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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Self-reported seatbelt use,United States, 2002–2010: Does prevalence vary by state and type of seatbelt law?

ProblemMotor-vehicle crashes are a leading cause of death in the United States. Seatbelts are highly effective in preventing serious injury and death in the event of a crash. Not all states have primary enforcement of seatbelt laws.MethodsData from the 2002, 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seatbelt use by state and type of state seatbelt law (primary vs. secondary enforcement).Results and discussionSelf-reported seatbelt use among adults in the United States increased steadily between 2002 and 2010, with the national prevalence reaching 87% in 2010. Overall, seatbelt use in 2010 was 9 percentage points higher in the states with primary enforcement laws than in the states with secondary enforcement laws (89% vs. 80%). Impact on industry: Primary enforcement seatbelt laws and enhanced enforcement of seatbelt laws are proven strategies for increasing seatbelt use and reducing traffic fatalities.     

Effects of Washington, D.C. law on drivers' hand-held cell phone use

OBJECTIVE: To assess the effects of Washington, D.C. law prohibiting drivers' use of hand-held cell phones on such use. METHODS: Daytime observations of drivers were conducted at signalized intersections in D.C. in March 2004, several months before the law took effect on July 1, 2004, and again in October 2004. As a comparison, observations also were conducted in areas of Virginia and Maryland located close to the D.C. border. Maryland and Virginia placed no limitations on drivers' phone use. Use was observed for 36,091 vehicles in D.C., 25,151 vehicles in Maryland, and 28,483 vehicles in Virginia. RESULTS: The rate of talking on hand-held cell phones among drivers in D.C. declined significantly from 6.1% before the law to 3.5% after. Phone use declined slightly in Maryland and increased significantly in Virginia so that, relative to the patterns of hand-held phone use in the two states, phone use in D.C. declined 50%. Hand-held phone use in D.C. declined comparably among drivers of vehicles registered in all three jurisdictions. D.C. police issued 2,556 citations and 1,232 warnings for cell phone violations during July-November 2004. There were spates of media coverage when the law was passed and when it took effect. CONCLUSIONS: D.C.'s law prohibiting drivers' hand-held phone use had a strong effect on such use among drivers in D.C. Without ongoing publicized enforcement of the law, long-term compliance may be difficult to achieve.     

Tracking traffic citations through court adjudications to posting to public driver records

Research has shown that one of the best predictors of a driver's future crash risk is the number of prior moving traffic violations (e.g., speeding). Public driver records are used by government and nongovernment users to assess drivers' future crash risks. However, the adequacy of such records may be compromised by deficient recordkeeping systems and by court-based diversion programs (e.g., probation before judgment, traffic school election) that allow drivers presumed guilty to avoid convictions in court and posting of the violations to their driver records. Using a case study approach in four jurisdictions in three states, citations issued for traffic violations were tracked through court adjudication to placement on driver records. Individual court case records and driver history records were reviewed. The percentages of citations issued that appeared on driver records were 58-87% for moving violations, 30-94% for driving while impaired (DWI), and 67-95% for occupant restraint violations. Diversion programs were a significant factor in two states, where 21% and 35% of moving violation citations resulted in diversions. Almost all court convictions in each jurisdiction were recorded on driver records, but few citations resulting in diversions were recorded. Thus, diversion programs in some jurisdictions substantially reduce the utility of public driver records as reliable indicators of prior traffic violations and future crash risks. Recordkeeping inefficiencies and errors were less important factors in this study.     

Graduated driver licensing restrictions: awareness, compliance, and enforcement in North Carolina

PROBLEM: This study examined the extent to which critical restrictions in North Carolina's graduated driver licensing (GDL) system are known, adhered to, and enforced. METHOD: Teenagers and their parents were recruited as they applied for either an intermediate or full license at 1 of 23 licensing offices. Telephone interviews were conducted with 900 teenagers and their parents. RESULTS: Awareness of North Carolina's night and passenger restrictions was very high among both parents and teenagers. Ten percent of teenagers reported violating the night restriction without their parents' knowledge, and 15% had done so with their parents' approval. Only 4% of parents reported allowing their teenagers to drive with more than one teenage passenger, but 19% of teenagers reported that they were allowed to do this. Violations of the passenger restriction without parental knowledge were more common than violations of the night restriction (22% vs. 10%, respectively). Among teenagers who violated restrictions without their parents' knowledge, most reported doing so only once or a few times. Teenagers expressed little concern about detection, although a majority reported driving more carefully to avoid police notice. Neither parents nor teenagers knew much about police enforcement of GDL restrictions. To obtain a sense of the views of law enforcement officers, informal interviews were conducted with 20 officers from five diverse communities and the state highway patrol. These officers were highly supportive of GDL but unfamiliar with many of the specific provisions. Moreover, enforcement of GDL restrictions did not appear to be a high priority. IMPACT ON INDUSTRY: There is a need to increase the belief among teens (and parents) that police are enforcing GDL restrictions in their community; law enforcement participation in well-publicized traffic safety enforcement efforts would likely produce this result.     

