Programs for Older Children
The number of older children killed in traffic fatalities has decreased substantially since 2006. For children 8 to 12 years old, there has been a 39% decrease from 527 fatalities in 2006 to 324 fatalities in 2021 (NCSA, 2023b). Similarly, for children 13 to 14 years old there has been a 29% decrease from 368 fatalities in 2006 to 262 fatalities in 2021. While increased seat belt use has undoubtedly contributed to these improvements, there is still room to improve seat belt use within these age groups. The 2021 National Survey of the Use of Booster Seats (NSUBS) found that 13.2% of children 8 to 12 were unrestrained, a slight increase from 2019 (12.8%) (Boyle, 2023). Although restraint use has increased over time the trend is positive, unrestrained children continue to be a concern. In 2021 some 36% of fatally injured children 8 to 12 and 59% of children 13 to 14 were unrestrained (NCSA, 2023b).
As noted by Kuhn and Lam (2008a; 2008b), there is not a great deal of information on the factors influencing restraint use for children 8 to 15 years old. The few available studies have tended to focus on changing nonuse behaviors without investigating attitudinal or motivational factors that might be useful in developing additional strategies.
Programs and campaigns aimed at increasing restraint use among school-aged children are likely common, but no summary is available. In March 2015 NHTSA announced a campaign focused on older children (ages 8-14), Don’t Give Up until They Buckle Up. The campaign is targeted to parents and caregivers of “tweens,” with material and resources for States and others interested in focusing on this age group. Some pilot programs have been implemented and evaluated that can be used as resources for program development. One extensive resource available is the report titled Increasing Seat Belt Use Among 8- to 15-Year-Olds: Volumes I and II (Kuhn & Lam, 2008a, 2008b).
The studies that have been conducted have generally produced encouraging results. Effectiveness may vary based on program and population specifics.
Programs Focusing on Tweens
The Avoiding Tween Tragedy Project was a comprehensive program aimed at increasing restraint use among 8- to 15-year-olds in Berks County, Pennsylvania (Alonge et al., 2012). The program included education at elementary, middle, and high schools, law enforcement participation, earned and paid media, and participation in community events. Restraint use increased significantly following the program (13% at elementary schools, 17% at middle schools, and 20% at high schools). Among elementary school students, back seat positioning also increased. The authors recommend that future programs targeting this age group focus on HVE and education using information designed for this age group. Because the behaviors of this age group are strongly influenced by others, a legislative focus on primary enforcement of restraint use for all occupants should be pursued if not already in place.
The Automotive Coalition for Traffic Safety (ACTS) launched two pilot programs in 2005 targeting 8- to 15-year-olds. These short-term school and community-based interventions targeted both children and their parents. Both programs were successful in changing knowledge and attitudes of the parents and children, but limited observations did not show significant changes in belt use among the targeted children (Jennings et al., 2006).
The Make It Click Program was developed in Virginia to address low seat belt use among children 8-12 in an economically disadvantaged urban school district (Will & Dunaway, 2017). Children, parents, and teachers were educated about proper seat belt use with activities throughout one school year. Children participated in a creativity contest, a safety-themed play, a buckle-challenge competition, afterschool programs, classroom assignments, and morning announcements. Parents were provided with flyers and presentations, while teachers received regular newsletters to keep them informed about the program. The program resulted in significantly higher observed seat belt use rates at intervention schools (32% before the program versus 68% after). During a follow-up period 4-months after the program, students at the intervention school were 3.3 times more likely to be observed wearing a seat belt than students at the control schools.
Similar improvements were observed in a pilot program to increase restraint use and rear-seating position among elementary schools and day care centers (Williams et al., 1997). The programs, held in conjunction with an ongoing statewide CIOT program, included letters and pamphlets sent to parents, proper restraint use demonstrations, assemblies emphasizing proper restraint use (at the schools), and enforcement checkpoints. Proper use increased substantially at elementary schools (36% to 64%; 49% to 71%) with smaller increases at the daycare centers (71% to 76%; 60% to 75%). The researchers concluded also that enforcement is a key ingredient of programs even among school-age children. The smaller increase in use could also be an artifact of the daycare center having younger kids who are traditionally more likely to be restrained than elementary-age kids.
Programs Focusing on Teens
The Just Get It Across program developed by the Rainbow Babies and Children’s Hospital in Cleveland, Ohio, targeted parents of 13- to 15-year-olds with a message encouraging parents to promote seat belt use among their teens (program description and implementation: University Hospitals Rainbow Babies & Children’s Hospital Injury Prevention Center, 2014). The program demonstrated increases in knowledge of seat belt laws and teen-reported reminders to wear seat belts by parents. Observed seat belt use by parents and teens also increased in the target community; however, it is not clear what role the program had in this increase because seat belt use in the control community also increased. Exposure in the control community to Just Get It Across messaging along with other seat belt promotions may have interfered with effective evaluation of the program (Zakrajsek et al., 2014).
Colorado and Nevada implemented a Teen Seat Belt Demonstration Project in 2007 to 2008 consisting of publicity and enforcement. Each State held four enforcement waves focused in areas and at times when teenagers were most likely to be driving. In addition to increases in teen awareness of seat belt messages and enforcement, teen belt use increased significantly in both States (5% in Colorado and 8% in Nevada) (Nichols et al., 2011).
A study by Nichols et al. (2018) explored the effectiveness of multi-wave teen seat belt demonstration programs in Louisiana, Mississippi, New Mexico, and Texas. All these programs were established in 2009, with the first wave of focused activities starting just prior to NHTSA’s CIOT (CIOT) campaign in May 2009. The remaining waves occurred in fall 2009, winter 2010, and in May 2010. Each wave consisted of teen-focused outreach, earned and paid media, and enforcement. Each State also had control areas where the program activity was not promoted. States differed in the type of primary media used for outreach (e.g., Louisiana and Mississippi spent more on television ads while New Mexico and Texas spent more on radio ads). The program in Mississippi appeared to be the most effective with higher awareness of seat belt messages, higher perception of strict enforcement, and statistically significant increases in observed seat belt use among teens in the program areas compared to the control areas. This coincides with the high levels of teen exposure to outreach in Mississippi (i.e., higher gross rating points of media ads) than in other States. Teens in the program areas in Texas had higher levels of awareness compared to the control, but the increases in seat belt use were similar in both areas. Neither Louisiana nor New Mexico showed increases in teen belt use above the control locations.
Kansas has implemented a school-based traffic safety program with some success. Seat Belts Are for Everyone (SAFE) aims to increase seat belt use among high school students. Freund et al. (2019) compared 5 schools implementing the SAFE program to 5 similar schools that were not participating in SAFE or any other traffic safety programs. The SAFE program allowed each school to run the program independently that led to different levels of implementation. To evaluate success, seat belt observations were conducted at both program and comparison schools. In aggregate, schools that participated in SAFE had higher seat belt use rates than those that did not participate. However, the inconsistent implementation made it difficult to evaluate.
Program costs will depend on the size of the target audience and the components of the program.
Time to implement:
The time needed for implementation will depend on program goals and population. It is important to allow enough time for planning, implementation, and evaluation.