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.     

PARTICIPATIVE EDUCATION FOR CHILDREN: AN EFFECTIVE APPROACH TO INCREASE SAFETY BELT USE

Vehicle license plate numbers and the shoulder belt use of front-seat occupants were recorded unobtrusively when parents delivered and picked up their children at a Montessori school during 5-day baseline, intervention, and follow-up phases. Practicing and presenting a 15-min safety belt skit increased the safety belt use of those 6 kindergarten children who were not consistent belt users 82% above their preintervention baseline belt use mean of 47%. The belt use of these children's parents (who watched the skit) increased to 56% above their baseline mean of 36%. Also, mean safety belt use of 11 primary school children who watched the skit increased to 70% above their baseline of 28%. Mean safety belt use of the older children's parents (who didn't watch the skit) remained at approximately 31% for each phase, regardless of whether children were vehicle occupants. The follow-up observations, taken 3 months after the intervention, revealed 60% belt use for the kindergartners, 48% for the primary school children, and 71% for the kindergartners' parents when the children were vehicle occupants but only 30% when the parents were driving alone.     

Improving the driving practices of pizza deliverers: Response generalization and moderating effects of driving history

A practical intervention program, targeting the safety belt use of pizza deliverers at two stores, increased significantly the use of both safety belts (143% above baseline) and turn signals (25% above baseline). Control subjects (i.e., pizza deliverers at a third no-intervention store and patrons driving to the pizza stores) showed no changes in belt or turn signal use over the course of 7-month study. The intervention program was staggered across two pizza stores and consisted of a group meeting wherein employees discussed the value of safety belts, received feedback regarding their low safety belt use, offered suggestions for increasing their belt use, and made a personal commitment to buckle up by signing buckle-up promise cards. Subsequently, employee-designed buckle-up reminder signs were placed in the pizza stores. By linking license plate numbers to individual driving records, we examined certain aspects of driving history as moderators of pre- and postintervention belt use. Although baseline belt use was significantly lower for drivers with one or more driving demerits or accidents in the previous 5 years, after the intervention these risk groups increased their belt use significantly and at the same rate as drivers with no demerits or accidents. Whereas baseline belt use was similar for younger (under 25) and older (25 or older) drivers, younger drivers were markedly more influenced by the intervention than were older drivers. Individual variation in belt use during baseline, intervention, and follow-up phases indicated that some drivers require more effective and costly intervention programs to motivate their safe driving practices.     

PROMOTING AUTOMOBILE SAFETY BELT USE BY YOUNG CHILDREN

A program using behavioral practice, assertiveness training, and social and contrived reinforcers was developed to establish and maintain automobile safety belt use by young children. Sixteen children (ages 4.8 to 7 years) who never used their safety belts during a 5-day preexperimental observation period were randomly assigned to two groups of eight each. A multiple baseline design across groups was used to evaluate the effectiveness of the training program. During the 8-day baseline period for Group 1, no children used their safety belts when unobtrusively observed while being driven from school. During the 26-day intervention period, the children were buckled up on 96% of the observations. Follow-up probes conducted 2–3 months after program discontinuance found safety belt use to range from 86% to 100%. For Group 2, the 14-day baseline safety belt use averaged 6% and increased to a mean of 81% during the 20-day training and maintenance program. Follow-up probes 2–3 months later found safety belt use to occur during 75% to 96% of the observations. Parent questionnaires indicated the generalizability and social validity of the program.     

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.     

A community program to reward children's use of seat belts

This paper reports on a community-wide effort to increase elementary school children's use of seat belts. Twenty-five schools serving over 9,000 children participated in a program of rewards (stickers, bumper strips, and chances on pizza dinners) administered by parent-teacher organization volunteers. Comprehensive observations were made at three representative schools. Categorization of compliance with safety rules required all passengers to be buckled into safety devices before the children received the rewards. The rewards, on average across schools, increased compliance from baseline of 18.1% to 62.4% during the interventions. Withdrawal of the rewards resulted in a decrease to 49% compliance, but this rate remained above baseline. The involvement of community groups and institutions in this safety program is highlighted.     

