Problem:Motor vehicle crashes killmore adolescents in the United States than any other cause, and often the teen is notwearing a seat belt. Methods: Using data fromthe 2011 Youth Risk Behavior Surveys from38 states, we examined teens\u27 self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with alwayswearing a seat belt. Results: Only 51% of high school students living in 38 states reported alwayswearing a seat beltwhen riding as a passenger; prevalence varied from32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to alwayswear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased. Discussion: Seat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups. Practical applications: This study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.
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