This article was downloaded by: [New York University] On: 23 June 2015, At: 06:22 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Traffic Injury Prevention Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcpi20
Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand a
a
Arunwan Tongklao M.D. , Somchit Jaruratanasirikul M.D. & Hutcha Sriplung M.D.
b
a
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand b
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand Accepted author version posted online: 11 Jun 2015.
Click for updates To cite this article: Arunwan Tongklao M.D., Somchit Jaruratanasirikul M.D. & Hutcha Sriplung M.D. (2015): Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand, Traffic Injury Prevention, DOI: 10.1080/15389588.2015.1045062 To link to this article: http://dx.doi.org/10.1080/15389588.2015.1045062
Disclaimer: This is a version of an unedited manuscript that has been accepted for publication. As a service to authors and researchers we are providing this version of the accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proof will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to this version also.
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
ACCEPTED MANUSCRIPT Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand 1
Arunwan Tongklao, M.D., 1Somchit Jaruratanasirikul, M.D., 2Hutcha Sriplung. M.D.
1
Department of Pediatrics, 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla
Downloaded by [New York University] at 06:22 23 June 2015
University, Hat Yai, Songkhla, 90110 Thailand
Corresponding author: Somchit Jaruratanasirikul, M.D. Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand Tel: 66-074-429618 Fax: 66-074-429618 Email: [email protected]
1
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT Abstract Background: In Thailand, road-traffic injuries are the leading cause of death of youth ages 1519 years with 80% of the injuries and deaths from motorcycle accidents. Objectives: To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors.
Downloaded by [New York University] at 06:22 23 June 2015
Method: A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors and helmet use while riding. Results: Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or being a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/hr, not wearing a helmet while riding and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively). Conclusion: Nearly two-thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries as more than 50% of them had
2
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT ridden at high speed, or not worn a helmet while riding, and some of them had consumed alcohol before riding.
Downloaded by [New York University] at 06:22 23 June 2015
Keywords: adolescents, motorcycle accident, helmet, traffic injuries
3
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT Introduction Road-traffic injuries have been identified as a global health problem and ranked as one of the leading causes of death, particularly in middle- and low-income countries (Ameratunga et al. 2006; Sharma 2008). Thailand is one of the developing countries in Southeast Asia, and in Thailand, road-traffic injuries have been ranked as the leading cause of death in the adolescent
Downloaded by [New York University] at 06:22 23 June 2015
and young adult age groups (Chadbunchachai et al. 2012). According to the Bureau of Policy and Strategy, Ministry of Public Health, Thailand (2013), traffic road accidents ranged from 60,000-80,000 per year during 2010-2012 with deaths resulting from road accidents (ICD-10, V01-V99) of 13,000-14,000 per year (Road Safety Directing Center, Thailand 2014). The age group that accounted for the highest percentage of motorcycle deaths (15.8%) was the adolescent age group (15-19 years of age), with an also high percentage of deaths in the 10-14 years age group of 3.8% (Bureau of Policy and Strategy, Thailand 2013; Department of Land Transport, Thailand 2013). As with most developing countries, motorcycles are widely used in Thailand as an economical mode of motorized transportation in middle- to low-income families. According to the Annual Report of the Thailand, Department of Land Transport, Thailand (2013), the registered number of motor vehicles in Thailand in 2013 was 33.1 million, of which nearly 20 million were motorcycles, almost twice as many as all other motor vehicles combined. In order to reduce the morbidity from motorcycle-related injuries and deaths, the Thai government passed a Compulsory Helmet Law nationwide in 1994-1995 ordering that all motorcyclists, including both riders and pillion passengers, must wear a helmet while riding a motorcycle, which was
4
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT expected to reduce the rate of head injuries from traffic accidents. However, despite the enactment of the law, large numbers of motorcycle riders can still be seen throughout the country riding without wearing a helmet. This is surely leading to higher-than-necessary rates of injuries and death in these young people, but to date there have been no published studies investigating motorcycle riding and helmet use in children and adolescents younger than 18 years.
Downloaded by [New York University] at 06:22 23 June 2015
Hat Yai is a business center and the largest city in Southern Thailand, with a population of about 160,000, of which about one-fourth are younger than 18 years of age. Although the minimum age for obtaining a Thai motorcycle driving license is 18 years, younger adolescents riding motorcycles are regularly seen in the streets and even on the main roads. Hence, the objective of this study was to determine the prevalence of underage motorcycle riders and their risk behaviors, particularly in regard to wearing helmets.
