The use of safety belts has long been considered an effective way to reduce deaths and injuries on the nation’s highways. The Department of Transportation (DOT) estimates that 10,000 additional lives could be saved annually if all of the occupants of motor vehicles used safety belts. Safety belt technology has existed for more than a century, but belts were not installed in new cars sold in the United States until the mid-1960s. Even after the belts were available, relatively few people used them. In 1984, New York became the first state to enact a law mandating the use of safety belts. Other states soon enacted similar laws. Currently, 48 states and the District of Columbia have some form of law on using belts. DOT’s National Highway Traffic Safety Administration (NHTSA) has estimated that safety belt use increased from 11 percent in 1982 to 67 percent in 1994. More than 40,000 people have died in traffic accidents in the United States almost every year since 1960. In 1966, 50,894 fatalities occurred on the highways; in 1994, about 40,700 people died. Although crashes of airplanes and trains receive more attention from the media, the number of highway fatalities far exceeds those that occur in all other modes of transportation combined. NHTSA estimates that annually about 20,000 occupants of motor vehicles die in crashes while not using about 600,000 occupants are injured in crashes while not using safety more people are killed or seriously injured in road crashes than are the victims of crimes, and traffic crashes cost society over $130 billion annually. NHTSA estimates that from 1982 through 1994, 65,290 lives were saved by safety belts, and about 1.5 million moderate to critical injuries were prevented. Despite these successes, enormous costs are still generated when people do not use safety belts. NHTSA reported in June 1994 that not using belts results in 10,000 deaths and 200,000 moderate to critical injuries annually. NHTSA estimates that these deaths and injuries cost society $20 billion annually in medical costs, lost productivity, and other injury-related expenses. Safety belts were developed in the 1880s to keep people from bouncing off horse-drawn buggies. However, automobile manufacturers did not offer safety belts in vehicles until the 1950s. In 1961, a few states required that belts be installed in the new cars sold in their states. In 1962, manufacturers began to install safety belt anchorages at the factory, making it easier for car dealers or owners to add safety belts later. In 1964, U.S. manufacturers began making safety belts standard equipment in the front seat of their cars. Various analyses have been conducted to show what happens to belted and unbelted occupants of vehicles involved in crashes. Figure 1.1 shows how a steering wheel, instrument panel, and windshield absorb crash forces affecting an unbelted dummy. In May 1992, we reported the results of various studies on the effectiveness of safety belts, laws on the mandatory use of belts, and the costs of not using belts. These studies showed that using safety belts generally reduced the rates of both fatalities and serious injuries by 50 to 75 percent in crashes involving motor vehicles. The studies also showed that state laws on safety belt use reduced both fatalities and serious injuries by 5 to 20 percent, even though the use of belts was relatively low during the periods in which these studies were performed. Most studies that addressed hospital costs reported that the crash victims who had used belts averaged 60 to 80 percent lower hospital costs than those who had not used belts. The studies also found that the occupants not using belts who were injured in crashes paid less than one-half of their hospital costs, since most of the costs were paid through insurance premiums or Medicare and Medicaid. The tax-supported programs paid between 8 and 28 percent of the hospital costs. The Congress and federal agencies have encouraged the installation and use of safety belts since the mid-1960s, and the states began enacting laws on safety belt use in the mid-1980s. Under the initial federal efforts, safety belts were required to meet minimum standards. Since few occupants of vehicles voluntarily used manual safety belts, DOT issued a rule in 1984 mandating that passive restraints—automatic safety belts and airbags—be phased in beginning with 1987 model year cars. Under the rule, the installation of passive restraints could be avoided if states representing two-thirds of the U.S. population enacted satisfactory laws mandating safety belt use. This provision focused attention on mandatory use laws and prompted automobile manufacturers and others to provide funding and support for such laws. The first state law mandating safety belt use was enacted in New York in 1984; by 1986, a total of 22 states and the District of Columbia had such laws in effect. Since DOT’s data showed little increase in safety belt use between 1987 and 1990, the Congress acted in 1991 to again focus attention on increasing the use of safety belts. The Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA) (P.L. 