Michigan Traffic Safety Michigan Traffic Safety ConferenceConference

A Review of Behavioral EffortsA Review of Behavioral EffortsTo Reduce Motor Vehicle FatalitiesTo Reduce Motor Vehicle Fatalities

James L. Nichols, Ph.D.James L. Nichols, Ph.D.Nichols and AssociatesNichols and Associates

Behavioral Countermeasures:Behavioral Countermeasures:Where Do We Fit?Where Do We Fit?

Pre-Pre-

CrashCrashCrashCrash Post-Post-

CrashCrash

DriverDriver Alcohol,Alcohol,

Safety Safety Belt Use,Belt Use,

Speed, Speed, etc.etc.

(Safety (Safety Belt Use)Belt Use)

(EMS)(EMS)

VehicleVehicle

RoadwayRoadway

What Problems are We Most What Problems are We Most Interested in?Interested in?

Alcohol-Impaired DrivingAlcohol-Impaired DrivingNon-Use of Restraint SystemsNon-Use of Restraint SystemsSpeedingSpeedingAggressive & Inattentive DrivingAggressive & Inattentive Driving

Pedestrian CrashesPedestrian CrashesBicyclist CrashesBicyclist CrashesMotorcyclist CrashesMotorcyclist Crashes

Relative Size of Various Relative Size of Various ProblemsProblems

(By Behavioral Categorization)(By Behavioral Categorization)

0

10

20

30

40

50

60

70

Alc SB Non-Use

Speed Drowsy Aggress

Perc

ent

of

Fata

liti

es

? ?

Relative Size of Fatality ProblemRelative Size of Fatality Problem(Vehicle Occupants and Non-Occupants)(Vehicle Occupants and Non-Occupants)

Source FARS, 2002Source FARS, 2002

0

5000

10000

15000

20000

25000

Num

ber

of

Death

s

?

Relative Size of Fatality ProblemRelative Size of Fatality Problem(By Age of Victim)(By Age of Victim)

0

2000

4000

6000

8000

10000

12000

0-15 16-24 25-34 35-44 45-54 55-64 65-74 >74

Num

ber

of

Death

s

?

Number of FatalitiesNumber of FatalitiesBy Year of Age (0-16)By Year of Age (0-16)Source: NHTSA/FARS, 2001Source: NHTSA/FARS, 2001

106 94 99 97 101 77 95 94 81 81 78 87 86 108183

298

822

0

200

400

600

800

1000

<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Year of Age

Nu

mb

er

of

Fa

talit

ies

Summary of the ProblemSummary of the Problem(as it relates to fatalities)(as it relates to fatalities)

Primarily Involves the 16-54 age groupPrimarily Involves the 16-54 age group16-24 is worst; major increases after age 1216-24 is worst; major increases after age 12

Mostly Occupants of Passenger VehiclesMostly Occupants of Passenger VehiclesCars and Light Trucks; MCs significantCars and Light Trucks; MCs significant

Largest Behavioral Issues are:Largest Behavioral Issues are:Alcohol, Safety Belts, SpeedAlcohol, Safety Belts, Speed

Emerging Issues Include: Emerging Issues Include: Drowsy, distracted, aggressive, elderly Drowsy, distracted, aggressive, elderly

drivingdriving

Trends in Michigan Trends in Michigan (and in 2 Benchmark States)(and in 2 Benchmark States)

Total FatalitiesTotal Fatalities

Long-TermLong-Term

Past Five YearsPast Five Years

Michigan Michigan (vs Illinois & Ohio)(vs Illinois & Ohio)

Number of Total FatalitiesNumber of Total Fatalities(1982-2002; FARS)(1982-2002; FARS)

1000

1100

1200

1300

1400

1500

1600

1700

1800

1900

IL

MI

OH

Michigan (vs. Illinois & Ohio)Michigan (vs. Illinois & Ohio)Number of Total FatalitiesNumber of Total Fatalities

(Past 5 Years; 1998-2002; FARS)(Past 5 Years; 1998-2002; FARS)

1200

1250

1300

1350

1400

1450

1500

'98 '99 '00 '01 '02

IL

MI

OH

AlcoholAlcohol

Michigan Michigan (vs. Illinois and Ohio)(vs. Illinois and Ohio)

Number of Alcohol-Related FatalitiesNumber of Alcohol-Related Fatalities(1982-2002; FARS)(1982-2002; FARS)

300

400

500

600

700

800

900

1000

1100

IL

MI

OH

Michigan Michigan (vs. Illinois and Ohio)(vs. Illinois and Ohio)

Number of Alcohol-Related FatalitiesNumber of Alcohol-Related FatalitiesPast Five Years (1998-2002); FARSPast Five Years (1998-2002); FARS

400

450

500

550

600

650

700

'98 '99 '00 '01 '02

IL

MI

OH

MichiganMichiganAlcohol-RelatedAlcohol-Related FatalitiesFatalities

Change in Various Indices Since 1998Change in Various Indices Since 1998

0.8

0.85

0.9

0.95

1

1.05

'98 '99 '00 '01 '02

Number Percent Rate

Non-Use of Seat BeltsNon-Use of Seat Belts

Michigan Michigan Observed Non-Use of Seat BeltsObserved Non-Use of Seat Belts

(from State-Reported Observed Data: NCSA, 2003)(from State-Reported Observed Data: NCSA, 2003)

34 33 30 30

14 18 17 16

0102030405060708090

100

'96 '97 '98 '99 '00 '01 '02 '03

Per

cen

t N

on

-Use

Observed Non-Use of Seat BeltsObserved Non-Use of Seat Beltsin all Region V Statesin all Region V States

(Source: Reported Results from State Surveys; NCSA, 2003)(Source: Reported Results from State Surveys; NCSA, 2003)

