Public Health
(1990), 104, 155 164
© The Society of Public Health, 1990
Risk-Taking Behaviors and Other Correlates of Seat Belt Use Among University Students W. A. Oleckno ~* and M. J. Blacconiere 2
7School of Allied Health Professions, Northern Illinois University, DeKalb, Illinois 60115; 2Veterans Administration Medical Center. North Chicago, Illinois 60064, USA
A cross-sectional study of 1,077 students enrolled in a large, comprehensive Midwestern university in the United States was conducted to elicit a better understanding of the correlates of seat belt use. Examined were seven risk-taking behaviors, health-promoting behavior, and age, sex, and race. Overall, five of the seven risk-taking behaviors, including cigarette smoking status, drinking status, amount of alcohol consumed, drug use, and drinking and driving were inversely correlated with the frequency of seat belt use (P=0.00). Health-promoting behavior, as measured by a 48-item index, was positively associated with seat belt use (r = 0.21; P = 0.00). Females and whites were more likely to wear seat belts than males or nonwhites, respectively. There was no significant difference in seat belt use by age. Regression analysis on all 11 variables examined revealed that drug use, smoking status, and sex were significant predictors of seat belt use. Overall, the 1 t variables explained 13.3% of the variance in seat belt use. Stepwise regression showed that slightly more than half of the explained variance could be attributed to amount of alcohol consumed and drug use (R 2= 0.071; P = 0.00).
Introduction M o t o r vehicle accidents (MVAs) are a significant public health problem in industrialized nations. ~'2 In the United States in 1986, 47,900 Americans lost their lives to M V A s o f all types. A p p r o x i m a t e l y one-third o f these deaths occurred in y o u n g people 15-24 years o f age? In fact, the fatality rate in this age g r o u p (39.7 per 100,000) was twice that o f all age g r o u p s c o m b i n e d (19.9 per 100,000), 3 m a k i n g M V A s the leading cause o f death a m o n g 15 24 year olds. 4 Fortunately, a significant portion o f the serious injuries and deaths from M V A s can be prevented by wearing seat belts. This fact has been consistently d e m o n s t r a t e d by a n u m b e r o f researchers, including Robertson; 5 Cambell; 6 Evans; 7 C h o r b a , Reinfurt, & H u l k a ; s and O r s a y e t al. 9 Robertson, 5 for example, estimated that seat belts were effective in reducing fatalities f r o m M V A s by a b o u t 50% based on an empirical analysis o f d a t a collected f r o m three states. M o r e recently, O r s a y e t al. 9 f o u n d that seat belt wearers had 60.1% fewer severe injuries, 64.6% fewer hospital admissions, and 66.3% less hospital expenses c o m p a r e d to non-wearers. U n f o r t u n a t e l y , seat belt use in the US has been historically low. ~°'~'~2'~3 A c c o r d i n g to Diane Steed, Administrator o f the N a t i o n a l H i g h w a y Traffic Safety Administration, 'As recently as 1982, only 11% o f A m e r i c a n motorists were 'buckling up ''~4 (p. 3651). F u r t h e r m o r e , m a j o r surveys c o n d u c t e d in the US f r o m 1981-1983 f o u n d that 18-24 year *To whom correspondence should be sent
156
W. A . Oleckno and M. J. Blacconiere
olds, the youngest group studied, used seat belts significantly less than the 25-34, 35-59, and 60 and over age groups. 1° Even after the passage of mandatory seat belt use laws in a number of states in the mid-1980s, the current average usage rate of 46% in the US is still well below that in England, parts of Canada, Australia, New Zealand, Austria, West Germany, and other countries. ~4,~5 The reasons for the relatively low rates of seat belt use are not yet clear, although some research has suggested that failure to wear seat belts may be part of a general pattern o f risk-taking behavior, especially among young people. 16,17'18 Indeed, Jessor 19 speaks of a possible 'syndrome' of risk-taking behavior in adolescents that may carry over into young adulthood. Clearly, a better understanding of the correlates o f seat belt use will have implications for the planning o f programs designed to increase seat belt use and thereby reduce the toll of serious injuries and deaths attributable to their non-use. As aptly noted by Spear and Akers, 'The effectiveness of any intervention program is enhanced by a clear understanding of (1) who within a given population is at high risk for the condition o f interest and (2) what variables are associated with the elevated risk. '2° (p. 336). This study, then, examines the relationship between seat belt use and various risk-taking behaviors and other factors in a relatively young population (i.e., university students) in order to elicit a better understanding o f the correlates of seat belt use in this group.
