Historically, the observed seat belt usage rate for occupants has varied across a number of factors (e.g., primary or secondary use law, seat location, etc.). Of these factors, the age of the driver or occupant has been consistently noted as an important characteristic that is linked to the use of the seat belt. For example, the seat belt use rate for drivers and front seat passengers in the U.S. in 2002 was estimated to be over 70% for adults [1] but over 10% less for pre-teens [2] and teenagers [3], which are generally less than 60%. This discrepancy between younger age groups and adults has been reported in several states across the country [2–5]. Eby et al. [4] reported that individuals 4–15 years old, seated in the second and third rows, wore seat belts about 50% of the time in the left and right positions. In a separate four-state observational study of teenage and older occupants by Womack et al. [6], teen seat belt use in the back seats was only 10.9%. Together, these studies indicate pre-teen and teenagers wear seat belts less frequently than comparable adult cohorts, and that they will be even less likely to wear a seat belt when they are located in the back seat positions.

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