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pdfCountermeasures That Work:
A Highway Safety Countermeasure Guide
For State Highway Safety Offices
Tenth Edition, 2020
Disclaimer
This publication is distributed by the U.S. Department of Transportation, National
Highway Traffic Safety Administration, in the interest of information exchange.
The opinions, findings, and conclusions expressed in this publication are those of
the authors and not necessarily those of the Department of Transportation or the
National Highway Traffic Safety Administration. The United States Government
assumes no liability for its content or use thereof. If trade or manufacturers’
names or products are mentioned, it is because they are considered essential to the
object of the publication and should not be construed as an endorsement. The
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Suggested APA Format Citation:
Venkatraman, V., Richard, C. M., Magee, K., & Johnson, K. (2021, July). Countermeasures that
work: A highway safety countermeasures guide for State Highway Safety Offices, 10th
edition, 2020 (Report No. DOT HS 813 097). National Highway Traffic Safety
Administration.
Technical Report Documentation Page
1. Report No.
2. Government Accession No.
DOT HS 813 097
4. Title and Subtitle
Countermeasures That Work: A Highway Safety Countermeasure Guide
for State Highway Safety Offices, 10th Edition, 2020
3. Recipient’s Catalog No.
7. Authors
Vindhya Venkatraman, Christian M. Richard, Kelly Magee, Battelle
Memorial Institute; and Kristie Johnson, NHTSA
8. Performing Organization Report
No.
9. Performing Organization Name and Address
Battelle Memorial Institute
1100 Dexter Avenue N
Suite #400
Seattle, WA 98109
10. Work Unit No. (TRAIS)
12. Sponsoring Agency Name and Address
13. Type of Report and Period
Covered
Final Report
5. Report Date
July 2021
6. Performing Organization Code
11. Contract or Grant No.
National Highway Traffic Safety Administration
Office of Behavioral Safety Research
1200 New Jersey Avenue SE
Washington, DC 20590
14. Sponsoring Agency Code
15. Supplementary Notes
Kristie Johnson, Ph.D., served as the Contracting Officer’s Representative on this project.
16. Abstract
The guide is a basic reference to assist State Highway Safety Offices (SHSOs) in selecting effective, evidencebased countermeasures for traffic safety problem areas. These areas include:
• Alcohol- and Drug-Impaired Driving;
• Seat Belts and Child Restraints;
• Speeding and Speed Management;
• Distracted Driving;
• Motorcycle Safety;
• Young Drivers;
• Older Drivers;
• Pedestrian Safety;
• Bicycle Safety; and
• Drowsy Driving.
The guide:
• describes major strategies and countermeasures that are relevant to SHSOs;
• summarizes strategy/countermeasure use, effectiveness, costs, and implementation time; and
• provides references to the most important research summaries and individual studies.
17. Key Words
alcohol-impaired driving, drug-impaired driving, seat belts, child
restraints, speeding, distracted driving, drowsy driving, motorcycle
safety, young drivers, older drivers, pedestrians, bicycles, unsafe driving
19 Security Classif. (of this report)
Unclassified
18. Distribution Statement
Document is available to the public
from the National Technical
Information Service, www.ntis.gov.
20. Security Classif. (of this page)
Unclassified
i
21 No. of Pages
641
22. Price
Table of Contents
Note: Asterisks next to topics indicate one- and two-star countermeasures. These
countermeasures are summarized in the main document, with full write-ups provided in the
appendices.
Preface to the 10th Edition, 2020.................................................................................................... x
User Suggestions and Future Editions ........................................................................................ x
Introduction ..................................................................................................................................... 1
Purpose of the Guide ................................................................................................................... 1
How to Use the Guide ................................................................................................................. 1
1. Alcohol- and Drug-Impaired Driving ...................................................................................... 1-1
Overview .................................................................................................................................. 1-1
Strategies to Reduce Impaired Driving .................................................................................... 1-6
Resources ................................................................................................................................. 1-8
Deterrence .............................................................................................................................. 1-14
1. Deterrence: Laws................................................................................................................ 1-16
1.1 Administrative License Revocation or Suspension ..................................................... 1-16
1.2 Open Container ............................................................................................................ 1-19
1.3 High-BAC Sanctions ................................................................................................... 1-20
1.4 BAC Test Refusal Penalties ......................................................................................... 1-22
1.5 Alcohol-Impaired-Driving Law Review ...................................................................... 1-24
2. Deterrence: Enforcement.................................................................................................... 1-25
2.1 Publicized Sobriety Checkpoints ................................................................................. 1-25
2.2 High-Visibility Saturation Patrols................................................................................ 1-29
2.3 Breath Test Devices ..................................................................................................... 1-31
2.4 Passive Alcohol Sensors .............................................................................................. 1-33
2.5 Integrated Enforcement ................................................................................................ 1-35
3. Deterrence: Prosecution and Adjudication ......................................................................... 1-37
3.1 DWI Courts .................................................................................................................. 1-37
3.2 Limits on Diversion and Plea Agreements .................................................................. 1-41
3.3 Court Monitoring ......................................................................................................... 1-43
3.4 Sanctions ...................................................................................................................... 1-44
4. Deterrence: DWI Offender Treatment, Monitoring, and Control ...................................... 1-45
4.1 Alcohol Problem Assessment and Treatment .............................................................. 1-45
4.2 Alcohol Ignition Interlocks .......................................................................................... 1-47
4.3 Vehicle and License Plate Sanctions ........................................................................... 1-51
4.4 DWI Offender Monitoring ........................................................................................... 1-53
4.5 Lower BAC Limits for Repeat Offenders .................................................................... 1-55
5. Prevention, Intervention, Communications, and Outreach ................................................ 1-57
5.1 Alcohol Screening and Brief Intervention ................................................................... 1-58
5.2 Mass Media Campaigns ............................................................................................... 1-60
5.3 Responsible Beverage Service ..................................................................................... 1-62
5.4 Alternative Transportation ........................................................................................... 1-63
ii
5.5 Designated Drivers....................................................................................................... 1-65
6. Underage Drinking and Driving ......................................................................................... 1-66
6.1 Minimum Legal Drinking Age 21 Laws ...................................................................... 1-67
6.2 Zero-Tolerance Law Enforcement ............................................................................... 1-69
6.3 Alcohol Vendor Compliance Checks........................................................................... 1-71
6.4 Other Minimum Legal Drinking Age 21 Law Enforcement........................................ 1-73
6.5 Youth Programs ........................................................................................................... 1-76
7. Drug-Impaired Driving ...................................................................................................... 1-77
7.1 Enforcement of Drug-Impaired Driving ...................................................................... 1-80
7.2 Drug-Impaired-Driving Laws ...................................................................................... 1-82
7.3 Education Regarding Medications ............................................................................... 1-83
Alcohol- and Drug-Impaired-Driving References ................................................................. 1-84
2. Seat Belts and Child Restraints ................................................................................................ 2-1
Overview .................................................................................................................................. 2-1
Strategies to Improve the Safety of Passenger Vehicle Occupants .......................................... 2-4
Resources ................................................................................................................................. 2-6
Countermeasures Targeting Adults ........................................................................................ 2-12
1. Seat Belt Use Laws ............................................................................................................ 2-12
1.1 State Primary Enforcement Seat Belt Use Laws .......................................................... 2-12
1.2 Local Primary Enforcement Seat Belt Use Laws and Ordinances............................... 2-15
1.3 Increased Seat Belt Use Law Penalties: Fines and Driver’s License Points................ 2-16
2. Seat Belt Law Enforcement................................................................................................ 2-18
2.1 Short-Term, High-Visibility Seat Belt Law Enforcement ........................................... 2-18
2.2 Integrated Nighttime Seat Belt Enforcement ............................................................... 2-21
2.3 Sustained Enforcement ................................................................................................ 2-24
3. Communications and Outreach .......................................................................................... 2-25
3.1 Supporting Enforcement .............................................................................................. 2-25
3.2 Strategies for Low-Belt-Use Groups ........................................................................... 2-26
Countermeasures Targeting Children and Youth ................................................................... 2-31
4. Child/Youth Occupant Restraint Laws .............................................................................. 2-31
4.1 Strengthening Child/Youth Occupant Restraint Laws ................................................. 2-31
5. Child Restraint/Booster Seat Law Enforcement ................................................................ 2-34
5.1 Short-Term High-Visibility Child Restraint/Booster Law Enforcement ..................... 2-34
6. Communications and Outreach .......................................................................................... 2-36
6.1 Strategies for Older Children ....................................................................................... 2-36
6.2 Strategies for Child Restraint and Booster Seat Use ................................................... 2-38
7. Other Strategies .................................................................................................................. 2-40
7.1 School-Based Programs ............................................................................................... 2-40
7.2 Inspection Stations ....................................................................................................... 2-41
Seat Belts and Child Restraints References ........................................................................... 2-44
3. Speeding and Speed Management ........................................................................................... 3-1
Overview .................................................................................................................................. 3-1
Strategies to Reduce Speeding and Aggressive Driving .......................................................... 3-5
Resources ............................................................................................................................... 3-10
iii
1. Laws ................................................................................................................................... 3-15
1.1 Speed Limits ................................................................................................................ 3-15
1.2 Aggressive Driving and Other Laws............................................................................ 3-20
2. Enforcement ....................................................................................................................... 3-21
2.1 Automated Enforcement .............................................................................................. 3-21
2.2 High-Visibility Enforcement ....................................................................................... 3-28
2.3 Other Enforcement Methods ........................................................................................ 3-29
3. Penalties and Adjudication ................................................................................................. 3-30
3.1 Penalty Types and Levels ............................................................................................ 3-30
3.2 Diversion and Plea Agreement Restrictions; Traffic Violator School......................... 3-31
4. Communications and Outreach .......................................................................................... 3-32
4.1 Communications and Outreach Supporting Enforcement ........................................... 3-32
Speed and Speed Management References ............................................................................ 3-34
4. Distracted Driving.................................................................................................................... 4-1
Overview .................................................................................................................................. 4-1
Strategies to Reduce Distracted Driving .................................................................................. 4-5
Resources ................................................................................................................................. 4-7
1. Laws and Enforcement ....................................................................................................... 4-11
1.1 Graduated Driver Licensing Requirements for Beginning Drivers ............................. 4-11
1.2 Cell Phone and Text Messaging Laws ......................................................................... 4-13
1.3 High-Visibility Cell Phone and Text Messaging Enforcement ................................... 4-14
1.4 General Driver Distraction Laws ................................................................................. 4-16
2. Communications and Outreach .......................................................................................... 4-17
2.1 Communications and Outreach on Distracted Driving ................................................ 4-17
3. Other Countermeasures ...................................................................................................... 4-18
3.1 Employer Programs ..................................................................................................... 4-18
Distracted Driving References ............................................................................................... 4-19
5. Motorcycle Safety .................................................................................................................... 5-1
Overview .................................................................................................................................. 5-1
Strategies to Improve Motorcycle Safety ................................................................................. 5-3
Resources ................................................................................................................................. 5-4
1. Motorcycle Helmets ............................................................................................................. 5-9
1.1 Universal Motorcycle Helmet Use Laws ....................................................................... 5-9
1.2 Motorcycle Helmet Use Promotion Programs ............................................................. 5-13
1.3 Motorcycle Helmet Law Enforcement: Noncompliant Helmets ................................. 5-14
2. Alcohol Impairment ........................................................................................................... 5-15
2.1 Alcohol-Impaired Motorcyclists: Detection, Enforcement, and Sanctions ................. 5-15
2.2 Alcohol-Impaired Motorcyclists: Communications and Outreach .............................. 5-18
3. Motorcycle Rider Licensing and Training ......................................................................... 5-19
3.1 Motorcycle Rider Licensing ........................................................................................ 5-19
3.2 Motorcycle Rider Training .......................................................................................... 5-20
4. Communications and Outreach .......................................................................................... 5-21
4.1 Communications and Outreach: Conspicuity and Protective Clothing ....................... 5-21
4.2 Communications and Outreach: Motorist Awareness of Motorcyclists ...................... 5-22
iv
Motorcycle Safety References ............................................................................................... 5-23
6. Young Drivers.......................................................................................................................... 6-1
Overview .................................................................................................................................. 6-1
Strategies to Reduce Crashes Involving Young Drivers .......................................................... 6-3
Resources ................................................................................................................................. 6-5
1. Graduated Driver Licensing ............................................................................................... 6-10
1.1 Graduated Driver Licensing ......................................................................................... 6-10
1.2 GDL Learner’s Permit Length, Supervised Hours ...................................................... 6-12
1.3 GDL Intermediate License Nighttime Restrictions ..................................................... 6-14
1.4 GDL Intermediate License Passenger Restrictions...................................................... 6-16
1.5 GDL Cell Phone Restrictions....................................................................................... 6-18
1.6 GDL Belt Use Requirements ....................................................................................... 6-19
1.7 GDL Intermediate License Violation Penalties ........................................................... 6-20
2. Driver Education ................................................................................................................ 6-21
2.1 Pre-Licensure Driver Education................................................................................... 6-21
2.2 Post-Licensure or Second-Tier Driver Education ........................................................ 6-22
3. Parents ................................................................................................................................ 6-23
3.1 Parental Roles in Teaching and Managing Young Drivers ......................................... 6-23
3.2 Electronic Technology for Parental Monitoring .......................................................... 6-24
4. Traffic Law Enforcement ................................................................................................... 6-26
4.1 Enforcement of GDL and Zero-Tolerance Laws ......................................................... 6-26
Young Driver References ....................................................................................................... 6-29
7. Older Drivers ........................................................................................................................... 7-1
Overview .................................................................................................................................. 7-1
Strategies to Reduce Crashes and Injuries Involving Older Drivers ........................................ 7-4
Resources ................................................................................................................................. 7-6
1. Communications and Outreach .......................................................................................... 7-11
1.1 Formal Courses for Older Drivers ............................................................................... 7-11
1.2 General Communications and Education..................................................................... 7-12
2. Licensing ............................................................................................................................ 7-13
2.1 License Screening and Testing .................................................................................... 7-13
2.2 Referring Older Drivers to Licensing Agencies .......................................................... 7-15
2.3 License Restrictions ..................................................................................................... 7-19
2.4 Medical Advisory Boards ............................................................................................ 7-21
2.5 License Renewal Policies: In-Person Renewal, Vision Test ....................................... 7-22
3. Traffic Law Enforcement ................................................................................................... 7-23
3.1 Law Enforcement Roles ............................................................................................... 7-23
Older Driver References......................................................................................................... 7-24
8. Pedestrian Safety ...................................................................................................................... 8-1
Overview .................................................................................................................................. 8-1
Strategies to Increase Pedestrian Safety ................................................................................. 8-11
Resources ............................................................................................................................... 8-12
1. Preschool-Age Children ..................................................................................................... 8-17
v
1.1 Children’s Safety Clubs ............................................................................................... 8-17
1.2 Child Supervision......................................................................................................... 8-18
2. School-Age Children .......................................................................................................... 8-19
2.1 Elementary-Age Child Pedestrian Training ................................................................. 8-19
2.2 Safe Routes to School .................................................................................................. 8-23
2.3 Walking School Buses ................................................................................................. 8-27
2.4 Child School Bus Training........................................................................................... 8-29
3. Impaired Pedestrians .......................................................................................................... 8-30
3.1 Impaired Pedestrians: Communications and Outreach ................................................ 8-30
3.2 “Sweeper” Patrols of Impaired Pedestrians ................................................................. 8-31
4. All Pedestrians.................................................................................................................... 8-32
4.1 Pedestrian Safety Zones ............................................................................................... 8-32
4.2 Reduce and Enforce Speed Limits ............................................................................... 8-34
4.3 Conspicuity Enhancement ........................................................................................... 8-37
4.4 Enforcement Strategies ................................................................................................ 8-39
4.5 Driver Training ............................................................................................................ 8-42
4.6 Pedestrian Gap Acceptance Training ........................................................................... 8-43
4.7 University Educational Campaign ............................................................................... 8-44
Pedestrian Safety References ................................................................................................. 8-45
9. Bicycle Safety .......................................................................................................................... 9-1
Overview .................................................................................................................................. 9-1
Strategies to Increase Bicyclist Safety ..................................................................................... 9-7
Resources ................................................................................................................................. 9-9
1. Children .............................................................................................................................. 9-15
1.1 Bicycle Helmet Laws for Children .............................................................................. 9-15
1.2 Safe Routes to School .................................................................................................. 9-18
1.3 Bicycle Safety Education for Children ........................................................................ 9-21
1.4 Cycling Skills Clinics, Bike Fairs, Bike Rodeos ......................................................... 9-22
2. Adults ................................................................................................................................. 9-23
2.1 Bicycle Helmet Laws for Adults.................................................................................. 9-23
2.2 Bicycle Safety Education for Adult Cyclists ............................................................... 9-26
3. All Bicyclists ...................................................................................................................... 9-27
3.1 Active Lighting and Rider Conspicuity ....................................................................... 9-27
3.2 Promote Bicycle Helmet Use With Education............................................................. 9-30
3.3 Enforcement Strategies ................................................................................................ 9-31
3.4 Motorist Passing Bicyclist Laws .................................................................................. 9-32
4. Drivers and Bicyclists ........................................................................................................ 9-33
4.1 Driver Training ............................................................................................................ 9-33
4.2 Share the Road Awareness Programs .......................................................................... 9-34
Bicycle Safety References ...................................................................................................... 9-35
10. Drowsy Driving ................................................................................................................... 10-1
Overview ................................................................................................................................ 10-1
Strategies to Reduce Drowsy Driving .................................................................................... 10-3
Resources ............................................................................................................................... 10-5
vi
1. Laws and Enforcement ....................................................................................................... 10-9
1.1 Graduated Driver Licensing Requirements for Beginning Drivers ............................. 10-9
1.2 General Driver Drowsiness Laws .............................................................................. 10-11
2. Communications and Outreach ........................................................................................ 10-12
2.1 Communications and Outreach on Drowsy Driving .................................................. 10-12
3. Other Countermeasures .................................................................................................... 10-13
3.1 Employer Programs ................................................................................................... 10-13
3.2 Education Regarding Medical Conditions and Medications ..................................... 10-14
Drowsy Driving References ................................................................................................. 10-15
A1. Alcohol- and Drug-Impaired Driving ................................................................................ A1-1
1. Deterrence: Laws............................................................................................................... A1-3
1.5 Alcohol-Impaired-Driving Law Review ..................................................................... A1-3
3. Deterrence: Prosecution and Adjudication ........................................................................ A1-5
3.4 Sanctions ..................................................................................................................... A1-5
5. Prevention, Intervention, Communications and Outreach ................................................ A1-8
5.3 Responsible Beverage Service .................................................................................... A1-8
5.5 Designated Drivers.................................................................................................... A1-11
6. Underage Drinking and Drinking and Driving ............................................................... A1-13
6.5 Youth Programs ........................................................................................................ A1-13
7. Drug-Impaired Driving ................................................................................................... A1-16
7.2 Drug-Impaired-Driving Laws ................................................................................... A1-16
7.3 Education Regarding Medications ............................................................................ A1-19
Alcohol- and Drug-Impaired-Driving References .............................................................. A1-22
A2. Seat Belt and Child Restraints ........................................................................................... A2-1
A3. Speeding and Speed Management ..................................................................................... A3-1
1. Laws .................................................................................................................................. A3-3
1.2 Aggressive Driving and Other Laws........................................................................... A3-3
2. Enforcement ...................................................................................................................... A3-5
2.2 High-Visibility Enforcement ...................................................................................... A3-5
2.3 Other Enforcement Methods ....................................................................................... A3-9
3. Penalties and Adjudication .............................................................................................. A3-12
3.1 Penalty Types and Levels ......................................................................................... A3-12
3.2 Diversion and Plea Agreement Restrictions; Traffic Violator School...................... A3-16
Speed and Speed Management References ......................................................................... A3-18
A4. Distracted Driving .............................................................................................................. A4-1
1. Laws and Enforcement ...................................................................................................... A4-3
1.2 Cell Phone and Text Messaging Laws ........................................................................ A4-3
1.4 General Driver Distraction Laws ................................................................................ A4-8
2. Communications and Outreach ....................................................................................... A4-10
2.1 Communications and Outreach on Distracted Driving ............................................. A4-10
3. Other Countermeasures ................................................................................................... A4-13
3.1 Employer Programs .................................................................................................. A4-13
vii
Distracted Driving References ............................................................................................ A4-14
A5. Motorcycle Safety .............................................................................................................. A5-1
1. Motorcycle Helmets .......................................................................................................... A5-3
1.2 Motorcycle Helmet Use Promotion Programs ............................................................ A5-3
1.3 Motorcycle Helmet Law Enforcement: Noncompliant Helmets ................................ A5-4
2. Alcohol Impairment .......................................................................................................... A5-6
2.2 Alcohol-Impaired Motorcyclists: Communications and Outreach ............................. A5-6
3. Motorcycle Rider Licensing and Training ........................................................................ A5-8
3.1 Motorcycle Rider Licensing ....................................................................................... A5-8
3.2 Motorcycle Rider Training ....................................................................................... A5-11
4. Communications and Outreach ....................................................................................... A5-13
4.1 Communications and Outreach: Conspicuity and Protective Clothing .................... A5-13
4.2 Communications and Outreach: Motorist Awareness of Motorcyclists ................... A5-15
Motorcycle Safety References ............................................................................................ A5-17
A6. Young Drivers .................................................................................................................... A6-1
1. Graduated Driver Licensing .............................................................................................. A6-3
1.5 GDL Cell Phone Restrictions...................................................................................... A6-3
1.6 GDL Belt Use Requirements ...................................................................................... A6-5
1.7 GDL Intermediate License Violation Penalties .......................................................... A6-6
2. Driver Education ............................................................................................................... A6-7
2.1 Pre-Licensure Driver Education.................................................................................. A6-7
2.2 Post-Licensure or Second-Tier Driver Education ..................................................... A6-11
3. Parents ............................................................................................................................. A6-12
3.1 Parental Role in Teaching and Managing Young Drivers ........................................ A6-12
Young Driver References .................................................................................................... A6-16
A7. Older Drivers...................................................................................................................... A7-1
1. Communications and Outreach ......................................................................................... A7-3
1.1 Formal Courses for Older Drivers .............................................................................. A7-3
1.2 General Communications and Education.................................................................... A7-6
2. Licensing ........................................................................................................................... A7-9
2.4 Medical Advisory Boards ........................................................................................... A7-9
2.5 License Renewal Policies: In-Person Renewal, Vision Test .................................... A7-11
Older Driver References...................................................................................................... A7-14
A8. Pedestrian Safety ................................................................................................................ A8-1
1. Preschool-Age Children .................................................................................................... A8-3
1.1 Children’s Safety Clubs .............................................................................................. A8-3
1.2 Child Supervision........................................................................................................ A8-5
2. School-Age Children ......................................................................................................... A8-7
2.3 Child School Bus Training
A8-7
3. Impaired Pedestrians ......................................................................................................... A8-9
3.1 Communications and Outreach Addressing Impaired Pedestrians ............................. A8-9
3.2 “Sweeper” Patrols of Impaired Pedestrians .............................................................. A8-10
viii
4. All Pedestrians................................................................................................................. A8-12
4.5 Driver Training ......................................................................................................... A8-12
4.6 Pedestrian Gap Acceptance Training ........................................................................ A8-14
4.7 University Educational Campaign ............................................................................ A8-16
Pedestrian Safety References .............................................................................................. A8-18
A9. Bicycle Safety .................................................................................................................... A9-1
1. Children ............................................................................................................................. A9-3
1.3 Bicycle Safety Education for Children ....................................................................... A9-3
1.4 Cycling Skills Clinics, Bike Fairs, Bike Rodeos ........................................................ A9-7
2. Adults ................................................................................................................................ A9-9
2.2 Bicycle Safety Education for Adult Cyclists .............................................................. A9-9
3. All Bicyclists ................................................................................................................... A9-11
3.2 Promote Bicycle Helmet Use With Education.......................................................... A9-11
3.3 Enforcement Strategies ............................................................................................. A9-14
3.4 Motorist Passing Bicyclist Laws ............................................................................... A9-18
4. Drivers and Bicyclists ..................................................................................................... A9-20
4.1 Driver Training ......................................................................................................... A9-20
4.2 Share the Road Awareness Programs ....................................................................... A9-22
Bicycle Safety References ................................................................................................... A9-24
A10. Drowsy Drivers .............................................................................................................. A10-1
1. Laws and Enforcement .................................................................................................... A10-3
1.2 General Driver Drowsiness Laws ............................................................................. A10-3
2. Communications and Outreach ....................................................................................... A10-5
2.1 Communications and Outreach on Drowsy Driving
A10-5
3. Other Countermeasures ................................................................................................... A10-8
3.1 Employer Programs .................................................................................................. A10-8
3.2 Education Regarding Medical Conditions and Medications .................................. A10-10
Drowsy Driving References .............................................................................................. A10-12
ix
Preface to the 10th Edition, 2020
This edition of Countermeasures That Work was prepared by Battelle Memorial Institute.
Researchers who contributed to this edition include Vindhya Venkatraman, Christian M.
Richard, and Kelly Magee. The original Countermeasures That Work 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. The chapters on pedestrian and
bicycle safety were added in the Second Edition by William A. Leaf of Preusser Research
Group.
All chapters have been revised and updated for this edition. Information and research studies
through May 31, 2018, have been reviewed and included as appropriate. Data have been updated
to include information from the 2018 FARS (Fatality Analysis Reporting System) Annual Report
File (ARF).
A significant change in the 10th Edition is that the chapter on distracted and drowsy driving was
separated into two chapters (Chapter 4: Distracted Driving and Chapter 10: Drowsy Driving) to
align with the differences in the underlying driver behaviors and the growing body of literature
under each topic. Three new countermeasures were added: “Employer Programs” in the
Distracted Driving chapter, “Electronic Technology for Parental Monitoring” in the Young
Drivers chapter, and “Walking School Buses” in the Pedestrian Safety chapter.
A significant change added in the 9th edition and continued in the 10th edition is that detailed
descriptions of one- and two-star countermeasures were moved to appendices. The main part of
the guide retains brief summaries for the one- and two-star countermeasures to facilitate
navigation of the topics and to maintain continuity with previous chapters.
User Suggestions and Future Editions
NHTSA updates this guide biennially and may expand it with additional problem areas and
countermeasures as appropriate. 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 Behavioral Safety Research, NPD-300
1200 New Jersey Avenue SE
Washington, DC 20590
or by email to [email protected].
x
Introduction
Introduction
Purpose of the Guide
This guide is a basic reference to assist State Highway Safety Offices in selecting effective,
science-based traffic safety countermeasures for major highway safety problems. The guide
o describes major strategies and countermeasures 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 have either 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 of 10 problem areas. 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 effectiveness, costs, use, and
implementation time. Each countermeasure is then discussed in about a page.
The guide is an overview and starting point for readers to become familiar with the behavioral
strategies and countermeasures in each program area. It includes countermeasures that have the
most evidence of effectiveness as well as those used most regularly by SHSOs. Updates to the
guide are based only on published research. Unpublished programs and efforts are not included
in this edition.
Some countermeasure areas are covered in more depth than others due to availability of
published research. For example, impaired driving has a long and rich research history while
topics such as driver distraction and driver drowsiness have received less attention. This
difference in the availability of published research findings is due to the relative scale of problem
areas, availability of reliable data on frequency and characteristics of some safety problems, and
the challenge of conducting scientifically valid studies in some behavioral areas.
1
Introduction
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 a problem area or specific countermeasure are urged to
consult the references. Although all web links in this guide were accurate at the time of
publication, please note that web links change periodically. For broken links to NHTSA
documents, we recommend searching NHTSA’s behavioral safety research reports
(https://ntlsearch.bts.gov/repository/ntlc/nhtsa/index.shtm). For broken links to other reports or
documents, refer to the website for the agency that produced the report.
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. 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 blood alcohol concentration
laws. The guide does not include substantive details of specific countermeasures for emergency
medical services or 911 services; these services are supported by traffic safety partners including
State Offices of EMS. 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 countermeasures 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 highquality implementation. Many countermeasures have not been evaluated well or at all, as noted
in the effectiveness data. Effectiveness ratings are based primarily on demonstrated reductions in
crashes; however, changes in behavior and knowledge are taken into account in the ratings when
crash information is not available.
NCHRP Guides: The National Cooperative Highway Research Program is developing a series
of guides for State Departments of Transportation to use in implementing the American
Association of State Highway and Transportation Officials Strategic Highway Safety Plan. 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
www.trb.org/Publications/PubsNCHRPProjectReportsAll.aspx.
NCHRP has also developed a framework for estimating the costs and benefits associated with
behavioral countermeasures. Each countermeasure included in Countermeasures That Work was
reviewed and the potential savings of the countermeasures were projected. The subsequent report
2
Introduction
was designed to help States select countermeasures that will result in the greatest reduction in
crashes, injuries, and fatalities, available at
www.cmfclearinghouse.org/collateral/NCHRP_Report_622.pdf.
Cochrane Reviews: Several chapters cite Cochrane Reviews. The Cochrane Collaboration is a
nonprofit organization that produces and disseminates systematic reviews of the effects of
healthcare interventions. The database of reviews is published quarterly as part of the Cochrane
Library. More information about Cochrane Reviews can be found at www.cochrane.org/.
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 authors and do not necessarily represent the views of 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 x for
details).
New traffic safety programs and research appear almost weekly and sometimes daily. Websites
change frequently. This means that this guide was out-of-date even before it was published.
Readers interested in a specific problem area or countermeasure are urged to contact NHTSA for
up-to-date information.
Abbreviations, Acronyms, and Initialisms Used
•
•
•
•
•
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
AAA: was the American Automobile Association but now 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 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, measured in grams per deciliter (g/dL)
BrAC: breath alcohol concentration, measured in grams per 210 liters of breath (g/210L)
CDC: Centers for Disease Control and Prevention
CIOT: NHTSA’s Click It or Ticket high-visibility seat belt enforcement campaign
CPS: child passenger safety
CPSC: Consumer Product Safety Commission
CTIA: Cellular Telecommunications and Internet Association
DOT: Department of Transportation (Federal or State)
DUID: driving under the influence of drugs
DWI: driving while impaired or intoxicated, and also often includes DUI, driving under
the influence
DWS: driving while [driver’s license is] suspended
3
Introduction
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
FHWA: Federal Highway Administration
FMCSA: Federal Motor Carrier Safety Administration
FMVSS: Federal Motor Vehicle Safety Standards
GDL: graduated driver licensing
GHSA: Governors Highway Safety Association
HVE: high-visibility enforcement
HOS: hours of service
IIHS: Insurance Institute for Highway Safety
IACP: International Association of Chiefs of Police
ITS: Intelligent Transportation Systems
LATCH: Lower Anchors and Tethers for Children
LEA: law enforcement agency
LEO: law enforcement officer
MAB: medical advisory board
MADD: Mothers Against Drunk Driving
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 [disbanded]
NHTSA: National Highway Traffic Safety Administration
NIAAA: National Institute on Alcohol Abuse and Alcoholism (a branch of NIH)
NIH: National Institutes of Health
NMSL: National Maximum Speed Limit
NCRUSS: The National Child Restraint Use Special Study. A NHTSA observational
study of the use of car seats and booster seats for child passengers.
NSC: National Safety Council
NSF: National Sleep Foundation
NTSB: National Transportation Safety Board
PAS: passive alcohol sensor, a device to detect alcohol 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 BrAC
SFST: Standardized Field Sobriety Tests
SHSO: State Highway Safety Office
SMSA: National Association of State Motorcycle Safety Administrators
STEP: Selective Traffic Enforcement Program
THC: delta-9 tetrahydrocannabinol, the psychoactive constituent in cannabis. The THC
metabolite, hydroxy-THC, is also psychoactive.
TIRF: Traffic Injury Research Foundation
TRB: Transportation Research Board
UVC: Uniform Vehicle Code
4
Chapter 1. Alcohol- and Drug-Impaired Driving
1. Alcohol- and Drug-Impaired Driving
Overview
In 2018 there were 10,511 people killed in crashes involving alcohol-impaired drivers (defined as
drivers or motorcycle riders with blood alcohol concentrations of >.08 g/dL). This is a decrease
of 3.6% from the 10,908 fatalities in 2017 (NCSA, 2019). Fatalities in crashes involving alcoholimpaired drivers continue to represent almost one-third (29%) of the total motor vehicle fatalities
in the United States. See also NHTSA’s most recent State Alcohol-Impaired-Driving Estimates
Traffic Safety Facts (NCSA, 2020a) for additional national and State data.
Trends. Alcohol-impaired driving steadily decreased from the early 1980s to the mid-1990s. A
study showed that much of this decrease could be attributed to alcohol-related legislation (e.g.,
.08 BAC, administrative license revocation, and minimum drinking age laws) and to
demographic trends (e.g., population aging and the increased proportion of female drivers; Dang,
2008). However, substantial public attention during this period to the issue of alcohol-impaired
driving included the growth of grassroots organizations such as Mothers Against Drunk Driving
and Remove Intoxicated Drivers, increased Federal programs and funding, State task forces, and
increased enforcement and intensive publicity, which combined to help address this critical
traffic safety problem.
Alcohol-impaired-driving fatalities changed very little from 1992 to 2007 as the chart shows, but
began declining from 2008 to 2011, likely due in part to the economic recession during that
period. Alcohol-impaired-driving fatalities decreased 2% from 2009 to 2018 (NCSA, 2019).
U.S. Alcohol-Impaired Driving Fatalities
20,000
15,000
10,000
Year
Source: NHTSA - FARS (1982-2018), NCSA (2019)
1-1
2018
2016
2014
2012
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
0
1984
5,000
1982
Number of Fatalities
25,000
Chapter 1. Alcohol- and Drug-Impaired Driving
0.9
40%
0.8
35%
0.7
30%
0.6
25%
0.5
20%
0.4
15%
10%
5%
0%
0.3
Percent Alcohol-impaired
0.2
Fatality rate per 100 Million VMT
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Percent
45%
Percent of U.S. Driving Fatalites That Were Alcohol-Impaired
and Alcohol-Impaired Fatality Rate by VMT
Source: NHTSA - FARS (1990-2018), NCSA (2019)
0.1
0
Fatality Rate per 100 Million VMT
The next chart shows the rate of alcohol-impaired-driving fatalities, based on vehicle miles
traveled, also declined noticeably over the last two decades. However, the percentage of U.S.
fatalities that involved alcohol-impaired driving decreased only slightly during this time (NCSA,
2019).
Year
Older teens have shown a sizeable decrease in alcohol-related traffic fatalities. From 2009 to
2018 the percentage of fatally injured drivers 16 to 18 years old with positive BACs (.01 g/dL or
higher) decreased by 27% (NCSA, 2020b). Self-reported drinking and driving among high
school students has also declined. In 1991 some 22% of high school students reported drinking
and driving in the past 30 days, compared to just 10% of high school students in 2011 (CDC,
2012). Since 2011 the percentage of high school students who self-reported drinking and driving
has further decreased to 5.5% in 2017 (CDC, 2018). Note that most States implemented
graduated driver licensing systems during this time period. GDL systems have substantially
reduced the crash risk of young, beginning drivers. (For more information on young drivers and
GDL, see Chapter 6.)
Drinking-and-driving characteristics. Half (52%) of U.S. adults can be considered “regular”
drinkers; that is, they have consumed at least 12 drinks during the past year, according to the
CDC (2014). Drivers with BACs of .08 g/dL or higher make an estimated 112 million trips
annually (CDC, 2011). Studies show drivers with BACs over .08 are arrested once for every 80
trips they make (Ferguson, 2012). The 2013-2014 National Roadside Survey found 8.3% of
drivers on weekend nights have positive BACs, while 1.5% have BACs of .08 g/dL or higher
(Berning et al., 2015). This is a significant reduction from 2007, when 12.4% of drivers had
positive BACs and 2.2% had BACs of .08 g/dL or higher. The percentage of drivers drinking on
weekend nights has fallen dramatically since the first National Roadside Survey in 1973, which
found that 35.9% of drivers had positive BACs and 7.5% of drivers had BACs of .08 g/dL or
higher (Berning et al., 2015).
1-2
Chapter 1. Alcohol- and Drug-Impaired Driving
NHTSA surveyed approximately 7,000 people in 2008 about attitudes and behaviors related to
drinking and driving (Moulton et al., 2010). Twenty percent reported they had driven within 2
hours of drinking alcohol in the past year. Males, college graduates, and full-time employees
were more likely than their respective counterparts to report driving after drinking. Similarly, an
AAA Foundation survey of 2,613 U.S. residents conducted in 2017 found that 94% believe it is
unacceptable to drink and drive. Nonetheless, 14% reported they had driven when they may have
been close to or above the illegal limit in the previous year (AAAFTS, 2018a).
Alcohol-impaired drivers include both occasional drinkers who may drive after drinking too
much, as well as persistent offenders who regularly drive while impaired. Impaired drivers are
“high risk” if they have high BACs, prior convictions, or alcohol abuse problems. For example,
among drivers involved in fatal crashes during 2018 with positive BACs (.01 g/dL or higher),
55% had BACs at or above .15 g/dL (NCSA, 2019), almost twice the legal limit. Additionally,
one-quarter of all drivers arrested for impaired driving and 30% of drivers convicted of impaired
driving have prior DWI convictions (Warren-Kigenyi & Coleman, 2014). In 2018 some 8% of
drivers with BACs of .08 g/dL or above involved in fatal motor vehicle crashes had been
convicted of DWI in the previous 5 years, compared to 2% of sober drivers (NCSA, 2019).
Several external factors that affect alcohol-impaired-driving fatalities include geography,
urbanization, road structure and conditions, and economic activity, as well as State laws and
programs. For these reasons the current level of alcohol-impaired driving and the progress in
reducing alcohol-impaired driving vary greatly from State to State. For example, the proportion
of traffic fatalities that involve drivers with BACs of .08 g/dL or higher in 2018 ranged from
19% in the lowest States (Kentucky and West Virginia) to 43% in the highest (Montana) (NCSA,
2019).
Drug-impaired-driving characteristics. Historically, there has been less research on drugimpaired driving compared to alcohol-impaired driving. Factors contributing to the increased
interest include decriminalization and legalization of marijuana in many States. In January 2018
NHTSA launched the Drug-Impaired Driving Initiative with the aim of engaging stakeholders in
addressing the problems of drug-impaired driving (NHTSA, 2018a). Stakeholders including law
enforcement, prosecutors, judicial professionals, National, State, and community agencies and
organizations, and policy experts engaged in dialogue to identify countermeasures to reduce
drug-impaired driving. NHTSA’s Drug-Impaired Driving Kickoff Summit in March 2018
collected the best ideas and approaches to address drug-impairment by focusing on communityspecific issues (NHTSA, 2018b). IIHS hosted a How do we move the needle?: Combating
alcohol- and drug-impaired driving conference in 2018 (IIHS, 2018).
Driving after marijuana use might be more prevalent among high school students than drunk
driving. The 2017 High School Youth Risk Behaviors Survey reported that 13% of all
respondents admitted to driving one or more times after using marijuana during the 30 days
before the survey, in contrast with only 5.5% who reported driving after drinking (CDC, 2018).
A 2017 survey found that 91% of the respondents consider driving after using illegal drugs to be
a personal safety threat (AAA, 2018a). However, three roadside surveys found some drivers have
1-3
Chapter 1. Alcohol- and Drug-Impaired Driving
detectable levels of one or more drugs in their systems. The NHTSA 2013-2014 National
Roadside Survey collected voluntary and anonymous oral fluid samples from 7,881 drivers and
blood samples from 4,686 drivers across the United States (Berning et al., 2015). Among
weekend nighttime drivers who provided samples:
• 15.2% tested positive for the presence of illegal drugs;
• 7.3% tested positive for the presence of prescription or over-the-counter medications; and
• 12.6% tested positive for THC and/or its active metabolites, a 48% increase from the
2007 NRS. (Testing positive for THC does not necessarily imply impairment, since THC
can be detected in the blood weeks after psychoactive effects have ended.)
A follow-up analysis of the same data found that prescription or over-the-counter (OTC)
medication use was prevalent in about 10.7% of daytime drivers and 7.4% of nighttime drivers
(Kelley-Baker et al., 2017). An additional 2.3% of daytime drivers and 2.0% of nighttime drivers
tested positive for both OTC medication and other illegal substances.
Another NHTSA study examined the prevalence of drivers testing positive for THC and other
drugs in Washington State in an anonymous roadside survey collecting voluntary breath, oral
fluid, and blood samples from 2,400 drivers (Ramirez et al., 2016). Washington State’s Initiative
502 legalized recreational marijuana use in November 2012; a per se limit for driving under the
influence of marijuana became effective December 6, 2012. The survey, conducted before and
after legalization, involved three data collection waves that occurred 1 month prior, 5 months
after, and 11 months after implementation of legal sales. Positive THC measurements were
recorded in 14.6%, 19.4%, and 21.4% of drivers in Waves 1, 2, and 3. This increasing trend was
not statistically significant across waves. However, there was a statistically significant increase
in daytime prevalence of THC-positive drivers between Wave 1 (7.8%) and Wave 2 (18.4%),
and also between Wave 1 and Wave 3 (18.9%). This contrasts with findings for nighttime
driving, where the percentage of THC-positive nighttime drivers increased with each successive
wave, however, increases were not statistically significant.
Banta-Green et al. (2016) studied the prevalence of marijuana use as reported by blood testing
among drivers arrested in DUI collisions or violations in Washington State. From 2005 to 2014
the proportion of DUI cases involving THC increased, as did increases in the level of THC
detected. However, when positive alcohol cases were excluded, there were no significant
increases in THC related to the introduction of Initiative 502 in 2012. The THC blood level for
the population under study was estimated to decline 5 ng/mL on average during the first 120
minutes from contact with the police; however, the median time for blood draw in THC-positive
drivers was 139 minutes. Logistical delays in blood testing may lead to underestimation of the
prevalence of drugged driving and difficulty in its enforcement, particularly in relation to the per
se limit (5 ng/mL). Drivers arrested for involvement in collisions or because of suspected DUI
violation were most commonly under the influence of alcohol and above the illegal BAC limit of
.08 g/dL (53% and 30%, respectively). Furthermore, 7% of those in collisions and 20% of those
suspected of violations had THC levels that met or exceeded the per se limit. Logan et al. (2016)
evaluated if quantitative thresholds (per se limits) could establish driver impairment from
marijuana use. DRE evaluations and toxicology tests established baseline impairment status.
Logan’s group found no evidence of an objective quantitative threshold that establishes
marijuana impairment status for per se laws.
1-4
Chapter 1. Alcohol- and Drug-Impaired Driving
Another study in Washington State by Tefft et al. (2016) reported that 10% of all drivers
involved in fatal crashes between 2010 and 2014 had detectable THC in their blood. Among
these THC-positive drivers, 34% had neither alcohol nor other commonly tested drugs, 39% had
detectable alcohol in addition to THC, 16.5% had other drugs with THC, and 10.5% had alcohol,
other drugs, and THC in their blood at or shortly after the time of crash. Despite these numbers,
it is difficult to determine the real crash risk associated with THC use given that drug presence
and not impairment was tested.
A study conducted in Virginia Beach, Virginia, estimated the relative crash risk of alcohol- and
drug-positive driving (Compton & Berning, 2015). BrACs were obtained from 10,221 drivers,
oral fluid samples from 9,285 drivers, and BAC samples from 1,764 drivers. A statistically
significant increase in unadjusted crash risk was found for drivers who tested positive for use of
illegal drugs (1.21 times), and THC specifically (1.25 times). However, after adjusting for factors
known to be associated with crash risk (age, gender, ethnicity, and BAC level) there was no
longer statistical evidence of increased crash risk associated with any drugs, including illegal
drugs and THC. This finding indicates these other variables (age, gender, ethnicity, and alcohol
use) account for much of the increased risk associated with the use of illegal drugs and with
THC. In contrast, this study found large, statistically significant associations between driver
alcohol level and crash risk both before and after adjustment for demographic factors.
Almost one-third of respondents in a national survey of drivers 18 and older contacted from 2013
to 2015 reported they were unaware of how driving within an hour of marijuana use affects crash
risk (Arnold & Tefft, 2016). Another 9.8% believed that crash risk was either unaffected or
decreased when driving under the influence of marijuana; these drivers also reported they were
more likely to drive within an hour of marijuana use. Notably, less than half (48.5%) of the
drivers in States with per se DUI marijuana laws were aware of the laws.
Keep in mind a positive drug test does not necessarily indicate “impairment.” The level of drugs
detected may have been too low to be impairing. Many drugs can be detected in oral or blood
tests long after their effects have diminished. For example, marijuana can be detected for 30 days
or longer among heavy users (CLR, 2020).
Although some countries such as Sweden and Finland have carefully tracked the prevalence of
driving under the influence of drugs (Ojaniemi et al., 2009), little is known about trends in drugimpaired driving in the United States. One study from Washington State found a significant
increase in methamphetamine use among fatally injured drivers from 1992 to 2002 (Schwilke et
al., 2006). In part, this likely reflects larger trends across the nation in the drug’s popularity.
Data regarding drug use and crashes are limited, and there are important shortcomings in FARS
data used to track drug-related driving fatalities. Specifically, a NHTSA Research Note described
the key methodological and data limitations of FARS drug test information and reporting
(Berning & Smither, 2014; see also Compton et al., 2009). These limitations include:
• Only a minority of drivers are tested for drugs (e.g., only 42% of drivers involved in fatal
crashes were tested in 2014; NHTSA - FARS data file);
• Testing rates are higher for drivers who died in crashes (65% in 2014) compared to
surviving drivers (22% in 2014);
1-5
Chapter 1. Alcohol- and Drug-Impaired Driving
•
•
•
•
•
In addition to those tested for drugs and not tested for drugs, there are a small subset (6%
in 2015), but significant number of drivers for which it is unknown if they were tested for
drugs;
Testing positive for a drug indicates the presence of the drug in the driver’s system, but it
does not necessarily indicate that the driver was impaired at the time of the crash;
There is no consistent set of policies or procedures for drug testing across States, which
leads to variation in the drivers and drugs tested, in addition to the types of tests, cut-off
levels, and equipment used; 1
Decreases in the cost of drug testing may have led to increases in the number of people
tested, as well as the range of drug types tested; and
The more drivers tested, the more drugs will be detected.
Although drugs are often detected among drivers involved in crashes, this does not necessarily
imply that drug impairment played a causal role in the crash. Not all testing is comprehensive in
that some drugs may not be detected either because the tests are insufficiently sensitive or the
right tests are not conducted despite other evidence of a drug being present. Currently, the
evidence is mixed on whether cannabis and benzodiazepines increase crash risk, and fewer
studies have examined the risks associated with stimulants, opioids, and other drugs (Stewart,
2006; Elvik, 2013).
Strategies to Reduce Impaired Driving
Four basic strategies are used to reduce impaired-driving crashes and driving under the influence.
• Deterrence: enact, publicize, enforce, and adjudicate laws prohibiting impaired driving so
people choose not to drive impaired;
• Prevention: reduce drinking and drug use and keep impaired drivers 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; and
• Alcohol and drug treatment: reduce alcohol and drug dependency or addiction among
drivers.
Impaired-driving deterrence countermeasures are divided into four sections in this chapter: (1)
laws, (2) enforcement, (3) prosecution and adjudication, and (4) offender treatment, monitoring,
and control. Prevention, intervention, communications, and outreach countermeasures are
combined in a single section. Finally, the Underage Drinking and Drinking section includes
deterrence, prevention, and communications measures specific to this age group.
This chapter also briefly considers countermeasures to address drugs other than alcohol. Drugs
pose quite different and difficult issues at every step, from estimating their prevalence and effect
Some law enforcement officers are trained to become “DREs,” drug recognition experts. DREs use a tool called
the Drug Influence Evaluation Matrix which divides drugs into seven categories: central nervous system depressants
(including alcohol), central nervous system stimulants, hallucinogens, dissociative anesthetics, narcotic analgesics,
inhalants, and cannabis (marijuana). DRE training notes the extremely wide variability in how these drugs impair
people, signs and symptoms associated with impairment, difficulty in recognizing the signs and symptoms
associated with the use of a single drug, and use of several drugs at the same time (“polydrug” use), among many
other topics. Impairing drugs may be taken illegally, legally prescribed, and may be sold over-the-counter.
1
1-6
Chapter 1. Alcohol- and Drug-Impaired Driving
on driving, to developing effective laws and strategies for enforcement, prevention, and
treatment. However, many countermeasures to address alcohol-impaired driving may also deter
drug-impaired driving.
Many other traffic safety countermeasures help reduce alcohol- and drug-impaired drivingrelated crashes and casualties, but are not discussed in this chapter. Some vehicular strategies
may help detect or prevent impaired driving. For example, NHTSA has studied the feasibility of
using vehicle-based sensors to detect alcohol-impaired drivers (Lee et al., 2010). The Driver
Alcohol Detection System for Safety (DADSS; see www.dadss.org/) program is a collaborative
research partnership between the automotive industry and NHTSA to assess and develop
alcohol-detection technologies to prevent vehicles from being driven when driver BACs exceed
the illegal limit of .08 g/dL. There are also many environmental countermeasures such as
improved vehicle structures and centerline rumble strips and barriers that may reduce the
likelihood of crashes and/or injuries sustained by impaired drivers and passengers. However,
vehicular and environmental countermeasures are not included in this chapter because State
Highway Safety Offices have little or no authority or responsibility for them. These typically
come under the jurisdiction of local, State, or Federal highway departments.
1-7
Chapter 1. Alcohol- and Drug-Impaired Driving
Resources
The agencies and organizations below have more information on impaired driving and links to
numerous other resources.
• National Highway Traffic Safety Administration:
o Drunk Driving – www.nhtsa.gov/risky-driving/drunk-driving
o Drugged Driving – www.nhtsa.gov/risky-driving/drug-impaired-driving
o Risky Driving – www.nhtsa.gov/risky-driving
o Behavioral Safety Research Reports – https://rosap.ntl.bts.gov/
• Centers for Disease Control and Prevention:
www.cdc.gov/MotorVehicleSafety/Impaired_Driving/impaired-drv_factsheet.html
• Office of National Drug Control Policy: www.whitehouse.gov/ondcp/
• American Automobile Association: https://duijusticelink.aaa.com/for-the-public
• Governors Highway Safety Association: www.ghsa.org/issues/alcohol-impaired-driving
• International Association of Chiefs of Police: www.theiacp.org/
• Insurance Institute for Highway Safety: www.iihs.org/topics/alcohol-and-drugs
• Mothers Against Drunk Driving: www.madd.org
• National Conference of State Legislatures:
www.ncsl.org/research/transportation/drunken-impaired-driving
• National Safety Council:
www.nsc.org/safety_road/DriverSafety/Pages/ImpairedDriving.aspx
• National Institute on Alcohol Abuse and Alcoholism: www.niaaa.nih.gov
• National Institute on Drug Abuse: www.drugabuse.gov
• Traffic Injury Research Foundation: www.tirf.ca
For overviews of alcohol-impaired-driving prevalence, risks, legislation, research, and
recommended strategies, see the following.
• National Highway Traffic Safety Administration:
o Alcohol and Highway Safety 2006: A Review of the State of Knowledge (Voas &
Lacey, 2011)
o Compendium of Traffic Safety Research Projects 1985-2013 (Agimi et al., 2014)
o Digest of Impaired Driving and Selected Beverage Control Laws (NHTSA, 2017)
• National Cooperative Highway Research Program: A Guide for Reducing AlcoholRelated Collisions (Stutts et al., 2005)
• National Conference of State Legislatures (NCSL): Alcohol Impaired and Drunken
Driving webpage: www.ncsl.org/research/transportation/drunken-impaired-driving.aspx
• Transportation Research Board’s Alcohol, Other Drugs, and Transportation Committee’s
e-Circular (TRB, 2013)
• Centers for Disease Control and Prevention: www.thecommunityguide.org
For information on the prevalence, State laws, known risks, and current strategies against drugimpaired driving, see the following.
• Impact of the Legalization and Decriminalization of Marijuana on the DWI System
(NHTSA, GHSA, & Volpe National Transportation Center, 2017) from NHTSA, GHSA,
and Volpe
1-8
Chapter 1. Alcohol- and Drug-Impaired Driving
•
•
Marijuana-Impaired Driving: A Report to Congress (Compton, 2017) from NHTSA
2016 Digest of State Laws: Driving Under the Influence of Drugs, 1st Edition (Boddie &
O’Brien, 2018) from GHSA and NHTSA
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
BrAC: breath alcohol concentration (breath tests use a different measuring scale from
blood tests, but are often “converted” to BAC terminology, such as “.08” or “.08 g/dL”
DUID: driving under the influence of drugs
DRE: drug recognition expert, a law enforcement officer trained in identifying drivers
who are drug-impaired
DWI: the offense of driving while impaired by alcohol or drugs. In different States the
offense may be called driving while intoxicated, driving under the influence (DUI), or
other similar terms
Ignition interlock: a breathalyzer installed into a vehicle that prevents the vehicle from
being started if the driver’s BrAC is above a specified limit
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, and/or under the influence of drugs
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 BrAC
SFST: Standardized Field Sobriety Test, a battery of three tests (one-leg stand, walkand-turn, and horizontal gaze nystagmus) used by law enforcement at the roadside to
estimate whether a driver is at or above the illegal limit of .08 g/dL BAC
THC: delta-9 tetrahydrocannabinol, the psychoactive constituent in cannabis. The THC
metabolite, hydroxy-THC, is also psychoactive.
1-9
Chapter 1. Alcohol- and Drug-Impaired Driving
Alcohol- and Drug-Impaired-Driving Countermeasures
The first six sections address alcohol-impaired driving and the last section deals specifically with
drug-impaired driving. Countermeasures to reduce alcohol- and drug-impaired driving are listed
in the table below, providing a rough estimate of each countermeasure’s effectiveness, use, cost,
and time required for implementation. Effectiveness is shown using a five-star rating system.
• Countermeasures that receive or have been determined to be
effective.
• Countermeasures that receive are considered promising, and likely to be
effective.
•
✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
Countermeasures that receive
States, communities, and other organizations are encouraged to use and especially
or countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, as conclusive evidence is not available to demonstrate the effectiveness
of these countermeasures. If they decide to use a new or emerging countermeasure that has not
yet been studied sufficiently to demonstrate that the countermeasure is effective, they are
encouraged to evaluate the countermeasure.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to reduce alcohol- and drug-impaired driving is discussed individually. Full
descriptions are included for , , and countermeasures. Brief
descriptions are included for ✩ and ✩✩ countermeasures. Further details about the ✩ and
✩✩ countermeasures are included in Appendix A1.
1. Deterrence: Laws
Countermeasure
Effectiveness
1.1 Administrative License Revocation or
Suspension (ALR/ALS)
1.2 Open Container
✩✩
1.3 High-BAC Sanctions
1.4 BAC Test Refusal Penalties
1.5 Alcohol-Impaired Driving Law Review
1-10
Cost
Use
Time
$$$
High
Medium
$
High
Short
$
Medium
Short
$
Unknown
Short
$$
Unknown
Medium
Chapter 1. Alcohol- and Drug-Impaired Driving
2. Deterrence: Enforcement
Countermeasure
Effectiveness
2.1 Publicized Sobriety Checkpoints
2.2 High-Visibility Saturation Patrols
2.3 Preliminary Breath Test Devices†
2.4 Passive Alcohol Sensors††
2.5 Integrated Enforcement
† Proven
for increasing arrests
for detecting impaired drivers
Cost
Use
Time
$$$
Medium
Short
$$
High
Short
$$
High
Short
$$
Unknown
Short
$
Unknown
Short
Cost
Use
Time
$$$
Low
Medium
$
Medium
Short
$
Low
Short
Varies
Varies
Varies
†† Proven
3. Deterrence: Prosecution and Adjudication
Countermeasure
Effectiveness
3.1 DWI Courts†
3.2 Limits on Diversion & Plea Agreements††
3.3 Court Monitoring
††
3.4 Sanctions
for reducing recidivism
†† Proven for increasing conviction
† Proven
✩✩
4. Deterrence: DWI Offender Treatment, Monitoring, and Control
Countermeasure
4.1 Alcohol Problem Assessment and
Treatment
4.4 DWI Offender Monitoring
Cost
Varies
Use
High
Time
Varies
$$
Medium
Medium
Varies
Medium
Medium
$$$
Unknown
Varies
$
Low
Short
Cost
Use
Time
$$
Medium
Short
$$$
High
Medium
$$
Medium
Medium
$$
Unknown
Short
$
Medium
Short
4.2 Alcohol Ignition Interlocks†
4.3 Vehicle and License Plate Sanctions
Effectiveness
†
†
4.5 Lower BAC Limit for Repeat Offenders
for reducing recidivism
† Proven
5. Prevention, Intervention, Communications and Outreach
Countermeasure
5.1 Alcohol Screening and Brief intervention
5.2 Mass-Media Campaigns
5.3 Responsible Beverage Service
5.4 Alternative Transportation
5.5 Designated Drivers
Effectiveness
✩✩
✩✩
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Chapter 1. Alcohol- and Drug-Impaired Driving
6. Underage Drinking and Drinking and Driving
Countermeasure
Effectiveness
6.1 Minimum Drinking Age 21 Laws
6.2 Zero-Tolerance Law Enforcement
6.3 Alcohol Vendor Compliance Checks
†
6.4 Other Minimum Legal Drinking Age 21
Law Enforcement
6.5 Youth Programs
† Proven
Cost
Use
Time
$$$
High
Low
$
Unknown
Short
$$
Unknown
Short
$$
Varies
Varies
✩✩
Varies
High
Medium
Effectiveness
Cost
Use
Time
$$
Unknown
for reducing sales to underage people
7. Drug-Impaired Driving
Countermeasure
7.1 Enforcement of Drug-Impaired Driving
7.2 Drug-Impaired-Driving Laws
7.3 Education Regarding Medication
† Use
✩
✩
†
Unknown
Medium
Unknown
Unknown
Short
Short
Long
for drug per se laws
Effectiveness:
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
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Chapter 1. Alcohol- and Drug-Impaired Driving
Cost to implement:
$$$ Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 1. Alcohol- and Drug-Impaired Driving
Deterrence
Deterrence means enacting laws that prohibit impaired driving, publicizing and enforcing those
laws, and punishing offenders. Deterrence works by changing behavior through fear of
apprehension and punishment. If drivers believe their impaired driving is likely to be detected
and they are likely to be arrested, convicted, and punished, many will not drive impaired by
alcohol. This strategy, called general deterrence, influences the general driving public. Examples
include well-publicized and highly visible enforcement such as sobriety checkpoints. In contrast,
specific deterrence refers to efforts to influence drivers who have been arrested for impaired
driving so they will not continue to drive impaired. Examples include ignition interlocks and
vehicle sanctions for DWI offenders. Although most of this discussion relates to alcoholimpaired driving, much could be applied to drug-impaired driving as well.
Deterrence works when consequences are swift, sure, and severe (with swift and sure being more
important in affecting behavior than severe). All States have basic laws in place to define
impaired driving, set illegal per se limits at .08 g/dL BAC (Utah went to .05 g/dL BAC on
December 30, 2018), 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. Law enforcement agencies have limited
resources and except at checkpoints officers must observe traffic violations or other
aberrant behavior before they can stop motorists.
• Conviction also may be difficult. DWI laws are complicated; the evidence needed to
define and demonstrate impairment is complex; and judges or juries may not impose
specified penalties if they believe the penalties are too severe.
• The DWI control system is complex. There are many opportunities for breakdowns in the
system that allow impaired drivers to go unaddressed.
DWI control system operations and management. The DWI control system consists of a set of
laws together with the enforcement, prosecution, adjudication, and offender monitoring 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 19 specific impaired-driving countermeasures in the deterrence section, in
four groups: laws; enforcement; prosecution and adjudication; and offender treatment,
monitoring, and supervision. But the overall DWI control system, including its management and
leadership, is more important than any individual countermeasure.
Studies have highlighted the key characteristics of efficient and effective DWI control systems
(Hedlund & McCartt, 2002; Robertson & 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 completion of all sentence requirements;
• adequate resources for staff, facilities, training, equipment, and new technology; and
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Chapter 1. Alcohol- and Drug-Impaired Driving
•
coordination and cooperation in and across all components.
Some countermeasures discussed in this chapter, such as BAC Test Refusal Penalties (Section
1.4), Alcohol-Impaired-Driving Law Review (Section 1.5), and DWI courts (Section 3.1), are
directed at improving DWI system operations. In some instances, the most important action that
SHSOs can take to reduce alcohol-impaired driving is to review and improve DWI control
system operations, perhaps using State DWI task forces and/or State impaired-driving program
assessments.
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. Although
two decades have passed, the basic findings of the Ulmer group are still applicable. SHSOs
should keep this in mind as they consider the specific countermeasures in this chapter.
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Chapter 1. Alcohol- and Drug-Impaired Driving
1. Deterrence: Laws
1.1 Administrative License Revocation or Suspension
Effectiveness:
Cost: $$$
Use: High
Time: Medium
Administrative license revocation or suspension (ALR or ALS) laws allow law enforcement and
driver licensing authorities to suspend driver licenses if drivers fail or refuse to take BAC tests.
Administrative license revocation laws are similar, except the offender must re-apply for a
license once the suspension period ends. Usually the arresting officer takes the license when a
BAC test is failed or refused. The driver typically receives a temporary license allowing the
driver time to make other transportation arrangements and to request and receive an
administrative hearing or review. In most jurisdictions, offenders may obtain occupational or
hardship licenses during part or all the revocation or suspension periods (NHTSA, 2008a).
NHTSA recommends that ALR laws include a minimum license suspension of 90 days
(NHTSA, 2006a). The National Committee on Uniform Traffic Laws and Ordinances
(NCUTLO, 2000) has a model of an ALR law.
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). More information about ALR laws can be found in the NCHRP
guide on reducing impaired-driving (Goodwin et al., 2005, Strategy C1) and NHTSA’s Traffic
Safety Facts on ALR (NHTSA, 2008a).
Use: As of July 2019 there were 44 States and the District of Columbia that had some form of
ALR or ALS law for first offenses (GHSA, 2019). Thirty-eight States had minimum license
suspensions of at least 90 days, as recommended by NHTSA (GHSA, 2019).
Effectiveness: Many States have had ALR and ALS laws in place for decades, and much of the
research examining their effectiveness is now dated. For example, a summary of 12 evaluations
through 1991 found ALR and ALS laws reduced crashes of different types by an average of 13%
(Wagenaar et al., 2000). A more recent study examining the long-term effects of license
suspension policies across the United States concluded that ALR reduces alcohol-related fatal
crash involvement by 5%, saving an estimated 800 lives each year (Wagenaar & MaldonadoMolina, 2007). See DeYoung (2013a) for a review of the research on the effectiveness of
ALR/ALS laws.
Drivers are less likely to commit offenses when they believe sanctions will be certain and swift
(Wright, 2010; Nagin & Pogarsky, 2006). A study in Ontario, Canada, found a 17% decrease in
fatalities and injuries after enactment of a law that required immediate roadside license
suspensions for driving with BACs in the range of .05 to .08 g/dL, which was in addition to
existing sanctions for BACs above .08 g/dL (Byrne et al., 2016). Furthermore, a companion
study of the same law found that an immediate 7-day impoundment of driver vehicles resulted in
a 33% decrease in drivers who were caught violating court-mandated 90-day suspensions. The 7day impoundment also reduced recidivism in the following 3-month period by 29%.
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Chapter 1. Alcohol- and Drug-Impaired Driving
Fell & Scherer (2017) found that States with ALR laws, irrespective of the duration, had a 13.1%
decrease in the drinking driver ratios (ratio of drivers with BAC ≥ .01 g/dL to drivers with BAC
= .00 g/dL) involved in fatal crashes. The effectiveness of ALR was found to be influenced by
the length of the ALR suspension period. Increases in States’ ALR laws for suspension duration
were associated with decreases in drinking driver ratios among drivers without prior DWI
records involved in fatal crashes. Thus, ALR seems to have a general deterrent effect on
impaired driving. States with ALR suspension periods longer than 90 days had significantly
lower drinking driver ratios than States with shorter suspension periods. In contrast, the presence
of an ALR led to a smaller decrease of 1.8% in the intoxicated driver ratio (ratio of drivers with
BAC ≥ .08 to drivers with BAC >.00 but < .08) involved in fatal crashes. Thus, ALR may be less
effective on habitual or binge drinking drivers. Another notable finding of this study was that
ALR may not be effective as a specific deterrent. A comparison of alcohol-positive and alcoholnegative drivers with DWI convictions in the prior 3 years involved in fatal crashes was used as
a measure of the specific deterrent effect of ALR suspension length. The authors concluded there
was no significant difference in the drinking driver ratio. This finding indicates that other
measures such as alcohol ignition interlocks might be needed for specific deterrence among
individual drivers, particularly those who habitually drive drunk.
Costs: ALR/ALS laws require funds to design, implement, and operate systems 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 or ALS system costs
through offender fees (Century Council, 2008; NHTSA, 2008a).
Time to implement: Six to 12 months are required to design and implement the system and to
recruit and train administrative hearing officers.
Other issues:
• Two-track system: Under ALR/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 challenged in
some States.
• Driving with a suspended license: Some DWI offenders sometimes continue to drive
with suspended or revoked licenses (Lenton et al., 2010; McCartt et al., 2002). For
strategies to reduce driving with a suspended or revoked license, see Neuman et al.
(2003), and Chapter 1, Sections 4.2, 4.3 and 5.4.
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Chapter 1. Alcohol- and Drug-Impaired Driving
•
•
Delaying license reinstatement: Many DWI offenders do not reinstate their licenses
when they are eligible to do so. About half (49%) of DWI offenders delay license
reinstatement for at least a year, while 30% delay reinstatement for 5 years or more
(Voas, Tippetts, & McKnight, 2010). Offenders who delay reinstatement are more likely
to recidivate than those who have their licenses restored. This suggests it may be
important to encourage DWI offenders to reinstate their licenses once eligible, but with
appropriate controls such as ignition interlocks (see Section 4.2) and close monitoring
(see Section 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 vehicle and require a BrAC
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 an administrative hearing is not restricted in this
way, it can serve as an opportunity for the defense attorney to question the arresting
officer about aspects of the DWI case. This may reduce the chance of a criminal DWI
conviction (Hedlund & McCartt, 2002). Officers often spend substantial time appearing
in person at ALR hearings, and a case may be dismissed if an officer fails to appear.
Some States use telephonic hearings to solve these problems (Wiliszowski et al., 2003).
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Chapter 1. Alcohol- and Drug-Impaired Driving
1.2 Open Container
Effectiveness:
Cost: $
Use: High
Time: Short
Open-container laws prohibit possession of any open alcoholic beverage container and the
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 Federalaid highway construction funds redirected to alcohol-impaired driving or hazard elimination
(NHTSA, 2008b). To comply, State open-container laws must:
• Prohibit possession of alcoholic beverage containers and consumption of alcohol in motor vehicles;
• Cover the entire passenger area;
• Apply to all types of alcoholic beverages;
• Apply to all vehicle occupants;
• Apply to all vehicles on public highways; and
• Provide for primary enforcement of the law.
Certain exceptions are permitted. For additional information, see www.federalregister.gov/documents/2016/09/30/2016-23788/regulatory-update-of-transfer-and-sanction-programs.
Use: As of July 2019 there were 39 States and the District of Columbia with open-container laws
that complied with the Federal requirements (FHWA, 2020).
Effectiveness: A study of 4 States that enacted laws in 1999 found the proportion of alcoholinvolved fatal crashes appeared to decline in 3 of the 4 States during the first 6 months after the
laws were implemented, but the declines were not statistically significant (Stuster et al., 2002). In
general, the proportion of alcohol-involved fatal crashes was higher in States with no opencontainer laws than in States with laws. Open container laws are associated with fewer alcoholrelated fatalities (Ying et al., 2013; Whetten-Goldstein et al., 2000). Survey data in both law and
no-law States show strong public support for open-container laws (NHTSA, 2008b).
Active enforcement of open container laws is important for open container laws to be effective.
In one study self-reported impaired driving was 17.5% lower in States that actively enforced
open container laws compared with States that did not (Lenk et al., 2016).
Costs: Open container laws require funds to train LEOs and to implement enforcement.
Time to implement: Open-container laws can be implemented as soon as appropriate legislation
is enacted.
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Chapter 1. Alcohol- and Drug-Impaired Driving
1.3 High-BAC Sanctions
Effectiveness:
Cost: $
Use: Medium
Time: Short
Almost all States increase the penalties for the standard impaired-driving (DWI) offense for
repeat offenders. Some States also have increased the penalties for drivers with high BACs,
typically .15 to .20 g/dL. In 2018 67% of alcohol-impaired-driving fatalities were in crashes that
involved at least one driver with a BAC of .15 g/dL or higher (NCSA, 2019).
High-BAC sanctions are based on the observation that many high-BAC drivers are habitual
impaired-driving offenders, even though they may not have records of previous arrests and
convictions. Moreover, drivers with high BACs put themselves and other road users at risk; more
than half (55%) of drivers with BACs of .01 g/dL or higher involved in fatal crashes in 2018 had
BACs of .15 g/dL or greater (NCSA, 2019). Enhanced sanctions for high-BAC drivers vary by
State, and may include mandatory assessment and treatment for alcohol abuse problems, close
monitoring or home confinement, installation of ignition interlocks, and vehicle or license plate
sanctions (see Chapter 1, Sections 4.1, 4.2, 4.3 and 4.4). NHTSA recommends sanctions for firsttime offenders with high BACs be comparable to those for repeat offenders (NHTSA, 2008c).
Use: As of July 2019 there were 47 States and the District of Columbia that had increased
penalties for drivers with high BACs (GHSA, 2019). While there is no uniform definition of
“high BAC,” these States define drivers with BACs of .10 to .20 g/dL or even greater to be highBAC offenders.
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, which again dissipated with time. The BAC test refusal rate declined for first
offenders and was unchanged for repeat offenders after the high-BAC law was implemented. The
authors pointed out that, at the time, Minnesota’s law had a high threshold of .20 g/dL BAC,
relatively strong administrative and criminal sanctions, and strong penalties for BAC test refusal.
Since the study was conducted, Minnesota changed its threshold for high BAC to .16 g/dL, twice
the illegal limit.
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.
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Chapter 1. Alcohol- and Drug-Impaired Driving
Other issues:
• Test refusal: High-BAC sanctions 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 1.4.
• Child endangerment laws: Similar to high-BAC laws, child endangerment laws
recognize there are certain instances where impaired drivers pose extreme risk to others.
In 2018 there were 231 children 14 or younger (22% of all child fatalities) who were
killed in alcohol-impaired-driving crashes (NCSA, 2019). Of those, 128 were occupants
of vehicles with drivers who had BACs of .08 g/dL or higher. Child endangerment laws
create a separate offense or enhance DWI penalties for impaired drivers who carry
children. Presently, 46 States and the District of Columbia have separate or higher
penalties for impaired drivers who have children in their vehicles (MADD, 2018).
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Chapter 1. Alcohol- and Drug-Impaired Driving
1.4 BAC Test Refusal Penalties
Effectiveness:
Cost: $
Use: Unknown
Time: Short
All States have implied consent laws stipulating that people implicitly consent to be tested if they
are suspected of impaired driving (Shinkle et al., 2019; NHTSA, 2017). However, some drivers
refuse to provide breath or blood samples for BAC tests. Nationwide, an average of 24% of
drivers arrested for DWI refuse BAC testing, although this figure ranges from 1% to 82%
depending on the State (Jones & Nichols, 2012; Namuswe et al., 2014). A driver’s BAC is a
critical piece of evidence in an alcohol-impaired-driving case. The absence of a BAC test can
make it more difficult to convict the impaired driver.
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. Therefore, the model DWI code sets a
more severe penalty for test refusal than for test failure (NCUTLO, 2000).
Reduced test refusal rates will help the overall DWI control system by providing better BAC
evidence. Having driver BACs may increase DWI and high-BAC DWI convictions, increase the
likelihood prior DWI offenses will be properly identified, and give courts better evidence for
offender alcohol assessment. For a thorough discussion of issues related to BAC test refusal, see
NHTSA’s Refusal of Intoxication Testing: A Report to Congress (Berning et al., 2008). See also
Voas et al. (2009) for a history of implied consent laws in the United States and a review of the
research on breath test refusal.
Use: The penalties in each State for failing or 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 Wyoming
impose administrative sanctions for test refusal (NHTSA, 2017). See
NHTSA’s Digest of Impaired Driving and Selected Beverage Control Laws, 30th Edition,
Current as of December 31, 2015, for more detail on each State’s laws (NHTSA, 2017).
The U.S. Supreme Court decision Birchfield v. North Dakota upheld the ability of States to
criminalize refusal for breath testing, but not for warrantless blood tests. The implications of the
Birchfield decision are described in more detail in Lemons and Birst (2016). The U.S. Supreme
Court decision Mitchell v. Wisconsin (2019) ruled that police may order a blood draw from an
unconscious person suspected of impaired driving without a warrant.
Effectiveness: Zwicker et al. (2005) found that test refusal rates appear to be lower in States
where the consequences of test refusal are greater than the consequences of test failure. No study
has examined whether stronger test refusal penalties are associated with reduced alcoholimpaired crashes.
Costs: The cost for BAC test refusal penalties depends on the number of offenders detected and
the fines and other penalties applied to them.
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Chapter 1. Alcohol- and Drug-Impaired Driving
Time to implement: Increased BAC test refusal penalties can be implemented as soon as
appropriate legislation is enacted.
Other issues:
• Criminalizing test refusal: As of June 2018 BAC test refusal was a criminal offense in
at least 12 States (NCSL, 2018). Criminalizing test refusal may reduce refusal rates and
increase the likelihood of convictions for DWI (Jones & Nichols, 2012). It also ensures
the drivers will be identified as repeat offenders upon subsequent arrests.
• Warrants: To reduce breath test refusals and increase the number of drivers successfully
prosecuted for DWI, some States issue warrants for drivers who refuse breath tests.
Issued by a judge or magistrate, the warrant requires the driver to provide a blood sample,
by force if necessary. One study reviewed how warrants are used in Arizona, Michigan,
Oregon, and Utah (Hedlund & Beirness, 2007), which found that warrants may
successfully reduce breath test refusals and result in more pleas, fewer trials, and more
convictions. Although warrants require additional time for law enforcement, officers
report the chemical evidence obtained from the warrant are of great value and worth the
effort to obtain (Haire et al., 2011). Note that following the Birchfield v. North Dakota
Supreme Court decision, warrants are required for blood tests unless there are exigent
circumstances (see Lemons & Birst, 2016) as was decided in the Mitchell v. Wisconsin
(2019) Supreme Court decision.
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Chapter 1. Alcohol- and Drug-Impaired Driving
1.5 Alcohol-Impaired-Driving Law Review
Effectiveness: ✩✩
Cost: $$
Use: Unknown
Time: Medium
Alcohol-impaired-driving laws in many States are extremely complex. DWI laws have evolved
over the past 30 years to incorporate new definitions of the offense of driving while impaired
(illegal per se laws), new technology and methods for determining impairment (e.g., BAC tests,
SFSTs), and new sentencing and monitoring alternatives (e.g., electronic monitoring, alcohol
ignition interlocks). Many States have modified their laws to incorporate these new ideas without
reviewing their effect on the overall DWI control systems. The result is often an inconsistent
patchwork of laws that may be difficult to understand, enforce, prosecute, and adjudicate, with
many inconsistencies and unintended consequences. In many States, thorough reviews and
revisions would produce systems of laws that would be far simpler and more understandable,
efficient, and effective.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A1, Section 1.5.
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Chapter 1. Alcohol- and Drug-Impaired Driving
2. Deterrence: Enforcement
2.1 Publicized Sobriety Checkpoints
Effectiveness:
Cost: $$$
Use: Medium
Time: Short
Law enforcement officers stop vehicles at predetermined sobriety checkpoints to check for driver
impairment. They may 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, as part of an ongoing sobriety checkpoint program. Fell et
al. (2004) provide an overview of checkpoint operations, use, effectiveness, and issues. See Fell
et al. (2013) for a detailed description of six HVE programs in the United States, including
enforcement strategies, visibility elements, use of media, funding, and many other issues.
Use: As of November 2018 sobriety checkpoints are authorized in 37 States and the District of
Columbia, but they vary in terms of how regularly they are conducted (GHSA, 2018b). Only 16
States conduct checkpoints somewhere in their State on a weekly basis.
Two national surveys shed light on the frequency of use of sobriety checkpoints by State and
local LEAs. Erickson et al. (2015) found that of the 48 State patrol and 1,082 local LEAs that
permitted checkpoints in 2010 and 2011, some 73% of State patrol agencies and 55% of local
agencies conducted them. The main reasons cited as why checkpoints were not used more
frequently were lack of law enforcement personnel and lack of funding (Fell et al., 2003). A
possible solution for this is to combine resources with other agencies. Specifically, the results of
a survey by Eichelberger and McCartt (2016) found that 40% of agencies that conducted
checkpoints reported pooling resources with other LEAs.
Erickson et al. (2015) suggest lack of legislation to allow checkpoints and low levels of public
support (Fell et al., 2003) can also be barriers to implementation. The Erickson study found that
State agencies in the South (with drier weather), local agencies with full-time officers for alcohol
enforcement, and local agencies with alcohol divisions were more likely to conduct saturation
patrols (i.e., impaired driving-specific patrols by a large number of officers in a target area within
a given duration; see Section 2.2).
Effectiveness: The CDC’s systematic review of 15 high-quality studies found that checkpoints
reduce alcohol-related fatal crashes by 9% (Bergen et al., 2014). Similarly, a meta-analysis by
Erke et al. (2009) found that checkpoints reduce alcohol-related crashes by 17%, and all crashes
by 10 to 15%. Publicized sobriety checkpoint programs have proven effective in reducing
alcohol-related crashes among high-risk populations including males and drivers 21 to 34 years
old (Bergen et al., 2014).
NHTSA has supported efforts to reduce alcohol-impaired driving using publicized sobriety
checkpoint programs. Evaluations of sobriety checkpoints and extensive paid media in statewide
campaigns in Connecticut and West Virginia found decreases in alcohol-related fatalities, as well
as fewer drivers with positive BACs at roadside surveys (Zwicker, Chaudhary, Maloney, &
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Chapter 1. Alcohol- and Drug-Impaired Driving
Squeglia, 2007; Zwicker, Chaudhary, Solomon, Siegler, & Meadows, 2007). In addition, a study
of demonstration programs in 7 States found reductions in alcohol-related fatalities from 11% to
20% in States using numerous checkpoints, other high-visibility operations and intensive
publicity, including paid advertising (Fell, Langston, et al., 2008). States with lower levels of
enforcement and publicity did not demonstrate decreases in fatalities relative to neighboring
States. See also NHTSA’s Strategic Evaluation States initiative (NHTSA, 2007; Syner et al.,
2008), the Checkpoint Strikeforce program (Lacey et al., 2008), and the national Labor Day
holiday campaign: Drunk Driving. Over the Limit. Under Arrest (Solomon et al., 2008).
Safety campaigns involving education and enforcement can be improved by explaining where
and when they are effective. Schneider et al. (2017) demonstrated that resources invested at ideal
locations for checkpoints can be justified based on areas with higher crash injury severity and by
comparing the value of patrolling with the probability of potential pullovers over a period of
time. This type of analysis helps stakeholders predict resource needs as well as where and when
to implement campaigns based on spatial, temporal, and geographic patterns specific to given
counties. NHTSA’s fact sheets, media releases, op-eds, and other information aid in planning
and preparation of campaigns tailored to holidays and special events. See
www.trafficsafetymarketing.gov/get-materials/drunk-driving/drive-sober-or-get-pulled-over/4thjuly-drive-sober for examples of the 4th of July Drive Sober campaign.
Costs: The main costs are for law enforcement time and for publicity. A typical checkpoint using
15 or more officers can cost $5,000 to $7,000 (Robertson & Holmes, 2011). However, law
enforcement costs can be reduced by operating checkpoints with smaller teams of 3 to 5 officers
(NHTSA, 2006b; Stuster & Blowers, 1995).
Law enforcement agencies in two rural West Virginia counties were able to sustain year-long
programming of weekly low-staff checkpoints. The proportion of nighttime drivers with BACs
of .05 g/dL or higher was 70% lower in these counties compared to comparison counties without
additional checkpoints (Lacey et al., 2006). These smaller checkpoints can be conducted for as
little as $500 to $1,500 (Maistros et al., 2014). NHTSA has a guidebook available to assist LEAs
in planning, operating, and evaluating low-staff sobriety checkpoints (NHTSA, 2006b).
Checkpoint publicity can be costly if paid media are used. For the Checkpoint Strikeforce
program, paid media budgets ranged from $25,000 in West Virginia to $433,000 in Maryland
(Fell et al., 2013). Publicity for checkpoints should also include earned and social media.
Time to implement: Sobriety checkpoints can be implemented very quickly if officers are
trained in detecting impaired drivers, SFST, and checkpoint operational procedures. NHTSA
provides resources and further details on HVE at www.nhtsa.gov/enforcement-justiceservices/high-visibility-enforcement-hve-toolkit.
Other issues:
• Legality: As of November 2018 checkpoints were not conducted in 13 States (GHSA,
2018b). In 12 of these States (Alaska, Idaho, Iowa, Michigan, Minnesota, Montana,
Oregon, Rhode Island, Texas, Washington, Wisconsin, and Wyoming), checkpoints are
prohibited by State laws, State constitutions, or interpretations of the State law. In
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Chapter 1. Alcohol- and Drug-Impaired Driving
•
•
•
•
Missouri checkpoints are authorized by law but the State budget prohibits funding them
(GHSA, 2018b). States where checkpoints are not permitted may use other enforcement
strategies such as saturation patrols (see Chapter 1, Section 2.2).
Visibility: 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. See
Fell et al. (2013) for additional recommendations concerning checkpoint visibility.
Arrests: The primary purpose of publicized sobriety checkpoint programs is to deter
impaired driving, not to increase arrests. However, impaired drivers detected at
checkpoints should be arrested and arrests should be publicized. That said, arrests at
checkpoints should not be used as measures of effectiveness; the number of contacts
would be more appropriate. Secondary values of checkpoints are they are checking for
valid driver licenses, seat belt use, outstanding warrants, stolen vehicles, and other traffic
and criminal infractions.
Combining checkpoints with other activities: To boost visibility, some jurisdictions
combine checkpoints with activities such as saturation patrols or enforcement of open
container laws (Sanem et al., 2015). For example, some LEAs conduct both checkpoints
and saturation patrols during the same weekend. Others alternate checkpoints and
saturation patrols on different weekends as part of a larger publicized impaired-driving
enforcement effort. According to the results of a survey conducted with State patrol
agencies and local LEAs, the prevalence of self-reported alcohol-impaired driving was
lower in States where sobriety checkpoints, saturation patrols, and enforcement of open
container laws were conducted. These results demonstrate the potential value of LEAs
implementing enforcement-related strategies to more effectively reduce alcohol-impaired
driving. NHTSA strongly supports that officers conducting such be trained in the SFST
battery. Officers trained in Drug recognition (DREs) can supplement sobriety
checkpoints to detect drivers who are impaired with substances other than alcohol.
Another easy-to-implement, cost-effective strategy to leverage the benefits of traditional
checkpoint campaigns are flexible or “phantom” checkpoints. Typically, signs, displays,
and law enforcement vehicles are set up at a mock checkpoint location although neither
enforcement nor arrests are planned. This high-visibility strategy deters impaired driving
with lower costs than full checkpoint implementation. Flexible checkpoints are suitable
for small agencies with few staff, especially on rural roadways with high frequencies of
alcohol-related crashes. Lacey et al. (2017) evaluated use and effectiveness of these
checkpoints as complements to driver awareness of enforcement in one jurisdiction.
Feedback from staff was positive and staff and supervisors believed that flexible
checkpoints were practical and easy to implement. However, empirical evaluations of
effectiveness were inconclusive because of the small scale of the evaluation. Another
study based on survey responses and from field inspections in two counties in Illinois
concluded flexible checkpoints were not a statistically effective strategy. One proposed
explanation was the lack of media publicity for flexible checkpoints compared to planned
activities.
Standardized Field Sobriety Tests: LEAs have used SFSTs for more than 40 years to
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Chapter 1. Alcohol- and Drug-Impaired Driving
identify impaired drivers. 2 The SFST is a three-test battery - the horizontal gaze
nystagmus test, the walk-and-turn test, and the one-leg-stand test. Research shows the
combined components of the SFST are 91% accurate in identifying drivers with BACs
above the illegal limit of .08 g/dL (Stuster & Burns, 1998). It is recommended that any
officers working HVE should be SFST-trained. Some localities require that officers have
SFST refresher training before participating in such activities. State Highway Safety
Offices may request through their NHTSA Regional Offices SFST assessments (and
SFST with DRE-module add-on assessment) that look at a State’s application of basic
law enforcement tools for detecting impaired drivers.
NHTSA began researching how to test suspects in 1975. The first SFSTs were put into the effect in 1981. The
"founding document" for SFSTs was NHTSA's report, Development and Field Test of Psychophysical
Tests for DWI Arrest, by Van K. Tharp, Marcelline Burns, and Herbert Moskowitz (1981, March), Report No. DOT
HS 805 864, https://rosap.ntl.bts.gov/view/dot/1325
2
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Chapter 1. Alcohol- and Drug-Impaired Driving
2.2 High-Visibility Saturation Patrols
Effectiveness:
Cost: $$
Use: High
Time: Short
A saturation patrol (also called a blanket patrol or dedicated DWI patrol) consists of a large
number of LEOs patrolling a specific area looking for impaired drivers. These patrols usually
take place at times and locations where impaired-driving crashes commonly occur. Like
publicized sobriety checkpoint programs, the primary purpose of publicized saturation patrol
programs is to deter driving after drinking by increasing the perceived risk of arrest. Saturation
patrols should be publicized extensively and conducted regularly as part of an ongoing saturation
patrol program. State-level enforcement campaigns from 7 States were found effective in
reducing 11% to 20% of total alcohol related fatalities when enforcement and paid media were
used (National Academies of Sciences, Engineering, and Medicine, 2018). NHTSA provides
resources on HVE at www.nhtsa.gov/enforcement-justice-services/high-visibility-enforcementhve-toolkit. NHTSA strongly recommends that officers conducting saturation patrols be trained
in the SFST battery.
Use: A survey conducted by the Century Council (2008) reported that 44 States used saturation
patrols, among the most common alcohol-related enforcement across State as well as local
agencies. A national survey reported that 63% of local agencies and 96% of State agencies
conducted such patrols (Erickson et al., 2015).
Effectiveness: A demonstration program in Michigan, where sobriety checkpoints are prohibited
by State law, revealed that saturation patrols can be effective in reducing alcohol-related fatal
crashes when accompanied by extensive publicity (Fell et al., 2008).
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 3 months if officers are
trained in detecting impaired drivers and in SFST. See the NHTSA HVE toolkit for
implementation information (www.nhtsa.gov/enforcement-justice-services/high-visibilityenforcement-hve-toolkit).
Other issues:
• Legality: Saturation patrols are legal in all jurisdictions.
• Publicity: As with sobriety checkpoints, saturation patrols should be highly visible and
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 social media, news
stories, and other earned media, especially in a continuing saturation patrol program
(Goodwin et al., 2005, Strategy B1).
• Arrests: While the primary purpose of saturation patrols is to deter drinking after driving
by increasing the perceived risk of arrest, saturation patrols also can be very effective in
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Chapter 1. Alcohol- and Drug-Impaired Driving
arresting impaired drivers. For example, LEOs in Minnesota conducted 290 saturation
patrols in 2006, stopping 33,923 vehicles and arresting 2,796 impaired drivers (Century
Council, 2008). A 10% increase in the DUI arrest rate (from enforcement including
saturation patrols and checkpoints) lowers alcohol-related crash rates by 1% (Fell et al.,
2014). Similar to publicized sobriety checkpoint programs, publicized saturation patrol
programs are also effective in detecting other driving and criminal offenses.
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Chapter 1. Alcohol- and Drug-Impaired Driving
2.3 Breath Test Devices
Effectiveness: †
†Proven for increasing arrests
Cost: $$
Use: High
Time: Short
A breath test device is a stationary or portable alcohol sensor used to measure a person’s breath
alcohol concentration (BrAC). Law enforcement officers use breath test devices in the field to
help establish probable cause for a DWI arrest. A driver blows into a mouthpiece and the breath
test device displays a numerical BrAC often converted to BAC terminology such as .12 g/dL. 3
Several breath test device models are available commercially. There are two categories of breath
test devices. Evidential breath test devices are State-approved and conform to established
specifications and can be used as evidence in court. Preliminary breath test devices, also known
as screeners, are handheld devices used at the roadside by officers to establish probable cause
prior to arrest. NHTSA provides a “Conforming Products List” of alcohol testing (EBT) and
screening (PBT) instruments, as well as calibration units for these devices. While some States
may maintain separate lists of approved devices they have tested and approved for purchase,
devices included on NHTSA’s Conforming Products Lists are eligible for purchase using Federal
funds.
• www.nhtsa.gov/drunk-driving/alcohol-measurement-devices
• NHTSA Conforming Products List of Evidential Breath Alcohol Measurement Devices,
Docket No. NHTSA–2017–0053, Federal Register, Vol. 82, No. 211, Thursday,
November 2, 2017), available at
www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/2017-23869.pdf
• NHTSA Conforming Products List of Screening Devices to Measure Alcohol in Bodily
Fluids, Docket No. NHTSA–2012–0062, Federal Register, Vol. 77, No. 115, Thursday,
June 14, 2012, available at
www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/cpl_asds_june_2012.pdf
• NHTSA Conforming Products List of Calibrating Units for Breath Alcohol Testers,
Docket No. NHTSA–2012–0063, Federal Register, Vol. 77, No. 204, Monday, October
22, 2012, available at
www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/cpl_cus_oct_2012.pdf
Use: PBTs are often used to establish probable cause for arrest, but they are rarely used as
evidence in court. One exception is California, which allows PBT results as evidence of presence
of alcohol (Nesci, 2015). California officers can use PBT evidence to enforce zero-tolerance
laws for drivers under 21; an officer at the roadside can issue a citation and seize the driver’s
license (Ferguson et al., 2000). EBTs are commonly used to provide evidence of alcohol
impairment that is presented in court.
Effectiveness: Law enforcement officers generally agree that breath test devices are useful.
Sixty-nine percent of the 2,731 LEOs surveyed by Simpson and Robertson (2001) supported
A BAC measures the weight of alcohol (usually in grams) per volume of blood (usually deciliters, centiliters, or
milliliters, commonly expressed in NHTSA reports as grams per deciliter, g/dL). A BrAC measures the weight of
alcohol in a volume of breath, usually grams per 210 liters (g/210L). Some breathalyzers report readings as BrACs,
g/210L, and some convert the BrAC to BAC terminology, g/dL.
3
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Chapter 1. Alcohol- and Drug-Impaired Driving
greater breath test devices availability and use. Breath test devices are especially valuable for
two classes of drivers who may appear to perform normally on many tasks: drivers with high
tolerance to alcohol (Simpson & Robertson, 2001) and drivers under 21 who may be in violation
of zero-tolerance laws (Ferguson et al., 2000). A breath test device also can be useful at crash
scenes where a driver is injured and unable to perform an SFST. There is some evidence that
breath test devices use increases DWI arrests and reduces alcohol-involved fatal crashes
(Century Council, 2008).
Costs: Breath test devices cost from $200 to $2,000 a piece, with PBTs typically costing less
than EBTs. Many LEAs have limited numbers of breath test devices and many patrol officers do
not have regular access to them. Officers surveyed by Simpson and Robertson (2001) estimated
that three-fourths of all DWI arrests occur on routine patrols, so DWI detection would be
substantially improved if every patrol officer had a breath test device.
Time to implement: Breath test devices can be used as soon as they are purchased and officers
are trained in their use and maintenance, especially regular calibration checks. Most LEAs 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: The PBT and EBT devices commonly used are designed strictly for
identifying alcohol and cannot detect the presence of drugs other than alcohol.
• Personal breath-testing devices: It is important to note that these devices are not used
by law enforcement and they do not meet NHTSA’s Model Standards. Personal breathtesting devices can be paired to smartphones to record breath samples and deliver
cautionary messages and notifications of BACs to drivers including safety measures to
hail a ride share or alert social contacts. Smartphone cameras can be used to verify driver
identity and to provide time-stamped and georeferenced breath sample record. One
limitation of these personal breath-testing devices is the requirement of active use and
engagement provides only point-in-time BAC estimates. A point-in-time BAC estimate
could create a hazardous situation where someone’s BAC is rising, but the device
indicates that the person is below the illegal per se limit leading them to drive.
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Chapter 1. Alcohol- and Drug-Impaired Driving
2.4 Passive Alcohol Sensors
Effectiveness: †
†Proven for detecting impaired drivers
Cost: $$
Use: Unknown
Time: Short
A passive alcohol sensor (PAS) detects alcohol presence in the air. The sensor usually is
integrated into a flashlight or clipboard. An officer holds the flashlight or clipboard near the
driver’s mouth, where it measures alcohol presence in the air where the driver is breathing. The
PAS displays a BrAC range, such as a red light for any BAC at or above .08 g/dL. It 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).
Based on the survey conducted by Eichelberger and McCartt (2016), the majority of police
agencies do not have PAS equipment. In one survey only 15% of the municipal, county, and
State agencies (out of 235 total) used PAS, and with varying frequency.
Several PAS models are available commercially. They are generally reliable and effective at
detecting alcohol in the surrounding ambient air. In one study, breath samples and PAS measures
were obtained from over 12,000 drivers. Results showed that a PAS score was a strong predictor
of a driver’s BAC status, leading to the conclusion that “the PAS can be an effective tool for
officers when deciding whether to initiate a DWI investigation” (Voas et al., 2006). NHTSA
does not maintain a list of PAS models.
Use: PAS units are typically used at the vehicle window after a traffic stop or at a checkpoint. A
PAS report of alcohol presence may give the officer probable cause to request further
examination with SFSTs or a PBT device. Except for the Eichelberger and McCartt report
(2016), no other data are available on how many PAS units may be in use.
Effectiveness: The PAS is especially effective at detecting impaired drivers at checkpoints,
where officers must screen drivers quickly with little or no opportunity to observe the drivers on
the road. Evaluations show that officers using PAS at checkpoints can detect 50% more drivers
at BACs of .10 g/dL or higher than officers not using PAS (Century Council, 2008; Farmer et al.,
1999; Fell et al., 2004; Voas, 2008). The PAS appears to be especially effective in assisting
officers who rarely make arrests for DWI to make more arrests. (Fell, Compton, & Voas, 2008).
Costs: PAS units cost from $300 to $700 apiece.
Time to implement: PAS units can be used as soon as they are purchased and officers are
trained in their use and maintenance. Training can usually be accomplished quickly.
Other issues:
• Acceptance by law enforcement: Officers tend to dislike using the PAS. Common
reasons given by officers are they require officers to be closer to drivers than they wish to
be, they require some portion of officers’ attention at a time when they may have other
things to be concerned about (including personal safety), or they may keep officers from
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Chapter 1. Alcohol- and Drug-Impaired Driving
•
having a hand free (Preusser, 2000; Eichelberger & McCartt, 2016). Other officers
believe they can detect the odor of alcohol accurately without assistance from PAS
devices (Preusser, 2000).
Other drugs: As with a PBT, a PAS cannot detect the presence of drugs other than
alcohol.
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Chapter 1. Alcohol- and Drug-Impaired Driving
2.5 Integrated Enforcement
Effectiveness:
Cost: $
Use: Unknown
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.
Special enforcement directed primarily at other offenses such as speeding or seat belt nonuse,
offer an additional opportunity to detect impaired drivers, especially at night, as impaired drivers
often speed or fail to wear seat belts. However, when conducting enforcement for other offenses,
such as speeding and seat belt nonuse, it is important to maintain the enforcement focus on those
offenses.
Use: There are no data on how frequently integrated enforcement methods are used.
Effectiveness: The More Cops, More Stops program was conducted in six phases from 2011 to
2013 in Oklahoma and Tennessee cities. The program aimed at HVE of impaired driving, seat
belt, and speeding laws (Nichols et al., 2016). A small but statistically significant decline was
observed in the percentage of impaired drivers with BACs > .00 g/DL and BACs ≥ .08 g/dL in
Nashville during the enforcement period; declines were greater when checkpoints were used.
However, there was not enough evidence to suggest that More Cops, More Stops enhanced
outcomes over other ongoing campaigns such as Drive Sober or Get Pulled Over. Instead, the
complex focus of the HVE campaign and the demands on LEAs to enforce three traffic safety
issues together may have led to no more than modest benefits. Other studies have also produced
mixed results. Jones et al. (1995) conducted a three-site evaluation of integrated impaired
driving, speed, and seat belt use enforcement. Sites that combined high publicity with increased
enforcement reduced crashes likely to involve alcohol (such as single-vehicle nighttime crashes)
by 10% to 35%. They concluded that the results were encouraging, but not definitive. The
Massachusetts Saving Lives comprehensive programs in six communities used integrated
enforcement methods. The programs reduced fatal crashes involving alcohol by 42% (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. See also Voas and Lacey
(2011), Goodwin et al. (2005, Strategy B2), and Stuster (2000).
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 within 3 months
if officers are trained in detecting impaired drivers and in SFST.
Other issues:
• Publicity: Integrated enforcement 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 an ongoing program
(Goodwin et al., 2005, Strategy B2).
• Priorities: Integrated enforcement sends a message to the public and to LEOs alike that
traffic safety is not a single-issue activity.
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Chapter 1. Alcohol- and Drug-Impaired Driving
•
Citizen reporting programs: Some jurisdictions have dedicated programs where drivers
can call to report suspected impaired drivers. These can generate support for law
enforcement efforts and increase the perception in the community that impaired drivers
will be caught. A study of a grassroots DWI witness reward program in Stockton,
California, found a significant decrease in alcohol-related injury/fatality crashes
following the program, relative to six comparison communities (Van Vleck & Brinkley,
2009). Mothers Against Drunk Driving Canada launched a program in 2007 called
Campaign 911 to encourage the general public to report impaired drivers. Calls to 911
increased sharply after the program was implemented, as did the number of vehicles
stopped and the number of criminal charges issued (Solomon & Chamberlain, 2013). The
effect of the program on crashes was not examined. NHTSA offers a manual for LEAs
and local organizations interested in establishing citizen DWI reporting programs in their
communities (Kelley-Baker et al., 2008).
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Chapter 1. Alcohol- and Drug-Impaired Driving
3. Deterrence: Prosecution and Adjudication
3.1 DWI Courts
Effectiveness: †
† Proven for reducing recidivism
Cost: $$$
Use: Low
Time: Medium
Based on the drug court model, DWI courts are specialized courts dedicated to changing the
behavior of DWI offenders through intensive supervision and treatment. A dedicated DWI court
provides a systematic and coordinated approach to prosecuting, sentencing, monitoring, and
treating DWI offenders. Prosecutors and judges in DWI courts specialize in DWI cases. The
underlying goal is to change offender behavior by identifying and treating alcohol abuse
problems and by holding offenders accountable for their actions. DWI courts usually target the
enrollment, treatment, and supervision of drivers with prior DWI offenses or those with BACs of
.15 g/dL or higher (National Academies of Sciences, Engineering, and Medicine, 2018; NHTSA,
2016b). DWI courts have greater success in changing driver behavior compared to traditional
court processes and sanctions, and can be particularly useful countermeasures for repeat
offenders.
Intensive supervision is a key component of DWI courts. Probation officers monitor offenders
closely and report probation infractions to the judge immediately for prompt action. These
include failure to appear at court, testing positive on an alcohol or drug test, and not participating
in court-ordered treatment sessions (NHTSA, 2016b). Restrictions and monitoring are gradually
relaxed as offenders demonstrate responsible behavior. The frequency of meetings is higher at
the beginning of the DWI programs, usually one or more a week, and then it varies as
participants progress to the next phases. Participants are also required to submit alcohol and drug
tests several times once the program begins. Most programs also reward participants with things
like verbal or small token acknowledgements or reductions in sanctions as they complete phases
of the program, meet treatment requirements, maintain sobriety, and comply with appointments.
DWI courts follow the model established by over 3,000 drug courts around the Nation (U.S.
DOJ, 2020; NDCI, 2020; Huddleston et al., 2008; NADCP, 2009; Goodwin et al., 2005, Strategy
D3). See Brunson and Knighten (2005), Practice #1, for a comprehensive overview of DWI
courts. The National Center for DWI Courts (2011) summarized 10 guiding principles for States
implementing DWI courts. The guide also outlines recommendations for assessing and
establishing plans for treatment, evaluation, stakeholder collaboration, and sustainability of the
program.
A DWI court reduces 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 for offenders on an individual basis. Treatment programs typically involve relapse
prevention, counseling, support groups, drug education, and mental health programs for
participants with co-occurring disorders. Most programs (75%) rely on treatment providers
operating separately from court (NHTSA, 2016b).
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Chapter 1. Alcohol- and Drug-Impaired Driving
A key feature of a DWI court is that the team meets regularly, giving all parties opportunity to
discuss the status of a case. Judges can then immediately revise restrictions, if appropriate. DWI
courts can be more efficient and effective than regular courts because judges and prosecutors
closely supervise the offenders and are familiar with the complex DWI laws, evidentiary issues,
sentencing options, and the offenders. A NHTSA report (2003a) describes the operation of a
DWI court in Albuquerque, New Mexico.
Use: As of June 2018 the National Drug Court Resource Center reported 278 designated DWI
courts in 34 States (NDCRC, 2018). In addition, there were 420 hybrid DWI/drug courts in 30
States, which are drug courts that also take DWI offenders. States with the most designated DWI
courts include Michigan (33), Texas (23), Georgia (21), Missouri (21), Wisconsin (17),
Pennsylvania (16), and Colorado (15).
In collaboration with the National Center for DWI Courts, NHTSA conducted an online survey
with DWI courts and DWI/drug courts to obtain specific information about how the courts were
being operated (NHTSA, 2016b). A total of 105 DWI and DWI/drug courts responded to the
survey in its entirety. Of those, 44% reported they serve primarily rural areas, 33% serve
primarily urban areas, and 22% serve primarily suburban areas. Respondents reported a range in
the number of DWI participants currently active in their programs from less than 10 to more than
200.
Effectiveness: Based on the National Academies of Sciences and Medicine (2018), longduration DWI court programs appear to be more effective due to the high intensity and frequency
of contact involved, although effectiveness has also been demonstrated in short-term analyses. A
systematic review found that DWI courts appear to be effective at reducing recidivism, although
the available studies had too many shortcomings to draw definitive conclusions (Marlowe et al.,
2009). A meta-analysis of 28 studies suggests DWI courts reduce recidivism among DWI
offenders by approximately 50% compared to traditional court programs (Mitchell et al., 2012).
However, the authors note that more rigorous experimental evaluations of DWI courts are still
needed.
Some program evaluations show that DWI courts can be successful. Low DWI recidivism rates
have been found for graduates of DWI courts in Athens, Georgia, Maricopa County, Arizona,
Los Angeles County, California, and elsewhere (Marlowe et al., 2009). One study in Michigan
found that DWI court participants were 19 times less likely to be rearrested for DWI within 2
years than a comparison group of offenders in traditional probation (Michigan Supreme Court &
NPC Research, 2008). Another study of three DWI courts in Georgia found that offenders who
graduated from the court program had a 9% recidivism rate within the next 4 years, compared to
a 24% recidivism rate for a comparison group of offenders processed in traditional courts (Fell,
Tippetts, & Langston, 2011). A study of DWI and hybrid DWI/drug courts in North Carolina
found that participants who graduated from the court program were less likely to be rearrested or
convicted on DWI charges than others who did not participate in the court program. Hybrid
courts were less effective than DWI courts when participant re-arrests were compared. The study
reported that while either court program was generally effective, approximately only 1% of those
convicted of DWI offenses were being referred to these courts (Sloan et al., 2016).
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Evaluations have shown that close monitoring and individualized sanctions for DWI offenders
reduce recidivism (Kubas et al., 2017; see also Chapter 1, Section 4.4); similarly, greater
interaction and involvement between courts and participants was found to lead to better
outcomes for the participants (Sloan et al., 2013). When these are incorporated in comprehensive
DWI court programs, their effects are likely even greater.
Costs: DWI court costs are difficult to estimate and compare with regular courts. Costs may be
greater because more probation officers will be needed to reduce caseloads and to provide close
monitoring, and because judges must allocate time to meet regularly with probationers and to
deal with any probation violations. However, total time offenders spend in jail is reduced, thus
saving the justice system time and money (Michigan Supreme Court & NPC Research, 2008).
Moreover, DWI courts may reduce long-term system costs substantially if they decrease DWI
recidivism as expected. These savings can spread across systems, such as health care facilities (in
the form of reduced numbers of crashes and reduced alcohol abuse).
According to the meta-analysis conducted by Mitchell et al. (2012), the cost of DWI courts is
lower than standard probation (see also National Academies of Sciences, Engineering, and
Medicine, 2018, for a summary). A cost-benefit analysis conducted by the Department of Justice
in 2014 estimated a generalized Criminal Justice System cost component based on interviews
with 20 drug courts (Downey & Roman, 2014). The cost estimate amounted to $4,869 for drug
court participants, which was lower than the estimated cost of $5,863 for the “status quo”
approach. An analysis of Maryland’s Anne Arundel County criminal justice system showed the
per-person cost over the 2-year program for DUI court graduates was $3,143. This was an
average savings of $5,873 compared to people with DUI offenses who choose not to enroll in the
DUI court program (NPC Research, 2009). These evaluations show that while DWI courts
provide more intensive and expensive services than standard probation, they still cost less to
administer due to the shortened time required for supervising participants and reduced
incarceration (Harron & Kavanaugh, 2015). The majority of DWI court programs are funded
mostly through State grants (69%) and fees imposed on the client for the payment of ignition
interlocks, treatments, and fines. Federal, municipal, and nonprofit grant funding sources are less
predominant. Overall, less than half of the DWI courts have sustainability plans for long-term
DWI court programs (NHTSA, 2016b).
Time to implement: DWI courts can be implemented 4 to 6 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 a year or more.
Other Information:
• Traffic Safety Resource Prosecutors: DWI cases can be highly complex and difficult to
prosecute, yet they are often assigned to the least experienced prosecutors. In one survey,
about half of prosecutors and judges said the training and education they received prior to
assuming their positions were inadequate for preparing them to prosecute and preside
over DWI cases (Robertson & Simpson, 2002). Traffic Safety Resource Prosecutors
(TSRPs) are professionals with prosecutorial experience who specialize in the
prosecution of traffic crimes, and DWI cases in particular. They provide training,
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•
education, and technical support to prosecutors and LEAs in their States. Resources for
prosecuting drug-impaired drivers are available at the National Traffic Law Center (visit
ndaa.org/programs/ntlc/). The National District Attorneys Association provides TSRP
training webinars and resources (visit https://ndaa.org/training/prosecuting-dui-cases/).
NHTSA has also developed a manual to assist new TSRPs (Robertson et al., 2016),
available at
www.nhtsa.gov/sites/nhtsa.gov/files/documents/12323_tsrpmanual_092216_v3-tag.pdf.
Judicial Outreach Liaisons (JOLs): These are current or former judges experienced in
adjudicating DWI cases. Many JOLs have presided over DWI or drug courts. They share
information and provide education to judges and other court personnel about DWI cases.
NHTSA has developed guidelines for creating State JOLs (Axel et al., 2019).
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3.2 Limits on Diversion and Plea Agreements
Effectiveness: †
† Proven for increasing convictions
Cost: $
Use: Medium
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.
A survey of prosecutors found that of defendants who plead guilty, 67% negotiated a plea
agreement resulting in a reduced penalty (Robertson & Simpson, 2002). 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 DWI
offenses and to have their penalties reduced or eliminated. Offenders pleading guilty to lesser
offenses are of concern to prosecutors, judiciary, and advocacy groups because avoiding the
original DWI charges result in no conviction records for the offenders (Walden & Walden,
2011). However, deferred adjudication provides other sentencing options but keeps convictions
on record temporarily. Thus, in the case of a second offense, sanctions can still be increased as
long as the deferred conviction is still in the record.
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 offender
records (Hedlund & McCartt, 2002; Goodwin et al., 2005; NTSB, 2000; Robertson & Simpson,
2002). Otherwise, offenders who recidivate will receive less severe penalties than if the original
charges had been retained on their records.
Use: As of 2006 there were 33 States that provided for diversion programs in State law or
statewide practice. Local courts and judges in some additional States also offer diversion
programs (NHTSA, 2006c). The Century Council (2008) documented diversion programs
restrictions in several States. As of December 2014 there were 22 States that had laws limiting
plea agreements in certain cases (NHTSA, 2016a).
Effectiveness: The evidence for the effectiveness of diversion programs has been mixed (Voas
& Fisher, 2001). Although a few studies have shown diversion programs reduce recidivism,
others have shown no benefits. However, there is substantial anecdotal evidence that by
eliminating the offenses from the offender records, diversion programs allow repeat offenders to
avoid being identified (Hedlund & McCartt, 2002). Eliminating or establishing limits on
diversion programs should remove a major loophole in the DWI control system.
Another component of the plea agreement is the duration of pre-trial elapse time that offenders
take to accept charges. Prolonged pre-trial procedures involving conviction avoidance and “not
guilty” pleas can result in high court costs. (Ma et al., 2016). In an evaluation performed in
Ontario, first-time alcohol-impaired offenders were compared according to whether they pled
guilty before (early) or after 90 days. The comparisons between groups of offenders in the
“early” and the “after-90 day” plea groups did not demonstrate differences in recidivism.
However, the evaluation showed a reduction in the duration of pre-trial process, reductions in
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court costs, and increases in installation rates of ignition interlocks under the Reduced
Suspension With Ignition Interlock Conduct Review program.
Wagenaar et al. (2000) reviewed 52 studies of plea agreement restrictions applied in combination
with other DWI control policies and found an average reduction of 11% across outcome
measures such as rates of crashes/fatalities/injuries, alcohol-involved crashes, and roadside
BACs. 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 20
years ago (Surla & Koons, 1989; NTSB, 2000). It found that plea agreement restrictions reduced
recidivism in all three study communities.
Costs: Costs for eliminating or limiting diversion programs can be determined by comparing the
per-offender 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 full trials, resulting in significant costs.
Time to implement: Eliminating or limiting diversion programs and restricting plea agreements
statewide may require changes to State's DWI laws. Once legislation is enacted, policies and
practices can be changed within 3 months. Individual prosecutor offices and courts may change
local policies and practices without statewide legislation.
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3.3 Court Monitoring
Effectiveness: †
† Proven for increasing convictions
Cost: $
Use: Low
Time: Short
In court monitoring programs, people observe, track, and report on DWI court or administrative
hearings. 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 Mothers Against Drunk Driving.
Use: As of 2006 court monitoring programs were active in at least 13 States. 4 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.
Costs: The main requirement for a court monitoring program is a reliable supply of monitors.
Monitors typically are unpaid volunteers from advocacy groups like MADD, or similar
organizations. 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.
4
Personal communication with Joey Syner, highway safety specialist, NHTSA.
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3.4 Sanctions
Effectiveness: ✩✩
Cost: Varies
Use: Varies
Time: Varies
This countermeasure involves the standard court sanctions for DWI offenses, which include
driver’s license suspension or revocation, fines, jail, community service, and victim impact
panels. All States use some combination of these sanctions. Some States set mandatory minimum
levels for some sanctions, which often increase for second and subsequent offences.
Effectiveness Concerns: Most of these measures are widely used. Their effectiveness has been
examined in research studies. Despite some positive findings, the balance of evidence regarding
the effectiveness of these countermeasures remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement are available in Appendix A1, Section 3.4.
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4. Deterrence: DWI Offender Treatment, Monitoring, and Control
4.1 Alcohol Problem Assessment and Treatment
Effectiveness:
Cost: Varies
Use: High
Time: Varies
It is widely recognized that many DWI first offenders and most repeat offenders are dependent
on alcohol or have alcohol abuse problems (White & Gasperin, 2007). They likely will continue
to drink and drive unless their alcohol abuse problems are addressed. DWI arrests provide
opportunity to identify offenders with alcohol abuse problems and to refer them to treatment as
appropriate. However, treatment should not be provided in lieu of other sanctions or as part of
plea bargain or diversion programs that eliminates records of DWI offenses (see Chapter 1,
Section 3.2).
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 (2008), Dill and Wells-Parker (2006), Voas and Lacey (2011), NCHRP (Goodwin et al.,
2005, Strategy C4), and Robertson et al. (2008).
Part of the assessment process is determining the likelihood that an offender will continue to
drive impaired. Under a cooperative agreement with NHTSA, the American Probation and
Parole Association developed a screening tool – the Impaired Driving Assessment – to determine
an offender’s risk of recidivism and to help determine the most appropriate and effective
community supervision program to reduce that risk (Lowe, 2014). Pilot testing of the IDA
revealed that probation failure is commonly associated with extensive prior legal histories,
mental health problems, and higher levels of alcohol/drug use.
Use: All States have laws for alcohol treatment for DWI offenders (NHTSA, 2017). However,
the nature of the treatment – and to whom it applies – varies greatly. Some States mandate
treatment, especially for repeat offenders, but usually treatment requirements are at the court’s
discretion.
Effectiveness: Even the best of the many assessment instruments currently in use are subject to
error. Chang et al. (2002) found that none of the assessment instruments studied correctly
identified more than 70% of offenders who were likely to recidivate. However, the assessment
process itself can have therapeutic benefits. See Chapter 1, Section 5.1 on alcohol screening and
brief interventions.
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%.
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, 2008; Dill & Wells-Parker, 2006).
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Costs: Treatment expenses vary widely depending on program type. However, several studies
suggest alcohol abuse treatment can be cost effective (NIDA, 2020; UKATT Research Team,
2005). For example, a study from California found every dollar spent on treatment potentially
saved taxpayers up to $7 (Gerstein et al., 1994). Offenders can bear some of the costs of both
assessment and treatment, though provisions must be made for indigent offenders.
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: There are many effective treatment options for alcohol abuse
problems including cognitive-behavioral therapy, group counseling, pharmacological
interventions (e.g., naltrexone, acamprosate), and brief interventions (see Chapter 1,
Section 5.1). It is important that treatment be tailored to the individual. Also, combining
therapies can result in better outcomes because DWI offenders usually have a range of
diverse and complex problems (Dill & Wells-Parker, 2006).
• DWI Courts: Alcohol problem assessment and treatment are integral parts of DWI
courts. In addition, DWI courts can sanction offenders who fail to complete assigned
treatment programs. For more information, see Chapter 1, Section 3.1.
• Other mental health issues: Alcohol assessment and treatment provide opportunity to
address other problems that may underlie or contribute to problems with alcohol. One
study found that more than 60% of DWI repeat offenders have other psychiatric disorders
in addition to alcohol-related problems, such as post-traumatic stress disorder, anxiety
disorders, and bipolar disorder (Shaffer et al., 2007). This is substantially higher than the
rate of about 30% for the general population.
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4.2 Alcohol Ignition Interlocks
Cost: $$
Effectiveness: †
† Proven for reducing recidivism while on the vehicle
Use: Medium
Time: Medium
An alcohol ignition interlock prevents a vehicle from starting unless the driver provides a breath
sample with a BrAC 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 vehicles to be started by sober drivers, but not by
alcohol-impaired drivers. A post-start retest requires the driver to remain sober while driving. A
data recorder logs driver BrAC at each test and can be used by probation officers to monitor
offender drinking and driving behavior. Marques and Voas (2010) provide an overview of
interlock use, effectiveness, operational considerations, and program management issues.
Marques (2005), Beirness and Robertson (2005), and Robertson et al. (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), Neuman et al. (2003, Strategy
C2), and proceedings from the 11th Annual International Alcohol Interlock Symposium
(Robertson et al., 2011).
NHTSA offers an ignition interlock toolkit to assist policymakers, highway safety professionals,
and advocates (Mayer, 2014). In addition, NHTSA has published a report, Case Studies of
Ignition Interlock Programs, featuring State ignition interlock programs (Fieldler et al., 2012)
and an Evaluation of State Ignition Interlock Programs: Interlock Use Analysis From 28 States
2006-2011 (Casanova-Powell et al., 2015). Finally, NHTSA has created model guidelines to
assist States in developing and implementing highly-effective interlock programs based on
successful practices in the United States and other countries (NHTSA, 2013b).
Use: All 50 States and the District of Columbia allow interlocks to be used for some DWI
offenders (NHTSA, 2013a). In 30 States, the District of Columbia, and 4 California counties
interlocks are mandatory for all convicted offenders, including first offenders (IIHS, 2017).
Indiana, Montana, North Dakota, and South Dakota have no mandatory interlock requirements.
Despite widespread laws, a relatively small percentage of eligible offenders have an interlock
installed. However, interlock use has increased substantially over the past 10 years, from 146,000
in 2008 to 348,476 in 2017 (based on information supplied by interlock manufacturers;
Robertson et al., 2018). Given the roughly 1.4 million arrests in the United States each year for
DWI, the ratio of installed interlocks to arrests is approximately 1 in 5. Use of interlocks is
substantially higher when they are required as a prerequisite to license reinstatement. For
example, among DWI offenders in Florida who were subject to the State’s interlock requirement,
93% installed interlocks once they qualified for reinstatement (Voas, Tippetts, Fisher, & Grosz,
2010). Similarly, an examination of effects of the incremental expansion of interlock laws in
Washington State to cover all DUI offences found corresponding improvements in installation
rates and recidivism with the implementation of each legislative change (McCartt et al., 2018).
Use of interlocks is also higher when interlocks are offered as alternatives to home confinement
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via electronic monitoring (Roth et al., 2009). Through a combination of these measures, New
Mexico installed interlocks in the vehicles of half of all convicted DWI offenders in 2007 – the
highest level of penetration of any State (Marques et al., 2010). Finally, use of interlocks in a
pilot program in California was higher in the four pilot counties that required interlocks for DWI
offenders (42.4%) than in non-pilot counties (4.3%) (Chapman et al., 2015). The authors
concluded that the main reason for this significant increase was due to the fact that interlock
installation was mandatory in pilot counties, while interlock installation was optional in non-pilot
counties.
Effectiveness: A review of 15 studies of interlock effectiveness found that offenders who had
interlocks installed in their vehicles had arrest recidivism rates that were 75% lower than drivers
who did not have interlocks installed (Elder et al., 2011; see also GAO, 2014). Findings were
similar for first offenders and repeat offenders. After interlocks were removed, however, the
effects largely disappeared, with interlock and comparison drivers having similar recidivism
rates. Similarly, a study conducted in California found that the strong and reliable reduction in
recidivism diminished over time for DWI offenders that had one or two prior DWI convictions
(California DMV, 2018).
Studies that have examined the effects of interlocks on crashes, indicate that alcohol-related
crashes decrease while interlocks are installed in vehicles (Elder et al., 2011; Kaufman & Wiebe,
2016; McGinty et al., 2017; Vanlaar, Hing & Robertson, 2017). One study that evaluated the
effects of State interlock laws on alcohol-involved fatal crashes found that laws requiring
interlocks for all offenders were associated with a 7% reduction in crashes with BACs > .08 g/dL
and an 8% reduction in crashes with BACs ≥ .15 g/dL (McGinty et al., 2016; see also Kaufman
& Wiebe, 2016). The benefits were greater in States with mandatory laws than those with partial
laws.
One limitation of interlock research is that study participants often are not randomly assigned to
interlock or no-interlock groups, so there may be important pre-existing differences between
groups (GAO, 2014). However, research suggests that interlocks are a highly effective method
for preventing alcohol-impaired driving – and possibly crashes – while they are installed.
While they are installed, interlocks stop impaired motorists from driving, but unless motorists
change their attitudes and behaviors, they may simply continue driving impaired once the
interlocks are removed (Voas et al., 2016). Florida passed legislation in 2008 to address this
problem by mandating treatment for DUI offenders in interlock programs who commit 4 or more
interlock violations. These offenders are required to attend 8 to 12 weeks of treatment from
certified substance abuse counselors/programs, which includes individualized treatment plans
involving individual or group therapy. One study examined the effectiveness of combining
mandated treatment with interlocks on recidivism among interlock offenders with 3 or more
interlock violations. Compared to a control group that had interlocks but only 1 or 2 interlock
violations, those with 3 violations that received treatment showed a significant 32% reduction in
recidivism after the interlocks were removed. This improvement was not significantly different
for women than for men, or for Hispanics and Blacks than for Whites. However, the additional
treatment was much less effective for drivers under 25.
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Costs: A 2012 estimate collected from States lists interlock device rental costs from $12 to $90
per month. Device installation and removal fees range from $70 to $150. In addition, other costs
such as device recalibration and monitoring fees can add $30 to $150 each month (Fieldler,
Brittle, & Stafford, 2012). Offenders usually pay these costs; however, some States such as
Illinois and New Mexico have indigent funds and unaffordability criteria to reduce the costs for
low-income offenders.
Time to implement: Interlock programs may require enabling legislation. Once authorized,
interlock programs require 4 to 6 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 lengthy license suspension periods, offenders who delay license
reinstatement, judges who lack confidence in the interlock technology or who fail to
enforce “mandatory” interlock requirements, interlock costs, and localities that lack
enough interlock providers. In an effort to increase the number of offenders who drive
interlock-equipped vehicles, some States have made the alternatives to interlocks more
undesirable. For example, pilot programs in Indiana and New Mexico found that roughly
two-thirds of offenders chose to have interlocks installed when the alternative was house
arrest with electronic alcohol monitoring (Marques et al., 2010; Voas et al., 2001). Other
States allow offenders to shorten (or eliminate) the license suspension period if they are
willing to operate an interlock-installed vehicle. For example, Colorado reduced the
license suspension period from 1 year to 1 month for offenders who apply for interlocks
(NCSL, 2014). Arkansas, Maine, Mississippi, and Nebraska passed similar laws. An
evaluation of a similar law in Ontario found that a reduced suspension program increased
installation rates from 45% to 70% among eligible first-time offenders (Ma et al., 2016).
For a discussion of barriers to interlock use, see Beirness and Marques (2004), Beirness et
al. (2008), Beirness and Robertson (2005), and Neuman et al. (2003, Strategy C2). For a
discussion on how States have successfully overcome obstacles encountered with
interlock programs, see Casanova-Powell et al. (2015).
• Compliance with interlocks: Some offenders have relatively high rates of breath test
failures and other violations, typically near the beginning of their participation in interlock programs (Vanlaar et al., 2013; Vanlaar et al., 2010). Offenders become familiar
with how the equipment operates, and in some cases, may seek ways to circumvent the
interlocks. Presently, few jurisdictions use the compliance data collected by interlocks to
identify offenders who may be at high risk for recidivism. The data could also be used to
require an extension of the interlock period for those with poor compliance, or even to
inform treatment options (Marques et al., 2010). To improve compliance with interlocks,
it is important to closely monitor offenders during their participation in interlock programs. One study found that offenders who were closely monitored (e.g., their data were
reviewed weekly and they received letters documenting their progress) had fewer initial
breath test failures and other indicators of non-compliance than offenders who received
standard monitoring through the State licensing office (Zador et al., 2011). Similarly, an
in-depth study of three State interlock programs found non-compliance was highest in the
State with less consistent monitoring practices (California) than in the two States (Florida
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Chapter 1. Alcohol- and Drug-Impaired Driving
•
•
•
•
and Texas) with stronger monitoring practices (Vanlaar et al., 2013). Monitoring the
number of miles driven on interlock vehicles can prevent offenders from circumventing
the devices by driving other vehicles. Some States set vehicle usage criteria for the number of miles the offender will likely be driving per week while the interlock is installed. If
the mileage on the interlock-equipped vehicle is unexpectedly low, further sanctions can
be put in place (Mayer, 2014).
First-time offenders: There are special issues concerning interlocks and first-time
offenders. Historically, interlock programs were for repeat offenders and voluntary for
first-time offenders (Robertson et al., 2010). In many jurisdictions, first-time offenders
are not monitored by the court system. Consequently, it can be difficult to respond to
violations and to ensure that first-time offenders participate, install the devices, and
complete the interlock program. Despite challenges in closely monitoring first-time
offenders, evidence suggests interlocks effectively reduce recidivism among this group
while the interlock is installed (Marques et al., 2010; McCartt et al., 2012; McCartt et al.,
2018). For more information about issues in implementing interlock programs with firsttime offenders, see Robertson et al. (2010).
Rural areas: For offenders living in rural areas, access to interlock service providers may
be problematic (Cheesman et al., 2014). Interlock service providers may be limited or
non-existent in rural jurisdictions, requiring offenders to drive long distances to get
interlocks installed or serviced. To improve the availability of interlocks, States can
require vendors to provide service to rural areas as prerequisites for obtaining contracts
with the State (Mayer, 2014).
Public support: There is strong support among the general public for ignition interlocks.
