July/August 2005 · Vol. 69 · No. 1

July/August 2005

Motivating Teens to Buckle Up
by Daniel Berman

Researchers in Rhode Island are promoting increased seatbelt use among high school students.

According to the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention, motor vehicle crashes are the leading cause of death for 15- to 20-year-olds in the United States. The U.S. Department of Transportation's National Highway Traffic Safety Administration (NHTSA) reports that teenagers have the highest fatality rate in motor vehicle crashes of all age groups. In 2001 teens accounted for 10 percent of the U.S. population, but 13 percent of motor vehicle deaths.

One of the simplest steps that teens can take to prevent this needless loss of life is to fasten their seatbelts, whether they are passengers or drivers. A 2004 survey conducted by NHTSA found that the seatbelt usage rate for 16- to 24-year-olds was 77 percent (up from 69 percent in 2002), compared to the national average of 80 percent. Research on passenger cars has shown that seatbelts reduce the risk of fatal injury to front-seat occupants by 45 percent and the risk of injury by 50 percent.

A URITC researcher counts cars with drivers and front-seat passengers wearing their seatbelts.

Finding effective ways to encourage teenagers to buckle up was the impetus for a recent study on seatbelt use among high school students in Rhode Island. The State's overall seatbelt use rate was 74 percent in 2003 (as reported to NHTSA for national survey data), up from 63 percent in 2001, but still below the national average. One problem was a lack of data on students' seatbelt use and attitudes toward buckling up among Rhode Island teens.

A north Kingstown High School, shown here, researchers from URITC conducted student surveys and observational behavior studies to assess seatbelt usage among Rhode Island teenagers.

"We had very little information about seatbelt use among high school students," says Dr. Jerome Schaffran, a professor of human development and family studies at the University of Rhode Island. "Because Rhode Island is small, we decided to see if we could gather enough surveys to develop good baseline information about seatbelt use among teens and begin to develop interventions to raise the rate."

Rhode Island Seatbelt Survey We are conducting an anonymous study of high school seatbelt usage. The survey is completely confidential. What grade are you in? 9th grade 10th grade 11th grade 12th grade What is your gender? Male Female When driving/riding in a car (truck or van), do you wear your seatbelt? Yes No When was the last time you did not wear your seatbelt when in a car (truck or van)? Today Within the past week Within the past month Within the past 12 months A year or more ago/I always wear it Are you more likely, less likely, or just as likely to wear your seatbelt when driving with friends as compared to driving alone? More likely Just as likely Less likely Why are you less likely to wear your seatbelt when there are others in the car? I'm worried what my friends will think I'm only driving a short distance There are not enough seatbelts in the car I ride in the back seat I always wear a seatbelt In the past 12 months, has your use of seatbelts increased, decreased, or stayed the same? Increased Decreased Stayed the same What will increase your usage of a seatbelt? (Check all that apply) Becoming more aware of safety issues Becoming aware of the seatbelt law Fear of getting a ticket Getting a seatbelt ticket Someone you know was in a crash Other people encouraging you to use a seatbelt Other

Conducting the Survey

Armed with a grant from NHTSA, representatives from the University of Rhode Island Transportation Center (URITC), the Rhode Island Department of Transportation, and the Federal Highway Administration (FHWA) collaborated to conduct a survey of seatbelt use among high school and college students in Rhode Island.

The URITC researchers developed a survey tool based on the one that NHTSA uses nationally to collect data on seatbelt use. Building the survey on the NHTSA model would facilitate a loose comparison between the Rhode Island responses and those at the national level. (Note: The Rhode Island observation survey used a different sampling strategy than the NHTSA survey, which used randomly selected locations across a range of demographics and road types.)

Between February and April 2004, the survey team obtained more than 15,000 completed paper surveys from students at 29 high schools, representing about one-third of the State's high school population. Homeroom teachers handed out the eight-question survey, and the students spent an average of 1 minute answering the multiple-choice questions. The teachers returned the completed surveys to URITC for processing. The survey team also received more than 3,200 similar electronic surveys from students at five Rhode Island colleges.

To verify the results of the paper surveys, researchers conducted observational studies in parking lots at 13 high schools during the morning arrival period between February and April 2004. Pairs of observers recorded shoulder belt use for drivers and front-seat passengers. They also noted the vehicle type and the gender of the driver and passenger. Researchers also conducted an observational survey at one college.

Analysis of the Survey Data

The researchers concluded that 69.5 percent of Rhode Island high school students actually wear seatbelts, factoring in full- and part-time users.

