Associations between sociodemographics and safety belt use in states with and without primary enforcement laws

Surveillance methods and interventions implemented in American Indian and Alaska Native communities to increase child restraint device and seat belt use in motor vehicles: a systematic review

BACKGROUND

American Indian/Alaska Native (AI/AN) children are disproportionately affected by injuries and deaths related to motor vehicle crashes. We aimed to synthesise published evidence on surveillance methods and interventions implemented in AI/AN communities and analyse characteristics that make them successful in increasing child restraint devices and seat belt use.

METHODS

Studies were collected from the PubMed, Scopus, and TRID databases and the CDC Tribal Road Safety website, Community Guide, and Indian Health Service registers. Included studies collected primary data on AI/AN children (0-17) and reported morbidity/mortality outcomes related to child restraint devices or seat belt use. Studies with poor methodological quality, published before 2002, whose data were collected outside of the USA, or were non-English, were excluded. Checklists from the Joanna Briggs Institute were used to assess the risk of bias. In the synthesis of results, studies were grouped by whether a surveillance method or intervention was employed.

RESULTS

The final review included 9 studies covering 72 381 participants. Studies conducted surveillance methods, interventions involving law enforcement only and multipronged interventions. Multipronged approaches were most effective by using the distribution of child restraint devices combined with at least some of the following components: educational programmes, media campaigns, enactment/enforcement of child passenger restraint laws, incentive programmes and surveillance.

DISCUSSION

Although this review was limited by the number and quality of included studies, available resources suggest that we need multipronged, culturally tailored and sustainable interventions fostered by mutually beneficial and trusting partnerships. Continued investment in AI/AN road safety initiatives is necessary.

Are out-of-state drivers more seatbelt compliant than in-state drivers in the United States?

INTRODUCTION

This study explored the seatbelt use among in-state and out-of-state drivers in relation to their personal (age, gender, license status, etc.) and crash characteristics (time, location, roadway factors, etc.) using crash data over a 10-year period (2010-2019) from the Fatality Analysis Reporting System (FARS).

METHOD

Comparison of seatbelt use between the two groups (in-state vs. out-of-state drivers) were conducted using Z-test statistics. Logistic regression models were developed to examine the probability of seatbelt use among each group.

RESULTS

New findings in this study showed that out-of-state drivers were 5% more likely than in-state drivers to use seatbelts. Regardless of the driver's age, gender, license status, vehicle type, and injury severity, seatbelt use was significantly higher among out-of-state drivers. Moreover, irrespective of the location (rural or urban), the season (time, day, or month), road type (arterial, local streets, etc.), and jurisdictional seatbelt law (primary or secondary), out-of-state drivers were more seatbelt compliant than in-state drivers. Finally, out-of-state drivers traveling from states with secondary/no seatbelt laws exhibited higher seatbelt compliance rate in primary seatbelt law states than in states with less strict laws (i.e., secondary/no law).

PRACTICAL APPLICATIONS

The findings in this study are critical to addressing a myriad of policy questions related to seatbelt laws and seatbelt use. Future research should focus on the disparity in seatbelt use between the two groups and determine intervention strategies that are effective at promoting seatbelt use across the United States. Additionally, given the significant differences in driver seatbelt use behavior based on the type of seatbelt law, if states with less strict laws upgrade to primary seatbelt laws, there likely will be increases in seatbelt compliance in those states.

Factors that Associate Japanese University Students' Use of Rear Seat Belts on General Roads and Expressways

This study clarifies the prevalence of rear seat belt use among university students and explores the factors that influence seat belt use on general roads and expressways. Questionnaires were distributed to 1,091 students who attended health education lectures: 893 students (81.9%) agreed to participate and met the criteria; among them, 660 (73.9%) provided complete responses. While one-third (33.0%) of rear seat passengers "always" used seat belts on general traffic roads, three-fourths (73.2%) "always" used them on expressways. Multivariate analysis revealed that being male and the perception of obligation and recognition of the benefits of rear seat belt use were associated with use on general roads, whereas the possession of a driver's license and recognition of benefits were associated with use on expressways. Finally, we suggest that educational programs on seat belt use be developed and delivered to general road and expressway users to promote seat belt use.

The effects of Chile's 2005 traffic law reform and in-country socioeconomic differences on road traffic deaths among children aged 0-14 years: A 12-year interrupted time series analysis

OBJECTIVES

This study assessed the effect of Chile's 2005 traffic law reform (TLR) on the rates of road traffic deaths (RTD) in children aged 0-14 years, adjusting for socioeconomic differences among the regions of the country.

