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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 165-172

Seat belt use behavior among teen students: The role of their demographic characteristics and family members' behaviors


1 Department of Public Health, Hamadan University of Medical Sciences; Research Center for Health Sciences, Hamadan University of Medical Sciences; Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
3 Department of Biostatistics, , Noncommunicable DiseasesResearch Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
4 Department of Public Health, Hamadan University of Medical Sciences; Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
5 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Date of Submission26-Jul-2021
Date of Decision14-Aug-2021
Date of Acceptance09-Sep-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Fatemeh Malekpour
Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atr.atr_61_21

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  Abstract 


Background and Objectives: The lack of seat belt use is considered as one of the most common behavioral factors encountering the life of a driver or an occupant to traffic injury risk. The aim of this study was to determine the relationship between seat belt-wearing behavior among school students and their demographic characteristics and family members' behaviors. Methods: In this cross-sectional study, 942 students (497 girls and 445 boys) were included and randomly selected from junior high schools in Tabriz, Iran. A questionnaire on the seat belt-wearing behavior of students and their parents was used to collect data, followed by applying a generalized estimating equation approach to identify the correlation of pupils' traffic behaviors to account for intra-cluster correlation. Results: The results revealed that seat belt-wearing behaviors among male students were significantly more frequent compared to female students (P < 0.0001). The mother's occupation, the father's age, and the student's educational level had a significant impact on seat belt wearing among the students (P < 0.01). In addition, student's adherence to traffic rules was correlated with their seat belt-wearing behavior. Finally, the seat belt-wearing behavior of parents and siblings had a significant positive effect on students' behaviors (P < 0.01). Conclusion: Male students further demonstrated risky behaviors compared to their female peers, and family has an important role in improving the seat belt-wearing behavior of their children. Therefore, involving adolescents' families including their parents and sibling can be important and helpful in developing preventive programs for promoting the use of seat belts among adolescents.

Keywords: Adolescent, health promotion, injury prevention, parents, safe behavior, seat belt wearing


How to cite this article:
Rezapur-Shahkolai F, Malekpour F, Tapak L, Moeini B, Sadeghi-Bazargani H. Seat belt use behavior among teen students: The role of their demographic characteristics and family members' behaviors. Arch Trauma Res 2021;10:165-72

How to cite this URL:
Rezapur-Shahkolai F, Malekpour F, Tapak L, Moeini B, Sadeghi-Bazargani H. Seat belt use behavior among teen students: The role of their demographic characteristics and family members' behaviors. Arch Trauma Res [serial online] 2021 [cited 2021 Nov 30];10:165-72. Available from: https://www.archtrauma.com/text.asp?2021/10/3/165/328038




  Introduction Top


Road traffic injuries (RTIs) are the cause of death or disability of nearly 10 million children worldwide. Most RTI-related deaths occur in low- and middle-income countries.[1],[2] In addition, RTIs impose considerable expenses on governments, individuals, and their families. Iran has one of the highest rates of RTIs in the world. Based on a report, 16946 and 347307 people died and were injured due to RTIs in 2019, respectively.[3] According to mortality statistics of Iran, RTIs are reported as one of the main reasons for mortality.[4]

The nonusing of seat belts of teen drivers or occupants is one of the main reasons for road traffic fatality and severe injuries.[5],[6],[7] Previous studies have reported that the use of seat belts could reduce severe RTIs and deaths in addition to decreasing fatality rates by approximately 50%.[8],[9],[10]

The fatality analysis reporting system of the United States has shown that more than two-third of dead teen passengers in crashes wore no seat belts.[11]

The rate of seat belt use varies in different countries, and relies on the seat belt use laws.[12] In recent years, this rate has globally increased mostly due to strict driving laws and cash penalties for the lack of using seat belts, although the rate of increase among children and teenagers has been reported low compared to the adults.[13],[14],[15],[16]

A mandatory seat belt use law was initiated in Iran on March 21, 2005.[17] Although the use of seat belts is mandatory for front- and rear-seat occupants on suburban roads, regarding urban roads, nonuse of seat belts has fine only for front-seat occupants. Previous research demonstrated that more teen passengers in a car increase the likelihood of the lack of wearing seat belts, although the presence of a person over the age of 30 can increase the use of seat belts in this group of occupants.[18] Despite the advantage of seat belt use, individuals living in most low/middle-income countries such as Iran do not sufficiently use it.[15] Teenagers are more likely to take risky behaviors such as the nonuse of seat belts compared to children or adults.[19],[20],[21],[22] Teenagers are breaking ties with childhood while being fascinated by gaining independence. In addition, they perform risky behaviors due to the lack of emotional and cognitive maturity compared to the adults.[23],[24]

