1. Introduction
   1. In Ontario, 1000 people are killed and 90,000+ are injured in traffic crashes
   2. Public and private efforts have stabilized or decreased crash rates but the dead and injured rates still fluctuate
   3. Ontario Road Safety Plan is a new strategy aimed at changing the behaviors of drivers to help make roads safer (reduce accidents, deaths, injuries)
      1. Identifying What Behaviors to Change
         1. There are many influences that generate a specific behavior but not enough empirical information to determine what those influences are
         2. In order to initiate change in behavior various things need to be addressed concurrently
         3. The purpose of the behavior change model is
            1. Prevent potentially bad drivers from developing behaviors that are more likely to cause collisions
            2. Prevent errors of normal road user
2. Behavior Change Models
   1. There are many behavior models (theories) that can give a possible explanation of how to determine behavior
      1. Cognitive Models: the beliefs, attitutdes, emotions, intentions, and expectations that drives a person's actions
      2. Behavioral Models: focus on environmental events and consequences that influence an action
      3. Risk, Utility, Decision and Game models (between Cognitive and Behavioral theories): focus on observable behavior and external influences that drives a person to make "that decision"
   2. Applying Theory to Road Safety
      1. Can not really compare the effectiveness of road safety programs based on behavior because it has not really been done
      2. Consideration of models when designing programs is a good theory to incorporate
3. Changing Road User Behavior
   1. Past efforts have focused on four areas
      1. Legislation
         1. Effects
            1. Declarative effect: the setting of socially accepted norms
            2. Deterrent effect: "punishing" violators
         2. In order for either effect to be a viable method it needs to have other influences
            1. Declarative depends on education and communication
            2. Deterrent depends on enforcement
         3. Legislation by itself has limited influence and needs support over the long term for the effects to aid in behavior change
            1. Effective enforcement aids in getting people to comply with the law if the "negative" consequence is unwanted
            2. "Positive" Reinforcements such as prompts, incentives, or feedback increases the desire to continue the good habit
            3. Education helps with increased knowledge and skills that influence attitude that guides actions
         4. Examples
            1. Seat belt legislation
               1. 1976 Ontario legislation aided in increased seatbelt use from 17% to 77% with enforcement
               2. Between this time and the early 1900s the seat belt usage has flucutated based on legislation
               3. 1994 usage went up to 91%
               4. Overall effect of legislation may not be as clear upon the public
            2. Child restraint legislation
               1. Effects vary across states
               2. The correct use of restraints is still a problem
               3. There needs to be more coordinated support and attention towards maintaining a high rate use rather than focusing on "paternalistic legislation"
            3. Motorcycle helmet legislation
               1. When laws were inforced it helped to reduce 28% to 73% of serious and fatal injuries
               2. In many states the law was repealed due to complaints that it limited sight and hearing while on the road
               3. Helmet repeal laws estimated a "$250 million in direct and indirect costs resulting from death and disability"
            4. Speed limit changes
               1. 1987, legislative changed the law to allow states to raise their speed limits
               2. Streff and Schultz (1990) study found that speed limit changes in Michigan increased the severity of a crash but did not incrase the occurances of accidents
               3. Other studies about other states found similar results
               4. States that did not increase their speed limits experienced a 5% increase in fatalities
                  1. It is hypothesized this is due to the change of attitudes about speeding at the time that some states raised their speed limits and others did not
            5. DWI legislation
               1. Moskowitz (1989) showed DWI legislation with an enforcement program has at least a short term effect
                  1. Possbilities for short term effect
                     1. Low probability of apprehension
                        1. A study showed that 1/200 is arrested under the influence
               2. New South Wales (Australia) created legislation that remained effective over a number of years
                  1. Random breath testing and massive publicity
               3. Another legislative act that aided for decline is when the drinking age was increased
               4. There's evidence that the loss of one's license is more of a deterrent effect than jail time
         5. Overall effectiveness depends on how its implemented and managed as the examples shown above
      2. Enforcement
         1. Uphold's society's expectations and standards (norms)
         2. Discourages people from repeating behavior through learned consequences
         3. Rothengatter (1982) identified three kinds of effects
            1. On-view effects: short term effect on behavior based on what is seen in front of the person (ex. visual of a police car and perceived consequences)
            2. Memory effect: behavior is based on the knowledge that it is always there or is not based on repeated sitings (ex. driving the same route each day you see an officer at "that spot" during this hour)
            3. General "halo" effect: behavior is determined with the knowledge that enforcement is in many areas
         4. Models
            1. The theory of games
               1. Behavior changes with the presence of enforcement
                  1. Ex., when a cop is sited everyone slows down
               2. Bjornskau and Elvik (1992) found that a drivers' perceptions and chance of taking risks is based on the level of enforcement and how it is enforced by authorities (ex. frequency, etc.)
