Belt Use Research Articles

Longitudinal relationships between youth assets, seat belt use while driving, and the environment

Abstract Background Positive youth development theory can provide an alternative approach to promote Seat Belt Use while Driving in a Car (SBUDC) among youth. The study aims to explore the relationship between youth assets, and the neighborhood environment in predicting SBUDC. Methods The Youth Asset Study (YAS) is a 4-year (5 waves) longitudinal study of a random sample of 1,111 youth (12-17 years old) and their parents, taking place in a Midwestern city, USA from 2003-2008. Seventeen youth assets were developed. The environment was measured objectively via the broken windows survey and subjectively via parents’ interviews. Assets and environmental factors at Waves 1-4 were predicted SBUDC at Waves 4-5 while controlling for demographics. Data were analyzed via marginal logistic regression and generalized estimated equations analyses. Results The sample consisted of 1001 youth: 53% female; mean age=14.36 (SD = 1.59); 50% with income <$35,000; and 69% two-parent families. The proportion of youth not wearing a seat belt while driving increased from wave 4 to 5 only among African American youth. Individually, most assets had a positive relationship with SBUDC (ORs ranged from 1.3 to 2.7), with general aspirations for the future, educational aspirations for the future and positive peer role models having the largest ORs [2.7, 95% CI (1.7, 4.3); 2.2, 95% CI (1.5, 2.0); 1.9, 95% CI (1.5,2.4)] respectively. Youth with a higher (≥ 12) number of assets were almost twice as likely to use a seat belt while driving than those with a lower (<12) number [OR = 1.8, 95% CI (1.4, 2.3)]. Only one environmental factor had a significant effect on SBUDC [(OR = 1.32, 95% CI (1.01, 1.72)]. Assets retained their impact on SBUDC, controlling for the environmental and demographic factors. Conclusions Youth assets can be a promising approach to promote SBUDC among teens with emphasis on promoting general aspirations for the future, educational aspirations, and positive peer role modeling. Key messages • Building youth assets can be another mechanism to promote seat belt use while driving among youth. • The neighborhood environment might not be as important as other factors are in the promotion of seat belt use while driving.

Age-based variability in the association between restraint use and injury type and severity in multi-occupant crashes

PurposePrevious studies have shown older adults receive relatively less protection from seat belts against fatal injuries, however it is unknown how seat belt protection against severe and torso injury changes with age. We estimated age-based variability in seat belt protection against fatal injuries, injuries with maximum abbreviated injury scale greater than two (MAIS 3+), and torso injuries. MethodsWe leveraged the Crash Outcome Data Evaluation System to analyze binary indicators of fatal, MAIS 3+, and torso injuries. Using a matched cohort design and conditional Poisson regression, we estimated age-based relative risks (RR) of the outcomes associated with seat belt use. ResultsOur results suggested that seat belts were highly protective against fatal injuries for all ages. For ages 16–30, seat belt use was associated with 66% lower risk of MAIS3+ injury (RR 0.34, 95% CI 0.30, 0.38) for occupants of the same vehicle, whereas for ages 75 and older, seat belt use was associated with 38% lower risk of MAIS3+ injury (RR 0.62; 95% CI 0.45, 0.86) for occupants in the same vehicle. The association between restraint use and torso injury also attenuated with age. ConclusionsIn multi-occupant crashes, seat belts were highly protective against fatal and MAIS3+ injury, however seat belt protection against MAIS3+ and torso injury attenuated with age.

