Effect of enhanced seat belt reminders on driver fatality risk

Objective

Enhanced seat belt reminders in automobiles have been shown to increase belt use rates by approximately 3 percentage points. The objective of this study was to estimate the effect of enhanced seat belt reminders on driver fatality risk.

Method

Data included all passenger vehicle driver deaths and vehicle registration counts in the United States for calendar years 2000-2007. Driver fatality rates per vehicle registration per year were compared for otherwise identical vehicle models with and without enhanced seat belt reminders.

Results

Driver fatality rates were 6% lower for vehicles with enhanced seat belt reminders compared with vehicles without enhanced belt reminders. After adjusting for vehicle age differences, the estimated effect of enhanced belt reminders on driver fatality risk ranged from a 9% reduction for General Motors vehicles to a 2% increase for Honda vehicles. Combining all manufacturers, enhanced belt reminders reduced fatality risk by approximately 2%. Although not statistically significant, the 2% reduction in fatality risk agrees with what should be expected from a 3 percentage point increase in seat belt use rates.

Conclusions

Enhanced seat belt reminders have raised driver belt use rates and reduced fatality rates, but more aggressive systems may be needed for some drivers. It can be inferred that nonfatal injury rates also have been reduced.

Impact on Industry

Manufacturers should be encouraged to put enhanced seat belt reminders on all vehicles as soon as possible.     

Effectiveness and driver acceptance of the Honda belt reminder system

OBJECTIVE: Prior research suggests that vehicle-based seat belt reminder systems can produce moderate increases in belt use rates. However, these findings were based on a limited set of Ford vehicles in one geographic location. As more vehicles with reminder systems enter the market, it is important to determine their effectiveness as well as acceptance by consumers. The present study investigated the effectiveness of Honda's belt reminder system. METHODS: Driver belt use was observed unobtrusively as drivers brought their Honda vehicles to dealerships for service. Drivers also were asked to complete a mail-in survey designed to elicit their experience with the system. RESULTS: Belt use was significantly higher among drivers of vehicles with belt reminders compared with drivers of vehicles without reminders (90 vs. 84 percent). Use rates in vehicles with reminders were higher among both male and female drivers and in all vehicle types observed. Drivers of the Honda vehicles with belt reminders viewed the system very favorably, and nearly 90 percent said they would want one in their next vehicle. The reminder was perceived to be most effective by part-time belt users; 81 percent of part-time users said they now use belts more often, compared with 32 percent of respondents who said they always use belts and 18 percent who use belts occasionally. CONCLUSION: Belt reminders in Honda as well as Ford vehicles are increasing. Although the increase is moderate (5.6 percentage points), on a national level it could have prevented at least 736 driver deaths in 2004.     

Factors related to seat belt use among fatally injured teenage drivers

PROBLEM: In the United States, teenage drivers have a higher crash risk and lower observed seat belt use than other age groups. METHOD: Seat belt use was examined for teenage (16-19 years) drivers who were fatally injured in traffic crashes occurring in the United States during the years 1995-2000. Vehicle, driver, and crash factors potentially related to belt use were examined. State differences in belt use rates among fatally injured teenage drivers were related to states' observed belt use rates for all ages and other state-level variables. RESULTS: During 1995-2000, mean belt use was 36% among fatally injured teenage drivers and 23% among fatally injured teenage passengers. One of the strongest predictors of higher belt use for both drivers and passengers was whether the crash occurred in a state with a primary seat belt law. Belt use rates for 1995-2000 for fatally injured teenage drivers ranged from 20% or less in six states to more than 60% in two states. States with the highest use rates were those with strong primary belt use laws and those with high rates of observed belt use for all ages. Lower belt use among fatally injured teenage drivers was associated with increasing age; male drivers; drivers of SUVs, vans, or pickup trucks rather than cars; older vehicles; crashes occurring late at night; crashes occurring on rural roadways; single vehicle crashes; and drivers with BACs of 0.10 or higher. Teenage driver belt use declined as the number of teenage passengers increased, but increased in the presence of at least one passenger 30 years or older. IMPACT ON TRAFFIC SAFETY: It is suggested that to increase teenage belt use, states should enact strong primary belt use laws and mount highly publicized efforts to enforce these laws. Graduated driver licensing systems should incorporate strong provisions that require seat belt use by teenage drivers and passengers.     

