Accident Analysis & Prevention

In the past few decades, numerous policies, including those that lower legal blood alcohol concentration limits, have been enacted to reduce alcohol-impaired driving. In the US, 41 states and the District of Columbia have enacted 0.08 per se laws, which specify that if a driver's BAC is at or above 0.08, a violation has occurred even if the driver does not show signs of intoxication. We examined effects of lowering the blood alcohol concentration limit to 0.08 per se on fatal traffic crashes in 18 states and the District of Columbia, and whether effects of the law varied by state or by baseline rates of fatal traffic crashes. Data on fatal traffic crashes were obtained from the Fatality Analysis Reporting System, including all states that enacted 0.08 per se prior to 2001 in the contiguous United States. Effects of the 0.08 law were examined in each state separately, and the overall effect across states was examined using a mixed-model Poisson regression on single-vehicle-nighttime fatal traffic crashes. State-specific analyses showed that fatal traffic crashes significantly decreased in three of the 19 states following the introduction of the 0.08 law, prior to adjusting for potential confounders. The mixed-model regression showed a statistically significant 5.2% reduction in single-vehicle-nighttime fatal traffic crashes associated with the 0.08 law across all states, after adjusting for administrative license revocation, the number of Friday and Saturday nights in a month, and trends in all other types of fatal traffic crashes. Findings indicate that the effect of the 0.08 law does not vary significantly by state or baseline rate of fatal traffic crashes in a state, and no significant statistical interaction exists between 0.08 and administrative license revocation policy effects.

This study was conducted to determine whether the lowered BAC limit for drivers in North Carolina resulted in fewer alcohol-related motor vehicle crashes. We used time-series analysis to examine several indicators of alcohol involvement in both injury and fatal crashes between 1991 and 1996. Data from NC crash files as well as the Fatality Analysis Reporting System (FARS) are used. We also examined several indicators used in previous research on lower BAC limits using a before-after design to compare North Carolina with 37 states that did not change their BAC limit for 24 months before and after the BAC limit was lowered. When controlling for the pre-existing downward trend in drinking driver crashes, along with other pertinent factors such as amount of travel and number of weekends per month, there was no evidence of either a significant shift or a change in the downward trend of alcohol-related crashes associated with the lowered BAC limit. In conclusion, although the lower BAC limit was actively enforced and a substantial proportion of drinkers were aware of the new BAC limit, the drinking-driving population in North Carolina, at the time the lower limit took effect in October 1993, was simply unresponsive to this change.

More than a dozen studies on the effectiveness of the .08 blood alcohol concentration (BAC) laws have been published; however, those studies have varied both in the statistical methods and the type of outcome measure used, so it is difficult to integrate the findings into an overall estimate of the effectiveness of the law. This study used a consistent outcome measure, drinking drivers in fatal crashes and an identical methodology time-series analysis, to analyze the introduction of the .08 law in 18 states and the District of Columbia from 1982 to 2000. Each analysis accounted for other key safety laws (administrative license suspension/revocation and safety belt laws), as well as economic conditions that might influence the effectiveness of the .08 law. This provided 19 independent evaluations in which the effectiveness (treatment effect) of the law could be measured in the same quantitative terms. The number of drinking drivers in fatal crashes declined in 16 of the 19 jurisdictions after the .08 law was adopted. Nine of the 16 reductions were statistically significant (p < .05). The effect size combined across all 19 locations showed statistically significant decline (p < .005) of 14.8% in the rate of drinking drivers in fatal crashes after the .08 laws were introduced. The reduction was greater in states that had an administrative license suspension/revocation law and implemented frequent sobriety checkpoints. This analysis suggests that 947 lives might have been saved, had all 50 states and the District of Columbia had the .08 law throughout the year 2000.

Speeding is recognized as a major contributing factor in traffic crashes. In order to reduce speed-related crashes, the city of Scottsdale, Arizona implemented the first fixed-camera photo speed enforcement program (SEP) on a limited access freeway in the US. The 9-month demonstration program spanning from January 2006 to October 2006 was implemented on a 6.5 mile urban freeway segment of Arizona State Route 101 running through Scottsdale. This paper presents the results of a comprehensive analysis of the impact of the SEP on speeding behavior, crashes, and the economic impact of crashes. The impact on speeding behavior was estimated using generalized least square estimation, in which the observed speeds and the speeding frequencies during the program period were compared to those during other periods. The impact of the SEP on crashes was estimated using 3 evaluation methods: a before-and-after (BA) analysis using a comparison group, a BA analysis with traffic flow correction, and an empirical Bayes BA analysis with time-variant safety. The analysis results reveal that speeding detection frequencies (speeds> or =76 mph) increased by a factor of 10.5 after the SEP was (temporarily) terminated. Average speeds in the enforcement zone were reduced by about 9 mph when the SEP was implemented, after accounting for the influence of traffic flow. All crash types were reduced except rear-end crashes, although the estimated magnitude of impact varies across estimation methods (and their corresponding assumptions). When considering Arizona-specific crash related injury costs, the SEP is estimated to yield about $17 million in annual safety benefits.

