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4Efforts to increase SBU in the United States began with the introduction of lap belts in a small percentage of vehicles in the 1950s. By 1968, such devices were required in the front seats of all new passenger vehicles. Beginning in the late 1960s and ex- tending into the mid-1980s, however, efforts to increase man- ual SBU competed with automatic occupant protection efforts, in the form of air bags and automatic safety belts. As a result of these competing efforts, progress in persuading motorists to buckle up may have been curtailed to some extent. Williams and Lund (1988) point out that rulemaking to require automobile manufacturers to install automatic crash protection was, to some extent, based upon a premise that motorists could not be convinced to buckle up. This approach sought to have automatic devices, such as air bags and/or au- tomatic safety belts, installed that would require no action by occupants of vehicles to buckle up. This rulemaking began in the mid-1960s, with a Notice of Proposed Rulemaking issued in 1970 [Federal Motor Vehicle Safety Standard (FMVSS) 208]. Over the next 15 years, this standard caused substantial con- troversy. It was debated heavily and delayed or altered several times. In 1981, the rule was cancelled by the National High- way Traffic Safety Administration (NHTSA). The U.S. Supreme Court then ordered that it be reconsidered. The issue was finally resolved by a compromise rule issued by Secretary of Transportation Elizabeth Dole in 1984. While initial efforts to obtain SBU laws in the 1970s were un- successful, a 1976 Highway Safety Needs Report found that in- creasing SBU was the single most effective (and cost-effective) countermeasure that could be deployed to forestall deaths and injuries associated with motor vehicle crashes (U.S. Depart- ment of Transportation, 1976).2 This report was followed in 1977 by a NHTSA project to develop a compendium of known methods for increasing manual SBU3 and by a series of NHTSA workshops with the states (and its regional offices) in 1979, 1980, and 1981. As a follow-up, a national conference was held in 1982 to consolidate the findings of the workshops and to provide additional impetus to efforts to increase SBU (and re- duce alcohol-related deaths).4 Unfortunately, increasing SBU proved to be a difficult task, as it took more than 25 years to reach the current na- tional usage rate of just over 80%. Reviews by J. L. Nichols (2002) and by J. H. Hedlund (2006) have suggested that the strongest evidence of impact resulted from a combination of mandatory SBU laws, primary law upgrades,5 and highly visible enforcement. This combination of activity has been associated with most of the increases in SBU documented since 1983. However, even at the relatively high rates of observed usage in recent years, many high-risk motorists, including drinking drivers, those on the road during late-night hours, young males, drivers with violations and crashes on their record, and occupants involved in serious crashes still do not buckle up. Future efforts to reduce fatalities and injuries involving C H A P T E R 1 Background measures. For example, it reported that the top-ranking countermeasure (mandatory SBU) was 15,000 times more cost effective as the lowest ranking countermeasure (roadway alignment and gradient). 3Safety Belts: The Uncollected Dividends was a manual including methods for increasing SBU that was developed for NHTSA in 1977 and 1978 by the Highway Safety Research Center of the University of North Carolina. The information in this manual provided the basis for regional safety belt workshops held with the states in 1979. 4This conference, held in Detroit, Michigan, in 1982, became the first Lifesavers Conference. 5Primary law upgrades provide police officers with the authority to stop a vehicle and issue a citation solely on the basis of an observed safety belt violation. Such laws contrast with secondary safety belt laws, which require an officer to first observe some other traffic law violation before stopping a motorist for safety belt nonuse. 2This study was based upon a combination of state-of-the art informa- tion regarding the effectiveness and costs associated with counter- measures along with a Delphi Panel of 103 safety managers, planners, evaluators, and researchers. It found large differences in the costs and potential for reducing deaths and injuries among 37 identified counter-
5unrestrained occupants will need to focus on such high-risk motorists, particularly at night when many of these high-risk motorists are on the roadway. Figure 1 shows national SBU in the United States from 1979 through 2006, along with the cumulative number of state SBU laws and the number of primary (standard) en- forcement laws in effect during this period. Three time peri- ods are identified, during which national usage increased from less than 15% to more than 80%. They include: 1) a pre- law period, when only voluntary approaches were being pur- sued; 2) an initial law period, during which most state SBU laws were implemented; and 3) a combined upgrade and en- forcement period, during which 18 secondary laws were up- graded to allow for standard/primary enforcement and HVE was implemented to increase usage.7 As this figure suggests, Law Upgrades & Enforcement 0 10 20 30 40 50 60 70 80 90 19 79 19 81 19 83 19 85 19 87 19 89 19 91 19 93 19 95 19 97 19 99 20 01 20 03 20 05 Primary Laws Secondary Laws Observed Safety Belt Use Initial SBU LawsVoluntary SBU Laws (#) Observed Use (%) Figure 1. Observed SBU rates in the United States: 1979â2006.6 Sources: 19 city surveys, aggregate of state surveys, National Occupant Protection Use Survey (NOPUS). Indiana (1998), Alabama (1999), Michigan (2000), New Jersey (2000), Washington (2002), Delaware (2003), Illinois (2003), Tennessee (2004), South Carolina (2005), Mississippi (2006), Alaska (2006), and Kentucky (2007). 8The greater effectiveness of mandatory approaches over voluntary ap- proaches is consistent with the documented experiences of Australia, European nations, and Canada as well. 9Hardware approaches, such as safety belt interlock devices; visual and auditory reminder systems; and the improved comfort and convenience of safety belt systems have also played an important role in terms of in- creasing SBU. legislation and enforcement have been closely associated with increases in observed SBU in the United States.8 One objective of this report is to summarize the character- istics and effectiveness of various mandatory approaches to increase SBU, both observed and among fatal crash-involved occupants. Another objective is to relate these findings to the current environment in which many states already have pri- mary laws, most states have been conducting periodic waves of HVE, and some states have observed usage rates above 90%, all in an environment of relatively low penalties. This review begins with the impact of initial SBU laws.9 6 National usage is estimated using data from a variety of sources in- cluding NHTSAâs 19-city surveys (1979â1991); a weighted aggregate of statewide survey results (1992â1993), and NHTSAâs NOPUS (1994â2006). The number of states with SBU laws is derived from a review of SBU legislation by Nichols and Jones (under review). The number of laws and primary laws in effect excludes those in Puerto Rico (primary law in effect in 1975) and the District of Columbia (sec- ondary law in effect in 1986, primary law in effect in 1997). 7Eighteen upgrades were implemented from January 1993 through Jan- uary 2007. They included: California (1993), Louisiana (1995), Georgia (1996), District of Columbia (1997), Maryland (1997), Oklahoma (1997),
