred method is to focus on overall injury rate, rather than trying to determine 

specific cases of whiplash.

The data extracted from each state, for the selected pickup trucks, are presented in 

Exhibit 2-1. Shown are the numbers of uninjured and injured occupants for the two 

model years before the vehicles were equipped with head restraints, labeled “Before, 

Uninjured” and Before, Injured,” respectively. Also shown are the (uninjured and 

injured) occupants for the two years after the vehicles were equipped with head restraints, 

labeled “After, Uninjured” and “After, Injured,” respectively. Data for both rear and 

frontal impacts are shown. The final column shows the total number of occupants, by 
15

head restraint, crash type, and injury status, in all of the eight states included in the 

analysis.

Exhibit 2-1: Number of Occupants in Selected Pickup Trucks, 2 Model Years 

Before and 2 Model Years After Head Restraint Installation, by Injury Status and 

Crash Type, by State (State Data, Calendar Years 1993 - 1998)

Florida Indiana MarylandMissouriNorth 

Carolina

Pennsyl

-vania

Texas Utah Total of 

all Eight 

States

Rear Impact

Before,

Uninjured

3,335 5,248 674 4,170 3,022 1,743 12,909 919 32,020

Before,

Injured

1,628 638 221 693 1,000 883 6,253 184 11,500

Before, Total N 4,963 5,886 895 4,863 4,022 2,626 19,162 1,103 43,520

After,Uninjured 4,460 5,369 741 4,841 3,635 1,743 16,345 993 38,127

After,Injured 1,975 533 201 719 1,036 791 6,859 193 12,307

After,Total N 6,435 5,902 942 5,560 4,671 2,534 23,204 1,186 50,434

Frontal Impact

Before,

Uninjured

7,390 11,406 1,654 9,483 6,619 5,883 30,427 2,098 74,960

Before,

Injured

3,051 1,863 512 1,902 1,683 2,552 11,614 404 23,581

Before, Total N 10,441 13,269 2,166 11,385 8,302 8,435 42,041 2,502 98,541

After,Uninjured 9,147 10,703 1,673 9,612 7,848 5,414 35,115 2,274 82,786

After,Injured 3,482 1,488 545 1,834 1,835 2,299 12,676 472 24,631

After,Total N 12,629 12,191 2,218 11,446 9,683 7,713 47,791 2,746 106,417

2.2 Changes in Rear Impact Injury Rates in Pickup Trucks

In order to estimate the effectiveness of head restraints in preventing injuries in rear 

impact crashes, it was necessary to compute injury rates both before and after installation. 

The injury rates are calculated by dividing the number of injured occupants by the total 

number of occupants in the appropriate group (e.g. occupants in rear impact crashes in 

Florida) as shown here:

“Before” Injury Rate = 0.3280

(1,628 3,335)

1,628

=

+

The injury rates for rear impacts, both before and after being equipped with head 

restraints, are presented (as percentages) for each state in Exhibit 2-2.
16

Exhibit 2-2: Injury Rates Before and After Vehicles were Equipped with Head 

Restraints, Rear Impacts, in Selected Pickup Trucks (State Data)

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas UtahEight 

States

Rear

Before 32.80 10.84 24.69 14.25 24.86 33.63 32.63 16.68 26.42

After 30.69 9.03 21.34 12.93 22.18 31.22 29.56 16.27 24.40

% reduction 6.44 16.68 13.59 9.25 10.79 7.17 9.42 2.45 7.65

The effectiveness, measured as the reduction in injury rate, is also shown, with a positive 

number indicating an improvement (a decrease in the injury rate). This is calculated by 

taking the difference between the two rates, and dividing by the earlier rate:

Effectiveness (E) = 

1

1 2

p

p − p

where pi = the percent of injured occupants as:

i=1 for the group without head restraints (“Before”) and

i=2 for the group with head restraints (“After”)

Note that this is mathematically equivalent to:

E = 

p

p

1 -

1

2

So, for example, in Florida, the effectiveness is determined as:

E = 1 - 











0.3280

0.3069 = 0.0644

Thus, in Florida, a reduction of 6.44 percent is seen in rear impacts after the introduction 

of head restraints.

The rates for the combined total for the eight states are shown in the final column. These 

were computed by summing the data for all states, by impact type, head restraint and 

injury status, and calculating the injury rates as above.

Note that the injury rates are presented as rounded to two decimal places. The percent 

change has been calculated using the original data, without rounding, so that calculations 

using the presented rounded data might give slightly different results. This will be true 

throughout this report – values presented in any formula will be rounded, for 

convenience, but results will have been computed using unrounded data, and therefore 

may differ slightly from calculations made using values in the formula.

(1)
17

The initial step in evaluating the effectiveness of head restraints in reducing injuries in 

rear impact crashes is to examine the change in injury rate as a result of having head 

restraints. One method would be to look at the combined state data. As shown in the last 

column of Exhibit 2-2, injuries in rear impact crashes were 7.65 percent lower after the 

vehicles were equipped with head restraints.

Looking at the combined state data, while providing useful information, has several 

flaws. In examining the data for each state, it can be seen that the injury rates vary 

widely from state to state. For example, in rear impact crashes before the installation of 

head restraints, Pennsylvania has an injury rate of 33.63 percent, more than three times 

that of Indiana’s rate of 10.84 percent. It is important to note that each state has its own 

reporting threshold for police-reported crashes. Some require a certain dollar amount of 

damage, which varies from state to state. In the states used for this analysis, this amount 

ranges from $250 in Texas to $750 in Indiana. Some states (Pennsylvania and Utah in 

the current analysis) require that one of the vehicles be towed from the accident scene, 

regardless of the dollar amount involved.

These differing thresholds result in very different injury rates across states, and also 

contribute (along with state population differences) to very different raw counts of 

injured and involved occupants. These differences can be out of proportion to the actual 

differences in the “sizes” of the states. For example, in rear impact crashes before head 

restraints were installed, Texas had over 6,000 injured occupants, while Maryland and 

Utah had about 200 each (see Exhibit 2-1), even though Texas is not 30 times as “large” 

as Maryland in term of population, Vehicle Miles Traveled (VMT), number of registered 

pickup trucks, etc. As another example, Maryland with a 1998 population of 5.17 million 

and Missouri with a population of 5.47 million are similar in “size,” but Missouri has 

more than five times the number of occupants in the data shown in Exhibit 2-1. Clearly, 

the states with lower counts (regardless of the reason) will wind up contributing far less 

to any estimate calculated by simply summing the data across states.

An alternative process would be to consider each state as an estimate of head restraint 

effectiveness. The percent reduction for each state, as noted in Exhibit 2-2, would be 

used as each state’s effectiveness estimate. When the simple arithmetic average of these 

is taken, we find a 9.19 percent decrease in the injury rate in rear impact crashes. This 

method, however, gives equal weight to each of the states. This is undesirable, since the 

states differ greatly in size.

States vary in countless ways. Clearly there are size differences, but also worth 

considering are the differences found in the data. States with less variable data give a 

more precise picture of whatever factor is being examined. Therefore, a more 

statistically sound method of determining a single estimate using the data from these 

eight states would be to combine them in such a way as to give greater weight to those 

states with ‘better,’ more accurate estimates.

A variance for each injury rate is first calculated as:
18

N

p p

p

(1 ) 2 × −

s =

where p=percent of occupants injured 

N= number of occupants involved

Therefore, in Florida, where 4,963 occupants (see Exhibit 2-1) were involved in rear 

impacts before head restraints were installed, and 32.80 percent of them were injured, the 

variance of this statistic would be computed as:

4963

0.3280 × (1− 0.3280)

= 0.000044412

 

Exhibit 2-3 presents the variances for the eight state states, for the injury rates both before 

(p1) and after (p2) the installation of head restraints, in rear impacts.

Exhibit 2-3: Variance of Injury Rates and Effectiveness Estimates, and Coefficients 

for Determining Variance based Estimate, Rear Impacts

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah

Rear

Variance p1 0.000044 0.000016 0.000208 0.000025 0.000046 0.000085 0.000011 0.000126

Variance p2 0.000033 0.000014 0.000178 0.000020 0.000037 0.000085 0.000009 0.000115

Variance E 0.0007 0.0022 0.0055 0.0020 0.0012 0.0014 0.0002 0.0084

1/Var(E) 1495.78 464.08 182.92 496.00 836.36 715.70 5791.39 118.52

Coefficient 0.1481 0.0459 0.0181 0.0491 0.0828 0.0709 0.5734 0.0117

Recall that effectiveness was calculated as:

E = 

p

p

1 -

1

2

The variance of the effectiveness is equivilent to the variance of p2/p1, or (1 -

effectiveness). The linear approximation of the variance of the ratio p2/p1 is calculated, 

separately for each state, as:

2

1

2

4

1

2 2

2 2 1 2

p p

p p p

E

s s

s +

×

=

where σ

2

E=the variance of the effectiveness estimate

p1=injury rate before installation of head restraints

p2=injury rate after installation of head restraints

σ

2

pi=variance of the injury rate (percent injured)

(2)
19

The variance for each state’s effectiveness estimates, for rear impacts, are included in 

Exhibit 2-3. Also presented is the inverse of the variance (1/σ

2

) for each state. If these 

inverses are summed, and the inverse of the total taken, a constant is obtained. A 

coefficient for each state is then derived, by dividing this constant by the variance of the 

effectiveness, for each state. Note that these coefficients would sum to one. It can be 

shown mathematically that using coefficients that are inversely proportional to the 

variances results in the linear combination of a set of estimates with minimum variance. 

These coefficients are presented in Exhibit 2-3 as well.

Weighting each effectiveness estimate by its respective coefficient, and summing across 

states, gives an overall estimate of head restraint effectiveness, emphasizing the states 

with less variable data. Using this method, head restraints are estimated to be 9.25 

percent effective in rear impacts.

To determine the significance of this, a z-score is computed as:

z = 

s E

E

First the variance of the overall effectiveness estimate, which has been weighted by the 

coefficients, must be determined as:

∑=

= ×

8

1

2 2 2

i

E i i s c s

where ci=coefficient for statei

σi

2

=variance of the estimate for statei,

Since the coefficient is equal to the constant divided by the variance for each state, this is 

equal to:

∑=

















8

1

2

4

2

i

i

i

K

s

s

where K=constant

This simplifies to

∑=

8

1

2

2 1

i

i

K

s

Since the constant is the inverse of the sum of the inverses of the variances across states, 

this is actually equal to the constant. Therefore, the z-score is calculated as:
20

K

E

z =

where E=Effectiveness estimate

K=constant

For rear impacts, this would be calculated as:

0.0000990026

0.0925

z = = 9.30

which is statistically significant.

The eight states differ greatly in size and population, which logically should be reflected 

in calculating an effectiveness estimate. Since the data involve pickup trucks, weighting 

each state’s change in injury rate by the number of registered pickup trucks in the state 

would be advisable. This information for 1998 (the most recent year available) is 

presented in Exhibit 2-4.

Exhibit 2-4: Number of Registered Pickup Trucks, by State, 1998

Florida 1,425,339

Indiana 1,025,244

Maryland 435,292

Missouri 943,717

North Carolina 1,168,132

Pennsylvania 1,010,419

Texas 3,120,226

Utah 324,611

When each state’s change in injury rate is weighted by registered pickup trucks in that 

state, the average decrease in injuries in rear impact crashes is 9.62 percent, calculated as:

E = 

N

∑ni pi

where ni = number of registered pickup trucks in state i

pi = percent change from before head restraints installed to after, in state i

N = total number of registered pickup trucks in the eight states in the analysis

Therefore,

(3)
21

1,425,339 1,025,244 435,244 943,717 1,168,132 1,010,419 3,120,226 324,611

(1,168,132 10.79) (1,010,419 7.17) (3,120,226 9.42) (324,611 2.45)

(1,425,339 6.44) (1,025,244 16.68) (435,244 13.59) (943,717 9.25)

+ + + + + + +

















× + × + × + ×

× + × + × + × +

= 9.62 percent

This is a statistically significant reduction, with a t-score of 8.01. The value of the t-score 

is obtained using a SAS computer program2. The numbers of injured and uninjured 

occupants in rear impact crashes, both before and after the installation of head restraints, 

were input, along with the number of registered pickups, for each state. The rate of 

injury before and after head restraint installation, and the change (decrease) in the injury 

rate, were calculated from these data. Then a PROC MEANS was performed, with 

output including the mean (9.62), t-score (8.01), and standard error of the estimate (1.20). 

The mean reported by this SAS program is identical to the decrease in the injury rate as 

calculated above.

With 7 degrees of freedom (using eight states, n – 1 = 7), a t-score larger than 1.895 

indicates a significant reduction at the two-sided 90 % (or one-sided 95 %) confidence 

level; larger than 2.365, significance at the two-sided 95 % level; larger than 2.998, 

significant at the one-sided 99 % level.

Notice that the effectiveness estimate determined by weighting the data by the number of 

registered pickup trucks (9.62) is very close to the value arrived at when the data are 

weighted according to the variance (9.25).

2.3 Comparison of Rear vs Frontal Impacts in Pickup Trucks

For various reasons, there is a tendency to report crashes involving older vehicles only 

when they are more serious, such as when an injury is involved. Because of this, a larger 

proportion of crashes in the “earlier” or “before head restraint” years would tend to 

involve injuries for any given model year. Left unchecked, this “vehicle age effect” 

would tend to show a decrease in injury rates regardless of any additional safety benefits 

that were present.3

Therefore, it is necessary to have a control group for comparison, so it can be stated with 

confidence that any observed improvements are actually due to the presence of head 

restraints rather than an artifact of the data. In this analysis, frontal impacts are used as 

the control group. These pickup trucks did not get air bags or, as far as we know, any 

other modification that would have significantly improved frontal crashworthiness during 

the model years considered in this study. While the number of frontal impacts is larger 

than rear impacts, and tend to be more serious, the rate of injury would be expected to 

change in a similar manner regardless of type of crash, if there were no outside factors 

influencing only one crash type. If the injury rates change in different ways, particularly 

if they do so consistently across a set of several states, it can be said that these differences 

are due to some outside factor. In this case, we assume that factor to be the presence of 

head restraints.
22

Important to notice in Exhibit 2-2 is that, in every state, injuries in rear impacts occurred 

less frequently in vehicles after head restraints were installed. Certainly, this is not 

unexpected, since the equipped vehicles are also newer vehicles. As mentioned earlier, 

crashes involving older vehicles tend to be reported only when there are injuries, which 

often results in a lower injury rate for newer vehicles for no other reason than the age of 

the vehicle.

The equivalent data for frontal impacts are shown in Exhibit 2-5. These data are based 

on the frontal crash counts shown in Exhibit 2-1. Note that two of the eight states show 

an increased injury rate in frontal impacts. Rear impacts consistently showed a decrease 

in injury rate, even when the rate in frontal impacts increase. Additionally, in every state 

in which frontal impacts showed a decreased injury rate, rear impacts showed a larger 

decrease. This definitely suggests that head restraints may very well be effective in 

lowering the rate of injury in rear impact crashes.