This study investigated the association between individual and area socioeconomic status (SES) and leading causes of unintentional injury mortality in Canadian adults. Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N=2,735,152), Cox proportional hazard regression was used to calculate hazard ratios and 95% confidence intervals for all-cause unintentional injury, motor vehicle collision (MVC), fall, poisoning, suffocation, fire/burn, and drowning deaths. Results indicated that associations with SES differed by cause of injury, and were generally more pronounced for males. Low education was associated with an elevated risk of mortality from all-cause unintentional injury and MVC (males only) and poisoning and drowning (both sexes). Low income was strongly associated with most causes of injury mortality, particularly fire/burn and poisoning. Having no occupation or low occupational status was associated with higher risks of all-cause injury, fall, poisoning and suffocation (both sexes) and MVC deaths among men. Associations with area deprivation were weak, and only areas with high deprivation had elevated risk of all-cause injury, MVC (males only), poisoning and drowning (both sexes). This study reveals the importance of examining SES differentials by cause of death from a multilevel perspective. Future research is needed to clarify the mechanisms underlying these differences to implement equity-oriented approaches for reducing differential exposures, vulnerability or consequences of injury mortality.

We used data from 11 states (5,449 respondents) to examine the association between self-reported consistent use of occupant restraints for children under 11 years of age and presence of adult belt-use laws while controlling for other factors. Self-reported safety belt use by adults, age of youngest child in the household (child restraint use decreased with increasing age), and adult educational attainment were significant predictors of child restraint use; respondent age, race/ethnicity, sex, marital status, household income, and employment status were not. Adult and child occupant restraint use was higher in states with an adult safety belt law than in states without such a law.

A total population study of childhood fresh water drowning accidents (fatalities) for the 15 year period, 1967-1981, is reported. These data are from the ongoing Brisbane Drowning Study which has now also analysed 255 fresh water child immersions (both fatalities and near-fatalities) over the eleven year period, 1978-1981, and as such forms a consecutive unselected series for over one decade. The annual fatality (drowning) rate is 3.53 per 100,000. Details of immersion accidents by site, sex and by outcome (survivors versus fatalities) are presented. An analysis of secular trends revealed that one epidemic peak of child drownings in swimming pools and domestic baths (noted in the mid 1970s in Australia and other countries) is now passed. Evidence is presented to suggest that a vigorous education, and public awareness campaign can reduce the incidence of serious child immersion accidents by one-third. Such a campaign may have influence on all types of childhood household drownings (pools, baths, garden ponds), irrespective of site. Survival rates for unsupervised children who lose consciousness in fresh water are site-dependent, only 21% of such potential victims surviving after losing consciousness in rivers and creeks, compared with the survival rate of 65% for those in potential drowning incidents in their own backyard. Violent death continues to account for more than half of all deaths in childhood up to the age of 14 years [Gratz, 1979; Mayer, Walker and Johnson et al., 1981].(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to assess demographic correlates of the presence and use of stair gates in homes with toddlers. In 2004, self-administered questionnaires were mailed to 2470 parents with toddlers living in both urban and rural areas (response rate 70.1%). The questionnaires were sent by the youth healthcare providers that the parents visited regarding their toddler. In total, 83% of the parents reported to have at least one stair gate installed; however, 50% of these parents reported that they did not always close the stair gate. Households with a non-Dutch ethnic mother, one child, a female child, a young child or a child who cannot crawl, were less likely to have a stair gate. Households with one child, a toddler who cannot walk, and a mother with a higher educational level were less likely to use the gate adequately. This study shows that parents of toddlers often report to have a stair gate; however, in homes with a gate the parents do not necessarily use the gate adequately. Different demographic characteristics were shown to be correlated with both having a stair gate and the use of a stair gate.

Aircraft evacuation effectiveness is a critical but challenging issue in the civil aviation industry. This paper explores the cabin safety perceptions of passengers from their emergency evacuation experiences in an actual aviation accident. A questionnaire survey and in-depth interviews were conducted with China Airlines flight CI-120 passengers. The qualitative and quantitative results provide insights into passengers' views of cabin safety. The in-depth interview results show that passenger safety education requires more instructions about the use of emergency equipment. The data from the passenger perception questionnaire were analyzed using the factor analysis method; the findings indicate that crew assistance and emergency procedures are the most important factors. The results are likely to be of value to the aviation industry when taking into account passenger perceptions in implementing safety programs.

This paper is a corrigendum to the previously published paper: “Publication bias and time-trend bias in meta-analysis of bicycle helmet efficacy: A re-analysis of Attewell, Glase and McFadden, 2001” [Accid. Anal. Prev. (2011) 1245–1251]. This corrigendum was prepared to correct errors in data and analysis in the previously published paper. Like the previously published paper, this paper confirms that the meta-analysis of bicycle helmet efficacy reported by Attewell, Glase and McFadden (Accident Analysis and Prevention, 2001, 345–352) was influenced by publication bias and time-trend bias that was not controlled for. As a result, the analysis reported inflated estimates of the effects of bicycle helmets. This paper presents a re-analysis of the study. The re-analysis included: (1) Ensuring the inclusion of all published studies by means of continuity corrections of estimates of effect relying on zero counts; (2) detecting and adjusting for publication bias by means of the trim-and-fill method; (3) detecting and trying to account for a time-trend bias in estimates of the effects of bicycle helmets; (4) updating the study by including recently published studies evaluating the effects of bicycle helmets. The re-analysis shows smaller safety benefits associated with the use of bicycle helmets than the original study.

A formative evaluation for a communication campaign to decrease rail-automobile accidents was conducted with a survey of 891 randomly selected residents in Michigan, USA. The formative evaluation was theoretically grounded in the extended parallel process model. The results of the study suggest that the majority of respondents engage in safe driving behaviors around railways. However, 10-20% reported extremely risky behaviors such as trying to 'beat the train' (labeled 'risk seekers'). Further analyses revealed that the risk seekers were disproportionately male with strong sensation seeking tendencies to engage in new and novel experiences and to avoid boredom. The results suggest that high sensation seeking tendencies cause one to experience greater frustration and exhibit greater judgment distortions around rail crossings, which in turn, cause one to try and beat the train. Specific recommendations are given for campaign developers and limitations to the study are addressed.

