Increased Safety Belt Use Research Articles

Effectiveness of a collaborative, student-run campaign to increase safety belt use among adolescents

BackgroundMVCs are the leading cause of death among adolescents. Seat belts have been shown to decrease MVC-related death. The purpose of this retrospective cohort study was to evaluate the effectiveness...

2440 - Analyzing Border to Border (B2B): Nationwide Campaign to Increase Seat Belt Use and Enforcement along State Borders

Each year, approximately 40,000 Americans die in traffic crashes and almost three million are injured. In 2016, with a 90 percent national seat belt use rate, seat belts prevented 14,668 fatalities. In 2010, the medical and work loss combined cost for occupant fatalities in motor vehicle crashes was over $12 billion. Sadly, many of these fatalities, injuries, and costs could have been prevented if the victims had been wearing seat belts or were properly restrained in child seats. In 2015, only 52% of those killed in motor vehicle crashes were restrained. Despite an overall increase in seat belt use over the past decade, traffic crashes are still the leading cause of unintentional injury-related death in the United States. Primary seat belt laws have proven to be effective in increasing state’s seat belt use rate. When States upgrade their laws from secondary to primary, significant increases in safety belt use are often observed. This report will look at the National Highway Traffic Safety Administration’s Border to Border initiative aimed at addressing seat belt non-use. Border to Border (B2B) is a one-day seat belt-awareness effort coordinated by participating State highway safety offices and their respective law enforcement liaisons. The goal is to reduce seat belt fatalities in their regions by implementing the Click It or Ticket (CIOT) campaign brand. The B2B program aims to increase law enforcement participation by coordinating highly visible seat belt enforcement and providing seat belt fact sheets for drivers at heavily traveled and highly visible areas along state borders. The B2B initiative encourages cross-jurisdiction collaboration, across State borders, which will help law enforcement officers enforce seat belt laws. Since its inception in 2014, Region 2 has spearheaded the B2B program. Due to its size and success this year, NHTSA national headquarters is organizing the effort for 2018, which will include a 4-hour enforcement crackdown on May 21. This report will outline the expansion of the B2B program to a nationwide level. It will discuss state participation; engagement of law enforcement agencies, citations issued, and earned media. In addition to the results, it will look at the overall strengths and challenges of the initiative to inform future programs that require cross state collaboration by law makers, law enforcement, and public health programs globally.

Child Safety in Grocery Stores: The Impact of Verbal Prompts and Reinforcement on Safety Strap Use in Shopping Carts

Head and face injuries requiring a hospital visit are a consistent problem for young children shopping with their caregivers. Falls from shopping carts are the most common cause of such injuries. Using a reversal design with a 2-month follow-up, research assistants verbally prompted caregivers with small children seated in a shopping cart to put a safety strap on their child when entering a grocery store. Compliance resulted in the child receiving a gold star sticker. The sticker was used to identify participants for subsequent data collection when exiting the store. Verbal prompts and stickers increased safety belt use, and most children (95%) remained strapped in during their entire visit. A 2-month follow-up showed the effects to be short lived.

Implementation and Early Outcomes of a Peer-Led Traffic Safety Initiative for High School Students

Compared with other age groups, teenagers have the lowest rate of safety belt use. We sought to determine whether an ongoing, student-led initiative would be effective in increasing safety belt use among high school students compared with another school in which the intervention did not take place. At the intervention school, there was a statistically significant increase of 15% in observed safety belt use and evidence of increased knowledge regarding proper safety belt use. High schools can be effective in changing the traffic safety behaviors of its students.

