"Flash for life": Community-based prompting for safety belt promotion

A community-based strategy for promoting safety belt use was field-tested in two adjacent rural communities, one populated by a preponderance of students, faculty, and staff of a major university. The intervention involved the front-seat passenger of a stopped vehicle displaying to the driver of an adjacent, stopped vehicle an 11 x 14 inch flash card that read, "PLEASE BUCKLE UP-I CARE." If the driver buckled up, the "flasher" flipped over the card and displayed the message, "THANK YOU." This flash card was shown to 1,087 unbuckled drivers; 82% of these drivers looked at the flash card and 22% of these complied with the buckle-up request. Compliance was not influenced by the age or gender of the "flasher" (young child vs. college student), nor by the gender of the driver; but significantly more drivers in the university town buckled up following the flash card presentation (25% mean compliance in the college town vs. 14% in the other community). To date, over 2,000 individuals have received a buckle-up flash card for their own use.     

Motivating signage prompts safety belt use among drivers exiting senior communities

Senior drivers are vulnerable to automobile crashes and subsequent injury and death. Safety belts reduce health risks associated with auto crashes. Therefore, it is important to encourage senior drivers to wear safety belts while driving. Using an AB design, replicated five times, we evaluated the short- and long-term effects of a sign with the message "BUCKLE UP, STAY SAFE" attached to a stop sign at the exits of five different senior communities. Safety belt use was stable during two pretreatment assessments averaged across the five sites and 250 drivers (72% and 68% usage), but significantly increased following installation of these signs (94% usage). Six months after installation of the signs, the effect persisted (88% usage). Use of such signs may be a cost-effective way of promoting safety belt use.     

A university-based incentive program to increase safety belt use: Toward cost-effective institutionalization

A cost-effective incentive program to increase safety belt use was implemented by the campus police of a large university. For each of the 3-week intervention periods during three consecutive academic quarters, the 22 campus police officers recorded the license plate numbers of vehicles with drivers wearing a shoulder belt. From these numbers, 10 raffle winners were drawn who received gift certificates donated by community merchants. Faculty and staff increased their belt usage markedly as a result of the "Seatbelt Sweepstakes," whereas students increased their belt use only slightly. A cost-effectiveness analysis indicated that the sweepstakes cost an average of $0.98 per each newly buckled driver. During each sweepstakes intervention, officers' belt usage increased significantly, but diminished to initial baseline levels after the final withdrawal of the program. Surveys of officers' opinions indicated that the police would accept the program demands as a regular task requirement. This result and the fact that program promotion and coordination were eventually taken over by two student organizations suggest that institutionalization of the "Seatbelt Sweepstakes" is feasible.     

The behavioral impact of an advertising campaign to promote safety belt use.

Safety belt use was observed at one restaurant during McDonald''s "Make It Click" promotional campaign. Following baseline, the program was monitored without intervention. During the final 2 weeks of the campaign an incentive strategy was added providing a large soft drink contingent on safety belt use. Safety belt use did not change from baseline levels before the incentive phase. The rate of belt use increased under contingent reward and declined during follow-up. The effects of a verbal prompt could not be assessed because of the almost nonexistent use of the "Make It Click" stickers throughout the study.     

Using personal digital assistants (PDAs) for the collection of safety belt use data in the field

From 1975 through 2003, because of the use of safety belts, an estimated 180,000 deaths from traffic crashes have been prevented. In order to assess the gains that have been made in safety belt use across the U.S., in individual states, and in communities, belt use surveys are conducted at regular intervals to determine use rates. The most valid method for surveying safety belt use is through direct observation. Direct observation surveys are conducted along roadways by trained researchers looking into passing vehicles and recording safety belt use. This method of data collection has been effective in the past through the use of paper-and-pencil data recording, yet it could be improved through the use of electronic and communication technology. Reported here is a study designed to compare electronic data collection, using personal digital assistants (PDAs), with collection using the traditional paperand-pencil method during the annual statewide survey of safety belt use in Michigan that we have been conducting since 1984. The goals of the study were to develop a PDA database program for data entry in the field, to directly compare the PDA data collection process with the paper-and-pencil method on both accuracy and speed, and to assess mechanical and environmental factors, such as battery life, screen visibility, and reaction to adverse weather, that may act as limitations to the PDA method, in comparison with the paper-and-pencil method. In a direct comparison of methods, two observers collected data at the same roadway intersections, one using paper and a pencil and one using a PDA equipped with our custom software. The study showed that the PDA method was as fast and as accurate as the paper-and-pencil method. There were no adverse effects on the PDA caused by environmental conditions. The PDA was superior to the paper-and-pencil method in rainy weather and for data collector supervision. In addition, the use of the PDA obviated the need for entry of paper-recorded data into an electronic format. We conclude that the use of PDAs for safety belt field data collection is superior to the paper-and-pencil method. A Web address is given where the custom PDA safety belt data collection software can be obtained free of charge.     