Coverage and enforcement provisions of safety belt use laws vary by state. Most laws cover drivers and passengers age 16 and above. "Primary" enforcement laws allow police to stop and ticket a motorist for a safety belt law violation. With "secondary" enforcement laws, ticketing can only occur in the presence of another traffic infraction. Given the lower rates of restraint use among teen drivers and their passengers, the effect of primary enforcement laws on the restraint use of young teen passengers is of particular interest. To compare restraint use by 13-15 year olds passengers in motor vehicle crashes in states with primary versus secondary enforcement safety belt laws. Cross-sectional study of 3953 crashes involving 5372 children, representing 54,226 children aged 13-15 years in 41,198 crashes of insured vehicles in 16 states and Washington, DC between December 1, 1998 and December 31, 2004, with data collected via insurance claims records and a telephone survey. Non-use of restraints by 13-15 year olds was 7.2% (95% CI 4.3-10.1%) greater in secondary enforcement states (10.8%) as compared to states with primary enforcement laws (3.6%). After controlling for driver's age and restraint status and the seating row of the occupant, a 13-15 year olds was over twice as likely to be unrestrained in a secondary enforcement state as compared to a primary enforcement state (adjusted RR=2.2, 95% CI 1.5-3.1). States considering primary enforcement provisions to their restraint laws should consider the potential benefits these laws may have to all occupants in the vehicle, particularly young adolescents who are nearing driving age.

Despite the fact that bicycle helmet usage reduces the risk of bicycle-related head injuries, only a small percentage of children routinely wear helmets. The aim of this study was to qualitatively explore the barriers to bicycle helmet usage among 12 and 13 year old children. The study is based on four focus groups with 31 children from schools is an urban New York City area. A majority of both boys and girls did not perceive a need for wearing helmets for routine riding or short trips, and felt that helmet usage was uncomfortable and made them appear dumb. Also, students could not recall any health promotion efforts by a variety of health providers and felt local legislation had little impact on usage rates. The qualitative findings of this study provide valuable material for researchers seeking to understand the factors associated with non-use of bicycle helmets.

Bicyclists are vulnerable road users for severe injury all over the world. The nature and extent of such injuries are less well known in Iran. Using data from a comprehensive survey conducted by the Ministry of Health and Medical Education in 13 health divisions of Iran, in 2003, we examined circumstances around bicyclist injury and death. Trained health workers completed the survey instruments by interviewing patients who stayed more than 24h in hospitals and/or relatives, hospital personnel and by reviewing patient charts. Data were cross-matched with medico-legal documents to prevent missing deaths. The information that was collected from 64 cities/towns' emergency departments (EDs), over the study period, showed that 440 injured cyclists were hospitalized and/or died due to traffic collisions. Most injuries occurred in males (94.8%) and in the young (median age: 14 years with 75% </=18 years). Head injury occurred in 14% of all hospitalized and in 90% of fatally injured bicyclists. Striking a moving vehicle increased the odds of death (OR: 32.3; 95% CI 3.5-291.0) as well as the odds of severe injury (OR: 1.9; 95% CI 1.2-3.2) compared with other mechanisms of injury. As a conclusion, bicyclists in Iran, particularly males and young children, are vulnerable to severe injury and death when struck by moving vehicles on highways.

This study investigates the injury rate levels, changes, and trends between 1987 and 2002 for the 14 Swedish municipalities designated as WHO Safe Communities. The injury rate was defined as the number of injured patients discharged from hospital per 1000 persons. Injury rates were age standardised. Each municipality was compared with its respective municipality group, according to a classification of Sweden's 288 municipalities into nine groups based on numerous structural parameters. The average injury rate levels for the 14 WHO-designated Safe Community municipalities ranged from 11.54 to 19.09 per 1000 population during the study period, which was defined as the time period during which a municipality's injury prevention program has been operational. Eleven of 14 municipalities had higher levels than their corresponding municipality groups. Five of the 14 municipalities "outperformed" their respective municipality groups and achieved a greater relative injury rate decrease during the study period. The trends for the 14 municipalities in relation to their municipality groups showed an inconsistent pattern, with only four municipalities exhibiting overall favourable trends for the study period.

The aim of this study was to analyze the sorts and the external causes of hospitalized unintentional injuries among children aged 0-14 so as to learn the status of children's unintentional injuries in northwest China and then to give some references for the prevention. As many as 6215 abstracts of the discharged medical records of hospitalized children for unintentional injuries from 31 hospitals in northwest China from January 1, 2002 to December 31, 2003 were analyzed, especially for the different external causes and sorts of injuries according to ages, genders and locations. We identified 2081 (33.5%) fractures, 1279 (20.6%) scald/burns, 1125 (18.1%) internal organ injuries and 611 (9.8%) open injuries among the 6215 hospitalized children for unintentional injuries. Boy's cases were 2.2 times as many as those of girl's. The age characteristics of each injury was as follows: scald/burns occurred mostly in children under 3 (53.8%), especially in children under 1 year (58.5%); fractures occurred mostly in children above 4 (38.2%), especially in children aged 7-14 years (41.0%). The proportion of traffic accidents and falls were the highest among children aged 7-14, with 28.5% for traffic accidents and 34.4% for falls, respectively. The total cost of hospitalization was US $1033876.0, with a mean cost of US $166.3 per case. The total length of stay in hospital was 106915.2 days, with a mean of 17.2 days per case. A large proportion of fall, traffic accident, and fire/explosion induced fractures, scald/burns, internal organ and encephalic injuries characterize the childhood unintentional injuries in northwest China. From the analyses of external causes, prevention strategies for different external causes should be correspondingly specific.

