The validity of self-reported seatbelt use: Hispanic and non-Hispanic drivers in El Paso

Seat belt use among pregnant women in the United Arab Emirates: the Mutaba'ah Study

INTRODUCTION

Motor vehicle collisions are a major cause of death and injury among pregnant women and their fetuses. Seat belt use compliance during pregnancy varies in different populations. We aimed to study seat belt use among pregnant women and factors affecting seat belt use during pregnancy in Al Ain City, the United Arab Emirates.

METHODS

This cross-sectional analysis used the baseline data collected from pregnant women participating in the Mutaba'ah Study from May 2017 to November 2022. Data were collected using self-administered questionnaires. Variables included sociodemographic, gestation periods and seat belt-related information. All pregnant women who responded to the questions related to seat belt use were included (N=2354).

RESULTS

Seat belt use before and during pregnancy was estimated at 69.7% (95% CI 67.9% to 71.6%) and 65.5% (95% CI 63.6% to 67.4%), respectively. The reasons for not using seat belts during pregnancy included being uncomfortable to wear, habitual non-use and considering them unsafe for pregnancy. Age, higher levels of education of the pregnant woman or her spouse, being employed, having a sufficient household income, lower gestational age, and using a seat belt before pregnancy were positively associated with using a seat belt during pregnancy in the bivariate analyses. Pregnant women in their third trimester had independently significant lower odds of using a seat belt compared with those in the first trimester (OR 0.42, 95% CI 0.24 to 0.76).

CONCLUSIONS

The findings indicate decreased compliance with seat belt use during pregnancy and as gestation progressed. The decrease was related to several reasons, including feeling uncomfortable wearing seat belts, habitual non-use and unsafe for pregnancy, necessitating appropriate measures to increase awareness. Raising public awareness about the advantages of wearing seat belts during pregnancy and the involvement of healthcare professionals in educating pregnant women are warranted.

Self-reported Non-nominal Sitting in Passengers is Influenced by Age and Height

Automotive safety devices, such as airbags and seatbelts, are generally designed for optimal performance when occupants adopt a "nominal" upright anatomical sitting position. While a driver's sitting behavior is largely influenced by the requirements of driving, a passenger may adopt any number of non-nominal positions and behaviors. Very few studies have investigated the behaviors that teen and adult passengers actually adopt. The present study investigates self-reported nonnominal sitting in passengers and quantifies the influence of age and anthropometrics on these behaviors. A better understanding of passenger behavior is a timely research topic because advanced sensors may eventually allow better detection of non-nominal sitting and the advent of autonomous vehicles increases the number of passengers and seating options. Ten online survey questions were created to assess how frequently non-nominal sitting was adopted. Results were obtained from 561 anonymous participants, ranging in age from 14 to 83 years old. Analyses included 1) averages for each question, 2) a statistical linear mixed model to test for the influence of age and height on responses, and 3) correlations between all questions. Statistical significance was set at p<0.05. In summary, there was a sizable percentage of participants who self-reported behaviors or sitting positions that potentially increase risk of injury. Younger subjects were significantly more likely to adopt non-nominal sitting. Shorter subjects adopted non-nominal foot position more often, while taller subjects' knees were significantly closer to the dash. Participants opted not to wear their seat belt in the rear seat more than the front seat.

Association between cellphone use while driving legislation and self-reported behaviour among adult drivers in USA: a cross-sectional study

OBJECTIVES

Cellphone use behaviours can vary demographically in the USA. This study examined whether legislation restricting cellphone use while driving was associated with lower self-reported hand-held cellphone conversations or texting behaviours among adult drivers of different ages (19-24, 25-39, 40-59,≥60 years), sex, race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Other) or rurality (urban, rural).

DESIGN

Cross-sectional study.

SETTING

USA.

PARTICIPANTS

Individuals ≥19 years of age who indicated they were a current driver and participated in the 2011-2014 Traffic Safety Culture Index Surveys (n=9706).

PRIMARY OUTCOME

The exposure was the presence of a hand-held calling or texting ban applicable to all drivers (ie, universal) at time of survey. Modified Poisson regression with robust SE was used to estimate the risk of engaging in these self-reported behaviours.

RESULTS

In fully adjusted models, universal texting bans were not associated with lower texting behaviours (adjusted risk ratio [aRR]=0.92; 95% CI 0.84, 1.01). In stratified, fully adjusted models, men and those of other racial/ethnic origin were 13% and 33% less likely, respectively (aRR=0.87; 95% CI 0.77, 0.98; aRR=0.67; 95% CI 0.46, 0.97), to engage in texting behaviours if a universal texting ban was effective in their state. Conversely, universal hand-held calling bans were associated with lower self-reported hand-held cellphone conversations across every sub-group. In fully adjusted models, the presence of a hand-held calling ban was associated with 40% lower (aRR=0.60, 95% CI 0.54, 0.67) self-reported hand-held cellphone conversations while driving.

CONCLUSIONS

Universal hand-held calling bans were associated with lower self-reported cellphone conversations for adult drivers. More interventional work targeting adult drivers may be needed to reduce texting while driving.

Trends in the use of seat belts and mobile phones and their seasonal variations in Florence (2005-2015)

INTRODUCTION

About 1.25 million people worldwide die every year because of road accidents. Risk is higher when drivers use mobile phones, whereas seat belts help to prevent crash-related injury. We aimed to evaluate the prevalence, associated factors, and temporal trend of the use of seat belts and mobile phones among drivers and passengers in Florence, Italy (2005-2015).

METHODS

Use of seat belts and mobile phones use was monitored via direct observation in four areas in the province of Florence. We fitted Poisson regression models with robust variance to investigate the factors associated with the use of seat belts and mobile phones use by the drivers and to explore long-term trends and seasonal patterns in the two time-series.

