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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Public Health 1/2012

Non-seatbelt use and associated factors among Thai drivers during Songkran festival

Zeitschrift:
BMC Public Health > Ausgabe 1/2012
Autoren:
Penprapa Siviroj, Karl Peltzer, Supa Pengpid, Sompong Morarit
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

PS, KP and SP were the main contributors to the conceptualization of the study. KP, PS and SP contributed significantly to the first draft of the paper and all authors contributed to the subsequent drafts and finalization. All authors read and approved the final manuscript.

Background

The Road Traffic Injury (RTI) fatality rate in Thailand was 40 per 100,000 populations, i.e., double the world average for low and middle income countries [1], and RTIs are the second largest cause of burden of disease in Thailand [2]. A number of known behavioural risk factors for RTIs have been identified in Thailand, including drinking and driving, speeding, substance abuse and failure to use seatbelts [35]. Aekplakorn et al. [6] conducted an observational study after enactment of the seatbelt law in 1996 in major cities in Thailand. The results showed that 57.3% of motor vehicle drivers did not use seatbelts in January and 69.3% in July 1996. In another study in Thailand non-seatbelt use was found to be considerably lower in passengers than in drivers [5]. Studies on observed seatbelt use in low and middle income countries found high rates of non-seatbelt use among drivers, ranging from 99% among drivers in Kenya [7], 91% in Argentina [8], 83.4% in Ghana [9], 53% in South Africa [10], 50% -32% in Nigeria [11, 12], 45% in Russia [13] and 44.1%-32.7% in China [14, 15]. In most of these studies passengers in motor vehicles seemed to use less often a seatbelt than drivers [5, 9, 11, 14]. Factors associated with non-seatbelt use among drivers were male gender [6, 9, 16], younger age [9], professional and pickup versus general drivers [5, 9, 14], lowest within the Central Business District (CBD) compared to the outskirts of the city [6, 9], lower on highways than on local streets [17], lower on urban roads compared to those on main highways and rural roads [13], lower at daytime, early in the morning than at night [14, 15], and fatalistic orientation [10].
Songkran is the New Year celebration in Thailand, set by the solar calendar since ancient times. It takes place between 13 and 15 April. At Songkran festival are major holidays that encourage a million of travellers who travel to/from their hometown and doing the activities during these holiday periods [18]. Unfortunately, number of road accidents, fatalities, and injuries, increase dramatically; in April the number of road traffic fatalities almost 1200, way above average of <1000 [18]. The daily fatalities during Songkran festival rise up to 84 and 95 persons per day, an increase of 147% and 179%, respectively, compared with an average of 34 persons per day in the non-festival period. Similarly, daily injuries during Songkran holidays increased to 4,900 and 5,650 persons, compared with an average of 2,468 persons per day during the non-festival period [19, 20]. The risks of road traffic accidents during long holidays such as New Year and Songkran festival were found to be alcohol drinking driver, high speed drivers and not using safety equipments [20]. In Thailand there is law on seatbelt wearing; according to the Road Traffic Act 1979 a seatbelt must be fastened at all time during driving and passengers are also obliged to fasten the seatbelt at all times [21]. From 1997 an active public education programme was undertaken on a national scale to raise awareness about road safety and to support law enforcement. This included dissemination of knowledge through multiple channels, e.g., roadside posters, stickers on the back of vehicles, sporadic radio and TV programmes or spots, public announcements and press reports [22]. After 2000, communication about the law was increased and both governmental and nongovernmental agencies started to participate in traffic injury prevention and control programmes including seatbelt wearing among drivers [23, 24]. This included also increased road safety awareness (RSA) campaigns during the Songkran festival [21], but seemingly not everywhere the full range of RSA campaigns was implemented [25]. Among the risks of road traffic accidents during long holidays the lack of using safety equipments has not been adequately studied. Therefore, the aim of this study was to assess the prevalence and associated factors of non-seatbelt use among drivers during Songkran festival in Thailand.

