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| MMWR Weekly Vol. 65, No. 23 June 17, 2016 |
| PDF of this issue |
Seat Belt Use Among Adult Workers — 21 States, 2013
Weekly / June 17, 2016 / 65(23);593–597
Summary
What is already known about this topic?Although motor vehicle crashes are the leading cause of occupational fatalities, and seat belts have been shown to reduce injuries, previous reports on worker seat belt use have been narrowly focused on only a few occupations.
What is added by this report?This is the first report on seat belt use among a broad range of occupational groups in a representative, population-based sample. For all occupational groups, the prevalence of not always using seat belts was higher in states with secondary seat belt laws (23.6% unadjusted) than in states with primary seat belt laws (10.4% unadjusted). After adjusting for age, sex, race/ethnicity, education, marital status, body mass index, county urbanization, and state seat belt law type, there was substantial variability among occupational groups in self-reported seat belt use. The occupational groups with the highest adjusted prevalences included construction and extraction (14.1%); legal (14.0%); installation, maintenance, and repair (12.8%); protective service (12.7%); and farming, fishing, and forestry (12.7%).
What are the implications for public health practice?Employers can establish comprehensive safety programs that require consistent seat belt use at all times. States that implement primary seat belt laws might see a substantial increase in seat belt use by currently employed workers. Seat belt safety advocates could focus interventions on the occupational groups with the lowest reported seat belt use.
Roadway incidents involving motorized vehicles accounted for 24% of fatal occupational injuries in the United States during 2013 and were the leading cause of fatal injuries among workers.* In 2013, workers’ compensation costs for serious, nonfatal injuries among work-related roadway incidents involving motorized land vehicles were estimated at $2.96 billion.† Seat belt use is a proven method to reduce injuries to motor vehicle occupants (1). Use of lap/shoulder seat belts reduces the risk for fatal injuries to front seat occupants of cars by 45% and the risk to light truck occupants by 60%.§ To characterize seat belt use among adult workers by occupational group, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and found that not always using a seat belt was significantly associated with occupational group after controlling for factors known to influence seat belt use. Occupational groups with the highest prevalences of not always using a seat belt included construction and extraction; farming, fishing, and forestry; and installation, maintenance, and repair. To increase seat belt use among persons currently employed, states can enact and enforce primary seat belt laws, employers can set and enforce safety policies requiring seat belt use by all vehicle occupants, and seat belt safety advocates can target interventions to workers in occupational groups with lower reported seat belt use.
BRFSS is an annual, state-based, random-digit–dialed landline and cell phone survey of noninstitutionalized adults aged ≥18 years residing in the United States.¶ In 2013, all states asked survey participants about seat belt use.** Industry and occupation were first available on the BRFSS survey in 2013, and 21 states asked currently employed respondents about their industry and occupation.†† This report describes self-reported seat belt use by occupational group among workers in those 21 states who were employed for wages or self-employed at the time of the interview. All responses to the question about frequency of seat belt use except “always” (i.e., “nearly always,” “sometimes,” “seldom,” and “never”) were combined and categorized as “not always.” Participants’ responses were coded to 2002 U.S. Census Bureau occupation numeric codes. Census occupation codes were then grouped for analysis into 2000 Standard Occupational Classification (SOC) System major groups. Records with missing occupation codes or that were not able to be coded because of insufficient information were excluded, as were records where the seat belt responses were blank, “don’t know/not sure,” “never drive or ride in a car,” or “refused.” Because BRFSS data are not representative of active duty service members, the 263 respondents who worked in the armed forces also were excluded.
Results were stratified by type of seat belt law in the state of residence because type of law is known to be associated with seat belt use (1,2). Fourteen of the 21 states had primary seat belt laws in 2013; in these states, a driver can be stopped and ticketed solely for not using a seat belt. Six states had secondary seat belt laws; in these states, a driver can be ticketed for not using a seat belt only if stopped for another offense. New Hampshire had no seat belt law covering adults§§ and was grouped with the secondary law states.
