Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the reservation

OBJECTIVES: American Indians (AI's) have the lowest rate of seatbelt use in the nation, putting them at significant risk for motor vehicle crash (MVC) morbidity and mortality. This study compares seatbelt use in victims of level one trauma crashes presenting from on and off AI reservations. Predictors of seatbelt use were evaluated as well. We hypothesized that AI's in crashes on a reservation would have lower rates of seatbelt use, even compared to AI's in crashes from off the reservation. METHODS: This is a retrospective cohort study of consecutive MVC victims presenting to a level one trauma facility in Phoenix, Arizona from July 2003 to June 2005. Inclusion criteria were age >11 and transported directly from the crash; struck pedestrians were excluded. Inter-facility transports were also excluded, as these patients would likely represent a sicker population, possibly introducing bias. Characteristics of those patients (sex, race, location of crash, alcohol and seatbelt use) were analyzed in univariate and multivariate logistic regression. RESULTS: Data were collected on 2339 patients. Three hundred ninety-two were excluded, leaving 1947 (83%) available for analysis. AI's had lower rates of seatbelt use compared to all other races. Additionally, AI's on a reservation were less likely to wear seatbelts than those off a reservation (25.9% versus 42.7%). However, when tested in a multivariate analysis with alcohol as a covariate, race and location became insignificant. Low seatbelt use by AI's on the reservation was primarily associated with alcohol use. CONCLUSION: In this analysis, alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility. If we assume unbelted passengers are more severely injured, this would bias our results. The application of these data may help direct future public service efforts to increase seatbelt use in target populations.     

Drug and alcohol use among drivers admitted to a Level-1 trauma center

The purpose of this research was to determine the incidence and prevalence of drug use, alcohol use, and the combination of drug and alcohol use among motor vehicle crash (MVC) victims admitted to a Level-1 trauma center. In a 90-day study, nearly two-thirds of trauma center admissions were victims of motor vehicle crashes. Blood and urine was collected from 168 MVC victims of whom 108 were identified as the driver in the crash. Toxicology results indicated that 65.7% of drivers tested positive for either commonly abused drugs or alcohol. More than half of the drivers tested positive for drugs (50.9%) other than alcohol, with one in four drivers testing positive for marijuana use. About one-third of those using drugs had also been drinking, but alcohol was detected in only 30.6% of all injured drivers. Within the total MVC patient pool, passenger drug/alcohol use was equivalent to the driver population; however, injured pedestrians had higher rates of alcohol only than other MVC victims. There were no significant differences in drug and alcohol use between MVCs and trauma admissions of other causes. Of the patients with positive toxicology results, less than half (42%) were referred for evaluation for substance abuse disorders.     

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.     

Legal consequences for alcohol-impaired drivers injured in motor vehicle collisions: A systematic review

Background

The treatment of alcohol-impaired drivers injured in a motor vehicle collision (MVC) is a complex public health issue. We conducted a systematic review to describe the legal consequences for alcohol-impaired drivers injured in a MVC and taken to a hospital or trauma center. Methods We searched MEDLINE, Embase, and CINAHL databases from inception until August 2014. We included studies that reported legal consequences including charges or convictions of injured drivers taken to a hospital or trauma center after a MVC with a blood alcohol concentration (BAC) exceeding the legal limit.Results Twenty-six studies met inclusion criteria; twenty studies were conducted in the USA, five in Canada, and one in Sweden. All were cohort studies (23 retrospective, 3 prospective) and included 11,409 patients overall. A total of 5,127 drivers had a BAC exceeding the legal limit, with legal consequences reported in 4937 cases. The median overall DUI/DWI conviction rate was 13% (range 0–85%). The median percentage of drivers with a previous conviction on their record for driving under the influence (DUI) or driving while intoxicated (DWI) was 15.5% (range 6–40%). The median percentage of drivers convicted again for DUI/DWI during the study period was 3.5% (range 2–10%). Heterogeneity between study designs, legal jurisdictions, institutional procedures and policies for obtaining a legally admissible BAC measurement precluded a meta-analysis. Conclusions The majority of intoxicated drivers injured in MVCs and seen in the emergency department are never charged or convicted. A substantial proportion of injured intoxicated drivers had more than one conviction for DUI/DWI on their police record.     

