Accident Analysis and Prevention 43 (2011) 889897

Contents lists available at ScienceDirect

Accident Analysis and Prevention

journal homepage: www.elsevier.com/locate/aap

Attitudes and behavior of Chinese drivers regarding seatbelt use

Yueng-Hsiang Huang a, , Wei Zhang b , Lauren Murphy c , Guangyuan Shi b , Yanjie Lin b
a

Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA
Department of Industrial Engineering, Tsinghua University, Beijing, China
c
Department of Psychology, Portland State University, Portland, OR, USA
b

a r t i c l e

i n f o

Article history:
Received 18 May 2010
Received in revised form 20 October 2010
Accepted 8 November 2010
Keywords:
Chinese drivers
Seatbelt use

a b s t r a c t
In the current study, research was conducted in ve cities in China to examine seatbelt use and to explore
Chinese drivers attitudes toward using seatbelts. Multiple data collection methods consisted of 35 initial
semi-structured interviews to create questions for an in-person survey and 500 driver observations that
included administering the in-person survey. Questions explored were why Chinese drivers use or do not
use seatbelts and what they think would be the best interventions to increase the rate of seatbelt use in
Chinese drivers. The relationships between various personal characteristics and seatbelt use rates were
investigated. Also examined were the relationships between seatbelt use (both objective observation
and subjective self-reported use) and self-reported car crashes and trafc violations. This study provides
insight into the attitudes of Chinese drivers on seatbelt use and potential interventions.
2010 Elsevier Ltd. All rights reserved.

1. Introduction
1.1. Why research seatbelt use in China?
China is not only the largest developing country, but it is classied as the largest country overall by population with over 1.3
billion people (The World Bank, 2010). Along with the increase in
population and development in China has come a growth in the
demand for motor vehicles. The nations sales of passenger cars,
buses and trucks have increased dramatically from over 5 million
in 2004, to over 8 million in 2007, and to 13.6 million in 2009
(CAAM, 2010), making China the worlds largest market for motor
vehicles. During the 1990s, motor vehicle production tripled in
China (Zhou et al., 2003), and in 2009, China became the worlds
largest manufacturer, as well as consumer, of automobiles, achieving 23% of the worldwide production of motor vehicles (ACEA,
2010).
With so many vehicles on the roads, the trafc fatality number in China climbed to 109,381 people in 2003, with that being
the highest number in any country (CRTAS, 2003), accounting for
roughly 20% of the total trafc fatalities in the entire world that
year. The number of trafc fatalities in China increased by 95%
between 1985 and 2005, with 3.9 deaths per 100,000 people in
1985 to 7.6 deaths per 100,000 people in 2005 (Hu et al., 2008),
and it is predicted that deaths as a result of trafc accidents will

Corresponding author. Tel.: +1 508 497 0208; fax: +1 508 435 0482.
E-mail address: Yueng-hsiang.Huang@Libertymutual.com (Y.-H. Huang).
0001-4575/$ see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.aap.2010.11.009

increase by 92% between 2000 and 2020 (Kopitis and Cropper,

2005). These numbers are alarming, and are made more so when
it is stated that trafc fatalities are the leading cause of death in
China for people up to 45 years of age (Hu et al., 2008). Compared
to the United States, the largest developed country, during approximately the same time period, the fatalities for China per vehicle
(China: US = 17.6:1) and per driver (China: US = 6.7:1) were much
higher (AUSTST, 2002; CRTAS, 2002). As seen by the drastic difference between the US and China, and given the fact that over 90%
of trafc fatalities occur in low-income and middle-income countries (World Health Organization, 2009), it is obvious that more
attention regarding road safety is vital for those countries in the
most need.
There have been many research studies showing that the
number of injuries from vehicle accidents has been signicantly
decreased by the use of seatbelts, with seatbelts minimizing the
extent of those injuries that do occur (Bendak, 2005; Cooper, 1994;
Evans, 1996; Koushki et al., 2002; Wang and Jiang, 2003). By
restraining people in their seats during vehicle accidents, seatbelts
prevent the occupants from being ejected from the vehicle or from
hitting objects that are close by, thereby reducing the severity of
injuries suffered. According to the Highway Trafc Safety Administration (NHTSA, June 2009), use of seatbelts in passenger cars saved
an estimated 13,250 lives in the US in 2008 and over 75,000 lives
between 2004 and 2008. The United States had a national seatbelt use rate in 2008 of 83%, ranging from 66.8% in Massachusetts
to 97.2% in Michigan (NHTSA, April 2009). The National Safety
Council reports it is estimated that in 2007 more than 1600 lives
could have been saved and 22,000 injuries prevented if seatbelt use
were at least 90% in every state in the US (National Safety Council,

890

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

2010). The rates in other developed countries are 90% or more (Eby
et al., 2000, 2002; Eby and Vivoda, 2003; European Transport Safety
Council, 1996; Filde et al., 2004; Transport Canada, 2000; Vivoda
et al., 2004; Wells et al., 2002).
Recently, several studies started exploring seatbelt use in China
and showed that the seatbelt use rate varied widely between 7%
and 65% (Fleiter et al., 2009; Passmore and Ozanne-Smith, 2006;
Routley et al., 2008; Stevenson et al., 2007; Zhang et al., 2006). For
example, one observational study conducted in Beijing, in which
approximately 2300 drivers were observed, indicated the average
use rate was 63.6% (Zhang et al., 2006). Routley et al. (2008) found
the rate of wearing seatbelts was 49.9% in Nanjing and 47.4% in
Zhoushan for drivers, 9.1% in Nanjing and 1.0% in Zhoushan for front
seat passengers, and 0.5% in Nanjing and 0.2% in Zhoushan for rear
passengers. Another study from Routley et al. (2009) also found
that 31.7% of taxi drivers (results from roadside observation) and
20.4% (in-taxi observation) in Nanjing use seatbelts. A smaller study
observing 235 taxi drivers in Beijing in 2004 revealed that only
7.7% were correctly wearing a belt (Passmore and Ozanne-Smith,
2006). This wide variation makes it difcult to have a relatively
clear understanding of the nationwide seatbelt use situation. One
limitation of these prior studies is that all the cities examined (Beijing, Nanjing, Guangzhou, Nanning, and Zhoushan) are very large
cities. It is obvious that more research is needed to explore the issue
of safety belt use in China (Zhang et al., 2006).
A few studies have provided information on the design of
interventions for developing and low-income countries for improving road safety (e.g., Forjuoh, 2003; Forjuoh and Li, 1996). One
study in particular (i.e., Stevenson et al., 2007) involved a seatbelt intervention project in China which included three sections:
health promotion (e.g., running television ads), training program
(e.g., conducting train-the-trainer programs), and law enforcement
improvement (e.g., better execution of the laws by police). After
spending 3 million RMB (approximately 400K US dollars) for the
project, the authors reported that, although there was a signicant
increase in the prevalence of seatbelt use in the intervention city
(Guangzhou) compared to the control city (Nanning), the prevalence of seatbelt use in the intervention city remains low (62%)
when compared to other highly motorized countries (e.g., 83% in
the US and 95% in Australia). It was reported by the project investigators that the level of change was not as originally expected.