Methods

Sample and procedure

A cross-sectional survey has been performed to determine the prevalence of helmet use among drivers. The recruitment period of this project was during four days of the Songkran festival from 13–16 April 2007. For this sample the population of drivers from 12 petrol stations were selected from four provinces from each of the four main geographical regions of Thailand excluding Bangkok. Provinces were Chiang Mai, Lampang, Nakhon Sawan and Phichit in the northern region, Nakhon Ratchasima, Khon Kaen, Udon Thani, and Loei in the Northeastern region, Songkhla, Phuket, Surat Thani, and Trang in the southern region, and Phra Nakhon Si Ayutthaya, Chonburi, Chachoengsao, and Phetchaburi in the central region. In total 48 petrol stations (three petrol stations per province) was selected using quota sampling. In town, the petrol station on the road with the largest shopping mall was selected; out of town the petrol station on the road leading to the largest district was selected; in terms of petrol station on the highway, each province only has one highway. If there was more than one petrol station on the selected road or highway, the largest petrol station was selected. The study team spent four days at each petrol station road venue (roads in town, outside town and highway) from 7:00–9:00, 13:00–15:00, 17:00–19:00, 22:00–24:00. All consecutive motor vehicle occupants who entered the petrol station were asked to participate by trained personnel (who were students from Chiang Mai University that were trained by the research team) while they were having their gas tank filled. The number of vehicles and time interval for vehicle selection were determined by the availability of field staff to conduct a motor cycle rider observation, interview and alcohol test. The target sample size was 100 drivers from each of the petrol stations per time period, except during 22:00–24:00 for which 50 drivers were targeted. Trained field staff administered a structured questionnaire and performed an observation checklist. The project was approved by the Ethics Committee for research in human subjects of the public health programme, Chiang Mai University.

Measures

The primary outcome of the study was seatbelt use. Seatbelt use was assessed by observation. The questionnaire covered demographic data, vehicle characteristics, history of road traffic accidents, known risk factors such as, age, sex, environmental factors, seatbelt use experiences and attitudes, and exposure to the road safety awareness (RSA) campaign.

Data analysis

Data were analyzed using Statistical Package for the Social Sciences (SPSS) for Windows software application programme version 19.0. Frequencies, means, standard deviations, were calculated to describe the sample. Data were checked for normality distribution and outliers. For non-normal distribution non-parametric tests were used. Associations of non-seatbelt use were identified using logistic regression analyses. Following each univariate regression, multivariable regression models were constructed. Independent variables from the univariate analyses were entered into the multivariable model if significant at P<0.05 level. For each model, the R2 are presented to describe the amount of variance explained by the multivariable model. Probability below 0.05 was regarded as statistically significant.

Results

Sample characteristics

The total sample included 13722 drivers (288 refused, response rate 98.3%); 77.4% of the drivers were male and 22.6% female. The majority of the drivers (79.9%) were between 26 to 59 years old and about half (50.7%) were driving a pickup. Driver participation in the study was equally distributed across four of Thailand’s four regions, four data collection times during the day, four dates of data collection and three locations of data collection. The overall prevalence of non-seatbelt use was 28.4% (see Table 1). Seatbelt use of passengers was also assessed. In 33.2% of the cases or cars there was no passenger, and in 66.8% of the cars where there was a passenger 60.3% were not and 39.7% were wearing a seatbelt. More female (67.2%) than male (50.6%) passengers had not been wearing a seatbelt.
Table 1
Sample characteristics of drivers during Songkran festival
 
Total
Non-seatbelt use of driver
 
N
%
N
%
All
13722
 
3879
28.4
Male
10603
77.4
3160
29.9
Female
3095
22.6
719
23.3
Age (by self-report)
    
<18
180
1.3
85
47.5
18–25
2379
17.4
803
33.8
26–59
10950
79.9
2922
26.8
60 or more
191
1.4
63
33.2
Type of car
    
Mini-truck
6948
50.7
2157
31.1
Saloon
5416
39.6
1326
24.5
Mini bus
965
7.0
209
21.7
Truck
365
2.7
179
49.0
Region
    
North
3575
26.1
1196
33.5
Central
3455
25.2
1057
30.2
Northeast
3333
24.3
427
14.4
South
3359
24.5
1151
34.3
Data collection time
    
