Seat-Belt Use In US Counties: Limited Progress Toward Healthy People 2020 Objectives

The prevalence of seat belt use among drivers and passengers: a systematic review and meta-analysis

BACKGROUND

Seat belts might save people's lives in car accidents by preventing severe collision damage and keeping passengers safe from critical injuries. This meta-analysis was performed to assess the prevalence of seat belt use among drivers and passengers.

METHODS

The databases of PubMed, Web of Science (WOS), and Google Scholar were searched from the beginning of 2000 to late December 2020 to identify studies that investigated the prevalence of seat belt use among drivers and passengers. The pooled prevalence was calculated using a random-effects model. The STATA-v14 software was used to perform data analysis.

RESULTS

Sixty-eight studies that met the inclusion criteria and were suitable for this meta-analysis were identified. The pooled prevalence of seat belt use was 43.94% (95% CI: 42.23-45.73) among drivers, 38.47% (95% CI: 34.89-42.42) among front-seat passengers, and 15.32% (95% CI: 12.33-19.03) among rear-seat passengers. The lowest seat belt use among drivers and passengers was observed in Asia, the Middle East, and Africa, while the highest use was reported in Europe and America. Moreover, the prevalence of seat belt use was higher among women drivers [51.47% (95% CI: 48.62-54.48)] than men drivers [38.27% (95% CI: 34.98-41.87)] (P < 0.001). Furthermore, the highest prevalence of seat belt use was seen among drivers (68.9%) and front-seat passengers (50.5%) of sports utility vehicles (SUVs); in contrast, the lowest prevalence was observed among drivers and passengers of public vehicles such as buses, minibuses, and taxis.

CONCLUSIONS

In general, the prevalence of seat belt use was not high among drivers and was even lower among passengers. Moreover, drivers and passengers in Asia, the Middle East, and Africa had the lowest prevalence of seat belt usage. Additionally, drivers and passengers of public transportation (buses, minibuses, and taxis) had a lower rate of seat belt use, especially among men. Therefore, effective interventional programs to improve seat belt use should be designed and implemented, particularly among these at-risk populations in Asia, the Middle East, and Africa.

Does driver seatbelt use increase usage among front seat passengers? An exploratory analysis

INTRODUCTION AND METHOD

Observational data collected during the Wisconsin 2017, 2018, and 2019 National Occupant Protection Use Survey (NOPUS) were analyzed for this study to explore the influence of drivers' seatbelt use on front seat passengers' usage in the same vehicle. The analyses include comparing seatbelt usage rates for drivers and front passenger(s) based on their gender and based on geographical area as well as analyses of the aggregated data.

RESULTS

The descriptive analyses strongly suggest that seatbelt usage rates of passengers differ considerably depending on whether the driver uses the seatbelt. When female drivers wear seatbelts, seatbelt usage rates for female front seat passengers for the three years 2017, 2018, and 2019 are 97.8%, 96.3%, and 97.1% respectively, with corresponding usage rates for male passengers being 95.5%, 93.0%, and 96.0% respectively. When male drivers wear seatbelts, the seatbelt usage rates for male front seat passengers for the three years 2017, 2018, and 2019, are 93.4%, 95.5%, and 94.3%, respectively, with the corresponding usage rates for female passengers being 97.7%, 96.0%, and 97.7%, respectively. The evidence suggests that drivers' use of seatbelts significantly improves the seatbelt usage of front seat passengers. Seatbelt usage rates of male passengers as well as female passengers are higher while traveling with female drivers who use seatbelts than while traveling with male drivers who use seatbelts. Conclusions and Practical Applications: Future seatbelt use campaigns should target males.

