In compliance with its mandatory seat belt law, Hawaii is a high-use state. Seat belt use from 1998 to 2001 has averaged 81%, compared with 70% nationally. Efforts to increase belt use beyond 90% have not been successful, at least until the most recent effort, which entailed a combined enforcement and public information campaign. Described are patterns of belt use over time and the effects of the "Click It or Ticket" campaign that was launched this year. In January 2002, before the program was started, there was an overall belt use rate of 83.5%. After increased enforcement and publicity, Hawaii experienced an immediate increase in belt use by 6.9%. Belt use increased dramatically in each of the state's four counties: in Honolulu, a 7.5% increase; Maui, 10.1% increase; and Kauai, 5% increase. The county of Hawaii, however, increased its rate by only 2.7%. Additional surveys in the months following the campaign indicated that in the days and weeks immediately after the Click It or Ticket campaign, there was a significant drop-off in belt use; but 144 days after, belt use in Honolulu County has stabilized at above 90%. This is surprising because the actual observed current rate is higher than the rate projected on the basis of observations conducted during the weeks immediately after the campaign was initiated. While more surveys and analysis are planned, the campaign was successful in Hawaii. Comments are provided about increasing belt use in a high-use state and implications are described for other traffic safety programs and initiatives.
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