Data were weighted and analyzed to account for the complex BRFSS multistage sampling design. The prevalence of not always using a seat belt was estimated by occupational group and sociodemographic characteristics. Adjusted prevalences, stratified by type of seat belt law, were estimated with logistic regression controlling for the potential confounders of age, sex, race/ethnicity, education, marital status, body mass index, and county urbanization. All statistically significant interaction terms between occupational group and confounders, including the interaction between occupational group and type of seat belt law, were included in the model. County of residence was classified as metropolitan (codes 1–3), urban (4–7), or rural (8–9), based on the U.S. Department of Agriculture’s 2013 Rural-Urban Continuum Codes.¶¶
Among the 21 states, the overall survey response rates ranged from 31.1% to 59.2%.*** Data from 84,593 respondents were included in the analysis, including 54,187 (64%) who lived in states with primary seat belt laws and 30,406 (36%) who lived in states with secondary seat belt laws. The prevalence of not always using a seat belt varied by age, sex, race/ethnicity, education, marital status, body mass index, and county urbanization, and for each characteristic, was higher in states with secondary seat belt laws (Table 1).
For all occupational groups combined, the crude prevalence of not always using a seat belt was 10.4% in states with primary seat belt laws and 23.6% in states with secondary seat belt laws (Table 2). For every occupational group, the prevalence was higher in states with secondary seat belt laws. Crude prevalences ranged from 5.4% (business and financial operations) to 18.0% (construction and extraction) in the states with primary seat belt laws and from 8.1% (life, physical, and social science) to 55.5% (farming, fishing, and forestry) in states with secondary seat belt laws. Among workers in the transportation and material moving group, which includes several occupations that involve frequent driving, 12.4% and 33.7% in states with primary and secondary seat belt laws, respectively, did not always use a seat belt.
Among all occupational groups, the adjusted prevalence of not always using a seat belt was higher in states with secondary seat belt laws. The highest adjusted prevalences in states with primary seat belt laws were observed in the construction and extraction (14.1%); legal (14.0%); installation, maintenance, and repair (12.8%); protective service (12.7%); and farming, fishing, and forestry (12.7%) occupational groups. In states with secondary seat belt laws, the highest adjusted prevalences were in the farming, fishing, and forestry (38.1%); construction and extraction (32.1%); installation, maintenance, and repair (27.0%); building and grounds cleaning and maintenance (25.9%); and protective service (25.4%) occupational groups. Percentage-point differences between adjusted prevalences of states with primary and secondary seat belt laws ranged from a low of 2.0 (life, physical, and, social science) to a high of 25.5 (farming, fishing, and forestry) (Table 2).
Discussion
This analysis provides, for the first time, seat belt use estimates among a wide variety of occupational groups in 21 U.S. states. It indicates that self-reported seat belt use among adult workers in those states varies by occupation and that this variation persists after adjustment for factors known to be associated with seat belt use (age, sex, race/ethnicity, education, marital status, body mass index, county urbanization, and state seat belt law type). Overall and by occupational group, in 2013, seat belt use among employed adults was lower in states that did not have primary seat belt laws.
Limited data are available on work-related seat belt use. A CDC study found that approximately 14% of long-haul truck drivers did not use a seat belt on every trip and that never using a seat belt at work was associated with living in a state that did not have a primary seat belt law (3).
The current report estimates that workers in several groups with occupations for which driving is not a primary job duty (including construction and extraction; farming, fishing, and forestry; installation, maintenance, and repair; and protective service) report lower frequency of seat belt use than workers in transportation and material moving occupations. Previous research has suggested lower seat belt use rates among construction workers and occupants of commercial light vehicles (4), particularly pick-up trucks (5,6), and that police officers might view seat belt use as a safety concern in high threat situations (7). However, it is possible that not enough attention has been directed toward promoting seat belt use among the 14 million workers in these broad categories because driving is not their primary job duty.