This study compares injuries of restrained and unrestrained 4- to 14-year-olds in nine emergency rooms and the Coroner's office in Orange County, California from 1983 to 1989. Analyses were performed separately for 4- to 9- and 10- to 14-year-olds because of differences related to the fit of the seat belt. Significantly fewer intracranial injuries and a significantly lower mean Injury Severity Score (ISS) were seen between the restrained and unrestrained for 10- to 14-year-olds in the front passenger and back seats; but for 4- to 9-year-olds in the back seat only. These same differences were noted between restrained 4- to 9-year-olds in the back compared with those in the front passenger seat. Except for 4- to 9-year-olds in the front passenger seat, our findings are consistent with similar studies of occupants of all ages. Our results suggest that lap-shoulder belts (primary restraint in front seat) may provide less protection for 4- to 9-year-olds than for 10- to 14-year-olds and adults.

Looking back over 30 years of my own and other safety-climate scholars' research, my primary reflection is that we have achieved an enormous task of validating safety climate as a robust leading indicator or predictor of safety outcomes across industries and countries. The time has therefore come for moving to the next phase of scientific inquiry in which constructs are being augmented by testing its relationships with antecedents, moderators and mediators, as well as relationships with other established constructs. Whereas there has been some significant progress in this direction over the last 30 years (e.g. leadership as a climate antecedent), much more work is required for augmenting safety climate theory. I hope this article will stimulate further work along these lines.

There is general agreement in the literature that both age and driving experience correlate with aggregated accident risk for driver populations. The very young and beginning drivers have been classified as groups that are overrepresented in crashes, but unfortunately the former is often used as a surrogate for conclusions concerning the latter. The research that we undertook examined the interactions of various driving exposure and accident characteristics with both culpable and nonculpable crash involvements for 149,000 British Columbia novice drivers between the ages of 16 and 55. In assessing the results of our enquiry we were unable to substantiate that any of the supposed "risky" driving situations often proposed for graduated licencing system exposure restrictions (such as nighttime curfews, no highway driving, etc.) more adversely affected drivers in their first as compared to subsequent two years of driving, even though some (such as alcohol presence) were significantly correlated with accident fault assessment. The results did, however, suggest that licence restrictions or some other form of sanction applied following initial traffic law contraventions could address a substantial proportion of subsequent crash involvement likelihood. When considering only young novices (aged 16 to 18 years), the results were not greatly different, although for these drivers the carrying of passengers was found to be significantly more associated with first-year crashes than with those in subsequent years.

The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries. Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured. Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, falling, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting. The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives.

Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing injury due to inadequate car seat restraint use in children 0-16 years of age. A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years of age; outcome measure was either injury rates due to motor vehicle crashes or observed changes in child restraint use; and use of community control or historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. This review found eight studies, that met all the inclusion criteria. In the studies that measured injury outcomes, significant reductions in risk of motor vehicle occupant injury (33-55%) were reported in the study communities. For those studies reporting observed car seat restraint use the community-based programs were successful in increasing toddler restraint use in 1-5 year aged children by up to 11%; child booster seat use in 4-8 year aged children by up to 13%; rear restraint use in children aged 0-15 years by 8%; a 50% increase in restraint use in pre-school aged children in a high-risk community; and a 44% increase in children aged 5-11 years. While this review highlights that there is some evidence to support the effectiveness of community-based programs to promote car restraint use and/or motor vehicle occupant injury, limitations in the evaluation methodologies of the studies requires the results to be interpreted with caution. There is clearly a need for further high quality program evaluation research to develop an evidence base.

The study aims to clarify the most typical circumstances in which car crashes involving young drivers and leading to the occurrence of injuries and to consider the various licensing statuses of the drivers in such crashes. Young Swedish drivers born between 1984 and 1986 were followed up in the Police register (2003-2004) for their involvement in car crashes as drivers (n=2448). A set of five variables (25 categories) descriptive of those crashes was analyzed simultaneously by means of cluster analysis. Associations between crash clusters and licensing status (including none), licensing duration and alcohol involvement were also measured. Five clusters were identified, typical of one or some specific crash type(s): single-vehicle in sparsely populated areas, front-on collisions, crashes at dawn or at dusk, turning, cars of later model, crashes in urban areas and speed limits below 50 km/h. Clusters differ in consequences and in the proportions of alcohol impaired drivers involved but not regarding proportions of novice drivers. Unlicensed drivers were found in excess in some clusters (especially single and night time crashes). Young drivers are involved in crashes leading to injuries in rather specific circumstances. For some of them, novice drivers or even unlicensed drivers are over-represented, which points to the need for targeted counter-measures, alongside those general ones already in place.