Factors related to seatbelt-wearing among rear-seat passengers in Malaysia

The benefit of wearing a rear seatbelt in reducing the risk of motor vehicle crash-related fatalities and injuries has been well documented in previous studies. Wearing a seatbelt not only reduces the risk of injury to rear-seat passengers, but also reduces the risk of injury to front-seat occupant who could be crushed by unbelted rear-seat passengers in a motor vehicle crash. Despite the benefits of wearing a rear seatbelt, its rate of use in Malaysia is generally low. The objective of this study was to identify factors that are associated with the wearing of a seatbelt among rear-seat passengers in Malaysia. Multinomial logistic regression analysis of the results of a questionnaire survey of 1651 rear-seat passengers revealed that rear-seat passengers who were younger, male, single and less educated and who had a perception of a low level of legislation enforcement, a lower risk-aversion and less driving experience (only for passengers who are also drivers) were less likely to wear a rear seatbelt. There was also a significant positive correlation between driver seatbelt and rear seatbelt-wearing behaviour. This implies that, in regards to seatbelt-wearing behaviour, drivers are more likely to adopt the same seatbelt-wearing behaviour when travelling as rear-seat passengers as they do when driving. These findings are crucial to the development of new interventions to increase the compliance rate of wearing a rear seatbelt.     

Perceived driving safety and seatbelt usage

Swedish and U.S. subjects judged their own driving skills and safety in relation to other drivers. As in earlier studies, most subjects showed an optimism bias: a tendency to judge oneself as safer and more skillful than the average driver, with a smaller risk of getting involved and injured in an accident. Different measures of the optimism effect were strongly correlated with one another, with driving experience and with the judged importance of human factors (as opposed to technical and chance factors) in causing accidents. Degree of optimism was positively, but weakly, correlated with reported seatbelt usage and worry about traffic accidents. Seatbelt usage was positively related to the extent to which belts are judged to be convenient and popular, and more modestly related to the belt's perceived contributions to safety. These results suggest that providing more information about the effectiveness of seatbelts may not be as efficient a way of increasing seatbelt usage as emphasizing other factors, such as comfort and social norms, which cannot be outweighed by optimism.     

Trends of behavioral risk factors in motor vehicle crashes in Utah, 1992-1997

OBJECTIVE: Measure changes in the prevalence of behavioral factors including police-reported fatigue and alcohol intoxication, as well as self-reported seatbelt use, and assess their effect on hospitalization or death after a motor vehicle crash. METHODS: Probabilistic linkage was used to match drivers in motor vehicle crashes with hospital discharge records for the years 1992-1997. Frequencies of specific behavioral factors were evaluated using the Cochran-Armitage test for trend. Odds ratios and corresponding 95% confidence intervals were calculated using generalized estimating equations (GEEs) with crash and driver characteristics as independent variables and hospitalization or death as the dependent variable. RESULTS: The analysis database consisted of 450,286 crash driver records, which linked to 4219 (0.9%) hospitalizations or deaths. There was an increasing trend for self-reported seatbelt use among crash-involved drivers from 80.5% in 1992 to 89.3% in 1997 (P<0.001). Police-reported alcohol intoxication among crash-involved drivers showed a decreasing trend from 2.4% in 1992 to 1.5% in 1997 (P<0.001). There was no trend for police-reported fatigue-related crashes. Odds ratios of hospitalization or death for seatbelt use, alcohol involvement, and fatigue were significant and did not fluctuate considerably between 1992 and 1997. Seatbelt use offered a protective effect from hospitalization or death, while alcohol intoxication and fatigue contributed to increased likelihood of hospitalization or death. CONCLUSIONS: These results suggest that while some improvement has been made in decreasing seatbelt non-use and driver alcohol intoxication among crash-involved drivers, no improvement has been made in reducing fatigue-related crashes.     

