Injury Prevention
Do reminder signs promote use of safety belts?*,**

https://doi.org/10.1067/mem.2000.111059Get rights and content

Abstract

Study Objective: To determine whether reminder signs placed at the exits to parking decks increase the rate of safety belt use. Methods: The subjects in this study were drivers of automobiles with permits to park in campus decks at a major university. Volunteer observers were positioned near the exits of 5 parking decks around the campus. Rates of safety belt use were noted before and at 2 intervals after reminder signs were installed. Results: A total of 6,780 observations were collected. The baseline rate of safety belt use was 83%. Female drivers were significantly more likely to wear a safety belt than male drivers (85.3% versus 79.6%, P <.001). Safety belt use did not increase after the signs were installed (83.3% before versus 83.5% after, P =.86). Conclusion: Placing reminder signs at the exits to parking decks did not boost the rate of safety belt use at our institution. Other strategies are needed to achieve the National Highway Traffic Safety Administration’s goal of increasing the overall rate of safety belt usage to 90% by the year 2005. [Clack ZA, Pitts SR, Kellermann AL. Do reminder signs promote use of safety belts? Ann Emerg Med. December 2000;36:597-601.]

Introduction

Every 14 seconds, someone in America is injured in a traffic crash. Every 12 minutes, someone is killed. Traffic injuries are the leading cause of premature death for US citizens 6 to 27 years, and the third leading cause of death for all Americans. Each year, motor vehicle crashes cost Americans $150 billion in economic costs and claim 41,000 lives.1

The most effective intervention to decrease motor vehicle occupant deaths and injuries is to promote the use of safety belts. It is estimated that safety belt use saves approximately 9,500 lives each year. Wearing a safety belt reduces the odds of death or serious injury in a crash by approximately 45%.2 Between 1982 and 1995, safety belts saved approximately 74,769 lives.2

Despite the proven effectiveness of safety belts, many drivers and passengers fail to use them. A survey in 1994 found nationwide safety belt usage to be 67%. Because the use of safety belts is so important, the National Highway Traffic Safety Administration (NHTSA) has embarked on a campaign to boost rates of safety belt use to 90% or greater by the year 2005.1

A variety of strategies have been used to encourage voluntary use of safety belts. Early efforts primarily relied on public education through billboards, radio spots, television ads, and other media. Faced with mounting evidence that education alone is of minimal benefit, the federal government provided incentives to states to enact laws that mandate safety belt use.1 The subsequent increase in belt use during the 1980s (from 11% in 1980 to 59% in 1991) has been attributed to enactment and subsequent enforcement of these laws.3 Government regulators also required automobile manufacturers to build more “crashworthy” vehicles that absorb energy and incorporate passive restraint systems, such as motorized safety belts or air bags.4 The cumulative effect of these interventions was a marked and sustained reduction in the rate of motor vehicle occupant deaths per million miles driven.3

Despite the success of engineering and enforcement strategies, there may still be a role for targeted education to promote safe behavior. Can delivering the right message at the right time promote safety belt use? To answer this question, we positioned a friendly, eye-catching sign at the exit of parking decks on the campus of a major university. To test the hypothesis that a reminder sign can encourage drivers to buckle their safety belts, we measured rates of safety belt use before and at 2 time points after installation of these signs.

Section snippets

Materials and methods

Emory University is a private, church-affiliated institution in Atlanta, GA. The campus contains a number of graduate schools, 3 hospitals, and a large multispecialty clinic. The daytime population of the campus includes 9,500 undergraduate and graduate students, 2,500 faculty, and 4,300 university, hospital, and research staff. Approximately 16,000 people drive automobiles to and from the campus each day. There are 6 large parking decks on campus, each of which has multiple exits.

The 5

Results

A total of 6,780 observations were collected during the 3 phases of the study. Roughly one third of the observations were collected in each phase (Table).The number of observations collected at any individual exit ranged from 79 to 538. Observers covered assigned parking decks on all but 5 of the assigned shifts (89%).

The overall rate of belt use in the preintervention period was significantly higher than the county rate (83% versus 62%). Safety belt use rates also differed significantly

Discussion

When prompts are delivered in a specific and polite manner, they can be effective in modifying a variety of convenient behaviors.6 Data collected from many previous studies suggest that visual prompts such as signs work best when they are paired with enforcement of a specific safety regulation.3 Studies done in the early 1980s, before the enactment of safety belt laws, suggested that prompting techniques such as direct personal prompts, dashboard signs, flash cards, flyers, and signs at exits

Acknowledgements

We thank the following undergraduate and graduate students at Emory University: Nailah Coleman, Jay Curtin, Kara Iskyan, Jon Lampkin, Michael Pinckney, Gabriel Rainish, Reginald Warren, and Adam Wurstle. Without their help, this study would not have been possible. We also thank Bill Collier and Randy Wilson from the Emory Parking Office for their support. Elyse Harrison designed our sign.

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*

The views expressed are those of the authors and do not necessarily reflect those of Emory University.

**

Address for reprints: Zoanne Clack, MD, MPH, Center for Injury Control, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322;,404-727-9977, fax 404-727-8744; E-mail [email protected].

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