ÁREAS DE SENSIBILIDAD SOCIOECONÓMICA Y CULTURAL

Support was expressed for the use of car seat belts in most focus groups. Support was particularly strong in The Netherlands, Sweden and the UK. Wearing seat belts was seen as being in everyoneÕs best interests and justified paternalistic legislation.

ÒI donÕt wear my belt because of the law; I wear it for safetyÓ.

Denmark/male/20-30/married/children/standard education

ÒI think sometimes people have to be forced to do something and that makes obvious sense to wear a seat belt. There's no reason why anybody shouldn't wear a seat beltÓ.

UK/male/45-60/married/children/further education

Some participants gave personal examples of why wearing seat belts is important:

ÒBecause I donÕt want to be thrownÉbecause one of my colleagues was thrown through the windscreen and he lost his sight.Ó

France/male/45-60/married/children/further education

The majority also supported seat belts in Poland, Luxemburg and Spain although reluctant and opposing views were more strongly presented. Some individuals held strong views against any form of legislation and refused to wear a seat belt at all.

ÒI don't fasten my seatbelts and I will never do it because I simply don't like it. Even if I pay a fine I will still drive without fastening seatbeltsÓ.

Poland/male/20-30/married/children/standard education

7.3.1 Infringement of Personal Freedom

An argument used by those opposing seat belt legislation was that it should be an individualÕs own choice to wear a seat belt, as not wearing one posed little or no threat to anyone but the individual in question.

ÒI consider the inside of a car to be free space, like the inside of a house.Ó

France/male/45-60/married/children/further education

Civil liberty arguments were frequently criticised within the groups and it was pointed out that even if the direct costs by an individual not wearing his or her seat belt are slight, indirect

costs do exist, and have a potentially critical impact of justifying necessity.

ÒBut if you have an accident and end up in a hospital, and youÕre handicapped for the rest of your life, then the community pays for all that.Ó

Belgium/female/45-60/married/children/further education

The opinion that each individual should think beyond restrictions in personal liberty and more towards community advantages was common. Some group members took the topic further.

ÒAt the danger of sounding extreme again, in my opinion there are certain basic laws that have to be observed. Otherwise life in a community does not function.Ó

7.3.2 Risk of Accidents

Some participants did not believe that the risk of serious injury was great enough to warrant frequent belt use. Even those individuals who generally supported seat belt use admitted non compliance in some circumstances. There was an association between perceived risk of having an accident and journey length.

ÒI think being truthful it depends what journey I am going on, if it is a long journey I put my seat belt on, if it is a short journey I am being lazy, I sometimes donÕt ÉBut if I was going on a long journey, yes, I would put a seat belt on ÉI know it sounds stupid, you have got more chance of something happening.Ó

UK/male/20-30/married/children/further education

However, others recognised that any length of car journey was associated with risk.

ÒYou can sit in the car for five hours and nothing happens, you can be in the car for five minutes and can be totally, totally collided and deadÓ

Netherlands/female/20-30/married/children/standard education

The risk associated with seat belt compliance differed from that of other traffic regulations. This was often used to promote seat belt necessity.

ÒBeing a responsible driver I wear a seat belt and am protected. However things like red lights are a different issue. According to the law I am not allowed to cross red lights. I donÕt do it, and I especially donÕt do it if there is other traffic around. If the lights are red however, and no car is to be seen or even heard anywhere, of course I go through the lights.Ó

Germany/male/20-30/single/no children/standard education

7.3.3 Law Enforcement

The separate issue of being caught by the police for non-compliance was perceived as a powerful factor in legislation enforcement.

ÒIÕm talking about the authorities, the cops and everybody else, given the fact that they donÕt fine people for [not wearing seat belts] then it must mean theyÕre not entirely convinced by it either.Ó

France/male/45-60/married/children/further education

If those enforcing the law do not do so adequately the public may assume reasoning behind legislation to be weak. Some participants were also of the opinion that a good example should be set by law enforcement authorities.

ÒI have seen policemen in the car in front of me not wearing a seatbelt. ThatÕs not exactly serving as a good exampleÓ.

7.3.4 Habit

Habit was frequently used to reinforce both compliance and non compliance arguments.

ÒIÕve been damaged by work, I guess. Because I jump into different vehicles all the time, so itÕs impossible, that is, itÕs too much hassle. And then, unfortunately, you take that with you homeÓ.

Sweden/male/20-30/married/children/further education

ÒI have been told to wear a safety belt since I was a child, so it is instinctiveÓ.

Finland/female/20-30/single/no children/further education

7.3.5 Setting an example for children

In focus groups where participants were parents, a large majority made their children wear seat belts in both the front and rear seats for safety. It was also expressed that educating children in this way had the capacity to change a parentÕs behaviour.