Evaluation of effectiveness of safety seatbelt legislation in the United Arab Emirates

Seatbelt legalisation was implemented in the United Arab Emirates (UAE) in January 1999. This provided the opportunity to evaluate the effectiveness of the legislation in the Eastern District of Abu Dhabi Emirate in the UAE by establishing levels of injury severity from motor vehicle crashes (MVC) before and after the legislation and the rate of compliance with the legislation. Data were obtained from a major hospital in the Eastern District of Abu Dhabi Emirate, UAE. Subjects were a systematic sample of MVC victims who arrived alive at hospital in either the pre-implementation period (January-June 1998) or the post-implementation period (February-August 2000). The main measures of outcome were injury severity codes, numbers of hospital bed days and rates of admission and discharge at hospital. The analysis of injury severity from MVCs, from the pre- to the post-implementation period, revealed a significant declining trend (chi-square = 77.68, P < 0.001). While the proportion of minor injuries increased from 42% (95% CI: 36-48%) in the pre-implementation period to 77% (95% CI: 71-83%) in the post-implementation period, the proportion of "moderate to fatal injuries" declined from 54% (95% CI: 48-60%) to 17% (P = 0.001) and the median number of hospital bed days declined from 5 days (25% = 2; 75% = 8 ) to 3 days (25% = 1; 75% = 4 ). The rate of seatbelt compliance reported by occupants involved in MVCs in the post-implementation period was 59% (95% CI: 52-67%). The implementation of the seatbelt legislation in the Eastern District of Abu Dhabi Emirate was associated with statistically significant reduction in morbidity in those arriving alive at hospital following MVC, including reduced severity of injury, admission rate to hospital and the duration of hospital stay. More active implementation of seatbelt law would most likely further reduce severity of MVC injuries and fatalities in the Eastern District of Abu Dhabi Emirate, UAE.     

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 validity of self-reported seatbelt use: Hispanic and non-Hispanic drivers in El Paso

The validity of self-reported seatbelt use among low belt use populations has not been evaluated directly, despite the importance of such data for estimating the effectiveness of community-wide interventions and compliance with state laws. To address this gap in knowledge 612 drivers were recruited from convenience stores located in 12 randomly generated zip code areas located in El Paso, TX. Self-reported seatbelt use was compared with observed seatbelt use in a single sample of participants. Both data sets were collected almost contemporaneously and no participant was aware of having their seatbelt use observed. Hispanic (n = 388) and white/non-Hispanic (n = 126) drivers over reported seatbelt use by 27 and 21%, respectively. These findings suggest that response bias within low belt use populations may be greater than suggested by state and national data.     

Deaths of teenagers as passengers in motor vehicles

Teenagers far exceed all other ages in fatalities per capita both as drivers and as passengers in motor vehicles. Most studies of vehicle crashes involving teenagers focus on teenage drivers, despite the fact that the numbers of teenage deaths as passengers and as drivers are about equal. In 1978, 63% of all fatally injured teenage passengers sustained their injuries in vehicles driven by teenage drivers: 72% of the passengers fatally injured in vehicles driven by teenage drivers were teenagers. Half of the teenage passenger deaths occurred in nighttime crashes. Possible ways to reduce the crash deaths of teenagers are discussed. These include restricting the driving of teenagers; prohibiting teenage drivers from transporting teenage passengers; greater implementation of crash packaging technologies; cleaning up highway and roadside hazards, and laws requiring seat belt use by teenagers.     

