Using Rural⁻Urban Continuum Codes (RUCCS) to Examine Alcohol-Related Motor Vehicle Crash Injury and Enforcement in New York State

Fatal Motor Vehicle Crashes in Upstate and Long Island New York: The Impact of High Visibility Seat Belt Enforcement on Multiple Risky Driving Behaviors

Despite an observed daytime front-seat seat belt use that exceeds 90%, nearly half of motor vehicle occupants who die in New York State (NYS) each year are not wearing a seat belt. Crash outcomes were examined by occupant, vehicle, environmental and traffic enforcement patterns related to the annual Click It or Ticket high visibility seat belt enforcement campaign. Three periods of enforcement were examined: pre-enforcement, peri-enforcement (during/immediately after), and post-enforcement. Of the 14.4 million traffic citations, 713,990 (5.0%) were seat belt violations. Relative risk with 95% CI was assessed using deaths from the Fatality Analysis Reporting System (FARS) and SAS Glimmix 9.4 software. Mortality was lower peri-enforcement (32.9%) compared to pre- (40.9%) or post-enforcement (37.1%) (p < 0.001) and tended to be elevated in low enforcement response areas (43.6%). Fatalities were 30% lower (0.7, 95% CI 0.6−0.9) during peri-enforcement in models adjusted for demographics, law coverage, enforcement response, rural, weekend, impairment, speeding, and vehicle type. Adjusted mortality was higher in rural (1.9, 1.6−2.6), alcohol-involved (1.8, 1.4−2.9), and speeding-involved (2.0, 1.7−2.5) crashes. Peri-enforcement alcohol- and speed-involved fatalities tended to be lower in restrained, unrestrained and occupants missing belt status. The finding of lower mortality in both belted and unbelted occupant’s peri-enforcement—in the context of fewer fatal speed and alcohol-involved crashes—suggests that the mechanism(s) through which high visibility seat belt enforcement lowers mortality is through impacting multiple risky driving behaviors.

Differences in rural and urban drivers' attitudes and beliefs about seat belts

In the United States, a disproportionate number of motor vehicle crash fatalities occur in rural areas. While many factors likely contribute to the discrepancy between fatality rates in rural and urban areas, prior studies suggest that rural drivers may be more likely to engage in risky driving behaviors like seat belt non-use. Although having favorable attitudes or beliefs about seat belts increases the likelihood of wearing them, few studies have investigated the possibility that lower rates of seat belt use in rural areas may result from a greater prevalence of unfavorable seat belt attitudes and beliefs-one part of a distinct rural "traffic safety culture." In the current study, we analyzed responses from the 2016 Motor Vehicle Occupant Safety Survey (MVOSS) to test the hypotheses that rural drivers are more likely than urban drivers to hold unfavorable attitudes and beliefs about seat belts, and that these unfavorable attitudes and beliefs predict lower self-reported seat belt use. We found that rural and urban drivers differed significantly on several seat belt attitudes and beliefs and that these differences persisted after controlling for possible demographic differences between rural and urban drivers. We also found that drivers who hold less favorable attitudes and beliefs were less likely to always wear their seat belts. However, even after accounting for demographic factors and differences in attitudes and beliefs, rural drivers continued to be less likely to report full-time seat belt use than urban drivers. Our findings suggest that rural drivers should be treated as a distinct market segment for seat belt messaging and public awareness campaigns, and that interventions designed to change the unfavorable attitudes and beliefs about seat belts held by rural drivers may help reduce the disparity between rural and urban traffic fatality rates.