Challenging Dogma


...Using social sciences to improve the practice of public health

Saturday, April 21, 2007

A Critique of the Click-It or Ticket Campaign based on Social Science Theory - Alina Schmidt

Low use of safety belts is associated with increased fatality and increased seriousness of injuries for automotive accidents. In Massachusetts in 2005, a major factor in the 441 fatalities and 5,000 serious injuries was the low use of seatbelts. (1) Although the Click-it or Ticket campaign had been ongoing for the three years prior, there were still many incidences of occupants not wearing seatbelts. In fact, a 2002 Safety Belt Survey found Massachusetts’s seatbelt usage rate only 51%, which was also the lowest rate in any state with a seatbelt law. For the following year, the state aimed to increase the seatbelt rate to 60% by implementing the “Click-it or Ticket” campaign. (2) As of 2006, the current rate of seatbelt usage is 67%, which is still well below the national average of 80% and the Healthy People 2010 goal of 92%. (1) The Massachusetts campaign fails to incorporate the social sciences in its design, and thereby does not address the factors that contribute to individuals’ behavior choices and their ability to change. The campaign relies on three flawed theories and focuses on fear and negative reinforcement. In order to increase the rate of seat belt usage, the campaign must address the societal factors influencing individuals.

Massachusetts law requires all vehicle occupants to be properly restrained and the Massachusetts Governor’s Highway Safety Bureau implemented a campaign that focuses on the negative consequences that may occur if individuals do not comply with the law. The Massachusetts campaign uses an approach similar to the national Click-it or Ticket campaign. The state campaign consists of increasing patrols for officers to enforce the law, media advertisements to inform residents of the program and local community education events to raise awareness. The campaign is widely known, as it is prevalent on road signs, television, and radio promotions.

While there has been a general increase in seatbelt usage, there is evidence that this may not be entirely attributable to the public health campaign. For instance, the campaign initiation began in a few pilot communities and a study assessed seatbelt usage in both pilot and control communities prior to and after the campaign intervention. The study found an increase in seatbelt usage in all of the communities studied, regardless of intervention. (2) This finding suggests that the success may not be attributable to the campaign itself, and instead may reflect a change in societal values or other influences.

Furthermore, most campaigns do not address the changes necessary for long-term behavior modification. An educational intervention done with trauma center employees found an initial improvement in seat belt usage; however, the levels receded to pre-intervention rates just one month after the intervention. (3)

The Theory of Reinforcement

The theories underlying this campaign may explain the failures. The major theory this campaign relies on is the theory of reinforcement. This theory asserts that consequences will change a behavior; specifically, that rewards will increase a behavior, punishments will decrease a behavior and something that gives neither rewards nor punishments stifles the behavior. (4)

For example, to increase a positive behavior, there is a reward for the individual when they complete the desired action. The Click-it or Ticket campaign focuses on the punishment aspect of the theory, which assumes that the negative incentive of a $25 ticket will deter people from this behavior, and lead them to wearing their seatbelts. However, this is an ineffective use of the theory for multiple reasons. Firstly, the fine is not burdensome so it may affect individuals’ behavior choices. Secondly, there is no way to enforce the law if the individuals not wearing seatbelts remain elusive to the police. Therefore, individuals will think about the chance of police apprehension, which is quite slim when most police officers have much more important matters to attend to and only have the power to stop individuals if they incur an additional infraction. Lastly, only some individuals will make their behavior choice based on the fear of punishment, so a campaign based on this theory will not reach the entire population.

Reinforcement theory is a “functional theory” which means that the rewards and punishments are defined by how they work, and not how they look. For example, there is not a set group of appropriate rewards; a reward (or punishment) is only appropriate if it is successful. (4) Therefore, there is no single appropriate award or punishment, as both differ with circumstance and the intended target. In the case of Click it or Ticket campaign, the punishment of a $25 fine is only appropriate if it deters people from doing the harmful behavior. Based on the previously mentioned research, it is clear that the current punishment is not effective. (4)

A limitation of reinforcement theory is that people learn that the consequences occur only in certain situations. (4) In regards to the Click-It or Ticket campaign, people learn that the punishment, the fine, only occurs when there is a police officer in nearby distance, and when they have committed another driving infraction. Because Massachusetts has a secondary offense law, drivers (and passengers) know that police can only ticket them for seatbelt non-compliance if they are doing an additional illegal behavior.