A single-subject approach to evaluating vehicle safety belt reminders: Back to basics

A single-subject ABA reversal design was applied to evaluate the effectiveness of a limited 8-s safety belt reminder system and two modified reminder systems (a delayed and second reminder) to increase the safety belt use of 13 drivers. The research was conducted with a specially equipped research vehicle that permitted the manipulation of different safety belt reminder stimuli and the unobtrusive recording of a driver's belt use. For 2 subjects, the limited 8-s reminder increased safety belt use. For another 2 subjects, the second reminder markedly increased belt use. Some subjects were uninfluenced by the reminder systems presented; others always buckled up during both baseline and intervention conditions. The approach and results are discussed with regard to the application of behavior analysis methodologies (e.g., cumulative records) and principles (e.g., schedules of reinforcement) to advance the utility and investigation of safety belt reminder systems.     

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.     

ENFORCEMENT OR INCENTIVES? PROMOTING SAFETY BELT USE AMONG MILITARY PERSONNEL IN THE NETHERLANDS

During a nationwide campaign to promote safety belt use among military personnel, a field study was conducted at 12 different military bases in the Netherlands. Amount of enforcement, type of publicity, and incentive strategies were varied among military bases. Observations of safety belt use among servicemen in their personal vehicles were conducted before the campaign, immediately following the campaign, and 3 months later. Safety belt use increased from 65% during baseline to 73% directly after the campaign and to 76% 3 months later. An overall 28.6% increase in safety belt use (from 63% to 81%) was observed at seven bases, whereas no changes were found at five bases (68% on all occasions). To a large degree the effects were due to a 37.7% increase among young drivers. These results confirmed that enforcement, as well as incentives, can be effective in promoting safety belt use. However, treatment effects were not systematic, thereby complicating the interpretation of the results. Implications of these varied outcomes are discussed.     

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.     

Promoting Safety Belt Use on a University Campus: An Integration of Commitment and Incentive Strategies1

Safety belt use on a university campus was substantially increased by offering faculty/ staff and students who signed and returned “buckle up” pledge cards the opportunity to win prizes donated by community merchants. The 28,000 pledge cards, committing signers to buckle up for an academic quarter, were distributed during the spring and fall of 1985. One portion of the card was designed to be hung from a vehicle's rearview mirror as a reminder of the pledge to buckle up. The other portion served as a sweepstakes ticket and was deposited in boxes located throughout the campus community. Each quarter, winners were drawn from the returned pledge cards during three consecutive weeks. Although a relatively small proportion of the pledge cards were signed and turned in (i.e., 11.9% during spring and 9.4% during fall), those who signed and returned a pledge card (n = 3117) increased their safety belt use significantly. Across both quarters, faculty/ staff pledgers went from a high pre-pledge belt use level of 32.2% to a post-pledge level of 46.7%, and students increased their belt use from a pre-pledge use of 21.4% to a post-pledge level of 36.6%.     

Long-term benefits of prompts to use safety belts 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 a repeated baseline design (AAB), we previously reported that motivating signs boosted safety belt usage by drivers exiting senior communities from baseline (72% and 68% usage), to postinstallation of signs (94%), to 6 months follow-up (80%). The current study was a 4-year follow-up in which six senior communities, with seat belt signs, were compared to six matched control senior communities with no signs. Safety belt usage was stable, across 4 years, at approximately 80% for both male and female drivers and front seat passengers for the six communities with signs, and was approximately 55% for control sites. These finding suggest that the simple and low-cost intervention of erecting signs to prompt safety belt use has persistent benefits that affect driver and passenger behavior alike.     

BEHAVIOR CHANGE IN THE FUNNY PAPERS: FEEDBACK TO CARTOONISTS ON SAFETY BELT USE

A multiple baseline across 8 nationally syndicated cartoonists evaluated the effects of personal advocacy letters encouraging presentations of a specific prevention message—the depiction of safety belt use in comic strips showing motor vehicle occupants. During baseline these cartoonists depicted safety belt use in only 15% (6 of 41) of their strips with occupied vehicles, but following receipt of a personal letter requesting safety belt use 41% (42 of 102) of their strips depicted safety belt use. Four cartoonists showed clear and immediate increases in depiction of safety belt use, 2 demonstrated delayed and somewhat less consistent belt use, and 2 cartoonists showed no change. The approach and results are discussed with regard to advocacy efforts intended to influence presentation of prevention messages in the media.     