Exhibit 2-5: Injury Rates Before and After Vehicles were Equipped with Head 

Restraints, Frontal Impacts, and Effectiveness Estimates, in Selected Pickup 

Trucks, by State (State Data)

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah Eight 

States

Frontal

Before 29.22 14.04 23.64 16.71 20.27 30.25 27.63 16.15 23.93

After 27.57 12.21 24.57 16.02 18.95 29.81 26.52 17.19 23.15

% reduction 5.65 13.07 -3.95 4.09 6.52 1.48 3.99 -6.45 3.28

In order to quantify this effectiveness more accurately, changes in frontal impacts were

compared to those calculated for rear impacts. When the data for the eight states are 

combined using Formula 1, there is a 3.28 percent decrease in the injury rate in frontal 

crashes after head restraints are installed. Using the same calculation methods as shown 

earlier on rear impact crashes, a z-test on these data results in a value of 4.18. Recall that, 

in rear impacts, there was a 7.65 percent decrease in the injury rate. Observation of the 

data showed that rear impacts experienced a greater improvement in injury rate than did 

frontal impacts. The effectiveness estimates permit a comparison of those differences.

Calculations could also be done using the method which combines individual state 

estimates based on the variance of the estimate. As was done for rear impacts in Section 

2.2, the variance is calculated for the injury rates before (p1) and after (p2), as well as for 

the effectiveness estimate, for each state. These are shown in Exhibit 2-6 for frontal 

impacts. Also shown, and used in the calculations, are the value for the inverse of the 

effectiveness estimate and the coefficient used for combining the data across states.
23

Exhibit 2-6: Variance of Injury Rates and Effectiveness Estimates, and Coefficients 

for Determining Variance based Estimate, Frontal Impacts

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah

Frontal

Variance p1 0.000020 0.000009 0.000083 0.000012 0.000019 0.000025 0.000005 0.000054

Variance p2 0.000016 0.000009 0.000084 0.000012 0.000016 0.000027 0.000004 0.000052

Variance E 0.0004 0.0008 0.0031 0.0008 0.0008 0.0006 0.0001 0.0043

1/Var(E) 2552.90 1258.48 321.85 1213.51 1250.07 1780.61 9018.76 230.41

Coefficient 0.1448 0.0714 0.0183 0.0688 0.0709 0.1010 0.5117 0.0131

Using this method, the effectiveness estimate for frontal impacts is 4.53 percent. The zscore is determined as:

0.0000567325

0.0453

z = = 6.01

The third method used to determine effectiveness weights the data by the number of 

registered pickup trucks in the state. When this method is employed, using Formula 3, 

the effectiveness estimate is 4.55 percent. The resulting t-score is 2.91.

Notice that, again, the result obtained by weighting the data by registered pickup trucks is 

very similar to the estimate when data are weighted according to their variances.

There is no intuitive reason to expect head restraints to reduce injuries by more than a 

small amount, if any, in frontal crashes. It is possible that, in some frontal crashes, the 

occupant could rebound and derive some benefit from the head restraint. In addition, a 

vehicle can be involved in both a frontal and a rear impact in the same crash. The impact 

location could be coded as ‘Frontal Impact,’ but the head restraint would provide 

protection at least during the rear-impact portion of the crash. Nevertheless, any 

protection head restraints provide in vehicles determined to be in frontal crashes would 

be, at best, a second order effect.

As evidenced by the significant results for both methods above, however, clearly 

something is going on. The most likely cause is the age of the vehicle and its impact on 

reporting a crash to the authorities. In order to determine a valid measure of effectiveness 

of head restraints, this age effect needs to be eliminated. Using frontal impacts as a 

control group for the rear impacts, a more accurate measure of the effectiveness of head 

restraints can be determined. Since the purpose of head restraints is to prevent whiplash 

and related injury in rear impact crashes, frontal crashes are an appropriate control.

The effectiveness of head restraints, as measured by injury reduction in rear impacts 

controlled for by frontal impacts, is calculated for the eight states combined as:
24

p

p

p

p

E 1-

21

22

11

12 











































=

Where pij = percent of injured occupants (injury rate)

 i = impact location (1=rear, 2=front)

 j = status of head restraint installation (1=before, 2=after)

Combining the eight states into a single estimate gives:

E = 

















































−

23.93

23.15

26.42

24.40

1 = 4.52 percent

Therefore, when the data from the eight states are combined, it is estimated that head 

restraints reduce injuries in rear impact crashes (when controlled for frontal crashed) by 

4.52 percent. 

The z-score for this is 3.29, which is significant, is calculated as follows:

s

E

z =

where:

1 22

22

1 21

21

1 12

12

1 11

1 11 1 1 1

n p

p

n p

p

n p

p

n p

p

s

−

+

−

+

−

+

−

=

106,417 0.2315

(1 0.2315)

98,541 0.2393

(1 0.2393)

50,434 0.2440

(1 0.2440)

43,520 0.2642

(1 0.2642)

×

−

+

×

−

+

×

−

+

×

−

=

0.000189 = 0.01374

Therefore:

3.29

0.01374

0.0452

z = =

In order to derive an effectiveness estimate based on the variances of the estimates, 

Formula 2, as introduced in section 2-2, is used. 

2

1

2

4

1

2 2

2 2 1 2

p p

p p p

E

s s

s +

×

=

(4)
25

In this case, however, pFA/pFB (percent in the “After” group injured in frontal crashes 

divided by the percent in the “Before” group injured in frontal crashes) would be 

substituted for p1 in the formula. Similarly for the rear impacts, as p2. The variances for 

these are equivalent to the variances for the respective effectiveness estimates, which 

have already been calculated and presented in Exhibits 2-3 and 2-6. The effectiveness for 

each state is calculated using the same method as was used for the combined state data 

above, using Formula 4:

p

p

p

p

E 1-

21

22

11

12

i 











































=

The eight states’ individual effectiveness estimates, and the values used for their 

calculation, are presented in Exhibit 2-7. The front and rear effectiveness data have been 

presented earlier, in Exhibits 2-2 and 2-5, but are repeated here together for reference.

Exhibit 2-7: Injury Rates Before and After Vehicles were Equipped with Head 

Restraints, Rear and Frontal Impacts, and Effectiveness Estimates, in Selected 

Pickup Trucks, by State (State Data)

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah Eight 

States

Rear

Before 32.80 10.84 24.69 14.25 24.86 33.63 32.63 16.68 26.42

After 30.69 9.03 21.34 12.93 22.18 31.22 29.56 16.27 24.40

% reduction 6.44 16.68 13.59 9.25 10.79 7.17 9.42 2.45 7.65

Frontal

Before 29.22 14.04 23.64 16.71 20.27 30.25 27.63 16.15 23.93

After 27.57 12.21 24.57 16.02 18.95 29.81 26.52 17.19 23.15

% reduction 5.65 13.07 -3.95 4.09 6.52 1.48 3.99 -6.45 3.28

E 0.84 4.16 16.67 5.39 4.57 5.77 5.65 8.36 4.52

Using this methodology, the effectiveness estimate of head restraints in rear impacts, 

controlled for by frontal impacts, is 5.14 percent, with a z-score of 3.99.

The effectiveness estimate determined by weighting the data by registered pickup trucks 

is calculated as:

E = 

N

n Ei ∑ i

where ni = number of registered pickup trucks in state i

Ei = Effectiveness estimate in state i

N = total number of registered pickup trucks in the eight states in the analysis

So that:

(5)
26

1,425,339 1,025,244 435,244 943,717 1,168,132 1,010,419 3,120,226 324,611

(1,168,132 4.57) (1,010,419 5.77) (3,120,226 5.65) (324,611 8.36)

(1,425,339 0.84) (1,025,244 4.16) (435,244 16.87) (943,717 5.39)

+ + + + + + +

















× + × + × + ×

× + × + × + × +

= 5.23 percent

Calculated using the SAS procedure as described above, the standard error is 1.18. The tscore is calculated as

4.43

1.18

5.23

= = =

s

E

t

and is statistically significant.

In summary, it was shown that the injury rates in both rear and frontal impacts were 

lower in the two years following the installation of head restraints in pickup trucks. 

While the decrease in the rate for rear impact injures was expected, because of head 

restraints, and larger than the decrease in frontal impacts, both were significant. Thus, in 

order to determine the actual effectiveness of head restraints in rear impact crashes, 

controlling for the decrease in injury rate in frontal impacts would be necessary. While 

this process of calculating an effectiveness estimate is the most complex thus far, it is 

also the one that best accounts for the needs of the data.

This was done using three alternative methods - combining all state data into a single 

estimate, weighting estimates based on the variance of the data, and weighting based on 

the number of registered pickup trucks. All three methods gave similar results (4.52, 

5.14, and 5.23, respectively).

The estimate of the effectiveness derived from combining the data across states has the 

same shortcomings as the earlier ones calculated using this method. The estimates based 

on treating each state as an individual estimate, and weighting according to the variances 

of those estimates, are statistically sound but intuitively lacking. The final method uses 

an estimate for each state, weighting each of these sample values by the state’s number of 

registered pickup trucks. This minimizes the effect of differing reporting thresholds in 

each state, while providing a means for those states with larger numbers of pickup trucks 

to have a greater impact on the estimate.

The two methods that weight the estimate for each state (by variance or by registered 

pickup trucks) result in extremely similar estimates overall. There is little practical 

difference in selecting one over the other. Therefore, the method which weights the data 

by registered pickup truck counts will be considered the preferred one, since it simpler as 

well as being more straightforward to comprehending the meaning of the final estimates.

For the remainder of this report, the variance weighted estimates will not be presented. 

Because they provide a simple but flawed alternative, the estimates based on combining 

all the data into a single estimate will be calculated, but significance testing will not be 
27

performed. It is important in any research report to establish the selection of method, 

including whatever procedure is used to determine estimates, early in the analysis. 

Otherwise, if numerous procedures are performed, statistically significant results would, 

at some point, be expected by chance alone. To avoid this, it is important to logically 

establish a single method of determining the estimates. Therefore, weighting data by the 

number of registered pickup trucks will be considered the preferred method.

2.4 Changes in Injury Rates in Passenger Cars

The previous estimate controls for the vehicle age effect by using frontal crashes of 

pickup trucks as a control group. However, the results could still be biased if the vehicle 

age effect exhibited in frontal crashes is not the same as the one that occurs in rear 

impacts. It might be better to derive a vehicle age effect specifically for rear impacts, by 

considering passenger cars. Cars, unlike the pickup trucks, already had head restraints by 

model year 1969. They did not significantly modify their head restraints or other 

components that affect rear-impact crashworthiness during the model years considered in 

our study, 1988-93. (Although the maximum and minimum heights of head restraints in 

passenger cars have increased since the standard initially took effect, there is no evidence 

that there was a noteworthy change in the height of passenger car head restraints during 

this time frame.) In other words, if the injury rates in rear impacts of passenger cars, 

measured the same way as in pickup trucks, show any important reductions for later vs. 

earlier cars, this is due to the age effect, and it can be deducted from the observed injury 

reduction in pickup trucks in order to obtain the true effect of head restraints.

Recall that pickup truck manufacturers introduced head restraints in different years. 

Therefore, the “Before” and “After” model years, in this analysis, vary by manufacturer. 

The “After” years for Dodge are 1990 and 1991; for Ford Rangers, 1991 and 1992; and 

for Chevy and GMC pickups, 1992 and 1993. In each case, the “Before” model years are 

the two model years proceeding the “After” years. In order to account for any possible 

changes in passenger car injury rates, it would be necessary to examine the changes over 

the same sets of model years. Accordingly, injury rates in passenger cars were 

determined for the same pairs of years as had been done for the pickup trucks, by state 

and type of crash (rear or frontal).

Note that the data involving pickup trucks were designated as “Before” or “After” 

regarding head restraint installation (based on manufacturer), and then combined into 

“Before” and “After” groups. Passenger cars, as a comparison group, do not belong to a 

“Before” or “After” groups based on head restraint status, but are classified according to 

model year only.

Let us define three overlapping cohorts of passenger cars:

C The “Dodge truck comparison group” consists of all passenger cars (of any 

manufacturer) of model years 1988-91, with MY 1988-89 considered as the 

“Before” group and MY 1990-91 counted as “After. ”
28

C The “Ford Ranger comparison group” consists of all passenger cars of model 

years 1989-92, with MY 1989-90 considered as the “Before” group and MY 

1991-92 counted as “After.”

C The “GM truck comparison group” consists of all passenger cars of model years 

1990-93, with MY 1990-91 considered as the “Before” group and MY 1992-93 

counted as “After.”

Injury rates for passenger cars, by state and crash type, for each set of “Before” and 

“After” years (in each of the three comparison groups), are presented in Exhibit 2-8. 

Note that the pair of “After” years in the first group, 1990-91, is the same set of years in 

the “Before” group in the last set of data. Also, the data as presented here are not 

mutually exclusive, so that the data for model year 1990 passenger cars, for example, are 

incorporated as part of the “After” data in the first set, and in the “Before” data in the 

remaining two sets. In most cases, the cars had some “After” vs. “Before” reduction in 

the reported injury rate (a “vehicle age effect”), although the reductions were typically 

smaller than for the trucks in the rear impacts (Exhibit 2-2).

Simply looking at the injury rates in passenger cars, however, is not appropriate. The car 

data need to be combined and weighted so they will have the same model-year mix as the 

truck data in Exhibits 2-1, 2-2, and 2-5. That will make the vehicle-age effect exhibited 

by the cars directly analogous to the vehicle age effect that is presumably hidden in the 

truck injury rates of Exhibits 2-1, 2-2, and 2-5. In other words, the cases for the three 

comparison groups of cars must be weighted so that they will make the same contribution 

to the total as the three make-model groups of trucks did in Exhibits 2-1, 2-2, and 2-5. 

Specifically, since the number of Dodge truck cases in our study was small, the car cases 

in the Dodge truck comparison group will have low case-weight factors. Since the 

number of GM truck cases was large, the cars in the GM truck comparison group will 

have higher case weights.

2.4.1 Weighting Passenger Car Counts

First, the raw counts of front outboard passenger car occupants for the Dodge truck, Ford 

Ranger, and GM truck comparison groups, by injury status (injured or uninjured), impact 

location (rear or frontal), “Before/After” status, and state were obtained. These data, 

which are the basis for the injury rates shown in Exhibit 2-8, are presented in Exhibit 2-9. 

Rear and frontal impacts for these crashes were then combined, and are shown in Exhibit 

2-10 for both cars and trucks. The purpose of weighting the passenger car counts is to 

obtain comparable weights based on the model year of the vehicle. Combining the rear 

and frontal impacts allows for a more robust procedure. While the raw data for passenger 

cars are the same as in Exhibit 2-9, later calculations performed on the data are more 

easily followed when the car data are presented both separated by injury status as well as 

combined.

