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High-Visibility Enforcement for Seat Belt and Child Restraint Laws										Related Pages
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			Effectiveness and UseRecent or Current LegislationCosts and Time to ImplementOther Issues and ResourcesHistoryReferences
High-visibility enforcement (HVE) is a technique that combines intense enforcement, in this case of seat belt and child restraint laws, over a fixed period of time with a publicity campaign.1*Click It or Ticket*is an example of HVE.1 These programs have also been called enhanced enforcement campaigns.
Effectiveness and Use of HVE for Seat Belt and Child Restraint Laws
For adults and older children, using seat belts correctly and consistently is the most effective way to reduce injuries and save lives in crashes.1 Seat belts are designed to help keep occupants inside vehicles and lower the risk of being ejected if a crash occurs.2,3 They also gradually decelerate the occupants which spreads crash forces across the stronger parts of the body.2,3 Seat belts reduce harmful contact between the occupants and the vehicle interior.2,3 Seat belts also prevent occupants from becoming projectiles and injuring others in the vehicle.2,3 Seat belts reduce serious crash-related injuries and deaths by about half.4 Seat belts were estimated to have saved the lives of 14,955 passenger vehicle occupants in 2017 alone; an additional 2,549 lives could have been saved that year with 100% seat belt use.5
For children, deaths and injuries can be prevented in motor vehicle crashes by always properly buckling them in a car seat, booster seat, or seat belt (whichever is appropriate for their age, height, and weight).6-9 You can read more on CDC’s child passenger safety recommendations. Car seat use saved an estimated 325 children under age 5 in 2017 alone.5
There is evidence for the effectiveness of HVE for increasing seat belt and child restraint use. A Community Guide Systematic Review of studies through 2000 found that enhanced enforcement programs increased seat belt use by 16 percentage points during the program period.10,11 New programs would not be expected to make the same level of impact because current seat belt use is higher than when the studies included in the review were conducted.11 Fewer studies have examined the effectiveness of high-visibility enforcement programs on child passenger safety. Another Community Guide Systematic Review, this one a review of child passenger safety studies through 1998, found two studies in which publicized enhanced enforcement was found to be effective at increasing car seat use (increases of 13% and 21%).12
The National Highway Traffic Safety Administration evaluates the effects of the *Click It or Ticket* campaign on seat belt use in the United States. From 2003 to 2013, recognition of the *Click It or Ticket* slogan went from 35% to 85%, and seatbelt use went from 79% to 87%.13 This is a substantial improvement, but the effect of *Click It or Ticket* campaign cannot be isolated from other law or enforcement changes nationwide.13 However, high and low seat belt use states do differ in their enforcement levels during *Click It or Ticket.*14 In the 2005 *Click It or Ticket* campaign, twice as many seat belt citations were issued per capita in high belt use states than in low belt use states.14 An evaluation of the 2002 *Click It or Ticket* campaign also found larger belt use increases in states that used paid advertisements.15
HVEs combine increased law enforcement and media coverage and are particularly effective for reaching people who are less likely to use seat belts regularly, such as men and young drivers.1,10,11
Recent or Current Legislation by State
You can visit the seat belt laws webpageexternal icon on the Insurance Institute for Highway Safety’s website for up-to-date information on seat belt laws by state, including the type of enforcement, ages and seating positions covered, and fines for violating seat belt laws.2,16 The same webpage also contains up-to-date information on child restraint laws by state, such as child age, height, and weight requirements for different seat types, fines for violating child restraint laws, and seating position requirements.
CDC’s state-specific restraint use fact sheets provide national and state data on restraint use and occupant crash deaths, as well as an overview of proven strategies for increasing the use of seat belts, car seats, and booster seats.