Evaluation of the Click It or Ticket intervention in Utah

Objective To evaluate the Click It or Ticket (CIOT) intervention conducted in Utah by comparing changes in safety belt use using observational safety belt surveys pre- and post-intervention. Methods Observational surveys of safety belt use for drivers and front seat passengers (collectively referred to as front seat occupants) were conducted before and after the media and enforcement blitz of the CIOT intervention. Data were collected from 16 urban sites during the daytime and nighttime. Logistic regression and generalized estimating equations were used to compute odds ratios for safety belt use adjusted for front seat occupant characteristics. Results Overall safety belt use was observed at 76.5% pre-intervention and 84.8% post-intervention, an improvement of 8.3% (95% confidence interval [CI]: 5.2%, 11.3%). Daytime and nighttime safety belt use improved by 7.8% (95% CI: 3.5%, 12.1%) and 9.7% (95% CI: 6.4%, 13.0%), respectively. While males showed a greater improvement (9.9%) in safety belt use when compared to females (5.7%); males were still less likely to use safety belts than females. Conclusions The CIOT intervention is associated with increased safety belt use at the sites observed in Utah, including among the two high risk groups targeted by the intervention: nighttime occupants and males.

PROMPTING SAFETY BELT USE: COMPARATIVE IMPACT ON THE TARGET BEHAVIOR AND RELEVANT BODY LANGUAGE

ResearcherS used two behavioral prompts to compare increases in safety belt use: a Click It or Ticket prompt or a Flash-for-Life prompt. Participants were 1,822 unbuckled drivers exiting two student parking lots of a large university. Research assistants identified unbuckled drivers, flashed one of the two prompts, and recorded whether drivers buckled after the prompt and the drivers' facial expressions and hand gestures. Findings and implications are discussed.

Brief Motivational Intervention to Increase Self‐reported Safety Belt Use among Emergency Department Patients

Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients. From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self-reported SBU. Those with SBU other than "always" were asked to participate. At baseline, participants answered a 9-item series of situational SBU questions, each scored on a 5-point Likert scale. SBU was defined as a continuous variable (9-item average) and as a dichotomous variable (response of "always" across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5- to 7-minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3-month follow-up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi-square testing. Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] +/-11 years; 61% male). At baseline, the intervention and control groups had similar mean (+/-SD) SBU scores (2.8 [+/-1.1] vs. 2.6 [+/-1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow-up. The intervention group had significantly greater improvement in mean (+/-SD) SBU scores than controls (0.76 [+/-0.91] vs. 0.34 [+/-0.88], p < 0.001). Also, SBU prevalence of "always" was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03). Participants receiving a brief motivational intervention reported higher SBU at follow-up compared to controls. An ED-based intervention may be useful to increase SBU.

Risk Compensation or Risk Reduction? Seatbelts, State Laws, and Traffic Fatalities*

Objective. The risk compensation hypothesis suggests that drivers enjoying greater safety will drive more recklessly and thereby impose greater risks on nonoccupants. We provide a test of the risk compensation hypothesis in the context of state seatbelt laws and belt use rates.Methods. Fixed‐effects models with policy and demographic variables are estimated using annual state data from 1985 to 2002 to test the effect of seatbelt laws and seatbelt use rates on logged fatality rates for occupants, pedestrians, motorcyclists, and all nonoccupants in separate models.Results. Contrary to the risk compensation hypothesis, the results indicate that both occupants and nonoccupants enjoy greater safety due to state mandatory use laws and increased safety belt use rates.Conclusion. Overall, seatbelt laws and the higher belt use these laws induce do not increase nonoccupant risk exposure. If anything, these laws and the accompanying increase in belt use result in safer driving behavior.

Motor Vehicle Crashes and Injury among High School and College Aged Drivers. Miami-Dade County, FL 2005

Purpose To describe motor vehicle crashes and injury occurring among high school and college aged drivers in order to guide prevention efforts targeted toward reducing motor vehicle related injuries among the young population. Methods The 2005 crash data used in this study was obtained from the Florida Department of Highway Safety and Motor Vehicles. Data was analyzed using SAS by age, injury severity, alcohol/drug involvement, restraint use, day of week, and time of day. Results There were 16,311 drivers between the ages of 15–24 involved in motor vehicle crashes. Of these, over a 1/3 were injured, 14% were unrestrained, and 1.5% were alcohol and/or drug related. Alcohol and/or drug use among college aged drivers 20–24 years of age was higher than that in other age groups. The majority of crashes (38%) occurred between the hours of 12 PM and 5 PM. Friday and Saturday accounted for 30% of all crashes in this age group. High school and college aged drivers were less likely to use safety restraints compared to all other age groups. Those without restraints were 5 times more likely to suffer severe injuries. Drivers who were using alcohol and/or drugs were twice as likely to be unrestrained and three times more likely to be severely injured. Among those using alcohol and/or drugs 27% were not restrained. Over half of drivers using alcohol and/or drugs crashed between the hours of 12 AM and 5 AM. Conclusion Interventions targeting 15–24 year olds should focus on increasing safety belt use in this age group. Furthermore, college based interventions should also aim to reduce impaired driving due to alcohol and/or drugs. Since the majority of crashes occurred between the hours of 12 PM and 5 PM, intervention campaigns should target students as they leave the school premises for lunch or after class. In addition, localities should make use of readily available data such as the Florida Department of Highway Safety and Motor Vehicles crash database in order to enhance injury surveillance activities and program planning and evaluation.

