Secondary Enforcement Research Articles

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system. Method The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law. Results Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt. Summary and Impact on Industry Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death. Methods Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement). Results In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws. Discussion Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.

Effectiveness of Media and Enforcement Campaigns in Increasing Seat Belt Usage Rates in a State with a Secondary Seat Belt Law

Objective: In 2005, in terms of seat belt usage rates, Nevada ranked third nationally and first among states with secondary seat belt use enforcement laws in the United States. An effective combination of a media-based education and enforcement campaign helped in this regard. The objective of this article is to document the effectiveness of enforcement and media-based education and outreach campaigns on the seat belt usage rates in Nevada, a state with a secondary seat belt usage law Methods: Observational data on seat belt usage and passenger fatality data are used to evaluate the effectiveness of enforcement campaigns and media-based education and outreach campaigns. Data based on observations of about 40,000 vehicles in each of the years 2003 to 2005 were analyzed. Results: Statistical analyses show that a significant increase in seat belt usage rates among both drivers and passengers for both genders resulted from the accompanying the media and enforcement campaigns. Conclusions: The results from this study indicate that effective and well-planned media/enforcement campaigns can have a significant impact on seat belt usage rates even in a state where the enforcement of seat belt laws can only be as a secondary violation. They validate and expand on findings from other efforts documented in the literature. These results demonstrate that, if coordinated properly, media and enforcement campaigns work very effectively in increasing seat belt usage rates even in states with secondary seat belt laws.

Cannabis Use in Canada: The Need for a ‘Public Health’ Approach

Cannabis is the most commonly used illicit drug in Canada, used by 1 in 7 adults and 1 in 4 students. Other forms of drug use (e.g., alcohol or injection drug use) are increasingly approached within a public health policy framework that focuses on reducing harms rather than use per se. Cannabis, by contrast, remains formally controlled by a criminal justice approach that focuses on enforcing abstinence. Its use is associated with a variety of possible acute or chronic health problems that include cognitive and respiratory impairment, psychotic episodes, dependence and injury risk. The incidence of these outcomes, however, is predicted by early onset and a high frequency and length of use that only apply to a minority of users. In a public health framework, cannabis use - especially in young populations - should be systematically monitored and high-risk patterns of use screened for in appropriate settings, e.g., schools and GP offices. Evidence-based primary and secondary prevention, treatment and enforcement need to be targeted at these high-risk patterns of use. Given the large cannabis user population, especially among young people, and the failure of the criminalization approach to discourage use, a public health framework for cannabis use is urgently needed in Canada.

Konzept zur Verbesserung der Impfraten in Bayern

The aim of the Bavarian immunisation concept is the effective implementation of national vaccination recommendations taking into account known characteristics in Bavaria and social groups with limited access to vaccinations. Furthermore, it intends to coordinate the various players in the field of vaccine-prevention of disease. Key points of this concept are, among others, improvement of the available data, definition of vaccination aims, implementation of vaccination recall systems during the regular examination on entering primary and secondary school, coordination and enforcement of vaccination campaigns in schools as well as steps for the qualification and motivation of the physicians involved in vaccination. In addition, an independent committee for the coordination of professionals and institutions participating in vaccine prevention in Bavaria was created. This "Bayerische Landesarbeitsgemeinschaft Impfen (LAGI)", which was established at the end of 2006 includes representatives from medical associations and corporations, health insurance companies and public health agencies and is the key for the realisation and further development of this concept.

Associations Between Sociodemographics and Safety Belt Use in States With and Without Primary Enforcement Laws

secondary enforcement laws (police may issue a safety belt citation only if the vehicle has been stopped for another reason). We analyzed 2002 Behavioral Risk Factor Surveillance System data from 50 states and the District of Columbia. We performed multivariable, log-linear regression analyses to assess the effect of sociodemographic characteristics and safety belt laws on safety belt use. Analyses were stratified by the type of enforcement permitted by state laws. Reported safety belt use was higher in states that had primary versus secondary enforcement laws, both overall and for each sociodemographic characteristic examined. Safety belt use was 85% in states that had primary enforcement laws and 74% in states that had secondary enforcement laws. Cross-sectional data suggested that primary enforcement laws may have the greatest effect on sociodemographic groups that reported lower levels of safety belt use. Primary enforcement laws are an effective population-based strategy for reducing disparities in safety belt use and may, therefore, reduce disparities in crash-related injuries and fatalities.