Assessment of Drivers and Passengers Seat Belt Compliances in Baghdad City

Baghdad city population is growing rapidly and soon it will reach 10 million, and this has increased the number of drivers on city streets which accompanied with the absence of adequate traffic enforcement and traffic control devices to match this increase. Current research main objective is to assess city drivers and passenger’s compliance to use seat belts as a safety precaution. The study consists of two main surveys conducted in the field considering gender, vehicle type, and other drivers characteristics. The first one consists of a questionnaire asking respondents to answer multiple choice questions about seat belt use and other questions associated with respondents’ demographics. Whereas second part involves observing seat belt use among city drivers and passengers at selected locations. Also, we sought information about seat belt use as a driver, front seat passenger, and rear seat passenger. Only 20% of the sample in field observational survey were wearing seat belt as a driver. Printed questionnaire reveals that only 12% are used to buckle up all the time, and 28% never use seat belt in their life, and the rest use seat belt occasionally. Seat belt rates for passengers were 5% only, and most passengers do not care about seat belts and many cars have disabled or malfunction seat belts. Four reasons for putting seat belt were considered and ranked as to avoid injuries, to avoid fines, to follow seat belt law, and wearing seat belt when people in the same car are wearing it.

Measuring and understanding the association between license-related infractions and road crash severity

The relationship between license-related infractions (LRIs) and the severity of road crashes has been scarcely addressed in previous research. This study estimates the association between each LRI and the severity of driver injuries and the partial severity of the crash (i.e., crash severity after excluding the severity of the driver’s own injuries) in a cohort comprising 78,720 drivers who were considered responsible for crashes in the Spanish National Register for Road Traffic Accident Victims, from 2014 to 2017. Adjusted Relative Risk Ratios for each LRI and severity level were obtained through multinomial logistic regression models. Age- and sex-adjusted estimates revealed an increased severity for almost all LRIs. Additional adjustment for seat belt use showed a decrease in the magnitude of the associations, particularly regarding driver injury severity, suggesting that part of these associations was related to increased vulnerability of the driver. Adjustment for other vehicle- and environment-related variables showed a further decrease in the associations but remained significant for “never having obtained a license” and other specific LRIs. These results support the need for maintaining police surveillance and legal measures to identify these subgroups of drivers, remove them from the road and adopt strategies for their safe return to driving.

An Interrupted Time Series Analysis of the Sociodemographics of Crash Victims during the Illinois Stay at Home Order

The race/ethnicity and gender of motor vehicle crash victims during the 2020 Illinois stay at home order are compared to previous years. The median poverty rate of crash victims are compared across the five years of 2016-20, finding that poverty is strongly associated with Black male and female crash victims. Several contributing crash factors like speed, distracted driving, seat belt use, and intoxication are also compared. Within race/ethnicity females significantly decreased their proportion of crash involvement while males significantly increased theirs. An interrupted time series analysis and a segmented binary logistic regression are used in conjunction with a presentation of summary statistics.

Effectiveness of a Text Message Intervention Promoting Seat Belt Use Among Young Adults

