Abstract
Objective: Despite the importance of understanding seat belt use patterns among drivers and passengers for the purpose of direct interventions or monitoring improvements, no study has described wearing rates for all seat positions in Russia. This study describes observed seat belt use and knowledge, attitudes, and perceptions of seat belt use in Lipetskaya Oblast, Russia.
Methods: An observational study on the use of seat belts and child restraints in the Lipetskaya region conducted during October 2010 collected data in 6 districts and on 3 different road types. A roadside survey gathered information on knowledge, attitudes, and perceptions toward the use of seat belts from randomly selected drivers. Frequencies of seat belt use by seat position, gender, and road type were calculated. A multivariable logit model disclosed the associations between seat belt use and sociodemographic factors. The study design permitted comparison of observed seat belt use to self-reported seat belt use.
Results: A total of 25,795 vehicles and 39,833 drivers and passengers contributed observations. Overall, 55 percent of drivers were observed to be using seat belts. More than half (58%) of front seat passengers wore seat belts and only 9 percent of back seat passengers were observed to be wearing seat belts; 11 percent of cars with children had any type of child safety measure. Drivers on urban roads were less likely to wear seat belts compared to those on main highways and rural roads. Nearly 60 percent of survey respondents mentioned “seat belts save lives,” and more than half mentioned law requirements and fines.
Conclusions: Although the observed seat belt use in Lipetskaya Oblast is much higher than previous estimates in Russia, overall wearing rates remain far from universal. Rear seat passengers and children are particularly at risk. Because combined education and enforcement has proven to be effective elsewhere, such interventions are needed to improve seat belt use.
INTRODUCTION
Russia has experienced a rapid increase in motorization. The total number of motor vehicles has more than doubled in Russia between 1991 and 2004, with vehicles per capita growing at an average of 25 percent per year. Rapid motorization has contributed to Russia's high mortality from road traffic injuries (RTIs). According to the Department of Road Safety within the Ministry of Interior (GIBDD), there were 26,081 road traffic deaths and 257,062 RTIs in the Russian Federation in 2009, representing a rate of 18.4/100,000 and 181/100,000 population, respectively, for road deaths and RTIs (GIBDD 2010). Road traffic crashes account for more than 20 percent of years of life lost due to disability and death (Glassbrenner et al. Citation2004). In 2008, the cost of RTIs in the Russian Federation was the equivalent of 2.5 percent of the Russian GDP. According to the European Conference of Ministers of Transportation (ECMT) review, deaths among the economically active age groups, those between 15 and 44 years, make up more than half of all road traffic deaths.
Figure 1a Map of Russia and Lipetskaya Oblast.
The use of seat belts has been shown to be an important means of reducing the risk of death or serious injury in a crash by almost 50 percent for both drivers and front seat passengers and about 25 percent for rear seat passengers (Elvik and Vaa Citation2004; International Research Council on Biomechanics of Injury [IRCOBI] 1986). Developed countries that have introduced legislation on seat belt use since the 1970s now enjoy relatively high seat belt use rates: as high as 95 percent for front seat occupants and 90 percent for rear seat occupants in Australia, 93 and 83 percent respectively in the UK (Milne Citation1979), and 79 percent for all occupants in the United States (Glassbrenner et al. Citation2004). Seat belt wearing rates in low- and middle-income countries (LMICs) are lower, as low at 0 and 1 percent in Cambodia and Chad, respectively. There are exceptions, such as such as Rwanda, which has reached an 80 percent seat belt wearing rate; Brazil, China, Croatia, Argentina, and South Africa have seat belt wearing rates between 45 and 60 percent; and Malaysia, Poland, Romania, and Indonesia have rates between 70 and 85 percent (Routley et al. Citation2007; World Health Organization [WHO] 2009). Many countries, particularly LMICs, do not report seat belt utilization data.
In Russia, the high RTI rate has been attributed in part to low rates of seat belt use. The estimates of overall seat belt use in the Russian Federation vary widely from as low as 15 to 33 percent (Akhmadeeva et al. Citation2008). In 1993, Russian Federation Government Decree #1090 23.10.1993 approved “Road traffic rules in Russian Federation,” which stated: “All drivers and passengers must fasten the seat-belts. It is obligatory for drivers, for occupants in front seats and in rear seats … child passengers less than 12 years old are to be transported in special seats attached in rear seats of vehicles” (WHO Citation2009, p. 176). As of January 1, 2008, the federal government mandated a 5-fold increase in fines for not using seat belts, from 100 to 500 Russian rubles (about US$4 to $18) (Citation110KM), and enforcement of seat belt legislation also recommended. Between 2006 and 2008 the number of reported offenses nearly doubled from 1,300,000 to 2,300,000 (European Conference of Ministers of Transport). According to the Ministry of Internal Affairs’ report, surveys indicated an increase in self-reported seat belt use from 33 percent in 2007 to 60 percent in 2009 nationwide (Zelinsky Citation2009).