METHODS

Free-access sources of official and national information provided the data for every year of the study period (2002-2013) and for each of the country's 13 upper administrative divisions with respect to RTD in child pedestrians and RTD in child passengers (dependent variables), and the following control variables: the number of road traffic tickets processed, investment in road infrastructure, poverty, income inequality, insufficient education, unemployment, population aged 0-14 years, and prevalence of alcohol consumption in the general population. Interrupted time series analyses (level and slope change impact model), using generalized estimating equation methods, were conducted to assess the impact of the TLR (independent variable) on the dependents variables.

RESULTS

There was a significant interaction between time and Chile's 2005 TLR for a reduction in child pedestrians (incidence rate ratio [IRR] 0.87, 95% confidence interval [CI] 0.79-0.96) and passengers RTD (IRR for interaction 0.80, 95% CI 0.67-0.96) trends. In addition, in child pedestrians, RTD rates were affected by poverty (IRR 1.04, 95% CI 1.02-1.05), income inequality (IRR 1.02, 95% CI 1.00-1.04), and unemployment (IRR 0.94, 95% CI 0.90-0.98), whereas in the case of child passengers, poverty (IRR 1.05, 95% CI 1.01-1.08) and income inequality (IRR 0.93, 95% CI 0.91-0.95) were significant.

CONCLUSIONS

Large-scale legislative actions can be effective road safety measures if they are aimed at promoting behavioral change in developing countries, improving the safety of children on the road. Additionally, regional socioeconomic differences are associated with higher RTD rates in this population, making this an argument in favor of road safety policies that consider these inequalities. The number of road traffic tickets processed and the investment in road infrastructure were not significant.

More aware, more protected: a cross-sectional study on road safety skills predicting the use of passive safety elements among Spanish teenagers

OBJECTIVE

This study had two objectives: first, to test the effects of sociodemographic variables, and the effects of three key road safety skills (knowledge-risk perception-attitudes) on the use of passive safety elements (PSEs) among teenagers; and second, to assess the differential impact of the study variables on PSEs use from a gender-based perspective.

SETTING AND PARTICIPANTS

This cross-sectional study was framed in the paradigm of primary care, and it involved students from several educational centres in Spain. A sample of 827 Spanish teenagers (52.4% females and 47.6% males) with a mean age of M=14.41-7 (12-19) years was used.

RESULTS

Through SEM modelling, we found that the use of PSEs is largely explained by psychosocial variables through the mediation of three road safety skills: risk perception (β=0.103^***), rule knowledge (β=0.095^*) and attitudes towards road safety (β=0.186^***). Furthermore, multigroup analyses showed that, although most variables explain the use of PSEs among teenagers in a similar way, key gender-based differences exist in this regard.

CONCLUSIONS

Road safety skills have a significant effect on the use of PSEs among Spanish teenagers, and gender explains some differences in the mechanisms which predict them. Also, in the study we discuss the need for strengthening school-based interventions aimed at helping this vulnerable group of road users acquire and develop positive behavioural competences.

Research on Injury Disparities: A Scoping Review

Background: Research on disparities in traumatic injury has not been well characterized, limiting understanding of gaps in research and development of successful interventions. We conducted a scoping review to identify and synthesize research on disparities in intentional and unintentional traumatic injuries.

Methods: The review was guided by PRISMA Extension for Scoping Reviews. PubMed, PsycINFO, Web of Science, and CINAHL and systematic reviews from 2007 to 2017 were searched. Eligible articles were peer reviewed; conducted in the United States; and reported on clearly defined physical trauma and disparity, defined by Cochrane PROGRESS-Plus criteria. One reviewer assessed article titles and a second reviewer validated the inclusion with a random sample. Abstract and full-text review by two reviewers determined final inclusion.

Results: Of 7382 unique articles screened, 653 articles were included; inter-rater agreement was high (K=0.995). Studies reported on disparities in the acute hospital setting (104) or postacute/rehabilitation (86), with fewer focused on prevention (57) and policy development (6). Research methods used were quantitative (593) with 25 intervention studies, qualitative (45), qualitative/quantitative (7), and community-based participatory research (8). Age ranges of included studies were all ages (124), adults (318), pediatric/youth/adolescents (172), and older adults (40). Racial disparities were most commonly measured (439 studies); 38 created a white/nonwhite binary. Other commonly measured disparities were place of residence (122), insurance (111 studies), gender (89), age (75), and socioeconomic status measures (61). Disparities were noted in all of the categories. Studies commonly aggregated all types of traumatic injuries (129) or all types of violence (105).

Conclusions: The extant injury literature lacks research on prevention and policy to address disparities. Many studies aggregated types of trauma and patient groups, preventing an understanding of distinctions between groups and potential interventions. Intervention and community-based research strategies were limited. Future research can better specify measurement of understudied equity categories, trauma types and intent, and racial groups.