07.00-09.00
3897
28.4
1114
28.7
13.00-15.00
3914
28.5
1158
29.7
17.00-19.00
3918
28.6
1019
26.1
22.00-24.00
1993
14.5
530
29.7
Date of data collection
    
13 April 2007
3401
24.8
1065
31.5
14 April
3435
25.0
1030
30.0
15 April
3442
25.1
860
25.0
16 April 2007
3444
24.1
926
27.0
Location of data collection
    
Main road in town
4677
34.1
1569
33.7
Roads out of town
4623
33.7
1333
28.9
Highway
4422
32.2
979
22.2

Seatbelt use experiences, attitudes and road safety awareness campaign exposure

Regarding previous driving experience, 25.6% of the sample indicated that they had been in an accident before. Of those who had ever been in an accident before, most had been involved in the accident as a driver (77.5%), followed by passenger (22.5%) and pedestrian (2.0%). A large group of participants (46.6%) indicated that they had not usually been using a seatbelt before and 41.5% had not intended to use a seatbelt. The majority (73.7%) perceived a danger of not wearing a seatbelt and 53.0% were highly aware of the danger of not wearing a seatbelt. A significant number of 26.4% indicated that they had been caught by the police because of not wearing a seatbelt and 67.3% perceived a moderate to high risk about being caught by the police because of not wearing a seatbelt. Almost all (90.4%) had heard about the RSA campaign and more than one-thirds (36.3%) had frequently heard or seen the RSA campaign on the radio or on TV. More than half (57.0%) of the participants had been talking to others about the RSA campaign. One-thirds (33.3%) liked the RSA campaign very much, 31.4% frequently followed the TV news reports on road traffic injury (RTI) statistics and more than half (54.7%) believed perceived that the RSA campaign had a high effect (see Table 2).
Table 2
Seatbelt use experiences, attitudes and exposure to road safety awareness campaign of drivers during Songkran festival
Variables
Response options
Total
 
Non-seatbelt use of driver
    
N
%
Seatbelt use experiences and attitudes
Been in accident before
No
10123
74.4
2726
27.0
 
Yes
3482
25.6
1104
31.8
Driver status when in accident
Driver
2603
75.5
812
31.3
 
Passenger
775
22.5
242
31.2
 
Pedestrian
69
2.0
28
40.6
Not usually used a seatbelt before
No
6372
46.6
2303
36.3
 
Yes
7310
53.4
1567
21.5
Intention to use a seatbelt
No
5662
41.5
1777
31.5
 
Yes
7978
58.5
2081
26.2
Awareness of danger of no seatbelt use
Low
652
4.8
270
41.4
 
Moderate
5769
42.2
1756
30.5
 
High
7243
53.0
1841
25.5
Perceived risk about being caught by the police because of not wearing a seatbelt
No risk
1961
14.4
553
28.2
 
Low risk
2494
18.3
821
32.9
 
Moderate risk
5209
38.2
1367
26.3
 
High risk
3975
29.1
1122
28.4
Caught not wearing a seatbelt
No
10045
73.6
2885
28.8
 
Yes
3608
26.4
978
27.3
Exposure to road safety awareness (RSA) campaign
Heard of RSA campaign
No
1312
9.6
396
30.3
 
Yes
12410
90.4
3485
28.2
Frequency of exposure to RSA campaign
Never
1059
7.8
365
34.5
 
Not often
7342
54.1
2048
28.0
 
Frequently
4928
36.3
1374
27.9
 
Not sure
235
1.7
68
28.9
Talking to others about RSA campaign
Never
3878
28.3
1316
34.0
 
Ever
7795
57.0
1999
25.7
 
Not sure
2014
14.7
553
27.5
Follows TV news on RTI statistics
Never
1288
9.4
561
43.7
 
Not often
7569
55.4
2149
28.5
 
Frequently
4287
31.4
1024
24.0
 
Not sure
514
3.8
129
25.3
How feels about RSA campaign
Not like
952
7.0
332
34.9
 
Like a little bit
7566
55.2
2324
30.8
 
Like very much
4567
33.3
1047
23.0
 
Not sure
610
4.5
162
26.6
Perceived effect of RSA campaign
Low
1492
10.9
450
30.4
 