Costs of HVE for Seat Belt and Child Restraint Laws and Time to Implement
HVE campaigns include communications and outreach strategies that often use paid advertising to increase effectiveness so they can be quite expensive.1
HVE programs and accompanying paid advertising can require four to six months to plan and implement.1 Developing, producing, and distributing publicity for HVE programs requires extensive time from state highway safety office and media staff (and often from consultants).1
Other Issues and Resources
One barrier to overcome in the enforcement component of HVEs is the reluctance of law enforcement officers to enforce child restraint laws because of a lack of knowledge about child restraints (if they are not a child passenger safety technician) and competing priorities within their departments.1,17 Training on child passenger safety for law enforcement officers and support for child passenger safety activities from chiefs of police have been identified as strategies to increase the effectiveness of the enforcement of child restraint laws.1,17
You can read Chapter 2, Sections 2.1 and 5.1 of NHTSA’s Countermeasures that Work: A Highway Safety Countermeasure Guide for State Highway Safety Officespdf iconexternal icon (Tenth Edition, 2020) to learn more about the topics above or other issues related to HVE of seat belt and child restraint laws.1
More information can also be found on The Community Guide’s webpages covering Motor Vehicle Injury – Child Safety Seats: Community-Wide Information and Enhanced Enforcement Campaignsexternal icon18 and Motor Vehicle Injury – Safety Belts: Enhanced Enforcement Programsexternal icon.19
For more information about the history of *Click It or Ticket,*please see NHTSA’s Analyzing the First Years of the Click It or Ticket Mobilizationspdf iconexternal icon.20
You can read the RAND Corporation’s final reports for MV PICCS 1.0/2.0external icon and MV PICCS 3.0external icon for more information about how effectiveness and costs were incorporated into the MV PICCS tool for this intervention.
History
HVE programs have been used in conjunction with mandatory seat belt laws in Canada since at least 1979.21 These programs were then adopted in the United States, first by small and medium-sized cities.20 In 1993, using the slogan *Click It or Ticket,*North Carolina was the first to implement a statewide HVE program for restraint use.20 This program was eventually adopted across the country and at the national level.20 Over 10,000 law enforcement agencies across the country participated in the 2018 national *Click It or Ticket campaign*.22 Enforcement of child restraint (i.e., car seat and booster seat) laws are typically included in *Click It or Ticket* campaigns.1
References
Venkatraman, V., Richard, C. M., Magee, K., & Johnson, K. (2021). *Countermeasures that work: A highway safety countermeasures guide for State Highway Safety Offices*. (Report No. DOT HS 813 097). Washington, DC: National Highway Traffic Safety Administration https://www.nhtsa.gov/sites/nhtsa.gov/files/2021-09/15100_Countermeasures10th_080621_v5_tag.pdfpdf iconexternal icon
Insurance Institute for Highway Safety, & Highway Loss Data Institute. (2021). Seat belts. https://www.iihs.org/topics/seat-beltsexternal icon. Accessed on 1/27/2022.
Kahane, C. J. (2015). *Lives saved by vehicle safety technologies and associated federal motor vehicle safety standards, 1960 to 2012: Passenger cars and LTVs: With reviews of 26 FMVSS and the effectiveness of their associated safety technologies in reducing fatalities, injuries, and crashes*. (Report No. DOT HS 812 069). Washington, DC: National Highway Traffic Safety Administration https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812069external icon
Kahane, C. J. (2000). *Fatality reduction by safety belts for front-seat occupants of cars and light trucks: Updated and expanded estimates based on 1986–99 FARS data*. (Report No. DOT HS 809 199). Washington, DC: National Highway Traffic Safety Administration https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/809199external icon
National Center for Statistics and Analysis. (2021). *Occupant protection in passenger vehicles: 2019 data*. (Traffic Safety Facts. Report No. DOT HS 813 176). Washington, DC: National Highway Traffic Safety Administration https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813176external icon
Centers for Disease Control and Prevention. (2021). Child passenger safety. https://www.cdc.gov/transportationsafety/child_passenger_safety/index.html. Accessed on 1/26/2022.