In two national surveys, approximately 80% of respondents approved of requiring
interlocks in the vehicles of convicted DWI offenders, including first offenders
(AAAFTS, 2014; McCartt, Wells, & Teoh, 2010; see also Bishop et al., 2017; Downs et
al., 2017). Moreover, about 65% of respondents favored having alcohol detection
technology in all new vehicles. The general public also believes strongly that interlocks
work. In a NHTSA survey, respondents were asked about the effectiveness of eight
strategies to reduce or prevent impaired driving. Interlocks ranked highest in the
percentage who rated the strategy “very effective” (63%) (Moulton et al., 2010).
General Deterrence: The implementation of ignition interlock programs targeting DWI
offenders does not seem to produce general deterrence effects among the broader driving
population. In particular, an evaluation of general deterrence was conducted in California
by comparing recidivism rates in four counties that participated in a pilot program
involving mandatory interlock installation to recidivism rates in all other California
counties (Chapman et al., 2015). The study found that mandatory interlock installation
was ineffective at reducing county-wide DWI recidivism below those of the comparison
counties. This lack of difference in conviction rates held for drivers with one, two, or
three-or-more prior DWI convictions. Note that this study did not track local advertising
of the program in the four pilot counties, so it is unknown if the absence of a general
deterrence effect was affected by the level of outreach effort.
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4.3 Vehicle and License Plate Sanctions
Effectiveness: †
† Proven for reducing recidivism
Cost: Varies
Use: Medium
Time: Short
Many States have implemented sanctions affecting DWI offender license plates or vehicles.
These sanctions are intended to prevent the offender from driving the vehicle while the sanctions
are in effect, and also to 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 offenders’ vehicles but permit
law enforcement to stop the vehicles to verify that the drivers are properly licensed.
• License plate impoundment. Officers seize and impound or destroy the license plates.
• Vehicle immobilization. Vehicles are immobilized on the offenders’ property with
“boots” or “clubs.”
• Vehicle impoundment. Vehicles are stored in public impound lots.
• Vehicle forfeiture. Vehicles are confiscated and sold at auction.
NHTSA (2008d), DeYoung (2013b), and Voas et al. (2004) give an overview of vehicle and
license plate sanctions and are the basic references for the information provided below. See also
Brunson and Knighten (2005, Practice #4), and Neuman et al. (2003, Strategies B1, B2, and C1).
All vehicle and license plate sanctions require at least several months to implement.
Use, effectiveness, and costs:
• Special license plates are permitted in Georgia, Iowa, Minnesota, Ohio, and Oregon
(NCSL, 2016a). Ohio requires special plates for all first-time offenders with BACs of .17
g/dL and above and for all repeat offenders. Effectiveness and costs have not been
evaluated in any State. In the 1990s, Oregon and Washington adopted versions of this
strategy by allowing arresting officers to place “zebra stripe” stickers on the license
plates at the time of arrest. Oregon’s program effectively reduced DWI recidivism but
Washington’s did not. Use has been discontinued in both States (Neuman et al., 2003,
Strategy B1; NHTSA, 2008d).
• License plate impoundment is used in at least 9 States (NHTSA, 2016a). In Minnesota
license plate impoundment administered by arresting officers was shown to reduce both
recidivism and driving with suspended licenses, especially among the youngest offenders
(Leaf & Preusser, 2011; Rogers, 1995). Since plate impoundment does not involve the
courts, it occurs quickly, consistently, and efficiently (Neuman et al., 2003, Strategy B2;
NHTSA, 2008d; NTSB, 2000).
• Laws in 12 States allow vehicle immobilization (NHTSA, 2017). An evaluation in Ohio
found that immobilization reduced recidivism (Voas et al., 1998). Costs are minimal
compared to impoundment or forfeiture (Neuman et al., 2003, Strategy C1; NTSB, 2000).
• Thirteen States and the District of Columbia allow for vehicle impoundment and some
use it extensively (GHSA, 2018a). Vehicle impoundment reduces recidivism while
vehicles are in custody and to a lesser extent after vehicles have been released (Byrne,
Ma, & Elzohairy, 2016). The strategy is costly, and owners may abandon low-value
vehicles rather than pay substantial storage costs (Neuman et al., 2003, Strategy C1;
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•
NTSB, 2000). Towing fees are often considerable, and storage fees can range from $18 to
$95 per day (City of Columbus, 2019; San Jose Police Department, 2018). In California
impoundment programs are administered largely by towing contractors and supported by
fees paid when drivers reclaim their vehicles or by the sale of unclaimed vehicles. An
evaluation of California’s impoundment law found both first-time and repeat offenders
whose vehicles were impounded had fewer subsequent arrests for driving with suspended
licenses and fewer crashes (DeYoung, 1997).
Twenty-nine States have provisions allowing vehicle forfeiture for impaired driving
and/or driving with a suspended license (NHTSA, 2016a); however, there is little
information on its use or effectiveness. Vehicle forfeiture programs must pay storage
costs until the vehicles are sold or otherwise disposed (Neuman et al., 2003, Strategy C1;
NTSB, 2000).
Time to implement: Vehicle and license plate sanctions can be implemented as soon as
appropriate legislation is enacted.
Other issues:
• To whom are vehicle sanctions applied: Most vehicle sanctions have been applied to
repeat offenders rather than first offenders, although some States also apply vehicle
sanctions to high-BAC (.15 g/dL or higher) first offenders. If someone other than the
offender owns the vehicle, a State should consider requiring the vehicle owner to sign an
affidavit stating the owner will not allow the offender to drive the vehicle while the
suspension is in effect (NHTSA, 2008d).
• Administrative issues: All license plate and vehicle sanctions require administrative
structures to process the license plates or vehicles. Laws should permit officers to
impound vehicles or license plates at the time of arrest so offenders do not have the
opportunity to transfer vehicle ownership (NHTSA, 2008d).
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4.4 DWI Offender Monitoring
Effectiveness: †
† Proven for reducing recidivism
Cost: $$$
Use: Unknown
Time: Varies
The most successful methods for controlling convicted DWI offenders and reducing recidivism
have the common feature that they monitor offenders closely. Note that while these methods
monitor sobriety, they do not actually prevent someone from drinking or driving the vehicle.
Close monitoring can be accomplished at levels and in ways, including formal intensive
supervision programs, home confinement with electronic monitoring, and dedicated detention
facilities. South Dakota’s 24/7 Sobriety Project is one example of an intensive supervision
program. Participants are usually offenders who must not use alcohol or drugs as conditions of
remaining in the community and avoiding incarceration. The program includes twice-daily
alcohol breath testing, transdermal devices that monitor alcohol consumption, and random drug
testing. If offenders test positive for alcohol or drugs, they are taken into custody and appear
before a judge within 24 hours. The goal of the program is to ensure that sanctions are swift and
certain. South Dakota’s 24/7 Sobriety Project has been adopted in Idaho, Montana, North
Dakota, Washington, and Wyoming.
For overviews of DWI offender monitoring and further references, see Century Council (2008)
and Goodwin et al. (2005, Strategy D4). See also Wiliszowski et al. (2011) for more information
about intensive supervision programs and descriptions of eight different programs, and Fisher et
al. (2013) for additional details about South Dakota’s 24/7 Sobriety Project. Information about
transdermal alcohol monitoring, including six case studies, can be found in McKnight et al.
(2012). DWI courts and alcohol ignition interlocks discussed in this chapter’s Sections 3.1 and
4.2, also assist in monitoring offenders closely. Finally, guidelines for community supervision of
DWI offenders are available from NHTSA (Dunlap et al., 2008).
Use: Little available data shows how extensively these programs are used. The most commonly
used transdermal device is SCRAM (secure continuous remote alcohol monitoring). In 2011
approximately 50,000 people were monitored with SCRAM devices, roughly two-thirds of whom
were DWI offenders (Fell & McKnight, 2013). In total, 49 States have used SCRAMs with at
least some offenders, and 34 States have used SCRAMs with more than 1,000 offenders each
(Fell & McKnight, 2013). The number of States using other types monitoring programs and
devices is unknown.
Effectiveness: Intensive supervision, home confinement with electronic monitoring, and
dedicated detention facilities all have been evaluated in individual settings and show substantial
reductions in DWI recidivism. Studies examining the effectiveness of the 24/7 sobriety program
in North and South Dakota have found reductions in recidivism for DWI convictions (Kilmer et
al., 2013; Kubas et al., 2015; Loudenburg et al., 2010). South Dakota’s implementation of the
24/7 sobriety program resulted in a 12% decrease in repeat DWI arrests, and a 4% decrease in
collisions by participants (Kilmer et al., 2013). North Dakota implementation resulted in a
reduced number of crashes, non-DUI-related citations, and impaired driving arrests, while longer
sentencing periods (1 year versus 60 days) appeared to have a stronger deterrent effect (Kubas et
al., 2016). Continued enrollment in the North Dakota program was associated with significant
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decreases in recidivism after 60 days (29.7%), 1 year (34.2%), and 2 years (39.5%) (Kubas et al.,
2017). In other studies recidivism was reduced by half in intensive supervision programs in
Oregon (Lapham et al., 2006) and Connecticut (Barta et al., 2017), and by one-third in an
electronic monitoring program in Los Angeles County (Brunson & Knighten, 2005; Jones et al.,
1996). A dedicated detention facility in Baltimore County had a 4% recidivism rate 1 year after
program completion, compared to a normal recidivism rate of 35% for offenders (Century
Council, 2008).
A study in Nebraska and Wisconsin examined effectiveness of intensive supervision programs
that used SCRAM to provide continuous monitoring of sobriety for drivers with alcohol-related
offenses (Tison et al., 2015). Offenders assigned to SCRAM were matched to a control group of
comparable offenders that were not assigned to SCRAM. Measured as re-arrests for an alcohol
offense during the first 2 years following arrest, recidivism occurred at a slightly higher rate in
the SCRAM group relative to the control group in both States (7.6% versus 6.2% in Wisconsin;
9.8% versus 7.7% in Nebraska, neither of which were statistically significant). However, a significant positive outcome was that there was virtually no recidivism while on SCRAM, and the
SCRAM offenders who did recidivate remained compliant longer than offenders in the control
group (360 versus 271 days in Wisconsin; 458 versus 333 days in Nebraska). The authors noted
that the SCRAM population may represent a particularly high-risk group of offenders, thus
higher long-term recidivism was expected.
Costs: All close monitoring programs are more expensive than the standard high-caseload and
low-contact probation but less expensive than jail. Offenders in 24/7 programs typically pay $4
per day for breath testing, while electronic monitoring fees typically range from $5 to $10 per
day (Fell & McKnight, 2013). SCRAM Systems’ 24/7 Sobriety Program Implementation Guide
suggests a $2 fee per day for on-site breath testing and a $6 fee per day for remote electronic
alcohol monitoring for participants (SCRAM Systems, 2018). One goal of 24/7 programs is to be
self-sufficient (i.e., entirely funded by offenders). 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, 2008). Dedicated detention facility costs can approach jail costs: $37 per day
in the Baltimore County dedicated detention facility compared to $45 per day for jail. Offenders
can bear some program costs, especially for the less expensive alternatives.
Time to implement: All close monitoring programs require many months to plan and
implement. Dedicated facilities require years to plan and build.
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4.5 Lower BAC Limits for Repeat Offenders
Effectiveness:
Cost: $
Use: Low
Time: Short
All States have illegal per se BAC limits of .08 g/dL with the exception of Utah, which enacted a
.05 g/dL law that went into effect at the end of 2018. All States also have BAC limits of .02 g/dL
or lower for drivers under 21. These laws reinforce minimum drinking age laws prohibiting
people under 21 from purchasing or possessing alcohol in public in all States. As of November
2016, Nebraska, North Carolina, Vermont, and Virginia set BAC limits of .02 or .04 g/dL for
people convicted of DWI to emphasize they should not drive after drinking even moderate
amounts (NCSL, 2016b).
Use: Four States have lowered BAC limits for people convicted of DWI (NCSL, 2016b).
Effectiveness: In 1988 Maine established a .05 g/dL BAC limit for 1 year after a first DWI
offense and for 10 years after a subsequent offense. Violators received administrative license
suspensions. In 1995 this BAC limit was lowered to .00 g/dL. Hingson et al. (1998) evaluated the
1988 law and concluded that it reduced the proportion of fatal crashes that involved repeat
offender drivers by 25%. Jones and Rodriguez-Iglesias (2004) evaluated the overall effects of
both laws, using data from 1988 to 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 g/dL and higher.
Costs: Implementation and operation costs are minimal. Jones and Rodriguez-Iglesias (2004)
found that Maine’s laws had little or no cost 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.
Other issues:
• Lower BAC limits for all drivers: Laboratory studies show impairment in driving
ability begins at levels below .08 g/dL BAC. Consequently, many countries and some
U.S. jurisdictions impose penalties for all drivers who have BACs of .05 g/dL or higher,
not just repeat offenders (Colorado has a driving while ability impaired law and West
Virginia may revoke your license at a BAC above .05g/dL). Evaluations from other
countries suggest lower BAC limits reduce alcohol-impaired crashes (NHTSA, 2003b).
For example, a law introduced in British Columbia, Canada, in 2010 included an
administrative 3-day license suspension and possible vehicle impoundment for drivers
with BACs from .05 to .08 g/dL. The law was intended to maximize deterrence by
increasing the certainty and swiftness of sanctions. In the year after the law took effect,
there was a 40% decrease in alcohol-related fatal crashes (Macdonald et al., 2013).
Moreover, roadside surveys revealed a 44% decrease in drivers with BACs of .05 g/dL or
higher, and a 59% decrease in drivers with BACs over .08 g/dL (Beirness & Beasley,
2014). In sum, administrative penalties beginning at .05 g/dL BAC appear to increase
deterrence among the general population without creating additional burdens on the court
system. A majority (63%) of drivers in the United States support lowering the BAC limit
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for all drivers from .08 to .05 g/dL (AAAFTS, 2014). The National Transportation Safety
Board (NTSB) has recommended a BAC of .05 g/dL for all drivers (NTSB, 2013).
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5. Prevention, Intervention, Communications, and Outreach
Prevention and intervention.
Prevention and intervention strategies seek to reduce drinking, or to prevent driving by people
who have been drinking. Prevention and intervention work through laws, policies, and programs
that:
• control hours, locations, and promotions of alcohol sales;
• 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 years old.
These are discussed in the Youth section that follows, with further discussion of one-star and
two-star countermeasures included in Appendix A1.
Many prevention and intervention measures fall under the authority of a State’s alcohol control
agency rather than the SHSO. However, the SHSO can be a critical partner in many prevention
and intervention. Only countermeasures directly associated with drinking and driving are
discussed in this section. For information regarding more general countermeasures directed at
alcohol, see Alcohol Epidemiology Program (2000), Grube and Stewart (2004), National
Academies of Sciences, Engineering, and Medicine (2018), and Toomey and Wagenaar (1999).
Communications and outreach.
Communications and outreach strategies seek to inform the public of the dangers of driving
while impaired by alcohol or drugs and to promote positive social norms of not driving while
impaired. As with prevention and intervention, education through communications and outreach
strategies is especially important for youth under 21 years old. Education may occur through
formal classroom settings, social media, news media, paid advertisements and PSAs, and a wide
variety of other communication channels such as posters, billboards, web banners, and the like.
Communication and outreach strategies are critical parts of many deterrence and prevention
strategies. This section discusses only stand-alone communication and outreach
countermeasures.
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5.1 Alcohol Screening and Brief Intervention
Effectiveness:
Cost: $$
Use: Medium
Time: Short
Alcohol screening uses a few questions to estimate the level and severity of alcohol use and to
determine whether a person may be at risk of alcohol misuse or dependence (SAMHSA, 2015).
Brief interventions are short, one-time encounters with people who may be at risk of alcoholrelated injuries or other health problems. Brief interventions focus on awareness of the problem
and motivation toward behavior change. The combination of alcohol screening and brief
intervention is most commonly used with injured patients in hospital emergency departments and
trauma centers. Patients are screened for alcohol abuse problems and, if appropriate, are
counseled on how alcohol can affect injury risk and overall health. Patients also may be referred
to follow-up alcohol treatment programs. A brief intervention takes advantage of a “teachable
moment” when a patient can be shown that alcohol use can have serious health consequences.
Dill et al. (2004) and Higgins-Biddle and Dilonardo (2013) summarize alcohol screening and
brief intervention studies. NHTSA and the American Public Health Association (APHA) have
also produced an alcohol and brief intervention guide for public health practitioners (Guard &
Rosenblum, 2008). Finally, NHTSA offers a toolkit to help conduct screening and brief
intervention on college campuses (Quinn-Zobeck, 2007).
Use: About half of all trauma centers screen patients for alcohol abuse problems and one-third
use some form of brief intervention (Goodwin et al., 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 (Goodwin et al., 2005, Strategy A4). Brief interventions
have also been used to reduce DWI among young adults and adolescents (Tanner-Smith &
Lipsey, 2015).
Effectiveness: Many studies show that alcohol screening and brief interventions in medical
facilities can reduce drinking and self-reported driving after drinking (D’Onofrio & 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 relevant outcomes, such as personal
alcohol use and motor vehicle collision injuries. These studies generally found that alcohol
screening and brief interventions reduced both drinking and alcohol-related traffic crashes and
injuries. Considering the variety of brief intervention implementations based on the clinician’s
expertise and time constraints (they can be anywhere from 5 to 30 minutes, and use techniques
such as motivational interviewing, brief negotiated interviewing, and/or cognitive behavioral
therapy), brief interventions are more effective with some populations (National Academies of
Sciences, Engineering, and Medicine, 2018). For example, patients with alcohol use disorders
may need to be referred to increasingly intensive treatment plans (National Academies of
Sciences, Engineering, and Medicine, 2018). In their 2015 meta-analysis Steinka-Fry et al.
examined the effectiveness of brief interventions in reducing driving after drinking among young
people 11 to 25 years old. Results based on 12 studies reported in 30 documents reported brief
interventions were associated with modest but positive reductions in driving after drinking and
the related consequences among young people. They also suggest that brief interventions may
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constitute cost-effective preventative approaches for addressing drinking and driving, which is
widespread in young age groups.
However, a study of adult emergency department patients who screened positive for risky
alcohol use did not find any impact of brief interventions (Baird et al., 2017). A limitation to the
intervention tool used in this study was that none of the patients were screened for alcohol use
disorder or were referred to treatment, which is often an integral part of the brief intervention
process (National Academies of Sciences, Engineering, and Medicine, 2018). Participant
outcomes were measured by self-reported drinking and driving behaviors (based on the 6 items
from the Impaired Driving Scale) in follow-up interviews. One group of patients was
administered a brief intervention program (3 telephone counseling intervention sessions based on
the principles of motivational interviewing; n = 204) and the control group was given a placebo
program on fire and burn home safety (n = 203). Neither participant groups’ pre-treatment selfreported readiness to change, nor the mechanism of injury (motor vehicle crash versus other)
affected self-reported outcomes (Baird et al., 2017).
Costs: Alcohol screening and brief interventions in medical facilities require people with special
training to administer the intervention. However, several studies show intervention is cost
effective and substantially reduces future health care costs such as hospital and emergency room
visits (Guard & Rosenblum, 2008).
Time to implement: Procedures for alcohol screening and brief interventions are readily
available from APHA (Guard & Rosenblum, 2008), the American College of Emergency
Physicians (ACEP, 2006), and the National Institute on Alcohol Abuse and Alcoholism
(NIAAA, 2005), and can be implemented as soon as staff is identified and trained.
Other issues:
• Alcohol exclusion laws: An alcohol exclusion law (Uniform Accident and Sickness
Policy Provision Law or UPPL) allows insurance companies to deny payment to hospitals
for treating patients injured while impaired by alcohol or a non-prescription drug
(NHTSA, 2008). These laws may cause hospitals to be reluctant to determine the BACs
of injured drivers and may limit the use of alcohol screening (although screening does not
measure the patient's BAC). As of April 2018 alcohol exclusion laws were in effect in 37
States (GHSA, 2018a), though the extent to which insurance companies deny payment is,
at best, sporadic.
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5.2 Mass Media Campaigns
Effectiveness:
Cost: $$$
Use: High
Time: Medium
A mass media campaign consists of intensive communication and outreach regarding alcoholimpaired driving that use radio, television, print, social, 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 deterrence or prevention measures such as changes
in a State’s DWI laws, or checkpoints or other highly visible enforcement. Other campaigns
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 many other ways. An effective campaign identifies a
specific target audience and communication goal and develops messages and delivery methods
that are appropriate to – and effective for – the audience and goal (Williams, 2007).
Use: Most States use some form of alcohol-impaired-driving mass media campaign every year.
These are essential to 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, wellfunded, well-executed, achieved high levels of audience exposure (usually by using paid
advertising), had high-quality messages that were pre-tested for effectiveness, and were
conducted in conjunction with other impaired-driving activities (usually enforcement). These
mass media campaigns were associated with a 13% reduction in alcohol-related crashes. In
general, mass media outreach works best as part of a multifaceted campaign that includes HVE
(see Sections 2.1, 2.2 in this chapter). 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.
Broad campaigns may not be as effective as single-issue campaigns. The “More Cops More
Stops” campaign covered impaired driving, seatbelt use, and speeding enforcement. It was
deployed from November 2011 to August 2013 in Oklahoma and Tennessee both as standalone
campaign, and in conjunction with specific enforcement campaigns such as Click It or Ticket and
Drive Sober or Get Pulled Over. The campaign evaluation used driver awareness surveys in
program and control regions in addition to roadside BrAC data. The evaluation found that
although there was a small but significant decline in the percentage of drivers with positive
BrACs in the two tested program areas, overall there was not enough evidence to suggest that the
More Cops More Stops campaign added to the impact of ongoing campaigns. Instead, the
complex focus of the campaign may have exacerbated “enforcement fatigue” (Nichols et al.,
2016).
Costs: High-quality and effective mass media campaigns are expensive. Funds are needed for
market research, design, pre-testing, and production. Paid advertising expenses depend on the
media chosen and the media markets needed to reach the target audience.
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Time to implement: A high-quality mass media campaign will require at least 6 months to
research, plan, produce, and distribute.
Other issues:
• Campaign quality: Poor-quality or stand-alone campaigns that are not tied to program
activities are unlikely to be effective. Similarly, although public service announcements
(PSAs) are relatively inexpensive ways to deliver messages about impaired driving, they
are likely to be aired infrequently, reach small audiences, miss the target audience, and
have little or no effect. To be successful, mass media campaigns must be carefully pretested, communicate information not previously known, be long-term, and have
substantial funding (Williams, 2007).
• Comprehensive media strategy: Mass media campaigns should be planned as part of an
overall communications and outreach strategy that supports specific impaired-driving
activities, such as enforcement.
• Fear appeals: Media campaigns commonly provoke fear or anxiety by showing the
severe consequences of impaired driving -- injuries, deaths, grieving families. Evidence
suggests this approach can potentially increase undesirable behaviors (Wundersitz et al.,
2010). For this reason, appeals to fear should be used with caution, and other types of
approaches should be considered first.
• Social norms campaigns: Social norms marketing campaigns are a more recent
approach to reducing alcohol-related crashes. They are built on the premise that a
person’s behavior is influenced by perceptions of how most people behave. A Montana
study demonstrated the potential effectiveness of this approach in surveys of young adults
21 to 34 years old that revealed only 20% had driven in the previous month after
consuming two or more alcoholic drinks. However, more than 90% thought their peers
had done so (Linkenbach & Perkins, 2005). Based on this finding, a paid media campaign
was developed with the social norming message, “MOST Montana Young Adults (4 out
of 5) Don’t Drink and Drive.” By the end of the campaign, there was a 13.7% difference
in young adults who reported driving after drinking relative to a comparison community.
During the campaign, reported drunk driving among young adults in target counties
decreased from 22.9% to 20.9%, while the percentage in non-targeted counties increased
from 16.9% to 28.6%.
• Social media: NHTSA and most States have begun using social networking sites to reach
the general public with messages about alcohol-impaired driving. Although sites such as
Facebook, Twitter, Instagram, Snapchat, and YouTube can effectively and inexpensively
reach large numbers of people, there are no evaluations of alcohol-impaired-driving
campaigns that use this approach. Similar to mass media campaigns and other types of
communication described above, social media is unlikely to be as effective as a standalone strategy; however, it may be useful combined with other communications to
support specific impaired-driving activities. A recent survey of the role and use of social
media in traffic safety messaging recommended practices to incorporate social media in
outreach efforts (Sack et al., 2019). These include reusing the same messages across
traditional and social media platforms, using images and videos strategically, timing the
messaging and content appropriately, and collaborating with other agencies to maximize
visibility.
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5.3 Responsible Beverage Service
Effectiveness: ✩✩
Cost: $$
Use: Medium
Time: Medium
This countermeasure covers alcohol sales policies and practices that prevent or discourage
restaurant/bar patrons from drinking to excess or from driving while impaired by alcohol. It
includes server training programs and management policies.
Effectiveness Concerns: This countermeasure is widely used. Its effectiveness has been
examined in several research studies; however, server training programs are the only segment of
responsible beverage service for adults that has been adequately documented and evaluated.
Research suggests that server training programs can be effective if they involve intensive, highquality, face-to-face server training accompanied by strong and active management support
(Shults et al. 2001). When server training programs are not intensive and are not supported, they
are unlikely to result in greater refusals of service to intoxicated patrons. Despite these positive
research findings, the balance of evidence regarding countermeasure effectiveness remains
inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement are available in Appendix A1, Section 5.3.
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5.4 Alternative Transportation
Effectiveness:
Cost: $$
Use: Unknown
Time: Short
Alternative transportation describes methods people can use to get to and from places where they
drink without having to drive. They supplement normal public transportation provided by
subways, buses, and other means.
Ride service options may include for-profit and nonprofit safe rides (Barrett et al., 2017;
Vanlaar, Hing, Powell, & Robertson, 2017). For-profit safe rides include transportation network
companies that are on-demand and may be accessed through a mobile application. Nonprofit safe
rides are free or charge minimal fees and often operate in specific regions -- near university
campuses -- or at specific times such as weekends and holidays when impaired crashes occur at
higher rates.
Ride services transport drinkers home from, and sometimes to and between, drinking
establishments using taxis, private cars, buses, tow trucks, and even police cars. Some services
drive the drinker’s car home along with the drinker. Ride service programs are relatively
inexpensive and easy for communities to implement. Although it can be difficult to measure their
effectiveness, they can play a role in a community’s efforts to reduce drinking and driving. For
an overview, see Barrett et al. (2017), Decina et al. (2009), and Neuman et al. (2003, Strategy
E1).
Use: As of April 2019 the National Directory of Designated Driver Services website listed 1,042
participating transportation providers in 787 different Counties in 41 States.
In a Traffic Injury Research Foundation multi-year survey of randomly selected American
drivers 21 and older, 44% to 47% 5 said they were familiar with safe ride home programs
(Vanlaar, Hing, Powell, & Robertson, 2017). Of these, 5% to 8% reported they always used such
programs, and 4% said they sometimes used them. On the other hand, 87% to 91% of
respondents stated they had never used safe rides programs. In the second round of data
collection, 19% of respondents stated that they had used a for-profit ride share service such as
Lyft or Uber after drinking. Women were more likely to rely on designated drivers than ride
share services or public transportation than men. Safe-ride-home programs were used more by
younger drivers than older drivers and more in urban areas than rural. Ride service programs
vary considerably by region; and some in operation in North America are outlined in Barrett et
al. (2017). Additional information is available on the NHTSA Buzzed Driving campaign page at
www.nhtsa.gov/campaign/buzzed-driving.
Effectiveness: Barrett et al.’s group (2017) concluded in a literature review of 40 studies that
research suggests a positive association between for-profit (5 studies showing an effect, 1 study
showing no effect) and nonprofit (2 studies showing effects, 1 showing mixed results) safe ride
programs and the reduction of alcohol-impaired driving arrests, crashes, and fatalities. Other
evaluations of nonprofit safe ride programs also found mixed results. One examined one year5
Range based on responses over the years of the survey.
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round program and one holiday program. Both functioned smoothly and delivered rides, but
neither demonstrated any effect on crashes (Molof et al., 1995). Another evaluation examined a
year-round program in Aspen, Colorado, concluding it reduced injury crashes in the surrounding
county by 15% (Lacey, Jones, & Anderson, 2000). Finally, a program using older luxury
vehicles in Wisconsin that provided rides to and from bars resulted in a 17% decline in alcoholrelated crashes during the first year (Rothschild et al., 2006). The program became largely selfsustaining through fares and tavern contributions. These and other programs are summarized in
Decina et al. (2009). After reviewing select programs, Decina et al. (2009) concluded that a
model alternative transportation program that reduces alcohol- related crashes should be
continually available, free to users, convenient, and easy to use.
Costs: The major costs are for the ride service program rides. Short-term programs can be
operated largely with donated rides. Year-round programs need enough steady funding to
accommodate demand (Neuman et al., 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.
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5.5 Designated Drivers
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Short
Designated drivers are people who agree not to drink so they can drive home their friends who
have been drinking. Formal designated driver programs in bars and restaurants provide
incentives such as free soft drinks for people who agree to be designated drivers. Usually,
designated driver arrangements are completely informal. Designated driver programs focus on
specific actions taken at drinking establishments, which contrast with designated driver mass
media campaigns that seek to generally raise awareness of this countermeasure and promote its
informal use among the general driving population (see Section 5.2)
Effectiveness Concerns: The countermeasure effectiveness has been examined in a few research
studies. There have been some positive research findings in terms of driver awareness of the
countermeasure. However, the balance of evidence regarding the effectiveness of this
countermeasure in reducing crashes remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement are available in Appendix A1, Section 5.5.
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6. Underage Drinking and Driving
Teenagers drink and drive less often than adults but are more likely to crash when they do drink
and drive (Williams, 2003). Teenagers’ brains are still developing, and teenagers are
inexperienced with both driving and drinking. In addition to inexperience, teenagers do not fully
understand risks and consequences (Tymula et al., 2012). Consequently, they have a higher crash
risks than adult drivers no matter the BAC (Mayhew et al., 1986; Zador et al., 2000). Alcoholrelated crashes among teenagers are typically at night, on weekends, and with passengers
(Bingham et al., 2009).
Many countermeasures in previous sections of this chapter apply both to adults and teenagers as
well. However, some countermeasures to reduce drinking and alcohol-related crashes are
directed specifically to those under 21.
Since 1988 minimum-drinking-age laws in all States prohibit youth under 21 from possessing
alcohol. Most States also prohibit minors from buying and drinking alcohol. These laws
influence all youth impaired-driving strategies. For people 21 and older, drinking is legal, but
driving with BACs of .08 g/dL or higher is not. Utah is currently the only State that has an illegal
BAC limit law of .05 g/dL effective since the end of 2018. The message for those under 21 is
unambiguous: they should not be drinking at all, and they certainly should not be driving after
drinking.
Zero-tolerance laws in all States reinforce this message by setting a maximum BAC limit of less
than .02 g/dL or less for drivers under 21. This effectively prohibits driving after drinking any
amount of alcohol. Presently, zero-tolerance laws are not actively publicized or enforced by
many States. In addition, compliance checks of alcohol vendors can reduce the availability of
alcohol to those under 21, though again this strategy is not used as widely as it could be. Many
other policies and programs reinforce the no-drinking message directed primarily at adults (beer
keg registration, social host liability) or take place in schools or youth organizations (Students
Against Destructive Decisions chapters, alcohol-free prom and graduation parties). Youth
receive limited education and information about alcohol and alcohol-impaired driving in schools
and colleges, through licensing agencies, 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.
Except for zero-tolerance law enforcement and alcohol vendor compliance checks, many
countermeasures discussed next require cooperation between traditional highway safety
organizations, law enforcement, motor vehicle departments, and community, health, and
educational organizations with social agendas broader than traffic safety.
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6.1 Minimum Legal Drinking Age 21 Laws
Effectiveness:
Cost: $
Use: High
Time: Low
The primary strategies to reduce underage drinking as well as drinking and driving have been
restricting access to alcohol via minimum purchase age laws. Since July 1988 the minimum legal
drinking age (MLDA) has been 21 in all States. There is strong evidence that MLDA-21 laws
reduce drinking, driving after drinking, and alcohol-related crashes and injuries among youth
(Hingson et al., 2004; McCartt, Hellinga, & Kirley, 2010; Shults et al., 2001; Wagenaar &
Toomey, 2002). In fact, MLDA-21 laws reduced youth drinking and driving more than youth
drinking alone (using the measurements of self-reporting and testing of impaired drivers in fatal
crashes). Drinking and driving has become less socially acceptable among youth, and more
youth have separated their drinking from their driving (Azofeifa et al., 2019; Hedlund et al.,
2001).
The implementation of MLDA-21 laws for alcohol vendors, adults, and youth differ substantially
from State to State. See the Alcohol Policy Information System for State-by-State summaries of
some of the key provisions: https://alcoholpolicy.niaaa.nih.gov/underage-drinking/state-profiles.
Use: The minimum age to buy alcohol is 21 in all 50 States and the District of Columbia.
Effectiveness: Several reviews point to the effectiveness of MLDA-21 laws. Shults et al. (2001)
identified 33 studies examining effects of changing the legal drinking age. Overall, changes to
the MLDA affected alcohol-related crashes by 10% to 16%, with crashes decreasing when the
MLDA was raised, and increasing when it was lowered. Wagenaar and Toomey (2002) reviewed
79 high-quality studies examining the relationship between the MLDA and crashes. Of these,
58% found fewer crashes associated with higher MLDA, whereas none found fewer crashes
associated with lower MLDA. These findings prompted McCartt, Hellinga, and Kirley (2010) to
conclude: “The highway safety benefits of MLDA-21 have been proven, and the cause-andeffect relationship between MLDA and highway crashes is clear. Deaths go up when the
drinking age is lowered, and they go down when it is raised” (p. 180). NHTSA estimates that
MLDA-21 laws have saved 31,959 lives since 1975, and an estimated 538 lives in 2017 alone
(NCSA, 2020b).
A Canadian study compared alcohol-impaired driving offenses among drivers slightly older than
the MLDA and drivers slightly younger than the MLDA (Callaghan, Gatley, Sanches, Asbridge,
& Stockwell, 2016; Callaghan Gatley, Sanches, Benny, & Asbridge, 2016). The MLDA is 18 in
Alberta, Manitoba, and Quebec provinces, and 19 elsewhere in Canada. The study found that
drivers aging out of the drinking-age restriction were associated with increases in alcoholimpaired driving offenses ranging from 28 to 43% among males and 19 to 40% among females.
The authors conclude that these findings provide support for raising the MLDA in Canada and
implementing widespread zero-tolerance BAC policies for young drivers (Callaghan, Gatley,
Sanches, Asbridge, & Stockwell, 2016). Both measures, along with focused public health
awareness interventions, promote the development of safe driving skills and driving experience
in young drivers.
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Costs: There are no direct costs of MLDA-21 laws. Costs may be needed for enforcement of
MLDA-21 laws. (See Chapter 1, Sections 6.2 and 6.3).
Time to implement: MLDA-21 laws can be implemented as soon as appropriate legislation is
enacted.
Other issues:
• Repealing MLDA-21 laws: From 2007 to 2010 six U.S. States introduced legislation
allowing at least some people under 21 to purchase and consume certain types of alcoholic
beverages (McCartt et al., 2010); to date none have passed. Perhaps the most notable and
highly publicized effort to lower the MLDA was a statement signed by approximately 120
college and university presidents in 2008 suggesting MLDA be lowered to 18. This group
questioned the validity of MLDA-21 research, and advocated for education in place of laws
to reduce drinking among young people. Many organizations have opposed lowering the
legal drinking age. There has been more research on the MLDA than perhaps any other
alcohol-control policy (Wechsler & Nelson, 2010). Most traffic safety experts have
concluded that MLDA-21 laws are effective, and they recommend strengthening
enforcement of MLDA-21 laws and establishing policies to support them. For further
discussion of this issue, see Wechsler and Nelson (2010) and McCartt, Hellinga, and Kirley
(2010).
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6.2 Zero-Tolerance Law Enforcement
Effectiveness:
Cost: $$
Use: Unknown
Time: Short
Zero-tolerance laws set a maximum BAC of less than .02 g/dL or less for drivers under 21.
Violators have their driver licenses suspended or revoked. There is strong evidence that zerotolerance laws reduce alcohol-related crashes and injuries (Voas & Lacey, 2011; Goodwin et al.,
2005, Strategy B3; Shults et al., 2001). Fell et al. (2009) estimate that zero-tolerance laws save
159 lives each year.
However, zero-tolerance laws often are not actively enforced or publicized (Hedlund et al., 2001;
Voas & Lacey, 2011). Studies have found that young drivers are not arrested in proportion to
their involvement in alcohol-related crashes (Hingson et al., 2004). One exception is Washington
State, where a study found arrests for alcohol violations among 16- to 20-year-old drivers
increased by about 50% after the zero-tolerance law went into effect (McCartt et al., 2007).
Enforcement may be greater in Washington because the law allows officers to request tests for
alcohol based on suspicion of either a DWI or zero-tolerance offense. In other States where
drivers can only be tested if DWI is suspected, zero-tolerance laws may be more difficult to
enforce.
Use: Zero-tolerance laws have been in effect in all States since 1998. The degree to which they
are enforced in States is unknown.
Effectiveness: An early (1992) study in Maryland found that alcohol-involved crashes for
drivers under
21 dropped by 21% in six counties after the zero-tolerance law was implemented. After the law
was publicized extensively, these crashes dropped by an additional 30% (Blomberg, 1992). No
other studies have examined the effect of increasing enforcement and publicity for an existing
zero-tolerance law. Lacey, Jones, and Wiliszowski (2000) documented how zero-tolerance laws
are administered and enforced in 4 States. Highly publicized enforcement has proven effective in
increasing compliance with many traffic safety laws and reducing crashes and injuries: see for
example sobriety checkpoints (Chapter 1, Section 2.1) and seat belt use mobilizations (Chapter 2,
Section 2.1). A review of impaired driving law impacts on alcohol-related fatalities from 1980 to
2009 found zero-tolerance laws to have the most impact with an estimate of 19 to 29 lives saved
in 2012 (Ying et al., 2013). The study also found that areas with historically high impaireddriving fatalities may need ex-post regulations, such as the zero-tolerance and other penalizing
laws, to reverse the trend. This contrasts to other locations that can show improvements with
preventative regulations such as the MLDA and open container laws.
Costs: Zero-tolerance laws can be enforced during regular patrols or during special patrols
directed at times and areas when young impaired 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 3 or 4 months, as soon
as appropriate training, publicity, and equipment are in place.
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Other issues:
• Zero-tolerance-law provisions: Zero-tolerance laws are far easier to enforce if the offense
is an administrative rather than criminal violation as an administrative license suspension
can be implemented without a court conviction, and if LEOs can use PBTs (preliminary
breath test devices) at the roadside to determine if the law has been violated and, if so, to
seize the driver’s license (Jones & Lacey, 2001). 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: Preliminary breath test devices are important for effective and efficient
enforcement in States that allow PBT use for zero-tolerance laws. A passive alcohol sensor
(PAS) can help officers detect violators who have consumed alcohol. See Chapter 1,
Sections 2.3 and 2.4.
• Holding juveniles in custody: A complication of enforcing zero-tolerance laws is deciding
how and where to hold young offenders once they are taken into custody. NHTSA helped
produce an implementation guide for developing a juvenile holdover program (NHTSA,
2001).
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6.3 Alcohol Vendor Compliance Checks
Cost: $$
Effectiveness: †
† Proven for reducing sales to underage people
Use: Unknown
Time: Short
In all 50 States alcohol venders must verify the age of young customers to be sure they are at
least 21. However, several studies suggest young people can obtain alcohol without much
difficulty. Across studies, young buyers successfully purchased alcohol in 44% to 97% of
attempts without showing identification (Goodwin et al., 2005, Strategy A3). To reduce the
likelihood that alcohol vendors sell alcohol to underage people, LEOs can conduct frequent
compliance checks. In a compliance check “sting,” LEOs watch as underage people attempt to
buy alcohol and cite the server or vendor for an MLDA-21 violation if a sale is made. Vendors
can include on-premise retailers (bars and restaurants) or off-premise outlets (convenience stores
or liquor stores). Currently, online sales of alcohol are not well regulated, and vendors’ age
verification practices may not be stringent. In a 2011 study in North Carolina, 45% of online
alcohol orders placed by underage students were delivered; 23% of these orders did not require
age verification (Williams & Ribisl, 2012). Twelve percent of orders were rejected due to age
verification at order placement or during fulfilment, and an additional 16% were rejected due to
age verification at delivery.
An effective compliance check program works primarily through deterrence. The goal is to
increase perception among vendors they will be caught if they sell alcohol to underage people.
To maximize deterrence, compliance checks should be:
• Conducted frequently and on an unscheduled basis. Vendors should know compliance
checks are taking place, but should not know exactly when.
• Conducted at all vendors, not just a sample of vendors in the community. One study
showed the benefits of compliance checks did not generalize to vendors who were not
checked (Wagenaar et al., 2005).
• Well-publicized among vendors and the community at large. This will discourage young
people from trying to obtain alcohol, and encourage vendors to put policies and
procedures in place that prevent the sale of alcohol to underage customers.
• Sustained over time. The effects of compliance checks decay over a few months, so an
ongoing program is needed to maintain deterrence (Wagenaar et al., 2005).
A useful resource on how to conduct compliance checks is the Alcohol Epidemiology Program’s
Alcohol Compliance Checks: A Procedures Manual for Enforcing Alcohol Age-of-Sale Laws,
available at www.aep.umn.edu/wpcontent/uploads/2012/04/comp_check_maunal_updated_2013.docx.
Use: Twenty-two States and the District of Columbia prohibit all alcohol purchase by underage
youth. Another 24 States prohibit purchase other than for law enforcement purposes such as
merchant compliance checks (APIS, 2018a). Although many jurisdictions conduct compliance
checks of alcohol retailers at least occasionally, few jurisdictions do so frequently or regularly.
One national survey conducted in 2010-2011 found that only 35% of all local LEAs reported
conducting compliance checks, and only 55% of these agencies reported checking all
establishments that sold alcohol (Erickson et al., 2014). Less than 1 in 4 of these agencies
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conducted checks more than twice a year. Seventy-six percent of State agencies reported
conducting compliance checks; 59% of these reported checks at all establishments. Twenty-one
percent of State agencies conducted checks more than twice a year.
Effectiveness: Several studies document that well-publicized and vigorous compliance checks
reduce alcohol sales to youth; for example, a review of eight high-quality studies found that
compliance checks reduced sales to underage people by an average of 42% (Elder et al., 2007).
The effect of compliance checks on motor vehicle crashes has not been studied. In San Diego
County, annual DUI citation data (2000-2013) were analyzed and the results suggested that retail
beverage service laws (which prevent alcohol sales and service to minors including compliance
checks) and social host laws (which prohibit hosting underage drinking) contributed to lower
underage DUI rates (-25% and -32.1%, respectively) (Scherer et al., 2018).
Costs: Compliance checks require time from law enforcement. These costs can be supported, in
part, through alcohol license fees or fines collected from non-compliant vendors.
Time to implement: Compliance checks can be implemented within 3 months if officers are
trained in proper procedures.
Other issues:
• Penalties for violations: To increase the likelihood that penalties will be quickly and
consistently enforced, Goodwin et al. (2005, Strategy A3) recommend that all penalties for
violations should be administrative in nature. Also, the penalties must be substantial enough
to deter alcohol vendors from selling to underage people. Some States employ graduated
penalties for vendors who fail compliance checks, where both fines and suspension periods
increase with each violation (Goodwin et al., 2005, Strategy A3).
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6.4 Other Minimum Legal Drinking Age 21 Law Enforcement
Effectiveness:
Cost: Varies
Use: Varies
Time: Varies
MLDA-21 law enforcement is very limited in many communities (Hedlund et al., 2001).
Enforcement can take several forms, as summarized by Stewart (1999):
• Actions directed at alcohol vendors: Compliance checks to verify vendors will not sell to
youth (see Chapter 1, Section 6.3), “dram shop” 6 liability laws or responsible beverage
service training laws.
• 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 (in which decoy minors ask
adults to purchase alcohol for them and if the adults comply, they are cited or arrested),
and programs to penalize parents who provide alcohol to youth at parties.
Fell et al. (2016) found that nine laws that support enforcement of the MLDA-21 law
significantly decreased fatal crash ratios of drinking to nondrinking drivers under 21. The nine
MLDA-21 support laws are
(1) possession of alcohol,
(2) purchase of alcohol,
(3) use alcohol and lose your license,
(4) zero-tolerance .02 BAC limit for underage,
(5) age of bartender ≥ 21,
(6) State responsible beverage service program,
(7) fake identification support provisions for retailers,
(8) dram shop liability, and
(9) social host civil liability.
The study estimated that combined the nine MLDA-21 support laws save approximately 1,355
lives each year. However, only 5 States have enacted all nine laws. While these enforcement
strategies have been used frequently, few have been evaluated. Several strategies are briefly
described below, along with supporting research evidence.
“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 MLDA-21 law. Ulmer et al. (2001)
investigated “use and lose” law implementation and effects in Pennsylvania. License suspensions
for violations of MLDA-21 appeared to reduce subsequent traffic violations and crashes. In a
The word “dram” has the same root as the Greek coin, a drachma, and was once a Greek unit of weight. In the 17th
and 18th centuries British taverns called “dram shops” sold alcohol by the dram, then a unit of weight and roughly
equivalent to a small teaspoon of liquid. It is now equivalent to 1/8 of an ounce and was used as a pharmaceutical
measure even in the United States well into the 20th century. The Temperance Movement early in the 20th century
used the term “dram shop” in its terminology opposing alcohol and the places that sold it, and the term became
incorporated in law. A dram shop law usually holds the seller of alcohol – such as bar or tavern owner – responsible
for a subsequent injury to an intoxicated person who bought alcohol from that vendor.
6
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national study Fell et al. (2009) found “use and lose” laws were associated with a 5% decrease in
fatal crashes among underage drivers. The study estimated that 165 lives would be saved each
year if all States had these laws. “Use and lose” laws can be implemented quickly and
inexpensively once enacted. To be effective, they should be publicized extensively. As of
January 2018, 28 States and the District of Columbia had mandatory “use and lose” laws and
another 8 States had “use and lose” authority that may be applied in varying circumstances. In
Arkansas and Hawaii, “use and lose” laws have some mandatory and some discretionary sections
(APIS, 2018a).
Keg registration laws: These laws link beer keg purchasers to identification numbers on the
kegs, which provide a method of identifying adults who supply beer to parties attended by youth.
As of January 2018 thirty States and the District of Columbia had mandatory keg registration
laws (APIS, 2018b). Utah only permits the sale of kegs to authorized beer retailers to dispense
beer on draft for consumption on the beer retailer’s premises. In a study on the effectiveness of
these laws, keg registration was shown to be associated with reduced traffic fatality rates in 97
U.S. communities (Cohen et al., 2001). However, the authors could not conclude that keg
registration caused the lower fatality rates. A study by Fell et al. (2015) found that keg
registration laws were associated with decreases in per-capita beer consumption, but increases in
the ratio of drinking to sober underage drivers involved in fatal crashes.
Media campaigns: Ohio has conducted statewide media campaigns, Parents Who Host Lose the
Most, since 2000, and it is now also used in other States and communities. 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 2006
showed that about 55% of parents and youth had heard messages about underage drinking
(Applied Research Center, 2008). About two-thirds of those who had heard a message said that it
prompted a conversation between parents and their teenagers about drinking. In comparison with
surveys conducted in 2001, there was a 42% decrease among youth who reported knowing of
parents who host parties where alcohol is served to teens.
Underage Drinking Tip line: In 2006 Kansas launched a statewide underage drinking tip line,
866-MustB21 and Pennsylvania uses 1-888-UNDER21. The toll-free tip lines operate 24 hours a
day, 7 days a week, for people to report underage drinking parties, plans to purchase alcohol for
underage people, and willingness of retailers to sell alcohol to underage people. The effect of the
tip lines has not been evaluated. Nebraska introduced a statewide underage drinking tip line in
2009, using the same phone number as Kansas. States including New York, Texas, and Iowa
have since implemented underage drinking tip lines.
Social Host Liability: Under social host laws, an adult who hosts an underage drinking party
(specific laws), or who allow underage drinking to occur on that person’s property (general
laws), can be held accountable if a young person is subsequently involved in a crash. This
liability might discourage adults (parents, older siblings, and friends) from purchasing alcohol
for underage people or hosting underage parties. Conducting source investigations where law
enforcement teams identify providers of the alcohol, can be resource-intensive and timeconsuming (Curtis & Ramirez, 2011). Moreover, the few research studies that have examined the
effect of social host liability laws have obtained conflicting findings (Voas & Lacey, 2011).
Nonetheless, comprehensive and well-publicized efforts to hold providers accountable appear to
be promising. Social host laws, and their accompanying penalties, vary from State to State. A
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description of each State’s social host laws may be found in NHTSA’s Digest of Impaired
Driving and Selected Beverage Control Laws (NHTSA, 2017). Another good resource is
available from the Alcohol Policy Information System (2018c). As of January 2018 ten States
have hosting laws specific to underage parties, and 21 States have general hosting laws (APIS,
2018c).
Comprehensive community programs: Community programs focus on changing the local
environment to prevent alcohol abuse through changes in ordinances and norms, incorporating
discrete counseling and prevention programs, or combinations of such strategies (Fagan et al.,
2011). Several comprehensive community initiatives have reduced youth drinking and alcoholrelated problems (Fagan et al., 2011; Hingson et al., 2004; Shults et al., 2009). These initiatives
typically bring together several community government departments, such as schools, health, and
law enforcement, with alcohol sellers, parents, youth, and citizen organizations (Fagan et al.,
2011). 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. In particular, successful community initiatives are centered
around data-driven practices and evidence-based measures, making the careful monitoring of
program processes necessary to ensure quality outcomes.
The costs depend on the activities included; however, fiscal savings can be generated through the
prevention of costs related to alcohol-abuse-related individual health and community expenses
(Fagan et al., 2011). One example is a campaign conducted in Huntington, West Virginia, that
included checkpoints to look for violations of the MLDA-21 law, checks of alcohol outlets to
reduce sales to minors, and publicity for program activities. Roadside surveys conducted before
and during the program showed a 93% drop in 16- to 20-year-old drivers having BACs greater
than .05 g/dL (IIHS, 2008). Another promising program is Oregon’s Reducing Youth Access to
Alcohol. The program involves community mobilization including “reward and reminder” visits
(where vendors receive rewards if they decline to sell alcohol to a minor), regular compliance
checks, enforcement of minor in possession laws, and media advocacy. The program has been
effective in reducing the sale of alcohol to minors: successful purchase attempts by minors
dropped from 24% before the program to 5% afterwards. Additionally, the individual
communities with the strongest programs also experienced reductions in underage drinking
(Flewelling et al., 2013). NHTSA has produced a guide on how communities can prevent
underage drinking, available at: https://one.nhtsa.gov/people/injury/alcohol/Community%20Guides%20HTML/Guides_index.html.
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6.5 Youth Programs
Effectiveness: ✩✩
Cost: Varies
Use: High
Time: Medium
This countermeasure involves youth drinking-and-driving prevention programs that seek to
motivate youth not to drink, not to drink and drive, and not to ride with drivers who have been
drinking. Although some programs use scare tactics, many employ positive messages and
methods by 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. A more recent type of approach focuses on “social norms” or “normative feedback”
that provides students with accurate information about drinking. Recognizing that young people
often respond better to messages from their peers, some programs have adopted a peer-to-peer
approach.
Effectiveness Concerns: This countermeasure has been examined in several research studies.
Despite some positive research findings, the balance of evidence regarding countermeasure
effectiveness remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement are available in Appendix A1, Section 6.5.
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7. Drug-Impaired Driving
The impairing effects of alcohol and the dangers of drinking and driving are well-documented.
By contrast, there is considerably less research investigating the potentially impairing effects of
drugs on drivers. Some of the challenges in studying, measuring, and creating countermeasures
to address drug-impaired driving include the following (Arnold & Scopatz, 2016; Berning &
Smither, 2014; Compton et al., 2009; Compton, 2017; Logan et al., 2016; Smith et al., 2018;
Stewart, 2006):
• There is a wide range of drugs, both licit and illicit, that can impair driving. Moreover,
the list of drugs in common usage is constantly changing.
• Although the relationship between BAC and driving impairment is clear and welldocumented, the relationship between blood levels of drugs and driving impairment has
not been established for drugs other than alcohol.
• Alcohol leaves the body in a predictable pattern, whereas other drugs are eliminated at
many rates; hence, timing is critical when conducting drug tests. In addition, blood levels
of certain drugs can accumulate with repeated administrations, and can be detected well
after impairment has ceased.
• It is not unusual for drivers to take more than one impairing drug at the same time or to
combine drugs with alcohol. Although individual drugs, taken at normal doses, may not
impair driving, drug effects may be synergistic when taken together and substantially
increase the risk of a crash.
• Alcohol can be measured reliably through breath tests, but other types of drugs can only
be measured through more intrusive tests of bodily fluids such as blood, urine, or saliva.
• Improvements to the quality and type of data collected during drug-impaired driving
incidents are still in the initial stages of development and adoption by States and
agencies.
• Countermeasures for addressing potential driving impairments from prescription and
over-the-counter drugs may need to be different than countermeasures for alcohol- and
illicit drug-impaired driving.
Despite these challenges, a growing body of research suggests that many illicit, prescription, and
over-the-counter drugs may impair a driver’s ability to operate a vehicle (for reviews, see Couper
& Logan, 2004; Jones et al., 2003; Kelly et al., 2004; and Strand et al., 2016). Much of this
research has involved laboratory or experimental studies using driving simulators, although some
epidemiological studies have examined the effect of drugs on crash prevalence and risk. See
Compton et al. (2009) for a discussion of this research.
In most cases, the research investigating the effect of drugs on driving has had variable results, in
large part depending on the methodology employed. The crash risk associated with specific types
of drugs is summarized below.
• Benzodiazepines: Common benzodiazepines include Valium, Xanax, and Klonopin.
Several studies suggest benzodiazepine users are at increased risk of being involved in a
crash (Movig et al., 2004; Rapoport et al., 2009), although some studies have not found
these results. The risk appears to depend on the type of benzodiazepine used, the dose,
the time since last use, and whether the drug was combined with alcohol (Dassanayake et
al., 2011; Leung, 2011).
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•
•
•
•
•
Marijuana: The findings for marijuana also have been mixed, although a meta-analysis
of epidemiological data concluded marijuana doubles the risk of a property damage or
fatal crash (Asbridge et al., 2012). However, another study found only a 50% increase in
the risk of property damage crashes, and no increase in the risk of fatal or injury crashes
(Elvik, 2013). A large-scale study in Virginia found no elevated crash risk for THC users
after adjusting for demographic variables and alcohol use (Compton & Berning, 2015).
Generally, the risk appears highest when marijuana has been used recently, and especially
when marijuana is combined with alcohol (Beirness & Simpson, 2006; Sewell et al.,
2009). Pre-/post-studies on traffic safety related to marijuana legalization were conducted
in Colorado and Washington. Both States legalized recreational marijuana use by adults
21 and older in 2014. A report from the National Bureau of Economic Research found
that there was no firm evidence that the presence of THC was related to changes in
marijuana-involved fatal crash risk in a comparison study between the two States and
other control States between 2000 and 2016 (Hansen et al., 2018). However, some trends
pointed to the potential for detrimental effects on safety. Fatal crashes involving
marijuana increased in both States and THC-positive drivers involved in crashes
increased in Washington (20% to 30% between 2005-2014); however, impairment status
is unknown for these drivers.
Stimulants: There have been fewer studies examining the risks of stimulants such as
amphetamines and cocaine on driving. The available studies suggest stimulants are
strongly associated with fatal crashes (Elvik, 2013).
Narcotics: Several studies have showed that narcotic drugs such as morphine, heroin,
and opiates increase crash risk. One case-control study found a three times higher risk of
a fatal crash when a driver is under the influence of a narcotic (Li et al., 2013). However,
this study used FARS data that have limitations with respect to the interpretation,
reporting, and testing of drug impairment in fatal crashes (Berning & Smither, 2014).
Antihistamines: The relationship between antihistamines and motor vehicle crashes is
ambiguous (Moskowitz & Wilkinson, 2004). A small connection has been found between
first-generation antihistamines and crashes, but second-generation antihistamines appear
to cause less sedation.
Antidepressants: Second-generation antidepressant medications such as selective
serotonin reuptake inhibitors do not seem to impair driving performance, but this is not
necessarily the case with older types of antidepressants (Brunnauer & Laux, 2013).
Compton et al. (2009) describe four basic issues that must be addressed to better understand the
extent of the problem of drug-impaired driving:
• What drugs impair driving ability?
• What drug dose levels are associated with impaired driving?
• How frequently are impairing drugs being used by drivers?
• What drugs are associated with higher crash rates?
In sum, there are still sizeable gaps in our understanding of the effects of drugs on driving. In
their review of drug-impaired driving, Jones et al. (2003) concluded: “The role of drugs as a
causal factor in traffic crashes involving drug-positive drivers is still not understood… Current
research does not enable one to predict with confidence whether a driver testing positive for a
drug, even at some measured level of concentration, was actually impaired by that drug at the
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time of crash” (p. 96). Perhaps the one consistent finding across studies is the risk of driver
impairment increases substantially when drugs are combined with alcohol.
Similar to alcohol-impaired driving, drug-impaired driving is primarily addressed through a
combination of laws, enforcement, and education (AAAFTS, 2018b; AAAFTS, 2018c).
Relatively few countermeasures have been developed to specifically address drug-impaired
driving, and there has been little evaluation of drug-impaired-driving countermeasures. The
AAA Foundation for Traffic Safety investigated the potential for alcohol-impaired driving
countermeasures to be applied to drugged and drug-impaired driving. Subject matter experts
from across the United States participated in five panel discussions that were then summarized in
two brief reports. The reports summarize the strengths and limitations of a range of
countermeasures, including behavioral and educational interventions (AAAFTS, 2018b) and
enforcement- and legal and policy-interventions (AAAFTS, 2018c). The conclusions point to the
need for more research to better understand the nature and degree of traffic safety risk posed by
drugs, as well as the effectiveness of potential countermeasures to address this issue. See the
guide on drug-impaired driving produced by the Center for Problem-Oriented Policing for more
information about drug-impaired-driving countermeasures (Kuhns, 2012). Marijuana-specific
summaries can be found in NHTSA’s Report to Congress (Compton, 2017) and the AAA
Foundation for Traffic Safety’s report (Logan et al., 2016). Smith et al. (2018) review the state of
knowledge on countermeasures against impaired driving due to prescription and over-the-counter
drugs.
Arnold & Scopatz (2016) provide 12 recommendations to States to address barriers to collecting
and maintaining drug-impaired driving data. Based on these recommendations, an assessment of
data collection procedures from across all States was performed (Fell et al., 2018). As of 2018 at
least two-thirds of LEOs in 37 States had completed SFST training. Forty-nine States permit
blood collection for drug testing, 35 States permit breath testing, and 39 States permit urine
collection for drug testing. Fifteen States permit collection of oral fluids for drug testing and an
additional 10 States had pilot test programs in place for oral fluid testing. Two States—Maryland
and Washington—legally distinguish between arrests due to DUI-alcohol and DUI-drugs. An
additional 32 States and the District of Columbia also report DUI-alcohol and DUI-drugs arrests
separately.
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7.1 Enforcement of Drug-Impaired Driving
Effectiveness:
Cost: $$
Use: Unknown
Time: Short
Enforcement of drug-impaired driving laws can be difficult. Typically, drug-impaired driving is
only investigated when a driver is obviously impaired but the driver's BAC is low. If drivers
have BACs over the illegal limit, many officers and prosecutors do not probe for drugs, as in
many States drug-impaired driving carries no additional penalties.
Although several devices are available that allow officers to screen suspects for illegal drug use
at point-of-contact, none have been proven to be accurate and reliable (Compton et al., 2009).
Many LEAs employ drug recognition experts to assist in investigating potential drug-impaireddriving cases. NHTSA recommends that DREs participate in HVE and checkpoints, and respond
to serious and fatal crashes. DREs use a standardized procedure to observe a suspect’s
appearance, behavior, vital signs, and performance on psychophysical and physiological tests to
determine whether and what type of drug or drug category may have been used (Talpins et al.,
2018). If drug intoxication is suspected, a blood or urine sample is collected and submitted to a
laboratory for confirmation. NHTSA has developed the Advanced Roadside Impaired Driving
Enforcement training, which bridges the gap between the SFST and the DRE training programs.
This program is available to those who are already certified to conduct the SFST and requires 16
hours of pre-classroom instruction and 56 hours of classroom instruction (International
Association of Chiefs of Police, 2020b).
Use: As of August 2014 all 50 States and the District of Columbia had drug evaluation and
classification (DEC) programs, which are designed to train officers to become DREs (GHSA,
2015). As of December 2019 these programs have prepared more than 1,700 instructors and
trained more than 9,800 officers (IACP, 2020a). During 2019 there were over 36,000 drug
enforcement evaluations conducted by DREs as part of enforcement. This suggests drugimpaired-driving arrests are not as common in comparison to arrests for alcohol-impaired
driving. However, it should be noted that the number of drug-impaired-driving arrests cannot be
known as many States only record “impaired-driving” arrests, and do not separate alcohol from
drug arrests. Additionally, it is suspected, many arrests are a combination of drugs and alcohol.
In DRE enforcement evaluations in 2019, cannabis was the most frequently identified drug
category, followed by CNS stimulants, narcotic analgesics (opioids), and CNS depressants
(IACP, 2020). Porath-Waller and Beirness (2014) investigated the validity of using SFSTs in
detecting drug impairment among suspected drug-impaired drivers. Results of their study
indicate CNS stimulants, CNS depressants, narcotic analgesics, and cannabis are significantly
associated with impairment using SFST. Specifically, users of all drug types were significantly
more likely to sway while balancing and use their arms to maintain balance on the one-leg-stand.
Users of CNS depressants, CNS stimulants, and narcotic analgesics were significantly less likely
to keep their balance while listening to test instructions on the walk-and-turn test. Finally, users
of CNS depressants were significantly more likely to experience lack of smooth pursuit and
distinct nystagmus at maximum deviation on the horizontal gaze nystagmus test.
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Chapter 1. Alcohol- and Drug-Impaired Driving
Effectiveness: Several studies have shown DRE judgments of drug impairment are corroborated
by toxicological analysis in 85% or more of cases (NHTSA, 1996). However, one experimental
laboratory study found DREs' ability to distinguish between impaired and non-impaired people
was moderate to poor for several types of drugs including marijuana, codeine, and amphetamines
(Shinar et al., 2000). This study showed DREs tended to rely on just one or two “pivotal” cues to
identify specific drug impairment.
A study of the drug evaluation and classification program determined that a combination of cues
could provide higher levels of true positives in DRE identification of cannabis consumption
(Hartman et al., 2016). These cues included metrics from physiological tests (finger-to-nose test,
one-leg stand, and the walk-and-turn) and visual indicators (eyelid tremors). The findings
suggest that there are certain differentiating cues for use by DREs in discerning cannabis
consumption, though the relation to driving impairment is still unclear.
To date there have been no studies examining the effectiveness of enforcement in reducing drugimpaired driving or crashes. Research has been focused on the impact of decriminalization and
legalization of marijuana on several aspects of the DWI system, including prevalence and
enforcement. See the joint report by NHTSA, GHSA, and the Volpe National Transportation
Systems Center (2017) and Otto et al. (2016) for comparative discussions across States.
Costs: As with other enforcement strategies, the primary costs are for law enforcement time and
training. The time to conduct a DRE evaluation can be 2 to 4 hours. Training includes 72 hours
of classroom instruction and approximately 50 hours of field work.
Time to implement: Drug-impaired-driving enforcement can be integrated into other
enforcement within 3 months; however, time will be needed to train DREs in detecting drug
impairment. DRE training consists of 9 days of classroom instruction, and DRE candidates are
also required to perform supervised field evaluations to become certified (Compton et al., 2009).
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Chapter 1. Alcohol- and Drug-Impaired Driving
7.2 Drug-Impaired-Driving Laws
Effectiveness: ✩
†Use for drug per se laws
Cost: Unknown
Use: Medium†
Time: Short
This countermeasure involves laws that prohibit the use of impairing drugs by drivers. This
includes impairment-based statutes, which stipulate that prosecution must prove the driver was
impaired (for example, by driving recklessly or erratically). It also includes per se laws in which
it is illegal to operate a motor vehicle if there are specific detectable levels of a prohibited drug in
a driver’s system. In some States, a positive drug test is sufficient for conviction, which is
equivalent to “zero tolerance.”
Effectiveness Concerns: To date there have been no evaluations of the effect of drug-impaireddriving laws on the prevalence of drug-impaired driving or crashes.
Further information about the known research, potential effectiveness, costs, use, and time to
implement are available in Appendix A1, Section 7.2.
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7.3 Education Regarding Medications
Effectiveness: ✩
Cost: Unknown
Use: Unknown
Time: Long
This countermeasure involves providing education to physicians, pharmacists, and patients about
the potential risk of motor vehicle crashes associated with certain prescription medications.
Instruction targeting pharmacists can include modules that cover potentially driver-impairing
prescription drugs, laws relating to medication use and DWI, and the role of pharmacists in
counseling patients regarding medications and driving risk. More generally, education can also
include use of clear warning labels on drug packaging.
Effectiveness Concerns: This countermeasure has only been examined in a few studies.
Although some of the studies report increased awareness by pharmacists of the effects of
medication, there is no evidence of increased awareness among drivers. Overall, there are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement are available in Appendix A1, Section 7.3.
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Chapter 2. Seat Belts and Child Restraints
2. Seat Belts and Child Restraints
Overview
Abundant research has shown that correctly using appropriate child restraints or seat belts is the
single most effective way to save lives and reduce injuries in crashes. Lap and shoulder
combination seat belts, when used, reduce the risk of fatal injury to front-seat passenger car
occupants by 45% and the risk of moderate-to-critical injury by 50% (Kahane, 2015). For lighttruck occupants, seat belts reduce the risk of fatal injury by 60% and moderate-to-critical injury
by 65%.
NHTSA estimates that correctly used child restraints are even more effective than seat belts in
reducing fatalities to children. Child restraints reduce fatalities by 71% for infants younger than 1
year old and by 54% for children 1 to 4 years old in passenger cars. In light trucks the fatality
reductions are 58% for infants and 59% for children 1 to 4 years old (NCSA, 1996; Kahane,
2015). In addition, research conducted by the Partners for Child Passenger Safety Program at the
Children’s Hospital of Philadelphia found that belt-positioning booster seats reduce the risk of
injury to children 4 to 8 years in crashes by 45% when compared to the effectiveness of seat belts
alone (Arbogast et al., 2009). However, unrestrained children continue to be overrepresented in
motor vehicle fatalities, which indicates that additional lives can be saved by increasing restraint
use among children (Sauber-Schatz et al., 2014).
Trends. The challenge is to convince all passenger vehicle occupants to buckle up. Current data
show that observed daytime seat belt use nationwide was 90.7% in 2019 for adult drivers and
right-front seat passengers combined (NCSA, 2019). There was no significant difference in use
from 2018 (89.6%) to 2019 (90.7%). In 2019 seat belt use was over 90% in 26 States, the District
of Columbia, and two U.S. Territories, with 4 States, the District of Columbia, and Guam
achieving belt use rates higher than 95% (California, 96.0%, Georgia, 95.9%; Hawaii, 97.1%;
Oregon, 95.7%; District of Columbia, 95.4%; and Guam, 96.9%) (NCSA, 2020a). Seat belt use,
however, was less than 80% in 4 States (New Hampshire, 70.7%; Nebraska, 79.7%; South
Dakota, 75.2%; and Wyoming, 78.3%) and the U.S. Virgin Islands (71.1%). Nationally, seat belt
use has increased dramatically since seat belt use laws went into effect in the early 1980s
(Hedlund et al., 2008; Li & Pickrell, 2018a). The National seat belt use rate has been trending
upwards over the past two decades, rising 20 percentage points since 2000 (Enriquez & Pickrell,
2019; NCSA, 2019).
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Chapter 2. Seat Belts and Child Restraints
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
U.S. Driver and Front Seat Passenger Seat Belt Use
Rates: 2000 – 2019
Year
Sources: Enriquez & Pickrell (2019); NCSA, 2019
In general, overall restraint use for children is higher than what is demonstrated in the adult
population, particularly among the youngest children. In 2017 restraint use for children less than
13 years old was 90.1% (Li & Pickrell, 2018b). Restraint use ranged from 97.9% for infants
under 1 year old, to 86.5% for children 8 to 12. In general, child restraint usage rates decline as
children age.
Restraint Use Rates for Children* by Age, 2017
100%
90%
80%
70%
60%
50%
<1
1-3
Age
4-7
8-12
*Restraint use rates do not indicate correct use.
Source: Li and Pickrell (2018b)
However, restraint use for children is more complicated than simply “restrained versus
unrestrained.” In addition to overall restraint use, it is also important to consider correct restraint
use. The current NHTSA recommendations include keeping children rear-facing until the rearfacing height or weight limits of the car seat are outgrown, then forward-facing with a harness
until the harness is outgrown by height or weight, and then booster seat use until the seat belt fits
properly on its own (NHTSA, 2014a).
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Chapter 2. Seat Belts and Child Restraints
The 2017 National Survey of the Use of Booster Seats (Li & Pickrell, 2018b) details the
observed restraint use for children under 1, 1 to 3, 4 to 7, and 8 to 12. There were some
indications of premature transition to restraint types that are not appropriate for children’s age,
height, and weight. In 2017 there were 92.1% of children under 1 observed in the appropriate
rear-facing seats, up from 87.4% in 2015. Rear-facing and eventually forward-facing car seats
are appropriate for children 1 to 3. The 2017 NSUBS found that 85.1% of children 1 to 3 used
the appropriate restraint, compared to 77.0% in 2015, and 68.5% of children 4 to 7 were
restrained using the appropriate forward-facing car seat or booster seat, which is up from 62.4%
in 2015. Children 8 to 12 should use a booster seat until a seat belt fits properly. Of children 8 to
12 there were 85.4% appropriately restrained, compared to 83% in 2015. Child restraint use
varies by race and ethnicity. Across children younger than 13 years old, White Non-Hispanics
had the highest restraint use for infants birth to 12 months (99.4%) and White Non-Hispanic and
Asian Non-Hispanic children had the highest restraint use for children 1 to 3 (98.1% and 98.6%,
respectively) and children 8 to 12 (91.1% and 90.7%, respectively). Asian Non-Hispanic children
had the highest restraint use for children 4 to 7 (99.8%). Non-Hispanic Black children had the
lowest restraint use rates (birth to 12 months, 93.0%; 1 to 3, 86.8%, 4 to 7, 75.8%; 8 to 12,
79.9%).
Despite high observed belt use rates, many unrestrained people die in crashes each year. In 2018
there were 22,697 passenger vehicle occupants killed in crashes (NCSA, 2020b). Of these, where
restraint use was known, 47% were unrestrained. Of the 736 children in 2018 under 15 who died
in passenger vehicles, 35% were unrestrained.
History of Occupant Restraint Laws. All new passenger cars had some form of seat belts
beginning with lap belts in 1964, shoulder belts in 1968, and integrated lap and shoulder belts in
1974 (Automobile Coalition for Traffic Safety [ACTS], 2001). However, few occupants used the
belts. The first widespread survey completed in 19 cities in 1982, observed 11% belt use for
drivers and front-seat passengers (Williams & Wells, 2004). This survey became the benchmark
for tracking belt use nationally, until the National Occupant Protection Use Survey (NOPUS)
began in 1994.
New York enacted the first statewide seat belt use law in 1984 with other States soon following.
Evaluations of the first seat belt laws found that seat belt use increased following implementation
of the law from baseline levels of about 15% to 20% to post-law use rates of about 50% (Nichols
& Ledingham, 2008). Florida implemented a primary seat belt law in 2009. An evaluation of the
law found observed seat belt use to increase by 4.3 percentage points from 80.9% to 85.2%
(Nichols et al., 2012). Looking at law evaluations it appears that the relative effectiveness of
implementing a primary law decreases as baseline seat belt use rates increase. As of June 2019
all States except New Hampshire require adult passenger vehicle drivers and front seat occupants
to wear seat belts and 30 States and the District of Columbia also require seat belts for all rear
seat passengers (GHSA, 2019a). Thirty-four States and the District of Columbia have primary
enforcement seat belt use laws that permit LEOs to stop and cite a violator independent of any
other traffic violation. Fifteen States have secondary enforcement laws that allow LEOs to cite
violators only after they first have been stopped for some other traffic violation.
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Chapter 2. Seat Belts and Child Restraints
From 1978 to 1985 every State and the District of Columbia passed laws requiring child
restraints for young child passengers (Kahane, 1986), and most of these laws have since been
amended and strengthened to include more children and to close loopholes and exemptions. Still,
great variation exists on the requirements and ages covered by State child restraint laws. See
IIHS (2019a) and GHSA (2019b) for a summary of State law requirements.
For more information on the history of seat belt systems, seat belt use laws, enforcement
programs, and seat belt use trends, see Kahane (2015), ACTS (2001), Solomon et al. (2004),
Milano et al. (2004), NHTSA (2003), Williams and Wells (2004), and Hedlund et al. (2008). For
a comprehensive summary on facts about child restraint use, see Dunn et al. (2016).
Strategies to Improve the Safety of Passenger Vehicle Occupants
The most effective strategy for achieving and maintaining restraint use at acceptable levels is
well-publicized, HVE of strong occupant restraint use laws. The effectiveness of HVE 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 of the
components is weak or missing (Nichols & Ledingham, 2008; Tison & Williams, 2010).
These high-visibility, short-duration seat belt law enforcement programs that in the past were
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%
(Williams & Wells, 2004). The Click It or Ticket model expanded nationwide in 2003 (Solomon
et al., 2004) and belt use increased in almost all States from 2000 to 2006, in part due to the
Click It or Ticket seat belt enforcement programs (Tison & Williams, 2010). Since then, most
States have continued to increase or maintain their seat belt use rates. The number of States, DC,
and Territories who achieved use rates of 90% or higher increased from 11 in 2006, to 29 in
2019 (NCSA, 2007; NCSA, 2020a).
A recent study examined differences between States with high and low seat belt use and how
they approach occupant protection (Thomas et al., 2017). A goal of this study was to identify
effective strategies employed by high belt-use States that could be adopted by low belt-use
States. There were clear demographic differences in the populations in each group, and low beltuse States had a higher proportion of drivers residing in rural areas. Political and legislative
support for general highway safety, and occupant protection was not as strong in low-belt-use
States. Several lacked sufficient resources for safety, dedicated occupant protection coordinators,
and/or internal research staff, and spent relatively little on media campaigns. Examining these
differences in detail led researchers to identify four activities characteristic of the high belt-use
States that the low belt-use group could adopt with reasonable expectation they would increase
seat belt use. These included 1) build political, law enforcement, and community support to
promote seat belt use; 2) increase enforcement of seat belt laws throughout the year; 3) develop
in-house research and data analysis capabilities in the SHSO; and 4) determine what motivates a
State’s population to use seat belts.
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Chapter 2. Seat Belts and Child Restraints
Other strategies have been implemented to increase the correct use of child restraints. Child
restraint misuse is an issue that has been a concern for many years. In reaction to the high levels
of child restraint misuse and incompatibility issues between seat belts and child restraints, a
concept of standardized child restraint installation, initially called ISOFIX, was completed as an
international standard in 1999 (Klinich et al., 2012). 7 The intent of ISOFIX, later renamed as
LATCH (Lower Anchors and Tethers For Children) as implemented in the United States, was to
provide a simpler way to install child restraints and reduce misuse using special attachments on
the car seat that fasten to anchors built into the vehicle. LATCH consists of two components in
the vehicle – the lower anchors and the top tether anchor – with complimentary connectors on
the child restraint. However, even with LATCH, misuse remains a problem with forward-facing
car seats. The National Child Restraint Use Special Study (NCRUSS) conducted in 2011, found
that only 48% of forward-facing child restraints were installed using the top tether, which is an
important component of the LATCH system (Greenwell, 2015). It should be noted that at the
time of data collection, tether use with car seats installed with the seat belt was not aggressively
promoted (MacKay & Walker, 2017).
The NCRUSS examined misuse rates of car seats and booster seats in a nationally representative
sample of 4,167 vehicles (Greenwell, 2015). A group of subject matter experts determined what
constituted “misuse” of child restraints. Misuse was defined as an installation of the car
seat/booster to the vehicle, or restraining the child in such a way that could reduce the protection
of the car seat/booster in the event of a crash. Restraint-use errors varied by restraint type.
Overall misuse was estimated to be 46%. Estimated misuse by restraint type was 61% for
forward-facing car seats, 49% for rear-facing car seats, 44% for rear-facing convertible car seats,
24% for backless booster seats, and 16% for high-back booster seats. The most common errors
for rear-facing car seats were more than three inches of lateral movement, car seat angle of less
than 30 degrees (if child was less than 1), and harness slack of more than 2 inches. The most
common errors for booster seats were lap belt across the abdomen/ribcage, shoulder belt behind
arm or back, seat belt not buckled, and child’s head above the vehicle seat back.
In order to combat this misuse, programs have been implemented to provide parents and other
caregivers with “hands-on” assistance with the installation and use of child restraints. The
NHTSA Standardized Child Passenger Safety (CPS) Training Course, complemented by the
national certification process (funded by NHTSA and administered by Safe Kids Worldwide)
developed and implemented a system to train safety professionals and other interested parties in
the fundamentals of correctly choosing and installing the proper car seat for child passengers and
correct placement of the child in the car seat. People who successfully completed the course are
certified to educate the public in using child restraints properly and provide caregivers with this
“hands-on” assistance (Womack et al., 2005). Currently, there are over 41,000 certified CPS
technicians and instructors (Safe Kids Worldwide, 2018). One study found that parents and
caregivers who were initially taught how to install a child restraint by a CPS technician were
ISOFIX or Isofix is International Organization for Standardization standard ISO 13216, specifying the anchoring
system for Group 1 child safety seats. It defines standard attachment points to be manufactured into cars, enabling
compliant child safety seats to be quickly and safely secured. Isofix is an alternative to securing the seat with seat
belts. Seats are secured with a single attachment at the top (top tether) and two attachments at the base of each side
of the seat. It has regional names including LATCH ("Lower Anchors and Tethers for Children") in the United
States and LUAS ("Lower Universal Anchorage System") or Canfix in Canada. It has also been called the
"Universal Child Safety Seat System" or UCSSS.
7
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Chapter 2. Seat Belts and Child Restraints
more likely to achieve an accurate installation than those who initially learned from other
sources, typically the manufacturer’s manual (Mirman et al., 2017).
Child passenger safety inspection stations are places or events where parents and caregivers can
receive assistance from certified CPS technicians, and are popular services provided by a variety
of local CPS programs. Child passenger safety inspection stations are commonly housed at public health departments, fire departments, LEAs, healthcare organizations, family and social services departments, and other organizations that serve the community, including economically
disadvantaged populations. A small study conducted in Florida examined the possibility of
providing parents with remote help installing child seats using a phone app that allowed parents
to interact directly with a CPS technician located elsewhere (Schwebel et al., 2017). The results
reported that the accuracy of installations improved significantly compared to the installation
prior to the instruction, and that parents felt more confident about the installation.
Resources
The agencies and organizations listed below can provide more information on seat belt use and
child passenger safety, and links to numerous other resources.
Seat Belts and Child Passenger Safety
• National Highway Traffic Safety Administration:
o Occupant Protection – www.nhtsa.gov/risky-driving/seat-belts#resources-resources
o Car Seats and Booster Seats – www.nhtsa.gov/equipment/car-seats-and-booster-seats
o Research and Evaluation – www.nhtsa.gov/behavioral-research;
o Behavioral Safety Research Reports – http://rosap.ntl.bts.gov/
• AAA:
o Seat Belts – http://exchange.aaa.com/safety/roadway-safety/safety-belts/
o Child Passenger Safety – http://exchange.aaa.com/safety/child-safety/
• AAA Foundation for Traffic Safety: www.aaafoundation.org
• American Academy of Pediatrics, Annual Car Seat Information For Families guide:
www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-SeatsInformation-for-Families.aspx
• Automotive Safety Program, Riley Hospital for Children: www.preventinjury.org
• Centers for Disease Control and Prevention (CDC), Injury Prevention & Control: Motor
Vehicle Safety: www.cdc.gov/Motorvehiclesafety/index.html
• Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia:
https://injury.research.chop.edu/traffic-injury-prevention/child-passengersafety#.WMauPU2Qzcs
• Governors Highway Safety Association: www.ghsa.org/html/issues/occprotection/index.html
• Insurance Institute for Highway Safety:
o Safety Belts – www.iihs.org/topics/seat-belts
o Child Safety – www.iihs.org/topics/child-safety
• National Safety Council:
o Child Passenger Safety – www.nsc.org/learn/safety-knowledge/Pages/Child-Passenger-Safety.aspx
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Chapter 2. Seat Belts and Child Restraints
•
•
•
•
•
o Child Safety Seats & Boosters www.nsc.org/safety_road/DriverSafety/Pages/ChildPassengerSafety.aspx
Safe Kids Worldwide:
o Seat Belts: www.safekids.org/safetytips/field_risks/seatbelt
o Car Seats: www.safekids.org/car-seat
o Booster Seats: www.safekids.org/safetytips/field_risks/booster-seat
Safe Ride News Publications: www.saferidenews.com
National Child Passenger Safety Board: www.cpsboard.org
SafetyBeltSafe U.S.A.: www.carseat.org/
University of Michigan Transportation Research Institute: www.cpsbestpractice.org
Key terms
•
•
•
•
•
•
•
CIOT: NHTSA’s Click It or Ticket high-visibility seat belt enforcement campaign.
CPS: Child Passenger Safety
HVE: High-Visibility Enforcement
LATCH: Lower Anchors and Tethers For Children
NCRUSS: The National Child Restraint Use Special Study. A NHTSA observational
study of the use of car seats and booster seats for child passengers.
Primary enforcement seat belt use laws permit LEOs to stop and cite a violator
independent of any other traffic violation. Child Passenger Safety laws are primary,
unless they are covering older children in the rear seat.
Secondary enforcement laws allow LEOs to cite violators only after they first have been
stopped for some other traffic violation.
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Chapter 2. Seat Belts and Child Restraints
Seat Belt and Child Restraint Countermeasures
Countermeasures to increase seat belt and child restraint use are listed in the table below. The
table is intended to provide a rough estimate of each countermeasure’s effectiveness, use, cost,
and time required for implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to increase seat belt and child restraint use is discussed individually in this
chapter. Full descriptions are included for , and
countermeasures. Brief descriptions are included for ✩ and ✩✩ countermeasures. Further
details about the ✩ and ✩✩ countermeasures are included in Appendix A2 to this report.
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Chapter 2. Seat Belts and Child Restraints
Countermeasures Targeting Adults
1. Seat Belt Use Laws
Countermeasure
1.1 State Primary Enforcement Seat Belt Use
Laws
1.2 Local Primary Enforcement Seat Belt Use
Laws
1.3 Increased Seat Belt Use Law Penalties
Effectiveness
†
Cost
Use
Time
$
Medium
Short
$
Low
Short
$
Low
Short
†Effectiveness has been demonstrated for increased fines but has not yet been demonstrated for driver’s
license points.
2. Seat Belt Law Enforcement
Countermeasure
Effectiveness
Cost
Use
Time
2.1 Short Term, High-Visibility Seat Belt Law
Enforcement
$$$
Medium†
Medium
$$$
Unknown
Medium
Varies
Unknown
Varies
Cost
Use
Time
Varies
Medium
Medium
Unknown
Unknown
Medium
Effectiveness
Cost
Use
Time
$
High
Short
Cost
Use
Medium
Time
2.2 Integrated Nighttime Seat Belt Enforcement
2.3 Sustained Enforcement
†Used
in many jurisdictions but often only once or twice each year
3. Communications and Outreach
Countermeasure
3.1 Supporting Enforcement
3.2 Strategies for Low-Belt-Use Groups
†For programs supporting enforcement
Effectiveness
†
Countermeasures Targeting Children and Youth
4. Child/Youth Occupant Restraint Laws
Countermeasure
4.1 Strengthening Child/Youth Occupant
Restraint Laws
5. Child Restraint/Booster Seat Law Enforcement
Countermeasure
5.1 Short High-Visibility CR Law Enforcement
Effectiveness
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$$$
Medium
Chapter 2. Seat Belts and Child Restraints
6. Communications and Outreach
Countermeasure
Effectiveness
6.1 Strategies for Older Children
6.2 Strategies for Child Restraint and Booster
†
Seat Use
† For stand-alone programs not supporting enforcement
Cost
Varies
Use
Unknown
Time
Medium
Varies
Unknown
Medium
Cost
Use
Time
Varies
Unknown
Varies
$$
High
Short
7. Other Strategies
Countermeasure
Effectiveness
7.1 School-Based Programs
7.2 Inspection Stations
Effectiveness:
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
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Chapter 2. Seat Belts and Child Restraints
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 2. Seat Belts and Child Restraints
Countermeasures Targeting Adults
1. Seat Belt Use Laws
1.1 State Primary Enforcement Seat Belt Use Laws
Effectiveness:
Cost: $
Use: Medium
Time: Short
Primary enforcement seat belt use laws permit LEOs to stop and cite violators independent of
any other traffic violation. Secondary enforcement laws allow LEOs to cite violators only after
they first have been stopped for some other traffic violation.
Use: As of June 2019 there were 34 States and the District of Columbia that had primary belt use
laws and 15 States had secondary enforcement laws. Only New Hampshire had no belt use law
applicable to adults (GHSA, 2019a; IIHS, 2019a). However, some States only have primary
enforcement for certain occupants (for instance drivers or people older than a specified age) and
secondary enforcement for other occupants (for example, North Carolina’s seat belt law is
primary for drivers and front seat passengers 16 and older but secondary for rear seat passengers
16 and older). Twenty States do not have laws requiring the use of seat belts in the rear seat
(GHSA, 2019a). More information on the effect of having no rear seat belt requirement is
included in the “Other Issues” section below.
Effectiveness: In 2019 belt use averaged 92.0% in the 34 States and District of Columbia with
primary belt laws and 86.2% in States with secondary or no enforcement laws (NCSA, 2019).
Nichols, Tippetts, et al. (2010) examined the relationship between the type of seat belt law
enforcement and seat belt use from 1997 to 2008. Compared with secondary laws, primary laws
were associated with a higher observed seat belt use (10 to 12% higher) and higher seat belt use
among front-seat occupants killed in crashes (9% higher).
The 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%
compared to secondary laws. Similarly, Nichols et al. (2014) found that primary enforcement
laws were associated with a 9- to 10-percentage-point increase in belt use. In another study,
Farmer and Williams (2005), found that passenger vehicle driver death rates dropped by 7%
when States changed from secondary to primary enforcement. However, the findings from a
recent analysis of crash fatalities suggest that the safety benefits of upgrading to a primary law
from a secondary law may not be as great as in earlier periods when seat belt use was lower and
implementing primary laws resulted in more reductions in crash fatalities specifically associated
with increased seat belt use (Harper & Strumpf, 2017). One possible explanation is that recent
improvements in road and vehicle safety, in addition to the reduction in VMT post 2008, have
reduced the proportion of fatal crashes that could benefit from increased belt use. It should be
noted that the analysis did not account for before-and-after belt use rates in the States, which also
may have contributed to the smaller observed benefits.
Research has provided strong support that changing from secondary to primary enforcement seat
belt laws increases occupant seat belt use during the nighttime hours as well as the daytime hours
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Chapter 2. Seat Belts and Child Restraints
(Chaudhary et al., 2010; Masten, 2007). Chaudhary et al. (2010) evaluated the effects of Maine's
change from secondary to primary enforcement of their seat belt law. Observational surveys
conducted over an 18-month period after this change went into effect measured increases in seat
belt use from 77% to 84% during the daytime and from 69% to 81% at night.
Hedlund et al. (2008) studied the effects of primary law changes on seat belt use and occupant
fatalities in Michigan, New Jersey, Washington, Delaware, Illinois, and Tennessee. Strong
evidence was found that primary seat belt laws increase seat belt use. Furthermore, statistically
significant decreases in the number of front-seat passenger vehicle occupant fatalities were found
in Michigan and Washington and the decrease in New Jersey was marginally significant. The
lack of significant effects on fatalities in Illinois and Tennessee, as well as a marginal increase in
Delaware, was attributed in part to the short amount of time since the implementation of the
primary provisions in these States as well as the small number of fatalities in Delaware.
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 may be low if the media covers 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
unless it has a delayed effective date, however it could include a warning period before
enforcement is authorized.
Other issues:
• Partial coverage seat belt laws: 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. However, belt use laws do not cover adult rear seat
passengers in 20 States (GHSA, 2019a). The National Occupant Protection Use Survey
(NOPUS) found higher observed rear seat belt use in States with belt laws covering all
seating positions than in States not requiring rear seat belt use (84.3% and 62.7% in 2017,
respectively) (Li & Pickrell, 2019). An analysis of Iowa, which has primary laws for
front-seat passengers but no law for rear-seat passengers, found that occupants reported
using seat belts 30 to 40% less often if they were a passenger in the rear than in the front
(Reyes et al., 2014). This is consistent with findings obtained using household survey
data from the ConsumerStyles 2012 database (Bhat, Beck, Bergen, & Kresnow, 2015).
Most States’ laws exempt some vehicles, such as those designed for more than 10
passengers, taxis, emergency vehicles, postal delivery vehicles, farm vehicles, pickup
trucks, or vehicles not required to have seat belts (Glassbrenner, 2005). Some States
exempt passengers for specified medical or physical reason. A good seat belt use law
should be comprehensive, covering all seating positions equipped with a seat belt in all
passenger vehicles (ACTS, 2001; NCUTLO, 2000; NHTSA, 2003). Such a law sends a
clear and consistent message to the public.
• Opposition to primary seat belt laws: Opponents of primary seat belt use laws claim
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Chapter 2. Seat Belts and Child Restraints
•
•
that primary laws impinge on individual rights and provide opportunities for law
enforcement to harass minority groups (St. Louis et al., 2011). 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; Tison et al., 2011). 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 (Eby et al., 2004). 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.
Effect on low-seat-belt-use groups: Studies in States that changed their laws 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 impaired drivers, than for all occupants (Shults et al.,
2004). This was also found in Florida where the greatest gains were among males,
African Americans, pickup truck occupants, younger occupants, and those on local roads
(Nichols et al., 2012).
Impact of regional characteristics on effectiveness of primary seat belt laws:
Research suggests that primary seat belt laws may be less effective in regions with certain
economic, societal, and cultural characteristics. Specifically, there is initial evidence that
primary seat belt laws were only associated with higher belt use rates in States that had
higher levels of academic achievement and higher health rankings (Ash et al., 2014).
Moreover, primary law States that had a high proportion of rural roads relative to urban
roads were also associated with no significant increase in seat belt usage in comparison to
States with secondary seat belt laws.
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Chapter 2. Seat Belts and Child Restraints
1.2 Local Primary Enforcement Seat Belt Use Laws and Ordinances
Effectiveness:
Cost: $
Use: 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. Note that this option is not
available in all States.
Use: No comprehensive data are available on how many communities have primary laws, but
local implementations have occurred in States such as Missouri (Missouri Department of
Transportation, 2017).
Effectiveness: St. Louis County, Missouri, implemented a primary seat belt use ordinance in
March 2007. Following implementation of this ordinance, the St. Louis County Police
Department conducted an intense HVE campaign, accompanied by publicity in the form of
variable message boards and permanent road signs, along an 8-mile corridor on State Highway
21. Observational surveys were conducted along the Highway 21 corridor and a control site prior
to the start of the enforcement and immediately after its conclusion. The observational surveys
measured increases in belt use from 83% to 88% along the Highway 21 corridor and a small,
59% to 57% decrease in belt use along the control corridor (Nichols, Solomon, et al., 2010).
The limited available evidence and extrapolation from the effectiveness of primary seat belt
enforcement laws at the State level suggest that this countermeasure should work at the local
level (Lucke et al., 2004).
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, however it could include a warning period before enforcement is authorized. 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.
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Chapter 2. Seat Belts and Child Restraints
1.3 Increased Seat Belt Use Law Penalties: Fines and Driver’s License Points
Cost: $
Use: Low
Time: Short
Effectiveness: †
†Effectiveness has been demonstrated for increased fines but has not yet been demonstrated for driver’s
license points
Penalties for most seat belt use law violations are low. As of January 2019, a violation resulted in
a typical fine of $25 or more in all but 14 States (IIHS, 2019b). Low fines may not convince
nonusers to buckle up and may also send a message that seat belt use laws are not taken
seriously. Some States use higher fines for first time offenders, with a maximum fine of $200 in
Texas (IIHS, 2019b).
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 in a
specified period of time.
Use: As of May 2019 there were 14 primary law States in addition to the District of Columbia
and 2 secondary law States that had maximum fines of $30 or more for at least some occupants
(IIHS, 2019b). New Mexico and the District of Columbia assessed driver license points for all
seat belt law violations and 11 States assessed points for violations of child safety seat laws.
Effectiveness: The effect of driver’s license points on seat belt use has not been evaluated.
Houston and Richardson (2006) studied the effects of seat 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 seat belt use.
Nichols, Tippetts, et al. (2010 and 2014) examined the relationship between seat belt violation
fines and seat belt use and found that increasing fines was associated with increased seat belt use.
Increasing a State’s fine from $25 to $60 was associated with increases of 3% to 4% in both
observed seat belt use and belt use among front-seat occupants killed in crashes, an effect that
was additive with increases attributed to the type of seat belt law. Increasing the fine from $25 to
$100 was associated with increases of 6% to 7% for these measures; however, there were
diminishing returns for fines above this amount (Nichols, Tippetts, et al., 2014).
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 (around $25 or less), then they may have little
effect. If they are excessively high, then LEOs may be reluctant to issue citations and
judges may be reluctant to impose them. States should choose penalty levels that strike an
appropriate balance.
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Chapter 2. Seat Belts and Child Restraints
•
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.
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Chapter 2. Seat Belts and Child Restraints
2. Seat Belt Law Enforcement
2.1 Short-Term, High-Visibility Seat Belt Law Enforcement
Cost: $$$
Use: Medium†
Effectiveness:
† Used in many jurisdictions but often only once or twice each year
Time: Medium
The most common high-visibility seat belt law enforcement method consists of short (typically
lasting 2 weeks), intense, highly publicized periods of increased belt law enforcement, frequently
using checkpoints (in States where checkpoints are permitted), saturation patrols, or enforcement
zones. This short-duration seat belt enforcement method was developed in Canada in the 1980s
(Boase et al., 2004) and demonstrated in several U.S. communities (Williams & 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 HVE model is described in detail in
Solomon et al. (2003 and 2007).
All HVE programs include communications and outreach strategies that use some combination
of earned media (e.g., news stories and social media) and paid advertising. Communications and
outreach can be conducted at local, State, regional, or national levels.
Use: Most States currently conduct short-term, high-visibility belt law enforcement programs in
May of each year as part of national seat belt mobilizations (Nichols, Chaffee, Solomon, &
Tison, 2016). Some States also conduct seat belt mobilizations in November. NHTSA has
supported these campaigns. More than 10,000 LEAs took part in the May 2017 campaign
(NHTSA, 2018). See Milano et al. (2004) for a detailed account of the history and evolution of
the national campaigns and NHTSA (2016) for a timeline of use over time.
Effectiveness: Hedlund et al. (2008) compared 16 States with high seat belt rates and 15 States
with low seat belt rates. The single most important difference between the two groups was the
level of enforcement (how much enforcement), rather than demographic characteristics or the
amount spent on media. High-belt-use States issued twice as many citations per capita during
their Click It or Ticket campaigns as low-belt-use States. Level of enforcement is also related to
type of seat belt law. Nichols, Chaffe, Solomon, and Tison (2016) found that law enforcement in
primary belt use law States issued more seat belt citations in the 2013 campaign than did law
enforcement in secondary belt use law States.
The CDC’s systematic review of 15 high-quality studies (Dinh-Zarr et al., 2001; Shults et al.,
2004) found that short-term, HVE programs increased belt use by about 16 percentage points,
with greater gains when pre-program belt use was lower. Because many studies were conducted
when belt use rates were considerably lower than at present, new programs likely will not have
as large an effect. Following the enforcement program, belt use often dropped by about 6
percentage points demonstrating the ratchet effect typical of these programs (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).
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Chapter 2. Seat Belts and Child Restraints
Media plays an instrumental role in HVE campaigns. The May 2002 Click It or Ticket campaign
evaluation demonstrated the effect of different media strategies used in conjunction with
enforcement (Solomon, Ulmer, & Preusser, 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 only 0.5
percentage points across 4 States that used no paid advertising. From 2008 to 2013 National
funding for the Click it or Ticket campaign remained steady at $8 million per year, while State
funding for the campaign dropped from $16 million to $11 million per year (Nichols, Chaffe,
Solomon, & Tison, 2016). Even though less funding was used to support the media portion of the
program, the effect of repeating the CIOT campaign yearly acts as a booster shot for seat belt use
awareness and behavior change. This is demonstrated by looking at indicators during that same
period, i.e., CIOT tagline recognition increased from 73% to 83%, seat belt citations per 100,000
people dropped from 19 to 12 among reporting jurisdictions, and national observed daytime belt
use increased from 83% to 87%.
Smaller-scale campaigns limited to a single travel corridor can yield a short-term improvement
in observed seat belt usage along the corridor, but the effects appear to be limited to the
enforcement area. Specifically, an HVE campaign conducted along a route frequented by
commuters used inexpensive roadway signs and magnetic message strips on enforcement
vehicles in the corridor, but only a press release was available to residents in a nearby city, which
was typically the destination for commuters (Elliot et al., 2014). Although observed belt use
improved significantly in the corridor, observed belt use and overall awareness of the seat belt
campaign was unchanged in the nearby city. A likely explanation for this difference is lack of
exposure to the location-specific campaign, since most respondents from the city reported
traveling the route less than once a month.
Since 2002 and especially after 2003, there has been a history of using extensive paid advertising
both nationally and in States to support the Click it or Ticket campaign with clear enforcement
images and messages (Milano et al., 2004). The 2013 Click It or Ticket (CIOT) campaign used
extensive paid advertising ($8 million nationally and $11 million in individual States). National
observed seat belt use following CIOT was statistically unchanged from 2012 to 2013 (86% and
87%, respectively). While the effect of CIOT on observed belt use cannot be isolated from the
effect of other interventions, national observed seat belt use increased from 79% to 87% over 11
years of CIOT activity (2003 – 2013) (Nichols, Chaffe, & Solomon, & Tison, 2016).
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 LEOs to conduct the enforcement. Paid advertising increases a
campaign’s effectiveness, but can be quite expensive. In the average State, paid advertising costs
were nearly $350,000 for the 2007 campaign (Solomon, Preusser, Tison, & Chaudhary, 2009).
More recently, the 2013 Click It or Ticket campaign used extensive paid advertising ($8 million
nationally and $11 million in individual States) (Nichols, Chaffe, & Solomon, & Tison, 2016).
Time to implement: An HVE program (including media) requires 4 to 6 months to plan and
implement.
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Chapter 2. Seat Belts and Child Restraints
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 with the primary law
States having had higher use rates before the campaigns (Solomon et al., 2003).
NHTSA’s evaluation of the 2004 Click It or Ticket campaign 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 et al., 2007). NHTSA examined the effect of enforcement in the 2012 Click It
or Ticket campaign and found that citations per 10,000 residents were twice as high in
States with primary laws (16 citations versus 8 citations) as those with secondary laws
(Hinch, Solomon, & Tison, 2014). The authors suggested that increasing citations in
secondary States (when drivers are stopped for other violations) could be an opportunity
to increase belt use.
• Effects on low-belt-use groups: The CDC’s systematic review observed that short-term,
HVE campaigns increased belt use more among traditionally lower-belt-use groups,
including young drivers, rural drivers, males, African Americans, and Hispanics (Shults
et al., 2004). See Chapter 2, Section 3.2 for further discussion on strategies to reach lowbelt-use groups. Similarly, a more recent study also found that increases in observed seat
belt use in an enforcement area were greatest among the groups that had the lowest
baseline usage rates, such as males, passengers, and drivers of pickup trucks (Elliot et al.,
2014).
• Nighttime programs: A three-year high-visibility nighttime seat belt enforcement
program conducted in Maryland successfully raised nighttime seat belt use (Retting et al.,
2018). This program included five waves of HVE coupled with extensive paid and earned
media campaigns. The primary message of the ad campaign was that “Cops are cracking
down on seat belt violations, especially at night.” Driver awareness of the seat belt
enforcement increased significantly during the HVE period. Furthermore, despite the fact
that seat belt use rates were already high in this region (90-95%), there was a small but
significant increase in observed nighttime seat belt use in three of the five waves when
compared to a pre-HVE period. Control sites showed no changes in nighttime belt use
across the same timeframe. A similar pattern was observed with unbelted injury crashes
at night. These rates dropped at HVE sites when compared to the pre-HVE period and
control sites showed no change in crash rates. Similar to the Washington program,
nighttime unbelted drivers were more likely to have poorer driving records and more
prior citations for speeding, negligent/reckless driving, license-related offences, and
crashes.
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Chapter 2. Seat Belts and Child Restraints
2.2 Integrated Nighttime Seat Belt Enforcement
Effectiveness:
Cost: $$$
Use: Low
Time: Medium
Short-term, high-visibility seat belt law enforcement programs (Chapter 2, Section 2.1) require
substantial funding and law enforcement resources. In addition, some States have experienced
smaller gains in seat belt use associated with enforcement campaigns after conducting them for
several years (Nichols & Ledingham, 2008). These programs also have been conducted almost
exclusively during daytime, and the available data suggest that belt use is lower at night
(Chaudhary et al., 2005; Hedlund et al., 2004; Nichols & Ledingham, 2008).
In 2018 some 56% of passenger vehicle occupants killed in crashes at night were unrestrained
(NCSA, 2020b). In contrast, 39% of fatally injured passenger vehicle occupants in daytime
crashes were unrestrained. Furthermore, nighttime seat belt use among passenger vehicle
occupants killed was on average 17 percentage points lower than daytime belt use, according to
FARS data for the 10-year period from 2009 to 2018.
Although some data suggest that more emphasis on seat belt enforcement during the late-night
hours and in conjunction with alcohol laws can provide additional gains in seat belt use and
injury reduction (Nichols & Ledingham, 2008), more recent evaluations have shown mixed
results (Nichols, Chaffe, & Solomon, 2016; Thomas et al., 2017). In theory, retaining the shortterm, high- intensity enforcement model, but including other traffic safety issues such as DWI
and excessive speed, could be effective since the same drivers tend to drink, speed, and not
buckle up (Nichols, Chaffe, & Solomon, 2016). 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. Enforcement
should be conducted in locations with adequate lighting or by using light enhancing
technologies. The first demonstration of this strategy took place in 2004 in Reading,
Pennsylvania (Chaudhary et al., 2005). See Chapter 1, Section 2.5 “Integrated Enforcement” for
further discussion on combined seat belt and alcohol enforcement.
Use: There is little information available on how frequently integrated nighttime, HVE strategies
are used. One demonstration of a nighttime program in Pennsylvania was conducted in 2004
(Chaudhary et al., 2005), another demonstration program involving three North Carolina
communities was conducted in 2007 (Solomon et al., 2009), Washington State conducted a 2year statewide high-visibility nighttime seat belt enforcement program from May 2007 to May
2009 (Thomas et al., 2010), and Oklahoma, Tennessee, and Maryland conducted enforcement
waves from 2011 to 2013 (Nichols, Chaffe, & Solomon, 2016; Retting et al., 2018).
Effectiveness: A 2004 nighttime high-visibility belt enforcement program in Reading,
Pennsylvania, increased nighttime front-seat-occupant belt use by 6 percentage points, from 50%
to 56%. Daytime belt use increased by 3 percentage points, from 56% to 59% (Chaudhary et al.,
2005).
A 2007 evaluation of three HVE demonstration programs designed to improve nighttime seat
belt use in three communities – two in North Carolina with a primary seat belt law and one in
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Chapter 2. Seat Belts and Child Restraints
West Virginia with a secondary law – concluded that nighttime high- visibility seat belt law
enforcement programs can be effective for increasing nighttime belt use (Solomon, Chaffe, &
Preusser, 2009). Furthermore, roadside breath tests used to collect BAC measures in one North
Carolina community reported that the program also decreased drinking and driving.
A detailed evaluation of the Washington nighttime seat belt enforcement program found that it
was effective across outcome measures (Thomas et al., 2017). The program used a combination
of HVE and both paid and earned media. Public surveys reported that 70% of motorists reported
hearing or seeing campaign messages and noticed increased enforcement. Over the course of the
program, observed daytime and nighttime seat belt use levels trended upwards from initially high
levels, with a larger increase occurring for nighttime use (from around 95% to 97% at night).
Additional time-series analyses of crash data found that the program was associated with 3.4
fewer nighttime fatalities per month, even after accounting for the effects associated with the
State adopting primary seat belt enforcement prior to the program. An evaluation of the first year
of this Washington program also looked at the characteristics of observed drivers (through selfreport, driving, and criminal records) finding notable differences between unrestrained and
restrained drivers by time of day (Thomas et al., 2010). For example, unrestrained nighttime
drivers were 2.7 times more likely than restrained daytime drivers to have had a felony arrest and
3.0 times more likely to have had an alcohol citation. As part of the outcome evaluation,
debriefings with local LEAs reported that enforcement personnel felt that the publicity campaign
enhanced their efforts and that they would recommend the program to other agencies.
An evaluation study examined the effectiveness of the More Cops More Stops (MCMS) HVE
program implemented in Oklahoma and Tennessee (Nichols, Chaffe, & Solomon, 2016). The
program addressed traffic safety issues with one integrated message. The MCMS program
covered impaired driving, seat belt, and speeding enforcement under a single message. During
four of the six campaign waves, MCMS activity was accompanied by Click It or Ticket (CIOT)
or Drive Sober or Get Pulled Over (DSOGPO) statewide campaigns. The effectiveness of the
MCMS program was limited. While there were some positive outcomes in terms of increased
recognition of the MCMS slogan and some increases in awareness of general traffic
enforcement, overall driver perceptions of the risk of a traffic stop did not increase. The
integrated program (i.e., MCMS plus statewide campaigns) likely had an impact on seat belt
usage, although observational surveys provided little evidence that the MCMS phases yield gains
above and beyond that associated with the statewide campaigns. However, one of the five market
areas (Memphis) experienced a significant increase in daytime and nighttime seat belt usage.
While the evaluation did find some positive outcomes associated with the overall program
(MCMS plus statewide), the evaluation found no evidence of MCMS being an effective tool for
enhancing the effect of the CIOT and DSOGPO statewide campaigns. An additional
consideration was that the MCMS integrated program was taxing on law enforcement, and
challenging to maintain for the full program duration.
Costs: The costs of combined HVE 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 LEOs must have the training and equipment to
address different offenses. Nighttime programs may entail somewhat higher costs if new nightvision technology is used.
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Time to implement: Integrated and nighttime HVE programs require 4 to 6 months to plan and
implement.
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2.3 Sustained Enforcement
Effectiveness:
Cost: Varies
Use: Unknown
Time: Varies
Some jurisdictions, including California, Illinois, Kentucky, Oregon, and Washington, enforce
their belt use laws vigorously as part of customary traffic enforcement .
Use: The extent of vigorous sustained belt law enforcement, with or without extensive publicity,
is unknown.
Effectiveness: There are few studies of the effectiveness of sustained enforcement (Hedlund et
al., 2004). California and Oregon, States that are reported to use sustained enforcement, have
recorded statewide belt use well above national belt use rates since 2002 (seat belt use rates for
2002 to 2019 - California: 91 to 96% and Oregon: 88 to 96% versus nationwide: 75 to 91%)
(NCSA, 2007: NCSA, 2020a).
Nichols and Ledingham (2008) conducted a review of the impact of enforcement, as well as
legislation and sanctions, on seat belt use over the past two decades and concluded that sustained
enforcement (implemented as a component of regular patrols or as special patrols) is as effective
as “blitz” enforcement (short-term, HVE) and unlike blitz campaigns, is not usually associated
with abrupt drops in belt use after program completion.
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.
Time to implement: Sustained enforcement by LEOs can be implemented once the LEA
develops and implements a sustained seat belt enforcement plan. Extensive publicity will take 3
or 4 months to plan and implement initially, but this time will decrease once the program has
been implemented for some period of time.
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Chapter 2. Seat Belts and Child Restraints
3. Communications and Outreach
3.1 Supporting Enforcement
Effectiveness:
Cost: Varies
Use: Medium
Time: Medium
Effective, high-visibility communications and outreach are an essential part of successful seat
belt law HVE programs (Solomon et al., 2003). 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 HVE programs include communications and outreach strategies that use some
combination of earned media (news stories, social media) and paid advertising. Communications
and outreach can be conducted at local, State, regional, or national levels.
Effectiveness: 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 to 2003. While the campaign is still used
widely, there have not been recent effectiveness evaluations that consider communications and
outreach changes such as the prevalence of social media and changing media mode shares.
Costs: Paid advertising can be expensive. On average participating States’ paid advertising costs
were about $2,200,000 for the 2013 campaign (Nichols, Chaffe, Solomon, & Tison, 2016).
Time to implement: An effective media campaign requires 4 to 6 months to plan and
implement.
Other Issues:
• Social media: NHTSA and some States use social networking sites to reach the general
public with messages concerning seat belt use. Although sites such as Facebook, Twitter,
and YouTube can effectively and inexpensively reach large numbers of people, there are
no evaluations of seat belt use campaigns that use this approach. The CDC offers tools to
help with using social media, including a social media toolkit and guide for writing social
media (www.cdc.gov/socialmedia/tools/guidelines). In addition, there is information
available on NHTSA’s traffic safety marketing website
(www.trafficsafetymarketing.gov/marketing-tools/social-media).
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3.2 Strategies for Low-Belt-Use Groups
Effectiveness: †
programs supporting enforcement
Cost: Varies
Use: Unknown
Time: Medium
† For
Nationally in 2018, daytime seat belt use was at 89.6%, with 47 States and the District of
Columbia having seat belt use at 80% or higher (NCSA, 2020a). This indicates the large majority
of drivers and passengers are wearing their seat belts during daytime hours; however, there
remains a proportion of the population who still do not buckle up regularly.
Generally, seat belt use rates for male occupants are lower than rates for female occupants,
87.7% and 92.0% respectively in 2018 (Enriquez, 2019). This trend has been evident since at
least 2005. Similarly, belt use rates for occupants 16 to 24 tend to be lower than the use rates of
other age groups. In 2018 belt use was 91.3% for occupants 8 to 15, 87.6% for occupants 16 to
24, 89.5% for occupants 25 to 69, and 92.4% for those occupants 70 and older. Since 2005, belt
use rates for Black occupants have been lower than use rates for members of other races. In 2018
belt use for Black occupants was 85.5% compared to 89.7% among White occupants, and 92.6%
among members of other races. Additionally, NHTSA’s 2019 National Occupant Protection Use
Survey reported belt use was lower for front seat passengers (89.8%) compared to drivers
(90.9%), and pickup truck occupants (85.6%) compared to occupants of passenger cars (91.2%)
and vans/SUVs (92.5%) (NCSA, 2019). NHTSA’s 2007 national Motor Vehicle Occupant
Safety Survey (MVOSS) found the same patterns with males, young drivers, rural drivers, and
pickup truck drivers-all reporting lower seat belt use (Boyle & Lampkin, 2008). An in-depth
examination conducted in Louisiana of driver factors underlying self-reported seat belt use found
that, in addition to demographic factors, driver motivations and habits were strong correlates of
belt use (Schneider et al., 2017). Internal (want to) and external (have to) motivations to wear a
seat belt along with having a well-formed habit of buckling early in a trip were associated with
100% belt use. Motivated drivers who were nevertheless inconsistent seat belt users typically
lacked well-formed seat belt use habits and routines.
Most non-seat belt users report wearing seat belts at least some of the time. In NHTSA’s 2007
national MVOSS, only 1% of drivers said they never used their seat belts and another 1% said
they rarely used seat belts (Boyle & Lampkin, 2008). Passenger seat belt use also appears to be
strongly associated with driver belt use (Han, 2017). The most frequent reasons given by drivers
for not wearing a belt were that they: were only driving a short distance (59%), forgot (52%),
were in a rush (39%), or they found the belt uncomfortable (35%) (Boyle & Lampkin, 2008).
Drivers were able to give more than one reason for not wearing a belt so the percentages do not
add up to 100%.
Riding as a backseat passenger is another factor that affects seat belt use. In one survey, 72%
said they always use their belt in the back seat, compared to 91% who said they always use their
belt when seated in front (IIHS, 2017). A recent analysis of data from the 2016 MVOSS found
that 63% of rear-seat passengers reported being full-time users, 26% reported being part-time
users, and 11% reported being non-users (Spado et al., 2019). The factors that had the strongest
association with rear belt use included support for rear-belt laws, using a belt in the front seat,
and belief that their State has a rear-belt law.
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Use: Communications and outreach campaigns directed at low-belt-use groups are common, but
no summary is available.
Effectiveness: Communications and outreach campaigns directed at low-belt-use groups have
been demonstrated to be effective for targeted programs that support, and are supported by,
enforcement. The effectiveness of stand-alone programs not supported by enforcement is
unclear, though North Dakota has demonstrated success with its 2003 “Pick Up the Habit for
Someone You Love” campaign (North Dakota DOT, 2004).
Trauma Nurses Talk Tough, originally developed in Oregon in 1988, is a seat belt diversion
program implemented by trauma nurses in a hospital setting that targets drivers who have been
ticketed for not wearing a seat belt. The program was implemented in Robeson County, North
Carolina, a diverse county whose seat belt rates were consistently lower than the rest of the State.
Those who went through the program were more likely to have a positive outlook on the use of
seat belts. Following the program, observed seat belt use increased significantly in the county at
8 survey locations (from 81% to 86%) and 2 additional sites (from 69% to 78%) (NHTSA,
2014b; Thomas et al., 2014).
Demonstration programs conducted in Kentucky, Mississippi, North Dakota, and Wyoming from
2004 to 2007 sought to increase seat belt use through a variety of innovative approaches. The
primary method employed by Mississippi, North Dakota, and Wyoming was to target low- beltuse counties for additional enforcement and enforcement focused publicity. The seat belt laws in
Kentucky and Mississippi were also upgraded from secondary to primary enforcement during the
demonstration programs. All 4 States achieved significant statewide increases in belt use above
baseline belt use rates (Blomberg et al., 2009).
A variety of low-belt use groups have been targeted by countermeasure efforts. These are
discussed in separate sections below.
Young Males: High-visibility enforcement programs generally have been effective in increasing
belt use (see Chapter 2, Section 2.1; Shults et al., 2004). Their publicity messages and placement
can be directed at specific lower-belt-use groups. The 2013 Click It or Ticket campaign targeted
18- to 34-year old males and found they showed greater increases in awareness of seat belt
enforcement activity and seat belt checkpoints than the general population (14% versus 10% for
seat belt enforcement and 10% versus 7% for seat belt checkpoints, respectively) (Nichols,
Chaffe, Solomon, & Tison, 2016).The target group did not show significant increases in
awareness of the CIOT slogan (5%), messages to buckle up (6%), or perceived risk of a ticket
(6%), while the general population showed significant increases in these indices (6%, 8%, and
5%, respectively). The small sample size for the target group may have contributed to not finding
significant increases among this group for some indices.
Pickup Truck Drivers: The 5 States of NHTSA’s Region 6 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
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rollover crashes. The campaign spent nearly $600,000 for paid advertising in the 5 participating
States. Surveys at the end of the campaign, before any enforcement-based Click It or Ticket
publicity, showed that belt use among pickup truck occupants increased by about 2 percentage
points. Following the Click It or Ticket publicity, belt use among pickup truck occupants
increased by another 6 percentage points (Solomon, Chaffe, et al., 2007).
In a November 2004 follow-up study, an intensive campaign using the same Buckle Up in Your
Truck message was conducted in Amarillo, Texas. The campaign used paid advertising
emphasizing belt law enforcement as well as earned media featuring local LEOs. 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 et al., 2007).
Iowa, Kansas, Missouri, and Nebraska (in NHTSA’s Region 7) implemented a similar Buckle Up
in Your Truck program in May 2006 and 2007. The campaign sought to increase seat belt use
among pickup truck occupants by focusing on the dangers of riding unbuckled and increasing
awareness of ongoing enforcement efforts. Following this campaign, these States also conducted
statewide Click It or Ticket campaigns that included additional paid media and enforcement
directed at occupants of all vehicle types. The Buckle Up in Your Truck campaign did increase
the awareness of “buckle up in trucks” messages, but in terms of observed seat belt use, the Click
It or Ticket campaign had the greater effect (Nichols et al., 2009).
North Dakota’s Pick Up the Habit for Someone You Love campaign in 2003 provides one of the
few examples 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% 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) (North Dakota DOT, 2004). The
program increased observed belt use of male pickup drivers by 7 percentage points at a total cost
of $295,000.
The North Dakota and Amarillo campaigns are well-documented examples of successful
programs that target low-belt-use groups. 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, but Kentucky (67% to 76%
statewide), Mississippi (58% to 65% in targeted counties), North Dakota (66% to 80% in
targeted counties), and Wyoming (55% to 70% in targeted counties) were able to achieve
significant increases in seat belt use through their programs (Blomberg et al., 2009).
Rural Drivers: NHTSA’s Region 5 implemented a Rural Demonstration Program (RDP) prior
to the May 2005 Click It or Ticket mobilization. The goal of the RDP was to evaluate strategies
for increasing seat belt usage in rural areas. Paid media was used to notify rural residents that
seat belt laws were being enforced. Active enforcement was included during the initial phase in 3
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of the six Region 5 States (Illinois, Indiana, Ohio), but only the paid media component was
implemented in the remaining three States (Minnesota, Michigan, Wisconsin). During the
Demonstration Project phase, States that had intensified enforcement had significant increases in
usage in their targeted rural areas (Nichols et al., 2007). All six Region 5 States intensified
enforcement during the Click It or Ticket mobilization, but States that had intensified
enforcement during the Demonstration Project showed substantially greater overall statewide
gains during the Click It or Ticket phase than did the States that had not intensified enforcement
during the RDP.
More recent evaluations of rural programs following the HVE model have yielded mixed results.
An evaluation of Rural Initiatives conducted in Missouri and Kansas showed positive outcomes
(Thomas & Blomberg, 2016). These States ran multi-wave HVE campaigns focused on rural
counties from Spring 2009 to Spring 2010. The evaluations reported that seat belt use in the rural
Missouri counties increased from 66.4% to 69.2%, while seat belt use in the rural Kansas
counties increased from 61% to 70%. However, not all counties covered by the program
experienced significant increases. Driver awareness of the targeted seat belt safety messages also
increased following local media campaigns. A multi-state RDP that covered rural parts of
Florida, Georgia, and Tennessee was less successful (Nichols, Chaffe, Solomon, & Tison, 2016).
It included an HVE model paired with paid and earned media in four waves from November
2008 to May 2010, and it overlapped with annual CIOT campaigns. The RPD increased driver
awareness of rural seat belt messages and the perceived risk of getting a ticket for driving
unrestrained. Seat belt use increased in all three States but was only significantly greater than at
control locations in Georgia. Concurrent, statewide CIOT may have muted the differences
relative to control, and the greater effectiveness in Georgia may have been partially attributable
to the broader awareness among drivers of seat belt check points (Nichols, Chaffe, Solomon, &
Tison, 2016).
Native American Drivers: A multifaceted program was implemented on the Pine Ridge Indian
Reservation (PRIR) in South Dakota to address the reservation’s high proportion of fatal motor
vehicle crashes and chronically low seat belt use rates (Amiotte et al., 2016). Although the PRIR
was covered by an existing primary seat belt law adopted by the Oglala Sioux Tribe, the law was
rarely enforced by PRIR tribal courts and LEOs stopped issuing seat belts tickets. This
contributed to seat belt use rates that were as low as 10% across the PRIR. The program
implemented by the PRIR included data collection on belt use, increased policing resources and
enforcement, funding for a traffic court to enforce seat belt citations, funding for injury
prevention specialists to address child restraint usage, and outreach involving local media and
school programs. These efforts resulted in a 34% increase in observed seat belt use on the PRIR
between 2007 and 2013. Another study used similar multifaceted approaches for increasing child
restraint use in five tribal communities (Billie et al., 2016). Separate programs were run in each
community, and each included child restraint distribution and parent education, along with
varying combinations of increased citations, checkpoints, and enhanced media campaigns. These
efforts resulted in higher child restraint use rates in all five communities, with larger
improvements occurring in communities with low initial use rates. An important factor in the
success of these programs was tailoring the interventions to local communities and adapting
programming and media messages in culturally appropriate ways.
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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 4 to 6 months to plan and implement.
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Chapter 2. Seat Belts and Child Restraints
Countermeasures Targeting Children and Youth
4. Child/Youth Occupant Restraint Laws
4.1 Strengthening Child/Youth Occupant Restraint Laws
Effectiveness:
Cost: $
Use: High
Time: Short
Beginning with Tennessee, every State from 1978 to 1985 passed laws requiring children
traveling in motor vehicles to be restrained in child restraints appropriate for the child’s age and
size (Kahane, 1986). Today, State child restraint laws vary in terms of who is covered by the
law, the types of restraints required, and whether children are required to ride in the rear seat. In
some States, children as young as 5 may be restrained using the adult seat belt, while other State
laws require children up to age 9 or 80 pounds or 57 inches tall to be restrained in a child
restraint or booster seat (GHSA, 2019b; IIHS, 2019a, 2019b). Research has shown that laws
requiring a child restraint or booster seat for children 4 to 7 are associated with a decrease in
fatalities (Mannix et al., 2012).
In general, young children are usually covered by child restraint laws, while older children and
adults are covered by seat belt laws. However, in 4 States some children under 16 are covered by
neither law (IIHS, 2019a, 2019b). This seems to arise from the specific wording of laws in
certain States that exclude some young occupants (perhaps inadvertently) because of a particular
combination of age, height, or seating position. Most child passenger safety laws are primary;
however, most seat belt laws start coverage before a child reaches 18, so older children and teens
might be covered by a secondary enforcement seat belt law in some States. Research has found
that teens living in a secondary enforcement State are less likely to report wearing their seat belt
than teens living in primary enforcement States (Garcia-Espana et al., 2012). Strong occupant
restraint use laws should be comprehensive, covering all seating positions equipped with a seat
belt in all passenger vehicles (ACTS, 2001; NCUTLO, 2000; NHTSA, 2003). Such a law sends a
clear and consistent message to the public. NHTSA and partners have encouraged States to
expand their child restraint laws to include “booster” provisions that cover children until they are
big enough for the lap and shoulder belts to fit properly.
Use: As of November 2018, all but one State had enacted child restraint laws covering children
through at least age 5 (South Dakota’s law only covers children 4 and younger) (IIHS, 2019a,
2019b). However, a wide variation in age, height, and weight requirements exists among the
laws of the States (GHSA, 2019b; IIHS, 2019a, 2019b).
Effectiveness: Research conducted by Arbogast et al. (2009) found that transitioning children
from child restraints with harnesses to belt-positioning booster seats instead of vehicle seat belts
provides significant safety benefits for children at least through 8, and that belt-positioning
booster seats lower the risk of injury to children in crashes by 45% compared to the use of
vehicle seat belts alone. Some studies evaluated the effect of booster provisions in States’ laws
on booster seat use (Gunn et al., 2007). Observational surveys conducted in Washington State
before their booster seat law was expanded found that only 21% of children from ages 4 to 8
were using booster seats (Ebel et al., 2003). Following a new law requiring booster seats for
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Chapter 2. Seat Belts and Child Restraints
children weighing from 40 and 60 pounds or younger than 6 years old, observational surveys in
Washington State found close to half of children 4 to 8 years old in a booster seat (Stehr &
Lovrich, 2003). Similarly, an observational study of child restraint legislation in Canadian
provinces found that provinces with newly passed legislation saw booster/front-facing restraint
use increase to 54% from 26% previously (Simniceanu et al., 2014). However, during the same
period, provinces with existing legislation saw no increase (31% versus 30%). This suggests that
legislation on its own may be insufficient, and that the outreach, education, and enforcement
associated with new legislation play a vital role in increasing restraint use. Another Canadian
study found that a new booster-seat law was associated with a 10.8% reduction in motor-vehicle
injuries among children 4-8 (Brubacher et al., 2016). The National Survey of the Use of Booster
Seats found that booster seat use has remained relatively stable, despite the enactment of laws to
encourage the use of booster seats (Li & Pickrell, 2018b). Booster seat use by 4- to 7-year-olds
in 2017 was 40%, a non-significant change from 41% in 2006, the first year of the survey.
