Form 1366 Complete Survey

OMB Control Number: 2017XX-2127-XXX

Expiration Date: XX/XX/XXXX

Psychological Constructs Related to Seat Belt Use

Survey

Under the Paperwork Reduction Act, a federal agency may not conduct or sponsor, and a person is not required to respond to collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control number. The OMB Control Number for this information collection is XXXX-XXXX (expiration date: MM/DD/YYYY). The average amount of time to complete this survey is 19 minutes. All responses to this collection of information are voluntary. The purpose of this research is to identify psychological constructs and psychosocial factors associated with not wearing seat belts. This research will inform development of countermeasures designed to more effectively encourage seat belt use. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden send them to Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590.

Protecting your privacy is important. We use confidentiality standards set by the Council of American Survey Research Organizations. We never give your identity or contact information to anyone without your permission. You can read our Panel Member privacy statement here.

Survey

1. A decision rule is a rule you follow that determines or otherwise informs your behavior in certain situations. For example, you may have a decision rule about the weather and sunscreen use, such as: “If it is sunny outside, I will put on sunscreen.” Do you have a rule like this that you follow about when to use your seat belt when you are driving or riding as a passenger in a motor vehicle?

If selects “No” or “Do not wish to answer (Refuse)” skip to Question 3.

2. How often would you say that you follow this rule?

3. Some people’s use of a seat belt differs depending on the situation. We’d like to know how often you use a seat belt in certain situations. How often do you wear your seat belt when…

	Never	Rarely	Some of the time	Most of the time	All of the time	Not applicable	Do not wish to answer (Refuse)
a. You are driving a motor vehicle?
b. You are riding as a front seat passenger in a motor vehicle?
c. You are riding as a back seat passenger in a motor vehicle?

d. You are riding as a passenger in a taxi/cab?
e. You are riding as a passenger while using a ride sharing service such as Uber or Lyft?
f. You are driving or riding as a passenger in a work vehicle (e.g., a mail carrier driving a mail van)?

g. You are driving or riding as a passenger during the day?
h. You are driving or riding as a passenger at night?

i. others are present in the motor vehicle?
j. Others are not present in the motor vehicle?

4. Next, please tell us how the presence of SPECIFIC individuals in a vehicle with you is likely to alter your seat belt use, if at all.

	Less likely to wear my seat belt	More likely to wear my seat belt	Does not affect the likelihood I will wear my seat belt	Not applicable	Do not wish to answer (Refuse)
a. A friend?
b. A child under the age of 12?
c. A teenager or adolescent?
d. A parent?
e. An adult child of yours?
f. A family member that is not a parent or child of yours?

5. Below is a list of reasons why you might wear your seat belt. Please indicate whether each reason applies to you.

		No	Yes	Do not wish to answer (Refuse)
a. It’s a habit.
b. I don’t want to get a ticket.
c. I’m uncomfortable without it.
d. Others want me to wear it.
e. It’s the law.
f. I want to avoid serious injury or death.
g. The people I’m with are wearing seat belts.
h. My car, truck, or van has a bell, buzzer, or light that reminds me.
i. I was brought up to wear it.
j. The seat belt is automatic.
k. Road, traffic, or weather conditions.
l. I’m going to be driving/riding for a long distance.
m. I’m going to be driving/riding on the highway.
n. Other (please specify):

6. Below is a list of reasons why you might not wear your seat belt. Please indicate whether each reason applies to you.

		No	Yes	Do not wish to answer (Refuse)
a. I’m only driving a short distance.
b. I’m driving in light traffic.
c. I’m in a rush.
d. I forget to put it on.
e. It’s a hassle to put on.
f. I don’t want my clothes to get wrinkled.
g. The seat belt is uncomfortable.
h. The probability of being in a crash is too low.
i. The people I am with are not wearing seat belts.
j. I don’t like being told what to do.
k. It may cause injury or trap me if I’m in an accident.
l. I or someone I know was previously in an accident where the seat belt caused an injury.
m. I don’t need to wear one.
n. Other (please specify):

7. Below is a list of different groups of people. Please tell us whether you believe the TYPICAL MEMBER of each group wears their seat belt never, rarely, some of the time, most of the time, or all of the time.

	Never	Rarely	Some of the time	Most of the time	All of the time	Do not wish to answer (Refuse)
a. People your age
b. Your friends
c. Your family members

8. Now, tell us whether you believe the TYPICAL MEMBER of each group thinks OTHERS should wear their seat belts never, rarely, some of the time, most of the time, or all of the time.