Correlates of front-seat passengers' non-use of seatbelts at night

When properly worn, seatbelts can save lives. They are designed to prevent occupants from hitting objects inside their vehicle and from being ejected out of their vehicle in the event of a crash. Despite their proven effectiveness in reducing the severity of injuries, seatbelt non-use among passengers still remains a problem, especially at night. Although the factors associated with not using a seatbelt have been widely studied, research studies documenting this behavior at night are limited in the literature. The primary objective of this paper is to explore the factors related to front-seat passengers' seatbelt non-use at night using a 2015-2016 longitudinal observation survey conducted in five counties in East Tennessee. The Generalized Estimating Equation, a rigorous modeling technique, is employed for the data analysis. The findings show that front-seat passengers who are most likely to not wear seatbelts at night are males, traveling in passenger cars and pickup trucks, traveling during the first half of the year (January to June), traveling late at night (after 10 p.m) and on local streets. The findings also indicate that drivers may have the greatest influence on their accompanying passengers' seatbelt use. That is, when drivers fail to wear seatbelts at night, their accompanying front-seat passengers are more likely to fail as well. The model results show that there are many consistent correlations between the non-use of seatbelts and personal, vehicle and environmental characteristics. Accounting for these factors may be important when developing intervention strategies that promote nighttime seatbelt use.

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.

Assessment of seat belt use and its associated factors among public transport drivers in North Gondar, Ethiopia: a cross-sectional study

OBJECTIVE

Road traffic injuries are the major and neglected public health challenges. It causes 1.2 million deaths and 50 million injuries yearly and the use of seat belt reduces 60% of the cases. However, little is known about the magnitude of utilizing seat belt and associated factors in Ethiopia. Hence, the aim of this study was to assess the seat belt practice and associated factors among minibus and taxi drivers.

RESULTS

The magnitude of seat belt users is 69.6%. The majority (98.1%) of drivers used seat belt to minimize injuries, 95.8% to prevent casualties, 92.5% to safeguard vehicle occupants, 29.9% to generate revenue for government and 22.8% to beautify the vehicle. Almost 80% of participants reported that wearing seat belt could save lives; and 29.6% of them wear belts because of stiffer penalties. For not using seat belts, more than 18% drivers reasoned out that it is not guarantee for safety and it wastes time to wear. In the multiple logistic regression being taxi driver (AOR = 1.998, 95% CI 1.250, 3.192), being married (AOR = 2.91, 95% CI 1.118, 7.601) and attended vocational school and above (AOR = 2.140, 95% CI 1.014, 4.519) were associated with 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.

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.

Seatbelt use among drivers in an urban city in Nigeria: an observational study

Studies from parts of Nigeria reported low compliance with seatbelt. This study sought to establish driver seatbelt use in Enugu, Nigeria by gender, vehicle type/use and time of day. Observations were done day and night at randomly selected locations. Data were analysed with SPSS version 15. Differences in response were checked with chi-square for trend. Confidence interval was 95% and P value < 0.05 was regarded as significant. Average compliance was 37.6% for the 510 males (85%) and 90 females (15%) observed. It was 74.8% in the day and 0.3% at night. Among males, 218 (42.7%) wore seatbelt while 9 (10%) females did. For commercial drivers 159 (65.2%) complied while 68 (19.1%) private drivers did. Truck drivers had 100% compliance while sports utility vehicle drivers had the lowest (18.8%). There is poor seatbelt compliance in Enugu, Nigeria and need for educational campaigns and stricter enforcement.

Who actually receives cell phone use while driving citations and how much are these laws enforced among states? A descriptive, cross-sectional study

OBJECTIVES

While numerous cell phone use while driving laws have been passed among states, little information exists regarding who gets cited for these traffic infractions and how much these laws are enforced at the state-level within the USA.

DESIGN

Cross-sectional, descriptive study.

SETTING

14 states and the District of Columbia.

PARTICIPANTS

Those receiving cell phone use while driving citations within included states from 2007 to 2013.

PRIMARY OUTCOME

Demographic characteristics of cited drivers were assessed. Rates of infractions per 100 000 licensed in-state drivers per year for various cell phone use while driving violations were calculated.

RESULTS

Drivers were cited for hand-held use violations (n=2.5 million) more than texting (n=14 682) or young driver all cell phone bans (n=342). Among states that provided data for all traffic violations, cell phone use while driving citations comprised 1% of all written citations. Regardless of ban type, males (68.2%) were cited more frequently than females. Drivers 25-64 years of age (90.8%) were more likely to be cited for hand-held phone use. The average yearly rate of infractions per 100 000 licensed in-state drivers from 2010-2013 was 5.8 for texting bans, 2607 for hand-held bans, and 9954 for any traffic violation.

