Research article
Seat Belt Use Among American Indians/Alaska Natives and Non-Hispanic Whites

https://doi.org/10.1016/j.amepre.2007.04.032Get rights and content

Background

Accidents (including motor vehicle injuries) are a leading cause of death among American Indians/Alaskan Natives (AI/AN). The purpose of this study was to examine geographic variation and the existence of a seat belt law on seat belt use among AI/AN and non-Hispanic whites (NHW).

Methods

Self-reported seat belt behavior data from the 1997 and 2002 Behavioral Risk Factor Surveillance System were analyzed in 2006–2007 and were restricted to AI/AN (n=4310 for 2002, and n=1758 for 1997) and NHW (n=193,617 for 2002, and n=108,551 for 1997) aged 18 years and older.

Results

Seat belt non-use varied significantly across geographic regions for both AI/AN and NHW. For example, AI/AN living in the Northern Plains (odds ratio [OR]=12.4, 95% confidence interval [CI]=6.5–23.7) and Alaska (OR=10.3, 95%CI=5.3–19.9) had significantly higher seat belt non-use compared to AI/AN living in the West. In addition, compared to those residing in urban areas, those living in rural areas were 60% more likely in NHW and 2.6 times more likely in AI/AN not to wear a seat belt. Both AI/AN and NHW living in states without primary seat belt laws were approximately twice as likely to report seat belt non-use in 2002 as those living in states with primary laws. In states with primary laws enacted between 1997 and 2002, AI/AN experienced greater decline in seat belt non-use than NHW.

Conclusions

Seat belt use among AI/AN and NHW varied significantly by region and urban–rural residency in 2002. Primary seat belt laws appear to help reduce regional and racial disparities in seat belt non-use.

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

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