6.1 Strategies for Older Children

The number of older children killed in traffic fatalities has decreased substantially since 2007. For children 8 to 12, there has been a 16% decrease from 402 fatalities in 2009 to 339 fatalities in 2018 (NCSA, 2021). Similarly, for children 13 and 14 there has been a 38% decrease from 254 fatalities in 2009 to 158 fatalities in 2018. While increased seat belt use has undoubtedly contributed to these improvements, there is still room to improve seat belt use in these age groups. The 2017 NSUBS found that more children 8 to12 were using restraints, and only 14% were unrestrained in 2017, which is an improvement from 16% unrestrained in the 2015 NSUBS (Li & Pickrell, 2018b). While older children are using restraints more often, those who were unrestrained made up a higher proportion of deaths in fatal crashes (NCSA, 2021). For children 8 to 12, some 43% of the children killed were unrestrained, whereas only 12% of the children who survived were unrestrained. Similarly, for children 13 to 14, about 51% of the children killed were unrestrained, whereas only 21% of the children who survived were unrestrained.

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.

Use: There is more of an emphasis on developing and implementing programs targeting children 8 to 14. In March 2015 NHTSA announced a new campaign focused on older children 8 to 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 programs 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).

Effectiveness: The few studies that have been conducted have produced encouraging results. 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 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 (program evaluation: Zakrajsek et al., 2014).

Colorado and Nevada implemented Teen Seat Belt Demonstration Projects in 2007 and 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. These programs were established in 2009, with the first wave of focused activities starting just prior to NHTSA’s Click It or Ticket (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.

The Automotive Coalition for Traffic Safety (ACTS) launched two pilot programs in 2005 targeting 8- to 15-year-old tweens. 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).

Costs: Program costs will depend on the size of the target audience and the components of the program.

Time to implement: Complete programs will require at least 4 months to plan and implement. School-based programs may require a full year.

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