Risky business: safety regulations, risk compensation, and individual behavior

Editors comment: We are proud to be able to bring to our readers this full text version of the Haddon Memorial Lecture delivered at the recent Fifth World Conference on Injury Prevention and Control in New Delhi, India. James Hedlund offers a brilliant review of one of the most important areas of debate in the entire field of injury control. This is the most complete, most perceptive, and well balanced appraisals of this complex issue I have ever read. Take the time to digest it completely. Our thanks to the Insurance Institute for Highway Safety for agreeing to permit us to publish it. Government regulations and industry practices constrain our behavior in many ways in an attempt to reduce injuries. Safety features are designed into products we use: cars now have airbags; medicine bottles have “childproof” caps. Laws require us to act in a safe manner: we must wear seat belts while driving and hard hats in construction areas. But do these measures influence our behavior in other ways? Risk compensation theory hypothesizes that they do, that we “use up” the additional safety though more risky actions. This paper surveys risk compensation by reviewing its history, discussing its theoretical foundations, outlining evidence for and against its claims, and providing the author's own views. It concludes by discussing the relevance of risk compensation for injury prevention workers who seek to reduce unintentional injuries. Injury prevention as a discipline began when injuries were understood to be both predictable and preventable. Most injuries are the unintended consequences of individual actions in a risky environment; they are not due to fate or to problem behavior. This understanding led to three fundamental injury prevention strategies, as described in the comprehensive report Injury in America 1:

[1]  Leonard Evans,et al.  Human behavior and traffic safety , 2011 .

[2]  Lloyd Orr,et al.  Goals, Risks, and Choices , 1982 .

[3]  H. C. Joksch,et al.  Critique of Sam Peltzman's study: The effects of automobile safety regulation , 1976 .

[4]  E. Tenner.  Why things bite back : technology and the revenge of unintended consequences , 1996 .

[5]  R. J. Smeed,et al.  Some Statistical Aspects of Road Safety Research , 1949 .

[6]  Stephen B. Withey,et al.  The risk of aggregation , 1982 .

[7]  L S Robertson,et al.  Automobile safety regulations and death reductions in the United States. , 1981, American journal of public health.

[8]  Gerald J.S. Wilde.  Evidence refuting the theory of risk homoeostasis? A rejoinder to Frank P. McKenna , 1984 .

[9]  L Evans,et al.  Risk homeostasis theory and traffic accident data. , 1986, Risk analysis : an official publication of the Society for Risk Analysis.

[10]  Leonard Evans,et al.  Traffic Safety and the Driver , 1991 .

[11]  F P McKenna,et al.  The human factor in driving accidents. An overview of approaches and problems. , 1982, Ergonomics.

[12]  Jess F. Kraus.  The effect of the 1992 California motorcycle helmet use law on motorcycle crash fatalities and injuries. , 1995 .

[13]  G J Wilde,et al.  Risk homeostasis theory: an overview , 1998, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[14]  John D. Graham,et al.  Automobile Safety Regulation and Offsetting Behavior: Some New Empirical Estimates , 1984 .

[15]  Gerald J.S. Wilde,et al.  The Theory of Risk Homeostasis: Implications for Safety and Health , 1982 .

[16]  Michael J. Moore,et al.  Consumer Product Safety Regulation in the United States and the United Kingdom: The Case of Bicycles , 1995 .

[17]  S. Peltzman.  The Effects of Automobile Safety Regulation , 1975, Journal of Political Economy.

[18]  L S Robertson,et al.  Automobile safety regulation: rebuttal and new data. , 1984, American journal of public health.

[19]  Glenn C. Blomquist,et al.  The Regulation of Motor Vehicle and Traffic Safety , 1988 .

[20]  J. Graham.  On Wilde's theory of risk homeostasis , 1982 .

[21]  Thomas W. Hoyes,et al.  A review of risk homeostasis theory in simulated environments , 1996 .

[22]  Frank P. McKenna,et al.  Do safety measures really work? An examination of risk homoeostasis theory , 1985 .

[23]  A C Wagenaar.  Importance of systematic reviews and meta-analyses for research and practice. , 1999, American journal of preventive medicine.

[24]  W. Kip Viscusi,et al.  The Impact of Occupational Safety and Health Regulation, 1973-1983 , 1986 .

[25]  P. London.  Injury in America. A continuing public health problem , 1986 .

[26]  Harold D. Lasswell,et al.  The Policy Sciences , 1953 .

[27]  W. Kip Viscusi,et al.  The Impact of Occupational Safety and Health Regulation , 1979 .

[28]  Christopher Garbacz,et al.  How effective is automobile safety regulation , 1990 .

[29]  Leon S. Robertson,et al.  State and federal new-car safety regulation: Effects on fatality rates , 1977 .

[30]  Gerald J.S. Wilde,et al.  Accident countermeasures and behavioural compensation: The position of risk homeostasis theory , 1989 .

[31]  Leon S. Robertson,et al.  A Critical Analysis of Peltzman's "The Effects of Automobile Safety Regulation" , 1977 .

[32]  G. Wilde,et al.  Notes on the interpretation of traffic accident data and of risk homeostasis theory: a reply to L. Evans. , 1986, Risk analysis : an official publication of the Society for Risk Analysis.

[33]  Leonard Evans.  Comments on Wilde's Notes on “Risk Homeostasis Theory and Traffic Accident Data” , 1986 .