1.2. The attitudes of Chinese drivers regarding seatbelt use

According to the Theory of Planned Behavior (Ajzen, 1988,
1991), attitudes inuence behavior. If attitudes toward specic
behaviors are clearer, there may be a better chance for affecting
change in the behavior. Although prior intervention studies (e.g.,
Stevenson et al., 2007) have shown some success in improving the
seatbelt use in China, perhaps it could be improved upon through
a more in-depth examination of Chinese drivers attitudes toward
seatbelt use. Stevenson et al. (2007) made a start, from their focus
group results, at illustrating some reasons for Chinese seatbelt
non-use, such as forgetting, uncomfortable, annoying, low
speed, and traveling short distances. Quantitative data needs to
be gathered and analyzed to examine why Chinese drivers wear
or do not wear seatbelts in order to determine the best methods/interventions for improving seatbelt use for Chinese drivers.
The rst purpose of this study is:
Purpose 1. To examine Chinese drivers attitudes toward seatbelt
use, using both qualitative and quantitative methods, by exploring
the reasons why Chinese drivers use or dont use seatbelts and what
they think would be the best interventions to increase the rate of
seatbelt use in Chinese drivers.

1.3. The relationship between certain personal characteristics

and seatbelt use
Many studies have shown that certain personal characteristics
(e.g., gender, socioeconomic status) were correlated with seatbelt
use rate (e.g., Bendak, 2005; Wells et al., 2002). Li et al. (2006)
compared two types of personal characteristics in their study conducted in China drivers of different car types (taxi/passenger
car/other type) and male versus female drivers to see whether
there were differences in the use and non-use of seatbelts. The
results of their study showed that people who drove passenger
cars and female drivers had higher rates of proper use of seatbelts in both Guangzhou and Nanning cities. The current study will
continue exploring possible correlations between personal characteristics and the rate of seatbelt use for Chinese drivers.
The personal characteristics in the current study selected as
important factors, which might relate to seatbelt use in China, were
chosen from prior studies conducted in China (e.g., Li et al., 2006)
and in Western societies (e.g., Bendak, 2005; Wells et al., 2002), and
from the results suggested from in-depth interviews in the current
project. The results of the study should provide useful information
on who should be in the targeted group when conducting seatbelt
interventions in China.
Purpose 2. To investigate the relationships between various personal characteristics and seatbelt use rate.
1.4. Relationships between seatbelt use and self-reported car
crashes and trafc violations
Research in Western societies has also shown that non-users of
seatbelts have characteristics that put them at a higher crash risk.
For example, non-users are more likely to drive after drinking, and
they have been found to be more likely than seatbelt users to tailgate, run red lights, and drive at illegally high speeds (Evans, 1987;
Lund, 1986; Preusser et al., 1991; Reinfurt et al., 1996; Wells et al.,
2002). This results in a situation in which those who most need the
protection of the belts are less likely to use them. The current study
examines the relationship between seatbelt users/non-users and
their self-reported car crash and trafc violation information to see
whether this situation occurs in China as well.
Purpose 3. To investigate the relationships between seatbelt use
(both objective observation and subjective self-reported use) and
self-reported car crashes and trafc violations.
2. Methods
This study employed multiple data collection methods and conducted research in multiple regions in China. Data were collected
in ve cities of different sizes (Beijing capital, 16.3 Million (M) in
population; Tianjin, 11.2 M; Yantai, 0.88 M; Changzhi, 0.61 M; and
Pingyi, 0.34 M). The data collection methods included (1) in-depth
semi-structured interviews to initially explore Chinese drivers attitudes toward seatbelt use (using the results to develop survey
questions), (2) direct observation of drivers for seatbelt use when
entering gas stations, and (3) administration of survey to drivers
being observed at gas stations to collect quantitative data in each
of these ve cities.
2.1. A qualitative approach to initially explore Chinese drivers
attitudes toward seatbelt use
Thirty-ve in-depth semi-structured interviews with subject
matter experts (i.e., professional drivers, experienced drivers,
police ofcers) were conducted to examine Chinese drivers attitudes toward seatbelt use by exploring the reasons why Chinese

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

drivers use or do not use seatbelts and what they think would be
the best interventions to improve seatbelt use for Chinese drivers.
Recruitment of participants included drivers working or studying
at universities and personal contacts. Participants were licensed
drivers with at least 12 months of active driving experience. An
incentive was provided (40RMB = 5 US dollars) for participation. Fifteen interviews were conducted in Beijing with an additional ve
interviews in each of the four other cities. Informed consent was
obtained. Interviews were conducted at a location convenient for
participants. The interviews lasted approximately 30 min. Facilitators asked four open-ended questions to collect data regarding the
project purposes. The questions focused on their opinions about:
driving situations in which they would/would not be likely to wear
a seatbelt, why Chinese drivers wear seatbelts, why Chinese drivers
do not wear seatbelts, and what would be the best interventions to
increase seatbelt use. Notes were taken during the interviews and
transcribed. Comments in reaction to the open-ended questions
were content analyzed by three members of the project team. Categories were rst created by one project member and two other
members sorted participants responses into each category independently. Any discrepancies were discussed among the project
team until consensus was reached. The interview results were used
to create a survey questionnaire.
2.2. Direct observation and survey of drivers in gas stations
2.2.1. Survey measures
The survey included three parts: (1) attitudes toward seatbelt
use, self-report of seatbelt use, (2) personal characteristics and
demographic variables, including age, gender, education, years of
driving, annual driving distance, size of residence city, driver type
(professional/non-professional), and (3) self-report of crashes and
of trafc violations in the prior year. The primary part of the survey included questions exploring drivers attitudes toward seatbelt
use, whether or not they generally wear a seatbelt, opinions on why
Chinese drivers use or do not use seatbelts, and potential intervention suggestions for increasing the rate of seatbelt use in China (see
Appendix A). Ten cognitive interviews were conducted to clarify
survey items. The nal draft of the survey questions was pilottested with ten drivers recruited at a gas station. The pilot test
demonstrated the feasibility of recruiting participants and conducting surveys at gas stations.
We believe that the survey items used in this study sampled
the content of what we wanted to measure. Content validity refers
to the degree to which a measure covers the range of meanings
included within the concept (Babbie, 1995). Content validity is
assessed by subject matter experts (SMEs) in the area the test covers. The SMEs render an opinion regarding the degree of content
validity manifested in the test (Muchinsky, 1997). Our survey items
were developed based on the results of interviews with SMEs, and
the initial survey questions were reviewed, revised, and pilot tested
by actual Chinese drivers. We assume this questionnaire achieves
content validity.
2.2.2. Procedure
Data were collected at two gas stations in each of the ve cities.
Project staff observed the rst arriving car as it entered the station
and noted seatbelt use by the driver. The staff then approached the
driver at the pump to recruit him/her for the survey. If the driver
declined, the staff went back to the entrance to observe the next car.
Participants agreeing to the survey were asked to park their car in a
nearby parking space. A verbal consent statement was given to the
participants. It took approximately 10 min to complete the survey.
An incentive was provided to all the survey participants (40RMB = 5
US dollars for participation). Once the survey process was completed, the project staff returned to the gas station entrance and

