Lessons From a Statewide Pilot of “The Battle of the Belts Project” in a State Without a Primary Seat Belt Law

Abstract

Teen driving issues result in higher rates of injury. The Arizona Department of Health Services recommended addressing teen seat belt use. Driver belt use has been reported as lowest among those transporting passengers of similar age. Self-management is essential for long-term behavioral change. Peer-to-peer approaches have been shown to be effective. A group of trauma center representatives in Arizona replicated the Battle of the Belt program that began in 2005 in Missouri to address teen seat belt use using a peer-to-peer approach. Each trauma center "adopted" one school securing an adult champion and a group of students responsible for the project. Monetary awards were made for the schools with the most improved and highest seat belt use. A toolkit was provided. Random observations measured change. Injury Free of Phoenix provided data entry and analysis. Of the six original schools, one withdrew because of the death of a student in a motor vehicle crash. A total of 2,892 vehicles were observed. Significant increases were found for drivers (70.6-91.4%, p = 0.000), front passengers (51.1-67.9%, p = 0.000), and first rear passenger (26.2-68.8%, p = 0.002). Additional rear passenger use also increased, but small numbers created unstable results. The largest changes were seen in schools with closer trauma rep involvement. Odds ratios were computed for the likelihood of belted passengers based on driver seat belt use (baseline 9.08, follow-up 5.5). The peer-to-peer methods appear to be productive with long-term impact unknown. Results associated with drivers compared with passengers may indicate youth "thinking for themselves."