The prevalence of seat belt use among drivers and passengers: a systematic review and meta-analysis
Journal of the Egyptian Public Health Association volume 98, Article number: 14 (2023)
Seat belts might save people’s lives in car accidents by preventing severe collision damage and keeping passengers safe from critical injuries. This meta-analysis was performed to assess the prevalence of seat belt use among drivers and passengers.
The databases of PubMed, Web of Science (WOS), and Google Scholar were searched from the beginning of 2000 to late December 2020 to identify studies that investigated the prevalence of seat belt use among drivers and passengers. The pooled prevalence was calculated using a random-effects model. The STATA-v14 software was used to perform data analysis.
Sixty-eight studies that met the inclusion criteria and were suitable for this meta-analysis were identified. The pooled prevalence of seat belt use was 43.94% (95% CI: 42.23–45.73) among drivers, 38.47% (95% CI: 34.89–42.42) among front-seat passengers, and 15.32% (95% CI: 12.33–19.03) among rear-seat passengers. The lowest seat belt use among drivers and passengers was observed in Asia, the Middle East, and Africa, while the highest use was reported in Europe and America. Moreover, the prevalence of seat belt use was higher among women drivers [51.47% (95% CI: 48.62–54.48)] than men drivers [38.27% (95% CI: 34.98–41.87)] (P < 0.001). Furthermore, the highest prevalence of seat belt use was seen among drivers (68.9%) and front-seat passengers (50.5%) of sports utility vehicles (SUVs); in contrast, the lowest prevalence was observed among drivers and passengers of public vehicles such as buses, minibuses, and taxis.
In general, the prevalence of seat belt use was not high among drivers and was even lower among passengers. Moreover, drivers and passengers in Asia, the Middle East, and Africa had the lowest prevalence of seat belt usage. Additionally, drivers and passengers of public transportation (buses, minibuses, and taxis) had a lower rate of seat belt use, especially among men. Therefore, effective interventional programs to improve seat belt use should be designed and implemented, particularly among these at-risk populations in Asia, the Middle East, and Africa.
Motor vehicle crashes are one of the significant causes of morbidity and mortality worldwide . According to the World Health Organization, around 1.3 million people lose their lives every year, and between 20 and 50 million are injured as a result of road traffic accidents .
Road injuries create an enormous economic burden for countries. The global economy is estimated to incur a cost of US $1.8 trillion (constant 2010 US dollars) due to road injuries in 2015–2030, equivalent to 0.12% of the global gross domestic product (GDP) annually . As a result, it is crucial to establish motor vehicle crashes prevention programs worldwide.
Most deaths from motor vehicle crashes occur among the car’s occupants . Therefore, seat belts are a cost-effective preventive measure for reducing the severity of injury, disability, and death caused by road accidents . By wearing a seat belt, the risk of death among drivers and passengers in the front seat decreases by 45–50%, and the risk of death and serious injury among passengers in the rear seat decreases by about 25% .
The prevalence of seat belt use varies across different countries of the world and depends to some extent on the regulations in place. Seat belt use in low- and middle-income countries is not high, despite strict driving laws and fines for those who do not use seat belts [6, 7]. Studies have shown that men, young people (18–34 years old), obese individuals, rear seat occupants, and villagers have lower rates of seat belt use [8,9,10].
Accordingly, estimating the prevalence of seat belt use is very important for public health policymakers to implement programs aiming at reducing mortality and morbidity from motor vehicle crashes. Moreover, there were no recent systematic reviews on seat belt use in the previous 5 years. Therefore, this study was conducted to determine the prevalence of seat belt use among drivers, front-seat passengers, and rear-seat passengers from the beginning of 2000 to late December 2020.
2.1 Search strategy and study selection
This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines . Relevant articles were identified through the databases of PubMed, Web of Science (WOS), and Google Scholar from the beginning of 2000 to late December 2020 using combined keywords and Medical Subject Headings (MESH) heading strategies such as "Seatbelt, "Safety belt, "Seat Belt Usage, "Prevalence," "Frequency, "Driver," "Vehicle," and "Passenger." Additionally, references from previous reviews were scanned to identify other relevant articles.
Studies that met the following criteria were selected for the current meta-analysis:
Cross-sectional studies that reported data on seat belt use in commercial or personal vehicles for both drivers and front or rear seat passengers separately.
Studies performed on passengers over the age of 12, as the seat belt use is suggested for those aged 12 and above, and passengers under the age of 12 should use child restraints .
The target population was either the general population or a specific population, such as high school and university students, drivers, or passengers involved in motor vehicle crashes.
The exclusion criteria were as follows:
Studies that were not written in English
Studies conducted on specific populations, such as pregnant women and people with physical limitations on seat belt use and those who had undergone abdominal surgery
Studies that lacked data for prevalence calculation with a 95% confidence interval
Studies that reported mixed reporting of seat belt use among drivers and passengers
We also excluded studies for which we were unable to obtain a full text after contacting the corresponding author.
