Increase Seat Belt Use Research Articles

Education, incentive, and engineering-based interventions to promote the use of seat belts.

Education, incentive, and engineering-based interventions to promote the use of seat belts.

Are crash causation studies the best way to understand system failures – Who can we blame?

The search for common and serious single causes of road crashes naturally leads to a concentration on the road user. This is supported by a legal framework in the search for the main cause and the suspect for this cause.In prevention, we havefor decades been more inclined to look for systematic improvements of all elements of the road transport system, and we direct the recommendations for actions towards system designers, organizations, products and services.In this paper the discussion about causation and prevention is broadened in the light of Vision Zero and its approach to prevention of serious and fatal injuries. We also discuss the Swedish judicial system and why the prevention approach has not been legislated or even generally accepted. Occupational health and safety legislation and road rules are compared, as well as how sustainability practices and reporting are tools to apply prevention where organizations have a natural sphere of influence that could mitigate deaths and serious injuries within value chains.It is recommended that we stop using the term causation as it is only directing actions in one direction. There is a risk that the focus on causation, in particular single causes, will deviate actions away from robust prevention countermeasures such as increased seat belt use, relevant speed limits, and well functioning roundabouts and median barriers. Furthermore, there is also a risk that important preventative actions from organizations are overlooked.

Increasing seat belt use in the United States by promoting and requiring more effective seat belt reminder systems

Objective Federal Motor Vehicle Safety Standard (FMVSS) 208 requires every passenger vehicle to provide an auditory signal lasting 4 to 8 seconds and a visual display lasting 60 seconds when the driver is unbelted at ignition. This requirement does not increase seat belt use. This paper summarizes the latest research on using vehicle technology to increase seat belt use and existing safety standards worldwide to support the strengthening of FMVSS 208. Method Studies of seat belt reminders and interlocks published in peer-reviewed journals, conference proceedings, or as technical reports were identified in online databases and reviewed along with current requirements worldwide. Results from past research were used to estimate the front- and rear-seat daytime belt use rate and the annual number of lives that could be saved by a persistent audible reminder at each seating position. Results Most motor vehicle occupants routinely buckle up. Those that do not typically forget, are going a short distance, or find belts uncomfortable. Seat belt reminders can remind or motivate occupants to buckle up. Enhanced reminders that exceed FMVSS 208 increase belt use by 6 percentage points. Reminders also can increase rear belt use, and although required throughout the world, are not required by FMVSS 208. More persistent reminders, like those required around the world, with a continuous, long-lasting audible signal increase belt use by 30% among drivers who do not routinely buckle up. If every vehicle in the U.S. had such a reminder at each seating position, then it was estimated that the daytime belt use rate in the U.S. would increase about 3 percentage points from 90.3% to 93.2% in the front row and by about 6 percentage points from 80% to 85.9% in the rear row. It was estimated that the increase in belt use from a continuous, long-lasting audible reminder could potentially save about 1,600 lives each year. Seat belt interlocks can increase belt use, but acceptance is a stumbling block. Public outcry ensued after interlocks were required in 1973, and public sentiment remains negative. Opinions toward front and rear reminders are more favorable. Furthermore, past research suggests interlocks may be no more effective for increasing seat belt use than persistent audible reminders. The effect of interlocks on rear belt use have not been explored. Conclusion Persistent seat belt reminder systems that last at least 90 seconds can potentially save hundreds of U.S. motorists each year. Robust empirical evidence, successful exemplars from organizations throughout the world, and a clear public health benefit exists for strengthening FMVSS 208 to require more persistent audible reminders at every seating position.

