BEHAVIORAL STRATEGIES FOR REDUCING TRAFFIC CRASHES
The World Health Organization predicts that by 2020 road trauma will be the world's third leading cause of death and disability, after heart disease and mental depression. These facts make motor-vehicle-injury prevention one of the most formidable public health challenges of the future. Motor-vehicle crashes are the leading cause of injury-related deaths in the United States, and the leading cause of death from all causes for Americans aged one to thirty-four. In 1997, nearly 42,000 people died on the nation's roads and highways, and another 3.5 million suffered nonfatal injuries. Road trauma results in about 500,000 hospitalizations and 4 million emergency department visits annually. These deaths and injuries cost the United States more than $150 billion annually, including $52.1 billion in property damage, $42.4 billion in lost productivity, and $17 billion in medical expenses.
The reduction in motor-vehicle-related deaths attributable to crashes in the United States also represents one of the great public health achievements of the twentieth century. Despite the tenfold increase in motor-vehicle travel between 1925 and 2000, the annual death rate declined during this period from 18 per 100 million vehicle-miles traveled in 1925 to 1.7 in 1997—a 90 percent decrease. A significant decline in traffic deaths per 100,000 population also occurred during this period. These reductions have come about by reciprocal changes in the design of vehicles, changes in the behavior of road users, and structural changes that make roads and environments safer.
BEHAVIORAL APPROACHES
While structural approaches to preventing road trauma, such as changes to the vehicle and the road, have led to many positive safety advantages, driver behavior still remains a key impediment to further progress. Unlike most diseases that have been prevented with vaccines, most traffic injuries cannot be controlled quickly by introducing a vaccine-like technology, as the technology must be proven safe, adopted by people, and used properly in order to be effective. Behavior-based strategies have succeeded in reducing both injury-risk behaviors and injury outcomes. The most successful strategies have been planned and implemented with a theoretical framework such as behavior modification or applied behavior analysis.
APPLIED BEHAVIOR ANALYSIS
Perhaps the most widespread use of behavioral technologies to modify road-use behaviors has been applied behavior analysis. This framework uses contingency management through various forms of rewards and incentives, behavioral shaping, and modifying environmental cues and conditions to affect driver, occupant, and pedestrian behaviors. At the societal level, laws and enforcement strategies that discourage or punish risky behaviors are a form of contingency management.
For example, in studying drinking and driving behavior, behaviorists are interested in identifying antecedents (A) to the behavior, such as legal requirements, cues in the environment, and "happy hour" inducements; studying the behavior itself(B), such as frequency and speed of drinking, and the drinking and driving environment; and consequences (C) that follow the behavior, such as social attention, or punishment in the form of DWI (driving while intoxicated) arrests. Understanding the ABCs of a behavior chain can help the behaviorist shape the individual and the environment to yield change. Reminders, prompts, incentives, and cues in the environment can be used to modify antecedents. Behavioral modeling, demonstration, and skill building can be used to modify the risk behavior. Social support, feedback, reinforcement, and punishment (or perception of punishment) can be used to modify the consequences of the behavior. Application of these strategies, and others that rely on legislative and enforcement strategies to change behaviors, has been found effective. Behavioral road safety intervention research has been used to modify safety belt use, drinking and driving, use of child restraints, speeding, and other risky road safety practices.
THEORETICAL AND INTEGRATED APPROACHES
Application of a theoretical approach to changing traffic-related behavior holds the greatest promise for future success. Using the theory of planned behavior, the theory of reasoned action, social learning theory, subjective norm development, protection motivation, the health belief model, stages of change, and risk perception approaches, researchers have sought to apply models of behavior change to modify individual behaviors and social norms that enhance traffic safety. While early motor-vehicle safety resulted from vehicle and highway engineering, future success will require an integrated approach, using what we have learned from health promotion, health education, behavioral and social science, and law together with structural approaches like engineering and environmental science to produce long-term positive outcomes. This approach can also prove effective on those who make laws, design roads, and build cars in ways that protect whole populations. The rigorous scientific application of behavioral science principles to injury prevention is an important strategy that is necessary to further reduce traffic crashes and motor-vehicle injuries.
Centers for Disease Control and Prevention (1999). "Motor Vehicle Safety: A Twentieth Century Public Health Achievement." Morbidity and Mortality Weekly Report 48:369–374.
—— (2001). "Motor-Vehicle Occupant Injury: Strategies for Increasing Use of Child Safety Seats, Increasing Use of Safety Belts, and Reducing Alcohol-Impaired Driving." Morbidity and Mortality Weekly Report. 50 (May 18):1–13.
Evans, L. (1991). Traffic Safety and the Driver. New York: Van Nostrand Reinhold.
Geller, E. S., ed. (1991). "Road Safety: International Perspectives." Journal of Applied Behavior Analysis 24:1–94.
Geller, E. S.; Elder, J. P.; Hovell, M. F.; and Sleet, D. A. (1991). "Behavior Change Approaches to Deterring Alcohol-Impaired Driving." In Advances in Health Education and Promotion, Vol. 3, eds. W. Ward and F. M. Lewis. London: Jessica Kingsley.
Gielen, A. C., and Girasek, D. C. (2001). "Integrating Perspectives on the Prevention of Unintentional Injuries." In Integrating Behavioral and Social Sciences with Public Health, eds. N. Schneiderman et al. Washington, DC: American Psychological Association.
Krause, T. R.; Hidley, J. H.; and Hodson, S. J. (1990). The Behavior-Based Safety Process. New York: Van Nostrand Reinhold.
Lonero, L. P.; Clinton, K.; Wilde, G. J. S.; Roach, K.; McKnight, A. J.; MacLean, H.; Guastello, S. J.; and Lamble, R. W. The Roles of Legislation, Education and Reinforcement in Changing Road User Behavior. Ontario, Canada: Safety Research Office, Safety Policy Branch.
Roberts, M. C.; Fanurik, D.; and Layfield, D. A. (1987). "Behavioral Approaches to Prevention of Childhood Injuries." Journal of Social Issues. 43(2):105–118.
Rothengatter, T., and Vaya, E. C. (1997). Traffic and Transport Psychology: Theory and Application. New York: Pergamon.
Sleet, D. A.; Hollenbach, K.; and Hovell, M. (1986). "Applying Behavioral Principles to Motor Vehicle Occupant Protection." Education and Treatment of Children 9(4):320–333.
Von Holst, H; Nyugren, A.; and Andersson, A. E., eds. (1998). Transportation, Traffic Safety and Health: Prevention and Health. Stockholm: Karolinska Institute.