Overall, 83 percent of the students indicated on the self-report survey that they use their seatbelts. But on a followup question, 13.5 percent of reported seatbelt users said they did not wear a seatbelt that day. Reducing the reported usage rate by the percentage for "today's nonuse," the researchers established the State average for teens at 69.5 percent.

The reported use rates were similar among males (82.9 percent) and females (83.6 percent). Results from the observational surveys, however, found that male drivers scored significantly lower than females in seatbelt use, ranking 68.4 percent and 79 percent, respectively.

At the high schools where researchers conducted observational studies, the average observed rate for seatbelt use was 73.7 percent, 9.1 percent less than the reported rates at those schools. When the study team compared the observed rate to the reported rate (minus the percentage for "today's nonuse") or 71.9 percent, the rates differed by about 2 percent.

Specific Results

Juniors reported the highest percentage of seatbelt use among high school students at 85.6 percent. In Rhode Island, the junior year is when most students take driver's education and apply for a driver's license.

"We were surprised that younger kids reported not buckling up as often as juniors," Schaffran says. "We thought that freshmen and sophomores would buckle up more because they come to school with their parents."

Three of the survey questions were about the effect of peer pressure on students' seatbelt use. When asked if they are more likely, less likely, or just as likely to wear a seatbelt when driving with friends compared to driving alone, 67.6 percent reported that they are just as likely to buckle up. Only 11.9 percent said they would be less likely.

Just as older students are more likely to wear their seatbelts in general, peer pressure seems to affect usage less as students advance in grade. Although 63.3 percent of ninth graders reported that they were just as likely to fasten their seatbelts when friends are in the vehicle, the number rose to 72.8 percent for 12th graders.

Students reported that the number one reason that they are less likely to wear a seatbelt is if they are traveling a short distance (17.5 percent of respondents). When the same information was evaluated by grade, ninth graders were the most likely to cite that reason, with a response rate of 22.6 percent.

When asked what would increase their seatbelt use, 44 percent reported that knowing someone in a crash would influence them. Thirty-seven percent answered that fear of getting a ticket for not buckling up would be enough reason to wear a seatbelt. A statewide "Click It or Ticket" campaign, which informs motorists that failure to buckle up could result in a substantial fine, was ongoing during the survey.

The URITC researchers surveyed college students as well, because they, like high school students, are in a major stage of social development. The researchers found that 90 percent of the students who responded to the electronic survey reported that they wear seatbelts. The actual average observational usage rate—determined from a study at the University of Rhode Island—was only 70.5 percent.

Similar to the high school students surveyed, college students' seatbelt use improves as they age and mature. Freshmen reported the lowest use at 80 percent, while graduate students reported 97 percent usage. College students also cited driving a short distance as their top reason for not wearing a seatbelt.

When asked what would encourage them to increase their seatbelt use, 25.4 percent of college students said knowing someone in a crash. Although that response garnered the highest percentage rate among college students, it was significantly less than the 44 percent reported by high school students.

Promoting Behavioral Change

The next step for the URITC researchers is to design and test initiatives that schools can use to promote healthy behavioral changes. "Now that we have some information, we can begin to develop interventions," Schaffran says.

To plan effective initiatives, the researchers are applying what is known as the Transtheoretical Model of Change, which describes how people modify a problem behavior or acquire a positive behavior by going through stages of change. Developed in the 1980s by Dr. James O. Prochaska and his colleagues with the Cancer Prevention Research Center at the University of Rhode Island, the model has served as the foundation for developing interventions to encourage a variety of behavioral changes, including quitting smoking, losing weight, or using sunscreen to prevent skin cancer.

The model's central feature is the identification of stages that define where individuals are in the continuum of the change process. The stages are precontemplation, contemplation, preparation, action, and maintenance. In the case of seatbelt usage, those in the earliest stage—precontemplation—are unaware or unconcerned about the benefits of using seatbelts. Students in the next stage, contemplation, are aware that not using a seatbelt is a risk, but still do not buckle up.

In the preparation stage, students acknowledge that they want to change their behavior but do not wear seatbelts regularly. Students in the action stage report themselves as seatbelt users and only rarely fail to buckle up. At the maintenance stage, the students have adopted a consistent pattern of seatbelt use.

By applying the model to the data from the Rhode Island survey, researchers found that the highest percentage of students—36.1 percent—fell in the preparation stage, although 18.2 percent were still in the precontemplation stage.