Epidemiology of traumatic brain injuries at a rural-serving Level II trauma center, 2004 - 2016

ABSTRACT Objective To describe the epidemiology of traumatic brain injury (TBI) and quantify rural and urban differences. Methods Patient characteristics, injury characteristics, imaging, and outcomes were extracted from the trauma registry of the level II trauma center at Essentia Health-St. Mary’s Medical Center, Duluth, MN, for patients admitted for a TBI from January 1, 2004, through December 31, 2016. Estimated relative risk (RR) per year, Wald 95% confidence intervals, and p-values were calculated. Results Of the 5,079 TBI admissions during the study period, just under half (2,510, 49.4%) resided in rural areas at the time of admission. Overall, there was a 3.8% unadjusted annual increase in TBI risk rom 2004–2016, with 2.9% and 4.7% annual increases among rural and urban U.S. residents, respectively. Rural residents had significant annual increases in risk of TBI admission resulting in 30-day post-discharge emergency department readmission and 30-day post-discharge combined inpatient/emergency department readmission of 35.2% and 22.4%, respectively. Conclusions We found that risk of rural resident TBI admission due to MVC was significantly greater than that for urban residents. Public health and medical interventions to decrease the rural/urban disparity are warranted, including public health campaigns to increase seat belt use, and supportive care post-discharge into rural communities.

A VR-Enhanced Rollover Car Simulator and Edutainment Application for Increasing Seat Belt Use Awareness

Most countries have active road safety policies that seek the objective of reducing deaths in traffic accidents. One of the main factors in this regard is the awareness of the safety measures, one of the most important being the correct usage of the seat belt, a device that is known to save thousands of lives every year. The presented work shows a VR-enhanced edutainment application designed to increase awareness on the use of seat belts. For this goal, a motorized rollover system was developed that, synchronized with a VR application (shown in a head-mounted display for each user inside a real car), rolls over this car with up to four passengers inside. This way, users feel the sensations of a real overturn and therefore they realize the consequences and the results of not wearing a seat belt. The system was tested for a month in the context of a road safety exhibition in Dammam, Saudi Arabia, one of the leading countries in car accidents per capita. More than 500 users tested and assessed the usefulness of the system. We measured, before and after the rollover experience, the perception of risk of not using the seat belt. Results show that awareness regarding the use of seat belts increases very significantly after using the presented edutainment tool.

A home-based approach to understanding seatbelt use in single-occupant vehicles in Tennessee: Application of a latent class binary logit model

Although the enforcement of seatbelt use is considered to be an effective strategy in reducing road injuries and fatalities, lack of seatbelt use still accounts for a substantial proportion of fatal crashes in Tennessee, United States. This problem has raised the need to better understand factors influencing seatbelt use. These factors may arise from spatial/temporal characteristics of a driving location, type of vehicle, demographic and socioeconomic attributes of the vehicle occupants, driver behaviours, attitudes, and social norms. However, the above factors may not have the same effects on seatbelt use across different individuals. In addition, the behavioural factors are usually difficult to measure and may not always be readily available. Meanwhile, residential locations of vehicle occupants have been shown to be associated with their behavioural patterns and thus may serve as a proxy for behavioural factors. However, the suitability of geographic and residential locations of vehicle occupants to understand the seatbelt use behaviour is not known to date.This study aims to fill the above gaps by incorporating the residential location characteristics of vehicle occupants in addition to their demographics and crash characteristics into their seatbelt use while accounting for the varying effects of these factors on individual seatbelt use choices. To achieve this goal, empirical data are collected for vehicular crashes in Tennessee, United States, and the home addresses of vehicle occupants at the time of the crash are geocoded and linked with the census tract information. The resulting data is then used as explanatory variables in a latent class binary logit model to investigate the determinants of vehicle occupants’ seatbelt use at the time of the crash. The latent class specification is employed to capture the unobserved heterogeneity in data. Results show that Tennessean drivers belong to two general categories—conformist and eccentric—with gender, vehicle type, and income per capita determining the likelihood of these categories. Overall, male drivers, younger drivers, and drivers who have consumed drugs are less likely to wear a seatbelt, whereas drivers who come from areas with higher population density, travel time, and income per capita are more likely to wear a seatbelt. In addition, driving during the day and in rainy weather are associated with an increased likelihood of seatbelt use. The findings of this study will help developing effective policies to increase seatbelt use rate and improve safety.

