Increase Seat Belt Use Research Articles

Use of a Community Program to Increase Seat Belt Use Among Shopping Center Patrons in Charlotte, North Carolina

A community program was implemented at one mall and two shopping centers in Charlotte, North Carolina, to increase patron seat belt use in the context of an ongoing statewide seat belt law enforcement program, “Click It or Ticket.” The program consisted of feedback signs at mall and shopping center exits displaying patron seat belt use rates, posters providing information about the benefits (number of lives and amount of money saved) of the “Click It or Ticket” program and urging patrons to use their seat belts and check seat belt use rate information posted at mall exits, as well as flyers providing similar information as the posters. Following a baseline period, the program was implemented at Carolina Place Mall, whereas the other two retail centers remained in the baseline condition. The program then was introduced at Matthews Festival Center, followed by Town Center Plaza. Seat belt use among drivers increased significantly from a range of 73–74% to 83–85% at all three sites following introduction of the program. Belt use among right front passengers also increased, but this change was statistically significant at only one of the three sites. Resumption of the statewide “Click It or Ticket” enforcement program was not associated with further increases in seat belt use.

Condoms and seat belts: the parallels and the lessons

This paper investigates the relation between behavior adaptation and safety benefits of seat belts and whether condom promotion can be undermined by unintended changes in sexual risk perception and behavior. The comparison between 13 countries that passed seat belt laws and 4 countries without such laws shows a significant number of deaths among countries with seat belt laws. It has been suggested that drivers who wear seat belts feel safer and drive faster and more carelessly compared to those without seat belts. A model of individual risk management, postulating that every individual is comfortable with a certain level of risk and aims to balance the rewards of risk-taking against perceived hazards was developed to describe the behavior. This increase in seat belt use was then paralleled with condom use since the rise of HIV, with 3 ways in which a large increase in condom use could fail to affect transmission: 1) it appeals to risk-averse individuals who contribute little to epidemic transmission; 2) increased use of condom increases the number of transmission caused by condom failure; and 3) the increased use of condoms reflect the change in the decision of individuals from one partner to maintaining higher rates of partners and reliance on condoms. This paper, in conclusion, emphasizes the need for program development and implementation in response to this sexual behavior, particularly among developing countries.

Evaluation of a pilot program in rural schools to increase bicycle and motor vehicle safety.

Concerned with high bicycle-and motor vehicle-related mortality rates among children, Idaho's South Central District Health Department provided a competition to increase use of 1) seat belts, 2) motor vehicle rear seating, and 3) bicycle helmets among children attending elementary schools in the eight rural counties it serves. Nine of the 44 elementary schools in the health district chose to participate in the contest. Eight schools addressed increasing helmet use, four schools also addressed increasing seat belt use and rear seating, and one school addressed safety in general. A $1,000 prize was awarded to each of four schools judged to have the highest levels of student and community involvement, outreach, creativity, and changes in safety behavior (based on perceptions of outside judges). In 1997, baseline observations were collected for 1) seat belt use and rear seating for children in 28 schools, and for 2) bicycle helmet use among children in 25 schools. In 1998, follow up data were collected for 1) seat belt and rear seating in 42 schools, and 2) bicycle helmet use in 35 schools. Data were analyzed using SAS. Adjusting for differences in baseline rates, regression analysis was used to compare 1997 and 1998 rates for seat belt use, rear seating, and bicycle helmet use for those schools having baseline data. Results showed that although there was no significant difference between participating and non-participating schools in rear-seating behaviors, there was an increase in seat belt and bicycle helmet use for participating schools. Since schools self-selected participation, it is unknown whether those schools were fundamentally different from nonparticipating schools.

Effectiveness of a comprehensive multisector campaign to increase seat belt use in the greater Athens area, Greece. Hellenic Road Traffic Police Department.

This study assessed the effectiveness of a comprehensive campaign to increase seat belt use in Athens. In 1996 a survey focusing on seat belt use was undertaken among occupants of 1400 passenger cars. From October 1997 to June 1998 the campaign was implemented; during the campaign, seat belt law enforcement was not intensified. In 1998 another inspection survey of 2250 cars was undertaken. The program brought only a 6% increase in compliance, but there was an estimated gain of about 50 averted deaths and 1500 averted injuries. An intensive campaign to increase seat belt use, conducted in the absence of increased law enforcement, resulted in moderate gains.