Seat belt use among 13–15 year olds in primary and secondary enforcement law states

Context Coverage and enforcement provisions of safety belt use laws vary by state. Most laws cover drivers and passengers age 16 and above. “Primary” enforcement laws allow police to stop and ticket a motorist for a safety belt law violation. With “secondary” enforcement laws, ticketing can only occur in the presence of another traffic infraction. Given the lower rates of restraint use among teen drivers and their passengers, the effect of primary enforcement laws on the restraint use of young teen passengers is of particular interest. Objective To compare restraint use by 13–15 year olds passengers in motor vehicle crashes in states with primary versus secondary enforcement safety belt laws. Methods Cross-sectional study of 3953 crashes involving 5372 children, representing 54,226 children aged 13–15 years in 41,198 crashes of insured vehicles in 16 states and Washington, DC between December 1, 1998 and December 31, 2004, with data collected via insurance claims records and a telephone survey. Results Non-use of restraints by 13–15 year olds was 7.2% (95% CI 4.3–10.1%) greater in secondary enforcement states (10.8%) as compared to states with primary enforcement laws (3.6%). After controlling for driver's age and restraint status and the seating row of the occupant, a 13–15 year olds was over twice as likely to be unrestrained in a secondary enforcement state as compared to a primary enforcement state (adjusted RR = 2.2, 95% CI 1.5–3.1). Conclusions States considering primary enforcement provisions to their restraint laws should consider the potential benefits these laws may have to all occupants in the vehicle, particularly young adolescents who are nearing driving age.

Safety Belt Use and the Switch to Primary Enforcement, 1991–2003

State seat belt laws have increased use rates and have reduced traffic fatalities, but tremendous variation exists in the laws. New Hampshire does not have a law, and 30 states have only secondary enforcement laws. Whereas primary enforcement allows an officer to issue a citation for any infraction, secondary enforcement permits a citation only if a motorist is stopped for another infraction first. We performed a cross-sectional time-series analysis of the impact of upgrading to primary enforcement on belt use rates for 47 states and the District of Columbia from 1991 to 2003. Our results suggest that states with secondary enforcement laws could increase belt use by 10 percentage points and improve public safety considerably by upgrading to primary enforcement.

Reducing traffic fatalities in the American States by upgrading seat belt use laws to primary enforcement

A key component of crime deterrence is the certainty of detection, but in 2005 seat belt laws in 27 states prohibited law enforcement officers from ticketing an observed violation unless the driver is stopped for another offense, which is referred to as secondary enforcement. Thirteen states and the District of Columbia have upgraded from secondary to primary enforcement, which authorizes police to stop a motor vehicle if a driver or occupant covered by the law is observed not using a seat belt. To test the impact of seat belt enforcement provisions, cross-sectional time series regressions are estimated for annual driver and occupant fatality rates in the American states from 1990 to 2002. Using several control variables for other traffic policies and state demographics, the results indicate primary enforcement is more effective in saving lives than secondary enforcement. Furthermore, upgrading to a primary law enhances the effectiveness of an existing state mandatory use law. © 2006 by the Association for Public Policy Analysis and Management Language: en

Requiring Belt Use as Part of a School Parking Permit Program: Does It Increase Students' Belt Use?

