Increasing Seat belt use rates in
rural communities

Seat belt use rates in rural areas can be increased using well-­documented approaches that have proved successful nationwide, starting with ­NHTSA’s Buckle Up America Campaign. The underpinnings of successful Buckle Up America campaigns include the enactment of a strong seat belt law; development of public/private partnerships at the local, State and Federal level; conduct of high-visibility enforcement; and promotion of public information and education about the benefits of buckling up and the consequences of not doing so. The most effective programs are those comprised of strong leadership, community support, activities addressing local issues and concerns, and community involvement in the planning process and activities.

Seat Belt Use Data

Identifying the belt use rate in your area and determining where to focus your program efforts are important basic steps in planning a program and measuring success.

There are several methods for collecting data on seat belt use in your community or State, including observational surveys, telephone surveys, and in-person surveys. Keep in mind that, when using Federal funds, there are strict guidelines to be followed regarding data collection. Consult your NHTSA regional office for details on the guidelines that apply to your survey methods and sample instruments available to use.

Observational surveys are the most accurate, and therefore credible, method of determining seat belt use rates, as they collect information on what people actually do, rather than what people say they do. Observational surveys should be conducted before and after program activity and enforcement efforts, in exactly the same way each time, using the same locations, directions of travel, days of the week, and times of day. (See ­Appendix A for a sample seat belt observation form.)

Telephone and in-person surveys can collect self-reported seat belt use rates, which can reveal characteristics of groups with low use and their reasons for not using seat belts. This knowledge can be useful in defining and shaping educational and enforcement efforts.⁴ (See Appendix B for a sample in-person survey form.)

The Importance of Primary Seat Belt Laws

Seat belt laws in many States are secondary enforcement laws. This means that police officers cannot stop drivers for the sole purpose of enforcing the use of occupant restraints. Rather, police officers can write tickets for not using occupant restraints only if they stop the vehicle for another driving infraction. As of September 2006, 24 States still have secondary laws, while 25 States, the District of Columbia, and Puerto Rico have primary laws. Only one State, New Hampshire, does not have any adult seat belt use law.

States with stronger belt enforcement laws continue to exhibit generally higher use rates than those with weaker laws. South Carolina strengthened its belt law to a “primary” enforcement law, effective December 2005. This State saw a jump in use from 65.7 percent in 2004 to 69.7 percent in 2005. Because the 2005 survey was conducted before the primary law took effect, greater gains may be realized in 2006.

The greatest success in increasing seat belt use occurs in States with primary belt laws that are enforced. In 2005, the national seat belt use rate reported by NHTSA was 82 percent. The national use rate is based on the National Occupant Protection Use Survey (NOPUS) conducted by NHTSA, separate from the State Belt Use Surveys tallied above.

The 2005 State surveys show the average use rate for primary law States was 85.5 percent and 75 percent for secondary law States. Similarly, the NOPUS Survey showed an average of 85 percent for primary law States and 75 percent for secondary law States. The difference in seat belt laws may also contribute to lower use rates in rural areas because there are more secondary laws in States with large rural populations. See the following chart.

In tracking national belt use rates since 1984, the following chart ­further shows the effect of seat belt use laws and adoption of primary laws on national use rates through 2005.

Seat Belt Use by Ambient Enforcement Law and Urbanization

Source: National Occupant Protection Use Survey, NHTSA's National Center for Statistics and Analysis, 2005

Improving Secondary Seat Belt Laws

Competing political and legislative priorities, concerns about personal liberties, and misinformation about the effectiveness of seat belts continue to interfere with efforts to upgrade secondary laws. However, this does not mean that a secondary law cannot be improved so that some or all of the benefits of a primary law – enforceability and deterrence – are achieved. The following case study provides an excellent example of how a coalition of health and traffic safety professionals persuaded their legislature to improve the Idaho secondary seat belt law.

State* Belt Laws & National Belt Use Rates

Source: State Surveys and NOPUS *Includes Puerto Rico and District of Columbia

Idaho had conducted significant enforcement and education efforts to improve seat belt use rates, but belt use had increased only about 5 ­percentage points (from 58% in 1999 to 63% in 2002). Dedicated health and traffic safety specialists realized that there were problems with the law. The cost of a ticket was only $5 – the lowest fine in the country – and the law applied only to front-seat passengers. However, the biggest stumbling block was that the law required an officer to write a ticket for the primary offense before a ticket for not using a seat belt could be issued. For example, an officer who pulled over an unbelted driver for going 5 mph over the speed limit had to issue tickets for both speeding and failure to use seat belts in order to give the seat belt ticket at all. When the primary violation wasn’t too extreme, the officer knew that it was unlikely that the ticket would be upheld in court.

