Motor Vehicle Injuries

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The Problem

Motor vehicle crashes are a leading cause of death in the United States for people aged 30 years or younger.⁶ In 2011, motor vehicle crashes killed more than 32,000 people and injured more than 2.6 million.^6,7

Policies & Practices

Seat belt law

People who are wearing a seat belt are more likely to survive a motor vehicle crash or suffer less serious injuries than those who are not, and seat belt laws have been proven to increase seat belt use.^1,2,5,8,9

Primary enforcement seat belt laws allow police to stop vehicles solely because a driver or passenger is not wearing a seat belt. Secondary enforcement seat belt laws require police to have some other reason for stopping a vehicle before citing a driver or passenger for not buckling up. The most comprehensive policies are primary enforcement seat belt laws that cover all occupants regardless of where they are sitting in the vehicle. Some states have primary laws that cover only the front seat occupants.

The Community Preventive Services Task Force recommends primary enforcement seat belt laws on the basis of strong evidence of their superior effectiveness over secondary laws in reducing motor vehicle-related injuries and deaths.^1,2 Rates of seat belt use range from 9 to 14 percentage points higher in primary law states than secondary law states.^1,2,5,8,9

Status of state seat belt laws, United States (as of August 1, 2013)

(State count includes the District of Columbia.)

These ratings were based on evidence that states with primary enforcement seat belt laws covering all seating positions in the vehicle are the most effective at increasing seat belt use.^1,2,5,8,9

States were rated green, yellow, or red according to the following criteria:

Green	As of August 1, 2013, the state had a primary enforcement seat belt law covering all seating positions.
Yellow	As of August 1, 2013, the state had a primary enforcement seat belt law covering only the front seats.
Red	As of August 1, 2013, the state had a secondary enforcement seat belt law or no law.

Child passenger restraint law

Appropriate restraints for child passengers reduce children’s risks for death or serious injury in a crash.^5,10,11 Child passenger restraint laws require children to travel in appropriate child restraints, such as car seats or booster seats, until adult seat belts fit them properly. Evidence shows that laws mandating use of car seats and booster seats increase their use.^3,5,12

The Community Preventive Services Task Force recommends laws mandating the use of car seats and booster seats to increase restraint use and reduce injuries and deaths among child passengers.³ The Task Force found that child passenger restraint laws increased car seat use by a median of 13%, decreased deaths by 35%, and decreased injuries and deaths combined by 17%.³

Status of state child passenger restraint laws, United States (as of August 1, 2013)

(State count includes the District of Columbia.)

All states and the District of Columbia have some form of child passenger restraint law. However, the ages covered vary, with some states requiring car/booster seat use only through age 3 or 4 years. For children aged 4–8 years, booster seats reduce the risk for serious injury by 45%, compared with seatbelt use alone.¹¹

Increasing the required age for car seat or booster seat use is an effective way to keep children protected. For example, among states that increased the required age to 7 or 8 years, car seat and booster seat use tripled, and fatal and incapacitating injuries decreased 17%.¹²

These ratings were based on evidence indicating that laws requiring the use of car/booster seats through at least age 8 more effectively increase restraint use and decrease injuries and deaths than laws requiring use through younger ages.

States were rated green, yellow, or red according to the following criteria:

Green	As of August 1, 2013, the state’s child passenger restraint law covered children through age 8 years.
Yellow	As of August 1, 2013, the state’s child passenger restraint law covered children through age 6 or 7 years only.
Red	As of August 1, 2013, the state’s child passenger restraint law covered children aged 5 years or younger only.

Graduated driver licensing system

Motor vehicle crashes are the leading cause of death for teens in the United States. In 2011, nearly 2,000 drivers aged 15–20 years were killed and 180,000 injured in motor vehicle crashes. Young drivers are at the greatest risk.¹³

Graduated driver licensing (GDL) systems have been proven effective at keeping teens safer on the road.^5,14,15 They help new drivers gain experience under low-risk conditions by granting driving privileges in stages. As teens move through the stages of GDL, they are given additional privileges, such as driving without adult supervision.

Research indicates that more comprehensive GDL systems prevent more crashes and save more lives than less comprehensive GDL systems.^5,14,15 On the basis of this evidence, the following five components^5,14-16 are recommended for more comprehensive GDL systems:

Minimum age of 16 years for a learner’s permit
Mandatory holding period of at least six months for a learner’s permit
Restrictions against nighttime driving between 10:00 pm and 5:00 am (or longer)
Limit of zero or one for the number of young passengers without adult supervision
Minimum age of 18 years for full licensure

Status of state GDL systems, United States (as of August 1, 2013)

(State count includes the District of Columbia.)

If a state met all five criteria for a more comprehensive GDL system, it was rated green. Much research has focused on the nighttime driving and young passenger restrictions of GDL systems and has found that these two components greatly contribute to reduction of injuries and death.^5,14,15 Therefore, if a state had at least these two components but not all five, it received a yellow rating.

States were rated green, yellow, or red according to the following criteria:

Green	As of August 1, 2013, the state’s GDL system included all five GDL components.
Yellow	As of August 1, 2013, the state’s GDL system required both nighttime driving and young passenger limits but not all five components.
Red	As of August 1, 2013, the state’s GDL system lacked either the nighttime driving or young passenger limits, or both.

