title: Seatbelt wearing rates in middle income countries: a cross-country analysis.
abstract: In settings with low seatbelt use prevalence, self-reported seatbelt use estimates often lack validity, and routine observational studies are scarce. In this paper, we aim to describe the prevalence of seatbelt use and associated factors in drivers and front-seat passengers across eight sites in four countries (Egypt, Mexico, Russia, Turkey) using observational studies as well as to produce estimates of country-level and site-level variance. As part of the Bloomberg Philanthropies Global Road Safety Program, data on driver and passenger seatbelt use across four middle-income countries was collected between October 2010 and May 2011 (n=122,931 vehicles). Logistic regression and Intraclass Correlation Coefficient analyses for sites- and country-level clustering were performed. We found high variability of seatbelt wearing rates ranging from 4 to 72% in drivers and 3-50% in front-seat passengers. Overall, average seatbelt wearing rates were low (under 60% in most sites). At the individual level, older and female drivers were more likely to wear seatbelts, as well as drivers of vehicles transiting at times of increased vehicle flow. We also found that 26-32% and 37-41% of the variance in seatbelt use among drivers and front-seat passengers respectively was explained by differences across sites and countries. Our results demonstrate that there is room for improvement on seatbelt use in middle-income countries and that standardized cross-country studies on road safety risk factors are feasible, providing valuable information for prevention and monitoring activities.
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Andres I
authors.initials: AI
authors.lastname: Vecino-Ortiz
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Aruna
authors.initials: A
authors.lastname: Chandran
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Kavi
authors.initials: K
authors.lastname: Bhalla
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Abdulgafoor M
authors.initials: AM
authors.lastname: Bachani
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Shivam
authors.initials: S
authors.lastname: Gupta
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Slyunkina
authors.affiliation: International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. Electronic address: ahyder1@jhu.edu.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000328:Adult; D000367:Age Factors; D001334:Automobile Driving / Q000706:statistics & numerical data*; D004534:Egypt; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D008800:Mexico; D008875:Middle Aged; D012426:Russia; D012622:Seat Belts / Q000706:statistics & numerical data*; D012737:Sex Factors; D014421:Turkey
keywords: Injuries; Middle income countries; Road safety; Seat belts; Traffic accidents