Teens and seat belt use: What makes them click?

ProblemMotor vehicle crashes kill more adolescents in the United States than any other cause, and often the teen is not wearing a seat belt.MethodsUsing data from the 2011 Youth Risk Behavior Surveys from 38 states, we examined teens' self-reported seat belt use while riding as a passenger and identified individual characteristics and environmental factors associated with always wearing a seat belt.ResultsOnly 51% of high school students living in 38 states reported always wearing a seat belt when riding as a passenger; prevalence varied from 32% in South Dakota to 65% in Delaware. Seat belt use was 11 percentage points lower in states with secondary enforcement seat belt laws compared to states with primary enforcement laws. Racial/ethnic minorities, teens living in states with secondary enforcement seat belt laws, and those engaged in substance use were least likely to always wear their seat belts. The likelihood of always being belted declined steadily as the number of substance use behaviors increased.DiscussionSeat belt use among teens in the United States remains unacceptably low. Results suggest that environmental influences can compound individual risk factors, contributing to even lower seat belt use among some subgroups.Practical applicationsThis study provides the most comprehensive state-level estimates to date of seat belt use among U.S. teens. This information can be useful when considering policy options to increase seat belt use and for targeting injury prevention interventions to high-risk teens. States can best increase teen seat belt use by making evidence-informed decisions about state policy options and prevention strategies.     

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.     

Is seat belt usage by front seat passengers related to seat belt usage by their drivers?

INTRODUCTION: Unrestrained drivers and passengers are involved in a significant amount of fatalities and injuries in motor-vehicle crashes in the United States. While the literature documents the effectiveness of seat belt usage in reducing crash outcomes, such as fatalities and the severity of injuries, there is a need to evaluate the impact of seat belt usage by drivers and passengers in their respective vehicles. These findings could help develop effective education and enforcement strategies to enhance occupant safety. METHOD: This paper summarizes a study comparing seat belt usage rates of drivers and passengers based on whether or not the driver uses a seat belt. Observational data from 50 sites in the state of Nevada over 3 years are used for analyses. The data are stratified based on the gender of the driver and passengers in the front seat of the vehicle and are based on area type (rural or urban). RESULTS: A comparison of the rates of seat belt usage across for the aggregated data and for various types of disaggregation and statistical analyses to compare the rates of seat belt use among passengers based on the use of seat belts by drivers confirms that when drivers use seat belts, their respective passengers are much more likely to use seat belts. Further, if drivers do not use seat belts, their passengers are not likely to use seat belts. This observation is comparable for male drivers and female drivers, and also for male passengers and female passengers. Further, there are no differences for combinations of the genders of the drivers and passenger (i.e., both male or female, or one male and one female). IMPACT ON INDUSTRY: These results suggest that education and enforcement strategies would benefit most by working toward increasing seat belt usage rates among drivers.     

Predicting vehicle belt fit for children ages 6–12

Objective: To predict shoulder belt fit and lap belt fit as a function of child age, vehicle seat characteristics, and belt geometry.

Methods: In a previous study, the lap belt and shoulder belt fit of 44 children aged 5–12 were measured in a simulated vehicle seat while varying cushion length, cushion angle, seatback angle, and belt anchorage geometry. A regression model was developed to predict lap belt fit and shoulder belt fit as a function of vehicle parameters and child stature. These regression models were applied to the stature distribution of 6- to 12-year-olds using a range of vehicle geometry data to predict the proportion of children expected to achieve good belt fit in the second-row, outboard seating positions of 46 vehicles when not using belt-positioning boosters.

Results: Across the ranges observed in vehicles, lap belt angle had the strongest effect on lap belt fit, although vehicle cushion length also contributed. Shoulder belt fit was most strongly affected by D-ring location. Vehicles with the geometric conditions most suitable for children are estimated to provide good lap belt fit for 25% of children aged 6 to 12. In 20% of vehicles, the shoulder belt is too far inboard for the target child population; 20% of vehicles are estimated to have shoulder belt fit too far outboard for children ages 6 to 12.

Conclusions: Based on this geometric analysis, the rear seats of most vehicles are unlikely to provide good lap belt fit for up to 75% of children ages 6–12. Shoulder belt fit is outside the target range for 40% of children. Consequently, children under 12 years of age are likely to experience markedly poorer belt fit when transitioning out of a booster seat.     

