ii

Table of Contents

Preface to the 2007 Edition vi 

Introduction 1 

Purpose of the Guide 1 

How to Use the Guide 1 

 Abbreviations 3 

 Acknowledgements 4 

1. Alcohol-Impaired Driving 

Overview 1-1 

 Strategies 1-2 

 Countermeasures 1-4 

 Deterrence 1-6 

 1. Laws 1-8 

1.1 Administrative license revocation or suspension (ALR or ALS) 1-8 

1.2 BAC test refusal penalties 1-10 

1.3 High BAC sanctions 1-12 

1.4 Open containers 1-13 

1.5 Alcohol-impaired driving law review 1-14 

 2. Enforcement 1-15 

 2.1 Sobriety checkpoints 1-15 

 2.2 Saturation patrols 1-17 

 2.3 Integrated enforcement 1-18 

 2.4 Preliminary breath test devices (PBT) 1-19 

 2.5 Passive alcohol sensors (PAS) 1-20 

 3. Prosecution and Adjudication 1-21 

3.1 Sanctions 1-21 

3.2 Diversion and plea agreement restrictions 1-23 

3.3 DWI courts 1-24 

 3.4 Court monitoring 1-26 

 4. DWI Offender Treatment, Monitoring, and Control 1-27 

 4.1 Alcohol problem assessment and treatment 1-27 

 4.2 DWI offender monitoring 1-28 

 4.3 Alcohol interlocks 1-30 

 4.4 Vehicle and license plate sanctions 1-31 

 4.5 Lower BAC limits for repeat offenders 1-33 

 5. Prevention, Intervention, Communications and Outreach 1-34 

 5.1 Responsible beverage service 1-35 

 5.2 Alternative transportation 1-37 

 5.3 Designated drivers 1-38 
 iii

 5.4 Alcohol screening and brief interventions 1-39 

 5.5 Mass media campaigns 1-40 

 6. Underage Drinking and Alcohol-related Driving 1-41 

 6.1 Minimum drinking age 21 law enforcement 1-42 

 6.2 Zero tolerance law enforcement 1-44 

 6.3 School education programs 1-45 

 6.4 Youth programs 1-46 

 References 1-47 

 

2. Seat Belts 

Overview 2-1 

 Strategies 2-3 

Countermeasures 2-4 

 1. Laws 2-6 

1.1 State primary enforcement belt use laws 2-6 

1.2 Local primary enforcement belt use laws and ordinances 2-8 

1.3 Increased belt use law penalties: fines and driver’s license points 2-9 

1.4 Belt use law coverage: seating positions, vehicles ages 2-11 

 2. Enforcement 2-12 

 2.1 Short-term, high-visibility enforcement 2-12 

 2.2 Sustained enforcement 2-14 

 2.3 Combined enforcement; nighttime enforcement 2-15 

 3. Communications and Outreach 2-16 

 3.1 Communications and outreach supporting enforcement 2-16 

 3.2 Communications and outreach strategies for low belt use groups 2-17 

 4. Other Strategies 2-19 

 4.1 Employer and school programs 2-19 

 4.2 Incentive programs 2-20 

 References 2-21 

3. Aggressive Driving and Speeding 

 Overview 3-1 

Strategies 3-2 

 Countermeasures That Work 3-3 

1. Laws 3-5 

 1.1 Speed limits 3-5 

 1.2 Aggressive-driving laws 3-7 

2. Enforcement 3-8 

 2.1 High-visibility enforcement 3-8 

 2.2 Automated enforcement 3-10 

 2.3 Other enforcement methods 3-12 

3. Penalties and adjudication 3-14 

 3.1 Penalty types and levels 3-14 

 3.2 Diversion and plea agreement restrictions; traffic violator school 3-16 

 4. Communications and outreach 3-18 

 4.1 Communications and outreach supporting enforcement 3-18 
 iv

References 3-19 

4. Distracted and Fatigued Driving 

 Overview 4-1 

 Strategies 4-2 

 Countermeasures That Work 4-5 

 1. Laws and enforcement 4-7 

 1.1 Cell phone laws 4-7 

 1.2 Graduated driver licensing requirements for beginning drivers 4-9 

 1.3 General driver fatigue and distraction laws 4-10 

 2. Communications and outreach 4-11 

 2.1 Communications and outreach on fatigued driving 4-11 

 2.2 Communications and outreach on distracted driving 4-13 

 3. Other countermeasures 4-14 

 3.1 Employer programs 4-14 

 3.2 Medical conditions and medications 4-16 

 References 4-18 

5. Motorcycle Safety 

Overview 5-1 

 Strategies 5-2 

 Countermeasures That Work 5-4 

 1. Operator licensing and training 5-6 

 1.1 Operator education and training 5-6 

 1.2 Operator licensing 5-8 

 2. Motorcycle helmets 5-10 

 2.1 State motorcycle helmet use laws 5-10 

 2.2 Helmet law enforcement; noncompliant helmets 5-12 

 2.3 Helmet use promotion programs 5-13 

 3. Alcohol impairment 5-14 

 3.1 Alcohol impairment: detection, sanction 5-14 

 3.2 Alcohol impairment: communications 5-16 

 4. Communications and outreach 5-18 

 4.1 Protective and conspicuous clothing 5-18 

 4.2 Other driver awareness of motorcyclists 5-20 

 References 5-21 

6. Young Drivers 

Overview 6-1 

 Strategies 6-2 

 Countermeasures That Work 6-4 

 1. Graduated driver licensing (GDL) 6-6 

 1.1 Graduated driver licensing 6-6 

 1.2 Learner’s permit length, supervised hours 6-8 

 1.3 Intermediate – nighttime restrictions 6-9 

 1.4 Intermediate – passenger restrictions 6-10 
 v

 1.5 Belt use requirements 6-11 

 1.6 Cell phone restrictions 6-12 

1.7 Intermediate – violation penalties 6-13 

 2. Driver education 6-14 

 2.1 Pre-licensure driver education 6-14 

 2.2 Post-licensure or second-tier driver education 6-16 

 3. Parents 6-17 

 3.1 Parent roles in teaching and monitoring 6-17 

 4. Traffic law enforcement 6-19 

 4.1 Enforcement of GDL and zero tolerance laws 6-19 

 References 6-20 

7. Older Drivers 

Overview 7-1 

 Strategies 7-3 

 Countermeasures That Work 7-5 

 1. Communications and outreach 7-7 

 1.1 Formal courses for older drivers 7-7 

 1.2 General communications and education 7-8 

 2. Licensing 7-10 

 2.1 License renewal policies 7-10 

 2.2 Referring older drivers to DMVs 7-12 

 2.3 License screening and testing 7-14 

 2.4 Medical advisory boards 7-15 

 2.5 License restrictions 7-16 

 3. Traffic law enforcement 7-17 

 3.1 Law enforcement roles 7-17 

 References 7-18 

8. Pedestrians 

Overview 8-1 

 Strategies 8-3 

 Countermeasures That Work 8-4 

 1. Young children 8-6 

 1.1 Children’s safety clubs 8-6 

 1.2 Child supervision 8-7 

 2. School-age children 8-8 

 2.1 Elementary school pedestrian training 8-8 

 2.2 Safe Routes to School (SR2S) 8-9 

 2.3 Model “ice cream vendor” ordinance 8-10 

 2.4 Child school bus training 8-11 

 3. Adults 8-12 

 3.1 Model road work site law 8-12 

 3.2 Pedestrian safety zones 8-13 

 4. Impaired pedestrians 8-14 

 4.1 Communications and outreach 8-14 
 vi

 4.2 Pedestrian “sweeper” patrols 8-15 

 5. All pedestrians 8-17 

 5.1 Reduced speed limits 8-17 

 5.2 Daylight savings time 8-19 

 5.3 Conspicuity enhancement 8-20 

 5.4 Driver training 8-21 

 5.5 Targeted enforcement 8-22 

 References 8-23 

9. Bicyclists 

Overview 9-1 

 Strategies 9-3 

 Countermeasures That Work 9-5 

 1. Children 9-7 

 1.1 Bike fairs, bike rodeos 9-7 

 1.2 Bicycle education in schools 9-8 

 1.3 Bicycle helmet laws for children 9-9 

 1.2 Safe Routes to School (SR2S) for bicyclists 9-10 

 2. Adults 9-11 

 2.1 Share the Road awareness programs 9-11 

 2.2 Bicycle safety in driver education 9-12 

 2.3 Bicycle helmet laws for adults 9-13 

 3. All bicyclists 9-14 

 3.1 Rider conspicuity 9-14 

 3.2 Active bicycle lighting 9-15 

 3.3 Targeted enforcement 9-17 

 3.2 Bicycle helmet promotions with education 9-19 

 References 9-20 
 vii

Preface to the Second Edition (2007)

The original Countermeasures that Work guide was prepared in 2005 by James H. Hedlund, 

Ph.D., of Highway Safety North, with the assistance of Barbara Harsha, Executive Director of 

the Governors Highway Safety Association. James H. Hedlund, Highway Safety North, and 

William A. Leaf, Preusser Research Group, contributed to this 2007 edition. 

The first seven chapters – Alcohol-Impaired Driving through Older Drivers – were included in 

the original guide and have been revised and updated for this Second Edition. Information and 

research studies through June 30, 2006 have been reviewed and included as appropriate. Data 

have been updated to include information from NHTSA’s Traffic Safety Facts 2005 annual 

report. 

Chapters 8 and 9, on pedestrian and bicycle safety, have been added. These chapters were 

prepared by William A. Leaf, of Preusser Research Group, funded by the Transportation 

Research Board, NCHRP Project 17-33, Effectiveness of Behavioral Highway Safety 

Countermeasures. 

User Suggestions and Future Editions

NHTSA will update this guide annually and may expand it with additional problem areas and 

countermeasures as appropriate. In particular, NHTSA is considering adding a chapter on drugs 

other than alcohol to the next edition. Users are invited to provide their suggestions and 

recommendations for the guide: 

• How can it be improved, in form and content? 

• Specific comments on information in the guide. 

• Additional problem areas to include. 

• Additional countermeasures to include for the current problem areas. 

• Additional key references to include. 

Please send your suggestions and recommendations to: 

Countermeasures That Work 

NHTSA 

Office of Research and Technology, NTI-130 

400 Seventh Street SW., Room 5119 

Washington, DC 20590 

or by e-mail to countermeasuresthatwork@nhtsa.dot.gov 
 1 

Introduction

Purpose of the Guide

This guide is a basic reference to assist State Highway Safety Offices (SHSOs) in selecting 

effective, science-based traffic safety countermeasures for major highway safety problem areas. 

The guide: 

o describes major strategies and countermeasures that are relevant to SHSOs; 

o summarizes their use, effectiveness, costs, and implementation time; and 

o provides references to the most important research summaries and individual studies. 

The guide is not intended to be a comprehensive list of countermeasures available for State use 

or a list of expectations for SHSO implementation. For a description of an optimal State 

countermeasure program, SHSOs should refer to the Highway Safety Program Guidelines, which 

delineate the principal components of each of the major program areas. 

States should identify problem areas through systematic data collection and analysis and are 

encouraged to continue to apply innovation in developing appropriate countermeasures. The 

evaluations summarized in this guide allow SHSOs to benefit from the experience and 

knowledge gained by others and to select countermeasure strategies that either have proven to be 

effective or that have shown promise. States choosing to use innovative programs can contribute 

to the collective knowledge pool by carefully evaluating the effectiveness of their efforts and 

publishing the findings for the benefit of others. 

How to Use the Guide 

What’s included: The guide contains a chapter for each problem area. Each chapter begins with 

a brief overview of the problem area’s size and characteristics, the main countermeasure 

strategies, a glossary of key terms, and a few general references. Next, a table lists specific 

countermeasures and summarizes their use, effectiveness, costs, and implementation time. Each 

countermeasure is then discussed in approximately one page. 

The guide provides an overview and starting point for readers to become familiar with the 

behavioral strategies and countermeasures in each program area. It has attempted to include 

countermeasures that have the most evidence of effectiveness as well as those that are used most 

regularly by SHSOs. Only those countermeasures that could be supported by traditional highway 

safety grant programs have been considered. 

Some countermeasure areas are covered in more depth than others due to the availability of 

published research. For example, impaired driving has a long and rich research history while 

other topics, such as driver distraction and fatigue, have received less attention. This difference 

in the availability of published research findings is due to a number of factors, including the 

relative scale of the problem areas, the availability of reliable data on the frequency and 

characteristics of some safety problems, and the challenge of conducting scientifically valid 

studies in certain behavioral areas. 
 2 

References are provided for each countermeasure. When possible, summaries of available 

research are cited, with Web links where available, so users can find most of the evaluation 

information in one place. If no summaries are available, one or two key studies are cited. There 

has been no attempt to list all research, current studies, or program information available on any 

countermeasure. Readers interested in any problem area or in specific countermeasures are urged 

to consult the references. 

What’s not included: Since the guide is intended as a tool for SHSO use, it does not include 

countermeasures for which SHSOs have little or no authority or responsibility, or that cannot be 

supported under typical highway safety grant programs. For example, the guide does not include 

vehicle- or roadway-based solutions. Also, it does not include countermeasures that already are 

in place in every State, such as .08 blood alcohol concentration (BAC) laws. Finally, the guide 

does not include administrative or management topics such as traffic safety data systems and 

analyses, program planning and assessments, State and community task forces, or comprehensive 

community traffic safety programs. 

What the effectiveness data mean: The effectiveness of any countermeasure can vary 

immensely from State to State or community to community. What is done is often less important 

than how it is done. The best countermeasure may have little effect if it is not implemented 

vigorously, publicized extensively, and funded satisfactorily. Evaluation studies generally 

examine and report on high-quality implementation because there is little interest in evaluating 

poor implementation. Also, the fact that a countermeasure is being evaluated usually gets the 

attention of those implementing it, so that it is likely to be done well. The countermeasure 

effectiveness data presented in this guide probably show the maximum effect that can be realized 

with high-quality implementation. Many countermeasures have not been evaluated well, or at all, 

as noted in the effectiveness data. 

NCHRP Guides: The National Cooperative Highway Research Program (NCHRP) is 

developing a series of guides for State DOTs to use in implementing the American Association 

of State Highway and Transportation Officials (AASHTO) Strategic Highway Safety Plan. As of 

summer 2005, 13 guides had been published and several more were being prepared. This guide 

draws heavily on the published NCHRP guides and on several draft guides. It differs from the 

NCHRP guides because it is written for SHSOs, contains only behavioral countermeasures, and 

is considerably more concise. Readers are urged to consult the NCHRP guides relevant to their 

interests. They are available at http://safety.transportation.org/guides.aspx

Disclaimers: As with any attempt to summarize a large amount of sometimes-conflicting 

information, this guide is highly subjective. All statements, judgments, omissions, and errors are 

solely the responsibility of the author and do not necessarily represent the views of the 

Governors Highway Safety Association (GHSA) or NHTSA. Users who disagree with any 

statement or who wish to add information or key references are invited to send their comments 

and suggestions for future editions (see bottom of page vi for details). 

New traffic safety programs and research appear almost weekly. Web sites change frequently. 

This means that this guide was out of date even before it was published. Readers interested in a 
 3 

specific problem area or countermeasure are urged to contact NHTSA for up-to-date 

information. 

Abbreviations, acronyms, and initials used throughout:

• AAA: was the American Automobile Association but now the organization uses only the 

initials 

• AAAFTS: AAA Foundation for Traffic Safety 

• AAMVA: American Association of Motor Vehicle Administrators 

• AARP: was the American Association of Retired Persons but now the organization uses 

only the initials 

• AASHTO: American Association of State Highway and Transportation Officials 

• ADTSEA: American Driver and Traffic Safety Education Association 

• ALR: administrative license revocation 

• ALS: administrative license suspension 

• AMA: American Medical Association 

• ASA: American Society on Aging 

• BAC: blood alcohol concentration 

• CDC: Centers for Disease Control and Prevention 

• CTIA: Cellular Telecommunications and Internet Association 

• DOT: Department of Transportation (Federal or State) 

• DWI: driving while intoxicated 

• DWS: driving while driver’s license is suspended 

• FHWA: Federal Highway Administration 

• FMCSA: Federal Motor Carrier Safety Administration 

• GDL: graduated driver licensing 

• GHSA: Governors Highway Safety Association 

• HOS: hours of service 

• IIHS: Insurance Institute for Highway Safety 

• ITS: Intelligent Transportation Systems 

• MAB: medical advisory board 

• MSF: Motorcycle Safety Foundation 

• NCHRP: National Cooperative Highway Research Program 

• NCSDR: National Center for Sleep Disorders Research 

• NCUTLO: National Committee on Uniform Traffic Laws and Ordinances 

• NHTSA: National Highway Traffic Safety Administration (U.S. DOT) 

• NIAAA: National Institute on Alcohol Abuse and Alcoholism (NIH) 

• NIH: National Institutes of Health 

• NMSL: National Maximum Speed Limit 

• NSC: National Safety Council 

• NSF: National Sleep Foundation 

• NTSB: National Transportation Safety Board 

• SFST: Standardized Field Sobriety Tests 

• SHSO: State Highway Safety Office 
 4 

• SMSA: National Association of State Motorcycle Safety Administrators 

• STEP: selective traffic enforcement program 

• TIRF: Traffic Injury Research Foundation 

• TRB: Transportation Research Board 

• UVC: Uniform Vehicle Code 

Acknowledgments: 

Many people provided invaluable help in the preparation of this guide. 

• Eminent traffic safety researchers Daniel Mayhew, David Preusser, Ruth Shults, and 

Allan Williams recommended what countermeasures to include and what research 

studies were most useful. 

• Governors Highway Safety Representatives or Coordinators Chuck Abbott of Nevada, 

Jim Champagne of Louisiana, Lorrie Laing of Ohio, Terry Pence of Texas, Priscilla 

Sinclair of Montana, and Kathy Swanson of Minnesota reviewed drafts, corrected errors, 

filled in gaps, and provided other valuable advice. 

• Many people at NHTSA, too many to name individually, reviewed drafts and provided 

information on the most recent research and program activities. Special thanks go to Jo 

Ann Kelley for coordinating all NHTSA comments and advice. 

. 
 1 - 1 

1. Alcohol-Impaired Driving

Overview 

Alcohol-impaired drivers were involved in about one-quarter of U. S. traffic fatalities in 2005 

(NHTSA, 2005a, Table 19; NHTSA, 2005b, Table 4): 

• 14,068 alcohol-involved drivers in fatal crashes (24% of all drivers in fatal crashes); 

• 11,921 drivers in fatal crashes with a BAC over .08 grams per deciliter (20% of all 

drivers in fatal crashes). 

The number of alcohol-involved drivers decreased slightly in 2005, as the number of alcoholrelated fatalities decreased from 16,919 in 2004 to 16,885 in 2005. See NHTSA’s most recent 

Traffic Safety Facts (NHTSA, 2006a) and State Alcohol Estimates (NHTSA, 2006b) for the 

latest national and State data. 

Trends. Alcohol-impaired driving dropped steadily from 1982 to the mid-1990s for many 

reasons. Substantial public attention, the growth of grassroots organizations such as MADD and 

RID, increased Federal funding, State task forces, tougher laws, increased enforcement, and 

intensive publicity all combined to help address this critical traffic safety problem. 

Unfortunately, as the chart shows, impaired driving levels have changed very little since 1992. 

The easy gains have been made. Public attention and government resources have been redirected 

to other social problems. 

 Source: FARS 

Drinking and driving characteristics. Drinking and driving is common, with at least 80 million 

trips made annually by drivers who are over .08 BAC. Arrests are rare, with less than one arrest 

for every 50 trips by a driver over .08 BAC (Hedlund and McCartt, 2002). 

Many drinking drivers are “high risk,” with one or more of the following characteristics:

U.S. Alcohol-related Traffic Fatalities

0

5,000

10,000

15,000

20,000

25,000

30,000

82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Year

Fatalities
 1 - 2 

• Half of drinking drivers in crashes or arrests have a BAC of .15 or higher.

• One-third of drinking drivers in crashes or arrests have a prior DWI conviction. 

• One-quarter of drinking drivers in surveys have some indication of an alcohol problem.

Alcohol-impaired driving is affected by several external factors, including geography, 

urbanization, road structure and conditions, and economic activity, as well as by a State’s laws 

and programs. For all of these reasons, both the current level of alcohol-impaired driving and the 

progress in reducing alcohol-impaired driving vary greatly from State to State. For example, 

comparing all 50 States and the District of Columbia (NHTSA, 2005b):

• The proportion of drivers in fatal crashes with a BAC of .08 or higher in 2004 ranged 

from 14 percent in the lowest States to 33 percent in the highest.

• The change in traffic fatalities involving any alcohol from 1982 to 2004 ranged from a 

decrease of 64 percent in the best State to an increase of 5 percent in the worst.

Strategies to Reduce Alcohol-Impaired Driving

Five basic strategies are used to reduce alcohol-impaired driving crashes and consequences: 

• Deterrence: enact, publicize, enforce, and adjudicate laws prohibiting alcohol-impaired 

driving; 

• Prevention and intervention: reduce drinking, keep drinkers from driving; 

• Communications and outreach: inform the public of the dangers of impaired driving and 

establish positive social norms that make driving while impaired unacceptable; 

• Alcohol treatment: reduce alcohol dependency or addiction among drivers; and 

• Other traffic safety measures: implement strategies that affect alcohol-impaired drivers 

and other drivers as well. 

This chapter includes countermeasures for the first four strategies. Deterrence countermeasures 

are divided into four sections: (1) laws, (2) enforcement, (3) prosecution and adjudication, and 

(4) offender treatment, monitoring, and control. Alcohol treatment is included in the offender 

section. Prevention, intervention, communications, and outreach countermeasures are combined 

in a single section. The Underage Drinking and Alcohol-Related Driving section includes 

deterrence, prevention, and communications measures specific to this age group. 

Many other traffic safety countermeasures help reduce alcohol-related crashes and casualties but 

are not discussed in this chapter. Behavioral countermeasures, such as those that increase seat 

belt use and reduce speeding, are discussed in other chapters. Vehicle and environmental 

countermeasures, such as improved vehicle structures and centerline rumble strips, are not 

included because SHSOs have little or no authority or responsibility for them. See the series of 

NCHRP Report 500 guides for the AASHTO Strategic Highway Safety Plan, especially the 

impaired-driving guide (NCHRP, 2005), for detailed discussions of environmental measures. 

This chapter does not consider drugs other than alcohol. Other drugs pose quite different and 

difficult issues at every step, from estimating their prevalence and effect on driving, to 

developing effective laws and strategies for enforcement, prevention, and treatment.
 1 - 3 

Key terms 

• BAC: Blood alcohol concentration in the body, expressed in grams of alcohol per 

deciliter (g/dL) of blood, usually measured with a breath or blood test. 

• DWI: the offense of driving while impaired by alcohol. In different States the offense 

may be called Driving While Intoxicated, Driving Under the Influence (DUI), or other 

similar terms. 

• MADD: Mothers Against Drunk Driving. 

• PAS: Passive Alcohol Sensor, a device to detect alcohol presence in the air near a 

driver’s face, used to estimate whether the driver has been drinking. 

• PBT: Preliminary Breath Test device, a small handheld alcohol sensor used to estimate 

or measure a driver’s BAC. 

• RID: Remove Intoxicated Drivers 

• SFST: Standardized Field Sobriety Tests, a battery of three simple tasks (one-leg stand, 

walk-and-turn, and horizontal gaze nystagmus) used by law enforcement at the roadside 

to estimate whether a driver is impaired by alcohol. 

• Illegal per se law: A law that makes it an offense to operate a motor vehicle with a BAC 

at or above a specified level. 
 1 - 4 

Countermeasures That Work 

Countermeasures to reduce alcohol-impaired driving are listed below and discussed individually 

in the remainder of this chapter. The table is intended to give a rough estimate of each 

countermeasure’s effectiveness, use, cost, and time required for implementation. The terms used 

are described below. Effectiveness, cost, and time to implement can vary substantially from State 

to State and community to community. Costs for many countermeasures are difficult to measure, 

so the summary terms are very approximate. See each countermeasure discussion for more 

information. 

1. Deterrence: laws 

Countermeasure Effectiveness Use Cost Time 

1.1 ALR/ALS Proven High High Medium 

1.2 BAC test refusal penalties Proven-refusals Unknown Low Short 

1.3 High-BAC sanctions Uncertain Medium Low Short 

1.4 Open containers Uncertain High Low Short 

1.5 DWI code review Likely Low Medium Medium 

2. Deterrence: enforcement 

Countermeasure Effectiveness Use Cost Time 

2.1 Sobriety checkpoints Proven Medium High Short 

2.2 Saturation patrols Proven-arrests High Medium Short 

2.3 Integrated enforcement Likely Unknown Low Short 

2.4 Preliminary Breath Test devices (PBT) Proven-arrests High Medium Short 

2.5 Passive sensors (PAS) Proven-detection Unknown Medium Short 

3. Deterrence: prosecution and adjudication 

Countermeasure Effectiveness Use Cost Time 

3.1 Sanctions Varies Varies Varies Varies 

3.2 Diversion, plea agreement restrictions Proven-convictions Medium Low Short 

3.3 DWI courts Likely Low High Medium 

3.4 Court monitoring Proven-convictions Low Low Short 

4. Deterrence: DWI offender treatment, monitoring, and control 

Countermeasure Effectiveness Use Cost Time 

4.1 Alcohol problem assessment, treatment Proven High Varies Varies 

4.2 DWI offender monitoring Proven-recidivism Unknown High Medium 

4.3 Alcohol interlocks Proven Medium Medium Medium 

4.4 Vehicle and license plate sanctions Varies Medium Varies Medium 

4.5 Lower BAC limit for repeat offenders Uncertain Low Low Short 
 1 - 5 

5. Prevention, intervention, communications and outreach 

Countermeasure Effectiveness Use Cost Time 

5.1 Responsible beverage service Likely Medium Medium Medium 

5.2 Alternative transportation Unknown Unknown Medium Short 

5.3 Designated drivers Unknown Medium Low Short 

5.4 Alcohol screening and brief interventions Proven Medium Medium Short 

5.5 Mass-media campaigns Proven * High High Medium 

* High-quality campaigns supporting other program activities, such as enforcement 

6. Underage drinking and alcohol-related driving 

Countermeasure Effectiveness Use Cost Time 

6.1 Age 21 enforcement Varies Varies Varies Varies 

6.2 Zero-tolerance enforcement Likely Unknown Medium Short 

6.3 School education programs Uncertain Unknown Low Long 

6.4 Youth programs Uncertain High Varies Medium 

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results 

 Likely: balance of evidence from high-quality evaluations or other sources 

 Uncertain: limited and perhaps ambiguous evidence 

 Unknown: no high-quality evaluation evidence 

 Varies: different methods of implementing this countermeasure produce different results 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. See 

individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 

Use: 

 High: more than two-thirds of the States, or a substantial majority of communities 

 Medium: between one-third and two-thirds of States or communities 

 Low: less than one-third of the States or communities 

 Unknown: data not available 

Cost to implement: 

 High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources 

 Medium: requires some additional staff time, equipment, facilities, and/or publicity 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment, facilities, and publicity 

Time to implement: 

 Long: more than one year 

 Medium: more than three months but less than one year 

 Short: three months or less 

These estimates do not include the time required to enact legislation or establish policies. 
 1 - 6 

Deterrence 

Deterrence means enacting laws that prohibit driving while impaired, publicizing and enforcing 

those laws, and punishing the offenders. Deterrence works by changing behavior through the fear 

of punishment. If drivers believe that impaired driving is likely to be detected and that impaired 

drivers are likely to be arrested, convicted, and punished, many will not drive while impaired by 

alcohol. This strategy is sometimes called general deterrence because it influences the general 

driving public through well publicized and highly visible enforcement activities and subsequent 

punishment. In contrast, specific deterrence refers to efforts to influence drivers who have been 

arrested for impaired driving so that they will not continue to drive while impaired by alcohol.

Deterrence works when consequences are swift, sure, and severe (with swift and sure being more 

important in affecting behavior than severe). All States have the basic laws in place to define 

impaired driving, set illegal per se limits at .08 BAC, and provide standard penalties. 

Deterrence, however, is far from straightforward, and complexities can limit the success of 

deterrence measures. For instance: 

• Detecting alcohol-impaired drivers is difficult. Alcohol-impaired driving is a common 

behavior, law enforcement agencies have limited resources, and (except at 

checkpoints) officers must observe some traffic violation or other aberrant behavior 

before they can stop a motorist. 

• Conviction also may be difficult. DWI laws are extremely complicated (20 pages in 

some State codes); the evidence needed to define and demonstrate impairment is 

complex; judges and juries may not impose specified penalties for an action that they 

do not believe is a “real crime.” 

• The DWI control system is complex. There are many opportunities for breakdowns in 

the system that allow impaired drivers to go unpunished. 

DWI control system operations and management. 

The DWI control system consists of a set of laws together with the enforcement, prosecution, 

adjudication, and offender follow-up policies and programs to support the laws. In this 

complicated system, the operations of each component affect all the other components. Each new 

policy, law, or program affects operations throughout the system, often in ways that are not 

anticipated. 

This guide documents 16 specific impaired-driving countermeasures in the deterrence section, in 

four groups: laws, enforcement, prosecution and adjudication, and offender treatment, 

monitoring, and control. But the overall DWI control system, including its management and 

leadership, is more important than any individual countermeasure. 

Recent studies have highlighted the key characteristics of an efficient and effective DWI control 

system (Hedlund and McCartt, 2002; Robertson and Simpson, 2003): 

• Training and education for law enforcement, prosecutors, judges, and probation officers; 

• record systems that are accurate, up-to-date, easily accessible, and able to track each DWI 

offender from arrest through the completion of all sentence requirements; 
 1 - 7 

• adequate resources for staff, facilities, training, equipment, and new technology; and 

• coordination and cooperation within and across all components. 

A few of the countermeasures discussed in this guide, such as BAC test refusal penalties 

(Chapter 1, Section 1.2), DWI code review (1.5), and DWI courts (3.2), are directed at improving 

DWI system operations. Most, though, are not. The most important action many SHSOs can take 

to reduce alcohol-impaired driving may be to review and improve DWI control system 

operations, perhaps using a State DWI task force and/or a State alcohol program assessment. 

Ulmer et al. (1999) investigated why some States reduced alcohol-related traffic fatalities more 

than others. They concluded that there is no “silver bullet,” no single critical law, enforcement 

practice, or communications strategy. Once a State has effective laws, high-visibility 

enforcement, and substantial communications and outreach to support them, the critical factors 

are strong leadership, commitment to reducing impaired driving, and adequate funding. SHSOs 

should keep this in mind as they consider the specific countermeasures in this chapter. 
 1 - 8 

1.1 Administrative License Revocation or Suspension (ALR or ALS) 

Effectiveness: Proven Use: High Cost: High Time: Medium 

Administrative license revocation or administrative license suspension laws allow law 

enforcement and driver licensing authorities to revoke or suspend a driver's license if the driver 

fails or refuses to take a BAC test. The license revocation or suspension occurs very quickly: 

usually the arresting officer takes the license at the time that a BAC test is failed or refused. The 

driver typically receives a temporary license that allows the driver time to make other 

transportation arrangements and to request and receive an administrative hearing or review. In 

most jurisdictions, offenders may obtain an occupational or hardship license during part or all of 

the revocation or suspension period (NCHRP, 2003; NHTSA, 2006b1; McCartt et al., 2002). 

ALR and ALS laws provide for swift and certain penalties for DWI, rather than the lengthy and 

uncertain outcomes of criminal courts. They also protect the driving public by removing some 

DWI offenders from the road (but see the discussion of driving with a suspended license, under 

other issues, below). 

Use: As of January 2006, 41 States and the District of Columbia had some form of ALR or ALS 

law. An additional two States had an alternative method for removing the license quickly, before 

criminal action in court (McCartt et al., 2002; NHTSA, 2006c). 

Effectiveness: A summary of 12 evaluations through 1991 found that ALR and ALS laws 

reduced crashes of different types by an average of 13 percent (Wagenaar et al., 2000). Studies 

that evaluated ALR in combination with other laws found similar effects. More recently, Voas 

and Tippetts found that ALR laws in combination with other laws reduced alcohol-related fatal 

crashes by about 30 percent over the period 1982-1997 (Jones and Lacey, 2001, pp. 105-106). 

There is some evidence that ALR laws also are effective in reducing repeat offenses (Jones and 

Lacey, 2001, pp. 105-106). The Centers for Disease Control and Prevention concluded that ALR 

and ALS effectiveness is so well established that a synthesis of the evaluation evidence is not 

needed. 

Costs: ALR laws require funds to design, implement, and operate a system to record and process 

administrative license actions. In addition, a system of administrative hearing officers must be 

established and maintained. Some States have recovered ALR system costs through offender fees 

(Century Council, 2003, 57-61; NHTSA, 2006c). 

Time to implement: Six to twelve months are required to design and implement the system and 

to recruit and train administrative hearing officers. 

Other issues: 

• Two-track system: Under ALR or ALS laws, drivers face both administrative and 

criminal actions for DWI. The two systems operate independently. Drivers whose 

licenses have been suspended or revoked administratively still may face criminal actions 

that also may include license suspension or revocation. This two-track system has been 
 1 - 9 

challenged in some States. All State supreme courts have ruled against these challenges 

(NHTSA, 2006c).

• Driving with a suspended license: Many DWI offenders continue to drive with a 

suspended or revoked license, though there is some evidence that they drive less 

frequently and/or more carefully than before their license action. Both administrative and 

criminal laws that remove a driver’s license should be accompanied by strategies to 

reduce driving with a suspended or revoked license (see NCHRP, 2003, for a thorough 

discussion of ten potential strategies; see also Chapter 1, Sections 4.3 and 4.4). 

• Hearings: An effective ALR system will restrict administrative hearings to the relevant 

facts: that the arresting officer had probable cause to stop the car and require a BAC test 

and that the driver refused or failed the test. Such a system will reduce the number of 

hearings requested, reduce the time required for each hearing, and minimize the number 

of licenses that are reinstated. When administrative hearings are not restricted in this way 

they can serve as an opportunity for defense attorneys to question the arresting officer 

about many aspects of the DWI case. This may reduce the chance of a criminal DWI 

conviction (Hedlund and McCartt, 2002, pp. 58-59). Officers often spend substantial time 

appearing in person at ALR hearings, and cases may be dismissed if an officer fails to 

appear. Some States use telephonic hearings to solve these problems (Wiliszowski et al., 

2003). 
 1 - 10 

1.2 BAC Test Refusal Penalties 

Effectiveness: Proven-refusals Use: Unknown Cost: Low Time: Short 

A driver’s BAC is a critical piece of evidence in any alcohol-impaired driving action. A positive 

BAC provides evidence of alcohol presence that supports the basic DWI charge. All States have 

enacted per se laws under which it is illegal to drive with a BAC of .08 or greater, with no other 

evidence required. Many States have established more severe penalties for drivers with BACs 

that exceed a specific higher BAC level, typically .15 or .16 (see Chapter 1, Section 1.3, HighBAC Sanctions). Finally, administrative license revocation or suspension (ALR or ALS) laws are 

based entirely on the driver’s BAC level. 

However, many drivers refuse to provide a breath or blood sample for a BAC test. In 2001, in 

half the States with BAC testing data, more than 18 percent of drivers refused a BAC test, and in 

one-quarter of the States more than 32 percent refused (Zwicker et al., 2005, p. 6; data from 41 

States). All States have established separate penalties for BAC test refusal, typically involving 

administrative license revocation or suspension. If the penalties for refusal are less severe than 

the penalties for failing the test, many drivers will refuse (see also Simpson and Robertson, 2001, 

pp. 39-46). The Model DWI code sets a more severe penalty for test refusal than for test failure 

(NCUTLO, 2000). 

Use: The relative penalties in each State for failing and refusing a BAC test cannot be 

categorized in a straightforward manner due to the complexity of State alcohol-impaired driving 

laws and the differences in how these laws are prosecuted and adjudicated. All States except 

Nevada impose administrative sanctions for test refusal (NHTSA, 2006d). Zwicker et al. (2005) 

summarizes each State’s laws as of 2001 in Appendices A and B. NHTSA (2006b1) gives more 

detail on each State’s laws. 

Effectiveness: Zwicker et al. (2005) found that test refusal rates are lower in States where the 

consequences of test refusal are greater than the consequences of test failure. These 

consequences are determined both by the statutory penalties for test refusal and failure and by 

operational considerations of the DWI system. Operational considerations include issues such as 

whether test refusal is admissible in court as part of the DWI proceedings and whether hardship 

licenses are routinely available for drivers whose licenses are suspended for test refusal. 

Reduced test refusal rates will help the overall DWI control system by providing better BAC 

evidence. This in turn reduces pleas to non-alcohol offenses, increases DWI and high-BAC DWI 

convictions, increases the likelihood that prior DWI offenses will be properly identified, and 

provides the court with better evidence for offender alcohol assessment. 

Costs: There are no direct costs of increasing penalties for BAC test refusal. 

Time to implement: Increased BAC test refusal penalties can be implemented as soon as 

appropriate legislation is enacted. 

Other issues: 
 1 - 11 

• Criminalizing test refusal: BAC test refusal is a criminal offense in at least some 

circumstances in 19 States (NHTSA, 2006d; see also Zwicker et al., 2005, Appendix A; 

Century Council, 2003, p. 31; NCHRP, 2005, Strategy C2). 
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1.3 High-BAC Sanctions 

Effectiveness: Uncertain Use: Medium Cost: Low Time: Short 

Many States increase the penalties for the standard impaired driving (DWI) offense for two 

classes of drivers. Almost all States increase the penalties for repeat offenders. Recently, some 

States also have increased the penalties for drivers with a high BAC, typically .15 or .16 or 

higher. 

High-BAC sanctions are based on the observation that many high-BAC drivers are habitual 

impaired driving offenders, even though they may not have a record of previous arrests and 

convictions. 

Use: As of January 2006, 31 States and the District of Columbia had high-BAC laws (NHTSA, 

2006e). MADD (2006) lists 38 States and the District of Columbia. 

Effectiveness: In the only evaluation of high-BAC sanctions to date, McCartt and Northrup 

(2003, 2004) found that Minnesota’s law appears to have increased the severity of case 

dispositions for high-BAC offenders, although the severity apparently declined somewhat over 

time. They also found some evidence of an initial decrease in recidivism among high-BAC first 

offenders. The BAC test refusal rate declined for first offenders and was unchanged for repeat 

offenders after the high-BAC law was implemented. The authors point out that Minnesota’s law 

has a high threshold of .20 BAC, relatively strong administrative and criminal sanctions, and 

strong penalties for BAC test refusal. 

Costs: High-BAC sanctions will produce increased costs if the high-BAC penalties are more 

costly per offender than the lower-BAC penalties. Over a longer period, if high-BAC sanctions 

reduce recidivism and deter alcohol-impaired driving, then costs will decrease. 

Time to implement: High-BAC sanctions can be implemented as soon as appropriate legislation 

is enacted. 

Other issues: 

• Test refusal: High-BAC laws may encourage some drivers to refuse the BAC test unless 

the penalties for test refusal are at least as severe as the high-BAC penalties. See Chapter 

1, Section 1.2.
 1 - 13 

1.4 Open Containers 

Effectiveness: Uncertain Use: High Cost: Low Time: Short 

Open-container laws prohibit the possession and consumption of alcoholic beverages by motor 

vehicle drivers or passengers. These laws typically exempt passengers in buses, taxis, and the 

living quarters of mobile homes. 

In 1998, Congress required States to enact open-container laws or have a portion of their Federal 

aid highway construction funds redirected to alcohol-impaired driving or hazard elimination 

activities (23 U.S.C. § 154; NHTSA, 2006f). 

Use: As of January 2006, 39 States and the District of Columbia had open-container laws that 

complied with the Federal requirements (NHTSA, 2006f). 

Effectiveness: The only study of open-container law effectiveness (Stuster et al., 2002) 

examined four States that enacted laws in 1999. It found that the proportion of alcohol-involved 

fatal crashes appeared to decline in three of the four States during the first six months after the 

laws were implemented, but the declines were not statistically significant. In 1999, the 

proportion of alcohol-involved fatal crashes was higher in States with no open-container law 

than in States with a law. Survey data show strong public support for open-container laws in both 

law and no-law States. 

Costs: Open-container law costs depend on the number of offenders detected and the penalties 

applied to them. 

Time to implement: Open-container laws can be implemented as soon as appropriate legislation 

is enacted. 
 1 - 14 

1.5 Alcohol-Impaired Driving Law Review 

Effectiveness: Likely Use: Low Cost: Medium Time: Medium

 

Alcohol-impaired driving laws in many States are extremely complex. They are difficult to 

understand, enforce, prosecute, and adjudicate, with many inconsistencies and unintended 

consequences. In many States, a thorough review and revision would produce a system of laws 

that would be far simpler and more understandable, efficient, and effective. 

DWI laws have evolved over the past 30 years to incorporate new definitions of the offense of 

driving while impaired (illegal per se laws), new technology and methods for determining 

impairment (BAC tests, Standardized Field Sobriety Tests), and new sentencing and monitoring 

alternatives (electronic monitoring, alcohol ignition interlocks). Many States modified their laws 

to incorporate these new ideas without reviewing their effect on the overall DWI control system. 

The result is often an inconsistent patchwork. Robertson and Simpson (2003, p. 18) summarized 

the opinions of thousands of law enforcement officers, prosecutors, judges, and probation 

officials across the country: “Professionals unanimously support the simplification and 

streamlining of existing DWI statutes.” See also Hedlund and McCartt (2002, p. 53). 

The National Committee on Uniform Traffic Laws and Ordinances has prepared a model DWI 

law, which has been incorporated into the Uniform Vehicle Code (NCUTLO, 1999). It addresses 

BAC testing, BAC test refusals, higher penalties for high-BAC drivers, ALR hearing procedures, 

and many other issues of current interest. States can use the NCUTLO model as a reference point 

in reviewing their own laws. 

Use: Minnesota and Virginia recently reviewed and revised their DWI laws. 

Effectiveness: The effect of a law review will depend on the extent of inconsistencies and 

inefficiencies in a State’s current laws. A law review may be the most important single action a 

State can take to address its alcohol-impaired driving problem, because a thorough law review 

also will review the function of the entire DWI control system and will identify problem areas. 

The immediate effect of a law review will be a more efficient and effective DWI control system. 

Costs: The review itself will require substantial staff time. Outside groups, such as the defense 

bar and citizen groups, should be asked to participate, through a mechanism such as a State-level 

task force. Implementation costs of course will depend on the extent to which the laws are 

changed. 

Time to implement: The review will require four to six months. Its recommendations must then 

be enacted by the legislature and implemented. 
 1 - 15 

2.1 Sobriety Checkpoints 

Effectiveness: Proven Use: Medium Cost: High Time: Short

At a sobriety checkpoint, law enforcement officers stop vehicles at a predetermined location to 

check whether the driver is impaired. They either stop every vehicle or stop vehicles at some 

regular interval, such as every third or tenth vehicle. The purpose of checkpoints is to deter 

driving after drinking by increasing the perceived risk of arrest. To do this, checkpoints should 

be highly visible, publicized extensively, and conducted regularly. Fell et al. (2004) provide an 

overview of checkpoint operations, use, effectiveness, and issues. 

Use: Sobriety checkpoints are used occasionally in most of the 40 States and the District of 

Columbia in which they are permitted (MADD, 2006), but few States conduct them regularly. 

Fell et al. (2003) found that 37 States and the District of Columbia conducted checkpoints at 

least once in the year 2000 but only 11 States conducted them on a weekly basis. The main 

reasons given for not using checkpoints more frequently were lack of law enforcement personnel 

and lack of funding. Some States have increased checkpoint operations recently. For example, 

each of the six jurisdictions in NHTSA’s Mid-Atlantic Region (the District of Columbia, 

Delaware, Maryland, Pennsylvania, Virginia, and West Virginia) conducted weekly checkpoints 

for much of 2003. 

Effectiveness: CDC’s systematic review of 11 high-quality studies (Elder et al., 2002) found that 

checkpoints reduced alcohol-related fatal, injury, and property damage crashes each by about 20 

percent. 

Costs: The main costs are for law enforcement time and for publicity. A typical checkpoint 

requires several hours from each law enforcement officer involved. Officers must either be 

diverted from other duties or paid overtime. Law enforcement costs can be reduced by operating 

checkpoints with 3 to 5 officers, perhaps supplemented by volunteers, instead of the 10 to 12 or 

more officers used in some jurisdictions (NHTSA, 2002, p. 4; NHTSA, 2006j; Stuster and 

Blowers, 1995). Recently, police agencies in two rural West Virginia counties were able to 

sustain a year-long program of weekly low-staff checkpoints (Lacey et al., 2006). The proportion 

of nighttime drivers with BACs of .05 and higher was 70-percent lower in these counties 

compared to drivers in comparison counties that did not operate additional checkpoints. 

Checkpoint publicity can be costly if paid media are used. 

Time to implement: Checkpoints can be implemented within three months if officers are trained 

in detecting impaired drivers, SFST, and checkpoint operational procedures. See NHTSA (2002) 

for implementation information. 

Other issues: 

• Legality: Checkpoints currently are permitted in 39 States and the District of Columbia 

(NHTSA, 2002). Checkpoints are permitted under the U.S. Constitution but some State 

courts have held that checkpoints violate their State’s constitution. Other State 
 1 - 16 

legislatures have not authorized checkpoints. States where checkpoints are not permitted 

may use saturation patrols (see Chapter 1, Section 2.2). 

• Publicity: Checkpoints must be highly visible and publicized extensively to be effective. 

Communication and enforcement plans should be coordinated. Messages should clearly 

and unambiguously support enforcement. Paid media may be necessary to complement 

news stories and other earned media, especially in a continuing checkpoint program 

(NCHRP, 2005, Strategy B1).

• Arrests: The purpose of checkpoints is to deter impaired driving, not to increase arrests. 

Impaired drivers detected at checkpoints should be arrested and arrests should be 

publicized, but arrests at checkpoints should not be used as a measure of checkpoint 

effectiveness.

• Other offenses: Checkpoints may also be used to check for valid driver licenses, safety 

belt use, outstanding warrants, stolen vehicles, and other traffic and criminal infractions. 
 1 - 17 

2.2 Saturation Patrols 

Effectiveness: Proven-arrests Use: High Cost: Medium Time: Short 

A saturation patrol (also called a blanket patrol, “wolf pack,” or dedicated DWI patrol) consists 

of a large number of law enforcement officers patrolling a specific area for a set time to detect 

and arrest impaired drivers. The purpose of saturation patrols is to arrest impaired drivers and 

also to deter driving after drinking by increasing the perceived risk of arrest. To do this, 

saturation patrols should be publicized extensively and conducted regularly. A less-intensive 

strategy is the “roving patrol” in which individual patrol officers concentrate on detecting and 

arresting impaired drivers in an area where impaired driving is common or where alcoholinvolved crashes have occurred (Stuster, 2000). 

Use: The Century Council (2003, p. 20) survey reported that 44 States used saturation patrols. 

Effectiveness: Saturation patrols can be very effective in arresting impaired drivers. For 

example, in 2001 Minnesota’s 96 saturation patrols stopped 13,681 vehicles and arrested 566 

impaired drivers (Century Council, 2003). The effects of saturation patrols on alcohol-related 

crashes or injuries have not been evaluated. 

Costs: The main costs are for law enforcement time and for publicity. Saturation patrol 

operations are quite flexible in both the number of officers required and the time that each officer 

participates in the patrol. As with sobriety checkpoints, publicity can be costly if paid media is 

used. 

Time to implement: Saturation patrols can be implemented within three months if officers are 

trained in detecting impaired drivers and in SFST. See NHTSA (2002) for implementation 

information. 

Other issues: 

• Legality: Saturation patrols are legal in all jurisdictions. 

• Publicity: Saturation patrols should be publicized extensively to be effective in deterring 

impaired driving. Communication and enforcement plans should be coordinated. 

Messages should clearly and unambiguously support enforcement. Paid media may be 

necessary to complement news stories and other earned media, especially in a continuing 

saturation patrol program (NCHRP, 2005, Strategy B2).

• Other offenses: Saturation patrols are effective in detecting other driving and criminal 

offenses. 
 1 - 18 

2.3 Integrated Enforcement 

Effectiveness: Likely Use: Unknown Cost: Low Time: Short

Impaired drivers are detected and arrested through regular traffic enforcement and crash 

investigations as well as through special impaired driving checkpoints and saturation patrols. A 

third opportunity is to integrate impaired-driving enforcement into special enforcement activities 

directed primarily at other offenses such as speeding or seat belt nonuse, especially since 

impaired drivers often speed or fail to wear sear belts. 

Use: There are no data on how frequently integrated enforcement methods are used. 

Effectiveness: Jones et al. (1995) evaluated a three-site evaluation of integrated impaired 

driving, speed, and seat belt use enforcement. They found that the sites that combined high 

publicity with increased enforcement reduced crashes likely to involve alcohol (such as singlevehicle nighttime crashes) by 10 percent to 35 percent. They concluded that the results were 

encouraging but not definitive. See also Jones and Lacey (2001, pp. 113-115), NCHRP (2005, 

Strategy B2), and Stuster (2000). 

The Massachusetts Saving Lives comprehensive programs in five communities used integrated 

enforcement methods. The programs reduced fatal crashes involving alcohol by 42 percent 

(Hingson et al., 1996). About half the speeding drivers detected through these enforcement 

activities had been drinking and about half the impaired drivers were speeding. 

Costs: As with other enforcement strategies, the primary costs are for law enforcement time and 

for publicity. 

Time to implement: Impaired driving can be integrated into other enforcement activities within 

three months if officers are trained in detecting impaired drivers and in SFST. 

Other issues:

• Publicity: Integrated enforcement activities should be publicized extensively to be 

effective in deterring impaired driving and other traffic offenses. Paid media may be 

necessary to complement news stories and other earned media, especially in a continuing 

saturation patrol program.

• Priorities: Integrated enforcement activities send a message to the public and to law 

enforcement officers alike that traffic safety is not a single-issue activity.
 1 - 19 

2.4 Preliminary Breath Test Devices (PBTs) 

Effectiveness: Proven-arrests Use: High Cost: Medium Time: Short

A Preliminary Breath Test (PBT) device is a small handheld alcohol sensor used to estimate or 

measure a driver’s BAC. Law enforcement officers use PBTs in the field to help establish 

evidence for a DWI arrest. The driver blows into a mouthpiece and the PBT displays either a 

numerical BAC level, such as .12, or a BAC range, such as a red light for BACs above .08. 

Several PBT models are available commercially. They are quite accurate and generally reliable. 

NHTSA maintains a “Conforming Products List” of alcohol testing and screening instruments, 

including PBTs, that meet accuracy and reliability standards (NHTSA, 2004). 

Use: PBTs are used in 39 States to provide evidence of alcohol use to support a DWI arrest 

(Century Council, 2003, p. 24). This evidence of alcohol use is admissible in court in 

approximately half the States, but in most States PBT evidence cannot be used to establish a 

driver’s BAC. California allows officers to use PBT evidence to enforce zero-tolerance laws for 

drivers under the age of 21: officers at the roadside can issue a citation and seize the driver’s 

license (Ferguson et al., 2000). 

Effectiveness: Law enforcement officers generally agree that PBTs are useful. Sixty-nine 

percent of the 2,731 law enforcement officers surveyed by Simpson and Robertson (2001, p. 51) 

supported greater PBT availability and use. PBTs are especially valuable for two classes of 

drivers who may appear to perform normally on many tasks: drivers with a high tolerance to 

alcohol (Simpson and Robertson, 2001, p. 47) and drivers under the age of 21 who may be in 

violation of zero-tolerance laws (Ferguson et al., 2000). PBTs also can be useful at crash scenes 

where a driver is injured and unable to perform a Standardized Field Sobriety Test. There is 

some direct evidence that PBT use increases DWI arrests and reduces alcohol-involved fatal 

crashes (Century Council, 2003, p. 24). 

Costs: PBTs cost from $450 to $750 apiece. Many law enforcement departments have only a 

limited number of PBTs and many patrol officers do not have regular access to them. Officers 

surveyed by Simpson and Robertson (2001, p. 71) estimated that three-fourths of all DWI arrests 

occur on routine patrol, so that DWI detection would be substantially improved if every patrol 

officer had a PBT. 

Time to implement: PBTs can be used as soon as they are purchased and officers are trained in 

their use and maintenance. PBT instruments must have regular calibration checks. Most law 

enforcement agencies have the facilities to conduct these checks. 

Other issues: 

• The “one test” rule: Some State statutes allow only one chemical BAC test to be taken 

from a driver arrested for DWI. These States do not use PBTs because an evidential BAC 

test cannot be requested if an officer previously has taken a PBT test in the field. 

• Other drugs: A PBT will not detect the presence of drugs other than alcohol. 
 1 - 20 

2.5 Passive Alcohol Sensors 

Effectiveness: Proven-detection Use: Unknown Cost: Medium Time: Short

A Passive Alcohol Sensor (PAS) is a device to detect alcohol presence in the air. The sensor 

usually is integrated into a flashlight or clipboard. Officers hold the flashlight or clipboard near 

the driver’s mouth, where it measures alcohol presence in the air where the driver is breathing. 

The PAS can be used without the driver’s knowledge and without any probable cause because 

the PAS is considered “an extension of the officer’s nose” and records information that is “in 

plain view” (Preusser, 2000, p. E5). The PAS displays its results using lights of different colors 

to indicate different alcohol concentration ranges. 

Several PAS models are available commercially. They generally are reliable and effective at 

detecting alcohol in the surrounding air. NHTSA does not maintain a list of PAS models.

Use: PAS units typically are used at the car window after a traffic stop or at a checkpoint. A PAS 

report of alcohol presence gives the officer evidence to request further examination with SFSTs 

or a PBT device. No data are available on how many PAS units are in use. 

Effectiveness: The PAS is especially effective at checkpoints, where officers must screen drivers 

quickly with little or no opportunity to observe the drivers on the road. Several evaluations show 

that officers using a PAS at checkpoints can detect twice as many drivers at BACs of .10 and 

above than officers not using a PAS (Fell et al., 2004; Century Council, 2003, p. 25). The PAS 

can help officers avoid detaining drivers with BACs of .04 or below. The PAS also assists 

officers on routine patrol in detecting alcohol-impaired drivers (Preusser, 2000, p. E5). The PAS 

can be used to help enforce zero tolerance laws for drivers under 21, where violators may have 

relatively low BAC levels. 

Costs: PAS units cost from $500 to $750 apiece. 

Time to implement: PAS units can be used as soon as they are purchased and officers are 

trained in their use and maintenance. 

Other issues: 

• Acceptance by law enforcement: Some officers dislike using a PAS because they 

believe it requires them to be closer to the driver than they wish to be, it requires some 

portion of the officer’s attention at a time when the officer has several other things to be 

concerned about (including personal safety), or it may keep the officer from having a 

hand free. Other officers believe they can detect the odor of alcohol accurately without 

assistance from a PAS (Preusser, 2000, p. E5). 

• Other drugs: As with a PBT, a PAS will not detect the presence of drugs other than 

alcohol. 
 1 - 21 

3.1 Sanctions 

Effectiveness: Varies Use: Varies Cost: Varies Time: Varies

The standard court sanctions for DWI offenses are driver’s license suspension or revocation, 

fines, jail, and community service. All States use some combination of these sanctions. Details of 

each State’s laws may be found in NHTSA’s Digest of Impaired Driving and Selected Beverage 

Control Laws (NHTSA, 2006b1), which is updated annually. MADD summarizes current 

alcohol-related laws by State and by topic (MADD, 2006). Some States set mandatory minimum 

levels for some sanctions, which often increase for second and subsequent offenders. 

DWI offenders also may have their driver’s licenses revoked or suspended administratively and 

may have sanctions imposed on their vehicles or license plates. See Chapter 1, Section 1.1, 

Administrative License Revocation or Suspension, and Chapter 1, Section 4.4, Vehicle and 

License Plate Sanctions, for discussions of these sanctions. See also NHTSA’s Guide to 

Sentencing DW! Offenders (NHTSA, 2006k) for an overview of sanctions and sentencing 

practices for judges and prosecutors, with extensive references. The Guide also includes 

screening and brief intervention, alcohol treatment, and DWI courts. 

License suspension or revocation: All States allow post-conviction license actions. Twentyeight States set a mandatory minimum length for first offenders. This suspension or revocation 

typically runs concurrently with any administrative license action. In most States, offenders may 

obtain an occupational or hardship license during part of all of the revocation or suspension 

period (McCartt et al., 2002; NHTSA, 2006b1). 

Both court-imposed and administrative license actions are highly effective in reducing crashes. 