RESULTS

We observed a total of an overall 134,775 vehicles: seat belts were worn by 71.8% of drivers and front-seat passengers and 27.6% of back-seat passengers, while mobile phones were being used by 4.8% of drivers. Drivers were more likely to wear seat belt when transporting passengers (≥2 vs none: prevalence ratio [PR] 1.21, 95% confidence intervals [CI] 1.14-1.29) and while driving in the afternoon (PR 1.04, 95% CI 1.03-1.05), and less likely when the front-seat passenger was not wearing seat belts (PR 0.33, 95% CI 0.32-0.34). After an initial increase, seat belts use by the driver decreased over time (-0.5% each year during 2010-2015), with significant peaks and troughs in July and January, respectively. Mobile phone use by the driver was inversely associated with wearing seat belts (PR 0.67, 95% CI 0.64-0.70) and carrying passengers (≥2 vs. none PR 0.20, 95% CI 0.07-0.52). The proportion of drivers using mobile phones did not vary over time nor showed any clear seasonality.

CONCLUSIONS

Drivers' risky behaviours (not wearing a seat belt and using a mobile phone) are associated, showing a global misperception of risk among a subset of drivers. The number of passengers and their behaviour is also associated with the driver's attitude. The effectiveness of primary enforcement laws has declined in Italy in recent years; therefore, other strategies should be devised and implemented.

Predicting road safety behavior with implicit attitudes and the Theory of Planned Behavior

Introduction The Theory of Planned Behavior (TPB) is one of the most widely used psychological models when it comes to explaining road safety behaviors. Recently, studies have also been conducted from the perspective of dual-process models. However, the present is the first study on road safety behaviors that integrates both perspectives. The study evaluates the roles of both implicit attitudes and TPB constructs in the prediction of seatbelt use. Method A sample of 100 drivers completed: (1) a self-reporting instrument on seatbelt use, (2) a questionnaire addressing TPB constructs, (3) an indirect measure of attitudes (Implicit Association Test), and (4) a social desirability scale. Results Results suggest that both types of attitudes make a significant and quite similar contribution to the explanation of seatbelt use. Interestingly, implicit attitudes were a better predictor than explicit attitudes among participants reporting inconsistent seatbelt use. In addition, path analysis models suggested that implicit attitudes appear to be relatively independent of TPB constructs and have a direct effect on seatbelt use. Conclusion The findings advance the idea of adding implicit attitudes to variables from the TPB model in order to increase the explanatory power of models used to predict road safety behaviors. Practical applications Potential use of implicit attitude measures in the education and training of drivers are discussed.

Executive function and dangerous driving behaviors in young drivers

The purpose of the present study was to investigate the behavioral and cognitive processes underlying dangerous driving behaviors. We used a survey to assess levels of executive function in college students. The sample consisted of 59 males and 77 females and their age ranged from 18 to 24. We stratified the students into two groups based on executive function scores and compared the extent to which each group engaged in four dangerous driving behaviors (texting while driving, driving without a seat belt, driving while intoxicated, and speeding) as well as how often they experienced three negative driving outcomes (crashes, pulled over, and ticketed). We also investigated how these driving behaviors and outcomes are correlated with subcategories of executive function. The results show that students with a low level of executive function were more likely to engage in dangerous driving behaviors and more likely to experience negative driving outcomes. The results also show that texting while driving, driving while intoxicated, and speeding were most strongly correlated with the executive function subcategory of Impulse Control, whereas driving without a seat belt was most strongly correlated with the executive function subcategory of Strategic Planning. These results suggest that different behavioral or cognitive processes are involved in different dangerous driving behaviors and different interventions may be needed to target each underlying process.

Prevalence of rear seat belt use among pregnant women in a suburban area of Japan

AIM

The aim of this study was to clarify the prevalence and influencing factors of rear seat belt use among pregnant women.

METHODS

Questionnaires were given to 1546 pregnant women who visited obstetrics clinics and hospitals for prenatal checkups from October to December 2013. A total of 1494 pregnant women (96.6%) agreed to participate in this study and completed the questionnaire.

RESULTS

Fewer than 20% of the rear-seat passengers 'always' used seat belts before and during pregnancy, whereas a third 'never' used a seat belt before or during pregnancy. There was no significant decrease in seat belt use by rear-seat passengers during compared to before pregnancy. Multivariate analysis revealed that age, knowledge of how to use a seat belt during pregnancy, belief in the compulsory use of a rear seat belt and driver behavioral characteristics before pregnancy were associated with rear seat belt use during pregnancy.

CONCLUSIONS

The prevalence of fastening seat belts was substantially low. The provision of information regarding proper seat belt use and its role in protecting the fetus may increase use.

Texting while driving, executive function, and impulsivity in college students

The purpose of the present study was to investigate the cognitive processes underlying texting while driving. A sample of 120 college students completed a survey to assess how frequently they send and read a text message while driving. Based on this information, students were assigned to one of two groups: 20 students who frequently text while driving and 20 matched-control students who infrequently text while driving but were similar in gender, age, years of education, and years driving. The groups were compared on the extent to which they differed in self-reported measures of executive function and impulsivity. The groups were also compared on a behavioral measure of impulsivity: the extent to which they discounted hypothetical monetary rewards as a function of the delay. For this measure, the students made repeated choices between smaller monetary rewards available immediately and larger rewards available after delays ranging from 1 week to 6 months. The results show that the group of students who frequently text while driving showed (a) significantly lower levels of executive function and (b) higher levels of self-reported impulsivity, although the groups did not differ significantly on the behavioral measure of impulsivity. These results support a general conclusion that drivers with lower levels of executive function and higher levels of impulsivity are more likely to text while driving.