Predictors of Seatbelt Use Among Saudi Adults: Results From the National Biobank Project

Introduction: Road traffic crashes (RTCs) are a leading cause of death and disabilities and impose a significant burden on the healthcare system and economy of Saudi Arabia. Around 20% of all hospital beds are occupied by victims of RTCs, which represent approximately 80% of trauma deaths occurring in these facilities. Using a seatbelt is an effective method to reduce traffic deaths and minimize the extent of associated injuries. However, little is currently known about the prevalence and predictors of seatbelt use in Saudi Arabia. More studies are needed to determine the trends of seatbelt use and study the relationship between individual factors and compliance with seatbelt use laws. The aim of the present study is to examine the prevalence and predictors of seatbelt use using the National Saudi Biobank dataset.

Materials and Methods: This cross-sectional study was conducted using an in-person survey from the Saudi National Biobank (SNB). The participants were adults affiliated with the Ministry of National Guard Health Affairs in Riyadh who were examined between 2017 and 2019. Chi-squared and Wald tests were used to assess the association between the respondents' characteristics and their seatbelt use. In addition, logistic regression models were constructed to assess the univariate and multivariate associations between seatbelt use and potential predictors. All statistical tests were two-sided, and the findings were considered significant at P < 0.05.

Results: A total of 5,790 adults participated in the survey. The majority of the participants (52.44%) were between 18 and 25 years old, half were males, and 58.80% were single. About 42.83% of the participants reported consistent seatbelt use as drivers or passengers. In the multivariable analysis, females were 86% less likely to wear seatbelts than males (OR = 0.136, 95%CI = 0.107–0.173). Individuals who rated their mental health as “weak” were 26% less likely to wear seatbelts than those who reported “excellent” mental health status.

Conclusion: Seatbelt use remains low in the country and substantially lower than in developed countries. Young adults, females, and individuals reporting suboptimal mental health were less likely to fasten their seatbelts. These findings are valuable for public health programs to target specific groups and raise awareness about the need to increase seatbelt compliance and reduce traffic injuries.

Using Bluetooth beacon technology to reduce distracted pedestrian behaviour: a cross-over trial study protocol

OBJECTIVE

Over 6400 American pedestrians die annually, a figure that is currently increasing. One hypothesised reason for the increasing trend is the role of mobile technology in distracting both pedestrians and drivers. Scientists and policy-makers have attended somewhat to distracted driving, but attention to distracted pedestrian behaviour has lagged. We will evaluate Bluetooth beacon technology as a means to alert and warn pedestrians when they approach intersections, reminding them to attend to the traffic environment and cross streets safely.

METHODS

Bluetooth beacons are small devices that broadcast information unidirectionally within a closed proximal network. We will place beacons at an intersection frequently trafficked by urban college students. From there, the beacons will transmit to an app installed on users' smartphones, signalling users to attend to their environment and cross the street safely. A cross-over trial will evaluate the app with 411 adults who frequently cross the target intersection on an urban university campus. We will monitor those participants' behaviour over three distinct time periods: (1) 3 weeks without the app being activated, (2) 3 weeks with the app activated and (3) 4 weeks without the app activated to assess retention of behaviour. Throughout the 10-week period, we will gather information to evaluate whether the intervention changes distracted pedestrian behaviour using a logistic regression to estimate the likelihood of key behavioural outcome measures and adjusting for any residual confounding. We also will test for changes in perceived risk. The trial will follow CONSORT (Consolidated Standards of Reporting Trials) statement guidelines, as modified for cross-over design studies.

CONCLUSION

If this program proves successful, it offers exciting implications for future testing and ultimately for broad distribution to reduce distracted pedestrian behavior. We discuss issues of feasibility, acceptability and scalability.

Self-reported factors that influence rear seat belt use among adults

INTRODUCTION

While seat belt use among front seat occupants has significantly increased overtime a substantial usage gap still exists between front and back seat occupants. This study aims to identify factors that predict rear seat belt use among adult back seat passengers.

METHODS

We examined data from the 2016 Motor Vehicle Occupant Safety Survey, conducted by the National Highway Traffic Safety Administration, to determine the influence of front seat belt use, support of and belief of rear seat belt use laws, peer perception of seat belt use, nighttime belt use, and demographic factors on self-reported rear seat belt use. Rao-Scott chi-squared tests were used to determine significant associations between self-reported rear belt use and each predictor. Multivariate logistic regression was used to calculate adjusted odds ratios and determine the influence of significant predictors on rear seat belt use. Sampling weights were applied to produce nationally representative estimates; all statistical significance tests accounted for the complex survey design.