See Chapter 1, Section 1.1 for details. Court-imposed license actions have few direct costs. As 

with administrative license actions, they should be accompanied by strategies to reduce driving 

with a suspended or revoked license. 

Fines: Most States impose fines on DWI offenders. Twenty-eight States have mandatory 

minimum fines for first offenders, typically ranging from $250 to $500. In addition to fines, 

offenders often face substantial costs for license reinstatement, mandated alcohol education or 

treatment, insurance rate increases, and legal fees. 

The scanty information available suggests that fines at the levels currently imposed have little 

effect on reducing alcohol-impaired driving (Century Council, 2003, p. 65). 

Jail: All States allow some DWI offenders to be sentenced to jail. Eighteen States require some 

jail time for first offenders, though 11 of these States allow community service in lieu of jail. 

Forty-nine States require jail for third offenders, though even these offenders can substitute 

community service in nine States. 

Jail is the most severe and most contentious of the DWI sanctions. Jail is expensive: $16,500 per 

offender per year in Maryland and $27,500 in New Mexico, for example (Century Council, 

2003; pp. 72 and 100). Judges and prosecutors may be reluctant to use limited jail space for DWI 

offenders rather than “real” criminals. Offenses with mandatory jail terms may be pled down, or 
 1 - 22 

judges simply may ignore the mandatory jail requirement (Robertson and Simpson, 2002b, pp. 

85-90). 

Research on the effectiveness of jail is equivocal at best (Jones and Lacey, 2001, p. 119; NTSB, 

2000, p. 29). Very short (48-hour) jail sentences for first offenders may be effective (NTSB, 

2000, p. 29) but other jail policies appear to have little effect. Wagenaar et al. (2000, p. 12) 

reviewed 18 studies and concluded: “The balance of the evidence clearly suggests the 

ineffectiveness of mandatory jail sentence policies.” In fact, they find “numerous studies that 

indicate that [mandatory jail] might be a counterproductive policy” that increases alcohol-related 

crashes. 

Community service: Many States allow community service as part of a DWI offender’s 

sentence and 11 States allow community service in lieu of mandatory jail for first-time offenders. 

Community service can provide benefits to society if offenders perform useful work, but even if 

appropriate jobs can be found there are costs for program operation, offender supervision, and 

liability. The effects of community service programs on alcohol-impaired driving have not been 

evaluated (Century Council, 2003, p. 63). 
 1 - 23 

3.2 Diversion and Plea Agreement Restrictions 

Effectiveness: Proven-convictions Use: Medium Cost: Low Time: Short

Diversion programs defer sentencing while a DWI offender participates in some form of alcohol 

education or treatment. In many States, charges are dropped or the offender’s DWI record is 

erased if the education or treatment is completed satisfactorily. 

Negotiated plea agreements are a necessary part of efficient and effective DWI prosecution and 

adjudication. However, plea agreements in some States allow offenders to eliminate any record 

of a DWI offense and to have their penalties reduced or eliminated. 

Effective DWI control systems can use a variety of adjudication and sanction methods and 

requirements. The key feature is that an alcohol-related offense must be retained on the 

offender’s record (Hedlund and McCartt, 2002; NCHRP, 2005; NTSB, 2000; Robertson and 

Simpson, 2002a). 

Use: As of July 2006, 33 States provide for diversion programs in State law or statewide 

practice, and local courts and judges in some additional States also offer diversion programs 

(NHTSA 2006i; see also Century Council, 1997). Eighteen States restrict plea agreements in at 

least some DWI cases (NHTS, 2006i, MADD, 2006). The Century Council (2003, pp. 49, 52) 

documented diversion programs and plea agreement restrictions in several States. 

Effectiveness: There are no studies that demonstrate that diversion programs reduce recidivism 

(NTSB, 2000, p. 28) and there is substantial anecdotal evidence that diversion programs, by 

eliminating the offense from the offender’s record, allow repeat offenders to avoid being 

identified (Hedlund and McCartt, 2002, p. 38). Eliminating diversion programs should remove a 

major loophole in the DWI control system. Wagenaar et al. (2000) reviewed 52 studies of plea 

agreement restrictions applied in combination with other DWI control policies and found that 

they reduced various outcome measures by an average of 11 percent. However, the effects of 

plea agreement restrictions by themselves cannot be determined in these studies. The only direct 

study of plea agreement restrictions was completed over 15 years ago (NHTSA, 1989; see 

NTSB, 2000, p. 27). It found that plea agreement restrictions reduced recidivism in all three 

study communities. 

Costs: Costs for eliminating diversion programs can be determined by comparing the peroffender costs of the diversion program and the non-diversion sanctions. Similarly, costs for 

restricting plea agreements will depend on the relative costs of sanctions with and without the 

plea agreement restrictions. In addition, if plea agreements are restricted, some charges may be 

dismissed or some offenders may request a full trial, resulting in significant costs. 

Time to implement: Eliminating diversion programs and restricting plea agreements statewide 

may require changes to a State’s DWI laws. Once legislation is enacted, policies and practices 

can be changed within three months. Individual prosecutor offices and courts also can change 

local policies and practices without statewide legislation. 
 1 - 24 

3.3 DWI Courts 

Effectiveness: Likely Use: Low Cost: High Time: Medium

A dedicated DWI court provides a systematic and coordinated approach to prosecuting, 

sentencing, monitoring, and treating DWI offenders. A DWI court’s underlying goal is to change 

offenders’ behavior by identifying and treating their alcohol problems and by holding offenders 

accountable for their actions. 

Prosecutors and judges in DWI courts specialize in DWI cases. Probation officers monitor 

offenders closely and report any probation infraction to the judge immediately for prompt action. 

Restrictions and monitoring are relaxed as offenders demonstrate responsible behavior. DWI 

courts follow the model established by the more than 1,600 drug courts around the nation 

(Huddleston et al., 2005, pp. 3-4; NADCP, 2005; NCHRP, 2005, Strategy D3). See Brunson and 

Knighten (2005), Practice #1, for an excellent overview of DWI courts and NDCI (2006) for a 

more complete description. 

DWI courts can reduce recidivism because judge, prosecutor, probation staff, and treatment staff 

work together as a team to assure that alcohol treatment and other sentencing requirements are 

satisfied. DWI courts can be more efficient and effective than regular courts because judges and 

prosecutors are familiar with the complex DWI laws, evidentiary issues, and sentencing options. 

NHTSA (2003, p. 18) describes the operation of a DWI court in Albuquerque, New Mexico. 

Over half the judges in Robertson and Simpson’s survey (2002b, p. 63) recommended DWI 

courts, as did participants in NHTSA’s Criminal Justice Summit (NHTSA, 2003, p. 18). 

Use: As of July 2006, NDCI reported 86 designated DWI Courts and 90 hybrid DWI/Drug 

Courts, which are drug courts that also take DWI offenders (NDCI, 2006). 

Effectiveness: Some individual program evaluations show that DWI courts are quite successful, 

with low recidivism rates. For example, initial data from the Kootenai County, Idaho program 

show that only four percent of the first 46 program graduates had a subsequent DWI, compared 

to 14 percent of 100 persons eligible for the program who did not participate (Crancer, 2005). 

Graduates of the Bernalillo County New Mexico DWI/Drug Court program, most of whom were 

referred for DWI offenses, had substantially lower DWI recidivism rates than a comparison 

group (Guerin, 2002). 

Evaluations have shown that close monitoring and individualized sanctions for DWI offenders 

reduce recidivism (see Chapter 1, Section 4.2). When these are incorporated within a 

comprehensive DWI court program, their effect is likely to be even greater. 

Costs: DWI court costs are difficult to estimate and compare with regular courts. Court 

operations may become more efficient as judges and prosecutors specialize in DWI cases. 

Follow-up costs may be greater because probation officer caseloads may need to be reduced to 

provide close monitoring and because judges must allocate time to meet regularly with 

probationers and to deal with any probation violations. Offenders can bear some of the 

monitoring and treatment costs (see Chapter 1, Sections 4.1, 4.2, and 4.3). DWI courts may 
 1 - 25 

reduce long-term system costs substantially if they decrease DWI recidivism as expected. 

Offenders in DWI court programs definitely cost far less than offenders in jail. For example, the 

cost per offender in the Anchorage, Alaska DWI court is less than 10 percent of the cost of jail 

(NDCI, 2006). 

Time to implement: DWI courts can be implemented four to six months after the participating 

organizations agree on the program structure if enough trained prosecutors, judges, probation 

officers, and treatment providers are available. Otherwise, planning and implementation may 

require one year or more. 
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3.4 Court Monitoring 

Effectiveness: Proven-convictions Use: Low Cost: Low Time: Short

In court monitoring programs, citizens observe, track, and report on DWI court or administrative 

hearing activities. Court monitoring provides data on how many cases are dismissed or pled 

down to lesser offenses, how many result in convictions, what sanctions are imposed, and how 

these results compare across different judges and different courts. Court monitoring programs 

usually are operated and funded by citizen organizations such as MADD, though Mississippi 

funds a statewide court monitor (Century Council, 2003, p. 51). MADD is preparing a policy and 

procedures manual for its court monitoring programs, which is scheduled to be available in 2008. 

Use: Court monitoring programs are active in at least 13 States (Syner, 2006). It is generally 

believed that court monitoring has decreased substantially since the mid-1980s, when Probst et 

al. (1987) identified over 300 programs in the United States. 

Effectiveness: Shinar (1992) found that court-monitored cases in Maine produced higher 

conviction rates and stiffer sentences than unmonitored cases. Probst et al. (1987) found that 

judges, prosecutors, and other officials in 51 communities believed that court monitoring 

programs helped increase DWI arrests, decrease plea agreements, and increase guilty pleas. Both 

studies are summarized in Hedlund and McCartt (2003, p. 60). 

Costs: The main requirement for a court monitoring program is a reliable supply of monitors. 

Monitors typically are unpaid volunteers from MADD, RID, or a similar organization. Modest 

funds are needed to establish and maintain court monitoring records and to publicize the results. 

Time to implement: Court monitoring programs can be implemented very quickly if volunteer 

monitors are available. A few weeks will be required to set up the program and train monitors. 
 1 - 27 

4.1 Alcohol Problem Assessment and Treatment 

Effectiveness: Proven Use: High Cost: Varies Time: Varies

It is widely recognized that many DWI first offenders and most repeat offenders are dependent 

on alcohol or have alcohol use problems. They likely will continue to drink and drive unless their 

alcohol problems are addressed. A DWI arrest provides an opportunity to identify offenders with 

alcohol problems and to refer them to treatment as appropriate. 

Alcohol problem assessment can take many forms, from a brief paper-and-pencil questionnaire 

to a detailed interview with a treatment professional. Alcohol treatment can be even more varied, 

ranging from classroom alcohol education programs to long-term inpatient facilities. For brief 

overviews of alcohol assessment and treatment programs and further references see Century 

Council (2003, pp. 89-104), Dill and Wells-Parker (2006), Jones and Lacey (2001, pp. 116-118), 

and NCHRP (2006, Strategy C4). 

Use: Forty-two States require alcohol assessment for some DWI offenders (MADD, 2006; 

NHTSA, 2006i; see also Century Council 2003, p. 92). Though data on the use of alcohol 

treatment are not available, some judges in all States probably assign some form of treatment to 

some DWI offenders. 

Effectiveness: Even the best of the many assessment instruments currently in use is relatively 

inaccurate. Chang et al. (2002) found that none correctly identified more than 70 percent of 

offenders who were likely to recidivate. Wells-Parker et al. (1995) reviewed the studies 

evaluating treatment effectiveness. They found that, on average, treatment reduced DWI 

recidivism and alcohol-related crashes by 7 to 9 percent. Treatment appears to be most effective 

when combined with other sanctions and when offenders are monitored closely to assure that 

both treatment and sanction requirements are met (Century Council, 2003, p. 95; Dill and WellsParker, 2006). 

Costs: Trained personnel are required to assess offenders. Treatment expenses vary widely 

depending on program type. Offenders can bear some of the costs of both assessment and 

treatment, though provisions must be made for indigent offenders. Both assessment and 

treatment require good record systems to track offenders and monitor progress. 

 

Time to implement: Implementation time also varies depending on program type. The simplest 

can be implemented in several months, while others may take years. 

Other issues: 

• Treatment options: Alcohol assessment and treatment programs are long-term and 

expensive investments. States and communities should carefully weigh the costs and 

benefits of the many options available before implementing any. Implementation time 

will depend on the specific programs chosen. 

• DWI Courts: Alcohol problem assessment and treatment are an integral part of DWI 

courts. Conversely, a DWI court can sanction offenders who fail to complete assigned 

treatment programs. See Chapter 1, Section 3.3. 
 1 - 28 

4.2 DWI Offender Monitoring 

Effectiveness: Proven-recidivism Use: Unknown Cost: High Time: Medium

The most successful methods for controlling convicted DWI offenders and reducing recidivism 

have the common feature that they monitor offenders closely. Close monitoring can be 

accomplished at various levels and in various ways, including a formal intensive supervision 

program, home confinement with electronic monitoring, dedicated detention facilities, and 

individual oversight by judges. DWI courts and alcohol ignition interlocks, which are discussed 

in Chapter 1, Sections 3.3 and 4.3, also assist in monitoring offenders closely. 

Use: There are no data showing how extensively these programs are used. 

Effectiveness: All four methods cited above have been evaluated in individual settings and show 

substantial reductions in DWI recidivism. For example, recidivism was reduced by one-half in 

two intensive supervision programs, by one-third in an electronic monitoring program, by onehalf in a dedicated detention facility, and by one-half by a judge’s individual oversight. The 

references cited below provide additional detail. 

Costs: All close monitoring programs are more expensive than the standard high-caseload and 

low-contact probation but less expensive than jail. Electronic monitoring fees typically range 

from $3 to $15 per day (NCHRP, 2005, Strategy 5.1 D3). New Mexico estimated that intensive 

supervision costs $2,500 per offender per year compared to $27,500 per offender per year for jail 

(Century Council, 2003, p. 72). Dedicated detention facility costs can approach jail costs: 

$13,500 annually in Maryland for dedicated detention compared to $16,500 for jail (Century 

Council, 2003, p. 100). Offenders can bear some program costs, especially for the less expensive 

alternatives (Century Council, 2003, pp. 72, 74). 

Time to implement: All close monitoring programs require many months to plan and 

implement. Dedicated facilities require years to plan and build. 

References providing summaries and containing further references to detailed studies: 

Intensive supervision 

• The Century Council (2003), Hard Core Drunk Driving: A Sourcebook of Promising 

Strategies, Laws & Programs. Washington, DC: The Century Council. www.dwidata.org, 

pp. 69-72. 

• Jones, R. K., and Lacey, J.H. (2001). Alcohol and Highway Safety 2001: A Review of the 

State of Knowledge. DOT HS 809 383. Washington, DC: National Highway Traffic 

Safety Administration. www.nhtsa.dot.gov/people/injury/research/AlcoholHighway/, p. 

120. 

• Lapham, S.C., Kapitula, L.R., C’de Baca, J., and McMillan, G.P. (2006). Impaireddriving recidivism among repeat offenders following an intensive court-based 

intervention. Accident Analysis and Prevention 38, pp. 162-169. 
 1 - 29 

• NCHRP Report 500, Vol. 16 (2005). A Guide for Reducing Alcohol-Related Collisions. 

Washington, DC: Transportation Research Board. 

trb.org/publications/nchrp/nchrp_rpt_500v15.pdf, strategy D3. 

Home confinement with electronic monitoring 

• Brunson W., and Knighten, P., editors. (2005). Strategies for Addressing the DWI 

Offender: 10 Promising Sentencing Practices. DOT HS 809 850. Washington, DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/enforce/PromisingSentence/images/10Promising.pdf, 

Practice #6. 

• The Century Council (2003), Hardcore Drunk Driving: A Sourcebook of Promising 

Strategies, Laws & Programs. Washington, DC: The Century Council. www.dwidata.org, 

pp. 73-75. 

• Jones R.K., and Lacey J.H. (2001). Alcohol and Highway Safety 2001: A Review of the 

State of Knowledge. DOT HS 809 383. Washington, DC: National Highway Traffic 

Safety Administration. www.nhtsa.dot.gov/people/injury/research/AlcoholHighway/, p. 

120. 

• NCHRP Report 500, Vol. 2 (2003). Guidance for Implementation of the AASHTO 

Strategic Highway Safety Plan, Volume 2: A Guide for Addressing Collisions Involving 

Unlicensed Drivers and Drivers with Suspended or Revoked Licenses. Washington, DC: 

Transportation Research Board. trb.org/publications/nchrp/nchrp_rpt_500v2.pdf, Strategy 

2.1 D1.

• NCHRP Report 500, Vol. 16 (2005). A Guide for Reducing Alcohol-Related Collisions. 

Washington, DC: Transportation Research Board. 

trb.org/publications/nchrp/nchrp_rpt_500v16.pdf, strategy D3. 

Dedicated detention facilities 

• The Century Council (2003), Hardcore Drunk Driving: A Sourcebook of Promising 

Strategies, Laws & Programs. Washington, DC: The Century Council. www.dwidata.org, 

pp. 100-103. 

• NTSB (2000). Actions to Reduce Fatalities, Injuries, and Crashes Involving the Hard 

Core Drinking Driver. NTSB/SR-00/01. Washington, DC: National Transportation 

Safety Board. www.ntsb.gov/publictn/2000/sr0001.pdf 

Individual judicial oversight 

• The Century Council (2003), Hardcore Drunk Driving: A Sourcebook of Promising 

Strategies, Laws & Programs. Washington, DC: The Century Council. www.dwidata.org, 

pp. 71-72. 

• Jones, R.K., and Lacey, J.H. (2001). Alcohol and Highway Safety 2001: A Review of the 

State of Knowledge. DOT HS 809 383. Washington, DC: National Highway Traffic 

Safety Administration. www.nhtsa.dot.gov/people/injury/research/AlcoholHighway/, p. 

120. 
 1 - 30 

4.3 Alcohol Interlocks 

Effectiveness: Proven Use: Medium Cost: Medium Time: Medium

An alcohol ignition interlock prevents a car from starting unless the driver provides a breath 

sample with a BAC lower than a pre-set level, usually .02. Interlocks typically are used as a 

condition of probation for DWI offenders, to prevent them from driving while impaired by 

alcohol after their driver’s licenses have been reinstated. 

Interlocks are highly effective in allowing a car to be started by sober drivers but not by alcoholimpaired drivers. A “running retest” requires the driver to remain sober while driving. A data 

recorder logs the driver’s BAC at each test and can be used by probation officers to monitor the 

offender’s drinking and driving behavior. Beirness and Marques (2004) provide an overview of 

interlock use, effectiveness, operational considerations, and program management issues. 

Marques (2005), Beirness and Robertson (2005), and Robertson, Vanlaar, and Beirness (2006) 

summarize interlock programs in the United States and other countries and discuss typical 

problems and solutions. See also Brunson and Knighten (2005), Practice #5. 

Use: As of 2006, 44 States and the District of Columbia allow interlocks to be required for some 

DWI offenders (NHTSA, 2006i; see also MADD, 2006). As or July 2006, about 100,000 

interlocks were in use, on the cars of perhaps 10 percent of eligible offenders (Marques, 2006). 

Effectiveness: Beirness and Marques (2004) summarized 10 evaluations of interlock programs 

in the United States and Canada. Interlocks cut DWI recidivism at least in half, and sometimes 

more, compared to similar offenders without interlocks. After the interlock was removed, the 

effects largely disappeared, with interlock and comparison drivers having similar recidivism 

rates. A Cochrane review of 11 completed and 3 ongoing studies reached similar conclusions 

(Willis et al., 2006). Thus, interlocks are an effective method for preventing alcohol-impaired 

driving while they are installed. 

Costs: Interlock programs are managed by private interlock equipment providers. Costs in 2006 

averaged about $175 to install an interlock and $2.25 per day while the interlock is installed. The 

offenders usually pay these costs (Marques, 2006). 

Time to implement: Interlock programs may require enabling legislation. Once authorized, 

interlock programs require four to six months to implement a network of interlock providers. 

Other issues: 

• Barriers to use: Interlocks have demonstrated their effectiveness in controlling impaired 

driving while they are installed. In light of this success, their limited use may be due to 

several factors, such as long license suspension periods during which offenders are not 

eligible for any driving, judges who lack confidence in the interlock technology or who 

fail to enforce “mandatory” interlock requirements, and interlock costs. See Beirness and 

Marques (2004), Beirness and Robertson (2005), and NCHRP (2003, strategy C2) for 

discussion. 
 1 - 31 

4.4 Vehicle and License Plate Sanctions 

Effectiveness: Varies Use: Medium Cost: Varies Time: Short

In recent years many States have implemented sanctions affecting a DWI offender’s license plate 

or vehicle. These sanctions both prevent the offender from driving the vehicle while the 

sanctions are in effect and also deter impaired driving by the general public. Vehicle and plate 

sanctions include: 

• Special license plates for drivers whose licenses have been revoked or suspended. The 

plates allow family members and other people to drive the offender’s car but permit law 

enforcement to stop the car to verify that the driver is properly licensed. 

• License plate impoundment. Officers seize and impound or destroy the license plate. 

• Vehicle immobilization: vehicles are immobilized on the offender’s property with a 

“boot” or “club.” 

• Vehicle impoundment. Vehicles are stored in a public impound lot. 

• Vehicle forfeiture. Vehicles are confiscated and sold at auction. 

Voas et al. (2004) give an overview of all vehicle and license plate sanctions currently in use and 

are the basic reference for the information provided below. See also Brunson and Knighten 

(2005), Practice #4. All vehicle and license plate sanctions require at least several months to 

implement. 

Use, effectiveness, and costs: 

• Special license plates: Used in some jurisdictions in Hawaii, Iowa, Minnesota, and Ohio 

(NHTSA, 2006i). A 2004 law in Ohio requires special plates for all first-time offenders 

with a BAC of 0.17 and above and for all repeat offenders. Effectiveness and costs have 

not been evaluated in any State. In the 1990s Oregon and Washington adopted a version 

of this strategy by allowing arresting officers to place a “zebra stripe” sticker on the 

license plate at the time of arrest. Oregon’s program proved effective in reducing DWI 

recidivism but Washington’s did not. Use has been discontinued in both States (NCHRP, 

2003, Strategy B1; NHTSA 2006g). 

• License plate impoundment: Used in Minnesota, where it has been shown to reduce 

recidivism. Since plate impoundment does not involve the courts, it occurs quickly, 

consistently, and efficiently (NCHRP, 2003, Strategy B2; NHTSA, 2006g; NTSB, 2000, 

p. 21). Twenty-seven other States and the District of Columbia allow for impounding a 

vehicle’s registration (NHTSA, 2006i). 

• Vehicle immobilization: Laws in 17 States allow vehicle immobilization but it is 

currently used only in a few States (NHTSA, 2006i). An evaluation in Ohio found that 

immobilization reduced recidivism. Costs are minimal compared to impoundment or 

forfeiture (NCHRP, 2003, Strategy C1; NHTSA, 2006g; NTSB, 2000, p. 21). 

• Vehicle impoundment: 25 States and the District of Columbia allow for vehicle 

impoundment and some use it extensively (NHTSA, 2006i). Vehicle impoundment 

reduces recidivism while the vehicle is in custody and to a lesser extent after the vehicle 

has been released. The strategy is costly, as storage fees can be $20 daily and owners may 

abandon low-value vehicles rather than pay substantial storage costs (NCHRP, 2003, 

Strategy C1; NHTSA, 2006g; NTSB, 2000, p. 22). In California, impoundment programs 
 1 - 32 

are administered largely by towing contractors and supported by fees paid when drivers 

reclaim their vehicles or by the sale of unclaimed vehicles. 

• Vehicle forfeiture: Vehicle forfeiture has been applied to first-DWI offenders in New 

York City, to first Driving While Suspended (DWS) offenders in Portland, Oregon, and 

to second-DWS offenders in California. Thirty-one States have provisions allowing 

vehicle forfeiture but there is little information on its use or effectiveness (NHTSA, 

2006i). Vehicle forfeiture programs must pay storage costs until the vehicles are sold or 

otherwise disposed (NCHRP, 2003, Strategy C1; NHTSA, 2006g; NTSB, 2000, p. 24). 

Other issues: 

• To whom are vehicle sanctions applied: Most vehicle sanctions have been applied to 

repeat offenders rather than first offenders. All vehicle and license plate sanctions must 

address the issue of what action to take when a DWI offender is driving a vehicle 

registered to someone else or when the offender transfers the title to any vehicles before 

vehicle sanctions can be applied. 

• Administrative issues: All license plate and vehicle sanctions require an administrative 

structure to process the license plates or vehicles. 
 1 - 33 

4.5 Lower BAC Limits for Repeat Offenders 

Effectiveness: Uncertain Use: Low Cost: Low Time: Short

All States now have an illegal per se BAC limit of .08. All States also have a BAC limit of .02 or 

lower for drivers under the age of 21. These laws reinforce the minimum drinking age 21 laws in 

all States that prohibit people under 21 from purchasing or possessing alcohol in public. Six 

States also lower the BAC limit for people convicted of DWI, to emphasize that they should not 

be driving after drinking even moderate amounts. 

Use: Six States have established lower BAC limits for some drivers with one or more DWI 

offenses (NHTSA, 2006i; see also MADD, 2006). 

Effectiveness: In 1988, Maine established a .05 BAC limit for one year after a first DWI offense 

and for 10 years after a subsequent offense. Violators receive an administrative license 

suspension. In 1995 this BAC limit was lowered to .00. Hingson et al. (1998) evaluated the 1988 

law and concluded that it reduced the proportion of repeat offender drivers in fatal crashes by 25 

percent. Jones and Rodriguez-Iglesias (2004) evaluated the overall effects of both laws, using 

data from 1988-2001. They also concluded that the laws contributed to a reduction in the 

proportion of repeat offenders in fatal crashes, primarily due to a reduction in drivers at BACs of 

.10 and higher. 

Costs: Implementation and operation costs are minimal. Jones and Rodriguez-Iglesias (2004) 

found that Maine’s laws had little or no effect on the operations of the DWI control system. 

Time to implement: Lower BAC limit laws can be implemented as soon as legislation is 

enacted. 
 1 - 34 

Prevention, Intervention, Communications and Outreach 

Prevention and intervention. 

Prevention and intervention strategies seek to reduce drinking, especially drinking associated 

with driving, or to prevent driving by people who have been drinking. Prevention and 

intervention work through laws, policies, and programs that: 

• control alcohol sales hours, locations, and promotions; 

• implement responsible alcohol service practices; 

• control alcohol purchase and use through increased alcohol taxes and restrictions on 

consumption in public locations such as parks and sports facilities; or 

• provide alternatives to driving for people who have been drinking. 

Prevention and intervention measures are especially important for those under 21. These are 

discussed in the Youth section that follows. 

Many prevention and intervention measures fall under the authority of a State’s alcohol control 

board rather than the SHSO. However, the SHSO can be a critical partner in many prevention 

and intervention activities. Only countermeasures directly associated with drinking and driving 

are discussed in this section. For information regarding more general countermeasures directed at 

alcohol see Grube and Stewart (2004), Toomey and Wagenaar (1999), and Alcohol 

Epidemiology Program (2000). 

Communications and outreach. 

Communications and outreach strategies seek to inform the public of the dangers of driving 

while impaired by alcohol and to promote positive social norms of not driving while impaired. 

As with prevention and intervention, education through various communications and outreach 

strategies is especially important for youth under 21. Education may occur through formal 

classroom settings, news media, paid advertisements and public service announcements, and a 

wide variety of other communication channels such as posters, billboards, Web banners, and the 

like. 

Communications and outreach strategies are a critical part of many deterrence and prevention 

strategies. This section discusses only stand-alone communications and outreach 

countermeasures. 

 
 1 - 35 

5.1 Responsible Beverage Service 

Effectiveness: Likely Use: Medium Cost: Medium Time: Medium

Responsible beverage service covers a range of alcohol sales policies and practices that prevent 

or discourage restaurant and bar patrons from drinking to excess or from driving while impaired 

by alcohol. Server training programs teach servers how to recognize the signs of intoxication and 

how to prevent intoxicated patrons from further drinking and from driving. Management policies 

and programs include limits on cheap drinks and other promotions, support for designated driver 

programs, strong commitment to server training, and strong support for servers who refuse 

alcohol to intoxicated patrons. 

NCHRP (2005, Strategy A2) provides an overview of responsible beverage service. Server 

training programs are the only segment of responsible beverage service for adults that has been 

documented and evaluated well. Activities directed at people under 21 are discussed separately 

in Chapter 1, Section 6.1. 

Use: As of 2006, 17 States and the District of Columbia had some form of mandatory server 

training programs (NHTSA, 2006i; MADD, 2006). As of 2000, 10 States had non-mandatory 

programs that provided some liability protection to participating establishments (Alcohol 

Epidemiology Program, 2000, p. 14). 

Effectiveness: In their systematic review, Shults et al. (2001) found five high-quality evaluations 

of server training programs. They concluded that “intensive, high-quality, face-to-face server 

training, when accompanied by strong and active management support, is effective in reducing 

the level of intoxication in patrons.” The one evaluation of a statewide server training program, 

in Oregon, showed that it reduced single-vehicle nighttime injury crashes by 23 percent. Jones 

and Lacey (2001, pp. 137-138) note that no other evaluations have attempted to measure the 

effects of server training programs on alcohol-related crashes. 

Costs: A typical alcohol server course takes about 4 hours. Course costs can be borne by the 

servers themselves, their employers, or the State. 

Time to implement: Server training courses are offered by several private vendors and can be 

implemented in a few weeks. A statewide requirement for server training or more general 

responsible beverage service policies would require time to enact any necessary legislation, 

establish policies, and provide for program administration. 

Other issues: 

• Program quality: The quality of responsible beverage service programs can vary 

enormously, from excellent to abysmal. Management support can vary from enthusiastic 

to nonexistent. Shults et al. (2001) clearly limit their conclusions to high-quality 

programs with strong management support. Alcohol Epidemiology Program (2000, p. 13) 

cites some server training program evaluation studies that found no effect and notes that 

these programs may have been poorly supported or implemented. 
 1 - 36 

• Responsible beverage service is more than server training: Grube and Stewart (2004) 

emphasize that management policy and its implementation may be at least as important 

as server training in determining responsible beverage service program effectiveness. 
 1 - 37 

5.2 Alternative Transportation 

Effectiveness: Unknown Use: Unknown Cost: Medium Time: Short

Alternative transportation describes methods by which people can get to and from places where 

they drink without having to drive. Alternative transportation supplements normal public 

transportation provided by subways, buses, taxis, and other means. 

Ride service programs transport drinkers home from, and sometimes to and between, drinking 

establishments using taxis, private cars, buses, tow trucks, and even police cars. Some will drive 

the drinker’s car home along with the drinker. For an overview, see Jones and Lacey (2001, pp. 

133-134). Most operate only for short periods of the year, such as the Christmas and New Year’s 

holidays. Many are free; some charge users a minimal fee; some are operated commercially on a 

for-profit basis. 

Use: There are no data on current ride service programs, but more than 300 were in operation at 

some time in the 1980s (Jones and Lacey, 2001, p. 133). 

Effectiveness: Unless a ride service program operates for a long period of time or over a large 

area it is difficult to determine whether it has any effect on alcohol-related crashes. Two studies 

have evaluated ride service programs (Jones and Lacey, 2001, pp. 133-134). The first examined 

one year-round and one holiday program. Both functioned smoothly and delivered rides but 

neither demonstrated any effect on crashes. The second study examined a year-round program in 

Aspen, Colorado, and concluded that it reduced injury crashes in the surrounding county by 15 

percent (see also NCHRP, 2003, Strategy E1). 

Costs: The major ride service program costs are for the rides that are provided. Short-term ride 

service programs can be operated largely with donated rides. Year-round programs need enough 

steady funding to accommodate demand (NCHRP, 2003, Strategy E1). 

Time to implement: Short-term ride service programs can be established and operated 

informally in a few weeks. Longer-term programs need to establish long-term strategies for 

funding and managing the program. 
 1 - 38 

5.3 Designated Drivers 

Effectiveness: Unknown Use: Medium Cost: Low Time: Short

Designated drivers are individuals who agree not to drink so they can drive their friends who 

have been drinking. Formal designated driver programs in drinking establishments provide 

incentives such as free soft drinks for people who agree to be designated drivers. Usually, 

though, designated driver arrangements are completely informal. 

Use: The designated driver concept is widely understood and accepted. Surveys show that 

designated driver use is common: for example, about one-third of college students in a national 

survey in 1993 reported that they had served as a designated driver and one-third of students who 

drink had ridden with a designated driver (Hedlund et al., 2001, p. 47). 

Effectiveness: The designated driver concept has been questioned on two grounds: that it may 

encourage passengers to drink to excess and that the designated driver may drink, though 

perhaps less than the passengers. In a national survey, over half of the college student drinkers 

who served as designated drivers did not drink and only 2 percent had five or more drinks. 

Because designated drivers are informally determined and somewhat imprecisely defined, it’s no 

surprise there appear to be no data on the impact of designated drivers on crashes. CDC’s 

systematic review found insufficient evidence to determine the effectiveness of designated driver 

programs (Ditter et al., 2005). 

Costs: The only costs associated with informal designated driver programs are for publicity. 

Designated drivers can be promoted independently or can be included with other impaired 

driving publicity. Establishments that operate formal designated driver programs have minimal 

costs for the drinks provided and for publicity. 

Time to implement: Designated driver promotion can be implemented in a few weeks and 

formal programs can be established equally quickly. 
 1 - 39 

5.4 Alcohol Screening and Brief Interventions 

Effectiveness: Proven Use: Medium Cost: Medium Time: Short

Alcohol screening is a quick form of estimating whether a person has an alcohol problem (see 

Chapter 1, Section 4.1). Brief interventions are short, one-time encounters with people who may 

be at risk of alcohol-related injuries or other health problems. The combination of alcohol 

screening and brief intervention is most commonly used with injured patients in emergency 

departments or trauma centers. Patients are screened for alcohol use problems. If appropriate, 

they may be counseled on how alcohol can affect injury risk and overall health and may be 

referred to a follow-up alcohol treatment program. Brief interventions take advantage of a 

“teachable moment” when a patient can be shown that alcohol use can have serious health 

consequences. Dill et al. (2004) provide an extensive summary and bibliography of alcohol 

screening and brief intervention studies. 

Use: Approximately one-half of trauma centers screen patients for alcohol problems and onethird use some form of brief intervention (NCHRP, 2005, Strategy A4; Schermer et al., 2003). 

Alcohol screening and brief interventions also are used in colleges, primary care medical 

facilities, and social service settings (NCHRP, 2004, Strategy A4; Jones and Lacey, 2001, p. 

146). 

Effectiveness: Many studies show that alcohol screening and brief interventions in medical 

facilities can reduce drinking and self-reported driving after drinking (D’Onofrio and Degutis, 

2002; Moyer et al., 2002; Wilk et al., 1997). Dill et al. (2004) reviewed nine studies that 

evaluated alcohol screening and brief intervention effects on injury. These studies generally 

found that alcohol screening and brief interventions reduced both drinking and alcohol-related 

traffic crashes and injuries. 

Costs: Alcohol screening and brief interventions in medical facilities require a trained person to 

administer the intervention. 

Time to implement: Procedures for alcohol screening and brief interventions are readily 

available, for example from ACEP (2006) or NIAAA (2005), and can be implemented as soon as 

staff is identified and trained. 

Other issues: 

• Alcohol exclusion laws: An alcohol exclusion law allows insurance companies to deny 

payment to hospitals for treating patients who are injured while impaired by alcohol or a 

non-prescription drug. These laws may make hospitals reluctant to determine the BAC of 

an injured driver and may limit the use of alcohol screening. As of January 2006, alcohol 

exclusion laws were in effect in 37 States and the District of Columbia, though the extent 

to which insurance companies do deny payment is not known (NHTSA, 2006h). 
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5.5 Mass Media Campaigns 

Effectiveness: Proven* Use: High Cost: High Time: Medium

* High-quality campaigns supporting other program activities, such as enforcement 

A mass media campaign consists of intensive communications and outreach activities regarding 

alcohol-impaired driving that use radio, television, print, and other mass media, both paid and/or 

earned. Mass media campaigns are a standard part of every State’s efforts to reduce alcoholimpaired driving. Some campaigns publicize a deterrence or prevention measure such as a 

change in a State’s DWI laws or a checkpoint program. Others promote specific behaviors such 

as the use of designated drivers, illustrate how impaired driving can injure and kill, or simply 

urge the public not to drink and drive. Campaigns vary enormously in quality, size, duration, 

funding, and every other way imaginable. Effective campaigns identify a specific audience and 

communications goal and develop messages and delivery methods that are appropriate to and 

effective for the audience and goal. 

Use: Most States use some form of alcohol-impaired driving mass media campaign every year. 

Mass media campaigns are an essential part of many deterrence and prevention countermeasures 

that depend on public knowledge to be effective. 

Effectiveness: Most mass media campaigns are not evaluated. Elder et al. (2004) studied the few 

available high-quality evaluations. The campaigns being evaluated were carefully planned, well 

funded, well executed, achieved high levels of audience exposure (usually by using paid 

advertising), had high-quality messages that were pretested for effectiveness, and were 

conducted in conjunction with other impaired-driving activities. These mass media campaigns 

reduced alcohol-related crashes by about 13 percent. Levy et al. (2004) documented the costs and 

media strategy of a high-quality national media campaign and its effects on driver knowledge 

and awareness. NHTSA’s evaluation of portions of the 2006 Labor Day “You Drink & Drive. 

You Lose” National Crackdown media should be available in 2007. 

Costs: High-quality and effective mass media campaigns are expensive. Funds are needed for 

market research, design, pretesting, and production. Paid advertising expenses depend on the 

media chosen and the media markets needed to reach the target audience. 

 

Time to implement: A high-quality mass media campaign will require at least six months to 

research, plan, produce, and distribute. 

Other issues: 

• Campaign quality: These conclusions apply only to high-quality and well-funded mass 

media campaigns that complement other impaired driving activities. Poor-quality or 

stand-alone campaigns are likely to be ineffective. Public service announcements (PSAs) 

may be an easy way to spend money quickly and to appear to be doing something about 

impaired driving but they are likely to be aired infrequently, reach small audiences, and 

have little or no effect.

• Comprehensive media strategy: Mass media campaigns should be planned as part of an 

overall communications and outreach strategy that supports specific impaired driving 

activities. 
 1 - 41 

Underage Drinking and Alcohol-Related Driving

In addition to the deterrence, prevention, intervention, communications, and outreach 

countermeasures that apply to all drivers, some countermeasures are directed specifically to 

those under 21. 

Since 1987, minimum-drinking-age laws in all States prohibit youth under 21 from purchasing 

alcohol or consuming it in public. These laws influence all youth impaired-driving strategies. For 

people over 21, drinking is legal but driving while impaired by alcohol is not. With a BAC limit 

of .08, drivers know they should not drive after drinking “too much,” but are faced with mixed 

messages at low levels of alcohol, because a BAC of .05 is not illegal per se. The message for 

those under 21 is unambiguous: they should not be drinking at all, and certainly should not be 

driving after drinking. 

Zero-tolerance laws in all States reinforce this message by setting a maximum BAC limit of .02 

or less for drivers under 21. This effectively prohibits driving after drinking any amount of 

alcohol. Many policies and programs reinforcing the no-drinking message are directed primarily 

at youth (beer keg registration) or take place in schools or youth organizations (SADD clubs, 

alcohol-free prom and graduation parties). Youth receive education and information about 

alcohol and alcohol-impaired driving in schools and colleges and through media directed to 

youth. 

The minimum-drinking-age laws and the no-drinking message for youth mean that youth 

impaired-driving activities must work hand-in-hand with activities to control youth drinking. 

With the exception of zero-tolerance law enforcement, all the countermeasures discussed below 

require cooperative activities between traditional highway safety organizations, such as law 

enforcement and motor vehicle departments, and community, health, and educational 

organizations with a broader social agenda than traffic safety. 
 1 - 42 

6.1 Minimum Drinking Age 21 Law Enforcement 

Effectiveness: Varies Use: Varies Cost: Varies Time: Varies

The minimum legal drinking age (MDA) has been 21 in all States since 1987. There is strong 

evidence that MDA-21 laws reduced drinking, driving after drinking, and alcohol-related crashes 

and injuries among youth (Hingson et al., 2004; Shults et al., 2001). In fact, MDA-21 laws 

reduced youth drinking and driving more than youth drinking alone (using the measurements of 

self-reporting and testing of drinking drivers in fatal crashes). Drinking and driving has become 

less socially acceptable among youth, and more youth have separated their drinking from their 

driving (Hedlund et al., 2001, pp. 43-48). 

The specific laws implementing MDA 21 for alcohol vendors, adults, and youth differ 

substantially from State to State. See Alcohol Epidemiology Program (2000) and Century 

Council (2005) for State-by-State summaries of some of the key provisions. 

MDA-21 law enforcement is very limited in many communities (Hedlund et al., 2001, p. 52). 

Enforcement can take several forms, as summarized by Stewart (1999): 

• Actions directed at alcohol vendors: compliance checks to verify that vendors will not 

sell to youth. 

• Actions directed at youth: “use-and-lose” laws that confiscate the driver’s license of an 

underage drinker, “Cops in Shops” directed at underage alcohol purchasers, law 

enforcement “party patrols” using party dispersal techniques, and penalties for using false 

identification. 

• Actions directed at adults: beer keg registration laws, enforcement of laws prohibiting 

purchasing alcohol for youth, shoulder tap operations, and programs to limit parties 

where parents provide alcohol to youth. 

While these enforcement strategies have been used frequently, few have been evaluated. Four 

strategies with some research evidence are discussed below, followed by a recent program and a 

discussion of comprehensive, multi-strategy community programs. 

Alcohol vendor compliance checks: In a compliance check or “sting,” law enforcement officers 

watch as underage people attempt to purchase alcohol and cite the vendor for an MDA-21 

violation if a sale is made. Several studies document that well-publicized and vigorous 

compliance checks reduce alcohol sales to youth (NCHRP, 2005, Strategy A3; Stewart, 1999, p. 

9). Compliance checks require strong community support, education for alcohol vendors on their 

responsibilities under MDA 21, and publicity to underage youth. They require staff time from 

traffic or alcohol beverage control staff. See NCHRP (2005, Strategy A3) for a full discussion. 

“Use and lose” laws: These laws allow confiscation of the driver’s license or postpone licensure 

for a period of time for youth who violate a State’s MDA-21 law. In the only study to date, 

Ulmer et al. (2001) investigated “use and lose” law implementation and effects in Missouri and 

Pennsylvania. Missouri suspended the driver’s licenses of most youth arrested for DWI but 

rarely suspended the licenses of youth who violated the MDA-21 law by drinking but not 

driving. Pennsylvania, in contrast, applied the “use and lose” law to violations of the MDA 21 
 1 - 43 

both for youth arrested while driving and youth arrested while not driving. Pennsylvania’s “use 

and lose” license suspensions appeared to reduce subsequent traffic violations and crashes. “Use 

and lose” laws can be implemented quickly and inexpensively once enacted. To be effective, 

they should be publicized extensively. As of 2006, 29 States have “use and lose” laws and 

another 10 States and the District of Columbia have “use and lose” authority that may be applied 

in varying circumstances (NHTSA, 2006i). 

Keg registration laws: These laws link beer keg purchasers to an identification number on the 

keg, which provides a method of identifying adults who supply beer to parties attended by youth. 

As of July 2006, 28 States and the District of Columbia have keg registration laws, as do many 

communities in other States (NHTSA, 2006i; MADD, 2006; Alcohol Epidemiology Program, 

2000, p. 22). The only known study, of 97 communities, found that keg registration laws reduced 

traffic fatality rates (Grube and Stewart, 2004). However, Grube and Stewart conclude that the 

evidence for the effectiveness of keg registration “is best considered inconclusive.” 

Media campaigns directed at parents: Ohio has conducted a statewide media campaign, 

Parents Who Host Lose the Most, since 2000. The campaign informs parents and youth about 

Ohio’s underage drinking laws and attempts to discourage parents from providing alcohol to 

underage drinkers at parties. Telephone surveys in 2004, the campaign’s fifth year, showed that 

about two-thirds of parents and youth had heard messages about underage drinking (Seufert et 

al., 2004). About two-thirds of those who had heard a message said that it prompted a 

conversation between parents and their teenagers about drinking. The evaluation did not 

investigate any changes in behavior. 

Underage Drinking Tipline: In 2006 Kansas launched a statewide underage drinking tipline, 

866-MustB21. The toll-free tipline operates 24 hours a day, seven days a week, for citizens to 

report parties involving underage drinking, plans to purchase alcohol for underage persons, and 

willingness of retailers to sell alcohol to underage persons. See 

www.ksdot.org/burTrafficSaf/1866mustb21.pdf for a program poster. 

Comprehensive community programs: Several comprehensive community initiatives have 

reduced youth drinking and alcohol-related problems (Hingson et al., 2004). These initiatives 

typically bring together several community government departments, such as schools, health, and 

law enforcement, with alcohol sellers, parents, youth, and citizen organizations. They may 

include school-based programs, law enforcement, media, and other intervention strategies. They 

require strong leadership and organization. They may take many months to plan and implement. 

Costs depend on the activities included. 
 1 - 44 

6.2 Zero Tolerance Law Enforcement 

Effectiveness: Likely Use: Unknown Cost: Medium Time: Short

Zero-tolerance laws set a maximum BAC of .02 or less for drivers under 21. Violators have their 

driver’s licenses suspended or revoked. There is strong evidence that zero-tolerance laws reduce 

alcohol-related crashes and injuries (Jones and Lacey, 2001, p. 109; NCHRP, 2005, Strategy B3; 

Shults et al., 2001). 

However, zero-tolerance laws often are not actively enforced or publicized (Hedlund et al., 2001, 

p. 54; Jones and Lacey, 2001, p. 109). Studies have found that young drivers are not arrested in 

proportion to their involvement in alcohol-related crashes (Hingson et al., 2004). 

Use: Zero-tolerance laws have been in effect in all States since 1998. 

Effectiveness: An early study in Maryland found that alcohol-involved crashes for drivers under 

the age of 21 dropped by 21 percent in six counties after the zero-tolerance law was 

implemented. After the law was publicized extensively, these crashes dropped by an additional 

30 percent (Jones and Lacey, 2001, p. 109). No other studies have examined the effect of 

increasing enforcement and publicity for an existing zero-tolerance law. Lacey et al. (2000) 

document how zero-tolerance laws are administered and enforced in four States. Highly 

publicized enforcement has proven effective in increasing compliance with many traffic safety 

laws and reducing crashes and injuries: see for example checkpoints (Chapter 1, Section 2.1) and 

safety belt use mobilizations (Chapter 2, Section 2.1). 

Costs: Zero-tolerance laws can be enforced on regular patrol or on special patrols directed at 

times and areas when young drinking drivers may be present. Enforcement will require moderate 

costs for appropriate training, publicity, and perhaps equipment (see Other Issues). 

Time to implement: Enforcement programs can be implemented within three or four months, as 

soon as appropriate training, publicity, and equipment are in place. 

Other issues: 

• Zero-tolerance-law provisions: Zero-tolerance laws are far easier to enforce if the 

offense is an administrative rather than criminal violation and if law enforcement officers 

can use PBTs at the roadside to determine if the law has been violated and to seize the 

driver’s license if it has (Jones and Lacey, 2001, p. 110). Some State laws require the 

same probable cause as for a standard DWI arrest, or even require a full DWI arrest, 

before a BAC test for a zero-tolerance-law violation can be administered. In these States, 

the zero-tolerance law is not enforced independently of the standard DWI law, and in fact 

young drivers may not be aware of the zero-tolerance law (Hingson et al., 2004).

• PBT and PAS: PBTs are critical to effective and efficient enforcement in States that 

allow PBT use for zero-tolerance laws. PAS units can help officers detect violators with 

BAC levels below 0.08. See Chapter 1, Sections 2.4 and 2.5.
 1 - 45 

6.3 School Education Programs 

Effectiveness: Uncertain Use: Unknown Cost: Low Time: Long

Elementary and secondary schools often include education on alcohol, impaired driving, and 

traffic safety as regular topics in health and driver education courses. 

Use: Health education is a standard course for most students, but the coverage of impaireddriving issues is not known. Driver education is an elective course in some schools and is not 

offered in others. Commercial instructors offer driver education courses in many communities. In 

each, the coverage of impaired-driving issues is not known. 

Effectiveness: Evaluations generally have found that prevention curricula have weak and 

inconsistent effects on alcohol use (Stewart, 1999, p. 13). CDC’s systematic review found that 

education programs are effective in reducing riding with a drinking driver. There was insufficient 

evidence to determine the programs’ effectiveness in reducing drinking and driving (Elder et al., 

2005). 

Costs: Many education programs or course units are available. They must compete with other 

pressing educational needs for space in a crowded school curriculum. 

Time to implement: School education programs require at least a year to plan, schedule, acquire 

material, and train teaching staff. 
 1 - 46 

6.4 Youth Programs 

Effectiveness: Uncertain Use: High Cost: Varies Time: Medium

States and communities have conducted extensive youth drinking-and-driving-prevention 

programs over the past 25 years. These programs seek to motivate youth not to drink, not to 

drink and drive, and not to ride with a driver who has been drinking. They use positive messages 

and methods: educating youth on the crash and injury risks of drinking and driving and on the 

effects of alcohol use and abuse, providing positive role models that discourage alcohol use, 

promoting positive norms that do not involve alcohol, and encouraging youth activities that do 

not involve or lead to alcohol use. 

The best-known youth program is SADD, founded in 1981 as Students Against Driving Drunk, 

then renamed Students Against Destructive Decisions. In 1994 an estimated 16,000 U.S. high 

schools had SADD chapters (Hedlund et al, 2001, p. 56). Some States conducted similar 

activities under different names, such as STAND in Colorado and SAFTYE in Washington. 

MADD’s Youth In Action is active in 43 States (www.youthinaction.org/index.cfm?cID=home). 

One specific activity, operated either by a youth program or independently, is Project 

Graduation, which provides alcohol-free prom and graduation parties for high school students. 

See Hedlund et al. (2001, pp. 56-60) for brief examples of State programs. 

Use: Youth programs of some type are conducted in most, if not all, States. 

Effectiveness: Two studies attempted to evaluate SADD’s activities and effects. One study, in 

two schools, found that neither school implemented the model SADD program well and found 

no evidence of SADD effects on any drinking and driving measure. The second study, in six 

schools, found that SADD affected drinking and driving attitudes as well as self-reported 

drinking and driving (Hedlund et al., 2001, p 60). No other youth programs have been evaluated. 

CDC’s systematic review found that there was insufficient evidence to determine the 

effectiveness of youth programs (Elder et al., 2005). 

Costs: Youth program costs can vary substantially depending on the size and nature of the 

individual activities. States have spent substantial sums on youth drinking-and-driving programs 

overall: $10 million in Federal funds in 1993, $21 million in 1994, and $22 million in 1995. 

These figures include a special $8 million appropriation in both 1994 and 1995 (Hedlund et al., 

2001, p. 60). In each year, States also spent substantial non-Federal funds on youth drinking-anddriving programs. These funds were used for a variety of youth education, enforcement, and 

program activities. 

Time to implement: With model programs available and organizations such as SADD and 

MADD available for assistance, youth programs can be started easily in six months. 
 1 - 47 

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Administration. www.nhtsa.dot.gov/people/injury/alcohol/ebtcpl040714FR.pdf 

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Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pubs/tsf2005ee.pdf 

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Washington, DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pubs/statealcoholesttsf05.pdf 

NHTSA (2006b1). Digest of Impaired Driving and Selected Beverage Control Laws, TwentyThird Edition. DOT HS 810 571. Washington, DC: National Highway Traffic Safety 

Administration. 

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NHTSA (2006c). Administrative License Revocation. Traffic Safety Facts: Laws. Washington, 

DC: National Highway Traffic Safety Administration. 

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%20Admin%20Lic%20Rev.pdf 

NHTSA (2006d). Blood Alcohol Concentration Test Refusal Laws. Traffic Safety Facts: Laws. 

Washington, DC: National Highway Traffic Safety Administration. 

http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated%20Files/07

%20BAC%20Test%20Refusal.pdf 
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NHTSA (2006e). High BAC Laws. Traffic Safety Facts: Laws. Washington, DC: National 

Highway Traffic Safety Administration. 

http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated%20Files/08

%20High%20BAC%20Laws.pdf 

NHTSA (2006f). Open Container Laws. Traffic Safety Facts: Laws. Washington, DC: National 

Highway Traffic Safety Administration. 

http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated%20Files/09

%20Open%20Container%20Laws.pdf 

NHTSA (2006g). Vehicle and License Plate Sanctions. Traffic Safety Facts: Laws. Washington, 

DC: National Highway Traffic Safety Administration. 

http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated%20Files/14

%20Vehicle%20Lic%20Plate%20Sanctions.pdf 

NHTSA (2006h). Alcohol Exclusion Laws. Traffic Safety Facts: Laws. Washington, DC: 

National Highway Traffic Safety Administration. 

http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated%20Files/06

%20Alcohol%20Exclusion.pdf 

NHTSA (2006i). Office of Impaired Driving and Occupant Protection, personal communication, 

July 21, 2006. 

NHTSA (2006j). Low-Staffing Sobriety Checkpoints. Washington, DC: National Highway 

Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/enforce/LowStaffing_Checkpoints/images/LowStaffing.pdf 

NHTSA (2006k). A Guide to Sentencing DWI Offenders. Second Edition, 2005. DOT HS 810 

555. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/alcohol/DWIOffenders/ 

NIAAA (2005). A Pocket Guide for Alcohol Screening and Brief Intervention. Rockville, MD: 

National Institute on Alcohol Abuse and Alcoholism. 

pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket_guide.htm 

NTSB (2000). Actions to Reduce Fatalities, Injuries, and Crashes Involving the Hard Core 

Drinking Driver. NTSB/SR-00/01. Washington, DC: National Transportation Safety Board. 

www.ntsb.gov/publictn/2000/sr0001.pdf 

Preusser, D.F. (2000). Identification of alcohol impairment on initial interview. In Issues and 

Methods in the Detection of Alcohol and Other Drugs, TRB Circular E-C020, pp. E1-E7. 

Washington, DC: Transportation Research Board. 

gulliver.trb.org/publications/circulars/ec020.pdf 
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Probst, J., Lewis, J., and Asunka, K. et al. (1987). Assessment of Citizen Group Court 

Monitoring Programs. DOT HS 807 113. Washington, DC: National Highway Traffic Safety 

Administration. 

Robertson, R.D., and Simpson, H.M. (2002a). DWI System Improvements for Dealing with Hard 

Core Drinking Drivers: Prosecution. Ottawa, ON: Traffic Injury Research Foundation. 

www.trafficinjuryresearch.com/publications/PDF_publications/Prosecution_Report.pdf 

Robertson, R.D., and Simpson, H.M. (2002b). DWI System Improvements for Dealing with Hard 

Core Drinking Drivers: Sanctioning. Ottawa, ON: Traffic Injury Research Foundation. 

www.trafficinjuryresearch.com/publications/PDF_publications/Sanctioning_Report.pdf 

Robertson, R.D., and Simpson, H.M. (2003). DWI System Improvement: Stopping the Revolving 

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Robertson, R.D., Vanlaar, W.G.M., and Beirness, D.J. (2006). Alcohol Interlock Programs: A 

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%20Files/Breath_TestRefusals.pdf 
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2. Seat Belt Use

Overview 

Wearing a seat belt is the single most effective way to save lives and reduce injuries in crashes. 

NHTSA (2001, pp. 9, 13) estimates that seat belts in passenger cars (a manual lap- and shoulderbelt combination) reduce serious injuries by 69 percent and fatalities by 45 percent. In 

comparison, air bags without seat belts reduce serious injuries by 30 percent and fatalities by 14 

percent. Seat belts are similarly effective for pickup truck and other light-truck occupants. 

The challenge is to convince all passenger vehicle occupants to buckle up. Current data show 

that for adult drivers and passengers: 

• seat belt use nationwide reached 82 percent in June 2005 (Glassbrenner, 2005a); 

• in 2005, belt use was greater than 90 percent in eight States (Arizona, California, Hawaii, 

Maryland, Michigan, Nevada, Oregon, and Washington); but 

• in 2005, belt use was less than 70 percent in five States (Arkansas, Kansas, Kentucky, 

Massachusetts, and Mississippi) (Glassbrenner, 2005b). 

Belt use data for New Hampshire are not available. See NHTSA’s most recent reports 

(Glassbrenner 2005a, 2005b) for the latest national and State data. 