2.2 Quality assessment
An assessment of the quality of the included studies was performed using a quality checklist adapted from Loney et al. . The checklist assesses the different aspects of methodology (study design and sampling method, sampling frame, sample size, appropriate measurement, unbiased measurement, and response rate) as well as the interpretation of results and application of findings. The study received 1 point for each criterion that was met. Scores for high-quality studies range from 7 to 8 points, for moderate-quality studies from 4 to 6 points, and for low-quality studies from 0 to 3.
2.3 Data extraction
Two researchers independently screened the identified articles from the databases based on the title and abstract. Then, the full text and abstract of the related articles were reviewed. Data were extracted from the eligible articles and recorded in an Excel checklist containing the names of authors, year of publication, study setting (country), age, gender, the number of participants, method, the prevalence of wearing a seat belt, and its 95% confidence interval. In this study, individuals who reported that they always, sometimes, often, full time, most of the time, or regularly wear seat belts were considered seat belt users. Table 1 presents a summary of the included studies in the meta-analysis.
2.4 Statistical analysis
The pooled prevalence of wearing a seat belt with a 95% confidence interval was calculated using random-effect meta-analyses. Inter-study heterogeneity was assessed using chi-squared tests and the I2 statistic. Additionally, subgroup analyses were performed to explore the sources of heterogeneity, and Egger’s test was used to detect publication bias. The STATA-v14 (Stata Corp, TX, USA) software was used to analyze the data .
Out of 836 identified articles in the databases, 435 were excluded due to duplication or unrelated titles. Another 254 articles were removed after screening based on the abstract as they were review articles, published before 2000, or were not cross-sectional or observation studies. After that, 147 full-text articles were reviewed and assessed according to the eligibility criteria. Out of these, 79 articles were excluded as they did not report the prevalence or had sufficient data to calculate 95% CI or had mixed reporting of the prevalence of seat belt use among drivers and passengers. Finally, 68 articles with a total of 1,490,226 participants that met the inclusion criteria were included in this meta-analysis. The flowchart of the study selection process is shown in Fig. 1.
Out of 68 studies included in the meta-analysis, ten were considered high quality, 53 were considered moderate quality, and five were considered low quality (Supplementary Table S1). The pooled prevalence of seat belt use among drivers in the high-quality studies, the moderate quality studies, and the low-quality studies were 37.12% (95% CI: 33.00–41.76), 47.72% (95% CI: 45.77–49.75), and 37.75% (95% CI: 27.46–51.91), respectively, which showed some evidence of heterogeneity (P < 0.001) in terms of study quality. Therefore, we estimated pooled prevalence based on the type of vehicle in the three study groups, and no heterogeneity was observed. Therefore, the quality of the studies did not affect the present meta-analysis results (Supplementary Table S2).
3.1 Prevalence of seat belt use
In general, the pooled prevalence of seat belt use among drivers, front-seat passengers, and rear-seat passengers was 43.94% (95% CI: 42.23–45.73), 38.47% (95% CI: 34.89–42.42), and 15.32% (95% CI: 12.33–19.03), respectively. The lowest prevalence of seat belt use among drivers was in Asia [37.86% (95% CI: 34.44–41.61)] and Middle East [38.17% (95% CI: 34.25–42.55)] region, and the highest was in Western Europe [84.42% (95% CI: 72.32–98.55)] and the Americas [51.57% (95% CI: 47.54–55.93)]. Also, the lowest prevalence of seat belt use among front- and rear-seat passengers was found in Africa (17.43%, 2.29%), Asia (34.62%, 7.93%), and the Middle East (31.53%, 9.24%) (P < 0.001).
The prevalence of seat belt use was significantly higher in female drivers [51.47% (95% CI: 48.62–54.48)] compared to male drivers [38.27% (95% CI: 34.98–41.87)] (P < 0.001). In addition, the prevalence of seat belt use among female front-seat passengers [33.09% (95% CI: 29.45–37.18)] and rear-seat passengers [18.27% (95% CI: 13.73–24.32)] was higher than among male front-seat passengers [25.96% (95% CI: 20.18–33.38)] and rear-seat passengers [15.55% (95% CI: 10.97–22.04)], although this difference was not statistically significant (P = 0.08, P = 0.48).
The drivers and front-seat passengers of SUVs (68.9%, 50.5%) and vans (70.39%, 19.83%) showed a higher prevalence of seat belt use compared to drivers and front-seat passengers of other vehicle types. In contrast, drivers of buses (21.84%) and minibuses (28.16%) and front-seat passengers of minibuses (1.80%) and taxis (3.82%) displayed lower prevalence of seat belt use (P < 0.001).
Furthermore, the highest prevalence of seat belt use among drivers was in the morning [54.89% (95% CI: 46.85–64.32)], followed by in the afternoon/evenings [50.78% (95% CI: 43.52–59.25)] and the night [46.59% (95% CI: 31.49–68.91)], but the differences were not statistically significant (P = 0.66). On the other hand, the highest prevalence of seat belt use among front-seat passengers was at night [51.3% (95% CI: 41.80–60.70)] (P < 0.001).