Features of Low-Income and Middle-Income Countries making Road Safety more Challenging

Low- and Middle-Income Countries suffer the large majority (93%) of global road crash deaths and face particular challenges in managing this crisis. This paper presents global data and trends revealing underlying features of the problem for LMICs. LMICs are commonly grouped and described together in road safety commentaries, yet appreciation of the substantial differences between LICs and MICs is vital. While global deaths per 100,000 people have stabilized during the UN Decade of Road Safety, the population rate has increased in LICs (by 8.2%), while decreasing in HIC and MIC. LICs have less resources to address road safety and younger populations adding to risk. Wide variations on road safety performance exist within country income groups, with some of this variance occurring systematically between regions. Absolute numbers of deaths are increasing due to increasing population and increasing vehicle fleets in LMICs compared with HICs. The capacity of MICs, and especially LICs, to manage road safety is hampered by poor crash data to guide action as well less available funding and resources to achieve safer road engineering, safer vehicles, and protect the large proportions of vulnerable road users. Road crash deaths and injuries are retarding the economic growth of LMICs and investing road safety is a costeffective means by which LMICs can move towards becoming HICs. Vital opportunities for cost-effective savings of lives and debilitating injuries in LMICs include better management of speed (especially through infrastructure), improving safety infrastructure for pedestrians, increasing seatbelt use, and shifting travel from motorcycles to buses through provision of Bus Rapid Transit systems.

Seatbelt and child restraint use among vehicle occupants in Ho Chi Minh City: an observational study in Vietnam

This paper presents the trend of seatbelt use, disaggregated by vehicle occupants, in Ho Chi Minh City between 2016 and 2018. We conducted statistical analyses to identify the determinants of seatbelt use, including the effect of a new fine imposed against seatbelt law violation in the rear seats that became effective in January 2018. Seatbelt use was observed in at least half of all vehicle occupants, and drivers were more likely to use seatbelts than passengers. Only 4.4% of children younger than 5-years and 2.5% of 5 to12-year-olds used a child restraint system. Seatbelt use increased among all occupants after the imposed fine, especially among rear-seat passengers. Imposing new or increasing fixed penalties, with enforcement and public education, may increase seatbelt use to prevent road traffic injuries.

Obesity and motor vehicle deaths: a panel-data analysis

PurposeThis paper analyzes the impact of obesity on the probability of a motor vehicle fatality (highway death rate) and on its component probabilities: the probability of a fatality, given a crash (vulnerability rate) and the probability of a crash (crash rate).Design/methodology/approachUsing state-level data for 1995–2015, the paper estimates models explaining all three rates. Explanatory factors include obesity and a representative set of potential determinants.FindingsResults indicate that obesity has a statistically significant positive relationship with the highway death rate and the crash rate. Also having a statistically significant positive association with at least one of the three rates are the proportions of young and old drivers, alcohol consumption, the ratio of rural to urban vehicle miles and temperature. Factors with a statistically significant negative relationship with at least one of the rates include primary seat belt laws and precipitation. In 2016, a total of 928 traffic fatalities could have been avoided if obesity rates decreased by one percentage point.Practical implicationsSeat belts and crash dummies should be better designed to fit and represent those with higher BMIs, and education efforts to increase seat belt use should be supplemented with information about the adverse impact of obesity on highway safety.Originality/valueThis paper uses 21 years of state-level information, including socio-economic and regulation data, and contributes to the existing research on the relationship between obesity and highway safety.

Seatbelt laws and seatbelt use among front- and rear-seat vehicle occupants in fatal crashes in the United States