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

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

Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States

Introduction: Unrestrained drivers and passengers represent almost half of all passenger vehicle occupant deaths in the United States. The current study assessed the relationship between the belief about importance of seat belt use and the behavior of always wearing a seat belt. Method: Data from 2012 ConsumerStyles were analyzed separately for front and rear passenger seating positions. Multivariable regression models were constructed to identify the association between seat belt belief and behavior (i.e., always wears seat belt) among adults. Models controlled for type of state seat belt law (primary, secondary, or none). Results: Seat belt use was higher in front passenger seats (86.1%) than in rear passenger seats (61.6%). Similarly, belief that seat belt use was very important was higher in reference to the front passenger seat (84.2%) versus the rear passenger seat (70.5%). For the front passenger seat, belief was significantly associated with seat belt use in states with both primary enforcement laws (adjPR 1.64) and secondary enforcement laws (adjPR 2.77). For the rear passenger seat, belief was also significantly associated with seat belt use, and two 2-way interactions were observed (belief by sex, belief by region). Conclusions: Despite overall high rates of seat belt use in the United States, certain groups are less likely to buckle up than others. The study findings suggest that efforts to increase seat belt use among high-risk populations, such as those who live in states with secondary or no seat belt laws and those who ride in rear seats (which include people who utilize taxis or ride-hailing vehicles) could benefit from interventions designed to strengthen beliefs related to the benefits of seat belt use. Practical applications: Future research that uses a theoretical framework to better understand the relationship between beliefs and behavior may inform interventions to improve seat belt use.     

Nighttime seat belt use among front seat passengers: Does the driver's belt use matter?

Introduction and Method: We explored the relationship between nighttime seat belt use of right-front passengers and their drivers using observational data from 33,310 vehicles in east Tennessee during March 2015 – May 2017. Results: Overall, nighttime passenger seat belt use varied by 50 percentage points from 92% when drivers were belted to 42% when drivers were not belted, suggesting that part-time seat belt users can be heavily influenced by the seat belt status of their traveling companions. When stratified by vehicle type and sex, passenger seat belt use by driver seat belt status varied as much as 74 percentage points from 96% to 22%. Passenger seat belt use was typically lower when riding with unbelted same-sex drivers than when riding with unbelted drivers of the opposite sex. Conclusions and Practical Applications: This finding suggests that the role of peer influence in decision-making about seat belt use may differ depending on the sex of a vehicle driver and his or her passengers. Further research is warranted to explore this finding as well as other social and cultural influences that have not been fully examined in seat belt research.     

The use of seat belt by motor vehicle occupants in South Africa

OBJECTIVE: The purpose of this article was to examine the use of seat belt by motor vehicle users in the various provinces in South Africa. METHODS: Data were abstracted from published reports of the national Department of Transport. Percentage distribution and correlation of road safety variables and seat belt wearing rates for motor vehicle users were calculated for the different provinces. RESULTS: High seat belt wearing rates by the drivers (between 75.1% and 88.1%, national rate was 81%). The seat belt wearing rates for the front and back seat passengers were much lower than for the drivers. The seat belt wearing rates for front seat passengers (44.5% to 60.5%, national - 50.1%) and back seat passengers (1% to 16%, national - 7.6%) were much lower than for the drivers. The national seat belt wearing rate for all vehicles between 1982 and 1995 was between 46.9% and 69.2%, but this has generally declined. CONCLUSION: There is a need for the implementation of strategies to increase the use of seat belts to reduce injuries and fatalities.     

Characteristics of drivers not using seat belts in a high belt use state

A study was undertaken in North Carolina to determine the characteristics of the minority of drivers who were not using seat belts following an extensive publicity/enforcement campaign, which had increased statewide use to 80%. Vehicles and drivers whose seat belt use was observed at sites across North Carolina were matched against Division of Motor Vehicles registration and driver history files for vehicle owners. The study file consisted of those observed drivers who matched the owners with respect to sex, race, and approximate age. The results of this investigation indicate that nonuse of seat belts was associated with males; younger age (<35); older vehicles (pre-1985); vehicles other than cars, especially pickups; and poor driving records. Telephone survey information indicated that nonusers were less likely to have health care coverage, more likely to acknowledge having consumed large amounts of alcohol in the past year, and more likely to have an arrest record. When asked about enforcement of the belt use law, many nonusers said that they would not respond to higher fines but they would respond to driver license points. To change the belt use behavior of this hard-core nonuser population, it well may be necessary as was done in Canada to combine publicity/enforcement campaigns with driver license points as a penalty for nonuse.     