In addition, the highest prevalence of seat belt use among drivers was observed on intercity roads [45.49% (95% CI: 33.48–61.80)], while the lowest prevalence was observed on side streets [29.68% (95% CI: 23.12–38.11)] (P = 0.04). Additionally, the highest prevalence of seat belt use among front-seat passengers was also on intercity roads [16.98% (95% CI: 4.06–70.91)] (P = 0.28) (Table 2, Fig. 2).
Moreover, a subgroup analysis was performed between the data obtained from national surveys and the findings from observational studies. There was no evidence of heterogeneity between the pooled prevalence of seat belt use among drivers in observational studies [43.26% (95% CI: 40.93–45.72)] and national surveys [42.35% (95% CI: 38.7–46.24)] (P = 0.69).
This study assessed the prevalence of seat belt use among drivers, front-seat passengers, and rear-seat passengers between 2000 and 2020. The results showed that the prevalence of seat belt use among drivers was not high (43.94%). Additionally, the study found that rear-seat passengers (15.32%) are less likely to always or more often wear seat belts compared to front-seat passengers (38.47%), which is consistent with the results of other studies [67, 82, 83]. A survey of adults also revealed that those who did not wear seat belts in the back seat believed that the rear seat was safer than the front seat and that seat belts were not necessary on short trips .
This study showed that the prevalence of seat belt use in the Asian, Mediterranean and Middle East, and African regions was lower than in Europe and the Americas, which may partially be attributed to the differences in driving laws and regulations within countries in these regions.
According to Word Health Organization’s previous reporting, the African region has the highest traffic injury death rates, while the European region has the lowest . Other studies have also highlighted that the prevalence of seat belt use is not high in low- and middle-income countries, and more than 90% of the world’s road fatalities occur in these countries [7, 84].
The National Highway Traffic Safety Administration (NHTSA) of the USA recommended that wearing a seat belt is one of the safest choices that drivers and passengers can make on the road. It also asserted that the national use rate was 90.4% in 2021, and that seat belts saved an estimated 14,955 American lives in 2017 alone, and they could have saved an additional 2549 people if they had been wearing seat belts .
It has been demonstrated that in 2013, almost 85,000 people died from road traffic injuries in the WHO European Region. In this region, 95% of the population is governed by comprehensive traffic laws which are in line with best practices for seat belts. Additionally, in 36 European countries, the median reported usage of seat belts among front-seat occupants was 86%, and the median proportion of rear seat-belt use was 65% .
This study also found that the prevalence of seat belt use in women drivers and passengers was significantly higher than in men. This pattern has been observed in other studies [87,88,89], which may be due to women being more conservative drivers and more likely to follow driving laws. Previous studies have also reported more traffic violations among men than women , which explains why men are more likely to be injured in traffic accidents .
This study observed a significant relationship between the type of vehicle and seat belt use among drivers and passengers. SUV drivers and passengers were more likely to wear seat belts than drivers and passengers of other vehicles, which is consistent with a study conducted in the USA . This difference could be due to various factors, including SUV drivers and passengers exhibiting healthier behaviors due to their higher socioeconomic status [92, 93].
On the other hand, drivers and passengers of public vehicles (buses, minibuses, and taxis) tend to wear seat belts less frequently. In many countries, public transport makes frequent stops, and drivers are sometimes forced to disembark at many stations to meet passengers’ needs, making it uncomfortable for them to wear seat belts. Other studies have also shown that seat belt use is less common in public transport due to the frequent stops [71, 94].
Previous studies have shown a statistically significant relationship between seat belt use and the time of day [37, 95, 96]. In many countries, officers are usually present to monitor the roads at any time of day, and drivers familiar with the regulations tend to use seat belts as a precaution. In agreement, this study found that drivers wore seat belts more frequently during the day than at night, although this difference was not statistically significant. This study also showed that drivers were more likely to use seat belts while driving on intercity roads than on the main and side streets in the city. This finding may be attributed to the greater presence of traffic police and the higher number of traffic cameras on intercity roads. Moreover, a study in Nigeria has shown that seat belt use is more common on interurban roads than on rural roads .
Finally, there were limitations to this study that should be taken into consideration when interpreting the results. The first limitation was the different methods used to measure seat belt usage across different studies. The second limitation was the unequal number of studies conducted in the five geographical regions, as well as the use of different sampling methods, which could be a contributing source to the variation in the prevalence of seat belt use across these regions. The third limitation was the lack of information on seat belt use by time and road type in some studies.
This meta-analysis showed that, in general, the prevalence of seat belt use among drivers and car passengers is not high. Seat belt use was found to be lower in Asia, the Mediterranean and Middle East, and Africa compared to Europe and the Americas. We also found that women wore seat belts significantly more than men. Furthermore, seat belt use among drivers and passengers of public transportation (buses, minibuses, taxis) was lower than in other vehicles. Therefore, it is necessary to design and implement well-structured targeted interventional programs, such as developing training campaigns about the benefits of seat belt use among these vulnerable populations, especially in Asia, the Mediterranean and Middle East, and Africa. Additionally, we recommend further research be conducted to explore the factors that affect drivers’ and passengers’ attitudes and knowledge about seat belt use.
