Behavioral and Non-Behavioral Correlates of Seat Belt Usage among Bus Passengers in Iran

Harouni, J.; Rakhshanderou, S.; Bahrambeygi, F.; Ghaffari, M.

doi:10.58209/hehp.14.1.189

Behavioral and Non-Behavioral Correlates of Seat Belt Usage among Bus Passengers in Iran

Document Type : Descriptive & Survey

Authors

J. Harouni ¹

S. Rakhshanderou ²

F. Bahrambeygi ³

M. Ghaffari ²

¹ Department of Occupational Health, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran

² Department of Public Health, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran

³ Chronic Respiratory Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.58209/hehp.14.1.189

Abstract

Aims: Despite evidence supporting the protective effect of seat belts, compliance with seat belt use during bus travel remains understudied, particularly in Iran. This study aimed to identify predictors of seat belt use among intercity bus passengers.
Instrument & Methods: This cross-sectional study was conducted with 448 passengers recruited from intercity bus terminals in Tehran using a multistage sampling method. Data were collected through a validated 57-item questionnaire. Logistic regression analyses were performed to examine predictors of seatbelt non-use across three models incorporating behavioral, demographic, and background variables. Data were analyzed using SPSS 16.
Findings: Only 24% of passengers consistently used seatbelts. In the final logistic regression model, significant predictors of seatbelt non-use included perceived barriers (OR=1.08; p=0.003), low supervision (OR=1.13; p=0.04), health locus of control (OR=1.18; p=0.05), and poor law adherence (OR=2.6; p<0.001). Conversely, subjective norms (OR=0.75; p<0.001) and environmental factors (OR=0.82; p=0.02) were associated with higher seatbelt use. The model demonstrated acceptable goodness of fit (Hosmer-Lemeshow p=0.08) and good discrimination (area under the curve=0.78; 95%CI: 0.74-0.87).
Conclusion: Seatbelt use among intercity bus passengers in Iran is low and externally motivated.

Keywords

Seat Belt

Behavioral Risk Factors

Transportation

Passenger

Subjects

Health Education and Health Behavior

1- WHO. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.

2- Chen S, Kuhn M, Prettner K, Bloom DE. The global macroeconomic burden of road injuries: Estimates and projections for 166 countries. Lancet Planet Health. 2019;3(9):e390-8.

3- WHO. Global status report on road safety 2018. Geneva: World Health Organization; 2018.

4- Martin A, Lagarde E, Salmi LR. Burden of road traffic injuries related to delays in implementing safety belt laws in low-and lower-middle-income countries. Traffic Inj Prev. 2018;19(Suppl 1):S1-6.

5- Jafari M, Hokmabadi R, Soori H. The status of road safety in Iran during 2001-2006. J Health Saf Work. 2013;3(2):1-12. [Persian]

6- WHO. Strengthening road safety legislation: A practice and resource manual for countries. Geneva: World Health Organization; 2013.

7- Mehrara M, Mohsenzadeh P. The road travel demand in Iran. Int J Phys Soc Sci. 2012;2(6):159-68.

8- WHO. Seat-belts and child restraints: A road safety manual for decision-makers and practitioners. London: FIA Foundation for the Automobile and Society; 2009.

9- Sadeghnejad F, Niknami S, Hydarnia A, Montazeri A. Using extended parallel process model (EPPM) to improve seat belt wearing among drivers in Tehran, Iran. PAYESH Health Monit. 2016;15(1):103-11. [Persian]

10- Nævestad TO, Høye AK, Elvik R. Safety in bus transport in Europe: Status of safety and discussion of. Int J Crashworthiness. 2019;12(1):217-25.

11- Nambulee W, Jomnonkwao S, Siridhara S, Ratanavaraha V. Modelling of seat belt use intention for intercity buses based on health belief model. Transportmetrica A Transp Sci. 2019;15(2):944-62.

12- Dinh-Zarr TB, Sleet DA, Shults RA, Zaza S, Elder RW, Nichols JL, et al. Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med. 2001;21(Suppl 4):48-65.