21 23 20 18 1624 25

30

0102030405060708090

100

U.S. R5(Ave)

IL IN MI MN OH WI

* Regional Average is unweighted

Reported Non-Use of Seat BeltsReported Non-Use of Seat BeltsAmong FatalitiesAmong Fatalities in Region V States in Region V States

(Source: FARS, (Source: FARS, 20022002; Passenger Vehicle Occupants); Passenger Vehicle Occupants)

59 5763

54

41

59 61 64

010

2030

405060

7080

90100

U.S. R5 IL IN MI MN OH WI

Motorcycle FatalitiesMotorcycle Fatalities

Michigan Michigan (vs. Illinois and Ohio)(vs. Illinois and Ohio)Change in Number of Change in Number of MotorcycleMotorcycle Fatalities Fatalities

(1997-2002; FARS)(1997-2002; FARS)

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

'97 '98 '99 '00 '01 '02

IL

MI

OH

Pedestrian FatalitiesPedestrian Fatalities

MichiganMichigan (vs. Illinois and Ohio)(vs. Illinois and Ohio)Number of Number of PedestrianPedestrian Fatalities Fatalities

(1997-2002; FARS)(1997-2002; FARS)

020406080

100120140160180200220

'97 '98 '99 '00 '01 '02

IL

MI

OH

Our Focus TodayOur Focus Today

Alcohol Impaired DrivingAlcohol Impaired Driving

Non-Use of Safety BeltsNon-Use of Safety Belts

Our OptionsOur Options

Alcohol Impaired Alcohol Impaired DrivingDriving PreventionPrevention InterventionIntervention Deterrence (Traffic Deterrence (Traffic

Law System)Law System) TreatmentTreatment

Safety Belt Non-Safety Belt Non-UseUse EducationEducation IncentivesIncentives Public InformationPublic Information Deterrence (Traffic Deterrence (Traffic

Law System)Law System)

Alcohol Impaired DrivingAlcohol Impaired Driving

Characteristics of the ProblemCharacteristics of the Problem

Implications for Implications for CountermeasuresCountermeasures

Number of Drinking Drivers in Fatal CrashesNumber of Drinking Drivers in Fatal Crashesby Age Groupby Age Group

(FARS, 1999)(FARS, 1999)

0

1000

2000

3000

4000

5000

6000

<21 21-34 35-54 55+

Occupants and Non-Occupants Occupants and Non-Occupants as Victims of A/R Crashesas Victims of A/R Crashes

1999 FARS1999 FARS

62%23%

15%

Drivers Passengers Pedestrians

Number of Prior Offenses RecordedNumber of Prior Offenses Recordedof Drivers in Fatal Crashesof Drivers in Fatal CrashesModerate Estimate: Based on 1985 MN DataModerate Estimate: Based on 1985 MN Data

75%

25%

None One or More

BAC Level of BAC Level of Alcohol Positive Drivers in A/R CrashesAlcohol Positive Drivers in A/R Crashes

23%

77%

Low-to Moderate BAC (.01-.09) High BAC (>= .10)

Restraint UseRestraint UseAmong A/R Crash VictimsAmong A/R Crash Victims

(FARS)(FARS)

20%

80%

Restrained Unrestrained

EstimatedEstimated % of DWI’s Caught % of DWI’s Caught(One Year Period)(One Year Period)

Uncaught 1st Time Repeat Offender

Implications forImplications forCountermeasuresCountermeasures

GeneralGeneral versus versus SpecificSpecific EffectsEffects

Significant Risk FactorsSignificant Risk Factors in Alcohol-Related Fatal Crashes in Alcohol-Related Fatal Crashes Alcohol Consumption Among YouthAlcohol Consumption Among Youth Problem Drinking/Binge Drinking/BeerProblem Drinking/Binge Drinking/Beer Males Males Age (16-34)Age (16-34) Most Victims are in the DWI’s VehicleMost Victims are in the DWI’s Vehicle Most DWIs have no Prior A/R Arrest Most DWIs have no Prior A/R Arrest Late Night/Early Morning/Weekend Late Night/Early Morning/Weekend

ProblemProblem Low Seat Belt Use (as low as 15-20%)Low Seat Belt Use (as low as 15-20%)

Alcohol Impaired DrivingAlcohol Impaired DrivingCountermeasuresCountermeasures

What the Research SaysWhat the Research Says

Major ApproachesMajor Approaches

PreventionPrevention InterventionInterventionDeterrenceDeterrenceRehabilitationRehabilitationTechnologyTechnology

PreventionPrevention

Mass Media*Mass Media*Alcohol EducationAlcohol EducationAlcohol Policy*Alcohol Policy*

Mass Media:Mass Media: An Essential Component of Any ProgramAn Essential Component of Any Program

LegislationLegislationrequires public awarenessrequires public awareness

EnforcementEnforcementrequires public awarenessrequires public awareness

SanctionsSanctionsrequire public awarenessrequire public awareness

IncentivesIncentivesrequire public awarenessrequire public awareness

Mass MediaMass Media

Much potential for general impactMuch potential for general impact Weak to moderate number of studiesWeak to moderate number of studiesRecent CDC review suggests 13% effectRecent CDC review suggests 13% effectContributes to impact of other Contributes to impact of other

programsprogramsAgenda setting potentialAgenda setting potentialPublic Service vs. “Earned” vs. PaidPublic Service vs. “Earned” vs. Paid

Mass Media*Mass Media*

Brief, intense campaigns (most Brief, intense campaigns (most effective?)effective?)