Availability of data and materials
Data are available upon request.
Sports utility vehicles
Global gross domestic product
Anjuman T, Hasanat-E-Rabbi S, Siddiqui CKA, Hoque MM. Road traffic accident: a leading cause of the global burden of public health injuries and fatalities. In Proc Int Conf Mech Eng Dhaka Bangladesh; 2020. Available from: https://me.buet.ac.bd/icme/icme2007/Proceedings/PDF/ICME07-AM-30.pdf.
World Health Organization (WHO). Road traffic injuries. 2022. [Available from: https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries]. (Accessed June 2022).
Chen S, Kuhn M, Prettner K, Bloom DE. The global macroeconomic burden of road injuries: estimates and projections for 166 countries. Lancet Planetary Health. 2019;3(9):e390–8. https://doi.org/10.1016/s2542-5196(19)30170-6.
Fouda Mbarga N, Abubakari A-R, Aminde LN, Morgan AR. Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies. BMC Public Health. 2018;18(1):1–11. https://doi.org/10.1186/s12889-018-6280-1.
Cummins JS, Koval KJ, Cantu RV, Spratt KF. Do seat belts and air bags reduce mortality and injury severity after car accidents. Am J Orthop (Belle Mead NJ). 2011;40(3):E26–9.
World Health Organization (WHO). Global status report on road safety. Available from: https://irap.org/2018/12/world-health-organisation-who-releases-the-global-status-report-on-road-safety-2018/. Accessed 7 Dec 2018.
Ghaffari M, Armoon B, Rakhshanderou S, Mehrabi Y, Soori H, Simsekoghlu O, et al. Determinants of seat belt use behaviour: a protocol for a systematic review. BMJ Open. 2018;8(5):e020348. https://doi.org/10.1136/bmjopen-2017-020348.
Beck LF, Downs J, Stevens MR, Sauber-Schatz EK. Rural and urban differences in passenger-vehicle–occupant deaths and seat belt use among adults—United States, 2014. MMWR Surveillance Summaries. 2017;66(17):1. https://doi.org/10.15585/mmwr.ss6617a1.
Bhat G, Beck L, Bergen G, Kresnow MJ. Predictors of rear seat belt use among US adults, 2012. J Saf Res. 2015;53:103–6. https://doi.org/10.1016/j.jsr.2015.03.011.
Strine TW, Beck LF, Bolen J, Okoro C, Dhingra S, Balluz L. Geographic and sociodemographic variation in self-reported seat belt use in the United States. Accid Anal Prev. 2010;42(4):1066–71. https://doi.org/10.1016/j.aap.2009.12.014.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.31222/osf.io/v7gm2.
World Health Organization (WHO). Seat-belts and child restraints: a road safety manual for decision-makers and practitioners. London: FIA Foundation for the Automobile and Society. 2009. Available from: https://www.who.int/publications/m/item/seat-belts-and-child-restraints--a-road-safety-manual-for-decision-makers-and-practitioners. Accessed 10 Sep 2009.
Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can. 1998;19(4):170–6.
Kim S, Kim K. Personal, temporal and spatial characteristics of seriously injured crash-involved seat belt non-users in Hawaii. Accid Anal Prev. 2003;35(1):121–30. https://doi.org/10.1016/s0001-4575(01)00097-5.
La QN, Lee AH, Meuleners LB, Van Duong D. Prevalence and factors associated with road traffic crash among taxi drivers in Hanoi Vietnam. Accid Anal Prev. 2013;50:451–5. https://doi.org/10.1016/j.aap.2012.05.022.
Routley V, Ozanne-Smith J, Qin Y, Wu M. Taxi driver seat belt wearing in Nanjing. Chin J Saf Res. 2009;40(6):449–54. https://doi.org/10.1016/j.jsr.2009.10.004.
Mohammadi G. Prevalence of seat belt and mobile phone use and road accident injuries amongst college students in Kerman. Iran Chin J Traumatol (English Edition). 2011;14(3):165–9.
Allen HK, Beck KH, Zanjani F. Driving concerns among older adults: associations with driving skill, behaviors, and experiences. Traffic Inj Prev. 2019;20(1):45–51. https://doi.org/10.1080/15389588.2018.1528358.
Pérez-Núñez R, Chandran A, Híjar M, Celis A, Carmona-Lozano MS, Lunnen JC, et al. The use of seatbelts and child restraints in three Mexican cities. Int J Inj Contr Saf Promot. 2013;20(4):385–93. https://doi.org/10.1080/17457300.2012.754477.
García-España JF, Winston FK, Durbin DR. Safety belt laws and disparities in safety belt use among US high-school drivers. Am J Public Health. 2012;102(6):1128–34. https://doi.org/10.2105/ajph.2011.300493.
Chen GX, Collins JW, Sieber WK, Pratt SG, Rodríguez-Acosta RL, Lincoln JE, et al. Vital signs: seat belt use among long-haul truck drivers—United States, 2010. MMWR Morb Mortal Wkly Rep. 2015;64(8):217.
