Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Keywords: Mass media campaigns; meta-analysis; seat belts.