title: Seatbelt use, attitudes, and changes in legislation: an international study.
abstract: BACKGROUND
  The use of seat belts is among the most effective methods of reducing injury in motor vehicle crashes. We examined trends in seat belt use by university students from 13 European countries between 1990 and 2000, in relation to changes in legislation, attitudes, and hazardous driver behaviors.
  
  
  METHODS
  Data were collected via an anonymous standardized questionnaire from university students in Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, the Netherlands, Poland, Portugal, and Spain. There were 10,576 respondents in 1990, and 10,294 in 2000. Data were also collected from 1672 students in the United States in 2000. Analyses were performed in early 2002.
  
  
  RESULTS
  Reported seat belt use increased from 63% to 73% in male students, and from 66% to 77% in female students over the decade. There were marked increases in seat belt use in countries with changes in legislation or enforcement from 1990 to 2000, with 24% to 64% more respondents reporting seat belt use in 2000. The prevalence of use and noted changes during this period correlated with findings from national surveys (r= 0.91). Attitudes to seat belt use were associated with behavior both within and between countries. Nonuse of seat belts was positively related to alcohol-impaired driving and failure to obey speed limits.
  
  
  CONCLUSIONS
  Legislation has a substantial impact on the use of vehicle seat belts, but additional gains require efforts to change attitudes within the university student population.
authors.affiliation: Department of Epidemiology and Public Health, University College, London, United Kingdom. a.steptoe@ucl.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.forename: Ray
authors.initials: R
authors.lastname: Fuller
authors.forename: Sigurlina
authors.initials: S
authors.lastname: Davidsdottir
authors.forename: Bettina
authors.initials: B
authors.lastname: Davou
authors.forename: Joao
authors.initials: J
authors.lastname: Justo
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D001294:Attitude to Health; D005060:Europe / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012622:Seat Belts / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D014495:Universities