Improving teen seatbelt use through health communication: Effects of a research-driven in-school peer-led initiative

Motor vehicle crashes (MVC) are the leading cause of death among teenagers in the US. Seatbelt-wearing reduces the risk of fatal and non-fatal injury in an MVC by more than half, but teen passengers report significantly lower rates of use when riding with a teen driver than when riding with an adult. In 2008, Ride Like A Friend (RLAF), a peer-to-peer school-based week-long initiative, was piloted in two Philadelphia area high schools. Developed from extensive formative research and pre-testing with teens, RLAF uses a series of materials and activities (e.g. posters, in-school polling) facilitated by students to promote safe driver and passenger beliefs and behaviors, including those around seatbelt use. RLAF was evaluated using behaviorally based in-class questionnaires. Post-test data (N= 1793) showed that, compared to teens with no RLAF exposure, teens who had at least some exposure (55% of the sample) were significantly more likely to report better attitudes (96.3% vs. 90.6%, adjusted RR = 1.05, 95% CI=1.02-1.08), self-efficacy (96.1% vs. 90.0%, adjusted RR = 1.06, 95% CI=1.03-1.08), subjective norms (96.4% vs. 90.4%, adjusted RR = 1.05, 95% CI=1.03-1.08) and descriptive norms (68.6% vs. 57.4%, adjusted RR= 1.15, 95% CI=1.07-1.24) towards wearing a seatbelt. Teens with at least some RLAF exposure were also significantly more likely to wear a seatbelt after completion of the initiative (93.4% vs. 88.5%, adjusted RR = 1.05, 95% CI=1.02-1.09). The results demonstrate that in-school peer-led initiatives can positively influence cognitions and behaviors which can help reduce driver and passenger injury from MVCs.