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E-1 APPENDIX E OVERVIEW OF NHTSA PASSENGER CAR CAMPAIGN This appendix has not been edited by TRB. Background: 19501977 likely the most important event of the period. This legislation was followed by similar legislation in all of the Australian states and in Increasing safety belt use (SBU) is an objective that has been pur- New Zealand. The Australian laws resulted in an increase in safety sued in many nations and by many organizations within the United belt usage from just over 20% to about 75% across Australia (Liv- States, particularly by safety and health groups and by the automobile ingston et al., 1978, Nichols, 1982). Similar results were obtained industry. The U.S. Congress has also played an important role at var- by several European nations which enacted SBU laws. Luxem- ious times over the past 30 years. Certainly, the Highway Safety Act bourg, France, Belgium, Finland, Netherlands, Norway, and Spain of 1966 was a major milestone for all traffic safety programs as it cre- all enacted such laws by 1977 and experienced increases in SBU in ated the National Highway Safety Bureau, which later became the these European nations ranging from 25% to 75%, with a median of National Highway Traffic Safety Administration (NHTSA) and it about 45% (Nichols, 1982). Several additional nations (Portugal, provided for funding to be managed both by NHTSA and the newly Greece, Ireland, Switzerland, and Great Britain) followed by enact- created State Offices of Highway Safety (OHS). ing laws prior to the first SBU law in the United States in 1984. In the U.S., safety belts were first installed in vehicles in the late Early efforts were also initiated to encourage mandatory SBU 1950's but their installation in new vehicles was not required until laws in the U.S. NHTSA asked for a concurrent resolution requir- 1968. Efforts to develop and promote the use of air bags, as an alter- ing State SBU laws in 1972 and the Congress responded with an native means to protect occupants of motor vehicles, was also intro- incentive program in 1973. At the same time, both the automobile duced in the 1960s and formalized with a proposed requirement for industry and NHTSA continued to conduct research to determine such devices in 1969. the impact of various vehicle-related approaches to increase SBU. Meanwhile, initial public awareness efforts were being imple- They included more comfortable and convenient safety belt sys- mented, both here and in Australia. Perhaps the most widely known tems; reminders such as buzzers and lights (which resulted in usage of the early media campaigns in the U.S. was the "Buckle Up for rates of about 28% in some 1973 model vehicles), and ignition inter- Safety" Campaign implemented by the National Safety Council locks (which resulted in usage rates of 60% and above in some 1974 (NSC) in 1968. This was an extensive campaign, the impact of which model vehicles). However, there was a negative reaction to inter- was not documented in terms of increased SBU. However, NHTSA locks and, in 1974, Congress repealed a 1973 rule requiring them surveys showed that, as late as 1979, safety belt use (among drivers) and, in the same year, withdrew the incentive program implemented in the U.S. was only about 11% (see Goodell-Grivas, 1983, 1987). A to encourage States to enact mandatory SBU laws. geographically smaller effort, initiated in Oakland County, Michigan, At the end of the decade, however, there was a very important resulted in a 3 percentage point increase in SBU (i.e., from 18% to event that may have increased the potential for enacting SBU laws in 21%) among drivers and no increase among passengers (Oakland the U.S. In 1977, Tennessee enacted the first child passenger safety County TIA, 1969). About the same time (196769), extensive media (CPS) law. All States followed by enacting such laws by 1985 efforts were implemented in Australia. These campaigns resulted in and, as a result, the use of child safety seats among young children usage rates of about 22% (Livingston et al., 1978; Nichols, 1982). increased from less than 15% to over 50% during that time period. Beginning in the early 1970's, multi-year media efforts were Finally, it is worth mentioning that, throughout much of its his- implemented in various European nations. Some of the best recorded tory and particularly from 1970 to 1990, the movement to increase campaigns took place in Great Britain, from 1971 to 1978 (Fabry, safety belt use (SBU) was also significantly affected by a parallel 1973, Nichols, 1982) and in Sweden from 1971 to 1974 (Edvardson effort to protect motor vehicle occupants by means of passive and Degermark, 1976). Support for these efforts appears to