	Never	Rarely	Some of the time	Most of the time	All of the time	Do not wish to answer (Refuse)
a. People your age
b. Your friends
c. Your family members

9. When driving or riding as a passenger in a motor vehicle, how often does your SIGNIFICANT OTHER (i.e., wife/husband, boyfriend/girlfriend, partner) wear their seat belt?

10. What’s the year of the motor vehicle you ride in most often?

11. Have you ever been in a motor vehicle crash?

People differ in the ways they act and think in certain situations. The next few questions ask about your own risk taking behaviors and perceptions.

12. How often do you engage in the following types of risks?

	Never	Rarely	Occasionally	Often	Very often	Do not wish to answer (Refuse)
a. Recreational risks (e.g., rock-climbing, scuba diving)
b. Health risks (e.g., smoking, poor diet, high alcohol consumption)
c. Career risks (e.g., quitting a job without another to go to)
d. Financial risks (e.g., gambling, risky investments)
e. Safety risks (e.g., fast driving, city cycling without a helmet)
f. Social risks (e.g., standing for election, publicly challenging a rule or decision)

For Questions 19 through 22, please circle the number that most closely reflects your opinion.

13. Not wearing a seat belt is…

1	2	3	4	5
Safe				Dangerous

14. Not wearing a seat belt is…

1	2	3	4	5
Not risky				Risky

15. How possible do you think it is that BAD LUCK has caused an accident you’ve been involved in, or one that you will be involved in at some point in the future?

1	2	3	4	5
Not at all possible				Highly possible

16. How possible do you think it is that FATE has caused an accident you’ve been involved in, or one that you will be involved in at some point in the future?

1	2	3	4	5
Not at all possible				Highly possible

17. People differ in how they act and think in different situations. The following items ask about how often you act and think in certain ways.

	Never	Rarely	Often	Almost always	Always	Do not wish to answer (Refuse)
a. I am a careful thinker.
b. I plan trips well ahead of time.
c. I do things without thinking.
d. I concentrate easily.
e. I plan for job security.
f. I act on impulse.
g. I am self-controlled.
h. I say things without thinking.
i. I don’t pay attention.
j. I act on the spur of the moment.
k. I plan tasks carefully.
l. I am a steady thinker.
m. I am future oriented.

18. To what extent do you agree with the following statements?

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Do not wish to answer (Refuse)
a. I am an even-tempered person.
b. Sometimes I fly off the handle for no good reason.
c. I have trouble controlling my temper.
d. Other people always seem to get the breaks.
e. I sometimes feel that people are laughing at me behind my back.
f. When people are especially nice, I wonder what they want.
g. I would like to explore strange places.
h. I would like to take off on a trip with no pre-planned routes or timetables.
i. I get restless when I spend too much time at home.
j. I prefer friends who are excitingly unpredictable.
k. I like to do frightening things.
l. I would like to try bungee jumping.
m. I like wild parties.
n. I would love to have new and exciting experiences, even if they are illegal.

19. To what extent would you say the following statements are characteristic of you?

	Extremely uncharacteristic	Somewhat uncharacteristic	Uncertain	Somewhat characteristic	Extremely characteristic	Do not wish to answer (Refuse)
a. I consider how things might be in the future, and try to influence those things with my day to day behavior.
b. I often engage in particular behavior in order to achieve outcomes that may not result for many years.
c. I only act to satisfy immediate concerns, figuring the future will take care of itself.
d. My behavior is only influenced by the immediate (i.e., a matter of day or weeks) outcomes of my actions.
e. My convenience is a big factor in the decisions I make or actions I take.
f. I am willing to sacrifice my immediate happiness or well-being in order to achieve future outcomes.
g. I think it is important to take warnings about negative outcomes seriously even if the negative outcome will not occur for many years.
h. I think it is more important to perform a behavior with important distant consequences than a behavior with less important immediate consequences.
i. I generally ignore warnings about possible future problems because I think the problems will be resolved before they reach crisis level.
j. I think that sacrificing now is usually unnecessary since future outcomes can be dealt with at a later time.
k. I only act to satisfy immediate concerns, figuring that I will take care of future problems that may occur at a later date.
l. Since my day to day work has specific outcomes, it is more important to me than behavior that has distant outcomes.

Social norms are rules or expectations that determine what behaviors are considered appropriate within a particular group or society. The following questions ask about your perceptions of social norms and their influence your own behavior and the behavior of others.