Medium
4700
34.4
1621
34.6
 
High
7473
54.7
1798
24.1

Association between non-seatbelt use and demographics, experiences, attitudes and RSA campaign exposure

In multivariable analysis demographics (being male, younger age, coming from the Northern or Southern region in Thailand), environmental factors (earlier during the Songkran festival, in the morning and late evening and on main roads in town), seatbelt use experiences and attitudes (having been in an accident before, not usually using a seatbelt, no intention to use a seatbelt, lack of awareness of danger of non-seatbelt use and lower perceived risk of being caught with non-seatbelt use) and lower exposure to RSA campaign (less frequent exposure to RSA campaign, less frequent following of RTI statistics and not talking with others about the RSA campaign) were associated with non-seatbelt use (see Table 3).
Table 3
Association between non-seatbelt use and demographics, environmental factors, seatbelt use experiences and attitudes and RSA campaign exposure (during Songkran festival)
 
Variables
Unadjusted Odds Ratio
Adjusted Odds Ratioa
Demographics
Female vs. Male
1.41 (1.28-1.54)***
1.19 (1.06-1.34)**
 
Age
 
<18 years
1.00
1.00
 
18–25
0.57 (0.42-0.77)***
0.79 (0.54-1.14)
 
26–59
0.40 (0.30-0.54)***
0.65 (0.45-0.93)*
 
60 or more
0.55 (0.36-0.84)***
0.76 (0.46-1.26)
 
Region
 
North
1.00
1.00
 
Central
0.88 (0.80-0.97)*
0.75 (0.67-0.85)***
 
Northeast
0.34 (0.30-0.38)***
0.27 (0.23-0.31)***
 
South
1.04 (0.94-1.15)
1.01 (0.90-1.21)
Environmental factors
Mini-truck (Pickup)
1.00
1.00
 
Saloon
0.72 (0.66-0.78)***
0.70 (0.63-0.77)***
 
Mini bus
0.61 (0.52-0.72)***
0.53 (0.44-0.64)***
 
Truck
2.13 (1.72-2.65)***
1.91 (1.48-2.46)***
 
Day of Songkran festival
 
13 April 2007
1.00
1.00
 
14 April
0.94 (0.84-1.04)
0.95 (0.84-1.07)
 
15 April
0.73 (0.65-0.81)***
0.77 (0.68-0.87)***
 
16 April 2007
0.80 (0.72-0.89)***
0.80 (0.71-0.91)***
 
Time of the day
 
07.00-09.00
1.00
1.00
 
13.00-15.00
1.05 (0.95-1.16)
1.04 (0.92-1.16)
 
17.00-19.00
0.88 (0.80-0.97)*
0.87 (0.78-0.98)*
 
22.00-24.00
1.05 (0.93-1.18)
1.05 (0.91-1.20)
 
Type of road
 
Main road in town
1.00
1.00
 
Roads out of town
0.80 (0.73-0.88)***
0.70 (0.63-0.78)***
 
Highway
0.56 (0.51-0.62)***
0.52 (0.47-0.59)***
Seatbelt use experiences and attitudes
Been in accident before
1.26 (1.16-1.37)***
1.18 (1.07-1.30)***
 
Driver status when in accident
  
 
Driver
1.00
---
 
Passenger
1.00 (0.84-1.19)
 
 
Pedestrian
1.50 (0.92-2.45)
 
 
Not usually used a seatbelt
2.08 (1.93-2.25)***
2.40 (2.19-2.63)***
 
No intention to use a seatbelt
1.30 (1.20-1.40)***
1.28 (1.17-1.41)**
 
Awareness of danger of no seatbelt use
 
High
1.00
1.00
 
Moderate
1.29 (1.19-1.39)***
1.47 (1.34-1.62)***
 
Low
2.07 (1.75-2.44)***
1.55 (1.28-1.89)***
 
Perceived risk to be caught with no seatbelt use
 
High
1.00
1.00
 
Moderate
0.90 (0.82-0.99)*
0.82 (0.73-0.92)***
 
No/low
1.13 (1.03-1.24)*
0.97 (0.86-1.09)
 