Arbogast, K., Durbin, D., Cornejo, R., Kallan, M., & Winston, F. (2004). An evaluation of forward-facing child restraint systems. *Accident Analysis and Prevention, 36*(585*–*9). https://www.sciencedirect.com/science/article/pii/S0001457503000654external icon
Zaloshnja, E., Miller, T., & Hendrie, D. (2007). Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. *Archives of Pediatrics and Adolescent Medicine, 161*(1):65*–*68. https://jamanetwork.com/journals/jamapediatrics/fullarticle/569418external icon
Arbogast, K., Jermakian, J., Kallan, M., & Durbin, D. (2009). Effectiveness of belt positioning booster seats: An updated assessment. *Pediatrics, 124*, 1281*–*1286. https://pediatrics.aappublications.org/content/124/5/1281.shortexternal icon
Dinh-Zarr, T. B., Sleet, D. A., Shults, R. A., Zaza, S., Elder, R. W., Nichols, J. L., . . . Task Force on Community Preventive Services. (2001). Reviews of evidence regarding interventions to increase the use of safety belts. *American Journal of Preventive Medicine, 21*(4 Suppl), 48*–*65. https://www.sciencedirect.com/science/article/pii/S0749379701003786external icon
Shults, R. A., Nichols, J. L., Dinh-Zarr, T. B., Sleet, D. A., & Elder, R. W. (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*(2), 189*–*196. https://www.sciencedirect.com/science/article/pii/S0022437504000234?via%3Dihubexternal icon
Zaza, S., Sleet, D. A., Thompson, R. S., Sosin, D. M., Bolen, J. C., & Task Force on Community Preventive Services. (2001). Reviews of evidence regarding interventions to increase use of child safety seats. *American Journal of Preventive Medicine, 21*(4 Suppl), 31*–*47. https://pubmed.ncbi.nlm.nih.gov/11691560/external icon
Nichols, J., Chaffe, R., Solomon, M., & Tison, J. (2016). The Click It or Ticket evaluation, 2013pdf iconexternal icon**(Traffic Safety Facts Research Note. Report No. DOT HS 812 238). Washington, DC: National Highway Traffic Safety Administration
Hedlund J, Gilert H, Ledingham K, & Preusser D. (2008). *How states achieve high seat belt use rates*. (Report No. DOT HS 810 962). Washington, DC: National Highway Traffic Safety Administration https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/810962external icon.
Solomon, M. G., Ulmer, R. G., & Preusser, D. F. (2002). *Evaluation of Click It or Ticket model programs*. (Report No. DOT HS 809 498). Washington, DC: National Highway Traffic Safety Administration https://rosap.ntl.bts.gov/view/dot/1747external icon
Insurance Institute for Highway Safety, & Highway Loss Data Institute. (2022). Seat belt and child seat laws by state. https://www.iihs.org/topics/seat-belts/seat-belt-law-tableexternal icon. Accessed on 1/27/2022.
Decina, L. E., Lococo, K. H., Ashburn, W., Hall, W. B., & Rose, J. (2008). *Identifying strategies to improve the effectiveness of booster seat laws*. (Report No. DOT HS 810 969). Washington, DC: National Highway Traffic Safety Administration https://rosap.ntl.bts.gov/view/dot/1835external icon
Guide to Community Preventive Services. (2021). Motor vehicle injury – child safety seats: Community-wide information and enhanced enforcement campaigns. https://www.thecommunityguide.org/findings/motor-vehicle-injury-child-safety-seats-community-wide-information-and-enhanced-enforcementexternal icon. Accessed on 1/27/2022.
Guide to Community Preventive Services. (2021). Motor vehicle injury – safety belts: Enhanced enforcement programs. https://www.thecommunityguide.org/findings/motor-vehicle-injury-safety-belts-enhanced-enforcement-programsexternal icon. Accessed on 1/27/2022.
Tison, J., & Williams, A. F. (2010). *Analyzing the first years of the Click It or Ticket mobilizations*(DOT HS 811 232). Washington, DC: National Highway Traffic Safety Administration https://www.ems.gov/pdf/811232.pdfpdf iconexternal icon
Jonah, B. A., Dawson, N. E., & Smith, G. A. (1982). Effects of a selective traffic enforcement program on seat belt usage. *Journal of Applied Psychology, 67*(1), 89*–*96. https://doi.org/10.1037/0021-9010.67.1.89external icon
National Highway Traffic Safety Administration. (2018). Buckle up. It could save your life. NHTSA kicks off its annual seat belt campaign [Press release]. Retrieved from https://www.nhtsa.gov/press-releases/buckle-it-could-save-your-lifeexternal iconTop of Page
							
					
						Page last reviewed:  February 28, 2022					Content source: 	Centers for Disease Control and Prevention, National Center for Injury Prevention and Control homeTransportation Safety
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