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.     

Ninety five percent: an evaluation of law, policy, and programs to promote seat belt use in Washington state

Seat belt use in Washington state was 83% in 2001. In 2002, a series of law, policy, and program initiatives coalesced to produce a dramatic increase in seat belt use. Washington enacted a primary enforcement seat belt, the Chief of the Washington State Patrol made safety belt enforcement one of the core missions of that agency, and Washington participated in the national Memorial Day Click It or Ticket program during May 2002 and continued the program into 2003. Evaluation of these initiatives was accomplished through observation surveys of seat belt use, analysis of seat belt violation data, and analysis of data on traffic deaths of motor vehicle occupants. The major findings were that there was a two- to three-fold increase in enforcement of the seat belt law, belt use rates increased to 93% in 2002 and again to 95% in 2003, and motor-vehicle occupant fatalities decreased by 13%. IMPACT ON PRACTICE AND POLICY: The primary seat belt law and Click It or Ticket program activities were critical factors in increasing belt use in Washington state. Media and enforcement programs targeting seat belt use can be very effective in raising the belt use rate, but a long-term commitment to continuation of these program activities is essential. Other states implementing new primary seat belt laws should consider delivering a Click It or Ticket campaign prior to the effective date of the primary law and continuing these activities during subsequent months and years.     

The association between enforcement and seat belt use

A statistical association is found between the number of traffic citations for belt law violations versus observed belt use. Also, belt use is higher in primary enforcement states where officers issue such citations for belt law violations alone. In secondary enforcement states officers issue such citations only after stopping motorists for another reason. Most belt laws provide for secondary enforcement. Enforcement data were confined to the highway patrol in each state (local arrest data are rarely compiled statewide). Belt use data were based on observational surveys conducted in each belt law state.     

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.     

Drivers' opinions of enforcement and incentive strategies to promote safety belt use

During a nationwide campaign to promote safety belt use among military personnel, a field study was conducted at 12 military bases in the Netherlands. Enforcement and incentive programs were varied among military bases. A written survey was administered to personnel of these bases. The survey contained items concerning reported belt use, motivation to use a safety belt, attitudes toward legislation, public information, enforcement and incentive strategies, and awareness of the campaign. The results showed that enforcement was clearly a better accepted countermeasure than rewarding drivers for the use of safety belts. Respondents from bases exposed to the incentive treatment tend to have relatively more positive opinions of incentives than those exposed to the enforcement treatment. Two independent dimensions were present in the response patterns: one representing opinions of enforcement and the other of incentives/rewards.     

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.     

The role of enforcement programs in increasing seat belt use

Seat belt laws by themselves led to increased belt use in the United States and Canada, but initial effects were limited. Canadian provincial officials launched highly publicized enforcement campaigns in the early 1980s that resulted in substantially increased belt use. Canadian-style enforcement programs subsequently were adopted in the United States, and the use of such programs has grown in recent years. Lessons from these efforts include the importance of police leadership, focused publicity about enforcement, and sustained rather than single-shot efforts. What is needed in the United States to achieve a national belt use rate of 90% or greater is widespread, methodical, and sustained application of enforcement programs augmented by creative publicity. Enhanced penalties-in particular drivers license points-likely will be needed to reach hard-core nonusers.     

Increasing seat belt use through PI&E and enforcement: The Thumbs Up campaign

Campaigns to increase seat belt use have been effective in controlled environments, in small geographic areas, in primary enforcement states, and when conducted in conjunction with the enactment of seat belt legislation. The Thumbs Up project was undertaken to determine if belt use could be facilitated in less advantageous conditions. A 3-month campaign to increase seat belt use was conducted in two sites, each consisting of two Florida counties. At its conclusion, the Thumbs Up project did not yield an overall increase in seat belt use across the two sites. However, observed seat belt use and the number of seat belt citations issued increased significantly in one site. The results are discussed in terms of the two components necessary for a successful campaign: public information and education, and enforcement. Further, recommendations for conducting successful community-based seat belt interventions are offered.     

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

Introduction: Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt. Method: Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none). Results: Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region). Conclusions: Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.     

Evaluation of the Reading, PA nighttime safety belt enforcement campaign: September 2004

PROBLEM: Safety belt use rates among front seat occupants of passenger vehicles are substantially lower at night than during the day despite the fact that night driving is more dangerous. METHOD: Recent advances in night vision equipment now make it possible to enforce belt use laws in darkness. Reading, Pennsylvania conducted a night belt use publicity and enforcement campaign during September 2004 using night vision equipment. RESULTS: Front seat occupant belt use at night increased significantly from 50% prior to the campaign to 56% just after the campaign. Daylight belt use also increased though to a lesser extent (56% to 59%). Survey data indicated that motorists had heard about the campaign in newspapers and on television. Belt use increases were not seen during the same time period in a comparison community.     

Recent estimates of safety belt use

The National Occupant Protection Use Survey (NOPUS) has shown that safety belt use in the United States has increased steadily over the past decade. Increases have been consistent since 2000, when the National Highway Traffic Safety Administration, in partnership with the Air Bag & Seat Belt Safety Campaign, increased its encouragement of states to implement highly visible enforcement programs. In 2003, significant increases were found in the South; in secondary law states; in all types of vehicles; during both weekdays and weekends; and during both rush-hours and non-rush-hours. In spite of these increases, use remains significantly lower in secondary law states; pickup trucks; the Northeast; and the Midwest. The differences between primary and secondary law states and between pickups and other passenger vehicles have been consistent from year to year. A controlled intersection study, which is part of the NOPUS, has shown that safety belt use has increased for both sexes, for nearly all age groups, and for all races for which data are available. Finally, the NOPUS suggests that children are 3-4 times as likely to be unrestrained when riding with an unbuckled driver as when driving with a buckled driver.     

