International survey of seat belt use exemptions

Seatbelt Use in Females of Childbearing Age at an Urban Safety-Net Level 1 Trauma Center

BACKGROUND

Safety restraint system (SRS) use is known to improve maternal and fetal outcomes in pregnant women. Factors associated with seatbelt use in females of childbearing age are largely unstudied despite global public health endeavors to increase use. We sought to define its use and uncover risk factors for not using a restraint system in this vulnerable patient cohort.

MATERIALS AND METHODS

A retrospective chart review of all female patients aged 15-35 y presenting from 2007 to 2017 was performed using our institutional level 1 trauma database. Age, pregnancy, insurance status (commercial or private, Medicaid plan, and uninsured), race, and Injury Severity Score (ISS) were examined in unmatched data. A matched cohort was created to evaluate the impact of pregnancy on SRS use based on ISS, age, race, and insurance status with blinding to belt use during matching (two nonpregnant to one pregnant). Differences in restraint use were then examined using Mann-Whitney U and Chi-square tests.

RESULTS

A total of 779 patients met inclusion criteria, of which 140 were pregnant. In unmatched data, there was no difference in belt use with regard to age, race, or insurance type. Overall belt use was 59%. Twenty-five percent of patients were uninsured, and 39% used a Medicaid plan. Pregnant patients were statistically more likely to wear belts (71% versus 57%, P = 0.003). In ISS-matched data, this difference was not upheld (63% pregnant belt use versus 58%, P = 0.615).

CONCLUSIONS

Pregnancy did not induce improved safety behavior in our population. More study is needed to confirm our findings. Overall SRS use in our urban population is very poor, lags behind the national average, and requires additional public health attention.

Impact of transportation policy on injury characteristics in a teaching hospital, Calabar, Nigeria

INTRODUCTION

The global burden of road traffic injury (RTI)-related trauma is enormous and has the highest impact in low income economies. Loss of lives in the most productive age groups and the socio-economic costs to these weak economies, coupled with poor infrastructure for management of the severely injured dictate that well executed preventive measures be instituted in these countries. Low and middle income economies account for 90% RTI-related deaths in the world, yet in these regions, public health regulations on road safety hardly exist and where they do, are hardly enforced.

AIM

To document variations in injury frequency, severity and outcomes following the ban on the use of motorcycles as a means of public transportation in Calabar.

PATIENTS AND METHODS

A prospective study of RTI patients who presented in our Emergency center over a 12 month period. Information recorded included biodata, anatomic location of injury, injury-arrival time, mode of transportation to hospital and final disposition at discharge. Chest injuries were excluded as there were no data for comparison. Results were analyzed by SPSS version 20 and compared with the 2005 Trauma Study Group results.

RESULTS

There were 366 road traffic injuries out of 5612 emergency room presentations during the period. There were 237 males and 99 females (M: F= 2.4: 1), mean age of patients was 30.13±12.62 years. Businessmen were the most commonly involved occupational group (n= 138; 38.7%) and the mean injury-arrival interval was 16.57±56.14 hours. Only 12 (3.6%) patients arrived by ambulance and 108 (32.1%) left against medical advice.

CONCLUSION

RTIs constitute a major socioeconomic burden in the developing world. Lack of research, high risk behaviors and lack of enforceable road use regulations contribute to high rates of RTI-related mortality and morbidity. Preventive interventions and appropriate research to identify risk factors will reduce the burden of RTIs in low and middle income economies.

How can Saudi Arabia use the Decade of Action for Road Safety to catalyse road traffic injury prevention policy and interventions?

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. The rate of road traffic accidents caused by four-wheeled vehicles is the highest globally reported road traffic accidents statistic. In Saudi Arabia, the motor vehicle is the main means of transportation with one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Road traffic injuries cause considerable economic losses to victims, their families, and to nations as a whole. Strategic prevention plans should be implemented soon by various sectors (health, police, transport, and education) to decrease the mortality and morbidity among adolescent and young age group. Strong and effective coordination between ministry of health and other ministries together with World Health Organization and other related organisations will be an important step towards implementing the international Decade of Action for Road Safety (2011-2020). The aim of this review article is to highlight some aspects of the health impacts of road traffic accidents.

Practices, attitudes and perceptions toward road safety in yerevan, republic of armenia

OBJECTIVES

: To determine knowledge and attitudes regarding traffic safety devices, measures, and legislation in the general population in Yerevan, Republic of Armenia.

METHODS

: We conducted a baseline random digit dial fixed line telephone verbal survey of Yerevan households in April 2009 with a follow-up survey in May 2010. Survey domains included restraint use, motor vehicle crash experiences, and attitudes regarding traffic safety.

