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.     

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.     

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.     

Connecticut nighttime safety belt use

Problem

Safety belt use in the United States, as measured over daylight hours, has risen steadily over recent years reaching 80% in 2004. Yet, using the National Highway Traffic Safety Administration's (NHTSA) Fatality Analysis Reporting System (FARS), safety belt use among fatally injured front seat outboard occupants of passenger vehicles was only between 42% and 46% for the years 1999 to 2003. One possible contributing factor is that safety belt use at night, when crash rates are highest, is lower than during the day.

Method

A full statewide nighttime belt use observation survey was conducted in 2004. This survey was conducted simultaneously with Connecticut's annual full statewide daytime belt use survey. Night belt use observations of drivers and passengers are possible using newly available near military grade night vision goggles and handheld infrared spotlights. Both day and goggle-assisted night observations were conducted at 100 observation sites in Connecticut. Procedures for day and night observations were as nearly identical as possible.

Results

The night belt use rate was 6.4 percentage points lower than the day rate (83.0 vs. 76.6). Consistent with belt use among Connecticut fatalities, day versus night differences were greatest in urban areas. There was evidence that day versus night differences were greater before as compared to after a May 2004 belt use enforcement program.     

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 the ambulance patient compartment by emergency medical services professionals is low regardless of patient presence,seating position,or patient acuity

Background: Inconsistent use of seat belts in an ambulance may increase the risk of injury for emergency medical services (EMS) professionals and their patients. Our objectives were to: (1) describe the prevalence of seat belt usage based on patient acuity and seat location, and (2) assess the association between EMS-related characteristics and consistent use of a seat belt. Methods: We administered a cross-sectional electronic questionnaire to a random sample of 20,000 nationally-certified EMS professionals, measuring seat belt use in each seating location of an ambulance during transport of stable, critical, or no patients. We included practicing, non-military, emergency medical technicians or higher who reported working in ambulances. We used multivariable logistic regression models to estimate the odds of consistent (≥50% of the time) use of seat belts for the rear-facing jump seat and right-sided crew bench during transport of stable and critical patients. Results: A total of 1431 respondents were included in the analysis. Patient compartment seat belt use varied with the highest use in forward-facing seats when no patient was being transported (59.8%) and lowest use in the left-side “CPR” seat with a critical patient (9.4%). Only 40.2% of respondents reported an agency policy regarding seat belt use while riding in the patient compartment. In all multivariable logistic regression models, advanced life support level certification and fewer years of experience were associated with decreased odds of consistent seat belt use. An agency seat belt policy was strongly associated with increased odds of seat belt use in the patient compartment. Conclusions: Seat belt use was low and varied by seating location and patient acuity in the patient compartment of an ambulance. Practical Applications: EMS organizations should consider primary prevention approaches of provider education, improved ambulance designs, enactment and enforcement of policies to improve seat belt compliance and provider safety.     

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 factors that influence rear seat belt use among adults

Introduction: While seat belt use among front seat occupants has significantly increased overtime a substantial usage gap still exists between front and back seat occupants. This study aims to identify factors that predict rear seat belt use among adult back seat passengers. Methods: We examined data from the 2016 Motor Vehicle Occupant Safety Survey, conducted by the National Highway Traffic Safety Administration, to determine the influence of front seat belt use, support of and belief of rear seat belt use laws, peer perception of seat belt use, nighttime belt use, and demographic factors on self-reported rear seat belt use. Rao-Scott chi-squared tests were used to determine significant associations between self-reported rear belt use and each predictor. Multivariate logistic regression was used to calculate adjusted odds ratios and determine the influence of significant predictors on rear seat belt use. Sampling weights were applied to produce nationally representative estimates; all statistical significance tests accounted for the complex survey design. Results: Among adults who reported riding in the back seat, 63% reported always using a rear seat belt. Front seat belt use, support and belief of state seat belt laws, nighttime seat belt use, age, and education were significantly associated with rear seat belt use. Multivariate regression results showed that adults who supported rear seat belt laws, reported front seat belt use and believed their state has a rear seat belt law were significantly more likely to report full-time use in the back seat. Conclusions: Seat belt laws and front seat belt use had the strongest association with reporting full-time use in the back seat. Practical Applications: Increasing familiarity with existing laws directed towards rear seat belt use as well as increasing awareness about the benefits of seat belts in all seating positions may help improve rear seat belt use.     

