The role of enforcement programs in increasing seat belt use
Introduction
It is a major frustration in the public health community that some drivers and passengers choose not to use seat belts, in violation of laws in all U.S. states except New Hampshire. Seat belts are available in virtually all passenger vehicles. They are easy to use and highly effective in preventing deaths and serious injuries. By the same token, it is understandable that some people do not take advantage of this protection. In public health terms, using seat belts is an “active” countermeasure approach, requiring individual action. It is at the extreme end of the active-passive, or automatic, continuum. Achieving high belt use rates is contingent on individuals being motivated to and remembering to fasten their seat belts on each and every trip, as opposed to other active preventive measures such as getting a flu shot. Unfortunately, but not unexpectedly, people who do not buckle up are at higher crash risk than those who do. Thus, although we are approaching 80% use in the observed noncrash population, belt use in higher severity crashes (e.g., delta Vs of 25 mph or higher) is only about 50% (O'Neill, 2001). We need to keep in mind that this is our primary target group—people likely to be in serious crashes.
Section snippets
Why education alone does not work
Major efforts have been made to find ways to increase seat belt use. Attempts to convince people to use belts through education, exhortation, or persuasion have had little success Mackay, 1985, Robertson, 1977, Robertson et al., 1974. Most people, even nonusers, respond in surveys that they think belts are effective in reducing injury and that using belts is advisable. For example, in a national survey of drivers, the importance of using seat belts was endorsed by 94% of the respondents, and
Voluntary belt use before laws
Seat belt use was very low before laws were passed. In observational surveys conducted in the 1970s, belt use in major cities often was around 10% (Robertson, 1978a). In a survey of student drivers arriving at high schools in 1982, driver belt use was 5% or less at 4 out of 6 schools (Williams, Wells, & Lund, 1983). At one school near Baltimore, Maryland, only 1 out of 121 drivers was belted. The 19-city observational survey conducted in major cities around the country found belt use rates of
Initial effects of laws
Seat belt use laws produced substantial increases in belt use. This was to be expected. Most of the demonstrable gains toward changing behavior in ways that will reduce motor-vehicle-related injuries have come through federal and state laws and their application. When seat belt or motorcycle helmet use laws are introduced, or when the legal maximum speed limit is changed, the effect on the relevant behavior is immediate and dramatic. For example, on the day British Columbia's seat belt use law
Introduction of enforcement programs
In response to the disappointing use rates in Canada, provincial officials in the early 1980s launched enforcement programs that substantially increased belt use. These programs varied, but they all had several components in common—increased publicity about the importance of using seat belts, greatly increased law enforcement, and publicity aimed at heightened visibility and awareness of the enforcement Jonah et al., 1982, Jonah & Grant, 1985, Lamb, 1982, Manduca, 1983. Campaigns continued in
More of the same
After the first round of Click It or Ticket, belt use in North Carolina reached 80% but, somewhat surprisingly, did not reach much beyond that in the five years of special funding for the program. Belt use ranged from 80% to 84% after enforcement waves and generally was 82% to 83%, dropping back to the high 70% range during interim periods. The Canadian model involves waves of heightened, publicized enforcement, alternating with periods during which enforcement and publicity are at normal
Leadership by the police
As discussed earlier, the public generally supports belt use laws, but there has been little public pressure for enforcement. Politicians typically have been somewhat wary of stepped-up belt law enforcement campaigns, and police sometimes have been reluctant to ticket aggressively, thinking there may be public backlash. In fact, the Elmira program actually would have been the “Watertown, New York” program if Watertown officials had not been concerned about reactions to a ticketing campaign.
Maximizing publicity
Police agencies in North Carolina made an all-out effort to enforce the belt use law, but enforcement resources are finite so it is important to maximize and focus publicity about the enforcement. This creates an atmosphere in which drivers anticipate they are likely to be stopped and fined if not obeying the law, especially in primary enforcement states. The original North Carolina program employed both paid and earned media. Survey data gathered during 1993–1998 indicated that an impressive
Reaching the high-crash-risk holdouts
Once belt use reached 80% in North Carolina, efforts were made to determine what it would take to get the other 20% to buckle up. In one study, observed nonusers were telephoned and questioned about belt use. Compared with users, the characteristics of nonusers were typical—they were likely to be male, to be young, to drive older vehicles, to drive pick-up trucks, and to have poor driving records (Reinfurt, Williams, Wells, & Rodgman, 1996). Nearly half of those observed without their belts
Summary
Highly publicized enforcement programs have proven their worth as a technique for increasing seat belt use. This is the model that has worked in Canada, the United States, and other countries, with police agencies playing a central leadership role. Most of the United States still lags behind Canada in successful application of enforcement programs. What is needed in U.S. states to achieve belt use rates of 90% or greater is widespread, methodical, and sustained application of enforcement
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