A. Unrestrained Rural Fatalities in the Great Lakes Region

Rural traffic deaths account for nearly 70 percent of total and unrestrained traffic deaths in the Great Lakes Region (GLR) of the United States, which includes six States: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Of a total of 4,810 occupant deaths in 2004, 68 percent occurred in rural areas and 54 percent of those rural fatalities were unrestrained. Passenger cars were more frequently involved in rural deaths than any other vehicle type, but pickup trucks were more frequently involved than would be expected based on their numbers. As is the case in so many traffic safety problem areas, young occupants, males, and drivers contributed most to unrestrained rural deaths in the GLR. Males and drivers accounted for 2.5 times as many unrestrained deaths as females and passengers, respectively.

B. An Approach for Reducing Unrestrained Rural Fatalities

There is much evidence that highly publicized enforcement programs are associated with increases in seat belt use. This evidence began to accumulate with Selective Traffic Enforcement Programs (STEPs) implemented in the Canadian provinces in the 1980s (e.g., Jonah, Dawson, and Smith, 1982; Jonah and Grant, 1985). These efforts were followed by several local demonstrations in the United States, one of the most prominent of which occurred in Elmira, New York, in 1985 (Williams, Lund, Preusser, and Blomberg, 1987). Six years later, NHTSA implemented a nationwide effort called the National 70% by ’92 Program. It resulted in increased media and enforcement activities in nearly all States and most reported some increases in usage, based on statewide observational surveys (Nichols, 1993). There was little or no paid advertising and many States were reluctant to emphasize enforcement activities in their media efforts.

In 1993, North Carolina implemented a statewide Click It or Ticket (CIOT) program. It included extensive earned media (news) and paid media; more than 3,000 checkpoints; and more than 58,000 citations issued for seat belt violations (81 per 10,000 residents). Usage increased by about 16 points, from 64 percent to 80 percent (Williams, Reinfurt, and Wells, 1996). This was the first STEP to increase usage across an entire State and it became a benchmark for measuring activity and impact in other States. From 1993 through 1997, NHTSA provided demonstration funds to conduct similar programs in more than 20 States. Compared with the North Carolina program, these STEPs had less funding and they were not as fully implemented. Enforcement reached modest levels of intensity, but paid media and high-visibility enforcement were not generally included in these programs. As a result, increases in usage averaged 4 to 5 percentage points after multiple waves of STEP activity.

In 1996, NHTSA worked with the National Safety Council and the National Transportation Safety Board to respond to an increasing number of air-bag-related deaths among young children. One key outcome of the activity that followed was the establishment of a public-private coalition, supported with funding from auto manufacturers, air bag suppliers, and insurance companies. This coalition eventually became known as the Air Bag and Seat Belt Safety Campaign (AB&SBSC) and national enforcement mobilizations became a key component of its activities. Initially called Operation ABC (for Always Buckle Children), these mobilizations involved the participation of thousands of State and local enforcement agencies over the years. More importantly, the number of States that actively participated by implementing organized enforcement and media efforts of their own grew from only a handful in 1997 to more than 40 by 2003. The growth and intensity of this participation was made possible by the availability of (Section 157) innovative grant funds authorized by the Transportation Equity Act for the 21st Century (TEA-21). Beginning in 1998, NHTSA channeled an increasing proportion of these funds to support Operation ABC efforts in the States.

Extensive use of paid media began in 2000, with a $500,000 contribution from AB&SBSC to the State of South Carolina. These funds (about 12¢ per resident) were used for the purchase of ads in the November mobilization. With the addition of Section 157 funds, South Carolina implemented the second statewide Click It or Ticket program in the United States. More than 3,300 checkpoints were conducted over a two-week period, resulting in nearly 20,000 citations issued for seat belt violations (50 per 10,000 residents). As a result, telephone surveys showed a 51-percentage-point increase in awareness of enforcement efforts and observational surveys found a 9-to 14-point increase in seat belt usage. Increases were greater among blacks, males, and rural motorists, compared with whites, females, and urban motorists (NHTSA, 2002).

Based upon these successes, eight States in NHTSA’s Southeast Region conducted a Click It or Ticket mobilization in conjunction with the May 2001 mobilization. About $3.6 million in Section 157 funds were used for paid media (about 6¢ per resident) to alert the public to seat belt enforcement activities. Checkpoints were again the dominant form of enforcement but other approaches were used as well. Nearly 120,000 seat belt citations were issued during the two-week period (22 per 10,000 residents). Telephone surveys found a 34-point increase in awareness of enforcement efforts and observational surveys found a 9-point increase in usage region-wide (from 64.5% to 74.2%). Increases in rural areas and among minorities were similar to those in urban areas and among whites (Solomon, 2002).