One study evaluated the effects of Tennessee’s “booster” provisions that added new
requirements for 4- to 8-year-olds in 2005 (Gunn et al., 2007). Pre- and post-law observational
survey data revealed a significant increase in booster seat use among 4- to 8-year-olds from 29%
to 39%. Decina et al. (2008) reported that an observational study conducted to evaluate a
demonstration program found a 9-percentage-point increase in the use of child restraints,
including booster seats, for children 4 to 8 following enactment of an enhanced child restraint
law (booster seat law) in Wisconsin. Similarly, a second evaluation of Wisconsin’s booster seat
law found that while total booster seat use did increase, the law did not impact all children
equally. Specifically, use of booster seats and proper use of booster seats varied among different
racial and socioeconomic groups suggesting that further study is needed of the effects of booster
seat legislation on all children (Brixey et al., 2011).
Several research studies (Fell et al., 2005; Margolis et al., 1996) have found restraint use levels
among children and teens covered by restraint use laws are higher than those not covered, and
that injury levels among children covered by child passenger safety laws are lower than children
not covered.
Costs: The costs of expanding a restraint use law to include all seating positions in all passenger
vehicles are minimal.
Time to implement: Expanded restraint use law coverage can be implemented as soon as the
law is enacted and publicized.
Other issues:
• Elements of child/youth occupant restraint laws: The scope and wording of these laws
may affect proper use of child restraints. An analysis of NASS-GES crashes involving
children in not-at-fault vehicles examined predictors of restraint use (Benedetti et al.,
2017). This study employed an “induced exposure” approach that approximates a random
sample in the driving population. The study found that children were more likely to ride
in the recommended type of restraint if their State’s child/youth occupant restraint law
followed best practices for child occupant protection (i.e., AAP, 2011). However, State
laws did not seem to affect whether or not a child was restrained at all. The strongest
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predictor of unrestrained children in this study was an unrestrained driver (see also
Raymond et al., 2018). This reinforces longstanding research findings of a direct
correlation between adult and child occupant restraint status, including Starnes (2003).
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Chapter 2. Seat Belts and Child Restraints
5. Child Restraint/Booster Seat Law Enforcement
5.1 Short-Term High-Visibility Child Restraint/Booster Law Enforcement
Effectiveness:
Cost: $$$
Use: Medium
Time: Medium
As noted in Section 2.1, high-visibility short-duration belt law enforcement programs, such as
Click It or Ticket, have proven to be the most effective countermeasure to date for increasing seat
belt use. NHTSA typically includes child restraint and booster seat use and enforcement as a part
of their Click It or Ticket campaigns (although adult seat belt use is the main focus of CIOT, as
demonstrated in the type of citations issued and depicted in the accompanying paid advertising,
earned media, and social media). There is concern that LEOs are reluctant to enforce child
restraint laws due to competing priorities in their departments and a lack of knowledge on the
part of officers on the subject of child restraints (Decina et al., 2008; Decina et al., 1994;
NHTSA, 1990). More recent research demonstrates that effective approaches for enforcing child
restraint laws – in particular booster seat laws – are possible, but they depend on top
management support and enforcement methods that are dedicated to booster seat and other child
restraint laws (Decina, Hall, & Lococo, 2010).
As with HVE aimed at adult occupants (Section 3.1), enforcement of child restraint/booster laws
should be coupled with high-visibility communications and outreach (Solomon et al., 2003). 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: Most States currently conduct short-term, high-visibility child restraint/booster seat law
enforcement programs in May of each year as part of national seat belt mobilizations (Solomon
et al., 2004; Solomon et al., 2007) and in September as part of Child Passenger Safety (CPS)
Week.
Effectiveness: In their systematic review of evidence of effectiveness for child restraint
interventions, Zaza et al. (2001) determined that community-wide information plus enhanced
enforcement campaigns were effective in increasing child restraint use.
Costs: High-visibility enforcement campaigns are expensive. They require extensive time from
State highway safety offices, time from LEOs to conduct the enforcement, and time from media
staff and often from consultants to develop, produce, and distribute publicity. Paid advertising
increases a campaign’s effectiveness but can be quite expensive.
Time to implement: An HVE program requires 4 to 6 months to plan and implement.
Other issues:
• Barriers to enhanced enforcement programs: Decina et al. (2008) concluded that
barriers to enhanced enforcement programs, especially as related to booster seats,
include: low awareness of child restraint laws among parents/caregivers; low perception
of risk to child passengers; lack of knowledge about the safety benefits of booster seats
among the public; lack of knowledge about the safety benefits of booster seats among
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Chapter 2. Seat Belts and Child Restraints
•
LEOs and members of the courts; low threat of being ticketed for violations; and lack of
commitment to child passenger safety by law enforcement top management.
Strategies to enhance enforcement programs: Decina et al. (2010) found that the most
effective approaches for enforcing booster seat laws depend on top management support
to enforce these laws, having resources to support dedicated booster seat law enforcement
programs, and enforcement methods that are dedicated to booster seat and other child
restraint laws. These elements are in addition to other aspects that have typically been
used to maximize the results of child restraint enforcement efforts (NHTSA, 1990).
Specifically, effective program components that have worked over time include: media
coverage of enforcement and public information by the local press and radio and
television stations; training of LEOs in the benefits of child passenger safety and methods
of effective law enforcement; information aimed at target audiences; information
coinciding with community events; a network of child restraint inspection stations; child
restraint distribution programs; and PSAs and other media coverage.
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Chapter 2. Seat Belts and Child Restraints
6. Communications and Outreach
6.1 Strategies for Older Children
Effectiveness:
Cost: Varies
Use: Unknown
Time: Medium
The number of older children killed in traffic fatalities has decreased substantially since 2007.
For children 8 to 12, there has been a 16% decrease from 402 fatalities in 2009 to 339 fatalities
in 2018 (NCSA, 2021). Similarly, for children 13 and 14 there has been a 38% decrease from
254 fatalities in 2009 to 158 fatalities in 2018. While increased seat belt use has undoubtedly
contributed to these improvements, there is still room to improve seat belt use in these age
groups. The 2017 NSUBS found that more children 8 to12 were using restraints, and only 14%
were unrestrained in 2017, which is an improvement from 16% unrestrained in the 2015 NSUBS
(Li & Pickrell, 2018b). While older children are using restraints more often, those who were
unrestrained made up a higher proportion of deaths in fatal crashes (NCSA, 2021). For children 8
to 12, some 43% of the children killed were unrestrained, whereas only 12% of the children who
survived were unrestrained. Similarly, for children 13 to 14, about 51% of the children killed
were unrestrained, whereas only 21% of the children who survived were unrestrained.
As noted by Kuhn and Lam (2008a; 2008b), there is not a great deal of information on the
factors influencing restraint use for children 8 to 15 years old. The few available studies have
tended to focus on changing nonuse behaviors without investigating attitudinal or motivational
factors that might be useful in developing additional strategies.
Use: There is more of an emphasis on developing and implementing programs targeting children
8 to 14. In March 2015 NHTSA announced a new campaign focused on older children 8 to 14,
Don’t Give Up Until They Buckle Up. The campaign is targeted to parents and caregivers of
“tweens,” with material and resources for States and programs interested in focusing on this age
group. Some pilot programs have been implemented and evaluated that can be used as resources
for program development. One extensive resource available is the report titled Increasing Seat
Belt Use Among 8- to 15-Year-Olds: Volumes I and II (Kuhn & Lam, 2008a, 2008b).
Effectiveness: The few studies that have been conducted have produced encouraging results.
The Avoiding Tween Tragedy Project was a comprehensive program aimed at increasing
restraint use among 8- to 15-year-olds in Berks County, Pennsylvania (Alonge et al., 2012). The
program included education at elementary, middle, and high schools, law enforcement
participation, earned and paid media, and participation in community events. Restraint use
increased significantly following the program (13% at elementary schools, 17% at middle
schools, and 20% at high schools). Among elementary school students, back seat positioning also
increased. The authors recommend that future programs targeting this age group focus on HVE
and education using information designed for this age group. Because the behaviors of this age
group are strongly influenced by others, a legislative focus on primary enforcement of restraint
use for all occupants should be pursued if not already in place.
The Just Get It Across program developed by the Rainbow Babies and Children’s Hospital in
Cleveland, Ohio, targeted parents of 13- to 15-year-olds with a message encouraging parents to
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promote seat belt use among their teens (program description and implementation: University
Hospitals Rainbow Babies & Children’s Hospital Injury Prevention Center, 2014). The program
demonstrated increases in knowledge of seat belt laws and teen-reported reminders to wear seat
belts by parents. Observed seat belt use by parents and teens also increased in the target
community; however, it is not clear what role the program had in this increase because seat belt
use in the control community also increased. Exposure in the control community to Just Get It
Across messaging along with other seat belt promotions may have interfered with effective
evaluation of the program (program evaluation: Zakrajsek et al., 2014).
Colorado and Nevada implemented Teen Seat Belt Demonstration Projects in 2007 and 2008
consisting of publicity and enforcement. Each State held four enforcement waves focused in
areas and at times when teenagers were most likely to be driving. In addition to increases in teen
awareness of seat belt messages and enforcement, teen belt use increased significantly in both
States (5% in Colorado and 8% in Nevada) (Nichols et al., 2011).
A study by Nichols et al. (2018) explored the effectiveness of multi-wave teen seat belt
demonstration programs in Louisiana, Mississippi, New Mexico, and Texas. These programs
were established in 2009, with the first wave of focused activities starting just prior to NHTSA’s
Click It or Ticket (CIOT) campaign in May 2009. The remaining waves occurred in fall 2009,
winter 2010, and in May 2010. Each wave consisted of teen-focused outreach, earned and paid
media, and enforcement. Each State also had control areas where the program activity was not
promoted. States differed in the type of primary media used for outreach (e.g., Louisiana and
Mississippi spent more on television ads while New Mexico and Texas spent more on radio ads).
The program in Mississippi appeared to be the most effective with higher awareness of seat belt
messages, higher perception of strict enforcement, and statistically significant increases in
observed seat belt use among teens in the program areas compared to the control areas. This
coincides with the high levels of teen exposure to outreach in Mississippi (i.e., higher gross
rating points of media ads) than in other States. Teens in the program areas in Texas had higher
levels of awareness compared to the control, but the increases in seat belt use were similar in
both areas. Neither Louisiana nor New Mexico showed increases in teen belt use above the
control locations.
The Automotive Coalition for Traffic Safety (ACTS) launched two pilot programs in 2005
targeting 8- to 15-year-old tweens. These short-term school and community-based interventions
targeted both children and their parents. Both programs were successful in changing knowledge
and attitudes of the parents and children, but limited observations did not show significant
changes in belt use among the targeted children (Jennings et al., 2006).
Costs: Program costs will depend on the size of the target audience and the components of the
program.
Time to implement: Complete programs will require at least 4 months to plan and implement.
School-based programs may require a full year.
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6.2 Strategies for Child Restraint and Booster Seat Use
Effectiveness:
Cost: Varies
Use: Unknown
Time: Medium
Both the American Academy of Pediatrics and NHTSA recommend children stay rear-facing as
long as possible until they outgrow the height or weight limits of the seats, and then use
forward-facing harnesses for as long as possible (Durbin et al., 2018; NHTSA, 2019). However,
observational data from the 2017 National Survey of the Use of Booster Seats (NSUBS) show
that 5.2% of children under age 1 were moved prematurely to forward-facing child restraints.
Similarly, 14.9% of children 1 to 3 were not in a rear- or forward-facing child restraints but were
instead in booster seats, the seat belts alone, or were unrestrained (Li & Pickrell, 2018b). Note
however, that some 3-year-olds may meet the requirement of a booster seat, so while it is not
best practice, it also is not technically “misuse.”
A booster seat is recommended until the lap/shoulder combination belt fits properly on its own,
typically when a child is 8 to 12 years old and/or 4 feet 9 inches tall. However, 2017 NSUBS
data show that many children are moving into seat belts much earlier than recommended. In
2017 some 20.8% of children 4 to 7 were restrained using seat belts alone and 40.1% were using
booster seats. Only 10.7% of children 8 to 12 were using booster seats (Li & Pickrell, 2018b).
Due to differences in growth, children may meet the requirements for seat belts or booster seats
earlier than their peers. If a child has grown to meet the requirements of a booster seat or a seat
belt before reaching the recommended age group, it is not necessarily misuse.
Compared to the 2015 NSUBS, child restraint use in age groups is either unchanged or slightly
higher. In 2017 some 13.7% of children 1 to 3 were rear-facing, slightly more than the 9.4% in
2015. In addition, a smaller number of children 1 to 3 were prematurely moved to booster seats
(7.6% in 2017 compared to 13.6% in 2015). There were also more children 4 to 7 riding in car
seats or booster seats compared with 2013 (68.5% versus 62.4%) (Li & Pickrell, 2018b).
Use: Communications and outreach campaigns directed at booster-seat-age children are likely
common, but no summary is available.
Effectiveness: The effectiveness of communication and outreach strategies has been examined
in various ways. Will et al. (2009) used a threat-based message to increase booster seat use
among attendees of two large daycare/after-school programs in Eastern Virginia. The
intervention included a video made with images to invoke emotions, crash test footage, wellrespected experts, and personal stories to convey a message of high-threat consequences without
using graphic, “gory” images. The study found significant increases in overall restraint use and
booster seat use following exposure to the intervention and concluded that applying messages of
high-threat consequences (without gore) to booster seat interventions is a promising approach.
Similarly, some studies have also used a different threat-based message (“No Regrets”) with
some success (Bryant-Stephens et al., 2013; Winston et al., 2007). Another study found that the
strongest predictors of booster seat use among Canadian parents of 4- to 9-year-olds was the
parents’ knowledge of the purpose and benefit of booster seat use as well as perceived
community norms (Bruce et al., 2011).
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The “Strike Out Child Passenger Injury” program used community sports programs to promote
booster seat use among 4- to 7-year-olds in 20 rural communities across Alabama, Arkansas,
Illinois, and Indiana (Aitken et al., 2013). In the intervention communities, information about
proper restraint use was shared in conjunction with T-ball season. In addition to information,
parents were given the opportunity to meet with a CPS technician during a T-ball event in order
to get a personal assessment and recommendation for proper restraint use. Child restraints and
booster seats were provided to families in need and baseball-themed prizes were provided to
participants. Control communities received only an informational brochure. Following the short
program, proper restraint use increased in intervention communities in 3 of 4 States. This study
demonstrated that tailoring a program to fit in an established community event can have a shortterm impact on restraint use in a rural community where resources are limited.
Costs: As with enforcement-related communications and outreach, costs vary depending on
program quality and delivery.
Time to implement: A good educational campaign will require 4 to 6 months to plan and
implement.
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Chapter 2. Seat Belts and Child Restraints
7. Other Strategies
7.1 School-Based Programs
Effectiveness:
Cost: Varies
Use: Unknown
Time: Varies
Schools provide well-defined and somewhat controlled audiences for seat belt use programs.
Education and other communications strategies can be tailored to a specific audience. While
these programs are often well received in the community, there is limited information on their
effectiveness.
Use: There are no data on the number of school-based programs operating currently.
Effectiveness: School programs have been shown to increase seat belt use in the few evaluations
of school programs that have been conducted. The “Make It Click” program was developed in
Virginia to address low seat belt use among children 8 to 12 in an economically disadvantaged
urban school district (Will & Dunaway, 2017). Children, parents, and teachers were educated
about proper seat belt use with activities throughout one school year. Children participated in a
creativity contest, a safety-themed play, a buckle-challenge competition, afterschool programs,
classroom assignments, and morning announcements. Parents were provided with flyers and
presentations, while teachers received regular newsletters to keep them informed about the
program. The program resulted in significantly higher observed seat belt use rates at intervention
schools (32% before the program versus 68% after). During a follow-up period 4 months after
the program, students at the intervention school were 3.3 times more likely to be observed
wearing seat belts than students at the control schools.
Similar improvements were observed in a pilot program to increase restraint use and rear seating
position among elementary schools and day care centers (Williams et al., 1997). The programs,
held in conjunction with an ongoing statewide Click It or Ticket program, included letters and
pamphlets sent to parents, proper restraint use demonstrations, assemblies emphasizing proper
restraint use (at the schools), and enforcement checkpoints. Proper use increased substantially at
elementary schools (36% to 64%; 49% to 71%) with smaller increases at the daycare centers
(71% to 76%; 60% to 75%). The researchers concluded also that enforcement is a key ingredient
of programs even among school-aged children. The smaller increase in use could also be an
artifact of the daycare center having younger kids who are traditionally more likely to be
restrained than elementary-aged kids.
See Section 6.1 Communications and Outreach Strategies for Older Children for additional
information about programs targeting school-aged children.
Costs: Program costs will depend on the size of the target audience and the components of the
program.
Time to implement: School policies can be implemented immediately. Complete programs will
require at least 4 months to plan and implement and may require a full year.
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7.2 Inspection Stations
Effectiveness:
Cost: $$
Use: High
Time: Short
The misuse of child restraints has been a concern for many years. Some programs have been
implemented to provide parents and other caregivers with “hands-on” assistance and education
about the proper installation and use of child restraints in an effort to combat widespread misuse.
CPS inspection stations, sometimes called “fitting stations,” are places or events where parents
and caregivers can receive this assistance from certified CPS technicians. Certification courses
for child safety seat checks are available through the National Child Passenger Safety
Certification Program (http://cert.safekids.org).
Inspection stations in urban communities may be effective in reaching households that
improperly use child restraints. One study conducted in Los Angeles that reached out to parents
and caregivers using advertisements found that vehicles visiting the inspection stations had a rate
of child restraint misuse of 96.2% (Bachman et al., 2016). Examples of misuse included
inappropriate use of the top tether, older children prematurely restrained in front seats, and seat
belts routed incorrectly. While this rate was substantially higher than the 46% misuse rate
observed in the nationally representative NCRUSS sample (Greenwell, 2015), some of this
difference likely reflects a broader definition of misuse in the Los Angeles study as the
determination of misuse was based on American Academy of Pediatrics (AAP) best practice
recommendations. It is also possible that the households targeted in this community study had
particularly high misuse rates. The Los Angeles inspection station study found that factors such
as child age, child weight, and vehicle year led to systematic instances of child restraint misuse
and should be considered when conducting inspections and addressing deficiencies in restraint
use (Bachman et al., 2016).
Use: Child restraint inspection stations have become common components of State and local
child passenger safety programs. As of 2018 more than 10,000 inspection stations were
registered with NHTSA (see www.nhtsa.gov/equipment/car-seats-and-booster-seats#installationhelp-inspection for locations).
Effectiveness: One study found that child restraint inspection events sponsored by Safe Kids
Worldwide held at car dealerships, hospitals, retail outlets and other community locations
positively changed parents’ behavior and increased their knowledge over a 6-week follow-up
period. Children arriving at the second event were restrained more safely and more appropriately
than they were at the first (Dukehart et al., 2007). Another small study found that attending
inspection stations may be more effective for increasing restraint use in children older than 4
(Kroeker et al., 2015). Specifically, children in this age range were more likely to depart the
inspection in a restraint configuration that was more appropriate for their size and weight than
prior to the inspection. Inspection stations were included in a multifaceted program to increase
child restraint use in five tribal communities. At inspection stations, child restraint seats were
checked, replaced, and re-installed if needed, and new seats were provided to caregivers that did
not have them. Although the specific contribution of the inspection stations was not assessed, the
full program resulted in four of the five tribes exceeding their overall restraint-use goals—some
by a substantial margin.
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Chapter 2. Seat Belts and Child Restraints
Another study evaluated whether a “hands-on” educational intervention makes a difference in
whether or not parents correctly use their child restraints. All study participants received a free
child restraint and education, but the experimental group also received a hands-on demonstration
of correct installation and use of the child restraint in their own vehicles. Parents who received
this demonstration were also required to demonstrate in return that they could correctly install
the restraint. Follow-up observations found that the intervention group was four times more
likely to correctly use their child restraints than was the control group (Tessier, 2010).
An evaluation of the child restraint fitting station network in New South Wales, Australia, found
that children whose parents attended a fitting station were significantly more likely to be
properly restrained than children whose parents had not visited a fitting station. While specific to
Australia, these results suggest similar benefits are possible in the United States (Brown et al.,
2011).
Costs: Program costs will depend on the size of the target audience, the components of the
program, and the level of services offered. Since permanent inspection stations listed on
NHTSA’s locator must have a currently certified child passenger safety technician on site during
the posted hours, costs for maintaining the service includes personnel costs as well as operational
expenses.
Time to implement: Complete programs typically require several months to plan and
implement.
Other issues:
• Programs to make child restraints available at low cost: One of the issues identified
when child passenger safety laws were being considered was the costs associated with
obtaining child restraints. Because of this, many State and local organizations initiated
programs to make child restraints available at low or no cost to parents through child
restraint loan or rental programs (Zaza et al., 2001). Since then, the popularity of these
programs has decreased significantly as child restraints have become more readily
available and funding for such programs scarce. A recent study by CDC, however, found
that child safety seat distributions—in combination with other evidence-based
practices—may have contributed to significant increases in proper child restraint use in
five American Indian/Alaskan Native tribal communities (Billie et al., 2016; West &
Naumann, 2014). From 2010 to 2014 all five communities conducted distribution of child
safety seats along with educational programs and enhanced enforcement practices. All
communities reported increases in observed use of child safety seats (ranging from 6% to
40%) with four communities exceeding their initial goals. A meta-analysis of five studies
(four from the United States conducted from 2000 to 2005 and one from Australia
conducted in 1987) assessed the effectiveness of interventions in increasing the use of
booster seats for children between 4 and 8 years old (Ehiri et al., 2006). Offering
incentives such as free booster seats or discount coupons combined with education on the
risk of using adult seat belts instead of booster seats, as well as education-only
interventions, were all found effective in increasing use when compared to no
interventions. An Australian study (Bowman et al., 1987) found no evidence of increased
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Chapter 2. Seat Belts and Child Restraints
use in booster seats due to law enforcement practices. Zaza et al. (2001) conducted a
systematic review of evidence of effectiveness for five interventions, including child
restraint distribution programs. Evidence suggests child restraint distribution coupled
with education can be effective. However, the studies evaluated were mostly from the
1980s when child passenger safety laws were first being passed and the availability and
costs of child restraints were much different. Louis and Lewis (1997) conducted a project
to increase child restraint use in low-income minority families. Families in the program
were divided into two study groups with both groups receiving free child restraints. One
group also received education regarding child restraint use. The results of the study
reported that distributing child restraints resulted in increased long-term use among a
low-use population.
•
Availability of CPS Technicians: The overall availability of CPS technicians throughout
a State is a consideration in this countermeasure. A study conducted in Michigan
compared where CPS technicians lived and worked to where the greatest needs existed,
as defined by at-risk children under 9 (Macy et al., 2016). In general, there was a
reasonable match between where the CPS technicians were located and where the most
at-risk children resided. In most counties, the estimated distance that families traveled
from home to the nearest seat check location was less than 10 miles. However, there were
still many counties that had too few technicians to adequately meet local needs. Training
new CPS technicians at underserved locations may be an important part of maintaining
the effectiveness of this countermeasure. Digital access to CPS technicians is a potential
solution. A small study in Florida provided parents with phone apps to interact directly
with CPS technicians located elsewhere, to receive help installing child seats (Schwebel
et al., 2017). The results reported that the accuracy of installations improved significantly
compared to the installation prior to the instruction, and that parents felt more confident
about the installation.
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Chapter 2. Seat Belts and Child Restraints
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Chapter 2. Seat Belts and Child Restraints
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2-50
Chapter 2. Seat Belts and Child Restraints
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Chapter 2. Seat Belts and Child Restraints
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Chapter 2. Seat Belts and Child Restraints
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Chapter 3. Speeding and Speed Management
3. Speeding and Speed Management
Overview
Characteristics and problem size: Speeding. NHTSA defines a crash to be speeding-related if
any driver involved in the crash is charged with a speeding-related offense or if a police officer
indicates that racing, driving too fast for conditions, or exceeding the posted speed limit was a
contributing factor in the crash. Speeding-related fatalities have generally decreased over the last
decade, as shown in the figure below. In 2018 there were 9,378 speeding-related fatalities, a
decrease of 6% from the 9,947 fatalities in 2017 (NCSA, 2020). Speeding is a contributing factor
for 26% of fatalities in motor vehicle traffic crashes in the United States, a percentage that
decreased from 31% since 2009. NHTSA has developed a webpage to visualize speeding-related
fatal crashes by location, time-of-day, road type, and other factors
(https://icsw.nhtsa.gov/nhtsa/fars/speeding_data_visualization/).
14,000
SR fatalities
Speeding-related Fatalities
12,000
SR% of total fatalities
60%
50%
10,000
40%
8,000
30%
6,000
20%
4,000
10%
2,000
0
0%
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Source: NCSA (2020)
-10%
Speeding-related % of Total Fatalities
70%
Year
Younger drivers, particularly young males, continued to be the most likely to be identified as
speeding in fatal crashes in 2018 (NCSA, 2020). In 2018 nearly one-third (30%) of male drivers
in the 15- to 20-year-old age group involved in fatal crashes were speeding at the time of the
crashes, compared to 18% for the female drivers in the same age group. Other risk factors
associated with speeding in 2018 included driver alcohol use, lack of seat belt usage, driver not
being properly licensed, and nighttime hours. In 2018 some 31% of all motorcycle riders
(operators) involved in fatal crashes were speeding, compared to 18% of passenger car drivers,
14% of light-truck drivers, and 7% of large-truck drivers.
3-1
Chapter 3. Speeding and Speed Management
Speeding is legally defined by States and municipalities in terms of a “basic speed rule” and
statutory maximum speed limits. The basic speed rule generally requires drivers to operate a
vehicle at a speed that is reasonable and prudent for roadway conditions. Making a determination
to take enforcement action is at the LEO’s discretion, which may be impacted by weather,
surface conditions, traffic volume, and special locations (e.g., work zones, school zones, or other
environmental conditions). Statutory speed limits set maximum limits for different types of
roads, and generally apply to all roads of that type even when the limits are not posted. These
limits can be superseded by limits posted for specific roadway segments, usually determined by
engineering studies. Special Report 254 of the Transportation Research Board, which reviewed
much of the past research regarding the effects of speed and speed limits on crashes, describes
the reasons for setting speed limits and other actions for managing travel speeds (TRB, 1998).
The TRB guide contains much valuable information that is still very relevant for setting limits
and managing speeds.
A document prepared by the Global Road Safety Partnership (Howard et al., 2008) with input
from U.S. experts, updates speed management guidance based on more recent knowledge, and
describes the evolution of practices used by countries with a zero deaths vision and framework.
For example, practices used in such countries no longer rely on the 85th percentile or other
operating speed distributions, but set limits according to injury minimization principles. A
detailed description and comparison of these and other methods is provided in Methods and
Practices for Setting Speed Limits: An Informational Report (Forbes et al., 2012), prepared by
the Institute of Transportation Engineers in cooperation with FHWA. In the United States, Vision
Zero is primarily an initiative targeting local jurisdictions to get them to adopt speedmanagement policies and roadway design practices that encourage driving at speeds that are less
likely to result in serious injuries or fatalities. As of January 2018 thirty-five cities had adopted
policies from this initiative (Vision Zero Network, 2018).
Speeding can be dangerous on all types of roads, but particularly on non-interstate rural and
urban roadways. In 2018 there were 41% of speed-related fatalities that occurred on noninterstate rural roadways, another 44% on non-interstate urban roadways, 9% on interstate urban
roadways, and 5% on interstate rural roadways (NCSA, 2020).
Speeding is also common. A 2007 nationally representative observational survey for NHTSA
estimated that, in free-flowing traffic, 48% of drivers on limited access highways were exceeding
the speed limit, 60% were exceeding speed limits on other major arterials, and 61% were
exceeding speed limits on minor arterials and collectors (Huey et al., 2012). This percentage
range is comparable to findings from a study among Organisation for Economic Co-operation
and Development countries, which showed that 40 to 50% of vehicles were driving above the
posted speed limit (WHO, 2017).
In the 2007 NHTSA survey, many drivers were exceeding the posted speed limit by more than 10
mph on all these road types, including 16% on limited access roads, 14% on major arterials, and
15% on minor arterials and collectors. NHTSA’s nationally representative observational survey
was repeated in 2009, and found that free-flow speeds on limited access highways increased by 6
mph as compared with 2007 (Huey et al., 2012). The percentage of drivers exceeding the speed
limit by more than 10 mph increased from 16% in 2007 to 19% in 2009 on limited access
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Chapter 3. Speeding and Speed Management
highways. There was little change in speeds on major and minor arterials from 2007 to 2009.
Slight declines (0.3 to 0.5 mph) in mean speeds were observed for major arterials, with slight
increases (0.2 to 0.4 mph) on minor arterials and collectors. The percentage of drivers exceeding
the speed limit by more than 10 mph increased on minor arterials and collectors (from 15% to
16%) from 2007 to 2009. A more recent survey compared data from 2009 to 2015 (NHTSA,
2018). Mean speed on the major arterials increased by 3.1 mph from 2009 to 2015, whereas only
a minor change (-0.1 mph) was observed on limited access roads. In terms of percentage of
vehicles surpassing the speed limit, the percent exceeding by more than 10 mph on major
arterials increased from 13.3% in 2009 to 18.1% in 2015, whereas on the limited access roads,
the percent exceeding by more than 10 mph was almost the same (20.1% in 2009 and 20.3% in
2015). Traffic Tech summaries are available for all three studies (NHTSA, 2012a; NHTSA,
2012b; NHTSA 2018).
Drivers themselves also report high percentages of speeding. NHTSA’s most recent nationally
representative survey of drivers conducted, the National Survey of Speeding Attitudes and
Behaviors (NSSAB), suggests that some trends in driver attitudes and speeding behaviors may be
improving (Schroeder et al., 2013). In 1997 some 31% of surveyed drivers reported passing other
cars more often than other cars passed them. In 2011 about 27% of surveyed drivers reported
passing other drivers more often. The percentage of drivers who reported that they enjoy the
feeling of driving fast also declined, from 40% in 1997 to 27% in 2011. In addition, the
percentage who thought the faster they drive, the more alert they are decreased (from 29% in
1997 to 15% in 2011), as did the percentage who reported that they try to get where they are
going as fast as they can (from 30% in 1997 to 21% in 2011). A few trends did not improve:
Driver impatience with slower drivers was about the same in 2011 (61%) as in 1997 (60%). In
addition, the proportion of drivers stopped by police for speeding was fairly similar over these
different survey periods. In 1997 some 9% of drivers reported having been stopped by police for
speeding within the past 12 months, 11% reported being stopped in 2002, and 9% reported being
stopped in 2011. Other driver beliefs were sometimes at odds with each other. For example, twothirds of drivers agreed strongly that “It is unacceptable to exceed the limits by more than 20
mph,” and 91% agreed that “Everyone should obey the speed limit because it’s the law.” Yet
82% agreed that “People should keep up with the flow of traffic,” and 51% agreed that speeding
tickets have more to do with raising money than they do with reducing speeding.
Drivers in the 2011 NSSAB were grouped (by analysis) into three clusters or categories
according to their responses on six questions about speeding behavior (Schroeder et al., 2013).
Of the sample, 30% were classified as “frequent” speeders. Forty percent of the sample of drivers
was classified as “sometime” speeders, and 30% as “non-speeders” or drivers who rarely speed.
The vast majority of speeders reported that they often pass others, speed by at least 15 mph on
multi-lane divided highways and two-lane highways and by at least 10 mph on residential streets,
and were five times more likely to have been stopped for speeding in the past 12 months than
non-speeders. Unfortunately, speeders also reported taking other risky actions more often than
non-speeders and sometime speeders. Speeders reported talking on the phone or texting more
often, using seat belts less often, and drinking before driving slightly more often than the other
groups. Speeders also tended to be younger compared to non-speeders and sometime speeders,
and to view the need to do something about speeding as less important. Across all drivers,
however, 87% of surveyed drivers thought it was very important (48%) or somewhat important
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Chapter 3. Speeding and Speed Management
(39%) that something is done to reduce speeding. A recent study re-examined the NSSAB
typology, and compared driver types with their speeding conviction history. The study involved a
survey of Idaho drivers with 0, 1, or 2+ speeding convictions in the past 3 years (Richard et al.,
2017). The study validated the notion of different types of speeders, and found that the frequent
speeder group was significantly associated with a greater number of speeding convictions. Driver
attitudes were also related to speeding. Survey responses reported that the frequent speeder group
was more accepting of risky driving behaviors (such as drinking and driving, not using a seat
belt, or red-light running) than other groups that sped less. Another study characterized
motivations and types of speeders using naturalistic driving data (Richard et al., 2012, for a
summary of findings; also see Richard et al., 2013a, 2013b). Speeders were classified into four
general patterns based on the percentages of trips with speeding and the average amount of
speeding per trip. The four patterns were: (1) incidental or infrequent speeders (few trips with
speeding and little speeding on those trips); (2) situational speeders (few trips with speeding but a
lot of speeding on those trips); (3) casual speeders (many trips with speeding but only small
amounts of speeding on those trips); and (4) habitual speeders (speeding on most trips with a lot
of speeding on those trips). Young males and young females in urban settings and young males
in rural settings were more likely than older drivers to have trips with speeding. Follow-up focus
groups revealed some interesting differences between speeding drivers and those who did not
speed. Particularly interesting was the drivers’ perception of the meaning of posted speed limits.
Drivers that sped a lot considered posted limits to be guidelines rather than strict limits, while the
non-speeders considered speed limits to be firm limits not to be exceeded.
A follow-up analysis using the naturalistic driving data described above found evidence for a
specific type of speeding behavior that had more aggressive characteristics, such as high
maximum speeds and high speed variability, in comparison to other types of speeding behaviors
(Richard et al., 2016). Moreover, drivers that engaged in this type of aggressive speeding differed
from other drivers in terms of self-reported measures. In general, these drivers were significantly
more likely to report engaging in other risky behaviors such as tailgating, taking risks when in a
hurry, and cutting off other drivers. Taken together, this analysis based on naturalistic driving
behaviors suggests that aggressive driving may arise from persistent driver attitudes and
personality traits.
While the legal definitions of speeding include exceeding the posted speed limit, driving too fast
for existing conditions, and racing, speeding becomes an element of aggressive driving when a
vehicle’s speed substantially exceeds the prevailing travel speeds of other vehicles, and other
driving behaviors contribute to unsafe conditions, e.g., tailgating, weaving, and rapid lane
changes. Speeding is a more clearly defined problem than aggressive driving, and strategies to
reduce speeding (and other serious traffic law violations) may provide a means to address the
problem of aggressive driving. However, speeding is among the most complex traffic safety
issues to address and requires a multi-disciplinary approach to effectively manage. Enforcement
is an important element in developing a strategy to address speeding, as are considerations of
engineering issues and public education and communications efforts.
Characteristics and problem size: Aggressive and risky driving. Aggressive and risky driving
actions are also perceived to be common, although they are difficult to measure accurately. In
NHTSA’s 2002 survey of speeding and unsafe driving behaviors, 40% of drivers reported that
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Chapter 3. Speeding and Speed Management
they sometimes enter an intersection “just as the light turned from yellow to red,” and 11% said
they often did this. In the same survey 10% reported sometimes cutting in front of another driver,
and 2% said they often did this (NHTSA, 2004). About one-third (34%) of drivers reported that
they feel threatened by other drivers at least several times monthly. The 2011 NSSAB did not ask
about these other risky behaviors. NHTSA has estimated that two-thirds of traffic fatalities
involve behaviors commonly associated with aggressive driving such as speeding, red-light
running, and improper lane changes (NHTSA, 2001). Similarly, the AAA Foundation for Traffic
Safety estimated that 56% of fatal crashes involved one or more driver actions typically
associated with aggressive driving, the most common being excessive speed (AAAFTS, 2009).
Aggressive driving is generally understood to mean driving actions that markedly exceed the
norms of safe driving behavior and that directly affect other road users by placing them in
unnecessary danger. Aggressive driving may involve driver anger, attempts to gain an advantage
over other drivers, and deliberate violations and deviations from normal traffic speeds (Neuman
et al., 2003). It has proven challenging to arrive at a consensus for a theoretical definition of
aggressive driving, and hence to come up with a working definition. Not every moving violation
is considered to be aggressive driving. However, violations that encroach on others’ safe space,
such as driving much faster than prevailing speeds, following too closely, making unsafe lane
changes, and running red lights, either on one occasion or over a period of time, may indicate a
pattern of aggressive driving. Although some States have passed laws criminalizing aggressive
driving, it should not be confused with road rage, which is an intentional assault by a driver or
passenger with a motor vehicle or a weapon that occurs on the roadway or is precipitated by an
incident on the roadway.
Causes of aggressive driving can include both personal influences, such as peer or social
pressures, and environmental triggers. A predisposal to styles or habits of driving that frequently
puts others at risk might be the norm for a small proportion of drivers, while others may be
provoked to drive aggressively, at least occasionally, by exceptional congestion, work zone
delays, poorly timed traffic signals, being late, and other frustrating conditions. Other drivers’
actions are also sources of irritation for “reactive” style drivers. More than half of drivers in one
study reported that they would react aggressively, particularly to being impeded, by others’
reckless driving or actions perceived as directly hostile (Björklund, 2008). Other life stressors,
such as combat deployments, may also contribute to aggressive driving (Sarkar, 2009). Driving
actions are, however, ultimately under individual drivers’ control. Behavioral countermeasures
for speeding and aggressive driving must reinforce and help teach such control.
Strategies to Reduce Speeding and Aggressive Driving
Speeding and aggressive driving actions, such as red-light running, 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 alcoholimpaired driving or seat belt nonuse: highly publicized and highly visible enforcement of
practical, sound, and broadly accepted laws. Another important strategy involves setting
appropriate speed limits using engineering practices that take into consideration the road
segment’s design, vulnerable users, traffic operations, land use, and environmental conditions
(NHTSA, FHWA, & FMCSA, 2014). Information on different speed limit setting approaches is
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Chapter 3. Speeding and Speed Management
described in Methods and Practices for Setting Speed Limits: An Informational Report (Forbes et
al., 2012). Additionally, the NCHRP Guide for Addressing Aggressive-Driving Collisions
(Neuman et al., 2003) suggests that successful anti-aggressive driving programs place an
emphasis on enforcing all traffic laws. Such a strategy increases respect for all laws and the
public’s expectation that traffic laws should be obeyed.
Speeding is a traffic safety problem that is national in scope, but requires local decision making
and action to be managed effectively. Local communities are in the best position to make
judgments in balancing risk against mobility, and are encouraged to use all the tools that are
available to make determinations regarding speed management.
Speed enforcement is among the most common traffic enforcement conducted by law
enforcement across the country. Sustained enforcement of all traffic laws is strongly encouraged,
including speeding violations. The enforcement of traffic laws and attentiveness to traffic safety
should be a core value and practice among LEAs in order to achieve results that contribute to the
quality of life in communities that are impacted by the movement of traffic. A recent analysis of
speeding-related traffic issues by the National Transportation Safety Board points to the need for
cooperation across Federal, State, local jurisdictions, and LEAs towards developing legislation,
guidelines, and data-driven reporting practices for successful speed management (NTSB, 2017).
Specific action and decision making with respect to enforcement generally falls to the discretion
of the LEO engaged with the traffic violator. While enforcement action is not always reported, it
does reinforce the concept of consequences for unsafe driving and creates a perception of risk for
drivers operating a vehicle unsafely. Enforcement actions for speeding violations should be fair,
consistent with local or State statutes, and taken in the interest of preventing traffic crashes.
Correspondingly, enforcement activity in locations with a demonstrable speeding/crash issue are
ideally recommended for focused enforcement.
To support fair, defensible, and reasonable enforcement of speed, speed limits should be
established through appropriate engineering practices. Roadway design can take many forms and
can manage the smooth and efficient movement of traffic based on the nature of the roadway.
These practices include making determinations about appropriate and reasonable speed limits.
Engineering measures may include the application of traffic calming roadway design, such as
roadway diets, using devices, markings, and structures to slow traffic to increase safety, or
support safety efforts near schools, parks, and other areas, particularly on collector and
neighborhood roads (NHTSA, FHWA, & FMCSA, 2014; TRB, 1998; also see FHWA, 2009).
“Self-enforcing” roadways is a related concept where roadways are designed in such a way as to
encourage drivers to intuitively adopt speeds appropriate for the roadway without the need for
posted speed limit signs (Neuman et al., 2009). This approach relies on geometric features and
visual cues to shape driver speed selection towards speeds that feel safe and comfortable.
Although such measures must be carefully implemented so as not to shift speeding or safety
problems to other locations, they can be useful on both local streets and transition areas such as
State highways that pass through towns or rural villages (Bagdade et al., 2012). Roundabout
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Chapter 3. Speeding and Speed Management
intersection designs and “road diets” 8 also reduce speed and crashes and can, at the same time,
improve traffic flows in some situations (Rodegerdts et al., 2007; Harkey et al., 2008; Srinivasan
et al., 2011). Well-timed and coordinated traffic signals can improve traffic flow and reduce redlight running and are potentially useful for managing speeds. Adequately designed turn bays and
entrance and exit ramps can reduce improper merging and driving on the shoulder (Neuman et
al., 2003, Strategy B1). Advance warnings of congestion or delays and well-designed and
managed work zones may also decrease unexpected frustration. Intelligent Transportation
System technologies such as real-time transit information, variable speed limits, variable
message signs, traffic control warning devices, and other systems that respond to changing traffic
and environmental conditions and provide motorists with timely information, also hold promise
for improving mobility and safety by mitigating causes of delay and warning of hazardous
conditions that require lower speeds. Company policies, backed up with speed monitors and logs
or even speed regulators, can reduce commercial vehicle speeding. A variety of measures to
reduce congestion, such as mass-transit, ride-sharing, or bicycle riding, can also diminish driver
frustration that leads to aggressive driving (Shinar & Compton, 2004).
Vehicle technologies that interact with the environment, such as adaptive cruise control, ACC,
and intelligent speed adaptation, hold promise. ACC works similarly to standard cruise control,
except that, in addition to maintaining a speed set by the driver, a radar system in the front of the
vehicle detects and responds to other vehicles in the lane ahead to maintain a safe following
distance. Intelligent Speed Adaptation, or ISA, involves in-vehicle devices that “know” the speed
limit through accurate speed limit mapping and vehicle location data, and provide a warning or
active controls to help prevent speeding above limits (see Sections 2.3 and 3.1). These
environmental and vehicular strategies are generally not included in this guide because SHSOs
have little or no direct authority or responsibility for them.
Any measures that can achieve reductions in average operating speeds, including lower speed
limits, enhanced enforcement, and communications campaigns, as well as engineering measures,
are expected to reduce fatal and injury crashes (AASHTO, 2010). Small changes in average
speed are predicted to have a substantial impact. For example, a reduction of 3 mph in average
operating speed on a road with a baseline average operating speed of 30 mph is expected to
produce a reduction of 27% in injury crashes and 49% in fatal crashes (AASHTO, 2010; p. 3-57,
Table 3E-2). The effects on injury and fatal crashes of changes in average roadway operating
speed are also greater, as a percentage, at lower initial average speeds than at higher speeds. The
table below reproduces Table 3E-2 from the Highway Safety Manual and shows crash
modification factors (CMFs) for fatal and injury crash reductions. To determine the expected
crash reductions for different changes in average speed, subtract the CMF from 1. In the example
described above – a 3 mph reduction from an initial average operating speed of 30 mph – the
CMF is .73, so 1 – .73 is .27, or a 27% reduction in injury crashes. Actual effects may vary
depending on the type of countermeasure and other factors. No single strategy will be
appropriate for all locations, and combinations of treatments may be needed to obtain speed limit
compliance and achieve crash reduction goals.
A “road diet,” also called a road rechannelization or a lane reduction, is a technique whereby the number or width
of travel lanes is reduced to achieve improvements such as converting a through lane to a turn lane, or adding a
bicycle lane.
8
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Chapter 3. Speeding and Speed Management
Expected injury and fatal crash modifications by change in
average operating speed*
Injury Crashes
Change
in avg.
speed
-5
-4
-3
-2
-1
0
1
2
3
4
5
Baseline average operating speed in mph
30
40
50
60
70
80
0.57
0.64
0.73
0.81
0.9
1
1.1
1.2
1.31
1.43
1.54
0.66
0.72
0.79
0.86
0.93
1
1.07
1.15
1.22
1.3
1.38
0.71
0.77
0.83
0.88
0.94
1
1.06
1.12
1.18
1.24
1.3
0.75
0.8
0.85
0.9
0.95
1
1.05
1.1
1.15
1.2
1.26
0.78
0.83
0.87
0.91
0.96
1
1.04
1.09
1.13
1.18
1.22
0.81
0.85
0.88
0.92
0.96
1
1.04
1.08
1.12
1.16
1.2
Fatal Crashes
-5
0.22
0.36
0.48
0.58
0.67
0.75
-4
0.36
0.48
0.58
0.66
0.73
0.8
-3
0.51
0.61
0.68
0.74
0.8
0.85
-2
0.66
0.73
0.79
0.83
0.86
0.9
-1
0.83
0.86
0.89
0.91
0.93
0.95
0
1
1
1
1
1
1
1
1.18
1.14
1.11
1.09
1.07
1.05
2
1.38
1.28
1.22
1.18
1.14
1.1
3
1.59
1.43
1.34
1.27
1.21
1.16
4
1.81
1.59
1.46
1.36
1.28
1.21
5
2.04
1.75
1.58
1.46
1.36
1.27
NOTE: Although data used to develop these CMFs are international, the
results apply to North American conditions.
*This table can be used to estimate expected changes in injury and fatal crashes (if
no Crash Modification Factors are available) for treatments reducing average travel
speeds of a road by the amounts listed.
Source: Reproduced from AASHTO (2010), p. 3-57; Table 3E-2. Crash Modification
Factors for Changes in Average Operating Speed from Highway Safety Manual.
Speed management and the setting of appropriate speed limits requires a coordinated effort
among State and local highway safety offices, engineering offices, and LEAs. A collaborative
effort using a multi-disciplinary approach will support better informed and enforceable speed
limits likely to have public and political support. Neuman et al. (2009) and other guides in the
NCHRP report 500 series provide more detailed information and steps to develop comprehensive
safety plans. For example, a comprehensive strategy may begin with data analysis to prioritize
corridors, intersections or other areas with crash problems related to speeding or aggressive
driving. Analyses may require, at a minimum, crash data and roadway inventory data, both of
which are typically maintained and analyzed by State DOTs. Next steps should include
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Chapter 3. Speeding and Speed Management
identifying other important partners, establishing crash reduction goals, and performing
additional diagnosis such as through interdisciplinary, roadway safety audits to identify the
specific problems and potential solutions. Next, program developers should conduct economic
and feasibility analyses to prioritize among alternate solutions and develop implementation
plans. Finally, partners cooperate to implement engineering, enforcement and communications
strategies to achieve the desired behaviors and target crash reductions. Combining appropriate
countermeasures may achieve greater effects. Communications strategies are important to
support enforcement and some types of engineering countermeasures. See Neuman et al. (2003)
for specific examples of cooperative strategies on aggressive driving, and Neuman et al. (2009)
for more information on speed limit setting, roadway design, traffic enforcement, and public
information and educational strategies to reduce speeding-related crashes. State highway safety
offices can also promote dissemination of effective practices through the types of safety projects
recommended and funded.
The same cooperative methods can be useful in addressing local speeding or aggressive driving
concerns, for example, in a neighborhood or on a road segment or corridor. Public safety, local
public works or engineering departments, the State DOT, and potentially other partners including
community leaders and concerned people should be involved at an early stage in the speed
management process. An interdisciplinary speed management working group may help to foster
long-term commitment, cooperation, and improvement over time (Bagdade et al., 2012).
The national Speed Management Program Plan updated the national speed management goals
and actions for the U.S. Department of Transportation. This plan emphasizes the importance of
comprehensive and cooperative efforts, and outlines the national role in helping States and local
agencies reduce speeding-related crashes, injuries and fatalities using the traditional approaches
of engineering, enforcement, education and evaluation (NHTSA, FHWA, & FMCSA, 2014).
This national plan has several goals and objectives for the DOT related to developing knowledge
about the relationships between travel speed and speed limits on crash risk, causes and types of
speeding, and developing and testing innovation measures such as variable speed limits
combined with automated enforcement and other new technologies. The plan also aims to
provide leadership for public policy decision-making, and technical assistance and tools to help
agencies develop speed management strategies that meet local needs. The plan promotes the
development of data driven models that target enforcement resources where they are most
needed to achieve the greatest safety benefits.
The national efforts to address dangerous speeding and aggressive driving include better
understanding of speeding in relation to road designs and environments, and the motivations and
choices of drivers. More comprehensive or different types of measures may be needed to address
certain types of speeders, including flagrant and repeat offenders, than are generally employed.
As part of a comprehensive road safety strategy, the United Kingdom has embarked upon an
ambitious research program known as High UnSafe Speed Accident Reduction (HUSSAR) to
understand the human, psychological, and emotional factors in speeding and other dangerous
driver behaviors so that interventions may better target barriers to speed compliance (Fuller,
Bates, et al., 2008; Fuller, Hannigan, et al., 2008; Stradling et al., 2008; and others). These
efforts resulted in the implementation of a national speed awareness course in the United
Kingdom that speeders can take as an alternative to paying penalties for low-level speeding
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Chapter 3. Speeding and Speed Management
infractions (Ipsos MORI et al., 2018). More information is provided about this countermeasure in
section A.3.2. As already mentioned, several recent U.S. studies have also begun to characterize
speeding motivations and attitudes and types of speeding behaviors that may warrant different
types of strategies.
A significant body of research has also emerged in the past few years shedding light on
characteristics of angry and aggressive drivers and risk-taking tendencies such as impulsiveness
or even genetic predispositions. A few pilot studies have noted glimmers of success in helping
some of these drivers achieve better control. As examples, a group in Estonia pilot-tested an
intervention with promising results (Paaver et al., 2013). The intervention was provided by
trained psychologists and focused on teaching driving students about impulsive personality and
information processing styles, different types of impulsivity and how to recognize such
tendencies in oneself, and potential situational triggers that may induce subjects to behave
impulsively and take risks. The test group had half as many speeding violations over a year
following the intervention as a control group of students from the same driving schools.
Another effort in the United Kingdom developed and trialed an intensive personal intervention to
target attitudes, skills, and knowledge relating to crash risk among young men with social and
behavioral risk factors and high levels of road traffic collisions (Tapp et al., 2013). The
intervention sought to teach “smoothness and control.” The study measured positive and longlasting impacts among the men who completed the program. One of the challenges, however,
was achieving recruitment and completion among this cohort.
A small study pilot-tested a work-related driver behavior modification program using feedback
and goal setting, as well as a social-norming branding (Newman et al., 2014). This trial showed
at least short-term improvement in drivers’ compliance with speed limits. These and other
research efforts may ultimately lead to changes in education, training, and enforcement
interventions that will have more beneficial effects on safety than most driver interventions to
date.
Resources
As mentioned in the introduction, this document is restricted to behavioral countermeasures that
are typically under the direct authority of SHSOs. But a comprehensive, multifaceted approach
that incorporates assessing and addressing engineering and environmental issues as well as
enforcement, legislative, and program evaluation needs, is essential to most effectively reduce
speeding-related crashes and injuries.
Other resources and links:
• National Highway Traffic Safety Administration
o Speeding – www.nhtsa.gov/risky-driving/speeding
o Speeding Visualization –
https://icsw.nhtsa.gov/nhtsa/fars/speeding_data_visualization/
o Enforcement and Justice Services – www.nhtsa.gov/enforcement-justice-services
o Research and Evaluation – www.nhtsa.gov/behavioral-research
o Behavioral Safety Research Reports – https://rosap.ntl.bts.gov
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Chapter 3. Speeding and Speed Management
•
•
•
•
•
•
•
•
•
•
FHWA Safety Office, Speed Management Safety page and links:
www.safety.fhwa.dot.gov/speedmgt/
o Speed Concepts: Informational Guide –
www.safety.fhwa.dot.gov/speedmgt/ref_mats/fhwasa10001/
o Methods and Practices for Setting Speed Limitswww.safety.fhwa.dot.gov/speedmgt/ref_mats/fhwasa12004/
AASHTO Highway Safety Manual: www.highwaysafetymanual.org/
o AASHTO Strategic Highway Safety Plan, including the NCHRP Report 500 series
guides on reducing crashes: www.trb.org/Main/Blurbs/152868.aspx
Centers for Disease Control, Community Speed Reduction and Public Health. Health
Resources In Action resources:
www.cdc.gov/healthyplaces/healthtopics/transportation/practice.htm
Crash Modification Factors Clearinghouse: www.cmfclearinghouse.org/
NCHRP Report 504, Design Speed, Operating Speed, and Posted Speed Practices:
https://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_504.pdf
NCHRP Report 622, Effectiveness of Behavioral Highway Safety Countermeasures:
www.nap.edu/openbook.php?record_id=14195
Transportation Research Board Special Report 254, Managing Speed: Review of Current
Practice for Setting and Enforcing Speed Limits:
https://onlinepubs.trb.org/onlinepubs/sr/sr254.pdf
Global Road Safety Partnership, Speed Management: Road Safety Manual for Decisionmakers and Practitioners: www.who.int/roadsafety/projects/manuals/speed_manual/en/
Transportation Research International Documentation (TRID) database – bibliographic
database of transportation-related research: https://trid.trb.org
National Transportation Safety Board, Reducing Speeding-Related Crashes Involving
Passenger Vehicles: www.ntsb.gov/safety/safety-studies/Documents/SS1701.pdf
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Chapter 3. Speeding and Speed Management
Speeding and Speed Management Countermeasures
Countermeasures to reduce aggressive driving and speeding are listed in the table below. The
table is intended to provide a rough estimate of each countermeasure’s effectiveness, use, cost,
and time required for implementation. Effectiveness is shown using a five-star rating system.
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
•
•
•
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to reduce aggressive driving and speeding is discussed individually in this
chapter. Full descriptions are included for , and
countermeasures. Brief descriptions are included for ✩ and ✩✩ countermeasures. Further
details about the ✩ and ✩✩ countermeasures are included in Appendix A3 to this report.
1. Laws
Countermeasure
1.1 Speed Limits
1.2 Aggressive Driving and Other Laws
† When
enforced and obeyed
Effectiveness
†
✩
Cost
Use
Time
$
High
Short
$
Low
Short
Cost
Use
Time
$$$†
Medium
Medium
$$$
Low††
Medium
Varies
Unknown
Varies
2. Enforcement
Countermeasure
2.1 Automated Enforcement
2.2 High-Visibility Enforcement
2.3 Other Enforcement Methods
† Can
†† For
Effectiveness
✩✩
✩✩
be covered by violator fines
aggressive driving, but use of short-term, HVE campaigns for speeding is more widespread
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Chapter 3. Speeding and Speed Management
3. Penalties and Adjudication
Countermeasure
Effectiveness
3.1 Penalty Types and Levels
3.2 Diversion and Plea Agreement Restrictions,
Traffic Violator School
Cost
Use
Time
Varies
High
Low
Varies
Unknown
Varies
Effectiveness
Cost
Use
Time
Varies
Medium
Medium
✩✩
✩
4. Communications and Outreach
Countermeasure
4.1 Communications and Outreach Supporting
Enforcement
Effectiveness:
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
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Chapter 3. Speeding and Speed Management
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 3. Speeding and Speed Management
1. Laws
1.1 Speed Limits
Effectiveness: †
† When
Cost: $
Use: High
Time: Short
enforced and obeyed
Speed limits are only one part of the system that attempts to control driving speeds. Wellestablished speed limits based on the use of appropriate engineering practices form the basis for
roadway design and operations. Active enforcement and supportive adjudication are also
essential to support established limits (NHTSA, FHWA, & FMCSA, 2014).
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. 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 freeflowing travel speeds, crash experience, road and land use conditions, and other factors (TRB,
1998).
Use: A speed limit is in effect on all road segments in all States. For summaries of each State’s
maximum speed limits see the Governors Highway Safety Association (2018a) and the Insurance
Institute for Highway Safety (2019a) websites. NHTSA (2013) provides an updated publication
with each State’s complete speed limit laws.
Effectiveness: The effects of maximum speed limits on speeds, crashes, and casualties have
been studied extensively over the past 40 years. However, recent actions by States raising
maximum limits, as well as changes in road design, hardware, vehicles, and drivers suggest that
new studies may be needed. 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). As fuel became plentiful again, travel increased and compliance with
the 55-mph limit decreased markedly. 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. 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 as well as increases in traffic fatalities
(TRB, 1998; TRB, 2006). Speed limit increases from 75 to 80 mph on rural Texas interstates in
2006 also resulted in increased speeds relative to a comparison highway where the limit wasn’t
changed (Retting & Cheung, 2008). Utah increased maximum speed limits on certain highways
from 75 to 80 mph in 2010 and again in 2013. After the limit increases, average vehicle speed
increased by about 3 mph, and vehicles were significantly more likely to surpass 80 mph (Hu,
2017). A recent study found that each 5 mph increase of the State maximum speed limit was
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Chapter 3. Speeding and Speed Management
associated with an 8% increase in fatality rates on interstates and freeways and a 4% increase on
other roads (Farmer, 2016). The study estimated that there were 33,000 more traffic fatalities
between 1995 and 2013 than would have been expected if State maximum speed limits had not
increased since 1993.
Lower maximum speed limits definitely reduce crashes and casualties when lower limits result in
reduced speeds. In general, speeds tend to decrease, but to a lower degree than the reduction in
limits. Similarly, when limits are raised, speeds tend to increase by a smaller amount than the
change in limits. The same holds true on any road: if a lower speed limit yields reduced
operating speeds, crashes and injuries are expected to decrease (AASHTO, 2010). A more
comprehensive effort that includes changes to the roadway and/or enhanced enforcement may be
required to reduce travel speeds by the desired amount, especially if the road design does not
reflect the desired speed limit and operating speeds (TRB, 1998). The State of Victoria,
Australia, implemented a comprehensive effort to reduce speeds that combined review and
adjustment of speed limits, covert and overt forms of enforcement, a media campaign, penalty
restructuring, and other efforts. An evaluation found these combined elements reduced injury
crashes by 10% and fatal crashes by 27% (D’Elia et al., 2007).
Several studies examined the effects of speed limit changes (both increases and decreases) in
Hungary. For example, urban speed limits were decreased from 60 km/h to 50 km/h
(approximately 37 mph to 31 mph) in March 1993, and this change resulted in a decrease in
mean speed by 8% and a decrease in road fatalities by 18%. In other cases rural speed limits
were increased from 80 km/h (50 mph) to 90 km/h (56 mph) in May 2001, and the mean speed
increased by 2.5% and fatalities increased by 13%. A detailed description and more case studies
(Australia, Denmark, Norway, etc.) are provided in Speed and Crash Risk (International
Transport Forum, 2018).
When urban speed limits were increased from 50 to 70 km/h (from 31 to 43 mph) or from 70 to
80 km/h (from 43 to 50 mph) on 19 urban road segments in Hong Kong, crashes increased by 20
to 30% (Wong et al., 2005).
A systematic evaluation of changed speed limits on rural roads and motorways in Sweden also
found fairly consistent increases in travel speeds on all types of rural roads when limits were
raised and decreases on roads where limits were lowered (TRB, 1998). Increases of the posted
speed limit by 10 km/h (6.2 mph) led to increases in speeds on the order of about 3 to 3.6 km/h
(1.9 to 2.2 mph) in mean speeds (weighted for segments length and volume, and including all
vehicles on a section for a given time period, not just free flow speeds). Decreases of the posted
speed limit of 10 km/h (6.2 mph) led to decreases of about 2 to 3.3 km/h (1.2 to 2 mph) for most
road types (Vadeby & Forsman, 2014). These findings are generally in line with those of earlier
studies of the effects of changing limits by 5 or more mph.
Relatively few studies have examined the safety 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). However, a study from
Edmonton, Alberta, Canada, found that speeds on residential streets decreased significantly when
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Chapter 3. Speeding and Speed Management
limits were lowered and supported with enforcement or other measures (Islam et al., 2013).
Specifically, this study found significant speed reductions (3.9 to 4.9 km/h [2.4 to 3.0 mph], 3
and 6 months after treatment, respectively) when posted speed limits in residential areas were
reduced from 50 km/h (31 mph) to 40 km/h (25 mph). Changes in posted limits were
accompanied by education and enforcement measures, but no changes were made to the
roadway. Speeds were reduced on both collector and local road types, in all types of
communities, for light and heavy vehicles, for different times of day and on weekends and
weekdays. Compliance improved over time up to 6 months post-implementation. Following the
lowering of urban default maximum speed limits from 60 km/h (37.3 mph) to 50 km/h (31.1
mph) in 2003 in Adelaide (South Australia), low speed roads showed a significant reduction in
mean speed from 46.9 km/h (29.1 mph) to 44.8 km/h (27.8 mph) (Kloeden & Woolley, 2012).
From 2003 to 2010 yearly mean speeds have remained lower than before the limits were
changed, fluctuating between a high of 44.8 km/h (27.8 mph) and a low of 43.3 km/h (26.9
mph). A follow-up study (Kloeden & Wooley, 2017) found a general downward trend in speeds
from 2003 to 2016. In 2016 the mean speed was 41.67 km/h (25.9 mph).
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: Lowering
speed limits can reduce average driving speeds, but it is generally difficult to enforce and
obtain broad compliance with a lower speed limit on a roadway designed for much higher
speeds (TRB, 1998). Thus, speed limits must be considered as part of a system including
roadway design and other characteristics, active enforcement, and publicity.
• 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 carefully set and enforce
credible speed limits for homogeneous road segments. Once credible, also called rational,
speed limits are established, aggressive enforcement is used to enforce close to the actual
limit. The goal of this strategy 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. Evidence suggests that drivers’ perceptions of safe speed are in fact influenced by
their expectation of what speed above the limit would trigger a ticket (Mannering, 2009).
Therefore, lower tolerances would help to increase the perception of the risk of exceeding
limits by even small amounts. Although consistency in speed limit setting practices
should provide better information about appropriate speeds to drivers, the safety effects of
combining rational speed limit setting (with limits raised to between the 50th and 85th
percentile free flow operating speed) with enhanced enforcement close to the new limit
are uncertain. Reviews of the evidence suggest that it can be difficult to implement or
sustain enhanced levels of enforcement. In general, higher speed limits are very likely to
lead to higher average speeds if nothing is done to the road or enhanced enforcement is
not maintained (Hauer, 2009). Higher average speeds are predicted to lead to increases in
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Chapter 3. Speeding and Speed Management
fatal and injury crashes (ASHTO, 2010). When testing the effects of raising speed limits,
followed by enhanced enforcement in Mississippi and Virginia, average speeds increased
in both locations.
In Virginia average speeds tended to increase about 2 mph at locations where the limit
was raised by 5 mph and by 3 to 4 mph where it was raised by 15 mph (Freedman et al.,
2007). Average speed in Virginia increased by a statistically significant 3 to 4 mph when
the limit was raised from 55 to 65 mph on two rural highways (Fontain et al., 2007).
Speed variance did not increase and compliance overall was improved in Virginia, which
supplemented stricter enforcement with enhanced roadside signs, media publicity, and
brochures. Average speeds as well as speed variance increased in Mississippi, where
limits were increased on different sections of one route by 5 to 15 mph and the number of
extreme speeders were not reduced, except on sections where limits were increased by 15
mph (Freedman et al., 2007).
Mississippi chose to enforce only flagrant violators (at least 5 mph above the limit). Crash
effects were inconclusive over both of these fairly short-term evaluations (1 to 1.5 years),
although crashes were higher during the Mississippi trial compared to a prior three-year
period. A test in Minnesota yielded more promising, though inconclusive crash trends
(Harder & Bloomfield, 2007). The Minnesota campaign, which used speeding and crash
histories to help target enforcement, effectively reduced mean speeds and especially
excessive speeding (speeds of 70 mph and more), but the study period was insufficient to
assess crash trends. Extensive radio publicity supplemented by earned media was used in
the Minnesota campaign, but it was unclear if these efforts were successful at reaching
the target audience.
•
Variable speed limits: Speed limits that may adjust to adverse or changing
environmental conditions are considered by FHWA to have promise in restoring
credibility of speed limits on some highways. Variable speed limits (VSLs) have long
been used on European freeways to manage speed and traffic flows. As of 2013 five
metropolitan areas in the United States are employing enforceable, variable speed limits
on freeways (posted on changeable message signs) (Office of the Assistant Secretary for
Research and Technology, 2013). Variable speed limits are also being used in work zones
by 11 agencies including Utah DOT, Minnesota DOT, and Texas DOT (Office of the
Assistant Secretary for Research and Technology, 2013; National Work Zone Safety
Information Clearinghouse, 2016). A high-quality study of safety effects of variable
limits deployed on freeways in the St. Louis area reported crash reductions of 8%. The
congestion relief benefits were not as high as the public and agencies had hoped,
however, leading to somewhat equivocal support for the measure (Bham et al., 2010). No
other quality evaluations are available at present. Preliminary investigation of a Wyoming
freeway VSL system showed speed reductions from 0.47 to 0.75 mph for every mph
reduction in speed limit (Buddemeyer et al., 2010). Other States that have used VSL
systems to alter speed limits for weather conditions include Alabama, Delaware, and
Washington (Katz et al., 2012). Automated speed enforcement could potentially be linked
to variable limits to increase compliance.
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Chapter 3. Speeding and Speed Management
•
•
•
•
Work zone speed limits: If drivers perceive that limits are too low, workers are not
present, and other changes to the roadway do not seem to justify the lower limits, they
may not comply, and extensive enforcement may be needed to enforce the limit (Ullman
et al., 2013). Sharma et al. (2017) collected data from nine construction work zones in
Iowa during 2014 and 2015. The study found consistent speed reductions associated with
work zone speed limits, compared to data collected from the time period when work
zones were not in place at the same locations.
Speed limit reductions with advance warning flasher (AWF): In Nebraska seven
high-speed intersections equipped with AWFs were selected and tested to examine
effects of speed limit reductions in transitional speed zones (Wang & Sharma, 2017). The
results showed that a 10-mph reduction from 65 mph posted speed zones led to a 3.8 mph
reduction in mean speed, but a 5-mph reduction from a 60 mph posted speed zones did
not yield any significant reductions in mean speed.
Setting speed limits at high-risk locations: A project by Jurewicz et al. (2014) provided
guidelines for setting speed limits at high-risk locations in Australia based on the road
category/function and the presence of a severe crash risk (i.e., severe crash rate per 100
million vehicle kilometers traveled), types of road use and users, road features, and
speeds. The recommendations incorporate other considerations that affect crash risk such
as the presences of high-numbers of pedestrians and cyclists, access point density,
AADT, among other factors.
Vision Zero speed limit resolutions: An increasing number of cities are adopting the
objectives of Vision Zero to prevent reckless driving, increase safety for all road users,
and mitigate road trauma. A range of measures can be used to achieve objectives through
speed limit reductions, automated enforcement of speed violations using an expansive
network of speed cameras, media campaigns, and engineering measures such as speed
humps. New York City is one of the early adopters of the program and enacted a law to
implement city-wide speed limits of 25 mph in October 2014 (a decrease from the
previous 30 mph) (New York City Mayor’s Office of Operations, 2015). This speed limit
reduction potentially halves the fatality risk for a struck pedestrian. Similarly, the Seattle
lowered its speed limit to 20 mph on residential streets and to 25 mph on arterials in 2016
(Seattle Department of Transportation, 2017).
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Chapter 3. Speeding and Speed Management
1.2 Aggressive Driving and Other Laws
Effectiveness: ✩
Cost: $
Use: Low
Time: Short
This approach targets aggressive drivers who violate traffic laws repeatedly or whose violations
lead to crashes producing serious injury or death. Aggressive driving actions are covered by
specific traffic laws, such as the laws regarding speeding, improper lane changes, and following
too closely, or by general laws, such as those that target reckless driving. The primary 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.
Effectiveness Concerns: There is currently no evidence that aggressive driving laws in general,
or increased penalties, in particular, affect aggressive driving and related crashes.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A3, Section 1.2.
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Chapter 3. Speeding and Speed Management
2. Enforcement
2.1 Automated Enforcement
Effectiveness:
† Can
Cost: $$$†
Use: Medium
Time: Medium
be covered by violator fines
The use of automated enforcement systems to address speeding and red-light running are in use
across the United States. Many States have prohibitions in their laws to prevent the use of
automated enforcement technology; others have enabling legislation and/or parameters on the use
of the technology; and others still have no legislation that addresses the technology’s use.
Automated speed enforcement (commonly referred to as “photo radar”) and red light camera
systems should be used as a component of a broader traffic safety and speed management
program supported by a demonstrated need through problem identification. These systems should
be used to support traditional enforcement efforts, or be deployed in locations where enforcement
may be unsafe or impractical for LEOs to make traffic stops.
Automated enforcement systems function by capturing violations, recording relevant data about
the violations, and recording images of the violator vehicles. Red light camera systems employ
sensors linked to a camera and data collection equipment. Vehicles that enter an intersection
against red signal lights are detected; the cameras capture series of images (and with some
systems, video) to depict the violations. Sensors provide additional violation data, such as the
vehicle speed, the time the light had been red at the point the vehicle entered the intersection, and
temporal information. Images and violation data are reviewed at a later time, and when
appropriate a traffic citation is issued and mailed to the registered owner of the vehicle. Some
States involve driver liability to determine responsibility for violations. This approach requires a
more involved process in which approaching and receding images are captured, and include an
image of the driver. Review and processing of citations in such States is more intensive, and
places a higher burden on the State to identify the driver for a conviction or finding of
responsibility. Many States operating in this manner apply penalty points against the license of
the driver.
Other jurisdictions use a registered owner liability approach to enforcement. The processes for
this approach are generally more limited and are not reliant on charging the actual driver of the
vehicle. This approach places the burden on the registered owner, regardless of who was driving
the vehicle to resolve the citation. In many cases, the only defenses would be in cases where it
can be demonstrated the vehicle had changed ownership, was stolen, or an error occurred in
processing the citation.
Guidance documents have been produced by the FHWA and NHTSA for the use of red light
camera systems and automated speed enforcement. Red-Light Camera Systems Operational
Guidelines (FHWA, 2005) provides information on red light camera program costs,
effectiveness, implementation, and other issues, Eccles et al. (2012), and NHTSA and FHWA
(2008) released automated enforcement program and operational guides with information on
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Chapter 3. Speeding and Speed Management
identifying problems and setting up and maintaining an effective and transparent, communitysupported enforcement program using speed or red light cameras.
In 2011 and 2012 Miller et al. (2016) surveyed agencies with current or recently discontinued
automated speed enforcement programs. They found that States and agencies varied greatly in
the legislation and the technologies used for automated enforcement. These differences
influenced the amount and type of data collected, types of fixed and mobile camera units used,
and enforcement duration and schedule. Almost 63% of the 90 responding agencies reported not
being aware of the NHTSA Speed Enforcement Camera Systems Operational Guidelines
(NHTSA, 2008). Half of the surveyed agencies reported past or upcoming plans for evaluation of
crash-related effectiveness of the program; however, 62% of agencies regularly reviewed speed
data and 63% regularly reviewed crash data to determine locations for deployment of automated
enforcement.
Use: Red light camera systems are used extensively in other industrialized countries and were
first employed in the United Sates in 1993 (National Campaign to Stop Red Light Running,
2002). As of September 2019 red light camera systems were being used in 341 communities in
22 States and the District of Columbia (GHSA, 2019; IIHS, 2019b). As of 2018 speed cameras
were being used in approximately 137 jurisdictions in 14 States and the District of Columbia
(GHSA, 2019; IIHS, 2019c). Speed cameras also are used extensively in other countries (Speed
Camera Database, 2019; WHO, 2004).
Effectiveness: The effectiveness of red light camera systems has been studied previously and
mixed results with respect to crash type and experience were found. It should be noted that red
light camera technology does not cause traffic crashes. While the presence of a red light camera
system has reflected increased numbers of lower impact rear end crashes at intersections where
the systems are installed resulting from drivers stopping for the red light, research has also found
a reduction in more dangerous offset and right angle crashes at intersections with red light
cameras (Aeron-Thomas & Hess, 2006; Decina et al., 2007; MacCubbin et al., 2001; McGee &
Eccles, 2003; Retting et al., 2003; Washington & Shin, 2005; WHO, 2004; IIHS, 2017). The
best-controlled studies have found that intersections with high total volumes, higher entering
volumes on the main road, longer green (through) cycle lengths, protected left turn phases, and
higher publicity may also increase the safety and cost benefits of red light camera enforcement
(Council et al., 2005; Washington & Shin, 2005). Additional studies may provide greater insight
into whether or not such crashes persist where the technology is in place for longer periods of
time. The effect of warning signs, public education, and familiarity with the presence of the
system in the fullness of time is not clear.
Warning signs for drivers indicate the presence of automated enforcement systems in the
community, and the approaches where the technology is deployed. Washington and Shin (2005)
recommended the use of warning signs as they enable drivers to come into compliance before
crashes or enforcement events occur, and provide fair warning to drivers of potential
enforcement action in general. The researchers also caution that less expensive engineering
solutions should be sought before implementing camera programs.
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Chapter 3. Speeding and Speed Management
The use of speed cameras can contribute to reductions in speed and crash experience. Decina et
al. (2007) reviewed 13 safety impact studies of automated speed enforcement internationally,
including one study from a U.S. jurisdiction. The best-controlled studies suggest injury crash
reductions relating to the introduction of speed cameras are likely to be in the range of 20 to 25%
at conspicuous, fixed camera sites. Similarly, in South Australia, injury crash data for 35 safety
camera intersections for 5 years before and after the speed camera installation showed an
estimated reduction of up to 21% (Kloeden et al., 2018). Wilson et al. (2010) reviewed 28 studies
of automated enforcement from U.S. sites and found reductions of 8 to 49% for all crashes and
reductions of 11 to 44% for crashes related to serious injuries and fatalities. Covert, mobile
enforcement programs also result in significant crash reductions area-wide (Thomas et al., 2008).
Crash-based studies from the United States have reported positive safety benefits of crash and
speed reductions from mobile camera enforcement on 14 urban arterials in Charlotte, North
Carolina (Cunningham et al., 2008), and from fixed camera enforcement on an urban Arizona
freeway (Shin et al., 2009). In Great Britain the effects of fixed speed cameras on crashes were
estimated by examining data from before and after camera installations at 2,500 locations.
Researchers estimated that installing another 1,000 cameras could prevent approximately 1,130
collisions and approximately 330 serious injuries (Tang, 2017). In France 2,756 speed cameras
were installed from 2003 to 2010. A program evaluation estimated that the cameras prevented
around 15,000 road traffic deaths during that time (WHO, 2017).
The Shin et al. (2009) study examined effects of a fixed camera enforcement program applied to
a 6.5-mile urban freeway section through Scottsdale, Arizona. The speed limit on the freeway
was 65 mph; the enforcement trigger was set to 76 mph. Total target crashes were reduced by an
estimated 44 to 54%, injury crashes by 28 to 48%, and property damage only crashes by 46 to
56% during the 9-month program period. Since analyses found low speeding detection rates
during peak travel times, the target crashes (speeding-related crashes) were considered to be
those that occurred during non-peak flow periods (weekends, holidays, and non- peak weekdays
hours). In addition to the crash reductions, average speed was decreased by about 9 mph and
speed variance also decreased around the enforced zones. Another positive finding from this
study was that all types of crashes appeared to be reduced, with the possible exception of rearend crashes, for which effects were non-significant. Thus, there were no obvious trade-offs of
decreases in some crash types at the expense of increases in others. The program effects should
be considered short-term. There was also very limited examination of spillover effects, including
the possibility of traffic or crash diversion to other routes.
Speed cameras were also installed on Interstate 10, west of central Phoenix, and were supported
by mobile (vehicle mounted) speed camera units. In 2009 and 2010, a political determination was
made to discontinue the speed camera program. Among the factors impacting the decision was
the fatal shooting of the operator of a mobile speed camera in his vehicle that created concerns
for the safety of field personnel. Additionally, a change in administration in the State shifted the
view of automated enforcement in general, and on the freeways around Phoenix, in particular.
However, there are local jurisdictions in Arizona that have retained their automated enforcement
systems, and continue to operate speed enforcement and red light camera programs.
Pilot project evaluations of speed camera use in the United States have also obtained promising
speed reductions from fixed speed cameras in low-speed school zones in Portland, Oregon
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Chapter 3. Speeding and Speed Management
(Freedman et al., 2006), and low-speed limit residential streets and school zones in Montgomery
County, Maryland (Retting et al., 2008). In the latter case, speed reductions attributed to spillover
from the automated enforcement program were also observed on unenforced comparison streets.
In an update to the original study by Retting et al. (2008), Hu and McCartt (2016) evaluated
speed data from 18 of the 20 original speed cameras and data from 9 of the 10 control sites.
Between the 6 months before and 7.5 years after the start of the speed camera program, mean
speeds decreased by 13% at the camera sites, 5% at the spillover sites, and by 4% at the
unenforced comparison sites. The percentage of vehicles exceeding the speed limit by more than
10 mph decreased by 64% at camera sites, by 39% at spillover sites, and by 43% at unenforced
comparison sites.
The percentage of speeders was also substantially reduced when police-operated photo radar
enforcement vans were present in a work zone on a non-interstate highway in Portland, Oregon,
but there was no carry-over when the enforcement was not present (Joerger, 2010). Given that
there was no evidence of any accompanying signs or publicity, there was, however, no reason to
expect carry-over outside of the enforced periods. Crash and injury outcomes were not evaluated
in these studies.
The use of fixed speed cameras has also been evaluated in Norway. Hoye (2015) investigated the
effects of speed cameras on injury crashes and the number killed or severely injured (KSI) on
short, medium, and long road lengths downstream of camera sites from 2000 to 2010. Short road
lengths were 100 m upstream to 100 m downstream of the camera site, medium road lengths
were 100 m upstream to 1 km downstream of the camera site, and long road lengths were 100 m
upstream to 3 km downstream of the camera site. There was a 22% reduction in injury crashes on
road sections of medium length, but no significant reductions for short or long road lengths.
Additional speed cameras installed in 2004 or later furthered the reduction in injury crashes and
KSI with 9% and 39% reductions respectively on long road lengths, and 32% and 49%
reductions respectively on medium road lengths.
Costs: Costs will be based on equipment choices, operational and administrative characteristics
of the program, and specific negotiations with vendors. Cameras may be purchased, leased, or
installed and maintained by contractors for a negotiated fee (NHTSA & FHWA, 2008). Most
jurisdictions contract with private vendors to install and maintain the cameras and, to process
images and violations. A substantial portion of the fines from red-light citations is generally used
to cover program costs (Washington & Shin, 2005). Operating costs of automated enforcement
systems vary based on the nature of the system, administrative costs, and negotiated fees to
vendors providing services to a jurisdiction. Many systems are turnkey operations in which a
vendor provides all the equipment, vehicles, and support services necessary to collect violation
data and issue a citation. The cost for this service may be based on a fixed monthly fee, or on a
negotiated fee for issued or paid citations.
Costs to communities or States for the installation of fixed equipment can vary based on the type
of system, the number of devices in use, and the type of sensors being employed to collect
violation data. Jurisdictions must make the return on investment decisions for accepting these
costs based on their determination of need, risk versus mobility assessment, and budgetary
projections and constraints.
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Chapter 3. Speeding and Speed Management
Fixed speed camera costs may not be similar to those for red light camera programs, based on
volume of activity and violations they generate. An economic analysis estimated the total cost
savings of the Scottsdale freeway fixed speed enforcement were from $16.5 to $17.1 million per
year, considering only camera installation and operational cost estimates and crash cost impacts
(other potential economic impacts were not considered) (Shin et al., 2009). Chen (2005) provides
an extensive analysis of the costs and benefits of the British Columbia, Canada, mobile speed
camera program and estimated a societal savings of C$114 million and a savings of over C$38
million for the Insurance Corporation of British Columbia that funded the program. Gains et al.
(2004) reported a 4:1 overall societal cost to benefit ratio of operating the national (fixed) speed
camera program in the United Kingdom based on 33% reductions in personal injury crashes at
camera sites and a 40% reduction in the number of people killed and seriously injured. Also,
Tang (2017) estimated net benefits of installing 1,000 cameras to be around £21 million in Great
Britain based on data from 2,500 fixed cameras crashes.
Time to implement: Once any necessary legislation is enacted, automated enforcement
programs generally require up to 9 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. Others prohibit or restrict some forms of automated enforcement (GHSA, 2018a;
IIHS, 2019a). In yet others there is no specific statute, and it cannot be inferred from case
law whether the State allows automated enforcement. As of December 2018, nine States
permit the use of speed cameras under at least some circumstances, 13 States have laws
that prohibit speed cameras, and 28 States have no laws addressing speed camera use
(GHSA, 2018a). See NCUTLO (2000) for a model automated enforcement law.
• Public acceptance: Public surveys typically show strong support for red light cameras
and somewhat weaker support for speed cameras (NHTSA, 2004). A 2011 nationally
representative survey of drivers found that 86% thought automated speed cameras would
be acceptable to enforce speed limits in school zones. Significant majorities also thought
they would be acceptable at high-crash locations (84%), in construction zones (74%), and
in areas that would be hazardous for police officers to stop vehicles (70%) or would cause
congestion (63%). Thirty-five percent thought automated camera enforcement of speeds
is acceptable on all roads (Schroeder et al., 2013). Support appears highest in jurisdictions
that have implemented red-light or speed cameras. A survey of District of Columbia
residents found 76% favored speed cameras, with even higher support among non-drivers
(Cicchino et al., 2014). A larger majority of 87% favored the use of red light cameras.
Interestingly, support was lower for measures not currently in use, including photoenforcement of stop signs (50%) and yielding at crosswalks (47%). Again, support was
higher among non-drivers for these measures. 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. Drivers responding to the NHTSA survey, although
indicating support generally for automated enforcement in certain types of locations or
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Chapter 3. Speeding and Speed Management
•
•
•
conditions, were also more likely to somewhat agree or strongly agree with the statement
that speed cameras are used to generate revenue (70%) than with the statement that speed
cameras are used to prevent accidents (55%) (Schroeder et al., 2013). Such concerns
should be carefully and openly addressed in any automated enforcement program. FHWA
recommends, for example, that per citation payment arrangements to private contractors
should be avoided to reduce the appearance of conflicts of interest (FHWA, 2005). A case
study from the Portland, Oregon, RLC program indicates that the vendor payment
structure is a blended contract. The vendor receives a fixed amount per intersection to
install and operate the cameras (the city picks the sites) and a monthly amount based on
the number of citations that are issued (Eccles et al., 2012). The marginal amount
decreases with more citations issued. The current payment structure is $27 per citation for
the first 500 paid citations in a month, $20 for citations 501 to 700, and $18 for each paid
citation over 700. Two research papers have discussed how Australia and the United
Kingdom have dealt with the opponents of and controversies associated with speed
cameras and expanded programs at the same time (Delaney et al., 2003; Delaney et al.,
2005). Also see Eccles et al. (2012) for more in-depth description of best practices for
speed camera programs and case study examples of sustained programs.
Legality: State courts have consistently supported the constitutionality of automated
enforcement (Poole, 2012).
Covert versus overt enforcement: Covert, mobile speed camera enforcement programs
may provide a more generalized deterrent effect and may have the added benefit that
drivers are less likely to know precisely when and where cameras are operating. Drivers
may therefore be less likely to adapt to cameras by taking alternate routes or speeding up
after passing cameras, but data are lacking to confirm this idea (Thomas et al., 2008).
Public acceptance may be somewhat harder to gain with more covert forms of
enforcement (NHTSA & FHWA, 2008). Fixed, or signed, conspicuous mobile
enforcement may also be more noticeable and achieve more rapid site-specific speed and
crash reductions at high crash locations. However, the use of general signs in jurisdictions
with automated enforcement (not at specifically enforced zones), media, and other
program publicity about the need for speed enforcement may help to overcome the idea
that covert enforcement is unfair, and promote the perception that enforcement is
widespread, enhancing deterrence effects. Based on lessons learned abroad, a mix of
conspicuous and covert forms of enforcement may be most effective. See Belin et al.
(2010) for a comparison of Australian covert and Swedish fixed, overt systems. NHTSA
and FHWA’s operational guidelines document outlines other considerations of overt and
covert speed enforcement and signing strategies (NHTSA & FHWA, 2008).
Halo effects: More research is needed to shed light on spillover effects (positive or
negative) of automated speed enforcement programs of varying characteristics. While
fixed cameras may yield more dramatic decreases in crashes at the treated sites (which,
however, are often sites with high crash frequencies that are likely to decrease in
subsequent years) than mobile enforcement, there is little reason to expect that there
would be a significant positive spillover effect. In fact, some studies have detected crash
migration related to conspicuous, fixed camera enforcement (Decina et al., 2007). There
is also a possibility of negative spillover resulting from mobile camera enforcement, but
signing and random deployment practices may reduce that possibility (Thomas et al.,
2008).
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Chapter 3. Speeding and Speed Management
•
•
•
Average speed (over distance) enforcement: A review of the evidence to date suggests
that enforcement (using cameras and camera sites) of average motorist speed over
distance is associated with reductions in average and 85th percentile speeds, and the
proportion of speeding vehicles (e.g., Ilgaz & Saltan, 2017). Such systems have the
potential to reduce speed variability and improve traffic flow characteristics, and may
help to avoid negative halo effects such as crash migration to downstream sites that fixed
or overt mobile enforcement sometimes experience (Soole et al., 2013). In Italy section
control was implemented in December 2005, and by 2014, a total of 320 camera sites
were operational. A program evaluation showed decreases in mean speed and speed
variability. For example, on urban motorways, mean speed decreased by 10% and the
number of crashes decreased by 32% (Montella et al., 2015).
Enforcement threshold: Victoria, Australia, has had success with a program that
tightened enforcement tolerances as part of an overall speed management package that
included automated and other enforcement, publicity, and penalty restructuring (D’Elia et
al., 2007). An experiment in Finland also found that lowering the enforcement threshold
of fixed, speed camera enforcement on a rural, two-lane road from 20 km/h (12.4 mph)
above the limit to 4 km/h (2.5 mph) above the limit (advertised as zero tolerance) and
publicity of the measure reduced mean speeds by 2.5 km/h (1.6 mph) and speed variance
by 1.1 km/h (0.7 mph) in comparison with a similar, camera-enforced corridor where the
threshold was not reduced (Luoma et al., 2012). The percentage of vehicles exceeding the
speed limit was reduced from 23% to 10%, so deterrence of speeding was increased
without increasing the processed citations (police or administrative burden). The speed
effect of the reduced threshold was within the range of effect of the initial implementation
of the automated camera enforcement.
Implementation Considerations: Ontario, Canada, offers suggestions for municipalities
that are considering initiating a red light camera program based on the lessons learned
during 13 years of red light camera program operations. As of 2014 there were over 190
camera operating sites in South and Central Ontario, spanning seven municipalities
according to Solomon et al. (2014), who offer suggestions for improving the effectiveness
of these programs covering aspects related to planning, implementation, performance,
evaluation, and supporting policy.
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Chapter 3. Speeding and Speed Management
2.2 High-Visibility Enforcement
Effectiveness: ✩✩
Cost: $$$
Use: Low-Medium† Time: Medium
† Use is low for aggressive driving, but use of short-term, HVE campaigns for speeding is more
widespread
High-visibility enforcement campaigns have been used to deter speeding and aggressive driving
through specific and general deterrence. In the HVE model, law enforcement targets certain highcrash or high-violation geographical areas using either expanded regular patrols or designated
aggressive driving patrols. The objective is to convince the public that speeding and aggressive
driving actions are likely to be detected and that offenders will be arrested and punished.
Effectiveness Concerns: This countermeasure has been examined in several research studies.
Overall, the findings regarding countermeasure effectiveness are inconclusive. While some
studies suggest that high-visibility, anti-speeding and aggressive driving enforcement campaigns
produce some safety-related benefits, other comparable studies show no benefits or even
negative outcomes.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A3, 2.2.
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Chapter 3. Speeding and Speed Management
2.3 Other Enforcement Methods
Effectiveness: ✩✩
Cost: Varies
Use: Unknown
Time: Varies
Several technologies have been recommended to address speeding and aggressive driving, and
LEAs around the country have conducted innovative and effective aggressive driving
enforcement programs. These include several different types of infrastructure-based and invehicle technologies, such as speed trailers, drone radar, and intelligent speed adaptation (see
Appendix A3, Section 2.3 for more details).
Effectiveness Concerns: In general, these technological measures have not been adequately
studied to reliably determine their effectiveness.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A3, Section 2.3.
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Chapter 3. Speeding and Speed Management
3. Penalties and Adjudication
3.1 Penalty Types and Levels
Effectiveness: ✩✩†
† For general traffic offenses
Cost: Varies
Use: High
Time: Low
This countermeasure involves implementing progressive penalty types and levels for speeding
and the traffic offenses included under aggressive driving as part of each State’s overall driver
control system.
Effectiveness Concerns: This countermeasure is widely used. Its effectiveness has been
examined in several research studies. The balance of the evidence suggests that these types of
countermeasures are ineffective in the long term.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A3, Section 3.1.
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Chapter 3. Speeding and Speed Management
3.2 Diversion and Plea Agreement Restrictions; Traffic Violator School
Effectiveness: ✩
Cost: Varies
Use: Unknown
Time: Varies
In this countermeasure, drivers who have accumulated a specific number of demerit points on
their driver’s licenses are given the option of attending Traffic Violator School in order to reduce
their punishment.
Effectiveness Concerns: Although there is some research examining the effectiveness of this
countermeasure, there is insufficient evidence to conclude that the positive effects outweigh the
negative effects that have also been observed.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A3, Section 3.2.
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Chapter 3. Speeding and Speed Management
4. Communications and Outreach
4.1 Communications and Outreach Supporting Enforcement
Effectiveness:
Cost: Varies
Use: Medium
Time: Medium
Effective, high-visibility communications and outreach are essential parts of successful speed
and aggressive-driving enforcement programs (Neuman et al., 2003; NHTSA, 2000). All
examples discussed in Chapter 3, Sections 2.2, 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 seat belt use campaigns (Chapter 2, Section 3.1) suggests that it is worth considering for speed
and aggressive driving enforcement campaigns.
The objective should be to provide information about the program, including expected safety
benefits, and to persuade motorists that detection and punishment for violations is likely. See also
Neuman et al. (2003, Strategy A2). 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 (Neuman et al., 2003, Strategy A2). Campaign messages that are pre-tested to
ensure they are relevant to the target audience and that reach the audience with sufficient
intensity and duration to be perceived and noticed are most likely to be effective (Preusser et al.,
2008). Other State and community partners may also help leverage resources and achieve a wider
reach if they have common goals and concerns (GHSA, 2018b).
An assessment report prepared for the Governors Highway Safety Association also recommends
raising the priority of speed enforcement as a traffic safety priority among LEAs, the general
public, and the courts (Sprattler, 2012). Such an effort may require careful framing of the
message that speed enforcement is a public injury prevention strategy. Health Resources in
Action developed community resources for the CDC highlighting injury-reduction and public
health and community livability issues in relation to speed and speed management (Health
Resources in Action, 2013; and other resources available at
www.cdc.gov/healthyplaces/healthtopics/transportation/practice.htm).
Use: Most aggressive driving and speed enforcement programs have a communications and
outreach component. At least half the States have a named public awareness campaign (Sprattler,
2012).
Effectiveness: A meta-analysis of 67 worldwide studies of the effect of road safety campaigns
on crashes suggests a general campaign effect of 9%; however, anti-drunk-driving campaigns
were considerably more effective than anti-speeding campaigns (Phillips et al., 2011). Other
evidence comes from publicity associated with automated enforcement programs. Reductions in
crashes in Victoria, Australia, have been attributed to a television advertising campaign that
supported, but did not relate directly, to automated speed enforcement initiatives (Bobevski et al.,
2007). A study from Charlotte, NC also found that publicity from an aggressive media outreach
campaign and on-going publicity related to automated enforcement was responsible for an 8 to
9% reduction in crashes (Moon & Hummer, 2010). Effects carried over for several months after
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Chapter 3. Speeding and Speed Management
the program ended before gradually returning to pre-intervention levels. Earlier evidence from
Australia also suggested that paid media advertising could enhance the effectiveness of
automated speed enforcement (Cameron et al., 1992). The evidence from seat 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 also strongly suggests that good communications and outreach are
essential to a successful enforcement program.
Costs: Good media campaigns can be expensive. See Chapter 2, Section 3.1.
Time to implement: An effective media campaign requires 4 to 6 months to plan and
implement.
Other issues:
• Effective campaign characteristics: The Phillips et al. (2011) meta-analysis of publicity
campaigns attempted to identify factors associated with successful campaigns. The
researchers caution that they could not assess factors that were not reported on frequently,
or had little variation, and also could not assess important program aspects such as the
degree of publicity achieved, whether a campaign addressed the social norm, or whether
behavioral change was achieved. As mentioned above, they found that speed-based
campaigns were generally less effective than alcohol-themed ones. In addition, results
suggested that the type of message delivery had an effect. Messages delivered through
personal communications or at the roadside (such as variable and mixed message signs,
etc.) were independently associated with greater effectiveness than campaigns that used
mass media. Roadside delivery may provide the message in a context-relevant way that is
more proximal to the potentially negative behaviors (such as speeding), while personal
communications may improve processing of the message and message uptake compared
with mass media delivery. However, the authors emphasized that the potential target
reach of mass media suggests it still be considered a viable method of delivery.
• As found in Philadelphia’s Heed the Speed campaign, getting message penetration
through signs, flyers and other community outreach is a challenge in a large urban setting
(Blomberg et al., 2012).
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Chapter 3. Speeding and Speed Management
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Chapter 3. Speeding and Speed Management
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Chapter 3. Speeding and Speed Management
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Chapter 3. Speeding and Speed Management
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Newman, S., Lewis, I., & Warmerdam, A. (2014). Modifying behaviour to reduce over-speeding
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Chapter 3. Speeding and Speed Management
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Chapter 4. Distracted Driving
4. Distracted Driving
Overview
Distracted driving is common, though difficult to measure and sometimes observe. Similar to
drowsy driving, distracted driving is associated with lifestyle patterns, attitudes, and choices
(Ranney, 2008). Distracted driving has received a great deal of attention over the last decade.
The U.S. Department of Transportation held two distracted driving summits in Washington, DC,
and developed a Blueprint for Ending Distracted Driving (NHTSA, 2012). Although much of the
attention and research has concentrated on cell phones and texting, that is just one of many
potential distractions behind the wheel. NHTSA has defined distracted driving as “anything that
diverts the driver’s attention from the primary tasks of navigating the vehicle and responding to
critical events. To put it another way, a distraction is anything that takes your eyes off the road
(visual distraction), your mind off the task of driving (cognitive distraction), or your hands off
the wheel (manual distraction)” (NHTSA, n.d.). NHTSA hosted a technical meeting in 2015 to
discuss cognitive distraction or mind-wandering (when drivers take their minds off the driving
task).
A related issue that is emerging as a growing safety concern is distracted pedestrians using cell
phones and electronic devices in the roadway environment. A literature review from NHTSA
found that, based on the limited amount of research done on pedestrian distraction, distraction is
associated with a small but statistically significant decrease in pedestrian safety (Scopatz &
Zhou, 2016). This issue is discussed in more detail in Chapter 8.
Problem size and characteristics. Distraction occurs when a driver’s attention is diverted away
from driving to some other activity. 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 cell phone conversations (Goodwin et al., 2005, Section III).
It is clear that the public perceives driver distraction to be a serious traffic safety issue. In 2013
the AAA Foundation for Traffic Safety surveyed 3,103 U.S. residents and found that about 9 in
10 (88%) of people say distracted driving is a “somewhat” or “much bigger” problem today
compared to 3 years ago, and 89% believe drivers talking on cell phones are a “somewhat” or
“very serious” threat to their personal safety (Hamilton et al., 2013). In 2015 the AAA
Foundation repeated this survey with 2,442 U.S. residents and found that almost the same
proportion (85%) say distracted driving is a “somewhat” or “much bigger” problem today
compared to 3 years ago, and 86% believe drivers talking on cell phones are a “somewhat” or
“very serious” threat to their personal safety (AAAFTS, 2016). This trend continued in the 2017
AAA Foundation survey conducted with 2,613 respondents (AAAFTS, 2018). Distracted driving
was reported to be the most prevalent traffic safety problem by the majority (87.5%) of
respondents. Almost all respondents (97%) reported that drivers who text or email while driving
pose a serious threat, followed by drivers who talk on the phone while driving (88%). Similarly,
in 2012 NHTSA conducted 6,016 telephone interviews and asked respondents how safe they
would feel in a variety of situations in which they are passengers in vehicles operated by drivers
who are engaged in other activities while driving. NHTSA found that about two-thirds (66%)
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Chapter 4. Distracted Driving
would feel “somewhat” or “very” unsafe if the driver was to “talk on a cell phone while holding
the phone” and almost all (95%) would feel “somewhat” or “very” unsafe if the driver was to
“read emails or text messages” or “send text messages or emails” (Schroeder et al., 2013). This
survey was repeated in 2015 with 6,011 respondents and very similar proportions were reported
for these questions (Schroeder et al., 2018).
Although people are concerned about distracted driving they frequently admit to engaging in
such behaviors behind the wheel. In the 2013 AAA Foundation survey two-thirds (67%) of
respondents admitted to talking on the phone while driving during the past 30 days (Hamilton et
al., 2013). A third (35%) admitted to reading text messages while driving and a fourth (26%) had
sent text messages. The 2015 AAA Foundation survey found that more than two-thirds (69.9%)
of respondents admitted to talking on the phone while driving during the past 30 days (AAAFTS,
2016). Two in five drivers (42.3%) admitted to reading text messages while driving in the past
30 days, and nearly one-third (31.5%) had sent text messages. The proportions continued to
increase in the 2017 AAA Foundation survey in which 45% of drivers reported reading and 35%
reported composing messages and emails while driving (AAAFTS, 2018). These findings show
that the problem has gradually worsened since the 2013 survey. The AAA Foundation
summarized its findings by observing that a substantial number of drivers have a “Do as I say,
not as I do” attitude with regard to distracted driving – they view these behaviors as dangerous,
but engage in them nevertheless. The 2015 NHTSA survey also asked about a variety of
behaviors related to distracted driving (Schroeder et al., 2018). Among the behaviors that drivers
reported doing at least sometimes:
• 82% talking to other passengers;
• 68% adjusting the car radio;
• 48% eating or drinking;
• 42% interacting with children in the back seat;
• 38% making or accepting phone calls;
• 36% using a navigational system;
• 36% using a smartphone for driving directions;
• 17% changing CDs, DVDs, or tapes;
• 12% reading email or text messages;
• 9% sending text messages or email;
• 5% taking pictures with phones.
The type of device and interaction also influences drivers’ perception of the potential for
distraction and their willingness to use the device while driving. People perceive the use of
hands-free devices as less risky than the use of handheld devices when driving. The proportion of
drivers who reported talking on hands-free cell phones (60.5%) in the 2017 AAA Foundation
(2018) survey was higher than those who reported talking on handheld cell phones (49.1%).
Similarly, nearly half (47%) of the respondents in the 2015 NHTSA telephone survey reported
feeling safe if the driver was using a hands-free cell phone to make or answer calls; this is a 7point and 27-point increase from the reported results of the NHTSA surveys conducted in 2012
and 2010 respectively (Schroeder et al., 2013; Schroeder et al., 2018; Tison et al., 2011).
Many factors can affect drivers’ decisions to engage in distracted driving. Most often, the
perceived benefits outweigh the perceived risks (Lissy et al., 2000). Recent research has focused
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Chapter 4. Distracted Driving
on factors influencing teen drivers’ cell phone use. Trivedi et al. (2017) conducted a longitudinal
multistage survey study of teens starting in 10th grade through 2 years after high school. They
found that peer texting behaviors were significantly associated with participants’ own reported
texting behaviors while driving. A recent study of 249 university undergraduate students (18-44
years, M = 22) reported that the perceived benefits of cell phone conversations while driving
include less boredom and the feeling of “getting more done” (Sanbonmatsu et al., 2016).
Students who reported using their cell phones while driving were also more likely to perceive
higher ability to drive when distracted for themselves and others. Unsurprisingly, these students
were also less likely to support legislation to restrict cell phone use while driving. The presence
of legislation regulating cell phone use does not necessarily prevent drivers from engaging in
such behaviors. An analysis of reported cell phone use among U.S. adolescent drivers (16 to 18
years old) was conducted using the 2011-2014 Traffic Safety Culture surveys. The study found
that legislation banning handheld phone use may lower the incidence of reported phone
conversations in this population; however, texting bans were not associated with similar
decreases in reported texting behaviors while driving (Rudisill et al., 2018).
The role of distraction in crashes can be difficult to determine because pre-crash distractions
often leave no evidence for LEOs or crash investigators to observe and drivers are often reluctant
to admit to having been distracted right before a crash. Distraction-affected crashes is a relatively
new measure that focuses on distractions that are most likely to influence crash involvement,
such as dialing a cell phone or texting, and distraction by an outside person/event (NHTSA,
2012). According to the NCSA (2020), there were 2,841 fatalities in distraction-affected crashes
in 2018. This represents a decrease of 12% from the 3,242 fatalities in 2017 (NCSA, 2019,
2020). Eight percent (2,628) of all fatal crashes in 2018 were distraction-affected crashes
(NCSA, 2020).
The risks posed by specific distracted driving behaviors are beginning to be understood thanks to
naturalistic driving studies that use onboard sensors and cameras to capture data right before
crashes as well as during normal driving situations. The Second Strategic Highway Research
Program Naturalistic Driving Study (SHRP2 NDS) included 3,500 participants, 35 million miles
of continuous driving data, and 905 injury and property-damage-only (PDO) crashes. As such, it
provided the first opportunity to perform a direct case-cohort analysis of the crash risk associated
with observable distractions compared to regular driving (Dingus et al., 2016). In the table
below, a change in risk greater than 1 represents increases in crash risk due to the secondary task,
while a change in risk less than 1 represents a decrease in crash risk. For example, interacting
with a handheld cell phone increases the risk of a crash 3.6 times compared to baseline driving
without a phone in hand. The table also shows baseline prevalence of the distraction in terms of
the percentage of time drivers engaged in a distracting task while driving.
Type of Distraction
Change in Risk
(Odds Ratio)
3.6
12.2
6.1
4.8
2.7
2.2
2.5
Total cell (handheld)
Cell dial (handheld)
Cell text (handheld)
Cell reach
Cell browse
Cell talk
Total in-vehicle device
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Baseline
Prevalence
6.4%
0.1%
1.9%
0.6%
0.7%
3.2%
3.5%
Chapter 4. Distracted Driving
In-vehicle device (other, e.g., touchscreen)
4.6
0.8%
In-vehicle climate control
2.3
0.6%
In-vehicle radio
1.9
2.2%
9.9
0.1%
Reading/writing (including tablet)
9.1
1.1%
Reaching for object (other than cell phone)
7.1
0.9%
Looking at outside object
1.8
1.9%
Eating
Note: All odds ratios statistically different from 1 at the 0.05 level of significance.
Source: Dingus et al. (2016).
A recent study focused on the relationship between drivers’ handheld cell phone use and
subsequent crash involvement. Owens et al. (2018) performed a case-crossover analysis using
the SHRP2 NDS data. A total of 566 crashes of varying severity were matched to 1,749 instances
of normal driving on variables including the subject driver, weather, time of day, and speed. The
use of handheld cell phones in general, and specifically performing tasks with visual and manual
elements (such as texting) were significantly associated with increased crash involvement
(excluding crashes where the driver was struck from behind). Of the visual-manual tasks, texting
was significantly associated with increased crash involvement. The table below presents these
changes in crash involvement when using a handheld cell phone relative to driving without
performing secondary tasks.
Type of Distraction
Change in Risk
(Odds Ratio, 95% CI)
Any cell phone use
1.80 (1.06 - 3.07)
Overall visual-manual tasks
2.19 (1.19 – 4.02)
Texting
2.54 (1.18 – 5.50)
Note: All odds ratios statistically different from 1 at the 0.05 level of significance.
Source: Owens et al. (2018).
The study also found that increases in crash involvement associated with visual-manual tasks
were greater for crashes in free-flow traffic. Rear-end crashes and run-off road crashes were
more prevalent in the crash data than other types of crashes; drivers’ visual-manual cell phone
interactions were associated with increased instances of both these crash types. Run-off road
crashes were also significantly associated with any cell phone use, including reaching for the
device, browsing, or answering calls (Owens et al., 2018).
Another naturalistic study was conducted from 2007 to 2015 with approximately 15,000 teen
drivers (16 to 19 years old). Videos of 2,229 moderate to severe crashes (vehicle impact forces >
1g) including single- and multi-vehicle crashes were extracted and analyzed (Carney et al.,
2018). About 59% involved teen drivers who were distracted in the 6 seconds prior to crashing.
The most common distractions included attending to passengers (15%), using cell phones (12%),
or attending/reaching inside the vehicles (11%). Over the course of the study duration, there were
increases in the proportion of crashes in which the drivers were attending to passengers,
attending to objects inside or outside the vehicles, singing/dancing to music, or operating/looking
at cell phones (i.e., not talking or listening); whereas crashes associated with behaviors such as
talking/listening on cell phone and smoking declined.
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Chapter 4. Distracted Driving
Klauer et al. (2014) used a naturalistic study to examine distracted behaviors and their effects on
the risk of being involved in crashes or near-crashes among 42 novice drivers. Some of the
findings are shown in the table below. Novices were eight times more likely to be involved in
crashes or near-crashes when dialing cell phones and seven times more likely to be involved in
crashes or near-crashes when reaching for cell phones. While the novice driver study had far
fewer participants than the SHRP 2 NDS study above, it demonstrated that the risks posed by
types of distraction are problematic for young drivers just as they are for the general driving
population.
Estimated Change in Crash Risk When Engaging in Secondary
Tasks, Newly Licensed (Novice) Drivers
Type of secondary task
Change in risk
Using a cell phone
Dialing
8.3
Reaching for phone
7.1
Texting
3.9
8.0
Reaching for object (other than cell phone)
3.9
Looking at outside object
3.0
Eating
Note: All odds ratios statistically different from 1 at the 0.05 level of significance.
Source: Klauer et al. (2014).
Given the possible visual, manual, and cognitive attention changes caused by secondary tasks
while driving, none of the distractions listed in the tables above is easily addressed. Moreover, it
is important to note that many studies on distracted driving and its consequences were conducted
prior to the proliferation of smart phones, navigation apps and devices, and built-in technologies.
Consequently, it is possible that distraction-related crashes will escalate as the prevalence,
diversity, and use of new technologies continues to increase.
Strategies to Reduce Distracted Driving
It is difficult to convince or require drivers to avoid distractions while driving. Many drivers
consider some distractions such as eating or drinking, listening to the radio, or talking on on cell
phones, to be important and common activities and they are unlikely to give them up. Moreover,
studies indicate that drivers themselves are poor judges of the performance decrements that result
from distracting activities (Horrey et al., 2008). The 2015 National Survey on Distracted Driving
Attitudes and Behaviors found that a large portion of drivers do not believe that their driving
performance is affected by cell phone use, and that over half of drivers who talk on the phone
while driving believe that their driving is the same while using cell phones (Schroeder et al.,
2018).
Some States have investigated ways to counter distracted driving. For example, Oregon formed a
distracted driving task force committee to identify the factors leading to distracted driving and to
develop recommendations to mitigate the problem (Oregon Department of Transportation, 2017).
The committee encouraged the revision of Oregon’s current cell phone law to make it more
effective by enforcing, educating, citing, and convicting cell phone use violations, improving
collection of crash and citation data, and increasing coordinated communication of strategies
among stakeholders involved in reducing distracted driving. Other recommendations also
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Chapter 4. Distracted Driving
included the increase in government and academic distracted driving research, the development
of a public educational campaign, and the development of a distracted driving toolkit (research,
education, policy, and enforcement resources) tailored to local communities.
Few studies have examined if the standard behavioral countermeasures of laws, enforcement,
and sanctions (which are used successfully for impaired driving, seat belt use, aggressive driving,
and speeding) are effective for distracted drivers. However, the results of three NHTSA
demonstration projects, focused on HVE combined with paid and earned media, suggest that
these elements show promise in reducing the use of handheld phones and texting (Cosgrove et
al., 2011). Some GDL provisions help reduce distracted driving in young drivers by enforcing
limits on the number of passengers and restrictions on cell phone use (see Chapter 6, Sections 1.3
to 1.5).
Job-related distracted driving may be reduced through employer policies and programs.
Employer-based resources are available from the Network of Employers for Traffic Safety
through trafficsafety.org. The National Safety Council also provides resources to employers,
including an online distracted driving course at www.nsc.org/safety-training/defensivedriving/courses/online/distracted. Communications and outreach may be useful in raising
awareness of specific distraction issues among certain high-risk populations. Currently, it is
unknown if these strategies have been evaluated. As with the environmental and vehicular
countermeasures mentioned below, commercial driver countermeasures are not discussed in this
guide because they generally do not fall under the SHSO jurisdiction.
A variety of environmental and vehicular strategies have the potential to address distracted
driving. Rumble strips, both on the shoulder and the centerline, have demonstrated their
effectiveness in preventing crashes associated with inattention (Persaud et al., 2016). 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. Vehicular strategies also can
address driver distraction. Collision avoidance technologies, such as lane departure warning,
crash-imminent braking, and forward collision warning, and vehicle-to-vehicle and vehicle-toinfrastructure communications technologies, hold promise for reducing crashes among drivers
who are inattentive (IIHS, 2012; IIHS, 2014). Such technologies, once available only in luxury
brands, are now offered in many new vehicles. Additionally, in-vehicle technology in the future
may be able to detect driver distraction by monitoring driver performance and then alerting
drivers (Aghaei et al., 2016; Donmez et al., 2007; Koesdwiady et al., 2016; Kuo et al., 2019). On
the other hand, built-in technologies such as navigation and entertainment systems in vehicles
may create more potential distractions (Strayer et al., 2017). NHTSA developed Visual-Manual
Driver Distraction Guidelines for In-Vehicle Electronic Devices pertaining to original equipment
in-vehicle electronic devices (78 Fed. Reg. 24,817, 2013). Although voluntary, the Guidelines
encourage automobile manufactures to design in-vehicle devices so that potentially distracting
tasks are limited while driving. This chapter only addresses behavioral strategies. It does not
include environmental, vehicular, and engineering countermeasures because SHSOs generally do
not have authority or responsibility in these areas.
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Chapter 4. Distracted Driving
Resources
The agencies and organizations listed below can provide more information on distracted driving
and links to numerous other resources.
• National Highway Traffic Safety Administration:
o Research and Evaluation – www.nhtsa.gov/behavioral-research
o Distracted Driving – www.nhtsa.gov/risky-driving/distracted-driving
o Behavioral Safety Research Reports – https://rosap.ntl.bts.gov/
o Traffic Safety Marketing – www.trafficsafetymarketing.gov/get-materials/distracteddriving
• Governors Highway Safety Association: www.ghsa.org
• National Safety Council: www.nsc.org/learn/NSC-Initiatives/Pages/distracted-driving.aspx; www.nsc.org/road-safety/tools-resources/infographics/hands-free-is-not-riskfree
• National Conference of State Legislatures: www.ncsl.org/research/transportation/spotlight-distracted-driving
• Insurance Institute for Highway Safety: www.iihs.org
• AAA Foundation for Traffic Safety: www.aaafoundation.org
• Network of Employers for Traffic Safety: https://trafficsafety.org
For overviews of distracted driving prevalence, risks, legislation, research, and recommended
strategies, see the following.
•
•
•
•
•
•
NHTSA’s Understanding the Effects of Distracted Driving and Developing Strategies to
Reduce Resulting Deaths and Injuries: A Report to Congress – DOT HS 812 053 (Vegega et al., 2013).
NHTSA’s Driver Distraction: A Review of the Current State-of-Knowledge – DOT HS
810 787 (Ranney, 2008).
Overview of the National Highway Traffic Safety Administration’s Driver Distraction
Program – DOT HS 811 299 (NHTSA, 2010).
GHSA’s Distracted Driving: Survey of the States (GHSA, 2013).
World Health Organization’s Mobile Phone Use: A Growing Problem of Driver Distraction (WHO & NHTSA, 2011).
NHTSA’s Blueprint for Ending Distracted Driving – DOT HS 811 629 (NHTSA, 2012).
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.
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Chapter 4. Distracted Driving
Distracted Driving Countermeasures
Countermeasures to reduce distracted driving are listed in the table below. The table is intended
to provide a rough estimate of each countermeasure’s effectiveness, use, cost, and time required
for implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to reduce distracted driving is discussed individually in this chapter. Full
descriptions are included for , , and countermeasures. Brief
descriptions are included for ✩ and ✩✩ countermeasures. Further details about the ✩ and
✩✩ countermeasures are included in Appendix A4 to this report.
1. Laws and Enforcement
Countermeasure
Effectiveness
Cost
Use
Time
$
High
Medium
$
Medium
Short
1.2 Cell Phone and Text Messaging Laws
†
✩✩
1.3 High-Visibility Cell Phone/Text Messaging
Enforcement
$$$
Low
1.4 General Distraction Laws
✩
Varies
High††
1.1 GDL Requirements for Beginning Drivers
Effectiveness demonstrated for passenger restrictions
†† Included under reckless driving; use of explicit distraction laws is low
†
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Medium
Short
Chapter 4. Distracted Driving
2. Communications and Outreach
Countermeasure
2.1 Communications and Outreach on
Distracted Driving
Effectiveness
Cost
Use
✩
$$
High
Time
Medium
3. Other Countermeasures
Countermeasure
Effectiveness
3.1 Employer Programs
✩
Cost
Use
Time
$
Unknown
Short
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
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Chapter 4. Distracted Driving
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 4. Distracted Driving
1. Laws and Enforcement
1.1 Graduated Driver Licensing Requirements for Beginning Drivers
Effectiveness: †
† Effectiveness
Cost: $
Use: High
Time: Medium
demonstrated for passenger restrictions
Studies suggest teenagers and adults are similar in terms of how often they engage in potentially
distracting activities while driving (Foss & Goodwin, 2014; Klauer et al., 2014). However, as
mentioned in the introduction, teens are at higher risk for a crash when engaged in distracting
activities compared to adults (Klauer et al., 2014). Driving requires more of their deliberate
attention compared to experienced drivers (Lansdown, 2002). Moreover, key areas of the brain
are still developing during adolescence, making it difficult for teens to manage potential
distractions (Keating, 2007).
Several elements of GDL reduce the likelihood of distractions for newly licensed drivers. GDL
systems usually include a passenger restriction. Passengers, especially teenage passengers, are a
major source of distraction for young, beginning drivers (Foss & Goodwin, 2014). Cell phones
can also distract drivers (see Appendix A4, Section 1.2), so they are often restricted under GDL.
The NCHRP guide for reducing crashes involving young drivers describes key provisions of
GDL laws (Goodwin et al., 2007). The Insurance Institute for Highway Safety (2019) and the
Governors Highway Safety Association (2019) summarize State GDL laws. These summaries are
updated monthly. See Chapter 6, Sections 1.1 and Appendix A6, Section 1.7, for a complete
discussion of GDL for beginning young drivers.
Use: As of November 2016 all 50 States and the District of Columbia had some GDL
components in place. Laws in 46 States and the District of Columbia limit the number of
passengers allowed with a driver with a provisional license (GHSA, 2019). Thirty-eight States
and the District of Columbia prohibit the use of cell phones, both handheld and hands-free, by
drivers with learner’s permits or provisional licenses or by drivers under 18.
Effectiveness: Several studies document that passenger GDL restrictions reduce teenage driver
crashes and injuries (Chaudhary et al., 2018; Goodwin et al., 2007; Hedlund & Compton, 2005;
Williams, 2007); however, an evaluation of a GDL cell phone restriction suggests cell phone
restrictions may have little effect on teenage drivers’ cell phone use (Ehsani et al., 2016; Foss et
al., 2009; Goodwin et al., 2012). This finding is consistent with McCartt et al. (2014) who
determined that cell phone laws, in general, have little effect on teenagers’ use of cell phones
while driving.
One factor that may undermine the effectiveness of GDL restrictions on cell phone use in teen
drivers is the perception that the risk of penalty from not complying with the law is low. A study
of GDL violations in Washington State and North Carolina found low overall enforcement of the
GDL requirement laws, particularly the cell phone use requirement in both States (AAAFTS,
2014). The authors cite that one possible explanation for low enforcement of cell phone
requirements is that it may be difficult for officers to discern whether a particular cell phone
activity is a banned task or one that is allowed.
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Chapter 4. Distracted Driving
As GDL cell phone non-use requirements can be difficult to enforce, the most frequently charged
GDL violation in Washington and North Carolina study was violation of passenger restrictions
that are easier to observe (AAAFTS, 2014). In an analysis of naturalistic driving data, the most
frequently seen driving behavior leading up to a teen crash was attending to passengers (Carney
et al., 2015). Limiting the number of young passengers to none or one significantly decreases
crash risk (Masten et al., 2013; McCarett et al., 2010). Not only are GDL passenger restrictions
associated with a decrease in crashes, they may also help with reducing passenger injuries (Zhu
et al., 2016) and multi-passenger crashes (McCarrtt & Teoh, 2015).
It should be noted that the AAA Foundation (AAAFTS, 2014) found that a high proportion of
GDL citations, including those for cell phone and passenger restrictions, were dismissed by the
Washington and North Carolina courts and that these dismissals “may very well be detrimental to
the overall effectiveness of GDL programs.”
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 can be minimal. Information about GDL restrictions can also be provided
through driver education courses.
Time to implement: GDL passenger or cell phone restriction changes require several months to
implement for drivers receiving a provisional license. They then will take 1 or 2 years before all
provisionally licensed drivers are subject to the new restrictions.
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Chapter 4. Distracted Driving
1.2 Cell Phone and Text Messaging Laws
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Short
This countermeasure involves legislation to curtail distracted driving or driver cell phone use. It
has been implemented at both the State and local level throughout the country. Bans on texting
are more common than bans on handheld cell phone use. Twenty-one States and the District of
Columbia have laws banning handheld cell phones while driving, but at present no State restricts
hands-free phone use for all drivers (GHSA, 2020). Forty-eight States and the District of
Columbia have banned text messaging for all drivers. An additional State, Missouri, bans drivers
under 21 from text messaging. As of February 2020, Montana is the only State with no laws on
driver cell phone use (GHSA, 2020).
Effectiveness Concerns: The effectiveness of laws banning cell phone use has been examined in
several research studies. The results across types of phone use are inconsistent. Specifically,
research examining prohibitions on hands-free phone use and texting have yielded mixed results
in terms of reductions in phone use while driving and reduced crashes. There is some evidence
that banning handheld cell phone use leads to long-term reductions in this behavior; however, it
is unknown if drivers are simply switching to hands-free use. At this time, there is insufficient
consensus across research findings to determine that this countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A4, Section 1.2.
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Chapter 4. Distracted Driving
1.3 High-Visibility Cell Phone and Text Messaging Enforcement
Effectiveness:
Cost: $$$
Use: Low
Time: Medium
Numerous studies demonstrate that HVE can be effective in curbing alcohol-impaired driving
and increasing seat belt use among drivers (see Chapter 1, Section 2.1 and Chapter 2, Section
2.1). NHTSA has examined whether the HVE model could be effective in reducing handheld cell
phone use and texting among drivers.
Similar to sobriety checkpoints, the objective is to deter cell phone use by increasing the
perceived risk of a ticket. The HVE model combines dedicated law enforcement with paid and
earned media supporting the enforcement activity. Law enforcement officers actively seek out
cell phone users through special roving patrols or through a variety of enforcement techniques
such as the spotter technique where a stationary officer will radio ahead to another officer when a
driver using a cell phone is detected. Officers report that higher vantage points, SUVs, and
unmarked vehicles are strategies useful in identifying violators (Chaudhary et al., 2014). Both
earned and paid media are critical to ensure the general public is aware of the enforcement
activity and to increase the perception that being caught is likely.
NHTSA conducted an HVE demonstration project aimed at reducing cell phone use among
drivers. The program tagline was: “Phone in one hand. Ticket in the other.” Pilot programs were
tested in Hartford, Connecticut, and Syracuse, New York, from April 2010 to April 2011. Law
enforcement officers conducted four waves of enforcement during the year. Approximately 100
to 200 citations were issued per 10,000 population during each enforcement wave. Paid media
(TV, radio, online advertisements, and billboards) and earned media (e.g., press events and news
releases) supported the enforcement activity. For more details about the program, see Chaudhary
et al. (2014).
To examine the effectiveness of HVE in larger jurisdictions, NHTSA proceeded to implement an
HVE campaign in Delaware and in nine California counties in the Sacramento area. Three waves
of enforcement were conducted from November 2012 to June 2013. Paid and earned media were
similar to that in Hartford and Syracuse. See Schick et al. (2014) and Chaudhary et al. (2015) for
more information.
Observations from the previous demonstration projects in Hartford/Syracuse and
California/Delaware reported that relatively few citations were issued for texting while driving.
Moreover, feedback from LEOs suggested that enforcing laws prohibiting texting while driving
was difficult. In 2012 NHTSA undertook a third demonstration program to determine the
enforceability of texting laws and to test methods for enforcing these laws. LEAs in Connecticut
and Massachusetts participated in the program. Four waves of enforcement were conducted in
each State over 2013 and 2014. The evaluation suggested that having a strong set of distracted
driving laws helps with enforcement of texting laws (see Retting et al., 2017).
Use: To date a limited number of States have implemented HVE programs to address talking on
cell phones and texting while driving.
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Chapter 4. Distracted Driving
Effectiveness: Results from the NHTSA HVE program suggest handheld cell phone use among
drivers dropped 57% in Hartford and 32% in Syracuse (Chaudhary et al., 2014). The percentage
of drivers observed manipulating a phone (e.g., texting or dialing) also declined. Public
awareness of distracted driving was already high before the program, but surveys suggest
awareness of the program and enforcement activity increased in both Hartford and Syracuse.
Surveys also showed most motorists supported the enforcement activity. Similar reductions in
cell phone use were observed following the campaign in California (34% reduction) and
Delaware (33% reduction), although decreases were also noted in comparison communities
(Chaudhary et al., 2015; Schick et al., 2014). Although these results are encouraging, the effect
of HVE campaigns on crashes is not certain. An analysis of crash data from before and after the
enforcement period found no effects of HVE on the incidence of distraction-related crashes
(Chaudhary et al., 2015). Note that the evidence for effectiveness is based on community and
smaller statewide programs that targeted handheld cell phone use. There is no evidence available
that HVE programs specifically targeting texting will be as effective.
Costs: High-visibility enforcement campaigns are expensive. They require time from LEOs to
conduct the enforcement. In addition, time is needed from State highway safety office and media
staff and often from consultants to develop, produce, and distribute advertising, educational
material, and other communications tools. In the NHTSA demonstration program, both
Connecticut and New York received $200,000 to implement and evaluate the program, and each
State contributed an additional $100,000 to the Federal funds. Paid media costs for the program
in the two States were over $500,000.
Time to implement: An HVE program requires 4 to 6 months to plan and implement.
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Chapter 4. Distracted Driving
1.4 General Driver Distraction Laws
Effectiveness: ✩
† Included
Cost: Varies
Use: High†
Time: Short
under reckless driving; use of explicit distraction laws is low
This countermeasure involves laws that specifically target the issue of distracted drivers. This
law would permit drivers who are involved in a crash or who commit an infraction to be cited for
distracted driving if a police officer believes distraction to be the underlying cause. Distraction is
“anything that diverts the driver’s attention from the primary tasks of navigating the vehicle and
responding to critical events” (NHTSA, n.d.).
Effectiveness Concerns: Laws that specifically target distracted drivers are not widely
enforced, and this countermeasure has not been systematically examined. There are insufficient
evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A4, Section 1.4.
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Chapter 4. Distracted Driving
2. Communications and Outreach
2.1 Communications and Outreach on Distracted Driving
Effectiveness: ✩
Cost: $$
Use: High
Time: Medium
This countermeasure involves distracted driving communications and outreach campaigns
directed to the general public. Since distracted driving is a particular concern among teenage
drivers (Foss & Goodwin, 2014; NHTSA, 2012), distracted driving campaigns may specifically
target teen drivers. Some campaigns carry a general “pay attention” message, while others are
directed at specific behaviors such as cell phone use.
Effectiveness Concerns: Based on NCHRP research, there are no studies of any campaign’s
effects on driver knowledge, attitudes, or behavior (Stutts et al., 2005, Strategies C1 and D2).
Though distracted driving outreach campaigns are widespread, there is little information that
exists regarding their effectiveness.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A4, Section 2.1.
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Chapter 4. Distracted Driving
3. Other Countermeasures
3.1 Employer Programs
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
This countermeasure involves job-related distracted driving. There are many ways States can
work with employers to address distracted driving. Employers can protect themselves by
implementing policies that prohibit distracted driving and by monitoring compliance. The
Network of Employers for Traffic Safety (NETS) program is an initiative founded by NHTSA
and led by participating employers that is aimed at improving traffic safety of employees and
broader members of the community. NETS provides a variety of road safety resources for
participating employers that can be found at https://trafficsafety.org/road-safetyresources/distracted-driving-campaign-materials-graphics/. The National Safety Council has
developed a policy kit to assist employers with implementing or strengthening a cell phone ban,
available at https://safety.nsc.org/cellphonekit.