have restraints, primarily air bags. Both the approach and the intensity of involved a combination of government, safety, and medical organi- SBU promotional programs were affected by the air bag movement, zations, as well as the news media (Livingston et al., 1978; Nichols, sometimes in a limiting manner and other times in an enhancing 1982). The highest documented SBU rate resulting from such cam- manner. No other nation was affected to the same extent by these paigns was 36%, achieved in Sweden in 1974, following a 3-year two competing approaches to protect motor vehicle occupants. campaign involving both public awareness efforts and incentives In summary, there were many domestic and foreign efforts imple- (Edvardson and Degermark, 1976). mented to increase SBU prior to 1978. Legislation in Australia and At about the same time as the British campaign was being con- in several European nations had resulted in substantial increases in ducted, NHTSA was evaluating the effectiveness of media efforts SBU but, in the U.S., usage had increased very little. This lack of in three California communities. The Agency found no clear evi- progress was in spite of a variety of initiatives including vehicle dence of increases in SBU resulting from media programs of dif- requirements, media campaigns, and a brief incentive program to fering intensity (Fleischer, 1973). Finally, later in the decade, an enact SBU laws. automobile industry group launched an intense paid media cam- paign in southeast Michigan. This campaign, which included nearly $1 million in paid media in this relatively small geographical area, Increasing Safety Belt Usage: 19782004 resulted in a 45 percentage point increase in SBU (Motorists Infor- mation Inc., 1978). With regard to increasing SBU, the 1970 enact- This historical account of efforts to increase safety belt usage in ment of the first mandatory SBU law in Victoria, Australia, was the U.S. begins in 1978, with the completion of an NHTSA-funded

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E-2 project to develop a compendium of behavioral approaches for that there was not much support for mandatory SBU laws among increasing SBU. As a result of this and subsequent efforts, a num- either the public or State and local officials at the time. At the start ber of approaches for increasing the use of safety belts have been of these workshop series, usage among drivers of passenger cars was identified. They include: public information (e.g., mass media cam- about 10% and there was no measurable change in usage by 1981 paigns); education focused on specific target groups (e.g., school- (Goodell-Grivas, 1987). based or employer-based programs); incentives and/or rewards 19811984: Outreach and Education. While there was no doc- (e.g., an opportunity to win a prize based on a pledge to buckle-up umented impact of the NHTSA workshops in terms of increased or receipt of a prize for being observed buckled-up); requirements SBU at the time, they provided a background for greatly expanded to buckle up (e.g., laws, regulations, or organizational policies SBU programs pursued by the Agency from 1981 to 1984. Under a requiring SBU); enforcement of SBU requirements (e.g., highly vis- new administration, the Agency implemented an extensive net- ible enforcement campaigns); and sanctions (e.g., fines and license working and education program in 1981 that was designed to enlist demerit points). the support of public health, medical, education, civic, and service, In addition, to these behavioral approaches, several vehicle- and other groups (including employers) to encourage voluntary SBU related approaches for increasing SBU have been identified. They among the general public and mandatory use among employees. include reminders (e.g., buzzers and lights), interlocks, and safety This approach resulted in the enlistment of scores of such organi- belt systems that are more comfortable and convenient. Although zations promoting SBU in the States and among their own members some of these approaches, such as more comfortable and con- and employees. There was no stated numerical objective of this pro- venient safety belt systems, have undoubtedly facilitated recent gram and there was only a modest change in observed SBU as mea- increases in SBU, their impact has not been evaluated independent sured by NHTSA's 19-city survey (i.e., observed use increased from of behavioral efforts. A recent report by the Transportation Research about 11% in 1981 to about 14% in 1984). However, it is commonly Board (TRB) reviewed these vehicle-related approaches and their held that this outreach and education program greatly facilitated current potential for increasing SBU (Transportation Research