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Effectiveness: 5 Star Cost: $$$
Use: Medium
Time: Medium

The most common high-visibility seat belt law enforcement method consists of short (typically lasting for 2 weeks), intense, highly publicized periods of increased belt law enforcement, frequently using checkpoints (in States where checkpoints are permitted), saturation patrols, or enforcement zones. This short-duration seat belt enforcement method was developed in Canada in the 1980s (Boase et al., 2004) and demonstrated in several communities in the United States (Williams & Wells, 2004). It was implemented statewide in North Carolina in 1993 using the CIOT slogan (Reinfurt, 2004), and subsequently adopted in other States under different names and sponsors (Solomon, Compton, & Preusser, 2004). NHTSA’s CIOT HVE model is described in NHTSA (2021) and in more detail in Solomon, Compton, and Preusser (2004) and Solomon, Gilbert, et al. (2007).

Effective communications and outreach are an essential part of successful seat belt law HVE programs (Solomon, Compton, & Preusser, 2004). All HVE programs include communications and outreach strategies that use some combination of earned media (e.g., news stories and social media) and paid advertising. Paid advertising can be a critical part of the media strategy and brings with it the ability to control message content, timing, placement, and repetition (Milano et al., 2004).

The May 2002 CIOT campaign evaluation demonstrated the effect of different media strategies used in conjunction with enforcement (Solomon et al., 2002). Seat belt use increased by 8.6 percentage points across 10 States that used paid advertising extensively in their campaigns, by 2.7 percentage points across 4 States that used limited paid advertising, and only 0.5 percentage points across 4 States that used no paid advertising. While important for demonstrating effective media strategies at the time, it is important to note this study was done when seat belt use rates were significantly lower. A similar effort today is not likely to result in the same gains. Additionally, the media strategies used in 2002 may not be the same strategies implemented today.

NHTSA and some States now use social networking sites to reach the general public with messages concerning seat belt use. Although sites such as Facebook, Twitter, and YouTube can effectively and affordably reach large numbers of people, there are no evaluations of seat belt use campaigns that use this approach. The CDC offers resources to help with social media, including a toolkit and guide for social media writing. In addition, there is information available on NHTSA’s traffic safety marketing website.


All States currently conduct short-term, high-visibility belt law enforcement programs in May of each year as part of national seat belt mobilizations (Nichols, Chaffee, Solomon, & Tison, 2016). Some States also conduct seat belt mobilizations in November. NHTSA has supported these campaigns financially with States contributing significant funding as well. See Milano et al. (2004) for a detailed account of the history and evolution of the national campaigns and NHTSA (2016) for a timeline of use over time.


It is well established that short-term, HVE programs are effective at increasing seat belt use. CDC’s systematic review of 15 high-quality studies (Dinh-Zarr et al., 2001; Shults et al., 2004) found that short-term, HVE programs increased belt use by about 16 percentage points, with greater gains when pre-program belt use was lower. Following the enforcement program, belt use often dropped by about 6 percentage points demonstrating the ratchet effect typical of these programs. (Belt use increases during the program but decreases somewhat afterwards, though belt use remains at a level higher than prior to the program.)

Tison and Williams (2010) summarized the effects of the 2000 to 2006 CIOT campaigns and concluded they were an important component of the increase in seat belt use during that period. Nationwide observed seat belt use increased from 79% to 87% over 11 years of CIOT activity from 2003 to 2013, though it is difficult to isolate the effect of CIOT on observed seat belt use from the effect of other interventions done at the same time (Nichols, Chaffe, & Solomon, & Tison, 2016). Research has also found HVE campaigns to be effective in both primary and secondary-law States (Solomon, Chaudhary, & Cosgrove, 2004; Solomon, Gilbert, et al., 2007).

Many of the studies evaluating the effectiveness of CIOT were conducted years ago when seat belt use was much lower overall. In recent years seat belt rates have plateaued both nationally and in many States (NCSA, 2022). Because of this, it is unlikely that campaigns conducted today will continue to produce the gains seen in earlier studies. However, continued campaigns are likely important for maintaining high seat belt use rates. Nichols, Chaffe, Solomon, and Tison (2016) found the effect of repeating the CIOT campaign annually acted as a “booster shot” for seat belt use awareness and behavior change. This is demonstrated by several indicators: CIOT tagline recognition increased from 73% to 83%; seat belt citations per 100,000 people dropped from 19 to 12 among reporting jurisdictions; and national observed daytime belt use increased from 83% to 87%. A study of overtime seat belt enforcement in Michigan from 2013 to 2017 found that overtime traffic enforcement was associated with a 6.4% increase in observed driver seat belt use compared to communities who did not participate in overtime traffic enforcement (Acosta-Rodriguez et al., 2020).

Hedlund et al. (2008) compared 16 States with high seat belt rates and 15 States with low seat belt rates. The single most important difference between the two groups was the amount of enforcement rather than demographic characteristics or the amount spent on media. High-belt-use States issued twice as many citations per capita during their CIOT campaigns as low-belt-use States. Level of enforcement is also related to type of seat belt law. Nichols, Chaffe, Solomon, and Tison (2016) found that law enforcement in primary belt use law States issued more seat belt citations in the 2013 campaign than did law enforcement in secondary belt use law States. NHTSA examined the effect of enforcement in the 2012 CIOT campaign and found that citations per 10,000 residents were twice as high in States with primary laws (16 citations versus 8 citations) as those with secondary laws (Hinch et al., 2014). The authors suggested that increasing citations in secondary-law States (when drivers are stopped for other violations) could be an opportunity to increase belt use.

Smaller-scale campaigns limited to a single travel corridor can yield a short-term improvement in observed seat belt usage along the corridor, but the effects appear to be limited to the enforcement area. Specifically, an HVE campaign conducted along a route frequented by commuters used inexpensive roadway signs and magnetic message strips on enforcement vehicles within the corridor, but only a press release was available to residents in a nearby city, which was typically the destination for commuters (Elliot et al., 2014). Although observed belt use improved significantly within the corridor, observed belt use and overall awareness of the seat belt campaign was unchanged in the nearby city. A likely explanation for this difference is lack of exposure to the location-specific campaign since most respondents from the city reported traveling the route less than once a month.

St. Louis County, Missouri, implemented a primary seat belt use ordinance in March 2007. Following implementation, the St. Louis County Police Department conducted an intense HVE campaign accompanied by publicity in the form of variable message boards and permanent road signs, along an 8-mile corridor on State Highway 21. Observational surveys were conducted along the Highway 21 corridor and a control site prior to the start of the enforcement and immediately after its conclusion. The observational surveys measured increases in belt use from 83% to 88% along the Highway 21 corridor and a small, 59% to 57% decrease in belt use along the control corridor (Nichols, Solomon, et al., 2010).


High-visibility enforcement campaigns are expensive. They require extensive time from SHSOs and communications staff and often from consultants to develop, produce, and distribute publicity. Additionally, they require significant time from law enforcement officers to conduct the enforcement. Paid advertising increases a campaign’s effectiveness. In the average State, paid advertising costs were nearly $350,000 for the 2007 campaign (Solomon, Preusser, et al., 2009). More recently, the 2013 CIOT campaign used extensive paid advertising totaling $8 million nationally and $11 million in individual States (Nichols, Chaffe, & Solomon, & Tison, 2016).

Time to Implement:

An HVE program (including media placement) requires 4 to 6 months to plan and implement.