The effects of persistent audible seat belt reminders and a speed-limiting interlock on the seat belt use of drivers who do not always use a seat belt

Introduction: Vehicle technologies that increase seat belt use can save thousands of lives each year. Kidd, Singer, Huey, and Kerfoot (2018) found that a gearshift interlock was more effective for increasing seat belt use than an intermittent audible reminder, but interlocks may not be more effective than persistent audible reminders lasting at least 90 seconds. Method: Forty-nine part-time belt users with a recent seat belt citation who self-reported not always using a seat belt drove two vehicles for 1 week each. Thirty-three drove a Chevrolet with an intermittent audible reminder followed by either a BMW with a persistent 90-second audible reminder (n = 17) or a Subaru with an incessant audible reminder (n = 16). The other 16 participants experienced the BMW persistent reminder followed by an interlock that limited speed to 15 mph during unbelted driving. These data were combined with data from 32 part-time belt users in Kidd et al. (2018) who experienced the intermittent reminder for 2 weeks or the intermittent reminder for 1 week and a gearshift interlock the next. Results: Relative to the intermittent reminder, seat belt use was significantly increased an estimated 30% by the BMW persistent reminder, 34% by the Subaru incessant reminder, and 33% by the speed-limiting interlock. Belt use was increased an estimated 16% by the gearshift interlock, but this change was not significant. More participants circumvented the speed-limiting interlock to drive unbelted than the audible reminders. Responses to a poststudy survey indicated that interlocks were less acceptable than reminders. Conclusions: Audible reminders lasting at least 90 seconds and a speed-limiting interlock were more effective for increasing seat belt use than an intermittent audible reminder, but reminders were found more acceptable. Practical applications: Strengthening existing U.S. safety standards to require audible reminders lasting at least 90 seconds for front-row occupants could save up to 1,489 lives annually.     

Nighttime seat belt use among front seat passengers: Does the driver's belt use matter?

Introduction and Method: We explored the relationship between nighttime seat belt use of right-front passengers and their drivers using observational data from 33,310 vehicles in east Tennessee during March 2015 – May 2017. Results: Overall, nighttime passenger seat belt use varied by 50 percentage points from 92% when drivers were belted to 42% when drivers were not belted, suggesting that part-time seat belt users can be heavily influenced by the seat belt status of their traveling companions. When stratified by vehicle type and sex, passenger seat belt use by driver seat belt status varied as much as 74 percentage points from 96% to 22%. Passenger seat belt use was typically lower when riding with unbelted same-sex drivers than when riding with unbelted drivers of the opposite sex. Conclusions and Practical Applications: This finding suggests that the role of peer influence in decision-making about seat belt use may differ depending on the sex of a vehicle driver and his or her passengers. Further research is warranted to explore this finding as well as other social and cultural influences that have not been fully examined in seat belt research.     

The effect of a gearshift interlock on seat belt use by drivers who do not always use a belt and its acceptance among those who do