subsequent legislative efforts. Board, 2003). During this period, NHTSA also supported a number of evalua- In 1978, the Congress also required States to allocate a portion tions of incentive programs, most often in employer situations, but their highway funds for programs to increase SBU. This require- also in community settings. These efforts resulted in relatively con- ment, along with the new NHTSA compendium, provided focus for sistent evidence of increased SBU in controlled organizational envi- NHTSA efforts over the next several years. Following is a summary ronments but somewhat less often in more open, community-wide of key periods of change in what has been a relatively continuous environments (e.g., see Geller, 1982 and Hunter et al., 1986). SBU effort on the part of NHTSA (and others) to increase SBU. increases associated with such programs generally declined after Because the effectiveness of safety belts, when worn, is well the programs were concluded. established, the primary objective of most SBU programs has been 198487: Intense Legislative Activity in the States. The largest to increase observed use, as measured by the results of observa- nationwide increase in usage occurred from 1984 to 1987, when tional surveys. The characteristics of such surveys have evolved 31 States enacted mandatory SBU laws. This legislative movement over time. From the late 1970s to 1991, the primary source of obser- was initiated by efforts of a medical coalition in New York which vational data was NHTSA's 19-city survey (e.g., Goodell-Grivas, resulted in the New York SBU law being enacted in 1984. However, 1983, 1992). From 1991 through 1994, when nearly all States were the primary force behind this movement after 1984 was Traffic conducting statewide observational surveys, national estimates of Safety Now (TSN), an automobile industry-funded organization safety belt usage were obtained by aggregating the results of these established to push for State SBU laws. This effort was in response statewide surveys. Since 1994, the primary source of observational to a Supreme Court decision not to require auto manufacturers to data has been NHTSA's National Occupant Protection Usage Sur- install automatic restraints in new vehicles if two-thirds of the pop- vey (NOPUS). The results of period NOPUS surveys have been ulation was covered by mandatory SBU laws (with specific mini- summarized in a number of reports issued by the National Center mum requirements). TSN was the primary stimulus behind the leg- for Statistics and Analysis (e.g., see NCSA, 1997 and 2001 and islative activity in nearly all of the States that enacted SBU laws Glassbrenner et al., 2004). after 1984. 19791981: Workshops in the States. The first phase of the revi- Most of these new SBU laws were secondary enforcement laws, talized efforts to increase SBU involved several series of regional as opposed to primary enforcement laws which allow a police offi- and State workshops initiated by NHTSA. These workshops, which cer to stop and/or ticket a driver for an observed violation of the involved representatives of State highway safety officials and key SBU law. This legislative "compromise" made such laws harder to advocacy groups, identified legislation as the most effective demon- enforce and diminished their impact to some extent, compared with strated means for increasing SBU. While one series of workshops, the impact of SBU laws in Australia and Europe. On average, States which focused on child passenger safety (CPS), was followed by that enacted SBU laws during this period experienced gains in their the introduction of a substantial number of CPS bills introduced SBU rate of more than 30 percentage points (Campbell et al., 1987, in the States, the focus on legislation in the SBU workshops was Dinh-Zarr et al., 2001). But these rates frequently declined to some more muted. These workshops focused more on non-mandatory extent within a year after the laws went into effect. NHTSA sup- approaches for increasing usage (i.e., public information, education, ported this legislative movement by providing funding for special and incentives) and on community and employer regulations and evaluations of these early laws. The Agency also continued to pro- policies to require SBU. This limited emphasis on legislation in the mote media, education, and incentive programs in the States. Dur- SBU workshops was in part due to previous actions by the Congress ing this period, the national SBU rate increased from 14% in 1984 (e.g., canceling the SBU law incentive program in 1974 and strong to 42% in 1987, a 28 percentage point (200%) increase (e.g., see language that accompanied this action) and, in part due to the fact Goodell-Grivas 1987, 1992).