RESULTS

Among adults who reported riding in the back seat, 63% reported always using a rear seat belt. Front seat belt use, support and belief of state seat belt laws, nighttime seat belt use, age, and education were significantly associated with rear seat belt use. Multivariate regression results showed that adults who supported rear seat belt laws, reported front seat belt use and believed their state has a rear seat belt law were significantly more likely to report full-time use in the back seat.

CONCLUSIONS

Seat belt laws and front seat belt use had the strongest association with reporting full-time use in the back seat. Practical Applications: Increasing familiarity with existing laws directed towards rear seat belt use as well as increasing awareness about the benefits of seat belts in all seating positions may help improve rear seat belt use.

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

INTRODUCTION

Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt.

METHOD

Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none).

RESULTS

Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region).

CONCLUSIONS

Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.

Rural and Urban Differences in Passenger-Vehicle-Occupant Deaths and Seat Belt Use Among Adults - United States, 2014

PROBLEM/CONDITION

Motor-vehicle crashes are a leading cause of death in the United States. Compared with urban residents, rural residents are at an increased risk for death from crashes and are less likely to wear seat belts. These differences have not been well described by levels of rurality.

REPORTING PERIOD

2014.

DESCRIPTION OF SYSTEMS

Data from the Fatality Analysis Reporting System (FARS) and the Behavioral Risk Factor Surveillance System (BRFSS) were used to identify passenger-vehicle-occupant deaths from motor-vehicle crashes and estimate the prevalence of seat belt use. FARS, a census of U.S. motor-vehicle crashes involving one or more deaths, was used to identify passenger-vehicle-occupant deaths among adults aged ≥18 years. Passenger-vehicle occupants were defined as persons driving or riding in passenger cars, light trucks, vans, or sport utility vehicles. Death rates per 100,000 population, age-adjusted to the 2000 U.S. standard population and the proportion of occupants who were unrestrained at the time of the fatal crash, were calculated. BRFSS, an annual, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years, was used to estimate prevalence of seat belt use. FARS and BRFSS data were analyzed by a six-level rural-urban designation, based on the U.S. Department of Agriculture 2013 rural-urban continuum codes, and stratified by census region and type of state seat belt enforcement law (primary or secondary).

RESULTS

Within each census region, age-adjusted passenger-vehicle-occupant death rates per 100,000 population increased with increasing rurality, from the most urban to the most rural counties: South, 6.8 to 29.2; Midwest, 5.3 to 25.8; West, 3.9 to 40.0; and Northeast, 3.5 to 10.8. (For the Northeast, data for the most rural counties were not reported because of suppression criteria; comparison is for the most urban to the second-most rural counties.) Similarly, the proportion of occupants who were unrestrained at the time of the fatal crash increased as rurality increased. Self-reported seat belt use in the United States decreased with increasing rurality, ranging from 88.8% in the most urban counties to 74.7% in the most rural counties. Similar differences in age-adjusted death rates and seat belt use were observed in states with primary and secondary seat belt enforcement laws.

INTERPRETATION

Rurality was associated with higher age-adjusted passenger-vehicle-occupant death rates, a higher proportion of unrestrained passenger-vehicle-occupant deaths, and lower seat belt use among adults in all census regions and regardless of state seat belt enforcement type.

PUBLIC HEALTH ACTIONS

Seat belt use decreases and age-adjusted passenger-vehicle-occupant death rates increase with increasing levels of rurality. Improving seat belt use remains a critical strategy to reduce crash-related deaths in the United States, especially in rural areas where seat belt use is lower and age-adjusted death rates are higher than in urban areas. States and communities can consider using evidence-based interventions to reduce rural-urban disparities in seat belt use and passenger-vehicle-occupant death rates.