Seat belt use among car drivers in Iranian safe communities: An observational study

Objective: The number of road traffic injuries and fatalities in Iran is high. The aim of the present study was to investigate the rate of drivers' seat belt use and a number of related factors in Kashmar, Bardaskan, and Khalilabad (Iranian Safe Communities).Methods: In 2014, driver observations were made at 48 road sites on intercity roads, main streets, side streets, and rural roads in these 3 cities.Results: A total of 10,255 vehicles were observed, with the overall rate of seat belt use being 51.8%. The rates in Kashmar, Bardaskan, and Khalilabad were 51.4, 56.3, and 47.7%, respectively. In Kashmar, the odds of seat belt use were higher among drivers who were female, older, and taxi drivers. Higher use was also found during the afternoon, and lower use was observed on rural roads. In Khalilabad the odds of seat belt use were higher among females, older drivers, taxis, and private car drivers. Seat belt use was also higher on weekends and during the morning but was significantly lower on rural roads. Similarly, in Bardaskan the odds of using a seat belt were higher among females, older drivers, taxis, and private car drivers. Seat belt use was also higher during the afternoon but was significantly lower on rural roads, in comparison to main streets and intercity roads.Conclusions: The rate of seat belt use in these 3 cities was found to be low, despite these cities being designated as International Safe Communities. Therefore, seat belt promotion programs, tougher regulations, stronger enforcement, public awareness campaigns, and more research are needed to promote seat belt use in these Iranian cities.     

Taxi driver seat belt wearing in Nanjing, China

Objective

To determine and validate patterns of seat belt use and attitudes of taxi drivers on wearing a seat belt following national and provincial seat belt legislation in 2004-2005. Design: Roadside daylight seat belt observation and interview survey methods were used, as well as observations from inside taxis during routine trips and a taxi driver focus group. The setting was Nanjing, Jiangsu Province, PR China in April of 2006 and 2007.

Main outcome measures

Prevalence of seat belt use and attitudes to wearing a seat belt were determined, as were vehicle and driver characteristics, and comparisons with other motor-vehicle driver's seat belt use and attitudes.

Results

Taxi drivers interviewed were predominantly male and aged 30-39 years. They spent more hours per week in their vehicles and had more driving experience than other drivers. Over half (56.2%) of taxi drivers interviewed reported that they always wore seat belts, while observation of taxi drivers showed lower wearing rates (i.e., roadside observation was 43.8%, and observation from inside taxis was 36.2%). Belt tampering was a practice of 12-15% of taxi drivers. “Fine avoidance, safety, high speed and long trips” were given as important reasons for wearing and “feeling trapped and uncomfortable” for not wearing. Seat belt reminder signs in taxis were common (82.6% of taxis), but did not appear to impact on driver seat belt use.

Conclusion

The four research methods found taxi drivers to have consistently low “correct wearing” rates.

Impact on industry

As in several other countries, taxi drivers are particularly resistant to seat belt use. Innovative strategies, including occupational health and safety approaches, may be required to achieve increased levels of seat belt use.     

How future trends in societal aging, air bag availability, seat belt use, and fleet composition will affect serious injury risk and occurrence in the United States

The objective of this study was to quantify the importance of societal aging relative to other factors that are known to affect injury risk. An aging population's effect on Maximum Abbreviated Injury Scale (MAIS) 3+ injury trends for passenger car drivers in frontal crashes was projected and compared to the effects of projected changes in fleet composition, changes in seat belt usage, and changes in air bag availability. It was determined that increased frailty due to an aging population will result in 19,816 to 43,568 additional injuries to passenger car drivers in frontal crashes from 1996 to 2012. Aging was shown to have an effect similar to the increased presence of light trucks in the fleet (a cumulative increase of approximately 47,428 injuries). Aging and changing fleet composition were shown to have a smaller effect than the projected increases in seat belt use or air bag availability, though the effect of increased belt use is not much greater than the effect of aging. After 2012, however, air bag availability and seat belt use will plateau, while societal aging will continue.     

The effect of a gearshift interlock on seat belt use by drivers who do not always use a belt and its acceptance among those who do