The next step was to form a ratio of the number of trucks to the number of cars, for each 

state and manufacturer (for pickup trucks) or its comparison group (for passenger cars), 

by “Before” or “After” head restraint status. These ratios were then multiplied by the 
29

appropriate corresponding data, as presented in Exhibit 2-9. The calculations were 

performed as follows:

NWijk = Cijk

Ci

Ti N

N

N

×











where NW = Weighted number of passenger car cases

NT = Number of trucks

NC = Number of cars

i = model year grouping (before, after)

j = impact location (rear, frontal)

k = injury status (injured, uninjured)

For example, in Florida, there were 2,058 Dodge pickup trucks in the “Before” groups, 

and 265,346 passenger cars in the “Before” portion of the Dodge comparison group. The 

ratio for this cell would be 2,058/265,346 = 0.00776. If each passenger car case in the 

Florida “Before” Dodge truck comparison group is weighted by 0.00776, the weighted 

number of cars will be exactly the same as the actual number of trucks: 2,058. So every 

passenger car count in the 1988/90 vs 1990/91 “Before” group would be multiplied by 

the ratio described above. Four values, then, would be multiplied by each ratio – both 

injured and uninjured occupants, rear and frontal impacts, in the proper grouping for that 

state. In the present example, these calculations, for the Dodge comparison group in the 

state of Florida, are:

Before, Rear Impact, Uninjured: 49,209 x 0.00776 = 382

Before, Rear Impact, Injured: 32,746 x 0.00776 = 254 

Before, Frontal Impact, Uninjured: 120,758 x 0.00776 = 937 

Before, Frontal Impact, Injured: 62,633 x 0.00776 = 486 

Cells were then summed across model year combinations – the “Before, Rear Impact, 

Uninjured” are totaled for the three “Before/After” time periods, which coincide with the 

“Before/After” model years for the three manufacturer groups of pickup trucks. The 

results of this weighting are presented in Exhibit 2-11. Notice that this results in the 

same total number of weighted car cases as was seen for corresponding totals of pickup 

trucks. The overall model-year mix of the weighted car cases is exactly the same, in each 

state, as the model-year mix of the actual truck cases.
30

Exhibit 2-8: Injury Rates and Percent Changes in Passenger Cars, by Sets of 

“Before” and “After” Model Years for each Pickup Manufacturer, by State

Florida Indiana Maryland Missouri North 

Carolina

PennsylvaniaTexas Utah

Any Injury, Dodge Truck Comparison Group

Rear Impact

1988-1989 39.96 17.50 40.63 20.90 30.52 45.29 44.41 23.60

1990-1991 38.41 16.93 38.07 20.13 28.99 44.18 43.96 22.80

Percent 

reduction

3.88 3.26 6.30 3.68 5.01 2.45 1.01 3.39

Frontal Impact

1988-1989 34.15 13.82 26.94 19.35 24.49 38.55 34.56 20.57

1990-1991 33.28 12.81 26.17 18.46 23.66 37.49 34.85 20.33

Percent 

reduction

2.55 7.31 2.86 4.60 3.39 2.75 -0.84 1.17

Any Injury, Ford Ranger Comparison Group

Rear Impact

1989-1990 39.19 17.15 39.38 20.78 29.91 45.06 44.33 23.28

1991-1992 38.20 16.86 37.53 19.46 28.35 43.65 43.99 23.23

Percent 

reduction

2.53 1.69 4.70 6.35 5.22 3.13 0.77 0.21

Frontal Impact

1989-1990 33.57 13.31 26.56 18.76 23.94 37.88 34.57 20.29

1991-1992 33.25 12.24 26.53 18.36 23.36 36.80 34.87 20.49

Percent 

reduction

0.95 8.04 0.11 2.13 2.42 2.85 -0.87 -0.99

Any Injury, GM Truck Comparison Group

Rear Impact

1990-1991 38.41 16.93 38.07 20.13 28.99 44.18 43.96 22.80

1992-1993 37.82 16.57 38.06 19.24 28.07 43.76 44.42 24.02

Percent 

reduction

1.54 2.13 0.03 4.42 3.17 0.95 -1.05 -5.35

Frontal Impact

1990-1991 33.28 12.81 26.17 18.46 23.66 37.49 34.85 20.33

1992-1993 33.30 11.77 26.58 18.61 23.14 36.55 35.70 20.87

Percent 

reduction

-0.06 8.12 -1.57 -0.81 2.20 2.51 -2.44 -2.66
31

Exhibit 2-9a: Number of Front Outboard Occupants in Passenger Cars, by Model 

Year, Injury Status, and Crash Type, Dodge Truck Comparison Group, by State 

(State Data, Calendar Year 1993 – 1998)

1988/89 vs 

1990/91

Florida Indiana Maryland Missouri North

Carolina

PennsylvaniaTexas Utah

Rear Impact

Before,Uninjured 49,209 28,327 10,827 26,962 56,386 20,908 51,577 9,111

Before,Injured 32,746 6,010 5,718 7,123 24,770 17,311 41,196 2,815

After,Total N 81,955 34,377 16,545 34,085 81,156 38,219 92,773 11,926

After,Uninjured 47,039 25,710 10,847 27,237 50,847 19,595 53,030 9,393

After,Injured 29,330 5,239 5,357 6,863 20,757 15,507 41,604 2,774

After,Total N 76,369 30,949 16,204 34,100 71,604 35,102 94,634 12,167

Frontal Impact

Before,Uninjured 120,758 48,799 32,528 70,204 150,297 75,489 149,732 27,582

Before,Injured 62,633 7,827 14,318 16,840 48,755 47,363 79,093 7,146

Before,Total N 183,391 56,626 46,846 87,044 199,052 122,852 228,825 34,728

After,Uninjured 106,247 40,748 30,882 64,778 127,125 65,665 149,841 27,183

After,Injured 52,991 5,985 13,451 14,661 39,409 39,378 80,143 6,938

After,Total N 159,238 46,733 44,333 79,439 166,534 105,043 229,984 34,121

Exhibit 2-9b: Number of Front Outboard Occupants in Passenger Cars, by Model 

Year, Injury Status, and Crash Type, Ford Ranger Comparison Group, by State 

(State Data, Calendar Year 1993 – 1998)

1989/90 vs 

1991/92

Florida Indiana Maryland Missouri North

Carolina

PennsylvaniaTexas Utah

Rear Impact

Before, Uninjured 47,614 26,814 10,902 26,865 53,209 20,425 52,263 9,295

Before, Injured 30,689 5,551 5,570 7,049 22,701 16,753 41,625 2,820

Before, Total N 78,303 32,365 16,472 33,914 75,910 37,178 93,888 12,115

After,Uninjured 50,906 26,260 10,797 28,378 54,966 19,370 53,517 9,227

After,Injured 31,469 5,326 5,222 6,858 21,751 15,007 42,026 2,792

After,Total N 82,375 31,586 16,019 35,236 76,717 34,377 95,543 12,019

Frontal Impact

Before, Uninjured 111,616 44,347 31,628 67,295 137,928 70,832 150,558 27,805

Before, Injured 56,405 6,811 13,918 15,540 43,405 43,199 79,547 7,078

Before, Total N 168,021 51,158 45,546 82,835 181,333 114,031 230,105 34,883

After Uninjured 110,248 39,671 29,664 62,324 131,035 62,122 145,433 25,676

After Injured 54,912 5,531 13,044 14,014 39,942 36,165 77,855 6,618

After,Total N 165,160 45,202 42,708 76,338 170,977 98,287 223,288 32,294
32

Exhibit 2-9c: Number of Front Outboard Occupants in Passenger Cars, by Model 

Year, Injury Status, and Crash Type, GM Truck Comparison Group, by State 

(State Data, Calendar Year 1993 – 1998)

1990/91 vs 

1992/93

Florida Indiana Maryland Missouri North

Carolina

PennsylvaniaTexas Utah

Rear Impact

Before,Uninjured 47,039 25,710 10,847 27,237 50,847 19,595 53,030 9,393

Before,Injured 29,330 5,239 5,357 6,863 20,757 15,507 41,604 2,774

Before,Total N 76,369 30,949 16,204 34,100 71,604 35,102 94,634 12,167

After,Uninjured 60,023 26,487 11,383 29,074 61,940 19,576 54,294 9,261

After,Injured 36,502 5,259 5,600 6,925 24,167 15,231 43,400 2,928

After,Total N 96,525 31,746 16,983 35,999 86,107 34,807 97,694 12,189

Frontal Impact

Before,Uninjured 106,247 40,748 30,882 64,778 127,125 65,665 149,841 27,183

Before,Injured 52,991 5,985 13,451 14,661 39,409 39,378 80,143 6,938

Before,Total N 159,238 46,733 44,333 79,439 166,534 105,043 229,984 34,121

After,Uninjured 123,284 37,775 29,757 59,312 141,807 60,445 140,487 24,715

After,Injured 61,561 5,037 13,325 13,564 42,697 34,813 77,986 6,518

After,Total N 184,845 42,812 43,082 72,876 184,504 95,258 218,473 31,233
33

Exhibit 2-10: Number of Front Outboard Occupants in Pickup Trucks by 

Manufacturer, and Passenger Cars by Model Year; by Head Restraint Status and 

State (State Data, Calendar Year 1993 – 1998)

[To determine weighting factors for Cars]

Raw Counts, Pickup Truck Front Outboard Occupants

Florida Indiana MarylandMissouri North

Carolina

PennsylvaniaTexas Utah

Dodge

Before 2,058 2,544 466 2,377 1,496 1,806 6,665 399

After 1,591 2,003 442 2,186 1,240 1,358 6,248 533

Ford

Before 4,444 1,463 812 2,915 3,461 2,581 9,008 959

After 5,321 1,557 932 3,823 3,849 2,499 12,803 963

Chevy/GMC

Before 8,902 15,148 1,783 10,956 7,367 6,674 45,530 2,247

After 12,152 14,533 1,786 10,997 9,265 6,390 51,944 2,436

Raw Counts, Passenger Car Front Outboard Occupants

Florida Indiana MarylandMissouri North

Carolina

PennsylvaniaTexas Utah

1988/89 vs 1990/91

Before 265,346 90,963 63,391 121,129 280,208 161,071 321,598 46,659

After 235,607 77,682 60,537 113,539 238,138 140,145 324,618 46,288

1989/90 vs 1991/92

Before 246,324 83,523 62,018 116,749 257,243 151,209 323,993 46,998

After 247,535 76,788 58,727 111,574 247,694 132,664 318,831 44,313

1990/91 vs 1992/93

Before 235,607 77,682 60,537 113,539 238,138 140,145 324,618 46,288

After 281,370 74,558 60,065 108,875 270,611 130,065 316,167 43,422
34

Exhibit 2-11: Weighted Passenger Car Cases

Florida Indiana MarylandMissouri North

Carolina

PennsylvaniaTexas Utah Total of

Eight

 States

Rear Impact

Before

Uninjured 3,018 6,275 542 3,828 2,590 1,516 9,960 724 28,459

Injured 1,916 1,287 273 978 1,080 1,219 7,846 216 14,816

After

Uninjured 4,004 6,358 589 4,433 3,240 1,517 12,090 828 33,066

Injured 2,451 1,268 288 1,067 1,273 1,181 9,619 257 17,407

Frontal Impact

Before

Uninjured 6,965 10,087 1,563 9,309 6,591 5,183 28,305 2,123 70,143

Injured 3,506 1,505 684 2,133 2,063 3,144 15,091 542 28,673

After

Uninjured 8,412 9,218 1,581 9,374 7,553 4,776 31,805 2,258 74,996

Injured 4,197 1,248 701 2,132 2,288 2,773 17,481 589 31,416

Total 34,468 37,248 6,221 33,254 26,678 21,308 132,198 7,537 298,976

2.4.2 Changes in Rear Impact Injury Rates in Passenger Cars

As was done for pickup trucks, the initial step in determining what has occurred in injury 

rates in passenger cars is examining the changes over time. Exhibit 2-12 presents, by 

state, the injury rates in rear impact crashes, in the “Before” and “After” model years, 

based on the weighted data detailed in the previous section. The last column shows the 

data for the eight states combined, as had been done for pickup trucks. Again, positive 

values in the “% reduction” row indicate an improvement, which is a decrease in the 

injury rate.

Exhibit 2-12: Weighted Injury Rates in Passenger Cars, Rear Impacts, in the 

“Before” and “After” Model Years (State Data)

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah Eight 

States

Before 38.83 17.02 33.48 20.35 29.42 44.56 44.07 23.01 34.24

After 37.97 16.63 32.88 19.39 28.22 43.79 44.31 23.67 34.49

% reduction 2.22 2.29 1.81 4.70 4.10 1.73 -0.55 -2.87 -0.73

Analogous data for pickup trucks were presented in Exhibit 2-2, and some comparisons 

are notable. Observe that, while pickup trucks showed a decrease in the injury rate in 

every state, for passenger cars two of the states actually have higher injury rates in the 

later years. This is reflected in the negative percent reduction shown for Texas and Utah 
35

in Exhibit 2-12. Furthermore, not only is there always a lower injury rate in the “After” 

years for the pickup trucks, the percent reduction is always greater than is seen in 

passenger cars, state for state. One of the states with a higher injury rate in the “After” 

years is Texas, which contributes a large proportion of the total data. Thus, when the 

data for the eight states are combined using Formula 1, there is an increase in the injury 

rate (an effectiveness estimate of negative 0.73 percent) in the “After” years. This is 

shown in the last column in Exhibit 2-12.

When the data in Exhibit 2-12 are weighted by each state’s number of registered pickup 

trucks, the overall injury reduction in passenger car rear impacts is 1.55 % (using 

Formula 3 detailed in section 2.2). Notice that, using this method, a positive 

effectiveness results, whereas when the unweighted data are combined there is a negative 

effectiveness. This is explained by the differing proportions contributed by each state, 

between the raw data counts and the data weighted by number of registered pickups. For 

example, Texas is one of the two states with a higher injury rate in the “After” group. 

Texas contributes 44% of the data when they are simply totaled for all states, but only 

33% when weighted by registered pickups. Conversely, three states with a lower rate in 

the “After” group contribute a notably larger proportion when the registration-weighted 

data are used: Maryland (2% of the raw data, to 5% of that weighted by registered 

pickups), Florida (12% raw data, 15% weighted), and North Carolina, with a relatively 

high reduction in injury rate (9% raw data, 12% weighted).

This particular example shows why the data weighted by the number of registered pickup 

trucks in the state is the preferred method to use. Simply summing the data into a single 

estimate depends too heavily on the amount of data provided by a given state. As 

discussed previously, this is based on various factors (such as police reporting criteria), 

not all of which are relevant to measuring the effectiveness of head restraints in pickup 

trucks. The change in the distribution, which is a more accurate reflection of ‘real world’ 

data, causes the effectiveness estimate to switch from an increase in the injury rate (using 

the unweighted data) to a decrease. Thus, the effectiveness estimate of a 1.55 % 

reduction in the injury rate in passenger cars would be considered the ‘better’ estimate of 

the “vehicle age effect” in rear impacts of passenger cars.