Evaluation of the five-year Bloomberg Philanthropies Global Road Safety Program in the Russian Federation

Road traffic injuries are a leading cause of morbidity and mortality in the world. In Russia, a road safety program was implemented in Lipetskaya and Ivanovskaya oblasts (regions) as part of a 10-country effort funded by Bloomberg Philanthropies. The program was focused on increasing seat belt and child restraint use and reducing speeding. The primary goals of this monitoring and evaluation study are to assess trends in seat belt use, child restraint use, and speed compliance in the two oblasts over the 5 years and to explore the overall impact of the program on road traffic injury and death rates. Primary data via roadside observations and interviews, and secondary data from official government sources were collected and analyzed for this study. Our results indicate significant improvements in seat belt wearing and child seat use rates and in prevalence of speeding in both intervention oblasts. The observations were consistent with the results from the roadside interviews. In Lipetskaya, restraint use by all occupants increased from 52.4% (baseline, October 2010) to 77.4% (final round, October 2014) and child restraint use increased from 20.9% to 54.1% during the same period. In Ivanovskaya, restraint use by all occupants increased from 48% (baseline, April 2012) to 88.7% (final round, October 2014) and child restraint use increased from 20.6% to 89.4% during the same period. In Lipetskaya, the overall prevalence of speeding (vehicles driving above speed limit) declined from 47.0% (baseline, July 2011) to 30.4% (final round, October 2014) and a similar pattern was observed in Ivanovskaya where the prevalence of speeding decreased from 54.6% (baseline, March 2012) to 46.6% (final round, October 2014). Through 2010-2014, the road traffic crash and injury rates per 100,000 population decreased in Lipetskaya oblast (191.5 and 246.9 in 2010 and 170.4 and 208.6 in 2014, respectively) and slightly increased in Ivanovskaya oblast (184.4 and 236.0 in 2010 and 186.7 and 243.4 in 2014, respectively). These road safety improvements are associated with the program that enabled a combined focus on policy reform, legislation, enforcement, advocacy, education, and data collection and use. However, the existence of other road safety efforts, lack of data from comparable regions, and unavailability of risk factor-specific data make it difficult to attribute these changes to the program.

A comparison of observed and self-reported helmet use and associated factors among motorcyclists in Hyderabad city, India

OBJECTIVES

India has a high burden of fatal road traffic injuries (RTIs). A large proportion of fatal RTIs in India are among motorcyclists. The overall goal of this study is to assess and compare observed and self-reported prevalence of helmet use; and to identify factors associated with helmet use and over-reporting in Hyderabad city, India.

STUDY DESIGN

Roadside knowledge, attitude and practice interviews.

METHODS

Six rounds of roadside interviews were conducted with motorcyclists (drivers and pillion riders) between July 2011 and August 2013 using a structured tool developed for this study. Observations on helmet use were recorded and respondents were also asked if they 'always wear a helmet'. Prevalence of helmet use was calculated and a paired t-test was used to compare observed and self-reported helmet use proportions. Unadjusted and adjusted odds ratios were calculated to identify factors associated with helmet use and over-reporting.

RESULTS

A total of 4872 respondents participated in the roadside interview. The response rate was 94.4%. The overall observed helmet use was 34.5% and 44.5% of respondents reported that they 'always wear a helmet'. As the observed helmet use increased, the over-reporting of helmet use was found to decrease. However, factors associated with observed and self-reported helmet use are similar. Male gender, youth (≤24 years), a lower level of education and non-ownership of helmet were associated with a higher risk of not wearing helmets. Male gender, youth (≤24 years), no schooling, riding a lower engine capacity motorcycle and using a motorcycle for purposes other than travelling to school/work were associated with over-reporting of helmet use.

CONCLUSIONS

Self-reports provide an overestimate of helmet use that lessens as actual helmet use increases. Interviews also allow identification of factors associated with helmet use. Increasing helmet ownership and enhanced enforcement may help increase helmet use.

Cluster analytical approach to Lifestyle characteristics: A population based study in Shiraz, Iran

INTRODUCTION

A limited number of risky behaviors cause most morbidity and mortality. The aim of this study was to determine the possible clustering of lifestyle behaviors, including transportation behaviors, diet, physical activity, and smoking in Shiraz, Iran.

METHODS

There were 776 representative Shirazi adults who participated in this cross-sectional study. The questionnaires were completed via person-to-person interviews. The datasets were searched for any clustering patterns. Cluster analysis was used for statistical analysis, and the data were analyzed using SPSS version 11.5.

RESULTS

Three distinct clusters were identified. Cluster 1 was named "Healthy," and it included non-smokers, safe drivers, appropriate or acceptable fruit, vegetable, and fast-food consumers, and physically-active people. Cluster 2, "Moderately Healthy," was relatively risky drivers who had appropriate behaviors on the rest of the health-related behaviors. Cluster 3, "Unhealthy," was smokers, risky drivers, inappropriate or unacceptable fruit, vegetable & fast-food consumers, and a sedentary lifestyle.

CONCLUSIONS

It was obvious that health-related behaviors were clustered together and unhealthy behaviors were not established in isolation.

Challenges in the Accurate Surveillance of Booster Seat and Bicycle Helmet Usage by Children: Lessons from the Field

Motor vehicle collisions and bicycle collisions and falls are a leading cause of death by preventable injury for children. In order to design, implement and evaluate campaigns and programs aimed at improving child safety, accurate surveillance is needed. This paper examined the challenges that confront efforts to collect surveillance data relevant to child traffic safety, including observation, interview, and focus group methods. Strategies to address key challenges in order to improve the efficiency and accuracy of surveillance methods were recommended. The potential for new technology to enhance existing surveillance methods was also explored.

Seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar: an observational study

BACKGROUND

In Qatar traffic injuries and fatalities are of serious concern. Mobile phone use whilst driving has been associated with increased risk of vehicular collisions and injuries. Seat belt use has been demonstrated to save lives and reduce the severity of road traffic injuries. Whereas previously published studies may have looked at all front passengers, this study aims to obtain reliable estimates of the prevalence of seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar. Additionally, we aim to investigate the association of these behaviors with other variables namely gender, time of the day and type of vehicle.

METHODS

An observational study on 2,011 vehicles was conducted in 2013. Data were collected at ten sites within Doha city over a two-week period. Two trained observers surveyed each car and recorded observations on a data collection form adapted from a form used in a 2012 Oklahoma observational study. Associations were assessed using the Chi-squared test or Fisher's exact test. A p-value of .05 or less was considered statistically significant.

RESULTS

Overall, 1,463 (72.7 %) drivers were found using a seat belt (95 % CI: 70.8-74.7 %) and 150 (7.5 %) their mobile phones (95 % CI: 6.3-8.6 %) during the observation period. Mobile phone use was significantly associated with not using a seat belt and driving a sport utility vehicle. Significantly lower rates of seat belt use were observed in the early morning and late afternoon. No gender differences were observed.

DISCUSSION

Seatbelt use in Doha was found to be similar to countries in the region but lower than those in western countries. Also, studies from other high-income locations, reported lower rates of mobile phone use while driving than in Doha.

CONCLUSIONS

Despite road traffic crashes being one of the leading causes of death in Qatar, three out of 10 drivers in Doha, Qatar, do not use a seat belt and about one in 12 use a mobile phone while driving. More efforts, in the form of awareness campaigns and increased law enforcement, are needed to improve compliance with laws requiring seat belt use and prohibiting mobile phone use while driving.

Pedestrian injury patterns and risk in minibus collisions in China

Background

The minibus, with a nearly flat front, is widely used in China, especially in the underdeveloped regions, and results in large numbers of pedestrian injuries and deaths. The purpose of this study was to determine the injury patterns and risk for pedestrians involved in these crashes.

Material/Methods

We conducted an in-depth investigation of minibus/pedestrian accidents in Chongqing, China, occurring between September 2000 and April 2014. The enrolled pedestrians was classified into 3 groups: young (aged 14–44 years), middle-aged (aged 45–59 years), and elderly (aged over 60 years). Pedestrian injuries were coded according to the Abbreviated Injury Scale (AIS).

Results

A total of 109 pedestrians, with an average age of 55.7±16.2 years, were injured or killed – 30.3% were young, 23.9% were middle-aged, and 45.9% were elderly. Pedestrians hit by a minibus had a high proportion of head, chest, and extremity injuries – 84.4%, 50.5%, and 52.3%, respectively. In addition, impact speeds in excess of 75 km/h all ultimately resulted in fatalities. At an impact speed of 30 km/h, the risk of pedestrian fatality and AIS3+ injury are approximately 12.0% and 37.2%, respectively. At 50 km/h the risks are 65.2% and 96.9%, respectively, and at 70 km/h the risks are 96.3% and 99.9%, respectively.

Conclusions

A higher likelihood of chest injury was associated with being older and impact speed of over 40 km/h in minibus/pedestrian collision. Our data suggest that the injury patterns of pedestrians in minibus collisions differ from that in other vehicle/pedestrian collisions. These findings could contribute to better understanding of the injury patterns and risk of pedestrian in minibus collisions in China, which may play an important role in developing measures to improve traffic safety.

The validity of self-reported seatbelt use in a country where levels of use are low

The validity of self-reported seatbelt use among low belt use populations in low belt use countries has not been evaluated directly. Nine hundred and ninety drivers were recruited from shopping centers, car parks, and other suitable locations located in Afyon and Ankara cities of Turkey in order to compare the self-reported and observed seatbelt usage rates. Data sets were collected simultaneously from the participants not being aware of having their seatbelt use observed. Participants interviewed in Afyon (n=301) and Ankara (n=658) reported seatbelt usage ("always using a seatbelt") rates of 39% and 45%, respectively. When observed, however, only 47% in Afyon and 70% in Ankara of these drivers actually fasten their seat-belts. It seems that the drivers in both cities exaggerated their use seat belts considerably.

Seat belt and child seat use in Lipetskaya Oblast, Russia: frequencies, attitudes, and perceptions

OBJECTIVE

Despite the importance of understanding seat belt use patterns among drivers and passengers for the purpose of direct interventions or monitoring improvements, no study has described wearing rates for all seat positions in Russia. This study describes observed seat belt use and knowledge, attitudes, and perceptions of seat belt use in Lipetskaya Oblast, Russia.

METHODS

An observational study on the use of seat belts and child restraints in the Lipetskaya region conducted during October 2010 collected data in 6 districts and on 3 different road types. A roadside survey gathered information on knowledge, attitudes, and perceptions toward the use of seat belts from randomly selected drivers. Frequencies of seat belt use by seat position, gender, and road type were calculated. A multivariable logit model disclosed the associations between seat belt use and sociodemographic factors. The study design permitted comparison of observed seat belt use to self-reported seat belt use.

RESULTS

A total of 25,795 vehicles and 39,833 drivers and passengers contributed observations. Overall, 55 percent of drivers were observed to be using seat belts. More than half (58%) of front seat passengers wore seat belts and only 9 percent of back seat passengers were observed to be wearing seat belts; 11 percent of cars with children had any type of child safety measure. Drivers on urban roads were less likely to wear seat belts compared to those on main highways and rural roads. Nearly 60 percent of survey respondents mentioned "seat belts save lives," and more than half mentioned law requirements and fines.

CONCLUSIONS

Although the observed seat belt use in Lipetskaya Oblast is much higher than previous estimates in Russia, overall wearing rates remain far from universal. Rear seat passengers and children are particularly at risk. Because combined education and enforcement has proven to be effective elsewhere, such interventions are needed to improve seat belt use.