13- Mehri A, Sedighi SKZ. Application and comparison of the theories of health belief model and planned behavior in determining the predictive factors associated with seat belt use among drivers in Sabzevar. Iran J Med Educ. 2012;11(7):806-18. [Persian]

14- Chang LY, Chien JT. Analysis of driver injury severity in truck-involved accidents using a non-parametric classification tree model. Saf Sci. 2013;51(1):17-22.

15- Assari S, Moghani Lankarani M, Dejman M, Farnia M, Alasvand R, Sehat M, et al. Drug use among Iranian drivers involved in fatal car accidents. Front Psychiatry. 2014;5(1):69.

16- Vardaki S, Yannis G. Investigating the self-reported behavior of drivers and their attitudes to traffic violations. J Safety Res. 2013;46(1):1-11.

17- Fisa R, Musukuma M, Sampa M, Musonda P, Young T. Effects of interventions for preventing road traffic crashes: An overview of systematic reviews. BMC Public Health. 2022;22(1):513.

18- Shaaban K. Self-report and observational assessment and investigation of seat belt use among young drivers and passengers: The case of Qatar. Arab J Sci Eng. 2019;44(5):4441-51.

19- Malekpour F, Moeini B, Tapak L, Sadeghi-Bazargani H, Rezapur-Shahkolai F. Prediction of seat belt use behavior among adolescents based on the theory of planned behavior. J Res Health Sci. 2021;21(4):e00536.

20- Høye A. How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants?. Accid Anal Prev. 2016;88(1):175-86.

21- Fowler M, Choudhury A. Motor vehicle crashes and seat belt compliance among law enforcement officers: A systematic literature review. J Saf Sustain. 2025;2(1):11-21.

22- Foxwell S, Lewis I, Watson B. Identifying factors that predict seatbelt use among drivers in Queensland, Australia using an extended theory of planned behaviour. Transp Res Part F Traffic Psychol Behav. 2023;92(1):56-72.

23- Tosi JD, Poó FM, Ledesma RD, Arrarás D. The reluctance of taxi drivers to use seat belts. Observed and self-reported behavior in Argentina. AVANCES EN PSICOLOGÍA LATINOAMERICANA. 2022;40(3):1-16.

24- Simsekoglu Ö. Factors related to seat belt use: A Turkish case. Helsinki: University of Helsinki; 2009.

25- Şimşekoĝlu Ö, Lajunen T. Environmental and psychosocial factors affecting seat belt use among Turkish front-seat occupants in Ankara: Two observation studies. Traffic Inj Prev. 2008;9(3):264-7.

26- Rezapour M, Ksaiabti K. Factors impacting the choice of seatbelt use, accounting for complexity of travelers’ behaviors. Future Transp. 2022;2(1):237-48.

27- Sadeghnejad F, Niknami S, Montazeri A, Hydarnia A. Safety belt use among drivers and front passengers in Tehran: Findings from observations and an interview survey. PAYESH Health Monit. 2014;13(2):177-87. [Persian]

28- Ogundele OJ, Ifesanya AO, Adeyanju SA, Ogunlade SO. The impact of seat‑belts in limiting the severity of injuries in patients presenting to a university hospital in the developing world. Niger Med J. 2013;54(1):17-21.

29- Lajunen T, Räsänen M. Can social psychological models be used to promote bicycle helmet use among teenagers? A comparison of the Health Belief Model, Theory of Planned Behavior and the Locus of Control. J Saf Res. 2004;35(1):115-23.

30- Glanz K, Rimer BK, Viswanath K. Health behavior: Theory, research, and practice. Hoboken: John Wiley & Sons; 2015.

31- Akbari MR, Nabipour AR, Hesampour M, Khanjani N. The rate of safety belt use and its associated factors in 15 to 44-years old of Kerman in 2012. J Saf Promot Inj Prev. 2013;1(3):116-22. [Persian]