IntroductionSeat belts reduce the risk of fatal injury in a crash, yet in 2015, nearly 10,000 people killed in passenger vehicles were unrestrained. Enhanced seat belt reminders increase belt use, but a gearshift interlock that prevents the vehicle from being placed into gear unless the seat belt is used may prove more effective.MethodThirty-two people with a recent seat belt citation and who admitted to not always using a seat belt as a driver were recruited as part-time belt users and asked to evaluate two new vehicles. Sixteen drove two vehicles with an enhanced reminder for one week each, and 16 drove a vehicle with an enhanced reminder for one week and a vehicle with a gearshift interlock the following week. Sixteen full-time belt users who reported always using a seat belt drove a vehicle with a gearshift interlock for one week to evaluate acceptance.ResultsRelative to the enhanced reminder, the gearshift interlock significantly increased the likelihood that a part-time belt user used a belt during travel time in a trip by 21%, and increased the rate of belt use by 16%; this effect approached significance. Although every full-time belt user experienced the gearshift interlock, their acceptance of the technology reported in a post-study survey was fairly positive and not significantly different from part-time belt users. Six part-time belt users circumvented the gearshift interlock by sitting on a seat belt, waiting for the system to deactivate, or unbuckling during travel.ConclusionThe gearshift interlock increased the likelihood that part-time belt users buckled up and the rate of belt use during travel relative to the enhanced reminder but could be more effective if it prevented circumvention.Practical applicationsAn estimated 718–942 lives could be saved annually if the belt use of unbuckled drivers and front passengers increased 16–21%.     

Children's and Adults’ Comfort Experience of Extra Seat Belts When Riding in the Rear Seat of a Passenger Car

Objective: The objective of this study was to explore passengers’ comfort experience of extra seat belts during on-road driving in the rear seat of a passenger car and to investigate how the use of extra belts affects children's and adults’ attitudes to the product.

Methods: Two different seat belt systems were tested, criss-cross (CC) and backpack (BP), consisting of the standard 3-point belt together with an additional 2-point belt. In total, 32 participants (15 children aged 6–10, 6 youths aged 11–15, and 11 adults aged 20–79, who differed considerably in size, shape, and proportions) traveled for one hour with each system, including city traffic and highway driving. Four video cameras monitored the test subject during the drive. Subjective data regarding emotions and perceived discomfort were collected in questionnaires every 20 min. A semistructured interview was held afterwards.

Results: All participant groups accepted the new products and especially the increased feeling of safety (P <.01); 56% preferred CC and 44% preferred BP but the difference was not significant. In total, 81% wanted to have extra seat belts in their family car. CC was appreciated for its symmetry, comfort, and the perceived feeling of safety. Some participants found CC unpleasant because the belts tended to slip close to the neck, described as a strangling feeling. BP was simpler to use and did not cause annoyance to the neck in the way CC did. Instead, it felt asymmetric and to some extent less safe than CC. Body size and shape affected seat belt fit to a great extent, which in turn affected the experience of comfort, both initially and over time. Perceived safety benefit and experienced comfort were the most determinant factors for the attitude toward the extra seat belts. The extra seat belts were perceived as being better than the participants had expected before the test, and they became more used to them over time.

Conclusion: This exploratory study provided valuable knowledge from a user perspective for further development of new seat belt systems in cars. In addition to an increased feeling of safety, seat belt fit and comfort are supplementary influencing factors when it comes to gaining acceptance of new seat belt systems.     

Organizational policy and other factors associated with emergency medical technician seat belt use

INTRODUCTION: The purpose of this study was to determine factors associated with seat belt usage among Emergency Medical Technicians (EMTs). METHODS: As part of biennial re-registration paperwork, nationally registered EMTs completed a survey on the safety and health risks facing Emergency Medical Services (EMS) providers. Respondents were asked to describe their seat belt use while in the front seats of an ambulance. They were categorized as "high" in seat belt use if it had been more than a year since they had not worn their seat belt or "low" in seat belt use if they had not worn their seat belt at least once within the past 12 months. A logistic regression model was fit to estimate the association between seat belt use, organizational seat belt policy, type of EMS organization worked for, EMT certification level, and the size of community where EMS work is performed. RESULTS: Of the 41,823 EMTs that re-registered in 2003, surveys were received from 29,575 (70.7%). A significant interaction between organizational seat belt policy and type of EMS organization was found to exist. Participants reporting no organizational seat belt policy had lower odds of seat belt usage when compared to individuals that do have a seat belt policy. Odds Ratios ranged from 0.20 (95% CI 0.10-0.40) for military organizations to 0.59 (95% CI 0.38-0.93) for private EMS organizations. Paramedics and those working in rural areas also had lower odds of seat belt use. CONCLUSION: Several factors were found to be associated with seat belt usage among EMTs while in the front compartment of an ambulance. However, it appears that only one, organizational policy, is a modifiable characteristic.     

