North Carolina's "Click It or Ticket" campaign and seat belt usage results

Boosting Seat Belt Awareness and Usage in North Carolina: A Public Health Campaign Case Study

The case study by Williams, Wells, and Reinfurt (2002) entitled Increasing Seat Belt Use in North Carolina examines a number of strategies that North Carolina could implement in order to increase the number of drivers who use safety belts when driving. The study identifies Canada as a nation that had a similar problem of low rate of drivers wearing seat belts until the country implemented a three-fold strategy of public education about "the importance of wearing seat belts," tighter law enforcement in terms of fining drivers/passengers for not wearing the seat belt, and increased publicity regarding the intention of law enforcement to begin cracking down on motorists not wearing seat belts (p. 85). This strategy allowed Canada to increase its numbers of drivers who wear seat belts dramatically.

According to the study, North Carolina was in place to be able to employ all three of these actions. It was a "primary" belt use law, meaning that law enforcement could stop a motorist for the sole reason that the motorist was not wearing a seat belt (most other states could only issue citations if the motorist had committed another offense first) (p. 86). Indeed, this is what North Carolina did: for two weeks in 1993, Governor Hunt appeared on TV to state that seat belt wearing was very important, that police would enforce the law now, and throughout the rest of the year, ads appeared in newspapers, on radio and TV educating the populace about the issue. Checkpoints were instituted and the following year more publicity was given to the campaign with nearly 1000 TV spots and nearly 1500 radio spots (Williams, Wells, Reinfurt, 2002, p. 87).

With over half a million dollars spent on the 1993 and 1994 campaigns (on publicity and enforcement), the results of the effectiveness of the campaign were looked forward to. Police reported that the number of citations given during the "Click it or Ticket" campaign increased substantially, and overall seat belt usage increased significantly to upwards of 80% by the summer of 1994 (Williams, Wells, Reinfurt, 2002, p. 89), up from the 60-65%ile range it had been in during the early 1990s (Williams Wells, Reinfurt, 2002, p. 86).

In terms of the impact on the overall safety of motorists, there was a 9% decline in fatalities with nearly 50 fewer than predicted over the same course of time and a 7% decrease in injuries, with nearly 400 fewer than predicted (Williams, Wells, Reinfurt, 2002, p. 92).

A public survey showed that respondents appreciated and favored the "Click It or Ticket" program because they felt it was making the roadways safer and nearly half of the respondents asserted that the campaign helped them to start wearing their seat belts when driving.

Thus, this case study concluded that by implementing the methods utilized by Canada regarding promoting seat belt usage among motorists, North Carolina was able to increase the number of its drivers who wear seat belts and it was able to do so while maintaining public support for the initiative. This was, in effect, a result of the increase in attention given to raising public awareness about the importance of wearing seat belts and the efforts of law enforcement to enforce the law. In order to keep increasing the number of users wearing seat belts, North Carolina should, according to the researchers, implement a strategy to continue awareness and consider alternative forms of punishment (such as instead of higher ticket fines using driver's license points as a way to encourage adherence to the law).

Analysis

The specific criteria used to assess this case will be the co-orientation model and the theories of behavior prediction and the situational theory of publics. The study is also assessed in terms of the effectiveness of its qualitative and quantitative analysis, its methodology, and its limitations.

The case study employed both qualitative and quantitative data gathering and analysis, making it a mixed-methods study and well-rounded in terms of gathering subjective and objective evidence to better understand the impact of the public health campaign centering on seat belt usage in North Carolina. The qualitative methods used were interviews and surveys conducted with the populace in North Carolina, and the responses were gathered and used to provide a sense of what the average person in North Carolina thought of the "Click It or Ticket" campaign. The quantitative methods involved in this case study included using predictive models, surveillance, and measurements of money spent and ads run. Correlation between the campaign efforts and the results was then assessed using simple percentile assessment statistics and comparing estimates with actual numbers. Each method supplied a different aspect of knowledge regarding the effectiveness of the campaign and was thus useful in gauging the overall impact in terms of actual, concrete data and in terms of public opinion and what the average person thought (Baxter, Jack, 2008; Creswell, 2007; Powell, 2006).

The theory of public relations that the study used was based on the co-orientation model: it addressed the various aspects of a public relations campaign coupled with a campaign to improve public health and awareness regarding the safety of wearing seat belts. For this reason, the study examined what it was that the state of North Carolina wished to do -- its goals and objectives relating to the problem of motor safety. It used evidence from a Canadian campaign as a means of implementing a strategy to address the issue.

The issue was then taken to the public and stated in terms of public safety: the public was educate via popular media -- radio, television spots and newspaper ads raising awareness about the importance of using seat belts when driving. The study did not include any discussion of what type of ads were used but did describe the campaign as being part of the "Click It or Ticket" campaign, a popular nationwide effort to increase the number of drivers wearing seatbelts. A depiction of the ads might have added to the qualitative design of the methodology, giving further evidence of the type of ads used and whether certain ads were more effective than others based on survey responses. This could help to guide future campaigns or to regenerate interest in the issue over a period of time by returning to the same quality of ad or theme/approach used by the spot to help draw the audience into the message.