ÒI used to be careless in driving. But when I had my child, from then I always wear a seat belt because I think, if something happens to me what will happen to my child, and I always but the child in the safety seat because I think, if something happens to my child, what will happen to me?Ó

Greece/female/20-30/married/children/standard education

7.3.6 Discussion

Traffic volume within the European Union has tripled over the last 30 years, though the number of road deaths have fallen by half. Despite these reductions the EU has stated that the figures are still too high and have set new targets.162 Over 41,000 people were killed across Europe in road traffic accidents in the year 2000, and it has become the primary cause of death in 14-25 year olds.163 The European Commission plans to halve this number by 2010, as set out in the White Paper on European Transport Policy. However, the European Transport Safety Council (ETSC) reported only a 17.5% reduction in road traffic fatalities in 2005, well below that projected, and needed 25% at this stage for the European Union to hit its target.164 With non seat belt use being one of the three major aggravating factors for fatal accidents, alongside speeding and driving under the influence of alcohol165, increasing seat belt compliance would be hugely beneficial in achieving the 50% reduction. It has been estimated that universal seat belt use, to the best international rate, could prevent more than 6,000 deaths and 380,000 injuries a year within the original 15 European Union Member States.166

In 1991, the European Commission passed a Directive (91/671/EEC) requiring that a seat belt must be worn in both front and rear seats in all vehicles less than 3.5 tonnes.167 This was revised in 2003 (Directive 2003/20/EC) extending the obligatory use of seat belts to occupants of all motor vehicles, including trucks and coaches.168 As of 9 May 2006 the latest Directive had to be transposed into national law in all Member States. It is the duty of the individual Member States to enforce such legislation and improve seat belt usage and road safety.

Incorporating seat belt legislation into national law is only one step to improving widespread seat belt use. In order to benefit public health, the legislation must be publicised, explained and, if necessary, enforced. Factors influencing public understanding and attitudes to seat belt legislation include socio-economic differences, population density, age, fatalistic attitudes and law enforcement. 169 170171

Most focus group participants were convinced of the benefits of seat belt use and hence restrictions in personal freedom may be perceived as less severe if one wears a seat belt habitually.

Classically a north-south divide exists across the European Union, with northern countries having a higher overall rate of seat belt use than other Member States.172 The differences are so stark that whilst the Southern and Eastern Member States represent only 34% of the European Union's population, 54% of all road deaths occur in these countries.173 The European Transport Safety Council (ETSC) stated in April 2006 that seat belt wearing rates in the EU vary between 59% (Hungary) and 97% (France) for the front seat and 21% (Estonia) and 90% (Germany) for the rear seat.172 This is despite all countries requiring use of seat belts. Differences in belt use can be largely attributed to effective planning and implementation of legislation.

Only 1% of non seat belt users are totally against seat belts.174 They generally do not acknowledge the benefits of seat belts and are opposed to their use. Many hard core non- users object to being forced to buckle up, believing that belt use should be a matter of personal choice.175 People within the focus groups who refused to wear seat belts were rare, but those that did cited civil liberty arguments as justification.

Habitual behaviour has been recognised as one of the most influential factors in improving overall compliance rates170 and its importance is reflected in the focus group data, being used to reinforce reasoning for both regular and irregular use of seatbelts. The focus groups highlighted the inconsistencies in seat belt use dependent on the journey taken and the perceived risk of having an accident, despite a widespread agreement on the safety benefits of seat belts. People who do not always use seat belts understood the importance of wearing a seat belt, but did so inconsistently due to the predominant effects of habit. SARTRE 3164 also found that people were less likely to wear seat belts in built up areas compared to motorways or other main roads.

People who do more driving each year (more than 10,000 km) were less likely to always wear seat belts.170 These frequent drivers may need to use vehicles as part of their work. Some of the focus group participants described how occupational work patterns could reinforce bad habits for seat belt use.

SARTRE 3164 found that drivers who use seat belts less frequently tended to underestimate the benefits of wearing belts if one drives carefully and overestimated the risks of being trapped by the belt in case of emergency. The report also recommended that education and information campaigns were necessary to improve understanding of the benefits of seat belt wearing.

Although no significant demographic differences were apparent from the focus group analysis, those participants who had children were more likely to recognise the safety benefits

of wearing a belt. SARTRE 3170 found that those drivers who always made children wear a seat belt or restraint was a significant predictor for the driver wearing a seatbelt themselves. The problems identified in the focus group data regarding law enforcement are a cause for concern. In order to effectively promote seat belt use it is necessary for the police to adhere to, as well as enforce the law, especially with such strong majority support for seat belts. There are two main ways in which law enforcement is most effective. Either more fines are issued by the police or an increased perception of being fined is created with effective use of the media. Maximum benefit is most likely through a combination of the two.176 A USA study observed a clear relationship between belt use and the perceived risk of being ticketed.177 It is important to note that individual risk perceptions of being ticketed appeared to be irrespective of the actual chance of receiving a ticket.

SARTRE 3170 found that the percentages of drivers who were fined or punished in some way for not wearing seat belts in the last 3 years was between 10% and 20% in Estonia, Slovenia, Slovakia, Croatia and just over 20% in Cyprus. The percentages in other EU States were less than 10% and many were less than 5% (lowest in UK). The proportion of drivers who were fined or punished for not wearing a seat belt was low for countries where the wearing rate was highest. However, comparison of wearing and punishment rates suggested that non-users are punished relatively infrequently in many countries.

ETSC recommend that the best way to enforce seat belt use is through intensive and highly

visible specific seat belt actions. Such blitz enforcement should last only one to four weeks

and be repeated several times a year. These could be combined with other enforcement

actions, for example on drink driving to be a more cost-effective use of police resources.176

If seat belt compliance rates can be improved in drivers who use them some but not all of the time, the likelihood of the EU reaching its 2010 target may be significantly increased. The ETSC has endorsed the use of seat belt reminders in new cars as a cost effective intervention aimed predominantly at this group and suggested that reminders can increase compliance rates to 99%.174

It is doubtful that seat belt reminders alone will be enough to promote vast attitudinal change. However, combined with education and other interventions, it may be possible to not only improve immediate compliance rates but also long term adherence to legislation. In order to achieve such long term effects, focus groups recognised that paternalistic legislation, provided it is appropriately enforced, can be an important motivation factor to encourage people to do what they recognised is in their own best interests.