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.     

Patterns of safety belt usage following introduction of a safety belt wearing law

The paper reviews the process of enacting a safety belt wearing law in Israel, and studies the impact it has had on belt usage and on casualty reductions. Safety belt legislation in Israel had several unique features in that, on the one hand, all passenger vehicles were retrofitted with safety belts, but, on the other hand, it exempted drivers and front-seat passengers of pre-1969 model vehicles from the compulsory use of belts. Also, the legislation applied only to the use of belts on interurban roads. Repeated counts of safety belt usage, before and after the implementation of the law, provided strong evidence for the efficacy of the legislative act as such. Usage rates rose from an average of 6% to upward of 70%. There was a marked carryover effect of the law on belt wearing rates on urban roads and on the use by drivers of pre-1969 model cars. However, this effect diminished with time. Results of a questionnaire survey provided further evidence for the general acceptance of the law by the public. Only a small minority of drivers completely rejected the use of safety belts. A comparison with data from other countries shows that the impact of a compulsory safety belt wearing law on safety belt usage and on casualty reduction is a universal phenomenon. This fact should encourage researchers, legislators and adminstrators in jurisdictions which are still deliberating the value of mandatory safety belt legislation. On the basis of the trends in fatalities and casualties to car drivers and passengers on urban roads during the two and one-half year period following the introduction of the seat belt law, it is estimated that a reduction of 42% in car fatalities and 44% in car passengers occurred on interurban roads during those two and one-half years. The corresponding reductions in casualties were 18% and eight percent respectively.     

Availability, functionality, and use of seat belts in Beijing taxis prior to the 2008 Beijing Olympic Games

Use of driver seat belts and availability and functionality of passenger seat belts in a convenience sample of 231 Beijing taxis were examined in the months prior to the 2008 Beijing Olympic Games. Driver and front passenger seat belt use was mandated in China from 2004 to help address the growing public health crisis of road trauma. Results from observations made by in-vehicle passengers revealed that 21.2% of drivers were correctly wearing a belt, approximately half were not, and one third were using the belt in a non-functional way. Over 3/4 of this sample of taxi drivers were unrestrained while working. The percentage of functionally available belts was higher for front than rear passengers (88.3% and 22.9%, respectively). This low rate of belt availability in rear seats calls into question the preparedness of the fleet to cater for the safety needs of foreign visitors to China, particularly those from countries with high levels of restraint use. Factors influencing the use/misuse of seat belts in China remain largely unexplored. Results of this pilot study support further investigations of barriers to using injury prevention mechanisms such as seat belts in less motorised countries.     

Method to evaluate the effect of safety belt use by rear seat passengers on the injury severity of front seat occupants

Although the effectiveness of seat belts for reducing injury to rear seat passengers in traffic accidents has been well documented, the ratio of rear-seat passengers restrained by seatbelts remains lower than that of drivers or passengers in front seats. If passengers in rear seats do not wear seat belts, they may sustain unexpected injury to themselves when involved in accidents, and also endanger front occupants (drivers or front seat passengers). This paper focuses on the tendency of front seat occupants to sustain severer injuries due to forward movement of passengers in rear seats at the moment of frontal collisions, and evaluates the effectiveness of rear passengers' wearing seat belts in reducing injuries of front seat occupants. Since the occurrence of occupant injuries depends considerably on the crash severity, we proposed to use pseudo-delta V in regression analysis to represent velocity change during a collision when analyzing statistical accident data. As the crash severity can be estimated from pseudo-delta V, it becomes possible to make appropriate estimations even when the crash severity differs in data. The binary model derived from the ordered response model was used to evaluate the influence on the injury level based on pseudo-delta V, belted or unbelted status, gender and age. Occupants in cars with a hood in the case of car-to-car frontal collisions were extracted from the statistical data on accidents in Japan. Among 81,817 cars, where at least one passenger was present, a total of 6847 cars in which all passengers sustained injuries and which had at least one rear seat passenger aboard were analyzed. The number of killed or seriously injured drivers is estimated to decrease by around 25% if rear seat occupants come to wear seat belts. Also, the number of killed or seriously injured passengers in front seats is estimated to decrease by 28% if unbelted rear seat occupants come to wear seat belts. Thus, wearing of seat belts by previously unbelted rear seat passengers is considered effective in reducing not only injuries to the rear seat passengers themselves but also injuries to front seat occupants.     