5
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT Subjects and methods A cross-sectional study was conducted between June 2011 and March 2012 in 9 primary and secondary schools in Hat Yai municipality, with subjects randomly recruited by probability proportional to size sampling (Figure 1) from 3 private and 2 public primary schools (3rd-6th grade), and 2 private and 2 public secondary schools (7th-12th grade). Of the total 2,471 recruited
Downloaded by [New York University] at 06:22 23 June 2015
students, ages 8 to 18 years, 893 (36.1%) were male and 1,578 (63.9%) were female. The participants were divided into 3 age groups and separated by gender in order to compare whether there were differences in prevalence rates of being a rider or a pillion passenger amongst the children (age younger than 10 years), young adolescents (age 10-15 years) and middle-age adolescents (age older than 15-18 years). The questionnaire designed for this study included questions on demographic data (gender, age, family status), motorcycle riding data from the past 3 months (frequency, speed, type of road while driving, alcohol consumption, and helmet use) or being a motorcycle passenger (helmet use, type of road, and riding with a driver who had consumed alcohol) and general knowledge of the laws involved with riding a motorcycle and helmet use for both riders and pillion passengers. A “rider” was defined by having driven a motorcycle on their own at least once during the previous 3 months and a “pillion passenger” was defined as one who had never been a rider but had been a passenger at least once. For riding behaviors that change from time to time while riding such as frequency, speed and type of road, the participants were instructed to report the most frequent pattern they used while motorcycle riding.
6
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT The questionnaire was pre-tested for validity by 5 pediatricians, with an index of itemobjective congruence score of 0.80 and reliability by test-retest in 50 students, 4 weeks apart, with a correlation coefficient of 0.90. The students were given twenty minutes during a school guidance class to complete the questionnaires. Written informed consent and assent was obtained from all participants and their parents.
Downloaded by [New York University] at 06:22 23 June 2015
This study was approved by the Institutional Review Board and the Ethics Committee of the Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. Statistical analysis Frequencies or percentages were used for descriptive analyses. Chi-squared and Fisher exact test were used to compare the variable differences in categorical data between males and females. ANOVA was used to compare the differences of variables among the 3 age groups. Univariate logistic regression analysis was used to analyse the association between helmet use while riding and knowledge that helmet use can prevent head injury from motorcycle accidents. Stepwise multivariate regression analysis was used to analyse whether there were any associations between motorcycle injuries and risk behaviors such as frequency of riding, type of road while riding, speed greater than 60 km/hr, not wearing a helmet while riding, and alcohol consumption before riding. Statistical differences were deemed significant at a p value
Traffic Injury Prevention Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcpi20
Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand a
a
Arunwan Tongklao M.D. , Somchit Jaruratanasirikul M.D. & Hutcha Sriplung M.D.
b
a
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand b
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand Accepted author version posted online: 11 Jun 2015.
Click for updates To cite this article: Arunwan Tongklao M.D., Somchit Jaruratanasirikul M.D. & Hutcha Sriplung M.D. (2015): Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand, Traffic Injury Prevention, DOI: 10.1080/15389588.2015.1045062 To link to this article: http://dx.doi.org/10.1080/15389588.2015.1045062
Disclaimer: This is a version of an unedited manuscript that has been accepted for publication. As a service to authors and researchers we are providing this version of the accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proof will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to this version also.
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
ACCEPTED MANUSCRIPT Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand 1
Arunwan Tongklao, M.D., 1Somchit Jaruratanasirikul, M.D., 2Hutcha Sriplung. M.D.
1
Department of Pediatrics, 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla
Downloaded by [New York University] at 06:22 23 June 2015
University, Hat Yai, Songkhla, 90110 Thailand
Corresponding author: Somchit Jaruratanasirikul, M.D. Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110 Thailand Tel: 66-074-429618 Fax: 66-074-429618 Email: [email protected]
1
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT Abstract Background: In Thailand, road-traffic injuries are the leading cause of death of youth ages 1519 years with 80% of the injuries and deaths from motorcycle accidents. Objectives: To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors.
Downloaded by [New York University] at 06:22 23 June 2015
Method: A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors and helmet use while riding. Results: Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or being a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/hr, not wearing a helmet while riding and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively). Conclusion: Nearly two-thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries as more than 50% of them had
2
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT ridden at high speed, or not worn a helmet while riding, and some of them had consumed alcohol before riding.