Approximately 1 in 10 adults do not always wear a seat belt, with the lowest use rates reported among young adults. To determine the efficacy of a 6-week automated behavioral text message program promoting seat belt use compared with an attention control. This parallel, 2-group, single-blind, individually randomized clinical trial included a convenience sample of patients recruited from 4 emergency departments in 2 cities in Pennsylvania from December 2019 to September 2021, with follow-ups at 6 and 12 weeks after randomization. Patients in stable condition aged 18 to 25 years who, in standardized screening, reported driving or being a passenger in a car without always using a seat belt in the past 2 weeks were eligible for recruitment. Participants who completed a 2-week trial run-in phase were randomly assigned 1:1 to the intervention or the assessment control. Data were analyzed from October 2019 to January 2020. The intervention group received Safe Vehicle Engagement (SAVE), a 6-week automated interactive text message program, including weekly seat belt use queries with feedback and goal support to promote consistent use of a seat belt. The control group received identical weekly seat belt use queries but no additional feedback. The primary outcome was the proportion of young adults reporting always wearing a seat belt over the past 2 weeks, collected at 6 weeks (after a 2-week run-in) via web-based self-assessments and analyzed under intent-to-treat models using multiple imputation procedures. Sensitivity analyses included complete-case analyses of ordered categorical outcomes by vehicle seat position. Secondary outcomes included seatbelt use at 12 weeks and select cognitive constructs related to seat belt use. A total of 218 participants (mean [SD] age, 21.5 [2.1] years; 139 [63.8%] women) were randomized, with 110 randomized to SAVE and 108 randomized to the control group. A total of 158 individuals (72.4%) were included in the 6-week follow-up. The rate of always using a seat belt over the past 2 weeks at the 6-week follow-up was 41.3% (95% CI, 30.6%-52.0%) among SAVE participants and 20.0% (95% CI, 10.6%-29.3%) among control participants (odds ratio [OR], 2.8; 95% CI, 1.4-5.8; P = .005). A total of 140 individuals (64.2%) participated in the 12-week follow-up. At 12 weeks, the rate of always using a seat belt over the past 2-weeks was 42.8% (95% CI, 31.2%-54.2%) among SAVE participants and 30.7% (95% CI, 19.6%-41.6%) among control participants (OR, 1.7; 95% CI, 0.9-3.4; P = .13). When examining ordered categories of seat belt use by seat position, there were significantly greater odds of wearing a seat belt at 6 and 12 weeks among SAVE participants vs control participants (eg, 6 weeks for driver: OR, 5.2; 95% CI, 2.6-10.5; 6 weeks for front passenger: OR, 4.3; 95% CI, 2.2-8.2; 6 weeks for back passenger: OR, 4.3; 95% CI, 2.2-8.2). In this randomized clinical trial, an interactive text message intervention was more effective at promoting seat belt use among targeted young adults than an attention control at 6 weeks. There was no significant difference between groups in always wearing a seat belt at 12 weeks. These findings, if replicated in a larger sample, suggest a scalable approach to improve seat belt use. ClinicalTrials.gov Identifier: NCT03833713.

Trends in Passenger Seat Belt Use Among High School Students—United States, 1991–2019

PurposeDespite having the highest risk per miles driven for motor vehicle crash involvement, only 57% of US high school students reported always using a seat belt when riding in a car with another driver in 2019. MethodsData from the national Youth Risk Behavior Surveys conducted biennially from 1991 to 2019 were used to assess trends in seat belt use. Modified Poisson regression with robust variance estimates and linear splines was used to examine seat belt use trend changes overall and by gender, race/ethnicity, and grade. ResultsFrom 1991 to 2015, seat belt use was about 3.3% higher each survey cycle compared with the previous survey cycle, adjusting for gender, race/ethnicity, and age. After 2015, seat belt use was about 1.8% lower each survey cycle than the previous survey cycle, adjusting for the same covariates. DiscussionNew and effective strategies should be considered for promoting consistent seat belt use among US high school students.

Examining Seat Belt Use Habits in Wyoming: A Bayesian Hierarchical Logit Approach

Wyoming has one of the lowest seat belt law compliance rates in the United States. Understanding the factors associated with seat belt non-use is crucial for the development of appropriate mitigation measures that aid in increasing seat belt usage rates. In this study, Bayesian binary logistic regression models were developed to: i) investigate the factors associated with daytime seat belt non-use using observational survey data; and ii) assess the factors related to seat belt non-use in fatal crashes while accounting for possible intra-class correlation (effects of unobserved factors common to occupants in the same vehicle). The results indicated that males were less likely to use seat belts than females. Also, trips made in pick-up trucks, those made within urban areas, those made during weekdays, and those made by means of vehicles with Wyoming license plates were likely to involve seat belt non-use. Furthermore, counties with thriving oil and gas industries had lower seat belt use rates. It was also inferred that young occupants, rear seat occupants, impairment, weekdays, traveling around midnight, traveling on collector roads, and traveling on local roads were associated with seat belt non-use. A strong correlation in seat belt non-use among occupants within the same vehicle warrants the implementation of the hierarchical logistic model to investigate seat belt use among occupants involved in fatal crashes. The findings of this study highlight remarkable trends in seat belt use habits in Wyoming, which will aid legislatures in proposing road safety measures aimed at raising seat belt usage proportions.