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E-3 19871990: Diminished Legislative Activity and Recognition 19921996: Upgrades to State SBU Laws and STEP Demon- of a Need for Highly Visible Enforcement. By 1987, 37 States had strations. The 70% by '92 Program was followed by a period of enacted SBU laws. Seven additional States enacted such laws from reduced enforcement activity in the States as many State and local 1987 to 1990. As a result, national usage rate increased more mod- officials were still were not totally comfortable with highly visible estly, from 42% in 1987 to 49% in 1989. At this time, it was also clear SBU enforcement campaigns. NHTSA continued to support such that usage in the States with SBU laws (both primary and secondary) activity in the form of STEP demonstration programs in 1220 were not as high as the level achieved in foreign nations, particularly States over the next several years, but the level of implementation in Canadian provinces where highly visible enforcement efforts had was not as intense in most of these States as it had been in 1991 and resulted in much higher usage rates, some approaching 90 percent 1992, and generally not as intense as in the 1987 Elmira demonstra- (e.g., see Lonero and Pierce, 1981 and Dussault, 1990). In 1987, the tion. An NHTSA evaluation of these efforts found that an average Insurance Institute for Highway Safety (IIHS) reported on a highly of 5 waves of STEP enforcement resulted in large increases in pri- visible enforcement effort in Elmira, New York, which resulted in an mary law states (1617 percentage points) but much more modest increase in SBU from 49% to 77%, a 28 percentage point increase increases (56 percentage points) in secondary law states (Solomon (Williams et al., 1987). A similar study by NHTSA was conducted in et al., 1999). Albany and Greece, New York (Rood, 1987). These two demonstra- Several States (i.e., California, Louisiana, and Georgia) initiated tions, plus the results of Special Traffic Enforcement Programs a rather slow (and continuing) movement among secondary law (STEPS) in Canada, provided the stimuli for an increasing focus on States to upgrade their laws to allow for primary enforcement. On highly visible enforcement as an effective approach for increasing average, these upgrades resulted in relatively immediate increases SBU. During this period, there was also a growing recognition of in SBU of more than 10 percentage points Ulmer et al., 1994 and the need to upgrade existing secondary enforcement laws to allow 1997; and Preusser and Presser, 1997). for primary enforcement. During this period, a new method was introduced for measuring 19901992: Operation Buckle Down and the 70% by '92 Pro- SBU. In 1994, NHTSA implemented the first National Occupant gram. By 1990, there was still much opposition to buckling up. It Protection Usage Survey (NOPUS), which was a nationwide prob- was recognized that, if increased enforcement was a desired objec- ability sample to measure changes in SBU. According to NOPUS, tive, there had to be more effective communication regarding SBU the national SBU rate increased from 58% in 1994 to 61% in 1996 within the enforcement community. As a result an outreach and (e.g., see NCSA, 1997). communications program called Operation Buckle Down (OBD) 19962000: A Crisis Leads Results in a Call to Action and a was developed and implemented in the form of grants with States Reinvigorated Program. In early 1996, following the highly pub- to hire prominent members of the enforcement community (often licized child deaths associated with deploying passenger-side air retired police chiefs, sheriffs, or leaders in the State Patrol/State bags, there was a National "Call to Action" conference called by Police) to become SBU liaisons within the enforcement community. NHTSA, NSC, and the National Transportation Safety Board (NTSB) These officers were initially called OBD spokespersons and later to respond to these deaths. This conference and a subsequent meet- called Law Enforcement Liaisons (LELs). Their objectives were to ing of key stakeholders called by the Secretary of Transportation familiarize police officers with the benefits of safety belt use, to resulted in the formation of a broad coalition of automobile and increase SBU within the enforcement community, and to enlist the child seat manufacturers and suppliers, as well as several major support of enforcement agencies in State and local SBU campaigns. insurance companies. This coalition eventually came to be called The first national enforcement campaign was implemented dur- the Air Bag and Seat Belt Safety Campaign (AB&SBSC). Based on ing the summers of 1991 and 1992. It was called the "70% by '92" a review of the research literature (Nichols, 1996), the Campaign program and it focused on generating highly visible STEP enforce- adopted a 3-point multi-million dollar program to increase both ment programs, similar to campaigns in Elmira, New