"There were marked increases in [reported] seat belt use in countries with changes in legislation or enforcement from 1990 to 2000, with [up to] 64 percent more respondents reporting seat belt use in 2000," according to lead author Andrew Steptoe, D.Phil., of University College London (UCL), UK.
In addition, Steptoe notes, the researchers "found a strong correlation ... across countries between changes in reported behavior and changes in belief ratings over the decade," with increased seat belt use strongly linked to more positive attitudes toward safety equipment.
This evidence of a shift toward healthier behaviors and attitudes, the investigators explain, is particularly noteworthy because it comes from a vulnerable population. Previous studies have found that motor vehicle crashes are the leading cause of death in men and women in the student age group, and that seat belt use is one of the most effective methods of reducing fatal and nonfatal injuries in such crashes.
"It seems probable that more positive attitudes emerged once the behavior was established through legislative change, and its benefits were found to outweigh barriers," such as the perceived inconvenience of using a seat belt, Steptoe observes.
Steptoe and his colleagues evaluated seat belt data collected in two major European studies of health and behavior among university students aged 17 to 30. Their analysis, which was limited to the 13 countries covered by both surveys, compared responses to self-completed, anonymous questionnaires on frequency and perceived importance of seat belt use obtained from 10,376 students in 1990 and 10,294 students in 2000.
The researchers' findings appear in the October issue of the American Journal of Preventive Medicine.
Between the two surveys, new laws requiring seat belt use by front-seat passengers were enacted in three countries. The result, according to Steptoe, was "striking increases in seat belt use." Rates of use went from 56 percent to 80 percent in Spain, from 25 percent to 76 percent in Poland and from 30 percent to 94 percent in Portugal.
The most dramatic change was seen in Portugal, which went "from being among the lowest reported users of seat belts in 1990" to "higher than all 12 other countries" in 2000, Steptoe reports.
During the same period, significant increases in enforcement of seat belt laws -- involving more stringent surveillance and higher fines -- were linked to increases in seat belt use ranging from 7 percent to 32 percent in Greece, Hungary and Ireland.
In contrast, the researchers found only minor fluctuations in seat belt use in all but one country where seat belt legislation and enforcement remained unchanged. In many of these countries the current rate of seat belt use is well below national safety goals, Steptoe notes, as it is in the United States.
"The results of this survey endorse the effectiveness of legislation in stimulating greater seat belt use," Steptoe concludes. However, "important though legislation is, it is clearly not sufficient to maximize seat belt use," he adds.
The researchers' observation that nonusers tend to be skeptical about the benefits of seat belts may provide insight into how to increase use even where legislation and enforcement are already strong. According to Steptoe, it "suggest[s] that efforts to modify attitudes may be central to further increases in seat belt use by drivers and passengers."
The study was supported by the Economic and Social Research Council of the United Kingdom.
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