The findings in this report are subject to at least five limitations. First, seat belt use is self-reported, which, because of social desirability bias, might result in higher reported frequency of seat belt use than that reported in observational studies. Second, this analysis does not distinguish between work-related and personal driving, and there is evidence from one study that frequency of seat belt use among commercial motor vehicle drivers is higher when driving a personal vehicle than when engaged in work-related driving (4). Third, the seat belt use question says “car”; it is not known whether respondents who drive vehicles other than cars (e.g., trucks) interpreted “car” to include other vehicles. Fourth, households without telephones are excluded from BRFSS; however, this should have a minimal impact on the findings because only an estimated 2.5% of households do not have telephones.††† Finally, because the overall survey response rates among the 21 states ranged from 31.1% to 59.2%, nonresponse bias is possible.
Because seat belt laws are strongly associated with seat belt use (1,8), states that implement new primary seat belt laws might see a substantial increase in seat belt use by all drivers, including currently employed workers; this would benefit employers, workers, and the general public. Employers can reduce injuries among workers by implementing comprehensive safety programs that require seat belt use at all times for employees and contractors (drivers and passengers) and reinforcing this policy in training programs (3,6,9,10).§§§ Although many of the workers in occupations with low rates of seat belt use might be self-employed or work in small businesses that do not have comprehensive safety programs, it would still be beneficial for employers to focus on seat belt safety. Employers and seat belt safety advocates might consider developing additional interventions directed at workers in the occupations with the lowest self-reported seat belt use.
Acknowledgments
Jan Birdsey, Susan Burton, Stephanie Pratt, Jeff Purdin, Pam Schumacher, Aaron Sussell; 21 state BRFSS coordinators.
Corresponding author: Winifred L. Boal, wboal@cdc.gov, 513-841-4266.
1Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, CDC; 2Division of Safety Research, Center for Motor Vehicle Safety, National Institute for Occupational Safety and Health, CDC.
References
- CDC. Vital signs: nonfatal, motor vehicle–occupant injuries (2009) and seat belt use (2008) among adults—United States. MMWR Morb Mortal Wkly Rep 2011;59:1681–6. PubMed
- Beck LF, Shults RA, Mack KA, Ryan GW. Associations between sociodemographics and safety belt use in states with and without primary enforcement laws. Am J Public Health 2007;97:1619–24. CrossRef PubMed
- Chen GX, Collins JW, Sieber WK, et al. . Vital signs: seat belt use among long-haul truck drivers—United States, 2010. MMWR Morb Mortal Wkly Rep 2015;64:217–21. PubMed
- Kim K, Yamashita EY. Attitudes of commercial motor vehicle drivers towards safety belts. Accid Anal Prev 2007;39:1097–106. CrossRef PubMed
- Eby DW, Fordyce TA, Vivoda JM. A comparison of safety belt use between commercial and noncommercial light-vehicle occupants. Accid Anal Prev 2002;34:285–91. CrossRef PubMed
- Retzer KD, Hill RD, Pratt SG. Motor vehicle fatalities among oil and gas extraction workers. Accid Anal Prev 2013;51:168–74. CrossRef PubMed
- Oron-Gilad T, Szalma JL, Stafford SC, Hancock PA. Police officers seat belt use while on duty. Transp Res, Part F Traffic Psychol Behav 2005;8:1–18 CrossRef
- Shults RA, Nichols JL, Dinh-Zarr TB, Sleet DA, Elder RW. Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews. J Safety Res 2004;35:189–96. CrossRef PubMed
- American National Standards Institute/American Society of Safety Engineers (ANSI/ASSE). Safe practices for motor vehicle operations (ANSI/ASSE Z15.1–2012). New York, NY: American National Standards Institute; 2012.
- Network of Employers for Traffic Safety. NETS’ comprehensive guide to road safety. Vienna, VA: Network of Employers for Traffic Safety; 2014. http://trafficsafety.org/nets-comprehensive-guide-to-road-safety-download
† https://www.libertymutualgroup.com/about-lm/research-institute/communications/workplace-safety-index.
** Seat belt use was elicited by the question, “How often do you use seat belts when you drive or ride in a car? Would you say—always, nearly always, sometimes, seldom, never?”