Similarly, Section 157 funds were used to support fully implemented STEPs in 10 geographically dispersed States in conjunction with the May 2002 mobilization. Just over $9 million was expended on paid advertising in these States (about 10¢ per resident) and more than 140,000 citations were issued (about 19 per 10,000 residents). As in the previous CIOT programs conducted in South Carolina and in 8 southeastern States, there were significant increases in awareness of enforcement (+43 points) and observed seat belt use (+9 points) across the 10 States (Solomon, Ulmer, and Preusser, 2002).
In May 2003, Operation ABC was renamed the National Click It or Ticket Mobilization. Participating law enforcement agencies in 44 States issued about 508,000 citations for seat belt violations (20 citations per 10,000 residents) and about $24 million in Section 157 funds was spent on national, State, and local media (about 8¢ per United States resident). National telephone surveys recorded significant increases in awareness of seat belt enforcement efforts (+24 points) and NHTSA’s National Occupant Protection Use Survey (NOPUS) found a 4-point increase in seat belt use over the previous year (Solomon, Chaudhary, and Cosgrove, 2004; Glassbrenner, 2004).

The 6 States in NHTSA’s Great Lakes Region (GLR) also participated in the 2003 mobilization, intensifying enforcement and spending more than $3 million for paid media (about 6¢ per resident). Telephone surveys showed a median 37-point increase in awareness of enforcement efforts across the region and statewide observational surveys showed an average 4-to 5-point gain in seat belt usage (Nichols, 2004).

National Occupant Protection Use Surveys (NOPUS) have provided additional insights regarding changes in usage since the Operation ABC and CIOT mobilizations were initiated. These surveys have shown decreasing gaps in usage between higher-and lower-use groups over time. For example, there has been a decline in nonuse in the largely rural southern regions of the nation, as well as in the Midwest. Further, nonuse has declined more among males and blacks than among females and whites. Nonuse among blacks, for example, declined by about 12 points from 1998 (35%) to 2002 (23%), nearly eliminating the gap between blacks and whites (Glassbrenner, 2004). Nonuse remains highest in secondary-law States and in pickup trucks.

In summary, the United States’ experience has provided consistent evidence of increases in public awareness and seat belt usage associated with fully implemented STEPs. There is also consistent evidence that such gains dissipate if STEP programs are not repeated and reinforced. Usage must be periodically ratcheted up. Fortunately, the North Carolina experience shows that, after successive implementations, usage rates greater than 80 percent can be maintained with less intensive efforts.

C. The Great Lakes Region Rural Demonstration Program

At a GLR regional meeting held in December 2004, NHTSA proposed the concept of a region wide project to increase rural seat belt use. Subsequently, all six GLR States agreed to participate in a rural seat belt initiative called the Rural Demonstration Project. The States adopted a three-phase program as proposed by NHTSA. These phases included: paid and earned media, along with intensified enforcement and outreach, to be implemented immediately preceding the May 2005 Click It or Ticket mobilization; a reminder campaign to be implemented in November 2005; and a second media, enforcement, and outreach effort to be implemented immediately preceding the May 2006 Click It or Ticket mobilization. This report covers the results of the first phase of that program plan.

Key organizers of this program included: NHTSA headquarters and its Great Lakes Regional Office; the Governor’s Highway Safety Office in each of the participating States; and contractors working at the regional level to provide (1) overall program coordination (the Michigan Public Health Institute via Mercer Consulting Group – MCG); (2) media support for NHTSA and the States (the Tombras Group); and (3) regional coordination of evaluation activities (the Preusser Research Group --PRG).

Within NHTSA, the Office of Occupant Protection served as the lead program manager and provided Federal resources for program management and coordination activities; the Office of Communications and Consumer Information provided media resources and served as the media and communications advisor (via Tombras); and the Behavioral Technology and Research Division provided evaluation resources and served as the project’s evaluation advisor (via PRG). NHTSA’s GLR Office played a key role in the implementation of the program by providing direction to the States and by brokering participation with regional and State partners.

Within each State, the Highway Safety Office was responsible for the actual planning and implementing paid and earned media campaigns, recruiting law enforcement participation, developing rural community outreach efforts, and reporting on activities and the results of awareness and seat belt surveys.

Each of the regional-level contractors provided specific contributions to the project. MCG served as the project manager and was a single point of contact for communication and information exchange. The Tombras group coordinated all media activities (State and national) including market research, developing creative materials (paid and earned media) and paid media plans for each State, and providing post-buy summaries. PRG provided liaison with State evaluators and evaluation contractors; planned and provided direction with regard the type and timing of surveys; received, reviewed and analyzed all activity, awareness, and observed usage data; provided technical assistance to the States; and prepared interim and final evaluation summaries.