891

observed the next car to arrive. This method has been previously
utilized in Wells et al. (2002). Surveys were conducted with drivers
until 50 drivers participated from each gas station. Response rates
ranged from 79% to 83%. The total number of survey participants
was 500 (50 participants for each of the 2 gas stations per city, with
a total of 100 participants for each of the ve cities).
3. Results
3.1. In-depth semi-structured interviews with subject matter
experts
Thirty-ve in-depth semi-structured interviews were conducted with subject matter experts in ve cities in China to explore
Chinese drivers attitudes toward and the perceived important factors which may relate to seatbelt use. The interview results were
used to develop a questionnaire (see Appendix A).
3.2. Participants involved in direct observation and survey in gas
stations
3.2.1. Observed seatbelt use rates in multiple cities
The average observed seatbelt use rate when drivers entered
the gas stations was 36.2% for these 500 drivers. The use rates for
the ve study cities (from large to small in population) were 47% in
Beijing, 23% in Tianjin, 41% in Yantai, 47% in Changzhi, and 23% in
Pingyi.
3.2.2. Survey results
3.2.2.1. Demographic information. Among the participants, 84%
(n = 420) were male drivers, the average age was 36.81 years, the
average driving distance was 32,613 KM per year, and the average amount of driving experience was 9.86 years. Regarding the
highest level of education attained, the largest percentage of participants graduated from high school (43.4%). Professional drivers
comprised 22.8% (n = 114) of the drivers in the sample. FortyTable 1
Descriptive information of survey participants.
Gender

Male (84.0%, n = 420)

Female (16.0%, n = 80)

Education level

No education (0.4%, n = 2)
Elementary (3.0%, n = 15)
Middle school (24.6%, n = 123)
High school (43.4%, n = 217)
College (26.6%, n = 133)
Graduate school (2%, n = 10)

Professional drivers

Yes (22.8%, n = 114)

No (77.2%, n = 386)

Number of trafc violations

(tickets)

0 Tickets (49.4%, n = 247)

1 Ticket (26.2%, n = 130)
2 Tickets (12.2%, n = 61)
3 Tickets (6.6%, n = 34)
4 Tickets (3.0%, n = 15)
5 Tickets (1.2%, n = 6)
6 Tickets (1.4%, n = 7)

Type of trafc violations

(tickets)

Speeding (n = 148)
Parking (n = 108)
Run red light (n = 80)
Make a turn illegally (n = 61)
Change lane illegally (n = 57)
Drink and drive (n = 21)
Tailgating (n = 11)
Others (n = 2)

Have car incidents/major crash in

the prior 12 months of driving

Yes (9.0%, n = 41)

No (91%, n = 459)

Note: N = 500.

892

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

Table 2
Intercorrelations among study variables.
Variables
1. Age
2. Gender
3. Education
4. Years of driving
5. Annual driving distance
6. Size of residence cities
7. Professional driver
8. Attitude toward seatbelt use
9. Drivers self-reported seatbelt use
10. Observed seatbelt use
11. Self-reported crash prior year
12. Self-reported trafc violations

.03

.05
.16**

**

.62
.03
.23**
.26**
**
.09 18

.24**

.09
.06
.14**
.07
.03

10

.03
.22**
.21**
.24**
.36**
.00

.01
.08
.06
.10*
.08
.01
.04

.08
.06
.16**
.03
.04
.13**
.14**
.31**

.05
.09*
.15**
.08
.08
.07
.06
.25**
.62**

11

08
.03
.03
.08
.02
.07
.09*
.09*
.10*
.06

.06
.02
.14**
.03
.03
.01
.04
.22**
.30**
.14**
.24**

Note: Male was coded as 1 and female was coded as 0. Professional driver was coded as 1, and not a professional driver was coded as 0. Observed wearing seatbelt was coded
as 1 and not using seatbelt was coded as 0. Report having crash in the prior year was coded as 1 and no crash was coded as 0. For all the other variables, the higher numbers
represent higher levels of the factors (i.e., older, higher level of education, more years of driving, greater annual driving distance, and live in larger cities).
*
Correlation is signicant at alpha < 0.05, two-tailed.
**
Correlation is signicant at alpha < 0.01, two-tailed.

ve people (9%) reported having a major car crash and 50.6%

of drivers reported having at least one trafc violation (ticket)
in the prior 12 months. Speeding, illegally parking, and running red lights were the three most reported trafc violations
among participants. Further demographic information is reported
in Table 1. Correlations between study variables are provided in
Table 2.
3.2.2.2. Estimation of seatbelt use. Several questions asked participants to estimate the seatbelt use rates for various situations. Three
questions asked participants to estimate the seatbelt use rates for
general drivers, front seat passengers, and back seat passengers in
China. The average estimations of seatbelt use rates were 53.97%
(SD = 29.82) for general drivers, 12.10% (SD = 20.43) for front seat

passengers, and 1.13% (SD = 7.20) for back seat passengers. Three
questions asked the participants to estimate their own percentages
of time wearing seatbelts. The results showed that, in general, as the
driver of the car, they estimated that they wore a seatbelt 63.05%
(SD = 37.40) of the time, 14.83% of the time as the front seat passenger (SD = 27.81), and 0.82% of the time as a back seat passenger
(SD = 6.60). One question asked, If there are kids in your car, where
do they usually sit? Fifty-one participants (10.2%) reported front
seat, 340 (68.0%) reported back seat, and 109 (21.8%) reported
no consistency. Another item asked the participants, If there are
kids in your car, do they wear seatbelts in general? Participants
who reported no comprised 76.8% (n = 383) of the sample. Among
the 23.2% (n = 116) of participants who said yes, the average was
65.99% (SD = 32.22) of the time.