Methods
Subjects The subjects for this cross-sectional analysis consisted of 1,077 students enrolled in a large, comprehensive Midwestern university in the United States. The respondents were 59% female and 41% male. The overwhelming majority (93%) were between the ages of 17 and 22 years. By class level, 38.0% were freshmen, 34.6% were sophomores, 19.9% were juniors, 6.7% were seniors, and 0.8% were graduate students. The racial and ethnic background of the respondents was as follows: 86.5% white, 5.4% black, 4.3% Asian or Pacific Islander, 2.8% Hispanic, and 1.0% other or unknown. The respondents were enrolled in a variety of academic fields, including business, education, liberal arts and sciences, visual and performing arts, and professional studies. Nearly 96% of the respondents reported never having been married. Procedure The study employed a nonrandom cluster sampling procedure designed to obtain a broad cross section of university students representing a variety of academic majors. To achieve this end, large general education classes enrolling 100 or more students with a distribution of freshmen through seniors were targeted for inclusion in the sample. General education classes include those in the sciences, social sciences, humanities, and other areas from which all undergraduates must select a prescribed number of courses. Data from the university's Office of Registration and Records were used to select classes meeting the criteria outlined above. Cla.ss instructors were then contacted to explain the purpose of the study, secure permission to administer the survey instrument, and schedule appropriate administration times. All students in the selected classes who agreed to participate in the study were surveyed. Although the students were informed orally and in writing that participation was voluntary and anonymous, most students elected to complete the survey instrument. The survey was administered between February and April, 1988.
Risk-Taking and Seat Belt Use
157
Variables
Since this study was part of a larger survey of health behaviors conducted by the investigators, only the results from an analysis o f the responses to selected items of the original instrument are reported here. These items related to cigarette smoking, alcohol consumption, drug use, driving practices, and health-promoting behavior. Specifically, items related to cigarette smoking included current smoking status (Do you currently smoke cigarettes?) and amount smoked (How many cigarettes do you smoke per day?). Items related to alcohol consumption included current drinking status (Do you drink any alcoholic beverages?) and amount consumed (How many alcoholic drinks do you have per week?). One item related to drug use (How often do you use drugs or medication to alter your mood or to help you relax or gain energy?). Items related to driving practices included drinking and driving (How often do you drive after drinking?), speeding (How often do you exceed the posted speed limit when driving a motor vehicle?), and seat belt use (How often do you wear seat belts when you drive or ride in a motor vehicle?). The Health-Promoting Lifestyle Profile, an index of forty-eight items, was used to measure health-promoting behavior (see Appendix for details). Except for current smoking and drinking status, where the response options were dichotomous ('yes' or 'no'), each item provided a range of possible responses relevant to the question being asked. A pilot study conducted prior to the survey in two community health classes revealed an average test-retest reliability for the selected items of 0.83 over a two-week interval (n = 47). In performing correlations and regression analyses all data were analyzed assuming they represented an underlying interval scale of measurement. Comparable nonparametric analyses for zero-order correlations confirmed that this was a reasonable assumption. Because of individual nonresponses to some items, the total sample for overall analyses may be based on slightly less than 1,077 subjects, but in no case less than 99% of the original sample.