The t-score for this estimate is 2.03, which is just significant at the 90% level. Since it is 

significant, however, it would be appropriate to take it into account. Rear impacts in 

passenger cars show a decreased injury rate from the ‘”Before” years to the “After” 

years. Whatever the reason, this general tendency for lower injury rates in later model 

year vehicles should be taken into consideration when determining a final effectiveness 

estimate for head restraints in pickup trucks.

Recall that the effectiveness estimate for head restraints in pickup truck rear impact 

crashes was 9.62 (based on the registration-weighted average of eight states, as described 

in Section 2.2). When controlled for the reduction in injury in frontal crashes for pickup 

trucks, the estimate was 5.23 (as derived in Section 2.3). Now, rather than using frontal 

impact pickup crashes as the control, rear impact passenger car crashes will be used

instead. Data for rear impact crashes, for both pickup trucks and passengers cars, are 

presented in Exhibit 2-13. Although both sets of data have appeared previously, they are 

presented here again for ease of comprehension.
36

Exhibit 2-13: Injury Rates in Pickup Trucks and Weighted Injury Rates in 

Passenger Cars, Rear Impacts, and Effectiveness Estimates, in the “Before” and 

“After” Model Years, by State (State Data)

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah Eight 

States

Pickup Trucks, Rear Impact

Before 32.80 10.84 24.69 14.25 24.86 33.63 32.63 16.68 26.42

After 30.69 9.03 21.34 12.93 22.18 31.22 29.56 16.27 24.40

% reduction 6.44 16.68 13.59 9.25 10.79 7.17 9.42 2.45 7.65

Passenger Cars, Rear Impact

Before 38.83 17.02 33.48 20.35 29.42 44.56 44.07 23.01 34.24

After 37.97 16.63 32.88 19.39 28.22 43.79 44.31 23.67 34.49

% reduction 2.22 2.29 1.81 4.70 4.10 1.73 -0.55 -2.87 -0.73

E 4.31 14.73 11.99 4.78 6.98 5.53 9.91 5.17 8.32

The final row of Exhibit 2-13 presents new information – the effectiveness estimate for 

each state, as well as for the unweighted combined data, using passenger car rear impacts 

as the control group. These are calculated using the same formula as was used for the 

effectiveness of head restraints in rear impact pickup truck crashes when controlled for 

by pickup frontal impacts, presented in Section 2.3. Formula 4, shown here again for 

convenience, is:

p

p

p

p

E 1-

21

22

11

12 











































=

Note that, in the current calculation, it is the vehicle type rather than the impact location 

that varies. Therefore, in this occurrence:

 i=vehicle type (1=truck, 2= passenger car).

The final entry shows that, when state data are combined into a single estimate, the 

installation of head restraints results in an 8.32 percent reduction in the injury rate in rear 

impact crashes in pickup trucks, when controlled for by rear impacts in passenger cars. 

This was calculated as:

E = 

















































−

34.24

34.49

26.42

24.40

1 = 8.32 percent

Using Formula 5 for registration-weighted data detailed in section 2.3, and substituting 

car/rear impact data for pickup truck/frontal, we obtain:
37

1,425,339 1,025,244 435,244 943,717 1,168,132 1,010,419 3,120,226 324,611

(1,168,132 6.98) (1,010,419 5.53) (3,120,226 9.91) (324,611 5.17)

(1,425,339 4.31) (1,025,244 14.73) (435,244 11.99) (943,717 4.78)

+ + + + + + +

















× + × + × + ×

× + × + × + × +

= 8.18 percent

Thus, when the data are weighted by the number of registered pickup trucks per state, 

there is an 8.18 percent reduction in the injury rate in pickup truck rear impact crashes, 

when controlled for by passenger car rear impact crashes.

2.5 Comparison of Rear vs Frontal, Passenger Cars vs Pickup Trucks

Two groupings of estimates previously calculated use controls to adjust the effectiveness 

estimate for pickup trucks in rear impact crashes. One used truck frontal crashes as the 

control group (Section 2.3), while the other used rear impacts in passenger cars as a 

control (Section 2.4.2). An additional estimate will be determined, which utilizes both of 

these methods of control.

It has been shown that, over time, injury rates tend to decrease for reasons other than the 

presence of head restraints, a development that must be taken into account. Thus far, 

both frontal impacts in pickup trucks and rear impacts in passenger cars have been used 

as controls for rear impact crashes in pickup trucks. A final estimate will be determined, 

in which rear impacts in pickup trucks will be controlled for by frontal impacts in 

pickups, which in turn will be controlled for by passenger car rear impacts controlled for 

by passenger car frontal impacts. 

A simpler way to think of this estimate is as the combination of two similar estimates. 

Remember that head restraints were designed to reduce injury in rear impacts. Therefore, 

when pickup trucks with head restraints are compared to those without them, a decreased 

injury rate in rear impacts would be expected, while no change in frontal impacts would 

be anticipated. Any change in frontal impacts would be attributed to something other 

than the installation of head restraints, and assumed to affect rear as well as frontal 

impacts, and thus could serve as a control for whatever changes occur to injury rates over 

time.

The data for rear and frontal impacts, for both pickup trucks and passenger cars, are 

presented in Exhibit 2-14. In Section 2.3, it was determined that when rear impacts in 

pickup trucks were controlled for by frontal impacts, the effectiveness rate is 4.52 percent 

when the data from the eight states are simply combined, as shown in Exhibit 2-14, or 

5.23 using Formula 5, with registered pickup weighted data. The same procedure could 

be performed on passenger cars (which were equipped with head restraints throughout the 

time frame of our data). The row in Exhibit 2-14 labeled “Rear vs Frontal” in the 

Passenger Car section presents the effectiveness estimates for rear impacts controlled for 

by frontal in passenger cars. When the eight states are combined, this estimate is a 

nonsignificant 1.00. The estimate when the states are weighted by registered pickup 

trucks is 0.62, which also is not significant (t-score=0.59). Since these calculations are of 

interest only as intermediary steps, they will not be discussed in further detail.
38

Exhibit 2-14: Injury Rates Before and After Pickup Trucks were Equipped with 

Head Restraints, and Weighted Injury Rates in Passenger Cars in the “Before” and 

“After” Model Years. Rear and Frontal Impacts, and Effectiveness Estimates, in 

Selected Pickup Trucks, by State (State Data)

Florida Indiana Maryland Missouri North 

Carolina

Pennsylvania Texas Utah Eight 

States

Pickup Trucks

Rear

Before 32.80 10.84 24.69 14.25 24.86 33.63 32.63 16.68 26.42

After 30.69 9.03 21.34 12.93 22.18 31.22 29.56 16.27 24.40

% reduction 6.44 16.68 13.59 9.25 10.79 7.17 9.42 2.45 7.65

Frontal

Before 29.22 14.04 23.64 16.71 20.27 30.25 27.63 16.15 23.93

After 27.57 12.21 24.57 16.02 18.95 29.81 26.52 17.19 23.15

% reduction 5.65 13.07 -3.95 4.09 6.52 1.48 3.99 -6.45 3.28

Rear vs 

Frontal 0.84 4.16 16.67 5.39 4.57 5.77 5.65 8.36 4.52

Passenger Cars

Rear

Before 38.83 17.02 33.48 20.35 29.42 44.56 44.07 23.01 34.24

After 37.97 16.63 32.88 19.39 28.22 43.79 44.31 23.67 34.49

% reduction 2.22 2.29 1.81 4.70 4.10 1.73 -0.55 -2.87 -0.73

Frontal

Before 33.48 12.98 30.43 18.64 23.84 37.76 34.78 20.35 29.02

After 33.29 11.93 30.73 18.53 23.25 36.73 35.47 20.70 29.52

% reduction 0.58 8.15 -0.98 0.59 2.50 2.71 -1.99 -1.74 -1.74

Rear vs 

Frontal 1.65 -6.38 2.77 4.14 1.64 -1.00 1.41 -1.12 1.00

E -0.82 9.91 14.51 1.30 2.98 6.71 4.30 9.37 3.56

The final effectiveness estimate calculated will be a combination of these two estimates –

rear impacts controlled for frontal impacts in pickup trucks, in turn controlled for by rear 

impacts controlled for by frontal impact in passenger cars. This is shown as “E” in the 

last row of Exhibit 2-14.

Extending Formula 4, this effectiveness estimate would be determined using the formula:
39

E = 

















































































































−

122

222

112

212

121

221

111

211

1

p

p

p

p

p

p

p

p

Where pijk = percent of injured occupants (injury rate)

i = status of head restraint installation (1=before, 2=after)

j = impact location (1=rear, 2=front)

k= vehicle type (1=pickup truck, 2=passenger car)

So that effectiveness when the eight states are combined into one set of data would be 

calculated as:

E = 

































































































−

29.02

29.52

34.24

34.49

23.93

23.15

26.42

24.40

1 = 3.56 percent

Thus, when the eight states are combined into one set of data, it is estimated that there is 

a 3.56 percent reduction in the injury rate in rear impact crashes in pickup trucks, when 

they are controlled for by frontal impacts, in turn controlled for by rear impacts in 

passenger cars controlled for by frontal impacts in passenger cars.

The final row of Exhibit 2-14 presents the effectiveness estimates, calculated using 

Formula 6 above, for each state. When these are combined using Formula 5, weighting 

each state by its respective number of registered pickup trucks, as:

1,425,339 1,025,244 435,244 943,717 1,168,132 1,010,419 3,120,226 324,611

(1,168,132 2.98) (1,010,419 6.71) (3,120,226 4.30) (324,611 9.37)

- (1,425,339 0.82) (1,025,244 9.91) (435,244 14.51) (943,717 1.30)

+ + + + + + +

















× + × + × + ×

× + × + × + × +

= 4.58 percent

(6)
40

Therefore, when the effectiveness estimates are weighted by the number of registered 

pickup trucks in each state, the result is an overall estimate of 4.58 percent. The t-score is 

significant at 2.98.

Exhibit 2-15 summarizes all effectiveness estimates of head restraints in pickup trucks 

that have been calculated in previous sections, with significance tests provided where 

determined. Recall that, at the 0.10 significance level, a t-score of 1.895 or greater, or a 

z-score of 1.645 or greater, indicates significance. Thus, all t-scores and z-scores 

presented are significant.

Exhibit 2-15: Point Estimates of Overall Injury Reduction by Head Restraints

Mean of Eight States, Weighted by 

Number of Registered Pickup 

Trucks

Effectiveness

Estimate t-score

Truck Rear 9.62 8.01

Truck Rear, controlled for Truck 

Frontal 5.23 4.43

Truck Rear, controlled for Car Rear 8.18 6.54

Truck Rear, controlled for Truck 

Frontal, controlled for Car Rear, 

controlled for Car Frontal

4.58 2.98

Mean of Eight States, Weighting 

based on variance

Effectiveness

Estimate z-score

Truck Rear 9.25 9.30

Truck Rear, controlled for Truck 

Frontal 5.14 3.99

Eight States Combined, Unweighted Effectiveness

Estimate z-score

Truck Rear 7.65 7.11

Truck Rear, controlled for Truck 

Frontal 4.52 3.29

Truck Rear, controlled for Car Rear 8.32

Truck Rear, controlled for Truck 

Frontal, controlled for Car Rear, 

controlled for Car Frontal

3.56

The numerical value of this most recently determined estimate, which uses passenger cars 

to control for pickup trucks, as well as frontal impacts to control for rear, is very close to 

the simpler “Truck Rear controlled for Truck Frontal” (4.58 vs 5.23) in the top section of 

Exhibit 2-15.
41

2.6 Computation of Effectiveness Estimates in a 0% to 100% Head Restraint 

Equipped Fleet

All of the estimates of effectiveness so far have been calculated using pickup truck data 

available in the real world. There is no direct way to determine which individual vehicles 

did or did not have head restraints from the data. This information is not coded in the 

VIN, nor is it perfectly consistent across any model or styling group. Based on the State 

crash data, it was only possible to classify the trucks by make-model and model years.

Recall that it was required for this analysis that make-models in the “Before” model years 

have no more than 25% equipped with head restraints, while the “After” group needed to 

be at least 75% equipped. While this permitted an examination of the change from a 

small to a large percent of head restraints, the intent of this evaluation is to estimate the 

effectiveness when head restraints are installed in vehicles that were previously 

unequipped. The goal is to measure what happens when the change is from 0% to 100% 

equipped. No group of vehicles went from not having head restraints at all to a totally 

equipped fleet. However, if the percent of vehicles with head restraints is known, the 

effectiveness estimates obtained can be adjusted to account this.

As discussed earlier in Section 2.1.1.1, data from NASS-CDS was used to determine the 

percentage of vehicles, by manufacturer and/or model, that were equipped with head 

restraints. This information was also verified by the vehicle manufacturers. Exhibit 2-16 

presents the percentage of vehicles equipped with head restraints. The different lines of 

Chevrolet/GMC pickup trucks are treated separately here since they differ in the percent 

equipped in the “Before” model years.

Exhibit 2-16: Percent of Pickup Trucks Equipped with Head Restraints in “Before” 

and “After” Model Years, by Manufacturer/Model

Before After

Dodge Pickups 0 100

Chevrolet C/K, GMC Sierra 5 100

Chevrolet S/T, GMC Sonoma 20 100

Ford Ranger 24 94

This information shows the presence of head restraints in each of these vehicles in 

nationwide registration data. What is required is a method of combining them in a way 

that reflects the appropriate relative proportion of each vehicle in state crash data.

The first step in this process was to determine the percentage of each manufacturer (and, 

in the case of GM, model) in the crash data, based on the six VIN states where the actual 

make-model could be identified: Florida, Maryland, Missouri, North Carolina, 

Pennsylvania and Utah. All impact locations were included. Indiana and Texas do not 

include VIN on their state data file, and are not included in these counts.