York, and in the SBU and CPS. The three primary components of this program were Canadian Provinces. Its stated objective was to reach 70% national (1) a media and education effort to move children to the rear seat; SBU by 1992 (from a baseline of approximately 49%). The program (2) support for primary law upgrades in secondary law States; and involved highly visible enforcement (and media) efforts surround- (3) implementation of twice-annual media and enforcement mobi- ing the three summer holidays (i.e., Memorial Day, Independence lizations (i.e., national STEPs) called Operation ABC--America Day, and Labor Day) in 1991 and 1992. National OBD conferences Buckles Children. Each subsequent mobilization resulted in the par- were held twice each year to maximize the energy and focus of the ticipation of a larger number of enforcement agencies across the program on a combination of enforcement and media activity. This nation, reaching more than 10,000 agencies pledged to participate program generated unprecedented SBU enforcement and media by November 2000. activity in the States and it resulted in an increase in SBU, although Also in 1996, the President signed an executive order that directed the magnitude of the increase is not absolutely clear due to a shift in the Secretary of Transportation to work with the Congress, the survey approach. Using NHTSA's 19-city survey, usage increased States, and other concerned groups, including the automobile and by 2 percentage points in the first year (from 49% in 1990 to 51% in insurance industries and safety and health groups, to develop a new 1991) but, using a population-weighted average of state surveys, plan to increase SBU nationwide. This effort ultimately resulted in usage increased by about 6 percentage points (from 53% to 59%) the National Buckle-Up America (BUA) program, administered by during that period. Gains in 1992 were somewhat smaller, increas- NHTSA. It represented an ambitious new effort with the goal of ing from 59% to 62%, according to the weighted aggregate of state increasing SBU from 68% in 1996 to 85% by 2000, a 17 percent- surveys (the 19-city survey was discontinued in 1991). Overall, the age point increase. The four elements of the BUA program were state-survey aggregate indicated that SBU increased by 9 percent- (1) public-private relationships; (2) enhanced legislation; (3) high age-points from 1990 to 1992, the second largest increase in U.S. visibility enforcement; and (4) effective public education. One exam- history (Nichols, 1993). ple of the increased emphasis on public-private relationships

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E-4 involved cooperation with the AB&SBSC in the implementation of Click It or Ticket mobilization. As a result of these efforts, there have its media and enforcement efforts. been significant increases in both public awareness and SBU in par- Finally, another very important event of this period was the re- ticipating States. Evaluations of these programs generally found authorization of funding for transportation in 1996. In this bill (Sec- statewide SBU increases of 810 percentage points associated with tion 157, Title 23, U.S. Code), Congress not only provided substan- these programs (e.g., see NHTSA [2001] regarding the South Car- tial rewards for States that achieved high SBU rates, it also provided olina CIOT in 2000; Solomon [2002] regarding the CIOT effort in additional funding, in the form of "innovative" grants, for States to eight Southeastern States in 2001; Solomon et al., [2002] regarding improve their SBU rates. NHTSA immediately began to steer these fully implemented STEPs in 12 States across the nation in 2002; and funds into State grants for combined media and enforcement efforts Compton and Solomon [2004] regarding the nationwide CIOT to support the ongoing Operation ABC mobilizations. As this effort mobilization in 2003). These increases in SBU have generally been progressed, an increasing number of States began implementing more associated with significant increases in awareness of SBU messages, intense and visible enforcement efforts, organized at the State level, enforcement, and slogans (Milano et al., 2004). but coordinated with the national mobilizations. Associated with the above efforts, the national SBU rate rose from Associated with these and other activities, including secondary- 71% in 2000 to 79% in 2003. The greatest increase (4 percentage to-primary law upgrades in Indiana, Alabama, Michigan, and New points) took place in 2003 when most States participated in the Jersey, the national SBU rate increased by 10 percentage points dur- national CIOT mobilization (Glassbrenner et al., 2004). ing this period, from 61% in 1996 to 71% in 2000 (NCSA, 2001). 