CONCLUSIONS

Among cited drivers, age and sex differences existed by the type of ban violated. State-level enforcement appeared sparse. Due to the potential serious consequences of cell phone use while driving in the USA, more enforcement and targeted public safety campaigns are likely needed.

A comparison of self-reported seat belt usage among the Appalachian and non-Appalachian United States

PURPOSE

Seat belts are known to effectively prevent death and serious injury among motorists involved in vehicular collisions. Limited research exists regarding seat belt usage in Appalachia. This study compares self-reported seat belt use in the Appalachian and non-Appalachian counties of the United States.

METHODS

Data from 2012 Behavioral Risk Factor Surveillance System were used to calculate nationally representative estimates of consistent seat belt usage in each region. These estimates were stratified by age, sex, and rurality. Total and potential lives saved by seat belts were calculated for each region using 2012 Fatality Analysis Reporting System data.

RESULTS

Of the 345,513 respondents (unweighted), Appalachians were 6% less likely than non-Appalachians to always wear a seat belt (relative risk = 0.94, 95% confidence interval, 0.93-0.95). Seat belt usage was consistently lower among Appalachians regardless of sex, age, or rurality. Only 68.1% of rural, Appalachian youth reported always wearing a seat belt. Seat belt usage was highest among non-Appalachian females residing in urban areas (92.5%). With 100% belt compliance, an additional 360 and 1712 potential lives could have been saved in Appalachia and non-Appalachia, respectively.

CONCLUSIONS

Regional differences possibly influence seat belt usage. Therefore, public health interventions to increase seat belt usage in Appalachia are likely warranted.

Trends in Socioeconomic Inequalities in Motor Vehicle Accident Deaths in the United States, 1995-2010

Motor vehicle accident (MVA) mortality has been declining overall, but little is known about trends by socioeconomic position. We examined trends in education-related inequalities in US MVA death rates from 1995 to 2010. We used mortality data from the National Center for Health Statistics and population estimates from the Current Population Survey, and we calculated vehicle- and person-miles traveled using data from the National Household Travel Survey. We used negative binomial regression to estimate crude and age-, sex-, and race-adjusted mortality rates among adults aged 25 years or more. We found larger mortality decreases among the more highly educated and some evidence of mortality increases among the least educated. Adjusted death rates were 15.3 per 100,000 population (95% confidence interval (CI): 10.7, 19.9) higher at the bottom of the education distribution than at the top of the education distribution in 1995, increasing to 17.9 per 100,000 population (95% CI: 14.8, 21.0) by 2010. In relative terms, adjusted death rates were 2.4 (95% CI: 1.7, 3.0) times higher at the bottom of the education distribution than at the top in 1995, increasing to 4.3 times higher (95% CI: 3.4, 5.3) by 2010. Inequality increases were larger in terms of vehicle-miles traveled. Although overall MVA death rates declined during this period, socioeconomic differences in MVA mortality have persisted or worsened over time.

Predictors of rear seat belt use among U.S. adults, 2012

INTRODUCTION

Seat belt use reduces the risk of injuries and fatalities among motor vehicle occupants in a crash, but belt use in rear seating positions is consistently lower than front seating positions. Knowledge is limited concerning factors associated with seat belt use among adult rear seat passengers.

METHODS

Data from the 2012 ConsumerStyles survey were used to calculate weighted percentages of self-reported rear seat belt use by demographic characteristics and type of rear seat belt use enforcement. Multivariable regression was used to calculate prevalence ratios for rear seat belt use, adjusting for person-, household- and geographic-level demographic variables as well as for type of seat belt law in place in the state.

RESULTS

Rear seat belt use varied by age, race, geographic region, metropolitan status, and type of enforcement. Multivariable regression showed that respondents living in states with primary (Adjusted Prevalence Ratio (APR): 1.23) and secondary (APR: 1.11) rear seat belt use enforcement laws were significantly more likely to report always wearing a seat belt in the rear seat compared with those living in a state with no rear seat belt use enforcement law.

CONCLUSIONS AND PRACTICAL APPLICATIONS

Several factors were associated with self-reported seat belt use in rear seating positions. Evidence suggests that primary enforcement covering all seating positions is an effective intervention that can be employed to increase seat belt use and in turn prevent motor vehicle injuries to rear-seated occupants.

Using Enforcement and Adjudication Data to Assess the Impact of a Primary Safety Belt Law

BACKGROUND

Identification of effective implementation strategies for motor vehicle injury prevention law is an important priority for research in public health law and policy. Extensive literature in related fields demonstrates the relationship between enforcement activities and achievement of safety objectives.