This chapter addresses only seat belt use by adults and older children. Younger children require 

infant, child safety, or booster seats appropriate to their size and weight and are covered by 

separate restraint use laws. Many issues and strategies for increasing child occupant protection 

are quite different from those raised by adult belt use. 

 Source: NHTSA, Office of Impaired Driving and Occupant Protection 

Trends. All new passenger cars had some form of seat belts beginning in 1964, shoulder belts in 

1968, and integrated lap and shoulder belts in 1974 (ACTS, 2001, Appendix A). Few occupants 

wore the belts: surveys in various locations recorded belt use of about 10 percent. The first 

widespread survey, taken in 19 cities in 1982, observed 11-percent belt use for drivers and frontU.S. Seat Belt Use

0

10

20

30

40

50

60

70

80

90

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Year

Percent front seat belt use
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seat passengers (Williams and Wells, 2004). This survey became the benchmark for tracking belt 

use nationwide. The chart shows the best available estimate of national belt use annually since 

1982. 

New York enacted the first belt use law in 1984. Other States soon followed. In a typical State, 

belt use rose quickly to about 50 percent shortly after the State’s belt law went into effect. Over 

the next year the rate usually decreased slightly, on average by about four percentage points 

(Nichols, 2002). 

High-visibility short-duration belt law enforcement programs, often called STEPs (Selective 

Traffic Enforcement Programs), “STEP waves,” or “blitzes,” were demonstrated in individual 

communities in the late 1980s. North Carolina’s Click It or Ticket program took this model 

statewide beginning in 1993 and raised the use rate above 80 percent (Williams and Wells, 

2004). Statewide, multi-State, and national enforcement programs increased through the 1990s 

under different names and sponsors. These enforcement programs typically raised belt use by 13 

to 26 percentage points, with greater gains where belt use was lower (Dinh-Zarr et al., 2001; 

Nichols, 2002). Belt use often decreased by about six percentage points after the enforcement 

program ended. 

Recently, the Click It or Ticket model has expanded beyond North Carolina: to South Carolina in 

2000, to all eight States of NHTSA’s Southeast Region in 2001, and nationally in 2003 

(Solomon et al., 2004). Recent programs have used extensive paid advertising as part of their 

communications and outreach strategies. The national belt use rate increased to 82 percent in 

2005 (Glassbrenner, 2004b). 

For more information on the history of belt systems, belt use laws, enforcement programs, and 

belt use trends, see ACTS (2001), Solomon et al. (2004), Milano et al. (2004), NCHRP (2004), 

NHTSA (2001, 2003), Nichols and Jones (in review), and Williams and Wells (2004). 

Belt use laws. As of October 2006, all States except New Hampshire required adult passenger 

vehicle occupants to wear belts. The laws in 25 States and the District of Columbia permit law 

enforcement to stop and cite all nonusers. These are called primary enforcement laws. The 

remaining 24 States have secondary enforcement laws that allow nonusers to be cited only after 

they first have been stopped for some other traffic violation (IIHS, 2006). In 2005, minimum 

fines in primary law States ranged from $10 to $101 with a fine of $25 or more in all but four 

States. Minimum fines in secondary law States ranged from $10 to $75 with a fine of $25 or less 

in all but two States (Glassbrenner, 2005b). Some laws cover only front-seat occupants or allow 

other exemptions. See also NHTSA (2006b) for details on State laws. 

Strategies to Increase Belt Use

The basic strategy for achieving and maintaining high belt use is highly publicized high-visibility 

enforcement of strong belt use laws. This strategy’s effectiveness has been documented 

repeatedly in the United States and abroad. The strategy’s three components – laws, 

enforcement, and publicity – cannot be separated: effectiveness decreases if any one is weak or 

lacking. The sections in this chapter discuss each component’s key features. Some 
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communications and outreach and incentive programs directed to well-defined and limited 

audiences such as schools, businesses, and communities have been moderately successful and 

also are discussed in this chapter. NCHRP (2004) discusses several of these strategies and 

provides links to additional information. 

Seat belt use may also be affected by vehicle design features such as the comfort and 

convenience of belt systems, and by lights or buzzers to remind occupants to buckle up 

(NHTSA, 2003). These vehicular countermeasures are not included in this guide because SHSOs 

have little or no authority or responsibility for them. 

Key terms 

• Primary enforcement: laws that permit seat belt use law violators to be stopped and cited 

by a law enforcement officer independently of any other traffic behavior. 

• Secondary enforcement: laws that permit safety belt use law violators to be cited only 

after they have been stopped for some other traffic violation. 
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Countermeasures That Work 

Countermeasures to increase seat belt use are listed below and discussed individually in this 

chapter. The table is intended to give a rough estimate of each countermeasure’s effectiveness, 

use, cost, and time required for implementation. The terms used are described below. 

Effectiveness, cost, and time to implement can vary substantially from State to State and 

community to community. Costs for many countermeasures are difficult to measure, so the 

summary terms are very approximate. See each countermeasure discussion for more information 

on each item.

1. Seat belt use laws 

Countermeasure Effectiveness Use Cost Time 

1.1 State primary enforcement belt use laws Proven Medium Low Short 

1.2 Local primary enforcement belt use laws Likely Low Low Short 

1.3 Increased belt use law penalties Likely Low Low Short 

1.4 Coverage: seating position, vehicles, ages Unknown Medium Low Short 

2. Seat belt law enforcement 

Countermeasure Effectiveness Use Cost Time 

2.1 Short high-visibility belt law enforcement Proven Medium* High Medium 

2.2 Sustained enforcement Likely Unknown Varies Varies 

2.3 Combined enforcement, nighttime Likely Unknown High Medium 

* Used in many jurisdictions but often only once or twice each year 

3. Communications and outreach 

Countermeasure Effectiveness Use Cost Time 

3.1 Supporting enforcement Proven Medium Varies Medium 

3.2 Strategies for low belt use groups Uncertain* Unknown Unknown Medium 

* For stand-alone programs not supporting enforcement

4. Other strategies 

Countermeasure Effectiveness Use Cost Time 

4.1 Employer and school programs Proven* Unknown Varies Varies 

4.2 Incentive programs Proven* Low Varies Medium 

* In low belt use settings with no belt use law

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results. 

 Likely: balance of evidence from high-quality evaluations or other sources. 

 Uncertain: limited and perhaps ambiguous evidence. 

 Unknown: no high-quality evaluation evidence. 

 Varies: different methods of implementing this countermeasure produce different results. 

Effectiveness is measured by increases in observed seat belt use. See individual countermeasure 

descriptions for information on effectiveness size and how effectiveness is measured. 
 2 - 5 

Use: 

 High: more than two-thirds of the States, or a substantial majority of communities. 

 Medium: between one-third and two-thirds of States or communities. 

 Low: fewer than one-third of the States or communities. 

 Unknown: data not available. 

Cost to implement: 

 High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources. 

 Medium: requires some additional staff time, equipment, and/or facilities. 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment or facilities. 

These estimates do not include the costs of enacting legislation or establishing policies. 

Time to implement: 

 Long: more than one year. 

 Medium: more than three months but less than one year. 

 Short: three months or less. 

These estimates do not include the time required to enact legislation or establish policies. 
 2 - 6 

1.1 State Primary Enforcement Belt Use Laws 

Effectiveness: Proven Use: Medium Cost: Low Time: Short 

Primary enforcement belt use laws permit seat belt use law violators to be stopped and cited 

independently of any other traffic behavior. Secondary enforcement laws allow violators to be 

cited only after they first have been stopped for some other traffic violation. 

Use: As of October 2006, 25 States and the District of Columbia had primary belt use laws, 24 

States had secondary enforcement laws, and New Hampshire had no belt use law applicable to 

adults (IIHS, 2006). Some of the secondary laws are primary for drivers under a specified age. 

Effectiveness: In June 2005, belt use averaged 85 percent in the 21 States and the District of 

Columbia (the States with primary laws at that time; South Carolina’s primary law became 

effective in December 2005 and Mississippi’s in May 2006) and averaged 75 percent in the 27 

secondary law States (Glassbrenner, 2005b). Studies of five States that changed their belt use 

laws from secondary to primary enforcement found that belt use increased from 12 to 18 

percentage points where all passenger vehicles were covered by the law and 8 percentage points 

in one State where pickup trucks were excluded (Nichols, 2002). CDC’s systematic review of 13 

high-quality studies (Shults et al., 2004) found that primary laws increase belt use by about 14 

percentage points and reduce occupant fatalities by about 8 percent compared to secondary laws. 

In the most recent study, Farmer and Williams (2005) found that passenger vehicle driver death 

rates dropped by seven percent when States changed from secondary to primary enforcement. 

Costs: Once legislation has been enacted to upgrade a secondary law to primary, the costs are to 

publicize the change and enforce the new law. Publicity costs to inform the public of the law 

change should be low because the media will cover the law change extensively. Law 

enforcement can adapt its secondary law enforcement strategies for use under the primary law or 

may be able to use new strategies permitted by the primary law. States wishing to increase 

enforcement and publicity to magnify the effect of the law change will incur additional costs: see 

Chapter 2, Section 2.1. 

Time to implement: A primary belt use law can be implemented as soon as the law is enacted. 

Other issues: 

• Opposition to primary belt laws: In most States there is substantial opposition to 

changing a secondary law to a primary belt use law. Opponents claim that primary laws 

impinge on individual rights and provide opportunities for law enforcement to harass 

minority groups. Studies in several States have found that minority groups were ticketed 

at similar or lower rates than others after a primary law was implemented (Shults et al., 

2004). When Michigan changed from a secondary to a primary law, harassment 

complaints were very uncommon both before and after the law change. The proportion of 

seat belt use citations issued to minority groups decreased under the primary law. In a 

telephone survey, the vast majority of people who actually received seat belt citations did 

not feel that they were singled out on the basis of race, age, or gender. However, some 

minorities and young drivers reported perceptions of harassment (Eby et al., 2004).
 2 - 7 

• Effect on low-belt-use groups: Studies in States that changed their law from secondary 

to primary show that belt use increased across a broad range of drivers and passengers. In 

some States, belt use increased more for low-belt-use groups, including Hispanics, 

African-Americans, and drinking drivers, than for all occupants (Shults et al., 2004). 
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1.2 Local Primary Enforcement Belt Use Laws and Ordinances 

Effectiveness: Likely Use: Low Cost: Low Time: Short 

In some States with secondary enforcement belt use laws, individual communities have enacted 

and enforced community-wide primary laws or ordinances. These laws differ from statewide 

laws only in that they are enacted, publicized, and enforced locally. 

Use: No data are available on how many communities have primary laws. NHTSA’s Great 

Lakes Region reports that 47 communities in Illinois, with a combined population of 1.3 million 

residents, had local primary laws in effect before the Illinois statewide law was enacted. 

Similarly, Memphis had a primary law before Tennessee’s statewide primary law (Lacey et al., 

2005). 

Effectiveness: While there are no formal studies of local primary belt laws, the available 

evidence suggests that they increase belt use. See also NCHRP (2004, strategy A3). 

• Illinois: The statewide primary belt use law was enacted in 2003. From 1997 to 2002, 

Illinois Department of Transportation data show that average belt use was higher in 

communities with local primary belt use laws. In the annual statewide belt use surveys 

over these six years, average belt use in the 39 sites with local laws was 5.6 percentage 

points higher than the statewide belt use rate (Nassirpour, 2005). 

• Tennessee: The University of Tennessee conducted regional belt use surveys before and 

after the 2003 combined seat belt and impaired-driving campaigns. At this time 

Tennessee did not have a statewide primary belt law. The western region of the State is 

dominated by Memphis, where a local primary belt law was in place. The other three 

regions had no local belt use laws. Belt use was substantially higher in the western region 

than in the other regions before the campaigns: 74 percent in the west compared to 55 

percent, 66 percent, and 68 percent in the other regions. The media campaign in the west 

used only the You Drink & Drive. You Lose. impaired-driving message and no belt use 

message. Belt use in the west slipped slightly to 72 percent after the campaign. The 

media campaigns in the other three regions used the Click It or Ticket seat belt message 

either alone or together with the You Drink & Drive. You Lose message. Belt use in these 

regions increased slightly to 62 percent, 67 percent, and 70 percent, respectively, still 

lower that the west’s 72 percent (Lacey et al., 2005). 

Costs: As with a statewide law, the costs are for publicity and enforcement. Both must be 

directed to the community itself. 

Time to implement: As with a statewide law, a local law can be implemented as soon as it is 

enacted. The law’s debate and passage likely will generate initial publicity. 

Other issues: See the discussion under Chapter 2, Section 1.1, Primary Enforcement Belt Use 

Laws. 
 2 - 9 

1.3 Increased Belt Use Law Penalties: Fines and Driver’s License Points 

Effectiveness: Likely Use: Low Cost: Low Time: Short 

Penalties for most belt use law violations are low. As of November 2005, a violation resulted in a 

typical fine of $25 or less in all but nine States (Glassbrenner, 2005b). Low fines may not 

convince nonusers to buckle up. They also may send a message that belt use laws are not taken 

seriously. 

Most States penalize serious traffic law violations by assessing demerit points against a driver’s 

license. Drivers lose their licenses if they accumulate more than a specified number of points 

within a specified period of time. In a national survey in 2000, drivers who were not regular belt 

users considered license points the most effective way to increase their belt use. License points 

were considered more effective than increased fines or increased enforcement, in both primary 

and secondary law States (ACTS, 2000, Appendix D). 

Use: As of November 2005, seven primary law States and two secondary law States had a 

minimum fine of $30 or more. Three other States allowed a fine of $30 or more in some 

circumstances. Three jurisdictions assessed driver’s license points: New Mexico, New York, and 

the District of Columbia (Glassbrenner, 2005b). 

Effectiveness: Houston and Richardson (2005) studied the effects of belt law type (primary or 

secondary), fine level, and coverage (front seat only or front and rear seats) using belt use data 

from 1991 to 2001. They found that primary belt laws and higher fines increase belt use. 

Evidence from 2005 is mixed. In primary law States, belt use averaged 4.1 percentage points 

higher in the seven States with fines of $30 or more compared to the 15 States with fines of $25 

or less (89.3% compared to 85.2%). In secondary law States, the two States with fines of $30 or 

more averaged lower belt use than the 26 States at $25 or less: 74.3 percent compared to 77.1 

percent (Glassbrenner, 2005b). The laws may be publicized and enforced more vigorously in 

primary law States with higher fines, and the enforcement and publicity may account for some or 

all of the differences in usage rates. 

In a national survey in 2000, 42 percent of drivers who did not use belts regularly said they 

would definitely be more likely to wear belts if the fine were increased. Another 25 percent of 

these drivers said they would probably be more likely to wear their belts (ACTS, 2001, 

Appendix D). Surveys in North Carolina also found that some nonusers would buckle up if the 

fine were doubled to $50 (Williams and Wells, 2004). 

The effect of driver’s license points on belt use has not been evaluated. The evidence from 2005 

sheds little light on the effectiveness of points. All three jurisdictions with points had primary 

laws. Belt use averaged 86.1 percent in the three jurisdictions with points and 86.6 percent in the 

remaining primary law States (Glassbrenner, 2005b). 

In the 2000 national survey, 49 percent of drivers who were not regular belt users said they 

would definitely be more likely to wear their seat belts if violators were assessed driver’s license 

points. Another 27 percent of these drivers said they would probably be more likely to wear their 
 2 - 10 

belts (ACTS, 2001, Appendix D). In a North Carolina survey, 62 percent of nonusers said they 

always would wear their belts if violations led to driver’s license points (Williams and Wells, 

2004). 

Costs: The direct costs associated with increasing fine levels or assessing driver’s license points 

are minimal. 

Time to implement: Both measures can be implemented as soon as they are publicized and 

appropriate changes are made to the motor vehicle records systems. 

Other issues: 

• Balance: If penalties are excessively low, then they may have little effect. If they are 

excessively high, then law enforcement officers may be reluctant to issue citations and 

judges may be reluctant to impose them. States should choose penalty levels that strike an 

appropriate balance.

• Penalty levels are part of a system: Penalty levels are part of the complete system of 

well-publicized enforcement of strong belt use laws. Appropriate penalty levels help 

make strong laws. But without effective enforcement, judicial support, and good 

publicity, increased penalties may have little effect.
 2 - 11 

1.4 Belt Use Law Coverage: Seating Positions, Vehicles, Ages 

Effectiveness: Unknown Use: Medium Cost: Low Time: Short 

Belt use laws do not cover adult rear seat passengers in more than half of the States 

(Glassbrenner, 2005b). Most States’ laws exempt some vehicles, such as those designed for more 

than 10 passengers, taxis, postal delivery vehicles, farm vehicles, pickup trucks, or vehicles not 

required to have safety belts (Glassbrenner, 2005b).

Most State belt use laws cover passengers over a specified age and are designed to work in 

combination with child passenger safety laws covering younger passengers. Some States exempt 

passengers for specified medical or physical reasons (Glassbrenner, 2005b). Many States make 

belt use mandatory under their Graduated Driver Licensing laws for beginning drivers (see 

Chapter 6, Section 1.1). 

A good belt use law should be comprehensive, covering all seating positions equipped with a 

safety belt in all passenger vehicles (ACTS, 2001, p. 3; NCUTLO, 2004; NHTSA, 2003, Table 

3). Such a law sends a clear and consistent message to the public. 

Use: In many States, belt use laws exempt adult passengers in some seating positions or in some 

passenger vehicles (Glassbrenner, 2005b). 

Effectiveness: Since belt use surveys observe only front seat occupants, there is no direct survey 

evidence on whether belt laws that include rear seat adult passengers affect belt use. In NHTSA’s 

2003 national telephone survey, rear-seat passengers who thought they were covered by their 

State’s law reported higher belt use than those who did not: 62 percent “always use belts” 

compared to 45 percent (Boyle and Vanderwolf, 2003, p. 130). 

In general, belt use is lower in pickup trucks than in other passenger vehicles: in 2005, belt use 

nationwide was 73 percent in pickup trucks compared to 83 percent in cars and 85 percent in 

vans and SUVs (Glassbrenner, 2005a). However, there are no available State-level data on 

whether pickup truck belt use is affected by a pickup truck or farm vehicle belt use law 

exemption. 

Costs: The costs of expanding a belt use law to include all seating positions in all passenger 

vehicles are minimal. 

Time to implement: Expanded belt use law coverage can be implemented as soon as the law is 

enacted and publicized. 
 2 - 12 

2.1 Short-Term, High-Visibility Belt Law Enforcement 

Effectiveness: Proven Use: Medium* Cost: High Time: Medium 

* Used in many jurisdictions but often only once or twice each year

The most common high-visibility belt law enforcement method consists of short (typically 

lasting for two weeks), intense, highly publicized periods of increased belt law enforcement, 

frequently using checkpoints (in States where checkpoints are permitted), saturation patrols, or 

enforcement zones. These periods sometimes are called STEP waves (Selective Traffic 

Enforcement Programs) or blitzes. The method was developed in Canada in the 1980s (Boase et 

al., 2004) and demonstrated in several United States communities (Williams and Wells, 2004). It 

was implemented statewide in North Carolina in 1993 using the Click It or Ticket slogan 

(Reinfurt, 2004), and subsequently adopted in other States under different names and sponsors 

(Solomon et al., 2004). NHTSA’s Click It or Ticket high-visibility enforcement model is 

described in detail in Solomon et al. (2003) and Solomon and Chaffe (2006). 

Use: Most States currently conduct short-term, high-visibility belt law enforcement programs in 

May of each year as part of national safety belt mobilizations (Solomon et al., 2004; Solomon 

and Chaffe, 2006). In previous years, two mobilizations were conducted each year, in May and 

November. In recent years the Air Bag and Seat Belt Safety Campaign and NHTSA have 

supported these campaigns. Approximately 12,000 law enforcement agencies took part in the 

May 2006 campaign (NHTSA, 2006c). See Milano et al. (2004) for a detailed account of the 

history and evolution of the national campaigns. 

Effectiveness: CDC’s systematic review of 15 high-quality studies (Dinh-Zarr et al., 2001; 

Shults et al., 2004) found that short-term, high-visibility enforcement programs increased belt 

use by about 16 percentage points, with greater gains when pre-program belt use was lower. 

CDC noted that many of the studies were conducted when belt use rates were considerably lower 

than at present, so that new programs likely will not have as large an effect. Belt use often 

dropped by about 6 percentage points after the enforcement program ended. Short-term, highvisibility enforcement programs thus typically have a ratchet effect: belt use increases during and 

immediately after the program and then decreases somewhat, but remains at a level higher than 

the pre-program belt use. 

 

NHTSA evaluated the effects of the May 2002, 2003, and 2004 Click It or Ticket campaigns on 

belt use in the States. In 2002, belt use increased by 8.6 percentage points across 10 States that 

used paid advertising extensively in their campaigns. Belt use increased by 2.7 percentage points 

across 4 States that used limited paid advertising and increased by 0.5 percentage points across 4 

States that used no paid advertising (Solomon et al., 2002). 

The 2003 campaign used extensive paid advertising: about $8 million nationally and $16 million 

in individual States (Solomon et al., 2003, Technical Summary). The advertising strongly 

supported the campaign with clear enforcement images and messages. Nationally, belt use 

following the 2003 campaign was 79 percent compared to 75 percent at the same time in 2002 

(Glassbrenner, 2005a). Twenty-eight States conducted small belt use surveys immediately before 

the May 2003 campaign. Across these States, belt use was 75.2 percent in 2002, 72.8 percent 

before the 2003 campaign and 78.5 percent immediately after the campaign. These results show 
 2 - 13 

the typical ratchet effect, with belt use dropping gradually after the 2002 campaign and then 

rising rapidly immediately after the 2003 campaign to a higher level than after the previous 

campaign (Solomon et al., 2003, Chapter IV). 

The 2004 campaign increased paid advertising to about $12 million nationally and $20 million in 

the States (Solomon and Chafee, 2006). As in 2003, the advertising strongly supported 

enforcement activities. Belt use nationally reached 80 percent following the campaign 

(Glassbrenner, 2005a). Across the 50 States and the District of Columbia, belt use increased in 

42 jurisdictions compared to the same time in 2003. Averaged across all 51 jurisdictions, belt use 

increased by 2.4 percentage points (Solomon and Chafee, 2006, p. iv). 

Activities were similar in 2005 and 2006, with approximately $12 million in national paid 

advertising and $20 million in the States each year (NHTSA, 2006c). Belt use nationwide 

increased to 82 percent following the June 2005 campaign (Glassbrenner, 2005a). 

Costs: High-visibility enforcement campaigns are expensive. They require extensive time from 

State highway safety office and media staff and often from consultants to develop, produce, and 

distribute publicity and time from law enforcement officers to conduct the enforcement. Paid 

advertising increases a campaign’s effectiveness, as discussed above, but can be quite expensive. 

Averaged across all States, paid advertising costs were about $125,000 per State for the 2002 

campaign and over $400,000 in 2004 (Solomon and Chafee, 2006, Chapter II). 

Time to implement: A high-visibility enforcement program requires four to six months to plan 

and implement. 

Other issues: 

• Effects in primary and secondary belt law States: High-visibility enforcement 

campaigns are effective in both primary and secondary law States. NHTSA’s 2003 

evaluation found that belt use increased by 4.6 percentage points across the primary law 

States and by 6.6 percentage points across the secondary law States; the primary law 

States had higher use rates before the campaigns (Solomon et al, 2003, Chapter IV; see 

also Nichols, 2002). The 2004 evaluation found that the campaign increased belt use in 

25 secondary jurisdictions by an average of 3.7 percentage points. Belt use decreased in 

the remaining 5 jurisdictions by an average of 2.3 percentage points (Solomon and 

Chafee, 2006, Chapter IV). 

• Effects on low-belt-use groups: CDC’s systematic review observed that short-term, 

high-visibility enforcement campaigns increased belt use more among lower-belt-use 

groups, including young drivers, rural drivers, males, African-Americans, and Hispanics, 

than among higher-belt-use drivers such as older drivers, suburban drivers, females, and 

Caucasians (Shults et al., 2004).
 2 - 14 

2.2 Sustained Enforcement 

Effectiveness: Likely Use: Unknown Cost: Varies Time: Varies 

Some jurisdictions, including California, Oregon, and Washington, enforce their belt use laws 

vigorously as part of standard traffic enforcement activities. 

Use: The extent of vigorous sustained belt law enforcement, with or without extensive publicity, 

is unknown. 

Effectiveness: There are no studies of the effectiveness of sustained enforcement (Hedlund et al, 

2004). California, Oregon, and Washington, States reported to use sustained enforcement, have 

recorded statewide belt use well above national belt use rates since 2002 (California: 90-92 

percent; Oregon: 88-93 percent; Washington: 93-95 percent) (Glassbrenner, 2005b). 

Costs: Sustained enforcement may require funds for publicity. As with short-term, highvisibility enforcement programs, publicity costs will depend on the mix of earned and paid 

media. Paid media can be expensive. 

Time to implement: Sustained enforcement by law enforcement officers can be implemented 

immediately. Extensive publicity will take three or four months to plan and implement.
 2 - 15 

2.3 Combined Enforcement; Nighttime Enforcement 

Effectiveness: Likely Use: Unknown Cost: High Time: Medium 

Short-term, high-visibility belt law enforcement programs (Chapter 2, Section 2.1) require 

substantial funding and law enforcement resources, so they can be difficult to sustain over a 

period of several years (Nichols, 2002). These programs also have been conducted almost 

exclusively during the daylight hours, and the limited available data suggest that belt use is lower 

at night (Chaudhary et al., 2005; Hedlund et al., 2004). Continual enforcement (Chapter 2, 

Section 2.2), in which belt law violations are enforced as standard part of regular traffic patrol, is 

one way to address these issues. 

A second way is to retain the short-term, high-intensity enforcement model but include other 

traffic safety issues such as impaired driving (DWI) and excessive speed, especially since the 

same drivers tend to drink, speed, and not buckle up. In particular, combined DWI and belt law 

checkpoints, saturation patrols, or enforcement zone operations could be conducted at night, 

when belt use is lower, DWI higher, and crash risk greater than during the day. 

Another way to increase belt use at night is to use new night-vision technology for nighttime 

enforcement. The first demonstration of this strategy took place in 2004 in Reading, 

Pennsylvania (Chaudhary et al., 2005). 

Use: There is no available information on how frequently the multifocused high-visibility 

enforcement strategy is used. A single demonstration of a nighttime program was conducted in 

2004 (Chaudhary et al., 2005). 

Effectiveness: The one study of combined high-visibility enforcement, in three demonstration 

sites, produced “encouraging but inconclusive” overall results (Jones et al., 1995; Jones and 

Lacey, 2001, p. 113). Each site targeted belt use, speeding, and alcohol-impaired driving (DWI). 

One site maintained the planned high-intensity enforcement directed at all three behaviors and 

saw reduced DWI and speeding while maintaining a high belt use rate. A second site conducted 

only high-visibility DWI enforcement, which had an effect only on DWI. The third site failed to 

conduct high-visibility enforcement of any type and saw no effect. 

A 2004 nighttime high-visibility belt enforcement program in Reading, Pennsylvania, increased 

nighttime front-seat-occupant belt use by 6 percentage points, from 50 percent to 56 percent. 

Daytime belt use increased by 3 percentage points, from 56 percent to 59 percent (Chaudhary et 

al., 2005). 

Costs: The costs of combined high-visibility enforcement programs are similar to and probably 

somewhat greater than the costs of programs directed exclusively at belt law violators (Chapter 

2, Section 2.1). Publicity must be directed at different offenses in turn, and law enforcement 

officers must have the training and equipment to address different offenses. Nighttime and 

daytime programs should have similar costs. 

Time to implement: As with standard belt law short-term, high-visibility enforcement 

programs, combined or nighttime programs require four to six months to plan and implement.
 2 - 16 

3.1 Communications and Outreach Supporting Enforcement 

Effectiveness: Proven Use: Medium Cost: Varies Time: Medium 

Effective, high-visibility communications and outreach are an essential part of successful safety 

belt law high-visibility enforcement programs (Solomon et al., 2003, Chapter II). Paid 

advertising can be a critical part of the media strategy. Paid advertising brings with it the ability 

to control message content, timing, placement, and repetition (Milano et al., 2004). 

Use: All high-visibility enforcement programs include communications and outreach strategies 

that use some combination of earned media (news stories) and paid advertising. Communications 

and outreach can be conducted at local, state, regional, or national levels. 

Effectiveness: As discussed in Section 2.1, the May 2002 Click It or Ticket campaign evaluation 

demonstrated the effect of different media strategies. Belt use increased by 8.6 percentage points 

across 10 States that used paid advertising extensively in their campaigns. Belt use increased by 

2.7 percentage points across 4 States that used limited paid advertising and increased by only 0.5 

percentage points across 4 States that used no paid advertising (Solomon et al., 2002). Milano et 

al. (2004) summarize an extensive amount of information from national telephone surveys 

conducted in conjunction with each national campaign from 1997 through 2003. 

Costs: As discussed in Chapter 2, Section 2.1, paid advertising can be quite expensive. In the 

average State, paid advertising costs were about $125,000 for the 2002 campaign and over 

$400,000 in 2004 (Solomon and Chafee, 2006, Chapter II). 

Time to implement: An effective media campaign requires four to six months to plan and 

implement. 
 2 - 17 

3.2 Communications and Outreach Strategies for Low-Belt-Use Groups 

Effectiveness: Uncertain* Use: Unknown Cost: Varies Time: Medium 

* For stand-alone programs not supporting enforcement

With belt use at 82 percent nationally and 70 percent or higher in 45 States and the District of 

Columbia, the large majority of drivers and passengers use their belts on every trip. The 

challenge is to reach the minority who still do not buckle up regularly. 

Observations and telephone surveys show who these nonusers are. NHTSA’s 2003 national 

observation survey found lower use for males (77%) than females (81%), lower use for drivers 

age 16 to 24 (75%) than those 25 to 69 (80%), lower use for rural drivers (74%) compared to 

urban (79%) and suburban (84%) drivers (all data from Glassbrenner, 2004, Table 5), and lower 

use for passengers (77%) than for drivers (80%) (Glassbrenner, 2003, Table 1). Belt use is lower 

for pickup truck drivers (69%) than passenger car drivers (81%) (Glassbrenner, 2003, Table 1). 

Available data from the 2005 survey confirm these differences for the categories reported 

(Glassbrenner, 2005a). NHTSA’s 2003 national telephone survey found the same patterns, with 

males, young drivers, rural drivers, pickup truck drivers, and passengers reporting lower belt use 

(Boyle and Vanderwolf, 2003, p. iv). In the telephone survey, no ethnic or racial group reported 

substantially lower than average belt use (Boyle and Vanderwolf, 2003, p. 16). In a 2002 

observation survey in Michigan, Vivoda et al. (2004) found significantly lower belt use among 

front seat occupants identified as Black (76%) compared to those identified as White (82%) or 

Other (84%). 

Most nonusers do wear belts some of the time, or at least say they do. In NHTSA’s 2003 national 

telephone survey, only two percent of drivers and front-seat passengers said they never used their 

belts and another two percent said they rarely used them (Boyle and Vanderwolf, 2003, pp. 11, 

39). Backseat passengers are more frequently unbelted: 13 percent said they never use belts and 

another 8 percent said they rarely use them, while only 53 percent reported wearing belts all the 

time (Boyle and Vanderwolf, 2003, p. 41). The most frequent reasons given for not wearing a 

belt were forgetting to buckle up (55% of drivers and 44% of passengers), only driving a short 

distance (56% and 34%), in a hurry (40% and 31%), and uncomfortable belts (32% and 30%) 

(Boyle and Vanderwolf, 2003, p. 81). 

In the 1960s and 1970s, during the period of low belt use before belt use laws were enacted, 

communications and outreach campaigns did not increase belt use (ACTS, 2001, Appendix A). 

More recently, many communications efforts that do not carry an enforcement message have 

been used in attempts to raise the belt use of low-belt-use groups but few have been evaluated. 

High-visibility enforcement programs generally have been effective in increasing belt use among 

these lower-use groups (see Chapter 2, Section 2.1; Shults et al., 2004). Their publicity messages 

and placement can be directed at specific lower-belt-use groups. Two 2001 programs 

successfully targeted pickup trucks as part of high-visibility safety belt enforcement activities. 

The “Pick Up the Buckle, Each Time, Every Time” campaign in South Dakota increased belt use 

in pickup trucks from 33 percent to 49 percent and the “When you get in a truck, you’d better 

buckle up” campaign in Florida increased use from 47 percent to 68 percent (NHTSA, 2005). 
 2 - 18 

North Dakota’s “Pick Up the Habit for Someone You Love” campaign in 2003 provides the bestdocumented example of a successful communications and outreach program not directly 

connected to enforcement. It was directed at male pickup drivers, whose pre-program belt use 

was 20-percentage-points lower than the statewide 63-percent rate. A survey of these drivers 

identified effective message goals (choose and remember to buckle up); message strategies 

(motivation through loved ones, sometimes using humor); and message placement (combining 

paid and earned radio and television, posters, and public relations events). The program 

increased observed belt use of male pickup drivers by seven percentage points at a total cost of 

$295,000 (North Dakota DOT, 2004). 

The five States of NHTSA’s South Central Region conducted a two-week “Buckle Up in Your 

Truck” paid advertising campaign immediately before their May 2004 Click It or Ticket

campaign. The truck campaign’s message complemented the Click It or Ticket message by 

focusing on the dangers of riding unrestrained in a truck and stressing the usefulness of belts in 

rollover crashes. The campaign spent nearly $600,000 for paid advertising in the five States. 

Surveys at the end of the campaign, before any enforcement-based Click It or Ticket publicity, 

showed that belt use increased in pickup trucks by about 2 percentage points. Belt use in pickup 

trucks increased by another 6 percentage points after the Click It or Ticket publicity (Solomon 

and Chaffe, 2006, Chapter IV). The campaign will continue to be conducted and evaluated in 

2005 and 2006. 

In a follow-up study, an intensive campaign using the same “Buckle Up in Your Truck” message 

was conducted in Amarillo, Texas, in November 2004. The campaign used paid advertising 

emphasizing belt law enforcement as well as earned media featuring local law enforcement 

officers. Belt use in pickup trucks increased by 12 percentage points in Amarillo and belt use in 

cars increased by 8 percentage points. At the same time, belt use in a comparison community 

increased by 5 percentage points for pickup truck occupants and by 4 percentage points for car 

occupants (Solomon and Chafee, 2006, Chapter V). 

Use: Communications and outreach campaigns directed at low-belt-use groups probably are 

quite common, but no summary is available. 

Effectiveness: Uncertain. The North Dakota and Amarillo campaigns are the only welldocumented and successful examples. They used all the characteristics of effective 

communications and outreach campaigns: good target audience research, effective and creative 

message development, and good message placement using both paid and earned media. The 

overall South Central Region campaign produced only modest gains. 

Costs: As with enforcement-related communications and outreach, costs vary depending on 

program quality and delivery. Paid advertising can be expensive.

Time to implement: A good media campaign will require four to six months to plan and 

implement. 
 2 - 19 

4.1 Employer and School Programs 

Effectiveness: Proven* Use: Unknown Cost: Varies Time: Varies 

* In low belt use settings with no belt use law 

Employers, schools, and similar institutions provide well-defined and somewhat controlled 

audiences for seat belt use programs. Education and other communications strategies can be 

tailored to a specific audience. Safety belt use policies can be implemented and enforced in 

certain settings. Incentive programs can be conducted (Chapter 2, Section 4.2). 

Little information is available on what employer and school programs have been conducted 

recently and how effective they have been. The few high-quality published studies were 

conducted more than 15 years ago, in a low belt use environment (Nichols, 2002). 

Use: There are no data on the number of employer and school programs operating currently. 

Effectiveness: Employer and school programs in a low belt use environment with no belt use 

law have increased belt use substantially: by an average of 24 percentage points in five corporate 

programs and by 6 to 28 percentage points in several school programs (Nichols, 2002). 

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

program. 

Time to implement: Employer and school policies can be implemented immediately. Complete 

programs will require at least four months to plan and implement. School programs may require 

a full year. 

Other issues: 

• Employer and school programs in high-belt-use settings: As noted above, there is 

little information on employer and school programs in a setting with a belt use law and 

high baseline belt use. No evaluations appear to have been conducted since 1994. 
 2 - 20 

4.2 Incentive Programs 

Effectiveness: Proven* Use: Low Cost: Varies Time: Medium 

* In low belt use settings with no belt use law 

Incentive programs use rewards of some sort as an inducement to wear seat belts. Incentive 

programs have been implemented by employers, in schools, and across entire communities. 

Rewards have included cash, coupons for merchandise or food, T-shirts or other promotional 

items, and raffle tickets for valuable prizes. Rewards typically have been given to people 

observed to be wearing their belts but sometimes have been given for a pledge to buckle up. 

Incentive programs usually are accompanied by seat belt communications and outreach and may 

also be combined with seat belt use policies (Nichols, 2002). 

Hagenzieker et al. (1997) summarized 34 incentive program evaluations published between 1978 

and 1992. Almost all (95 percent) programs were conducted in the United States. Almost all (83 

percent) were conducted when no belt use law was in effect, so that pre-program belt use was 

low. No incentive program evaluations appear to have been conducted since 1992 (Hagenzieker 

et al., 1997; Nichols, 2002). 

Use: Incentive programs were popular before belt use laws were implemented but most appear to 

have been discontinued. There are no data on the number of incentive programs operating 

currently. 

Effectiveness: In the situations studied – low baseline belt use and no belt use law in effect – 

incentive programs raised belt use immediately by 12 percentage points on average. As with 

enforcement programs, belt use subsequently decreased somewhat, so that the average long-term 

belt use increase was nine percentage points (Hagenzieker et al., 1997; Nichols, 2002). In 

general, the effects were greater when baseline belt use was lower and when the target 

population was more confined: elementary school programs had the greatest impact, followed by 

employers, colleges, and finally entire communities. 

Costs: Incentive program costs will depend on the size of the target audience, the nature of the 

incentives, and the nature and amount of publicity required. Sponsors can be sought to donate 

incentive rewards or otherwise offset program costs. 

Time to implement: An incentive program should take four to six months to plan and 

implement. 

Other issues: 

• Incentive programs in high-belt-use settings: As noted above, there is little or no 

information on incentive programs in a setting with a belt use law and high baseline belt 

use. No incentive program evaluations appear to have been conducted since 1992.
 2 - 21 

Seat Belt Use References 

ACTS (2001). 2001 Seat Belt Summit: Policy Options for Increasing Seat Belt Use in the United 

States. Arlington, VA: Automotive Coalition for Traffic Safety. 

www.actsinc.org/Acrobat/SeatbeltSummit2000.pdf 

Boase, P., Jonah, B.A., and Dawson, N. (2004). Occupant Restraint Use in Canada. Journal of 

Safety Research, 35, pp. 223-229. 

Boyle, J.M., and Vanderwolf, P. (2003). 2003 Motor Vehicle Occupant Safety Survey, Vol. 2, 

Safety Belt Report. DOT HS 809 789. Washington DC: National Highway Traffic Safety 

Administration. 

Chaudhary, N.K., Alonge, M., and Preusser, D.F. (2005). Evaluation of the Reading, PA 

nighttime safety belt enforcement campaign: September 2004. Journal of Safety Research 36, pp. 

321-326. 

Dinh-Zarr, T.B., Sleet, D.A., Shults, R.A., et al. (2001). Reviews of Evidence Regarding 

Strategies to Increase the Use of Safety Belts. American Journal of Preventive Medicine, 21(4S), 

pp. 48-65. www.thecommunityguide.org/mvoi/mvoi-AJPM-evrev-seat-belts.pdf. 

Eby, D.W., Kostyniuk, L.P., Molnar, L.J. et al. (2004). The effect of changing from secondary to 

primary safety belt enforcement on police harassment. Accident Analysis and Prevention 36, pp. 

819-828. 

Farmer, C.M. and Williams, A. F. (2005). Effect on fatality risk of changing from secondary to 

primary seat belt enforcement. Journal of Safety Research 36, pp. 189-194. 

Glassbrenner, D. (2003). Safety Belt Use in 2003. DOT HS 809 646. Washington, DC: National 

Highway Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/airbags/809646.pdf 

Glassbrenner, D. (2004). Safety Belt Use in 2003: Demographic Characteristics. DOT HS 809 

729. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/airbags/809729.pdf. 

Glassbrenner, D. (2005a). Safety Belt Use in 2005: Overall Results. Traffic Safety Facts: 

Research Note. DOT HS 809 932. Washington, DC: National Highway Traffic Safety 

Administration. www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809932.pdf. 

Glassbrenner, D. (2005b). Safety Belt Use in 2005: Use Rates in the States and Territories. DOT 

HS 809 970. Washington DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809970.pdf. 

Hagenzieker, M.P., Bijleveld, F.D., and Davidse, R.J. (1997). Effects of Incentive Programs to 

Stimulate Safety Belt Use: A Meta-Analysis. Accident Analysis and Prevention 29, pp. 759-777. 
 2 - 22 

Hedlund, J.H., Preusser, D.F., and Shults, R.A. (2004). A Research Agenda for Increasing Safety 

Belt Use in the United States. Journal of Safety Research, 35, 231-235. 

Houston, D.J. and Richardson, L.E. (2006). Getting Americans to buckle up: The efficacy of 

state seat belt laws. Accident Analysis and Prevention 37, pp. 1114-1120. 

IIHS (2006). Safety Belt Use Laws. Arlington, VA: Insurance Institute for Highway Safety. 

www.iihs.org/laws/state_laws/restrain3.html. 

Jones, R.K., Joksch, H.C., Lacey, J.H., et al. (1995). Summary Report: Field Test of Combined 

Speed, Alcohol, and Safety Belt Strategies. DOT HS 808 242. Washington, DC: National 

Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/traffic_tech/1995/TT096.htm 

Jones, R.K., Lacey, J.H. (2001). Alcohol and Highway Safety 2001: A Review of the State of 

Knowledge. DOT HS 809 383. Washington, DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/research/AlcoholHighway/ 

Lacey, J., Fell, J.C., Cosgrove, L., et al. (2005). Tennessee’s Combined Safety Belt and Impaired 

Driving Campaign in 2003 Yields Mixed Results. Research Note. Washington, DC: National 

Highway Traffic Safety Administration (under review). 

Milano, M., McInturff, B., and Nichols, J.L. (2004). The Effect of Earned and Paid Media 

Strategies in High-Visibility Enforcement Campaigns. Journal of Safety Research, 35, 203-214. 

M. Nassirpour, M. (2005). Personal communication. 

NCHRP Report 500, Vol. 11 (2004). A Guide for Increasing Seatbelt Use. Washington, DC: 

Transportation Research Board. trb.org/publications/nchrp/nchrp_rpt_500v11.pdf 

NCUTLO (2004). Model Occupant Protection Law. Alexandria, VA: National Committee on 

Uniform Traffic Laws and Ordinances. www.ncutlo.org/occprotect02.html 

NHTSA (2001). Fifth/Sixth Report to Congress: Effectiveness of Occupant Protection Systems 

and Their Use. DOT HS 809 442. Washington, DC: National Highway Traffic Safety 

Administration. www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2002/809-442.pdf 

NHTSA (2003). Initiatives to Address Safety Belt Use. Washington, DC: National Highway 

Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/SafetyBelt/OPIPT_FinalRpt_07-17-03.html 

NHTSA (2005). Office of Impaired Driving and Occupant Protection, personal communication. 
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NHTSA (2006a). Strengthening Safety Belt Use Laws. Traffic Safety Facts: Laws. Washington, 

DC: National Highway Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/newfact-sheet03/SeatBeltLaws.pdf. 

NHTSA (2006b). Summary of Vehicle Occupant Protection Laws, 7th Edition. DOT HS 810 570. 

Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/airbags/VehOccProtectionLaws.pdf 

NHTSA (2006c). Office of Impaired Driving and Occupant Protection, personal communication, 

July 14, 2006. 

Nichols, J.L. (2002). A Review of Research-Based Findings and Recommendations for Programs 

to Increase Seat Belt Usage. Washington, DC: National Highway Traffic Safety Administration. 

Nichols, J.L., and Jones, R.K. (in review). Increasing Safety Belt Usage in the United States: A 

Review of the State of Knowledge. Washington, DC: National Highway Traffic Safety 

Administration. 

North Dakota DOT (2004). “Pick Up the Habit for Someone You Love” Campaign. Final report, 

Contract PHSP4030301. Bismarck, ND: North Dakota Department of Transportation. 

Reinfurt, D.W. (2004). Click It or Ticket in North Carolina: A Decade of Progress. Journal of 

Safety Research, 35, pp. 181-188. 

Shults, R.A., Nichols, J.L., Dinh-Zarr, T.B., et al. (2004). Effectiveness of Primary Enforcement 

Safety Belt Laws and Enhanced Enforcement of Safety Belt Laws: A Summary of the Guide to 

Community Preventive Services Systematic Reviews. Journal of Safety Research, 35, pp. 189-

196. 

Solomon, M.G. and Chaffe, R.H.B. (2006). May 2004 “Click It or Ticket” Safety Belt 

Mobilization Evaluation. Final report, contract DTNH22-99-D-25099. Washington, DC: 

National Highway Traffic Safety Administration. 

Solomon, M.G., Chaudhary, N.K., and Cosgrove, L.A. (2003). May 2003 Click It or Ticket 

Safety Belt Mobilization Evaluation Final Report. Washington, DC: National Highway Traffic 

Safety Administration. www.nhtsa.dot.gov/people/injury/airbags/clickit_ticke03/ciotreport04/CIOT%20May%202003/index.htm 

Solomon, M.G., Compton, R.P., and Preusser, D.F. (2004). Taking the “Click It or Ticket”

model nationwide. Journal of Safety Research, 35, 197-201. 

Solomon, M.G., Ulmer, R.G., and Preusser, D.F. (2002). Evaluation of Click It or Ticket Model 

Programs. DOT HS 809 498. Washington, DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/airbags/clickitcomposite/clickit_composite.pdf 
 2 - 24 

Vivoda, J.M., Eby, D.W., and Kostyniuk, L.P. (2004). Differences in safety belt use by race. 

Accident Analysis and Prevention 36, pp. 1105-1109. 

Williams, A.F., and Wells, J.K. (2004). The role of enforcement programs in increasing seat belt 

use. Journal of Safety Research, 35, pp. 175-180.
 3 - 1 

3. Aggressive Driving and Speeding 

Overview

Aggressive driving is generally understood to mean driving actions that markedly exceed the 

norms of safe driving behavior and that place the driver or other road users in unnecessary 

danger (NHTSA, 2000; NCHRP, 2003). Aggressive behaviors may be directed at other drivers or 

pedestrians through actions such as following too closely or erratic and unsafe lane changes. 

Aggressive behaviors may violate the established traffic control system through speeding or 

running red lights. All aggressive driving violates some traffic laws, but not every moving 

violation is considered aggressive driving. Aggressive driving should not be confused with road 

rage: an intentional assault by a driver or passenger, with a motor vehicle or a weapon, on the 

roadway or precipitated by an incident on the roadway. 

The legal definition of speeding is exceeding the posted speed limit. In practice, law enforcement 

officers seldom write citations for speeds less than 5 or sometimes 10 mph over the posted limit 

(GHSA, 2005). Speeding becomes aggressive driving when a vehicle’s speed is too high for 

conditions or substantially exceeds the prevailing travel speeds of other vehicles. See Aarts and 

van Schagen (2006) for a review of studies of how individual vehicle speeds, average travel 

speeds, and speed variation affect crash risk. 

Problem size. Speeding is common, and on some roads almost universal. About two-thirds of all 

drivers in NHTSA’s 2002 national survey reported that they exceeded the posted speed limit on 

each type of road – interstate, non-interstate multilane, two lane, and city streets – within the past 

week, and about one-third reported this behavior on the day of the interview (Royal, 2004, p. 

29). One-third of all drivers reported that they often or sometimes drive at least 10 mph faster 

than most other vehicles (Royal, 2004, p. 31). Yet two-thirds of drivers felt that other speeding 

drivers pose a major threat to their personal safety (Royal, 2004, p. 43; NHTSA, 2003). NHTSA 

estimated that speeding, as determined by the investigating officer, was a contributing factor in 

30 percent of fatal crashes in 2005 (NHTSA, 2006a). In-depth investigations found speeding to 

be a causal factor in 19 percent of a sample of serious crashes in 1996-1997 (Hendricks et al., 

2001a; Hendricks et al., 2001b). 

Speeding can be dangerous on all roads. In 2005, half of the speed-related traffic fatalities 

occurred on roads posted at 50 mph or less and one-fifth occurred on roads posted at 35 mph or 

less (NHTSA, 2006b, Table 118). 

Aggressive driving actions other than speeding also are common, though they are more difficult 

to measure accurately. In NHTSA’s survey, 40 percent of drivers reported that they sometimes or 

often enter an intersection “just as the light turned from yellow to red,” which is a good working 

definition of red light running. In the same survey, 10 percent reported sometimes or often 

cutting in front of another driver (Royal, 2004, p. 47; NHTSA, 2003). About one-third of drivers 

reported that they feel threatened by other drivers at least several times monthly (Royal, 2004, p. 

59). NHTSA estimated that two-thirds of traffic fatalities involve behaviors commonly 
 3 - 2 

associated with aggressive driving such as speeding, red-light running, and improper lane 

changes (NHTSA, 2001a). 

Strategies to Reduce Aggressive Driving and Speeding

Aggressive driving, speeding, and red-light running all involve traffic law violations. Therefore, 

deterrence through traffic law enforcement is the basic behavioral strategy that has been used to 

control them. This strategy involves the same components used to deter alcohol-impaired driving 

or safety belt nonuse: highly publicized and highly visible enforcement of practical, sound, and 

broadly accepted laws. In particular, speed limits should be set carefully and rationally, taking 

into account the road segment’s design speed, traffic operations, and environmental conditions; if 

not, many drivers will exceed the speed limit. Enforcement can be conducted through regular 

traffic patrols; short, intense, highly publicized enforcement periods; or automated speed or redlight enforcement. The sections in this chapter discuss the relevant laws and sanctions, 

enforcement techniques, and publicity needs. General communications and outreach campaigns 

urging tolerant and non-aggressive driving behavior also have been used in an attempt to reduce 

aggressive driving and speeding. 

Environmental and vehicular measures also can be effective. As examples, traffic calming 

measures can reduce speeds, especially on local roads (TRB, 1998, p. 13). Well-coordinated 

traffic signals can improve traffic flow and reduce red-light running. Adequately designed turn 

bays and entrance and exit ramps can reduce improper merging and driving on the shoulder 

(NCHRP, 2003, Strategy B1). A variety of measures to reduce congestion can diminish driver 

frustration that leads to aggressive driving (Shinar and Compton, 2004). Company policies, 

backed up with speed monitors and logs or even speed regulators, can reduce commercial vehicle 

speeding. These environmental and vehicular strategies are not included in this guide because 

SHSOs have little or no direct authority or responsibility for them. However, managing traffic 

operations in general and speeds in particular requires cooperative efforts between State DOTs 

and SHSOs. SHSOs are encouraged to act cooperatively with State DOTs to identify their 

aggressive driving and speeding problems and to adopt comprehensive plans and programs to 

address them. See NCHRP (2003) for examples of cooperative strategies. 

The same cooperative methods can be useful in addressing local aggressive driving or speeding 

concerns, for example in a neighborhood or on a road segment or corridor. Working together, 

State and community traffic engineers, law enforcement, safety officials, community leaders, and 

concerned citizens can develop comprehensive plans and programs.

The Department of Transportation’s 2005 Speed Management Strategic Initiative (U.S. DOT, 

2005) contains a comprehensive set of engineering, enforcement, and education strategies to 

reduce speeding-related fatalities and injuries. The Department, together with GHSA and several 

national organizations, sponsored a National Forum on Speeding in June 2005. The forum’s 

invited presentations documented speed-related issues and summarized speed management 

practices in Australia, Canada, and the Netherlands. The presentations are available at 

www.nhtsa.dot.gov/people/injury/enforce/Speed_Forum_Presentations/. The forum report 

(NHTSA, 2005c) presents an action agenda. 
 3 - 3 

Countermeasures That Work 

Countermeasures to reduce aggressive driving and speeding are listed below and discussed 

individually in this chapter. The table is intended to give a rough estimate of each 

countermeasure’s effectiveness, use, cost, and time required for implementation. The terms used 

are described below. Effectiveness, cost, and time to implement can vary substantially from State 

to State and community to community. Costs for many countermeasures are difficult to measure, 

so the summary terms are very approximate. See each countermeasure discussion for more 

information. 

1. Laws 

Countermeasure Effectiveness Use Cost Time 

1.1 Speed limits Proven* High Low Short 

1.2 Aggressive driving laws Unknown Low Low Short 

* When enforced and obeyed 

2. Enforcement 

Countermeasure Effectiveness Use Cost Time 

2.1 High-visibility enforcement Uncertain Low High Medium 

2.2 Automated enforcement Proven Medium High* Medium 

2.3 Other enforcement methods Varies Unknown Varies Varies 

*Can be covered by income from citations 

3. Penalties and Adjudication 

Countermeasure Effectiveness Use Cost Time 

3.1 Penalty types and levels Proven High Varies Low 

3.2 Diversion and plea agreements Unknown Unknown Varies Varies 

4. Communications and Outreach 

Countermeasure Effectiveness Use Cost Time 

4.1 Supporting enforcement Likely Medium Varies Medium 

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results. 

 Likely: balance of evidence from high-quality evaluations. 

 Uncertain: limited and perhaps ambiguous evidence. 

 Unknown: no high-quality evaluation evidence. 

 Varies: different methods of implementing this countermeasure produce different results. 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. 

See individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 

Use: 
 3 - 4 

 High: more than two-thirds of the States, or a substantial majority of communities. 

 Medium: between one-third and two-thirds of States or communities. 

 Low: fewer than one-third of the States or communities. 

 Unknown: data not available. 

Cost to implement: 

 High: requires extensive new facilities, staff, or equipment, or makes heavy demands on 

 current resources. 

 Medium: requires some additional staff time, equipment, and/or facilities. 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment or facilities. 

Time to implement: 

 Long: more than one year. 

 Medium: more than three months but less than one year. 

 Short: three months or less. 

These estimates do not include the time required to enact legislation or establish policies. 
 3 - 5 

1.1 Speed Limits 

Effectiveness: Proven* Use: High Cost: Low Time: Short 

*When enforced and obeyed 

Speed limits are only one part of the system that attempts to control driving speeds. Without 

broad public acceptance and active enforcement they have little effect. With public acceptance 

and enforcement, lower speed limits can reduce travel speeds and casualties. 

Speed limits are set both by legislation and by administrative action. General speed limits apply 

to all roads in a class, such as rural interstates or local streets. They are set by State, municipal, 

or even at times by Federal law based on tradeoffs between safety, travel efficiency, and 

community concerns, taking into account the design characteristics of each road class. GHSA 

(2005) and IIHS (2006a) summarize each State’s maximum speed limits and NHTSA (2006) 

provides each State’s complete speed limit laws. Speed zones apply to road segments where the 

general speed limit is thought to be inappropriate. Speed limits in these zones usually are set by 

administrative action based on the road segment’s free-flowing travel speeds, crash experience, 

road and land use conditions, and other factors. Speed limits in many speed zones are set near the 

85th percentile travel speed: the speed at or below which 85 percent of vehicles travel in good 

weather, with no congestion (TRB, 1998, p. 2). 

The effects of maximum speed limits on speeds, crashes, and casualties have been studied 

extensively over the past 30 years. In 1974 the 55 mph National Maximum Speed Limit (NMSL) 

was enacted to conserve fuel. Travel decreased, speeds decreased on roads where the speed limit 

was lowered to 55 mph, and total traffic fatalities decreased by 9,100 from 1973. The slower and 

more uniform speeds due to the 55 mph limit are judged to have saved between 3,000 and 5,000 

lives in 1974 (TRB, 1984, p. 2). As fuel became plentiful again, travel increased and compliance 

with the 55 mph limit decreased markedly (TRB, 1984, p. 5). In 1987 Congress allowed States to 

raise speed limits to 65 mph on rural interstate highways. States that raised their limits generally 

saw increases of about 4 mph in average speeds and 85th percentile speeds and statistically 

significant increases in traffic fatalities on these roads (TRB, 1998, p. 5). In 1995, Congress 

repealed the NMSL and returned full authority to set speed limits back to the States. Again, 

increased speed limits produced modest increases in both average and 85th percentile speeds and 

increases in traffic fatalities (TRB, 1998, p. 6; for the most recent analysis, see TRB, 2006). 

Few studies have examined the effects of speed limit changes on lower-speed roads. Earlier 

studies found little effect on driving speeds or crash rates when speed limits were raised to near 

the 85th percentile travel speed or lowered to near the 35th percentile speed, either on rural roads 

or on urban and suburban arterials (TRB, 1998, p. 6). A recent study found that crashes increased 

by 20-30 percent when speed limits were increased from 50 to 70 kph (31 to 43 mph) or from 70 

to 80 kph (43 to 50 mph) on 19 urban road segments in Hong Kong (Wong et al., 2005). 

