Increase Seat Belt Use Research Articles

Estimating the Effect of Standard Enforcement of a Rear Seat Belt Law for Rear Seat Fatality Prevention

Data were collected from the NHTSA’s Fatality Analysis Reporting System to analyze the link between primary enforcement of rear seat belt use and injury severity in fatal vehicle collisions. Specifically, this study predicted the amount of fatalities that may have been prevented had there been standard enforcement of a rear seat belt law in effect. Previous literature concludes that increasing seat belt use will decrease injury severity in collisions and the primary enforcement of seat belts laws will increase seat belt use by approximately 14%. This study recorded and compared the number of rear seat fatalities in states that did and did not have primary enforcement laws for rear seat occupants. The results indicated that, on average, for every properly restrained rear seat fatality there are 0.45 more rear seat fatalities in states without primary enforcement than states with primary enforcement. It also predicts that the states that do not practice standard seat belt enforcement could have seen approximately 772 to 1,032 fatalities prevented from 2011 to 2015, had there been primary rear seat belt enforcement. This corresponds to an estimated national crash cost savings of $8.6 billion, or $1.7 billion annually.

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.

Seat Belt Messaging for Diverse Populations

In the United States, Hispanics and African Americans are disproportionately killed and injured in motor vehicle crashes (MVCs) compared with non-Hispanic Whites. In 2013, more African Americans died from MVC-related injuries than any other unintentional injury, and 64.5% of fatally injured Hispanic youth (ages 15-20) were unrestrained or otherwise incorrectly belted at the time of the crash. As the minority population in the US continues to increase, it is imperative to develop effective and culturally sensitive countermeasures to reach those most at risk of death and injury from MVCs. The Hispanic Toolkit and the African American toolkit were developed using cultural competency strategies to encourage an increase in seat belt use. The Hispanic Toolkit includes bilingual brochures, posters, and radio/video public safety announcements that address common attitudes and practices among recently emigrated Latinos regarding traffic safety culture. The African American toolkit includes E-blasts, fact sheets, and an educational power point to engage local African American organizations in educating their communities and encourage traffic safety behaviors. Both toolkits are user friendly and can be downloaded online.

Protective Effects of Regular Seat Belt Use on Other Risky Motor Vehicle Behaviors Among Young Drivers

Background Motor vehicle crashes (MVCs) are the leading cause of death among adolescents ages 15–24 in the United States. Young drivers are nearly three times more likely to die in a crash compared with drivers older than 20. From 2014 to 2015, fatalities among drivers ages 15–20 increased by nearly 10%, and in 2015, 47% of drivers ages 15 to 19 who died in a crash were unrestrained. Although the prevalence of seat belt use among young drivers is well-established, there is limited research on how regular usage impacts other motor vehicle (MV) behaviors. This study explores the prevalence of regular seat belt use and associations with other risky MV behaviors among US high school students. Methods Data came from the Centers for Disease Control and Prevention's 2015 national Youth Risk Behavior Survey (YRBS), a nationally representative sample of US high school students. The YRBS assessed seat belt use as a passenger during the 30 days before the survey, which included 9,895 students ages 16 or older. Seat belt use was coded into dichotomous (regular/always v. irregular) and polychotomous variables. Chi-square tests examined bivariate associations between regular seat belt use and demographic variables. Logistic regression assessed associations between regular seat belt use and other risky MV behaviors. Results The prevalence of regular seat belt use among students 16 or older was 62.3%. Students who regularly wore their seat belts were less likely to drink and drive (adjusted odds ratio: .294; 95% confidence interval: .245–.352; p Conclusions Less than two-thirds of US high school students ages 16 or older report regular seat belt use, and students who do not are more likely to engage in additional risky MV behaviors. This study suggests that increasing seat belt use among young drivers may have compounding benefits in reducing risky MV behavior and corresponding injuries and fatalities.

Vital Signs: Motor Vehicle Injury Prevention - United States and 19 Comparison Countries.