Objective: Teenagers have very high motor vehicle crash rates, and their use of seat belts is generally lower than that of adults. A potential school-based strategy to increase teenagers' belt use is a policy making parking privileges contingent on belt use by student drivers and their passengers. This study evaluated the effects of implementing a school belt policy. Methods: The effects of a belt policy were evaluated during the 2003–2004 school year at high schools in two states: Connecticut, a state with a primary enforcement belt law and high belt use rates, and Mississippi, a state with a secondary enforcement law and generally low use rates. Both schools enforced the policy, and violations resulted in a graduated set of penalties leading to the potential loss of parking privileges. Baseline and post-policy belt use rates were obtained from observation surveys of student drivers and their teenage passengers coming to and from school. Changes in belt use were examined relative to belt use trends at comparison schools without a belt policy. Implementation of the policies also was monitored. Results: In Mississippi, among students arriving at school in the morning, driver belt use increased from 42% before the policy to 67% about 6 months after; passenger belt use increased from 16% to 61%, although sample sizes were small. These increases were significantly larger than expected, based on belt use trends at the comparison school in Mississippi. In Connecticut, where 86% of drivers and 79% of their passengers already were belted prior to the policy, there was no significant change. Both schools publicized and monitored the belt policy, and most enforcement occurred in the morning as students arrived at school. Conclusions: Based on a small-scale application of a belt policy at two schools in different states, a school belt policy may have stronger effects in states where belt use is low. Strong penalties and enforcement are essential elements of an effective policy. Adequate resources and commitment are needed for schools to implement and monitor the type of strong policy needed to sustain high belt use rates. Replication of this study in additional schools appears warranted.

Effect on fatality risk of changing from secondary to primary seat belt enforcement

Background: Most seat belt use laws originally passed in the United States contained language restricting enforcement to drivers already stopped for some other reason. States that have since removed this secondary enforcement restriction have reported increased seat belt use. The purpose of the present study was to estimate the effect of these law changes on driver fatality rates. Method: Trends in passenger vehicle driver death rates per billion miles traveled were compared for 10 states that changed from secondary to primary seat belt enforcement and 14 states that remained with secondary enforcement. Results: After accounting for possible economic effects and other general time trends, the change from secondary to primary enforcement was found to reduce annual passenger vehicle driver death rates by an estimated 7% (95% confidence limits 3.0–10.9). Conclusion: The majority of U.S. states still have secondary enforcement laws. If these remaining secondary laws were amended, an estimated 696 deaths per year could be prevented.

Race and seatbelt law enforcement: health policy in search of descriptive epidemiology

Primary enforcement of state seatbelt laws (motorists can be stopped and cited solely for seatbelt nonuse) more effectively prevents motor vehicle crash injuries than does secondary enforcement (motorists can be cited only if stopped for another offense). Enactment of primary laws in most states has been hampered by concern that enforcement would engender racial profiling, but little is known about racial differences in seatbelt law enforcement. To explore racial profiling in relation to state seat belt laws, we analyzed data from telephone interviews performed by the U.S. Department of Transportation with a national probability sample of motorists in 2000. The study population comprised 466 black and 3117 white drivers residing in 12 primary law states and 13 secondary law states from which there were five or more black survey participants. As a measure of profiling, race-specific seatbelt violation citation histories were compared for all motorists stopped by police in the preceding year who had not been wearing seatbelts at the time. Logistic regression was used in computation of prevalence odds ratios (OR) and 95% confidence intervals (95% CI) with and without stratification by type of state seatbelt law. For all states collectively, among blacks and whites stopped while not wearing seatbelts, blacks were nearly three times as likely to be cited exclusively for violating a seatbelt law (OR = 2.8; 95% CI = 1.0, 8.1). Stratification by state law, however, indicated that in primary law states blacks were nearly four times as likely as whites to be cited only for a seatbelt law violation (OR = 3.7, 95% CI = 0.8, 16.7), whereas in secondary law states blacks were more than three times less likely to be cited only for seatbelt law violations (OR = 0.32, 95% CI = 0.1, 2.0). Although these findings were based on a small size and confidence intervals were wide, they suggest that primary seatbelt laws may lead to racial profiling.

The effect of earned and paid media strategies in high visibility enforcement campaigns

The primary objective of this paper is to describe the impact of national seat belt enforcement mobilizations in terms of changes in public awareness, perceptions, and opinions as they relate to Operation ABC (Always Buckle Up). In order to monitor changes in public awareness and perceptions, a number of national telephone surveys were conducted. Survey results indicated that the following characteristics were associated with lower self-reported seat belt use rates: (a) males; (b) 18–34 age group; (c) persons with lower income; (d) persons with lower education; (e) persons living in rural areas; (f) residents of the Northeast, Midwest, and Great Lakes; (g) residents of states with secondary enforcement laws; and (h) persons less likely to read a newspaper and more likely to listen to the radio. Telephone surveys also suggested that the following groups are more likely to fail to properly secure a child under 12: (a) persons who say they have problems securing a child in seat belt; (b) farm belt residents; (c) Hispanic and Latinos; (d) persons who indicate that they always wear a seat belt but indicate they have not in the past month; (e) persons with older vehicles; (f) lower income respondents; (g) residents of the Deep South; (h) internet non-users; and (i) urban men. These findings provide support for some basic guidelines and suggestions for conducting seat belt enforcement activities.