Use: A speed limit is in effect on all road segments in all States. 

Effectiveness: Lower maximum speed limits definitely reduce crashes and casualties when the 

limits are obeyed. The same holds true on any road: if a lower speed limit is obeyed, then crashes 

and casualties will drop. But lower speed limits by themselves may not reduce travel speeds. 
 3 - 6 

Costs: The immediate costs of changing speed limits are for new signage and for publicizing the 

new limit. Enforcing the new limit may involve substantial costs. 

Time to implement: Speed limit changes can be implemented quickly, as soon as signage is in 

place and the new limits are publicized. 

Other issues: 

• Public acceptance, roadway characteristics, enforcement, and publicity: Speed limit 

changes may not by themselves affect speeding, whether defined either as average travel 

speed or as the proportion of drivers traveling substantially faster than the average speed. 

Speed limits can reduce speeding if most drivers believe that the limits are reasonable and 

if the threat of enforcement is great enough to affect the few drivers who would not 

comply voluntarily. It is generally very difficult to enforce and obtain general compliance 

with a lower speed limit on a roadway designed for higher speeds (TRB, 1998, p 12). 

Thus, speed limits must be considered as part of a system including broad public 

acceptance, roadway characteristics, active enforcement, and publicity (TRB, 1998, p. 

133).

• Rational speed limits: Speed limits on many road segments are frequently not obeyed, 

and average travel speeds on these segments substantially exceed the speed limit. One 

strategy that has been proposed to increase overall safety is to increase the speed limit to 

a generally accepted level on selected road segments and at the same time aggressively 

publicize and enforce this speed limit. The strategy’s goal is to increase the public’s 

overall acceptance of speed limits while reducing the number of people driving at speeds 

considerably higher than the limit. NHTSA began a demonstration of this strategy in 

2003. Preliminary data as of December 2004 suggested that the increased speed limits 

have had little effect on travel speeds. Final demonstration reports, which will include 

data on speeds, crashes, and casualties, should be available in 2007.

 
 3 - 7 

1.2 Aggressive Driving Laws 

Effectiveness: Unknown Use: Low Cost: Low Time: Short 

Aggressive driving actions are covered by specific traffic laws such as speeding, improper lane 

changes, and following too closely, or by general laws such as reckless driving. These laws 

typically carry relatively minor penalties and may be difficult to prosecute (NHTSA, 2001a, 

Statutory Strategies). Aggressive drivers often can be identified as those who violate these traffic 

laws repeatedly or whose violations lead to crashes producing serious injury or death. The traffic 

law strategy to address aggressive driving is to assure that more severe penalties are available for 

repeat offenders and for violations causing death or serious injuries. 

NHTSA’s 1999 Symposium on Aggressive Driving and the Law (NHTSA, 2001a, Statutory 

Strategies) recommended that States implement this strategy by providing for: 

• enhanced penalties for repeat offenders, including increased driver’s license points, 

license suspension or revocation, higher fines, and jail or probation; and 

• felony charges for violations resulting in serious injury or death. 

The symposium developed a model aggressive driving statute that defines aggressive driving as 

three moving violations in a single driving incident. The NCHRP Aggressive Driving Guide also 

recommends increased sanctions for repeat offenders and serious offenses (NCHRP, 2003, 

Strategy A3). 

Use: In general, States provide for increased penalties for repeat offenders and for violations 

with serious consequences. Ten States have a formal aggressive driving law and two other States 

have laws relating to assault-type crimes involving motor vehicles (GHSA, 2005). 

Effectiveness: There are no studies of the effects of aggressive driving laws in general or of 

increased penalties in particular on aggressive driving, traffic law violations, or crashes. See 

Chapter 3, Section 3.1 for a discussion of the effects of driver improvement actions in general. 

Costs: The only immediate costs of the recommended law changes are to publicize the new laws. 

Additional costs may result as drivers are sentenced to more costly sanctions. 

Time to implement: Law changes can be implemented quickly, as soon as they are publicized. 

Other issues: 

• Public acceptance, enforcement, and publicity: Law changes by themselves cannot 

reduce aggressive driving. Traffic laws in general and aggressive driving laws in 

particular are essential to, but only a part of, a system that includes broad public 

acceptance, active enforcement, and publicity (NHTSA, 2001a, Executive Summary). 
 3 - 8 

2.1 High-Visibility Enforcement 

Effectiveness: Uncertain Use: Low Cost: High Time: Medium 

High-visibility enforcement campaigns have been used to deter aggressive driving and speeding. 

They are based on the same principles as high-visibility seat belt and alcohol-impaired-driving 

enforcement: to convince the public that speeding and aggressive driving actions are likely to be 

detected and that offenders will be arrested and punished (see Chapter 1, Alcohol-Impaired 

Driving, Sections 2.1 and 2.2, and Chapter 2, Safety Belt Use, Section 2.1). Speeding and 

aggressive driving are moving violations. Enforcement cannot use checkpoints but must observe 

driving behavior on the road. 

In the high-visibility enforcement model, law enforcement targets selected high-crash or highviolation geographical areas using either expanded regular patrols or designated aggressive 

driving patrols. Officers focus on drivers who commit common aggressive driving actions such 

as speeding, following too closely, and running red lights. Enforcement is publicized widely. The 

strategy is very similar to saturation patrols directed at alcohol-impaired drivers (Chapter 1, 

Section 2.2). 

Use: No data are available on the number of jurisdictions operating high-visibility aggressive 

driving enforcement campaigns, but it is likely that they are not common. NCHRP (2003, 

Strategy A1) provides a few examples of recent aggressive driving enforcement programs. 

Effectiveness: Some effectiveness evidence comes from NHTSA demonstrations in three 

communities. All three demonstrations lasted six months and included extensive publicity but 

differed in other respects. Milwaukee was the most successful. Red-light running decreased at 

targeted intersections. Crashes in the city dropped by 12 percent in targeted corridors and by 2 

percent in comparison corridors (NHTSA, 2002; McCartt et al., 2001). The Indianapolis 

demonstration was not a success. Average speeds dropped slightly. Total crashes increased 32 

percent over the previous year. Crashes increased more in the demonstration area than in other 

areas, and the proportion of crashes involving aggressive driving behaviors also increased in the 

demonstration areas (NHTSA, 2004; Stuster, 2004). Tucson had mixed results. Average speeds 

dropped moderately. Total crashes increased 10 percent in the demonstration areas and 

decreased in comparison areas. However, the proportion of crashes involving aggressive driving 

behaviors decreased by eight percent in the demonstration areas (NHTSA, 2004b; Stuster, 2004). 

More recently, Davis et al. (2006) report on a high-visibility enforcement program in Fresno, 

California in 2003 and 2004. The program increased traffic citations significantly and reduced 

crashes, injuries, fatalities, and fatalities related to speed. It reduced hospital admissions resulting 

from crashes and reduced the injury levels, length of stay in hospital, and hospital charges for 

those crash victims who were hospitalized. Taken together, the evaluation evidence suggests that 

high-visibility aggressive driving enforcement campaigns have promise but success is far from 

guaranteed. 

Costs: As with alcohol-impaired driving and seat belt use enforcement campaigns, the main 

costs are for law enforcement time and for publicity. The Milwaukee demonstration received a 

$650,000 grant and the other two demonstrations each received a $200,000 grant. 
 3 - 9 

Time to implement: High-visibility enforcement campaigns may require four to six months to 

plan, publicize, and implement. 
 3 - 10 

2.2 Automated Enforcement 

Effectiveness: Proven Use: Medium Cost: High* Time: Medium 

*Can be covered by income from citations 

Automated enforcement is used in some jurisdictions to reduce red-light running and speeding. 

At intersections with traffic lights, automated cameras take photographs of vehicles entering the 

intersection on a red light. Citations are sent to the vehicle’s registered owner. FHWA’s RedLight Running Cameras (FHWA, 2005a) and Red-Light Camera Systems Operational Guidelines 

(FHWA, 2005b) and the National Campaign to Stop Red-Light Running’s Guide to Red-Light 

Camera Programs (NCSRLR, 2002) provide information on red-light camera program costs, 

effectiveness, implementation, and other issues. Maccubbin et al. (2002) provide more detailed 

information on programs operating in 2001. Speed cameras, also called photo radar, operate 

similarly, recording a vehicle’s speed using radar or other instrumentation and taking a 

photograph of the vehicle. 

 

Use: Red-light cameras are used extensively in other industrialized countries and were first 

employed in the United Sates in 1993 (NCSRLR, 2002). As of July 2006, red-light cameras were 

used in more than 100 U.S. communities in 21 States and the District of Columbia (IIHS, 2006c). 

Speed cameras also are used extensively in other countries (WHO, 2004, p. 128). As of February 

2006 they were used in 18 U.S. communities in eight States and the District of Columbia (IIHS, 

2006d). 

Effectiveness: Red-light camera effectiveness has been studied fairly extensively. Summary 

reviews conclude that they increase rear-end crashes, reduce side-impact crashes, and reduce 

overall injury crashes perhaps by as much as 25 percent (Aeron-Thomas and Hess, 2006; 

FHWA, 2005b; IIHS, 2002; Maccubbin, 2001; McGee and Eccles, 2003; Retting et al., 2003; 

WHO, 2004, p. 132). Speed cameras reduce crashes substantially, though no studies have been 

conducted in the United States. Pilkington and Kinra (2005) reviewed 14 high-quality studies of 

speed camera programs in Australia, Canada, New Zealand, Norway, and the United Kingdom 

and concluded that speed cameras reduce traffic crashes, injuries, and fatalities. 

Costs: In 2001, red-light cameras cost about $50,000 to $60,000 to purchase and $25,000 to 

install. Monthly operating costs were about $5,000 (Maccubbin et al., 2001). Most jurisdictions 

contract with private vendors to install and maintain the cameras and use a substantial portion of 

the income from red-light citations to cover program costs. Speed camera costs probably are 

similar. Chen (2005) provides an extensive analysis of the costs and benefits of the British 

Columbia speed camera program. 

Time to implement: Once any necessary legislation is enacted, automated enforcement 

programs probably require four to six months to plan, publicize, and implement. 

Other issues: 

• Laws: Many jurisdictions using automated enforcement are in States with laws 

authorizing its use. Some States permit automated enforcement without a specific State 

law. A few States prohibit some forms of automated enforcement (IIHS, 2006b). See 

NCUTLO (2004) for a model automated enforcement law. The National Campaign to 
 3 - 11 

Stop Red-Light Running newsletter, Safety Focus, provides periodic summaries of State 

automated enforcement legislative activity (www.stopredlightrunning.com). 

• Public acceptance: Public surveys typically show strong support for red-light cameras 

and somewhat weaker support for speed cameras (IIHS, 2005, 2006e; Royal, 2004, p. 

66). Support appears highest in jurisdictions that have implemented red-light or speed 

cameras. However, efforts to institute automated enforcement often are opposed by 

people who believe that speed or red-light cameras intrude on individual privacy or are an 

inappropriate extension of law enforcement authority. They also may be opposed if they 

are viewed as revenue generators rather than methods for improving safety. Delaney et al. 

(2004) discuss how Australia and the United Kingdom dealt with the opponents of speed 

cameras.

• Legality: State courts have consistently supported the constitutionality of automated 

enforcement.
 3 - 12 

2.3 Other Enforcement Methods 

Effectiveness: Varies Use: Unknown Cost: Varies Time: Varies 

Many traffic enforcement operations help to deter speeding and aggressive driving as well as 

other traffic offenses. In addition to high-visibility enforcement campaigns (Chapter 3, Section 

2.1) and automated enforcement (Section 2.2), two strategies have been recommended to address 

speeding and aggressive driving: targeting repeat offenders and using new technology (NCHRP, 

2003, Strategies A1 and A3; NHTSA, 2001a). Several law enforcement agencies around the 

country have conducted innovative and effective aggressive driving enforcement programs 

(NHTSA, 2000). 

Repeat offenders: Repeat speeding and aggressive driving offenders have not been deterred by 

their arrest and punishment for their previous offenses. Recommended methods to reach them 

include: 

• Enhanced penalties, including increased driver’s license points, immediate license 

suspension or revocation, higher fines, and jail or probation. See Chapter 3, Sections 1.2 

and 3.1, for more information. 

• Improved traffic record systems, to better identify repeat offenders and to allow patrol 

officers to immediately access a driver’s complete driving record (NHTSA, 2001a). 

There are no studies of the effects of improved record systems on repeat offenders. Costs 

and implementation time will vary. 

New technology: Improved technology may help in several ways. 

• In-car video equipment in patrol cars allows law enforcement to record aggressive 

driving actions and can enhance the ability to prosecute and convict offenders (NHTSA, 

2001a). 

• Laser speed measuring equipment can provide more accurate and reliable evidence of 

speeding (NHTSA, 2001a). 

• Unstaffed speed display devices, also known as speed trailers, can show drivers that they 

are speeding and may encourage some drivers to slow down. They also provide an 

automated method to collect location-specific travel speed data. 

Many jurisdictions use some of these new technologies. Each has costs for new equipment and 

training. Each can be implemented quickly as soon as equipment is purchased and training 

completed. 

Innovative programs: NHTSA (2000) provided brief descriptions of 12 aggressive driving 

enforcement programs around the country. See NHTSA’s Aggressive Driving Programs 

(NHTSA, 2001b) for additional examples. 

• The Albuquerque, New Mexico, Safe Streets program used saturation patrols in four 

high-crash and high-crime areas. On freeways they observed speeding and aggressive 

driving from a “cherry picker” platform and radioed to patrol officers. 

• The Arizona Department of Public Safety’s Operation Chill used both marked and 

unmarked patrol vehicles backed up with an extensive publicity campaign. 
 3 - 13 

• The Colorado State Patrol ADAPT (Aggressive Drivers Are Public Threats) campaign 

used unmarked patrol vehicles, motorcycles, airplanes, and motorist calls to *277 to 

detect aggressive drivers. The campaign was publicized extensively. 

• The Maryland State Police used a special ADVANCE (Aggressive Driving Video and 

Non-Contact Enforcement) vehicle equipped with lasers to determine a vehicle’s range 

and speed and a computer system to record video images of the vehicle. 

• The Massachusetts State Police 3D Program, (Dangerous Drunk and Drugged Driving) 

used unmarked patrol vehicles as well as unmarked or nontraditional vehicles, equipped 

with in-car video cameras and radar units, and emergency lights, working in cooperation 

with two or more marked patrol vehicles.

• The Milwaukee, Wisconsin, Police Department used an "angel patrol" (for those drivers 

who “drive faster than their guardian angel can fly”), a "flasher patrol" for those drivers 

who do not use their turn signals when turning or switching lanes, and a "basket patrol" 

for the drivers who like to weave in and out of traffic. See Chapter 3, Section 2.1 for 

evaluation data. 

• The Ohio State Highway Patrol’s Operation TRIAD (Targeting Reckless, Intimidating, 

and Aggressive Drivers) used a large, fixed-wing aviation division and local highway 

patrol officers to target aggressive driving. 

• The Oklahoma City Police Department’s RAAID (Reduction of Accidents and 

Aggressive and Inconsiderate Drivers) used dedicated law enforcement teams to target 10 

high-crash areas. 

• The Pennsylvania State Police used two programs. Operation Centipede stationed 8 to 10 

officers one to two miles apart along a roadway, in both marked and unmarked vehicles. 

TAG-D (Ticket the AGgressive Driver) used saturation patrols with marked and 

unmarked law enforcement vehicles, a vehicle that appears disabled, radar, fixed-wing 

aircraft, and pursuit vehicles. 

• The Richardson, Texas, Police Department used a downstream light system to reduce 

red-light running. A white light on the back of a traffic light was activated when the light 

turned red. Officers across the intersection or downstream from the traffic light could 

then tell when the light turned red and wait for the red-light runners to reach them.

• The St. Petersburg, Florida, Police Department’s “Where’s Jockers?” program featured 

Patrol Officer Mike Jockers, equipped with a radar gun and handheld radio, sitting in 

unexpected places to observe aggressive driving and call ahead to marked patrol vehicles. 

Locations included on lawn mowers and bus benches, and in road construction vehicles. 

• The greater Washington, DC, area multi-agency Smooth Operator program used 

coordinated enforcement waves with marked and unmarked patrol vehicles as well as 

nontraditional vehicles. 
 3 - 14 

3.1 Penalty Types and Levels 

Effectiveness: Proven Use: High Cost: Varies Time: Low 

Penalty types and levels for speeding and the various traffic offenses included under aggressive 

driving are part of each State’s overall driver control system. Penalties typically are low for first 

offenses that do not produce serious crashes and casualties and include small fines and perhaps a 

few demerit points assessed against the driver’s license. When violations cause a crash producing 

serious injury or death, the offense may carry criminal charges and sanctions may be more 

severe. As discussed in Chapter 3, Section 1.2, NHTSA’s Aggressive Driving Symposium and 

NCHRP’s Aggressive Driving Guide recommend enhanced penalties for repeat aggressive 

driving offenders and felony charges for offenses resulting in serious injury or death (NHTSA, 

2001a, Statutory Strategies; NCHRP, 2004, Strategy A3). 

States use the demerit point system in an attempt to prevent drivers from committing repeated 

traffic offenses. As drivers accumulate demerit points, States use various actions and penalties 

such as warning letters, educational brochures, group counseling meetings, individual 

counseling, administrative hearings, and driver’s license suspension or revocation (Masten and 

Peck, 2004). Penalty levels and types for speeding and aggressive driving offenses should be 

considered within the context of a State’s overall driver control and problem driver remediation 

system. 

Use: Each State has a system of penalties for traffic offenses. Each system includes more severe 

penalties for significant individual offenses, such as those producing serious injury or death, and 

for repeated offenses, often determined through accumulated driver’s license demerit points. 

Effectiveness: Masten and Peck (2004) reviewed the effectiveness evidence for different driver 

improvement and driver control actions, including penalty levels and types, from 35 high-quality 

studies of 106 individual actions and penalties. They found that, taken together, all actions and 

penalties reduced subsequent crashes by 6 percent and violations by 8 percent. Even simple 

warning letters have some effect on both violations and crashes. The effect increased as the 

“obtrusiveness” of the action increased, with license suspension or revocation the most effective 

by far. The authors noted that the threat of license suspension probably is responsible for the 

effectiveness of the weaker actions such as warning letters. Educational brochures by themselves 

had no effect. Finally, administrative penalties imposed by the driver licensing agency were 

more effective than penalties imposed by the courts. 

Costs: Costs vary by penalty type. For example, warning letters are very cheap once a record 

system has been established to identify drivers who should receive letters. Individual counseling 

and administrative hearings may require substantial staff time. Some costs may be recovered 

through offender fees. 

Time to implement: Most changes in penalty levels can be implemented quickly within a 

State’s overall driver improvement system. 

Other issues: 
 3 - 15 

• Public acceptance, enforcement, and publicity: Changes in speeding and aggressive 

driving penalty types and levels by themselves cannot reduce speeding and aggressive 

driving. Traffic laws, penalty types, and penalty levels are essential to, but only a part of, 

a system that includes broad public acceptance, active enforcement, and publicity 

(NHTSA, 2001a, Executive Summary). 
 3 - 16 

3.2 Diversion and Plea Agreement Restrictions; Traffic Violator School 

Effectiveness: Unknown Use: Unknown Cost: Varies Time: Varies 

In many jurisdictions, drivers who accumulate enough demerit points on their driver’s licenses 

are allowed to attend a Traffic Violator School. In most instances, drivers who complete Traffic 

Violator School have their traffic offenses dismissed or removed from their driving record 

(Masten and Peck, 2004). 

Negotiated plea agreements are a necessary part of an effective and efficient court system. 

However, plea agreements may allow offenders to have their penalties reduced or eliminated, for 

example if a driver is allowed to avoid a driver’s license suspension by attending Traffic Violator 

School. 

Use: No data are available on the number of jurisdictions in which Traffic Violator School is 

available or the number of offenders who use Traffic Violator School to reduce their penalties. 

Similarly, no data are available on the availability and use of other plea agreements for speeding 

or aggressive driving violations. 

Effectiveness: Masten and Peck’s review (2004) included high-quality studies of over 30 group 

meeting programs, including Traffic Violator School. Taken together, these group meeting 

programs reduced subsequent crashes by five percent and violations by eight percent. Masten 

and Peck point out that Traffic Violator School programs in California increased, rather than 

decreased, crashes because they allowed offenders to escape more severe penalties and start 

again with a clean driving record. Their review was not able to determine whether other Traffic 

Violator School programs that dismissed an offender’s violation had similar negative effects. 

Costs: Costs for establishing diversion or Traffic Violator School programs will depend on the 

nature of the program. Costs include developing and maintaining a tracking system, notifying 

offenders, and administering the Traffic Violator School. Costs for limiting or eliminating 

diversion programs, plea agreements, and Traffic Violator School can be determined by 

comparing the per-offender costs of these programs with the costs of the penalties that would 

otherwise be applied. 

Time to implement: Diversion or Traffic Violator School programs will require at least six 

months to establish and implement. They can be modified within a few months. 

Other issues: 

• Diversion and Plea Agreement Issues in Alcohol-Impaired Driving: Diversion and 

plea agreements have been discussed and evaluated more extensively for alcoholimpaired driving offenses than for speeding and aggressive driving offenses. See Chapter 

1, Section 3.2 for additional discussion.

• Public acceptance, enforcement, and publicity: Changes in the adjudication of 

speeding and aggressive driving infractions, such as limiting or eliminating diversion and 

plea agreements, by themselves cannot reduce speeding and aggressive driving. Traffic 

laws and adjudication are essential to, but only a part of, a system that includes broad 
 3 - 17 

public acceptance, active enforcement, and publicity (NHTSA, 2001a, Executive 

Summary).
 3 - 18 

4.1 Communications and Outreach Supporting Enforcement 

Effectiveness: Likely Use: Medium Cost: Varies Time: Medium 

Effective, high-visibility communications and outreach are an essential part of successful speed 

and aggressive-driving enforcement programs (NCHRP, 2003; NHTSA, 2000). All the examples 

discussed in Chapter 3, Sections 2.1, High-Visibility Enforcement, and 2.3, Other Enforcement 

Methods, used extensive communications campaigns to support their enforcement efforts. Most 

campaigns to date have not used paid advertising. The success of paid advertising in safety belt 

use campaigns (Chapter 2, Section 3.1) suggests that it is worth considering for speed and 

aggressive driving enforcement campaigns. 

Communications and outreach programs urging drivers to behave courteously or not to speed are 

unlikely to have any effect unless they are tied to vigorous enforcement (NCHRP, 2003, Strategy 

A2). 

Use: All aggressive driving and speed enforcement programs have a communications and 

outreach component. 

Effectiveness: No studies have evaluated how different communications and outreach strategies 

influence the effectiveness of speed and aggressive driving enforcement programs. The evidence 

from safety belt (Chapter 2, Sections 2.1, 2.2, and 3.1) and alcohol-impaired driving (Chapter 1, 

Sections 2.1 and 2.2) enforcement programs strongly suggests that good communications and 

outreach are essential to a successful enforcement program. See also NCHRP (2003, Strategy 

A2). 

Costs: Good media campaigns can be expensive. See Chapter 2, Section 3.1. 

Time to implement: An effective media campaign requires four to six months to plan and 

implement. 
 3 - 19 

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Accident Analysis and Prevention 38, pp. 215-224. 

Aeron-Thomas, A.S., and Hess, S. (2006) Red-light cameras for the prevention of road traffic 

crashes. The Cochrane Database of Systematic Reviews 2006, Issue 2, CD003862. 

www.cochrane.org/reviews/en/ab003862.html 

Chen, G. (2005). Safety and economic impacts of photo radar program. Traffic Injury Prevention

6, pp. 299-307. 

Davis, J.W., Bennink, L.D., Pepper, D.R., Parks, S.N., Lemaster, D.M., and Townsend, R.N. 

(2006). Aggressive traffic enforcement: a simple and effective injury prevention program. 

Journal of Trauma 60, pp. 972-977. 

Delaney, A., Ward, H., Cameron, M., and Williams, A.F. (2004). Controversies and Speed 

Cameras: Lessons Learnt Internationally. Arlington, VA: Insurance Institute for Highway 

Safety. 

FHWA (2005a). Red Light Running Cameras. Washington, DC: Federal Highway 

Administration. safety.fhwa.dot.gov/intersections/redl_cameras.htm 

FHWA (2005b). Red-Light Camera Systems Operational Guidelines. Washington, DC: Federal 

Highway Administration. safety.fhwa.dot.gov/intersections/rlc_guide/index.htm 

GHSA (2005). Survey of the States: Speeding. Washington, DC: Governors Highway Safety 

Association. 

www.statehighwaysafety.org/html/publications/pdf/surveystates2005/surveystates_speeding.pdf 

Hendricks, D.L., Fell, J.C., and Freedman, M. (2001a). The Relative Frequency of Unsafe 

Driving Acts in Serious Traffic Crashes: Summary Technical Report. Washington, DC: National 

Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/research/UDAshortrpt/UDAsummtechrept.pdf 

Hendricks, D.L., Freedman, M., Zador, P.L., and Fell, J.C. (2001b). The Relative Frequency of 

Unsafe Driving Acts in Serious Traffic Crashes. Washington, DC: National Highway Traffic 

Safety Administration. 

www.nhtsa.dot.gov/people/injury/research/UDAshortrpt/UDAlongreport.pdf 

IIHS (2002). Automated Enforcement. IIHS Status Report 37(5). Arlington, VA: Insurance 

Institute for Highway Safety. www.hwysafety.org/sr/pdfs/sr3705.pdf 

IIHS (2005). Q&A: Red Light Cameras. Arlington, VA: Insurance Institute for Highway Safety. 

www.iihs.org/research/qanda/rlr.html 
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IIHS (2006a). Maximum Posted Speed Limits for Passenger Vehicles. Arlington, VA: Insurance 

Institute for Highway Safety. www.iihs.org/laws/state_laws/speed_limit_laws.html 

IIHS (2006b). Automated Enforcement Laws. Arlington, VA: Insurance Institute for Highway 

Safety. www.iihs.org/laws/state_laws/auto_enforce.html 

IIHS (2006c). Communities with Red Light Cameras as of May 2006. Arlington, VA: Insurance 

Institute for Highway Safety. www.hwysafety.org/research/topics/rlc_cities.html 

IIHS (2006d). Communities with Speed Cameras as of February 2006. Arlington, VA: Insurance 

Institute for Highway Safety. www.iihs.org/research/topics/sc_cities.html 

IIHS (2006e). Q&A: Speed – Law Enforcement. Arlington, VA: Insurance Institute for Highway 

Safety. www.hwysafety.org/research/qanda/speed_lawenf.html 

Maccubbin, R., Staples, B., and Salwin, A. (2001). Automated Enforcement of Traffic Signals: A 

Literature Review. Washington, DC: Federal Highway Administration. 

www.itsdocs.fhwa.dot.gov//JPODOCS/REPTS_TE//13603.html. Abstract available at: 

www.benefitcost.its.dot.gov/its/benecost.nsf/0/7BCBD2BEE5EEA1D985256C1A0070B736?Op

enDocument&Flag=Country 

Masten, S.V., and Peck, R.C. (2004). Problem driver remediation: A meta-analysis of the driver 

improvement literature. Journal of Safety Research 35, 403-425. www.sciencedirect.com 

McCartt, A.T., Leaf, W.A., Witkowski, T.L., and Solomon, M.G. (2001). Evaluation of the 

Aggression Suppression Program, Milwaukee, Wisconsin. DOT HS 809 395. Washington DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/research/Aggressionwisc/contents.htm 

McGee, H.W. and Eccles, K.A. (2003). Impact of Red Light Camera Enforcement on Crash 

Experience. NCHRP Synthesis No. 310. Washington, DC: Transportation Research Board. 

onlinepubs.trb.org/onlinepubs/nchrp/nchrp_syn_310.pdf 

NCHRP Report 500, Vol. 1 (2003). A Guide for Addressing Aggressive-Driving Collisions.

Washington, DC: Transportation Research Board. 

www.ch2m.com/nchrp/AggDrvr/assets/ADguide.pdf 

NCSRLR (2002). Stop on Red = Safe on Green: A Guide to Red Light Camera Programs. 

Washington, DC: National Campaign to Stop Red Light Running. 

www.stopredlightrunning.com/pdfs/StopOnRedSafeOnGreen.pdf 

NCUTLO (2004). Automated Traffic Law Enforcement Model Law. Alexandria VA: National 

Committee on Uniform Traffic Laws and Ordinances. www.ncutlo.org/autoenforce622.htm 
 3 - 21 

NHTSA (2000). Aggressive Driving Enforcement: Strategies for Implementing Best Practices.

Washington DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/enforce/aggressdrivers/aggenforce/index.html 

NHTSA (2001a). National Aggressive Driving Action Guide: A Criminal Justice Approach.

DOT HS 809 351. Washington DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/enforce/DOT%20Aggress%20Action/index.htm#Contents 

NHTSA (2001b). Aggressive Driving Programs. DOT HS 808 730. Washington DC: National 

Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/enforce/AggressiveDrivingHTML/Aggressive_index.htm 

NHTSA (2002). Aggression Suppression Program in Milwaukee Reduces Crashes and Changes 

Motorist Behavior. Traffic Safety Facts: Traffic Tech No. 268. Washington DC: National 

Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/traffic_tech/2002/TT268.htm 

NHTSA (2003). National Survey of Speeding and Unsafe Driving Attitudes and Behavior: 2002. 

Traffic Safety Facts: Traffic Tech No. 289. Washington DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/traffic_tech/2003/TrafficTech289.html 

NHTSA (2004). Aggressive driving enforcement in two demonstration communities. Traffic 

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Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pubs/speedingtsf05.pdf 

NHTSA (2006b). Traffic Safety Facts 2005. DOT HS 810 631. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pubs/tsf2005ee.pdf. 

NHTSA (2005c). National Forum on Speeding: Strategies for Reducing Speed-Related Fatalities 

and Injuries. DOT HS 809 963. Washington, DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/enforce/NatForumSpeeding/ 

NHTSA (2006). Summary of State Speed Laws, Ninth Edition, Current as of January 1, 2006.

Washington DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/enforce/Summary_StateSpeedLaws.pdf 

Pilkington, P. and Kinra, S. (2005). Effectiveness of speed cameras in preventing road traffic 

collisions and related casualties: systematic review. British Medical Journal 330, pp. 331-334. 

bmj.bmjjournals.com/cgi/reprint/330/7487/331 

Retting, R.A., Ferguson, S.A., and Hakkert, A.S. (2003). Effects of red light cameras on 

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17-23. 
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Royal, D. (2004). National Survey of Speeding and Unsafe Driving Attitudes and Behavior: 

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Administration. 

www.nhtsa.dot.gov/people/injury/research/speed_volII_finding/SpeedVolumeIIFindingsFinal.pd

f

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vehicle, and situational variables. Accident Analysis and Prevention 36, pp. 429-437. 

Stuster, J. (2004). Aggressive Driving Enforcement: Evaluation of Two Demonstration 

Programs. DOT HS 809 707. Washington DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/research/AggDrivingEnf/images/AggresDrvngEnforce-5.0.pdf 

TRB (1984). 55: A Decade of Experience. Transportation Research Board Special Report 254. 

Washington DC: National Academy Press. trb.org/news/blurb_detail.asp?id=2721 

TRB (1998). Managing Speed: Review of Current Practice for Setting and Enforcing Speed 

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377-388. 
 4 - 1 

4. Distracted and Fatigued Driving

Overview

Distracted and fatigued driving are common, though both are difficult to define, measure, and 

sometimes observe. Both distracted and fatigued driving result in large part from lifestyle 

patterns and choices: they are societal issues rather than just driving and transportation system 

issues. For these reasons, few behavioral highway safety countermeasures have been shown to 

reduce distracted or fatigued driving. Rumble strips and other environmental measures have 

proven quite successful in reducing crashes by distracted or fatigued drivers. A variety of 

vehicular measures may either increase or reduce distractions and fatigue. 

Recent distracted driving attention and research has concentrated on cell phones, but other 

distractions are more common and appear to contribute more to crashes. Attention and research 

on fatigue has concentrated on commercial truck drivers, but the problem is far more widespread. 

Problem size and characteristics: distracted driving. Distractions take a driver’s attention 

away from driving. A distraction can be produced by something a driver sees or hears, some 

physical task not directly involved in driving (such as eating or operating the car radio), or 

mental activities (such as conversations with passengers or on a cell phone) (NHCRP, 2005, 

Section III). 

NHTSA surveyed 4,010 drivers in spring 2002 and asked about a variety of potentially 

distracting behaviors (Royal, 2003, p. 1). The vast majority reported these behaviors on some 

trips, often on many or most trips. The most common were: 

• 81 percent talked to other passengers on some trips; 

• 66 percent changed radio stations or looked for CDs or tapes; 

• 49 percent ate or drank; 

• 26 percent took incoming calls on a cell phone and 25 percent made outgoing calls; 

• 24 percent dealt with children in the back seat; 

• 12 percent read a map or directions. 

About one-quarter of the drivers reported that they had been involved in a crash in the previous 

five years in which some vehicle was damaged. About 14 percent attributed their crash to 

distracted driving (Royal, 2003, p. 28). Similarly, about 10 percent of the drivers in a sample of 

crashes involving at least one towed vehicle in 1995-1999 were classified by NHTSA 

investigators as having been distracted (Stutts et al., 2001, p. 3). The true role of distraction in 

crashes probably is higher because pre-crash distractions often leave no evidence for law 

enforcement officers or crash investigators to observe. A recent study that monitored 100 drivers 

for a year, using specialized instrumentation, reported that nearly 80 percent of the 72 recorded 

crashes and 65 percent of the 761 near-crashes involved driver inattention just prior to the 

incident (VTTI, 2005) and that driver distraction contributed to 22 percent of the crashes and 

near-crashes (Klauer et al., 2006, p. x). 
 4 - 2 

In crashes where distractions were reported, the most common distractions were similar in 

NHTSA’s driver survey and crash investigations. 

• 37 percent in survey, 29 percent in crashes: something outside the car, such as a street 

sign or another driver; 

• 19 percent in survey, 11 percent in crashes: other passengers, including children; 

• 16 percent in survey, 21 percent in crashes: objects or controls inside the car; 

• 2 percent in survey, 2 percent in crashes: dialing or using a cell phone. 

None of the leading distractions is easily addressed. Cell phone use falls well down this list. 

Problem size and characteristics: fatigued or drowsy driving. Three recent national telephone 

surveys, two in the United States and one in Canada, provide consistent estimates of the 

prevalence and key characteristics of drowsy driving. Of the 1,456 adult drivers surveyed by the 

National Sleep Foundation (NSF) in fall 2004, 60 percent reported that they had driven while 

feeling drowsy at least once within the past year. Further, 37 percent said they had “nodded off 

or fallen asleep” while driving a vehicle at least once in their life (NSF, 2005, p. 42). Canadian 

responses from 1,209 drivers were similar: 57 percent had driven while tired and 20 percent had 

dozed off (Beirness et al, 2005). In NHTSA’s survey, 11 percent reported that they had nodded 

off while driving during the past year (Royal, 2003, p. 42). Of those who nodded off, 66 percent 

said they had six or fewer hours of sleep the previous night (Royal, 2004, p. 46). The NHTSA 

and Canadian surveys found that drivers under age 30 and male drivers were more likely than 

older drivers and female drivers to have dozed off at the wheel, as did a previous NSF survey 

(Beirness et al., 2005, p. iii; NSF, 2002a, p. 25; Royal, 2003, p. 42) (the 2005 NSF survey did not 

examine driver age and gender). 

The NHTSA and Canadian surveys provide additional useful information about drowsy driving. 

Drivers nodded off throughout the day and night. In each survey, over one-quarter of the most 

recent incidents occurred in the afternoon (noon to 6 p.m.) and over one-quarter between 

midnight and 6 a.m. In both surveys, nearly half of the drivers who nodded off had been driving 

for an hour or less (Royal, 2003, p. 44; Beirness et al, 2005, p. 12). About 0.7 percent of all 

drivers reported that they had been in a crash in the past five years that they attributed to their 

drowsy driving. That’s about one-fifth as many as reported a crash that they attributed to 

distracted driving (Royal, 2003, p. 50). 

It’s often difficult to determine whether drowsy driving contributed to a crash. NHTSA estimated 

that “drowsy driving causes more than 100,000 crashes a year, resulting in 40,000 injuries and 

1,550 deaths,” slightly less than four percent of the 2.6 million traffic injuries and 43,000 

fatalities in 2004 (NHTSA and NCSDR, undated).The recent 100-car study reported that drowsy 

driving contributed to 22 to 24 percent of the crashes and near-crashes (Klauer et al., 2006, p. x). 

Strategies to Reduce Distracted and Fatigued Driving

The obvious way to reduce distracted or drowsy driving crashes is to convince or require drivers 

to get enough sleep and to pay attention to their driving. These are very difficult goals. Drowsy 

driving may result from lifestyles that include insufficient or irregular sleep (shift workers, for 
 4 - 3 

instance) or from medical problems – issues beyond a driver’s immediate control. Many drivers 

consider some distractions, such as eating or drinking, listening to the radio, or talking on a cell 

phone, to be important and common activities and are unlikely to give them up. 

Behavioral strategies to reduce distracted or drowsy driving attempt to remove some of the 

underlying causes or to promote awareness of the risks. The standard behavioral 

countermeasures of laws, enforcement, and sanctions, which are used successfully for alcohol 

impairment, safety belt use, aggressive driving, and speeding, are unlikely to be effective for 

distracted or drowsy drivers. One exception is for young drivers: some graduated driver licensing 

provisions help reduce distractions by limiting the number of passengers or restricting cell phone 

use. 

Distracted or fatigued driving that is related to a driver’s job may be reduced through employer 

policies and programs. Drowsy driving caused by medical conditions such as sleep apnea or by 

drugs or medications may be addressed through policies, communications, and outreach. 

Similarly, communications and outreach may be useful in raising awareness of specific 

distraction or fatigue issues among certain high-risk populations. However, none of these 

strategies has been evaluated. 

This chapter discusses these behavioral strategies. It does not include the environmental, 

vehicular, and regulatory countermeasures mentioned below because SHSOs do not have 

authority or responsibility in these areas. 

Environmental strategies can address both distracted and drowsy driving. Rumble strips, both on 

the shoulder and the centerline, have demonstrated their effectiveness in preventing crashes 

caused by inattention or fatigue. Other roadway improvements, such as wide and visible edge 

lines, more easily visible road signs, and better lighting at night, can help drivers who are not 

fully alert. See NCHRP (2005) for a thorough discussion and for references to other NCHRP 

guides. In the future, IVI (Intelligent Vehicle Initiative) technology also may help drivers remain 

alert or warn them of risky situations (IVI, 2004a, 2004b). 

Vehicular strategies also affect driver distraction and fatigue. In-car televisions, vehicle location 

and route-finding systems, and other new technologies in vehicles may create more potential 

distractions (Hedlund et al., 2006). On the other hand, in-vehicle technology in the future may be 

able to detect driver distraction or fatigue, by monitoring driver performance, and then alert 

drivers. In-vehicle technology also may be able to warn drivers of risky situations. Automobile 

manufacturers and NHTSA are vigorously investigating many possibilities (NHTSA, 2000; ITS, 

2003). 

Driver fatigue is a critical issue for commercial drivers. The Federal Motor Carrier Safety 

Administrtion attempts to control commercial driver fatigue through Hours of Service 

regulations, driver logs and inspections (see for example FMCSA, 2005a). FMCSA has an 

extensive driver fatigue research program focused on commercial drivers (FMCSA, 2005b). As 

with the environmental and vehiclular countermeasures mentioned above, commercial driver 

countermeasures are not discussed in this guide because they do not fall under SHSO 

jurisdiction. 
 4 - 4 

For overviews of distracted driving prevalence, risks, legislation, research, and recommended 

strategies, see NCHRP (2005) and Hedlund et al. (2006). 

Key terms 

• GDL: Graduated Driver Licensing, a three-phase system for beginning drivers consisting 

of a learner’s permit, a provisional license, and a full license. A learner’s permit allows 

driving only while supervised by a fully licensed driver. A provisional license allows 

unsupervised driving under certain restrictions. 

• NCSDR: National Center for Sleep Disorders Research 

• NSF: National Sleep Foundation. 
 4 - 5 

Countermeasures That Work 

Countermeasures to reduce distracted and fatigued driving are listed below and discussed 

individually in this chapter. The table is intended to give a rough estimate of each 

countermeasure’s effectiveness, use, cost, and time required for implementation. The terms used 

are described below. Effectiveness, cost, and time to implement can vary substantially from State 

to State and community to community. Costs for many countermeasures are difficult to measure, 

so the summary terms are very approximate. See each countermeasure discussion for more 

information.

1. Laws and enforcement 

Countermeasure Effectiveness Use Cost Time 

1.1 Cell phone laws Uncertain Low Varies Short 

1.2 GDL requirements for beginning drivers Proven High Low Medium 

1.3 General fatigue and distraction laws Unknown High* Varies Short 

*Included under reckless driving; use of explicit fatigue and distraction laws is low

2. Communications and outreach 

Countermeasure Effectiveness Use Cost Time 

2.1 Fatigued or drowsy driving Unknown Unknown Medium Medium 

2.2 Distracted driving Unknown Unknown Medium Medium 

3. Other countermeasures 

Countermeasure Effectiveness Use Cost Time 

3.1 Employer programs Unknown Unknown Low Short 

3.2 Medical conditions and medications Unknown Unknown Variable Medium 

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results. 

 Likely: balance of evidence from high-quality evaluations. 

 Uncertain: limited and perhaps ambiguous evidence. 

 Unknown: no high-quality evaluation evidence. 

 Varies: different methods of implementing this countermeasure produce different results. 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. 

See individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 

Use: 

 High: more than two-thirds of the States, or a substantial majority of communities. 

 Medium: between one-third and two-thirds of States or communities. 

 Low: fewer than one-third of the States or communities. 

 Unknown: data not available. 
 4 - 6 

Cost to implement: 

 High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources. 

 Medium: requires some additional staff time, equipment, facilities, and/or publicity . 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment or facilities. 

Time to implement: 

 Long: more than one year. 

 Medium: more than three months but less than one year. 

 Short: three months or less. 

These estimates do not include the time required to enact legislation or establish policies. 
 4 - 7 

1.1 Cell phone laws 

Effectiveness: Uncertain Use: Low Cost: Varies Time: Short 

Cell phones have become an essential feature of modern life. In December 2005, about 208 

million Americans had cell phones, an increase of more than 50 million in two years (CITA, 

2006). About two out of every three drivers now have cell phones, and before long almost all of 

them will. In NHTSA’s 2002 national telephone survey, 60 percent of drivers reported that they 

had cell phones and about one-third of all drivers used a cell phone at some time while driving 

(Royal, 2003, p. 20). NHTSA’s 2005 national observation survey found that six percent of 

drivers on the road at any time were using handheld cell phones, up from five percent in 2004, 

four percent in 2002, and three percent in 2000 (Glassbrenner, 2005a, 2005b). Several statewide 

surveys found similar use rates (McCartt et al., 2006). 

While more than 125 research studies have investigated various aspects of cell phone use, they 

do not provide clear answers to critical questions (McCartt et al., 2006). Experiments on 

simulators or test tracks document that cell phone use has some effect on driving performance 

but these experiments cannot measure the impact on crash risk. Most studies find similar effects 

for handheld and hands-free phones. Most crash studies rely on driver’s own reports or on law 

enforcement investigations to estimate whether cell phone use contributed to the crash. A recent 

review of these studies concluded that cell phones were reported to be involved in 1 to 4 percent 

of crashes, an amount consistent with the 2 percent found in NHTSA’s telephone survey and 

crash investigations discussed in the Overview. The best studies concluded that that the risk of a 

crash was about four times higher when using a cell phone, either hands-free or handheld 

(McCartt et al., 2006). 

While cell phone use occurs less frequently than other driver distractions (see Overview), it has 

been singled out for special attention, probably for several reasons. Cell phone use is a multisensory distraction, requiring a driver’s eyes to locate a ringing phone, hands to hold or dial the 

phone, hearing to listen to the call, and attention to carry on a conversation. Handheld cell phone 

use is easy to observe and may send the message that drivers using cell phones are more 

interested in their conversations than they are in driving safely. Several highly publicized crashes 

have been attributed to cell phones. 

In response to these concerns, Connecticut, New Jersey, New York, the District of Columbia, 

and at least 26 communities prohibit handheld cell phone use while driving (GHSA, 2006a; 

IIHS, 2006a; Sundeen, 2005a). Several States prohibit all cell phone use by drivers under the age 

of 18 or 21, drivers with a GDL, and school bus drivers. Other States do not allow communities 

to restrict cell phone use. Between 2000 and 2005 every State considered at least one bill related 

to cell phones and driving, and 24 States passed some cell phone legislation (Sundeen, 2005b). 

No United States jurisdiction restricts hands-free phone use for all drivers. As many as 40 

countries prohibit handheld phone use (Sundeen, 2005a, p. 11). 

Use: Connecticut, New Jersey, New York, the District of Columbia, and at least 26 communities 

prohibit handheld cell phone use while driving (GHSA, 2006a; IIHS, 2006a; Sundeen, 2005a). 
 4 - 8 

Effectiveness: Evaluations in New York, the District of Columbia, Finland, and the United 

Kingdom consistently show that cell phone laws reduced handheld phone use by about 50 

percent shortly after the laws became effective (McCartt et al., 2006). Follow-up observations in 

New York and Finland found that handheld phone use had returned to pre-law levels a year later. 

The New York study noted that publicity regarding the law diminished substantially after the law 

was implemented and no targeted enforcement was conducted. In contrast, handheld cell phone 

use in the District of Columbia remained at half of pre-law levels after a year. 

Costs: As with any law, costs are required to publicize and enforce it. New York’s experience 

suggests that a strong communications campaign and vigorous enforcement may be necessary to 

reduce cell phone use over the long term. A handheld cell phone law can be enforced during 

regular traffic patrol because cell phone use can be observed easily, so that enforcement costs 

should be minimal. Publicity can be expensive. Paid advertising supporting highly visible law 

enforcement may be necessary to achieve substantial effects. Paid advertising can be expensive: 

for example, costs for some belt use enforcement campaigns in 2003 averaged $500,000 per 

State (Chapter 2, Section 2.1; Solomon et al., 2003). 

Time to implement: A cell phone law can be implemented quickly, as soon as it is publicized. 

Other issues: 

• Handheld or hands-free: All current cell phone laws applying to all drivers prohibit 

handheld phones but not hands-free phones. However, current research finds little 

difference in the distracting effects of handheld and hands-free phones (McCartt et al., 

2006).

 
 4 - 9 

1.2 Graduated driver licensing requirements for beginning drivers 

Effectiveness: Proven Use: High Cost: Low Time: Medium 

Graduated driver licensing (GDL) is a three-phase system for beginning drivers consisting of a 

learner’s permit, then a provisional license, and finally a full license. A learner’s permit allows 

driving only while supervised by a fully licensed driver. A provisional license allows 

unsupervised driving under certain restrictions. IIHS and TIRF (2004) describe the key 

provisions of GDL laws and IIHS (2006b) summarizes State GDL laws as of July 2006. See 

Chapter 6, Sections 1.1 to 1.6, for a complete discussion of GDL for beginning young drivers. 

GDL helps beginning drivers acquire their initial driving experience in lower-risk situations. 

During the provisional phase, this is accomplished by restricting driving under certain high-risk 

circumstances. Some of these restrictions are directly linked to fatigue and distractions. Driving 

at night is more dangerous overall than during the day and also may pose greater risks of drowsy 

driving. Passengers, especially teenage passengers, are a major source of distraction. Cell phones 

can distract drivers, as discussed in Chapter 4, Section 1.l. 

Use: As of July 2006, all States and the District of Columbia had some GDL components in 

place. The laws in 44 States and the District of Columbia do not allow driving during certain 

nighttime hours. Laws in 35 States and the District of Columbia limit the number of passengers 

allowed with a driver with a provisional license. Twelve States and the District of Columbia 

prohibit all cell phone use by drivers with a learner’s permit or provisional license or by drivers 

under 18 (GHSA, 2006b, IIHS 2006b). 

Effectiveness: Several studies document that nighttime and passenger GDL restrictions reduce 

teenage driver crashes and injuries (Hedlund and Compton, 2005; IIHS and TIRF, 2004; Lin and 

Fearn, 2003). There are no evaluations of GDL cell phone prohibitions. 

Costs: Publicity for GDL restriction changes can be delivered directly by the Department of 

Motor Vehicles to young drivers as they apply for their learner’s permits and provisional 

licenses, so costs will be minimal. GDL enforcement to date has been low, so costs are also low. 

Time to implement: GDL nighttime, passenger, or cell phone restriction changes require several 

months to implement for drivers receiving a provisional license. They then will take one or two 

years before all provisionally licensed drivers are subject to the new restrictions. 
 4 - 10 

1.3 General driver fatigue and distraction laws 

Effectiveness: Unknown Use: High* Cost: Varies Time: Short 

*included under reckless driving; use of explicit fatigue and distraction laws is low 

 

States implicitly prohibit driving while seriously distracted or fatigued through their reckless 

driving laws (NCHRP, 2005, Strategy C2). In 2003, New Jersey enacted a law under which 

drivers can be prosecuted for vehicular homicide if they have not slept in 24 hours and they 

cause a crash in which someone is killed (NCHRP, 2005, Strategy C2). 

No studies have evaluated whether general reckless driving laws or specific drowsy or distracted 

driving laws have any effect (except for cell phone laws: see Chapter 4, Section 1.1). Based on 

extensive experience in other traffic safety areas, it is likely that these laws will have little or no 

effect unless they are vigorously publicized and enforced. See Chapter 1, Sections 2.1 and 5.5 on 

alcohol-impaired driving, Chapter 2, Sections 2.1, 3.1, and 3.2, on seat belt use laws, and 

Chapter 3, Sections 2.1 and 4.1, on aggressive driving and speeding laws. Enforcement of 

fatigued or distracted driving laws is likely to be especially difficult because fatigue and 

distraction often are difficult to observe, measure, and document. Nevertheless, these laws may 

increase the impact of communications and outreach efforts to reduce fatigued and distracted 

driving discussed in Chapter 4, Sections 2.1 and 2.2 (see also NCHRP, 2005, Strategy C2). 

Use: New Jersey is the only State with a law explicitly addressing fatigued driving or 

distractions other than cell phones (Chapter 4, Section 1.1). Other States include these conditions 

under their laws regarding reckless driving or similar offenses. 

 

Effectiveness: The effects of any laws on reducing drowsy or distracted driving are unknown. 

Costs: Costs are required for publicity and enforcement. Enforcement costs likely will be 

minimal, as most enforcement likely will be included under regular traffic patrols or combined 

with enforcement activities directed primarily at other offenses such as alcohol-impaired or 

aggressive driving. 

Time to implement: A new fatigued or distracted driving law can be implemented quickly, as 

soon as it is publicized and law enforcement patrol officers are trained. 
 4 - 11 

2.1 Communications and outreach on fatigued driving 

Effectiveness: Unknown Use: Unknown Cost: Medium Time: Medium 

Fatigued or drowsy driving occurs because drivers don’t get enough sleep. This apparently 

obvious statement is well-documented. In NHTSA’s telephone survey, 66 percent of the drivers 

who reported they had nodded off while driving had six or fewer hours of sleep the previous 

night (Royal, 2003, p. 46). Stutts et al. (1999) interviewed 467 crash-involved drowsy drivers 

(reported as “fatigued” or “asleep” by the investigating officer) and 529 other crash-involved 

drivers who were not drowsy. Half of the drowsy drivers had six or fewer hours of sleep the 

previous night compared to fewer than 10 percent of the other drivers. 

States and national organizations such as the National Sleep Foundation have conducted drowsy 

driving communications and outreach campaigns directed to the general public (NCHRP, 2005, 

Strategy C1; NSF, 2004a). Campaign goals usually include: 

• raising awareness of the dangers of drowsy driving; 

• motivating drivers to take action to reduce drowsy driving; and 

• providing information on what drivers can do, either before they start out on a trip or if 

they become drowsy while driving. 

NHTSA and NCSDR (NHTSA, 1997, p. viii) identified three groups that are over-involved in 

drowsy driving crashes: drivers in their teens and 20s, shift workers, and people suffering from 

sleep apnea or narcolepsy. The joint NHTSA-NCSDR Report to Congress on drowsy driving 

recommended that communications and outreach on drowsy driving be directed to these groups, 

especially to young drivers (NHTSA, 1999). This information can be delivered in several ways. 

Driver education programs can include information on both drowsy and distracted driving, and 

the new model curriculum developed by NHTSA and the American Driver and Traffic Safety 

Education Association (ADTSEA) includes both. See Chapter 4, Sections 3.1 and 3.2, for 

additional discussion of shift workers and medical conditions, respectively. 

Communications and outreach campaigns can be delivered in high schools, colleges, military 

training programs and bases, and other locations where there are many young drivers. NCHRP 

(2005, Strategy D2) provides examples. Many young drivers have part-time jobs, which place 

them at even higher risk for drowsy driving. See Chapter 4, Section 3.1, for discussion. Finally, 

information can be delivered through Web sites and other media with a youthful target audience. 

The ultimate goal of drowsy driving communications and outreach is to change driver behavior, 

but they face substantial obstacles. As discussed in other chapters, communications and outreach 

by themselves rarely change driving behavior (Chapter 1, Section 5.5; Chapter 2, Section 3.2; 

Chapter 3, Section 4.1; see also NCHRP, 2005, Strategy C1). To have any chance of success, 

stand-alone campaigns must have careful planning, good target audience identification and 

research, good message development and placement, and substantial funding. 

An additional barrier is that drowsy driving is a byproduct of busy lifestyles that do not include 

enough sleep. The only truly effective method to prevent drowsy driving crashes is to get enough 

sleep (Nguen et al., 1998; NHTSA, 1997). Traffic safety messages urging enough sleep may be 
 4 - 12 

overwhelmed by the other demands on a driver’s time that are responsible for insufficient sleep. 

Focus group discussions with young men and shift workers, two groups at high risk of drowsy 

driving, confirmed this conclusion (Nelson et al., 2001). Most shift workers and many young 

men understood well the risks caused by lack of sleep. Many had crashed or almost crashed after 

falling asleep at the wheel or had friends who had crashed. But neither their knowledge nor their 

crash experience changed their sleep habits. They sacrificed sleep for the demands of their work, 

families, and social lives. Campaigns directed to young drivers also must overcome the higher 

risk-taking behavior and overall immaturity of young drivers discussed in Chapter 6. No drowsy 

driving communications and outreach program for the general public has been evaluated 

(NCHRP, 2005, Strategies C1 and D2). 

 

Use: Utah is the only State known to have conducted a drowsy driving campaign for the general 

public (see NCHRP, 2005, Strategy C1). NCHRP (2005, Strategy D2) gives examples of college 

programs. 

Effectiveness: There are no studies of any campaign’s effects on driver knowledge, attitudes, or 

behavior (NCHRP, 2005, Strategies C1 and D2). 

 

Costs: A high-quality campaign will be expensive to develop, test, and implement. 

Time to implement: A high-quality campaign will require at least six months to plan, produce, 

and distribute. 
 4 - 13 

2.2 Communications and outreach on distracted driving 

Effectiveness: Unknown Use: Unknown Cost: Medium Time: Medium 

Distracted driving communications and outreach campaigns for the general public face different, 

but equally difficult, obstacles than drowsy driving campaigns. All drivers “know” at some level 

that they should be alert. However, as discussed in the Overview, distractions come in many 

forms. Distractions outside the car are not under the driver’s control. Many distractions inside the 

car also cannot be controlled easily (conversations, children), or are intentional (listening to the 

radio or CD player, eating). They may in fact be useful, to keep drivers alert on a long trip. 

States (including California and New York) and national organizations (AAA Foundation for 

Traffic Safety) have conducted or provided material for distracted driving communications and 

outreach campaigns directed to the general public (AAAFTS, 2004; NCHRP, 2005, Strategy 

C1). Some carry a general “pay attention” message while others are directed at specific 

behaviors such as cell phone use. 

 

Drivers in their teens and early 20s are often distracted while driving (Ferguson, 2003; NCHRP, 

2005, Strategy D2). GDL passenger and cell phone restrictions directly address two sources of 

distractions, as discussed in Chapter 4, Section 1.2. Broader communications and outreach 

efforts for young drivers regarding distracted driving also have been proposed. They can be 

combined with or complementary to information on drowsy driving and can be delivered in the 

same ways. See Chapter 4, Section 2.1, and NCHRP (2005, Strategy D2) for discussion. 