Prompting safety belt use: comparative impact on the target behavior and relevant body language

ResearcherS used two behavioral prompts to compare increases in safety belt use: a Click It or Ticket prompt or a Flash-for-Life prompt. Participants were 1,822 unbuckled drivers exiting two student parking lots of a large university. Research assistants identified unbuckled drivers, flashed one of the two prompts, and recorded whether drivers buckled after the prompt and the drivers' facial expressions and hand gestures. Findings and implications are discussed.     

Promoting safety belt use among state employees: the effects of prompting and a stimulus-control intervention.

This study assessed the effects of dashboard stickers and signature sheets on safety belt use among occupants of state-owned vehicles in three Florida agencies. The stickers and signature sheets contained information regarding a regulation requiring safety belt use and a consequence of a 25% reduction in benefits for noncompliance if the driver were to become involved in an accident. Safety belt use significantly increased during the intervention phase in all three agencies and maintained variable but high levels for 5 months. In Agency 1 and Agency 2 (stickers plus signature sheets) safety belt use increased from averages of 10.8% and 9.4% during baseline to 57.4% and 47.0%, respectively, during intervention. In Agency 3 (stickers only) the rates of safety belt use averaged 9.7% during baseline and 38.0% during intervention. Some increases in private vehicle use were observed. A substantial reduction in workers'' compensation claim costs was shown for the target agencies with some reductions also shown in the nontarget agencies.     

Motivating safety belt use at a community hospital: An effective integration of incentive and commitment strategies

An effective hospital-based safety-belt program incorporated several advantages over prior attempts to increase safety belt use, including (a) the use of indigenous staff as program sponsors, coordinators, and delivery agents; (b) a yearlong program evaluation; and (c) a combination of extrinsic incentives and intrinsic commitment. To be eligible for a weekly $5, employees met the following contingencies: (a) signed a pledge card; (b) displayed the signed pledge card in their vehicle; and (c) wore a safety belt. Overall, belt use increased from a 2-week baseline mean of 15.6% to 34.7% during the 6-month intervention, and decreased to 25.6% at withdrawal. For the pledge card signers (n = 188) and the nonsigners (n = 533), belt use increased from baseline means of 29.4% and 11.8% to intervention use rates of 75.1 and 17.7%, respectively. Withdrawal and 4-month follow-up use rates were 56.0% and 44.9% for the Pledge group, and 17.2% and 22.1% for the Nonpledge group.     

Behavioural Change Techniques used in road safety interventions for young people

IntroductionDeath and injury from road traffic is a public health problem worldwide and accordingly there is substantial interest and investment in developing interventions to change road user behaviour. Alongside this, there is growing awareness of the need to evaluate interventions and to identify the most effective mechanisms by which behaviour can be changed. Progress has been hindered due to lack of a common taxonomy with which to define specific techniques used in attempts to change behaviour.ObjectiveBehavioural Change Techniques (BCTs) have been successfully deployed to change a range of different health behaviours. This paper defines a series of BCTs that can be applied in the road safety setting and asks which ones are found in road safety interventions for young road users?MethodAbraham and Michie (2008) identified twenty-six techniques used in behavioural change interventions. These BCTs, plus one other adapted from forensic psychology, are classified into nine groupings. Six educational road safety interventions commonly used in the UK with pre-drivers and young, novice drivers are characterised in terms of the BCTs they employ.ResultsOnly a small subset of BCTs are employed in most of the interventions. They concentrate primarily on increasing awareness of the risks associated with a particular behaviour, and the severity of the potential adverse consequences.ConclusionRecommendations are given for improving the effectiveness of road safety interventions for young people including young, novice drivers by increasing the range of BCTs deployed.     