Transportation behaviors in Shiraz, Iran

OBJECTIVE

Motor vehicle accidents can occur as a result of improper driver behavior. There needs to be a comprehensive collection of information concerning driver behavior and its predisposing factors.

METHODS

Study participants (500 males and 500 females ≥18 years old) living in Shiraz, Iran, were selected using a multistage sampling methodology. Data came from questionnaires completed using a face-to-face interview process. Independent variables such as age, gender, marital status, occupation, educational level, socioeconomic status (SES), and history of smoking and stress levels were compared to the dependent variables using a private automobile, public transportation, or motorcycle, wearing a seat belts, wearing safety helmets, and obeying the speed limit. Statistical significance was set at a P value of .05 or less.

RESULTS

In general, female, better educated persons, and those with higher SES reported better driving behaviors. Better drivers also did not use tobacco or hookah. Compliance with driving safety factors was disappointing 49.8 percent always wore a seat belt, 22.4 percent always wore a safety helmet (29.4% never wore a helmet), and 49.4 percent always observed the speed limit.

CONCLUSIONS

There is a need to improve driver safety compliance in Shiraz, Iran. One factor that can be addressed concerns regulation of male drivers, especially among lower SES groups.

Parental awareness and perception for correct use of child occupant restraints in Korea

OBJECTIVE

To determine the rate of correct use of child occupant restraints (CORs) and to evaluate the parental awareness and perception associated with the use of CORs.

METHODS

A cross-sectional survey using self-report questionnaires was performed at 10 different hospitals. A total of 1573 parents and 2209 of their children 6 years of age or younger were studied.

RESULTS

The overall percentage of parents using CORs or adult seat belt was 57.7 percent. However, only 44.4 percent of those parents, which corresponds to 25.6 percent of all parents recruited, were correctly using the restraints for their children. The overall percentage of children using CORs or adult seat belt was 53 percent. However, the percentage of children correctly using the restraints was 14.3 percent for infants (<12 months of age), 42 percent for children one years old, 43.8 percent for children 2 years old, 28.7 percent for children 3 years old, 18.9 percent for children 4 years old, 13.9 percent for children 5 years old, and 10.5 percent for children 6 years old. The logistic regression analysis revealed that the mother's level of education, number of children in each household, child's age when parents started to use the CORs, and parental awareness about the fine for violation of car seat laws were the most influential variables associated with the correct use of CORs. The rates of correct use of CORs and parental preferences about CORs, respectively, differed by ages of their children. Most parents showed a negative perception of placing children in the front passenger seat. However, many parents were prematurely using adult seat belts for children without realizing the risk of injury.

CONCLUSION

More aggressive educational campaigns and increased enforcement of the car seat laws are needed to improve the awareness of parents on the efficacy of CORs.

Traffic safety behaviour among young people in different residential settings: the use of seat belts, bicycle helmets, and reflectors by young people in Sweden

This study examines if, and how, the size of the community in which people live may contribute to explaining differences in traffic safety behaviour (self-reported behaviour regarding the use of seat belts, bicycle helmets and reflectors) among young people in Sweden. The study is based on a Swedish nationwide traffic safety survey with a net sample of 2854 respondents aged 16-25. Ordered logit regressions were performed, and place of residence is shown to have an impact on traffic safety behaviour. The results are presented and discussed in relation to risk exposure and traffic safety facilities in different settings. The implications of the study are considered, and the importance of investigating the way in which young people see traffic safety behaviour is emphasised.

Taxi driver seat belt wearing in Nanjing, China

OBJECTIVE

To determine and validate patterns of seat belt use and attitudes of taxi drivers on wearing a seat belt following national and provincial seat belt legislation in 2004-2005.

DESIGN

Roadside daylight seat belt observation and interview survey methods were used, as well as observations from inside taxis during routine trips and a taxi driver focus group. The setting was Nanjing, Jiangsu Province, PR China in April of 2006 and 2007.

MAIN OUTCOME MEASURES

Prevalence of seat belt use and attitudes to wearing a seat belt were determined, as were vehicle and driver characteristics, and comparisons with other motor-vehicle driver's seat belt use and attitudes.

RESULTS

Taxi drivers interviewed were predominantly male and aged 30-39 years. They spent more hours per week in their vehicles and had more driving experience than other drivers. Over half (56.2%) of taxi drivers interviewed reported that they always wore seat belts, while observation of taxi drivers showed lower wearing rates (i.e., roadside observation was 43.8%, and observation from inside taxis was 36.2%). Belt tampering was a practice of 12-15% of taxi drivers. "Fine avoidance, safety, high speed and long trips" were given as important reasons for wearing and "feeling trapped and uncomfortable" for not wearing. Seat belt reminder signs in taxis were common (82.6% of taxis), but did not appear to impact on driver seat belt use.

CONCLUSION

The four research methods found taxi drivers to have consistently low "correct wearing" rates.

IMPACT ON INDUSTRY

As in several other countries, taxi drivers are particularly resistant to seat belt use. Innovative strategies, including occupational health and safety approaches, may be required to achieve increased levels of seat belt use.

Belt use: comparison of NASS-CDS and police crash reports

OBJECTIVE

This study compares belt use in police reports with NASS-CDS investigator-determined belt use. The NASS-CDS cases were analyzed by severity of occupant injury and the crash type.

METHODS

1993-2007 NASS-CDS was analyzed for occupant injury severity and crash type. Light vehicles were included with model year 1994+. Injury severity was subdivided by MAIS 0, 1-2, 3, 4+F, and fatal. Crash types were frontal, side, rear, and rollover. The NASS-CDS determination of belt use was assumed the gold standard used to determine miscoding by the police.