The Russian federal government has implemented the Federal Targeted Program for Ensuring Road Traffic Safety 2006–2012. The goal of this program is to decrease the number of road traffic deaths by one third from 2004 rates through better legislation and enforcement. The program strengthened regulations on drink driving and elevated seat belt violation fines. Regulation was accompanied by campaigns to inform the public about safer driving. Although the Russian Motor Vehicle Department claims lower rates of road traffic crashes due to the Federal Target Program (Department of Road Safety Ministry of the Interior 2010), there has been no study published in English to rigorously examine the impact of the national policy change. At the local level, one study described a program comprising tougher laws, enhanced law enforcement, education, and mass media campaigns on Sakhalin Island and reported that seat belt use rates increased to an average of 80 percent (Zelinsky Citation2009).
Figure 1b Observation sites in Lipetskaya Oblast (color figure available online).
This article will add to what is known about seat belt use in Russia by establishing seat belt wearing rates for all seat positions in one city in Russia. We chose to study the population of Lipetskaya Oblast in consultation with local partners in the Road Safety in 10 Countries (RS-10) consortium sponsored by Bloomberg Philanthropies. Lipetskaya Oblast is located approximately 500 km southeast of Moscow and is comprised of 18 districts within 24,100 km2 (). The population of Lipetskaya Oblast is 1,213,499, of which 64 percent of citizens live in urban areas and 36 percent live in rural areas (Europea Publications 2010). In Lipetskaya Oblast, the rate of road traffic fatalities is slighter higher than in the Russian Federation, at 22.8/100,000 population, representing 266 deaths and 2959 RTIs in 2009 (GIBDD 2010). This article documents observed seat belt use and knowledge, attitudes, and perceptions of seat belt use.
METHODS
We conducted an observational study on the use of seat belts and child restraints in Lipetskaya Oblast during October 2010. The study was held in 6 districts of Lipetskaya Oblast shown in : Lipetsk, Yelets, Gryazi, Dankov, Usman, and Chaplygin. The observation was carried out in 3 sites in each district, for a total of 18 sites. The sites used for the observations were selected to ensure diversity of traffic and roads. For each of the 6 districts within Lipetskaya, the following site selection process was used: site 1, paved city road (urban); site 2, main highway; and site 3, village road (rural). The observation was carried out for 7 days simultaneously in 6 districts for 1.5 h in each site by a group of 4 observers with 2 people on each side of the road: one data collector randomly selected cars and counted the number of vehicles and people wearing seat belts and the other recorded them in the notebook. The study involved 48 observers who covered the 6 sites over the course of 7 days. The points of observation were situated close to intersections and roundabouts where drivers must slow down or stop. This provided more time for the data collectors to make the observations.
In addition to the observational study of seat belt use, a survey on knowledge, attitudes, and practices was implemented. The roadside survey instrument consisted of 32 questions aimed at measuring the knowledge and attitudes of drivers in Lipetskaya Oblast toward seat belt use. The survey also solicited self-reported seat belt wearing rates from the drivers. Trained interviewers from the Lipetsk State University conducted the interviews in collaboration with the local police, who assisted in randomly stopping traffic. Police stopped vehicles, told drivers about the survey, and then redirected them to the data collectors. The interviewers then explained the project to the drivers, obtained oral consent, and offered them the choice of not participating or not answering any particular questions. Each survey took on average 15 min per vehicle. There are 6 major highways going out of Lipetsk City, all of which were surveyed. One site per highway, in total 6 sites, was recommended by the road police because they were considered safe and could accommodate several vehicles at the same time. The survey sites cover 5 out of the 6 districts where the observations were conducted. This allowed coverage of a wide variety of the population from all of Lipetskaya Oblast. In order for the survey study to be as representative as possible, it was conducted at varying times of the day over the course of the study week.