[34]  S Fosser,et al.  An investigation of behavioural adaptation to airbags and antilock brakes among taxi drivers. , 1997, Accident; analysis and prevention.

[35]  W. Kip Viscusi,et al.  Safety behavior and consumer responses to cigarette lighter safety mechanisms , 1996 .

[36]  B O'Neill,et al.  Risk homeostasis hypothesis: a rebuttal , 1998, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[37]  Paul Lanoie,et al.  Government Intervention in Occupational Safety: Lessons from the American and Canadian Experience , 1992 .

[38]  Hugh Laurence Ross,et al.  Smeed’s Law, Seat Belts, and the Emperor’s New Clothes , 1985 .

[39]  Brian O'Neill,et al.  Mandatory Belt Use and Driver Risk Taking: An Empirical Evaluation of the Risk-Compensation Hypothesis , 1985 .

[40]  F P Rivara,et al.  Systematic reviews of strategies to prevent motor vehicle injuries. , 1999, American journal of preventive medicine.

[41]  Jgu Adams,et al.  RISK AND FREEDOM: THE RECORD OF ROAD SAFETY REGULATION , 1985 .

[42]  John D. Graham,et al.  Evaluating the Effects of Automobile Safety Regulation , 1984 .

[43]  Fiona M. Davidson,et al.  Reply to Robertson , 1997 .

[44]  G B Rodgers,et al.  The safety effects of child-resistant packaging for oral prescription drugs. Two decades of experience. , 1996, JAMA.

[45]  W. Kip Viscusi,et al.  Consumer Behavior and the Safety Effects of Product Safety Regulation , 1985, The Journal of Law and Economics.

[46]  Gerald J.S. Wilde,et al.  Target risk: Dealing with the danger of death, disease and damage in everyday decisions. , 1994 .

[47]  L. Robertson.  Reducing death on the road: the effects of minimum safety standards, publicized crash tests, seat belts, and alcohol. , 1996, American journal of public health.

[48]  Robert S. Chirinko,et al.  BUCKLE UP OR SLOW DOWN? NEW ESTIMATES OF OFFSETTING BEHAVIOR AND THEIR IMPLICATIONS FOR AUTOMOBILE SAFETY REGULATION , 1993 .

[49]  DAVID T. LEVYM,et al.  Review: Risk Compensation Literature — The Theory and Evidence , 2000 .

[50]  Leon S. Robertson.  Rejoinder to Peltzman , 1977 .

[51]  Michael J. Moore,et al.  Labeling and performance standards for product safety: The case of CPSC's lawn mower standards , 1996 .

[52]  G J Wilde.  Assumptions necessary and unnecessary to risk homoeostasis. , 1985, Ergonomics.

[53]  Sam Peltzman,et al.  The effects of automobile safety regulation: Reply , 1976 .

[54]  H. C. Joksch.  The effects of automobile safety regulation: Comments on Peltzman's reply , 1976 .

[55]  R. Muelleman,et al.  Motorcycle crash injuries and costs: effect of a reenacted comprehensive helmet use law. , 1992, Annals of emergency medicine.

[56]  Alan Irwin,et al.  Technical expertise and risk conflict: An institutional study of the British compulsory seat belt debate , 1987 .

[57]  John Adams,et al.  RISK HOMEOSTASIS AND THE PURPOSE OF SAFETY REGULATION , 1988 .

[58]  Thomas J. Zlatoper,et al.  REGRESSION ANALYSIS OF TIME SERIES DATA ON MOTOR VEHICLE DEATHS IN THE UNITED STATES , 1984 .

[59]  L D Orr,et al.  The effectiveness of automobile safety regulation: evidence from the FARS data. , 1984, American journal of public health.

[60]  Tapio Klen,et al.  Personal protectors and working behaviour of loggers , 1997 .

[61]  Donald L. Alexander,et al.  An empirical investigation of lawn mower safety regulation , 1990 .

[62]  D. Istance.  Organization for Economic Co-operation and Development , 1966, Nature.

[63]  R. Blackman,et al.  A driving-simulator test of Wilde's risk homeostasis theory. , 1994 .

[64]  Gerald J.S. Wilde,et al.  Critical Issues in Risk Homeostasis Theory , 1982 .

[65]  Leonard Evans,et al.  Human Behavior Feedback and Traffic Safety , 1985 .

[66]  J. Graham.  Target Risk: Dealing with the Danger of Death, Disease and Damage in Everyday Decisions. , 1998 .

[67]  Murray Mackay,et al.  Seat Belt Use Under Voluntary and Mandatory Conditions and its Effect on Casualties , 1985 .

[68]  Neville A. Stanton,et al.  Risk homeostasis and risk assessment , 1996 .

[69]  F. McKenna.  WHAT ROLE SHOULD THE CONCEPT OF RISK PLAY IN THEORIES OF ACCIDENT INVOLVEMENT , 1988 .

[70]  G. Sjöberg,et al.  The successful introduction of child resistant closures for liquid paracetamol preparations , 1995 .

[71]  F P McKenna,et al.  Evidence and assumptions relevant to risk homoeostasis. , 1985, Ergonomics.

[72]  Frank P. McKenna,et al.  Behavioural compensation and safety , 1987 .

[73]  Edmund R. Becker,et al.  The Impact of the Texas 1989 Motorcycle Helmet Law on Total and Head-Related Fatalities, Severe Injuries, and Overall Injuries , 1992, Medical care.