Research article
Seatbelt use, attitudes, and changes in legislation: An international study

https://doi.org/10.1016/S0749-3797(02)00513-5Get rights and content

Abstract

Background

The use of seat belts is among the most effective methods of reducing injury in motor vehicle crashes. We examined trends in seat belt use by university students from 13 European countries between 1990 and 2000, in relation to changes in legislation, attitudes, and hazardous driver behaviors.

Methods

Data were collected via an anonymous standardized questionnaire from university students in Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, the Netherlands, Poland, Portugal, and Spain. There were 10,576 respondents in 1990, and 10,294 in 2000. Data were also collected from 1672 students in the United States in 2000. Analyses were performed in early 2002.

Results

Reported seat belt use increased from 63% to 73% in male students, and from 66% to 77% in female students over the decade. There were marked increases in seat belt use in countries with changes in legislation or enforcement from 1990 to 2000, with 24% to 64% more respondents reporting seat belt use in 2000. The prevalence of use and noted changes during this period correlated with findings from national surveys (r= 0.91). Attitudes to seat belt use were associated with behavior both within and between countries. Nonuse of seat belts was positively related to alcohol-impaired driving and failure to obey speed limits.

Conclusions

Legislation has a substantial impact on the use of vehicle seat belts, but additional gains require efforts to change attitudes within the university student population.

Introduction

R oad traffic crashes result in widespread suffering and premature death throughout the world.1 The use of seat belts is one of the most effective methods of reducing fatal and nonfatal injuries in motor vehicle crashes.2, 3 Seat belt legislation is in place in much of the developed world, but seat belt use varies widely. Increasing seat belt use to 92% is a Healthy People 20104 objective in the United States and a major priority in other countries as well.5

Analyses of trends in seatbelt use provide important information about progression to these goals. International surveys allow the consistency of determinants of protective behaviors to be assessed in diverse cultures and environments.6 This study compared seatbelt use in 1990 and again in 2000 in samples of university students drawn from 13 European countries representing Northwestern, Eastern European, and Mediterranean cultures. There is evidence that the introduction of seat belt laws and more stringent enforcement leads to increases in self-reported and observed use.2 Between 1990 and 2000, new laws were introduced in three of the countries (Poland, Portugal, and Spain) included in this survey to make seat belt use mandatory on all road types for front-seat passengers. In addition, there was a significant increase in enforcement of seat belt laws in Greece, Hungary, and Ireland in the latter half of the 1990s, with more stringent surveillance and higher fines. We therefore hypothesized that changes in legislation would impact seatbelt use over and above any secular trends through time.

Attitudinal factors are important determinants of seatbelt use. Belief in the health benefits of seat belts and concern about complying with the law are associated with greater use, while discomfort, perceptions of low risk of injury, and belief that seat belts are not necessary for careful drivers are related to nonuse.7, 8, 9 We hypothesized that beliefs in the health benefits of seat belts would be positively associated with reported use, both within and between country samples. In addition, we assessed associations between wearing seat belts and two high risk driving behaviors—speeding and alcohol-impaired driving—since seat belt nonuse has been related to hazardous driving and other negative health behaviors in young adults.10, 11

This analysis used data collected from university students; thus, the samples were not representative of the countries involved. Since seatbelt use is associated with educational attainment7, 12 and self-report overestimates actual use,13 the absolute rates are likely to be inflated. However, the main purpose was to assess changes over time and differences among country samples within the study; therefore, such comparisons are not invalidated by these factors. Nonetheless, comparisons between reported seat belt use and levels of use described in contemporary crossnational surveys were made to discover whether reported use was consistent with national statistics.

Section snippets

Methods

The data analyzed in this investigation were collected as part of the European Health and Behaviour Survey (EHBS), which was carried out from 1989 to 1991, and the International Health and Behaviour Survey (IHBS), which was conducted from 1999 to 2001. Both surveys involved university students aged 17 to 30 years studying non–health-related courses. The EHBS included 16,483 respondents (7302 men and 9181 women) from 21 European countries, while IHBS data were collected from 19,298 students

Results

The prevalence of always wearing a seat belt in 1990 and 2000 is summarized in Table 1. There were small gender differences in both surveys, with more women than men using a seat belt in 1990 (66% vs 63%, respectively) and in 2000 (77% vs 73%, respectively). Seat belt use was greater than 80% in both men and women in 1990 in England, France, Germany, and the Netherlands, but below 60% in Greece, Italy, Poland, Portugal, and Spain. Between 1990 and 2000, striking increases in seat belt use were

Discussion

The limitations of this study should be noted. The reported rates of seat belt use must be interpreted cautiously. Although self-reporting correlates with objective measures, utilization is typically overestimated by 9% to 19%.13 Only one or two universities in each country were sampled, so rates of use may not be representative of the general student population. Variations in the composition of samples in 1990 and 2000 may also have contributed to the pattern of results. As expected, reported

Acknowledgements

This study was supported by the Economic and Social Research Council of the United Kingdom. We are grateful to Weiwei Cui for her assistance with data analysis. The following colleagues participated in the EHBS and IHBS and contributed to data collection—Belgium: Jan Vinck; France: France Bellisle and Marie-Odile Monneuse; Germany: Claus Vögele and Gudrun Sartory; Greece: Nicolas Paritsis and Bettina Davou; Hungary: Maria Kopp and Reka Baranyai; Iceland: Erlendur Haraldsson and Sigurlina

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