Table I Observational seat belt use from Lipetskaya Oblast, Russia
Table II Seat belt use observations, by site, road types, and passengers in Russia
The survey was developed in Microsoft Access (Microsoft, Seattle, WA) and EpiInfo (CDC, Atlanta, GA). Local collaborators from Russia entered data in Microsoft Excel. Both the observational study and roadside surveys were approved by both the Institutional Review Board (IRB) at Johns Hopkins School of Public Health and by Department of Public Health of Lipetskaya Oblast. For data analysis, both Microsoft Excel (Microsoft, Seattle, WA) and Stata 11 (StataCorp, TX) were utilized. We calculated the frequencies for each of the survey questions and then used a multivariable logit model to analyze the survey results in order to examine whether or not demographic factors (i.e., age groups, gender, and education levels [less than college vs. college and beyond]) were associated with seat belt use.
RESULTS
Seat Belt Use Observations
Observations were made of 26,961 vehicles for seat belt use across 18 sites in 6 towns in Lipetskaya Oblast, among which 1166 vehicles (4.5%) did not have complete records and thus were excluded from further analysis. Therefore, the analytical sample was 25,795 vehicles and a total of 39,833 drivers and passengers. The mean number of people per vehicle was 1.6 persons with a maximum of 6 individuals observed per vehicle. There were a total of 14,038 passengers observed: 10,855 (77%) were front seat passengers and 3183 (33%) were rear seat passengers. Only slightly more than half of drivers were observed to be using seat belts (55%; ). Seat belt use was slightly lower among passengers, with 47 percent (n = 6561) wearing seat belts. Though more than half (58%) of front seat passengers wore seat belts, only 9 percent of back seat passengers were observed to be wearing seat belts. The use of child safety devices was very low. Only 11.3 percent (n = 66) of cars with children had any type of child safety measure, such as a child booster seat, strapped carrycot, or rear-facing seat. Among 25,795 drivers, 89 percent were male and 11 percent were female; 54 percent of male drivers were wearing seat belts, and 70 percent of female drivers were wearing seat belts. Among passengers, 41 percent were male and 59 percent were female; 41 percent of male passengers and 50 percent of female passengers were wearing seat belts. summarizes the seat belt use by road types in each district. Overall, drivers on the urban roads typically had lower seat belt wearing rates than those on main highways and rural roads.
Roadside Surveys
A total of 600 surveys were successfully carried out to assess prevailing knowledge, attitudes, and perceptions around seat belt use and driving while drunk. The response rate was 90 percent. presents the basic demographic characteristics of the respondents. The age of respondents ranged from 18 to 72 years, with a mean age of 38.6 years. The majority (91%) of respondents were males. The drivers interviewed had an average of 14.2 years of driving experience, with a minimum of one year or less and a maximum of 51 years. The majority of respondents had either high school or college degrees (50.8% and 38.7%, respectively).
Table III Demographic information from roadside survey in Lipetskaya Oblast, Russia
Overall, 79 percent (n = 474) of respondents reported that they always use seat belts. Direct observation of seat belt use by research staff closely corroborated the responses to the survey, with 78 percent (n = 468) of respondents observed to be wearing a seat belt at the time of the interview. The primary reason cited for using seat belts appears to be the knowledge that seat belts are lifesaving by lessening the impact of a crash (58%). Thirty-seven percent indicated that the use of a seat belt was required by law, and 20 percent stated that the reason they were using seat belts was because they expected to be fined if stopped.
Among those who reported not always wearing a seat belt, discomfort was the most frequently cited reason (42%), and 20 percent of respondents indicated that their use of a seat belt depended on where they were driving. We found that 12 percent of respondents indicated that they forgot to wear seat belts, and 11 percent feared that seat belts could trap them. Fines were the most frequently named penalties (among warning, citations, or fines) for not using seat belts, with 333 (56%) respondents reporting fines as one of the penalties. The size of the fine reported by drivers ranged from 50 to 1000 rubles (about US$2 to $35) with a mean of 501 rubles (about US$18), and 27.8 percent of respondents reported they had been stopped in the 3 months prior to the survey. When questioned about the likelihood of being caught by the police for not wearing seat belts, 16 percent thought it was certain that they would be caught and 20 percent of the respondents indicated that they thought it was very likely that they would be caught not wearing seat belts. More than half of the respondents indicated that it was very unlikely or somewhat likely that they would be caught if they did not wear seat belts.
One hundred sixty-four cars had children inside, and 33 percent of those drivers said they owned a car seat, and the remaining 67 percent did not own car seats. Only 44 out of 164 respondents said that they always used child car seats. The mostly frequently mentioned reasons as to why they did not always use car seats included “child does not like to sit in it” (29%) and “it is unnecessary” (20%).