RESULTS

The fraction of unbelted occupants increased with the severity of injury from 3.8 percent with no injury to 53.9 percent with fatalities in the police reports. NASS-CDS reported no belt use of 7.9 percent (2.18 times greater than the police) with no injury to 58.2 percent (1.08 times) with fatalities. In side impacts, severely injured occupants were unbelted in 46.9 percent of NASS-CDS cases. This was 1.35 times greater than the 34.7 percent unbelted reported by the police. For severely injured occupants (MAIS 4+F), 18.4 percent of the police reported cases with belt use were actually unbelted occupants by NASS-CDS. The reporting error decreased to 5.0 percent for uninjured occupants (MAIS 0). For uninjured occupants, 35.7 percent of the police-reported cases of no belt use were coded as belted by NASS after inspecting the belt system. This difference decreased to 2.6 percent for fatally injured occupants.

CONCLUSIONS

For occupants with serious-to-fatal injury, the error in police reporting belt use was 13-18 percent. The police often rely on self-reported belt use, which overestimates actual belt wearing and they do not always conduct in-depth investigation of vehicle, seat belt, and occupant injury to reach a conclusion of belt use. The police generally overreport belt use in motor vehicle crashes.

Seat belt use among rear passengers: validity of self-reported versus observational measures

BACKGROUND

The effects of seat belt laws and public education campaigns on seat belt use are assessed on the basis of observational or self-reported data on seat belt use. Previous studies focusing on front seat occupants have shown that self-reports indicate a greater seat belt usage than observational findings. Whether this over-reporting in self reports applies to rear seat belt usage, and to what extent, have yet to be investigated. We aimed to evaluate the over-reporting factor for rear seat passengers and whether this varies by gender and under different compulsory seat belt use conditions.

METHODS

The study was conducted in the Veneto Region, an area in the North-East of Italy with a population of 4.7 million. The prevalence of seat belt use among rear seat passengers was determined by means of a cross-sectional self-report survey and an observational study. Both investigations were performed in two time periods: in 2003, when rear seat belt use was not enforced by primary legislation, and in 2005, after rear seat belt use had become compulsory (June 2003). Overall, 8138 observations and 7902 interviews were recorded. Gender differences in the prevalence of rear seat belt use were examined using the chi-square test. The over-reporting factor, defined as the ratio of the self-reported to the observed prevalence of rear seat belt use, was calculated by gender before and after the rear seat belt legislation came into effect.

RESULTS

Among rear seat passengers, self-reported rates were always higher than the observational findings, with an overall over-reporting factor of 1.4. We registered no statistically significant changes over time in the over-reporting factor, nor any major differences between genders.

CONCLUSION

Self-reported seat belt usage by rear passengers represents an efficient alternative to observational studies for tracking changes in actual behavior, although the reported figures need to be adjusted using an appropriate over-reporting factor in order to gain an idea of genuine seat belt use.

Sustainability of the effects of the demerit points system on seat belt use: a region-wide before-and-after observational study in Italy

To assess the short and long term effects of the demerit points system on seat belt use, we set a region-wide cross-sectional observational study 3 months before, and 3 and 15 months after the introduction of the scheme (July 2003) in the Veneto Region, Italy. We analysed differences in seat belt use by year of observation, gender and position in the vehicle, and obtained adjusted prevalence ratio (APR) through Poisson regression. A total of 29,303 drivers, 28,778 front and 12,186 rear passengers were observed. Prevalence levels of 54% for drivers and 53% for front passengers in 2003 switched to 83 and 76%, respectively, 3 months after the new legislation, with further slight increases 15 months thereafter. Seventy-four percent rear passengers were still not compliant with the legislation in 2005. The probability of being belted was 25% lower in males than females (APR=0.75, 95% CI 0.73-0.77) at the beginning of the study period. However, the effect of the new legislation was 19% greater among males (APR=1.19, 95% CI 1.16-1.23). A substantial increase in seat belt use was reached and sustained with the demerit points system. Specific efforts should target rear passengers whose seat belt use still remains worryingly low.

Seat belt use among Hispanic ethnic subgroups of national origin

OBJECTIVE

Findings from over a dozen studies of Hispanic/white disparities in seat belt use have been inconsistent, variably revealing that seat belt use prevalence among Hispanics is higher, lower, or comparable to use among non-Hispanics. In contrast to previous studies, this study investigates disparities in seat belt use by Hispanic subgroups of national origin.

METHODS

Data from the US Fatality Analysis Reporting System were used to compare seat belt use among 60 758 non-Hispanic whites and 6879 Hispanics (Mexican American (MA), n = 5175; Central American/South American (CASA), n = 876; Puerto Rican (PR), n = 412; Cuban (CU), n = 416) killed in crashes from 1999-2003. Logistic regression was used to adjust for age, gender, seat belt law, seat position, urban/rural region, and income.

RESULTS

Overall adjusted odds ratios for seat belt use among Hispanic subgroups, relative to non-Hispanic whites, were 1.04 (95% confidence interval (CI) 0.85 to 1.28) for CUs, 1.17 (95% CI 0.95 to 1.44) for PRs, 1.33 (95% CI 1.25 to 1.42) for MAs, and 1.66 (95% CI 1.44 to 1.91) for CASAs. Relative to their non-Hispanic white counterparts, odds ratios among MA and CASA Hispanics were highest for men, younger age groups, drivers, primary law states, rural areas, and lower income quartiles.

CONCLUSION

Among all Hispanic subgroups, seat belt use was at least as prevalent as among non-Hispanic whites. In the CASA and MA subgroups, which have the most rapidly growing subpopulations of immigrants, seat belt use was significantly more common than among whites.

