Today road traffic accidents pose a major public health problem with a significant number of deaths and injuries among drivers and passengers of all ages. As part of road safety strategy in Fife the Health Board and Regional Council have carried out an observational study of 7,885 occupants in 4,292 cars to determine the extent of appropriate restraint use in the region. Overall restraint use for urban and non-urban sites was found to be 80%. In car drivers restraint use was 94%. Passengers in all rear seat positions were observed to have a significantly lower level of restraint use, 33% overall compared with 92% overall in the front (chi 2 2,827.9, P << 0.001), with usage of restraint declining with increasing age. Particular problems noted were: the much lower use of restraint among children travelling to and from school, the use of restraint inappropriate to children's age, and the significantly lower level of restraint among taxi drivers and their passengers compared with other cars (chi 2 114.9, P << 0.001). These findings have implications for the promotion of restraint use for all car occupants.