Traktör İlişkili Ölümler (Devrilme, Düşme, Kaza, Yıldırım Çarpması)

Objective: Tractor-related accidents are more common than other agricultural vehicles. Tractor overturning is one of the major risk factors for farmers. In this study, it was aimed to discuss the sociodemographic characteristics, autopsy findings, the cause of death and measures to be taken of the tractor-related deaths with literatüre.Material and Methods: In this study, reports of tractor-related deaths were investigated retrospectively in cases where an autopsy was performed in the Morgue Department of Istanbul Council of Forensic Medicine between 2008 and 2012.Results: It was determined that 42 (0.2%) of 20,559 cases who were autopsied in Istanbul between 2008-2012 were tractor-related deaths. Thirty-eight (90.5%) of the cases were male and four cases (9.5%) were female. The average age was 44.54 ± 20.66 (min: 2, max: 80) with the most common death occurring at 60 years and above. Twenty-six (61.9%) of the cases were drivers. The most common death occurred in July and November (n: 7, 16.6%). The death occurred due to tractor overturns in 50% of the cases (n: 21), whereas the reason for death was falling from the tractor in 31% (n=13), traffic accident in 7.1% (n=3), run-over in 7.1% (n=3) and lightning strikes in 4.8% (n=2).Conclusion: In the prevention of tractor-related deaths, is necessary to prohibit the use of tractors as a means of transport and increase the use of seat belts and roll-over protective structures (ROPS) in all tractors.

Alcohol Intoxication Is Associated With Bladder Injury and Bladder Surgical Repair in Patients Sustaining Motor Vehicle Collisions.

Alcohol intoxication is a known risk factor for motor vehicle collisions. We hypothesize ethanol intoxication increases the risk of bladder injury and surgical repair, especially at higher blood alcohol content levels. We identified all patients involved in motor vehicle collisions from the National Trauma Data Bank from 2017-2019. Patients were categorized into an intoxication and intoxication negative group. Variables collected included age, sex, blood alcohol content level, driver status, seat belt restraint use, nonalcoholic intoxication, pelvic fracture, and Injury Severity Scale. Primary outcome measures of bladder injury and bladder surgical repair were assessed and interaction with pelvic fracture and restraint use were measured. We identified 594,484 patients and 97,831 (16.5%) had a positive alcohol screen. Patients in the intoxication group were more likely to be intoxicated with other substances (32.8% vs 14.6%, P < .001), have a bladder injury (1% vs 0.4%, P < .001) and receive bladder surgical repair (0.7% vs 0.15%, P < .001). Injury Severity Scale and pelvic fracture were statistically significant predictors of bladder injury. In adjusted analysis, higher blood alcohol content was associated with both outcomes. Above the legal limit, alcohol intoxication was more predictive of bladder surgical repair than pelvic fracture. The association of alcohol intoxication with both outcomes did not differ by pelvic fracture, but strengthened with seat belt use at higher intoxication levels. Alcohol intoxication is independently associated with increased risk of bladder injury and subsequent bladder surgical repair following motor vehicle collisions. Trauma providers should have a high index of suspicion for bladder injuries in alcohol intoxicated patients, particularly those using seat belt restraints.

Comparison of Vehicle-Based Crash Severity Metrics for Predicting Occupant Injury in Real-World Oblique Crashes

