JMIR Publications

Background:

Road traffic injuries are a leading cause of death among teenagers globally, particularly in Low-and middle-income countries such as Thailand. Despite national and local road safety strategies, policies and educational programs, unsafe road safety behaviours remain rampant among teenagers.

Objective:

To determine the prevalence of safe road traffic practices and identify socio-demographic, attitudinal, and environmental factors associated with these behaviours among secondary school teenagers in Nakhon Si Thammarat province, Thailand.

Methods:

A cross-sectional mixed-methods study was conducted among 500 secondary school teenagers (aged 13 – 18 years; mean age 16.0 ± 1.6). Data on knowledge, attitudes, and practices (KAP) were collected using a validated structured questionnaire (expert reviewed, pre-tested, and psychometrically reliable) administered through Google Forms under classroom supervision by trained research assistants. Informed consent was obtained before participation, with assurances of voluntary participation and confidentiality. Qualitative insights were captured through open-ended survey responses. Modified Poisson Regression with robust variance was used to estimate Prevalence Ratios (PRs) and adjusted PRs with 95% Confidence Intervals (CI). Qualitative responses were thematically analyzed using NVIVO 12.

Results:

Overall, 21.2% (106/500) of teenagers consistently engaged in safe road traffic safety practices and behaviours, including helmet and seatbelt use. In bivariate analysis, favourable external perceptions (road signage, visibility, enforcement, community safety initiatives) were strongly associated with safe road traffic practices (CPR = 2.09, 95% CI: 1.41 – 3.08, p < 0.001), as were positive attitudes (CPR = 2.28, 95% CI: 1.48 – 2.93, p <0.001). In multivariate analysis, both favourable external factors (APR = 1.91, 95% CI: 1.29 – 2.82, p = 0.001) and positive attitudes (APR = 1.99, 95% CI: 1.40 – 2.82, p < 0.001) remained significant predictors while educational attainment lost significance (APR = 1.83, 95% CI: 0.96 – 3.51, p = 0.067). Qualitative themes reinforced these findings, highlighting peer influence, perceived invulnerability, and weak enforcement as the drivers of unsafe road traffic practices.

Conclusions:

Fewer than one in four Thai teenagers consistently adopt safe road traffic practices. Targeted interventions that strengthen road infrastructure, law and regulations enforcement, and culturally appropriate education are urgently needed to improve teenage road safety.

ClinicalTrial:

Not applicabe for this study.