Seat belt utilization in Saudi Arabia and its impact on road accident injuries

Most industrialized countries and many developing countries have passed laws that require the use of seat belts in motor vehicles. It is widely believed that seat belt use is an effective way to reduce road accident fatalities and injuries. Saudi Arabia joined these countries when it enacted a similar law on 5 December 2000 making seat belt use compulsory for all drivers and front-seat passengers. This study measures seat belt use rate and its impact on the number of road accident injuries during the first few months that followed the enactment of the law. It also investigates drivers' behaviour and personal characteristics and their relationship with using seat belts by using a questionnaire specially prepared for this purpose. Results show that seat belt use rate in two Riyadh suburbs were 33% and 87%, respectively, for drivers and 4% and 41%, respectively, for front-seat passengers (FSP's). Such belt use rates are considered low yet encouraging when compared with use rates before enacting the law. Results also show that there was a significant drop in certain types of injuries due to traffic accidents after the enactment of the seat belt law. Questionnaire results show that certain personal characteristics were correlated with seat belt use rate. Finally, implications of these findings in terms of future plans for improving traffic safety are discussed.     

Speed as a measure of driver risk: Observed speeds versus driver and vehicle characteristics

This investigation was performed to determine relationships between driver and vehicle characteristics and freely chosen speeds of cars on a two lane road with little commercial or residential development. Speed is taken as a measure of a driver's willingness to expose himself to risk of accident, in the same way that short freeway headways were interpreted in an earlier study. A total of 6638 passenger car speeds were measured by radar while each oncoming vehicle was simultaneously photographed. Driver and vehicle characteristics were derived from the photographs, both by direct observation (vehicle type, driver sex, presence of front seat passengers, seat belt use) and from the car license plate through the use of State vehicle registration and driver licensing files. The State files provided the car mass and model year and the owner (usually driver) age, sex, and recorded accidents and violations. Higher speeds were observed for younger drivers, drivers with prior accidents and convictions, newer cars, heavier cars and cars with no passengers.     

Risky driving related to driver and vehicle characteristics

This investigation was performed to determine relationships between driver and vehicle characteristics and risk taking in everyday driving, as measured by close following in freeway traffic. A total of 12,000 observations were made of headways (time intervals between successive vehicles) in high flow freely moving freeway traffic at two sites, one in Michigan, the other in Toronto, Canada. The headways were measured using a photographic technique which allowed vehicle and occupant characteristics to be recorded, including type of vehicle and sex and seat belt use. For the Michigan observations, the vehicle license number was recorded, from which additional information on the vehicle and owner (usually the driver) was obtained from state files, including the vehicle mass and model year and the owner's age. sex and history of recorded accidents and traffic violations. Shorter headways, corresponding to higher risk, were found for drivers with prior accidents or violations, young drivers, male drivers, drivers with no passengers. and drivers who did not wear a seat belt. Vehicles associated with shorter headways included newer cars and cars of intermediate mass (1600–1900 kg).     

Seat belt legislation and seat belt use: effects on differences related to sex, social class and smoking

As part of a larger study of preventive health behavior, 177 adults answered a question about how often they wore seat belts both before and after seat belt legislation was introduced in Britain. Analyses by smoking status, sex and socioeconomic status (SES) showed that all groups increased the frequency of self-reported seat belt use after the law was introduced. Regression analyses showed that before the law, SES, sex and general preventive behavior were significant predictors of seat belt use, while only SES was a significant predictor of post-legislation seat belt use. Overall the results suggested that seat belt legislation was effective in promoting seat belt use since most of the demographic differences were eliminated by the legislation.     

Characterological, situational, and behavioral risk factors for motor vehicle accidents: a prospective examination

The occurrence of motor vehicle accidents (MVAs) was studied prospectively in a sample of 500 drivers aged 19-88. Over a 4-year interval from 1991 to 1995, 36% of these drivers had a minor accident and 9% had a serious (injury-producing) accident. Data collected in 1991 demonstrated that crashes could be predicted from a combination of pre-existing characterological, situational, and behavioral risk factors, and that these risk factors largely explained sex and age differences in accident rates. The best predictors of future MVAs were younger age, high hostility in combination with poor self-esteem, residence in a larger city, recent relocation, high job stress, prior MVAs, and self-reported tendencies to speed and disregard traffic rules. Failure to wear seat belts did not predict accidents but did significantly influence the severity of accidents that did occur; that is, those who had earlier reported using seat belts 'always' were less likely than others to be injured when accidents did occur. Financial stress increased the likelihood of involvement in more serious accidents.     