Results Seat belt use
Overall, 85.0% (n = 911) of the respondents reported wearing seat belts at least occasionally when driving or riding in a motor vehicle. Fifteen per cent (n = 161) reported never wearing seat belts. Table I presents the frequency of reported seat belt use by age, sex, and race. There was no significant difference in the frequency of seat belt use by age (Z~= 5.97; P = 0.11), but seat belt use varied significantly by sex (Z2 = 23.90; P = 0.00) and race (Z32= 13.71; P = 0.00). In general, female students were more likely to wear seat belts compared to male students. Likewise, white students were more likely to wear seat belts than nonwhite students. Pearson product-moment correlations between seat belt use and selected factors are shown in Tables II and III. These findings are discussed in the sections which follow. Cigarette smoking and seat belt use
As shown in Table [I, cigarette smoking status was inversely related to the frequency o f seat belt use (r-- - 0.13; P = 0.00). Thus, students who reported smoking cigarettes were less
158
W. A. Oleckno and M. J. Blacconiere Table I
Frequency and percent seat belt use by age, sex, and race Never
Frequency of seat belt use Sometimes Often No. (%) No. (%)
Routinely No. (%)
Characteristic
No.
(%)
Age (years) 17-19 20 or more
88 73
(14.0) (16.4)
235 135
(37.5) (30.4)
115 92
(18.3) (20.7)
189 144
(30.1)
90 70
(20.6) (ll.1)
152 217
(34.8) (34.4)
85 121
(19.5) (19.2)
110 222
(25.2) (35.2)
143 17 161
(15.4) (12.0) (15.0)
301 68 370
(32.4) (47.9) (34.5)
182 25 207
(19.6) (l 7.6) (19.3)
302 32 334
(32.5) (22.5) (31.2)
(32.4)
Sex
Male Female Race White Nonwhite Overall
Table 1I Correlations of cigarette smoking, alcohol consumption, and other factors with seat belt use
Factor Cigarette smoking Smoking status Amount smoked Alcohol consumption Drinking status Amount consumed Drug use Driving practices Drinking and driving Speeding Health-promoting behavior
Correlation coefficient (r) Significance - 0.13 - 0.03
0.00 0.64
- 0.11 - 0.22 - 0.15
0.00 0.00 0.00
- 0.19 - 0.05
0.00 0.11
0.21
0.00
likely to use seat belts on a r e g u l a r basis c o m p a r e d to those w h o classified themselves as n o n s m o k e r s . M o d e s t b u t significant inverse a s s o c i a t i o n s b e t w e e n s m o k i n g status a n d seat belt use were also f o u n d in each o f the age, sex, a n d race s u b g r o u p s d e p i c t e d in T a b l e III. A m o n g s t u d e n t s m o k e r s in general, the a m o u n t o f cigarettes s m o k e d was not significantly c o r r e l a t e d w i t h the f r e q u e n c y o f seat belt use (see T a b l e II). Q u i t e a different p a t t e r n e m e r g e d , however, when age-specific s u b g r o u p s were e x a m i n e d . A s p r e s e n t e d in T a b l e III, there was a n inverse a s s o c i a t i o n b e t w e e n a m o u n t o f cigarettes s m o k e d a n d seat
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belt use in the 17-19-year-old group, which reached significance at conventional levels (r = - 0 . 1 7 ; P = 0.05). By contrast, the association was positive (r = 0.10) in the 20 and over age group, although not statistically significant (P=0.30). None of the correlation coefficients in the sex and race subgroups was significant for a m o u n t of cigarettes smoked and seat belt use.