2004: The Current Program. Recently, NHTSA reviewed all Although this increase did not meet the ambitious goal of 85% SBU potential efforts for increasing SBU and created a new strategic plan in 2000, it represented steady progress over the period and this which focuses on continued efforts to conduct high visibility enforce- progress was associated with State programs that were increasingly ment of safety belt use laws, development of a multi-year national focused on highly visible enforcement and were increasingly coor- communications effort that supports enforcement and other effective dinated with the twice annual Operation ABC mobilizations. means for increasing SBU, expanding its employer policies and reg- 20002003: A Refocus on Click-It or Ticket and on Primary ulations to increase employee SBU; and improving the comfort and Laws. There are several important aspects of the SBU effort since convenience of safety belt systems. year 2000 that have been associated with increasing SBU across the Although tracking safety belt usage rates continues via the nation. One of the most important characteristics of this period is the NOPUS, there is also a new metric for tracking progress. It is called continued evolution of highly visible STEP programs with increas- the conversion rate and it refers to the percent of SB non-users con- ing emphasis on paid media and "hard" enforcement messaging in verted to SB users each year or by each campaign effort. Assuming the twice annual national Operation ABC mobilizations. This phase an 8.5% conversion rate of non-users to users, NHTSA projects an of the mobilizations actually began with the implementation and 81% SBU rate by 2005 and an 88% rate by 2010. evaluation of the South Carolina Click It or Ticket (CIOT) program Perhaps the most important unfinished business with regard to in the fall of 2000. However, it was not until later that multiple states implementing a maximally effective program to increase SBU is the adopted similarly intense and visible enforcement efforts in con- enactment of primary enforcement laws in all states. Without such junction with Operation ABC. In 2001, eight southeastern States laws, a national usage rate above 80 percent will be very hard to fully adopted the Click It or Ticket model; in 2002, more than a achieve. Currently, 21 States plus the District of Columbia and dozen States in geographically dispersed regions implemented sim- Puerto Rico have such laws. That means upgraded legislation is ilar programs; and, in 2003, the majority of States across the nation needed in 28 States with secondary laws and in New Hampshire, participated in the national mobilization which was renamed the which has no adult safety belt law. TABLE E-1 Program efforts and phases associated with overall increase in SBU Period Activity SBU Change Measurement 19781981 SBU Workshops with the States none n/a 19811984 Outreach and Education 11% to 14% 19-city Survey 19841987 Rapid Expansion of SBU Laws 14% to 42% 19-city survey (Vince and Larry Campaign) 19871990 Declining Expansion of SBU Laws 42% to 49% 19-city survey (Vince and Larry Campaign) 19901992 Highly Visible Enforcement 53% to 62% State Survey (Vince and Larry Campaign) Aggregate 19921996 Modest increase in Primary Laws relatively flat State Surveys Modest STEP activity NOPUS (Vince and Larry Campaign) Many changes in measurement 19962000 Modest increase in Primary Laws 61% to 71% NOPUS National Enforcement Mobilizations 20002003 Greatly enhanced Enforcement 71% to 79% NOPUS and Paid Media Efforts; Modest Increases in Primary Laws

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E-5 In Summary, progress has been made relative to increasing SBU 319, National Center for Statistics and Analysis, Washington, from 11% in 1978 to 79% in 2003. Most of this increase has been D.C., August 2001. associated with the enactment of SBU laws and with highly visible Goodell-Grivas, Inc. Restraint System Use in the Traffic Population. enforcement and media programs in support of these laws. Other U.S. DOT HS Technical Report No. 806-424, National Highway programs, such as public information, education, and incentives Traffic Safety Administration (earliest rates) Washington, D.C., appear to work best in an environment of enforced SBU laws. Table May 1983. E-1 is an abbreviated list of the program efforts and phases that have Goodell-Grivas, Inc. Restraint System Use in the Traffic Popula- been associated with the overall increase in SBU. tion. U.S. DOT HS Technical Report No. 807-080, National Post Script: The "Vince and Larry" (V&L) media campaign has Highway Traffic Safety Administration, Washington, D.C., been included in several of the above phases because, throughout March 1987. much of the 1980s and 1990s, this public service campaign, man- Haseltine, P. W. Seat Belt Use in Motor Vehicles: The U.S. Expe- aged by the Ad Council, was a central part NHTSA's occupant pro- rience. Summit Report. Automotive Coalition for Traffic Safety, tection program. As such, it has been suggested at times that this Inc., Arlington, VA, 2001. popular campaign may have been a key factor in the increase in Hunter, W. W., Campbell, B. J., and