The ultimate goal of these campaigns is to change driver behavior, but they face substantial 

obstacles. As discussed in other chapters, communications and outreach by themselves rarely 

change driving behavior (Chapter 1, Section 5.5; Chapter 2, Section 3.2; Chapter 3, Section 4.1; 

see also NCHRP, 2005, Strategy C1). To have any chance, stand-alone campaigns must have 

careful planning, good target audience identification and research, good message development 

and placement, and substantial funding. A broad “stay alert” message may be too general to have 

any impact. Specific distractions are not linked as clearly to crashes as is falling asleep at the 

wheel because they are not recorded consistently in State crash data files. 

Use: California and New York are known to have conducted driver alertness campaigns for the 

general public (see NCHRP, 2005, Strategy C1). NCHRP (2005, Strategy D2) cites a Cingular 

Wireless educational program aimed at young drivers on the problem of distractions. 

Effectiveness: There are no studies of any campaign’s effects on driver knowledge, attitudes, or 

behavior (NCHRP, 2005, Strategies C1 and D2). 

 

Costs: A high-quality campaign will be expensive to develop, test and implement. 

Time to implement: A high-quality campaign will require at least six months to plan, produce 

and distribute. 
 4 - 14 

3.1 Employer programs 

Effectiveness: Unknown Use: Unknown Cost: Low Time: Short 

Driver fatigue and distractions are critical issues for commercial drivers. As discussed in the 

Overview, commercial driver countermeasures, including employer policies and programs to 

reduce commercial driver fatigue, are not discussed in this guide because they do not fall under 

SHSO jurisdiction. 

Shift workers are another employment group at high risk for drowsy-driving crashes. Young 

male drivers with part-time jobs are at especially high risk, as they satisfy two of the three highrisk conditions identified by NHTSA and NCSDR (NHTSA, 1999, p. iii): shift workers; young 

drivers, especially males; and drivers with the medical conditions of sleep apnea or narcolepsy. 

“Shift workers” include people who work long or irregular hours or who work at night, including 

many law enforcement officers (NCHRP, 2005, Strategy D6). 

A recent study documents the dangers for medical interns, who frequently work extended shifts 

of 24 hours or more. Barger et al. (2005) collected monthly reports from 2,737 interns. Interns 

were 2.3 times more likely to report a crash and 5.9 times more likely to report a near miss after 

an extended shift than a shorter shift. Each extended shift in a month increased the monthly risk 

of a crash during the commute from work by 16 percent. 

NHTSA and NCSDR have produced a comprehensive workplace education program for shift 

workers. It includes information on sleep habits in general and drowsy driving in particular. 

Program material includes a video, posters, brochures for workers and their families, tip cards, a 

PowerPoint training session, and an administrator’s guide (NHTSA and NCSDR, undated). 

Focus-group discussions with shift workers highlight the difficulties faced by employer 

programs (Nelson et al., 2001). Most shift workers understood well the risks caused by lack of 

sleep. Many had crashed or almost crashed after falling asleep at the wheel or had friends who 

had crashed. But neither their knowledge nor their crash experience changed their sleep habits. 

They sacrificed sleep for the demands of their work, families, and social lives. 

Use: The number of employers who use the NHTSA/NCSDR program, or any drowsy driving 

prevention material or program, is not known. 

Effectiveness: The NHTSA/NCSDR program was tested by more than 20 U.S. companies and 

was well received by workers and management. It has not been evaluated further (NCHRP, 

2005, Strategy D3). Gander et al. (2005) evaluated the effects of a two-hour fatigue management 

training class given to a group of commercial light vehicle drivers and a group of petroleum 

tanker drivers. For both groups, the class substantially increased the drivers’ knowledge of 

fatigue management and the knowledge gains were retained after several months. About half the 

drivers in each group implemented some fatigue management strategies at home, on the job, or 

in both places. No other employer drowsy driving program has been evaluated. 

Costs: Since a comprehensive program is available at no cost, program costs will consist only of 

material production and employer time for training. 
 4 - 15 

Time to implement: An employer program can be implemented within three months. 
 4 - 16 

3.2 Medical conditions and medications 

Effectiveness: Unknown Use: Unknown Cost: Variable Time: Medium 

Two medical conditions can cause drivers to fall asleep at the wheel (NCHRP, 2005, Strategy 

D6; NHTSA, 1997). 

• Sleep apnea is a breathing disorder characterized by brief interruptions of breathing 

during sleep, perhaps as many as 20 to 60 per hour (NSF, 2002b). By fragmenting 

nighttime sleep, sleep apnea produces daytime sleepiness. NSF estimates that about 4 

percent of men and 2 percent of women are affected by sleep apnea. It can be treated by 

physical or mechanical therapy or by surgery. 

• Narcolepsy is a disorder of the central nervous system’s sleep-wake mechanism that can 

cause narcoleptics to fall asleep suddenly at any time (NSF, 2004b). It is quite rare, 

affecting about one person in 2,000. It can be treated with medications. 

The number of crashes resulting from sleep apnea or narcolepsy is not known. 

Most cases of sleep apnea or narcolepsy are undiagnosed and untreated (NCHRP, 2005, Strategy 

D6; NHTSA, 1997). Indeed, falling asleep at the wheel may be one of the main ways to raise the 

possibility of a sleep disorder and motivate a driver to seek medical attention (NHTSA, 1997). 

Even without treatment, drivers who are aware that they have one of these disorders can take 

precautions to avoid falling asleep at the wheel. 

Many common prescription and over-the-counter medications can cause drowsiness. Warning 

labels on the medications note this and caution users against driving or other activities that could 

be affected by drowsiness. As with sleep apnea and narcolepsy, the number of crashes resulting 

from or affected by drowsiness produced by medications is unknown. 

The principal countermeasures to address sleep apnea, narcolepsy, and medication effects are 

(NCHRP, 2005, Strategy D6): 

1. Communications and outreach on sleep disorders to increase overall awareness of their 

symptoms, consequences, and treatment. 

2. Efforts with driver licensing medical advisory boards to increase their awareness of these 

conditions as they review driver fitness for licensing. 

3. Efforts with physicians to increase their awareness of these conditions and their potential 

effects on driving, to treat these conditions as appropriate, and to counsel their patients to 

take steps to reduce the risk of drowsy driving. 

Use and Effectiveness: There is no information available on how frequently these 

countermeasures are used or on how effective they have been in raising awareness, increasing 

knowledge, or affecting behavior (NCHRP, 2005, Strategy D6). 

Costs: Targeted communications and outreach to drivers (through driver licensing handbooks or 

flyers in license renewal material) or to physicians (through medical associations) would be 

relatively inexpensive. A communications and outreach campaign directed at all drivers will be 

expensive to develop, test and implement. See Chapter 1, Section 5.5 and Chapter 2, Sections 2.1 

and 3.1, for additional discussion. 
 4 - 17 

Time to implement: Either targeted or general communications and outreach activities will 

require at least six months to plan, produce, and distribute. Efforts with driver licensing medical 

advisory boards could be implemented quickly. 
 4 - 18 

Distracted and Fatigued Driving References 

AAAFTS (2004). Pay Attention! Washington, DC: AAA Foundation for Traffic Safety. 

www.aaafoundation.org/products/index.cfm?button=item-detail&ID=962&storeid=1 

Barger, L.K., Cade, B.E., Ayas, N.T., Cronin, J.W., Rosner, B., Speizer, F.E., and Czeisler, C.A. 

(2005). Extended work shifts and the risk of motor vehicle crashes among interns. New England 

Journal of Medicine 352, pp. 125-134. www.nejm.org 

Beirness, D.J., Simpson, H.M., and Desmond, K. (2005). The Road Safety Monitor 2004: 

Drowsy Driving. Ottawa, ON: Traffic Injury Research Foundation. 

trafficinjuryresearch.com/whatNew/newsItemPDFs/RSM_Drowsy_Driving_2004.pdf 

CTIA (2006). CTIA’s semi-annual wireless industry survey results, June 1985-December 2005. 

Washington, DC: Cellular Telecommunications and Internet Association. 

www.ctia.org/research_statistics/index.cfm/AID/10030 

Ferguson, S.A. (2003). Other high-risk factors for young drivers - how graduated licensing does, 

doesn’t, or could address them. Journal of Safety Research 34(1), pp. 71-77. 

www.nsc.org/gdlsym/index.htm 

FMCSA (2005a). Hours-of-Service Regulations – Effective October 1, 2005. Washington, DC: 

Federal Motor Carrier Safety Administration. www.fmcsa.dot.gov/rulesregulations/topics/hos/hos-2005.htm 

FMCSA (2005b). 5-Year Strategic Plan, FY2005-FY2009. Washington, DC: Federal Motor 

Carrier Safety Administration. www.fmcsa.dot.gov/facts-research/research-technology/report/rt5year-strategicplan.htm#drivera 

Gander, P.H., Marshall, N.S., Bolger, W., and Girling, I. (2005). An evaluation of driver training 

as a fatigue countermeasure. Transportation Research Part F: Traffic Psychology and Behavior

8, pp. 47-58. 

GHSA (2006a). Cell Phone Restrictions - State and Local Jurisdictions. Washington, DC: 

Governors Highway Safety Association. 

www.statehighwaysafety.org/html/stateinfo/laws/cellphone_laws.html 

GHSA (2006b). Graduated Licensing Laws. Washington, DC: Governors Highway Safety 

Association. 

www.statehighwaysafety.org/html/stateinfo/laws/license_laws.html 

Glassbrenner, D. (2005a). Driver cell phone use in 2004: Overall results. DOT HS 809 847. 

Washington, DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809-847/images/ResNoteCellPhoneUse.pdf 
 4 - 19 

Glassbrenner, D. (2005b). Driver cell phone use in 2005: Overall results. DOT HS 809 967. 

Washington, DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809967.pdf 

Hedlund, J. and Compton, R. (2005). Graduated driver licensing research in 2004 and 2005. 

Journal of Safety Research 36, pp. 109-119. 

Hedlund, J.H., Simpson, H.M., and Mayhew, D.R. (2006). International Conference on 

Distracted Driving: Summary of Proceedings and Recommendations. Ottawa, ON: Canadian 

Automobile Association and Traffic Injury Research Foundation. www.distracteddriving.ca/ 

IIHS (2006a). Cell Phone Laws. Arlington, VA: Insurance Institute for Highway Safety. 

www.iihs.org/laws/state_laws/cell_phones.html 

IIHS (2006b). U.S. Licensing Systems for Young Drivers: Laws as of July 2006. Arlington, VA: 

Insurance Institute for Highway Safety. 

www.iihs.org/laws/state_laws/pdf/us_licensing_systems.pdf 

IIHS and TIRF (2004). Graduated Licensing: A Blueprint for North America. Arlington, VA: 

Insurance Institute for Highway Safety. www.iihs.org/laws/state_laws/pdf/blueprint.pdf 

IVI (2004a). IVI Human Factor Reports: Driver Condition Warning Links. Washington, DC: 

U.S. Department of Transportation. 

www.its.dot.gov/ivi/ivihf/reportsdcwlinks.html 

IVI (2004b). IVI Human Factor Reports: Driver Distraction and Workload. Washington, DC: 

U.S. Department of Transportation. www.its.dot.gov/ivi/ivihf/REPORTSddw.html 

Klauer, S.G., Dingus, T.A., Neale, V.L., Sudweeks, J.D., and Ramsey, D.J. (2006). The Impact 

of Driver Inattention On Near-Crash/Crash Risk: An Analysis Using the 100-Car Naturalistic 

Driving Study Data. DOT HS 810 594. Washington, DC:National Highway Traffic Safety 

Administration, 2006. www-nrd.nhtsa.dot.gov/departments/nrd-13/driverdistraction/PDF/DriverInattention.pdf 

Lin, M-L., and Fearn, K.T. (2003). The provisional license: nighttime and passenger restrictions 

- a literature review. Journal of Safety Research 34, pp. 51-61. www.nsc.org/gdlsym/index.htm 

McCartt, A.T., Hellinga, L.A., and Braitman, K.A. (2006). Cell phones and driving: review of 

research. Traffic Injury Prevention 7, pp. 89-106. 

NCHRP Report 500, Vol. 14 (2005). A Guide for Addressing Collisions Involving Distracted or 

Fatigued Drivers. Washington, DC: Transportation Research Board. 

trb.org/news/blurb_detail.asp?id=5468 

Nelson, T.F., Isaac, N.E., and Graham, J.D. (2001). Development and Testing of 

Countermeasures for Fatigue Related Highway Crashes. Washington, DC: National Highway 
 4 - 20 

Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/drowsy_driving1/listening/title.htm#title 

Nguen, L.T., Jauregui, B., and Dinges, D.F. (1998). Changing Behaviors to Prevent Drowsy 

Driving and Promote Traffic Safety: Review of Proven, Promising, and Unproven Techniques.

Washington, DC: AAA Foundation for Traffic Safety. 

www.aaafoundation.org/pdf/drowsydriving.pdf 

NHTSA (1997). Drowsy Driving and Automobile Crashes. Washington, DC: National Highway 

Traffic Safety Administration. www.sleepfoundation.org/ddsummit/CrashesNHTSAReport.PDF 

NHTSA (1999). The NHTSA and NCSDR Program to Combat Drowsy Driving. Washington, 

DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/drowsy_driving1/drowsy2/drws-cov.htm 

NHTSA (2000). NHTSA’s Drowsy Driver Technology Program. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/departments/nrd01/summaries/ITS_11.html 

NHTSA and NCSDR (undated). Wake Up and Get Some Sleep Program. Washington, DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/drowsy_driving1/human/drows_driving/index.html 

NSF (2002a). 2002 “Sleep in America” Poll. Washington, DC: National Sleep Foundation. 

www.sleepfoundation.org/_content/hottopics/2002SleepInAmericaPoll.pdf 

NSF (2002b). Sleep Apnea. Washington, DC: National Sleep Foundation. 

www.sleepfoundation.org/publications/sleepap.cfm 

NSF (2004a). Drive Alert - Arrive Alive National Campaign. Washington, DC: National Sleep 

Foundation. www.sleepfoundation.org/activities/daaamain.cfm 

NSF (2004b). Living with Narcolepsy. Washington, DC: National Sleep Foundation. 

www.sleepfoundation.org/publications/livingnarcolepsy.cfm 

NSF (2005). 2005 “Sleep in America” Poll. Washington, DC: National Sleep Foundation. 

www.sleepfoundation.org/_content/hottopics/2005_summary_of_findings.pdf 

Royal, D. (2003). National Survey of Distracted and Drowsy Driving Attitudes and Behavior: 

2002 Volume I: Findings. DOT HS 809 566. Washington, DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/drowsy_driving1/surveydistractive03/index.htm 

Solomon, M.G., Chaudhary, N.K., and Cosgrove, L.A. (2003). May 2003 Click It or Ticket 

Safety Belt Mobilization Evaluation Final Report. Washington, DC: National Highway Traffic 
 4 - 21 

Safety Administration. www.nhtsa.dot.gov/people/injury/airbags/clickit_ticke03/ciotreport04/CIOT%20May%202003/index.htm 

Stutts, J.C., Reinfurt, D.W., Staplin, L., and Rodgman, E.A. (2001). The Role of Driver 

Distraction in Traffic Crashes. Washington, DC: AAA Foundation for Traffic Safety. 

www.aaafoundation.org/pdf/distraction.pdf 

Stutts, J.C., Wilkins, J.W., and Vaughn, B.V. (1999). “Why Do People Have Drowsy Driving 

Crashes? Input from Drivers Who Just Did. Washington, DC: AAA Foundation for Traffic 

Safety. www.aaafoundation.org/pdf/Sleep.pdf 

Sundeen, M. (2005a). Cell Phones and Highway Safety. 2005 Legislative Update. Denver, CO: 

National Conference of State Legislatures. 

www.ncsl.org/print/transportation/cellphoneup805.pdf 

Sundeen, M. (2005b). Distracted Driving Legislation. Presentation at International Conference 

on Distracted Driving. Ottawa, ON: Canadian Automobile Association and Traffic Injury 

Research Foundation. www.distracteddriving.ca/ 

VTTI (2005). 100-Car Naturalistic Driving Study Tracks Drivers for a Year. Press release. 

Blacksburg, VA: Virginia Tech Transportation Institute. www.vtti.vt.edu/documents/100-

Car%20Naturalistic%20Driving%20Study%20Press%20Release.pdf 
 5 - 1 

5. Motorcycle Safety

Overview 

A two-wheeled motorcycle is inherently more difficult to operate and more unstable than a fourwheeled passenger vehicle. A motorcycle offers riders almost no protection in a crash. Crash 

data confirm these observations. NHTSA estimates that 80 percent of motorcycle crashes injure 

or kill a motorcycle rider, while only 20 percent of passenger car crashes injure or kill an 

occupant (NHTSA, 2003, p. 3). For each mile of travel in 2004, motorcycle riders were seven 

times more likely to be injured in a crash and 33 times more likely to die than passenger car 

occupants (NHTSA, 2005, Tables 7 and 10). NHTSA’s 2005 motorcycle rider fatalities 

increased for the eighth consecutive year, to 4,553, and now account for 10 percent of all traffic 

fatalities. The 87,000 motorcycle rider injuries were 3 percent of all traffic crash injuries 

(NHTSA, 2005, Table 4). 

Trends. Motorcycling has become increasingly popular over the last 30 years, but only 

somewhat less dangerous. Motorcycle mileage increased 78 percent from 1975 to 2004, 

compared to 58 percent for passenger cars (NHTSA, 2005, Tables 7 and 10). During this period, 

the motorcycle rider fatality rate per mile of travel decreased by 30 percent, while the passenger 

car occupant fatality rate decreased by 53 percent. Motorcycle safety has not kept pace with 

passenger car safety. 

 

Source: NHTSA 

Trends over the last seven years are especially discouraging. From 1997 to 2004, the number of 

registered motorcycles increased by 51 percent while motorcycle travel mileage was unchanged. 

Thus, average annual mileage per motorcycle dropped by 34 percent, from 2,635 to 1,738. From 

1997 to 2005, motorcycle rider fatalities increased by 115 percent and injuries increased by 64 

percent. Motorcycle rider fatalities in 2005 reached a level not seen since 1986 (NHTSA, 2005, 

Motorcycle rider fatalities and travel

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05

Year

Fatalities

Fatalities per 10 billion VMT
 5 - 2 

Table 10). The 2005 motorcycle rider fatalities increased 13 percent over 2004. Motorcycle rider 

fatalities have more than doubled since 1997 (NHTSA, 2006a, slide 12). 

Motorcycling today is not a young person’s activity. In 2005, 58 percent of the motorcycle 

operators involved in a fatal crash were age 35 or older and 36 percent were 45 or older 

(NHTSA, 2006, Table 91). The change in only six years is striking: in 1997, only 46 percent 

were 35 or older and 22 percent were 45 or older (NHTSA 1998, Table 91). 

Strategies to Increase Motorcycle Safety

Motorcycle operators should be properly trained and licensed. They should be alert and aware of 

the risks they face while riding; in particular, they should not be impaired by alcohol. All 

motorcycle riders should wear a motorcycle helmet that meets FMVSS 218 and clothing that 

provides both protection and visibility. These and other strategies are discussed in the National 

Agenda for Motorcycle Safety, NAMS (NHTSA, 2000a), a comprehensive, collaborative, and 

multidisciplinary blueprint for motorcycle safety. See also the NAMS Implementation Guide 

(Hedlund, under review), and NHTSA’s motorcycle program guideline (NHTSA, undated). This 

guideline will be updated in 2006 (NHTSA, 2006b, p. 13). 

Unfortunately, many motorcyclists do not take these straightforward precautionary measures. In 

2004, almost one-quarter of the motorcycle operators involved in a fatal crash did not have a 

valid motorcycle operator’s license (NHTSA, 2005, Table 91). More than one-third of the 

motorcycle operators killed in a crash had been drinking (NHTSA, 2005, Table 80). Almost half 

of the motorcycle rider fatalities were not wearing a helmet (NHTSA, 2005, Table 90). 

The most important objectives for improving motorcycle safety are to increase helmet use, 

reduce alcohol impairment, and increase proper licensing and training. These all are difficult to 

accomplish. State helmet use laws are extremely effective in assuring virtually universal helmet 

use, but they also are politically difficult to enact and retain. Strategies using only 

communications and outreach to promote helmet use, reduce impaired motorcycling, and 

increase licensing and training appear to have been no more successful with motorcyclists than 

with other drivers. A fourth objective is to increase other drivers’ awareness of motorcyclists by 

increasing the visibility of motorcyclists and by educating other drivers on the importance of 

sharing the road with motorcycles. 

Many environmental measures can affect motorcycle safety. Slippery roadway surfaces and 

markings, surface irregularities, unpaved shoulders, and unforgiving roadway barriers all can be 

dangerous. These issues are not included in this guide because SHSOs have little or no authority 

or responsibility for them. See NCHRP (under review) for a thorough discussion. Daytime 

running lights for motorcycles, in the form of headlights that are always lighted, improve 

motorcycle conspicuity. Most motorcycles on the road have headlights that turn on automatically 

when the engines are started (NCHRP, under review, Strategy D2). In addition, 24 States require 

daytime headlight use for all motorcycles manufactured since 1980 (MSF, 2004). Modulating 

headlights, which cause the headlight to move from high- to low beam rapidly, also increase 

visibility but are not legal in many States. 
 5 - 3 

Key terms 

• Motorcycle operator, motorcyclist: a person operating or driving a motorcycle. 

• Passenger: a person riding on but not operating a motorcycle. 

• Motorcycle rider: any person on a motorcycle, both operators and passengers. 

• AAMVA: American Association of Motor Vehicle Administrators 

• AMA: American Motorcyclist Association. 

• BAC: Blood alcohol concentration in the body, expressed as grams of alcohol per deciliter 

of blood, and usually measured with a breath or blood test. 

• FMVSS 218: the Federal Motor Vehicle Safety Standard that sets performance 

requirements for motorcycle helmets. 

• MSF: Motorcycle Safety Foundation. 

• NAMS: the National Agenda for Motorcycle Safety (NHTSA, 2000a). 

• SMSA: National Association of State Motorcycle Safety Administrators. 
 5 - 4 

Countermeasures That Work 

Countermeasures to improve motorcycle safety are listed below and discussed individually in 

this chapter. The table is intended to give a rough estimate of each countermeasure’s 

effectiveness, use, cost, and time required for implementation. The terms used are described 

below. Effectiveness, cost, and time to implement can vary substantially from State to State and 

community to community. Costs for many countermeasures are difficult to measure, so the 

summary terms are very approximate. See each countermeasure discussion for more information. 

1. Motorcycle operator licensing and training 

Countermeasure Effectiveness Use Cost Time 

1.1 Operator education and training Uncertain High Medium Varies 

1.2 Operator licensing Uncertain High Low Medium 

2. Motorcycle helmets 

Countermeasure Effectiveness Use Cost Time 

2.1 State motorcycle helmet use laws Proven Medium Low Short 

2.2 Helmet law enforcement; noncompliant 

helmets 

Unknown Unknown Low Medium 

2.3 Helmet use promotion programs Unknown Low Varies Medium 

3. Alcohol impairment 

Countermeasure Effectiveness Use Cost Time 

3.1 Alcohol impairment: detection, sanction Unknown Unknown Varies Varies 

3.2 Alcohol impairment: communications Unknown Medium Medium Medium 

4. Communications and outreach 

Countermeasure Effectiveness Use Cost Time 

4.1 Protective and conspicuous clothing Unknown Unknown Varies Medium 

4.2 Other driver awareness of motorcyclists Unknown Unknown Varies Medium 

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results. 

 Likely: balance of evidence from high-quality evaluations or other sources. 

 Uncertain: limited and perhaps ambiguous evidence. 

 Unknown: no high-quality evaluation evidence. 

 Varies: different methods of implementing this countermeasure produce different results 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. See 

individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 

Use: 

 High: more than two-thirds of the States, or a substantial majority of communities. 

 Medium: between one-third and two-thirds of States or communities. 
 5 - 5 

 Low: fewer than one-third of the States or communities. 

 Unknown: data not available. 

Cost to implement: 

 High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources. 

 Medium: requires some additional staff time, equipment, facilities, and/or publicity. 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment or facilities. 

These estimates do not include the costs of enacting legislation or establishing policies. 

Time to implement: 

 Long: more than one year. 

 Medium: more than three months but less than one year. 

 Short: three months or less. 

These estimates do not include the time required to enact legislation or establish policies. 
 5 - 6 

1.1 Operator Education and Training 

Effectiveness: Uncertain Use: High Cost: Medium Time: Varies 

Motorcycle operator education and training has been thoroughly integrated into all aspects of 

motorcycle safety. The National Agenda for Motorcycle Safety calls it “the centerpiece of a 

comprehensive motorcycle safety program” (NHTSA, 2000a, Rider Education and Training). 

NHTSA’s motorcycle safety program guideline states that “safe motorcycle operation requires 

specialized training by qualified instructors” and recommends that States conduct education and 

training (NHTSA, undated). Education and training enjoy broad support from the motorcycle 

industry, motorcycle user organizations, and motorcyclists (NCHRP, under review, Strategy C1). 

Forty-seven States have State-operated and legislated education and training programs and the 

other three have privately operated programs (Baer, Cook, and Baldi, 2005, p. 5). Training also 

is provided by some rider organizations (for example, some ABATE and Gold Wing groups), 

manufacturers (Harley-Davidson’s Riders Edge), and private providers. Many States encourage 

training either by requiring it for all motorcycle operators under a specified age or by waiving 

some licensing or testing requirements for motorcycle operators who complete an approved 

training course (Baer, Cook, and Baldi, 2005, p. 22). Effective in July 2008, Florida will require 

training for all first-time applicants for a motorcycle operators license, regardless of age (Florida 

SB 1742, §322.12). Most training uses one of the curricula developed by MSF: BRC (Basic

RiderCourse, introduced in 2001 to replace the RSS – Riding and Street Skills – course), and the 

ERC Suite (Experienced RiderCourse Suite). Oregon developed its own basic rider course (BRT) 

and also offers its own intermediate and advanced rider courses. 

However, it is not at all clear what constitutes good operator education and training, nor whether 

current training reduces crashes. As to content, the National Agenda concluded that “it is 

assumed, yet unknown, that the current [operator education and training] programs are teaching 

necessary skills to survive in traffic” (NHTSA, 2000a, Rider Education and Training). It 

recommended that a “uniform, educationally sound” curriculum be adopted. NHTSA (2003, p. 

13) reported wide differences in training program content and administration from State to State. 

Baer, Cook, and Baldi (2005, p. 17) summarize the curricula offered in each State. 

Training effectiveness is equally uncertain. Mayhew and Simpson (1996, pp. 29-36) reviewed all 

available high-quality studies of motorcycle operator education and training programs. Only one 

of six studies in the United States showed any positive results, and only for the first six months 

following training. They concluded that the studies to date “have failed to provide definitive 

conclusions about the effectiveness of rider education and training in reducing crashes.” They 

also summarized four studies from Canada and one from the United Kingdom that add further 

support to this conclusion. No major motorcycle training evaluations have been conducted in the 

past ten years. A study of the effectiveness of motorcycle operator education and training in 

developing crash avoidance skills, sponsored by NHTSA and MSF, is being conducted in 2006. 

Training also may not be easily available to many beginning motorcycle operators. The National 

Agenda (NHTSA, 2000a, Rider Education and Training) estimated that no more than half of 

those who wanted training received it. Both NHTSA (2003, p. 13) and NCHRP (under review, 

Strategy C1) reported that waiting times of 3 to 12 months were not unusual. Some States 
 5 - 7 

increased their training offerings in recent years to accommodate their demand, but MSF reports 

that the waiting time in other States still can be months. 

Baer, Cook, and Baldi (2005) summarized each State’s motorcycle education and licensing 

programs and practices. A companion report (Baer, Baldi, and Cook, 2005) describes effective 

training and licensing programs and actions to promote training and licensing. 

States should do their best to provide motorcycle training on a timely basis to all who wish to 

take it. See Baer, Baldi, and Cook (2005) and Hedlund (in review) for examples of successful 

methods to use training capacity more effectively, including creative scheduling, centralized online registration systems, and use of private providers. 

NHTSA and motorcycle organizations assist States in several ways. SMSA provides software to 

its members to help states predict training demand and capacity (www.smsa.org). NHTSA and 

SMSA are creating professional development workshops to assist States in improving their 

operator training programs and to increase capacity to meet student demands and reduce 

backlogs. NHTSA will award demonstration grants to States to promote the implementation of 

successful practices in administering operator training programs. Starting in 2006, NHTSA will 

award Section 2010 grants to States to support operator training (NHTSA, 2006b, p. 12 and 18). 

Use: 47 States have State-operated motorcycle operator education and training programs and the 

other three have privately-operated programs. The District of Columbia does not offer operator 

education and training. 

Effectiveness: As discussed above, the effectiveness of current operator training programs in 

reducing crashes is unknown. Student evaluations regularly report that training was valuable. 

Some students retake the courses as a refresher (Baer, Baldi, and Cook, 2005, p. 37). 

Costs: Operator training programs are funded in part by the States and in part by fees paid by the 

students who take them. State costs per student in 2001 ranged from less than $35 to more than 

$200 and averaged $106.98. Student fees ranged from zero to more than $200 and averaged 

$106.16 (Baer, Cook, and Baldi, 2005, pp. 14-15). Many States offset some or all of their costs 

through motorcycle license or registration fees. 

Time to implement: Operator training currently is conducted in all States. Training capacity is 

limited by the number of available training sites (a broad expanse of paved surface is required), 

qualified instructors, and motorcycles for students to use during training. Some measures to 

increase capacity can be implemented quickly while others may take 6 to 12 months. 

Other issues: 

• Training for experienced motorcyclists: MSF and the States offer training courses for 

experienced motorcyclists (www.msf-usa.org/sitemap.cfm). The courses have not been 

evaluated. 

• Training for other motorcycle configurations (three-wheeled motorcycles and 

motorcycles pulling trailers): Several motorcycle organizations offer courses addressing 

these special motorcycle configurations. The courses have not been evaluated. 
 5 - 8 

1.2 Operator Licensing 

Effectiveness: Uncertain Use: High Cost: Low Time: Medium 

All 50 States and the District of Columbia require motorcyclists to obtain a motorcycle operator 

license or endorsement before they ride on public highways. The goal of licensing is to assure 

that motorcyclists have the minimum skills needed to operate a motorcycle safely (NHTSA, 

2000a, Licensing). 

Operator licensing faces three issues. 

• Many motorcyclists are not properly licensed. In 2005, 24 percent of motorcyclists 

involved in fatal crashes did not have a valid motorcycle license, compared to 13 percent 

of all vehicle drivers who were not properly licensed (NHTSA, 2005, Tables 64 and 91). 

Many of these motorcyclists did have a driver’s license, but not a separate motorcycle 

license or endorsement (NHTSA, 2005, Table 91). Barriers to obtaining a motorcycle 

license include limited and inconvenient licensing examination hours, which sometimes 

require appointments weeks or months in advance, and licensing systems in some States 

that provide no incentive to become fully licensed because learner’s permits may be 

renewed indefinitely (NCHRP, under review, Strategy C3). 

• State motorcycle licensing practices vary substantially. Most States have a learner’s 

permit requiring only vision and knowledge tests. Motorcyclists with a learner’s permit 

can ride only in restricted circumstances, typically some combination of no passengers, 

only during daylight hours, and only with the supervision of a fully licensed motorcyclist. 

A skills test is required for full licensure. Two-thirds of the States use one of three tests 

developed by the MSF and AAMVA, while one-third use their own tests. Most States 

will waive the skills test, and sometimes the knowledge test, for motorcyclists who have 

completed an approved training course. See Baer, Cook, and Baldi (2005) for a summary 

of each State’s licensing requirements and procedures and NCHRP (under review, 

Strategy C1) for brief summaries of the major skills tests currently in use. 

• The goal of motorcycle operator licensing is to assure that motorcyclists have basic riding 

skills, but its effectiveness is not known. This is perhaps not surprising given the 

variability of licensing tests and procedures. The National Agenda recommends research 

to “ensure that licensing tests measure skills and behaviors required for crash avoidance” 

(NHTSA, 2000a, Licensing). NCHRP (under review, Strategy C3) notes that there are no 

evaluations of whether increasing the proportion of motorcyclists who are validly 

licensed would reduce motorcycle crashes or injuries. 

Baer, Cook, and Baldi (2005) reviewed and summarized each State’s motorcycle education and 

licensing programs and practices. A companion report (Baer, Baldi, and Cook, 2005) describes 

effective training and licensing programs and actions to promote training and licensing. NHTSA 

is completing a study in Maryland of methods to increase proper licensure (NHTSA, 2006b, p. 

20). Under a cooperative agreement with NHTSA, AAMVA is updating its Motorcycle Operator 

Licensing System and Integrating Motorcycle Rider Education and Licensing manuals, which 

provide guidelines for state motorcycle licensing programs (www.aamva.org). 
 5 - 9 

States should encourage all motorcyclists to be validly licensed. NAMS (NHTSA, 2000a, 

Licensing) and NCHRP (under review, Strategy C3) recommend that States: 

• provide enough convenient testing times and locations to accommodate the demand, for 

example by offering testing during evening hours; 

• waive skills and knowledge tests for graduates of approved education and training 

courses; 

• actively enforce motorcycle operator licensing requirements; and 

• promote motorcyclist licensing. 

 

NCHRP (under review, Strategy C3) describes how Maryland and Minnesota used some of these 

strategies to increase proper licensing for motorcyclists. Maryland used the additional strategy of 

comparing their vehicle registration and driver licensing files. A letter was sent to each owner of 

a registered motorcycle who did not have a motorcycle operator’s license. This quick and 

inexpensive strategy caused 1,700 owners to become licensed within four months. 

Maryland and Pennsylvania have “one-stop shops” which provide a motorcycle endorsement 

immediately upon successful completion of a State-approved basic riding course. For 

Pennsylvania’s procedures, see www.pamsp.com/CourseInfo_Basic.aspx. 

Use: All States require motorcyclists to obtain a motorcycle license or endorsement to ride on 

public highways. 

Effectiveness: The effectiveness of current licensing and testing has not been evaluated. 

Costs: Most States charge a small fee for the motorcycle licensing tests (MSF, 2002). The costs 

of changing the licensing tests and procedures depend on the extent of changes and the amount 

of retraining needed for licensing examiners. 

Time to implement: New licensing tests and procedures likely would require 6 to 12 months to 

implement. 

Other issues: 

• Graduated licensing: Most States employ graduated driver licensing for beginning 

automobile drivers. Under GDL, new drivers must pass through learner’s permit and 

provisional license stages before becoming fully licensed. A learner’s permit allows 

driving only while supervised by a fully licensed driver and a provisional license allows 

unsupervised driving under certain conditions, such as limiting the number of passengers 

and prohibiting driving at night. Many States place restrictions similar to these on 

motorcyclists with a learner’s permit or younger than a specified age (MSF, 2002). 

Mayhew and Simpson (2001) describe motorcyclist GDL programs in California, 

Maryland, and South Dakota. Baer et al. (2005, p. 24) report that seven States had some 

form of graduated licensing in 2001 and five restricted motorcyclists in some age groups 

to motorcycles of certain sizes. GDL programs for automobile drivers are proven to be 

effective in reducing crashes (Hedlund, Shults, and Compton, 2003, 2006). Evaluations in 

New Zealand and evidence from Quebec suggest that they may do the same for 

motorcyclists (Mayhew and Simpson, 2001). 
 5 - 10 

2.1 State Motorcycle Helmet Use Laws 

Effectiveness: Proven Use: Medium Cost: Low Time: Short 

Motorcycle helmets are highly effective in protecting motorcycle riders’ heads in a crash. The 

latest research, using data from 1993-2002, showed that helmets reduce motorcycle rider 

fatalities by 37 percent and brain injuries by 65 percent (Deuterman, 2004; NHTSA, 2003, p. 18; 

NHTSA, 2006a; NCHRP, under review, Strategy E1). The Cochrane review, summarizing five 

well-conducted studies, estimated that helmets reduce head injuries by 72 percent (Liu et al., 

2003). Helmets do not increase neck injuries (NCHRP, under review, Strategy E1; NHTSA, 

2000a; Ulmer and Preusser, 2003, p. 8). 

State helmet use laws are quite effective. In 2005, helmet use was 79 percent across all States 

with a universal helmet law that covers all riders and 46 percent across States with no law or a 

law covering only young riders (Glassbrenner, 2005). Studies in States that enacted universal 

helmet laws observed use rates of 90 percent or higher immediately after the law, compared to 

50 percent or lower before the law (Ulmer and Preusser, 2003, Section II). States that repealed 

universal helmet laws saw the opposite effect, as use rates dropped from above 90 percent to 

about 50 percent (Preusser et al., 2000, Section V; Ulmer and Preusser, 2003, Sections IV and 

V). 

The first universal helmet law was enacted in 1966. Universal laws were in force in 47 States and 

the District of Columbia by 1975. After Federal penalties were eliminated in 1975 for States 

failing to have a universal law, about half the States repealed their laws. Several States have 

enacted or repealed helmet laws since then. IIHS (2004) summarizes the helmet law history in 

each State through 2004. 

 

Use: As of July 2006, 20 States and the District of Columbia had helmet laws covering all riders. 

Most other States had laws covering only riders under a specified age, typically 18 or 21 (IIHS, 

2006; NHTSA, 2006c). In 2006, the Michigan legislature’s bill to repeal Michigan’s universal 

helmet law was vetoed by Governor Granholm on June 23. 

Effectiveness: The U.S. General Accountability Office (GAO) reviewed 46 methodologically 

sound studies of State helmet laws published before 1990. GAO concluded that motorcycle rider 

fatality rates were 20 to 40 percent lower with universal helmet laws (GAO, 1991, p. 4; Ulmer 

and Preusser, 2003, Section II). Studies since 1990 confirm these results (Kyrychenko and 

McCartt, 2006; Morris, 2006; NHTSA, 2006c; Ulmer and Preusser, 2003, Section II). Helmet 

use was low among young riders in States with laws covering only young riders (GAO, 1991; 

NHTSA, 2006c). Laws covering only young riders are difficult to enforce because it is hard for 

law enforcement officers to estimate a motorcycle rider’s age. 

Costs: Once legislation requiring helmet use has been enacted, implementation costs are 

minimal. The inevitable controversy surrounding the legislation will publicize the new law 

extensively. Motorcycle helmet laws can be enforced during regular traffic patrol operations 

because helmet use is easily observed. 
 5 - 11 

Time to implement: A universal helmet use law can be implemented as soon as the law is 

enacted. 

Other issues: 

• Opposition to motorcycle helmet laws: Any effort to enact a universal helmet law can 

expect immediate, well-coordinated, and highly political opposition (NHTSA 2003, p. 

18). Helmet law opponents claim that helmet laws impinge on individual rights. They 

also claim that helmets interfere with motorcycle riders’ vision or hearing, though 

research shows that these effects are minimal (NHTSA, 1996). 

• Noncompliant helmets: Some riders in States with universal helmet laws wear 

noncompliant helmets that do not comply with FMVSS 218 in order to avoid a helmet 

law citation. See the discussion in Chapter 5, Section 2.2.
 5 - 12 

2.2 Motorcycle Helmet Law Enforcement; Noncompliant Helmets 

Effectiveness: Unknown Use: Unknown Cost: Low Time: Medium 

Law enforcement officers in universal helmet law States easily can observe and cite motorcycle 

riders who are not wearing a helmet. This likely explains why helmet use rates are high in 

universal helmet law States (Chapter 5, Section 2.1). However, some helmets are noncompliant 

in that they do not meet the FMVSS 218 performance requirements. Many State helmet laws 

require motorcycle riders to wear helmets that comply with FMVSS 218, and federal regulations 

require all motorcycle helmets sold in the United States to meet or exceed the FMVSS 218 

standards. In the latest national survey, nine percent of motorcycle riders in 2005 were wearing 

noncompliant helmets (Glassbrenner, 2005). Since 48 percent of riders were wearing compliant 

helmets, this means that almost one-sixth of the helmets observed on the road in 2005 were 

noncompliant. Motorcycle riders wearing these helmets are no safer than if they wore no helmets 

at all (NCHRP, under review, Strategy E1). The challenge of motorcycle helmet law 

enforcement in states requiring FMVSS 218 compliant helmets is to actively identify and cite 

motorcycle riders wearing noncompliant helmets. 

In addition to flimsy construction, noncompliant helmets often cover only a portion of the rider’s 

head and have inadequate chin straps. These features are fairly easy for an observer to identify. 

Some noncompliant helmets also have spikes or other protrusions that mark them as 

noncompliant. A recent NHTSA brochure (NHTSA, 2004) discusses how to identify 

noncompliant helmets. 

Identifying a noncompliant helmet is easier than proving that it is noncompliant. Compliant 

helmets are formally identified by a DOT sticker on the back of the helmet. However, counterfeit 

DOT stickers are easily available and are found on many noncompliant helmets. As a result, it is 

difficult to obtain a conviction for a noncompliant helmet citation in some courts (NHCRP, 

under review, Strategy E1). NHTSA is considering ways to strengthen the labeling requirement 

to make it easier to prove that a helmet is noncompliant (NHTSA, 2006b, p. 16). NHTSA also is 

preparing a video clip for motorcyclists and law enforcement demonstrating how to identify 

compliant and noncompliant helmets and how to choose a helmet that fits properly. The video 

clip should be available on the NHTSA Web site in fall 2006 (NHTSA, 2006b, p. 17). 

Use: The extent of helmet law enforcement activities to identify and cite noncompliant-helmet 

wearers is not known. 

Effectiveness: The effectiveness of an active helmet law enforcement program on noncompliant 

helmet use has not been evaluated. 

Costs: Since helmet laws can be enforced during regular traffic patrols, the only costs will be for 

training law enforcement officers, prosecutors, and judges. 

Time to implement: An active helmet-law enforcement program requires training for law 

enforcement to identify noncompliant helmets and training for prosecutors and judges to assure 

that citations will be prosecuted and adjudicated. This training probably will require four to six 

months to implement.
 5 - 13 

2.3 Motorcycle Helmet Use Promotion Programs 

Effectiveness: Unknown Use: Low Cost: Varies Time: Medium 

A few States with no motorcycle helmet use law have attempted to promote helmet use through 

communications and outreach campaigns. NCHRP (under review, Strategy F1) provides brief 

information about campaigns in Washington and Wisconsin. The AMA, the MSF, and NHTSA 

all encourage helmet use. NHTSA is developing new helmet use promotion materials and public 

service announcements for television and radio that should be available in fall 2006 (NHTSA, 

2006b, p. 17). 

Use: Few States without universal helmet laws conduct helmet use promotion campaigns 

(NHTSA, 2005c). 

Effectiveness: There appear to be no formal evaluations of the effect of helmet use promotion 

programs in States without universal helmet laws (NCHRP, under review, Strategy F1). 

However, there also are no examples of helmet use rates much over 50 percent in States without 

a universal helmet law. 

Recent helmet use data are not encouraging. In NHTSA’s national survey, use of helmets 

complying with FMVSS 218 dropped from 71 percent in 2000 to 48 percent in 2005 

(Glassbrenner, 2005). The survey provides separate use rates for States with and without 

universal helmet laws only in 2005. However, the 2005 use rate of 67 percent in helmet law 

States is lower than the 2000 use rate of 71 percent in all States combined. Only one State, 

Pennsylvania, changed a helmet law in this period (its universal helmet law repeal became 

effective September 4, 2003). It appears that helmet use has decreased substantially between 

2000 and 2005 in both law and non-law states. 

Costs: Good communications and outreach campaigns can be expensive to develop and 

implement: see Chapter 2, Section 3.1. Helmet use promotion material is available from various 

sources including MSF, NHTSA (2003), and States that have conducted these campaigns. 

Time to implement: A good campaign, including market research, materials development, and 

message placement, will require at least six months to plan and implement.
 5 - 14 

3.1 Alcohol-Impaired Motorcyclists: Detection and Sanction 

Effectiveness: Unknown Use: Unknown Cost: Varies Time: Varies 

Alcohol impairment is a substantial problem for motorcycle operators, more so than for drivers 

of other motor vehicles. In 2005, 34 percent of motorcycle operators involved in fatal crashes 

had been drinking, compared to 26 percent for passenger car drivers and 25 percent for light 

truck drivers. Motorcycle operators in fatal crashes had a BAC of .08 or higher more frequently 

than other drivers (NHTSA, 2006, Table 17). Operators in injury or property-damage crashes 

also had higher alcohol-involvement rates than other vehicle drivers (NHTSA, 2005, Table 80). 

One recent study found that alcohol-impaired motorcycle operators were 16.9 times more likely 

to be at fault in a crash than sober operators (NCHRP, under review, Strategy B1). Fatally 

injured motorcycle operators wore helmets less frequently than sober operators (NHTSA, 2003, 

p. 12). 

Motorcyclists are included in and affected by the comprehensive strategies to reduce alcoholimpaired driving discussed in detail in Chapter 1. However, some law enforcement, sanction, and 

communication strategies may be especially useful for motorcyclists, while others may be 

relatively ineffective. This section discusses law enforcement and sanctions. Section 3.2 

discusses communications. 

Law enforcement officers on traffic patrol use characteristic driving behaviors, or cues, to 

identify drivers who may be impaired by alcohol. Some of the cues for motorcyclists, such as 

trouble maintaining balance at a stop, are different from those for cars and trucks. Stuster (1993) 

identified and validated 14 cues useful for identifying alcohol-impaired motorcyclists. NHTSA 

prepared a brochure discussing the cues, a law enforcement training video for roll-call use, and a 

pocket detection guide (NHTSA, 2000b). The cues for motorcyclists are an optional part of the 

SFST training given to all law enforcement officers. 

Vehicle impoundment or forfeiture can be an effective deterrent to drinking and driving for all 

drivers (see Chapter 1, Section 4.4). It may be even more effective for motorcyclists. Recent 

research (Becker et al., 2003) confirmed earlier findings that many motorcyclists do not find 

traditional impaired driving sanctions such as fines and license suspension to be effective 

deterrents. However, they are strongly concerned for the safety and security of their motorcycles. 

These findings suggest a potentially effective strategy to reduce alcohol-impaired motorcycling: 

highly publicized enforcement, using officers trained in identifying impaired motorcyclists as 

well as other vehicle drivers, with offender sanctions including vehicle impoundment or 

forfeiture. This will treat motorcyclists on an equal footing with other vehicle drivers in 

impaired-driving enforcement and publicity. 

Use: The extent to which law enforcement agencies train officers to detect alcohol-impaired 

motorcyclists, or include alcohol-impaired motorcycling in any way in their traffic patrol 

activities, is not known. Hedlund (under review) provides examples and links of state programs 

that distribute the NHTSA cue cards and brochures widely to law enforcement (Illinois), present 

this information in a web-based seminar for officers (Minnesota), and regularly establish highvisibility law enforcement presence at major rider events (Ohio, Wisconsin). 
 5 - 15 

Effectiveness: Some agencies have reported some success in using the cues for identifying 

alcohol-impaired motorcyclists, but no evaluation data are available (NCHRP, under review, 

Strategy B3). 

Costs: Law enforcement training costs are low and training material is available. Enforcement 

itself can be carried out during regular traffic patrol. A major campaign including alcoholimpaired motorcyclists will require additional costs for publicity. 

Time to implement: Law enforcement training can be conducted quickly. A major campaign 

will require four to six months to plan and implement. 

Other issues: 

• Motorcyclist groups: Motorcyclist groups likely will object strenuously to any 

enforcement activities that are perceived to target motorcyclists unfairly. The best 

strategy is to assure that motorcyclists, rider organizations, and motorcycle dealers are 

included in planning and publicizing impaired riding enforcement. 

• Drugs other than alcohol: Drugs other than alcohol can impair motorcycle operators. 

Potentially impairing drugs include over-the-counter and prescription medications as well 

as illegal drugs. Beyond this, little more can be said with any confidence. Studies of 

vehicle drivers, typically in individual hospitals, find drug presence considerably lower 

than alcohol presence. Motorcycle operators usually are not separated out in these 

studies. The extent to which various drugs impair driving performance or contribute to 

crashes is not well understood, either for four-wheeled vehicles or for motorcycles. See 

Jones et al. (2003) for a thorough summary of current knowledge. Law enforcement 

should consider drugs as potential impairing agents for motorcycle operators just as for 

other vehicle operators.
 5 - 16 

3.2 Alcohol-Impaired Motorcyclists: Communications and Outreach 

Effectiveness: Unknown Use: Medium Cost: Medium Time: Medium 

Alcohol impairment is a substantial problem for motorcyclists, more so than for drivers of other 

motor vehicles. Chapter 5, Section 3.1 discusses the problem and suggests law enforcement and 

sanction strategies that may help alleviate it. This section discusses communications strategies. 

Many States have conducted communications and outreach campaigns directed at drinking and 

motorcycling. See Hedlund (under review, Section 1) and NCHRP (under review, Strategy B1) 

for examples and links. Organizations including AMA, MSF, and SMSA have produced 

campaigns and material on drinking and motorcycling. Again, see Hedlund (under review) and 

NCHRP (under review) for examples and links. There are no evaluations of the effectiveness of 

any of these campaigns at any level, from awareness to knowledge and attitude change to any 

effect on motorcyclists’ drinking and motorcycling behavior. The experience of drinking and 

driving campaigns directed at all drivers suggests that they are unlikely to have any effect unless 

they are carefully researched and planned, well funded, well executed, achieve high levels of 

target audience exposure (perhaps using paid advertising), use high-quality messages that are 

pre-tested for effectiveness, and are conducted in conjunction with other activities directed at 

impaired motorcyclists. See Chapter 1, Section 5.5, for further discussion. 

A recent focus group study (Becker et al., 2002) examined motorcyclists’ attitudes, beliefs, and 

behaviors regarding drinking and motorcycling. It concluded that many motorcyclists have 

strong feelings of freedom, independence, and individual responsibility and believe that drinking 

motorcyclists endanger only themselves. Consequently, they believe that government efforts to 

discourage drinking and motorcycling are inappropriate. These beliefs also limit some 

motorcyclists’ willingness to take actions to prevent others from riding while impaired. 

These findings suggest that only very high-quality drinking and motorcycling campaigns have 

any chance of being effective. In particular, any campaign should be researched, designed, and 

pre-tested thoroughly and must appeal to common motorcyclist attitudes and beliefs. 

Rider groups can play a critical role in planning and implementing activities to reduce drinking 

and motorcycling. Some state and local rider groups sponsor alcohol-free events or adopting 

alcohol-free policies. As examples, the Fox Valley Wisconsin Harley Owners Group (H.O.G.) 

chapter has an alcohol-free policy for all organized rides and Illinois ABATE sponsors alcoholfree rides (Hedlund, under review, Section 1). 

Use: Many States have conducted drinking and motorcycling campaigns (Hedlund, under 

review; NCHRP, under review, Strategy C1), but the total number of States that have done so is 

not known. It also is not known whether States have included messages directed to motorcyclists 

in their overall alcohol-impaired driving campaigns. 

 

Effectiveness: There are no evaluations of the effectiveness of any drinking and motorcycling 

campaigns. 
 5 - 17 

Costs: A good campaign will require substantial funds to conduct market research, design and 

test messages, and place campaign material where it will reach motorcyclists frequently. 

Time to implement: A good campaign will require at least six months to research, design, test, 

and implement. 

Other issues: 

• Drugs other than alcohol: Drugs other than alcohol can impair motorcycle operators. 

Potentially impairing drugs include over-the-counter and prescription medications and 

illegal drugs. See Chapter 5, Section 3.1, for additional discussion and Jones et al. (2003) 

for a thorough summary of current knowledge. Drinking and motorcycling campaigns 

may wish to include other drugs as well as alcohol in their messages.
 5 - 18 

4.1 Communications and Outreach: Protective and Conspicuous Clothing 

Effectiveness: Unknown Use: Unknown Cost: Varies Time: Medium 

Motorcycle riders should wear clothing that provides both protection and visibility. FMVSS 218 

helmets (Chapter 5, Sections 2.1-2.3) with face shields protect the eyes from wind and foreign 

objects in addition to protecting the head in a crash. Well-constructed jackets, pants, boots, and 

gloves can prevent abrasions and bruises. If made of impact-resistant material, they even may 

prevent arm and leg fractures or serious torso and spinal cord injuries (NHTSA, 2000a, Personal 

Protective Equipment). 

A common cause of motorcycle crashes involving other vehicles is that other vehicle drivers do 

not see the motorcycle. This observation is reported anecdotally and confirmed in motorcycle 

crash causation studies (NCHRP, under review, Strategy D2; NHTSA, 2000a, Conspicuity). One 

easy way to increase motorcycle conspicuity is through lighted headlights. Most motorcycles on 

the road have their headlights always on, because most motorcycles manufactured since 1979 

have this feature (NCHRP, under review, Strategy D2) and because 24 States require daytime 

headlight use for all motorcycles manufactured since 1980 (MSF, 2004). 

A second way to increase conspicuity is to wear brightly colored clothing (for increased visibility 

during daylight) incorporating some retro-reflective material (for increased visibility at night). 

Recent studies confirm that motorcyclists wearing conspicuous clothing or helmets are less likely 

to be involved in a crash (NCHRP, under review, Strategy D1). 

There are no data on how many motorcycle riders wear various types of protective clothing other 

than helmets. Only a minority wears brightly colored clothing (NHTSA, 2000a, Conspicuity); in 

fact, the predominant color of motorcycle clothing is black (NCHRP, under review, Strategy 

D1). Helmet manufacturers and distributors report that more than half the helmets sold for street 

use are black (NCHRP, under review, Strategy D1). 

Communications and outreach campaigns promoting protective and conspicuous clothing have 

been conducted by States and by motorcyclist organizations. NCHRP (under review, Strategy 

D1) provides examples of material from Oregon and the MSF and references to additional 

material from the SMSA, the Gold Wing Road Riders Association, and the Motorcycle Council 

of New South Wales, Australia.

Use: The number of States that conduct campaigns to promote protective and conspicuous 

clothing for motorcycle riders is not known. 

Effectiveness: There are no evaluations of the effectiveness of campaigns to increase the use of 

protective and conspicuous clothing (NCHRP, under review, Strategy D1). 

Costs: Good communications and outreach campaigns can be expensive to develop and 

implement: see Chapter 2, Section 3.1. Materials promoting protective and conspicuous clothing 

are available from various sources including MSF, other motorcyclist organizations, and States 

that have conducted these campaigns (NCHRP, under review, Strategy D1). 
 5 - 19 

Time to implement: A good campaign, including market research, message development and 

testing, and implementation, will require at least six months to plan and implement. 
 5 - 20 

4.2 Communications and Outreach: Awareness of Motorcyclists 

Effectiveness: Unknown Use: Unknown Cost: Varies Time: Medium 

When motorcycles crash with other vehicles, the other vehicle driver usually violates the 

motorcyclist’s right-of-way (NCHRP, under review, Strategy F3; NHTSA, 2000a, Motorist 

Awareness). Motorcycles and motorcyclists obviously are a smaller visual target than cars or 

trucks. Motorcyclists may not be conspicuous (see Chapter 5, Section 4.1). Also, drivers may not 

expect to see motorcycles on the road and may not anticipate how motorcycles are likely to be 

driven (NCHRP, under review, Strategy F3; NHTSA, 2000a, Motorist Awareness). 

Several States have conducted communications and outreach campaigns to increase other 

drivers’ awareness of motorcyclists. Typical themes are “Share the Road” or “Watch for 

Motorcyclists.” Some States build a campaign around a “Motorcycle Awareness Month,” often 

in May, early in the summer riding season. Many motorcyclist organizations, including MSF, 

SMSA, the Gold Wing Road Riders Association, and State and local rider groups, have driver 

awareness material available. See Hedlund (under review, Section 5) and NCHRP (under review, 

Strategy F3) for links and references. These organizations also make presentations on drivers’ 

awareness of motorcyclists to driver education classes. 

As required by SAFETEA-LU, NHTSA developed model language on sharing the road safely 

with motorcyclists. The model language is appropriate for traffic safety education courses, driver 

manuals, and other communication and outreach activities. NHTSA is using this model language 

in a “Share the Road” program for states and communities, which will be available in 2007 

(NHTSA, 2006b, p. 12.) 

Use: The number of States that conduct campaigns to increase drivers’ awareness of motorcycles 

and motorcyclists is not known. Hedlund (under review, Section 5) and NCHRP (under review, 

Strategy F3) provide examples or links to campaigns from a dozen States. 

Effectiveness: There are no evaluations of the effectiveness of campaigns to increase driver 

awareness of motorcyclists (NCHRP, under review, Strategy F3). NHTSA conducted a 

demonstration of driver awareness programs in New York and Washington but the results have 

not yet been released (NHTSA, 2003, p. 18). 

