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Objectives. To test low-cost, scalable interventions designed to encourage seat belt use (primary outcome) and discourage handheld phone use while driving. Methods. A randomized controlled trial assigned 1139 consenting General Motors‒connected vehicle customers in the United States to 1 of 4 groups for a 10-week intervention: (1) control, (2) behavioral engagement, (3) behavioral engagement plus raffle, and (4) behavioral engagement plus shared pot. Behavioral engagement involved education, personalized tips, a “wish outcome obstacle plan” exercise, and weekly feedback about buckling and handheld-free streaks. Participants in the behavioral engagement plus raffle group also earned a chance at a $125 prize each week they had a buckling or handheld-free streak. Those in the behavioral engagement plus shared pot group earned an equal share of this prize for each streak. The intervention was delivered virtually in spring 2023. Results. Participants in the behavioral engagement plus shared pot group had a higher buckling rate (91.3%) than those in the behavioral engagement plus raffle (89.5%), behavioral engagement (89.4%), or control (88.3%) groups—differences that remained significant at follow-up. Handheld phone use did not differ significantly. Conclusions. A behavioral intervention with a shared pot incentive could be delivered at scale to reduce injuries and deaths associated with vehicular crashes. Trial Registration. ClinicalTrials.gov identifier: NCT05469477. ( Am J Public Health. 2025;115(5):758–768. https://doi.org/10.2105/AJPH.2024.307980 )

Background Child passenger safety is an important public health problem in China. This study aimed to examine the prevalence of child passenger restraint use while riding in a car in the city of Shantou in China from 2012 to 2017. Methods Three large-scale cross-sectional observational studies were conducted in 2012, 2015 and 2017, respectively. The observation sites included randomly selected hospitals, kindergartens, and primary and secondary schools. The outcome measures included the changes in percentages of seating position (e.g., front vs. rear), whether sitting on lap, and use of child restraint systems (CRS) or seat belts by year and by age group. Descriptive statistics, Chi-square tests and logistic regression were used to address the study aims. Results A total of 9858 commuting children aged 17 and younger were observed in passenger cars in Shantou, China during the study. The proportion of children aged 0–5 sitting on adult’s lap decreased from 26.6% in 2012 to 24.6% in 2017, while the proportion of CRS use among the children sitting in the rear row increased among children aged 0–5 (from 0.7% in 2012 to 14.2% in 2017) and children aged 6–11 (from 0.7% in 2012 to 2.4% in 2017). Comparing children aged 0–11 in 2012, children in the same ages were less likely to sit in the front row in 2015 (OR = 0.42, 95%CI = 0.37, 0.48) and in 2017 (OR = 0.27, 95%CI = 0.23, 0.31). Children aged 0–11 were more likely to sit in the rear row with CRS use in 2015 (OR = 8.50, 95%CI = 5.44, 13.28) and in 2017 (OR = 10.95, 95%CI = 7.02, 17.08) comparing with children in the same ages in 2012. As for children aged 12–17, they were more likely to use seat belt in 2017 (OR = 1.40, 95%CI = 1.06, 1.85) compared with those children in 2012. Conclusions While child passenger safety behaviors improved from 2012 to 2017 in Shantou, China, more efforts are needed to protect child passengers from injuries.

Every year around the world road traffic accidents (RTAs) cause 1.19 to 1.35 million deaths and 20-50 million non-fatal injuries that result in long-term disabilities and loss of potential life years (YPLL). These injuries have far-reaching consequences that extend beyond the injured person to impact both their families and their wider communities. The Middle East shows a wide range of death rates from RTAs and Saudi Arabia experiences the highest fatality rate. This study aims to identify different maxillofacial fractures and other skeletal fractures in road traffic accident victims while investigating seatbelt usage's correlation with maxillofacial fractures and also examines demographic variables (age, gender) and crash-related factors (seating position, vehicle type) to contextualize seatbelt efficacy. The study evaluated road traffic accident cases from a retrospective record-based dataset spanning 2011-2021 during the period from January 2023 through May 15th 2023 and marked 542 records with complete details as eligible after filtering. Out of 3629 RTA records, 907 (25%) were randomly selected. Among these, 542 (65%) met the inclusion criteria and were analyzed. The male population comprised 76% of the 412 victims and 82.8% of the victims neglected seatbelt usage while 284 of the 542 participants experienced multiple bone fractures and 126 individuals suffered from single maxillofacial bone fractures. The mandible fracture was the most common facial bone injury with 246 cases (45.3%), followed by Lefort1 fractures which occurred 244 times (45.0%), and Zygomatic maxillary complex fractures which had 216 occurrences (39.8%). Research results highlight the necessity for stronger public health strategies and road safety programs to improve seatbelt usage and decrease injury severity in road traffic accidents. Research findings indicate specific vehicle safety design enhancements needed to prevent facial injuries more effectively.

