Sixteen years into this U.S. belt enforcement program and its blunt message still resonates. A record 83 percent of front seat occupants buckled up in 2008, thanks largely to Click It or Ticket. Considering only 73 percent used belts just 7 years earlier, the gain is impressive. More than 91,000 people have survived crashes since 2002 in the United States because of belts, federal data show. Primary laws help, too. Arkansas, Florida, Minnesota, and Wisconsin are the latest states to allow police officers to stop and ticket motorists solely for not using safety belts. Now 30 states and the District of Columbia have primary laws. In secondary law states, officers must stop a motorist for another violation before issuing a citation for not buckling up.
Click It or Ticket "has raised seat belt use rates more substantially and more quickly than any other program," says a recent report from the National Highway Traffic Safety Administration (NHTSA) evaluating the 2006 enforcement and publicity campaign against the 2005 effort. The agency this spring issued several belt use reports, including 2008 results of the National Occupant Protection Use Survey.
Click It or Ticket began in 1993 in North Carolina as a 5-year public-private partnership to reduce crash injuries and deaths (see "North Carolina shows how to boost belt use with enforcement, publicity," Dec. 20, 1993, and "Carolina belt use peaks at 84 percent; future gains sought," March 7, 1998). The Institute and insurers joined forces with NHTSA, North Carolina Gov. Jim Hunt, law enforcement officers, and other leaders to launch the campaign to raise restraint use. It was the first statewide belt use enforcement and publicity program in the U.S. Belt use jumped from 65 percent to 80 percent in the effort's first year and has continued to climb. Last year 90 percent of front seat occupants used belts in North Carolina.
South Carolina adopted the program in November 2000, and in May 2001 six more Southeastern states joined up for a coordinated regional campaign. Then in 2002 a federally led national pilot program launched with 18 states taking part in a May mobilization. By 2003, 43 states and the District of Columbia were using Click It or Ticket. Today all states with belt laws participate. The spring campaign features several weeks of advertising and public awareness messages, plus 2 weeks of belt checkpoints and special patrols.
"Click It or Ticket works because it combines intense enforcement with frequent media messages that police are cracking down on belt law violators," Institute president Adrian Lund says. "The blitz is designed to make drivers understand chances are good they'll be ticketed if they don't buckle up."
The target ad audience is 18-34 year-old men because they're less likely to use belts and more likely to take risks that lead to crashes. Fifty-seven percent of 18-34 year-old male drivers who died in passenger vehicle crashes in 2007 were unbelted. Click It or Ticket messages also focus on pickup truck drivers. Sixty-two percent of fatally injured pickup drivers in crashes were unbelted during 2007.
New Hampshire is the only state that doesn't require adults to use belts, so it's not surprising that it has one of the lowest use rates. In 2008, just 69 percent of front seat occupants in the state buckled up. In most states, belt laws cover people in front seats only, although laws in 22 states and the District of Columbia extend to people in rear seats. Belt use continues to be lower among rear passengers than people in front. Nationwide, rear use was 74 percent in 2008, compared with 83 percent for front occupants.
Primary laws boost usage
Gains in belt use aren't consistent nationwide, and 1 out of every 6 occupants still isn't buckling up. Primary law states generally have higher belt use. During 2008, the average belt use rate in these states was 13 percentage points higher than in secondary states, NHTSA reports. Seventeen states and the District of Columbia had 90 percent or better use rates. All but 2 of these, Nevada and West Virginia, have primary laws. Michigan had the highest rate at just above 97 percent, followed by Hawaii and Washington. The lowest belt use rate, 67 percent, belonged to Massachusetts, which has a secondary law.
Belt use rates, 2001 pre-Click It or Ticket vs. 2008
States with lowest rates
|2001||2008||Type of law|
States with highest rates
|2001||2008||Type of law|
"Buckling up is the easiest and best life-saving tool motorists have," Lund says. "It's the main thing people can do to dramatically improve the odds they'll survive a crash because lap/shoulder belts cut the risk of dying by half. Primary laws remind people to fasten belts on each and every trip or risk a fine. Click It or Ticket helps drive home that message."