Alcohol consumption and seat belt use
Overall, alcohol consumption (drinking status) was inversely correlated with the frequency of seat belt use (see Table II). In other words, students who reported drinking alcohol (90.2% of the sample) were less likely to use seat belts on a regular basis than those who reported being nondrinkers. This relationship remained relatively consistent a m o n g age, sex, and race subgroups as noted in Table III. Only in nonwhites was the association not significant. Even here, however, the direction and magnitude o f the correlation coefficient ( r = - 0 . 1 3 ) were consistent with the overall finding. The amount of alcohol consumed by student drinkers was also inversely associated with the frequency o f seat belt use as shown in Table II. This association was fairly consistent in the age and sex subgroups and a m o n g whites (Table III). The correlation coefficient for whites was significantly different, however, from the coefficient for nonwhites (r = - 0.26 vs. r= -0.01; P
(1990), 104, 155 164
© The Society of Public Health, 1990
Risk-Taking Behaviors and Other Correlates of Seat Belt Use Among University Students W. A. Oleckno ~* and M. J. Blacconiere 2
7School of Allied Health Professions, Northern Illinois University, DeKalb, Illinois 60115; 2Veterans Administration Medical Center. North Chicago, Illinois 60064, USA
A cross-sectional study of 1,077 students enrolled in a large, comprehensive Midwestern university in the United States was conducted to elicit a better understanding of the correlates of seat belt use. Examined were seven risk-taking behaviors, health-promoting behavior, and age, sex, and race. Overall, five of the seven risk-taking behaviors, including cigarette smoking status, drinking status, amount of alcohol consumed, drug use, and drinking and driving were inversely correlated with the frequency of seat belt use (P=0.00). Health-promoting behavior, as measured by a 48-item index, was positively associated with seat belt use (r = 0.21; P = 0.00). Females and whites were more likely to wear seat belts than males or nonwhites, respectively. There was no significant difference in seat belt use by age. Regression analysis on all 11 variables examined revealed that drug use, smoking status, and sex were significant predictors of seat belt use. Overall, the 1 t variables explained 13.3% of the variance in seat belt use. Stepwise regression showed that slightly more than half of the explained variance could be attributed to amount of alcohol consumed and drug use (R 2= 0.071; P = 0.00).
Introduction M o t o r vehicle accidents (MVAs) are a significant public health problem in industrialized nations. ~'2 In the United States in 1986, 47,900 Americans lost their lives to M V A s o f all types. A p p r o x i m a t e l y one-third o f these deaths occurred in y o u n g people 15-24 years o f age? In fact, the fatality rate in this age g r o u p (39.7 per 100,000) was twice that o f all age g r o u p s c o m b i n e d (19.9 per 100,000), 3 m a k i n g M V A s the leading cause o f death a m o n g 15 24 year olds. 4 Fortunately, a significant portion o f the serious injuries and deaths from M V A s can be prevented by wearing seat belts. This fact has been consistently d e m o n s t r a t e d by a n u m b e r o f researchers, including Robertson; 5 Cambell; 6 Evans; 7 C h o r b a , Reinfurt, & H u l k a ; s and O r s a y e t al. 9 Robertson, 5 for example, estimated that seat belts were effective in reducing fatalities f r o m M V A s by a b o u t 50% based on an empirical analysis o f d a t a collected f r o m three states. M o r e recently, O r s a y e t al. 9 f o u n d that seat belt wearers had 60.1% fewer severe injuries, 64.6% fewer hospital admissions, and 66.3% less hospital expenses c o m p a r e d to non-wearers. U n f o r t u n a t e l y , seat belt use in the US has been historically low. ~°'~'~2'~3 A c c o r d i n g to Diane Steed, Administrator o f the N a t i o n a l H i g h w a y Traffic Safety Administration, 'As recently as 1982, only 11% o f A m e r i c a n motorists were 'buckling up ''~4 (p. 3651). F u r t h e r m o r e , m a j o r surveys c o n d u c t e d in the US f r o m 1981-1983 f o u n d that 18-24 year *To whom correspondence should be sent
156
W. A . Oleckno and M. J. Blacconiere
olds, the youngest group studied, used seat belts significantly less than the 25-34, 35-59, and 60 and over age groups. 1° Even after the passage of mandatory seat belt use laws in a number of states in the mid-1980s, the current average usage rate of 46% in the US is still well below that in England, parts of Canada, Australia, New Zealand, Austria, West Germany, and other countries. ~4,~5 The reasons for the relatively low rates of seat belt use are not yet clear, although some research has suggested that failure to wear seat belts may be part of a general pattern o f risk-taking behavior, especially among young people. 16,17'18 Indeed, Jessor 19 speaks of a possible 'syndrome' of risk-taking behavior in adolescents that may carry over into young adulthood. Clearly, a better understanding of the correlates o f seat belt use will have implications for the planning o f programs designed to increase seat belt use and thereby reduce the toll of serious injuries and deaths attributable to their non-use. As aptly noted by Spear and Akers, 'The effectiveness of any intervention program is enhanced by a clear understanding of (1) who within a given population is at high risk for the condition o f interest and (2) what variables are associated with the elevated risk. '2° (p. 336). This study, then, examines the relationship between seat belt use and various risk-taking behaviors and other factors in a relatively young population (i.e., university students) in order to elicit a better understanding o f the correlates of seat belt use in this group.