Seatbelt laws are deemed effective at increasing seatbelt use, consequently, reducing fatalities associated with motor vehicle crashes in the United States. Previous studies have provided significant insights about the effectiveness of seatbelt laws, however, studies exploring passenger seatbelt use accounting for the variations in seatbelt laws are not well documented in the literature. Seatbelt laws vary by whether they cover front-seat occupants only or include rear-seat passengers as well. The primary objective of this study was to investigate the differences in adult seatbelt compliance rate based on six categories of seatbelt laws in the United States using crash data. In this present study, six categories of seatbelt laws are considered ranging from no seatbelt law to primary seatbelt law covering all vehicle occupants. Using Tukey-type multiple comparison test, a positive relationship between seatbelt laws and adult seatbelt use was found. Specifically, states with stricter seatbelt laws, that is primary law for all front- and rear-seat occupants, exhibit higher seatbelt compliance rate than those with less strict (partial primary/secondary laws) or no seatbelt laws. Given the significant differences in adult seatbelt use based on our study design (using six categories of seatbelt laws), the analysis support that if states upgrade their seatbelt laws from no/secondary laws to primary laws covering all vehicle occupants, there likely will be positive impacts on adult seatbelt use. The findings in this study are to inform and support decision policies and intervention strategies that are effective at promoting safety for motor vehicle occupants.

State-level seat belt use in the United States, 2011–2016: Comparison of self-reported with observed use and use by fatally injured occupants

Introduction: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. Objective: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011–2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. Results: During 2011–2016, national self-reported seat belt use ranged from 86–88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = −0.77). Conclusion: National self-reported seat belt use remained essentially stable during 2011–2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.

Factors affecting injury severity of single-vehicle rollover crashes in the United States

Objective: This study investigated the confounding effects of factors on injury outcomes for all occupants in fatal single-vehicle crashes that involved a rollover event.Method: A generalized ordered logit model was used to investigate the role of roadway attributes, environmental factors, driver characteristics, and vehicle features in injury severity outcomes for occupants. Five years of single-vehicle rollover crash data for the United States were studied.Results: Results showed that the likelihood of serious and fatal injuries increases in rollover crashes with partial or complete ejection of the occupant, no seat belt use, speeding, higher posted speed limits, roadside and median rollovers, undulating terrain, blacktop road surface, and rural roads. We also found that evening, weekdays, previous driver crash, careless or inattentive driving, driver–passenger engagement, aggressive driving, and vehicle type affect injury severity. The deployment of airbags was associated with fewer serious and fatal injuries. Regional differences were found for injury severity outcomes in rollover crashes.Conclusions: The study provides valuable insight for reducing injury severity in single-vehicle crashes where a rollover occurs. Several proven countermeasures may prevent rollovers or reduce injury severity. These strategies include increasing seatbelt use, posting lower speed limits and installing speed enforcement cameras in high-risk areas, flattening roadside embankments, and promoting in-vehicle stability enhancement systems such as electronic stability control and rollover-activated side curtain airbags.

The effects of persistent audible seat belt reminders and a speed-limiting interlock on the seat belt use of drivers who do not always use a seat belt

Introduction: Vehicle technologies that increase seat belt use can save thousands of lives each year. Kidd, Singer, Huey, and Kerfoot (2018) found that a gearshift interlock was more effective for increasing seat belt use than an intermittent audible reminder, but interlocks may not be more effective than persistent audible reminders lasting at least 90 seconds. Method: Forty-nine part-time belt users with a recent seat belt citation who self-reported not always using a seat belt drove two vehicles for 1 week each. Thirty-three drove a Chevrolet with an intermittent audible reminder followed by either a BMW with a persistent 90-second audible reminder (n = 17) or a Subaru with an incessant audible reminder (n = 16). The other 16 participants experienced the BMW persistent reminder followed by an interlock that limited speed to 15 mph during unbelted driving. These data were combined with data from 32 part-time belt users in Kidd et al. (2018) who experienced the intermittent reminder for 2 weeks or the intermittent reminder for 1 week and a gearshift interlock the next. Results: Relative to the intermittent reminder, seat belt use was significantly increased an estimated 30% by the BMW persistent reminder, 34% by the Subaru incessant reminder, and 33% by the speed-limiting interlock. Belt use was increased an estimated 16% by the gearshift interlock, but this change was not significant. More participants circumvented the speed-limiting interlock to drive unbelted than the audible reminders. Responses to a poststudy survey indicated that interlocks were less acceptable than reminders. Conclusions: Audible reminders lasting at least 90 seconds and a speed-limiting interlock were more effective for increasing seat belt use than an intermittent audible reminder, but reminders were found more acceptable. Practical applications: Strengthening existing U.S. safety standards to require audible reminders lasting at least 90 seconds for front-row occupants could save up to 1,489 lives annually.

