China belting up or down? Seat belt wearing trends in Nanjing and Zhoushan
Introduction
China’s first national seat belt law, “When vehicles are running, drivers and passengers shall tighten seat belts in conformity with provisions”, took effect in May 2004 in response to rapid motorisation and an associated increase in road traffic fatalities (National Peoples Congress, 2003). At this time registrations of passenger vehicles had increased from 3.5 m in 1993 to 23.3 m over 10 years (National Bureau of Statistics of China, 2004). The latest official road traffic fatality count (for 2002) was 109 381 deaths (National Bureau of Statistics of China, 2003), unofficial figures were higher (Peden et al., 2004). Extensive seat belt wearing, a highly proven road safety intervention, has the potential to considerably reduce both the Chinese and global vehicle occupant road traffic injury (RTI) burden. The literature providing supporting evidence of seat belt effectiveness in reducing injury is vast. Summarising references include Elvik and Vaa (2004), Evans (2004), and Peden et al. (2004). Examples of others are Milne (1979), Evans and Frick (1986), Campbell (1987) and NHTSA (2003).
Zhejiang and Jiangsu are eastern provinces in China with relatively high economic growth, motorisation and RTI rates (Wang et al., 2003; National Bureau of Statistics of China, 2007). A seat belt wearing study was conducted in Nanjing, Jiangsu Province and Zhoushan, Zhejiang Province. Located on the Yangze and the provincial capital, Nanjing is a major industrial and historic city with a population of 6 million; Zhoushan, an island with population 1 million is a base for fishing, naval activities, summer beach tourism and travel to the Putuoshan Buddhist monastery. Dinghai is the major city, Putuo the next largest.
In addition to the May 2004 national seat belt wearing law, rear seat belts were required to be fitted nationally from October 2004 “All seats of new cars (except row 3 and after the folding seat) should install seat belts”, these having been required in the front seat since 1993 (PR China, 1992, PR China, 2004). As of January 2005 for Jiangsu, and June 2006 for Zhejiang, provincial regulations stipulate that “Drivers can be fined RMB50 (US$ 7.1) if they don’t wear seat belts” (People’s Congress of Jiangsu Province, 2005; Zhejiang Provincial People’s Congress, 2006). Passenger regulations have neither been so consistent nor clear but for front passengers fines have approximated 5 or 20 RMB.
The seat belt wearing surveys reported here were conducted over the 3 years 2005–2007 in April each year by Monash University Accident Research Centre (MUARC) in collaboration with the National, Jiangsu and Zhejiang Centers for Disease Control and Prevention (China CDC). They are the major component of a broader seat belt program which has involved interview fitment and attitude surveys, focus groups and eventually a comparison with the introduction of the first seat belt wearing law in 1970 in Victoria, Australia. Relationship establishment and maintenance through visiting delegations to MUARC, lectures to China CDC, training and capacity building have been an essential component of this cooperative venture. In Zhoushan several levels of government and departments, including the Municipal Government and Bureaus of Public Security and Health have been involved, unusual for China. Obtaining consistent and meaningful information on relevant laws, enforcement, education and road traffic injury data has been a considerable challenge.
Pilot surveys held in 2004, detailed methodology and Nanjing 2005 results have been reported previously (Routley et al., 2007a, Routley et al., 2007b). To date other seat belt surveys in China have been scarce. A road safety study with a driver seat belt component was conducted in Beijing in 2004, driver wearing was reported as 64% (Zhang et al., 2006). In Guangzhou and Nanning driver and front passenger seat belt wearing surveys were conducted in 2005 and 2006 coinciding with the first 2 years of this study (Stevenson et al., 2007).
Seat belt studies have been regularly undertaken in motorised countries and examples of current high rates are over 90% for front seat occupants in Australia, Germany, France and the UK and close to 90% for rear occupants in Germany and Australia (European Transport Safety Council, 2006; Whelan et al., 2003). Rates approximate 79% for all occupants in the USA (Glassbrenner et al., 2004). Seating position is but one of many factors found by previous studies to influence seat belt wearing (drivers most, rear passengers least likely to wear). Other factors include sex (higher for females), road type (higher for main than local roads), time of day (lower at night), day of week (less at weekend), presence of front seat passengers (drivers more likely to wear), vehicle type (less for pickups) and driver wearing (passengers more likely to wear) (Boughton et al., 1981, Mackay et al., 1982, Wagenaar et al., 1987, Diamantopoulou et al., 1996, Aekplakorn et al., 2000, Vivoda and Eby, 2002, Glassbrenner et al., 2004).
To describe the patterns and trends in seat belt wearing in two cities (Nanjing and Zhoushan) over 3 years following the introduction of a national seat belt wearing law and associated provincial regulations.
In two contrasting Chinese cities:
- (1)
Observe and record seat belt wearing of drivers, front seat passengers and up to three rear occupants in passenger motor vehicles.
- (2)
Describe the traffic mix, i.e. vehicle types observed moving in all lanes in the observed direction, thereby identifying any selection bias in observed vehicles.
- (3)
Describe secular vehicle trends.
Section snippets
Survey method
- (1)
Ethics approval was obtained from the Monash University Standing Committee on Ethics and Human Research.
- (2)
A training day, which included instructions, site visits, trial observations and discussion of observation issues was held prior to each observational survey period. The observers were public health medical students on fieldwork experience at Jiangsu or Zhejiang Provincial CDCs or Zhoushan/Zhejiang Provincial CDC public health professionals.
- (3)
The sites for each city were located on the approach
Overview
Over the 3 years in the two cities there were 56,195 vehicles and 95,933 occupants for whom seat belt wearing was clearly observed. Drivers accounted for over half (58.6%) of all occupants, front seat passengers 24.6% and rear passengers 16.9%. There were 35,256 vehicles observed in Nanjing and 20,939 in Zhoushan (Table 2, Table 3).
In both cities males dominated all seating positions and vehicle types and overall they accounted for almost 80% of occupants. Drivers were predominantly male
Major patterns and trends
With one exception, there were consistent wearing patterns between and within cities and between years. Seat belt wearing declined each year in all seating positions where levels were sufficient to identify a decline; wearing was virtually non-existent for Zhoushan front seat passengers and rear passengers in both cities and wearing was higher in all seating positions in Nanjing than Zhoushan. The one exception was Zhoushan 2006 drivers for whom 2005 levels were maintained, coinciding with
Acknowledgements
Final year public health medical science students from Nanjing Medical University and South-East University (2007 only) on field experience at Jiangsu CDC and Zhoushan and Zhejiang CDC employees for seat belt wearing observations, contributions to data entry and co-supervision of data collection. Zhoushan Municipal Health Bureau, Zhoushan Ministry of Public Security and Zhoushan City government for co-operation, support and generous hospitality. Dr. Stuart Newstead (MUARC) and Assoc. Prof. Rory
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