The counts by manufacturer (and GM model) are presented in Exhibit 2-17, and the 

percent of each manufacturer’s presence by state is presented in Exhibit 2-18.
42

Exhibit 2-17: Number of Pickup Trucks by Manufacturer in Each State, All Impact 

Locations

Florida Maryland Missouri North 

Carolina

PennsylvaniaUtah

Before

Dodge 2725 585 2191 2400 2209 573

GM C/K 7063 1250 6097 6668 4408 2282

GM S/T 4606 962 4741 4722 3665 922

Ford Ranger 5894 1029 3958 5606 3189 1394

Total 20288 3826 16987 19396 13471 5171

After

Dodge 2095 537 2179 1841 1689 788

GM C/K 9533 1251 7432 7553 4266 2751

GM S/T 6473 922 3879 6569 3364 710

Ford Ranger 7003 1146 5075 6086 3049 1320

Total 25104 3856 18565 22049 12368 5569

Exhibit 2-18: Percent of Pickup Trucks by Manufacturer in Each State, all Impact 

Locations

Florida Maryland Missouri North 

Carolina

Pennsylvania Utah

Before

Dodge 13.43% 15.29% 12.90% 12.37% 16.40% 11.08%

GM C/K 34.81% 32.67% 35.89% 34.38% 32.72% 44.13%

GM S/T 22.70% 25.14% 27.91% 24.35% 27.21% 17.83%

Ford Ranger 29.05% 26.89% 23.30% 28.90% 23.67% 26.96%

After

Dodge 8.35% 13.93% 11.74% 8.35% 13.66% 14.15%

GM C/K 37.97% 32.44% 40.03% 34.26% 34.49% 49.40%

GM S/T 25.78% 23.91% 20.89% 29.79% 27.20% 12.75%

Ford Ranger 27.90% 29.72% 27.34% 27.60% 24.65% 23.70%

These percentages were then combined to form a weighted average, using registered 

pickup trucks per state, which were presented in Exhibit 2-4. The overall percents by 

manufacturer, before and after the installation of head restraints, are presented in Exhibit 

2-19.
43

Exhibit 2-19: Percent of Pickup Trucks by Manufacturer, Across Six States, 

Weighted by Number of Registered Pickup Trucks per State

Before After

Dodge 13.68% 10.77%

Chevy C/K 34.91% 37.10%

Chevy S/T 24.75% 25.12%

Ford Ranger 26.67% 27.01%

These values were then multiplied by the percent of each type of vehicle equipped with 

head restraints (from Exhibit 2-16), and summed to obtain an overall “Before” and an 

“After” percent of vehicles equipped with head restraints, as follows:

Before: (13.68× 0) + (34.91×.05) + (24.75×.2) + (26.67 ×.24) = 13.10%

After: (10.77 ×1) + (37.10 ×1) + (25.12×1) + (27.01×.94) = 98.38%

Overall, 13.10 percent of pickup trucks were equipped with head restraints in the 

“Before” model years, and 98.38 percent in the “After” years (recall that the “Before” 

and “After” years varied by manufacturer). Consequently, what has actually been 

measured is E1, the reduction in injuries in rear impacts in a fleet that is 98.38 percent 

equipped with head restraints relative to a fleet that is 13.10 percent equipped. The actual 

measurement needed is E2, the reduction for a 100 percent head restraint equipped fleet 

relative to one without any head restraints. Since

(1 ) (1 )

(1 ) (1 )

1

2

2

1

p p E

p p E

E

B B

A A

− + −

− + −

− =

where pA = percent of fleet equipped with head restraints in the “After” model years

pB = percent of fleet equipped with head restraints in the “Before” model years.

Substituting 0.1310 for pB and 0.9838 for pA, and solving for E2,

0.8528 (0.1310 )1

1

2

E

E

E

+ ×

=

So, for each effectiveness estimate E1 that has been determined, a new value, E2, that 

adjusts the estimate to measure the change from a fleet with no head restraints to one that 

is 100 percent equipped, can be calculated. These adjusted measures are presented in 

Exhibit 2-20 for the effectiveness estimates of head restraints in pickup truck rear 

impacts.

(8)

(7)
44

Exhibit 2-20: Point Estimates of Overall Injury Reduction by Head Restraints, 

adjusted for 0 Percent to 100 Percent Head Restraint Equipped Fleet.

Mean of Eight States, Weighted by 

Number of Registered Pickup Trucks

Effectiveness

Estimate

Truck Rear 11.12

Truck Rear, controlled for Truck Frontal 6.08

Truck Rear, controlled for Car Rear 9.47

Truck Rear, controlled for Truck 

Frontal, controlled for Car Rear, 

controlled for Car Frontal

5.33

Eight States Combined, Unweighted Effectiveness

Estimate

Truck Rear 8.87

Truck Rear, controlled for Truck Frontal 5.27

Truck Rear, controlled for Car Rear 9.64

Truck Rear, controlled for Truck 

Frontal, controlled for Car Rear, 

controlled for Car Frontal

4.15

The argument could be made to adjust the individual state effectiveness estimates and 

then combine them, rather than adjust the already combined estimates. If this were done, 

however, it would be more appropriate to use each individual state’s distribution of 

vehicles by manufacturer. However, because accurate distributions could not be 

determined for Indiana and Texas, no estimates could be used for these states. Using the 

overall percent equipped and applying that to each state could also be done, but the final 

difference in obtained estimates is trivial. For example, the largest effectiveness estimate 

is obtained for “Pickup Trucks in Rear Impacts” without using any controls and 

weighting the data by registered pickups. The estimate adjusted for a zero to 100 percent 

equipped fleet using the aggregated state data (and shown in Exhibit 2-20) is 11.12. If 

the “Before” percent of 13.10 and “After” of 98.38 are used to adjust each state before 

combining and weighting by registered pickup trucks, the effectiveness estimate is 11.10. 

The t-score increases from the originally calculated 8.01 (for the unadjusted effectiveness 

estimate of 9.62) to 8.06. Given the uncertainty of having to use combined state data to 

adjust individual state estimates, the method of adjusting the final estimate seems 

preferable.

2.7 Selection of the Best Estimate of Effectiveness of Head Restraints in Pickup 

Trucks

Exhibit 2-20 presents the eight effectiveness estimates of head restraint injury reduction 

in pickup trucks that have been determined. These range from 4.15 to 11.12 percent. It 

remains to discuss which of these estimates best represents what head restraints have 

done to improve passenger safety.

Recall the two basic methods used to determine effectiveness estimates, by combining all 

the data into a single ‘eight state estimate,’ or by weighting each estimate by the number 
45

of registered pickup trucks in that state. In Section 2.2 it was discussed that the amount 

of data provided per state was not proportional to the ‘sizes’ of the states, on whatever 

metric they might be measured. Combining each state’s effectiveness estimate and 

computing the average gives equal weight to each state, which is equally unsound. 

Alternatively, each state’s estimate was weighted by its number of registered pickup 

trucks. This gave an overall estimate that reflected each state’s contribution 

appropriately. Consequently, the ‘best’ estimate would be selected from those that were 

calculated using registered pickup trucks.

Of the four such estimates, the estimate derived from pickup truck rear impact data alone 

is not particularly useful. Since there is no control for whatever changes took place, 

anything affecting the injury rate would be attributed to the installation of head restraints. 

This would include the “vehicle age” factor discussed earlier. The estimate of injury 

reduction in pickup truck frontal impacts was also significant, demonstrating that some 

reduction in the measured injury rate was taking place that could not be attributed to the 

installation of head restraints.

The “Rear Controlled for Frontal” comparison for pickup trucks (5.23, calculated in 

Section 2.3) was significant, while that for passenger cars (0.62, Section 2.5) was not. In 

addition, the change in injury rate in frontal crashes was significant in pickup trucks, but 

not in passenger cars. Clearly, cars and trucks differ with respect to the changes 

occurring in injury rates over these model years. This suggests that using frontal impacts 

in pickup trucks is a preferred control to rear impacts in passenger cars. In addition, the 

“Truck Rear controlled for Truck Frontal” is a more conservative estimate than “Truck 

Rear controlled for Car Rear”. This prevents overstating obtained benefits.

The final calculated estimate, in which pickup truck rear impacts were controlled for by 

pickup truck frontal impacts, which in turn were controlled for by passenger car rear 

impacts controlled for by car frontal impacts, likely provides more control than is needed. 

The “Passenger Car Rear controlled for Frontal” portion is not significant, meaning that 

there is no real difference, between frontal and rear impact, in the change in injury rates 

in passenger cars in the model years examined. Therefore, it isn’t necessary to control 

for these differences, as they don’t add any substantive benefit to the estimate.

The conclusion, then, is that the adjusted estimate of 6.08, in which pickup truck rear 

impacts are controlled for by pickup truck frontal impacts, is the estimate of choice. 

Since this is being used as the best estimate of head restraint effectiveness, confidence 

limits need to be determined. The 90 percent confidence bounds for the estimate of 

injury reduction are first calculated on the original estimate. Then the values are adjusted 

for a fleet with no head restraints compared to a one with all vehicles equipped. 

Calculated using the same SAS procedure as described earlier, the standard error for this 

estimate is 1.18.

Original Estimate ±[1.895× standard error]

5.23 ± (1.895×1.18) = [2.99,7.46]
46

By applying Formula 8 to the upper and lower limits, the confidence interval for this 

estimate, which ranges from 3.49 to 8.65, is obtained.
47

Chapter 2 Footnotes

1. National Automotive Sampling System 1997 Crashworthiness Data System Data 

Collection, Coding, And Editing Manual. US Department of Transportation, National 

Highway Traffic Safety Administration, National Center for Statistics and Analysis, 

January, 1997.

2. SAS: Procedures Guide, Version 6, Third Edition, SAS Institute Inc., Cary, NC, 

1990, pp 365-387.

3. Kahane, Charles J. An Evaluation of Head Restraints, NHTSA Publication No. DOT 

HS 806 108, Washington, DC, 1982, pp. 154-160 and 181-197.
48
49

Chapter 3: Effectiveness in Rear Impacts, for Specific 

Populations and Situations

The previous chapter discussed the overall effectiveness of head restraints in rear 

impacts. There are some circumstances, however, in which head restraints may offer 

greater protection to certain groups of people, in particular types of crashes, or with 

specific characteristics of vehicles.

Analyses of data from the eight states indicate that head restraints are more effective in 

rear impacts for pickup trucks with minor, nontowaway damage than in trucks with 

towaway damage. Adjustable head restraints seem to be at least as effective as integral 

head restraints, although it is not possible to clearly distinguish between the two types. 

Head restraint effectiveness is about the same for younger and older, as well as for male 

and female drivers. Effectiveness was about the same regardless of whether the rear 

impact was to the rear center of the vehicle or off to one side. The presence or absence of 

a back seat was also not a factor in how effective head restraints were in preventing 

injuries.

The effectiveness estimates in this chapter are presented as a way of exploring and 

demonstrating general trends in the data. Unless there appears to be a possible significant 

difference, the estimates are not controlled for age affects or other influencing factors. In 

most instances, they are not corrected to represent a fleet changing from no head 

restraints to one that is fully equipped. To put them in perspective, they would be 

comparable to the “Truck Rear” estimates of 7.65% for combined state data, and 9.62% 

for data weighted by registered pickup trucks, presented in Chapter 2 (see Exhibit 2-15). 

If the analysis on rear impacts showed no significant difference between groups, further 

analyses were not performed. In the two cases where initial data suggest significance, 

further analyses were done.

3.1 Male vs. Female

Gender differences have been noted in several of the studies discussed in Chapter 1. 

Women have a higher probability of whiplash injury, given a rear impact, than do men. 

Since the experience of a rear impact differs for men and women, it is reasonable to 

speculate that head restraints, which were designed to prevent whiplash injuries in rear 

impacts, would perform differently for women than for men.

Data from the combined eight states in the current analysis are presented by gender in 

Exhibit 3-1. Note that the totals in the “Before” as well as the “After” groups differ from 

combined state totals presented in Chapter 2. This will be the case generally for all 

specific groups and situations, since these data require a known condition for an 

additional variable. Specifically in this case, all occupants with non-reported gender 

were necessarily excluded from the analysis. Additionally, Florida records gender 

information for drivers only, so the right front passengers present in other analyses are 

excluded here.
50

As reported earlier, some researchers have found injury rates in rear impacts are 

substantially higher for females than males. However, the overwhelming majority of all 

pickup truck occupants, and even of the injured occupants, are males.

Exhibit 3-1: Injury Status by Gender for Eight States Combined, Before and After 

Installation of Head Restraints, Rear Impacts

Male Female

Before After Before After

Injured 7,599 7,929 3,414 3,797

Uninjured 24,640 28,810 5,891 7,653

Injury Rate 23.57 21.58 36.69 33.16

Effectiveness estimates were determined for each state individually, as well as for the 

combined state data, using Formula 1 covered in Section 2-2. These results are presented 

in Exhibit 3-2.

Exhibit 3-2: Estimates of Effectiveness of Head Restraints in Rear Impacts, by State 

and Gender

Male Female

Florida 6.14 12.33

Indiana 14.43 25.26

Maryland 12.98 13.28

Missouri 9.21 29.85

North Carolina 12.64 7.58

Pennsylvania 9.18 -0.35

Texas 9.85 10.01

Utah -3.29 2.12

Eight States Combined 8.44 9.62

Eight States Weighted 9.69 12.47

For each state, the higher effectiveness estimate is in bold. Note that, although the 

estimates for the combined states are relatively close (8.44 for males and 9.62 for 

females), six of the eight individual states had higher effectiveness estimates for females 

than for males. This is not a statistically significant advantage for females, but only 

suggest the results are slightly in their favor. By an exact binomial test, at least seven of 

the eight states would have to have higher effectiveness for females to indicate a 

significant trend.

The data from each state were also weighted by the number of registered pickups in the 

respective state, using Formula 3 as shown in Section 2-2. Effectiveness for males was 

9.69%, and for females, 12.47%. These estimates, using the preferred method of 

weighting the data, show a more pronounced advantage for females using head restraints.
51

Because the data suggest that there may be a real difference between the benefits for 

males and females, the data were examined further. As an additional check, effectiveness 

of head restraints for males and for females in rear impacts, using frontal impacts as a 

control, were determined. Calculations were performed as shown in Formula 5 for 

combined state data and in Exhibit 2-8 and Formula 6 for data weighted by number of 

registered pickup trucks. Using the combined data, the effectiveness for males was 

5.13% (confidence bounds 2.46 and 7.80, z=3.00). For females, the effectiveness was 

almost identical, 5.01% (confidence bounds 1.25 and 8.76, z=2.08). Using the data 

weighted by registered pickup trucks gave similar results. Effectiveness for males was 

5.70% (confidence bounds 3.02 and 8.38, t=4.03) while for females it was 5.88% 

(confidence bounds 0.27 and 9.74, t=2.35).

Adjusting the data to reflect a fleet going from no head restraints to one in which all 

vehicles are equipped gives similar results. For the combined state data, effectiveness for 

males in rear impacts, controlled by frontal impacts, was 5.97 (confidence bounds 2.87 

and 9.04) and for females was 5.82 (confidence bounds 1.46 and 10.14). Using the data 

weighted by registered pickups, effectiveness for males was 6.63 (confidence bounds 

3.53 and 9.71) and for females was 6.84 (confidence bounds 0.31 and 11.26).

Therefore, upon further investigation, the data show no significant difference between 

males and females in the benefit of head restraints in rear impact crashes. The small 

difference seen earlier when looking only at rear impacts disappears when using frontal 

impacts as a control.

3.2 Older vs. Younger

Age differences have been reported in some earlier studies on head restraints. For the 

present study, a frequency distribution of injured pickup occupant ages was produced, 

and the median age determined, for each state. These are presented in Exhibit 3-3.

Exhibit 3-3: Median Age of Injured Occupants, by State

State Median 

Age

Florida 33

Indiana 33

Maryland 34

Missouri 32

North Carolina 35

Pennsylvania 33

Texas 31

Utah 28

The median age of all injured occupants in all states combined was 32. To simplify the 

analysis, occupants were placed in one of two age groups – those through age 30 were in 

the “younger” group, those age 31 and above in the “older” group (30 being the decade 

closest to the median age).
52

Data from the combined eight states are presented by age group in Exhibit 3-4. Younger 

occupants had slightly lower injury rates than the older occupants. Note also that both 

the older and younger group saw lower injury rates in rear impacts after head restraints 

were installed.