The occupational health and safety standard OHSAS 18001 has gained considerable acceptance worldwide, and firms from diverse sectors and of varying sizes have implemented it. Despite this, very few studies have analysed safety management or the safety climate in OHSAS 18001-certified organisations. The current work aims to analyse the safety climate in these organisations, identify its dimensions, and propose and test a structural equation model that will help determine the antecedents and consequences of employees' safety behaviour. For this purpose, the authors carry out an empirical study using a sample of 131 OHSAS 18001-certified organisations located in Spain. The results show that management's commitment, and particularly communication, have an effect on safety behaviour and on safety performance, employee satisfaction, and firm competitiveness. These findings are particularly important for management since they provide evidence about the factors that should be encouraged to reduce risks and improve performance in this type of organisation.

To examine the secular trends of mortality from motor vehicle crashes, the authors compiled annual population and mortality data for the United States from 1910 to 1994 and performed an age-period-cohort analysis through graphical presentation, median polish, and Poisson regression modeling. During the 85-year study period, death rates from motor vehicle crashes showed two peaks, first in 1935-39 and then in 1965-69. Age and period effects accounted for 94% of the variation in motor vehicle mortality in men and 84% of the variation in women. Age patterns of motor vehicle mortality varied greatly with birth cohorts: for those who were born before 1910, death rates increased with age; for those born after 1910, death rates peaked at age 20-24 years for men and at age 15-19 years for women. A crossover characterized by a downward trend in death rates among the elderly and an upward trend among adolescents and young adults was observed in both sexes. The complex age, period, and cohort patterns of motor vehicle mortality are likely to have been shaped by changes in traffic patterns and driver behavior, and by improvements in safety design and emergency medical service systems.

Overall motor vehicle mortality rates in the United States varied little between 1940 (26 deaths per 100,000 per year) and 1980 (23 deaths per 100,000 per year). However, the distribution of motor vehicle deaths by age, sex, and road user status has changed considerably. Among the elderly there has been a substantial increase in motor vehicle death rates. The result of these changes, and of the altered age structure of the population, is that the number of years of life lost to motor vehicle crash injury before age 70 has increased 84 percent between 1940 and 1980.

We identified 36 English language studies (1950-1985) on alcohol and drownings. The majority of these were descriptive, reporting on the percent of drowning victims positive for alcohol upon autopsy. Most studies fell into one of three categories: Type A--complete ascertainment, duration of submergence specified; Type B--complete ascertainment, duration of submergence unspecified; Type C--partial ascertainment. Among Type A studies, percent of positives for alcohol ranged from 29% to 47%. Among Type B studies, percents ranged from 15% to 69%. Among Type C studies, percents ranged from 18% to 86%. We conclude that (1) between 25% and 50% of adult drowning victims have been exposed to alcohol and that (2) without data on the frequency of alcohol consumption among non-victims engaged in aquatic activities, the causal role of alcohol in drownings is uncertain. Suggestions for further research are offered.

To estimate the association between per capita alcohol consumption and fatal accidents in the United States and to compare the outcome with findings from Europe and Canada. Yearly data on fatal accidents by gender and age were analysed in relation to per capita alcohol consumption for 1950-2002 using the Box-Jenkins technique for time series analysis. A 1-L increase in per capita consumption was on average followed by 4.4 male deaths per 100,000 inhabitants, but had no significant effect on female accident mortality. Regarding specific categories of accidents, the effect on fatal motor vehicle accidents accounted for a large part of the overall effect for men and was also significant for women. With respect to fatal falling accidents and other accidents, the only significant effects were found among young males. As concerns women, the association with per capita consumption in the US was weak in comparison with Canada and Europe. The US effect estimate for overall male accidents was however equally strong as in Northern Europe (5.2) or Canada (5.9), and stronger than that found in Central and Southern Europe (2.1 and 1.6, respectively). With respect to alcohol and fatal motor vehicle accidents, the association for men of 3.2 was stronger than in Europe and more similar to the Canadian finding (3.6). Per capita alcohol consumption has at least partly been an explanation for the development of male fatal accidents and particularly motor vehicle accident rates in the post-war United States. High traffic density and relatively high legal limits for drunken driving blood alcohol concentration (BAC) are suggested to explain the strong association found between alcohol and fatal motor vehicle accidents. The results also suggest that a reduction in per capita consumption would have its most preventive impact on fatal accidents among younger males.

In this research, the impact of per capita consumption of alcohol on alcohol-related traffic fatalities in Ontario between 1957 and 1983 was examined. Three measures of alcohol involvement were selected. The first, drinking drivers (police reported) involved in fatal accidents, was a direct measure. The second and third, single-vehicle fatal accidents and nighttime fatal accidents, were surrogate measures. Also, three corresponding measures of fatal accidents not involving alcohol (normal drivers [police reported] involved in fatal accidents, multiple vehicle fatal accidents, and daytime fatal accidents) were chosen to control for general road safety trends. The results of regression analyses indicated that both per capita consumption and general road safety trends were significant contributors to all three measures of alcohol-involved fatalities. These and other recent data suggest that any effort to prevent alcohol-related problems such as liver cirrhosis through control of per capita consumption will also have a beneficial impact on alcohol-related accidents.

We searched the drink-drive control literature over the past three decades, finding over six thousand documents. After detailed review of the abstracts and papers, 125 studies contained separate empirical evaluations of the effects of 12 DWI control policies and enforcement efforts (administrative license suspension, illegal per se, implied consent, preliminary breath test, mandatory jail sentence, mandatory community service, mandatory license suspension, limits on plea bargaining, mandatory fines, selective enforcement patrols, regular police patrols, and sobriety checkpoints). The 125 studies contained 664 distinct analyses that formed the basis for meta-analysis. All of the DWI control efforts were associated with reductions in drink-driving and traffic crashes. The DWI control literature is limited by the preponderance of weak study designs and reports that often fail to include basic data required for meta-analysis. Because of the poor quality of much extant research, we were limited to simple gain scores or percent change estimates in the current study. Further research that does not include appropriate research designs and analytic methods will be of limited utility. We recommend that all future reports include effect estimates and standard error estimates, minimum data required for effective meta-analysis.