Use: At least 17 States and the District of Columbia have worked with employers in their States
to develop distracted driving policies (GHSA, 2013).
Effectiveness Concerns: No employer distracted driving program has currently been evaluated.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A4, Section 2.1.
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Chapter 4. Distracted Driving
Distracted Driving References
78 Fed. Reg. 24,817 (proposed April 26, 2013). Visual-Manual NHTSA Driver Distraction
Guidelines for In-Vehicle Electronic Devices.
AAA Foundation for Traffic Safety. (2014, August). Violations and enforcement of graduated
driver licensing restrictions in North Carolina and Washington State.
http://docplayer.net/27987553-Violations-and-enforcement-of-graduated-driverlicensing-restrictions-in-north-carolina-and-washington-state.html
AAAFTS. (2016, February). 2015 traffic safety culture index. https://aaafoundation.org/wpcontent/uploads/2016/02/2015TrafficSafetyCultureIndexReport.pdf
AAAFTS. (2018, March). 2017 Traffic Safety Culture Index. AAA Foundation for Traffic Safety.
https://aaafoundation.org/wp-content/uploads/2018/03/TSCI-2017-Report.pdf
Aghaei, A. S., Donmez, B., Liu, C. C., He, D., Liu, G., Plataniotis, K. N., Chen, H.-Y. W., &
Sojoudi, Z. (2016). Smart driver monitoring: When signal processing meets human
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March). Evaluation of NHTSA distracted driving demonstration projects in Connecticut
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in Connecticut and New York reduce hand-held phone use. (Traffic Safety Facts
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4-19
Chapter 4. Distracted Driving
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teenage driver cell phone restriction. Accident Analysis & Prevention, 41, 419-424.
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Goodwin, A. H., O’Brien, N. P., & Foss, R. D. (2012). Effect of North Carolina's restriction on
teenage driver cell phone use two years after implementation. Accident Analysis &
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perceptions of hands-free technologies. Findings from the 2013 Traffic Safety Culture
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Journal of Safety Research, 36, 109-119.
Horrey, W. J., Lesch, M. F., & Garabet, A. (2008). Assessing the awareness of performance
decrements in distracted drivers. Accident Analysis & Prevention, 40, 675-682.
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Chapter 4. Distracted Driving
IIHS. (2019). Teenagers - May 2019 (Web
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Klauer, S. G., Guo, F., Simons-Morton, B. G., Ouimet, M. C., Lee, S. E., & Dingus, T. A.
(2014). Distracted driving and risk of road crashes among novice and experienced
drivers. The New England Journal of Medicine, 370, 54-59.
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drowsiness in shift-workers during naturalistic driving. Safety Science, 119, 112-116.
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the risks and benefits. Risk in Perspective, 8(6), 1-6.
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Chapter 4. Distracted Driving
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Chapter 4. Distracted Driving
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Chapter 5. Motorcycle Safety
5.Motorcycle Safety
Overview
A motorcycle is inherently more difficult to operate than a passenger vehicle because it requires
more physical skill and strength. The relationship of motorcycle speed and stability is also a
critical consideration when riding a motorcycle, as the stability of a motorcycle is relative to
speed. As speed increases, the motorcycle becomes more stable, requiring less effort from the
operator to maintain its balance, even as it becomes less maneuverable. At lower speeds, the
motorcycle becomes less stable, requiring greater effort from the operator to balance it.
A motorcycle offers the rider virtually no protection in a crash. Crash data confirm this
observation. For example, NHTSA estimates that in 2018, motorcyclists were about 27 times
more likely than passenger car occupants to die in traffic crashes per vehicle mile traveled
(VMT), and motorcyclists were killed at a rate of 24.83 fatalities per 100 million VMT compared
to 0.91 fatalities per 100 million VMT for passenger cars (NCSA, 2020).
Trends. Motorcycling has become increasingly popular over the last 20 years and the total VMT
on motorcycles has nearly doubled since 1998 (NCSA, 2000; NCSA, 2020). Along with this
growth in popularity are increases in crashes and fatalities involving motorcyclists. From 2000 to
2008 the number of motorcyclists killed in crashes increased by 83% and the number injured
increased by 66%. In 2008 motorcyclist fatalities increased for the 11th consecutive year to
5,312, a level not seen since 1980 (NHTSA, 2011). Between 2008 and 2014 the number of
motorcyclist fatalities fluctuated, but steadily increased since 2014 (see figure below) with a
slight decrease in 2017 and again in 2018. The most recent data show that in 2018 there were
4,985 fatalities, a 5% decrease from the 5,229 motorcyclists killed in 2017 (NCSA, 2020).
Motorcyclists accounted for 14% of total motor vehicle related fatalities during 2018.
Motorcyclist Fatalities in Crashes
5,000
4,000
3,000
2,000
Year
Source data: NHTSA (2011), NCSA (2020)
5-1
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
0
2001
1,000
2000
Number of Fatalities
6,000
Chapter 5. Motorcycle Safety
In 2018 some 38% of motorcyclist fatalities (NCSA, 2020) and 55% of all motorcyclists injured
(NHTSA, 2020) occurred in single-vehicle crashes. More than half (52%) of all fatalities
occurred on weekdays, and 59% of fatalities occurred in daylight (NCSA, 2020). Ninety-one
percent of motorcyclists killed were males (NHTSA, 2020), and passengers comprised 6% of
motorcycle fatalities (NCSA, 2020).
While the number of motorcyclists involved in injury crashes increased among all age groups,
one trend that has continued for about 20 years are increases in fatalities and injuries among
older motorcyclists. In 2018 some 63% of the motorcyclists killed in crashes were 35 or older
and 46% were 45 or older, compared to 1998, when 45% of the motorcyclists killed were 35 or
older and 22% were 45 or older (NHTSA, 2020). Moreover, injuries among motorcyclists 50 and
older increased at the fastest rate. Motorcyclists 50 and older were estimated to account for 15%
and 26% of motorcyclists injured nationally during 1998 and 2008, respectively (NHTSA, 1998,
2008). In 2018 motorcyclists 50 and older were estimated to account for 31% of the
motorcyclists injured (NHTSA, 2018b [FARS]; NHTSA, 2018a [CRSS]). Note that CRSS
estimates and NASS GES estimates are not comparable due to different sample designs.
Speeding is more prevalent in fatal crashes involving motorcycle operators than among other
types of motor vehicle operators. Thirty-one percent of all motorcycle operators involved in fatal
crashes in 2018 were speeding, compared to 18% of passenger car drivers (NCSA, 2020).
Motorcycle operators involved in fatal crashes had worse prior driving records than other
passenger vehicle drivers, including more driving while impaired (DWI) convictions, speeding
convictions, and suspensions or revocations. Additionally, 28% of the motorcycle operators
involved in crashes in 2018 did not have valid motorcycle operator licenses. In 2018 there were
26% of the motorcycle operators killed in crashes who had BACs of .08 g/dL or higher.
Nationally, 38% of fatally injured motorcyclists in known cases of helmet use were not
helmeted, although this percentage varies from State to State from a high of 81% in Indiana to a
low of 3% in Louisiana. Among the 19 States with mandatory helmet use by all motorcycle
riders, the known helmet use in fatal crashes ranged from 62% in West Virginia to 97% in
Louisiana. In contrast, States with helmet use requirements for only a subset of the motorcyclists
or no requirement had known helmet use in fatal crashes ranging from 19% in Indiana to 58% in
Michigan.
Other trends in motorcycle safety relate to the types of motorcycles being produced and
purchased. The number of registrations for all types of motorcycles has steadily increased and
doubled from 2002 (4.2 million) to 2017 (8.4 million); there was a slight decrease in total
registrations in 2018 (8.3 million) (Toeh, 2019). The majority of registrations in 2018 were
cruiser (3.5 million) and touring bikes (1.8 million). Registrations for supersport motorcycles,
which are built on racing bike frames and can reach speeds of nearly 190 mph, peaked between
2008 and 2010, and then declined to about 602,000 in 2018; however, supersport registrations
are still 66% higher than in 2002. Operators of cruisers (32%) and supersport bikes (22%) were
the highest number of fatalities among all motorcycle rider deaths in 2017 (IIHS, 2018). Fifty-six
percent of supersport operator fatalities in 2017 were 30 years old or younger. In contrast, the
majority of fatally injured cruiser (84%) and touring bike operators (94%) were older than 30.
Motorcyclist fatality rates per 100,000 registered vehicles have increased from 56.36 in 2009 to
57.52 in 2018 (NHTSA, 2020). Helmet use varied among operators of different motorcycle types
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Chapter 5. Motorcycle Safety
in 2017; 81% of fatally injured supersport operators and 51% of cruiser and touring bike
operators were helmeted (IIHS, 2018). These results suggest that the types of risks taken may
vary in association with the style of bike chosen (Teoh & Campbell, 2010).
Another emerging trend having safety implications is the increased use of low-powered cycles
such as mopeds, electric-assist bicycles, and scooters. State laws defining and regulating these
vehicles vary as do crash reporting procedures, making it difficult to track crash data trends.
While these are different vehicles in terms of their speed and power capabilities (most States
classify these vehicles based on criteria including maximum speed, generally 20 to 30 mph),
some countermeasures aimed at motorcycles (such as helmet use laws) apply to low-powered
cycles. However, riders of low-powered cycles may face different safety problems than
motorcycle riders.
Strategies to Improve Motorcycle Safety
Various strategies are employed to improve motorcycle safety. The most demonstrably effective
strategy is the use of motorcycle helmets that meet FMVSS 218. Other strategies include training
and the use of high-visibility gear. It is generally understood that motorcycle riders should be
properly trained and licensed. They should also be alert and aware of the risks they face while
riding while impaired by alcohol or drugs. These and other strategies are discussed in the
National Agenda for Motorcycle Safety (NAMS), a comprehensive, collaborative, and
multidisciplinary blueprint for motorcycle safety (NHTSA, 2000a). The recommendations of the
NAMS were prioritized in 2013 (NHTSA, 2013a). See also the NAMS Implementation Guide
(NHTSA, 2006), NHTSA’s Motorcycle Safety 5-Year Plan (NHTSA, 2019), the U.S. DOT
Action Plan to Reduce Motorcycle Fatalities (U.S. DOT, 2007), and the CDC’s Motorcycle
Safety Guide (CDC, 2011). In addition, a review of State Motorcycle Safety Program Technical
Assessments summarizes program recommendations, implementations, and barriers to
implementation from nine State motorcycle safety program technical assessments conducted by
NHTSA (Baer & Skemer, 2009).
The most demonstrable objectives for improving motorcycle safety are to increase helmet use
and reduce alcohol- and drug-impaired motorcycle riding. These objectives are difficult to
accomplish. However, universal helmet laws are highly effective in assuring that virtually all
motorcycle riders use helmets, but they also are politically difficult to enact and retain. Based on
the research discussed in this document, strategies based only on communications and outreach
to promote helmet use and reduce impaired motorcycling appear to be no more successful with
motorcycle riders than other communications and outreach campaigns for other road users.
Another objective is to increase other motorists’ awareness of motorcyclists by increasing the
visibility of motorcyclists and educating drivers on the importance of sharing the road with
motorcycles. Daytime running lights (DRLs) for motorcycles improve motorcycle conspicuity,
but there is evidence suggesting that the increased prevalence of DRLs in the vehicle fleet has
reduced the benefits of DRLs on motorcycles (for example, see Jenness et al., 2011, and
Pierowicz et al., 2011). Most motorcycles on the road have headlights that turn on automatically
when the engines are started (NCHRP, 2008, Strategy 11.1 D2). In addition, as of June 2017, at
least 24 States required daytime headlight—some States required use on all motorcycles while
5-3
Chapter 5. Motorcycle Safety
others specified requirement based on year of the motorcycle model manufacture (MSF, 2017;
MLF, 2018). At least 22 other States and the District of Columbia that require the use of
headlights permit modulating headlights (MLF, 2018). Modulating headlights cause the
headlight to move from high- to low-beam rapidly. These can increase motorcycle visibility
(Olson et al., 1979), but integration of these devices into the motorcycle fleet has been slow.
A similar way to improve motorcycle conspicuity is to manipulate the front-light configuration.
A 2012 simulation study by Cavallo and Pinto showed that daytime running lights on cars create
“visual noise” that interferes with the lighting of motorcycles and affects their visual conspicuity
(Cavallo & Pinto, 2012). As a potential solution, Pinto et al. (2014) tested three front-light
configurations in a daytime environment that included cars using day running lights. They found
that while adding more lights to the configuration did not improve conspicuity over a typical
single front-light configuration, changing the color of that light from white to yellow resulted in
significantly higher detection (74% versus 54%). A similar study found that a single, white,
central headlight with two additional yellow lights on the forks and one on the motorcyclist’s
helmet increased motorcyclist conspicuity both in daylight and nighttime driving (Ranchet et al.,
2016). These findings suggest that lighting has a role promoting motorcycle conspicuity.
Motorcycle crashes can also be prevented, or the crash severity mitigated, by the use of vehicle
technologies such as antilock brakes (Bayly et al., 2006). For example, two studies by IIHS
found that motorcycles with antilock brakes had a lower fatal crash involvement than
motorcycles without antilock brakes (Teoh, 2011, 2013).
Many environmental factors can also affect motorcycle safety. Slippery roadway surfaces and
markings, surface irregularities and debris, unpaved shoulders, and unforgiving roadway barriers
all can be dangerous. These issues are not included in this guide because State Highway Safety
Offices have little or no authority or responsibility for them. See National Cooperative Highway
Safety Research Report 500, Volume 22, Guide for Addressing Collisions Involving
Motorcycles, for a thorough discussion of environmental and other strategies.
www.trb.org/Publications/Public/Blurbs/A_Guide_for_Addressing_Collisions_Involving_Motor
c_160626.aspx
Resources
For a broad set of resources for State safety agencies and on-going research efforts:
• Government Accountability Office’s Report to Congressional Committees –
www.gao.gov/assets/660/650037.pdf
• The Community Guide’s Motorcycle Helmets: Universal Helmet Laws – www.thecommunityguide.org/sites/default/files/assets/MVOI-Motorcycle-Helmets-Laws-MandatingUse_1.pdf
NHTSA’s web pages:
• Motorcycles – www.nhtsa.gov/road-safety/motorcycles
• NHTSA’s NCSA Motor Vehicle Traffic Crash Data Resource Page https://crashstats.nhtsa.dot.gov/#!/
• Research and Evaluation - www.nhtsa.gov/research-data
5-4
Chapter 5. Motorcycle Safety
•
•
Behavioral Safety Research Reports – https://rosap.ntl.bts.gov
www.trafficsafetymarketing.gov/get-materials/motorcycle-safety
5-5
Chapter 5. Motorcycle Safety
Motorcycle Safety Countermeasures
Countermeasures to improve motorcycle safety are listed in the table below. The table is
intended to provide a rough estimate of each countermeasure’s effectiveness, use, cost, and time
required for implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective,
either because there is limited or no high-quality evidence (✩) or because effectiveness
is undetermined based on current evidence (✩✩).
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures, and to exercise caution when selecting ✩ or
✩✩ countermeasures, as these countermeasures do not have conclusive evidence on their
effectiveness. When deploying a new or emerging countermeasure with unproven effectiveness,
it is valuable to include an evaluation of the countermeasure in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to improve motorcycle safety is discussed individually in this chapter. Full
descriptions are included for , and countermeasures. Brief
descriptions are included for ✩ and ✩✩ countermeasures. Further details about the ✩ and
✩✩ countermeasures are included in Appendix A5 to this report.
1. Motorcycle Helmets
Countermeasure
1.1 Universal Motorcycle
Helmet Use Laws
1.2 Motorcycle Helmet Use Promotion
Programs
1.3 Motorcycle Helmet Law Enforcement:
Noncompliant Helmets
Effectiveness
Cost
Use
Time
$
Medium
Short
✩
Varies
Low to
Medium
Varies
✩
$
Unknown
Medium
Effectiveness
Cost
Use
Time
✩
Varies
Unknown
Varies
$$
Medium
Medium
2. Alcohol Impairment
Countermeasure
2.1 Alcohol-Impaired Motorcyclists: Detection,
Enforcement, and Sanctions
2.2 Alcohol-Impaired Motorcyclists:
Communications
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Chapter 5. Motorcycle Safety
3. Motorcycle Rider Licensing and Training
Countermeasure
Effectiveness
3.1 Motorcycle Rider Licensing
3.2 Motorcycle Rider Training
✩
✩✩
Cost
Use
Time
$
High
Medium
$$
High
Varies
Cost
Use
Time
Varies
High
Medium
Varies
High
Medium
4. Communications and Outreach
Countermeasure
Effectiveness
4.1 Conspicuity and Protective Clothing
4.2 Motorist Awareness of Motorcyclists
✩
✩
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
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Chapter 5. Motorcycle Safety
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 5. Motorcycle Safety
1. Motorcycle Helmets
1.1 Universal Motorcycle Helmet Use Laws
Effectiveness:
Cost: $
Use: Medium
Time: Short
Motorcycle helmets are highly effective in protecting motorcycle riders’ heads in crashes.
Research indicates that helmets reduce motorcycle rider fatalities by 22 to 42% and brain injuries
by 41 to 69% (Coben et al., 2007; Cummings et al., 2006; Deuterman, 2004; Liu et al., 2008;
NHTSA, 2003; NHTSA, 2006; NHTSA, 2019). A Cochrane Collaboration review of 61 studies
concluded that risk reductions were on the high end of the ranges mentioned above, with higher
quality studies indicating that the protective effect of helmets was about a 42% reduction in risk
of fatality in a crash and 69% for risk of a head injury in a crash. This review found that there
was insufficient evidence to determine the effect on neck or facial injuries, or the effects of
types of FMVSS 218 compliant helmets on injury outcomes (Liu et al., 2008). Others have found
no evidence that helmets increase the risk of neck injuries (Brewer et al., 2013; NCHRP, 2008,
Strategy E1; NHTSA, 2000; Philip et al., 2013; Ulmer & Preusser, 2003).
State universal coverage helmet-use laws are effective at increasing helmet use. In 2018
observed compliant helmet use was 83% across States with universal helmet laws that cover all
riders, and 57% across States with no law or partial coverage laws (NCSA, 2019). A systematic
review of U.S. motorcycle helmet laws found that States with universal coverage laws: (1) had
motorcycle helmet use rates 53 percentage points higher than States with partial coverage or no
law; (2) had 29% fewer motorcycle fatalities; and (3) had lower fatality rates per registered
motorcycle and per vehicle mile traveled (Guide to Community Preventive Services, 2013).
Nationally in 2018, FMVSS 218 compliant helmet use was 71% (NCSA, 2019). Use of
noncompliant helmets increased slightly from 7% in 2017 to 9% in 2018, while helmet non-use
decreased slightly from 28% in 2017 to 20% in 2018.
Use: The first universal helmet law was enacted in 1966. Universal laws were in effect 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. The IIHS (2019) summarizes the helmet law
history in each State.
As of 2019 there were 19 States and the District of Columbia that had helmet laws covering all
riders (IIHS, 2019). Three States (Illinois, Iowa, and New Hampshire) did not have motorcycle
helmet laws. The remaining States had laws covering only riders under a specified age, typically
17 or 20. The motorcycle helmet laws of 30 States and the District of Columbia apply to
motorcycles. Seventeen States have motorcycle helmet laws that do not cover certain lowpowered cycles, typically those with engine displacements under 50cc or with maximum speeds
less than 30 mph.
Effectiveness: Studies of helmet use among motorcyclists indicate that universal helmet use
laws are effective in increasing helmet use, which reduces injuries, decreases hospital admissions
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and treatment costs, and lowers insurance claims. Studies in States that enacted universal helmet
laws observed use rates of 90% or higher immediately after the laws became effective, compared
to 50% or lower before the laws (Ulmer & Preusser, 2003, Section II). States that repealed
universal helmet laws observed the opposite effect, as use rates dropped from above 90% to
about 50% (Kyrychenko & McCartt, 2006; Preusser et al., 2000, Section V; Ulmer & Preusser,
2003, Sections IV and V). Injury severity and mortality rates increased in States that repealed
universal helmet laws, with post-repeal rates similar to rates in States with partial motorcycle
helmet laws (Striker et al., 2016; Wiznia et al., 2016). Carter et al. (2017) evaluated the impact of
the repeal of Michigan’s helmet law by comparing motorcyclist fatalities, injuries, and helmet
use rates over a period of 12 months before and after the repeal. Among riders involved in
crashes, helmet use decreased 24% to 27% after the repeal. The decrease was sharper among
alcohol-intoxicated riders, among passengers than operators, and among females than males. A
14% increase was observed in head injury trauma in hospitalized motorcycle riders. There was
no change in overall fatality rates in the 12 months before and after the repeal. Reenactment of a
universal law in Louisiana (after a cycle of repeals and reenactments since 1968) resulted in
increases in helmet use among riders involved in crashes, from 42% before reenactment to 87%
following (Gilbert et al., 2008).
The Community Preventive Services Task Force conducted a systematic review of 60 studies
(through August 2012) evaluating motorcycle helmet laws in the United States. This review
found that universal helmet use laws consistently increased helmet use and decreased injuries
and deaths associated with motorcycling. Universal helmet laws are also associated with
economic benefits at the societal level due to avoided productivity loss and healthcare costs
(Peng et al., 2017). The Task Force concluded that universal coverage laws were substantially
more effective than partial coverage laws or no law (Guide to Community Preventive Services,
2013; Peng et al., 2017). The U.S. General Accounting Office (GAO, now the Government
Accountability Office) reviewed 46 studies of State helmet laws published before 1990. GAO
concluded that motorcycle rider fatality rates were 20 to 40% lower with universal helmet laws
(GAO, 1991; Ulmer & Preusser, 2003, Section II). Studies since 1990 confirm these results
(Cummings et al., 2006; Houston & Richardson, 2008; Kyrychenko & McCartt, 2006; Morris,
2006; Ulmer & Northrup, 2005; Ulmer & Preusser, 2003, Section II).
Some States have helmet laws that mandate use for young riders. Helmet use is generally low in
these States (GAO, 1991; Olsen et al., 2016), and these partial coverage laws do not translate
into meaningful reductions in young rider fatality rates (Brooks et al., 2010; Houston, 2007).
Additionally, Weiss et al. (2010) compared the risk of traumatic brain injury among youth in
States with limited-age helmet laws and States with universal helmet laws. They found a 37%
increase in risk of traumatic brain injury requiring hospitalization for youth in States with partial
coverage helmet laws compared to States with universal helmet laws. A recent study of
emergency department and inpatient records in 11 States (5 with universal helmet laws and 6
with partial helmet laws) reported increases of 2 percentage points in traumatic brain injuries in
States with partial helmet laws compared to States with universal helmet laws (Olsen et al.,
2016). Injuries to the head and neck areas were found to be lower and injuries to extremities
higher in States with universal coverage helmet laws. Overall, the study concluded that helmet
use was associated with reduced risk of head, facial, and traumatic brain injury, as well as
motorcycle-crash related fatalities. However, this risk reduction was less pronounced in States
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with universal helmet laws than States with partial helmet laws. Another study reported a
reduction in fatality rates among all ages for partial coverage laws compared to no law, but the
effect was much smaller (7% to 8%) than that for universal coverage (22% to 33%) (Houston &
Richardson, 2008). Moreover, when Florida eliminated the requirement that all motorcycle riders
21 and older wear helmets, there was an 81% increase in motorcyclist fatalities (Ulmer &
Northrup, 2005). Fatalities even increased among riders under 21 who were still covered by the
helmet law.
Hospital admissions and treatment costs have also increased following repeal of universal helmet
laws (Derrick & Faucher, 2009; GAO, 1991; Peng et al., 2017). Almost half of all motorcyclists
admitted to hospitals lacked sufficient health care insurance or were covered by government
services, so the public ultimately shares many costs, as well as a greater long-term burden of care
(Derrick & Faucher, 2009; GAO, 1991; NHTSA, 2019). In addition, an analysis of insurance
claims data found that when Michigan’s helmet law was amended from a universal coverage law
to a partial coverage law (effective since April 2012), claims increased by more than 22%
compared with control States (HLDI, 2013). Medical costs related to motorcycle crashes are
typically higher in States with partial helmet laws. Olsen et al. (2016) reported that median
medical costs were 37% lower for emergency department visits and 21% lower for in-patient
hospital charges in States with universal helmet laws. The Community Preventive Services Task
Force found in their systematic review of 22 studies that universal coverage motorcycle helmet
laws resulted in significant economic benefits (Guide to Community Preventive Services, 2013;
Community Preventive Services Task Force, 2017; Peng et al., 2017). These studies show that
universal coverage laws provide greater safety and cost benefits than laws that cover only a
specific age group or riders having a certain amount of insurance.
Costs: Once legislation requiring universal helmet use has been enacted, implementation costs
are minimal. The inevitable controversy surrounding the legislation will help to publicize the
new law extensively. Motorcycle helmet laws can be enforced during regular traffic patrol
operations because helmet use is easily observed.
Time to implement: Although a universal helmet use law can be implemented as soon as the
law is enacted, enacting such a law is a complex and time-consuming process, and may require
the involvement of a “champion.”
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).
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). See Jones and Bayer (2007) for a
history of opposition to helmet laws in the United States. Derrick and Faucher (2009)
also discuss national policy, organized opposition, and helmet law changes over four
decades.
• Noncompliant helmets: Some riders in States with universal helmet laws wear helmets
that do not comply with FMVSS 218 (NCSA, 2019). See the discussion in Appendix A5,
Section 1.3.
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• Compliance Benefits from Enacting Other Safety Laws: Helmet law compliance has
been shown to benefit from the enactment and enforcement of other motorcycle safety
laws. In 2007 existing motorcycle safety laws in Puerto Rico were augmented to reduce
the legal BAC limit to .02 g/dL, and require motorcycle riders to wear protective safety
apparel, along with other requirements. One benefit of the amended law was that the use
of DOT-compliant motorcycle helmets increased, even though helmet laws already
existed (Fell et al., 2017). From 2006 to 2007 Puerto Rico riders’ use of DOT-compliant
motorcycle helmets rose from 39.4% to 56.4% and continued to increase to greater than
70% three years later. Observed DOT-compliant helmet use reached 86%, 4 years after
the 2007 Puerto Rico law change.
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1.2 Motorcycle Helmet Use Promotion Programs
Effectiveness: ✩
Cost: Varies
Use: Unknown
Time: Varies
A few States with or without universal motorcycle helmet-use laws promote helmet use through
communications and outreach campaigns. NHTSA has developed helmet use promotion
brochures, flyers, and PSAs suitable for television and radio that are available online. NCHRP
(2008) describes elements that should be included in a campaign should one be undertaken. The
WHO has developed a manual for decision-makers and safety practitioners to use when
developing programs to improve motorcycle helmet use (see Chapter 3 in WHO, 2006).
Effectiveness Concerns: There appear to be no formal evaluations of the effect of helmet use
promotion programs in States without universal helmet laws (NCHRP, 2008).
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 1.2.
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1.3 Motorcycle Helmet Law Enforcement: Noncompliant Helmets
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Medium
This countermeasure involves legislation and enforcement of laws that require motorcyclists to
wear helmets that comply with FMVSS 218. For FMVSS 218 compliant helmet laws to be
effective, they must be enforced, publicized, and adequately funded. NHTSA makes videos
available for motorcyclists and law enforcement demonstrating how to identify compliant and
noncompliant helmets, and how to choose a helmet that fits correctly
(www.trafficsafetymarketing.gov/get-materials/motorcycle-safety/rider-safety). States may
access these videos for their own outreach campaigns. NHTSA also produced a brochure on how
to identify noncompliant helmets, www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/14283identify_unsafe_motorcycle_helmets_070919_v4_tag.pdf. See NHTSA’s Choose the Right
Motorcycle Helmet page for information on identifying the correct helmet fit and helmet safety
ratings (www.nhtsa.gov/motorcycle-safety/choose-right-motorcycle-helmet). NHTSA also
produced publications designed to teach motorists about motorcycle rider behaviors of which
they may not be aware (see www.trafficsafetymarketing.gov/get-materials/motorcyclesafety/motorist-awareness-motorcycles).
Effectiveness Concern: The effectiveness of an enforcement program on noncompliant helmet
use has not been evaluated.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 1.3.
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2. Alcohol Impairment
2.1 Alcohol-Impaired Motorcyclists: Detection, Enforcement, and Sanctions
Effectiveness:
Cost: Varies
Use: Unknown
Time: Varies
Alcohol impairment is a substantial problem for motorcyclist operators, even more than for
drivers of other motor vehicles. In 2018 some 25% of motorcycle operators involved in fatal
crashes had BACs of .08 g/dL or higher, which is higher than the rate for passenger car drivers
(21%) and light-truck drivers (19%) (NCSA, 2020). The highest percentages of alcohol-impaired
motorcycle operators killed were in the 40-to-44 age group (34%) followed by the 45-to-49 age
group (33%) and the 35-to-39 age group (33%), when compared to other age groups (NCSA,
2020). An additional 8% of fatally injured motorcycle operators had at least some measurable
level of alcohol in their blood (BAC .01 to .07 g/dL). Fatally injured motorcycle operators with
BACs .08 g/dL or higher were less likely to wear helmets than were sober operators – 53%
versus 66%, respectively. In 2018 some 33% of operators killed in single-vehicle crashes on
weekdays had BACs of .08 g/dL or above, and on weekends, this figure climbed to 44%. The
2013-2014 National Roadside Survey found that 5.0% of motorcycle operators on weekend
nights had BACs of .08 g/dL or above, as compared to 1.4% of passenger vehicle drivers
(Ramirez et al., 2016).
Motorcyclists are included in and affected by the comprehensive strategies to reduce alcoholimpaired driving discussed in detail in Chapter 1. However, some law enforcement and sanction
strategies may be especially useful for motorcyclists, while others may be less effective.
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 motorcycle operators,
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 motorcycle
operators. NHTSA published a brochure and a law enforcement training video discussing the
cues (NHTSA, 2013b). The cues for motorcycle operators are part of the Standardized Field
Sobriety Tests training given to all LEOs.
Vehicle impoundment or forfeiture can be an effective deterrent to drinking and driving for all
drivers (see Chapter 1, Section 4.3). It may be even more effective for motorcyclists. Research
by 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
(although self-reported beliefs may not reflect actual effectiveness of these other sanctions).
However, motorcyclists tended to be highly concerned for the safety and security of their
motorcycles.
These findings suggest a potentially effective strategy to reduce alcohol-impaired motorcycling:
HVE using officers trained in identifying impaired motorcycle riders and other motor vehicle
drivers, with offender sanctions including vehicle impoundment or forfeiture. This strategy
would treat motorcyclist operators on an equal footing with other vehicle drivers in impaireddriving enforcement and publicity, but it may be controversial and therefore difficult to enact or
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enforce. However, a Washington State law that allows officers to impound motorcycles for
impaired riding was not found to cause unforeseen problems with LEOs or with towing
companies (McKnight et al., 2013).
Use: Thirty-two of 43 responding States reported that they have programs for law enforcement
on how to detect impaired motorcyclists or enforce laws related to operating motorcycles while
impaired (Baer et al., 2010). NHTSA (2006) provides resources for law enforcement and State
programs on the detection of impaired riding, including examples of State programs that
distribute the NHTSA cue cards and brochures to law enforcement (Illinois), provide a webbased seminar for officers (Minnesota), and regularly establish high-visibility law enforcement
presence at major rider events (Ohio, Wisconsin).
Effectiveness: Some agencies have reported some success in using the cues for identifying
alcohol-impaired motorcycle riders, but no evaluation data on the extent of their use are available
(NCHRP, 2008, Strategy B3). Although there is limited evidence of the effects of enforcement
and sanctions on impaired motorcycle riding, sobriety checkpoints and saturation patrols have
demonstrated effectiveness in reducing impaired driving and crashes generally. See Chapter 1 for
more information on enforcement strategies and other tools.
Costs: Law enforcement training costs are low and training material is available. Enforcement
itself can be carried out during regular traffic patrol and as part of all impaired driving
enforcement programs. A major campaign including alcohol-impaired motorcycle operators may
require additional costs for publicity.
Time to implement: Law enforcement training can be conducted quickly. A major campaign
will require 4 to 6 months to plan and implement.
Other issues:
• BAC limits: BACs as low as .05 g/dL caused some detectable levels of impairment,
primarily in reaction time, among experienced riders in tests on controlled courses
(Creaser et al., 2007). Puerto Rico passed a law in 2007 lowering the BAC limit for
motorcyclists to .02 g/dL. In Fell et al. (2017), LEOs expressed that it was difficult to
detect operator impairment with BAC of just over the .02 g/dL limit. Nevertheless, more
than half of citations at checkpoints for riding impaired were for BACs between .01 and
.07 g/dL, suggesting that checkpoints are a successful method of enforcing the .02 g/dL
limit.
• Drugs other than alcohol: Drugs other than alcohol can impair motorcycle riders.
Potentially impairing drugs include over-the-counter and prescription medications as well
as illegal drugs. The 2013-2014 National Roadside Survey reported that 22.3% of
nighttime weekend motorcycle operators who provided oral fluid and/or blood samples
tested positive for drugs (illegal drugs or medications), compared to similar numbers of
passenger car drivers, 24.3% (Kelly-Baker et al., 2017). The extent to which drugs
impair driving performance or contribute to crashes is not well understood, however, for
either four-wheeled vehicles or for motorcycles. Furthermore, individual differences in
metabolism of drugs and level of impairment, as well as polydrug use complicate the
understanding of drug impairment on motor vehicle drivers (Compton et al., 2009). (See
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Chapter 5. Motorcycle Safety
•
•
Compton et al.’s [2009] Report to Congress on drug-impaired driving for a discussion of
current knowledge and recommendations for improving States data and records systems
and statutes.) Law enforcement should consider drugs as potential impairing agents for
motorcycle riders just as for other vehicle operators. See also Chapter 1, Section 7 on
drug-impaired driving.
Targeted enforcement: As with other crash problems, better identification of problem
areas (either impaired riding or impaired riding crashes) and targeting enforcement to
such locations, events, or times could improve enforcement effectiveness.
Alcohol Ignition Interlocks: One strategy to reduce alcohol-impaired motorcycling is to
use ignition interlocks to prevent impaired motorcyclists from being able to operate their
motorcycles. Although it is feasible to implement interlocks on motorcycles, there are
liability and safety concerns primarily associated with retests that must be considered. In
a study of motorcycle interlocks (Marques & McKnight, 2017), retesting while riding
was considered to be unsafe by most study participants. It can sometimes be difficult to
find a safe place to stop and perform the retest. The requirements and option to
implement motorcycle interlocks depends on State regulations. Some States require
interlocks on all vehicles driven by offenders, while other States expressly forbid them on
motorcycles, and the level of enforcement varies greatly between jurisdictions.
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2.2 Alcohol-Impaired Motorcyclists: Communications and Outreach
Effectiveness: ✩
Cost: $$
Use: Medium
Time: Medium
This countermeasure involves communications and outreach campaigns directed at drinking and
riding. Although States typically implement these campaigns, they can also be conducted by
local riding groups.
Effectiveness Concerns: A literature search found no evaluations of the safety effectiveness of
any drinking and riding campaigns.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 2.2.
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3. Motorcycle Rider Licensing and Training
3.1 Motorcycle Rider Licensing
Effectiveness: ✩
Cost: $
Use: High
Time: Medium
The goal of licensing is to ensure that motorcycle riders have the minimum skills needed to
operate motorcycles safely (NHTSA, 2000). All 50 States, the District of Columbia, and Puerto
Rico require motorcycle operators to obtain a motorcycle operator license or endorsement before
they ride on public highways (MSF, 2018). Most States will waive the skills test, and sometimes
the knowledge test, for motorcyclists who have completed approved motorcycle rider training
courses, if the student passes the knowledge and skills tests administered at the conclusion of the
course.
Effectiveness Concerns: Although this countermeasure is widely used, the effectiveness of
current licensing and testing on crashes and safety has not been evaluated.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 3.1.
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3.2 Motorcycle Rider Training
Effectiveness: ✩✩
Cost: $$
Use: High
Time: Varies
This countermeasure involves rider education and training courses provided by States, rider
organizations (for example, some ABATE and Gold Wing groups), manufacturers (HarleyDavidson), the U.S. military, and others. This training can be required for all motorcycle
operators or those under a specified age.
Effectiveness Concerns: This countermeasure is widely used. Its effectiveness has been
examined in several research studies. Despite some positive research findings, the balance of
evidence regarding countermeasure effectiveness remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 3.2.
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4. Communications and Outreach
4.1 Communications and Outreach: Conspicuity and Protective Clothing
Effectiveness: ✩
Cost: Varies
Use: High
Time: Medium
This countermeasure involves communications and outreach campaigns promoting the use of
protective clothing and measures that increase rider conspicuity, such as clothing and auxiliary
devices. Measures that may increase rider conspicuity include wearing brightly colored clothing,
clothing that incorporates retroreflective materials, and/or white- or bright-colored helmets (for
increased visibility during day or night). Additional solutions include the use of continuous
headlights, auxiliary head and brake lights, and flashing headlights.
Effectiveness Concerns: This countermeasure is widely used, but it has not been extensively
studied. There is some evidence that certain approaches may lead to limited positive outcomes;
however, there are insufficient evaluation data to determine the extent of effectiveness.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 4.1.
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4.2 Communications and Outreach: Motorist Awareness of Motorcyclists
Effectiveness: ✩
Cost: Varies
Use: High
Time: Medium
This countermeasure involves communications and outreach campaigns to increase other drivers’
awareness of motorcyclists. Typical themes are “Share the Road ” or “Watch for Motorcyclists.”
(See NHTSA’s Traffic Safety Marketing website for Motorist Awareness of Motorcycles
information - www.trafficsafetymarketing.gov/get-materials/motorcycle-safety/motoristawareness-motorcycles.) Some States build campaigns around “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. Some organizations also make presentations on driver
awareness of motorcyclists to driver education classes.
Effectiveness: Although this countermeasure is widely used, no evaluations of the effectiveness
of campaigns to increase driver awareness of motorcyclists are available.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A5, Section 4.2.
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Motorcycle Safety References
Baer, J. D., Ayotte, K., & Baldi, S. (2010, February). Evaluation of state motorcycle safety
programs (Report No. DOT HS 811 269). National Highway Traffic Safety
Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811269
Baer, J., & Skemer, M. (2009, January). Review of state motorcycle safety program technical
assessments (Report No. DOT HS 811 082). National Highway Traffic Safety
Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811082
Bayly, M., Regan, M., & Hosking, S. (2006). Intelligent transport systems and motorcycle safety
(Report No. 260). Monash University Accident Research Centre.
www.monash.edu.au/muarc/reports/muarc260.pdf
Becker, L. R., McKnight, A. S., Nelkin, V. S., & Piper, D. L. (2003, February). Drinking, riding,
and prevention: A focus group study (Report No. DOT HS 809 490). National Highway
Traffic Safety Administration.
www.nhtsa.gov/people/injury/pedbimot/motorcycle/drinkrideprevent/DrinkRidePreventio
n.pdf
Brewer, B. L., Diehl, A. H., Johnson, L. S., Salomone, J. P., Wilson, K. L., Atallah, H. Y.,
Feliciano, D. V., & Rozycki, G. S. (2013). Choice of motorcycle helmet makes a
difference: A prospective observational study. Journal of Trauma and Acute Care
Surgery, 75, 88-91.
Brooks, E., Naud, S., & Shapiro, S. (2010). Are youth-only motorcycle helmet laws better than
none at all? American Journal of Forensic Medicine and Pathology, 31, 125-129.
Carter, P. M., Buckley, L., Flannagan, C. A., Cicchino, J. B., Hemmila, M., Bowman, P. J.,
Almani, F., & Bingham, C. R. (2017, January). The impact of Michigan’s partial repeal
of the universal motorcycle helmet law on helmet use, fatalities, and head
injuries. American Journal of Public Health, 107(1), 166-172.
Cavallo, V., & Pinto, M. (2012). Are car daytime running lights detrimental to motorcycle
conspicuity? Accident Analysis & Prevention, 49, 78-85.
Centers for Disease Control and Prevention. (2011). Motorcycle safety: How to save lives and
save money. www.cdc.gov/motorvehiclesafety/pdf/mc2012/MotorcycleSafetyBook.pdf
Coben, J. H., Steiner, C. A., & Miller, T. R. (2007). Characteristics of motorcycle-related
hospitalizations: Comparing states with different helmet laws. Accident Analysis &
Prevention, 39, 190-196.
Community Preventive Services Task Force. (2017). Motorcycle helmet laws prevent injury and
save lives: Recommendation of the Community Preventive Services Task Force.
American Journal of Preventive Medicine, 52(6), 817–819.
www.thecommunityguide.org/sites/default/files/publications/mvoi-ajpm-recuniversalhelmets.pdf
Compton, R., Vegega, M., & Smithers. D. (2009, December) Drug-impaired driving:
Understanding the problem and ways to reduce it: A Report to Congress (Report No. HS
811 268). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/1949
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Creaser, J. I., Ward, N. J., Rakauskas, M. E., Boer, E., Shankwitz, C., & Nardi, F. (2007,
December). Effects of alcohol on motorcycle riding skills (Report No. DOT HS 810 877).
National Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1826
Cummings, P., Rivara, F. P., Olson, C. M., & Smith, K. M. (2006). Changes in traffic crash
mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle
helmet, or bicycle helmet, United States, 1982-2001. Injury Prevention, 12, 148-154.
Derrick, A. J. & Faucher, L. D. (2009). Motorcycle helmets and rider safety: A legislative crisis.
Journal of Public Health Policy, 30, 226-242.
Deuterman, W. (2004, March). Motorcycle helmet effectiveness revisited (Report No. DOT HS
809 715). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/809715
Fell, J. C., Ramirez, A., McKnight, A. S., Yao, J., & Auld-Owens, A. (2017, April). Changes to
Puerto Rico’s motorcycle rider law (Report No. DOT HS 812 397). National Highway
Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/2091
General Accounting Office. (1991). Highway safety: Motorcycle helmet laws save lives and
reduce costs to society. U.S. General Accounting Office (now the Government
Accountability Office). http://archive.gao.gov/d19t9/144486.pdf
Gilbert, H., Chaudhary, N., Solomon, M., Preusser, D., & Cosgrove, L. (2008, May). Evaluation
of the reinstatement of the helmet law in Louisiana (Report No. DOT HS 810 956).
National Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1838
Guide to Community Preventive Services. (2013). Motor vehicle-related injury prevention: Use
of motorcycle helmets, universal helmet laws.
www.thecommunityguide.org/sites/default/files/assets/MVOI-Motorcycle-HelmetsLaws-Mandating-Use.pdf
Highway Loss Data Institute. (2013). The effects of Michigan’s weakened motorcycle helmet use
law on insurance losses. IIHS. www.iihs.org/media/13465fd7-23d7-46fd-a15eddf13d66c490/-2043639476/HLDI%20Research/Bulletins/hldi_bulletin_30.09.pdf
Houston, D. J. (2007). Are helmet laws protecting young motorcyclists? Journal of Safety
Research, 38, 329-336.
Houston, D. J., & Richardson, L. E. (2008). Motorcyclist fatality rates and mandatory helmet-use
laws. Accident Analysis & Prevention, 40, 200-208.
IIHS. (2018). Motorcycles and ATVs—Fatality facts 2017. www.iihs.org/topics/fatalitystatistics/detail/motorcycles-and-atvs
IIHS. (2019). Motorcycles, May 2019. www.iihs.org/topics/motorcycles#overview
Jenness, J. W., Jenkins, F., & Zador, P. (2011, September). Motorcycle conspicuity and the effect
of fleet DRL: Analysis of two-vehicle fatal crashes in Canada and the United States 20012007 (DOT HS 811 505). National Highway Traffic Safety Administration.
www.nhtsa.gov/sites/nhtsa.dot.gov/files/811505.pdf
Jones, M. M., & Bayer, R. B. (2007). Paternalism & its discontents: Motorcycle helmet laws,
libertarian values, and public health. American Journal of Public Health, 97, 208-217.
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Chapter 5. Motorcycle Safety
Kelley-Baker, T., Berning, A., Ramirez, A., Lacey, J. H., Carr, K., Waehrer, G., & Compton, R.
(2017, May). 2013-2014 National Roadside Study of alcohol and drug use by drivers: Drug
results (Report No. DOT HS 812 411). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/2097
Kyrychenko, S. Y., & McCartt, A. T. (2006). Florida’s weakened motorcycle helmet law: Effects
on death rates in motorcycle crashes. Traffic Injury Prevention, 7, 55-60.
Liu, B. C., Ivers, R., Norton, R., Blows, S., & Lo, S. K. (2008). Helmets for preventing injury in
motorcycle riders. The Cochrane Database of Systematic Reviews, 1. Art No.:
CD004333.
Marques, P. R., & McKnight, A. S. (2017, June). Examination of the feasibility of alcohol
interlocks for motorcycles (Report No DOT HS 812 423). National Highway Traffic
Safety Administration. https://rosap.ntl.bts.gov/view/dot/2099
McKnight, A. S., Billheimer, J. W., & Tippetts, S. (2013, January). An examination of
Washington state’s vehicle impoundment law for motorcycle endorsements (Report No.
DOT HS 811 696). National Highway Traffic Safety Administration.
www.nhtsa.gov/staticfiles/nti/pdf/811696.pdf
Morris, C. C. (2006). Generalized linear regression analysis of association of universal helmet
laws with motorcyclist fatality rates. Accident Analysis & Prevention, 38, 142-147.
Motorcycle Legal Foundation. (2018). State-by-state guide to motorcycle laws.
www.motorcyclelegalfoundation.com/state-by-state-guide-to-motorcyclelaws/#daytimeheadlights
Motorcycle Safety Foundation. (2017). State on-highway motorcycle equipment requirements.
www.msf-usa.org/downloads/Equipment_Chart_2017-MSFlogo.pdf
MSF. (2018). State motorcycle operator licensing - 2018. www.msf-usa.org/downloads/StateMotorcycle-Operator-Licensing-CSI-2018.pdf
National Center for Statistics and Analysis. (2000). Traffic safety facts 1999 (Report No. DOT
HS 809 089). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/809089
NCSA. (2017, March). Motorcycles: 2015 data (Report No. DOT HS 812 353). National
Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812353
NCSA. (2019, July). Motorcycle helmet use in 2018 – Overall result. (Traffic Safety Facts
Research Note. Report No. DOT HS 812 720). National Highway Traffic Safety
Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812720
NCSA. (2020, November). Motorcycles: 2018 data (Traffic Safety Facts. Report No. DOT HS
812 979). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812979
National Cooperative Highway Research Program. (2008). Guidance for implementation of the
AASHTO Strategic Highway Safety Plan, volume 22: A guide for addressing collisions
involving motorcycles (NCHRP Report 500). Transportation Research Board.
https://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_500v22.pdf
5-25
Chapter 5. Motorcycle Safety
National Highway Traffic Safety Administration. (1996, June). Do motorcycle helmets interfere
with the vision and hearing of riders? (Traffic Tech. Technology Transfer Series No.
127). www.nhtsa.gov/sites/nhtsa.dot.gov/files/tt127.pdf
NHTSA. (1998, 2008). National Automotive Sampling System – General Estimates System
[Custom data set analysis.]. National Highway Traffic Safety Administration.
NHTSA. (2000a, November). National Agenda for Motorcycle Safety. (Report No. DOT HS 809
156). https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/00-nht-212motorcycle/toc.html
NHTSA. (2003, January). The National Highway Traffic Safety Administration motorcycle safety
program (Report No. DOT HS 809 539).
https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/motorcycle03/McycleSafetyPro
gram.pdf
NHTSA. (2006, December). Implementation guide for the National Agenda for Motorcycle
Safety (Report No. DOT HS 810 680).
https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/NAMS2006/images/Implement
ationGuide.pdf
NHTSA. (2011, October). Traffic safety facts - 2009: Motorcycles (Report No. DOT HS 811
389). https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811389
NHTSA. (2013a, June). Prioritized recommendations of the National Agenda for Motorcycle
Safety (Report No. DOT HS 811 789). www.nhtsa.gov/staticfiles/nti/pdf/811789.pdf
NHTSA. (2013b, March). The detection of DWI motorcyclists.
https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/610DWIMotorcyWeb/pages/80
7856-Detection-DWI-Motorcyclists.pdf [See also Stuster, 1993, below.]
NHTSA. (2018a). Crash Report Sampling System [Custom data set analysis]. National Highway
Traffic Safety Administration.
NHTSA. (2018b, 2020). Fatality Analysis Reporting System [Custom data set analysis]. National
Highway Traffic Safety Administration.
NHTSA. (2019, May). Motorcycle safety 5-year plan (Report No. DOT HS 812 488).
Olsen, C. S., Thomas, A. M., Singleton, M., Gaichas, A. M., Smith, T. J., Smith, G. A., Peng, J.,
Bauer, M. J., Qu, M., Yeager, D., Kerns, T., Burch, C., & Cook, L. J. (2016). Motorcycle
helmet effectiveness in reducing head, face and brain injuries by state and helmet law.
Injury Epidemiology, 3(1), 8.
Olson, P. L., Halstead-Nussloch, R., & Sivak, M. (1979, October). Development and testing of
techniques for increasing the conspicuity of motorcycles and motorcycle drivers
(Unnumbered report). National Highway Traffic Safety Administration.
https://deepblue.lib.umich.edu/bitstream/2027.42/487/2/43121.0001.001.pdf
Peng, Y., Vaidya, N., Finnie, R., Reynolds, J., Dumitru, C., Njie, G., Elder, R., Ivers, R.,
Sakashita, C., Shults, R. A., & Sleet, D. A. (2017). Universal motorcycle helmet laws to
reduce injuries: A community guide systematic review. American Journal of Preventive
Medicine, 52(6), 820-832.
5-26
Chapter 5. Motorcycle Safety
Philip, A. F., Fangman, W., Junlin, L., Lilienthal, M., & Choi, K. (2013). Helmets prevent
motorcycle injuries with significant economic benefits. Traffic Injury Prevention, 14,
496-500.
Pierowicz, J., Gawron, V., Wilson, G., & Bisantz, A. (2011, September). The effects of motor
vehicle fleet daytime running lights (DRL) on motorcycle conspicuity (DOT HS 811 504).
National Highway Traffic Safety Administration.
www.nhtsa.gov/sites/nhtsa.dot.gov/files/811504.pdf
Pinto, M., Cavallo, V., & Saint-Pierre, G. (2014). Influence of front light configuration on the
visual conspicuity of motorcycles. Accident Analysis & Prevention, 62, 230-237.
Preusser, D. F., Hedlund, J. H., & Ulmer, R. G. (2000, September). Evaluation of motorcycle
helmet law repeal in Arkansas and Texas (Report No. DOT HS 809 131). National
Highway Traffic Safety Administration.
www.nhtsa.dot.gov/people/injury/pedbimot/motorcycle/EvalofMotor.pdf
Ramirez, A, Berning, A., Kelley-Baker, T., Lacey, J. H., Yao, J., Tippetts, A. S., Scherer, M.,
Carr, K., Pell, K., & Compton, R. (2016, December). 2013–2014 national roadside study
of alcohol and drug use by drivers: Alcohol results (Report No. DOT HS 812 362).
National Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/2084
Ranchet, M., Cavallo, V., Dang, N.-T., & Vienne, F. (2016). Improving motorcycle conspicuity
through innovative headlight configurations. Accident Analysis & Prevention, 94, 119126.
Striker, R. H., Chapman, A. J., Titus, R. A., Davis, A. T., & Rodriguez, C. H. (2016). Repeal of
the Michigan helmet law: The evolving clinical impact. American Journal of Surgery,
211(3), 529-533.
Stuster, J. (1993). The detection of DWI motorcyclists (Report No. DOT HS 807 839). National
Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1559 [Note:
Revised in 2013 as DOT HS 807 856, see NHTSA 2013b above.]
Teoh, E. R. (2011). Effectiveness of antilock braking systems in reducing motorcycle fatal
crashes. Traffic Injury Prevention, 12, 169-173.
Teoh, E. R. (2013). Effects of antilock braking systems on motorcycle fatal crash rates: An
update. IIHS. www.iihs.org/api/datastoredocument/bibliography/2042
Toeh, E. R. (2019). Motorcycles registered in the United States, 2002-18. IIHS.
www.iihs.org/api/datastoredocument/bibliography/2181
Teoh, E. R., & Campbell, M. (2010). Role of motorcycle type in fatal motorcycle crashes.
Journal of Safety Research, 41, 507-512.
Ulmer, R. G., & Northrup, V. S. (2005, August). Evaluation of the repeal of the all-rider
motorcycle helmet law in Florida (Report No. DOT HS 809 849). National Highway
Traffic Safety Administration.
https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/FlaMCReport/pages/Index.htm
5-27
Chapter 5. Motorcycle Safety
Ulmer, R. G., & Preusser, D. F. (2003, October). Evaluation of the repeal of motorcycle helmet
laws in Kentucky and Louisiana (Report No. DOT HS 809 530). National Highway
Traffic Safety Administration.
www.nhtsa.gov/PEOPLE/injury/pedbimot/motorcycle/kentuky-la03/index.html
U.S. Department of Transportation. (2007, October). U.S. Department of Transportation action
plan to reduce motorcycle fatalities (Report No. DOT HS 810 855). National Highway
Traffic Safety Administration.
www.nhtsa.gov/DOT/NHTSA/Communication%20&%20Consumer%20Information/Arti
cles/Associated%20Files/4640-report2.pdf
Weiss, H., Agimi, Y., & Steiner, C. (2010). Youth motorcycle-related brain injury by state
helmet law type: United States, 2005-2007. Pediatrics, 126, 1149-1155.
Wiznia, D. H., Kim, C.-Y., Dai, F., Goel, A., & Leslie, M. P. (2016). The effect of helmets on
motorcycle outcomes in a level I trauma center in Connecticut. Traffic Injury Prevention,
17(6), 633-637.
World Health Organization (WHO). (2006). Helmets: A road safety manual for decision-makers
and practitioners. Geneva. www.who.int/roadsafety/projects/manuals/helmet_manual/en/
5-28
Chapter 6. Young Drivers
6. Young Drivers
Overview
Motor vehicle crashes were the leading cause of unintentional death in 2018 for the 15 to 24years old age group in the United States (CDC, 2020). In 2018 there were 1,719 drivers 15- to
20- years old who were killed, and an estimated 199,000 were injured in motor vehicle crashes
(NCSA, 2020). In comparison with adult drivers, young drivers are substantially over-involved
in crashes. In 2018 drivers 15 to 20 made up 5.3% of licensed drivers in the United States, yet
they made up 8% of total drivers in all fatal crashes and 12% of drivers in all crashes. As shown
in the figure below, drivers 16 to 20 years old have the highest involvement in fatal crashes of
any age group.
40
Driver Involvement in Fatal Crashes Per 100,000
Licensed Drivers, 2018
Involvement Rate
35
30
25
20
15
10
5
0
16-20
21-24
25-34
35-44 45-54
Driver Age
55-64
65-74
>74
Sources: NCSA (2020); FHWA (2020), Table DL-220
As shown in the figure below, the number of young driver fatalities increases with age. However,
the rate of young driver fatalities per 10,000 licensed drivers is relatively stable among drivers
age 16 to 20 (between 1.25 at 16 and 1.51 at 18).
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Chapter 6. Young Drivers
2.5
Number of Young Driver Fatalities
Number of Fatalities
Fatalities per 10,000 Licensed Drivers
400
2.0
300
1.5
200
1.0
100
0.5
0
16
17
18
Driver Age
19
20
Fatalities per 10,000 Licensed Drivers
500
Young Driver Fatalities, 2018
0.0
Sources: NCSA (2020); FHWA (2020), Table DL-220
With the exception of drivers 80 and older, per mile driven, young drivers are even more overinvolved in fatal crashes than older drivers. The trend has largely remained the same over the
years (McCartt & Teoh, 2015). From April 2016 to March 2017, drivers 16 to 19 years old had
the highest crash rate as compared to all other age groups, except drivers 80 and older. Drivers
16 to 19 years old were involved in 4.8 fatal crashes per 100 million travel miles, compared to
3.3 for drivers 20 to 24, 2.3 for drivers 25-29, 1.4 for drivers 30-59, 1.3 for drivers 60-69, 1.8 for
drivers 70-79, and 5.4 for drivers 80+ (IIHS, 2019a). Sixty-three percent of the people killed in
young driver crashes in 2018 were the teen driver themselves. Twelve percent of fatalities were
passengers of the teen drivers and 57% of these were teen passengers.
Trends. From 2009 to 2018 there was a 20% decrease in the number of young drivers (15 to 20)
involved in fatal crashes, compared to a 14% increase in all drivers involved in fatal crashes
during the same period (NCSA, 2020). The number of young drivers involved in police reported
crashes decreased 1% from 2017 to 2018. The reasons for the reductions in the number of fatal
crash involvements and police-reported crashes among young drivers are not entirely known.
Many factors could have led to this decline, including teen drivers waiting longer to get licensed,
the advancement in vehicle safety technology, establishment of multi-stage licensing systems,
and education and enforcement of traffic laws (Alderman & Johnston, 2018; Shults et al., 2016).
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
6-2
Chapter 6. Young Drivers
situations. Second, normal adolescent development involves increases in novelty seeking and
risk-taking behaviors (Kelley et al., 2004). In fact, research on adolescent development suggests
that key areas of the brain involved in judgments and decision making continue to develop
beyond adolescence (Dahl, 2008; Keating, 2007; Somerville, 2016; Steinberg, 2007).
Inexperience makes certain circumstances more dangerous for younger drivers. In addition,
immaturity increases the likelihood of young drivers putting themselves in risky circumstances.
Young drivers are especially at-risk in the following five circumstances (Alderman & Johnston,
2018; Ferguson, 2003; Williams, 2003):
• Nighttime driving: Driving is more difficult and dangerous at night for everyone, but
particularly for teenagers. Young drivers have less experience driving at night than
during the day, and drowsiness and alcohol may be more of a factor at night (Lin &
Fearn, 2003; Paterson & Dawson, 2016).
• Driving under the influence of substances: Young drivers’ inexperience with both driving
and drinking means that they have a higher crash risk at all BACs than older drivers
(Voas et al., 2012). Self-reported incidence of alcohol-impaired driving by high school
seniors has steadily decreased from 13.1% in 2013, to 9.1% in 2015, and to 8.1% in the
most recent survey in 2017 (CDC, 2018). The percentage of high school seniors reporting
that they rode with an impaired teen driver has steadily decreased from 31.5% in 2007 to
16% in 2017. In contrast, the percentage of high school seniors who self-reported driving
after the use of drugs including marijuana and combinations of drugs and alcohol in 2017
was 13%. Historical data on young drivers’ driving under the influence of drugs other
than alcohol are sparse; however, some surveys show that the use of marijuana and other
illicit drugs may be more prevalent than alcohol in young drivers (Li et al., 2016;
O’Malley & Johnston, 2013).
• Passenger interactions: Teenage passengers can distract young drivers and encourage
them to take risks (Foss & Goodwin, 2014; Lin & Fearn, 2003).
• Belt use: Seat belts reduce the risk of injury or fatality in a crash (see Chapter 2,
Overview), but teenage drivers and passengers have lower reported belt use rates than
adult drivers and passengers (Ferguson, 2003; Shults et al., 2016). In 2017 teen drivers
had the lowest self-reported seat belt use rates compared to all other age groups (CDC,
2018).
• Cell phone use: All drivers are at higher risk when talking or texting (see Appendix A4,
Section 1.2); however, young drivers have more difficulty handling distractions (Lee,
2007). Teenage and young drivers have repeatedly been found to have increased levels of
crash risk due to distractions involving cell phone use (Guo et al., 2017; Delgado et al.,
2016).
Strategies to Reduce Crashes Involving Young Drivers
Graduated driver licensing 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 young driver crashes has been demonstrated
many times (Chaudhary et al., 2018; Masten et al., 2013; Masten et al., 2015; Russell et al.,
2011; Shope, 2007; Simpson, 2003; Williams, 2017; Williams et al., 2012).
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Chapter 6. Young Drivers
Driver education was developed to teach both driving skills and safe driving practices. Based on
evaluations to date driver education for beginning drivers does a good job at teaching driving
skills but has not definitively been shown to reduce the number of crashes or crash rate. Rather,
some research has suggested that it lowers the age at which teenagers become licensed, and
therefore increases exposure, so its overall effect is to increase the number of crashes (Roberts &
Kwan, 2001; Thomas, Blomberg, & Fisher, 2012; Vernick et al., 1999). Current research is
investigating ways to integrate driver education with GDL (Mayhew et al., 2014 and 2017) and
is developing second-level programs for drivers who have acquired basic driving skills and have
been, or are nearing, licensure. Driver education is more effective if combined with an effective
GDL program that does not allow a lower licensing age. Many States have completed NHTSAsponsored driver education assessments to strengthen their programs and align with national
standards.
Parents play key roles in their teenagers’ driving. In many States, a parent or guardian must sign
the driver’s license application for a teenager under 18, and a parent can withdraw approval at
any time. Parents can set limits on their teenagers’ driving. In addition, parents can be involved
explicitly and formally through GDL requirements such as minimum hours of supervised driving
practice, or they can be involved voluntarily and informally. Several parent- teen driving guide
programs can provide assistance (Curry, Peek-Asa, et al., 2015). At least one driving guide
program has successfully encouraged parents to impose more driving restrictions on their teens
(Simons-Morton, 2007). Technologies are available to assist parents in monitoring their newly
licensed teen driver. When combined with a comprehensive system for providing feedback to
parents and teens, these technologies have been promising in reducing the incidence of risky
driving behaviors among teens (Carney et al., 2010; Farah et al., 2014; McGehee et al., 2007;
Reyes et al., 2018; Reyes et al., 2016; Simons-Morton et al., 2013). Finally, several States now
require parent involvement in driver education, usually in the form of a mandatory parent
orientation class. All these approaches are promising, though none have been shown as of yet to
reduce young driver crashes or fatalities.
Some traffic laws apply only to young drivers. GDL systems have been adopted by all 50 States
to help novices gain experience in safe settings. Minimum legal drinking age (MLDA) and zerotolerance BAC laws apply specifically to people under 21, as discussed in Chapter 1. Some
States have restrictions on cell phone use and texting that apply only to young drivers (see
Appendix A4, Section 1.2). With all these, enforcement is critical if the laws are to have any
effect. The law enforcement system faces several problems when dealing with young drivers. In
deciding whether to make a traffic stop, it can be difficult for LEOs to determine a person’s age
to know whether GDL and zero-tolerance laws apply. It has been suggested that a vehicle decal
identifying a driver as “young” and subject to GDL requirements may be beneficial for
enforcement reasons. New Jersey is the first State to pass legislation requiring young drivers
subject to GDL restrictions to be identified via a vehicle decal. Studies examining the
effectiveness of the decal requirement in New Jersey found that citation rates for violations of
licensing restrictions sharply increased and police-reported crash rates decreased the year after
the decal requirement went into effect (Curry et al., 2013; McCartt et al., 2012). A follow-up
study found that the decline in crash rates could not be attributed to increases in young drivers’
compliance with passenger or nighttime restrictions but may have been the result of a general
6-4
Chapter 6. Young Drivers
increase in safer behaviors when displaying decals (Palumbo et al., 2018). Even if the driver is
young, in many States, teens may only be stopped for a primary offense, such as speeding. Once
stopped, there may be a tendency for officers in some situations not to make arrests or for
prosecutors to dismiss charges because the offender is “just a kid.” Finally, 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 the following.
• 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 4, Distracted Driving, Sections 1.1 and Appendix A4, Sections 2.1 and 3.1 (GDL
requirements, communications and outreach, and employer programs).
• Appendix A5, Motorcycle Safety, Section 3.1 (GDL for motorcyclists).
• Chapter 10, Drowsy Driving, Sections 1.1 and Appendix A10, Sections 2.1 and 3.1 (GDL
requirements, communications and outreach, and employer programs).
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. However, these types of countermeasures are not included because State Highway Safety
Offices do not have authority or responsibility in these areas.
Resources
The agencies and organizations listed below can provide more information on young drivers and
links to numerous other resources.
• National Highway Traffic Safety Administration:
• Teen Drivers – www.nhtsa.gov/road-safety/teen-driving
• Driver Safety Research Reports: New Drivers – www.nhtsa.gov/road-safety/teendriving#resources
• Behavioral Safety Research Reports – https://rosap.ntl.bts.gov
• Centers for Disease Control and Prevention:
www.cdc.gov/Motorvehiclesafety/Teen_Drivers/index.html
• Governors Highway Safety: Association: www.ghsa.org/html/issues/teens/index.html
• Insurance Institute for Highway Safety:
www.iihs.org/iihs/topics/t/teenagers/topicoverview
• National Safety Council: www.nsc.org/learn/NSC-Initiatives/Pages/teen-driving.aspx
• American Automobile Association: https://teendriving.aaa.com
For an overview of young-driver issues and research, see the papers in the June 2006 Supplement
of Injury Prevention (www.injuryprevention.bmj.com/content/12/suppl_1), the special issue of
the 2007 Journal of Safety Research (www.sciencedirect.com/science/journal/00224375/38/2), or
the special issue of the 2008 American Journal of Preventive Medicine
6-5
Chapter 6. Young Drivers
(www.ajpmonline.org/issue/S0749-3797%2808%29X0014-5). See also Alderman & Johnston
(2018) and Williams et al. (2012) for summaries of much of the research on young driver issues.
Additionally, an NCHRP Report 500 guide for the American Association of Motor Vehicle
Administrators’ Strategic Highway Safety Plan provides a detailed discussion of strategies for
reducing crashes involving young drivers (Goodwin et al., 2007), and GHSA (2012) published
Curbing Teen Driver Crashes: An In-Depth Look at State Initiatives, which describes strategies
States employ to reduce teen driver crashes.
6-6
Chapter 6. Young Drivers
Young Driver Countermeasures
Countermeasures to improve young-driver safety are listed in the table below. The table is
intended to provide a rough estimate of each countermeasure’s effectiveness, use, cost, and time
required for implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to improve young-driver safety is discussed individually in this chapter.
Full descriptions are included for , and countermeasures.
Brief descriptions are included for ✩ and ✩✩ countermeasures. Further details about the ✩
and ✩✩ countermeasures are included in Appendix A6 to this report
1. Graduated Driver Licensing
Countermeasure
1.1 Graduated Driver Licensing (GDL)
1.2 Learner’s Permit Length, Supervised Hours
1.3 Intermediate – Nighttime Restrictions
1.4 Intermediate – Passenger Restrictions
1.5 Cell Phone Restrictions
1.6 Belt Use Requirements
1.7 Intermediate – Violation Penalties
Effectiveness
✩✩
✩✩
✩
6-7
Cost
Use
Time
$
High
Medium
$
High
Medium
$
High
Medium
$
High
Medium
$
Medium
Medium
$
Low
Medium
$
High
Medium
Chapter 6. Young Drivers
2. Driver Education
Countermeasure
Effectiveness
2.1 Pre-Licensure Driver Education
2.2 Post-Licensure Driver Education
✩✩
✩
Cost
Use
Time
$$$
Medium
Long
$$$
Low
Long
3. Parents
Countermeasure
3.1 Parent Roles in Teaching and Managing
Young Drivers
Effectiveness
Cost
Use
Time
✩✩
$$
Medium
Short
3.2 Electronic Technology for Parental
Monitoring
$
Low
Short
Effectiveness
Cost
Use
Time
$$
Unknown
Short
4. Traffic Law Enforcement
Countermeasure
4.1 Enforcement of GDL and ZeroTolerance Laws
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
Can be implemented with current staff, perhaps with training; limited costs for
equipment or facilities
6-8
Chapter 6. Young Drivers
These estimates do not include the costs of enacting legislation or establishing policies.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
6-9
Chapter 6. Young Drivers
1. Graduated Driver Licensing
1.1 Graduated Driver Licensing
Effectiveness:
Cost: $
Use: High
Time: Medium
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 and 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 16 (and sometimes earlier) by passing a minimal driving test, GDL
reduces the amount of unsupervised driving by 16-year-olds. GDL also ensures that young
drivers are more mature when they receive their first unrestricted license. Based on a national
survey, the majority of parents (61 to 98% depending on the policy) support GDL policies that
are as strong as, or even stronger, than policies currently in place in the United States (Williams
et al., 2011).
All States now have some form of GDL in place. However, as of September 2020, no State GDL
systems met all the qualification criteria set forth by the Fixing America’s Surface Transportation
(FAST) Act for GDL incentive grants. For example, some States have night restrictions
beginning later than 10 p.m., or allow teens to carry more than one passenger younger than 21.
GHSA (2019a) and IIHS (2019b) document GDL laws in each State. These websites are updated
monthly. The papers in the special issue of the 2007 Journal of Safety Research describe GDL’s
history, components, effectiveness, parental roles, potential enhancements, and research needs.
Strategies for implementing or improving GDL systems are described in NCHRP’s Guide for
Reducing Collisions Involving Young Drivers (Goodwin et al., 2007, strategies A1 through A5).
See also NHTSA’s Traffic Safety Facts on GDL (NHTSA, 2008) and Report to Congress
(Compton & Ellison-Potter, 2008), and the Traffic Injury Research Foundation’s New GDL
Framework: Evidence Base to Integrate Novice Driver Strategies (Mayhew et al., 2014).
Use: All States and the District of Columbia had some GDL components in place as of May
2019. In addition, all States and the District of Columbia had a three-phase GDL system in place
(GHSA, 2019a; IIHS, 2019b).
Effectiveness: GDL’s effectiveness in reducing young driver crashes and fatalities has been
well-documented (Baker, Chen, & Li, 2007; Chapman et al., 2014; Chaudhary et al., 2018; Fell
et al., 2011; Lyon et al., 2012; Masten et al., 2011, 2013, and 2015; McCartt et al., 2010; Russell
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et al., 2011; Shope, 2007; Simpson, 2003; Williams, 2017). The most restrictive GDL programs–
those with at least a 6-month holding period during the learner stage, a night restriction
beginning no later than 10 p.m., and restrictions allowing no more than one teen passenger–are
associated with a 38% reduction in fatal crashes and a 40% reduction in injury crashes among
16-year-old drivers (Baker et al., 2007). In addition to reducing crashes, GDL is associated with
declines in hospitalization rates and charges for 16-year-old drivers (Margolis et al., 2007;
Pressley et al., 2009). A review of Georgia’s GDL laws 15.5 years after implementation suggests
that positive outcomes continue to be seen over time (Thompson et al., 2016). Fatal crash rates of
young drivers 16 to 19 who participated in the State’s GDL system were examined over 21 years
(5.5 years prior to and 15.5 years after GDL law implementation). Overall, the fatal crash rates
stayed similar to the pre-implementation rates, but they did decrease for certain groups of young
drivers. The highest rates of decline were among male drivers who were 16 and 17 years old.
The greatest changes in the rate of decline between pre- and post-law implementation were for
alcohol- and speeding-related crashes, which are two of the three risky behaviors targeted by the
State’s GDL laws.
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. These costs are typically covered by small fees charged by the licensing agency.
Time to implement: Licensing changes typically require up to a year to plan, publicize, and
implement.
Other issues:
• Age of licensure: Over the years, there has been discussion about the most appropriate
age for allowing teenagers to drive independently (Foss et al., 2014; Williams, 2009;
Williams et al., 2013). Licensing ages vary from State to State, from a low of 14½ in
South Dakota to a high of 17 in New Jersey. Delaying licensure, either through higher
entry ages or GDL requirements such as extended learner stages, can reduce young driver
crashes (Foss et al., 2014). For example, New Jersey’s GDL system has eliminated most
crashes among 16-year-old drivers and has reduced crashes among 17-year-olds by 16%
(Williams et al., 2010). However, a national study found a significant increase in fatal
crash rates among 18-year-olds associated with stronger GDL components (Masten et al.,
2011). Similar increases in overall crash rates have been found in drivers 18 and older
(Conner & Smith, 2017; Curry, Metzger, et al., 2017; Thompson et al., 2016). (But see
Foss et al. [2014] for an exception: drivers licensed at 18 were more likely than drivers
licensed at any other age to be involved in injury crashes in the first year post-licensure).
These findings indicate that there might be value in extending GDL provisions for drivers
20 and younger; one study found a lack of evidence for extension of provisions beyond
21 years old (Curry, Metzger, et al., 2017). In addition, licensure rates have decreased
among young teenagers (HLDI, 2013; Shults & Williams, 2013). Thus, there is concern
that teens may be delaying licensure until they are 18 or older in order to avoid GDL
provisions, leading them to miss out on the safety benefits of GDL. However, based on
findings from additional studies, it appears the economic recession and lack of
employment for young teenagers has been the driving force behind the delay of licensure
and not avoidance of GDL (HLDI, 2013; Tefft et al., 2013a; Williams, 2011).
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1.2 GDL Learner’s Permit Length, Supervised Hours
Cost: $
Effectiveness: †
permit length proven to reduce crash rates
Use: High
Time: Medium
†Learner’s
With a learner’s permit, a novice can drive when accompanied by an adult supervisor. 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. Surveys show that
parents and teenagers strongly support the learner’s permit holding period and supervised driving
requirements (Block & Walker, 2008; Mayhew, 2003; McKay et al., 2008; Williams, 2011;
Williams et al., 2011).
Use: As of September 2019 there were 48 States and the District of Columbia that required
learner’s permits to be held for at least 6 months, with 8 of these States requiring a minimum
holding period of a full year. However, Connecticut and South Dakota reduce the required length
of time for a permit to be held if the young driver completes driver’s education (IIHS, 2019b).
Forty-six States and the District of Columbia required some minimum number of supervised
driving hours, with about half of them requiring 50 hours. Forty-one States plus the District of
Columbia required that at least some of these hours be obtained at night. In addition, a few States
required additional supervised hours to be completed during the intermediate license phase
(GHSA, 2019a). Some States reduced or eliminated supervised driving requirements for driver
education graduates. However, evidence suggests this practice results in higher crash rates
among young drivers (Mayhew, 2007).
Effectiveness: Since learner’s permit drivers are being supervised, it is not surprising that crash
rates during the learner’s permit period are very low. For young drivers holding their first
unsupervised licenses, the limited available evidence suggests that crash rates decreased after
jurisdictions with no learner’s permit holding requirement implemented a 6-month requirement
(Ehsani et al., 2013; Mayhew, 2003). Moreover, longer permit holding periods appear to result in
even larger crash reductions. Masten et al. (2013) found that a 9- to 12-month leaner’s permit
holding period resulted in 26% lower fatal crash incidence among 16-year-old drivers and 17%
lower incidence among 17-year-olds compared to requiring learner permits for up to 4 months.
Furthermore, Curry et al. (2014) found that intermediate-phase drivers had incrementally smaller
increases in crash rates during their initial months of driving independently for every month up to
6 months that they delayed obtaining full licensure.
However, the effect of supervised hours is currently unclear. Some studies have found supervised
hours requirements lead to reductions in fatal crashes when hourly requirements are combined
with mandatory learner’s permit holding periods (Baker et al., 2006; Lyon et al., 2012).
However, evaluations have found no relationship between the number of required supervised
driving hours and fatal crash involvement among young drivers (Ehsani et al., 2013; Foss et al.,
2012; Masten et al., 2013; McCartt et al., 2010). Based on telephone interviews with parents in 5
States, only 32% knew the correct number of supervised driving hours their teens were required
to complete (Foss et al., 2012; O’Brien et al., 2013). Therefore, the lack of effect of supervised
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hours on fatal crash outcomes may be explained, in part, by a lack of parental knowledge of the
supervised driving requirements.
Costs: Once GDL is in place, requirements for the learner’s permit can be implemented at very
little cost.
Time to implement: GDL requirement changes typically require about 6 months to notify the
public and implement the changes.
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1.3 GDL Intermediate License Nighttime Restrictions
Effectiveness:
Cost: $
Use: High
Time: Medium
Driving at night increases the fatal crash risk for all drivers, and especially for teenage drivers
(Hedlund et al., 2003; Tefft et al., 2013b; Williams, 2003). A study found that the rate of driver
fatalities was 5 times higher among 16- and 17-year-olds from 10 p.m. to 5:59 a.m. compared to
driving during the day (Tefft et al., 2013b). Driving at night is more difficult, driver drowsiness
is more common, and alcohol is more likely to be used. Many intermediate license drivers have
limited experience driving at night. For these reasons, a nighttime driving restriction helps reduce
risk for intermediate level drivers.
The restricted hours vary widely, from 6 p.m. to 6 a.m. in the most restrictive State, to 1 a.m. to 5
a.m. in the least restrictive (GHSA, 2019a; IIHS, 2019b). The most common hours are 11 p.m. or
midnight to 5 or 6 a.m. However, a starting time earlier than midnight will prevent more crashes,
especially since teenage driver crashes occur more frequently before midnight than after (Foss &
Goodwin, 2003; Shults & Williams, 2016; Williams, 2003). An analysis of fatal crash data for
drivers 16 and 17 estimated that while these drivers only take about 11% of their trips from 9
p.m. to 5:59 a.m., these trips account for almost one-third (31%) of fatal crash involvement in
this age-group (Shults & Williams, 2016).
NHTSA’s Motor Vehicle Occupant Safety Survey found that 73% of the general public believe
teenagers should not be allowed to drive unsupervised after 9 p.m. (Block & Walker, 2008).
Another national survey of parents found 90% support a nighttime driving restriction, with 77%
saying it should be 10 p.m. or earlier (Williams et al., 2011). These perceptions match observed
driving trends, which show that greater reductions in crash rates are associated with nighttime
restrictions starting at or before 10 p.m. (Shults & Williams, 2016). There is an almost two-fold
increase in the proportion of young driver (16 and 17 years old) involvement in fatal crashes
before midnight compared to after midnight. Twenty-three States and the District of Columbia
had nighttime restrictions starting at 12 a.m. or later, with almost 93% of nighttime travel by
drivers 16 and 17 ending before midnight.
Use: As of September 2019 there were 49 States and the District of Columbia that restricted
intermediate license drivers from driving during specified nighttime hours (the exception is
Vermont). Many States allowed driving during the restricted hours for work or school-related
activities (GHSA, 2019a; IIHS, 2019b).
Effectiveness: The effectiveness of nighttime driving restrictions in reducing both nighttime
driving and nighttime crashes has been demonstrated conclusively (Fell et al., 2011; Hedlund et
al., 2003; Hedlund & Compton, 2005; Lin & Fearn, 2003; Lyon et al., 2012; Masten et al., 2013;
McCartt et al., 2010). The earlier a night restriction begins, the greater the reduction in crashes.
For example, night restrictions that begin at 9 p.m. are associated with an 18% reduction in fatal
crashes compared to no restriction. The reduction is only 9% when the night restriction begins at
1 a.m. (McCartt et al., 2010).
Costs: Once GDL is in place, a nighttime driving restriction can be implemented or modified at
very little cost.
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Time to implement: GDL requirement changes typically require about 6 months to notify the
public and implement the changes.
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1.4 GDL Intermediate License Passenger Restrictions
Effectiveness:
Cost: $
Use: High
Time: Medium
Young passengers are associated with a substantial increase in the risk of a fatal crash for teenage
drivers (Chen et al., 2000; Ouimet et al., 2010; Ouimet et al., 2015; Preusser et al., 1998; Tefft et
al., 2013b). Each additional passenger is associated with an additional increase in fatal crash risk
(Chen et al., 2000; Ouimet et al., 2015; Preusser et al., 1998; Tefft et al., 2013b). Fatal crash risks
are highest when young male drivers carry same age passengers, especially if those passengers
are also male (Chen et al., 2000; Ouimet et al., 2010; Ouimet et al., 2015; Tefft et al., 2013b).
To reduce this risk, most States include a passenger restriction in their GDL requirements for
intermediate licensees. According to NHTSA’s Motor Vehicle Occupant Safety Survey, 86% of
the general public believe that teenagers should have a restriction on the number of teenage
passengers they can carry (Block & Walker, 2008). In a national survey 89% of parents say they
support passenger restrictions; 82% think the passenger limit should be one or zero (Williams et
al., 2011).
Use: As of September 2019 there were 46 States and the District of Columbia that restricted in
some way the number of passengers who can be carried by an intermediate license driver
(GHSA, 2019a; IIHS, 2019b). The most common passenger restrictions limit teenage drivers to
zero or just one passenger. Some restrictions apply to all passengers and some only to passengers
younger than a specified age. A few States allow exceptions for transporting family or household
members.
Effectiveness: There is growing evidence that passenger restrictions are effective in reducing
young driver crashes, though the restrictions sometimes are violated (Carpenter & Pressley,
2013; Fell et al., 2011; Goodwin & Foss, 2004; Lyon et al., 2012; Masten et al., 2013; McCartt et
al., 2010; Williams, 2007). California allows no passengers younger than 20 for teenagers who
hold intermediate licenses. Four studies demonstrate the positive effects of this restriction. For
example, one study showed a 38% decrease in 16-year-old-driver crashes in California in which
a teen passenger was killed or injured (Williams, 2007). A NHTSA study evaluated passenger
restrictions in California, Massachusetts, and Virginia. Results showed 16-year-old driver crashes
were reduced in all three States, as were motor-vehicle-related injuries among 15- to 17-yearolds (Chaudhary et al., 2007). In North Carolina a teen passenger restriction was enacted
independent of any other changes to the State’s GDL system. Subsequent to this restriction, 16year-old-driver crashes involving passengers decreased by 32% (Foss, 2009). National studies
have also found large crash rate reductions for passenger restrictions. For example, McCartt et al.
(2010) found a 21% reduction in fatal crashes among 15- to 17-year-olds when no passengers
were permitted and a 7% reduction when one passenger was allowed. Similarly, Masten et al.
(2013) found a 20% lower fatal crash rate among 16-year-old drivers and a 12% lower fatal crash
rate among 17-year-old drivers when no more than one young passenger was allowed for at least
the first 6 months of independent driving.
Costs: Once GDL is in place, a passenger restriction can be implemented at very little cost.
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Time to implement: GDL requirement changes typically require about 6 months to notify the
public and implement the changes.
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1.5 GDL Cell Phone Restrictions
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Medium
This countermeasure involves States including cell phone restrictions in their GDL laws.
These bans cover all cell phone use, not just handheld phones. In some States, the cell phone
restrictions cover teenagers holding a learner’s permit and intermediate license; in other States,
the restrictions cover all drivers under a certain age, such as 18 or 19 (GHSA, 2019b; IIHS,
2019c).
Effectiveness Concerns: This countermeasure is widely used. Its effectiveness has been
examined in a few research studies. Despite some positive research findings, the balance of
evidence regarding countermeasure effectiveness remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A6, Section 1.5.
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1.6 GDL Belt Use Requirements
Effectiveness: ✩✩
Cost: $
Use: Low
Time: Medium
This countermeasure involves explicitly requiring belt use under their GDL laws. Note that
young drivers are covered by seat belt laws in all States (with the exception of New Hampshire,
which only requires seat belts for people under 18) (GHSA 2019c; IIHS, 2019d). 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. This may be especially true in States where a GDL belt use
requirement is coupled with primary enforcement for young drivers and in States where seat belt
violations result in delayed graduation to the next GDL stage.
Effectiveness Concerns: To date there has been only one evaluation of the effects of explicit seat
belt use requirements in GDL laws. This evaluation found no evidence that the countermeasure
had any effect on teen driver belt use (Freedman & Levi, 2008).
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A6, Section 1.6.
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1.7 GDL Intermediate License Violation Penalties
Effectiveness: ✩
Cost: $
Use: High
Time: Medium
This countermeasure involves a probationary feature included in the intermediate phase of many
graduated licensing systems, which is commonly referred to as contingent advancement.
Typically, contingent advancement means that an intermediate license holder must maintain a
violation free driving record for a specified amount of time before they can obtain a full license.
Effectiveness: The few evaluations of early stand-alone probationary license systems generally
found no substantial benefits (McKnight & 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. There are insufficient evaluation data available to conclude that the
countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A6, Section 1.7.
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Chapter 6. Young Drivers
2. Driver Education
2.1 Pre-Licensure Driver Education
Effectiveness: ✩✩
Cost: $$$
Use: Medium
Time: Long
This countermeasure involves some form of driver education before licensure, typically for
anyone younger than 18. Most commonly, this includes 30 hours of classroom instruction and 6
hours of behind-the-wheel practice, although requirements vary considerably across States
(Thomas et al., 2012). This training can include either commercial or high school driver
education programs.
Effectiveness Concerns: This countermeasure is used in many States. Its effectiveness has been
examined in several research studies. The balance of the evidence suggests that these types of
countermeasures are ineffective in the long term.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A6, Section 2.1.
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2.2 Post-Licensure or Second-Tier Driver Education
Effectiveness: ✩
Cost: $$$
Use: Low
Time: Long
This countermeasure involves post-licensure driver education curricula that are integrated with
driver education included in GDL (Smith, 1994). These “second-tier” post-licensure courses
teach safety-related information, building on the on-road experience that the students have
acquired in their initial months of driving. They should not be confused with “advanced driving
performance” courses that teach driving skills such as panic braking, skid control, and evasive
lane-changing maneuvers.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A6, Section 2.2.
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3. Parents
3.1 Parental Roles in Teaching and Managing Young Drivers
Effectiveness: ✩✩
Cost: $$
Use: Medium
Time: Short
This countermeasure involves programs based on direct interaction and engagement with parents
to better equip them to supervise and manage their teens’ driving during the GDL phase. These
programs typically involve a variety of approaches to educate parents and get them involved in
promoting their teen’s safe driving.
Effectiveness Concerns: This countermeasure has been examined in several research studies.
Despite some positive research findings, particularly in terms of behavioral changes, the balance
of evidence regarding countermeasure effectiveness remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A6, Section 3.1.
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3.2 Electronic Technology for Parental Monitoring
Effectiveness:
Cost: $
Use: Low
Time: Short
Technologies have been developed to aid parents in monitoring their teenage drivers. Monitoring
can include driving behaviors and performance (e.g., aggressive driving, drowsiness, and
distraction), as well as situational aspects of trips (geographic extent, passengers, road and trip
characteristics; Lerner et al., 2010). For example, many GPS companies offer “teen tracking”
services that will notify parents if their teens go beyond geographical boundaries or if they are
speeding at any given time. Video-based in-vehicle devices, such as DriveCam, can provide
visual monitoring of teen drivers.
The smartphone-based Teen Driver Support System (TDSS) has been used to provide real-time
feedback to teen drivers about unsafe driving behaviors. If a monitored driver does not cease the
unsafe behavior (e.g., texting or aggressive driving), text notifications are used to report the
behavior to parents (Creaser et al., 2015). The effectiveness of the TDSS program is currently
under evaluation by the Minnesota Local Road Research Board (see
https://mntransportationresearch.org/2019/08/21/new-project-effectiveness-of-teenage-driversupport-system for details).
In addition to aftermarket in-vehicle systems, vehicle-embedded systems that enable parental
monitoring and setting limits on speed and infotainment use are becoming available. Some
examples include Ford’s MyKey, GM’s Teen Driver, and Hyundai’s Curfew Alert technologies.
See www.carfax.com/blog/5-teen-driving-technologies for descriptions of these systems.
Use: The extent of the use of electronic monitoring and feedback systems is currently unknown;
however, the advent of smartphone-based systems and applications may provide low-cost
alternatives to more expensive aftermarket devices.
Trust in teenagers, costs, or concerns about privacy may dissuade parents from using electronic
monitoring systems (McCartt et al., 2007; Curry, Peek-Asa, et al., 2015). One survey in Ireland
of teen drivers’ willingness to use a smartphone-based monitoring system reported that the risk
of increased insurance premiums and the potential for device-based distraction deterred
willingness to use the technology (Kervick, Hogan, O’Hora, & Sarma, 2015). However, peer
approval and adoption of the technology was associated with positive willingness.
Effectiveness: While more research is needed to determine the impact of electronic monitoring
on crashes and fatalities among young drivers (Reyes et al., 2016), many studies have reported
positive benefits due to electronic monitoring of teen drivers in both learner and early postlicensure periods.
Reyes et al. (2016) conducted two studies to evaluate if post-drive electronic device feedback
provided to newly licensed teen drivers can reduce risky behaviors, and if video feedback
enhanced benefits of the intervention. In the first study, the rate of unsafe driving events (such as
abrupt acceleration, deceleration, or steering maneuvers; traffic violations; or improper seat belt
use) for teens who received feedback from an electronic monitoring device (video-based or non6-24
Chapter 6. Young Drivers
video based) were significantly lower than the control group. Mean unsafe event rates were 6.1
per 1,000 miles for teens with either form of feedback in comparison with 35.3 per 1,000 miles
among teens with no feedback. There were no significant differences between the video and nonvideo intervention groups, suggesting that the provision of any feedback is likely to deter unsafe
driving behaviors among teens. A second study was conducted with teen drivers of varying ages
during unsupervised driving experiences (Reyes et al., 2018). Drivers who received video-based
feedback--irrespective of age or experience--had lower rates of unsafe driving events than drivers
who received no feedback.
Electronic monitoring technologies can help reduce the incidence of risky driving behaviors
among teens by encouraging parental feedback. (Carney et al., 2010; Farah et al., 2014; Farmer
et al., 2010; McGehee et al., 2007; Musicant & Lampel, 2010; Peek-Asa et al., 2019; SimonsMorton et al., 2013). One evaluation of the Steering Teens Safe (see section A3.1 for more
information) program points to the importance of electronic monitoring systems in enabling
event-focused feedback and communication between parents and teen drivers (Peek-Asa et al.
2019). The Peek-Asa group found that teen drivers who received parental feedback based on
electronic monitoring had 85% fewer unsafe events than those who received no feedback at all,
whereas those who received only electronic feedback had 65% fewer events than the control
group.
Currently, there are no evaluations of vehicle-embedded electronic monitoring systems for
parental monitoring.
Costs: The costs of electronic monitoring devices are usually paid for by the teen drivers and
their families. Costs to the State or agency is low, but the device purchase and maintenance costs
to parents or guardians can be substantial. Smartphone-based systems offer low cost alternatives
to vehicle-based devices.
Time to Implement: Use of monitoring devices can start immediately upon installation.
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4. Traffic Law Enforcement
4.1 Enforcement of GDL and Zero-Tolerance Laws
Effectiveness:
Cost: $$
Use: Unknown
Time: Short
Two traffic laws apply only to young drivers: GDL laws and zero-tolerance laws that prohibit
drivers under 21 from having BACs of .02 g/dL or greater. As discussed in Chapter 1, Section
6.2, zero-tolerance laws are often 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 1.1-1.6, also appear not to be enforced vigorously. A
study in two States identified modest numbers of citations for some offenses, noting that other
GDL restrictions were rarely enforced (AAAFTS, 2014). Some GDL provisions such as
nighttime driving restrictions are inherently difficult to enforce because violations are difficult to
detect (Hedlund et al., 2003). A 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. Although surveys of LEOs found that most were supportive of GDL, officers
were not familiar with GDL details and considered GDL enforcement a low priority (Goodwin &
Foss, 2004). Another study found that teen drivers reported frequently violating passenger
restrictions, with and/or without their parents’ knowledge/permission, because local police did
not routinely enforce GDL restrictions (Chaudhary et al., 2007).
A recent study of fatal teen driver crashes from 1998 to 2016 in New Jersey reported both
extensive public health campaigns and targeted enforcement of GDL laws are necessary for the
prevention of such crashes (Bonne et al., 2018). GDL was implemented in New Jersey in 2002.
However, significant reductions in teen fatal crashes and the number of fatally injured teenagers
were seen only after a comprehensive campaign of public awareness, education, and enforcement
began in 2010. School outreach, classroom discussions, parent/teen orientations, and PSAs on
GDL were distributed as part of the awareness campaign. Enforcement practices consisted of
checkpoints near high schools and targeted enforcement of GDL provisions based on decals.
Teen driver crashes in the 4-year pre-campaign period (2006-2010) was compared with a 6-year
post-campaign period (2010-2016). Teen-involved crashes decreased 31%, teen driver fatalities
decreased 47%, and teen-involved fatal crashes decreased by 43% after the campaign.
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 important. 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 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 more efficient and allow for a
more immediate sanction than criminal penalties. Another issue with enforcement concerns the
difficulties in identifying drivers that qualify as falling under the GDL system in a given State. It
has been suggested that young drivers should be required to affix a vehicle decal identifying
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them as qualifying for the GDL program to make them more readily identifiable (Curry et al.,
2015). New Jersey was the first State to implement this countermeasure.
Use: The amount of enforcement of zero-tolerance and GDL laws is unknown.
Effectiveness: Zero-tolerance law publicity and enforcement likely will reduce teenage drinking
and driving, as discussed in Chapter 1, Section 6.2. High-visibility enforcement of GDL
provisions would be most effective if compliance with nighttime and passenger restrictions are
included as part of the zero-tolerance efforts. One study investigated whether well-publicized
enforcement, including checkpoints near high schools, could increase compliance with seat belt
laws and GDL provisions. The study found only modest increases in seat belt use and
compliance with the GDL passenger restriction, although levels of compliance prior to the
enforcement efforts were already high (Goodwin et al., 2006).
Studies evaluating the effectiveness of vehicle decals in New Jersey have found increases in
citations for violations of licensing restrictions and decreases in crash rates among intermediate
license holders in the year after the requirement went into effect (Curry et al., 2013; McCartt et
al., 2012). A longer term (2-year) evaluation of the effect of the decal provision on policereported crash rates and citations was conducted and baseline comparisons using data from a 4year pre-decal period were performed (Curry, Elliott, et al., 2015). The study showed that the
adjusted crash rates for intermediate license holders were 9.5% lower after the decal provision.
There were no changes in crash rates or citations for holders of learner’s permit (Curry, Pfeiffer,
et al., 2015).
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. To be most effective, all enforcement efforts 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. The cost of vehicle
decals can be paid for by the licensee when they receive a learner’s permit or intermediate
license. In New Jersey vehicle decals cost $4 for a pair.
Time to implement: Enforcement programs can be implemented in 3 or 4 months, as soon as
appropriate training, publicity, and equipment are in place.
Other issues:
• Preventative measures: A recent NHTSA study examined the feasibility of deterring
drunk driving among teen drivers by fitting the vehicle with alcohol ignition interlocks
(Kelley-Baker et al., 2017). Stakeholders participated in meetings conducted in 2010,
including interlock device and service providers, community representatives, insurance
companies, current voluntary and involuntary users of interlock devices 16- to 26 years
old, parents, and teen drivers. Insights from these discussions pointed to the need for a
change in the social norming of interlock devices from a punitive to a preventative
measure. Parents were generally supportive of interlock devices as a way to prevent
drunk driving among their children. The responses from current users pointed to mixed
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Chapter 6. Young Drivers
•
•
acceptance of the device. Future research into such preventative measures could provide a
front-line enforcement of laws and restrictions.
Compliance with restrictions: Several studies have shown that teenagers do not always
comply with GDL restrictions (Goodwin & Foss, 2004; Williams et al., 2002) and
effectiveness of GDL may be reduced. It should be noted, however, that GDL has been
shown to be effective even in the absence of police enforcement. For example, focus
groups with parents and teen drivers conducted in California, Massachusetts, and Virginia
revealed that passenger restrictions were frequently violated in all three States, but even
incomplete adherence to the restrictions had a positive impact on teen driver crashes
(Chaudhary et al., 2007). In general, compliance with restrictions will be higher in States
that have well-designed GDL systems with restrictions that are considered reasonable by
parents and teens (Foss & Goodwin, 2003). Curry, Pfeiffer, and Elliott (2017) used the
quasi-induced exposure (QIE) method to estimate young, intermediate drivers’
compliance with both the passenger and nighttime restrictions of GDL in New Jersey.
The QIE method assumed that young intermediate drivers in multi-vehicle crashes (with
only one driver held responsible for the crash) were reasonably representative of the
population of young intermediate drivers. Data from 9,250 drivers who were involved in
multi-vehicle crashes from July 2010 to June 2012 were examined. Noncompliance with
the passenger restriction averaged 8.3%, and noncompliance with the nighttime
restriction was 3.1%. Certain groups and situations were associated with higher rates of
noncompliance—male drivers, those residing in low-income and urban areas, weekend
trips, and trips in the summer months. The authors concluded that outreach should be
focused, where possible, on higher-risk situations and groups with higher noncompliance.
Citation dismissal in the courts: One study in two States noted relatively high rates of
GDL-related citations being dismissed by the courts, which could have a negative impact
on the effectiveness of those programs (AAAFTS, 2014).
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Chapter 6. Young Drivers
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Vernick, J. S., Li, G., Ogaitis, S., MacKenzie, E. J., Baker, S. P., & Gielen, A. C. (1999). Effects
of high school driver education on motor vehicle crashes, violations, and licensure.
American Journal of Preventive Medicine, 16, 40-46.
Voas, R. B., Torres, P., Romano, E., & Lacey, J. H. (2012). Alcohol-related risk of driver
fatalities: An update using 2007 data. Journal of Studies on Alcohol and Drugs, 73(3),
341-50.
Williams, A. F. (2003). Teenage drivers: patterns of risk. Journal of Safety Research, 34, 5-15.
Williams, A. F. (2007). Contribution of the components of graduated licensing to crash
reductions. Journal of Safety Research, 38, 177-184.
Williams, A. F. (2009). Licensing age and teenage driver crashes: A review of the evidence.
Traffic Injury Prevention, 10, 9-15.
Williams, A. F. (2011). Teenagers’ licensing decisions and their views of licensing policies: A
national survey. Traffic Injury Prevention, 12(4), 312-319.
Williams, A. F. (2017). Graduated driver licensing (GDL) in the United States in 2016: A
literature review and commentary. Journal of Safety Research, 63, 29-41.
Williams, A. F., Braitman, K. A., & McCartt, A. T. (2011). Views of parents of teenagers about
licensing policies: A national survey, Traffic Injury Prevention, 12, 1-8
Williams, A. F., Chaudhary, N. K., Tefft, B. C., & Tison, J. (2010). Evaluation of New Jersey’s
graduated driver licensing program. Traffic Injury Prevention, 11, 1-7.
Williams, A. F., McCartt, A. T., Mayhew, D. R., & Watson, B. (2013). Licensing age issues:
Deliberations from a workshop devoted to this topic. Traffic Injury Prevention, 14, 237243.
Williams, A. F., Nelson, L. A., & Leaf, W. A. (2002). Responses of teenagers and their parents
to California’s graduated licensing system. Accident Analysis & Prevention, 34, 835-842.
Williams, A. F., Tefft, B. C., & Grabowski, J. G. (2012). Graduated driver licensing research,
2010-present. Journal of Safety Research, 43, 195-203.
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Chapter 7. Older Drivers
7. Older Drivers
Overview
In 2018 nearly 20% of licensed drivers in the United States were 65 or older (FHWA, 2020). As
drivers age, their physical and mental abilities, driving behaviors, and crash risks all change,
though age alone is not determinative of 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 2018 the proportion of licensed drivers 65 and older rose from 11% to
20% and the proportion of these older drivers in fatal crashes rose from 7% to 14%.
People 65 and Older: Number and Proportion of Total Populations
Resident Population
Licensed Drivers
Drivers In Fatal Crashes
Year
Million
%
Million
%
N
%
1982
2018
26.8
52.4
12%
16%
16.8
45.2
11%
20%
3,894
7,316
7%
14%
2030
73.1*
21%*
62.1*
> 20%*
?
?
*Projected numbers based on 2017 population estimates
Sources: NHTSA - FARS (1982, 2018); FHWA Highway Statistics (1995, 2020); NCSA (2020); Vespa et al. (2020)
The U.S. population 65 and older increased at a much faster rate (15.1%) than the total
population (9.7%) from 2000 to 2010 (Census Bureau, 2014). Between 2010 and 2017, the
resident population 65 and older continued to increase at a much higher rate (25.7%) than all
other age groups combined (2.2%) (Census Bureau, 2018). By 2030, the Census Bureau
estimates that the resident population over 65 will double the 2010 population, to over 73
million, and will comprise 21% of the total U.S. population (Vespa et al., 2020).
The licensed driver population likely will grow even faster. The proportion of people 65 or
older who held a driver’s license rose from 63% in 1982 to 86% in 2018 (FHWA, 2020). As of
2018, there were 92.8% of people 65 to 69 who were licensed, as are 91.1% of people 70 to 74,
86.7% of people 75 to 79, 79.2% of people 80 to 84, and 61.5% of people 85 and older
(FHWA, 2020). With current life expectancy in this country at 78.6 years on average (CDC,
2017), and with advances in medical science, older Americans are staying mobile and active
longer. Those who will reach 65 in the coming decade have been projected to drive more miles
and are expected to continue driving later in life than previous generations. This increasingly
active and mobile older population gives rise to the need to enhance their safety, and the safety
of all road users, while addressing their mobility needs and quality of life.
7-1
Chapter 7. Older Drivers
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% of older people are
licensed, there will be over to 62 million licensed drivers who are at least 65 years old.
Older driver characteristics. Certain changes are often linked to the normal aging process
(Potts et al.’s 2004 NCHRP report, Section III; IIHS, 2019).
• Fragility increases. The same crash force produces more serious injuries to a 70-year-old
than to a 20-year-old, and injuries take longer to heal.
• Drivers’ overall functional abilities decline as their physical, visual, and cognitive
capabilities diminish with age. Though at very different rates for different people,
physical capabilities including hearing, muscle tone, and reaction time as well as visual
capabilities (especially night vision) all decline. Cognitive capabilities can also
diminish. Driving is a complex activity that requires a variety of high-level cognitive
skills that can diminish through changes that occur with normal aging and/or as a result
of dementia. As drivers get older, they tend to be overrepresented in crashes requiring
navigation of more complex situations such as intersections, left turns, and reacting to
an impending crash (Stutts et al., 2009). That said, mild cognitive decline can still allow
for safe driving (Staplin et al., 2019). Overall, tests of functional ability to drive may
provide better indicators of driving health. The state of current research on visual
scanning ability and availability of training programs for visual scanning skills has been
summarized in a recent NHTSA report (Lococo & Staplin, 2018).
• Many older drivers use medications, with over 90% taking prescription medications
(Rosenbloom & Santos, 2014). These medications alone and/or in combination with
other medications may be necessary to control disease or health conditions, but also may
cause drowsiness or otherwise affect driving.
• Older drivers are less likely than younger people to drive after drinking or using
recreational drugs. While drivers over 70 were overrepresented in several crash types,
drivers 60 and older were less likely than younger drivers to be involved in alcoholrelated crashes (Stutts et al., 2009).
• Older drivers are less likely to drive aggressively or to speed. However, they may
exhibit other risky behaviors, such as driving more slowly than prevailing traffic or
failing to detect or accurately judge the speed of an oncoming vehicle while making a
left turn. The most frequent driving errors made by older adults include the failure to
yield right-of-way (Mayhew et al., 2006), inadequate surveillance, and misjudgment of
gaps (Cicchino & McCartt, 2015). Older adults are more likely to be involved in angle
collisions, overtaking- and merging-related collisions, and crashes in intersections
(Lombardi et al., 2017).
• Most older drivers reduce their driving mileage as their lifestyles change. Many older
drivers recognize and avoid driving in situations in which they feel uncomfortable, such
as at night, on high-speed roads, or in unfamiliar situations (Staplin & Lococo, 2003).
Older drivers were underrepresented in nighttime-related crashes, probably due in part
to this group’s tendency to avoid or limit driving at night (Stutts et al., 2009). However,
such driving avoidance may not always be due to consideration of functional
impairments, and can instead arise due to other factors including changes in lifestyle or
travel preferences or a reduced need to drive (Molnar et al., 2015).
7-2
Chapter 7. Older Drivers
40
Driver Involvement in Fatal Crashes per 100,000
Licensed Drivers - 2018
Involvement Rate
35
30
25
20
15
10
5
0
16-20
21-24
25-34
35-44
45-54
Age
55-64
65-74
>74
Source: NHTSA (2020), Table 62
Fatal Crashes per 100 Million Miles Traveled, by Driver Age, 2017
8.0
7.0
6.0
Rate
5.0
4.0
3.0
2.0
1.0
0.0
16-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 ≥85
Age
Source: Insurance Institute for Highway Safety [IIHS] (2019)
These characteristics produce the following results.
• The older driver (65+) crash involvement rate in fatal crashes per licensed driver is lower
than for younger drivers (<65).
• The average fatal crash rate for drivers 70 and older per mile traveled is higher than for
all age groups except drivers 16 to19 (IIHS, 2019). This is due to changes in driving
habits and increased susceptibility to injury among older drivers:
o Older drivers drive fewer miles annually than younger drivers but tend to drive
more on local roads where there are more potential hazards, such as traffic
congestion and confusing intersections (Wang et al., 2003). The majority of older
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Chapter 7. Older Drivers
drivers’ fatal crashes occur on rural roadways (Stutts et al., 2009). In 2018 more
drivers 65 and older were killed on rural roadways (53%) as compared to urban
roadways (46%) (NCSA, 2020).
o Older drivers are more fragile; thus, they will more likely sustain a serious injury
or fatality than younger drivers. They may also experience long-term health issues
and resultant frailty due to the lack of physiological stamina. Fragility, as
measured by deaths per driver involved in crashes, begins to increase between 60
to 64 years old and increases steadily with advancing age. Fragility, rather than an
increased tendency to get into crashes, accounts for about 60% to 95% (depending
on age group and gender) of the increased fatality rates per miles traveled in older
drivers (Li et al., 2003).
o Other research has concluded that the fatal crash risk for drivers 70 and older
declined in 1997 to 2005 at a rate faster than that for the comparison group of 35to 54-year-old drivers (Cheung & McCartt, 2011). Cheung and McCartt suggest
that this reduction in fatality risk for older drivers is due to their decreased
likelihood of being involved in crashes combined with increases in their chances
of survival when they are involved in crashes. The exact reasons for the increase
in survivability were unclear, and could have included factors such as safer
vehicles, lesser driving exposure, access to better emergency and trauma care, and
improvements in overall health. For example, improvement in occupant restraint
systems have been shown to improve crash outcomes across age groups. Although
these changes have benefitted younger occupants to a greater extent than older
occupants, all occupants are safer when belted (Kahane, 2013). The decline in the
national fatal crash rate for drivers 70 and older were similar to the decline for
middle age drivers during the 2007–2012-time period. However, when
considering the duration from 1997 to 2012, fatal crash rates per licensed driver
fell 42% for drivers 70 and older and 30% for 35- to 54-year-old drivers. The 49%
decline in the national fatal crash involvement rate for drivers 80 and older was
the largest for any age group (Cicchino & McCartt, 2014).
Strategies to Reduce Crashes and Injuries Involving Older Drivers
The overall goal of older-driver-related countermeasures 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” was the key phrase used in the U.S.
Department of Transportation’s Safe Mobility for a Maturing Society: Challenges and
Opportunities plan published in 2003 (U.S. DOT, 2003). The plan established strategies to
address safe mobility on the State or local level. Strategies included educating and training older
drivers to assess their driving capabilities and limitations; improving skills when possible;
voluntarily limiting driving to circumstances in which they feel most comfortable driving;
helping drivers adapt to medical or functional limitations affecting driving with treatment (such
as eyeglasses or cataract surgery to improve vision) or vehicle adaptations (such as extra mirrors,
extended gear shift levers, hand controls, or pedal extenders); and using license renewal
procedures or referrals from law enforcement, clinicians (primary care providers or specialists),
7-4
Chapter 7. Older Drivers
family, or friends to identify older drivers who cannot drive safely, in certain situations or at all,
and restrict or revoke their driver’s licenses.
In 2005 NHTSA developed the Older Driver Traffic Safety Plan that synthesized research
findings and expert opinions and guided subsequent NHTSA research and programs (NHTSA,
2005). Building on that work, NHTSA produced the Older Driver Program Five-Year Strategic
Plan in 2010 focused on how NHTSA would address the safety needs of older drivers from 2012
to 2017 (NHTSA, 2010). Based on interviews and expert panel input and other research, NHTSA
identified three main program initiatives (communications, partnerships, and driver licensing
policies) to guide the implementation of its Older Driver Traffic Safety Plan for 2012-2017.
In 2013 NHTSA developed the Traffic Safety for Older People – 5-Year Plan to address traffic
safety concerns of older road users - drivers, passengers, and pedestrians. The plan described
research and other program activities in the near term (within the next 2 years), short term (3 to 5
years), and long term (beyond 5 years from the initiation of the plan). The plan was developed
around four main elements, data, vehicle, behavior, and pedestrian safety. NHTSA notes this
plan was intended to be a dynamic guide, reviewed and modified in response to new research
and other information related to traffic safety for older people (NHTSA, 2013). In November
2016 NHTSA conducted a day-long meeting of experts titled Enhancing Safety for Aging Road
Users to identify interventions to improve older driver traffic safety. The inputs from the meeting
influenced NHTSA research and program related projects for 2017-2018 and will be considered
in the next revision of the Traffic Safety for Older People – 5 Year Plan. The meeting videos are
available at www.nhtsa.gov/events/enhancing-safety-aging-road-users. NHTSA also provides
actionable information for family and friends of older drivers on its website, including the How
to Understand and Influence Older Drivers resource at www.nhtsa.gov/older-drivers/howunderstand-and-influence-older-drivers.
There are vehicular, environmental, and societal strategies critical to providing safety and
mobility for older people, but are for the most part beyond the control of SHSOs. Vehicles can
be designed with better crash protection for older and more easily injured occupants, with
controls and displays that are easier to see, reach 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 assist all drivers. These subjects are not
discussed in this guide because they do not fall under direct SHSO jurisdiction. However, it is
important that SHSOs become at least somewhat familiar with basic concepts of transportation
planning and engineering – such as those mentioned above – since SHSOs can be expected to
play increasingly important roles in partnerships to enhance older driver safety and mobility
efforts.
NHTSA’s Highway Safety Program Guideline No. 13 – Older Driver Safety provides States with
key elements of a comprehensive older driver safety program aiming to reduce older driver
crashes, fatalities, and injuries. Many guideline elements can be addressed directly by SHSOs, as
NHTSA notes, “each State older driver safety program should address driver licensing and
medical review of at-risk drivers, medical and law enforcement education, roadway design, and
7-5
Chapter 7. Older Drivers
collaboration with social services and transportation services providers” to maximize benefits.
The guideline also includes recommendations for program management, communications, and
program evaluation and data components that should be included in a State older driver safety
program (NHTSA, 2014). FHWA also provides an updated list of resources on transportation
engineering aspects as relevant to older driver and road user safety:
https://safety.fhwa.dot.gov/older_users/.
Of all the subject areas in this countermeasure guide, those related to 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 people must restrict or cease driving, either by choice or as the
result of the State licensing authority restricting or revoking their license. Driving cessation can
have a substantial effect 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 community activities to improve older people’s safety,
mobility, and health. As just one example, some communities have established referral centers
where people can go for “one-stop” 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. The Florida DOT, in
collaboration with a range of State, industry, academic, and community partners, supports the
Safe Mobility for Life Coalition (http://safemobilityfl.com/index.htm). Its coalition partners
provide education, services, and tips for older drivers in community events. California’s
Department of Aging collaborates with Area Agencies on Aging to provide local communitybased services, including transportation assistance
(www.aging.ca.gov/Programs_and_Services/Home_and_Community_Services/). See Stutts
(2005) for summaries of comprehensive programs for older drivers in six States.
Several studies and policy papers discuss older driver safety. See, in particular, the Department
of Transportation’s Safe Mobility for a Maturing Society: Challenges and Opportunities (U.S.
DOT, 2003) and NCHRP’s Guide for Addressing Collisions Involving Older Drivers (Potts et al.,
2004) for summaries and references to further information. The Organisation for Economic CoOperation and Development’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. A report
issued by the AAA Foundation for Traffic Safety (Stutts & Wilkins, 2009) documents U.S.
policies and practices for improving the safety of older drivers and identifies model programs.
These policies and practices and model programs are updated and made available through the
AAAFTS “Driver Licensing Policies and Practices” and “Noteworthy Initiatives” databases that
can be searched by State or by policy/topic area (http://lpp.seniordrivers.org/).
Resources
The agencies and organizations listed below can provide more information on older drivers and
links to numerous other resources.
• National Highway Traffic Safety Administration:
o Older Drivers – www.nhtsa.gov/road-safety/older-drivers
7-6
Chapter 7. Older Drivers
•
•
•
•
•
•
•
•
•
•
•
•
o Older Driver Safety Research Reports and Fact Sheets: www.nhtsa.gov/roadsafety/older-drivers#resources
Clearinghouse for Older Road User Safety (ChORUS): www.roadsafeseniors.org/
Behavioral Safety Research Reports – https://rosap.ntl.bts.gov/
Centers for Disease Control and Prevention, Injury Prevention & Control: Motor Vehicle
Safety: Older Adult Drivers: www.cdc.gov/Motorvehiclesafety/Older_Adult_Drivers/index.html
AAA: www.seniordriving.aaa.com/
AAA Foundation for Traffic Safety: www.aaafoundation.org/category/vulnerable-roadusers/
AARP: www.aarp.org/driversafety
Governors Highway Safety Association: www.ghsa.org/html/issues/olderdriver.html
Insurance Institute for Highway Safety:
www.iihs.org/iihs/topics/t/older-drivers/topicoverview
National Aging and Disability Transportation Center: www.nadtc.org/
The International Association of Directors of Law Enforcement Standards and Training:
www.iadlest.org/training/older-driver-law-enforcement-training
National Safety Council: www.nsc.org/road-safety
FHWA’s 2014 Handbook for Designing Roadways for the Older Population:
www.safety.fhwa.dot.gov/older_users/handbook/
7-7
Chapter 7. Older Drivers
Older Driver Countermeasures
Countermeasures to improve older driver safety are listed in the table below. The table is
intended to provide a rough estimate of each countermeasure’s effectiveness, use, cost, and time
required for implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to improve older driver safety is discussed individually in this chapter. Full
descriptions are included for , and countermeasures. Brief
descriptions are included for ✩ and ✩✩ countermeasures. Further details about the ✩ and
✩✩ countermeasures are included in Appendix A7 to this report.
1. Communications and Outreach
Countermeasure
1.1 Formal Courses for Older Drivers
1.2 General Communications and Education
Effectiveness
✩✩
✩
7-8
Cost
Use
Time
$
Low
Short
$
Unknown
Short
Chapter 7. Older Drivers
2. Licensing
Countermeasure
Effectiveness
2.1 License Screening and Testing
2.2 Referring Older Drivers to Licensing
Agencies
2.3 License Restrictions
2.4 Medical Advisory Boards
2.5 License Renewal Policies: In-Person
Renewal, Vision Test
✩
✩✩
Cost
Use
Time
$$
High
Medium
$$
Low
Medium
$
Low
Short
Varies
High
Medium
$$$
Medium
Medium
3. Traffic Law Enforcement
Countermeasure
Effectiveness
3.1 Law Enforcement Roles
Cost
Use
Time
Varies
Medium
Varies
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
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.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
7-9
Chapter 7. Older Drivers
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
7-10
Chapter 7. Older Drivers
1. Communications and Outreach
1.1 Formal Courses for Older Drivers
Effectiveness: ✩✩
Cost: $
Use: Low
Time: Short
This countermeasure involves formal courses specifically developed for older drivers. These
courses are typically offered by organizations such as AAA, AARP, and the National Safety
Council, either independently or under accreditation by States. 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. Courses combining classroom and onthe-road instruction have been offered in some locations (Potts et al., 2004, Strategy D2).
Effectiveness Concerns: The effectiveness of formal courses for older drivers has been
examined in several research studies. While these studies have found some positive outcomes in
self-reported driving behaviors and reductions in police-issued citations, there is no evidence
that this countermeasure reduces crashes relative to comparison groups.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A7, Section 1.1.
7-11
Chapter 7. Older Drivers
1.2 General Communications and Education
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
This countermeasure involves 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. These include a variety of self-assessment tools, programs, and other information
developed by organizations such as AAA, AARP, American Geriatrics Society (AGS), American
Medical Association (AMA), American Society on Aging (ASA), American Occupational
Therapy Association (AOTA), CDC, NHTSA, and WebMD.
Other material is available to assist drivers and family members in understanding how aging
affects driving, the effects of medications and health conditions on driving ability, 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). Additional
information can be found on the NHTSA website (www.nhtsa.gov/road-safety/older-drivers) and
the ChORUS website (www.roadsafeseniors.org). In February 2017 AGS, under a cooperative
agreement with NHTSA, released a “Driving Safety” toolkit with resources for older drivers and
caregivers, on their public education website (HealthinAging.org), see
www.healthinaging.org/aging-and-health-a-to-z/topic:driving-safety/. See
www.programsforelderly.com/index-senior-safety.php#drivingandsafety for information on
programs that promote safe driving for older drivers. WebMD also presents resources to guide
caregiver discussions on driving safety.
Effectiveness Concerns: There are no known evaluations of the effects of this material on
driving or on crashes (Potts et al., 2004, Strategy D2).
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix Section 7, 1.2.
7-12
Chapter 7. Older Drivers
2. Licensing
2.1 License Screening and Testing
Cost: $$
Effectiveness: †
† Proven for identifying drivers whose driving should be limited
Use: High
Time: Medium
State licensing agencies vary considerably in their procedures for screening and evaluating driver
abilities and skills (Potts et al., 2004, Strategy C2; American Geriatrics Society, 2016; Lococo,
Stutts, et al., 2017; NHTSA, 2017). Many do not include all the recommendations on medical
conditions from the American Medical Association’s 1st and 2nd editions of the Physician’s
Guide to Assessing and Counseling Older Drivers (Carr et al., 2010; Wang et al., 2003). In 2016
the American Geriatric Society assumed the role of updating the Physician’s Guide, and changed
the name for the 3rd edition to the Clinician’s Guide to Assessing and Counseling Older Drivers
(AGS, 2016), to be inclusive of the varying health care practitioners involved with health care
issues associated with older people. The 4th edition was released in 2019 and is available at
https://geriatricscareonline.org/ProductAbstract/clinicians-guide-to-assessing-and-counselingolder-drivers-4th-edition/B047.
NHTSA conducted extensive evaluations of the state of driver medical review practices and
licensing outcomes (Lococo et al., 2016; Lococo, Sifrit, et al., 2017; Lococo, Stutts, et al., 2017).
States that have medical review practices in the form of medical professionals on licensing
review panels or have Medical Advisory Boards benefit from their inputs in addition to the
referrals by the driver’s physician (NHTSA, 2017).
NHTSA and AAMVA have developed Model Driver Screening and Evaluation Program
Guidelines for Motor Vehicle Administrators (Staplin & 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, Lococo, Gish, & Decina, 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 & Lococo, 2003). The guidelines, tested in Maryland, outlined a
complete process of driver referral, screening, assessment, counseling, and licensing action
(Staplin & Lococo, 2003; Staplin, Lococo, Gish, & Decina, 2003b). They include 9 simple visual
inspection tests licensing agency personnel can administer to screen for functional ability
(Staplin & Lococo, 2003). The results of a survey of State motor vehicle departments outlines
some of the legal, policy, cost, and other criteria required before the implementation of
guidelines in some States (Staplin & Lococo, 2003, Appendix C).
In 2008 the screening and testing of older drivers was a major discussion at the North American
License Policies Workshop sponsored by the AAA Foundation for Traffic Safety. One of the
general themes of this workshop was “while certain declines are generally associated with aging,
consensus is lacking on whether or at what age people should be required to be screened or
tested. Regardless, it is generally accepted that final licensing decisions should be based on
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functional performance, not age, as there is wide variation in how people age” (Molnar & Eby,
2008, p.3). In 2009 NHTSA and AAMVA also developed the Driver Fitness Medical
Guidelines; see
www.aamva.org/uploadedFiles/MainSite/Content/SolutionsBestPractices/BestPracticesModelLe
gislation(1)/DriverFitnessMedicalGuidelines_092009.pdf.
Use: All States screen and test referred drivers, though their procedures and criteria vary
considerably (Potts et al., 2004, Strategy C2). See also the AAAFTS (2016a) “Driver Licensing
Policies and Practices” database showing each State's driver licensing policies and practices
regarding older and medically at-risk drivers. As of 2016 Utah was evaluating its restricted
licensing practices; results are yet unavailable (AAAFTS, 2016b; See Chapter 7, section 2.3
License Restrictions for more information).
Effectiveness: There is strong 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, “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). In a study evaluating the use of a
screening tool on Alabama drivers 18 to 87, older drivers (65 and older) performed significantly
worse than drivers less than 65 years old, and older drivers with a crash history, performed worse
than older drivers without crashes (Edwards et al., 2008).
A NHTSA-sponsored project conducted by Eby et al. (2008) sought to improve existing selfscreening tools for older drivers by focusing on symptoms associated with medical conditions.
The researchers created a self-screening survey to provide feedback to older drivers to increase
general awareness of issues associated with driving and the aging process, and to provide
recommendations for behavioral changes and vehicle modifications they could make to maintain
safe driving. Evaluation results found the self-screening instrument had a positive value, but
primarily as a “screening tool to determine gross impairment rather than fitness to drive” (Eby et
al., 2008, p. 19).
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).
Time to implement: States should be able to modify their driver license screening and
assessment procedures in 4 to 6 months.
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Chapter 7. Older Drivers
2.2 Referring Older Drivers to Licensing Agencies
Effectiveness: †
† Proven for increasing physician referrals
Cost: $$
Use: Low
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 three sources accounted for 85% of referrals: law enforcement
(37%), physicians and other medical professionals (35%), and family and friends (13%) (Stutts,
2005). The remaining 15% came from crash and violation record checks, courts, self-reports, and
other sources.
Referrals by Law Enforcement: LEOs 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 Potts
et al., 2004, Strategy C3, and Stutts, 2005, Chapter 7).
States can increase driver referrals by establishing and publicizing procedures for referring
drivers, establishing referral policies and providing appropriate training and information to
LEOs, and informing physicians and health professionals of their responsibilities. The presence
of MABs and/or medical professionals providing case review of medically at-risk driver referrals
may help improve licensing decisions at little extra cost to the program (Lococo et al., 2016;
Lococo, Sifrit, et al., 2017; NHTSA, 2017). In 2009 NHTSA, in collaboration with the American
Association of Motor Vehicle Administrators produced, “Driver Fitness Medical Guidelines” to
provide guidance to licensing agencies for use in making decisions about a person’s fitness for
driving (NHTSA, 2009). Guidelines are provided for a variety of physical limitations and
impairments as well as medical conditions. In addition, this guide provides information useful
for State licensing agencies to educate medical professionals about the effects of functional
impairments and medical conditions on safe driving in order to encourage them to refer drivers
for additional evaluations related to driving. Many components of this product have been
incorporated into the Clinician’s Guide to Counseling Older Drivers (American Geriatrics
Society & Pomidor, 2016). NHTSA plans to revise a simple pull out reference specifically for
DMV personnel, and otherwise refer them to specifics in the Clinician’s Guide.
Referrals by Health Care Providers: Health care providers (HCPs), including physicians, nurse
practitioners, and physician assistants, are in an excellent position to assess if changes in their
patients’ physical or cognitive abilities may increase their crash risk. In addition, varying
clinicians, such as pharmacists, nurses, occupational or physical therapists, social workers or
case managers, can, in the course of their work, assess for physical, cognitive, or functional
limitations warranting further evaluation, counseling, or referral to the licensing agency, if
appropriate. As of 2016, 6 States require physicians to report patients who have specific medical
conditions, such as epilepsy or dementia (AAAFTS, 2016a). Other States require physicians to
report “unsafe” drivers, with varying guidelines for defining “unsafe.” In all 50 States and the
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District of Columbia, physicians are permitted to report medically-at risk drivers. Physicians
must balance their legal and ethical responsibilities to protect their patient’s health and
confidentiality with their duty to protect the general public from unsafe drivers. Physicians have
been held liable for damages from crashes involving patients because they failed to report the
patient to the licensing agency (Wang et al., 2003, Chapter 7).
Licensing decisions based on drivers’ medical fitness to drive can be established through review
by a medical advisory board (MAB) and/or with one or more medical professionals performing
reviews of the referrals (NHTSA, 2017). Having medical professionals or a MAB perform case
reviews provides certain advantages, including legal immunity to physicians voluntarily referring
at-risk drivers (Lococo et al., 2016; NHTSA, 2017). NHTSA conducted a study of MAB
structures, referrals, and outcomes in six States, and found that physician referrals resulted in
changes in license status in 90% of cases studied (Lococo, Sifrit et al., 2017). In fact, physician
referrals were most likely to result in changes to driver license statuses, and the presence of a
MAB may serve to promote physician referrals (NHTSA, 2017). See Lococo, Stutts et al., 2017
for a summary of the medical review structures and referral processes in all States.