Exhibit 3-4: Injury Status by Age Group, for Eight States Combined, Before and 

After Installation of Head Restraints, Rear Impact

Younger Older

Before After Before After

Injured 4,227 4,641 7,122 7,515

Uninjured 12,773 15,395 18,253 21,741

Injury Rate 24.86 23.16 28.07 25.69

Effectiveness estimates were determined for each state, for the combined state data, using 

Formula 1, as well as the data weighted by registered pickups, using Formula 3. The 

results are presented in Exhibit 3-5. Again, for each state, the higher effectiveness 

estimate is noted with bold type.

Exhibit 3-5: Estimates of Effectiveness of Head Restraints in Rear Impacts, by State 

and Age Group

Younger Older

Florida 3.53 7.28

Indiana -1.80 25.00

Maryland 30.36 6.27

Missouri 14.45 14.09

North Carolina 15.24 6.64

Pennsylvania 9.50 6.07

Texas 9.22 9.43

Utah -22.23 16.43

Eight States Combined 6.84 8.48

Eight States Weighted 8.36 10.65

Four of the states show a greater benefit for older occupants, while the other four show

more benefit for younger occupants. In addition, in both Missouri and Texas, the two 

effectiveness estimates are extremely close in value. Both the combined and weighted 

state data show a slightly larger benefit for older occupants. Overall, neither age group 

appears to benefit more in rear impacts from the installation of head restraints in pickup 

trucks. There is not a significant difference between the two groups.

3.3 Vehicle Damage Severity

As stated earlier, the majority of injuries in rear impact crashes occur in low-speed 

crashes, such as those involving vehicles that have not been towed from the scene. As 

with any safety device, it is possible that head restraint effectiveness could vary with 

crash severity. An analysis was done to compare head restraint effectiveness for vehicles 
53

having minor/non-towaway damage as compared to those with major/towaway damage. 

For this analysis, rear-impacted vehicles with minor damage were compared with rearimpacted vehicles that were towed and/or sustained major damage.

Since the concern of this report is injury reduction as a result of installing head restraints 

in light trucks (specifically, for the analysis, pickup trucks), it was important to use a 

consistent standard of damage for the vehicle of interest. There could be many cases 

where, for example, a passenger car and pickup truck collide. If the passenger car 

sustained more severe damage and required towing from the scene, while the pickup 

truck remained drivable, this should not be considered “major damage” for the pickup 

truck. A measure of damage to the vehicle, rather than accident severity, was required. 

Utah’s state data codes accident severity, which is based on injuries rather than vehicle 

damage, but has no damage indicator for individual vehicles. Therefore, Utah was 

excluded from the vehicle damage severity portion of the analysis.

States vary in how they determine and record vehicle damage. Several of the state data 

files used in this analysis record whether the vehicle was towed from the scene. When 

available, this measure was used, as it is an objective measure of vehicle damage. 

Indiana, Missouri, North Carolina, and Pennsylvania record tow status of each vehicle in 

the crash.

Florida and Maryland state data files both contain a “Vehicle Damage Severity” variable. 

In the Florida data, severity is coded as “Disabling”, “Functional”, or “No Damage.” In 

Maryland, the options are “Not Applicable”, “No Damage”, “Minor”, “Functional”, 

”Disabling”, “Destroyed”, “Other”, and “Unknown.” In each case, Disabling damage 

refers to damage to the motor vehicle such that it can not be driven. In other words, the 

vehicle would need to be towed from the scene. For Maryland data, “Destroyed” was 

also included in the “Major Damage” category.

Texas has no variable that is equivalent to tow status. It does, however, have a Damage 

Scale variable that records the extent of damage to the vehicle. The scale ranges from 1 

to 7, with 1 being “Minor Damage” and 7 being “Vehicle Totally Damaged.” Minor 

damage is coded as 1 or 2, Moderate as 3 or 4, and Severe as 5 or 6, with 7 being a 

totaled vehicle. A frequency distribution of the damage scale on light trucks in the Texas 

state data showed that about 18 percent of the vehicles were coded as having a damage 

scale of 4 or greater, and about 39 percent as having 3 or greater. Including vehicles 

recorded as having a damage scale of 3 and above provided a similar percentage of more 

severely damaged vehicles to those selected using the tow status variables of the other 

states. Therefore, vehicles in the Texas data file with a Damage Scale of 3 through 7 

were considered as having major damage for the purpose of this analysis.

Exhibit 3-6 shows the relevant variable in each state, the values used, and the percent of 

light trucks considered as having major damage. Note that for most of the states, 30 to 40 

percent of the vehicles experienced major damage. Pennsylvania, however, has a much 

higher 57 percent of vehicles with major damage. Recall, as stated in Section 2.2, that 

Pennsylvania requires that one of the vehicles be towed from the accident scene, 

regardless of the dollar amount involved, in order to file a police report. Therefore, it 
54

would be expected that a larger proportion of vehicles in the data file would have been 

towed.

Exhibit 3-6: Vehicle Damage Severity Data in State Files, and Percent of Trucks 

State Variable Name Values Included as 

Major Damage

Percent of Light 

Trucks with 

Major Damage

Florida Vehicle Damage 

Severity

Disabling 32%

Indiana Towaway Towed 29%

Maryland Vehicle Damage 

Severity

Disabling, Destroyed 36%

Missouri Towaway Towed 27%

North Carolina Towaway Not Driveable 30%

Pennsylvania Towaway Towed 57%

Texas Damage Scale 3-7 (Moderate and above) 39%

Vehicles that were towed from scene, not driveable, disabled, or totaled were considered 

as having major damage. Vehicles with lesser types of known damage were considered 

as having minor damage. Those vehicles for which the extent of damage was unknown 

were excluded from this portion of the analysis.

Exhibit 3-7 presents the number of occupants in the total of the seven states, grouped by 

damage severity, presence or absence of any type of injury, and head restraint status. As 

would be expected, the injury rates are much higher in vehicles experiencing major 

damage. The number of occupants in vehicles with minor damage, however, is much 

higher, and close to 75 percent of the injured occupants were in the vehicles with minor 

damage.

Exhibit 3-7: Injury Status by Damage Severity, for Seven States Combined, Before 

and After Installation of Head Restraints, Rear Impact

Minor Damage Major Damage

Before After Before After

Injured 8,065 8,637 2,907 3,091

Uninjured 26,001 31,068 3,225 3,712

Injury Rate 23.67 21.75 47.41 45.44

The estimates of head restraint effectiveness in reducing overall injury risk are presented 

for each state in Exhibit 3-8. Important to note is that, in each of the seven states 

included in the analysis, head restraints are more effective in vehicles with minor damage 

than those with major damage. By an exact binomial test, all seven of the states would 

have to have higher effectiveness for vehicles with minor damage in order to indicate a 

significant trend. In fewer than 99% of the cases would such an occurrence happen by 

chance without some real underlying difference existing. Thus, it can be stated that head 
55

restraints are significantly more effective in reducing overall injury risk in vehicles 

sustaining minor damage than those having major damage.

Exhibit 3-8: Estimates of Effectiveness of Head Restraints in Rear Impacts, by State 

and Damage Severity

Minor 

Damage

Major 

Damage

Florida 7.10 3.99

Indiana 13.11 12.90

Maryland 12.66 4.17

Missouri 16.03 -0.89

North Carolina 12.87 -3.37

Pennsylvania 8.18 6.95

Texas 10.02 5.00

Seven States Combined 8.12 4.16

Seven States Weighted 10.82 4.23

For the seven states of combined data, effectiveness is estimated to be 8.12% in vehicles 

with minor damage and 4.16% in those with major damage. When the data are weighted 

by registered pickup trucks in each state, the estimate in vehicles with minor damage is 

10.82%, and in those with major damage, 4.23%. Note that the estimates in vehicles with 

minor damage are relatively close to the overall estimates obtained for rear impacts 

(7.65% for combined data, 9.62% for weighted data). This should be no surprise, since 

the majority of occupants are in vehicles experiencing minor damage.

Since benefits do appear to be different in crashes with major and minor damage, further 

examination is warranted. Effectiveness in rear impacts by crash severity will be 

determined using frontal impacts as a control. Combining the state data (for the seven 

states usable for analysis of damage severity) as in Formula 4 results in an effectiveness 

in crashes with minor (nontowaway) damage of 7.17% (confidence bounds of 3.68 and 

10.67, z=3.14). The effectiveness in crashes with major (towaway) damage is 1.07%, 

with a confidence interval ranging from –2.29 to 4.42, and a z-score of 0.52. For the data 

weighted by registered pickup trucks, effectiveness in crashes with minor damage is 

6.68% (confidence bounds of 2.21 and 11.14, t=2.91) and in crashes with major damage 

is 0.28% (confidence bounds of –3.32 and 3.89, t=0.15).

Adjusting these data for a fleet going from no vehicles having head restraints to one in 

which all vehicles are equipped shows the same pattern. For the combined state data, 

effectiveness in minor damage crashes is 8.32% (confidence bounds of 4.29 and 12.31, 

z=3.14) and in major damage crashes is 1.25% (confidence bounds of –2.70 and 5.15, 

z=0.52). Using the data weighted by registered pickup trucks, effectiveness in crashes 

with minor damage is 7.75% (confidence interval ranging from 2.59 to 12.84, t=2.91) and 

in crashes with major damage is 0.33% (confidence bounds of –3.92 and 4.53, t=0.15).

These results strengthen the earlier conclusion that head restraints are in fact more 

effective in reducing injuries in vehicles receiving minor damage than for those with 
56

major damage. In fact, the data show that head restraints are significantly effective in 

vehicles sustaining minor damage, and do not have a significant benefit in vehicles 

sustaining major damage. The effectiveness estimates of 7.75% for vehicles with minor 

damage and 0.33% for those with major damage are directly comparable to the overall 

estimate of 6.08% for registered pickup truck weighted data for the unequipped to fully 

equipped fleet. Again, since the vast majority of crashes do not involve any vehicles with 

towaway damage, it is not surprising that the effectiveness for minor damage vehicles is 

so similar to the overall rate. In addition, a much larger number of occupants is involved 

in these lower severity crashes.

It is not obvious why head restraints should be more effective in vehicles with minor 

damage. One factor, however, is that the analysis is based on overall injury risk. The 

more severe crashes are more likely to involve multiple injuries, including non-whiplash 

injuries, that head restraints are unlikely to reduce to “no injury.” As discussed in 

Section 2.1.2.5, these data do not realistically permit a separate analysis of whiplash 

injuries.

3.4 Rear Impact Location – Center vs Off-Center

Rear impacts have been the focus of injury reduction due to head restraints. To better 

understand how head restraints reduce injury, an analysis was done comparing centered 

rear impacts to off-centered ones. Different impact location schemes are used by various 

states, and an attempt was made to standardize the criterion for inclusion as a center or 

off-center impact.

The following table presents the variables used in each state, and the values used to 

determine a rear center impact. All other values were considered off-center. Also shown 

is the percent of vehicles in the dataset (of rear impacts) that were considered as having a 

centered rear impact. Since only rear impact crashes were used, there were no cases with 

unknown impact location.

State Rear Center Impact Percent of Rear Impacts 

with Center Impact

Florida Point of Impact is 8 76%

Indiana Initial Point of Impact is 6 48%

Maryland Either Initial Impact or Vehicle 

Damage Area1 is 9,10

71%

Missouri Vehicle Damage Area is 8 63%

North Carolina TAD1 is 11,12 68%

Pennsylvania Initial Impact Point is 6 77%

Texas Damage Scale is BC, BD 56%

Utah Damage Areas 1 or 2 is 8 8%

The percent of vehicles having a rear center impact in the Utah file is much smaller than 

that in the other states. Utah’s codes for rear impact are 7 (Left Back), 8 (Middle Back), 

and 9 (Right Back). Of the 2,289 vehicles in the Utah state data file used for the analysis, 

there were 67 with Damage Area 1 reported as Middle Back, 125 with Damage Area 2 

reported as Middle Back, and none with both Damage Areas 1 and 2 as Middle Back. 
57

About half the cases (1135) list no second damage area. Clearly, since the percentage of 

rear impacts that are center impacts is much lower in Utah than the other states, Utah 

state data reports or records centered vs off-centered crashes differently than do the other 

states. Therefore, Utah was excluded from this portion of the analysis.

Data from the combined seven states are presented by rear impact location in Exhibit 3-

19. Injury rates are higher for center crashes than for those off-center. Both types of 

crashes experienced lower injury rates in the later years, when head restraints were 

present.

Exhibit 3-9: Injury Status by Rear Impact Location, for Seven States Combined, 

Before and After Installation of Head Restraints, Rear Impact

Off-Center Center

Before After Before After

Injured 3,041 3,226 8,188 8,810

Uninjured 13,423 15,599 17,027 20,929

Injury Rate 18.47 17.14 32.47 29.62

Effectiveness estimates were determined for each of the seven states in the analysis, as 

well as for the combined state data. The results are presented in Exhibit 3-10. Again, the 

higher effectiveness estimate is noted with bold type. For location of rear impact, the 

data are mixed. Three of the states show greater effectiveness for off-center rear impacts, 

while the remaining four states show greater effectiveness for centered rear impacts. The 

combined data shows a slightly greater benefit in centered rear impact crashes, but the 

data weighted by registered pickup trucks shows the opposite.

Exhibit 3-10: Estimates of Effectiveness of Head Restraints in Rear Impacts, by 

State and Impact Location (Percent Fatality Reduction)

Off-Center Center

Florida 21.33 3.00

Indiana 32.68 8.50

Maryland 2.79 14.73

Missouri 11.70 16.96

North Carolina 1.95 12.06

Pennsylvania 15.61 3.17

Texas 5.69 11.41

Seven States Combined 7.22 8.77

Seven States Weighted 12.26 9.67

There is no evidence of any strong effect for head restraints being more effective in either 

rear center or off-center crashes. There are not enough data to draw a definitive 

conclusion. The varying types of data and definitions used for “rear center impact” likely 

contribute to this lack of observable effect. Overall, although head restraint protection 

depends on the direction of impact, it doesn’t depend on the location of the (rear) impact. 

Head restraints cushion the head and neck of the occupant in either type of impact.
58

3.5 Integral vs. Adjustable Head Restraints

The 1982 evaluation1 of head restraints in passenger cars found integral restraints to 

reduce the overall injury risk to occupants in rear impacts by 17 percent, and adjustable 

restraints by 10 percent. It is of interest to compare the performance of these types of 

head restraints in pickup trucks. The first step is to determine the type of head restraint 

found in each type of vehicle, in each of the “After” years. There were two possible 

sources of data available to determine the type of head restraint in the various makes and 

models of pickup trucks. Where available, data from the manufacturer were used, as this 

provided a definitive census of the make-up of head restraints available in each vehicle. 