The effect of changing from secondary to primary safety belt enforcement on police harassment

The purpose of the study was to investigate whether changing Michigan’s safety belt law from secondary to primary (standard) enforcement resulted in police harassment. The study investigated safety-belt-enforcement-related harassment by considering three measures: citizen complaints arising from enforcement of the safety belt law; citation over-representation, that is, a statistical determination of whether certain groups received more citations than would be expected based upon their presence in the driving population and their rate of violating the safety belt use law; and self-reported harassment among the population of people who receive safety belt citations. Safety-belt-related harassment complaints were very uncommon both before and after primary enforcement. Implementation of primary enforcement did not lead to an increase in citation over-representation, and, therefore, safety-belt-related harassment by sex, race, or age. The vast majority of people receiving safety belt citations reported officer behavior as professional and did not feel that they were singled out for their citation. However, a sizeable minority of Blacks and young people report perceptions of safety-belt-related harassment. Results suggest that states with secondary enforcement should continue their efforts to change to primary enforcement, but should also make a strong effort to educate both law enforcement and the public about the harassment issue.

Operational models for epidemics of problematic drug use: the Mover–Stayer approach to heterogeneity

A modified version of a susceptibles–infectives–removed (S–I–R) model for the HIV/AIDS epidemic, proposed at the beginning of the 1990s and recently generalized, is presented to mirror the epidemics of problematic drug use. The generalized model, which belongs to the susceptibles–infectives–susceptibles (S–I–S) class of epidemic models, can be used both to estimate interesting epidemic macro-parameters and to make scenario analyses. The model is a compartmental Mover–Stayer-type structure (Soc. Methods Res. 11 (1983) 345; Bull. Narcotics LIII (1-2) (2001) 39; Biometrics 55(4) (1999) 1252; Math. Biosci. 107 (1991) 521) and allows taking into account possible heterogeneous behaviours of the susceptibles. Such models, in fact, consider the susceptible population as subdivided into two main groups: the group of stayers, that is, the group of individuals who are considered not at risk of “infection”, and the group of movers (possibly divided into sub-groups with different risk behaviour) who are at risk of infection. Due to the interactions between infectious individuals and the susceptibles, some of these may pass to the drug user compartments and begin a “drug user career”. The model is presented and studied from a qualitative point of view using a Markov hybrid approximation. Some qualitative evaluation of the possible impact of interventions directed both towards susceptibles (primary prevention) and towards users (secondary prevention and/or law enforcement) are presented. Specific “what if” scenario analyses are obtained by simulation. Possible future developments are outlined.

Traffic safety and the switch to a primary seat belt law: the California experience

This study explores whether the change of an existing seat belt law from secondary to primary enforcement enhances traffic safety. In particular, we examine traffic fatalities and injuries in California from 1988 to 1997. During the first half of this period, California law provided for secondary enforcement of its mandatory seat belt law, but in 1993 it upgraded the law to primary enforcement. Controlling for the number of motor vehicle collisions, a Box–Tiao intervention analysis of the time series is used to compare the monthly fatalities and injuries before and after the change in the enforcement provision. The results show that California experienced an improvement in traffic safety in terms of a significant reduction in injuries, but the change in enforcement provision had no statistically significant impact on fatalities.

Seat belt use among African Americans, Hispanics, and Whites

Objectives: This study investigated seat belt use among White, Black, and Hispanic drivers, in cities in which standard enforcement of the belt use law is permitted (primary enforcement) and in cities in which a motorist has to be first cited for another offense (secondary enforcement). Socioeconomic and gender differences in belt use were also studied. Methods: Belt use observations were obtained at gas stations in Boston, Chicago, Houston, and New York City. In short interviews with drivers, information on race/ethnicity and education was obtained. Results: Belt use was higher in primary enforcement cities, among women, and among those with at least a college degree. In primary law cities there were no clear differences in belt use by race/ethnicity; in secondary cities African Americans were less likely than Whites or Hispanics to be belted, among populations both with and without college degrees. This is consistent with data from other studies indicating that African Americans are more sensitive than Whites to the enforcement of primary laws and are more likely to increase belt use when states shift from secondary to primary. There has been no evidence of enforcement bias against African Americans — increases in citations generally have been greater among Whites than African Americans once primary enforcement is implemented. Conclusions: More widespread application of primary laws — standard throughout the world but in only 17 US states and the District of Columbia — would increase belt use for all drivers, especially African Americans.

