Pattern of seat belt wearing in Nanjing, China

Objective: To describe the patterns of seat belt wearing in Nanjing, China for drivers, front seat passengers, and rear occupants of motor vehicles. Design: Roadside observational study. Setting: Four sites in central and northern Nanjing during daylight hours over 1 week in April 2005. Subjects: Drivers and passengers of 17 147 cars, taxis, goods vans, and pickups, which traveled in the inside traffic lane. Main outcome measures: Percentage seat belt wearing for each of seating position, age/ sex, time of day, vehicle type, day of week. Results: The rate of seat belt wearing was significantly higher in drivers (67.3%, 95% CI 66.6 to 68.0) than front seat passengers (18.9%, 95% CI, 18.0 to 19.8). It was negligible for second front seat passengers (2.6%, 95% CI 0.3 to 4.9) and rear seat passengers (0.5%, 95% CI 0.3 to 0.7). Belt tampering, such that protection would be reduced in the event of a crash, was observed for 18.5% of taxi drivers. Drivers were most likely to wear seat belts in cars and vans and at a city roundabout; front seat passengers were most likely to wear seat belts in non-taxi vehicles, during the evening rush hour, if the driver was wearing a belt, and on the local north road. Drivers were least likely to wear a belt in the early morning, in pickups and taxis, on Tuesday (or the following week), and on the local north road; front seat passengers were least likely to wear a belt in taxis and if the driver was not wearing a belt. Conclusions: Rates of seat belt wearing by passengers were low despite national legislation and provincial regulations coming into effect several months before the survey. Combined education and enforcement are necessary accompaniments to legislation.