Hawaii is known for having one of the highest rates of seat belt use in the United States. We examine seat belt usage and its relationship to injuries among crash-involved front seat occupants of motor vehicles. We compare no restraint use, lap only, shoulder only, and combined lap-shoulder protection systems. We demonstrate that lapshoulder systems afford the greatest level of protection, followed by lap only, shoulder only, and no restraints. This has implication for occupant protection systems with automatic shoulder belts and manual lap belts. Other studies have found low rates of lap belt usage in cars with automatic shoulder belts and manual lap belts. These results suggest a need to increase public education regarding the benefits of using both lap and shoulder belts.