Effects of a mandatory safety belt law on hospital admissions

Although the effectiveness of automobile safety belts in reducing risk of serious injury in traffic crashes is well documented, safety belt use in many U.S. jurisdictions remains low. Michigan's mandatory safety belt law for front-seat occupants, implemented in July 1985, is one of 34 similar laws in the United States intended to increase belt use and reduce crash-related injuries. Using time-series intervention analyses of data from 14 hospitals throughout the state, we found a 19% reduction in the rate of admitted patients for all automobile occupant injuries and a 20% reduction in the rate of admitted patients with extremity injuries following implementation of the safety belt law. The utility of hospital data for the evaluation of interventions like the safety belt law reinforce the importance of consistently recording E-codes for all injury patients.     

Seat belt use and accident involvement: A comparison of driving behavior before and after a seat belt law

In an earlier study, researchers at the University of North Carolina Highway Safety Research Center found drivers classified as seat belt nonusers on the basis of direct observation and self-reported belt use to be overrepresented in prior accidents and violations. This study represents a follow-up and extension of the earlier study where accident and violation rates over a 2.5-year interval following the classification by seat belt use status are compared. Seat belt nonusers were again found to be overrepresented in both accidents and violations. In other analyses of these data, changes in seat belt use status were found not to be associated with changes in accident or violation rates, and seat belt use rates reported by police in accidents following the mandatory seat belt law greatly exceeded both the observed and self-reported use rates. This was especially pronounced for drivers who responded that they rarely or never used seat belts.     

Attitudes of commercial motor vehicle drivers towards safety belts

Despite the fact that Hawaii has one of the highest seat belt use rates for passenger vehicles in the United States, and has had a mandatory seat belt use law since the 1980s, studies have shown that commercial motor vehicles (CMV) seat belt use rates are low. To better understand this phenomenon, a comprehensive survey of commercial vehicle drivers was conducted in Hawaii to ascertain attitudes and self-reported behaviors regarding seat belt use. A total of 791 drivers responded to a written questionnaire implemented at weigh stations and distributed to various trucking firms and transport centers. Approximately 67% reported that they use seat belts “always” when driving a CMV (commercial motor vehicle), yet when asked how often do other CMV drivers use seat belts, only 31% responded “always.” Interestingly, 86% of these same drivers reported that they use seat belts “always” when driving a personal vehicle. The major reason cited for non-use of belts was “frequent stops/inconvenience” (29%), and “not safety conscious” (23%). Notably, the self-reported use of safety belts is highest among operators of vans (88% said “always”), followed by buses (87% said “always”) and lowest among truck drivers (only 60% said “always”). In this paper, some of the differences between self-reported users and non-users are explored and a multivariate logit model was developed to predict the odds of belt use as a function of various factors.     

The actual threat posed by unrestrained rear seat car passengers

A statistical analysis of the threat posed by unrestrained rear seat car passengers to restrained drivers and front seat passengers was published in 2002. This was based on Japanese accident data from 1995 to 1999, and the conclusions have been checked using corresponding accident data from Great Britain. The law in respect of the use of seat belts and other restraint systems was less strict in Japan than in Great Britain between 1995 and 1999, so an earlier period had to be studied. The results suggest that the risk of death to a front seat car occupant is increased by about three-quarters by the presence of an unrestrained rear seat passenger behind them, a much smaller increase than was claimed by the Japanese researchers.     

Seatbelt wearing rates in middle income countries: A cross-country analysis

In settings with low seatbelt use prevalence, self-reported seatbelt use estimates often lack validity, and routine observational studies are scarce. In this paper, we aim to describe the prevalence of seatbelt use and associated factors in drivers and front-seat passengers across eight sites in four countries (Egypt, Mexico, Russia, Turkey) using observational studies as well as to produce estimates of country-level and site-level variance. As part of the Bloomberg Philanthropies Global Road Safety Program, data on driver and passenger seatbelt use across four middle-income countries was collected between October 2010 and May 2011 (n = 122,931 vehicles). Logistic regression and Intraclass Correlation Coefficient analyses for sites- and country-level clustering were performed. We found high variability of seatbelt wearing rates ranging from 4 to 72% in drivers and 3–50% in front-seat passengers. Overall, average seatbelt wearing rates were low (under 60% in most sites). At the individual level, older and female drivers were more likely to wear seatbelts, as well as drivers of vehicles transiting at times of increased vehicle flow. We also found that 26–32% and 37–41% of the variance in seatbelt use among drivers and front-seat passengers respectively was explained by differences across sites and countries. Our results demonstrate that there is room for improvement on seatbelt use in middle-income countries and that standardized cross-country studies on road safety risk factors are feasible, providing valuable information for prevention and monitoring activities.     

