News — PHILADELPHIA— We’ve all heard “Click It, or Ticket” as a reminder to buckle up in the car, but “Click It and Win It!” appears to be an effective approach for sustaining consistent seatbelt use among drivers. When drivers were promised a share of $125 weekly prize money for maintaining perfect seatbelt use streaks, they established good, long-lasting habits. Driving without a seatbelt decreased 26% relative to the control during the incentive program and was 33% than the control even after the program ended, according to research from the Perelman School of Medicine at the University of Pennsylvania, published in the American Journal of Public Health.
The shared prize approach outperformed two other approaches: one that promised a weekly lottery entry for the full $125 prize for maintaining a streak, and another that texted drivers personalized feedback on their buckling habits. The study, involving more than 1,100 drivers from 49 states, is among the first to demonstrate that using connected vehicle data to provide feedback to drivers can encourage more consistent seatbelt use in a large, national population.
“We know that seatbelts reduce serious crash-related injuries and death by about half,” said lead author Jeff Ebert, PhD, director of Applied Behavioral Science at the Penn Medicine Nudge Unit. “About 3,000 lives could be saved each year in the United States if everyone wore seatbelts. If this ‘nudge’ combined with incentives could be scaled up, our results show it could lead to a substantial reduction in driving without seatbelts. Even a 25% decrease in unbuckled trips would mean about 750 more people going home to their families every year.”
Perfect streaks pay off
Participants in the study who were promised a weekly share of a $125 pot for achieving a perfect streak—using their seatbelts every time they drove their car more than a tenth of a mile—drove unbuckled 8.7 percent of the time. The group that was given a chance to win $125 in a lottery among their fellow participants drove unbuckled 10.5 percent of the time. And the group that only received text message feedback on their seatbelt habits drove unbuckled 10.6 percent of the time. A control group, which didn’t get feedback or incentives, drove unbuckled 11.9% percent of the time.
In a five-week follow-up after the interventions ceased, the shared prize group maintained a lower rate of unbuckled trips (8.0%) compared to the control group (11.7%), representing a 33% relative reduction—even without a monetary incentive on the line. The group receiving feedback texts also saw a reduction in unbuckled trips (9.8%), while the lottery group’s rate (10.4%) was statistically similar to the control group.
Incentives cut phone use while driving, but gradual rewards may work better
In addition to seatbelt use, the researchers also measured handheld phone use while driving among a smaller sample of the participants. Distracted driving contributes to more than 3,000 deaths each year, with 12% including incidence of cell phone use. Participants offered a shared pot incentive for perfect phone-free streaks had a minute less handheld phone use per hour of driving (2 minutes 47 seconds per hour) than the control group (3 minutes 49 seconds per hour); this difference wasn’t statistically significant in the smaller sample.
“Tying incentives to perfect streaks worked really well for buckling up—a simple, one-click behavior that most drivers already perform, but sometimes forget,” said M. Kit Delgado, MD, MS, faculty director of the Penn Medicine Nudge Unit and an associate professor of Emergency Medicine and Epidemiology. “For behaviors like reducing handheld phone use, which require more effort to change, we’ve found in prior studies that rewarding step-by-step improvements can be a more effective long-term strategy, especially among high-risk drivers.
Nudging towards safety
The Nudge Unit is Penn Medicine’s center that tests small behavioral science-informed interventions to encourage positive changes in behavior.
“We know that the ‘stick’ approach of giving traffic tickets for not buckling works—but enforcement is variable and can sometimes be biased. With connected vehicles that measure and transmit seatbelt use data, and with customers who consent to sharing these data, we can experiment with ‘carrot’ approaches, too,” said Ebert. “This study found an increase in seatbelt use similar to what we see with seatbelt laws.”
Participants in the study all drove General Motors vehicles and volunteered to participate after being emailed by the company. They received $20 for filling out a survey requesting demographic information and $50 if they installed an app on their phones to track handheld phone use while driving during the study.
Moving forward
The total cost of incentives for drivers assigned to this 10-week intervention was a modest $4.40 per driver—a cost that could potentially be sustained within auto insurance programs.
“Auto insurance companies already pay billions per year to customers who drive safely in their ‘usage-based insurance’ programs,” said Delgado. “By applying lessons from this study—offering real-time feedback and shared prizes for perfect streaks—insurers can improve driver safety and their bottom lines.”
Current research by Ebert and Delgado is testing ways insurers can optimize and focus feedback in their smartphone apps to reduce speeding, phone use, hard braking, and hard acceleration, behaviors that lead to safer roads for all.
(Editor’s Note: This study was undertaken as a partnership between Penn Medicine’s Nudge Unit and General Motors.)
###Penn Medicine鈥痠s one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the鈥疷niversity of Pennsylvania Health System鈥痑nd Penn’s鈥疪aymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $580 million awarded in the 2023 fiscal year. Home to a proud history of “firsts,” Penn Medicine teams have pioneered discoveries that have shaped modern medicine, including CAR T cell therapy for cancer and the Nobel Prize-winning mRNA technology used in COVID-19 vaccines.
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