Non-seatbelt use and associated factors among Thai drivers during Songkran festival

The Road Traffic Injury (RTI) fatality rate in Thailand was 40 per 100,000 populations, i.e., double the world average for low and middle income countries [1], and RTIs are the second largest cause of burden of disease in Thailand [2]. A number of known behavioural risk factors for RTIs have been identified in Thailand, including drinking and driving, speeding, substance abuse and failure to use seatbelts [3–5]. Aekplakorn et al. [6] conducted an observational study after enactment of the seatbelt law in 1996 in major cities in Thailand. The results showed that 57.3% of motor vehicle drivers did not use seatbelts in January and 69.3% in July 1996. In another study in Thailand non-seatbelt use was found to be considerably lower in passengers than in drivers [5]. Studies on observed seatbelt use in low and middle income countries found high rates of non-seatbelt use among drivers, ranging from 99% among drivers in Kenya [7], 91% in Argentina [8], 83.4% in Ghana [9], 53% in South Africa [10], 50% -32% in Nigeria [11, 12], 45% in Russia [13] and 44.1%-32.7% in China [14, 15]. In most of these studies passengers in motor vehicles seemed to use less often a seatbelt than drivers [5, 9, 11, 14]. Factors associated with non-seatbelt use among drivers were male gender [6, 9, 16], younger age [9], professional and pickup versus general drivers [5, 9, 14], lowest within the Central Business District (CBD) compared to the outskirts of the city [6, 9], lower on highways than on local streets [17], lower on urban roads compared to those on main highways and rural roads [13], lower at daytime, early in the morning than at night [14, 15], and fatalistic orientation [10].

Songkran is the New Year celebration in Thailand, set by the solar calendar since ancient times. It takes place between 13 and 15 April. At Songkran festival are major holidays that encourage a million of travellers who travel to/from their hometown and doing the activities during these holiday periods [18]. Unfortunately, number of road accidents, fatalities, and injuries, increase dramatically; in April the number of road traffic fatalities almost 1200, way above average of <1000 [18]. The daily fatalities during Songkran festival rise up to 84 and 95 persons per day, an increase of 147% and 179%, respectively, compared with an average of 34 persons per day in the non-festival period. Similarly, daily injuries during Songkran holidays increased to 4,900 and 5,650 persons, compared with an average of 2,468 persons per day during the non-festival period [19, 20]. The risks of road traffic accidents during long holidays such as New Year and Songkran festival were found to be alcohol drinking driver, high speed drivers and not using safety equipments [20]. In Thailand there is law on seatbelt wearing; according to the Road Traffic Act 1979 a seatbelt must be fastened at all time during driving and passengers are also obliged to fasten the seatbelt at all times [21]. From 1997 an active public education programme was undertaken on a national scale to raise awareness about road safety and to support law enforcement. This included dissemination of knowledge through multiple channels, e.g., roadside posters, stickers on the back of vehicles, sporadic radio and TV programmes or spots, public announcements and press reports [22]. After 2000, communication about the law was increased and both governmental and nongovernmental agencies started to participate in traffic injury prevention and control programmes including seatbelt wearing among drivers [23, 24]. This included also increased road safety awareness (RSA) campaigns during the Songkran festival [21], but seemingly not everywhere the full range of RSA campaigns was implemented [25]. Among the risks of road traffic accidents during long holidays the lack of using safety equipments has not been adequately studied. Therefore, the aim of this study was to assess the prevalence and associated factors of non-seatbelt use among drivers during Songkran festival in Thailand.

In this study among a large sample of divers in Thailand 28.4% were observed of non-seatbelt use, which seemed to be better than in previous studies in Thailand [6]. Previous studies of non-seatbelt use among drivers in low and middle income countries seemed to have also found worse rates of non-seatbelt use than in the current study [7–15]. In concordance with other studies, this study found that being male [6, 9, 16], younger age [9], professional and pickup versus general drivers [5, 9, 14, 26, 27], location of road (main roads in town) [6, 9], time of the day (earlier time in the day) [14, 15] were associated with non-seatbelt use among drivers. The study also found in concordance with most studies [5, 9, 11, 14] that passengers in motor vehicles had used less often a seatbelt than drivers. Non-seatbelt use was in this study higher at the beginning than at the end of Songkran festival and it was found higher when driving on main roads in town than out of town or on the highway. Some of these differences may be explained by the actual driving location, as it could be that higher non-seatbelt use was found when celebrating the Songkran festival in their home town involving higher non-seatbelt use compared to celebrating the Songkran festival away from current residence which involves driving on the high way and possibly less non-seatbelt use. Among truck drivers non-seatbelt use was found to be higher than among drivers of a saloon car or minibus, which may be explained by different personalities. It is recommended that the RSA campaign should be improved by specifically targeting risk groups such as truck drivers and risky places such as main road in town.

Further, having been in an accident before, not usually having used a seatbelt, not having intended to use a seatbelt, lack of awareness of the danger of non-seatbelt use and lower perceived risk of being caught with non-seatbelt use was found in this study to be associated with non-seatbelt use. Drivers may seem not to be inclined to protect themselves voluntarily against very low probability threats [28]. Thai people also believe in karma, meaning that if the time for an accident or death has come one cannot avoid it.

Importantly, lower exposure to RSA campaign (less frequent exposure to RSA campaign, less frequent following of RTI statistics and not talking with others about the RSA campaign) were in this study associated with non-seatbelt use. Phillips et al. [29] found from a meta-analysis of 67 studies that the weighted average effect of road safety campaigns was a 9% reduction in accidents.

Rates of non-seatbelt use by Thai drivers and passengers during Songkran festival was 28.4%. Lower exposure to the RSA campaign was found to be associated with non-seatbelt use among drivers during the Songkran festival.