Multi-year, planned effortsMulti-year, planned effortsHigh saturation, paid media, televisionHigh saturation, paid media, televisionTargeted messaging?Targeted messaging?Support for other, more effective, Support for other, more effective,

measures appears to be most effectivemeasures appears to be most effective

Alcohol EducationAlcohol Education

Major obstacles to population-wide impactMajor obstacles to population-wide impact Education, normative, peer, resistance Education, normative, peer, resistance Evidence of Evidence of self-reportedself-reported impact on impact on

DD/RDD in classroom and on campusDD/RDD in classroom and on campusNo evidence of crash reduction impactNo evidence of crash reduction impactOne of the best studies here in MichiganOne of the best studies here in Michigan

Alcohol Policy*Alcohol Policy*

Alcohol Advertising and MarketingAlcohol Advertising and Marketing

Alcohol AvailabilityAlcohol Availability

Physical, Economic, Social, SubjectivePhysical, Economic, Social, Subjective Minimum Drinking Age Laws* Minimum Drinking Age Laws*

Alcohol Policy*Alcohol Policy*

Strong Strong potentialpotential for population-wide effect for population-wide effect Some programs have shown impact (MDA)Some programs have shown impact (MDA)Consistent Findings that advertising and Consistent Findings that advertising and

availability can affect consumption, but ..availability can affect consumption, but ..Little evidence of impact to date (likely Little evidence of impact to date (likely

due to less than full implementation)due to less than full implementation)

InterventionInterventionRide ServiceRide ServiceDesignated DriversDesignated Drivers

Server TrainingServer TrainingServer LiabilityServer Liability

Enforcing ABC LawsEnforcing ABC Laws

Ride ServiceRide Service

Weak research baseWeak research baseOne example of community-wide impactOne example of community-wide impact

Capable of creating general Capable of creating general deterrence?deterrence?

Important part of a comprehensive Important part of a comprehensive community programcommunity program

Media likely essential for impactMedia likely essential for impact

Designated DriverDesignated Driver

Very weak research base; CDC reviewVery weak research base; CDC review Not likely to create general effect; Not likely to create general effect;

more likely to be a response to more likely to be a response to deterrencedeterrenceMajor obstacle: lack of use by high risk Major obstacle: lack of use by high risk Some concern about increased drinkingSome concern about increased drinking

Another component of a comprehensive Another component of a comprehensive community programcommunity program

Media likely essential for impactMedia likely essential for impact

Responsible Beverage Service Responsible Beverage Service (RBS)*(RBS)*

Three Elements of RBSThree Elements of RBSServer TrainingServer TrainingManagement PolicyManagement PolicyABC EnforcementABC Enforcement

Server Liability may be an essential Server Liability may be an essential factor factor (i.e. RBS likely to be a response to (i.e. RBS likely to be a response to deterrence)deterrence)

Responsible Beverage ServiceResponsible Beverage ServiceServer Training Component*Server Training Component*

Moderate research baseModerate research base Potential for population-wide impactPotential for population-wide impact

Major obstacle management disinterestMajor obstacle management disinterestRelatively consistent findings of server Relatively consistent findings of server

changechangeNeed “carrot and stick” incentivesNeed “carrot and stick” incentives

Server LiabilityServer LiabilityABC EnforcementABC Enforcement

Responsible Beverage ServiceResponsible Beverage ServiceManagement Policy Component*Management Policy Component*

Weak research baseWeak research base Potential for population-wide impactPotential for population-wide impact

Major obstacle management disinterestMajor obstacle management disinterest Need more research on policies (e.g. happy Need more research on policies (e.g. happy

hours, cut off of serving at specified times, hours, cut off of serving at specified times, etc.)etc.)

Need “carrot and stick” incentivesNeed “carrot and stick” incentives Server LiabilityServer Liability ABC EnforcementABC Enforcement

Responsible Beverage ServiceResponsible Beverage ServiceABC Enforcement Component*ABC Enforcement Component*

Weak research baseWeak research base Potential for population-wide impactPotential for population-wide impact

Major obstacle is lack of resourcesMajor obstacle is lack of resourcesSome evidence of ImpactSome evidence of Impact

Stings or Decoy ProgramsStings or Decoy ProgramsCops in ShopsCops in Shops

Server Liability*Server Liability*Dram Shop Laws/Model LawDram Shop Laws/Model Law

Weak research baseWeak research base

Strong Potential for general impactStrong Potential for general impact

Some evidence of Impact (e.g. Texas)Some evidence of Impact (e.g. Texas)

Incentives for Responsible Alcohol Incentives for Responsible Alcohol ServiceService

DeterrenceDeterrence(Traffic Law System)(Traffic Law System)

LegislationLegislationEnforcementEnforcementSanctionsSanctions

FinesFinesLicenseLicenseVehicleVehicleJailJailInterlocksInterlocks

Laws That Have Shown ImpactLaws That Have Shown Impact

Illegal Per SeIllegal Per Se Administrative License Revocation Administrative License Revocation

(ALR)(ALR)Minimum Drinking Age (MDA)Minimum Drinking Age (MDA).08 Illegal Per Se.08 Illegal Per SeZero Tolerance for YouthZero Tolerance for YouthVehicle SanctionsVehicle SanctionsPrimary Seat Belt Laws (Michigan)Primary Seat Belt Laws (Michigan)

Enforcement*Enforcement*

Strong research base; consistentStrong research base; consistentCheckpoints are most effective (-20%)Checkpoints are most effective (-20%)

Obstacles among officers and managementObstacles among officers and managementSaturation patrols and regular patrols Saturation patrols and regular patrols

are also effectiveare also effective Intensive media is an essential Intensive media is an essential

componentcomponentMajor obstacle: competing prioritiesMajor obstacle: competing priorities

License Sanctions*License Sanctions*

Strong research base; very consistentStrong research base; very consistentGeneral and Specific EffectGeneral and Specific Effect