Impact of safety belt use on road accident injury and injury type in Kuwait

The enactment of Kuwait's seat belt law in January 1994 provided an opportunity to examine the impact of seat belt use on road accident fatalities and injury types in this affluent Persian Gulf nation. Via a structured data form, the results of injurious/fatal road accidents for more than 1200 accident victims were gathered from the files of the six major government hospitals which treat most traffic accident victims. Statistical analysis of the data showed that seat belt use has had a positive effect in reducing both road traffic fatalities and multiple injuries in Kuwait. The use of seat belts has also affected the nature of the injuries resulting from road traffic accidents. Non-users of belts experienced higher frequencies of head, face, abdominal and limb injuries. Users of belts, on the other hand, suffered higher frequencies of neck and chest injuries. The interrelationship between the victim, his age, and the type of injuries resulting from road traffic accidents is also investigated.     

Interaction between socio-demographic characteristics: Traffic rule violations and traffic crash history for young drivers

Young drivers’ high traffic violation involvement rate and significant contribution to traffic crashes compared to older drivers creates the need for detailed analyses of factors affecting young drivers’ behaviors. This study is based on survey data collected from 2,057 18–29 year old young adults. Data were collected via face-to-face questionnaire surveys in four different cities in Turkey. The main objective of this study is to identify the relationship between socio-demographic characteristics, traffic rule violations, and traffic crashes among young drivers. Four main traffic rule violations are examined: red light violations, seat belt violations, speeding, and driving under the influence of alcohol, which are decisive in determining driving behavior and traffic crashes. The survey investigates the socio-demographic characteristics, traffic rule violation behavior and traffic crash histories of young adults. Four hypothetical scenarios were prepared for each traffic rule violation and data from the scenarios were modeled using the ordered probit model. Significant variables affecting each traffic rule violation are stated. Finally, significant variables that interact with crash involvements were investigated with binary logit models. According to the data analysis, 23.9% of drivers stated that they were involved in at least one traffic crash within the last three years. This crash rate increases to 38.3% for those who received at least one traffic citation/violation in last three years and peaks to 47.4% for those who were fined for seat belt violations in last three years.     

Self-reported and observed seat belt use – A case study: Bosnia and Herzegovina

The issue of seat belt use in middle- and low-income countries is strongly evident and has as a result higher rates of fatalities and seriously injured on the roads. The first systematic field research of the seat belt use while driving was carried out in Bosnia and Herzegovina, in 2011–2012. Research methodology consisted of two mutually conditioned parts (observation and self-reported behavior). Specific features of the methodology used are in the relationship between the observed and interviewed drivers which enabled the analysis of their observed and self-reported behavior while driving. The logistic regression method was used in this work to make the analysis of the influence of personal human characteristics (gender, age, education, exposure) and vehicles’ characteristics (age) on the observed and self-reported driving behavior, from the point of view of seat belt use while driving. The influence of the listed factors on driving behavior, depending on road type (urban or rural), was given special attention in the analysis. The paper shows that certain factors do not have the same impact on driving behavior, in various conditions. Based on results from this study, it will be possible to define certain critical groups of road users and the way in which they must be addressed in order to increase the seat belt wearing rate.     

Are there really shortcuts? estimating seat belt use with self-report measures

We examined the utility of estimating rates of automobile seat belt use with selfreport measures. Self-report measures overestimate belt use rates compared to observational surveys of the same population. Laws mandating seat belt use did not substantially affect the degree to which self-reports are upwardly biased. We found self-report measures overestimate observed belt use by 8.9 to 19.4 percentage points or by a factor of 1.2 to 2. Our best estimate is that self-reported seat belt use rates be discounted by 12 percentage points to estimate actual belt use rates.     

Predicting seat belt use in fatal motor vehicle crashes from observation surveys of belt use

There is a large difference between the rates of observed seat belt use by the general public and belt use by motor vehicle occupants who are fatally injured in crashes. Seat belt use rates of fatally injured occupants, as reported in the Fatality Analysis Reporting System (FARS), are much lower than the use rates found in observation surveys conducted by the states. A series of mathematical models describing the empirical relationship between FARS and observed rates were explored. The initial model was a 'straw man' and used two simplifying assumptions: (a) belt users and nonusers are equally likely to be involved in 'potentially fatal collisions', and (b) belts are 45% effective in preventing deaths. The model was examined by comparing each state's FARS use rate with the predicted rate. The model did not fit the state data points even when possible biases in the data were controlled. We next examined the assumptions in the model. Changing the seat belt effectiveness parameter provided a reasonable fit, but required an assumption that seat belts are 67% effective in preventing fatalities. The inclusion of a risk coefficient for non-belted occupants also provided a reasonable fit between the model and data. A variable risk model produced the best fit with the data. The major finding was that a model consistent with the data can be obtained by incorporating the assumption that nonusers of seat belts have a higher risk of involvement in potentially fatal collisions than do seat belt users. It was concluded that unbelted occupants are over-represented in fatal collisions for two reasons: (a) because of a greater chance of involvement in potentially fatal collisions in the first place, and (b) because they are not afforded the protection of seat belts when a collision does occur.     