Increasing Safety Belt Use: Effects of Modeling and Trip Length1

Effects of modeling on car safety belt use were investigated in a field experiment. Modeling, anticipated trip length, and gender of the model were manipulated in a 2 × 2 × 2 factorial design. Sixty-four female college students were told that they were to participate in an experiment that would take place in another location, requiring a drive either of less than one mile or of several miles. The driver either used or did not use a safety belt. Subjects' belt use was significantly related to the model's behavior. When the driver used a safety belt, 77.4% of the subjects used one; when the driver did not use a safety belt, only 313% of the subjects used one. A significant effect for trip length was also found. In the long trip condition, 71.9% of the subjects used a belt; in the short trip condition, 35.5% used one. Results are interpreted as support for a social learning theory approach to increasing voluntary safety belt use.     

PROMPTING PATRON SAFETY BELT USE AT A SUPERMARKET

We used a reversal (ABAB) design to assess the effects of a personal prompt on safety belt usage by grocery store patrons. A personal prompt delivered by grocery carriers resulted in a 12% increase in the number of patrons exiting the parking lot with their safety belts buckled. This simple, low-cost intervention offers potential savings to society from increased safety belt use.     

PROMOTING LAW ENFORCEMENT FOR CHILD PROTECTION: A COMMUNITY ANALYSIS

The Colorado Occupant Protection Project (COPP) intervention provided police with brief instruction concerning the importance of citations for drivers' failure to use child safety seats and special coupons to accompany citations. Coupons were exchangeable by drivers for a safety seat and brief training in its use, plus a waiver of the $50 citation fine. Over 4.5 years of archival records were employed, using an ABA design and a comparison community to evaluate the program. Few tickets were issued for nonuse of safety seats during the 3-year baseline in either community. Citations for nonuse of safety seats increased to over 50 per month during the intervention period at the test site, whereas rates remained essentially zero at the comparison site. After the COPP intervention was removed at the intervention site, citation rates for nonuse of safety seats decreased to about 15 per month. Differences between intervention conditions and settings were statistically significant. During the intervention, officers were 44 times more likely to write citations than were controls. Results suggested that a behavioral program can increase police citation writing for child protection purposes.     

A preliminary study of a traumatic injury prevention program

Abstract

This study examined the long-term impact of a five component spinal cord injury prevention program presented to adolescents. A sample of 445 teenagers who attended a junior high school in which an educational intervention was presented three years earlier and a control group of 379 students who had not been exposed to the intervention completed a questionnaire assessing their safety knowledge, attitudes, and self-reported behaviors. Total scores on the questionnaire between treatment and control groups differed significantly. Students in the treatment group reported significantly more frequent seat belt use, stronger belief that seat belts were important to their safety, lower likelihood of riding with friends who had been drinking, higher rates of friends' use of seat belts, greater awareness of the age group most likely to be injured, and increased knowledge that they could prevent spinal cord injury.     

Rewarding safety belt usage at an industrial setting: Tests of treatment generality and response maintenance

An incentive program to motivate seat belt use was implemented at a large munitions plant. Seat belt usage was assessed daily at an entrance/exit gate of the industrial complex when employees arrived for work in the morning and departed in the afternoon. During treatment incentive fliers, which prompted seat belt usage and gave belt wearers opportunities to win prizes, were distributed only in the afternoon. Seat belt wearing increased from baseline means of 20.4% and 17.3% during the morning and afternoon, respectively, to averages of 55.5% during afternoon departures and 31.1% during morning arrivals. During follow-up, mean belt use dropped almost to baseline levels. Categorizing vehicles according to driver sex and license plate number enabled a study of belt wearing practices of individuals, and revealed that the incentive program influenced some drivers to wear their seat belts during morning arrival when incentives were not distributed (i.e., treatment generalization) and during a follow-up period after the incentives were withdrawn (i.e., response maintenance).     

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.     

BEHAVIORAL COMMUNITY INTERVENTION TO REDUCE THE RISK OF SKIN CANCER

Peer leader modeling, posted feedback, posted goals, and a commitment raffle were used at two swimming pools to increase behaviors associated with skin cancer prevention. During the intervention condition, pool lifeguards modeled the protective behaviors by wearing sunglasses, t-shirts, and hats, using zinc oxide and sunscreen, and staying in the shade. Children and adolescents (1 to 16 years old) increased their use of two or more protective behaviors from a baseline mean of 6.5% to 26.9% during the intervention. Adults (older than 16 years) increased their protective behaviors from a baseline mean of 22% to 37.95% during the intervention. The lifeguards increased their use of all the protective behaviors from a baseline mean of 16.7% to 63.5% during intervention. Ways to improve and expand this intervention are discussed.