20. How much do you agree with the statements below?

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Do not wish to answer (Refuse)
a. I go out of my way to follow social norms.
b. We shouldn’t always have to follow a set of social rules.
c. People should always be able to behave as they wish rather than trying to fit the norm.
d. There is a correct way to behave in every situation.
e. If more people followed society’s rules, the world would be a better place.
f. People need to follow life’s unwritten rules every bit as strictly as they follow the written rules.
g. There are lots of vital customs that people should follow as members of society.
h. The standards that society expects us to meet are far too restrictive.
i. People who do what society expects of them lead happier lives.
j. Our society is built on unwritten rules that members need to follow.
k. I am at ease only when everyone around me is adhering to society’s norms.
l. We would be happier if we didn’t try to follow society’s norms.
m. My idea of a perfect world would be one with few social expectations.
n. I always do my best to follow society’s rules.

21. For each of the following questions, decide which sort of person you are most like—the one described on the left OR the one described on the right. Then, decide if the statement you chose is “sort of true” or “really true” for you, and mark that choice. You should mark only ONE CHOICE for EACH ROW.

Really true for me	Sort of true for me					Sort of true for me	Really true for me
		Some people go along with their friends just to keep their friends happy.	BUT	Other people refuse to go along with what their friends want to do, even though they know it will make their friends unhappy.
		Some people think it’s more important to be an individual than to fit in with the crowd.	BUT	Other people think it is more important to fit in with the crowd than to stand out as an individual.
		For some people, it’s pretty easy for their friends to get them to change their mind.	BUT	For other people, it’s pretty hard for their friends to get them to change their mind.
		Some people would do something that they knew was wrong just to stay on their friends’ good side.	BUT	Other people would not do something they knew was wrong just to stay on their friends’ good side.
		Some people hide their true opinion from their friends if they think their friends will make fun of them because of it.	BUT	Other people will say their true opinion in front of their friends, even if they know their friends will make fun of them because of it.
		Some people will not break the law just because their friends say that they would.	BUT	Other people would break the law if their friends said that they would break it.
		Some people change the way they act so much when they are with their friends that they wonder who they “really are.”	BUT	Other people act the same way when they are alone as they do when they are with their friends.
		Some people take more risks when they are with their friends than they do when they are alone.	BUT	Other people act just as risky when they are alone as when they are with their friends.
		Some people say things they don’t really believe because they think it will make their friends respect them more.	BUT	Other people would not say things they didn’t really believe just to get their friends to respect them more.
		Some people think it’s better to be an individual even if people will be angry at you for going against the crowd.	BUT	Other people think it’s better to go along with the crowd than to make people angry at you.

22. Please indicate how much you agree or disagree with each of the following statements.

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Do not wish to answer (Refuse)
a. In uncertain times, I usually expect the best.
b. If something can go wrong for me, it will.
c. I’m always optimistic about the future.
d. I hardly ever expect things to go my way.
e. I rarely count on good things happening to me.
f. Overall, I expect more good things to happen to me than bad.
g. In most ways my life is close to my ideal.
h. The conditions of my life are excellent.
i. I am satisfied with my life.
j. So far I have gotten the important things I want in life.
k. If I could live my life over, I would change almost nothing.
l. I feel part of a group of friends.
m. My friends understand my motives and reasoning.
n. I don’t have any friends who share my views, but I wish I did.
o. I am able to depend on my friends for help.
p. I do not have any friends who understand me, but I wish I did.

These final two questions ask about your opinions on certain political and social issues.

23. Please respond to each of the following statements using the scale provided.

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Do not wish to answer (Refuse)
a. I think the government needs to be a part of leveling the playing field for people from different racial groups.
b. I believe government should protect the rights of minorities.
c. I think it is the right of all citizens to have their basic needs met.
d. I believe the role of government is to act as a referee, making decisions that promote the quality of life and well-being of the people.

24. How much do you agree or disagree with the following statements?

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree	Do not wish to answer (Refuse)
a. There is no need to obey laws that seem unreasonable to me.
b. It is okay to disobey a law if I’m not causing any harm to anybody.
c. Sometimes it is okay to ignore unimportant laws.
d. If a law is unjust, I don’t have to obey it.
e. Often I find myself objecting to the symbols of the country (e.g., the flag, the national anthem).
f. I disagree with the values that the USA represents.
g. It is okay for people who are in a difficult situation to occasionally disobey the law.
h. Sometimes I get so frustrated I feel like damaging public property.

NHTSA Form Number 1366