PURPOSE

We conducted this study to determine the role of enforcement and adjudication in the implementation of a primary safety belt law, including the level and sustainability of safety belt-related conviction rates, using newly available data from the state judicial administrative authority. A secondary goal was to assess the contribution of the administrative data set to the analysis of the primary safety belt law.

METHODS

The analysis used an interrupted time series design to evaluate the longitudinal effect of the primary safety belt law implementation in 2007 on safety belt infractions and convictions in Kentucky, 2003-2012. Segmented regression analysis was used to estimate changes in the level and trend of safety belt nonuse conviction rate after the full implementation of the law, while controlling for the baseline level and trend. The association between the safety belt-related conviction rates and other expected outcomes of the law's implementation was studied.

RESULTS

Safety belt citations doubled and convictions nearly tripled during the decade studied, most dramatically in the first year. Increases were sustained throughout the study period. There was a strong positive linear association between the safety belt nonuse conviction rate and the observed safety belt use in the state, as well as a strong negative association between the safety belt nonuse conviction rate and the number of nonrestrained motor vehicle crash fatalities.

DISCUSSION

Our analysis demonstrates that Kentucky's public safety and judicial systems took the new law seriously and enforced it effectively and that the increased level of enforcement persisted for at least 5 years after implementation. We also find that data from judicial system administrative agency reports make an important contribution to public policy analysis. In the face of persistent antiregulatory forces and public-sector budget cuts, it is critically important to document the relationship between enforcement activities and the achievement of legislative goals.

Share of mass transit miles traveled and reduced motor vehicle fatalities in major cities of the United States

The USA leads the developed world in motor vehicle fatalities, presenting a critical public health threat. We examined whether an increasing share of mass transit use, relative to vehicle miles traveled on public roads, was associated with reduced motor vehicle fatalities. We used annual city-level data for the USA from 1982-2010 provided by the Fatality Accident Reporting System, the Texas A&M Transportation Institute, the Census Bureau, and the National Oceanic and Atmospheric Administration to estimate a structural equation model of the factors associated with mass transit miles and motor vehicle fatalities. The final analytic data included 2,900 observations from 100 cities over 29 years. After accounting for climate, year, and the economic costs of driving, an increasing share of mass transit miles traveled per capita was associated with reduced motor vehicle fatalities. The costs of congestion to the average commuter and gas prices were positively associated with increasing the share of mass transit miles traveled. The economic costs of driving increased over time, while both the fatality rate and the share of mass transit miles traveled decreased over time. Increasing the share of mass transit miles traveled may be associated with fewer motor vehicle miles traveled. Increasing mass transit uptake may be an effective public health intervention to reduce motor vehicle fatalities in cities.

State-by-state variations in cardiac rehabilitation participation are associated with educational attainment, income, and program availability

PURPOSE

Wide geographic variations in cardiac rehabilitation (CR) participation in the United States have been demonstrated but are not well understood. Socioeconomic factors such as educational attainment are robust predictors of many health-related behaviors, including smoking, obesity, physical activity, substance abuse, and cardiovascular disease. We investigated potential associations between state-level differences in educational attainment, other socioeconomic factors, CR program availability, and variations in CR participation.

METHODS

A retrospective database analysis was conducted using data from the US Census Bureau, the Centers for Disease Control and Prevention, and the 1997 Medicare database. The outcome of interest was CR participation rates by state, and predictors included state-level high school (HS) graduation rates (in 2001 and 1970), median household income, smoking rates, density of CR program (programs per square mile and per state population), sex and race ratios, and median age.

RESULTS

The relationship between HS graduation rates and CR participation by state was significant for both 2001 and 1970 (r = 0.64 and 0.44, respectively, P < .01). Adding the density of CR programs (per population) and income contributed significantly with a cumulative r value of 0.74 and 0.71 for the models using 2001 and 1970, respectively (Ps < .01). The amount of variance accounted for by each of the 3 variables differed between the 2000 and 1970 graduation rates, but both models were unaltered by including additional variables.

CONCLUSIONS

State-level HS graduation rates, CR programs expressed as programs per population, and median income were strongly associated with geographic variations in CR participation rates.

Modeling the impact of rescinding Michigan's primary and secondary seat belt laws on death and injury from passenger vehicle crashes

BACKGROUND

Seat belts are the most effective method of decreasing fatal and nonfatal motor vehicle crash injury. Advocacy groups have recently been successful in enacting repeals of mandatory motorcycle helmet laws in several states. In some states, this has prompted renewed efforts aimed at repealing mandatory seat belt laws.

PURPOSE

To evaluate and quantify the potential impact of rescinding seat belt laws on annual crash-related fatalities, nonfatal injuries, and associated economic costs, using Michigan as a model, to inform the national debate.

