Introduction Road traffic accidents and associated injuries, is a major public health issue in Pakistan.

Objective To determine the use of seat belt among drivers and front passengers and factors associated with use and non use of seatbelt among drivers and front passengers.

Methods and materials This was a cross sectional study conducted in Peshawar from October 2015 to March 2016. Multistage cluster sampling was used. Total sample size was 1690. Proportions were compared using chi-square test. Logistic regression was used to know the association between dependent and independent variable after adjustment for potential confounders using STATA 13.1.

Results Total of 1690 vehicles were included in the study. 35.5% of drivers were using seat belt while in front passengers no one was using seat belt. In drivers most frequently reported reasons for using seat-belts were avoiding fines and penalties (72.2%). The most common reasons of not wearing seat-belt in drivers were embarrassment (45.6%) while in front passengers the most frequent reason of not wearing seat belt were embarrassment (42.8%). Those drivers having education of post graduate level were significantly less likely to wear seat belt (OR 0.40, 95% CI 0.25 to 0.62, P-value<0.001) compared to Illiterate. Private cars (OR 0.44, 95% CI 0.34 to 0.56, P-value<0.001) were less likely to wear seat belt Compared to taxi.

Conclusion The findings showed that a considerable proportion of people in Peshawar do not use seat- belts. To improve seat-belt use, it is suggested that law enforcement for drivers as well as for front passengers accompanied by more public education should be seen as priority.