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.

本系统综述与元分析旨在评估大众媒体宣传活动在提升驾驶员及前排座椅乘客安全带使用率方面的有效性。本研究系统检索了1974年11月至2020年6月期间PubMed、EMBASE、Web of Science（WOS）及Scopus数据库，以识别探讨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）工具对纳入的所有研究进行质量评价。采用卡方检验及I²统计量评估研究间异质性，以比值比（odds ratio, OR）作为效应量指标。初始检索共获得793条记录，最终纳入20篇符合要求的文献用于本次元分析，其中13篇、5篇、2篇研究分别被评为良好、一般、较差质量等级。采用随机效应模型开展的元分析结果显示，大众媒体宣传活动可使驾驶员（OR=1.40，95%置信区间：1.18~1.68）及前排座椅乘客（OR=1.54，95%置信区间：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%），本研究开展了补充分析。敏感性分析结果显示，逐一剔除单项研究后合并比值比仍保持稳定。进一步分析发现，在测量周期超过12个月、与执法活动联合开展、2000年后发表且质量评分良好的大众媒体宣传活动中，驾驶员安全带使用率均出现统计学意义的显著提升。本次元分析结果表明，大众媒体宣传活动可提升驾驶员及前排乘客的安全带使用率。但由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持谨慎态度。尽管大众媒体宣传活动呈现出积极影响，未来仍需开展更严谨的长期研究。