               3. Enforcement should not be reduced once a desired level is obtained because 'when the cat is away the mouse will play'
            2. The STEP model
               1. Selective Traffic Enforcement Program developed in Canada
               2. Temporary program that can be repeated periodically
               3. Program recognizes value of "specific targets, planning, community support, training for enforcement officers and evaluations"
               4. Has helped Canada obtain a 95% seatbelt usage by 1995
         5. Effects of different types of enfrocement
            1. Presence of officers on the road affects speed and speed variance but is a short-term effect
            2. Hauer et al (1982) study showed that Metropolitan Toronto's visible road enforcement affected speeds but it was more of a "halo effect"
            3. Feedback signs with increased enforcement seems be effective
               1. Dartmouth, Nova Scotia found feedback signs (% of drivers not speeding records announced publically, etc.) helped to decrease people driving 10km over the limit
               2. Other studies found with increased police presence that stopped anyone for the following reasons worked well in curtailing speed
                  1. A person is stopped for speeding, given a warning ticket, and informational matieral
                  2. A person is stopped for driving close to the speed limit, thanked by the officer, and given a token reward
                  3. Helped to recuded speeders over 10kph over the limit by 48% and speeders over 20kph over the limit by 64%
            4. Overall, depending on how a program is structured and enforced (frequency, etc.) the program may be effective for just the short-term or could work long-term
         6. Targeting specific behaviors
            1. Seat belt enforcement
               1. focuses on resistant drivers
               2. can be enforced with publicity and other measures
            2. DWI enforcement
               1. focuses on compliance of drivers
               2. can be enforced with check points, publicity, and preventive behavior measures
      3. Reinforcement
         1. Includes incentives, rewards, prompts, feedbacks
         2. Focus is on encouraging specific desirable behaviors
         3. Reinforcement through incentives and rewards
            1. California offered an incentive for a clean record through the renewal of a license
               1. Person with a pervious crash record was told that if they keep a clean record the following year they would receive a 12 month extension for free
                  1. Drivers who were informed performed well
                  2. Drivers who were not informed of the new program did not have a very good record the following year
            2. Incentives have been tested with seatbelt use
               1. Had a short-term effect
               2. Also created a habitual use effect
         4. Effects of different reward types
            1. Review of seat belt use shows that no-reward is the best type of program
            2. No reward is a better program since a person internalizes a motive for the actions (affective self) where they choose to do it
            3. Studies have shown that targeting seat belt and restraint with children (and parents) through informational plays, etc. produce a higher effect --extrinsic rewards did not have an additional effect
         5. Commitment, prompts, cues and feedback
            1. Prompt cards posted in a person's car as well as a prompt person helped to increase the use of seat belt use
            2. According to Russ et al (1989) feedback does not aid in all situations (ex. drinking and driving)
      4. Education
         1. Evaluating road safety education
            1. Effectiveness of an education program is based on the explicitness of objectives and should include intermediate measures and measures aimed at reducing collisions
            2. What is taught needs to be in relation to what a "road uswer needs to learn"
            3. Organization of Economic Cooperation and Development (OECD) explains other variables need to be considered for a well rounded program to be effective
               1. content
               2. location of education program
               3. quantity of what is taught
               4. frequency of classes
               5. taking into consideration of cultural differences
         2. School-based programs
            1. Road safety is rare in schools
            2. How it is done
               1. Police officer lectures with visual aids (only increases knowledge, does not necessarily change behavior)
               2. Simulation games work well with young children (does not necessarily teach a child to transfer learning to a traffic environment)
               3. Play and simulation techniques with children seem to have lasting effects
               4. Incorporation of traffic safety into curriculum showed a lasting effect in Australia and New Zealand (part of it may be due to social acceptance of wearing helmets)
               5. Targeting of parents to help enforce what is learned in school with their children
               6. Printed materials are widely used but found ineffective
         3. Public education and information
            1. Wilde (1991) concluded that appropriate facts influence changes in a person's behavior (not the media)
            2. Dussault (1993) offers the APPLE (analysis, safety products, promotion, legislation, enforcement) that stresses participation and involvement betwen the target population and intervention agent
               1. Methods
                  1. visual methods (little impact)
                  2. targeting community organizations and institutions with projects and civic pride as the strategy (seemed useful)
                  3. Focus on risks attached to non-use of seat belts (may have seemed useful due to relation of police charges)
            3. Cost and benefits need to be taken into account
         4. Parent education
            1. Holland and Germany Programs show parents are effective trainers of their children
            2. Dutch study showed that children were better trainers in teaching pedestrian crossing skills to 4-6 year olds
         5. Patient education
            1. Physicians educate in bicycle safety (some physicians do not feel they should be that involved)
            2. Seat belt use tends to be higher amongst better-educated
            3. Programs for higher-risk low-use groups are recommended
         6. Community education programs
            1. Should not need to "pin down" WHO to educate and how
            2. Programs should reach to everyone in the public (ex. Seattle helmet program)
         7. Formal driver education programs
            1. DeKalb Driver Education Project provided three different DE programs (improved curriculum, minimum curriculum, no training) where those who participated in the improved curriculum ended up with more collisions in the long run than the other groups
            2. Suggests DE should not be regarded as a method to teach basic driving skills only and not used as a strategy to reduce collisions (Lund et al, 1986)
            3. Well-designed manuals and tests are useful aids
            4. Different manuals for different age groups are useful
            5. Peer influence is useful
         8. Advanced driver training
            1. Evaluations of advanced driving programs do not show reductions in collisions
            2. Study in Germany showed that a person who engaged in more than one DE class was involved in more collisions (may be due to more confidence than their skill warrants--similar to the DeKalb Driver Education Project)
         9. Motorcycle rider training
            1. Simpson and Mayhew (1990) indicate age and experience is an important factor in determining crash rates
            2. Motivation and not just skill is an important factor in reducing crashes
         10. Anti-DWI education
             1. Has a minor influence amongst teens
             2. May work on first time offenders but weak for serious users
             3. Treatment and deterrance needs to be assecessed in "tandem" and supported by all parts of a person's environment
   2. Implimentation of these areas were found to work best when combined with another area
4. Health promotion: A model for road safety?
   1. There is not enough evidence to concur or disagree
   2. Quebec's health department has been actively involved in road safety and have seen some gains
   3. Research suggests health promotion programs that promote the lengthening of life does not actually do that
      1. If this model is applied to driving a "good driver" needs to be better defined than just having less collisions
      2. One way to do it is to link knowledge with healthy behavior
5. Management of road safety
   1. This report suggests that tools are not utilized to its maximum capability
   2. Studies suggests that strong programs are effective with a combination of "domains" that should address "organizational behavior change"

Tiffany Akiyama © Spring 2007