METHODS

Proportional injury rates were calculated utilizing police-reported statewide passenger vehicle crash data from 1999 and 2002, where belt use rates approximate estimates associated with repeal of primary and secondary seat belt laws. Proportional rates were applied to the most recent year of crash data (2011) to estimate changes in statewide fatalities and nonfatal injuries. National cost estimates were applied to injury data to calculate associated economic costs.

RESULTS

Full repeal of the seat belt law is estimated to result in an additional 163 fatalities, 13,722 nonfatal injuries, and an associated societal cost of $1.6 billion annually. Repeal of the primary seat belt law only is estimated to result in an additional 95 fatalities, 9156 nonfatal injuries, and an associated societal cost of $1.0 billion annually.

CONCLUSIONS

This analysis suggests that repealing the either the primary or full seat belt law would have a substantial and negative impact on public health, increasing motor vehicle crash related fatality, nonfatal injury, and associated economic costs.

Vehicle occupant restraint systems impact on eye injuries: a review

Vehicle occupant trauma to the eyes and associated facial structures has evolved rapidly in conjunction with safety-oriented vehicle design, including restraint systems. Trends vary worldwide with culture, personal factors, vehicle safety equipment, and the traffic environment-including physical, legislative, and enforcement. Wearing safety belts is essential to occupant protection. Airbags were designed as a supplement to protect the head from hard surfaces in frontal crashes, not as a primary countermeasure. Even where vehicle fleets are new with high airbag prevalence, but safety culture and knowledge of restraints is less than robust, injury attributable to not wearing seatbelts is frequent, especially in countries where high-powered vehicles are prevalent. Upper bodies of rapidly forward-moving unrestrained occupants collide with rearward-accelerating airbags. Airbag deployment produces injuries such as corneal abrasions, alkali burns, and the effects of globe compression.

Disparities in motor vehicle-related deaths among females-United States, 2005-2009

BACKGROUND

In 2010, almost 11,000 females were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally.

METHODS

To assess disparities in motor vehicle-related death rates by race/ethnicity among females in the United States, the Centers for Disease Control and Prevention analyzed 2005-2009 data from the National Vital Statistics System. Death rates and corresponding 95% confidence intervals were calculated, and differences between 2005 and 2009 death rates were examined.

RESULTS

The motor vehicle-related death rate for females was 6.8 deaths per 100,000 population in 2009. American Indian/Alaska Native females had the highest motor vehicle-related death rates, followed by whites, blacks, Hispanics, and Asian/Pacific Islanders. The greatest decrease in death rates between 2005 and 2009 occurred among whites from a rate of 9.4 per 100,000 population (95% CI: 9.2-9.6) to 7.1 per 100,000 population (95% CI: 6.9-7.2; absolute rate change: -2.3; p<0.001).

CONCLUSION

Despite the recent declines in motor vehicle-related death rates noted in this article, the need remains for increased use of evidence-based strategies to reduce the burden of motor vehicle-related deaths among females overall and especially among American Indian/Alaska Natives.

Self-reported seatbelt use, United States, 2002-2010: does prevalence vary by state and type of seatbelt law?

PROBLEM

Motor-vehicle crashes are a leading cause of death in the United States. Seatbelts are highly effective in preventing serious injury and death in the event of a crash. Not all states have primary enforcement of seatbelt laws.

METHODS

Data from the 2002, 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seatbelt use by state and type of state seatbelt law (primary vs. secondary enforcement).

RESULTS AND DISCUSSION

Self-reported seatbelt use among adults in the United States increased steadily between 2002 and 2010, with the national prevalence reaching 87% in 2010. Overall, seatbelt use in 2010 was 9 percentage points higher in the states with primary enforcement laws than in the states with secondary enforcement laws (89% vs. 80%).

IMPACT ON INDUSTRY

Primary enforcement seatbelt laws and enhanced enforcement of seatbelt laws are proven strategies for increasing seatbelt use and reducing traffic fatalities.

Buckle up: non-seat belt use and antisocial behavior in the United States

OBJECTIVE

To compare persons who report that they never wear a seat belt while driving or as a passenger with those who do in a nationally representative sample in the United States. Our guiding hypothesis is that failure to wear a seat belt is part of an antisocial behavior spectrum.

METHODS

Using public-use data from the 2010 National Survey on Drug Use and Health, this study employed binary logistic regression with adjustments for complex survey sampling to assess relationships between never wearing a seat belt and sociodemographic variables, antisocial behaviors, substance abuse and co-occurring problems, and criminal justice system contact.

