Motor Vehicle Injury Safety Belts: Enhanced Enforcement Programs

The CPSTF finding is based on evidence from a systematic review of 15 studies (search period through June 2000).

The review was conducted on behalf of the CPSTF by scientists from CDC’s Division of Unintentional Injury Prevention with input from a team of specialists in systematic review methods and experts in research, practice and policy related to motor vehicle injury prevention.

More details about study results are available in the published evidence review.

The systematic review included 15 studies.

• Observed safety belt use increased by a median of 16 percentage points (15 studies)
• Increases in safety belt use were similar for supplemental and targeted patrols.
• Deaths and injuries combined decreased by 7% and 15% (2 studies)

An economic review of this intervention did not find any relevant studies.

These findings should be generally applicable to all U.S. motorists covered by safety belt laws.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How does the length and frequency of enhanced enforcement programs influence their effectiveness?
• Does the effectiveness of enhanced enforcement programs vary based on the scale of the interventions (e.g., single community vs. multi-community programs)?
• How does publicity, public education, and news coverage affect enhanced enforcement programs?
• What penalties for violations of laws (e.g., fines, license demerits) are most effective among high-risk drivers (e.g., teenagers, drinking drivers)?
• What are the most effective methods of publicizing enhanced enforcement to reach high-risk drivers?
• Do enhanced enforcement programs for safety belt use decrease risky driving?
• Do enhanced enforcement programs deter alcohol-impaired driving?
• What are the cost-benefit, cost utility, and cost-effectiveness of enhanced enforcement programs?
• Do enhanced enforcement programs divert police from other crimes?

• Included studies focused on enhanced enforcement programs that specifically targeted safety belt use. Studies of programs targeting multiple unsafe driving practices were excluded from the review.
• Included studies evaluated city, county, state, provincial, and national programs in the United States and Canada.
• Evaluated programs varied in the amount of publicity they used. Studies were conducted in states with primary safety belt laws and states with secondary laws.

Dinh-Zarr TB, Sleet DA, Shults RA, et al. Reviews of evidence regarding interventions to increase use of safety belts. American Journal of Preventive Medicine. 2001;21(4S):48-65.

Task Force on Community Services. Recommendations to reduce injuries to motor vehicle occupants: increasing child safety seat use, increasing safety belt use, and reducing alcohol-impaired driving. American Journal of Preventive Medicine. 2001;21(4S):16-22.

Zaza S, Carande-Kulis VG, Sleet DA, et al. Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to reduce injuries to motor vehicle occupants. American Journal of Preventive Medicine. 2001;21(4S):23-30.

Centers for Disease Control and Prevention. Motor-vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol-impaired driving. MMWR. 2001;50(RR-7):1-13. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5007a1.htm.

Shults RA, Nichols JL, Dinh-Zarr TB, Sleet DA, Elder RW. Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services Systematic Reviews. Journal of Safety Research. 2004;35:189-96. Available at: http://www.sciencedirect.com/science/article/pii/S0022437504000234.

Sleet DA, Branche CM. Road Safety is No Accident. Proceedings from a Symposium on High Visibility Enforcement – Building Sustained Safety Belt Use. Journal of Safety Research. 2004;35(2):173-4. Available at: http://www.sciencedirect.com/science/article/pii/S0022437504000295.

Zaza S, Sleet DA, Elder RW, Shults RA, Dellinger A, Thompson RS. Response to letter to the editor. American Journal of Preventive Medicine. 2002;22:330-1.

Sleet DA. Evidence based injury prevention: guidance for community action. In: Australian Third National Conference on Injury Prevention and Control. Australian Third National Conference on Injury Prevention and Control. Brisbane, Queensland, Australia; 1999.

Novick LF, Kelter A. Guide to Community Preventive Services: a public health imperative. American Journal of Preventive Medicine. 2001;21(4S):13-15.

Moffat J. Motor vehicle occupant injury prevention: the states’ perspective. American Journal of Preventive Medicine. 2001;21(4S):5-6.

Miller TR. The effectiveness review trials of Hercules and some economic estimates for the stables. American Journal of Preventive Medicine. 2001;21(4S):9-12.

Webb M. Research as an advocate’s toolkit to reduce motor vehicle occupant deaths and injuries. American Journal of Preventive Medicine. 2001;21(4S):7-8.

Waller PF. Public health’s contribution to motor vehicle injury prevention. American Journal of Preventive Medicine. 2001;21(4S):3-4.

Satcher D. Note from the Surgeon General. American Journal of Preventive Medicine. 2001;21(4S):1-2.

Task Force on Community Services, Zaza S, Briss PA, Harris KW. Motor vehicle occupant injury. In: The Guide to Community Preventive Services: What Works to Promote Health?. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press; 2005:329-84.

Effectiveness Review

Analytic Framework see Figure 1 on page 49

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Dussault C. Effectiveness of a Selective Traffic Enforcement Program combined with incentives for seat belt use in Quebec. Health Educ Res 1990;5:217 23.

Hagenzieker MP. Enforcement or incentives? Promoting safety belt use among military personnel in the Netherlands. J Appl Behav Anal 1991; 24:23 30.

Jonah BA, Dawson NE, Smith GA. Effects of a selective traffic enforcement program on seat belt usage. J Appl Psychol 1982;67:89 96.

