The effectiveness of mass media campaigns in increasing the use of seat belts: A systematic review

This systematic review and meta-analysis was conducted to determine the effectiveness of mass media campaigns for increasing the use of seat belts among drivers and front seat passengers. We systematically searched the PubMed, EMBASE, Web of Science (WOS), and Scopus databases from November 1974 until June 2020 to identify before-after studies investigating the effect of mass media campaigns on seat belt use. The quality of all included studies was assessed using the National Institute of Health (NIH) tool. Chi-Squared tests and the I2 statistic were used to evaluate inter-study heterogeneity, while the odds ratio (OR) was used as a measure of effect size. Of the 793 records initially identified, twenty articles were found to be appropriate for the current meta-analysis. Of these, 13, 5, and 2 studies were rated as good, fair, and poor quality, respectively. The meta-analysis finding using random effects model showed that mass media campaigns resulted in statistically significant increases in seat belt usage among drivers (OR= 1.40, 95% CI: 1.18- 1.68) and front seat passengers (OR= 1.54, 95% CI: 1.31- 1.82). Due to the presence of heterogeneity (I2: 99.7% for drivers; I2: 99.1% for front passengers), additional analyses were also undertaken. Sensitivity analyses showed that the pooled ORs remained consistent after removing each study one by one. Statistically significant increases in seat belt use among drivers were found in mass media campaigns which: had measurement periods longer than 12 months, were used in combination with enforcement activities, were published after 2000, and had good quality scores. The current meta-analysis found that mass media campaigns can lead to an increase in seat belt use among drivers and front passengers. However, these results should be interpreted with some degree of caution, due to the high degree of heterogeneity between studies and the fact that most of the studies were from high-income countries without control groups. Despite the apparent favorable impact of mass media campaigns, more robust long term studies are needed.

本系统综述与荟萃分析旨在评估大众媒体宣传活动在提升驾驶员及前排乘客安全带使用率方面的有效性。我们于1974年11月至2020年6月间，系统检索了PubMed、EMBASE、Web of Science（WOS）及Scopus数据库，以识别探究大众媒体宣传活动对安全带使用影响的前后对照研究。采用美国国立卫生研究院（National Institute of Health, NIH）质量评估工具对纳入的所有研究进行质量评价。使用卡方检验（Chi-Squared tests）与I²统计量评估研究间异质性，并以比值比（odds ratio, OR）作为效应量指标。初始检索共获取793条记录，最终筛选出20篇符合本次荟萃分析要求的文献。其中，研究质量评级为良好、一般与较差的文献分别为13篇、5篇与2篇。采用随机效应模型开展的荟萃分析结果显示，大众媒体宣传活动可使驾驶员（OR=1.40，95%置信区间（confidence interval, CI）: 1.18~1.68）及前排乘客（OR=1.54，95%置信区间（confidence interval, CI）:1.31~1.82）的安全带使用率出现具有统计学意义的提升。由于研究间存在较高异质性（驾驶员组I²=99.7%，前排乘客组I²=99.1%），我们额外开展了补充分析。敏感性分析结果显示，逐一剔除单项研究后，合并比值比结果仍保持稳定。进一步分析发现，当宣传活动的测量周期超过12个月、与执法活动联合开展、发表于2000年之后且研究质量评级为良好时，可显著提升驾驶员的安全带使用率。本次荟萃分析表明，大众媒体宣传活动能够有效提升驾驶员与前排乘客的安全带使用率。但鉴于研究间异质性较高，且多数研究来自高收入国家且未设置对照组，解读本研究结果时需保持谨慎。尽管大众媒体宣传活动展现出积极的干预效果，未来仍需开展更严谨的长期研究。