Costs: Good communications and outreach campaigns can be expensive to develop and 

implement: see Chapter 2, Section 3.1. Motorcyclist awareness material is available from various 

sources including the MSF, other motorcyclist organizations, and States that have conducted 

these campaigns (NCHRP, under review, Strategy F3). 

Time to implement: A good campaign, including market research, message development and 

testing, and implementation, will require at least six months to plan and implement. 
 5 - 21 

Motorcycle Safety References 

Baer, J.D., Baldi, S., and Cook, A.L. (2005). Promising Practices in Motorcycle Rider Education 

and Licensing. DOT HS 809 922. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/MotorcycleRider/ 

Baer, J.D., Cook, A.L., and Baldi, S. (2005). Motorcycle Rider Education and Licensing: A 

Review of Programs and Practices. DOT HS 809 852. Washington, DC: National Highway 

Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/McycleRiderWeb/pages/index.htm 

Becker, L.R., McKnight, A.S., and Nelkin, V.S., et al. (2003). Drinking, Riding, and Prevention: 

A Focus Group Study. DOT HS 809 490. Washington, DC: National Highway Traffic Safety 

Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/DrinkRidePrevent/index.htm#TABLE%

20OF%20CONTENTS 

Billheimer, J.W. (1996). California Motorcyclist Safety Program: Program Effectiveness.

Sacramento, CA: California Highway Patrol. 

Deuterman, W. (2004). Motorcycle Helmet Effectiveness Revisited. DOT HS 809 715. 

Washington, DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/Rpts/2004/809-715/pages/TRDpage.html 

GAO (1991). Highway Safety: Motorcycle Helmet Laws Save Lives and Reduce Costs to Society.

Washington, DC: U.S. General Accounting Office (now the General Accountability Office). 

Glassbrenner, D. (2005). Motorcycle Helmet Use in 2005 - Overall Results. DOT HS 809 937. 

Washington, DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809-937/809937.html.

Hedlund, J. (under review). Implementation Guide for the National Agenda for Motorcycle 

Safety. Washington, DC: National Highway Traffic Safety Administration. 

Hedlund, J., Shults, R.A., and Compton, R. (2003). What we know, what we don’t know, and 

what we need to know about graduated driver licensing. Journal of Safety Research 34, pp. 107-

115. www.nsc.org/gdlsym/index.htm 

Hedlund, J., Shults, R.A., and Compton, R. (2006). Graduated driver licensing and teenage 

driver research in 2006. Journal of Safety Research 37, pp. 107-121. 

IIHS (2004). History of U.S. motorcycle laws and changes in coverage. Arlington, VA: 

Insurance Institute for Highway Safety. www.iihs.org/laws/state_laws/helmet_history.html 

IIHS (2006). Current U.S. Motorcycle and Bicycle Helmet Laws, April 2006. Arlington, VA: 

Insurance Institute for Highway Safety. www.iihs.org/laws/state_laws/helmet_current.html 
 5 - 22 

Jones, R.K., Shinar, D., and Walsh, J.M. (2003). State of Knowledge of Drug-Impaired Driving.

DOT HS 809 642. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/research/StateofKnwlegeDrugs/StateofKnwlegeDrugs/index.ht

ml 

Kyrychenko, S.Y and McCartt, A.T. (2006). Florida’s weakened motorcycle helmet law: Effects 

on death rates in motorcycle crashes. Traffic Injury Prevention 7, pp. 55-60. 

Liu, B., Ivers, R., Norton, R., et al. (2003). Helmets for preventing injury in motorcycle riders. 

The Cochrane Database of Systematic Reviews.

www.cochrane.org/cochrane/revabstr/AB004333.htm 

Mayhew, D.R., and Simpson, H.M. (1996). Effectiveness and Role of Driver Education and 

Training in a Graduated Licensing System. Ottawa, ON: Traffic Injury Research Foundation. 

www.trafficinjuryresearch.com/publications/pub_details.cfm?intPubID=65 

Mayhew, D.R., and Simpson, H.M. (2001). Graduated Licensing for Motorcyclists. Ottawa, ON: 

Traffic Injury Research Foundation. 

www.trafficinjuryresearch.com/publications/PDF_publications/GDL_for_Motorcyclists_Report.

pdf 

Morris, C.C. (2006). Generalized linear regression analysis of association of universal helmet 

laws with motorcyclist fatality rates. Accident Analysis and Prevention 38, pp. 142-147. 

MSF (2002). State Motorcycle Operator Licensing - 2002. Irvine, CA: Motorcycle Safety 

Foundation. www.msf-usa.org/Downloads/2002%20CSI%20Licensing.pdf 

MSF (2004). State On-Highway Motorcycle Equipment Requirements. Irvine, CA: Motorcycle 

Safety Foundation. www.msf-usa.org/downloads/Equipment_Chart_2004_MSFlogo.pdf 

NCHRP Report 500 (under review). A Guide for Addressing Collisions Involving Motorcycles.

Washington, DC: Transportation Research Board. www.ch2m.com/nchrp/over/default.htm 

NHTSA (1996). Do Motorcycle Helmets Interfere with the Vision and Hearing of Riders?

Traffic Tech No. 127. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/outreach/traftech/pub/tt127.pdf 

NHTSA (1998). Traffic Safety Facts 1997. DOT HS 808 806. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/TSFAnn/TSF97.pdf 

NHTSA (2000a). National Agenda for Motorcycle Safety. DOT HS 809 156. Washington, DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/00-NHT-212-motorcycle/index.html 
 5 - 23 

NHTSA (2000b). The Detection of DWI Motorcyclists. Washington, DC: National Highway 

Traffic Safety Administration.

www.nhtsa.dot.gov/people/injury/alcohol/SobrietyCheck/order_form.html 

NHTSA (2003). The National Highway Traffic Safety Administration Motorcycle Safety 

Program. DOT HS 809 539. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.gov/people/injury/pedbimot/motorcycle/motorcycle03/index.htm 

NHTSA (2004). How to Identify Unsafe Motorcycle Helmets. DOT HS 807 880 (revised). 

Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/UnsafeHelmetID/images/UnsafeHelmets

.pdf 

NHTSA (2006). Traffic Safety Facts 2005. DOT HS 810 631. wwwnrd.nhtsa.dot.gov/pubs/tsf2005ee.pdf. 

NHTSA (2006b). 2006 Motorcycle Safety Program Plan. Washington, DC: National Highway 

Traffic Safety Administration. DOT HS 810 615. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/MotorcycleSafety.pdf. 

NHTSA (2006c). Motorcycle Helmet Use Laws. Washington, DC: National Highway Traffic 

Safety Administration. 

www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated%20Files/03%20M

otorcycle%20Helmet%20Use.pdf 

NHTSA (undated). Highway Safety Program Guideline No 3: Motorcycle Safety. Washington, 

DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/nhtsa/whatsup/tea21/tea21programs/402Guide.html#g3 

Preusser, D.F., Hedlund, J.H., and Ulmer, R.G. (2000). Evaluation of Motorcycle Helmet Law 

Repeal in Arkansas and Texas. DOT HS 809 131. Washington, DC: National Highway Traffic 

Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/EvalofMotor.pdf 

Stuster, J. (1993). The Detection of DWI Motorcyclists. DOT HS 807 839. Washington, DC: 

National Highway Traffic Safety Administration. 

Ulmer, R.G., and Preusser, D.F. (2003). Evaluation of the Repeal of Motorcycle Helmet Laws in 

Kentucky and Louisiana. DOT HS 809 530. Washington, DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/research/kenturky-la03/TecDoc.htm 
 6 - 1 

6. Young Drivers

Overview

Young drivers are substantially over-involved in crashes. In 2004, drivers age 16 to 20 were 6.3 

percent of all licensed drivers in the United States, 13.3 percent of drivers in fatal crashes, and 

17.9 percent of drivers in all crashes (NHTSA, 2005, Table 63). 

Fatal: crashes per 30,000 drivers (FARS) 

All: crashes per 100 drivers (GES) 

Per mile driven, young drivers are even more over-involved. From April 2001 through March 

2002, young drivers were involved in 7.4 fatal crashes per 100 million miles of travel, compared 

to 4.3 for drivers 21 to 24 and 1.6 for drivers 30 to 69 years old (IIHS, 2005). 

Trends. The number of drivers under the age of 21 in fatal crashes dropped 26 percent over the 

past 22 years, from 10,270 in 1982 to 7,597 in 2005. However, the decrease occurred during the 

first 10 years, from 1982 to 1992, and the number of young drivers in fatal crashes increased 1 

percent from 1992 to 2005. The decrease was due entirely to a reduction in alcohol-involved 

drivers from 1982 to 1993. Sober driver involvement increased 10 percent from 1982 to 2004, 

and the number of alcohol-involved drivers has been essentially constant since 1993 (NHTSA, 

2006). 

Young-driver characteristics. Young drivers have high crash risks for two main reasons, as 

documented by extensive research (summarized in Hedlund et al., 2003). First, they are 

inexperienced, just learning to drive. The mechanics of driving require much of their attention, 

so safety considerations frequently are secondary. They do not have experience in recognizing 

potentially risky situations or in reacting appropriately and controlling their vehicles in these 

situations. Second, they are immature, sometimes seeking risks for their own sake, often not able 

or willing to think ahead to the potentially harmful consequences of risky actions. 

Crashes per Licensed Driver - 2004

0

4

8

12

16

20

16-20 21-24 25-34 35-44 45-54 55-64 65-74 >74

Driver age

All crashes

Fatal crashes
 6 - 2 

Inexperience and immaturity combine to make young drivers especially at-risk in four 

circumstances: 

• At night: Driving is more difficult and dangerous at night for everyone; young drivers 

have less experience driving at night than during the day; they may be tired and may have 

been drinking (Lin and Fearn, 2003, Williams, 2003). 

• After drinking alcohol: Young drivers’ inexperience with both driving and drinking 

means that they have a higher crash risk at all BAC levels than older drivers (Williams, 

2003). 

• With passengers: Teenage passengers can distract young drivers and encourage them to 

take risks (Lin and Fearn, 2003, Williams, 2003). 

• When unbelted: Seat belts reduce the risk of injury or fatality in a crash (see Chapter 2, 

Overview), but teenage drivers and passengers have lower belt use rates than older 

drivers and passengers (Ferguson, 2003). 

Source: FARS 

Strategies to Reduce Crashes Involving Young Drivers 

Graduated driver licensing (GDL) addresses both the inexperience and immaturity of young 

drivers. GDL provides a structure in which beginning drivers gain substantial driving experience 

in less-risky situations. GDL raises the minimum age of full licensure and helps parents manage 

their teenage drivers. GDL’s effectiveness in reducing crashes has been demonstrated many 

times (Hartling et al., 2006; Hedlund et al., 2006; Shope and Molnar, 2003; Simpson, 2003). 

Driver education was developed to teach both driving skills and safe driving practices. Based on 

evaluations to date, school-based driver education for beginning drivers does not reduce crashes. 

Rather, it lowers the age at which teenagers become licensed, so its overall effect is to increase 

crashes (Roberts et al., 2001; Vernick et al., 1999). Current research is investigating ways to 

integrate driver education with GDL and is developing second-level programs for drivers who 

have acquired basic driving skills and have been licensed. 

Drivers Under Age 21 in Fatal Crashes

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

Year

No alcohol

Any acohol
 6 - 3 

Parents play a key role in their teenagers’ driving. In many States a parent or guardian must sign 

the driver’s license application for a teenager under 18 and parents can withdraw their approval 

at any time. Parents can set limits on their teenagers’ driving. Through their own driving, parents 

provide role models for good or bad driving practices. Parents can be involved explicitly and 

formally, through GDL requirements for a minimum number of hours of supervised driving 

practice under a learner’s permit. Or they can be involved voluntarily and informally. Several 

parent-teen driving guide programs can provide assistance. 

Young drivers are subject to two traffic laws that apply only to them: GDL and the zero 

tolerance BAC laws discussed in Chapter 1. In addition, they are subject to all other traffic laws. 

Enforcement is critical if these laws are to have any effect. The law enforcement system faces 

two problems when dealing with young drivers. First, in some situations there may be a tendency 

for officers not to make arrests or for prosecutors to dismiss charges because the offender is “just 

a kid.” Second, the legal system imposes additional requirements for people under the age of 

legal adulthood (18 in most States). See NHTSA and NIAAA (1999) for a discussion of these 

requirements and processes for alcohol-related offenses. 

Young drivers are discussed in other chapters of this guide. See in particular: 

• Chapter 1, Alcohol-Impaired Driving, Sections 6.1-6.4 (minimum-drinking-age-21 laws, 

zero tolerance BAC laws, school and youth alcohol programs). 

• Chapter 2, Safety Belt Use, Sections 3.2 and 4.1 (communications and outreach for lowbelt-use groups, school and employer programs). 

• Chapter 4, Distracted and Fatigued Driving, Sections 1.2, 2.2, and 3.1 (GDL 

requirements, communications and outreach, and employer programs). 

• Chapter 5, Motorcycle Safety, Section 1.2 (GDL for motorcyclists). 

Except for GDL requirements applying to automobile drivers, these discussions are not repeated 

in this chapter. 

Environmental and vehicular strategies can improve safety for young drivers, as they can for all 

drivers. Two vehicle issues are especially relevant. Driving older, smaller, or less-stable vehicles 

can raise their crash risk (Ferguson, 2003). Some parents are installing devices on their 

teenagers’ vehicles to monitor the vehicle’s location, speed, or other performance characteristics 

(Williamson, 2005). 

For an overview of young-driver issues and research, see the papers in the June 2006 Supplement 

of Injury Prevention (ip.bmjjournals.com/content/vol12/suppl_1/). An NCHRP guide for 

reducing crashes involving young drivers should be released in 2006 (NCHRP, under review).
 6 - 4 

Countermeasures That Work 

Countermeasures to improve young-driver safety are listed below and discussed individually in 

this chapter. The table is intended to give a rough estimate of each countermeasure’s 

effectiveness, use, cost, and time required for implementation. The terms used are described 

below. Effectiveness, cost, and time to implement can vary substantially from State to State and 

community to community. Costs for many countermeasures are difficult to measure, so the 

summary terms are very approximate. See each countermeasure discussion for more information.

1. Graduated Driver Licensing 

Countermeasure Effectiveness Use Cost Time 

1.1 Graduated driver licensing (GDL) Proven High Medium Long 

1.2 Learner’s permit length, supervised hours Proven High Low Medium 

1.3 Intermediate - nighttime restrictions Proven High Low Medium 

1.4 Intermediate - passenger restrictions Likely Medium Low Medium 

1.5 Belt use requirements Likely Low Low Medium 

1.6 Cell phone restrictions Unknown Low Low Medium 

1.7 Intermediate - violation penalties Uncertain High Low Medium 

2. Driver education 

Countermeasure Effectiveness Use Cost Time 

2.1 Pre-licensure driver education None Unknown High Long 

2.2 Post-licensure driver education Unknown Low High Long 

3. Parents 

Countermeasure Effectiveness Use Cost Time 

3.1 Parent roles in teaching and managing Varies Medium Low Short 

4. Traffic law enforcement 

Countermeasure Effectiveness Use Cost Time 

4.1 Enforcement of GDL and zero tolerance 

laws 

Likely Unknown Medium Short 

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results. 

 Likely: balance of evidence from high-quality evaluations or other sources. 

 Uncertain: limited and perhaps ambiguous evidence. 

 Unknown: no high-quality evaluation evidence. 

 Varies: different methods of implementing this countermeasure produce different results. 

 None: several high-quality evaluations show no effect. 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. 

See individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 
 6 - 5 

Use: 

 High: more than two-thirds of the States, or a substantial majority of communities. 

 Medium: between one-third and two-thirds of States or communities. 

 Low: fewer than one-third of the States or communities. 

 Unknown: data not available. 

Cost to implement: 

 High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources. 

 Medium: requires some additional staff time, equipment, facilities, and/or publicity. 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment or facilities. 

Time to implement: 

 Long: more than one year. 

 Medium: more than three months but less than one year. 

 Short: three months or less. 

These estimates do not include the time required to enact legislation or establish policies. 
 6 - 6 

1.1 Graduated Driver Licensing 

Effectiveness: Proven Use: High Cost: Medium Time: Long 

GDL is a three-phase system for beginning drivers, consisting of a learner’s permit, an 

intermediate license, and a full license. A learner’s permit allows driving only while supervised 

by a fully licensed driver. An intermediate license allows unsupervised driving under certain 

restrictions. These usually include limits on driving at night or with teenage passengers. The 

learner’s permit and the intermediate license each must be held for a specified minimum period 

of time. 

GDL serves two functions: reducing risk and reducing exposure. GDL allows beginning drivers 

to acquire driving experience in less-risky situations, under direct supervision during the 

learner’s permit phase. It helps young drivers avoid dangerous conditions such as late-night 

driving or driving with teenage passengers in the vehicle during the intermediate phase. GDL 

delays full licensure by requiring a minimum time in both the learner’s permit and intermediate 

phases. Compared to earlier requirements in many jurisdictions, where beginning drivers could 

receive a full license at age 16 (and sometimes earlier) by passing a minimal driving test, GDL 

reduces the amount of driving by 16-year-old drivers. GDL also assures that young drivers are 

more mature when they receive their first unrestricted license. 

Most States now have some form of GDL in place. NCUTLO (2000) provides a model GDL law. 

IIHS and TIRF (2004) summarize and discuss GDL provisions. GHSA (2006) and IIHS (2006) 

document GDL laws in each State as of July 2006. The papers in the Journal of Safety Research

special issue of January 2003 document GDL’s history, components, effectiveness, parental 

roles, potential enhancements, and research needs. See Hedlund et al. (2003) for a summary and 

links to other papers, and Hedlund and Compton (2004, 2005) and Hedlund et al. (2006) for 

updates. The latter three papers document much of the recent research on all young driver issues. 

Use: All States and the District of Columbia had some GDL components in place as of July 

2006; 45 States and the District of Columbia had a three-phase GDL system (GHSA, 2006; IIHS, 

2006). 

Effectiveness: GDL’s effectiveness in reducing crashes has been documented repeatedly (Baker 

et al., 2006; Hartling et al., 2004; Hedlund et al., 2006; Shope and Molnar, 2003; Simpson, 

2003). 

Costs: GDL’s primary costs result from the intermediate license, which adds to licensing agency 

workload by requiring each beginning driver to receive three licenses in succession rather than 

two. 

Time to implement: Licensing changes typically require more than a year to plan, publicize, and 

implement. 

Other issues: 
 6 - 7 

• GDL provisions: The specific provisions in current GDL systems vary substantially 

from State to State. GHSA (2006) and IIHS (2006) document the main provisions of each 

State’s law. Sections 1.2-1.7 of this Chapter discuss the main provisions in more detail. 

Mayhew et al. (2005) describe GDL standards for Canadian provinces and compare GDL 

systems in Canada, United States, Australia, and New Zealand.
 6 - 8 

1.2 GDL Learner’s Permit Length, Supervised Hours 

Effectiveness: Proven Use: High Cost: Low Time: Medium 

With a learner’s permit, a beginning driver can drive when supervised by a fully licensed driver 

at least 21 years old. The learner’s permit allows and encourages beginning drivers to acquire 

substantial driving experience. To aid this, most States require the learner’s permit to be held for 

a minimum period of time and most require a minimum number of supervised driving hours. 

NCUTLO’s model GDL law suggests minimum requirements of six months holding period and 

30 hours supervised driving (NCUTLO, 2000). Most States meet or exceed these 

recommendations. 

Use: As of July 2006, 41 States and the District of Columbia required learner’s permits to be 

held for at least six months and another 5 had minimum holding periods of 10 days to five 

months. Forty States and the District of Columbia required some minimum number of supervised 

driving hours: 20 required at least 50 hours, 8 required 40 hours, 5 required 30 to 35 hours, and 8 

required 12 to 25 hours. Some States reduced or eliminated supervised driving requirements for 

driver education graduates. NCUTLO’s model requirements of at least six months’ holding time 

and at least 30 hours of supervised practice seem to be generally accepted as minimum standards, 

met or exceeded by more than two-thirds of the States (IIHS, 2006). 

Effectiveness: Several studies, summarized in Mayhew (2003), show that learner’s permit 

drivers in various jurisdictions regularly drive under adult supervision and often exceed the 

minimum requirement for supervised driving hours. Thus the combination of a minimum 

learner’s permit holding period and a supervised driving hour requirement is successful in 

achieving substantial supervised driving practice. In surveys, both parents and teenagers strongly 

support GDL overall. In particular, they support the learner’s permit holding period and 

supervised driving requirements (Mayhew, 2003). 

Since learner’s permit drivers are being supervised, it’s not surprising that crash rates during the 

learner’s permit period are very low. For young drivers holding their first unsupervised license, 

the limited available evidence suggests that crash rates decreased after jurisdictions with no 

learner’s permit holding requirement implemented a six-month requirement (Mayhew, 2003). 

Baker et al. (2006) found that a learner’s permit holding period of at least three months and a 

supervised driving requirement reduced fatal crash involvements. 

Costs: Once GDL is in place, a requirement for a minimum learner’s permit holding period 

length or a minimum number of supervised driving hours can be implemented at very little cost. 

Time to implement: GDL requirement changes typically require at least six months to notify the 

public and implement the changes. 
 6 - 9 

1.3 GDL Intermediate License Nighttime Restrictions 

Effectiveness: Proven Use: High Cost: Low Time: Medium 

Driving at night increases the fatal crash risk per mile of travel for all drivers, and especially for 

teenage drivers (Hedlund et al., 2003; Williams, 2003). At night, driving is more difficult, driver 

fatigue is more common, and alcohol is more likely to be used. Many intermediate license 

drivers have limited experience driving at night. For all of these reasons, a night driving 

restriction or prohibition is the most common intermediate license restriction. 

The restricted hours vary widely, from “sunset to sunrise” or 6 p.m. to 6 a.m. in the most 

restrictive States, to 1 a.m. to 5 a.m. in the least restrictive (GHSA, 2006; IIHS, 2006). The most 

common hours are 11 p.m. or midnight to 5 or 6 a.m. The NCUTLO model law recommends a 

10 p.m. starting time (NCUTLO, 2000) and the IIHS-TIRF Blueprint recommends a 9 or 10 p.m. 

starting time, but only eight States start their restrictions as early as 10 p.m. A starting time 

earlier than midnight will prevent more crashes, especially since teenage driver crashes occur 

more frequently before midnight than after (Foss and Goodwin, 2003; Williams, 2003). 

Use: As of July 2006, 44 States and the District of Columbia restricted intermediate license 

drivers from driving during specified nighttime hours. Many States allowed driving during the 

restricted hours for work or school-related activities (GHSA, 2006; IIHS, 2006). 

 

Effectiveness: The effectiveness of nighttime driving restrictions in reducing both nighttime 

driving and nighttime crashes has been demonstrated conclusively (Hedlund et al., 2003; 

Hedlund and Compton, 2004; Hedlund and Compton, 2005; Lin and Fearn, 2003). 

Costs: Once GDL is in place, a nighttime driving restriction can be implemented or modified at 

very little cost. 

Time to implement: GDL requirement changes typically require at least six months to notify the 

public and implement the changes. 
 6 - 10 

1.4 GDL Intermediate License Passenger Restrictions 

Effectiveness: Likely Use: Medium Cost: Low Time: Medium 

Passengers increase the crash risk for teenage drivers, especially the youngest drivers. Each 

additional passenger produces an additional increase in crash risk. In contrast, passengers 

decrease crash risk for drivers 30 to 59 years old (Williams, 2003). To reduce the risk to teen 

drivers, half the States include a passenger restriction in their GDL requirements for intermediate 

licensees. NCUTLO’s model law prohibits passengers younger than 20 (NCUTLO, 2000). 

Use: As of July 2006, 35 States and the District of Columbia restricted in some way the number 

of passengers who can be carried by an intermediate license driver (GHSA, 2006; IIHS, 2006). 

Some restrictions apply to all passengers and some only to passengers younger than a specified 

age. Some restrictions apply only during the initial months of the intermediate license. 

Effectiveness: Passenger restrictions are generally effective in reducing the number of 

passengers, though the restrictions sometimes are violated (Hedlund et al., 2003). A recent study 

in California found that 16-year-old drivers who were at fault in crashes were more frequently 

carrying teenage passengers than 16-year-old drivers involved in crashes who were not at fault 

(Hedlund and Compton, 2005). Baker et al. (2006) found that passenger restrictions in 

combination with other GDL requirements reduced fatal crash involvements. Two studies in 

progress in 2005 are evaluating the effects of passenger restrictions in four States (Hedlund and 

Compton, 2005). 

Costs: Once GDL is in place, a passenger restriction can be implemented at very little cost. 

Time to implement: GDL requirement changes typically require at least six months to notify the 

public and implement the changes. 
 6 - 11 

1.5 GDL Belt Use Requirements 

Effectiveness: Likely Use: Low Cost: Low Time: Medium 

Teenage drivers and passengers have lower seat belt use rates than older drivers and passengers 

(Ferguson, 2003). All States except New Hampshire have belt use laws covering passengers of 

all ages, though the laws in over half the States exempt passengers in some seating positions or 

in some passenger vehicles (Glassbrenner, 2005). New Hampshire requires belt use by all 

passengers under 18. Six States have primary enforcement belt use laws for passengers under the 

age of 18 or 19 but secondary enforcement for older passengers (Glassbrenner, 2004; see also 

Chapter 2, Sections 2.1 and 2.4). Some States explicitly require belt use under their GDL laws. 

NCUTLO’s model law requires intermediate license drivers and all their passengers to be belted 

(NCUTLO, 2000). An explicit belt use requirement in a State’s GDL law may have more 

influence on beginning drivers than the State’s overall belt use law, especially in States with 

primary enforcement for young drivers and in States where seat belt violations result in delayed 

graduation to the next GDL phase. 

Use: In 2005, GDL laws in 15 States explicitly required belt use (AAA, 2005). Sanctions for 

violating this requirement varied across the States. 

Effectiveness: There are no evaluations of the effects of explicit belt use requirements in GDL 

laws. A NHTSA-funded study is examining whether increased publicity for seat belt GDL 

requirements leads to increased belt use (Hedlund and Compton, 2005). 

Costs: Once GDL is in place, a belt use requirement can be implemented at very little cost. 

Time to implement: GDL requirement changes typically require at least six months to notify the 

public and implement the changes. 
 6 - 12 

1.6 GDL Cell Phone Restrictions 

Effectiveness: Unknown Use: Low Cost: Low Time: Medium 

Cell phones may distract drivers, as discussed in Chapter 4, Section 1.1. Their distractions may 

pose greater risks for beginning drivers than for experienced drivers, for the reasons outlined in 

the Overview (see also Ferguson, 2003). To reduce this risk, a few States include cell phone 

restrictions in their GDL laws. NCUTLO’s model law does not include a cell phone restriction 

for either learner’s permit or intermediate license drivers (NCUTLO, 2000). See Chapter 4, 

Section 1.1 for a discussion of cell phone laws applying to all drivers. 

Use: Twelve States and the District of Columbia prohibit all cell phone use for some young 

drivers: ten States for all drivers with a GDL, Connecticut and the District of Columbia for 

drivers with a learner’s permit, and Rhode Island for all drivers under the age of 18 (GHSA, 

2006; IIHS 2006). New York prohibits handheld cell phone use by all drivers (see Chapter 4, 

Section 1.1). 

Effectiveness: There are no evaluations of the effects of cell phone prohibitions in GDL laws. 

Costs: Once GDL is in place, a cell phone restriction can be implemented at very little cost. 

Time to implement: GDL requirement changes typically require at least six months to notify the 

public and implement the changes. 
 6 - 13 

1.7 GDL Intermediate License Violation Penalties 

Effectiveness: Uncertain Use: High Cost: Low Time: Medium 

Probationary licensing preceded graduated licensing. Probationary licensing had no intermediate 

phase, so that beginning drivers received a full and unrestricted license after their learner’s 

permit. However, the initial full licensure period was probationary in that the license could be 

revoked or suspended, or some driver improvement actions could be required, at a lower 

threshold than for drivers with a standard non-probationary license (Simpson, 2003). 

The probationary feature has been included in the intermediate phase of graduated licensing, 

typically by delaying full licensure until the intermediate licensee has demonstrated a good 

driving record. For example, the NCUTLO model law recommends a six-month period free of all 

traffic violation convictions before full licensure (NCUTLO, 2000). 

Use: Almost all States penalize some GDL or traffic law violations by delaying full licensure 

(IIHS and TIRF, 2004). 

Effectiveness: The few evaluations of early stand-alone probationary license systems generally 

found no substantial benefits (McKnight and Peck, 2003; Simpson, 2003). No recent evaluations 

have attempted to separate out the effect of penalties for GDL or other traffic law violations from 

the overall effects of GDL (see Chapter 6, Section 1.1). Two studies evaluated the effects on 

young drivers of lower-threshold driver improvement actions, with mixed results (NCHRP, 

under review, Strategy A4). 

Costs: Once GDL is in place, penalties for violating its provisions can be changed at very little 

cost. 

Time to implement: GDL requirement changes typically require at least six months to notify the 

public and implement the changes. 
 6 - 14 

2.1 Pre-licensure Driver Education 

Effectiveness: None Use: Unknown Cost: High Time: Long 

Driver education has long been advocated and used to teach both driving skills and safe driving 

practices. Driver education in high schools grew in popularity in the 1950s, using a standard 

curriculum of at least 30 hours classroom instruction and 6 hours on-the-road driving practice. 

By about 1970, approximately 14,000 high schools taught driver education to about 70 percent of 

all eligible teenagers. Many States and insurance companies encouraged driver education: States 

licensed graduates at an earlier age and insurance companies reduced auto insurance premiums 

for graduates. During the 1980s driver education offerings decreased as State and Federal 

funding for driver education decreased. By the early 1990s fewer than half of all high schools 

offered driver education and the majority of beginning drivers did not take driver education. See 

Smith (1994) for a concise review of the history of driver education in the United States. 

The evaluations to date find that driver education does not improve safety. Roberts et al. (2006) 

concluded from three well-designed evaluations in Australia, New Zealand, and the United 

States that driver education lowers the age at which teenagers become licensed but does not 

affect their crash rates once they do become licensed. The net effect of driver education is to 

increase crashes because it puts more young drivers on the road. Vernick et al. (1999) reached 

the same conclusion from a review of nine studies, eight from the United States and one from 

Australia. 

The study most familiar in the United States is the extensive NHTSA-sponsored study in DeKalb 

County, Georgia, in the late 1970s. Over 16,000 students were randomly assigned to three 

groups: standard driver education; an 80-hour long course including classroom, simulation, 

driving range, and on-the-road components; and a control group of no formal driver education. 

The initial analysis found no significant difference in crashes or traffic violations among the 

three groups (Smith, 1994). A second analysis, which tracked the students’ driving records for a 

longer period of time, found a slight crash reduction for standard course graduates during their 

first months of driving only, and no difference between the long course and no course graduates 

(Smith, 1994). See Vernick (1999) for brief summaries of all DeKalb study analyses. 

Based primarily on these results, NHTSA dropped driver education from its list of priority 

highway safety program areas for States (Smith, 1994). NHTSA concluded that driver education 

should be integrated into a GDL program. It also concluded that driver education should be 

“distributed over time.” NHTSA proposed a two-stage driver education system, both prelicensure and post-licensure. See Chapter 6, Section 2.2, for further discussion. 

As of July 2006, most States encouraged driver education by lowering the minimum learners, 

intermediate, or unrestricted licensing age for driver education graduates or by reducing the 

required number of supervised driving hours (IIHS, 2006). Based on the evaluation data 

discussed above, these driver education “discounts” likely increase rather than reduce crashes. A 

recent study in British Columbia supports this conclusion. Crash rates were 27-percent higher for 

driver education graduates, who reduced their learner’s permit holding period by three months, 

than for non-graduates (Wiggins, 2004). Two other current studies are examining the same issue 

(Hedlund and Compton, 2005). 
 6 - 15 

Use: There are no current data on the number of high schools that offer driver education or the 

number of teenagers who complete a driver education course. NHTSA and the American Driver 

and Traffic Safety Education Association (ADTSEA) plan to acquire these data shortly (Hedlund 

and Compton, 2005). There also are no data on commercial driver education courses or students. 

Effectiveness: Driver education leads to earlier licensure but does not reduce crash rates 

(Roberts et al, 2006; Vernick et al., 1999). 

Costs: Even a minimal driver education course of 30 hours in the classroom and 6 hours on the 

road requires extensive funds. Driver education also requires students to find time for it in their 

schedules of high school classes, extracurricular and summer activities, and jobs. 

Time to implement: A driver education course requires at least a year to plan and implement. 
 6 - 16 

2.2 Post-licensure or Second-tier Driver Education 

Effectiveness: Unknown Use: Low Cost: High Time: Long 

As discussed in Chapter 6, Section 2.1, standard pre-licensure driver education leads to earlier 

licensure but does not reduce crash rates. Based on this conclusion, recent driver education 

research has sought to develop post-licensure driver education curricula and to integrate driver 

education with GDL (Smith, 1994). These “second-tier” post-licensure courses teach safetyrelated information, building on the on-road experience that the students have acquired in their 

initial months of driving. They should not be confused with “advanced driving performance” 

courses that teach driving skills such as panic braking, skid control, and evasive lane-changing 

maneuvers. 

Previous post-licensure driver education courses were remedial, directed at drivers who had 

accumulated enough violations or crashes to warrant some attention. For this audience, driver 

education had no effect (Ker et al., 2005, 2006). 

Christie and colleagues have developed a model “best practice” curriculum for intermediate 

license drivers with at least six months of driving experience (Christie et al., 2004) in Australia. 

The 8-hour curriculum consists of eight modular sessions with a mentor or coach, including oneon-one driving and discussion, group observation and discussion of driving behavior, and 

telephone follow-up. A trial involving 14,000 intermediate drivers in New South Wales and 

Victoria, funded by a consortium of government bodies, insurers, industry groups, and 

automobile clubs, began in 2005. 

NHTSA is conducting a feasibility study in anticipation of a major evaluation of the benefits of 

an integrated driver education and GDL program (Hedlund and Compton, 2005). 

Use: Post-licensure driver education is still under development and is not in regular use in any 

State. 

Effectiveness: Post-licensure driver education has not yet been evaluated. 

Costs: If a post-licensure driver education program proves to be effective, it likely will require 

substantial funds to implement. 

Time to implement: Any course requires at least a year to plan and implement. 
 6 - 17 

3.1 Parental Role in Teaching and Managing Young Drivers 

Effectiveness: Varies Use: Medium Cost: Low Time: Short 

Most parents are heavily involved in teaching driving skills to their beginning teenage drivers 

and supervising their driving while they have a learner’s permit. Parents are in the best position 

to enforce GDL restrictions for intermediate drivers, and many parents impose additional driving 

restrictions on their teenagers. Parents strongly support GDL. But many parents do not 

understand the dangers of high-risk situations, such as driving with teenage passengers. Parents 

could use guidance and assistance in teaching and managing their teenage drivers (Hedlund et 

al., 2003; NCHRP, under review, Strategies C1-C4). Simons-Morton and Ouimet (2006) 

summarize the research on parent involvement in teen driving. 

Several programs to assist parents and beginning drivers have been developed recently. Four 

examples follow. The first, Checkpoints, is the only one with any evaluation data. There are no 

data yet on whether any of these programs reduces crashes. 

The central feature of the Checkpoints program, developed by Simons-Morton and colleagues at 

the National Institute of Child Health and Human Development, is a written agreement that 

parents and teens sign. The agreement limits teens' driving under various higher-risk situations, 

such as driving at night, with other teens in the car, or in bad weather. A supporting video and 

periodic newsletter explain the risks that new drivers face and reinforce the need for parents to 

limit their newly licensed teens' driving under these risky conditions (Simons-Morton and 

Hartos, 2003). 

Driving Skills for Life, developed by Ford and GHSA, emphasizes four skills: hazard 

recognition, vehicle handling, space management, and speed management (Ford and GHSA, 

2003). The program’s educational kit includes a video, guide, and brochure, and the Web site 

contains online learning material and parental tips and coaching guide. It has been sent to every 

public high school in the United States and the materials have reached an estimated 4 million 

teenagers and their parents. 

Road Ready Teens, developed by DaimlerChrysler together with AAA, MADD, and the National 

Safety Council, provides a parent’s guide, a parent-teen contract, and a video game and Road 

Ready Reality Check quiz for teens (DaimlerChrysler, 2003). 

The National Safety Council released its 68-page book, Teen Driver: A Family Guide to Teen 

Driver Safety, in 2004 (NSC, 2004). The book provides information and advice to parents and 

teens on crash risks, how to develop a family plan and written agreement for beginning drivers, 

and GDL components and restrictions. 

Use: Checkpoints is still being tested and has not been released to the general public. Teen 

Driver has been distributed to individual families upon request. Driving Skills for Life and Road 

Ready Teens are available on the Web. 

Effectiveness: Results from testing in several States show that the Checkpoints program 

increased parents’ restrictions on teen driving (Simons-Morton and Hartos, 2003; Simons-
 6 - 18 

Morton et al., 2005; Simons-Morton et al., 2006). None of the other programs has been 

evaluated. 

Two other parental assistance programs have been evaluated and were not successful. Each sent 

information on driving instruction and driving management to parents of teens who had just 

received their learner’s permits. Parents said that the information was helpful, but used the 

information in only a general way. The information had no effect on the amount or type of 

supervised driving during the learner’s stage or on parental restrictions on driving after licensure 

(Hedlund and Compton, 2005). 

Costs: Driving Skills for Life and Road Ready Teens are available on the Web at no cost. Teen 

Driver is available to parents and teenagers at minimal cost. 

Time to implement: The Checkpoints program has not been released for use by the general 

public. The other three programs are available immediately. 
 6 - 19 

4.1 Enforcement of GDL and Zero Tolerance Laws 

Effectiveness: Likely Use: Unknown Cost: Medium Time: Short 

Two traffic laws apply only to young drivers: GDL laws and zero tolerance laws that set a 

maximum BAC of .02 or less for drivers under the age of 21. As discussed in Chapter 1, Section 

6.2, zero tolerance laws are not actively publicized or enforced. It’s likely that increased 

publicity and enforcement would reduce teenage drinking and driving. 

GDL laws, discussed in Chapter 6, Sections 1.1-1.7, also appear not to be enforced vigorously. 

Some GDL provisions such as nighttime driving restrictions are inherently difficult to enforce 

because violations are difficult to detect (Hedlund et al, 2003). A recent study in one State found 

that intermediate license drivers and their parents were quite aware of their GDL law’s nighttime 

and passenger restrictions. Both restrictions were violated, though not frequently. Teenagers 

expressed little concern regarding GDL enforcement. Law enforcement officers were not 

familiar with GDL details and considered GDL enforcement a low priority (Hedlund and 

Compton, 2005). 

Parents are in the best position to enforce GDL requirements (Chapter 6, Section 3.1). However, 

some law enforcement support for GDL nighttime driving and teenage passenger restrictions 

may be useful to emphasize that the requirements are serious. GDL law violations are penalized 

by driver license actions, such as suspension or revocation of the learner’s permit or intermediate 

license or an extension of the time before full licensure. This means that they can be applied 

administratively and do not involve criminal court proceedings. As noted in Chapter 1, Section 

6.2, administrative penalties for zero tolerance laws are far easier to enforce than criminal 

penalties. 

 

Use: The amount of enforcement of zero tolerance and GDL laws is unknown but probably is 

low. 

Effectiveness: Zero-tolerance law publicity and enforcement likely will reduce teenage drinking 

and driving, as discussed in Chapter 1, Section 6.2. A 2005 study is investigating whether wellpublicized enforcement, including checkpoints near high schools, can increase compliance with 

GDL provisions (Hedlund and Compton, 2005). 

Costs: See Chapter 1, Section 6.2, for zero-tolerance law enforcement strategies and costs. GDL 

law enforcement costs will depend on how the enforcement is conducted. Enforcement through 

regular patrols will require moderate costs for training. Special patrols or checkpoints will 

require additional staff time. All enforcement will require good publicity to both teens and 

parents. Publicity to teens can be delivered through high schools, colleges, recreational venues 

attended by youth, and media directed to youth. 

Time to implement: Enforcement programs can be implemented within three or four months, as 

soon as appropriate training, publicity, and equipment are in place. 
 6 - 20 

Young Driver References 

AAA (2005). GDL Laws. Heathrow, FL: AAA Public Affairs. 

Baker, S.P., Chen, L-H., and Li, G. (2006). National Evaluation of Graduated Driver Licensing 

Programs. DOT HS 810 614. Washington DC: National Highway Traffic Safety Administration. 

www.nhtsa.gov/staticfiles/DOT/NHTSA/Communication%20&%20Consumer%20Information/

GDL_6-20-2006.pdf 

Christie, R., Harrison, W., and Johnston, D. (2004). Development of a Novice Driver Education 

Curriculum for the ATSB. Report CR 222. Canberra, Australia: Australian Transport Safety 

Bureau. www.atsb.gov.au/road/res-exec/cr222ex.cfm 

DaimlerChrysler (2003). Road Ready Teens. Auburn Hills, MI: DaimlerChrysler. 

www.roadreadyteens.org/index.html 

Ferguson, S.A. (2003). Other high-risk factors for young drivers - how graduated licensing does, 

doesn’t, or could address them. Journal of Safety Research 34(1), pp. 71-77. 

www.nsc.org/gdlsym/index.htm 

Ford and GHSA (2003). Driving Skills for Life. Dearborn, MI: Ford Motor Company. 

www.drivingskillsforlife.com/ 

Foss, R., and Goodwin, A. (2003). Enhancing the effectiveness of graduated driver licensing 

legislation. Journal of Safety Research 34(1), pp. 79-84. www.nsc.org/gdlsym/index.htm 

GHSA (2006). Graduated Licensing Laws. Washington, DC: Governors Highway Safety 

Association. 

www.statehighwaysafety.org/html/stateinfo/laws/license_laws.html 

Glassbrenner, D. (2004). Safety Belt Use in 2004: Use Rates in the States and Territories. DOT 

HS 809 813. Washington DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2004/809-813/ 

Glassbrenner, D. (2005). Safety Belt Use in 2005: Use Rates in the States and Territories. DOT 

HS 809 970. Washington DC: National Highway Traffic Safety Administration. wwwnrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809970.pdf. 

Hartling, L., Wiebe, N., Russell, K., Petruk, J., Spinola, C., and Klassen, T.P. (2006). Graduated 

driver licensing for reducing motor vehicle crashes among young drivers. The Cochrane 

Database of Systematic Reviews 2006, Issue 2. www.cochrane.org/reviews/en/ab003300.html 

Hedlund, J., and Compton, R. (2004). Graduated driver licensing research in 2003 and beyond. 

Journal of Safety Research 35(1), pp. 5-11. 
 6 - 21 

Hedlund, J., and Compton, R. (2005). Graduated driver licensing research in 2004 and 2005. 

Journal of Safety Research 36 (2), pp. 109-114. 

Hedlund, J., Shults, R.A., and Compton, R. (2003). What we know, what we don’t know, and 

what we need to know about graduated driver licensing. Journal of Safety Research 34(1), pp. 

107-115. www.nsc.org/gdlsym/index.htm 

Hedlund, J., Shults, R.A., and Compton, R. (2003). Graduated driver licensing and teenage 

driver research in 2006. Journal of Safety Research 37, pp. 107-121. 

IIHS (2005). Fatality Facts 2003: Teenagers. Arlington, VA: Insurance Institute for Highway 

Safety. 12.4.65.102/safety_facts/fatality_facts/teenagers.htm 

IIHS (2006). U.S. Licensing Systems for Young Drivers: Laws as of July 2006. Arlington, VA: 

Insurance Institute for Highway Safety. 

www.iihs.org/laws/state_laws/pdf/us_licensing_systems.pdf 

IIHS and TIRF (2004). Graduated Licensing: A Blueprint for North America. Arlington, VA: 

Insurance Institute for Highway Safety. www.hwysafety.org/research/topics/pdf/blueprint.pdf 

Ker, K., Roberts, I., Collier, T., Beyer, F., Bunn, F., and Frost, C. (2005). Post-license driver 

education for the prevention of road traffic crashes: a systematic review of randomised 

controlled trials. Accident Analysis and Prevention 37(2), pp. 305-313. 

Ker, K., Roberts, I., Collier, T., Beyer, F., Bunn, F., and Frost, C. (2006). Post-license driver 

education for the prevention of road traffic crashes. The Cochrane Database of Systematic 

Reviews 2006, Issue 2. www.cochrane.org/reviews/en/ab003734.html 

Lin, M-L., and Fearn, K.T. (2003). The provisional license: nighttime and passenger restrictions 

-- a literature review. Journal of Safety Research 34(1), pp. 51-61. 

www.nsc.org/gdlsym/index.htm 

Mayhew, D.R. (2003). The learner’s permit. Journal of Safety Research 34(1), pp. 35-43. 

www.nsc.org/gdlsym/index.htm 

Mayhew, D.R., Simpson, H.M., and Singhal, D. (2005). Best Practices for Graduated Driver 

Licensing in Canada. Ottawa, ON: Traffic Injury Research Foundation. 

www.trafficinjuryresearch.com/publications/pub_details.cfm?intPubID=204 

McKnight, A.J., and Peck, R.C. (2003). Graduated driver licensing and safer driving. Journal of 

Safety Research 34(1), pp. 85-89. www.nsc.org/gdlsym/index.htm 

NCHRP Report 500 (under review). A Guide for Addressing Collisions Involving Young Drivers.

Washington, DC: Transportation Research Board. www.ch2m.com/nchrp/over/default.htm 
 6 - 22 

NCUTLO (2000). Graduated Driver Licensing Model Law. Alexandria, VA: National 

Committee on Uniform Traffic Laws and Ordinances. www.ncutlo.org/gradlaw2.html 

NHTSA (2006). Traffic Safety Facts 2005. DOT HS 810 631. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pubs/tsf2005ee.pdf 

NHTSA and NIAAA (1999). Sentencing and Dispositions of Youth DUI and Other Alcohol 

Offenses: A Guide for Judges and Prosecutors. DOT HS 808 891. Washington, DC: National 

Highway Traffic Safety Administration. 

NSC (2004). Teen Driver: A Family Guide to Teen Driver Safety. Itasca, IL: National Safety 

Council. www.nsc.org/issues/teendriving/guide.htm 

Roberts, I., Kwan, I., and the Cochrane Injuries Group Driver Education Reviewers (2006). 

School based driver education for the prevention of traffic crashes. The Cochrane Database of 

Systematic Reviews 2006, Issue 2. www.cochrane.org/reviews/en/ab003201.html 

Shope, J.T., and Molnar, L.J. (2003). Graduated driver licensing in the United States: evaluation 

results from the early programs. Journal of Safety Research 34(1), pp. 63-69. 

www.nsc.org/gdlsym/index.htm 

Simons-Morton, B.G., and Hartos, J.L. (2003). How well do parents manage young driver crash 

risks? Journal of Safety Research 34(1), pp. 91-97. www.nsc.org/gdlsym/index.htm 

Simons-Morton, B.G., Hartos, J.L., Leaf, W.A., and Preusser, D. (2005). The persistence of 

effects of the Checkpoints program on parental restrictions of teen driving privileges. American 

Journal of Public Health 95(3), pp. 447-452. 

Simons-Morton, B.G., Hartos, J.L., Leaf, W.A., and Preusser, D. (2006). The effects of the 

Checkpoints program on parent-imposed driving limits and crash outcomes among Connecticut 

novice teen drivers at 6-months post-licensure. Journal of Safety Research 37(1), pp. 9-15. 

Simons-Morton, B.G. and Ouimet, M.C. (2006). Parent involvement in novice teen driving: a 

review of the literature. Injury Prevention 12(Suppl 1), pp. i30-i37. 

Simpson, H.M. (2003). The evolution and effectiveness of graduated licensing. Journal of Safety 

Research 34(1), pp. 25-34. www.nsc.org/gdlsym/index.htm 

Smith, M.F. (1994). Research Agenda for an Improved Novice Driver Education Program.

Report to Congress, May 31, 1994. DOT HS 808 161. Washington, DC: National Highway 

Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/research/pub/drive-ed.pdf 

Vernick, J.S., Li, G., Ogaitis, S., MacKenzie, E.J., Baker, S.P., and Gielen, A.C. (1999). Effects 

of high school driver education on motor vehicle crashes, violations, and licensure. American 

Journal of Preventive Medicine 16(1S), pp. 40-46. www.oshweb.com/s/AFRT-542JXK-01
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Wiggins, S. (2004). Graduated Licensing Program: Interim Evaluation Report - Year 3. 

Victoria, BC: Insurance Corporation of British Columbia. www.icbc.com 

Williams, A.F. (2003). Teenage drivers: patterns of risk. Journal of Safety Research 34(1), pp. 5-

15. www.nsc.org/gdlsym/index.htm 

Williamson, E. (2005). Parents Hand Out Keys, and a Monitoring Device. Washington Post, 

March 2, 2005, p. A1. www.washingtonpost.com/wp-dyn/articles/A64176-2005Mar1.html 
 7 - 1 

7. Older Drivers 

Overview

In 2004, almost 15 percent of licensed drivers in the United States were at least 65 years old. By 

2030 this proportion will rise to at least 20 percent. As drivers age, their physical and mental 

abilities, driving behaviors, and crash risks all change, though age itself does not determine 

driving performance. Many features of the current system of roads, traffic signals and controls, 

laws, licensing practices, and vehicles were not designed to accommodate older drivers. Older 

Americans are increasingly dependent on driving to maintain their mobility, independence, and 

health. The challenge is to balance mobility for older drivers with safety for all road users. 

Trends. From 1982 to 2004, the proportion of older licensed drivers (65 and above) rose from 

11.2 percent to 14.6 percent while the proportion of older drivers in fatal crashes rose slightly 

more rapidly, from 7.0 percent to 10.7 percent. 

People 65 and older; number and proportion of total populations 

65 & up resident population licensed drivers drivers in fatal crashes 

year million percent million percent percent 

1982 26.8 11.6 % 16.8 11.2 % 3,864 7.0 % 

2004 37.1 12.7 % 29.0 14.6 % 6,199 10.7 % 

2030 71.4* 19.1 %* 57- 61** > 20 %** ? ? 

Resident population: U.S. Census Bureau (2005) * estimated 

 Licensed drivers: FHWA Highway Statistics (1995, 2004) ** see discussion 

 Fatal crashes: NHTSA Traffic Safety Facts (2005) 

By 2030, the Census Bureau estimates that the resident population over age 65 will double, to 

over 71 million, and will comprise 19.1 percent of the total population. The licensed driver 

population likely will grow even faster. The proportion of people over age 65 who held a driver’s 

license rose from 63 percent in 1982 to 78 percent in 2004. If the licensure rate rises only to 80 

percent, by 2030 there will be twice as many older drivers in the United States as there are today 

– as many as 57 million licensed drivers 65 and older. Currently 91 percent of people 65 to 69 

are licensed, as are 86 percent of people 70 to 74. The licensure rate probably will increase 

because tomorrow’s older people likely will be healthier and more accustomed to driving than 

today’s. By 2030, if 85 percent of older people are licensed there will be 61 million licensed 

drivers at least 65 years old. 

Older driver characteristics. Certain changes are inevitable as drivers age (NCHRP, 2004, 

Section III). 

• Physical capabilities diminish. Hearing, muscle tone, reaction time, and vision (especially 

at night) all decline, though at very different rates for different people. 

• Fragility increases. The same force produces more serious injuries to a 70-year-old than 

to a 20-year-old. Injuries take longer to heal. 

• Older drivers use more medications, which may be necessary to control disease or health 

conditions but which also may cause drowsiness or otherwise affect driving. Older 
 7 - 2 

drivers are less likely than younger people to drive after drinking or using recreational 

drugs. 

• Older drivers rarely drive aggressively or speed. But they may exhibit other risky 

behaviors such as driving more slowly than prevailing traffic or not accurately judging 

the speed of an oncoming vehicle while making a left turn. 

• Most older drivers reduce their driving mileage as their lifestyles change. Many older 

drivers recognize and voluntarily avoid driving in situations in which they feel 

uncomfortable, such as at night, on high-speed roads, or in unfamiliar situations (Staplin 

and Lococo, 2003, p. 25). 

Fatal: crashes per 30,000 drivers (FARS) 

All: crashes per 100 drivers (GES) 

Source: IIHS (2005) 

These characteristics produce the following results. 

• The older driver crash rate per licensed driver is lower than for younger drivers. 

Crashes per Licensed Driver - 2004

0

4

8

12

16

20

16-20 21-24 25-34 35-44 45-54 55-64 65-74 >74

Driver Age

All crashes

Fatal crashes

Fatal Crashes per 100 Million VMT - 2001-02

0

2

4

6

8

10

16-19 20-24 25-34 35-44 45-54 55-64 65-74 >74

Driver Age
 7 - 3 

• Because older drivers are more fragile, a crash is more likely to produce a serious injury 

or fatality than for younger drivers. Thus the fatal crash rate per licensed driver increases 

for the oldest drivers. 

• And because older drivers drive fewer miles annually than younger drivers, their fatal 

crash rate per mile traveled is higher than for all but the youngest drivers. 

Strategies to Reduce Crashes and Injuries Involving Older Drivers 

The overall goal is to enable older drivers to retain as much mobility through driving as is 

consistent with safety on the road for themselves, their passengers, and other road users. “Safe 

mobility for life” is the phrase used in the U.S. Department of Transportation’s plan (USDOT, 

2003). Four behavioral strategies address this goal. 

• Educate and train older drivers to assess their driving capabilities and limitations, 

improve their skills when possible, and voluntarily limit their driving to circumstances in 

which they can drive safely. This can be accomplished through formal courses or through 

communications and outreach provided directly to older drivers or to families, friends, 

and organizations that deal regularly with older drivers. 

• Help drivers adapt to medical or functional conditions that may affect driving, through 

treatment (such as eyeglasses or cataract surgery to improve vision) or through vehicle 

adaptations (such as extra mirrors, extended gear shift levers, or hand controls). 

• Identify older drivers who cannot drive safely, in certain situations or at all, and restrict 

or revoke their driver’s licenses. This involves two steps: 

o Bring these drivers to the attention of the motor vehicle department through 

license renewal procedures or through referral from law enforcement, physicians, 

family, or friends. 

o At the motor vehicle department, assess their driving abilities and take appropriate 

action to re-issue an unrestricted license, issue a restricted license, or revoke the 

license. 

• Increase seat belt use, because seat belts are even more effective for older than for 

younger occupants. 

Vehicular, environmental, and societal strategies are critical to provide safety and mobility for 

older people. Vehicles can be designed with better crash protection for older and more easily 

injured occupants, with controls and displays that are easier to see and understand, and with 

crash warning and crash avoidance technology. These measures will make vehicles safer for 

everyone, not just older people. Aftermarket vehicle devices such as one-hand joystick driving 

controls can make driving possible or easier for people with some physical limitations. 

Roadways with separate left turn lanes, protected left turn signal phases, larger and more-visible 

signage, more-visible lane markings, rumble strips, and a host of other measures will assist all 

drivers. These subjects are not discussed in this guide because they do not fall under direct 

SHSO jurisdiction. 

Of all the problem areas in this guide, older drivers are perhaps the most complex because they 

involve so many issues beyond traffic safety. Sooner or later, in the interest of safety, most older 

drivers must restrict or eliminate driving. Frequently, this has substantial effects on the older 

driver’s mobility and on physical and mental health. SHSOs and licensing agencies cannot act 

alone but must plan and implement their older driver policies and programs as part of integrated 
 7 - 4 

community activities to improve older persons’ safety, mobility, and health. As just one 

example, some communities have established referral centers where people can go for “onestop” access to resources for addressing the full range of transportation safety and mobility 

issues, including driving skills assessment, educational courses, licensing regulations and 

practices, and public transportation. See Stutts (2005, Chapter 8) for summaries of 

comprehensive programs for older drivers in six States. 

Several recent studies and policy papers discuss these issues. See in particular the Department of 

Transportation’s Safe Mobility for a Maturing Society: Challenges and Opportunities (USDOT, 

2003) and NCHRP’s Guide for Addressing Collisions Involving Older Drivers (NCHRP, 2004) 

for excellent summaries and references to further information. OECD’s Ageing and Transport: 

Mobility Needs and Safety Issues (OECD, 2001) presents a discussion from an international 

perspective. The NCHRP synthesis Improving the Safety of Older Road Users (Stutts, 2005) 

summarizes State activities as of 2005. 