Relationship between quality of life and child traffic fatalities

Traffic injuries are the leading cause of morbidity and mortality of children around the world. Economic development and quality of life are main components of public health. Using canonical correlation analysis, this study examined the relationship between quality of life and traffic fatality among children. Data were collected from 19 countries by using World Health Organization and OECD statistics. The results indicated that there is a strong relationship between quality of life and children traffic fatality. Growing quality of life has become protective against child traffic accident mortality. Increasing in gross national income per capita, life expectancy at birth number of years, road motor vehicles per thousand population, and share of persons of working age (15-64 years) in employment also increases children traffic safety.

How children with special needs travel with their parents: observed versus reported use of vehicle restraints

OBJECTIVES

The difficulties entailed in transporting children with special physical and behavioral needs could influence child restraint misuse and nonuse within this population. Although parental interview is often used to assess child vehicle restraint use, little research had been performed to validate this approach, and none has been done in the special-needs population. The objectives of this study were to assess the prevalence of nonuse and misuse of child restraints in the special-needs population and to assess the validity of using parental report as a measure of child restraint use.

METHODS

Restraint use in 115 children with special needs, aged 0 to 18 years, was observed on their arrival at the parking lot of the Alyn Hospital Pediatric Rehabilitation Center in Jerusalem. The observation noted type of restraint used or absence thereof. If a restraint was used, correct use/misuse was recorded. In 94 cases, the parents were interviewed later that day in the clinic.

RESULTS

Seventy percent of the children were observed as traveling unrestrained or with a restraint that was grossly misused to the extent that it provided no meaningful protection. The remaining children were observed displaying a variety of errors in the selection or use of the restraint that compromised their safety to varying degrees. Analysis of the observation results versus parental reporting revealed a 44% overreporting of child restraint use. Sensitivity was 71%, and specificity was 86%.

CONCLUSIONS

The high prevalence of restraint nonuse and misuse within the special-needs population defines this as a population at risk and emphasizes the need for intervention. Cautious interpretation is required of information acquired from parental reporting of child restraint use. The results of this study should raise awareness among professionals working with children with special needs as to the need for tailored assessment and intervention in the area of child-passenger safety.

Self-reported safety belt use among emergency department patients in Boston, Massachusetts

Background

Safety belt use is 80% nationally, yet only 63% in Massachusetts. Safety belt use among potentially at-risk groups in Boston is unknown. We sought to assess the prevalence and correlates of belt non-use among emergency department (ED) patients in Boston.

Methods

A cross-sectional survey with systematic sampling was conducted on non-urgent ED patients age ≥18. A closed-ended survey was administered by interview. Safety belt use was defined via two methods: a single-item and a multiple-item measure of safety belt use. Each was scored using a 5-point frequency scale. Responses were used to categorize safety belt use as 'always' or less than 'always'. Outcome for multivariate logistic regression analysis was safety belt use less than 'always'.

Results

Of 478 patients approached, 381 (80%) participated. Participants were 48% female, 48% African-American, 40% White, median age 39. Among participants, 250 (66%) had been in a car crash; 234 (61%) had a valid driver's license, and 42 (11%) had been ticketed for belt non-use. Using two different survey measures, a single-item and a multiple-item measure, safety belt use 'always' was 51% and 36% respectively. According to separate regression models, factors associated with belt non-use included male gender, alcohol consumption >5 drinks in one episode, riding with others that drink and drive, ever receiving a citation for belt non-use, believing that safety belt use is 'uncomfortable', and that 'I just forget', while 'It's my usual habit' was protective.

Conclusion

ED patients at an urban hospital in Boston have considerably lower self-reported safety belt use than state or national estimates. An ED-based intervention to increase safety belt use among this hard-to-reach population warrants consideration.

Validation of parent self reported home safety practices

OBJECTIVES

To evaluate the validity of parents' self reported home safety practices concerning smoke detectors, bike helmets, car seats, and water heater temperature.

SETTING

Parents of children 12 years old and under whose child had made at least one visit to a study clinic in the years 2000-2003.

METHODS

As part of a randomized controlled trial to improve patient provider communication and preventive practices, parents' responses to telephone interview were compared with observations of safety practices during a home visit. Home visits were completed within nine weeks of the telephone interview. Parents were not told that the visit was part of a validation study and home visit observers were unaware of the interview responses. The authors calculated sensitivities, specificities, positive and negative predictive values, and their corresponding confidence intervals.

RESULTS

Sensitivity (0.78 to 0.98) and positive predictive values (0.75 to 1.00) were high for all items. Specificities and negative predictive values were more variable and the highest estimates (specificity 0.95 to 1.00, negative predictive value 0.95 to 0.97) were for car seat types.

CONCLUSIONS

The results suggest that parent self report practice of certain injury prevention behaviors (owning a car seat, hot water temperatures) is reliable, whereas self reports on other practices (working smoke detectors, properly fitting bike helmets) may be overstated.

Acculturation, income, education, safety belt use, and fatal motor vehicle crashes in California

This paper investigates the role that acculturation, income, and education play in safety belt nonuse among Californian drivers involved in fatal Motor Vehicle Crashes (MVCs). To achieve this goal, measures of acculturation, income, and education were stochastically incorporated into the Fatality Analysis Reporting System (FARS). Using the 1990 California Tobacco Survey and U.S. Census data, we estimated the combination of zip-code-based measures that most accurately predicts an individual, language-based acculturation index for Hispanics and Asians. Logistic regression was used to investigate the role of these variables in safety belt nonuse in fatal MVCs. We found that acculturation has a positive direct effect on safety belt use among Hispanics. We hypothesize that this positive direct effect is caused by Hispanic immigrants learning the benefits of wearing safety belts. However, our study also suggests an indirect negative effect of acculturation on safety belt use through drinking and driving. Prevention programs aimed at increasing the safety of Hispanic drivers not only need to take acculturation differences into account, but also need to be comprehensive in their message, simultaneously targeting both seat belt nonuse and drinking-and-driving problems.

Why are hispanics at greater risk for PTSD?