Another restriction in the reinforcement theory is that punishment is difficult to design where it will be effective for a large population. In the case of seatbelts, while there is a punishment, (the ticket) it is not effective because it is not immediate, intense, unavoidable or consistent. (4) When individuals receive a ticket they have thirty days to pay it and a $25 ticket is a moderate consequence, as many people would barely notice the lost income. The ticket is avoidable, since police only give it to those individuals they catch; therefore, it is also not consistent since the punishment only occurs if there is a police officer that notices both illegal behaviors.

In addition, teens are less likely to be affected because of their beliefs of invincibility. (8) This belief may stem from their confidence in their driving aptitude and their certainty that they will not get in an accident. However, teens can also feel invincible to the law and that they are unlikely to be caught when they are not wearing their seatbelts. A five-year analysis of teen driver car fatalities found that seatbelt use was associated with states that had a primary seat belt law. (5) Massachusetts only has a secondary law, and thus teens are less likely to listen to the message and change their behavior. Teens feel they are unlikely to commit a primary offense; therefore, there will be no punishment for not wearing their seatbelt.

Agenda Setting Theory

Another theory the campaign uses is agenda setting, with the goal of increasing the general knowledge about the topic. (9) For this campaign, the Governor’s Highway Safety Bureau assumes that most people will be compelled to wear their seatbelts after they see the advertisements, because they will remember it is the right thing to do. Furthermore, the theory also presumes that if individuals talk about seatbelt usage, their likelihood of complying will increase. This theory does not account for the barriers and reasons individuals do not change their behavior. Some of the reasons for lack of compliance include lack of knowledge, habit, feelings of invincibility, peer pressure and personal choice.

Barriers to changing behavior

Many individuals remain unaware of the benefits of seatbelts. An observational study of child seat belt use found that parents feel children riding in the back seat are less likely to be injured because seat belt usage was only 14% compared to 40% of children riding in the front seat. (12) For other people, the decision not to wear a seatbelt was passive, because they simply forgot; possibly indicating that it was a habit not to wear it. (13)

While invincibility is often associated with teens, it is also applicable to adults. Many people surveyed by the NHTSA reported occasional use of seatbelt for reasons such as they were traveling a short distance, they were driving in light traffic and there is a small chance of getting in an accident. (13)

Adolescents are at greatest risk for not wearing a seatbelt because they are influenced strongly by peer pressure in numerous aspects of living, including seatbelt usage. One study found that as the number of teenage passengers increased, the seat belt use decreased. (5)

Many drivers report wearing their seatbelt infrequently because the belts are uncomfortable. (13) In the case of seatbelts, most individuals recognize the importance of wearing them; however, this understanding does not necessarily result in usage. The use of seatbelts is a distinct habit and people will not change their behavior after simply talking about it.

Social Cognitive Theory

A third model that this campaign utilizes is social cognitive theory, which relies on self-efficacy resulting in a behavior change. (10) Self-efficacy is the belief in oneself that a specific action is possible or a goal is attainable. (11) A campaign should lead to self-efficacy in order to enact a behavior change because people will not attempt a behavior change if they believe it is unattainable. Another aspect of self-efficacy is that the campaign must also show action efficacy, meaning that the action will actually result in the behavior. (6) In the case of seatbelt usage, the campaign does not explicitly have to show that seatbelt usage reduces mortality, as that is general knowledge. However, they must show self-efficacy, and they do this by telling people exactly what they need to do in order to prevent getting a ticket. In the case of this theory, some individuals may feel that it is unreasonable for them to wear a seatbelt every time they are in a car, so they may not even bother to change.

Social Sciences Theory

Instead of using these models, the campaign should use the social sciences and not preach to the public. They should also mention the benefits of wearing seatbelts, and not simply focus on the harm that will result (the ticket). Another use of the social sciences would be to show how the behavior of not wearing seatbelts could be modified so that individuals remember to wear it. Ultimately, the campaign should consider the main reasons why people do not wear their seatbelt and try to address those, instead of using a scare tactic.

