Demonstration of the Trauma Nurses Talk Tough Seat Belt Diversion Program in North Carolina.
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Demonstration of the Trauma Nurses Talk Tough Seat Belt Diversion Program in North Carolina.

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      Trauma Nurses Talk Tough is a seat belt diversion program originally developed at the Legacy Emanuel Hospital in Portland, Oregon, in 1988. Attendance at the course is a condition for a one-time dismissal of a seat belt citation without fine or court cost penalties. Seat belt violators can choose to attend the course or pay the fine. The North Carolina Governor’s Highway Safety Program was interested in testing the program in Robeson County, a region with lower belt usage rates than the statewide average. The theory behind the program is that violators diverted to the program would be less likely to recidivate than violators sanctioned with the normal fines. Emergency room or trauma nurses lead the course at a main hospital in the area. The nurses bring practical experience from the local emergency room or trauma care, and the class site emphasizes public health consequences. The nurses discuss proper and improper use of seat belts and child safety seats, the costs of nonuse, the effects of alcohol and speed, and the physics of crashes, all supported by highly graphic visuals of injuries from non-use of seat belts.

      Southeastern Regional Medical Center (SRMC) in Lumberton, NC, successfully implemented the diversion program with the full support of hospital management and staff, the Robeson County district attorney, the clerk of the court, and all law enforcement agencies in the county. During the 15-month study period, local law enforcement agencies in the county, the Sheriff’s Office, and the Highway Patrol participated. They issued 10,358 seat belt citations, an increase of 29% from the same period the year before. SRMC conducted 62 class sessions with a total attendance of 4,503. Half (50%) of those people who received citations and were eligible to attend the course did so, exceeding program expectations. Since violators must pay $20 to attend the Tuesday evening course (less than North Carolina’s seat belt fine plus fees of $126.50 at the time), the program is self-sufficient. There were significant increases in observed seat belt use from baseline at eight annual observation sites (81% to 86%, up over 5 percentage points) and two new observation sites (69% to 78%, up 9 percentage points) added for this study. Course attendees expressed positive changes in attitudes, especially about seat belt use and seat belt enforcement in before-and-after SRMC surveys. The results of this study support the combination of high-visibility enforcement and a diversion classroombased brief intervention as a means of increasing seat belt use in a predominately rural, low-belt-use area. North Carolina has a primary belt law and relatively high fines and fees.

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