Where manufacturer information was unavailable, the Crashworthiness Data System 

(CDS) data were used. Recall that CDS is a sample of crashes in the United States, and 

isn’t an exact measure of how the types of head restraints were distributed. However, it’s 

the best information available in the absence of manufacturer provided data.

The pickup trucks used in the present study vary with respect to the composition of the 

type of head restraints found in them. About 80 percent of the Ford Rangers in the CDS 

in 1991 (the first year with at least 75 percent having head restraints) were equipped with 

integral head restraints. The remaining 20 percent were evenly split between adjustable 

and no head restraints. In 1992, 90 percent of the Ford Rangers in CDS had integral head 

restraints, and the remaining 10 percent had adjustable. Data from the manufacturer 

confirm that 91 percent of Rangers manufactured in 1992 (the earliest year for which data 

were available) had integral head restraints, and the remainder had adjustable ones.

Dodge pickup trucks were more frequently equipped with adjustable head restraints. 

According to the manufacturer, all Dodge D/Ws in 1990 and 91 were equipped with 

them. In 1990, 84 percent of Dodge Dakotas were equipped with adjustable head 

restraints. In 1991, 89 percent of Dakotas had adjustable head restraints. In both years, 

the remaining vehicles had integral head restraints.

CDS data show that 82 percent of C/K pickups, and 65 percent of S/T pickups, had 

adjustable head restraints in 1992. In 1993, 73 percent of the C/K pickup trucks and 57 

percent of the S/Ts were equipped with adjustable head restraints. For all these GM 

vehicles, the remaining trucks were equipped with integral head restraints.

Recall, as discussed in Section 2.6, that there is no direct way to determine which 

individual vehicles did or did not have head restraints from the data. Similarly, unless a 

specific make of vehicle was equipped with only one type of head restraint, it is 

impossible to determine the type of head restraint present in a particular vehicle. 

Therefore, the best solution is to look at the type of head restraint found most frequently 

in a particular type of vehicle, and assign all such trucks to that group. For the present 

analysis, Ford Rangers were most frequently equipped with integral head restraints when 

a head restraint was present. The Dodge and GM pickup trucks most often had adjustable 

head restraints. Therefore, this section will compare the effectiveness of Ford Ranger 

head restraints as compared to those in Dodge and GM pickups. The separation is far 

from clean, however, particularly with the General Motors S/T line.
59

Exhibit 3-11 presents data from the combined eight states grouped by manufacturer 

according to the type of head restraint that predominated in the vehicles. In general, 

occupants in GM and Dodge pickup trucks had lower injury rates than those in Ford 

Rangers. All vehicles saw a decrease in injury rates in the “After” years.

Exhibit 3-11: Injury Status by Predominant Type of Head Restraint, for Eight 

States Combined, Before and After Installation of Head Restraints, Rear Impact

GM/Dodge 

(Adjustable)

Ford Ranger

(Integral)

Before After Before After

Injured 9,081 9,280 2,332 2,951

Uninjured 25,814 29,911 5,562 7,601

Injury Rate 26.02 23.68 29.54 27.97

The effectiveness estimates for each state are presented in Exhibit 3-12. Also presented 

are the estimates for the combined and weighted state data. Bold type highlights the 

higher effectiveness estimate in each state.

Exhibit 3-12: Estimates of Effectiveness of Head Restraints in Rear Impacts, by 

State and Predominant Type of Head Restraint (Percent Fatality Reduction)

GM/Dodge 

(Adjustable)

Ford Ranger 

(Integral)

Florida 6.99 5.28

Indiana 17.29 14.43

Maryland 19.29 -1.59

Missouri 17.20 8.77

North Carolina 12.39 5.67

Pennsylvania 8.90 -1.61

Texas 10.03 7.80

Utah -3.02 12.54

Eight States Combined 9.01 5.33

Eight States Weighted 11.22 6.70

Note that seven of the eight states show a higher effectiveness estimate for the “Mostly 

Adjustable” group, which would indicate a significant trend according to an Exact 

Binomial Test. This is contrary to what was observed in passenger cars. The combined 

as well as the weighted data also favor adjustable restraints.

All the data used in the analysis are confounded by the fact that the fleets do not go from 

being zero to 100 percent head restraint equipped. A method of correcting for this was 

discussed and used in Section 2.6. The data examined in the present section, however, 

are further confounded by not being separable into purely “Integral” and “Adjustable” 

groups. Therefore, it was decided that, for this set of data, the correction for adjusting to 
60

a zero to 100 percent equipped fleet would be used to at least partially adjust the 

estimates.

The adjustments for the GM/Dodge and Ford Ranger groups would have to be done 

separately. The first step is to determine the makeup of each group by vehicle make. The 

same process used in Section 2.6 were applied to the data here. As noted in Section 2.6, 

Indiana and Texas are excluded from the portion of the analysis that derives the formulae 

for adjustment, since these states do not provide the VIN on their data files. Once 

derived, however, the adjustments can of course be used on the Indiana and Texas 

estimates. Data for the correction for the GM/Dodge vehicles are presented in Exhibit 3-

13. These are the same data presented in Exhibit 2-17, excluding the Ford Rangers.

Exhibit 3-13: Number of Pickup Trucks by Manufacturer in Each State, All Impact 

Locations, Mainly Adjustable Head Restraint Vehicles

Florida Maryland Missouri North 

Carolina

Pennsylvania Utah

Before

Dodge 2725 585 2191 2400 2209 573

GM C/K 7063 1250 6097 6668 4408 2282

GM S/T 4606 962 4741 4722 3665 922

Total 20288 3826 16987 19396 13471 5171

After

Dodge 2095 537 2179 1841 1689 788

GM C/K 9533 1251 7432 7553 4266 2751

GM S/T 6473 922 3879 6569 3364 710

Total 25104 3856 18565 22049 12368 5569

Exhibit 3-14 shows the percent of pickup trucks by manufacturer in each state, using the 

data from Exhibit 3-13. These percentages reflect the fact that Ford Rangers are not 

included in them. Therefore, while the counts in Exhibit 3-13 are the same as in 2-14, 

these percentages differ from those in Exhibit 2-18.

Exhibit 3-14: Percent of Pickup Trucks by Manufacturer in Each State, all Impact 

Locations, Mainly Adjustable Head Restraint Vehicles

Florida Maryland Missouri North 

Carolina

Pennsylvania Utah

Before

Dodge 18.93% 20.92% 16.82% 17.40% 21.48% 15.17%

GM C/K 49.07% 44.69% 46.80% 48.35% 42.87% 60.42%

GM S/T 32.00% 34.39% 36.39% 34.24% 35.64% 24.41%

After

Dodge 11.57% 19.82% 16.15% 11.53% 18.12% 18.55%

GM C/K 52.67% 46.16% 55.09% 47.32% 45.78% 64.74%

GM S/T 35.76% 34.02% 28.75% 41.15% 36.10% 16.71%
61

These percentages were then combined to form a weighted average, using registered 

pickup trucks per state, originally presented in Exhibit 2-4. The overall percents by 

manufacturer for vehicles in the “Mainly Adjustable Head Restraint” group, before and 

after the installation of head restraints, are presented in Exhibit 3-15.

Exhibit 3-15: Percent of Pickup Trucks by Manufacturer, Across Six States, 

Weighted by Number of Registered Pickup Trucks per State

Before After

Dodge 18.64 14.73

Chevy C/K 47.66 50.81

Chevy S/T 33.70 34.46

These values were then multiplied by the percent of each type of vehicle equipped with 

head restraints (from Exhibit 2-16), and summed to obtain an overall “Before” and an 

“After” percent of vehicles equipped with head restraints, as follows:

Before: (18.64× 0) + (47.66×.05) + (33.70 ×.2) = 9.12%

After: (14.73×1) + (50.81×1) + (34.46 ×1) = 100

Since Ford Rangers were the only vehicle make with any unequipped vehicles in the 

“After” years (and are excluded here), the “After” group for the “Mostly Adjustable” 

group is 100 percent equipped. Overall, 9.12 percent of pickup trucks were equipped 

with head restraints in the “Before” model years. Consequently, what has actually been 

measured is E1, the reduction in injuries in rear impacts in a fleet that is 100 percent 

equipped with head restraints relative to a fleet that is 9.12 percent equipped. The actual 

measurement needed is E2, the reduction for a 100 percent head restraint equipped fleet 

relative to one without any head restraints. Using Formula 7 (repeated here for 

convenience), 

(1 ) (1 )

(1 ) (1 )

1

2

2

1

p p E

p p E

E

B B

A A

− + −

− + −

− =

where pA = percent of fleet equipped with head restraints in the “After” model years

pB = percent of fleet equipped with head restraints in the “Before” model years.

Substituting 0.0912 for pB and 1 for pA, and solving for E2,

0.9088 (0.0912 )1

1

2

E

E

E

+ ×

=

Each estimate for the “Mostly Adjustable” group would be adjusted using this formula.
62

The process for Ford Rangers is easier, since it involved only one type of vehicle. As 

shown in Exhibit 2-16, 24 percent of Ford Rangers in the “Before” group and 94 percent 

in the “After” group were equipped with head restraints. Thus, in Formula 7, 0.24 is 

substituted for pB and 0.94 for pA. Solving for E2 it becomes:

0.7 (0.24 )1

1

2

E

E

E

+ ×

=

The adjusted effectiveness estimates for the “Mostly Adjustable” (GM/Dodge pickup 

trucks) and the “Mostly Integral” (Ford Rangers) using the correction formulas derived 

above are shown in Exhibit 3-16.

Exhibit 3-16: Estimates of Effectiveness of Head Restraints in Rear Impacts, by 

State and Predominant Type of Head Restraint (Percent Fatality Reduction), 

adjusted for 0 Percent to 100 Percent Head Restraint Equipped Fleet.

GM/Dodge 

(Adjustable)

Ford Ranger 

(Integral)

Florida 7.64 7.40

Indiana 18.70 19.64

Maryland 20.82 -2.29

Missouri 18.61 12.16

North Carolina 13.47 7.95

Pennsylvania 9.70 -2.31

Texas 10.92 10.85

Utah -3.34 17.18

Eight States Combined 9.83 7.48

Eight States Weighted 12.21 9.35

Comparing Exhibits 3-12 and 3-16, it is notable that the Ford Ranger effective estimates 

change to a greater degree than do the GM/Dodge estimates. The Rangers were adjusted 

from a fleet that actually went from 24 to 94 percent equipped to one going from zero to 

100 percent. The GM/Dodge vehicles needed less correction, adjusting only from a fleet 

actually 9.12 to 100 percent equipped. Because of this, note that in Indiana, the adjusted 

estimate for Ford Rangers is higher than that for GM/Dodge, where the opposite was true 

of the unadjusted estimates. Six of the eight states are not enough to indicate significance 

using the Exact Binomial Test. In addition, observe that the adjusted combined state 

estimates, as well as the adjusted weighted ones, while still higher for the “Mostly 

Adjustable” group, are much closer in magnitude than the unadjusted estimates were.

Adjustable head restraints seem to be at least as effective as integral head restraints. 

Unlike the 1982 evaluation of passenger cars, the data do not show an advantage for 

integral head restraints in light trucks. At the same time, they do not show a statistically

significant advantage for adjustable head restraints. However, the analysis of light trucks 

is hampered by the fact that it is not possible to clearly distinguish between the two types.
63

In addition, the assumption is made that the “before” seats in vehicles that eventually had 

integral head restraints installed were equivalent to those that eventually had adjustable 

ones. This might not be a valid assumption if one vehicle had a seat more amenable (for 

whatever reason) to introducing integral rather than adjustable head restraints, or vice 

versa. Overall, these data do not show a difference between integral and adjustable head 

restraints.

3.6 Pickup Trucks with Back Seats vs. Pickup Trucks without Back Seats

Pickup trucks without back seats have a window directly behind the (front-seat) 

occupants. It is possible that this window offered some measure of support to the head in 

a rear impact before head restraints were installed; thus, head restraints were less 

essential and would have lower effectiveness. Conversely, it is conceivable that the 

window and its frame presented an extra hazard to occupants; in that case, the head 

restraint would be all the more beneficial. Therefore, it would be of interest to compare 

the changes in injury rates between pickup trucks with and without back seats. Using the 

VIN, it is possible to distinguish which vehicles had back seats from those that did not.

The Ford Ranger Supercab produced in model years 1989 through 1992 (the model years 

of interest for Ford Rangers) was manufactured with a back seat. Other Ford Rangers in 

these model years did not have a back seat, and therefore had the rear window closer to 

the front-seat occupants’ heads.

The model years of interest for General Motors pickup trucks are 1990 through 1993. 

During these model years, vehicles designated as “Maxicab,” “Extended Cab,” or “Crew 

Cab,” as well as the four door pickups, had back seats. Other General Motors pickup 

trucks did not.

During model years 1988 through 1991, Dodge D/W Club Cab Pickup Trucks had back 

seats, while other models of D/W pickup trucks did not. Over the same model years, 

Dodge Dakota Club Cabs, other than the Short Bed model, had back seats. Other Dodge 

Dakotas, including the Club Cab Short Bed, had no rear seat. All of the back seat 

models, however, were produced during model years 1990 and later only. Since there 

were no “Before” Dodge vehicles having back seats, no comparison could be made for 

them. Therefore, Dodge vehicles were excluded from this portion of the analysis. In 

addition, since presence or absence of a back seat was determined from the VIN, Texas 

and Indiana, which do not contain the VIN on their state data files, were excluded from 

this portion of the analysis.

Data from the combined remaining six states (Florida, Maryland, Missouri, North 

Carolina, Pennsylvania, and Utah) are presented by presence or absence of back seat in 

Exhibit 3-17. Note that both types of vehicles saw a decrease in the injury rate in the 

later years.
64

Exhibit 3-17: Injury Status by Presence/Absence of Back Seat, for Six States 

Combined, Before and After Installation of Head Restraints, Rear Impact

No Back Seat Back Seat

Before After Before After

Injured 3,088 3,202 808 1,178

Uninjured 8,667 10,022 2,536 4,067

Injury Rate 26.27 24.21 24.16 22.42

Effectiveness estimates were determined for each of the six states, for the combined state 

data, and the data weighted by the number of registered pickup trucks. These are 

presented in Exhibit 3-18.