Impact of Primary Safety Belt Laws on Alcohol-Related Front-Seat Occupant Fatalities: Five Case Studies

Objective. Impaired drivers and other high-risk road users are less likely to use their safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety belt laws have been shown to increase wearing rates for daytime non-crash-involved drivers and their front-seat passengers, little evidence is available on the effect these laws have on belt usage by crash-involved drinking drivers and their passengers. Methods. This study evaluated the influence of primary safety belt law upgrades from secondary laws on front-seat occupants of passenger cars driven by drinking drivers in fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The outcome measures used to evaluate these law upgrades were (1) the change in safety belt usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger cars driven by drinking drivers. Results. Four of the five states demonstrated increases in safety belt use by front-seat occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to primary safety belt laws. Three states (California, Michigan, and Washington) experienced significant reductions in the number of front-seat occupant fatalities in vehicles driven by drinking drivers. Conclusions. The adoption of primary law upgrades was associated with significant increases in safety belt use (four of five states) and significant reductions in fatalities among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles driven by drinking drivers) in three of the five states studied.

Self-reported safety belt use among emergency department patients in Boston, Massachusetts

BackgroundSafety belt use is 80% nationally, yet only 63% in Massachusetts. Safety belt use among potentially at-risk groups in Boston is unknown. We sought to assess the prevalence and correlates of belt non-use among emergency department (ED) patients in Boston.MethodsA cross-sectional survey with systematic sampling was conducted on non-urgent ED patients age ≥18. A closed-ended survey was administered by interview. Safety belt use was defined via two methods: a single-item and a multiple-item measure of safety belt use. Each was scored using a 5-point frequency scale. Responses were used to categorize safety belt use as 'always' or less than 'always'. Outcome for multivariate logistic regression analysis was safety belt use less than 'always'.ResultsOf 478 patients approached, 381 (80%) participated. Participants were 48% female, 48% African-American, 40% White, median age 39. Among participants, 250 (66%) had been in a car crash; 234 (61%) had a valid driver's license, and 42 (11%) had been ticketed for belt non-use. Using two different survey measures, a single-item and a multiple-item measure, safety belt use 'always' was 51% and 36% respectively. According to separate regression models, factors associated with belt non-use included male gender, alcohol consumption >5 drinks in one episode, riding with others that drink and drive, ever receiving a citation for belt non-use, believing that safety belt use is 'uncomfortable', and that 'I just forget', while 'It's my usual habit' was protective.ConclusionED patients at an urban hospital in Boston have considerably lower self-reported safety belt use than state or national estimates. An ED-based intervention to increase safety belt use among this hard-to-reach population warrants consideration.

Getting Americans to buckle up: The efficacy of state seat belt laws

Annual state observed safety belt use rates over the period 1991–2001 are examined using time-series cross-section regression analysis. It was found that seat belt laws are associated with higher use rates and that the enforcement provision matters. Primary states experience belt use rates that on average are 9.1 percentage points higher than their secondary counterparts. In addition, the level of the fine imposed by statute has an effect on safety belt use apart from that attributable to the enforcement provision. The current median fine of $25 is associated with an additional 3.8 percentage points increase in belt use. To further increase safety belt use, it is recommended that states adopt primary enforcement and impose fines of at least $50 for violating a seat belt law.

Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: A summary of the Guide to Community Preventive Services systematic reviews

Background: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor-vehicle crashes. This paper summarizes the systematic reviews of two interventions to increase safety belt use: primary enforcement safety belt laws and enhanced enforcement of safety belt laws. The reviews were previously published in the American Journal of Preventive Medicine. Methods: We conducted the systematic reviews using the methodology developed for the Guide to Community Preventive Services. Results: These reviews provide strong evidence that primary laws are more effective than secondary laws in increasing safety belt use and decreasing fatalities and that enhanced enforcement is effective in increasing safety belt use. Increases in belt use are generally highest in states with low baseline rates of belt use. Discussion: Primary safety belt laws and enhanced enforcement programs tend to result in greater increases in usage rates for target groups with lower baseline rates. Concerns regarding public opposition to these interventions may impede their implementation in some jurisdictions. However, surveys indicate that a substantial majority of the public supports implementation of both primary laws and enhanced enforcement programs. Conclusion: Based on the strong evidence for effectiveness of primary safety belt laws and enhanced enforcement programs, the Task Force on Community Preventive Services recommended that all states enact primary safety belt laws and that communities implement enhanced enforcement programs.

Taking the Click It or Ticket model nationwide

Click It or Ticket is an occupant protection Selective Traffic Enforcement Program (sTEP) combining intensive paid and earned publicity with enforcement during a brief two to four week period. North Carolina demonstrated substantial increases in safety belt use associated with their implementation of the first statewide Click It or Ticket program in 1993. In 2000, Click It or Ticket was implemented in South Carolina. In 2001, Click It or Ticket was implemented across all eight states of the southeast. In 2002, ten states in various parts of the country implemented Click It or Ticket; four states implemented parts of the full Click It or Ticket program; and four states were used as comparisons. Belt use increases were greatest in the full implementation states. Click It or Ticket was implemented nationally in 2003. This paper presents a historical perspective on the implementation and evaluation of Click It or Ticket programs.

A research agenda for increasing safety belt use in the United States

On November 13–14, 2003, a symposium on high-visibility safety belt use enforcement in Raleigh, NC: (a) celebrated the 10th anniversary of North Carolina's Click It or Ticket program; (b) documented current knowledge regarding safety belt use; (c) proposed strategies to increase use further; and (d) discussed research to support these strategies.

The relationship between perceived risk of being ticketed and self-reported seat belt use

Problem: Twenty-nine percent of Americans failed to use their seat belts in 2000. Efforts to improve safety belt usage can be enhanced by identifying specific factors that motivate belt use. Method: Motorist survey data were used to examine the effect of Perceived Risk of being Ticketed (PRT) for a seat belt infraction on self-reported seat belt use. Results: Analyses indicated that individuals and groups of individuals who have higher PRT typically report higher belt usage. Factorial analyses indicated that this perceived risk to belt use relationship holds both within groups with generally high (e.g., upper income) and generally low (e.g. young men) overall self-reported belt use. Discussion: Applications of PRT to improve seat belt use are discussed. Impact on Industry: Enforcement of existing laws, perhaps through selective traffic enforcement programs, and strengthening laws to create a higher perception of being ticketed by motorists should increase safety belt use thereby saving lives and reducing cost for individuals, government, and industry.

The effects of standard enforcement on Michigan safety belt use

The purpose of this study was to assess the effects of standard enforcement legislation on safety belt use in Michigan through a series of seven statewide direct observation surveys. A secondary purpose of the study was to compare the results in Michigan to the results in other states that have changed the provision of their mandatory safety belt use law from secondary to standard enforcement. The study found that standard enforcement has been effective in increasing safety belt use in Michigan. Immediately following the implementation of standard enforcement, Michigan's belt use rate increased to 83.5%, 13.4 percentage points higher than the highest rate previously observed. One year after the change, safety belt use in Michigan was still nearly 10 percentage points greater than the highest observed rate before standard enforcement legislation was enacted. Results indicated that safety belt use decreased slightly in the year following the implementation of standard enforcement. This appears to be an overall trend across all observed groups, and not due to any single demographic category. The results also suggest that standard enforcement legislation appears to have a greater effect on groups with historically low belt use, such as young people, males, passengers, and Black/African–Americans. When compared with other states that have made the change from secondary to standard enforcement, the increase in the safety belt use rate in Michigan was comparable to the increase seen in states with relatively high safety belt use prior to standard enforcement. However, states that had low safety belt use rates prior to adopting standard enforcement legislation observed a larger percentage point increase in the year following their change to standard enforcement.