The flail space model (FSM) is currently used in U.S. roadside hardware crash testing as a means of assessing occupant injury risk using observed vehicle kinematics data. European roadside hardware crash tests use an FSM variant along with a variant of the acceleration severity index (ASI). Although the FSM and ASI are currently used in roadside hardware testing, other vehicle-based crash severity metrics exist. Previous research has focused on examining the ability of these metrics to predict injury in frontal crashes. Despite the Manual for Assessing Safety Hardware prescribing a significant number of oblique crash tests, there has been little research on how well these metrics predict real-world oblique crash injury. This study compared the ability of six different vehicle-based metrics to predict occupant injury in oblique crashes: maximum delta-v, occupant impact velocity, ridedown acceleration, ASI, occupant load criterion, and vehicle pulse index. The crash severity metrics were calculated from real-world crash pulse data recorded by event data recorders. Oblique crashes from the National Automotive Sampling System Crashworthiness Data System were used to train logistic regression models that predict moderate to fatal injuries. The models were then compared on a dataset of oblique crashes from the Crash Investigation Sampling System. The results of this study confirmed that vehicle-based metrics provide a reasonable means of predicting real-world occupant injury risk in oblique crashes and suggest little difference between the investigated metrics. In addition to the vehicle-based metrics, belt use and vehicle damage location were found to influence injury risk.

Outcomes of Road Traffic Accidents Before and After the Implementation of a Seat Belt Detection System: A Comparative Retrospective Study in Riyadh.

IntroductionRoad traffic accidents (RTAs) are considered a major cause of death in Saudi Arabia. As seat belt compliance provides significant safety among drivers, a camera detection system has been implemented in March 2018 to enforce seat belt utilization, which can decrease the severity of road traffic injuries. There are no previous studies in the country that have assessed the effectiveness of a seat belt camera detection system on the severity of RTA-related injuries.MethodsA retrospective cohort study was conducted at King Abdulaziz Medical Trauma Center in Riyadh, Saudi Arabia. The study included 688 adult patients who were involved in RTAs from the period of March 2016 to March 2020. A data extraction form included sociodemographics, clinical variables, and outcome measures. The data were analyzed using Statistical Analysis Software (SAS) to evaluate the primary outcome measures: mortality, ejection from the vehicle, ICU admissions, and severity measures (injury severity score (ISS) and Glasgow Coma Scale (GCS)) before and after the implementation of seat belt detection system. Associations of the outcome measures in the pre-implementation and the post-implementation periods' seat belt detection were assessed using regression tests.ResultsThere was no significant difference in the mean age between the pre-implementation and post-implementation periods of the seat belt detection system (31.39 years and 32.57 years, respectively). All of the outcome measures have improved following the implementation of the seat belt detection system. Mortality and ejection rates decreased significantly with 58% lower risk of death (OR= 0.42; 95% CI= 0.2,0.8) and 37% lower risk of ejection (OR= 0.63; 95% CI= 0.42,0.94). ICU admissions showed a slight decline in the post-implementation period compared to the pre-implementation period (30.37% vs. 31.37, p<0.7764). Severity measures (ISS and GCS) were slightly improved in the post-implementation period. Head and neck injuries were dominant in the pre-implementation period, and chest injuries were the most common body injuries after the implementation.ConclusionThis study highlights the direct association between compliance with seat belt use and the primary outcome measures among patients who survived a road traffic accident. All of the outcome measures showed improvement in the post-implementation period, which indicates the effectiveness of the newly implemented seat belt detection system. These findings raise awareness to the public in regard to seat belt compliance.

Child restraint headrest and belt routing design features and their association with child passenger behavior and restraint misuse

Objectives Ergonomic design of child restraint systems (CRS) may facilitate optimal travel behavior and crash protection of child passengers during motor vehicle trips. However there have been few studies examining the relationship between CRS design and child passenger travel behavior. The aim of this study was to examine whether associations between CRS design features and child passenger behavior exist during real-world, everyday vehicle trips. Methods Video from a naturalistic driving study (NDS) was analyzed in this study. Families drove an instrumented study vehicle for approximately two weeks with at least one child aged between one and eight years traveling in their own forward-facing (FF) CRS or belt positioning booster (BPB). Video for one child passenger was randomly selected from each trip for analysis. Video was coded for five-second epochs at nine time points (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip length). Two types of child passenger travel behaviors were identified by manual review of the video and audio recordings: (i) optimal/suboptimal head position and (ii) correct/incorrect use of the internal harness/shoulder belt. Video screenshots were used to characterize CRS design features. Random effects logistic regression models were used to examine the associations between specific CRS design features and the travel behaviors of interest, whilst accounting for clustering of data by child and trip. Results Suboptimal head position was associated with the absence of a height adjustable headrest and a narrow headrest wing width in FFCRS. Incorrect harness use in a FFCRS was associated with the absence of an adjustable headrest, in addition to headrest features such as wing width and depth. In BPBs, a reduction in suboptimal head position was associated with the absence of a sash belt guide, however no restraint design features were associated with incorrect shoulder belt use. Conclusions Some CRS design features may influence undesirable child passenger travel behavior. These early findings support enhanced and user-centric CRS design as a likely important mechanism to improve child passenger safety.