Finally, we conducted a multivariate logit model analysis to examine the associations between seat belt use and sociodemographic factors (). Gender was not significantly related to seat belt use. Compared to those aged 30 and younger, those aged 51 and above were slightly more likely to use a seat belt (odds ratio [OR] = 1.78, P < .1). Surprisingly, having a college degree or higher education was found to have a significant negative association with seat belt use (OR = 0.66, P = .05).
Table IV Result of multivariable logit analysis of seat belt use in Lipetskaya Oblast, Russia
DISCUSSION
To the best of our knowledge, this is the first study published in English that describes the patterns of seat belt use and attitudes among drivers and passengers toward seat belt use within Russia. This study has several strengths, including a large sample size (25,795 vehicles and a total of 39,833 drivers and passengers), carefully designed representation of the region (6 districts with 3 types of roads including highways), detailed records of all seat positions, and roadside surveys with drivers on the road. Overall, we found a 55 percent seat belt wearing rate among drivers in Lipetskaya Oblast, which is higher than the previously estimated 33 percent but lower than the 60 percent estimated from self-reported surveys by the Ministry of Internal Affairs (Zelinsky 2009). Front seat passengers had a slightly higher seat belt use rate of 58 percent and only 9 percent of rear seat passengers were wearing seat belts. Only 11 percent of the children were observed to use any kind of restraint in the vehicles; however, observers had limited ability to see into cars, which could be one possible factor for the low rates. Given the proven effectiveness of the use of seat belts (IRCOBI Citation1986; WHO Citation2009), and the effectiveness of child car seats (European Transportation Safety Council [ETSC] Citation2001), there is still substantial work to be done in order to increase seat belt use, particularly among rear seat passengers.
Through the 2 methods—observational and roadside surveys—we were able to compare observed and self-reported seat belt use rates among drivers in Lipetskaya Oblast. This comparison reveals a discrepancy: as many as 79 percent of drivers reported that they always used a seat belt in the roadside survey, whereas observed seat belt usage among drivers in Lipetskaya Oblast was only 55 percent. Overestimations of usage through self-report have been well documented by previous studies (Fhaner and Hane Citation1973; Parada and Cohn Citation2001; Routley et al. Citation2009; Zambon et al. Citation2008) and are usually attributed to a desire to report positive behavior.
What is interesting is the difference between the observed rates in normal traffic (done without stopping the vehicle) and the observed rates of seat belt usage during the roadside surveys. During the roadside surveys, interviewers noted that 78 percent of the drivers wore seat belts, which is much higher than the 55 percent noted through roadside observations. This discrepancy can be explained because cars were stopped by traffic police but the motorists did not know why they were being stopped. Therefore, it is both possible and likely that drivers and passengers may have secured their seat belts when they were stopped, which increased the appearance of seat belt usage. This suggests the benefits of conducting observations without stopping individuals and without the involvement of police, because their involvement can potentially influence the behaviors of motorists. However, this is not to diminish the value of surveys: roadside surveys can provide rich information on drivers’ knowledge, attitudes, and sense of enforcement. To conduct such surveys, we still recommend collaborating with the police, because it is very dangerous to try to stop moving vehicles. Alternatively, the discrepancies between data sources described above could also be due to the research design: first, surveys were not conducted at the same time and sites where observations were conducted; second, the survey sample is far smaller than that of the observations. Nevertheless, we do not think that the research design alone could result in 23 percent differences in seat belt use.
Among the roadside survey respondents, negative attitudes toward seat belt use were similar to those recorded in developed countries when their legislation was first introduced. However, other countries’ experiences showed that persistent education and sustained enforcement could help people overcome the perceived barriers such as “discomfort” (Routley et al. Citation2009). Nearly 60 percent of respondents mentioned “seat belts save lives,” and more than half mentioned law requirements and fines, which implies that “saving life” and “law enforcement” are the most effective messages in improving seat belt use. These might be useful for future communications and enforcement efforts in Lipetskaya Oblast.
CONCLUSIONS
Although the observed seat belt use in Lipetskaya Oblast is much higher than the previously estimated 33 percent in Russia, the overall seat belt use rate at 55 percent leaves room for improvement. Rear seat passengers and children remain at risk. Interventions including social marketing strategies and enhanced enforcement to promote seat belt use and to improve road safety will be implemented in Lipetskaya in 2011/2012, permitting longitudinal follow-up to assess how seat belt use will change in response to policy initiatives.
ACKNOWLEDGMENTS
This work was conducted as part of the Road Safety in 10 Countries project funded by the Bloomberg Philanthropies.
Related Research Data
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