Several studies reported that teenagers have a high potential risk of mortality in RTIs.[25],[26],[27],[28] Although most people believe that seat belt use is an effective way for reducing mortality and severe RTIs, there is a lack of the necessary motivation for performing this healthy behavior.[29]

Demographic characteristics such as age, gender, and educational level could influence safety belt use;[30],[31],[32] and the highest rate of accidents and the lowest rate of seat belt use are observed among teens.[18],[33] There are limited number of studies on the impact of gender on seat belt use among teens, and contradictory results have been reported in this regard.[34],[35] In general, the rate of seat belt use among female adults was more prevalent compared to male adults, and a low-risk perception of males compared to females could be the reason for this difference.[36],[37]

The use of seat belts in the driver and front passenger is interrelated, and observance of this behavior in the former meaningfully predicts that of the latter.[35] Therefore, parents' use of seat belts may influence teenagers' behavior in this regard. Given the scarcity of studies in this area, further research is necessary.

The use of seat belts among teenagers does not seem to be at a desirable level, and factors associated with nonseat belt use among teen passengers have not been well-documented yet. Moreover, there is limited knowledge about the impact of demographic characteristics, especially family members' behaviors on seat belt use among teenagers. Therefore, this study sought to evaluate the influence of these important variables on the seat belt use of teen students.


  Methods Top


Study design and participants

This cross-sectional study was performed on 942 junior high school students including 497 girls and 445 boys who were in 7–9 educational grades (13–15 years old) in the schools of Tabriz during 2019–2020 academic years. Tabriz is located in the northwest of Iran and has five educational regions according to the divisions of the Tabriz Department of Education. The data were collected from November 30, 2019, to January 5, 2020.

The sample size was estimated using the

formula for cluster sampling Where, (the prevalence of using seat belt which was determined based on the previous studies.[38] Also, a cluster sampling correction coefficient of 1.5 and a 10% attrition rate were considered, so the final sample size was considered 952.

This study was conducted after coordination with the Department of Education authorities in the province and the managers of the selected schools. In this study, the cluster random sampling method was used for the selection of students. In the first step of sampling, the list of junior high schools was prepared by the Department of Education. Twenty schools from the mentioned regions (four schools in each region, including two public and two private schools) were selected in the terms of gender classifications (male/female). In Iran, girls and boys are trained in single-sex schools. In each school (male/female), one classroom from each grade (7–9), and then a number of students from each classroom were chosen through the simple random sampling method based on the sample size.

The inclusion criteria were being male and female students studying in junior high schools (7–9 educational grades), studying at the schools of Tabriz, showing a willingness for participation in the study, and obtaining parents' consent for their children's participation. On the other hand, the exclusion criterion included not showing consent for participating in the study (students and/or their parents). It should be noted that 942 out of 952 students participated in the study, and only 10 participants did not answer the questionnaire (the response rate was about 99%).

Data collection instrument

A researcher-made questionnaire consisting of four sections was used to collect the required data. The first section contained questions on demographic information including students' educational grades and physical condition, the father's and mother's age, occupation, and educational level. The second section included questions on the student's seat belt-wearing behavior as a front- or rear-seat occupant inside or outside of the city. These questions were based on a 5-point Likert-type scale, and students' answers were scored from 5 to 1, representing always, most of the time, sometimes, seldom, and never using a seat belt, respectively. The third section encompassed questions on the students' reported adherence to the traffic rules of seat belt use as a rear- or front-seat occupant inside or outside of the city. In the fourth section, there were questions on the seat belt-wearing behavior of students' parents and siblings during driving or as a front- or rear-seat occupant inside or outside of the city. A qualitative assessment was conducted by 12 experts in the fields of health education, health promotions, and traffic safety to standardize and validate the questionnaire. Further, reliability assessment was performed among 50 junior high school students in Tabriz using a test–retest method and Cronbach's alpha, and the Cronbach's alpha coefficient of the behavior structure was 0.81.