RESULTS

: In the initial survey, of 2137 numbers dialed, 436 persons were reached and 390 (90%) agreed to participate. Of survey respondents, 90% percent of household cars had seatbelts, while 47% had airbags. Twenty-four percent always or usually wore a seatbelt when driving, 21% wore a belt as a passenger. 39% were unaware of child restraints. Of the 61% who were aware of child restraints, only 32% had ever used one. A follow-up survey was conducted one year later after enforcement efforts were increased. In the follow-up survey, 81% percent always or usually wore a seatbelt when driving, and 69% wore a belt as a passenger. There was no significant increase of awareness or use of child restraints in the follow-up survey.

CONCLUSIONS

: Although cars in Yerevan have seat belts, the majority of drivers and passengers prior to the intervention did not use them. Knowledge and use of child restraints was poor. The follow-up survey conducted after an enforcement campaign was underway in Yerevan showed that improved enforcement greatly increased awareness and compliance with current legislation. This study provides vital baseline information for the formulation of future policy. It also highlights the need for a multi-dimensional road traffic safety initiative through public educational campaigns, enforcement of current laws, and development of novel prevention policies and regulations.

Focus on seat belt use in China

OBJECTIVE

To explain low seat belt use prevalence results of observation and interview surveys in Nanjing, Jiangsu Province, and Zhoushan, Zhejiang Province, and to extend knowledge on associated seat belt use determinants.

METHOD

Ten focus groups comprising professional, owner, and taxi drivers; passengers; van drivers (Nanjing); or police (Zhoushan) were conducted to capture a range of experiences, attitudes, and opinions.

RESULTS

There was common agreement in all focus groups on the need to use seat belts on highways in the front seat but not to use in the rear seat regardless of road type. Participants generally agreed with the apparent practice of fines for drivers and warnings for front seat passengers, especially on highways. Lack of seat belt comfort was elaborated on. Professional and taxi drivers were inconvenienced by the effort involved for short trips to put on seat belts and discomfort was greater for those who did not have or could not afford to operate air conditioning. There was lack of agreement on the need to use seat belts in the city areas. Crash video clips on the nonuse of seat belts were judged by participants as potentially effective for promotion of seat belt use, especially if scenarios were associated with relatively low speeds.

CONCLUSIONS

The benefits of seat belt use for all seating positions and at low and medium speeds and awareness of passenger seat belt responsibility need to be promoted. Enforcement should be applied more consistently.

Effects of seat belts worn by pregnant drivers during low-impact collisions

OBJECTIVE

The aim of this study was to understand the injury mechanisms of pregnant drivers and associated fetal outcomes.

STUDY DESIGN

Frontal and rear impact tests using a dummy representing the anthropometry of a pregnant woman were conducted.

RESULTS

In frontal impact tests without a seat belt, abdominal pressure peaked at the point where the dummy contacted the steering wheel. Rear impact tests without a seat belt showed that the dummy moved forward because of rebound and contacted the steering wheel, which was avoided when a seat belt was worn.

CONCLUSION

Wearing a seat belt reduces abdominal pressure or prevents contact with the steering wheel during collisions.

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.

Analysis of seating position and anthropometric parameters of pregnant Japanese drivers

OBJECTIVE

An anthropometric study was performed to understand the quantitative characteristics of the seating posture of Japanese pregnant drivers.

METHODS

Twenty pregnant women with a mean gestation of 31.4 +/- 1.9 weeks and 20 age-matched, non-pregnant women provided written informed consent to participate in this study. A mid-sized, sedan-type passenger vehicle was used for measurement. The subjects, wearing light clothing, sat in the driver's seat of the vehicle and fastened the seatbelt after adjusting the seat to their usual driving posture. Longitudinal displacement of the slide adjuster and the reclining angle of the seat back were measured, relative to the reference position. Seating posture was investigated by measuring the coordinates of the anthropometric datum points of the drivers (head, shoulder, hip joint, knee joint, and the clearance between the steering wheel and the upper torso).

RESULTS

The mean horizontal clearance between the lower rim of the steering wheel and the abdomen of the pregnant women was 146 +/- 56 mm, significantly smaller than that of the non-pregnant women (251 +/- 51 mm), due to the protrusion of the abdomen. There was no significant difference in seat adjustment position between the two groups. The height of the pregnant women and the horizontal distance from the lower rim of the steering wheel to the abdomen showed a moderate linear correlation in the pregnant group (R2 = 0.56).

CONCLUSIONS

Compared to previous studies, the differences of longitudinal distance were found between American and Japanese subjects without significant differences of body heights, due to the difference of body weights and abdominal circumferences. This is the first report to analyze the seating position and anthropometric parameters of pregnant drivers in an Asian population.