The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The “seat belt sign” (SBS) is an important physical exam finding that has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention. PubMed and Scopus databases were searched from their beginnings through August 4, 2023 for eligible studies. Outcomes included the prevalence of intra-abdominal injury and need for surgical intervention. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess for heterogeneity. The search yielded nine observational studies involving 3050 patients, 1937 (63.5%) of which had a positive SBS. The pooled prevalence of any intra-abdominal injury was 0.42, (95% CI 0.28–0.58, I2 = 96%) The presence of a SBS was significantly associated with increased odds of intra-abdominal injury (OR 3.62, 95% CI 1.12–11.6, P = 0.03; I2 = 89%), and an increased likelihood of surgical intervention (OR 7.34, 95% CI 2.03–26.54, P < 0.001; I2 = 29%). The measurement for any intra-abdominal injury was associated with high heterogeneity, I2 = 89%. This meta-analysis suggests that the presence of a SBS was associated with a statistically significant higher likelihood of intra-abdominal injury and need for surgical intervention. The study had high heterogeneity, likely due to the technological advancements over the course of this study, including seat belt design and diagnostic imaging sensitivity. Further studies with more recent data are needed to confirm these results.

Induction-based breathing sensors in automobiles enable unobtrusive respiratory rate monitoring as an indicator of a driver’s alertness and health. This paper introduces a quantitative method based on signal quality to guide the integration of textile inductive electrodes in automotive applications. A case study with a simplified setup illustrated the ability of the method to successfully provide basic design rules about where and how to integrate the electrodes on seat belts and seat backs to gather good quality respiratory signals in an automobile. The best signals came from the subject’s waist, then from the chest, then from the upper back, and finally from the lower back. Furthermore, folding the electrodes before their integration on a seat back improves the signal quality for both the upper and lower back. This analysis provided guidelines with three design rules to increase the chance of acquiring good quality signals: (1) use a multi-electrode acquisition approach, (2) place the electrodes in locations that maximize breathing-induced body displacement, and (3) use a mechanical amplifying method such as folding the electrodes in locations with little potential for breathing-induced displacement.

In vehicle collisions, the lap belt should engage the anterior superior iliac spine (ASIS). In this study, threedimensional (3D) shapes of bones and soft tissues around the pelvis were acquired using a computed tomography (CT) scan of 10 male and 10 female participants wearing a lap belt. Standing, upright sitting, and reclined postures were scanned using an upright CT and a supine CT scan system. In the upright sitting posture, the thigh height was larger with a higher BMI while the ASIS height did not change significantly with BMI. As a result, the height of the ASIS relative to the thigh (ASIS-thigh height) became smaller as the BMI increased. Because the thigh height of females was smaller than that of males, the ASIS-thigh height was larger for females than for males. As the ASIS-thigh height was larger, the overlap of the lap belt with the ASIS increased. Thus, the lap belt overlapped more with the ASIS for the females than for the males. The abdomen outer shape is characterized by the trouser cord formed valley, the torso/thigh junction, and the anterior convexity formed between them depending on the adipose tissues. The abdomen outer shapes changed from the standing, the reclined posture to the upright sitting posture. In the reclined sitting posture, the lap belt is positioned upward and rearward relative to the ASIS, and the overlap of the lap belt with the ASIS was smaller compared to the upright posture.