Analysis of factors associated with injury severity in crashes involving young New Zealand drivers

Young people are a risk to themselves and other road users, as motor vehicle crashes are the leading cause of their death. A thorough understanding of the most important factors associated with injury severity in crashes involving young drivers is important for designing well-targeted restrictive measures within youth-oriented road safety programs. The current study estimates discrete choice models of injury severity of crashes involving young drivers conditional on these crashes having occurred. The analysis examined a comprehensive set of single-vehicle and two-vehicle crashes involving at least one 15–24 year-old driver in New Zealand between 2002 and 2011 that resulted in minor, serious or fatal injuries. A mixed logit model accounting for heterogeneity and heteroscedasticity in the propensity to injury severity outcomes and for correlation between serious and fatal injuries proved a better fit than a binary and a generalized ordered logit. Results show that the young drivers’ behavior, the presence of passengers and the involvement of vulnerable road users were the most relevant factors associated with higher injury severity in both single-vehicle and two-vehicle crashes. Seatbelt non-use, inexperience and alcohol use were the deadliest behavioral factors in single-vehicle crashes, while fatigue, reckless driving and seatbelt non-use were the deadliest factors in two-vehicle crashes. The presence of passengers in the young drivers’ vehicle, and in particular a combination of males and females, dramatically increased the probability of serious and fatal injuries. The involvement of vulnerable road users, in particular on rural highways and open roads, considerably amplified the probability of higher crash injury severity.     

The validity of self-reported seatbelt use in a country where levels of use are low

The validity of self-reported seatbelt use among low belt use populations in low belt use countries has not been evaluated directly. Nine hundred and ninety drivers were recruited from shopping centers, car parks, and other suitable locations located in Afyon and Ankara cities of Turkey in order to compare the self-reported and observed seatbelt usage rates. Data sets were collected simultaneously from the participants not being aware of having their seatbelt use observed. Participants interviewed in Afyon (n = 301) and Ankara (n = 658) reported seatbelt usage (“always using a seatbelt”) rates of 39% and 45%, respectively. When observed, however, only 47% in Afyon and 70% in Ankara of these drivers actually fasten their seat-belts. It seems that the drivers in both cities exaggerated their use seat belts considerably.     

Driver seat belt use indicates decreased risk for child passengers in a motor vehicle crash

Study objective

We examined the association between driver restraint use and child emergency department (ED) evaluation following a motor vehicle crash (MVC).

Methods

This cohort study included child passengers aged 0-12 years riding with an adult driver aged 21 years or older involved in a MVC in Utah from 1999 to 2004. The 6 years of Utah MVC records were probabilistically linked to statewide Utah ED records. We estimated the relative risk of ED evaluation following a MVC for children riding with restrained versus unrestrained drivers. Generalized estimating equations were used to calculate relative risks adjusted for child, driver, and crash characteristics.

Results

Six percent (6%) of children riding with restrained adult drivers were evaluated in the ED compared to twenty-two percent (22%) of children riding with unrestrained adult drivers following a MVC (relative risk 0.29, 95% confidence interval 0.26-0.32). After adjusting for child, vehicle, and crash characteristics, the relative risk of child ED evaluation associated with driver restraint remained significant (relative risk 0.82, 95% confidence interval 0.72-0.94). Driver restraint use was associated with child restraint use, less alcohol/drug involvement, and lower relative risk of severe collision types (head-on, rollover).

Conclusions

Driver seat belt use is associated with decreased risk of ED evaluation for child passengers in the event of a MVC.     

Differences in safety belt use by race

The purpose of the study was to identify daytime differences in safety belt use by race. Safety belt use was investigated in a direct observation survey of drivers and front-outboard passengers throughout Michigan. Data were weighted to calculate statewide safety belt use rates by race. Race was assessed visually by trained observers. The study showed that motor vehicle occupants identified as Black had significantly lower safety belt use than those occupants identified as White or Other.     