The effectiveness of the Canadian mandatory seat belt use laws

The impact of four provincial mandatory seat belt use laws passed in 1976 and 1977 on seat belt use and on motor vehicle occupant casualties is examined. Subsequent to the passage of the laws, belt use typically increased from 20 to the 70% level dropping to around 50% over the next several years. Ontario exhibited a clear drop in the fatality and injury rates in the years following the introduction of the law. Quebec experienced little reduction in casualties. The changes in casualties for British Columbia and Saskatchewan were mixed with the former showing a drop only in the fatality rate subsequent to the seat belt law, while the latter experienced a reduction only in the injury rate. The provinces without seat belt use laws also enjoyed some reductions in occupant casualty rates. The changes in occupant casualties in the legislated provinces were also examined relative to the changes in non-occupant casualties and relative to the unlegislated provinces. It was concluded that three provinces experienced some reductions as a result of legislation but not as much as anticipated. It is speculated that the impact of the seat belt use laws fell short of expectations because it was mainly the safe drivers who buckled up in response to the laws.     

Voluntary seat belt use among U.S. drivers: geographic, socioeconomic and demographic variation

Although voluntary seat belt use rates are low, they are not uniform among different populations of U.S. drivers. In detailed analyses of 1982 data from 12 of the 19 cities in the National Highway Traffic Safety Administration's national seat belt survey and from three of the National Accident Sampling System regions, belt use rates varied greatly by geographic region, socioeconomic status and demographic group. These factors also moderated the effects of other factors such as car size and origin of manufacture. Nevertheless, all together, the factors included in the study explained less than 5% of the variation in voluntary seat belt use, and no subpopulation was identified in which seat belts were used by a majority of the members.     

How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants?

The expected effects of increasing seat belt use on the number of killed or seriously injured (KSI) light vehicle occupants have been estimated for three scenarios of increased seat belt use in Norway, taking into account current seat belt use, the effects of seat belts and differences in crash risk between belted and unbelted drivers. The effects of seat belts on fatality and injury risk were investigated in a meta-analysis that is based on 24 studies from 2000 or later. The results indicate that seat belts reduce both fatal and non-fatal injuries by 60% among front seat occupants and by 44% among rear seat occupants. Both results are statistically significant. Seat belt use among rear seat occupants was additionally found to about halve fatality risk among belted front seat occupants in a meta-analysis that is based on six studies. Based on an analysis of seat belt wearing rates among crash involved and non-crash involved drivers in Norway it is estimated that unbelted drivers have 8.3 times the fatal crash risk and 5.2 times the serious injury crash risk of belted drivers. The large differences in crash risk are likely to be due to other risk factors that are common among unbelted drivers such as drunk driving and speeding. Without taking into account differences in crash risk between belted and unbelted drivers, the estimated effects of increasing seat belt use are likely to be biased. When differences in crash risk are taken into account, it is estimated that the annual numbers of KSI front seat occupants in light vehicles in Norway could be reduced by 11.3% if all vehicles had seat belt reminders (assumed seat belt wearing rate 98.9%), by 17.5% if all light vehicles had seat belt interlocks (assumed seat belt wearing rate 99.7%) and by 19.9% if all front seat occupants of light vehicles were belted. Currently 96.6% of all (non-crash involved) front seat occupants are belted. The effect on KSI per percentage increase of seat belt use increases with increasing initial levels of seat belt use. Had all rear seat occupants been belted, the number of KSI front seat occupants could additionally be reduced by about 0.6%. The reduction of the number of KSI rear seat occupants would be about the same in terms of numbers of prevented KSI.     

Driver hand-held mobile phone use and safety belt use

The purposes of the study were to identify hand-held mobile phone use trends for Michigan and to compare safety belt use between users and nonusers. Mobile phone and safety belt use was investigated by a direct observation survey of drivers at intersections in Michigan. Data were weighted to calculate mobile phone use and safety belt use rates statewide. The study showed 2.7% of Michigan drivers were using a mobile phone at any given daylight time. Safety belt use of current mobile phone users was significantly lower than those not using mobile phones.     