Seat belt use among car drivers in Iranian safe communities: An observational study

Objective: The number of road traffic injuries and fatalities in Iran is high. The aim of the present study was to investigate the rate of drivers' seat belt use and a number of related factors in Kashmar, Bardaskan, and Khalilabad (Iranian Safe Communities).Methods: In 2014, driver observations were made at 48 road sites on intercity roads, main streets, side streets, and rural roads in these 3 cities.Results: A total of 10,255 vehicles were observed, with the overall rate of seat belt use being 51.8%. The rates in Kashmar, Bardaskan, and Khalilabad were 51.4, 56.3, and 47.7%, respectively. In Kashmar, the odds of seat belt use were higher among drivers who were female, older, and taxi drivers. Higher use was also found during the afternoon, and lower use was observed on rural roads. In Khalilabad the odds of seat belt use were higher among females, older drivers, taxis, and private car drivers. Seat belt use was also higher on weekends and during the morning but was significantly lower on rural roads. Similarly, in Bardaskan the odds of using a seat belt were higher among females, older drivers, taxis, and private car drivers. Seat belt use was also higher during the afternoon but was significantly lower on rural roads, in comparison to main streets and intercity roads.Conclusions: The rate of seat belt use in these 3 cities was found to be low, despite these cities being designated as International Safe Communities. Therefore, seat belt promotion programs, tougher regulations, stronger enforcement, public awareness campaigns, and more research are needed to promote seat belt use in these Iranian cities.     

Seat belts pay off: The evaluation of a community-wide incentive program

This research explores the effectiveness of a seat-belt incentive program in an entire community. The project was conducted during 1983 in Chapel Hill/Carrboro, North Carolina, a community with a population of 50,000. The campaign, entitled “Seat Belts Pay Off,” comprised several steps: (a) planning and developing support, (b) developing data collection and other evaluative procedures, (c) implementing a public education/involvement campaign, and (d) giving modest economic incentives to belted occupants of vehicles passing checkpoints over a 6-month period. Belt use matching the highest level recorded in a U.S. community was achieved. Incentives, generally ranging in value from $3 to $5, were donated by many community businesses. The prizes, which included meals, containers of soft drinks, $5 cash coupons, T-shirts, and gift certificates, were given out for 6 months (April 19 to October 17, 1983). Additionally, six monthly $500 drawings were held, along with a $1,000 grand prize drawing. Eligible participants were those who had been stopped and rewarded for wearing their seat belt(s) and who then mailed in a preaddressed, postage-paid entry card. The drawings were conducted to stimulate public interest at selected intervals in the campaign. The effectiveness of the effort was measured by monitoring driver shoulder-belt use in passenger cars equipped with shoulder belts before, during, and after the education and incentive phases. A systematic, stratified sample was used to obtain weekly belt use data from 7 of 17 permanent data collection stations located around the community. Results indicate that driver overall belt use increased from 24 % in the baseline phase to a peak value of 41 % in the last week of the incentive phase. During the initial 6 months of the follow-up phase, weekly belt use held consistently around 36%. Over the next year, use rates increased slightly, although a small scale 2-month follow-up intervention introduced in the fall of 1984 had little, if any, impact.     

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.     