Trends in driver and front-right passenger safety belt use in Michigan: 1984–1998

As part of Michigan’s effort to track trends in safety belt use within the state over time, the University of Michigan Transportation Research Institute conducted 20 statewide surveys of safety belt use between 1984 and 1998. Results indicate that Michigan safety belt use trends for drivers and front-right passengers are similar to other statewide and national trends. Belt use in Michigan increased dramatically immediately after the state implemented its mandatory belt use law (secondary enforcement) followed by a smaller decline that leveled off at a rate more than 20 percentage points higher than before the law. Belt use was consistently higher among drivers than front-right passengers, older than younger front-outboard occupants, females than males, and front-outboard occupants exiting freeways than those stopped at local intersections. Examination of belt use trends in Michigan provides useful information for continued efforts to increase belt use in our state and for all states interested in meeting national goals for safety belt use for the year 2000 and beyond.

Effectiveness of primary and secondary enforced seat belt laws

Objective: The objective of this study was to determine the relative efficacy of primary and secondary enforced motor vehicle occupant restraint laws on the outcomes of restraint use, crash-related mortality, and crash-related injuries. Search strategy: We used the Cochrane Collaboration search strategy to search the following electronic databases: MEDLINE, EMBASE, National Technical Information Service (NTIS), PsycINFO, ERIC, Nursing and Allied Health (CINAHL), Transportation Research Information Service (TRIS), and EI Compendex. The reference lists from each potentially eligible study were checked, and knowledgeable people in the field were contacted, for additional leads to published reports. Selection criteria: Studies had to include a comparison of primary enforcement law to no law, secondary enforcement law to no law, or a primary to a secondary law. Any study design was acceptable. Acceptable outcome measures included observed restraint use, and counts or rates of deaths or serious injuries. Data collection: Data were collected using a standard abstract reporting form. Relative differences in outcomes and absolute differences were calculated when possible. Main results: We identified 48 studies for the review. When places or time periods with primary enforcement laws were compared to those without such laws, the relative prevalence of seat belt use ranged from 1.5 to 4.5; the prevalence differences ranged from 10 to 50 per 100 observed drivers. Secondary laws had smaller effects. Two studies evaluated a change in law from secondary to primary enforcement; this was associated with an increase in belt use 6 months later of 5.3 per 100 observed drivers in Louisiana and 18 per 100 drivers in California. Primary enforcement laws were associated with a relative risk of death in MV crashes of .54 to .97. The reduction in mortality associated with secondary enforcement laws was much more modest, with relative risks estimates of .81 to 1.025. Primary enforcement laws were associated with a relative risk of severe injuries of .20 to .89; the association of secondary enforcement laws with severe injuries was smaller. Conclusions: Our review of existing studies suggests that primary enforcement laws are likely to be more effective than secondary laws. However, few studies are of good quality, and quantitative estimates of the relative effect of primary compared with secondary laws are limited.

Illicit drugs and driving: a review of epidemiological, behavioural and psychological correlates

Large numbers of individuals use illicit drugs (e.g. cannabis, heroin, cocaine). The number of people driving vehicles has also increased. There is an increasing overlap between populations of illicit drug users and drivers. This paper describes the magnitude and nature of an illicit drugs and driving problem. The relationship between the consumption of illicit substances and driving skills, accident involvement and driving behaviour are examined using epidemiological data, injury and fatality statistics, empirical/behavioural evidence and survey research. Problems for the interpretation of such data are identified, and a number of questions remain unanswered for characterizing the magnitude and nature of the problem. Measures designed to counter the drugs and driving issue (e.g. secondary enforcement) are discussed. Proposals are made for further countermeasures based on current evidence.