Statistical analysis

In this study, the mean (standard deviation) and frequency (percentage) were used to present descriptive statistics of quantitative and qualitative variables, respectively. Due to the clustering structure of the sampling method, a multivariate generalized estimating equation (GEE) approach was used to identify the correlates of traffic behaviors or pupils to account for intra-cluster correlation. Finally, SPSS software Ver. 16.0 (SPSS, Chicago, IL) was employed to analyze the data.

Ethical considerations

The students were informed about the study and voluntary participation in the study. Oral and written informed consent forms were obtained from the students and their parents, respectively. The questionnaires were anonymous and other data were kept confidential and used only for this study. This study was confirmed by the Ethics Committee of Hamadan University of Medical Sciences (Ref. No: IR.UMSHA.REC.1397.819).


  Results Top


The results showed that 24.6% and 12.1% of students as front-seat occupants never wore seat belts inside and outside the city, respectively [Table 1]. The results further revealed that only about 20% of students as rear- or front-seat occupants permanently use seat belts.
Table 1: n (%) of seat belt use behavior of the students (n=942)

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[Table 2] provides data on the relationship between demographic variables and the seat belt-wearing behavior of students.
Table 2: The relationship between demographic variables with the seat belt use behaviors of the students based on the multivariate generalized estimating equation regression model

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According to the results of the analytical regression model of GEE [Table 2], the mean score of seat belt-wearing behavior among male students was significantly lower than that of female students (P < 0.0001).

The mean score of the seat belt-wearing behavior was significantly higher among the students whose mothers were government employees compared to the students with retired mothers (P = 0.007). However, the mean score of the seat belt-wearing behavior of the students of housewife mothers was significantly lower in comparison with that of students of retired mothers (P = 0.0001). Eventually, the mean score of the seat belt-wearing behavior of students of self-employed mothers was significantly lower than that of students with retired mothers (P = 0.0001).

According to the results, the mean score of seat belt-wearing behavior was significantly higher among seventh-grade students than that of the ninth-grade students (P < 0.0001).

[Table 2] shows that the mean score of seat belt-wearing behavior among the students increased significantly by an increase in the father's age (P = 0.003).

[Table 3] presents data regarding the relationship between traffic-related variables and seat belt-wearing behavior among students by the GEE regression model.
Table 3: The relationship between traffic-related variables and seat belt-wearing behaviors among the students by the multivariate generalized estimating equation regression model

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The mean score of the seat belt-wearing behavior was significantly more remarkable among the students who completely or somewhat adhered to these rules compared to the students who did not adhere to traffic rules at all (P < 0.01).

The mean score of seat belt-wearing behavior of students who chose the front seat for sitting was significantly less considerable compared to the students who did not care about sitting on the front or back seat (P = 0.039).

The mean of the seat belt-wearing behavior of students who considered wearing a seat belt to be legally mandatory for the front- or rear-seat occupants inside or outside the city was significantly more noticeable (P < 0.01) compared to the students who did not consider this behavior to be legally mandatory for the front-seat occupants of the car inside the city.

[Table 4] summarizes data on the relationship between the traffic behaviors of the family and seat belt-wearing behavior variables by the GEE regression model.
Table 4: The relationship between the traffic behaviors of family and seat belt-wearing behaviors using a multivariate generalized estimating equation regression model

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The mean score of the seat belt-wearing behavior of students whose fathers wore seat belts during driving was significantly (P < 0.0001) higher than that of students whose fathers did not observe this behavior while driving.

The results further revealed that the mean score of the seat belt-wearing behavior was significantly greater among the students whose older siblings were a driver or always wore a seat belt compared to the students whose older siblings were not a driver or sometimes wore a seat belt (P < 0.05).

The results further represented that the mean score of the seat belt-wearing behavior of students whose parents or siblings wore a seat belt as the front- or rear-seat occupant inside or outside of the city was significantly more considerable than that of the students whose mothers did not wear a seat belt (P < 0.01).

Finally, the mean of the seat belt-wearing behavior among students whose parents or siblings have ever been fined by the police for not wearing a seat belt was significantly lower compared to the students whose parents or siblings have never been fined for this reason (P < 0.009).


