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Written Testimony before the Joint Committee on Public Health, Connecticut General Assembly on House Bill 5161 - Seat Belt Use in All Positions of a Vehicle, Hartford, CT
T. Bella Dinh-Zarr, PhD, MPH
Hartford, CT

​Good afternoon Co-Chairs Steinberg, Gerratana and Somers. Thank you for providing an opportunity to appear before you today to discuss the National Transportation Safety Board’s (NTSB) recommendations regarding seat belt use requirements. NTSB recommends that all states require seat belt use in all vehicle seating positions equipped with a passenger restraint system and has been making this recommendation for decades.

The NTSB is an independent federal agency charged by Congress with investigating every civil aviation accident in the U.S. and significant accidents in other modes of transportation – railroad, highway, marine and pipeline. The NTSB determines the probable cause of each accident it investigates and makes safety recommendations aimed at preventing future accidents. In addition, the NTSB carries out special studies concerning transportation.  The recommendations that arise from our investigations and safety studies are the NTSB’s most important tool for saving lives and preventing injury.

Motor vehicle crashes are responsible for more deaths than crashes in all other transportation modes combined.  Almost 95 percent of all transportation-related deaths each year result from highway crashes. Further, motor vehicle crashes are a leading cause of death for children, youth and young adults.

In April 2016, I had the privilege of chairing an NTSB workshop, “Rear Seat Safety in Passenger Vehicles.” That day-long event focused on short- and long- term countermeasures that could improve safety for rear-seated individuals. The workshop brought together leading experts in occupant protection and public health to focus on safety in passenger vehicle rear seats, as well as measures to mitigate injuries among those passengers. The workshop participants identified many countermeasures, including promoting the adoption of a rear seat belt use requirement.

According to the most recent survey, observed seat belt use in the United States is 90.1 percent.  However, seat belt use is lower in fatal crashes, which are often the most violent motor vehicle crashes. In 2016, according to the National Highway Traffic Safety Administration (NHTSA), among those occupants fatally injured in traffic crashes, 48 percent were unrestrained.  Further, a lower proportion of fatally injured rear seat occupants (43 percent) were restrained than fatally injured front seat occupants (53 percent).

Connecticut has been a leader for many years with its primary enforcement law. Its observed belt use rate was almost 90 percent in 2016.  However, Connecticut’s primary seat belt law only applies to the front seat.

In 2015, NHTSA’s National Occupant Protection Use Survey revealed that belt use in rear seats was only 74.8 percent, compared to 88.5 percent in the front seat.  Additionally, that study found that average seat belt use in the back was higher among states with laws requiring seat belt use in all seating positions than in states requiring seat belt use only in the front seat.

Seat Belts Are Effective

Unfortunately, some motor vehicle occupants mistakenly believe that they are safer without a seat belt, that their vehicle and/or their air bag provides sufficient occupant protection, or that they will not be in a motor vehicle crash where seat belts would make a difference. However, seat belts are the number one defense against motor vehicle injuries and fatalities.  They restrain vehicle occupants from the extreme forces experienced during motor vehicle crashes.  Further, unbelted vehicle occupants frequently injure other occupants, and unbelted drivers are less likely than belted drivers to be able to control their vehicle.

Unrestrained rear seat occupants can pose a risk to other individuals in the vehicle because they become human projectiles that can injure other occupants.  An article in the Annals of Emergency Medicine noted that the odds of dying for restrained drivers are higher when the passenger behind the driver is unrestrained; the odds increase more in head-on collisions.  A separate study in The Journal of the American Medical Association stated that an occupant’s risk of death in a crash is associated with the restraint use of other occupants, and the risk is lowest when all vehicle occupants are restrained.

In addition, seat belts prevent occupant ejections.  In 2015, only 1 percent of vehicle occupants using seat belts were ejected, while 30 percent of unrestrained vehicle occupants were ejected.  Among those occupants totally ejected from their passenger vehicles, 80 percent were killed.

NHTSA estimates that from 1975 through 2016, seat belts saved almost 360,000 (359,241) lives nationwide.  According to NHTSA, had all passenger vehicle occupants age 5 and older used seat belts in 2016, an additional 2,456 deaths could have been prevented.

Economic Costs from the Failure to Use Seat Belts Are Significant

Although opponents to strong seat belt laws claim that nonuse is a personal choice and affects only the individual, the fact is that motor vehicle injuries and fatalities have a significant societal cost.  NHTSA calculated that the lifetime cost to society for each motor vehicle fatality is over $977,000.  More than 80 percent of these costs were attributed to lost workplace and household productivity.

NHTSA estimates that each critically injured survivor of a motor vehicle crash costs an average of $1.4 million.  Medical expenses and lost productivity account for 84 percent of the cost of the most serious level of non-fatal injury.  In a 1996 study, NHTSA found that the average inpatient cost for unbelted crash victims was 55 percent higher than for belted crash victims.

The emotional and financial costs to Connecticut are just as staggering.  In 2016, some 169 vehicle occupants died in motor vehicle crashes; almost half were not using seat belts.  NHTSA estimates that if everyone in Connecticut used a seat belt, rear occupants included, Connecticut would prevent an additional 18 fatalities every year.

Increasing seat belt use by including rear seats in Connecticut’s primary seat belt law means simply using a technology that is already there. Nothing has to be bought or installed.  Every car manufactured today has rear seat belts installed and ready to be used.  Utilizing this existing, but often neglected, safety technology would save both lives and money.


Primary enforcement seat belt laws remain the best way to raise and maintain high seat belt use rates, but the laws need to apply to all vehicle occupants.  As noted above, belt use in rear seats is higher in states that require rear seat occupants to use these safety devices.

The NTSB believes that a significant number of lives can be saved and injuries prevented if Connecticut closes this loophole in its occupant restraint law. A comprehensive primary enforcement seat belt law should include coverage of all vehicle occupants in all seating positions.  House Bill 5161 will save lives and reduce injuries in Connecticut.  The NTSB strongly supports this lifesaving measure to improve the health of the people of Connecticut.

Thank you again for giving the NTSB an opportunity to testify on this important issue.  I would be happy to answer any questions you may have.