An estimated 300,000 persons die and 10-15 million persons are
injured each year in traffic crashes throughout the world (1).
Safety-belt use is one of the most effective means of reducing the
number and severity of injuries in motor-vehicle crashes (2). In
Hungary, front-seat occupants of all motor vehicles have been
required to use safety belts since 1976. Since March 1993,
rear-seat passengers have been required to wear safety belts in
nonurban areas. Drivers in violation of the law are subject to
fines and potential suspension of driving privileges. To evaluate
driver compliance with the safety-belt use law, on May 10, 1993,
CDC conducted an observational prevalence survey of safety-belt use
in Budapest in conjunction with the U.S. Department of State and
the American International School of Budapest; this survey was
performed in collaboration with the Hungarian Ministry of
Transport, Communication, and Water Management and the Budapest
Police Department. This report presents findings of the study.
Driver lap/shoulder safety-belt use was observed at seven
moderate- to high-volume traffic sites in Budapest (1993 estimated
population: 2,009,000). Sites were selected to reduce repetitive
counting of observed vehicles. Pairs of pretrained high school
students from the American International School collected
information between 4:30 p.m. and 6 p.m. by observing vehicles at
intersections convenient and safe for the students and by using a
standardized form to record driver's safety-belt use, sex, and the
type of vehicle (Eastern European or non-Eastern European {i.e.,
any cars not manufactured in the former Warsaw Pact countries}).
Drivers of taxis (who are not required to wear safety belts) were
included; drivers of buses, trucks, farm machinery, and motorcycles
were excluded. Data differentiating taxis from other vehicles were
not systematically recorded.
A total of 4894 eligible vehicles were included in the survey.
Of the drivers, 3850 (79%) were male. The overall belt-use rate was
61%; however, the percentage of drivers using safety belts varied
by observation site (range: 58%-65%). The prevalence of safety-belt
use was higher among female (64%) than male (60%) drivers
(prevalence ratio {PR}=1.03; 95% confidence interval {CI}=1.00-
1.06). Fifty percent of the vehicles were non-Eastern European
models; drivers of Eastern European vehicles were more likely to
use safety belts than drivers of non-Eastern European vehicles (65%
versus 57%) (PR=1.2; 95% CI=1.1-1.3). Safety-belt use was higher
among both female and male drivers of Eastern European vehicles
(68% {95% CI=64%-72%} and 64% {95% CI=62%-66%}, respectively) than
among female and male drivers of non-Eastern European vehicles (59%
{95% CI=55%-63%} and 56% {95% CI=54%-58%}, respectively).
Reported by: LE Cohen, Environment, Science, and Technology
Attache, MD Laude, Fascell Fellow, US Embassy, Dept of State,
Budapest; G Csaszar, Div of Roads and Road Transport, Ministry of
Transport, Communication, and Water Management; E Komaromi, Dept of
Prevention, Budapest Police Dept; FL Wassersug, Student Services,
American International School of Budapest. Air Pollution and
Respiratory Health Br, Div of Environmental Hazards and Health
Effects, National Center for Environmental Health; National Center
for Injury Prevention and Control, CDC.
Editorial Note
Editorial Note: Safety-belt use legislation, first introduced in
Australia in 1970, is the most effective means of increasing
safety-belt use in many countries (3). At least 35 countries
require safety-belt use (4). In the United States, safety-belt use
is mandatory in 44 states. The only U.S. jurisdictions that have
enacted legislation similar to that in Hungary -- allowing primary
enforcement of safety-belt use in all seating positions -- are
Oregon, California, American Samoa, and the Mariana Islands. When
compared with secondary enforcement laws, implementation of primary
enforcement laws appears to result in greater and more rapid and
sustained increases in safety-belt use (5).
Observations in this study indicate that by May 1993, the
prevalence of safety-belt use by drivers had increased from that
documented by the Ministry of Transport, Communication, and Water
Management in October 1992 (6). In that study, 31% of front-seat
occupants (both drivers and passengers) were belted (6); however,
only 40% of cars had a front-seat passenger. Although recent
changes in the safety-belt use law in Hungary have targeted persons
in rear-seat positions, increased use of safety belts among drivers
may reflect three factors: 1) recent increases in fines, 2)
stricter police enforcement of the law since April 1, 1993, and 3)
increased public awareness generated by the media, which during
April 1993 routinely broadcast information about the changes in the
law.
The findings in this report are subject to at least three
limitations. First, because many Eastern European vehicles have
nonretractable lap/shoulder belts, some drivers of these vehicles
may have been categorized as belted when they may have placed the
belts across their shoulders and laps without buckling them.
Second, this survey also included taxi drivers, who are not
required to wear safety belts, and data differentiating taxis from
other vehicles were not systematically gathered. Therefore, the
percentage of drivers subject to the law who were in compliance was
greater than 61%. Third, other potential sources of bias in the
interpretation of the data from this study include lack of random
selection of observation sites, restriction of observations to the
commuting hour on a single day, and the highly urbanized
environment in which the observations were made.
In Hungary, traffic crashes were the second leading cause of
violent deaths (after suicide) in 1992, resulting in 2346 deaths
(7). Although the number of deaths that could have been prevented
by safety-belt use has not been determined, the crude mortality
rate for motor-vehicle crashes decreased 9% in the month after the
safety-belt use law was expanded (Ministry of Transport,
Communication, and Water Management, unpublished data, 1993). To
increase safety-belt use, law enforcement officials in Budapest
plan to widely disseminate the results of this study on television
and are considering a campaign of expanded and long-term
enforcement of the safety-belt law, with initial emphasis on low
safety-belt use locations identified by this study.
References
Ross A, Baguley C, Hills B, McDonald M, Silcock D. Towards safer
roads in developing countries: a guide for planners and engineers.
Crowthorne, England: Transport and Road Research Laboratory, 1991.
Chorba TL. Assessing technology for preventing injuries in motor
vehicle crashes. Int J Technol Assess Health Care 1991;7:296-314.
Vaaje T. Safety belt usage laws in various countries. In:
Effectiveness of safety belt use laws: a multinational examination.
Washington, DC: US Department of Transportation, National Highway
Traffic Safety Administration, 1986:13-23; publication no.
DOT-HS-807-018.
El-Nour S, Mufti MH. Seat belt legislation and the experience of
the world. Journal of Traffic Medicine 1992;20:83-90.
Escobedo LG, Chorba TL, Remington PL, Anda RF, Sanderson L,
Zaidi AA. The influence of safety belt laws on self-reported safety
belt use in the United States. Accid Anal Prev 1992;24:643-53.
Kozlekedesi Hirkozlesi es Vizðgyi Miniszterium {Ministry of
Transport, Communication, and Water Management}. Szemelygepkocsik
biztonsagi oveinek viselesi aranyai {Frequency of safety belt use
in passenger cars}. Budapest: Technischer Uberwachungs Verein
Hannover Kft., 1992.
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