IntroductionSeat belts reduce the risk of fatal injury in a crash, yet in 2015, nearly 10,000 people killed in passenger vehicles were unrestrained. Enhanced seat belt reminders increase belt use, but a gearshift interlock that prevents the vehicle from being placed into gear unless the seat belt is used may prove more effective.MethodThirty-two people with a recent seat belt citation and who admitted to not always using a seat belt as a driver were recruited as part-time belt users and asked to evaluate two new vehicles. Sixteen drove two vehicles with an enhanced reminder for one week each, and 16 drove a vehicle with an enhanced reminder for one week and a vehicle with a gearshift interlock the following week. Sixteen full-time belt users who reported always using a seat belt drove a vehicle with a gearshift interlock for one week to evaluate acceptance.ResultsRelative to the enhanced reminder, the gearshift interlock significantly increased the likelihood that a part-time belt user used a belt during travel time in a trip by 21%, and increased the rate of belt use by 16%; this effect approached significance. Although every full-time belt user experienced the gearshift interlock, their acceptance of the technology reported in a post-study survey was fairly positive and not significantly different from part-time belt users. Six part-time belt users circumvented the gearshift interlock by sitting on a seat belt, waiting for the system to deactivate, or unbuckling during travel.ConclusionThe gearshift interlock increased the likelihood that part-time belt users buckled up and the rate of belt use during travel relative to the enhanced reminder but could be more effective if it prevented circumvention.Practical applicationsAn estimated 718–942 lives could be saved annually if the belt use of unbuckled drivers and front passengers increased 16–21%.     

Passenger use of and attitudes toward rear seat belts

Objectives: This study sought to identify attitudes toward belt use in the rear seat and to gain insight into the experiences of rear-seat passengers. Method: A telephone survey conducted between June and August 2016 targeted adult passengers who had recently ridden in the rear and who did not always wear their seat belt when doing so. Respondents were questioned regarding their reasons for not buckling up and possible conditions under which they would be more likely to buckle up during rear-seat travel. Results: Of 1163 recent rear-seat passengers, 72% reported always using their seat belt in the rear. Full-time belt use was lower among passengers who primarily travel in the rear of hired vehicles compared with personal vehicles. The most common explanation for not buckling up was that the back seat is safer than the front. Four out of five agreed they do not buckle up because of type of trip; two-thirds forget or do not see the need; and two-thirds agreed with reasons related to design, comfort, or usability issues. Nearly 40% agreed that they sometimes do not buckle up in the rear because there is no law requiring it. Conclusion: Many reasons for not using belts in the rear are similar to reasons in the front, such as forgetfulness, inconvenience, or discomfort. One difference is that many rear-seat passengers perceive using the belt is unnecessary because the back seat is safer than the front. More than half of part-time belt users and nonusers reported interventions such as rear seat belt reminders, stronger belt-use laws, and more comfortable belts would make them more likely to use their seat belt in the rear seat. Practical applications: This study identifies barriers to rear seat belt use that point to the need for a multi-faceted approach to increase belt use.     

Organizational policy and other factors associated with emergency medical technician seat belt use

INTRODUCTION: The purpose of this study was to determine factors associated with seat belt usage among Emergency Medical Technicians (EMTs). METHODS: As part of biennial re-registration paperwork, nationally registered EMTs completed a survey on the safety and health risks facing Emergency Medical Services (EMS) providers. Respondents were asked to describe their seat belt use while in the front seats of an ambulance. They were categorized as "high" in seat belt use if it had been more than a year since they had not worn their seat belt or "low" in seat belt use if they had not worn their seat belt at least once within the past 12 months. A logistic regression model was fit to estimate the association between seat belt use, organizational seat belt policy, type of EMS organization worked for, EMT certification level, and the size of community where EMS work is performed. RESULTS: Of the 41,823 EMTs that re-registered in 2003, surveys were received from 29,575 (70.7%). A significant interaction between organizational seat belt policy and type of EMS organization was found to exist. Participants reporting no organizational seat belt policy had lower odds of seat belt usage when compared to individuals that do have a seat belt policy. Odds Ratios ranged from 0.20 (95% CI 0.10-0.40) for military organizations to 0.59 (95% CI 0.38-0.93) for private EMS organizations. Paramedics and those working in rural areas also had lower odds of seat belt use. CONCLUSION: Several factors were found to be associated with seat belt usage among EMTs while in the front compartment of an ambulance. However, it appears that only one, organizational policy, is a modifiable characteristic.     