The deterrent effect of increasing fixed penalties for traffic offences: the Norwegian experience

PROBLEM: Many motorized countries use fixed penalties to deter the most common traffic violations. Fixed penalties are usually given at the spot by a police officer. If the offender accepts the fixed penalty, no court hearing or trial is held. During the years 1995-2004, the rates for fixed penalties for traffic offences in Norway increased substantially. This paper evaluates the effects on compliance of these increases. METHOD: Regression analysis was performed to determine the effects of increases in fixed penalties. RESULTS: For speeding in general, no effect of increasing fixed penalties can be found. For speeding close to speed camera sites, there is a weak tendency for the violation rate to go down. This tendency is not statistically significant at conventional levels. For seat belt wearing, wearing rates are found to increase as fixed penalties have increased. In recent years, however, enforcement of the seat belt law has stepped up, making it impossible to separate the effect of enforcement from that of fixed penalties. IMPACT ON INDUSTRY: It has been suggested that the police may adapt to stricter penalties by reducing enforcement or by adopting larger tolerance margins for violations. Available evidence does not support this hypothesis.     

Impaired driving enforcement practices among state and local law enforcement agencies in the United States

IntroductionAlcohol-impaired driving (DUI) persists as a substantial problem, yet detailed data on DUI enforcement practices are rarely collected. The present study surveyed state and local law enforcement agencies about their DUI enforcement activities.MethodTelephone interviews were conducted with law enforcement liaisons in state highway safety offices. Officers from a nationally representative sample of municipal, county, and state law enforcement agencies were also interviewed about their agency's DUI enforcement activities, including the types of enforcement, frequency of use, and whether activities were publicized. Response rates were 100% among law enforcement liaisons, 86% among county agencies, 93% among municipal agencies, and 98% among state agencies.ResultsBased on the highway safety office survey, 38 states conducted sobriety checkpoints in 2011. Nationally, 58% of law enforcement agencies reported that they conducted or helped conduct sobriety checkpoints during 2011–12, with 14% of all agencies conducting them monthly or more frequently. The vast majority (87%) of agencies reported conducting dedicated DUI patrols. However, dedicated DUI patrols were less likely to be publicized than checkpoints. Less than a quarter of agencies reported using passive alcohol sensors to improve detection of alcohol-impaired drivers.ConclusionsResults show that 38 states conducted sobriety checkpoints in 2011, little changed from a previous survey in 2000. Despite evidence of effectiveness, many agencies do not conduct frequent, publicized DUI enforcement or use passive alcohol sensors.Practical applicationsThe survey suggests that there are several areas in which impaired driving enforcement could be improved: increasing the frequency of special enforcement, such as sobriety checkpoints and/or dedicated patrols; publicizing these efforts to maximize deterrent effects; and using passive alcohol sensors to improve detection of alcohol-impaired drivers.     

Connecticut statewide sTEP wave evaluation

INTRODUCTION: Selective Traffic Enforcement Programs (sTEPs) are a proven method to change motorists' behavior. Since 1997, the Connecticut DOT's Division of Highway Safety has organized a statewide seat belt enforcement program, with sTEP waves every three or four months. To date, 28 waves have been implemented. METHOD: Pre-wave and post-wave seat belt observation surveys are conducted by both state and municipal police across the state. Survey results, as well as a summary of all enforcement activity during the wave, are submitted for evaluation. RESULTS: Connecticut seat belt use has continued to rise from one wave to the next in a predictable "saw blade" pattern. CONCLUSIONS: The data clearly demonstrate that agencies that have participated in a greater number of waves have experienced the greatest increase in belt use. Belt use has not yet plateaued and additional sTEP enforcement seems indicated. However, evidence from other states suggests that a plateau may occur somewhere in the mid 80% range. IMPACT ON INDUSTRY: Should this occur, Connecticut will work toward strengthening the round the clock model, emphasizing the importance of aggressive primary enforcement.