This study compares certain demographic and accident characteristics among Western European countries and between Western Europe and the United States. The specific objectives of the study were to: Identify various changes in fatalities and fatality rates experienced by each of eleven Western European Countries, by these countries as a whole, and by the United States from 1970 through 1980, with special attention given to the energy crisis and its aftermath from 1974 through 1980. Determine whether there were statistically significant changes during the 1970-1980 time period in the traffic accident characteristics studied. The findings of this study are as follows: During the decade studied, Western Europe as a whole experienced a fatality rate reduction per 10(9) vehicle-kilometers traveled of 45.8% while the U.S. experienced a 29.1% reduction during this same period. In Western Europe the age groups 0-14, 25-64 and over 64 and its road user groups pedestrians, bicyclists and motorcyclists and moped riders showed statistically significant improvements in the characteristics studied. The only U.S. group to experience a significant reduction in fatalities during this period was the age group 0-14; however the 1980 fatality rate per 10(9) vehicle-kilometers of travel of 21.0 for the U.S., versus 34.8 for Western Europe, indicates that driving in the U.S. is still much safer.

The aim of this study was to examine the effects of age, calendar period of death and birth cohort in motor vehicle mortality in Taiwan over the period 1974-1992. A log-linear model modified from the method of Osmond and Gardner (Stat. Med. 1: 245-259; 1982) was used. Age turned out to be a significant predictor of motor vehicle mortality. The most risky group (over 70 years) had 27.1 and 16.3 times the mortality of the least risky group (5-9 years, 10-14 years) for males and females respectively. The period effect showed a continuously increasing mortality trend since 1974 in females. The pattern in males is similar except that it has slightly leveled off in recent years. The birth cohorts at the highest risk of motor vehicle death were those born between 1979 and 1983 for both sexes. However, males born between 1929 and 1933 also had a high mortality. This analysis provided a better understanding of the trend of mortality from motor vehicle crashes.

North Carolina motor vehicle crash data for even-numbered years 1974-1988, inclusive, are analyzed in conjunction with North Carolina population, licensed driver, and mileage data to examine trends in motor vehicle crash involvement by driver age, sex, and race. Crash rates per licensed driver are presented along with crash rates per estimated vehicle miles travelled calculated on the basis of induced exposure. Results focus particularly on older drivers. They show that older drivers' representation in the licensed driver population has increased at a greater rate than their representation in either the census or crash involvement populations. These trends are particularly strong for females and for nonwhites. Furthermore, crash rates have declined more for drivers aged 55 and older than for younger drivers. The greatest declines, both in terms of crashes per licensed driver and crashes per estimated miles travelled, have been experienced by drivers age 65 and older, particularly nonwhites. Males show higher overall crash rates per miles travelled than females, but this effect decreases with age and disappears entirely in the oldest age categories. Results are discussed in light of the changing nature of the overall driving population and the cohort of older drivers in particular.

To find out the prevalence of suicides and other types of self-destructive behaviour in fatal motor traffic accidents in Finland, all the data on fatal accidents compiled by road accident investigation teams in the years 1987-1988 and 1991-1992 were investigated. The results were compared to an earlier study covering the years 1974-1975 and 1984-1985. The two 4-year periods covered a total of 2440 cases, which were classified into four groups: suicides, unclears, negligents and 'true' accidents. During the studied, nearly 20-year period, the number of suicides and negligent drivers had increased significantly. Also the relative proportion of suicides had increased from 1.1% to 7.4% and the relative proportion of negligents from 11.2% to 20.0%. There were no significant changes in the number of unclear cases. Suicide and unclear cases were similar to each other in many respects, whereas the negligent cases differed from these two. Most of the drivers were males in each of the three groups. Single-vehicle accidents were typical in the negligent group and collisions in the other groups. The drivers in the negligent group were younger than the drivers in the suicide and unclear groups. At the time of the accident, the most common mental state among suicide drivers was 'depression'.

Relationships among mine and injured miner characteristics and degrees of injury are examined for 91 404 injuries in underground bituminous coal mines in the United States from 1975 through 1982. Injury severity varies by the mining system, geographical region, circumstances surrounding the injury, the injured miner's age, whether the miner was using powered equipment, the year in which the injury occurred and the location in the mine where the injury happened. Injury severity is not related to the injured miner's total mining experience, job experience and experience in the mine in which the injury occurred.

Since the mid-1980s there has been concern about the growing number of female drivers in the US involved in fatal motor vehicle crashes, and similar trends have been noted in other parts of the world. The present study examined whether this trend has continued into the 1990s and the reasons for it. Fatal crash data were obtained from the Fatality Analysis Reporting System (FARS), mileage data from the National Personal Transportation Survey, and licensure data from the Federal Highway Administration. Many more women were licensed to drive in 1998 than in 1975, and on average they drove more miles. When changes in total annual mileage were taken into account, per-mile crash rates decreased similarly for men and women (about 40%). An examination of the characteristics of their fatal crashes revealed that male and female drivers have seen similar reductions in single-vehicle, nighttime, and alcohol-related crashes. However, men continue to be involved more often in these types of crashes.