Mathematical models assuming selective recruitment fitted to data for driver mortality and seat belt use in Japan

Previous research has indicated that unbelted drivers are at higher risk of involvement in fatal crashes than belted drivers, suggesting selective recruitment that high-risk drivers are unlikely to become belt users. However, how the risk of involvement in fatal crashes among unbelted drivers varies according to the level of seat belt use among general drivers has yet to be clearly quantified. We, therefore, developed mathematical models describing the risk of fatal crashes in relation to seat belt use among the general public, and explored how these models fitted to changes in driver mortality and changes in observed seat belt use using Japanese data. Mortality data between 1979 and 1994 were obtained from vital statistics, and mortality data in the daytime and nighttime between 1980 and 2001 and belt use data between 1979 and 2001 were obtained from the National Police Agency. Regardless of the data set analyzed, exponential models, assuming that high-risk drivers would gradually become belt users in order of increasing risk as seat belt use among general motorists reached high levels, showed the best fit. Our models provide an insight into behavioral changes among high-risk drivers and support the selective recruitment hypothesis.     

Self-reported road traffic violations in France and how they have changed since 1983

Goals

The goal was to gain a picture of current driver behaviour, and of the links between committed violations and accident history. It was also to identify how driver behaviour has changed over the last 20 years.

Methods

A questionnaire-based cross-sectional study of a sample of 1161 drivers about the frequency of violations and the perception of the dangers and penalties associated with them was used in 2005. Self-reported violations and mental representations were also compared to the results of Biecheler who used similar methods (Biecheler-Fretel, 1983).

Results, conclusions

Road traffic violations are frequent in France, particularly among male drivers. Several violations are linked with history of accidents in our sample. Frequently or fairly frequently exceeding the speed limit by 10 km/h (a violation reported by almost 53% of our sample), increases accident occurrence by a factor of 1.4. Progress in drivers’ behaviour has been slow and nonuniform, and appears in part to be related to safety campaigns that have been run (seat belts, alcohol). The results could inform future campaigns. In particular, a campaign on the use of indicators would seem worthwhile.     

The influence of safety belt laws on self- reported safety belt use in the United States

We assessed rates and trends in safety belt use by presence and type of safety belt law using data from states participating in the 1984–1989 Behavioral Risk Factor Surveillance System. State(s) with a safety belt law allowing law enforcement officers to stop vehicles for occupants' failure to use safety belts (primary enforcement law) had greater and more rapid increases in safety belt use rates than did states with laws requiring that vehicles must first be stopped for some other violation before a citation or fine for occupants' failure to use safety belts could be imposed (secondary enforcement law). Larger and sustained increases in safety belt use occurred when safety belt laws became effective or when fines were imposed for violations than when laws were first enacted. These data suggest that primary enforcement laws result in greater and more rapid increases in safety belt use than do secondary enforcement laws, and that initial increases in safety belt use following implementation of laws are sustained.     

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.     

Statistical adjustment for misclassification of seat belt and alcohol use in the analysis of motor vehicle accident data

The use of seat belts and alcohol is often mis-reported in police motor vehicle accident reports for a number of reasons. To avoid penalties, occupants often over report seat belt use and under report alcohol use. Police officers sometimes fail to account for evidence such as presence of belt burn, condition of belts, odor of alcohol, crash patterns, etc. Biased conclusions result when using misclassified accident data to estimate the effectiveness of seat belts in preventing injuries and reducing medical costs. We investigated the effects of misclassification of seat belt and alcohol use on the odds ratio of injury as well as medical costs. A statistical method and a SAS program were developed to adjust odds ratios of injury and medical cost estimates to account for misclassification of seat belts and alcohol use. The method allowed for incorporation of variables that could affect misclassification of seat belt and alcohol use. We conducted a Monte Carlo simulation and found that when there were large differences between the misclassification rates for major and minor injury, the unadjusted odds ratio could have up to a 90% bias while our adjusted odds ratio was effectively unbiased. To illustrate the method, we estimated the misclassification rates of seat belt and alcohol use by comparing merged police and hospital reports from Nebraska motor vehicle accident data sets (1996-1997) and then evaluated the bias of the odds ratio of injury and medical costs estimates due to misclassification. Our results showed that the bias of the odds ratio of injury and medical costs due to misclassification of seat belts and alcohol use depended both on the amount of misclassification and the reported frequencies. Misclassification about seat belt and alcohol use only slightly biased the unadjusted odds ratio estimates and mean hospital charge, while misclassification resulted in approximately a 69% underestimate of the total medical costs savings due to seatbelts. However, due to the small size of the merged Nebraska police and hospital data set used to estimate misclassification rates, these results are likely somewhat imprecise.