The Effects of an Intervention Campaign to Enhance Seat Belt Use on Campus

The national health objectives for the year 2000 called for an increase in the use of safety restraints to 85% of motor vehicle occupants. An assessment on one campus indicated that only 79% of those observed were wearing seat belts. Nursing faculty and students undertook a multimodal intervention campaign to increase seat belt use in the campus community. Observed use of seat belts increased to 81% after the week-long intervention consisting of reminder banners, media coverage, permanent reminder signs, roll-over demonstrations, a presentation on the need for seat belt use, and distribution of seat belt use pledge cards. Although the increase was small, it was statistically significant and could represent considerable savings in healthcare costs if even 2% of the population could be saved from serious injury by using seat belts. In addition, the change in seat belt use represented a decline of nearly 10% in the number of nonusers.

Factors associated with seat belt use: an evaluation from the Ontario Health Survey.

This study examines the factors associated with seat belt use for drivers and passengers in Ontario. Using the 1990 Ontario Health Survey, a population-based survey of non-institutionalized Ontario residents, factors associated with seat belt use among drivers and passengers were identified and are reported as unadjusted and adjusted odds ratios (OR; 95% CI). Seat belt non-use in Ontario drivers was most strongly associated with younger age (p < 0.0001), high risk health behaviours (drinking and driving (OR: 2.43), speeding (OR: 2.04), smoking (OR: 1.66)), being male (OR: 1.87), living in northern (OR: 1.80) or rural (OR: 1.69) regions, and achieving lower education (OR: 1.46). Seat belt non-use in passengers was associated with younger age (p < 0.0001), smoking (OR: 1.62), being male (OR: 1.68), living in northern (OR: 1.63) or rural (OR: 1.46) regions, and low education (OR: 1.31). Vehicular trauma is a major public health problem and seat belt use has been shown to reduce injuries in the event of a crash. Any strategy to increase seat belt use in Ontario should be targeted to involve both drivers and passengers. Attention should be paid to increasing seat belt usage by younger adults, males, and especially those living in northern and rural regions.

Factors Associated with Seat Belt Use: An Evaluation from the Ontario Health Survey

This study examines the factors associated with seat belt use for drivers and passengers in Ontario. Using the 1990 Ontario Health Survey, a population-based survey of non-institutionalized Ontario residents, factors associated with seat belt use among drivers and passengers were identified and are reported as unadjusted and adjusted odds ratios (OR; 95% CI). Seat belt non-use in Ontario drivers was most strongly associated with younger age (p < 0.0001), high risk health behaviours (drinking and driving (OR: 2.43), speeding (OR: 2.04), smoking (OR: 1.66)), being male (OR: 1.87), living in northern (OR: 1.80) or rural (OR: 1.69) regions, and achieving lower education (OR: 1.46). Seat belt non-use in passengers was associated with younger age (p < 0.0001), smoking (OR: 1.62), being male (OR: 1.68), living in northern (OR: 1.63) or rural (OR: 1.46) regions, and low education (OR: 1.31). Vehicular trauma is a major public health problem and seat belt use has been shown to reduce injuries in the event of a crash. Any strategy to increase seat belt use in Ontario should be targeted to involve both drivers and passengers. Attention should be paid to increasing seat belt usage by younger adults, males, and especially those living in northern and rural regions.

ADOLESCENT INJURY AND DEATH: THE PLAGUES OF ACCIDENT, SELF-INFLICTION AND VIOLENCE

Motor vehicle-related accidents and firearm-related violence are the first and second leading causes of adolescent morbidity and mortality. Fortunately, considerable progress has been made in reducing motor vehicle-related injuries and death through state-level legislation designed to decrease alcohol use and increase seat belt use. Homicide and suicide, however, are increasing dramatically among teenagers. Family violence and the epidemic of gang activity also contribute significantly to both; violence portrayed on television, in movies, and in adolescent music also has become a more significant part of teen life. Family physicians are encouraged to implement preventive strategies for combating the problems of injury and violence in their offices, their communities, and on the broader states of medical education and public policy.

Strategy for Increasing Seat Belt Use Nationwide

[National Highway Traffic Safety Administration: Strategy for increasing seat belt use nationwide. Ann Emerg Med October 1997;30:535-536.]