To address this problem with enforceability, highway safety partners (especially public health) worked together on a media advocacy program to modify the law. They sent documentation to the legislature and developed multi-media material that focused on the costs to society of motor vehicle crashes. The main message was positioned as a question, “Can Idaho afford the cost of not buckling up?” Answers to the question addressed the percentage of crash costs that were passed on to the public and the annual medical costs of crashes per resident. Messages typically ended with the slogan, “Seat belts . . . a matter of dollars and sense.”

The program worked. As of July 1, 2003, the law was changed. The new law pertains to all seating positions in the vehicle. A citation for the primary stop is no longer required – an officer can issue a seat belt ticket alone, as long as another violation was observed to warrant the stop. The fine was changed to $10 for adults, $5 of which goes to the State’s catastrophic health care fund to cover crash costs. If there is an unrestrained passenger under 18, the driver gets the ticket. For drivers under 18, the cost is $42.50 ($10 plus court costs).

Prior to the enactment of the changes to the law, the State initiated an intensive public information campaign. Using the slogan “Click It, Don’t Risk It,” billboards portrayed young (18- to 34-year-old) males in pickup trucks. The campaign also included radio and television advertising followed by increased enforcement. As a result, seat belt use rose to 72 percent – an increase of nearly 10 percentage points. The success of the new law and the fact that Idaho is still well behind the nationwide use rate of 82 percent has prompted renewed efforts for a further upgrade to a primary law.

Forming Private-Public Sector Partnerships

There are many benefits to forming partnerships, coalitions, and advisory groups. Public and private sector individuals and organizations can directly and indirectly support a rural seat belt program and expand its reach. In some instances coalitions and advisory groups are used to lend credibility and access to various populations within a community. In other instances, partnerships are formed with groups that have direct contact with a particular sub-group that is known to have a low seat belt use rate. Still other groups can demonstrate support by distributing information about seat belt use to clients, customers, and employees.
When forming partnerships in rural areas it is important to join with other organizations that promote health and safety, these include local highway offices that are responsible for making roads safer for driving. The following information on multi-sector traffic safety teams and injury prevention organizations demonstrate the benefits of working with these other types of organizations and individuals.

Multi-Sector Traffic Safety Teams

Safe Community Coalitions. Through the Safe Communities Program, advocates from the fields of prevention, acute care, and rehabilitation form local coalitions to address injury prevention and control, with a special emphasis on motor vehicle-related injuries. The program provides a model for reviewing multiple sources of injury and cost data to clearly identify local problems. It allows citizens to accurately predict when and where motor vehicle-related injuries are most likely to occur and to take the best course of action to keep them from happening. To find out more about the Safe Communities program go to www.nhtsa.dot.gov/safecommunities.

Partners for Rural Traffic Safety. Another successful model for building a multi-sector team at the State and local level was developed through the NRHA’s Partnership for Rural Traffic Safety Project. The Association, working with State Offices of Rural Health in Arizona, Colorado, Michigan, and North Dakota, identified 16 rural communities in which to implement traffic safety campaigns. An integral part of the project was the formation of State teams to provide technical assistance to the local communities. State team members were drawn from health care organizations, traffic safety offices, State police agencies, cooperative extension units, and other pertinent organizations.

The project was designed so that the local campaigns would coincide with the seat belt mobilizations conducted by the national Buckle Up America, Click It or Ticket program. The State Offices of Rural Health administered $5,000 grants to each community to cover the costs associated with campaign implementation and the community development process. Community team leaders, who were representatives of the health sector, were responsible for getting commitments from five other sector representatives, e.g., law enforcement, business, education, faith community, and the community at large, to participate on the local team. All team members were responsible for organizing activities and getting their sectors involved in the campaign.

In 15 of the 16 communities, seat belt use increased significantly. Seven sites reported an increase of more than 30 percentage points, and two sites reported an increase of more than 20 percentage points. In addition to increasing seat belt use, the project demonstrated the important role that rural health and safety professionals can play in promoting traffic safety, specifically occupant protection, in rural communities. Many of the project team members expressed the likelihood of continuing the effort—fruitful seeds for future Safe Communities Coalitions.

Highway Department Corridor Programs. Local highway departments that are responsible for roadway safety are willing partners for the promotion of all traffic safety issues, especially seat belt use. Department engineers use the corridor program model to reduce crashes, injuries, and fatalities on specific stretches of a roadway that have high motor vehicle crash and fatality rates. These programs look for ways to combine low-cost engineering improvements, PI&E, and enforcement.

The State of Washington developed a corridor program for one of its rural two-lane roads in the eastern part of the State. On this road, there were several over-the-centerline crashes caused by passing vehicles. To address the problem, centerline rumble strips were installed, enforcement was increased, and Click It or Ticket signs were mounted on the roadway. This initiative was so successful that it received the 2002 Governor’s Award for Public Benefit.