Using change in a seat belt law to study racially-biased policing in South Carolina

Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.

Are we SAFE now? An evaluation of the Seatbelts Are for Everyone teen traffic safety program in Kansas

Objective: Teens represent the highest risk group for automobile accidents and are almost 3 times as likely to be killed in an accident. Seat belt use interventions are one way to address this issue, and a student-led program in Kansas called Seatbelts Are For Everyone (SAFE) has increased seat belt use for the past decade. An evaluation of SAFE enabled decisions to be made about program improvement and expansion.Methods: Mixed methods examined multiple aspects of the SAFE program, including summative and formative results. Researchers investigated the program through (1) a quasi-experimental observation to explore whether seat belt use at schools implementing SAFE for the first time was higher than at non-SAFE and (2) stakeholder interviews at SAFE schools. Each method examined whether SAFE programs accomplished goals set by program staff and how SAFE could better meet schools’ needs.Results: Summative results suggest that SAFE affects seat belt use. It is less influential on distracted driving but has a small but significant influence on that behavior. Stakeholders cited infrastructure and functional challenges affecting implementation, highlighting ways in which SAFE program staff could improve program compliance and outcomes. Formative recommendations included curriculum support, sharing among SAFE schools, and increasing student leadership opportunities.Conclusions: The evaluation of SAFE suggests that students are receptive to programs about seat belt and traffic safety. States may consider the recommendations for improvement of this program with other published evaluations and programs to determine how best to implement similar programs in their communities.

Consumer acceptance of enhanced seat belt reminders, a gearshift interlock, or different speed-limiting interlocks to encourage seat belt use following a brief hands-on experience

Seat belt interlock systems that restrict the use of the vehicle or a vehicle feature when an occupant is unbelted are effective for increasing seat belt use but might be unacceptable to consumers. This study collected driver opinions about whether 3 seat belt reminder systems and 3 interlock systems, two that restricted speed and one that prevented shifting into gear, would increase belt use and were acceptable. Twenty-eight volunteers, 22 who routinely did use a belt and 6 who routinely did, drove 6 vehicles with these technologies on a closed course while unbelted or completing tasks that led to unbelted driving. Participants indicated their level of agreement from 1 (strongly disagree) to 5 (strongly agree) with 5 statements after driving each vehicle. Participants reported stronger levels of agreement that each interlock system would make them buckle up more frequently than 2 of the 3 reminder systems. Agreement about finding the various technologies acceptable, requiring them in a vehicle, avoiding purchasing a vehicle with them, or circumventing them was not significantly different among technologies. When asked to circumvent each interlock system, participants most commonly sat on a buckled belt, routed the belt behind their back, or buckled and unbuckled in various manners. Most participants raised safety concerns in a post-study interview about the interlock systems, particularly those that restricted speed. Hence, although interlocks were perceived as more effective for increasing belt use and no more or less acceptable than reminders following a brief hands-on experience, interlocks created safety concerns that may impede acceptance.

Using cameras of automatic number plate recognition system for seat belt enforcement a case study of Sanliurfa (Turkey)