Jonah BA, Grant BA. Long-term effectiveness of selective traffic enforcement programs for increasing seat belt use. J Appl Psychol 1985;70:257 63.

Lund AK, Stuster J, Fleming A. Special publicity and enforcement of California’s belt use law: making a “secondary” law work. J Criminal Justice 1989;17:329 41.

Malenfant JE, Van Houten R. The effects of nighttime seat belt enforcement on seat belt use by tavern patrons: a preliminary analysis. J Appl Behav Anal 1988;21:271 6.

Mortimer RG, Goldsteen K, Armstrong RW, Macrina D. Effects of incentives and enforcement on the use of seat belts by drivers. J Safety Res 1990;21:25 37.

Roberts DS, Geller ES. A statewide intervention to increase safety belt use: adding to the impact of a belt use law. Am J Health Promot 1994;8:172 4.

Rood DH, Kraichy PP, Carman JA. Selective Traffic Enforcement Program for occupant restraints. Final report. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, 1987. DOT HS 807 120.

Solomon MG, Nissen WJ, Preusser DF. Occupant protection Special Traffic Enforcement Program evaluation. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, 1999. DOT HS 808 884.

Streff FM, Molnar LJ, Christoff C. Increasing safety belt use in a secondary enforcement state: evaluation of a three-county special enforcement program. Accid Anal Prev 1992;24:369 83.

Watson REL. The effectiveness of increased police enforcement as a general deterrent. Law Society Rev 1986;20:293 9.

Williams AF, Hall WL, Tolbert WG, Wells JK. Development and evaluation of pilot programs to increase seat belt use in North Carolina. J Safety Res 1994;25:167 75.

Williams AF, Lund AK, Preusser DF, Blomberg RD. Results of a seat belt use law enforcement and publicity campaign in Elmira, New York. Accid Anal Prev 1987;19:243 9.

Williams AF, Reinfurt D, Wells JK. Increasing seat belt use in North Carolina. J Safety Res 1996;27:33 41.

The following outlines the search strategy used for reviews of these interventions to increase use of safety belts: Laws Mandating Use; Primary (vs. Secondary) Enforcement Laws; Enhanced Enforcement Programs.

The reviews of interventions to reduce motor vehicle-related injury reflect systematic searches of multiple databases as well as reviews of reference lists and consultations with experts in the field. The team searched six computerized databases (MEDLINE, Embase, Psychlit, Sociological Abstracts, EI Compendex, and Transportation Research Information Services [TRIS]), which yielded 10,958 titles and abstracts for articles, book chapters, reports, and published papers from the Association for the Advancement of Automotive Medicine proceedings about safety belts, alcohol-impaired driving or child passenger safety. Studies were eligible for inclusion if:

• They were published from the originating date of the database through June 2000 (March 1998 for child safety seat interventions)
• They involved primary studies, not guidelines or reviews
• They were published in English
• They were relevant to the interventions selected for review
• The evaluation included a comparison to an unexposed or less-exposed population
• The evaluation measured outcomes defined by the analytic framework for the intervention

Search Strategy for Use of Safety Belts:

(MOTOR(W)VEHICLE?) OR AUTOMOBILE? OR CAR OR CARS OR TRUCK? OR (TRAFFIC(2N)(ACCIDENT? OR CRASH? OR DEATH? OR FATALIT? OR INJUR?))

AND

(SEAT(W)BELT?) OR SEATBELT? OR (SAFETY(W)RESTRAINT?) OR (SAFETY(W)BELT?) OR (OCCUPANT(W)RESTRAINT?) OR OCCUPANT(W)PROTECTION)

AND

INTERVENTION? OR OUTREACH? OR PREVENTION OR (COMMUNITY(3N)(RELATION? OR PROGRAM? OR ACTION)) OR DETERRENT? OR PROGRAM? OR LEGISLATION? OR LAW? OR EDUCATION OR DETERRENCE OR COUNSELING OR CLASS OR CLASSES OR TRAINING OR PROMOTION? OR BEHAVIOR?

NOT

PEDESTRIAN? OR MOTORCYCLE OR BICYCL? OR CYCLIST? OR (SCHOOL(W)BUS?) OR BUS OR BUSES OR AIRPLANE? OR AIR(W)TRANSPORTATION?) OR AVIATION? OR (AIR(W)TRAFFIC) OR (AIR(W)CRAFT) OR DIAGNOSIS OR THERAPY OR GUIDELINE OR COMMENT? OR HISTORY OR EDITORIAL

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

Enhanced enforcement programs may be intense efforts of short duration (called waves or blitzes). They may last for days or weeks, and they may be repeated periodically or maintained continuously over several weeks, months, or years.

• Enhanced enforcement may lead to increased arrests for other crimes, such as possession of weapons or drugs, impaired driving, or license violations.
• One potential barrier to implementation is the reluctance of state and community officials to implement these programs because of concerns about public opposition.
• Police officers may be reluctant to participate in enhanced enforcement programs out of concern that they will be diverted from investigating more serious crimes. One study found, however, that crime rates do not increase during enhanced enforcement campaigns. Interviews with both police and members of the public revealed positive attitudes toward enhanced enforcement programs.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce deaths from motor vehicle crashes — IVP-06
• Reduce the proportion of deaths of car passengers who weren’t buckled in — IVP-07