Another example of how advocates came together to address several traffic safety issues occurred in Pennsylvania. Along a stretch of rural roadway, the Pennsylvania Department of Transportation posted signs that encouraged drivers to wear their seat belts, to avoid aggressive driving, and not to drink and drive. It also lowered the speed limit on ­a portion of the corridor that went through a township.

The Federal Highway Administration and several State Departments of Transportation also have successfully incorporated seat belt education and enforcement into their engineering programs. For more information about these programs contact your State Department of Transportation or district Federal Highway Office.

Injury Prevention Organizations

Public and private sector injury prevention organizations make excellent partners for promoting seat belt use. Health care, emergency medical services, public health, and other safety organizations all have a stake in increasing seat belt use rates. The follow examples highlight two very different approaches that support seat belt use.

Oregon’s Injury Prevention Program. The State of Oregon’s injury prevention program addresses all ages and causes of injury, death, and disability. It also includes a seat belt alternative sentencing class that a judge can assign as the penalty for a first-time seat belt offense. The class, Trauma Nurses Talk Tough, is taught by nurses and paramedics and addresses the facts concerning the need for and benefits of seat belt use.

Joanne Fairchild, a trauma nurse coordinator for the program, has reported that the most common remark she receives from people who attend the class is, “I wish I had known this information before … why is this class not a requirement for getting a driver’s license?” One woman called her to say that she didn’t know what was covered in the class, but her husband, who attended the class, came home afterwards, ordered the whole family into the dining room, and apologized for not listening to them about seat belts. Fairchild commented that, “I have had people say it not only changed their attitude and behavior about seat belts, but changed how they are raising their children.”

Emergency Nurses Association (ENA). The ENA and its Injury Prevention Institute, Emergency Nurses CARE (ENCARE), actively promote traffic safety and injury prevention at the national, State, and local levels. Association members deliver alcohol awareness programs to educate the public about the dangers of alcohol, drinking and driving, and seat belt non-compliance. They also deliver programs on bicycle safety and proper helmet use, along with other injury prevention education. ENCARE volunteers present programs to over 300,000 people a year. Many ENCARE nurses also are certified Child Passenger Safety (CPS) Technicians and Instructors. They participate in CPS educational programs and volunteer at safety seat checks in their communities. For more information: E-mail encare@aol.com or write ENA/EN CARE 915 Lee Street Des Plaines, IL 60016-6569, or telephone at: 847-460-4000.

Conducting High-Visibility Enforcement

To address the reality of limited police patrol hours, especially in rural communities, law enforcement agencies use a general deterrence model to create the belief that law enforcement officers are positioned in the community to enforce traffic safety laws. This model combines intermittent enforcement waves with carefully designed communications strategies to convince large numbers of people that they are at risk of being ticketed.

Reports from NHTSA demonstration projects and other rural traffic safety programs, point to the benefits of having law enforcement officers conduct highly visible community outreach prior to enforcement waves. In many of these projects (see below), law enforcement officers participated in communication activities in the schools, at community fairs, and at other venues in which community members gathered. Their participation let community members know that they cared about the health and welfare of the community and also increased their (the officers) comfort level with enforcement activities.

Click It or Ticket Campaigns

In recent years, Click It or Ticket campaigns, which are based on the general deterrence model, have emerged as a major means of increasing seat belt use. Click It or Ticket’s proven success has been demonstrated at the community level, statewide, regionally, and nationally. In May 2005, 50 States, the District of Columbia, and Puerto Rico participated in the national annual Click It or Ticket Mobilization that raised the national seat belt use rate from 80 to 82 percent (this means that approximately 2.8 million more people are buckling up).

Click It or Ticket campaigns involve a 2-week period of intensive enforcement of seat belt laws, coupled with extensive media and outreach communications including paid advertising. These nationwide mobilizations are conducted each May in conjunction with Memorial Day ­Weekend/Buckle Up America Week. In 2005, more than 10,000 law enforcement agencies across the Nation participated. Some areas also conduct additional mobilizations at other times during the year. Click It or Ticket planners and program information are available on the Buckle Up America Web site at www.buckleupamerica.org and NHTSA’s Web site at www.nhtsa.gov.

Dispelling Concerns about Enforcing Seat Belt Laws in Rural Areas

In the past, low seat belt use and law enforcement rates raised concerns about the viability of high-visibility enforcement and communications strategies for increasing seat belt use in rural communities. Concerns stemmed from perceptions that (1) law enforcement officers in rural communities were reluctant to give citations to friends or acquaintances, (2) elected law enforcement leaders felt that their political careers would suffer if they cracked down on voters who did not buckle up, and (3) rural communities did not believe that seat belt use was necessary in rural areas. Related to these perceptions was the question of whether a rural seat belt program could target a sub-group, such as pickup truck drivers, who are known to have lower seat belt use rates.