The Clinician’s Guide to Assessing and Counseling Older Drivers (AGS & Pomidor, 2016)
provides detailed information for physicians and medical professionals. The guide was prepared
by AGS, and is an update to the Physician’s Guide to Assessing and Counseling Older Drivers
(Wang et al., 2003; Carr et al., 2010). 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 State-level information and Potts et al. (2004, Strategy C3) for overall discussion of different
strategies. See Lococo et al., 2016 for a classification of medical review practices and Lococo,
Stutts et al., 2017 for detailed information on State medical review practices and procedures.
Chapter 3 of the Clinician’s Guide to Assessing and Counseling Older Drivers (AGS &
Pomidor, 2016) discusses the assessment of functional abilities and provides physicians with the
instructions and basic forms needed for them to conduct a brief in-office Clinical Assessment of
Driving Related Skills (CADReS). The CADReS screening tool assesses some aspects of the key
functional areas of vision, cognition, and motor/sensory functions to help physicians identify
specific areas of concern as they relate to driving. An evaluation of an earlier version of
CADReS (McCarthy et al., 2009) suggests that while this tool was able to identify all the study
participants who failed the behind-the-wheel test included as a part of the study, the tool may
need to be revised to give physicians a more effective and efficient tool for in-office assessments.
To encourage use of the Clinician’s Guide to Assessing and Counseling Older Drivers, a fivemodule curriculum including slides, video case segments, and handouts was developed by the
AMA and revised in 2016 by the American Geriatrics Society (3rd edition, AGS & Pomidor,
2016). The guide’s goal is to heighten knowledge and skills necessary for a clinician to evaluate
driver fitness in a typical care encounter, and to develop a plan for further evaluation by other
specialists or licensing authorities, if needed. An evaluation of this curriculum, performed when
it was launched by AMA, found continuing education training can enhance the confidence and
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Chapter 7. Older Drivers
clinical practices of health professionals as related to driver fitness evaluations and mobility
planning (Meuser et al., 2010).
NHTSA published a literature review on the effects of medication use and medical conditions on
older drivers’ functional driving performance and safety (Lococo et al., 2018). A range of
medical conditions were reviewed in light of their potential effects on crash risk, and the
researchers prioritized eight conditions as particularly concerning for older driver safety—
diabetes, dementia, obstructive sleep apnea, glaucoma, hepatic encephalopathy, macular
degeneration, stroke, and Parkinson’s disease.
Referrals by Families and Friends: Many States have established procedures for family
members and friends to report drivers of any age whose abilities may be impaired (Lococo,
Stutts et al., 2017). For example, fitnesstodrive.phhp.ufl.edu/us/ is a questionnaire that caregivers
or friends and family can use to evaluate an older drivers’ fitness to continue driving. See
www.michigan.gov/sos/0,4670,7-127-1627_8665_9066-23762--,00.html for an example of
information on driver referrals that can be submitted by families and friends in Michigan.
Use: A survey of all State licensing agencies found less than 100,000 drivers 65 and older are
referred each year from all sources, or less than 0.4% 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: Establishing and publicizing effective referral procedures will increase referrals.
Potts et al., 2004, Strategy C3 provide examples. and web links. As one example, Pennsylvania
increased physician referrals substantially by sending letters to all physicians (Potts et al., 2004,
Strategy C3).
A recent analysis of older driver hospitalizations in 37 States from 2004 to 2009 showed no
significant association between mandatory physician reporting laws and older drivers’ crashrelated in-patient stays. This was true even among the 27 States that provide legal immunity to
referring physicians (Agimi et al., 2018). The authors note that removing barriers to physician
referrals by increasing awareness of the law and requirements and providing training to identify
at-risk drivers may help improve safety benefits of mandatory laws.
Mandatory physician referrals may improve other measures of older driver safety. A study of
Missouri’s voluntary reporting law (enacted in 1999) and the resulting licensing outcomes found
crash involvement of reported drivers decreased after implementation of the law and, to a lesser
degree, mortality declined as well. Though the Missouri law is not specific as to age, the mean
age of reported drivers was 80 and only 3.5% of the 4,100 people (reported by a combination of
LEOs, driver license office staff, physicians, family members and others) retained their drivers’
licenses after the process (Meuser et al., 2009). As part of this law, reported people are required
to undergo a physician evaluation. To better understand the observations and concerns of family
members and to investigate why older drivers were referred to the licensing agency, Meuser et
al. (2015) reviewed reporting forms submitted by family members each indicating an older
individual who is potentially unfit to drive. Of the 689 older adults, 448 were reported to have a
cognitive issue (e.g., confusion, memory loss, and becoming lost while driving) and 365 cases
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Chapter 7. Older Drivers
included diagnostic labels such as Alzheimer’s disease, cognitive impairment/dementia, or brain
injury. When the observations of family members and physicians were compared, agreement was
high for Alzheimer’s disease (100%) and for acute brain injury (97%). However, agreement was
lower for cognitive impairment/dementia (75%). This discrepancy for cognitive
impairment/dementia suggests that family members and physicians may understand cognitive
impairment differently. Overall, the researchers concluded that physicians and driver licensing
authorities would do well to consider family member observations when assessing fitness-todrive in older people.
The mandatory reporting law in Oregon was enacted in 2002 and requires primary physicians
and other health care providers functioning as a primary provider, to report cognitively impaired
drivers to the Department of Motor Vehicles. Reports by primary care providers result in
automatic suspensions of driving privileges, but the suspended driver has the opportunity to
request retesting and/or a hearing to appeal the suspension. A study of this Oregon law found
over 1,600 drivers reported as being cognitively impaired from 2003 to 2006, with the majority
of the reported drivers being older than 80. The most common cognitive impairments were in
judgment and problem solving, but impairments in memory and reaction time were also reported
about half the time. Of the 1,664 people reported who lost their licenses, less than 20% requested
retesting or a hearing to contest their license suspensions and only about 10% of the total number
reported and suspended (173) regained their driving privileges (Snyder & Ganzini, 2009).
Costs: Costs for establishing and publicizing effective referral procedures vary depending on the
procedures adopted, but should not be extensive. Educational and training publications are
available for use with law enforcement and medical professionals. Funds will be required to
distribute this material 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 6 months to
develop, implement, and publicize new policies and procedures.
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Chapter 7. Older Drivers
2.3 License Restrictions
Effectiveness:
Cost: $
Use: 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.
The AAAFTS “Noteworthy Initiatives” database lists Iowa, Minnesota, and Utah as having
noteworthy ongoing restricted licensing programs (AAAFTS, 2016b). Iowa offers tailored drive
tests that allow drivers to be tested in their own community on roads they would typically drive
and, if successful, these drivers are allowed to drive where they have demonstrated proficiency.
Iowa license examiners conduct approximately 100 to 150 such examinations each year. In
Minnesota, drivers who live in rural areas and only need driving privileges close to home may
arrange for road test examiners to go to the drivers’ homes. Examiners perform only about 25 of
these road tests per year, and they may result in very customized licenses such as being limited to
a specific route, specific hours of the day, or any combination of restrictions as appropriate. Utah
has a well-established and mature restricted licensing program. In 2011 the State established the
Driver Review Program to evaluate the program, including a review of the factors and processes
being used to make decisions on restricted licenses. Kansas also had a Local Drive Program to
enable restricted licensing for medically at-risk and older populations; however, the program was
terminated in 2011 (AAAFTS, 2016b). Though the program was not evaluated formally, it was
historically appreciated by the customers and program staff for having been a key safety program
enabling a segment of the population to continue living independently.
Use: Iowa, Minnesota, and Utah are known to issue restricted licenses (AAAFTS, 2016b). The
number of States currently issuing restricted licenses specifically for older drivers is not known,
but the AAAFTS “Driver Licensing Policies and Practices” database shows 49 States and the
District of Columbia can place at least some types of conditions or restrictions on licenses of
older and medically at-risk drivers (AAAFTS, 2016a). Restrictions are generally determined
using medical records or in consultation with physicians.
Effectiveness: Several studies show driver license restrictions lower the crash risk for older
drivers, though their crash risk is still higher than for similar-age drivers with unrestricted
licenses (Potts et al., 2004, Strategy C2; Vernon et al., 2001). Research conducted by Braitman et
al. (2010) found license restrictions may be an effective alternative to complete driving
cessation, and provide drivers with some degree of continued mobility and independence.
However, they also concluded, while the overall safety benefits of license restrictions may be
unknown, license restrictions tend to reduce driving exposure, especially in higher risk
situations.
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Chapter 7. Older Drivers
Langford and Koppel (2011) found imposing license restrictions were usually associated with
reductions in absolute crash rates, and identified three restrictions producing lower crash rates for
consideration. The three restrictions (driving in a specified distance of home, not driving at night,
and driving only in specified areas) can be thought of as major components of a graduated
driving reduction program.
An evaluation of the “local drive test” (LDT) option, offered to older Iowa drivers who might not
otherwise be able to renew their licenses, found the overall crash rate of LDT drivers was higher
than the general population of licensed drivers 65 and older, but was lower than the overall
driver crash rate for Iowa drivers (Stutts & Wilkins, 2012).
NHTSA published a report on the compliance of older drivers with license restrictions (Joyce et
al., 2018). The study used a combination of approaches including a literature review; a driving
evaluator panel consisting of license administrators and LEOs from Florida, Iowa, and Virginia;
an analysis of driver license and crash data from the three States and Maryland; and a field study
of driving exposure of adults 70 and older. Restrictions included daytime driving only, maximum
limit on travel speeds, and limits on geographic locations or distances traveled from home. In
Maryland the restrictions on locations and distances traveled included limits on trip purpose.
Crash rate analysis from the 4 States showed mixed outcomes. Drivers with restrictions had
lower crash rates than when they drove without restrictions in Iowa and Maryland. In Virginia
the crash rates slightly increased post-restriction. Notably, restrictions for speed and location
(geographic limits) were associated with about a 25% reduction in crash rates in Iowa, whereas
the daylight driving-only restriction was not associated with a crash rate reduction.
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.
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Chapter 7. Older Drivers
2.4 Medical Advisory Boards
Effectiveness: ✩†
† Quality varies considerably
Cost: Varies
Use: High
Time: Medium
This countermeasure involves medical advisory boards assisting licensing agencies in evaluating
people with medical conditions or functional limitations potentially affecting their ability to drive
(AAAFTS, 2016a). MABs generally make policy recommendations on what licensing actions
are appropriate for people with specific medical conditions or functional limitations.
Effectiveness Concerns: This countermeasure is widely used; however, there are no known
studies evaluating the crash relevant effects of MABs. In 2017 NHTSA published a series of
reports on studies outlining the operational benefits of having MABs. A summary of the studies
is available as a Traffic Tech report (NHTSA, 2017). See Appendix A, Section 2.4 for detailed
discussion of the reports. Further information about the known research, potential effectiveness,
costs, use, and time to implement is available in Appendix A7, Section 2.4.
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Chapter 7. Older Drivers
2.5 License Renewal Policies: In-Person Renewal, Vision Test
Effectiveness: ✩✩
Cost: $$$
Use: Medium
Time: Medium
This countermeasure involves changes to the license renewal requirements for drivers older than
a specified age, typically 65 or 70. These changes may include a shorter interval between
renewals, in-person renewal (no renewal by mail or electronically), or a vision test at every
renewal. Requirements for older renewal applicants can also involve written or road tests.
Effectiveness Concerns: Some version of this countermeasure has been implemented in more
than half the States. Its effectiveness has been examined in several research studies. Despite
some positive research findings, the balance of evidence regarding countermeasure effectiveness
remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A7, Section 2.5.
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Chapter 7. Older Drivers
3. Traffic Law Enforcement
3.1 Law Enforcement Roles
Effectiveness:
Cost: Varies
Use: Medium
Time: Varies
Enforcement plays three overall roles in improving the safety of older drivers. Law enforcement
officers:
• 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 2, Section 2.1, 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) summarizes several examples. NHTSA (2003) 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.
Use: The International Association of Directors of Law Enforcement Standards and Training
(IADLEST) has developed a training course for law enforcement instructors covering a range of
topics related to older people and driving, (www.iadlest.org/training/older-driver-lawenforcement-training). This course aims to train instructors on how to provide LEOs the
information they need to effectively interact with and evaluate older drivers. NHTSA also
provides a series of video and web-based resources to help LEOs determine signs of older driver
driving impairments. See Law Enforcement: Cite and Refer Medically Impaired Drivers
(updated in 2017) at www.youtube.com/watch?v=0aShDPSbJls&feature=youtu.be and Cues for
Law Enforcement: https://one.nhtsa.gov/people/injury/olddrive/lawcues.html.
Effectiveness: LEOs provide more than one-third of all referrals to licensing agencies for driver
screening and assessment (Stutts, 2005; see also 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.
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Chapter 7. Older Drivers
Older Driver References
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(2018, April). Older driver compliance with license restrictions (Report No. DOT HS
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Lococo, K. H., Sifrit, K. J., Stutts, J., Joyce, J. J., & Staplin, L. (2017, March). Medical review
practices for driver licensing, Volume 2: Case studies of medical referrals and licensing
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literature review (Report No. DOT HS 812 514). National Highway Traffic Safety
Administration. https://rosap.ntl.bts.gov/view/dot/35967
Lococo, K. H. Staplin, L., & Schultz, M. W. (2018, July). The effects of medical conditions on
driving performance: A literature review and synthesis (Report No. DOT HS 812 526).
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Lococo, K. H., Stutts, J., & Staplin, L. (2016, October). Medical review practices for driver
licensing, Volume 1: A case study of guidelines and processes in seven U.S. States (Report
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DOT HS 812 402). National Highway Traffic Safety Administration.
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high-risk conditions and locations. Traffic Injury Prevention, 7(2), 117-124.
McCarthy, D. P., Mann, W. C., & Lanford, D. (2009, May). Process and outcomes evaluation of
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Meuser, T. M., Carr, D. B., Irmiter, C., Schwartzberg, J. G. & Ulfarsson, G. F. (2010). The
American Medical Association older driver curriculum for health professionals: Changes
in trainee confidence, attitudes, and practice behavior. Gerontology & Geriatrics
Education, 31, 290-309.
Meuser, T. M., Carr, D. B., & Ulfarsson, G. F. (2009). Motor-vehicle crash history and licensing
outcomes for older drivers reported as medically impaired in Missouri. Accident Analysis
& Prevention, 41, 246-252.
Meuser, T.M., Carr, D.B., Unger, E.A., and Ulfarsson, G.F. (2015). Family reports of medically
impaired drivers in Missouri: Cognitive concerns and licensing outcomes. Accident
Analysis & Prevention, 74, 17-23.
Molnar, L. J. & Eby, D. W. (2008). 2008 North American license policies workshop
recommendations. AAA Foundation. https://aaafoundation.org/wpcontent/uploads/2018/02/LPWorkshopRecommendationsReport.pdf
Molnar, L.J., Eby, D.W., Zhang, L., Zanier, N., St. Louis, R. & Kostyniuk, L. (2015). SelfRegulation of Driving by Older Adults: A LongROAD Study. AAA Foundation for
Traffic Safety. https://aaafoundation.org/wpcontent/uploads/2017/12/SelfRegulationOfDrivingByOlderAdultsReport.pdf
National Center for Statistics and Analysis. (2020, April). Older population: 2018 data (Traffic
Safety Facts. Report No. DOT HS 812 928). National Highway Traffic Safety Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812928
National Highway Traffic Safety Administration. (1982, 2018). Fatality Analysis Reporting
System (FARS) [Custom data analysis]. National Highway Traffic Safety
Administration.
NHTSA. (1998). Older drivers: Cues for law enforcement (Report No. DOT HS 808 778).
www.nhtsa.dot.gov/people/injury/olddrive/cuesindex.html
NHTSA. (2003). A compendium of law enforcement older driver programs.
www.nhtsa.dot.gov/people/injury/olddrive/LawEnforcementOlderDriver03/index.htm
NHTSA. (2005). Older driver traffic safety plan (Unnumbered report).
www.nhtsa.gov/people/injury/olddrive/OlderDriverPlan/images/OlderDriverSafetyPlan.p
df
NHTSA. (2009, September). Driver fitness medical guidelines (Report No. DOT HS 811 210).
www.nhtsa.dot.gov/files/driver-fitness-medical-guidelines
NHTSA. (2010, December). Older driver program five-year strategic plan 2012-2017 (Report
No. DOT HS 811 432). www.nhtsa.gov/staticfiles/nti/pdf/811432.pdf
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Chapter 7. Older Drivers
NHTSA. (2013, December). Traffic safety for older people — 5-Year Plan (Report No. DOT HS
811 837). www.nhtsa.gov/staticfiles/nti/older_drivers/pdf/Older_People_811873.pdf
NHTSA. (2014, April). Older driver safety (Highway Safety Program Guideline No. 13. Report
No. DOT HS 812 007D).
https://tntrafficsafety.org/sites/default/files/11.%20NHTSA%20Guideline%2013.%20Old
erDriverSafety.pdf
NHTSA. (2017, April). Driver medical review practices across the United States (Traffic Safety
Facts Traffic Tech. Report No. DOT HS 812 403). https://rosap.ntl.bts.gov/view/dot/2095
NHTSA. (2020). Driver involvement rates per 100,000 licensed drivers by age, sex, and crash
severity, 2018 (Table 62). https://cdan.nhtsa.gov/tsftables/tsfar.htm#
Organisation for Economic Cooperation and Development. (2001). Ageing and transport:
Mobility needs and safety issues.
www.internationaltransportforum.org/Pub/pdf/01Ageing.pdf
Potts, I., Stutts, J., Pfefer, R., Neuman, T. R., Slack, K. L, & Hardy, K. K. (2004). A guide for
reducing collisions involving older drivers (NCHRP Report 500, Vol. 9). Transportation
Research Board. https://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_500v9.pdf
Rosenbloom, S., & Santos, R. (2014). Understanding older drivers: An examination of medical
conditions, medication use, and travel behavior. AAA Foundation for Traffic Safety.
https://aaafoundation.org/wp-content/uploads/2018/01/MedicationTravelBehaviorsReport.pdf
Snyder, K. M., & Ganzini, L. (2009). Outcomes of Oregon’s law mandating physician reporting
of impaired drivers. Journal of Geriatric Psychiatry and Neurology, 22, 161-165.
Staplin, L., & Lococo, K. H. (2003, May). Model driver screening and evaluation program. Vol.
3: Guidelines for motor vehicle administrators (Report No. DOT HS 809 581). National
Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1724
Staplin, L., Lococo, K. H., Gish, K. W., & Decina, L. E. (2003a, May). Model driver screening
and evaluation program. Vol. 1: Project summary and model program recommendations
(Report No. DOT HS 809 582). National Highway Traffic Safety Administration.
https://icsw.nhtsa.gov/people/injury/olddrive/modeldriver/volume_i.htm
Staplin, L., Lococo, K. H., Gish, K. W., & Decina, L. E. (2003b, May). Model driver screening
and evaluation program. Vol. 2: Maryland pilot older driver study (Report No. DOT HS
809 583). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/1738
Staplin, L., Lococo, K., Mastromatto, T., Gish, K. W., Golembiewski, G., & Sifrit, K. J. (2019,
January). Mild cognitive impairment and driving performance (Report No. DOT HS 812
577). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/38688
Stutts, J. C. (2005). Improving the safety of older road users (NCHRP Synthesis Project 20-5,
Synthesis Topic 35-10). Transportation Research Board.
https://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_syn_348.pdf
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Stutts, J. C., Martell, C., & Staplin, L. (2009, June). Identifying behaviors and situations
associated with increased crash risk for older drivers (Report No. DOT HS 811 093).
National Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1880
Stutts, J. C. & Wilkins, J. (2009). Driver licensing policies and practices: Gearing up for an
aging population. Project Summary Report. AAA Foundation.
https://pdfs.semanticscholar.org/350a/d8df19f51cf149f9fe45f144b3de35dd0c2e.pdf?_ga
=2.185635881.1459334143.1613484610-2079465180.1610541089
Stutts, J. C., & Wilkins, J. (2012). Keeping seniors safe and mobile: An evaluation of a local
drive test option. AAA Foundation. https://aaafoundation.org/wpcontent/uploads/2018/01/KeepingSeniorSafeReport.pdf
U.S. Department of Transportation. (2003, November). Safe mobility for a maturing society:
Challenges and opportunities. https://rosap.ntl.bts.gov/view/dot/1726
Vespa, J., Lauren M., & Armstrong, D. M. (2020). Demographic turning points for the United
States: Population projections for 2020 to 2060. Current Population Reports, 25-1144.
U.S. Census Bureau.
www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf
Vernon, D. D., Diller, E., Cook, L., Reading, J., & Dean, J. M. (2001, March). Further analysis
of drivers licensed with medical conditions in Utah (Report No. DOT HS 809 211).
National Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1703
Wang, C. C., Kosinski, C. J., Schwartzberg, J. G., & Shanklin, A. V. (2003). Physician’s guide
to assessing and counseling older drivers (Report No. DOT HS 809 647). National
Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/39100
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Chapter 8. Pedestrian Safety
8.Pedestrian Safety
Overview
In 2018 there were 6,283 pedestrians who died and approximately 75,000 were injured in traffic
crashes in the United States (NCSA, 2020). Pedestrians accounted for 17% of total traffic
fatalities and 3% of total people injured. Since 2003 there has been a gradual rise in the
proportion of total pedestrian fatalities. Of the pedestrian fatalities in 2018 (NHTSA - CRSS,
2018; NHTSA - FARS, 2018; NCSA, 2020):
• 69% of pedestrians killed were males;
• 33% of pedestrians killed had BACs of .08 g/dL or greater;
• 81% of pedestrian fatalities occurred in urban areas;
• 74% of pedestrian fatalities occurred at non-intersection locations;
• 76% of pedestrians were killed in collisions that occurred when it was dark;
• The average age of a pedestrian killed was 48; injured was 39;
• Of all motor vehicle crash fatalities among adults, 21% of those 50-54, 21% of those 5559, 22% of those 60-64, and 20% of those 65-69 were pedestrians. Adults 55-59 also had
the highest number of pedestrian fatalities (608).
• The pedestrian fatality rate among children and teens (range of 0.29-1.08 fatalities per
100,000 population for ages 0-19) was lower than the pedestrian fatality rate for all adult
age groups (range of 1.97-2.85 per 100,000 population).
• Child pedestrians 14 and younger accounted for 17% of the child motor vehicle fatalities
and an estimated 11% of all pedestrians injured in traffic crashes;
• Of all the adults 65 and older killed in motor vehicle crashes, 18% were pedestrians, including 361 pedestrians 80 years and older; and
• The highest total pedestrian injury rates by age group were those 15 to 19 and 20 to 24
(31 and 32 per 100,000 population, respectively).
Crash Trends. Until the last 5 years, average pedestrian fatalities per year had dropped over the
past 20 years, from an average of about 5,600 annually from 1991-1995 to an average of about
4,600 annually from 2009-2014. However, the percentage of pedestrian fatalities started
increasing in 2009, leading to a new trend where the number of pedestrians killed averaged 5,768
annually during the 5 most recent years (2014-2018, see figure below). In 2018 the number of
pedestrians killed was 6,283, up 3.4% from 6,075 in 2017 (NCSA, 2020), which was the highest
total since 1990. Fatality rate trends—or fatalities adjusted per number of walking trips or miles
traveled by walking—are unavailable because there is no systematically collected and consistent
measure of walking (exposure) to estimate and compare fatality rates each year. The populationbased fatality rate for pedestrians overall was 1.92 per 100,000 population, with a rate of 2.71 for
males and 1.14 for females (NCSA, 2020). Males 80+ years had the highest fatality rate (4.33)
among all age and gender groups. However, population-based rates do not fully account for
trends in amounts of walking.
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Chapter 8. Pedestrian Safety
Pedestrian Fatalities in Motor Vehicle Crashes
21.0%
18.0%
15.0%
12.0%
9.0%
6.0%
3.0%
0.0%
Percent of Total Fatalities
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
Pedestrians - Percent of Total Fatalities
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Pedestrian Fatalities
Pedestrian Fatalities
Year
Source: NCSA, 2020
The average age of pedestrians killed has remained similar over the past 10 years, increasing
from 45 to 48. As shown in the figure below, numbers of pedestrian fatalities among age groups
fluctuated over the last decade. The largest decrease occurred in the age group 10 to 15, and the
largest increase occurred in the age group 55 to 64. Not all fluctuations in pedestrian fatalities are
explained by changes in population by age group, as the population-based rates have also varied
by year. (Fatalities and fatality rates by population for age groups are available for 2018 in
NHTSA’s Traffic Safety Facts report, NCSA, 2020).
Comparing average fatalities for the range 2014-2018 to those from 2009-2013, pedestrian
fatalities decreased for the youngest age groups - less than 5, 5 to 9, 10 to 15, while all older age
groups saw increases in fatalities (see figure below). For those 55 to 64, a notable increase in
pedestrian fatalities was observed from around 674 per year to around 1,046 per year. As noted
earlier, this increase may reflect increases in population and walking among this age group;
however, not all the changes are explained by changes in population by age group, as the
population-based rates have also varied by year. (Fatalities and fatality rates by population for
age groups are available for 2018 in NHTSA’s Traffic Safety Facts report, NCSA, 2020). Older
pedestrians (generally those over 65) are more likely to die from their injuries when struck due to
the inherent fragility associated with the aging process. Factors that may increase vulnerability to
being struck for some older pedestrians include age-related physical changes that may lead to
walking more slowly; difficulty crossing the curb, difficulty judging walking speeds and
oncoming vehicle speeds, and difficulty with interactions dealing with turning vehicles at
intersections; and possible confusion about pedestrian signal phases (Dommes et al., 2012;
Holland & Hill, 2010; Coffin & Morrall, 1995).
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Average Yearly Number of Fatalities
Chapter 8. Pedestrian Safety
Average Yearly Pedestrian Fatalities, by Age
1,200
Average 2009-2013
1,000
Average 2014-2018
800
600
400
200
0
<5
5–9
10–15 16–20 21–24 25–34 35–44 45–54 55–64 65-74
75+
Age
Source: FARS data (NHTSA, 2018)
Note that different age group spans are used. The intent of the chart is to compare general trends in different age
groups, not to compare fatalities by age.
Several studies have also noted the overrepresentation of minorities, immigrants, and lowincome populations in pedestrian-vehicle crashes (Anderson et al., 2010; Chakravarthy et al.,
2012; Chen et al., 2011; Lin et al.; Murtha, 2005); however, the causes and contributing factors
of these elevated crash rates are not well understood. Some studies attribute higher minority
crashes to potential inequities in how pedestrian facilities are distributed across areas with
different socioeconomic indicators (Kravetz & Noland, 2012). Other studies have found that
lower income and minority populations have higher transit use and walking rates (or exposure)
that may help partially explain elevated crash figures (Cottrill & Thakuriah, 2010). An analysis
of pedestrian-involved traffic crashes in Florida found that among other factors, higher densities
of discount grocery and convenience stores, banks, barber shops, and fast food outlets were
associated with higher crash frequencies in areas with higher densities of low-income and
minority populations (Lin et al., 2017). Still others have postulated that social-behavioral
mechanisms and differing “safety cultures” play a role in pedestrian crashes, particularly for
recent immigrants (Chen et al., 2011).
Despite the vulnerability of these groups to pedestrian crashes, the effectiveness of
countermeasures in reaching these special populations is both unknown and challenging to
evaluate. This is due to the lack of information about pedestrian safety programs targeted to the
specific needs of low-income, minority, or immigrant populations, and because the courses or
programs targeting these groups have been unsuccessful in measuring changes in behaviors.
NHTSA developed and pilot-tested two English as a Second Language (ESL) courses to teach
basic walking and bicycling safety concepts to adult immigrants learning the English language
(see nhtsa.gov/pedestrian-safety/english-second-language-esl-teachers-and-learners). Both
courses are free for use by formal programs or less formal settings with volunteer instructors.
While NHTSA was able to evaluate the ease of use of these courses by ESL instructors and
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Chapter 8. Pedestrian Safety
found increases in pre/post knowledge for the beginning level course, it was unable to
successfully evaluate behavior changes as a result of this knowledge. A separate resource, the
Resident’s Guide for Creating Safer Communities for Walking and Biking, demonstrated for use
in communities, generated several case studies on inclusive approaches to outreach, communitybased planning, and improving conditions for pedestrians, and was part of the update to the guide
(Sandt, Thomas, et al., 2015). Finally, another challenge noted by NHTSA relates to the
translation of educational material. Among some non-English speakers living in the United
States, translating material is ineffective because they are not literate in their native languages.
This knowledge spurred NHTSA to develop visual educational tools (motion graphics) to teach
desired pedestrian behaviors, bicyclist behaviors around motorized traffic, and safe driver
behavior around pedestrians and bicyclists. The motion graphics demonstrate motions visually
without language to deliver safety education and are specifically designed for audiences that lack
English language skills or literacy in their native languages as well as visual learners.
Walking Trends. Walking trends can be used to estimate exposure. The National Household
Travel Survey (NHTS), conducted by the FHWA, captures walking and other travel trends in the
United States. According to estimates from these surveys, the number of walking trips changed
from 20.3 billion in 1995 to 33.1 billion in 2001, and to about 41 billion in 2009 (Santos et al.,
2011). It is likely that at least some of the increases in 2001 and 2009 relate to more detailed
questions prompting respondents to include walk trips in those 2 years, which was not done in
the prior surveys. The latest 2017 NHTS was conducted from April 2016 to April 2017 by
McGuckin and Fucci (2018). Major changes were made to the survey methodology including the
use of address-based sampling, a web-based survey instead of a telephone survey, and the use of
Google API to calculate trip length (see McGuckin & Fucci, 2018, and nhts.ornl.gov/ for more
details). During the 2016-2017 survey period, an estimated 39 billion walking trips were made
for all purposes (work or work-related commute, shopping and errands, school and church, social
and recreational, and other trips). The 39 billion walking trips in 2017 represent approximately
10.5% of all transportation mode trips reported. About 4% of all trips to work were made by
walking. Commuting to work, however, makes up only a small percentage (6.5%) of all walking
trips. The largest proportion of walking trips were made for recreational and social reasons
(47.5%) followed by shopping and personal errands (29.5%). McGuckin and Fucci found
walking to school or church made up nearly 10.7% of walking trips (Table 9a). The percentage
of students walking to school has also increased from 11.9% in 2007 to 15.2% in 2014 for
morning trips and from 15.2% to 18.4% for afternoon trips (National Center for Safe Routes To
School, 2016). This represents increases of 32% and 24%.
The increase in walking trips is especially significant since it represents increases in the average
number of daily walking trips per person (Pucher et al., 2011), whereas total daily personal trips
per person have been declining since the 1995 survey (Santos et al., 2011). The CDC’s National
Health Interview Survey, collected in 2005 and 2010, assessed changes in prevalence of walking
for at least 10 minutes one or more times in the preceding 7 days. Walking prevalence increased
significantly, from 55.7% in 2005 to 62.0% in 2010. In 2010 walkers were also significantly
more likely to meet the aerobic physical activity guidelines (CDC, 2012). The 2015 National
Health Interview Survey found that 63.9% of adults reported walking for at least one bout of 10
or more minutes in the preceding week (Ussery et al., 2017; NPAP, 2017). There were increases
in the prevalence of walking among adults between 2005 and 2010; however, the increase
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Chapter 8. Pedestrian Safety
plateaued from 2010 to 2015 among adults (Ussery et al., 2017). The CDC encourages walking
and bicycling to help meet physical activity guidelines. The CDC also supports building
communities that provide safe and equitable opportunities to walk such as implementing
Complete Streets policies and designs and lowering speed limits in urban areas, etc. For more
information see www.cdc.gov/nccdphp/dch/programs/communitiesputtingpreventiontowork/resources/physical_activity.htm. Also see Health Resources in Action’s web pages on
Community Speed Reduction and Public Health, www.hria.org/resources/reports/communityspeed-reduction/2013-resources-speed-reduction.html. In 2015 the Surgeon Generalreleased Step
It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities.
Visit www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/call-to-actionwalking-and-walkable-communites.pdf (see also CDC, 2017).
Classifying Crash Types. Beginning in the 1970s, pedestrian crashes were categorized into
types based on pedestrian and motor vehicle pre-crash actions, and crash location. In the early
1990s, this methodology was used to categorize more than 5,000 pedestrian crashes in
California, Florida, Maryland, Minnesota, North Carolina, and Utah and analyze related
characteristics (Hunter et al., 1996).
Of these 5,000+ pedestrian-motor vehicle crashes:
• 32% occurred at or within 50 feet of aintersections. Of these intersection crashes:
o 30% involved turning vehicles;
o 22% involved pedestrians dashing into intersections;
o 16% involved driver violations (e.g., running a red light);
o Older pedestrians were overrepresented in collisions with turning vehicles and motorist violations;
o Children were overrepresented in intersection dashes;
• 26% occurred at the middles of blocks (mid-block). Of these mid-block crashes:
o 35% involved pedestrians running into the street and the drivers’ view was not obscured.
o 17% were “dart-outs” in which pedestrians walked or ran into the street from locations where the pedestrians could not be seen.
o Children were also overrepresented in dash-and-dart-out crashes;
• 7% occurred walking along roadways, not on sidewalks. Of these crashes:
o 73% of the pedestrians were struck from behind while walking in the same direction
as traffic;
o Darkness and rural locations were overrepresented. This association is expected
since rural areas are less likely to have sidewalks and supplemental street lighting.
The Pedestrian and Bicycle Crash Analysis Tool (PBCAT) software helps jurisdictions type
pedestrian crashes to develop a database for analyzing pedestrian crash problems. Crash typing
methodology has been used to develop tools that communities or States may use to discover
more information about pedestrian and bicycle crashes. They can use crash type information and
other crash characteristics to help select appropriate countermeasures. It is important to consider
on-site field review of behaviors and site-specific characteristics before determining whether
specific enforcement, educational, or engineering countermeasures are appropriate (Zegeer et al.,
2008). Research has begun disentangling the behavioral elements included in some of the
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Chapter 8. Pedestrian Safety
PBCAT crash types (Schneider & Stefanich, 2016). The study found that pedestrian crashes were
more prevalent on the far side than the nearside of intersections, and were more likely fatal when
the impacting vehicle had been traveling straight, if they were on roads in between intersections,
and if they involved pedestrians approaching from the left of the vehicle. PBCAT may be
downloaded from www.pedbikeinfo.org/pbcat_us/. Registration is requested for this free
software, so the user may receive software updates or important technical information.
Underreporting and Crash Analysis. Another consideration when analyzing crash data is that
pedestrian as well as bicycle crashes tend to be underreported. Many States may not require
reporting nor collect off-road or private-road crash records. Non-roadway crashes may, however,
constitute a significant portion of pedestrian-related crashes with motor vehicles. In several
studies, parking lot and driveway-related crashes represented up to 15% to 25% or more of all
reported pedestrian crashes (Stutts & Hunter, 1999a; Thomas & Levitt, 2014). Many more
roadway and non-roadway crashes go unreported. Research is needed to better understand the
extent and causes of non-roadway pedestrian crashes and effective countermeasures. NHTSA’s
Not in Traffic Surveillance (NiTS) monitors and reports on not-in-traffic-related motor vehicle
deaths. Many events involve young children. See Section 1.1 for more information.
Underreporting of traffic-related crashes on road right of ways likely decreases as the crash
severity increases because police are likely to be called to injury and fatal crashes, and the
pedestrian is more likely to be transported or seek examination at a healthcare facility. Therefore,
the FARS data presented earlier are thought to be reliable sources for estimating pedestrian fatal
crash frequencies. Even so, not all fatal pedestrian crashes are included in FARS, including fatal
pedestrian crashes involving bicycles, or those that did not occur on public roads, as already
mentioned.
Many more pedestrian and bicyclist injuries, including those due to falls, collisions with
bicycles, and others, likely go unreported to State crash databases (Stutts & Hunter, 1999a,
1999b; Sciortino et al., 2005). A study of crashes reported to police and in emergency rooms
from 2003-2007 in Funen, Denmark, estimated that 44% of severe and 76% of slight pedestrian
injury crashes were not captured in police reports (Janstrup et al., 2016). Injured pedestrians may
only report to the emergency rooms when coming in for treatment without informing the police
of the crashes (Janstrup et al., 2016); this shows the need for analyzing emergency room records
in addition to police records when developing injury estimates. Research is also needed to better
understand the causes of these types of injuries. Maintenance of surfaces and Americans With
Disabilities Act-compliant design of sidewalks, landings, and access ramps are certainly
important for maintaining smooth surfaces and safe and accessible sidewalks and ramps. Other
measures, such as providing space for bicyclists to ride separated from pedestrian walkways,
may also be important but are outside the scope of this document.
Pedestrian Attributes – Everyone is a pedestrian, though when asked a person may not think of
being one until prompted. Pedestrians span the full spectrum of ages from babies pushed in
strollers to older adults. This includes foreign visitors and immigrants used to different traffic
conventions, who speak many languages, and who may not be literate in their native languages.
Pedestrians include disabled people who may be visually impaired, hearing impaired or deaf, or
may require devices like walkers, wheelchairs, or crutches. More generally, we are all
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Chapter 8. Pedestrian Safety
pedestrians when we walk our dogs, cross the street to talk to neighbors, go to the store, go to
school, or walk to or from the bus stop.
Crash Factors – A large body of historical research has established numerous factors associated
with pedestrian crashes. Pedestrian and driver pre-crash actions and behaviors (such as
distraction, driver speed, and alcohol use, and vehicle type and design) all contribute to
pedestrian crashes. Crash factors are not mutually exclusive and in many ways, have
compounding effects on pedestrian risk. More details about these factors are discussed below.
Several studies have provided evidence of the role of the transportation environment in
pedestrian safety and summarized best practices in engineering and design for pedestrian safety
(FHWA, 2010; Redmon, 2011; Retting et al., 2003). Complete Streets (also known as Livable
Streets) policies are one of the more low-cost and effective countermeasures, as evidenced by
numerous cities and States across the United States (FHWA, 2010). For more on Complete
Streets, visit www.smartgrowthamerica.org/complete-streets/. Also, search for a program in your
State or city. Vision Zero is another large program that aims to reduce pedestrian fatalities
through a focus on engineering changes and speed management (Kim et al., 2017).
Distraction – Cell phones and electronic devices are sources of distraction, not only for
motorists (discussed in Chapter 4), but also for pedestrians. A literature review from NHTSA
found that, based on the limited amount of research done on pedestrian distraction, distraction is
associated with a small but statistically significant decrease in pedestrian safety (Scopatz &
Zhou, 2016). Talking on cell phones is associated with cognitive distraction that may reduce the
frequency of prudent pedestrian behaviors, particularly among college-age pedestrians who may
be more engaged with such devices (Hatfield & Murphy, 2007; Nasar et al., 2008; Ortiz et al.,
2017; Stavrinos et al., 2009, 2011); however, the results from real-world observational studies
are mixed (Walker et al., 2012; Thompson et al., 2013). A study of road user distraction at four
intersections in Washington, DC, found that of the 4,871 people observed, the primary form of
distraction was engaging with other people for both pedestrians (44%) and drivers (49%) (Ortiz
et al., 2017). More than a quarter (27%) of all people observed were distracted by cell phone use.
The prevalence of distraction among pedestrians was higher than for drivers: pedestrians had 1.5
increased odds of being distracted. Thompson et al. (2013) sampled pedestrian behaviors at 20
high-risk intersections and reported that only pedestrians who were texting were associated with
suboptimal crossing behaviors. Ortiz et al. (2017) reported that the majority of interactions (20 of
21 or 95%) between distracted pedestrians and distracted drivers resulted in some form of
evasive maneuver by either.
These studies report 7% to 30% of pedestrians using varyious portable electronic devices.
Nationally representative estimates on use of portable electronic devices are unavailable, but
would likely only capture a snapshot in time, as device use continues to grow in popularity.
FARS/GES data on pedestrian device use or involvement in pedestrian crashes are unavailable at
the national level.
Driver speed – Driving speed is a key risk factor in severe pedestrian crashes. The study by
Rosen and Sander (2009) is believed to be one of the more robust in terms of estimating the risk
of pedestrian fatality based on driver impact speeds. The study estimated fatality risk curves
based on driver impact speeds, ranging from 8% at 50 km/h (31 mph) and reaching 50% at 75
km/h (about 47 mph). Other studies have estimated similar relationships, although the magnitude
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Chapter 8. Pedestrian Safety
varies (Leaf & Preusser, 1999; Tefft, 2011). As pedestrians are particularly vulnerable to severe
injury and fatality when struck by higher-speed vehicles, countermeasures aimed at reducing
vehicle speeds have the potential to save lives for both pedestrians and drivers. Driving speed
also appears to affect the tendency for drivers to yield to pedestrians at crosswalks, with fewer
drivers yielding as speeds increase (Bertulis & Dulaski, 2014; Gårder, 2004). Speeding-related
countermeasures are presented in Chapter 3.
Risk of severe injury (left) and death (right) in relation to impact speed in a sample of 422 pedestrians 15+ years struck by
a single forward-moving car or light truck model year 1989–1999, United States, 1994–1998. Risks are adjusted for
pedestrian age, height, weight, body mass index, and type of striking vehicle, and standardized to the distribution of pedestrian
age and type of striking vehicle for pedestrians struck in the United States in years 2007–2009. Dotted lines represent pointwise
95% confidence intervals. Serious injury is defined as AIS score of 4 or greater and includes death irrespective of AIS score.
Source: Tefft (2011)
Alcohol – The role of alcohol in pedestrian crashes has not been well defined, based on the lack
of complete and high-quality data on alcohol use or BACs of drivers and pedestrians involved in
crashes. Driver or pedestrian alcohol use is estimated to be a contributing factor in 48% of
pedestrian fatalities (NCSA, 2020). Thirty-three percent of pedestrians killed in crashes had
BACs of .08 or higher, while 16% of fatal pedestrian crashes had drivers with BACs of .08 or
higher. From 1982 to 2014 the proportion of fatally injured pedestrians with BACs of .08 or
higher decreased at a lesser rate than fatally injured passenger drivers with BACs of .08 or higher
(Eichelberger et al., 2018). One recent study of alcohol outlet density and pedestrian safety in
Baltimore found that each additional off-premise alcohol outlet was associated with a 12.3%
increase in the risk of pedestrian injuries in the neighborhood, and an attributable risk of 4.9%
(Nesoff et al., 2018). Alcohol-related countermeasures that may help address certain pedestrian
crashes are presented in Chapter 1.
Vehicle Type and Design - Previous studies have focused on the role of vehicle type, design,
and warning systems in the event of crashes (Searson & Anderson, 2011), and in the ability of
pedestrians and even vehicle technology to detect and prevent crashes (Fredriksson et al., 2011;
Greene et al., 2011). A study of pedestrian, bicyclist, and motorcyclist collisions with reversing
cars conducted in Germany found that pedestrians were seriously injured in 9.1% of all such
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Chapter 8. Pedestrian Safety
crashes from 1999 to 2012 (Decker et al., 2016). Of the crashes for which impact zone data were
available, impact with the rear of the car was the most frequent (81%), followed by impact with
the side (18%). Backup cameras in vehicles can help prevent these crashes with reversing cars.
See www.nhtsa.gov/equipment/driver-assistance-technologies for descriptions of in-vehicle
driver assistance technologies. Another issue in the literature, as hybrid and electric vehicles
constitute larger portions of the vehicle fleet, is the consequence of “quiet” vehicles on
pedestrian safety, particularly among pedestrians with visual disabilities who rely more on
auditory cues to detect traffic (Garay-Vega et al., 2011).
Engineering and Roadway Design. While not dismissing the importance of vehicle design and
the role of the built environment in preventing pedestrian crashes, the countermeasures described
in this guide relate primarily to educational and enforcement measures aimed at improving the
knowledge and behaviors of road users to prevent crashes. However, there is a growing
recognition of the importance of road design and the built environment in fostering safer user
behaviors. A comprehensive approach that uses a combination of effective engineering,
enforcement, and educational measures may have the best chance of achieving desired crash
reductions. U.S. DOT released a national pedestrian safety action plan summary focusing
significant attention on the built environment research and countermeasures (2014). Key
infrastructure resources are included in the Resources section.
Emerging Technologies or Emerging Vehicle Technologies. Further, emerging research is
exploring whether vehicle technologies known as Pedestrian Crash Avoidance/Mitigation
(PCAM) systems show promise in reducing motor vehicle-pedestrian crashes (Yanagisawa et al.,
2014; Yanagisawa et al., 2017). Current testing is largely limited to a research environment
involving light vehicles and measuring the systems' capabilities to detect a pedestrian in the road
ahead. The systems may alert drivers, automatically brake, or take other measures to prevent
crashes with pedestrians. An increasingly relevant issue is the emergence of connected and
automated vehicles, and research is required to investigate their safety and equity impacts on
pedestrians and walkability (Shay et al., 2018). A small-scale crowdsourced survey reported that
study participants perceived higher safety for pedestrians with automated vehicles (Deb et al.,
2017); however, Millard-Ball argues that pedestrians may adapt to safety benefits offered by
automated vehicles and expect the same from interactions with non-automated vehicles (MillardBall, 2018).
Safety in Numbers. Finally, the idea that vulnerable road user safety may be improved by
increasing the numbers of pedestrians and bicyclists is gaining traction and empirical support
(Elvik & Bjørnskau, 2017; Elvik & Goel, 2019; Jacobsen et al., 2015). As numbers of
pedestrians increase, drivers should expect to see more pedestrians and thus become more
attentive to them. This effect has been found to be consistent when analyzing data from
communities of varying sizes and population scales (Jacobsen et al., 2015). A 2009 scanning tour
by U.S. transportation officials and researchers of Denmark, Sweden, Germany, Switzerland, and
the United Kingdom reported that the concept of “safety in numbers” has motivated the
promotion of more bicycling and walking in these countries as a safety countermeasure (Fischer
et al., 2010). However, encouragement in these countries is done in the context of commitments
to comprehensive planning, funding, engineering, and design and maintenance policies to
provide safe and connected pedestrian networks. The scan report also documents numerous
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Chapter 8. Pedestrian Safety
examples of how these policies are put into practice through traffic calming, traffic and parking
management, enforcement, education and other systemic approaches. Research from abroad as
well as the United States finds that, although the actual number of crashes may go up with
increases in walking (and bicycling) with increased exposure, individual risk of crashes with
motor vehicles (crash rate) is lower as numbers of pedestrians and bicyclists increase (Alliance
for Biking and Walking, 2014; Geyer et al., 2006; Jacobsen, 2003: Jacobsen et al., 2015; Leden
et al., 2000). The European countries mentioned above are also committed to reducing the total
numbers of pedestrian fatalities and injuries while increasing walking and bicycling. Many
European countries have adopted “toward zero deaths” safety philosophies (for more information
see - https://ec.europa.eu/transport/road_safety/home_en). In the United States, the “Vision
Zero” initiative primarily targets local jurisdictions to get them to adopt speed-management
policies and roadway design practices that encourage driving at speeds that are less likely to
result in serious injuries or fatalities. As of mid-2018, more than 30 cities had adopted policies
from this initiative (Vision Zero Network, 2018).
A non-linear relationship between traffic volumes (motorist, pedestrian, or bicyclist) and crashes
has long been demonstrated (AASHTO, 2010; Bhatia & Wier, 2011; Elvik & Bjørnskau, 2017),
but a causal mechanism for how increased volumes improve pedestrian safety has not been
demonstrated (Bhatia & Wier, 2011). This means that crashes do not tend to increase in direct
proportion to increases in volume, but absolute crash numbers are still likely to increase (and
have increased) with increases in walking – all else being equal. Additionally, all the studies
cited above, and others attempting to characterize pedestrian safety relationships, are based on
cross-sectional comparisons. There are frequently safety factors such as motorist speed,
congestion, or law enforcement activity that are unmeasured or have not been accounted for in
such studies. However, a recent meta-analysis of motorist-pedestrian or motorist-bicyclist injury
crashes accounted for some of the similarities among factors included in previous studies and
estimated that there is safety in numbers for both pedestrians and bicyclists (Elvik & Bjørnskau,
2017). By their estimate, if the number of pedestrians or cyclists doubles (100% increase), the
increase in accidents is expected to be 41%, which is much less than direct proportionality. A
subsequent expanded meta-analysis determined that the safety in numbers effect may be much
stronger for pedestrians than cyclists, and at the macro level (cities) than the micro-level, such as
an individual junction (Elvik & Goel, 2019).
One issue that makes the direct application of the safety in numbers findings difficult is that the
cross-sectional studies cannot demonstrate the direction of effect – that is, whether a safer
environment comes before the increased number of crashes or as a result (Bhatia & Wier, 2011).
Impaired pedestrians also contribute to the overall safety problem; however, more research is
needed about this issue in general, in addition to a better understanding of how laws and
education can mitigate risks posed by impaired pedestrians. It is clear, however, that a focus on
improving the environment, both infrastructure and road users’ compliance with laws and safe
behaviors, is important to increasing both population-level safety (measured as a reduction in
population-wide fatalities and injuries) and numbers of pedestrians or amounts of walking. As
these two elements – safety improvements and increases in walking – go together, individual risk
will also be reduced.
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Chapter 8. Pedestrian Safety
Strategies to Increase Pedestrian Safety
Countermeasures in this chapter are primarily aimed at improving safety behaviors of pedestrians
and drivers through education and enforcement measures, and are organized by pedestrian sub
groups:
• Preschool-age children;
• School-age children;
• Alcohol-impaired pedestrians; and
• All pedestrians.
The final section contains countermeasures that may affect all groups of pedestrians as well as
drivers. Additional information about countermeasures involving a comprehensive approach to
improving pedestrian (and bicycle) safety is provided in NHTSA’s Advancing Pedestrian and
Bicyclist Safety: A Primer for Highway Safety Professionals (Brookshire et al., 2016).
Basic countermeasure principles include addressing those issues identified specifically through
problem identification at the community level. Common themes include:
• Reducing vehicle speed, which allows pedestrians and drivers more time to react and
reduces impact forces if crashes do occur.
• Conducting speed enforcement, especially at high risk crash locations (for
pedestrian/motorist interactions).
• Reducing exposure to known risky situations through behavioral and environmental
countermeasures (without necessarily discouraging walking).
• Increasing enforcement of pedestrian-friendly laws addressing behaviors of both
pedestrians and motorists.
• Increasing the conspicuity of pedestrians and/or encouraging walking in areas of
enhanced lighting for road crossing.
• Reducing distracted walking or driving behaviors (cell phones, headphones, etc.). See the
chapter on distracted and drowsy driving for countermeasures targeting drivers.
• Decreasing walking or driving while impaired. See the chapter on strategies to reduce
alcohol-impaired driving. Some of the countermeasures would be applicable to address
any type of impaired roadway use.
• Educating motorists and pedestrians on required safety behaviors related to specific laws
to enhance safe interaction between motorists and pedestrians on the roadway.
• Tailoring countermeasures to diverse populations, including groups such as recent
immigrants who may not be familiar with U.S. traffic laws, the U.S. traffic environment,
may not speak or read English, or may not be literate in their native language.
Select countermeasures to address particular problems identified in communities or common to a
high-risk group in a community, such as middle aged or older adults, the homeless, or children of
varying ages. Remember to base the selected groups on the data. Tailoring may be needed to
address diverse populations, such as recent immigrants who may not be familiar with U.S. traffic
laws, the U.S. traffic environment, may not speak or read English, or be literate in their native
language.
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Chapter 8. Pedestrian Safety
Resources
The agencies and organizations listed below can provide more information on comprehensive
pedestrian safety issues and countermeasures, and links to numerous other resources.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
National Highway Traffic Safety Administration:
o Pedestrians – www.nhtsa.gov/road-safety/pedestrian-safety
o Research and Evaluation – www.nhtsa.gov/research-data
o Behavioral Safety Research Reports – https://rosap.ntl.bts.gov
Pedestrian and Bicycle Information Center (PBIC): www.pedbikeinfo.org – a national
information center funded by FHWA and NHTSA.
Federal Highway Administration: www.fhwa.dot.gov/
o Office of Planning, Environment, & Realty (Pedestrian and Bicycle Program) –
www.fhwa.dot.gov/environment/bicycle_pedestrian/
o Safety Office, Pedestrian and Bicycle Safety – http://safety.fhwa.dot.gov/ped_bike/
o Federal Highway Administration Research and Technology, Coordinating,
Developing, and Delivering Highway Transportation Innovations, Pedestrian and
Bicyclist Safety – www.fhwa.dot.gov/research/topics/safety/pedbike/
o Federal Highway Administration Division Office State Bicycle and Pedestrian
Coordinators:
www.fhwa.dot.gov/environment/bicycle_pedestrian/state_fhwa_contacts.cfm
o State Bicycle and Pedestrian Coordinators:
www.fhwa.dot.gov/environment/bicycle_pedestrian/state_contacts.cfm
Governors Highway Safety Association: www.ghsa.org/issues/bicyclists-pedestrians
National Center for Safe Routes to School: www.saferoutesinfo.org
Smart Growth America – National Complete Streets Coalition: www.smartgrowthamerica.org/complete-streets
SAFE KIDS Worldwide: www.safekids.org/
Safe Routes to School National Partnership: www.saferoutespartnership.org
Safe States Alliance: www.safestates.org
United States Access Board: www.access-board.gov
National Center for Bicycling and Walking: www.bikewalk.org
America Walks: www.americawalks.org
Association of Pedestrian and Bicycle Professionals: www.apbp.org
Vision Zero Network: www.visionzeronetwork.org
Several specific resources that provide further information on engineering, enforcement, and
educational strategies are:
• Pedestrian Safety Enforcement Operation: A How-to Guide:
www.nhtsa.gov/staticfiles/nti/pdf/812059PedestrianSafetyEnforceOperaHowToGuide.pdf
• Uniform Guidelines for State Highway Safety Programs: Highway Safety Program
Guideline No. 14: Pedestrian and Bicycle Safety:
https://one.nhtsa.gov/nhtsa/whatsup/tea21/tea21programs/pages/PedBikeSafety.htm
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Chapter 8. Pedestrian Safety
•
•
•
•
•
•
•
Pedestrian Safety Training for Law Enforcement: www.nhtsa.gov/pedestrian-safety/pedestrian-safety-training-law-enforcement
Identifying Countermeasure Strategies to Increase Safety of Older Pedestrians:
www.nhtsa.gov/staticfiles/nti/pdf/811799.pdf
NHTSA Motion Graphics:
o Walking Safety –
www.nhtsa.gov/links/PedMotionGraphics/PedMotionWalkingSafely.zip
o Driving Safely Around Pedestrians and Bicyclists www.trafficsafetymarketing.gov/get-materials/pedestrian-safety/everyone-pedestrian
Pedestrian Safer Journey: Skills for Safe Walking for Ages 5 to 18 www.pedbikeinfo.org/pedsaferjourney/
PEDSAFE: Pedestrian Safety Guide and Countermeasure Selection System: www.pedbikesafe.org/PEDSAFE/
How to Develop a Pedestrian and Bicycle Safety Action Plan:
https://safety.fhwa.dot.gov/ped_bike/ped_focus/docs/fhwasa17050.pdf
Safer People, Safer Streets: Summary of U.S. Department of Transportation Action Plan
to Increase Walking and Biking and Reduce Pedestrian and Bicyclist Fatalities:
www.dot.gov/sites/dot.gov/files/docs/safer_people_safer_streets_summary_doc_acc_v111-9.pdf
Resources released or updated since the last Countermeasures That Work update:
• U.S. DOT: Safety for All Users: Report Developed by the U.S. DOT under Section 1442
of the Fixing America’s Surface Transportation (FAST) Act: FHWA, 2017: www.transportation.gov/sites/dot.gov/files/docs/mission/safety/303201/safety-all-users-report.pdf
• FHWA: Accessible Shared Streets: Notable Practices and Considerations for Accommodating Pedestrians with Vision Disabilities: www.fhwa.dot.gov/environment/bicycle_pedestrian/publications/accessible_shared_streets/fhwahep17096.pdf
• FHWA: Strategic Agenda for Pedestrian and Bicycle Transportation:
www.fhwa.dot.gov/environment/bicycle_pedestrian/publications/strategic_agenda/fhwahep16086.pdf
• PBIC: The Role of Law Enforcement in Supporting Pedestrian and Bicycle Safety: An
Idea Book: https://rosap.ntl.bts.gov/view/dot/49827
• PBIC: An Overview of Automated Enforcement Systems and Their Potential for Improving Pedestrian and Bicyclist Safety: www.pedbikeinfo.org/cms/downloads/WhitePaper_AutomatedSafetyEnforcement_PBIC.pdf
• Safe Routes to School National Partnership: Engaging Students with Disabilities in Safe
Routes to School: www.saferoutespartnership.org/sites/default/files/resource_files/engaging_students_with_disabilities_in_srts_final.pdf
• The League of American Bicyclists. Bicycling and Walking in the United States: 2018,
Benchmarking Report: https://bikeleague.org/benchmarking-report
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Chapter 8. Pedestrian Safety
Pedestrian Safety Countermeasures
Countermeasures to improve pedestrian safety are listed in the table below. The table is intended
to provide a rough estimate of each countermeasure’s effectiveness, use, cost, and time required
for implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
Countermeasures that receive
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each pedestrian safety countermeasure is discussed individually in this chapter. Full descriptions
are included for , and countermeasures. Brief descriptions
are included for ✩ and ✩✩ countermeasures. Further details about the
countermeasures are included in Appendix A8 to this report.
✩ and ✩✩
1. Preschool-Age Children
Countermeasure
1.1 Children’s Safety Clubs
1.2 Child Supervision
Effectiveness
✩
✩
8-14
Cost
Use
Time
Varies
Unknown
Unknown
$
Unknown
Short
Chapter 8. Pedestrian Safety
2. School-Age Children
Countermeasure
Effectiveness
2.1 Elementary-Age Child Pedestrian Training
2.2 Safe Routes to School
2.3 Walking School Buses
2.4 Child School Bus Training
Cost
Use
Time
$
Unknown
Short
$
High
Short
$
Low
Short
$
High
Short
Cost
Use
Time
Varies
Low
Medium
$$
Low
Medium
Cost
Use
Time
$$$
Low
Medium
$
High
Varies
$
Low
Medium
$$
Low
Short
$
Low
Medium
$$
Unknown
Medium
$
High
Medium
✩✩
3. Impaired Pedestrians
Countermeasure
3.1 Communications and Outreach Addressing
Impaired Pedestrians
3.2 “Sweeper” Patrols of Impaired Pedestrians
Effectiveness
✩✩
✩
4. All Pedestrians
Countermeasure
Effectiveness
4.1 Pedestrian Safety Zones
4.2 Reduce and Enforce Speed Limits
4.3 Conspicuity Enhancement
4.4 Enforcement Strategies
4.5 Driver Training
4.6 Pedestrian Gap Acceptance Training
4.7 University Educational Campaign
✩
✩
✩
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how
effectiveness is measured.
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Chapter 8. Pedestrian Safety
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy
demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 8. Pedestrian Safety
1. Preschool-Age Children
1.1 Children’s Safety Clubs
Effectiveness: ✩
Cost: Varies
Use: Unknown
Time: Unknown
This countermeasure involves sponsoring safety clubs in which parents/caregivers can enroll
their children as young as age three. Children then regularly receive books or other print or electronic media that provide instruction to both the child and parents about safe walking practices.
A primary purpose of children’s safety clubs is to help parents and caregivers become more involved in educating young children about safe walking practices. An equally important objective
of safety clubs is for parents and other caregivers to recognize children’s limits and capabilities,
and to understand their obligation to provide adequate supervision and control (Gregersen & Nolen, 1994).
Effectiveness Concerns: This countermeasure has been examined in a small number of research
studies. The research suggests that this countermeasure does not translate into crash and injury
reductions.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 1.1.
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Chapter 8. Pedestrian Safety
1.2 Child Supervision
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
The primary purpose of this countermeasure is to increase caregiver supervision of children
when they are exposed to traffic, or when they are nearby direct access to traffic. The State can
require such training 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,
faith-based organizations or places of worship, medical providers, or even direct mail or internet
access.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 1.2.
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Chapter 8. Pedestrian Safety
2. School-Age Children
2.1 Elementary-Age Child Pedestrian Training
Effectiveness:
Cost: $
Use: Unknown
Time: Short
Elementary school pedestrian training equips school-age children with knowledge and practice to
enable them to walk safely in environments with traffic and other safety hazards. NHTSA and
the States have developed elementary school pedestrian training programs over the years.
NHTSA’s “Willy Whistle” pedestrian safety videos were updated to “Stop and Look and Listen
with Willy Whistle” (2008) for grades K-2, emphasizing to look left-right-left before crossing.
“Getting There Safely” (2014) for grades 3 to 6 emphasizes critical thinking with walking around
traffic. Both videos are best used in conjunction with some discussion allowing for
questions/answers and clarification. The Willy Whistle video is available at
www.youtube.com/watch?v=-idpfcP6bY4 and Getting There Safely at
www.youtube.com/watch?v=ATyNXDMvBuE.
WalkSafe, a program adapted from many earlier resources, was implemented initially as a 5-day
program in a high-risk district in Miami-Dade County, Florida, and later as a 3-day program in
all 220 Miami-Dade County elementary schools as part of a comprehensive effort to address
pedestrian crashes in the county (Zegeer, Blomberg, et al., 2008).
In 2011 NHTSA produced a Child Pedestrian Safety Curriculum for elementary school students
along with an instructor guide (see www.nhtsa.gov/pedestrian-safety/child-pedestrian-safetycurriculum). The curriculum includes five lesson plans for each grade group, K-1, 2-3, and 4-5,
with developmentally appropriate lessons and messages that also address standards of learning,
caregiver tip sheets, skills practice exercises, and student tests to evaluate knowledge change.
The curriculum was pilot-tested in schools when it was developed. Thomas, Blomberg, and
Korbelak (2017) detail its formal evaluation.
School-based programs are useful to teach basic pedestrian concepts and safe behaviors at
schools, faith-based settings, and other institutions with groups of elementary-age children.
Pedestrian safety programs are especially important for children such as those from lowerincome families and neighborhoods, or those who may be more likely to make risky decisions
and are less able to control their behavior (Barton & Schwebel, 2007). A study from Australia
identified younger ages, and attentional and developmental issues including hyperactivity and
inattentiveness as factors in unsafe road-crossing decisions by children. Children who had some
independent walking experience were less likely to make incorrect decisions (Congiu et al.,
2008).
Other resources that may be used independently or in a group setting include an online, videotraining resource, Pedestrian Safer Journey, developed for the FHWA. This resource provides
video-based training modules for child pedestrians 5 to 9, 10 to 14, and 15 to 18; teachers’
material including discussion guides. This information is available on the PBIC website at
www.pedbikeinfo.org/pedsaferjourney/index.html. In addition, the National Center for Safe
Routes to School hosts extensive educational resources including Teaching Children to Walk
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Chapter 8. Pedestrian Safety
Safely as They Grow and Develop: A Guide for Parents and Caregivers, with learning objectives
and tips for caregivers of children 4 and older. This resource can be found at
http://guide.saferoutesinfo.org/graduated_walking/index.cfm. Other resources and tips for
educators, parents, drivers, children, and even neighbors are available at
www.pedbikeinfo.org/resources/pbic_resources.cfm.
Resources are also available to help parents become role models and provide on-going practice
and positive reinforcement. As mentioned in Section 1.1 on preschool age children, NHTSA has
several brochures to educate parents and caregivers on child pedestrian safety, including
Preventing Pedestrian Crashes: Parents and Caregivers of Preschool Children and Elementary
School Children (www.nhtsa.gov/document/pedestrian-crashes). Safe Kids Worldwide also has
tips for caregivers and links to other resources (www.safekids.org/walkingsafelytips).
Use: Unknown. Information has been available for years, and distributed widely, but not
necessarily as part of a systematic or national program. In addition, much material and resources
have been updated to new technologies and formats such as interactive internet resources and
video trainings. With schools being called on for a wider variety of services and narrower set of
teaching requirements, finding time to add child traffic safety modules may be difficult. Newer
technologies and information formats may help expand the reach of training information. Some
States are adapting existing curriculum or developing curriculum to meet their State’s Standards
of Learning; this allows teachers to use pedestrian (and bicycle) educational material to correlate
with meeting the establish minimum expectations for what students should know and be able to
do at the end of each grade or course in English, mathematics, science, history/social science and
other subjects.
Effectiveness: Child pedestrian training programs have been shown to increase knowledge.
Long-lasting behavior improvements may be harder to achieve. Evaluations of 5-day and 3-day
WalkSafe programs in the Miami school district that used videos, formal curricula, workbooks,
and outside simulation activities on an imaginary road on school grounds showed improvements
in safety knowledge compared to before, although no control group was used in the evaluation.
Improvements were more consistent for grades K-3 than for 4 and 5. Actual in-traffic behaviors
were also reportedly improved in the short term, but did not hold up at 3 months after the
program and no comparison group was used (Hotz et al., 2004; Hotz et al., 2009). In a study of
the longer-term impacts of the WalkSafe program, knowledge and behavior of more than 1,500
students receiving a one-time per year WalkSafe instruction were evaluated over 2 years
(Livingston et al., 2011). While short- and intermediate-term knowledge retention was observed
among all grades, long-term (i.e., more than a year) knowledge retention of pedestrian safety
behaviors were observed only among children moving from 3rd to 4th grade. Knowledge change
did not appear to result in improved pedestrian behaviors. The authors concluded that repetition
and reinforcement may be needed for long-term knowledge and behavior change, as well as
engagement by caregivers. The North Carolina DOT adapted NHTSA’s child pedestrian safety
curriculum and launched the pedestrian bicycle safety program, “Let’s GO NC!” An examination
of the effectiveness of the program showed that the program increased students’ self-reported
pedestrian knowledge and supervised crossing behaviors in simulated street crossing situations
(Thomas et al., 2017). Older students (Grade 3-5) showed greater improvements in knowledge
and behavior compared to younger students (Grade K-2).
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Chapter 8. Pedestrian Safety
Another study by Gates et al. (2010) also indicates the importance of repetition in school-based
trainings. In a study of 930 students in grades 2 to 7 in Detroit, pedestrian safety training was
provided once and then again seven to 12 months later. Measures of safety violations gathered by
observing street-crossing behaviors before and after the trainings, as well as knowledge change
based on pre/post tests were collected. After the initial training, both test scores and observed
behaviors improved, but were only partially sustained. Once retraining occurred, there were
increases in test scores, and the cumulative difference (after initial training and retraining) was
consistently larger than the impact of initial training alone for both test scores and observational
behavioral measures. One trial suggested that video-based training may be an effective method
for conveying knowledge and appropriate behaviors (Arbogast et al., 2014), although neither
before (baseline) nor long-term behavioral observations were conducted. Another study
suggested that virtual and roadside training are more effective than videos for improving
behaviors (Schwebel, McClure, & Severson, 2014), but more research is needed. Reach,
feasibility, and cost are also factors to consider.
Barton et al. (2007) reported that children crossed a road more safely immediately following a
brief pedestrian safety training that included instruction followed by practice crossings on a
pretend road. Schwebel et al. (2016) implemented street-crossing training for children 7 and 8
over a 3-week period. The training involved six sessions of 45 crossings in a virtual pedestrian
environment, and subsequent evaluation showed that the training decreased unsafe crossing and
departure delays, while increasing their observation of traffic compared to baseline preintervention performance. In the United Kingdom, a combination of adult-led training and peer
discussions for children 5 to 8 led to improved roadside search skills (Tolmie et al., 2005). In a
small study of mostly middle-class preschool children, Albert and Dolgin (2010) also reported
that 4- and 5-year-olds trained by adults in groups of 3 or 4 using a “playmat” model retained
real-world behavioral (street crossing choices) improvement 6 months later compared to peers
trained using two other less interactive methods or who received no training. According to the
authors, the success of this treatment may lie in the opportunities for peer collaboration and
corrective feedback from the adult trainers.
Thus, numerous studies suggest that knowledge and behaviors of young children may be
improved through education and training programs, but that behavior in real-world traffic
situations is more likely to be modified if the program incorporates interactive training with
opportunities for practice and positive reinforcement (Percer, 2009). Effectiveness of schoolbased child pedestrian training would also likely be enhanced if it combined child training with
emphasis to teachers, parents, and other caregivers on the limits of children and the need for
careful supervision, particularly for those younger than 10 years (see Section 1.2).
Costs: NHTSA publications are free for download, and can be distributed at low expense.
Time to implement: Short, once a decision is made by a school district to offer such a program.
Time is needed to review the recommended material, work it into the school’s existing
curriculum, and train teachers. The training needs to be repeatedly implemented to sustain
effectiveness.
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Other issues:
• A consensus from reviews is that practical training—that is, learning by doing with
reinforcement of correct behaviors—is the most effective way for children to learn traffic
safety skills (Bruce & McGrath, 2005; Dragutinovic & Twisk, 2006; Percer, 2009). The
need for experiential learning is especially key for younger children who lack the
capacity to generalize concepts and need to practice in environments with real objects
that are as close as possible to those they will experience (Dragutinovic & Twisk, 2006).
Although it can be done with adult supervision, real-world practice may be difficult to
achieve with large groups of school children and without undue exposure to traffic risks.
• Classroom education may be enhanced by using outdoor simulation, three-dimensional
models, games, or other interactive learning methods such as with computer games and
models, particularly in adult-led and small-group activities. These methods do not replace
real-world practice but evidence from a few studies suggests that interactive training with
opportunities for feedback, correction, and practice (more than one session) may lead to
more lasting behavior improvements (Tolmie et al., 2005; Albert & Dolgin, 2009).
• Hammond et al. (2014) found that trainers often modified the training from
recommended best practices in a program (“Kerbcraft”) developed to provide roadside
training for 5- to 7-year-olds in the United Kingdom. This deviation seems to have been
toward conserving resources by conducting shorter trainings and introducing more
classroom elements than the program recommended. It isn’t clear, however, if the
adaptations diminish effectiveness, but that is certainly a risk since the modifications
have not been evaluated. The other possible implication is that the longer, all-roadside
training may not be practical for consistent implementation (Hammond et al., 2014). It is
important that whenever programs are modified, however, that the changed program is
also evaluated to ensure continued effectiveness.
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Chapter 8. Pedestrian Safety
2.2 Safe Routes to School
Effectiveness:
Cost: $
Use: High
Time: Short
From 2009 to 2018 there were 1,207 people killed in school-transportation-related crashes—an
average of 1,214 fatalities per year (NHTSA - FARS, 2009-2018). During that period 100
school-age pedestrians younger than 19 died in school-transportation-related crashes.
The goal of Safe Routes to School Programs (SRTS) is to increase the amount of walking and
bicycling trips to and from school while simultaneously improving safety for children walking or
bicycling to school. SRTS programs are community-based and intended to be comprehensive.
Programs educate children, school personnel, parents, community members, and LEOs about
safe walking and bicycling behavior and safe driving behavior around pedestrians and bicyclists.
In addition, programs include enforcement and engineering activities to improve traffic safety
and reduce or eliminate risky elements of the traffic environment around primary and secondary
schools so children can safely walk or bicycle to school. Walking or biking to school has
additional benefits to students’ health. Studies have found an association between active
transport to school and lower BMIs as well as higher performance on standardized tests (Active
Living Research, 2015).
The CDC has identified SRTS programs as one of eight non-clinical, context-based, communitywide interventions that have the potential to improve population health. See CDC’s Health
Impact in 5 Years (HI-5) strategies for health transformation at
www.cdc.gov/policy/hst/hi5/index.html.
From 2005 to mid-2012 SAFETEA-LU required each State to have its own SRTS program,
including a full-time coordinator to manage Federal funds. Each year, Federal funding was
allocated on infrastructure (engineering) improvements and on non-infrastructure projects
(public awareness and outreach, enforcement near schools, education, and training for
volunteers) to encourage walking and bicycling to school. In June 2012 new legislation, MAP21, was enacted that significantly altered how SRTS and other pedestrian and bicycle programs
are structured and funded. Under MAP-21, SRTS was no longer a standalone program (no new
funding); however, SRTS projects were still eligible to compete for funding alongside other
bicycle and pedestrian-related programs, including former Transportation Enhancements and
Recreational Trails projects.
Under the Fixing America’s Surface Transportation (FAST) Act (signed in 2015 and authorized
until 2020), as part of the Surface Transportation Program Set-Aside funds, States can determine
their own funding priorities. The total available STPS funds are expected to be from $819
million to $850 million per year through 2020. Few changes were made to the funding, but most
features of MAP-21 have been retained. Local communities and school systems can apply for the
Federal STPS funds through the State DOTs, but local and State agencies have to provide up to
20% in matching funds for project costs. To learn more, visit www.fhwa.dot.gov/fastact/ and
www.saferoutespartnership.org/healthy-communities/policy-change/federal/FAST-actbackground-resources.
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For a brief history of the SRTS program including funding, see
www.saferoutespartnership.org/safe-routes-school/101/history.
Use: With the establishment of the national SRTS program, all 50 States and the District of
Columbia initiated SRTS programs. From July to September 2016, four out of 37 reporting
States announced $7 million in MAP-21 funding for local and statewide SRTS projects, 2 States
announced $1.9 million in SAFETEA-LU funding for local and statewide SRTS projects, and 1
State announced $5.3 million in FAST Act funding. Additionally, as of January 31, 2017, $1.06
billion out of the $1.147 billion in SAFETEA-LU funds apportioned to local and statewide SRTS
programs had been allocated. At that time 19,378 schools, representing an estimated 7.6 million
students, had received funding or were slated to receive funds for SRTS programs. Historically,
approximately 68% of award recipients were classified as Title 1 (low-income) schools, a finding
that is relevant because areas with lower median income are over-represented in bicyclist- and
pedestrian-related crashes (McArthur et al., 2014).
Of the projects funded, 48% included infrastructure improvements, such as sidewalk
improvements (20%), pedestrian and bicyclist access (15%), and traffic calming improvements
(13%). In addition, 10% of projects funded were related to law enforcement countermeasures.
About 19.5% of all elementary and middle schools have had SRTS programming in the past 10
years. To learn more, visit www.fhwa.dot.gov/MAP21/. From 2005 to 2012 nearly 14,000
schools received SRTS funding (Active Living Research, 2015). See Chapter 9, Section 1.2 for
more information.
Effectiveness: SRTS efforts include a 3E approach to pedestrian and bicycle safety addressing
engineering, education, and enforcement (programs can also include encouragement, evaluation,
environment, engagement, and equity considerations). SRTS programs including education and
training can be effective in teaching children and their parents how to evaluate and choose the
safest routes for walking or bicycling to and from school, what safe behaviors are associated with
walking and biking, and instilling the need to practice and model safe behaviors when walking,
biking or driving around children walking/biking to school, how to use common engineering
treatments to enhance their safety (sidewalks, crosswalks), the need to adhere to crossing guard
direction, and to abide by traffic laws, especially in and around school zones. See Section 2.1
(Elementary-Age Child Pedestrian Training), Section 4.2 (Reduce and Enforce Speed Limits),
and 4.4 (Enforcement Strategies). Safety is a key concern in the decision to participate in SRTS
and associated programs (Safe Routes to School Partnership, n.d.). Traffic speeds and volume
along the route to school, safety when crossing intersections, and prevalence of crime were
reported as safety-related factors influencing child participation in walking or biking to school,
according to one survey conducted in Florida (Zhou et al., 2009). Improvements to the road
infrastructure with traffic calming measures, improved walking and biking facilities, policies to
support active transportation, and community engagement and mobilization are key to addressing
safety concerns.
A growing body of evidence suggests SRTS programs are effective in reducing injuries. Overall
safety improvements have been demonstrated for SRTS programs in regional studies (NCSRTS
& FHWA, 2015). One study found a 60% decrease in the number of pedestrians involved in car
crashes after the implementation of SRTS in Miami-Dade County. Similarly, school-aged injury
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rates in New York City decreased by 44% in census tracts with SRTS interventions relative to
those without interventions (NCSRTS & FHWA, 2015). Child pedestrian and bicyclist injuries in
Texas decreased 43% (NCSRTS & FHWA, 2016). In Washington, DC, the effectiveness of
school crossing guards was examined using data from 20 schools (Robey et al., 2018). Crash
reduction and traffic safety statistics during the morning before school time period were
compared before and after the deployment of crossing guards. Results showed a 25% decrease in
all crash types, a 38% decrease in injuries, and a 23% decrease in pedestrian-/cyclist-involved
crashes. Another study (DiMaggio et al., 2016) reported a 13% decline in pedestrian and
bicyclist fatality risk in 18 U.S. States. When the effectiveness assessment of SRTS was
extended to nationwide, SRTS was associated with a 14-16% decline in pedestrian and bicyclist
injury risk.
Although the full SRTS program emphasizes a comprehensive education, enforcement, and
engineering approach, some specific implementations have centered on site-appropriate
engineering changes; results have shown behavioral improvements for pedestrians, bicyclists,
and motorists (Britt et al., 1995). However, a study by the NCSRTS found that schools that were
able to increase the percentage of students walking or bicycling to school were more likely to
have leaders in the schools to promote SRTS, frequent events to reinforce walking or biking to
school, strong parental support, and supportive policies (NCSRTS & FHWA, 2015).
Data for 130 legacy SRTS programs initiated before the national program were evaluated to
ascertain safety effects (Blomberg et al., 2008). Declining trends in school-age child pedestrian
and bicycle crashes during school trip times were found for both SRTS focus sites and nonSRTS sites in the same States. Either no decrease or inconsistent patterns were found for other
ages. The results suggested that the programs at least did not cause any adverse safety effects on
total crash numbers although exposure data were lacking to know whether the amounts of biking
and walking had changed. If children were walking and biking at higher rates in SRTS locations
than in other areas, or the programs resulted in positive spillover effects to other areas, the
programs may have reduced crash rates, although data were insufficient to test this. A later study
of 801 schools found that engineering improvements were associated with an 18% increase in the
percentage of students walking or biking to school, regardless of when the improvements were
made (McDonald et al., 2014).
Education and encouragement programs were associated with a 5% increase per year in the
percentage of children walking or biking to school. This increase was cumulative, so a school
could expect to see a 25% increase over 5 years from education and encouragement efforts. In
contrast, enforcement efforts were not associated with a significant change (McDonald et al.,
2014). A detailed analysis of a specific SRTS implementation in Maryland found that using a
combination of education, enforcement, and engineering programs resulted in a 79% decrease in
the number of collisions within a quarter mile of targeted SRTS areas over the first 5 years of the
program (Dunckel et al., 2014).
A 2013 study attempted to assess the safety effects of New York City’s SRTS program. Results
were encouraging, but again, not conclusively so. The study compared school-aged pedestrian
injury rates (by population) for traffic injuries that occurred during typical school travel times for
census areas that had SRTS interventions compared to rates in areas with no such treatments
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Chapter 8. Pedestrian Safety
(DiMaggio & Li, 2013). Census tracts that covered 30 schools with either short-term
interventions (apparently low-cost engineering measures such as signs and crosswalk markings)
or completed capital infrastructure improvement projects were included in the SRTS group.
Although study design limitations preclude a conclusion that SRTS treatments were responsible,
the trends were encouraging. Injury rates in census tract areas with SRTS treatments fell
substantially compared to non-intervention areas, where injury levels remained virtually
unchanged. Since schools were chosen for treatment because of high crash rates, it is likely that
some of the crash reductions observed were due to a natural tendency for crashes to return
toward an “average” level (known as regression toward the mean). A separate cost analysis study
found that New York City’s SRTS program was cost effective when analyzed over just one
cohort of intersection users (yielding an estimated savings of $224 million), and even more
effective over the course of many years (Muenning et al., 2014). The authors concluded that
SRTS programs can remain effective for decades, because of the engineering component.
Costs: Education and encouragement associated with SRTS may be low cost and may also be
eligible for grant funding through the State, and perhaps other sources. Activities formerly
eligible under Federal SR2S funding are now eligible under the TAP program outlined in MAP
21, but funding priorities are established by each State. State contacts may be located on the Safe
Routes Partnership website (www.saferoutespartnership.org/safe-routes-school/srtsprogram/state-contacts), or search individual States’ DOT websites for information about TAP
and SR2S funding. Material and resources can be accessed at no cost. NCSRTS provides
downloadable material for State and local SRTS programs.
Time to implement: Once the school or district has decided to implement an SRTS program, a
range of material, including an on-line step-by-step guide on getting started, is available from
NCSRTS. Programs funded through State DOTs typically require applications on a funding
cycle and can take significantly longer to implement.
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Chapter 8. Pedestrian Safety
2.3 Walking School Buses
Effectiveness:
Cost: $
Use: Low
Time: Short
“Walking school buses” use volunteer adults, usually parents, to walk a group of students on a
specific route to and from school, collecting or dropping off children on the way. Walking school
buses have fixed routes, pick-up and drop-off times, and stops (CDC, 2019). The CDC
recommends one adult for every six children in the group; however, twice as many adults may be
needed to supervise younger children.
A recent focus group study in the United Kingdom revealed six factors that influenced parents’
decision-making about walking school buses (Nikitas et al., 2019). Safety was a major concern,
and included concerns about road safety (e.g., crossing intersections, speeding vehicles) and
stranger danger (e.g., unfamiliar chaperones). Other concerns included uncertainties about
logistics, health (e.g., air pollution), emotional needs (e.g., spending time with child when taking
them to school), trust (e.g., trust in chaperone, trust in child to behave responsibly), and
education (e.g., child may not be well aware of road dangers).
Active involvement from communities, schools, and State policy-makers are central to the
development and maintenance of walking school bus programs (Turner et al. 2013; Pérez-Martín
et al., 2018). Particularly, the presence of programs such as safe routes to school and school
crossing guards, is associated with increased school-organized walking school buses (Turner et
al., 2013). Promotional activities such as educational campaigns and policies supporting a
comprehensive agenda towards increasing active transport to schools are prerequisites to
effective walking school bus programs (Yang et al., 2014). The National Center for Safe Routes
to School and PedNet released a primer and training material to help communities plan and
launch a walking school bus program, identify community partners, and secure program funding.
Information is available at http://apps.saferoutesinfo.org/training/walking_school_bus/modules.cfm/. See also www.walkingschoolbus.org/resources.html for additional resources.
Use: One study of U.S. elementary schools found that from 2008 to 2010 the percentage of
schools organizing walking school buses increased 48%, increasing from 4.2% to 6.2% (Turner
et al., 2013). As of September 2019 the total extent of the use of walking school buses is
unknown; but many localities have active programs, including programs in Apex, NC, Seattle,
WA, and El Monte, CA (visit www.saferoutespartnership.org/blog/its-match-how-walk-us-elmonte-adapted-walking-school-bus-program-fit-their-community and
www.seattle.gov/Documents/Departments/SDOT/SRTS/StartingASafeRoutestoSchoolCampaign
.pdf for more information).
Effectiveness: In a study of fourth grade students from eight low-income schools in Houston,
Texas, researchers examined the impact of walking school buses on several pedestrian behaviors
(Mendoza et al., 2012). Researchers found these students were five times more likely to cross at
the intersection or crosswalk (rather than midblock locations) as opposed to children at schools
without walking school buses. An evaluation of a walking school bus program in Seattle found a
modest increase in most student safety crossing behaviors after the implementation of the
program, but safe crossing behaviors remained low overall (Johnston et al., 2006).
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A pilot study of walking school buses was conducted in Spain (Pérez-Martín et al., 2018). Fiftyfive children participated in this 13-week pilot, and were each assigned to one of three routes.
Parents could monitor real-time information of the walking school bus on a mobile app. Postpilot, more than 43% of the participants were found to have partially or completely changed their
mode of school transportation from automobile to walking.
Costs: Walking school buses could cost as little as $500 per school year (PedNet Coalition,
2014).
Time to implement: Walking school buses could be improved with support from local or State
policies, and promotional activities. Once these are in place, planning and implementing the
program could take 3 months (Moening et al., 2016).
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Chapter 8. Pedestrian Safety
2.4 Child School Bus Training
Effectiveness: ✩✩
Cost: $
Use: High
Time: Short
The purpose of school bus training for children is to teach school-age children how to safely
approach, board, disembark, and walk away from school buses. Basic training for children who
ride school buses is provided as part of the normal school routine. Additionally, education about
safety behaviors of parents in school zones and around school buses can be reinforced as part of
Back to School night, in school bulletins, or other creative means. NHTSA also has a refresher
training module for school bus drivers.
Effectiveness Concerns: There are no evaluation studies showing reductions in crashes or
injuries. These outcomes are difficult to demonstrate because minimal, basic training is very
widespread and the choice to adopt a stronger curriculum would be confounded with any
number of other factors.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 2.4.
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Chapter 8. Pedestrian Safety
3. Impaired Pedestrians
3.1 Impaired Pedestrians: Communications and Outreach
Effectiveness: ✩✩
Cost: Varies
Use: Low
Time: Medium
Communications and outreach to reduce impaired-pedestrian crashes can be directed at a variety
of audiences, including law enforcement, drivers, alcohol servers and vendors, civic and
neighborhood leaders, faith-based communities, universities, and friends and family of likely
impaired pedestrians. Impaired pedestrians are also a target audience, of course. However, they
are viewed as a difficult audience for communications and outreach to have a meaningful effect
on their behavior because their decision-making is compromised.
Effectiveness Concerns: There are insufficient evaluation data available to conclude that the
countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 3.1.
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Chapter 8. Pedestrian Safety
3.2 “Sweeper” Patrols of Impaired Pedestrians
Effectiveness: ✩
Cost: Varies
Use: Low
Time: Medium
The purpose of this countermeasure is to keep alcohol-impaired pedestrians off the streets until
they no longer have high BACs. This measure is intended to reduce the exposure of these at-risk
pedestrians to traffic, and can also address other social issues such as public intoxication and
crime. One approach involves police “sweeper” squads and “support on call” programs involving
taxis and trained escorts to get intoxicated people home or to a detoxification center.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 3.2.
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Chapter 8. Pedestrian Safety
4. All Pedestrians
4.1 Pedestrian Safety Zones
Effectiveness:
Cost: $$$
Use: Low
Time: Medium
The pedestrian safety zone concept was developed in a joint effort study by NHTSA and FHWA
(Blomberg & Cleven, 1998). The idea is to strive for large decreases in pedestrian crashes and
injuries by more effectively targeting resources to problem areas. Specifically, the objective of
pedestrian safety zones is to increase cost-effectiveness of interventions by targeting education,
enforcement, and engineering measures to geographic areas and audiences where significant
portions of the pedestrian crash problem exist (NHTSA, 2008). Pedestrian zone programs can
target a full range of pedestrian crash problems in a limited geographic area or focus on
particular types of problems that make up a large portion of the problem in a limited area.
Blomberg and Cleven (1998) implemented and analyzed an early pedestrian safety zone program
in Phoenix, Arizona. Crash data were analyzed to identify areas where older pedestrian crashes
occurred and “zones” were drawn around the high-incidence areas. Countermeasures were
developed for the kinds of crashes that involved older pedestrians. The measures included
lengthening the signal timing to allow more time for older pedestrians to cross the street,
providing communications and outreach to both drivers and pedestrians living near the crash
zones, and enhanced enforcement. The result was a significant reduction in crashes and injuries
involving older pedestrians in the target areas.
In a Miami-Dade County comprehensive application of the safety zone strategy, high crash zones
were identified, and then the characteristics of those crashes were further analyzed in the zones
(Zegeer, Blomberg, et al., 2008). The four zones, comprising less than 1% of the total land area
of the County, accounted for about 20% of the total number of collisions (Zegeer, Henderson, et
al., 2008). Further analyses identified high child involvement in crashes in some areas, young
adult involvement in others (particularly at night), and older adult involvement in certain
corridors. Overall, there was an 8.5% to 13.3% reduction in pedestrian crash rates during and
following the program implementation compared to control groups (Zegeer, Blomberg, et al.,
2008).
Montgomery County, Maryland, reduced crashes in high incidence areas using a combination of
education, enforcement, and engineering measures (Dunckel et al., 2014). After 3 years of the
program, crashes in 10 high-incidence areas fell by 43% and countywide pedestrian crashes fell
by 7%, with a 38% decrease in pedestrian fatalities.
Smart Street NJ is a pedestrian safety campaign conducted in two phases (2013 and 2016) across
nine communities in New Jersey. A combination of education and enforcement were used to
decrease road user violations of pedestrian safety laws. An evaluation of pre- and post- behaviors
of pedestrians and drivers was conducted using three proxy measures of pedestrian compliance
with crossing/crosswalk signs and signals, driver yielding/stopping at red or stop signs, and
drivers yielding to pedestrians during green signals (Gonzales, 2017). While the study found
mixed results across the communities’ overall, compliance with pedestrian safety laws improved
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in urban locations over suburban locations, and particularly at intersections. The program is still
under active research.
Use: Pedestrian zone programs are known to 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 & Cleven, 1998), for
impaired pedestrians (Blomberg & Cleven, 2000), and for child and adult pedestrian crashes in
Miami-Dade County (Zegeer, Blomberg, et al., 2008; Zegeer, Henderson, et al., 2008) and in
decreasing pedestrian fatalities (Dunckel et al., 2014).
Costs: 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 countermeasures can be implemented. More comprehensive
programs, such as in Miami-Dade, may be years-long programs involving data analysis and onsite evaluations, lining up partners, and identifying, implementing, and evaluating
countermeasures. Programs to date have included local task forces, usually assembled for the
program, to take critical leadership roles.
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Chapter 8. Pedestrian Safety
4.2 Reduce and Enforce Speed Limits
Effectiveness:
Cost: $
Use: High
Time: Varies
The goal of reducing motorist travel speeds is to increase reaction time for both drivers and
pedestrians to avoid crashes, as well as reduce the severity of pedestrian injuries when these
crashes occur. Higher vehicle speeds produce more frequent and more serious pedestrian crashes
and casualties, as evidenced by several studies (Leaf & Preusser, 1999; Rosen & Sander, 2009;
Tefft, 2011). The Rosen and Sander (2009) study estimated fatality risk curves based on driver
impact speeds, ranging from 8% at 50 km/h (31 mph) and reaching 50% at 75 km/h (about 47
mph).
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. However, even 1-2
mph reductions in average speed are estimated to yield substantial fatal and injury crash
reductions over all, with higher percentage reductions on streets with lower initial speeds
(AASHTO, 2010, Table 3E-2; and see Chapter 3). Speed affects pedestrian injury severity to an
even greater degree, as mentioned above and earlier in the chapter, and consequently also affects
pedestrians’ perceptions of whether it is safe to walk. For maximum effectiveness, speed limit
reductions need to be accompanied by communications and outreach that inform the public and
make the case for the speed reduction, and by heightened, visible enforcement (Leaf & Preusser,
1999). Some reasons that travel speeds do not decrease by the same proportion as speed limit
reductions, include drivers not noticing the new speed limit, drivers not understanding the safety
reasons to reduce speed, drivers speeding out of habit, or continuing to keep up with the speeds
maintained by other drivers. Speed limit reductions need to be made compelling through
communications strategies (framing the problem), appropriate engineering changes such as road
diets (typically modifying a four-lane roadway to three lanes, with the middle lane becoming a
turn lane), traffic calming, and roundabouts, and by speed enforcement (including by automated
means). On roads intended for higher speeds, measures that separate pedestrians from traffic as
they travel along the road (on sidewalks), or cross the road (such as median refuges and signals
like pedestrian walk signals or leading pedestrian intervals, that provide pedestrians opportunities
to cross) should be provided and are also keys to safer environments (Howard et al., 2008). For
more on speeding-related issues and countermeasures, see Chapter 3. Combinations of these
measures can improve road safety and are increasingly used as part of the Vision Zero initiative
in many cities in the United States (Kim et al., 2017; Vision Zero Network, 2018).
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 be accomplished with relatively modest engineering changes and expense. As mentioned
above, “road diets,” a proven safety measure, may be a low-cost way to reduce a “big, wide”
street that suggests high speeds to drivers and also provide more space for pedestrians, bicyclists,
or on-street parking. (For more information, see www.pedbikeinfo.org/cms/downloads/WhitePaper_RoadDiets_PBIC.pdf for a review of road diets and safety effects and FHWA’s
Road Diet Informational Guide, www.safety.fhwa.dot.gov/road_diets/guidance/info_guide. As
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Chapter 8. Pedestrian Safety
of January 2018 many cities including Boston, New York, Seattle, and Portland, have
implemented the Vision Zero framework to improve pedestrian safety and survival chances by
lowering speed limits on roads with a high frequency of multimodal traffic (Vision Zero
Network, 2018).
If speed limits are routinely ignored, then enforcing speed limits may be a more effective
strategy than attempting to change them. Blomberg and Cleven (2006) reported 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. One attempt to scale up a similar program to a
large city (Philadelphia) met with challenges in garnering community involvement and
increasing enforcement due to a State restriction on using radar to enforce speeds, and seemed to
have limited success in reducing injuries (Blomberg et al., 2012). However, speed reductions
were observed on 17 of 24 corridors, six of which had pavement treatments simulating traffic
calming devices. Although no pedestrian crash reductions were observed in the police districts
with the program compared to those without, pedestrian crashes were too small in number to
achieve measurable effects. For more information, see Chapter 3, Sections 1.1, 2.2, and 4.1.
Use: High, in the sense that all public roads have a speed limit and speed limit enforcement is
widely employed.
Effectiveness: Reduced speed limits with enforcement can reduce vehicle speeds and all types of
crashes and crash severity. The association of pedestrian injury with speed trends strongly
suggests that pedestrian injuries and crashes will be reduced if travel speeds are reduced. This
association is currently being examined by communities that lowered citywide speed limits. In
January 2017 Boston lowered speed limits on city streets to 25 mph from 30 mph. The speed
reductions were heavily publicized on traditional and social media (Hu & Cicchino, 2020). An
analysis of vehicle speeds during September to November 2017 found statistically significant
reductions of 2.9%, 8.5%, and 29.3% in the odds of vehicles exceeding 25 mph, 30 mph, and 35
mph on the city streets. The effect of enforcement was not studied in this analysis; however, the
city had installed speed limit and speed feedback signs at certain locations (Hu & Cicchino,
2020).
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 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.
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 that
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justify the lower limits. Also, speed limit changes can be more effective if there is citizen
buy-in, which involves a clear understanding of the reasons for the change.
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4.3 Conspicuity Enhancement
Effectiveness:
Cost: $
Use: Low
Time: Medium
Enhancing conspicuity for pedestrians increases opportunity for drivers to see and avoid
pedestrians, particularly when it is dark, since this is when 75% of pedestrian fatalities occur
nationally (NHTSA, 2020). Pedestrians who are more visible are less likely to be struck. A
comprehensive review performed by Tyrrell et al. (2016) describes research methods and
findings from over 124 publications that have quantified the effect of visual factors on perceiving
pedestrians at night. This review describes the aspects of night vision that limit the conspicuity
of pedestrians based on twilight and nighttime settings, poor retroreflective markings, headlight
beam ranges, and visual impairment. This literature summarizes visual challenges at night and
provides evidence of human efficacy to detect pedestrians due to a natural visual sensitivity to
perceive biological motion. Based on the research reviewed, conspicuity is greatly enhanced at
night regardless of any visual clutter when pedestrians are in motion and use retroreflective
clothing, especially on their extremities. This summary emphasizes the importance of enhancing
educational interventions to raise awareness for pedestrians of visual risks at night due to the
visual conditions, and it suggests directing future research towards promoting the use of wearing
retroreflective garments.
Retroreflective materials that reflect light are built into many shoes, including children’s and
athletic shoes. Other accessories such as arm or leg bands, gloves, vests, and caps are available
from sporting goods stores and other vendors. 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. Due to the extra step and the appearance of the conspicuity enhancements not
looking like “normal” clothing, they are very much underused. Pedestrians also tend to
overestimate their own visibility, wrongly assuming if they can see vehicles, vehicles must see
them (Karsch et al., 2012). See also Chapter 9, Section 3.1 on bicyclist conspicuity measures for
more information. Bright colors and fluorescent clothing may also help to improve daytime
conspicuity for pedestrians in some environments, but most research has focused on bicyclists
and there may be differences in effectiveness for these groups. Adding electroluminescent (EL)
garments to other retroreflective clothing improves pedestrian conspicuity at night. A nighttime
on-road evaluation found that the addition of EL garments resulted in vehicles reacting sooner to
pedestrians farther outside the vehicle’s headlight light beam (Fekety et al., 2016). Increasing
pedestrian's visibility with retroreflective and EL garments provided the greatest benefits to
pedestrians in situations when vehicles are approaching pedestrians from a curve or when
vehicles’ head lights are turned off.
Nearly 14% of pedestrian fatalities in 2018 involved pedestrians who were not visible – dark
clothing, no lighting, etc. (NHTSA, 2020). There are opportunities for improving pedestrian
conspicuity. NHTSA’s child education program includes information about conspicuity
messages targeting different age groups. (See www.nhtsa.gov/pedestrian-safety/child-pedestriansafety-curriculum.) Other educational efforts should include a focus on being visible at night and
in the daytime and making use of the conspicuity aids described in this section. Devices designed
to be semi-permanently fastened to children’s clothing can be provided to parents through
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schools, group activities, or health care providers. Light sticks and reflective bands can be
supplied with new cars, or distributed by automobile clubs or insurance companies for use during
vehicle breakdowns or emergencies. In these cases, drivers become pedestrians in potentially
vulnerable locations on the roadside (e.g., changing a flat tire), where other drivers may not
expect them. Thus, pairing visibility devices with the vehicle provides a way for these
unintentional pedestrians to remain visible regardless of their level of preparation.
Use: Retroreflective materials are used regularly in athletic-type shoes, occasionally in
backpacks and jackets, and minimally in other clothing.
Effectiveness: Widespread use of retroreflective materials would increase the ability of drivers
to detect pedestrians at night in time to avoid crashes. Pedestrians wearing good retroreflective
materials, particularly materials that highlight a person’s shape and moving extremities (i.e.,
wrists and ankles), or widespread use of active (flashing) lights can be detected hundreds of feet
farther than can pedestrians in normal clothing, even with low-beam illumination (Koo & Huang,
2015; Karsch et al., 2012; Zegeer et al., 2004, Strategy B5). A study in a controlled (closed road)
environment also validated that pedestrians are detected more readily when they wear reflective
elements on their moving body parts rather than attached to the torso (Tyrrell et al., 2009).
Costs: The cost to provide retroreflective materials is low, if such supplementary materials are
distributed in quantity and added to existing programs. Such items as reflective wrist and ankle
bands are available commercially. To develop new programs promoting use of conspicuity
materials would require somewhat more planning and start-up time and costs would also depend
on communications strategies used.
Time to implement: Promoting increased conspicuity may require development of targeted
messages and a publicity strategy.
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Chapter 8. Pedestrian Safety
4.4 Enforcement Strategies
Effectiveness:
Cost: $$
Use: Low
Time: Short
The purpose of enforcement strategies is to increase compliance with the pedestrian and motorist
traffic laws that are most likely to enhance the safety of pedestrians in areas where crashes are
happening or most likely to happen due to increased pedestrian and motorist exposure.
Behavioral pedestrian safety initiatives require improvements in unsafe driver and pedestrian
behaviors. Once pedestrians and drivers are informed of the behavior changes needed and why
they are important, enforcement often is necessary to encourage compliance for the same reasons
found with seatbelt use, etc. Although enforcement was implied or stated for many earlier
countermeasures, enforcement strategies and targeted enforcement deserve additional discussion
in relation to pedestrian safety. Many enforcement or crosswalk operations use plainclothes
officers to act as pedestrians crossing the street, typically with one or two uniformed officers
observing for violations and another giving warnings or writing citations (NHTSA, 2014).
Traffic enforcement is most effective when it is highly visible and publicized, to reinforce the
required behavior and to raise the expectation that failure to comply may result in legal
consequences. Enforcement campaigns should be aimed at drivers and pedestrians, starting with
the communications and outreach that announce, describe, and publicize the traffic safety
campaign through community meetings, media coverage, social media, mass emails, and signage
(NHTSA, 2014).
A coordinated program of targeted enforcement should involve a range of support, such as
communications and outreach to notify the public of the campaign, training LEOs on
enforcement procedures and pedestrian and crosswalk laws, and educating prosecutors and
judges so they understand the purposes of the campaign and are prepared for the increase in
citations enforcement will produce (NHTSA, 2014). Training for prosecutors and judges can
help build the case for enforcement of traffic laws and planned enforcement operations with
appropriate follow-up throughout the judicial system. A pilot study in North Carolina found that
once prosecution that was more stringent was publicized, the court case load did not increase as
feared, because more drivers paid their citations automatically (Hunter et al., 2001).
NHTSA’s web-based law enforcement training course teaches law enforcement personnel the
basics of pedestrian safety and targeted enforcement techniques and is available from the
International Association of Directors of Law Enforcement Standards and Training (IADLEST),
an international organization of training managers and executives dedicated to the improvement
of public safety personnel. IADLEST serves as the national forum of Peace Officer Standards
and Training (POST) agencies, boards, and commissions as well as statewide training academies
throughout the United States. Training officers or individual officers wishing to access the
training, can submit a request for access: www.nhtsa.gov/pedestrian-safety/pedestrian-safetytraining-law-enforcement. This resource will be updated in the coming years to include new
pedestrian laws and engineering countermeasures to assist officers’ understanding of how
engineering, education, and enforcement play a vital role in pedestrian safety enforcement. Note
this training is national in scope, so common themes and laws are addressed. Officers must look
to their own States for specific laws. Some States are offering quick training and resources to
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Chapter 8. Pedestrian Safety
supplement the NHTSA course with a State specific focus through bulletins, on-line, group inperson, or on the job training. As part of their Alert Today, Alive Tomorrow pedestrian safety
campaign in Florida, for example, officers may sign up for overtime pedestrian crosswalk
enforcement. However, they first must provide documentation that they have taken NHTSA’s
web-based training (referenced above) and watched both their State specific Pedestrian Safety
Roll Call for Law Enforcement (YouTube) and the Cycling Safety Roll Call for Law
Enforcement (YouTube), each approximately 15 minutes.
A targeted North Carolina program called “Watch for Me NC” is aimed at increasing pedestrian
and bicyclist safety by reducing their crash risk (Sandt et al., 2016). The campaign includes
tailored safety messages directed towards pedestrian, bicyclists, and drivers, and HVE of traffic
safety laws. As part of the campaign 118 police officers in North Carolina attended one-day
workshops on pedestrian safety. In a pre-post test evaluation, officers who participated scored
24% higher on knowledge surveys about pedestrians and driver yielding laws after taking the
workshop (Sandt, LaJeuness, et al., 2015). Only 14% of participating officers reported having
taken a pedestrian and bicycle law course before. NHTSA’s Pedestrian Safety Enforcement
Operations: How-To Guide (2014) offers LEAs a resource for setting up staged crosswalk
enforcement operations (see www.nhtsa.gov/sites/nhtsa.dot.gov/files/812059pedestriansafetyenforceoperahowtoguide.pdf). An FHWA report summarizes information on the
Watch for Me NC campaign for consideration by other States (see
www.fhwa.dot.gov/publications/publicroads/17sept/06.cfm).
Use: Low. Enforcement is largely a local option, and often is integrated into other police duties,
so special enforcement efforts are difficult to isolate and track. However, the use of targeted
pedestrian safety enforcement is on the rise. Several localities (including Chicago, Detroit,
Miami, Pinellas County, Florida and Raleigh/Durham, North Carolina) and States such as New
Jersey and New Mexico have, in the past few years, implemented training for LEOs and
conducted targeted enforcement efforts for pedestrian safety. The Watch for Me NC campaign
and another Florida enforcement program in Gainesville have been evaluated and are described
below.
Effectiveness: Enforcement strategies and targeted enforcement can be employed for a wide
range of purposes in a wide range of circumstances, so effectiveness is context-dependent. As
reported above, the Watch for Me NC campaign’s training course increased police officers’
knowledge and capacity for enforcement operations. An evaluation of the first-year activities
found that enforcement efforts were noteworthy; however, there was still room for improvement
in drivers’ yielding behaviors. Pre-post enforcement evaluations showed that drivers’ yielding
behaviors were modestly improved only in areas with the highest enforcement, while yielding
behaviors in other areas did not change. Though not conclusive due to limited data, the study
also found that pedestrian crossing violations may have decreased by 24% during the first year of
implementation (Sandt et al., 2016).
Similarly, a before/after study with a comparison group examined the effects of sustained,
enhanced HVE of motorist yielding to pedestrians, combined with publicity and other
community outreach in Gainesville (e.g., flyers given to stopped drivers, information sent home
with school children, roadside feedback signs, and earned and paid media) (Van Houten,
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Chapter 8. Pedestrian Safety
Malenfant, Blomberg, et al., 2013; Van Houten, Malenfant, Huitema, & Blomberg, 2013). Driver
yielding rose throughout the 1-year study period that included four, 2-week waves of
enforcement, along with the other activities. Four of the six enforcement sites observed
significant increases in yielding at the end of the period with a fifth experiencing a positive trend.
Only one location, on a university campus with an already high baseline rate of yielding, did not
observe an increase. Yielding also increased at the comparison sites, although not by the same
degree. Driver awareness of the enforcement, especially awareness of the enforcement-related
feedback signs, also increased to a high level from 13% at baseline to 78% at the end of the year.
A follow-up study 4 years after the HVE program ended found that yielding behavior actually
increased at both the enforcement and comparison sites after the program had ceased despite
there being no additional enforcement efforts (Van Houten et al., 2017). This suggests that there
was a sustained change in the driving culture of the area. Earlier, Van Houten and Malenfant
(2004) had found more modest increases in driver yielding to pedestrians in response to a single
wave of targeted police enforcement at crosswalks on two corridors in Miami Beach. Warnings
and educational flyers were handed out to most violators, while citations were issued for flagrant
violations. Some publicity also resulted from the enforcement efforts. The yielding reductions
are promising, but effects on crashes and injuries were undetermined as pedestrian crashes are
relatively infrequent events.
In a NHTSA study by Savolainen et al. (2011), law enforcement officials in Detroit implemented
two pedestrian-oriented enforcement campaigns at Wayne State University aiming to educate
campus pedestrians on proper use of crosswalks and the importance of obeying signals through
the issuance of warnings. The study saw pedestrian violations (walking outside the crosswalk or
against the signal) reduced between 17% and 27% immediately after the campaign, with
sustained reductions of between 8% and 10% several weeks after active enforcement ceased.
Study authors noted that pedestrian compliance was also heavily associated with the presence,
quality, and location of pedestrian facilities (including pedestrian signals, bus stops, crosswalks,
and convenient crossing opportunities).
Costs: The cost of the enforcement is a direct function of the size of the effort, the amount of
enforcement, and associated supplies, ranging from vehicle operating costs to equipment such as
speed measurement devices or alcohol test machines. If overtime is used to increase
enforcement, costs would be higher. Free or low-cost training of enforcement officers on data
driven focused efforts at the local level, can enhance both the cost and time spent to educate and
enforce those laws and pedestrian and motorist behaviors most likely to influence serious injury
or fatalities to pedestrians.
Time to implement: Short. Law enforcement resources can be diverted to targeted enforcement
very quickly. However, special training to ensure safe and consistent crosswalk enforcement
operations may be needed, and periodic data analysis conducted to ensure potential high crash
locations are targeted for safety behaviors that influence the safety of pedestrians, including
speed and distraction. Developing a plan that coordinates law changes, environmental changes,
or support communications and outreach with enforcement can take longer. Communications and
outreach are keys to maximal effectiveness.
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Chapter 8. Pedestrian Safety
4.5 Driver Training
Effectiveness: ✩
Cost: $
Use: Low
Time: Medium
The purpose of pedestrian safety-related driver training is to increase the sensitivity of drivers to
the presence of pedestrians and their shared responsibility as drivers to prevent crashes and
enhance the safety of all road users, including pedestrians. Specifications for driver education
curricula, typically a State requirement, can be adjusted to include more specific information on
pedestrians as part of the traffic environment, right-of-way laws for drivers and pedestrians in
relation to one another, high-risk behaviors in relation to pedestrian/motorist crash types, and key
ways drivers can avoid being involved in such crashes.
Effectiveness Concerns: Driver training alone has not been shown to reduce overall crash
rates. There is no evidence indicating that this countermeasure is effective. However, driving
skill begins with knowledge education and then practicing defensive driving in relation to all
other types of traffic, including pedestrians.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 4.5.
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Chapter 8. Pedestrian Safety
4.6 Pedestrian Gap Acceptance Training
Effectiveness: ✩
Cost: $$
Use: Unknown
Time: Medium
The purpose of pedestrian gap acceptance training is to help pedestrians learn to make better
road crossing decisions, which may reduce the incidence of crossing-related injuries and
fatalities. This can include video-based training and feedback geared towards improving
pedestrian judgment of speed and/or distance of oncoming traffic.
Effectiveness Concerns: This countermeasure has been examined in few research studies. While
there is some evidence that certain approaches may lead to limited positive outcomes, There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 4.6.
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Chapter 8. Pedestrian Safety
4.7 University Educational Campaign
Effectiveness: ✩
Cost: $
Use: High
Time: Medium
This countermeasure involves conducting educational campaigns targeted at new students and
staff that may be unfamiliar with walking and driving in the campus environment. Potential
educational messages include right-of-way rules and the importance of yielding right-of-way
(pedestrians and drivers), being visible and predictable at both day and night times and during
inclement weather (pedestrians and cyclists), making eye contact at conflict points (pedestrians
and drivers), avoiding distractions (pedestrians and drivers), and speed control (drivers and
potentially cyclists) (Zegeer, Sandt, & Scully, 2008). Partnerships may include campus public
safety offices, student health and wellness programs, city/county public safety agencies, injury
prevention agencies, parking and transportation services, transit agencies, and student groups.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A8, Section 4.7.
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Chapter 8. Pedestrian Safety
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Chapter 9. Bicycle Safety
9. Bicycle Safety
Overview
In 2018 there were 857 bicyclists and other pedalcyclists who died in traffic crashes nationwide,
an increase of 6.3% from the 806 in 2017 (NCSA, 2020). In addition, approximately 47,000
bicyclists were injured. Bicyclists accounted for 2.3% of total traffic fatalities and 1.7% of total
people injured. Of the bicyclist fatalities during 2018:
• Teens 15 to 19 years old had the highest fatality rates among those under 20 years old
(2.51 fatalities per hundred thousand population), followed by 10- to 14-year-olds (0.91
fatalities per hundred thousand population);
• The average age of cyclists killed was 47, and 35 for cyclists injured;
• Cyclists 25 to 64 represented 65% of all bicycle fatalities;
• 86% of the bicyclists killed and 81% of those injured were male; and
• 20% of bicyclists killed had BACs of .08 g/dL or higher, with alcohol use by either bicyclist, driver, or both reported in 37% of fatal crashes.
The majority of bicyclist fatalities occurred in urban areas (79% in 2018), and at non-intersection
locations (60% in 2018) (NCSA, 2020). The proportion of urban bicyclists fatalities in the last 10
years has increased from 69% in 2009 to 75% in 2018.
Crash Trends. From 1998 to 2014, bicyclist fatalities fluctuated from 600 to 800 per year. The
most recent upward trend in fatalities pushed the number of fatalities over 800 in 2015, where it
has remained (see figure below). The increased number of fatalities may reflect increases in
riding. (See trends in riding below.) There are, however, substantial fluctuations in fatalities
year-to-year that may not be explained only by exposure.
Bicyclists - Percent of Total Fatalities
3.0%
2.5%
2.0%
1.5%
1.0%
Year
Source: NCSA (2020)
9-1
2018
2017
2016
2015
2014
2013
2012
2011
0.5%
0.0%
Percent of Total Fatalities
Bicyclist Fatalities
2010
900
800
700
600
500
400
300
200
100
0
2009
Number of Fatalities
U.S. Bicyclist Fatalities
Chapter 9. Bicycle Safety
A study assessed the burden of injured bicyclists admitted to hospitals in terms of length of
hospital stay in days, total hospital charges, and non-routine discharge (Hamann et al., 2013).
Non-routine discharges included death, transfer to a nursing or other short-term hospital, or
home health care. The data came from the Nationwide Inpatient Sample (NIS) database. In total,
more than $1 billion of hospital charges, $425 million for motor-vehicle crashes, and $588
million for non-motor vehicle crashes, per year resulted from bicycle crash injuries. Despite nonmotor vehicle collisions (18,457) accounting for nearly 2.7 times as many admissions as
collisions with motor vehicles (6,877) from 2002 to 2009, the total economic costs of longer
hospital stays for those involved in motor vehicle collisions was 72% higher than the same costs
for the non-motor vehicle collisions, not including further care associated with non-routine
discharges.
Average Yearly Number of Fatalities
There has been a slight rise in the average age of bicyclists killed over the past decade, from an
average of 41 in 2009 to 47 in 2018 (NCSA, 2020). Comparing the 5-year period from 2014 to
2018 with the period from 2009 to 2013, fatalities increased most among bicyclists 25 to 34
years old and those 45 and older, particularly for bicyclists 55 to 64 (48% higher) and bicyclists
65 to 74 (52% higher) (see figure below). It is likely that much of these differences relate to
changes in population age distributions over this time period, including the rapid expansion of
older age groups since 2000. It is unclear whether increases in amounts or types of riding or
other changes in exposure among these age groups may also play a part in the increases in
fatalities among those in the 45-and-older age groups. Fatalities decreased among those younger
than 20, and the greatest decrease was seen for those 5 to 9 (24% lower).
200
180
160
140
120
100
80
60
40
20
0
Average Yearly Bicyclist Fatalities, by Age
Average 2009-2013
Average 2014-2018
<5
5–9 10–15 16–20 21–24 25–34 35–44 45–54 55–64 65-74
75+
Age
Sources: NHTSA - FARS 2009-2018, NCSA, 2020
Note that different age group spans are used; the intent of the chart is to compare change in
fatalities by age group, not to compare fatalities by age.
It is also worth noting that older adult bicyclists are more vulnerable when involved in crashes.
Data from Sweden found that older adult bicyclists were twice as likely to be hospitalized when
injured, and spent three times as long in the hospital as cyclists under 65 (Scheiman et al., 2010).
9-2
Chapter 9. Bicycle Safety
Bicycling Trends. Estimates from the Census Bureau’s American Community Survey suggest
that U.S. workers (of all ages) who travel to work by bicycle increased from 0.4% of workers in
2000 to an average of 0.6% of workers for the 2008-to-2012 period (McKenzie, 2014). The share
of workers who “usually traveled to work” by bicycle increased at a faster rate than any other
mode of travel (McKenzie, 2014). In 2016 the number of workers who biked to work remained
at 0.6% of all surveyed workers (McKenzie et al., 2017). Fatality rate trends, fatalities adjusted
per different measures of exposure such as time spent bicycling, number of bicycling trips, or
total miles traveled by bicycle are currently unavailable because there is no consistent measure of
bicycling (exposure) to estimate and compare such fatality rates. According to the National
Household Travel Survey (NHTS), which aims to capture all kinds of bicycling trips, not just
commuting trips, the annual number of bicycling trips has also increased from 1.7 billion in 1990
(FHWA, 1990) to 3.3 billion in both 1995 (FHWA, 1995) and 2001 (FHWA, 2001), to 4.1
billion in 2009 (Pucher et al., 2011), then dropping to 3.8 billion in 2017 (Buehler, 2018). The
surveys used somewhat different methodologies. For example, the use of prompts beginning with
the 2001 survey has resulted in capturing more bicycle trips in the 2001 and later surveys (Hu &
Reuscher, 2004).
Cycling trends increased from 2001 to 2009, and then decreased. An analysis by Pucher et al.
(2011) found the average number of cycle trips, and the average miles of cycling per capita per
year, each rose a few percentage points from 2001 to 2009. Both the annual per capita average
number of cycle trips and the annual per capita average duration of trips decreased slightly from
2009 to 2017 (Buehler, 2018). On average, each person made 12 cycling trips and spent 4.3
hours cycling in 2017 compared to 14 trips and 4.5 hours in 2009. Bike-share operations have
also been growing in popularity in the United States and have a strong safety record so far, with
just two fatalities in over 88 million bike share trips between 2010 to 2016 (Fischer, 2017).
In addition to number of trips, exposure to traffic and crashes is affected by where, when, and for
how long a cyclist rides; the skill, knowledge and application of safe behaviors by the cyclist;
and the application of safe behaviors by drivers around the cyclist. The risk of a crash may also
be increased due to inattention, distraction, or impairment by either the cyclist or driver. The
severity of a crash also increases with higher impact speeds (AASHTO, 2010). While impaired
driving and riding have been an ongoing challenge, emerging problems include the use of cell
phones, media players, or other electronic devices while riding or driving.
Classifying Crash Types. Bicycle crashes can be classified into types based on bicyclist and
motor vehicle pre-crash actions and the location of the crash. In the early 1990s this
methodology was used to classify more than 3,000 bicycle-motor vehicle crashes in California,
Florida, Maryland, Minnesota, North Carolina, and Utah (Hunter et al., 1996). The sample was
approximately evenly divided among small/rural communities, medium-sized cities, and large
cities (as opposed to representing the proportion of crashes that occurred in each of those area
types).
Of the more than 3,000 bicycle-motor vehicle crashes:
• Half (51%) occurred at intersections or were related to intersections.
o The most common type of crash involved bicyclists riding out or through
intersections and into the path of a motorist.
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Chapter 9. Bicycle Safety
•
•
o The second most common type of crash involved motorists failing to yield at
intersections.
o Another common type included motorists turning or merging into the path of a
parallel moving bicyclist (same or opposite direction).
o Child bicyclists were overrepresented when the bicyclist failed to yield at an
intersection
o Adult bicyclists were overrepresented in crashes at intersections where motorists
turned across their path.
Twenty-two percent occurred at junctions with commercial and private driveways or
alleys.
o Children were highly overrepresented in these crashes.
Twenty-seven percent occurred at roadway sections with no special features (meaning no
intersections or driveways at the segment near the crash); fatal and serious injuries
occurred at a higher rate at such non-junction locations.
o Adult cyclists were over-involved in crashes with overtaking motor vehicles at
midblock locations.
Bicyclist Factors.
• In the Hunter et al. (1996) study, bicyclist factors contributing to crashes, especially at
intersections or other junctions, included bicyclists riding the wrong-way (facing traffic
rather than riding with traffic).
• Thirty-two percent of all bicyclists in the study were riding against traffic; for
intersection collisions, the proportion was 42%.
• Fifteen percent of crashes were coded with bicyclist riding wrong-way as a contributing
factor to the crash.
• Twenty-one percent of crashes were coded as bicyclist failure to yield
• Eight percent of crashes were coded as stop sign violations.
• Children were overrepresented in stop sign and yield violations and crashes on local and
two-lane streets, whereas adult bicyclists were more likely to contribute to their crashes
through alcohol or drug use and lane position and lane change errors.
Driver Factors.
• The Hunter et al. (1996) study also found that most common driver contributing factor
was a yield violation at either an intersection or midblock location (a factor in 24% of
crashes). However, as mentioned the bicyclist riding the wrong-way may have been a
contributing factor in such crashes.
Different crash types can be targeted by different countermeasures. The Pedestrian and Bicycle
Crash Analysis Tool software (www.pedbikeinfo.org/pbcat_us/) is available to assist
jurisdictions in typing bicycle-motor vehicle crashes and developing a database that contains
information on pre-crash maneuvers as well as other crash factors. States and communities can
then analyze their own bicycle crashes and can also use PBCAT and PedSafe
(www.pedbikesafe.org) to help select appropriate countermeasures. Thomas et al. (2019) used
the PBCAT system to type bicycle crashes in the United States, North Carolina, and Boulder,
Colorado, finding similar crash types but differing in prevalence of crash type by locality.
FHWA is currently updating PBCAT.
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Chapter 9. Bicycle Safety
Underreporting and Crash Analysis. Another consideration when analyzing crash data is that
bicycle crashes as well as pedestrian crashes tend to be underreported. A recent online analysis
from a survey of more than 7,000 bicyclists from 17 countries found that, on average, only 9% of
bicycle crashes were reported to the police (Shinar et al., 2018). Bicycle-motor vehicle and
bicycle-bicycle crashes were among the most likely crashes to be reported, and crashes with
pedestrians, fixed objects, or falls from the bike were the least likely. Even among the 157
bicyclists who reported being admitted to a hospital due to a crash, only 37% filed police reports
of the crash.
Many States may neither require reporting nor collect off-road or private-road crash records.
Non-roadway crashes may, however, constitute a significant portion of bicycle-related crashes
with motor vehicles. In one study, parking lot, sidewalk, and driveway-related crashes
represented 31% of all reported bicyclist crashes (Stutts & Hunter, 1999a). Many more roadway
and non-roadway crashes go unreported. Research is needed to better understand the extent and
causes of non-roadway bicycle crashes and effective countermeasures. NHTSA’s Not in Traffic
Surveillance (NiTS) monitors and reports on not-in-traffic-related motor vehicle deaths. Many
events involve young children. See Section 1.1 for more information.
Underreporting of traffic-related crashes on road right of ways likely decreases as the crash
severity increases because police are likely to be called to injury and fatal crashes, and the
bicyclist is more likely to be transported or seek examination at a health care facility. Therefore,
the FARS data presented earlier are thought to be reliable sources for estimating bicyclist fatal
crash frequencies. Even so, not all fatal bicycle crashes are included in FARS, including fatal
bicycle crashes involving another bicycle or a pedestrian, or those that did not occur on public
roads, as already mentioned.
Many more bicyclist and pedestrian injuries, including those due to falls, collisions with
bicycles, and others, likely go unreported to State crash databases (Stutts & Hunter, 1999a,
1999b). However, up-to-date information is lacking, and research is also needed to better
understand the causes of these types of injuries. Maintenance of (roadway and sidewalk) surfaces
and Americans With Disabilities Act-compliant design of sidewalks, landings, and access ramps
are certainly important for maintaining smooth surfaces, which bicycles are more sensitive to and
which puts bicyclists at higher risks than motorists if not maintained due to their lighter weight
and tire size. Other measures, such as providing space for bicyclists to ride separated from
motorists and pedestrian walkways may also be important, but are outside the scope of this
document.
Bicyclist Attributes. As with pedestrians, bicyclists come in all ages with many levels of
knowledge, skill, perception, and judgment. Thus, educational and enforcement programs must
take these factors into account and be designed to target age-specific concerns and the
knowledge, skills and behavioral attributes of these different groups of riders. Several studies
have also identified demographic differences in injury risk, amounts of bicycle riding, and
helmet use. In Washington State, an analysis of bicycle collisions along main street highways
(State routes that also function as main streets for local residents) found that low income areas
and communities with large minority populations have a higher probability of crashes, most
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Chapter 9. Bicycle Safety
likely due to lower vehicle ownership leading to higher exposure (Moudon & Kang, 2017).
Davison et al. (2013) found being male and being a recent immigrant were both associated with
increased bicycling injury risk among Canadian youth. Lower socioeconomic class was
associated with lower helmet use. Richard et al. (2013) found helmet use to be lower among
females, younger and older riders, lower income people, and urban dwellers than among rural
and suburban residents in France, although some of the gaps were lessening over time. At a
minimum, programs should be inclusive, or incorporate extra focus on groups at higher risk of
injury.
Bicycles have an even smaller profile than motorcycles, and while they have white front
reflectors and red rear reflectors, headlights and rear active lights typically must be purchased
and attached separately. Bicyclists are more difficult for many motorists to notice than fourwheeled vehicles, especially at night. Because they are human powered, there may be substantial
speed differentials between bicycles and motorized traffic, though this certainly varies in high
traffic areas and with avid bicyclists. Bicyclists also lack the protective body of a motorized
vehicle in the event of a crash and some riders feel uncomfortable mingling with traffic,
especially in high speed, high-volume situations.
Other Bike Types. Powered bikes and scooters are gaining popularity, particularly in urban and
suburban communities and through shared ride programs. Electric bikes (e-bikes) or pedelecs
(bikes that must be pedaled to activate motorized pedaling assistance) provide greater speeds,
terrain fitness, and hill-climb assistance that can enable bicyclists to commute farther. Motorized
or electric scooters are often used in dense urban communities for short rides. While many
behavioral safety issues between traditional bicycles and these alternative bikes are common,
there are differences that may require additional laws and targeted countermeasures. Using ebikes may subtly change bicyclist perceptions of the risks, as these bikes provide better hard
braking capabilities than traditional bicycles (Huertas-Leyva et al., 2018). One survey in
Australia reported that a majority of e-bike users are males 50 and older. Few female users of ebikes in that survey had experience riding a traditional bike (Johnson & Rose, 2016). Cyclists
also choose higher travel speeds on e-bikes than traditional bicycles (Huertas-Leyva et al., 2018).
Quantifying safety issues is also challenging with these forms of transportation, since
underreporting may be common. Specifically, incident and crash reporting is seldom specific
enough to indicate these bike types, with e-bike crashes often recorded as bicycle crashes, and escooters often recorded as pedestrian crashes. Note that e-scooter safety falls under the purview
of the Consumer Product Safety Commission.
Crash Factors. As with all crashes, bicycle crashes often result from contributing factors.
