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8 analyzed a total of 139 articles each (this includes duplicate the work done by Geller and others indicating that incentives articles) during their research. The final synthesis of these and stronger enforcement techniques are most effective. articles resulted in a differentiation between the short- and Research conducted by Boyce and Geller (1999) on what is long-term effects of incentive tools. As might be expected, termed a multiple intervention level (MIL) hierarchy found there were found to be substantial increases in usage of safety that there was a modest increase in safety belt use with the belts during the immediate time after an incentive was offered promise-card commitment strategy (a driver signs a card com- and/or received. Long-term effects, however, did not show mitting to future safety belt use) combined with an incentive/ the same results. During follow-up surveys of incentive pro- rewards strategy. The study overall indicated that repeated grams, there was still found to be an overall increase in safety attempts to change behavior using similar interventions (those belt use from the use rates before the incentive program. with the same level of intrusiveness) were not as effective at Finally, Herbal and Skopatz discuss the literature of and changing behavior which was unaffected by the first applica- practices for motivating safety belt use. More specifically, tion of the intervention. It is therefore necessary to progres- their research focused on two areas, the first was an exami- sively use more intrusive interventions if the initial attempts nation of employer influence on employee safety behavior are not effective. (regardless of regulatory efforts), and the second was a review Some recent research in the United States (Shults et al. of programs produced to help employers increase safety 2004) has indicated that states that directly enacted primary among their employees. They concluded that there were many laws (in which the driver is penalized for non-use) demon- motivating factors that could be used to compel employees to strated more safety belt use than those that relied on sec- use safety belts, but none stood out as the `best practice' ondary laws (in which the driver can only be penalized for method. non-use after a moving violation is witnessed). International studies have found that when individuals were personally prompted to wear safety belts they were more likely 2.4 BEHAVIOR-BASED SAFETY to do so than when more methods, other than personally Assuming that safety belt use can help prevent death and focused methods, were used (Gras et al. 2003). Studies con- reduce the severity of injuries that result during crashes, the lit- ducted in Greece indicated that similar issues manifested them- erature on safety practices suggests that BBS practices offer a selves when the non-use of safety belts was studied. In workplace an approach to positively reinforce desired behav- particular, the study by Chliaoutakis et al. (2000) found that ior. A detailed discussion of BBS in a commercial vehicle while legal requirements increased safety belt use, discomfort safety setting can be found in CTBSSP Synthesis 1 (Knipling, and miles traveled reduced safety belt use. Hickman, and Bergoffen 2003). A study of incentive programs and enforcement on mili- White and Washington (2001) found that enforcement tary bases in the Netherlands found that enforcement was a intensity was positively correlated with safety belt use. When more accepted countermeasure than rewarding drivers for enforcement covered a greater area however (lane miles of safety belt use. However, the caveat is that participants who enforcement coverage) safety belt use declined. Safety belt were receiving the incentive treatment had a more positive use was also higher in urban areas than in rural areas. These opinion of this program than those who were exposed to the findings were consistent with the other research that indicated enforcement treatment (Hagenzieker 1992). that safety belt use for strong non-users was reduced when A research study in Canada found that safety belt non-use drivers did not think they were being observed or their risk of was most common among drivers who (1) were younger and `being caught' is lower. It should be noted that a desire for male, (2) had high-risk health habits (e.g., drinking and driv- greater enforcement was indicated as something that would ing), (3) were speeding, (4) were smoking, (5) were living in increase safety belt use by CMV drivers who were inter- rural regions, and (6) had lower education levels (Sahai et al. viewed by this research team. 1998). A study of taxicab drivers, who are often exempt from safety belt laws, found that use rates were typically lower for these 2.5 RESEARCH ON SAFETY BELT COMFORT drivers than for the general population. When strong laws that AND USABILITY did apply to them were put into place, safety belt use increased dramatically among cab drivers. The study suggests that a The literature indicated that discomfort was one reason `punishment'/disincentive may be very effective in increasing some CMV drivers did not wear safety belts. Specific rea- safety belt use, where fear of losing a license may be the nec- sons included harness belt rubbing (especially when com- essary incentive to use safety belts (Ferguson et al. 1999). plicated by vibrations), tightness or looseness, and lack of Other studies have found that while any type of program mobility. Though many drivers indicated that the effective- had some effect on increasing safety belt use rates, law and ness of the safety belt would be decreased if changes were incentive programs produced the highest increase in use made, there was still a desire for a system that had greater (Johnston, Hendricks, and Fike 1994). This again supports levels of comfort.