Most effective of any sanction/in spite of DWSMost effective of any sanction/in spite of DWSDWS erodes general deterrence impact DWS erodes general deterrence impact

although specific deterrence remains highalthough specific deterrence remains high Intensive media is an essential componentIntensive media is an essential componentAdministrative application has shown most Administrative application has shown most

effecteffect

Vehicle Sanctions*Vehicle Sanctions*for repeat DWI or Driving While Suspended (DWS)for repeat DWI or Driving While Suspended (DWS)

Moderate research base; consistent resultsModerate research base; consistent resultsStrong specific effect; potential for generalStrong specific effect; potential for general

Works better for repeat offenders than 1Works better for repeat offenders than 1stst off. off.Can be used to counter DWS and to deal Can be used to counter DWS and to deal

with repeat offenderswith repeat offendersIntensive media is an essential componentIntensive media is an essential component

Administrative application is neededAdministrative application is needed

JailJail

Moderate research base; inconsistent Moderate research base; inconsistent resultsresults

Possible specific effect for 1Possible specific effect for 1stst offenders offendersSome studies show detrimental effectSome studies show detrimental effect

Much potential for general effect Much potential for general effect Generally used for leverage/ last resortGenerally used for leverage/ last resortMay work best in special facilities May work best in special facilities

w/treat.w/treat.CostlyCostly

Alcohol Safety InterlocksAlcohol Safety Interlocks

Moderate research base; consistent resultsModerate research base; consistent results Strong specific effect (as much as -65%)Strong specific effect (as much as -65%)

Effect appears limited to period of useEffect appears limited to period of use No demonstrated potential for No demonstrated potential for generalgeneral

impactimpact May counter DWS; often used to deal with May counter DWS; often used to deal with

repeat offendersrepeat offenders CanCan work well with treatment work well with treatment

Alternatives to Jail*Alternatives to Jail*(e.g., In-home detention, Intense Probation, (e.g., In-home detention, Intense Probation,

Custom Sentencing)Custom Sentencing)

Weak research base; but consistent resultsWeak research base; but consistent results Specific effect most likely to be Specific effect most likely to be

demonstrateddemonstrated Potential for general effect (but universal Potential for general effect (but universal

application is unlikely via courts) application is unlikely via courts) Generally leveraged by threat of jailGenerally leveraged by threat of jail Many approaches complement treatmentMany approaches complement treatment Potential for affecting hard core, repeat Potential for affecting hard core, repeat

offenderoffender

Education and Education and TreatmentTreatment

Strong research base; relatively consistent Strong research base; relatively consistent resultsresults

Some Some specificspecific effect demonstrated (8-9%) effect demonstrated (8-9%) Less potential for general effect (but should be Less potential for general effect (but should be

part of a comprehensive, balanced program) part of a comprehensive, balanced program) Often used in lieu of jail; should not be used in Often used in lieu of jail; should not be used in

lieu of license sanction (add to license effect)lieu of license sanction (add to license effect) Perhaps most appropriate for hard core, repeat Perhaps most appropriate for hard core, repeat

offender, but major behavior change unlikely.offender, but major behavior change unlikely.

What Has Worked Worldwide?What Has Worked Worldwide?Transportation Research Board (TRB) Transportation Research Board (TRB)

ReviewReviewPrograms of the 1980’sPrograms of the 1980’s

ActivismActivismLegislationLegislationEnforcementEnforcementSanctionsSanctionsPublic InformationPublic Information

Result Has Been A Change in the Norm!Result Has Been A Change in the Norm! (Programs of the 1990’s Remain Less Clear)(Programs of the 1990’s Remain Less Clear)

Results of CDC Systematic Results of CDC Systematic ReviewReview

..08 BAC Laws – (7% effect)08 BAC Laws – (7% effect)Zero Tolerance Laws – (17% effect)Zero Tolerance Laws – (17% effect)MLDA Laws – 16% effectMLDA Laws – 16% effect Checkpoints – (18 to 21% effect)Checkpoints – (18 to 21% effect)Server Training Programs – some impact?Server Training Programs – some impact?Mass Media Programs – (13% effect)?Mass Media Programs – (13% effect)?Designated Driver – Insufficient Evidence?Designated Driver – Insufficient Evidence?School-Based Education – effect on RDD?School-Based Education – effect on RDD?

Deterrence:Deterrence:Does It Work Only for the Does It Work Only for the Least Severe Offenders?Least Severe Offenders?

There is Evidence to the There is Evidence to the ContraryContrary

Youth A/R FatalitiesYouth A/R Fatalities1989-19991989-1999

0

500

1000

1500

2000

2500

3000

3500

4000

89 90 91 92 93 94 95 96 97 98 99

High BAC FatalitiesHigh BAC Fatalities1989-19991989-1999

02000400060008000

100001200014000160001800020000

89 90 91 92 93 94 95 96 97 98 99

Where Are We Now?Where Are We Now?

Progress Has Clearly Leveled OffProgress Has Clearly Leveled OffAwareness and Concern Has DeclinedAwareness and Concern Has DeclinedEnforcement Has Declined SignificantlyEnforcement Has Declined SignificantlyYouth Laws Not Being EnforcedYouth Laws Not Being EnforcedMany Laws Being ErodedMany Laws Being ErodedSeat Belt Use Among A/R Drivers LowSeat Belt Use Among A/R Drivers LowOther Priorities Other Priorities (not much has changed in several years)(not much has changed in several years)

Problems With the SystemProblems With the SystemHedlund and McCartt (2001)Hedlund and McCartt (2001)

Failure to detect, arrest, convict, sanction, Failure to detect, arrest, convict, sanction, monitormonitor

DWI laws are complicated; inconsistenciesDWI laws are complicated; inconsistencies Arrest rates have been decliningArrest rates have been declining Arrest procedures time-consuming/complicatedArrest procedures time-consuming/complicated Plea bargains and diversionsPlea bargains and diversions Sanctions not applied (swiftly or certainly)Sanctions not applied (swiftly or certainly) Do not identify repeat offendersDo not identify repeat offenders Do not monitor offenders in the systemDo not monitor offenders in the system Poor data and records systemsPoor data and records systems Inadequate resourcesInadequate resources

What Will Likely Work in the Future?What Will Likely Work in the Future?