†† Occupation was elicited by the question, “What kind of work do you do (for example, registered nurse, janitor, cashier, auto mechanic)?”
§§§ CDC. Preventing work-related motor vehicle crashes. DHHS (NIOSH) publication no. 2015-111. March 2015. http://www.cdc.gov/niosh/docs/2015-111/.
TABLE 1. Prevalence* of not always using a seat belt among currently employed workers, by selected characteristics and state seat belt law status — Behavioral Risk Factor Surveillance System, 21 states, 2013
| Characteristic | States with primary seat belt laws† | States with secondary seat belt laws§ | ||
|---|---|---|---|---|
| No. in sample | Not always using seat belt % (95% CI) | No. in sample | Not always using seat belt % (95% CI) | |
| Age group (yrs) | ||||
| 18–24 | 2,753 | 19.9 (16.9–22.8) | 1,671 | 33.3 (30.0–36.6) |
| 25–34 | 7,232 | 13.1 (11.7–14.4) | 4,353 | 27.9 (25.8–30.0) |
| 35–44 | 10,010 | 9.2 (8.2–10.2) | 5,579 | 21.1 (19.4–22.9) |
| 45–54 | 14,304 | 8.4 (7.4–9.3) | 7,590 | 21.4 (20.0–22.8) |
| 55–64 | 14,346 | 7.5 (6.7–8.3) | 8,037 | 19.6 (18.2–21.1) |
| ≥65 | 5,542 | 6.8 (5.5–8.1) | 3,176 | 21.3 (18.8–23.8) |
| Sex | ||||
| Men | 24,770 | 13.3 (12.4–14.1) | 14,622 | 30.1 (28.9–31.4) |
| Women | 29,417 | 7.1 (6.4–7.7) | 15,784 | 16.1 (15.1–17.0) |
| Race/Ethnicity | ||||
| White, non-Hispanic | 41,022 | 10.8 (10.2–11.4) | 27,048 | 24.2 (23.3–25.0) |
| Black, non-Hispanic | 4,666 | 13.8 (11.3–16.2) | 455 | 22.5 (15.7–29.4) |
| Other, non-Hispanic | 2,962 | 8.1 (5.7–10.4) | 1,305 | 20.4 (16.7–24.1) |
| Hispanic | 4,778 | 8.3 (6.9–9.6) | 1,300 | 19.1 (15.9–22.2) |
| Education | ||||
| Less than high school | 2,534 | 11.2 (9.0–13.5) | 1,063 | 33.5 (28.8–38.2) |
| High school graduate | 12,356 | 13.2 (12.1–14.3) | 7,406 | 31.9 (30.0–33.8) |
| Some college or technical school | 15,034 | 11.4 (10.3–12.4) | 8,972 | 25.8 (24.4–27.3) |
| College graduate or more | 24,192 | 7.2 (6.5–7.9) | 12,923 | 14.3 (13.4–15.2) |
| Marital status | ||||
| Married | 31,262 | 8.4 (7.7–9.0) | 19,086 | 20.3 (19.5–21.2) |
| Divorced, widowed, or separated | 11,585 | 9.6 (8.5–10.6) | 5,667 | 24.6 (22.5–26.7) |
| Never married or a member of an unmarried couple | 11,089 | 14.9 (13.6–16.2) | 5,538 | 30.6 (28.6–32.7) |
| Body mass index | ||||
| Underweight or normal | 17,679 | 9.8 (8.8–10.9) | 10,070 | 19.6 (18.3–20.9) |
| Overweight | 19,256 | 10.2 (9.3–11.0) | 10,963 | 24.4 (23.0–25.8) |
| Obese | 15,029 | 11.7 (10.7–12.6) | 8,041 | 29.8 (28.1–31.6) |
| Metropolitan/Urban/Rural county of residence | ||||
| Metropolitan | 41,406 | 9.8 (9.2–10.4) | 16,912 | 20.2 (19.2–21.2) |
| Urban | 11,096 | 15.0 (13.6–16.4) | 10,166 | 33.7 (32.3–35.1) |
| Rural | 1,685 | 20.0 (16.4–23.6) | 3,328 | 46.8 (44.5–49.2) |
Abbreviation: CI = confidence interval.