Caught not wearing a seatbelt
0.93 (0.85-1.01)
---
Exposure to road safety awareness campaign
Not heard RSA campaign
1.11 (0.98-1.25)
---
 
Frequency of exposure to RSA campaign
 
Frequently
1.00
1.00
 
Not often
1.00 (0.93-1.10)
1.08 (0.97-1.19)
 
Never/not sure
1.30 (1.14-1.48)***
1.92 (1.82-2.29)***
 
Not talking to others about RSA campaign
1.49 (1.37-1.62)***
1.14 (1.04-1.26)**
 
Follows RTI stats
 
Frequently
1.00
1.00
 
Not often
1.26 (1.16-1.38)***
1.18 (1.06-1.31)**
 
Never, not sure
1.99 (1.77-2.24)***
1.72 (1.48-1.99)***
a Hosmer & Lemeshow Chi-square=16.48, P=0.036; Nagelkerke R 2 : 0.17.

Discussion

In this study among a large sample of divers in Thailand 28.4% were observed of non-seatbelt use, which seemed to be better than in previous studies in Thailand [6]. Previous studies of non-seatbelt use among drivers in low and middle income countries seemed to have also found worse rates of non-seatbelt use than in the current study [715]. In concordance with other studies, this study found that being male [6, 9, 16], younger age [9], professional and pickup versus general drivers [5, 9, 14, 26, 27], location of road (main roads in town) [6, 9], time of the day (earlier time in the day) [14, 15] were associated with non-seatbelt use among drivers. The study also found in concordance with most studies [5, 9, 11, 14] that passengers in motor vehicles had used less often a seatbelt than drivers. Non-seatbelt use was in this study higher at the beginning than at the end of Songkran festival and it was found higher when driving on main roads in town than out of town or on the highway. Some of these differences may be explained by the actual driving location, as it could be that higher non-seatbelt use was found when celebrating the Songkran festival in their home town involving higher non-seatbelt use compared to celebrating the Songkran festival away from current residence which involves driving on the high way and possibly less non-seatbelt use. Among truck drivers non-seatbelt use was found to be higher than among drivers of a saloon car or minibus, which may be explained by different personalities. It is recommended that the RSA campaign should be improved by specifically targeting risk groups such as truck drivers and risky places such as main road in town.
Further, having been in an accident before, not usually having used a seatbelt, not having intended to use a seatbelt, lack of awareness of the danger of non-seatbelt use and lower perceived risk of being caught with non-seatbelt use was found in this study to be associated with non-seatbelt use. Drivers may seem not to be inclined to protect themselves voluntarily against very low probability threats [28]. Thai people also believe in karma, meaning that if the time for an accident or death has come one cannot avoid it.
Importantly, lower exposure to RSA campaign (less frequent exposure to RSA campaign, less frequent following of RTI statistics and not talking with others about the RSA campaign) were in this study associated with non-seatbelt use. Phillips et al. [29] found from a meta-analysis of 67 studies that the weighted average effect of road safety campaigns was a 9% reduction in accidents.

Study limitations

Caution should be taken when interpreting the results of this study because of certain limitations. As this was a cross-sectional study, causality between the compared variables cannot be concluded. A further limitation was that some variables were assessed by self-report and desirable responses may have been given. Other examples of limitations include that other substance use (illicit drugs) were not assessed, as found to be prevalent in other studies in Thailand [19]. Future studies should also investigate non-helmet use among motorcyclists in Thailand, as it has been found to be a significant problem in previous studies [21].

Conclusion

Rates of non-seatbelt use by Thai drivers and passengers during Songkran festival was 28.4%. Lower exposure to the RSA campaign was found to be associated with non-seatbelt use among drivers during the Songkran festival.

Acknowledgement

The study was funded by the Thai Health Promotion Foundation.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

PS, KP and SP were the main contributors to the conceptualization of the study. KP, PS and SP contributed significantly to the first draft of the paper and all authors contributed to the subsequent drafts and finalization. All authors read and approved the final manuscript.
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