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Driver Safety-Belt Use -- Budapest, Hungary, 1993

An estimated 300,000 persons die and 10-15 million persons are injured each year in traffic crashes throughout the world (1). Safety-belt use is one of the most effective means of reducing the number and severity of injuries in motor-vehicle crashes (2). In Hungary, front-seat occupants of all motor vehicles have been required to use safety belts since 1976. Since March 1993, rear-seat passengers have been required to wear safety belts in nonurban areas. Drivers in violation of the law are subject to fines and potential suspension of driving privileges. To evaluate driver compliance with the safety-belt use law, on May 10, 1993, CDC conducted an observational prevalence survey of safety-belt use in Budapest in conjunction with the U.S. Department of State and the American International School of Budapest; this survey was performed in collaboration with the Hungarian Ministry of Transport, Communication, and Water Management and the Budapest Police Department. This report presents findings of the study.

Driver lap/shoulder safety-belt use was observed at seven moderate- to high-volume traffic sites in Budapest (1993 estimated population: 2,009,000). Sites were selected to reduce repetitive counting of observed vehicles. Pairs of pretrained high school students from the American International School collected information between 4:30 p.m. and 6 p.m. by observing vehicles at intersections convenient and safe for the students and by using a standardized form to record driver's safety-belt use, sex, and the type of vehicle (Eastern European or non-Eastern European {i.e., any cars not manufactured in the former Warsaw Pact countries}). Drivers of taxis (who are not required to wear safety belts) were included; drivers of buses, trucks, farm machinery, and motorcycles were excluded. Data differentiating taxis from other vehicles were not systematically recorded.

A total of 4894 eligible vehicles were included in the survey. Of the drivers, 3850 (79%) were male. The overall belt-use rate was 61%; however, the percentage of drivers using safety belts varied by observation site (range: 58%-65%). The prevalence of safety-belt use was higher among female (64%) than male (60%) drivers (prevalence ratio {PR}=1.03; 95% confidence interval {CI}=1.00- 1.06). Fifty percent of the vehicles were non-Eastern European models; drivers of Eastern European vehicles were more likely to use safety belts than drivers of non-Eastern European vehicles (65% versus 57%) (PR=1.2; 95% CI=1.1-1.3). Safety-belt use was higher among both female and male drivers of Eastern European vehicles (68% {95% CI=64%-72%} and 64% {95% CI=62%-66%}, respectively) than among female and male drivers of non-Eastern European vehicles (59% {95% CI=55%-63%} and 56% {95% CI=54%-58%}, respectively). Reported by: LE Cohen, Environment, Science, and Technology Attache, MD Laude, Fascell Fellow, US Embassy, Dept of State, Budapest; G Csaszar, Div of Roads and Road Transport, Ministry of Transport, Communication, and Water Management; E Komaromi, Dept of Prevention, Budapest Police Dept; FL Wassersug, Student Services, American International School of Budapest. Air Pollution and Respiratory Health Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: Safety-belt use legislation, first introduced in Australia in 1970, is the most effective means of increasing safety-belt use in many countries (3). At least 35 countries require safety-belt use (4). In the United States, safety-belt use is mandatory in 44 states. The only U.S. jurisdictions that have enacted legislation similar to that in Hungary -- allowing primary enforcement of safety-belt use in all seating positions -- are Oregon, California, American Samoa, and the Mariana Islands. When compared with secondary enforcement laws, implementation of primary enforcement laws appears to result in greater and more rapid and sustained increases in safety-belt use (5).

Observations in this study indicate that by May 1993, the prevalence of safety-belt use by drivers had increased from that documented by the Ministry of Transport, Communication, and Water Management in October 1992 (6). In that study, 31% of front-seat occupants (both drivers and passengers) were belted (6); however, only 40% of cars had a front-seat passenger. Although recent changes in the safety-belt use law in Hungary have targeted persons in rear-seat positions, increased use of safety belts among drivers may reflect three factors: 1) recent increases in fines, 2) stricter police enforcement of the law since April 1, 1993, and 3) increased public awareness generated by the media, which during April 1993 routinely broadcast information about the changes in the law.

The findings in this report are subject to at least three limitations. First, because many Eastern European vehicles have nonretractable lap/shoulder belts, some drivers of these vehicles may have been categorized as belted when they may have placed the belts across their shoulders and laps without buckling them. Second, this survey also included taxi drivers, who are not required to wear safety belts, and data differentiating taxis from other vehicles were not systematically gathered. Therefore, the percentage of drivers subject to the law who were in compliance was greater than 61%. Third, other potential sources of bias in the interpretation of the data from this study include lack of random selection of observation sites, restriction of observations to the commuting hour on a single day, and the highly urbanized environment in which the observations were made.

In Hungary, traffic crashes were the second leading cause of violent deaths (after suicide) in 1992, resulting in 2346 deaths (7). Although the number of deaths that could have been prevented by safety-belt use has not been determined, the crude mortality rate for motor-vehicle crashes decreased 9% in the month after the safety-belt use law was expanded (Ministry of Transport, Communication, and Water Management, unpublished data, 1993). To increase safety-belt use, law enforcement officials in Budapest plan to widely disseminate the results of this study on television and are considering a campaign of expanded and long-term enforcement of the safety-belt law, with initial emphasis on low safety-belt use locations identified by this study.


  1. Ross A, Baguley C, Hills B, McDonald M, Silcock D. Towards safer roads in developing countries: a guide for planners and engineers. Crowthorne, England: Transport and Road Research Laboratory, 1991.

  2. Chorba TL. Assessing technology for preventing injuries in motor vehicle crashes. Int J Technol Assess Health Care 1991;7:296-314.

  3. Vaaje T. Safety belt usage laws in various countries. In: Effectiveness of safety belt use laws: a multinational examination. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1986:13-23; publication no. DOT-HS-807-018.

  4. El-Nour S, Mufti MH. Seat belt legislation and the experience of the world. Journal of Traffic Medicine 1992;20:83-90.

  5. Escobedo LG, Chorba TL, Remington PL, Anda RF, Sanderson L, Zaidi AA. The influence of safety belt laws on self-reported safety belt use in the United States. Accid Anal Prev 1992;24:643-53.

  6. Kozlekedesi Hirkozlesi es Vizđgyi Miniszterium {Ministry of Transport, Communication, and Water Management}. Szemelygepkocsik biztonsagi oveinek viselesi aranyai {Frequency of safety belt use in passenger cars}. Budapest: Technischer Uberwachungs Verein Hannover Kft., 1992.

  7. Kozponti Statisztikai Hivatal {Central Statistical Office}. Kozlekedesi balesetek {Transport accidents}. Budapest: Agria Kiado Kft., 1991.

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