Factors influencing injury severity to belted drivers in car crashes in India

Objective The 2019 revised Indian seat belt regulation resulted in a significant increase in driver belt use. This study examines the factors influencing Maximum Abbreviated Injury Scale (MAIS) 2+ injuries to belted car drivers using Indian crash data. Methods Crash data obtained from Road Accident Sampling System–India (RASSI; 2011 to 2020) were used. Analysis was performed on a sample of 662 belted car drivers, representing 1.7 million drivers nationally. Survey logistic regression was used to identify factors influencing the odds of MAIS 2+ injuries to belted car drivers. Factors including delta-V, mass ratio (striking vehicle/struck vehicle), crash type, and driver age and gender were examined. The model fits and the statistical significance of each factor included in the models were examined. In addition, clinical review of crashes with belted drivers sustaining MAIS 3+ injury is presented. Results Delta-V was the most significant factor (odds ratio = 12%; 95% confidence interval 6%–19%) influencing belted driver injuries. Older drivers (55+ years) have a higher odds of MAIS 2+ injury. By adding mass ratio to the model, the odds ratio for delta-V increased to 1.16. If the mass ratio is 2.5 (striking vehicle weight = 2.5 times struck vehicle weight), then the odds of MAIS 2+ injury for the struck vehicle driver doubles. The average Delta-V for MAIS 2+ crashes is 34 mph and injury risk increases significantly when delta-V approaches 30 mph. Seventy percent of crashes with injured drivers had a mass ratio >2. For drivers with minor/no injuries, 88% of crashes had a mass ratio <2. Review of MAIS 3+ injury crashes showed that these crashes had a high delta-V (38 mph) and high mass ratio (5). Sixty percent of belted drivers sustained MAIS 3+ head or chest injury resulting from reduction in survival space. About 37% of AIS 3+ head injuries were subdural hemorrhages and 20% were crush injury to head. AIS 3+ chest injuries were rib fractures (40%) and lung lacerations/ruptures (27%). Conclusion Delta-V and mass ratio are significant factors of belted driver injuries in India. Serious injuries are mainly to the head and chest. Increased rear underrun protection device (RUPD) fitment rate, improved airbag and RUPD design, safe speed enforcement, and improved road infrastructure will reduce injury severity.

Changes in Traffic Crash Rates After Legalization of Marijuana: Results by Crash Severity

The objective of this study was to estimate the effects of marijuana legalization and the subsequent onset of retail sales on injury and fatal traffic crash rates in the United States during the period 2009-2019. State-by-state quarterly crash rates per mile of travel were modeled as a function of time, unemployment rate, maximum posted speed limit, seat belt use rate, alcohol use rate, percent of miles driven on rural roads, and indicators of legalized recreational marijuana use and sales. Legalization of the recreational use of marijuana was associated with a 6.5% increase in injury crash rates and a 2.3% increase in fatal crash rates, but the subsequent onset of retail marijuana sales did not elicit additional substantial changes. Thus, the combined effect of legalization and retail sales was a 5.8% increase in injury crash rates and a 4.1% increase in fatal crash rates. Across states, the effects on injury crash rates ranged from a 7% decrease to an 18% increase. The effects on fatal crash rates ranged from a 10% decrease to a 4% increase. The estimated increases in injury and fatal crash rates after recreational marijuana legalization are consistent with earlier studies, but the effects varied across states. Because this is an early look at the time trends, researchers and policymakers need to continue monitoring the data.