* Weighted estimates.
† California, Florida, Illinois, Louisiana, Maryland, Michigan, Minnesota, Mississippi, New Jersey, New Mexico, New York, Oregon, Washington, and Wisconsin (n = 54,187, 64% of respondents).
§ Massachusetts, Montana, Nebraska, New Hampshire (no seat belt law), North Dakota, Utah, and Wyoming (n = 30,406, 36% of respondents).
* Weighted estimates.
† California, Florida, Illinois, Louisiana, Maryland, Michigan, Minnesota, Mississippi, New Jersey, New Mexico, New York, Oregon, Washington, and Wisconsin (n = 54,187, 64% of respondents).
§ Massachusetts, Montana, Nebraska, New Hampshire (no seat belt law), North Dakota, Utah, and Wyoming (n = 30,406, 36% of respondents).
TABLE 2. Prevalence* of not always using a seat belt among currently employed workers, by occupational group† and state seat belt law status, ranked from lowest to highest crude prevalence among states with primary seat belt laws — Behavioral Risk Factor Surveillance System, 21 states, 2013
| Occupational group | States with primary seat belt laws§ | States with secondary seat belt laws¶ | Percentage-point difference in adjusted % between primary and secondary law states | ||||
|---|---|---|---|---|---|---|---|
| No. in sample | Not always using seat belt, crude % (95% CI) | Not always using seat belt, adjusted** % (95% CI) | No. in sample | Not always using seat belt, crude % (95% CI) | Not always using seat belt, adjusted** % (95% CI) | ||
| Business and financial operations | 2,572 | 5.4 (4.0–6.7) | 7.0 (5.4–9.0) | 1,273 | 14.1 (11.4–16.9) | 16.9 (13.9–20.4) | −9.9 |
| Life, physical, and social science | 1,014 | 6.2 (3.5–8.9) | 8.1 (5.3–12.4) | 519 | 8.1 (5.5–10.7) | 10.1 (7.4–13.8) | −2.0 |
| Architecture and engineering | 1,481 | 6.3 (4.3–8.4) | 6.6 (4.7–9.1) | 797 | 15.7 (12.0–19.3) | 14.9 (11.6–18.9) | −8.3 |
| Health care practitioners and technical | 4,658 | 6.7 (4.8–8.6) | 9.1 (6.8–12.1) | 2,530 | 15.1 (12.6–17.5) | 19.2 (16.5–22.3) | −10.1 |
| Education, training, and library | 4,549 | 6.9 (5.1–8.7) | 10.2 (7.8–13.1) | 2,648 | 11.5 (9.7–13.4) | 15.0 (12.6–17.8) | −4.8 |
| Computer and mathematical | 1,639 | 7.4 (5.0–9.9) | 7.7 (5.5–10.7) | 839 | 14.3 (10.3–18.4) | 14.4 (10.8–18.8) | −6.6 |
| Office and administrative support | 6,561 | 8.1 (6.9–9.4) | 9.5 (8.0–11.2) | 3,692 | 17.7 (15.8–19.7) | 18.4 (16.2–20.7) | −8.9 |
| Healthcare support | 1,353 | 9.2 (6.2–12.2) | 9.8 (7.0–13.6) | 733 | 21.1 (16.6–25.6) | 20.6 (16.3–25.7) | −10.8 |
| Community and social services | 1,342 | 9.4 (6.1–12.7) | 11.7 (8.1–16.7) | 658 | 16.1 (11.8–20.4) | 19.9 (15.5–25.3) | −8.2 |
| Personal care and service | 1,843 | 9.7 (5.4–14.0) | 10.1 (6.7–15.0) | 928 | 21.3 (16.3–26.4) | 20.3 (15.6–26.0) | −10.2 |
| Management | 5,891 | 9.7 (8.4–11.0) | 10.6 (9.1–12.2) | 3,917 | 26.3 (24.1–28.6) | 24.9 (22.6–27.2) | −14.3 |