To examine changes in red-light running and distracted riding among motorcyclists and cyclists before and after the 2020 implementation of the One Helmet, One Seatbelt campaign in China. We obtained 192 hours of film before (2019) and after (2021) implementation of the campaign in eight road intersections in Changsha. We calculated percentages and ratios of red-light running and distracted riding. To assess the associations between these traffic behaviours and the campaign, we used multivariable logistic regression models to calculate adjusted odds ratios (aOR). We filmed 5256 motorcyclists and cyclists in 2019 and 6269 in 2021. Red-light running decreased from 45.1% to 41.5% during this period (ratio: 0.92; 95% confidence interval, CI: 0.88-0.96), while distracted riding increased from 3.5% to 5.0% (ratio: 1.42; 95% CI: 1.19-1.69). After adjusting for covariates, male riders were more likely to run a red light compared to female riders (aOR: 1.28; 95% CI: 1.06-1.55). Red-light running was also more likely among electric bicycle riders (aOR: 1.46; 95% CI: 1.10-1.95) and motorcyclists (aOR: 1.47; 95% CI: 1.13-1.90) compared to traditional cyclists. All types of riders were less prone to run a red light during peak hours than off-peak hours (aOR: 0.85; 95% CI: 0.73-0.99). Distracted riding was more common on weekends compared to weekdays (aOR: 3.01; 95% CI: 2.02-4.49). China's national road safety campaign, which focuses on helmet and seatbelt use, was associated with reduced red-light running. Strict enforcement and targeted modifications could improve the campaign's effectiveness.

Background In 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers. Methods Cohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger’s test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309). Results Eleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I 2  = 99.7; P  = 0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR = 0.56, 95% CI = 0.37 to 0.84), abdominal injuries (RR = 0.87; 95% CI = 0.78 to 0.98) and, spinal injuries (RR = 0.56, 95% CI = 0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR = 0.49; 95% CI = 0.22 to 1.08), neck injuries (RR = 0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR = 1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR = 0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers. Conclusion In sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.

Transportation agencies often rely on manual surveys to monitor seat belt compliance; however, these methods are limited by surveyor fatigue, reduced visibility due to tinted windows or low lighting, and restricted geographic coverage, making manual surveys prone to errors and unrepresentative of the broader driving population. This paper presents an automated seat belt detection system leveraging the YOLO11 neural network on video footage captured by a tethered uncrewed aerial vehicle (UAV). The objectives are to (1) develop a robust system for detecting seat belt use at stop-controlled intersections, (2) evaluate factors affecting detection accuracy, and (3) demonstrate the potential of UAV-based compliance monitoring. The model was tested in real-world scenarios at a single-lane and a complex multi-lane stop-controlled intersection in Iowa. Three studies examined key factors influencing detection accuracy: (i) seat belt–shirt color contrast, (ii) sunlight direction, and (iii) vehicle type. System performance was compared against manual video review and large language model (LLM)-assisted analysis, with assessments focused on accuracy, resource requirements, and computational efficiency. The model achieved a mean average precision (mAP) of 0.902, maintained high accuracy across the three studies, and outperformed manual methods in reliability and efficiency while offering a scalable, cost-effective alternative to LLM-based solutions.

In comparisons of similar crashes between sexes, females exhibit an elevated risk of injury to the cervical spine and ribs. This preliminary study aims to investigate the relationship between upper body shape and shoulder belt fit, which may provide further insight into sex-based differences in seat belt loading and potential injury patterns. A non-ferromagnetic seat was fabricated for use with an open magnetic resonance (MR) imaging system, as well as a seat belt made of standard automotive webbing material with MR-visible markers. MR scans were acquired for 10 volunteers (5 female, 5 male) in an upright self-selected seat back position. This analysis focused on the shoulder belt positioning relative to the sternum and clavicle, with consideration of soft tissue interactions on this routing. Females in this study exhibited over three times greater range in the distance of the shoulder belt to the top of the sternum (SBD) compared to the males, despite similar or less variability than males in all gross anthropometric measures (SBD range, females: 21–116 mm, males: 51–78 mm). Such differences in variability highlight the diversity in routing patterns that may be influenced by different body geometries, such as breast tissue volume and distribution. Understanding how shoulder belt fit varies among and within diverse occupant populations highlights the need for improving the robustness of restraint design and performance.