Bener A, Dafeeah E, Verjee M, Yousafzai M, Al-Khatib H, Nema N, et al. Gender and age differences in risk taking behaviour in road traffic crashes. Adv Trans Stud. 2013;31:53–62.
Kritsotakis G, Papadakaki M, Tumwesigye R. Co-occurence of risky driving behaviours and associations with seatbelt and helmet use-a descriptive cross-sectional study among young adults. Epidemiol Biostat Public Health. 2019;16(2).
Mohammadi M, Ansari Moghaddam A, Rad M, Hashemi Habybabady R, Tabasi MA. Seatbelt use and related factors among drivers involved in road crashes in southeast Iran. Health Scope. 2015;4(4). https://doi.org/10.17795/jhealthscope-30782.
Popoola S, Oluwadiya K, Kortor J, Denen-Akaa P, Onyemaechi N. Compliance with seat belt use in Makurdi, Nigeria: an observational study. Ann Med Health Sci Res. 2013;3(3):427–32. https://doi.org/10.4103/2141-9248.117950.
Sangowawa AO, Alagh BT, Ekanem SE, Ebong IP, Faseru B, Adekunle BJ, et al. An observational study of seatbelt use among vehicle occupants in Nigeria. Inj Prev. 2010;16(2):85–9. https://doi.org/10.1136/ip.2009.023242.
Mohammadzadeh M, Paravar M, Mirzadeh AS, Mohammadzadeh J, Mahdian S. Seat belt usage in injured car occupants: injury patterns, severity and outcome after two main car accident mechanisms in Kashan, Iran, 2012. Arch Trauma Res. 2015;4(1). https://doi.org/10.5812/atr.22203.
Paveen B, Ramesh A, Kumar M. Development of model for seat belt use and assessment of perspective behavior among Indian drivers. Int J Traffic Transport Eng (Belgrade). 2020;10(2):126–37. https://doi.org/10.7708/ijtte.2020.10(2).01.
Bener A, Crundall D. Role of gender and driver behaviour in road traffic crashes. Int J Crashworthiness. 2008;13(3):331–6. https://doi.org/10.1080/13588260801942684.
Briggs NC, Lambert EW, Goldzweig IA, Levine RS, Warren RC. Driver and passenger seatbelt use among US high school students. Am J Prev Med. 2008;35(3):224–9. https://doi.org/10.1016/j.amepre.2008.03.038.
Fernandez WG, Mehta SD, Coles T, Feldman JA, Mitchell P, Olshaker J. Self-reported safety belt use among emergency department patients in Boston Massachusetts. BMC Public Health. 2006;6(1):1–10. https://doi.org/10.1186/1471-2458-6-111.
Alomari A, Taamneh M. Front-seat seatbelt compliance in Jordan: an observational study. Adv Trans Stud. 2020;52:101–16. https://doi.org/10.4399/97888255370317.
Gebresenbet RF, Aliyu AD. Injury severity level and associated factors among road traffic accident victims attending emergency department of Tirunesh Beijing Hospital, Addis Ababa, Ethiopia: a cross sectional hospital-based study. PLoS One. 2019;14(9):e0222793. https://doi.org/10.1371/journal.pone.0222793.
Raman SR, Ottensmeyer CA, Landry MD, Alfadhli J, Procter S, Jacob S, et al. Seat-belt use still low in Kuwait: self-reported driving behaviours among adult drivers. Int J Inj Contr Saf Promot. 2014;21(4):328–37. https://doi.org/10.1080/17457300.2013.826698.
Jermakian JS, Weast RA. Passenger use of and attitudes toward rear seat belts. J Safety Res. 2018;64:113–9. https://doi.org/10.1016/j.jsr.2017.12.006.
Koushki PA, Bustan M. Smoking, belt use, and road accidents of youth in Kuwait. Saf Sci. 2006;44(8):733–46. https://doi.org/10.1016/j.ssci.2006.03.003.
Wong TH, Lim GH, Chow KY, Zaw NN, Nguyen HV, Chin HC, et al. Buckling up in Singapore: residency and other risk factors for seatbelt non-compliance–a cross-sectional study based on trauma registry data. BMC Public Health. 2016;16(1):1–11. https://doi.org/10.1186/s12889-016-3080-3.
Vaughn MG, Salas-Wright CP, Piquero AR. Buckle up: non-seat belt use and antisocial behavior in the United States. Ann Epidemiol. 2012;22(12):825–31. https://doi.org/10.1016/j.annepidem.2012.09.010.
Taylor NL, Daily M. Self-reported factors that influence rear seat belt use among adults. J Safety Res. 2019;70:25–31. https://doi.org/10.1016/j.jsr.2019.04.005.
Tavafian SS, Aghamolaei T, Gregory D, Madani A. Prediction of seat belt use among Iranian automobile drivers: application of the theory of planned behavior and the health belief model. Traffic Inj Prev. 2011;12(1):48–53. https://doi.org/10.1080/15389588.2010.532523.
