Safety belts are the most effective safety device in vehicles in terms of preventing injuries (1). Every year, safety belt usage data across the nation is collected by the individual states, the District of Columbia, and U.S. territories in a probability-based observational survey. Using this survey, Massachusetts, a secondary seat belt law state, ranked last in safety belt usage in 2008. This percentage was approximately a 2 percent decrease from 2007. This value was not an aberration as within the recent past, Massachusetts, a secondary safety belt law state, has consistently ranked at or near the bottom of the 50 states. The foremost issue with safety belt usage is the inherent disregard of the safety related benefits for both drivers and passengers, alike. While there is a significant amount of literature documenting the safety related benefits, there is still a need for continued study of the persistent attributes that are associated with those vehicle occupants who make the decision to not buckle up. The scope of this research encompasses the use of the collected data in the 2009 Massachusetts Safety Belt Usage Observation Study to determine what demographic variables; such as age, gender, race, occupant location, community median income, community population density, community education level, and combined demographics, are at high and low ends of the safety belt usage spectrum. Using this data, along with Massachusetts safety belt usage data from the immediate past observational studies, usage based on these and additional demographic information was quantified and analyzed. An outcome of this research was to identify specific strategies, such as increased education and concentrated enforcement, aimed at increasing safety belt usage amidst those targeted subsections of the population that are not buckling up.

Personal lifestyle and behavior are associated with the 10 leading causes of death for Americans. Motor vehicle crashes kill more than 40,000 people and injure more than 3 million people annually in the United States, representing one of America's most serious health and economic problems. According to the National Highway Traffic Safety Administration (NHTSA), someone in America is injured in a motor vehicle crash every 14 seconds and someone is killed every 12 minutes (as cited in Ad Council, 2003). It is widely accepted that increased use of safety belts and reductions in driving while impaired are two of the most effective means to reduce the risk of death and serious injury of occupants in motor vehicle crashes. The Centers for Disease Control and Prevention (CDC) and NHTSA monitor the use of seat belts by surveying the population. The CDC annually conducts a telephone survey called the Behavioral Risk Factor Surveillance System (BRFSS). The NHTSA conducts an observational survey called the National Occupant Protection Use Survey (NOPUS). The purpose of this study was to examine three questions when estimating safety belt use in the United States: (1) Does the BRFSS differ from NOPUS? (2) Is there regional variation in the differences between BRFSS and NOPUS? (3) Do BRFSS and NOPUS data differ significantly depending on whether the safety belt law is primary, secondary, or none? In this study, the two surveys were compared. Three research hypotheses were tested in the null format at the .05 level of significance using a two-tailed test. The z test was used to determine the difference in the nominal data of the two independent proportions. The results of the study revealed that there is a difference between the self-reported BRFSS survey and the NOPUS observational data.