Influence of Demographic Disparities on Seat Belt Compliance in an Urban Area (Washington, DC)

This study evaluated the potential influence of demographic factors on seat belt compliance rates in an urban area. Washington D.C., which is the capital of the United States, is an urban area with mixed and diverse population. The city (and all states) conducts seat belt compliance surveys annually as a requirement of the National Highway Traffic Safety Administration (NHTSA). This article used compliance rates obtained from the field for 2014 through 2020 and matched those with demographic data for the same timeframe. The demographic data for the city was obtained from the United States Census Bureau. Demographic variables including race, educational and income levels for the eight wards in Washington D.C. we extracted for analysis. Overall, seat belt compliance usage in Washington ranged from 93% to 95.7% between 2014 and 2020. Approximately 42.3% of its population are Caucasian while 43.9% are African Americans with the remaining being Asian, Hispanics and other races. In addition, seat belt usage was reported by ward. Using single factor analysis of variance, it was determined that compliance rates in the wards were not statistically influenced by race, educational level, or income level at 5% level of significance. However, when comparing yearly seatbelt compliance from 2014 to 2020, the compliance rates of 2014 versus 2019, and 2014 versus 2020 were determined to be statistically different. Seat belt use should be encouraged for everyone in all jurisdictions. The analysis shows that, in this urban area, the three demographic variables do not have any influence on the compliance rates.

Temporal-spatial evolution analysis of severe traffic violations using three functional forms of models considering the diurnal variation of meteorology

Traffic violations and crashes are inherently associated. Analysis of traffic violation frequency is a prerequisite for improvements in crash prevention and corresponding countermeasures. One of the essential works in the field of traffic violations relates to the exploration of the correlations between a certain violation type (e.g., speeding or safety belt use) and its causal factors (e.g., demographics and road types). Till now, the effects of spatiotemporal and meteorological factors on severe traffic violations, a general term for dangerous driving behaviors, have not been fully considered. Using the dataset consisting of daily severe traffic violations and meteorological conditions during 12 months in Jiangsu Province, China, violation performance functions were developed for three violation types (total violations, driving under the influence, and speeding) based on three models (Poisson regression, zero-inflated Poisson regression, and negative binomial model). The findings indicate that the negative binomial model has a better performance for traffic violation frequency estimation. Additionally, elastic analysis for three violation types relying on the negative binomial model was conducted to present the relationships between the explanatory variables and the expected violation frequency. The effects of spatiotemporal factors have revealed that the violation situations are significantly different in varying cities and the frequency of drunk driving shows a significant time instability. It is also found that rainy days will generate a decrease in the possibility of violation occurrence. With regard to temperature, a significant negative effect is found and the decrease in temperature will bring about an increase in violation frequency. Besides, traffic violation frequency is significantly increased during holidays with comfortable weather conditions. The conclusion of this study can provide insightful suggestions for the department of traffic enforcement to adjust the patrol plans according to the specified periods (weeks, months, or holidays) and weather conditions. Special rectification actions and targeted educational activities are also advised to be put forward simultaneously.

A naturalistic study of passenger seating position, posture, and restraint use in second-row seats