Extra enforcement and the use of seat belts by drivers in Illinois

The use of seat belts by drivers was measured in three target and three control cities in Illinois before, during, and after the application of heightened police enforcement of the seat belt law in the target cities. The extra enforcement produced increases in the use of seat belts by drivers during the four months of the heightened enforcement. Observations of seat belt use continued for four months after the end of the enforcement, and a substantial residual effect remained in two of the three target cities. In one target city the use of seat belts had dropped close to the level at the start of the project by the end of the second month after the end of enforcement. Taking account of the percentage of drivers who became aware of the increased enforcement suggested that a sustained program of enforcement may result in 60%–70% of drivers using seat belts.     

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.     

Characteristics of belted and unbelted drivers

Drivers who had been observed wearing or not wearing shoulder belts were compared using vehicle registration data, driver records, and telephone interviews. The observations were made on the New York Thruway during a special seat belt publicity and enforcement program, which achieved a 75% overall belt use. The results showed that those drivers who still did not wear a shoulder belt despite New York law and the special Thruway program were more likely to be male, to be driving older vehicles, to have more prior traffic convictions, to have more prior injury crash involvements, and to say they are more likely to take risks than others. Although drivers reported that assessing points against the drivers license for belt law violations could increase belt use, citations for belt use law violations were very rare, and enforcement would probably have to increase before any new penalty could be effective.     

An aggregate accident model based on pooled, regional time-series data.

The determinants of personal injury road accidents and their severity are studied by means of generalized Poisson regression models estimated on the basis of combined cross-section/time-series data. Monthly data have been assembled for 18 Norwegian counties (every county but one), covering the period from January 1974 until December 1986. A rather wide range of potential explanatory factors are taken into account, including road use (exposure), weather, daylight, traffic density, road investment and maintenance expenditure, accident reporting routines, vehicle inspection, law enforcement, seat belt usage, proportion of inexperienced drivers, and alcohol sales. Separate probability models are estimated for the number of personal injury accidents, fatal accidents, injury victims, death victims, car occupants injured, and bicyclists and pedestrians injured. The fraction of personal injury accidents that are fatal is interpreted as an average severity measure and studied by means of a binomial logit model.     

What can we learn about North Dakota's youngest drivers from their crashes?

For North Dakota teens, three of every four deaths are from motor vehicle crashes. Injury crash records for teen drivers were studied to gain insight regarding driver, vehicle, and road factors for public safety policy and program discussions. Results show 14-year-old drivers are three times more likely to die or be disabled in an injury crash than 17-year-old drivers, and that male drivers are 30% less likely to incur severe injury. As expected, seat belt use is a critical factor in severe injury avoidance. The likelihood for death or disablement is 165% greater for unbelted teen drivers than for those who are properly belted. In addition, rural and gravel roads pose a risk. Teens are six times more likely to be severely injured in crashes on rural roads than on urban roads. Findings suggest that an increased licensing age and seat belt emphasis may reduce teen traffic injuries in the state. In addition, more information on exposure should be attained to better understand rural and gravel road as risks.     

Predictors of safety belt use among crash-involved drivers and front seat passengers: adjusting for over-reporting

Police-reported crash data are rarely used to investigate safety belt use and its predictors, even though these data have a number of advantages over data collected in roadside surveys. It has been widely recognized that motorists tend to over-report their safety belt use to police when mandatory belt use becomes law. In this paper, we use a logistic regression model that allows for misclassification errors in outcome variable to examine predictors of safety belt use among crash-involved drivers and front seat passengers. Our analysis shows significant associations between occupant characteristics, driving circumstances, and safety belt use. Alcohol involvement has the strongest negative association with safety belt use, but this association would be considerably underestimated without adjusting for the over-reporting of safety belt use in police-reported crash data. The adjusted belt use rate among front seat occupants with at least nonincapacitating injuries is about 81%, compared to 90% in police-reported crash data.     