Stewart, J. R. "Seat Belts Pay SBU from 1981 through 1995. However, a review of changes in off: An Evaluation of a Community-wide Incentive Program." SBU suggests that increases at the State level corresponded with Journal of Safety Research, Vol. 17, 1986, pp. 2331. changes in legislation and/or enforcement efforts and not necessar- Livingston, C., Fee, D., Knaff, R., Ziegler, P., Nichols, J., Trilling, ily with the presence of the V&L program (which was relatively D., Voas, R., and Womack, J. Task Force Report on Safety Belt continuous over time). This program is likely one of the very best Usage Laws. U.S. Department of Transportation, National examples of a popular and visible public service effort and, as such, Highway Traffic Safety Administration, Washington, D.C., it is possible that it contributed to the visibility and acceptability of 1978. the overall program. However, it is unclear whether this public ser- Lonero, L. P., Gardner, N., Pang, H., Pierce, J., Toomer, M., and vice program, in the absence of more powerful activities, resulted Young, P. Evaluating the Effects of Seat Belt Information and Leg- in significant increases in SBU. islation in Ontario. Proc., 1976 International Symposium on Occu- pant Restraints. American Association for Automotive Medicine, 1976. REFERENCES Lonero, L. P., and Pierce, J. A. History and Evaluation of Seat Belt Legislation in Ontario. Proc., International Symposium on Occu- American Seat Belt Council. Safety Belt Use Abroad. Washington, pant Restraints. American Association for Automotive Medi- D.C., 1996. cine, 1981. Campbell, B. J., Stewart, J. R., and Campbell, F. A. 19851986 Milano, M., McInturff, B., and Nichols, J. L. "The Effect of Earned Experience with Belt Laws in the United States. University of and Paid Media Strategies in High Visibility Enforcement Cam- North Carolina Highway Safety Research Center, Chapel Hill, paigns." Journal of Safety Research, Vol. 35, 2004, pp. 203214. 1987. Motorists Information, Inc. Michigan Safety Belt Project. Detroit, Compton, R., and Solomon, M. "Exporting `Click it or Ticket' to MI, 1978. Other States." Journal of Safety Research, Vol. 35, 2004. National Center for Statistics and Analysis. National Occupant Pro- Dinh-Zarr, T. B., Sleet, D. A., Shults, R. A., Zaza S., Elder, R. W., tection Use Survey-1996 Controlled Intersection Study. Nichols. J. L., Thompson, R. S., and Sosin, D. M. "Reviews of Research Note. National Highway Traffic Safety Administration, Evidence Regarding Interventions to Increase Use of Safety U.S. Department of Transportation, Washington, D.C., August Belts." American Journal of Preventive Medicine, 21 (4S), 2001, 1997. pp. 4865. National Highway Traffic Safety Administration. Evaluation of Dussault, C. "Effectiveness of a Selective Traffic Enforcement Pro- South Carolina's Click-It or Ticket Program, National Highway gram Combined with Incentives for Seat Belt Use in Quebec." Traffic Safety Administration, U.S. Department of Transporta- Health Education Research, Vol. 5, 1990, pp. 217223. tion, Washington, D.C., 2001. Fabry, R. "Campaign Case History: Seat Belts 1971." Department Nichols, J. L. Increasing Safety Belt and Child Seat Usage to Prevent of Environment, London, United Kingdom, 1973. Deaths and Injuries to Unrestrained and Improperly Restrained Edvardsson, K., and Degermark, M. The Use of Seat Belts in Motor Vehicle Occupants. Background paper for Safety Belts, Air Vehicles in Sweden, 197175: Effects of Campaign and Legisla- Bags, and Passenger Safety: A Call to Action Conference, tion. Report Number 35, Swedish Road Safety Office, Analysis National Highway Traffic Safety Administration. Washington, Office, Stockholm, Sweden, 1976. D.C., January 1617, 1996. Fleischer, G. A. "A Study of the Effectiveness of a Radio/TV Cam- Nichols, J. L. (1993). Results of the 199192 Campaign to Increase paign on Safety Belt Use." Journal of Safety Research, 5(1), 1973. Safety Belt Usage. Paper presented at the Second World Confer- Geller, E. S. (1982). Corporate Incentives for Promoting Safety Belt ence on Injury Control. Atlanta, GA, May 2023, 1993. Use: Rationale, Guidelines, and Examples. U.S. DOT HS Tech- Nichols, J. L. Effectiveness and Efficiency of Safety Belt and Child nical Report No. 806-389, National Highway Traffic Safety Restraint Programs. National Highway Traffic Safety Adminis- Administration, Washington, D.C., 1982. tration, U.S. Department of Transportation, Washington, D.C., Glassbrenner, D., Cara, J., and Nichols, J. L. "Recent Estimates of May 1983. Safety Belt Use." Journal of Safety Research, Vol. 35, 2004. Oakland County Traffic Improvement Association. A Report on the Glassbrenner, D., and Utter, D. Observed Shoulder Belt Use from the Activities and Measured Effectiveness of a Public Education Pro- June 2001 Mini NOPUS. U.S. DOT HS Research Note No. 809- gram for Safety Belt Use. Oakland County, Michigan, 1969.

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