Table 3
Participants evaluation of various driving situations and the likelihood that they will use a seatbelt, using >, < or = to compare the likelihood in each situation. A
comparison of how much more (>), less (<) or equal to (=) they are to use a seatbelt under one condition (Situation A) than the other (Situation B). > indicates that the
seatbelt use rate of the prior factor is higher than the one after, and < indicates that the seatbelt use rate of the prior factor is less than the one after.
Participants likelihood of using a seatbelt in Situation 1 compared to Situation 2

Comparison between Situation A to Situation B

1. On an expressway/highway (A) versus on urban
roads (B)
2. On countryside roads (A) versus on urban roads (B)
3. On a winding mountain road (A) versus on a
straight, at road (B)
4. In bad weather (A) versus in good weather (B)
5. In very hot weather (A) versus when the weather
temperature is nice (B)
6. In very cold weather (A) versus when the weather
temperature is nice (B)
7. In day time (A) versus at night (B)
8. Driving to/from work during a weekday (A) versus
driving for pleasure during the weekend (B)
9. When the road surface is good (A) versus when
the road surface is bad (B)
10. When you drive alone (A) versus when there are
other people in the car (B)
11. When you see police ofcers are around (A)
versus when you see no police are around (B)
12. When you are driving for a long-distance travel
(A) versus when you are driving for a short
distance (B)
13. When you know many other drivers in China are
wearing seatbelts (A) versus when you know few
other drivers in china are wearing seatbelts (B)

Response 1
A>B

Response 2
A=B

Response 3
A<B

2
Responses 1
versus 2

2
Responses 2
versus 3

2
Responses 3
versus 1

435 (87.0%)

41 (8.2%)

24 (4.8%)

326.13*

4.45*

368.02*

70 (14.0%)
183 (36.6%)

191 (38.2%)
263 (52.6%)

232 (46.4%)
54 (10.8%)

56.10*
14.35*

3.97*
137.80*

86.90*
70.22*

196 (39.2%)
17 (3.4%)

264 (52.8%)
286 (57.2%)

40 (8.0%)
196 (39.2%)

10.05*
238.82*

165.05*
16.81*

103.12*
150.43*

32 (6.4%)

420 (84.0%)

48 (9.6%)

333.06*

295.69*

3.20

63 (12.6%)
24 (4.8%)

376 (75.2%)
466 (93.2%)

61 (12.2%)
10 (2.0%)

223.16
398.70*

227.06
436.84*

0.03
5.76*

41(8.2%)

399 (79.8%)

60 (12.0%)

291.28*

250.37*

3.57

22 (4.4%)

452 (90.4%)

26 (5.2%)

390.08*

379.66*

0.33

331 (66.2%)

168 (33.6%)

1 (0.2%)

53.24*

165.02*

328.01*

334 (66.8%)

161(32.2%)

5 (1.0%)

60.46*

146.60*

319.30*

118 (23.6%)

382 (76.4%)

0 (0%)

139.39*

382.00*

118.00*

Bold values indicate the most chosen response for each question.
*
p < .05.

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

893

Table 4
Chinese drivers attitudes toward seat belt use.
Participants responses to the request to choose the
three most important reasons why Chinese drivers
wear seatbelts (a total of 1500 possible counts)

Safer 30.4% (n = 456)

Avoid penalty 21.1% (n = 316)
Already have the habit 10.3% (n = 154)
My family asks me to 5.9% (n = 89)
My company asks me to 0.6% (n = 9)
Other reasons (e.g., obeying the rule, belt warning) 1% (n = 15)
No responses 30.7% (n = 461)

Participants responses to the request to choose the

three most important reasons why Chinese drivers
do not wear seatbelts (a total of 1500 possible
counts)

Too much trouble 19.0% (n = 285)

Uncomfortable 15.4% (n = 231)
Only traveling short distances 10.9% (n = 163)
No needed at low speeds 10.3% (n = 155)
Do not have the safety consciousness 8.8% (n = 132)
Forget 4.9% (n = 74)
Trust their own driving skill 1.6% (n = 24)
Not used to 1.4% (n = 22)
When not moving in a trafc jam 0.8% (n = 12)
Other reasons (e.g., belt too dirty, following most people, not important) 1.4% (n = 22)
No responses 25.5% (n = 382)

Participants responses to the request to choose

the three best interventions to increase seatbelt
use rate in China

Health promotion (for example, running television ads) 22.0% (n = 330)

Law enforcement improvement (for example, more executing/enforcement of the laws by police) 16.8% (n = 252)
Increase the penalty for not wearing a seatbelt 13.4% (n = 201)
Improve seatbelt warning signals inside the car (will warn people if not wearing seatbelt) 8.4% (n = 126)
Improve the design of seatbelts, make them more comfortable 5.7% (n = 86)
Training (for example, strengthen the importance of using seatbelts in drivers training school) 4.9% (n = 73)
Add more safety signs on the side of the road to remind people about wearing seatbelts 3.3% (n = 50)
Promote/ask family and friends to encourage drivers to use seatbelts for safety 1.9% (n = 29)
Others (e.g., belt warning) 0.5% (n = 8)
No responses 23.0% (n = 345)

Note: N = 500.

3.2.2.3. Factors affecting seatbelt use rates. One set of questions on

the survey asked participants to evaluate various driving situations
and to compare the likelihood in each situation that they would use
a seatbelt. The purpose of these questions was to explore whether
there are factors affecting peoples use of seatbelts in China. Results
are shown in Table 3. The inferential test of Chi-square statistics
based on the differences between observed and expected frequencies was applied to each comparison of different responses given by
participants. Looking at the most chosen response for each driving
situation reveals that, in most of the situations, they saw no differences (i.e., choosing =) between the proposed factors as far as their
likelihood of using a seatbelt. These no difference responses were
all signicantly chosen over the more (>) or less (<) responses. However, there were some signicant differences in choices for a few
specic situations. It showed that participants reported they would
be more likely to wear seatbelts on an expressway/highway than
on urban roads and more likely on urban roads than on countryside roads. Participants reported they would be more likely to
wear seatbelts when they see police ofcers are around compared
to no police are around and more likely when they are driving
for a long-distance travel than driving for a short distance.