Bicyclist and driver pre-crash actions and behaviors (such as distraction, driver speed, and
alcohol/drug use), vehicle type and design, cyclist and vehicle volumes/exposure, and elements
of the built environment (including roadway design, presence of bicycle facilities) all contribute
to cycle crashes. Several resources have provided evidence of the role of the transportation
environment in bicycle safety and summarized best practices in planning, engineering, and
design for bicycle safety (AASHTO, 2012; FHWA, 2010; NACTO, 2014). Adopting and
implementing Complete Streets policies has been identified as one of the lower cost and more
effective strategies to improve conditions for bicyclists. (For more on Complete Streets, visit
www.completestreets.org/.)
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Chapter 9. Bicycle Safety
Other. Some studies have focused on the role of vehicle type and design in the event of a crash.
Ackery et al. (2012) found that larger motor vehicles—especially freight trucks and SUVs—
were overrepresented in bicycle crashes compared to other vehicle types. While not dismissing
the importance of vehicle design and the role of the built environment in preventing bicycle
crashes, the countermeasures described in this report relate primarily to educational and
enforcement measures aimed at improving the knowledge and behaviors of road users to prevent
or mitigate the severity of a crash. For more discussion, see Chapter 8, page 6-7 related to
distraction, driver speed, alcohol, and vehicle type and design.
Strategies to Increase Bicyclist Safety
Many same principles discussed in Chapter 8: Pedestrians (pages 8-10) also apply for bicyclists.
Countermeasures in this chapter are primarily aimed at improving safety behaviors of bicyclists
and drivers through education and enforcement measures, and are organized by bicyclist
subgroups:
• Children;
• Adult bicyclists;
• All bicyclists;
• Drivers and bicyclists.
A combination of strategies can be used to develop more focused programs to decrease bicycle
crashes and injuries. (For examples of combining strategies, see Brookshire et al., 2016.)
•
•
•
•
•
•
•
•
•
•
Increase the use of properly fitted bicycle helmets by all bicyclists, including children and
adults, to mitigate head/brain injury in the event of a crash.
Increase enforcement of helmet laws to increase compliance.
Increase the conspicuity of bicyclists.
Reduce vehicle speeds, which allows bicyclists and drivers more time to react and
reduces impact forces if crashes do occur.
Reduce exposure to known risky situations through behavioral and environmental
countermeasures (without necessarily discouraging bicycling).
Reduce distracted riding or driving behaviors (cell phones, headphones, etc.). See the
chapter on distracted and drowsy driving for countermeasures targeting drivers.
Decrease riding or driving while impaired. See the chapter on strategies to reduce
alcohol-impaired driving. Some of the countermeasures would be applicable to address
any type of impaired roadway use.
Enact and enforce bicycle friendly laws that facilitate safe, predictable, and efficient
bicycling in traffic, and safe driving around bicyclists, to update and fill gaps in existing
laws.
Educate LEOs on enforcement of bicycle-specific laws. Educate the public on any new
laws, such as safe passing of bicyclists.
Increase traffic law compliance by both motorists and bicyclists. Train LEOs in
appropriate enforcement strategies. In particular, decrease wrong-way riding, sidewalk
riding, and traffic control violations by bicyclists (and motorists); proper nighttime
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Chapter 9. Bicycle Safety
•
•
•
lighting; decrease speeding, cutting off bicyclists, passing too closely, or blocking or
driving in a designated bicycle lane by motorists; and decrease distraction and
impairment that affects the safety of all road users including bicyclists.
Educate motorists and bicyclists on required safety behaviors related to specific laws to
enhance safe interaction between motorists and bicyclists on the roadway.
Improve bicycle handling skills for bicyclists of all ages.
Tailor countermeasures to diverse populations, including groups such as recent
immigrants who may not be familiar with U.S. traffic laws, the U.S. traffic environment,
may not speak or read English, or may not be literate in their native language.
Additional information about countermeasures involving a comprehensive approach to
improving pedestrian safety is provided in NHTSA’s Advancing Pedestrian and Bicyclist Safety:
A Primer for Highway Safety Professionals (Brookshire et al., 2016).
Most of the above strategies are covered in this chapter under various descriptions. A few, such
as “reduce distracted riding or driving” are not described, because as yet, literature searches do
not detect any studies that have evaluated laws or programs aiming to reduce distracted riding. A
survey of bicyclist attitudes and behaviors indicates that 21% of bicyclists use an electronic
device on at least some of their bicycle trips with 9% indicating they use a device during nearly
all their trips (Schroeder & Wilbur, 2013). An observational study of 1,974 bicyclists in Boston
found that 31.2% of riders were distracted: 17.7% of the riders were wearing earbuds or
headphones and 13.5% had objects or cell phones in their hands or on the handlebars (Wolfe et
al., 2016). Currently, there is a lack of information about the impact of distracted bicycling on
bicyclist safety (Mwakalonge et al., 2014). Organizations with existing or new training or
educational programs might consider including these topics in outreach and educational
programs and evaluating how well target audiences respond. Trying new strategies and
evaluating them is the only way to gain new knowledge of what works. In addition, emerging
technologies may help to combat distractions associated with those technologies. Cell phone
applications are now available that have the ability to block incoming calls and texts while the
cyclist (or other driver) is in motion.
Engineering and Roadway Design. While not dismissing the importance of vehicle design and
the role of the built environment in preventing pedestrian crashes, the countermeasures described
in this report relate primarily to educational and enforcement measures aimed at improving the
knowledge and behaviors of road users to prevent a crash. However, there is a growing
recognition of the importance of road design and the built environment in fostering safer user
behaviors. A comprehensive approach that uses a combination of effective engineering,
enforcement, and educational measures may have the best chance of achieving desired crash
reductions.
Safety in Numbers. Finally, the idea that vulnerable road users’ safety may be improved by
increasing the numbers of pedestrians and bicyclists is gaining traction and some empirical
support. Research from abroad as well as the United States finds that, although actual numbers of
crashes may go up, individual risk of crashes with motor vehicles are often lower as numbers of
bicyclists and pedestrians increase (Fyhri et al., 2016; Elvik & Bjørnskau, 2017; Geyer et al.,
2006; Jacobsen, 2003; Leden et al., 2000). This relationship may not always be linear. An
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Chapter 9. Bicycle Safety
analysis of bicycle crash data from Minneapolis – St. Paul intersections from 2000 to 2013 found
that the probability of a crash increased with greater daily bicyclist traffic volume, until the daily
volume through the intersection reached 1,532 bicycles. Crash probability then decreased as
daily traffic volume exceeded 1,532 bicycles (Carlson et al., 2018).
In 2009 U.S. transportation officials and researchers took a “scanning tour” (assessing innovative
technologies and practices in other countries that could significantly improve highways and
highway transportation services in the United States) of Denmark, Sweden, Germany,
Switzerland, and the United Kingdom. It reported the concept of “safety in numbers” motivated
promotion of increased bicycling and walking in these countries as a safety countermeasure
(Fischer et al., 2010). These European countries are committed to driving down the total
numbers of bicyclist fatalities and injuries while increasing amounts of bicycling.
Encouragement in these countries is done in the context of commitments to comprehensive
planning, funding, engineering and design improvements, and maintenance policies to provide
safe and connected bicycle networks. The report also documents numerous examples of how
these policies are put into practice.
A non-linear relationship between traffic volumes (motorist, pedestrian, or bicyclist) and crashes
has been demonstrated (AASHTO, 2010; Bhatia & Wier, 2011; Carlson et al., 2018; Elvik &
Bjørnskau, 2017), but a causal mechanism for how increased volumes improve bicyclist safety
has not been demonstrated (Bhatia & Wier, 2011; Elvik & Bjørnskau, 2017). This means that
crashes do not tend to increase in direct proportion to increases in volume, but absolute crash
numbers are still likely to increase (and have increased) with increases in cycling – all else being
equal. Additionally, all the studies cited above, and others attempting to characterize volume and
safety relationships, are based on cross-sectional comparisons. Other safety factors such as
motorist speed, congestion, or law enforcement activity that are unmeasured or have not been
accounted for in such studies are likely to influence crashes, making it a challenge to isolate the
influence of safety and crashes based on increases in cycling alone. Also, cross-sectional studies
cannot easily demonstrate the direction of effect – that is, whether a safer environment comes
before the greater numbers of bicyclists or is a result of that increase (Bhatia & Wier, 2011). The
underreporting of bicycle crashes undermines the estimates of safety effects, particularly for
crashes that led to minor or no injuries (Elvik & Bjørnskau, 2017). It is clear, however, that a
focus on improving the environment, both the infrastructure and road users’ compliance with
laws and safe behaviors, are important to increasing both population-level safety (measured as a
reduction in population-wide fatalities and injuries) and numbers of bicyclists or amounts of
cycling. As these two elements – safety improvements and increases in bicycling – occur
collectively (or in combination), individual risk, or crash rates, may also be reduced.
Resources
The agencies and organizations listed below can provide more information on bicycle safety
issues and countermeasures and links to numerous other resources.
• Pedestrian and Bicycle Information Center: www.pedbikeinfo.org/
• National Highway Traffic Safety Administration:
o Bicycles – www.nhtsa.gov/road-safety/bicyclists
9-9
Chapter 9. Bicycle Safety
•
•
•
•
•
•
•
•
•
•
•
•
•
•
o Research and Evaluation – www.nhtsa.gov/research-data
o Behavioral Safety Research Reports – https://rosap.ntl.bts.gov/
Federal Highway Administration:
o Office of Planning, Environment, & Realty (Pedestrian and Bicycle Program) –
www.fhwa.dot.gov/environment/bicycle_pedestrian/
o Office of Safety – https://safety.fhwa.dot.gov/
League of American Bicyclists: www.bikeleague.org/
o Smart Cycling Videos – www.bikeleague.org/ridesmartvideos
Governors Highway Safety Association: www.ghsa.org/issues/bicyclists-pedestrians
Centers for Disease Control and Prevention: www.cdc.gov/
National Center for Safe Routes to School: www.saferoutesinfo.org/
SAFE KIDS Worldwide: www.safekids.org
Consumer Product Safety Commission: www.cpsc.gov
Bicycle Helmet Safety Institute: www.helmets.org
Association of Pedestrian and Bicycle Professionals: www.apbp.org
Complete Streets Coalition: www.completestreets.org
National Center for Bicycling and Walking: www.bikewalk.org
Safe Routes to School National Partnership: www.saferoutespartnership.org
Bicycle Safer Journey: Skills for Safe Bicycling for Ages 5 to 18: www.pedbikeinfo.org/bicyclesaferjourney/
A Resident’s Guide for Creating a Safer Communities for Walking and Biking:
www.safety.fhwa.dot.gov/ped_bike/ped_cmnity/ped_walkguide/
Specific resources that provide further information on engineering, enforcement, and educational
strategies are:
• NHTSA Advancing Pedestrian and Bicyclist Safety: A Primer for Highway Safety
Professionals: www.nhtsa.gov/staticfiles/nti/pdf/812258-Peds_Bike_Primer.pdf
• NHTSA Motion Graphics - Fitting a Bicycle Helmet, Rules of the Road, Driving Safely
Around Pedestrians and Bicyclists, and Bike Riding Safety:
www.trafficsafetymarketing.gov/get-materials/bicycle-safety/evergreen-campaignmaterial
• FHWA A Resident’s Guide for Creating Safer Communities for Walking and Biking:
http://safety.fhwa.dot.gov/ped_bike/ped_cmnity/ped_walkguide/
• AASHTO Guide for the Development of Bicycle Facilities, 4th Edition, American
Association of State Highway and Transportation Officials:
o https://njdotlocalaidrc.com/perch/resources/aashto-gbf-4-2012-bicycle.pdf
o Updated version, to be released soon: https://tooledesign.com/project/update-tothe-aashto-guide-for-the-design-of-bicycle-facilities-2019/
• NACTO Urban Bikeway Design Guide, National Association of City Transportation
Officials: www.nacto.org/cities-for-cycling/design-guide/
• Public Policies for Pedestrian and Bicycle Safety and Mobility: An Implementation
Project of the Pedestrian and Bicyclist Safety and Mobility International Scan:
www.pedbikeinfo.org/cms/downloads/PBSPolicyReview.pdf
• Uniform Guidelines for State Highway Safety Programs: Highway Safety Program
Guideline No. 14: Pedestrian and Bicycle Safety:
9-10
Chapter 9. Bicycle Safety
https://one.nhtsa.gov/nhtsa/whatsup/tea21/tea21programs/pages/PedBikeSafety.htm
• National Cooperative Highway Safety Research Program, NCHRP Report 500, Volume
18, A Guide for Reducing Collisions Involving Bicycles:
https://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_500v18.pdf
• BIKESAFE: Bicycle Countermeasure Selection System: www.pedbikesafe.org/BIKESAFE/
• National Center for Safe Routes to School, Enforcement: Role for Law Enforcement in
SRTS: http://apps.saferoutesinfo.org/lawenforcement/
• AAA Bicycle Safety Exchange: https://exchange.aaa.com/safety/bicyclesafety/#.XV2Rd5XfOpo
Resources released or updated since the last Countermeasures That Work update:
• The League of American Bicyclists: Bicycling and Walking in the United States - 2018,
Benchmarking Report: https://bikeleague.org/benchmarking-report
• FHWA Strategic Agenda for Pedestrian and Bicycle Transportation:
www.fhwa.dot.gov/environment/bicycle_pedestrian/publications/strategic_agenda/fhwahep16086.pdf
For more information on education, engineering, vehicular, and legislative practices and
recommended strategies from International resources, refer to PBIC’s Compendium of
International Resources - www.pedbikeinfo.org/resources/resources_details.cfm?id=5080.
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Chapter 9. Bicycle Safety
Bicycle Safety Countermeasures
Countermeasures to improve bicycle safety are listed in the table below and discussed
individually in the remainder of this chapter. The table is intended to provide a rough estimate of
each countermeasure’s effectiveness, use, cost, and time required for implementation.
Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
Countermeasures that receive
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to improve bicycle safety is discussed individually in this chapter. Full
descriptions are included for , and countermeasures. Brief
descriptions are included for
✩ and ✩✩ countermeasures. Further details about the ✩ and
✩✩ countermeasures are included in Appendix A9 to this report.
1. Children
Countermeasure
1.1 Bicycle Helmet Laws for Children
1.2 Safe Routes to School
1.3 Bicycle Safety Education for Children
1.4 Cycling Skills Clinics, Bike Fairs, Bike
Rodeos
Effectiveness
✩✩
✩
9-12
Cost
Use
Time
$$
Medium
Short
$
High
Short
$
Unknown
Short
$
Unknown
Short
Chapter 9. Bicycle Safety
2. Adults
Countermeasure
Effectiveness
2.1 Bicycle Helmet Laws for Adults
2.2 Bicycle Safety Education for Adult Cyclists
✩
Cost
Use
Time
$
Low
Short
$$
Low
Medium
3. All Bicyclists
Countermeasure
Effectiveness
3.1 Active Lighting and Rider Conspicuity
3.2 Promote Bicycle Helmet Use with Education
3.3 Enforcement Strategies
3.4 Motorist Passing Bicyclist Laws
†High
✩✩
✩
✩
Cost
Use
Time
$
High†
Varies
$$$
Medium
Medium
$$
Unknown
Varies
$
Medium
Short
Cost
Use
Time
$
Low
Medium
$$
Unknown
Medium
for active lighting laws; unknown for promoting other conspicuity measures.
4. Drivers and Bicyclists
Countermeasure
Effectiveness
4.1 Driver Training
4.2 Share the Road Awareness Programs
✩
✩✩
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
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Chapter 9. Bicycle Safety
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
Can be implemented with current staff, perhaps with training; limited costs for
equipment or facilities
These estimates do not include the costs of enacting legislation or establishing policies.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 9. Bicycle Safety
1. Children
1.1 Bicycle Helmet Laws for Children
Effectiveness:
Cost: $$
Use: Medium
Time: Short
The purpose of bicycle helmet laws for children is to increase bicycle helmet use, thereby
reducing the number of severe and fatal head injuries to children involved in bicycle crashes.
Earlier crash-trend analyses using FARS data suggested that State helmet-use laws for children
reduce child bicycle fatalities by about 15% in the long run (Grant & Rutner, 2004). Several
meta-analyses discuss the effectiveness of bicycle helmets in reducing head injuries and fatalities
in all types of crashes including bike-only falls (Attewell et al., 2001; Thompson et al., 2006).
Elvik (2011) focused on all riders, not just children, estimating that bicycle helmet use results in
about a 42% reduction in the risk of a non-fatal head injury. In another case control study,
Bambach et al. (2013) found protective effects of helmet use to be 50% for moderate injury, 62%
for serious injury, and 75% for severe head injury. Another study that examined emergency room
visits of children who had bicycle-related injuries found that unhelmeted children were more
likely to sustain injuries (40% versus 25.7%), meet the trauma activation criteria (45.5% versus
16.8%), and be admitted to the hospital (42.4% versus 14.9%). Overall, injury severity was
worse with unhelmeted children, and these children were significantly more likely to have brain
injuries, skull fractures, and facial fractures (Michael et al., 2017). Additional recent studies have
reported increased risk of severe injury or death for non-use of helmets among riders involved in
crashes. For more information, see Section 2.1 Bicycle Helmet Laws for Adults.
A helmet law is a significant tool in increasing helmet use, but as with all laws, effectiveness is
related to implementation. Legislation effectiveness is enhanced when combined with supportive
publicity and education campaigns or programs. See, for example, Rivara et al. (1998), Kanny et
al. (2001), Rodgers (2002), and Sandt et al. (2015). The practical effect of bicycle helmet laws is
to encourage parents to require their children to use helmets (and educate parents to serve as role
models to wear a helmet despite the lack of a law).
Law enforcement and other safety officials can reinforce the need to wear a helmet through
positive interactions, free, or discounted helmet distribution programs (combined with proper
helmet fitting), or other positive incentives for helmet use. Publicizing helmet laws and
child/parent education on helmet fitting and the importance of wearing a helmet every ride may
enhance effectiveness. Educational programs have been shown to increase knowledge about
proper use of helmets. See Chapter 9, Sections 1.3 and 3.2 for more information.
Use: As of March 30, 2019, there were 22 States, the District of Columbia, and at least 201
municipalities or counties that have child helmet laws (BHSI, 2019a). Most U.S. laws cover
child bicyclists younger than 18. Only 13 States have no State or local bicycle helmet laws.
Effectiveness: Two systematic reviews found that legislation may be effective at increasing
helmet use (Karkhaneh et al., 2006; Macpherson & Spinks, 2007). Two of three controlled
studies reported reductions in head or traumatic brain injury following legislation (Macpherson
& Spinks, 2007). The degree of improvement varied but there was a lack of evidence to
determine whether enforcement, supporting publicity, and helmet distribution efforts explain
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some of the variation (Karkhaneh et al., 2006; Macpherson & Spinks, 2007). There was a nonsignificant trend toward a greater overall increase in helmet use in communities with laws
covering all cyclists compared to those covering only children, and effects were larger among
children (Karkhaneh et al., 2006). Dennis et al. (2010) also found self-reported helmet use was
highest in a province with a law covering all ages, next highest in a province with a law covering
children up to 18, and lowest in a province with no law.
A survey study of adults across the United States conducted by the CDC found that children who
lived in States with child helmet legislation were more likely to wear a helmet (51% of
respondents reported that their child always wears a helmet, and 21% self-reported their child
never wears a helmet) than those in States that did not have a child helmet law (40% always and
35% never) (Jewett et al., 2016). In addition, the strongest predictor of child helmet use was
adult helmet use. Parents who reported always wearing helmets were 40% more likely to report
that their youngest child always wore a helmet than parents who did not always wear helmets. In
Australia an observational study of helmet-law compliance was performed at 17 sites in
Queensland, 24 years after mandatory helmet legislation was introduced in 1991 (Debnath et al.,
2016). Video data of bicyclists (n = 27,057) showed overall high compliance rates, although
children had a lower helmet wearing rate (94.2%) than adults (98.6%). Along roadways, children
were more likely to be non-compliant than adults (5.1 times higher odds) and boys were less
likely to be compliant than girls. Another study reported a clear and systematic increase in
helmet use rates across Australian states following the introduction of bicycle helmet legislation
(Olivier et al., 2019). The post-law rates increased from a range of 12% to 46% to a range of
71% to 85% for children (depending on the state), with the rates generally being lower than the
rate increases for adult bicyclists.
Effectiveness of legislation in reducing head injuries is challenging to assess because of the
difficulty of controlling for other safety measures that may differ across jurisdictions, and for
exposure to crashes of different severities across people in case control studies. Two studies from
Canada have found somewhat mixed results. Karkaneh et al. (2013) found that legislation
targeting those less than 18 had a beneficial effect on child, adolescent, and adult bicyclists
hospitalized for head injury in the province of Alberta, Canada. Helmet use increased from 75%
to 92% among children, from 30% to 63% among adolescents, and from 52% to 55% among
adults (Karkaneh et al., 2011). A national study compared trends in provinces with and without
legislation. Despite lower injury rates in provinces with helmet laws than in those without, the
effect could not be attributed to the introduction of the laws (Dennis et al., 2013). However, the
study also found that one province that implemented a law covering all ages, not just children,
did have a significantly lower injury rate trend for the period covered by the law.
Enactment of a helmet law can be effective even if the law is difficult to enforce. Bonander et al.
(2014) found that the proportion of juvenile head injury hospitalizations in Sweden decreased by
7.8% for males younger than 14 after the enactment of a law requiring children to wear a helmet
when riding a bicycle. Importantly, Swedish law prohibits law enforcement from issuing fines to
children under 15, effectively preventing police from enforcing the law; however, the law may
have been successful because it provided parents with additional leverage to persuade their
children to wear a helmet.
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Chapter 9. Bicycle Safety
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 material that can be used to educate and promote the use of a helmet every ride,
demonstrate helmet effectiveness, and educate and demonstrate how to properly fit a helmet.
Helmets that meet safety requirements can be purchased for under $20. Some States provide free
or discounted helmets to some children (or parents if requested). When considering the costs of
providing helmets, agencies should consider the benefits. A NHTSA summary of helmet laws
reported that “every dollar spent on bicycle helmets saves society $30 in indirect medical and
other costs” (NHTSA, 2008). The Bicycle Helmet Safety Institute has information on important
considerations in buying a helmet, sources for low-cost helmets, and partners such as Safe Kids
may be able to help with providing low-cost or free helmets (www.helmets.org/index.htm). A
helmet should be replaced when it has been involved in a crash, when any part of the helmet is
damaged, or the foam appears to be dry or changed in texture (brittle). According to BHSI, some
manufacturers suggest replacement every 5 years, although BHSI indicates that it may depend on
use and care of the helmet and that a helmet may provide good protection for longer
(www.helmets.org/guide.htm).
Time to implement: A bicycle helmet law can be implemented as soon as the appropriate
legislation is enacted. Enacting local ordinances may take less time than enacting statewide
legislation. To develop custom communications and outreach, train LEOs on implementing the
law, or start a helmet distribution or subsidy program in support of the law may require a
medium-to longer-term effort.
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Chapter 9. Bicycle Safety
1.2 Safe Routes to School
Effectiveness:
Cost: $
Use: High
Time: Short
The goal of Safe Routes to School programs is to increase the amount of bicycling and walking
trips to and from school while simultaneously improving safety for children bicycling or walking
to school. SRTS programs are community-based and are intended to be comprehensive in nature.
Programs include education of children, school personnel, parents, community members, and
LEOs about safe bicycling and walking behavior and safe driving behavior around pedestrians
and bicyclists. In addition, programs include enforcement and engineering activities to improve
traffic safety and risky elements of the traffic environment around primary and secondary
schools so children can safely bicycle or walk to school. Information on the role of law
enforcement in SRTS is available on the National Center for Safe Routes to School website
(http://apps.saferoutesinfo.org/lawenforcement).
The CDC has identified SRTS programs as one of eight non-clinical, context-based, communitywide intervention that has the potential to improve population health. See CDC’s Health Impact
in 5 Years (HI-5) strategies for health transformation: www.cdc.gov/policy/hst/hi5/index.html.
From 2005 to mid-2012, SAFETEA-LU required each State to have its own SRTS program,
including a full-time coordinator to manage Federal funds. Each year, Federal funding was
allocated on infrastructure (engineering) improvements and on non-infrastructure projects
(public awareness and outreach, enforcement near schools, education, and training for
volunteers) to encourage walking and bicycling to school. In June 2012 new legislation, MAP21, was enacted that significantly altered how SRTS and other pedestrian and bicycle programs
are structured and funded. Under the MAP-21 Act, SRTS was no longer a standalone program
(no new funding); however, SRTS projects were still eligible to compete for funding alongside
other bicycle and pedestrian-related programs, including former Transportation Enhancements
and Recreational Trails projects.
Under the Fixing America’s Surface Transportation (FAST) Act (signed in 2015 and authorized
until 2020), as part of the Surface Transportation Program Setaside (STPS) funds, States can
determine their own funding priorities. Few changes were made to the funding, and most features
of MAP-21 have been retained. Local communities and school systems can apply for the Federal
STPS funds through the State DOTs, but local and State agencies have to provide up to 20% in
matching funds for project costs. To learn more, visit www.fhwa.dot.gov/fastact/ and
www.saferoutespartnership.org/healthy-communities/policy-change/federal/FAST-actbackground-resources.
For a brief history of the SRTS program including funding, see
www.saferoutespartnership.org/safe-routes-school/101/history.
Use: With the establishment of the national SRTS program all 50 States and the District of
Columbia initiated SRTS programs. As of 2015, more than $1.03 billion out of the $1.147 billion
in SAFETEA-LU funds apportioned to local and statewide SRTS programs had been allocated
(FHWA, 2015). At that time 17,400 schools representing 6.8 million students had received
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funding or were slated to receive funds for SRTS programs. Importantly, 68% of award
recipients were classified as Title 1 (low-income) schools, a finding that is relevant because areas
with lower median income are over-represented in bicyclist- and pedestrian-related crashes
(McArthur et al., 2014).
Of the projects funded 48% included infrastructure improvements, such as sidewalk
improvements (20%), pedestrian and bicyclist access (15%), and traffic calming improvements
(13%). In addition, 10% of projects funded were related to law enforcement countermeasures.
About 19.5% of all elementary and middle schools have had SRTS programming in the past 10
years. From 2005 to 2012 nearly 14,000 schools received SRTS funding (Active Living
Research, 2015). See Chapter 8, Section 2.2 for more information.
As of September 2019 the number of SRTS programs in the country is still undetermined, but a
census is underway (see www.saferoutespartnership.org/safe-routes-school/local-work/census).
Effectiveness: SRTS efforts include, at a minimum, a 3E approach to pedestrian and bicycle
safety addressing engineering, education, and enforcement (programs can also include
encouragement, evaluation, and equity considerations). SRTS programs, including education and
training, can be effective in teaching children and their parents how to evaluate and choose the
safest routes for walking or bicycling to and from school, to practice safe behaviors when
walking, biking or driving around children walking/biking to school, how to use common
engineering treatments to enhance their safety (sidewalks, crosswalks), to adhere to crossing
guard direction, and to abide by traffic laws, especially in and around school zones. Although the
full program emphasizes broad education, some specific implementations have centered on siteappropriate engineering changes; results have shown behavioral improvements for pedestrians,
bicyclists, and motorists (NHTSA, 2004, 2015).
While no bicycle-specific safety studies have been reported, overall safety improvements have
been demonstrated for SRTS programs in regional studies. A study that looked at pedestrian and
bicyclist injury and fatality data from 18 States over 16 years (1995 to 2010) associated SRTS
with a 23% reduction in pedestrian/bicyclist injury risk and a 20% reduction in
pedestrian/bicyclist fatality risk in school-age children compared to adults 30 to 64 years old
(DiMaggio et al., 2016). On a State-by-State basis, only Florida, Maryland, New York, South
Carolina of the 18 States showed statistically significant risk reductions in child
pedestrian/bicyclist injury, while the remainder showed no effect. Another study found a 60%
decrease in the number of pedestrians involved in car crashes after the implementation of SRTS
in Miami-Dade County. Similarly, school-aged injury rates in New York City decreased by 44%
in census tracts with SRTS interventions relative to those without interventions (NHTSA, 2015).
A cost-effectiveness model estimates a savings of $224 million for one cohort of intersection
users in New York City by implementing the SRTS program (Muennig et al., 2014). The authors
concluded that SRTS programs can remain effective for decades because of the lasting
engineering component.
Notably, one study of 44 Texas SRTS programs found that the presence of infrastructure or noninfrastructure funding alone was associated with modest sustained long-term (3-year) changes in
active commuting to school (Hoelscher et al., 2016). Over time, the percentage of students who
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reported walking or biking in schools with non-infrastructure SRTS funding decreased while
those in comparison control schools with no SRTS or infrastructure projects increased. This
trend suggests a need for sustained non-infrastructure SRTS activities. Parents’ anecdotal reports
of decreased bikeability due to increases in traffic and decreases in the quality of road
maintenance played a role in the students’ active commuting behaviors, suggesting the need to
involve parents in SRTS intervention education.
Because funds are limited for SRTS programs, prioritizing the allocation of funding across the
schools in a State can help improve the overall effectiveness of SRTS programs by focusing on
those schools that are most likely to experience the greatest safety benefits. McArthur et al.
(2014) found that frequency of pedestrian/bicycle crashes generally were greater with greater
population density, larger average family sizes, lower median income, and fewer two-parent
households. In addition, schools located on local roads experienced higher crash rates than those
located on higher-class roads or arterials. For more information about the effectiveness of SRTS
(including information on the effectiveness of SRTS on injury rates, behavioral improvements,
and the percentage of students walking or biking to school, see Chapter 8, Section 2.2.
Costs: Activities associated with SRTS may be low cost and may also be eligible for noninfrastructure grants mentioned above. Grants are administered by each State’s SRTS
coordinator. Significant material and resources can be accessed at no cost. NCSRTS provides
downloadable material for State and local SRTS programs.
Time to implement: It is short for education. Once a school or district has decided to implement
an SRTS program, a range of material, including an on-line step-by-step guide on getting started,
is available from the NCSRTS. Programs funded through State DOTs, including
engineering/infrastructure components typically require applications on a funding cycle and can
take significantly longer to implement.
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Chapter 9. Bicycle Safety
1.3 Bicycle Safety Education for Children
Effectiveness: ✩✩
Cost: $
Use: Unknown
Time: Short
The purpose of bicycle education is to teach children basic bicycle handling skills, traffic signs
and signals, how to ride on streets with traffic present, proper helmet use, bicycle safety checks,
and bicycle maintenance. As part of a regular school curriculum, education can reach every
student, but providing training outside of school settings such as through parks and recreation
departments, community centers, or faith-based organizations may be more feasible in some
circumstances. Community-based programs could also provide greater flexibility in tailoring a
program to meet the needs of specific target groups.
Effectiveness Concerns: Previous studies examining the effectiveness of this countermeasure
found that bicycle safety education increases children’s knowledge of laws and safe behaviors
(Hooshmand et al., 2016; Lachapelle et al., 2013; Thomas et al., 2005), but whether this
translates into adoption of the safe behaviors is less certain. The balance of evidence regarding
countermeasure effectiveness remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 1.3.
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Chapter 9. Bicycle Safety
1.4 Cycling Skills Clinics, Bike Fairs, Bike Rodeos
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
Cycling Skills Clinics, bicycle safety fairs, and rodeos are local events often run by law
enforcement, school personnel, or other civic and volunteer organizations. Their purpose is to
teach children on-bicycle skills and how to ride defensively in traffic conditions. The intent of
these types of activities is to introduce or reinforce bicycle safety concepts learned in a
classroom with actual on-bike practice and application. Events can also include discussions and
examples of proper bicycle helmet fitting.
Effectiveness Concerns: While cycling skills clinics or rodeos can result in increases in
knowledge and skills, a review of the research literature does not reveal any studies that
document crash and injury reduction, at least not in isolation. There are insufficient evaluation
data available to conclude that the countermeasure is effective in reducing crashes.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 1.4.
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2. Adults
2.1 Bicycle Helmet Laws for Adults
Effectiveness:
Cost: $
Use: Low
Time: Short
The purpose of bicycle helmet laws is to reduce the number of severe and fatal injuries resulting
from bicycle crashes. Bicycle helmets, when worn properly, are the single most effective piece
of equipment to reduce head injuries in the event of a crash. A meta-analysis of 40 studies found
that helmet use by bicyclists was associated with 33% to 69% reduction in the odds of facial,
head, and fatal injuries (Olivier & Creighton, 2017). A meta-analysis of bicycle helmet
effectiveness estimated that bicycle helmet use results in about a 42% reduction in the risk of a
non-fatal head injury (Elvik, 2011). Other studies have also found increased risk for all types of
severe injury for helmet non-use (Boufous et al., 2012); for head and brain injury controlling for
alcohol use by the bicyclist (Crocker et al., 2012); and controlling for other risk factors such as
type of crash, age, and sex of the rider (Persaud et al., 2012).
According to a nationally representative population-based survey of attitudes and behaviors
about walking and biking, 63% of respondents 16 and older favored laws requiring adults to use
helmets when bicycling (Schroeder & Wilbur, 2013). However, only 37% said they use helmets
on all or nearly all rides. Forty-six percent reported they never use helmets.
Use: No States have yet enacted laws requiring adults to wear bicycle helmets. There are 49 local
jurisdictions in the United States that require people of all ages to wear helmets when bicycling
(BHSI, 2019b).
Effectiveness: A meta-analysis of 21 empirical studies from Australia, Canada, New Zealand,
Sweden, and the United States found that mandatory all-age helmet laws were effective in
reducing serious head injuries by 35% for cyclists of all ages (Høye, 2018). An analysis that
compared bicycle fatalities before and after helmet laws were introduced in Australian states
found a 46% reduction in fatalities among bicyclist of all ages (Olivier et al., 2019). The
longitudinal trend in the data was best explained by increased helmet use following the
introduction of the legislation.
Two studies from Canada, and one study from three New York city suburbs show helmet laws
for all ages produce higher helmet wearing rates than laws covering only children (Dennis et al.,
2010; Karkhaneh et al., 2006; Puder et al., 1999; Høye, 2018), See the Effectiveness section on
Bicycle Helmet Laws for Children (Chapter 9, Section 1.1) for more information. A longitudinal
study in Nova Scotia found that helmet legislation was associated with a sustained increase in
helmet use, and that increased enforcement (through issuing summary offense tickets) along with
education efforts were associated with significant increases in helmet use (Huybers et al., 2017).
Dennis et al. (2013) found suggestive trends that laws in Canadian provinces that cover all ages
resulted in fewer head injuries as a ratio of all bicycle injuries than no helmet law or a law
covering only youth. Walter et al. (2011) found a decrease in head injury rates over and above
decreasing trends in all bicyclist injury rates associated with a comprehensive and long-term
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bicycle helmet use law in New South Wales, Australia. Further, the proportion of cyclists
involved in crashes who were wearing a helmet increased from 20% to more than 60% among
children, and to more than 70% among adults. For adults, the increase occurred within 2 months
of the law effective date, whereas the increase was more gradual among children. Olivier et al.
(2013) also found the rate of bicyclist head injuries decreased in comparison to the rate of
bicyclist arm injuries (used to reflect differences in the amounts of riding) since 1991, when the
law was enacted, suggesting that benefits continue long term. Studies have also found that when
children are accompanied by adults using helmets, the children are also more likely to be using
helmets (Wesson et al., 2008). Universal (all ages) helmet requirements for motorcyclists
similarly result in higher helmet use rates and the greatest reductions in fatalities and injuries
(see Chapter 5, Section 1.1).
Costs: Minimal costs could be incurred for informing and educating the public and providing
training for enforcement personnel.
Time to implement: A universal helmet use law can be implemented as soon as the law is
enacted.
Other issues:
• Encouragement to use helmets: While helmet use is effective for preventing serious
head injuries among all ages, some jurisdictions are concerned mandatory helmet use for
all ages will discourage bicycling. However, some research has found that legislation is
not associated with the likelihood that children will cycle (Jewett et al., 2016), and that
implementing legislation is not associated with changes in the number of cyclists as a
percentage of the population (Huybers et al., 2017; Radun & Olivier, 2018). Given that
increased riding provides health benefits, some agencies prefer to use encouragement in
lieu of a law to increase helmet use by adults. See Section 3.2 for more information.
• In cities implementing bike-share programs, complementary helmets may increase helmet
use among bike-share riders. An observational study in Vancouver, Canada, where
helmet legislation has been enacted since 1996 and where the bike-share system provides
helmets along with their bicycles, found that a significantly lower proportion of bikeshare riders wore helmets than personal-use bicycle riders (15% fewer) (Zanotto &
Winters, 2017). However, the gap in helmet use is much smaller than in other cities (i.e.,
30-48% gap for Toronto, Boston, New York, Washington, London, and Montreal) where
bike-share companies do not provide complementary helmets.
• Helmet standards: All helmets sold in the United States must pass minimum testing
standards for head protection (“impact attenuation”), requirements to prevent helmets
coming off in a crash, peripheral vision tests and other requirements developed by the
Consumer Product Safety Commission (CPSC). Final rules were passed in 1999. The full
standards are available on the BHSI website (www.helmets.org/index.htm#standards). A
folding helmet intended to be more convenient to carry that meets the CPSC standards is
now available per the BHSI website (www.helmets.org/shared.htm#studies).
• Buying, fitting, and replacing helmets: Most importantly, helmets must fit properly, be
worn properly, and be worn every time in order to offer the desired protection. NHTSA
(http://one.nhtsa.gov/staticfiles/nti/bicycles/pdf/8019_Fitting-A-Helmet.pdf,
www.trafficsafetymarketing.gov/get-materials/evergreen-campaign-material/web9-24
Chapter 9. Bicycle Safety
videos/web-motion-graphics-fitting-bike-helmet), the League of American Bicyclists
(http://bikeleague.org/content/smart-cycling-tips-0), and SafeKids Worldwide
(www.safekids.org/tip/bike-safety-tips), provide tips on helmet fitting and other guidance
on riding safely in traffic. Such tips may be included on bike maps and other local
resources for bicyclists. Helmets should be replaced if involved in a crash. They should
also be replaced at some interval just because of natural deterioration (e.g., the foam is
dented or becomes brittle, there are cracks in the outer shell, or the straps breaking or
becoming loose). The Bicycle Helmet Safety Institute has more information on buying,
fitting, and replacing helmets, and also reviews new helmets that come out each year and
discusses costs (www.helmets.org/). BHSI suggests, from the results of impact tests they
conducted, that lower-cost helmets are just as impact-resistant as more costly ones.
Reflective and bright colors are recommended, and rounder helmets are also suggested by
BHSI to provide a smoother, less snag-prone surface in the event of a crash.
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Chapter 9. Bicycle Safety
2.2 Bicycle Safety Education for Adult Cyclists
Effectiveness: ✩
Cost: $$
Use: Low
Time: Medium
The goal of bicycle safety education for adult bicycle commuters is to improve knowledge of
laws, risks, and cycling best practices, and to lead to safer cycling behaviors, including riding
predictably and use of safety materials such as reflective clothing and helmets. This
countermeasure can include educational material, tip sheets, and a pledge program for local
agencies to adopt and disseminate.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 2.2.
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Chapter 9. Bicycle Safety
3. All Bicyclists
3.1 Active Lighting and Rider Conspicuity
Cost: $
Use: High†
Effectiveness:
†High for active lighting laws; unknown for promoting other conspicuity measures
Time: Varies
Improving bicyclist conspicuity is intended to make bicyclists more visible to motorists and to
allow motorists more opportunity to see and avoid collisions with bicyclists. A common
contributing factor for crashes involving bicyclists in the roadway is the failure of the driver to
notice the bicyclist, particularly at night. White or light-colored clothing, long a recommended
solution, does little to improve conspicuity at night (Raborn et al., 2008, Strategy F2). A study of
bicyclists admitted to hospitals from bicycling injuries suggested that white upper body clothing
may provide a protective effect for motor vehicle collisions during daylight hours (Hagel et al.,
2014).
New bicycles must be sold with reflectors meeting the CPSC requirements. The reflectors may
improve a bicycle’s night-time visibility when they are illuminated by motor vehicle lights
approaching from behind. Active bicycle lighting requires the user turn it on/off to activate it
versus a passive light (reflector). Active bicycle lighting can also be critical for the detection of
bicyclists coming toward the path of a motor vehicle, because the bicyclist is outside the
vehicle’s headlight beam until the last moment (Raborn et al., 2008). In most States and
jurisdictions, bicycles ridden after dark are required by law to have active white front lights and
most States also require red rear reflectors or active lights. White in front and red in rear is meant
to replicate the lighting used in motorized vehicles. Some State laws have specific requirements
for the power of the light, i.e., ability to see the light at a certain distance of feet ahead. Some
laws, such as in Oregon, require bicycle lighting not only at night, but also in other less than
favorable conditions. Efforts to increase enforcement of laws requiring use of lights is needed to
maximize use (Raborn et al., 2008). Communications and outreach to the general public and
LEOs about State and local laws regarding the use of active bicycle lighting (and other
conspicuity aids) should be provided. However, a study from Australia found the use of a bicycle
light alone, whether static or flashing, did not enhance the conspicuity of the bicyclist among
study drivers, so additional measures to improve conspicuity (such as clothing or reflective leg
straps) may be needed (Wood et al., 2012).
Most bicycles do not come equipped with permanently mounted lighting (Osberg et al., 1998).
Newer mounting devices may, however, make it easy to attach or remove lights as needed. Many
currently available lights may also be easily switched from continuously lit to flashing modes.
Batteries also last much longer with LED lighting, increasing convenience.
Additional materials attached to bicyclists or their bikes can increase rider conspicuity day or
night. For daytime, bright-colored or fluorescent clothing, including shirts, vests, caps, etc., make
the bicyclist more noticeable. In low-light conditions (e.g., rain, fog) and at night, the same items
can have retroreflective (reflects light back toward the original source of light) materials
incorporated in them, to make the bicyclist more visible and identifiable from much greater
distances. Retroreflective bicycle tires, and now frames, are also available. Another product to
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Chapter 9. Bicycle Safety
increase visibility include bright neon tubes 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. Lower cost stickers to put on rims (or cyclist extremities) and other parts of
the bike are also available. Pedal reflectors are another option and may help drivers identify
cyclists and estimate their speeds based on pedal rotations, though further research is needed.
Lights also may be applied to helmets or backpacks to make the rider more conspicuous to other
vehicles. Other emerging active lighting technologies may also enhance conspicuity of nighttime
cyclists when used. Lights or retroreflective material attached to moving extremities (i.e., wrists
and ankles) can create the perception of human movement and increase cyclist visibility (Koo &
Huang, 2015; Karsch et al., 2012). A study of the effectiveness of different configurations of
flashing lights on bicyclists’ joints found that lights placed on the lower body (hips, knees, and
ankles) were the most effective in increasing bicyclist visibility (Koo & Huang, 2015). See also
Chapter 8 Section 4.3 on pedestrian conspicuity measures for more information.
Use: Most States have laws requiring use of active lights and reflectors on bikes ridden at night.
There are no data on how frequently active lighting is used among those who bicycle after dark,
but bicyclists involved in collisions at night appear to use lights infrequently. Use of bicycle
reflectors is thought to be higher since they come pre-attached to bicycles at purchase, but these
may be removed, or broken, after purchase, so use is not guaranteed. Nearly three-fourths of U.S.
survey respondents who reported having ridden in the dark reported they took some measures,
either using a bike headlight or reflective/fluorescent gear or clothing, to make themselves more
visible (Schroeder & Wilbur, 2013).
Most, if not all, athletic shoes contain some retroreflective material. Some athletic clothing also
has retroreflective material. Bicycle helmets may have retroreflective elements. Some bicyclists
may be seen wearing additional retroreflective materials, such as vests, jackets, arm bands, or
rear-mounted reflective triangles located under their bicycle seats.
Effectiveness: A Cochrane review of studies of pedestrian and bicycle conspicuity aids
concluded that “fluorescent materials in yellow, red, and orange improved driver detection
during the day ...” (Kwan & Mapstone, 2004). Even low-beam headlights can illuminate figures
wearing florescent materials hundreds of feet away, much farther than figures wearing normal
clothing (Zegeer et al., 2004, Strategy B5; Raborn et al., 2008, Strategy F2). One study among a
cohort of riders who had participated in a large mass bicycle event found results suggesting that
consistent use of fluorescent colors provides a protective effect against crashes and injuries
(Thornley et al., 2008).
A small Australian study found that bicyclist clothing such as vests and ankle and knee reflectors
significantly affected conspicuity, enabling drivers to react to bicyclists from further away than
when the bicyclists wore only vests or no reflective material at all (Wood et al., 2012). Younger
drivers detected and responded to bicyclists more often and from further distances than older
drivers. In a year-long Danish study (Lahrmann, Madsen, & Olesen, 2018; Lahrmann, Madsen,
Olesen, et al., 2018), researchers gave running lights to 1,845 bicycle riders (compared to 2,000
riders in the control group), and fluorescent yellow jackets to 3,402 riders (compared to 3,391
riders in the control group). Over the course of the trial, the treatment groups self-reported fewer
multi-party personal injury events than their control groups (38% fewer for the running light
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group, and 47% fewer for the yellow jacket group after accounting for response bias). The group
with the yellow jackets also reported 55% fewer accidents with motor vehicles than the control
group (Lahrmann, Madsen, Olesen, et al., 2018). When sorted in half based on jacket usage rate,
the multi-party personal injury event rate for the higher jacket usage group was 53% lower, while
there was no significant difference between the lower jacket usage group and the jacket control
group.
A study of bicyclists admitted to hospital emergency departments in Edmonton and Calgary,
Canada, did not find a significant protective effect for using head- or tail lights, for retroreflective
upper body clothing, nor for other reflective items for nighttime crashes. However, the sample
size was small, and there was no apparent control for the riding environment or type of
ambient/street lighting available (Hagel et al., 2014). A set of four on-road studies performed in
Italy on a closed-circuit track found that relative detection performance of bicyclists with
ECE/ONU 104 reflective tape applied to left and right posterior forks, seat post, and rear
reflector was significantly better than the control condition (no reflective material; Costa et al.,
2017). This difference was maintained under a variety of environment conditions (darkness with
street lighting, darkness with no street lighting, and darkness with rain). However, further
research is still needed to assess the effects of types of conspicuity aids under different road
environments and ambient and supplemental light conditions.
Another challenge is getting bicyclists to wear retro-reflective materials and use proper lighting
and other conspicuity aids routinely (and appropriately). It is possible to obtain widespread use of
lighting. Osberg et al. (1998) found nearly half of nighttime bicyclists in Paris used active
lighting, compared to just 14% of Boston bicyclists, reflecting differences in laws, public health
priorities, and perceived risk.
Evidence is unavailable about the effectiveness of conspicuity promotional measures, or of laws
requiring use of active lighting at increasing use. Raborn et al. (2008) suggest that increased
enforcement of laws enhanced by coordinated communications and outreach efforts could
heighten awareness among cyclists of the need for using proper lighting and the benefits of
retroreflective materials at enhancing conspicuity. Logic suggests that if bicyclists are more
noticeable, the frequency and severity of crashes would likely be reduced. With this goal in
mind, certain local LEAs are engaging in community outreach and handing out bicycle safety
lights rather than ticketing bicyclists.
Costs: Moderate costs are involved for communications and outreach and for law enforcement
training to enforce active lighting laws. Conspicuity-enhancing gear, such as retroreflective wrist
and ankle straps, or small active front and back lights, are sometimes distributed for free as part
of school and community educational efforts. Additional costs for such materials are modest.
Time to implement: Brochures and flyers for a bicycle safety education campaign highlighting
conspicuity can be created quickly. Often an extra line or two about rider conspicuity can be
added to existing educational material and/or reinforced at community events. Several months
can be taken up by designing, producing, and implementing the communications and outreach
and law enforcement training for enforcing active lighting laws. See Section 3.3 for more on
enforcement and available resources.
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Chapter 9. Bicycle Safety
3.2 Promote Bicycle Helmet Use With Education
Effectiveness: ✩✩
Cost: $$$
Use: Medium
Time: Medium
The purpose of bicycle helmet promotions is to increase the use of helmets and thereby decrease
the number of severe and fatal brain injuries to bicyclists involved in crashes. This
countermeasure involves conducting single events or extended campaigns to promote helmet
distribution and use among children and adults. Promotions can target barriers to helmet use,
including absence of a helmet, child and families’ lack of understanding of the importance of
helmet use, and negative attitudes or beliefs about helmet use. Programs that provide helmets can
include sponsoring organizations and often involve law enforcement and schools to deliver
helmets, fit the helmets, and teach proper fitting and use. Bicycle helmet promotions must
include teaching adults and children the importance of and how to properly fit the bicycle
helmet. Many schools and community centers are able to assist in identifying those families that
due to their socioeconomic status or eligibility for lunches, are suitable for free helmets. Other
times, helmets can be purchased in bulk and distributed at a lower cost.
Effectiveness Concerns: This countermeasure has been examined in several research studies.
There is some evidence that certain approaches may lead to increased helmet use and more
favorable attitudes towards helmet use, especially among children. However, more research is
needed to conclude that the countermeasure is effective when broadly targeted towards all
cyclists.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 3.2.
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Chapter 9. Bicycle Safety
3.3 Enforcement Strategies
Effectiveness: ✩
Cost: $$
Use: Unknown
Time: Varies
This countermeasure involves promoting traffic safety laws to enhance the safety of bicyclists,
including those laws expected of bicyclists and drivers around them. This includes
communications and outreach campaigns and by training LEOs about the laws, the safety
benefits of obeying the laws, and how to enforce bicycle safety-related laws. The purpose of
targeted enforcement is to increase compliance with appropriate traffic laws by both bicyclists
and motorists through enforcement of traffic laws for all operators.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 3.3.
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Chapter 9. Bicycle Safety
3.4 Motorist Passing Bicyclist Laws
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Short
The purpose of bicyclist passing laws is to require motor vehicle drivers to leave at least a legally
defined amount of clearance space between the vehicle and the cyclist when overtaking the
cyclist. This helps to minimize the likelihood of a sideswipe, and to reduce the chance of a close
encounter that could potentially destabilize or divert the course of a cyclist and cause a crash.
Effectiveness Concerns: Although there is some research examining the effectiveness of this
countermeasure, there is insufficient evidence to conclude that the countermeasure yields
consistent benefits.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 3.4.
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Chapter 9. Bicycle Safety
4. Drivers and Bicyclists
4.1 Driver Training
Effectiveness: ✩
Cost: $
Use: Low
Time: Medium
This countermeasure involves enhancing existing driver training or conducting new driver
training about sharing the road with bicyclists. The purpose of addressing bicycle safety as part
of driver education is to increase the sensitivity of drivers to the presence and characteristics of
bicyclists and how to safely share the road with them.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 4.1.
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Chapter 9. Bicycle Safety
4.2 Share the Road Awareness Programs
Effectiveness: ✩✩
Cost: $$
Use: Unknown
Time: Medium
The purpose of Share the Road programs is to increase drivers’ awareness of bicyclists’ rights
and the need for mutual respect of bicyclists on the roadway. Campaign education efforts are
intended to improve the safety of all road users, including bicyclists and to enhance the
understanding and compliance with relevant traffic laws.
Effectiveness Concerns: This countermeasure has been examined in a small number of research
studies. Despite some positive findings, the balance of evidence regarding countermeasure
effectiveness remains inconclusive.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A9, Section 4.2.
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Chapter 9. Bicycle Safety
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676. https://doi.org/10.1177/0361198119849056
Thompson, D. C., Rivara, F. P., & Thompson R. (2006). Helmets for preventing head and facial
injuries in bicyclists. The Cochrane Database of Systematic Reviews, Issue 2.
www.cochrane.org/reviews/en/ab001855.html
Thornley, S. J., Woodward, A., Langley, J. D., Ameratunga, S. N. & Rodgers, A. (2008).
Conspicuity and bicycle crashes: Preliminary findings of the Taupo bicycle study. Injury
Prevention, 14, 11-18.
Walter, S. R., Olivier, J., Churches, T., & Grzebieta, R. (2011). The impact of compulsory cycle
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Analysis & Prevention, 43, 2064-2071.
Wesson, D. E., Stephens, D., Lam, K., Parsons, D., Spence, L., & Parkin, P. C. (2008). Trends in
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Wolfe, E. S., Arabian, S. S., Breeze, J. L., & Salzler, M. J. (2016). Distracted biking: An
observational study. Journal of Trauma Nursing, 23(2), 65-70.
Wood, J. M., Tyrrell, R. A., Marszalek, R., Lacherez, P., Carberry, T., & Chu, B. S. (2012).
Using reflective clothing to enhance the conspicuity of bicyclists at night. Accident
Analysis & Prevention, 45, 726-730.
Zanotto, M., & Winters, M. L. (2017). Helmet use among personal bicycle riders and bike share
users in Vancouver, BC. American Journal of Preventive Medicine, 53(4), 465-472.
Zegeer, C. V., Stutts, J., Huang, H., Cynecki, M. J., Van Houten, R., Alberson, B., Pfefer, R.,
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www.trb.org/Publications/Blurbs/154863.aspx
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Chapter 10. Drowsy Driving
10. Drowsy Driving
Overview
Drowsy driving is a prevalent safety concern that results in large part from lifestyle patterns and
choices. In 2018 there were 775 fatalities involving drowsy drivers, representing 2.1% of all
motor vehicle traffic crash fatalities (NCSA, 2019). Drowsy driving was reportedly involved in
2.1% to 2.5% of fatal crashes (NHTSA - FARS, 2014-2018) and 1.8% to 2.2% of overall injury
crashes from 2016 to 2018 (NHTSA - CRSS, 2016-2018). Until recently, attention and research
on drowsiness has primarily been concentrated on commercial truck drivers, but the problem is
far more widespread. In a 2006 survey by the National Sleep Foundation, 51% of 552 young
drivers (grades 10 to 12) reported driving at least once while drowsy (NSF, 2006). In 2014 more
than one-third of 444,306 respondents 18 and older in the United States reported sleeping less
than 7 hours a day—the minimum sleep duration recommended for optimal well-being (Liu,
2016). The 2017 AAA Traffic Safety Culture Index found that more than 40% of 2,613 drivers
reported getting less than 6 hours of sleep a night in a typical week (AAAFTS, 2018).
Another study by the AAA Foundation aimed to quantify the relationship between sleep
deprivation and crash risk (Tefft, 2016). A sample of 4,571 crashes that occurred from July 2005
to December 2007 in the United States was analyzed using a case-control design. Elevated crash
risk was associated with fewer number of hours of sleep in the 24 hours before a crash. Drivers
who reported less than 4 hours, 4-5 hours, 5-6 hours, and 6-7 hours of sleep were associated with
a 11.5, 4.3, 1.9, and 1.3 times increase in crash rate than drivers who reported sleeping at least 7
of the past 24 hours. In addition, the study also estimated that changes from their normal sleep
patterns can elevate drivers’ crash risk. Drivers who slept 1-2 hours, 2-3 hours, 3-4 hours, or 4+
hours less than usual had crash rates that were 1.3, 3.0, 2.1, and 10.2 times greater than drivers
who reported sleeping as usual. Overall, drivers who averaged 4 to 5 hours of sleep daily were
estimated to have 5.4 times the crash rate of drivers who averaged seven or more hours of sleep
(Tefft, 2016).
A change in the social perception of sleep and public awareness about the risks of drowsy
driving are necessary to change a driver’s decisions to drive when drowsy (Higgins et al., 2017).
Few behavioral highway safety countermeasures have been shown to reduce drowsy driving,
although new countermeasures are currently being developed and evaluated. NHTSA hosted the
Asleep at the Wheel: A Nation of Drowsy Drivers forum in 2015 with the objective of addressing
drowsy driving by bringing together the traffic safety and the sleep science communities
(NHTSA, 2016a; Higgins et al., 2017). NHTSA released the Drowsy Driving Research and
Program Plan in 2016 describing projects related to quantifying the problem, building public
awareness and education, developing policy, identifying high-risk populations, and advancing
vehicle technology and infrastructure (NHTSA, 2016b; Higgins et al., 2017). The National
Transportation Safety Board reported that about 36 major transportation investigations from
2001 to 2012 identified fatigue as a potential cause or contributing factor; this included
approximately 14 highway incident investigations (Marcus & Rosekind, 2017; GHSA, 2016).
NTSB added “human fatigue” as an issue in its “Most Wanted List of Transportation Safety
Improvements” in 2016 (GHSA, 2016; NTSB, 2016).
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Chapter 10. Drowsy Driving
Problem size and characteristics
Drowsy driving can cause drivers to be less responsive to driving events in a way that potentially
increases the risk of crashing (Lyznicki et al., 1998). Similar to distracted driving, most drivers
acknowledge drowsy driving is potentially dangerous, but many still engage in this behavior.
Several studies across the past two decades have estimated the portion of the population who
have fallen asleep at the wheel through self-reporting. NHTSA surveyed 4,010 drivers in spring
2002 and found 11% reported that they had nodded off while driving during the past year (Royal,
2003). Of those who nodded off, 66% said they had 6 or fewer hours of sleep the previous night.
A 2010 survey of 2,000 U.S. residents found 41% of drivers reported having ever fallen asleep or
nodding off while driving (AAAFTS, 2010). Four percent of drivers reported falling asleep while
driving in the past month, while 11% had done so in the past year. A similar, more recent study
found that nearly all drivers (97%) believe it is unacceptable to drive while excessively drowsy,
yet 32% admitted to having driven while too tired to easily keep their eyes open in the past 30
days (AAAFTS, 2016; similar results from the 2017 Traffic Safety Culture Index are reported in
AAAFTS, 2018). A CDC analysis of the Behavioral Risk Factor Surveillance System phone
survey across 19 States and the District of Columbia found that about 4% of 147,076 respondents
reported falling asleep while driving at least once in the past 30 days (Wheaton et al., 2013). This
proportion was consistent with a different sample of over 90,000 U.S. residents surveyed in
2011-2012 (Wheaton et al., 2014). A meta-analysis of seventeen international studies published
between 1993 and 2014 reported that drivers who self-reported experiencing sleepiness while
driving were at more than twice the risk of being involved in a motor vehicle crash compared to
drivers who reported no such instances (Bioulac et al., 2017).
These surveys provide additional useful information about drowsy driving. Three of the studies
found that young drivers and male drivers were more likely than older drivers and female drivers
to have dozed off at the wheel (AAAFTS, 2010; Wheaton et al., 2013; Wheaton et al., 2014;
Royal, 2003). Moreover, driving while drowsy does not just occur late at night. About onequarter of those drivers who admit to nodding off say the most recent incident occurred in the
afternoon (noon to 5 p.m.), which might be attributable to circadian rhythms (Royal, 2003).
Drowsy driving is also not limited to long trips – roughly half of the drivers who nodded off had
been driving for an hour or less. Adults who reported sleeping less than 6 hours per day, snoring,
or unintentionally falling asleep during the day were more likely to fall asleep while driving
(Wheaton et al., 2013). Drowsy driving was also found to be more prevalent among binge
drinkers and those who seldom or never used seatbelts (Wheaton et al., 2014), which suggests
that drowsy driving may be more prevalent among drivers who generally engage in riskier
behaviors. A driving simulator study conducted in Australia identified another vulnerable group
of fatigue-prone drivers—regular commuters (Caponecchia & Williamson, 2018). Participants
with sleep deprivation were worse at lane keeping than participants with no sleep deprivation
with longer durations of sleep deprivation producing greater lane deviations. The effect was
increased in the morning even on short drives, and the authors suggest that sleep inertia could be
a potential factor. Sleep inertia is a transitional phase between sleep and wakefulness that results
in low arousal and impaired performance (Tassi & Muzet, 2000; Caponecchia & Williamson,
2018).
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Chapter 10. Drowsy Driving
Even though post-hoc estimates provide a useful picture of the risk of driver drowsiness (Tefft,
2016), it is often difficult to determine whether drowsy driving contributed to a crash. Similar to
distracted driving, drivers may be reluctant to admit they dozed off following a crash. Current
data estimates that 2% to 20% of annual traffic deaths are attributable to driver drowsiness,
according to the NHTSA Drowsy Driving Research and Program Plan (NHTSA, 2016b).
According to NHTSA’s Fatality Analysis Reporting System (FARS) and the Crash Report
Sampling System, (CRSS) annually from 2016 to 2018, there were on average over 96,000
police-reported crashes involving drowsy drivers. These crashes injured more than 52,000 people
and killed more than 800. However, researchers have inferred the existence of additional
drowsy-driving crashes by looking for correlations with related factors such as the number of
passengers in the vehicle, crash time and day of week, sex of the driver, and crash type. A study
by the AAA Foundation, using data from 1999 to 2013, found that driver drowsiness may have
contributed to 6% of all crashes and 21% of fatal crashes (Tefft, 2014). This estimate suggests
that more than 6,000 people may have died in drowsy-driving-related motor vehicle crashes
across the United States last year.
Naturalistic driving studies (NDSs) may help us understand the associations between driver
drowsiness and crash risk. One recent study by the AAA Foundation for Traffic Safety used the
Strategic Highway Research Program 2 (SHRP2) NDS data to estimate the prevalence of driver
drowsiness immediately before crashes (Owens et al., 2018). Drowsiness was assessed as the
percent of time a driver’s eyes were closed (Wierwille et al., 1994). It examined 701 crashes.
Estimates show that drowsiness may have been a contributing factor in 8.8% to 9.5% of all
crashes examined and in 10.6% to 10.8% of crashes that resulted in airbag deployment,
significant property damage, or injury (Owens et al., 2018).
Strategies to Reduce Drowsy Driving
The seemingly easy way to reduce drowsy driving crashes is to convince or require drivers to get
enough sleep daily or arrange alternate transportation. However, getting more sleep may be a
difficult goal. Drowsy driving may result from lifestyles that include insufficient or irregular
sleep (shift workers, for instance) or from medical problems – issues beyond a driver’s
immediate control. For example, a recent CDC study in 29 States found that people in certain
occupational groups—production, healthcare support, healthcare practice, food preparation,
protective services, and some transportation services—were more at risk for having short sleep
duration of less than 7 hours each day (Shockey & Wheaton, 2017). Moreover, studies indicate
that drivers themselves are poor judges of the performance decrements that result from
drowsiness (Powell & Chau, 2011).
Behavioral strategies for drowsy driving focus on removing some of the underlying causes or
promoting awareness of the risks. Currently, few studies have examined whether the standard
behavioral countermeasures of laws, enforcement, and sanctions (which are used successfully for
alcohol impairment, seat belt use, aggressive driving, and speeding) are effective for drowsy
drivers. Additionally, standard behavioral countermeasures have been studied with young
drivers. Some GDL provisions help reduce drowsy driving by prohibiting nighttime driving (see
Chapter 6, Sections 1.3 to 1.5).
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Chapter 10. Drowsy Driving
Drowsy driving that is related to a driver’s job may be reduced through employer policies and
programs. Links to employer-based resources are available from the Network of Employers for
Traffic Safety through trafficsafety.org. The National Safety Council also provides resources to
employers, including an online fatigue toolkit - safety.nsc.org/fatigue-risk-management-toolkit.
The NTSB provides an overview of employer measures at
www.ntsb.gov/safety/mwl/Documents/2017-18/2017MWL-FctSht-Fatigue-H.pdf. 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 drowsiness issues among certain highrisk populations. However, it is unknown if any of these strategies have been evaluated.
There are a variety of environmental and vehicular strategies to address drowsy driving. Rumble
strips, both on the shoulder and the centerline, have demonstrated their effectiveness in
preventing crashes associated with inattention or drowsiness (Persaud et al., 2016). 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, particularly due to sleepiness.
Vehicular strategies that hold promise for reducing crashes among drivers who are drowsy or
inattentive include collision avoidance technologies such as lane departure warning, crashimminent braking, and forward collision warning, and vehicle-to-vehicle and vehicle-toinfrastructure communications technologies (IIHS, 2012; IIHS, 2014). Such technologies, once
available only in luxury brands, are now offered in many new vehicles. Additionally, in-vehicle
technologies are available and being further developed to detect driver drowsiness by monitoring
driver performance and then warning drivers (May & Baldwin, 2009; Papadelis et al., 2007;
Sahayadhas et al., 2012; Brown et al., 2014). This chapter only addresses behavioral strategies. It
does not include environmental, vehicular, and engineering countermeasures because State
Highway Safety Offices generally do not have authority or responsibility in these areas.
Driver drowsiness is a critical issue for commercial drivers. About 14% of truck drivers reported
a near-crash due to drowsiness according to a 2012 survey by the National Sleep Foundation
(NSF, 2012). The Federal Motor Carrier Safety Administration, in partnership with Transport
Canada and several Canadian Provinces, created the North American Fatigue Management
Program (NAFMP) to research and educate against fatigued driving (FMCSA, 2016). FMCSA
regulates drowsiness in commercial drivers through Hours of Service regulations, driver logs and
inspections; starting December 2017, the use of electronic logging devices (ELDs) were made
mandatory for commercial bus and truck drivers (80 Fed. Reg. 78292, 2015). NHTSA has also
developed a prototype Drowsy Driver Warning System that appears promising in reducing
drowsiness among drivers of heavy vehicles (Blanco et al., 2009; see also Brown et al., 2014).
As with the environmental and vehicular countermeasures mentioned above, commercial driver
countermeasures are not discussed in this guide because they generally do not fall under SHSO
jurisdiction.
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Chapter 10. Drowsy Driving
Resources
The agencies and organizations listed below can provide more information on drowsy driving
and links to numerous other resources.
•
•
•
•
•
•
•
•
•
National Highway Traffic Safety Administration:
o Asleep at the Wheel: A Nation of Drowsy Drivers Forum (NHTSA, 2016a).
o Drowsy Driving Research and Program Plan – DOT HS 812 252 (NHTSA,
2016b).
o Drowsy Driving – www.nhtsa.gov/risky-driving/drowsy-driving
o Behavioral Safety Research Reports – https://rosap.ntl.bts.gov
Governors Highway Safety Association: www.ghsa.org
• Wake Up Call! Understanding Drowsy Driving and What States Can Do (GHSA,
2016).
National Transportation Safety Board: www.ntsb.gov/safety/mwl/Documents/201718/2017MWL-FctSht-Fatigue-H.pdf (overview) and www.ntsb.gov/safety/safetyalerts/Documents/SA_061.pdf (drowsy driving risks for teen drivers)
National Safety Council: www.nsc.org/road-safety/safety-topics/fatigued-driving
National Conference of State Legislatures:
www.ncsl.org/research/transportation/summaries-of-current-drowsy-driving-laws.aspx
National Sleep Foundation: www.sleepfoundation.org and www.sleep.org
Insurance Institute for Highway Safety: www.iihs.org
AAA Foundation for Traffic Safety: www.aaafoundation.org
Network of Employers for Traffic Safety: www.trafficsafety.org
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.
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Chapter 10. Drowsy Driving
Drowsy Driving Countermeasures
Countermeasures to reduce drowsy driving are listed in the table below. The table is intended to
provide a rough estimate of each countermeasure’s effectiveness, use, cost, and time required for
implementation. Effectiveness is shown using a five-star rating system.
•
•
•
Countermeasures that receive or have been determined to be
effective.
Countermeasures that receive are considered promising, and likely to be
effective.
✩ or ✩✩ have NOT been determined to be effective,
either because there has been limited or no high-quality evidence (✩) or because
effectiveness is still undetermined based on the available evidence (✩✩).
Countermeasures that receive
States, communities, and other organizations are encouraged to use , and especially
or , countermeasures. They should use caution in selecting ✩ or
✩✩ countermeasures, since conclusive evidence is not available to demonstrate the
effectiveness of these countermeasures. If they decide to use a new or emerging countermeasure
that has not yet been studied sufficiently to demonstrate that the countermeasure is effective, they
are encouraged to have the countermeasure evaluated in connection with its use.
Further details about the symbols and terms used are included after the table. 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.
Each countermeasure to reduce drowsy driving is discussed individually in this chapter. Full
descriptions are included for , and countermeasures. Brief
descriptions are included for ✩ and ✩✩ countermeasures. Further details about the ✩ and
✩✩ countermeasures are included in Appendix A4 to this report.
1. Laws and Enforcement
Countermeasure
1.1 GDL Requirements for Beginning Drivers
1.2 General Drowsiness Laws
†
Effectiveness
†
✩
Cost
Use
Time
$
High
Medium
Varies
High††
Short
Effectiveness demonstrated for nighttime restrictions
Included under reckless driving; use of explicit drowsiness laws is low
††
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Chapter 10. Drowsy Driving
2. Communications and Outreach
Countermeasure
2.1 Communications and Outreach on Drowsy
Driving
Effectiveness
Cost
Use
Time
✩
$$
Unknown
Medium
Effectiveness
Cost
Use
Time
$
Unknown
Short
Variable
Unknown
Medium
3. Other Countermeasures
Countermeasure
3.1 Employer Programs
3.2 Education Regarding Medical Conditions
and Medications
✩✩
✩
Effectiveness:
✩✩
✩
Demonstrated to be effective by several high-quality evaluations with
consistent results
Demonstrated to be effective in certain situations
Likely to be effective based on balance of evidence from high-quality
evaluations or other sources
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
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Chapter 10. Drowsy Driving
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Chapter 10. Drowsy Driving
1. Laws and Enforcement
1.1 Graduated Driver Licensing Requirements for Beginning Drivers
Effectiveness: †
† Effectiveness
Cost: $
Use: High
Time: Medium
demonstrated for nighttime restrictions
Teens are less experienced at the task of driving, so driving requires more of their deliberate
attention than is the case for experienced drivers (Lansdown, 2002). Some studies suggest that
drivers 16 to 24 are somewhat more likely than other age groups to drive while drowsy (Royal,
2003; Wheaton et al., 2014).
The nighttime driving restriction of GDL reduces the likelihood of drowsiness for newly licensed
drivers. Driving at night is associated with higher fatal crash risk than during the day for teen
drivers (McCartt & Teoh, 2015), and also may pose greater risks of drowsy driving. The NCHRP
guide for reducing crashes involving young drivers describes the key provisions of GDL laws
(Goodwin et al., 2007). The Insurance Institute for Highway Safety (IIHS, 2019) and the
Governors Highway Safety Association (2019) summarize State GDL laws. These summaries are
updated monthly. See Chapter 6, Sections 1.1 and Appendix A6, Section 1.7, for a complete
discussion of GDL for beginning young drivers.
Use: As of November 2016, all 50 States and the District of Columbia had some GDL
components in place. The laws in 49 States and the District of Columbia do not allow driving
during certain nighttime hours during the intermediate license stage. (This stage limits
unsupervised driving during high risk situations.)
Effectiveness: Several studies document that nighttime GDL restrictions reduce teenage driver
crashes and injuries (Hedlund & Compton, 2005; Goodwin et al., 2007; Williams, 2007;
Williams, 2017). Young drivers are involved in a disproportionately high number fatal crashes
that occur between 9 p.m. and 6 a.m. compared to the number of miles driven during that time
frame (Williams & Preusser, 1997). When a GDL system with appropriate restrictions (including
earlier nighttime restrictions) is implemented, crash rates for 16-year-old drivers are reduced 25
to 35% and for 17-year-old drivers by 15 to 20% (Goodwin et al., 2007). In North Carolina
following the introduction of a 9 p.m. nighttime restriction, Foss et al. (2001) reported a 43%
decrease in crashes between 9 p.m. and 5 a.m. compared to a 20% reduction in daytime crashes.
After a nighttime restriction beginning at midnight was implemented in Michigan, there was a
53% decrease in crashes among 16-year-old drivers between midnight and 4:59 a.m. compared to
a 24% decrease during the day (5 a.m. to 8:59 p.m.) and a 21% decrease from 9 p.m. to 11:59
p.m. (Shope et al., 2001). Goodwin et al. (2007) recommend nighttime GDL restrictions start
earlier (i.e., 9 p.m.) rather than later.
One factor that may undermine the effectiveness of GDL restrictions in teen drivers is the
perception that the risk of penalty from not complying with the law is low. In particular, a study
of GDL violations in Washington State and North Carolina found low overall enforcement of the
GDL requirement laws (AAAFTS, 2014). The AAA Foundation also found that a high
proportion of GDL citations, including those requiring nighttime supervision (27%), were
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Chapter 10. Drowsy Driving
dismissed by the courts, which “may very well be detrimental to the overall effectiveness of
GDL programs.”
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 can be minimal. Information about GDL restrictions can also be provided
through driver education courses.
Time to implement: GDL nighttime restriction changes require several months to implement for
drivers receiving a provisional license. They then will take 1 or 2 years before all provisionally
licensed drivers are subject to the new restrictions.
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Chapter 10. Drowsy Driving
1.2 General Driver Drowsiness Laws
Effectiveness: ✩
† Included
Cost: Varies
Use: High†
Time: Short
under reckless driving; use of explicit drowsiness laws is low.
This countermeasure involves laws that specifically target the issue of drowsy drivers. With
regard to drowsy driving, this type of law would permit drivers to be prosecuted for vehicular
homicide if they have not slept in 24 hours and they cause a crash in which someone is killed.
Effectiveness Concerns: Laws that specifically target drowsy drivers are not widely used, and
this countermeasure has not been systematically examined. There are insufficient evaluation data
available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A10, Section 1.2.
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Chapter 10. Drowsy Driving
2. Communications and Outreach
2.1 Communications and Outreach on Drowsy Driving
Effectiveness: ✩
Cost: $$
Use: Unknown
Time: Medium
This countermeasure involves drowsy driving communications and outreach campaigns directed
to the general public (Stutts et al., 2005, Strategy C1; NSF, 2004). 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.
These campaigns are conducted by States and national organizations such as the National Sleep
Foundation.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A10, Section 2.1.
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Chapter 10. Drowsy Driving
3. Other Countermeasures
3.1 Employer Programs
Effectiveness: ✩✩
Cost: $
Use: Unknown
Time: Short
This countermeasure involves employer-based programs targeting workers that are at higher risk
of drowsy-driving crashes. These groups include shift workers who work long or irregular hours
or who work at night, including many LEOs (Stutts et al., 2005, Strategy D6). Another at-risk
group for drowsy driving crashes is medical interns and emergency responders (such as EMS),
who frequently work extended shifts of 24 hours or more. Education program for shift workers
can include information on sleep habits in general and drowsy driving in particular. Employer
programs can also include medical condition testing/education.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A10, Section 3.1.
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Chapter 10. Drowsy Driving
3.2 Education Regarding Medical Conditions and Medications
Effectiveness: ✩
Cost: Variable
Use: Unknown
Time: Medium
This countermeasure involves providing education about chronic medical conditions and sleep
disorders that may compromise sleep and lead to drowsy driving or falling asleep at the wheel.
These conditions include insomnia, sleep apnea, and narcolepsy.
The principal countermeasures to address these conditions are:
• Communications and outreach on sleep disorders to increase overall awareness of their
symptoms, consequences, and treatment.
• Efforts with driver licensing medical advisory boards to increase their awareness of these
conditions as they review driver fitness for licensing.
• Efforts with physicians to increase their awareness of these conditions and their potential
effects on driving, to treatment for these conditions as appropriate, and to counsel their
patients to take steps to reduce the risk of drowsy driving.
Effectiveness Concerns: This countermeasure has not been systematically examined. There are
insufficient evaluation data available to conclude that the countermeasure is effective.
Further information about the known research, potential effectiveness, costs, use, and time to
implement is available in Appendix A10, Section 3.2.
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Chapter 10. Drowsy Driving
Drowsy Driving References
80 Fed. Reg. 78292 (December 16, 2015), Electronic logging devices and hours of service
supporting documents; Federal Motor Carrier Safety Administration, Final rule.
www.gpo.gov/fdsys/pkg/FR-2015-12-16/pdf/2015-31336.pdf
AAA Foundation for Traffic Safety . (2010). Asleep at the wheel: The prevalence and impact of
drowsy driving. www.aaafoundation.org/pdf/2010DrowsyDrivingReport.pdf
AAAFTS. (2014). Violations and enforcement of graduated driver licensing restrictions in North
Carolina and Washington State.
AAAFTS. (2016). 2015 traffic safety culture index. https://aaafoundation.org/wpcontent/uploads/2016/02/2015TrafficSafetyCultureIndexReport.pdf
AAAFTS. (2018). 2017 traffic safety culture index. https://aaafoundation.org/wpcontent/uploads/2018/03/TSCI-2017-Report.pdf
Bioulac, S., Franchi, J. A. M., Arnaud, M., Sagaspe, P., Moore, N., Salvo, F., & Philip, P.
(2017). Risk of motor vehicle accidents related to sleepiness at the wheel: A systematic
review and meta-analysis. Sleep, 40(10), zsx134.
Blanco, M., Bocanegra, J. L., Morgan, J. F., Fitch, G. M, Medina, A., Olson, R. L., Hanowski,
R., J., Daily, B. &Zimmermann, R. P. [Part I], Howarth, H. D., Domenico, T., E., Barr, L.
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Foss, R. D., Feaganes, J. R., & Rodgman, E. A. (2001). Initial effects of graduated driver
licensing on 16-year-old driver crashes in North Carolina. Journal of the American
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and what States can do. www.ghsa.org/sites/default/files/2017-02/Drowsy%202016U.pdf
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Goodwin, A., Foss, R., Sohn, J., & Mayhew, D. (2007). Guidance for implementation of the
AASHTO Strategic Highway Safety Plan, Volume 19: A guide for reducing collisions
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Chapter 10. Drowsy Driving
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Verbal protocol and visual allocation findings. Accident Analysis & Prevention, 34(5),
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10-18
Appendix 1. Alcohol- and Drug-Impaired Driving
A1. Alcohol and Drug Impaired Driving
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Deterrence: Laws
Countermeasure
1.5 Alcohol-Impaired-Driving Law Review
Effectiveness
✩✩
Cost
Use
Time
$$
Unknown
Medium
Cost
Use
Time
Varies
Varies
Varies
3. Deterrence: Prosecution and Adjudication
Countermeasure
3.4 Sanctions
Effectiveness
✩✩
5. Prevention, Intervention, Communications and Outreach
Countermeasure
5.3 Responsible Beverage Service
5.5 Designated Drivers
Effectiveness
✩✩
✩✩
Cost
Use
Time
$$
Medium
Medium
$
Medium
Short
Cost
Use
Time
Varies
High
Medium
Cost
Use
6. Underage Drinking and Drinking and Driving
Countermeasure
6.5 Youth Programs
Effectiveness
✩✩
7. Drug-Impaired Driving
Countermeasure
7.2 Drug-Impaired Driving Laws
7.3 Education Regarding Medication
† Use
for drug per se laws
Effectiveness
✩
✩
A1-1
Time
†
Unknown
Medium
Unknown
Unknown
Short
Long
Appendix 1. Alcohol- and Drug-Impaired Driving
Effectiveness:
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
✩
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.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy
demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A1-2
Appendix 1. Alcohol- and Drug-Impaired Driving
1. Deterrence: Laws
1.5 Alcohol-Impaired-Driving Law Review
Effectiveness: ✩✩
Cost: $$
Use: Unknown
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
Alcohol-impaired-driving laws in many States are extremely complex. They may be 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 (e.g., BAC tests, SFSTs), and new sentencing and monitoring alternatives (e.g.,
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 (2002) summarized the
opinions of hundreds of LEOs, prosecutors, judges, and probation officials across the country:
“Professionals unanimously support the simplification and streamlining of existing DWI
statutes” (p. 18). See also Hedlund and McCartt (2002).
About a year before it disbanded, the National Committee on Uniform Traffic Laws and
Ordinances prepared a model DWI law, which has been incorporated into the Uniform Vehicle
Code (NCUTLO, 2000). It addressed BAC testing, BAC test refusals, higher penalties for highBAC 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. In addition, the Traffic
Injury Research Foundation has a guidebook to assist policymakers in leading a strategic review
of DWI systems, with the goal of streamlining systems and closing loopholes that can be
exploited by offenders (Robertson, Vanlaar, & Simpson, 2007). NHTSA also has created several
guidebooks, including one to assist States in establishing impaired-driving statewide task forces
to review key legislation and improve current DWI systems (Fell & Langston, 2009), and another
to assist officials and the general public in establishing task forces at local or regional levels (Fell
et al., 2011).
At a State’s request, NHTSA will facilitate an Impaired Driving Program Assessment to evaluate
the State’s impaired-driving system and to make recommendations for strengthening its
programs, policies, and practices. NHTSA and the SHSO assemble an assessment team
comprised of national and State experts in impaired driving. The team reviews and documents
the strengths and weaknesses of the State’s existing impaired-driving system and provides the
State recommendations on actions that can be taken to improve the impaired driving system.
Use: No data are available on which States have reviewed and revised their DWI laws.
A1-3
Appendix 1. Alcohol- and Drug-Impaired Driving
Effectiveness: To date no studies have examined the effectiveness of law reviews in reducing
alcohol-impaired crashes. The effect of a law review will depend on the extent of inconsistencies
and inefficiencies in a State’s current laws. A law review can be an important action a State takes
to address its alcohol-impaired-driving problem, because a thorough law review will examine the
function of the entire DWI control system and will identify problem areas. The immediate effect
of a law review should be a more efficient and effective DWI control system.
Some States that have incorporated assessments into their programs have experienced declines in
impaired driving fatality rates (Coleman & Mizenko, 2018). Based on the results of an
assessment, each of three States developed an impaired-driving strategic plan and formed a
leadership team comprised of both government and non-government stakeholders to develop and
implement policies and procedures for reducing impaired fatalities. Impaired-fatality rates per
100 million VMT improved in each State (0.66 to 0.36 from 2004 to 2015 in New Mexico, 0.42
to 0.23 from 2000 to 2009 in Washington State, and 0.44 to 0.36 from 2012 to 2015 in
Oklahoma) after adopting the model. However, these outcomes do not suggest a causal
relationship between the specifics of the impaired-driving strategic plan and improvements in
fatality rates. More research is needed to determine what factors influenced the improvements.
Costs: The review will require substantial staff time. Implementation costs of course will depend
on the extent to which the laws are changed.
Time to implement: It can take considerable time to identify qualified stakeholders and
establish a task force to conduct the law review.
A1-4
Appendix 1. Alcohol- and Drug-Impaired Driving
3. Deterrence: Prosecution and Adjudication
3.4 Sanctions
Effectiveness: ✩✩
Cost: Varies
Use: Varies
Time: Varies
Overall Effectiveness Concerns: Most of these measures are widely used. Their respective
effectiveness has been examined in research studies. Despite some positive research findings, the
balance of evidence regarding the effectiveness of these countermeasures remains inconclusive.
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, 2017a). 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 4.3, Vehicle and
License Plate Sanctions, for discussions of these sanctions. See also NHTSA’s Guide to
Sentencing DWI Offenders (NHTSA, 2006) 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. As of 2015
there were 19 States and the District of Columbia that set mandatory minimum lengths for first
offenders (NHTSA, 2017a). 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 or all the revocation or suspension period.
Although administrative license actions are highly effective in reducing crashes (see Chapter 1,
Section 1.1), court-imposed license actions appear less effective. A study of 46 States found that
post-conviction license suspension had no discernible effects on alcohol-related fatal crashes
(Wagenaar & Maldonado-Molina, 2007). As discussed in Chapter 1, Section 1.1, some DWI
offenders continue to drive with suspended or revoked licenses, and many DWI offenders do not
reinstate their licenses when they are eligible to do so. Consequently, long court-imposed license
suspensions may do little to reduce recidivism. Instead, it may be important to encourage DWI
offenders to reinstate their licenses, but with appropriate controls such as ignition interlocks
(Section 4.2) and close monitoring (Section 4.4).
Fines: Most States impose fines on DWI offenders. As of 2015 there were 29 States and the
District of Columbia that had mandatory minimum fines for first offenders, ranging from $200
(West Virginia; BAC ≥ .15 g/dL) to $1,500 (Alaska) (NHTSA, 2017a). In addition to fines,
offenders often face substantial costs for license reinstatement, mandated alcohol education or
treatment, insurance rate increases, and legal fees. Available evidence suggests that fines appear
to have little effect on reducing alcohol-impaired driving. For example, Wagenaar et al. (2008)
A1-5
Appendix 1. Alcohol- and Drug-Impaired Driving
examined alcohol-related fatal crashes across 32 States and concluded that mandatory fines “do
not have clearly demonstrable general deterrent or preventive effects” (p. 992). Another study
from Australia found the size of fines was unrelated to recidivism rates among DWI offenders
(Weatherburn & Moffatt, 2011). Even though fines may not reduce alcohol-impaired driving,
they do help support the system financially.
According to a report by the European Transport Safety Council (2016), most countries in
Europe impose fines that are not income related as a sanction for alcohol offenders. Fines are
preferred over jail sentences because of a higher benefit-to-cost ratio and the additional support
they offer to alcohol programs through the earned money. Imprisonment is most common when
alcohol-related crashes result in a fatality. In addition, the effectiveness of sanctions is enhanced
with strong enforcement and when integrated into other treatment programs.
Jail: All States allow some DWI offenders to be sentenced to jail. The length of sentences varies
by State and often depends on the number of prior convictions, the driver’s BAC, whether the
crash resulted in an injury or fatality, whether a child passenger was present (child endangerment
laws), and several other factors. Additionally, some States allow community service in lieu of
jail. Details of each State’s laws may be found in NHTSA’s Digest of Impaired Driving and
Selected Beverage Control Laws (NHTSA, 2017a).
Jail is the most severe and most contentious of the DWI sanctions. Jail is expensive. In 2015 the
average annual cost per inmate among 45 States was $33,274. Alabama had the lowest cost at
$14,780, and the highest was in New York at $69,355 (Mai & Subramanian, 2017). 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 judges simply may ignore
the mandatory jail requirement (Robertson & Simpson, 2002).
Research on the effectiveness of jail is equivocal at best (Voas & Lacey, 2011, pp. 215-216;
NTSB, 2000). Very short (48-hour) jail sentences for first offenders may be effective (NTSB,
2000) and the threat of jail may be effective as a deterrent (as is done in DWI and drug courts),
but other jail policies appear to have little effect. Wagenaar et al. (2000) reviewed 18 studies and
concluded: “The balance of the evidence clearly suggests the ineffectiveness of mandatory jail
sentence policies” (p. 12). In fact, they find “numerous studies that indicate that [mandatory jail]
might be a counterproductive policy” (p. 12) that increases alcohol-related crashes.
Community service: Many States allow community service as part of DWI offenders’ sentences
and 9 States allow community service in lieu of mandatory jail for first-time offenders (NHTSA,
2017a). 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, 2008).
Victim Impact Panels: DWI offenders are often required to attend victim impact panels, in
which offenders hear from people whose lives have been permanently altered by impaired
drivers. An estimated 400,000 offenders each year attend victim impact panels conducted by
more than 200 MADD chapters across the United States (Voas & Lacey, 2011). Although victim
A1-6
Appendix 1. Alcohol- and Drug-Impaired Driving
impact panels are intuitively appealing, most studies suggest they do not reduce recidivism
(Crew & Johnson, 2011; deBaca et al., 2001; Shinar & Compton, 1995; Wheeler et al., 2004).
Vehicle Impoundment: A 7-day vehicle impoundment program implemented as an additional
penalty in Ontario, Canada, in 2010 has been associated with decreases in alcohol-related driving
offenses. The program targets alcohol convictions specific to driving with a BAC> .08 g/dL,
refusal to comply to roadside screening, and violations of license suspension or ignition interlock
conditions. One study found a 29% decrease in which recidivism in the 3 months following a
suspension was attributed to the 7-day vehicle impound program (Byrne et al., 2016).
A1-7
Appendix 1. Alcohol- and Drug-Impaired Driving
5. Prevention, Intervention, Communications and Outreach
5.3 Responsible Beverage Service
Effectiveness: ✩✩
Cost: $$
Use: Medium
Time: Medium
Overall Effectiveness Concerns: This countermeasure’s effectiveness has been examined in
several research studies; however, server training programs are the only segment of responsible
beverage service for adults that has been adequately documented and evaluated. Research
suggests that server training programs can be effective if they involve intensive, high-quality,
face-to-face server training accompanied by strong and active management support (Shults et
al., 2001). When server training programs are not intensive and are not supported, they are
unlikely to result in greater refusals of service to intoxicated patrons. Despite these positive
research findings, the balance of evidence regarding countermeasure effectiveness remains
inconclusive.
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. See also Wagenaar and Tobler (2007) and Voas and Lacey (2011; pp. 131-137)
for reviews and discussion of the research literature on this issue.
Beginning in the early 1980s a major effort was undertaken to encourage alcohol servers to
comply with laws prohibiting the sale of alcoholic beverages to visibly intoxicated patrons. Since
that time, many “server intervention” programs have been developed as a means of securing
more responsible behavior on the part of servers. Some States have mandatory programs that
require at least some alcohol retail employees to attend a server training course. Other States
have voluntary programs that provide incentives for retailers to participate (e.g., liability
protection or insurance discounts). The quality of server training programs can vary
considerably. Wagenaar and Tobler (2007) note that many server training laws “are not
optimally designed, do not ensure quality training, and do not ensure all servers are consistently
trained, or retrained periodically” (p. 158).
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, Sections 6.1 through 6.4.
Use: As of January 1, 2018, there were 23 States that had some form of mandatory server
training program in place; another 26 States had voluntary programs (NIAAA, 2018).
Effectiveness: The findings on the effectiveness of server training have been mixed. In their
systematic review, Shults et al. (2001) found five high-quality evaluations of server training
A1-8
Appendix 1. Alcohol- and Drug-Impaired Driving
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” (p. 80). When server training programs are not intensive and are not
supported, they are unlikely to result in greater refusals of service to intoxicated patrons.
Few studies have examined the effect of server training on alcohol-impaired crashes. An
evaluation of a statewide server training program in Oregon found a 23% reduction in singlevehicle nighttime injury crashes following the program (Holder & Wagenaar, 1994). However,
Molof and Kimball (1994) reviewed the same Oregon program and observed no decline in
alcohol-related fatalities. A recent evaluation of a responsible beverage service program in two
US communities examined outcome measures (Fell, Fisher, Yao, & McKnight, 2017; Fell,
Fisher, Yao, McKnight, et al., 2017; NHTSA, 2017b). Outcomes were collected in stages at 10
intervention bars (pre-intervention, 6 months after intervention startup, and 1 year after
intervention startup). The methods included bar patron breath tests at each bar to determine the
proportion of patrons at high BACs and police-reported alcohol-crash involvement in the two
treatment and two control communities. There was no significant impact of responsible beverage
service on impaired driving related crashes or single vehicle nighttime crashes. However, patrons
had lower average BACs, and a smaller proportion of patrons were intoxicated (BACs of .08
g/dL or higher). This effect was sustained when servers were properly trained in responsible
beverage service and bar managers and owners were onboard with the program and aware of its
enforcement. Another outcome of the study was the recommendation to target training programs
toward problem establishments identified by “place of last drink” responses from DWI arrests
(Fell, Fisher, Yao, & McKnight, 2017; Fell, Fisher, Yao, McKnight, et al., 2017; NHTSA,
2017b).
Costs: A typical alcohol server course takes about 4 to 8 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. The Alcohol Epidemiology Program (2000)
cites several server training program evaluation studies that found no effect and notes that
these programs may have been poorly supported or implemented. 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.
• Dram shop laws: As of 2015 there were 41 States that allow people injured by
intoxicated drivers to recover damages from the licensed establishment that served or
sold the alcohol in at least some situations (so-called “dram shop” laws) (NHTSA,
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Appendix 1. Alcohol- and Drug-Impaired Driving
•
•
2017a). The potential threat of legal liability can provide strong encouragement to
retailers to adopt responsible beverage service policies and practices. Research shows the
implementation of dram shop laws is associated with reductions in alcohol-related
crashes and fatalities (Voas & Lacey, 2011; Scherer et al., 2015).
Enforcement of responsible beverage service: Enforcement of alcohol service laws is
key, but largely lacking. Mosher et al. (2009) identified three main reasons for this: (1) a
lack of societal and political will to address violations; (2) limited resources for
enforcement operations; and (3) statutory provisions that make collection of evidence
overly burdensome. As a result, action against licensed establishments (“dram shops”)
has historically been limited to case law action involving serious crashes. Although
alcohol enforcement by police is almost exclusively directed toward drivers, research has
demonstrated that enforcement of alcohol service laws can help ensure alcohol retailers
follow responsible serving practices. For example, an enforcement program in Michigan
resulted in a three-fold increase in refusals of service to “pseudo-patrons” who simulated
intoxication (McKnight & Streff, 1994).
“Last Drink” programs: The goal of “Last Drink” programs is to determine where
someone who was apprehended for impaired driving consumed the last drink prior to the
arrest. This information is then provided to licensing authorities who may issue a warning
letter to the retail establishment or take disciplinary action. An evaluation of a last drink
program in Washington State found mixed results. No change was observed in retail
establishment practices, but there were reductions in impaired-driving arrests and lower
BACs among arrested drivers in the intervention community (Ramirez et al., 2008).
Similar pilot programs have been tried in Australia, Canada, and New Zealand, although
effectiveness data are lacking.
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Appendix 1. Alcohol- and Drug-Impaired Driving
5.5 Designated Drivers
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Short
Overall Effectiveness Concerns: The countermeasure effectiveness has been examined in a few
research studies. There have been some positive research findings in terms of driver awareness
of the countermeasure. However, the balance of evidence regarding the effectiveness of this
countermeasure in reducing crashes remains inconclusive.
Designated drivers are people 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. Designated driver programs focus on
specific actions taken at drinking establishments, which contrast with designated driver mass
media campaigns that seek to raise awareness of this countermeasure and promote its informal
use among the general driving population (see Section 5.2)
The designated driver concept has been questioned on two grounds: (1) designated drivers may
still drink, though perhaps less than the passengers; and (2) it may encourage passengers to drink
to excess. Previous national roadside surveys found self-identified designated drivers were more
likely to have positive BACs in comparison to all drivers on the road (Fell et al., 1997; Lacey et
al., 2009). Also, some designated drivers had very high BACs, especially those coming from
bars. Apparently, some groups of drinkers had selected the designated drivers near the end of a
night of drinking. To be effective, Voas and Lacey (2011) argue the designated driver must be
chosen before the drinking begins, and must be willing to abstain (or substantially limit) his or
her drinking.
Use: The designated driver concept is widely understood and accepted. Surveys show that
designated driver use is common. In NHTSA’s general population survey of 7,000 people, some
44% said they had served as designated drivers during the past year, and 33% reported riding
with designated drivers (Moulton et al., 2010). In a multi-year survey by the Traffic Injury
Research Foundation of a random representative sample of American drivers 21 and older, 98%
of respondents agreed that having a designated driver was important (Vanlaar et al., 2017). Using
the 2016 survey results of these drivers, 71% stated they had served as designated drivers and
64% reported nearly always using designated drivers. On the other hand, around 19% reported
never using designated drivers, and 8% reported they had been passengers with impaired drivers
in the past 30 days.
Effectiveness: Because designated drivers are informally determined and somewhat imprecisely
defined, it’s no surprise there are little 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). A review from Australia concluded that
designated driver programs can successfully increase awareness and use of designated drivers,
but evidence for changes in alcohol-related crashes is inconclusive (Nielson & Watson, 2009).
However, the authors note the lack of supporting evidence “does not necessarily mean that such
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Appendix 1. Alcohol- and Drug-Impaired Driving
programs should be discouraged. On the contrary, it highlights the need for them to be better
implemented and evaluated” (Nielson & Watson, 2009, p.36).
The “Skipper” designated driver program in Queensland, Australia, is a good example of a
partially successful program. The program provides free soft drinks to people who agree to stay
sober and serve as designated drivers. The program was pilot-tested in 41 venues, and was
heavily advertised through radio, earned media, and on-premise promotions. Self-report surveys
showed awareness for the program was very high, and the proportion of respondents who
reported acting as, or using, designated drivers increased after the program was implemented
(Watson & Watson, 2014). However, roadside surveys found no change in the proportion of
drivers who had been drinking, and there were no changes in alcohol-related crashes.
Costs: The only cost associated with informal designated driver programs is for publicity.
Designated drivers can be promoted independently or can be included with other impaireddriving 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.
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Appendix 1. Alcohol- and Drug-Impaired Driving
6. Underage Drinking and Drinking and Driving
6.5 Youth Programs
Effectiveness: ✩✩
Cost: Varies
Use: High
Time: Medium
Overall Effectiveness Concerns: This countermeasure has been examined in several research
studies. Despite some positive research findings, the balance of evidence regarding
countermeasure effectiveness remains inconclusive.
States, communities, nonprofit organizations, and schools 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 drivers who have been
drinking. Although some programs use scare tactics, many employ positive messages and
methods: 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.
Research has shown that teens’ behavior is influenced by their parents first and foremost, but
also by their peers. As a result, peer-to-peer programs have been widely used. Students Against
Destructive Decisions (SADD), founded in 1981 as Students Against Driving Drunk, employs a
peer-to-peer education model in chapters across the country to raise awareness about the dangers
of underage drinking and driving. Some States conduct similar activities under different names,
such as Students Taking a New Direction (STAND) in Colorado and Teens in the Driver Seat in
Texas. Many programs are targeted at celebratory times of the year, including prom and
graduation season; the summer, when young people are out of school and more likely to be
involved in a crash; and the winter holiday season. 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 Fisher (2019) and Hedlund et al. (2001) for brief
examples of State programs.
A recent study found that young adults who are convicted of DWI 1 year post high school may
have been influenced by prevalent substance-use norms among their five closest high-school
friends (Li et al., 2016). NHTSA and the Ad Council published an online and social media
campaign, “Ultimate Party Foul,” about the dangers and consequences of underage drinking and
driving (www.multivu.com/players/English/7662551-ad-council-ultimate-party-foul/). The
campaign also provided tips on how young adults can resist peer and social pressure related to
drunk driving.
Another type of approach focuses on “social norms” or “normative feedback.” Social norms
programs are based on studies showing that students often overestimate alcohol use among their
peers. By providing students with accurate information about drinking, social norms programs
reduce the pressure that light- or non-drinkers feel to drink, and help heavier drinkers realize
their drinking is atypical (Perkins, 2002, 2003). Although many social norms programs focus on
alcohol or other substance use, a few have addressed drinking and driving. Examples of social
norms programs can be found at the National Social Norms Institute (www.socialnorms.org).
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Appendix 1. Alcohol- and Drug-Impaired Driving
Other initiatives focus on brief interventions that involve the use of therapeutic components for
a short duration to potentially reduce DWI, or driving after drinking in young adults and
adolescents. An example intervention might include a discussion of the perceived costs and
assumed benefits of alcohol consumption, a review of the legal consequences of drinking alcohol
underage and driving or riding in a car with someone who has been drinking, providing
opportunities to discuss options for moderating alcohol consumption, and providing personalized
BAC charts based on the participant’s height and weight. For more information on brief
interventions, see Chapter 1, Section 5.1.
Use: Youth programs of some type are conducted in most, if not all, States.
Effectiveness: CDC’s systematic review found there was insufficient evidence to determine the
effectiveness of youth programs (Elder et al., 2005). Two studies have attempted to evaluate
SADD’s activities and effects. One study in two schools in California and New Mexico, found
that neither school implemented the model SADD program well and found no evidence of effects
on any drinking and driving measure (Klitzner et al., 1994). The second study in 6 schools with
strong SADD programs located in Arizona, Ohio, and Wisconsin were matched with similar
schools without programs (Leaf & Preusser, 1995). Results reported that students in schools with
SADD programs were more likely to hold attitudes opposed to drinking and driving and selfreported drinking and driving was slightly lower.
Goodwin (2004) examined the long-term effects of a social norms program on drinking and
driving. Breath samples were taken from students at a large public university as they returned
home late at night. Following the social norms program, there was a marginally significant
decrease in drivers who registered positive BACs, from 15.3% to 10.8%. Among drivers who
had been drinking, self-reported number of drinks consumed and measured BACs decreased, as
did the number of drinking drivers who reported having five or more drinks at one sitting on the
night of the survey. Reducing this type of binge drinking may have safety benefits. Evans-Polce
et al. (2017) examined the relationship between 12th grade drinking intensity and driving-related
consequences at 19 and 20 years old and found that 12th grade binge drinkers were more likely
to experience negative driving-related consequences at 19 and 20, compared to 12th grade nonbinge drinkers. Overall, education programs that train young adults on how to resist peer
pressure and enhance informed decision-making skills may be the most successful approaches
(Kelly-Weeder et al., 2011; Botvin & Griffin, 2007).
Costs: Youth program costs can vary substantially depending on the size and nature of the
individual activities. States have spent substantial funds, both Federal and non-Federal, on youth
drinking-and-driving programs. These funds have been used for a variety of youth education,
enforcement, and programs.
Time to implement: With model programs available from organizations such as SADD and
MADD, youth programs can be started easily in 3 to 6 months.
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Appendix 1. Alcohol- and Drug-Impaired Driving
Other Issues:
• Other programs aimed at youths: A variety of programs are directed at youth. To
increase the perceived risks of drinking and driving, many schools have employed “fatal
vision goggles,” peer-to-peer programs, role plays, or drunk-driving crash reenactments
(e.g., “Every 15 Minutes”). Although popular, the vast majority of these programs have
not been evaluated. The few existing studies suggest these types of programs may
produce changes in knowledge or attitudes, but have little or no effect on behaviors
(Hover et al., 2000; Jewell & Hupp, 2005). Broader community-based programs have had
much greater success at reducing drinking and driving among youth than standard
education programs (see Chapter 1, Section 6.4).
• Mandatory education for young offenders: Young people who violate zero-tolerance
or MLDA-21 laws are often required to attend alcohol or traffic safety education
programs. Unfortunately, these programs often fail to produce positive outcomes. For
example, Rhode Island’s Reducing Youthful Dangerous Driving program was mandated
for youths 16- to 20 years old who received driving citations or who had substancerelated offenses. The 20-hour program consisted of four group sessions and two
emergency department visits. Twelve months following the program, there was no
difference between program participants and a comparison group in terms of high-risk
driving behaviors and traffic citation recidivism (Baird et al., 2013).
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Appendix 1. Alcohol- and Drug-Impaired Driving
7. Drug-Impaired Driving
7.2 Drug-Impaired-Driving Laws
Effectiveness: ✩
†Use for drug per se laws
Cost: Unknown
Use: Medium†
Time: Short
Overall Effectiveness Concerns: To date there have been no evaluations of the effect of drugimpaired-driving laws on the prevalence of drug-impaired driving or crashes.
It is illegal to drive under the influence of drugs or controlled substances in all 50 States, Puerto
Rico, and the District of Columbia (Boddie & O’Brien, 2018). However, there is a great deal of
variability in how States approach this issue. In some States impairment-based statutes stipulate
that prosecution must prove the driver was impaired (for example, by driving recklessly or
erratically). Some States have per se laws in which it is illegal to operate motor vehicles if there
are specific detectable levels of the prohibited drug in drivers’ systems. Other States make it
illegal to drive if there is a positive drug test. This is equivalent to “zero tolerance.” Some of
these laws exclude prescription drugs or marijuana (Compton, 2017).
Lacey et al. (2010) conducted interviews with LEOs, prosecutors, and other traffic safety
professionals in States with per se laws. Most were supportive of such laws. Although they did
not believe per se laws made enforcement easier, they reported these laws had positive effects on
the prosecution and conviction of drug-impaired drivers. Moreover, discussions with officers and
prosecutors in States without per se laws also revealed relatively high conviction rates, with few
cases reaching trial.
NHTSA’s 2009 Report to Congress included a model drug-impaired-driving law (Compton et
al., 2009). Because the relationship between blood levels of drugs and driving impairment has
not been established for drugs other than alcohol, the model law does not include a per se
provision. However, NHTSA recommends States include enhanced penalties for drivers who are
under the influence of drugs (including alcohol). In addition, NHTSA recommends State statutes
provide separate and distinct offenses and sanctions for alcohol- and drug-impaired-driving
(Compton et al., 2009; Compton, 2017). NHTSA’s 2017 Report to Congress also recommended
measures for improved data and records maintenance at the State level, including the distinction
between alcohol-use, drug-use, or both in impaired driving cases, and the distinction between the
types of drugs. See Compton (2017) for a detailed list of recommendations.
For a detailed discussion of issues related to drug-impaired-driving laws, see DuPont et al.
(2012). The authors make recommendations including improvement of drug testing technology,
enactment of laws requiring drug testing of all drivers in injury crashes, and addition of drug use
to underage zero-tolerance laws. See also Reisfeld et al. (2012) for arguments in favor of per se
laws for drug-impaired driving and a discussion of the challenges of establishing impaired drug
thresholds equivalent to .08 g/dL BAC. Finally, see NHTSA (2007) for recommendations to
improve the prosecution of drug-impaired-driving cases.
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Appendix 1. Alcohol- and Drug-Impaired Driving
Use: Twelve States (Arizona, Delaware, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota,
Pennsylvania, Rhode Island, Utah, and Wisconsin) forbid the presence of any prohibited drug or
its metabolites while drivers are in control of vehicles (NCSL, 2017). Six States (Kentucky,
Nevada, North Carolina, Ohio, Oklahoma, and Virginia) allow drivers to be charged with
impaired driving if any amount of specified drugs are found in them. Drivers under 21 may not
drive with any amount of specified drugs (NCSL, 2017). In 18 States it is illegal for drivers to
have any presence of marijuana in body fluid samples, and this includes 5 States (Montana,
Nevada, Ohio, Pennsylvania, and Washington) with specific per se limits for THC ranging from
1 to 5 ng (GHSA, 2018). As of March 2019 there were 34 States and the District of Columbia
that legalized marijuana use for medical purposes, and 12 States permitted the use low THC
products that had high cannabidiol (CBD) for medical use (NCSL, 2019). More information
about the drug-impaired-driving laws in each State can be found in NCSL (2019), Boddie &
O’Brien (2018), NHTSA (2018), Lacey et al. (2010), and Walsh (2009).
Effectiveness: Lacey et al. (2010) tried to determine whether drug per se laws increased drugimpaired-driving arrests and convictions. However, they were hampered by the fact that many
States do not record drug-impaired offenses separately from alcohol-impaired offenses. To date
there have been no evaluations of the effect of drug-impaired-driving laws on the prevalence of
drug-impaired driving or crashes. The GHSA recommends zero-tolerance laws over per se laws
for illegal drug-, marijuana-, or opioid-impaired driving (Hedlund, 2018). Zero tolerance laws
may be easier for drivers to understand over per se laws because, unlike standards for alcohol
drinks, there are no standard measures of drug doses that can be consumed to stay below the per
se levels (Hedlund, 2018).
Costs: The costs of drug-impaired-driving laws will depend on the number of offenders detected
and the penalties applied to them.
Time to implement: Drug-impaired-driving laws can be implemented as soon as appropriate
legislation is enacted, although time will be needed to train LEOs, prosecutors, and judges about
the new legislation and to inform the general public.
Other issues:
• Per se laws and prescription medications: Some States with per se laws for drugimpaired driving exclude prescription medications from the list of prohibited drugs.
Others require drivers to provide valid prescriptions to avoid being charged or convicted
for drug-impaired driving. Using a medication as prescribed, however, can still lead to
impairments in driving ability. For that reason, it is important that warning labels include
information about the risks of using medications while driving. Also, physicians and
pharmacists should counsel patients about driving risks, as appropriate. See Chapter 1,
Section 7.3 for more information about patient education regarding medications. See also
Smith et al. (2018) and Voas et al. (2013) for a discussion of issues related to per se laws
and prescription medications.
• Drug testing of fatally injured drivers: Driver drug use is not reported in many fatal
crashes. Moreover, there is inconsistent testing of drugs by laboratories, threshold
differences for determining a positive test result, and variation in how results are
reported. To better understand and track the drug-impaired-driving problem in the United
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Appendix 1. Alcohol- and Drug-Impaired Driving
•
States, improved data and data collection on drug-impaired drivers are needed, see
Berning and Smither (2014). Logan et al. (2013) describe minimum recommendations for
toxicological investigation of fatal motor vehicle crashes.
Public support: There is strong approval among the general public for laws that prohibit
drug-impaired driving. A 2013 survey by the AAA Foundation for Traffic Safety found
that 80% of drivers support per se laws for marijuana (AAAFTS, 2014).
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Appendix 1. Alcohol- and Drug-Impaired Driving
7.3 Education Regarding Medications
Effectiveness: ✩
Cost: Unknown
Use: Unknown
Time: Long
Overall Effectiveness Concerns: This countermeasure has only been examined in a few studies.
Although some of the studies report increased awareness by pharmacists of the effects of
medication, there is no evidence of increased awareness among drivers. Overall, there are
insufficient evaluation data available to conclude that the countermeasure is effective.
Some medications prescribed by doctors can pose a risk for drivers. Prescription or OTC
medication use was found in about 13.0% (daytime) and 9.4% (nighttime) of all drivers in a
nationally representative roadside survey conducted in 2013 and 2014 (Kelley-Baker et al.,
2017). It is important that physicians, pharmacists, and patients receive information about the
potential risk of motor vehicle crashes associated with certain medications. Medscape offers
continuing medical education on medication-related driving impairments. NHTSA and the
American Geriatrics Society provide guidance for clinicians on counseling patients, particularly
older adults, on the potential for medication-related driving impairments. The report lists
common impairing classes of medication and their symptoms (see section 13 of Chapter 9 in
AGS & Pomidor, 2016). Clinicians are recommended to select non-impairing alternative
medication (if possible) and to consider the patients’ medication regime (e.g., other drugs,
substances) to avoid drug-additive driving impairment effects (AGS & Pomidor, 2016). The
AAA Foundation provides a free online tool that patients can use to check which of their
medications may potentially impair driving (www.roadwiserx.com).
The International Council on Alcohol, Drugs, and Traffic Safety has developed a categorization
system for medicinal drugs that can affect driving performance (Alvarez et al., 2007). The list
was intended for physicians and pharmacists, so they could better identify medications that could
impair driving skills and look for safer alternatives when possible. In 2008 and 2009 NHTSA
convened an expert panel to develop a list of medications or classes of medications that may be
“safe” for driving; however, the panel found inadequate information about specific medications
to develop such a list (Kay & Logan, 2011). The FDA published guidance for evaluating the
effects of psychoactive drugs on drivers’ ability to operate motor vehicles, Evaluating Drug
Effects on the Ability to Operate a Motor Vehicle: Guidance for Industry (82 Fed. Reg. 52052,
November 9, 2017). The FDA recommends a tiered approach consisting of
pharmacology/toxicology testing, epidemiology, and standardized behavioral/clinical
assessments of functional driving ability (e.g., executive functions, psychomotor performance).
The FDA also recommends the inclusion of driving impairment effects in the product labeling.
The effects of medications on driving are a particular concern with older drivers. Nearly 70% of
people 55 and older each use at least one prescription medication that could potentially impair
driving (MacLennan et al., 2009). In addition, research shows that older drivers taking three or
more impairing medications are 87% more likely to be involved in crashes (LeRoy & Morse,
2008). For reviews on medications and road safety, see De Gier (2006), Vandrevala et al. (2010),
and Smith et al. (2018).
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Appendix 1. Alcohol- and Drug-Impaired Driving
The AAA Foundation for Traffic Safety conducted a study of countermeasures for driving
impairments due to prescription and OTC drugs (Smith et al., 2018). The study included
literature reviews, panel and individual interviews with experts, and reviews of existing data. The
author summary noted that patient counseling, prescription labeling, placing impairing OTC
drugs behind the pharmacy counter, and implementation of new technologies such as electronic
pharmacy prompts show promise in preventing impaired driving. Other recommendations
included the push for States and localities to develop their own material targeting education
around specific medications or populations (see Colorado DOT’s campaign material at
www.codot.gov/safety/alcohol-and-impaired-driving/druggeddriving/assets/2016-campaignmaterials/dui-poster-espanol.pdf). Challenges to implementation of these measures included the
lack of deterministic research on drug-specific driving impairments and sparse availability of
patient counseling time across healthcare units.
Use and Effectiveness: There is little information available on how frequently this
countermeasure is used in the United States, or how effective it has been in raising awareness,
increasing knowledge, or changing behavior. NHTSA worked with Walgreens, the country's
largest drugstore chain, to develop a curriculum for pharmacists on medication-impaired driving.
The curriculum modules covered potentially driver-impairing prescription drugs, laws relating to
medication use and DWI, and the role of pharmacists in counseling patients regarding
medications and driving risk. A pilot test with 640 pharmacists showed that the curriculum was
effective in increasing pharmacists’ knowledge of medication-related impaired driving (Lococo
& Tyree, 2007). The complete curriculum has not yet been evaluated.
Legrand et al. (2012) tested several methods of training and administering the DRUID 9 system
with pharmacists in Belgium. Following training, more pharmacists reported being aware of the
effects of medications on driving, and more pharmacists talked with their patients about drivingrelated risks. The results were strongest among pharmacists who had the DRUID system
integrated into their existing computer software for dispensing medications.
Studies with patients have been less encouraging. Smyth et al. (2013) conducted interviews with
patients who were using medications that could influence their driving. Half (49%) did not recall
seeing the warning label on the medication. Instead, there was a high level of confidence among
patients that they could determine themselves whether it was safe to drive. Monteiro et al. (2013)
investigated the effectiveness of pictograms in communicating the degree of driving risk
associated with certain medications. It was apparent that many patients failed to fully understand
what was being conveyed by pictograms, and often misjudged how risky it would be to drive
while taking the medication. Smith et al. (2018) also arrived at similar findings from expert
interviews, including the insight that many Americans do not associate the warning to “not
operate heavy machinery” to driving their vehicles. The experts in their study suggested adding
The forward to a report on the DRUID project says, “[T]he European Union’s research project on Driving
Under the Influence of Drugs, Alcohol and Medicines, [is] known as the DRUID project. The project was
set up by the European Commission’s Directorate-General for Energy and Transport and comprised
seven work packages: experimental studies, epidemiological studies, enforcement, classification (of
medicines), rehabilitation, withdrawal (of driving licence), and dissemination and guidelines. Over
5 years of work across 18 countries, the project has produced some 50 reports, each one
contributing key evidence to road safety policy” (Schulze et al., 2012).
9
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Appendix 1. Alcohol- and Drug-Impaired Driving
visual indicators such as changes to the color of the driving-specific warning label, color of the
prescription bottle, and increasing the minimum font size to accommodate older drivers.
Part of the 2013-2014 National Roadside Survey of Alcohol and Drug Use surveyed drivers and
collected data on prescription drug use. Questions on the frequency of use of potentially
impairing prescription drugs, types of medication warnings, and perceptions of risk were
included in the survey. Of the 7,405 drivers who completed the survey, 19.7% reported taking at
least one potentially impairing drug in the past 2 days, and of these, 78.2% reported that the drug
was prescribed for use. Sedatives (8.0%), antidepressants (7.7%), and narcotics (7.5%) were the
most commonly prescribed drugs, followed by stimulants (3.9%). Most of the drivers taking
sedatives (85.8%) and narcotics (85.1%) reported receiving warnings from their health care
provider or the medication label; however, fewer people reported the same for antidepressants
(62.6%) and stimulants (57.7%). Drivers perceived sleep aids, morphine/codeine, amphetamines,
and relaxants as most likely to affect safe driving, whereas, ADHD medications were perceived
least likely to affect safety. These results provide direction on specific medications and patient
populations that may be chosen to receive increased education from healthcare providers (and
warning labels) (Pollini et al., 2017).
Costs: Targeted education to physicians and pharmacists through drug categorization systems
and to drivers through warning labels would be needed. The former would likely be costlier.
Time to implement: Targeted communications could require a year or more to plan, produce,
and distribute.
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Appendix 1. Alcohol- and Drug-Impaired Driving
Alcohol- and Drug-Impaired-Driving References
82 Fed. Reg. 52052 (November 9, 2017), Evaluating Drug Effects on the Ability to Operate a
Motor Vehicle: Guidance for Industry: Food and Drug Administration.
www.federalregister.gov/documents/2017/11/09/2017-24367/evaluating-drug-effects-onthe-ability-to-operate-a-motor-vehicle-guidance-for-industry-availability
AAA Foundation for Traffic Safety. (2014). 2013 Traffic Safety Culture Index.
https://aaafoundation.org/wpcontent/uploads/2018/01/2013TrafficSafetyCultureIndexReport.pdf
Alcohol Epidemiology Program. (2000). Alcohol policies in the United States: Highlights from
the 50 States. Minneapolis, MI: University of Minnesota, School of Public Health.
www.impacteen.org/generalarea_PDFs/Alcohol%20Policies%20in%20the%20United%2
0States.PDF
Alvarez, J., de Gier, H., Mercier-Guyon, C., & Verstraete, A. (2007, June 26). Categorization
system for medicinal drugs affecting driving performance [Report of the ICADTS
Working Group]. International Council on Alcohol, Drugs and Traffic Safety
www.icadts.nl/reports/medicinaldrugs1.pdf
American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing
and counseling older drivers, 3rd edition (Report No. DOT HS 812 228). National
Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1988
Baird, J., Nirenberg, T. D., Longabaugh, R., & Mello, M. J. (2013). The effect of group-adapted
motivational interviewing on traffic convictions and driving behaviors of courtadjudicated youth. Traffic Injury Prevention, 14, 572-577.
Berning, A., & Smither, D. D. (2014, November). Understanding the limitations of drug test
information, reporting, and testing practices in fatal crashes (Traffic Safety Facts
Research Note. DOT HS 812 072). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812072
Boddie, A., & O’Brien, A. (2018, March). 2016 digest of State laws: Driving under the influence
of drugs. First edition (Report No. DOT HS 812 468). National Highway Traffic Safety
Administration. https://rosap.ntl.bts.gov/view/dot/40782
Botvin, G. J., & Griffin, K. W. (2007). School-based programmes to prevent alcohol, tobacco
and other drug use. International Review of Psychiatry, 19(6), 607-615.
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A1-22
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A1-23
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A1-24
Appendix 1. Alcohol- and Drug-Impaired Driving
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A1-25
Appendix 1. Alcohol- and Drug-Impaired Driving
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A1-26
Appendix 1. Alcohol- and Drug-Impaired Driving
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A1-27
Appendix 1. Alcohol- and Drug-Impaired Driving
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A1-28
Appendix 1. Alcohol- and Drug-Impaired Driving
Wheeler, D. R., Rogers, E. M., Tonigan, J. S., & Woodall, W. G. (2004). Effectiveness of
customized victim impact panels on first-time DWI offender inmates. Accident Analysis
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A1-29
Appendix 2. Seat Belts and Child Restraints
A2. Seat Belts and Child Restraints
There are no ✩ or ✩✩ countermeasures in this program area.
A2-1
Appendix 3. Speeding and Speed Management
A3. Speeding and Speed Management
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Laws
Countermeasure
1.2 Aggressive Driving and Other Laws
Effectiveness
✩
Cost
Use
Time
$
Low
Short
Cost
Use
Time
$$$
Low†
Medium
Varies
Unknown
Varies
2. Enforcement
Countermeasure
2.2 High-Visibility Enforcement
2.3 Other Enforcement Methods
† For
Effectiveness
✩✩
✩✩
aggressive driving, but use of short-term, HVE campaigns for speeding is more widespread
3. Penalties and Adjudication
Countermeasure
3.1 Penalty Types and Levels
3.2 Diversion and Plea Agreement Restrictions;
Traffic Violator School
Effectiveness
✩✩
✩
A3-1
Cost
Use
Time
Varies
High
Low
Varies
Unknown
Varies
Appendix 3. Speeding and Speed Management
Effectiveness:
✩✩
Effectiveness still undetermined; different methods of implementing this countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A3-2
Appendix 3. Speeding and Speed Management
1. Laws
1.2 Aggressive Driving and Other Laws
Effectiveness: ✩
Cost: $
Use: Low
Time: Short
Overall Effectiveness Concerns: There is currently no evidence that aggressive driving laws in
general, or increased penalties in particular, affect aggressive driving and related crashes.
Aggressive driving actions are covered by specific traffic laws, such as the laws regarding
speeding, improper lane changes, and following too closely, or by general laws, such as those
that target reckless driving. Most existing reckless driving statues carry relatively minor penalties
and may be difficult to prosecute according to NHTSA (2001a). Aggressive drivers, as distinct
from aggressive driving, often can be identified as those who violate traffic laws repeatedly or
whose violations lead to crashes producing serious injury or death. Therefore, the primary 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. Existing statutes, including
reckless driving laws, may be strengthened or aggressive driving laws may be enacted.
NHTSA’s 1999 Symposium on Aggressive Driving and the Law recommended that States
implement laws targeting aggressive drivers 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 (NHTSA, 2001a).
NHTSA also developed a model statute that defines aggressive driving as three moving
violations in a single driving incident and some States have adopted similar laws; however,
aggressive driving violations may be difficult to enforce and prosecute (Flango & Keith, 2004).
The NCHRP Aggressive Driving Guide also suggests a strategy of applying increased sanctions
and treatment for repeat offenders and serious offenses (Neuman, Pfefer, Slack, Hardy, Raub, et
al., 2003, Strategy A3).
Use: In general, States provide for increased penalties for repeat offenders and for violations
with serious consequences. As of May 2018 some 11 States have aggressive driving laws—
Arizona, Delaware, Florida, Georgia, Indiana, Maryland, Nevada, North Carolina, Rhode Island,
Vermont, and Virginia (Essex et al., 2018). Some other States that do not have aggressive
driving laws per se, still include behaviors similar to aggressive driving in other laws, such as
reckless driving (California, New Jersey, and Utah). In 2006 Pennsylvania passed a resolution to
support practices that promote safe driving and to encourage drivers to not drive aggressively.
Effectiveness: There is as yet no evidence for whether aggressive driving laws in general, or
increased penalties in particular, affect aggressive driving and related 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 or
altered laws. Additional costs may result as drivers are sentenced to more costly sanctions.
A3-3
Appendix 3. Speeding and Speed Management
Time to implement: Law changes can be implemented quickly, once legislation is passed and
publicized.
Other issues:
• Public acceptance, enforcement, and publicity: Without the use of enforcement and/or
publicity, law changes by themselves cannot reduce aggressive driving. As noted
previously, highly publicized enforcement has proven effective in increasing compliance
with many traffic safety laws and reducing crashes and injuries: see for example sobriety
checkpoints (Chapter 1, Section 2.1) and seat belt use mobilizations (Chapter 2, Section
2.1). 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,
effective adjudication, and publicity (NHTSA, 2001a).
• Record-keeping: Information on prior convictions of offenders must be up-to-date and
available to prosecutors and court officials so that repeat and flagrant violators may be
prosecuted in keeping with the strategy to increase sanctions for these offenders.
Providing the technology and ability for patrol officers to obtain up-to-date driver history
information at the time of traffic stops is another strategy recommended to deal with
drivers with suspended or revoked licenses who continue to violate traffic laws (Neuman,
Pfefer, Slack, Hardy, & Waller, 2003).
A3-4
Appendix 3. Speeding and Speed Management
2. Enforcement
2.2 High-Visibility Enforcement
Effectiveness: ✩✩
Cost: $$$
Use: Low-Medium† Time: Medium
† Use is low for aggressive driving, but use of short-term, HVE campaigns for speeding is more
widespread
Overall Effectiveness Concerns: This countermeasure has been examined in several research
studies. Overall, the findings regarding countermeasure effectiveness are inconclusive. While
some studies suggest that high-visibility, anti-speeding and aggressive driving enforcement
campaigns produce some safety-related benefits, other comparable studies show no benefits or
even negative outcomes.
High-visibility enforcement campaigns have been used to deter speeding and aggressive driving
through both specific and general deterrence. In the HVE model, law enforcement targets
selected high-crash or high-violation geographical areas using either expanded regular patrols or
designated aggressive driving patrols. This model is based on the same principles as highvisibility 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, Seat Belt Use, Section 2.1).
In the HVE model, 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). Because speeding and aggressive driving are moving violations, officers
cannot use checkpoints. Rather, they must observe driving behavior on the road.
NHTSA’s Aggressive Driving Enforcement: Strategies for Implementing Best Practices
(NHTSA, 2000) provides brief descriptions of 12 aggressive driving enforcement programs from
around the country. A few examples:
• The Albuquerque, New Mexico, Safe Streets program used saturation patrols in four
high-crash and high-crime areas, writing tickets when infractions were observed. At
about the midpoint of the program, traffic enforcement focus was shifted from the high
crime neighborhoods to high crash corridors and intersections. On freeways, they
observed speeding and aggressive driving from a “cherry picker” platform and radioed
to patrol officers. See Stuster (2001) for more information including some measures of
program effects.
• The greater Washington, DC, area multi-agency Smooth Operator program used shared
publicity and coordinated enforcement waves with marked and unmarked patrol
vehicles as well as nontraditional vehicles. See this program brochure for more
specifics. https://safety.fhwa.dot.gov/speedmgt/ref_mats/fhwasa09028/resources/Smooth%20Operator%20Brochure.pdf
• The Washington State Patrol’s Enforcement Target Zero Program involves State troopers,
county sheriff’s deputies, and city and tribal police officers collaborating to focus on
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Appendix 3. Speeding and Speed Management
those violations proven to cause fatal or serious injury collisions. The program uses
mapping to target resources and experienced officers and training on completing
investigations and arrest reports to assist with prosecution. See Thomas et al. (2015) for
more information.