Increasing seat belt use in North Carolina

North Carolina has embarked on an ambitious multiyear program designed to increase seat belt and child restraint use and to reduce other traffic law violations, including alcohol-impaired driving. Increasing seat belt use, based on the Canadian model of a combination of intensive enforcement and publicity about the enforcement, was emphasized during the first phase. The program called “Click It or Ticket,” was implemented in October and November 1993 and followed up with a second enforcement blitz in July 1994. In all, 6,364 seat belt checkpoints were held, and 58,883 citations for not using belts along with 3,728 citations for not using child safety seats were issued at these checkpoints and by patrols. Driver belt use increased from 64% before the program to 80% in November 1993, dropped to 73% by May 1994, and then rose slightly higher to 81% in August 1994. Based on time-series analyses, it is estimated that 45 more fatalities and 320 additional serious injuries would have occurred during the 6 months following the program than were actually observed. Using a model based on the costs of medical care and emergency services, these estimated injury reductions translate to medical care cost savings of more than $7 million. To gauge public knowledge and opinion, several random digit telephone surveys were carried out following the two program blitzes. At least 75% of the respondents were aware of the program, and more than 85% of the total sample were in favor of such programs.

Reducing death on the road: the effects of minimum safety standards, publicized crash tests, seat belts, and alcohol.

Two phases of attempts to improve passenger car crash worthiness have occurred: minimum safety standards and publicized crash tests. This study evaluated these attempts, as well as changes in seat belt and alcohol use, in terms of their effect on occupant death and fatal crash rates. Data on passenger car occupant fatalities and total involvement in fatal crashes, for 1975 through 1991, were obtained from the Fatal Accident Reporting System. Rates per mile were calculated through published sources on vehicle use by vehicle age. Regression estimates of effects of regulation, publicized crash tests, seat belt use and alcohol involvement were obtained. Substantial reductions in fatalities occurred in the vehicle model years from the late 1960s through most of the 1970s, when federal standards were applied. Some additional increments in reduced death rates, attributable to additional improved vehicle crashworthiness, occurred during the period of publicized crash tests. Increased seat belt use and reduced alcohol use also contributed significantly to reduced deaths. Minimum safety standards, crashworthiness improvements, seat belt use laws, and reduced alcohol use each contributed to a large reduction in passenger car occupant deaths.

Increasing seat belt use through PI&E and enforcement: The Thumbs Up campaign

Campaigns to increase seat belt use have been effective in controlled environments, in small geographic areas, in primary enforcement states, and when conducted in conjunction with the enactment of seat belt legislation. The Thumbs Up project was undertaken to determine if belt use could be facilitated in less advantageous conditions. A 3-month campaign to increase seat belt use was conducted in two sites, each consisting of two Florida counties. At its conclusion, the Thumbs Up project did not yield an overall increase in seat belt use across the two sites. However, observed seat belt use and the number of seat belt citations issued increased significantly in one site. The results are discussed in terms of the two components necessary for a successful campaign: public information and education, and enforcement. Further, recommendations for conducting successful community-based seat belt interventions are offered.

Development and evaluation of pilot programs to increase seat belt use in North Carolina

Three pilot programs designed to investigate and evaluate techniques to increase seat belt use were carried out in North Carolina, in preparation for a statewide belt use enhancement program. The three pilot sites were chosen to represent different types of North Carolina communities in terms of geography, size, demographics, and history of belt law enforcement. Each of the pilot programs involved radio, TV, and newspaper advertising on the importance of seat belt use, four weeks of intensive enforcement including checkpoints and roving patrols concentrating on seat belt violations, and extensive publicity about the enforcement. More than 2,500 citations were written for belt law violations during the programs; belt use rates among front seat occupants increased from 65% to 78% in High Point, 69% to 79% in Elizabeth City, and 43% to 81% in Haywood County. Telephone surveys revealed strong public support for the publicity and enforcement efforts.

Enforcing alcohol-impaired driving and seat belt use laws, Binghamton, NY

An evaluation of an integrated enforcement program designed to reduce alcohol-impaired driving and increase seat belt use in Binghamton, NY, was conducted. The program's emphasis is on the publicized use of sobriety and seat belt use checkpoints, passive alcohol sensors, and seat belt law enforcement. A study of the program's first two years shows that a relative overall reduction of about 39% in the number of drivers who had been drinking and were stopped at police checkpoints was sustained from Fall 1988 to Fall 1990; evidence was also found of significantly fewer injury-producing crashes and significantly fewer late-night crashes during months when checkpoints were held. Drivers with high blood alcohol concentrations were relatively unaffected by the program. Seat belt use rose, especially at night. Results suggest that checkpoints may have to be both constant and visible features of enforcement for their benefits to be lasting.

Race, belief in destiny, and seat belt usage: a pilot study.