3.2.2.4. Chinese drivers attitudes toward seatbelt use. One question

asked participants, Do you agree that it is important in general to
wear a seatbelt when you drive a car? on a 5-point Likert scale
from 1 Disagree to 5 Agree. The average was 4.7 (SD = .69). Four
hundred (80%) of the participants chose agree.
Results in terms of Purpose 1, regarding Chinese drivers attitudes toward seatbelt use (why Chinese drivers use or do not
use seatbelts and what they think would be the best interventions to improve seatbelt use for Chinese drivers), are shown in
Table 4. The top three reasons reported for why Chinese drivers
wear seatbelts were: Safer 30.4% (n = 456), Avoid penalty 21.1%
(n = 316), and Already have the habit 10.3% (n = 154). The top three
reasons reported for why Chinese drivers do not wear seatbelts
were: Too much trouble 19.0% (n = 285), Uncomfortable 15.4%
(n = 231), and Only traveling short distances 10.9% (n = 163). The

top three chosen best interventions to increase the rate of seatbelt

use in China were: Health promotion (for example, running television ads) 22.0% (n = 330), Law enforcement improvement 16.8%
(n = 252), and Increase the penalty for not wearing a seatbelt 13.4%
(n = 201).
3.2.2.5. The relationship between various personal characteristics and
seatbelt use rate. For Purpose 2, data from both the direct observation (objective data) and the survey of drivers in gas stations
(self-reported data) were used to investigate the relationships
between the seatbelt use rate and drivers personal characteristics. First, multiple regression was used to analyze the impact
of personal characteristics on drivers estimated percentage of
time wearing seatbelts. Results from Table 5 show that having a higher education level (beta = .16, p < .01), living in larger
cities (beta = .09, p < .05), being a professional driver (beta = .21,
p < .01), and having a better attitude toward the importance of
wearing seatbelts (beta = .31, p < .01) were signicant predictors of

Table 5
Regression effects on drivers self-reported percentage of time wearing seatbelts.
Independent variable

Beta

p-value

Age
Gender
Education level
Years of driving
Annual driving distance (KM)
Residence city size
Professional driver or not
Attitude toward seatbelt use

.11
.04
.16**
.03
.02
.09*
.21**
.31**

.05
.32
.00**
.57
.74
.03*
.00**
.00**

R2

.17

Note: Male was coded as 1 and female was coded as 0. Professional driver was coded
as 1, and not a professional driver was coded as 0. For all the other variables, the
higher numbers represent higher levels of the factors (i.e., older, higher level of
education, more years of driving, greater annual driving distance, and live in larger
cities).
*
p < .05.
**
p < .01.

894

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

Table 6
Regression effects on observed seatbelt use of participants.
Independent variable

SE

Wald

Exp(B)

Age
Gender
Education level
Years of driving
Annual driving distance (KM)
Residence city size
Professional driver or not
Attitude toward seatbelt use
Constant

.034*
.113
.306*
.037
.000
.076
.094
1.31**
.897

.016
.278
.306
.122
.000
.071
.270
.275
1.555

4.68
.16
6.25
3.8
1.03
1.14
.12
22.54
33.31

1.034
.894
1.358
.963
1.000
1.079
1.098
3.698
.000

95% C.I. for EXP(B)

Lower

Upper

1.00
.52
1.07
.93
1.00
.94
.65
2.16

1.06
1.54
1.73
1.00
1.00
1.24
1.87
6.34

Note: Male was coded as 1 and female was coded as 0. Professional driver was coded as 1, and not a professional driver was coded as 0. For all the other variables, the higher
numbers represent higher levels of the factors (i.e., older, higher level of education, more years of driving, greater annual driving distance, and live in larger cities).
*
p < .05.
**
p < .01.

self-reported seatbelt use. There were no differences concerning

participants age, gender, years of driving, and annual driving distance. Second, logistic regression was used to analyze the impact
of personal characteristics on observed seatbelt use. Results from
Table 6 show that being an older driver (z = 4.68, p < .05), having a
higher education level (z = 6.25, p < .01), and having a better attitude toward the importance of wearing seatbelts (z = 22.54, p < .00)
were signicant predictors of observed seatbelt use. There were no
differences concerning participants gender, years of driving, residence city size, annual driving distance, and professional driver
or not.
3.2.2.6. Seatbelt use and self-reported car crashes and trafc violations. For Purpose 3, data were used to investigate the relationships
between seatbelt use (both objective observation and subjective
self-reported use) and self-reported car crashes and trafc violations. Self-report of the percentage of time wearing seatbelts was
negatively correlated to car crashes (r = .10, p < .05) and number
of trafc violations (r = .30, p < .01). Observed seatbelt use was not
signicantly correlated to self-reported car crashes, but was signicantly correlated to the number of trafc violations (r = .14,
p < .01).
4. Discussion
The current study employed multiple data collection methods
and conducted research in multiple cities of various sizes to examine seatbelt use in China and to explore Chinese drivers attitudes
toward seatbelt use. The potential factors which may impact seatbelt use (i.e., various driving conditions, personal characteristics)
and safety outcomes that may be related to seatbelt use (i.e., car
crashes, trafc violations) were also explored.
In general, from both observation data and self-reported data,
drivers seatbelt use rate is very low in China and much lower compared to developed countries. Our results showed that the average
observed seatbelt use rate when drivers entered the gas stations
was 36.2% for these 500 drivers. The use rates for the ve study
cities (from large to small in population) were 47% in Beijing, 23%
in Tianjin, 41% in Yantai, 47% in Changzhi, and 23% in Pingyi. These
numbers were consistently within the range, 765%, illustrated by
prior studies (e.g., Fleiter et al., 2009). From the self-reported data
of our study, participants estimated the average seatbelt use rates
were 53.97% for general drivers, 12.10% for front seat passengers,
and 1.13% for back seat passengers. The pattern is consistent with
the results from the observation study conducted by Routley et al.
(2008) (49.9% in Nanjing and 47.4% in Zhoushan for drivers, 9.1% in
Nanjing and 1.0% in Zhoushan for front seat passengers, and 0.5% in
Nanjing and 0.2% in Zhoushan for back seat passengers). The results

of our study on seatbelt use rates were consistent with and similar
to prior studies.
According to the participants, only 68% of children sit in the back
seats (recommended in Western societies) and 76.8% of children do
not wear seatbelts. Since the use of seatbelts signicantly decreases
vehicle accident injuries, and with the results of the current study
showing the high crash rates and trafc violations in China, it is very
important for future studies to identify ways to improve the use of
seatbelts for both drivers and passengers in China and, potentially,
for other developing countries with low levels of seatbelt use.
Our results also showed that, for Chinese drivers, the use of seatbelts may vary in different situations. For example, people reported
being more likely to wear seatbelts when driving on highways than
urban roads or countryside roads and when driving for a long distance than for a short distance. These indicators suggest that drivers
in China not only have low levels of seatbelt use, but that those who
do wear seatbelts may not make a regular habit of doing so and may
use personal judgments to determine when they need to use a seatbelt. This shows that not only is there a need to increase the seatbelt
use rate for drivers, but efforts are also needed to increase the consistency and the habit for Chinese drivers to wear seatbelts across
all driving situations.
The results of the study provide some insights into Chinese
drivers attitudes toward seatbelt use and suggested best interventions for increasing their use. Drivers reported the number
one reason why they wear seatbelts was because it is safer,
although this reason was chosen by less than one third of the drivers
(30.4%). This indicates that efforts are needed in increasing drivers
understanding of how important it is to wear seatbelts. This was
tied/linked to the number one best intervention chosen by participants, which was health promotion (e.g., running television ads).
General public education on the importance of wearing seatbelts
may be the most pressing need for improving seatbelt use in China.
This may have an impact not only for drivers, but also for all the
passengers, including children. Increasing awareness and improving peoples attitudes and perceptions toward seatbelt use in China
is critical.
According to the drivers manual published by the Ministry of
Public Security of the Peoples Republic of China (2010), drivers will
not pass the licensing test if they are not correctly wearing seatbelts
during the test. By law, drivers and passengers of motor vehicles are required to properly wear seatbelts (The Central Peoples
Government of the Peoples Republic of China, 2010). However, the
results of the current study illustrated the reality of low seatbelt
use rates in China.
Chinese drivers mainly receive information about the safety
benets of seatbelts and general trafc safety when they attend
driver education and license testing. Huang et al. (2006), during