Enforcing DUI Laws Enforcing DUI Laws Enforcing MDA and ZT laws for YouthEnforcing MDA and ZT laws for Youth Alcohol Control and Serving PoliciesAlcohol Control and Serving Policies Graduated Sanctioning SystemsGraduated Sanctioning Systems Graduated Licensing and Vehicle SanctionsGraduated Licensing and Vehicle Sanctions Primary Seat Belt LawsPrimary Seat Belt Laws Technology?Technology? Fixing the Traffic Law System Components*Fixing the Traffic Law System Components*

Increasing Safety Belt Increasing Safety Belt UseUse

What the Research SaysWhat the Research Says

Increasing Safety Belt Use:Increasing Safety Belt Use:Approaches UsedApproaches Used

EducationEducation IncentivesIncentivesMass Media/Public InformationMass Media/Public InformationLegislationLegislationEnforcementEnforcementPenaltiesPenalties

Education ProgramsEducation Programs

Very little evidence of impact to dateVery little evidence of impact to date Early programs increased usage by very Early programs increased usage by very

small amounts; little evidence of small amounts; little evidence of sustained impact sustained impact

No evidence of impact on usage among No evidence of impact on usage among crash victimscrash victims

Even if impact were documented, it Even if impact were documented, it would likely only affect those persons would likely only affect those persons exposedexposed

Elementary School Education ProgramElementary School Education Program(Ages 6-11) Loudon County, VA(Ages 6-11) Loudon County, VA

(Senk and Schwartz, 1972)(Senk and Schwartz, 1972)

68

1010

6 5

0

5

10

15

20

25

30

Base Educ Followeffect size = 2 pct pts; follow-up = 4 pct pts

ob

se

rve

d U

se Education

Control

Evaluation of “Beltman” Education ProgramEvaluation of “Beltman” Education Programin Missouri (target group = 500)in Missouri (target group = 500)

(Missouri Office of Highway Safety, 1981)(Missouri Office of Highway Safety, 1981)

18

46

0

10

20

30

40

50

60

70

Base Educ

percent reporting belt use "all or most of the time"

se

lf-r

ep

ort

ed

se

at

be

lt u

se

Incentive ProgramsIncentive Programs

Some evidence of impact at low use ratesSome evidence of impact at low use rates Early programs increased usage by Early programs increased usage by

modest amounts but there is little modest amounts but there is little evidence that such impact remained over evidence that such impact remained over time time

No evidence of impact on usage among No evidence of impact on usage among crash victimscrash victims

Somewhat broader impact potential than Somewhat broader impact potential than education programseducation programs

Corporate Education/Incentive Program:Corporate Education/Incentive Program:BCBS, Chapel Hill, NCBCBS, Chapel Hill, NC

(Campbell et al., 1982)(Campbell et al., 1982)

8

28

56

25

35

28

0

10

20

30

40

50

60

70

Base Educ Incent. Follow Incent Follow

ob

serv

ed U

se

Incentive/Education/Policy Program:Incentive/Education/Policy Program:U.S.D.O.T. Headquarters, Washington, DCU.S.D.O.T. Headquarters, Washington, DC

23

47

60 59

0102030405060708090

100

Pre Aware Inc Post 1mo

SBU policy (not enforced)

ob

se

rve

d U

se

Mass MediaMass Media

Potential for population-wide impactPotential for population-wide impact Little evidence of impact (when use Little evidence of impact (when use

alone) even at very low usage ratesalone) even at very low usage ratesRecent consistent evidence of impact Recent consistent evidence of impact

in conjunction with enforcement effortsin conjunction with enforcement efforts““Click it or Ticket” programsClick it or Ticket” programsPaid media efforts have been shown to Paid media efforts have been shown to

result in major increases in awarenessresult in major increases in awareness

How Effective is Mass Media By Itself?How Effective is Mass Media By Itself?

Perhaps the most frequently implemented Perhaps the most frequently implemented countermeasure since the 1960’scountermeasure since the 1960’s

Not nearly as much documented research as Not nearly as much documented research as for legislation and enforcementfor legislation and enforcement

Much of the available research was Much of the available research was conducted when usage rates were very low conducted when usage rates were very low (which is also when programs are likely to be (which is also when programs are likely to be most effective)most effective)

BUT …there is some evidence of potentialBUT …there is some evidence of potential

Effect of Public Information Effect of Public Information Campaign in Oakland Co. MichiganCampaign in Oakland Co. Michigan(Oakland Co.Traffic Improvement Assoc.,1969)(Oakland Co.Traffic Improvement Assoc.,1969)

17.5 20.8

0

10

20

30

40

50

60

70

Drivers

Effect size = 3 pct pts (drivers)

PrePost

Effect of Public Information Effect of Public Information CampaignCampaign

in Southeast Michigan in Southeast Michigan(Motorists Information Inc., 1978)(Motorists Information Inc., 1978)

12.416.8

0

5

10

15

20

25

30

35

40

45

50

Effect size = 4.4 pct. pts.