Methods
Subjects The subjects for this cross-sectional analysis consisted of 1,077 students enrolled in a large, comprehensive Midwestern university in the United States. The respondents were 59% female and 41% male. The overwhelming majority (93%) were between the ages of 17 and 22 years. By class level, 38.0% were freshmen, 34.6% were sophomores, 19.9% were juniors, 6.7% were seniors, and 0.8% were graduate students. The racial and ethnic background of the respondents was as follows: 86.5% white, 5.4% black, 4.3% Asian or Pacific Islander, 2.8% Hispanic, and 1.0% other or unknown. The respondents were enrolled in a variety of academic fields, including business, education, liberal arts and sciences, visual and performing arts, and professional studies. Nearly 96% of the respondents reported never having been married. Procedure The study employed a nonrandom cluster sampling procedure designed to obtain a broad cross section of university students representing a variety of academic majors. To achieve this end, large general education classes enrolling 100 or more students with a distribution of freshmen through seniors were targeted for inclusion in the sample. General education classes include those in the sciences, social sciences, humanities, and other areas from which all undergraduates must select a prescribed number of courses. Data from the university's Office of Registration and Records were used to select classes meeting the criteria outlined above. Cla.ss instructors were then contacted to explain the purpose of the study, secure permission to administer the survey instrument, and schedule appropriate administration times. All students in the selected classes who agreed to participate in the study were surveyed. Although the students were informed orally and in writing that participation was voluntary and anonymous, most students elected to complete the survey instrument. The survey was administered between February and April, 1988.
Risk-Taking and Seat Belt Use
157
Variables
Since this study was part of a larger survey of health behaviors conducted by the investigators, only the results from an analysis o f the responses to selected items of the original instrument are reported here. These items related to cigarette smoking, alcohol consumption, drug use, driving practices, and health-promoting behavior. Specifically, items related to cigarette smoking included current smoking status (Do you currently smoke cigarettes?) and amount smoked (How many cigarettes do you smoke per day?). Items related to alcohol consumption included current drinking status (Do you drink any alcoholic beverages?) and amount consumed (How many alcoholic drinks do you have per week?). One item related to drug use (How often do you use drugs or medication to alter your mood or to help you relax or gain energy?). Items related to driving practices included drinking and driving (How often do you drive after drinking?), speeding (How often do you exceed the posted speed limit when driving a motor vehicle?), and seat belt use (How often do you wear seat belts when you drive or ride in a motor vehicle?). The Health-Promoting Lifestyle Profile, an index of forty-eight items, was used to measure health-promoting behavior (see Appendix for details). Except for current smoking and drinking status, where the response options were dichotomous ('yes' or 'no'), each item provided a range of possible responses relevant to the question being asked. A pilot study conducted prior to the survey in two community health classes revealed an average test-retest reliability for the selected items of 0.83 over a two-week interval (n = 47). In performing correlations and regression analyses all data were analyzed assuming they represented an underlying interval scale of measurement. Comparable nonparametric analyses for zero-order correlations confirmed that this was a reasonable assumption. Because of individual nonresponses to some items, the total sample for overall analyses may be based on slightly less than 1,077 subjects, but in no case less than 99% of the original sample.