Characteristics of drivers not using seat belts in a high belt use state

A study was undertaken in North Carolina to determine the characteristics of the minority of drivers who were not using seat belts following an extensive publicity/enforcement campaign, which had increased statewide use to 80%. Vehicles and drivers whose seat belt use was observed at sites across North Carolina were matched against Division of Motor Vehicles registration and driver history files for vehicle owners. The study file consisted of those observed drivers who matched the owners with respect to sex, race, and approximate age. The results of this investigation indicate that nonuse of seat belts was associated with males; younger age (<35); older vehicles (pre-1985); vehicles other than cars, especially pickups; and poor driving records. Telephone survey information indicated that nonusers were less likely to have health care coverage, more likely to acknowledge having consumed large amounts of alcohol in the past year, and more likely to have an arrest record. When asked about enforcement of the belt use law, many nonusers said that they would not respond to higher fines but they would respond to driver license points. To change the belt use behavior of this hard-core nonuser population, it well may be necessary as was done in Canada to combine publicity/enforcement campaigns with driver license points as a penalty for nonuse.     

Exposure to the sobriety "Checkpoint Strikeforce" campaign in Maryland: impact on driver perceptions of vulnerability and behavior

OBJECTIVES: To compare drivers who were: (1) exposed to Maryland's sobriety "Checkpoint Strikeforce" campaign; (2) not exposed but were aware of it; and (3) neither exposed nor aware of it. This six-month campaign involved periodic road-side sobriety checkpoints, in which police attempted to detect and arrest drunk drivers and a series of radio Public Service Announcements (PSAs) that promoted public awareness. METHODS: A statewide sample of 1725 drivers were interviewed by telephone to determine their exposure to and awareness of this campaign, as well as their beliefs and behaviors concerning drunk driving and seat belt usage. RESULTS: Relatively few people (9.6%) were exposed in any way to the campaign; however almost 30% were aware of it. Significant increases in perceived vulnerability to arrest for drinking and driving were found among those who were exposed. There were no differences in reported drinking and driving, but seat belt usage in the last 30 days was higher among those who were exposed. There were no differences among those people who had been directly exposed to the campaign (i.e., personally gone through a sobriety checkpoint) and those who were indirectly exposed (i.e., knew a family member or someone else who went through a checkpoint). CONCLUSIONS: Exposure to a sobriety checkpoint was associated with increased perceptions of drink-driving risk (i.e., likelihood of getting caught by the police), which was not dependent upon having personally experienced it. Awareness without exposure appears to be insufficient to change perceived risk. The need to increase the reach and frequency of the sobriety "Checkpoint Strikeforce" campaign is indicated.     

Passenger use of and attitudes toward rear seat belts

Objectives: This study sought to identify attitudes toward belt use in the rear seat and to gain insight into the experiences of rear-seat passengers. Method: A telephone survey conducted between June and August 2016 targeted adult passengers who had recently ridden in the rear and who did not always wear their seat belt when doing so. Respondents were questioned regarding their reasons for not buckling up and possible conditions under which they would be more likely to buckle up during rear-seat travel. Results: Of 1163 recent rear-seat passengers, 72% reported always using their seat belt in the rear. Full-time belt use was lower among passengers who primarily travel in the rear of hired vehicles compared with personal vehicles. The most common explanation for not buckling up was that the back seat is safer than the front. Four out of five agreed they do not buckle up because of type of trip; two-thirds forget or do not see the need; and two-thirds agreed with reasons related to design, comfort, or usability issues. Nearly 40% agreed that they sometimes do not buckle up in the rear because there is no law requiring it. Conclusion: Many reasons for not using belts in the rear are similar to reasons in the front, such as forgetfulness, inconvenience, or discomfort. One difference is that many rear-seat passengers perceive using the belt is unnecessary because the back seat is safer than the front. More than half of part-time belt users and nonusers reported interventions such as rear seat belt reminders, stronger belt-use laws, and more comfortable belts would make them more likely to use their seat belt in the rear seat. Practical applications: This study identifies barriers to rear seat belt use that point to the need for a multi-faceted approach to increase belt use.