The models on which this campaign is based fail to account for some important influences that contribute to individuals’ decisions to wear a seatbelt. Personal changes, or changes in habit are often difficult to incur, and these models fail to consider this as an influencing factor for seatbelt use. The majority of people acknowledge the importance of seatbelt usage; however, they fail to use it out of habit.

Another factor that is not accounted for in the previous models is the influence of modeling. Specifically, people often mimic behavior that they know, and modeling results when people follow behavior they see. In the case of seatbelt usage, children often follow their parents’ examples, and then continue these behaviors into adulthood.

The environment also influences behavior, although, none of the theories account for this factor. For seatbelt usage, some cars have loud noises that play until the seatbelt is used and these devices cannot be disarmed. This may actually be a more effective way to get people to wear seatbelts because they will do it to stop the annoyance. An analysis of injured car drivers found a higher percentage of seat belt use among those with light and sound reminders in their car.(7)

Most people who do not wear seatbelts are not actively choosing not to, but instead it is a passive behavior. Therefore, by changing the process and provide an obstacle to not doing the behavior, this may increase the compliance of seatbelts. Another environmental factor is peer pressure, and this could influence peoples' decisions to wear a seatbelt, especially in the case of adolescents. While peer pressure is often unspoken for seatbelts, it is still present and may influence some individuals and their decision-making process.

A social science model also includes self-efficacy as a major contributing factor of one’s behavior choice. If individuals do not see the message as being attainable, they will be less inclined to attempt. With seatbelt usage, people may think it is an unrealistic goal that they will wear them every time they are in an automobile and therefore they many give up and not bother trying to meet the goal of one-hundred percent compliance.

After five years of implementation, the Click-it or Ticket campaign has failed to increase the rates of seatbelt usage dramatically. Because the campaign fails to utilize the social sciences in the design and implementation, there is little hope of improvement. Instead, the campaign must incorporate the numerous influences affecting individuals’ behaviors and create a message that people see as attainable and will adhere to. The only hope of reaching the Healthy People 2010 goal is to renovate the current campaign.

References

1. The Official Website of the Executive Office of Public Safety (EOPS). Click It or Ticket Campaign. MA: Department of Public Safety. http://www.mass.gov
2. National Highway Traffic Safety Administration. MASSACHUSETTSClick It or Ticket Campaign Enhancement and Evaluation. Washington, DC. National Highway Traffic Safety Administration. http://www.nhtsa.dot.gov
3. Scheltema K, Brost S, Skager G, Roberts D. Seat-belt use by trauma center employees before and after a safety campaign. American Journal of Health Behavior 2002; 26:278-83.
4. Reinforcement Theory. http://www.as.wvu.edu/~sbb/comm221/chapters/rf.htm
5. McCartt A, Northrup V. Factors related to seat belt use among fatally injured teenage drivers. Journal of Safety Research 2004; 35:29-38.
6. Morgan S. How to Develop Effective Mass Communication Messages. Kentucky: Communications Department, University of Kentucky, 2000.
7. Bylund P, Bornstig U. Use of seat belts in cars with different seat belt reminder systems. A study of injured car drivers. Annual Proceedings/Association for the Advancement of Automotive Medicine 2001; 45:1-9.
8. Advocates for Youth. Growth and Development. Washington, DC. Advocates for Youth. http://www.advocatesforyouth.org/parents/18_over.htm
9. McCombs M, Shaw D. The Agenda-Setting Function of Mass Media. The Public Opinion Quarterly 1972; 36:176-187.
10. Bandura A. Social cognitive theory: An agentic perspective. Annual Review of Psychology 2001; 52:1-26.
11.Ormrod, J. E. (2006). Educational Psychology: Developing Learners (5th ed.), "glossary". N.J., Merrill: Upper Saddle River
12. Edgerton E, Duan N, Seidel J, Asch S. Predictors of seat-belt use among school-aged children in two low-income Hispanic communities. American Journal of Preventive Medicine 2002; 22:113-116.
13. National Highway Traffic Safety Administration. Motor Vehicle Occupant Safety Survey: Volume 2 Seat Belt Report. Washington, DC. 2000. National Highway Traffic Safety Administration. http:// www.nhtsa.dot.gov.

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