In 2007, 38 states and the District of Columbia had a belt use rate below 90 percent. If they had achieved at least 90 percent belt use, 1,652 more lives would have been saved above the estimated 15,147 lives belts saved in crashes that year, NHTSA reports. More than half of the additional lives saved would be in states without primary laws. The agency hasn't released 2008 estimates.
Moves by Arkansas, Florida, Minnesota, and Wisconsin to allow primary enforcement should boost the national use rate, Lund notes. Studies show belt use climbs after states upgrade to primary laws. Death rates decline, too. A 2005 Institute study found a 7 percent drop in driver death rates when states strengthen laws to primary (see "Primary belt laws would save about 700 lives per year," Jan. 31, 2005).
Having a primary belt law doesn't guarantee that all motorists will use belts. Kentucky and Mississippi are both primary law states and ranked in the bottom 10 for belt use in 2008. Kentucky's rate was 73 percent, up from 72 percent in 2007, while Mississippi's was 71 percent, down from a high of 74 percent in 2006.
A 2008 NHTSA-sponsored study by James Hedlund and the Preusser Research Group investigated why some states have high belt use rates and others don't. Hedlund says the analysis suggests "the most important difference between the high and low seat belt use states is enforcement, not demographics or funds spent on media." Both high and low belt use states in the study had Click It or Ticket campaigns, but "enforcement was much more vigorous in the high belt use states."
If high-visibility enforcement is a priority, Lund observes, it's possible to achieve strong belt use even in a state with a secondary belt law. A 1986 Institute study in Modesto, Calif., showed stepped-up enforcement and lots of media coverage result in significant gains in belt use in a secondary state (see "Belt use law: Success is tied to type of enforcement permitted," Dec. 13, 1986).
Enforcement is more difficult in states without primary laws, but "officers tell us they're still able to cite belt violators just by cracking down on drivers who break routine traffic laws like speed limits and stop signs," Lund says. Nevada's belt use rate was 91 percent in 2008 and West Virginia's was 90 percent, he notes. "These are states with secondary laws, but they top 11 primary law states when it comes to buckling up."
Late-night drivers and drinking
Among the belt holdouts are people who drive late at night and people who drive after consuming alcohol. Based on miles traveled, the nighttime passenger vehicle occupant fatality rate is about 3 times higher than the daytime rate. Data for fatal crashes show belt use declines as the evening progresses, reaching the lowest levels between midnight and 4 a.m. Alcohol use in night crashes is higher for fatally injured passenger vehicle drivers who are unbelted than for those who use belts.
Percent belt use by states and belt law, 2008
Several states have used Click It or Ticket to reach nighttime holdouts with some success. Most Click It or Ticket checkpoints and special patrols occur during daylight hours because it's trickier to enforce belt laws after dark. Pennsylvania, North Carolina, and West Virginia are among states that have focused on boosting night use. A 2004 mobilization in Reading, Pa., raised belt use during both the day and night, and reduced by half the gap between nighttime and daytime use.
Asheville, N.C., and Charleston, W.Va., used quarterly nighttime checkpoints in 2007 to lift belt use. Asheville's mobilization also included roadside surveys to see if night belt enforcement could deter alcohol-impaired driving. At checkpoints in this community, randomly selected drivers were asked to provide a voluntary breath test for alcohol. The percentage of drivers with positive blood alcohol concentrations (BACs) fell from 16 percent to 10 percent during the well-publicized program, a 2009 study by the Preusser Research Group found. Researchers concluded that night belt checkpoints increase belt use and also reduce drinking and driving.
The Asheville mobilization was modeled after one in Binghamton, New York. The city's 1988-1990 Buckle Up and Drive Sober program used safety belt and sobriety checkpoints to lift daytime and nighttime belt use, lower the percentage of drinking drivers, and reduce night crashes, a 1992 Institute study showed (see "Belt use rises, drinking declines in checkpoint program," Oct. 19, 1991).