A survey of 1063 individuals found that when belief in destiny was statistically controlled, differences in seat belt use by race disappeared. Thus, racial differences in seat belt use are statistically accounted for and might be explained by belief in destiny. Efforts to increase seat belt use should target minority groups rather than include them in broadbrush programs. Further, these efforts should take into account this important difference in motivation.

The New Vital Sign-Reply

In Reply. —I appreciate the support of Drs Conwill and Currier for institutionalizing clinical prevention interventions and, specifically, the assessment of patient smoking status as a new vital sign. What is essential in such interventions is that they are brief in nature and provide an opportunity for meaningful clinical responses, such as lowering blood pressure or treating nicotine addiction. Clearly, it would be desirable to increase seatbelt use and thereby decrease years of potential life lost; this could constitute a defensible addition to the basic vital signs. However, it is equally important that the case for making a fundamental institutional change, such as expanding the vital signs, be compelling and unequivocal. In creating effective institutional changes, it may be necessary to introduce them in a stepwise manner, assessing their implementation and impact at each stage of the process. In this way, we can strive to achieve maximum benefit through these

Judging the Roles of Legislation, Education and Offsetting Behaviour in Seat Belt Use: A Survey and New Evidence from Alberta

A recent court decision in Alberta overturned provincial legislation making seat belt use mandatory. Arguments supporting this decision included the possibility that the life-saving benefits of increased seat belt use might be offset by other changes in driving behaviour, as well as the potential for the same safety improvements to be achieved through a less intrusive means such as public education. A higher court subsequently reinstated the seat belt legislation without effectively addressing these issues. Here, in the context of a model that allows for driver behavioural responses, we survey the evidence concerning the effects of education programs and legislation in promoting seat belt use, and include some new empirical findings based on a survey undertaken in Alberta prior to such use becoming mandatory. We conclude that effective driver education programs must be designed in a way that allows drivers to gain experience with and develop the habit of wearing seat belts. Paradoxically, mandatory seat belt use legislation may be one of the most effective means for providing drivers with the opportunity for developing these habits.

The effects of mandatory seat belt legislation on self-reported seat belt use among male and female college students

The effect of seat belt legislation on self-reported seat belt use among male and female college students was investigated. Questionnaires inquiring about seat belt use were administered to college students on three separate occasions: (i) two months prior to the time a mandatory seat belt law went into effect, (ii) two months after the law went into effect, and (iii) 16 months after the law went into effect. Reported seat belt use increased significantly for male and female college students two months after the law took effect. At 16 months postlaw, reported seat belt use remained high for female students but declined almost to the prelaw level for males. Possible reasons offered for these findings are that male college students may be more resistant to having their behavior regulated and, therefore, less likely to internalize changes forced on them, and college-age males may be more inclined to engage in risk-taking behavior than college-age females. The importance of considering males and females separately with respect to seat belt use and interventions designed to increase seat belt use is discussed.

The Relation Between Perceived Risk and Preventive Action: A Within‐Subject Analysis of Perceived Driving Risk and Intentions to Wear Seatbelts

Intentions to wear seatbelts in 12 different driving situations were predicted from attitudes toward wearing seatbelts, subjective norms concerning seatbelt uses, and perceived driving risk. In a given driving situation, appropriate measures of attitudes and subjective norms both had significant effects on intentions to wear a seatbelt, whereas there was little relation between risk and intentions. Intentions across the 12 driving situations were significantly related to perceived driving risk, both for aggregate data and for a substantial portion of individual subjects. However, further analyses indicated that risk seemed to affect intentions indirectly through subjective norms and attitudes associated with seat‐belt use. The results suggest that attempts to increase seatbelt use should target all relevant beliefs important in determining people's attitudes toward and subjective norms concerning seatbelt use, rather than just focusing upon making people aware of the risks associated with driving.

Pediatric Chance Fractures

Seven cases of Chance fractures of the spine in children are presented, with their association to intra-abdominal injuries secondary to seatbelt use. A discussion and review of the literature suggest an increasing frequency of this particular injury with a high association given the clinical sign known as the "seatbelt sign." Also reviewed is the association of intra-abdominal injuries secondary to seatbelt restraints, and particular attention is paid to the concurrence of intra-abdominal injury with Chance fractures of the spine. The unique features of the pediatric anatomy in relation to the design of the adult seat restraint as it relates to the vertebral fracture and intra-abdominal injuries are noted. A review of the literature discusses the development of a classification for this flexion-distraction type of vertebral injury, and supports our experience of the increasing frequency of these particular injuries with increasing seatbelt use.