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1 SUMMARY Effectiveness of Behavioral Highway Safety Countermeasures The goal of this project is to assist states in selecting programs, projects, and activities that have the greatest potential for the reduction of highway death and injury. The specific objectives are as follows: Produce a manual for application of behavioral highway safety countermeasures and develop a frame- work and guidance for estimating the costs and benefits of emerging, experimental, untried, or unproven behavioral highway safety countermeasures. There are 104 countermeasures in Countermeasures That Work: A Highway Safety Counter- measure Guide for State Highway Safety Offices (NHTSA, 2007b). Of these, 34 have been "proven" effective. These countermeasures should be implemented whenever feasible, practi- cal, and politically acceptable. Many involve little direct cost either because the primary effort involves passage of a law (e.g., universal mandatory motorcycle helmet law, bicycle helmet law for children, primary seat belt law, graduated driver licensing) or because they are revenue neu- tral "user pay" (e.g., alcohol interlock, speed cameras, and red-light cameras). Some counter- measures rated Proven do involve direct costs for their implementation. Benefit/cost calcula- tions indicate that most will produce a positive benefit/cost ratio for most states (e.g., booster seat promotions, sobriety checkpoints, short-term high-visibility belt use enforcement). Estimated effectiveness for 54 of the 104 countermeasures is rated as Unlikely/Uncertain or Unknown. Three countermeasures have actually been shown to have negative conse- quences. All of these countermeasures should be avoided at least until more evidence becomes available. In between the Proven countermeasures and the Unlikely/Uncertain/Unknown, fall 13 countermeasures that are believed "likely" to work but for which evaluation evidence is not yet available, as well as emerging and developing countermeasures that have not yet been fully implemented, let alone evaluated. This report provides the following classification scheme to estimate the effectiveness of these measures: 1. Voluntary action (countermeasures that are designed to train, educate, or request some behavior); 2. Law or regulation (require the behavior); 3. Laws plus enhancements (high-visibility enforcement of the law); and 4. Sanctions and treatments of offenders. Guidelines are presented for estimating when countermeasures within each of these clas- sifications are likely to be cost effective.