Ob

serv

ed U

sag

e

Pre

Post

Study of High vs. Low Use CommunitiesStudy of High vs. Low Use CommunitiesThree Activities Associated with High UseThree Activities Associated with High Use

(Burkhart et al., 1987)(Burkhart et al., 1987)

Tailored Media Tailored Media

Greater Market PenetrationGreater Market Penetration

Higher Enforcement LevelsHigher Enforcement Levels

Conclusions Regarding Effect of Conclusions Regarding Effect of U.S. Mass Media Programs U.S. Mass Media Programs to increase Seat Belt Use to increase Seat Belt Use

All studies were conducted in pre-law situations All studies were conducted in pre-law situations when baseline use rates were very lowwhen baseline use rates were very low

Although some media programs were of high Although some media programs were of high quality, the studies were of moderate quality.quality, the studies were of moderate quality.

Very little evidence of impact; greatest Very little evidence of impact; greatest evidence comes from MII study which showed a evidence comes from MII study which showed a 4.4 pct. pt increase from a 12% baseline rate.4.4 pct. pt increase from a 12% baseline rate.

This result is not all that different from foreignThis result is not all that different from foreign

Summary of Research on Effectiveness of Summary of Research on Effectiveness of Mass Media to Increase Seat Belt UseMass Media to Increase Seat Belt Use

Foreign (multi-year) studies showed 10-20 point Foreign (multi-year) studies showed 10-20 point increases from low baselines (average of 4-5 pts increases from low baselines (average of 4-5 pts per campaign)per campaign)

U.S. studies also found 4-5 percentage point gains U.S. studies also found 4-5 percentage point gains from similar pre-law, low use baselinesfrom similar pre-law, low use baselines

Community programs show some impactCommunity programs show some impact

High vs. Low Use CommunitiesHigh vs. Low Use Communities

““Model” CommunitiesModel” Communities

CDC review of mass media programs to reduce CDC review of mass media programs to reduce impaired-driving suggest impact of mass media impaired-driving suggest impact of mass media in the context of other prevention efforts (Elder in the context of other prevention efforts (Elder et al., in process)et al., in process)..

Mass Media:Mass Media: An Essential Component of Any ProgramAn Essential Component of Any Program

LegislationLegislationrequires public awarenessrequires public awareness

EnforcementEnforcementrequires public awarenessrequires public awareness

SanctionsSanctionsrequire public awarenessrequire public awareness

IncentivesIncentivesrequire public awarenessrequire public awareness

Legislation/PenaltiesLegislation/Penalties

Safety Belt Laws Have Been EffectiveSafety Belt Laws Have Been EffectiveIncreased U.S. Use from <15% to nearly Increased U.S. Use from <15% to nearly

50%50%Primary Laws Have Been Most EffectivePrimary Laws Have Been Most Effective

Generally Result in 10-15 point increaseGenerally Result in 10-15 point increaseFines Make a DifferenceFines Make a Difference

Much Weaker Research BaseMuch Weaker Research BasePoints Would Likely Make a DifferencePoints Would Likely Make a Difference

Still Less Weaker Research BaseStill Less Weaker Research Base

Average Changes in Usage Among 25 Average Changes in Usage Among 25 Initial States Enacting Safety Belt LawsInitial States Enacting Safety Belt Laws

(Campbell et al. 1987)(Campbell et al. 1987)

17

4844

0

10

20

30

40

50

60

70

Pre-Law Post-Law 1-Yr Later

Ob

se

rve

d U

se

Average Changes in Usage Among 25 Average Changes in Usage Among 25 Initial States Enacting Safety Belt LawsInitial States Enacting Safety Belt Laws

Primary vs. Secondary LawsPrimary vs. Secondary Laws(Campbell et al. 1987)(Campbell et al. 1987)

17

44 42

21

6458

0

10

20

30

40

50

60

70

Pre-Law Post-Law 1-Yr Later

Ob

se

rve

d U

se

SecondaryPrimary

Changes in U.S. Usage Rate EstimatesChanges in U.S. Usage Rate Estimatesas States Enacted Safety Belt Lawsas States Enacted Safety Belt Laws

14 1421

3742

45 4649

5962

0 1

10

23

31 31 3337

41 42

0

10

20

30

40

50

60

70

'83 '84 '85 '86 '87 '88 '89 '90 '91 '92 *

Ob

se

rve

d U

se

Usage

Number of Laws

Primary Laws Have Primary Laws Have Clearly Been Most Clearly Been Most

EffectiveEffective

Changes in Usage In Changes in Usage In MarylandMarylandAfter Upgrading to a Primary LawAfter Upgrading to a Primary Law

6358

66

81 7882

20

30

40

50

60

70

80

90

100

'95 '96 '97 Primary '99 '00

Ob

se

rve

d U

se

Changes in Usage In Changes in Usage In MichiganMichiganAfter Upgrading to a Primary LawAfter Upgrading to a Primary Law

70 70 70

83 82

30

40

50

60

70

80

90

100

'97 '98 '99 Primary '01

Ob

se

rve

d U

se

CA +18

DC +16

MD +12

NJ +11

GA +4

AL +13

IN +9

MI +14

LA +16

OK +8

Pre/Post Difference in Safety Belt Use RatesStates Upgrading from Secondary to Primary Laws

Median Point Change = 12

Source: NHTSA published research reports on state changes to a primary enforcement law

Summary of Effect of LawsSummary of Effect of Laws

Initial Seat Belt Laws Gained Average of 30 Initial Seat Belt Laws Gained Average of 30 ptspts

Primary Law upgrades have gained an Primary Law upgrades have gained an average of 12-14 points (over pre-existing 2average of 12-14 points (over pre-existing 2ndnd law levels)law levels)

Although some decay results without follow-Although some decay results without follow-up, all states have continued to show up, all states have continued to show increases with continued enforcementincreases with continued enforcement

Intensive media is an essential component of Intensive media is an essential component of both the law and enforcement interventionsboth the law and enforcement interventions

Enforcement*Enforcement*

As with DWI, there is strong consistent As with DWI, there is strong consistent evidence of impactevidence of impact