Purpose The purpose of this paper is to quantify the effect of the enforcement, which was carried out with ANPRs, on seat belt use. Though the Seat belt Act was enacted in 1992, it did not lead to an expected increase in seat belt use in Turkey including Sanliurfa, which is one of the immense provinces with a population of over 2m. The Sanliurfa Police Department set in an enforcement campaign, in which automatic number plate recognition (ANPR) cameras were used to facilitate an increment in using seat belts in the city center. Under the police leadership, seat belt use enforcement campaign was hugely publicized and sustained throughout the city. Design/methodology/approach The ANPRs did not have a feature to detect seat belt wearing automatically. Thus, this study tested whether automated plate recognition cameras have a deterrence effect on seat belt usage. To assess the efficacy of this enforcement project, the authors employed a pre/post-implementation design. For this study, the records of the 11 ANPR camera sites, 2 non-camera sites and 2 control sites were utilized. Findings The results of this study revealed that the seat belt use rate was around 8 percent, before camera enforcement in Sanliurfa. Overall increases were 12 percent during the warning period, 60 percent for the beginning period and 78 percent three months after enforcement began at camera sites. One-way ANOVA results suggested the differences between means of seat belt use counts were statistically significant F (3, 61,596)=15,456, p=0.000. Research limitations/implications The findings suggest that there are several reasons for the substantial increase in the seat belt use rate. The first reason for the success of the cameras was their deterrent effect on the drivers, because the drivers were aware that the traffic offense had become readily observable via camera detection in the intersections, and the drivers did not want to be penalized. Second, it is considered that a well-organized publicity of the cameras made a significant contribution to the effectiveness of the enforcement by increasing perceived detection risk. Finally, it is considered that the reason behind the sudden increase in seat belt use was the red-light cameras that had been already in use in Sanliurfa. Namely, the experience of the drivers about camera enforcement gave rise to the rapid decrease in seat belt violation rate in the warning period. Practical implications Using cameras (automatic or not) for seat belt enforcement and publicizing this enforcement can help to save resources and lives. Originality/value This study found a lot of news about similar enforcement on the internet, but no study was found in the literature that reveals if the enforcement can produce an effective result. Thus, this is the first study in Turkey, may be in the world, that evaluated if cameras of the ANPRS can generate effective seat belt enforcement. Furthermore, the study betokened that traffic violations, which cannot be automatically detected by cameras such as cell phone use and smoking in a vehicle can be effectively enforced by non-automatic cameras. Therefore, we believe that the study will contribute policing and the traffic safety literature.

Effectiveness of a collaborative, student-run campaign to increase safety belt use among adolescents

BackgroundMVCs are the leading cause of death among adolescents. Seat belts have been shown to decrease MVC-related death. The purpose of this retrospective cohort study was to evaluate the effectiveness...

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.

The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia

BackgroundBecause Saudi Arabia (SA) has struggled with the burden of Road Traffic Injuries (RTIs) for decades, a new automated citations system was implemented in 2018 to improve compliance with seatbelt and mobile phone laws. Therefore, the purpose of this study is to evaluate the impact of the system on the prevalence of seatbelt and mobile phone use among drivers in Riyadh. This is an observational study conducted between 2017 and 2018. A Pre-Post evaluation was employed to determine the impact of a camera detection system on seatbelt and mobile phone use. Two research coordinators collected the observations at several highways and inner intersections around Riyadh (n = 3400). We evaluated differences in the prevalence of seatbelt and mobile phone use across the two time periods using a chi-2 test. In addition, we evaluated the association between the new intervention and traffic violation using a logistic regression model.ResultsThe overall seatbelt compliance increased significantly from 33.9% (95% CI = 31.7–36.2) to 75.8% (95% CI = 73.7–77.8; P < 0.01). In addition, mobile phone use declined significantly from 13.8% (95% CI = 12.2–15.5) to 9.8 (95% CI = 8.8–9.1; P < 0.01). We found the detection system to be associated with a significant increase in seatbelt use and also a significant decline in mobile phone use while driving. After implementing the intervention, drivers were 6.1 times (OR = 6.1, 95% CI = 5.2–7.0) more likely to wear seatbelts than before the technology went into effect. Similarly, drivers observed after implementing the cameras were 32% (OR = 0.68, 95% CI = 0.55,0.84) less likely to use mobile phones while driving than those seen prior to the intervention.ConclusionsThis study found a significant reduction in traffic violations following the implementation of a camera detection system in Riyadh. This positive impact is evidence for the role preventative structural strategies play to improve traffic safety and reduce RTI in SA. Therefore, these findings may facilitate further support for policymakers that public health interventions play a significant role to improve traffic safety. Seatbelt and mobile phone use while driving should continue to be monitored, and traffic police may evaluate whether increasing the fine is associated with a significant reduction in traffic violations and associated crashes.