Objective The objective of the current study was to increase scientific understanding of rear-seat passenger seating position, postures, CRS use, and belt use through a naturalistic study. A secondary objective was to compare data from vehicles used in ride-hailing with data from other vehicles. Method Video cameras were installed in the passenger cabins of the vehicles of 75 drivers near the center of the windshield. The video data were downloaded after the vehicles were operated by their owners for two weeks. Video frames were sampled from near the ends and in the middle of each trip, and at five-minute intervals in trips longer than 15 min. A total of 7,323 frames with second-row passengers were manually coded. Results A total of 444 unique second-row passengers were identified in video frames from 1,188 trips taken in 65 of the 75 vehicles in the study. Two of the vehicles that were driven for commercial ride-hailing during the study period accounted for 199 (45%) of the passengers. Considering multiple passengers in some trips, a total of 1,899 passenger-trips were identified. For passengers not using child restraint systems (CRS), the belt use rate was 65% in the non-ride-hailing vehicles versus 32% among passengers in the ride-hailing vehicles. No CRS use was observed in the ride-hailing vehicles. Among children using backless boosters, the shoulder belt was lateral to the clavicle or under the arm in 26% of frames. Among belted passengers not using CRS, the belt was lateral to the clavicle or on the neck about 6% of the time. Belted passengers not using CRS were observed leaning to the left or right about 27% of the time, with leaning away from the shoulder belt more common than leaning into the belt. Conclusions This study is the first to report seating position, posture, and belt fit observations for a large naturalistic sample of second-row passengers that includes adult occupants. The data suggest that low rear seat belt use rates remain a concern, particularly in ride-hailing vehicles. Non-nominal belt placement and posture may also be common in second-row seating positions.

Current Use of Gait Belt in Hospitals of Certain Areas in China

<bold>Objective</bold> To investigate the current status of gait belt use in the hospitals in China and to explore the factors that are related to the decision-making of Chinese rehabilitation practitioners. <bold>Methods</bold> Survey method was used in the study. A survey questionnaire was developed and distributed through the social media Wechat. SPSS 24.0 software was used to complete the statistical analyses. <bold>Results</bold> A total of 378 questionnaires were returned. The results showed that most participants had never heard about gait belt (64.0%). The awareness of gait belt was significantly associated with the professions of the participants (<italic>P</italic>=0.038). The resources in which participants learned about gait belt were mainly textbooks, journals, internships, friends, coworkers, and the internet. Among the 136 participants who had heard about gait belt, forty-seven (34.6%) of them reported the reason for using gait belt was because it was convenient, safe, and energy saving. Most of the participants didn't use it on patients (65.4%) even though they knew about gait belt. Almost all the participants who did not know gait belts voiced that they were willing to use it once they understand the benefits of gait belt use and ways to use it correctly (92.2%). <bold>Conclusion</bold> Gait belt is not widely known and used by the participants. Rehabilitation practitioners' knowledge of gait belt is the most important factor that is related to the use of gait belt in China. To advocate gait belt use, awareness and education of gait belt should be considered as the first step which can be implemented in various ways, such as required content in the professional school curriculum, in continued education and review of pertinent literature. At the same time, the access to gait belt, which can be facilitated by the leaders in healthcare facilities, would contribute to this advocacy remarkably.

Child Restraint Use and Seating Position of Child Passengers in Motor Vehicles and Their Correlations: Application of a Random-Effects Bivariate Probit Model

Motor vehicle crashes are a leading cause of death and injury for children aged under 8 years. In the U.S.A., while some states are showing increases in the proportion of child restraint device use, only around half of child passengers aged from 4 to 7 years are being properly restrained. This study was undertaken to identify the factors contributing to the proper child restraint use and child passenger’s seating position through the direct observation surveys of more than 10,000 child passengers in 2015 and 2018 in Michigan. A bivariate probit model with random effects was developed to identify simultaneously the contributing factors for the proper restraint use and seating position of child passengers, accounting for the unobserved heterogeneity in the data. The bivariate framework is able to account for the correlation of the two dependent variables in the study. The results show that the two dependent variables are positively correlated, and this correlation is strongly significant. The key factors simultaneously influencing proper child restraint use and appropriate seating position of the child passenger include the age of the child, the number of child passengers in the vehicle, driver belt use, driver gender, age, and race, vehicle type, stratum, weather, and the time of the day and week. However, factors such as county-specific population, income, and education, and the type of location did not have any significant association with either child restraint use or the seating position of the child passenger.