Each year >32,000 deaths and 2 million nonfatal injuries occur on U.S. roads. CDC analyzed 2000 and 2013 data compiled by the World Health Organization and the Organisation for Economic Co-operation and Development (OECD) to determine the number and rate of motor vehicle crash deaths in the United States and 19 other high-income OECD countries and analyzed estimated seat belt use and the percentage of deaths that involved alcohol-impaired driving or speeding, by country. In 2013, the United States motor vehicle crash death rate of 10.3 per 100,000 population had decreased 31% from the rate in 2000; among the 19 comparison countries, the rate had declined an average of 56% during this time. Among all 20 countries, the United States had the highest rate of crash deaths per 100,000 population (10.3); the highest rate of crash deaths per 10,000 registered vehicles (1.24), and the fifth highest rate of motor vehicle crash deaths per 100 million vehicle miles traveled (1.10). Among countries for which information on national seat belt use was available, the United States ranked 18th out of 20 for front seat use, and 13th out of 18 for rear seat use. Among 19 countries, the United States reported the second highest percentage of motor vehicle crash deaths involving alcohol-impaired driving (31%), and among 15, had the eighth highest percentage of crash deaths that involved speeding (29%). Motor vehicle injuries are predictable and preventable. Lower death rates in other high-income countries, as well as a high prevalence of risk factors in the United States, suggest that the United States can make more progress in reducing crash deaths. With a projected increase in U.S. crash deaths in 2015, the time is right to reassess U.S. progress and set new goals. By implementing effective strategies, including those that increase seat belt use and reduce alcohol-impaired driving and speeding, the United States can prevent thousands of motor vehicle crash-related injuries and deaths and hundreds of millions of dollars in direct medical costs every year.

Seat Belt Use Among Adult Workers - 21 States, 2013.

Roadway incidents involving motorized vehicles accounted for 24% of fatal occupational injuries in the United States during 2013 and were the leading cause of fatal injuries among workers.* In 2013, workers' compensation costs for serious, nonfatal injuries among work-related roadway incidents involving motorized land vehicles were estimated at $2.96 billion.(†) Seat belt use is a proven method to reduce injuries to motor vehicle occupants (1). Use of lap/shoulder seat belts reduces the risk for fatal injuries to front seat occupants of cars by 45% and the risk to light truck occupants by 60%.(§) To characterize seat belt use among adult workers by occupational group, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and found that not always using a seat belt was significantly associated with occupational group after controlling for factors known to influence seat belt use. Occupational groups with the highest prevalences of not always using a seat belt included construction and extraction; farming, fishing, and forestry; and installation, maintenance, and repair. To increase seat belt use among persons currently employed, states can enact and enforce primary seat belt laws, employers can set and enforce safety policies requiring seat belt use by all vehicle occupants, and seat belt safety advocates can target interventions to workers in occupational groups with lower reported seat belt use.

Seatbelt use to save money: Impact on hospital costs of occupants who are involved in motor vehicle crashes

ObjectiveSeatbelt use is the single most effective way to save lives in motor vehicle crashes (MVC). However, although safety belt laws have been enacted in many countries, seatbelt usage throughout the world remains below optimal levels, and educational interventions may be needed to further increase seatbelt use. In addition to reducing crash-related injuries and deaths, reduced medical expenditures resulting from seatbelt use are an additional benefit that could make such interventions cost-effective. Accordingly, the objective of this study was to estimate the correlation between seatbelt use and hospital costs of injuries involved in MVC. MethodsThe data used in this study were from the Nebraska CODES database for motor vehicle crashes that occurred between 2004 and 2013. The hospital cost information and information about other factors were obtained by linking crash reports with hospital discharge data. A multivariable regression model was performed for the association between seatbelt use and hospital costs. ResultsMean hospital costs were significantly lower among motor vehicle occupants using a lap–shoulder seatbelt ($2909), lap-only seatbelt ($2289), children’s seatbelt ($1132), or booster ($1473) when compared with those not using any type of seatbelt ($7099). After adjusting for relevant factors, there were still significantly decreased hospital costs for motor vehicle occupants using a lap–shoulder seatbelt (84.7%), lap-only seatbelt (74.1%), shoulder-only seatbelt (40.6%), children’s seatbelt (95.9%), or booster (82.8%) compared to those not using a seatbelt. ConclusionSeatbelt use is significantly associated with reduced hospital costs among injured MVC occupants. The findings in this study will provide important educational information for emergency department nurses who can encourage safety belt use for vehicle occupants.