Seat belt use and stress in adolescents

This study explored the association of adolescent seat belt use with psychosocial risk factors in an urban minority population after the enactment of a mandatory seat belt law. Data on seat belt use, family support, feelings of being down, suicidal ideation, substance abuse, sexual activity, school troubles, and problems with the law were obtained from 541 self-report intake forms administered to an adolescent medicine clinic population from 1986 to 1987. Respondents were almost exclusively black and Hispanic; 315 (59%) were females and 222 (41%) males, with a mean age of 15.4. Seat belt use was reported by 249 (46%) and no or intermittent use by 292 (54%). Chi-square and Wilcoxon rank sums tests were used to examine associations between seat belt use and risk factors. Results showed that the group comprised of those reporting no and intermittent seat belt use was significantly more likely to feel down, have decreased home support, have problems with school and the law, have been on probation, and feel that life in general was not going very well. No association was found between seat belt use and cigarette, drug, or alcohol use or sexual activity without contraceptives. Taking into account the lack of observed behavioral information to validate such self-report questionnaires, these data nevertheless point to the nonuse or intermittent use of seat belts as a possible manifestation of a lack of self-care due to feeling down and/or preoccupation with family, school, or societal problems.     

Planning and self-efficacy interventions encouraging replacing energy-dense foods intake with fruit and vegetable: A longitudinal experimental study

Objective: This longitudinal experimental study compared effects of self-efficacy, planning and education-based conditions, encouraging adolescents to eat fruit and vegetable in place of energy-dense foods.

Design: Data were collected among 506 adolescents (13–18 years old) who were randomly assigned to control (n = 181), planning (n = 153) or self-efficacy (n = 172) conditions. Measurements were taken at baseline (T1), at a 2-month follow-up (T2), and at a 14-month follow-up (T3). Interventions/control group procedures were delivered at T1 and T2.

Outcome measures: Self-reports of fruit and vegetable intake (FVI) and energy-dense foods intake were collected at three times. Cognitive mediators (self-efficacy and planning) were assessed at T1 and T2. Body weight and height were objectively measured at T1 and T3.

Results and conclusions: Similar significant increases of FVI were found for planning and self-efficacy interventions (T3). The planning intervention did not influence energy-dense food intake (T3), but the self-efficacy intervention tended to result in stabilising intake (compared to an increase found in the control group). There were no effects on body weight. Similar patterns were found for the total sample and for a subsample of adolescents with overweight/obesity. The effects of interventions on FVI were mediated by respective cognitions.     

A behavioral analysis of incentive prompts for motivating seat belt use

The seat belt usage of drivers was observed at the entrance to two campus parking lots during morning arrival times. After 11 days of baseline, fliers which prompted seat belt wearing were handed to drivers of incoming vehicles. At one parking lot all fliers offered a chance to win a prize (noncontingent rewards); while at the second lot only those fliers given to seat belt wearers included a chance to win a prize (contingent rewards). After 24 consecutive observation days, these interventions were removed for 14 days of withdrawal. The recording of vehicle license plates enabled an analysis of belt usage per individual over repeated exposures to the experimental conditions. At the lot with the contingent reward intervention, mean belt usage was 26.3% during baseline, 45.7% during treatment, and 37.9% during withdrawal. At the noncontingent reward lot, the mean percentage of belt wearing was 22.2% during baseline, 24.1% during treatment, and 21.8% during withdrawal. The analysis of repeated exposures per individual verified that only contingent rewards influenced substantial increases in belt wearing, and showed that most of the influence occurred after the initial incentive prompt.     

Community-based college guidance for the disadvantaged

New techniques of counseling and guidance must be developed in order to increase substantially the number of disadvantaged students going to college. One major effort should be an organized community guidance program whose essential elements are: (a) professional school and college counselors operating outside the school; (b) key community persons acting as links between potential college students and professional counselors; and (c) ongoing programs providing literature, speakers, and special services geared to motivate and help disadvantaged students to enroll in and be successful at college.     