RESULTS

Individuals who do not wear seat belts are younger, more likely to be male, less likely to be African American or Hispanic, have incomes of less than $75,000, and be a high school or college graduate. After controlling for the effects of age, gender, race, income, education, and population density, individuals reporting that they never wear a seat belt while driving or as a passenger are more likely to report using alcohol and drugs (adjusted odds, 1.61-2.56), committing antisocial behaviors including felony offenses (adjusted odds, 2.13-3.57), and possess a dual diagnosis (adjusted odds, 1.62-1.73).

CONCLUSIONS

Findings indicate that non-seat belt use is convergent with a spectrum of serious antisocial behavior and comorbid psychological distress. Importantly, results suggest that standard seat belt use policies and campaigns may not be effective for non-seat belt using individuals and a targeted approach may be needed.

Explaining state-to-state differences in seat belt use: A multivariate analysis of cultural variables

There is considerable variation in seat belt use within the United States despite extensive evidence that the use of seat belts saves lives. Previous studies have identified some important factors that affect belt use rates, including gender, age, race, vehicle type, seat-belt enforcement laws, and amount of fine for belt-use law violation. In this study, we examined the influence of additional socio-demographic factors on state-level use rates: education (percentage of high school educated population), racial composition (percentage White), median household income, political leaning (percentage Democrat), and a measure of religiosity. These variables, which collectively characterize the 'culture' of a state, have received little attention in seat-belt studies. The paper reports results from a multiple regression analysis of data from the 2008 Fatality Analysis Reporting System (FARS). Many of the use rate patterns in FARS data were consistent with those found in other data sets, suggesting that conclusions based on FARS data are likely to hold for the population-at-large. Of the five cultural factors considered in the study, three were identified as important in explaining the differences in seat belt use at the state level: religiosity, race (percentage White), and political leaning (percentage Democrat). The other two variables - income and education - were not significant. Hold-out analyses confirmed that this conclusion was consistent across different subsets of data. The findings from this study are preliminary and have to be confirmed on other data sets. Nevertheless, they demonstrate the potential usefulness of cultural factors in explaining state-to-state variation in seat belt use rates. If factors such as religiosity are indeed important, they can be used to develop culturally appropriate programs for increasing belt use.

Safety belt laws and disparities in safety belt use among US high-school drivers

OBJECTIVES

We compared reported safety belt use, for both drivers and passengers, among teenagers with learner's permits, provisional licenses, and unrestricted licenses in states with primary or secondary enforcement of safety belt laws.

METHODS

Our data source was the 2006 National Young Driver Survey, which included a national representative sample of 3126 high-school drivers. We used multivariate, log-linear regression analyses to assess associations between safety belt laws and belt use.

RESULTS

Teenaged drivers were 12% less likely to wear a safety belt as drivers and 15% less likely to wear one as passengers in states with a secondary safety belt law than in states with a primary law. The apparent reduction in belt use among teenagers as they progressed from learner to unrestricted license holder occurred in only secondary enforcement states. Groups reporting particularly low use included African American drivers, rural residents, academically challenged students, and those driving pickup trucks.

CONCLUSIONS

The results provided further evidence for enactment of primary enforcement provisions in safety belt laws because primary laws are associated with higher safety belt use rates and lower crash-related injuries and mortality.

The prevalence of seatbelt use among pediatric hospital workers

Eighteen percent of drivers do not consistently wear their seatbelts when driving. The purpose of this article is to report the problem of noncompliance with seatbelt use among health care workers at a Level I pediatric trauma center in the midwest United States with evidence from a non-experimental, observational study. Results showed that 84% (n=3,641) of drivers and 73% (n=113) of passengers wore their seatbelts. A significant correlation was found between driver seatbelt use and passenger seatbelt use (p=.272, p<.001). Drivers from primary seatbelt legislation states wore their seatbelts significantly more often than drivers from the secondary seatbelt legislation state, χ(1)=0.913, p=.012. Non-compliance with seatbelt use among pediatric health care workers is a problem equal to that of the general population. It may be necessary to adopt and enforce mandatory seatbelt use policies at the organizational level to increase seatbelt use in this population of hospital workers.

Making the case for laws that improve health: a framework for public health law research

CONTEXT

Public health law has received considerable attention in recent years and has become an essential field in public health. Public health law research, however, has received less attention.

METHODS

Expert commentary.

FINDINGS

This article explores public health law research, defined as the scientific study of the relation of law and legal practices to population health. The article offers a logic model of public health law research and a typology of approaches to studying the effects of law on public health. Research on the content and prevalence of public health laws, processes of adopting and implementing laws, and the extent to which and mechanisms through which law affects health outcomes can use methods drawn from epidemiology, economics, sociology, and other disciplines. The maturation of public health law research as a field depends on methodological rigor, adequate research funding, access to appropriate data sources, and policymakers' use of research findings.

