Demographic characteristics of the 2002 sample are presented in . The AI/AN population was younger than the NHW population. In addition, the majority of AI/AN were male, as opposed to NHW (56.3% and 48.2%, respectively). While both groups had similar high school graduation rates, there were fewer college graduates among AI/AN compared to NHW (15.1% and 32.4%, respectively). The majority of AI/AN participants lived in the West or the South & East regions (26.7% and 28.9%, respectively), while the majority of NHW participants resided in the South & East or Great Lakes regions (44.6% and 20.1%, respectively). Similar distributions of AI/AN and NHW lived in urban and rural areas. Finally, approximately two-thirds of AI/AN lived in states with primary seatbelt laws whereas a little under half of NHW lived in such states.
Demographic and regional characteristics (%) of the study sample, BRFSS 2002
In , the overall age and gender-adjusted prevalence estimates of seatbelt non-use were similar for AI/AN and NHW. However, racial disparities in seatbelt non-use varied substantially by region. AI/AN had significantly higher seatbelt non-use than NHW in the Northern Plains and Alaska, but significantly lower seatbelt non-use than NHW in the West. shows that residence in less urbanized areas was associated with higher reported seatbelt non-use for both AI/AN and NHW. Seatbelt non-use was significantly higher in rural AI compared to rural NHW.
Age and gender-adjusted regional and racial comparison of seatbelt non-use, BRFSS 2002
Age and gender-adjusted urban-rural and racial comparison of seatbelt non-use, BRFSS 2002
presents logistic regression models stratified by race. Younger adults were more likely to report seatbelt non-use than older adults. AI/AN men were 60% more likely than AI/AN women to report seatbelt non-use, and NHW men were nearly twice as likely than NHW women to report seatbelt non-use. In addition, those with a high school education or lower were more likely not to use a seatbelt when compared with college graduates.
Odds ratios for seatbelt non-use according to demographic characteristics and seatbelt laws
For regional comparisons, the West was the reference group because it had the lowest prevalence of seatbelt non-use for both populations. As shown in Model 1 of , AI/AN in the Northern Plains were 12.4 times more likely to report seatbelt non-use compared to AI/AN in the West, while NHW in the Northern Plains were 4.8 times more likely to report seatbelt non-use than NHW in the West. Similarly, AI/AN in Alaska were 10.2 times more likely to report seatbelt non-use than AI/AN in the West, while NHW in Alaska were 2.7 times more likely to report seatbelt non-use than NHW in the reference group.
Degree of urbanization variables were entered into Model 2 of . In both AI/AN and NHW, the odds ratio for seatbelt non-use increased with decreasing urbanization, confirming the trend seen in . Compared to Model 1, adjustment for degree of urbanization slightly attenuated the association of region with seatbelt non-use. Finally, Model 3 examines state seatbelt laws and degree of urbanization. AI/AN and NHW who resided in states without primary seatbelt laws were twice as likely not to wear a seatbelt, compared to those AI/AN and NHW in the reference group. Across models the adjustments for seatbelt laws and degree of urbanization reduced the strength of association between region and seatbelt non-use, but had little effect on the association of age, gender, and education with seatbelt non-use. This reduced effect of region was especially pronounced in AI/AN, wherein the risk of seatbelt non-use associated with residing in the Northern Plains and Alaska was reduced by approximately half.
In 1997, the overall age-gender adjusted prevalence estimates of seatbelt non-use in AI/AN and NHW were 24.7% and 25.9%, respectively. By 2002, these estimates decreased to 16.7% and 18.7%, respectively. As shown in , AI/AN experienced a greater decline in seatbelt non-use when they resided in states with primary laws. Both AI/AN and NHW who lived in states with primary laws passed before 1997 had the lowest prevalence of the three law categories in 1997 and 2002. When a primary law was passed between 1997 and 2002, the racial disparity was no longer significant in 2002. In fact, seatbelt non-use declines for AI/AN and NHW were 55% and 43%, respectively. However, in states without primary laws, percent declines for both races were minimal. Both AI/AN and NHW living in states without primary laws experienced the highest seatbelt non-use prevalence of the three law categories in 2002, wherein AI/AN had significantly higher seatbelt non-use than NHW (p=0.01).
Age and gender-adjusted prevalence of seatbelt non-use by race and primary traffic law in 1997 and 2002