Self-reported factors that influence rear seat belt use among adults

Introduction: While seat belt use among front seat occupants has significantly increased overtime a substantial usage gap still exists between front and back seat occupants. This study aims to identify factors that predict rear seat belt use among adult back seat passengers. Methods: We examined data from the 2016 Motor Vehicle Occupant Safety Survey, conducted by the National Highway Traffic Safety Administration, to determine the influence of front seat belt use, support of and belief of rear seat belt use laws, peer perception of seat belt use, nighttime belt use, and demographic factors on self-reported rear seat belt use. Rao-Scott chi-squared tests were used to determine significant associations between self-reported rear belt use and each predictor. Multivariate logistic regression was used to calculate adjusted odds ratios and determine the influence of significant predictors on rear seat belt use. Sampling weights were applied to produce nationally representative estimates; all statistical significance tests accounted for the complex survey design. Results: Among adults who reported riding in the back seat, 63% reported always using a rear seat belt. Front seat belt use, support and belief of state seat belt laws, nighttime seat belt use, age, and education were significantly associated with rear seat belt use. Multivariate regression results showed that adults who supported rear seat belt laws, reported front seat belt use and believed their state has a rear seat belt law were significantly more likely to report full-time use in the back seat. Conclusions: Seat belt laws and front seat belt use had the strongest association with reporting full-time use in the back seat. Practical Applications: Increasing familiarity with existing laws directed towards rear seat belt use as well as increasing awareness about the benefits of seat belts in all seating positions may help improve rear seat belt use.     

Investigation of seat belt use among the drivers of different education levels

Seat belt use habit has been investigated according to the education level of drivers. Copies of a questionnaire were distributed to 1000 participants of four different education levels. Factors such as seat belt usage habit, restricting factors and crash data have been investigated. Data have been analyzed with SPSS 15.0 software. Increased level of education leads to increased seat belt usage, lower numbers of crashes and crash severities. The factors restricting seat belt use are lack of habit, discomfort and short distance driving. The use of precaution signal and increases in comfort can increase seat belt usage. The primary and high school education on traffic safety and seat belt usage has been serving the purpose.     

The relationship between perceived risk of being ticketed and self-reported seat belt use

PROBLEM: Twenty-nine percent of Americans failed to use their seat belts in 2000. Efforts to improve safety belt usage can be enhanced by identifying specific factors that motivate belt use. METHOD: Motorist survey data were used to examine the effect of Perceived Risk of being Ticketed (PRT) for a seat belt infraction on self-reported seat belt use. RESULTS: Analyses indicated that individuals and groups of individuals who have higher PRT typically report higher belt usage. Factorial analyses indicated that this perceived risk to belt use relationship holds both within groups with generally high (e.g., upper income) and generally low (e.g. young men) overall self-reported belt use. DISCUSSION: Applications of PRT to improve seat belt use are discussed. IMPACT ON INDUSTRY: Enforcement of existing laws, perhaps through selective traffic enforcement programs, and strengthening laws to create a higher perception of being ticketed by motorists should increase safety belt use thereby saving lives and reducing cost for individuals, government, and industry.     

Increasing seat belt use through PI&E and enforcement: The Thumbs Up campaign

Campaigns to increase seat belt use have been effective in controlled environments, in small geographic areas, in primary enforcement states, and when conducted in conjunction with the enactment of seat belt legislation. The Thumbs Up project was undertaken to determine if belt use could be facilitated in less advantageous conditions. A 3-month campaign to increase seat belt use was conducted in two sites, each consisting of two Florida counties. At its conclusion, the Thumbs Up project did not yield an overall increase in seat belt use across the two sites. However, observed seat belt use and the number of seat belt citations issued increased significantly in one site. The results are discussed in terms of the two components necessary for a successful campaign: public information and education, and enforcement. Further, recommendations for conducting successful community-based seat belt interventions are offered.     

Predictors of rear seat belt use among U.S. adults, 2012

IntroductionSeat belt use reduces the risk of injuries and fatalities among motor vehicle occupants in a crash, but belt use in rear seating positions is consistently lower than front seating positions. Knowledge is limited concerning factors associated with seat belt use among adult rear seat passengers.MethodsData from the 2012 ConsumerStyles survey were used to calculate weighted percentages of self-reported rear seat belt use by demographic characteristics and type of rear seat belt use enforcement. Multivariable regression was used to calculate prevalence ratios for rear seat belt use, adjusting for person-, household- and geographic-level demographic variables as well as for type of seat belt law in place in the state.ResultsRear seat belt use varied by age, race, geographic region, metropolitan status, and type of enforcement. Multivariable regression showed that respondents living in states with primary (Adjusted Prevalence Ratio (APR): 1.23) and secondary (APR: 1.11) rear seat belt use enforcement laws were significantly more likely to report always wearing a seat belt in the rear seat compared with those living in a state with no rear seat belt use enforcement law.Conclusions and practical applicationsSeveral factors were associated with self-reported seat belt use in rear seating positions. Evidence suggests that primary enforcement covering all seating positions is an effective intervention that can be employed to increase seat belt use and in turn prevent motor vehicle injuries to rear-seated occupants.