Since the passage of mandatory passive restraint legislation (Federal
Motor Vehicle Safety Standard 208) in 1984, numerous investigators hav
e examined patterns of use among the different types of restraint syst
ems and user populations. In this paper, we review the available data
on usage patterns in automatic shoulder belt and manual lap belt syste
ms. The restraint systems involving automatic shoulder belts have gene
rally been regarded as highly successful in increasing the use rates o
f shoulder belts for American drivers (frequently greater than 90%). A
t the same time, the use of the manual lap belt with automatic shoulde
r belts remains roughly similar to the use rate for manual three-point
systems. We also review studies of driver's knowledge about the exist
ence and importance of the elements of these automatic systems. These
findings have potential application for the design of manual and autom
atic restraint systems in automobiles.