Siviroj P, Peltzer K, Pengpid S, Morarit S. Non-seatbelt use and associated factors among Thai drivers during Songkran festival. BMC Public Health. 2012;12(1):1–7. https://doi.org/10.1186/1471-2458-12-608.
Densu SN. Occupant protection: observed seatbelt use in the Sekondi-Takoradi Metropolis (STM), Ghana. Int J Struct Civil Eng Res. 2013;2(4):201–12. https://doi.org/10.47963/joss.v8i1.305.
Jawadi AH, Alolayan LI, Alsumai TS, Aljawadi MH, Philip W, Alharthy NA, et al. Seat belt usage and distracted driving behaviors in Saudi Arabia: health-care providers versus nonhealth-care providers. J Musculoskelet Surg Res. 2017;1(1):10. https://doi.org/10.4103/jmsr.jmsr_8_17.
Mahfoud ZR, Cheema S, Alrouh H, Al-Thani MH, Mamtani R. Seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar: an observational study. BMC Public Health. 2015;15(1):1–6. https://doi.org/10.5339/qfarc.2014.hbpp0077.
Routley V, Ozanne-Smith J, Li D, Yu M, Wang J, Zhang J, et al. China belting up or down? Seat belt wearing trends in Nanjing and Zhoushan. Accid Anal Prev. 2008;40(6):1850–8. https://doi.org/10.1016/j.aap.2008.08.007.
Routley V, Ozanne-Smith J, Li D, Hu X, Wang P, Qin Y. Pattern of seat belt wearing in Nanjing, China. Inj Prev. 2007;13(6):388–93. https://doi.org/10.1136/ip.2007.015701.
Xiao D, Pengpeng Y, Yichong L, Leilei D, Limin W, Shults RA, et al. Prevalence of drink-driving among adults in China: a nationally representative survey in 2010. Traffic Inj Prev. 2017;18(8):795–800. https://doi.org/10.1080/15389588.2016.1161760.
Nabipour AR, Khanjani N, Soltani Z, Akbari M. The rate of seat belt use and its related factors among car drivers in Tehran, Iran after imposing new regulations. Int J Inj Contr Saf Promot. 2014;21(4):348–54. https://doi.org/10.1080/17457300.2013.833941.
Mohammadi G. Mobile phone and seat belt usage and its impact on road accident fatalities and injuries in southeast Iran. Int J Crashworthiness. 2009;14(4):309–14. https://doi.org/10.1080/13588260802671423.
Mohamed N, Mohd Yusoff MF, Isah N, Othman I, Syed Rahim S-A, Paiman N. Analysis of factors associated with seatbelt wearing among rear passengers in Malaysia. Int J Inj Contr Saf Promot. 2011;18(1):3–10. https://doi.org/10.1080/17457300.2010.487153.
Reagan IJ, McClafferty JA, Berlin SP, Hankey JM. Using naturalistic driving data to identify variables associated with infrequent, occasional, and consistent seat belt use. Accid Anal Prev. 2013;50:600–7. https://doi.org/10.1016/j.aap.2012.06.008.
Martínez-Sánchez JM, Curto A, Fu M, Martínez C, Sureda X, Ballbè M, et al. Safety belt and mobile phone usage in vehicles in Barcelona (Spain). Gac Sanit. 2014;28(4):305–8. https://doi.org/10.1016/j.gaceta.2014.01.002.
Abu-Zidan FM, Abbas AK, Hefny AF, Eid HO, Grivna M. Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study. World J Surg. 2012;36(2):255–9. https://doi.org/10.1007/s00268-011-1386-y.
Afukaar FK, Damsere-Derry J, Ackaah W. Observed seat belt use in Kumasi Metropolis, Ghana. J Prev Interv Community. 2010;38(4):280–9. https://doi.org/10.1080/10852352.2010.509020.
Beck LF, Shults RA. Seat belt use in states and territories with primary and secondary laws–United States, 2006. J Safety Res. 2009;40(6):469–72. https://doi.org/10.1016/j.jsr.2009.09.004.
Briggs NC, Schlundt DG, Levine RS, Goldzweig IA, Stinson N, Warren RC. Seat belt use among Hispanic ethnic subgroups of national origin. Inj Prev. 2006;12(6):421–6. https://doi.org/10.1136/ip.2006.012435.
Sadeghnejad F, Niknami S, Hydarnia A, Montazeri A. Seat-belt use among drivers and front passengers: an observational study from the Islamic Republic of Iran. EMHJ-Eastern Mediterr Health J. 2014;20(8):491–7. https://doi.org/10.26719/2014.20.8.491.
Han G-M, Newmyer A, Qu M. Seat belt use to save face: impact on drivers’ body region and nature of injury in motor vehicle crashes. Traffic Inj Prev. 2015;16(6):605–10. https://doi.org/10.1080/15389588.2014.999856.
Kim S, Depue L, Spence L, Reine J. Analysis of teenage seat belt use: from the 2007 Missouri high school seat belt survey. J Safety Res. 2009;40(4):311–6. https://doi.org/10.1016/j.jsr.2009.07.001.
