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Effectiveness in Disease and Injury Prevention Safety-Belt Use Among Drivers Involved in Alcohol-Related Fatal Motor-Vehicle Crashes --- United States, 1982 - 1989
Since the early 1980s, safety-belt use by motor-vehicle drivers in the United States has increased substantially from approximately 11% in 1982 to 49% in 1990 (1). From 1983 through 1989, the use of safety belts saved an estimated 20,086 lives and prevented approximately 523,100 moderate to critical injuries (2). Despite these benefits, a large proportion of drivers continues to drive without using safety belts, including many persons who drive after drinking alcoholic beverages (3--6). In addition, drivers who are unrestrained by safety belts are more likely to be involved in crashes (7) and to commit traffic violations (3,7). This report summarizes data from the National Highway Traffic Safety Administration's (NHTSA) Fatal Accident Reporting System on trends in safety-belt use among drivers involved in alcohol-related fatal crashes in the United States from 1982 through 1989. In addition, a quarterly table (page 414 of this issue) presents data on alcohol involvement in fatal motor-vehicle crashes in the United States for April--June 1990.
NHTSA defines a fatal traffic crash to be alcohol-related if either a driver or nonoccupant (e.g., a pedestrian) had a blood alcohol concentration (BAC) greater than or equal to 0.01 g/dL in a police-reported traffic crash. NHTSA defines a BAC greater than or equal to 0.01 g/dL but less than 0.10 g/dL as a low level of alcohol and a BAC greater than or equal to 0.10 g/dL (the legal level of intoxication in most states) as indicating intoxication. Because BAC levels are not available for all persons involved in fatal crashes, NHTSA estimates the number of alcohol-related traffic fatalities based on a discriminant analysis of information from all cases for which driver or nonoccupant BAC data are available (8). In this report, ``drinking driver'' refers to drivers with a BAC greater than or equal to 0.01 g/dL, and ``unrestrained'' refers to drivers not using safety belts. Data on drivers refer only to drivers involved in fatal crashes.
From 1982 through 1989, safety-belt use increased from 6.3% to 53.6% among nondrinking drivers involved in fatal crashes; in contrast, among drinking drivers involved in fatal crashes, safety-belt use increased from 2.0% to 19.6% (Table 1). During this same period, the proportion of unrestrained, nondrinking drivers involved in fatal crashes decreased 50%, while the proportion of unrestrained, drinking drivers involved in fatal crashes decreased 18%. For each year from 1982 through 1989, safety-belt use among drinking drivers involved in fatal crashes was less than that of nondrinking drivers.
Because driving after drinking and failure to use a safety belt are risk-taking behaviors, the proportion of unrestrained drivers among nondrinking and drinking drivers involved in fatal crashes was examined before and after 1984, when state legislatures began to enact laws regarding mandatory safety-belt use. From 1982 through 1984, the proportion of unrestrained, nondrinking drivers in fatal crashes decreased 4%, and the proportion of unrestrained, drinking drivers decreased 1%. However, from 1984 through 1989, the proportion of unrestrained, nondrinking drivers in fatal crashes decreased 48%; in comparison, the proportion of drinking drivers who were unrestrained decreased 17%. By 1989, when 33 states had mandatory safety-belt use laws, 80% of drinking drivers in fatal crashes were unrestrained, compared with 46% of nondrinking drivers (Table 1). Reported by: ME Vegega, PhD, Office of Alcohol and State Programs, Traffic Safety Programs; TM Klein, National Center for Statistics and Analysis, Research and Development, National Highway Traffic Safety Administration. Unintentional Injury Section, Epidemiology Br, Div of Injury Control, Center for Environmental Health and Injury Control, CDC.
Although the percentage of unrestrained drivers in both alcohol- and nonalcohol-related fatal crashes decreased from 1982 through 1989, the decreases were greater following passage of mandatory safety-belt use laws. Persons involved in fatal crashes may not be representative of the general driving population; however, data from observational surveys and data reported to CDC's Behavioral Risk Factor Surveillance System also indicate an overall increase in the percentage of drivers who use safety belts (6). The high proportion of unrestrained drivers in fatal alcohol-related crashes suggests an association between drinking and driving, and other risk-taking behaviors.