102-240) included financial incentives—grants and penalties—to encourage the states to enact basic safety belt laws and increase belt use. ISTEA provided for grants for up to 3 years to those states that had laws mandating safety belt use and that achieved minimal levels of belt use. The grants totaled $12 million per year for fiscal years 1992 through 1994. ISTEA also required those states that did not have basic safety belt laws to transfer up to 3 percent of their federal-aid highway funds to their state highway safety programs. Maine and New Hampshire are the only states that do not have laws on safety belt use. This report’s objectives were to determine (1) the nation’s progress in achieving goals for the use of safety belts, (2) the strategies used most successfully by some states to increase safety belt use, and (3) federal strategies that could help increase this use. Our work was requested by the Chairman and Ranking Minority Member, Subcommittee on Transportation and Related Agencies, House Committee on Appropriations. To conduct our work, we visited NHTSA’s headquarters in Washington, D.C., the agencies responsible for highway traffic safety programs in 10 states (California, Colorado, Idaho, Maryland, Mississippi, New Hampshire, New Jersey, New York, North Carolina, and South Carolina), and the seven NHTSA regional offices with responsibility for the 10 states. We judgmentally selected the 10 states to include a cross section of state safety belt programs. In making our selections, we considered whether a state’s survey on safety belt use had been approved by NHTSA, whether the state had a law on safety belt use involving primary or secondary enforcement, the fine the state assessed for noncompliance with the law, the state’s reported rate of safety belt use (so that we selected states with relatively high and low use), and the period in which the state’s last survey on safety belt use had been conducted. At NHTSA and the state agencies, we obtained and reviewed pertinent documents and discussed activities concerning safety belts with officials. More specifically, at the various locations, we obtained and reviewed pertinent documents, including NHTSA’s Regional Action Plans and the states’ Highway Safety Plans, which described the state’s strategies for increasing the use of safety belts and provided information on past successes; reviewed materials developed for public information and education campaigns and for community-based traffic safety programs; discussed with state officials what the federal government is currently doing to increase safety belt use, what is and is not working well, and what changes are desirable; reviewed appropriate laws and regulations and other relevant documents; reviewed the methodologies NHTSA used to calculate the rate of seat belt analyzed the methodologies used in state surveys to determine whether the states were consistent in how the surveys were planned and conducted; and reviewed NHTSA’s guidelines on the state surveys of safety belt use to determine the extent to which the guidance provides for consistent surveys. Also, as requested, we met with the Canadian officials responsible for implementing safety belt programs to learn what strategies Canada had used to achieve that country’s reported 90-percent rate of safety belt use. We provided DOT with a draft of our report for review and comment. We conducted our review between June 1994 and December 1995 in accordance with generally accepted government auditing standards. NHTSA has reported that safety belt use increased from 11 percent in 1982 to 67 percent in 1994. However, DOT’s recent goals for safety belt use nationwide have not been met. For example, DOT had a goal of 70-percent belt use by the end of 1992 and reported belt use in 1992 to be 62 percent. DOT’s current goal is to reach a rate of 75-percent belt use nationwide by 1997. Using two different methodologies, NHTSA has estimated the rate of safety belt use nationwide in 1994 to be either 67 or 58 percent. NHTSA recognized that its methodology for estimating the 67-percent nationwide rate of belt use was not precise because it relied on individual state surveys that did not measure belt use consistently. For example, 22 states surveyed only passenger cars, while 20 states surveyed cars, light trucks, and vans. Also, some states counted belt use by drivers only, while others included use by other passengers as well. During October and November 1994, NHTSA conducted a nationwide survey to gather more detailed data on the use of restraints. This survey found a nationwide use rate of 58 percent—63 percent in passenger cars and 50 percent in light trucks. The rate in light trucks is important because these vehicles now constitute about 40 percent of the new vehicles sold. Given NHTSA’s estimates of a 58-percent or 67-percent nationwide rate of belt use in 1994, significant progress must be made to meet DOT’s goal of a nationwide rate of 75-percent belt use by 1997. NHTSA has used various methodologies for estimating the rates of safety belt use, and all show substantial increases since the early 1980s.