OBJECTIVE: The study aimed to establish an association between seat belt ticketing by police, seat belt wearing rates, and decreases in casualty rates following the implementation of a community seat belt initiative in a northern region of British Columbia. METHODS: Annual and monthly violation ticket rates and the percentage of casualties unbelted in collisions were computed for the North Central region and a comparison region, the Southern Interior. The trends in annual seat belt ticket rates, seat belt use among injured victims, and injury data from 2001 through 2007 were examined by descriptive/univariate methods and with intervention time series analysis. Use of a casualty rate measure controlled for changes in collision frequency over time. The primary outcome measure was injury claim incidents involving injuries other than to soft tissue. Injury claims involving only soft tissue were examined as a control series, because it was reasoned this subset of casualties would be less impacted by seat belt use. RESULTS: Seat belt tickets per capita increased in the North Central (NC) region over the study period, exceeding levels in all other regions. The percentage of unbelted occupants in casualty crashes fell by about 3 percent per year in the NC region after the initiative was introduced compared to about 1 percent per year in the SI region. The time series models revealed a significant reduction in non soft tissue casualties per 100 collisions per month. No significant reduction in the soft tissue only injury criterion was detected. CONCLUSIONs: A strong community initiative backed by support at the provincial level can be successful in a largely rural and sparsely populated northern region despite the challenges faced in such regions.