Kim SM, Ha NH, Hahn HM, Lee IJ, Park MC, Park DH. Analysis of facial injuries in motor vehicle accidents according to the location of the seat and seat-belt use. J Craniofac Surg. 2019;30(7):1949–51. https://doi.org/10.1097/scs.0000000000005568.
Kwak BH, Ro YS, Do Shin S, Song KJ, Kim YJ, Jang DB. Preventive effects of seat belt on clinical outcomes for road traffic injuries. J Korean Med Sci. 2015;30(12):1881–8. https://doi.org/10.3346/jkms.2015.30.12.1881.
Lardelli-Claret P, Espigares-Rodríguez E, Amezcua-Prieto C, Jiménez-Moleón JJ, de Dios Luna-del-Castillo J, Bueno-Cavanillas A. Association of age, sex and seat belt use with the risk of early death in drivers of passenger cars involved in traffic crashes. Int J Epidemiol. 2009;38(4):1128–34. https://doi.org/10.1093/ije/dyp143.
Molnar LJ, Eby DW, Dasgupta K, Yang Y, Nair VN, Pollock SM. Explaining state-to-state differences in seat belt use: a multivariate analysis of cultural variables. Accid Anal Prev. 2012;47:78–86. https://doi.org/10.1016/j.aap.2012.01.006.
Torkamannejad Sabzevari J, Khanjani N, Molaei Tajkooh A, Nabipour AR, Sullman MJ. Seat belt use among car drivers in Iranian safe communities: an observational study. Traffic Inj Prev. 2016;17(2):134–41. https://doi.org/10.1080/15389588.2015.1052138.
Zambon F, Fedeli U, Marchesan M, Schievano E, Ferro A, Spolaore P. Seat belt use among rear passengers: validity of self-reported versus observational measures. BMC Public Health. 2008;8(1):1–6. https://doi.org/10.1186/1471-2458-8-233.
Dulf D, Peek-Asa C, Jurchiș F, Bărăgan E-A. Safety seat and seat belt use among child motor vehicle occupants, Cluj-Napoca, Romania. Injury Prev. 2020;26(1):18–23. https://doi.org/10.1136/injuryprev-2018-042989.
Beck LF, Kresnow MJ, Bergen G. Belief about seat belt use and seat belt wearing behavior among front and rear seat passengers in the United States. J Saf Res. 2019;68:81–8. https://doi.org/10.1016/j.jsr.2018.12.007.
Boakye KF, Shults RA, Everett JD. Nighttime seat belt use among front seat passengers: does the driver’s belt use matter? J Safety Res. 2019;70:13–7. https://doi.org/10.1016/j.jsr.2019.04.004.
Crandon I, Harding H, Branday J, Simeon D, Rhoden A, Carpenter M. The prevalence of seat belt use in Kingston, Jamaica. West Indian Med J. 2006;55(5):327–9.
Fong CK, Keay L, Coxon K, Clarke E, Brown J. Seat belt use and fit among drivers aged 75 years and older in their own vehicles. Traffic Inj Prev. 2016;17(2):142–50. https://doi.org/10.1080/15389588.2015.1052420.
Iribhogbe PE, Osime CO. Compliance with seat belt use in Benin City, Nigeria. Prehospital Disaster Med. 2008;23(1):16–9. https://doi.org/10.1017/s1049023x00005495.
Kamal WNHWA, Masuri MG, Dahlan A, Isa KAM. Seat belt compliance and quality of life among educated young adults in an urban university. Proc Soc Behav Sci. 2015;202:442–7. https://doi.org/10.1016/j.sbspro.2015.08.249.
Febres JD, García-Herrero S, Herrera S, Gutiérrez JM, López-García JR, Mariscal MA. Influence of seat-belt use on the severity of injury in traffic accidents. Eur Transp Res Rev. 2020;12(1):1–12. https://doi.org/10.1186/s12544-020-0401-5.
Ünal E, Atalay BI, Önsüz MF, Işıklı B, Metintaş S. Seat-belt use and related factors among high school students in a semi-rural area of Western Turkey. GMJ. 2020;31:117–21. https://doi.org/10.12996/gmj.2020.33.
Shaaban K. Self-report and observational assessment and investigation of seat belt use among young drivers and passengers: the case of Qatar. Arab J Sci Eng. 2019;44(5):4441–51. https://doi.org/10.1007/s13369-018-3436-3.
Shaaban K, Abdelwarith K. Understanding the association between cell phone use while driving and seat belt noncompliance in Qatar using logit models. J Trans Saf Secur. 2020;12(2):292–308. https://doi.org/10.1080/19439962.2018.1477895.
Siddiqui E, Ejaz K, Waheed S, Kazi GI, Khursheed M. Attitudes towards child restrains and seat belts usage in the learned population of Karachi, Pakistan. World J Emerg Med. 2014;5(3):223. https://doi.org/10.5847/wjem.j.issn.1920-8642.2014.03.012.