See a few other examples of high-visibility speed and aggressive driving enforcement programs
in GHSA’s Survey of the States: Speeding and Aggressive Driving (Sprattler, 2012), and
NHTSA’s Aggressive Driving Programs (NHTSA, 2001b).
Use: High-visibility speed enforcement campaigns are common, with most States providing
some funding for speed equipment (47 States and Guam), overtime enforcement (42 States and
Guam), or speed public information campaigns (31 States and Guam) (Sprattler, 2012).
Relatively few States fund aggressive driving-related equipment or enforcement (6 States;
Sprattler, 2012) and it is likely that high-visibility aggressive driving enforcement campaigns are
not common. Neuman, Pfefer, Slack, Hardy, Raub, et al. (2003, Strategy A1) provide a few
examples of aggressive driving enforcement programs.
Effectiveness: Moon and Hummer (2010) estimated that 8 to 9% of the total and injury crash
reduction effects of around 25% associated with an automated mobile, speed enforcement
program in Charlotte, North Carolina, were attributable to media coverage of the program. In
addition to results from automated camera enforcement programs (see Section 2.1), which
typically incorporate a significant amount of publicity and media coverage (see section 4.1),
some crash-based effectiveness evidence comes from NHTSA demonstrations in three
communities. All three demonstrations lasted 6 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% in targeted corridors and by 2% in
comparison corridors (McCartt et al., 2001). The Indianapolis demonstration was not a success.
Average speeds dropped slightly. Total crashes increased 32% 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 (Stuster, 2004).
Tucson had mixed results. Average speeds dropped moderately. Total crashes increased 10% in
the demonstration areas and decreased in comparison areas. However, the proportion of crashes
involving aggressive driving behaviors decreased by 8% in the demonstration areas.
Several studies have reported reductions in crashes or reductions in speeding or other violations
attributed to both general and targeted high-visibility speed enforcement campaigns. Although
the evidence is not conclusive, the trends are promising. These efforts have included a substantial
increase in general traffic enforcement in Fresno, California (Davis et al., 2006), and a
community-based, high-visibility speed enforcement campaign, entitled Heed the Speed, in the
Phoenix, Arizona, area that aimed to reduce pedestrian crashes and injuries (Blomberg & Cleven,
2006). No particular publicity measures were noted for the Fresno campaign, but it is likely that
the increase from 20 to 84 traffic patrol officers, the addition of 20 new police motorcycles and
radar guns, and more than 3-fold increase in citations in 2 years generated some publicity.
Publicity measures for the Heed the Speed campaign included street and yard signs, educational
material and active participation of neighborhood groups. Speed reductions were greatest in
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Appendix 3. Speeding and Speed Management
neighborhoods where new vertical traffic calming measures were also installed (Blomberg &
Cleven, 2006; also see a Traffic Tech summary, NHTSA, 2006).
An effort to scale-up the Heed the Speed program to 6 (out of 25 total) police districts in
Philadelphia, met with limited success and some challenges. There were both unique challenges,
including State legal restrictions on the use of radar for issuing citations, and other challenges,
which the planned use of a new speed enforcement technology was unable to overcome. These
other challenges such as competing law enforcement priorities, equipment loss, funding
limitations, difficulty engaging public involvement, and gaining message penetration that were
experienced in Philadelphia may also be challenges in other large cities. Even without increases
in speeding citations, however, there were decreasing trends in percentages of speeders on 17 of
24 streets over the 3 years of the program, especially on the streets that received a type of
engineering treatment– three-dimensional painted markings that simulate traffic calming devices.
Other treatments included ensuring appropriate posting of limits, message-oriented signs with
and without speed limit reminders along the roadways, and flyers and other outreach. See also
Section 4.1 Communications and Outreach in Support of Enforcement for more information.
A 2008 test of a 4-week, HVE campaign along a 6-mile corridor with a significant crash history
in London, England, found significant reductions in driver speeding in the enforced area. There
was also a halo effect up to two weeks following the end of the campaign (Walter et al., 2011). A
crash-based analysis was not conducted. The campaign was covered by print media as well as by
billboards and active messaging along the enforced corridor.
High-visibility model programs to target specific aggressive driving actions around large trucks
have also been undertaken in several States. The program, known as TACT (Ticketing
Aggressive Cars and Trucks) is modeled on the Click It or Ticket belt use campaigns. An
evaluation found promising results in reducing the number of targeted violations as the program
was implemented in Washington State; effects on crashes or injuries were not determined (Nerup
et al., 2006; Thomas et al., 2008). The TACT program was also used in Michigan. The
evaluation of this program by Kostyniuk et al. (2014) indicates that TACT messages reminding
drivers of the slogan “Leave More Space for Trucks” were successfully received with 40% of
drivers being aware of the slogan. However, given the awareness of this slogan, behaviors of
both light vehicle drivers did not change when driving around trucks. An unusual part of this
implementation of the TACT program was the visibility of two of four police vehicles at one
time in a relatively small geographical location. From a specific deterrence perspective, because
drivers generally revert back to the “old behaviors” once a police car passes by, having a second
police car available to follow up once drivers think they can revert back to unsafe behavior
increases the likelihood that these violators can be apprehended.
In summary, the evaluation evidence suggests that high-visibility, anti-speeding and aggressive
driving enforcement campaigns have promise, but safety benefits are far from guaranteed. Given
challenges in administering police enforcement resources, one approach to develop a sustainable
and effective campaign may be to randomly target low levels of conspicuous enforcement on an
unpredictable basis to a larger share of network roads that account for a significant majority of
injury crashes on the entire network (Newstead et al., 2001). Such a program may warrant
expanding enforcement coverage to many more roads in a jurisdiction to increase network-wide
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Appendix 3. Speeding and Speed Management
deterrence. In Queensland, Australia, the Random Road Watch enforcement program aims
explicitly to cover a large portion of the road network where serious crashes occur, not just crash
black spots, by randomly targeting police enforcement for two hour periods from 6 a.m. to
midnight using marked, parked police vehicles. Significant reductions in fatal and all crashes
were estimated for the enforced zones that translated into statewide reductions of 12% in all
severity of crashes and 15% of the State’s fatal road crashes (including non-metro areas). No
additional publicity was undertaken; it is unknown how much free publicity the program
generated.
Other methods making use of enforcement time halos such as enforcing a corridor or other area
for up to 4 weeks as described earlier, and then rotating the enforcement to another zone could
also be used to maximize enforcement’s deterrent effects.
Costs: As with alcohol-impaired driving and seat belt use enforcement campaigns, the main
costs are for law enforcement time and for publicity. The Minnesota Speed Management
Program cost approximately $3 million, with $2.5 million for increased enforcement, $350
thousand for paid media (primarily radio), and $150 thousand for data collection and evaluation.
The Minnesota DOT and State Patrol also made significant in-kind contributions toward project
management, sign installation, speed detection equipment, engineering reviews, and fuel and
vehicle costs (Harder & Bloomfield, 2007). The Milwaukee demonstration received a $650,000
grant and the other two demonstrations each received a $200,000 grant. Public-private partners
(such as those in interests in injury prevention and public health) may be able to assist with
publicity.
Time to implement: HVE campaigns may require 4 to 6 months to plan, publicize, and
implement.
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Appendix 3. Speeding and Speed Management
2.3 Other Enforcement Methods
Effectiveness: ✩✩
Cost: Varies
Use: Unknown
Time: Varies
Overall Effectiveness Concerns: In general, these technological measures have not been
adequately studied to reliably determine their effectiveness.
Many traffic enforcement operations help to deter speeding and aggressive driving as well as
other traffic offenses. In addition to HVE campaigns (Chapter 3, Section 2.2) and automated
enforcement (Section 2.1), new technologies have been recommended to address speeding and
aggressive driving (NHTSA, 2001a). LEAs around the country have also conducted innovative
and effective aggressive driving enforcement programs (NHTSA, 2000).
Technology: Both external and in-vehicle technologies 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, but effects may last only as
long as the devices are in place (Donnell & Cruzado, 2008). They may also suggest to
drivers that speeds are being monitored or enforcement is nearby. Signs that provided
either an implication that speeds were being monitored or a social norms message
(average speed at the site; your speed) were effective at reducing speeds in a 50 km/h
zone although not as much as in earlier studies (Wrapson et al., 2006). Other studies have
shown that speed trailers or portable changeable message signs, which may include speed
feedback plus other messages such as “Slow Down Now” can be effective in reducing
speeds in work zones (Brewer et al., 2006; Mattox et al., 2007) and school zones (Lee et
al., 2006). Automated speed display monitors also provide a method to collect locationspecific travel speed data. Speed feedback devices are likely to be more effective on twolane highways than multi-lane ones. In addition, they may not provide accurate speed
indications if traffic volumes are too high (Ullman et al., 2013). Speeds seem to rebound
quickly downstream and as soon as the devices are removed (Walter & Broughton, 2011;
Hajbabaie et al., 2011).
• In work zones, a combination of a parked police vehicle and speed feedback trailer
reduced average and 85th percentile traffic stream speeds and free flow speeds to a
similar degree as automated camera enforcement, whereas the effect of speed trailers
alone was the same as no treatment. Parked police alone was also effective, but to a lesser
extent than the combination of police + trailer or the camera system. The number of
speeders above 10 mph over the limit was essentially reduced to zero by both the
automated enforcement and police + trailer combination. However, the treatment effects
on speeds in work zones disappeared in 40 – 50 minutes of removal (Hajbabaie et al.,
2011). See the Ullman et al. (2013) Report 746 for in-depth discussion of advantages,
disadvantages and deployment considerations for methods of traffic enforcement in work
zones. According to this report, which provides state of the knowledge for work zone
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Appendix 3. Speeding and Speed Management
•
•
•
•
enforcement, there have been insufficient controlled trials to identify the optimal mix of
enforcement types and other treatments for different highway types, geometries, and
work zone situations. The report reiterates the importance of work zone speed limits that
reflect the situation, including the presence of workers or alignment changes.
Drone radar – A study of the use of this technology in work zones suggests that it may be
effective at reducing overall speed of the traffic stream, with particularly large speed
reductions among vehicles equipped with radar detectors (Eckenrode et al., 2007). Both
in-vehicle driver warning systems, as well as traditional cruise control, are widely
available technologies that may be well-accepted by drivers to help govern their own
speeds (Sivak et al., 2007; Young & Regan, 2007).
Intelligent speed adaptation (ISA) involves in-vehicle devices that “know” the speed limit
through accurate digital maps of speed limits and GPS data of the vehicle location. ISA
systems can either warn when the speed limit is being exceeded (i.e., open ISA) or apply
active controls to slow the vehicle (i.e., closed ISA) (more details about levels of ISA can
be found from European Commission, 2015). A pilot study was conducted in the United
States among a group of repeat violators. (See section 3.1 for information about this
study.) The devices have been widely studied in European countries for acceptability and
effects on driver behavior with more widespread on-road trials currently underway. (See
www.ec.europa.eu/transport/road_safety/specialist/knowledge/speed/new_technologies_n
ew_opportunities/intelligent_speed_adaptation_isa_en for more information.) In Europe,
the effects on speeding have been fairly dramatic for both warning and control type ISA
systems, decreasing the amount of speeding and narrowing the speed distributions
(Carsten, 2012; Lai & Carsten, 2012; van der Pas et al., 2014). These are very promising
results for potential crash and injury reductions. However, a widespread implementation
and trial have yet to be documented. While there remain issues to be resolved, including
the extent to which behaviors in international trials are generalizable to the United States,
the main roadblock to implementation may be political (Carsten, 2012) rather than safety
or technological reasons. Some issues uncovered in trials include that serious offenders
were more likely to disable or over-ride the devices than other drivers (van der Pas et al.,
2014), and may be less likely to adopt ISA use, even with incentives (Chorlton et al.,
2012; De Leonardis et al., 2014). It is not clear if drivers’ behavior may change after the
devices are inactivated, or when they are disabled. Drivers’ intentions to speed and actual
behaviors were assessed following driving with an Intelligent Speed Adaptation invehicle system that provided direct resistance to speeding (Chorlton & Connor, 2012).
While measured intentions to speed and impressions of time-savings that could be gained
by speeding were decreased among the participants, actual speeding behavior after the
system was inactivated returned to pre-exposure levels within 4 weeks.
According to researchers from the United Kingdom, the devices may potentially be overridden where they may be most needed (Lai & Carsten, 2012). Other uncertainties also
still exist about driver behaviors or adaptations, and even external forces that may
potentially affect the costs and benefits of ISA (van der Pas et al., 2012). Finally, there is
a need to provide current and accurate maps of speed limits (Carsten, 2012).
A study of the effects of in-vehicle warning and monitoring systems was disappointing
with respect to speed control by young teens (Farmer et al., 2010). Even with parental
notification (immediate or delayed) and with or without in-vehicle alerts, there was either
no reduction in instances of teens exceeding the limit by more than 10 mph or initial
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Appendix 3. Speeding and Speed Management
•
•
declining trends reversed after a few weeks.
Alerts or speed monitoring combined with rewards may work better than alerts and
monitoring alone. Several field tests from Europe have found that drivers exceeded limits
less when offered economic incentives such as reduced insurance premiums or discounts
(for lease vehicles). Results were positive for lease car drivers in the Netherlands
(Mazureck & van Hattem, 2006), young drivers in the Netherlands (Bolderdijk et al.,
2011), and members of a large motor club in Sweden (Stigson et al., 2014).
In the United States, several vehicles with intelligent speed adapation (ISA) capabilities
(open ISA level) are currently available (see NTSB, 2017). A study (Blomberg et al.,
2015) tested a half-open ISA system with young drivers (18-24 years old, N = 44) to
examine its effectiveness in speed reduction. The results showed that the ISA
significantly reduced the incidence of speeding episodes that exceed 5+ mph over the
posted speed limit.
Many jurisdictions use some of the above technologies. Each has costs for new equipment,
maintenance, and training, and perhaps other costs. In the case of ISA, accurate digital maps of
speed limits are needed.
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Appendix 3. Speeding and Speed Management
3. Penalties and Adjudication
3.1 Penalty Types and Levels
Effectiveness: ✩✩†
† For general traffic offenses
Cost: Varies
Use: High
Time: Low
Overall Effectiveness Concerns: This countermeasure’s effectiveness has been examined in
several research studies. The balance of the evidence suggests that these types of
countermeasures are ineffective in the long term.
Penalty types and levels for speeding and the 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 (Neuman,
Pfefer, Slack, Hardy, Raub, et al., 2003, Strategy A3; NHTSA, 2001a).
States use the demerit point system in an attempt to prevent drivers from committing repeated
traffic offenses. As drivers accumulate demerit points, States use actions and penalties such as
warning letters, educational brochures, group counseling meetings, individual counseling,
administrative hearings, and driver’s license suspension or revocation (Masten & Peck, 2004).
Penalty levels and types for speeding and aggressive driving offenses should be considered in 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: Generally, for penalties to be effective, perceived risk of getting caught must be
high. Evidence is mixed about effectiveness of varying severity of penalties. 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% and violations by 8%. Even simple warning letters had 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. However, administrative
penalties imposed by the driver licensing agency were more effective than penalties imposed by
the courts.
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Appendix 3. Speeding and Speed Management
Elvik and Christensen (2007) reported there was a weak tendency for speeding violations in
Norway to decrease near camera-enforced sites in response to increasing fixed penalties over
time. However, there was no general effect of increasing fixed penalties over the road system at
large. The researchers thought this was likely due to the overall low risk of detection.
Evaluations of the introduction of penalty point systems in European and Middle-Eastern
countries, including Kuwait in 2006, suggest that the introduction of penalty points, including for
speeding, have significantly reduced road traffic injuries (Akhtar & Ziyab, 2014). Although the
time series analysis may not have been able to control for all confounders, including driver
education weeks and the volume of citations, the results of this and other studies suggest that
introduction of a penalty system can be an effective safety measure, in conjunction with
enforcement and education. However, the long-term effects of penalty systems are somewhat
uncertain and likely depend on how they continue to be implemented.
For example, research in Maryland found that legal consequences for speeding had little impact
on future citations for individual drivers (Lawpoolsri et al., 2007). Drivers who received legal
consequences had the same likelihood of receiving another speeding citation as drivers who
escaped legal consequences. Only fines coupled with probation before judgment was associated
with a reduced risk of receiving a subsequent speeding ticket. A follow-on longitudinal study
found that the 54% of cited drivers who opted for court appearance to contest their speeding
citations were more likely to be involved in future crashes and receive future speeding citations
than drivers who accepted a guilty verdict and paid fines by mail (Li et al., 2011). In addition,
whether drivers who opted for court appearance received guilty or not-guilty verdicts, or had
charges dismissed had little effect on deterrence of future speeding or prevention of crashes, even
controlling for prior driver histories and other potential confounders. Only suspended types of
prosecutions (e.g., probation before judgment or other suspension) were associated with
somewhat decreased risk of speeding recidivism and future crashes, but a still higher risk
compared to those who paid fines by mail. The two types of suspended prosecutions associated
with somewhat reduced future speeding and crash risk both provide some incentive to avoid
additional citations that would result in a reinstatement of charges and potential loss of license.
Also, many drivers receiving suspended judgments may have had reduced exposure owing to
having prior alcohol traffic violations and license restriction/suspension.
Similar to the results from Maryland, a British study that examined survey and conviction data
found that the immediate threat of being disqualified from driving deterred those with points on
their license from further speeding. However, for a subset of drivers, the threat of this sanction
did not appear to affect their choice to speed (Corbett et al., 2008).
Most evidence suggests there is at least a subset of drivers for whom sanctions and increasing
penalties do not seem to have the desired deterrent effect. Many studies and NHTSA statistics
verify the prevalence of young, male driver involvement in speeding crashes. A review of the
literature by Fuller et al. (2008) suggests that young males may simply be immature, with
incomplete development of self-knowledge, self-control, social responsibility, and independence
of judgment. Drivers with attention deficit hyperactivity disorder (ADHD) may be particularly at
risk because of self-control challenges. In addition, there is evidence of socially deviant speeders
for whom speeding is associated with other forms of risk-taking. These groups are distinguished
from those who speed unintentionally due to failure to perceive risks and adjust accordingly.
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Appendix 3. Speeding and Speed Management
Repeat offenders: Repeat speeding and aggressive driving offenders may be especially difficult
to deter. Recommended methods to address these offenders include:
• Enhanced penalties, including increased driver’s license points, immediate license
suspension or revocation, higher fines, and jail or probation, but research described in this
section makes clear that the availability of such penalties alone is unlikely to lead to
individual deterrence of speeding. See Chapter 3, Sections 1.2 and 3.1, for more
information. The certainty of punishment may be more important than the level of
penalty (Li et al., 2011; Shinar, 2007). Furthermore, courts may be reluctant to impose
the most serious penalties, such as license suspension, for speeding violations, or simply
unable to effectively prosecute speeders as charged.
• Improved traffic record systems, to better identify repeat offenders and to allow patrol
officers to immediately access a driver’s complete driving record (Neuman, Pfefer, Slack,
Hardy, & Waller, 2003; NHTSA, 2001a). There are no studies of the effects of improved
record systems on repeat offenders. Costs and implementation time will vary.
• Providing alternate modes of transportation, electronic monitoring, enforced restrictions
or limits on mobility through license plate “striping” or vehicle impoundment are other
recommendations to address unlicensed drivers, including those who have already
received the maximum penalties but continue to drive (Neuman, Pfefer, Slack, Hardy, &
Waller, 2003).
In the future, there may be potential to use ISA (vehicle-based speed monitoring and warning or
control of speed) systems for repeat offenders. A Maryland pilot study assessed the effects of an
ISA warning type system on speeding behavior among 78 volunteer drivers who had at least
three speeding violations in the prior 3 years (De Leonardis et al., 2014). Both verbal and red
LED light alerts were provided in real time to the drivers when their speed exceeded the speed
limit on a given road by more than 8 mph. Subjects’ speeding behavior was monitored for 2
weeks prior to the systems being activated, for 4 weeks with the warning systems activated, and
for a 2-week follow-up period with the alert systems deactivated. Results were promising.
Drivers sped more than 8 mph over the limit a small, but significantly lower proportion of the
distance driven during the alerting phase (0.43) compared to the baseline phase (0.45).
Proportion of speeding also remained somewhat lower (0.44) during the two-week follow-up
period when the systems were turned off except among the more habitual speeders, who
immediately resumed their normal speeds. However, participants were very concerned about
providing driving speed data to insurance or licensing agencies. They anticipated negative
consequences, including the potential for revocation of their driver licenses and increased
insurance premiums. Such concerns would need to be addressed to encourage drivers to
voluntarily use such a system to help control their speed (De Leonardis et al., 2014). In general,
the systems seemed to be well accepted by a majority of the drivers, except for the concerns
mentioned. Two types of ISA – speed alerting and speed-controlling – were also evaluated
among a group of serious speeders in the Netherlands (van der Pas et al., 2014). While the
devices were active, there was much less speeding, but once inactivated, levels of speeding
quickly rebounded to normal levels.
Costs: Costs vary by penalty type. For example, warning letters are very inexpensive once a
record system has been established to identify drivers who should receive letters. Individual
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Appendix 3. Speeding and Speed Management
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 in a
State’s overall driver improvement system.
Other issues:
• Public acceptance, enforcement, and publicity: Changes in speeding and aggressive
driving sanctions by themselves cannot reduce speeding and aggressive driving. To be
effective, sanctions must be well known to violators and they must have a high
probability of being imposed (Preusser et al., 2008). Traffic laws, penalty types, and
penalty levels are essential to, but only a part of, a system that includes broad public
acceptance, active enforcement, effective administration of penalties, and publicity
(NHTSA, 2001a).
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Appendix 3. Speeding and Speed Management
3.2 Diversion and Plea Agreement Restrictions; Traffic Violator School
Effectiveness: ✩
Cost: Varies
Use: Unknown
Time: Varies
Overall Effectiveness Concerns: Although there is some research examining the effectiveness of
this countermeasure, there is insufficient evidence to conclude that the positive effects outweigh
the negative effects that have also been observed.
In many jurisdictions, drivers who have accumulated a specific number of demerit points on their
driver’s licenses are given the option of attending Traffic Violator School in order to reduce their
punishment. In most instances, if they complete Traffic Violator School, their traffic offenses are
dismissed or removed from their driving record (Masten & 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 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 5% and violations by 8%. 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 clean driving
records. This was reaffirmed in a study in 2010, where accounting for the favorable
characteristics of the Traffic Violator School participants (e.g., lower prior convictions) led to a
further increase (from 5% to 10%) in crash risk in the one-year after participation in the course
(as compared to a convicted group) (Gebers, 2010). Masten and Peck (2004) were not able to
determine whether other Traffic Violator School programs that dismissed an offender’s violation
had similar negative effects. These reductions or eliminations of penalties also make it difficult to
use driver histories to track and provide serious sanctions to repeat violators.
A more recent evaluation of a diversionary training course comes from the United Kingdom. The
National Speed Awareness Course is a short training course provided by police departments that
speeders can take as an alternative to paying penalties for low-level speeding infractions (Ipsos
MORI et al., 2018). The objective of the course is to convince participants to comply with speed
limits by fostering lasting changes in driver attitudes and behaviors towards speeding. The course
does this by directly challenging driver existing attitudes, offering insight, awareness and
understanding about their speed choices, and importantly, educating them on how they can
change their behavior. The effectiveness of the training course was evaluated by comparing crash
records for drivers that participated in the course with matched drivers that sited for similar
levels of speeding, but whom did not take the course, or were not offered the course (Ipsos
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Appendix 3. Speeding and Speed Management
MORI et al., 2018). The evaluation findings reported that drivers who took the course were
significantly less likely to reoffend over the 3-year evaluation period, with the difference
diminishing but remaining significant after the first 6 months following the course.
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 6
months to establish and implement. They can be modified in 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 alcohol-impaireddriving 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
public acceptance, active enforcement, and publicity (NHTSA, 200la).
A3-17
Appendix 3. Speeding and Speed Management
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A3-18
Appendix 3. Speeding and Speed Management
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A3-19
Appendix 3. Speeding and Speed Management
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A3-20
Appendix 3. Speeding and Speed Management
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A3-21
Appendix 3. Speeding and Speed Management
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by car drivers. Safety Science, 45, 473-485.
A3-22
Appendix 4. Distracted Driving
A4. Distracted Driving
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Laws and Enforcement
Countermeasure
1.2 Cell Phone and Text Messaging Laws
1.4 General Distraction Laws
††
Effectiveness
✩✩
✩
Cost
Use
Time
$
Medium
Short
Varies
High††
Short
Cost
Use
Time
$$
High
Medium
Cost
Use
Time
$
Unknown
Short
Included under reckless driving; use of explicit distraction laws is low.
2. Communications and Outreach
Countermeasure
2.1 Distracted Driving
Effectiveness
✩
3. Other Countermeasures
Countermeasure
3.1 Employer Programs
Effectiveness
✩
A4-1
Appendix 4. Distracted Driving
Effectiveness:
✩✩
Effectiveness still undetermined; different methods of implementing this countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A4-2
Appendix 4. Distracted Driving
1. Laws and Enforcement
1.2 Cell Phone and Text Messaging Laws
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Short
Overall Effectiveness Concerns: The effectiveness of laws banning cell phone use has been
examined in several research studies. The results across types of phone use are inconsistent.
Specifically, research examining prohibitions on hands-free phone use and texting have yielded
mixed results in terms of reductions in phone use while driving and reduced crashes. There is
some evidence that banning handheld cell phone use leads to long-term reductions in this
behavior; however, many State and Local laws were only recently passed and effectiveness is
still being examined. At this time, there is insufficient consensus across research findings to
determine that this countermeasure is effective.
Cell phones have become an essential feature of modern life. In a 2015 NHTSA survey of more
than 6,000 U.S. residents, 42% admitted to answering phone calls while driving and 56% of
these drivers continued driving while talking on the phone (Schroeder et al., 2018). NHTSA’s
2018 national observation survey found 3.2% of drivers on the road at any given moment were
using handheld cell phones (NCSA, 2019). The percentage of drivers who were manipulating a
handheld device (e.g., texting or dialing) increased from 0.6% in 2009 to 2.1% in 2018. NHTSA
currently estimates that 9.7% of drivers are using some type of phone (handheld or hands-free) in
a typical daylight moment. These estimates may underrepresent cell phone use given the inherent
difficulty in accurately observing these behaviors.
Many studies have investigated the effects of cell phone use on driving (see Caird et al., 2008,
and McCartt et al., 2006, for reviews). Experiments on simulators or test tracks indicate that
talking on cell phones has some effect on driving performance, most commonly slowed reaction
times, but these experiments cannot measure the impact on crash risk. For reasons outlined in the
overview, it can be difficult to determine whether cell phones contribute to individual crashes.
Two studies examining cell phone billing records concluded that drivers are four times more
likely to be involved in a serious crash when talking on cell phones (McEvoy et al., 2005;
Redelmeier & Tibshirani, 1997). In addition, these two studies and others have found that handsfree phones offer little or no safety advantage over handheld phones (Caird et al., 2008; Ishigami
& Klein, 2009). However, more recent studies have questioned the estimates of crash risk and
argued the real risk may be much smaller (Farmer et al., 2010; Young, 2012). Analyses of crash
events using SHRP2 NDS data found that aspects of cell phone use are associated with increased
odds of crash events (Dingus et al., 2016). The table below shows the increase in odds and the
baseline prevalence of the distraction in terms of the percentage of time drivers engaged in a
distracting task while driving. Actions such as dialing and texting show substantially elevated
odds of crash events, especially in comparison to more traditional sources of distraction, such as
tuning a radio (odds ratio of 2.9) and talking to a passenger (odds ratio of 1.4), which are not
shown in the table.
A4-3
Appendix 4. Distracted Driving
Type of Cell Phone Distraction
Change in Risk
Baseline
(Odds Ratio)
Prevalence
Total cell (handheld)
3.6
6.4%
Cell dial (handheld)
12.2
0.1%
Cell text (handheld)
6.1
1.9%
Cell reach
4.8
0.6%
Cell browse
2.7
0.7%
Cell talk
2.2
3.2%
Note: All odds ratios statistically different from 1 at the 0.05 level of significance.
Source: Dingus et al. (2016).
There is less disagreement about the dangers posed by texting while driving. In a study using
highly instrumented commercial motor vehicles, texting drivers were 23 times more likely to be
involved in a crash, near-crash, or other safety-critical event compared to uneventful baseline
driving (Olson et al., 2009). This is supported by experimental studies using driving simulations,
which suggest that texting drivers spend up to 400% more time looking away from the road and
are more likely to leave their lane than when not text messaging (Drews et al., 2009; Hosking et
al., 2009). In the 2015 NHTSA survey, 20% of drivers admitted to sending text messages or
emails while driving (Schroeder et al., 2018).
States have been very active in using legislation to address this issue. Since 2000 every State has
considered legislation to curtail distracted driving or driver cell phone use. In 2015 legislators in
42 States considered approximately 150 bills related to distracted driving (Teigen et al., 2016).
No State completely bans all types of cell phone use for all drivers. Bans on texting are more
common than bans on handheld cell phone use. Overall, public support is high for this
legislation. In surveys of the general public, between 70% and 80% favor bans on handheld cell
phone use, and 88% to 97% support bans on texting while driving (AAAFTS, 2013; Guarino,
2013; Schroeder et al., 2018).
Use: As of February 2020 talking on handheld cell phones was prohibited in 21 States (Arizona
[warning period through January 1, 2021], California, Connecticut, Delaware, Georgia, Hawaii,
Illinois, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey,
New York, Oregon, Rhode Island, Tennessee, Vermont, Washington, and West Virginia) and the
District of Columbia (GHSA, 2020). The cell phone bans in these States are primary laws. In
addition, several local jurisdictions such as Hampton, Virginia, and Cheyenne, Wyoming, have
enacted their own restrictions on cell phones. At present, no State restricts hands-free phone use
for all drivers.
Most States prohibit text messaging while driving. As of February 2020 there were 48 States and
the District of Columbia that prohibit text messaging for all drivers (GHSA, 2020).
Effectiveness: Evaluations in New York, Connecticut, the District of Columbia, and in other
countries consistently show that cell phone laws reduce handheld phone use by about 50%
shortly after the laws take effect (McCartt et al., 2006). The long-term effects of these reductions
in handheld cell phone use are unclear (McCartt & Geary, 2004; McCartt et al., 2010), and
currently, the effects of these laws on use of hands-free devices is unknown.
A4-4
Appendix 4. Distracted Driving
The effectiveness of handheld cell phone bans in reducing crashes is still unclear. Nikolaev et al.
(2010) examined driving injuries and fatalities in 62 counties in New York State both before and
after a handheld cell phone ban took effect. Forty-six counties showed significant decreases in
injury crashes following the ban, and 10 counties showed less-significant decreases in fatal
crashes. Although encouraging, the study did not include a control group to account for other
factors that may have decreased crashes. A study by the HLDI investigated State-level
automobile insurance collision claims in California, Connecticut, New York, and the District of
Columbia. When compared to neighboring States, there was no change in collision claim
frequency after these jurisdictions implemented handheld cell phone bans. The data from the
HLDI are proprietary, and not all crashes result in a collision claim, so collision claim rates may
differ from crash rates.
Four studies have examined the effectiveness of laws prohibiting cell phone use and texting
while driving. One study evaluated the effect of a texting ban in Michigan (Ehsani et al., 2014);
another examined insurance collision claims in States with texting bans compared to neighboring
States without such bans (HLDI, 2010). Both studies found small increases in types of crashes
and collision claims following enactment of texting bans. One possible explanation is that texting
drivers attempt to avoid detection by hiding their phones from view, which may result in more
time with drivers’ eyes off the roadway. Crash increases were also found in a study of crash data
in New Jersey (Maher & Ott, 2013). While crashes have declined statewide, cell phone-related
crashes increased after a cell phone and texting law was enacted. Additionally, the number of
citations issued declined after the first year after the ban took effect, possibly because law
enforcement resources are limited and issuing citations for cell phone use may be lower in
priority compared with other law enforcement objectives. Finally, a review and synthesis of 11
peer-reviewed articles found that, while such bans are highly effective at reducing cell phone use
while driving, the effect on crash outcomes is mixed (McCartt et al., 2014). Some studies
showed no change in crash rates for both handheld cell phone use and texting, while others
showed increases in crashes after the ban (although most of the studies reviewed had limitations
that diminish the strength of their conclusions). These findings suggest that the impact on crash
rates from cell phone bans is not clear, even though such bans are effective at reducing handheld
cell phone use.
Drivers’ attitudes and beliefs about the safety of using cell phones while driving are incongruous
with their actions. Maher and Ott (2013) found that New Jersey drivers are knowledgeable about
the law and assert that the law is necessary; however, a significant portion also admitted to
having violated the law. A more recent national survey indicates that communication of the
existence of State laws has generally been effective (Schroeder et al., 2018). Just over 90% of
drivers in States that have laws banning cell phones believe that these laws are in place.
However, driver perceptions are less accurate in States without these laws, where just over half
of drivers incorrectly believe that their State has such a law. The patterns are similar, but slightly
lower, when it comes to laws banning texting and emailing, where 78% of drivers correctly
report their State does or probably does have a ban. Just over half of drivers in States that do not
ban texting and emailing actually believe that such a ban is in place. Driver responses also
suggest that communication efforts have fostered the perception that drivers are at risk of getting
stopped for cell phone use. Specifically, over half of drivers think that they are very or somewhat
likely to get a ticket for talking on cell phones while driving, while only 3.6% of drivers report
ever having been stopped for engaging in this behavior (Schroeder et al., 2018).
A4-5
Appendix 4. Distracted Driving
Costs: As with any law, costs are required to publicize and enforce it. A handheld cell phone law
can be enforced during regular traffic patrol because drivers who are using handheld phones can
be observed relatively easily. However, some States with cell phone bans allow drivers to use
phones for specific purposes while driving (e.g., navigation), which can make enforcement more
challenging. As with other traffic safety laws, paid advertising supporting highly visible law
enforcement may be necessary to achieve substantial effects (see Chapter Y, Section 1.3).
Time to implement: A cell phone law can be implemented quickly, as soon as it is publicized.
Other issues:
• Cell phone blockers: In recent years, several manufacturers have created systems that can
block cell phones from making or receiving calls while people are driving. These systems
detect when the phone is in motion. During that time, incoming calls are automatically
diverted to voicemail and incoming texts are not shown until the driver has stopped moving.
Typically, these systems allow exceptions for phone calls from pre-specified numbers, and
some allow emergency calls to 911. Although these systems are potentially applicable to all
drivers, they have largely been marketed to parents of teen drivers. Researchers at the Texas
Transportation Institute tried to evaluate a cell phone disabling device for teens; however,
they encountered difficulty recruiting families and very strong resistance by parents and teens
to the device (Benden et al., 2012). NHTSA funded a study examining the effect of a
filtering/blocking application on the cell phones of 44 Michigan DOT employees. When the
application was active, participants placed and answered fewer calls while their vehicle was
in motion. However, participants were not very accepting of the application, and the
application was not completely reliable (Funkhouser & Sayer, 2013). NHTSA’s 2015
National Survey on Distracted Driving Attitudes and Behaviors found that 46% of applicants
would be open to using an app that would block phone calls and text messaging while driving
(Schroeder et al., 2018).
• Voice-to-text technology: There are several applications that allow drivers to send and
receive text messages using voice rather than manual entry. Although the research on these
applications is limited, it appears voice-to-text technology may offer little or no safety
benefit. In a study by Yager (2013), 42 participants drove instrumented vehicles on a closed
course while texting manually or using one of two voice-to-text applications. In all three
conditions, reaction times were slower and drivers spent more time looking away from the
roadway. More research is needed, but the findings suggest texting impairs driving
performance, regardless of what method of texting is used.
• Enforcement of cell phone and text messaging laws: Enforcement of cell phone use and
text messaging laws is challenging. Fewer States ban handheld phone use compared to text
messaging. It may be difficult for a LEO to determine whether a driver is messaging or
performing other functions on the phone (GHSA, 2013). A NHTSA study conducted in 2013
and 2014 investigated the enforceability of texting laws in Connecticut and Massachusetts
(Retting et al., 2017). A range of methods including spotter, stationary, and roving patrols,
with variations in the number of patrol officers, uniformed/plainclothes officers, and the
conspicuity of patrol vehicles, were used across four enforcement waves. Program evaluation
revealed insights for successful enforcement, including officer training, pre-planning of
operations, maximizing resources through local and State agency coordination, and the need
for strong distracted driving laws. The latter is particularly important in cases where officers
A4-6
Appendix 4. Distracted Driving
may not be able to prove that drivers were texting but can cite the violation of other laws
(e.g., handheld cell phone use). Twenty-six police officers from three Washington State
counties participated in focus groups to determine factors that influence consistent
enforcement of distracted driving legislation (Nevin et al., 2017). The factors that challenged
effective enforcement included inconsistency in what corresponds to legal use of handheld
devices, policies that do not extend to all drivers under all situations, and lack of clarity in
what constitutes a reportable driving violation. Other factors, including officers’ own beliefs
and attitudes towards electronics use in their own driving, drivers’ reactions and reasoning of
behavior when pulled over, departmental priorities related to distracted driving enforcement,
and prevalent local sociocultural norms also affected the success of enforcement practices.
Establishment of dedicated traffic patrol units, changes in local public perception through
campaigns, and clear delineation between prohibited activities and other electronic device
use in the law were improvements that the focus group participants noted might improve the
effectiveness of enforcement. In addition, some focus group participants also noted that
officer education on distracted driving can bring about a cultural change. The authors
developed an educational roll-call video for daily officer briefings that can help curb their
own distractions while driving and motivate them to enforce distracted driving (see
www.ncbi.nlm.nih.gov/pmc/articles/PMC5927816/bin/NIHMS942376-supplementOnline_Appendix_B.mp4).
A4-7
Appendix 4. Distracted Driving
1.4 General Driver Distraction Laws
Effectiveness: ✩
† Included
Cost: Varies
Use: High†
Time: Short
under reckless driving; use of explicit distraction laws is low
Overall Effectiveness Concerns: Laws that specifically target distracted drivers (including
handheld and texting bans) are not widely enforced, and this countermeasure has not been
systematically examined. There are insufficient evaluation data available to conclude that the
countermeasure is effective.
Existing State laws allow people to be cited and prosecuted if they cause crashes due to
distracted driving; however, the extent to which States pursue cases of inattentive driving is
currently unknown. In 2009 Maine enacted a general distracted driving law. A driver who is
involved in a crash or who commits an infraction can be cited for distracted driving if a police
officer believes that to be the underlying cause. The law defines distraction as an activity not
necessary to the operation of the vehicle that impairs, or could impair, the ability to drive safely.
Utah has a law that prohibits “careless driving,” which is defined as committing a moving
violation (other than speeding) while being distracted by one or more activities unrelated to
driving (GHSA, 2011). Potentially distracting activities covered by the law include talking on a
handheld phone, searching for an item in the vehicle, or attending to personal hygiene or
grooming.
No studies have evaluated whether general reckless driving laws or distracted driving laws have
any effect (except for cell phone laws: see Chapter Y, Section 1.2). 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 on
alcohol-impaired driving, Chapter 2, Sections 2.1, 3.1, and 3.2 on seat belt use laws, and Chapter
3, Sections 2.2 and 4.1 on aggressive driving and speeding laws. Enforcement of distracted
driving laws especially difficult because distraction is often difficult to observe, measure, and
document. Nevertheless, these laws may increase the impact of communications and outreach
efforts to reduce distracted driving (discussed in Section 2.1) as laws help emphasize the
importance of the message (see also Stutts et al., 2005, Strategy C2).
Use: New Jersey, Maine, and Utah have laws explicitly addressing distractions other than cell
phones (GHSA, 2011). Other States include these conditions under their laws regarding reckless
driving or similar offenses.
Effectiveness: The effect of general laws on reducing distracted driving is unknown. Part of the
challenge in enforcing the laws may be the complexity in establishing proof that a driver was
distracted by activities such as grooming. Officers might also face difficulties determining if a
driver was performing illegal functions on the phone or using it for reasons permitted by law,
such as navigation or hands-free use (GHSA, 2013). Inconsistencies in what constitutes legal use
of devices, policies that may not apply to all drivers under all situations, and cognitive
dissonance with officers enforcing distraction laws to which they themselves do not always
comply, could add to obstacles in enforcing distracted driving (Nevin et al., 2017).
A4-8
Appendix 4. Distracted Driving
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 directed primarily at other offenses such as alcohol-impaired or aggressive
driving. However, special patrols to enforce distracted driving laws will entail greater costs,
especially if overtime is required for LEOs.
Time to implement: The implementation time is primarily determined by the time required to
pass new distracted driving laws. Implementation can begin as soon as it is publicized and law
enforcement patrol officers are trained.
A4-9
Appendix 4. Distracted Driving
2. Communications and Outreach
2.1 Communications and Outreach on Distracted Driving
Effectiveness: ✩
Cost: $$
Use: High
Time: Medium
Overall Effectiveness Concerns: Based on NCHRP research, there are no studies of any
campaign’s effects on driver knowledge, attitudes, or behavior (Stutts et al., 2005, Strategies C1
and D2).
Distracted driving communications and outreach campaigns face challenges in how the issue of
distraction is characterized and understood by drivers. 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.
There is strong public support for communications and outreach to reduce distracted driving. For
example, 80% of respondents in a Canadian survey agreed that greater awareness and education
efforts are needed to alert drivers to the problem of distracted driving (Vanlaar et al., 2007).
Many organizations have developed or conducted distracted driving communications and
outreach campaigns directed to the general public. Some carry a general “pay attention”
message, while others are directed at specific behaviors such as cell phone use. Examples of
national communications and outreach campaigns over the last decade include:
• “U Drive. U Text. U Pay.” A campaign program released by NHTSA in 2014 in support
of texting ban enforcement during Distracted Driving Awareness Month
(www.trafficsafetymarketing.gov/get-materials/distracted-driving/u-drive-u-text-u-pay);
• “Put It Down.” A national campaign by the U.S. Department of Transportation to
discourage the public from driving distracted ;
• “Faces of Distracted Driving.” A national campaign created by DOT that tells the stories
of families who are victims of crashes involving a distracted driver;
• “No Phone Zone” by Oprah Winfrey;
• “On the Road, Off the Phone” by the National Safety Council;
• “Decide to Drive” by the American Academy of Orthopaedic Surgeons/Alliance of
Automobile Manufacturers;
• “Texting While Driving: It Can Wait” by AT&T; and
• “Stop Texts, Stop Wrecks.” by NHTSA and the Ad Council.
Driving while distracted is a particular concern for teenage drivers (Foss & Goodwin, 2014;
NHTSA, 2012). GDL passenger and cell phone restrictions directly address two sources of
distractions, as discussed in Chapter Y, Section 1.1. Broader communications and outreach
efforts for young drivers regarding distracted driving also have been proposed. For example, a
growing number of States are including distracted driving as a required component of driver
education, the State’s driver license test, or information provided in the driver license manual
(GHSA, 2013). Some States have also developed their own education material and programs
A4-10
Appendix 4. Distracted Driving
aimed at teen drivers. See Governors Highway Safety Association (2013) for links to these
materials.
A campaign at the University of Kansas combined traditional media (e.g., newspaper ads), social
media (e.g., Facebook, Twitter), and “guerilla marketing” strategies to increase awareness about
the dangers of texting and driving, and to foster a negative view of texting and driving among the
college community (Atchley & Geana, 2013a). The campaign promotes a “TXT L8R. Drive
Safer” message. A survey of University of Kansas students found 75% had seen the TXT L8R
message, and a third (32%) reported talking with a friend during the last month about the risks of
texting while driving (Atchley & Geana, 2013b). See Atchley and Geana (2013a) for more
information about the TXT L8R campaign.
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 5.2; Chapter 2, Section 3.1; Chapter 3, Section 4.1;
see also Stutts et al., 2005, Strategy C1). To have any chance, stand-alone campaigns must be
carefully pre-tested, communicate health information not previously known, be long-term, and
have substantial funding (Williams, 2007). A broad “stay alert” message may be too general to
have any impact. Also, commonly used fear appeals are generally ineffective and in some cases
may actually encourage greater distracted driving, especially among young adults (Lennon et al.,
2010, but see Bummara & Choi, 2015). This “boomerang effect” of fear appeals is thought to
occur because people deny the threat or feel their personal freedom is threatened, making the
undesirable behavior even more attractive (Lennon et al., 2010). Perceptions of distracted driving
messages may also differ among age and gender groups, which makes necessary the involvement
and input of stakeholder groups in the development and testing of distracted driving PSAs
(Bummara & Choi, 2015; Solomon et al., 2010).
Use: A GHSA survey found that 47 States and the District of Columbia have implemented public
information/education campaigns to address distracted driving (GHSA, 2013). In addition, some
States have developed distracted driving PSAs.
Effectiveness: Based on NCHRP research, there are no studies of any campaign’s effects on
driver knowledge, attitudes, or behavior (Stutts et al., 2005, Strategies C1 and D2). A scan of
documents through September 2019 found very few evaluations for the effectiveness of standalone outreach campaigns. One evaluation of a 30-second video among a small sample of
university students reported that the fear-inducing messaging may deter texting and driving
(Bummara & Choi, 2015). Almost 64% of the respondents reported that they strongly or
somewhat agreed that they were less likely to text and drive after exposure to the PSA.
Costs: A high-quality campaign will be expensive to develop, test and implement.
Time to implement: A high-quality campaign will require at least 6 months to plan, produce and
distribute.
Other issues:
• Non-traditional communication channels: At least 36 States as well as NHTSA use
social networking sites to educate motorists about distracted driving (GHSA, 2013). Sites
such as Facebook, Twitter, and YouTube can effectively and inexpensively reach large
A4-11
Appendix 4. Distracted Driving
numbers of people. Social networking sites are especially popular among young people,
who are often a primary target of distracted driving campaigns.
A4-12
Appendix 4. Distracted Driving
3. Other Countermeasures
3.1 Employer Programs
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
This countermeasure involves State-based programs that address job-related distracted driving,
which may pose a liability risk to employers. Employers can protect themselves by implementing
policies that prohibit distracted driving and by monitoring compliance. There are many ways
States can work with employers to address distracted driving. Some States, such as Delaware and
Kentucky, have corporate outreach program staff devoted to distracted driving (GHSA, 2013).
The programs usually involve dissemination of traffic safety material to employers, or sometimes
directly to the employees themselves. States can also assist employers in promoting and
enforcing policies to reduce distracted driving. Legally, employers can be held accountable for
employees who are using cell phones (or otherwise distracted), and who are involved in a crash
as part of their work (NSC, 2015).
Resources are available to employers to develop and maintain programs to prevent distracted
driving. The Network of Employers for Traffic Safety program founded by NHTSA and led by
private employers provides training and outreach material for member organizations. Australia’s
National Road Safety Partnership Program presents informational and promotional material on
the program website; see www.nrspp.org.au/knowledge-centre/?resource-category=safeusers&id=17&resource-sub-category=distraction for an example of distraction related resources
for employers. New Jersey has developed a sample cell phone use policy for businesses,
available at www.nj.gov/lps/hts/downloads/Sample_Cell_Phone_Policy.pdf. The Texas
Department of Insurance presents guidelines that employers may consider when incorporating
measures to curb distracted driving by employees, including a sample agreement policy on onthe job device use that should be signed by both employer and employee at
www.tdi.texas.gov/pubs/videoresource/stpcellphone.pdf.
Effectiveness: A systematic search in September 2019 did not result in finding any employer
distracted driving program evaluations.
Costs: In comprehensive programs that are available at no cost, expenses will consist only of
material production and employer time for training.
Time to implement: An employer program can be implemented within 3 months.
A4-13
Appendix 4. Distracted Driving
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technologies. Findings from the 2013 Traffic Safety Culture Index.
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Atchley, P., & Geana, M. (2013a). The texting and driving epidemic: Changing norms to change
behavior. Topeka, KS: Kansas Department of Transportation.
https://rosap.ntl.bts.gov/view/dot/26541
Atchley, P., & Geana, M. (2013b). TXT L8R: Lessons from a targeted safety campaign.
Presentation at the 31st Annual Lifesavers Conference. Denver, Colorado.
Benden, M., Fink, R., & Stafford, J. (2012). Teen driver cell phone blocker (Report No. UTCM
10-15-47). Department of Transportation.
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Bummara, V., & Choi, J. (2015). Exploring the effectiveness of distracted driving PSA (public
service announcement). Advances in Journalism and Communication, 3(04), 71.
Caird, J. K., Willness, C. R., Steel, P., & Scialfa, C. (2008). A meta-analysis of the effects of cell
phones on driver performance. Accident Analysis & Prevention, 40, 1282-1293.
Dingus, T. A., Guo, F., Lee, S., Antin, J. F., Perez, M., Buchanan-King, M., & Hankey, J.
(2016). Driver crash risk factors and prevalence evaluation using naturalistic driving
data. Proceedings of the National Academy of Sciences, 113(10), 2636-2641.
Drews, F. A., Yazdani, H., Godfrey, C. N., Cooper, J. M., & Strayer, D. L. (2009). Text
messaging in simulated driving. Human Factors, 51, 762-770.
Ehsani, J. P., Bingham, C. R., Ionides, E., & Childers, D. (2014). The impact of Michigan’s text
messaging restriction on motor vehicle crashes. Journal of Adolescent Health, 54, S68S74.
Farmer, C. M., Braitman, K. A., & Lund, A. K. (2010). Cell phone use while driving and
attributable crash risk. Traffic Injury Prevention, 11, 466-470.
Foss, R. D., & Goodwin, A. H. (2014). Distracted driver behaviors and distracting conditions
among adolescent drivers: Findings from a naturalistic study. Journal of Adolescent
Health, 54, S50-S60.
Funkhouser, D., & Sayer, J. R. (2013, December). Cell phone filter/blocker technology field test
(Report No. DOT HS 811 863). National Highway Traffic Safety Administration.
www.nhtsa.gov/DOT/NHTSA/NVS/Crash%20Avoidance/Technical%20Publications/20
13/Cell_Phone_Filter_Blocker_Technology_Field_Test_811863.pdf
Governors Highway Safety Association. (2011). Distracted driving: What research shows and
what states can do.
GHSA. (2013). Distracted driving: Survey of the States. www.ghsa.org/sites/default/files/201612/2013_distraction.pdf
A4-14
Appendix 4. Distracted Driving
GHSA. (2020). Distracted driving laws by state. www.ghsa.org/sites/default/files/202002/DistractedDrivingLawChart-FEB20_0.pdf
Guarino, J. (2013). Survey reveals public open to ban on hand-held cell phone use and texting.
RITA Bureau of Transportation Statistics, Special Report.
https://rosap.ntl.bts.gov/view/dot/25511
Highway Loss Data Institute. (2009). Hand-held cellphone laws and collision claim frequencies
(Highway Loss Data Institute Bulletin, Vol. 26, No.17).
www.iihs.org/iihs/topics/t/distracted-driving/hldi-research
HLDI. (2010). Texting laws and collision claim frequencies (Highway Loss Data Institute
Bulletin, Vol. 27, No.11). www.iihs.org/iihs/topics/t/distracted-driving/hldi-research
Hosking, S. G., Young, K. L., & Regan, M. A. (2009). The effects of text messaging on young
drivers. Human Factors, 51, 582-592.
Ishigami, Y., & Klein, R. M. (2009). Is a hands-free phone safer than a handheld phone? Journal
of Safety Research, 40, 157-164.
Lennon, R., Rentfro, R., & O’Leary, B. (2010). Social marketing and distracted driving
behaviors among young adults: The effectiveness of fear appeals. Academy of Marketing
Studies, 14, 95–113.
Maher, A., & Ott, P. (2013). Effects of New Jersey’s Cell Phone and Text Ban (No. CUNY49111-19-23). www.utrc2.org/sites/default/files/pubs/Final-NJ-Cell-Phone-Text-Ban.pdf
McCartt, A. T., & Geary, L. L. (2004). Long term effects of New York State’s law on drivers’
handheld cell phone use. Injury Prevention, 10, 11–15.
McCartt, A. T., Hellinga, L. A., & Braitman, K. A. (2006). Cell phones and driving: Review of
research. Traffic Injury Prevention, 7, 89-106.
McCartt, A. T., & Hellinga, L. A., Strouse, L. M., & Farmer, C. M. (2010). Long-term effects of
handheld cell phone laws on driver handheld cell phone use. Traffic Injury Prevention,
11, 133-141.
McCartt, A. T., Kidd, D. G., & Teoh, E. R. (2014). Driver cellphone and texting bans in the
United States: evidence of effectiveness. Annals of Advances in Automotive Medicine, 58,
99.
McEvoy, S. P. Stevenson, M. R., McCartt, A. T., Woodward, M., Haworth, C., Palamara, P., &
Cercarelli, R. (2005). Role of mobile phones in motor vehicle crashes resulting in
hospital attendance: A case-crossover study. British Medical Journal, 331, 428-434.
Nevin, P. E., Blanar, L., Kirk, A. P., Freedheim, A., Kaufman, R., Hitchcock, L., Maeser, J. D.,
& Ebel, B. E. (2017). “I wasn’t texting; I was just reading an email …”: a qualitative
study of distracted driving enforcement in Washington State. Injury Prevention, 23(3),
165-170.
National Center for Statistics and Analysis NCSA). (2019, October). Driver electronic device
use in 2018 (Traffic Safety Facts Research Note. Report No. DOT HS 812 818). National
Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812818
A4-15
Appendix 4. Distracted Driving
NHTSA. (2012). Blueprint for ending distracted driving (Report No. DOT HS 811 629).
www.nhtsa.gov/sites/nhtsa.dot.gov/files/811629.pdf
National Safety Council (NSC). (2015). Employer liability and the case for comprehensive cell
phone policies. www.nsc.org/Portals/0/Documents/DistractedDrivingDocuments/NSCCorpLiability-WP-lr-(1).pdf
Nikolaev, A. G., Robbins M. J., & Jacobson, S. H. (2010). Evaluating the impact of legislation
prohibiting hand-held cell phone use while driving. Transportation Research Part A, 44,
182-193.
Olson, R. L., Hanowski, R. J., Hickman, J. S., & Bocanegra, J. (2009). Driver distraction in
commercial vehicle operations (Report No. FMCSA-RRR-09-042). FMCSA.
www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/FMCSA-RRR-09-042.pdf
Redelmeier, D. A., & Tibshirani, R. J. (1997). Association between cellular telephone calls and
motor vehicle collisions. The New England Journal of Medicine, 336, 453-458.
Retting, R., Sprattler, K., Rothenberg, H., & Sexton, T. (2017, March). Evaluating the
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https://rosap.ntl.bts.gov/view/dot/2085
Schroeder, P., Wilbur, M., & Pena, R. (2018, March). National Survey on Distracted Driving
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Young, R. A. (2012). Cell phone use and crash risk. Epidemiology, 23, 116-118.
A4-16
Appendix 5. Motorcycle Safety
A5. Motorcycle Safety
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Motorcycle Helmets
Countermeasure
1.2 Helmet Use Promotion Programs
1.3 Helmet Law Enforcement; Noncompliant
Helmets
Effectiveness
✩
✩
Cost
Use
Time
Varies
Low
Varies
$
Unknown
Medium
Cost
Use
Time
$$
Medium
Medium
Cost
Use
Time
$
High
Medium
$$
High
Varies
Cost
Use
Time
Varies
High
Medium
Varies
High
Medium
2. Alcohol Impairment
Countermeasure
2.2 Alcohol Impairment: Communications
Effectiveness
✩
3. Motorcycle Rider Licensing and Training
Countermeasure
3.1 Motorcycle Rider Licensing
3.2 Motorcycle Rider Training
Effectiveness
✩
✩✩
4. Communications and Outreach
Countermeasure
4.1 Conspicuity and Protective Clothing
4.2 Motorist Awareness of Motorcyclists
Effectiveness
✩
✩
A5-1
Appendix 5. Motorcycle Safety
Effectiveness:
✩✩ Effectiveness still undetermined; different methods of implementing this countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
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.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A5-2
Appendix 5. Motorcycle Safety
1. Motorcycle Helmets
1.2 Motorcycle Helmet Use Promotion Programs
Effectiveness: ✩
Cost: Varies
Use: Unknown
Time: Varies
Overall Effectiveness Concerns: There appear to be no formal evaluations of the effect of
helmet use promotion programs in States without universal helmet laws (NCHRP, 2008).
Several States without universal motorcycle helmet use laws promote helmet use through
communications and outreach campaigns. To date there is little evidence that these efforts to
educate and promote helmet use among motorcyclists in the absence of universal helmet laws are
effective, unless the publicity helps to gain enactment of such laws (NCHRP, 2008). A parallel
experience is evident in the efforts to increase seat belt use through educational and promotional
efforts prior to the enactment of laws requiring seat belt use. Years of educational and
promotional campaigns did little to increase seat belt use. It was only after laws requiring use
were enacted that seat belt use began to rise substantially.
The MSF, GHSA, NHTSA, WHO, and other groups encourage helmet use. NHTSA has
developed helmet use promotion brochures, flyers and PSAs suitable for television and radio that
are available online (www.trafficsafetymarketing.gov/get-materials/motorcycle-safety for
material). NCHRP (2008) describes elements that should be included in a campaign should one
be undertaken. The WHO has published a manual for policy makers and road safety practitioners
to use when developing programs improving motorcycle helmet use (WHO, 2006).
Use: Baer et al. (2010) distributed self-report surveys to States on their motorcycle safety
programs and received responses from 45 States. Thirty-three of the 43 States that responded to a
question on helmet use promotion, both with and without helmet laws, reported they actively
promote helmet use, but the nature and extent of these promotions is unknown. Only one State
reported using paid broadcast media spots.
Effectiveness: There appear to be no formal evaluations of the effect of helmet use promotion
programs in States without universal helmet laws (NCHRP, 2008). However, helmet use remains
substantially lower in States without universal helmet laws than in States with such laws (NCSA,
2019).
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 sources
including MSF, NHTSA (2003), and from States that have conducted these campaigns.
Time to implement: A proper campaign, including market research, material development, and
message placement, will require at least 6 months to plan and implement. Baseline data and postcampaign evaluation can require an additional 6 months or longer.
A5-3
Appendix 5. Motorcycle Safety
1.3 Motorcycle Helmet Law Enforcement: Noncompliant Helmets
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Medium
Overall Effectiveness Concerns: The effectiveness of an enforcement program on noncompliant
helmet use has not been evaluated.
LEOs in universal helmet law States easily can observe and cite motorcycle riders not wearing
helmets. This deterrent to non-use likely explains why helmet use rates are high in universal
helmet law States (Chapter 5, Section 1.1). In addition, many States require motorcyclists 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. Helmets that do
not meet the FMVSS 218 performance requirements are considered noncompliant. The
prioritized recommendations of the National Agenda for Motorcycle Safety lists effective
strategies to increase the use of FMVSS 218-compliant helmets as a high priority item (NHTSA,
2013). Use of noncompliant helmets increased slightly from 7% in 2017 to 9% of all riders in
2018 according to a nationally representative observational survey of helmet use (NCSA, 2019).
Use of compliant helmets increased from 65% in 2017 to 71% in 2018.
Motorcycle riders wearing noncompliant helmets are essentially no safer than if they wore no
helmets at all. NHTSA tested non-compliant helmets and found that the energy allowed to
transfer to the head by the non-compliant helmet gave a 100% probability of fatal head injuries
(NHTSA, 2007a). In addition to offering no energy-absorbing materials, a noncompliant helmet
often covers only a portion of the rider’s head and has inadequate or unused chin straps so the
helmet is not likely to stay on the rider’s head in a crash. Rice et al. (2017) found that riders
wearing novelty helmets had 2.26 times the risk of fatal injury compared to wearing a full-face
helmet. In addition, not all compliant helmets provide the same level of protection. Brewer et al.
(2013) and Rice et al. (2017) found reduced risk of injury to motorcyclists wearing full-face
helmets compared to other types of DOT-compliant helmets.
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.
Identifying a noncompliant helmet is easier than proving that it is noncompliant. Some
noncompliant helmets have spikes or other protrusions, making them fairly easy to identify as
noncompliant. Compliant helmets are formally identified by a DOT label on the back of the
helmet. However, counterfeit DOT stickers are easily available and are found on many
noncompliant helmets (although some noncompliant helmets may have labels that say they are
novelty helmets and not motorcycle helmets). As a result of these stickers, it is difficult to
enforce a noncompliant helmet citation in some courts (NHCRP, 2008, Strategy E1). In May
2011 NHTSA issued a Final Rule that took effect in May 2013 to strengthen helmet labeling
requirements and to make it easier to prove that a helmet is noncompliant. For helmet laws to be
effective, such laws must be vigorously enforced, extensively publicized, and adequately funded.
NHTSA prepared 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
(NHTSA, 2006). NHTSA also produced a brochure on how to identify noncompliant helmets
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Appendix 5. Motorcycle Safety
(NHTSA, 2014) and provides further information to choose the right fit at
www.nhtsa.gov/motorcycle-safety/choose-right-motorcycle-helmet.
Use: Sixteen of 43 States reported to Baer et al. (2010) that they conduct enforcement to identify
and cite noncompliant-helmet wearers, but only States having universal helmet laws would
implement such programs (19 States and the District of Columbia as of May 2019, IIHS, 2019).
In 2007 the New York State Police pilot-tested a motorcycle safety checkpoint enforcement
program. In the pilot effort 225 motorcycles of 280 passing through the checkpoint were
inspected. Traffic citations were issued to 104 motorcyclists; the most common citation (41
issued) was for operating with a non-compliant helmet (Salmon, 2008).
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 costs will be for
training LEOs, prosecutors, and judges to identify noncompliant helmets.
Time to implement: An active helmet-law enforcement program requires planning an effective
enforcement strategy, training LEOs to identify noncompliant helmets and to carry out the
enforcement, and training for prosecutors and judges to assure that citations will be prosecuted
and adjudicated. This training can require 4 to 6 months to implement. Publications are available
to help with non-compliant helmet identification, but other program aspects and training may
need to be developed or adapted. These elements may require 6 months or longer.
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Appendix 5. Motorcycle Safety
2. Alcohol Impairment
2.2 Alcohol-Impaired Motorcyclists: Communications and Outreach
Effectiveness: ✩
Cost: $$
Use: Medium
Time: Medium
Overall Effectiveness Concerns: A literature search found no evaluations of the safety
effectiveness of any drinking and riding campaigns.
Many States have conducted communications and outreach campaigns directed at drinking and
riding. See NHTSA (2006) and NCHRP (2008, Strategy B1) for more information and links.
Organizations including AMA and MSF have produced campaigns and material on drinking and
riding. See NHTSA (2006) and NCHRP (2008) for strategies for implementation, examples, and
links to material. There are few 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 riding behavior. The experience of drinking and driving campaigns directed at all drivers
suggests that they are unlikely to have a positive 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 enforcement directed at impaired motorcyclists. See Chapter 1,
Section 5.2, for further discussion.
A focus group study (Becker et al., 2003) examined motorcyclists’ attitudes, beliefs, and
behaviors regarding drinking and riding. 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 riding are inappropriate. These beliefs also limit some motorcyclists’
willingness to take actions to prevent others from riding while impaired.
The “Riders Helping Riders” program targets the expressed willingness of some motorcycle
riders to help other riders by encouraging them to intervene to prevent other motorcycle riders
from riding impaired and to create a stronger safety culture among motorcyclists. This program
is based on the beliefs and attitudes of riders from focus group research (McKnight & Becker,
2007a, 2007b; McKnight et al., 2008). The material was pilot-tested in Georgia. Riders’ attitudes
and intentions toward intervening seemed to improve based on surveys taken before and
immediately after training. Longer-term evidence of attitude change, interventions actually
carried out, or definitive safety effects from behavioral changes will require exposure to large
numbers of riders and longer follow-up of crashes (McKnight et al., 2008).
Another program called “Green-Yellow-Red” was developed and tested in Wisconsin (Aguilar &
Delehanty, 2009). The campaign sought to educate motorcycle riders about the dangers of
drinking and riding, encourage them to make safer choices, and provide impaired motorcycle
riders with secure storage of their motorcycles so that they could find safe transport home. A
coalition was established that included motorcycle riders, tavern owners, law enforcement, and
local businesses, and substantial media attention was obtained at the program kick-off. While
there is evidence that riders were willing to leave their motorcycles in secure storage containers,
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Appendix 5. Motorcycle Safety
only small changes in rider behavior and alcohol-related motorcycle crashes were observed
following the program.
Rider groups can play critical roles in planning and implementing activities to reduce drinking
and riding. Some State and local rider groups sponsor alcohol-free events or adopt 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 American Bikers Aimed Toward
Education (ABATE) sponsors alcohol-free rides (NHTSA, 2006, Section 1).
Use: Many States have conducted anti-drinking-and-riding campaigns (NHTSA, 2006; NCHRP,
2008, Strategy C1), but the total number of States that have done so is unknown. Some examples
of States campaigns include Connecticut’s “Open the Throttle, Not the Bottle” and Minnesota’s
“Drinking and Riding: A Really Bad Idea.” Many other States have brochures and other material.
It also is not known how many States have included messages directed to motorcyclists in their
overall alcohol-impaired driving campaigns. However, motorcycle riders are now included in the
“Drunk Driving. Over the Limit. Under Arrest” paid media spots. NHTSA administers incentive
grants for States that apply and meet regulatory criteria for programs that prevent impaired
riding. See also NHTSA’s Stop Impaired Driving (www.trafficsafetymarketing.gov/getmaterials/motorcycle-safety/stop-impaired-riding) and other motorcycle campaigns
(www.trafficsafetymarketing.gov/get-materials/motorcycle-safety) for marketing material.
Effectiveness: There are no evaluations of the safety effectiveness of any drinking and riding
campaigns.
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 substantive campaign will require at least 12 months to research, design,
test, and implement. A vigorous implementation will require a significant duration.
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Appendix 5. Motorcycle Safety
3. Motorcycle Rider Licensing and Training
3.1 Motorcycle Rider Licensing
Effectiveness: ✩
Cost: $
Use: High
Time: Medium
Overall Effectiveness Concerns: Although this countermeasure is widely used, the effectiveness
of current licensing and testing on crashes and safety has not been evaluated.
All 50 States, the District of Columbia, and Puerto Rico require motorcycle riders to obtain
motorcycle operator licenses or endorsements before they ride on public highways (MSF, 2018).
The goal of licensing is to assure that motorcycle riders have a minimum skill level needed to
operate motorcycles safely (NHTSA, 2000).
State motorcycle licensing practices vary substantially. Most States have learner permits
requiring only vision and/or knowledge tests. A motorcycle rider 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 riding skills test
is required for full licensure (Alabama does not require a skills test for licensure). Two-thirds of
the States use one of three tests developed by the MSF and American Association of Motor
Vehicle Administrators, while one-third use their own test. Most States will waive the skills test,
and sometimes the knowledge test, for motorcyclists who have completed approved motorcycle
rider training courses, if the student passes the knowledge and skills tests administered at the
conclusion of the course. See Motorcycle Safety Foundation (2018) for a summary of each
State’s licensing requirements and procedures and NCHRP (2008, Strategy C1) for brief
summaries of the major skills tests currently in use.
The effectiveness of motorcycle operator licensing is not known. This is perhaps not surprising
given the variability of licensing tests and procedures. NAMS recommends research to “ensure
that licensing tests measure skill and behaviors required for crash avoidance” (NHTSA, 2000).
NCHRP (2008, Strategies C2 and C3) describes strategies to couple training and licensing to
help ensure that riders are both trained and obtain the necessary endorsements. The NCHRP
notes, however, that no evaluations discuss whether increasing the proportion of validly licensed
motorcycle riders would reduce motorcycle crashes or injuries.
Despite State requirements many motorcycle riders are not properly licensed. In 2018 some 28%
of motorcycle riders involved in fatal crashes did not have valid motorcycle licenses, compared
to 13% of passenger vehicle drivers involved in fatal crashes who were not properly licensed
(NCSA, 2020). Licensing systems in some States provide no incentive to become fully licensed
because learner’s permits may be renewed indefinitely (NCHRP, 2008, Strategy C3; MSF,
2018).
The NAMS (NHTSA, 2013) recommend the following prioritized approaches to encourage full
licensure:
• Merge rider education/training and licensing into one-stop operations (medium priority)
• States issue motorcycle endorsements immediately upon course completion (medium
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Appendix 5. Motorcycle Safety
•
•
•
•
•
•
priority)
Identify and remove barriers to obtaining a motorcycle endorsement (low priority)
Enforce penalties for improperly licensed riders (low priority)
Insurance policies should not be valid for improperly licensed riders (low priority)
Train license examiners in motorcycle issues (medium priority)
Develop and evaluate enhanced licensing model using graduated licensing concepts
(medium priority)
Research to assure that licensing tests measure crash avoidance skills, behaviors (low
priority)
The NCHRP (2008, Strategy C3) describes how Maryland and Minnesota used some of these
strategies to increase proper licensing for motorcycle riders. Maryland used the additional
strategy of comparing its 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. The letter
reminded each registered owner that a motorcycle endorsement was required of anyone operating
the registered motorcycle. This quick and inexpensive strategy caused 1,700 owners to become
licensed within 4 months. A randomized controlled experiment of this intervention suggested
that while the method did increase licensure, a large percentage remained unlicensed (Braver et
al., 2007). California also tried this approach with similar licensure results (Limrick & Masten,
2013). Effective July 22, 2007, the State of Washington added authorization to impound vehicles
operated by drivers without proper endorsement (including motorcycles as well as other
vehicles). However, an evaluation of the effects of this law did not find a significant impact on
new or total motorcycle endorsements after implementation (McKnight et al., 2013).
Maryland and Pennsylvania have “one-stop shops” that provide motorcycle endorsement
immediately upon successful completion of State-approved motorcycle rider training courses or
tests, without having to wait after receiving permit. For Pennsylvania’s procedures, see
www.pamsp.com/CourseInfo_Basic.aspx.
Baer, Cook, and Baldi (2005) reviewed and summarized each State’s motorcycle education and
licensing programs and practices. A companion report (Baer, Baldi, & Cook, 2005) describes
training and licensing programs and actions to promote training and licensing. Under a
cooperative agreement with NHTSA, AAMVA has updated its Motorcycle Operator Licensing
System and Integrating Motorcycle Rider Education and Licensing manuals by publishing the
Guidelines for Motorcycle Operator Licensing. The GMOL provides guidelines for State
motorcycle licensing programs (Hanchulak & Robinson, 2009).
Use: All States require motorcycle riders to obtain motorcycle licenses or endorsements to ride
on public highways. Less than half of responding States reported that they enforce laws relating
to improperly licensed motorcyclists (Baer et al., 2010).
Effectiveness: The effectiveness of current licensing and testing on crashes and safety has not
been evaluated. An evaluation of a California program to increase licensure among improperly
licensed motorcycle owners through DMV letters found that while the letters did increase
licensure, there was no identifiable causal effect on crash involvements or traffic violations
(Limerick & Masten, 2013).
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Appendix 5. Motorcycle Safety
Costs: Most States charge small fees for the motorcycle licensing tests (MSF, 2018). The costs
of changing the licensing tests and procedures depend on the extent of changes and the amount
of retraining needed for licensing examiners as well as what portion of costs are covered by
licensing fees.
Time to implement: Developing new policies to encourage higher rates of full motorcycle
licensure would likely require 6 to 12 months to implement. These include limiting the number
of times provisional licenses may be renewed, administrative practices such as adding testing
times and locations, or training motorcycle license examiners, or procedures such as waiving the
skills test for those who have passed approved training courses. Enforcement of motorcycle
licensing requirements could occur more readily if requirements for full licensure were clear
enough to enforce.
Other issues:
• Graduated driver licensing: The NAMS recommended States incorporate and evaluate
GDL concepts (NHTSA, 2000) and ranked it as a medium priority (NHTSA, 2013).
Additionally, the GAO recommended graduated licensing for motorcyclists as a high
priority in a 2012 Report to Congress (GAO, 2012).
Most States employ GDL for beginning automobile drivers. GDL programs for
automobile drivers have been shown to be effective in reducing crashes (Hedlund et al.,
2003, 2006; Williams et al., 2012). Evaluations in New Zealand and evidence from
Quebec suggest that the same may be true for motorcyclists (Mayhew & Simpson, 2001).
NHTSA’s GMOL includes a model graduated licensing program for motorcycle riders
(Hanchulak & Robinson, 2009).
Many States currently restrict motorcycle riders by learner permits or age (MSF, 2018).
For example, California GDL prohibits passengers, freeway riding, and nighttime riding
during the learner permit stage and requires all people under 21 to complete motorcycle
rider training courses offered by the California Highway Patrol. In Utah motorcycle
endorsements are restricted to motorcycles no larger than the size of the motorcycle used
for the skills test, or used during the approved State training course (substitute). The
endorsement can be changed by testing on a larger size motorcycle.
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Appendix 5. Motorcycle Safety
3.2 Motorcycle Rider Training
Effectiveness: ✩✩
Cost: $$
Use: High
Time: Varies
Overall Effectiveness Concerns: This countermeasure’s effectiveness has been examined in
several research studies. Despite some positive research findings, the balance of evidence
regarding countermeasure effectiveness remains inconclusive.
As of 2015 all 50 States offered rider education (MSF, 2016). Sixty percent of the 44 States that
responded to a survey question from Baer et al. (2010) reported they were able to accommodate
all riders seeking training within a calendar year. Training is also provided by some rider
organizations (some ABATE and Gold Wing groups), manufacturers (Harley-Davidson), the
U.S. military, and others. Many States encourage training either by requiring it for all motorcycle
operators or those under a specified age, or by waiving some testing requirements for motorcycle
riders who complete and pass approved training courses (Baer, Cook, & Baldi, 2005). Most
entry-level training uses the Basic RiderCourse curricula developed by the Motorcycle Safety
Foundation. The Experienced RiderCourse suite (ERC) is offered to riders with some previous
experience or for seasoned riders who want additional training; however, the ERC represents a
very small part of total training provided.
Although training is available, it is not clear what constitutes appropriate rider education and
training, or whether current training reduces crashes. Evidence suggests that in addition to
teaching motorcycle control skills, programs would better prepare riders if they were trained to
(1) recognize hazardous riding situations, (2) assess their own abilities and limitations, and (3)
ride within those constraints (Clarke et al., 2007; Elliott et al., 2007). Crash analyses have been
used to identify crash factors leading to the greatest injury severity (Pour-Rouholamin & Jalayer,
2016); results can be used to prioritize critical issues to emphasize in training. NHTSA supported
the development of Model National Standards for Entry Level Rider Training released in August
2011. These recommend content for motorcycle rider training courses. States are encouraged to
go beyond the standards to address State-specific crash needs (Windwalker Corporation &
Highway Safety Services, LLC., 2011).
NHTSA’s Motorcycle Safety 5-Year Plan recommends that States conduct frequent and timely
education and rider training at sites accessible throughout the State (NHTSA, 2019). NCHRP
(2008, Strategy C2) further recommends that States evaluate crash experience, compare data and
crash scenarios with training and licensing practices, and adjust targeted crash problems as
needed. This requires cooperation by agencies responsible for collecting and analyzing crash
data and those responsible for training and licensing.
States should provide motorcycle training on a timely basis to those who wish to take it. See
Baer, Baldi, and Cook (2005) and NHTSA (2006) for examples of successful methods to use
training capacity more effectively, including creative scheduling, centralized on-line registration
systems, and use of private providers.
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Appendix 5. Motorcycle Safety
Use: Most States offer training to both experienced and beginning motorcycle riders. For more
information, see Baer et al. (2010) and MSF’s overview table, available at www.msfusa.org/downloads/Rider-Ed-Programs-CSI-2016.pdf.
Effectiveness: Kardamanidis et al. (2010) evaluated the results of 23 studies for a Cochrane
Review and found conflicting evidence on effectiveness of motorcycle rider training in reducing
crashes or offenses. Due to the poor quality of the studies (most had selection and detection bias)
the authors could not draw conclusions about effectiveness. However, data suggest that
mandatory pre-license training for motorcyclists may reduce crashes and offenses by
discouraging motorcycle riding, thus limiting exposure.
While there are few positive studies on motorcycle rider training to date, a study conducted by
Boele and de Craen (2014) investigated the possibility of training higher-order motorcycle skills
with risk training. Specifically, their study investigated if the training had an effect on safe riding
behavior and hazard perception in the short-term (a few months) and long-term (12 to 18
months) after training. Training participants were divided into experimental and control groups.
Both took pre-tests that included questionnaires and on-road rides. They also took short-term
post-tests that included the same pre-test questionnaires and on-road rides as well as hazard
perception tests, followed by long-term post-tests of the same things. The experimental group
received the risk training between the pre-test and the short-term post-tests. Results reported that
the experimental (risk training) group demonstrated more safe riding behaviors compared to the
control group. The experimental (risk training) group also identified more hazards than the
control group. This result was also found for the long-term post-tests; however, it was not
statistically significant indicating that the impact on hazard perception was not sustained in the
long term.
Although the results of the Boele and de Craen study (2014) are positive, the authors were quick
to caution the idea of implementing this training on a large scale. Specifically, they attribute
retention of the training’s effect to closely following the design and curriculum as well as the
didactic and substantive quality of trainers, which need to be considered with implementing this
training.
Costs: Rider training programs are funded in part by States and in part by students’ fees. Many
States offset some or all their costs through motorcycle license or student registration fees.
Time to implement: Rider training currently is conducted in all States. Training capacity is
limited by the number of available training sites (a big paved area such as a school parking lot is
required), qualified instructors, and motorcycles and helmets for students to use. Some measures
to increase capacity can be implemented quickly while others may take 6 to 12 months.
Other issues:
• Training for other motorcycle configurations (three-wheeled motorcycles and motorcycles pulling trailers): Several motorcycle organizations offer courses that address
these special motorcycle configurations. These courses have not been evaluated.
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Appendix 5. Motorcycle Safety
4. Communications and Outreach
4.1 Communications and Outreach: Conspicuity and Protective Clothing
Effectiveness: ✩
Cost: Varies
Use: High
Time: Medium
Overall Effectiveness Concerns: This countermeasure is widely used, but it has not been
extensively studied. There is some evidence that certain approaches may lead to limited positive
outcomes; however, there are insufficient evaluation data to determine the extent of
effectiveness.
Motorcycle riders should wear clothing that provides both protection and visibility. FMVSS 218
helmets (Chapter 5, Sections 1.1-1.3) with face shields protect the eyes from wind and foreign
objects as well as protect the head in a crash (Brewer et al., 2013). 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,
2000). The benefits of protective clothing, especially equipped with body armor, was further
confirmed by studies of Australian motorcyclists involved in crashes (de Rome et al., 2011 and
2012).
While some protective gear is vented and mitigates overheating, some riders avoid wearing it in
hot weather. It has been shown to elevate body core and skin temperature and produce
cardiovascular stress, leading to increased reaction time, errors, perceived workload, and mood
disturbances (de Rome et al., 2016; de Rome & Brown, 2016).
A common perception among riders is that a frequent cause of motorcycle crashes involving
other vehicles is that other vehicle drivers do not see the motorcycles. The Hurt et al. (1981)
study from the United States and a Clarke et al. study from the United Kingdom (2007) report
right-of-way collisions are more frequently the fault of the other motorists rather than the
motorcycle riders. Failure of vehicle drivers to perceive motorcyclists seems to occur in a
significant portion of these crashes. One easy way to increase motorcycle conspicuity is through
continuous headlight use. Most motorcycles manufactured since 1979 have headlights that turn
on automatically when the vehicles are started (NCHRP, 2008, Strategy D2). Additionally, 24
States require daytime headlight use for all motorcycles manufactured after a certain date (all at
least 20 years ago) (MSF, 2016). However, the increasing prevalence of passenger vehicles using
continuous headlights may reduce the visibility and effectiveness of motorcycle headlights
(Cavallo & Pinto, 2012).
A second way to increase conspicuity is to wear brightly colored clothing, use white or brightcolored helmets (for increased visibility during daylight), and incorporate retroreflective
materials or devices for increased visibility at night. Research confirms that motorcyclists
wearing conspicuous clothing or helmets are less likely to be involved in crashes (Wells et al.,
2004; NCHRP, 2008, Strategy D1). However, many riders deliberately choose not to wear
brightly colored clothing or riding gear. There are no data on how many motorcycle riders wear
types of protective clothing (other than helmets) or use auxiliary devices. Helmet manufacturers
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Appendix 5. Motorcycle Safety
and distributors report that more than half the helmets sold for street use are black and the
predominant color of motorcycle clothing is black (NCHRP, 2008, Strategy D1).
As discussed, auxiliary headlights and brake lights, flashing headlights, and other vehicle
technologies enhance conspicuity, but their effects on crashes have not been studied. Adoption of
these technologies may be useful to promote among the motorcycling community, may require
changes in laws if visibility enhancing technologies are restricted by States, and may also
involve working with manufacturers and producers of motorcycles and auxiliary devices
(NCHRP, 2008).
States and motorcyclist organization communications and outreach promote protective and
conspicuous clothing. Some State training programs also teach the benefits of using highvisibility clothing. The NCHRP (2008, Strategy D1) provides examples of material from Oregon
and the MSF and references to additional material from the SMSA, and the Gold Wing Road
Riders Association.
Use: Of the 44 States responding to a survey question, 33 reported encouraging conspicuityenhancing clothing and helmets to enhance motorcyclists’ visibility (Baer et al., 2010). The
extent or nature of these efforts is unknown.
Effectiveness: High-visibility clothing and protective gear enhance safety. Some limited
evidence suggests programs aimed at increasing conspicuous and protective clothing would be
successful. An Australian study found that the observed proportion of riders wearing full body
protection increased in the month following an enforcement/educational campaign emphasizing
conspicuous and protective clothing among other safety issues. However, it is unclear whether
any real safety benefits were sustained (Baldock et al., 2012).
In Puerto Rico changes to motorcycle safety laws accompanied outreach to inform motorcyclists
about changes and to encourage compliance. In response, motorcyclists adopted the practice of
wearing protective clothing, and LEOs reported that riders both appeared to be aware of the law
and expected to be stopped and cited for infractions (Fell et al., 2017). Four years after
enactment, observations of motorcyclists found that more than 80% of motorcyclists wore
protective apparel, and 68% wore reflective vests after 6 pm in compliance with the law.
Costs: Good communications and outreach campaigns can be expensive to develop and
implement: see Chapter 2, Section 3.1. Information promoting protective and conspicuous
clothing is available from sources including MSF, other motorcyclist organizations, and States
that have conducted these campaigns (NCHRP, 2008, Strategy D1).
Time to implement: A proper campaign, including market research, message development and
testing, and implementation, will require at least 6 months to plan and implement.
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Appendix 5. Motorcycle Safety
4.2 Communications and Outreach: Motorist Awareness of Motorcyclists
Effectiveness: ✩
Cost: Varies
Use: High
Time: Medium
Overall Effectiveness Concerns: Although this countermeasure is widely used, no evaluations of
the effectiveness of campaigns to increase driver awareness of motorcyclists are available.
In multi-vehicle motorcycle crashes, the other vehicle drivers are frequently cited for having
violated the motorcyclists’ right-of-way (Clarke et al., 2007; Elliott et al., 2007; NCHRP, 2008,
Strategy F3; NHTSA, 2000). Motorcycles and motorcyclists are smaller visual targets than cars
or trucks, resulting in low conspicuity (see Chapter 5, Section 4.1). Also, drivers may not expect
to see motorcycles on the road (NCHRP, 2008, Strategy F3; NHTSA, 2000). Clarke et al. (2007)
reported that even when motorcyclists were using headlights and high-conspicuity clothing
drivers sometimes failed to notice them.
Several States have conducted communications and outreach campaigns to increase motorists’
awareness of motorcyclists. Typical themes are “Share the Road ” or “Watch for Motorcyclists.”
Some States build campaigns around “Motorcycle Awareness Month,” often in May, early in the
summer riding season. (See NHTSA’s Traffic Safety Marketing website for “Motorist
Awareness of Motorcycles” material - www.trafficsafetymarketing.gov/getmaterials/motorcycle-safety/motorist-awareness-motorcycles.) Many motorcyclist organizations
including MSF, SMSA, the Gold Wing Road Riders Association, and State and local rider
groups, have driver awareness material available. See NHTSA (2006, Section 5) and NCHRP
(2008, Strategy F3) for links and references. Some organizations also make presentations on
drivers’ awareness of motorcyclists to driver education classes.
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 (NHTSA, 2007b). NHTSA developed a “Share the Road” program
planner for use by States, communities, and the motorcycling community
(see www.trafficsafetymarketing.gov/ShareTheRoad).
Use: Thirty-six of 44 States that responded to a survey question reported they communicate ways
for drivers to increase their awareness of motorcycles and motorcyclists (Baer et al., 2010).
NHTSA (2006, Section 5) and NCHRP (2008, 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, 2008, Strategy F3).
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
sources including the MSF, other motorcyclist organizations, and States that have conducted
these campaigns (NCHRP, 2008, Strategy F3).
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Appendix 5. Motorcycle Safety
Time to implement: A proper campaign, including market research, message development and
testing, and implementation will require at least 6 months to plan and implement.
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Appendix 5. Motorcycle Safety
Motorcycle Safety References
Aguilar, M., & Delehanty, H. (2009, April). A social marketing initiative to reduce impaired
motorcycle operation (Report No. DOT HS 811 095). National Highway Traffic Safety
Administration. www.nhtsa.gov/sites/nhtsa.dot.gov/files/811095-gyr.pdf
Baer, J. D., Ayotte, K., & Baldi, S. (2010, February). Evaluation of state motorcycle safety
programs (Report No. DOT HS 811 269). National Highway Traffic Safety
Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811269
Baer, J. D., Baldi, S., & Cook, A. L. (2005, July). Promising practices in motorcycle rider
education and licensing (Report No. DOT HS 809 922). National Highway Traffic Safety
Administration. https://icsw.nhtsa.gov/people/injury/pedbimot/motorcycle/MotorcycleRider/pages/PromisingPractices.pdf
Baer, J. D., Cook, A. L., & Baldi, S. (2005, March). Motorcycle rider education and licensing: A
review of programs and practices (Report No. DOT HS 809 852). National Highway
Traffic Safety Administration. https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/McycleRiderWeb/images/Motorcycle%20Rider%20Education%20
and%20Licensing.pdf
Baldock, M., Kloeden, C., Lydon, M., Raftery, S., Grigo, J., & Ponte, G. (2012). The use of
protective clothing by motorcyclists in Victoria: Evaluation of the Community Policing
and Education Program. In Proceedings of the 2012 ACRS National Conference - A Safe
System: Expanding the Research: 9-10 August, Sydney, New South Wales, Australia,
2012: 11 p. www.acrs.org.au/wp-content/uploads/46_Baldock-PR-.pdf
Becker, L. R., McKnight, A. S., Nelkin, V. S., & Piper, D. L. (2003, February). Drinking, riding,
and prevention: A focus group study (Report No. DOT HS 809 490). National Highway
Traffic Safety Administration.
www.nhtsa.gov/people/injury/pedbimot/motorcycle/drinkrideprevent/DrinkRidePreventio
n.pdf
Boele, M., & de Craen, S. (2014). Evaluation advanced training course for motorcyclists:
motorcyclists ride safer after training. www.swov.nl/rapport/R-2014-22E.pdf
Braver, E. R., Kufera, J. A., Volpini, K. D., Lawpoolsri, S., Joyce, J. J., Alexander, M. T., &
Ellison-Potter, P. (2007). Persuasion and licensure: A randomized controlled intervention
trial to increase licensure rates among Maryland motorcycle owners. Traffic Injury
Prevention, 8, 39-46.
Brewer, B. L., Diehl, A.H., Johnson, L.S., Salomone, J.P., Wilson, K.L., Atallah, H.Y.,
Feliciano, D. V., & Rozycki, G. S. (2013). Choice of motorcycle helmet makes a
difference: A prospective observational study. Journal of Trauma and Acute Care
Surgery, 75, 88-91.
Cavallo, V., & Pinto, M. (2012). Are car daytime running lights detrimental to motorcycle
conspicuity? Accident Analysis & Prevention, 49, 78-85.
Clarke, D. D., Ward, P., Bartle, C., & Truman, W. (2007). The role of motorcyclist and other
driver behaviour in two types of serious accident in the UK. Accident Analysis &
Prevention, 39, 974-981.
A5-17
Appendix 5. Motorcycle Safety
de Rome, L., & Brown, J. (2016). Motorcycle protective clothing: Impact on cognitive
performance and mood when worn in hot conditions. Paper presented at the Australasian
College of Road Safety 2016 Conference.
de Rome, L., Ivers, R., Fitzharris, M., Du, W., Haworth, N., Heritier, S., & Richardson, D.
(2011). Motorcycle protective clothing: Protection from injury or just the weather?
Accident Analysis & Prevention, 43, 1893-1900.
de Rome, L., Ivers, R., Fitzharris, M., Haworth, N., Heritier, S., & Richardson, D. (2012).
Effectiveness of motorcycle protective clothing: Riders’ health outcomes in the six
months following a crash. Injury, 43, 2035-2015.
de Rome, L., Troynikov, O., Taylor, Y., & Brown, J. (2016). Motorcycle protective clothing:
Heat discomfort and physiological strain.
www.roadsafetytrust.org.au/c/rtt?a=da&did=1004593
Elliott, M. A., Baughan, C. J., & Sexton, B. F. (2007). Errors and violations in relation to
motorcyclists’ crash risk. Accident Analysis & Prevention, 39, 491-499.
Fell, J. C., Ramirez, A., McKnight, A. S., Yao, J., & Auld-Owens, A. (2017, April). Changes to
Puerto Rico’s motorcycle rider law (Report No. DOT HS 812 397). National Highway
Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/2091
Government Accountability Office. (2012). Motorcycle safety increasing Federal funding flexibility and identifying research priorities would help support states’ safety efforts.
www.gao.gov/assets/660/650037.pdf
Hanchulak, D., & Robinson, B. (2009, May). Guidelines for motorcycle operator licensing
(Report No. DOT HS 811 141). National Highway Traffic Safety Administration.
www.nhtsa.gov/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20File
s/811141.pdf
Hedlund, J., Shults, R. A., & 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,
107-115.
Hedlund, J., Shults, R. A., & Compton, R. (2006). Graduated driver licensing and teenage driver
research in 2006. Journal of Safety Research, 37, 107-121.
Hurt, H. H., Ouellet, J. V., & Thom, D. R. (1981). Motorcycle accident cause factors and
identification of countermeasures, Volume 1: Technical report (Report No. DOT HS-05
63). https://rosap.ntl.bts.gov/view/dot/6450
Insurance Institute for Highway Safety. (2019). Motorcycle helmet use laws, May 2019.
www.iihs.org/topics/motorcycles#helmet-laws
Kardamanidis, K., Martiniuk, A., Stevenson, M.R., & Thistlethwaite, K. (2010). Motorcycle
rider training for the prevention of road traffic crashes. Cochrane Database of Systematic
Reviews 2010, Issue 10. Art. No.: CD005240. doi: 10.1002/14651858.CD005240.pub2
Limrick, K.J. & Masten, S. V. (2013). Evaluation of a contact letter to increase licensure among
improperly licensed California motorcycle owners (Report No. CAL-DMV-RSS-13241). California Office of Traffic Safety. www.dmv.ca.gov/portal/uploads/2020/04/s6241.pdf
A5-18
Appendix 5. Motorcycle Safety
Mayhew, D. R., & Simpson, H. M. (2001). Graduated licensing for motorcyclists.
https://pdfs.semanticscholar.org/8d30/35fd2713e0a39fc158056254a33d17e99d04.pdf?_g
a=2.154761214.75762146.1570474381-1703944869.1510587726
McKnight, A. S., & Becker, L. R. (2007a, August 22). Impaired motorcycle operation, volume
II: Riders Helping Riders instructor’s guide (Report No. DOT HS 810 907). National
Highway Traffic Safety Administration.
www.nhtsa.gov/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20File
s/810907.pdf
McKnight, A. S., & Becker, L. R. (2007b, August 22). Impaired motorcycle operation, volume
III: Riders Helping Riders student manual (Report No. DOT HS 810 908). National
Highway Traffic Safety Administration.
www.nhtsa.gov/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20File
s/810908.pdf
McKnight, A. S., Becker, L. R., & Tippetts, A. S. (2008, August). Impaired motorcycle
operation, volume I: Riders Helping Riders evaluation (Report No. DOT HS 811 023).
National Highway Traffic Safety Administration.
www.nhtsa.gov/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20File
s/811023.pdf
McKnight, A. S., Billheimer, J. W., & Tippetts, S. (2013, January). An examination of
Washington state’s vehicle impoundment law for motorcycle endorsements (Report No.
DOT HS 811 696). National Highway Traffic Safety Administration.
www.nhtsa.gov/staticfiles/nti/pdf/811696.pdf
Motorcycle Safety Foundation. (2016). State motorcycle rider education programs – 2016.
www.msf-usa.org/downloads/Rider-Ed-Programs-CSI-2016.pdf
MSF. (2018). State motorcycle operator licensing - 2018. www.msf-usa.org/downloads/StateMotorcycle-Operator-Licensing-CSI-2018.pdf
National Center for Statistics and Analysis. (2019, July). Motorcycle helmet use in 2018 –
Overall results. (Traffic Safety Facts Research Note. Report No. DOT HS 812 720).
National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812720
NCSA. (2020, November). Motorcycles: 2018 data (Traffic Safety Facts. Report No. DOT HS
812 979). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812979
National Cooperative Highway Research Program. (2008). Guidance for implementation of the
AASHTO Strategic Highway Safety Plan, volume 22: A guide for addressing collisions
involving motorcycles (NCHRP Report 500). Transportation Research Board.
http://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_500v22.pdf
National Highway Traffic Safety Administration. (2000). National Agenda for Motorcycle
Safety. (Report No. DOT HS 809 156).
NHTSA. (2003). The National Highway Traffic Safety Administration motorcycle safety
program (Report No. DOT HS 809 539).
A5-19
Appendix 5. Motorcycle Safety
https://one.nhtsa.gov/people/injury/pedbimot/motorcycle/motorcycle03/McycleSafetyPro
gram.pdf
NHTSA. (2006, December). Implementation guide for the National Agenda for Motorcycle
Safety (Report No. DOT HS 810 680).
www.nhtsa.gov/sites/nhtsa.dot.gov/files/implementationguide.pdf
NHTSA. (2007a, April). Summary of novelty helmet performance testing (Traffic Safety Facts
Research Note. Report No. DOT HS 810 752).
www.nhtsa.gov/sites/nhtsa.dot.gov/files/novelty_helmets_tsf.pdf
NHTSA. (2007b, February). Share the road with motorcycles [Flyer] (Report No. DOT HS 809
713). .
https://icsw.nhtsa.gov/people/injury/pedbimot/motorcycle/ShareTheRoad/images/ShareT
heRoadwithMotorcycles.pdf
NHTSA. (2013, June). Prioritized recommendations of the National Agenda for Motorcycle
Safety (Report No. DOT HS 811 789). www.nhtsa.gov/staticfiles/nti/pdf/811789.pdf
NHTSA. (2014, June). Safety in numbers-Motorcyclists (Report No. DOT HS 812 036).
https://one.nhtsa.gov/nhtsa/Safety1nNum3ers/june2014/motorcycles/SIN_June14_Motor
cycle_1.html
NHTSA. (2019). Motorcycle safety 5-year plan (Report No. DOT HS 812 488). [Flyer].
www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/13507motorcycle_safety_plan_050919_v8-tag.pdf
Pour-Rouholamin, M., & Jalayer, M. (2016). Analyzing the severity of motorcycle crashes in
North Carolina using highway safety information systems data. ITE Journal, 86(10), 4549.
Rice, T. M., Troszak, L., Erhardt, T., Trent, R. B., & Zhu, M. (2017). Novelty helmet use and
motorcycle rider fatality. Accident Analysis & Prevention, 103, 123-128.
Salmon, D. A. (2008). Reducing motorcycle fatalities through checkpoints and education: The
New York State experience. The Police Chief, vol. LXXV, no. 7.
Wells, S., Mullin, B., Norton, R., Langley, J., Connor, J., Lay-Yee, R., & Jackson, R. (2004).
Motorcycle rider conspicuity and crash-related injury: case-control study. British Medical
Journal, 328, 857.
Williams, A. F., Tefft, B. C., & Grabowski, J. G. (2012). Graduated driver licensing research,
2010-present. Journal of Safety Research, 43, 195-203.
Windwalker Corporation & Highway Safety Services, LLC. (2011, August). Model national
standards for entry-level motorcycle rider training (Report No. DOT HS 811 503).
National Highway Traffic Safety Administration.
www.nhtsa.gov/staticfiles/nti/pdf/811503.pdf
World Health Organization. (2006). Helmets: A road safety manual for decision-makers and
practitioners. www.who.int/roadsafety/projects/manuals/helmet_manual/en/
A5-20
Appendix 6. Young Drivers
A6. Young Drivers
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Graduated Driver Licensing
Countermeasure
1.5 Cell Phone Restrictions
1.6 Belt Use Requirements
1.7 Intermediate – Violation Penalties
Effectiveness
✩✩
✩✩
✩
Cost
Use
Time
$
Medium
Medium
$
Low
Medium
$
High
Medium
Cost
Use
Time
$$$
Medium
Long
$$$
Low
Long
Cost
Use
Time
$$
Medium
Short
2. Driver Education
Countermeasure
2.1 Pre-Licensure Driver Education
2.2 Post-Licensure Driver Education
Effectiveness
✩✩
✩
3. Parents
Countermeasure
3.1 Parent Roles in Teaching and Managing
Effectiveness
✩✩
A6-1
Appendix 6. Young Drivers
Effectiveness:
✩✩ Effectiveness still undetermined; different methods of implementing this countermeasure produce different results
Limited or no high-quality evaluation evidence
✩
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
$$
$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy
demands on current resources
Requires some additional staff time, equipment, facilities, and/or publicity
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A6-2
Appendix 6. Young Drivers
1. Graduated Driver Licensing
1.5 GDL Cell Phone Restrictions
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Medium
Overall Effectiveness Concerns: The effectiveness of this widely used countermeasure has been
examined in a few research studies. Despite some positive research findings, the balance of
evidence regarding countermeasure effectiveness remains inconclusive.
As discussed in Chapter 4, Section 1.2, young drivers are at a greater risk of crashing when they
engage in distracting behaviors (Ferguson, 2003; Klauer et al., 2014). Specifically, with regard to
cell phone use, young drivers are at higher risk of crashing when they reach for cell phones, dial
cell phones, or text while driving compared to when they do not engage in these behaviors
(Klauer et al., 2014). In one study the use of cell phones was associated with significantly longer
response times (including no response, measured in seconds) than when drivers were not engaged in any cell phone use (2.8 s versus 2.1 s) (Carney et al., 2016). Drivers operating or looking at cell phones had longer response times than those engaged in phone calls (3.4 s versus 2.8
s), and they were more likely to make no evasive responses before collision compared to drivers
engaged in conversations with passengers. Generally, the use of cell phones was associated with
significantly longer eyes-off-road duration (4.1 s versus 0.9 s) and significantly longer response
times (3.4 s versus 2.1 s) than when drivers were not distracted. These results further show the
need for interventions that curb cell phone use by young drivers. A growing number of States include cell phone restrictions in their GDL laws. See Chapter 4, Section 1.2 for a discussion of
cell phone laws applying to all drivers.
Use: As of September 2019 there were 38 States and the District of Columbia that prohibit cell
phone use for young drivers. These bans cover all cell phone use, not just handheld phones. In
some States the cell phone restrictions cover teenagers holding learner permits and intermediate
licenses; in other States, the restrictions cover all drivers under a certain age such as 18 or 19
(GHSA, 2019a). Twenty States and the District of Columbia prohibit handheld cell phone use for
all drivers. In addition, 48 States and the District of Columbia prohibit text messaging for all
drivers. One of the 2 States without cell phone bans prohibits text messaging among novice
drivers (see Chapter 4, Section 1.2).
Effectiveness: There is conflicting evidence regarding the effectiveness of cell phone restrictions
on young drivers’ phone use and crash outcomes (McCartt et al., 2014; Delgado et al., 2016). See
also Ehsani et al. (2016) for a review of research published in 2014 or earlier. Ehsani et al.
conclude that cell phone restrictions may not result in a long-term deterrence of cell phone use by
young drivers. Part of the reason for the lack of consistent evidence is the methodological
differences among the studies. The authors highlight the need for future analysis to distinguish
between novice (e.g., early stages of driving, 16 or 17 years old) and more experienced young
drivers and to include distraction-affected crashes as an outcome measure.
Cell phone restrictions do not seem to reduce young drivers’ phone use. One study examined the
prevalence of distracting behaviors, including cell phone use, among drivers 16 to 19 years old
A6-3
Appendix 6. Young Drivers
enrolled in teen driving programs and involved in 412 rear-end crashes (Carney et al., 2018). The
crashes occurred from August 2007 to July 2013 in Arizona, Colorado, Illinois, Iowa, Minnesota,
Missouri, Nevada, and Wisconsin. Except Missouri and Nevada, these States have some form of
ban on young driver cell phone use (GHSA, 2019b). In the 6 seconds before collision, drivers
were most often using cell phones (18% of all distracting behaviors before rear-end crashes).
Some 95% of these behaviors were coded as “operating/looking at phone” and included actions
such as texting. A 2009 study examined the short-term effects of a teenage driver cell phone
restriction in North Carolina and found that 5 months after a ban on cell phones took effect, the
proportion of teens using cell phones while driving was unchanged (Foss et al., 2009). A followup study evaluated the long-term effect of North Carolina’s cell phone restriction 2 years after
the law went into effect (Goodwin et al., 2011). Teenagers were observed at high schools in
North Carolina and South Carolina, which did not have a cell phone restriction. In both States,
there was a decrease in cell phone use. However, the decrease in cell phone use did not
significantly differ between the two States, despite increased awareness of the restriction among
licensed teens in North Carolina.
Some studies have examined the effects of cell phone bans on young-driver crashes. The
outcomes provide inconclusive evidence of the effectiveness of cell phone restrictions. The
HLDI conducted two studies to compare the collision claims of drivers 25 or younger in a few
States with some form of cell phone restrictions relative to control States without these
restrictions (HLDI, 2009, 2010). There were no significant differences in the collision claims of
young drivers in States with handheld cell phone restrictions as compared to control States.
However, collision claims of young drivers were found to increase 5% to 11.5% in States with
texting restrictions relative to control States, perhaps as the result of concealing phones from
view to avoid fines (HLDI, 2010). The outcomes from Ehsani et al. (2014) follow similar trends.
They examined the effects of Michigan’s universal texting law on crash types among 16- and 17year-old drivers and found a slight increase in the more serious crashes including fatal/disabling
injury crashes and non-disabling injury crashes. However, they found a slight decrease in less
severe crashes (e.g., possible injury/property damage only crashes). A study by Lim and Chi
(2013) provides contradictory findings. Lim and Chi (2013) examined the relationship between
cell phone bans and fatal crashes among drivers 20 and younger. They compared States across
the United States that had no cell phone restrictions, cell phone restrictions that applied only to
young drivers, and cell phone restrictions that applied to all drivers regardless of age. They found
that cell phone restrictions that applied to all drivers regardless of age were associated with
decreases in fatal crashes among young drivers. However, States that had cell phone restrictions
that only applied to young drivers had no significant effect.
Delgado et al. (2016) suggest that a multi-pronged approach consisting of legal bans, HVE,
increased financial and legal penalties, and greater parental involvement will be more effective
in preventing phone-related distractions of young drivers.
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 about 6 months to notify the
public and implement the changes.
A6-4
Appendix 6. Young Drivers
1.6 GDL Belt Use Requirements
Effectiveness: ✩✩
Cost: $
Use: Low
Time: Medium
Overall Effectiveness Concerns: To date there has been only one evaluation of the effects of
explicit seat belt use requirements in GDL laws. This evaluation found no evidence the
countermeasure had any effect on teen driver belt use (Freedman & Levi, 2008).
Properly worn seat belts dramatically reduce the risk of injury or death to vehicle occupants in
crashes (Kahane, 2015). Seat belts are particularly important for teenage drivers because of their
elevated crash risk. Nonetheless, younger drivers and passengers have lower seat belt use rates
than older drivers and passengers (Enriquez, 2019). Belt use is particularly low among teenagers
who are male, drive pickup trucks, and live in rural areas (Kim et al., 2009).
Young drivers are covered by seat belt laws in all States except New Hampshire, which only
requires seat belts for people under 18 (GHSA, 2019c). Some States explicitly require belt use
under their GDL laws. An explicit belt use requirement in State GDL laws may have more
influence on beginning drivers than States’ overall belt use laws, especially in States where GDL
belt use requirements are coupled with primary enforcement for young drivers and in States
where seat belt violations result in delayed graduation to the next GDL stage.
Use: As of 2012 GDL laws in 22 States explicitly required seat belt use (AAA Public Affairs,
2012). Sanctions for violating this requirement varied across States.
Effectiveness: To date there has only been one evaluation of the effects of explicit seat belt use
requirements in GDL laws. Tennessee and Wisconsin both have a seat belt restriction in their
GDL programs. Evaluations of the restrictions in these two States found little if any effect on
teen driver belt use (Freedman & Levi, 2008). One problem is that teens (and parents) may not be
aware when seat belt laws are part of a State’s GDL system. For example, surveys in North
Carolina have shown very high awareness for the State’s nighttime and passenger restrictions,
but only 3% of teens and 5% of parents were aware of the special GDL provision concerning seat
belts (Goodwin & Foss, 2004).
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 about 6 months to notify the
public and implement the changes.
A6-5
Appendix 6. Young Drivers
1.7 GDL Intermediate License Violation Penalties
Effectiveness: ✩
Cost: $
Use: High
Time: Medium
Overall Effectiveness Concerns: The few evaluations of early stand-alone probationary license
systems generally found no substantial benefits (McKnight & 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. There are insufficient evaluation data available
to conclude that the countermeasure is effective.
A probationary feature is included in the intermediate phase of many graduated licensing
systems, which is commonly referred to as contingent advancement. Typically, contingent
advancement means that an intermediate license holder must maintain a violation free driving
record for a specified amount of time before they can obtain a full license.
Use: Almost all States penalize some GDL or traffic law violations by delaying full licensure
(IIHS & TIRF, 2004).
Effectiveness: The few evaluations of early stand-alone probationary license systems generally
found no substantial benefits (McKnight & 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.
An enforcement/education program dubbed Ticket Today = License Delay (the equal sign is not
pronounced) highlighted the resulting delay in licensure for teenagers who are convicted of
moving, seat belt, or GDL violations. Although teens and their parents clearly perceived the
increased enforcement, the program had only minimal effects on seat belt use and compliance
with GDL restrictions (Goodwin, Wells, Foss, & Williams, 2006). In general, it appears that
awareness of penalties for license violations among parents and teens is relatively low,
enforcement is rare, and licensing delays are not always applied even when violations are
enforced (Goodwin & Foss, 2004; Steenbergen et al., 2001; Williams, 2007).
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 about 6 months to notify the
public and implement the changes.
A6-6
Appendix 6. Young Drivers
2. Driver Education
2.1 Pre-Licensure Driver Education
Effectiveness: ✩✩
Cost: $$$
Use: Medium
Time: Long
Overall Effectiveness Concerns: This countermeasure is used in many States. Its effectiveness
has been examined in several research studies. The balance of the evidence suggests that these
types of countermeasures are ineffective in the long term.
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 and by about 1970,
approximately 14,000 high schools taught driver education to about 70% of all eligible teenagers.
However, State and Federal funding for driver education decreased, and by the early 1990s, less
than half of all high schools offered driver education, and the majority of beginning drivers did
not take driver education. See Smith (1994), Mayhew (2007), or Williams et al. (2009) for
concise reviews of the history of driver education in the United States, and see Beanland et al.
(2013) for a review of the effectiveness of driver training programs.
The study best known in the United States for evaluating the effect of driver education on crash
rates is the extensive NHTSA-sponsored study in DeKalb County, Georgia, in the late 1970s.
More than 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 that tracked student driving records for a longer 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. See Vernick et al. (1999) or
Williams et al. (2009) for brief summaries of all DeKalb study analyses.
Roberts and Kwan (2001) concluded from three well-designed evaluations in Australia, New
Zealand, and the United States that driver education may lower the age teenagers become
licensed but does not affect their crash rates once they do become licensed. The net effect of
driver education may actually increase crashes because it puts more young drivers on the road.
Vernick et al. (1999) reached the same conclusion from a review of 9 studies, 8 from the United
States and 1 from Australia. It has been suggested that crash outcomes are not appropriate or fair
measures for driver education and are unrealistic to expect (Waller, 2003). A New Zealand study
(after controlling for other factors) found newly licensed drivers who had received their full
licenses sooner for completing defensive driving courses were more likely to receive citations for
committing traffic offenses (Begg & Brookland, 2015).
In contrast, some studies have found decreases in crash risk associated with driver education. An
evaluation of Oregon’s driver education program showed small decreases in the risk of collisions
and convictions for teens who had participated in the driver education program (Mayhew et al.,
2017). Another archival study concluded there is a decrease in crash risk associated with driver
education (4.3%, AAAFTS, 2014), but this reduction is modest compared with those associated
A6-7
Appendix 6. Young Drivers
with GDL. This result is consistent with the suggestion that it may be unreasonable to expect prelicensure driver education to produce sizable changes in crash risk given the amount of time and
resources dedicated to it (Waller, 2003). Given that an effect of this size would require research
that includes over 140,000 students to reliably detect differences in crash rates between students
who do and do not complete driver education, it is unsurprising that most previous evaluations
have failed to detect any effect of driver education.
NHTSA concluded that driver education should be integrated into State GDL programs as there
was no evidence that driver education alone provided consistent effects (Compton & EllisonPotter, 2008; Thomas, Blomberg, & Fisher, 2012). 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.) Through support
from the driver education community and the Association of National Stakeholders in Traffic
Safety Education (ANSTSE), NHTSA developed the Novice Teen Driver Education and
Training Administrative Standards (NTDETAS) to enhance driver education delivery in the
States (NHTSA, 2010, 2017). In addition to an overall revision of the 2009 NTDETAS, the new
version includes updates to the instructor training and instruction delivery standards (NHTSA,
2017). The NTDETAS recommends the use of 45 hours of classroom instruction, 10 hours
behind-the-wheel, and 10 hours of additional flexible instruction consisting of classroom,
observation, range, simulation, or computer-based independent learning.
NHTSA offers a State Assessment Program to assist States in meeting the standards. At a State’s
request, NHTSA will send a team of peers with expertise in different areas of the NTDETAS to
review current State practices and make recommendations for improving the program. The
Oregon DOT’s driver education program was the second U.S. program to participate in a Driver
Education Assessment. Mayhew et al. (2017) discuss Oregon’s driver education program and its
initiative to integrate driver education and GDL by including specifics about how teens are
encouraged to take Oregon’s driver education program, which directly links to the State GDL
system.
Many States offer incentives for taking driver education. Twenty-five States encourage it by
allowing teens to get unrestricted licenses at an earlier age if they complete driver education, and
18 States offer other incentives such as reducing the required number of supervised driving
hours, waiving portions of licensing tests, or lowering the minimum permit age (Thomas,
Blomberg, & Fisher, 2012). However, research shows that driver education “discounts” may
have the opposite effect of increasing crashes (Mayhew, 2007). For example, a study in British
Columbia found that crash rates were 27% higher for driver education graduates who reduced
their learner’s permit holding period by 3 months than for non-graduates (Wiggins, 2004).
Use: NHTSA investigated driver education requirements in the United States and found that 23
States and the District of Columbia require some form of driver education before licensure for
anyone younger than 18 (Thomas, Blomberg, & Fisher, 2012). Most commonly, this included 30
hours of classroom instruction and 6 hours of behind-the-wheel practice, although requirements
vary considerably across States. For example, 15 States accepted online driver education in lieu
of standard in-person classroom-based instruction (Thomas, Blomberg, Korbelak, et al., 2012).
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Appendix 6. Young Drivers
Most States offered both commercial and high school driver education programs (Thomas,
Blomberg, & Fisher, 2012).
Effectiveness: Driver education leads to earlier licensure in some States and does not reduce
crash rates (Mayhew, 2007; Roberts & Kwan, 2001; Thomas, Blomberg, & Fisher, 2012;
Vernick et al., 1999; Williams et al., 2009). At best, safety benefits of driver education have thus
far been somewhat positive (Mayhew et al., 2017). Nonetheless, there has been a growing
interest in improving and evaluating driver education. Potential avenues for driver education
were summarized in a research circular by the Transportation Research Board (TRB, 2006). The
AAA Foundation for Traffic Safety has produced a series of publications that provide practical
information on how to conduct evaluations of driver education (Clinton & Lonero, 2006), and
NHTSA conducted a feasibility study on evaluating driver education curriculum (Williams et al.,
2009).
There have been advances in developing new training modules that can be part of driver
education programs, summarized in Thomas, Blomberg, and Fisher (2012). Given that visual
scanning, attention maintenance, and speed management are likely responsible for many crashes
among young drivers, new programs have been developed that focus on teaching these higherorder knowledge and skills, generally using computer simulation. The Risk Awareness and
Perception Training (RAPT) program is a computer-based training module designed to improve
visual scanning, hazard anticipation, and hazard avoidance skills in novice drivers (Pollatsek et
al., 2006; Pradhan et al., 2009). Other computer-based training programs have also been
developed, including SAFE-T, which addresses similar skills as RAPT—hazard anticipation,
hazard avoidance, and attention maintenance to the forward roadway (Yamani et al., 2016).
Similarly, the Accelerated Curriculum to Create Effective Learning (ACCEL) is an omnibus PCbased training program targeted at building six skills in novice drivers—strategic hazard
anticipation, tactical hazard anticipation, strategic attention mitigation, tactical attention
mitigation, strategic attention maintenance, and tactical attention maintenance (Fisher et al.,
2018). The SAFE-T and ACCEL training programs have shown positive outcomes in limited,
small-scale evaluations; however, they have not yet been evaluated as integrated parts of a driver
education program. See also Unverricht et al. (2018) for a review and meta-analysis of novice
driver training programs.
NHTSA funded a set of studies to further enhance RAPT and evaluate its effectiveness.
Participants in the first study viewed high-quality graphics of hazardous situations and were
asked to click on locations in the scene that they would look at if they were driving (Thomas et
al., 2016). The evaluation was conducted in California in collaboration with the California DMV.
A total of 5,251 drivers 16 to 18 years old were recruited and assigned to either the RAPT or a
comparison control group. Outcomes from this study showed a 23.7% lower crash risk for male
drivers who received the RAPT training relative to the male drivers in the comparison group. The
results for female drivers showed a statistically non-significant increase of 10.7% in crash risk
compared to the comparison group. The authors propose that further research with larger and
diverse samples might help identify reasons for potential gender differences in estimated crash
risk. In a further enhancement of RAPT, Thomas et al. (2017) updated the graphics from the first
study to high-definition videos and animations. An evaluation of this version with 205 trainees
reported that the revisions were a significant improvement over previous implementation.
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Appendix 6. Young Drivers
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.
Other issues:
• Parent involvement: There has been a growing interest in integrating parents into driver
education. For example, Connecticut, Massachusetts, and Montana and four counties in
Northern Virginia require parents to attend a parent information/orientation session as a
part of their teen’s driver education requirements (GHSA, 2013). Virginia passed
legislation in 2009 requiring a minimum of 90 minutes of parent participation in the inclassroom portion of driver education. Similarly, Massachusetts and Connecticut require
parents to attend a 2-hour driver education orientation programs. In 2012 Montana
revised its Traffic Education Standards to include a provision that parents of teens in
driver education must attend a mandatory session and the State specified the content that
must be included in the information session. Parents appear to support these
requirements. In a national survey, a majority (70%) of parents reported that orientation
courses should be required (Williams et al., 2011). Nonetheless, research has not yet
determined the most effective way to involve parents in the driver education process
(GHSA, 2013).
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Appendix 6. Young Drivers
2.2 Post-Licensure or Second-Tier Driver Education
Effectiveness: ✩†
†Effectiveness
Cost: $$$
Use: Low
Time: Long
has not yet been evaluated
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
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, 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 safety-related 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, postlicensure driver education had no effect (Ker et al., 2005).
Initiatives in Australia and Europe may provide insight on potential approaches for post-license
training for beginning drivers (Senserrick, 2007; Twisk & Stacey, 2007). Christie and colleagues
have developed a model “best practice” curriculum for intermediate license drivers with at least
6 months of driving experience in Australia (Christie et al., 2004). The 8-hour curriculum
consists of eight modular sessions with a mentor or coach, including one-on-one driving and
discussion, group observation and discussion of driving behavior, and telephone follow-up.
However, this curriculum has yet to be evaluated.
NHTSA has completed a feasibility study in anticipation of a major evaluation of the benefits of
an integrated driver education and GDL program (Hedlund & Compton, 2005).
Use: Post-licensure driver education is still under development. Michigan is the only State that
has adopted a two-stage system of driver education (Mayhew, 2007).
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.
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Appendix 6. Young Drivers
3. Parents
3.1 Parental Role in Teaching and Managing Young Drivers
Effectiveness: ✩✩
Cost: $$
Use: Medium
Time: Short
Overall Effectiveness Concerns: This countermeasure has been examined in several research
studies. Despite some positive research findings, particularly in terms of behavioral changes, the
balance of evidence regarding countermeasure effectiveness remains inconclusive.
Most parents are heavily involved in teaching driving skills to their beginning teenage drivers
and supervising their driving while they have learner permits. Parents are often in the best
position to enforce GDL restrictions for intermediate drivers and to impose additional driving
restrictions on their teenagers. Parents strongly support GDL; however, many do not understand
the dangers of high-risk situations for teen drivers, such as driving with teenage passengers. A
review of naturalistic driving data collected from young drivers reported that most parental
guidance is reactive and may not allow for the teens to practice driving in complex situations
(Simons-Morton et al., 2017). Parents could use systematic guidance and assistance in
supervising and training teens (Hedlund et al., 2003; Goodwin et al., 2007, Strategies C1-C3;
Simons-Morton et al., 2017). For summaries of the research on parent involvement in teen
driving, see Simons-Morton and Ouimet (2006) or Simons-Morton et al. (2008). For a review of
promising parent programs, see GHSA (2013).
The majority of States provide some form of guidance to parents of teen drivers in the form of
booklets/brochures and/or videos, much of it online. However, it has been demonstrated that
passive dissemination of information to parents is not an effective method to change parents’
behaviors and ultimately reduce teen driver crashes (Chaudhary et al., 2004; Goodwin et al.,
2006). In hopes of better equipping parents to supervise and manage their teens’ driving, there
has been a growing interest in programs that involve direct interaction and engagement with
parents. Although many such programs have been developed, the following programs are
highlighted because they have been evaluated and shown promising results: Checkpoints, Green
Light for Life, Steering Teens Safe, TeenDrivingPlan, and the Share the Keys Program. See
Curry et al. (2015) for a review of similar programs.
Checkpoints: The original Checkpoints program developed by Simons-Morton and colleagues at
the National Institute of Child Health and Human Development uses videos and periodic
newsletters to reinforce the need for parents to limit their newly licensed teens’ driving under
risky conditions. A central feature are written agreements parents and teens review and sign.
They limit teen driving under high-risk situations, such as driving at night, with other teens in
the cars, or in bad weather (Simons-Morton & Hartos, 2003). The facilitated Checkpoints
program has been adapted from the original version to include a 30-minute, in-person session to
introduce teens and parents to the Checkpoints program, and to have them work in pairs to begin
developing these parent-teen driving agreements (Zakrajsek et al., 2009).
Green Light for Life (GLL): This program has been implemented in Israel since 2005 (TaubmanBen-Ari & Lotan, 2011; Toledo et al., 2012). From 2005 to 2008 approximately 130,000 families
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Appendix 6. Young Drivers
participated in the program. GLL consists of an in-person, 45-minute meeting with a parent and
their young driver prior to entering the accompanied driving phase, otherwise known as the
learner’s permit stage in the United States. During the meeting, parents and teens are encouraged
to get as much supervised driving practice as possible in a variety of conditions. Parents are
encouraged to share their hazard perception knowledge and skills with their teen drivers.
Strategies for dealing with in-vehicle dynamics between the teen and parent are also discussed.
Families are given a booklet and CD to take home.
Steering Teens Safe: This 45-minute, in-person program focuses on improving parental
communication skills by teaching them to use motivational interviewing techniques to talk to
their teens about safe driving. Parents receive DVDs and workbooks with 19 safe driving lessons
to help them discuss, demonstrate, and practice safe driving behaviors and skills with their teens.
Steering Teens Safe is intended for parents of teens who are in the learner permit phase (PeekAsa et al., 2014; Ramirez et al., 2013).
TeenDrivingPlan: Parents use this web-based program in the learner permit phase to increase the
quantity and quality of their supervised driving practice. It includes 53 web-based videos, a webbased planner to structure practice sessions, and a web-based log to record and rate driving
practice sessions (Mirman et al., 2014). See
https://injury.research.chop.edu/sites/default/files/documents/tdp_logging_tool.pdf for the
logging and rating tool.
Share the Keys program: Previously known as the New Jersey Parent/Teen Driver Orientation
Program, Share the Keys was developed to educate parents about New Jersey’s GDL program,
laws, and the importance of parental involvement in teen driver safety (Knezek et al., 2018). It
lasts 60 to 90 minutes and is delivered as a 26-slide deck with 10 videos focused on parental
involvement and their roles in preventing risky teen driver behaviors. Parenting styles (e.g.,
authoritarian) and opportunities for parents to serve as role models of ideal behavior (e.g., not
texting while driving) are covered in the content. Parents and teens collaboratively develop
contracts and pledges related to GDL restrictions. Companion guides and online resources give
them information during the supervised training period.
Use: Checkpoints and TeenDrivingPlan are available on the web. Steering Teens Safe is being
evaluated and is not yet available for the public. Green Light for Life is not currently available in
the United States. Share the Keys presentations can be scheduled by schools and communities
free of charge, with online resources available for the public at any time.
Effectiveness:
Checkpoints: Results from testing in several States show the original Checkpoints program
produces modest increases in parents’ restrictions on teen driving (Simons-Morton & Hartos,
2003; Simons-Morton et al., 2005). However, a study in Connecticut found no differences in
violations or crashes for families who participated in the Checkpoints program when compared
with families who did not participate in the program (Simons-Morton et al., 2006).
The facilitated Checkpoints program has been evaluated and has had promising results. Zakrajsek
et al. (2009) evaluated the program delivered by trained health educators in driver education
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Appendix 6. Young Drivers
classes and found that, relative to a comparison group, parents who participated in the facilitated
Checkpoints program showed greater awareness of teen driving risks, were more likely to
complete a parent-teen driving agreement, and reported setting stricter limits on their teens’
driving during the intermediate license phase. Zakrajsek et al. (2013) conducted an evaluation of
the facilitated Checkpoints program delivered by driver education instructors and also found that
parents who participated in the program were more likely to report that they used a parent-teen
driving agreement and had stricter limits on their teens’ driving. Teens also self-reported less
risky driving. However, they found no differences in crashes for teens who participated in the
program compared to teens who did not participate.
Green Light for Life: To date it has undergone two evaluations. Taubman-Ben-Ari and Lotan
(2011) examined its effectiveness by comparing self-reports of 362 teenagers who participated in
the program with 376 teens who did not. They found no difference in the amount of accompanied
driving teens obtained during the supervised driving phase or the level of reckless driving
reported. However, teen participants reported more positive attitudes about the supervised
driving phase and reported less crash involvement. A national study evaluated injury crash
involvement between teens who participated in the GLL program from 2005 to 2007 compared
to teens who did not participate. Based on analysis of injury crash data during the first 2 years
after licensing, teen participants had 10% lower injury crash rates (Toledo et al., 2012).
Nonetheless, both studies suffered from possible effects of self-selection bias. A follow-up study
is underway to examine behavior and crash data of young drivers at the individual level, in an
attempt to address this potential bias.
Steering Teens Safe: This was evaluated via randomized controlled trials (Peek-Asa et al., 2014,
2019). The 2014 study examined the effectiveness of parent communication about driving safety
as perceived by the teen driver, and the teens’ self-reported risky driving. Teens reported a higher
quality of parent communication than control teens, and the teens in the program reported a 21%
reduction in self-reported risky driving compared with control teens. The 2019 report compared
teen drivers who received no feedback on their driving, drivers with electronic feedback, and
drivers with combined electronic and parental feedback based on event monitoring and who had
65% and 85% fewer unsafe driving events (such as distracted driving, speeding, or driver and
passenger seat belt use) respectively.
TeenDrivingPlan: To date one randomized controlled trial has been conducted to measure its
effects. Mirman et al. (2014) found that families who used the TeenDrivingPlan reported more
driving practice in environments and situations (i.e., night and bad weather) compared to teens
not in the program. In addition, teens in the TeenDrivingPlan group were less likely to be
terminated during on-road driving tests compared to teens not in the program (6% and 15%,
respectively).