Key terms 

• AAA: formerly the American Automobile Association; the organization now uses only 

the initials 

• AAMVA: American Association of Motor Vehicle Administrators 

• AARP: formerly the American Association of Retired Persons; the organization now uses 

only the initials 

• AMA: American Medical Association 

• ASA: American Society on Aging 

• Older driver: a driver at least 65 years old 
 7 - 5 

Countermeasures That Work 

Countermeasures to improve older driver safety are listed below and discussed individually in 

this chapter. The table is intended to give a rough estimate of each countermeasure’s 

effectiveness, use, cost, and time required for implementation. The terms used are described 

below. Effectiveness, cost, and time to implement can vary substantially from State to State and 

community to community. Costs for many countermeasures are difficult to measure, so the 

summary terms are very approximate. See each countermeasure discussion for more information.

1. Communications and Outreach 

Countermeasure Effectiveness Use Cost Time 

1.1 Formal courses for older drivers Uncertain Low Low Short 

1.2 General communications and education Uncertain Unknown Low Short 

2. Licensing 

Countermeasure Effectiveness Use Cost Time 

2.1 License renewal policies Unknown Medium High Medium 

2.2 Referring older drivers to DMVs Proven Low Medium Medium 

2.3 License screening and testing Proven High* Medium Medium 

2.4 Medical advisory boards Unknown High* Varies Medium 

2.5 License restrictions Likely Unknown Low Short 

* Quality varies considerably 

3. Traffic Law Enforcement 

Countermeasure Effectiveness Use Cost Time 

3.1 Law enforcement roles Likely Medium Varies Varies 

Effectiveness: 

 Proven: demonstrated by several high-quality evaluations with consistent results. 

 Likely: balance of evidence from high-quality evaluations or other sources. 

 Uncertain: limited and perhaps ambiguous evidence. 

 Unknown: no high-quality evaluation evidence. 

 Varies: different methods of implementing this countermeasure produce different results. 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. 

See individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 

Use: 

 High: more than two-thirds of the States, or a substantial majority of communities. 

 Medium: between one-third and two-thirds of States or communities. 

 Low: fewer than one-third of the States or communities. 

 Unknown: data not available. 

Cost to implement: 

 High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 
 7 - 6 

demands on current resources. 

 Medium: requires some additional staff time, equipment, facilities, and/or publicity. 

 Low: can be implemented with current staff, perhaps with training; limited costs for 

 equipment or facilities. 

Time to implement: 

 Long: more than one year. 

 Medium: more than three months but less than one year. 

 Short: three months or less. 

These estimates do not include the time required to enact legislation or establish policies. 
 7 - 7 

1.1 Formal Courses for Older Drivers 

Effectiveness: Uncertain Use: Low Cost: Low Time: Short 

Formal courses specifically for older drivers are offered by organizations including AAA, 

AARP, and NSC, either independently or under accreditation by States (NCHRP, 2004, Strategy 

D2; Stutts, 2005, Table 12). AARP’s Driver Safety Program, formerly called “55-Alive,” is the 

oldest and largest. It has been conducted since 1979 and is offered both in the classroom and 

online (AARP, 2006). The courses typically involve 6 to 10 hours of classroom training in basic 

safe driving practices and in how to adjust driving to accommodate age-related cognitive and 

physical changes. In 2006, 34 States and the District of Columbia mandated automobile 

insurance discounts for graduates of accredited courses (AARP, 2006). 

Courses combining classroom and on-the-road instruction have been offered recently in a few 

locations (NCHRP, 2004, Strategy D2). 

Use: Courses are taught in all States but reach only a small fraction of older drivers. For 

example, AARP reported that it conducted almost 34,000 classes in 2003 for 700,000 drivers, 

approximately 2.4 percent of the licensed drivers 65 and older (AARP, 2005). 

Effectiveness: AARP course graduates report that they changed some driving behaviors as a 

result of the course (AARP, 2005). However, none of the courses has been shown to reduce 

crashes (NCHRP, 2004, Strategy D2). NHTSA’s Older Road User Research Plan includes the 

high-priority research problem statement, “Do assessment and retraining programs improve 

driving?” (Raymond et al., 2001, Table 1). The most thorough evaluation studied approximately 

200,000 course graduates and a 360,000-driver comparison group in California from 1988 to 

1992. It found that course graduates had fewer citations but no fewer crashes than non-graduates 

(Janke, 1994; NCHRP, 2004, Strategy D2). AARP also concluded that its course reduces 

citations but has not been shown to reduce crashes (AARP, 2005). 

A recent study evaluated the effects of a well-designed three-hour educational course promoting 

safe driving strategies for older drivers with some visual defects. Course graduates reported that 

they regulated their driving more following the course than a control group that did not attend the 

course. There was no significant difference in crash rates between course graduates and the 

control group (Owsley et al, 2004). 

Costs: Courses typically charge a small fee, which may be offset by insurance discounts 

available to graduates. 

Time to implement: Courses are offered regularly by AAA, AARP, NSC, and other 

organizations. 
 7 - 8 

1.2 General Communications and Education 

Effectiveness: Uncertain Use: Unknown Cost: Low Time: Short 

Many organizations offer educational material for older drivers to inform them of driving risks, 

help them assess their driving knowledge and capabilities, suggest methods to adapt to and 

compensate for changing capabilities, and guide them in restricting their driving in more risky 

situations (NCHRP, 2004, Strategy D2). 

Self-assessment tools include: 

• AAA’s Roadwise Review, a CD-ROM and instruction booklet; 

• AARP’s Older Driver Skill Assessment and Resource Guide; 

• AMA’s Am I a Safe Driver? one-page checklist; and 

• University of Michigan’s Driving Decisions Workbook. 

See Stutts (2005, Table 12) for brief descriptions and Web links. 

Other programs and materials include: 

• Drive Well, a joint program of ASA and NHTSA; 

• Getting Around, from Emergency Nurses CARE, on safe driving decisions, pedestrian 

safety, and safe medication use; and 

• Information from NHTSA and many State motor vehicle offices on general issues of 

older drivers or specific topics such as driving with glaucoma or arthritis. 

See NCHRP (2004, Strategy D2) and Stutts (2005, Table 12) for examples, brief descriptions, 

and Web links. 

 

Other materials are available to assist drivers and family members in understanding how aging 

affects driving, the effects of medications and health conditions, how to assess an older driver’s 

skills, how to use specialized vehicle equipment to adapt to certain physical limitations, how to 

guide older drivers into voluntarily restricting their driving, and how to report older drivers to the 

department of motor vehicles if necessary (Stutts, 2005, Chapter 6). Examples include: 

• AAA’s How to Help an Older Driver; 

• AARP’s At the Crossroads: A Guide to Alzheimer’s Disease, Dementia and Driving; 

• The Association for Driver Rehabilitation Specialists’ series of fact sheets on issues such 

as driving after a stroke, driving with rheumatoid arthritis, and driving after a limb 

amputation; and 

• New York State Office for the Aging’s When You Are Concerned: A handbook for 

families, friends and caregivers worried about the safety of an aging driver. 

• NHTSA’s series of fact sheets and more detailed information for older drivers and their 

families and friends, available from NHTSA’s older driver program Web site 

www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.31176b9b03647a189ca8e410dba046a0/. 

Use: Data are not available on how frequently these programs or materials are used. 

Effectiveness: The limited information available suggests that some materials may increase 

driver’s knowledge. There are no evaluations of the effects of these materials on driving or on 

crashes (NCHRP, 2004, Strategy D2). As discussed in Chapter 7, Section 1.1, none of the more 
 7 - 9 

structured formal courses has been shown to reduce crashes. NHTSA’s Older Road User 

Research Plan includes the high-priority research problem statement, “Do assessment and 

retraining programs improve driving?” (Raymond et al., 2001, Table 1). 

Costs: Funds are required for producing and distributing materials. 

Time to implement: Materials and programs are available and ready for use. 

Other issues: 

• Safety belt use: Seat belts are even more effective in preventing injuries and fatalities to 

older than to younger occupants (NCHRP, 2004, Strategy E1). While belt use among 

older occupants is high compared to other occupants - 81 percent for occupants 70 and 

older in 2003, compared to 80 percent for occupants 25 to 69 (Glassbrenner, 2004, Table 

5) - one-fifth of older occupants are unbelted. Communications and outreach on the seat 

benefits of belt use may be more effective with older occupants than with younger 

because they may be more attentive to health and safety issues. For example, signs urging 

seat belt use increased belt use substantially in six senior communities compared to 

controls, and use remained higher after four years (Cox et al., 2005). No other State or 

local seat belt use efforts directed at older occupants have been identified (NCHRP, 2004, 

Strategy E1). 
 7 - 10 

2.1 License Renewal Policies: In-Person Renewal, Vision Test 

Effectiveness: Unknown Use: Medium Cost: High Time: Medium 

Driver’s licenses in most States are valid for four to six years, longer in a few States. To renew 

an expiring license, drivers in many States must appear in person, pay the license fee, and have 

new pictures taken for their licenses. A few States require a vision test for license renewal. Some 

States allow all drivers to renew by mail or electronically. 

More than half the States change license renewal requirements for drivers older than a specified 

age, typically 65 or 70. These changes may include a shorter interval between renewals, inperson renewal (no renewal by mail or electronically), or a vision test at every renewal. A very 

few States require written or road tests for some older renewal applicants. AAA (2006), IIHS 

(2006), and Stutts (2005, Chapter 5) summarize these requirements. NHTSA (2003b, Chapter 8) 

and Staplin and Lococo (2003, Appendix B) provide more detail on the requirements in effect in 

2001. 

License examiners report that the driver’s appearance at the motor vehicle office is the single 

most important criterion for identifying a person of any age whose driving skills may be 

impaired (NCHRP, 2004, Strategy C2). This observation is supported by Morrisey and 

Grabowski (2005), who found that in-person license renewal reduced traffic fatalities among the 

oldest drivers. Frequent in-person renewals and vision tests may be more useful for older drivers 

than for younger drivers because their abilities may change more quickly. AAMVA recommends 

that all drivers renew licenses in person and pass a vision test at least every four years (Staplin 

and Lococo, 2003, p. 54; Stutts, 2005, Chapter 5). Very few States meet these recommendations 

for all drivers. As of 2001, about one-fourth of the States met them for drivers over some 

specified age (Staplin and Lococo, 2003, Appendix B). In-person renewals would be even more 

useful, for drivers of all ages, if they included functional ability tests as recommended in the 

NHTSA-AAMVA Model Driver Screening and Evaluation Program Guidelines for Motor 

Vehicle Administrators (Staplin and Lococo, 2003) (see Chapter 7, Section 2.3). 

Use: At least 30 States and the District of Columbia have different license renewal requirements 

for older than for younger drivers (AAA, 2006; IIHS, 2006). These include 15 States with a 

shorter interval between renewals, seven that require in-person renewals, and nine plus the 

District of Columbia that require vision tests at renewal. On the other hand, Oklahoma and 

Tennessee reduce or waive licensing fees for older drivers and Tennessee driver’s licenses issued 

to persons 65 or older do not expire. In 2001, about 12 States met the AAMVA 

recommendations of in-person renewal, with a vision test, at least every four years for all drivers 

over some specified age (Staplin and Lococo, 2003, Appendix B). 

Effectiveness: License examiners report that in-person renewals and vision tests are effective in 

identifying people whose driving skills may be impaired (NCHRP, 2004, Strategy C2). No data 

are available on the number of potentially impaired drivers identified through these practices or 

on the effects of more frequent renewals and vision tests on crashes. 

Costs: More-frequent license renewals or additional testing at renewal impose direct costs on 

driver licensing agencies. For example, a State that reduces the renewal time from 6 years to 3 
 7 - 11 

years for drivers 65 and older would approximately double the licensing agency workload 

associated with these drivers. If 15 percent of licensed drivers in the State are 65 and older, then 

the agency’s overall workload would increase by about 15 percent to process the renewals. If 

more frequent renewals and vision tests identify more drivers who require additional screening 

and assessment, then additional costs are imposed. See Chapter 7, Section 2.3, for additional 

discussion. 

Time to implement: A vision test requirement for renewal or a change in the renewal interval 

can be implemented within months. The new requirements will not apply to all drivers for 

several years, until all currently valid licenses have expired and drivers appear at the driver 

licensing agency for licensing renewal. 

Other issues: 

• Age discrimination: A few States explicitly provide that age alone is not a justification 

for reexamining a driver’s qualifications (AAA, 2006; IIHS, 2006). These States have the 

same license renewal interval for all drivers.

• Road tests and medical reports: Several Australian States require a medical report, a 

road test, or both for drivers over a specified age to renew their licenses. Langford et al. 

(2004) compared States with and without these requirements. They found that States with 

these requirements had higher older-driver crash rates than States without them. They 

conclude that there are “no demonstrable road safety benefits” to requiring medical 

reports or road tests for older drivers.
 7 - 12 

2.2 Referring Older Drivers to Licensing Agencies 

Effectiveness: Proven Use: Low Cost: Medium Time: Medium 

Older drivers come to the attention of licensing agencies at regular license renewals, as discussed 

in Chapter 7, Section 2.1, or when they are referred to the licensing agency for reevaluation of 

their driving skills. 

Licensing agencies in all States accept reevaluation referrals for drivers of any age. A survey of 

all State licensing agencies found that 85 percent of referrals came from three sources: 37 

percent from law enforcement, 35 percent from physicians and other medical professionals, and 

13 percent from family and friends (Stutts, 2005, Table 11). The remaining 15 percent came 

from crash and violation record checks, courts, self-reports, and other sources. 

Law enforcement officers have the opportunity to observe drivers directly at traffic stops or 

crashes. With appropriate training they can identify many drivers who should be referred to the 

licensing agency for assessment. NHTSA has developed and field-tested a set of cues that 

officers can use to identify potentially impaired drivers (NHTSA, 1998; see also NCHRP, 2004, 

Strategy C3 and Stutts, 2005, Chapter 7). 

Physicians are in an excellent position to assess if changes in their patients’ physical or cognitive 

abilities may increase their crash risk. In addition to assessment, physicians should provide 

counseling and assistance on driving as needed and refer patients to the licensing agency if 

appropriate. In six States, physicians are required to report patients who have specific medical 

conditions such as epilepsy or dementia (NCHRP, 2004, Strategy C3). Other States require 

physicians to report “unsafe” drivers, with varying guidelines for defining “unsafe.” Physicians 

must balance their legal and ethical responsibilities to protect their patient’s physical and mental 

health and their patient confidentiality obligations with their duty to protect the general public 

from unsafe drivers. Physicians have been held liable for damages from crashes involving 

patients whom they failed to advise of medical conditions that may affect their driving or failed 

to report to the licensing agency (NHTSA, 2003b, Chapter 7). 

NHTSA’s Physician’s Guide to Assessing and Counseling Older Drivers (NHTSA, 2003b), 

prepared in cooperation with the AMA, provides detailed information for physicians and medical 

professionals. Chapter 8 has an extensive summary of State licensing and reporting laws. 

Chapter 9 contains a list of medical conditions and medications that may impair driving and 

consensus recommendations on what action to take for each. Other chapters include information 

on treatment and rehabilitation options that may allow patients to continue to drive and on how 

to counsel patients about retiring from driving. See also Lococo (2003, Appendix C) for Statelevel information and NCHRP (2004, Strategy C3) for overall discussion. 

Many States have established procedures for family members and friends to report drivers of any 

age whose abilities may be impaired. NCHRP (2004, Strategy C3) provides examples and Web 

links for programs in Florida, Missouri, Minnesota, and Oregon. 

States can increase driver referrals by establishing and publicizing procedures for referring 

drivers, establishing referral policies and providing appropriate training and materials to law 
 7 - 13 

enforcement officers, and informing physicians and health professionals of their responsibilities. 

NCUTLO’s model law on reporting drivers with a physical or mental disability (NCUTLO, 

2005) describes the responsibilities of health care providers and of State Medical Advisory 

Boards, driver licensing agencies, and license examiners. 

Use: A survey of all State licensing agencies found that fewer than 100,000 drivers 65 and older 

are referred each year from all sources, or fewer than 0.4 percent of the 28.6 million older 

licensed drivers (Stutts, 2005, Appendix E). The number of referrals varies substantially across 

the States, from a few hundred to 50,000. 

Effectiveness: States that establish and publicize effective referral procedures will increase 

referrals. NCHRP (2004, Strategy C3) provides examples and Web links. As one example, 

Pennsylvania increased physician referrals substantially by sending letters to all physicians 

(NCHRP, 2004, Strategy C3). 

Costs: Costs for establishing and publicizing effective referral procedures vary depending on the 

procedures adopted, but should not be extensive. Educational and training materials are available 

for use with law enforcement and medical professionals. Funds will be required to distribute 

these materials and for general communications and outreach. If referrals increase substantially, 

then licensing agency administrative costs will increase. 

Time to implement: States seeking to improve referrals will require at least six months to 

develop, implement, and publicize new policies and procedures. 
 7 - 14 

2.3 License Screening and Testing 

Effectiveness: Proven Use: High* Cost: Medium Time: Medium 

* Quality varies considerably 

State licensing agencies vary considerably in their procedures for screening and evaluating a 

driver’s abilities and skills (NCHRP, 2004, Strategy C2). Many State guidelines are outdated, 

incomplete, or not based on actual functional impairment. Most do not include all the 

recommendations on medical conditions from the recent Physician’s Guide (NHTSA, 2003b). 

NHTSA and AAMVA have developed Model Driver Screening and Evaluation Program 

Guidelines for Motor Vehicle Administrators (Staplin and Lococo, 2003). This was the final 

stage in a research program that investigated the relationships between functional impairment 

and driving skills; methods to screen for functional impairment; and the cost, time, legal, ethical, 

and policy implications of the guidelines (Staplin et al., 2003a). 

The Model Driver Guidelines’ goal is to keep drivers on the road as long as they are safe, 

through early identification and assessment together with counseling, remediation, and license 

restriction when needed (Staplin and Lococo, 2003, p. v). The guidelines outline a complete 

process of driver referral, screening, assessment, counseling, and licensing action (Staplin and 

Lococo, 2003, pp. 38-39). They include nine simple visual inspection tests that licensing agency 

personnel can administer to screen for functional ability (Staplin and Lococo, 2003, Table 2). A 

survey of State motor vehicle departments outlines some of the legal, policy, cost, and other 

criteria that must be met before the guidelines could be implemented in some States (Staplin and 

Lococo, 2003, Appendix C). The guidelines were tested in Maryland (Staplin et al., 2003b). 

Use: All States screen and test drivers referred to them, though their procedures and criteria vary 

considerably (NCHRP, 2004, Strategy C2). No State appears to have implemented the model 

guidelines. U.S. DOT recommends that further testing and evaluation of the guidelines are 

needed (USDOT, 2003, p. 15). 

Effectiveness: There is substantial evidence that State screening and assessment programs 

identify some drivers who should not be driving at all or whose driving should be limited. The 

Maryland pilot test of the model guidelines concluded that “the analysis results ... have provided 

perhaps the best evidence to date that functional capacity screening, conducted quickly and 

efficiently, in diverse settings, can yield scientifically valid predictions about the risk of driving 

impairment experienced by older individuals” (Staplin et al., 2003b, Chapter 5). 

Costs: The model guideline functional screening tests can be administered for less than $5 per 

driver, including administrative and support service costs (Staplin et al., 2003a, p. 32). 

Time to implement: States should be able to modify their driver license screening and 

assessment procedures in four to six months. 
 7 - 15 

2.4 Medical Advisory Boards 

Effectiveness: Unknown Use: High* Cost: Varies Time: Medium 

* Quality varies considerably 

Thirty-five States and the District of Columbia have medical advisory boards (MABs) to assist 

the licensing agencies in evaluating people with medical conditions or functional limitations that 

may affect their ability to drive (NCHRP, 2004, Strategy C1). MABs generally make policy 

recommendations on what licensing actions are appropriate for people with specific medical 

conditions or functional limitations. Most State MABs review individual cases, though this 

activity varies widely: seven States reported that their MABs review 1,000 cases or more 

annually while another seven review 10 or fewer cases (Lococo, 2003, Table D-6). 

In 2003, NHTSA and AAMVA surveyed MAB practices in all States. Lococo (2003) contains 

the results: detailed documentation of how each State’s medical review is organized; how drivers 

are identified, referred, screened, and assessed; and what licensing actions can be taken. 

MABs should play a key role in each State as the link between health care professionals, 

licensing agencies, law enforcement, and the public. They should take the lead in defining how 

various medical conditions and functional impairments affect driving; defining medical 

assessment and oversight standards; improving awareness and training for healthcare providers, 

law enforcement, and the public; advising health care professionals how drivers can compensate 

for certain medical conditions or functional impairments; and reviewing individual cases. AAA 

has developed its list of best practices and recommendations for MABs based on the NHTSAAAMVA study findings (AAA, 2004). NTSB has made similar recommendations (NTSB, 2004). 

In June 2005, NHTSA released a summary of recommended strategies for MABs and national 

medical guidelines for driving, prepared in collaboration with AAMVA (Lococo and Staplin, 

2005). 

Use: 35 States and the District of Columbia have MABs, though some are inactive (NCHRP, 

2004, Strategy C1). 

Effectiveness: There are no studies evaluating the effects of MABs. Maryland’s MAB reviewed 

over 500 individual cases in 2004 and recommended license suspension for about two-thirds of 

the cases (C. Soderstrom, personal communication, April 2005). 

Costs: MABs are comprised of physicians and other health care professionals together with 

appropriate administrative staff. Costs will be minimal for an MAB whose activities are limited 

to policy recommendations. Costs for an MAB that evaluates individual cases will depend on the 

caseload. 

Time to implement: States probably will need at least a year to establish and staff an MAB, 

depending on what duties the MAB undertakes. States likely can expand the functions of an 

existing MAB in six months. 
 7 - 16 

2.5 License Restrictions 

Effectiveness: Likely Use: Unknown Cost: Low Time: Short 

If a State licensing agency determines through screening, assessment, medical referrals, road 

tests, or other means that a driver poses excessive risks only in certain situations, the driver can 

be issued a restricted license. This process of “graduated de-licensing” preserves the driver’s 

mobility while protecting the driver, passengers, and others on the road. Drivers whose vision is 

adequate during daylight hours but not at night present an obvious example. Their licenses can 

be restricted to daylight driving only. Other common restrictions limit driving to a specific 

geographical area, such as the town or county where the driver lives, or limit driving only to lowspeed roads. 

Iowa issues restricted licenses as part of its overall older driver program (Chaudhary, 2005). As 

an example, drivers referred to the licensing agency for retesting who feel uncomfortable taking 

a driving test in strange surroundings can arrange to be tested in their hometowns. If they pass 

the test, they will be issued a license restricted to that town. About 2 percent of older drivers’ 

licenses in Iowa are restricted to daytime driving and another 2 percent to a limited geographic 

area. 

Use: Iowa and Utah are known to issue restricted licenses (Chaudhary, 2005; Stutts, 2005, 

Chapter 5; Vernon et al., 2001). A survey of State licensing agencies found that two-thirds of the 

States said that restricted licenses would be feasible under current State policies, though twothirds of these would require legislative changes before restricted licenses could be issued 

(Staplin and Lococo, 2003, Appendix C). The number of States that currently issue restricted 

licenses to older drivers is not known. 

Effectiveness: Several studies show that driver license restrictions lower the crash risk for these 

drivers, though their crash risk is still higher than for similar-age drivers with unrestricted 

licenses (NCHRP, 2004, Strategy C2; Vernon et al., 2001). 

Costs: Once drivers have been screened and assessed, the costs of issuing a restricted license are 

minimal. 

Time to implement: Restricted licenses can be implemented as soon as any needed policy or 

legislation changes are enacted. 
 7 - 17 

3.1 Law Enforcement Roles 

Effectiveness: Likely Use: Medium Cost: Varies Time: Varies 

Law enforcement plays three overall roles in improving the safety of older drivers: 

• Enforce traffic laws. In particular, active publicized enforcement of seat belt use laws can help 

increase belt use for older drivers and occupants. See Chapter 7, Section 1.2, for discussion. 

• Identify drivers with potential driving impairments and refer them to licensing agencies. 

Traffic stops and crash investigations provide officers excellent opportunities to observe and 

evaluate driving behavior. See Chapter 7, Section 2.2, for discussion. 

• Provide information and education. Law enforcement officers have formed many partnerships 

with public and private organizations to give talks, teach safe driving courses, work with 

media on news stories and PSAs, and other communications and outreach initiatives. Stutts 

(2005, Chapter 7) summarizes several examples. NHTSA (2003a) lists law enforcement 

programs that were active in 2003. They include training for officers, training for older 

drivers, and community relations programs that promote safety. 

NHTSA’s Older Driver Law Enforcement Course is scheduled to be released in 2006. The fourhour course provides background on older driver issues and discusses traffic stops, referring 

older drivers to licensing agencies, and community outreach. The course will be available on 

NHTSA’s older driver program Web site at 

www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.31176b9b03647a189ca8e410dba046a0/. 

Use: NHTSA (2003a) describes older driver programs in 28 States. 

Effectiveness: Enforcement activities, such as high-visibility safety belt law enforcement, 

probably affect older drivers even more than other drivers. Law enforcement provides more than 

one-third of all referrals to licensing agencies for driver screening and assessment (Chapter 7, 

Section 2.2). 

Costs: Costs vary depending on the nature and scope of activities. 

Time to implement: Implementation time varies depending on the nature and scope of activities. 
 7 - 18 

Older driver references 

AAA (2004). AAA Basic Best Practices for Medical Advisory/Review Boards. Heathrow, FL: 

American Automobile Association. www.aaanewsroom.net/Files/seniorbestpractices.doc 

AAA (2005). Senior Licensing Laws. Heathrow, FL: American Automobile Association. 

www.aaaexchange.com/Main/Default.asp?SearchText=Senior+Licensing+Laws&Button_DoSea

rch.x=9&Button_DoSearch.y=8 

AARP (2005). Driver Safety. Washington, DC: AARP. www.aarp.org/life/drive/ 

AARP (2006). Driver Safety. Washington, DC: AARP. www.aarp.org/life/drive/ 

Chaudhary, N. (2005). Personal communication. 

Cox, C.D., Cox, B.S., and Cox D.J. (2005). Long-term benefits of prompts to use safety belts 

among drivers exiting senior communities. Journal of Applied Behavior Analysis 38(4), pp. 533-

536. www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1309715 

FHWA (1995). Licensed Drivers by Sex and Age Group, 1963-1995. Washington, DC: Federal 

Highway Administration. www.fhwa.dot.gov/ohim/summary95/dl220.pdf 

FHWA (2005). Distribution of Licensed Drivers 2004; Table DL-20. Highway Statistics 2004.

Washington, DC: Federal Highway Administration. 

www.fhwa.dot.gov/policy/ohim/hs04/pdf/dl20.pdf 

Glassbrenner, D. (2004). Safety Belt Use in 2003 - Demographic Characteristics. DOT HS 809 

729. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/airbags/809729.pdf 

IIHS (2006). U.S. Driver Licensing Renewal Procedures for Older Drivers. Arlington, VA: 

Insurance Institute for Highway Safety. www.iihs.org/laws/state_laws/older_drivers.html 

IIHS (2005). Fatality Facts 2003: Older People. Arlington, VA: Insurance Institute for Highway 

Safety. www.hwysafety.org/safety%5Ffacts/fatality%5Ffacts/pdfs/olderpeople.pdf 

Janke, M.K. (1994). The Mature Driver Improvement Program in California. Sacramento, CA: 

California Department of Motor Vehicles. 

Langford, J., Fitzharris, M., Koppell, S., and Newstead, S. (2004). Effectiveness of mandatory 

license testing for older drivers in reducing crash risk among urban older Australian drivers. 

Traffic Injury Prevention 5(4), pp. 326-335. 

Lococo, K.H. (2003). Summary of Medical Advisory Board Practices in the United States.

Washington, DC: U.S. Department of Transportation. 

www.aamva.org/drivers/drvProblemDriversMedicalAdvisoryBoardPractices.asp 
 7 - 19 

Lococo, K.H., and Staplin, L. (2005). Strategies for Medical Advisory Boards and Licensing 

Review. DOT HS 809 874. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/research/MedicalAdvisory/pages/Job%201602%20-

%20final%20new.pdf 

Morrisey, M.A. and Grabowski, D.C. (2005). State motor vehicle laws and older drivers. Health 

Economics 14(4), pp. 407-419. 

NCHRP Report 500, Vol. 9 (2004). A Guide for Reducing Collisions Involving Older Drivers.

Washington, DC: Transportation Research Board. 

http://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_500v9.pdf 

NCUTLO (2005). Reporting of Driver Impairment Model Law. Alexandria VA: National 

Committee on Uniform Traffic Laws and Ordinances. www.ncutlo.org/impairment.htm 

NHTSA (1998). Older Drivers: Cues for Law Enforcement. DOT HS 808 778. Washington, DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/olddrive/cuesindex.html 

NHTSA (2003a). A Compendium of Law Enforcement Older Driver Programs. Washington, DC: 

www.nhtsa.dot.gov/people/injury/olddrive/LawEnforcementOlderDriver03/index.htm 

NHTSA (2003b). Physician’s Guide to Assessing and Counseling Older Drivers. DOT HS 809 

647. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.gov/people/injury/olddrive/OlderDriversBook/index.html 

NTSB (2004). Highway Special Investigation Report: Medical Oversight of Noncommercial 

Drivers. Washington, DC: National Transportation Safety Board. NTSB/SIR-04/01 PB2004-

917002 www.ntsb.gov/publictn/2004/SIR0401.pdf 

NHTSA (2005). Traffic Safety Facts 2004. DOT HS 809 919. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pdf/nrd30/NCSA/TSFAnn/TSF2004.pdf 

OECD (2001). Ageing and Transport: Mobility Needs and Safety Issues. Paris, France: 

Organization for Economic Cooperation and Development. 

www.oecd.org/dataoecd/40/63/2675189.pdf 

Owsley, C., McGwin, Jr. G., Phillips, J.M., McNeal, S.F., and Stalvey, B.T. (2004). Impact of an 

education program on the safety of high-risk, visually impaired, older drivers. American Journal 

of Preventive Medicine 26(3), pp. 222-229. 

Raymond, P., Knoblauch, R., and Nitzburg, M. (2001). Older Road User Research Plan. DOT 

HS 809 322. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/olddrive/OlderRoad/index.htm 
 7 - 20 

Staplin, L., and Lococo, K.H. (2003). Model Driver Screening and Evaluation Program. Vol. 3: 

Guidelines for Motor Vehicle Administrators. DOT HS 809 581. Washington, DC: National 

Highway Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/olddrive/modeldriver/ 

Staplin, L., Lococo, K.H., Gish, K.W., and Decina, L.E. (2003a). Model Driver Screening and 

Evaluation Program. Vol. 1: Project Summary and Model Program Recommendations. DOT HS 

809 582. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/olddrive/modeldriver/ 

Staplin, L., Lococo, K.H., Gish, K.W., and Decina, L.E. (2003b). Model Driver Screening and 

Evaluation Program. Vol. 2: Maryland Pilot Older Driver Study. DOT HS 809 583. Washington, 

DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/olddrive/modeldriver/ 

Stutts, J.C. (2005). Improving the Safety of Older Road Users. Final report, NCHRP Synthesis 

Project 20-5, Synthesis Topic 35-10. Washington, DC: Transportation Research Board. 

U.S. Census Bureau (2004). U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin.

Washington, DC: www.census.gov/ipc/www/usinterimproj/natprojtab02a.pdf 

USDOT (2003). Safe Mobility for a Maturing Society: Challenges and Opportunities.

Washington, DC: U.S. Department of Transportation. 

http://ostpxweb.dot.gov/policy/Data/SafeMobility.pdf 

Vernon, D.D., Diller, E., Cook, L., Reading, J., and Dean, J.M. (2001). Further Analysis of 

Drivers Licensed with Medical Conditions in Utah. DOT HS 809 211. Washington, DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/olddrive/utah/utah_index.htm 
 8 - 1 

8. Pedestrians

Overview 

In 2005, 4,881 pedestrians died and about 64,000 were injured in traffic crashes in the United 

States. Pedestrians accounted for 10 percent of total traffic fatalities and slightly more than two 

percent of total injuries (NHTSA, 2006, Table 53). Of the pedestrian casualties: 

• 388 fatalities and 18,000 of the injured were children age 15 and younger; 

• 981 fatalities and 5,000 of the injured were older adults age 65 and above; 

• 1,741 of those fatally injured had a positive blood alcohol concentration (NHTSA, 2005, 

Tables 94 and 82). 

See NHTSA’s most recent Traffic Safety Facts for the latest data. 

Trends. Pedestrian fatalities have dropped gradually over the past 20 years from about 7,000 to 

less than 5,000 annually. The amount of walking appears to have decreased during the 1980s and 

then may have increased during the 1990s. Between 1980 and 1990, the percentage of 

commuting trips made by walking and bicycling dropped from 6.7 percent to 4.4 percent; the 

figure dropped again, to 3.3 percent, in 2000. However, commuting is reported to account for 

only about 15 percent of all trips. Total walking trips appear to have risen from 7.2 percent of all 

trips in 1990 to 8.7 percent in 2001 (UNC HSRC, 2004), based on data from NHTSA’s 1990 

Nationwide Personal Transportation Survey (NPTS) and the 2001 successor National Household 

Travel Survey (NHTS), though the NPTS and NHTS surveys used somewhat different 

methodologies. 

 

Source: FARS

The age distribution of pedestrian fatalities has changed over the last decade. From 1995 to 2005, 

pedestrian fatalities decreased for all ages except 40 to 59. In particular, child pedestrian 

fatalities (ages below 16) decreased 49 percent, from 754 to 388. 

US pedestrian fatalities

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Year

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Year

U.S. Pedestrian Fatalities
 8 - 2 

Source: FARS 

Pedestrian crashes can be classified into types based on crash location and pedestrian and motor 

vehicle actions. In the early 1990s this methodology was used to classify more than 5,000 

pedestrian crashes in California, Florida, Maryland, Minnesota, North Carolina, and Utah 

(Hunter et al, 1996, summarized in www.walkinginfo.org/pc/types.cfm). Of these pedestrian 

crashes: 

• The largest major grouping was crashes occurring at or within 50 feet of an intersection, 

accounting for 32.2 percent of all crashes. Of these intersection crashes, 30 percent 

involved a turning vehicle; another 22 percent involved a pedestrian running across the 

intersection or darting out in front of a vehicle from a location where the pedestrian 

could not be seen, and 16 percent involved a driver violation. 

• The second major grouping was crashes occurring in the middle of a block, accounting 

for 26.5 percent. In one-third of these, the pedestrian ran into the street and the driver’s 

view was not obscured; one-sixth were “dart-outs” in which the pedestrian walked or ran 

into the street from a location where the pedestrian could not be seen. 

• Only seven percent of the crashes involved a pedestrian walking along a roadway not on 

a sidewalk. In three-quarters of these crashes the pedestrian was struck from behind 

while walking in the direction of traffic. 

Different crash types at different locations can be addressed by different countermeasures. The 

crash typing methodology is available as the Pedestrian and Bicycle Crash Analysis Tool 

(PBCAT) software. States and communities can use PBCAT to analyze pedestrian crashes and 

select countermeasures. PBCAT may be downloaded from www.walkinginfo.org/pc/pbcat.cfm. 

Strategies to Increase Pedestrian Safety

Countermeasures in this Chapter are organized by pedestrian type: 

• Young children; 

• School-age children; 

• Adults, including highway construction workers; and 

• Alcohol-impaired pedestrians. 

A final group contains countermeasures that may affect all pedestrians. 

US pedestrian fatalities by age, 1995 and 2005

0

200

400

600

800

1000

1200

0–4

5–9

10–1516–2021–24

25–29

30–3435–3940–44

45–4950–54

55–5960–6465–69

70+

Age

1995

2005

U.S. Pedestrian Fatalities by Age, 1995 and 2005 
 8 - 3 

Basic countermeasure principles include reducing vehicle speed, which allows pedestrians and 

drivers more time to react and reduces impact forces if crashes do occur; reducing exposure to 

known risky situations; and increasing enforcement of pedestrian-friendly laws. 

Countermeasures need to be tailored to diverse populations, including groups such as recent 

immigrants who may not be familiar with U.S. traffic laws, the U.S. traffic environment, or may 

not speak or read English. 

This chapter is restricted to behavioral countermeasures. Many environmental and engineering 

strategies affect pedestrian safety substantially, but they are outside the direct authority of 

SHSOs. For information on engineering strategies, see NCHRP (2004) or the Pedestrian and 

Bicycle Information Center (www.walkinginfo.org/). For a broad set of resources on behavioral 

strategies from NHTSA, see http://www.nhtsa.dot.gov/people/injury/pedbimot/ped/index.html. 

For information on education, engineering, vehicular, and legislative practices and recommended 

strategies in Europe, see OECD (2004). 

Key terms 

• NCHRP: National Cooperative Highway Research Program 

• NPTS: Nationwide Personal Transportation Survey, conducted by NHTSA 

approximately every 5 years through 1995. 

• NHTS: National Household Travel Survey, the successor to NPTS, conducted last in 

2001. 
 8 - 4 

Countermeasures That Work 

Countermeasures to improve pedestrian safety are listed below and discussed individually in the 

remainder of this chapter. The table is intended to give a rough estimate of each 

countermeasure’s effectiveness, use, cost, and time required for implementation. The terms used 

are described below. Effectiveness, cost, and time to implement can vary substantially from State 

to State and community to community. Costs for many countermeasures are difficult to measure, 

so the summary terms are very approximate. See each countermeasure discussion for more 

information on each item. 

1. Young children 

Countermeasure Effectiveness Use Cost Time 

1.1 Children’s safety clubs Uncertain Unknown Low Uncertain

1.2 Child supervision Unknown Unknown Low Short 

2. School-age children 

2.1 Elementary school pedestrian training Proven Unknown Low Short 

2.2 Safe Routes to School (SR2S) Likely Unknown Low Short 

2.3 Model “Ice cream vendor” ordinance Likely Low Low Medium 

2.4 Child school bus training Likely High Low Short 

3. Adults 

Countermeasure Effectiveness Use Cost Time 

3.1 Model road work site law Uncertain Medium Low Short 

3.2 Pedestrian safety zones Proven Low High Medium 

4. Impaired pedestrians 

Countermeasure Effectiveness Use Cost Time 

4.1 Communications and outreach Uncertain Low Medium Medium 

4.2 Pedestrian “sweeper” patrols Unknown Low Medium Short 

5. All pedestrians 

Countermeasure Effectiveness Use Cost Time 

5.1 Reduced speed limits Proven High Low Short 

5.2 Daylight saving time Likely High Low Medium 

5.3 Conspicuity enhancement Likely Low Low Short 

5.4 Driver training Unknown Low Low Medium 

5.5 Targeted enforcement Varies Unknown Medium Short 

Effectiveness: 

Proven: demonstrated by several high-quality evaluations with consistent results 

Likely: balance of evidence from high-quality evaluations or other sources 

Uncertain: limited and perhaps ambiguous evidence 

Unknown: no high-quality evaluation evidence 
 8 - 5 

Varies: different methods of implementing this countermeasure produce different results 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. See 

individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 

Use: 

High: more than two-thirds of the states, or a substantial majority of communities 

Medium: between one-third and two-thirds of states or communities 

Low: less than one-third of the states or communities 

Unknown: data not available 

Cost to implement: 

High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources 

Medium: requires some additional staff time, equipment, facilities, and/or publicity 

Low: can be implemented with current staff, perhaps with training; limited costs for 

equipment, facilities, and publicity 

These estimates do not include the costs of enacting legislation or establishing policies. 

Time to implement: 

Long: more than one year 

Medium: more than three months but less than one year 

Short: three months or less 

These estimates do not include the time required to enact legislation or establish policies. 
 8 - 6 

1.1 Children’s Safety Clubs 

Effectiveness: Uncertain Use: Unknown Cost: Low Time: Uncertain 

Very young children have limited abilities to perceive traffic hazards, little experience with 

which to anticipate and interpret, and limited abilities to reason and react. They are not 

developmentally capable of making the kinds of perceptions and judgments necessary to 

successfully negotiate motorized traffic (Jackson, 1978; Sandels, 1968). Motor vehicle crashes 

involving preschool children often involve slow-moving vehicles, frequently backing up in 

driveways and parking lots (Agran et al., 1994; Olson et al., 1993). It is important to teach 

children age-appropriate lessons about traffic. It is even more important that parents and 

caregivers take direct responsibility and supervise young children carefully, as discussed in the 

following Section 1.2 (Rivara et al., 1989). 

Safety clubs are a proven way to promote understanding and to teach a specific set of appropriate 

behaviors for these young pedestrians. However, the knowledge and skill benefits have not been 

found to translate into crash and injury reductions (Gregersen and Nolen, 1994; West et al., 

1993). An equally important outcome of safety clubs is for parents and caregivers to recognize 

their charges’ limits and to understand their own obligation to maintain supervisory control. 

NHTSA has a number of brochures on child pedestrian safety, as does Safe Kids Worldwide. 

The main development of safety clubs took place in Europe a number of years ago, but they have 

not been adopted broadly in the U.S. There do not appear to be any national or statewide 

standards, models, or curricula. One online game for parents and young children (Otto the Auto, 

from the California State Automobile Association) can be found at www.ottoclub.org. For a 

British traffic club source, see The Children's Traffic Club, Pin Point, 1-2 Rosslyn Crescent, 

Harrow, HA1 2SB; www.trafficclub.co.uk. 

Use: Pedestrian safety may be a topic at many preschools, but programs are likely to be unique, 

without consensus objectives, materials, or curriculum. 

Effectiveness: As noted, safety clubs, chiefly in Europe, have been shown to increase knowledge 

and safety behaviors in young children, but the anticipated crash and injury reductions have not 

been demonstrated. 

Costs: Only a few dollars per child for materials. If integrated into preschool programs, training 

for teachers may be needed. 

Time to implement: Before a safety club program could be implemented, program materials 

must be located and adapted as necessary. Following that, a modest time period would be needed 

to arrange for materials, disseminate information, and train teachers. 
 8 - 7 

1.2 Child Supervision 

Effectiveness: Unknown Use: Unknown Cost: Low Time: Short 

Programs to increase the supervision of children when they are exposed to traffic, or when they 

are nearby with direct access to traffic, can be an asset to anyone responsible for the supervision 

of children. The state can require such programs for teachers, day care workers, and others 

licensed to care for children. The programs can also be made available to parents, babysitters, or 

other caretakers through PTAs, churches, pediatricians, or even direct mail or Internet access. 

One of the ways to “sell” these programs may be to point out that parents don’t know how much 

their children need supervision (and effective training). Rivara et al. (1989) and Dunne et al. 

(1992), for example, have shown that parents consistently overestimate the ability of children 

younger than 9-10 to negotiate in traffic. 

Use: The availability and use of such programs is unknown. Two valuable resources are 

NHTSA, with materials like Walking Through the Years and Preventing Pedestrian Crashes: 

Preschool/Elementary School Children, and Safe Kids Worldwide, with Teach Your Child Street 

Smarts. 

Effectiveness: Programs or materials can provide effective training for caregivers if they point 

out specific risks as well as guidelines for the kind and degree of oversight that are necessary, but 

the caregivers need to put the training into practice. 

Costs: Materials for individuals are already available and quite inexpensive. Training for 

licensed caregivers would be inexpensive to develop and distribute. 

Time to implement: Short, for existing materials; medium, to develop and disseminate a 

training curriculum with materials. 
 8 - 8 

2.1 Elementary School Pedestrian Training 

Effectiveness: Proven Use: Unknown Cost: Low Time: Short 

A number of elementary school pedestrian training programs have been developed over the 

years. “Willy Whistle” was developed in the 1970s as a film to teach K-3 children to look LeftRight-Left before crossing. It has been updated in a video format. NHTSA-developed materials 

for grades 4-6 include “Keep on Looking” and “Walking with Your Eyes,” both videos. All of 

these materials include instructor guides. Additional curricula have been developed for rural 

pedestrian concerns (Cleven and Blomberg, 1994). 

These programs are useful to teach basic pedestrian concepts and safe behaviors at schools, 

churches, and other institutions with groups of elementary-age children. 

Use: Unknown. The materials have been available for years, and they have been distributed 

widely, but not in a systematic program. It is likely there are a number of copies that are “out 

there” but not in current use. With schools being called on for a wider and wider variety of 

services and teaching requirements, finding time to add child traffic safety modules may be quite 

difficult. 

Effectiveness: The materials are proven to increase knowledge and appropriate behaviors, as 

observed in normal (non-crash) circumstances. In tests in Los Angeles and Milwaukee, child 

dart-out crashes were reduced by 30 percent or more. In Miami schools, the WalkSafe program 

was found to increase left-right-left searching and reduce mid-block crossings and dart-outs 

(Hotz et al., 2004). In the United Kingdom, a combination of adult-led training and peer 

discussions for age 5-8 children led to improved roadside search skills (Tolmie et al., 2005). 

As for younger children, materials would be best if they combine child training with emphasis to 

teachers, parents, and other caregivers on the limits of children, particularly those younger than 

10, and the need for careful supervision. 

Costs: Low. NHTSA’s existing materials are valuable tools in the toolbox, and they can be 

recommended and provided at low expense. 

Time to implement: Short; after a decision is made by the school districts to offer such a 

program, time is needed for them to review recommended materials, select or enhance one 

choice, and work it into the curriculum. 
 8 - 9 

2.2 Safe Routes to School 

Effectiveness: Likely Use: Unknown Cost: Low Time: Short 

Safe Routes to School (SR2S) packages are available from NHTSA. They include student and 

instructor materials and can be implemented “off the shelf.” For an overview, see NHTSA’s Safe 

Routes to School: Practice and Promise, which presents the background, rationale, and steps to 

follow for SR2S and describes several existing programs (NHTSA, 2004). SAFETEA-LU 

requires each state to have its own SR2S program beginning in 2005, including infrastructure 

improvements, public awareness and outreach, traffic education and enforcement near schools, 

student sessions, training for volunteers and program managers, and a full-time state SR2S 

coordinator. See Safe Routes to School News at www.walkinginfo.org for information on SR2S 

programs around the country. 

Use: Unknown. 

Effectiveness: The materials are effective in teaching young children and their parents how to 

evaluate and choose the best routes for walking or bicycling to and from school. They are 

derived from analyses of types of crashes associated with to/from school trips, but it has not been 

possible to evaluate their effect on preventing crashes and injuries. Although the full program 

emphasizes broad education, some specific implementations have centered on site-appropriate 

engineering changes; results have shown behavioral improvements for pedestrians, bicyclists, 

and motorists (Britt et al., 1995). NHTSA is evaluating SR2S programs. 

A variation on the SR2S theme, “walking school buses,” uses volunteer adults, usually parents, 

to walk a specific route to and from school, collecting or dropping off children on the way, so 

that a group of children walks to school under the supervision of adults. The program has been 

found popular and practical in New Zealand and Italy (Collins and Kearns, 2005; Roberts, 1995). 

Roberts found in New Zealand that when parents walked with children to and from school, the 

risk of injury was only 36 percent of the risk for unaccompanied children, though the small 

sample sizes made the difference suggestive rather than statistically significant. 

Costs: Low. The materials are in production by NHTSA and can be procured and distributed 

from existing stock. 

Time to implement: Very short, once the school or district has decided to use SR2S; the 

materials are available from NHTSA. 
 8 - 10 

2.3 “Ice Cream Vendor” Ordinance 

Effectiveness: Likely Use: Low Cost: Low Time: Medium 

One very specific hazard for children is the neighborhood ice cream truck. As children run to or 

from the truck, they may pay little attention to traffic. The truck may screen the children from 

drivers. 

The ordinance requires that drivers come to a complete stop before passing an ice cream truck 

that is stopped to vend. Drivers may proceed when it is safe at no more than 15 mph and must 

yield to all nearby pedestrians. The ice cream truck must be equipped with flashing signal lamps 

and a stop signal arm, similar to those found on school buses, which can be activated when the 

truck is stopped for vending. 

The regulation includes provisions for permits and inspections for ice cream trucks and similar 

on-street vendors. Details of the model regulation are included in Blomberg (2001); see also 

Hale et al. (1978). 

Use: As of 2001 some form of ice cream vendor ordinance was in place in Florida, New Jersey, 

New York, South Carolina, and Texas, as well as Detroit, Michigan (Blomberg, 2001). 

Effectiveness: When tested in Detroit, crashes to pedestrians going to or from ice cream trucks 

were reduced by 77 percent (Hale et al., 1978). 

Costs: The primary costs are for modifications to vendor trucks, for inspections of trucks prior to 

issuing vending permits, and for training police officers for enforcement. 

Time to implement: Medium; following passage of an ordinance, implementation must allow 

enough time for truck modifications to be made and an inspection system established. 
 8 - 11 

2.4 Child School Bus Training 

Effectiveness: Likely Use: High Cost: Low Time: Short 

School buses are an extremely safe form of transportation, and children are far safer traveling to 

school on a school bus than in other ways. Approximately 800 children have died in traffic 

crashes in each recent year during normal school travel hours. On average, only 5 were school 

bus passengers and 15 were pedestrians near a school bus (TRB, 2002, p. 1). The 2004 

experience fits this model: three fatalities to children in a school bus and 15 to children around a 

school bus (NHTSA, 2006, Tables 92 and 93). An estimated 1,000 pedestrians of all ages were 

injured in school-bus related crashes in 2004. 

Basic training for children who ride school buses should be part of the normal school routine, if 

it is not already. Training should include behavior on the bus as well as getting on or off the bus 

at bus stops or school, obeying bus drivers and bus monitors, and any topics unique to the school. 

Jurisdictions should use a common curriculum for school bus safety training. NHTSA has 

developed and evaluated a safety training program for elementary children who ride the school 

bus (Cleven and Blomberg, 1994). Targeted behaviors include boarding and exiting from the bus 

and crossing the street to and from the bus. Burke et al. (1996) found that stenciled pavement 

markings, together with in-school training, led to improved behavior in waiting for and boarding 

the school bus (compared to training alone), for boys and girls in grades 4-6. 

Use: Most school districts have some form of school bus training in place, though the content 

and quality of those programs varies. Schools should be eager to provide this training, both for 

child safety and for legal liability. 

Effectiveness: School bus training to publicize and support the kinds of behaviors expected and 

required can be very useful. The most readily demonstrated effect of the training will be 

improved behavior on and around buses. The training, along with outreach publicizing it, can 

also communicate standards and expectations to parents and others. Any reductions in crashes 

and injuries are extremely difficult to demonstrate because some form of training is very 

widespread and the choice to adopt a stronger curriculum would be confounded with any number 

of other factors. 

Costs: Low; the primary cost for the SHSOs would be in adapting materials for their states and 

producing, stocking, and distributing the materials. 

Time to implement: Short. Basic materials can be obtained from NHTSA, and schools could 

adopt the recommended curriculum, or another of their choice, quickly. 
 8 - 12 

3.1 Model Road Work Site Laws 

Effectiveness: Uncertain Use: Medium Cost: Low Time: Short 

Road work sites are very hazardous. In 2005, 1,074 people were killed at work sites including 

137 pedestrians, most often road site workers. A number of countermeasures are common for 

work sites, including double fines, awareness campaigns (e.g., “Slow down. My daddy/mommy 

works here!”), requirements for worksite signing, lighting, traffic control, and heightened 

enforcement. 

There are two complementary model regulations for worksites. The first, from NCHRP, 

emphasizes marking and control of work zones including permissions and inspections, speed 

limit maintenance and reductions, and safe traffic control (NCUTLO, 1997). It calls for site 

markings consistent with requirements of the Manual on Uniform Traffic Control Devices

(MUTCD; FHWA, 2004). 

The second also emphasizes worker conspicuous materials and worker and driver 

responsibilities. For more information on this model law, see Blomberg, 2001. The model law 

expands on existing Uniform Vehicle Code (UVC) provisions (NCUTLO, 2000), in particular to 

improve the conspicuity of workers at the site. Many States have existing work site practices that 

match or exceed the requirements of this model law, and anyone considering adopting this law 

should compare its provisions to current practice. 

Use: States may not have these exact laws but may have most or all of their provisions in effect 

through alternative laws or regulations. No State had enacted the second model law as of 2001 

(Blomberg, 2001). 

Effectiveness: These model laws have not been specifically evaluated. 

Costs: Low; they may require the state, municipality, or contractors to increase payments for 

materials, site layout, and active supervision and marking, but these would be a small part of the 

costs for any project. 

Time to implement: Short. Once governing regulations are written, work site operators can be 

required to comply almost immediately. 
 8 - 13 

3.2 Pedestrian Safety Zones 

Effectiveness: Proven Use: Low Cost: High Time: Medium 

In 2005, 981 fatalities, or 20 percent of all pedestrian fatalities, and about 5,000 injuries, 8 

percent of all pedestrian injuries, occurred to pedestrians age 65 and older. About one-third of 

their fatalities and two-thirds of their injuries occurred at intersections, the highest values for any 

age group (NHTSA, 2006, Table 94). 

Most countermeasures specifically intended for older adult pedestrians involve engineering 

changes. These can range from simple actions such as traffic signal retiming to “pedestrian 

zones” which can combine communications and outreach messages for pedestrians and drivers, 

major alterations to the pedestrian environment to slow and channel vehicle traffic, and enhanced 

enforcement. Pedestrian zone programs can be targeted at a full range of pedestrian crash 

problems within a limited geographic area. 

Pedestrian safety zones are described by Blomberg and Cleven (1998) and NHTSA (1998). 

Crash data were analyzed to identify areas where older pedestrian crashes occur and “zones” 

were drawn around the high-incidence areas. Countermeasures were developed for the kinds of 

crashes that were seen. They included signal retiming, providing communications and outreach 

for both drivers and pedestrians living near the crash zones, and enhanced enforcement. The 

result in Phoenix, Arizona, was a significant reduction in crashes and injuries to older pedestrians 

in the target areas. 

Use: Low. Pedestrian zone programs have been implemented in only a handful of cities. 

Effectiveness: Properly designed and implemented pedestrian zone programs have been shown 

effective in reducing crashes and injuries for older pedestrians (Blomberg and Cleven, 1998) and 

for impaired pedestrians (Blomberg and Cleven, 2000). 

Costs: High. If properly done, pedestrian zone programs require up-front analysis and planning, 

countermeasure development and tailoring, and implementation. 

Time to implement: Medium. A pedestrian zone program can take several months of 

concentrated activity before it can be implemented. Programs done to date have included local 

task forces, usually assembled for the program, to take critical leadership roles. 
 8 - 14 

4.1 Impaired Pedestrians: Communications and Outreach 

Effectiveness: Uncertain Use: Low Cost: Medium Time: Medium 

In 2005, 36 percent of all fatally injured pedestrians had a positive blood alcohol concentration, 

and 32 percent had a BAC of .08 or higher (NHTSA, 2006, Table 82). Most are young adult 

males (Leaf and Preusser, 1997). This observation is confirmed in more recent FARS data. For 

the five years of 1999-2003, of the pedestrian fatalities age 18 and older, 44 percent of males and 

22 percent of females had a BAC of .08 or higher, elevated BACs (.08 g/dL or higher), with the 

highest proportions for ages 21 through 54. 

Some of the countermeasures proposed for impaired drivers in Chapter 1, such as responsible 

beverage service training and alternative transportation, are also appropriate for impaired 

pedestrians. Comprehensive programs also are appropriate. 

Communications and outreach to reduce impaired-pedestrian crashes can be directed at a wide 

variety of audiences. A recent study obtained expert evaluations of a wide range of possible 

communications and outreach approaches (Leaf et al., 2005). Recommended target audiences 

include drivers, alcohol servers and vendors, civic and neighborhood leaders, and friends and 

family of likely impaired pedestrians. Likely impaired pedestrians are also a target audience, of 

course. However, they are viewed as a very difficult audience for communications and outreach 

to have a meaningful effect on their behavior. It is felt that reaching others who are in a position 

to prevent these crashes, or to alter the circumstances that lead up to such crashes, is the most 

effective way to achieve success. 

Use: Low. NHTSA has successfully implemented one zone-based program in Baltimore, 

Maryland, but it is not currently active (Blomberg and Cleven, 2000). Most impaired-person 

programs focus on impaired drivers. 

Effectiveness: The use of communications and outreach countermeasures alone has been shown 

to increase knowledge and reported behavior changes, but there have been no demonstrations of 

crash or injury reductions unless the communications and outreach is part of a comprehensive 

program such as the one in Baltimore. 

Costs: The costs for such a program can range from low to high, depending on the extent of the 

campaign that is designed and implemented. 