CONCLUSIONS

Public health law research is a young field but holds great promise for supporting evidence-based policy making that will improve population health.

Geographic and sociodemographic variation in self-reported seat belt use in the United States

BACKGROUND

With new data available, we sought to update existing literature on the prevalence of self-reported seat belt use by state, region, and rural/urban status and to estimate the strength of the association between seat belt use and rural/urban status adjusted for type of seat belt law and several other factors.

METHODS

We examined data on self-reported use of seat belts from 50 states, the District of Columbia, and three territories using the 2008 Behavioral Risk Factor Surveillance System, a state-based random-digit-dialed telephone survey (n=406,552). Reported seat belt use was assessed by state, U.S. Census regions, and U.S. Department of Agriculture (USDA) rural/urban continuum codes.

RESULTS

Overall, 85% of adults in the United States reported they always used seat belts. Regionally, the West had the highest prevalence of persons who reported that they always wear seat belts (89.6%) and the Midwest had the lowest (80.4%). States with primary seat belt laws had the highest prevalence of reported seat belt use, compared with states with secondary or no laws. After adjusting for various sociodemographic characteristics, body mass index, and type of seat belt law, persons in the most densely populated metropolitan areas were significantly more likely to report always wearing seat belts than those in most sparsely populated rural areas (adjusted odds ratio=2.9).

CONCLUSION

Our findings reinforce the evidence that primary enforcement seat belt laws are effective for increasing seat belt use, and suggest that upgrading to primary enforcement laws will be an important strategy for reducing crash-related fatalities in rural areas.

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

INTRODUCTION

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

METHOD

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

RESULTS

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt. SUMMARY AND IMPACT ON INDUSTRY: Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.

Trends and subgroup differences in transportation-related injury risk and safety behaviors among US high school students, 1991-2007

BACKGROUND

Seventy percent of unintentional injury-related fatalities--the leading cause of death among youth in the United States--are motor vehicle traffic related. Examining traffic-related safety, therefore, is crucial to public health. This study examines trends in traffic safety issues among US high school students: helmet use while riding a bicycle, seat belt use as a passenger, driving when drinking alcohol, and riding in a car with a driver who had been drinking alcohol.

METHODS

Data from the 1991-2007 national Youth Risk Behavior Surveys (YRBS) were analyzed. The YRBS is a self-administered, anonymous survey that uses a national probability sample of US students in public and private schools in grades 9-12. Demographic subgroup differences were determined for 2007 data using t tests. Temporal changes were analyzed using logistic regression analyses.

RESULTS

From 1991 to 2007, the percentage of high school students who rarely or never wore bicycle helmets decreased from 96.2% to 85.1%; decreases were also seen in the percentage who never wore a seat belt (from 25.9% to 11.1%), rode with a driver who had been drinking alcohol (39.9-29.1%), and who drove when drinking alcohol (16.7-10.5%).

CONCLUSIONS

Although the trends are encouraging, many students still put themselves at risk. Policy approaches (eg, state or local laws or ordinances) complemented by community and school programs may be the best approach to reducing transportation-related injuries and fatalities.

Seat belt use in States and territories with primary and secondary laws--United States, 2006

PROBLEM

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

METHODS

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

RESULTS

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

DISCUSSION

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.

Observed seatbelt usage among drivers of heavy commercial vehicles in Utah

National seatbelt observation surveys indicate commercial vehicle drivers' seatbelt usage is lower than passenger vehicle drivers. Seatbelts are effective at preventing injuries and death following motor vehicle crashes and an important component in decreasing morbidity and mortality related to commercial vehicle crashes. We conducted an observation survey of heavy commercial vehicle drivers' seatbelt usage to gather baseline data and to aid in planning prevention programs. We found that the observed heavy commercial vehicle drivers had a seatbelt usage rate of 64%, approximately 20% lower than the national rate for drivers of passenger vehicles. Our observations demonstrate a need to increase seatbelt usage among heavy commercial vehicle drivers. Specific programs and resources for intervention programs targeting heavy commercial vehicle drivers are warranted.

Need and possibilities for seat belt use promotion in Bashkortostan, Russia

Bashkortostan is a republic in the Russian Federation with a population of 4.1 million. As with other health behaviors, the prevalence of seat belt use is low, which may account in part for the very high rate of motor-vehicle-related mortality in this republic. The authors discuss the need and potential for translating seat belt promotion programming from other Russian regions and other countries to Bashkortostan. The authors conclude that current policies developed in other countries could work well in the republic, if they are enforced. Meanwhile, initiatives such as the Sakhalin Road Safety Partnership offer great potential for translation in Bashkortostan as well as in other regions with similarly low seat belt use prevalence.