CheckpointsCheckpoints have been most effective; as have been most effective; as have highly visible “waves” of enforcementhave highly visible “waves” of enforcement

Saturation patrols and regular patrols can Saturation patrols and regular patrols can also be effectivealso be effective

Intensive media is an essential componentIntensive media is an essential component Major obstacle in competing prioritiesMajor obstacle in competing priorities Enforcement ZonesEnforcement Zones are providing new are providing new

energy **energy **

Effect of Click It or Ticket Program Effect of Click It or Ticket Program in in North CarolinaNorth Carolina in 1993 in 1993

(Observed Driver Seat Belt Use)(Observed Driver Seat Belt Use)

64

8073

81

30

40

50

60

70

80

90

100

Pre- CIOT 6-mo CIOT

Ob

se

rve

d U

se

Effect of Click It or Ticket Program Effect of Click It or Ticket Program in in South CarolinaSouth Carolina in 2000 in 2000

(Observed Driver Seat Belt Use)(Observed Driver Seat Belt Use)

65 6572

79

30

40

50

60

70

80

90

100

Pre- Earned Media Paid Media Enforcement

Ob

se

rve

d U

se

Effect of Click It or Ticket Program Effect of Click It or Ticket Program in in 8 Southeastern States8 Southeastern States in 2001 in 2001

(Observed Driver Seat Belt Use)(Observed Driver Seat Belt Use)

65 67 6774

30

40

50

60

70

80

90

100

Pre- Earned Media Paid Media Enforcement

Ob

se

rve

d U

se

Effect of Click It or Ticket Program Effect of Click It or Ticket Program in in 12 States Across the U.S.12 States Across the U.S. in 2002 in 2002

(Observed Driver Seat Belt Use)(Observed Driver Seat Belt Use)

69

77

30

40

50

60

70

80

90

100

Pre- Post

Ob

se

rve

d U

se

SummarySummaryImpact of (Highly Visible) Enforcement Impact of (Highly Visible) Enforcement

EffortsEfforts

Capable of immediate gains in safety belt useCapable of immediate gains in safety belt use Require intense media efforts Require intense media efforts Enhance impact of laws (secondary and Enhance impact of laws (secondary and

primary)primary) Must be periodically repeated (ratchet effect).Must be periodically repeated (ratchet effect). Responsible for recent gains in U.S. (and in Responsible for recent gains in U.S. (and in

Mich.)Mich.) Typical gains are 8-16 percentage pointsTypical gains are 8-16 percentage points Require “full implementation” to be effectiveRequire “full implementation” to be effective

Safety Belt Use and Safety Belt Use and Alcohol-Impaired DrivingAlcohol-Impaired Driving

Can they be Linked?Can they be Linked?

Should they be Linked?Should they be Linked?

Restraint Use Among A/R Crash VictimsRestraint Use Among A/R Crash Victims4 out of 5 Victims are Unbuckled4 out of 5 Victims are Unbuckled

20%

80%

Restrained Unrestrained

Seat Belt Use Among Fatalities:Seat Belt Use Among Fatalities:Time of DayTime of Day

McCartt et al., 2002McCartt et al., 2002

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

6am-midnight Midnight to 6am

Od

ds

Rat

io

Seat Belt Use Among Fatalities:Seat Belt Use Among Fatalities:by Driver Genderby Driver Gender

McCartt et al., 2002McCartt et al., 2002

00.20.40.60.8

11.21.41.61.8

2

Female Male

Od

ds

Rat

io

Seat Belt Use Rates in a Region V Seat Belt Use Rates in a Region V State:State:

A Comparison of Various GroupsA Comparison of Various Groups

65

38

2117

0

10

20

30

40

50

60

70

80

Observed Fatals Fatal 16-20 A/R Ftl Drvrs

SummarySummary

Most important need is to create new Most important need is to create new energy and focus on these issues.energy and focus on these issues.

Many combinations of efforts are likely Many combinations of efforts are likely to work, given sufficient effortto work, given sufficient effort

Enforcement is an essential componentEnforcement is an essential componentSwift and certain sanctions are effective Swift and certain sanctions are effective

(especially with impaired driving)(especially with impaired driving)Media will be key to future success.Media will be key to future success.

Summary (continued)Summary (continued)

Impaired driving efforts may wish to Impaired driving efforts may wish to start with the seat belt model and start with the seat belt model and expandexpand

Make Use of Special Tools for YouthMake Use of Special Tools for YouthProgressive Sanctions for Repeat Progressive Sanctions for Repeat

Offenders (particularly impaired drivers)Offenders (particularly impaired drivers) Integrate DUI and Seat Belt Efforts?Integrate DUI and Seat Belt Efforts?New enforcement approaches for safety New enforcement approaches for safety

belts may help impaired driving as well.belts may help impaired driving as well.

EndEnd

Appendix AAppendix A

A Summary of Potential for A Summary of Potential for Alcohol-Impaired Driving Alcohol-Impaired Driving

CountermeasuresCountermeasures

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding PreventionPrevention Efforts Efforts

Research Research StrengthStrength

Specific Specific Effect?Effect?

General General Effect?Effect?

Mass Mass MediaMedia

WeakWeak Yes?Yes? Yes?Yes?

Alcohol Alcohol EducatioEducationn

DidacticDidactic ModerateModerate K&AK&A Not likelyNot likely

NormativNormativee

ModerateModerate K&A (B)K&A (B) Not Not likely?likely?