Our aim was to describe the incidence and trends of driving under the influence of drugs (DUID) and to examine the main drug findings and their trends in suspected DUID cases in Finland. A register-based study was conducted of all suspected DUID cases during 1977-2007. The data included 31,963 DUID offenders apprehended by the police with a positive finding for illicit/licit drug impairing driving performance. Toxicological results were analyzed in blood and/or urine specimens in one central laboratory. The incidence of suspected DUID cases increased 18-fold during 1977-2007. Most of the suspects were men (89.7%). However, the male-female ratio decreased from 13.9 to 7.3. The mean age decreased from 36.2 years in 1977 to 29.9 years in 2001 but has since reincreased. Most often found substances were benzodiazepines (75.7%), amphetamines (46.0%), cannabinoids (27.7%) and opioids (13.8%). Most common illicit drugs, amphetamines and cannabinoids, started to appear at the end of the 1980s. Poly-drug findings were common (77.1%). Suspected DUID cases have increased sharply after the introduction of a zero tolerance law, especially in regard to amphetamines. DUID is an increasing problem in Finland, and needs serious attention.

High rates of serious road traffic accidents (RTAs) have been reported for several Arabian Gulf countries, including the United Arab Emirates (UAE), in recent years. This study aims to describe quantitatively the morbidity and mortality from RTAs in the UAE, to identify their trends during the period 1977-1998, to compare the results with those of developed countries, and to evaluate the information available on possible causes with a view to identifying the most useful direction for future research. Data were obtained from UAE's police and health sources and, for international comparison, from WHO Statistics reports and the published literature. Overall and cause-specific fatality and injury rates of RTAs were calculated. Estimates of trends were achieved by using linear regression. The characteristics of road users injured or killed were also analysed. The results revealed that during the period 1977-1998, the rates of RTAs per 100000 population and per 100000 motor vehicles declined in the UAE by a trend component of -56.3 (P<0.001; R2=0.69) and -521.8 (P<0.001; R2=0.92), respectively. RTA fatality and injury rates based on the same denominators also declined by -1.1 (P<0.001; R2=0.56) and -13.3 (P<0.001; R2=0.47); and by -3.8 (P<0.02; R2=0.23) and -90.0 (P<0.001; R2=0.59), respectively. Paradoxically, however, except for a short period (1977-1985), a steady increase in the risk of injury and death in each RTA accompanied these declines. Between 1985 and 1998 the severity rate (the ratio of fatalities and injuries per 1000 RTAs) more than tripled in the UAE. The UAE's rates were high when compared with a number of selected countries. The cause for the increasing severity of RTAs is not clear but the most likely cause could lie in speeding, careless driving, the changing vehicle mix on the roads and the standard of immediate care available for victims. Further investigation is essential and will require close collaboration between police and health authorities.

A detailed study of knee injuries recorded in the 1979-1995 National Accident Sampling System database maintained by the National Highway Traffic Safety Administration was conducted. Injuries to other body regions were also considered in order to illustrate the relative frequency of knee injuries. This study demonstrated that knee injuries constitute approximately 10% of all injuries recorded every year. However, the majority of these injuries were of low severity (i.e. contusions, abrasions, lacerations) with an abbreviated injury score (AIS) of 1. Most knee injuries occurred following a frontal collision with no intrusion. The study also indicated most knee fractures occur in crashes where the vehicle velocity differences (deltaVs) were less than 45 kmph, with some occurring at deltaVs as low as 10 kmph. Serious non-fracture knee injuries (i.e. ligament tears) rated AIS 2 accounted for 20 out of every 1000 injuries and predominantly occurred at deltaVs below 25 kmph. In this study it was noted that women were more likely to experience a knee contusion than men. This study further suggests that knee impact scenarios have remained relatively constant over the years as the knee injury rates showed little variation. The rate of lap and shoulder belt use was lower in occupants who experienced a knee injury vs. the rate in the overall database and airbags were present in only a small number of cases. As this study largely included only vehicles without airbags it provides a good baseline for analysis of the influence of the airbag on knee injury trends in the future.

In a regional study of the effect of the 1979 French seat-belt law, the nature and severity of car occupants' injuries were recorded for all car crashes during the same 3-month period in 1976, 1977, 1978 (before the law), and in 1979 (after the law). A trend analysis of data from all 4 years showed a slight decrease in the total injury rate, and significant decreases in the frequency of hospital admissions, and of head, face, arm, and leg injuries. Moderate pelvic and leg injuries, and serious head injuries were also less than expected in 1979. There was also a significant increase in the frequency of thoraco-lumbar spine injuries and of serious cervical spine injuries, but the absolute increase in these injuries was less than the absolute decrease in other injuries. These changes are compatible with the biomechanical effects of increased seat belt use, and thus suggest a beneficial effect of the law.

Death certificate analyses were conducted on all fatal occupational falls occurring between 1980 and 1989 in the United States' construction industry using the National Traumatic Occupational Fatalities surveillance system at the National Institute for Occupational Safety and Health, Division of Safety Research. Fatality rates were calculated by geographic location (region and state), and year of injury. From 1980 to 1989, there were 2798 deaths due to occupational falls in construction, representing 49.6% of all fatal occupational falls across all industries. Most of these incidents occurred among young white males. By geographical location, the highest fatality rates were observed within the subregions of the Southern states in the United States. In observing the time between the date of injury and the date of death, 66% of the fall victims died on the same day as the injury, whereas 5.7% lived more than 90 days before dying. Further research needs to be targeted at what occupations are at highest risk for a fall injury, what circumstances are attributable to these falls, and prevention strategies to reduce fall injuries and fatalities. Research is also needed to explain why there are geographic differences in occupational falls in the construction industry.