Seatbelt use and belief in destiny among Hispanic and non-Hispanic drivers

In order to determine if fatalism is associated with seatbelt use, 312 drivers were recruited from convenience stores located within 12 randomly generated zip-code areas along the Texas-Mexico border. The seatbelt use of drivers was recorded unobtrusively; self-reported seatbelt use and belief in destiny (fatalism) were subsequently obtained by interview. The majority of respondents rejected a fatalistic orientation, although Hispanic drivers were significantly less likely to do so. Fatalism was not associated with observed seatbelt use. Our results suggest that ethnic differences in seatbelt use are not due to ethnic differences in fatalism. These findings have implications for developing health interventions in Hispanic and non-Hispanic communities.     

Attitudes and behavior of Chinese drivers regarding seatbelt use

In the current study, research was conducted in five cities in China to examine seatbelt use and to explore Chinese drivers’ attitudes toward using seatbelts. Multiple data collection methods consisted of 35 initial semi-structured interviews to create questions for an in-person survey and 500 driver observations that included administering the in-person survey. Questions explored were why Chinese drivers use or do not use seatbelts and what they think would be the best interventions to increase the rate of seatbelt use in Chinese drivers. The relationships between various personal characteristics and seatbelt use rates were investigated. Also examined were the relationships between seatbelt use (both objective observation and subjective self-reported use) and self-reported car crashes and traffic violations. This study provides insight into the attitudes of Chinese drivers on seatbelt use and potential interventions.     

Seat belt use among African Americans,Hispanics, and Whites

OBJECTIVES: This study investigated seat belt use among White, Black, and Hispanic drivers, in cities in which standard enforcement of the belt use law is permitted (primary enforcement) and in cities in which a motorist has to be first cited for another offense (secondary enforcement). Socioeconomic and gender differences in belt use were also studied. METHODS: Belt use observations were obtained at gas stations in Boston, Chicago, Houston, and New York City. In short interviews with drivers, information on race/ethnicity and education was obtained. RESULTS: Belt use was higher in primary enforcement cities, among women, and among those with at least a college degree. In primary law cities there were no clear differences in belt use by race/ethnicity; in secondary cities African Americans were less likely than Whites or Hispanics to be belted, among populations both with and without college degrees. This is consistent with data from other studies indicating that African Americans are more sensitive than Whites to the enforcement of primary laws and are more likely to increase belt use when states shift from secondary to primary. There has been no evidence of enforcement bias against African Americans--increases in citations generally have been greater among Whites than African Americans once primary enforcement is implemented. CONCLUSIONS: More widespread application of primary laws--standard throughout the world but in only 17 US states and the District of Columbia--would increase belt use for all drivers, especially African Americans.     

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.     

Driving with pets as a risk factor for motor vehicle collisions among older drivers

Increasing rates of distraction-related motor vehicle collisions (MVCs) continue to raise concerns regarding driving safety. This study sought to evaluate a novel driving-related distraction, driving with a pet, as a risk factor for MVCs among older, community dwelling adults. Two thousand licensed drivers aged 70 and older were identified, of whom 691 reported pet ownership. Comparing pet owners who did and did not drive with their pets, neither overall MVC rates (rate ratio [RR] 0.97, 95% confidence interval [CI] 0.75–1.26) nor at-fault MVC rates (RR 0.84, 95% CI 0.57–1.24) were elevated. However, those who reported always driving with a pet in the vehicle had an elevated MVC rate (RR 1.89, 95% CI 1.10–3.25), as compared to those who did not drive with a pet. The MVC rate was not increased for those reporting only sometimes or rarely driving with a pet in the vehicle. The current study demonstrates an increased risk of MVC involvement in those older drivers who always take a pet with them when they drive a vehicle. When confronted with an increased cognitive or physical workload while driving, elderly drivers in prior studies have exhibited slower cognitive performance and delayed response times in comparison to younger age groups. Further study of pet-related distracted driving behaviors among older drivers as well as younger populations with respect to driver safety and performance is warranted to appropriately inform the need for policy regulation on this issue.