Results Seat belt use
Overall, 85.0% (n = 911) of the respondents reported wearing seat belts at least occasionally when driving or riding in a motor vehicle. Fifteen per cent (n = 161) reported never wearing seat belts. Table I presents the frequency of reported seat belt use by age, sex, and race. There was no significant difference in the frequency of seat belt use by age (Z~= 5.97; P = 0.11), but seat belt use varied significantly by sex (Z2 = 23.90; P = 0.00) and race (Z32= 13.71; P = 0.00). In general, female students were more likely to wear seat belts compared to male students. Likewise, white students were more likely to wear seat belts than nonwhite students. Pearson product-moment correlations between seat belt use and selected factors are shown in Tables II and III. These findings are discussed in the sections which follow. Cigarette smoking and seat belt use
As shown in Table [I, cigarette smoking status was inversely related to the frequency o f seat belt use (r-- - 0.13; P = 0.00). Thus, students who reported smoking cigarettes were less
158
W. A. Oleckno and M. J. Blacconiere Table I
Frequency and percent seat belt use by age, sex, and race Never
Frequency of seat belt use Sometimes Often No. (%) No. (%)
Routinely No. (%)
Characteristic
No.
(%)
Age (years) 17-19 20 or more
88 73
(14.0) (16.4)
235 135
(37.5) (30.4)
115 92
(18.3) (20.7)
189 144
(30.1)
90 70
(20.6) (ll.1)
152 217
(34.8) (34.4)
85 121
(19.5) (19.2)
110 222
(25.2) (35.2)
143 17 161
(15.4) (12.0) (15.0)
301 68 370
(32.4) (47.9) (34.5)
182 25 207
(19.6) (l 7.6) (19.3)
302 32 334
(32.5) (22.5) (31.2)
(32.4)
Sex
Male Female Race White Nonwhite Overall
Table 1I Correlations of cigarette smoking, alcohol consumption, and other factors with seat belt use
Factor Cigarette smoking Smoking status Amount smoked Alcohol consumption Drinking status Amount consumed Drug use Driving practices Drinking and driving Speeding Health-promoting behavior
Correlation coefficient (r) Significance - 0.13 - 0.03
0.00 0.64
- 0.11 - 0.22 - 0.15
0.00 0.00 0.00
- 0.19 - 0.05
0.00 0.11
0.21
0.00
likely to use seat belts on a r e g u l a r basis c o m p a r e d to those w h o classified themselves as n o n s m o k e r s . M o d e s t b u t significant inverse a s s o c i a t i o n s b e t w e e n s m o k i n g status a n d seat belt use were also f o u n d in each o f the age, sex, a n d race s u b g r o u p s d e p i c t e d in T a b l e III. A m o n g s t u d e n t s m o k e r s in general, the a m o u n t o f cigarettes s m o k e d was not significantly c o r r e l a t e d w i t h the f r e q u e n c y o f seat belt use (see T a b l e II). Q u i t e a different p a t t e r n e m e r g e d , however, when age-specific s u b g r o u p s were e x a m i n e d . A s p r e s e n t e d in T a b l e III, there was a n inverse a s s o c i a t i o n b e t w e e n a m o u n t o f cigarettes s m o k e d a n d seat
Risk-Taking and Seat Belt Use
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W. A. Oleckno and M . J. Blacconiere
belt use in the 17-19-year-old group, which reached significance at conventional levels (r = - 0 . 1 7 ; P = 0.05). By contrast, the association was positive (r = 0.10) in the 20 and over age group, although not statistically significant (P=0.30). None of the correlation coefficients in the sex and race subgroups was significant for a m o u n t of cigarettes smoked and seat belt use.
Alcohol consumption and seat belt use
Overall, alcohol consumption (drinking status) was inversely correlated with the frequency of seat belt use (see Table II). In other words, students who reported drinking alcohol (90.2% of the sample) were less likely to use seat belts on a regular basis than those who reported being nondrinkers. This relationship remained relatively consistent a m o n g age, sex, and race subgroups as noted in Table III. Only in nonwhites was the association not significant. Even here, however, the direction and magnitude o f the correlation coefficient ( r = - 0 . 1 3 ) were consistent with the overall finding. The amount of alcohol consumed by student drinkers was also inversely associated with the frequency o f seat belt use as shown in Table II. This association was fairly consistent in the age and sex subgroups and a m o n g whites (Table III). The correlation coefficient for whites was significantly different, however, from the coefficient for nonwhites (r = - 0.26 vs. r= -0.01; P