Non-seatbelt use and associated factors among passengers

Seatbelt use is the most effective way to save lives and reduce severe injuries. However, the percentage of non-seatbelt use is still high among drivers and passengers. Although the factors related to non-seatbelt use among drivers have been widely studied, the factors associated with non-seatbelt use among passengers have not been well documented. In addition, recent surveys showed that the driver's attitude has a significant impact on the passenger's seatbelt use. However, the lower response rate and less accurate of self-reported seatbelt use in survey studies, especially among participants who had a high level perception of penalty for non-seatbelt use. Therefore, we examined the association between passenger's seatbelt use and driver's seatbelt use with a statewide injury surveillance system. 36,012 passengers who were involved in motor vehicle crashes (MVC) in 2004–2013 were included in this study. Our results showed that if a driver wore a seatbelt, 92.6% of his/her passengers also wore seatbelts while if a driver did not wear a seatbelt, only 19.1% of his/her passengers wore seatbelts. Compared to the passenger whose driver wore a seatbelt, the passenger had a significantly higher probability of non-seatbelt use (odds ratio = 46.7; 95% confidence intervals, 42.7–51.1) if his/her driver did not wear a seatbelt. The driver has the greatest influence on the passenger's seatbelt use. The findings will provide important information for future public health practices to increase seatbelt use at the highest possible rate for passengers, such as educational interventions for drivers and seatbelt reminders use.

Restraint use in the Eastern Province of the Kingdom of Saudi Arabia

ABSTRACTObjectives: This study set out to examine seat belt and child restraint use in the Dammam Municipality of the Kingdom of Saudi Arabia, based on the premise that an increase in seat belt use would significantly reduce personal injury in traffic crashes. It was expected that local data would help identify intervention strategies necessary to improve seat belt use in the region.Methods: The research involved 2 methodologies. First, 1,389 face-to-face interviews were conducted with male and female adults in regional shopping plazas regarding their own and their children's restraint use in their vehicles and reasons for these attitudes and beliefs. Second, 2 on-road observation studies of adult and child restraint use were conducted by trained observers. Occupants of approximately 5,000 passenger vehicles were observed while stopped at representative signalized traffic intersections.Results: The findings showed front seat belt use rates of between 43 and 47% for drivers and 26 to 30% for front seat passengers; rear seat belt use rates were lower. While there seemed to be some knowledge about the purpose and reasons for restraining both adults and children in suitable restraints, this failed to be confirmed in the on-road observations.Conclusions: Reasons for these rates and findings are discussed fully, and recommendations for improving seat belt use in the Dammam Municipality are included.

Teens and seat belt use: What makes them click?

ProblemMotor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt. MethodsUsing data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with always wearing a seat belt. ResultsOnly 51% of high school students living in 38 states reported always wearing a seat belt when riding as a passenger; prevalence varied from 32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to always wear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased. DiscussionSeat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups. Practical applicationsThis study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.

How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants?

The expected effects of increasing seat belt use on the number of killed or seriously injured (KSI) light vehicle occupants have been estimated for three scenarios of increased seat belt use in Norway, taking into account current seat belt use, the effects of seat belts and differences in crash risk between belted and unbelted drivers. The effects of seat belts on fatality and injury risk were investigated in a meta-analysis that is based on 24 studies from 2000 or later. The results indicate that seat belts reduce both fatal and non-fatal injuries by 60% among front seat occupants and by 44% among rear seat occupants. Both results are statistically significant. Seat belt use among rear seat occupants was additionally found to about halve fatality risk among belted front seat occupants in a meta-analysis that is based on six studies. Based on an analysis of seat belt wearing rates among crash involved and non-crash involved drivers in Norway it is estimated that unbelted drivers have 8.3 times the fatal crash risk and 5.2 times the serious injury crash risk of belted drivers. The large differences in crash risk are likely to be due to other risk factors that are common among unbelted drivers such as drunk driving and speeding. Without taking into account differences in crash risk between belted and unbelted drivers, the estimated effects of increasing seat belt use are likely to be biased. When differences in crash risk are taken into account, it is estimated that the annual numbers of KSI front seat occupants in light vehicles in Norway could be reduced by 11.3% if all vehicles had seat belt reminders (assumed seat belt wearing rate 98.9%), by 17.5% if all light vehicles had seat belt interlocks (assumed seat belt wearing rate 99.7%) and by 19.9% if all front seat occupants of light vehicles were belted. Currently 96.6% of all (non-crash involved) front seat occupants are belted. The effect on KSI per percentage increase of seat belt use increases with increasing initial levels of seat belt use. Had all rear seat occupants been belted, the number of KSI front seat occupants could additionally be reduced by about 0.6%. The reduction of the number of KSI rear seat occupants would be about the same in terms of numbers of prevented KSI.