Exhibit 3-18: Estimates of Effectiveness of Head Restraints in Rear Impacts, by 

State and Presence/Absence of Back Seat (Percent Fatality Reduction)

No Back Seat Back Seat

Florida 6.31 5.00

Maryland 17.77 0.37

Missouri 13.83 18.90

North Carolina 10.20 3.95

Pennsylvania 6.14 9.38

Utah -5.57 -0.11

Six States Combined 7.83 7.21

Six States Weighted 8.69 7.38

Worth noting is that the Utah data showed a worsening in performance over time in both 

types of vehicles. (Utah’s overall rear impact improvement was the lowest of the eight 

states in the analysis (Exhibit 2-2).) Notice that three of the six states saw greater 

improvement in pickup trucks without a back seat. Two states saw a larger improvement, 

and Utah saw less worsening, in vehicles with back seats. While both the combined and 

weighted state data saw greater improvement in vehicles with no back seats, the 

differences are quite small. It would appear that neither vehicle configuration, either 

those with back seats or those without, benefit more in rear impacts from the installation 

of head restraints in pickup trucks.
65

Chapter 4: Benefits and Costs

In 1999, head restraints in light trucks prevented an estimated 13,156 injuries. If all light 

trucks had head restraints, a total of 14,882 injuries could have been prevented. The total 

cost of head restraints was $35.41 per vehicle. Given the number of light trucks sold in 

the United States during the preceding 15 years (1985-1999), this resulted in an average 

annual cost of $186,846,000, or $12,555 per injury prevented. 

4.1 Injuries Prevented by Head Restraints in Light Trucks

4.1.1 National Estimates of Injured Occupants

Most of the information presented thus far has been based on eight states for which 

NHTSA has relevant data files (Florida, Indiana, Maryland, Missouri, North Carolina, 

Pennsylvania, Texas, and Utah). In order to determine estimates of injuries prevented 

nationwide, the effectiveness estimate determined in Chapter 2 would need to be applied 

to a national estimate of injured front outboard occupants in light trucks experiencing a 

rear impact. Two possible ways to determine national estimates would be to use 

NHTSA’s General Estimates System (GES) data, or to base an estimate on the eight 

states used previously in the analysis. Both approaches are presented below.

4.1.1.1 General Estimates System

The GES is a probability sample of police-reported traffic crashes in the United States. 

National estimates are obtained by weighting the data with the “WEIGHT” variable on 

the data file.1 For some variables, GES provides either univariate or hot-deck imputed 

variables, which assign a value when one is unknown.2

The Hot-Deck Imputed Body Type variable was used to determine which vehicles were 

light trucks. For 1992 and later, these were coded in GES as Utility Vehicles (Body Type 

values 14,15,16, and 19), Van-Based Light Trucks (values 20-29), Light Conventional 

Trucks (values 30-39), and Other Light Trucks (values 40 through 48).

Unknown seat position was distributed using univariates. In 1998, for example, there 

were an estimated 118,806 drivers and 41,435 right front passengers in rear impacts in 

light trucks. There were an additional 3,647 front seat occupants with known seating, 

and 240 with unknown seating. The 118,806 drivers were 72.49 percent of the known 

seated position front occupants (a total of 163,888 occupants; 118,806 drivers + 41,435 

right front passengers + 3,647 other front occupants), so 72.49% of the 240 unknown seat 

position front occupants would be counted among the drivers. Right front passengers 

were distributed using the same method.

After distributing the front seat occupants, the remaining 2,320 occupants with 

completely unknown seating position were distributed. This resulted in final estimates 

of 120,484 drivers and 42,020 right front passengers, for a total of 162,504 injured front 

outboard occupants in light trucks involved in rear impact crashes. Performing similar 
66

calculations on the 1999 GES data results in a total of 182,004 injured front outboard 

occupants in light trucks involved in rear impact crashes.

4.1.1.2 State Data

The first step in using the state data for a national estimate of injured occupants is to 

determine the number of injured front outboard occupants in rear impacts. As stated in 

Section 2.1.2.4, Indiana and Missouri record data on right front passengers only when 

they are injured. This prohibited their use in determining injury rates, but does not 

prevent their being used in this portion of the analysis. The total number of injured front 

outboard occupants in the eight states for 1998 (the most recent year of data available) 

was 40,794.

This number of front outboard occupants can be used to calculate a national estimate. 

The 9,452,370 pickup trucks registered in these eight states are 26.11% of the 36,203,980 

registered nationwide. Using the formula

40,794 / 0.2611 = 156,234

estimates that a total of 156,234 injured front outboard occupants in light trucks were 

involved in rear impact collisions. This is very close to the 1998 GES estimate of 

162,504.

Light trucks are becoming a larger portion of the vehicle fleet annually. Therefore, it is 

beneficial to use the most current year of data available for the most accurate estimate. 

As of December 2000, state data files of calendar year 1999 are not available for analysis 

within NHTSA, but GES data are available for 1999. Since the estimates for both data 

systems were very similar for 1998, it was decided to use the 1999 GES estimate to 

determine the number of injuries prevented by head restraints in light trucks.

4.1.2 Injuries Prevented

According to NHTSA’s economic cost report3, in 1994 there were 4,130,606 policereported injured persons, and 1,126,001 unreported injured persons, for a total of 

5,256,607 injured. If the assumption is made that the ratio of reported to non-reported 

crashes for rear impacts is the same as for overall crashes, this data can be used to 

determine injuries prevented in both reported and unreported crashes. The ratio:

1.2726

4,130,606

5,256,607

=

gives a multiplier that can be used on reported crashes to determine the total number of 

crashes, including unreported ones. So the number of injured front outboard occupants in 

1999, in rear impacts, would be

182,004×1.2726 = 231,618
67

using the 1999 GES estimate.

This correction is most likely to be conservative. Unreported crashes would naturally 

tend to have less severe injuries than reported crashes. The “whiplash” injuries that head 

restraints were designed to prevent would typically be recorded as less serious or minor 

injuries. So the estimates obtained using these data could be viewed as a lower bound to 

the actual number of injuries prevented.

The final step in determining the number of injuries that head restraints have prevented in 

light trucks is to apply the effectiveness estimate of 6.08 percent to the number of injured 

occupants. Recall that this estimate was derived using pickup truck data only. The 

assumption will be made that head restraints have a similar effect in all light trucks. This 

assumption introduces some uncertainty but it is necessary because head-restraint 

effectiveness could not be evaluated in vans or SUVs: there were no high-sales makemodels that shifted from 0-25 percent to 75-100 percent head-restraint-equipped from 

one model year to the next one. Vans and to a lesser extent SUVs in a few ways 

resemble cars (where head restraint effectiveness is 13 percent) more closely than pickup 

trucks: they may be more often used as personal, urban transportation and have a higher 

proportion of female drivers than pickup trucks. But on the whole, the mass, height and 

rigidity of vans and SUVs makes them more similar to pickup trucks than cars. SUVs in 

particular are often derivatives of pickup-truck designs. Therefore, the effectiveness 

found for pickup trucks could be used to determine injuries prevented in vans and sport 

utility vehicles as well.

According to the CDS, the percent of light trucks having head restraints in calendar year 

1999 was 88.40 percent. The number of potential injured occupants if no light trucks at 

all had been equipped with head restraints is determined using the formula:

244,774

1 (0.0608 0.8840)

231,618

=

− ×

where 231,618 is the actual number of injured front outboard occupants in light trucks in 

rear impacts in 1999, and 0.0608 is the effectiveness estimate determined previously.

If every light truck on the road had head restraints in 1999, the injuries prevented would 

have been:

244,774 × 0.0608 = 14,882

The actual number of injuries prevented in 1999, however, was:

244,774 × 0.0608× 0.8840 = 13,156

Using the upper limit of 3.49 percent and the lower limit of 8.65 percent, previously 

calculated for the estimate of effectiveness (Exhibit 2-20), the confidence bounds around 

the estimates of injuries prevented can be determined. First, the upper and lower bounds 

for potential injuries are determined:
68

Lower Limit: 238,991

1 (0.0349 0.8840)

231,618

=

− ×

Upper Limit: 250,795

1 (0.0865 0.8840)

231,618

=

− ×

Using these values, the limits for the number of injuries that would have been prevented 

if all light trucks had been equipped with head restraints are:

Lower Limit: 238,991× 0.0349 = 8,341

Upper Limit: 250,795× 0.0865 = 21,694

The confidence bounds for the estimate of actual injuries prevented (given that not all 

light trucks were equipped with head restraints) are calculated as:

Lower Limit: 238,991× 0.0349× 0.8840 = 7,373

Upper Limit: 250,795× 0.0865× 0.8840 = 19,177

In sum, if every light truck on the road had head restraints in 1999, a total of 14,882 

injuries would have been prevented, relative to a fleet of light trucks with no head 

restraints (confidence bounds range from 8,341 to 21,694). Since 88.40 percent of light 

trucks were in fact equipped with head restraints by then, the actual number of injuries 

prevented in 1999 was 13,156 (confidence bounds range from 7,373 to 19,177). Note 

that these estimates are based on the effectiveness value calculated on pickup truck at the 

time head restraints were first installed in these vehicles. If head restraints in vans and 

sport utility vehicles were either more or less effective, this would of course change the 

number of injuries prevented. In addition, if head restraints had changed configuration in 

such a way as to have become more effective in recent years, this would also alter the 

number of injuries prevented. It is known that head restraints in passenger cars are higher 

today than when they were first installed. If this is also true for light trucks, then the 

number of injuries prevented would correspondingly increase.

NHTSA’s Evaluation of Head Restraints in Passenger Cars4 found that head restraints in 

passenger cars were going to prevent 64,000 injuries per year when they were in every 

car on the road. There are various reasons for the 4 to 1 difference between injuries 

prevented by head restraints in cars and in light trucks.

Although light truck sales have greatly increased over the last decade, they currently 

make up only 37% of the light vehicle fleet. This means there are twice as many cars as 

light trucks on the road. In addition, given that a rear impact occurs, there is less risk of 

injury for occupants in a light truck than for those in a passenger car. One reason for this 

discrepancy is gender difference. Women tend to be more prone to “whiplash” type 

injuries than are men. A larger proportion of men drives light trucks than do women, 

particularly pickup trucks. This combination of factors results in fewer “whiplash” 

injuries in rear impacts in light trucks than cars.
69

Finally, the effectiveness of head restraints in light trucks was determined to be 6.08%. 

Head restraints are more than twice as effective in passenger cars, about 13% for the mix 

of adjustable and integral head restraints. Note that the current fleet of passenger cars is 

equipped with head restraints that are higher the minimum required5, and effectiveness 

may have increased since this initial evaluation was performed. It is unknown why head 

restraints are more effective in cars. Perhaps the large mass and extensive rear structure 

of light trucks, especially pickup trucks, offers a degree of protection in rear impacts that 

makes it less beneficial to have head restraints.

Overall, the in rear impacts in passenger cars is more than twice the number injured in 

light trucks. This, combined with the lower effectiveness of head restraints in light 

trucks, results in one-fourth as many injuries prevented by head restraints in light trucks 

as in passenger cars.

4.2 Cost of Head Restraints in Light Trucks

NHTSA is preparing a report6 on cost estimates for the increase in the purchase price and 

weight associated with head restraints as well as other safety standards. It was 

determined that, on average, head restraints added $31.03 (in 1998 dollars) to the 

purchase price and 3.85 pounds to the weight of a light truck. Since the injuries 

prevented reflect 1999 data, the costs must also be indexed to 1999. The initial cost of 

the head restraint is multiplied by the factor of 104.77/103.22 (the ratio of the Implicit 

Price Deflator7 for 1999 relative to that of 1998). This is calculated as:

$31.03 $31.50

103.22

104.77

× =

resulting in a cost of $31.50 in 1999 dollars.

The consumer cost of head restraints over the life of a light truck is the sum of the 

purchase price increase and any additional operating costs. The additional weight of the 

head restraints will result in a slight increase in fuel consumption over the life of the 

vehicle. At 3.85 pounds, this results in an additional 5.38 gallons of fuel8 over the 

lifetime of the light truck. A 2000 price per gallon of $1.53 was used, adjusted by 

weighted average yearly mileage over a span of 25 years, as well as a discount factor of 7 

percent for net present value of future gasoline purchasing. This resulted in a lifetime 

fuel consumption having net present value $3.91 due to the weight increase of the frontseat head restraints. Since the head restraints are inside the passenger compartment, they 

do not add to aerodynamic drag, so there is no fuel penalty other than that due to the 

weight increase.

The lifetime consumer cost per light truck is the sum of the purchase price increase and 

the fuel penalty:

$31.50 + $3.91 = $35.41 per light truck
70

An average of 5,276,636 light trucks has been sold annually in the United States during 

the past 15 years (1985-1999). Since fifteen years is approximately the average lifespan 

of a light truck in the United States, this is a suitable period of time over which to 

determine the average annual cost, calculated as:

5,276,636 ×$35.41 = $186,845,678.40

The average annual cost of head restraints in light trucks is approximately $186,846,000. 

Given that a year’s output of head restraints will prevent 14,882 injuries over the lifetime 

of these vehicles, the cost per injury prevented is $12,555.
71

Chapter 4 Footnotes

1. National Estimates, National Automotive Sampling System (NASS) General Estimates 

System (GES) Analytical User's Manual 1988-1999. Washington, DC: U.S. 

Department of Transportation; National Highway Traffic Safety Administration; 

National Center for Statistics and Analysis, Dec, 2000, pp. 9-10.

2. Understanding the GES Imputation Process, National Automotive Sampling System 

(NASS) General Estimates System (GES) Analytical User's Manual 1988-1999.

Washington, DC: U.S. Department of Transportation; National Highway Traffic 

Safety Administration; National Center for Statistics and Analysis, Dec, 2000, pp. 7-

8.

3. Blinoe, Lawrence J. The Economic Cost of Motor Vehicle Crashes, 1994. DOT HS 

808 425. Washington, DC. U.S. Department of Transportation; National Highway 

Traffic Safety Administration, July 1996, p. 9.

4. Kahane, Charles J. An Evaluation of Head Restraints: Federal Motor Vehicle Safety 

Standard 202. Technical Report No. DOT HS 806 108. Washington” National 

Highway Traffic Safety Administration, 1982.

5. Preliminary Economic Assessment and Regulatory Flexibility Analysis: FMVSS No. 

202 Head Restraints for Passenger Vehicles. National Highway Traffic Safety 

Administration, Plans and Policy, Office of Regulatory Analysis and Evaluation. 

December, 2000.

6. Rymarz, Greg. The Cost and Weight of the Federal Motor Vehicle Safety Standards 

for Passenger Cars and Light Trucks. Washington, DC. U.S. Department of 

Transportation; National Highway Traffic Safety Administration, to be published.

7. Bureau of Economic Analysis Data. Internet Address: 

http://www.bea.doc.gov/bea/dn/nipaweb/AllTables.asp. Washington: Bureau of 

Economic Analysis, 2001.

8. FMVSS No. 208 Mandatory Air Bag Installation. Washington, Office of Regulatory 

Analysis, Plans and Policy, June 1993.

Page III-9 of the above report gives this formula for computing increased fuel 

consumption:





























− 















FuelEconomy mpg

LifetimeVMT

W

W

,

1

.8

1

2

where the values used in the present report are:

W1=Original vehicle weight (4169, average in-use weight of light truck in the 

U.S.)

W2=Vehicle Weight after increase due to head restraints (4169 + 3.85 = 4172.85)
72

Lifetime VMT=128,195

Actual Fuel Economy, MPG=17.6=85% of CAFÉ

Pages III-9 to III-12 of the same report compute the net present value of a gallon of 

fuel consumed over the life of the truck.