Several studies have found that Hispanic Americans have higher rates of posttraumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peritraumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States.

Endotracheal intubations in rural pediatric trauma patients

BACKGROUND/PURPOSE

Evidence from urban trauma centers questions the efficacy of pediatric field endotracheal intubations (ETIs). It is recognized that in the rural environment, discovery, transport delays, and a paucity of pediatric expertise contribute to higher pediatric trauma mortality rates compared with urban environments. The purpose of our study was to determine the effectiveness of field ETI in rural pediatric trauma patients.

METHODS

ETI attempts (field, referring hospital, trauma center [TC]) in trauma patients less than 19 years old were included. Prehospital and TC charts, including demographics, injury mechanism, indication, location, person performing, number of attempts, Glascow Coma Scale (GCS), complications from ETI, and outcome, were assessed.

RESULTS

Between 1991 and 2000, 105 of 2,907 patients met study criteria. Paramedics, trauma flight nurses (field ETIs), emergency physicians, surgeons, and anesthesiologists performed the ETI. One hundred fifty-five ETIs (1 to 6 per patient) were attempted in 105 children. Fifty-seven percent of the ETIs were attempted in the field, 22% in transferring hospital, and 21% at the TC. Successful intubation on first attempt was 67% (field), 69% (referring hospital), and 95% (TC). Subsequent ETI attempts had failure rates of 50% (field) and 0% (referring hospital, TC). Indication for ETI included fear of losing airway control (37%), closed head injury (36.1%), respiratory rate less than 10 or greater than 40 (11.2%), cardiopulmonary arrest (6.5%), respiratory arrest (4.6%), and airway obstruction 4.6%. Only 9.3% of children could not be oxygenated or ventilated by bag valve mask (BVM) before ETI. Twenty-three percent had complications directly related to ETI (eg, aspiration). The relative risk of an airway complication was 2.5x higher with more then one ETI attempt (P <.05). Four percent of the airway complications occurred in TC, 29% (transferring hospital) and 66% (field, P <.05), respectively. Airway complications and multiple ETIs were associated with transport delay, lower GCS, longer hospital stay, and lower discharge GCS (P <.001) but independent of injury severity score, sex, age, and survival (P >.05).

CONCLUSIONS

Multiple ETI attempts are associated with significant complications and may offer limited advantage over BVM and possibly may affect outcome. Indications for field intubations may require review especially in rural pediatric trauma.

An investigation of factors reducing seat belt use amongst Spanish drivers and passengers on urban roads

Seat belt use on Spain's highways is more than 80%, while on the urban roads this figure is around 50%. As there was little information available to explain the difference in seat belt use rates, the main aim of this study was to investigate why there is a lower rate of seat belt use on urban roads. A number of perceptions, beliefs and expectancies about seat belt use were examined to identify variables that discriminated between seat belt users and non-users on urban roads. The subjects were 398 undergraduate students (aged 17-47) studying at the University of Girona, Spain. On the urban roads reported discomfort from using the seat belt was higher, while perceptions of risk (for non-users), safety perceptions (for those using a seat belt), beliefs about the seriousness of a crash or the effectiveness of the seat belt were all lower than on the highway. Perceptions of safety, discomfort, and social influence predicted seat belt use on urban roads. Concern about being fined for not using a seat belt did not predict seat belt use. The results of this research suggest that in order to increase seat belt use on urban roads, the issue of discomfort must be addressed. In addition, prevention campaigns should include information about the effectiveness of the seat belt in preventing/reducing injuries or deaths on urban roads. The results also highlight the importance of social influence for determining seat belt use/non-use and the potential role social influence could play in increasing seat belt usage.

Validation of a home safety questionnaire used in a randomised controlled trial

OBJECTIVE

To measure the validity of self reported safety practices from a questionnaire, completed by families participating in a home safety randomised controlled trial.

METHODS

The postal questionnaire was used to measure secondary outcomes in a randomised controlled trial. The answers to 26 questions that could be assessed by observation were checked by a home visit. Families were invited to take part in a "home safety check"; they were not told that the visit was part of a validation study. At the time of the visit the researcher was blind to the self reports in the questionnaires.

RESULTS

Sixty four questionnaires were validated by visits to 64 households. Percentage agreement ranged from 58% to 100%. Sensitivity was high (68% or above) for most safety practices. The positive predictive value was also high for most safety practices (78% or above for 15 of the 16 practices).

CONCLUSIONS

This study found a fairly high degree of consistency between self reported data and actual observations. The findings from this relatively small study need confirmation from larger studies.

Car seatbelt use during pregnancy in Japan: determinants and policy implications

CONTEXT

Pregnant women are exempted from the current seatbelt legislation in Japan despite the fact that seatbelt use is essential to reduce the risk of fatalities for these women and their fetuses in car crashes.

OBJECTIVE

To examine factors that might influence seatbelt use during pregnancy.

METHODS

A cross sectional study, with data collected via an anonymous, self administered questionnaire at obstetric clinics in suburban areas of Japan. Altogether 880 pregnant women receiving prenatal care in July 2001 were recruited. The relative effects of factors that might influence seatbelt use during pregnancy were estimated using logistic regression analysis.

RESULTS

Almost 70%-80% of pregnant women were consistent seatbelt wearers before pregnancy but seatbelt compliance was reduced by about half at 20 weeks or more gestation. Only 20% had received information on maternal seatbelt use, with one third reporting that seatbelt use is beneficial during pregnancy. Those who perceived that maternal seatbelt use is beneficial tended to maintain use, but daily car users and those who knew that they were exempted from seatbelt legislation were more likely to reduce use.

CONCLUSIONS

Knowledge of the legislative exemption for pregnant women, misunderstanding of the benefits, and daily car use contributed to the reduction in seatbelt use after pregnancy.