State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s.

Monitoring trends is essential for evaluating past activities and guiding current preventive health program and policy efforts. Although tracking progress toward national health goals is helpful, use of national estimates is limited because most preventive health care activities, policies, and other efforts occur at the state or community level. There may be important state trends that are obscured by national data. To estimate state-specific trends for 5 health risk factors and 6 clinical preventive services. Telephone surveys were conducted from 1991 through 2000 as part of the Behavioral Risk Factor Surveillance System. Randomly selected adults aged 18 years or older from 49 US states. Annual state sample sizes ranged from 1188 to 7543. Statistically significant changes (P<.01) in state prevalences of cigarette smoking, binge alcohol use, physical inactivity, obesity, safety belt use, and mammography; screening for cervical cancer, colorectal cancer, and cholesterol levels; and receipt of influenza and pneumococcal disease vaccination. There were statistically significant increases in safety belt use for 39 of 47 states and receipt of mammography in the past 2 years for women aged 40 years or older for 43 of 47 states. For persons aged 65 years or older, there were increases in receipt of influenza vaccination for 44 of 49 states and ever receiving pneumococcal vaccination for 48 of 49 states. State trends were mixed for binge alcohol use (increasing in 19 of 47 states and declining in 3), physical inactivity (increasing in 3 of 48 states and declining in 11), and cholesterol screening (increasing in 13 of 47 states and decreasing in 5). Obesity increased in all states and smoking increased in 14 of 47 states (declining only in Minnesota). Cervical cancer screening increased in 8 of 48 states and colorectal cancer screening increased in 13 of 49 states. New York experienced improvements for 8 of 11 measures, while 7 of 11 measures improved in Delaware, Kentucky, and Maryland; in contrast, Alaska experienced improvements for no measures and at least 4 of 11 measures worsened in Iowa, North Dakota, and South Dakota. Most states experienced increases in safety belt use, mammography, and adult vaccinations. Trends for smoking and binge alcohol use are disturbing, and obesity data support previous findings. Trend data are useful for targeting state preventive health efforts.

Reviews of evidence regarding interventions to increase the use of safety belts

Background: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor vehicle crashes. If all motor vehicle occupants consistently wore safety belts, an estimated 9553 deaths would have been prevented in 1999 alone. Methods: The Guide to Community Preventive Services’s methods for systematic reviews were used to evaluate the effectiveness of three interventions to increase safety belt use. Effectiveness was assessed on the basis of changes in safety belt use and number of crash-related injuries. Results: Strong evidence was found for the effectiveness of safety belt laws in general and for the incremental effectiveness of primary safety belt laws relative to secondary laws. Strong evidence for the effectiveness of enhanced enforcement programs for safety belt laws was also found. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions. Conclusions: These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to increase safety belt use.

The Guide to Community Preventive Services: a public health imperative

The Guide to Community Preventive Services (the Community Guide) promises to be a substantial and necessary tool in collective efforts to improve the public health. This supplement to the American Journal of Preventive Medicine (AJPM) is important, not only for its content, but for the example provided of this approach in practice and policymaking. Painstaking and meticulous methodology yielded extensive reviews of evidence relevant to the reduction of injuries to motor vehicle occupants by increasing child safety seat use, increasing safety belt use, and reducing alcohol-impaired driving. The evidence is then weighed, with a specified protocol, to determine if recommendations can be formulated.1–3 Akin to the Guide to Clinical Preventive Services, initially issued in 1989 by the U.S. Preventive Services Task Force and aimed at prevention for the individual patient, this new guide steers an evidence-based course through the broader ocean of population-based prevention.4,5 Although great progress has been made, as this supplement demonstrates, the future holds significant challenges for this undertaking.