Time to implement: Medium; again, the actual time to implement depends on the scope and 

ambition of the program. Existing communications and outreach themes would need to be 

tailored to specific localities and conditions. 
 8 - 15 

4.2 Pedestrian “Sweeper” Patrols 

Effectiveness: Unknown Use: Low Cost: Medium Time: Short 

Pedestrians with high BACs are at high risk of injury due to motor vehicle crashes. A program of 

removing or “sweeping” inebriated pedestrians from the streets until they no longer have high 

BACs can be effective in reducing the exposure and thus the risk. 

There are some issues that need to be resolved when setting up sweeper programs, such as how 

to identify at-risk pedestrians (e.g., calls from bars or direct observers, observation by police or 

health professionals), who picks up the targets, where they are kept until they sober up, whether 

friends or family need to be notified at the time of the pickup, how the pedestrians are returned 

home after the intervention, and how the costs of the program are borne. 

Huntley (1984) focused on police “sweeper” squads and “support on call” programs involving 

taxis and trained escorts to get intoxicated persons home. Services of these types in the Boston 

area were surveyed. Both types of services appeared practical and effective, though the number 

of persons that could be reached by these services was relatively small. There was a problem 

related to the number of available detoxification beds in the community. The sweeper squads 

wanted to deliver intoxicated pedestrians to the mental health community, not to police facilities, 

and they stopped the sweep when the beds were filled. There were also problems with the 

number of taxi drivers who wanted to deal with intoxicated persons and the availability of 

volunteer escorts. 

Use: Well-publicized sweep operations, which involve picking up intoxicated persons from the 

street and letting them “sleep it off,” have been conducted in Puerto Rico and in Gallup, New 

Mexico. Puerto Rico’s program, which included a statute, communications and outreach, and 

police training, led to a seven-percent drop in alcohol-related pedestrian crashes (Stewart, 1994). 

There appear to be no well-publicized programs operating now. 

Effectiveness: Such programs typically reach only a fraction of those people who need the 

services. The sweeps typically deal with persons who are too drunk to walk or even know that 

they are being “swept.” These same persons are at risk while they are becoming intoxicated, and, 

in all likelihood, will be at risk again in the near future as they start to sober up. As described by 

Huntley, these individuals need intensive treatment for alcoholism; and sweeper programs may 

be useful in identifying potential treatment candidates. 

Costs: Medium. The program incurs ongoing costs directly related to the effectiveness, i.e., the 

number of people swept up. Depending on how it is set up, the program may incur costs related 

to the sweeper patrol (or police overtime), the use of facilities, and any subsequent treatment 

requirements. 

Time to implement: Once it is decided to offer the program, the logistics for starting it up could 

be handled within weeks or a few months. 

Other issues: 
 8 - 16 

• The legal rights of those potentially being swept need to be preserved. 

• Often if the police or other formal agencies are involved, their regular procedures would 

require some formal charge or other processing to take place. Alternatively, a sweeper 

program could be without subsequent consequences to those being swept, with no formal 

records kept. This might eliminate certain organizations or agencies from participating. 
 8 - 17 

5.1 Reduced Speed Limits 

Effectiveness: Proven Use: High Cost: Low Time: Medium 

Higher vehicle speeds produce more and more serious pedestrian crashes and casualties. 

Reducing speeds through lowering speed limits is a time-honored countermeasure. Evidence 

shows, though, that actual speeds are reduced by only a fraction of the reduction in speed limits – 

typically 1-2 mph speed reduction for every 5 mph speed limit reduction. For maximum 

effectiveness, speed limit reductions need to be accompanied by communications and outreach 

which inform the public and make the case for the reduction and by heightened, visible 

enforcement (Leaf and Preusser, 1999). 

Speed limit reductions can be most effective when introduced to a limited area as part of a 

visible area-wide change, for example, identifying a downtown area as a special pedestrianfriendly zone through signs, new landscaping or “streetscaping”, lighting, etc. If done cleverly, 

this can been accomplished with relatively modest engineering changes and expenses. 

If speed limits are routinely ignored, then enforcing speed limits may be more effective strategy 

than attempting to change them. Blomberg and Cleven (2006) report on demonstration programs 

in two cities in which speed limit enforcement, combined with engineering changes and 

extensive publicity, reduced both average speeds and the number of excessive speeders in 

residential neighborhoods. NHTSA is conducting a further evaluation to determine whether 

pedestrian crashes were reduced in these neighborhoods. 

See Chapter 3, Section 1.1, for further discussion of speed limits. 

Use: High, in the sense that all public roads have a speed limit and all speed limits take some 

account of pedestrian travel and pedestrian safety issues. 

Effectiveness: Actual speed reductions improve pedestrian safety. Just changing speed limits is 

of limited, though positive, effectiveness. Some reasons for this include drivers simply not 

noticing, if just old signs are updated, or drivers not understanding any reason to reduce speed, or 

drivers continuing to keep up with the speeds maintained by other drivers. Speed limit reductions 

need to be made compelling to be effective. 

Costs: Simply changing speed limits is low-cost, only requiring updating speed limit signs or, 

where few signs exist, adding some new ones. Combining speed limit changes with 

communications and outreach, enforcement, and decorative or engineering changes can be 

significantly more expensive. 

Time to implement: Depending on the scope of the program, the time can be very short, or it 

can take several months to a year to plan and implement a complex plan. 
 8 - 18 

Other issues: 

• Speed limit changes exist in the context of other, unchanged speed limits. The normal 

expectation is that there is an overall consistent approach to speed-limit setting. Where, 

for safety, some speed limits need to be reduced in a manner inconsistent with other 

speed limits, there must be clear and visible reminders that distinct conditions exist which 

justify the lower limits. 
 8 - 19 

5.2 Daylight Saving Time 

Effectiveness: Likely Use: High Cost: Low Time: Long 

Daylight saving time shifts an hour of daylight from the morning, when pedestrian traffic, 

crashes, and injuries are lighter, to the afternoon, when pedestrian traffic, crashes, and injuries 

are heavier. In daylight, pedestrians and drivers can see each other better, and fewer crashes 

occur. Shifting the hour of daylight by means of daylight saving time reduces afternoon crashes 

by many more than it adds in the morning. For example, if daylight saving time were extended 

for the entire year, it is estimated that about 727 pedestrian and 180 vehicle occupant fatalities 

would be saved each year (Ferguson et al., 1995). 

Only three States do not follow current daylight saving time rules: Arizona, Hawaii, and most of 

Indiana. Those States could change their practices to follow Federal daylight saving time. 

Use: As noted, daylight saving time is implemented in all but three States. Exceptions are longstanding local practice. Indiana has recently moved several counties from the Eastern to Central 

time zone, but in the process reaffirmed their commitment to daylight savings time exceptions. 

Effectiveness: The effectiveness of existing daylight saving time in reducing pedestrian crashes 

has been clearly demonstrated (Ferguson et al., 1995). 

Costs: Minimal to the traffic safety community. Any daylight saving time change will be 

publicized extensively. 

Time to implement: If a daylight savings time change is enacted, it can be implemented the 

following year. 

Other issues: 

• Local exceptions to daylight saving time have been in effect for many years, and the 

states with the exceptions have made deliberate choices to have them. Those exceptions 

will be difficult to overcome. 

• Farming interests have been opposed to daylight saving time in any form, because of the 

inconvenience of matching their work schedules, largely determined by the availability of 

sunlight, with shifts in the rest of the world’s schedules. 
 8 - 20 

5.3 Conspicuity Enhancement 

Effectiveness: Likely Use: Low Cost: Low Time: Medium 

Pedestrians who are more visible are less likely to be struck. Retro-reflective materials are built 

into many shoes. Other materials, such as arm or leg bands, gloves, vests, and caps are available. 

Light sources, including strobes and other flashing lights, are also available. Many have been 

designed for bicyclists but are equally applicable to pedestrians. The difficulty with most of these 

devices is that the user must decide in advance to take and use them. Because of this extra step, 

and because most of the conspicuity enhancements do not look like “normal” clothing, they are 

very much underused. Light-colored clothing, long a recommended solution, does virtually 

nothing to improve conspicuity (NCHRP, 2004, Strategy B5). 

There are a number of opportunities for improving pedestrian conspicuity. Devices designed to 

be semi-permanently fastened to children’s clothing can be provided to parents through schools, 

group activities, or pediatricians. Light sticks and reflective bands can be supplied with new cars, 

or distributed by automobile clubs or insurance companies, for use during emergencies. 

Use: Retro-reflective materials are used regularly in athletic-type shoes, occasionally in 

backpacks and jackets, and minimally in other clothing. 

Effectiveness: Widespread use of retro-reflective materials would increase the ability of drivers 

to detect pedestrians in time to avoid crashes. Pedestrians wearing good retro-reflective 

materials, particularly materials that fill out the person’s shape or outline, can be detected 

hundreds of feet farther than can pedestrians in normal clothing, even with low-beam 

illumination (NCHRP, 2004, Strategy B5). 

Costs: Low, if supplementary materials are distributed in quantity. 

Time to implement: Supplementary materials are available commercially. 
 8 - 21 

5.4 Driver Training 

Effectiveness: Unknown Use: Low Cost: Low Time: Medium 

Training for new drivers typically includes relatively little information on other road users. 

Information on pedestrians can be significantly strengthened. Specifications for driver education 

curricula, typically a state requirement, can be adjusted to include more and specific information 

on the status of the pedestrian in the traffic environment, right of way requirements for driver 

and pedestrian, other driver and pedestrian responsibilities, categories of pedestrian crash types, 

and key ways drivers can avoid being involved in such crashes. 

One of the best ways driver training can incorporate pedestrian and bicyclist concerns for new 

drivers is through “Share the Road” concepts and programs, though many focus exclusively on 

bicycles. One such resource is the State of New York’s highly readable Sharing the Road: New 

York State bicycle and pedestrian laws, which can be found at 

www.dot.state.ny.us/pubtrans/share.html. 

Any new information for driver education should be reflected in State publications, for example 

in the manual for new drivers which is handed out to learners and used as the basis for driver 

licensing exams. 

NHTSA current investigations of the workings and effectiveness of driver education may 

provide an opportunity to recommend modifications in the way driver training addresses 

pedestrian safety. 

Use: Low. As noted, all driver education curricula include some information on other road users, 

but the kind of expanded information recommended here is sparse. 

Effectiveness: Driver education has not been shown to reduce overall crash rates. The objective 

for adding more pedestrian information would be to increase knowledge, particularly of crash 

types and countermeasures, and to improve the new drivers’ anticipation of and interactions with 

pedestrians – as well as improve their behavior as pedestrians. 

Costs: Low. The cost would be for the development of the new segments of the standard 

curriculum and for getting it into the materials used by driver education instructors and schools. 

Time to implement: Medium. Materials would need to be developed and integrated into the 

standard driver education curriculum, and adjustments made elsewhere in the curriculum to 

reflect likely additional time required for the new pedestrian materials. 

The same timeframe would be appropriate for making changes to official State driving manuals, 

license exams, and related materials and procedures. 
 8 - 22 

5.5 Targeted Enforcement 

Effectiveness: Varies Use: Unknown Cost: Medium Time: Short 

Behavioral pedestrian safety initiatives require pedestrians or drivers to change their walking or 

driving actions and habits. Once pedestrians and drivers are informed of the changes needed and 

why they are important, enforcement often is necessary to encourage compliance. Although 

enforcement was implied or stated for many of the earlier countermeasures, it deserves to be 

called out separately. 

Enforcement is most effective when it is highly visible and publicized, to reinforce the message 

of the required behavior and to raise the expectation that failure to comply may result in legal 

consequences. Most enforcement is seen as aimed at drivers, with enforcement actions against 

pedestrians occurring only to sort out culpability in crashes. As much as possible, enforcement 

campaigns should balance their focus on pedestrians as well as drivers, starting with the 

communications and outreach efforts that announce and position the campaigns. 

A coordinated program of targeted enforcement may involve a range of support activities, such 

as communications and outreach to notify the public of the campaign, training for the police on 

enforcement goals and procedures, and training for prosecutors and judges so that they 

understand the purposes of the campaign and are prepared for the increase in citations that the 

enforcement will produce. 

Use: Unknown. Enforcement is largely a local option, and often is integrated into other police 

duties, so special enforcement efforts are difficult to isolate and track. 

Effectiveness: Because targeted enforcement can be employed for a wide range of purposes in a 

wide range of circumstances, no overall statement of effectiveness can be made. In Queens, New 

York, enforcement was a key part of a campaign that included minor engineering adjustments 

and communications and outreach and reduced pedestrian fatalities (CDC, 1989). In Seattle, a 

variety of communications and outreach and enforcement combinations were tested in 

conjunction with a change in the law for drivers to yield to pedestrians at crosswalks; the authors 

concluded that enforcement was not successful in increasing driver yielding (Britt, Bergman, and 

Moffat, 1995). 

Costs: Medium. The cost of the enforcement is a direct function of the size of the effort, the 

number of overtime officer hours and associated supplies, ranging from vehicle operating costs 

to equipment such as speed measurement devices or alcohol test machines. 

Time to implement: Short. Police resources can be diverted to targeted enforcement very 

quickly. Support equipment can take longer, as can developing a plan that coordinates law 

changes, environmental changes, support communications and outreach, and enforcement. 
 8 - 23 

Pedestrian Safety References 

Agran, P.F., Winn, D.G., and Anderson, C.L. (1994). Differences in child pedestrian injury 

events by location. Pediatrics 93(2), pp. 284-288. 

Blomberg, R.D. (2001). NHTSA Resource Guide on Laws Related to Pedestrian and Bicycle 

Safety. DOT HS 809 368. Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/bike/resourceguide/ 

Blomberg, R.D., and Cleven, A.M. (1998) Development, Implementation, and Evaluation of a 

Pedestrian Safety Zone for Elderly Pedestrians. DOT HS 808 692. U.S. Department of 

Transportation, National Highway Traffic Safety Administration. 

Blomberg, R.D., and Cleven, A.M. (2000). Development, Implementation, and Evaluation of a 

Countermeasure Program for Alcohol-Involved Pedestrian Crashes. DOT HS 809 067. 

Washington, DC: National Highway Traffic Safety Administration. 

Blomberg, R.D., and Cleven, A.M. (2006). Pilot Test of “Heed the Speed,” A Program to Reduce 

Speeds in Residential Neighborhoods. DOT HS 810 648. Washington, DC: National Highway 

Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/research/HeedSpeedWeb/ 

Britt, J,W,, Bergman, A,B,, and Moffat, J. (1995). Law enforcement, pedestrian safety, and driver 

compliance with crosswalk laws: evaluation of a four-year campaign in Seattle. Transportation 

Research Record, No. 1485, pp. 160-167. 

Burke, G.S., Lapidus, G.D., Zavoski, R.W., Wallace, L., and Banco, L.I. (1996). Evaluation of 

the effectiveness of a pavement stencil in promoting safe behavior among elementary school 

children boarding school buses. Pediatrics 97(4), pp. 520-523. 

CDC (1989). Queens Boulevard Pedestrian Safety Project--New York City. Morbidity and 

Mortality Weekly Report 38(5), pp. 61-64. 

Cleven, A.M. and Blomberg, R.D. (1994). Development and evaluation of a pedestrian safety 

training program for elementary school bus riders. Final report. Stamford, CT: Dunlap and 

Associates, Inc.Report No: HS 808 267 DA94-1 (631), 90 pp. 

Collins, D.C. and Kearns, R.A. (2005). Geographies of inequality: Child pedestrian injury and 

walking school buses in Auckland, New Zealand. Social Science and Medicine 60(1), pp. 61-69. 

Dunne, R.G., Asher, K.N., and Rivara, F.P. (1992). Behavior and parental expectations of child 

pedestrians. Pediatrics 89(3), pp. 486-490. 

FHWA (2004). Manual on Uniform Traffic Control Devices (MUTCD), 2003 Edition, Revision 

1. Washington, DC: Federal Highway Administration. 

www.mutcd.fhwa.dot.gov/pdfs/2003r1/pdf-index.htm 
 8 - 24 

Ferguson, S.A., Preusser, D.F., Lund, A.K., Zador, P.L. and Ulmer, R.G. (1995). Daylight saving 

time and motor vehicle crashes: The reduction in pedestrian and vehicle occupant fatalities. 

American Journal of Public Health, 85(1), 92-95. 

Gregersen, N.P. and Nolen S. (1994). Children's road safety and the strategy of voluntary traffic 

safety clubs. Accident Analysis and Prevention 26(4), pp. 463-470. 

Hale, A., Blomberg, R.D., and Preusser, D.F. (1978). Experimental field test of the model ice 

cream ordinance in Detroit. DOT HS 803 410. Washington, DC: National Highway Traffic 

Safety Administration. 

Hotz, G., Cohn, S., Castelblanco, A., Colston, S., Thomas, M., Weiss, A., Nelson, J., and 

Duncan, R. (2004). WalkSafe: a school-based pedestrian safety intervention program. Traffic 

Injury Prevention 5(4), pp. 382-389. 

HSRC (2004). National Bicycling and Walking Study: Ten Year Status Report. Chapel Hill, NC: 

Highway Safety Research Center, Pedestrian and Bicycle Information Center. 

www.bicyclinginfo.org/pdf/NBWS_10yr_Progress_Report.pdf 

Hunter, W.H., Stutts, J.C., Pein, W.E., and Cox, C.L. (1996). pedestrian and Bicycle Crash Types 

of the Early 1990’s. FHWA-RD-95-163. Washington, DC: Federal Highway Administration. 

Huntley, M.S. Jr. (1984). Pedestrian/alcohol problems: Countermeasures to consider. 

Cambridge, MA: Transportation Systems Center. 

Jackson, R.H. (1978). Hazards to children in traffic. A paediatrician looks at road accidents. 

Archives of Disease in Childhood 53, pp. 807-813. 

Leaf, W.A., Northrup, V.S., and Preusser, D.F. (2005). Evaluation of Alternative Approaches for 

Reducing Alcohol-Related Crashes Among Pedestrians: Targets of Opportunity. Draft Final 

Report, Contract No. DTNH22-98-D-45079, Task Order 12. Washington, DC: National Highway 

Traffic Safety Administration. 

Leaf, W.A. and Preusser, D.F. (1997). Identification of Alcohol-Pedestrian Crash Problems 

Among Selected Racial/Ethnic Groups. DOT HS 808 641. Washington, DC: National Highway 

Traffic Safety Administration. 

Leaf, W.A. and Preusser, D.F. (1999). Literature Review on Vehicle Travel Speeds and 

Pedestrian Injuries. DOT HS 809 021. Washington, DC: National Highway Traffic Safety 

Administration. www.nhtsa.dot.gov/people/injury/research/pub/HS809012.html 

NCHRP Report 500, Vol. 10 (2004). A Guide for Reducing Collisions Involving Pedestrians. 

Washington, DC: Transportation Research Board. http://safety.transportation.org/guides.aspx. 

NCUTLO (1997). Work Zone Model Law. Alexandria, VA: National Committee on Uniform 

Traffic Laws and Ordinances. www.ncutlo.org/work_zone.htm 
 8 - 25 

NCUTLO (2000) Uniform Vehicle Code and Model Traffic Ordinance. Alexandria, VA: 

National Committee on Uniform Traffic Laws and Ordinances. www.ncutlo.org 

NHTSA (1998). Zone Guide for Pedestrian Safety. DOT HS 808 742. Washington, DC: National 

Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/ped/ZoneGuideWeb/pages/index.htm. 

NHTSA (2004). Safe Routes to School: Promise and Practice. Washington, DC: National 

Highway Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/pedbimot/bike/SafeRoutes-2004/index.html 

NHTSA (2006). Traffic Safety Facts 2005. DOT HS 810 631. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pubs/tsf2005ee.pdf 

OECD (2004). Keeping Children Safe in Traffic. Organization for Economic Co-operation and 

Development. Paris, France: 

www.oecd.org/document/9/0,2340,en_2649_34351_31416393_1_1_1_1,00.html 

Olson, L.M., Sklar, D.P., Cobb, L,, Sapien, R., and Zumwalt, R. (1993). Analysis of childhood 

pedestrian deaths in New Mexico, 1986-1990. Annals of Emergency Medicine 22(3), pp. 512-

516. 

Rivara, F.P., Bergman, A.B., and Drake, C. (1989). Parental attitudes and practices toward 

children as pedestrians. Pediatrics 84(6), pp. 1017-1021. 

Roberts, I. (1995). Adult accompaniment and the risk of pedestrian injury on the school-home 

journey. Injury Prevention 1(4), pp. 242-244. 

Sandels, S. (1968) Children in Traffic. London: Elek Books. 

Stewart, K. (1994). Report of the ICADTS Working Group on Alcohol-Involved Pedestrians. 

www.druglibrary.org/schaffer/misc/driving/s25p1.htm 

Tolmie, A., Thomson, J.A., Foot, H.C., Whelan, K., Morrison, S., and McLaren, B. (2005). The 

effects of adult guidance and peer discussion on the development of children’s representations: 

evidence from the training of pedestrian skills. British Journal of Psychology 96(Pt 2), pp. 181-

204. 

TRB (2002). The Relative Risks of School Travel. Special Report 269. Washington, DC: 

Transportation Research Board. www.trb.org/news/blurb_detail.asp?id=673 

West, R., Sammons, P., and West, A. (1993). Effects of a traffic club on road safety knowledge 

and self-reported behaviour of young children and their parents. Accident Analysis and 

Prevention 25(5), pp. 609-618. 
 9 - 1 

9. Bicycles

Overview 

In 2005, 784 bicyclists died and about 45,000 were injured in traffic crashes in the United States. 

Bicyclists accounted for 1.8 percent of total traffic fatalities and about 1.6 percent of total 

injuries NHTSA, 2006, Table 53). Of the bicyclist casualties: 

• 144 children, ages 15 and younger, were killed and about 15,000 were injured; 

• 164 young adults, ages 16-34, were killed and about 14,000 were injured; 

• 306 mid-aged adults, ages 35-54, were killed and about 10,000 were injured; 

• 162 older adults, ages 55 and older, were killed and about 7,000 were injured (NHTSA, 

2005, Table 99). 

• 87 percent of the bicyclists killed and 80 percent of those injured were male (NHTSA, 

2006, Table 100). 

Trends. Bicyclist fatalities dropped by 34 percent in 15 years, from 948 in 1987 to 629 in 2003, 

before rising to 727 in 2004 and 784 in 2005. 

 Source: FARS

Over the past decade, fatalities have decreased for bicyclists under 35 years old and increased for 

age 35 and older. In absolute numbers, fatalities to bicyclists 34 or younger dropped by 205, or 

40 percent; fatalities to bicyclists 35 and older increased by 156, or 50 percent. 

US bicyclist fatalities

0

100

200

300

400

500

600

700

800

900

1,000

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Year

0

100

200

300

400

500

600

700

800

900

1,000

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Year

U.S. Bicyclist Fatalities
 9 - 2 

 Source: FARS 

Exposure. According to the Department of Transportation’s personal transportation surveys, the 

number of bicycling trips has increased from 1.7 billion in 1990 (NPTS, 1990) to 3.3 billion in 

1995 (NPTS, 1995) and 2001 (National Household Travel Survey, NHTS; U.S. DOT, 2001), 

though the NPTS and NHTS surveys used somewhat different methodologies. This is 

approximately 10 trips per year for each U.S. inhabitant. As a fraction of all trips, bicycling has 

remained nearly constant, going from 0.7 percent to 0.9 percent to 0.8 percent over the three 

surveys. 

Another estimate comes from the National Survey of Pedestrian and Bicyclist Attitudes and 

Behaviors (NHTSA and BTS, 2003). Using telephone surveys covering summer 2002, the study 

estimates that about 27.3 percent of persons age 16 and older, or about 57 million, rode a bicycle 

at least once between May and August 2002, and they averaged 1.6 trips on that day. 

A third source of information comes from the U.S. Census. Just for commuting, the Census 

reported nearly the same values in 1990 (0.4 percent of all commuters, or about 467,000 people) 

for bicycling commuting as in 2000 (0.4 percent, or 488,000 people). Commuting, however, 

makes up only a small percentage of all trips. 

For additional information, see NCHRP (to appear). 

Bicyclist types. Bicyclists can be considered in three general categories, with the two adult 

categories overlapping depending on trip purposes: 

• Purposive riders: Adults age 16 and older, old enough in most States to obtain a driver’s 

license, who are commuting, doing errands, or otherwise using the bicycle as a means to 

accomplish something. For these trips, bicyclists frequently use the shortest and quickest 

route, often involving major roads that may have relatively heavy motor vehicle traffic 

and less than optimal accommodations for bicyclists. 

• Recreational riders: Adults age 16 and older who ride for exercise or entertainment, or 

otherwise bicycle for the sake of bicycling. These bicyclists frequently seek low-traffic 

roads or separate bicycle-only facilities, perhaps driving in order to reach the place where 

US bicyclist fatalities by age, 1995 and 2005

0

20

40

60

80

100

120

140

160

180

0-4

5–9

10–15

16-2021-2425-34

35-44

45-5455-6465-69

70+

Bicyclist Age

1995

2005

U.S. Bicyclist Fatalities by Age, 1995 and 2005 
 9 - 3 

they want to bicycle. They are looking for pleasant and safe places to ride and tend to 

avoid complex road environments with much motor vehicle traffic. 

• Children: Children under the age of 16 have no experience from the perspective of a 

driver. Depending on their age and experience they have limited ability to detect, 

understand, and anticipate traffic hazards and immature decision-making capabilities. 

They may be taking purposive trips, such as to or from school or to go to a sports activity, 

or they may be just riding around, but they are not well equipped to take a full role as a 

traffic participant. 

Preschool and elementary-age beginners, who have almost no adult-level traffic 

awareness and who ride for play, are not able to handle unsupervised access to motor 

vehicle traffic. They are much different than older, early teenage riders, who lack adult 

traffic awareness and judgment but whose bicycle-handling skills approach or exceed 

those of most adult riders and who may have the ability to use specific strategies to ride 

safely in traffic. 

Strategies to Reduce Bicycle Crashes and Injuries 

Several strategies may be used to decrease bicycle crashes. 

• Educate motorists and bicyclists on how they should interact with each other and what 

the relevant laws require. For example, add materials on sharing the road with bicyclists 

to the driver education curriculum and appropriate questions to the driver licensing exam. 

• Pass laws to facilitate safe and efficient bicycling in traffic, to update and fill gaps in 

existing laws. Educate the public on any new laws. 

• Increase enforcement, to increase traffic law compliance by both motorists and bicyclists. 

Train law enforcement officers in appropriate enforcement strategies. In particular, 

decrease wrong-way riding, sidewalk riding, and traffic control violations by bicyclists 

and cutting off bicyclists, passing too closely, or blocking or driving in a designated 

bicycle lane by motorists. 

• Increase the conspicuity of bicyclists. 

• Increase the use of properly fitted bicycle helmets by all bicyclists, both children and 

adults. 

Resources 

The agencies and organizations listed below can provide information on bicycle safety issues and 

countermeasures and links to numerous other resources. 

• National Highway Traffic Safety Administration (NHTSA): 

www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.810acaee50c651189ca8e410dba046a0/ 

• DOT Pedestrian and Bicycle Clearinghouse at the Pedestrian and Bicycle Information 

Center, maintained by the UNC Highway Safety Research Center: www.pedbikeinfo.org 

and www.bicyclinginfo.org 

• Federal Highway Administration (FHWA): 

o Bicycle and pedestrian safety program 

www.fhwa.dot.gov/environment/bikeped/index.htm 
 9 - 4 

o Office of Safety: http://safety.fhwa.dot.gov/ped_bike/bike/index.htm 

o Bicycle Safety Resource Guide: 

http://safety.fhwa.dot.gov/tools/docs/welcome_bsg.pdf 

• League of American Bicyclists: www.bikeleague.org 

• National Center for Bicycling and Walking: www.bikewalk.org 

• Bicycle Helmet Safety Institute: www.helmets.org 

• SAFE KIDS Worldwide: www.safekids.org 

In addition, the NCHRP Report 500 Guide for Reducing Collisions Involving Bicyclists should 

be released in 2006 (NCHRP, to appear). It will include a comprehensive discussion of bicycle 

crash types, victims, and countermeasures emphasizing engineering solutions. When released, 

the Guide will be available at http://safety.transportation.org/guides.aspx. 
 9 - 5 

Countermeasures That Work 

Countermeasures to improve bicycle safety are listed below and discussed individually in the 

remainder of this chapter. The table is intended to give a rough estimate of each 

countermeasure’s effectiveness, use, cost, and time required for implementation. The terms used 

are described below. Effectiveness, cost, and time to implement can vary substantially from State 

to State and community to community. Costs for many countermeasures are difficult to measure, 

so the summary terms are very approximate. See each countermeasure discussion for more 

information on each item. 

Most States have a bicycle safety coordinator, often within the SHSO. The coordinator will be 

aware of active programs within the State and will have access to resources for implementing 

many of the countermeasures listed below. In addition, all States should have pedestrian-bicyclist 

coordinators in their department of transportation as required by FHWA. 

1. Children 

Countermeasure Effectiveness Use Cost Time 

1.1 Bike fairs, bike rodeos Unknown Unknown Low Medium 

1.2 Bicycle education in schools Unknown Unknown Medium Short 

1.3 Bicycle helmet laws for children Proven Medium Medium Short 

1.4 Safe Routes to School (SR2S) for bicyclists Unknown Unknown Low Medium 

2. Adults 

Countermeasure Effectiveness Use Cost Time 

2.1 Share the Road awareness programs Unknown Unknown Medium Medium 

2.2 Bicycle safety in driver education Unknown Low Low Medium 

2.3 Bicycle helmet laws for adults Likely Low Medium Short 

3. All bicyclists 

Countermeasure Effectiveness Use Cost Time 

3.1 Rider conspicuity Likely Medium Low Medium 

3.2 Active bicycle lighting Likely Low Medium Medium 

3.3 Targeted enforcement Varies Low Medium Medium 

3.4 Bicycle helmet promotions with education Likely Medium High Medium 

Effectiveness: 

Proven: demonstrated by several high-quality evaluations with consistent results 

Likely: balance of evidence from high-quality evaluations or other sources 

Uncertain: limited and perhaps ambiguous evidence 

Unknown: no high-quality evaluation evidence 

Varies: different methods of implementing this countermeasure produce different results 

Effectiveness is measured by reductions in crashes or injuries unless noted otherwise. See 

individual countermeasure descriptions for information on effectiveness size and how 

effectiveness is measured. 
 9 - 6 

Use: 

High: more than two-thirds of the states, or a substantial majority of communities 

Medium: between one-third and two-thirds of states or communities 

Low: less than one-third of the states or communities 

Unknown: data not available 

Cost to implement: 

High: requires extensive new facilities, staff, equipment, or publicity, or makes heavy 

demands on current resources 

Medium: requires some additional staff time, equipment, facilities, and/or publicity 

Low: can be implemented with current staff, perhaps with training; limited costs for 

equipment, facilities, and publicity 

These estimates do not include the costs of enacting legislation or establishing policies. 

Time to implement: 

Long: more than one year 

Medium: more than three months but less than one year 

Short: three months or less 

These estimates do not include the time required to enact legislation or establish policies. 
 9 - 7 

1.1 Bike Fairs, Bike Rodeos 

Effectiveness: Unknown Use: Unknown Cost: Low Time: Medium 

Young children are just learning about traffic. They have limited abilities to perceive traffic 

hazards, little experience with which to anticipate and interpret what may happen, and limited 

abilities to reason and react. Their brains are still developing and they lack the maturity and 

judgment needed to negotiate traffic safely and limit risk-taking behaviors. They also are less 

able to ride than adults. Their bicycles often are smaller and less stable, and most children aren’t 

able to maintain the same speeds that adults can. Bike fairs and rodeos can’t correct the physical 

shortcomings, but they can teach youngsters about traffic laws that apply to them and how to ride 

defensively in a number of typical traffic conditions. 

A bike fair or rodeo is an event which provides children an opportunity to learn and practice 

bicycling skills. A rodeo typically has several stations for specific skills and also includes bicycle 

and helmet inspections. 

There are a number of bicycle safety courses and models for fairs and rodeos. Examples include 

Chapin (2005), Minnesota Safety Council (undated), and Williams and Burden (1994). 

Use: Bicycle safety fairs and rodeos are local events. They are often run by the police, school 

personnel, or health educators. There may be permanent “neighborhood” layouts where the 

rodeos are conducted, and the events may be scheduled as part of the elementary and middle 

school curriculum. 

Effectiveness: While rodeos can result in knowledge improvements and may influence 

behaviors, we are not aware of any research testing crash and injury reduction. A recent program 

of comprehensive education for preschool children and their parents, including a skills and safety 

rodeo, led to a doubling of helmet use (Britt, Silver, and Rivara, 1998). 

Costs: A one-time rodeo can be operated with volunteers at minimal cost. A permanent rodeo 

facility could cost thousands of dollars. 

Time to implement: A one-time rodeo can be organized in a few months. 
 9 - 8 

1.2 Bicycle Education in Schools

Effectiveness: Unknown Use: Unknown Cost: Medium Time: Short 

A bicycle education curriculum offered in schools can teach traffic laws and how to ride on 

streets with traffic present. As part of the regular curriculum, the courses can reach every student. 

Most courses can include helmet fitting and wearing. In addition, the course could include 

pedestrian training, making it part of a comprehensive traffic safety program, with components 

assembled from separate NHTSA, or comparable, programs. Many programs target children in 

grades K-8, though some are aimed at younger children. 

For a careful review of training programs, many aimed at school children, see Rivara and Metrik 

(1998). A current listing of many training programs can be found in the FHWA Bicycle Safety 

Education Resource Center, www.bicyclinginfo.org/ee/education.htm. See also the Good 

Practices Guide for Bicycle Safety Education (FHWA, 2005). 

Use: The use of such programs, which may be at the option of local school districts, is unknown. 

Effectiveness: Programs such as these can increase knowledge of laws and proper behaviors, but 

their effectiveness in persistent behavior change and crash reductions has not been demonstrated. 

Costs: Existing materials can be used to set up the courses within the school environment, 

perhaps with temporary road and intersection layouts that can be used in the gym or outside 

parking lot, so the cost to the schools is moderate. If the sessions are used within the existing 

curriculum, then there would be no extra costs associated with the presentations. 

Time to implement: Short, for existing materials; medium, to develop and disseminate a 

training curriculum with materials. 
 9 - 9 

1.3 Bicycle Helmet Laws for Children 

Effectiveness: Proven Use: Medium Cost: Medium Time: Short 

Bicycle helmets, when used properly, reduce head injuries and fatalities. Attewell et al. (2001) 

examined all research studies published between 1987 and 1998. They found that helmets 

reduced overall head injuries by about 60 percent and reduced fatalities by about 73 percent. The 

recent Cochrane review (Thompson et al., 2006) confirms these findings. 

A helmet use law is a significant tool in increasing helmet use. Its effectiveness is enhanced 

when combined with a supportive publicity and education campaign. See, for example, Rivara et 

al. (1998), Kanny et al. (2001), and Rodgers (2002). 

Use: As of January 2006, 20 States, the District of Columbia, and at least 148 municipal 

localities have child helmet laws (NHTSA, 2006b). Most laws cover all bicyclists under the age 

of 16. Only 13 States have no State or local laws. 

Effectiveness: Grant and Rutner (2004) analyzed FARS data and concluded that State helmetuse laws for children reduce child bicycle fatalities by about 15 percent in the long run. 

Costs: A helmet law should be supported with appropriate communications and outreach to 

parents, children, schools, pediatric health care providers, and law enforcement. NHTSA has a 

wide range of materials that can be used to publicize proper helmet use. While helmets that meet 

safety requirements can be purchased for less than $10, States may wish to provide free or 

discounted helmets to some children. The practical effect of bicycle helmet laws is to encourage 

parents to require their children to use helmets. Law enforcement officers rarely issue citations, 

so law enforcement costs are minimal. 

Time to implement: Short, for existing materials; medium, to develop custom communications 

and outreach or to start a helmet distribution or subsidy program. 
 9 - 10 

1.4 Safe Routes to School (SR2S) for Bicyclists 

Effectiveness: Unknown Use: Unknown Cost: Low Time: Medium 

Safe Routes to School (SR2S) programs include identifying routes that are appropriate for 

bicycling and walking to school and improving the safety of those routes. The goal is to increase 

the amount of bicycling and walking trips to and from school while increasing the safety of those 

routes. SR2S is made up of training for children, improved traffic control around schools, and 

engineering to improve risky elements of the traffic environment. 

SR2S packages are available from NHTSA. They include student and instructor materials and 

can be implemented “off the shelf.” For an overview, see NHTSA’s Safe Routes to School: 

Practice and Promise, which presents the background, rationale, and steps to follow for SR2S 

and describes several existing programs (NHTSA, 2004). Beginning in 2005, SAFETEA-LU 

requires each state to have its own SR2S program including infrastructure improvements, public 

awareness and outreach, traffic education and enforcement near schools, student sessions, 

training for volunteers and program managers, and a full-time coordinator for the State’s entire 

SR2S program. A link to a list of current State coordinators can be found on the Safe Routes to 

School overview Web page, http://safety.fhwa.dot.gov/saferoutes/index.htm. See Safe Routes to 

School News at www.bicyclinginfo.org for additional information on SR2S bicycling programs. 

Use: Unknown. 

Effectiveness: The materials are effective in teaching young children and their parents how to 

evaluate and choose the best routes for walking or bicycling to and from school. They are 

derived from analyses of types of crashes associated with trips to and from school, but it has not 

been possible to directly evaluate their effect on crashes and injuries. Although the full program 

emphasizes broad education, some specific implementations have centered on site-appropriate 

engineering changes; results have shown behavioral improvements for pedestrians, bicyclists, 

and motorists (NHTSA, 2004). 

Costs: Low. Materials are available from NHTSA. 

Time to implement: Short; materials can be obtained and programs implemented quickly. 
 9 - 11 

2.1 Share the Road Awareness Programs 

Effectiveness: Unknown Use: Unknown Cost: Medium Time: Medium 

The National Strategies for Advancing Bicycle Safety was developed from a July 2000 

conference of bicycle advocates, injury prevention specialists, and government representatives 

(NHTSA, 2001). The result was five goals, each with a series of strategies and action steps. The 

first goal, Motorists Will Share the Road, called for the creation of a “coordinated ‘Share the 

Road’ public education campaign that can be adapted at the State and local levels.” 

The initiative has not yet resulted in a package of materials, but similar-themed training modules 

and communications and outreach materials are available from NHTSA and others. See for 

example www.bicyclinginfo.org/ee/ed_motorist.htm. 

Use: Unknown. 

Effectiveness: The materials can be effective in increasing knowledge and appropriate attitudes, 

but there is no systematic evidence of changes in driving behavior or reductions in crashes. 

Costs: Medium, including the costs to develop new materials or tailor current ones. The 

materials can be delivered as training for specific target audiences, such as new drivers or all 

high school students, or drivers as they renew their licenses, or general communications and 

outreach intended for mass media delivery. 

Time to implement: Medium. The first step in implementing this countermeasure would be to 

select the message, audience, and objectives, followed by identifying appropriate source 

materials and making whatever changes are needed to meet the specific requirements. 

Subsequent delivery could be implemented quickly. 
 9 - 12 

2.2 Bicycle Safety in Driver Education 

Effectiveness: Unknown Use: Low Cost: Low Time: Medium 

Though driver education and State driver manuals address sharing the road with bicyclists, they 

spend relatively little time on the topic. Materials exist which could be used to increase the 

emphasis on driving around bicyclists. For example, the League of American Bicyclists has two 

relevant products, Bike Ed: Motorist Education and Effective Cycling: Motorist Education 

(www.bikeleague.org). The former is intended to train driver education instructors on how to 

expand the topic in their driver education classes. The latter is a three-hour module which can be 

inserted into the standard driver education curriculum. It covers topics such as positioning of 

cyclists on the roadway, traffic and hand signals, right-of-way principles, and left- and right-turn 

problems. 

One standard approach would be to implement a Share the Road module (see 2.1, above), 

covering interactions with both bicyclists and pedestrians, into the driver education curriculum, 

as Maine does currently (for bicyclists). For complete coverage, the same message would need to 

be included in state-provided materials for new drivers and covered by new questions added to 

the knowledge license exam. 

Use: All driver education curricula have some coverage of bicycles on the road. However, 

enhanced modules in the spirit of this countermeasure likely are quite rare. 

Effectiveness: Unknown for crash and injury reduction. 

Costs: Low. Materials such as those listed above are available now. The cost to add them to the 

existing driver education curriculum would be low. Changes to state manuals and other materials 

could be done within the normal material update budget. 

Time to implement: A matter of months, once the scope and content of the added information 

was determined. Driver education curricula can be updated quickly. Changes to State driver 

manuals or licensing exams would wait for their normal update cycle, though as an interim 

measure the State could provide the information in the form of a separate supplement. 
 9 - 13 

2.3 Bicycle Helmet Laws for Adults 

Effectiveness: Likely Use: Low Cost: Medium Time: Short 

Bicycle helmets, when used properly, reduce head injuries and fatalities. Attewell et al. (2001) 

examined all research studies published between 1987 and 1998. They found that helmets 

reduced overall head injuries by about 60 percent and reduced fatalities by about 73 percent. The 

recent Cochrane review (Thompson et al., 2006) confirms these findings. 

Currently, no States require adult bicyclists to wear helmets. About 40 smaller governments, 

mostly in the State of Washington, require helmet use (BHSI, 2006). 

Use: Very low. 

Effectiveness: Likely to be effective. Ginsberg and Silverberg (1994) analyzed a prospective 

helmet law in Israel, finding a 3:1 benefit-to-cost ratio. Puder et al. (1999) found a helmet law for 

all ages produced higher helmet wearing than laws for children only; consistently, teens were 

least likely to wear helmets. 

Costs: Moderate costs could be incurred for informing and educating the public and providing 

training for enforcement personnel. 

Time to implement: Medium, with the need to adapt materials from those urging helmet use for 

children, or develop entirely new materials, and train police. 
 9 - 14 

3.1 Rider Conspicuity 

Effectiveness: Likely Use: Medium Cost: Low Time: Medium 

A common contributing factor for crashes involving bicyclists in the roadway is the failure of the 

driver to detect and notice the bicyclist. New bicycles must be sold with reflectors meeting the 

CPSC requirements (though owners are free to remove them after the purchase). The reflectors 

significantly improve a bicycle’s visibility when lit by vehicle lights. 

Additional materials attached to bicyclists can increase their conspicuity day or night. For 

daytime, bright clothing, including vests, caps, and ankle and wrist straps, can make the bicyclist 

much more noticeable. At night, the same items can have retro-reflective materials incorporated 

in them, so that headlights can make the bicyclist visible and identifiable from much greater 

distances. 

Use: Use of bicycle reflectors is high. Use of retro-reflective clothing is rare. Most, if not all, 

athletic shoes contain some retro-reflective material. Some athletic clothing has retro-reflective 

material. Bicycle helmets have retro-reflective elements. Some bicyclists may be seen wearing 

additional retro-reflective materials, such as vests, arm bands, or rear-mounted reflective 

triangles (“fanny bumpers”). 

There is much room for improvement. An aggressive education campaign may make riders more 

aware of the need for, and benefits of, retro-reflective materials and more likely to choose and 

use retro-reflective clothing or other enhancements. Such a campaign may encourage clothing 

and bicycling equipment manufacturers to develop and market a range of bicycling clothing with 

retro-reflective materials strategically embedded. 

Effectiveness: Retro-reflective vests can greatly increase the detection distance for pedestrians 

or, by extension, bicyclists at night. Even low beam headlights can illuminate figures hundreds 

of feet away, much farther than figures wearing normal clothing (NCHRP, 2004, Strategy B5; 

NCHRP, to appear). Bright colored or white clothing is not detected much more readily than 

dark clothing (Jacobs et al., 1980). The trick is getting bicyclists to wear retro-reflective 

materials routinely when bicycling at night. To the extent that all of their normal bicycling gear 

is retro-reflective, the likelihood of it being used increases. 

Costs: The cost of separate vests, wrist or ankle straps, etc. is relatively modest. Adding retroreflective fibers or patches to jackets or caps that bicyclists would wear anyway should be almost 

cost-free to the bicyclists. Much of the gear currently being made for bicycling can have retroreflective materials. 

Time to implement: Materials for an education campaign by bicycle safety can be created 

quickly. The time necessary for bicyclists to get the materials and integrate them into their 

normal routines will be much longer, with gradual adoption and use building over a year or 

more. 
 9 - 15 

3.2 Active Bicycle Lighting 

Effectiveness: Likely Use: Low Cost: Medium Time: Medium 

In most jurisdictions, bicycles ridden after dark are required to have active front and rear lights 

(i.e., devices that emit their own light, not just reflect light from automobile headlights or other 

external sources). Most bicycles do not have such lighting, however (Osberg et al., 1998). Active 

bicycle lighting can be critical for the detection of bicyclists coming at an angle toward the path 

of a motor vehicle, because the bicyclist is outside the vehicle’s headlight beam until the last 

moment. 

The laws for bicycle lighting typically specify lights on the bicycle. Though standard headlights 

and taillights are continuously lit, bicycle lights that flash are more readily detected. Lights also 

may be strapped to the bicyclist’s ankles, wrists, or elbows, where the motion of the rider makes 

them more detectable. More extreme lighting is also available. For example, bright neon tubes 

are designed to be mounted on the bicycle frame, where they cast a bright, broad pattern of light 

onto the roadway, creating the illusion of a vehicle much wider than a bicycle. See, for example, 

www.fossilfool.com/down-low-glow.htm. 

The goal is to encourage bicyclists to use active lighting. Most active lights are not permanently 

mounted on bicycles, so they are often not available when needed. Improvements in the lights 

themselves can help. Batteries last much longer with new LCD lighting, increasing convenience 

and safety. It is possible to obtain widespread use of lighting. Osberg et al. (1998) found nearly 

half of bicyclists in Paris used active lighting, compared to just 14 percent of Boston bicyclists, 

reflecting differences in laws, public health priorities, and perceived risk. 

The SHSO can provide communications and outreach on active bicycle lighting and by 

supporting police training leading to enforcement of the existing requirements. All of these steps 

can be important to increasing the use of lights. 

Use: Active lights appear to be used only occasionally by bicyclists who ride after dark. 

Effectiveness: Active lights can increase the distance at which bicyclists can be detected. A 

CPSC study showed that flashing taillights can be detected at significantly greater distances than 

bicycles with CPSC regulation reflectors (CPSC, 1999). Standard lighting patterns, designed 

specifically for bicycling, could also improve the ability of motorists to correctly identify the 

source as a bicyclist. 

Costs: Moderate costs are involved. Bicyclists will incur some costs to properly equip 

themselves and their bicycles with lights, and these costs can be substantial for something like 

the neon tubes described above. The State will also incur costs, for communications and outreach 

and for police training. 

Time to implement: Medium. Though lights are available now, at least several months can be 

taken up by designing, producing, and implementing the communications and outreach and 

police training. 
 9 - 16 

3.3 Targeted Enforcement 

Effectiveness: Varies Use: Low Cost: Medium Time: Medium 

Enforcing laws concerning bicyclists requires focus on both motorists and bicyclists. While 

bicyclists often fail to follow the rules of the road as they are written for motor vehicles, 

motorists often fail to treat bicyclists as legitimate vehicles on the roads. 

Bicyclists often take inappropriate paths, such as wrong-way riding, riding on sidewalks, and 

making left turns by creatively weaving through lanes and traffic. They also frequently ignore 

stop signs and red lights. Motorists may cut bicyclists off by overtaking and then turning through 

the bicyclist’s path without allowing enough room, or by making a left turn in front of an 

oncoming bicyclist. Motorists also may pass without allowing enough space between the car and 

the bicycle or drive in or otherwise block a designated bicycle lane. All of these actions, and 

others, are enforceable offenses. 

Enforcing bicycle-related laws for motorists falls within the normal scope of traffic law 

enforcement for police, though they may not be particularly alert to these specific violations. 

Enforcing laws for bicyclists can be a frustrating, unpopular activity for police. The public seems 

tolerant of a wide variety of non-legal bicyclist behavior, so that there may be little public 

support for the enforcement. Also, targets for potential enforcement are often young. In those 

cases, police may appropriately use stops as an opportunity to explain the correct behaviors as an 

extension of community policing principles. 

The SHSO can help ensure correct riding through a communications and outreach campaign and 

through training police to know the laws, the safety benefits of obeying the laws, and how to 

enforce bike laws. Specific training for police can be found at the Pedestrian and Bicycle 

Information Center, www.bicyclinginfo.org/ee/enforce_officer03.htm. The Center provides twoday training for community outreach; three-hour training for police enforcement, crash 

investigation, and other activities with regards to bicycle activity; and a bicycle safety roll-call 

video (all from NHTSA); plus a two-day course in bicycle safety and enforcement from the 

Wisconsin Bureau of Traffic Safety. These products can satisfy the needs of departments 

regardless of how they choose to emphasize bicycle safety. Additional training for prosecutors 

and judges is important as well so that there is appropriate follow-up for citations throughout the 

judicial system. 

Use: It is likely that targeted enforcement of bicycle-related violations is rarely used. 

Effectiveness: Gilchrist et al. (2000) describe an enforcement program in Georgia which 

impounded the bicycles of unhelmeted children and produced long-term increases in helmet 

wearing. This specific example seems unlikely to be broadly popular. Increasing community 

awareness and police enforcement efforts, however, through the training courses and approaches 

noted above, could yield benefits that go beyond bicycle safety, to include improved community 

relations and more positive interactions between police and younger members of the community. 

Costs: Medium. Training currently exists for the police. Roll-call videos can be implemented at 

essentially no cost to the departments. The longer courses take officers away from their regular 
 9 - 17 

duties or require overtime commitment. SHSOs may be able to provide funding for departments 

to participate in such training. Training for prosecutors and judges would likely need to be 

developed, as would a supporting communications and outreach programs for the public, 

motorists and bicyclists. 

Time to implement: For existing police training, with ongoing presentation schedules, 

implementation time can be quite short. For the full effort described above, a longer time frame 

would be needed. 
 9 - 18 

3.4 Bicycle Helmet Promotions with Education 

Effectiveness: Proven Use: Medium Cost: High Time: Medium 

Bicycle helmet promotions are frequent, but all have been aimed at child bicyclists, often 

through youth health organizations. Promotions can include sponsoring organizations and often 

involve police and schools to deliver helmets and teach their proper use. Promotions can be 

conducted through single events or extended campaigns to promote helmet distribution and use. 

Expanding helmet promotions to include adults will require an expansion in focus, and perhaps 

more sponsors. However, adding an adult focus can increase the appeal of the program and allow 

adding some adult-oriented riding tips. 

Bicycle helmet promotions must include instruction on properly fitting and wearing the helmets 

and would benefit from some kind of demonstration of how the helmets work to reduce injury. 

Use: Most States have conducted some bicycle helmet promotion for children within the last few 

years. 

Effectiveness: Bicycle helmets are proven to reduce injuries and fatalities (see Sections 1.3 and 

2.3). Of course, a bicyclist must have a helmet (that fits) before he or she can wear it. Helmet 

promotions are successful in getting more helmets into the hands of bicyclists. Rouzier and Alto 

(1995) describe a comprehensive program of presentations, media coverage, messages from 

doctors to patients, as well as low-cost helmet availability, which significantly increased helmet 

purchases and use for all ages. Though owning a helmet doesn’t guarantee its use, a large 

percentage of helmets distributed through a promotion do end up on the heads of bicyclists. 

Costs: The cost for underwriting large numbers of helmets can be quite high, including 

supporting communications and outreach materials. Adequate helmets can be purchased for less 

than $10 each, within reach of most adult bicyclists. Making those helmets or more expensive 

ones available at reduced cost, through subsidies or merchant-manufacturer participation, could 

greatly increase the possible impact of the program by making it available to all at-risk segments 

of the population. 

Time to implement: The time to recruit sponsors, develop support materials, and publicize the 

event can add up to several months or more. 
 9 - 19 

Bicycle Safety References 

Attewell, R.G., Glase, K., and McFadden, M. (2001) Bicycle helmet efficacy: a meta-analysis. 

Accident Analysis and Prevention 33, pp. 345-352. 

Bicycle Helmet Safety Institute. (2006). Helmet Laws for Bicycle Riders. Arlington, VA: Bicycle 

Helmet Safety Institute. www.helmets.org/mandator.htm. 

Britt, J., Silver, I., Rivara, F.P. (1998). Bicycle helmet promotion among low income preschool 

children. Injury Prevention 4(4), pp. 280-283. 

Chaplin, L. (2005). An Organizer’s Guide to Bicycle Rodeos. Ithaca, NY: Cornell University 

Cooperative Extension. www.bike.cornell.edu/pdf percent20files/Bike_Rodeo_404.2.pdf 

CPSC (1998). Bicycle Reflector Project. Bethesda, MD: U.S. Consumer Product Safety 

Commission. www.cpsc.gov/volstd/bike/BikeReport.pdf 

FHWA (2005). Good Practices Guide for Bicycle Safety Education, FHWA-SA-02-001, HAS4/30-02 (5M)QE. Washington, DC: Federal Highway Administration. 

www.bicyclinginfo.org/ee/bestguidedoc.html 

Gilchrist, J., Schieber, R.A., Leadbetter, S., and Davidson, S.C. (2000). Police enforcement as 

part of a comprehensive bicycle helmet program. Pediatrics 106(1 Pt 1), pp. 6-9. 

Ginsberg, G.M. and Silverberg, D.S. (1994). A cost-benefit analysis of legislation for bicycle 

safety helmets in Israel. American Journal of Public Health 84(4), pp. 653-656. 

Grant, D. and Rutner, S.M. (2004). The effect of bicycle helmet legislation on bicycling 

fatalities. Journal of Policy Analysis and Management 23(3), pp. 595-611. 

Jacobs, H.H., Leaf, W.A., and Shaw, C.W. (1980). Nighttime Visibility of Pedestrians Wearing 

Conventional and Retro-reflective Clothing. Darien, CT: Dunlap and Associates. 

Kanny, D., Schieber, R.A., Pryor, V., and Kresnow, M.J. (2001). Effectiveness of a state law 

mandating use of bicycle helmets among children: an observational evaluation. American 

Journal of Epidemiology 154(11), pp. 1072-1076. 

Minnesota Safety Council (undated). Bike Rodeo Planning Guide. St. Paul, MN: Minnesota 

Safety Council. www.mnsafetycouncil.org/bicycle/programs/rodeo/intro.htm 

NCHRP Report 500, Vol. 10 (2004). A Guide for Reducing Collisions Involving Pedestrians. 

Washington, DC: Transportation Research Board. http://safety.transportation.org/guides.aspx. 

NCHRP Report 500 (to appear). A Guide for Reducing Collisions Involving Bicycles. 

Washington, DC: Transportation Research Board. http://safety.transportation.org/guides.aspx. 
 9 - 20 

NHTSA (2001). National Strategies for Advancing Bicycle Safety. DOT HS 809 347. 

Washington, DC: National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/people/injury/pedbimot/bike/bicycle_safety/ 

NHTSA (2004). Safe Routes to School: Practice and Promise. Washington, DC: National 

Highway Traffic Safety Administration. www.nhtsa.dot.gov/people/injury/pedbimot/bike/SafeRoutes-2004/ 

NHTSA (2006). Traffic Safety Facts 2005: DOT HS 810 631. Washington, DC: National 

Highway Traffic Safety Administration. www-nrd.nhtsa.dot.gov/pubs/tsf2005ee.pdf 

NHTSA (2006b). Bicycle Helmet Use Laws. Traffic Safety Facts: Laws. Washington, DC: 

National Highway Traffic Safety Administration. 

www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Rulemaking/Articles/Associated percent20Files/02 

percent20Bike percent20Helmet percent20Use.pdf 

NHTSA and BTS (2003). National Survey of Pedestrian & Bicyclist Attitudes and Behaviors: 

Highlights Report. Washington, DC: National Highway Traffic Safety Administration and 

Bureau of Transportation Statistics. 

www.walkinginfo.org/pdf/FinalBikePedSurveyHighlightsReport_v2.pdf 

Osberg, J.S., Stiles, S.C., and Asare, O.K. (1998). Bicycle safety behavior in Paris and Boston. 

Accident Analysis and Prevention 30(5), pp. 679-687. 

Puder, D.R., Visintainer, P., Spitzer, D., and Casal, D. (1999). A comparison of the effect of 

different bicycle helmet laws in 3 New York City suburbs. American Journal of Public Health

89(11), pp. 1736-1738. 

Rivara, F.P. and Metrik, J. (1998) Training Programs for Bicycle Safety. Olympia, WA: 

Washington Traffic Safety Commission. 

Rivara, F.P., Thompson, D.C., Patterson, M.Q., and Thompson, R.S. (1998). Prevention of 

bicycle-related injuries: helmets, education, and legislation. Annual Review of Public Health 19, 

pp. 293-318. 

Rodgers, G.B. (2002). Effects of state helmet laws on bicycle helmet use by children and 

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