The quantitative statistics were also based on and measured against estimates for the same time period and this does not provide conclusive evidence of change for the better. A better quantitative assessment would be a measurement over a period of months and years following the campaign to decide whether or not the issue has been addressed adequately in the efficacious sense. At the same time, a study about how effective campaigns are in totally generating new social behaviors or initiating behaviors that the state would like to see its citizens adopt could have been discussed in a literature review section. This case study did not provide any such literature review and it might have been helpful in establishing better context for expectations. Overall, the study provided a slim window into the efficaciousness of the public health campaign and only gave a small window in terms of analysis. The study may have benefited from a more qualitative-focused assessment of the actual campaign itself and the ad strategies used to sway the populace towards adopting the measure in conjunction with the crackdown of law enforcement. In order to really gauge how beneficial these parts of the campaign are when applied together, a control study might be implemented in which only one part is utilized and the other not at all. Thus, a campaign in which only public awareness strategy is implemented, while law enforcement is not, or a campaign where law enforcement is utilized by public awareness is not, could provide evidence of why it is important that the parts be implemented as a whole. This could take the form of a qualitative study or even a phenomenological study (Merriam, 2002; Lin, 2013).

The study did acknowledge the public's response in keeping with the co-orientation model and noted that there was agreement between what the state sought to accomplish and what the public thought about it the endeavor. Thus, positive correlation was shown in terms of the state and public being aligned with the same vision and goal. Likewise, the public saw the state's objective as being one that was good and while the public did not wear seat belts overwhelmingly before the campaign, thanks to the public education the importance and value of wearing a seatbelt was brought home to citizens and the law enforcement drive was used as a push to reinforce the concept that this idea of safe driving was important enough that the state was going to fine people who did not conform. The perceived agreement, therefore, between the public and what the public thought the state was attempting was evident and the same held true with the state's perception of what the public was doing. The state accurately perceive that that public needed education and awareness of what the state wanted, what was good for itself, and what the state was prepared to do about. Thus, the state's three-fold approach to the issue of seatbelt safety (education, enforcement, and awareness of the enforcement) worked in terms of increasing seatbelt usage, lowering injuries and deaths and saving medical costs overall.

In short, the state was successful in implementing a persuasive campaign to change the public's attitude and behavior. Where the case study might have been more affective, however, would have been in describing and detailing some of the more popular persuasive ads used -- whether this were digital sign campaigns, radio spots, television ads or newspaper ads. With the rise of digital media, some of these spots may no longer be relevant in terms of changing public perception and behavior, and so a future study along the same lines might include testing the results of social media advertisement and public awareness campaigns using social media in order to produce the desired effect/outcome.

The state also engaged in a campaign to change its image and perception -- the way in which the public perceived the state. Although the case study does not sufficiently explore this topic, it is implied that one of the strategies employed by North Carolina was to alter the way in which the public viewed the state: by promoting public health and safety, the state came across as being concerned about its citizens. That is, at least, what is implied by the campaign. However, because the case study does not discuss the details of the campaign, the messages utilized, or the manner in which these messages were conveyed other than to briefly list the media used, it is difficult to properly assess or analyze just how the state went about changing the public's perception or how the state changed its image.

In order to predict outcomes, the state relied upon Theories of Behavior Prediction, assessing that x number of deaths could be expected during the months of 1993 and 1994 under scrutiny. These predictions were then used to gauge the actual results, and the study showed that the actual results (numbers of deaths, injuries) were lower than expected. However, in order to more accurately gauge the impact of the campaign, the study should continue to monitor fatality and injury levels over the months and years and not rely upon predictive modeling.

In terms of the situational theory of publics, the audience in the case of this campaign showed signs of apathy, latency and a lack of investment. Whether or not the public was really to any large degree aware of the seatbelt law or the importance of it was not assessed within the case study, but judging from the results following the campaign, it may be reasonable to surmise that the public had little awareness of the value of wearing a seatbelt. Thus, from the standpoint of situational theory, the state was able to move the public from a state of apathetic latency to an active state wherein the public to a large degree was participating with law enforcement and the state in terms of promoting seatbelt usage.

The study provided a clear example of how a state might implement a public health campaign, gauge its effectiveness and promote a positive image of itself and work to align the public's views with its own. Even if its methods and focus were limited in terms of scope and size, the study was still effective in highlighting an important aspect of the public health campaign, which is the actual implementation and strategy utilized to change the behavior of the public for the better. In this sense, the state took its leadership role seriously and used it to cultivate a better relationship with the public by appealing to what was in the mutual best interest of both the state and the public (Northouse, 2016). Whether state representatives used or demonstrated particular leadership strategies throughout this process might be something to consider in future studies. It might show that in conjunction with public campaigns, a servant style of leadership displayed by representatives of the state could be positively impactful on the minds of the public or that the utilization of likeability as a management quality, for instance, at checkpoints where interaction between officials and the public are inevitable is key to positive outcomes (Sanders, 2006; Hunter et al., 2013).

In terms of identifying whether or not the study could be reproduced, as a simple case study there is no doubt that the method of researching and examining a similar case could be effected. Where this study is limited in terms of supplying in-depth information, another study might surpass it. A discussion too of leadership styles utilized in conjunction with the study and its implementation of the communication design could also be useful in determining future frameworks. Overall there is a wide range of possibilities that could pursued in follow-up studies; but this case study is helpful in assessing the relationship between public reception of a public health campaign. It shows, essentially, that public health campaigns are impactful, that they do generate support for initiatives and ideas so long as they are conducted appropriately and with the right strategy. That strategy is only loosely defined in this case study, but that does not take away from the study's overall achievement. The overall achievement can be assessed in accordance with the model of co-orientation and the situational theory of publics and the predictive theories that support the predictive modeling of the case study's subjects.