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

focus groups with dual-country drivers, found that the training/licensing process in China seems to be more strict compared
to the US. People must attend more training classes before applying for driving licenses; however, people may not have enough real
road experience in China when they pass the driving tests. This may
be due to the situation that most people learn how to drive at driving school within isolated training areas and take the driving tests
in the same school. Some schools focus mainly on teaching students
how to pass the test instead of how to drive safely on the real road.
A study by Zhang et al. (2006) explored driver differences and
similarities between China and the US and suggested that Chinese
drivers concentrate more on driving skills and capabilities, whereas
US drivers concentrate more on practical safe driving measures.
Their study results also showed that in China, the safety belt use
ratio was about 64% in Beijing, use of running lights was nearly
zero during rainy and snowy weather, use of headlights after sunset
was substantially delayed, and only about 40% of drivers used turn
signals to indicate their intention to change lanes. These unsafe
behaviors may show that Chinese drivers do not have accurate safe
driving knowledge.
The second most chosen reason why Chinese drivers wear seatbelts, to avoid penalty, is consistent with the suggestions on the
reported best interventions of law enforcement improvement
and increase the penalty for not wearing a seatbelt. It suggests
that improving law enforcement of seatbelt use and increasing
the penalty for not complying with the law might be appropriate
approaches for increasing the behavior of seatbelt use. According
to a National Safety Council report, the rate of seatbelt use in the
United States rose from 69% in 1998 to 83% in 2008, and much of
that rise is attributed to the enactment of seatbelt laws in 49 states,
with seatbelt use being 10% higher in states with primary enforcement (National Safety Council, 2010). The top two reported reasons
for why Chinese drivers do not wear seatbelts, too much trouble
and uncomfortable, may suggest a need to improve the comfort of
the actual seatbelt system. Anthropometry may be used to examine whether the current seatbelts used in China are appropriate
for Chinese drivers or passengers body size. Efforts may include
designing a more comfortable, easy-to-use seatbelt system for Chinese drivers. It may also be a matter of conveying to drivers the
increased level of safety offered by seatbelts as a way to decrease
the perception of seatbelts being too much trouble to wear. If
people are made aware of the risks of not wearing seatbelts, they
may be more willing to ignore the discomfort.
Our results also showed that several personal and demographic
characteristics other than attitudes are correlated to seatbelt use
rates in China. By combining both observation and self-reported
data, the study results (see Table 2 for univariate analyses and
Tables 5 and 6 for multivariate analyses) provide some evidence
that being an older driver, being a female, having a higher education
level (which may be a potential factor for socioeconomic status),
living in larger cities, and being a professional driver, as well as having a better attitude toward the importance of wearing seatbelts,
were correlated with greater seatbelt use, although no signicant
relationships were found between years of driving, annual driving
distance, and the use of seatbelts. The results are similar to those
in prior studies conducted in various countries (e.g., Bendak, 2005;
Li et al., 2006; Lund, 1986; Reinfurt et al., 1996; Wells et al., 2002).
These data can be used to answer the question Who should be
in the targeted group when conducting seatbelt interventions in
China? Without further information, we are not able to provide
actual reasons why people with certain characteristics have better
or worse seatbelt use rates. The results of the study, however, suggest that there may be a need to target people with specic personal
characteristics when conducting seatbelt interventions in China.
Personal characteristics are important components of particular
theories that can be utilized to increase the use of seatbelts among

895

people in China. Social learning theory, which states that people

learn from each other through observation, imitation, and modeling
(Bandura, 1977), can be used by showing people, through such tools
as public service announcements, that wearing seatbelts is essential. It would be important to target those individuals who have a
lower seatbelt use rate (i.e., younger drivers and drivers with lower
levels of education) by using actors in the ads who are similar to
the target audience to make more of an impact on those who need
it. Also, it is vital that professional drivers (e.g., taxi drivers) always
properly wear their seatbelts because they serve as examples to
their passengers. As it stands now, many taxi drivers do not obey
Chinas Road Trafc Safety Law implemented in 2004 that requires
drivers and front seat passengers to wear seatbelts (Peden et al.,
2004). Passmore and Ozanne-Smith (2006) found that only 7.7% of
taxi driver in Beijing were correctly wearing their seatbelts, with
a large percentage (92.3%) either not wearing a seatbelt or wearing the seatbelt non-functionally (i.e., draping the seatbelt over the
shoulder without fastening the belt latch). In a recent study, taxi
drivers in Nanjing were observed from the roadside and from inside
the taxis, and they were found to wear their seatbelts only 43.8%
and 36.2% of the time, respectively (Routley et al., 2009).
Similar to the situations in Western societies (e.g., Lund, 1986),
seatbelt non-users in China have a higher risk in terms of trafc violations and car crashes. This results in a situation in which
those who most need the protection of the belts are least likely to
use them. This strengthens, again, how important it is to improve
seatbelt use in China.
As anticipated, our study results showed that when Chinese
drivers have better attitudes toward the importance of using seatbelts, they are more likely to wear seatbelts and have fewer trafc
violations and car crashes. The relationships between safety attitudes, safety behaviors, and safety outcomes are consistent with
prior published research. For example, according to the Theory of
Planned Behavior (Ajzen, 1988, 1991), attitudes inuence behavior.
Chinese drivers attitudes and perceptions toward seatbelt use predict drivers actual behavior of wearing seatbelts and subsequent
experience of car crashes and trafc violations. It is important to
identify ways to improve the attitudes and behavior of seatbelt use.
For example, public education may be used to change attitudes; law
enforcement and increased penalties may change behaviors.
The current study has several limitations. First, although this
study collected data from multiple cities using multiple sources,
thus improving on prior studies using a single method (e.g., observation studies) in one location (e.g., one large city), we were able to
collect data in only ve cities in China due to practical constraints
and to focus on contacting drivers only at gas stations. Even though
the ranges of the response rates (7983%) for these ve various
size cities in the current study seem reasonable, China is a large
country and there may be rather signicant differences between
regions. Future research may collect data from an expanded range
of cities/regions and in various situations (e.g., highway versus local
roads) in order to provide more generalizable information. Caution
needs to be used when generalizing the data from the current study
to the whole country. Second, in the study survey, attitude was
measured using only one item. If more generalized data is needed
in future studies, multiple-item scales can be created to measure
more precisely the attitudes of the Chinese regarding seatbelt use
in their country. Third, future studies should move on to conduct
interventions targeting improved seatbelt use in China. Stevenson
et al.s (2007) intervention study, which combined health promotion, training and law enforcement improvement, was a good start.
The use rate of 62% found in their intervention city, considered low
when compared to most developed countries, is higher than all the
cities in the current study.
Furthermore, although it is a strength of the current study that
two types of seatbelt use data were collected (i.e., self-reported