The unintended impact of helmet use on bicyclists’ risk-taking behaviors

Introduction: Safety is a critical factor in promoting sustainable urban non-motorized travel modes like bicycles. Helmets have shown to be effective in reducing injury severity in bicycle crashes, however, their effects on bicyclists’ behaviors still requires deeper understanding, especially amid the emerging trend of using shared bicycles. Risk compensation effects suggest that bicyclists may offset perceived gains in safety from wearing a helmet by increasing risk-taking behaviors. A better understanding of these compensation effects can be useful in assessing various bicycle safety related programs. Method: Using a sample of 131 bicyclists from the San Francisco Bay area, this research studies how bicyclists respond with respect to risk-taking behaviors under various urban-street conditions, as a function of helmet use. Study participants were each shown 12 videos, shot in Berkeley, California, from the perspective of a bicyclist riding behind another bicyclist. A fractional factorial experiment design was used to systematically vary contextual attributes (e.g., speed, bike lane facilities, on-street parking, passing vehicles) across the videos. After each video, participants were asked to indicate if they would overtake the bicyclist in the video. With the help of data adaptive estimation techniques, targeted maximum likelihood estimation (TMLE) was applied to estimate the average risk difference between helmeted users and non-users, controlling for self-selection effects. Individual-based nonparametric bootstrap was performed to assess the uncertainty associated with the estimator. Results: Our findings suggest, on average, individuals more likely to wear a helmet are 15.6% more likely to undertake a risky overtaking maneuver. Practical Applications: This study doesn’t try to oppose mandatory helmet laws, but rather serves as a cautionary warning that road safety programs may need to consider strategies in which unintended impact of bicycle helmet use can be mitigated. Moreover, our findings also provide additional evaluation component when it comes to the cost-benefit assessment of helmet-related laws.     

Are parents ready to use autonomous vehicles to transport children? Concerns and safety features

Introduction: This study addressed a gap in the literature – the potential of using autonomous vehicles (AV) to enhance children’s mobility. Prior studies documented the perceived benefits and concerns about this prospect, but did not examine the features in AV and support mechanisms that are desired by potential users. Method: An on-line survey was used to collect public opinions within the United States. In the survey, willingness to use AVs for this use case was asked twice to assess if participants changed their mind after being asked about concerns related to this prospect and importance of car features. A combination of statistical and machine-learning methods were used to profile individuals with high versus low post-willingness and to identify variables that differentiated the two groups. Results: Results indicated that respondents who were lower on their post-willingness to use AVs to transport children were more concerned about how AVs would protect children, how someone could harm the children inside, and whether there would be someone at the destination. In addition, they were less in favor of technology, older in age, and rated car features such as having a designated adult waiting at destination, a camera, and a microphone as relatively required (as opposed to optional). These results highlight potential users’ needs and requirements as they think about AVs in the context of parent–children mobility practices. Practical Applications: Relevant stakeholders should develop deployment and implementation plans while taking into account ridership contexts and vulnerable road users who can benefit from enhanced mobility.     

Does projection into use improve trust and exploration? An example with a cruise control system

We know that the systems which are trusted by the users are more often used, especially in a risky situation where they need to delegate control, but we still ignore largely the factors which improve trust in the systems. Our issue here was to explore whether the way we present the system to the users will have an effect on their confidence in it.In this study, we had nine subjects using for the first time a cruise control system on open road; before, we present the system to them in three different ways: (i) a function-oriented written presentation (G1), (ii) a use-oriented written presentation, “augmented” with difficult situations (G2) and (iii) a use-oriented film presentation (3). They evaluate their trust in the system on scales before the whole experiment, after the presentation and after the real use. At the end, they also have self-confrontation interviews, where they see the video of their driving and describe their activity, strategies and feelings. We then develop quantitative and qualitative analysis of trust, linked with specific situations of action.Our results indicate that the presentation of instructions lowers the evaluation of trust (and of efficiency) that conductors have a priori; they had constructed an a priori representation of a CCS that is rather idealistic, and realised, after reading the instructions, and above all after having watched a film, that its use is not so obvious as they had previously thought There is thenceforth a drop in trust that nevertheless goes up again after use of the system during driving We remark, from qualitative analyses of use experience of the regulator in real driving conditions, that this drop in trust in the system does not inhibit subjects in their use, and in particular, for subjects who have watched a film of projection into use They know more of the functions of the system in driving conditions, they produce less distorted reconstruction of the functioning, and they have a deeper level of understanding of the system.     

Safety teams. Government and business organizations want them and use them, but are they legal?