  Discussion Top


The results of the present study showed that only about one-fifth of the studied adolescents used seat belts. In addition, seat belt-wearing behaviors among male students were significantly more prevalent compared to female students. The mother's occupation, the father's age, and the student's educational level had a significant impact on seat belt-wearing behaviors among the students. The seat belt-wearing behaviors of parents and siblings positively contributed to those of the students. Based on the results, nearly 20% of the students as rear- or front-seat occupants always wore a seat belt. In line with the result of the current study, Mohammadi demonstrated 82% inconsistently (not always) seat belt use among Iranian college students.[39] In a study in the United States, only 51% of high school students living in 38 states reported that they always use a seat belt when riding as a passenger.[38] In a study among school teenagers in Qatar, 47% of participants reported using seat belts as a driver or a passenger.[40] In a study among Kuwaiti passengers, the prevalence of noncompliance with self-reported mandatory seat belt wearing as a passenger was 80.9%.[41] Likewise, Vecino-Ortiz et al. concluded that the mean of seat belt use rates was lower than 60% in most sites in four middle-income countries including Egypt, Mexico, Russia, and Turkey.[42] These results indicate that the rate of seat belt use among school students is low, and thus, prevention programs are required to increase the observance of this behavior among this group.

According to the results of this study, gender is an influential factor on seat belt use among teen students. More precisely, the rate of seat belt use among female students was more than that of male students. Korn and Bonny-Noach also concluded that risky behaviors among young adults during driving were significantly more frequent in males compared to females,[43] which corroborates with the result of the present study. These gender differences in seat belt wearing could explain males' further involvement in risky behaviors, greater sensation seeking, and lower use of equipment such as seat belts and helmets compared to females.[44],[45],[46] Females feel more concerned about road safety problems and perceive greater risk compared to males.[47],[48],[49] The results of other studies revealed that differences in risky behaviors among males and females may be due to biological factors, attitudes, perceptions, and behaviors across cultures.[50],[51],[52]

Based on the results of the present study, a mother's occupation was related to the seat belt-wearing behavior of students. Carine et al. found that the students of parents with an occupation that requires a high or scientific level of skills (e.g., a teacher) further used seat belts compared to the students of parents with occupations that only require elementary or a low level of skills including cleaning women.[53] In our study, the seat belt use of students with housewives or self-employed mothers was lower compared to the students with retired mothers. Contrarily to the result of the current study, a previous study showed that students' risky behaviors were not associated with mothers' occupations.[54] The result of our study also indicated that the father's occupation was not related to the student's behavior.

According to the results of the present study, seat belt-wearing behavior among students that completely or somewhat adhered to traffic rules was more noticeable compared to the students who did not adhere to traffic regulations. Moreover, the seat belt-wearing behavior of students, who considered wearing a seat belt to be legally mandatory for the front or rear seat of a car inside or outside the city, was more considerable in comparison with the students who did not consider this behavior to be legally mandatory. The law of seat belt use improves seat belt wearing while reduces traffic fatalities in the general population.[16] In the United States, some studies reported the effectiveness of enacting seat belt laws, especially on teens' seat belt wearing.[55],[56] Carpenter and Stehr suggested that primary enforcement seat belt laws increase regular youth seat belt use while decreasing youth fatalities.[55] Human factors (e.g., failure to comply with traffic rules) are one of the main reasons for traffic crashes and injuries.[6],[7]

The results of the present study represented that parents and sibling behaviors have a significant impact on a student's seat belt-wearing behavior. Han concluded that if a driver wears a seat belt, 92.6% of passengers also wear seat belts while if a driver does not follow this rule, only 19.1% of passengers would observe such traffic behavior.[57] According to the social learning theory, people are influenced by their observations and perceptions of how others are normally involved in health behaviors.[58],[59] Parents can affect their children's health beliefs and behaviors.[60] Simons-Morton et al. demonstrated that social norms may influence teenage traffic-related behaviors.[61] Parental social support prevents children's risky behaviors, and the encouragement of children for using seat belts increases the observance rate of this behavior among them.[62],[63] Finally, Dunlop and Romer found that normative perceptions related to seat belt-wearing behavior of friends and school peers were associated with seat belt nonwearing for boys and girls.[64] Self-reporting is one of the limitations of the present study.


  Conclusion Top


In general, the results indicated that the status of seat belt wearing among the studied students is unfavorable. Gender is an important factor in seat belt-wearing behavior, and the rate of seat belt use among males was lower compared to females. In addition, family plays an important role in their children's behaviors; therefore, involving adolescents' families including their parents and siblings can be important and helpful in developing any preventive programs for promoting the use of seat belts among this group of individuals.

Acknowledgments

This study, as a part of a Ph.D. thesis, was approved by Hamadan University of Medical Sciences and Tabriz University of Medical Sciences. The authors would like to thank all the students and their parents who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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