896

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

seatbelt use and objective observation information) and results

showed that there is a signicant consistency between these two
scores (r = .62, p < .01), both subjective and objective data have their
strengths and weaknesses. In our case, even though the subjects
themselves should know whether they wear seatbelts, some limitations with self-reported data (e.g., social desirability effects) may
occur and the data need to be interpreted with caution. On the other
hand, even though it is good that the objective observation data of
seatbelt use were also collected in the current study, bias may exist
as well since the data were collected only one time. Our results

showed that Chinese drivers reported that for some specic situations (e.g., driving on highways, urban roads or countryside roads),
their likelihood of using seatbelts were varied.
In conclusion, this study employed multiple data collection
methods (i.e., semi-structured interviews, observation, in-person
surveys) to explore seatbelt use in ve cities in China. This study
suggests the probability of extremely low use of seatbelts for
drivers, passengers, and children in China, corresponding with
what we anticipated, and provides insight into the attitudes of
Chinese drivers on seatbelt use and potential interventions.
Appendix A. Survey Questions

Q1. Based on your observation and estimation, what is the percentage rate of seatbelt use for the following people)
1.1 general drivers of the car (%)
1.2 the front seat passenger (%)
1.3 the back seat passenger (%)
Q2. In general, what percentage of the time (%) is it that you will wear a seatbelt in the following situations?
2.1 you as the driver of the car (%)
2.2 you as the front seat passenger (%)
2.3 you as the back seat passenger (%)
Q3. If there are kids in your car, where do they usually sit?

front seat;

Q4. If there are kids in your car, do they wear seatbelts in general?

back seat;

Yes:

no consistency

% of the time or

No

Q5. Regarding factors affecting seatbelt use rate

Please evaluate the following driving situations and the likelihood that you will use a seatbelt. Then use >, < or = to compare the likelihood in each situation. >
indicates that the seatbelt use rate of the prior factor is higher than the one after, and < indicates that the seatbelt use rate of the prior factor is less than the one after.
5.1. on an expressway/highway () on urban roads
5.2. on countryside roads () on urban roads
5.3. on a winding mountain road() on a straight, at road
5.4. in bad weather (for example, snowing, raining, foggy) () in good weather
5.5. in very hot weather () when the weather temperature is nice
5.6. in very cold weather () when the weather temperature is nice
5.7. in day time () at night
5.8. driving to/from work during a weekday () driving for pleasure during the weekend
5.9. when the road surface is good () when the road surface is bad
5.10. when you drive alone () when there are other people in the car
5.11. when you see police ofcers are around () when you see no police are around
5.12. when you are driving for a long-distance travel () when you are driving for a short distance
5.13. when you know many other drivers in China are wearing seatbelts () when you know few other drivers in China are wearing seatbelts
Q6. Do you agree that it is important in general to wear a seatbelt when you drive a car?
1. Disagree
2. Somewhat Disagree
3. Neither agree or disagree
4. Somewhat Agree
5. Agree
Q7. Regarding the reasons why Chinese drivers wear seatbelts, what do you think the three most important reasons are?
1. already have the habit
2. avoid penalty
3. their families ask them to
4. their companies ask them to
5. safer
6. other reasons
Q8. Regarding the reasons why Chinese drivers dont wear seatbelts, what do you think the three most important reasons are?
1. forget
2. uncomfortable
3. too much trouble
4. not needed at low speeds
5. only traveling short distances
6. dont have the safety conscientious
7. when not moving in a trafc jam
8. trust their own driving skill and believe these is no need
9. other reasons
Q9. Regarding the best interventions to increase seatbelt use rate in China, what do you think the three most useful interventions are?
1. health promotion (for example, running television ads)
2. provide training (for example, strengthen the importance of using seatbelts in drivers training school)

Y.-H. Huang et al. / Accident Analysis and Prevention 43 (2011) 889897

897

3. enforcement improvement (for example, more executing/enforcement of the laws by police)

4. improve the design of seatbelts, make them more comfortable
5. add more safety signs on the side of the road to remind people about wearing seatbelts
6. improve seatbelt warning signals inside the car (will warn people if not wearing seatbelt)
7. increase the penalty for not wearing a seatbelt
8. promote/ask family and friends to encourage drivers to use seatbelts for safety
9. others

References
ACEA, 2010. European Automobile Manufactures Association, http://www.acea.
be/index.php/news/news detail/production/.
Ajzen, I., 1988. Attitudes, Personality and Behavior. Dorsey, Chicago.
Ajzen, I., 1991. The theory of planned behavior. Organizational Behavior and Human
Decision Processes 50, 179211.
AUSTST, 2002. Annals of US Trafc Safety (Translation, published in Chinese). Trafc
Administration Research Institute of China State Security Ministry & Jiangsu
University, Wuxi, Jiangsu, China.
Babbie, E., 1995. The Practice of Social Research, 7th ed. Wadsworth Publishing
Company, Belmont, CA.
Bandura, A., 1977. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ.
Bendak, S., 2005. Seatbelt utilization in Saudi Arabia and its impact on road accident
injuries. Accident Analysis and Prevention 37, 367371.
CAAM, 2010. China Association of Automobile Manufacturers Statistics Report, Beijing, China.
Cooper, P.J., 1994. Estimating overinvolvement of seat belt non-wearers in crashes
and the effect of lap/shoulder restraint use on different crash severity consequences. Accident Analysis and Prevention 26 (2), 263275.
CRTAS, 2002. China Road Trafc Accidents Statistics. Trafc Administration Bureau
of China State Security Ministry, Beijing, China.
CRTAS, 2003. China Road Trafc Accidents Statistics. Trafc Administration Bureau
of China State Security Ministry, Beijing, China.
Eby, D.W., Molnar, L.J., Olk, M.L., 2000. Trends in driver and front-right passenger
safety belt use in Michigan: 19841998. Accident Analysis and Prevention 32,
837843.
Eby, D.W., Vivoda, J.M., 2003. Driver hand-held mobile phone use and safety belt
use. Accident Analysis and Prevention 35, 893895.
Eby, D.W., Vivoda, J.M., Fordyce, T.A., 2002. The effects of standard enforcement on Michigan safety belt use. Accident Analysis and Prevention 34,
815823.
European Transportation Safety Council, 1996. Seatbelts and Child Restraints:
Increasing Use and Optimizing Performance. European Transportation Safety
Council, Brussels, Belgium.
Evans, L., 1987. Belted and unbelted driver accident involvement rates compared.
Journal of Safety Research 18, 5764.
Evans, L., 1996. Safety-belt effectiveness: the inuence of crash severity and selective
recruitment. Accident Analysis and Prevention 28 (4), 423433.
Filde, B., Fitzharris, M., Vulcan, P., Koppel, S., 2004. Benets of Retrotting Seatbelt Reminder Systems to Australian Passenger Vehicles. Monash University
Accident Research Center, Clayton, Victoria.
Fleiter, J.J., Gao, L.P., Qiu, C., Shi, K., 2009. Availability, functionality, and use of seatbelts in Beijing taxis prior to the Beijing Olympic Games. Accident Analysis and
Prevention 41, 342344.
Forjuoh, S.N., 2003. Trafc-related injury prevention interventions for low-income
countries. Injury Control and Safety Promotion 10 (12), 109118.
Forjuoh, S.N., Li, G., 1996. A review of successful transport and home injury interventions to guide developing countries. Social Science and Medicine 43 (11),
15511560.
Hu, G., Wen, M., Baker, T.D., Baker, S.P., 2008. Road-trafc deaths in China,
19852005: threat and opportunity. Injury Prevention 14, 149153.
Huang, Y.H., Zhang, W., Roetting, M., Melton, D., 2006. Experiences from dualcountry drivers: driving safely in China and the US. Safety Science 44,
785795.
Kopitis, E., Cropper, M., 2005. Trafc fatalities and economic growth. Accident Analysis and Prevention 37, 169178.
Koushki, P.A., Bustan, M.A., Kartam, N., 2002. Impact of safety belt use on road accident injury and injury type in Kuwait. Accident Analysis and Prevention 35 (2),
237241.