The findings in this report suggest that drinking drivers are less likely to use safety belts; however, two considerations affect this interpretation. First, data regarding use of safety belts are not available for approximately 25% of all drivers; however, until 1989, the proportions of both drinking and nondrinking drivers for whom data were missing were consistent (Table 2). Second, in states with mandatory safety-belt use laws, police reports regarding safety-belt use in crashes may be biased (7). Previous studies indicate that estimates of safety-belt use based on self-reporting exceed those based on observation (4,7,9). Because the data presented here reflect police-reported safety-belt use based on information provided by drivers involved in fatal crashes or by witnesses, the levels of safety-belt use among drivers involved may be over reported.
Despite the potential limitations, the findings in this report indicate that among drivers involved in fatal crashes, the proportion using safety belts has increased. Factors associated with this increase include enactment of mandatory safety-belt use laws. By March 1991, mandatory use laws had been enacted in 38 states, the District of Columbia, and Puerto Rico.
Increases in safety-belt use were more rapid in the early years following passage of mandatory use laws; however, increases have not been as rapid in recent years (Table 1). From 1984 through 1987, overall safety-belt use increased by approximately 28 percentage points, compared with an increase of 7 percentage points for 1987--1990 (1). In addition, in states with primary enforcement laws (i.e., police are authorized to stop and cite a driver solely for nonuse of a safety belt), average safety-belt use rates are higher than those in states with secondary enforcement laws (i.e., police must observe a different violation before they can issue a citation for nonuse of safety belts) (10).
To increase safety-belt use and meet a Presidential goal of 70% safety-belt use among all motorists by 1992 (11), NHTSA is conducting a national campaign with three major components: 1) increased public information about the benefits of using safety belts and the importance of related law enforcement efforts; 2) increased enforcement of state safety-belt use and child-passenger safety laws, particularly at the local level; and 3) establishment of a national coalition of corporations and organizations in the private sector that supports increased use of safety belts and enforcement of laws regarding use of belts. This campaign is intended to increase public information and enforcement efforts in all states with mandatory use laws, particularly during the summer months and holidays (e.g., Memorial Day, Independence Day, and Labor Day).
For the Independence Day holiday, safety-belt and child safety-seat laws will be intensively enforced from June 30 through July 13. NHTSA will use its 19-City Index of Occupant Protection Trends as one method to assess this and other aspects of the national campaign. In addition, local jurisdictions are encouraged to conduct assessments of this enforcement campaign. Information on NHTSA's ``National 70% x '92 Safety Belt Program'' is available from Dr. James Nichols, Director, Office of Occupant Protection (NTS-10), NHTSA, 400 Seventh Street, S.W., Washington, DC 20590; telephone (202) 366-9294.
2. National Highway Traffic Safety Administration. Occupant protection facts. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1990.
3. Wilson RJ. The relationship of seat belt non-use to personality, lifestyle and driving record. Health Education Research 1990;5:175--85.
4. Wagenaar AC, Streff FM, Molnar LJ, Businski KL, Schultz RH. Factors related to non-use of seat belts in Michigan. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1987; report no. DOT-HS-807-217.
5. Waller PF, Stewart JR, Hansen AR, Stutts JC, Popkin CL, Rodgman EA. The potentiating effects of alcohol on driver injury. JAMA 1986;256:1461--6.
6. Bradstock MK, Marks JS, Forman MR, et al. Drinking-driving and health lifestyle in the United States: Behavioral Risk Factors Surveys. J Stud Alcohol 1987;48:147--52.
7. Hunter WW, Stutts JC, Stewart JR, Rodgman EA. Characteristics of seat belt users and non-users in a state with a mandatory belt use law. Health Education Research 1990;5:161--73.
8. Klein TM. A method for estimating posterior BAC distributions for persons involved in fatal traffic accidents: final report. Washington, DC: National Highway Traffic Safety Administration, 1986; report no. DOT-HS-807-094.
9. Chorba TL, Reinfurt D, Hulka BS. Efficacy of mandatory seat-belt use legislation: the North Carolina experience from 1983 through 1987. JAMA 1988;260:3593--7. 10. National Highway Traffic Safety Administration. Observed safety belt use statistics by state. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1990. 11. National Highway Traffic Safety Administration. Highway safety: priority plan---moving America into the 21st century. Washington, DC: US Department of Transportation, National Higway Traffic Safety Administration, 1990.
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