Obstructive sleep apnea and driving risk: The current Turkish legislation, controversies, and future perspectives

Motor vehicle accidents (MVA) are one of the leading causes of death and injury in Turkey. Fatality reduction currently targets increasing seat belt use and reducing high-speeding and alcohol usage. However, sleepiness is increasingly recognized as a contributing factor. Sleepiness accounts for up to 20% of MVAs on monotonous roads, especially highways. The most common medical disorder causing sleepiness is obstructive sleep apnea (OSA). Available data suggest that efficient treatment of OSA may reduce MVAs and MVA-related deaths and injuries. Several attempts have intensively been debated during the last decade in order to develop national and international strategies to screen high-risk drivers for sleepiness and OSA. In accordance with the directive of the European Union, the Turkish legislation has recently been revised for regulation of driving license issues for individuals with OSA. There are still many controversies and difficulties in implementation of these rules in practice. A fullnight polysomnography (PSG) is recommended, and treatment should be initiated as soon as possible when the OSA diagnosis is confirmed. However, given the limited resources, at-home portable cardiorespiratory sleep monitoring is a reasonable alternative to PSG for appropriately selected patients with high clinical suspicion for OSA, rather than no-PSG, and no treatment. Additional attempts for development of national guidelines for determining the driving risk, development of new screening tools for objective evaluation of sleepiness in drivers with suspected or confirmed OSA, and educating patients about the risks of excessive sleepiness as well as encouraging clinicians to become familiar with relevant laws are urging.

A quantitative approach to assessing the efficacy of occupant protection programs: A case study from Montana

Quantitative evaluation of vehicle occupant protection programs is critical for ensuring efficient government resource allocation, but few methods exist for conducting evaluation across multiple programs simultaneously. Here we present an analysis of occupant protection efficacy in the state of Montana. This approach relies on seat belt compliance rates as measured by the National Occupant Protection Usage Survey (NOPUS). A hierarchical logistic regression model is used to estimate the impacts of four Montana Department of Transportation (MDT)-funded occupant protection programs used in the state of Montana, following adjustment for a suite of potential confounders. Activity from two programs, Buckle Up coalitions and media campaigns, are associated with increased seat belt use in Montana, whereas the impact of another program, Selective Traffic Enforcement, is potentially masked by other program activity. A final program, Driver’s Education, is not associated with any shift in seat belt use. This method allows for a preliminary quantitative estimation of program impacts without requiring states to obtain any new seat belt use data. This approach provides states a preliminary look at program impacts, and a means for carefully planning future program allocation and investigation.

Predictors of rear seat belt use among U.S. adults, 2012

IntroductionSeat belt use reduces the risk of injuries and fatalities among motor vehicle occupants in a crash, but belt use in rear seating positions is consistently lower than front seating positions. Knowledge is limited concerning factors associated with seat belt use among adult rear seat passengers. MethodsData from the 2012 ConsumerStyles survey were used to calculate weighted percentages of self-reported rear seat belt use by demographic characteristics and type of rear seat belt use enforcement. Multivariable regression was used to calculate prevalence ratios for rear seat belt use, adjusting for person-, household- and geographic-level demographic variables as well as for type of seat belt law in place in the state. ResultsRear seat belt use varied by age, race, geographic region, metropolitan status, and type of enforcement. Multivariable regression showed that respondents living in states with primary (Adjusted Prevalence Ratio (APR): 1.23) and secondary (APR: 1.11) rear seat belt use enforcement laws were significantly more likely to report always wearing a seat belt in the rear seat compared with those living in a state with no rear seat belt use enforcement law. Conclusions and practical applicationsSeveral factors were associated with self-reported seat belt use in rear seating positions. Evidence suggests that primary enforcement covering all seating positions is an effective intervention that can be employed to increase seat belt use and in turn prevent motor vehicle injuries to rear-seated occupants.

Preventive Effects of Seat Belt on Clinical Outcomes for Road Traffic Injuries.

Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.

