Research articleSeat Belt Use Among American Indians/Alaska Natives and Non-Hispanic Whites
Introduction
Accidents (including motor vehicle injuries) have been the third leading cause of death for American Indians/Alaska Natives (AI/AN) since 1989, and the leading cause of death among AI/AN aged 1 to 44 years.1 A report by the National Highway Traffic and Safety Administration (NHTSA) estimated that over 76% of the fatally injured occupants on tribal reservations were not wearing seat belts at the time of the crash.2 Seat belt use is associated with a 45% decreased risk for motor vehicle related traffic fatality in light cars.3, 4, 5 The NHTSA recently estimated that the prevalence of seat belt use on reservations with tribal law and traffic law enforcement was 55.4%, which was substantially lower than the national prevalence of 82%.6 However, the generalizability of these findings is limited given that more than half of the nation’s 4.1 million AI/AN do not live on reservations.7 Previous studies examining seat belt use among AI/AN have also found that residence in urban versus rural areas as well as certain regions have higher prevalence than others, suggesting heterogeneity within Indian Country.6, 8 For instance, seat belt non-use among AI/AN between 1995 and 1998 has been found to vary from as low as 19.4% in the Pacific Coast region to as high as 53.8% in the Northern Plains region.8
Some of the variation in seat belt use may be related to traffic laws and enforcement.9, 10, 11, 12, 13 Primary laws, which allow an officer to stop and ticket occupants solely because they are unrestrained, have been shown to increase seat belt use by as much as 22%,10 and reduce fatality by as much as 7%.12 Secondary laws, which permit a citation for lack of restraint use only if a motorist has been stopped for another reason, have been shown to increase seat belt use as much as 11%.10 One NHTSA study showed that primary laws increase seat belt use on reservations.6 However, enforcement of state primary and secondary laws on reservations cannot be assumed due to the sovereign status of tribes and their unique government-to-government relationship with the U.S. federal government.
In view of excess traffic-related injury and death among AI/AN and the potential benefit of seat belt use, the current study examined variation in seat belt use among AI/AN and non-Hispanic whites (NHW) using the latest round of nationally representative data. Specifically, variation in seat belt use by region, degree of urbanization, state traffic laws, and change over time were examined. Based on previous studies, it was hypothesized that states without primary laws and geographic areas that are more rural would have higher seat belt non-use among AI/AN and NHW.
Section snippets
Data Source and Survey Design
The Behavioral Risk Factor Surveillance System (BRFSS) monitors national prevalence of major health behaviors that are associated with premature morbidity and mortality among adults. The BRFSS is a state-based, continuous cross-sectional telephone survey administered by state health departments in collaboration with the Centers for Disease Control and Prevention. Random-digit-dialing methods are used to capture a representative sample of the civilian, non-institutionalized U.S. adult population
Results
Demographic characteristics of the 2002 sample are presented in Table 1. The AI/AN population was younger than the NHW population. In addition, the majority of AI/AN were male, as opposed to NHW (56.3% and 48.2%, respectively). While both groups had similar high school graduation rates, there were fewer college graduates among AI/AN compared to NHW (15.1% and 32.4%, respectively). The majority of AI/AN participants lived in the West or the South and East regions (26.7% and 28.9%, respectively),
Discussion
While overall prevalence of seat belt non-use among AI/AN and NHW in 2002 was similar, seat belt non-use varied significantly by region and degree of urbanization among AI/AN and NHW. Indeed, in 2002 AI/AN had higher seat belt non-use prevalence than NHW in five out of seven regions (Figure 1). Prevalence of seat belt non-use in AI/AN was significantly higher compared to NHW in the Northern Plains and Alaska, but significantly lower in the West. Also, in rural areas, seat belt non-use occurred
References (31)
Restraint effectiveness, occupant ejection from cars, and fatality reductions
Accid Anal Prev
(1990)The effectiveness of safety belts in preventing fatalities
Accid Anal Prev
(1986)- et al.
Effect on fatality risk of changing from secondary to primary seat belt enforcement
J Saf Res
(2005) - et al.
Reviews of evidence regarding interventions to increase the use of safety belts
Am J Prev Med
(2001) - et al.
Effectiveness of primary and secondary enforced seat belt laws
Am J Prev Med
(1999) - et al.
Seat belt law enforcement and racial disparities in seat belt use
Am J Prev Med
(2006) - et al.
Motor-vehicle crash-injury risk factors among American Indians
Accid Anal Prev
(1997) - et al.
Seat belt use among African Americans, Hispanics, and whites
Accid Anal Prev
(2002) - Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System. Available at:...
Fatal motor vehicle crashes on Indian reservations 1975–2002 (DOT HS 809 727)
(2004)
Fatality reduction by safety belts for front-seat occupants of cars and light trucks (DOT HS 809 199)
Safety belt use estimate for Native American tribal reservations (DOT HS 809 921)
The American Indian and Alaska Native Population, 2000
Prevalence of selected risk factors for chronic disease and injury among American Indians and Alaska Natives—United States, 1995–1998
MMWR Morb Mortal Wkly Rep
Impact of primary laws on adult use of safety belts—United States, 2002
MMWR Morb Mortal Wkly Rep
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