To address these concerns, NHTSA and State Highway Safety Offices have funded local demonstration projects to identify effective strategies for developing rural seat belt programs. Since 1996, NHTSA also has worked with the National Rural Health Association (NRHA) to demonstrate the effectiveness of a community development/action program to promote rural traffic safety by implementing local traffic safety campaigns. The program is set forth in a NHTSA publication titled Partners for Rural Traffic Safety Action Kit. It embraces the basic tenets of community organizing and direct citizen involvement in addressing concerns that affect the entire community.

Other Special Seat Belt Enforcement Programs

In rural communities, law enforcement personnel have undertaken variations on the Click It or Ticket campaign, along with other approaches and activities that support general deterrence. The following summaries and case studies of special seat belt enforcement programs describe a variety of projects, approaches, and activities that have been effective in increasing seat belt use.

Special seat belt enforcement programs are often initiated with the availability of grant funds or when local safety advocates lobby for ­enforcement of occupant protection laws. Although these programs can achieve dramatic increases in seat belt use in a relatively short period of time, if the program stops, belt use rates tend to decline. However, research has shown that use rates usually do not completely decline to where they were before the program started. Moreover, if the programs are re-instated periodically, the residual seat belt use rate increases after each successive enforcement effort. The following case studies illustrate how the State of West Virginia, eight counties in Pennsylvania, and a Sheriff’s Office in Oklahoma are working to maintain special seat belt enforcement programs in their jurisdictions.

West Virginia’s Incentives for Law Enforcement Participation. For the past six years, West Virginia has had a seat belt incentive program to encourage all West Virginia law enforcement agencies to enforce occupant protection laws and promote the benefits of seat belts and child safety seats. Incentives for participation include additional funding for local agencies and all-expenses paid training trips for individual officers.

Many of the participants in the program come from small departments, and the program is set up so that small and large departments have an equal chance of winning. There are 11 categories of activities that officers can engage in to receive credits ranging from ticket writing to community presentations. The seat belt use rate in West Virginia increased from 52.3 percent in 2001 to 84.9 percent in 2005.

Pennsylvania’s Regional Comprehensive Highway Safety Program. The North Central Highway Safety Network conducts a year-round seat belt program in eight counties, seven of which are rural, that includes enforcement and outreach. Since Pennsylvania has a secondary enforcement law, law enforcement agencies use traffic safety checkpoints as an opportunity to write seat belt citations, as appropriate. In four scheduled mobilizations each year, vehicles are stopped for license, registration, and insurance information checks. To encourage seat belt use year-round, law enforcement officers hang plastic “Seat Belt ” signs on the side of their vehicles and turn on their flashing lights when they stop to do paperwork. As a result, motorists are never quite sure when checkpoints are taking place.

In addition, officers make presentations to community groups and at schools. They also lend an educational program, Survival 101, to middle schools and high schools (the presentation is available in slide, video, and DVD formats). It first addresses the benefits of seat belt use and then describes a crash from the police perspective.

Using this approach, the North Central Highway Safety Network found it could increase seat belt use by 20 percentage points in a 1-week period. One month later, half of that increase was typically lost, but the overall State seat belt use level in the eight counties increased approximately 20 percentage points in 2 years.

Oklahoma’s Oklahoma County Traffic Unit. Oklahoma County is the largest county in the State with an area of 775 square miles. The Sheriff’s office is responsible for unincorporated areas of the county (175 square miles). There had never been a traffic unit in Oklahoma County before John Whetsel took office as sheriff. In the words of Sgt. Darrell Sorrells: “The major concern was politics – the sheriffs were concerned that they would not be reelected if residents were cited for traffic violations.”

Sheriff Whetsel, an advocate for traffic safety, received a grant from the Oklahoma State Highway Safety Office to fund the acquisition of staff and equipment to start a traffic unit. The grant required officers to give warnings or citations for any traffic safety violation. Under Sheriff Whetsel’s leadership, the department adopted a zero-tolerance policy for people not wearing seat belts. The program has been firmly established and continues to grow on its own without additional funding by the State.

As Sgt. Sorrels put it, “The safety unit had no effect on politics.” In fact, Sheriff Whetsel is now in his second 4-year term.” In addition, residents come up to them now and say they are glad that traffic safety laws are being enforced in the county. Seat belt use has gone from 46.6 percent to 76.2 percent. As a side benefit, collisions are down by 67 percent and reported crimes by 88 percent.

⁴ Excerpt from Implementing a Standard Seat Belt Law in Your State: A How-To Guide. DOT-HS-809-291, June 2001. www.nhtsa.dot.gov/people/injury/airbags/buckleplan/enforceseatbeltlaws/page3.html#sub1