Downloaded by [New York University] at 06:22 23 June 2015
Keywords: adolescents, motorcycle accident, helmet, traffic injuries
3
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT Introduction Road-traffic injuries have been identified as a global health problem and ranked as one of the leading causes of death, particularly in middle- and low-income countries (Ameratunga et al. 2006; Sharma 2008). Thailand is one of the developing countries in Southeast Asia, and in Thailand, road-traffic injuries have been ranked as the leading cause of death in the adolescent
Downloaded by [New York University] at 06:22 23 June 2015
and young adult age groups (Chadbunchachai et al. 2012). According to the Bureau of Policy and Strategy, Ministry of Public Health, Thailand (2013), traffic road accidents ranged from 60,000-80,000 per year during 2010-2012 with deaths resulting from road accidents (ICD-10, V01-V99) of 13,000-14,000 per year (Road Safety Directing Center, Thailand 2014). The age group that accounted for the highest percentage of motorcycle deaths (15.8%) was the adolescent age group (15-19 years of age), with an also high percentage of deaths in the 10-14 years age group of 3.8% (Bureau of Policy and Strategy, Thailand 2013; Department of Land Transport, Thailand 2013). As with most developing countries, motorcycles are widely used in Thailand as an economical mode of motorized transportation in middle- to low-income families. According to the Annual Report of the Thailand, Department of Land Transport, Thailand (2013), the registered number of motor vehicles in Thailand in 2013 was 33.1 million, of which nearly 20 million were motorcycles, almost twice as many as all other motor vehicles combined. In order to reduce the morbidity from motorcycle-related injuries and deaths, the Thai government passed a Compulsory Helmet Law nationwide in 1994-1995 ordering that all motorcyclists, including both riders and pillion passengers, must wear a helmet while riding a motorcycle, which was
4
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT expected to reduce the rate of head injuries from traffic accidents. However, despite the enactment of the law, large numbers of motorcycle riders can still be seen throughout the country riding without wearing a helmet. This is surely leading to higher-than-necessary rates of injuries and death in these young people, but to date there have been no published studies investigating motorcycle riding and helmet use in children and adolescents younger than 18 years.
Downloaded by [New York University] at 06:22 23 June 2015
Hat Yai is a business center and the largest city in Southern Thailand, with a population of about 160,000, of which about one-fourth are younger than 18 years of age. Although the minimum age for obtaining a Thai motorcycle driving license is 18 years, younger adolescents riding motorcycles are regularly seen in the streets and even on the main roads. Hence, the objective of this study was to determine the prevalence of underage motorcycle riders and their risk behaviors, particularly in regard to wearing helmets.
5
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT Subjects and methods A cross-sectional study was conducted between June 2011 and March 2012 in 9 primary and secondary schools in Hat Yai municipality, with subjects randomly recruited by probability proportional to size sampling (Figure 1) from 3 private and 2 public primary schools (3rd-6th grade), and 2 private and 2 public secondary schools (7th-12th grade). Of the total 2,471 recruited
Downloaded by [New York University] at 06:22 23 June 2015
students, ages 8 to 18 years, 893 (36.1%) were male and 1,578 (63.9%) were female. The participants were divided into 3 age groups and separated by gender in order to compare whether there were differences in prevalence rates of being a rider or a pillion passenger amongst the children (age younger than 10 years), young adolescents (age 10-15 years) and middle-age adolescents (age older than 15-18 years). The questionnaire designed for this study included questions on demographic data (gender, age, family status), motorcycle riding data from the past 3 months (frequency, speed, type of road while driving, alcohol consumption, and helmet use) or being a motorcycle passenger (helmet use, type of road, and riding with a driver who had consumed alcohol) and general knowledge of the laws involved with riding a motorcycle and helmet use for both riders and pillion passengers. A “rider” was defined by having driven a motorcycle on their own at least once during the previous 3 months and a “pillion passenger” was defined as one who had never been a rider but had been a passenger at least once. For riding behaviors that change from time to time while riding such as frequency, speed and type of road, the participants were instructed to report the most frequent pattern they used while motorcycle riding.
6
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT The questionnaire was pre-tested for validity by 5 pediatricians, with an index of itemobjective congruence score of 0.80 and reliability by test-retest in 50 students, 4 weeks apart, with a correlation coefficient of 0.90. The students were given twenty minutes during a school guidance class to complete the questionnaires. Written informed consent and assent was obtained from all participants and their parents.
Downloaded by [New York University] at 06:22 23 June 2015
This study was approved by the Institutional Review Board and the Ethics Committee of the Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. Statistical analysis Frequencies or percentages were used for descriptive analyses. Chi-squared and Fisher exact test were used to compare the variable differences in categorical data between males and females. ANOVA was used to compare the differences of variables among the 3 age groups. Univariate logistic regression analysis was used to analyse the association between helmet use while riding and knowledge that helmet use can prevent head injury from motorcycle accidents. Stepwise multivariate regression analysis was used to analyse whether there were any associations between motorcycle injuries and risk behaviors such as frequency of riding, type of road while riding, speed greater than 60 km/hr, not wearing a helmet while riding, and alcohol consumption before riding. Statistical differences were deemed significant at a p value