Attitudinal factors in the non-use of seat belts

A stepwise method for the assessment of public opinions was developed and used to investigate attitudes towards seat belts. It was found that most people accept that seat belts are effective, despite the fact that a large majority usually or always drive with belts unfastened. This failure to use seat belts appeared to result primarily from a failure to acquire the habit of buckling up. It did not reflect distrust of seat belts or any very deep-seated systems of attitudes and beliefs. It was concluded that public-education programs will not increase use of seat belts, but that measures are called for which take the decision to wear a belt out of the hands of individual drivers and passengers.     

Compulsory seatbelt use: Further inferences

On 1 June 1972, the wearing of available seatbelts by front seat occupants (drivers and front seat passengers) became compulsory in New Zealand. A comparison of fatality rates for front seat occupants during the two years preceding and following the law has been made by Toomath and Laurenson (1976). The fatality rate per million gallons of taxable petrol consumption shows a drop of about 7% for such occupants, accompanied by a surveyed usage rate increase from 25% to 67%. Considering the well established value of seatbelts in reducing road trauma, the size of the fatality reduction is rather disappointing For clarification, fatality rates crudely adjusted for exposure were separately calculated for belted and unbelted front seat occupants. Comparative rates before and after the law were somewhat surprising, so a model was constructed in which the after-law use rate could be treated as an unknown. Principal findings were: Based on surveyed use data, the fatality rate for belted front seat occupants increased after the law; likewise so did the fatality rate for unbelted front seat occupants. Since the fatality rate for all front seat occupants (aggregate of belted and unbelted) decreased, there is an apparent paradox that can be resolved by assuming a qualitative shift in the user population. Inferential analysis suggests that belt use reduced the probability of fatal injury, in a given crash, by about 40%. Similar analysis suggests that the effects of the law, when added to those of voluntary use, were to save only about 40% as many lives as could have been saved by universal belt usage among front seat occupants. Apparently those still unbelted after the law represent a particularly high-risk group, by whom increased belt use would result in disproportionate savings.     

Psychosocial correlates of the impact of road traffic accidents among South African drivers and passengers

The aim of the study was to investigate the psychosocial consequences and coping strategies among accident victims in South Africa. Participants (138 drivers and 141 passengers) who had been involved in a road traffic accident were approached and interviewed in public places. In both groups the median age group was between 25 years and 34 years. In 34 accidents (12.2%) a family member was killed, in 68 accidents (24.4%) a non-family member was killed in the accident. In 272 accidents 197 (72.4%) persons (both drivers and passengers) were injured and 168 (61.7%) were hospitalized. Eighty-seven drivers (63%) did not perceive themselves at fault and 51 (37%) did. Following the road traffic accident both drivers and passengers showed a significant decline of their well-being. Drivers who perceived themselves to be at fault did not cope better than those not perceiving themselves at fault. Passengers related to the drivers showed more decline in their well-being than those not related. Path analysis for drivers found that holding oneself responsible had a direct, and mediated by self-blame, guilt and family distress, negative effect on personal well-being. In the passengers group, holding the driver or others responsible led, mediated by increased self-blame, feelings of guilt, and family distress, to lower psychological well-being (PWB). Findings have relevant implications for the development of coping strategies to aid victims of road traffic accidents in dealing with their trauma in this African context, which may differ to those in Western societies.     

The effect of New York's seat belt use law on teenage drivers

This study assessed the effects of New York State's recently adopted mandatory seat belt use law on teenage drivers. Teenage drivers were observed as they entered high school parking lots before the law was adopted, after it was adopted but before it was effective, one month after the effective date, and again five months after the effective date. The results showed that 14% of the teenage drivers were wearing either shoulder or lap belts or both prior to adoption of the law. This increased to 22% after adoption of the law, 60% one month after the effective date of the law, and 63% five months after the effective date. Teenagers using seat belts were more often female, were younger, had completed driver education and had a longer trip from home to school. Both before and after the law, teenage belt use was similar to, but typically lower than, belt use in the community in which the school was located.