The model can be applied to individual schools to identify the various stages of behavior change necessary to develop an effective program for interventions. If a high percentage of a school's ninth graders are in the precontemplation stage, for example, then a seatbelt initiative could be developed for use in freshman health classes.

Researchers are conducting focus groups at several schools to determine the types of interventions that would be most effective in influencing teens at various stages of change. "Since this is a choice behavior—buckling up or not buckling up—we want to find out what would tip them over the edge to buckle up more," Schaffran says.

Eventually, the research team plans to develop a program that schools can adopt to conduct their own focus groups and design targeted interventions. Student organizations, such as Students Against Destructive Decisions (SADD), student councils, and volunteer clubs, would conduct the focus groups and sponsor interventions.

"We want to help student advocacy groups generate ideas and initiate them the first year, and then let them take over from that point, with some adult supervision from teachers or counselors," Schaffran says.

Piloting Student Initiatives

So far, URITC researchers have worked with two high schools on pilot initiatives. At North Kingstown High School, students produced videos and showed them over the school's closed-circuit television system.

These two students are buckled up, representing community role models for consistent seatbelt usage.

Teacher Aaron Thomas requires students in his advanced communications class to do a community service project, and producing a 1-minute video on seatbelt use is one of the options. Before developing concepts for their videos, the students met with URITC researchers to learn about the survey.

"The kids were shocked at some of the survey results and the reasons [their peers] weren't using their seatbelts," Thomas says.

One video created by the students focuses on the chief reason teens do not wear seatbelts. In it, two students jump in a car and drive off without buckling up because they are going just a short distance. The screen fades to black with the sound of a car crash.

Another video features a North Kingstown police officer stopping a speeding car and noting that the fine will be even higher because the occupants are not wearing seatbelts. A video shown before the school's winter break includes a montage of students clicking their seatbelts in time to lively holiday music.

Although no followup surveys were conducted, Thomas reports that the videos appeared to have made students more conscious of the importance of seatbelt use. "If you see an ad on TV that isn't about anyone you know, you don't take it as seriously as one that has facts about your town and your State. It really hits home," he says.

Thomas believes the concept of making videos encouraging seatbelt use could translate easily to other schools. "Most schools have some type of video program," he says. "The kids like to see their work used, and it's a great way to learn how to do a public service announcement and promote a needed message."

Another pilot intervention was modeled after the "Click It or Ticket" program. At Narragansett High School, which had one of the lowest rates of seatbelt use among the schools surveyed, students handed out candy to peers arriving at school wearing seatbelts and fake tickets to those who failed to buckle up. Followup surveys showed that the incentive increased seatbelt use by 20 percent—but only for a short time, indicating the need to repeat successful approaches regularly.

A Model for Other States

The survey established baseline information that other researchers can use in ongoing efforts to develop targeted initiatives to increase seatbelt use among Rhode Island teens. By working with student groups to strategize ways to increase seatbelt use, the URITC research team—and eventually the schools themselves—can capitalize on students' abilities to influence their peers and encourage behavioral changes.

The research team also developed a model survey that other States or organizations could use to measure seatbelt use among teens and develop targeted initiatives to increase usage rates. "[Others] can certainly adapt the survey instrument we used," Schaffran says. "Once they have that baseline, they can start their own interventions and begin influencing behavioral change."

Ultimately, the goal in Rhode Island is to increase seatbelt use among teens to 90 percent or more, an accomplishment that would significantly lessen students' risk of death or serious injury on the State's roadways.

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Daniel Berman, assistant division administrator for the FHWA Rhode Island Division, collaborated on the seatbelt study as an executive in residence at URITC in 2004. During his 30 years at FHWA, Berman has worked in transportation engineering, planning, and management. In 1995, he won FHWA's Superior Achievement Award for his work as project manager for the Central Artery/Tunnel Project in Boston, MA. He has a bachelor's degree in civil engineering from Lamar University in Texas.

To view the report, Safety Belt Usage Rates at High Schools and Colleges in Rhode Island, visit www.uritc.uri.edu/media/finalreportspdf/2004_000318.pdf.

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Other Articles in this issue:

Direct User Charges

Making Trails

Preventing Roadway Departures

Motivating Teens to Buckle Up

Safety Scans—A Successful Two-Way Street

Where the Dowel Bars Are

Trans-Texas Corridor

Multistate Endeavor to Address Premature Pavement Distress

Looking to Load and Resistance Factor Rating

Achieving Concrete's Full Potential

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July/August 2005 · Vol. 69 · No. 1