BACKGROUND: Safety teams have become a popular means to recognize and prevent injuries in the workplace. In fact, organizations, such as OSHA, NIOSH, NIEHS, DOE, and the Ohio BWC, not only encourage safety teams, but have implemented them in their organizations. However, safety teams may not be legal as defined by NLRB Act Sections 2(5) and 8(a)(2). OBJECTIVE: To determine whether safety teams are illegal labor organizations. METHODS: A review of government regulations, safety programs, and safety teams was performed to create a framework of what types of safety programs/regulations are requested and/or required by a variety of government agencies. Next, these requirements were compared to existing case law on illegal labor organizations as defined by the NLRB. RESULTS: Most safety teams and programs, even those implemented by the Federal Government, are illegal labor organizations as defined by NLRB Act Sections 2(5) and 8(a)(2). CONCLUSIONS: The Federal Government needs to amend existing legislation and develop a revision of the NLRB Act that would allow safety teams to function legally in organizations without having to meet intrusive, constricting guidelines that may inhibit the value of safety teams. IMPACT ON INDUSTRY: Organizations must be aware that safety teams may be valuable in reducing job-related accidents and injuries but they may be illegal labor organizations.     

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000–2016

Introduction: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. Methods: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. Results: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39–49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14–19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04–1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65–85 years) passengers were less likely to be unrestrained than those aged 20–64 years. Conclusions: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.     

State helmet laws and helmet use among fatally injured moped riders in the United States, 2011–2015

Objective: Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States.

Methods: A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015.

Results: Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001).

Conclusions: Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.     

What’s in a name? Drivers’ perceptions of the use of five SAE Level 2 driving automation systems

Introduction: Automobile manufacturers are developing increasingly sophisticated driving automation systems. Currently, the highest level of automation available on the market is SAE Level 2, which provides sustained assistance for both lateral and longitudinal vehicle control. The purpose of this study was to evaluate how drivers’ perceptions of what behaviors secondary to driving are safe while a Level 2 system is operating vary by system name. Methods: A nationally representative telephone survey of 2005 drivers was conducted in 2018 with questions about behaviors respondents perceived as safe while a Level 2 driving automation system is in operation. Each respondent was asked about two out of five system names at random for a balanced study design. Results: The name “Autopilot” was associated with the highest likelihood that drivers believed a behavior was safe while in operation, for every behavior measured. There was less variation observed among the other four SAE Level 2 system names when compared with each other. A limited proportion of drivers had experience with advanced driver assistance systems and fewer of these reported driving a vehicle in which Level 2 systems were available. Drivers reported that they would consult a variety of sources for information on how to use a Level 2 system. Conclusions: The names of SAE Level 2 driving automation systems influence drivers’ perceptions of how to use them, and the name “Autopilot” was associated with the strongest effect. While a name alone cannot properly instruct drivers on how to use a system, it is a piece of information and must be considered so that drivers are not misled about the correct usage of these systems. Practical Applications: Manufacturers, suppliers, and organizations regulating or evaluating SAE Level 2 automated driving systems should ensure that systems are named so as not to mislead drivers about their safe use.     

Restraint use and seating position among children less than 13 years of age: Is it still a problem?

Introduction

The purpose of this study was to calculate national estimates and examine the extent to which children prematurely use adult seat belts and ride in the front seat of a vehicle during a 30 day period.

Methods

Data were obtained from a nationally representative cross-sectional random-digit-dial telephone survey that included child-specific questions on motor vehicle restraint use and seating position.

Results

Among children less than 13 years, parents reported an estimated 618,337 who rode unrestrained and more than one million who rode in the front seat of a vehicle at least some of the time in the past 30 days. During the same time period, close to 11 million children 8 years and younger reportedly used only adult seat belts.

Discussion

Our results highlight the need for continued outreach to parents regarding optimal restraint use and rear seating position for children every trip, every time.     

Using online databases to find journal articles on injury prevention and safety promotion topics: How do SafetyLit subscribers use other databases?

BackgroundA thorough search of the scholarly literature is an important part of any project. Although there are ethical and scientific reasons to justify the effort required to perform an exhaustive search, we hypothesize that many searchers do not use a sufficient number of databases nor do they use the query focusing techniques necessary to perform a comprehensive search.DesignSubscribers (approximately 19,000 people) to the SafetyLit email update, a weekly listing of recently published research on injury prevention and safety promotion, were surveyed to learn about their performance and knowledge of several key search behaviors necessary for conducting an exhaustive literature search.ResultsOver 90% of respondents perform searches of online databases and, although few have had any training in database use, they always or usually perform the search themselves. They reported performing searches using a wide variety of online bibliographic databases but only 10.3% queried two or more databases the last time they searched. Respondents’ assessment of their own knowledge and skills at searching a database had little to do with the amount of training they have received in the use of the database.ConclusionMost users self-limit the information they gather to that from one or two professional disciplines. Conducting a literature search using only one or two familiar sources can lead to a failure to access essential information published by researchers in parallel fields.     

Characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008–2012

Objective: Adults 65 years of age and older comprise the fastest growing demographic in the United States. As substance use is projected to increase in this population, there is concern that more seniors will drive under the influence of impairing drugs. The purpose of this analysis was to characterize the drug and alcohol usage among senior drivers fatally injured (FI) in traffic collisions.

Methods: Data from the Fatality Analysis Reporting System were analyzed from 2008 to 2012. Commonly used classes and specific drugs were explored. Rates of drug use, multiple drugs, concomitant drug and alcohol use, and alcohol use alone were generated using Poisson regression with robust error variance estimation. Rates were compared to a reference population of FI middle-aged drivers (30 to 50 years old) using rate ratios.

Results: Drug use among FI senior drivers occurred in 20.0% of those tested. Among drug-positive FI senior drivers, narcotics and depressants were frequent. The prevalence of testing positive for any drug, multiple drugs, combined drug and alcohol, and alcohol use alone among FI seniors were 47% less (relative risk [RR] = 0.53, 95% confidence interval [CI], 0.47, 0.62), 59% less (RR = 0.41, 95% CI, 0.34, 0.51), 87% less (RR = 0.13, 95% CI, 0.09, 0.19), and 77% less (RR = 0.23, 95% CI, 0.19, 0.28), respectively, compared to FI middle-aged drivers.

Conclusions: Though overall drug use is less common among FI senior drivers relative to FI middle-aged drivers, driving under the influence of drugs may be a relevant traffic safety concern in a portion of this population.     

The role of drug and alcohol use and the risk of motor vehicle crashes in Shiraz,Iran, 2014: A case–crossover study

Background: Traffic accidents and traffic-related injuries and mortality have become a major public health concern in Iran. This study aimed to examine the role of drug and alcohol use in motor vehicle accidents in Iran.

Methods: This case–crossover study was conducted on 441 drivers who survived a road traffic crash and were taken to the emergency department of Shahid Rajaee trauma hospital in Shiraz, southern Iran. Data were collected using checklists that included demographic characteristics and drug and alcohol use prior to driving. Alcohol and drug use was identified through self-report, and cannabis, morphine, and methamphetamine urine tests were used to confirm drug abuse among drivers.

Results: In total 17.9% of drivers reported using drugs (cannabis, opium, or metamphetamine) and 8.84% of drivers reported consuming alcohol prior to the collision. The crude odds ratios (ORs) for having a crash for opium, cannabis, and metamphetamine were 1.94 (95% interval confidence [CI], 1.11–3.38), 2.37 (95% CI, 1.03–5.42), 5.5 (95% CI, 1.21–24.81), respectively, and for all drugs was 3.83 (95% CI, 2.28–6.43). The OR for alcohol was 3.5 (95% CI, 1.73–7.06) based on self-report.

Conclusion: Drug and alcohol use are increasing the risk of traffic crashes in Iran. Risk-reducing programs must be designed and implemented.     

“Like it’s wrong,but it’s not that wrong:” Exploring the normalization of risk-compensatory strategies among young drivers engaging in illegal smartphone use

Introduction: Young drivers are the most vulnerable road users and most likely to use a smartphone illegally while driving. Although when compared with drink-driving, attitudes to illegal smartphone risk are nearly identical, smartphone use among young drivers continues to increase. Method: Four in-depth focus groups were conducted with 13 young (18–25 years) drivers to gain insight into their perceptions of the risks associated with the behavior. Our aim was to determine how drivers navigate that risk and if their behavior shapes and informs perceptions of norms. Results: Three key themes emerged: (a) participants perceived illegal smartphone use as commonplace, easy, and benign; (b) self-regulatory behaviors that compensate for risk are pervasive among illegal smartphone users; and (c) risk-compensation strategies rationalize risks and perceived norms, reducing the seriousness of transgression when compared with drink-driving. Young drivers rationalized their own use by comparing their selfregulatory smartphone and driving skills with those of “bad drivers,” not law abiders. Practical Applications: These findings suggest that smartphone behaviors shape attitudes to risk, highlighting the importance for any countermeasure aimed at reducing illegal use to acknowledge how a young person’s continued engagement in illegal smartphone use is justified by the dynamic composition of use, risk assessment and the perceived norms.