Predictors of seat belt use amongst Spanish drivers

Seat belt use on Spanish urban roads is very low. Surprisingly, there is very little information to explain this low level. A number of perceptions and expectancies about seat belt use were investigated to identify factors that were able to discriminate between observed seat belt use and non-use. Seat belt use was 88% for those whose journeys included travelling on the motorway, and 35% for those travelling solely on urban roads. Unbelted drivers reported that the seat belt limited their movement and was uncomfortable significantly more often than those observed to be wearing a seat belt. Seat belt use was predicted by the type of road participants had driven on (urban or motorway), beliefs about their friends’ seat belt use, reported discomfort and the number of years driving experience. This research suggests the need for particular types of advertising campaigns paired with enforcement to increase seat belt use in order to save the lives of those travelling on Spanish roads.     

Rewarding elementary schoolchildren for their use of safety belts

This study reports on the application of reward procedures to elementary schoolchildren to increase their use of seat belts en route to two schools. Following strict rules for assessing buckle-up compliance, all passengers in a car had to be safely secured in order for the schoolchildren to receive rewards. Compliant children received paper slips as they arrived at schools, which were redeemable for stickers, bumper stickers, and coloring books. The slips were also used in weekly drawings for pizza dinners. The mean compliance rate for School 1 was 4.3% during baseline, 66.2% for the reward phase across 4 weeks, 60% for return to baseline, 17.2% for Follow-Up 1, and 8.5% for Follow-Up 2. For School 2, the mean percentage was 5.3% at baseline, 69.8% for the reward phase, 68.5% for return to baseline, 40.1% for Follow-Up 1, and 20% for Follow-Up 2. These results indicate that rewarding the schoolchildren increased their own seat-belt use as well as that of their adult drivers and other passengers. Decreases in usage were observed after the rewards were removed.     

Developing traffic safety interventions from conceptions of risks and accidents

By means of investigating the mental background to young male drivers’ risky traffic behaviour, this explorative qualitative study outlines a framework for the construction of interventions that could mitigate risk-taking among young male drivers. Seven males, 20–23 years of age, demonstrating excessive speeding behaviour when driving, were interviewed in-depth. Five themes, “Self-image as a good driver brings self-esteem”, “Commanding high speed – a pleasurable sensation”, “High awareness of risks, but notions of serious outcomes are not salient”, “Imagined accident scenarios evoke outcome conceptions” and “Perceived cause of accident influences anticipated affective reactions”, had central positions in their conceptions about risk-taking and accidents. The results were analysed in relation to previous literature on the concepts of Anticipated Regret and Imagining as antecedents to attitude and behaviour change, and it was concluded that interventions based on imagining the emotional aftermath of being the perpetrator of a serious accident should be developed and tested.     

Teachers' resistance to the use of school-based interventions

This article focuses on consulting with teachers about the use of school-based interventions for the control and prevention of learning and adjustment problems. In the past, it has been assumed that teachers would want to use an intervention simply because it works (i.e., the intervention is effective in producing behavior change). However, it is becoming increasingly apparent that a teacher's decision to use an intervention is based upon a wide array of factors. Accordingly, this paper describes four factors that have been linked to teachers' decisions to utilize and to continue utilizing an intervention: effectiveness, time and resources required, theoretical orientation of the intervention, and ecological intrusiveness. Because they are recommended widely by school psychologists and because they sometimes lack acceptance among teachers, behavioral interventions represent a major focus of this review.     

Active prompting to decrease cell phone use and increase seat belt use while driving

Automobile crashes are the leading cause of death for those aged 3 to 33, with 43,005 (118 per day) Americans killed in 2002 alone. Seat belt use reduces the risk of serious injury in an accident, and refraining from using a cell phone while driving reduces the risk of an accident. Cell phone use while driving increases accident rates, and leads to 2,600 U.S. fatalities each year. An active prompting procedure was employed to increase seat belt use and decrease cell phone use among drivers exiting a university parking lot. A multiple baseline with reversal design was used to evaluate the presentation of two signs: "Please Hang Up, I Care" and "Please Buckle Up, I Care." The proportion of drivers who complied with the seat belt prompt was high and in line with previous research. The proportion of drivers who hung up their cell phones in response to the prompt was about equal to that of the seat belt prompt. A procedure that reduces cell phone use among automobile drivers is a significant contribution to the behavioral safety literature.