This study aims at comparing two data bases related to occupational injuries in the French sea fishing industry: a data base created between 1977 and 1980, a data base created between 1996 and 2001. These bases were made from report forms filled out by fishermen after an accident. The study focuses on the accidents occurring when the vessel is in the process of fishing. In the 1980s, as well as today, the processing of fishing gear seems to be a very dangerous task, correlated with the risk of being "struck by, swept along, pinned" by the elements of the rigging and the risk of serious injuries. The processing and handling of the catch also cause a large amount of accidents; during these tasks, fishermen have to cope with two main risks: being "cut or pricked" and making an "excessive effort, awkward movement". Rate and features of occupational accidents do not show notable evolution. These findings lead us to question the different prevention measures implemented in France during the last few decades and to propose new prevention direction.

To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures. The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden. All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present. Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time. Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

A study of work-related fatalities, based on coroners' records, has provided national data on work-related road fatalities. A total of 1,544 work-related fatalities were identified over 1982-1984. Of these, 600 (39%) resulted from injuries sustained in road vehicle accidents on public roads; 366 (24%) in the course of work, and 234 (15%) while commuting between home and work. These figures are likely to underestimate work-related road fatalities because the coroners' records often did not contain the required information. The incidence of road fatalities declined slightly over the three years, although the proportion amongst all work-related fatalities remained constant. The at-work victims tended to be older than victims of road death generally. Fifty-six percent of the at-work cases were in the occupational group "drivers, road transport". Articulated trucks accounted for 41% of the at-work cases. Drivers made up 79% of the at-work group. In contrast, drivers accounted for only 38% of all road deaths. Two-thirds of the at-work road fatalities occurred outside capital city districts, the proportion of nonmetropolitan cases being highest for deaths involving articulated trucks. This is striking, in view of Australia's highly urbanised population. Blood alcohol data were available for 76% of the at-work cases and 79% of the commuting fatalities. Of these, 15% and 13%, respectively, had a blood alcohol of 0.05 g/100mL or more. In contrast, 6% of other workplace fatalities for which blood alcohol data were available had such levels. This difference may reflect more assiduous blood-alcohol testing of road-accident victims.(ABSTRACT TRUNCATED AT 250 WORDS)

This study evaluated the impact of 1982 legislative reforms, including enhanced penalties, greater sentencing uniformity, and the introduction of an illegal per se standard, on California's driving-under-the-influence (DUI) countermeasure system. Intervention time series analysis was used to evaluate the general deterrent effects of these laws, as measured by alcohol-related fatal and injury accident rates, both statewide and in counties sharing similar demographic and enforcement patterns. In combination with the legislative effects, analyses also assessed the significance of prelegislative publicity associated with an emerging antidrunk driving sentiment largely popularized by the formation of Mothers Against Drunk Driving (MADD). Both implementation of the DUI statutes and the publicity and societal dynamics surrounding the creation of MADD were found to be associated with reductions in subsequent alcohol-related fatal and injury accident rates, with evidence of more pronounced effects among injury accidents.

Goals: The goal was to gain a picture of current driver behaviour, and of the links between committed violations and accident history. It was also to identify how driver behaviour has changed over the last 20 years. Methods: A questionnaire-based cross-sectional study of a sample of 1161 drivers about the frequency of violations and the perception of the dangers and penalties associated with them was used in 2005. Self-reported violations and mental representations were also compared to the results of Biecheler who used similar methods (Biecheler-Fretel, 1983). Results, conclusions: Road traffic violations are frequent in France, particularly among male drivers. Several violations are linked with history of accidents in our sample. Frequently or fairly frequently exceeding the speed limit by 10 km/h (a violation reported by almost 53% of our sample), increases accident occurrence by a factor of 1.4. Progress in drivers' behaviour has been slow and nonuniform, and appears in part to be related to safety campaigns that have been run (seat belts, alcohol). The results could inform future campaigns. In particular, a campaign on the use of indicators would seem worthwhile.

Very little systematic information is available about the predominant advertising themes automobile manufacturers have depicted over the years. The goal of the present study was to analyze television vehicle advertising to understand how cars and passenger vans are being portrayed in the media and how this has changed over time. A virtually complete sample (561) of car and passenger van advertisements from 1998, and a sample of advertisements from 1983 (98), 1988 (96), and 1993 (95), was analyzed for content. Performance, most often exemplified as speed, power, and maneuverability, was the primary theme in 17% of advertisements in 1998 and was depicted in half of all advertisements. Performance was also the most frequent theme over time. Sales incentives also was a popular theme in each year studied, and was predominant in 1993. Safety was mentioned infrequently, except in 1993; a time when manufacturers were competing to install airbags in their vehicles. A focus on vehicle performance in advertising that does not depict the potential negative consequences can have the deleterious effects of glamorizing and legitimizing high-speed travel. Furthermore, manufacturers are missing an opportunity to promote vehicle safety, a feature that consumers have indicated is very important to them.

This paper concerns the statistical relationship between the risk of a fatality and the age and sobriety of drivers in New South Wales, Australia. The estimation of this relationship is based on fatal accident data from New South Wales and non-accident or control data from South Australia collected between the hours of 5.00 AM and 3.00 PM. The results are presented in new ways. In particular, tables of "accidents attributable to alcohol" and age specific intensity functions of "risk attributable to alcohol" may be an aid to policy making.