V. Conclusions and Recommendations

Programs, Interventions and Strategies That Have Potential to Increase Safety Belt Use by Teens

It is clear from the statistical data, a comprehensive review of the literature, and discussions with various officials in the safety belt arena that the most promising strategies available to increase safety belt use by teens are likely to be the proven strategies that increase safety belt use in the general population. These include the following and are tailored, where appropriate, to the youth situation:

Legislation

Primary Safety Belt law
Primary safety belt laws have been shown to increase safety belt use in the general population. NHTSA recently estimated that adopting primary safety belt laws raises safety belt use by 11 percentage points. Teen belt use is also higher in states with primary safety belt laws. The evidence suggests that this strategy probably would have the greatest and most immediate effect on teen safety belt use.

Graduated Driver Licensing Law
A majority of States have adopted graduated driver licensing laws with three phases of licensure. Many of the laws either include safety belt use as a provision, or provide for sanctions if a safety belt violation occurs. The problem is that most teens and most parents are not aware of this requirement in GDL. They tend to be cognizant of nighttime restrictions and passenger restrictions, but not the consequences of a safety belt violation. For example, in a recent study in North Carolina, 92 percent of the parents and 96 percent of the teens were aware of the nighttime restriction in the GDL, and 82 percent of the parents and 86 percent of the teens were aware of the passenger restriction. However, only 5 percent of the parents and 3 percent of the teens were aware of a safety belt requirement in the GDL law and that a safety belt violation would affect their graduation to the next phase.⁵⁶ If safety belt requirements and consequences for safety belt violations are publicized, this element of GDL could substantially increase safety belt use by teens.

Unique Legislatively/Administratively Mandated Penalties
Safety belt violations result in points on the license in only one known jurisdiction in the United States (the District of Columbia). While there is no solid research on this provision to date, the potential for increasing safety belt use rates, especially for teens, is likely if such mandated penalties are adopted, publicized, and enforced.

Enforcement

Increased Enforcement
Increased enforcement of safety belt laws, if highly publicized and visible, has been shown to increase safety belt use in the general population. It is reasonable to assume teen belt use would increase concomitantly. The highly publicized Click It or Ticket-themed mobilizations have demonstrated that safety belt use will increase even in secondary enforcement States. If CIOT enforcement is tailored to young drivers (e.g., near high schools, colleges, recreational facilities; publicized on youth-oriented radio stations and television channels), it could substantially increase belt use by teens—but it must be frequent, consistent, and sustained.

Combined Efforts (Comprehensive Approaches Including Two or More Strategies)

The four NHTSA Teen Demonstration Projects, and other research of strategies that affect teen behavior, indicate that combined approaches, such as strengthening safety belt laws, educating the public, publicizing the law, enforcing the law, and working with community organizations to provide outreach to the citizens, have good potential to increase safety belt use. Most of the research shows that it takes combined strategies involving education, publicity, visible enforcement, and community outreach to affect behavior.

There are other strategies, which if aimed toward teens, appear to have potential to increase safety belt use for that population. These include:

Technological Approaches

Reminder Devices
Safety belt reminders, such as buzzers, lights, and messages on the dash board have shown some effectiveness for increasing belt use in the general population. The specific effectiveness of these devices for increasing teen belt use has not yet been tested but is now being explored by NHTSA.

Black Box
In-vehicle computer systems already exist whereby safety belt use, speed, and other behaviors can be recorded and monitored. Specific evidence of the effectiveness of these devices for changing teen driving behaviors is not available. It remains to be seen if parents will purchase vehicles for their teens equipped with these monitors.

Peer-Led Approaches

Education/Awareness
Peer-led educational and awareness approaches hold promise in changing youth norms and attitudes about safety belt use. Some States reported that peer-to-peer programs increased teen safety belt use slightly. Whether this translates to sustained use remains unclear.

Youth-Initiated Safety Belt Checks
There is some evidence that youth-initiated monitoring of safety belt use will have a modest effect on teen belt use. A large program needs to be demonstrated, such as the MADD Youth in Action program, which perform “compliance checks” on the frequency of underage purchases of alcohol, to determine if this type of approach translates to the safety belt arena.

Education

Information
We know education alone, and information by itself, probably will not affect teen belt use. However, education coupled with enforcement and other strategies may be effective.

Counseling
At least one study showed that brief counseling in a medical setting may increase self-reported belt use by teens. If brief interventions are used more frequently to reduce abusive drinking and impaired driving, they might also be effective in increasing belt use, especially by youth.

Media

Safety Awareness Messages
Safety belt use messages by themselves probably will not affect teen belt use. However, messages concerning increased enforcement of safety belt laws in the community, coupled with actual enforcement, have been shown to be effective in the CIOT mobilizations.

Multimedia Shows
MADD and other organizations have developed high-tech multimedia shows for schools that attempt to persuade youth to wear safety belts and not engage in underage drinking. Some of these shows, which are based on peer-to-peer messaging, are in the process of being evaluated for their effectiveness. Thus far, self-reported seat belt use has increased for students exposed to these shows, but it remains to be seen if observational surveys will verify that result.

Parental Involvement

Communication
Merely talking to teens about safety belts probably will not be effective. However, communication and close monitoring by parents could have an effect. Certainly, parents can set an example by always wearing their safety belts. For example, one State observational survey showed that youth 5 to 15 wore safety belts 72 percent of the time; however, when an adult driver was restrained, the passengers 5 to 15 were restrained 85 percent of the time.

Supervision
Close supervision and monitoring of teen behavior, including safety belt use, may have an effect on belt use. Teens report their parents have more influence over them than their parents think.

Incentives/ Promotion Programs

Competitions/Contests
There is some limited data indicating that competitions and contests with incentives will increase teen safety belt use around high schools. However, there is no indication that those increases will be sustained.

Contracts/Pledges
The research indicates that contracts or pledges to wear safety belts must be accompanied with follow-up incentives or enforcement to have any effect at all.

Normative Feedback/Education
There is mixed research on how social norming affects underage drinking. While this area has potential for teen safety belt use, there have been no proven demonstrations of its effectiveness on this issue to date.

Interpersonal Skill Building/Social Emotional Competence Building
There is some evidence in the literature that these strategies can change behavior; however, there is very little information on its application to teen safety belt use.

Summary

In summary, proven effective strategies that increase safety belt use in the general population will likely have the most immediate and greatest potential for increasing teen safety belt use. These include upgrading State safety belt laws to primary enforcement and highly publicized enforcement of safety belt use laws. GDL laws that explicitly include requirements for safety belt use in all three phases, and sanctions that prohibit “graduation” to the next licensing phase if there is a safety belt citation, could increase teen safety belt use substantially. Community programs that combine education, peer-to-peer persuasion, publicized enforcement, and parental monitoring have some potential for increasing teen belt use.

Technological solutions also hold promise. Enhanced safety belt reminders appear to be effective for all age groups. Safety belt use recorders could allow parents of teens to monitor teen behavior, if accepted by the public. Interlock systems, such as not allowing the radio or compact disk player to turn on until all passengers are wearing safety belts, also hold promise and could be very effective, especially for teens.

Combinations of strategies seem to work better than one strategy alone. A community program including education, diversity outreach, highly publicized enforcement, and parental involvement would likely have a substantial effect on teen belt use. However, these strategies would probably need to be sustained for the effect to last over time. While each strategy is not without barriers, careful planning, implementation and evaluation can result in effective programs and add greatly to our current knowledge of teen safety belt use.