Li, G.L., Li, L.P., Stevenson, M., Ivers, R., Zhou, Y., 2006. Roadside observations of
the use of seatbelts in Guangzhou and Nanning cities, China. Chinese Journal of
Epidemiology 27, 698701.
Lund, A.K., 1986. Voluntary seat belt use among U.S. drivers: geographic, socioeconomic, and demographic variation. Accident Analysis and Prevention 18, 5764.
Muchinsky, P.M., 1997. Psychology Applied to Work, 5th ed. Brook/Cole Publishing
Company, Pacic Grove, CA.
National Highway Trafc Safety Administration (NHTSA), April 2009. Seat Belt Use in
2008Use Rates in the States and Territories. (Research Note: DOT HS 811 106).
National Center for Statistics and Analysis, Washington, DC, Available on-line
at: http://www-nrd.nhtsa.dot.gov/Pubs/811106.PDF (accessed 12.05.10).
National Highway Trafc Safety Administration (NHTSA), June 2009. Lives Saved in
2008 by Restraint Use And Minimum Drinking Age Laws (Research Note: DOT HS
811 153). National Center for Statistics and Analysis, Washington, DC, Available
on-line at: http://www-nrd.nhtsa.dot.gov/Pubs/811153.PDF.
National Safety Council, 2010. Seat belts. NSC, Washington, DC, Available
on-line at: http://www.nsc.org/Safety road/DriverSafety/Pages/SeatBelts.aspx
(accessed 12.05.10).
Passmore, J., Ozanne-Smith, J., 2006. Seatbelt use amongst taxi drivers in Beijing,
China. International Journal of Injury Control and Safety Promotion 13 (3),
187189.
Peden, M., Scureld, R., Sleet, D., Mohan, D., Hyder, A.A., Jarawan, E., Mathers, C.
(Eds.), 2004. World report on road trafc injury prevention. World Health Organization (WHO), Geneva.
Preusser, D.F., Williams, A.F., Lund, A.K., 1991. Characteristics of belted and unbelted
drivers. Accident Analysis and Prevention 23, 475482.
Reinfurt, D.W., William, A.F., Wells, J.K., Rodgman, E., 1996. Characteristics of drivers
not using seat belts in a high belt use states. Journal of Safety Research 27,
209215.
Routley, V., Ozanne-Smith, J., Li, D., Yu, M., Wang, J., Zhang, J., Tong, Z., Wu, M., Wang,
P., Qin, Y., 2008. China belting up or down? Seatbelt wearing trends in Nanjing
and Zhoushan. Accident Analysis and Prevention 40, 18501858.
Routley, V., Ozanne-Smith, J., Qin, Y., Wu, M., 2009. Taxi driver seat belt wearing in
Nanjing, China. Journal of Safety Research 40 (6), 449454.
Stevenson, M., Yu, J., Ying, Z., Hendrie, D., Ivers, R., Li, L.P., Norton, R., 2007. China
Seatbelt Intervention, http://www.thegeorgeinstitute.org/shadomx/apps/fms/
fmsdownload.cfm?le uuid=C1624211-E2D3-643F-551EC2E82BA2A5AC&siteName=iih.
The Central Peoples Government of the Peoples Republic of China, 2010.
http://www.gov.cn/banshi/2005-08/23/content 25575 2.htm (in Chinese).
The Ministry of Public Security of the Peoples Republic of China, 2010.
http://www.mps.gov.cn/n16/n1282/n3493/n3823/n442207/2245672.html (in
Chinese).
The World Bank, 2010. 2010 World Development Indicators, Chapter 2. People, 2.1
Population dynamics. The World Bank, Development Data Group, Washington,
DC. Available at http://data.worldbank.org/sites/default/les/section2.pdf.
Transport Canada, 2000. Results of Transport Canadas July 2000 Survey of Seatbelt
Use in Canada. Leaet RS2000-02 E, Ottawa, Ontario.
Vivoda, J.M., Eby, D.W., Kostyniuk, L.P., 2004. Differences in safety belt use by race.
Accident Analysis and Prevention 36, 11051109.
Wang, Z., Jiang, J., 2003. An overview of research advances in road trafc trauma in
China. Trafc Injury Prevention 4 (1), 916.
Wells, J.K., Williams, A.F., Farmer, C.M., 2002. Seat belt use among African Americans,
Hispanics, and Whites. Accident Analysis and Prevention 34, 523529.
World Health Organization, 2009. Global Status Report on Road Safety: Time for
Action, http://whqlibdoc.who.int/publications/2009/9789241563840 eng.pdf.
Zhang, W., Huang, Y.H., Roetting, M., Wang, Y., Wei, H., 2006. Drivers views and
behaviors about safety in China: what do they NOT know about driving? Accident Analysis and Prevention 38 (1), 2227.
Zhou, Y., Baker, T.D., Rao, K., Li, G., 2003. Productivity losses from injury in China.
Injury Prevention 9, 124127.