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22 CHAPTER 7 Using this Guide The overall goal of this project is to help states allocate 1. Identify Proven Injury their money effectively. This chapter summarizes the infor- Reducing Countermeasures mation developed thus far into guidelines for doing so, as That Can Be Implemented follows: There are 23 countermeasures that are rated as Proven 1. It is critically important to focus on countermeasures that and for which injury reduction estimates are available have been proven to be effective (i.e., Proven countermea- (see Appendix B). Any of these measures that have not sures); that can be accomplished within existing financial yet been implemented in a given state should be consid- and political constraints; and that will provide the greatest ered first for inclusion in a state's highway safety plan. benefit/cost return on invested resources. The countermeasures in this Proven classification are as 2. It is appropriate to examine those countermeasures that follows: are judged Likely to be effective, even though there may not yet be firm evidence that they reduce crash injury. Some of 1. School pedestrian training, these may be quite appropriate for inclusion in your high- 2. Booster seat programs, way safety plan, although it may be necessary to conduct 3. Bike helmet law for children, additional evaluations of their effectiveness, since cur- 4. Motorcycle helmet use law, rently available data are not definitive. 5. Primary seat belt law, 3. To the extent possible, a state should avoid countermea- 6. Short, high-visibility belt law enforcement, sures that are unlikely to be effective or for which the 7. GDL, effects are unknown (i.e., Unknown/Uncertain/Unlikely 8. Extended learners permit, effective countermeasures). This will be quite a challenge 9. Night restrictions for young novice drivers, since nearly half of the 104 listed countermeasures are in 10. Passenger restrictions for young novice drivers, this category. To the extent countermeasures in this 11. Administrative license revocation, group are considered, priority should be given to those 12. Mass media in support of alcohol (or other) enforcement, with plus (+) ratings, indicating there is some basis sug- 13. Mandatory attendance at alcohol treatment programs, gesting they may work, although not enough to place them 14. Sobriety checkpoints, in the Likely group. 15. Alcohol safety interlocks, 4. It is important to stay away from measures that are 16. Multi-component community programs to address under- known to have negative consequences (i.e., those Proven age drinking, Not to Work). This may also be difficult due to commonly 17. Speed cameras (automated speed enforcement), accepted views of such actions (e.g., providing driver ed- 18. Red-light cameras (automated red-light enforcement), ucation as a more expedient way to license young novice 19. License suspension, drivers). 20. Individual meetings for traffic violators, 5. A state may want to explore newly developing, innovative 21. Group meetings for traffic violators, countermeasures that are untried. Guidelines are suggested 22. Warning letters for traffic violators, and for how to assess such new countermeasures. 23. Reduced speed limits (for pedestrian safety).

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23 It is recognized that it may not be feasible to implement Another issue that must be considered in selecting Proven some of these measures at the present time. There may be countermeasures is how long the program must be maintained political, legal, or financial constraints that make current to be effective or cost effective. This is a major consideration implementation difficult, if not impossible. Alternatively, im- for some of the programs in the Laws Plus Enhancements plementation may not be possible at the present time because Group. For example, sobriety checkpoints are a proven tech- the likely quality or intensity of activity that your state can pro- nique, but to work they have to be sustained over time. If vide is not sufficient to fully implement the countermeasure. checkpoints are run for just a short period of time, such as For example, in the Voluntary Action Group, booster seat during a single holiday period, they are likely to have little or promotions and parent management programs are rated as no long-term effect. Short-term media bursts to supplement Proven, but this rating is based on programs that are of very laws also have very limited effects. high quality. Successful programs in these areas have been In establishing an effective countermeasure program quite sophisticated, involving techniques associated with (and selecting countermeasures for that program), it is also more effective PI&E programs (e.g., interactive methods, in- important to take advantage of favorable trends. Graduated puts from multiple sources, long-term programs, financial licensing provides a good example of a trend that is both incentives, etc.). Lesser-quality programs that are short term, popular and effective at the present time. Research is now avail- or that are based on didactic approaches or posters in schools, able that has established the importance of the core elements for example, are not likely to increase booster seat use, or to of graduated licensing (extended learner permit, night and influence parents to better manage their teenagers' driving passenger restrictions, are all rated Proven). Some states do not practices. In general, every PI&E program proposed, whether have these provisions or have weak versions of them. Estab- it is used alone or in conjunction with other measures, needs lishing or upgrading the key provisions of GDL is an impor- careful formative evaluation and development to ensure that tant step forward. Because of the current trend of activities it is of sufficiently high quality and that it is based on behav- and public support, this may be an opportune time for a state ior change principles. to assess and upgrade its novice driver GDL program. There is a second-level judgment to be made as well. PI&E Some countermeasures are both highly cost effective and programs that work tend to have high development and highly controversial. Automated speed and red-light enforce- implementation costs, and one consideration in funding such ment provides a case in point, especially in reference to programs is whether or not they are intended to be repeated. speed cameras. Controlling high speeds is an important goal, For example, a booster seat program run one time in one and speed cameras are a proven countermeasure in accom- community may increase use, but can it be repeated and/or plishing this goal. It is important to note, however, that sustained, and is it a program that other communities can community programs involving camera technology can be adopt? This is somewhat of a Catch-22 situation, because in designed in ways that are publicly acceptable. Such programs order to work, such a program may have to be so extensive and exist in Scottsdale, Arizona; Charlotte, North Carolina; and thorough (with associated costs) that it is outside the reach of Montgomery County, Maryland, and can be used as models. other communities. On the other hand, there are more modest General guidelines also are available for conducting speed- PI&E programs for children, such as the Willy Whistle pro- control programs that are effective and acceptable, using such gram for teaching young children how to cross streets, that techniques as focusing on "extreme" speeders and speeding have modest costs associated with them and could readily be in school zones (Harsha and Hedlund, 2007). applied in school systems across the state. Still, it should Some highly effective countermeasures simply may not be be remembered that the savings associated with effective possible given existing state law or political climate. Sobriety programs are substantial and that high-cost programs checkpoints, for instance, are not legal in some states, and that produce substantial effects can be a stimulus for other a motorcycle helmet law or a primary seat belt law simply such programs. There have been demonstration programs, may be out of reach given the current legislature. for example, that have had high costs but that have also be- The result of this process will be the selection of Proven come models for other, often large-scale, effective efforts. For countermeasures for inclusion within the state's highway example, the seat belt enforcement program in Elmira, New safety plan that can be accomplished within the political, York, was a high-cost effort, but it demonstrated that vigor- legal, and financial conditions that currently exist within ous enforcement of belt use laws could be done with high the state. In addition, to be effective, the state must recognize public acceptance. This paved the way for the North Carolina that these countermeasures must share two characteristics: CIOT Program and eventually led to the nationwide launch (1) that they can be implemented; and (2) that they can be of high-intensity belt use enforcement programs (i.e., the implemented to the level necessary to achieve crash and in- national CIOT mobilizations). jury reduction.