Alcohol Alcohol PolicyPolicy

Weak to Weak to strongstrong

YesYes YesYes

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding InterventionIntervention Efforts Efforts

Ride Ride ServiceService

WeakWeak YesYes Not clearNot clear

Designated Designated DriverDriver

WeakWeak YesYes

(users)(users)No No evidenceevidence

Server Server Training*Training*

ModeratModeratee

To WeakTo Weak

YesYes

(server)(server)LikelyLikely

(1 study)(1 study)

Server Server Liability*Liability*

WeakWeak Yes Yes

(seller)(seller)LikelyLikely

(1 study)(1 study)

Enforce Enforce ABCABC

WeakWeak YesYes LikelyLikely

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding Traffic Law System/LegislationTraffic Law System/Legislation

EffortsEfforts

LegislatioLegislationn

Research Research StrengthStrength

Specific Specific Effect?Effect?

General General Effect?Effect?

MDA-21MDA-21 StrongStrong YesYes YesYes

Zero BACZero BAC ModerateModerate LikelyLikely LikelyLikely

ALR &ALR &

MandatorMandatoryy

StrongStrong YesYes YesYes

VehicleVehicle ModerateModerate YesYes LikelyLikely

.08 BAC.08 BAC ModerateModerate YesYes YesYes

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding Traffic Law System/LegislationTraffic Law System/Legislation

Efforts Efforts (continued)(continued)

LegislatioLegislationn

Research Research StrengthStrength

Specific Specific Effect?Effect?

General General Effect?Effect?

Per SePer Se moderatemoderate probablyprobably YesYes

Implied Implied Consent*Consent*

weakweak LikelyLikely LikelyLikely

JailJail mixedmixed possiblypossibly possiblypossibly

AlternativAlternativeto Jail*eto Jail*

weakweak YesYes LikelyLikely

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding Traffic Law System/EnforcementTraffic Law System/Enforcement

EffortsEffortsEnforcemeEnforcementnt

Research Research StrengthStrength

Specific Specific Effect?Effect?

General General Effect?Effect?

CheckpointCheckpoints*s*

StrongStrong YesYes YesYes

SaturationSaturation

Patrols*Patrols*ModerateModerate YesYes YesYes

Fix System Fix System Problems*Problems*

EmpiricalEmpirical

datadataLikelyLikely VeryVery

LikelyLikely

Publicize*Publicize* ConsisteConsistentnt

LikelyLikely LikelyLikely

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding Traffic Law System/SanctionTraffic Law System/Sanction

EffortsEfforts

Research Research StrengthStrength

Specific Specific Effect?Effect?

General General Effect?Effect?

LicenseLicense StrongStrong YesYes YesYes

VehicleVehicle ModerateModerate YesYes LikelyLikely

InterlocksInterlocks StrongStrong YesYes UnknownUnknown

JailJail MixedMixed PossiblyPossibly PossiblyPossibly

AlternativeAlternativess

Weak to Weak to ModerateModerate

YesYes LikelyLikely

(w/(w/media)media)

Summary of Research EvidenceSummary of Research EvidenceRegarding Regarding Treatment/RehabilitationTreatment/Rehabilitation

EffortsEfforts

ResearcResearch h StrengthStrength

Specific Specific Effect?Effect?

General General Effect?Effect?

AssessmentAssessment ModeratModeratee

Not Not clearclear

Not likelyNot likely

EducationEducation ModeratModerate to e to StrongStrong

ModestModest

(K&A)(K&A)Not likelyNot likely

TreatmentTreatment ModeratModerate to e to StrongStrong

ModestModest Not likelyNot likely

Brief Brief InterventionIntervention

WeakWeak Unk.Unk. Not likelyNot likely

Appendix BAppendix B

A Summary of Priority Target A Summary of Priority Target Groups for Alcohol-Impaired Groups for Alcohol-Impaired

DrivingDriving

Priority Target PopulationsPriority Target Populations

Under 21Under 21

21-3421-34

Repeat OffendersRepeat Offenders

Under Age 21Under Age 21

Inexperience in Drinking and DrivingInexperience in Drinking and DrivingAffected More By Lower BACsAffected More By Lower BACsMore Tools Available (e.g., MDA, ZT)More Tools Available (e.g., MDA, ZT)Tools Not Being UsedTools Not Being Used Difficulties in Arrest and Charging Difficulties in Arrest and Charging

ProcessProcess

Under Age 21Under Age 21Potential SolutionsPotential Solutions

MDA and Zero Tolerance Laws MDA and Zero Tolerance Laws (work out problems in process) (work out problems in process)

Alcohol Sales and Serving Alcohol Sales and Serving Laws/PracticesLaws/Practices

Seat Belt UseSeat Belt UseGraduated Driver LicensingGraduated Driver Licensing

21-34 Age Group21-34 Age Group

Legal to Use AlcoholLegal to Use Alcohol

Most DriveMost Drive

Account for about ½ of all A/R Account for about ½ of all A/R FatalitiesFatalities

Have Not “Matured Out”Have Not “Matured Out”

21-34 Age Group21-34 Age GroupPotential SolutionsPotential Solutions

General DeterrenceGeneral Deterrence

Special/Strategic Messaging?Special/Strategic Messaging?

Responsible Alcohol Service?Responsible Alcohol Service?

Alternative Transportation?Alternative Transportation?

Repeat OffendersRepeat Offenders

High Risk IndividualsHigh Risk Individuals1/3 of DWI Arrests1/3 of DWI Arrests Involved in 10-25% of A/R Fatal Involved in 10-25% of A/R Fatal

CrashesCrashesMost Never IdentifiedMost Never IdentifiedNeed Special Emphasis Need Special Emphasis

(Sanctions/Treatment(Sanctions/Treatment))

Repeat OffendersRepeat OffendersPotential SolutionsPotential Solutions

Special Enforcement EffortsSpecial Enforcement Efforts Interlocks?Interlocks?Vehicle Sanctions (administrative?)Vehicle Sanctions (administrative?)Assessment and Treatment?Assessment and Treatment? Incarceration?Incarceration?Alternatives (Probation and Alternatives (Probation and

Monitoring)Monitoring)