Ignition interlock law

Since the mid-1990s, alcohol-impaired driving has been involved in nearly one- third of all fatal crashes.^17-19 Drivers who have been convicted of driving while intoxicated (DWI) are seven times more likely than drivers without a DWI conviction to be involved in a fatal crash.¹⁸ Ignition interlock laws—which mandate the use of ignition interlocks for drivers convicted of DWI—can do much to reduce this risk. An ignition interlock is a device installed in a vehicle that analyzes a driver’s breath and prevents the vehicle from starting if alcohol is detected.

The Community Preventive Services Task Force recommends the use of ignition interlocks for all convicted DWI offenders. The Task Force found that ignition interlocks, while installed, reduced the rate of re-arrest among convicted DWI drivers by a median of 67%.⁴

(Note: A DWI offender is an individual who has been found by a court of law to be in violation of the jurisdiction’s DWI law. A DWI law makes it illegal to drive with a blood alcohol concentration (BAC) >0.08 g/dL. All 50 states and the District of Columbia have these laws.)

Status of state ignition interlock laws, United States (as of August 1, 2013)

(State count includes the District of Columbia.)

These ratings were based on evidence showing that ignition interlocks are effective at reducing recidivism while installed on the vehicles of convicted DWI offenders.⁴ Currently, ignition interlocks are installed on a very small proportion of convicted DWI offenders’ vehicles. Installing interlocks on a greater number of convicted DWI offenders’ vehicles would have a greater impact on preventing alcohol-impaired driving at the population level.⁴ This can be achieved by requiring installation of ignition interlocks on vehicles driven by all convicted DWI offenders.

States were rated green, yellow, or red according to the following criteria:

Green	As of August 1, 2013, the state had a law requiring ignition interlocks for all convicted DWI offenders (i.e., offenders with BAC >0.08 g/dL, including both first-time and repeat offenders).
Yellow	As of August 1, 2013, the state had a law requiring ignition interlocks for convicted repeat DWI offenders or first-time offenders who have a particularly high BAC (e.g., BAC >0.15 g/dL).
Red	As of August 1, 2013, the state had no law requiring ignition interlocks for any convicted DWI offenders.

Prevention Status Reports: Motor Vehicle Injuries, 2013

The files below are PDFs ranging in size from 100K to 500K.

Learn more and get involved

Motor Vehicle Safety

References

Shults RA, Nichols JL, Dinh-Zarr TB, et al. Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews. Journal of Safety Research 2004; 35(2):189-96.
Shults RA, Elder RW, Sleet DA, et al. Primary enforcement seat belt laws are effective even in the face of rising belt use rates. Accident Analysis and Prevention 2004;36(3):491-3.
Zaza S, Sleet DA, Thompson R, et al. Reviews of evidence regarding interventions to increase the use of child safety seats[PDF – 2.43MB]. American Journal of Preventive Medicine 2001;21(4S):31-47.
Elder RW, Voas R, Beirness D, et al. Effectiveness of ignition interlocks for preventing alcohol-impaired driving and alcohol-related crashes. A Community Guide Systematic Review[PDF -584KB]. American Journal of Preventive Medicine 2011;40(3):362-76.
Goodwin A, Kirley B, Sandt L, et al. Countermeasures That Work: A Highway Safety Countermeasures Guide for State Highway Safety Offices. 7th edition [PDF – 7.28MB]. (Report No. DOT HS 811 727). Washington, DC: National Highway Traffic Safety Administration; 2013.
CDC. WISQARS (Web-based Injury Statistics Query and Reporting System) [database]. Accessed Jun 5, 2013.
National Highway Traffic Safety Administration. Traffic Safety Facts, 2011 Data: Overview[PDF – 1MB]. Washington, DC: US Department of Transportation; 2013.
Beck LF, West BA. Vital signs: nonfatal, motor vehicle–occupant injuries (2009) and seat belt use (2008) among adults—United States. MMWR 2011;59:1681–6.
Shults, RA, Beck, LF. Self-reported seatbelt use, United States, 2002–2010: does prevalence vary by state and type of seatbelt law?Journal of Safety Research 2012;43(5–6):417–20.
Durbin DR, Committee on Injury, Violence, and Poison Prevention. Technical Report—Child Passenger Safety. Pediatrics 2011;127(4):e1050–66.
Arbogast KB, Jermakian JS, Kallan MJ, et al. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 2009;124;1281–6.
Eichelberger AH, Chouinard AO, Jermakian JS. Effects of booster seat laws on injury risk among children in crashes. Traffic Injury Prevention 2012;13:631–9.
National Highway Traffic Safety Administration. Traffic Safety Facts, 2011 Data: Young Drivers[PDF – 781KB]. Washington, DC: US Department of Transportation; 2013.
Williams AF, Tefft BC, Grabowski JG. Graduated driver licensing research, 2010–present. Journal of Safety Research 2012;43(3):195–203.
Baker SP, Chen LH, Li G. National Evaluation of Graduated Driver Licensing Programs[PDF – 1.73MB]. Washington, DC: US Department of Transportation; 2006.
US Department of Health and Human Services. Injury and violence prevention. In: Healthy People 2020. Updated Oct 30, 2012.
National Highway Traffic Safety Administration. Traffic Safety Facts, 2010 Data: State Alcohol-Impaired Driving Estimates[PDF – 997KB]. Washington, DC: US Department of Transportation; 2012.
National Highway Traffic Safety Administration. Traffic Safety Facts, 2011 Data: Alcohol-Impaired Driving[PDF – 821KB]. Washington, DC: US Department of Transportation; 2012.
National Highway Traffic Safety Administration. Traffic Safety Facts 2011: FARS/GES Annual Report[PDF – 3.24MB]. Washington, DC: US Department of Transportation; 2013.