title: A comparison of self-reported seat belt usage among the Appalachian and non-Appalachian United States.
abstract: OBJECTIVE
  Seat belts are known to effectively prevent death and serious injury among motorists involved in vehicular collisions. Limited research exists regarding seat belt usage in Appalachia. This study compares self-reported seat belt use in the Appalachian and non-Appalachian counties of the United States.
  
  
  METHODS
  Data from 2012 Behavioral Risk Factor Surveillance System were used to calculate nationally representative estimates of consistent seat belt usage in each region. These estimates were stratified by age, sex, and rurality. Total and potential lives saved by seat belts were calculated for each region using 2012 Fatality Analysis Reporting System data.
  
  
  RESULTS
  Of the 345,513 respondents (unweighted), Appalachians were 6% less likely than non-Appalachians to always wear a seat belt (relative risk = 0.94, 95% confidence interval, 0.93-0.95). Seat belt usage was consistently lower among Appalachians regardless of sex, age, or rurality. Only 68.1% of rural, Appalachian youth reported always wearing a seat belt. Seat belt usage was highest among non-Appalachian females residing in urban areas (92.5%). With 100% belt compliance, an additional 360 and 1712 potential lives could have been saved in Appalachia and non-Appalachia, respectively.
  
  
  CONCLUSIONS
  Regional differences possibly influence seat belt usage. Therefore, public health interventions to increase seat belt usage in Appalachia are likely warranted.
authors.affiliation: Department of Epidemiology, West Virginia University, Morgantown.
authors.forename: Hellina
authors.initials: H
authors.lastname: Birru
authors.affiliation: Injury Control Research Center, West Virginia University, Morgantown.
authors.forename: Toni M
authors.initials: TM
authors.lastname: Rudisill
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: Department of Epidemiology, West Virginia University, Morgantown; Injury Control Research Center, West Virginia University, Morgantown. Electronic address: mozhu@hsc.wvu.edu.
authors.forename: Motao
authors.initials: M
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region; D040343:Behavioral Risk Factor Surveillance System; D003617:Dangerous Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012622:Seat Belts / Q000706:statistics & numerical data*; D057566:Self Report; D014505:Urban Population; D055815:Young Adult
keywords: Appalachian region; Motor vehicles; Rural population; Seat belts; Traffic accidents