State-level seat belt use in the United States, 2011–2016: Comparison of self-reported with observed use and use by fatally injured occupants

Introduction: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. Objective: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011–2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. Results: During 2011–2016, national self-reported seat belt use ranged from 86–88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = −0.77). Conclusion: National self-reported seat belt use remained essentially stable during 2011–2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.     

Self-Reported Seat Belt Use in Four Countries: A Telephone Survey

A telephone survey was conducted in four countries in November 1998 to compare drivers in the United States with those in Australia, Canada, and the United Kingdom regarding their attitudes toward seat belts and belt use laws. More than 90 percent of the 2251 respondents said they thought seat belts are effective, but self-reported belt use was significantly lower in the United States than in the other countries. Respondents in Australia and the United Kingdom had similar views about what they thought were important reasons for using seat belts and had the highest self-reported use. Reasons given for using belts by Canadian and US respondents were quite similar to one another, yet US respondents had significantly lower self-reported use rates, a difference thought to be due to vigorous enforcement of the law in Canada. US drivers were less likely than Australian and UK drivers to say they used belts out of habit, to avoid a ticket, or because it is required by law and more likely to say they used belts for situational reasons. US drivers were least likely to be in favor of belt use laws. Canadian drivers reported the most experience being checked by police for belt use and were most likely to think that nonusers would be caught. US drivers in primary enforcement jurisdictions were more likely than those in secondary jurisdictions to think that drivers not using belts would be caught and more likely to say they always used belts. Results of this survey indicate that seat belt use in the United States could be increased by adoption of primary enforcement laws and highly visible enforcement programs of the type used in Canada, and that seat belt use could be increased in all countries by increasing the penalties for nonuse.     

Evaluation of California's safety belt law change from secondary to primary enforcement

Some states allow an officer to stop a vehicle for an observed belt law violation alone (primary). Most require that the initial stop be made for some other violation before a belt law citation can be issued (secondary). On January 1, 1993, California became the first state to implement an uninterrupted change from secondary to primary belt law enforcement. In six study communities, the percentage of drivers observed wearing seat belts increased from 58% prior to the law change to 76% soon thereafter. Drivers surveyed at DMV offices indicated that they had knowledge of the new law and were more likely to wear their belts now than in the past.     

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.     

A direct observation study of nighttime safety belt use in Indiana

INTRODUCTION: Nearly all direct observation studies of safety belt use are conducted exclusively during daylight hours. Recent work has suggested that safety belt use at night may differ from daytime belt use. METHODS: An observational study of nighttime safety belt use, utilizing specialized night vision equipment, was conducted in Indiana surrounding the Click It or Ticket 2006 safety belt mobilization activities. A pre- and a post-mobilization statewide direct observation survey was conducted at night coinciding with daytime safety belt use data collection conducted by the state of Indiana. Daytime and nighttime belt use rates were compared. RESULTS: The comparisons across the mobilization period revealed a significant increase during the day, but a significant decrease at night. Comparisons between daytime and nighttime belt use revealed no overall difference during the pre wave, but a significant difference during the post wave. Finally, many common daytime trends in belt use were also found at night, with the exception of the typical age and seating position effects. DISCUSSION: The mobilization activities had a positive effect on daytime belt use, but no effect on nighttime belt use, likely resulting in the differences between daytime and nighttime belt use observed during the post wave. IMPACT ON INDUSTRY: The findings of this study suggest that safety belt mobilizations implemented only during the day do not influence nighttime safety belt use. Changes to how these programs are implemented or additional programs specifically targeting belt use at night should be considered, along with continued monitoring of nighttime belt use.     

Factors related to seat belt use among fatally injured teenage drivers

PROBLEM: In the United States, teenage drivers have a higher crash risk and lower observed seat belt use than other age groups. METHOD: Seat belt use was examined for teenage (16-19 years) drivers who were fatally injured in traffic crashes occurring in the United States during the years 1995-2000. Vehicle, driver, and crash factors potentially related to belt use were examined. State differences in belt use rates among fatally injured teenage drivers were related to states' observed belt use rates for all ages and other state-level variables. RESULTS: During 1995-2000, mean belt use was 36% among fatally injured teenage drivers and 23% among fatally injured teenage passengers. One of the strongest predictors of higher belt use for both drivers and passengers was whether the crash occurred in a state with a primary seat belt law. Belt use rates for 1995-2000 for fatally injured teenage drivers ranged from 20% or less in six states to more than 60% in two states. States with the highest use rates were those with strong primary belt use laws and those with high rates of observed belt use for all ages. Lower belt use among fatally injured teenage drivers was associated with increasing age; male drivers; drivers of SUVs, vans, or pickup trucks rather than cars; older vehicles; crashes occurring late at night; crashes occurring on rural roadways; single vehicle crashes; and drivers with BACs of 0.10 or higher. Teenage driver belt use declined as the number of teenage passengers increased, but increased in the presence of at least one passenger 30 years or older. IMPACT ON TRAFFIC SAFETY: It is suggested that to increase teenage belt use, states should enact strong primary belt use laws and mount highly publicized efforts to enforce these laws. Graduated driver licensing systems should incorporate strong provisions that require seat belt use by teenage drivers and passengers.     

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.     

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.