| Legal | 895 | 9.8 (6.2–13.5) | 14.0 (9.8–19.6) | 333 | 14.6 (9.2–19.9) | 20.6 (14.4–28.6) | −6.6 |
| Sales and related | 5,077 | 10.6 (9.0–12.1) | 10.1 (8.7–11.8) | 2,728 | 25.7 (23.0–28.4) | 23.0 (20.5–25.8) | −12.9 |
| Production | 2,264 | 11.2 (9.0–13.4) | 9.4 (7.7–11.4) | 1,307 | 31.0 (26.9–35.1) | 24.4 (21.0–28.1) | −15.0 |
| Farming, fishing, and forestry | 420 | 12.2 (7.6–16.8) | 12.7 (8.7–18.1) | 311 | 55.5 (47.1–63.8) | 38.1 (29.7–47.3) | −25.5 |
| Arts, design, entertainment, sports, and media | 1,350 | 12.4 (6.3–18.6) | 12.3 (7.4–19.8) | 613 | 16.3 (11.9–20.7) | 18.0 (13.5–23.7) | −5.7 |
| Building and grounds cleaning and maintenance | 2,027 | 12.4 (9.1–15.8) | 11.6 (8.8–15.2) | 973 | 28.8 (23.9–33.8) | 25.9 (21.6–30.7) | −14.2 |
| Transportation and material moving | 2,328 | 12.4 (10.0–14.8) | 10.6 (8.7–12.9) | 1,426 | 33.7 (29.6–37.9) | 25.0 (21.5–28.9) | −14.4 |
| Food preparation and serving related | 1,748 | 14.7 (11.4–17.9) | 11.2 (8.7–14.2) | 867 | 27.0 (21.9–32.1) | 21.0 (16.8–25.9) | −9.8 |
| Protective service | 1,188 | 15.7 (11.7–19.7) | 12.7 (9.6–16.7) | 531 | 34.8 (26.8–42.7) | 25.4 (18.9–33.3) | −12.7 |
| Installation, maintenance, and repair | 1,518 | 16.2 (12.9–19.5) | 12.8 (10.3–15.8) | 991 | 38.4 (32.9–43.8) | 27.0 (22.7–31.9) | −14.2 |
| Construction and extraction | 2,469 | 18.0 (15.4–20.7) | 14.1 (12.0–16.4) | 1,792 | 43.7 (39.9–47.5) | 32.1 (28.6–35.8) | −18.0 |
| All occupational groups | 54,187 | 10.4 (9.9–10.9) | — | 30,406 | 23.6 (22.8–24.4) | — | — |
Abbreviation: CI = confidence interval.
* Weighted estimates.
† From the 2000 Standard Occupational Classification System. http://www.bls.gov/soc/.
§ California, Florida, Illinois, Louisiana, Maryland, Michigan, Minnesota, Mississippi, New Jersey, New Mexico, New York, Oregon, Washington, and Wisconsin (n = 54,187, 64% of respondents).
¶ Massachusetts, Montana, Nebraska, New Hampshire (no seat belt law), North Dakota, Utah, and Wyoming (n = 30,406, 36% of respondents).
** Adjusted by age group, sex, race/ethnicity, education, marital status, body mass index, urban/rural county of residence, and state seat belt law type.
* Weighted estimates.
† From the 2000 Standard Occupational Classification System. http://www.bls.gov/soc/.
§ California, Florida, Illinois, Louisiana, Maryland, Michigan, Minnesota, Mississippi, New Jersey, New Mexico, New York, Oregon, Washington, and Wisconsin (n = 54,187, 64% of respondents).
¶ Massachusetts, Montana, Nebraska, New Hampshire (no seat belt law), North Dakota, Utah, and Wyoming (n = 30,406, 36% of respondents).
** Adjusted by age group, sex, race/ethnicity, education, marital status, body mass index, urban/rural county of residence, and state seat belt law type.
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