Li Q, Peng J, Chen T, Yu Y, Hyder AA. Seatbelt wearing rate in a Chinese city: results from multi-round cross-sectional studies. Accid Anal Prev. 2018;121:279–84. https://doi.org/10.1016/j.aap.2018.09.027.
Kulanthayan S, Law T, Raha A, RADIN UR. Seat belt use among car users in Malaysia. IATSS Res. 2004;28(1):19–25. https://doi.org/10.1016/s0386-1112(14)60088-1.
Lerner EB, Jehle DV, Billittier AJ IV, Moscati RM, Connery CM, Stiller G. The influence of demographic factors on seatbelt use by adults injured in motor vehicle crashes. Accid Anal Prev. 2001;33(5):659–62. https://doi.org/10.1016/s0001-4575(00)00080-4.
StataCorp L. Stata statistical software: release 14. TX: Statacorp lp College Station; 2015. https://doi.org/10.1177/1536867x1501500122.
Vecino-Ortiz AI, Bishai D, Chandran A, Bhalla K, Bachani AM, Gupta S, et al. Seatbelt wearing rates in middle income countries: a cross-country analysis. Accid Anal Prev. 2014;71:115–9. https://doi.org/10.1016/j.aap.2014.04.020.
Yannis G, Laiou A, Vardaki S, Papadimitriou E, Dragomanovits A, Kanellaidis G. Parameters affecting seat belt use in Greece. Int J Inj Contr Saf Promot. 2011;18(3):189–97. https://doi.org/10.1080/17457300.2011.551941.
Chandran A, Hyder AA, Peek-Asa C. The global burden of unintentional injuries and an agenda for progress. Epidemiol Rev. 2010;32(1):110–20. https://doi.org/10.1093/epirev/mxq009.
National Highway Traffic Safety Administration (NHTSA). Seat Belt Safety: Buckle Up America. Available from: https://www.nhtsa.gov/risky-driving/seat-belts.
Jackisch J, Sethi D, Mitis F, Szymañski T, Arra I. 76 European facts and the Global Status Report on road safety 2015. BMJ Publishing Group Ltd; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/326340/9789289051262%20eng.pdf?sequence=1. Accessed 10 Sep 2016.
Hernández JMR, Ruiz KA, Valero CFF. Patrones de uso de cinturón de seguridad vial en dos ciudades de Colombia. Arch Med. 2017;13(2):15.
Sunshine J, Dwyer-Lindgren L, Chen A, Mokdad AH. Seat-belt use in US counties: limited progress toward Healthy People 2020 objectives. Health Aff. 2017;36(4):636–9. https://doi.org/10.1377/hlthaff.2016.1345.
Ghorbanali M. Prevalence of seat belt and mobile phone use and road accident injuries amongst college students in Kerman, Iran. Chin J Traumatol. 2011;14(03):165–9.
Oviedo-Trespalacios O, Scott-Parker B. The sex disparity in risky driving: a survey of Colombian young drivers. Traffic Inj Prev. 2018;19(1):9–17. https://doi.org/10.1080/15389588.2017.1333606.
Eluru N, Bhat CR. A joint econometric analysis of seat belt use and crash-related injury severity. Accid Anal Prev. 2007;39(5):1037–49. https://doi.org/10.1016/j.aap.2007.02.001.
Moradi G, Ardakani HM, Majdzadeh R, Bidarpour F, Mohammad K, Holakouie-Naieni K. Socioeconomic inequalities in nonuse of seatbelts in cars and helmets on motorcycles among people living in Kurdistan Province Iran. Iran J Public Health. 2014;43(9):1239. https://doi.org/10.3961/jpmph.17.035.
Colgan F, Gospel A, Petrie J, Adams J, Heywood P, White M. Does rear seat belt use vary according to socioeconomic status? J Epidemiol Community Health. 2004;58(11):929–30. https://doi.org/10.1136/jech.2003.016972.
Kim K, Yamashita EY. Attitudes of commercial motor vehicle drivers towards safety belts. Accid Anal Prev. 2007;39(6):1097–106. https://doi.org/10.1016/j.aap.2007.02.007.
Chaudhary NK, Tison J, Casanova T. The effects of Maine’s change to primary seat belt law on seat belt use and public perception and awareness. Traffic Inj Prev. 2010;11(2):165–72. https://doi.org/10.1080/15389580903524791.
Masten SV. Do states upgrading to primary enforcement of safety belt laws experience increased daytime and nighttime belt use? Accid Anal Prev. 2007;39(6):1131–9. https://doi.org/10.1016/j.aap.2007.02.010.
Ipingbemi O. The rate of compliance to seat belt usage among automobile drivers on three categories of roads in Nigeria: an observational survey. Int J Inj Contr Saf Promot. 2012;19(1):3–8. https://doi.org/10.1080/17457300.2011.575472.
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Kargar, S., Ansari-Moghaddam, A. & Ansari, H. The prevalence of seat belt use among drivers and passengers: a systematic review and meta-analysis. J. Egypt. Public. Health. Assoc. 98, 14 (2023). https://doi.org/10.1186/s42506-023-00139-3