Share the Keys program: A longitudinal survey-based evaluation was performed on the initial
implementation in New Jersey. Overall, parents reported high levels of engagement with their
teens in the GDL process. In general, parents were more reluctant to take on
authoritative/authoritarian roles in the process, which was associated with a lack of teen driver
compliance with nighttime curfews and passenger restrictions. Some positive changes were
observed, such as increases in passenger limit compliance over time. Parents also appreciated the
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Appendix 6. Young Drivers
ability to engage with other parents and teen drivers to allow for clarification of their own roles
as monitors and enforcers. Share the Keys can be combined with other programs such as
Checkpoints to provide consistent benefits in the short term (Knezek et al., 2017).
Although evaluations of programs to assist parents have not yet shown reductions in young
driver crashes, there is still reason to be optimistic. Programs such as Checkpoints have increased
parent limit setting, and several studies show that teenagers whose parents impose stricter driving
limits report fewer risky driving behaviors, traffic violations, and crashes (see Simons- Morton,
2007, for a review). Educational programs alone are unlikely to produce changes in behavior.
However, education in combination with other strategies may deliver stronger results.
Costs: Checkpoints is available on the web; however, in order to use the facilitated version, staff
time would be needed to implement in-person sessions. Share the Keys presentations are
provided free of charge to schools and communities.
Time to implement: The original Checkpoints program and the facilitated program are available
immediately. However, to implement the facilitated Checkpoints program on a large scale, it
would likely take a year for planning, staff training, and dissemination. Green Light for Life,
Steering Teens Safe, and the TeenDrivingPlan program implementation details are not available.
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Appendix 6. Young Drivers
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Appendix 6. Young Drivers
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Appendix 6. Young Drivers
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A6-21
Appendix 7. Older Drivers
A7. Older Drivers
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Communications and Outreach
Countermeasure
Effectiveness
1.1 Formal Courses for Older Drivers
1.2 General Communications and Education
✩✩
✩
Cost
Use
Time
$
Low
Short
$
Unknown
Short
Cost
Use
Time
Varies
High
Medium
$$$
Medium
Medium
2. Licensing
Countermeasure
Effectiveness
2.4 Medical Advisory Boards
2.5 License Renewal Policies: In-Person
Renewal, Vision Test
✩
✩✩
Effectiveness:
✩✩
✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
A7-1
Appendix 7. Older Drivers
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A7-2
Appendix 7. Older Drivers
1. Communications and Outreach
1.1 Formal Courses for Older Drivers
Effectiveness: ✩✩
Cost: $
Use: Low
Time: Short
Overall Effectiveness Concerns: The effectiveness of formal courses for older drivers has been
examined in several research studies. While these studies have found some positive outcomes,
there is no evidence that this countermeasure reduces crashes relative to comparison groups.
Formal courses specifically for older drivers are offered by organizations including AAA,
AARP, and the National Safety Council, either independently or under accreditation by States
(Potts et al., 2004, Strategy D2; Stutts, 2005, Table 12). AARP’s Driver Safety Program is the
largest of these courses. AARP developed the initial version in 1979 (“55 Alive”) and the current
version, named “AARP Smart Driver Course,” is offered in the classroom and online (Moreau,
2015). 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. As of 2010 there were 34 States and the District of Columbia that mandated automobile
insurance discounts for graduates of accredited courses (AARP, 2010). Insurance companies
may choose to offer discounts to graduates of accredited courses even in States that do not
mandate discounts. A relatively new AARP course, the Smart DriverTEK course, educates
drivers on the safety features and technologies in their vehicles (AARP, 2018). The course is
delivered as short-duration workshops and includes material on technologies including smart
headlights, reverse camera systems, collision and proximity warning (e.g., blind spot, lane
departure, and forward collision), and post-crash emergency (also known as automatic crash or
advanced automatic crash) notification systems. Insurance discounts are not offered for
participants taking this course (AARP, 2018). As an option to taking the in-person workshop,
people can register online for a self-paced version of the course, see
https://campaigns.aarp.org/findaworkshop/?cmp=RDRCT-ADS-SMDTEK-0-30917.
Courses combining classroom and on-the-road instruction have been offered in a few locations
(Potts et al., 2004, Strategy D2).
Use: Courses are taught in all States but reach only a small fraction of older drivers.
Effectiveness: Graduates of both the AARP classroom and online courses report they changed
some driving behaviors as a result of the course (Skufca, 2011). However, none of the courses
has been shown to reduce crashes (Potts et al., 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; Potts et al., 2004, Strategy D2).
A study conducted in 2004 evaluated the effects of a well-designed three-hour educational
course promoting safe driving strategies for older drivers with some visual defects. Course
A7-3
Appendix 7. Older Drivers
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).
Another 2004 study involving a systematic review of studies evaluating the effectiveness of
driver retraining programs (Kua et al., 2007) reached a similar conclusion as did Owsley et al.
(2004). These researchers reported that while there is moderate evidence that educational
interventions improve driving awareness and behavior, these interventions do not reduce crashes
in older drivers. Regardless, the authors felt the evidence regarding the effectiveness of
retraining aimed at older drivers is encouraging enough to warrant further research.
Several subsequent evaluations of courses for older drivers have produced mixed results related
to the crash rates of drivers attending these courses. Marottoli (2007) concluded that a training
program combining classroom education with on-road training improved the performance of
older drivers on written and on-road tests, and may allow these drivers to retain their licenses
longer, but did not attempt to assess the program’s impact on subsequent crash rates. Bedard et
al. (2008) concluded that an in-class education program coupled with on-road education led to
improvements in the participants’ knowledge of safe driving practices and improvements on
some aspects of safe driving performance, but further research is required to determine if these
changes will affect crash rates.
Nasvadi and Vavrik (2007) conducted research in British Columbia evaluating the crash risk of
drivers after attending a safe driving class and found that these classes were associated with an
increased number of crashes for certain men 75 and older. The findings reported that older men
who had at least one crash before and after the study were less likely to have used “compensation
and selection strategies” (avoiding difficult driving situations, driving less by ceasing to drive at
all or consolidating their trips so that they spend less time on the road, etc.). The study also found
that the oldest male drivers were less likely to be motivated by reasons other than spousal
pressure and that they were less likely to be able to recall specific things they had learned during
the course. These drivers reported higher emotional attachment to driving and higher confidence
about driving. Apart from these negative outcomes, attendance in these classes had no effect on
crashes for male attendees younger than 75 or female attendees of all ages. Though
acknowledging several limitations of this study, the authors stress, “Recognizing and
understanding characteristics and behaviors of older drivers who attend remedial driver
education is essential to the design and delivery of successful driver safety programs.”
Korner-Bitensky et al. (2009) conducted a review of articles published from 2004 to 2008 on the
effectiveness of older driver retraining programs for improving driving skills and reducing crash
rates. Four studies met the inclusion criteria for the review and provided strong evidence that
education combined with on-road training improves driving performance. They also found
moderate evidence that education alone is not effective in reducing crashes but combined with
physical retraining, does improve driving performance. The value of physical training in addition
to education is reinforced by research results by Romoser and Fisher (2009). They found that
active training, such as practice with feedback, is a more effective strategy for increasing older
drivers’ likelihood of side-to-side scanning, looking for threats, during turns than is passive
training (classroom lecture or video only) or no training.
A7-4
Appendix 7. Older Drivers
Costs: Costs for making courses for older drivers available can be minimal since they have been
developed and are offered by organizations such as AAA, AARP, and NSC. 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.
A7-5
Appendix 7. Older Drivers
1.2 General Communications and Education
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
Overall Effectiveness Concerns: There are no known evaluations of the effects of this material
on driving or on crashes (Potts et al., 2004, Strategy D2).
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 (Potts et al., 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;
• American Medical Association’s Am I a Safe Driver? one-page checklist; and
• University of Michigan’s Driving Decisions Workbook. See Stutts (2005) for brief descriptions and web links.
Other programs and material include:
• NHTSA’s Older Driver Safety web page contains information for caregivers and older
drivers, see www.nhtsa.gov/road-safety/older-drivers
• CarFit, a program developed by AAA, AARP, and the American Occupational Therapy
Association to help older drivers find a proper fit in their personal vehicles;
• Drive Well Toolkit, a joint program of American Society on Aging and NHTSA;
• Getting Around, from Emergency Nurses CARE, on safe driving decisions, pedestrian
safety, and safe medication use;
• 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; and
• NHTSA’s Introduction to Medically At Risk Driving
(www.youtube.com/watch?v=sMwis4jT4Fw) provides an introduction to the symptoms
of medical impairments in older drivers.
See Potts et al. (2004, Strategy D2) and Stutts (2005) for examples, brief descriptions, and web
links. See also AAAFTS (2009) for examples of public information and awareness material
included in its “Noteworthy Initiatives” database.
Other material is 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). Examples include:
A7-6
Appendix 7. Older Drivers
•
•
•
•
•
•
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 website:
www.nhtsa.gov/road-safety/older-drivers
Clearinghouse for Older Road User Safety: www.roadsafeseniors.org
AAA’s How to Help an Older Driver; https://seniordriving.aaa.com/download/how-tohelp-an-older-driver-brochure/
The Hartford’s At the Crossroads: A Guide to Alzheimer’s Disease, Dementia and
Driving; https://s0.hfdstatic.com/sites/the_hartford/files/cmme-crossroads.pdf
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; www.aded.net/page/510
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:
https://aging.ny.gov/system/files/documents/2019/10/when-you-are-concerned-2015-03km-ah-1opt.pdf.
Use: Data are not available on how frequently these programs are used.
Effectiveness: The limited information available suggests that some material may increase
driver’s knowledge. One recent study evaluated compliance of both younger and older drivers to
the CarFit program criteria (McConomy et al., 2018). The study found that post-CarFit
education, older drivers were five times more likely to adjust themselves to correct line of sight
criterion than younger drivers. Not all older drivers positioned themselves correctly with respect
to pedal access; some sat too far to reach the brake pedals. The study found that age and stature
were significantly associated with compliance to CarFit criteria. Recommendations include the
provision of education or equipment to enable older drivers’ fit with car pedal setups. As
discussed in Chapter 7, Section 1.1, none of the more structured formal courses has been shown
to reduce crashes.
Costs: Funds are required for producing and distributing material.
Time to implement: Material and programs are available and ready for use.
Other issues:
• Seat belt use: Seat belts are even more effective in preventing injuries and fatalities to
older than to younger occupants (Potts et al., 2004, Strategy E1). While belt use among
older occupants is comparable to that of younger occupants – 91% for occupants 70 and
older and 90% for occupants 25 to 69 in 2017 (Li & Pickrell, 2019) – the fact remains
that nearly 1 in 8 older occupants is unbelted. Communications and outreach on the
benefits of seat 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 6 senior communities compared to
controls, and use remained higher after 4 years (Cox et al., 2005). No other State or local
seat belt use efforts directed at older occupants have been identified (Potts et al., 2004,
Strategy E1).
A7-7
Appendix 7. Older Drivers
•
Considerations for Future Education for Older Drivers: In a review of the five-level
model of driver education, Goals for Driver Education in the Social Perspective (GDE 5
SOC), Keskinen (2014) indicates that education for older drivers could be improved if it
were more focused on a process of mutual understanding where the instructor helps older
drivers learn more about their own abilities and challenges while driving rather than
teaching knowledge or skills.
A7-8
Appendix 7. Older Drivers
2. Licensing
2.4 Medical Advisory Boards
Effectiveness: ✩†
† Quality varies considerably
Cost: Varies
Use: High
Time: Medium
Overall Effectiveness Concerns: This countermeasure is widely used; however, there are no
known studies evaluating the crash relevant effects of MABs.
Thirty-two States have medical advisory boards to assist the licensing agencies in evaluating
people with medical conditions or functional limitations that may affect their ability to drive
(Lococo, Stutts, et al., 2017). MABs generally make policy recommendations on what licensing
actions are appropriate for people with specific medical conditions or functional limitations. In
2016 and 2017, NHTSA published a series of reports on the analysis of the MAB
implementation practices. These reports document the medical review structures and processes
of all States and include case studies for several States. Most State MABs review individual
cases, though this activity varies widely; 5 States reported that their MABs reviewed 1,000 cases
or more in 2012 while another 7 reviewed 10 or fewer cases (Lococo, Stutts, et al., 2017).
MABs should play key roles as the links among health care professionals, licensing agencies,
law enforcement, and the public. They should take the lead in defining how 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 NHTSA- AAMVA study findings
(AAA, 2004). The National Transportation Safety Board 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 &
Staplin, 2005).
As noted above, NHTSA and AAMVA produced a guide in September 2009, “Driver Fitness
Medical Guidelines” designed to provide guidance to licensing agencies in making decisions
about a person’s fitness for driving (NHTSA, 2009). These guidelines, as well as NHTSA’s
Physician’s Guide to Assessing and Counseling Older Drivers (Wang et al., 2003; Carr et al.,
2010), can be used to provide guidance to MABs as they define how medical conditions and
functional impairments affect driving and what steps can be taken to compensate for any
limitations noted due to relevant conditions and limitations.
Use: Thirty-two States report having MABs or a formal liaison with other offices that functions
as MABs (Lococo, Stutts, et al., 2017).
A7-9
Appendix 7. Older Drivers
Effectiveness: There are no known studies evaluating the effects of MABs. Maryland’s MAB
reviewed over 500 individual cases in 2004 and recommended license suspension for about twothirds of the cases. 10
NHTSA performed a detailed examination of driver review practices across the country to
identify the strengths and weaknesses of the different implementations. The 51 agencies were
grouped into four categories based on two criteria:
• presence of a State MAB or similar liaison with a State health department and
• availability of in-house medical professionals to review license referral cases (Lococo et
al., 2016).
Seven States were selected for detailed analysis of their MAB practice—Maine, North Carolina,
Texas, Wisconsin, Ohio, Washington, and Oregon. These States were surveyed on the structure
and operation of their driver review programs, which included information on sources for
medical referrals, activities of the MAB, and the type of medical information collected from the
drivers. States without MABs or in-house physicians were found to rely on the assessments of
drivers’ physicians and licensing tests. Driver appeals to licensing decisions in these States were
found to be the lowest. States with MABs relied on the medical standards that were in place;
these generally also had legal immunity granted to physicians, which resulted in high physician
referrals.
Case studies of driver referrals from 6 of the States (all except for North Carolina) were
performed in 2012. A random sample of 500 drivers referred for initial medical were selected
from each State (Lococo, Sifrit, et al., 2017). Many were referrals by the driver (self-referral),
physicians, licensing agency staff, or LEOs. The States varied in terms of the licensing
outcomes. Overall, the majority of cases (99%) including all types of referrals in both Oregon
and Texas resulted in changes in licensing status. While overall changes in licensing status were
lower in the 4 remaining States (ranging from 76 to 88%), the majority of physician referrals
(ranging from 90 to 97%) resulted in licensing status changes. The authors concluded that the
identification of the source of referrals has implications for educational countermeasures to
increase number and quality of referrals. One example discussed is the participation of LEOs in
NHTSA’s 4-hour Older Driver Law Enforcement Course (see www.iadlest.org/training/olderdriver-law-enforcement-training) to increase identification of driving impairment signs.
Costs: MABs are comprised of physicians and other health care professionals together with
appropriate administrative staff. Costs will be minimal for a MAB whose activities are limited to
policy recommendations. Costs for a MAB that evaluates individual cases will depend on the
caseload. The presence of a MAB and/or in-house medical staff may not always result in higher
overall costs (Lococo et al., 2016).
Time to implement: States probably will need at least a year to establish and staff a MAB,
depending on what duties the MAB undertakes. States likely can expand the functions of an
existing MAB in 6 months.
10
Personal communication, Carl A. Soderstrom, M.D., University of Maryland School of Medicine, April, 2005.
A7-10
Appendix 7. Older Drivers
2.5 License Renewal Policies: In-Person Renewal, Vision Test
Effectiveness: ✩✩
Cost: $$$
Use: Medium
Time: Medium
Overall Effectiveness Concerns: Some version of this countermeasure has been implemented in
over half the States. Its effectiveness has been examined in several research studies. Despite
some positive research findings, the balance of evidence regarding countermeasure effectiveness
remains inconclusive.
Driver’s licenses in most States are valid for 4 to 6 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 (2017), IIHS
(2018), and Stutts (2005, Chapter 5) summarize these requirements.
License examiners report that driver 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
(Potts et al., 2004, Strategy C2). This observation is supported by Morrisey and Grabowski
(2005), who found that in-person license renewal was associated with reduced Statewide traffic
fatalities among the oldest drivers (85 and older). 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 4 years (Staplin & Lococo, 2003; Stutts, 2005). Very few States meet these
recommendations for all drivers. 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
& Lococo, 2003) (see Chapter 7, Section 2.1).
The value of in-person renewals and vision tests are further supported by AAA Foundation for
Traffic Safety’s study analyzing effects of laws and licensing policies in 46 U.S. States on the
fatal crash involvement rates of older drivers from 1985 to 2011 (Tefft, 2014). Requiring inperson renewal instead of allowing online or mail-in renewals was associated with a 9%
reduction in fatal crash involvement rates for drivers 55 and above. The effects of the in-person
renewal requirement were greatest (25% reduction in fatal crash involvement) for the oldest age
group studied, those 85 and older. There is question, however, whether the large effects of inperson renewal requirements were due to the examiners being able to remove unsafe older
drivers from the driving population or to older drivers possibly ceasing to drive prematurely.
Other driver license renewal policies investigated – vision test, knowledge test, on-road driving
test, and mandatory reporting laws for physicians – were not found to reduce fatal crash
involvement rates of older drivers.
A7-11
Appendix 7. Older Drivers
Use: At least 35 States and the District of Columbia have one or more different license renewal
requirements for older drivers than for younger drivers. These include 22 States with shorter
intervals between renewals, 17 plus the District of Columbia that require vision tests or other
vision screening at renewal more frequently, and 1 State (Illinois) that requires road tests for
applicants 75 and older. Sixteen States and the District of Columbia prohibit online and/or
renewals by mail; of these, Louisiana allows people 70 or older to renew online or by mail with
suitable physician certifications of health. The District of Columbia mandates physician approval
for all drivers 70 and older (IIHS, 2019).
Effectiveness: License examiners report that in-person renewals and vision tests are effective in
identifying people whose driving skills may be impaired (Potts et al., 2004, Strategy C2). No
known data are available on the number of potentially impaired drivers identified through these
practices or on the specific effects of more frequent renewals and vision tests on crashes.
Furthermore, studies regarding the effectiveness of vision screening for license renewal indicate
that the value of the vision tests commonly used for licensing decisions as predictors of increased
crash risk is inconclusive and that the aspects of vision currently assessed for licensing do not
adequately explain unsafe driving (Bohensky et al., 2008). Nonetheless, one study found that
fatalities among drivers 80 years and older in Florida decreased by 17% after the State passed a
law requiring these drivers to pass a vision test before renewing their driver licenses (McGwin et
al., 2008).
Thomas et al. (2013) examined driver licensing policies and procedures for drivers 65 and older.
They selected 4 States for in-depth study (Kansas, Illinois, Iowa, and New Hampshire) and six
comparison States (Indiana, Minnesota, Missouri, Nebraska, Vermont, and Wisconsin). The
study States that were chosen had policies with the potential to reduce older driver crashes,
including shorter renewal periods, in-person renewal, and vision testing for older drivers. In
addition, Illinois and New Hampshire mandated a road test for every renewal. Four or 5 years of
crash data were examined in all 10 States to measure population-based and per-licensed-driver
crash rates for drivers of all ages. Contrary to what might be expected, the older drivers
supported and accepted their States’ efforts to assure the safety of older drivers. Analysis of
crash data for all 10 States revealed either stable or declining crash rates per 1,000 licensed
drivers with increasing age for each 5-year age group in each State. Crash rates per licensed
driver for the different 5-year age groups showed a similar pattern, with declining rates with
increasing age in all States other than Illinois and New Hampshire, the two States that require an
on-road test at renewal for all drivers over 75. As there were more similarities than differences
for licensing renewal between States, analyses based on licensing practices did not yield reliable
differences. New Hampshire repealed its requirement for mandatory on-road testing for older
adults effective July 2011 (IIHS, 2018).
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
years for drivers 65 and older would approximately double the licensing agency workload
associated with these drivers. If 15% of licensed drivers in the State are 65 and older, then the
agency’s overall workload would increase by about 15% to process the renewals. If more
frequent renewals and vision tests identify more drivers who require additional screening and
A7-12
Appendix 7. Older Drivers
assessment, then additional costs are imposed. See Chapter 7, Section 2.1, 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 indicate that age alone is not a justification
for reexamining a driver’s qualifications (AAA, 2019; IIHS, 2019). These States have the
same license renewal interval for all drivers and/or have specific provisions that prohibit
licensing personnel from treating people differently solely due to age.
• Road tests and medical reports: Several Australian States require medical reports, road
tests, or both for drivers over a specified age to renew their licenses. Langford et al.
(2004) compared Australian States with and without these requirements. They found that
Australian 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.
A7-13
Appendix 7. Older Drivers
Older Driver References
American Automobile Association (AAA). (2004). AAA basic best practices for medical
advisory/review boards.
AAA. (2019). State laws. https://seniordriving.aaa.com/states/
AAA. (2017). Senior licensing policies and practices. www.exchange.aaa.com/safety/seniordriver-safety/senior-licensing-policies-and-practices/#.W7--83tKjQU
AAA Foundation for Traffic Safety. (2009). Driver licensing policies and practices: Noteworthy
initiatives database.
AARP. (2010). Auto insurance discounts. www.aarp.org/auto/car-maintenance-safety/info2010/auto-insurance-discounts.html
AARP. (2018). AARP driver safety program focuses on Tech: Workshops help older people take
advantage of new car safety technology. www.aarp.org/auto/driver-safety/info2018/smart-driver-course-car-technology.html
Bedard, M., Porter, M. M., Marshall, S., Isherwood, I., Riendeau, J., Weaver, B., Tuokko, H.,
Molnar, F., & Miller-Polgar, J. (2008, March). The combination of two training
approaches to improve older adults’ driving safety. Traffic Injury Prevention, 9, 70-76.
Bohensky, M., Charlton, J., Odell, M., & Keefe, J. (2008). Implications of vision testing for
older driver licensing. Traffic Injury Prevention, 9, 304-313.
Carr, D. B., Schwartzberg, J. G., Manning, L., & Sempek, J. (2010, June). Physician’s guide to
assessing and counseling older drivers, 2nd edition (Report No. DOT HS 811 298).
National Highway Traffic Safety Administration.
www.nhtsa.gov/staticfiles/nti/older_drivers/pdf/811298.pdf
Cox, C. D., Cox, B. S., & Cox D. J. (2005). Long-term benefits of prompts to use safety belts
among drivers exiting senior communities. Journal of Applied Behavior Analysis, 38,
533-536. www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1309715
Insurance Institute for Highway Safety. (2018). License renewal procedures for older drivers,
October 2018. www.iihs.org/topics/older-drivers/license-renewal-laws-table
IIHS. (2019). Older drivers; State laws. www.iihs.org/topics/older-drivers
Janke, M. K. (1994). The mature driver improvement program in California. California
Department of Motor Vehicles.
Keskinen, E. (2014). Education for older drivers in the future. IATSS Research, 38(1), 14-21.
Korner-Bitensky, N., Kua, A., von Zweck, C., & Van Benthem, K. (2009). Older driver
retraining: An updated systematic review of evidence of effectiveness. Journal of Safety
Research, 40, 105-111.
Kua, A., Korner-Bitensky, N., Desrosiers, J., Man-Son-Hing, M., & Marshall, S. (2007). Older
driver retraining: A systematic review of evidence of effectiveness. Journal of Safety
Research, 38, 81-90.
A7-14
Appendix 7. Older Drivers
Langford, J., Fitzharris, M., Koppell, S., & Newstead, S. (2004). Effectiveness of mandatory
license testing for older drivers in reducing crash risk among urban older Australian
drivers. Traffic Injury Prevention, 5, 326-335.
Li, R., & Pickrell, T. M. (2019, February). Occupant restraint use in 2017: Results from the
NOPUS controlled intersection study (Report No. DOT HS 812 594). National Highway
Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812594
Lococo, K. H., Sifrit, K. J., Stutts, J., Joyce, J. J., & Staplin, L. (2017, March). Medical review
practices for driver licensing, Volume 2: Case studies of medical referrals and licensing
outcomes in six states (Report No. DOT HS 812 380). National Highway Traffic Safety
Administration. https://rosap.ntl.bts.gov/view/dot/2087
Lococo, K. H., & Staplin, L. (2005, July). Strategies for medical advisory boards and licensing
review (Report No. DOT HS 809 874). National Highway Traffic Safety Administration.
https://icsw.nhtsa.gov/people/injury/research/MedicalAdvisory/pages/Job%201602%20%20final%20new.pdf
Lococo, K. H., Stutts, J., Sifrit, K. J., & Staplin, L. (2017, April). Medical review practices for
driver licensing, Volume 3: Guidelines and processes in the United States (Report No.
DOT HS 812 402). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/2094
Lococo, K. H., Stutts, J., & Staplin, L. (2016, October). Medical review practices for driver licensing, Volume 1: A case study of guidelines and processes in seven U.S. States (Report
No. DOT HS 812 331). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/1974
Marottoli, R. A. (2007). Enhancement of driving performance among older Drivers. AAA Foundation. https://aaafoundation.org/wp-content/uploads/2018/02/EnhancingSeniorDrivingPerfReport.pdf
McConomy, S., Brooks, J., Venhovens, P., Xi, Y., Rosopa, P., DesJardins, J., Kopera, K.,
Drouin, N., Belle, L., Truesdail, C., Tanner, S., Hennessy, S., Lococo, K., Staplin, L., &
Schold Davis, E.. (2018). Evaluation of CarFit criteria compliance and knowledge of
seat adjustment (SAE Technical Paper No. 2018-01-1314). SAE International.
www.sae.org/publications/technical-papers/content/2018-01-1314/
McGwin, G., Sarrels, S. A., Griffin, R., Owsley, C., & Rue, L. W. (2008). The impact of a vision
screening law on older driver fatality rates. Archives of Ophthalmology, 126, 1544-1547.
Moreau, K. (2015). AARP Smart Driver Courses Available in Your Area! AARP.
https://states.aarp.org/aarp-driver-safety-courses-available-in-your-area-2
Morrisey, M. A. & Grabowski, D. C. (2005). State motor vehicle laws and older drivers. Health
Economics, 14, 407-419.
Nasvadi, G. E., & Vavrik, J. (2007). Crash risk of older drivers after attending a mature driver
education program. Accident Analysis & Prevention, 39(6), 1073-1079.
National Highway Traffic Safety Administration. (2009, September). Driver fitness medical
guidelines (Report No. DOT HS 811 210). www.ems.gov/pdf/811210.pdf
A7-15
Appendix 7. Older Drivers
National Transportation Safety Board. (2004). Highway special investigation report: Medical
oversight of noncommercial drivers (NTSB/SIR-04/01 PB2004-917002).
www.carsandracingstuff.com/library/n/ntsb_hsirmedicaloversightofnoncommercialdriver
s.pdf
Owsley, C., McGwin, G., Jr., Phillips, J. M., McNeal, S. F., & 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, 222-229.
Potts, I., Stutts, J., Pfefer, R., Neuman, T. R., Slack, K. L, & Hardy, K. K. (2004). A guide for
reducing collisions involving older drivers (NCHRP Report 500, Vol. 9). Transportation
Research Board. https://onlinepubs.trb.org/onlinepubs/nchrp/nchrp_rpt_500v9.pdf
Raymond, P., Knoblauch, R., & Nitzburg, M. (2001, August). Older road user research plan
(Report No. DOT HS 809 322). National Highway Traffic Safety Administration.
https://one.nhtsa.gov/people/injury/olddrive/OlderRoad/index.htm#toc
Romoser, M. R. E., & Fisher, D. L. (2009). The effect of active versus passive training strategies
on improving older drivers’ scanning in intersections. Human Factors, 51, 652-668.
Skufca, L. (2011). 2010 driver safety program evaluation: A comparison of baseline and followup findings. AARP. https://assets.aarp.org/rgcenter/general/driver-safety-programevaluation.pdf
Staplin, L., & Lococo, K. H. (2003, May). Model driver screening and evaluation program. Vol.
3: Guidelines for motor vehicle administrators (Report No. DOT HS 809 581). National
Highway Traffic Safety Administration.
https://icsw.nhtsa.gov/people/injury/olddrive/modeldriver/vol3scr.pdf
Stutts, J. C. (2005). Improving the safety of older road users (NCHRP Synthesis Project 20-5,
Synthesis Topic 35-10). Transportation Research Board.
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Tefft, B. C. (2014). Driver license renewal policies and fatal crash involvement rates of older
drivers, United States, 1985–2011. AAA Foundation. https://aaafoundation.org/wpcontent/uploads/2018/01/OlderDriverLicenseRenewalReport.pdf
Thomas III, F. D., Blomberg, R. D., Knodler, M., & Romoser, M. R. E. (2013, September).
Licensing procedures for older drivers (Report No. DOT HS 811 833). National
Highway Traffic Safety Administration. www.nhtsa.gov/staticfiles/nti/pdf/811833.pdf
Wang, C. C., Kosinski, C. J., Schwartzberg, J. G., & Shanklin, A. V. (2003, September).
Physician’s guide to assessing and counseling older drivers (Report No. DOT HS 809
647). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/39100
A7-16
Appendix 8. Pedestrian Safety
A8. Pedestrian Safety
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Preschool-Age Children
Countermeasure
1.1 Children’s Safety Clubs
1.2 Child Supervision
Effectiveness
Cost
Use
Time
Varies
Unknown
Unknown
$
Unknown
Short
Cost
Use
Time
$
High
Short
Effectiveness
Cost
Use
Time
✩✩
✩
Varies
Low
Medium
$$
Low
Medium
Cost
Use
Time
$
Low
Medium
$$
Unknown
Medium
$
High
Medium
✩
✩
2. School-Age Children
Countermeasure
2.3 Child School Bus Training
Effectiveness
✩✩
3. Impaired Pedestrians
Countermeasure
3.1 Communications and Outreach Addressing
Impaired Pedestrians
3.2 “Sweeper” Patrols of Impaired Pedestrians
4. All Pedestrians
Countermeasure
4.5 Driver Training
4.6 Pedestrian Gap Acceptance Training
4.7 University Educational Campaign
Effectiveness
✩
✩
✩
A8-1
Appendix 8. Pedestrian Safety
Effectiveness:
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
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.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A8-2
Appendix 8. Pedestrian Safety
1. Preschool-Age Children
1.1 Children’s Safety Clubs
Effectiveness: ✩
Cost: Varies
Use: Unknown
Time: Unknown
Overall Effectiveness Concerns: This countermeasure has been examined in a small number of
research studies. The research suggests that this countermeasure does not translate into crash
and injury reductions.
Young children have limited abilities to perceive, understand, and react appropriately to traffic
hazards, and they have greater difficulty finding safe places to cross along the roadway (Percer,
2009). A primary purpose of children’s safety clubs is to help parents and caregivers become
more involved in educating young children about safe walking practices. Related goals are to
help promote ongoing, age-appropriate training, and safe attitudes towards traffic (Gregersen &
Nolen, 1994). An equally important objective of safety clubs is for parents and other caregivers
to recognize children’s limits and capabilities, and to understand their obligation to provide
adequate supervision and control (Gregersen & Nolen, 1994).
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).
From 2008 to 2011 there were 883 children 14 and younger killed in non-traffic-related crashes
in which they were not occupants of vehicles (Singh et al., 2014). Of these fatalities, 104
involved forward moving vehicles, 95 backing vehicles, 7 driverless vehicles, and 15 involved
other types, such as children struck near disabled or parked vehicles. A majority (84%) of these
children were age 4 or younger. These statistics are from the most recent release of these data,
and it remains important to teach children age-appropriate lessons about traffic and motor
vehicles. It is even more important that parents and caregivers take direct responsibility and
supervise young children carefully near roadways or in any areas where vehicles may be in use
(Rivara et al., 1989). See also the following section, Section 1.2, for more information on
supervision.
Parents are the primary role models and educators for their children. Research in the United
Kingdom has examined the interactions and messages between parents and children with regard
to road safety (Green et al., 2008). The researchers found that while parents feel competent to the
task, they were inconsistent role models and lacked knowledge of best approaches and messages
to train their children. Moreover, parents did not take full advantage of opportunities to teach
while walking, and attention was focused more on controlling their children’s behavior than
teaching, particularly under higher risk situations (Green et al., 2008; see also Percer, 2009). In
Israel a road-safety education program for children was conducted at select kindergartens; a
survey reported it increased child-safety awareness among parents of participating children
relative to parents who had children not in the program (Ben-Bassat & Avnieli, 2016).
A8-3
Appendix 8. Pedestrian Safety
The main development of safety clubs took place in Europe years ago, but they have not been
adopted broadly in the United States. In many European programs children may be enrolled in a
traffic safety club when they reach their third birthday. Books on traffic safety are then sent to
the child every 6 months until they reach 5 years or older (Dragutinovic & Twisk, 2006), but
other print or electronic media could be provided, bearing in mind that the intent is to engage
both the parent and child. There do not appear to be any national or statewide standards, models,
or curricula.
For a British traffic club source, see The Children's Traffic Club, www.childrenstrafficclub.com.
The United Kingdom’s Department of Transport released a set of games called Tales of the Road
to teach children about road safety, http://talesoftheroad.direct.gov.uk.
Similar websites are available from the following
• Scotland: https://roadsafety.scot/ziggy-toolkit/
• Australia: www.det.wa.edu.au/ccm-ldn-theme-assets/__ccm__/themesprod/sdera/flash/road_safety_games/index.html
• Renault: www.safety-mobility-for-all-the-game.com
Use: The extent of use of child safety clubs in the United States is unknown.
Effectiveness: Safety clubs are one way to teach and promote an understanding of a specific set
of appropriate pedestrian behaviors for young children. However, the knowledge and skill
benefits have not been found to translate into crash and injury reductions (Dragutinovic &
Twisk, 2006; Gregersen & Nolen, 1994; West et al., 1993). The one study that evaluated effects
on self- reported crashes found a negative result, but concluded that no impact on crashes could
be inferred (Gregersen & Nolen, 1994).
Costs: The costs would depend on the cost of material and delivery and whether the families are
charged anything for participation. In most of the clubs, enrollment is free to the participants;
some charge a fee for enrollment (Dragutinovic & Twisk, 2006). If integrated into preschool
programs, training for teachers may be needed.
Time to implement: Before a safety club program could be implemented, program material
must be located and adapted as necessary. Following that, a modest time period would be needed
to arrange for material, identify target recipients, disseminate information, and train teachers as
needed.
Other issues:
• A challenge would be to garner high enrollment among families with lower socioeconomic status and low-car-ownership. Participation in child safety clubs has been
found to be lower among low SES groups in European countries (Dragutinovic & Twisk,
2006).
• It is up to parents and caregivers of young children to use material appropriately and a
lack of control makes it difficult to monitor or assess results.
A8-4
Appendix 8. Pedestrian Safety
1.2 Child Supervision
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
This countermeasure increases caregiver supervision of children when they are exposed to
traffic, or when they are nearby with direct access to traffic. Caregiver involvement is an
effective means for shaping children’s behaviors (Percer, 2009). Because children do not have
the impulse control to make safe walking decisions, these programs can be an asset to anyone
responsible for the supervision of children. The State can require such training 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, faith-based organizations or places of
worship, medical providers, or even direct mail or internet access.
NHTSA also supports a website to reach parents, Parents Central, a gateway to keep children
safe on the road (www.safercar.gov/parents/walking.htm). Parent Central includes material
created through a partnership to provide preschool-aged children and their parents with
pedestrian safety messages. Worth noting is NHTSA’s resource, Teaching Children to Walk
Safely as They Grow and Develop: A Guide for Parents and Caregivers, with learning objectives
and tips for caregivers of children 4 to 6; 7 to 9; and 10, see www.saferoutesinfo.org/sites/default/files/TeachingChildrentoWalkSafely.pdf.
Another NHTSA website publication is Walking Through the Years, Preventing Pedestrian
Crashes: Preschool/Elementary School Children. NHTSA also has several brochures to educate
parents and caregivers on child pedestrian safety (www.nhtsa.gov/road-safety/pedestrian-safety)
as does Safe Kids Worldwide, including safety tips for parents of young children and links to
additional resources (www.safekids.org/safetytips/field_age/little-kids-1%E2%80%934years/field_risks/pedestrian-safety).
One of the ways to market these programs may be to demonstrate to parents the amount of
supervision their child/children needs (and effective training). For example, Rivara et al. (1989)
and Dunne et al. (1992) have shown that parents consistently overestimate the ability of children
younger than 9 or 10 to negotiate in traffic. Adults should actively supervise children and not
assume that their presence will be adequate to ensure safer behavior.
Use: The availability and use of programs to improve child supervision is unknown. Pedestrian
safety in general may be a topic at preschools, but programs are likely to be unique, without
consensus objectives, material, or curriculum. Many other outlets such as community centers,
churches, and local injury prevention offices may be used to reach caregivers and parents of preschool age children, but the extent of such outreach, and the penetration of traffic safety
messages for caregivers is unknown.
Effectiveness: Programs or material can provide helpful 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
A8-5
Appendix 8. Pedestrian Safety
caregivers need to put the training into practice. Widespread exposure of parents and caregivers
to this material and resources should be an objective of such programs with the goal to improve
safety and reduce injuries.
Costs: Material for people is already available and quite inexpensive. Training for licensed
caregivers would be inexpensive to develop and distribute.
Time to implement: Short, for existing material; medium, to develop and disseminate a training
curriculum with material.
Other issues:
o Differences in cultural, social, and perceived norms for pedestrian safety should be considered in the development of programs to improve child supervision. For example, in a
study by Pfeffer et al. (2010), 59% of adults held the hands of female children compared
with 36% who held the hands of male children when crossing the road. In another study,
children 9 and younger in one cultural group believed that more of their peers crossed
roadways alone than actually did (Rosenbloom et al., 2009). Addressing discrepancies in
perceived norms and actual norms may help to shift the actual norm toward safer trends.
A8-6
Appendix 8. Pedestrian Safety
2. School-Age Children
2.3 Child School Bus Training
Effectiveness: ✩✩
Cost: $
Use: High
Time: Short
Overall Effectiveness Concerns: There are no evaluation studies showing reductions in crashes
or injuries. These outcomes are difficult to demonstrate because minimal, basic training is very
widespread and the choice to adopt a stronger curriculum would be confounded with any
number of other factors.
The purpose of school bus training for children is to teach them how to safely approach, board,
disembark, and walk away from school buses. According to NHTSA, 100 school-aged
pedestrians 18 and younger died in school-transportation-related crashes from 2009 to 2018
(NCSA, 2020b). These fatalities represent 8.3% of all school-transportation-related fatalities,
most of which (70%) involved occupants of non-school-bus vehicles. Of the 100 school-aged
pedestrian fatalities, 47% were struck by school buses or vehicles functioning as school buses,
and 52% by other vehicles (passenger cars, etc.). In 2018 eleven pedestrians of all ages were
struck and killed by school buses.
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, emergency evacuation procedures,
and any topics unique to the school. Additionally, education about safety behaviors of parents in
school zones and around school buses should be reinforced as part of “Back to School” night, in
school bulletins, or other creative means. The Safe Routes to School website has many resources
(www.saferoutesinfo.org/) and the SRTS program guide includes messages for drivers and tips
for neighbors living in school walk zones to help improve safety for school-aged pedestrians
(guide.saferoutesinfo.org/education/index.cfm). NHTSA also has a refresher training module for
school bus drivers (see www.nhtsa.gov/school-buses/school-bus-driver-service-safety-series).
Jurisdictions should use a common curriculum for school bus safety training. Targeted behaviors
include boarding and exiting from the bus and crossing the street to and from the bus. The
NHTSA Child Pedestrian Safety Curriculum, previously discussed, includes a module on safety
around school buses.
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: Burke et al. (1996) found that stenciled pavement markings, together with inschool training, led to improved behavior in waiting for, and boarding, the school bus compared
to training alone for students in grades 4 to 6. Reductions in crashes and injuries are difficult to
demonstrate because minimal basic training is very widespread and the choice to adopt a
stronger curriculum would be confounded with other factors.
A8-7
Appendix 8. Pedestrian Safety
Costs: The primary cost for the SHSOs would be in adapting material for their States and
producing, stocking, and distributing the material. Much of this could be done electronically,
through school websites, newsletters, press releases, and other regular communications channels.
Time to implement: Basic material is available from many organizations including NTHSA,
and schools could adopt curricula of their choice quickly.
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Appendix 8. Pedestrian Safety
3. Impaired Pedestrians
3.1 Communications and Outreach Addressing Impaired Pedestrians
Effectiveness: ✩✩
Cost: Varies
Use: Low
Time: Medium
Overall Effectiveness Concerns: There are insufficient evaluation data available to conclude
that the countermeasure is effective.
In 2018 some 33% of all fatally injured pedestrians had BACs of .08 g/dL or higher, and 38% of
all fatally injured pedestrians had positive BACs (NCSA, 2020a).
Communications and outreach to reduce impaired-pedestrian crashes can be directed at
audiences such as law enforcement, drivers, alcohol servers and vendors, civic and neighborhood
leaders, faith-based communities, universities, and friends and family of likely impaired
pedestrians. Impaired pedestrians are also a target audience, of course. However, they are viewed
as a difficult audience for communications and outreach to have a meaningful effect on their
behavior because their decision-making is compromised. Reaching others who can prevent these
crashes, or to alter the circumstances that lead up to such crashes, may be among the most
effective ways to achieve success. 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.
Use: Low. NHTSA has successfully implemented one zone-based program in Baltimore that
included PSAs, posters, flyers, and interventions aimed at alcohol-impaired pedestrians, but the
program is not currently active (Blomberg & Cleven, 2000). Most impaired-roadway user
programs focus on impaired drivers.
Effectiveness: Using 5.5 years of before data and 2 years of after data, Blomberg and Cleven
(2000) found a 22% decrease in crashes among males 30 to 59 in the targeted zones where the
intervention took place. Although encouraging, there have been no demonstrations of crash or
injury reductions unless the communications and outreach is part of a comprehensive program
that includes engineering measures and some form of law enforcement involvement, as in the
case of Blomberg and Cleven (2000).
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: The actual time to implement depends on the scope and ambition of the
program.
A8-9
Appendix 8. Pedestrian Safety
3.2 “Sweeper” Patrols of Impaired Pedestrians
Effectiveness: ✩
Cost: Varies
Use: Low
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
The purpose of “sweeping” alcohol-impaired pedestrians from the streets until they no longer
have high BACs is intended to reduce the exposure of these at-risk pedestrians to traffic, and can
also address other social issues such as public intoxication and crime. Pedestrians with high
BACs are at high risk of injury due to motor vehicle crashes. A program of removing alcoholimpaired pedestrians from the streets can be effective in reducing their exposure and thus the
risk.
There are some important 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 will pick up the targets, where will they be kept until they
are sober, what friends or family need to be notified at the time of the pickup (if any), 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 people home or to a detoxification center. Services of
these types in the Boston area were surveyed. Both types of services appeared practical and
effective, though the number of people who 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 people
and the availability of volunteer escorts.
In 2005 the National Health Service of London created a program of alternative response
vehicles (often called “booze buses”) in response to an increasing number of alcohol related
ambulance calls (Hayes, 2010). Staffed with paramedics, these buses collect intoxicated
pedestrians and bring them to alcohol treatment centers or hospitals.
Use: Well-publicized sweep operations, which involve picking up intoxicated people 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 law
enforcement training, led to a 7% drop in alcohol-related pedestrian crashes (Stewart, 1994).
Current use of this program in the United States is minimal, and appears to be limited to smallscale, local efforts.
Effectiveness: Such programs typically reach only a fraction of those people who need the
services. The sweeps typically deal with people who are too drunk to walk or even know that
they are being “swept.” These same people are at risk while they are becoming intoxicated, and,
in all likelihood, will be at risk again in the near future as they become sober and thus more
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Appendix 8. Pedestrian Safety
mobile (Huntley, 1984). As described by Huntley, many people need intensive treatment for
alcoholism; and sweeper programs may be useful in identifying potential treatment candidates.
Costs: 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 law enforcement 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 in weeks or months, depending on the extent and coordination of services.
Other issues:
• The legal rights of those potentially being swept need to be preserved.
• Often if law enforcement 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.
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Appendix 8. Pedestrian Safety
4. All Pedestrians
4.5 Driver Training
Effectiveness: ✩
Cost: $
Use: Low
Time: Medium
Overall Effectiveness Concerns: Driver training alone has not been shown to reduce overall
crash rates. There is no evidence indicating that this countermeasure is effective. However,
driving skill begins with knowledge education and then practicing defensive driving in relation
to all other types of traffic, including pedestrians.
Pedestrian-safety-related driver training increases the sensitivity of drivers to the presence and
characteristics of pedestrians and their role as drivers to enhance the safety of pedestrians.
Current 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 specific
information on the status of the pedestrian in the traffic environment, right-of-way requirements
for drivers and pedestrians, other driver and pedestrian responsibilities, categories of pedestrian
crash types, and key ways drivers can avoid being involved in such crashes. Standards for
curriculum and training developed by the American Driver and Traffic Safety Education
Association include some of these pedestrian-related learning objectives (Driver Education
Working Group, 2009).
One way driver training can incorporate pedestrian and bicyclist concerns for new and existing
drivers is through “Share the Road ” education concepts and programs, though many focus
exclusively on bicycles. One of many such resources is the State of New York’s highly readable
Sharing the Road Safely (www.safeny.ny.gov/media/share-road.htm). It should be noted that
“Share the Road ” programs have not been accepted everywhere, and some States have
discontinued these programs after implementing them.
Use: 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 alone has not been shown to reduce overall crash rates. The
objective for adding more pedestrian information would be to increase knowledge and desire to
share the road safely with pedestrians, of how to avoid the most common types of motor
vehicle/pedestrian type crashes, and to improve drivers’ anticipation of, and interactions with,
pedestrians – as well as improve their behavior as pedestrians.
Cost: Low. The cost would be for the development of the new segments of the standard
curriculum and for getting it into the material used by driver education instructors and schools.
Time to implement: Material 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 material.
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Appendix 8. Pedestrian Safety
The same timeframe would be appropriate for making changes to official State driving manuals,
license exams, and related material and procedures.
A8-13
Appendix 8. Pedestrian Safety
4.6 Pedestrian Gap Acceptance Training
Effectiveness: ✩
Cost: $$
Use: Unknown
Time: Medium
Overall Effectiveness Concerns: This countermeasure has been examined in few research
studies. While there is some evidence that certain approaches may lead to limited positive
outcomes, there are insufficient evaluation data available to conclude that the countermeasure is
effective.
The purpose of pedestrian gap acceptance training is to help pedestrians learn to make better
road-crossing decisions, which may reduce the incidence of crossing-related injuries and
fatalities. Previous studies have reported that human error, such as poor judgment in gauging the
speed and/or distance of oncoming traffic, underlies a significant portion of roadway collisions
(Hunt et al., 2011).
Identifying safe gaps is a task that child pedestrians and bicyclists must be taught. Although
children as young as 5 can understand the concepts of speed and distance—and young children
can be taught to mimic gap judgments of adults—they can still have difficulty interpreting
vehicle speed and direction at 6 and 7 (Percer, 2009). Additionally, child bicyclists as old as 10
to 14 show developmental differences in learning to adjust their trajectories to match safe gaps
relative to older drivers (Chihak et al., 2014; Plumert & Kearney, 2014). These trends suggest
that children require training on different types of gap judgment skills than adults.
Use: Unknown. Preliminary studies have taken place in New Zealand and France but no adult
simulator trainings on gap acceptance have been found in the United States.
Effectiveness: Hunt et al. (2011) used a laboratory-based video simulating the roadway
environment to test three different approaches for giving feedback to pedestrians in how to better
incorporate vehicle speed information to their gap estimates and crossing decisions. While the
study group was small—58 people 18 to 80 years old—preliminary results indicate that videobased training with a feedback mechanism can be successful in improving the accuracy of
pedestrians’ estimates of driver speeds. However, improved speed estimation did not consistently
translate into improved gap-acceptance judgments, and participant age played a role in training
effectiveness. Older pedestrians, in particular, had significantly more conservative gap
judgments after the training, which were independent of improvements in vehicle speed
estimations.
Another study by Dommes and Cavallo (2012) evaluated the effectiveness of an education-based
intervention aimed at training older pedestrians (60+ years) to improve crossing safety by taking
into account vehicle speeds. Results showed that after simulated crossing training, the treatment
group participants crossed more quickly, had larger safety margins, and had fewer close
encounters than the control group, although differences were no longer significant 6 months after
training. Also, in contrast to the Hunt et al. (2011) study, participants did not appear to improve
in taking into account vehicle speed when making crossing decisions. The authors concluded that
age-related perceptual and cognitive difficulties may exist in gauging speed and gap acceptance
that cannot be remedied by educational training alone.
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Appendix 8. Pedestrian Safety
Costs: Medium. Costs would involve development of the training material (or adaptation from
existing study material) and determining an applicable and appropriate venue to reach the adult
and senior pedestrian population.
Time to implement: Medium. Training material could be developed and integrated into existing
educational channels for adult and senior pedestrians.
Other issues:
• As mentioned earlier, environmental treatments such as allowing sufficient time for the
pedestrian crossing in signal timing, median refuges, and careful attention to sidewalk accessibility issues are also important to older pedestrians who may have mobility declines.
A study funded by Michigan DOT evaluated the effects of pedestrian countdown signals
(PCS) on crash risk in a pre-post study of sites with and without PCS. Crash data from 3
years before and 3 years after installation of a PCS were collected from 93 sites and comparison data for the 6-year period were collected from 97 sites with a standard (noncountdown) pedestrian signal. Pedestrian countdown signals were found to be associated
with a significant 32% reduction in all crashes and a 65% reduction in crashes involving
people 65 and older (Kwigizile et al., 2016).
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Appendix 8. Pedestrian Safety
4.7 University Educational Campaign
Effectiveness: ✩
Cost: $
Use: High
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
Frequently, university settings are areas of high pedestrian concentrations. This, combined with a
younger age population who frequently take more risks as both pedestrians and drivers, may
result in increased pedestrian crashes on roads around and through a campus setting (Zegeer et
al., 2008). At the same time, a university campus may offer an opportune setting to reach a welldefined target audience of drivers and pedestrians about the risks of unsafe behaviors. A study
conducted in 2013 in the urban community around the Johns Hopkins medical center campus
examined knowledge of pedestrian-related laws, perceptions of pedestrian safety problems, and
perceptions of the effectiveness of interventions. This survey was part of a larger campaign
called “Be Alert: Don’t Get Hurt” (Johns Hopkins Center for Injury Research and Policy, 2015).
Study participants included students, faculty, and campus staff, as well as residents in the
surrounding areas. Most were drivers, while only 19.1% were pedestrians. Less than half the
respondents were aware of laws and penalties related to “jaywalking," and less than 6% were
aware that pedestrians do not always have the right-of-way in a crosswalk. More pedestrians
preferred longer signal crossing times, and more drivers supported structural interventions that
prevented midblock pedestrian incursions (Nesoff et al., 2019). These findings point a need for
more educational campaigns on pedestrian safety laws and road rules.
Fall of a new academic year may be a good time to reach new students, faculty, and staff who
may be less familiar with walking and driving in the campus environment. Activities may need
to be repeated several times a year for maximal effect, during higher risk times such as in the fall
as day length shortens, and again in spring as the weather warms and jogging and other outdoor
activities may increase. Potential educational messages may include right-of-way rules and the
importance of yielding right-of-way (pedestrians, bicyclists, and drivers), being visible and
predictable at both day and night times and during inclement weather (pedestrians and
bicyclists), making eye contact at conflict points (pedestrians and drivers), avoiding distractions
(pedestrians and drivers), and speed control (drivers and potentially bicyclists) (Zegeer et al.,
2008). Partnerships may include campus public safety offices, student health and wellness
programs, city/county public safety agencies, injury prevention agencies, parking and
transportation services, transit agencies, and student groups. There may be academic or research
units on campus that could also help with developing a campus campaign.
Use: Some universities conduct some form of outreach or have pedestrian safety campaigns. The
University of North Carolina combines educational outreach with targeted crosswalk
enforcement to remind both motorists and pedestrians of safe yielding behaviors, but the
program effects have not been evaluated. The John Hopkins University Arts and Sciences
campus developed a comprehensive intervention based on focus groups, university crash reports,
and an environmental audit. The intervention was framed by the three Es of education,
enforcement, and engineering. Based on its research, it increased enforcement at busy
intersections, included pedestrian safety education as part of new student orientation, and
A8-16
Appendix 8. Pedestrian Safety
increased signage to remind both drivers and pedestrians of the laws and safe behaviors (Pollack
et al., 2014). The effectiveness of this program has not been evaluated.
Effectiveness: No studies of crash effects are known. The University of South Florida at Tampa
conducted a one-week campaign in the fall that began with campus administrators, local
agencies, and elected officials leading a “parade” walk around campus. Over 4 days there were
lectures on walking and biking safely (WalkWise and Bike Smart), and posters and booklets with
walking and biking rules were distributed across campus. The campaign ended with a bicycle
celebration event. Zhang et al. (2013) reported some improvement in observed safety behaviors,
most notably at locations closest to a student center where many activities took place. They also
noted, however, that all groups (drivers, pedestrians, and bicyclists) self-reported better behavior
than was observed in the field, and that there were differences in perceptions of the interactions
among the groups. For example, drivers thought they yielded more frequently to pedestrians than
pedestrians thought they did, and vice versa.
Effectiveness is likely to be increased when education is combined with appropriate
infrastructure to facilitate safer interactions.
Costs: Costs vary depending on the activities implemented, but could include costs for events
and material. The well-identified campus environment and potential campus partners are
characteristics that provide an opportunity to lower and/or share costs when compared to other
similar types of educational campaigns in a broader community.
Time to Implement: The timeline may be short once problem identification and program
development has occurred. Time should be allowed to gather campus community input and to
develop and test material that resonates with the campus community.
A8-17
Appendix 8. Pedestrian Safety
Pedestrian Safety References
Agran, P. F., Winn, D. G., & Anderson, C. L. (1994). Differences in child pedestrian injury
events by location. Pediatrics, 93, 84-288.
Ben-Bassat, T., & Avnieli, S. (2016). The effect of a road safety educational program for
kindergarten children on their parents’ behavior and knowledge. Accident Analysis &
Prevention, 95, 78-85.
Blomberg, R. D., & Cleven, A. M. (2000, July). Development, implementation, and evaluation of
a countermeasure program for alcohol-involved pedestrian crashes (Report No. DOT HS
809 067). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/1634
Burke, G. S., Lapidus, G. D., Zavoski, R. W., Wallace, L., & 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, 520-523.
Chihak, B. J., Grechkin, T. Y., Kearney, J. K., Cremer F. J., & Plumert, J. M. (2014). How
children and adults learn to intercept moving gaps. Journal of Experimental Child
Psychology, 122, 134-152.
Dommes, A. & Cavallo, V. (2012). Can simulator-based training improve street-crossing safety
for elderly pedestrians? Transportation Research Part F: Traffic Psychology and
Behavior, 15, 206-218.
Dragutinovic, N. & Twisk, D. (2006). The effectiveness of road safety education: A literature
review. SWOV Institute for Road Safety Research. www.swov.nl/rapport/r-2006-06.pdf
Driver Education Working Group. (2009). Novice teen driver education and training
administrative standards. report from National Conference on Driver Education.
www.dsaa.org/files/galleries/DEStandards04-06-2009_master-0001.pdf
Dunne, R. G., Asher, K. N., & Rivara, F. P. (1992). Behavior and parental expectations of child
pedestrians. Pediatrics, 89, 486-490.
Green, J., Ayrton, R., Woodall, J., Woodward, J., Newell, C., Cattan, M., & Cross, R. (2008).
Child–parent interaction in relation to road safety education: Part 2 – Main report.
London Department for Transport.
http://webarchive.nationalarchives.gov.uk/20110509101621/www.dft.gov.uk/pgr/roadsaf
ety/research/rsrr/theme1/no102safetyresearch.pdf
Gregersen, N. P., & Nolen S. (1994). Children's road safety and the strategy of voluntary traffic
safety clubs. Accident Analysis & Prevention, 26, 463-470.
Hayes, B. (2010). Alternative response vehicle (PowerPoint web page). London Ambulance
Service NHS Trust.
www.infodrog.ch/files/content/clubhealth2010/pl4/PL4_Hayes.Brian_Booze.Bus_Clubhe
alth.pdf
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Appendix 8. Pedestrian Safety
Hunt, M., Harper, D. N., & Lie, C. (2011). Mind the gap: Training road users to use speed and
distance when making gap-acceptance decisions. Accident Analysis & Prevention, 43,
2015-2023.
Huntley, M. S., Jr. (1984). Pedestrian/alcohol problems: Countermeasures to consider.
Transportation Systems Center.
Johns Hopkins Center for Injury Research and Policy. (2015). Be Alert, Don’t Get Hurt: A
pedestrian safety campaign on an urban, academic campus.
www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-injury-researchand-policy/_documents/materials/pedestrian-safety-campaign/pedestrian-safetybrochure.pdf
Kwigizile, V., Boateng, R. A., Oh, J. S., & Lariviere, K. (2016). Evaluating the effectiveness of
pedestrian countdown signals on the safety of pedestrians in Michigan. Transportation
Research Board 95th Annual Meeting, Transportation Research Board, 17.
National Center for Statistics and Analysis. (2020a, March). Pedestrians: 2018 data. (Traffic
Safety Facts. Report No. DOT HS 812 850). National Highway Traffic Safety
Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812850
NCSA. (2020b, July). School transportation-related crashes: 2009-2018 data. (Traffic Safety
Facts. Report No. DOT HS 812 944). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812944
Nesoff, E. D., Porter, K. M. P., Bailey, M., & Gielen, A. C. (2019). Knowledge and beliefs about
pedestrian safety in an urban community: Implications for promoting safe walking.
Journal of Community Health, 44(1), 103-111.
Olson, L. M., Sklar, D. P., Cobb, L., Sapien, R., & Zumwalt, R. (1993). Analysis of childhood
pedestrian deaths in New Mexico, 1986-1990. Annals of Emergency Medicine, 22, 512516.
Percer, J. (2009, September). Child pedestrian safety education: Applying learning and
developmental theories to develop safe street crossing behaviors (Report No. DOT HS
811 190). National Highway Traffic Safety Administration.
https://rosap.ntl.bts.gov/view/dot/40199
Pfeffer, K., Fagbemi, H. P., & Stennet, S. (2010). Adult pedestrian behavior when accompanying
children on the route to school. Traffic Injury Prevention, 11, 188-193.
Plumert, J.M. & Kearney, J.K. (2014). How do children perceive and act on dynamic affordances
in crossing traffic-filled roads? Child Development Perspectives, 8(4), 207–212.
Pollack, K. M., Gielen, A. C., Ismail, M. N. M., Mitzner, M., Wu, M., & Links, J. M. (2014).
Investigating and improving pedestrian safety in an urban environment. Injury
Epidemiology, 1(1), 1-9. doi: 10.1186/2197-1714-1-11
Rivara, F. P., Bergman, A. B., & Drake, C. (1989). Parental attitudes and practices toward
children as pedestrians. Pediatrics, 84, 1017-1021.
Rosenbloom, T., Sapir-Lavid, Y., & Hadari-Carmi, O. (2009). Social norms of accompanied
young children and observed crossing behaviors. Journal of Safety Research, 40, 33-39.
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Appendix 8. Pedestrian Safety
Singh, S., Stern, & Subramanian, R. (2014, April). Not-in-traffic surveillance: Child fatality and
injury in nontraffic crashes – 2008 to 2011 (Traffic Safety Facts Crash●Stat. Report No.
DOT HS 811 812). National Highway Traffic Safety Administration.
https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811812
Stewart, K. (1994). Report of the ICADTS working group on alcohol-involved pedestrians.
www.druglibrary.org/schaffer/misc/driving/s25p1.htm
West, R., Sammons, P., & West, A. (1993). Effects of a traffic club on road safety knowledge
and self-reported behaviour of young children and their parents. Accident Analysis &
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Zegeer, C., Sandt, L., & Scully, M. (2008). How to develop a pedestrian safety action plan.
Federal Highway Administration.
http://safety.fhwa.dot.gov/ped_bike/ped_focus/docs/fhwasa0512.pdf
Zhang, Y., Gawade, M., Lin, P. S., & McPherson, T. (2013). Educational campaign for improving pedestrian safety: A university campus study. Procedia – Social and Behavioral Sciences, 96, 2756-2766.
A8-20
Appendix 9. Bicycle Safety
A9. Bicycle Safety
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Children
Countermeasure
Effectiveness
Cost
Use
Time
$
Unknown
Short
Unknown
Short
1.3 Bicycle Safety Education for Children
✩✩
1.4 Cycling Skills Clinics, Bike Fairs, Bike
Rodeos
✩
$
Effectiveness
Cost
Use
Time
$$
Low
Medium
2. Adults
Countermeasure
2.2 Bicycle Safety Education for Adult Cyclists
✩
3. All Bicyclists
Countermeasure
3.2 Promote Bicycle Helmet Use with Education
3.3 Enforcement Strategies
3.4 Motorist Passing Bicyclist Laws
Effectiveness
✩✩
✩
✩
Cost
Use
Time
$$$
Medium
Medium
$$
Unknown
Varies
$
Medium
Short
Cost
Use
Time
$
Low
Medium
$$
Unknown
Medium
4. Drivers and Bicyclists
Countermeasure
4.1 Driver Training
4.2 Share the Road Awareness Programs
Effectiveness
✩
✩✩
A9-1
Appendix 9. Bicycle Safety
Effectiveness:
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
Effectiveness is measured by reductions in crashes or injuries unless noted otherwise.
See individual countermeasure descriptions for information on effectiveness size and how effectiveness is measured.
Cost to implement:
$$$
Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
Medium
Low
Unknown
More than two-thirds of the States, or a substantial majority of communities
One-third to two-thirds of States or communities
Less than one-third of the States or communities
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
A9-2
Appendix 9. Bicycle Safety
1. Children
1.3 Bicycle Safety Education for Children
Effectiveness: ✩✩
Cost: $
Use: Unknown
Time: Short
Overall Effectiveness Concerns: Previous studies examining the effectiveness of this
countermeasure found that bicycle safety education increases children’s knowledge of laws and
safe behaviors (Hooshmand et al., 2014; Lachapelle et al., 2013; Thomas et al., 2005), but
whether this translates into adoption of the safe behaviors is less certain (Richmond et al., 2014).
The balance of evidence regarding countermeasure effectiveness remains inconclusive.
The purpose of bicycle education is to teach children basic bicycle handling skills, traffic laws,
how to ride on streets with traffic present, proper helmet use, bicycle safety checks, and bicycle
maintenance. As part of a regular school curriculum, education can reach every student, but
providing training outside of school settings such as through parks and recreation departments,
community centers or faith-based organizations may be more feasible in some circumstances.
Community-based programs could also provide greater flexibility in tailoring to meet the needs
of specific target groups.
Young children are just learning about traffic. They have little experience anticipating and
interpreting potential traffic hazards, 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 to
limit risk-taking behaviors. They are also less skilled at riding than older children or adults.
Many children under 10 have difficulty accurately judging the speed and movements of vehicles,
and may require adult supervision. Supervision is also recommended until children are able to
ride in a straight line, swerve to avoid hazards in the roadway, comfortably start and stop their
bicycles, and maintain balance at slow speeds.
Readers should note that safe bicycling principles can be counterintuitive, and safety skills taught
to pedestrians (such as walking facing traffic) do not necessarily hold true for bicyclists.
However, some actions are common to both, such as looking left-right-left for traffic, and going
only when clear. Making these connections is particularly helpful when correlating walking and
bicycling as precursors or stepping stones to safe driving (with older pre-driving youth). Further,
bicycle safety skills for children may differ from safety skills needed by adults riding in different
environments and at different speeds. For example, bicycle education programs may teach young
children to ride their bikes slowly on the sidewalk or adjacent paths, and as far away from the
roadway as possible. However, adult cyclists may need to be trained where to position
themselves in the travel lane, riding in the same direction with traffic, and further from the curb,
depending on the facility type. For more on adult bicyclist education, see Section 2.2. One
common theme in bicycle education for both children and adults is the need to scan for traffic
and potential hazards, ride predictably, and use correct hand signals to indicate changes in speed
or direction.
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Appendix 9. Bicycle Safety
Whether school or community-based, bicycle education should include, at a minimum, a
demonstration and handout on how to properly fit a bicycle helmet and an emphasis on everyone,
regardless of age, wearing a helmet for every ride. As noted above, the curriculum should also
include information on how parents and children should decide what locations are safe places to
ride, and how children can be predictable and visible to drivers. In addition, bicycle safety
training should be reinforced (potentially by caregivers), with opportunities to practice new skills
in appropriate settings (Ellis, 2014). Twisk et al. (2013) found that it may be very difficult to
improve behaviors in real-traffic situations using educational programs that occur in a controlled
school setting, even using models for the traffic situations, and even if recognition of risks
(knowledge) appears to be improved.
Bicycle safety training and education may be incorporated into life-long, comprehensive traffic
safety education, with components assembled from NHTSA or comparable programs. Much
bicycle safety education material target children in grades K-8, though some are aimed at
younger children. Bikeology, an on-bicycle skills curriculum specifically designed for
professional physical education teachers and recreation specialists, is suited for teaching middle
to high school students of varying abilities and with special needs (AAHPERD, 2018). This
curriculum is available at www.shapeamerica.org/publications/resources/teachingtools/qualitype/bicycle_curriculum.aspx.
NHTSA has produced publications on how to properly fit a bicycle helmet, rules of the road,
presentations to generate peer to peer discussion on safe walking and bicycling, and games to
educate children and parents on bicycle safety. This information is available on NHTSA’s
Bicycle and Traffic Safety Marketing pages. Bicycle Safer Journey is an updated series of webbased training videos and discussion guides targeted for bicyclists 5 to 9, 10 to 14, and 15 to 18
years old. The material is available on the Pedestrian and Bicycle Information Center website
(www.pedbikeinfo.org/bicyclesaferjourney/).
Use: The use of school-based programs, which is at the discretion of local school districts, is
unknown, but some localities are introducing bicycling as a physical activity class taught by
experienced teachers. In-school education and training; however, is a frequent part of local SRTS
programs. In addition to programs offered by teachers and school personnel, local bicycling
coalitions sometimes offer age-appropriate bicycle training in a school setting. Examples are the
Bicycle Transportation Alliance in Portland, and the Hawaii Bicycling League (Thomas et al.,
2005). The Let’s Go NC! – Pedestrian and Bicycle Safety Curriculum in North Carolina provides
educational material for training safe road use skills in children (www.ncdot.gov/initiativespolicies/safety/lets-go-nc/Pages/default.aspx). The prevalence of community-based programs is
also unknown, but there are programs active in some States such as California, New York, New
Jersey, and Virginia. The Kids on Bikes program offers a collection of community-based
resources in many localities including bike libraries, summer bike camps, and safe biking
education (https://kidsonbikes.net/).
Effectiveness: Both short lecture-based programs and more extensive programs with on-bicycle
training can increase children’s knowledge of laws and safe behaviors (Ellis, 2014; Hooshmand
et al., 2014; Lachapelle et al., 2013; van Lierop et al., 2016; Mandic et al., 2018; Thomas et al.,
2005), bicycling confidence (van Lierop et al., 2016), or observed behaviors in an educational
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Appendix 9. Bicycle Safety
context (Ducheyne et al., 2013, 2014), but whether these translate into adoption of the safe
behaviors is less certain (Hatfield et al., 2017; Richmond et al., 2014). One evaluation of a pilot
program in the French-speaking parts of Canada, the Certificat Cycliste Averti (CCA; English
translation: Certified Aware Cyclist), showed the program was successful in increasing
children’s knowledge of bicycling safety and bicycle-specific street signs (van Lierop et al.,
2016). The CCA program consists of theoretical off-bicycle lessons on traffic safety, practical
on-bicycle training in a safe environment, on-road urban bicycling training, and individual, onroad cycling exam. Additionally, there was some evidence that parents’ own cycling habits and
perceptions of their child’s cycling safety had been positively changed through child
participation in the CCA program. A 2005 study for NHTSA described four school-based, onbicycle training programs that each achieved sustained knowledge gains, and higher average
knowledge compared to students who had never had a training course (Thomas et al., 2005).
Self-reports from students and parents also suggested that safe riding behaviors and enjoyment of
riding improved, more so in the courses taught on road than those taught in a closed course (on
the school grounds). A European study examined the effectiveness of a classroom-based training
course that used videos to teach hazard detection to young bicyclists 9 and 10 years old (Zeuwts
et al., 2017). In a video-based evaluation study, children who received the training detected more
hazards and reacted faster to them than a control group that did not receive any training.
A review of evaluations of 13 educational programs (without legislation enactment) among
children and youth found that educational programs were effective at increasing observed helmet
use. Most programs also offered discounted or free helmet distribution. Meta-analyses found the
odds of observed helmet wearing to be more than 2 times higher than at baseline or among the
non-intervention group, but results were quite varied across the different studies (Royal et al.,
2007). The authors were unable to tease apart differences in programs that might contribute to
different outcomes other than whether they were community-based or school-based, and whether
or not they offered free or reduced-priced helmets. Community educational programs that
provided free helmets were reported to be more effective than programs set in schools or that
provided only an opportunity to purchase a discounted helmet, although the latter types also
increased use. School-based programs also tended to obtain best results among the younger
participants. Three of the studies found helmet use benefits persisting at 9- to 12-month followup, although evidence is still lacking regarding longer-term (1 year or more). Based on the
evidence of effectiveness of helmets at preventing head-injuries when worn, injury-reduction
benefits would be expected from programs that increase proper use of helmets. Crash reduction
benefits of educational programs have not been conclusively demonstrated (Richmond et al.,
2014). Evidence is also lacking as to whether programs might have any unintended effects such
as reducing amounts of riding or conferring overconfidence in one’s riding skills.
Costs: Coalitions may be paid by their associated State to provide training, or otherwise use
SRTS funds if money is still available, or if SRTS funding at the State is being maintained.
Activities formerly eligible under Federal SRTS funding are now eligible under the TAP
program outlined in MAP-21, but funding priorities are established by each State. State contacts
may be located on the PBIC website (pedbikeinfo.org/data/state.cfm) or search individual States’
DOT websites for information about TAP and SRTS funding. Teachers can provide education
using NHTSA’s free material, but training, administration, and supervision of a comprehensive
program could increase costs somewhat.
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Appendix 9. Bicycle Safety
Time to implement: Short, for existing material; medium, to develop and disseminate a training
curriculum with material.
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Appendix 9. Bicycle Safety
1.4 Cycling Skills Clinics, Bike Fairs, Bike Rodeos
Effectiveness: ✩
Cost: $
Use: Unknown
Time: Short
Overall Effectiveness Concerns: While cycling skills clinics or rodeos can result in increases in
knowledge and skills, a review of the research literature does not reveal any studies that
document crash and injury reduction, at least not in isolation. There are insufficient evaluation
data available to conclude that this countermeasure is effective.
The purpose of cycling skills clinics, bike fairs, or bike rodeos is to teach children bicycle
handling skills such as starting, stopping, weaving to avoid objects, and the meaning of traffic
signs and signals and some traffic laws. The intent of these types of activities is to introduce or
reinforce bicycle safety concepts learned in a classroom with actual on-bike practice and
application. It should be part of a more comprehensive program of traffic safety education and
training, parent education, and other efforts.
A cycling skills clinic, bike fair, or rodeo is an event that lets children learn and practice
bicycling skills. A clinic typically has several stations for specific skills and also includes bicycle
and helmet inspections. Parental involvement can also be a valuable component of bicycle fairs,
providing reinforcement of desired safe riding behaviors and modeling appropriate bicycling
behaviors. Events should also include discussions and examples of proper bicycle helmet fitting.
NHTSA collected many examples of these across the country and created a guide of best
practices. NHTSA’s Cycling Skills Clinic Guide aids first-time or seasoned organizers in how to
set-up a clinic, stations to choose based on their audience, station set-up, and teaching tools for
volunteers, see www.nhtsa.gov/sites/nhtsa.dot.gov/files/811260.pdf
There are a number of bicycle safety courses and models for fairs, rodeos, and clinics. Using
older bike rodeo as models, NHTSA developed a cycling skills clinic with the League of
American Bicyclists (NHTSA, 2011) to provide a how-to guide including stations based on a
basic, intermediate, or advanced skills. The League of American Bicyclists and the American
Bicycling Education Association have certified instructors across the country to teach levels of
courses that include a combination of classroom and on-bicycle courses to people of all ages and
skills. These courses teach more about defensive riding around traffic and about traffic laws.
Use: Bicycle safety fairs and rodeos are local events often run by law enforcement, school
personnel, or other civic and volunteer organizations. 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. Although the extent of use is unknown, they are
increasingly implemented as part of Safe Routes to School projects and as part of pedestrian and
bicycle safety efforts.
Effectiveness: While cycling skills clinics or rodeos can result in increases in knowledge and
skills, a review of the research literature does not reveal any studies that document crash and
injury reduction, at least not in isolation. One program of comprehensive education for preschool
children and their parents, that included a skills and safety rodeo, led to a doubling of helmet use
(Britt et al., 1998; Rivara & Metrik, 1998). Some studies have found that single-event bike
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Appendix 9. Bicycle Safety
rodeos did not lead to increases in knowledge or improvements in behaviors or attitudes
(Macarthur et al., 1998); thus, bike rodeos need to be part of larger, more comprehensive
programs. See Rivara and Metrik (1998) for a more in-depth discussion.
One study examined the effectiveness of the United Kingdom’s National Cycle Proficiency
Scheme (NCPS), a nationwide bicycle training program for children (Teyhan et al., 2016). Its
goal is to promote safe cycling by improving skills, knowledge, attitudes, behavior, and hazard
awareness. The training courses for children during the final years of primary school consist of
four to eight 1-1.5 hour sessions (usually in the school playground or on road), culminating in a
Cycle Proficiency Test. The results of a longitudinal analysis reported that NCPS training was
associated with children being more likely to cycle to school and engage in safety-related
behaviors, such as owning and wearing helmets. The differences were moderate for 14-year-olds
and persisted to age 16, but the effects were much smaller at the older age.
Costs: A one-time clinic or rodeo can be operated with volunteers at minimal cost. A permanent
rodeo facility could cost thousands of dollars. Associated costs may include bicycle and helmet
rentals, but many communities have bicycle coalitions that have purchased these resources and
bring them in trailers to scheduled events, or have children or community members bring their
own.
Time to implement: A one-time clinic or rodeo can be organized in a few months.
Implementing a permanent program with a facility may take up to a year or longer.
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Appendix 9. Bicycle Safety
2. Adults
2.2 Bicycle Safety Education for Adult Cyclists
Effectiveness: ✩
Cost: $$
Use: Low
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that this countermeasure is effective.
The goal of bicycle safety education for adult bicycle commuters is to improve knowledge of
laws, risks, and cycling best practices, and to lead to safer cycling behaviors, including riding
predictably and use of safety equipment such as reflective clothing and helmets. The Cycling
Skills Clinic discussed in 1.4 of this chapter can be adopted for use by adult audiences as can a
safety class prior to and part of planning for a community bike ride (like a ride to support a
particular cause). Opportunities to educate adults new to or returning to bicycling can reinforce
traffic safety principals and to generate more interest in additional on-bicycle classes to enhance
comfort, safety, and defensive riding maneuvers in and around traffic.
A handful of communities have developed bicycle education programs, with large variation in
program elements. Common elements include safety ads (radio, TV, outdoor), dissemination of
safety information, bike “ambassadors” and social supports, individual skills training or
workshops, and coordination with enforcement officers to reinforce safe behaviors. The League
of American Cyclists provides online training videos. Case study summaries are available of
programs in Tucson, Arizona, Portland, Oregon, Augusta, Maine, Chicago, Illinois, and many
other cities (PBIC, 2010). A University of Texas at Austin program was designed to provide
tailored education and encouragement to new or timid bicyclists in the African American
community and reported improvements in perceptions of comfort and safety among those
participating (McCray et al., 2013).
NHTSA’s Be a Roll Model campaign is aimed at encouraging all road users, including bicyclists,
to model safe travel behaviors for their children and others. It includes educational information,
tip sheets, and a pledge program for local agencies to adopt and disseminate
(https://one.nhtsa.gov/Driving-Safety/Bicycles/Be-a-Roll-Model).
Adult cyclists are trained that bicyclists fair best when riding and acting as vehicles in the
roadway, following the same rules as motorists such as riding in the same direction with traffic
and following the traffic signs and signals. For example, adults learning to ride safely are taught
where to position themselves in the travel lane based on their intent to go straight or turn, the use
of judgement to enhance their comfort and safety while riding in traffic, and when they must stay
in bicycle lanes if they are present.
Use: Documented use is low. Adult-oriented safety education programs in the United States are
not well documented and are rarely formally evaluated. Bicycle groups offer bicycle education to
adults (and youth) including both classroom and on-bicycle training to help cyclists of varying
levels enhance their knowledge of traffic laws and rules of the road and skills to ride safely and
more comfortably in traffic. The oldest and most well-known is the League of American
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Appendix 9. Bicycle Safety
Bicyclists, see http://bikeleague.org/content/take-class for more information and to find leaguetrained cycling instructors (called LCIs) by geographic area. LCIs typically provide group
training.
Effectiveness: This measure is unlikely to be effective in reducing crashes without
comprehensive and sustained efforts to improve the cycling environment. A high-quality
evaluation conducted in Brazil by Bacchieri et al. (2010) found that “an intervention based on an
educational component and the promotion of the active use of safety equipment is not capable of
reducing accidents among cycling workers” (in this case, male cycling commuters). The study
concluded that “isolated educational programs, attempting to only change individual behavior,
are not effective in reducing accidents” and that “the number of accidents will not considerably
decrease without actions that also include improved road infrastructure and the effective
application of legislation (with comprehensive and systematic law enforcement).”
A recent review of the effects of bicycle training programs on adults found that only a few
studies of mixed quality existed, and none of them examined the safety benefits of these
programs (Sersli et al., 2019). However, most of the studies reviewed reported that these
programs increased the frequency of bicycling to work and overall bicycle use among adults,
which may increase bicyclist exposure to risk.
Costs: The estimated costs for these programs is in the medium range. Costs may vary
depending on the intensity of the educational program. Costs for radio/TV ads, print material,
safety equipment, workshop and training events, and personnel time could be incurred.
Time to implement: A comprehensive education program could require several months of startup time to plan and develop program material.
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Appendix 9. Bicycle Safety
3. All Bicyclists
3.2 Promote Bicycle Helmet Use With Education
Effectiveness: ✩✩
Cost: $$$
Use: Medium
Time: Medium
Overall Effectiveness Concerns: This countermeasure has been examined in several research
studies. There is some evidence that certain approaches may lead to increased helmet use and
more favorable attitudes towards helmet use, especially among children. However, more
research is needed to conclude that the countermeasure is effective when broadly targeted
towards all cyclists.
Bicycle helmet promotions increase use of helmets and thereby decrease severe and fatal brain
injuries to bicyclists involved in crashes. Bicycle helmet promotions are frequent but usually aim
at child bicyclists only, often through youth health organizations and schools. Promotions can
target barriers to helmet use, including absence of a helmet, child and families’ lack of
understanding of the importance of helmet use, cost of helmets, and negative attitudes or beliefs
about helmet use. Programs that provide helmets can include sponsoring organizations and often
involve law enforcement and schools to deliver helmets, fit the helmets, and teach proper fitting
and use. Promotions can be conducted through single events or extended campaigns to promote
helmet distribution and use. These should not be limited to just children, but should include
adults requires as well because crashes are not limited to just children to those who are deemed
less skilled at bike riding. Expanding helmet promotions to adults requires expansion in focus,
and perhaps different sponsors. However, adding adult-oriented riding tips may increase the
appeal of the program. Other adult-oriented strategies should also be included, such as peerbased interventions on a college campus (Buckley et al., 2009).
Regardless of the target audience, bicycle helmet promotions must include instruction on how to
properly fit the helmet and the importance of wearing helmets on every trip. See Sections 1.1 and
2.1 for more information. The Bicycle Helmet Safety Institute has extensive information on
helmets, purchasing a helmet, helmet fit, when to buy a new helmet, helmet recalls, and the
difference between helmet brands, see www.helmets.org/. Programs might also need to target
differences in tendency to adopt helmet use for different riding purposes (recreational versus
commuting), or riders who identify as only one type of rider (Kakefuda et al., 2009). All
bicyclists could benefit from using resources that demonstrate how helmets work to reduce
injury. Moreover, further efforts are needed to encourage parents and authority figures (LEOs,
school officials and staff, and health-care professionals) to reinforce and model desired behaviors
including the use of a properly fitted bicycle helmet every ride (Maitland, 2013). Trained and
skilled cyclists may also be more likely to adopt helmet use (Kakefuda et al., 2009), so adult
bicycle training programs that incorporate the importance of helmet use may help increase
wearing by adult riders. A survey of U.S. attitudes toward bicycling and walking indicates that
about 34% of respondents who had ridden bicycles in the past year used helmets for all or nearly
all their rides (Schroeder & Wilbur, 2013).
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Appendix 9. Bicycle Safety
Use: Most States have conducted bicycle helmet promotions for children in the last few years,
although only a few have ongoing or regular programs. Some States have conducted bicycle
helmet promotions for general audiences.
Effectiveness: Bicycle helmets are proven to reduce injuries and fatalities (see Chapter 9,
Sections 1.1 and 2.1). Helmet promotions are successful in getting more helmets into the hands
of bicyclists. Rouzier and Alto (1995) described 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. A peer-led, social marketing
program on a medium-sized college campus also raised observed helmet use, at least for the
short term (Ludwig et al., 2005). A school-based injury-reduction program targeting 13- and 14year-olds incorporating opportunities for instruction, demonstration, rehearsal, feedback, social
reinforcement and practice was associated with a 20% increase in observed rate of helmet use
among this challenging target age group at 6 months follow-up (Buckley et al., 2009). In France,
voluntary helmet use increased from 7.3% in 2000 to 22% in 2010. During that time, national
public awareness and informational campaigns were initiated and carried out promoting helmet
use among youth, adults with children, and the general population (Richard et al., 2013). In
Cambodia a school-based helmet distribution program “Helmet for Kids” helped achieve and
sustain high helmet usage rates (Ederer et al., 2014). Prior to program implementation, helmet
usage rates were less than 0.5% in 9 intervention and four control schools. Free, high-quality
tropical helmets that were fitted to each student and designed for use with both bicycles and
motorcycles were distributed to more than 6,700 students in 9 schools. Voluntary helmet use
increased to 87.9% in the first 2 weeks after distribution, and the use rate was sustained (86.5%)
3 to 4 months after. Helmet use stayed below 1% in the control schools during this time.
A Cochrane systematic review and meta-analysis of 22 studies evaluating non- legislative helmet
promotion programs aimed at children under 18 found the odds of observed helmet wearing were
significantly greater among those receiving the interventions (Owen et al., 2011). The study
found the more effective programs were community-based rather than aimed at people, provided
free rather than subsidized helmets, and were set in schools. A Canadian program, Operation
Headway, involving enforcement of bike helmet legislation, education, rewards for wearing and
economic penalties for non-wearing, and provision of helmets to low-income groups was
evaluated by Lockhart et al. (2010). The researchers found the program increased wearing rates
(based on observations pre- and post-intervention), increased knowledge and commitment to
wearing a helmet, saw greater public awareness of the law through media tracking, and improved
relationships between police and the public (based on anecdotal evidence). Another helmet-use
promotion program, involving distributing helmets and information, was evaluated in France
(Constant et al., 2012). This study found that the helmet promotion program was of value in
increasing helmet use, but not sufficient to achieve high rates of helmet use among adult cyclists.
A related theme of these studies is that population-wide, multifaceted, integrated, and repeated
prevention programs are needed, which should include distribution of free helmets and safety
information and strategies to increase peer and parental pressure.
Programs that increase proper use of helmets would be expected to reduce injuries in the event of
a bicycle crash (see Section 1.3).
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Appendix 9. Bicycle Safety
Costs: The cost for underwriting large numbers of helmets can be quite high, including
supporting communications and outreach material. Adequate helmets can be purchased for as
little as $8 each, in reach of most adult bicyclists. Purchase of large quantities of helmets by
businesses, hospitals, or through partnerships with merchants for example can also lower the cost
per helmet and make free or subsidized distribution of helmets to at-risk segments of the
population more feasible.
Time to implement: A good campaign, including market research, material development, and
message placement, will require at least 6 months to plan and implement.
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Appendix 9. Bicycle Safety
3.3 Enforcement Strategies
Effectiveness: ✩
Cost: $$
Use: Unknown
Time: Varies
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
The purpose of targeted enforcement is to increase compliance with appropriate traffic laws by
both bicyclists and motorists. Enforcement of traffic laws for all operators, including speed,
distracted, and impaired enforcement, may help to enhance behavioral compliance and reduce
the severity and frequency of collisions as well as promote bicycle safety. (See Chapter 3 for
more information on strategies to reduce speeding and aggressive driving.) Targeted enforcement
directed at bicyclists is rare but does occur with their failure to obey traffic signs and signals.
Some college towns such as Madison, Wisconsin, have enforcement periods at the beginning of
each school year.
SHSOs can help ensure correct riding and driving around bicyclists through communications and
outreach campaigns, and through training LEOs about laws that impact the safety of bicyclists,
and applicable enforcement. Some violations may be especially pertinent to bicyclist safety. For
example, a motorist may violate a bicyclist’s right-of-way following an overtaking maneuver by
immediately turning right across the bicyclist’s path when making a right- or left-hand turn, or
by passing too close to a bicyclist (see Section 3.4 below). Similarly, bicyclists riding the wrongway put themselves at greater risk of head-on collisions or angle collisions with motorists pulling
out at side streets or driveways who are looking to the left for oncoming traffic. By enforcing and
educating bicyclists and drivers about relevant laws, the motoring and bicycling public may
become better-informed about the risk of these types of violations and importance of obeying all
traffic laws. Law enforcement can also reinforce active lighting and helmet use laws in effect by
stopping and educating offending bicyclists as well as writing citations if appropriate. (Also see
Chapter 9, Section 1.1, and BIKESAFE Law Enforcement countermeasure for more information:
www.pedbikesafe.org/BIKESAFE/countermeasures_detail.cfm?CM_NUM=40.)
LEOs typically receive little to no specialized training in bicycle or pedestrian safety, but such
training can yield safety improvements. For instance, the Watch for Me NC program in North
Carolina provided comprehensive officer training combined with public safety messages about
pedestrian and bicycle safety (Sandt et al., 2015). After receiving the training, officer test scores
increased from 77% to 90% correct, and they reported improvements in self-reported attitudes,
knowledge, and perceived ability to enhance safety through their enforcement efforts.
Importantly, driver yielding increased by an average of 15 to 16% after a year or more after the
program began. Officers in Utah who received training in bicycle safety enforcement, including
classroom and field training through a NHTSA cooperative agreement in 2012, stated they were
more likely to watch and enforce high-risk motorists’ behavior after having received training.
NHTSA offers free self-paced interactive training for law enforcement to enhance the safety of
bicyclists (and pedestrians). Training can be found from several sources including:
• NHTSA’s Law Enforcement’s Roll Call Video: Enforcing Law for Bicyclists:
www.nhtsa.gov/multimedia/bicycles/bicycle_safety_LE.wmv
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Appendix 9. Bicycle Safety
• NHTSA’s Enhancing Bicycle Safety: Law Enforcement’s Role (CD-ROM training):
https://one.nhtsa.gov/Driving-Safety/Bicycles/Enhancing-Bicycle-Safety:-Law-Enforcement%27s-Role
• Pedestrian and Bicycle Information Center: www.pedbikeinfo.org/resources/pbic_resources.cfm
• Safe Routes to School’s Enforcement: Role for Law Enforcement in SRTS:
http://apps.saferoutesinfo.org/lawenforcement/
Enforcement strategies can take formats to help satisfy the needs of departments regardless of
how they choose to emphasize bicycle safety.
• Training for prosecutors and judges. This helps build the case for enforcement of traffic
laws and planned enforcement operations with appropriate follow-up for citations
throughout the judicial system.
• Alternative programs. An example includes educational diversion programs for
adjudication of citations involving bicyclists. Diversion programs may be easier to
implement in settings such as universities and college campuses. For example, UC
Berkeley teamed with the East Bay Bicycle Coalition to provide free bicycle safety
classes as an option to reduce the fine for a bicycle ticket from the UC police
department. For more, visit: www.ebbc.org/safety. Trauma Nurses Talk Tough
collaborated with local Portland organizations (including the Portland Department of
Transportation) to create the Share the Road Safety Class program (Trauma Nurses Talk
Tough, 2016). The class teaches right-of-way safety to bicyclists, pedestrians, and
motorists who have received citations for incorrect lane use, lack of safety equipment, or
failure to yield. Pre- and post-class testing found a 20% increase in knowledge of laws
and safety issues, and 97% of students who evaluated the course rated it as worthwhile.
In Illinois, certain jurisdictions offer an online “Adult Bicyclist” quiz on key safety
techniques and State laws as a bicyclist ticket diversion program (see
www.bikesafetyquiz.com/, and http://rideillinois.org/wpcontent/uploads/2016/01/PoliceChiefsArticle_Spring2014.pdf for more information).
Other examples of programs can be found at the University of Wisconsin (Madison) and
through Marin County (California) Bicycle Coalition.
• Targeted enforcement. One example of a publicly available plan outlining policy and
enforcement practices for bicyclist and pedestrian safety is provided by Glendale,
California. See www.glendaleca.gov/home/showdocument?id=14284.
A Massachusetts law included measures for enforcement of motorist violations affecting cyclist
safety and enabled local jurisdictions to cite bicyclists for violating traffic laws under the same
procedure for ticketing motorists. This legislation has led to increased enforcement for bicyclist
laws in some jurisdictions. There was some initial confusion in implementing the law, but police
in Boston are now citing bicyclists for traffic violations as well as looking out for motor vehicle
violations that they may have overlooked before. Some jurisdictions see the measures as
primarily an aid to outreach and education of cyclists to increase their safety.
Use: Unknown. Targeted enforcement of bicycle-related violations is likely a rarely used
intervention.
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Appendix 9. Bicycle Safety
Effectiveness: Gilchrist et al. (2000) described an enforcement program in Georgia that
impounded 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 law enforcement through the training courses and approaches noted above could,
however, yield benefits that go beyond bicycle safety, to include improved community relations
and more positive interactions between law enforcement and members of the community. A
Japanese study by Okinaka and Shimazaki (2011) evaluated the effects of vocal and written
prompts delivered by security guards on a university campus to reinforce safe behaviors (such as
dismounting and walking bicycles on a sidewalk). The intervention involved posting campus
security guards at sidewalk locations. The guards wore sashes that read, “Let’s not drive on
campus” and provided vocal prompts, “Please get off and push [bicycles] to [bike racks] for
safety on campus,” and then thanked compliant riders for their cooperation. Results reported the
intervention was effective at increasing safe behaviors exhibited by bicycle riders in this context.
Riders walked their bicycles on the sidewalk 22% of the time at baseline, compared to 88% of
the time during the intervention phases.
A Canadian study examined the effects of enforcement after a mandatory all-age bicyclist helmet
law was passed in 1997 in Nova Scotia (Huybers et al., 2017). Non-compliance involved a total
fine of between $129-136 CDN, which could be avoided by participation in a diversion program
consisting of a 2-hour education course. The 16-year longitudinal study found that helmet use
increased from around 37% before the law to 75% in the first year of implementation. Helmet
use continued to rise to 94%, fourteen years after the law came into effect. Usage levels
increased in years with greater enforcement; however, given the nature of this study, it is not
possible to conclusively determine that the increases were attributable specifically to the
enforcement efforts.
Costs: Training currently exists for LEOs. Roll-call videos can be implemented at essentially no
cost to the departments. NHTSA’s nationally focused CD-ROM trainings (bicycle and
pedestrian) can be taken by officers on their work or personal computers. They were designed to
enable officers to earn eligibility for in-service training hours. (NHTSA expects to revamp these
trainings to include new laws and a web-based format in the next few years). Longer in-person
courses take officers away from their regular duties or require overtime commitment and may
incur a financial cost, which may make online courses a more cost effective option. Some States
or localities have developed their own training to reflect State and local laws, some are roll-call
videos, other in-person. In-person courses may offer an added value if they include observations
of bicycle-motorist interactions, on-bicycle experience, and/or training of a bicycle safety
enforcement operation. SHSOs may be able to provide funding for departments to participate in
longer training courses, especially for those States eligible through 405 (h) State Highway.
Training for prosecutors and judges would likely need to be developed, as would a supporting
communications and outreach program for the public, motorists and bicyclists.
Time to implement: For existing law enforcement training, with ongoing presentation
schedules, implementation time can be quite short. For the full effort described above, a longer
time frame would be needed.
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Appendix 9. Bicycle Safety
Other issues:
Some public interest groups have expressed concerns about selective enforcement of
bicycle-related minor violations, such as mandatory bicycle helmet laws, especially
against low-income people and people of color (NACTO, 2016). Officers may use
issuing bicycle-related citations as an excuse to stop, question, or search people
(NACTO, 2016).
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Appendix 9. Bicycle Safety
3.4 Motorist Passing Bicyclist Laws
Effectiveness: ✩✩
Cost: $
Use: Medium
Time: Short
Overall Effectiveness Concerns: Although there is some research examining the effectiveness of
this countermeasure, there is insufficient evidence to conclude that the countermeasure yields
consistent benefits.
The purpose of bicyclist passing laws are to require motor vehicle drivers to leave at least three
feet of clearance space between the vehicle and the cyclist when overtaking the cyclist, to
minimize the likelihood of a sideswipe, and to reduce the chance of a close encounter that could
potentially destabilize or divert the course of a cyclist and cause a crash.
Use: As of July 2018 there were 32 States and the District of Columbia known to have enacted
bicyclist passing laws requiring drivers to leave a space of 3 feet or more when passing cyclists
(NCSL, 2018). Pennsylvania requires at least 4 feet for passing, and South Dakota requires at
least 3 feet for roads with a speed limit of 35 mph or less and at least 6 feet for roads with a
speed limit greater than 35 mph. North Carolina requires at least 2 feet for passing, and permits
passing a bicyclist in a no-passing zone if the motorist leaves a clearance of at least 4 feet. Three
States—Delaware, Kentucky, and Nevada—require the motorist to change lanes to pass a cyclist
on roads with lanes in the same direction. Nine other States have laws requiring motorists to pass
at a safe distance and speed, but are usually not more specific.
Effectiveness: One analysis of 18,534 bicyclist fatalities from 1990 to 2014 in the United States
reported that minimum passing laws may at best prevent approximately one fatal bicyclist crash
every 20 months (Nehiba, 2018). Love et al. (2012) evaluated the effectiveness of a passing law
enacted in Baltimore, Maryland. The study saw low compliance with the passing law and little to
no enforcement of the law by area police. Other factors that influenced passing distance included
lane width, bicycle infrastructure, cyclist identity, and street type. The authors concluded that in
addition to the passage of a law, interventions such as driver education, signage, enforcement,
and bicycle infrastructure changes (such as bike lanes and Complete Streets designs) are needed
to influence driving behavior and to increase motorist compliance with the three-foot law. Public
education should include some level of description, or say something about equipment to
measure or visualize a safe distance, such as imaging the distance of an opened car door.
Bicycle passing laws can be difficult to enforce because it is a challenge to measure the exact
distance between bikes and vehicles. Police in Chattanooga, Tennessee, and Austin, Texas, used
a device called C3FT, a handlebar mounted ultrasonic device, to measure when a vehicle passes
a police bicycle with less than 3 feet of distance (Goodyear, 2015; Davis, 2017). These devices
can offer valuable, accurate information to help make passing laws enforceable.
There are some empirical data suggesting that these laws may change driver behavior. A
naturalistic observational study of driver passing behavior in Michigan measured vehicle passing
distance in five jurisdictions having 3 feet (1 city), 5 feet (3 cities), and no enacted (1 city)
passing laws (Van Houten et al., 2018). The results showed that drivers maintained a
significantly greater separation distance when they overtook bicyclists in sites with 5-feet laws,
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Appendix 9. Bicycle Safety
compared to sites with 3-feet or no law. Roadway infrastructure also influenced passing
behaviors. Roads with paved shoulders, wider roads, and greater number of lanes were
associated with greater separations between drivers and bicyclists. Shared use lanes led to closer
passing, as did passing situations with larger vehicles.
A study in Queensland, Australia, examined the factors associated with road-user noncompliance with a 2-year trial of a bicyclist passing rule (Debnath et al., 2018; Haworth et al.,
2017). Motor vehicle drivers and bicyclists were observed across 15 sites. Apparent rider
characteristics (age, gender, helmet use, clothing type) were not associated with compliance with
the law. Roadway infrastructure, such as horizontal curves and narrow lanes, resulted in higher
observed non-compliance. A concurrent online survey of motorists reported that 43% of
respondents were more aware of the presence of bicyclists after the implementation of the law;
however, more than 40% reported being uncertain about judging the required 3 feet passing
distance. About 73% of cyclists and 60% motorists reported that motorists were leaving more
passing distance after the implementation of the rule than before. Further, two focus group
discussions with LEOs were conducted. Officers reported that the passing law was difficult to
enforce, and that motorists were observed to sometimes allow for much greater than the required
distance, leading to erratic maneuvers and increased risk of collision with oncoming vehicles.
Appropriate public education with pictures of appropriate distance from the perspectives of
different types of vehicles were suggested as potential solutions for enhancing gap judgments.
Cyclist fatality rates were not statistically different during the 24 months before and 16 months
after implementation of the law.
Costs: Minimal costs could be incurred for informing and educating the public and providing
training for enforcement personnel.
Time to implement: A bicyclist passing law can be implemented as soon as the law is enacted.
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Appendix 9. Bicycle Safety
4. Drivers and Bicyclists
4.1 Driver Training
Effectiveness: ✩
Cost: $
Use: Low
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
The purpose of addressing bicycle safety as part of driver education is to increase the sensitivity
of drivers to the presence and characteristics of bicyclists and how to safely share the road with
them. Although driver education and most State driver manuals address sharing the road with
bicyclists, many devote little attention or emphasis to the topic. NCHRP released model driver
handbook material that may be adapted by States to enhance their driver handbook information
on sharing the road with bicyclists (Thomas et al., 2007). This material could also be used in
driver education courses. Other existing print and electronic publications from organizations
such as AAA could and are being used to increase the emphasis on safe driving around
bicyclists. NHTSA has developed a series of videos to reach audiences that are either not literate
in their native language or do not speak the English language to educate drivers about sharing the
road with cyclists, including a motion graphic called Driving Safely Around Pedestrians and
Bicyclists (www.youtube.com/watch?v=Herby4kNVOg). Several States distribute Share the
Road information. For example, the Utah Department of Health developed a 12-minute video to
be shown in driver education classes to reinforce how drivers can safely share the road with
bicyclists.
One standard approach would be to implement a Share the Road module, www.trafficsafetymarketing.gov/get-materials/motorcycle-safety/share-road (see Section 4.2), covering
interactions with bicyclists in driver education curriculums. For complete coverage, the same
messages would need to be included in State-provided material for new drivers and covered by
new questions added to the license knowledge exam. Standards for driver education curriculum
and training developed by the American Driver and Traffic Safety Education Association
mentions sharing the road with cyclists and pedestrians as a learning objective (Driver Education
Working Group, 2009).
For links to more resources and discussion of considerations in educating motorists about bicycle
safety, see the Pedestrian and Bicycle Information Center, www.pedbikeinfo.org/topics/drivertraining.cfm.
Use: As noted, all driver licensing handbooks have some coverage of driving safely with
bicycles on the road, but the information may not be very complete and there may be little
assessment or testing of the material. Information is unavailable on the extent of training material
being used. States including New Mexico, Louisiana, and Washington have expanded sections
on bicycle safety in their driver’s education handbooks and curriculum (for New Mexico’s
handbook see page 25 of https://driving-tests.org/new-mexico/nm-mvd-drivers-handbookmanual/).
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Appendix 9. Bicycle Safety
Effectiveness: Driver education has not been shown to reduce overall crash rates. The objective
for adding more bicycle information would be to increase knowledge and desire to share the road
safely with bicyclists, of the most common crash types and hazards and to improve new drivers’
anticipation of and interactions with bicyclists – as well as improve their behavior as bicyclists.
Lifelong traffic safety education that includes bicycle training might also provide motorists with
a greater understanding of bicyclist characteristics and needs and how to safely share the road.
Computer-based training programs, such as the Risk Awareness and Perception Training (RAPT)
and SAFE-T, can be used to train bicyclist anticipation and hazard mitigation skills to young
drivers (Pollatsek et al., 2006; Pradhan et al., 2009; Yamani et al., 2016; Yamani et al., 2014).
These programs present potential conflict situations to drivers in safe driving simulator settings
(e.g., bicyclist passing situation, passing a bicycle with no lights in low light) and help in training
and evaluating safe driving skills. For more details on these programs, see Chapter 6 and
Appendix 6, Section 2.1.
Costs: Free material like that above is available from NCHRP as well as the Transportation
Research Board, American Association of Motor Vehicle Administrators, and the League of
American Bicyclists. The cost would be for the adaptation or development of the new segments
of the standard curriculum and for getting it into the material used by driver education instructors
and schools. Changes to State driver manuals and other publications could be done in the normal
material update budget.
Time to implement: Material would need to be adapted and integrated into the standard driver
education curriculum, and adjustments made elsewhere in the curriculum to reflect likely
additional time required for the new bicycle material.
The same timeframe would be expected for making changes to official State driving manuals,
license exams, and related material and procedures.
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Appendix 9. Bicycle Safety
4.2 Share the Road Awareness Programs
Effectiveness: ✩✩
Cost: $$
Use: Unknown
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
The purpose of Share the Road programs is to increase drivers’ awareness of bicyclists, as well
as improve both bicyclist and driver compliance with relevant traffic laws. The National
Strategies for Advancing Bicycle Safety was developed from a July 2000 conference of bicycle
advocates, injury prevention specialists, and government representatives (NHTSA, CDC, &
FHWA, 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.”
For an example of communication and outreach material, see
www.pedbikeinfo.org/topics/drivertraining.cfm. AAA created a series of Share the Road
promotional videos in partnership with the Share the Road Cycling Coalition and the Canadian
Automobile Association. These videos can be accessed at htpps://exchange.aaa.com/safety/bicycle-safety.
Use: Unknown.
Effectiveness: Share the Road awareness educational information can be effective in increasing
knowledge and appropriate attitudes, but as with other awareness programs, there is limited
evidence of behavior change, and no evidence of reductions in crashes.
Some limited evidence suggests that Share the Road signs can have positive effects on drivers’
lane position and speed when passing bicyclists. Kay et al. (2014) conducted field studies
examining drivers’ passing behavior on a rural two-lane highway before and after the installation
of “Share the Road ” signs. Although the presence of the sign did not significantly reduce
crowding, fewer drivers traveled in the rightmost lane position after the signs were installed.
Drivers also reduced the vehicle speed by an average of 2.5 mph when passing bicyclists in the
presence of the sign. In a limited study, shared-use arrow (“sharrow”) pavement markings were
shown to influence bicyclist lane position toward the sharrow marking in the shared-use lane
(Pole et al., 2015). Similarly, adding dashed lines on either side of the sharrow (called dooringzone markings) led to safer bicyclist lateral positioning that was farther from parked vehicles,
while also reducing motor vehicle passing (Kassim et al., 2018). On the other hand, a 3-year
before-and-after analysis conducted in Chicago using dooring crash data (a crash where a cyclist
collides with an open car door) found that dooring crashes increased more in blocks where
sharrows were added than in blocks where bike lanes were added or where no improvements
were made (Turnbull, 2017). Although these studies do not provide conclusive evidence of
safety improvements, they suggest that these infrastructure interventions may have the potential
for positive effects on both driver and cyclist behavior, but more research is needed.
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Appendix 9. Bicycle Safety
Some cities and States are specifically changing their Share the Road signs to indicate that
bicyclists may occupy the full lanes. This is because Share the Road is perceived differently by
different users and not always in its intended way to encourage motorists to look out for and
drive safely around bicyclists.
Costs: Medium, including the costs to develop new publications or tailor current ones. The
material 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: A good campaign, including market research, message development and
testing, and implementation, will require at least 6 months to plan and implement.
A9-23
Appendix 9. Bicycle Safety
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Appendix 9. Bicycle Safety
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Appendix 9. Bicycle Safety
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Appendix 9. Bicycle Safety
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A9-28
Appendix 10. Drowsy Driving
A10. Drowsy Driving
This section provides expanded discussion of the ✩ and ✩✩ countermeasures.
Countermeasures that receive ✩ or ✩✩ have NOT been determined to be effective, either
because there has been limited or no high-quality evidence (✩) or because effectiveness is still
undetermined based on the available evidence (✩✩).
States should use caution in selecting ✩ or ✩✩ countermeasures, since conclusive evidence is
not available to demonstrate the effectiveness of these countermeasures. If they decide to use a
new or emerging countermeasure that has not yet been studied sufficiently to demonstrate that
the countermeasure is effective, they are encouraged to have the countermeasure evaluated in
connection with its use.
The ✩ and ✩✩ countermeasures covered in this section of the appendix are listed below.
1. Laws and Enforcement
Countermeasure
1.2 General Drowsiness and Distraction Laws
††
Effectiveness
✩
Cost
Use
Time
Varies
High††
Short
Included under reckless driving; use of explicit drowsiness laws is low
2. Communications and Outreach
Countermeasure
2.1 Communications and Outreach on Drowsy
Driving
Effectiveness
Cost
Use
Time
✩
$$
Unknown
Medium
Effectiveness
Cost
Use
Time
$
Unknown
Short
Variable
Unknown
Medium
3. Other Countermeasures
Countermeasure
3.1 Employer Programs
3.2 Education Regarding Medical Conditions
and Medications
✩✩
✩
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Appendix 10. Drowsy Driving
Effectiveness:
✩✩
Effectiveness still undetermined; different methods of implementing this
countermeasure produce different results
✩
Limited or no high-quality evaluation evidence
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.
Cost to implement:
$$$ Requires extensive new facilities, staff, equipment, or publicity, or makes heavy demands on current resources
$$
Requires some additional staff time, equipment, facilities, and/or publicity
$
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.
Use:
High
More than two-thirds of the States, or a substantial majority of communities
Medium
One-third to two-thirds of States or communities
Low
Less than one-third of the States or communities
Unknown
Data not available
Time to implement:
Long
More than 1 year
Medium
More than 3 months but less than 1 year
Short
3 months or less
These estimates do not include the time required to enact legislation or establish policies.
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Appendix 10. Drowsy Driving
1. Laws and Enforcement
1.2 General Driver Drowsiness Laws
Effectiveness: ✩
† Included
Cost: Varies
Use: High†
Time: Short
under reckless driving; use of explicit drowsiness laws is low.
Overall Effectiveness Concerns: Laws that specifically target drowsy drivers are not widely
used, and this countermeasure has not been systematically examined. There are insufficient
evaluation data available to conclude that the countermeasure is effective.
Existing State laws allow people to be cited and prosecuted if they cause crashes due to drowsy
driving; however, the extent to which States pursue these cases is currently unknown. Two States
have laws that specifically target the issue of drowsy drivers. In 2003 New Jersey enacted
“Maggie’s Law,” under which a driver can be prosecuted for vehicular homicide if the driver has
not slept in 24 hours and causes a crash in which someone is killed. Arkansas has a similar law –
a driver can be charged with negligent homicide if the driver is involved in a fatal crash and has
not slept in 24 hours. Three drivers were convicted between the time when the law was passed in
2013 and 2016 (GHSA, 2016).
No studies have evaluated whether general reckless driving laws or specific drowsy driving laws
have any effect on curbing drowsy driving. 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 on alcohol-impaired driving, Chapter 2, Sections 2.1,
3.1, and 3.2 on seat belt use laws, and Chapter 3, Sections 2.2 and 4.1 on aggressive driving and
speeding laws. Enforcement of drowsy driving laws is likely to be especially difficult because
drowsiness is difficult to observe, measure, and document (see overview of issues in GHSA,
2016). One survey of 293 Australian drivers found that young drivers with higher levels of
extraversion or with a more tolerant view of driving while drowsy were less likely to view
drowsy driving charges as legitimate, even in cases of crashes (Watling, 2018). Nevertheless,
these laws may increase the impact of communications and outreach efforts to reduce drowsy
driving discussed in Chapter 4, Sections 2.1 (see also Stutts et al., 2005, Strategy C2).
Use: As of July 2018, New Jersey and Arkansas were the only States with laws explicitly
addressing drowsy driving (NCSL, 2018). Two States (Alabama and California) designate a day
for drowsy driving awareness, two States designate a week of awareness activities (Florida and
Texas), and Utah has commissioned studies to determine which highways are high-risk for
observed instances of driver drowsiness. See NCSL (2018) for more information on these laws
and other drowsy driving related bills. The NSF’s Drowsy Driving Advocacy Kit
(www.sleepfoundation.org/national-sleep-foundation-drowsy-driving-advocacy-kit) is intended
to help local and State drowsy driving advocates develop legislative inputs (GHSA, 2016).
Effectiveness: The effect of any laws on reducing drowsy driving is 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
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Appendix 10. Drowsy Driving
with enforcement directed primarily at other offenses such as alcohol-impaired or aggressive
driving. However, special patrols to enforce drowsy driving laws will entail greater costs
including training (GHSA, 2016) and especially if overtime is required for LEOs.
Time to implement: The implementation time is primarily determined by the time required to
pass new drowsy driving laws. Implementation can begin as soon as the laws are publicized, and
law enforcement patrol officers are trained.
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Appendix 10. Drowsy Driving
2. Communications and Outreach
2.1 Communications and Outreach on Drowsy Driving
Effectiveness: ✩
Cost: $$
Use: Unknown
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
Drowsy driving typically occurs because drivers don’t get enough sleep (Royal,
2003), although certain medical conditions and medications can also cause drowsiness while
driving (Colvin & Collop, 2016; Watson et al., 2015). In a NHTSA telephone survey, 66% of the
drivers who reported they had nodded off while driving had 6 or fewer hours of sleep the
previous night (Royal, 2003). The AAA Foundation conducted a survey in 2015 and found that
almost one third of respondents (31.5%) reported driving when they were so tired that they had a
hard time keeping their eyes open in the past 30 days (AAAFTS, 2016). Stutts, Wilkins, and
Vaughn (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 6 or fewer hours of sleep the previous night compared to fewer
than 10% of the other drivers. Similarly, about 40% of 2,613 respondents reported sleeping 6
hours or fewer hours daily in a 2017 survey (AAAFTS, 2018); drivers who sleep fewer than 7
hours are estimated to be at elevated levels of crash risk compared to sleeping at least 7 hours
(Tefft, 2016).
States and national organizations such as the National Sleep Foundation have conducted drowsy
driving communications and outreach campaigns directed to the general public (Stutts et al.,
2005, Strategy C1; NSF, 2004; NSF, n.d.; GHSA, 2016). 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.
The GHSA summarizes public awareness efforts by NHTSA, the AAA Foundation for Traffic
Safety, and the American Academy of Sleep Medicine (AASM) in its 2016 report to States
(GHSA, 2016). The focus is on the development of evidence-based messages on the risk of
driver drowsiness, implementation or enhancement of employer-provided policies and education,
and the development of web-accessible awareness material for the general population. Examples
include the NSC’s Defensive Driving Course (www.nsc.org/safety-training/defensive-driving),
the North American Fatigue Management Program’s free training program for commercial driver
and employers (www.nafmp.com/index.php?lang=en), and the AASM online guide for children
and young adults on the benefits of good sleep habits (https://aasm.org/). The report also notes
the potential for SHSOs to partner with community or victim advocates and organizations (e.g.,
SADD) to develop and publicize information targeted at young or novice drivers and parents
(GHSA, 2016).
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Appendix 10. Drowsy Driving
GHSA’s Wake Up Call! identifies three groups that are over-involved in drowsy driving crashes:
drivers in their teens and 20s; shift and night workers (police and emergency medical services,
health care workers, commercial motor vehicle operators); and people suffering from sleep apnea
or narcolepsy (GHSA, 2016). The joint NHTSA-NCSDR Report to Congress on drowsy driving
recommended that communications and outreach on drowsy driving be directed to shift workers,
people with sleep disorders, and especially to young drivers (NHTSA, 1999). This information
can be delivered in several ways. The new model curriculum developed by NHTSA and the
American Driver and Traffic Safety Education Association includes information on drowsy
driving that can be used in driver education programs (www.adtsea.org/ADTSEA%20Curriculum%20Free%20Download.html). NHTSA’s 2015 Drowsy Driver Symposium identified
a short-term goal of improving messaging and developing new material (especially for high-risk
groups) that covers aspects of drowsy driving, including: intensity and risk, prevention measures,
danger signs, and responses to danger signs (www.nhtsa.gov/nhtsa/symposiums/november2015/index.html). See Chapter 10 and Appendix 10, Sections 3.1 and 3.2, for
additional discussion of shift workers and medical conditions, respectively.
The ultimate goal of drowsy driving communications and outreach is to change driver behavior;
however, there are substantial obstacles. As discussed in other chapters, communications and
outreach by themselves rarely change driving behavior (Chapter 1, Section 5.2; Chapter 2,
Sections 3.1 and 3.2; Chapter 3, Section 4.1; see also Stutts et al., 2005, Strategy C1). To have
any chance of success, stand-alone campaigns must be carefully pre-tested, communicate health
information not previously known, be long-term, and have substantial funding (Williams, 2007).
An additional barrier is that, for many drivers, drowsy driving is a byproduct of busy lifestyles
that do not include enough sleep. The only truly effective method to prevent drowsy driving
crashes in these cases is to get enough sleep (Nguen et al., 1998; NHTSA, 2001). Traffic safety
messages urging enough sleep may be 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, supported 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, as discussed in Chapter 6. The Governors Highway Safety Association’s report on
drowsy driving for States identifies online resources developed by organizations such as AAA,
National Sleep Foundation, and the American Academy of Sleep Medicine for providing
information and training on drowsy driving (GHSA, 2016).
In Greece a national communication campaign was implemented in 2008 and 2009 to curb
drowsy driving. Entitled “Sleep, but not at the wheel,” the campaign was designed to raise
awareness of the risks of driving while tired, and to increase knowledge of effective
countermeasures to reduce fatigue (e.g., taking short breaks while driving). The campaign
included thousands of TV and radio messages, as well as posters and leaflets distributed across
the country (Adamos et al., 2013).
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Appendix 10. Drowsy Driving
Use: States including Iowa, Texas, New York, and Utah have conducted drowsy driving
campaigns for the general public (GHSA, 2016). In addition, Alabama, California, Florida, and
Texas have instituted a drowsy driving awareness day/week (NCSL, 2018).
Effectiveness: The Greek communication campaign increased awareness for the causes and
effects of fatigue on drivers, and there was a small self-reported increase in the percentage of
drivers who reported stopping and resting when they got tired (Adamos et al., 2013). The effect
of the program on drowsy driver crashes is unknown. Beyond this, there are no other studies of
any campaign’s effects on driver knowledge, attitudes, or behavior.
Costs: A high-quality campaign will be expensive to develop, test, and implement.
Time to implement: A high-quality campaign will require at least 6 months to plan, produce,
and distribute.
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Appendix 10. Drowsy Driving
3. Other Countermeasures
3.1 Employer Programs
Effectiveness: ✩✩
Cost: $
Use: Unknown
Time: Short
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
Drowsy driving is closely related to a person’s employment. In 2008 the National Sleep
Foundation conducted a survey of 1,000 U.S. residents who were employed full time. Those who
work 50 or more hours per week were three times as likely to report driving drowsy on a weekly
basis compared to those who work 30 to 40 hours per week (Swanson et al., 2012).
Shift workers are one employment group at high risk for drowsy-driving crashes. Shift workers
include people who work long or irregular hours or who work at night, including many LEOs
(Stutts et al., 2005, Strategy D6). Another at-risk group for drowsy driving crashes is 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%. In
one driving simulator study, anesthesiology residents were found to have significant increases in
reaction times, attention lapses, impairments in speed and lane position maintenance, and
increased risk of collisions after six consecutive night shifts (Huffmyer et al., 2016).
Other shift workers such are commercial drivers and drivers in emergency medical services
(EMS) are also vulnerable to drowsiness-related driving impairments. One study of 96 truck
drivers found that safety critical driving events were associated with a sleep pattern of shorter
sleep duration, less sleep between 1 a.m. to 5 a.m., and sleep in the early stages of the non-work
period preceding the work-related driving (Chen et al., 2016).
The effect of scheduled naps on alleviating fatigue in EMS personnel was studied in a review and
meta-analysis of 13 articles (Martin-Gill, Barger, et al., 2018). Though direct measures of driving
were not included, general measures of acute fatigue and performance on the psychomotor
vigilance test were studied. Nap durations in 12 articles varied from 15 minutes to 2 hours; one
study did not include duration. Among fatigue related outcomes, naps had a moderate significant
effect on both end-of-shift sleepiness and difference between start- and end-of-shift sleepiness.
Effects on reaction times were not statistically significant (Martin-Gill, Barger, et al., 2018). This
study of napping as a countermeasure was part of a larger Fatigue in EMS Project by NHTSA
that was aimed at providing evidence-based guidelines to manage fatigue in EMS personnel.
Other recommendations by a NHTSA expert panel in this project include the use of sleepiness
survey instruments to measure and monitor fatigue, access to caffeine as a countermeasure
(although they cautioned against excessive caffeine consumption), and education and training of
EMS personnel to prevent and mitigate fatigue-related risks (Patterson, Higgins, et al., 2018;
Martin-Gill, Higgins, et al., 2018). The authors performed a systematic review of existing survey
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Appendix 10. Drowsy Driving
instruments for measuring fatigue and concluded that currently there exists limited evidence of
instrument reliability and validity (Patterson, Weaver, et al., 2018).
There are many ways States can work with employers to address drowsy driving. In general,
work culture, adherence to hours of service rules, and employer-provided interventions and
education can help address drowsy driving. The National Sleep Foundation provides material for
publicizing the Drowsy Driving Prevention Week and information on managing shift work
schedules (www.sleepfoundation.org/shift-work/content/tips-help-manage-your-shift-workschedule). NHTSA and the National Center on Sleep Disorders Research 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 that includes a video,
posters, brochures for workers and their families, tip cards, a PowerPoint training session, and an
administrator’s guide are available at https://icsw.nhtsa.gov/people/injury/drowsy_driving1/human/drows_driving/. Employer programs can also include medical condition
testing/education. See Section 3.2 for more information about medical conditions, medications,
and drowsy driving.
Use: How many employers use the NHTSA/NCSDR 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 (Stutts et al.,
2005, Strategy D3). 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.
Time to implement: An employer program can be implemented within 3 months.
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Appendix 10. Drowsy Driving
3.2 Education Regarding Medical Conditions and Medications
Effectiveness: ✩
Cost: Variable
Use: Unknown
Time: Medium
Overall Effectiveness Concerns: This countermeasure has not been systematically examined.
There are insufficient evaluation data available to conclude that the countermeasure is effective.
Chronic medical conditions and sleep disorders compromise sleep and elevate feelings of fatigue
(Smolensky et al., 2011). Three disorders, in particular, can cause drivers to fall asleep at the
wheel:
• Insomnia is the subjective experience of having difficulty falling asleep or staying asleep.
It affects an estimated 11% of the U.S. population (NSF, 2008). People suffering from
insomnia often report daytime sleepiness that interferes with their daily activities.
• Sleep apnea is a breathing disorder characterized by brief interruptions of breathing
during sleep, perhaps as many as 20 to 60 per hour (NSF, 2009a). By fragmenting
nighttime sleep, sleep apnea produces daytime sleepiness. NSF estimates that about 4%
of men and 2% 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, 2009b). It is quite rare,
affecting about one person in 2,000. It can be treated with medications.
Several studies suggest that people suffering from insomnia are 2 to 3 times more likely to be
involved in motor vehicle crashes compared to those without insomnia (Smolensky et al., 2011).
Similarly, research also shows that people with sleep apnea are up to 6 times more likely to be
involved in crashes (Teran-Santos et al., 1999). It has been estimated that crashes among people
with sleep apnea cost approximately 16 billion dollars each year (Sassani et al., 2004). The
number of crashes resulting from narcolepsy is not known.
Most cases of sleep apnea or narcolepsy are undiagnosed and untreated (Stutts et al., 2005,
Strategy D6; NHTSA, 1998). 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,
1998). Once treated, people with sleep apnea have crash rates that are no higher than the general
population (George, 2001).
There are many other medical conditions that can potentially compromise sleep or increase
daytime feelings of fatigue such as asthma, chronic obstructive pulmonary disease, and
rheumatoid or osteoarthritis. For a review of medical disorders and conditions that may affect
sleep and driving risk, see Smolensky et al. (2011).
Many common prescription and over-the-counter medications can also cause drowsiness. One
study of the sedative zolpidem 11 by drivers 70 and older in Alabama found increased at-fault
crash rates in women and drivers 80 or older when compared with non-users (using adjusted rate
ratios). Similar patterns were also observed for adjusted 5-year crash rate ratios (Booth et al.,
11
Brand name Ambien, among others.
A10-10
Appendix 10. Drowsy Driving
2016). Warning labels on the medications note this and caution users against driving or other
activities that could be affected by drowsiness. For more information about how medications can
impair drivers, see Chapter 1, Section 7.3.
The principal countermeasures to address sleep apnea, narcolepsy, and medication effects are
(Stutts et al., 2005, Strategy D6):
• Communications and outreach on sleep disorders to increase overall awareness of
their symptoms, consequences, and treatment.
• Efforts with driver licensing medical advisory boards to increase their awareness of
these conditions as they review driver fitness for licensing.
• 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.
Additionally, it is important that pharmacies and drug makers include patient education about the
potentially impairing effects of certain medications on driving (Smith et al., 2018; see also
Chapter 1, Section 7.3). Prescription labeling by drug makers as well as incorporation of
electronic prompts when dispensing medication can be other promising opportunities for patient
education (Smith et al., 2018). One survey study found that while pharmacists generally provide
warnings on sedatives and narcotics to many patients (about 85% of 7,405 people surveyed),
fewer people receive warnings on antidepressants (62.6%) and stimulants (57.7%) (Pollini et al.,
2017).
Use and Effectiveness: There is no known information available on how frequently these
countermeasures are used or on how effective they have been in raising awareness, increasing
knowledge, or affecting behavior. NHTSA recently developed an OTC/prescription driving
prevention initiative that is available at www.trafficsafetymarketing.gov/get-materials/drugimpaired-driving/otc-rx.
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. Communications and outreach campaigns directed at all drivers are
expensive to develop, test, and implement. See Chapter 1, Section 5.2 and Chapter 2, Sections
2.1 and 3.1, for additional discussion.
Time to implement: Either targeted or general communications and outreach will require at
least 6 months to plan, produce, and distribute. Efforts with driver licensing medical advisory
boards could be implemented quickly.
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Appendix 10. Drowsy Driving
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Appendix 10. Drowsy Driving
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Violanti, J. M. Lang, E. S., & Martin-Gill, C. (2018, January 11). Evidence-based
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Emergency Care, 22(sup1), 89-101. https://rosap.ntl.bts.gov/view/dot/35483
Patterson, P. D., Weaver, M. D., Fabio, A., Teasley, E. M., Renn, M. L., Curtis, B. R., Matthews,
M. E., Kroemer, A. J., Xun, X., Bizhanova, Z., Weiss, P. M., Sequeira, D. J., Coppler, P.
J., Lang, E. S., & Higgins, J. S. Weiss, P. M. (2018). Reliability and validity of survey
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Appendix 10. Drowsy Driving
Pollini, R. A., Waehrer, G., & Kelley-Baker, T. (2017). Receipt of warnings regarding
potentially impairing prescription medications and associated risk perceptions in a
national sample of US drivers. Journal of Studies on Alcohol and Drugs, 78(6), 805-813.
Royal, D. (2003, April). National survey of distracted and drowsy driving attitudes and
behavior: 2002 volume I: Findings (Report No. DOT HS 809 566). National Highway
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Sassani, A., Findley, L. J., Kryger, M., Goldlust, E., George, C., & Davidson, T. M. (2004).
Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep
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A10-14
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15100-080521-v5
| File Type | application/pdf |
| File Title | Countermeasures That Work: A Highway Safety Countermeasure Guide for State Highway Safety Offices, 10th Edition, 2020 |
| Subject | alcohol-impaired driving, drug-impaired driving, seat belts, child restraints, speeding, distracted driving, drowsy driving, mot |
| Author | Vindhya Venkatraman, Christian M. Richard, Kelly Magee, Battelle |
| File Modified | 2021-09-08 |
| File Created | 2021-08-05 |