SEATBELT USE AMONG DRUNK DRIVERS IN DIFFERENT LEGISLATIVE SETTINGS

We present evidence from the Fatality Analysis Reporting System and Behavioral Risk Factor Surveillance System that shows increased seatbelt use following the concurrent presence of stricter blood alcohol content thresholds and primarily enforced seatbelt laws. This suggests that inebriated drivers may use their seat belts more judiciously to avoid being identified as a drunk driver by law enforcement. The interactive effect of stricter drunk driving laws and primary seatbelt laws are also shown to be more effective than either law passed in isolation in terms of reducing traffic fatalities. (JEL K4, I18)

An investigation of state population characteristics that moderate the relationship of state seat belt law and use in the United States

ObjectivesPrimary enforcement laws have been shown to be effective methods for increasing seat belt use at the state level. MethodThis study investigates state differences in the effectiveness of primary enforcement laws by assessing whether a state's academic achievement, health ranking, economic prosperity, violent crime rates, government effectiveness, gender distribution, or proportion of rural roads moderate the relationship between those laws and seat belt compliance rates. ResultsAggregate state-level academic achievement, health ranking, government effectiveness, and proportion of rural roads uniquely moderated the seat belt use differences between primary and secondary enforcement states. ConclusionsThis evidence suggests that cultural, social, and demographic differences among regions may be important factors in explaining state-level differences in the effectiveness of primary enforcement of seat belt laws.

The Effects of Primary Enforcement Laws and Fine Levels on Seat Belt Usage in the United States

Background:Seat belt use in the United States increased from 11 percent in 1979 to 86 percent in 2012. Most of this increase has been attributed to seat belt laws, primary law upgrades, and highly visible enforcement. There has been less research on the effect of fines on seat belt usage.Methods: We examined law type and fine levels as predictors of seat belt use among fatally injured occupants of passenger vehicles from 1997 through 2008 using data from the Fatality Analysis Reporting System (FARS). Fine levels used were the statutory maximum base fines for a first offense.Results: Having a primary enforcement law was associated with a 9 to 10 percentage point increase in seat belt use. An increase in the fine amount, from the current median level of $25 to a level of $60, was associated with a 3 percentage point increase in usage. An increase in fine from $25 to $100 was associated with a 6- to 7-point increase. Such increases were in addition to the effects of a shift from secondary to primary enforcement.Discussion: The results of this study suggest that, in addition to current emphases on primary law upgrades and high-visibility enforcement of seat belt usage, increasing fine levels provides another viable strategy for increasing seat belt use. In addition, based on these results, states should consider publicizing such increases just as they publicize enforcement efforts.

Normative Misperceptions of Peer Seat Belt Use Among High School Students and Their Relationship to Personal Seat Belt Use

Objectives: This research examined gender-specific perceptions of peer seat belt use norms among high school students and their relationship with one's own seat belt use. We expected that students would underestimate the seat belt use of their peers and that these perceptions would be positively associated with their own seat belt use.Methods: High school students from 4 schools (N = 3348; 52% male) completed measures assessing perceived seat belt use and personal seat belt use.Results: Findings demonstrated that students perceived that others engaged in less seat belt use than they do and that perceived norms were positively associated with one's own seat belt use.Conclusions: Peer influences are a strong predictor of behavior, especially among adolescents. Ironically, adolescents’ behaviors are often influenced by inaccurate perceptions of their peers. This research establishes the presence of a misperception related to seat belt use and suggests that misperception is associated with own behaviors. This research provides a foundation for social norms–based interventions designed to increase seat belt use by correcting normative misperceptions among adolescents.

Increasing seat belt use: Two field experiments to test engineering-based behavioral interventions

This paper presents separate field experiments. The studies assessed engineering-based behavioral interventions to increase the frequency of drivers’ seat belt use. In Experiment 1, we instrumented a large portion of a commercial fleet with a seat belt gearshift interlock system. This system prevented drivers from engaging their transmissions unless they were buckled. The goals of Experiment 1 were to measure the change in belt use from a baseline period averaging about three months to an intervention period ranging one to three months and to assess the drivers’ acceptance of the system at the beginning, middle, and end of the intervention. The results indicated a significant increase in seat belt use from 81% to 96%, but ratings of driver acceptance were low, indicating poor acceptance. In Experiment 2, we evaluated a system that applied a counterforce that pushed against the accelerator pedal of unbelted drivers when vehicle speed exceeded 20 mile per hour (mph). Unbelted drivers could continue to drive and exceed 20mph by pressing harder than the counterforce but doing so required focused attention and physical effort. The results of Experiment 2 indicated that belt use increased from 56.2% during baseline to 99.74% during the intervention. Driver acceptance ratings were favorable. Taken together, the experiments indicate that such engineering-based behavioral interventions have considerable promise in terms of increasing seat belt use, but each faces challenges to becoming viable countermeasures. The challenges associated with the interlock appear to be attitudinal in nature on the part of the drivers, whereas those associated with the counterforce system are technical matters involving fitment of the hardware across different makes and models.